bid_id	contract_year	version	base_k0006	cs_b0055	cs_b0056	cs_b0057	cs_b0058	cs_b0059	cs_b0060	cs_b0061	cs_b0062	cs_b0063	cs_b0064	cs_c0055	cs_c0056	cs_c0057	cs_c0058	cs_c0059	cs_c0060	cs_c0061	cs_c0062	cs_c0063	cs_c0064	cs_d0055	cs_d0056	cs_d0057	cs_d0058	cs_d0059	cs_d0060	cs_d0061	cs_d0062	cs_d0063	cs_d0064	cs_e0025	cs_e0026	cs_e0027	cs_e0028	cs_e0029	cs_e0030	cs_e0031	cs_e0032	cs_e0033	cs_e0034	cs_e0035	cs_e0036	cs_e0037	cs_e0038	cs_e0039	cs_e0040	cs_e0041	cs_e0042	cs_e0043	cs_e0044	cs_e0045	cs_e0046	cs_e0047	cs_e0048	cs_e0049	cs_e0050	cs_e0051	cs_e0052	cs_e0053	cs_e0054	cs_e0055	cs_e0056	cs_e0057	cs_e0058	cs_e0059	cs_e0060	cs_e0061	cs_e0062	cs_e0063	cs_e0064	cs_f0025	cs_f0026	cs_f0027	cs_f0028	cs_f0029	cs_f0030	cs_f0031	cs_f0032	cs_f0033	cs_f0034	cs_f0035	cs_f0036	cs_f0037	cs_f0038	cs_f0039	cs_f0040	cs_f0041	cs_f0042	cs_f0043	cs_f0044	cs_f0045	cs_f0046	cs_f0047	cs_f0048	cs_f0049	cs_f0050	cs_f0051	cs_f0052	cs_f0053	cs_f0054	cs_f0055	cs_f0056	cs_f0057	cs_f0058	cs_f0059	cs_f0060	cs_f0061	cs_f0062	cs_f0063	cs_f0064	cs_f0065	cs_g0012	cs_g0025	cs_g0026	cs_g0027	cs_g0028	cs_g0029	cs_g0030	cs_g0031	cs_g0032	cs_g0033	cs_g0034	cs_g0035	cs_g0036	cs_g0037	cs_g0038	cs_g0039	cs_g0040	cs_g0041	cs_g0042	cs_g0043	cs_g0044	cs_g0045	cs_g0046	cs_g0047	cs_g0048	cs_g0049	cs_g0050	cs_g0051	cs_g0052	cs_g0053	cs_g0054	cs_g0055	cs_g0056	cs_g0057	cs_g0058	cs_g0059	cs_g0060	cs_g0061	cs_g0062	cs_g0063	cs_g0064	cs_h0012	cs_h0025	cs_h0026	cs_h0027	cs_h0028	cs_h0029	cs_h0030	cs_h0031	cs_h0032	cs_h0033	cs_h0034	cs_h0035	cs_h0036	cs_h0037	cs_h0038	cs_h0039	cs_h0040	cs_h0041	cs_h0042	cs_h0043	cs_h0044	cs_h0045	cs_h0046	cs_h0047	cs_h0048	cs_h0049	cs_h0050	cs_h0051	cs_h0052	cs_h0053	cs_h0054	cs_h0055	cs_h0056	cs_h0057	cs_h0058	cs_h0059	cs_h0060	cs_h0061	cs_h0062	cs_h0063	cs_h0064	cs_i0025	cs_i0026	cs_i0027	cs_i0028	cs_i0029	cs_i0030	cs_i0031	cs_i0032	cs_i0033	cs_i0034	cs_i0035	cs_i0036	cs_i0037	cs_i0038	cs_i0039	cs_i0040	cs_i0041	cs_i0042	cs_i0043	cs_i0044	cs_i0045	cs_i0046	cs_i0047	cs_i0048	cs_i0049	cs_i0050	cs_i0051	cs_i0052	cs_i0053	cs_i0054	cs_i0055	cs_i0056	cs_i0057	cs_i0058	cs_i0059	cs_i0060	cs_i0061	cs_i0062	cs_i0063	cs_i0064	cs_j0012	cs_j0025	cs_j0026	cs_j0027	cs_j0028	cs_j0029	cs_j0030	cs_j0031	cs_j0032	cs_j0033	cs_j0034	cs_j0035	cs_j0036	cs_j0037	cs_j0038	cs_j0039	cs_j0040	cs_j0041	cs_j0042	cs_j0043	cs_j0044	cs_j0045	cs_j0046	cs_j0047	cs_j0048	cs_j0049	cs_j0050	cs_j0051	cs_j0052	cs_j0053	cs_j0054	cs_j0055	cs_j0056	cs_j0057	cs_j0058	cs_j0059	cs_j0060	cs_j0061	cs_j0062	cs_j0063	cs_j0064	cs_k0012	cs_k0025	cs_k0026	cs_k0027	cs_k0028	cs_k0029	cs_k0030	cs_k0031	cs_k0032	cs_k0033	cs_k0034	cs_k0035	cs_k0036	cs_k0037	cs_k0038	cs_k0039	cs_k0040	cs_k0041	cs_k0042	cs_k0043	cs_k0044	cs_k0045	cs_k0046	cs_k0047	cs_k0048	cs_k0049	cs_k0050	cs_k0051	cs_k0052	cs_k0053	cs_k0054	cs_k0055	cs_k0056	cs_k0057	cs_k0058	cs_k0059	cs_k0060	cs_k0061	cs_k0062	cs_k0063	cs_k0064	cs_k0065	cs_k0066	cs_k0067	cs_l0025	cs_l0026	cs_l0027	cs_l0028	cs_l0029	cs_l0030	cs_l0031	cs_l0032	cs_l0033	cs_l0034	cs_l0035	cs_l0036	cs_l0037	cs_l0038	cs_l0039	cs_l0040	cs_l0041	cs_l0042	cs_l0043	cs_l0044	cs_l0045	cs_l0046	cs_l0047	cs_l0048	cs_l0049	cs_l0050	cs_l0051	cs_l0052	cs_l0053	cs_l0054	cs_l0055	cs_l0056	cs_l0057	cs_l0058	cs_l0059	cs_l0060	cs_l0061	cs_l0062	cs_l0063	cs_l0064	cs_l0065	cs_m0012	cs_m0025	cs_m0026	cs_m0027	cs_m0028	cs_m0029	cs_m0030	cs_m0031	cs_m0032	cs_m0033	cs_m0034	cs_m0035	cs_m0036	cs_m0037	cs_m0038	cs_m0039	cs_m0040	cs_m0041	cs_m0042	cs_m0043	cs_m0044	cs_m0045	cs_m0046	cs_m0047	cs_m0048	cs_m0049	cs_m0050	cs_m0051	cs_m0052	cs_m0053	cs_m0054	cs_m0055	cs_m0056	cs_m0057	cs_m0058	cs_m0059	cs_m0060	cs_m0061	cs_m0062	cs_m0063	cs_m0064	cs_n0012	cs_n0025	cs_n0026	cs_n0027	cs_n0028	cs_n0029	cs_n0030	cs_n0031	cs_n0032	cs_n0033	cs_n0034	cs_n0035	cs_n0036	cs_n0037	cs_n0038	cs_n0039	cs_n0040	cs_n0041	cs_n0042	cs_n0043	cs_n0044	cs_n0045	cs_n0046	cs_n0047	cs_n0048	cs_n0049	cs_n0050	cs_n0051	cs_n0052	cs_n0053	cs_n0054	cs_n0055	cs_n0056	cs_n0057	cs_n0058	cs_n0059	cs_n0060	cs_n0061	cs_n0062	cs_n0063	cs_n0064	cs_n0065	cs_n0066	cs_n0067	cs_o0025	cs_o0026	cs_o0027	cs_o0028	cs_o0029	cs_o0030	cs_o0031	cs_o0032	cs_o0033	cs_o0034	cs_o0035	cs_o0036	cs_o0037	cs_o0038	cs_o0039	cs_o0040	cs_o0041	cs_o0042	cs_o0043	cs_o0044	cs_o0045	cs_o0046	cs_o0047	cs_o0048	cs_o0049	cs_o0050	cs_o0051	cs_o0052	cs_o0053	cs_o0054	cs_o0055	cs_o0056	cs_o0057	cs_o0058	cs_o0059	cs_o0060	cs_o0061	cs_o0062	cs_o0063	cs_o0064	cs_o0065
E5088_801_0	2010	3	N/A	e.3.	h.6.	h.7.	h.8.	i.7.						DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Diabetic Mon Supplies	Urgent Care	PT/OT/ST/CORF/Cardiac Rehab/Pain Clinic	Hospital-based Clinic Visits	Outpatient Sub Abuse						A		D	V	T	Coin	Coin	V	V	Coin	V	Coin	Coin	Coin	V	V	V	V	V	V	Coin	P			V		V		V		Coin	V	V	V	Coin																																														0	YES	226.996441		1018.791021	1559.93004	117.2157059	24.38762109	4.898220925	286.4819679	459.9227317		739.5334194			0.046137382	4299.476292	4146.395731	179.6211513	1037.52835	2510.72	947.9066404	39.81076889	73.42362802			78.15267509		46.5077654		0		5.208671547	0.198805923	608.3480089	435.0083958	0.003113014						2500	"$500/admit, reduced to $400/admit if prenotify (PBP #1A/1B)"		$100/admit (waived if prenotify); $0/day for 1st 15 days; $75/day for days 16 - 100 (#2)	"$20/visit, reduced to $0/visit if prenotify (#6)"	$50 copay/day (#10A)	"Insulin Pumps: 10% coinsurance if prenotified, 20% otherwise; All other DME: 15% coinsurance if under $750 or prenotified, 25% otherwise (#11A)"	"Prosthetics: 15% coinsurance if under $750 or prenotified, 25% otherwise; Medical Supplies: 0% coinsurance; Diabetes Monitoring Supplies: see below (e.3.) (#11B)"	$50/visit (#4A)	$75/visit (#9A/9B)	0% coinsurance (#8A)	"$25 copay/day for MRI, MRA, PET, & SPECT; all other diagnostic radiology $0 copay; Therapeutic Radiology $20 copay (#8B)"	0% coinsurance	0% coinsurance (#12)	Partial Hospitalization: 50% coinsurance (#5)	$10/visit (#7A/7G/14C)	$20/visit (#7D/7F/7G/14C/16B)	$20/visit for individual therapy; $10/visit for group therapy (#7E/7H)	$20/visit (#7C/7I)	"$25 copay/day for MRI, MRA, PET, & SPECT; all other diagnostic radiology $0 copay; Therapeutic Radiology $20 copay (#8B)"	Chiropractic Services: $20/visit (#7B)	10% coinsurance (#15)	eyewear after cataract surgery or for Keratoconus: $20 copay (#17B)			$20/visit (#17A)		$20 copay ($10 if PCP provides exam) (#18A)		$20 copay (#14A)		"Glucose monitors: 20% coinsurance, reduced to 10% if prenotify; 10% coinsurance for test strips, lancets and all other supplies (#11C)"	$30 copay (#7A/7D/7F/7G/16B)	$20 copay (#3/9D)	$10/visit for PCPs; $20/visit for Specialists (#9A)	20% coinsurance (#9C)						419		36.2	5	50	0.153	0.047	50	75	0	4.27	0	0	0.5	10	20	19.41339236	20	2.35	20	0.1	20			20		19.49320148		20		0.1	30	20	10.27288732	0.2						NO	399.299079		34.49791566	4.764905477	47.64905477	0.145806108	0.044790111	47.64905477	71.47358216	0	4.069229278	0	0	0.476490548	9.529810955	19.05962191	18.50059592	19.05962191	2.239505574	19.05962191	0.09529811	19.05962191			19.05962191		18.5766525		20		0.09529811	28.58943286	19.05962191	9.789867416	0.2							7.5533	0	2.928847226	0.619409933	0.465434799	3.555864104	0.219391861	1.137549582	2.739360429	0	0.250777587	0	0	0.021984026	3.414433022	6.58572791	0.276924862	1.647908173	0.468564286	1.505561848	3.793891015	0.116618882	0	0	0.124130037	0	0.07199655	0	0	0	0.496376552	0.000473646	0.966240253	0.354889543	0.000622603	0	0	0	0	0	39.3163		1.94	7.5533	0	2.928847226	0.619409933	0.465434799	3.555864104	0.219391861	1.137549582	2.739360429	0	0.250777587	0	0	0.021984026	3.414433022	6.58572791	0.276924862	1.647908173	0.468564286	1.505561848	3.793891015	0.116618882	0	0	0.124130037	0	0.07199655	0	0	0	0.496376552	0.000473646	0.966240253	0.354889543	0.000622603	0	0	0	0	0	39.3163	NO																																																																																		0			7.5533	0	2.928847226	0.619409933	0.465434799	3.555864104	0.219391861	1.137549582	2.739360429	0	0.250777587	0	0	0.021984026	3.414433022	6.58572791	0.276924862	1.647908173	0.468564286	1.505561848	3.793891015	0.116618882	0	0	0.124130037	0	0.07199655	0	0	0	0.496376552	0.000473646	0.966240253	0.354889543	0.000622603	0	0	0	0	0	39.3163
E6036_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	P	P	P	P	P	P																																																			0	NO																								5.888717894																		#1A $0	#1B $0	#2 $0	#6 $0	#10A $0	#11A $0	"#11B $0, #11C $0"	"#4A $0, #4B $0"	"#9A $0, #9B $0"	#8A $0	#8B $0	$0 (incl. in h.5)	#12 $0	"#3 $0, #5 $0, #9C $0, #9D $0"	"#7A $0, #14B $0, #14C $0, #14D $0, #14E $0, #14F $0, #14G $0, #14H $0"	"#7B $0, #7D $0, #7F $0"	"#7E $0, #7H $0"	"#7C $0, #7I $0"	$0 (incl. in h.2)	"#7G $0, #14I $0, #14J $0"	#15 $0	#13A $0	#10B $0	"#16A 20%, #16B 20% ER/Diag, 30% Restor/Endo, 50% Prostho, $10 Deductible"	#17A $0	#17B $0	#18A $0	#18B $0	#14A $0	#13B $0																																		0.258161136																	NO																								0.258161136																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5202381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5202381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5202	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5202381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5202
H0046_001_0	2010	13	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	O	V	V	O	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V																																																			0	NO						24.50671091	12.5036572	270.229614	143.9184351		276.1707516					8737.052855	659.3877789	1255.079518		470.9342703					13.93875459																	PBP: 1A IP Acute: $0 per admit	1B IP Psych: $0 per admit	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	"11B Prosthetic Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 0%"	"4A ER/World Wide Coverage: $25, 4B Urgent Care: $0"	9B OutP Surg/ASC Services: $50	8A OP C/D/T: $0	8B OP X-Ray: $0; $25 MRI and CAT Scans	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0"	"7B Chiropractic: $9, 7D Physician Specialist (excl. Radiology): $9, 7F Podiatry: $9"	"7E Mental Health: $9, 7H Psychiatric: $9"	"7C Occupational Therapy: $9, 7I Physical and Speech Therapy: $9"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $9, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Medicare Covered Comprehensive Dental Services: $0, 17A Medicare Covered Eye Exams: $0"	10B Transportation: Not Covered	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: $0"	17A Routine Eye Exams: $15	17B Eye Wear: Medicare Covered: $0	18A Routine Hearing Exams: No benefit	18B Hearing Aids-- No benefit	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered																0.1	0.1	25	50		10					9	9	9		9					15																YES						0.1	0.1	25	50		10					9	9	9		9					15																1000	0	0	0	0	0	2.450671091	1.25036572	0.562978363	0.599660146	0	0.230142293	0	0	0	0	6.552789642	0.494540834	0.941309638	0	0.353200703	0	0	0	0	0.017423443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.4531	0	0	0	0	0	0	0	2.450671091	1.25036572	0.562978363	0.599660146	0	0.230142293	0	0	0	0	6.552789642	0.494540834	0.941309638	0	0.353200703	0	0	0	0	0.017423443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.4531	NO	PBP: 1A IP Acute: 20% Coinsurance	1B IP Psych: 20% Coinsurance	2 SNF: 20% Coinsurance	6 Home Health: 20% Coinsurance	10A Ambulance: 20% Coinsurance	11A DME:  20% Coinsurance	"11B Prosthetic Medical Supplies: 20% Coinsurance, 11C Diabetes Monitoring Supplies: 20% Coinsurance"	"4A ER/World Wide Coverage: 20% Coinsurance, 4B Urgent Care: 20% Coinsurance"	9B ASC Services: 20% Coinsurance	8A OP C/D/T: 20% Coinsurance	8B OP X-Ray: 20% Coinsurance	9A OP Hospital: 20% Coinsurance	12 Renal Dialysis: 20% Coinsurance	"3 CORF: 20% Coinsurance, 5 Partial Hosp: 20% Coinsurance, 9C OP Substance Abuse: 20% Coinsurance, 9D Cardiac Rehab: 20% Coinsurance"	"7A PCP: 20% Coinsurance, 14B Immunizations: 20% Coinsurance, 14C Routine Physical Exams: 20% Coinsurance, 14D Pap Smears: 20% Coinsurance, 14D Pelvic Exams: 20% Coinsurance, 14E Prostate Screening: 20% Coinsurance, 14F Colorectal Screening: 20% Coinsurance, 14G Bone Mass Measurement: 20% Coinsurance, 14H Mammography: 20% Coinsurance, 14I Diabetes Monitoring: 20% Coinsurance"	"7B Chiropractic: 20% Coinsurance, 7D Physician Specialist (excl. Radiology): 20% Coinsurance, 7F Podiatry: 20% Coinsurance"	"7E Mental Health: 20% Coinsurance, 7H Psychiatric: 20% Coinsurance"	"7C Occupational Therapy: 20% Coinsurance, 7I Physical and Speech Therapy: 20% Coinsurance"	7D Physician Specialist (Radiology): 20% Coinsurance	"7G Other Health Care: 20% Coinsurance, 18A Medicare Covered Hearing Exams: 20% Coinsurance"	15 Part B Drugs: 20% Coinsurance	"13A Blood: 20% Coinsurance, 16B Medicare Covered Comprehensive Dental Services: 20% Coinsurance, 17A Medicare Covered Eye Exams: 20% Coinsurance"	10B Transportation: Not Covered	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: Not Covered"	17A Routine Eye Exams: Not Covered	"17B Eye Wear: Medicare Covered: Not Covered, Routine: Not Covered"	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: Not Covered	13B Acupuncture: Not Covered												1.1417	0.02	0.0356	0.1898	0.0475	0.2743	0.1785	0.0669	0.1734	0.0172	0.0463	0.0081	0.0054	0.0719	0.4594	0.5645	0.046	0.0616	0.2527	0.5019	0.1919	0.0497			0.0002																4.4046	100	5.400206065	1.1417	0.020035094	0.03559363	0.189752241	0.047549795	2.724990208	1.428891878	0.62984599	0.773017985	0.017221538	0.276468964	0.008146963	0.005410242	0.071923906	0.459356793	7.117262873	0.540534398	1.00287504	0.252710303	0.855113134	0.191945875	0.049704724	0	0	0.017607927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.8577
H0046_002_0	2010	12	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	O	V	V	O	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V																																																			0	NO						24.50671091	12.5036572	270.229614	143.9184351		276.1707516					8737.052855	659.3877789	1255.079518		470.9342703					13.93875459																	PBP: 1A IP Acute: $0 per admit	1B IP Psych: $0 per admit	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	"11B Prosthetic Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 0%"	"4A ER/World Wide Coverage: $25, 4B Urgent Care: $0"	9B OutP Surg and ASC: $50	8A OP C/D/T: $0	8B OP X-Ray: $0; $25 MRI and CAT Scans	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0"	"7B Chiropractic: $7, 7D Physician Specialist (excl. Radiology): $7, 7F Podiatry: $7"	"7E Mental Health: $7, 7H Psychiatric: $7"	"7C Occupational Therapy: $7, 7I Physical and Speech Therapy: $7"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $7, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Medicare Covered Comprehensive Dental Services: $0, 17A Medicare Covered Eye Exams: $0"	10B Transportation: Not Covered	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: $0"	17A Routine Eye Exams: $15	17B Eye Wear: Medicare Covered: $0	18A Routine Hearing Exams: $0	18B Hearing Aids: $0	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered																0.1	0.1	25	50		10					7	7	7		7					15																YES						0.1	0.1	25	50		10					7	7	7		7					15																1000	0	0	0	0	0	2.450671091	1.25036572	0.562978363	0.599660146	0	0.230142293	0	0	0	0	5.096614166	0.384642871	0.732129719	0	0.274711658	0	0	0	0	0.017423443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5993	0	0	0	0	0	0	0	2.450671091	1.25036572	0.562978363	0.599660146	0	0.230142293	0	0	0	0	5.096614166	0.384642871	0.732129719	0	0.274711658	0	0	0	0	0.017423443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5993	NO	PBP: 1A IP Acute: 20% Coinsurance	1B IP Psych: 20% Coinsurance	2 SNF: 20% Coinsurance	6 Home Health: 20% Coinsurance	10A Ambulance: 20% Coinsurance	11A DME:  20% Coinsurance	"11B Prosthetic Medical Supplies: 20% Coinsurance, 11C Diabetes Monitoring Supplies: 20% Coinsurance"	"4A ER/World Wide Coverage: 20% Coinsurance, 4B Urgent Care: 20% Coinsurance"	9B ASC Services: 20% Coinsurance	8A OP C/D/T: 20% Coinsurance	8B OP X-Ray: 20% Coinsurance	9A OP Hospital: 20% Coinsurance	12 Renal Dialysis: 20% Coinsurance	"3 CORF: 20% Coinsurance, 5 Partial Hosp: 20% Coinsurance, 9C OP Substance Abuse: 20% Coinsurance, 9D Cardiac Rehab: 20% Coinsurance"	"7A PCP: 20% Coinsurance, 14B Immunizations: 20% Coinsurance, 14C Routine Physical Exams: 20% Coinsurance, 14D Pap Smears: 20% Coinsurance, 14D Pelvic Exams: 20% Coinsurance, 14E Prostate Screening: 20% Coinsurance, 14F Colorectal Screening: 20% Coinsurance, 14G Bone Mass Measurement: 20% Coinsurance, 14H Mammography: 20% Coinsurance, 14I Diabetes Monitoring: 20% Coinsurance"	"7B Chiropractic: 20% Coinsurance, 7D Physician Specialist (excl. Radiology): 20% Coinsurance, 7F Podiatry: 20% Coinsurance"	"7E Mental Health: 20% Coinsurance, 7H Psychiatric: 20% Coinsurance"	"7C Occupational Therapy: 20% Coinsurance, 7I Physical and Speech Therapy: 20% Coinsurance"	7D Physician Specialist (Radiology): 20% Coinsurance	"7G Other Health Care: 20% Coinsurance, 18A Medicare Covered Hearing Exams: 20% Coinsurance"	15 Part B Drugs: 20% Coinsurance	"13A Blood: 20% Coinsurance, 16B Medicare Covered Comprehensive Dental Services: 20% Coinsurance, 17A Medicare Covered Eye Exams: 20% Coinsurance"	10B Transportation: Not Covered	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: Not Covered"	17A Routine Eye Exams: Not Covered	"17B Eye Wear: Medicare Covered: Not Covered, Routine: Not Covered"	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: Not Covered	13B Acupuncture: Not Covered												1.1417	0.02	0.0356	0.1898	0.0475	0.2743	0.1785	0.0669	0.1734	0.0172	0.0463	0.0081	0.0054	0.0719	0.4594	0.5645	0.046	0.0616	0.2527	0.5019	0.1919	0.0497			0.0002																4.4046	100	5.400206065	1.1417	0.020035094	0.03559363	0.189752241	0.047549795	2.724990208	1.428891878	0.62984599	0.773017985	0.017221538	0.276468964	0.008146963	0.005410242	0.071923906	0.459356793	5.661087397	0.430636435	0.79369512	0.252710303	0.776624089	0.191945875	0.049704724	0	0	0.017607927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.0039
H0084_001_0	2010	10	N/A																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	V	V	O	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	NO	1055.15	5.18	642.07	36.7080576	10.62	10.65418246	9.85	262.68	395.14	3.28	18.11	53.42	0.14	79.28	3586.64	3256.63	196.04	696.83	38.15	1534.04	8.92	653.96	0	281.9	301.14	0	0	0	0	0												1A IP Acute: $290 Per Day for days 1-10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	"9A OP Hospital: $175, 9B ASC Services: $175"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: $50	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40 OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $40	"7E Mental Health: $40 MH (Group): $25, 7H Psychiatric: $40 Psychiatric (Group): $25"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $40, 7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $10"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $10	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											290	1000	130	0	0.326553672	0.2	0.044665641	48.93387392	175	0.199704973	0.200063688	50	0.199999986	40	25	40	40	40	0.162211309	40	0.200002068	10	0	10	10	0	0	0	0	0											NO	286.8207984	989.0372359	128.5748407	0	0.322973741	0.2	0.044175982	48.2355207	173.0815163	0.197515654	0.197870437	49.45186179	0.197807433	39.56148944	24.7259309	39.56148944	39.56148944	39.56148944	0.160433024	39.56148944	0.197809493	9.890372359	0	9.890372359	9.890372359	0	0	0	0	0												25.2199	0.426934407	6.879503996	0	3.429981134	2.130836491	0.435133422	1.055875548	5.699285862	0.647851345	3.583433611	0.220143205	0.027693041	0.261369574	7.390251066	10.73642778	0.646302866	2.297302724	6.120519877	5.057408938	1.764460673	0.538992326	0	0.232341331	0.248198894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0502	0	0.936780742	25.2199	0.426934407	6.879503996	0	3.429981134	2.130836491	0.435133422	1.055875548	5.699285862	0.647851345	3.583433611	0.220143205	0.027693041	0.261369574	7.390251066	10.73642778	0.646302866	2.297302724	6.120519877	5.057408938	1.764460673	0.538992326	0	0.232341331	0.248198894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0502	YES	1A IP Acute: $290 Per Day for days 1-10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	"9A OP Hospital: $175, 9B ASC Services: $175"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: $50	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40 OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $40	"7E Mental Health: $40 MH (Group): $25, 7H Psychiatric: $40 Psychiatric (Group): $25"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $40, 7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $10"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $10	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											3400	0	0	0	10.2579	0	1.2499	0	0.0035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											11.5113	0	0.133219258	25.2199	0.426934407	6.879503996	10.25787749	3.429981134	3.380693829	0.435133422	1.059419598	5.699285862	0.647851345	3.583433611	0.220143205	0.027693041	0.261369574	7.390251066	10.73642778	0.646302866	2.297302724	6.120519877	5.057408938	1.764460673	0.538992326	0	0.232341331	0.248198894	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5614
H0104_002_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	722.6642155	95.8809058	156.2209109	18.2521205	159.8637808	12.60240091	5.047766323	308.0132424	331.4423727	3.819774621	10.59257472	0	0.023615026	139.1654492	14752.41403	3129.055199	137.6256242	302.7629753	25.14634841	21.59353851	1.328847517	0	0	0	177.7053736	0	49.9662961	0	19.91164275	0											3000	1a:  Acute - $250/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-6/7-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $75/$0/day for 1-30/31-100/2:  Non-Medicare Covered Stay - $75/$0/day for 1-30/31-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit/9b:  Ambulatory Surgical Center Services - $300/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $25/visit/:  Routine Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $25/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit/18a:  Fitting for Hearing Aid - $25/visit	18b:  Hearing Aids - $0/service	14b:  Other Immunizations - $0/visit/:  Routine Exams - $25/visit/14c:  Routine Exams - $25/visit												250	250	75	0	150	0.2	0.087703036	32.29763839	300	0	0	0	0.2	25	4.664345148	25	25	25	0	0.002580943	0	0	0	0	25	0	25	0	25	0											YES	216.8884882	216.8884882	65.06654647	-3.80E-19	130.1330929	0.173510791	0.076087115	28.01994385	260.2661859	0	0	0	0.173510791	21.68884882	4.046571071	21.68884882	21.68884882	21.68884882	0	0.002239108	0	0	0	0	25	0	25	0	25	0											4500	13.0615	1.732955393	0.84706293	-6.94E-18	1.733630688	2.186652545	0.384069978	0.71920948	7.188603515	0	0	0	0.004097462	0.251528199	4.974724321	5.655467098	0.248745113	0.547215033	0	0.048350256	0	0	0	0	0.370219528	0	0.10409645	0	0.041482589	0	0	0	0	0	0	0	0	0	0	0	40.0996	0	6.043099031	13.0615	1.732955393	0.84706293	-6.94E-18	1.733630688	2.186652545	0.384069978	0.71920948	7.188603515	0	0	0	0.004097462	0.251528199	4.974724321	5.655467098	0.248745113	0.547215033	0	0.048350256	0	0	0	0	0.370219528	0	0.10409645	0	0.041482589	0	0	0	0	0	0	0	0	0	0	0	40.0996	NO	1a:  Acute - 30.0% for 1-/1-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-6/7-190/1b:  Non-Medicare Covered Stay - 30.0%	2:  Skilled Nursing Services - 30.0% for 1-100/2:  Non-Medicare Covered Stay - 30.0% for 1-100	6:  Home Health Services - 30.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%/9b:  Ambulatory Surgical Center Services - 30.0%	8a:  Outpatient Diagnostic Procedures/Tests - 30.0%/8a:  Outpatient Lab Services - 30.0%	8b:  Outpatient Diagnostic Radiological Services - 30.0%/8b:  Outpatient Therapeutic Radiological Services - 30.0%/8b:  Outpatient X-Ray Services - 30.0%		12:  Renal Dialysis - 30.0%	9d:  Cardiac Rehabilitation Services - 30.0%/3:  Rehab Services (CORF) - 30.0%/5:  Partial Hospitalization - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/18a:  Hearing Exams - 30.0%/:  Routine Exams - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/18a:  Hearing Exams - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 30.0%/7i:  Physical/Speech Therapy - 30.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 30.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 30.0%"	9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%			17a:  Routine Eye Exams - 30.0%		18a:  Routine Hearing Test - 30.0%/18a:  Fitting for Hearing Aid - 30.0%	18b:  Hearing Aids - $0/service	14b:  Other Immunizations - $0/visit/:  Routine Exams - 30.0%/14c:  Routine Exams - 30.0%													1.9088	0.1231	0.1664	0.1624	0	0.1165	0.0217	0.1004	0.4037	0	0.1322	0	0.0003	0.0846	0.3186	0.8188	0.0082	0.0277	0.2528	0.1686	0.019	0.0001	0	0	0.0098	0	0.0015	0	0.0013	0											4.8466	2000	0.98524947	14.9703	1.856092851	1.013416055	0.16236301	1.733630688	2.303174106	0.405802558	0.819634403	7.592317176	0	0.132184506	0	0.004384586	0.336116073	5.293354679	6.474303856	0.25695474	0.574932924	0.252849709	0.216912434	0.018961284	9.51E-05	0	0	0.380027999	0	0.105598299	0	0.042800546	0	0	0	0	0	0	0	0	0	0	0	44.9462
H0104_004_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	706.8561257	46.27556773	151.2881519	17.3043914	139.4927781	19.42901924	3.798058091	287.1885943	455.8189188	4.760069153	15.82005304	0	0.030857063	156.8510183	15403.33965	3968.697586	184.1617752	438.5528525	28.06304272	28.16321273	7.049757213	0	0	1118.007165	232.2766997	0	54.62713216	0	13.08288937	0											2500	1a:  Acute - $250/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-6/7-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $50/$0/day for 1-50/51-100/2:  Non-Medicare Covered Stay - $50/$0/day for 1-50/51-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $15/visit/3:  Rehab Services (CORF) - $15/day/5:  Partial Hospitalization - $15/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $15/visit/18a:  Hearing Exams - $15/visit/:  Routine Exams - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $15/visit/17a:  Vision Exams - $15/visit/18a:  Hearing Exams - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $15/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $15/visit/7h:  Psychiatric Services - Individual - $15/visit/7h:  Psychiatric Services - Group - $15/visit	7c:  Occupational Therapy Services - $15/visit/7i:  Physical/Speech Therapy - $15/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $15/visit/9c:  Outpatient Substance Abuse Svcs - Group - $15/visit/7g:  Other Health Care Professional Services - $15/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $15/visit		18a:  Routine Hearing Test - $15/visit/18a:  Fitting for Hearing Aid - $15/visit	18b:  Hearing Aids - $0/service	14b:  Other Immunizations - $0/visit/:  Routine Exams - $15/visit/14c:  Routine Exams - $15/visit												250	250	50	0	150	0.2	0.052116961	25.39936884	100	0	0	0	0.2	15	3.314222497	15	15	15	0	0.001476061	0	0	0	0	15	0	15	0	15	0											YES	219.1873493	219.1873493	43.83746987	0	131.5124096	0.175349879	0.045693514	22.26888132	87.67493974	0	0	0	0.175349879	13.15124096	2.905742577	13.15124096	13.15124096	13.15124096	0	0.001294136	0	0	0	0	15	0	15	0	15	0											2500	12.9112	0.845251586	0.55267415	0	1.528752615	3.406876183	0.17354662	0.532947394	3.330324687	0	0	0	0.005410782	0.171898795	3.729844988	4.349441521	0.201829657	0.480626186	0	0.036447018	0	0	0	0	0.290345875	0	0.068283915	0	0.016353612	0	0	0	0	0	0	0	0	0	0	0	32.632	0	4.534589556	12.9112	0.845251586	0.55267415	0	1.528752615	3.406876183	0.17354662	0.532947394	3.330324687	0	0	0	0.005410782	0.171898795	3.729844988	4.349441521	0.201829657	0.480626186	0	0.036447018	0	0	0	0	0.290345875	0	0.068283915	0	0.016353612	0	0	0	0	0	0	0	0	0	0	0	32.632	NO	1a:  Acute - 30.0% for 1-/1-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-6/7-190/1b:  Non-Medicare Covered Stay - 30.0%	2:  Skilled Nursing Services - 30.0% for 1-100/2:  Non-Medicare Covered Stay - 30.0% for 1-100	6:  Home Health Services - 30.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%/9b:  Ambulatory Surgical Center Services - 30.0%	8a:  Outpatient Diagnostic Procedures/Tests - 30.0%/8a:  Outpatient Lab Services - 30.0%	8b:  Outpatient Diagnostic Radiological Services - 30.0%/8b:  Outpatient Therapeutic Radiological Services - 30.0%/8b:  Outpatient X-Ray Services - 30.0%		12:  Renal Dialysis - 30.0%	9d:  Cardiac Rehabilitation Services - 30.0%/3:  Rehab Services (CORF) - 30.0%/5:  Partial Hospitalization - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/18a:  Hearing Exams - 30.0%/:  Routine Exams - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/18a:  Hearing Exams - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 30.0%/7i:  Physical/Speech Therapy - 30.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 30.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 30.0%"	9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%			17a:  Routine Eye Exams - 30.0%		18a:  Routine Hearing Test - 30.0%/18a:  Fitting for Hearing Aid - 30.0%	18b:  Hearing Aids - $0/service	14b:  Other Immunizations - $0/visit/:  Routine Exams - 30.0%/14c:  Routine Exams - 30.0%													0.8108	0.0203	0.0431	0.0621	0	0.0715	0.0086	0.045	0.2095	0	0.0778	0	0.0002	0.0485	0.156	0.4085	0.0046	0.0164	0.1164	0.0901	0.0409	0.0002	0	0	0.0062	0	0.0009	0	0.0009	0											2.2384	2000	0.952112698	13.722	0.865600764	0.595802386	0.062055628	1.528752615	3.478349949	0.18211437	0.577913321	3.539803159	0	0.077826435	0	0.005564475	0.220382703	3.885886447	4.757905331	0.206466869	0.496996655	0.116431016	0.126501254	0.040891718	0.000155236	0	0	0.296583794	0	0.069152417	0	0.017260868	0	0	0	0	0	0	0	0	0	0	0	34.8704
H0104_006_0	2010	3	N/A																															coin	coin	coin	coin	T	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	277.6044547	12.1374154	16.55468417	41.48702495	295.6363801	29.97259027	6.773325238	507.7745602	72.19089231	6.949536698	18.27377911	0	0.04657467	8.552618765	12000	0	1.998221652	5.141681569	37.21005902	37.75161313	3.384469284	0.014640593	0	1612.535304	0	0	0	0	0	0												1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - $0/service	11b:  Prosthetics Devices - $0/service/11b:  Medical Supplies - $0/service/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $0/visit/9b:  Ambulatory Surgical Center Services - $0/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/18a:  Hearing Exams - $0/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/18a:  Hearing Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $0/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $0/visit/7h:  Psychiatric Services - Individual - $0/visit/7h:  Psychiatric Services - Group - $0/visit	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit				14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												0	0	0	0	50	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											YES	1.00E-19	-7.15E-20	0	0	50	0	0	50	0	0	9.49E-20	0	-7.27E-20	2.03E-19	0	0	1.09E-19	-8.43E-20	0	0	0	0	0	0	0	0	0	0	0	0											2500	0	-8.67E-19	0	0	1.231818251	0	0	2.115727334	0	0	1.73E-18	0	-3.39E-21	1.73E-18	0	0	2.17E-19	-4.34E-19	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3475	0	0	0	-8.67E-19	0	0	1.231818251	0	0	2.115727334	0	0	1.73E-18	0	-3.39E-21	1.73E-18	0	0	2.17E-19	-4.34E-19	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3475	NO	1a:  Acute - 10.0% for 1-/1-90/1a:  Additional Days - 10.0% for 91-999	1b:  Psych - 10.0% for 1-/1-190/1b:  Non-Medicare Covered Stay - 10.0%	2:  Skilled Nursing Services - 10.0% for 1-100/2:  Non-Medicare Covered Stay - 10.0% for 1-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 10.0%/11b:  Medical Supplies - 10.0%/11c:  Diabetes Monitoring Supplies - 10.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 10.0%/9b:  Ambulatory Surgical Center Services - 10.0%	8a:  Outpatient Diagnostic Procedures/Tests - 10.0%/8a:  Outpatient Lab Services - 10.0%	8b:  Outpatient Diagnostic Radiological Services - 10.0%/8b:  Outpatient Therapeutic Radiological Services - 10.0%/8b:  Outpatient X-Ray Services - 10.0%		12:  Renal Dialysis - 10.0%	9d:  Cardiac Rehabilitation Services - 10.0%/3:  Rehab Services (CORF) - 10.0%/5:  Partial Hospitalization - 10.0%	7a:  Primary Care - 10.0%/17a:  Vision Exams - 10.0%/18a:  Hearing Exams - 10.0%/:  Routine Exams - 10.0%/14d:  Pap Smears and Pelvic Exams Screening - 10.0%/14g:  Bone Mass Measurement - 10.0%/14f:  Colorectal Screening - 10.0%/14g:  Bone Mass Measurement - 10.0%/14b:  Immunizations (Hepatitis B) - 10.0%/14i:  Diabetes Monitoring - 10.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 10.0%	7d:  Physician Specialist Services - 10.0%/7b:  Chiropractic Services - 10.0%/7f:  Podiatry Services - 10.0%/17a:  Vision Exams - 10.0%/18a:  Hearing Exams - 10.0%/14d:  Pap Smears and Pelvic Exams Screening - 10.0%/14g:  Bone Mass Measurement - 10.0%/14f:  Colorectal Screening - 10.0%/14g:  Bone Mass Measurement - 10.0%/14b:  Immunizations (Hepatitis B) - 10.0%/14i:  Diabetes Monitoring - 10.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 10.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 10.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 10.0%/7h:  Psychiatric Services - Individual - 10.0%/7h:  Psychiatric Services - Group - 10.0%	7c:  Occupational Therapy Services - 10.0%/7i:  Physical/Speech Therapy - 10.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 10.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 10.0%"	9c:  Outpatient Substance Abuse Svcs - Individual - 10.0%/9c:  Outpatient Substance Abuse Svcs - Group - 10.0%/7g:  Other Health Care Professional Services - 10.0%	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - 10.0%			17a:  Routine Eye Exams - 10.0%				14b:  Other Immunizations - $0/visit/:  Routine Exams - 10.0%/14c:  Routine Exams - 10.0%													1.037	0.0458	0.0891	0.1174	0	0.0925	0.014	0.0666	0.2477	0	0.0762	0	0.0002	0.0504	0.1794	0.4602	0.0068	0.0186	0.1187	0.0961	0.0154	0.0001	0	0	0.0025	0	0	0	0.0003	0											2.735	1500	0.436474238	1.037	0.045785417	0.08908364	0.117439866	1.231818251	0.092495087	0.014049282	2.182355841	0.247743411	0	0.076206997	0	0.000170816	0.050426883	0.179405313	0.460181896	0.006843209	0.018565915	0.118656048	0.09612588	0.015373593	6.07E-05	0	0	0.002546292	0	0	0	0.000302753	0	0	0	0	0	0	0	0	0	0	0	6.0826
H0104_008_0	2010	6	N/A																															D	D	D	coin	coin	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	1011.549105	54.71307798	277.1107215	25.28191867	7.257064357	25.19868249	5.894429165	324.0555884	630.5866153	6.136204102	17.3608748	0	0.050749503	219.5578126	16083.83252	4918.303754	167.7328209	741.5942947	38.81817843	38.93488122	6.565139967	0	0	1209.401478	252.5622571	0	66.67823631	0	10.57894526	0											2500	1a:  Acute - $200/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-6/7-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $50/$0/day for 1-50/51-100/2:  Non-Medicare Covered Stay - $50/$0/day for 1-50/51-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $0/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $10/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $10/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $10/visit	18b:  Hearing Aids - $0/service	14b:  Other Immunizations - $0/visit/:  Routine Exams - $10/visit/14c:  Routine Exams - $10/visit												200	200	50	0	0	0.2	0.06837771	22.36450775	100	0	0	0	0.2	10	2.539091672	10	10	10	0	0.000862324	0	0	0	0	10	0	10	0	10	0											YES	173.3312518	173.3312518	43.33281295	0	0	0.173331252	0.05925997	19.38234062	86.66562589	0	0	0	0.173331252	8.666562589	2.20051969	8.666562589	8.666562589	8.666562589	0	0.000747339	0	0	0	0	10	0	10	0	10	0											2500	14.6111	0.790290525	1.000665589	0	0	4.367719179	0.349303697	0.523412983	4.554181974	0	0	0	0.008796475	0.158567627	2.949399179	3.552065609	0.121138916	0.535589448	0	0.029097543	0	0	0	0	0.210468548	0	0.055565197	0	0.008815788	0	0	0	0	0	0	0	0	0	0	0	33.8262	0	5.162206158	14.6111	0.790290525	1.000665589	0	0	4.367719179	0.349303697	0.523412983	4.554181974	0	0	0	0.008796475	0.158567627	2.949399179	3.552065609	0.121138916	0.535589448	0	0.029097543	0	0	0	0	0.210468548	0	0.055565197	0	0.008815788	0	0	0	0	0	0	0	0	0	0	0	33.8262	NO	1a:  Acute - 30.0% for 1-/1-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-6/7-190/1b:  Non-Medicare Covered Stay - 30.0%	2:  Skilled Nursing Services - 30.0% for 1-100/2:  Non-Medicare Covered Stay - 30.0% for 1-100	6:  Home Health Services - 30.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%/9b:  Ambulatory Surgical Center Services - 30.0%	8a:  Outpatient Diagnostic Procedures/Tests - 30.0%/8a:  Outpatient Lab Services - 30.0%	8b:  Outpatient Diagnostic Radiological Services - 30.0%/8b:  Outpatient Therapeutic Radiological Services - 30.0%/8b:  Outpatient X-Ray Services - 30.0%		12:  Renal Dialysis - 30.0%	9d:  Cardiac Rehabilitation Services - 30.0%/3:  Rehab Services (CORF) - 30.0%/5:  Partial Hospitalization - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/18a:  Hearing Exams - 30.0%/:  Routine Exams - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/18a:  Hearing Exams - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 30.0%/7i:  Physical/Speech Therapy - 30.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 30.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 30.0%"	9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%			17a:  Routine Eye Exams - 30.0%		18a:  Routine Hearing Test - 30.0%/18a:  Fitting for Hearing Aid - 30.0%	18b:  Hearing Aids - $0/service	14b:  Other Immunizations - $0/visit/:  Routine Exams - 30.0%/14c:  Routine Exams - 30.0%													0.9577	0.0226	0.0653	0.0732	0	0.0753	0.0107	0.0446	0.2363	0	0.0694	0	0.0002	0.0521	0.1673	0.4566	0.004	0.0248	0.138	0.1083	0.0307	0.0002	0	0	0.0075	0	0.0011	0	0.0009	0											2.5469	2000	1.588300818	15.5688	0.812929284	1.065994537	0.073190088	0	4.442983245	0.359980213	0.568005754	4.79048224	0	0.069363146	0	0.008998224	0.210694549	3.116746676	4.008704969	0.125107058	0.560433243	0.137966462	0.13738202	0.03073605	0.000200016	0	0	0.218015202	0	0.05669308	0	0.009666117	0	0	0	0	0	0	0	0	0	0	0	36.3731
H0104_801_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	257.3842484	6.249942787	20.56142254	42.00390832	8.968076826	25.66707992	1.84503214	14.94566516	51.95189519	6.893358247	16.13937249	0	0.057817853	9.155674501	52.26422125	139.2591258	1.126562464	6.026715127	39.06390899	41.8023414	8.234852953	0.041722477	0	0	0	0	0	0	0	0												Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing											0.089920803	0.089920803	0.176153773	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.089920803	0.089920803	0.176153773	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.1442	0.561999873	3.621972159	0	2.0895619	5.980429621	0.429892489	3.482339982	12.10479158	1.606152471	3.76047379	0	0.01347156	2.133272159	12.17756355	32.44737631	0.262489054	1.404224625	9.101890795	9.739945547	1.918720738	0.009721337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9905	0	0	23.1442	0.561999873	3.621972159	0	2.0895619	5.980429621	0.429892489	3.482339982	12.10479158	1.606152471	3.76047379	0	0.01347156	2.133272159	12.17756355	32.44737631	0.262489054	1.404224625	9.101890795	9.739945547	1.918720738	0.009721337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9905	NO	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing												0.4862	0.0118	0.1138	0	0	0.098	0.002	0.0569	0.2562	0	0.0904	0	0.0003	0.0721	0.263	0.6748	0.0052	0.0283	0.1805	0.1531	0.0513	0.0003	0	0	0	0	0	0	0	0											2.5441	0	0	23.6304	0.573805532	3.735762537	0	2.0895619	6.078470443	0.431845679	3.53921334	12.36102264	1.606152471	3.850891074	0	0.013730172	2.205393958	12.44057448	33.12218467	0.26771475	1.432493207	9.282346187	9.893008063	1.970043215	0.009990895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.5346
H0104_802_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	257.3901571	6.250086265	20.55910088	42.0073819	8.968415742	25.66804991	1.845101866	14.94517233	51.95267965	6.892812274	16.13802416	0	0.057822368	9.153146925	52.26659844	139.2655787	1.126650417	6.027185735	39.06776792	41.80485841	8.233768111	0.04171698	0	0	0	0	0	0	0	0												Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing											0.089923509	0.089923509	0.176156635	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.089923509	0.089923509	0.176156635	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.1454	0.562029691	3.621622028	0	2.089640868	5.98065563	0.429908735	3.482225152	12.10497436	1.60602526	3.760159628	0	0.013472612	2.132683234	12.17811744	32.44887985	0.262509547	1.404334276	9.102789924	9.74053201	1.91846797	0.009720056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9942	0	0	23.1454	0.562029691	3.621622028	0	2.089640868	5.98065563	0.429908735	3.482225152	12.10497436	1.60602526	3.760159628	0	0.013472612	2.132683234	12.17811744	32.44887985	0.262509547	1.404334276	9.102789924	9.74053201	1.91846797	0.009720056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9942	NO	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing												0.4862	0.0118	0.1138	0	0	0.098	0.002	0.0569	0.2562	0	0.0904	0	0.0003	0.0721	0.263	0.6748	0.0052	0.0283	0.1805	0.1531	0.0513	0.0003	0	0	0	0	0	0	0	0											2.5441	0	0	23.6316	0.573835848	3.735414396	0	2.089640868	6.078696573	0.431861928	3.539098714	12.361206	1.60602526	3.850577115	0	0.013731225	2.204805194	12.4411287	33.12368906	0.267735254	1.432602894	9.283245547	9.89359471	1.969790574	0.009989615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.5383
H0104_804_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	257.3899878	6.250082154	20.55916741	42.00728236	8.96840603	25.66802212	1.845099868	14.94518645	51.95265717	6.89282792	16.13806279	0	0.057822239	9.153219358	52.26653032	139.2653938	1.126647897	6.027172249	39.06765733	41.80478628	8.233799199	0.041717138	0	0	0	0	0	0	0	0												Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing											0.089923432	0.089923432	0.176156553	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.089923432	0.089923432	0.176156553	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.1454	0.562028836	3.621632061	0	2.089638605	5.980649153	0.429908269	3.482228443	12.10496912	1.606028905	3.760168631	0	0.013472582	2.13270011	12.17810156	32.44883676	0.26250896	1.404331134	9.102764157	9.740515203	1.918475213	0.009720093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9941	0	0	23.1454	0.562028836	3.621632061	0	2.089638605	5.980649153	0.429908269	3.482228443	12.10496912	1.606028905	3.760168631	0	0.013472582	2.13270011	12.17810156	32.44883676	0.26250896	1.404331134	9.102764157	9.740515203	1.918475213	0.009720093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9941	NO	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing												0.4862	0.0118	0.1138	0	0	0.098	0.002	0.0569	0.2562	0	0.0904	0	0.0003	0.0721	0.263	0.6748	0.0052	0.0283	0.1805	0.1531	0.0513	0.0003	0	0	0	0	0	0	0	0											2.5441	0	0	23.6316	0.573834979	3.735424372	0	2.089638605	6.078690094	0.431861462	3.539101998	12.36120074	1.606028905	3.850586112	0	0.013731194	2.204822066	12.44111282	33.12364595	0.267734666	1.432599751	9.283219773	9.893577898	1.969797814	0.009989651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.5382
H0108_004_0	2010	6	N/A	r.	s.	t.	u.							OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)							Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O		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	YES	1676.496257	51.753704	776.789114	1330.087817	223.765355	10.079744	3.610904	372.55396	314.450528	1316.560473	1435.367221	64.362578	0.042784	355.948	4945.498566	4692.423403	76.837556	709.036722			30.563102	0							0.04		21.088239	0.05	0.55	2.43							5000	$250/Day(Days 1-5):1a	$250/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $200 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	$0/Visit:8a	"$0-$200/Visit:14h. $200 DMAM -- OP,8b. $200 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $200 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $200 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $200 Radiology OP -- Facility"	$200/Visit:9a	20% Coins:12	"$30-$200/Visit:9d. $30 Cardiac Rehab,8b. $200 Nuclear Medicine,9a. $200 OP Other,5. $200 Partial Hospitalization,7h. $200 Psych -- OP,8b. $200 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15								$0: Nurse hotline 14a		$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a							151.66775	126.678	58.254672	0	100	0.2	0.082363	50	200	0	144.062759	200	0.2	156.986688	15	30	30	30			0.2	0							0		0	0	0	0							NO	133.566356	111.559107	34.436317	0	86.6326	0.173265	0.071353	43.3163	173.2652	0	124.805313	173.2652	0.173265	136.001649	12.99489	25.98978	25.98978	25.98978			0.173265	0							0		0	0	0	0								18.6603	0.481133084	2.229146348	0	1.615447874	1.746466844	0.257648833	1.344804925	4.540277802	0	14.92845461	0.929316246	0.00741297	4.034126247	5.355517488	10.16292099	0.166415931	1.535642368	0	0	5.295515868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.2905	0	12.147181	18.6603	0.481133084	2.229146348	0	1.615447874	1.746466844	0.257648833	1.344804925	4.540277802	0	14.92845461	0.929316246	0.00741297	4.034126247	5.355517488	10.16292099	0.166415931	1.535642368	0	0	5.295515868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.2905	NO																																																																																		0	0	0	18.6603	0.481133084	2.229146348	0	1.615447874	1.746466844	0.257648833	1.344804925	4.540277802	0	14.92845461	0.929316246	0.00741297	4.034126247	5.355517488	10.16292099	0.166415931	1.535642368	0	0	5.295515868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.2905
H0108_005_0	2010	5	N/A	r.	s.	t.	u.							OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)							Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O		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	YES	1721.71399	53.149583	797.740334	1365.962371	229.800657	12.350863	4.424497	382.602325	322.931751	1352.070173	1474.081325	66.098538	0.052423	365.548476	5078.886418	4818.98542	78.909985	728.160554			37.449434	0		1.21					0.04		21.657022	0.05	0.55	2.43							5000	$125/Day(Days 1-5):1a	$125/Day(Days 1-5):1b	"$0/Day(Days 1-20) $120(Days 21-100):2. $0 SNF 1,2. $120 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $100 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	$15/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"					$0: Nurse hotline 14a		$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a							75.833875	63.339	43.02348	0	100	0.2	0.082363	50	100	0	72.031379	100	0.2	78.493344	5	15	15	15			0.2	0		0					0		0	0	0	0							NO	71.964831	60.107444	33.629174	0	92.6559	0.185312	0.076314	46.32795	92.6559	0	66.741323	92.6559	0.185312	72.728714	4.632795	13.898385	13.898385	13.898385			0.185312	0		0					0		0	0	0	0								10.3252	0.266223799	2.235612375	0	1.774365558	2.288763124	0.337651064	1.477098449	2.493461002	0	8.198511487	0.510368294	0.009714611	2.215489214	1.960786634	5.58134289	0.091393446	0.843354643	0	0	6.939829513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5492	0	3.946096	10.3252	0.266223799	2.235612375	0	1.774365558	2.288763124	0.337651064	1.477098449	2.493461002	0	8.198511487	0.510368294	0.009714611	2.215489214	1.960786634	5.58134289	0.091393446	0.843354643	0	0	6.939829513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5492	NO																																																																																		0	0	0	10.3252	0.266223799	2.235612375	0	1.774365558	2.288763124	0.337651064	1.477098449	2.493461002	0	8.198511487	0.510368294	0.009714611	2.215489214	1.960786634	5.58134289	0.091393446	0.843354643	0	0	6.939829513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5492
H0108_006_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)		Prosthetics/Supplies	Lab	Radiology	Renal Dialysis	Other						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O		Coin					O	O	Coin	V	V	P	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		0	NO	1637.371685	50.545923	758.661104	1010.370212	169.978137	7.865122	1.160311	363.859629	0	237.449437	421.287922	62.860542	0.049597	87.959998	4964.253964	4710.219034	77.128955	707.927277			36.5398	0		1.21					0.04	0.42	1.65724	1048.386323	985.145146	20.5961	259.681206	307.112162	0.05	0.55	2.43			$125/Day(Days 1-5):1a	$125/Day(Days 1-5):1b	"$0/Day(Days 1-20) $120(Days 21-100):2. $0 SNF 1,2. $120 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0-$15/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	$5/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	$15/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Nutritional benefit 14a	0% Coins:11b	$0/Visit:8a	"$100/Visit:14h, 8a, 8b, 9a"	$0/Proc:12	"$100/Visit:3, 5, 7h, 8b, 9a, 9d"	"$100/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a		75.833875	63.339	43.02348	0	100	0.2	0.2	50	0	0	6.01146	100	0.2	15	5	15	15	15			0.2	0		0					0	0	0	0	100	0	100	100	0	0	0		NO	73.528677	61.413621	38.799951	0	94.5788	0.189158	0.189158	47.2894	0	0	5.685567	94.5788	0.189158	14.18682	4.72894	14.18682	14.18682	14.18682			0.189158	0		0					0	0	0	0	94.5788	0	94.5788	94.5788	0	0	0			10.0328	0.258684013	2.453001138	0	1.339694019	1.487750747	0.219482108	1.433891962	0	0	0.199605059	0.495439552	0.009381669	0.103989388	1.956304928	5.5685858	0.09118455	0.836936404	0	0	6.911795488	0	0	0	0	0	0	0	0	0	0	0	7.764487145	0	2.046694737	2.420524979	0	0	0	0	45.6302	0	2.474655	10.0328	0.258684013	2.453001138	0	1.339694019	1.487750747	0.219482108	1.433891962	0	0	0.199605059	0.495439552	0.009381669	0.103989388	1.956304928	5.5685858	0.09118455	0.836936404	0	0	6.911795488	0	0	0	0	0	0	0	0	0	0	0	7.764487145	0	2.046694737	2.420524979	0	0	0	0	45.6302	YES	$225/Day(Days 1-15)	$225/Day(Days 1-15)	$0/Day(Days 1-20) $120(Days 20-100)	$0/Visit	$100/Trip	20% Coins	25% Coins	$50/Visit	$0/Visit	25% Coins	$0-$35/Visit	25% Coins	20% Coins	$35/Visit	$35/Visit	$35/Visit	$35/Visit	$35/Visit			20%-25% Coins	$0/Service									$0/Service	$0/Visit	20%-25% Coins	$0/Proc	20%-25% Coins	25% Coins					7500	2.7661	0.082	0.2336	0	0.5418	0.9256	0.1707	0.1503	0	0.1204	0.0356	0.1498	0.001	0.0254	1.0477	0.9941	0.0163	0.1601			0.5668	0									0	0	0.4882	0	0.2996	0.9915					9.7667	0	1.120787	12.7989	0.340724013	2.686632138	0	1.881453019	2.413334747	0.390167108	1.584223962	0	0.120432	0.235237059	0.645246552	0.010416669	0.129428388	3.003990928	6.5626588	0.10746255	0.997030404	0	0	7.478634488	0	0	0	0	0	0	0	0	0	0	0	8.252729145	0	2.346265737	3.412021979	0	0	0	0	55.397
H0108_801_0	2010	5	N/A																															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	NO	293.46143	1.805904	28.265741	13.673107	6.660088	6.481783	2.73966	26.830532	75.856074	10.907562	35.762161	5.536426	1.180456	19.538771	90.579615	112.365644	0.393088	7.642001			28.885948	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																			0.06752397	0.06752397	0.144326669	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.06752397	0.06752397	0.144326669	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.8157	0.121941807	4.079500257	0	1.551800504	1.510255439	0.63834078	6.251513956	17.67446524	2.541461946	8.332583513	1.289987258	0.275046248	4.552533643	21.1050503	26.18119505	0.091589504	1.780586233	0	0	6.730425884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.524	0	0	19.8157	0.121941807	4.079500257	0	1.551800504	1.510255439	0.63834078	6.251513956	17.67446524	2.541461946	8.332583513	1.289987258	0.275046248	4.552533643	21.1050503	26.18119505	0.091589504	1.780586233	0	0	6.730425884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.524	NO																																																																																		0	0	0	19.8157	0.121941807	4.079500257	0	1.551800504	1.510255439	0.63834078	6.251513956	17.67446524	2.541461946	8.332583513	1.289987258	0.275046248	4.552533643	21.1050503	26.18119505	0.091589504	1.780586233	0	0	6.730425884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.524
H0108_802_0	2010	3	N/A																															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	NO	293.46143	1.805904	28.265741	13.673107	6.660088	6.481783	2.73966	26.830532	75.856074	10.907562	35.762161	5.536426	1.180456	19.538771	90.579615	112.365644	0.393088	7.642001			28.885948	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																			0.067523788	0.067523788	0.144327318	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.067523788	0.067523788	0.144327318	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.8156	0.121941479	4.079518578	0	1.551800504	1.510255439	0.63834078	6.251513956	17.67446524	2.541461946	8.332583513	1.289987258	0.275046248	4.552533643	21.1050503	26.18119505	0.091589504	1.780586233	0	0	6.730425884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.5239	0	0	19.8156	0.121941479	4.079518578	0	1.551800504	1.510255439	0.63834078	6.251513956	17.67446524	2.541461946	8.332583513	1.289987258	0.275046248	4.552533643	21.1050503	26.18119505	0.091589504	1.780586233	0	0	6.730425884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.5239	NO																																																																																		0	0	0	19.8156	0.121941479	4.079518578	0	1.551800504	1.510255439	0.63834078	6.251513956	17.67446524	2.541461946	8.332583513	1.289987258	0.275046248	4.552533643	21.1050503	26.18119505	0.091589504	1.780586233	0	0	6.730425884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.5239
H0108_803_0	2010	3	N/A																															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	NO	293.46143	1.805904	28.265741	13.673107	6.660088	6.481783	2.73966	26.830532	75.856074	10.907562	35.762161	5.536426	1.180456	19.538771	90.579615	112.365644	0.393088	7.642001			28.885948	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																			0.067523788	0.067523788	0.144327318	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.067523788	0.067523788	0.144327318	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.8156	0.121941479	4.079518578	0	1.551800504	1.510255439	0.63834078	6.251513956	17.67446524	2.541461946	8.332583513	1.289987258	0.275046248	4.552533643	21.1050503	26.18119505	0.091589504	1.780586233	0	0	6.730425884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.5239	0	0	19.8156	0.121941479	4.079518578	0	1.551800504	1.510255439	0.63834078	6.251513956	17.67446524	2.541461946	8.332583513	1.289987258	0.275046248	4.552533643	21.1050503	26.18119505	0.091589504	1.780586233	0	0	6.730425884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.5239	NO																																																																																		0	0	0	19.8156	0.121941479	4.079518578	0	1.551800504	1.510255439	0.63834078	6.251513956	17.67446524	2.541461946	8.332583513	1.289987258	0.275046248	4.552533643	21.1050503	26.18119505	0.091589504	1.780586233	0	0	6.730425884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.5239
H0117_005_0	2010	5	N/A																															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	V	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	Yes	2479.753439	93.6781414	557.518914	336.6802859	493.6240633	8.17236976	4.41759682	1850.750816	290.6195437	9636.141527	1727.147466	122.4685407	0.064960779	781.319096	8912.151654	14984.38665	153.7454095	1363.789496	4080.993169	1693.703525	20.1922298	33.18664912	0	490.6666667	288	172.8	16.8	12.8	0	0											3400	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $10.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											115.6981289	92.9938255	54.67	1.935418136	39.17759075	0.2	0.091378779	20.93607527	110.8299512	0	69.30711046	59.5817897	0.2	21.89214005	4.728659308	8.784351081	24.70517064	16.11463252	20.96151112	6.237124048	0.2	0	0	0	0	0	0	0	0	0											NO	104.0132238	83.6019361	49.14861628	1.739951039	35.22085924	0.179801047	0.082150001	18.8216413	99.63670647	0	62.30745524	53.56434095	0.179801047	19.68114854	4.25108948	7.897177622	22.21007778	14.48713902	18.84450826	5.607207181	0.179801047	0	0	0	0	0	0	0	0	0												21.4939	0.652639499	2.283440265	0.048817268	1.448821971	1.469400642	0.362905582	2.902847333	2.413031181	0	8.96784695	0.546662222	0.011680016	1.281438099	3.157196178	9.861196911	0.284558125	1.646450669	6.408692458	0.791412214	3.630584066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6636	0	7.826043209	21.4939	0.652639499	2.283440265	0.048817268	1.448821971	1.469400642	0.362905582	2.902847333	2.413031181	0	8.96784695	0.546662222	0.011680016	1.281438099	3.157196178	9.861196911	0.284558125	1.646450669	6.408692458	0.791412214	3.630584066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6636	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.4939	0.652639499	2.283440265	0.048817268	1.448821971	1.469400642	0.362905582	2.902847333	2.413031181	0	8.96784695	0.546662222	0.011680016	1.281438099	3.157196178	9.861196911	0.284558125	1.646450669	6.408692458	0.791412214	3.630584066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6636
H0117_007_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	276.0172104	13.35252267	497.3981182	521.172362	8.053899195	7.648887906	2.377191314	21.96208052	26.86187681	9400.728523	25.15359527	1.584562115	0.054235428	8.250717329	8678.640716	82.47375909	2.353359697	7.159055851	21.8975485	9.85648026	23.66275116	0.296121632	0	490.6666667	0.96	172.8	0.056	0.224	0	2867.20946												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	Not Covered	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	$0.00 copayment											663.8955719	417.4624162	54.90260275	0	0.166309128	0.17000026	0.17	0.125495743	0.17	0	0.170054147	0.248635798	0.17	0.170090321	0	0.11427092	0.402968058	0.170004136	0.168756262	0.071055451	0.170003873	0.17	0	0	0	0	0	0	0	0											NO	663.8955719	417.4624162	54.90260275	0	0.166309128	0.17000026	0.17	0.125495743	0.17	0	0.170054147	0.248635798	0.17	0.170090321	0	0.11427092	0.402968058	0.170004136	0.168756262	0.071055451	0.170003873	0.17	0	0	0	0	0	0	0	0												15.2706	0.464514698	2.275704274	0	1.339436951	1.300312935	0.404122523	2.756147603	4.566519057	0	4.2774732	0.393978866	0.009220023	1.403367158	0	9.424352296	0.948328787	1.217069102	3.695348428	0.700356655	4.022759347	0.050340677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5199	0	0	15.2706	0.464514698	2.275704274	0	1.339436951	1.300312935	0.404122523	2.756147603	4.566519057	0	4.2774732	0.393978866	0.009220023	1.403367158	0	9.424352296	0.948328787	1.217069102	3.695348428	0.700356655	4.022759347	0.050340677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5199	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.2706	0.464514698	2.275704274	0	1.339436951	1.300312935	0.404122523	2.756147603	4.566519057	0	4.2774732	0.393978866	0.009220023	1.403367158	0	9.424352296	0.948328787	1.217069102	3.695348428	0.700356655	4.022759347	0.050340677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5199
H0141_001_0	2010	8	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	1621.122635	324.6547839	1824.595731	0	413.9843727	153.4847993	3919.680379	467.1968533	248.8698944	1982.901522	716.5095215	0	232.551195	2446.573849	8462.130996	11515.11439	1290.401345	1975.914188	4419.647489	18927.36347	309.6075743	10.05234269	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											176.0302808	68.12684355	71.80050733	0	119.7639551	458.4275953	13.59153161	124.6420736	295.0110678	15.084225	65.20238791	0	44.14503578	41.35951169	17.55837034	22.16200135	16.65600315	6.276815186	14.40648318	3.954502529	75.43564575	176.773305	0	0	0	0	0	0	0	0											NO	176.0302808	68.12684355	71.80050733	0	119.7639551	458.4275953	13.59153161	124.6420736	295.0110678	15.084225	65.20238791	0	44.14503578	41.35951169	17.55837034	22.16200135	16.65600315	6.276815186	14.40648318	3.954502529	75.43564575	176.773305	0	0	0	0	0	0	0	0												23.7806	1.843142139	10.9172416	0	4.131700486	5.86347229	4.439538313	4.852698713	6.118281109	2.492544393	3.893177647	0	0.855498402	8.432424974	12.38176916	21.2664984	1.791077405	1.033537348	5.305964768	6.237358892	1.946287275	0.148082153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.7309	0	0	23.7806	1.843142139	10.9172416	0	4.131700486	5.86347229	4.439538313	4.852698713	6.118281109	2.492544393	3.893177647	0	0.855498402	8.432424974	12.38176916	21.2664984	1.791077405	1.033537348	5.305964768	6.237358892	1.946287275	0.148082153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.7309	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.7806	1.843142139	10.9172416	0	4.131700486	5.86347229	4.439538313	4.852698713	6.118281109	2.492544393	3.893177647	0	0.855498402	8.432424974	12.38176916	21.2664984	1.791077405	1.033537348	5.305964768	6.237358892	1.946287275	0.148082153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.7309
H0150_001_0	2010	7	N/A																															D	D	D		T	COIN		P	P		P		COIN		V	V	COIN	V			COIN																																																												0	NO	1037.56	61.50631793	301.8667171		228.1961488	12.12958579		384.03165	425.5277593		2804.865324		0.546051643		4810.152414	7127.512367	1.535049309	125.2196151			50.23467457																					$195 per day for 1st 6 days	$185 per day for 1st 10 days	$0/day days 1-5; $95/day days 6-35		$150 Per Trip	20% Coinsurance		$50/visit	$255 per visit		"$25/Xray; $100/MRI,MRA, CT, PET, and  Nuc Scan"		20% Coinsurance		$10 per visit	$40 per visit	20% Coinsurance	$40 per visit			20% Script																				195	185	95		150	0.2		50	255		46.22808858		0.2		10	40	0.2	40			0.2																				NO	184.88	175.4075246	90.07413425		142.2223172	0.189629756		50	241.7655		43.83110586		0.189629756		10	40	0.2	40			0.189629756																					15.9853	0.899055915	2.265865267	0	2.704548755	2.300130397	0	1.600131875	8.573160958	0	10.24502908	0	0.10354764	0	4.008460345	23.75837456	0.307009862	0.417398717	0	0	9.525989098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.694		2.822909655	15.9853	0.899055915	2.265865267	0	2.704548755	2.300130397	0	1.600131875	8.573160958	0	10.24502908	0	0.10354764	0	4.008460345	23.75837456	0.307009862	0.417398717	0	0	9.525989098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.694	NO																																																																																		0			15.9853	0.899055915	2.265865267	0	2.704548755	2.300130397	0	1.600131875	8.573160958	0	10.24502908	0	0.10354764	0	4.008460345	23.75837456	0.307009862	0.417398717	0	0	9.525989098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.694
H0150_007_0	2010	9	N/A																															D	D	D		COIN	COIN		V	COIN		COIN		COIN	COIN	V	V	COIN	V			COIN																																																												0	NO	2029.452643	104.2459997	931.663865		15.07818618	25.20842882		846.1367193	64.44487908		20.72835722		2.141743134	57.50574976	6317.245921	9352.057757	3.635407126	190.5829582			47.69607562																					$185 per day for 1st 6 days	$185 per day for 1st 10 days	$0 day 1-5/ $85 day 6-35		20% Coinsurance	20% Coinsurance		$50 per visit	20% Coinsurance		20% Coinsurance		20% Coinsurance	20% Coinsurance	$0/visit	$5/visit	20% Coinsurance	$5/visit			20% Coinsurance																				185	185	85		0.2	0.2		50	0.2		0.2		0.2	0.2	0	5	0.2	5			0.2																				NO	185	185	85		0.2	0.2		50	0.2		0.2		0.2	0.2	0	5	0.2	5			0.2																					31.2874	1.607125828	6.59928571	0	3.015637235	5.041685763	0	3.525569664	12.88897582	0	4.145671445	0	0.428348627	11.50114995	0	3.896690732	0.727081425	0.079409566	0	0	9.539215123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2832		0	31.2874	1.607125828	6.59928571	0	3.015637235	5.041685763	0	3.525569664	12.88897582	0	4.145671445	0	0.428348627	11.50114995	0	3.896690732	0.727081425	0.079409566	0	0	9.539215123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2832	NO																																																																																		0			31.2874	1.607125828	6.59928571	0	3.015637235	5.041685763	0	3.525569664	12.88897582	0	4.145671445	0	0.428348627	11.50114995	0	3.896690732	0.727081425	0.079409566	0	0	9.539215123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2832
H0150_010_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	O	V	O	Coin		V	V	COIN	V			Coin	Coin	T	V	V	V			V																																																				0	NO	984.58	54.37047772	140.24		215.5274359	15.33838769		489.5844931	379.4521819		2650.979151		2.12		15820.39778	19016.97313	1.782218695	380.2023398			41.8544466																					$275 per day; days 1-6	$275 per day; days 1-7	"$0/day; days 1-5, $95/day;days 6 to 35"		$90 per trip	20% coinsurance		$50 per visit	$175 per visit		"$25/Xray; $100/MRI,MRA,CT,PET, and NUC Scans"		20% Coinsurance		$5 per visit	$30 per visit	20% coinsurance	$30 per visit			20% per script																				275	275	95		90	0.2		50	175		49.29711112		0.2		5	30	0.2	30			0.2																				NO	260.7409149	260.7409149	90.07413425		85.33339034	0.189629756		50	165.9260368		46.74099584		0.189629756		5	30	0.2	30			0.189629756																					21.3934	1.181384009	1.052666382	0	1.532640568	2.908614719	0	2.039935388	5.246749724	0	10.32578379	0	0.402015083	0	6.591832409	47.54243283	0.356443739	0.95050585	0	0	7.936848508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4612		3.350954639	21.3934	1.181384009	1.052666382	0	1.532640568	2.908614719	0	2.039935388	5.246749724	0	10.32578379	0	0.402015083	0	6.591832409	47.54243283	0.356443739	0.95050585	0	0	7.936848508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4612	NO																																																																																		0			21.3934	1.181384009	1.052666382	0	1.532640568	2.908614719	0	2.039935388	5.246749724	0	10.32578379	0	0.402015083	0	6.591832409	47.54243283	0.356443739	0.95050585	0	0	7.936848508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4612
H0150_012_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	O	V	O	COIN	O	V	V	COIN	V			Coin																																																												0	NO	1019.62	54.39209926	205.3673853		227.4692881	8.666426094		417.5987518	384.8544475		2418.294063		0.2142		4627.223901	6732.700691	1.247107035	115.809031			35.75053493																					$185 per day/days 1-6	$185 per day/days 1-10	$0/day; days 1-5; $95/day; days 6-35		$150 per trip	20% coinsurance		$50 per visit	$100 per visit		"$25/Xray; $100/MRI,MRA,CT,PET, and NUC Scans"		20% coinsurance		$5 per visit	$30 per visit	20% coinsurance	$30 per visit			20% per script																				185	185	95		150	0.2		50	100		38.63997526		0.2		5	30	0.2	30			0.2																				NO	175.4075246	175.4075246	90.07413425		142.2223172	0.189629756		50	94.81487815		36.63644546		0.189629756		5	30	0.2	30			0.189629756																					14.9041	0.795065291	1.541524119	0	2.695934105	1.643412268	0	1.739994799	3.040827295	0	7.383141547	0	0.040618694	0	1.928009959	16.83175173	0.249421407	0.289522578	0	0	6.779365226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8627		2.1231587	14.9041	0.795065291	1.541524119	0	2.695934105	1.643412268	0	1.739994799	3.040827295	0	7.383141547	0	0.040618694	0	1.928009959	16.83175173	0.249421407	0.289522578	0	0	6.779365226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8627	NO																																																																																		0			14.9041	0.795065291	1.541524119	0	2.695934105	1.643412268	0	1.739994799	3.040827295	0	7.383141547	0	0.040618694	0	1.928009959	16.83175173	0.249421407	0.289522578	0	0	6.779365226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8627
H0150_019_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	P	P	O	V	O	Coin	O	V	V	COIN	V			Coin																																																												0	NO	1836.632979	84.22433472	406.1569619		277.0986566	22.45710622		519.5137798	459.3882328		2764.363674		0.483758258		7171.371308	9724.998804	1.071486712	188.6825438			64.23457832																					$175/day for days 1-10	$175/day for days 1-10	$0 day/1-5; $95/day; days 6-35		$150 per trip	20% coinsurance		$50 per visit	$175 per visit		"$25/Xray; $100/MRI,MRA,PET,CT,NUC Scan"		20% Coinsurance		$5 per visit	$30 per visit	20% coinsurance	$30 per visit			20% per script																				175	175	95		150	0.2		50	175		46.25910772		0.2		5	30	0.2	30			0.2																				NO	165.9260368	165.9260368	90.07413425		142.2223172	0.189629756		50	165.9260368		43.86051662		0.189629756		5	30	0.2	30			0.189629756																					25.3954	1.164584172	3.048686393	0	3.28413442	4.258535579	0	2.164640749	6.352039067	0	10.10386824	0	0.091734961	0	2.988071378	24.31249701	0.214297342	0.47170636	0	0	12.18078743	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.031		3.602755484	25.3954	1.164584172	3.048686393	0	3.28413442	4.258535579	0	2.164640749	6.352039067	0	10.10386824	0	0.091734961	0	2.988071378	24.31249701	0.214297342	0.47170636	0	0	12.18078743	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.031	NO																																																																																		0			25.3954	1.164584172	3.048686393	0	3.28413442	4.258535579	0	2.164640749	6.352039067	0	10.10386824	0	0.091734961	0	2.988071378	24.31249701	0.214297342	0.47170636	0	0	12.18078743	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.031
H0150_021_0	2010	6	N/A																															A	D	D		T	COIN		P	P		P		COIN		V	V	COIN	V			COIN																																																												0	NO	264.5644273	10.40021234	498.7196628		240.6323737	12.38496247		389.4904519	420.0992399		2764.363674		0.595939236		3776.424267	5568.965403	1.54019382	98.24656672			48.66825307																					$300 per admit	$185/day days 1-10	$0 days 1-5; $50 days 6-35		$50 per trip	20% Coinsurance		$50 per visit	$50 per visit		"$25/Xray; $100/MRI,MRA,CT,PET, NUC Scan"		20% Coinsurance		$0 per visit	$15 per visit	20% Coinsurance	$15 per visit			20% per script																				300	185	50		50	0.2		50	50		46.14835788		0.2		0	15	0.2	15			0.2																				NO	284.4446345	175.4075246	47.40743908		47.40743908	0.189629756		50	47.40743908		43.75550929	0	0.189629756		0	15	0.2	15			0.189629756																					6.2712	0.152022959	1.970251836	0	0.95064705	2.348557415	0	1.622876883	1.659652427	0	10.07967837	0	0.113007812	0	0	6.961206754	0.308038764	0.122808208	0	0	9.22894897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.7889		1.792301086	6.2712	0.152022959	1.970251836	0	0.95064705	2.348557415	0	1.622876883	1.659652427	0	10.07967837	0	0.113007812	0	0	6.961206754	0.308038764	0.122808208	0	0	9.22894897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.7889	NO																																																																																		0			6.2712	0.152022959	1.970251836	0	0.95064705	2.348557415	0	1.622876883	1.659652427	0	10.07967837	0	0.113007812	0	0	6.961206754	0.308038764	0.122808208	0	0	9.22894897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.7889
H0150_802_0	2010	1	N/A																															D	D	D		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																				31.8619	2.3982	9.6529		0.4485	0.5871		0.7924	1.9457	0.5637	0.2693	0.0716	0.0197	0.5779	3.0561	5.5755	0.1978	0.047	1.2543		0.8555																				60.1752	NO	2562.737839	192.894246	1164.347561		13.59083929	17.79106501		25.83481288	59.00300534	17.08317248	8.160751185	2.168428172	0.598455087	17.5106404	99.64525626	181.78976	6.449590956	1.533856875	40.89668993		25.92563718																					Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits																				11.22957087	11.22957087	7.488102094		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																				NO	11.22957087	11.22957087	7.488102094		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																					2.3982	0.180509967	0.726562784	0	2.718167858	3.558213001	0	5.166962577	11.80060107	3.416634496	1.632150237	0.433685634	0.119691017	3.50212808	19.92905125	36.357952	1.289918191	0.306771375	8.179337986	0	5.185127436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9017	60.17516107	1.849619835	34.2601	2.578713816	10.37946834	0	3.166665554	4.145318146	0	5.959316288	13.74632547	3.980379188	1.901455026	0.505243764	0.139440035	4.079979213	22.98517126	41.93344394	1.487727146	0.353814765	9.433639466	0	6.040673463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0768	NO																																																																																		0			34.2601	2.578713816	10.37946834	0	3.166665554	4.145318146	0	5.959316288	13.74632547	3.980379188	1.901455026	0.505243764	0.139440035	4.079979213	22.98517126	41.93344394	1.487727146	0.353814765	9.433639466	0	6.040673463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0768
H0150_804_0	2010	1	N/A																															D	D	D		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																				31.8619	2.3982	9.6529		0.4485	0.5871		0.7924	1.9457	0.5637	0.2693	0.0716	0.0197	0.5779	3.0561	5.5755	0.1978	0.047	1.2543		0.8555																				60.1752	NO	2562.737839	192.894246	1164.347561		13.59083929	17.79106501		25.83481288	59.00300534	17.08317248	8.160751185	2.168428172	0.598455087	17.5106404	99.64525626	181.78976	6.449590956	1.533856875	40.89668993		25.92563718																					Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits																				11.22957087	11.22957087	7.488102094		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																				NO	11.22957087	11.22957087	7.488102094		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																					2.3982	0.180509967	0.726562784	0	2.718167858	3.558213001	0	5.166962577	11.80060107	3.416634496	1.632150237	0.433685634	0.119691017	3.50212808	19.92905125	36.357952	1.289918191	0.306771375	8.179337986	0	5.185127436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9017	60.17516107	1.849619835	34.2601	2.578713816	10.37946834	0	3.166665554	4.145318146	0	5.959316288	13.74632547	3.980379188	1.901455026	0.505243764	0.139440035	4.079979213	22.98517126	41.93344394	1.487727146	0.353814765	9.433639466	0	6.040673463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0768	NO																																																																																		0			34.2601	2.578713816	10.37946834	0	3.166665554	4.145318146	0	5.959316288	13.74632547	3.980379188	1.901455026	0.505243764	0.139440035	4.079979213	22.98517126	41.93344394	1.487727146	0.353814765	9.433639466	0	6.040673463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0768
H0151_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1920.977936	104.801424	957.2119384	1825.993721	323.4167293	10.95523467	10.31198648	538.8655409	36.50005992	9781.948549	35.04440935	0	0.182296424	12.55888835	6444.051636	4322.728436	491.985046	370.1679257	0	0	30.84249844	755.3869664	754.905178	0	217.2215825	276.888023	72.72818882	4.542637861	110.5404846	0											3800	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-22 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	85.64447017	0	150	0.2	0.123443044	49.50274095	0.2	3	0.178104212	0	0.2	0.150089451	11.63501	30	38.5	30	0	0	0.2	29.67174465	0	0	30	15	0	0	0	0											NO	141.870576	108.0516341	65.9488606	0	115.5045862	0.154006115	0.095054918	38.11862407	0.154006115	2.310091724	0.137145689	0	0.154006115	0.115934362	11.55741002	30	38.5	23.10091724	0	0	0.154006115	29.67174465	0	0	30	15	0	0	0	0												22.7109	0.94366376	5.26058639	0	3.113009625	1.687173129	0.980205031	1.711734415	5.621232425	1.883099866	4.806189669	0	0.028074764	1.456006711	6.206378914	10.80682109	1.578452023	0.712601552	0	0	4.749933361	1.867804098	0	0	0.543053956	0.346110029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.013	0	16.65993303	22.7109	0.94366376	5.26058639	0	3.113009625	1.687173129	0.980205031	1.711734415	5.621232425	1.883099866	4.806189669	0	0.028074764	1.456006711	6.206378914	10.80682109	1.578452023	0.712601552	0	0	4.749933361	1.867804098	0	0	0.543053956	0.346110029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.013	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.7109	0.94366376	5.26058639	0	3.113009625	1.687173129	0.980205031	1.711734415	5.621232425	1.883099866	4.806189669	0	0.028074764	1.456006711	6.206378914	10.80682109	1.578452023	0.712601552	0	0	4.749933361	1.867804098	0	0	0.543053956	0.346110029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.013
H0151_015_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2674.272065	39.6695641	1390.687343	2744.572773	527.5860294	17.11780745	19.34561639	980.3371568	42.36966879	11263.91275	45.91900992	0	0.102133526	14.9792009	7796.213905	5298.486143	258.8389851	466.6820356	0	0	45.38439839	795.3569322	875.9476059	0	266.3900958	328.856485	27.55236105	6.305952384	83.70264142	0											1950	"$150 Days 1-13 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-13 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	10% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 10% (8b2, 8b3)"	Included in h.5.	20% (12)	"$20 (3, 9d); $60 (5); 10% (9a); $40/$30 (9c)"	"$5 (7a); $20 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$20/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											129.1863608	112.6710137	56.94114738	0	150	0.2	0.130414743	49.38704008	0.1	3	0.107472396	0	0.2	0.075006812	4.255525699	20	38.5	20	0	0	0.2	19.72776028	0	0	20	15	0	0	0	0											NO	94.48874836	95.63638498	47.81819249	0	95.63638498	0.12751518	0.083149297	31.48798652	0.06375759	1.9127277	0.068521809	0	0.12751518	0.047884161	4.100402415	20	38.5	12.751518	0	0	0.12751518	19.72776028	0	0	20	15	0	0	0	0												21.0574	0.316154475	5.541679588	0	4.204701718	2.182780298	1.608574407	2.572403598	2.70138797	1.795399826	3.146453643	0	0.013023575	0.717266461	2.66396786	8.830810239	0.830441744	0.495908698	0	0	5.787199729	1.307550908	0	0	0.443983493	0.411070606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6281	0	29.73801357	21.0574	0.316154475	5.541679588	0	4.204701718	2.182780298	1.608574407	2.572403598	2.70138797	1.795399826	3.146453643	0	0.013023575	0.717266461	2.66396786	8.830810239	0.830441744	0.495908698	0	0	5.787199729	1.307550908	0	0	0.443983493	0.411070606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6281	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.0574	0.316154475	5.541679588	0	4.204701718	2.182780298	1.608574407	2.572403598	2.70138797	1.795399826	3.146453643	0	0.013023575	0.717266461	2.66396786	8.830810239	0.830441744	0.495908698	0	0	5.787199729	1.307550908	0	0	0.443983493	0.411070606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6281
H0151_023_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1547.91546	104.0467868	607.8941641	1533.870788	207.5307357	9.784021194	9.514996302	442.1309237	38.77776867	9104.569294	37.57221243	0	0.158182396	15.63635286	6657.465438	4041.010676	506.9585971	425.5792488	0	0	34.43774918	710.1573831	769.5884544	0	213.7057041	236.4629133	70.85740424	4.034116138	111.505633	0											3200	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-22 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	85.64447017	0	150	0.2	0.136072348	49.65164436	0.2	3	0.175768724	0	0.2	0.150402998	14.86768599	39.68238125	38.5	40	0	0	0.2	39.69845209	0	0	40	15	0	0	0	0											NO	141.4694745	107.7461467	65.76240767	0	115.1780276	0.153570703	0.104483631	38.12518977	0.153570703	2.303560552	0.134964633	0	0.153570703	0.115788869	14.81270007	39.68238125	38.5	30.7141407	0	0	0.153570703	39.69845209	0	0	40	15	0	0	0	0												18.2486	0.93422003	3.331381987	0	1.991915067	1.502539018	0.994161364	1.404693781	5.955129214	1.747743889	5.070919856	0	0.024292182	1.810515618	8.217919899	13.36307719	1.626492166	1.089275077	0	0	5.288629369	2.349345738	0	0	0.712352347	0.295578642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9587	0	14.95773603	18.2486	0.93422003	3.331381987	0	1.991915067	1.502539018	0.994161364	1.404693781	5.955129214	1.747743889	5.070919856	0	0.024292182	1.810515618	8.217919899	13.36307719	1.626492166	1.089275077	0	0	5.288629369	2.349345738	0	0	0.712352347	0.295578642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9587	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.2486	0.93422003	3.331381987	0	1.991915067	1.502539018	0.994161364	1.404693781	5.955129214	1.747743889	5.070919856	0	0.024292182	1.810515618	8.217919899	13.36307719	1.626492166	1.089275077	0	0	5.288629369	2.349345738	0	0	0.712352347	0.295578642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.9587
H0151_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	267.9836781	5.598982942	42.0144535	2073.141705	10.04891634	11.66425596	11.12097649	19.76548849	38.3611459	17.05563245	42.76312696	0	0.133196053	11.92657978	35.06351455	125.6107718	2.744403088	3.537333541	0	0	46.20777895	5.29604957	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.087685228	0.087685228	0.17994129	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.087685228	0.087685228	0.17994129	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												23.4982	0.490948094	7.56013495	0	2.341397506	2.717771638	2.591187521	4.605358819	8.938146996	3.973962361	9.963808581	0	0.03103468	2.77889309	8.169798891	29.26730983	0.639445919	0.824198715	0	0	10.76641249	1.23397955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.392	0	0	23.4982	0.490948094	7.56013495	0	2.341397506	2.717771638	2.591187521	4.605358819	8.938146996	3.973962361	9.963808581	0	0.03103468	2.77889309	8.169798891	29.26730983	0.639445919	0.824198715	0	0	10.76641249	1.23397955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.392	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.4982	0.490948094	7.56013495	0	2.341397506	2.717771638	2.591187521	4.605358819	8.938146996	3.973962361	9.963808581	0	0.03103468	2.77889309	8.169798891	29.26730983	0.639445919	0.824198715	0	0	10.76641249	1.23397955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.392
H0151_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	267.521057	5.598982942	41.94192382	2069.562834	10.03156886	11.64411991	11.10177831	19.73136727	38.29492293	17.02618926	42.68930483	0	0.132966117	11.90602547	35.00298429	125.3939295	2.744403088	3.531227031	0	0	46.12801031	5.286906983	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.087685228	0.087685228	0.17994129	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.087685228	0.087685228	0.17994129	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												23.4576	0.490948094	7.547083865	0	2.337355544	2.71307994	2.586714346	4.597408573	8.922717044	3.967102097	9.946608026	0	0.030981105	2.774103935	8.15569534	29.21678558	0.639445919	0.822775898	0	0	10.7478264	1.231849327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.1861	0	0	23.4576	0.490948094	7.547083865	0	2.337355544	2.71307994	2.586714346	4.597408573	8.922717044	3.967102097	9.946608026	0	0.030981105	2.774103935	8.15569534	29.21678558	0.639445919	0.822775898	0	0	10.7478264	1.231849327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.1861	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.4576	0.490948094	7.547083865	0	2.337355544	2.71307994	2.586714346	4.597408573	8.922717044	3.967102097	9.946608026	0	0.030981105	2.774103935	8.15569534	29.21678558	0.639445919	0.822775898	0	0	10.7478264	1.231849327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.1861
H0151_805_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	274.7268418	5.578950803	43.07164601	2097.249876	10.30177311	11.95775886	11.40080907	20.2628394	39.32641173	17.48479636	43.83915803	0	0.136547611	12.22617937	35.94580343	128.7714643	2.744403088	3.626342018	0	0	47.37048639	5.4293119	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.084811676	0.084811676	0.184366478	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.084811676	0.084811676	0.184366478	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												23.3	0.473160167	7.940967669	0	2.400313134	2.786157814	2.656388513	4.721241579	9.163053933	4.073957551	10.21452382	0	0.031815593	2.848699794	8.375372199	30.00375118	0.639445919	0.84493769	0	0	11.03732333	1.265029673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.7762	0	0	23.3	0.473160167	7.940967669	0	2.400313134	2.786157814	2.656388513	4.721241579	9.163053933	4.073957551	10.21452382	0	0.031815593	2.848699794	8.375372199	30.00375118	0.639445919	0.84493769	0	0	11.03732333	1.265029673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.7762	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.3	0.473160167	7.940967669	0	2.400313134	2.786157814	2.656388513	4.721241579	9.163053933	4.073957551	10.21452382	0	0.031815593	2.848699794	8.375372199	30.00375118	0.639445919	0.84493769	0	0	11.03732333	1.265029673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.7762
H0154_001_0	2010	5	N/A																															A	A	D	coin	T	coin	coin	V	V	coin	P	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	250.4228237	3.587925944	850.0257939	24.86818783	227.9008414	25.76920202	6.809662564	254.7487855	380.2205247	16.63863504	479.4924444	0	17.5420062	671.5816788	3021.693799	4850.152683	187.3624661	717.5086007	30.71372376	37.69335159	17.06639735	0	0	0	116.9983739	0	109.6442575	0	33.99427633	0												1a:  Acute - $500/admit for 1-90/1a:  Additional Days - $500/admit for 91-999 /$2500 Member OOP Max per year	1b:  Psych - $500/admit for 1-190 /$2500 Member OOP Max per year	2:  Skilled Nursing Services - $85/$0/day for 1-30/31-100/2:  Non-Medicare Covered Stay - $85/$0/day for 1-30/31-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $175/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $6/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $335/visit/9b:  Ambulatory Surgical Center Services - $335/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $40/visit/8b:  Outpatient Therapeutic Radiological Services - $40/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $50/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day/9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit	7a:  Primary Care - $20/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - PCP -$20; SCP-$30/visit/14c:  Physical Exams (Initial Exam) - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - PCP -$20; SCP-$30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7g:  Other Health Care Professional Services - $30/visit"	"15:  Medicare Part B Rx Drugs - Chemo - 20%, $2,500 annual out-of-pocket max/Medicare Part B Rx Drugs - Non-Chemo - 20%, $2,500 annual out-of-pocket max"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - PCP -$20; SCP-$30/visit		14c:  Routine Exams - $20/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit												500	500	85	0	175	0.2	0.110475097	50	335	0	40	0	40.70133354	30	20.00137459	29.97447633	30	30	0	0.003831578	0.193553492	0	0	0	30	0	23.33333333	0	20	0											NO	500	500	85	0	175	0.2	0.110475097	50	335	0	40	0	40.70133354	30	20.00137459	29.97447633	30	30	0	0.003831578	0.193553492	0	0	0	30	0	23.33333333	0	20	0												10.4343	0.149496914	6.02101604	0	3.323553936	5.153840403	0.752298133	1.061453273	10.61448965	0	1.598308148	0	0.059498587	1.678954197	5.036502465	12.11506557	0.468406165	1.793771502	0	0.144424998	3.3032608	0	0	0	0.292495935	0	0.213197167	0	0.056657127	0	0	0	0	0	0	0	0	0	0	0	64.271	0	0	10.4343	0.149496914	6.02101604	0	3.323553936	5.153840403	0.752298133	1.061453273	10.61448965	0	1.598308148	0	0.059498587	1.678954197	5.036502465	12.11506557	0.468406165	1.793771502	0	0.144424998	3.3032608	0	0	0	0.292495935	0	0.213197167	0	0.056657127	0	0	0	0	0	0	0	0	0	0	0	64.271	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.4343	0.149496914	6.02101604	0	3.323553936	5.153840403	0.752298133	1.061453273	10.61448965	0	1.598308148	0	0.059498587	1.678954197	5.036502465	12.11506557	0.468406165	1.793771502	0	0.144424998	3.3032608	0	0	0	0.292495935	0	0.213197167	0	0.056657127	0	0	0	0	0	0	0	0	0	0	0	64.271
H0154_008_0	2010	4	N/A																															A	A	D	coin	T	coin	coin	V	V	coin	P	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	263.5855781	3.776514936	441.1391097	25.2989676	159.310595	21.36660101	5.645897077	231.3126516	378.250218	16.99025493	466.8332402	0	17.10019594	650.9345883	2978.655953	4652.770402	182.6435839	699.476086	30.26807789	37.4474816	12.91966739	0	0	83.13133822	216.2925768	0	119.2321281	0	33.53409469	0												1a:  Acute - $450/admit for 1-90/1a:  Additional Days - $450/admit for 91-999 /$2250 Member OOP Max per year	1b:  Psych - $450/admit for 1-190 /$2250 Member OOP Max per year	2:  Skilled Nursing Services - $85/$0/day for 1-30/31-100/2:  Non-Medicare Covered Stay - $85/$0/day for 1-30/31-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $6/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $250/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $40/visit/8b:  Outpatient Therapeutic Radiological Services - $40/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $50/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day/9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - PCP -$15; SCP-$25/visit/14c:  Physical Exams (Initial Exam) - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - PCP -$15; SCP-$25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7g:  Other Health Care Professional Services - $30/visit"	"15:  Medicare Part B Rx Drugs - Chemo - 20%, $2,500 annual out-of-pocket max/Medicare Part B Rx Drugs - Non-Chemo - 20%, $2,500 annual out-of-pocket max"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a: Preventive Dental: $100/year	17a:  Routine Eye Exams - $25/visit	17b:  Eye Wear - $100/Per Year	18a:  Routine Hearing Test - PCP -$15; SCP-$25/visit		14c:  Routine Exams - $15/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit												450	450	85	0	150	0.2	0.110257839	50	250	0	40	0	40.6452444	30	15.00133912	24.9743669	30	30	0	0.002997794	0.193553492	0	0	0	25	0	18.33333333	0	15	0											NO	450	450	85	0	150	0.2	0.110257839	50	250	0	40	0	40.6452444	30	15.00133912	24.9743669	30	30	0	0.002997794	0.193553492	0	0	0	25	0	18.33333333	0	15	0												9.8845	0.14161931	3.124735361	0	1.991382437	4.273320202	0.622504411	0.963802715	7.880212876	0	1.556110801	0	0.057920137	1.627336471	3.72365234	9.683332927	0.45660896	1.748690215	0	0.112259821	2.500646736	0	0	0	0.450609535	0	0.182160196	0	0.041917618	0	0	0	0	0	0	0	0	0	0	0	51.0233	0	0	9.8845	0.14161931	3.124735361	0	1.991382437	4.273320202	0.622504411	0.963802715	7.880212876	0	1.556110801	0	0.057920137	1.627336471	3.72365234	9.683332927	0.45660896	1.748690215	0	0.112259821	2.500646736	0	0	0	0.450609535	0	0.182160196	0	0.041917618	0	0	0	0	0	0	0	0	0	0	0	51.0233	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.8845	0.14161931	3.124735361	0	1.991382437	4.273320202	0.622504411	0.963802715	7.880212876	0	1.556110801	0	0.057920137	1.627336471	3.72365234	9.683332927	0.45660896	1.748690215	0	0.112259821	2.500646736	0	0	0	0.450609535	0	0.182160196	0	0.041917618	0	0	0	0	0	0	0	0	0	0	0	51.0233
H0154_010_0	2010	8	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	P	V	V	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	236.9132282	2.698936667	44.02368998	25.89933044	12.83946138	29.22666395	7.124202357	18.13124087	36.90160624	14.35568413	37.76715398	0	0.064743661	0	0	0	1.65684976	5.931522123	34.93170515	40.45045227	10.73906229	1.919636742	12000	700.533325	0	0	0	0	0	0												1a:  Acute - $0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $0/admit for 1-190	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $0/trip	11a:  Durable Medical Equipment - $0/service	11b:  Prosthetics Devices - $0/service/11b:  Medical Supplies - $0/service/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $0/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $0/visit/9b:  Ambulatory Surgical Center Services - $0/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day/9c:  Outpatient Substance Abuse Svcs - Individual - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/18a:  Hearing Exams - PCP -$0; SCP-$0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/18a:  Hearing Exams - PCP -$0; SCP-$0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $0/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $0/visit/7h:  Psychiatric Services - Individual - $0/visit/7h:  Psychiatric Services - Group - $0/visit	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit		"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7g:  Other Health Care Professional Services - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 0.0%/Medicare Part B Rx Drugs - Non-Chemo - 0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service	10b:  Transportation - $0/trip	16a: Preventive Dental: 3 prophylaxis/year / $0/oral exam/ $0-$45/x-ray / 16b: Comprehensive Dental: 0%-75%/Emergency Service/Diagnostic Services/Endodontics/Periodontics/Extractions/Prosthondontics/Other	17a:  Routine Eye Exams - $0/visit	17b:  Eye Wear - $100/Per Year	18a:  Routine Hearing Test - PCP -$0; SCP-$0/visit		14c:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H0154_011_0	2010	5	N/A																															A	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	259.6258117	3.719781495	670.0890562	24.62470717	197.4215355	24.76668184	6.545267423	255.4508956	364.3808946	17.10895276	45.67467276	0	17.60816464	696.5322033	3221.271306	5279.766708	205.1662805	785.6886915	32.95962418	39.69698366	17.33491818	0	0	578.14425	103.7269269	0	111.8074851	0	36.09579285	0												1a:  Acute - $150/admit for 1-90/1a:  Additional Days - $150/admit for 91-999 /$750 Member OOP Max  per year	1b:  Psych - $150/admit for 1-190 /$750 Member OOP Max  per year	2:  Skilled Nursing Services - $50/$0/day for 1-30/31-100/2:  Non-Medicare Covered Stay - $50/$0/day for 1-30/31-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $50/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day/9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - PCP -$10; SCP-$10/visit/14c:  Physical Exams (Initial Exam) - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $10/visit/7f:  Podiatry Services - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - PCP -$10; SCP-$10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7g:  Other Health Care Professional Services - $10/visit"	"15:  Medicare Part B Rx Drugs - Chemo - 20%, $2,500 annual out-of-pocket max/Medicare Part B Rx Drugs - Non-Chemo - 20%, $2,500 annual out-of-pocket max"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a: Preventive Dental: $100/year	17a:  Routine Eye Exams - $10/visit	17b:  Eye Wear - $100/Per Year	18a:  Routine Hearing Test - PCP -$10; SCP-$10/visit	18b:  Hearing Aids - $0/service	14c:  Routine Exams - $10/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit												150	150	50	0	100	0.2	0.05018902	50	150	0	0	0	41.32997014	10	10	10	10	10	0	0.001680233	0.193553492	0	0	0	10	0	10	0	10	0											NO	150	150	50	0	100	0.2	0.05018902	50	150	0	0	0	41.32997014	10	10	10	10	10	0	0.001680233	0.193553492	0	0	0	10	0	10	0	10	0												3.2453	0.046497269	2.792037734	0	1.645179462	4.953336368	0.328500555	1.064378732	4.554761182	0	0	0	0.06064541	0.580443503	2.684392755	4.39980559	0.1709719	0.654740576	0	0.066700188	3.355233944	0	0	0	0.086439106	0	0.093172904	0	0.030079827	0	0	0	0	0	0	0	0	0	0	0	30.8126	0	0	3.2453	0.046497269	2.792037734	0	1.645179462	4.953336368	0.328500555	1.064378732	4.554761182	0	0	0	0.06064541	0.580443503	2.684392755	4.39980559	0.1709719	0.654740576	0	0.066700188	3.355233944	0	0	0	0.086439106	0	0.093172904	0	0.030079827	0	0	0	0	0	0	0	0	0	0	0	30.8126	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.2453	0.046497269	2.792037734	0	1.645179462	4.953336368	0.328500555	1.064378732	4.554761182	0	0	0	0.06064541	0.580443503	2.684392755	4.39980559	0.1709719	0.654740576	0	0.066700188	3.355233944	0	0	0	0.086439106	0	0.093172904	0	0.030079827	0	0	0	0	0	0	0	0	0	0	0	30.8126
H0154_012_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	P	V	V	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	270.2986059	3.079265875	69.36341818	34.88539943	13.78009928	31.25763976	7.61926682	17.23069721	41.6894975	17.23669204	45.07187933	0	0.066261081	0	0	0	1.695681942	6.070541335	36.04671455	41.77965099	25.22611137	4.509236371	12000	700.533325	0	0	0	0	0	0												1a:  Acute - $0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $0/admit for 1-190	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $0/trip	11a:  Durable Medical Equipment - $0/service	11b:  Prosthetics Devices - $0/service/11b:  Medical Supplies - $0/service/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $0/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $0/visit/9b:  Ambulatory Surgical Center Services - $0/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day/9c:  Outpatient Substance Abuse Svcs - Individual - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/18a:  Hearing Exams - PCP -$0; SCP-$0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/18a:  Hearing Exams - PCP -$0; SCP-$0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $0/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $0/visit/7h:  Psychiatric Services - Individual - $0/visit/7h:  Psychiatric Services - Group - $0/visit	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit		"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7g:  Other Health Care Professional Services - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 0.0%/Medicare Part B Rx Drugs - Non-Chemo - 0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service	10b:  Transportation - $0/trip	16a: Preventive Dental: 3 prophylaxis/year / $0/oral exam/ $0-$45/x-ray / 16b: Comprehensive Dental: 0%-75%/Emergency Service/Diagnostic Services/Endodontics/Periodontics/Extractions/Prosthondontics/Other	17a:  Routine Eye Exams - $0/visit	17b:  Eye Wear - $100/Per Year	18a:  Routine Hearing Test - PCP -$0; SCP-$0/visit		14c:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H0154_013_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	P	V	V	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	254.0600143	2.894014187	39.33676123	26.34628946	8.894337332	28.89474516	6.963084817	16.63550725	43.49913258	18.46429495	48.40436141	0	0.064800176	0	0	0	1.71665967	6.158179414	37.11651772	42.99942498	19.16562865	3.4079884	0	578.14425	0	0	0	0	0	0												1a:  Acute - $0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $0/admit for 1-190	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $0/trip	11a:  Durable Medical Equipment - $0/service	11b:  Prosthetics Devices - $0/service/11b:  Medical Supplies - $0/service/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $0/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $0/visit/9b:  Ambulatory Surgical Center Services - $0/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day/9c:  Outpatient Substance Abuse Svcs - Individual - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/18a:  Hearing Exams - PCP -$0; SCP-$0/visit/14c:  Physical Exams (Initial Exam) - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/18a:  Hearing Exams - PCP -$0; SCP-$0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14h:  Mammography - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Disease - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $0/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $0/visit/7h:  Psychiatric Services - Individual - $0/visit/7h:  Psychiatric Services - Group - $0/visit	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit		"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7g:  Other Health Care Professional Services - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 0.0%/Medicare Part B Rx Drugs - Non-Chemo - 0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a: Preventive Dental: $100/year	17a:  Routine Eye Exams - $0/visit	17b:  Eye Wear - $100/Per Year	18a:  Routine Hearing Test - PCP -$0; SCP-$0/visit	18b:  Hearing Aids - $0/service	14c:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H0154_801_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	P	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	183.4871278	2.100620471	29.4682048	19.14331993	6.496412407	19.48646946	4.764144217	7.561303115	30.59942432	13.10538392	35.28393907	0	0.040778004	1157.008684	25.37261906	77.23653417	0.963574778	3.794418683	22.1504257	27.18505751	13.58002104	2.369359683	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																			0.086631514	0.086631514	0.181463418	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	56.49888076	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.086631514	0.086631514	0.181463418	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	56.49888076	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												15.8958	0.181979933	5.347401165	0	1.513664091	4.540347385	1.110045603	1.761783626	7.129665867	3.053554454	8.221157803	0	0.009501275	5.447474641	5.911820242	17.99611246	0.224512923	0.884099553	5.161049188	6.334118401	3.164144902	0.552060806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4403	0	0	15.8958	0.181979933	5.347401165	0	1.513664091	4.540347385	1.110045603	1.761783626	7.129665867	3.053554454	8.221157803	0	0.009501275	5.447474641	5.911820242	17.99611246	0.224512923	0.884099553	5.161049188	6.334118401	3.164144902	0.552060806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4403	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.8958	0.181979933	5.347401165	0	1.513664091	4.540347385	1.110045603	1.761783626	7.129665867	3.053554454	8.221157803	0	0.009501275	5.447474641	5.911820242	17.99611246	0.224512923	0.884099553	5.161049188	6.334118401	3.164144902	0.552060806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4403
H0154_802_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	P	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	175.8607115	2.013317135	29.57797987	18.80773946	6.75190234	20.34405989	4.975197732	7.527346506	28.23473307	12.11355723	36.82777774	0	0.039222578	1157.467271	24.54346443	75.3606124	0.924421172	3.645224482	21.50045766	25.83185247	13.72972278	2.396416898	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																			0.089490526	0.089490526	0.176709055	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	56.33385209	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.089490526	0.089490526	0.176709055	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	56.33385209	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												15.7379	0.180172809	5.226696865	0	1.573193245	4.740165954	1.159221072	1.753871736	6.578692805	2.822458834	8.580872212	0	0.009138861	5.433715838	5.718627211	17.55902269	0.215390133	0.849337304	5.009606634	6.018821626	3.199025407	0.558365137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9243	0	0	15.7379	0.180172809	5.226696865	0	1.573193245	4.740165954	1.159221072	1.753871736	6.578692805	2.822458834	8.580872212	0	0.009138861	5.433715838	5.718627211	17.55902269	0.215390133	0.849337304	5.009606634	6.018821626	3.199025407	0.558365137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9243	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.7379	0.180172809	5.226696865	0	1.573193245	4.740165954	1.159221072	1.753871736	6.578692805	2.822458834	8.580872212	0	0.009138861	5.433715838	5.718627211	17.55902269	0.215390133	0.849337304	5.009606634	6.018821626	3.199025407	0.558365137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9243
H0154_803_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	P	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	175.8607115	2.013317135	29.57797987	18.80773946	6.75190234	20.34405989	4.975197732	7.527346506	28.23473307	12.11355723	36.82777774	0	0.039222578	1157.467271	24.54346443	75.3606124	0.924421172	3.645224482	21.50045766	25.83185247	13.72972278	2.396416898	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																			0.089490526	0.089490526	0.176709055	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	56.33385209	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.089490526	0.089490526	0.176709055	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	56.33385209	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												15.7379	0.180172809	5.226696865	0	1.573193245	4.740165954	1.159221072	1.753871736	6.578692805	2.822458834	8.580872212	0	0.009138861	5.433715838	5.718627211	17.55902269	0.215390133	0.849337304	5.009606634	6.018821626	3.199025407	0.558365137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9243	0	0	15.7379	0.180172809	5.226696865	0	1.573193245	4.740165954	1.159221072	1.753871736	6.578692805	2.822458834	8.580872212	0	0.009138861	5.433715838	5.718627211	17.55902269	0.215390133	0.849337304	5.009606634	6.018821626	3.199025407	0.558365137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9243	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.7379	0.180172809	5.226696865	0	1.573193245	4.740165954	1.159221072	1.753871736	6.578692805	2.822458834	8.580872212	0	0.009138861	5.433715838	5.718627211	17.55902269	0.215390133	0.849337304	5.009606634	6.018821626	3.199025407	0.558365137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9243
H0248_001_0	2010	7	N/A	r.	s.	t.	u.	v.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered																D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	O	T	Coin	V		V			O	O	O	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	YES	912.924199	44.288239	632.448438	362.619011	29.896706	6.779251	2.105926	289.977393	340.637544	1272.258892	930.739097	55.790153	50.577688	749.271957	2804.65302	3124.805113	89.626932	784.4706			15.654639	0	4.2	5.04	1.72		0.81			0.04	0.05	0.25	0.42	0.55	1.54						2500	$175/Day(Days 1-5):1a	$175/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$45/Visit:8a. $0 Lab -- FSL,8a. $45 Lab -- OP"	"$0-$125/Visit:14h. $100 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$125/Visit:9a	"$0-$100/Proc:12. $0 Dialysis -- Dialysis Center,12. $100 Dialysis -- OP Hosp"	"$20-$125/Visit:9d. $20 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $45 Partial Hospitalization,7h. $50 Psych -- OP,8b. $100 Rad therapy,3. $20 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$20/Visit:7b, 7d, 7f"	$20/Visit:7e	$20/Visit:7i			20% Coins:15		$0: Other - Transportation 10b	"DEN750: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"		"HER833: Hearing 18a, 18b"			$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						106.167425	88.6746	45.891712	0	100	0.2	0.2	50	125	27.612574	85.969557	125	3.013343	54.383659	5	20	20	20			0.2	0	0	0	0		0			0	0	0	0	0	0						NO	89.821676	75.022081	21.788834	0	83.709	0.167418	0.167418	41.8545	104.63625	23.11421	71.964256	104.63625	2.522439	45.524017	4.18545	16.7418	16.7418	16.7418			0.167418	0	0	0	0		0			0	0	0	0	0	0							6.8334	0.276882988	1.148359502	0	0.208551947	1.134968644	0.352569919	1.0114049	2.970252934	2.450604934	5.58166222	0.4864727	0.010631594	2.842489109	0.978227915	4.359571853	0.125043014	1.094454158	0	0	2.620868352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4864	0	7.66855	6.8334	0.276882988	1.148359502	0	0.208551947	1.134968644	0.352569919	1.0114049	2.970252934	2.450604934	5.58166222	0.4864727	0.010631594	2.842489109	0.978227915	4.359571853	0.125043014	1.094454158	0	0	2.620868352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4864	YES	$1000/Admit	$1000/Admit	40% Coins(Days 1-20) 40%(Days 21-100)	25% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	25% Coins	25% Coins	25% Coins	25% Coins	$0-$100/Proc	25% Coins	25% Coins	25% Coins	25% Coins	25% Coins			20%-25% Coins		0.5	50%-55%	"VIS752: Vision 7a, 7b"		"HER833: Hearing 18a, 18b"			$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						5000	2.3627	0.0673	0.4512	0.9698	0.8238	1.4781	0.4592	0.1763	1.783	0.3064	0.8515	0.116	0.0019	0.5349	0.8629	1.4857	0.0212	0.1921			0.5583		0	0	0		0			0	0	0	0	0	0						13.5022	0	3.77253	9.1961	0.344170988	1.599588502	0.969841	1.032396947	2.613038644	0.811721919	1.1876709	4.753298934	2.757012934	6.43312422	0.6024257	0.012484594	3.377380109	1.841158915	5.845300853	0.146211014	1.286543158	0	0	3.179163352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9886
H0248_002_0	2010	6	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered																	D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin	T	Coin	V		V		O	O	O	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	YES	1164.13231	56.474974	806.478415	462.400392	38.123342	8.644689	2.685411	369.770078	434.370314	1622.344644	1186.849309	71.141854	64.495081	955.448101	3576.405582	3984.653492	114.289453	1000.332309			19.962303	0	4.2	5.04	2.69		0.81		0.04	0.25	0.05	0.55	1.54	0.42							5000	$50/Day(Days 1-5):1a	$50/Day(Days 1-5):1b	"$0/Day(Days 1-20) $50(Days 21-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6	$50/Trip:10a	20% Coins:11a	0% Coins:11b	$50/Visit:4a	"$0-$25/Visit:9b. $0 Surgery ASC -- Physician,9b. $25 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $25 Surgery OP -- Facility"	"$0-$25/Visit:8a. $0 Lab -- FSL,8a. $25 Lab -- OP"	"$0-$25/Visit:14h. $25 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $25 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $25 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$50/Visit:9a	$0/Proc:12	"$25/Visit:3, 5, 7h, 8b, 9a, 9d"	$25/Visit:7a	"$20-$25/Visit:7b. $20 Chiropractic,7f. $25 Podiatry,7d. $25 Physician Services Spec,7d. $25 Spec Cap"	$25/Visit:7e	$25/Visit:7i			20% Coins:15		$0: Other - Transportation 10b	"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"		"HER833: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							30.33355	25.3356	17.92645	0	50	0.2	0	50	25	15.340319	20.43567	50	0	25	25	24.158083	25	25			0.2	0	0	0	0		0		0	0	0	0	0	0							NO	29.249277	24.429979	16.694526	0	46.45415	0.185817	0	46.45415	23.227075	14.252429	18.986433	46.45415	0	23.227075	23.227075	22.444865	23.227075	23.227075			0.185817	0	0	0	0		0		0	0	0	0	0	0								2.8375	0.114973536	1.121981239	0	0.147582287	1.606330176	0	1.431446222	0.840762655	1.926862654	1.877836241	0.275402863	0	1.849355392	6.92245339	7.452917475	0.221217475	1.936232797	0	0	3.709335257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2722	0	2.49724	2.8375	0.114973536	1.121981239	0	0.147582287	1.606330176	0	1.431446222	0.840762655	1.926862654	1.877836241	0.275402863	0	1.849355392	6.92245339	7.452917475	0.221217475	1.936232797	0	0	3.709335257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2722	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$50/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins	0.5	50%-55%	"VIS752: Vision 7a, 7b"		"HER833: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							7500	8.2252	0.1125	0.4495	2.1287	0.7535	2.0277	0.6299	0.3224	3.9137	0.6725	1.8689	0.2545	0	1.1741	1.8941	3.2611	0.0465	0.4216			1.1873	0	0	0	0		0		0	0	0	0	0	0							29.3435	1000	9.61202	11.0627	0.227437536	1.571498239	2.128736	0.901034287	3.633996176	0.62988	1.753856222	4.754431655	2.599407654	3.746740241	0.529911863	0	3.023406392	8.81653039	10.71399447	0.267679475	2.357854797	0	0	4.896612257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6157
H0248_003_0	2010	5	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered																	D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	O	T	Coin	V		V		O	O	O	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	YES	819.109923	39.737074	567.456522	325.355413	26.824449	6.0826	1.889517	260.178622	305.632814	1141.518524	835.09412	50.057024	45.380204	672.274976	2516.440163	2803.692662	80.416654	703.856523			14.04593	0	4.2	5.04	2.69		0.81		0.04	0.25	0.05	0.55	1.54	0.42							2500	$175/Day(Days 1-5):1a	$175/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$45/Visit:8a. $0 Lab -- FSL,8a. $45 Lab -- OP"	"$0-$125/Visit:14h. $100 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $125 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$125/Visit:9a	"$0-$100/Proc:12. $0 Dialysis -- Dialysis Center,12. $100 Dialysis -- OP Hosp"	"$20-$125/Visit:9d. $20 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $45 Partial Hospitalization,7h. $50 Psych -- OP,8b. $100 Rad therapy,3. $20 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$20/Visit:7b, 7d, 7f"	$20/Visit:7e	$20/Visit:7i			20% Coins:15		$0: Other - Transportation 10b	"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"		"HER833: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							106.167425	88.6746	45.891712	0	100	0.2	0.2	50	125	27.612574	85.969557	125	3.013343	54.383659	5	20	20	20			0.2	0	0	0	0		0		0	0	0	0	0	0							NO	92.62853	77.36646	23.982642	0	85.5932	0.171186	0.171186	42.7966	106.9915	23.634486	73.584095	106.9915	2.579216	46.548714	4.27966	17.11864	17.11864	17.11864			0.171186	0	0	0	0		0		0	0	0	0	0	0								6.3227	0.256193062	1.134092218	0	0.191332536	1.041255964	0.323458857	0.927896701	2.725009435	2.248266965	5.120803755	0.44630634	0.009753779	2.607794632	0.897459026	3.999617113	0.114718646	1.004088869	0	0	2.404466573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7753	0	6.047722	6.3227	0.256193062	1.134092218	0	0.191332536	1.041255964	0.323458857	0.927896701	2.725009435	2.248266965	5.120803755	0.44630634	0.009753779	2.607794632	0.897459026	3.999617113	0.114718646	1.004088869	0	0	2.404466573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7753	YES	$1000/Admit	$1000/Admit	40% Coins(Days 1-20) 40%(Days 21-100)	25% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	25% Coins	25% Coins	25% Coins	25% Coins	$0-$100/Proc	25% Coins	25% Coins	25% Coins	25% Coins	25% Coins			20%-25% Coins	$0/Service	0.5	50%-55%	"VIS752: Vision 7a, 7b"		"HER833: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							5000	2.1766	0.062	0.4628	0.8898	0.7558	1.3561	0.4213	0.1617	1.6359	0.2811	0.7812	0.1064	0.0017	0.4907	0.7917	1.3631	0.0194	0.1762			0.5122	0	0	0	0		0		0	0	0	0	0	0							12.4457	0	3.053854	8.4993	0.318179062	1.596869218	0.889796	0.947181536	2.397334964	0.744714857	1.089614701	4.360893435	2.529385965	5.901991755	0.55268934	0.011453779	3.098539632	1.689169026	5.362723113	0.134139646	1.180323869	0	0	2.916683573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.221
H0248_801_0	2010	5	N/A																															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	NO	189.190962	0.645351	32.848965	10.61467	1.24479	5.755745	2.81348	13.877224	39.514328	8.530664	20.33776	7.189517	0.631646	13.017016	24.157942	52.980803	0.254598	3.942674			17.220029	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																			0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				13.7736	0.046983242	4.67238776	0	0.29003607	1.341088585	0.65554084	3.233393192	9.206838424	1.987644712	4.73869808	1.675157461	0.147173518	3.032964728	5.628800486	12.3445271	0.059321334	0.918643042	0	0	4.012266757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7651	0	0	13.7736	0.046983242	4.67238776	0	0.29003607	1.341088585	0.65554084	3.233393192	9.206838424	1.987644712	4.73869808	1.675157461	0.147173518	3.032964728	5.628800486	12.3445271	0.059321334	0.918643042	0	0	4.012266757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7651	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				2.564	0.0087	0.8698	0	1.1601	0.8842	0.4322	0.8525	2.2185	0.524	1.1361	0.4417	0.0388	0.7937	1.0606	2.3259	0.0112	0.1972			0.756	0																			16.2753	0	0	16.3376	0.055719556	5.542176234	0	1.45014307	2.225323585	1.08775584	4.085940192	11.42534792	2.511661712	5.87480608	2.116808961	0.185968018	3.826679228	6.689416486	14.6704496	0.070505334	1.115877542	0	0	4.768235257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0404
H0248_802_0	2010	5	N/A																															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	NO	189.190962	0.645351	32.848965	10.61467	1.24479	5.755745	2.81348	13.877224	39.514328	8.530664	20.33776	7.189517	0.631646	13.017016	24.157942	52.980803	0.254598	3.942674			17.220029	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																			0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				13.7736	0.046983242	4.67238776	0	0.29003607	1.341088585	0.65554084	3.233393192	9.206838424	1.987644712	4.73869808	1.675157461	0.147173518	3.032964728	5.628800486	12.3445271	0.059321334	0.918643042	0	0	4.012266757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7651	0	0	13.7736	0.046983242	4.67238776	0	0.29003607	1.341088585	0.65554084	3.233393192	9.206838424	1.987644712	4.73869808	1.675157461	0.147173518	3.032964728	5.628800486	12.3445271	0.059321334	0.918643042	0	0	4.012266757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7651	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				2.564	0.0087	0.8698	0	1.1601	0.8842	0.4322	0.8525	2.2185	0.524	1.1361	0.4417	0.0388	0.7937	1.0606	2.3259	0.0112	0.1972			0.756	0																			16.2753	0	0	16.3376	0.055719556	5.542176234	0	1.45014307	2.225323585	1.08775584	4.085940192	11.42534792	2.511661712	5.87480608	2.116808961	0.185968018	3.826679228	6.689416486	14.6704496	0.070505334	1.115877542	0	0	4.768235257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0404
H0248_803_0	2010	5	N/A																															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	NO	189.190962	0.645351	32.848965	10.61467	1.24479	5.755745	2.81348	13.877224	39.514328	8.530664	20.33776	7.189517	0.631646	13.017016	24.157942	52.980803	0.254598	3.942674			17.220029	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																			0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				13.7736	0.046983242	4.67238776	0	0.29003607	1.341088585	0.65554084	3.233393192	9.206838424	1.987644712	4.73869808	1.675157461	0.147173518	3.032964728	5.628800486	12.3445271	0.059321334	0.918643042	0	0	4.012266757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7651	0	0	13.7736	0.046983242	4.67238776	0	0.29003607	1.341088585	0.65554084	3.233393192	9.206838424	1.987644712	4.73869808	1.675157461	0.147173518	3.032964728	5.628800486	12.3445271	0.059321334	0.918643042	0	0	4.012266757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7651	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				2.564	0.0087	0.8698	0	1.1601	0.8842	0.4322	0.8525	2.2185	0.524	1.1361	0.4417	0.0388	0.7937	1.0606	2.3259	0.0112	0.1972			0.756	0																			16.2753	0	0	16.3376	0.055719556	5.542176234	0	1.45014307	2.225323585	1.08775584	4.085940192	11.42534792	2.511661712	5.87480608	2.116808961	0.185968018	3.826679228	6.689416486	14.6704496	0.070505334	1.115877542	0	0	4.768235257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0404
H0251_001_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.6627	0.0052	0.0198	0	1.8031	0	1.4332	0	0.0159	2.1457	1.743	3.6301	0.8259	0.0694	0	0	1.147	0.157	0	0	0	0	0	0	0	0											13.658	NO	259.9448202	58.06728291	16.20407558	3390.91	19.52792294	0.151835963	0.583693598	59.5007211	53.13248697	36.36013974	42.23188853	0	0.46815114	63.22843364	54.22042576	107.1354867	24.33761753	2.04519329	0	5.151203013	33.79952461	4.743190994	668.5297051	1814.580628	119.3803045	152.8067897	17.37415612	9.948358706	3979.343482	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14e, 14f, 14g, 14h, 14i, 14j); $0 (14b, 14c, 14c1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0/20% (14d)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 18a); $0 n/c (13a1); $0 (17a, 17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 (14a1, 14a7, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.086836793	0.086836793	0.199311698	0	0.193212867	0.193212867	0.193212867	0.091331244	0.193212867	0.092104409	0.161172508	0	0.193212867	0.145196831	0.177173653	0.192916835	0.43472895	0.193212867	0	0.2	0.193212867	2.42E-05	0	0	0	0	0	0	0	0											NO	0.086836793	0.086836793	0.199311698	0	0.193212867	0.193212867	0.193212867	0.091331244	0.193212867	0.092104409	0.161172508	0	0.193212867	0.145196831	0.177173653	0.192916835	0.43472895	0.193212867	0	0.2	0.193212867	2.42E-05	0	0	0	0	0	0	0	0												22.5728	5.0423766	3.229661821	0	3.773045973	0.029336662	0.112777113	5.434274899	10.26588013	3.348929186	6.806619387	0	0.090452824	9.180568187	9.606430881	20.66823902	10.58026692	0.395157659	0	1.030240603	6.530503045	0.000114638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6976	146	0	22.5728	5.0423766	3.229661821	0	4.435739046	0.034489316	0.132585145	5.434274899	12.06896646	3.348929186	8.239786656	0	0.106339845	11.3262672	11.34947803	24.29838266	11.40618018	0.464562655	0	1.030240603	7.677512427	0.157088729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.3556	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	22.5728	5.0423766	3.229661821	0	4.435739046	0.034489316	0.132585145	5.434274899	12.06896646	3.348929186	8.239786656	0	0.106339845	11.3262672	11.34947803	24.29838266	11.40618018	0.464562655	0	1.030240603	7.677512427	0.157088729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.3556
H0251_002_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.6627	0.0052	0.0198	0	1.8032	0	1.4332	0	0.0159	2.1458	1.7431	3.6304	0.826	0.0694	0	0	1.1471	0.157	0	0	0	0	0	0	0	0											13.6588	NO	260.100516	58.10206273	16.21378113	3391.925353	19.53961933	0.151926906	0.584043206	59.53635948	53.16431105	36.38191791	42.25718362	0	0.468431543	63.26630477	54.25249506	107.1996562	24.35219472	2.046418273	0	5.154288363	33.81976907	4.746031962	668.5297051	1814.580628	119.3803045	152.8067897	17.37415612	9.948358706	3979.343482	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14e, 14f, 14g, 14h, 14i, 14j); $0 (14b, 14c, 14c1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0/20% (14d)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 18a); $0 n/c (13a1); $0 (17a, 17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 (14a1, 14a7, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.086785566	0.086785566	0.199449939	0	0.193216545	0.193216545	0.193216545	0.091303905	0.193216545	0.092104409	0.161175576	0	0.193216545	0.145199595	0.177178241	0.192920685	0.434737227	0.193216545	0	0.2	0.193216545	2.42E-05	0	0	0	0	0	0	0	0											NO	0.086785566	0.086785566	0.199449939	0	0.193216545	0.193216545	0.193216545	0.091303905	0.193216545	0.092104409	0.161175576	0	0.193216545	0.145199595	0.177178241	0.192920685	0.434737227	0.193216545	0	0.2	0.193216545	2.42E-05	0	0	0	0	0	0	0	0												22.573	5.042420396	3.233837662	0	3.775377745	0.029354792	0.112846811	5.435902104	10.27222452	3.350935051	6.810825931	0	0.090508724	9.18624185	9.612361646	20.68103115	10.58680561	0.395401869	0	1.030857673	6.534538947	0.000114709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7546	146	0	22.573	5.042420396	3.233837662	0	4.438108347	0.034507738	0.132655963	5.435902104	12.07541297	3.350935051	8.244074364	0	0.106396645	11.33206238	11.3555075	24.31138371	11.41276565	0.464810796	0	1.030857673	7.681613287	0.157097689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.4133	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	22.573	5.042420396	3.233837662	0	4.438108347	0.034507738	0.132655963	5.435902104	12.07541297	3.350935051	8.244074364	0	0.106396645	11.33206238	11.3555075	24.31138371	11.41276565	0.464810796	0	1.030857673	7.681613287	0.157097689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.4133
H0302_001_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	NO	1163.32818	141.5013139	691.1692088		422.0250182	13.67797059	15.74958724	297.8694491	136.1148975		671.6870946	62.83165347	42.09816761	597.293735	4729.502771	5474.620188	244.8803518	245.094466			20.14063893	75.23493938			15.34290843		0.05764314															1a: $125 days 1-4	"1b: $125 days 1-10, $175 days 31+"	"2: $0 days 1-15, $50 days 16-100"		10a: $125/20%	11a: 0%-15%	11b: 20%; 11c: $0	"4a: $50, 4b: $25"	9b: $150	8a: $0	8b: $0-$275	9a: $150	12: $25	"3, 9d: $10, 5: $20, 9c: $20, 7g: $10-$75, 9a: $25-$150"	"7a, 14c, 14j: $10, 14: $0-$25, 14d, 14e, 14h, 14i:  $0; 14f: $0-$150, 14g: $25"	"7b, 7f: $30, 16b: 20%; 7d, 17a: $30, 18a: $0"	"7e, 7h: $20"	"7c, 7i: $10"	$0 (incl in i.2.)		15: 20%	17b: $20			17a: $20		18a: $20														84.71281477	90.02207984	14.60896795		62.46985494	0.057028146	0.173833297	48.34680859	150		75.33535991	150	25	27.74734916	10.67125313	26.42204208	20	10			0.2	20			20		20														NO	84.71281477	90.02207984	14.60896795		62.46985494	0.057028146	0.173833297	48.34680859	150		75.33535991	150	25	27.74734916	10.67125313	26.42204208	20	10			0.2	20			20		20															8.2124	1.061520215	0.841439068	0	2.196986806	0.780029308	2.737802675	1.200086437	1.701436219	0	4.216815752	0.785395668	0.087704516	1.381109818	4.205810105	12.05422042	0.40813392	0.204245388	0	0	4.028127787	0.125391566	0	0	0.025571514	0	9.61E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2543	0	0	8.2124	1.061520215	0.841439068	0	2.196986806	0.780029308	2.737802675	1.200086437	1.701436219	0	4.216815752	0.785395668	0.087704516	1.381109818	4.205810105	12.05422042	0.40813392	0.204245388	0	0	4.028127787	0.125391566	0	0	0.025571514	0	9.61E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2543	NO																																																																																		0	0	0	8.2124	1.061520215	0.841439068	0	2.196986806	0.780029308	2.737802675	1.200086437	1.701436219	0	4.216815752	0.785395668	0.087704516	1.381109818	4.205810105	12.05422042	0.40813392	0.204245388	0	0	4.028127787	0.125391566	0	0	0.025571514	0	9.61E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2543
H0302_004_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	NO	3145.592496	193.250901	1477.392359		805.9464263	20.11354501	61.73151923	589.3209529	323.7299266		1224.731519	97.45354625	131.2767986	2407.734857	7599.575606	12287.18452	307.2284487	708.5143993		804.189553	58.74907494				102.7198756																	1a: $120 days 1-4	"1b: $125 days 1-10, $175 days 31+"	"2: $0 days 1-20, $50 days 21-100"		10a: $75/20%	11a: 0%-10%	11b: 20%; 11c: $0	"4a: $50, 4b: $15"	9b: $100	8a: $0	8b: $0-$250	9a: $100	12: $25	"3, 9d: $10, 5: $20, 9c: $20, 7g: $10-$75, 9a: $25-$100"	"7a, 14c, 14j: $10, 14d, 14e,  14g, 14h:  $0; 14f: $0-$150"	"7b, 7f: $30, 16b: 20%; 7d: $10-$20, 17a: $20, 18a: $0"	"7e, 7h: $20"	"7c, 7i: $10"	$0 (incl in i.2.)	7g $10-$75	15: 20%				17a: $10																88.61615854	96.21608386	10.33753544		41.25149445	0.047449855	0.160722249	48.92191051	100		52.58769179	100	25	16.2867002	10.00163309	20.15252999	20	10		6.692607004	0.2				10																NO	88.61615854	96.21608386	10.33753544		41.25149445	0.047449855	0.160722249	48.92191051	100		52.58769179	100	25	16.2867002	10.00163309	20.15252999	20	10		6.692607004	0.2				10																	23.2292	1.549487075	1.272716322	0	2.770541211	0.954384799	9.921628579	2.40255891	2.697749388	0	5.367150305	0.812112885	0.27349333	3.267837981	6.334013902	20.63482122	0.512047414	0.590428666	0	0.448510386	11.74981499	0	0	0	0.085599896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8741	0	0	23.2292	1.549487075	1.272716322	0	2.770541211	0.954384799	9.921628579	2.40255891	2.697749388	0	5.367150305	0.812112885	0.27349333	3.267837981	6.334013902	20.63482122	0.512047414	0.590428666	0	0.448510386	11.74981499	0	0	0	0.085599896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8741	NO																																																																																		0	0	0	23.2292	1.549487075	1.272716322	0	2.770541211	0.954384799	9.921628579	2.40255891	2.697749388	0	5.367150305	0.812112885	0.27349333	3.267837981	6.334013902	20.63482122	0.512047414	0.590428666	0	0.448510386	11.74981499	0	0	0	0.085599896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.8741
H0302_006_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	NO	1078.075394	131.1315993	640.517895		391.0975386	13.44396523	15.48014026	276.0405268	126.1399185	110.6367033	744.6429289	58.22712862	2.271109738	553.5219465	4382.908151	5073.42074	226.9346572	227.1330803			19.796069	69.72145805																				1a: $175 days 1-5	"1b: $125 days 1-10, $175 days 31+"	"2: $0 days 1-15, $100 days 16-100"		10a: $150/20%	11a: 0%-20%	11b: 20%; 11c: $0	"4a: $50, 4b: $25"	9b: $200	8a: $5	8b: $0-$300	9a: $200	12: 20%	"3: $10, 5: $20, 9c: $20, 7g: $10-$75, 9a: $25-$200, 9d: $15"	"7a:  $15, 14c, 14j: $10, 14b: $0-$25, 14d, 14e, 14h:  $0; 14f: $0-$200, 14g: $25"	"7b, 7d, 7f, 17a: $20-$40, 16b: 20%; 18a: $0"	"7e, 7h: $20"	"7c, 7i: $10"	$0 (incl in i.2.)		15: 20%	17b: $20																			129.6621394	90.02207984	29.2179359		74.96382592	0.076037528	0.173833297	48.34680859	200	5	72.16568892	200	0.2	27.87526622	14.98445365	33.63545286	20	10			0.2	20																			NO	129.6621394	90.02207984	29.2179359		74.96382592	0.076037528	0.173833297	48.34680859	200	5	72.16568892	200	0.2	27.87526622	14.98445365	33.63545286	20	10			0.2	20																				11.6488	0.983728275	1.5595509	0	2.44318065	1.022245889	2.690963819	1.112139876	2.102331975	0.046098626	4.478139164	0.970452144	0.454221948	1.285797635	5.472957002	14.22056701	0.378224429	0.189277567	0	0	3.959213801	0.11620243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1341	0	0	11.6488	0.983728275	1.5595509	0	2.44318065	1.022245889	2.690963819	1.112139876	2.102331975	0.046098626	4.478139164	0.970452144	0.454221948	1.285797635	5.472957002	14.22056701	0.378224429	0.189277567	0	0	3.959213801	0.11620243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1341	NO																																																																																		0	0	0	11.6488	0.983728275	1.5595509	0	2.44318065	1.022245889	2.690963819	1.112139876	2.102331975	0.046098626	4.478139164	0.970452144	0.454221948	1.285797635	5.472957002	14.22056701	0.378224429	0.189277567	0	0	3.959213801	0.11620243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1341
H0302_007_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	P	P	P	P	P	P	P	P																																																			0	NO	1536.776711	186.9256909	913.0465174		557.5023717	15.20497052	17.50786114	393.4907106	179.8101414		887.3103065	83.00170444	55.61240987	789.0353876	5968.795007	7232.068259	323.4911937	323.7740422			22.38912705	99.38666033			20.26824825		0.076147588															1a: $100 days 1-3	"1b: $125 days 1-10, $175 days 31+"	"2: $0 days 1-20, $50 days 21-100"		10a: $100/20%	11a: 0%-10%	11b: 20%; 11c: $0	"4a: $50, 4b: $15"	9b: $100	8a: $0	8b: $0-$250	9a: $100	12: $25	"3, 9d: $10, 5: $20, 9c: $20, 7g: $10-$75, 9a: $25-$100"	"7a: $5, 14c, 14j: $10, 14b: $0-$25, 14d, 14e,  14g, 14h:  $0; 14f: $0-$150"	"7b, 7f: $25; 7d, 17a: $15; 16b: 20%; 18a: $0"	"7e, 7h: $20"	"7c, 7i: $10"	$0 (incl in i.2.)		15: 20%	17b:  $10			17a: $10		18a: $20														59.31365932	90.02207984	10.25883387		49.97588395	0.050691686	0.173833297	47.68553203	100		63.41350157	100	25	27.87526622	5.486794411	14.1641169	20	10			0.2	10			10		20														NO	59.31365932	90.02207984	10.25883387		49.97588395	0.050691686	0.173833297	47.68553203	100		63.41350157	100	25	27.87526622	5.486794411	14.1641169	20	10			0.2	10			10		20															7.596	1.402286623	0.780566045	0	2.321806152	0.770765586	3.043449224	1.563651157	1.498417845	0	4.68895446	0.69168087	0.115859187	1.832880957	2.729129257	8.53632169	0.539151989	0.269811702	0	0	4.47782541	0.082822217	0	0	0.016890207	0	0.000126913	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9584	0	0	7.596	1.402286623	0.780566045	0	2.321806152	0.770765586	3.043449224	1.563651157	1.498417845	0	4.68895446	0.69168087	0.115859187	1.832880957	2.729129257	8.53632169	0.539151989	0.269811702	0	0	4.47782541	0.082822217	0	0	0.016890207	0	0.000126913	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9584	NO																																																																																		0	0	0	7.596	1.402286623	0.780566045	0	2.321806152	0.770765586	3.043449224	1.563651157	1.498417845	0	4.68895446	0.69168087	0.115859187	1.832880957	2.729129257	8.53632169	0.539151989	0.269811702	0	0	4.47782541	0.082822217	0	0	0.016890207	0	0.000126913	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9584
H0303_013_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1440.112397	72.75422148	1204.779894	913.3666304	887.7896411	7.865032835	13.37025814	305.1056683	310.4936506	10446.52244	39.91146729	0	4.3105663	616.9860666	6600.425187	5300.59902	311.5065288	551.2914875	0	0	26.3720926	2172.937214	0	0	251.6394193	138.6295301	17.29635651	4.753829291	0	0												"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$100 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$215 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $215 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$215 (14f, 14f1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	135.7848628	47.42544613	0	150	0.2	0.105993538	49.661414	215	3	0.158223793	0	0.2	83.21199725	10.77638702	39.92656329	38.5	35	0	0	0.2	37.33451801	0	0	40	30	0	0	0	0											NO	165.816167	135.7848628	47.42544613	0	150	0.2	0.105993538	49.661414	215	3	0.158223793	0	0.2	83.21199725	10.77638702	39.92656329	38.5	35	0	0	0.2	37.33451801	0	0	40	30	0	0	0	0												19.8995	0.823243498	4.761435329	0	11.09737051	1.573006567	1.417160966	1.262664909	5.56301124	2.611630609	6.314943756	0	0.86211326	4.278386906	5.927394692	17.63622519	0.99941678	1.607933505	0	0	5.274418519	6.760463628	0	0	0.838798064	0.346573825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8557	0	0	19.8995	0.823243498	4.761435329	0	11.09737051	1.573006567	1.417160966	1.262664909	5.56301124	2.611630609	6.314943756	0	0.86211326	4.278386906	5.927394692	17.63622519	0.99941678	1.607933505	0	0	5.274418519	6.760463628	0	0	0.838798064	0.346573825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8557	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.8995	0.823243498	4.761435329	0	11.09737051	1.573006567	1.417160966	1.262664909	5.56301124	2.611630609	6.314943756	0	0.86211326	4.278386906	5.927394692	17.63622519	0.99941678	1.607933505	0	0	5.274418519	6.760463628	0	0	0.838798064	0.346573825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.8557
H0303_015_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1461.674402	78.64901517	894.2487263	567.2559394	727.3018982	7.70915351	15.02669011	323.370326	226.4892772	8907.301673	53.30404254	0	4.447028085	784.3512194	6178.240821	5902.546324	336.275553	722.8438327	0	0	29.12797956	3044.115272	0	0	279.9716345	128.7760542	17.25437925	4.742292022	0	0												"$240 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$240 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$80 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$175 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											176.8705781	134.7083767	46.64840912	0	150	0.2	0.110732318	49.92776268	175	3	0.156271242	0	0.2	67.12366627	11.30341854	30	38.5	25	0	0	0.2	28.35581672	0	0	30	30	0	0	0	0											NO	176.8705781	134.7083767	46.64840912	0	150	0.2	0.110732318	49.92776268	175	3	0.156271242	0	0.2	67.12366627	11.30341854	30	38.5	25	0	0	0.2	28.35581672	0	0	30	30	0	0	0	0												21.5439	0.882890097	3.47627337	0	9.091273728	1.541830702	1.663940227	1.345429741	3.302968625	2.226825418	8.329888931	0	0.889405617	4.387377458	5.819603486	14.75636581	1.078884066	1.505924651	0	0	5.825595911	7.193197894	0	0	0.699929086	0.321940136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8835	0	0	21.5439	0.882890097	3.47627337	0	9.091273728	1.541830702	1.663940227	1.345429741	3.302968625	2.226825418	8.329888931	0	0.889405617	4.387377458	5.819603486	14.75636581	1.078884066	1.505924651	0	0	5.825595911	7.193197894	0	0	0.699929086	0.321940136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8835	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.5439	0.882890097	3.47627337	0	9.091273728	1.541830702	1.663940227	1.345429741	3.302968625	2.226825418	8.329888931	0	0.889405617	4.387377458	5.819603486	14.75636581	1.078884066	1.505924651	0	0	5.825595911	7.193197894	0	0	0.699929086	0.321940136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.8835
H0303_034_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.9277	0.3573	0.699	0	1.2252	0	1.7071	0	0.1734	0.4073	1.0463	6.1058	0.059	0.1687	0	0	1.084	0.4399	0	0	0	0	0	0	0	0											14.4007	NO	418.8240315	6.982039237	40.7201314	939.169457	27.68601191	10.66434317	20.86129283	30.76424782	36.5655222	17.23277143	50.94762271	0	5.174891537	12.15706981	36.422345	182.3913881	1.759356736	5.036219512	0	0	32.35282072	14.28755611	587.7415606	219.4996127	374.6560108	242.546093	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0/20% (14f)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075590438	0.076508254	0.137101762	0	0.193298627	0.193298627	0.193298627	0.086019567	0.193298627	0	0.15887615	0	0.193298627	0.143810826	0.14837252	0.193121394	0.193298627	0	0	0	0.193298627	0.186125171	0	0	0	0	0	0	0	0											NO	0.075590438	0.076508254	0.137101762	0	0.193298627	0.193298627	0.193298627	0.086019567	0.193298627	0	0.15887615	0	0.193298627	0.143810826	0.14837252	0.193121394	0.193298627	0	0	0	0.193298627	0.186125171	0	0	0	0	0	0	0	0												31.6591	0.534183631	5.582801744	0	5.351668093	2.061402895	4.032459264	2.646327283	7.068065243	0	8.094362149	0	1.00029943	1.748318252	5.404075105	35.22367917	0.340081242	0	0	0	6.253755831	2.659273825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6598	146	0	31.6591	0.534183631	5.582801744	0	6.279339535	2.418731594	4.731455771	2.646327283	8.293261231	0	9.801457226	0	1.173693818	2.15566354	6.450331812	41.32943922	0.399031769	0.168747923	0	0	7.337797402	3.099166966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.0605	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	31.6591	0.534183631	5.582801744	0	6.279339535	2.418731594	4.731455771	2.646327283	8.293261231	0	9.801457226	0	1.173693818	2.15566354	6.450331812	41.32943922	0.399031769	0.168747923	0	0	7.337797402	3.099166966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.0605
H0303_039_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1118.169577	75.71879407	719.9632245	493.0266749	531.7492097	7.055020158	16.02922276	292.5954076	214.7839745	6061.761944	49.27124136	0	4.377322604	772.6188919	6043.983632	5639.297618	320.4440277	841.3669053	0	0	32.10546443	3075.878017	0	0	142.3072838	115.6122343	17.2916707	4.752541415	497.2310068	0												"$180 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$180 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $200 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$200 (14f, 14f1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											132.6529336	101.0312825	52.47946026	0	150	0.2	0.121167812	49.94756671	200	3	0.155766193	0	0.2	77.53899521	8.349414764	39.93865246	38.5	35	0	0	0.2	37.92840542	0	0	40	30	0	0	0	0											NO	132.6529336	101.0312825	52.47946026	0	150	0.2	0.121167812	49.94756671	200	3	0.155766193	0	0.2	77.53899521	8.349414764	39.93865246	38.5	35	0	0	0.2	37.92840542	0	0	40	30	0	0	0	0												12.3607	0.63749724	3.148606786	0	6.646865121	1.411004032	1.94222585	1.217869053	3.579732908	1.515440486	7.674793699	0	0.875464521	4.992341046	4.205310514	18.76882897	1.028091255	2.453986807	0	0	6.421092886	9.721929039	0	0	0.474357613	0.289030586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3652	0	0	12.3607	0.63749724	3.148606786	0	6.646865121	1.411004032	1.94222585	1.217869053	3.579732908	1.515440486	7.674793699	0	0.875464521	4.992341046	4.205310514	18.76882897	1.028091255	2.453986807	0	0	6.421092886	9.721929039	0	0	0.474357613	0.289030586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3652	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.3607	0.63749724	3.148606786	0	6.646865121	1.411004032	1.94222585	1.217869053	3.579732908	1.515440486	7.674793699	0	0.875464521	4.992341046	4.205310514	18.76882897	1.028091255	2.453986807	0	0	6.421092886	9.721929039	0	0	0.474357613	0.289030586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3652
H0303_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	275.8703488	7.76220747	24.90391346	741.8180973	16.46212327	8.892400724	18.31640824	19.1441142	48.99904156	16.8187127	71.31105573	0	6.449172711	19.92925349	31.71634787	159.4120676	2.405313713	5.730973899	0	0	36.39453045	26.22902686	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.074610173	0.074610173	0.140988156	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074610173	0.074610173	0.140988156	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.5827	0.579139639	3.511156843	0	3.835674722	2.071929369	4.267723121	4.460578609	11.41677668	3.91876006	16.61547598	0	1.502657242	4.643516062	7.389909054	37.14301174	0.560438095	1.335316918	0	0	8.479925596	6.111363257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.4261	0	0	20.5827	0.579139639	3.511156843	0	3.835674722	2.071929369	4.267723121	4.460578609	11.41677668	3.91876006	16.61547598	0	1.502657242	4.643516062	7.389909054	37.14301174	0.560438095	1.335316918	0	0	8.479925596	6.111363257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.4261	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.5827	0.579139639	3.511156843	0	3.835674722	2.071929369	4.267723121	4.460578609	11.41677668	3.91876006	16.61547598	0	1.502657242	4.643516062	7.389909054	37.14301174	0.560438095	1.335316918	0	0	8.479925596	6.111363257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.4261
H0303_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	266.1995749	6.970885609	22.66655894	689.1302792	15.41562047	9.665966358	19.78993151	17.7065513	42.13728578	16.37783078	68.9316137	0	6.129428298	19.25905922	32.15423879	155.2046147	2.407555435	5.586459024	0	0	47.55677551	25.62267027	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07611228	0.07611228	0.137920743	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07611228	0.07611228	0.137920743	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.2611	0.530569997	3.12618866	0	3.591839571	2.252170161	4.611054041	4.125626453	9.817987588	3.816034572	16.06106599	0	1.428156794	4.487360799	7.491937637	36.16267522	0.560960416	1.301644953	0	0	11.08072869	5.970082174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.6771	0	0	20.2611	0.530569997	3.12618866	0	3.591839571	2.252170161	4.611054041	4.125626453	9.817987588	3.816034572	16.06106599	0	1.428156794	4.487360799	7.491937637	36.16267522	0.560960416	1.301644953	0	0	11.08072869	5.970082174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.6771	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.2611	0.530569997	3.12618866	0	3.591839571	2.252170161	4.611054041	4.125626453	9.817987588	3.816034572	16.06106599	0	1.428156794	4.487360799	7.491937637	36.16267522	0.560960416	1.301644953	0	0	11.08072869	5.970082174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.6771
H0303_805_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	271.4695963	7.047127302	22.93615932	694.9029841	15.58676176	9.827862672	19.97871236	18.1125184	42.87631963	16.71945021	69.75979649	0	6.182268882	19.5046764	32.60390363	157.2645058	2.430961163	5.656360552	0	0	48.01912904	26.06143725	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076108535	0.076108535	0.137928852	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076108535	0.076108535	0.137928852	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.6612	0.536346534	3.163558121	0	3.63171549	2.289892003	4.655039981	4.220216787	9.990182473	3.8956319	16.25403258	0	1.440468649	4.544589602	7.596709546	36.64262984	0.566413951	1.317932009	0	0	11.18845707	6.07231488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.6673	0	0	20.6612	0.536346534	3.163558121	0	3.63171549	2.289892003	4.655039981	4.220216787	9.990182473	3.8956319	16.25403258	0	1.440468649	4.544589602	7.596709546	36.64262984	0.566413951	1.317932009	0	0	11.18845707	6.07231488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.6673	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.6612	0.536346534	3.163558121	0	3.63171549	2.289892003	4.655039981	4.220216787	9.990182473	3.8956319	16.25403258	0	1.440468649	4.544589602	7.596709546	36.64262984	0.566413951	1.317932009	0	0	11.18845707	6.07231488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.6673
H0307_008_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered					Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	P	O	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	YES	1643.674224	89.666314	720.750063	6.923018	235.247495	3.605113	2.115814	365.330824	220.794686	376.796336	1364.016727	44.280202	0.016061	220.554181	4193.835404	4044.218306	39.36952	524.296533			24.896009	0							0.04	0.25	580.65252	14.818288	0.05	0.55	2.68	0.49					5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $100 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $35 SMAM -- FSR,14h. $35 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$35/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a					158.7573	140.3991	47.684357	0	100	0.2	0.2	50	150	14.775254	62.84937	150	0.2	107.569847	15	35	35	35			0.2	0							0	0	0	0	0	0	0	0					NO	145.986228	129.104835	33.187931	0	90.2468	0.180494	0.180494	45.1234	135.3702	13.334194	56.719545	135.3702	0.180494	97.078344	13.53702	31.58638	31.58638	31.58638			0.180494	0							0	0	0	0	0	0	0	0						19.9962	0.964696223	1.99335028	0	1.769194469	0.650701266	0.381891732	1.373747409	2.490751734	0.41868962	6.447200677	0.499518317	0.002898914	1.784252888	4.731002812	10.64518468	0.103628385	1.38005246	0	0	4.493580248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1265	0	6.72168	19.9962	0.964696223	1.99335028	0	1.769194469	0.650701266	0.381891732	1.373747409	2.490751734	0.41868962	6.447200677	0.499518317	0.002898914	1.784252888	4.731002812	10.64518468	0.103628385	1.38005246	0	0	4.493580248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1265	NO																																																																																		0	0	0	19.9962	0.964696223	1.99335028	0	1.769194469	0.650701266	0.381891732	1.373747409	2.490751734	0.41868962	6.447200677	0.499518317	0.002898914	1.784252888	4.731002812	10.64518468	0.103628385	1.38005246	0	0	4.493580248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1265
H0307_009_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)		Prosthetics/Supplies	Lab	Radiology	Renal Dialysis	Other						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O		Coin					O	O	Coin	V	V	P	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		0	NO	1318.355162	175.970482	525.671752	887.828145	200.138647	8.54382	0.999858	450.527278	118.071928	229.592789	573.556263	54.023205	0.085554	137.674816	4471.854249	4144.457339	78.582126	100.044961			22.75155	0		1.14					0.04	0.25	1.50434	736.840473	586.591016	46.199995	359.498831	181.503552	0.05	0.55	2.68			$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$50/Visit:8a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$40/Visit:9d. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,8b. $50 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$35/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	0% Coins:11b	$0/Visit:8a	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	"$35-$150/Visit:9d. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,8b. $50 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a		137.58966	121.67922	58.254672	0	100	0.2	0.2	50	150	50	36.069395	150	0.2	40	10	35	35	35			0.2	0		0					0	0	0	0	88.20759	0	98.941597	150	0	0	0		NO	128.091433	113.279338	41.968879	0	89.8358	0.179672	0.179672	44.9179	134.7537	44.9179	32.40323	134.7537	0.179672	35.93432	8.98358	31.44253	31.44253	31.44253			0.179672	0		0					0	0	0	0	79.241994	0	88.884975	134.7537	0	0	0			14.0725	1.661151642	1.838487846	0	1.498301289	1.535085227	0.179646487	1.686394935	1.325885764	0.859402161	1.548756292	0.60665223	0.015371658	0.412270908	3.3477717	10.85935202	0.205901738	0.262138891	0	0	4.087816492	0	0	0	0	0	0	0	0	0	0	0	3.873553481	0	2.66283705	2.0381896	0	0	0	0	54.5775	0	6.183244	14.0725	1.661151642	1.838487846	0	1.498301289	1.535085227	0.179646487	1.686394935	1.325885764	0.859402161	1.548756292	0.60665223	0.015371658	0.412270908	3.3477717	10.85935202	0.205901738	0.262138891	0	0	4.087816492	0	0	0	0	0	0	0	0	0	0	0	3.873553481	0	2.66283705	2.0381896	0	0	0	0	54.5775	YES	$195/Day(Days 1-7)	$195/Day(Days 1-7)		$0/Visit	$100/Trip	20% Coins	20% Coins	$50/Visit	$0-$150/Visit	15% Coins	$0-$25/Visit	15% Coins	20% Coins	$35-$40/Visit	$10/Visit	$35/Visit	$35/Visit	15% Coins			20% Coins	$0/Service									$0/Service	$0/Visit	15% Coins	$0/Proc	15% Coins	15% Coins					5000	0.2905	0.1577		0	0.1902	0.2411	0.0024	0.0935	0.0424	0.0175	0.0157	0.0063	0.0013	0.0311	0.0827	0.2521	0.0066	0.0016			0.0415	0									0	0	0.071	0	0.0532	0.2373					1.8356	0	0.057517	14.363	1.818836642	1.838487846	0	1.688497289	1.776187227	0.182034487	1.779886935	1.368252764	0.876941161	1.564473292	0.61291723	0.016665658	0.443419908	3.4304657	11.11146202	0.212477738	0.263729891	0	0	4.129272492	0	0	0	0	0	0	0	0	0	0	0	3.944590481	0	2.71599905	2.2755066	0	0	0	0	56.4131
H0307_010_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.			DME/Prosthetics/Supplies	OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered			Prosthetics/Supplies	Radiology	Renal Dialysis				Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	O	V	P	O	O	O	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	NO	1502.163232	51.668528	690.286432	792.395873	158.054587	6.306543	1.072614	334.710243	270.000153	1059.763766	373.471019	55.173714	0.040001	301.345109	4462.346834	4248.354881	65.798016	113.522856			31.397732	0							0.04	0.25	4405.259635	912.003898	18.004935	0.05	0.55	2.68	512.753876	0.49				$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$35/Visit:14h. $100 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$35/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	"$0-$150/Visit:14h. $100 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: Nutritional benefit 14a			158.7573	140.3991	47.684357	0	100	0.2	0.2	50	150	9.508238	13.475867	150	0.2	90.349352	15	35	35	35			0.2	0							0	0	0	81.312474	0	0	0	0	35	0			NO	150.60416	133.188764	37.950311	0	91.8911	0.183782	0.183782	45.94555	137.83665	8.737225	12.383122	137.83665	0.183782	83.023014	13.783665	32.161885	32.161885	32.161885			0.183782	0							0	0	0	74.718927	0	0	0	0	32.161885	0				18.8527	0.573472282	2.183048731	0	1.210317488	1.159029086	0.197127146	1.281537184	3.101326382	0.771616206	0.385394766	0.633746659	0.007351464	2.0848816	5.125624489	11.38625843	0.176349019	0.304259087	0	0	5.770337982	0	0	0	0	0	0	0	0	0	0	5.678662723	0	0	0	0	1.374260933	0	0	0	62.2573	0	5.198578	18.8527	0.573472282	2.183048731	0	1.210317488	1.159029086	0.197127146	1.281537184	3.101326382	0.771616206	0.385394766	0.633746659	0.007351464	2.0848816	5.125624489	11.38625843	0.176349019	0.304259087	0	0	5.770337982	0	0	0	0	0	0	0	0	0	0	5.678662723	0	0	0	0	1.374260933	0	0	0	62.2573	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	$0/Day(Days 1-20) $128(Days 21-100)	$0/Visit	$100/Trip	20% Coins	40% Coins	$50/Visit	20%-25% Coins	$0-$50/Visit	$0-$40/Visit	25% Coins	20% Coins	20%-25% Coins	$40/Visit	$40/Visit	$40/Visit	25% Coins			30% Coins	$0/Service									20% Coins	20%-25% Coins	$0/Proc				$40/Visit				7000	2.0487	0.0623	0.2205	0	0.5026	0.7404	0.2519	0.138	1.0403	0.0831	0.0346	0.1249	0.0008	0.2693	1.0738	1.0223	0.0158	0.0251			0.6959	0									0.1543	0.4907	0				0.1234				9.1186	0	1.07332	20.9013	0.635789282	2.403520731	0	1.712885488	1.899447086	0.448987146	1.419499184	4.141673382	0.854683206	0.419995766	0.758675659	0.008184464	2.3542016	6.199384489	12.40852643	0.192182019	0.329336087	0	0	6.466272982	0	0	0	0	0	0	0	0	0	0.15429	6.169376723	0	0	0	0	1.497642933	0	0	0	71.3759
H0307_011_0	2010	3	N/A	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)						Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	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	YES	1404.573093	43.359394	650.796018	866.717573	145.810948	6.570206	0.969277	312.126714	263.447501	1103.017919	1206.468917	53.923142	0.041431	298.214196	4258.445169	4040.528474	66.162898	607.275436			30.523878	0							0.04	0.25	4772.723366	17.667783	0.05	0.55	2.68						5000	$275/Day(Days 1-6):1a	$275/Day(Days 1-6):1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $200 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$200/Visit:14h. $200 DMAM -- OP,8b. $200 Radiology -- FSR,14h. $45 SMAM -- FSR,14h. $45 SMAM -- OP,8b. $200 Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. $200 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $200 Radiology OP -- Facility"	$200/Visit:9a	20% Coins:12	"$40-$200/Visit:9d. $45 Cardiac Rehab,8b. $200 Nuclear Medicine,9a. $200 OP Other,5. $40 Partial Hospitalization,7h. $200 Psych -- OP,8b. $200 Rad therapy,3. $45 Therapy (AT,PT,ST,OT) -- CORF"	$20/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$45/Visit:7i. $45 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						181.929825	156.906475	47.684357	0	100	0.2	0.2	50	200	9.233272	152.970522	200	0.2	125.693229	20	40	40	40.965797			0.2	0							0	0	0	0	0	0	0						NO	157.371482	135.725984	29.604547	0	85.4595	0.170919	0.170919	42.72975	170.919	7.890708	130.727843	170.919	0.170919	107.416805	17.0919	34.1838	34.1838	35.009165			0.170919	0							0	0	0	0	0	0	0							18.42	0.490416368	1.605543442	0	1.038410893	1.122973039	0.165667856	1.111424705	3.752348619	0.72529936	13.1432566	0.768040792	0.007081345	2.669434678	6.065409915	11.51005144	0.188474939	1.771683828	0	0	5.217110704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7726	0	12.312323	18.42	0.490416368	1.605543442	0	1.038410893	1.122973039	0.165667856	1.111424705	3.752348619	0.72529936	13.1432566	0.768040792	0.007081345	2.669434678	6.065409915	11.51005144	0.188474939	1.771683828	0	0	5.217110704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7726	NO																																																																																		0	0	0	18.42	0.490416368	1.605543442	0	1.038410893	1.122973039	0.165667856	1.111424705	3.752348619	0.72529936	13.1432566	0.768040792	0.007081345	2.669434678	6.065409915	11.51005144	0.188474939	1.771683828	0	0	5.217110704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7726
H0307_801_0	2010	3	N/A																															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	NO	211.957427	1.304345	20.415405	9.87563	4.81036	4.681576	1.978765	19.3788	54.788319	7.878169	25.829821	3.998776	0.852603	14.112201	65.422643	81.157966	0.283915	5.519564			20.863359	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																			0.078888782	0.078888782	0.132803851	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.078888782	0.078888782	0.132803851	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				16.7211	0.102898189	2.711244405	0	1.12081388	1.090807208	0.461052245	4.5152604	12.76567833	1.835613377	6.018348293	0.931714808	0.198656499	3.288142833	15.24347582	18.90980608	0.066152195	1.286058412	0	0	4.861162647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1279	0	0	16.7211	0.102898189	2.711244405	0	1.12081388	1.090807208	0.461052245	4.5152604	12.76567833	1.835613377	6.018348293	0.931714808	0.198656499	3.288142833	15.24347582	18.90980608	0.066152195	1.286058412	0	0	4.861162647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1279	NO																																																																																		0	0	0	16.7211	0.102898189	2.711244405	0	1.12081388	1.090807208	0.461052245	4.5152604	12.76567833	1.835613377	6.018348293	0.931714808	0.198656499	3.288142833	15.24347582	18.90980608	0.066152195	1.286058412	0	0	4.861162647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1279
H0307_802_0	2010	3	N/A																															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	NO	211.957427	1.304345	20.415405	9.87563	4.81036	4.681576	1.978765	19.3788	54.788319	7.878169	25.829821	3.998776	0.852603	14.112201	65.422643	81.157966	0.283915	5.519564			20.863359	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																			0.078888782	0.078888782	0.132803851	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.078888782	0.078888782	0.132803851	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				16.7211	0.102898189	2.711244405	0	1.12081388	1.090807208	0.461052245	4.5152604	12.76567833	1.835613377	6.018348293	0.931714808	0.198656499	3.288142833	15.24347582	18.90980608	0.066152195	1.286058412	0	0	4.861162647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1279	0	0	16.7211	0.102898189	2.711244405	0	1.12081388	1.090807208	0.461052245	4.5152604	12.76567833	1.835613377	6.018348293	0.931714808	0.198656499	3.288142833	15.24347582	18.90980608	0.066152195	1.286058412	0	0	4.861162647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1279	NO																																																																																		0	0	0	16.7211	0.102898189	2.711244405	0	1.12081388	1.090807208	0.461052245	4.5152604	12.76567833	1.835613377	6.018348293	0.931714808	0.198656499	3.288142833	15.24347582	18.90980608	0.066152195	1.286058412	0	0	4.861162647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1279
H0307_803_0	2010	3	N/A																															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	NO	211.957427	1.304345	20.415405	9.87563	4.81036	4.681576	1.978765	19.3788	54.788319	7.878169	25.829821	3.998776	0.852603	14.112201	65.422643	81.157966	0.283915	5.519564			20.863359	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																			0.078888782	0.078888782	0.132803851	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.078888782	0.078888782	0.132803851	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				16.7211	0.102898189	2.711244405	0	1.12081388	1.090807208	0.461052245	4.5152604	12.76567833	1.835613377	6.018348293	0.931714808	0.198656499	3.288142833	15.24347582	18.90980608	0.066152195	1.286058412	0	0	4.861162647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1279	0	0	16.7211	0.102898189	2.711244405	0	1.12081388	1.090807208	0.461052245	4.5152604	12.76567833	1.835613377	6.018348293	0.931714808	0.198656499	3.288142833	15.24347582	18.90980608	0.066152195	1.286058412	0	0	4.861162647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1279	NO																																																																																		0	0	0	16.7211	0.102898189	2.711244405	0	1.12081388	1.090807208	0.461052245	4.5152604	12.76567833	1.835613377	6.018348293	0.931714808	0.198656499	3.288142833	15.24347582	18.90980608	0.066152195	1.286058412	0	0	4.861162647	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1279
H0307_805_0	2010	5	N/A																															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	NO	233.522196	2.729038	23.68347	6.977561	4.49885	4.973844	1.882408	19.045346	35.233545	3.669667	23.484914	3.7859	0.620495	8.239181	33.514027	59.179904	0.358706	4.105414			24.762761	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																			0.073811679	0.073811679	0.143037841	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.073811679	0.073811679	0.143037841	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				17.2367	0.201434876	3.387632422	0	1.04823205	1.158905652	0.438601064	4.437565618	8.209415985	0.855032411	5.471984962	0.8821147	0.144575335	1.919729173	7.808768291	13.78891763	0.083578498	0.956561462	0	0	5.769723313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7994	0	0	17.2367	0.201434876	3.387632422	0	1.04823205	1.158905652	0.438601064	4.437565618	8.209415985	0.855032411	5.471984962	0.8821147	0.144575335	1.919729173	7.808768291	13.78891763	0.083578498	0.956561462	0	0	5.769723313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7994	NO																																																																																		0	0	0	17.2367	0.201434876	3.387632422	0	1.04823205	1.158905652	0.438601064	4.437565618	8.209415985	0.855032411	5.471984962	0.8821147	0.144575335	1.919729173	7.808768291	13.78891763	0.083578498	0.956561462	0	0	5.769723313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7994
H0307_806_0	2010	4	N/A																															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	NO	233.522196	2.729038	23.68347	6.977561	4.49885	4.973844	1.882408	19.045346	35.233545	3.669667	23.484914	3.7859	0.620495	8.239181	33.514027	59.179904	0.358706	4.105414			24.762761	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																			0.073811679	0.073811679	0.143037841	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.073811679	0.073811679	0.143037841	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				17.2367	0.201434876	3.387632422	0	1.04823205	1.158905652	0.438601064	4.437565618	8.209415985	0.855032411	5.471984962	0.8821147	0.144575335	1.919729173	7.808768291	13.78891763	0.083578498	0.956561462	0	0	5.769723313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7994	0	0	17.2367	0.201434876	3.387632422	0	1.04823205	1.158905652	0.438601064	4.437565618	8.209415985	0.855032411	5.471984962	0.8821147	0.144575335	1.919729173	7.808768291	13.78891763	0.083578498	0.956561462	0	0	5.769723313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7994	NO																																																																																		0	0	0	17.2367	0.201434876	3.387632422	0	1.04823205	1.158905652	0.438601064	4.437565618	8.209415985	0.855032411	5.471984962	0.8821147	0.144575335	1.919729173	7.808768291	13.78891763	0.083578498	0.956561462	0	0	5.769723313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7994
H0307_807_0	2010	4	N/A																															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	NO	233.522196	2.729038	23.68347	6.977561	4.49885	4.973844	1.882408	19.045346	35.233545	3.669667	23.484914	3.7859	0.620495	8.239181	33.514027	59.179904	0.358706	4.105414			24.762761	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																			0.073811679	0.073811679	0.143037841	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.073811679	0.073811679	0.143037841	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				17.2367	0.201434876	3.387632422	0	1.04823205	1.158905652	0.438601064	4.437565618	8.209415985	0.855032411	5.471984962	0.8821147	0.144575335	1.919729173	7.808768291	13.78891763	0.083578498	0.956561462	0	0	5.769723313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7994	0	0	17.2367	0.201434876	3.387632422	0	1.04823205	1.158905652	0.438601064	4.437565618	8.209415985	0.855032411	5.471984962	0.8821147	0.144575335	1.919729173	7.808768291	13.78891763	0.083578498	0.956561462	0	0	5.769723313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7994	NO																																																																																		0	0	0	17.2367	0.201434876	3.387632422	0	1.04823205	1.158905652	0.438601064	4.437565618	8.209415985	0.855032411	5.471984962	0.8821147	0.144575335	1.919729173	7.808768291	13.78891763	0.083578498	0.956561462	0	0	5.769723313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7994
H0316_002_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	951.7845843	122.2988859	549.3217238	481.8491463	201.1164582	7.468295744	6.470390806	399.9562478	28.87947536	8424.272384	35.29517193	0	0.801998389	8.245008007	5661.794245	3613.825741	558.1368632	250.1057531	0	0	24.48305902	1067.884726	0	0	115.2859541	0	17.84074148	4.74240015	129.1591578	0											3550	"$275 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-20 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											190.6084929	140.5472438	65.09002355	0	150	0.2	0.114532744	49.68760406	0.2	3	0.16978298	0	0.2	0.15196539	9.327447088	39.57140283	38.5	40	0	0	0.2	38.46993887	0	0	33.37497297	0	0	0	0	0											NO	163.3535145	120.4504892	55.78284548	0	128.5516023	0.171402136	0.098155785	42.58280744	0.171402136	2.571032046	0.145505828	0	0.171402136	0.130608496	9.278897952	39.57140283	38.5	34.28042728	0	0	0.171402136	38.46993887	0	0	33.37497297	0	0	0	0	0												12.9564	1.227580053	2.553560736	0	2.154486912	1.280081846	0.63510629	1.419271657	4.950003775	1.804922855	5.13565321	0	0.137464237	1.076868096	4.377934252	11.91701285	1.790689103	0.714477673	0	0	4.196448622	3.42345501	0	0	0.3206388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0721	0	6.733625236	12.9564	1.227580053	2.553560736	0	2.154486912	1.280081846	0.63510629	1.419271657	4.950003775	1.804922855	5.13565321	0	0.137464237	1.076868096	4.377934252	11.91701285	1.790689103	0.714477673	0	0	4.196448622	3.42345501	0	0	0.3206388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0721	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.9564	1.227580053	2.553560736	0	2.154486912	1.280081846	0.63510629	1.419271657	4.950003775	1.804922855	5.13565321	0	0.137464237	1.076868096	4.377934252	11.91701285	1.790689103	0.714477673	0	0	4.196448622	3.42345501	0	0	0.3206388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0721
H0316_013_0	2010	3	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1901.206554	165.4644544	30.01413164	1048.699097	246.8370898	15.04267962	14.21255003	486.7838264	43.22851056	13575.8942	45.68107463	0	0.186428236	25.48374423	8723.027717	5707.565544	450.6080031	327.1140581	0	0	21.69313634	1285.415287	658.7500166	0	128.9478247	0	17.11999563	4.705357261	77.63839481	0											3850	"$275 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											190.6084929	140.5472438	0.151722324	0	150	0.2	0.103794904	49.55509031	0.2	3	0.175394327	0	0.2	0.150411835	10.20572819	39.27564426	38.5	40	0	0	0.2	39.62759383	0	0	40	0	0	0	0	0											NO	147.4757561	108.7428515	0.117389127	0	116.0565465	0.154742062	0.080307188	38.34128428	0.154742062	2.32113093	0.135704399	0	0.154742062	0.116656023	10.11928722	39.27564426	38.5	30.9484124	0	0	0.154742062	39.62759383	0	0	40	0	0	0	0	0												23.3652	1.49942305	3.523332702	0	2.387255015	2.327735262	1.141369923	1.555326423	6.689268861	2.625952327	6.199122769	0	0.02884829	2.97283226	7.355901908	18.68069283	1.445700677	0.843638398	0	0	3.356840648	4.244826239	0	0	0.429826082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.673	0	17.16798941	23.3652	1.49942305	3.523332702	0	2.387255015	2.327735262	1.141369923	1.555326423	6.689268861	2.625952327	6.199122769	0	0.02884829	2.97283226	7.355901908	18.68069283	1.445700677	0.843638398	0	0	3.356840648	4.244826239	0	0	0.429826082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.673	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.3652	1.49942305	3.523332702	0	2.387255015	2.327735262	1.141369923	1.555326423	6.689268861	2.625952327	6.199122769	0	0.02884829	2.97283226	7.355901908	18.68069283	1.445700677	0.843638398	0	0	3.356840648	4.244826239	0	0	0.429826082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.673
H0316_014_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	822.2038894	84.55044399	383.380841	350.400693	146.2518858	5.262236302	4.559102446	290.8535544	20.34876883	6126.130769	24.86933316	0	0.565096132	5.803751185	4149.080597	2706.30704	376.2187262	184.3182011	0	0	17.48256683	786.9894602	0	0	89.51280283	149.6114333	13.02735336	4.74240015	78.24960248	0												"$150 Days 1-23 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-13 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 1-24 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											141.8955679	112.6710137	53.68956845	0	150	0.2	0.114532744	49.68760983	0.2	3	0.170504143	0	0.2	0.151661036	6.478046984	39.44119206	38.5	40	0	0	0.2	38.46893589	0	0	40	30	0	0	0	0											NO	125.3611932	95.30750823	45.41557601	0	126.8837988	0.169178398	0.096882331	42.03035127	0.169178398	2.537675977	0.144228089	0	0.169178398	0.128604138	6.408351776	39.44119206	38.5	33.83567969	0	0	0.169178398	38.46893589	0	0	40	30	0	0	0	0												8.5894	0.671524345	1.450955144	0	1.546416238	0.89025671	0.441696473	1.018723088	3.442572121	1.29551124	3.586856408	0	0.095602059	0.746386416	2.215730668	8.894997978	1.20703508	0.519710968	0	0	2.957672657	2.522887258	0	0	0.298376009	0.374028583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7663	0	4.987042202	8.5894	0.671524345	1.450955144	0	1.546416238	0.89025671	0.441696473	1.018723088	3.442572121	1.29551124	3.586856408	0	0.095602059	0.746386416	2.215730668	8.894997978	1.20703508	0.519710968	0	0	2.957672657	2.522887258	0	0	0.298376009	0.374028583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7663	YES	"$200 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$15 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											3380	1.4882	0.1276	1.0357	0.2577	0.5293	0.4571	0.396	0.4106	1.7675	0.4434	1.8102	0	0.0327	0.3795	1.3847	3.2307	0.4426	0.1897	0	0	1.4397	0.9283	0	0	0.1089	0	0.0159	0	0	0											16.876	0	1.944681901	10.0775	0.799160878	2.48669726	0.2576922	2.075726494	1.347334819	0.83770034	1.429341803	5.210067203	1.738941262	5.397087621	0	0.128324911	1.125838898	3.600472441	12.12564947	1.649590386	0.709439889	0	0	4.397334513	3.451148301	0	0	0.407303013	0.374028583	0.015852822	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6423
H0316_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	224.6513753	5.740280182	17.78732906	518.4979223	13.03177161	8.17525764	7.082889281	20.58628956	31.61325685	18.29285585	38.63627444	0	0.877916955	9.001993807	31.61328139	112.6528011	2.875080091	3.857825116	0	0	26.80066807	6.36582137	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071443514	0.071443514	0.148466259	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071443514	0.071443514	0.148466259	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.0499	0.410105789	2.640818202	0	3.036402785	1.90483503	1.650313202	4.796605468	7.365888846	4.262235414	9.002251945	0	0.204554651	2.097464557	7.365894565	26.24810265	0.669893661	0.898873252	0	0	6.244555661	1.483236379	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3319	0	0	16.0499	0.410105789	2.640818202	0	3.036402785	1.90483503	1.650313202	4.796605468	7.365888846	4.262235414	9.002251945	0	0.204554651	2.097464557	7.365894565	26.24810265	0.669893661	0.898873252	0	0	6.244555661	1.483236379	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3319	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.0499	0.410105789	2.640818202	0	3.036402785	1.90483503	1.650313202	4.796605468	7.365888846	4.262235414	9.002251945	0	0.204554651	2.097464557	7.365894565	26.24810265	0.669893661	0.898873252	0	0	6.244555661	1.483236379	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3319
H0316_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	224.6513299	5.740280182	17.78732546	518.4978699	13.03176898	8.175255987	7.082887849	20.5862854	31.61325046	18.29285215	38.63626663	0	0.877916778	9.001991991	31.613275	112.6527783	2.85532009	3.857824337	0	0	26.80066266	6.365820083	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071443512	0.071443512	0.148466265	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071443512	0.071443512	0.148466265	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.0499	0.410105775	2.64081778	0	3.036402172	1.904834645	1.650312869	4.796604498	7.365887357	4.262234552	9.002250125	0	0.204554609	2.097464134	7.365893076	26.24809734	0.665289581	0.89887307	0	0	6.244554399	1.483236079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3273	0	0	16.0499	0.410105775	2.64081778	0	3.036402172	1.904834645	1.650312869	4.796604498	7.365887357	4.262234552	9.002250125	0	0.204554609	2.097464134	7.365893076	26.24809734	0.665289581	0.89887307	0	0	6.244554399	1.483236079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3273	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.0499	0.410105775	2.64081778	0	3.036402172	1.904834645	1.650312869	4.796604498	7.365887357	4.262234552	9.002250125	0	0.204554609	2.097464134	7.365893076	26.24809734	0.665289581	0.89887307	0	0	6.244554399	1.483236079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3273
H0316_806_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	224.6513798	5.740280182	17.78732942	518.4979276	13.03177187	8.175257805	7.082889424	20.58628998	31.61325749	18.29285622	38.63627522	0	0.877916973	9.001993988	31.61328203	112.6528033	2.85532009	3.857825194	0	0	26.80066861	6.365821499	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071443514	0.071443514	0.148466258	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071443514	0.071443514	0.148466258	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.0499	0.41010579	2.640818244	0	3.036402847	1.904835069	1.650313236	4.796605565	7.365888995	4.2622355	9.002252127	0	0.204554655	2.097464599	7.365894713	26.24810318	0.665289581	0.89887327	0	0	6.244555787	1.483236409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3273	0	0	16.0499	0.41010579	2.640818244	0	3.036402847	1.904835069	1.650313236	4.796605565	7.365888995	4.2622355	9.002252127	0	0.204554655	2.097464599	7.365894713	26.24810318	0.665289581	0.89887327	0	0	6.244555787	1.483236409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3273	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.0499	0.41010579	2.640818244	0	3.036402847	1.904835069	1.650313236	4.796605565	7.365888995	4.2622355	9.002252127	0	0.204554655	2.097464599	7.365894713	26.24810318	0.665289581	0.89887327	0	0	6.244555787	1.483236409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3273
H0317_001_0	2010	4	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	P	O	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	NO	231.993095	10.41824	439.744092	261.707004	31.279452	8.963306	4.648526	334.531498	400.613573	1655.298684	1286.5308	47.74285	0.048073	846.440951	3423.852771	4725.1645	140.308982	990.563914			22.46748	0							0.04	0.25	30.692133	0.05	0.55	2.68	0.49							$300/Admit:1a	$300/Admit:1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $25 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,8b. $100 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$30/Visit:7i. $30 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						300	300	45.891712	0	100	0.2	0.2	50	150	54.846636	72.810185	100	0.2	94.926968	5	25	25	25.771431			0.2	0							0	0	0	0	0	0	0						NO	279.1179	279.1179	36.160466	0	88.3056	0.176611	0.176611	44.1528	132.4584	48.432651	64.295471	88.3056	0.176611	83.825829	4.41528	22.0764	22.0764	22.757617			0.176611	0							0	0	0	0	0	0	0							5.3961	0.242326439	1.325112607	0	0.230179231	1.583018436	0.820980825	1.230875194	4.422052741	6.680875289	6.893175312	0.351330085	0.008490221	5.912801201	1.259772389	8.692885131	0.258126434	1.878572847	0	0	3.96800411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1547	0	6.63072	5.3961	0.242326439	1.325112607	0	0.230179231	1.583018436	0.820980825	1.230875194	4.422052741	6.680875289	6.893175312	0.351330085	0.008490221	5.912801201	1.259772389	8.692885131	0.258126434	1.878572847	0	0	3.96800411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1547	YES	$600/Admit	$600/Admit	40% Coins(Days 1-20) 40%(Days 21-100)	40% Coins	$100/Trip	35% Coins	35% Coins	$50/Visit	15% Coins	15% Coins	15%-20% Coins	15% Coins	20% Coins	15% Coins	20% Coins	20% Coins	20% Coins	15%-20% Coins			20% Coins	$0/Service							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						5000	1.7182	0.0772	0.443	1.764	0.8464	1.6792	0.8709	0.1997	1.414	0.248	0.9442	0.0684	0.0014	0.4605	1.0312	2.2157	0.0325	0.2491			0.6589	0							0	0	0	0	0	0	0						14.9225	0	4.337637	7.1144	0.319488439	1.768095607	1.764048	1.076604231	3.262196436	1.691831825	1.430562194	5.836038741	6.928913289	7.837361312	0.419743085	0.009939221	6.373335201	2.290947389	10.90862713	0.290622434	2.127678847	0	0	4.62686111	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0772
H0317_002_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered				Renal Dialysis	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O		Coin					O	O	P	V	V	O	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	YES	873.503287	17.589465	433.369607	179.551355	31.951803	6.641273	3.765858	296.058331	138.014762	1464.36385	1334.215526	74.238621	0.004015	0	3486.916266	4263.191233	82.001763	856.101927			27.175898	0		1.5					0.04	0.25	129.983925	273.44835	166.341026	0.05	0.55	2.68	0.49				5000	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$35/Visit:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$40/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a				137.58966	121.67922	58.254672	0	100	0.2	0.2	50	150	15.133636	63.158579	100	0.2	0	15	35	40	43.764903			0.2	0		0					0	0	0	79.137858	100	0	0	0	0				NO	127.792175	113.014686	44.185703	0	89.8878	0.179776	0.179776	44.9439	134.8317	13.603292	56.771857	89.8878	0.179776	0	13.48317	31.46073	35.95512	39.339308			0.179776	0		0					0	0	0	71.13528	89.8878	0	0	0	0					9.3022	0.165655655	1.595728395	0	0.239339773	1.193941495	0.677010888	1.108834669	1.550730415	1.660014087	6.312157754	0.556095526	0.000721801	0	3.917890399	11.17692569	0.245698602	2.806538115	0	0	4.885574239	0	0	0	0	0	0	0	0	0	0	1.620985412	1.246002406	0	0	0	0	0	0	0	50.2621	0	5.643715	9.3022	0.165655655	1.595728395	0	0.239339773	1.193941495	0.677010888	1.108834669	1.550730415	1.660014087	6.312157754	0.556095526	0.000721801	0	3.917890399	11.17692569	0.245698602	2.806538115	0	0	4.885574239	0	0	0	0	0	0	0	0	0	0	1.620985412	1.246002406	0	0	0	0	0	0	0	50.2621	YES	$195/Day(Days 1-7)	$195/Day(Days 1-7)	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	$0-$150/Visit	30% Coins	$0-$100/Visit	$100/Visit	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit			20%-30% Coins	$0/Service		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$40-$100/Visit	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a				7500	2.1177	0.0377	0.589	2.8421	1.2589	1.2939	0.7337	0.2573	0.3598	0.524	1.4761	0.129	0.0002	0	2.4244	2.9641	0.057	0.7156			1.6132	0		0					0	0	0	0.3761	1.3584	0	0	0	0				21.1283	500	2.509499	11.42	0.203368655	2.184689395	2.842078	1.498218773	2.487871495	1.410719888	1.366139669	1.910577415	2.183976087	7.788292754	0.685137526	0.000897801	0	6.342279399	14.14104469	0.302712602	3.522166115	0	0	6.498752239	0	0	0	0	0	0	0	0	0	0	1.997134412	2.604386406	0	0	0	0	0	0	0	71.3904
H0317_004_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered				Renal Dialysis	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O		Coin					O	O	P	V	V	O	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	YES	886.558297	34.903682	512.673115	305.588267	30.100887	7.573595	2.817537	316.604103	119.42391	1270.321568	871.368196	55.15179	0.036928	0	2916.597693	3406.19398	89.686443	730.863511			15.00339	0		1.5					0.04	0.25	38.659283	667.978387	211.00379	0.05	0.55	2.68	0.42				5000	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$35/Visit:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$40/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a				137.58966	121.67922	58.254672	0	100	0.2	0.2	50	100	53.093079	66.708349	100	0.2	0	15	35	40	52.040683			0.2	0		0					0	0	0	86.725018	150	0	0	0	0				NO	127.457833	112.719006	42.097622	0	89.8351	0.17967	0.17967	44.91755	89.8351	47.69622	59.927512	89.8351	0.17967	0	13.475265	31.442285	35.93404	46.750799			0.17967	0		0					0	0	0	77.909507	134.75265	0	0	0	0					9.4166	0.327859028	1.798526584	0	0.225343016	1.360747814	0.506226873	1.185090052	0.894038241	5.049128082	4.351577335	0.412880547	0.006634854	0	3.275160568	8.924876824	0.268566353	2.847371092	0	0	2.695659081	0	0	0	0	0	0	0	0	0	0	4.336822235	2.369443322	0	0	0	0	0	0	0	50.2525	0	5.844886	9.4166	0.327859028	1.798526584	0	0.225343016	1.360747814	0.506226873	1.185090052	0.894038241	5.049128082	4.351577335	0.412880547	0.006634854	0	3.275160568	8.924876824	0.268566353	2.847371092	0	0	2.695659081	0	0	0	0	0	0	0	0	0	0	4.336822235	2.369443322	0	0	0	0	0	0	0	50.2525	YES	$195/Day(Days 1-7)	$195/Day(Days 1-7)	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	$0-$100/Visit	$100/Visit	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit			20%-30% Coins	$0/Service		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$40-$100/Visit	$0-$150/Visit	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a				7500	2.1508	0.0749	0.6475	1.6716	1.2438	1.5475	0.5757	0.2886	0.7981	0.6762	1.0707	0.1005	0.0017	0	2.1267	2.4837	0.0654	0.7425			0.9249	0		0					0	0	0	1.056	0.577	0	0	0	0				18.8239	500	1.996575	11.5674	0.402745028	2.445989584	1.671611	1.469115016	2.908261814	1.081934873	1.473666052	1.692182241	5.725317082	5.422303335	0.513419547	0.008334854	0	5.401880568	11.40859982	0.333963353	3.589874092	0	0	3.620550081	0	0	0	0	0	0	0	0	0	0	5.392862235	2.946416322	0	0	0	0	0	0	0	69.0764
H0317_006_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered				Renal Dialysis	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	P	V	V	O	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	YES	928.790803	45.057968	643.440379	368.921322	30.41631	7.564669	2.349912	295.017194	122.549911	1294.370726	946.915323	56.759785	0.045456	0	2853.397834	3179.114165	91.184646	798.104684			17.468325	0							0.04	0.25	49.90616	762.294288	224.007907	0.05	0.55	2.68	0.49				5000	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$35/Visit:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$40/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a				137.58966	121.67922	58.254672	0	100	0.2	0.2	50	100	61.361275	68.128684	100	0.2	0	15	35	40	52.335137			0.2	0							0	0	0	86.761569	150	0	0	0	0				NO	126.094457	111.513286	38.305476	0	89.0321	0.178064	0.178064	44.51605	89.0321	54.631232	60.656398	89.0321	0.178064	0	13.354815	31.161235	35.61284	46.595071			0.178064	0							0	0	0	77.245647	133.54815	0	0	0	0					9.7596	0.418713506	2.053940833	0	0.225668996	1.346995221	0.41843473	1.09441668	0.909239661	5.892755619	4.786372725	0.421120238	0.008094077	0	3.175550016	8.255426966	0.270612017	3.098978701	0	0	3.110479823	0	0	0	0	0	0	0	0	0	0	4.906992957	2.492986797	0	0	0	0	0	0	0	52.6464	0	6.976197	9.7596	0.418713506	2.053940833	0	0.225668996	1.346995221	0.41843473	1.09441668	0.909239661	5.892755619	4.786372725	0.421120238	0.008094077	0	3.175550016	8.255426966	0.270612017	3.098978701	0	0	3.110479823	0	0	0	0	0	0	0	0	0	0	4.906992957	2.492986797	0	0	0	0	0	0	0	52.6464	YES	$195/Day(Days 1-7)	$195/Day(Days 1-7)	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	$0-$100/Visit	$100/Visit	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit			20%-30% Coins	$0/Service							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$40-$100/Visit	$0-$150/Visit	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a				7500	2.2039	0.0946	0.6921	1.9207	1.2397	1.5246	0.4736	0.2652	0.8368	0.6068	1.1715	0.1021	0.0021	0	2.0522	2.2865	0.0656	0.8036			1.0713	0							0	0	0	1.1892	0.6042	0	0	0	0				19.2062	500	2.30704	11.9635	0.513266506	2.746022833	1.920706	1.465319996	2.871588221	0.89203873	1.35964668	1.746064661	6.499576619	5.957877725	0.523178238	0.010158077	0	5.227788016	10.54192797	0.336194017	3.902626701	0	0	4.181729823	0	0	0	0	0	0	0	0	0	0	6.096193957	3.097157797	0	0	0	0	0	0	0	71.8526
H0317_801_0	2010	4	N/A																															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	NO	207.190579	0.70675	35.974214	11.624549	1.36322	6.303347	3.081154	15.197503	43.27372	9.342273	22.272692	7.873528	0.691741	14.255455	26.456328	58.021392	0.27882	4.31778			18.858343	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																			0.070205762	0.070205762	0.151599407	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.070205762	0.070205762	0.151599407	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				14.546	0.049617922	5.453669512	0	0.31763026	1.468679851	0.717908882	3.541018199	10.08277676	2.176749609	5.189537236	1.834532024	0.161175653	3.321521015	6.164324424	13.51898434	0.06496506	1.00604274	0	0	4.393993919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0091	0	0	14.546	0.049617922	5.453669512	0	0.31763026	1.468679851	0.717908882	3.541018199	10.08277676	2.176749609	5.189537236	1.834532024	0.161175653	3.321521015	6.164324424	13.51898434	0.06496506	1.00604274	0	0	4.393993919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0091	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				2.7078	0.0092	1.0152	0	1.2705	0.9683	0.4733	0.9336	2.4296	0.5739	1.2442	0.4837	0.0425	0.8693	1.1615	2.5473	0.0122	0.216			0.828	0																			17.7863	0	0	17.2537	0.05884998	6.468854941	0	1.58817926	2.437027851	1.191248382	4.474649199	12.51238426	2.750628609	6.433757236	2.318240024	0.203698153	4.190844015	7.325829424	16.06625684	0.07719756	1.22203374	0	0	5.221959419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7954
H0317_802_0	2010	4	N/A																															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	NO	207.190579	0.70675	35.974214	11.624549	1.36322	6.303347	3.081154	15.197503	43.27372	9.342273	22.272692	7.873528	0.691741	14.255455	26.456328	58.021392	0.27882	4.31778			18.858343	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																			0.070205762	0.070205762	0.151599407	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.070205762	0.070205762	0.151599407	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				14.546	0.049617922	5.453669512	0	0.31763026	1.468679851	0.717908882	3.541018199	10.08277676	2.176749609	5.189537236	1.834532024	0.161175653	3.321521015	6.164324424	13.51898434	0.06496506	1.00604274	0	0	4.393993919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0091	0	0	14.546	0.049617922	5.453669512	0	0.31763026	1.468679851	0.717908882	3.541018199	10.08277676	2.176749609	5.189537236	1.834532024	0.161175653	3.321521015	6.164324424	13.51898434	0.06496506	1.00604274	0	0	4.393993919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0091	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				2.7078	0.0092	1.0152	0	1.2705	0.9683	0.4733	0.9336	2.4296	0.5739	1.2442	0.4837	0.0425	0.8693	1.1615	2.5473	0.0122	0.216			0.828	0																			17.7863	0	0	17.2537	0.05884998	6.468854941	0	1.58817926	2.437027851	1.191248382	4.474649199	12.51238426	2.750628609	6.433757236	2.318240024	0.203698153	4.190844015	7.325829424	16.06625684	0.07719756	1.22203374	0	0	5.221959419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7954
H0317_803_0	2010	4	N/A																															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	NO	207.190579	0.70675	35.974214	11.624549	1.36322	6.303347	3.081154	15.197503	43.27372	9.342273	22.272692	7.873528	0.691741	14.255455	26.456328	58.021392	0.27882	4.31778			18.858343	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																			0.070205762	0.070205762	0.151599407	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.070205762	0.070205762	0.151599407	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				14.546	0.049617922	5.453669512	0	0.31763026	1.468679851	0.717908882	3.541018199	10.08277676	2.176749609	5.189537236	1.834532024	0.161175653	3.321521015	6.164324424	13.51898434	0.06496506	1.00604274	0	0	4.393993919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0091	0	0	14.546	0.049617922	5.453669512	0	0.31763026	1.468679851	0.717908882	3.541018199	10.08277676	2.176749609	5.189537236	1.834532024	0.161175653	3.321521015	6.164324424	13.51898434	0.06496506	1.00604274	0	0	4.393993919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0091	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				2.7078	0.0092	1.0152	0	1.2705	0.9683	0.4733	0.9336	2.4296	0.5739	1.2442	0.4837	0.0425	0.8693	1.1615	2.5473	0.0122	0.216			0.828	0																			17.7863	0	0	17.2537	0.05884998	6.468854941	0	1.58817926	2.437027851	1.191248382	4.474649199	12.51238426	2.750628609	6.433757236	2.318240024	0.203698153	4.190844015	7.325829424	16.06625684	0.07719756	1.22203374	0	0	5.221959419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7954
H0318_002_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1457.290805	244.084183	792.1423088	635.2724392	207.4369103	12.00606878	0	345.5099482	411.0764815	2231.264546	2836.22082	39.8084171	0.139309411	242.1075115	3937.356457	4992.033877	290.0399161	644.4481425	0	0	278	0	0	0	648.1248436	0	50.29326453	0	66.30113346	0												$200/day 1-5	$200/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$200 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$10 per visit	$40 X-ray; $200 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$20 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$1100 Every 3 Yrs	Fitness Only	0											122.5677481	122.5677481	40.33133874	0	200	0.2	0.2	48.5	200	1.5	52	40	25	40	20	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0											NO	122.5677481	122.5677481	40.33133874	0	200	0.2	0.2	48.5	200	1.5	52	40	25	40	20	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0												14.8847	2.493070722	2.662346649	0	3.457281838	2.401213756	0	1.396436041	6.851274692	0.278908068	12.29029022	0.132694724	0.000290228	0.807025038	6.562260762	16.64011292	0.96679972	2.148160475	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0154	0	0	14.8847	2.493070722	2.662346649	0	3.457281838	2.401213756	0	1.396436041	6.851274692	0.278908068	12.29029022	0.132694724	0.000290228	0.807025038	6.562260762	16.64011292	0.96679972	2.148160475	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0154	NO																												0	0																																								0	0	0											0			14.8847	2.493070722	2.662346649	0	3.457281838	2.401213756	0	1.396436041	6.851274692	0.278908068	12.29029022	0.132694724	0.000290228	0.807025038	6.562260762	16.64011292	0.96679972	2.148160475	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0154
H0318_801_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	330.6730031	5.08153827	44.28476509	6.863484341	8.78048724	11.08591504	0	11.07999611	37.88638302	13.10986097	57.61034279	0.768913076	0.014628059	25.2575887	20.06331961	126.4621705	2.434403388	6.279034528	0	-9.93E-09	65.82513663	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												26.1036	0.401141464	5.876961919	0	2.045853527	2.583018205	0	2.581639094	8.827527244	3.054597605	13.42320987	0.179156747	0.003408338	5.885018168	4.67475347	29.46568572	0.567215989	1.463015045	0	-2.31E-09	15.33725683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4731			26.1036	0.401141464	5.876961919	0	2.045853527	2.583018205	0	2.581639094	8.827527244	3.054597605	13.42320987	0.179156747	0.003408338	5.885018168	4.67475347	29.46568572	0.567215989	1.463015045	0	-2.31E-09	15.33725683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4731	NO																																																																																		0			26.1036	0.401141464	5.876961919	0	2.045853527	2.583018205	0	2.581639094	8.827527244	3.054597605	13.42320987	0.179156747	0.003408338	5.885018168	4.67475347	29.46568572	0.567215989	1.463015045	0	-2.31E-09	15.33725683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4731
H0318_802_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	308.7811385	3.675078334	40.4064743	5.836581311	8.184845734	14.73784285	0	11.13953632	37.08411577	13.06299499	59.53317541	0.556094559	0.010579329	24.72274372	28.16448405	121.2909211	2.049816143	7.392675498	0	-7.18E-09	52.40548389	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.3755	0.290114179	5.362280013	0	1.907069056	3.433917385	0	2.595511963	8.640598975	3.043677832	13.87122987	0.129570032	0.002464984	5.760399286	6.562324784	28.26078461	0.477607161	1.722493391	0	-1.67E-09	12.21047775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.646			24.3755	0.290114179	5.362280013	0	1.907069056	3.433917385	0	2.595511963	8.640598975	3.043677832	13.87122987	0.129570032	0.002464984	5.760399286	6.562324784	28.26078461	0.477607161	1.722493391	0	-1.67E-09	12.21047775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.646	NO																																																																																		0			24.3755	0.290114179	5.362280013	0	1.907069056	3.433917385	0	2.595511963	8.640598975	3.043677832	13.87122987	0.129570032	0.002464984	5.760399286	6.562324784	28.26078461	0.477607161	1.722493391	0	-1.67E-09	12.21047775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.646
H0319_001_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	438.7121147	35.00075963	8613.202074	217.6185967	29.06742816	22.62189551	8.309068038	16.35351782	12.29726489	44.69691651	33.44167429	0	0.0166245	24.09322467	2.06996897	148.1645578	16.88046016	95.08005357	0	0	2.675819081	12.31207424	918.7106538	0	74.56328804	67.23422668	0	9.293414437	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075254649	0.076168673	0	0	0.2	0.2	0.116290062	0.052645658	0.2	0	0.061674445	0	0.2	0.15078126	0.00117836	0.199721132	0.2	0	0	0	0.2	0.197637538	0	0	0	0	0	0	0	0											NO	0.075254649	0.076168673	0	0	0.2	0.2	0.116290062	0.052645658	0.2	0	0.061674445	0	0.2	0.15078126	0.00117836	0.199721132	0.2	0	0	0	0.2	0.197637538	0	0	0	0	0	0	0	0												33.0151	2.665961418	0	0	5.813485633	4.524379103	0.96626204	0.860941713	2.459452977	0	2.062496687	0	0.0033249	3.632806768	0.002439168	29.59159317	3.376092032	0	0	0	0.535163816	2.433328038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9429	0	0	33.0151	2.665961418	0	0	5.813485633	4.524379103	0.96626204	0.860941713	2.459452977	0	2.062496687	0	0.0033249	3.632806768	0.002439168	29.59159317	3.376092032	0	0	0	0.535163816	2.433328038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9429	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												11.4447	0.9131	1.3929	0.0631	0.9689	0.7541	0.277	0.0957	0.4099	0.447	0.8765	0	0.0004	0.6055	0.0359	2.587	0.2947	0	0	0	0.0467	0.2124	0	0	0.0059	0	0	0	0	0											21.4312	0	0	44.4598	3.579024713	1.392945548	0.063073129	6.782399905	5.278442287	1.243230975	0.956601903	2.869361807	0.446969165	2.938979656	0	0.003694333	4.238274563	0.03836854	32.17859338	3.670830225	0	0	0	0.581884467	2.645761438	0	0	0.00585179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.3741
H0319_004_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1894.935712	52.38642185	47.58709264	1011.335677	576.1425697	19.23458802	17.01921726	429.0667804	52.88765778	13959.02597	59.63983278	0	0.301834178	35.01369983	7353.354656	6682.784495	626.4917544	697.1861571	0	0	28.25104804	1079.334546	667.1747619	0	144.9740982	0	15.17157515	4.527257313	78.63131122	0											3850	"$275 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											190.6084929	140.5472438	0.140506915	0	150	0.2	0.089545575	49.2570796	0.2	3	0.169934887	0	0.2	0.149480149	10.27830259	39.36565866	38.5	40	0	0	0.2	39.54961749	0	0	40	0	0	0	0	0											NO	135.2506482	99.72853537	0.099699919	0	106.4359564	0.141914608	0.063539126	34.95149584	0.141914608	2.128719127	0.120581215	0	0.141914608	0.106135981	10.07925411	39.36565866	38.5	28.3829217	0	0	0.141914608	39.54961749	0	0	40	0	0	0	0	0												21.3576	0.435368427	4.744429283	0	5.110190451	2.729669028	1.081386195	1.249710482	7.505531247	2.476237131	7.191443481	0	0.042834679	3.716213379	6.176360846	21.92268444	2.009994379	1.649015009	0	0	4.009236422	3.55727237	0	0	0.483246994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4484	0	26.02668654	21.3576	0.435368427	4.744429283	0	5.110190451	2.729669028	1.081386195	1.249710482	7.505531247	2.476237131	7.191443481	0	0.042834679	3.716213379	6.176360846	21.92268444	2.009994379	1.649015009	0	0	4.009236422	3.55727237	0	0	0.483246994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4484	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												11.6931	0.2993	0.2174	0.2776	0.7123	0.5707	0.505	0.1742	1.5692	0.3451	1.4789	0	0.006	0.7831	1.6163	6.201	0.3244	0.2507	0	0	1.2108	0.2753	0	0	0.0302	0	0.0028	0.003	0	0											28.5464	0	0	33.0507	0.734703532	4.961832244	0.277639816	5.822454617	3.300365595	1.586351982	1.423896553	9.074725488	2.821377883	8.670367988	0	0.048805026	4.499273184	7.792675545	28.12370099	2.334427609	1.899701952	0	0	5.219995624	3.832565824	0	0	0.513469004	0	0.002836946	0.002978459	0	0	0	0	0	0	0	0	0	0	0	0	125.9949
H0320_001_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	1252.077668	29.29828125	465.4656804	665.4424524	156.4629282	13.65505797	5.218822028	429.1847481	175.1154508	3.221281761	13.1257287	0.369738483	0.106926237	6.900790323	4837.177099	3452.46747	80.78095114	89.69154935	23.20738205	105.4839244	7.493466441	0	0	0	295	7.153245214	0	0	0	0												1a (IP Acute): $215 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $225 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $350 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $7 Copay per visit;	7d (SPC w/Copay): $34 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 55 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): $40 Copay per visit; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $125 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											130.0729293	154.9390105	55.54414372	0	225	0.2	0.193567504	48.51414977	350	0	0.188189246	0.2	0.2	0.199944574	5.754940435	34	40	40	0.2	0.158433941	0.2	0	0	0	25	0	0	0	0	0											NO	130.0729293	154.9390105	55.54414372	0	225	0.2	0.193567504	48.51414977	350	0	0.188189246	0.2	0.2	0.199944574	5.754940435	34	40	40	0.2	0.158433941	0.2	0	0	0	25	0	0	0	0	0												13.5718	0.378287226	2.154491054	0	2.933679903	2.731011595	1.010194353	1.735127762	5.107533981	0	2.470120986	0.073947697	0.021385247	1.379775581	2.319805507	9.781991164	0.269269837	0.298971831	4.64147641	16.71223384	1.498693288	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7044	0	0	13.5718	0.378287226	2.154491054	0	2.933679903	2.731011595	1.010194353	1.735127762	5.107533981	0	2.470120986	0.073947697	0.021385247	1.379775581	2.319805507	9.781991164	0.269269837	0.298971831	4.64147641	16.71223384	1.498693288	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7044	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.5718	0.378287226	2.154491054	0	2.933679903	2.731011595	1.010194353	1.735127762	5.107533981	0	2.470120986	0.073947697	0.021385247	1.379775581	2.319805507	9.781991164	0.269269837	0.298971831	4.64147641	16.71223384	1.498693288	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7044
H0320_005_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1625.542544	2.483395986	514.5010474	323.1823986	154.3401259	13.67541668	4.768895419	433.0651392	204.001909	4.078356434	21.59847557	0.03143828	0.695668954	3.381331756	4608.248428	4192.133885	39.18049133	80.12503281	12.75763011	127.720849	4.680109251	0	0	0	295	14.75287189	0	0	0	0											4950	1a (IP Acute): $215 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-6);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $225 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $350 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $55 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $7 Copay per visit;	7d (SPC w/Copay): $33 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 55 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $125 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											116.1868687	260	50.22637795	0	225	0.2	0.197476152	46.21578119	350	0	0.186411061	0.2	0.2	0.199202893	5.713430495	33	40	40	0.2	0.039528696	0.2	0	0	0	25	0	0	0	0	0											NO	107.8341387	241.3084748	46.61557945	0	208.8246416	0.185621904	0.183279496	42.89330642	324.8383314	0	0.17300988	0.185621904	0.185621904	0.184882101	5.302689225	30.6276141	37.12438073	37.12438073	0.185621904	0.036686959	0.185621904	0	0	0	25	0	0	0	0	0												14.6074	0.049938708	1.998647038	0	2.685835124	2.538456877	0.874040749	1.54796631	5.52230331	0	3.736749677	0.005835633	0.129131396	0.625147719	2.03634244	10.69958824	0.121212623	0.247882685	2.368095588	4.685689609	0.868730789	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9636	0	4.287281702	14.6074	0.049938708	1.998647038	0	2.685835124	2.538456877	0.874040749	1.54796631	5.52230331	0	3.736749677	0.005835633	0.129131396	0.625147719	2.03634244	10.69958824	0.121212623	0.247882685	2.368095588	4.685689609	0.868730789	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9636	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.6074	0.049938708	1.998647038	0	2.685835124	2.538456877	0.874040749	1.54796631	5.52230331	0	3.736749677	0.005835633	0.129131396	0.625147719	2.03634244	10.69958824	0.121212623	0.247882685	2.368095588	4.685689609	0.868730789	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9636
H0320_006_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	1357.829517	22.69663406	264.3542939	623.5948793	124.7557398	11.24324173	4.392617835	358.2961072	159.574452	2.09179577	8.19084408	0.142052571	0.06246906	5.046341848	4317.766498	3356.51666	85.70111297	67.55258982	28.61162217	94.84299348	7.208994637	0	0	0	295	7.375592635	0	0	0	0												1a (IP Acute): $215 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $225 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $350 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $45 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $7 Copay per visit;	7d (SPC w/Copay): $33 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 55 copay per visit;	7c (OT): $45 Copay per visit; 7i (PT/ST): $45 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 45 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $45 Copay per visit; 7b (Chiro): $45 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $45 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 45 copay per visit; 7g1 (Prof. Other Coins): $45 Copay per visit; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $125 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $45 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 45 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											97.93671522	181.9089898	46.85529103	0	225	0.2	0.194076333	48.5104455	350	0	0.186490472	0.2	0.2	0.19525137	5.682371993	33	40	45	0.2	0.17098758	0.2	0	0	0	25	0	0	0	0	0											NO	97.93671522	181.9089898	46.85529103	0	225	0.2	0.194076333	48.5104455	350	0	0.186490472	0.2	0.2	0.19525137	5.682371993	33	40	45	0.2	0.17098758	0.2	0	0	0	25	0	0	0	0	0												11.0818	0.344060148	1.032199781	0	2.339170121	2.248648345	0.852503162	1.448425315	4.654254851	0	1.527514379	0.028410514	0.012493812	0.985305159	2.044596285	9.230420815	0.285670377	0.253322212	5.722324435	16.21697396	1.441798927	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3645	0	0	11.0818	0.344060148	1.032199781	0	2.339170121	2.248648345	0.852503162	1.448425315	4.654254851	0	1.527514379	0.028410514	0.012493812	0.985305159	2.044596285	9.230420815	0.285670377	0.253322212	5.722324435	16.21697396	1.441798927	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3645	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.0818	0.344060148	1.032199781	0	2.339170121	2.248648345	0.852503162	1.448425315	4.654254851	0	1.527514379	0.028410514	0.012493812	0.985305159	2.044596285	9.230420815	0.285670377	0.253322212	5.722324435	16.21697396	1.441798927	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3645
H0320_007_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1090.29355	38.94181408	434.921705	867.4945813	141.703468	10.50485601	4.146053662	387.4824444	178.8971758	2.671180543	8.680904684	0.301243233	0.145509137	7.320263955	4244.348825	3007.937624	95.57453677	64.74263177	18.49146804	85.1802174	7.207304265	0	0	0	401	4.987994356	0	0	0	0											3950	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $225 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $350 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $125 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);	18b (Hearing Aids): 500 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											88.93913845	117.2682083	21.05796869	0	225	0.2	0.191238792	48.77883199	350	0	0.18783495	0.2	0.2	0.19887222	0	30	40	30	0.2	0.035100166	0.2	0	0	0	5	0	0	0	0	0											NO	80.99729471	106.7967128	19.17759185	0	204.9085659	0.182140947	0.174162074	44.42311337	318.7466581	0	0.171062178	0.182140947	0.182140947	0.181113873	0	27.32114212	36.42818949	27.32114212	0.182140947	0.031965887	0.182140947	0	0	0	5	0	0	0	0	0												7.3592	0.346571478	0.695062579	0	2.419687868	1.913364427	0.722085304	1.43443138	4.751906411	0	1.484974466	0.054868728	0.026503172	1.325801357	0	6.848357609	0.290133945	0.147403554	3.368053509	2.72286122	1.312745227	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3911	0	3.566009061	7.3592	0.346571478	0.695062579	0	2.419687868	1.913364427	0.722085304	1.43443138	4.751906411	0	1.484974466	0.054868728	0.026503172	1.325801357	0	6.848357609	0.290133945	0.147403554	3.368053509	2.72286122	1.312745227	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3911	NO	1a (IP Acute): 30% Coinsurance; 1a1 (Add'l Days): 30% coin per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): 30% Coinsurance;	2a (SNF): 20% Coinsurance; 2a2 (Waiver 3 Day): 20% coin;	6a (Home Health): 20% Coinsurance;	10a (Ambulance): 20% Coinsurance;	11a (DME): Not Covered; 11b (Prosthetics): Not Covered;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 20% Coinsurance;	4a (ER): Not Covered; 4a (ER) - Worldwide Coverage: n/a; 4b (UC): Not Covered;	9b (OP Surg): 20% Coinsurance;	8a (OP Diag Proc/Test/Lab): 20% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): Not Covered; 8b (X-Ray): 20% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): Not Covered;	3 (CORF): Not Covered; 5 (Partial Hosp): 20% Coinsurance; 9a (OP Chemo): Not Covered; 9a (OP Services): 20% Coinsurance; 9c (OP SA): Not Covered; 9d (OP Cardiac Rehab): 20% Coinsurance;	14b (Immunizations): 20% Coinsurance; 14c (Medicare Covered Physical Exam): 20% coin; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 20% coin; 14e (Prostate Screening): 20% coin; 14f (Colorectal Screening): 20% coin; 14g (Bone Mass): 20% coin; 14i (Diabetes Educ.): 20% coin; 14j (Nutrition Therapy Diabetes): 20% coin; 14h (Mammography): 20% Coinsurance; 7a (PCP w/Copay): $40 Copay per visit;	7d (SPC w/Copay): $40 Copay per visit;	7h (Psych): Not Covered; 7e (MH Non-Phys): n/a per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20% Coinsurance; 8b (X-Ray): 20% Coinsurance; 9a (OP Chemo): Not Covered; 9b (OP ASC): 20% Coinsurance; All other Services: No Cost Sharing;	15 (Part B Rx): Not Covered;	13a (Blood): 20% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): Not Covered;	17a1 (Routine Eye Exam): Not Covered;	17b1 (Non MCR Covered): Not Covered;	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;	18b (Hearing Aids) - Enhanced Benefit Limit ( $ allowance/ # years): 0% Coinsurance; 18b (Hearing Aids): Not Covered;		13c (OTC Rx): Not Covered;												2.9468	0.0496	0.173	0.2125	0.0726	0	0.0473	0	0.275	0.0305	0.099	0.0034	0	0.0819	0.5486	0.4898	0	0.0135	0.2111	0.8784	0	0	0	0	0	0	0	0	0	0											6.133	500	1.581577393	10.3061	0.396126884	0.86801553	0.212478378	2.49232515	1.913364427	0.769416754	1.43443138	5.026868673	0.030494263	1.583931275	0.058307728	0.026503172	1.407716763	0.548591853	7.338174616	0.290133945	0.160919444	3.579152562	3.60127978	1.312745227	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5241
H0321_002_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	Coin	P	P	P	P	O	O											0	0	0	0	0.9247	0.0198	0.0126	0	1.4519	0	1.4468	0	0.0161	0.8013	1.8783	3.6878	0.1197	0.1339	0	0	0.5745	0.5293	0	0	0	0	0	0	0	0											11.5967	NO	290.4381159	17.68171123	27.2650581	1748.357515	23.71585429	0.50847815	0.322637554	39.54042513	37.23498451	10.11175858	37.10403574	0	0.41195533	20.54895696	50.81479458	94.71739967	3.070954551	3.435122794	0	0	14.73277735	13.84458767	0	8.479039942	102.7762417	87.70239293	14.95766388	2.877734768	3425.874724	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14c, 14e, 14f, 14g, 14h, 14i, 14j); $0/20% (14b); $0 n/c (14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14d)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 17a, 18a); $0 n/c (13a1); $0 (17b)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1); 20% (16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.073419276	0.073419276	0.143941692	0	0.192201421	0.192201421	0.192201421	0.086350165	0.192201421	0.129235735	0.161838815	0	0.192201421	0.145996968	0.184710071	0.191914659	0.432453198	0.192201421	0	0	0.192201421	0.189255338	0	0.141010101	0	0	0	0	0	0											NO	0.073419276	0.073419276	0.143941692	0	0.192201421	0.192201421	0.192201421	0.086350165	0.192201421	0.129235735	0.161838815	0	0.192201421	0.145996968	0.184710071	0.191914659	0.432453198	0.192201421	0	0	0.192201421	0.189255338	0	0.141010101	0	0	0	0	0	0												21.3238	1.298178441	3.924578585	0	4.558220906	0.097730223	0.062011397	3.414322215	7.156616951	1.306800554	6.004873194	0	0.0791784	3.000085421	9.38600429	18.17765746	1.328044117	0.660235484	0	0	2.831660749	2.620162124	0	1.195630279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.4257	146	0	21.3238	1.298178441	3.924578585	0	5.48297067	0.117557257	0.074591968	3.414322215	8.608516709	1.306800554	7.451666881	0	0.09524173	3.801348696	11.26428368	21.8654525	1.447789519	0.794180859	0	0	3.406134356	3.149418441	0	1.195630279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0224	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	21.3238	1.298178441	3.924578585	0	5.48297067	0.117557257	0.074591968	3.414322215	8.608516709	1.306800554	7.451666881	0	0.09524173	3.801348696	11.26428368	21.8654525	1.447789519	0.794180859	0	0	3.406134356	3.149418441	0	1.195630279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.0224
H0332_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	Coin	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	0	0	0	0	0											0	YES	916.5889182	20.08867723	433.0624059	823.762283	119.8152701	6.093956704	7.009348212	272.8383652	318.7546249	5.721223	1178.03644	0	74.78680194	435.0384455	13661.45864	17301.63502	291.3524804	1088.700381	7520.785877	17707.24794	36.7271919	13.18711369	236.3673244	0	326.2183913	3.245923608	210.9377671	24.778301	450.6616507	375.9108717											3400	"$375 copay, days 1-1"	"$375 copay, days 1-1"	"$125 copay, days 21-100"	$0 copay	$100 copay	10% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$150 copay	$0 copay to $6.25 copay	Varies	$0 copay	$25 copay	Varies	$0 copay	$0 copay	"$20 copay Group, $35 copay Individual"	$0 copay	0% coinsurance	Varies	10% coinsurance	Varies	$0 copay	Not Covered	$0 copay	$0 copay; and $150 credit covered every 2years	$0 copay	$1000 credit	Varies	Varies											68.18181818	47.89272031	35.89406782	0	100	0.1	0.126904072	45	150	0	12.21038022	0	25	11.07006416	0.047037371	0.052482029	33.5	0	0	1.012481293	10	0	0	0	0	0	0	0	0	0											NO	67.60033702	47.89272031	35.43254728	0	100	0.097266866	0.12531994	45	149.3729748	0	12.04071891	0	25	10.76378135	0.034127343	0.039572001	33.5	0	0	1.004956419	10	0	0	0	0	0	0	0	0	0												5.1635	0.080175117	1.278708681	0	0.998460584	0.592740071	0.878411097	1.023143869	3.967777212	0	1.182033804	0	0.155805837	0.390221559	0.038852441	0.057055027	0.813359008	0	0	1.482917707	0.030605993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.1337		0.222074663	5.1635	0.080175117	1.278708681	0	0.998460584	0.592740071	0.878411097	1.023143869	3.967777212	0	1.182033804	0	0.155805837	0.390221559	0.038852441	0.057055027	0.813359008	0	0	1.482917707	0.030605993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.1337	NO																																																																																		0			5.1635	0.080175117	1.278708681	0	0.998460584	0.592740071	0.878411097	1.023143869	3.967777212	0	1.182033804	0	0.155805837	0.390221559	0.038852441	0.057055027	0.813359008	0	0	1.482917707	0.030605993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.1337
H0332_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	V	V	V	V	V	V	V	V	S	O	T	V	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	0	0	0	0	0											0	YES	1695.29217	37.16244205	416.0069519	593.7247265	184.7042364	6.094484411	7.009955187	315.0340541	283.8735539	5.561513225	1331.586926	0	85.44861756	495.7227729	10937.25732	13520.12353	240.1818294	832.6076279	6028.372116	14124.68543	21.31528396	4.538065627	68.82208646	0	315.5530317	0	133.1230276	16.67514783	143.2767117	240.5790971											3400	"$500 copay, days 1-1"	"$500 copay, days 1-1"	"$125 copay, days 21-100"	$0 copay	$100 copay	10% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$175 copay	$0 copay to $6.25 copay	Varies	$0 copay	$25 copay	Varies	$0 copay	$15 copay	"$20 copay Group, $35 copay Individual"	$15 copay	0% coinsurance	Varies	10 % coinsurance	Varies	$0 copay	Not Covered	$15 copay	"$0 copay, $0 credit"	$15 copay	$1000 credit	Varies	Varies											90.90909091	63.85696041	35.89406782	0	100	0.1	0.126904072	45	175	0	12.18010366	0	25	23.66660878	1.031048654	8.601738271	33.5	15	0	2.611145234	10	0	0	0	15	0	15	0	0	0											NO	89.27772904	63.85696041	33.40104909	0	100	0.085818965	0.118684705	45	171.3465666	0	11.40124867	0	25	22.27185997	0.946238827	8.516928443	33.5	15	0	2.562194852	10	0	0	0	15	0	15	0	0	0												12.6127	0.197756716	1.157922385	0	1.53920197	0.523022347	0.831974462	1.181377703	4.053396568	0	1.265146139	0	0.178017953	0.920055682	0.862438128	9.595827054	0.670507607	1.040759535	0	3.015849692	0.017762737	0	0	0	0.39444129	0	0.166403784	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2245		1.152347917	12.6127	0.197756716	1.157922385	0	1.53920197	0.523022347	0.831974462	1.181377703	4.053396568	0	1.265146139	0	0.178017953	0.920055682	0.862438128	9.595827054	0.670507607	1.040759535	0	3.015849692	0.017762737	0	0	0	0.39444129	0	0.166403784	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2245	NO																																																																																		0			12.6127	0.197756716	1.157922385	0	1.53920197	0.523022347	0.831974462	1.181377703	4.053396568	0	1.265146139	0	0.178017953	0.920055682	0.862438128	9.595827054	0.670507607	1.040759535	0	3.015849692	0.017762737	0	0	0	0.39444129	0	0.166403784	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2245
H0332_003_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	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	0	0	0	0	0											0	YES	1073.146271	23.51991023	888.79346	2268.901908	166.3247011	6.146401571	7.069670979	168.4655898	208.1147124	1043.654481	1236.582407	0	78.50355079	456.6589534	7061.614896	8940.913851	150.6456398	562.9194068	3888.66983	9155.644364	138.7961201	67.83962987	977	0	385.6939429	271.241053	164.0937993	19.27566413	2400	367.8949911											3400	"$375 copay, days 1-1"	"$375 copay, days 1-1"	"$125 copay, days 21-100"	$0 copay	$100 copay	10% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$150 copay	$0 copay to $6.25 copay	Varies	$0 copay	$25 copay	Varies	$0 copay	$0 copay	"$20 copay Group, $35 copay Individual"	$0 copay	0% coinsurance	Varies	10% coinsurance	Varies	$0 copay	Not Covered	$0 copay	$0 copay; and $150 credit covered every 2years	$0 copay	$1000 credit	Varies	Varies											64.77272727	47.89272031	35.89406782	0	95	0.1	0.126904072	45	142.5	0	11.59986121	0	23.75	10.51656095	0.044698972	0.049885841	33.5	0	0	0.961857228	9.5	0	0	0	0	0	0	0	0	0											NO	64.26181295	47.89272031	35.6505595	0	95	0.097065646	0.125203312	45	141.5120488	0	11.43359071	0	23.75	10.21639943	0.019002136	0.024189006	33.5	0	0	0.946885977	9.5	0	0	0	0	0	0	0	0	0												5.7469	0.093869374	2.640498677	0	1.316737217	0.59660444	0.885146223	0.631745962	2.454228278	0	1.178214759	0	0.155371611	0.388784189	0.011182147	0.018022652	0.420552411	0	0	0.722445938	0.109880262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.3701		0.229767635	5.7469	0.093869374	2.640498677	0	1.316737217	0.59660444	0.885146223	0.631745962	2.454228278	0	1.178214759	0	0.155371611	0.388784189	0.011182147	0.018022652	0.420552411	0	0	0.722445938	0.109880262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.3701	NO	"$1000 copay, days 1-1"	Not Covered	Not Covered	Not Covered	20% coinsurance	Not Covered	Not Covered	Not Covered	$60 copay to 20% coinsurance	20% coinsurance	Varies	$0 copay	20% coinsurance	Varies	20% coinsurance	20% coinsurance	Not Covered	Not Covered	20% coinsurance	Varies	$0 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												1.8304	0	0	0	0.1173	0	0	0	0.337	0.0756	0.3375	0	0.0127	0.1224	0.6517	1.492	0	0	0.4894	0.4588	0	0	0	0	0	0	0	0	0	0											5.9246			7.5773	0.093869374	2.640498677	0	1.434079577	0.59660444	0.885146223	0.631745962	2.791185974	0.07556248	1.515666198	0	0.168093918	0.511164967	0.662832277	1.509998692	0.420552411	0	0.489386416	1.181246628	0.109880262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2948
H0332_004_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	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	0	0	0	0	0											0	YES	1043.762049	22.88027239	863.9251879	2205.418464	161.6709675	5.93619912	6.827893388	163.7519546	201.9001019	1014.947038	1223.978892	0	78.54335472	456.2862791	6927.012512	8558.743279	152.1977671	527.6045327	3820.042415	8968.746647	136.3190013	65.94148992	977	0	373.5514953	0	151.8046375	19.01522837	2400	371.9010747											3400	"$500 copay, days 1-1"	"$500 copay, days 1-1"	"$125 copay, days 21-100"	$0 copay	$100 copay	10% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$175 copay	$0 copay to $6.25 copay	Varies	$0 copay	$25 copay	Varies	$0 copay	$15 copay	"$20 copay Group, $35 copay Individual"	$15 copay	0% coinsurance	Varies	10% coinsurance	Varies	$0 copay	Not Covered	$15 copay	"$0 copay, $0 credit"	$15 copay	$1000 credit	Varies	Varies											86.36363636	63.85696041	35.89406782	0	95	0.1	0.126904072	45	166.25	0	11.57109848	0	23.75	16.53271881	0.972448324	8.165506951	33.5	15	0	2.267078334	0	0	0	0	15	0	15	0	0	0											NO	83.81181193	63.85696041	34.67708676	0	95	0.085240547	0.118349452	45	161.3029418	0	10.75506189	0	23.75	15.07338417	0.843450867	8.036509494	33.5	15	0	2.192834474	0	0	0	0	15	0	15	0	0	0												7.29	0.121755387	2.496534058	0	1.27989516	0.506004863	0.808077441	0.61406983	2.713923365	0	1.096997395	0	0.15545039	0.573148198	0.486882892	5.731868468	0.424885433	0.659505666	0	1.638914736	0	0	0	0	0.466939369	0	0.189755797	0	0	0	0	0	0	0	0	0	0	0	0	0	27.2546		1.116105071	7.29	0.121755387	2.496534058	0	1.27989516	0.506004863	0.808077441	0.61406983	2.713923365	0	1.096997395	0	0.15545039	0.573148198	0.486882892	5.731868468	0.424885433	0.659505666	0	1.638914736	0	0	0	0	0.466939369	0	0.189755797	0	0	0	0	0	0	0	0	0	0	0	0	0	27.2546	NO	"$1000 copay, days 1-1"	Not Covered	Not Covered	Not Covered	20% coinsurance	Not Covered	Not Covered	Not Covered	$60 copay to 20% coinsurance	20% coinsurance	Varies	$0 copay	20% coinsurance	Varies	20% coinsurance	20% coinsurance	Not Covered	Not Covered	20% coinsurance	Varies	$0 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												1.8014	0	0	0	0.1155	0	0	0	0.3316	0.0744	0.3321	0	0.0125	0.1204	0.6548	1.4992	0	0	0.4917	0.4609	0	0	0	0	0	0	0	0	0	0											5.8945			9.0914	0.121755387	2.496534058	0	1.395380088	0.506004863	0.808077441	0.61406983	3.045547258	0.074366387	1.429107265	0	0.167971314	0.693591792	1.141683086	7.231056693	0.424885433	0.659505666	0.491651635	2.099827516	0	0	0	0	0.466939369	0	0.189755797	0	0	0	0	0	0	0	0	0	0	0	0	0	33.1491
H0332_801_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			10.85	0.09	0	0	0.14	0.15	0.18	0.23	0.68	0.16	0.8	0	0.03	0.54	3.18	6.3	0.08	0.3	2.19	1.67	0.16	0.07																			27.8	NO	833.5258633	18.39042916	677.3376306	1755.54934	4.279954133	4.617543676	5.311158756	7.050263102	20.71065443	4.964133753	24.17997131	0	1.007538108	16.48188545	96.41156999	190.9404921	2.55487249	9.109856365	66.2393499	50.62600847	4.867554341	2.222525697	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											13.6067669	5.260257841	80.82898937	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	0											NO	13.6067669	5.260257841	80.82898937	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	0												0.9451	0.008061533	4.562376345	0	0.855990827	0.923508735	1.062231751	1.41005262	4.142130887	0.992826751	4.835994261	0	0.201507622	3.296377091	19.282314	38.18809842	0.510974498	1.821971273	13.24786998	10.12520169	0.973510868	0.444505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8306	Medicare Standard Deductible(s)		11.7951	0.098061533	4.562376345	0	0.995990827	1.073508735	1.242231751	1.64005262	4.822130887	1.152826751	5.635994261	0	0.231507622	3.836377091	22.462314	44.48809842	0.590974498	2.121971273	15.43786998	11.79520169	1.133510868	0.514505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.6306	NO																																																																																		0			11.7951	0.098061533	4.562376345	0	0.995990827	1.073508735	1.242231751	1.64005262	4.822130887	1.152826751	5.635994261	0	0.231507622	3.836377091	22.462314	44.48809842	0.590974498	2.121971273	15.43786998	11.79520169	1.133510868	0.514505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.6306
H0332_803_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			12.81	0.11	0	0	0.17	0.18	0.2	0.28	0.82	0.17	0.83	0	0.03	0.57	3.19	6.33	0.08	0.3	2.19	1.67	0.18	0.09																			30.2	NO	947.5788673	20.91509072	776.369077	2012.222796	5.102355429	5.382870491	6.191447607	8.408399041	24.70027634	5.174014566	25.20590495	0	1.050314506	17.17962599	96.75861712	191.7009144	2.558846675	9.124027034	66.34243343	50.70481529	5.574910491	2.649777404	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											14.12915466	5.462661279	84.10312123	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	0											NO	14.12915466	5.462661279	84.10312123	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	0												1.1157	0.009521005	5.441255217	0	1.020471086	1.076574098	1.238289521	1.681679808	4.940055268	1.034802913	5.04118099	0	0.210062901	3.435925199	19.35172342	38.34018288	0.511769335	1.824805407	13.26848669	10.14096306	1.114982098	0.529955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3284	Medicare Standard Deductible(s)		13.9257	0.119521005	5.441255217	0	1.190471086	1.256574098	1.438289521	1.961679808	5.760055268	1.204802913	5.87118099	0	0.240062901	4.005925199	22.54172342	44.67018288	0.591769335	2.124805407	15.45848669	11.81096306	1.294982098	0.619955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5284	NO																																																																																		0			13.9257	0.119521005	5.441255217	0	1.190471086	1.256574098	1.438289521	1.961679808	5.760055268	1.204802913	5.87118099	0	0.240062901	4.005925199	22.54172342	44.67018288	0.591769335	2.124805407	15.45848669	11.81096306	1.294982098	0.619955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5284
H0332_804_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			10.85	0.09	0	0	0.14	0.15	0.18	0.23	0.68	0.16	0.8	0	0.03	0.54	3.18	6.3	0.08	0.3	2.19	1.67	0.16	0.07																			27.8	NO	833.5258633	18.39042916	677.3376306	1755.54934	4.279954133	4.617543676	5.311158756	7.050263102	20.71065443	4.964133753	24.17997131	0	1.007538108	16.48188545	96.41026106	190.9378971	2.554837679	9.10973224	66.23845079	50.62532286	4.867554341	2.222525697	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											13.6067669	5.260257841	80.82898937	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	0											NO	13.6067669	5.260257841	80.82898937	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	0												0.9451	0.008061533	4.562376345	0	0.855990827	0.923508735	1.062231751	1.41005262	4.142130887	0.992826751	4.835994261	0	0.201507622	3.296377091	19.28205221	38.18757942	0.510967536	1.821946448	13.24769016	10.12506457	0.973510868	0.444505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8295	Medicare Standard Deductible(s)		11.7951	0.098061533	4.562376345	0	0.995990827	1.073508735	1.242231751	1.64005262	4.822130887	1.152826751	5.635994261	0	0.231507622	3.836377091	22.46205221	44.48757942	0.590967536	2.121946448	15.43769016	11.79506457	1.133510868	0.514505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.6295	NO																																																																																		0			11.7951	0.098061533	4.562376345	0	0.995990827	1.073508735	1.242231751	1.64005262	4.822130887	1.152826751	5.635994261	0	0.231507622	3.836377091	22.46205221	44.48757942	0.590967536	2.121946448	15.43769016	11.79506457	1.133510868	0.514505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.6295
H0332_805_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			12.81	0.11	0	0	0.17	0.18	0.2	0.28	0.82	0.17	0.83	0	0.03	0.57	3.19	6.33	0.08	0.3	2.19	1.67	0.18	0.09																			30.2	NO	947.5788673	20.91509072	776.369077	2012.222796	5.102355429	5.382870491	6.191447607	8.408399041	24.70027634	5.174014566	25.20590495	0	1.050314506	17.17962599	96.75837545	191.7004351	2.558840261	9.124004163	66.34226777	50.70468896	5.574910491	2.649777404	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											14.12915466	5.462661279	84.10312123	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	0											NO	14.12915466	5.462661279	84.10312123	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	0												1.1157	0.009521005	5.441255217	0	1.020471086	1.076574098	1.238289521	1.681679808	4.940055268	1.034802913	5.04118099	0	0.210062901	3.435925199	19.35167509	38.34008702	0.511768052	1.824800833	13.26845355	10.14093779	1.114982098	0.529955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3282	Medicare Standard Deductible(s)		13.9257	0.119521005	5.441255217	0	1.190471086	1.256574098	1.438289521	1.961679808	5.760055268	1.204802913	5.87118099	0	0.240062901	4.005925199	22.54167509	44.67008702	0.591768052	2.124800833	15.45845355	11.81093779	1.294982098	0.619955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5282	NO																																																																																		0			13.9257	0.119521005	5.441255217	0	1.190471086	1.256574098	1.438289521	1.961679808	5.760055268	1.204802913	5.87118099	0	0.240062901	4.005925199	22.54167509	44.67008702	0.591768052	2.124800833	15.45845355	11.81093779	1.294982098	0.619955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5282
H0332_806_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			10.85	0.09	0	0	0.14	0.15	0.18	0.23	0.68	0.16	0.8	0	0.03	0.54	3.18	6.3	0.08	0.3	2.19	1.67	0.16	0.07																			27.8	NO	833.5258633	18.39042916	677.3376306	1755.54934	4.279954133	4.617543676	5.311158756	7.050263102	20.71065443	4.964133753	24.17997131	0	1.007538108	16.48188545	96.41026106	190.9378971	2.554837679	9.10973224	66.23845079	50.62532286	4.867554341	2.222525697	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											13.6067669	5.260257841	80.82898937	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	0											NO	13.6067669	5.260257841	80.82898937	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	0												0.9451	0.008061533	4.562376345	0	0.855990827	0.923508735	1.062231751	1.41005262	4.142130887	0.992826751	4.835994261	0	0.201507622	3.296377091	19.28205221	38.18757942	0.510967536	1.821946448	13.24769016	10.12506457	0.973510868	0.444505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8295	Medicare Standard Deductible(s)		11.7951	0.098061533	4.562376345	0	0.995990827	1.073508735	1.242231751	1.64005262	4.822130887	1.152826751	5.635994261	0	0.231507622	3.836377091	22.46205221	44.48757942	0.590967536	2.121946448	15.43769016	11.79506457	1.133510868	0.514505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.6295	NO																																																																																		0			11.7951	0.098061533	4.562376345	0	0.995990827	1.073508735	1.242231751	1.64005262	4.822130887	1.152826751	5.635994261	0	0.231507622	3.836377091	22.46205221	44.48757942	0.590967536	2.121946448	15.43769016	11.79506457	1.133510868	0.514505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.6295
H0332_807_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			12.81	0.11	0	0	0.17	0.18	0.2	0.28	0.82	0.17	0.83	0	0.03	0.57	3.19	6.33	0.08	0.3	2.19	1.67	0.18	0.09																			30.2	NO	947.5788673	20.91509072	776.369077	2012.222796	5.102355429	5.382870491	6.191447607	8.408399041	24.70027634	5.174014566	25.20590495	0	1.050314506	17.17962599	96.75837545	191.7004351	2.558840261	9.124004163	66.34226777	50.70468896	5.574910491	2.649777404	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											14.12915466	5.462661279	84.10312123	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	0											NO	14.12915466	5.462661279	84.10312123	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	0												1.1157	0.009521005	5.441255217	0	1.020471086	1.076574098	1.238289521	1.681679808	4.940055268	1.034802913	5.04118099	0	0.210062901	3.435925199	19.35167509	38.34008702	0.511768052	1.824800833	13.26845355	10.14093779	1.114982098	0.529955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3282	Medicare Standard Deductible(s)		13.9257	0.119521005	5.441255217	0	1.190471086	1.256574098	1.438289521	1.961679808	5.760055268	1.204802913	5.87118099	0	0.240062901	4.005925199	22.54167509	44.67008702	0.591768052	2.124800833	15.45845355	11.81093779	1.294982098	0.619955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5282	NO																																																																																		0			13.9257	0.119521005	5.441255217	0	1.190471086	1.256574098	1.438289521	1.961679808	5.760055268	1.204802913	5.87118099	0	0.240062901	4.005925199	22.54167509	44.67008702	0.591768052	2.124800833	15.45845355	11.81093779	1.294982098	0.619955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5282
H0332_808_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			10.85	0.09	0	0	0.14	0.15	0.18	0.23	0.68	0.16	0.8	0	0.03	0.54	3.18	6.3	0.08	0.3	2.19	1.67	0.16	0.07																			27.8	NO	833.5258633	18.39042916	677.3376306	1755.54934	4.279954133	4.617543676	5.311158756	7.050263102	20.71065443	4.964133753	24.17997131	0	1.007538108	16.48188545	96.41026106	190.9378971	2.554837679	9.10973224	66.23845079	50.62532286	4.867554341	2.222525697	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											13.6067669	5.260257841	80.82898937	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	0											NO	13.6067669	5.260257841	80.82898937	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	0												0.9451	0.008061533	4.562376345	0	0.855990827	0.923508735	1.062231751	1.41005262	4.142130887	0.992826751	4.835994261	0	0.201507622	3.296377091	19.28205221	38.18757942	0.510967536	1.821946448	13.24769016	10.12506457	0.973510868	0.444505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8295	Medicare Standard Deductible(s)		11.7951	0.098061533	4.562376345	0	0.995990827	1.073508735	1.242231751	1.64005262	4.822130887	1.152826751	5.635994261	0	0.231507622	3.836377091	22.46205221	44.48757942	0.590967536	2.121946448	15.43769016	11.79506457	1.133510868	0.514505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.6295	NO																																																																																		0			11.7951	0.098061533	4.562376345	0	0.995990827	1.073508735	1.242231751	1.64005262	4.822130887	1.152826751	5.635994261	0	0.231507622	3.836377091	22.46205221	44.48757942	0.590967536	2.121946448	15.43769016	11.79506457	1.133510868	0.514505139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.6295
H0332_809_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			12.81	0.11	0	0	0.17	0.18	0.2	0.28	0.82	0.17	0.83	0	0.03	0.57	3.19	6.33	0.08	0.3	2.19	1.67	0.18	0.09																			30.2	NO	947.5788673	20.91509072	776.369077	2012.222796	5.102355429	5.382870491	6.191447607	8.408399041	24.70027634	5.174014566	25.20590495	0	1.050314506	17.17962599	96.75837545	191.7004351	2.558840261	9.124004163	66.34226777	50.70468896	5.574910491	2.649777404	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											14.12915466	5.462661279	84.10312123	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	0											NO	14.12915466	5.462661279	84.10312123	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	0												1.1157	0.009521005	5.441255217	0	1.020471086	1.076574098	1.238289521	1.681679808	4.940055268	1.034802913	5.04118099	0	0.210062901	3.435925199	19.35167509	38.34008702	0.511768052	1.824800833	13.26845355	10.14093779	1.114982098	0.529955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3282	Medicare Standard Deductible(s)		13.9257	0.119521005	5.441255217	0	1.190471086	1.256574098	1.438289521	1.961679808	5.760055268	1.204802913	5.87118099	0	0.240062901	4.005925199	22.54167509	44.67008702	0.591768052	2.124800833	15.45845355	11.81093779	1.294982098	0.619955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5282	NO																																																																																		0			13.9257	0.119521005	5.441255217	0	1.190471086	1.256574098	1.438289521	1.961679808	5.760055268	1.204802913	5.87118099	0	0.240062901	4.005925199	22.54167509	44.67008702	0.591768052	2.124800833	15.45845355	11.81093779	1.294982098	0.619955481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5282
H0351_014_0	2010	4	N/A																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	YES	1125.068399	19.01230108	451.2031776	12.1345784	254.7994897	3.14756538	1.490026076	464.7022953	455.5209268	1089.521845	13.27821957	0	0.558617773	292.1243912	4033.174681	5699.118902	200.9389435	303.7016276	43.60640046	105.3194493	13.80350618	0	0	0	0	0	0	0	20800	0											3400	1a:  Acute - $200/$0/day for 1-10/11-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-10/11-190	2:  Skilled Nursing Services - $0/$100/day for 1-15/16-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-15/16-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $300/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b: Outpatient Diagnostic Radiology - CT/MRI/PET & Nuclear Medicine $125/$150/$200 per visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $25/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $40/visit/18a:  Hearing Exams - $40/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/18a:  Hearing Exams - $40/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $40/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												200	200	100	0	300	0.2	0.115067275	48.66888549	200	10	0.191464201	0	0.2	30	10.00368405	39.93918521	40	30	0	32.07598332	0.2	0	0	0	0	0	0	0	0	0											NO	160.3228924	160.3228924	80.16144622	0	240.4843387	0.160322892	0.092239592	39.01368247	160.3228924	8.016144622	0.153480472	0	0.160322892	24.04843387	8.019097811	32.01582847	32.06457849	24.04843387	0	25.71257211	0.160322892	0	0	0	0	0	0	0	0	0												15.0312	0.254008925	3.014091605	0	5.106273898	0.504626786	0.137439397	1.510812316	6.08586938	0.727813723	2.037947409	0	0.089559217	0.585427842	2.695201855	15.20516777	0.536918544	0.608629042	0	0.225669495	2.213018036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5697	0	14	15.0312	0.254008925	3.014091605	0	5.106273898	0.504626786	0.137439397	1.510812316	6.08586938	0.727813723	2.037947409	0	0.089559217	0.585427842	2.695201855	15.20516777	0.536918544	0.608629042	0	0.225669495	2.213018036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5697	NO																																																																																		0			15.0312	0.254008925	3.014091605	0	5.106273898	0.504626786	0.137439397	1.510812316	6.08586938	0.727813723	2.037947409	0	0.089559217	0.585427842	2.695201855	15.20516777	0.536918544	0.608629042	0	0.225669495	2.213018036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5697
H0351_029_0	2010	4	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1319.549226	12.34550804	550.55111	14.49524013	930.6520589	8.198509246	3.527316459	951.3025323	591.8034538	7.467476958	15.62056641	0	1.472010071	463.9753795	0.408267774	6234.092549	190.7622159	456.1222103	47.20040233	78.42569235	9.722305067	0	1320	3392.011873	315	236.25	0	0	10400	0												1a:  Acute - $150/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-5/6-190	2:  Skilled Nursing Services - $0/$50/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$50/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $50/visit/9b:  Ambulatory Surgical Center Services - $50/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b: Outpatient Diagnostic Radiology - CT/MRI/PET & Nuclear Medicine $50/$50/$100 per visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $15/visit/3:  Rehab Services (CORF) - $15/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $0/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $15/visit/7i:  Physical/Speech Therapy - $15/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $20/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service	10b:  Transportation - $0/trip	16b: Dental $19.75 copay	17a: Vision Exams $10 copay	17b: Vision Hardware $0 copay			14b:  Other Immunizations - $0/visit/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												150	150	50	0	100	0.2	0.106548854	44.97580985	50	0	0.100170232	0	0.2	15	20	18.98039305	20	15	0	20	0.2	0	0	19.74950107	10	0	0	0	0	0											NO	150	150	50	0	100	0.2	0.106548854	44.97580985	50	0	0.100170232	0	0.2	15	20	18.98039305	20	15	0	20	0.2	0	0	19.74950107	10	0	0	0	0	0												16.4944	0.154318851	2.293962959	0	7.755433824	1.639701849	0.375831526	3.565466817	2.465847724	0	1.564715755	0	0.294402014	0.579969224	0.000680446	9.860460574	0.317937026	0.570152763	0	0.130709487	1.944461013	0	0	5.582545175	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8535	0	0	16.4944	0.154318851	2.293962959	0	7.755433824	1.639701849	0.375831526	3.565466817	2.465847724	0	1.564715755	0	0.294402014	0.579969224	0.000680446	9.860460574	0.317937026	0.570152763	0	0.130709487	1.944461013	0	0	5.582545175	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8535	NO																																																																																		0			16.4944	0.154318851	2.293962959	0	7.755433824	1.639701849	0.375831526	3.565466817	2.465847724	0	1.564715755	0	0.294402014	0.579969224	0.000680446	9.860460574	0.317937026	0.570152763	0	0.130709487	1.944461013	0	0	5.582545175	0.2625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8535
H0351_030_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	944.2310158	15.75114007	255.9144345	11.88710539	223.6117234	2.527506312	2.114447446	431.188169	434.1591255	6.217844742	8.823092987	0	0.21581178	261.5612215	3271.407792	4656.557613	183.2067614	285.0161213	41.81297365	79.85926977	11.53757148	0	0	0	0	0	0	0	20800	0												1a:  Acute - $200/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $300/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b: Outpatient Diagnostic Radiology - CT/MRI/PET & Nuclear Medicine $125/$150/$200 per visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $25/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $40/visit/18a:  Hearing Exams - $40/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/18a:  Hearing Exams - $40/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $40/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												200	200	100	0	300	0.2	0.151939363	48.7050683	200	0	0.235231434	0	0.2	30	10.00347462	39.39009477	40	30	0	28.54692649	0.2	0	0	0	0	0	0	0	0	0											NO	200	200	100	0	300	0.2	0.151939363	48.7050683	200	0	0.235231434	0	0.2	30	10.00347462	39.39009477	40	30	0	28.54692649	0.2	0	0	0	0	0	0	0	0	0												15.7372	0.262519001	2.132620288	0	5.590293085	0.505501262	0.321267799	1.750087435	7.235985425	0	2.075468818	0	0.043162356	0.653903054	2.727120402	15.28518714	0.610689205	0.712540303	0	0.189978059	2.307514297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.141	0	0	15.7372	0.262519001	2.132620288	0	5.590293085	0.505501262	0.321267799	1.750087435	7.235985425	0	2.075468818	0	0.043162356	0.653903054	2.727120402	15.28518714	0.610689205	0.712540303	0	0.189978059	2.307514297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.141	NO																																																																																		0			15.7372	0.262519001	2.132620288	0	5.590293085	0.505501262	0.321267799	1.750087435	7.235985425	0	2.075468818	0	0.043162356	0.653903054	2.727120402	15.28518714	0.610689205	0.712540303	0	0.189978059	2.307514297	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.141
H0351_034_0	2010	3	N/A																															A	A	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	YES	313.5946887	2.917497508	386.5976977	12.5545695	272.1578176	3.350510623	1.586098331	492.088112	475.2821776	6.605479527	14.03572593	0	0.581583271	306.1429313	4381.613607	6177.444309	216.6354343	316.2632667	45.6205875	110.0012844	14.39994616	0	0	2656.471222	315	236.25	175.5959159	0	20800	0											3400	1a:  Acute - $695/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $695/admit for 1-190	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $250/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b: Outpatient Diagnostic Radiology - CT/MRI/PET & Nuclear Medicine $125/$150/$200 per visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $25/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $5/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16b: Dental $24.14 copay	17a: Vision Exams $10 copay	17b: Vision Hardware $0 copay	18a:  Routine Hearing Test - $35/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14b:  Other Immunizations - $0/visit/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												695	695	100	0	250	0.2	0.115067275	47.95865586	200	0	0.191657023	0	0.2	25	5.003665163	34.93976652	35	25	0	31.99992246	0.2	0	0	24.14004659	10	0	35	0	0	0											NO	568.8033795	568.8033795	81.84221287	0	204.6055322	0.163684426	0.094173604	39.25042522	163.6844257	0	0.156856349	0	0.163684426	20.46055322	4.095110294	28.59547809	28.64477451	20.46055322	0	26.18944466	0.163684426	0	0	24.14004659	10	0	28.64477451	0	0	0												14.8645	0.138290204	2.63666759	0	4.640416259	0.548426407	0.149368597	1.609555637	6.483024193	0	2.201592722	0	0.095196124	0.521987812	1.495265916	14.72058112	0.517122764	0.53924345	0	0.240072712	2.357046918	0	0	5.343944923	0.2625	0	0.419158785	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7839	0	12.02	14.8645	0.138290204	2.63666759	0	4.640416259	0.548426407	0.149368597	1.609555637	6.483024193	0	2.201592722	0	0.095196124	0.521987812	1.495265916	14.72058112	0.517122764	0.53924345	0	0.240072712	2.357046918	0	0	5.343944923	0.2625	0	0.419158785	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7839	NO																																																																																		0			14.8645	0.138290204	2.63666759	0	4.640416259	0.548426407	0.149368597	1.609555637	6.483024193	0	2.201592722	0	0.095196124	0.521987812	1.495265916	14.72058112	0.517122764	0.53924345	0	0.240072712	2.357046918	0	0	5.343944923	0.2625	0	0.419158785	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7839
H0351_035_0	2010	3	N/A																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											8.5346	0.0761	0.7848	0.3391	0.4843	0.0977	0.0463	0.6397	1.0324	0.2192	0.4753	0	0.0134	0.718	0.5785	3.495	0.1435	0.0532	1.0926	0.6901	0.4689	0.0875	0	0	0	0	0	0	0	0											20.07	YES	946.8050156	15.99986457	388.2575348	9.313611192	215.8898872	2.68313924	1.270171371	410.9656071	340.3270987	1120.825082	13.05316458	0	0.368651056	286.4838655	3312.002985	4397.352586	132.6346864	200.4657207	30.00528217	84.9804514	12.87612401	0	0	0	0	0	0	0	20800	0											3400	1a:  Acute - $200/$0/day for 1-10/11-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-10/11-190	2:  Skilled Nursing Services - $0/$100/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $300/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $45/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b: Outpatient Diagnostic Radiology - CT/MRI/PET & Nuclear Medicine $125/$150/$200 per visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $25/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $45/visit/18a:  Hearing Exams - $45/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $45/visit/18a:  Hearing Exams - $45/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $45/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $45/visit/7h:  Psychiatric Services - Individual - $45/visit/7h:  Psychiatric Services - Group - $45/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	9c:  Outpatient Substance Abuse Svcs - Individual - $45/visit/9c:  Outpatient Substance Abuse Svcs - Group - $45/visit/7g:  Other Health Care Professional Services - $45/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												200	200	100	0	300	0.2	0.115067275	49.34928189	200	10	0.192540842	0	0.2	35	15.0036292	44.62728195	45	35	0	31.81223092	0.2	0	0	0	0	0	0	0	0	0											NO	160.6561357	160.6561357	80.32806785	0	240.9842035	0.160656136	0.092431319	39.64132464	160.6561357	8.032806785	0.154664338	0	0.160656136	28.11482375	12.05212544	35.84823333	36.14763053	28.11482375	0	25.55415044	0.160656136	0	0	0	0	0	0	0	0	0												12.6758	0.214206368	2.598998133	0	4.335504376	0.431062782	0.117403615	1.357601754	4.556303046	0.750280944	2.018859058	0	0.059226054	0.671203615	3.32638962	13.13644346	0.399535803	0.469671534	0	0.180966937	2.068628326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3681	265	12.09	21.2104	0.290271665	3.383818488	0.339131141	4.819791283	0.52876238	0.163653631	1.997260338	5.588685247	0.969509229	2.494156395	0	0.072649532	1.389234082	3.904896265	16.63146869	0.54299738	0.522823368	1.092564997	0.871029945	2.537479188	0.087501113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4381	NO																																																																																		0			21.2104	0.290271665	3.383818488	0.339131141	4.819791283	0.52876238	0.163653631	1.997260338	5.588685247	0.969509229	2.494156395	0	0.072649532	1.389234082	3.904896265	16.63146869	0.54299738	0.522823368	1.092564997	0.871029945	2.537479188	0.087501113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4381
H0351_036_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											20.3685	0.1815	2.465	0.866	1.0328	0.2084	0.0986	1.2916	2.8169	0.3401	0.7987	0	0.0442	1.0608	1.5118	9.1366	0.4689	0.1737	3.2951	1.9486	0.8528	0.1592	0	0	0	0	0	0	0	0											49.12	YES	869.7431084	14.69761114	283.3274604	9.988755701	195.5054546	2.403091467	1.137599547	343.4701888	384.6016802	720.2250697	9.212421653	0	0.510333629	198.2271969	3418.284702	4665.077231	179.1532322	270.7744315	38.00500254	83.78630416	9.836039443	0	0	0	0	0	0	0	20800	0											3400	1a:  Acute - $125/$0/day for 1-10/11-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $125/$0/day for 1-10/11-190	2:  Skilled Nursing Services - $0/$100/day for 1-23/24-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-23/24-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $300/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $45/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $125/visit/9b:  Ambulatory Surgical Center Services - $125/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b: Outpatient Diagnostic Radiology - CT/MRI/PET & Nuclear Medicine $125/$150/$200 per visit/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $25/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $45/visit/18a:  Hearing Exams - $45/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $45/visit/18a:  Hearing Exams - $45/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $45/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $45/visit/7h:  Psychiatric Services - Individual - $45/visit/7h:  Psychiatric Services - Group - $45/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	9c:  Outpatient Substance Abuse Svcs - Individual - $45/visit/9c:  Outpatient Substance Abuse Svcs - Group - $45/visit/7g:  Other Health Care Professional Services - $45/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												125	125	100	0	300	0.2	0.115067275	49.34952869	125	10	0.190806768	0	0.2	35	20.00287676	44.61042197	45	35	0	32.37803945	0.2	0	0	0	0	0	0	0	0	0											NO	98.60007958	98.60007958	78.88006367	0	236.640191	0.157760127	0.09076514	38.92693965	98.60007958	7.888006367	0.1505085	0	0.157760127	27.60802228	15.77828193	35.18872925	35.49602865	27.60802228	0	25.53981814	0.157760127	0	0	0	0	0	0	0	0	0												7.1464	0.120765469	1.862407343	0	3.855370677	0.379112016	0.103254382	1.114186943	3.160146356	0.473428328	1.386547766	0	0.080510298	0.456055072	4.494554978	13.67984497	0.529935689	0.622962212	0	0.178323914	1.551734835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1955	700	11.03	27.5149	0.302301719	4.3274076	0.866040335	4.888148677	0.587463707	0.201885996	2.405758211	5.97706502	0.813559263	2.185278756	0	0.124757001	1.516831425	6.00638323	22.81639648	0.998880576	0.79670407	3.295091611	2.126874437	2.404534437	0.159233054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3155	NO																																																																																		0			27.5149	0.302301719	4.3274076	0.866040335	4.888148677	0.587463707	0.201885996	2.405758211	5.97706502	0.813559263	2.185278756	0	0.124757001	1.516831425	6.00638323	22.81639648	0.998880576	0.79670407	3.295091611	2.126874437	2.404534437	0.159233054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.3155
H0351_801_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	294.7196673	2.695402388	37.43693842	11.94253935	12.98492022	2.639166215	0.846202701	12.51847624	40.75123501	5.107394012	12.72651259	0	3.073731647	21.98398229	47.41627111	124.51284	5.690864091	3.538891754	43.97475916	25.80939887	8.91235166	1.589970464	0	0	0	0	0	0	0	0												Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure											0.076805608	0.076805608	0.136552702	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076805608	0.076805608	0.136552702	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.6361	0.20702202	5.112115108	0	3.025486412	0.614925728	0.197165229	2.916804965	9.495037758	1.190022805	2.965277434	0	0.716179474	5.122267873	11.04799117	29.01149173	1.325971333	0.824561779	10.24611888	6.013589937	2.076577937	0.370463118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1152	0	0	22.6361	0.20702202	5.112115108	0	3.025486412	0.614925728	0.197165229	2.916804965	9.495037758	1.190022805	2.965277434	0	0.716179474	5.122267873	11.04799117	29.01149173	1.325971333	0.824561779	10.24611888	6.013589937	2.076577937	0.370463118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1152	NO																																																																																		0			22.6361	0.20702202	5.112115108	0	3.025486412	0.614925728	0.197165229	2.916804965	9.495037758	1.190022805	2.965277434	0	0.716179474	5.122267873	11.04799117	29.01149173	1.325971333	0.824561779	10.24611888	6.013589937	2.076577937	0.370463118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1152
H0351_803_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	294.7196673	2.695402388	37.43693842	11.94253935	12.98492022	2.639166215	0.846202701	12.51847624	40.75123501	5.107394012	12.72651259	0	3.073731647	21.98398229	47.41627111	124.51284	5.690864091	3.538891754	43.97475916	25.80939887	8.91235166	1.589970464	0	0	0	0	0	0	0	0												Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure											0.076805608	0.076805608	0.136552702	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076805608	0.076805608	0.136552702	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.6361	0.20702202	5.112115108	0	3.025486412	0.614925728	0.197165229	2.916804965	9.495037758	1.190022805	2.965277434	0	0.716179474	5.122267873	11.04799117	29.01149173	1.325971333	0.824561779	10.24611888	6.013589937	2.076577937	0.370463118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1152	0	0	22.6361	0.20702202	5.112115108	0	3.025486412	0.614925728	0.197165229	2.916804965	9.495037758	1.190022805	2.965277434	0	0.716179474	5.122267873	11.04799117	29.01149173	1.325971333	0.824561779	10.24611888	6.013589937	2.076577937	0.370463118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1152	NO																																																																																		0			22.6361	0.20702202	5.112115108	0	3.025486412	0.614925728	0.197165229	2.916804965	9.495037758	1.190022805	2.965277434	0	0.716179474	5.122267873	11.04799117	29.01149173	1.325971333	0.824561779	10.24611888	6.013589937	2.076577937	0.370463118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1152
H0351_804_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	294.7196673	2.695402388	37.43693842	11.94253935	12.98492022	2.639166215	0.846202701	12.51847624	40.75123501	5.107394012	12.72651259	0	3.073731647	21.98398229	47.41627111	124.51284	5.690864091	3.538891754	43.97475916	25.80939887	8.91235166	1.589970464	0	0	0	0	0	0	0	0												Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure	Medicare FFS Cost Sharing Structure											0.076805608	0.076805608	0.136552702	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076805608	0.076805608	0.136552702	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.6361	0.20702202	5.112115108	0	3.025486412	0.614925728	0.197165229	2.916804965	9.495037758	1.190022805	2.965277434	0	0.716179474	5.122267873	11.04799117	29.01149173	1.325971333	0.824561779	10.24611888	6.013589937	2.076577937	0.370463118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1152	0	0	22.6361	0.20702202	5.112115108	0	3.025486412	0.614925728	0.197165229	2.916804965	9.495037758	1.190022805	2.965277434	0	0.716179474	5.122267873	11.04799117	29.01149173	1.325971333	0.824561779	10.24611888	6.013589937	2.076577937	0.370463118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1152	NO																																																																																		0			22.6361	0.20702202	5.112115108	0	3.025486412	0.614925728	0.197165229	2.916804965	9.495037758	1.190022805	2.965277434	0	0.716179474	5.122267873	11.04799117	29.01149173	1.325971333	0.824561779	10.24611888	6.013589937	2.076577937	0.370463118	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1152
H0354_001_0	2010	9	N/A																															A	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	297.6484068	2.309029789	283.1432168	22.29484866	294.2399129	5.183760405	1.403975119	579.7627569	178.8672961	10.70528805	40.78070878	0	0.674224311	492.9619299	4426.212746	4643.531268	18.71954061	11.34185724	35.99254244	53.35559341	51.7618591	0	0	0	490.4727581	0	93.68141723	0	131.4478186	0												1a:  Acute - $500/admit	1b:  Psych - $876/admit	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0% High Power DME	11b:  Prosthetics Devices - 0.0%/11b:  Medical Supplies - 0.0%/11c:  Diabetes Monitoring Supplies - 0.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $5/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150 CMG / $200 hospital outpatient department/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150 CMG / $200 Non-CMG/visit/8b:  Outpatient Therapeutic Radiological Services - $40/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $25/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $5/visit/17a:  Vision Exams - $5 CMG optometrist / $25 CMG opthamologist / $40 non-CMG opthamologist/visit/18a:  Hearing Exams - $5 CMG optometrist / $40 non-CMG contracted Hearing specialist/visit/:  Routine Exams - $5/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25 CMG / $40 non-CMG/visit/7b:  Chiropractic Services - $25 CMG chiropractor / $40 non-CMG contracted/visit/12 Additional Visits/7f:  Podiatry Services - $5 CMG nail tech / $25 CMG podiatrist / $40 non-CMG contracted/visit/Additional Visits/17a:  Vision Exams - $5 CMG optometrist / $25 CMG opthamologist / $40 non-CMG opthamologist/visit/18a:  Hearing Exams - $5 CMG optometrist / $40 non-CMG contracted Hearing specialist/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $25 CMG / $40 non-CMG/visit	"15:  Medicare Part B Rx Drugs - immunosuppressive drugs, oral cancer drugs, oral anti-emetic drugs - 20.0%/Medicare Part B Rx Drugs - All Other - $0/service"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $5/visit	"17b:  Wear - $0/service, $50/every other year allowance"	18a:  Routine Hearing Test - $5/visit/18a:  Fitting for Hearing Aid - $5/visit	"18b:  Hearing Aids - $0/service, $200 every other year allowance"	14b:  Other Immunizations - $0/visit/:  Routine Exams - $5/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $5/visit												500	876	125	0	150	0.007528234	0	18.48591713	177.0328751	0	0.17029015	0	25	40	5.000700101	28.16036193	40	40	0	7.309630239	0.006079501	0	0	0	5	0	5	0	1.902317716	0											NO	500	876	125	0	150	0.007528234	0	18.48591713	177.0328751	0	0.17029015	0	25	40	5.000700101	28.16036193	40	40	0	7.309630239	0.006079501	0	0	0	5	0	5	0	1.902317716	0												12.402	0.168559175	2.949408508	0	3.677998911	0.039024561	0	0.893120523	2.638782641	0	6.944553016	0	0.001404634	1.643206433	1.844513544	10.89696009	0.062398469	0.037806191	0	0.032500805	0.314686255	0	0	0	0.204363649	0	0.039033924	0	0.02083796	0	0	0	0	0	0	0	0	0	0	0	44.8112	0	0	12.402	0.168559175	2.949408508	0	3.677998911	0.039024561	0	0.893120523	2.638782641	0	6.944553016	0	0.001404634	1.643206433	1.844513544	10.89696009	0.062398469	0.037806191	0	0.032500805	0.314686255	0	0	0	0.204363649	0	0.039033924	0	0.02083796	0	0	0	0	0	0	0	0	0	0	0	44.8112	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.402	0.168559175	2.949408508	0	3.677998911	0.039024561	0	0.893120523	2.638782641	0	6.944553016	0	0.001404634	1.643206433	1.844513544	10.89696009	0.062398469	0.037806191	0	0.032500805	0.314686255	0	0	0	0.204363649	0	0.039033924	0	0.02083796	0	0	0	0	0	0	0	0	0	0	0	44.8112
H0354_012_0	2010	10	N/A																															coin	coin	coin	coin	T	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	441.1349898	2.114457945	35.54267557	29.49671709	321.7397371	6.346895736	1.718999915	294.6313422	39.14490043	13.53747914	47.47810926	0	0.040800349	18.3203227	0	0	1.813737674	0.665950897	46.33674304	0	77.89851823	1.634757295	318.9753772	0	0	0	0	0	81.74851229	0												1a:  Acute - $0/admit	1b:  Psych - $0/admit	2:  Skilled Nursing Services - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 20.0% High Power DME	11b:  Prosthetics Devices - 0.0%/11b:  Medical Supplies - 0.0%/11c:  Diabetes Monitoring Supplies - 0.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $0/visit/9b:  Ambulatory Surgical Center Services - $0/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/18a:  Hearing Exams - $0/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/12 Additional Visits/7f:  Podiatry Services - $0/visit/Additional Visits/17a:  Vision Exams - $0/visit/18a:  Hearing Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $0/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $0/visit/7h:  Psychiatric Services - Individual - $0/visit/7h:  Psychiatric Services - Group - $0/visit	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $0/visit/9c:  Outpatient Substance Abuse Svcs - Group - $0/visit/7g:  Other Health Care Professional Services - $0/visit	"15:  Medicare Part B Rx Drugs - immunosuppressive drugs, oral cancer drugs, oral anti-emetic drugs - $0/service/Medicare Part B Rx Drugs - All Other - $0/service"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service	10b:  Transportation - $0/trip		17a:  Routine Eye Exams - $0/visit	"17b:  Wear - $0/service, $150 per year allowance"	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	"18b:  Hearing Aids - $0/service, $900 allowance"	14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												0	0	0	0	50	0.010167712	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	50	0.010167712	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	0	0	0	1.340582238	0.064533411	0	1.227630593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.6327	0	0	0	0	0	0	1.340582238	0.064533411	0	1.227630593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.6327	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	1.340582238	0.064533411	0	1.227630593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.6327
H0354_801_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	313.2304985	2.141802414	17.64814325	24.25944409	10.94254399	6.162498847	1.520331469	27.05628754	33.25946707	23.44544146	61.15999842	0	0.03551606	15.67900309	89.056206	203.5224664	1.779199417	0.571785057	43.7187299	8650.551781	56.18784929	1.354636366	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS											0.078911865	0.078911865	0.132763166	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	9.725596858	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078911865	0.078911865	0.132763166	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	9.725596858	0.233	0.233	0	0	0	0	0	0	0	0												24.7176	0.169013622	2.343023379	0	2.54961275	1.435862231	0.354237232	6.304114997	7.749455828	5.462787861	14.25027963	0	0.008275242	3.653207721	20.750096	47.42073468	0.414553464	0.133225918	10.18646407	7.010981602	13.09176889	0.315630273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.3209	0	0	24.7176	0.169013622	2.343023379	0	2.54961275	1.435862231	0.354237232	6.304114997	7.749455828	5.462787861	14.25027963	0	0.008275242	3.653207721	20.750096	47.42073468	0.414553464	0.133225918	10.18646407	7.010981602	13.09176889	0.315630273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.3209	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.7176	0.169013622	2.343023379	0	2.54961275	1.435862231	0.354237232	6.304114997	7.749455828	5.462787861	14.25027963	0	0.008275242	3.653207721	20.750096	47.42073468	0.414553464	0.133225918	10.18646407	7.010981602	13.09176889	0.315630273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.3209
H0354_804_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	277.8283768	1.929729491	21.26061862	23.97295753	8.551503179	5.697384665	1.405584555	24.41759327	30.1296933	15.70113291	51.27349858	0	0.03258387	18.02133821	79.40952664	186.3538008	1.6195784	0.537180777	40.11904977	5594.61759	54.51006816	1.544442911	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS											0.078911865	0.078911865	0.132763166	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	13.60208954	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078911865	0.078911865	0.132763166	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	13.60208954	0.233	0.233	0	0	0	0	0	0	0	0												21.924	0.152278552	2.822627047	0	1.992500241	1.327490627	0.327501201	5.689299231	7.02021854	3.658363969	11.94672517	0	0.007592042	4.198971803	18.50241971	43.42043558	0.377361767	0.125163121	9.347738597	6.341540785	12.70084588	0.359855198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.2429	0	0	21.924	0.152278552	2.822627047	0	1.992500241	1.327490627	0.327501201	5.689299231	7.02021854	3.658363969	11.94672517	0	0.007592042	4.198971803	18.50241971	43.42043558	0.377361767	0.125163121	9.347738597	6.341540785	12.70084588	0.359855198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.2429	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.924	0.152278552	2.822627047	0	1.992500241	1.327490627	0.327501201	5.689299231	7.02021854	3.658363969	11.94672517	0	0.007592042	4.198971803	18.50241971	43.42043558	0.377361767	0.125163121	9.347738597	6.341540785	12.70084588	0.359855198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.2429
H0354_805_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	307.3264308	1.952870408	29.43688633	24.37312818	12.54837167	5.626177573	1.388017268	24.80666004	34.22643472	13.93024862	49.83834036	0	0.033532907	14.87959968	82.67619415	193.8004385	1.644606209	0.562742395	41.65291072	6226.501011	46.36885116	1.121662873	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS											0.078911865	0.078911865	0.132763166	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	12.45753186	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078911865	0.078911865	0.132763166	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	12.45753186	0.233	0.233	0	0	0	0	0	0	0	0												24.2517	0.154104645	3.908134239	0	2.923770599	1.310899374	0.323408023	5.77995179	7.974759291	3.245747928	11.6123333	0	0.007813167	3.466946726	19.26355324	45.15550217	0.383193247	0.131118978	9.705128198	6.463902894	10.80394232	0.261347449	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.1273	0	0	24.2517	0.154104645	3.908134239	0	2.923770599	1.310899374	0.323408023	5.77995179	7.974759291	3.245747928	11.6123333	0	0.007813167	3.466946726	19.26355324	45.15550217	0.383193247	0.131118978	9.705128198	6.463902894	10.80394232	0.261347449	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.1273	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.2517	0.154104645	3.908134239	0	2.923770599	1.310899374	0.323408023	5.77995179	7.974759291	3.245747928	11.6123333	0	0.007813167	3.466946726	19.26355324	45.15550217	0.383193247	0.131118978	9.705128198	6.463902894	10.80394232	0.261347449	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.1273
H0370_001_0	2010	7	N/A																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	V	COIN	COIN	COIN	P	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	YES	911.6411104	24.30493697	556.3358877	0	114.6398648	7.515443267	4.306280746	257.3829044	337.074045	7.403220267	16.51988118	1.68452102	0.797272931	8.308616617	3178.614478	89.50095073	122.9316613	711.1377479	9.180688599	1373.567553	21.14035612	0	0	0	0	0	0	0	0	137.5994765											5000	1a $175 days 1-9	1b $175 days 1-9	2 $100 days 7-22	6 $0	"10a $150, 10b $0"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $260, 9b $260"	"8a $0, 8b 20%, 11c $0, 11c 20%"	8b 20%/$260 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0"	7a $15	"17a $40, 18a $40, 7b $40,7d $40,7f $40, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b 20% Ther., $260 Adv. Imaging, 14h $0"	"7g $40, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0	14c $15											162.8134796	158.8235294	47.92899408	0	30.01437561	0.2	0.2	49.53927492	260	0.073116817	0.476146846	0.2	0.2	0.191945028	15	0.146635017	40	40	0.274270869	0.005434783	0.223398292	0	0	0	0	0	0	0	0	15											NO	141.3796221	137.9149357	41.61930013	0	26.06308208	0.17367066	0.17367066	43.01759281	225.7718577	0.063491229	0.413463685	0.17367066	0.17367066	0.166676098	13.02529948	0.127331001	34.73413196	34.73413196	0.238164014	0.004719311	0.193988644	0	0	0	0	0	0	0	0	13.02529948												10.7406	0.279334485	1.929525857	0	0.248989017	1.305211991	0.747874618	0.922666081	6.341819444	0.470039554	6.830370947	0.292551877	0.138462916	1.384847796	3.450200461	11.39624566	0.355827045	2.058396031	2.186509648	0.000540191	4.100989018	0	0	0	0	0	0	0	0	0.149356199	0	0	0	0	0	0	0	0	0	0	55.3304	0	8.388362482	10.7406	0.279334485	1.929525857	0	0.248989017	1.305211991	0.747874618	0.922666081	6.341819444	0.470039554	6.830370947	0.292551877	0.138462916	1.384847796	3.450200461	11.39624566	0.355827045	2.058396031	2.186509648	0.000540191	4.100989018	0	0	0	0	0	0	0	0	0.149356199	0	0	0	0	0	0	0	0	0	0	55.3304	NO	0.2	0.2	0.2	0.2	$150/$0	0.2	0.2	$50/$40	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																				4.5843	0.0711	0.4757	0.181	0.1313	0.2066	0.1184	0.1449	1.1206	0.2035	0.454	0.0463	0.0219	0.2284	0.5953	2.4409	0.0468	0.1339	0.2504	0.1768	0.1494	0	0	0	0	0	0	0	0	0											11.7814	0	0	15.3249	0.350437526	2.405241627	0.18101649	0.380286169	1.511764435	0.866227293	1.067558837	7.462410134	0.673507691	7.284398968	0.338848805	0.160374953	1.613199606	4.045493721	13.83718068	0.402673148	2.192344039	2.436892064	0.177336631	4.250347986	0	0	0	0	0	0	0	0	0.149356199	0	0	0	0	0	0	0	0	0	0	67.1118
H0370_801_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	166.1950186	2.57770602	17.24617378	0	4.629114298	7.69525016	4.409308464	12.53695038	42.18323825	7.580342227	16.91511915	1.724823166	0.816347677	8.507400174	23.06292671	94.56701292	1.814917628	5.189430654	9.700347207	6.84947	24.17855231	0	0	0	0	0	0	0	0	0												FFS Medicare  8.8%	FFS Medicare  8.8%	FFS Medicare  12.8%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.087996193	0.087996193	0.128305038	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.087996193	0.087996193	0.128305038	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												14.6245	0.226828317	2.212770975	0	1.078583632	1.792993287	1.027368872	2.921109439	9.828694512	1.766219739	3.941222762	0.401883798	0.190209009	1.98222424	5.373661923	22.03411401	0.422875807	1.209137342	2.260180899	1.59592651	5.633602689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5241	0	0	14.6245	0.226828317	2.212770975	0	1.078583632	1.792993287	1.027368872	2.921109439	9.828694512	1.766219739	3.941222762	0.401883798	0.190209009	1.98222424	5.373661923	22.03411401	0.422875807	1.209137342	2.260180899	1.59592651	5.633602689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5241	NO	FFS Medicare  8.8%	FFS Medicare  8.8%	FFS Medicare  12.8%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																				2.0653	0.032	0.3125	0	0.1482	0.2464	0.1412	0.4014	1.3506	0.2427	0.5416	0.0552	0.0261	0.2724	0.7328	3.0047	0.0577	0.1649	0.3082	0.2176	0.7682	0	0	0	0	0	0	0	0	0											11.0897	0	0	16.6898	0.25886077	2.525256139	0	1.22680116	2.039384041	1.168548536	3.322524414	11.17934064	2.008931307	4.482820353	0.457110135	0.216347278	2.25461886	6.106434004	25.03876592	0.48054069	1.374019707	2.568387385	1.813552852	6.401821237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6139
H0370_802_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	166.1950186	2.57770602	17.24617378	0	4.629114298	7.69525016	4.409308464	12.53695038	42.18323825	7.580342227	16.91511915	1.724823166	0.816347677	8.507400174	23.06292671	94.56701292	1.814917628	5.189430654	9.700347207	6.84947	24.17855231	0	0	0	0	0	0	0	0	0												FFS Medicare  8.8%	FFS Medicare  8.8%	FFS Medicare  12.8%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.087996193	0.087996193	0.128305038	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.087996193	0.087996193	0.128305038	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												14.6245	0.226828317	2.212770975	0	1.078583632	1.792993287	1.027368872	2.921109439	9.828694512	1.766219739	3.941222762	0.401883798	0.190209009	1.98222424	5.373661923	22.03411401	0.422875807	1.209137342	2.260180899	1.59592651	5.633602689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5241	0	0	14.6245	0.226828317	2.212770975	0	1.078583632	1.792993287	1.027368872	2.921109439	9.828694512	1.766219739	3.941222762	0.401883798	0.190209009	1.98222424	5.373661923	22.03411401	0.422875807	1.209137342	2.260180899	1.59592651	5.633602689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5241	NO	FFS Medicare  8.8%	FFS Medicare  8.8%	FFS Medicare  12.8%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																				2.0653	0.032	0.3125	0	0.1482	0.2464	0.1412	0.4014	1.3506	0.2427	0.5416	0.0552	0.0261	0.2724	0.7328	3.0047	0.0577	0.1649	0.3082	0.2176	0.7682	0	0	0	0	0	0	0	0	0											11.0897	0	0	16.6898	0.25886077	2.525256139	0	1.22680116	2.039384041	1.168548536	3.322524414	11.17934064	2.008931307	4.482820353	0.457110135	0.216347278	2.25461886	6.106434004	25.03876592	0.48054069	1.374019707	2.568387385	1.813552852	6.401821237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6139
H0370_803_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	166.1950186	2.57770602	17.24617378	0	4.629114298	7.69525016	4.409308464	12.53695038	42.18323825	7.580342227	16.91511915	1.724823166	0.816347677	8.507400174	23.06292671	94.56701292	1.814917628	5.189430654	9.700347207	6.84947	24.17855231	0	0	0	0	0	0	0	0	0												FFS Medicare  8.8%	FFS Medicare  8.8%	FFS Medicare  12.8%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.087996193	0.087996193	0.128305038	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.087996193	0.087996193	0.128305038	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												14.6245	0.226828317	2.212770975	0	1.078583632	1.792993287	1.027368872	2.921109439	9.828694512	1.766219739	3.941222762	0.401883798	0.190209009	1.98222424	5.373661923	22.03411401	0.422875807	1.209137342	2.260180899	1.59592651	5.633602689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5241	0	0	14.6245	0.226828317	2.212770975	0	1.078583632	1.792993287	1.027368872	2.921109439	9.828694512	1.766219739	3.941222762	0.401883798	0.190209009	1.98222424	5.373661923	22.03411401	0.422875807	1.209137342	2.260180899	1.59592651	5.633602689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5241	NO	FFS Medicare  8.8%	FFS Medicare  8.8%	FFS Medicare  12.8%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																				2.0653	0.032	0.3125	0	0.1482	0.2464	0.1412	0.4014	1.3506	0.2427	0.5416	0.0552	0.0261	0.2724	0.7328	3.0047	0.0577	0.1649	0.3082	0.2176	0.7682	0	0	0	0	0	0	0	0	0											11.0897	0	0	16.6898	0.25886077	2.525256139	0	1.22680116	2.039384041	1.168548536	3.322524414	11.17934064	2.008931307	4.482820353	0.457110135	0.216347278	2.25461886	6.106434004	25.03876592	0.48054069	1.374019707	2.568387385	1.813552852	6.401821237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6139
H0401_002_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1376.856264	105.9554158	795.1615148	591.5914394	155.3723	8.669641517	7.439473768	240.4921505	198.4920496	7429.456727	22.4033977	0	0.02199052	493.4537458	4748.463992	3515.727403	423.1562874	240.6270135	0	0	20.07242496	738.8137357	0	0	102.1840897	0	13.15547272	4.735346659	85.38128106	0											3350	"$175 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$70 Days 1-48 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $125 (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											162.6190857	122.8528282	64.04271628	0	150	0.2	0.12524562	49.40957397	125	3	0.17952953	0	0.2	48.91536243	10.13698139	25	38.5	25	0	0	0.2	23.65933211	0	0	25	0	0	0	0	0											YES	139.6597626	99.23422107	56.542414	0	121.1623157	0.161549754	0.101166996	39.91052267	100.9685964	2.423246314	0.145014757	0	0.161549754	39.58538912	10.05726998	25	38.5	20.19371929	0	0	0.161549754	23.65933211	0	0	25	0	0	0	0	0											3750	16.0243	0.876200263	3.746695964	0	1.568772305	1.400578457	0.75262921	0.799847285	1.670121971	1.500283636	3.24882328	0	0.003552563	1.627796545	3.979715362	7.32443209	1.357626422	0.40492953	0	0	3.24269532	1.456653295	0	0	0.21288352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1985	0	8.802488416	16.0243	0.876200263	3.746695964	0	1.568772305	1.400578457	0.75262921	0.799847285	1.670121971	1.500283636	3.24882328	0	0.003552563	1.627796545	3.979715362	7.32443209	1.357626422	0.40492953	0	0	3.24269532	1.456653295	0	0	0.21288352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1985	NO	"$250 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-15 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"20% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	20%/20%/$10 (8a1); $10 (8a2)	"$21 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $75 (5); 20% (9a); $45/$35 (9c)"	"$20 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 20% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $30 (16b, 17a, 18a); 20% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.6847	0.2091	2.8883	0.2121	0.4846	0.4327	0.3713	0.3356	0.9927	0.4635	1.0621	0	0.0011	0.5436	1.8682	2.8522	0.4978	0.1423	0	0	0.9497	0.5762	0	0	0.0829	0	0.0107	0	0	0											17.6612	0	4.309881529	18.709	1.085307536	6.634959579	0.212052294	2.053390997	1.833239397	1.123898277	1.135457115	2.662861726	1.96374509	4.310958826	0	0.004650006	2.171385731	5.847875311	10.17659505	1.855395532	0.547239776	0	0	4.192384778	2.032883358	0	0	0.295781209	0	0.010672486	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8597
H0401_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	240.4258531	5.810664962	38.58659128	836.5391856	7.040566913	12.26640193	10.52587644	13.14135052	28.14523736	15.40908126	31.69785974	0	0.031113692	20.53989183	30.8714304	104.115263	2.851073301	3.68888707	0	0	28.02368321	5.976242672	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.082702792	0.082702792	0.191849289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082702792	0.082702792	0.191849289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.8839	0.480558216	7.402810093	0	1.640452091	2.858071649	2.45252921	3.061934671	6.557840305	3.590315934	7.385601319	0	0.00724949	4.785794797	7.193043282	24.25885628	0.664300079	0.859510687	0	0	6.529518188	1.392464543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0047	0	0	19.8839	0.480558216	7.402810093	0	1.640452091	2.858071649	2.45252921	3.061934671	6.557840305	3.590315934	7.385601319	0	0.00724949	4.785794797	7.193043282	24.25885628	0.664300079	0.859510687	0	0	6.529518188	1.392464543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0047	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.8839	0.480558216	7.402810093	0	1.640452091	2.858071649	2.45252921	3.061934671	6.557840305	3.590315934	7.385601319	0	0.00724949	4.785794797	7.193043282	24.25885628	0.664300079	0.859510687	0	0	6.529518188	1.392464543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0047
H0401_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	240.4258531	5.810664962	38.58659128	836.5391856	7.040566913	12.26640193	10.52587644	13.14135052	28.14523736	15.40908126	31.69785974	0	0.031113692	20.53989183	30.8714304	104.115263	2.851073301	3.68888707	0	0	28.02368321	5.976242672	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.082702792	0.082702792	0.191849289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082702792	0.082702792	0.191849289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.8839	0.480558216	7.402810093	0	1.640452091	2.858071649	2.45252921	3.061934671	6.557840305	3.590315934	7.385601319	0	0.00724949	4.785794797	7.193043282	24.25885628	0.664300079	0.859510687	0	0	6.529518188	1.392464543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0047	0	0	19.8839	0.480558216	7.402810093	0	1.640452091	2.858071649	2.45252921	3.061934671	6.557840305	3.590315934	7.385601319	0	0.00724949	4.785794797	7.193043282	24.25885628	0.664300079	0.859510687	0	0	6.529518188	1.392464543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0047	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.8839	0.480558216	7.402810093	0	1.640452091	2.858071649	2.45252921	3.061934671	6.557840305	3.590315934	7.385601319	0	0.00724949	4.785794797	7.193043282	24.25885628	0.664300079	0.859510687	0	0	6.529518188	1.392464543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0047
H0401_805_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	240.4258531	5.810664962	38.58659128	836.5391856	7.040566913	12.26640193	10.52587644	13.14135052	28.14523736	15.40908126	31.69785974	0	0.031113692	20.53989183	30.8714304	104.115263	2.851073301	3.68888707	0	0	28.02368321	5.976242672	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.082702792	0.082702792	0.191849289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082702792	0.082702792	0.191849289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.8839	0.480558216	7.402810093	0	1.640452091	2.858071649	2.45252921	3.061934671	6.557840305	3.590315934	7.385601319	0	0.00724949	4.785794797	7.193043282	24.25885628	0.664300079	0.859510687	0	0	6.529518188	1.392464543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0047	0	0	19.8839	0.480558216	7.402810093	0	1.640452091	2.858071649	2.45252921	3.061934671	6.557840305	3.590315934	7.385601319	0	0.00724949	4.785794797	7.193043282	24.25885628	0.664300079	0.859510687	0	0	6.529518188	1.392464543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0047	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.8839	0.480558216	7.402810093	0	1.640452091	2.858071649	2.45252921	3.061934671	6.557840305	3.590315934	7.385601319	0	0.00724949	4.785794797	7.193043282	24.25885628	0.664300079	0.859510687	0	0	6.529518188	1.392464543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.0047
H0408_002_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	281.3999319	35.83544776	10815.34368	101.250329	25.29567445	16.59177019	14.97623581	18.25997731	5.250133362	40.94816553	24.17064005	0	0.021158625	10.31939855	0.99627774	100.3660117	16.30930039	30.29335687	0	0	1.266638007	10.70466437	1916.729831	0	106.7711973	189.1931161	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.099552677	0.100761819	0	0	0.2	0.2	0.090268188	0.042077707	0.2	0	0.07287301	0	0.2	0.151110107	0.004626609	0.198723418	0.2	0	0	0	0.2	0.189287003	0	0	0	0	0	0	0	0											NO	0.099552677	0.100761819	0	0	0.2	0.2	0.090268188	0.042077707	0.2	0	0.07287301	0	0.2	0.151110107	0.004626609	0.198723418	0.2	0	0	0	0.2	0.189287003	0	0	0	0	0	0	0	0												28.0141	3.6108449	0	0	5.059134889	3.318354037	1.351877663	0.768337968	1.050026672	0	1.761387294	0	0.004231725	1.559365419	0.004609387	19.94507691	3.261860078	0	0	0	0.253327601	2.026253836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9888	0	0	28.0141	3.6108449	0	0	5.059134889	3.318354037	1.351877663	0.768337968	1.050026672	0	1.761387294	0	0.004231725	1.559365419	0.004609387	19.94507691	3.261860078	0	0	0	0.253327601	2.026253836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9888	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.8449	0.8717	0.5526	0.0633	0.9379	0.6152	0.5553	0.095	0.1947	0.4555	0.7106	0	0.0005	0.2891	0.0271	2.7971	0.4545	0	0	0	0.0353	0.2823	0	0	0.0186	0	0	0	0	0											15.8011	0	0	34.859	4.482517954	0.552584725	0.06328239	5.997064391	3.933554505	1.907176294	0.863301087	1.244694539	0.45549083	2.47196592	0	0.004754747	1.848461256	0.031732213	22.74216248	3.716381564	0	0	0	0.288627349	2.308600682	0	0	0.018597442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7899
H0410_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2083.941167	144.4391615	2987.861245	3374.430213	616.0934381	6.706829759	5.684516311	398.8725869	285.0767532	13006.3795	4948.859367	0	9.841269401	684.8415233	6055.089755	7364.956693	830.4704869	798.2727636	0	0	998.2253539	1748.457785	1579.952657	355.9226868	115.2709132	167.6091351	16.02417873	11.71909755	2107.189914	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.33825757	100	0	13.26075139	0	0	38.89090298	1.34885035	28.89871253	21.83098952	0	0	0	0	29.60775176	0	30	30	0	30	0	0	0											NO	0	0	19.37599277	0	0	0.181343496	0.181343496	42.92242553	90.67174782	0	12.02375506	0	0	35.26306148	1.223026188	26.20296775	19.79453977	0	0	0	0	26.84586601	0	30	30	0	30	0	0	0												0	0	4.824398157	0	0	1.216239953	1.030850059	1.426714909	2.154033956	0	4.958656071	0	0	2.012467395	0.617127778	16.08197689	1.369898423	0	0	0	0	3.911571952	0	0.889806717	0.288177283	0	0.040060447	0	0	0	0	0	0	0	0	0	0	0	0	0	40.822	0	4.074427888	0	0	4.824398157	0	0	1.216239953	1.030850059	1.426714909	2.154033956	0	4.958656071	0	0	2.012467395	0.617127778	16.08197689	1.369898423	0	0	0	0	3.911571952	0	0.889806717	0.288177283	0	0.040060447	0	0	0	0	0	0	0	0	0	0	0	0	0	40.822	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.2166	0.1095	0.5813	0	0	0	0	0	0	0	0	0	0	0	0.8959	4.1769	0.208	0	0	0	0.4875	0.364	0	0	0.0194	0	0.002	0	0	0											11.0612	0	0	4.2166	0.109533126	5.405732965	0	0	1.216239953	1.030850059	1.426714909	2.154033956	0	4.958656071	0	0	2.012467395	1.513048275	20.2588448	1.577933608	0	0	0	0.487452802	4.275533569	0	0.889806717	0.307559705	0	0.042101529	0	0	0	0	0	0	0	0	0	0	0	0	0	51.8831
H0410_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2240.910468	153.6250318	2935.166613	3737.083819	621.1710482	7.194003998	5.923635766	421.1488697	275.8021966	12461.90651	4923.494412	0	11.63327515	634.7322475	5463.127651	6546.796966	712.241864	563.0593139	0	0	709.1370033	1700.288781	1576.881712	351.1520964	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02000553	100	0	13.14050144	0	0	38.98130397	1.767233295	28.74515739	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.54120853	0	0	0.18288978	0.18288978	42.99739245	91.44489024	0	12.01631712	0	0	35.64641063	1.616044547	26.28597763	17.13727865	0	0	0	0	26.99744971	0	30	30	0	30	0	0	0												0	0	4.779725239	0	0	1.315709812	1.083372445	1.509025269	2.101725133	0	4.930189181	0	0	1.885493861	0.735721471	14.34074655	1.017157274	0	0	0	0	3.825288405	0	0.877880241	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7148	0	3.510565333	0	0	4.779725239	0	0	1.315709812	1.083372445	1.509025269	2.101725133	0	4.930189181	0	0	1.885493861	0.735721471	14.34074655	1.017157274	0	0	0	0	3.825288405	0	0.877880241	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7148	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.424	0.1086	0.547	0	0	0	0	0	0	0	0	0	0	0	0.7785	3.9306	0.1832	0	0	0	0.4642	0.3507	0	0	0.0202	0	0.0021	0	0	0											10.809	0	0	4.424	0.108594423	5.326702273	0	0	1.315709812	1.083372445	1.509025269	2.101725133	0	4.930189181	0	0	1.885493861	1.514192743	18.27131073	1.200332197	0	0	0	0.464170936	4.176014015	0	0.877880241	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5238
H0410_003_0	2010	4	N/A																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	3230.722765	431.3068258	2395.391844	2421.100243	553.4306334	3097.907075	25.0386755	778.4910006	573.6595512	25275.42467	9369.829671	0	15.09458686	1472.076743	13856.4311	10294.14754	1848.682617	1143.38543	0	0	2863.907969	2004.655261	827.9991075	356.2279737	106.8087506	178.0064851	16.00143025	13.49511634	2070.673716	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0	0.108902906	49.08898681	100	0	13.49806232	0	0	39.08796492	0.393741336	29.62628217	21.75060418	0	0	0	0	29.73733741	0	30	0	0	30	0	0	0											NO	0	0	13.58287014	0	0	0	0.069221187	31.20208681	63.5622954	0	8.579678244	0	0	24.84520773	0.250271031	18.83114499	13.82518328	0	0	0	0	18.90173425	0	30	0	0	30	0	0	0												0	0	2.71135803	0	0	0	1.733206828	2.024211982	3.038593154	0	6.699176981	0	0	3.047837705	0.288988609	16.1542154	2.129864668	0	0	0	0	3.15762175	0	0.890569934	0	0	0.040003576	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9156	0	23.49509328	0	0	2.71135803	0	0	0	1.733206828	2.024211982	3.038593154	0	6.699176981	0	0	3.047837705	0.288988609	16.1542154	2.129864668	0	0	0	0	3.15762175	0	0.890569934	0	0	0.040003576	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9156	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.3567	0.402	0.523	0	0	0	0	0	0	0	0	0	0	0	2.1885	7.2918	0.4362	0	0	0	1.2328	0.3911	0	0	0.0182	0	0.002	0	0	0											19.8425	0	0	7.3567	0.402026746	3.234402639	0	0	0	1.733206828	2.024211982	3.038593154	0	6.699176981	0	0	3.047837705	2.477491687	23.4460477	2.566057912	0	0	0	1.232844433	3.548753261	0	0.890569934	0.018200616	0	0.042027249	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7581
H0410_004_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1419.50064	411.4963196	11873.95175	114.907723	850.520078	2221.295652	2011.422242	209.6963548	91.21911862	36297.26597	5149.267999	0	3.33103523	507.9081522	173.7867564	5549.36893	2162.755628	33.80369781	0	0	153.4428808	2242.005866	1533.383865	0	108.5215448	141.8948371	15.79381348	9.237945123	0	0											500	"$25 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$25 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $20 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											23.38815764	21.55472438	0	0	50	0	0	49.91275447	0	0	0	0	0	0	0.412624887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	20.29907195	20.54561938	0	0	41.09123876	0	0	41.01953822	0	0	0	0	0	0	0.339105355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												2.4012	0.70453723	0	0	2.9124103	0	0	0.71680397	0	0	0	0	0	0	0.004911002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7399	0	1.461234455	2.4012	0.70453723	0	0	2.9124103	0	0	0.71680397	0	0	0	0	0	0	0.004911002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.7399	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.0591	0.6497	0.667	0.0556	0.8234	0.5401	0.4875	0.0758	0.1709	0.3999	0.6238	0	0.0007	0.2526	0.0197	2.7965	0.3688	0	0	0	0.0353	0.2986	0	0	0.0153	0	0.0016	0	0	0											14.342	0	0	8.4603	1.354250954	0.667026902	0.055555192	3.735812404	0.54008042	0.487492994	0.792648337	0.170897632	0.399872386	0.623812274	0	0.000688737	0.252632701	0.024634338	2.796499842	0.368846365	0	0	0	0.035332325	0.298602032	0	0	0.015315541	0	0.001556039	0	0	0	0	0	0	0	0	0	0	0	0	0	21.0819
H0423_001_0	2010	7	N/A																															Coin	Coin	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	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	NO	530.04	49.23353332	0	0	0	0	0	602.4417507	0	0	0	0	0	290.7796331	0	781.2691415	142.0552123	61.17221223	0	79.5604452	0.16646966	0	0	0	0	0	0	0	0	0												1A IP Acute: Medicare coinsurance	1B IP Psych: Medicare coinsurance	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetic Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: 0%"	"4A ER: $50, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP C/D/T: $0	8B OP X-Ray: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0 Partial Hosp: $1000, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0"	7D Physician Specialist: $10	"7E Mental Health: $20 Ind, $10 Group, 7H Psychiatric: $20"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	Included in i.2.	"7B Chiropractic: $10, 7F Podiatry: $10, 7G Other Health Care: $10, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Medicare Covered Comprehensive Dental Services: $0, 17A Medicare Covered Eye Exams: $0"	10B Transportation: $0	"16A Preventive Dental Services: $0, 16B Non Medicare Covered Comprehensive Dental: Not Covered"	17A Routine Eye Exams: $0	"17B Eye Wear: Medicare Covered: $0, Routine: $0"	18A Routine Hearing Exams: $0	18B Hearing Aids: $0	14A Health Education/Wellness Programs: N/A	"13B Acupuncture: Not Covered, Health Related Expense Card: $0"											0.056909946	0.056909946	0	0	0	0	0	46.95	0	0	0	0	0	2.5	0	10	20	25	0	10	0.2	0	0	0	0	0	0	0	0	0											NO	0.056909946	0.056909946	0	0	0	0	0	46.95	0	0	0	0	0	2.5	0	10	20	25	0	10	0.2	0	0	0	0	0	0	0	0	0												30.1645	2.801877727	0	0	0	0	0	2.357053349	0	0	0	0	0	0.06057909	0	0.651057618	0.236758687	0.127442109	0	0.066300371	0.033293932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4989			30.1645	2.801877727	0	0	0	0	0	2.357053349	0	0	0	0	0	0.06057909	0	0.651057618	0.236758687	0.127442109	0	0.066300371	0.033293932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4989	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			30.1645	2.801877727	0	0	0	0	0	2.357053349	0	0	0	0	0	0.06057909	0	0.651057618	0.236758687	0.127442109	0	0.066300371	0.033293932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4989
H0423_002_0	2010	8	N/A																															Coin	Coin	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	COin	V	T	V	V	V	V	V	O	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	NO	724.99	25.74686692	0	0	0	0	0	581.3127016	0	0	0	0	0	396.3253319	0	585.6649716	146.506086	62.87191731	0	83.80631675	0.228752773	0	0	0	0	0	0	0	0	0												1A IP Acute: Medicare coinsurance	1B IP Psych: Medicare coinsurance	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetic Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: 0%"	"4A ER: $50, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP C/D/T: $0	8B OP X-Ray: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $1000, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0"	7D Physician Specialist: $10	"7E Mental Health: $20 Ind, $10 Group, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	Included in i.2.	"7B Chiropractic: $10, 7F Podiatry: $10, 7G Other Health Care: $0, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Medicare Covered Comprehensive Dental Services: $0, 17A Medicare Covered Eye Exams: $0"	10B Transportation: $0	"16A Preventive Dental Services: $0, 16B Non Medicare Covered Comprehensive Dental: Not Covered"	17A Routine Eye Exams: $0	"17B Eye Wear: Medicare Covered: $0, Routine: $0"	18A Routine Hearing Exams: $0	18B Hearing Aids: $0	14A Health Education/Wellness Programs: N/A	13B Acupuncture: Not Covered; Health Expense Reimbursement Card: $0											0.0569	0.0569	0	0	0	0	0	47.94	0	0	0	0	0	1.75	0	10	20	25	0	10	0.2	0	0	0	0	0	0	0	0	0											NO	0.0569	0.0569	0	0	0	0	0	47.94	0	0	0	0	0	1.75	0	10	20	25	0	10	0.2	0	0	0	0	0	0	0	0	0												41.2519	1.464996728	0	0	0	0	0	2.322344243	0	0	0	0	0	0.057797444	0	0.488054143	0.24417681	0.130983161	0	0.069838597	0.045750555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0759			41.2519	1.464996728	0	0	0	0	0	2.322344243	0	0	0	0	0	0.057797444	0	0.488054143	0.24417681	0.130983161	0	0.069838597	0.045750555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0759	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			41.2519	1.464996728	0	0	0	0	0	2.322344243	0	0	0	0	0	0.057797444	0	0.488054143	0.24417681	0.130983161	0	0.069838597	0.045750555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0759
H0423_003_0	2010	7	N/A																															Coin	Coin	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	0	0	0	0	0	0	0	563.1271524	0	0	0	0	0	0	0	0	0	0	0	72.56208867	0	0	0	0	0	0	0	0	0	0												PBP: 1A IP Acute: $0 per admit	1B IP Psych: $0 per admit	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetic Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: 0%"	"4A ER: $50, 4B Urgent Care: $10"	9B ASC Services: $0	8A OP C/D/T: $0	8B OP X-Ray: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0"	7D Physician Specialist: $0	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	Included in i.2.	"7B Chiropractic: $10, 7F Podiatry: $0, 7G Other Health Care: $0, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Medicare Covered Comprehensive Dental Services: $0, 17A Medicare Covered Eye Exams: $0"	10B Transportation: $0	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: Not Covered"	17A Routine Eye Exams: $0	"17B Eye Wear: Medicare Covered: $0, Routine: not covered"	18A Routine Hearing Exams: $0	18B Hearing Aids: $0	14A Health Education/Wellness Programs: $0	"13B Acupuncture: Not Covered, Massage Therapy"											0	0	0	0	0	0	0	47.56460885	0	0	0	0	0	0	0	0	0	0	0	10	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	47.56460885	0	0	0	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	2.232076894	0	0	0	0	0	0	0	0	0	0	0	0.060468407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.2925			0	0	0	0	0	0	0	2.232076894	0	0	0	0	0	0	0	0	0	0	0	0.060468407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.2925	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	2.232076894	0	0	0	0	0	0	0	0	0	0	0	0.060468407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.2925
H0423_004_0	2010	7	N/A																															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	O	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	NO	3432.777011	278.3332712	558.4655245	0	442.8084648	2.207833969	0.441566794	478.1177115	582.6816663	0	233.0726665	0	0	388.4544442	0	627.2595948	114.0522391	49.1134937	0	63.87690231	78.46501854	0	0	0	0	0	89.9	0	0	0												PBP: 1A IP Acute: $100 days 1 to 8	1B IP Psych: $100 days 1 to 8	2 SNF: $50 copay day 1 to 30	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	"11B Prosthetic Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 0%"	"4A ER: $50, 4B Urgent Care: $0"	9B ASC Services: $50	8A OP C/D/T: $0	8B OP X-Ray: $15	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $20, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $20"	"7A PCP: $0, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0"	7D Physician Specialist: $15	7E Mental Health: $30	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	Included in i.2.	"7B Chiropractic: $10, 7F Podiatry: $20, 7G Other Health Care: $10, 18A Medicare Covered Hearing Exams: $10"	15 Part B Drugs: $30	"13A Blood: $0, 16B Medicare Covered Comprehensive Dental Services: $0, 17A Medicare Covered Eye Exams: $0"	10B Transportation: $0	"16A Preventive Dental Services: $0 copay, 16B Non Medicare Covered Comprehensive Dental: Not Covered"	17A Routine Eye Exams: $0	"17B Eye Wear: Medicare Covered: $0, Routine: $0"	18A Routine Hearing Exams: $10	18B Hearing Aids: $0	14A Health Education/Wellness Programs: $0	"13B Acupuncture: Not Covered, Massage Therapy"											70	75	40	0	50	0.1	0.1	47.5	50	0	15	0	0	27	0	15	30	20	0	10	30	0	0	0	0	0	10	0	0	0											NO	70	75	40	0	50	0.1	0.1	47.5	50	0	15	0	0	27	0	15	30	20	0	10	30	0	0	0	0	0	10	0	0	0												20.0245	1.739582945	1.861551748	0	1.84503527	0.220783397	0.044156679	1.892549275	2.427840276	0	0.291340833	0	0	0.874022499	0	0.784074494	0.285130598	0.081855823	0	0.053230752	0.196162546	0	0	0	0	0	0.074916667	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6968			20.0245	1.739582945	1.861551748	0	1.84503527	0.220783397	0.044156679	1.892549275	2.427840276	0	0.291340833	0	0	0.874022499	0	0.784074494	0.285130598	0.081855823	0	0.053230752	0.196162546	0	0	0	0	0	0.074916667	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6968	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			20.0245	1.739582945	1.861551748	0	1.84503527	0.220783397	0.044156679	1.892549275	2.427840276	0	0.291340833	0	0	0.874022499	0	0.784074494	0.285130598	0.081855823	0	0.053230752	0.196162546	0	0	0	0	0	0.074916667	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6968
H0474_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1011.944839	33.15836977	764.5012682	543.3233736	247.1831913	7.882481866	1.092162456	834.1021172	110.4418385	11.22823917	2049.166692	0	0.411445882	2753.205812	4560.508433	5212.291974	66.25131359	391.3815079	0	2923.359722	29.39171123	21.95976718	0	404.0693456	278.5330726	324.1787096	29.66230679	0	0	0											1550	1a: $250 Days 1-1	1b: $275	2: $125 Days 4-15	6: none	10a: $100	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9b: $100	8a: 20%	8b: $50; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: 20%; 9a: $100; 9a: $50; 9d: $25	7a: $10	7d: $30	7h: $25; 7h: $35	7c: $25; 7i: $25	7d. 0%	14c: $10; 7b: $30; 7f: $30	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $20	18b. $0	14a. $0	13b. $0											57.21905935	109.1474941	70.08382859	0	70.83583805	0.200653942	0.156117264	14.31414383	84.78118376	0.009285708	20.63124615	0	0.200653942	10.16199722	8.251820298	15.31880456	34.79878977	23.13921082	0	2.269970494	0.190531033	0	0	19.99951286	8.451154515	17.67413789	19.10733274	0	0	0											NO	49.83954075	76.4828507	35.20786654	0	56.23004257	0.147081265	0.137000176	13.29952886	82.9514891	0.008939647	14.86802701	0	0.057703395	8.478588831	8.003110226	14.29077582	33.03339734	20.73773394	0	2.21049422	0.081817721	0	0	19.99951286	8.451154515	17.67413789	18.33658639	0	0	0												4.2029	0.21133722	2.243038219	0	1.158260114	1.159365402	0.149626448	0.924430431	0.763442914	0.1003765	2.538922144	0	0.023741824	1.945275004	3.041520973	6.207308011	0.182375497	0.676363798	0	0.538505814	2.404762839	0	0	0.673432506	0.196160503	0.477464935	0.045325454	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8639	0	9.123919293	4.2029	0.21133722	2.243038219	0	1.158260114	1.159365402	0.149626448	0.924430431	0.763442914	0.1003765	2.538922144	0	0.023741824	1.945275004	3.041520973	6.207308011	0.182375497	0.676363798	0	0.538505814	2.404762839	0	0	0.673432506	0.196160503	0.477464935	0.045325454	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8639	NO																																																																																		0		0	4.2029	0.21133722	2.243038219	0	1.158260114	1.159365402	0.149626448	0.924430431	0.763442914	0.1003765	2.538922144	0	0.023741824	1.945275004	3.041520973	6.207308011	0.182375497	0.676363798	0	0.538505814	2.404762839	0	0	0.673432506	0.196160503	0.477464935	0.045325454	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8639
H0474_002_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1539.912598	50.45827539	1163.368881	826.7945802	376.1474892	12.67172543	2.263702992	1269.282978	168.0632897	18.05030018	3118.290133	0	0.661432444	4189.651603	6939.888541	7931.730833	100.8169898	595.5792171	0	4448.580885	50.58007889	33.41696192	0	614.8867528	423.8537232	493.3143191	45.13819151	0	0	0											950	1a: $125 Days 1-1	1b: $275	2: $75 Days 4-15	6: none	10a: $100	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $30	9b: $50	8a: 20%	8b: $50; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: 20%; 9a: $50; 9d: $25	7a: $5	7d: $25	7h: $25; 7h: $35	7c: $25; 7i: $25	7d. 0%	14c: $5; 7b: $25; 7f: $25	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $20	18b. $0	14a. $0	13b. $0											19.06442503	38.46015638	31.19892736	0	70.83688776	0.200669567	0.121094752	14.08704375	42.49732217	0.009286431	21.07529372	0	0.200669567	8.10299599	4.125972359	12.82526386	34.79296115	23.14437958	0	1.786606436	0.177999049	0	0	19.9996477	8.451154515	17.67448726	19.10893917	0	0	0											NO	14.89158329	23.47176619	11.98686194	0	48.24707912	0.107262069	0.09187575	12.14838787	40.11577863	0.008249011	12.3259846	0	0.024652153	5.473933014	3.86931208	11.11078187	29.30957637	18.32322171	0	1.622243018	0.051621659	0	0	19.9996477	8.451154515	17.67448726	17.59050552	0	0	0												1.911	0.098695404	1.16209518	0	1.512334806	1.359195485	0.207979411	1.284978494	0.561832477	0.148897121	3.202999679	0	0.016305734	1.911156019	2.237716214	7.343977595	0.246241938	0.909410837	0	0.60138994	2.611027598	0	0	1.024793203	0.298504442	0.726589804	0.066166967	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4433	0	16.14010124	1.911	0.098695404	1.16209518	0	1.512334806	1.359195485	0.207979411	1.284978494	0.561832477	0.148897121	3.202999679	0	0.016305734	1.911156019	2.237716214	7.343977595	0.246241938	0.909410837	0	0.60138994	2.611027598	0	0	1.024793203	0.298504442	0.726589804	0.066166967	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4433	NO																																																																																		0		0	1.911	0.098695404	1.16209518	0	1.512334806	1.359195485	0.207979411	1.284978494	0.561832477	0.148897121	3.202999679	0	0.016305734	1.911156019	2.237716214	7.343977595	0.246241938	0.909410837	0	0.60138994	2.611027598	0	0	1.024793203	0.298504442	0.726589804	0.066166967	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4433
H0474_801_0	2010	2	N/A																															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																																																			0	NO	199.2357166	3.436563677	24.74241835	6.866735377	6.174266489	7.882534417	1.033144259	10.23419358	6.725566821	11.22831403	28.53746396	0	0.411448625	40.71637288	103.5642615	47.07362063	2.189152871	4.814888039	0	15.81164694	29.00489873	0.66480271	0	4.383432506	0.672441105	1.644015586	0.36496272	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.093387494	0.093387494	0.196173174	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.093387494	0.093387494	0.196173174	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.6061	0.320932069	4.853798729	0	1.438604092	1.836630519	0.240722612	2.384567104	1.567057069	2.616197169	6.649229103	0	0.09586753	9.48691488	24.13047294	10.96815361	0.510072619	1.121868913	0	3.684113737	6.758141404	0.154899031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4244	0	0	18.6061	0.320932069	4.853798729	0	1.438604092	1.836630519	0.240722612	2.384567104	1.567057069	2.616197169	6.649229103	0	0.09586753	9.48691488	24.13047294	10.96815361	0.510072619	1.121868913	0	3.684113737	6.758141404	0.154899031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4244	NO																																																																																		0		0	18.6061	0.320932069	4.853798729	0	1.438604092	1.836630519	0.240722612	2.384567104	1.567057069	2.616197169	6.649229103	0	0.09586753	9.48691488	24.13047294	10.96815361	0.510072619	1.121868913	0	3.684113737	6.758141404	0.154899031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4244
H0474_802_0	2010	3	N/A																															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																																																			0	NO	199.2357166	3.436563677	24.74241835	6.866735377	6.174266489	7.882534417	1.033144259	10.23419358	6.725566821	11.22831403	28.53746396	0	0.411448625	40.71637288	103.5642615	47.07362063	2.189152871	4.814888039	0	15.81164694	29.00489873	0.66480271	0	4.383432506	0.672441105	1.644015586	0.36496272	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.093387494	0.093387494	0.196173174	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.093387494	0.093387494	0.196173174	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.6061	0.320932069	4.853798729	0	1.438604092	1.836630519	0.240722612	2.384567104	1.567057069	2.616197169	6.649229103	0	0.09586753	9.48691488	24.13047294	10.96815361	0.510072619	1.121868913	0	3.684113737	6.758141404	0.154899031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4244	0	0	18.6061	0.320932069	4.853798729	0	1.438604092	1.836630519	0.240722612	2.384567104	1.567057069	2.616197169	6.649229103	0	0.09586753	9.48691488	24.13047294	10.96815361	0.510072619	1.121868913	0	3.684113737	6.758141404	0.154899031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4244	NO																																																																																		0		0	18.6061	0.320932069	4.853798729	0	1.438604092	1.836630519	0.240722612	2.384567104	1.567057069	2.616197169	6.649229103	0	0.09586753	9.48691488	24.13047294	10.96815361	0.510072619	1.121868913	0	3.684113737	6.758141404	0.154899031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4244
H0490_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	861.6838392	20.55092599	715.2098019	0	185.661393	9.274453715	6.247799026	232.8577108	342.3372436	0	704.1924819	0	0.329337538	14.14885372	4232.702395	5363.083204	143.8084874	424.3219834	1740.322431	1091.139064	7.837219147	0	0	0	449.904	0	192.816	0	0	0											3000	$150/Days 1-10 for IP Medical; $150/Days 1-10 for IP Surgical;	$150/Days 1-10 for IP Psych; $150/Days 1-10 for IP Substance Abuse;	$75/Days 11-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $35/Visit for Urgent Care;	$150/Case for OP Fac - Surgery; $150/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	20% Coinsurance for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $30/Visit for Prof - CORF; $30/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $10/Visit for PCP - Consults; $10/Exam for Physical Exams (Routine); $3/Procedure for PCP - Asst Surgeon (OP); $10/Visit for PCP - Tx Injections; $10/Visit for PCP - Allergy Testing; $10/Visit for PCP - Allergy Tx;	$30/Visit for Speclst - Office Visits; $10/Procedure for Speclst - Asst Surgeon (OP); $30/Visit for Speclst - Tx Injections; $30/Visit for Speclst - Allergy Testing; $30/Visit for Speclst - Allergy Tx; $30/Visit for Speclst - Consults;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	$23/Procedure for Prof Radiology (Office);	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; $30/Visit for Podiatry;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision Exams (Refractions);	No Cost-Sharing	$30/Exam for Hearing Exam;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	150	75	0	100	0.2	0.2	48.84472536	150	0	77.00386706	0	0.2	0.138779604	9.721503983	23.91614173	30	30	24.43193333	30	0.2	0	0	0	30	0	30	0	0	0											NO	145.2309431	145.2309431	72.61547155	0	96.82062874	0.193641257	0.193641257	47.2917702	145.2309431	0	74.55562824	0	0.193641257	0.134367286	9.412421278	23.15575879	29.04618862	29.04618862	23.65515146	29.04618862	0.193641257	0	0	0	29.04618862	0	29.04618862	0	0	0												10.4286	0.248719197	4.327941418	0	1.497987734	1.79591688	1.20983166	0.917687779	4.143163396	0	4.375126074	0	0.063773335	1.90114307	3.319998174	10.34885509	0.348090704	1.027078031	3.430632558	2.641119256	1.517608971	0	0	0	1.088999704	0	0.466714159	0	0	0	0	0	0	0	0	0	0	0	0	0	55.099	0	1.809326458	10.4286	0.248719197	4.327941418	0	1.497987734	1.79591688	1.20983166	0.917687779	4.143163396	0	4.375126074	0	0.063773335	1.90114307	3.319998174	10.34885509	0.348090704	1.027078031	3.430632558	2.641119256	1.517608971	0	0	0	1.088999704	0	0.466714159	0	0	0	0	0	0	0	0	0	0	0	0	0	55.099	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.4286	0.248719197	4.327941418	0	1.497987734	1.79591688	1.20983166	0.917687779	4.143163396	0	4.375126074	0	0.063773335	1.90114307	3.319998174	10.34885509	0.348090704	1.027078031	3.430632558	2.641119256	1.517608971	0	0	0	1.088999704	0	0.466714159	0	0	0	0	0	0	0	0	0	0	0	0	0	55.099
H0490_004_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	407.561405	4.766315673	110.9079882	0	12.43982827	17.99746682	11.29819224	21.33135762	64.93248858	10.73759734	38.10306017	0	0.460831507	33.85677729	59.97349668	153.0230652	1.797149991	5.594072188	39.85549898	56.34384286	13.2891235	1.481830068	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.0770578	0.0770578	0.160915058	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.0770578	0.0770578	0.160915058	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												31.4058	0.367281802	17.84676535	0	2.898479987	4.193409769	2.632478792	4.970206327	15.12926984	2.501860179	8.878013021	0	0.107373741	7.888629107	13.97382473	35.65437419	0.418735948	1.30341882	9.286331262	13.12811539	3.096365775	0.345266406	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	176.026	0	0	31.4058	0.367281802	17.84676535	0	2.898479987	4.193409769	2.632478792	4.970206327	15.12926984	2.501860179	8.878013021	0	0.107373741	7.888629107	13.97382473	35.65437419	0.418735948	1.30341882	9.286331262	13.12811539	3.096365775	0.345266406	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	176.026	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	31.4058	0.367281802	17.84676535	0	2.898479987	4.193409769	2.632478792	4.970206327	15.12926984	2.501860179	8.878013021	0	0.107373741	7.888629107	13.97382473	35.65437419	0.418735948	1.30341882	9.286331262	13.12811539	3.096365775	0.345266406	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	176.026
H0496_801_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	T	P	V	P	V	P	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	NO	1268.535702	24.68751987	281.3912049	0	202.5119831	22.73181937	0.331084077	228.5832747	91.40122538	0	1297.795023	0	16.33512772	185.4414691	4350.082091	4345.51362	137.8742357	682.2897109	109.1250246	0	12.76077319	0	0	0	739.1941148	0	51.45603208	0	0	0												1A IP Acute: 250.00/0.00 Per Day for days 1-10/11-90	1B IP Psych: 250.00/0.00 Per Day for days 1-10/11-90	2 SNF: 0.00/100.00 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min 0.00/ max 100.00	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $0"	9B ASC Services: min 0.00/ max 250.00	8A OP Diagnostic Procedures/Tests: min 0.00/ max 50.00	8B OP Radiology: min 0.00/ max 100.00	9A OP Hospital: min 0.00/ max 250.00	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $0"	"7A PCP: 20.00/35.00, 14B Immunizations: 20/40, 14C Physical Exams: 20/40, 14D Pap Smears and Pelvic Exams: 20/40, 14E Prostate Screening: 20/40, 14F Colorectal Screening: 20/40, 14G Bone Mass Measurement: 20/40, 14H Mammography: 20/40, 14I Diabetes Monitoring: 20/40, 14J Nutrition Therapy: 20/40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $40	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $40	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											250	250	100	0	100	0.2	0.2	48.16949128	250	0	83.39740509	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	40	0	0	0											NO	250	250	100	0	100	0.2	0.2	48.16949128	250	0	83.39740509	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	40	0	0	0												26.4278	0.514323331	2.344926707	0	1.687599859	4.546363873	0.066216815	0.917561672	1.904192195	0	9.019394774	0	3.267025544	0.61813823	7.250136818	14.4850454	0.459580786	2.274299036	0.181875041	0	2.552154637	0	0	0	2.463980383	0	0.171520107	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1522	0	0	26.4278	0.514323331	2.344926707	0	1.687599859	4.546363873	0.066216815	0.917561672	1.904192195	0	9.019394774	0	3.267025544	0.61813823	7.250136818	14.4850454	0.459580786	2.274299036	0.181875041	0	2.552154637	0	0	0	2.463980383	0	0.171520107	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1522	NO	1A IP Acute: Not Covered	1B IP Psych: Not Covered	2 SNF: Not Covered for days 1-10/11-100	6 Home Health: Not Covered	10A Ambulance: Not Covered	11A DME: Not Covered	"11B Prosthetics/Medical Supplies: Not Covered, 11C Diabetes Monitoring Supplies: Not Covered"	"4A ER: Not Covered, 4B Urgent Care: Not Covered"	9B ASC Services: Not Covered	8A OP Diagnostic Procedures/Tests: Not Covered	8B OP Radiology: Not Covered	9A OP Hospital: Not Covered	12 Renal Dialysis: Not Covered	"3 CORF: Not Covered, 5 Partial Hosp: Not Covered, 9C OP Substance Abuse: Not Covered, 9D Cardiac Rehab: Not Covered"	"7A PCP: Not Covered, 14B Immunizations: Not Covered, 14C Physical Exams: Not Covered, 14D Pap Smears and Pelvic Exams: Not Covered, 14E Prostate Screening: Not Covered, 14F Colorectal Screening: Not Covered, 14G Bone Mass Measurement: Not Covered, 14H Mammography: Not Covered, 14I Diabetes Monitoring: Not Covered, 14J Nutrition Therapy: Not Covered"	"7B Chiropractic: Not Covered, 7D Physician Specialist (excl. Radiology): Not Covered, 7F Podiatry: Not Covered"	"7E Mental Health: Not Covered, 7H Psychiatric: Not Covered"	"7C Occupational Therapy: Not Covered, 7I Physical and Speech Therapy: Not Covered"	7D Physician Specialist (Radiology): Not Covered	"7G Other Health Care: Not Covered, 18A Hearing Exams (Medicare Covered): Not Covered"	15 Part B Drugs: Not Covered	"13A Blood: Not Covered, 16B Comprehensive Dental (Medicare Covered): Not Covered, 17A Routine Eye Exams (Medicare Covered): Not Covered"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot 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	0	0	26.4278	0.514323331	2.344926707	0	1.687599859	4.546363873	0.066216815	0.917561672	1.904192195	0	9.019394774	0	3.267025544	0.61813823	7.250136818	14.4850454	0.459580786	2.274299036	0.181875041	0	2.552154637	0	0	0	2.463980383	0	0.171520107	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1522
H0496_805_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	T	P	V	P	V	P	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	NO	1268.535702	24.68751987	281.3912049	0	202.5119831	22.73181937	0.331084077	228.5832747	91.40122538	0	1297.795023	0	16.33512772	185.4414691	4350.082091	4345.51362	137.8742357	682.2897109	109.1250246	0	12.76077319	0	0	0	739.1941148	0	51.45603208	0	0	0												1A IP Acute: 250.00/0.00 Per Day for days 1-10/11-90	1B IP Psych: 250.00/0.00 Per Day for days 1-10/11-90	2 SNF: 0.00/100.00 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min 0.00/ max 100.00	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: min 0.00/ max 250.00	8A OP Diagnostic Procedures/Tests: min 0.00/ max 50.00	8B OP Radiology: min 0.00/ max 100.00	9A OP Hospital: min 0.00/ max 250.00	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $0"	"7A PCP: 20.00/35.00, 14B Immunizations: 20/40, 14C Physical Exams: 20/40, 14D Pap Smears and Pelvic Exams: 20/40, 14E Prostate Screening: 20/40, 14F Colorectal Screening: 20/40, 14G Bone Mass Measurement: 20/40, 14H Mammography: 20/40, 14I Diabetes Monitoring: 20/40, 14J Nutrition Therapy: 20/40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $40	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $40	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											250	250	100	0	100	0.2	0.2	48.16949128	250	0	83.39740509	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	40	0	0	0											NO	250	250	100	0	100	0.2	0.2	48.16949128	250	0	83.39740509	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	40	0	0	0												26.4278	0.514323331	2.344926707	0	1.687599859	4.546363873	0.066216815	0.917561672	1.904192195	0	9.019394774	0	3.267025544	0.61813823	7.250136818	14.4850454	0.459580786	2.274299036	0.181875041	0	2.552154637	0	0	0	2.463980383	0	0.171520107	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1522	0	0	26.4278	0.514323331	2.344926707	0	1.687599859	4.546363873	0.066216815	0.917561672	1.904192195	0	9.019394774	0	3.267025544	0.61813823	7.250136818	14.4850454	0.459580786	2.274299036	0.181875041	0	2.552154637	0	0	0	2.463980383	0	0.171520107	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1522	NO	1A IP Acute: Not Covered	1B IP Psych: Not Covered	2 SNF: Not Covered for days 1-10/11-100	6 Home Health: Not Covered	10A Ambulance: Not Covered	11A DME: Not Covered	"11B Prosthetics/Medical Supplies: Not Covered, 11C Diabetes Monitoring Supplies: Not Covered"	"4A ER: Not Covered, 4B Urgent Care: Not Covered"	9B ASC Services: Not Covered	8A OP Diagnostic Procedures/Tests: Not Covered	8B OP Radiology: Not Covered	9A OP Hospital: Not Covered	12 Renal Dialysis: Not Covered	"3 CORF: Not Covered, 5 Partial Hosp: Not Covered, 9C OP Substance Abuse: Not Covered, 9D Cardiac Rehab: Not Covered"	"7A PCP: Not Covered, 14B Immunizations: Not Covered, 14C Physical Exams: Not Covered, 14D Pap Smears and Pelvic Exams: Not Covered, 14E Prostate Screening: Not Covered, 14F Colorectal Screening: Not Covered, 14G Bone Mass Measurement: Not Covered, 14H Mammography: Not Covered, 14I Diabetes Monitoring: Not Covered, 14J Nutrition Therapy: Not Covered"	"7B Chiropractic: Not Covered, 7D Physician Specialist (excl. Radiology): Not Covered, 7F Podiatry: Not Covered"	"7E Mental Health: Not Covered, 7H Psychiatric: Not Covered"	"7C Occupational Therapy: Not Covered, 7I Physical and Speech Therapy: Not Covered"	7D Physician Specialist (Radiology): Not Covered	"7G Other Health Care: Not Covered, 18A Hearing Exams (Medicare Covered): Not Covered"	15 Part B Drugs: Not Covered	"13A Blood: Not Covered, 16B Comprehensive Dental (Medicare Covered): Not Covered, 17A Routine Eye Exams (Medicare Covered): Not Covered"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot 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	0	0	26.4278	0.514323331	2.344926707	0	1.687599859	4.546363873	0.066216815	0.917561672	1.904192195	0	9.019394774	0	3.267025544	0.61813823	7.250136818	14.4850454	0.459580786	2.274299036	0.181875041	0	2.552154637	0	0	0	2.463980383	0	0.171520107	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1522
H0504_015_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	P	P	P	V	P	P	P	Coin	O	T	V	P	P	P	P	O	O																																																			0	NO	1357.791182	1.850730345	1111.17236	1325.637692	322.0751147	13.44310164	1.127373238	233.1524984	158.5632388	880.8285393	2.331467142	16.80255626	4.845947059	1806.915924	4160.64821	5066.099101	274.3665098	3389.777194	2240.29029	11917.83271	34.65847725	0	0	3803.527217	338.2704631	94.63059904	0	0	0	0												$50.00 for Days 1-10	$900.00 per Admit	Days 1-20 is $0 and Days 21-100 is $85	$0 Copay	$100 Copay per trip (1-way)	20% Coinsurance of medicare-allowable	20% Coinsurance of medicare-allowable for prosthetics.  $0.00 copay for medical supplies.	$50 Copay - waived if admited to hospital	$0 Copay per visit	$0 Copay	"$0 copay for simple x-ray and lab and 20% for complex (i.e., MRI, CAT scan, radiation therapy etc.), to $500"	$0 Copay	10% Coinsurance of medicare allowable	$0 Copay per visit	$0 Copay per visit	$10 Copay per visit	$30 Copay per visit	$10 copay per visit	$10 Copay	$0 Copay	20% Coinsurance of Medicare allowable	$0 Copay	Not covered	$10 Copay	$10 Copay per Exam	$20 Copay for Frames & Lenses	$0 Copay.  Office visit copay may apply.	Not covered	Not covered	Not covered											34.44547477	104.3384355	25.77715949	0	100	0.157283922	0.172614972	50	0	0	0.174	0	0.1	0	0	10	30	10	10	0	0.19960229	0	0	10	10	20	0	0	0	0											NO	34.44547477	104.3384355	25.77715949	0	100	0.157283922	0.172614972	50	0	0	0.174	0	0.1	0	0	10	30	10	10	0	0.19960229	0	0	10	10	20	0	0	0	0												3.8975	0.016091859	2.386905595	0	2.683959289	2.114383747	0.1946015	0.971468743	0	0	0.405675283	0	0.484594706	0	0	4.221749251	0.685916275	2.824814328	1.866908575	0	6.917911427	0	0	3.169606014	0.281892053	0.157717665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2817			3.8975	0.016091859	2.386905595	0	2.683959289	2.114383747	0.1946015	0.971468743	0	0	0.405675283	0	0.484594706	0	0	4.221749251	0.685916275	2.824814328	1.866908575	0	6.917911427	0	0	3.169606014	0.281892053	0.157717665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2817	NO																																																																																		0			3.8975	0.016091859	2.386905595	0	2.683959289	2.114383747	0.1946015	0.971468743	0	0	0.405675283	0	0.484594706	0	0	4.221749251	0.685916275	2.824814328	1.866908575	0	6.917911427	0	0	3.169606014	0.281892053	0.157717665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2817
H0504_017_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	P	P	P	V	P	P	P	Coin	O	T	V	P	P	P	P	O	O																																																			0	NO	1148.959789	6.789286068	416.0970671	1034.042687	201.9532383	10.49615666	0.555442299	258.3295422	115.349017	830.2451002	0.094949823	27.42446696	1.07576669	1732.240203	4008.779705	4881.180585	264.3518128	3266.046379	2158.517086	11482.81794	33.09246739	0	0	3664.694044	325.9231973	91.17647199	0	0	0	0												$50.00 for Days 1-10	$900.00 per Admit	Days 1-20 is $0 and days 21-100 is $95	$0 Copay	$110 Copay per trip (1-way)	20% Coinsurance of medicare-allowable	20% Coinsurance of medicare-allowable for prosthetics.  $0.00 copay for medical supplies.	$50 Copay - waived if admited to hospital	$0 Copay per visit	$0 Copay	"$0 copay for simple x-ray and lab and 8% for complex (i.e., MRI, CAT scan, radiation therapy etc.)-"	$0 Copay	10% Coinsurance of medicare allowable	$0 Copay per visit	$0 Copay per visit	$10 Copay per visit	$30 Copay per visit	$10 Copay per visit	$10 Copay	$0 Copay per visit	20% Coinsurance of Medicare allowable	$0 Copay	Not covered	$10 Copay	$10 Copay per Exam	$20 Copay for Frames & Lenses	$0 Copay	Not covered	Not covered	Not covered											34.44547477	104.3384355	28.80976649	0	110	0.179026751	0.180780713	50	0	0	0.077682787	0	0.1	0	0	10	30	10	10	0	0.2	0	0	10	10	20	0	0	0	0											NO	34.44547477	104.3384355	28.80976649	0	110	0.179026751	0.180780713	50	0	0	0.077682787	0	0.1	0	0	10	30	10	10	0	0.2	0	0	10	10	20	0	0	0	0												3.298	0.059031957	0.998971612	0	1.851238018	1.879092823	0.100413255	1.076373092	0	0	0.007375967	0	0.107576669	0	0	4.067650487	0.660879532	2.721705316	1.798764238	0	6.618493477	0	0	3.053911704	0.271602664	0.151960787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.7231			3.298	0.059031957	0.998971612	0	1.851238018	1.879092823	0.100413255	1.076373092	0	0	0.007375967	0	0.107576669	0	0	4.067650487	0.660879532	2.721705316	1.798764238	0	6.618493477	0	0	3.053911704	0.271602664	0.151960787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.7231	NO																																																																																		0			3.298	0.059031957	0.998971612	0	1.851238018	1.879092823	0.100413255	1.076373092	0	0	0.007375967	0	0.107576669	0	0	4.067650487	0.660879532	2.721705316	1.798764238	0	6.618493477	0	0	3.053911704	0.271602664	0.151960787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.7231
H0504_021_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	P	P	P	V	P	P	P	Coin	O	T	V	P	P	P	P	O	O																																																			0	NO	929.6573204	0	863.6087522	203.1800299	137.7635261	9.332682137	0.814371685	264.1424609	20.5848477	587.8780503	0.401362974	22.95789592	580.5445712	1385.620506	4267.566725	5196.285496	281.4170602	3476.886203	2297.860289	12224.09196	35.54911561	0	0	3901.268593	346.9631893	97.06237472	0	0	0	0												$0.00 for Days 1-10	$900.00 Per Admit	Days 1-20 is $0 and Days 21-100 is $60	$0 Copay	$60 Copay per trip (1-way)	9% Coinsurance of medicare-allowable	0% Coinsurance of medicare-allowable for prosthetics.  $0.00 copay for medical supplies.	$50 Copay - waived if admited to hospital	$0 Copay per visit	$0 Copay	"$0 copay for simple x-ray and lab and 8% for complex (i.e., MRI, CAT scan, radiation therapy etc.)-"	$0 Copay	$25 Copay	$0 Copay per visit	$0 Copay per visit	$0 Copay per visit	$30 Copay per visit	$0 Copay per visit	$0 Copay	$0 Copay per visit	20% Coinsurance of Medicare allowable	$0 Copay	Not covered	$10 Copay	$10 Copay per Exam	$15 Copay for Frames & Lenses	$0 Copay.  Office visit copay may apply.	Not covered	Not covered	Not covered											0	104.3384355	18.19564199	0	60	0.063375961	0.038829971	50	0	0	0.077682787	0	0	0	0	0	30	0	0	0	0.2	0	0	10	10	15	0	0	0	0											NO	0	104.3384355	18.19564199	0	60	0.063375961	0.038829971	50	0	0	0.077682787	0	0	0	0	0	30	0	0	0	0.2	0	0	10	10	15	0	0	0	0												0	0	1.309492973	0	0.688817631	0.5914677	0.031622029	1.100593587	0	0	0.031178995	0	0	0	0	0	0.703542651	0	0	0	7.109823123	0	0	3.251057161	0.289135991	0.121327968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2281			0	0	1.309492973	0	0.688817631	0.5914677	0.031622029	1.100593587	0	0	0.031178995	0	0	0	0	0	0.703542651	0	0	0	7.109823123	0	0	3.251057161	0.289135991	0.121327968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2281	NO																																																																																		0			0	0	1.309492973	0	0.688817631	0.5914677	0.031622029	1.100593587	0	0	0.031178995	0	0	0	0	0	0.703542651	0	0	0	7.109823123	0	0	3.251057161	0.289135991	0.121327968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2281
H0504_026_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	P	P	P	V	P	P	P	Coin	O	T	V	P	P	P	P	O	O																																																			0	NO	1061.233274	6.27090378	684.8867249	1034.042687	255.0115419	11.50520406	0.608839711	250.6274945	7.164326944	830.2451002	0.101703025	27.42446696	1.152279412	1732.240203	4008.779705	4881.180585	264.3518128	3266.046379	2158.517086	11482.81794	33.09246739	0	0	3664.694044	325.9231973	91.17647199	0	0	0	0												$250.00 for Days 1-7	$900.00 for Days 1-1	Days 1-20 is $0 and days 11-100 is $90	$0 Copay	$200 Copay per trip (1-way)	20% Coinsurance of medicare-allowable	20% Coinsurance of medicare-allowable for prosthetics.  $0.00 copay for medical supplies.	$50 Copay - waived if admited to hospital	$250 Copay per visit	$0 Copay	"$0 copay for simple x-ray and lab and 8% for complex (i.e., MRI, CAT scan, radiation therapy etc.)-"	$0 Copay	10% Coinsurance of medicare allowable	$0 Copay per visit	$5 Copay per visit	$12.50 Copay	$30 Copay per visit	$12.50 Copay	$12.50 Copay	$0 Copay per visit	20% Coinsurance of Medicare allowable	$0 Copay	Not covered	Not covered	$10 Copay per Exam	$20 Copay for Frames & Lenses	$0 Copay	Not covered	Not covered	Not covered											144.5584465	104.3384355	49.71203961	0	200	0.179026751	0.180780713	50	250	0	0.077682787	0	0.1	0	4.872185702	12.5	30	12.5	12.5	0	0.2	0	0	0	10	20	0	0	0	0											NO	144.5584465	104.3384355	49.71203961	0	200	0.179026751	0.180780713	50	250	0	0.077682787	0	0.1	0	4.872185702	12.5	30	12.5	12.5	0	0.2	0	0	0	10	20	0	0	0	0												12.7842	0.054524691	2.837259667	0	4.250192366	2.0597393	0.110066477	1.044281227	0.149256811	0	0.007900574	0	0.115227941	0	1.627626597	5.084563109	0.660879532	3.402131645	2.248455298	0	6.618493477	0	0	0	0.271602664	0.151960787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4783			12.7842	0.054524691	2.837259667	0	4.250192366	2.0597393	0.110066477	1.044281227	0.149256811	0	0.007900574	0	0.115227941	0	1.627626597	5.084563109	0.660879532	3.402131645	2.248455298	0	6.618493477	0	0	0	0.271602664	0.151960787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4783	NO																																																																																		0			12.7842	0.054524691	2.837259667	0	4.250192366	2.0597393	0.110066477	1.044281227	0.149256811	0	0.007900574	0	0.115227941	0	1.627626597	5.084563109	0.660879532	3.402131645	2.248455298	0	6.618493477	0	0	0	0.271602664	0.151960787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4783
H0504_803_0	2010	4	N/A																															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											17.7869	0.0376	0	0	0.0901	0.0968	0.0078	0.151	0.0771	0.0015	0.0161	0.0004	0.038	0.1501	0.6509	2.4694	0.2283	0.6101	1.3915	4.4758	1.4907	0	0	0	0	0	0	0	0	0											29.7699	NO	282.6079422	0.596954388	32.56774756	12.19661075	12.7805182	13.73224384	1.107468459	21.4255614	10.93609385	0.20768519	2.282896539	0.049885925	5.396678987	21.29209336	19.67896655	74.65738786	6.902370146	18.44341203	42.06731814	135.3151716	45.06704492	0	0	0	0	0	0	0	0	0												"$1068 Deductible to days 1-60, $267 days 61-90 and $534 days 91+"	"$1068 Deductible to days 1-60, $267 days 61-90 and $534 days 91+"	$0 days 1-20 and $133.50/day for days 21-100	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.004396663	0.004396663	0.149795017	0	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0	0	0	0	0	0	0	0											NO	0.004396663	0.004396663	0.149795017	0	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0	0	0	0	0	0	0	0												1.2425	0.002624607	4.87848631	0	2.951287529	3.17106078	0.255737506	4.947607851	2.525371577	0.047958831	0.527168303	0.011519698	1.246205447	4.916787304	3.729473706	14.14874934	1.308107715	3.49531669	7.972418493	25.64435348	8.540913904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5637			19.0295	0.040196043	4.87848631	0	3.041366209	3.267847341	0.263543082	5.098617871	2.602450525	0.049422622	0.543258441	0.0118713	1.284241911	5.066856625	4.380393869	16.61818791	1.536417057	4.105368479	9.363877008	30.12016644	10.03159423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3336	NO																																																																																		0			19.0295	0.040196043	4.87848631	0	3.041366209	3.267847341	0.263543082	5.098617871	2.602450525	0.049422622	0.543258441	0.0118713	1.284241911	5.066856625	4.380393869	16.61818791	1.536417057	4.105368479	9.363877008	30.12016644	10.03159423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3336
H0504_804_0	2010	4	N/A																															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											17.7869	0.0376	0	0	0.0901	0.0968	0.0078	0.151	0.0771	0.0015	0.0161	0.0004	0.038	0.1501	0.6509	2.4694	0.2283	0.6101	1.3915	4.4758	1.4907	0	0	0	0	0	0	0	0	0											29.7699	NO	282.6079422	0.596954388	32.56774756	12.19661075	12.7805182	13.73224384	1.107468459	21.4255614	10.93609385	0.20768519	2.282896539	0.049885925	5.396678987	21.29209336	19.67896655	74.65738786	6.902370146	18.44341203	42.06731814	135.3151716	45.06704492	0	0	0	0	0	0	0	0	0												"$1068 Deductible to days 1-60, $267 days 61-90 and $534 days 91+"	"$1068 Deductible to days 1-60, $267 days 61-90 and $534 days 91+"	$0 days 1-20 and $133.50/day for days 21-100	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.004396663	0.004396663	0.149795017	0	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0	0	0	0	0	0	0	0											NO	0.004396663	0.004396663	0.149795017	0	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0	0	0	0	0	0	0	0												1.2425	0.002624607	4.87848631	0	2.951287529	3.17106078	0.255737506	4.947607851	2.525371577	0.047958831	0.527168303	0.011519698	1.246205447	4.916787304	3.729473706	14.14874934	1.308107715	3.49531669	7.972418493	25.64435348	8.540913904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5637			19.0295	0.040196043	4.87848631	0	3.041366209	3.267847341	0.263543082	5.098617871	2.602450525	0.049422622	0.543258441	0.0118713	1.284241911	5.066856625	4.380393869	16.61818791	1.536417057	4.105368479	9.363877008	30.12016644	10.03159423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3336	NO																																																																																		0			19.0295	0.040196043	4.87848631	0	3.041366209	3.267847341	0.263543082	5.098617871	2.602450525	0.049422622	0.543258441	0.0118713	1.284241911	5.066856625	4.380393869	16.61818791	1.536417057	4.105368479	9.363877008	30.12016644	10.03159423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3336
H0504_805_0	2010	6	N/A																															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											17.7869	0.0376	0	0	0.0901	0.0968	0.0078	0.151	0.0771	0.0015	0.0161	0.0004	0.038	0.1501	0.6509	2.4694	0.2283	0.6101	1.3915	4.4758	1.4907	0	0	0	0	0	0	0	0	0											29.7699	NO	282.6079422	0.596954388	32.56774756	12.19661075	12.7805182	13.73224384	1.107468459	21.4255614	10.93609385	0.20768519	2.282896539	0.049885925	5.396678987	21.29209336	19.67896655	74.65738786	6.902370146	18.44341203	42.06731814	135.3151716	45.06704492	0	0	0	0	0	0	0	0	0												"$1068 Deductible to days 1-60, $267 days 61-90 and $534 days 91+"	"$1068 Deductible to days 1-60, $267 days 61-90 and $534 days 91+"	$0 days 1-20 and $133.50/day for days 21-100	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	$135 Deductible and 20% Coins	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.004396663	0.004396663	0.149795017	0	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0	0	0	0	0	0	0	0											NO	0.004396663	0.004396663	0.149795017	0	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.230920803	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0.18951573	0	0	0	0	0	0	0	0												1.2425	0.002624607	4.87848631	0	2.951287529	3.17106078	0.255737506	4.947607851	2.525371577	0.047958831	0.527168303	0.011519698	1.246205447	4.916787304	3.729473706	14.14874934	1.308107715	3.49531669	7.972418493	25.64435348	8.540913904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5637			19.0295	0.040196043	4.87848631	0	3.041366209	3.267847341	0.263543082	5.098617871	2.602450525	0.049422622	0.543258441	0.0118713	1.284241911	5.066856625	4.380393869	16.61818791	1.536417057	4.105368479	9.363877008	30.12016644	10.03159423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3336	NO																																																																																		0			19.0295	0.040196043	4.87848631	0	3.041366209	3.267847341	0.263543082	5.098617871	2.602450525	0.049422622	0.543258441	0.0118713	1.284241911	5.066856625	4.380393869	16.61818791	1.536417057	4.105368479	9.363877008	30.12016644	10.03159423	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3336
H0523_002_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	2.05271007	0	241.9881482	399.6507869	2189.008447	2896.590884	53.86850793	0.348303762	2.195671162	4624.933905	5868.232937	216.7753503	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	0	0												$50 per stay	$50 per stay	"$0/d 1-20, $20/d 21-100"	$0 per visit	$75 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$25 per procedure	$0 per visit	$0 X-ray; $100 Complex Radiology	$10 per visit	$10 per visit	$10 per visit	$5 PCP visit; $10 if no PCP selected	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$45 per script	0	Not Covered	0	$0 per visit	$225 Every 2 Years	$0 per visit	$1200 Every 3 Yrs	Fitness Only	0											8.453846451	8.453846451	8.066267748	0	75	0.2	0.2	47.5	25	0	20	10	10	10	5	10	10	10	10	10	45	0	0	0	0	0	0	0	0	0											NO	8.453846451	8.453846451	8.066267748	0	75	0.2	0.2	47.5	25	0	20	10	10	10	5	10	10	10	10	10	45	0	0	0	0	0	0	0	0	0												1.2068	0.053642985	0.784815471	0	1.467166986	0.410542014	0	0.957869753	0.832605806	0	4.827651473	0.044890423	0.000290253	0.001829726	1.927055794	4.890194114	0.180646125	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.0907	0	0	1.2068	0.053642985	0.784815471	0	1.467166986	0.410542014	0	0.957869753	0.832605806	0	4.827651473	0.044890423	0.000290253	0.001829726	1.927055794	4.890194114	0.180646125	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.0907	NO																																																																																		0			1.2068	0.053642985	0.784815471	0	1.467166986	0.410542014	0	0.957869753	0.832605806	0	4.827651473	0.044890423	0.000290253	0.001829726	1.927055794	4.890194114	0.180646125	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.0907
H0523_022_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	1.296918591	0	241.9881482	406.3898267	2188.437638	2895.716995	53.86850793	0.348303762	0	4621.961138	5867.88256	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	0	0												$50 per stay	$50 per stay	"$0/d 1-20, $20/d 21-100"	$0 per visit	$75 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$25 per procedure	$0 per visit	$0 X-ray; $100 Complex Radiology	$10 per visit	$10 per visit	$10 per visit	$5 PCP visit; $10 if no PCP selected	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$45 per script	0	Not Covered	0	$0 per visit	$225 Every 2 Years	$0 per visit	$1200 Every 3 Yrs	Fitness Only	0											8.453846451	8.453846451	8.066267748	0	75	0.2	0.2	47.5	25	0	20	10	10	10	5	10	10	10	10	10	$45 	0	0	0	0	0	0	0	0	0											NO	8.453846451	8.453846451	8.066267748	0	75	0.2	0.2	47.5	25	0	20	10	10	10	5	10	10	10	10	10	$45 	0	0	0	0	0	0	0	0	0												1.2068	0.053642985	0.784815471	0	1.467166986	0.259383718	0	0.957869753	0.846645472	0	4.826194992	0.044890423	0.000290253	0	1.925817141	4.889902133	0.18060093	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9487	0	0	1.2068	0.053642985	0.784815471	0	1.467166986	0.259383718	0	0.957869753	0.846645472	0	4.826194992	0.044890423	0.000290253	0	1.925817141	4.889902133	0.18060093	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9487	NO																																																																																		0			1.2068	0.053642985	0.784815471	0	1.467166986	0.259383718	0	0.957869753	0.846645472	0	4.826194992	0.044890423	0.000290253	0	1.925817141	4.889902133	0.18060093	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9487
H0523_031_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	0.603426792	0	241.9881482	400.395675	2188.487486	2895.544605	53.86850793	0.348303762	0.705808468	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	0	0												$75/day 1-5	$75/day 1-5	"$0/d 1-20, $50/d 21-100"	$0 per visit	$75 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$85 per procedure	$0 per visit	$0 X-ray; $140 Complex Radiology	$0 per visit	$0 per visit	$0 per visit	$0 PCP visit; $0 if no PCP selected	$0 per visit	$0 per visit	$0 per visit	$0 per visit	$0 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$1200 every 3 Yrs	Fitness Only	0											45.96290555	45.96290555	20.16566937	0	75	0.2	0.2	47.5	85	0	28	0	0	0	0	0	0	0	0	0	45	0	0	0	0	0	0	0	0	0											NO	45.96290555	45.96290555	20.16566937	0	75	0.2	0.2	47.5	85	0	28	0	0	0	0	0	0	0	0	0	45	0	0	0	0	0	0	0	0	0												6.5612	0.291652735	1.962038678	0	1.467166986	0.120685358	0	0.957869753	2.836136031	0	6.756270746	0	0	0	0	0	0	0	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9955	0	0	6.5612	0.291652735	1.962038678	0	1.467166986	0.120685358	0	0.957869753	2.836136031	0	6.756270746	0	0	0	0	0	0	0	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9955	NO																																																																																		0			6.5612	0.291652735	1.962038678	0	1.467166986	0.120685358	0	0.957869753	2.836136031	0	6.756270746	0	0	0	0	0	0	0	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.9955
H0523_032_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	6.118935224	0	241.9881482	404.9752508	2188.379164	2895.523096	53.86850793	0.348303762	0	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	2.020795935	0												$150/day 1-5	$150/day 1-5	"$0/d 1-20, $25/d 21-100"	$0 per visit	$50 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$75 per procedure	$0 per visit	$0 X-ray; $75 Complex Radiology	$10 per visit	$15 per visit	$10 per visit	$5 PCP visit; $10 if no PCP selected	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$45 per script	0	Not Covered	0	$0 per visit	$225 Every 2 Years	$0 per visit	$1200 Every 3 Yrs	Fitness Only	0											91.92581111	91.92581111	10.08283469	0	50	0.2	0.2	47.5	75	0	15	10	15	10	5	10	10	10	10	10	$45 	0	0	0	0	0	0	0	0	0											NO	91.92581111	91.92581111	10.08283469	0	50	0.2	0.2	47.5	75	0	15	10	15	10	5	10	10	10	10	10	$45 	0	0	0	0	0	0	0	0	0												13.1224	0.583305471	0.981019339	0	0.978111324	1.223787045	0	0.957869753	2.531095317	0	3.61940387	0.044890423	0.00043538	0	1.925549037	4.889865384	0.18060093	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.543	0	0	13.1224	0.583305471	0.981019339	0	0.978111324	1.223787045	0	0.957869753	2.531095317	0	3.61940387	0.044890423	0.00043538	0	1.925549037	4.889865384	0.18060093	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.543	NO																																																																																		0			13.1224	0.583305471	0.981019339	0	0.978111324	1.223787045	0	0.957869753	2.531095317	0	3.61940387	0.044890423	0.00043538	0	1.925549037	4.889865384	0.18060093	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.543
H0523_051_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	0.333142049	0	241.9881482	403.9777845	2188.489333	2895.544798	53.86850793	0.348303762	0	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	0													$75/day 1-5	$75/day 1-5	"$0/d 1-20, $50/d 21-100"	$0 per visit	$75 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$85 per procedure	$0 per visit	$0 X-ray; $125 Complex Radiology	$0 per visit	$0 per visit	$0 per visit	$0 PCP visit; $0 if no PCP selected	$0 per visit	$0 per visit	$0 per visit	$0 per visit	$0 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$1200 Every 3 Yrs	Fitness Only												45.96290555	45.96290555	20.16566937	0	75	0.2	0.2	47.5	85	0	25	0	0	0	0	0	0	0	0	0	45	0	0	0	0	0	0	0	0												NO	45.96290555	45.96290555	20.16566937	0	75	0.2	0.2	47.5	85	0	25	0	0	0	0	0	0	0	0	0	45	0	0	0	0	0	0	0	0													6.5612	0.291652735	1.962038678	0	1.467166986	0.06662841	0	0.957869753	2.861509307	0	6.032384996	0	0	0	0	0	0	0	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2429	0	0	6.5612	0.291652735	1.962038678	0	1.467166986	0.06662841	0	0.957869753	2.861509307	0	6.032384996	0	0	0	0	0	0	0	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2429	NO																																																																																		0			6.5612	0.291652735	1.962038678	0	1.467166986	0.06662841	0	0.957869753	2.861509307	0	6.032384996	0	0	0	0	0	0	0	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.2429
H0523_052_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.92895534	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$250/day 1-5	$250/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$250 per procedure	$0 per visit	$0 X-ray; $200 Complex Radiology	$20 per visit	$20 per visit	$20 per visit	$10 PCP visit; $20 if no PCP selected	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$45 per script	0	Not Covered	0	$0 per visit	$125 Every 2 Years	$0 per visit	$750 Every 3 Yrs	Fitness Only	0											153.2096852	153.2096852	40.33133874	0	100	0.2	0.2	47.5	250	0	40	20	20	20	10	20	20	20	20	20	45	0	0	0	0	0	0	0	0	0											NO	153.2096852	153.2096852	40.33133874	0	100	0.2	0.2	47.5	250	0	40	20	20	20	10	20	20	20	20	20	45	0	0	0	0	0	0	0	0	0												21.8706	0.972175785	3.924077355	0	1.956222648	2.185791068	0	0.957869753	8.364532289	0	9.651743653	0.089780847	0.000580506	0	3.851098073	9.779730769	0.361201861	0.924458313	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9324	0	0	21.8706	0.972175785	3.924077355	0	1.956222648	2.185791068	0	0.957869753	8.364532289	0	9.651743653	0.089780847	0.000580506	0	3.851098073	9.779730769	0.361201861	0.924458313	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9324	NO																																																																																		0			21.8706	0.972175785	3.924077355	0	1.956222648	2.185791068	0	0.957869753	8.364532289	0	9.651743653	0.089780847	0.000580506	0	3.851098073	9.779730769	0.361201861	0.924458313	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9324
H0523_054_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.91804848	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$150/day 1-5	$150/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$0 per visit	$0 X-ray; $150 Complex Radiology	$15 per visit	$15 per visit	$15 per visit	$10 PCP visit; $15 if no PCP selected	$15 per visit	$15 per visit	$15 per visit	$15 per visit	$15 per visit	$45 per script	0	Not Covered	0	$0 per visit	$225 Every 2 Years	$0 per visit	$1200 Every 3 Yrs	Fitness Only	0											91.92581111	91.92581111	40.33133874	0	100	0.2	0.2	47.5	150	0	30	15	15	15	10	15	15	15	15	15	45	0	0	0	0	0	0	0	0	0											NO	91.92581111	91.92581111	40.33133874	0	100	0.2	0.2	47.5	150	0	30	15	15	15	10	15	15	15	15	15	45	0	0	0	0	0	0	0	0	0												13.1224	0.583305471	3.924077355	0	1.956222648	2.183609697	0	0.957869753	5.018719373	0	7.23880774	0.067335635	0.00043538	0	3.851098073	7.334798076	0.270901396	0.693343735	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2454	0	0	13.1224	0.583305471	3.924077355	0	1.956222648	2.183609697	0	0.957869753	5.018719373	0	7.23880774	0.067335635	0.00043538	0	3.851098073	7.334798076	0.270901396	0.693343735	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2454	NO																																																																																		0			13.1224	0.583305471	3.924077355	0	1.956222648	2.183609697	0	0.957869753	5.018719373	0	7.23880774	0.067335635	0.00043538	0	3.851098073	7.334798076	0.270901396	0.693343735	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2454
H0523_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	280.605119	3.443148438	35.77318232	7.107546643	7.505552515	8.091545913	0	10.23971712	34.59479065	11.33992807	48.08722784	0.521000082	0.00991168	17.2748968	20.55941946	106.7780941	2.843275936	4.254547891	0	-6.73E-09	58.6897673	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.065655413	0.065655413	0.152986624	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065655413	0.065655413	0.152986624	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.4232	0.226061331	5.472818379	0	1.748793736	1.885330198	0	2.385854088	8.060586221	2.64220324	11.20432409	0.121393019	0.002309421	4.025050954	4.790344733	24.87929593	0.662483293	0.991309659	0	-1.57E-09	13.67471578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.1961			18.4232	0.226061331	5.472818379	0	1.748793736	1.885330198	0	2.385854088	8.060586221	2.64220324	11.20432409	0.121393019	0.002309421	4.025050954	4.790344733	24.87929593	0.662483293	0.991309659	0	-1.57E-09	13.67471578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.1961	NO																																																																																		0			18.4232	0.226061331	5.472818379	0	1.748793736	1.885330198	0	2.385854088	8.060586221	2.64220324	11.20432409	0.121393019	0.002309421	4.025050954	4.790344733	24.87929593	0.662483293	0.991309659	0	-1.57E-09	13.67471578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.1961
H0523_805_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	292.7015845	2.15478363	37.09094584	10.41930195	8.127472793	4.906943795	0	11.20962422	42.19042535	12.44532779	49.93467502	0.326051133	0.006202906	11.70253993	26.60431238	110.9566974	4.419629527	2.897491534	0	-4.21E-09	57.50051685	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.066519252	0.066519252	0.150230452	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.066519252	0.066519252	0.150230452	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.4703	0.143334595	5.572189574	0	1.893701161	1.143317904	0	2.611842444	9.830369107	2.899761374	11.63477928	0.075969914	0.001445277	2.726691804	6.198804785	25.8529105	1.02977368	0.675115527	0	-9.81E-10	13.39762043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1579			19.4703	0.143334595	5.572189574	0	1.893701161	1.143317904	0	2.611842444	9.830369107	2.899761374	11.63477928	0.075969914	0.001445277	2.726691804	6.198804785	25.8529105	1.02977368	0.675115527	0	-9.81E-10	13.39762043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1579	NO																																																																																		0			19.4703	0.143334595	5.572189574	0	1.893701161	1.143317904	0	2.611842444	9.830369107	2.899761374	11.63477928	0.075969914	0.001445277	2.726691804	6.198804785	25.8529105	1.02977368	0.675115527	0	-9.81E-10	13.39762043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1579
H0524_002_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1133.295315	65.30347759	486.63275	0	247.9420629	8.550526868	0	531.5175912	52.73463706	4225.559188	1558.323814	0	0	60.56638421	10025.45827	3.061297078	275.3713098	932.784275	0	0	871.2687649	0	0	0	221.6085294	0	0	0	163.9082226	0											3400	$125/days 1-10	$125/days 1-10	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit,$5U/R OOA"	$0 to $50/procedure	$0 to $15/routine lab	"$0 to $15/x-ray, $50/MRI,PET, CAT Scans"			$05/visit	$0 to $5/visit	$0 to $5/visit	$5 Individual & $2 Group Visit	$05/visit	0	0	"$8/generic, $45/brand"	0		0	$05/visit		0		$05/visit	0											125	125	100	0	300	0.146	0	44.4675	47	14.1	14.4645	0	0	5	4.15	4.15	4.85	4.15	0	0	12.5538	0	0	0	4.15	0	0	0	4.15	0											NO	88.875	88.875	8.8	0	279.9	0.136218	0	41.4881775	43.851	13.1553	13.4953785	0	0	4.665	3.87195	3.87195	4.52505	3.87195	0	0	11.7126954	0	0	0	3.87195	0	0	0	3.87195	0												8.3935	0.483653881	0.356864017	0	5.783248617	1.164735669	0	1.837641347	0.192705547	4.632374899	1.752514142	0	0	0.023545182	3.234839429	0.000987766	0.103839079	0.300974506	0	0	0.850408805	0	0	0	0.071504762	0	0	0	0.052887037	0	0	0	0	0	0	0	0	0	0	0	29.2362		8.661532015	8.3935	0.483653881	0.356864017	0	5.783248617	1.164735669	0	1.837641347	0.192705547	4.632374899	1.752514142	0	0	0.023545182	3.234839429	0.000987766	0.103839079	0.300974506	0	0	0.850408805	0	0	0	0.071504762	0	0	0	0.052887037	0	0	0	0	0	0	0	0	0	0	0	29.2362	NO																																																																																		0			8.3935	0.483653881	0.356864017	0	5.783248617	1.164735669	0	1.837641347	0.192705547	4.632374899	1.752514142	0	0	0.023545182	3.234839429	0.000987766	0.103839079	0.300974506	0	0	0.850408805	0	0	0	0.071504762	0	0	0	0.052887037	0	0	0	0	0	0	0	0	0	0	0	29.2362
H0524_003_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	996.2954435	57.40918217	485.5796462	0	217.3804226	7.947209958	0	525.7480134	53.80594138	4140.13372	1526.820164	0	0	59.34195177	10323.69521	3.152364423	283.5630446	960.5327048	0	0	836.0167838	0	0	0	221.6085294	0	0	0	136.3003763	0											3400	$125/days 1-10	$125/days 1-10	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit,$5U/R OOA"	$0 to $50/procedure	$0 to $15/routine lab	"$0 to $15/x-ray, $50/MRI,PET, CAT Scans"			$05/visit	$0 to $5/visit	$0 to $5/visit	$5 Individual & $2 Group Visit	$05/visit	0	0	"$5/generic, $35/brand"	0		0	$05/visit		0		$05/visit	0											125	125	100	0	300	0.146	0	46.795	47	14.1	14.4645	0	0	5	4.15	4.15	4.85	4.15	0	0	8.722	0	0	0	4.15	0	0	0	4.15	0											NO	89.75	89.75	9.1	0	279.9	0.136218	0	43.659735	43.851	13.1553	13.4953785	0	0	4.665	3.87195	3.87195	4.52505	3.87195	0	0	8.137626	0	0	0	3.87195	0	0	0	3.87195	0												7.4515	0.429372842	0.368231232	0	5.070398356	1.082553046	0	1.912834912	0.196620361	4.538725094	1.717084667	0	0	0.023069184	3.331069304	0.00101715	0.10692808	0.309927884	0	0	0.56693266	0	0	0	0.071504762	0	0	0	0.04397902	0	0	0	0	0	0	0	0	0	0	0	27.2217		8.060331867	7.4515	0.429372842	0.368231232	0	5.070398356	1.082553046	0	1.912834912	0.196620361	4.538725094	1.717084667	0	0	0.023069184	3.331069304	0.00101715	0.10692808	0.309927884	0	0	0.56693266	0	0	0	0.071504762	0	0	0	0.04397902	0	0	0	0	0	0	0	0	0	0	0	27.2217	NO																																																																																		0			7.4515	0.429372842	0.368231232	0	5.070398356	1.082553046	0	1.912834912	0.196620361	4.538725094	1.717084667	0	0	0.023069184	3.331069304	0.00101715	0.10692808	0.309927884	0	0	0.56693266	0	0	0	0.071504762	0	0	0	0.04397902	0	0	0	0	0	0	0	0	0	0	0	27.2217
H0524_008_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1110.999619	51.21148773	754.8599827	0	276.2035928	11.24479597	0	402.9028387	64.22691845	2997.682875	1056.699543	0	0	38.91811496	9615.613598	2.285296166	299.9078176	861.3457265	0	0	31.56252961	0	0	0	214.708346	0	0	0	159.5838427	0											3400	$225/days 1-7	$225/days 1-7	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $100/MRI,PET, CAT Scans"			$30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$10/generic, $45/brand"	0		0	$30/visit		0		$30/visit	0											225	225	100	0	300	0.146	0	48.02	164.5	23.5	25.6075	0	0	30	24.9	24.9	29.25	24.9	0	0	12.985	0	0	0	24.9	0	0	0	24.9	0											NO	122.85	122.85	8.1	0	272.1	0.132422	0	43.55414	149.2015	21.3145	23.2260025	0	0	27.21	22.5843	22.5843	26.52975	22.5843	0	0	11.777395	0	0	0	22.5843	0	0	0	22.5843	0												11.3739	0.524277606	0.509530488	0	6.262916467	1.489058372	0	1.462340553	0.798562714	5.324509303	2.045242185	0	0	0.088246826	18.09682518	0.004300985	0.663039952	1.621074191	0	0	0.030977032	0	0	0	0.404086475	0	0	0	0.300340782	0	0	0	0	0	0	0	0	0	0	0	50.9992		19.48161735	11.3739	0.524277606	0.509530488	0	6.262916467	1.489058372	0	1.462340553	0.798562714	5.324509303	2.045242185	0	0	0.088246826	18.09682518	0.004300985	0.663039952	1.621074191	0	0	0.030977032	0	0	0	0.404086475	0	0	0	0.300340782	0	0	0	0	0	0	0	0	0	0	0	50.9992	NO																																																																																		0			11.3739	0.524277606	0.509530488	0	6.262916467	1.489058372	0	1.462340553	0.798562714	5.324509303	2.045242185	0	0	0.088246826	18.09682518	0.004300985	0.663039952	1.621074191	0	0	0.030977032	0	0	0	0.404086475	0	0	0	0.300340782	0	0	0	0	0	0	0	0	0	0	0	50.9992
H0524_010_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1200.111727	55.31910717	840.1342792	0	261.7196695	7.665696538	0	569.7997072	95.81289077	3035.17814	1069.916828	0	0	39.40490596	8397.409161	1.995771437	261.9124229	752.2216259	0	0	143.1794154	0	0	0	214.708346	0	0	0	172.0523376	0											3400	$225/days 1-7	$225/days 1-7	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $100/MRI,PET, CAT Scans"			$30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$10/generic, $45/brand"	0		0	$30/visit		0		$30/visit	0											225	225	100	0	300	0.146	0	48.02	164.5	23.5	25.6075	0	0	30	24.9	24.9	29.25	24.9	0	0	12.985	0	0	0	24.9	0	0	0	24.9	0											NO	122.85	122.85	8.1	0	272.1	0.132422	0	43.55414	149.2015	21.3145	23.2260025	0	0	27.21	22.5843	22.5843	26.52975	22.5843	0	0	11.777395	0	0	0	22.5843	0	0	0	22.5843	0												12.2861	0.56632936	0.567090638	0	5.934493506	1.015106867	0	2.068094685	1.191285585	5.391108705	2.070824243	0	0	0.089350624	15.80413398	0.003756092	0.579039258	1.415699905	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.323806801	0	0	0	0	0	0	0	0	0	0	0	49.8509		20.75530725	12.2861	0.56632936	0.567090638	0	5.934493506	1.015106867	0	2.068094685	1.191285585	5.391108705	2.070824243	0	0	0.089350624	15.80413398	0.003756092	0.579039258	1.415699905	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.323806801	0	0	0	0	0	0	0	0	0	0	0	49.8509	NO																																																																																		0			12.2861	0.56632936	0.567090638	0	5.934493506	1.015106867	0	2.068094685	1.191285585	5.391108705	2.070824243	0	0	0.089350624	15.80413398	0.003756092	0.579039258	1.415699905	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.323806801	0	0	0	0	0	0	0	0	0	0	0	49.8509
H0524_013_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	915.8073516	42.21410715	723.3669776	0	253.6221377	9.819462125	0	597.6182945	122.3126506	3063.98571	1080.071653	0	0	39.77890693	8526.988547	2.02656794	265.9539612	763.8290651	0	0	143.9622573	0	0	0	214.708346	0	0	0	144.6507936	0											3400	$225/days 1-7	$225/days 1-7	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $100/MRI,PET, CAT Scans"			$30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$10/generic, $45/brand"	0		0	$30/visit		0		$30/visit	0											225	225	100	0	300	0.146	0	48.02	164.5	23.5	25.6075	0	0	30	24.9	24.9	29.25	24.9	0	0	12.985	0	0	0	24.9	0	0	0	24.9	0											NO	122.85	122.85	8.1	0	272.1	0.132422	0	43.55414	149.2015	21.3145	23.2260025	0	0	27.21	22.5843	22.5843	26.52975	22.5843	0	0	11.777395	0	0	0	22.5843	0	0	0	22.5843	0												9.3756	0.432166922	0.48827271	0	5.750881973	1.300312814	0	2.169062572	1.520769245	5.442276951	2.09047891	0	0	0.090198671	16.04800562	0.003814052	0.587974342	1.437545396	0	0	0.141291697	0	0	0	0.404086475	0	0	0	0.27223641	0	0	0	0	0	0	0	0	0	0	0	47.555		17.38498442	9.3756	0.432166922	0.48827271	0	5.750881973	1.300312814	0	2.169062572	1.520769245	5.442276951	2.09047891	0	0	0.090198671	16.04800562	0.003814052	0.587974342	1.437545396	0	0	0.141291697	0	0	0	0.404086475	0	0	0	0.27223641	0	0	0	0	0	0	0	0	0	0	0	47.555	NO																																																																																		0			9.3756	0.432166922	0.48827271	0	5.750881973	1.300312814	0	2.169062572	1.520769245	5.442276951	2.09047891	0	0	0.090198671	16.04800562	0.003814052	0.587974342	1.437545396	0	0	0.141291697	0	0	0	0.404086475	0	0	0	0.27223641	0	0	0	0	0	0	0	0	0	0	0	47.555
H0524_015_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1074.199284	61.89820779	452.0732388	0	266.5543201	10.1384349	0	527.6463771	113.5482247	4323.052848	1594.278036	0	0	61.96379416	9704.59296	2.963320107	266.5580368	902.9304661	0	0	360.7213268	0	0	0	221.6085294	0	0	0	139.2314803	0											3400	$200/days 1-10	$200/days 1-10	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit,$15U/R OOA"	$0 to $100/procedure	$0 to $20/routine lab	"$0 to $20/x-ray, $50/MRI,PET, CAT Scans"			$15/visit	$0 to $15/visit	$0 to $15/visit	$15 Individual & $7 Group Visit	$15/visit	0	0	"$10/generic, $45/brand"	0		0	$15/visit		0		$15/visit	0											200	200	100	0	300	0.146	0	47.285	94	18.8	17.786	0	0	15	12.45	12.45	14.6	12.45	0	0	14.259	0	0	0	12.45	0	0	0	12.45	0											NO	121.8	121.8	5.4	0	272.1	0.132422	0	42.887495	85.258	17.0516	16.131902	0	0	13.605	11.29215	11.29215	13.2422	11.29215	0	0	12.932913	0	0	0	11.29215	0	0	0	11.29215	0												10.9031	0.628266809	0.203432957	0	6.044119209	1.342551827	0	1.885785947	0.806741212	6.142913995	2.143228087	0	0	0.070251452	9.132143282	0.002788521	0.294151236	0.849668855	0	0	0.388764795	0	0	0	0.208536396	0	0	0	0.131018563	0	0	0	0	0	0	0	0	0	0	0	41.1775		13.85167506	10.9031	0.628266809	0.203432957	0	6.044119209	1.342551827	0	1.885785947	0.806741212	6.142913995	2.143228087	0	0	0.070251452	9.132143282	0.002788521	0.294151236	0.849668855	0	0	0.388764795	0	0	0	0.208536396	0	0	0	0.131018563	0	0	0	0	0	0	0	0	0	0	0	41.1775	NO																																																																																		0			10.9031	0.628266809	0.203432957	0	6.044119209	1.342551827	0	1.885785947	0.806741212	6.142913995	2.143228087	0	0	0.070251452	9.132143282	0.002788521	0.294151236	0.849668855	0	0	0.388764795	0	0	0	0.208536396	0	0	0	0.131018563	0	0	0	0	0	0	0	0	0	0	0	41.1775
H0524_029_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1770.982981	102.0487299	751.9637713	0	472.6027223	22.10431539	0	922.6125127	63.45248975	4816.138921	1776.120897	0	0	69.0313654	11572.27794	3.533622074	317.8581216	1076.70279	0	0	856.9856703	0	0	0	221.6085294	0	0	0	162.7356686	0											3400	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0		0	0		0		0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H0524_030_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	2193.966799	101.1308212	1549.662663	0	692.0735016	29.62437835	0	1181.96021	102.7188201	4175.697666	1471.956174	0	0	54.21196591	11706.47606	2.782221288	365.1211283	1048.640632	0	0	141.9067095	0	0	0	214.708346	0	0	0	188.6680297	0											3400	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0		0	0		0		0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H0524_031_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1136.039463	52.36569848	564.3301413	0	220.9805909	8.271093995	0	651.0489303	90.77730427	3489.787932	1230.169256	0	0	45.30698329	9126.834428	2.169130396	284.6629565	817.5619528	0	0	90.41488604	0	0	0	214.708346	0	0	0	165.0107785	0											3400	$225/days 1-7	$225/days 1-7	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $100/MRI,PET, CAT Scans"			$30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$10/generic, $45/brand"	0		0	$30/visit		0		$30/visit	0											225	225	100	0	300	0.146	0	48.02	164.5	23.5	25.6075	0	0	30	24.9	24.9	29.25	24.9	0	0	12.985	0	0	0	24.9	0	0	0	24.9	0											NO	122.85	122.85	8.1	0	272.1	0.132422	0	43.55414	149.2015	21.3145	23.2260025	0	0	27.21	22.5843	22.5843	26.52975	22.5843	0	0	11.777395	0	0	0	22.5843	0	0	0	22.5843	0												11.6302	0.536093838	0.380922845	0	5.0107349	1.095274809	0	2.362989688	1.12867583	6.198590407	2.380992852	0	0	0.102733585	17.17693056	0.004082358	0.629336422	1.538672034	0	0	0.088737652	0	0	0	0.404086475	0	0	0	0.31055441	0	0	0	0	0	0	0	0	0	0	0	50.9796		18.26951371	11.6302	0.536093838	0.380922845	0	5.0107349	1.095274809	0	2.362989688	1.12867583	6.198590407	2.380992852	0	0	0.102733585	17.17693056	0.004082358	0.629336422	1.538672034	0	0	0.088737652	0	0	0	0.404086475	0	0	0	0.31055441	0	0	0	0	0	0	0	0	0	0	0	50.9796	NO																																																																																		0			11.6302	0.536093838	0.380922845	0	5.0107349	1.095274809	0	2.362989688	1.12867583	6.198590407	2.380992852	0	0	0.102733585	17.17693056	0.004082358	0.629336422	1.538672034	0	0	0.088737652	0	0	0	0.404086475	0	0	0	0.31055441	0	0	0	0	0	0	0	0	0	0	0	50.9796
H0524_032_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1141.716707	52.62739082	727.0587344	0	262.7862599	8.771328396	0	593.0794164	83.64198575	3082.452234	1086.581204	0	0	40.01865288	8370.476517	1.989370486	261.0724026	749.8090583	0	0	143.1794154	0	0	0	214.708346	0	0	0	147.0137056	0											3400	$225/days 1-7	$225/days 1-7	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $100/MRI,PET, CAT Scans"			$30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$10/generic, $45/brand"	0		0	$30/visit		0		$30/visit	0											225	225	100	0	300	0.146	0	48.02	164.5	23.5	25.6075	0	0	30	24.9	24.9	29.25	24.9	0	0	12.985	0	0	0	24.9	0	0	0	24.9	0											NO	122.85	122.85	8.1	0	272.1	0.132422	0	43.55414	149.2015	21.3145	23.2260025	0	0	27.21	22.5843	22.5843	26.52975	22.5843	0	0	11.777395	0	0	0	22.5843	0	0	0	22.5843	0												11.6883	0.538772914	0.490764646	0	5.958678443	1.161516849	0	2.152588661	1.039959145	5.475077345	2.103078146	0	0	0.090742295	15.75344607	0.003744045	0.577182131	1.411159393	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.276683469	0	0	0	0	0	0	0	0	0	0	0	49.2663		19.36633659	11.6883	0.538772914	0.490764646	0	5.958678443	1.161516849	0	2.152588661	1.039959145	5.475077345	2.103078146	0	0	0.090742295	15.75344607	0.003744045	0.577182131	1.411159393	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.276683469	0	0	0	0	0	0	0	0	0	0	0	49.2663	NO																																																																																		0			11.6883	0.538772914	0.490764646	0	5.958678443	1.161516849	0	2.152588661	1.039959145	5.475077345	2.103078146	0	0	0.090742295	15.75344607	0.003744045	0.577182131	1.411159393	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.276683469	0	0	0	0	0	0	0	0	0	0	0	49.2663
H0524_033_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1197.230144	55.18628072	796.3551206	0	257.5760536	10.37829678	0	584.6090405	65.16216237	3314.073759	1168.229053	0	0	43.02573318	8958.880386	2.129213575	279.4245253	802.5169955	0	0	143.1794154	0	0	0	214.708346	0	0	0	164.4394216	0											3400	$225/days 1-7	$225/days 1-7	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $100/MRI,PET, CAT Scans"			$30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$10/generic, $45/brand"	0		0	$30/visit		0		$30/visit	0											225	225	100	0	300	0.146	0	48.02	164.5	23.5	25.6075	0	0	30	24.9	24.9	29.25	24.9	0	0	12.985	0	0	0	24.9	0	0	0	24.9	0											NO	122.85	122.85	8.1	0	272.1	0.132422	0	43.55414	149.2015	21.3145	23.2260025	0	0	27.21	22.5843	22.5843	26.52975	22.5843	0	0	11.777395	0	0	0	22.5843	0	0	0	22.5843	0												12.2566	0.564969549	0.537539706	0	5.840537015	1.374314816	0	2.121845333	0.810191031	5.886485428	2.261107575	0	0	0.09756085	16.86083686	0.004007233	0.617755233	1.510357049	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.309479102	0	0	0	0	0	0	0	0	0	0	0	51.5982		20.54290197	12.2566	0.564969549	0.537539706	0	5.840537015	1.374314816	0	2.121845333	0.810191031	5.886485428	2.261107575	0	0	0.09756085	16.86083686	0.004007233	0.617755233	1.510357049	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.309479102	0	0	0	0	0	0	0	0	0	0	0	51.5982	NO																																																																																		0			12.2566	0.564969549	0.537539706	0	5.840537015	1.374314816	0	2.121845333	0.810191031	5.886485428	2.261107575	0	0	0.09756085	16.86083686	0.004007233	0.617755233	1.510357049	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.309479102	0	0	0	0	0	0	0	0	0	0	0	51.5982
H0524_034_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1011.247435	58.2707555	550.5074841	0	275.6309053	7.470396526	0	536.6278764	31.07825205	3910.390377	1442.094212	0	0	56.04896191	10400.46842	3.175807302	285.6717901	967.6758041	0	0	892.6934066	0	0	0	221.6085294	0	0	0	78.29909133	0											3400	$125/days 1-10	$125/days 1-10	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit,$10U/R OOA"	$0 to $50/procedure	$0 to $15/routine lab	"$0 to $15/x-ray, $50/MRI,PET, CAT Scans"			$10/visit	$0 to $10/visit	$0 to $10/visit	$10 Individual & $5 Group Visit	$10/visit	0	0	"$5/generic, $35/brand"	0		0	$10/visit		0		$10/visit	0											125	125	100	0	300	0.146	0	47.04	47	14.1	14.4645	0	0	10	8.3	8.3	9.75	8.3	0	0	8.722	0	0	0	8.3	0	0	0	8.3	0											NO	89.25	89.25	8.9	0	279.9	0.136218	0	43.88832	43.851	13.1553	13.4953785	0	0	9.33	7.7439	7.7439	9.09675	7.7439	0	0	8.137626	0	0	0	7.7439	0	0	0	7.7439	0												7.5212	0.433388744	0.408293051	0	6.429090866	1.017602474	0	1.96264133	0.113567703	4.28686321	1.621800602	0	0	0.043578068	6.711682281	0.002049428	0.216557071	0.624465388	0	0	0.60536709	0	0	0	0.143009524	0	0	0	0.050528361	0	0	0	0	0	0	0	0	0	0	0	32.1916		9.005742539	7.5212	0.433388744	0.408293051	0	6.429090866	1.017602474	0	1.96264133	0.113567703	4.28686321	1.621800602	0	0	0.043578068	6.711682281	0.002049428	0.216557071	0.624465388	0	0	0.60536709	0	0	0	0.143009524	0	0	0	0.050528361	0	0	0	0	0	0	0	0	0	0	0	32.1916	NO																																																																																		0			7.5212	0.433388744	0.408293051	0	6.429090866	1.017602474	0	1.96264133	0.113567703	4.28686321	1.621800602	0	0	0.043578068	6.711682281	0.002049428	0.216557071	0.624465388	0	0	0.60536709	0	0	0	0.143009524	0	0	0	0.050528361	0	0	0	0	0	0	0	0	0	0	0	32.1916
H0524_035_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1115.819554	64.29647798	688.6200058	0	294.8729948	9.997186138	0	256.7735615	5.517448428	3301.264817	1217.457703	0	0	47.31815705	9623.135146	2.938446774	264.3206184	895.3515041	0	0	866.20057	0	0	0	221.6085294	0	0	0	201.8112867	0											3400	$150/days 1-5	$150/days 1-5	$100/days 21-100	0	$100/trip	0% to 20% coinsurance	0	"$50/ER visit,$10U/R OOA"	$0 to $100/procedure	$00/routine lab	"$0/x-ray, $0/MRI,PET, CAT Scans"			$10/visit	$0 to $10/visit	$0 to $10/visit	$10 Individual & $5 Group Visit	$10/visit	0	0	"$10/generic, $45/brand"	0		0	$10/visit		0		$10/visit	0											150	150	100	0	100	0.146	0	47.04	94	0	0	0	0	10	8.3	8.3	9.75	8.3	0	0	14.259	0	0	0	8.3	0	0	0	8.3	0											NO	98.85	98.85	13.7	0	97.7	0.142642	0	45.95808	91.838	0	0	0	0	9.77	8.1091	8.1091	9.52575	8.1091	0	0	13.931043	0	0	0	8.1091	0	0	0	8.1091	0												9.1916	0.529642237	0.786174507	0	2.400757633	1.426018625	0	0.983401657	0.042225952	0	0	0	0	0.038524866	6.502913768	0.00198568	0.209821011	0.60504124	0	0	1.005589782	0	0	0	0.14975381	0	0	0	0.136375659	0	0	0	0	0	0	0	0	0	0	0	24.0098		10.26755334	9.1916	0.529642237	0.786174507	0	2.400757633	1.426018625	0	0.983401657	0.042225952	0	0	0	0	0.038524866	6.502913768	0.00198568	0.209821011	0.60504124	0	0	1.005589782	0	0	0	0.14975381	0	0	0	0.136375659	0	0	0	0	0	0	0	0	0	0	0	24.0098	NO																																																																																		0			9.1916	0.529642237	0.786174507	0	2.400757633	1.426018625	0	0.983401657	0.042225952	0	0	0	0	0.038524866	6.502913768	0.00198568	0.209821011	0.60504124	0	0	1.005589782	0	0	0	0.14975381	0	0	0	0.136375659	0	0	0	0	0	0	0	0	0	0	0	24.0098
H0524_036_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	792.8705132	45.68729891	488.562503	0	204.6660512	7.157989526	0	183.8499792	3.920262037	2168.762104	799.8074301	0	0	31.08560856	6459.533303	1.972433568	177.4253205	601.005054	0	0	607.0042323	0	0	0	158.6718013	0	0	0	144.4969671	0											3400	$200/days 1-7	$200/days 1-7	$125/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit,$20U/R OOA"	$0 to $150/procedure	$0 to $20/routine lab	"$0 to $20/x-ray, $50/MRI,PET, CAT Scans"			$20/visit	$0 to $20/visit	$0 to $20/visit	$20 Individual & $10 Group Visit	$20/visit	0	0	"$10/generic, $45/brand"	0		0	$20/visit		0		$20/visit	0											200	200	125	0	300	0.146	0	47.53	141	18.8	17.786	0	0	20	16.6	16.6	19.5	16.6	0	0	14.259	0	0	0	16.6	0	0	0	16.6	0											NO	115.2	115.2	6.375	0	272.4	0.132568	0	43.15724	128.028	17.0704	16.149688	0	0	18.16	15.0728	15.0728	17.706	15.0728	0	0	12.947172	0	0	0	15.0728	0	0	0	15.0728	0												7.6116	0.43859807	0.25954883	0	4.645919363	0.948920355	0	0.661204806	0.041825276	3.085136385	1.076386705	0	0	0.047042888	8.113604464	0.002477508	0.26179106	0.754902415	0	0	0.654915683	0	0	0	0.199302361	0	0	0	0.181497824	0	0	0	0	0	0	0	0	0	0	0	28.9846		12.75708133	7.6116	0.43859807	0.25954883	0	4.645919363	0.948920355	0	0.661204806	0.041825276	3.085136385	1.076386705	0	0	0.047042888	8.113604464	0.002477508	0.26179106	0.754902415	0	0	0.654915683	0	0	0	0.199302361	0	0	0	0.181497824	0	0	0	0	0	0	0	0	0	0	0	28.9846	NO																																																																																		0			7.6116	0.43859807	0.25954883	0	4.645919363	0.948920355	0	0.661204806	0.041825276	3.085136385	1.076386705	0	0	0.047042888	8.113604464	0.002477508	0.26179106	0.754902415	0	0	0.654915683	0	0	0	0.199302361	0	0	0	0.181497824	0	0	0	0	0	0	0	0	0	0	0	28.9846
H0524_037_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1009.798375	58.18725686	493.3425406	0	236.4692607	7.773044136	0	499.8283543	59.91489496	4000.351173	1475.270425	0	0	57.33840075	9141.837041	2.791481274	251.1007051	850.5707777	0	0	856.9856703	0	0	0	221.6085294	0	0	0	188.509298	0											3400	$200/days 1-10	$200/days 1-10	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit,$15U/R OOA"	$0 to $100/procedure	$0 to $20/routine lab	"$0 to $20/x-ray, $50/MRI,PET, CAT Scans"			$15/visit	$0 to $15/visit	$0 to $15/visit	$15 Individual & $7 Group Visit	$15/visit	0	0	"$10/generic, $45/brand"	0		0	$15/visit		0		$15/visit	0											200	200	100	0	300	0.146	0	47.285	94	18.8	17.786	0	0	15	12.45	12.45	14.6	12.45	0	0	14.259	0	0	0	12.45	0	0	0	12.45	0											NO	121.8	121.8	5.4	0	272.1	0.132422	0	42.887495	85.258	17.0516	16.131902	0	0	13.605	11.29215	11.29215	13.2422	11.29215	0	0	12.932913	0	0	0	11.29215	0	0	0	11.29215	0												10.2495	0.590600657	0.222004143	0	5.361940486	1.029322051	0	1.786365504	0.425685343	5.684365672	1.98324316	0	0	0.065007412	8.602582929	0.002626819	0.277093813	0.800397734	0	0	0.923610093	0	0	0	0.208536396	0	0	0	0.177389606	0	0	0	0	0	0	0	0	0	0	0	38.3902		13.54845807	10.2495	0.590600657	0.222004143	0	5.361940486	1.029322051	0	1.786365504	0.425685343	5.684365672	1.98324316	0	0	0.065007412	8.602582929	0.002626819	0.277093813	0.800397734	0	0	0.923610093	0	0	0	0.208536396	0	0	0	0.177389606	0	0	0	0	0	0	0	0	0	0	0	38.3902	NO																																																																																		0			10.2495	0.590600657	0.222004143	0	5.361940486	1.029322051	0	1.786365504	0.425685343	5.684365672	1.98324316	0	0	0.065007412	8.602582929	0.002626819	0.277093813	0.800397734	0	0	0.923610093	0	0	0	0.208536396	0	0	0	0.177389606	0	0	0	0	0	0	0	0	0	0	0	38.3902
H0524_038_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1074.811282	49.54338766	728.4955169	0	235.8413152	9.848120574	0	567.2987777	232.9348716	3509.435893	1237.095269	0	0	45.56206751	9411.398285	2.236761305	293.5384093	843.0525634	0	0	143.1794154	0	0	0	214.708346	0	0	0	147.334175	0											3400	$225/days 1-7	$225/days 1-7	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $100/MRI,PET, CAT Scans"			$30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$10/generic, $45/brand"	0		0	$30/visit		0		$30/visit	0											225	225	100	0	300	0.146	0	48.02	164.5	23.5	25.6075	0	0	30	24.9	24.9	29.25	24.9	0	0	12.985	0	0	0	24.9	0	0	0	24.9	0											NO	122.85	122.85	8.1	0	272.1	0.132422	0	43.55414	149.2015	21.3145	23.2260025	0	0	27.21	22.5843	22.5843	26.52975	22.5843	0	0	11.777395	0	0	0	22.5843	0	0	0	22.5843	0												11.0034	0.507200431	0.491734474	0	5.347701822	1.304107823	0	2.059017532	2.89618602	6.233489278	2.394398152	0	0	0.103311988	17.71248686	0.004209641	0.648958385	1.586646001	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.277286601	0	0	0	0	0	0	0	0	0	0	0	53.1147		19.23490207	11.0034	0.507200431	0.491734474	0	5.347701822	1.304107823	0	2.059017532	2.89618602	6.233489278	2.394398152	0	0	0.103311988	17.71248686	0.004209641	0.648958385	1.586646001	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.277286601	0	0	0	0	0	0	0	0	0	0	0	53.1147	NO																																																																																		0			11.0034	0.507200431	0.491734474	0	5.347701822	1.304107823	0	2.059017532	2.89618602	6.233489278	2.394398152	0	0	0.103311988	17.71248686	0.004209641	0.648958385	1.586646001	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.277286601	0	0	0	0	0	0	0	0	0	0	0	53.1147
H0524_039_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1167.060384	53.79560671	636.0131805	0	211.1269259	9.257328993	0	565.8843263	104.6667961	3323.721706	1171.630007	0	0	43.15098989	9219.824453	2.191230883	287.5632847	825.8917968	0	0	143.1794154	0	0	0	214.708346	0	0	0	158.9724467	0											3400	$225/days 1-7	$225/days 1-7	$100/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$0 to $175/procedure	$0 to $25/routine lab	"$0 to $25/x-ray, $100/MRI,PET, CAT Scans"			$30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$10/generic, $45/brand"	0		0	$30/visit		0		$30/visit	0											225	225	100	0	300	0.146	0	48.02	164.5	23.5	25.6075	0	0	30	24.9	24.9	29.25	24.9	0	0	12.985	0	0	0	24.9	0	0	0	24.9	0											NO	122.85	122.85	8.1	0	272.1	0.132422	0	43.55414	149.2015	21.3145	23.2260025	0	0	27.21	22.5843	22.5843	26.52975	22.5843	0	0	11.777395	0	0	0	22.5843	0	0	0	22.5843	0												11.9478	0.550732524	0.429308897	0	4.787303046	1.22587402	0	2.053883764	1.301370248	5.903622192	2.267690122	0	0	0.09784487	17.35194012	0.004123951	0.635748504	1.554349009	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.299190119	0	0	0	0	0	0	0	0	0	0	0	50.9554		19.03982207	11.9478	0.550732524	0.429308897	0	4.787303046	1.22587402	0	2.053883764	1.301370248	5.903622192	2.267690122	0	0	0.09784487	17.35194012	0.004123951	0.635748504	1.554349009	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.299190119	0	0	0	0	0	0	0	0	0	0	0	50.9554	NO																																																																																		0			11.9478	0.550732524	0.429308897	0	4.787303046	1.22587402	0	2.053883764	1.301370248	5.903622192	2.267690122	0	0	0.09784487	17.35194012	0.004123951	0.635748504	1.554349009	0	0	0.140523378	0	0	0	0.404086475	0	0	0	0.299190119	0	0	0	0	0	0	0	0	0	0	0	50.9554
H0524_040_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1331.744149	61.38669895	1193.059843	0	403.9658767	10.08326827	0	415.9162547	88.23802915	3033.034564	1069.161206	0	0	39.37707648	8372.047401	1.98974383	261.121398	749.9497746	0	0	150.8885086	0	0	0	207.797798	0	0	0	141.6302823	0											3400	$150/days 1-7	$150/days 1-7	$100/days 21-100	0	$200/trip	0% to 20% coinsurance	0	"$50/ER visit, $10/UR OOA"	$0 to $100/procedure	$0 to $20/routine lab	"$0 to $20/x-ray, $50/MRI,PET, CAT Scans"			$10/visit	$0 to $10/visit	$0 to $10/visit	$10 Individual & $5 Group Visit	$10/visit	0	0	"$07/generic, $35/brand"	0		0	$10/visit		0		$10/visit	0											150	150	100	0	200	0.146	0	47.04	94	18.8	17.786	0	0	10	8.3	8.3	10.25	8.3	0	0	10.4272	0	0	0	8.3	0	0	0	8.3	0											NO	97.35	97.35	12.6	0	190	0.1387	0	44.688	89.3	17.86	16.8967	0	0	9.5	7.885	7.885	9.7375	7.885	0	0	9.90584	0	0	0	7.885	0	0	0	7.885	0												10.8038	0.497999595	1.252712835	0	6.396126381	1.398549309	0	1.548872132	0.656638	4.514166443	1.505441346	0	0	0.031173519	5.501132813	0.001307428	0.211889134	0.492779498	0	0	0.124556452	0	0	0	0.13654047	0	0	0	0.093062898	0	0	0	0	0	0	0	0	0	0	0	35.1667		15.91986078	10.8038	0.497999595	1.252712835	0	6.396126381	1.398549309	0	1.548872132	0.656638	4.514166443	1.505441346	0	0	0.031173519	5.501132813	0.001307428	0.211889134	0.492779498	0	0	0.124556452	0	0	0	0.13654047	0	0	0	0.093062898	0	0	0	0	0	0	0	0	0	0	0	35.1667	NO																																																																																		0			10.8038	0.497999595	1.252712835	0	6.396126381	1.398549309	0	1.548872132	0.656638	4.514166443	1.505441346	0	0	0.031173519	5.501132813	0.001307428	0.211889134	0.492779498	0	0	0.124556452	0	0	0	0.13654047	0	0	0	0.093062898	0	0	0	0	0	0	0	0	0	0	0	35.1667
H0524_041_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	987.199885	45.50494343	886.5152151	0	297.9635165	7.554808141	0	311.6219288	65.86010779	2180.828656	768.7539808	0	0	28.31311512	5663.062566	1.345912566	176.6290542	507.2848124	0	0	105.6690204	0	0	0	155.690839	0	0	0	106.1153567	0											3400	$225/days 1-10	$225/days 1-10	$125/days 21-100	0	$300/trip	0% to 20% coinsurance	0	"$50/ER visit, $30/UR OOA"	$0 to $175/procedure	$0 to $30/routine lab	"$0 to $30/x-ray, $50/MRI,PET, CAT Scans"			$30/visit	$0 to $30/visit	$0 to $30/visit	$30 Individual & $15 Group Visit	$30/visit	0	0	"$10/generic, $35/brand"	0		0	$30/visit		0		$30/visit	0											225	225	125	0	300	0.146	0	48.02	164.5	28.2	24.429	0	0	30	24.9	24.9	29.25	24.9	0	0	12.985	0	0	0	24.9	0	0	0	24.9	0											NO	128.7	128.7	7.875	0	270.3	0.131546	0	43.26602	148.2145	25.4082	22.010529	0	0	27.03	22.4349	22.4349	26.35425	22.4349	0	0	11.699485	0	0	0	22.4349	0	0	0	22.4349	0												10.5877	0.488040518	0.58177561	0	6.71162821	0.993804792	0	1.123553384	0.813451912	4.617577554	1.410056816	0	0	0.063775292	10.5875202	0.002516284	0.387910521	0.948407003	0	0	0.10302276	0	0	0	0.2910757	0	0	0	0.198390618	0	0	0	0	0	0	0	0	0	0	0	39.9102		19.93857211	10.5877	0.488040518	0.58177561	0	6.71162821	0.993804792	0	1.123553384	0.813451912	4.617577554	1.410056816	0	0	0.063775292	10.5875202	0.002516284	0.387910521	0.948407003	0	0	0.10302276	0	0	0	0.2910757	0	0	0	0.198390618	0	0	0	0	0	0	0	0	0	0	0	39.9102	NO																																																																																		0			10.5877	0.488040518	0.58177561	0	6.71162821	0.993804792	0	1.123553384	0.813451912	4.617577554	1.410056816	0	0	0.063775292	10.5875202	0.002516284	0.387910521	0.948407003	0	0	0.10302276	0	0	0	0.2910757	0	0	0	0.198390618	0	0	0	0	0	0	0	0	0	0	0	39.9102
H0524_801_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1079.120065	62.18175621	691.0588335	0	266.3705923	9.804646104	0	502.1786925	46.77566585	3345.858968	1233.903367	0	0	47.95734026	7566.4132	2.310421928	207.8282167	703.9908862	0	0	692.2587499	0	0	0	221.6085294	0	0	0	139.5693001	0											2000	$500/admit	$500/admit	$125/days 21-100	0	$200/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$00/routine lab	"$00/x-ray, $00/MRI,PET, CAT Scans"			$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0		0	$25/visit		0		$25/visit	0											500	500	125	0	200	0.196	0	47.775	237.5	0	0	0	0	25	23.75	25	24.35	25	0	0	15.7486	0	0	0	23.75	0	0	0	23.75	0											NO	82.5	82.5	3.5	0	177.2	0.173656	0	42.32865	210.425	0	0	0	0	22.15	21.0425	22.15	21.5741	22.15	0	0	13.9532596	0	0	0	21.0425	0	0	0	21.0425	0												7.419	0.427499574	0.201558826	0	3.933405746	1.702635624	0	1.771378843	0.820230791	0	0	0	0	0.088521257	13.26802081	0.004264654	0.373642227	1.299449844	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.244740583	0	0	0	0	0	0	0	0	0	0	0	32.7478		11.25961793	7.419	0.427499574	0.201558826	0	3.933405746	1.702635624	0	1.771378843	0.820230791	0	0	0	0	0.088521257	13.26802081	0.004264654	0.373642227	1.299449844	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.244740583	0	0	0	0	0	0	0	0	0	0	0	32.7478	NO																																																																																		0			7.419	0.427499574	0.201558826	0	3.933405746	1.702635624	0	1.771378843	0.820230791	0	0	0	0	0.088521257	13.26802081	0.004264654	0.373642227	1.299449844	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.244740583	0	0	0	0	0	0	0	0	0	0	0	32.7478
H0524_802_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1267.583801	58.42923002	777.2029453	0	278.2798661	13.47200618	0	578.5153107	89.77806469	3157.258121	1112.950686	0	0	40.9898377	8826.041684	2.097642446	275.28133	790.6175939	0	0	113.8556736	0	0	0	214.708346	0	0	0	174.0502381	0											3400	$500/admit	$500/admit	$125/days 21-100	0	$200/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$00/routine lab	"$00/x-ray, $00/MRI,PET, CAT Scans"			$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0		0	$25/visit		0		$25/visit	0											500	500	125	0	200	0.196	0	47.775	237.5	0	0	0	0	25	23.75	25	24.35	25	0	0	15.7486	0	0	0	23.75	0	0	0	23.75	0											NO	90.5	90.5	16.25	0	192.4	0.188552	0	45.95955	228.475	0	0	0	0	24.05	22.8475	24.05	23.4247	24.05	0	0	15.1501532	0	0	0	22.8475	0	0	0	22.8475	0												9.5597	0.440653776	1.052462322	0	4.461753854	2.540173709	0	2.215691946	1.709336944	0	0	0	0	0.082150466	16.80441562	0.004204025	0.537365214	1.584529428	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.331384401	0	0	0	0	0	0	0	0	0	0	0	41.8764		10.75174874	9.5597	0.440653776	1.052462322	0	4.461753854	2.540173709	0	2.215691946	1.709336944	0	0	0	0	0.082150466	16.80441562	0.004204025	0.537365214	1.584529428	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.331384401	0	0	0	0	0	0	0	0	0	0	0	41.8764	NO																																																																																		0			9.5597	0.440653776	1.052462322	0	4.461753854	2.540173709	0	2.215691946	1.709336944	0	0	0	0	0.082150466	16.80441562	0.004204025	0.537365214	1.584529428	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.331384401	0	0	0	0	0	0	0	0	0	0	0	41.8764
H0524_803_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	898.5279771	51.77556182	426.3875489	0	199.3323323	10.88434471	0	445.5694633	62.79490021	3735.4111	1377.564439	0	0	53.54092412	8920.447034	2.723879319	245.0197405	829.9723061	0	0	692.2587499	0	0	0	221.6085294	0	0	0	230.5500012	0											2000	$500/admit	$500/admit	$125/days 21-100	0	$200/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$00/routine lab	"$00/x-ray, $00/MRI,PET, CAT Scans"			$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0		0	$25/visit		0		$25/visit	0											500	500	125	0	200	0.196	0	47.775	237.5	0	0	0	0	25	23.75	25	24.35	25	0	0	15.7486	0	0	0	23.75	0	0	0	23.75	0											NO	82.5	82.5	3.5	0	177.2	0.173656	0	42.32865	210.425	0	0	0	0	22.15	21.0425	22.15	21.5741	22.15	0	0	13.9532596	0	0	0	21.0425	0	0	0	21.0425	0												6.1774	0.355956988	0.124363035	0	2.943474107	1.890131765	0	1.571696155	1.10113474	0	0	0	0	0.098827622	15.64237556	0.005027827	0.440506699	1.531990548	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.404279033	0	0	0	0	0	0	0	0	0	0	0	33.4807		8.611556924	6.1774	0.355956988	0.124363035	0	2.943474107	1.890131765	0	1.571696155	1.10113474	0	0	0	0	0.098827622	15.64237556	0.005027827	0.440506699	1.531990548	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.404279033	0	0	0	0	0	0	0	0	0	0	0	33.4807	NO																																																																																		0			6.1774	0.355956988	0.124363035	0	2.943474107	1.890131765	0	1.571696155	1.10113474	0	0	0	0	0.098827622	15.64237556	0.005027827	0.440506699	1.531990548	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.404279033	0	0	0	0	0	0	0	0	0	0	0	33.4807
H0524_804_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1075.393124	49.57020761	709.3651164	0	213.3506294	11.52528417	0	492.5949585	95.16084866	3166.553402	1116.227323	0	0	41.11051584	8755.093217	2.080780468	273.0684707	784.2621846	0	0	113.8556736	0	0	0	214.708346	0	0	0	269.8027861	0											3400	$500/admit	$500/admit	$125/days 21-100	0	$200/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$00/routine lab	"$00/x-ray, $00/MRI,PET, CAT Scans"			$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0		0	$25/visit		0		$25/visit	0											500	500	125	0	200	0.196	0	47.775	237.5	0	0	0	0	25	23.75	25	24.35	25	0	0	15.7486	0	0	0	23.75	0	0	0	23.75	0											NO	90.5	90.5	16.25	0	192.4	0.188552	0	45.95955	228.475	0	0	0	0	24.05	22.8475	24.05	23.4247	24.05	0	0	15.1501532	0	0	0	22.8475	0	0	0	22.8475	0												8.1103	0.373841982	0.960598595	0	3.420721758	2.17311538	0	1.886620219	1.811822908	0	0	0	0	0.082392326	16.66933269	0.004170231	0.533045584	1.571792128	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.513693263	0	0	0	0	0	0	0	0	0	0	0	38.6639		9.695230601	8.1103	0.373841982	0.960598595	0	3.420721758	2.17311538	0	1.886620219	1.811822908	0	0	0	0	0.082392326	16.66933269	0.004170231	0.533045584	1.571792128	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.513693263	0	0	0	0	0	0	0	0	0	0	0	38.6639	NO																																																																																		0			8.1103	0.373841982	0.960598595	0	3.420721758	2.17311538	0	1.886620219	1.811822908	0	0	0	0	0.082392326	16.66933269	0.004170231	0.533045584	1.571792128	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.513693263	0	0	0	0	0	0	0	0	0	0	0	38.6639
H0524_805_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1104.170001	63.62519986	553.6842208	0	260.248169	11.96486673	0	529.3679141	64.4250137	4234.386889	1561.57934	0	0	60.69291467	9756.516846	2.979175187	267.9842408	907.7615455	0	0	692.2587499	0	0	0	221.6085294	0	0	0	224.0527848	0											2000	$500/admit	$500/admit	$125/days 21-100	0	$200/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$00/routine lab	"$00/x-ray, $00/MRI,PET, CAT Scans"			$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0		0	$25/visit		0		$25/visit	0											500	500	125	0	200	0.196	0	47.775	237.5	0	0	0	0	25	23.75	25	24.35	25	0	0	15.7486	0	0	0	23.75	0	0	0	23.75	0											NO	82.5	82.5	3.5	0	177.2	0.173656	0	42.32865	210.425	0	0	0	0	22.15	21.0425	22.15	21.5741	22.15	0	0	13.9532596	0	0	0	21.0425	0	0	0	21.0425	0												7.5912	0.437423249	0.161491231	0	3.842997962	2.077770896	0	1.867285763	1.129719459	0	0	0	0	0.112029005	17.10845881	0.005499061	0.481793234	1.675576519	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.392885894	0	0	0	0	0	0	0	0	0	0	0	38.0776		10.51807196	7.5912	0.437423249	0.161491231	0	3.842997962	2.077770896	0	1.867285763	1.129719459	0	0	0	0	0.112029005	17.10845881	0.005499061	0.481793234	1.675576519	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.392885894	0	0	0	0	0	0	0	0	0	0	0	38.0776	NO																																																																																		0			7.5912	0.437423249	0.161491231	0	3.842997962	2.077770896	0	1.867285763	1.129719459	0	0	0	0	0.112029005	17.10845881	0.005499061	0.481793234	1.675576519	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.392885894	0	0	0	0	0	0	0	0	0	0	0	38.0776
H0524_806_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1191.136888	54.90541228	763.4077816	0	272.5411633	13.93360463	0	607.3867149	100.8513352	3442.309088	1213.432705	0	0	44.69057816	9435.880813	2.242579949	294.3020113	845.245655	0	0	113.8556736	0	0	0	214.708346	0	0	0	241.5054016	0											3400	$500/admit	$500/admit	$125/days 21-100	0	$200/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$00/routine lab	"$00/x-ray, $00/MRI,PET, CAT Scans"			$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0		0	$25/visit		0		$25/visit	0											500	500	125	0	200	0.196	0	47.775	237.5	0	0	0	0	25	23.75	25	24.35	25	0	0	15.7486	0	0	0	23.75	0	0	0	23.75	0											NO	90.5	90.5	16.25	0	192.4	0.188552	0	45.95955	228.475	0	0	0	0	24.05	22.8475	24.05	23.4247	24.05	0	0	15.1501532	0	0	0	22.8475	0	0	0	22.8475	0												8.9832	0.414078318	1.033781371	0	4.369743318	2.62720902	0	2.326268341	1.920167401	0	0	0	0	0.089567367	17.96552391	0.004494504	0.574494694	1.694013167	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.459816222	0	0	0	0	0	0	0	0	0	0	0	43.0149		10.53655692	8.9832	0.414078318	1.033781371	0	4.369743318	2.62720902	0	2.326268341	1.920167401	0	0	0	0	0.089567367	17.96552391	0.004494504	0.574494694	1.694013167	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.459816222	0	0	0	0	0	0	0	0	0	0	0	43.0149	NO																																																																																		0			8.9832	0.414078318	1.033781371	0	4.369743318	2.62720902	0	2.326268341	1.920167401	0	0	0	0	0.089567367	17.96552391	0.004494504	0.574494694	1.694013167	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.459816222	0	0	0	0	0	0	0	0	0	0	0	43.0149
H0524_807_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1119.302703	64.49718625	787.0279567	0	274.1649589	11.95532574	0	519.8238345	47.97828574	3858.690082	1423.027907	0	0	55.30792392	8869.503584	2.708323618	243.6204664	825.2324481	0	0	692.2587499	0	0	0	221.6085294	0	0	0	160.7771362	0											2000	$500/admit	$500/admit	$125/days 21-100	0	$200/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$00/routine lab	"$00/x-ray, $00/MRI,PET, CAT Scans"			$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0		0	$25/visit		0		$25/visit	0											500	500	125	0	200	0.196	0	47.775	237.5	0	0	0	0	25	23.75	25	24.35	25	0	0	15.7486	0	0	0	23.75	0	0	0	23.75	0											NO	82.5	82.5	3.5	0	177.2	0.173656	0	42.32865	210.425	0	0	0	0	22.15	21.0425	22.15	21.5741	22.15	0	0	13.9532596	0	0	0	21.0425	0	0	0	21.0425	0												7.6952	0.443418155	0.229549821	0	4.04850256	2.076114047	0	1.833620096	0.841319231	0	0	0	0	0.10208921	15.5530441	0.004999114	0.437991025	1.52324156	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.281929407	0	0	0	0	0	0	0	0	0	0	0	36.2646		12.64290122	7.6952	0.443418155	0.229549821	0	4.04850256	2.076114047	0	1.833620096	0.841319231	0	0	0	0	0.10208921	15.5530441	0.004999114	0.437991025	1.52324156	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.281929407	0	0	0	0	0	0	0	0	0	0	0	36.2646	NO																																																																																		0			7.6952	0.443418155	0.229549821	0	4.04850256	2.076114047	0	1.833620096	0.841319231	0	0	0	0	0.10208921	15.5530441	0.004999114	0.437991025	1.52324156	0	0	0.804938837	0	0	0	0.38859979	0	0	0	0.281929407	0	0	0	0	0	0	0	0	0	0	0	36.2646
H0524_808_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1276.288047	58.83045192	1048.056859	0	342.8644093	15.41405172	0	678.5870135	102.3180189	3454.195944	1217.622886	0	0	44.84490202	9211.197677	2.189180599	287.2942184	825.1190289	0	0	113.8556736	0	0	0	214.708346	0	0	0	196.233259	0											3400	$500/admit	$500/admit	$125/days 21-100	0	$200/trip	20% coinsurance	0	"$50/ER visit, $25/UR OOA"	$250/procedure	$00/routine lab	"$00/x-ray, $00/MRI,PET, CAT Scans"			$25/visit	$25/visit	$25/visit	$25 Individual & $12 Group Visit	$25/visit	0	0	"$11/generic, $50/brand"	0		0	$25/visit		0		$25/visit	0											500	500	125	0	200	0.196	0	47.775	237.5	0	0	0	0	25	23.75	25	24.35	25	0	0	15.7486	0	0	0	23.75	0	0	0	23.75	0											NO	90.5	90.5	16.25	0	192.4	0.188552	0	45.95955	228.475	0	0	0	0	24.05	22.8475	24.05	23.4247	24.05	0	0	15.1501532	0	0	0	22.8475	0	0	0	22.8475	0												9.6253	0.443679658	1.419243663	0	5.497259362	2.906350281	0	2.598962815	1.948092447	0	0	0	0	0.089876658	17.53773658	0.004387483	0.560815073	1.653676054	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.373619949	0	0	0	0	0	0	0	0	0	0	0	45.2116		13.32423469	9.6253	0.443679658	1.419243663	0	5.497259362	2.906350281	0	2.598962815	1.948092447	0	0	0	0	0.089876658	17.53773658	0.004387483	0.560815073	1.653676054	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.373619949	0	0	0	0	0	0	0	0	0	0	0	45.2116	NO																																																																																		0			9.6253	0.443679658	1.419243663	0	5.497259362	2.906350281	0	2.598962815	1.948092447	0	0	0	0	0.089876658	17.53773658	0.004387483	0.560815073	1.653676054	0	0	0.143744241	0	0	0	0.408795745	0	0	0	0.373619949	0	0	0	0	0	0	0	0	0	0	0	45.2116
H0524_809_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1109.746617	63.94653926	557.2506248	0	263.349572	11.96486673	0	529.3679141	66.61176352	4200.238608	1548.985959	0	0	60.20345568	10310.86439	3.148446504	283.2106181	959.338906	0	0	726.0274694	0	0	0	221.6085294	0	0	0	224.0527848	0											2000	$250/admit	$250/admit	0	0	$125/trip	20% coinsurance	0	"$50/ER visit, $15/UR OOA"	$050/procedure	$10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"			$15/visit	$15/visit	$15/visit	$15 Individual & $7 Group Visit	$15/visit	0	0	"$10/generic, $30/brand"	0		0	$15/visit		0		$15/visit	0											250	250	0	0	125	0.196	0	47.285	47.5	9.6	13.6	0	0	15	14.25	15	14.6	15	0	0	12.348	0	0	0	14.25	0	0	0	14.25	0											NO	49.25	49.25	0	0	114.25	0.179144	0	43.21849	43.415	8.7744	12.4304	0	0	13.71	13.0245	13.71	13.3444	13.71	0	0	11.286072	0	0	0	13.0245	0	0	0	13.0245	0												4.5546	0.262447255	0	0	2.507307384	2.143434085	0	1.906540159	0.240995809	3.07121447	1.604542922	0	0	0.068782448	11.19115444	0.0035971	0.314939648	1.0960447	0	0	0.682833191	0	0	0	0.240528358	0	0	0	0.243181291	0	0	0	0	0	0	0	0	0	0	0	30.1321		2.069218155	4.5546	0.262447255	0	0	2.507307384	2.143434085	0	1.906540159	0.240995809	3.07121447	1.604542922	0	0	0.068782448	11.19115444	0.0035971	0.314939648	1.0960447	0	0	0.682833191	0	0	0	0.240528358	0	0	0	0.243181291	0	0	0	0	0	0	0	0	0	0	0	30.1321	NO																																																																																		0			4.5546	0.262447255	0	0	2.507307384	2.143434085	0	1.906540159	0.240995809	3.07121447	1.604542922	0	0	0.068782448	11.19115444	0.0035971	0.314939648	1.0960447	0	0	0.682833191	0	0	0	0.240528358	0	0	0	0.243181291	0	0	0	0	0	0	0	0	0	0	0	30.1321
H0524_810_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1197.152731	55.18271234	768.325062	0	275.7890632	13.93360463	0	607.3867149	104.2744876	3414.548531	1203.646957	0	0	44.33017027	9972.010405	2.369999264	311.0237165	893.2709763	0	0	119.4096089	0	0	0	214.708346	0	0	0	241.5054016	0											3400	$250/admit	$250/admit	0	0	$125/trip	20% coinsurance	0	"$50/ER visit, $15/UR OOA"	$050/procedure	$10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"			$15/visit	$15/visit	$15/visit	$15 Individual & $7 Group Visit	$15/visit	0	0	"$10/generic, $30/brand"	0		0	$15/visit		0		$15/visit	0											250	250	0	0	125	0.196	0	47.285	47.5	9.6	13.6	0	0	15	14.25	15	14.6	15	0	0	12.348	0	0	0	14.25	0	0	0	14.25	0											NO	47	47	0	0	123.125	0.19306	0	46.575725	46.7875	9.456	13.396	0	0	14.775	14.03625	14.775	14.381	14.775	0	0	12.16278	0	0	0	14.03625	0	0	0	14.03625	0												4.6888	0.21613229	0	0	2.8297107	2.69002171	0	2.357456383	0.406561882	2.690664243	1.34367122	0	0	0.054581522	11.66413592	0.002918062	0.372736006	1.09983989	0	0	0.1210294	0	0	0	0.251141668	0	0	0	0.282485849	0	0	0	0	0	0	0	0	0	0	0	31.0719		1.398461076	4.6888	0.21613229	0	0	2.8297107	2.69002171	0	2.357456383	0.406561882	2.690664243	1.34367122	0	0	0.054581522	11.66413592	0.002918062	0.372736006	1.09983989	0	0	0.1210294	0	0	0	0.251141668	0	0	0	0.282485849	0	0	0	0	0	0	0	0	0	0	0	31.0719	NO																																																																																		0			4.6888	0.21613229	0	0	2.8297107	2.69002171	0	2.357456383	0.406561882	2.690664243	1.34367122	0	0	0.054581522	11.66413592	0.002918062	0.372736006	1.09983989	0	0	0.1210294	0	0	0	0.251141668	0	0	0	0.282485849	0	0	0	0	0	0	0	0	0	0	0	31.0719
H0524_811_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1107.439381	63.81359025	568.0986551	0	263.6248173	11.82657024	0	527.1907076	65.26818379	4139.00793	1526.404989	0	0	59.32581545	10152.47438	3.100081744	278.8600873	944.6020522	0	0	726.0274694	0	0	0	221.6085294	0	0	0	218.0887363	0											2000	$250/admit	$250/admit	0	0	$125/trip	20% coinsurance	0	"$50/ER visit, $15/UR OOA"	$050/procedure	$10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"			$15/visit	$15/visit	$15/visit	$15 Individual & $7 Group Visit	$15/visit	0	0	"$10/generic, $30/brand"	0		0	$15/visit		0		$15/visit	0											250	250	0	0	125	0.196	0	47.285	47.5	9.6	13.6	0	0	15	14.25	15	14.6	15	0	0	12.348	0	0	0	14.25	0	0	0	14.25	0											NO	49.25	49.25	0	0	114.25	0.179144	0	43.21849	43.415	8.7744	12.4304	0	0	13.71	13.0245	13.71	13.3444	13.71	0	0	11.286072	0	0	0	13.0245	0	0	0	13.0245	0												4.5451	0.26190161	0	0	2.509927948	2.118659098	0	1.89869886	0.23613485	3.026442599	1.581152048	0	0	0.067779744	11.01924188	0.003541843	0.310101712	1.079207845	0	0	0.682833191	0	0	0	0.240528358	0	0	0	0.236708062	0	0	0	0	0	0	0	0	0	0	0	29.818		2.043170905	4.5451	0.26190161	0	0	2.509927948	2.118659098	0	1.89869886	0.23613485	3.026442599	1.581152048	0	0	0.067779744	11.01924188	0.003541843	0.310101712	1.079207845	0	0	0.682833191	0	0	0	0.240528358	0	0	0	0.236708062	0	0	0	0	0	0	0	0	0	0	0	29.818	NO																																																																																		0			4.5451	0.26190161	0	0	2.509927948	2.118659098	0	1.89869886	0.23613485	3.026442599	1.581152048	0	0	0.067779744	11.01924188	0.003541843	0.310101712	1.079207845	0	0	0.682833191	0	0	0	0.240528358	0	0	0	0.236708062	0	0	0	0	0	0	0	0	0	0	0	29.818
H0524_812_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin		Coin	V	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	YES	1202.389355	55.42409437	771.0148007	0	276.4458723	13.9046833	0	605.5595677	103.5087693	3395.000434	1196.756147	0	0	44.07638255	9925.290878	2.358895661	309.5665499	889.0859428	0	0	119.4096089	0	0	0	214.708346	0	0	0	236.8477259	0											3400	$250/admit	$250/admit	0	0	$125/trip	20% coinsurance	0	"$50/ER visit, $15/UR OOA"	$050/procedure	$10/routine lab	"$10/x-ray, $50/MRI,PET, CAT Scans"			$15/visit	$15/visit	$15/visit	$15 Individual & $7 Group Visit	$15/visit	0	0	"$10/generic, $30/brand"	0		0	$15/visit		0		$15/visit	0											250	250	0	0	125	0.196	0	47.285	47.5	9.6	13.6	0	0	15	14.25	15	14.6	15	0	0	12.348	0	0	0	14.25	0	0	0	14.25	0											NO	47	47	0	0	123.125	0.19306	0	46.575725	46.7875	9.456	13.396	0	0	14.775	14.03625	14.775	14.381	14.775	0	0	12.16278	0	0	0	14.03625	0	0	0	14.03625	0												4.7094	0.217077703	0	0	2.836449835	2.684438159	0	2.350364658	0.403576379	2.675260342	1.335978778	0	0	0.054269046	11.60948867	0.00290439	0.370989713	1.094687067	0	0	0.1210294	0	0	0	0.251141668	0	0	0	0.277037824	0	0	0	0	0	0	0	0	0	0	0	30.9941		1.401586668	4.7094	0.217077703	0	0	2.836449835	2.684438159	0	2.350364658	0.403576379	2.675260342	1.335978778	0	0	0.054269046	11.60948867	0.00290439	0.370989713	1.094687067	0	0	0.1210294	0	0	0	0.251141668	0	0	0	0.277037824	0	0	0	0	0	0	0	0	0	0	0	30.9941	NO																																																																																		0			4.7094	0.217077703	0	0	2.836449835	2.684438159	0	2.350364658	0.403576379	2.675260342	1.335978778	0	0	0.054269046	11.60948867	0.00290439	0.370989713	1.094687067	0	0	0.1210294	0	0	0	0.251141668	0	0	0	0.277037824	0	0	0	0	0	0	0	0	0	0	0	30.9941
H0532_001_0	2010	4	N/A																															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	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	YES	616.4273461	13.38000757	0	0	93.31347124	7.536932392	5.379339051	211.9908678	327.8370333	1642.02616	357.8187941	42.80040363	0	62.68736125	2634.011428	3518.038925	156.0691726	554.7748486	1231.758989	610.7746468	171.894778	421.5117306	0	0	241.3282795	242.8415237	103.0177598	0	0	0											3500	1A IP Acute: $250 Per Day for days 1-5	1B IP Psych: $250 Per Day for days 1-5	2 SNF: $0	6 Home Health: $0	10A Ambulance: $125	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	"9B ASC Services: $125, 9A OP Hospital: $125"	8A OP Diagnostic Procedures/Tests: $20	8B OP Radiology: $20	14E Observation: $20	12 Renal Dialysis: $0	"3 CORF: $20, 5 Partial Hosp: $20, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $20"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears and Pelvic Exams: $20, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $20"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $20	"17B Eye Wear (Medicare Covered): $0, (Non Medicare Covered): $10"	18A Routine Hearing Exams (Non Medicare Covered): $20	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											250	250	0	0	125	0.199999994	0.199943166	49.38377568	125	20	20	20	0	20	20	20	20	20	20	20	85.604	20	0	0	20	10	20	0	0	0											NO	217.7991249	217.7991249	0	0	108.8995625	0.174239295	0.174189786	43.02297251	108.8995625	17.42392999	17.42392999	17.42392999	0	17.42392999	17.42392999	17.42392999	17.42392999	17.42392999	17.42392999	17.42392999	74.57790516	17.42392999	0	0	17.42392999	8.711964997	17.42392999	0	0	0												11.1881	0.242846162	0	0	0.846816349	1.313229787	0.93702592	0.760039773	2.975109124	2.384212406	0.519550802	0.062145936	0	0.091021683	3.824569227	5.108171996	0.226611528	0.805529844	1.788506866	0.886841224	1.068296038	0.612032574	0	0	0.350407254	0.176302238	0.149581186	0	0	0	0	0	0	0	0	0	0	0	0	0	36.317	0	5.83	11.1881	0.242846162	0	0	0.846816349	1.313229787	0.93702592	0.760039773	2.975109124	2.384212406	0.519550802	0.062145936	0	0.091021683	3.824569227	5.108171996	0.226611528	0.805529844	1.788506866	0.886841224	1.068296038	0.612032574	0	0	0.350407254	0.176302238	0.149581186	0	0	0	0	0	0	0	0	0	0	0	0	0	36.317	NO	0	0	0	0	0	0	","	","	0	0	0	0	0	", , ,"	", , , , , , , , ,"	", ,"	","	","	0	","	0	", ,"	0	","	0	0	0	0	0	", , ,"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.1881	0.242846162	0	0	0.846816349	1.313229787	0.93702592	0.760039773	2.975109124	2.384212406	0.519550802	0.062145936	0	0.091021683	3.824569227	5.108171996	0.226611528	0.805529844	1.788506866	0.886841224	1.068296038	0.612032574	0	0	0.350407254	0.176302238	0.149581186	0	0	0	0	0	0	0	0	0	0	0	0	0	36.317
H0532_801_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	204.5487238	2.57684744	50.96881691	25.57833873	5.476305189	7.708023538	5.44860289	9.831527822	31.79756918	6.45317983	9.080403198	0.589377105	0.099894425	13.02623297	26.33454713	73.47799954	1.233491735	4.121667505	31.54930893	32.96331165	4.644020136	4.036947767	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, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	Medicare FFS Cost Sharing	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	Medicare FFS Cost Sharing	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	Medicare FFS Cost Sharing	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"											0.063544378	0.06372452	0.123588828	0	0.232828241	0.232999998	0.233210487	0.232932587	0.233000008	0.233001424	0.232878648	0.232999995	0.232999977	0.233064054	0.233012439	0.232996757	0.232992821	0.232995168	0.232993128	0.233013539	0.233001124	0.232991199	0	0	0	0	0	0	0	0											NO	0.063544378	0.06372452	0.123588828	0	0.232828241	0.232999998	0.233210487	0.232932587	0.233000008	0.233001424	0.232878648	0.232999995	0.232999977	0.233064054	0.233012439	0.232996757	0.232992821	0.232995168	0.232993128	0.233013539	0.233001124	0.232991199	0	0	0	0	0	0	0	0												12.9979	0.164208366	6.299176344	0	1.275038504	1.795969468	1.270671333	2.290083208	7.408833856	1.503600092	2.114632023	0.137324863	0.023275399	3.035946663	6.136277068	17.12013562	0.287394718	0.960328614	7.350772175	7.680897896	1.082061913	0.940573301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8751	0	0	12.9979	0.164208366	6.299176344	0	1.275038504	1.795969468	1.270671333	2.290083208	7.408833856	1.503600092	2.114632023	0.137324863	0.023275399	3.035946663	6.136277068	17.12013562	0.287394718	0.960328614	7.350772175	7.680897896	1.082061913	0.940573301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8751	NO	0	0	0	0	0	0	","	","	0	0	0	0	0	", , ,"	", , , , , , , , ,"	", ,"	","	","	0	","	0	", ,"	0	","	0	0	0	0	0	", , ,"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.9979	0.164208366	6.299176344	0	1.275038504	1.795969468	1.270671333	2.290083208	7.408833856	1.503600092	2.114632023	0.137324863	0.023275399	3.035946663	6.136277068	17.12013562	0.287394718	0.960328614	7.350772175	7.680897896	1.082061913	0.940573301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8751
H0532_803_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	204.5487238	2.57684744	50.96881691	25.57833873	5.476305189	7.708023538	5.44860289	9.831527822	31.79756918	6.45317983	9.080403198	0.589377105	0.099894425	13.02623297	26.33454713	73.47799954	1.233491735	4.121667505	31.54930893	32.96331165	4.644020136	4.036947767	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, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	Medicare FFS Cost Sharing	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	Medicare FFS Cost Sharing	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	Medicare FFS Cost Sharing	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	"Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing, Medicare FFS Cost Sharing"											0.063544378	0.06372452	0.123588828	0	0.232828241	0.232999998	0.233210487	0.232932587	0.233000008	0.233001424	0.232878648	0.232999995	0.232999977	0.233064054	0.233012439	0.232996757	0.232992821	0.232995168	0.232993128	0.233013539	0.233001124	0.232991199	0	0	0	0	0	0	0	0											NO	0.063544378	0.06372452	0.123588828	0	0.232828241	0.232999998	0.233210487	0.232932587	0.233000008	0.233001424	0.232878648	0.232999995	0.232999977	0.233064054	0.233012439	0.232996757	0.232992821	0.232995168	0.232993128	0.233013539	0.233001124	0.232991199	0	0	0	0	0	0	0	0												12.9979	0.164208366	6.299176344	0	1.275038504	1.795969468	1.270671333	2.290083208	7.408833856	1.503600092	2.114632023	0.137324863	0.023275399	3.035946663	6.136277068	17.12013562	0.287394718	0.960328614	7.350772175	7.680897896	1.082061913	0.940573301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8751	0	0	12.9979	0.164208366	6.299176344	0	1.275038504	1.795969468	1.270671333	2.290083208	7.408833856	1.503600092	2.114632023	0.137324863	0.023275399	3.035946663	6.136277068	17.12013562	0.287394718	0.960328614	7.350772175	7.680897896	1.082061913	0.940573301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8751	NO	0	0	0	0	0	0	","	","	0	0	0	0	0	", , ,"	", , , , , , , , ,"	", ,"	","	","	0	","	0	", ,"	0	","	0	0	0	0	0	", , ,"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.9979	0.164208366	6.299176344	0	1.275038504	1.795969468	1.270671333	2.290083208	7.408833856	1.503600092	2.114632023	0.137324863	0.023275399	3.035946663	6.136277068	17.12013562	0.287394718	0.960328614	7.350772175	7.680897896	1.082061913	0.940573301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8751
H0540_001_0	2010	7	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1445.282576	55.03411094	707.6294387	34.22477535	158.1565519	15.5717303	0.387721087	331.0591907	290.5026811	4437.354184	850.6328051	67.50632976	0.210864672	814.8504716	2509.1684	1840.764024	28.45095668	1106.986816	2692.052694	0	38.30468023	0	0	0	302.4	0	162	0	0	0	85.14550826	10.78819081	1815.929611	307.5748633	425.0929954	0.140035906	3.899165617	14.36274355	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	93.14680844	250	0.2	35	25	35	40	42.73549798	78.99259727	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	140.5978163	75.71489899	117.0785166	0	112.5754968	0.180120795	0.180120795	45.03019871	225.1509935	31.52113909	83.88838586	225.1509935	0.180120795	31.52113909	22.51509935	31.52113909	36.02415896	38.48775931	71.14104703	0	0.180120795	0	0	0	35	0	35	0	0	0	180.1207948	31.52113909	31.52113909	31.52113909	31.52113909	31.52113909	0.180120795	0.180120795	0	0		16.9336	0.347241846	6.904017084	0	1.4837127	2.804792438	0.06983663	1.242305095	5.450580607	11.65587154	5.946517748	1.266593101	0.037981112	2.140417921	4.707847984	4.835248236	0.085410149	3.550453511	15.95962061	0	6.899469449	0	0	0	0.882	0	0.4725	0	0	0	1.278039719	0.028338005	4.770014154	0.807925837	1.116617953	0.000367841	0.70232081	2.587028784	0	0	104.9667		11.56799216	16.9336	0.347241846	6.904017084	0	1.4837127	2.804792438	0.06983663	1.242305095	5.450580607	11.65587154	5.946517748	1.266593101	0.037981112	2.140417921	4.707847984	4.835248236	0.085410149	3.550453511	15.95962061	0	6.899469449	0	0	0	0.882	0	0.4725	0	0	0	1.278039719	0.028338005	4.770014154	0.807925837	1.116617953	0.000367841	0.70232081	2.587028784	0	0	104.9667	YES																																									5000																								0	0	0	0	0													0			16.9336	0.347241846	6.904017084	0	1.4837127	2.804792438	0.06983663	1.242305095	5.450580607	11.65587154	5.946517748	1.266593101	0.037981112	2.140417921	4.707847984	4.835248236	0.085410149	3.550453511	15.95962061	0	6.899469449	0	0	0	0.882	0	0.4725	0	0	0	1.278039719	0.028338005	4.770014154	0.807925837	1.116617953	0.000367841	0.70232081	2.587028784	0	0	104.9667
H0540_020_0	2010	11	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1414.915462	87.60076213	695.3676543	36.39573212	176.6238862	18.96773829	0.532946309	364.262211	264.505584	3999.755499	773.3103637	63.94727569	0.489724614	567.2844445	2599.588163	1706.188852	36.458999	851.8637424	2533.131253	0	40.56486188	0	0	0	302.4	0	162	0	0	0	80.9840344	7.384101063	771.0038425	233.0163539	365.1286781	0.418341748	4.339444668	12.25487505	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	92.50179322	250	0.2	35	25	35	40	42.56433409	79.22828166	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	141.6732192	81.55979779	117.9964294	0	113.4581052	0.181532968	0.181532968	45.38324208	226.9162104	31.76826945	83.96062548	226.9162104	0.181532968	31.76826945	22.69162104	31.76826945	36.30659366	38.63414955	71.91272572	0	0.181532968	0	0	0	35	0	35	0	0	0	181.5329683	31.76826945	31.76826945	31.76826945	31.76826945	31.76826945	0.181532968	0.181532968	0	0		16.7046	0.595391704	6.837575028	0	1.669950955	3.443269833	0.096747325	1.377616675	5.001717061	10.58877587	5.410635152	1.209222789	0.088901163	1.501803757	4.91573912	4.516888932	0.110308505	2.742585935	15.18036442	0	7.363859787	0	0	0	0.882	0	0.4725	0	0	0	1.225106012	0.019548343	2.041121485	0.616877193	0.966625519	0.001107499	0.787752271	2.224663845	0	0	98.5933		10.01523504	16.7046	0.595391704	6.837575028	0	1.669950955	3.443269833	0.096747325	1.377616675	5.001717061	10.58877587	5.410635152	1.209222789	0.088901163	1.501803757	4.91573912	4.516888932	0.110308505	2.742585935	15.18036442	0	7.363859787	0	0	0	0.882	0	0.4725	0	0	0	1.225106012	0.019548343	2.041121485	0.616877193	0.966625519	0.001107499	0.787752271	2.224663845	0	0	98.5933	YES																																									5000																								0	0	0	0	0													0			16.7046	0.595391704	6.837575028	0	1.669950955	3.443269833	0.096747325	1.377616675	5.001717061	10.58877587	5.410635152	1.209222789	0.088901163	1.501803757	4.91573912	4.516888932	0.110308505	2.742585935	15.18036442	0	7.363859787	0	0	0	0.882	0	0.4725	0	0	0	1.225106012	0.019548343	2.041121485	0.616877193	0.966625519	0.001107499	0.787752271	2.224663845	0	0	98.5933
H0540_088_0	2010	7	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1743.265959	59.48761469	716.4074847	45.545205	148.0219162	13.20573795	0.279052296	366.1743804	293.362129	3442.658503	893.5110607	66.68321463	0.037756306	1261.919316	1931.382336	1265.086406	56.39696236	949.989741	2217.639645	0	90.96579656	0	0	0	302.4	0	162	0	0	0	79.66773497	4.699746864	1693.073284	163.5909404	365.9882544	0	4.805065073	12.03890217	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	93.00492611	250	0.2	35	25	35	40	43.98246009	78.42452558	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	124.5907725	86.48620228	116.8125329	0	112.3197432	0.179711589	0.179711589	44.92789729	224.6394864	31.4495281	83.57031535	224.6394864	0.179711589	31.4495281	22.46394864	31.4495281	35.94231783	39.52078898	70.4689806	0	0.179711589	0	0	0	35	0	35	0	0	0	179.7115891	31.4495281	31.4495281	31.4495281	31.4495281	0	0.179711589	0.179711589	0	0		18.0996	0.428738156	6.973781076	0	1.385481968	2.373224152	0.050148932	1.370953746	5.4917265	9.022498777	6.222583425	1.248306924	0.006785246	3.307230582	3.615539467	3.315530872	0.168919795	3.128695341	13.02290043	0	16.34760786	0	0	0	0.882	0	0.4725	0	0	0	1.193101271	0.012317068	4.437196317	0.428738156	0.959179824	0	0.86352588	2.163530241	0	0	106.9923		12.06136889	18.0996	0.428738156	6.973781076	0	1.385481968	2.373224152	0.050148932	1.370953746	5.4917265	9.022498777	6.222583425	1.248306924	0.006785246	3.307230582	3.615539467	3.315530872	0.168919795	3.128695341	13.02290043	0	16.34760786	0	0	0	0.882	0	0.4725	0	0	0	1.193101271	0.012317068	4.437196317	0.428738156	0.959179824	0	0.86352588	2.163530241	0	0	106.9923	YES																																									5000																								0	0	0	0	0													0			18.0996	0.428738156	6.973781076	0	1.385481968	2.373224152	0.050148932	1.370953746	5.4917265	9.022498777	6.222583425	1.248306924	0.006785246	3.307230582	3.615539467	3.315530872	0.168919795	3.128695341	13.02290043	0	16.34760786	0	0	0	0.882	0	0.4725	0	0	0	1.193101271	0.012317068	4.437196317	0.428738156	0.959179824	0	0.86352588	2.163530241	0	0	106.9923
H0540_089_0	2010	13	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1508.652497	102.9207847	401.4549864	33.24149569	170.0430356	16.55581216	1.789146653	418.8111581	270.0221439	3651.353251	843.3651266	51.46161936	3.13699372	976.5599061	2421.249951	1386.341902	115.1856773	968.4999805	2364.832477	0	30.78149877	0	0	0	302.4	0	162	0	0	0	55.09420425	3.526092162	763.9151413	161.7326617	301.7304993	0	4.663255268	9.583218166	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	93.52117732	250	0.2	35	25	35	40	43.34648058	79.31163022	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	139.8985442	87.43238016	118.828553	0	114.2582241	0.182813159	0.182813159	45.70328963	228.5164481	31.99230274	85.48450906	228.5164481	0.182813159	31.99230274	22.85164481	31.99230274	36.5626317	39.62153513	72.49604813	0	0.182813159	0	0	0	35	0	35	0	0	0	182.8131585	31.99230274	31.99230274	31.99230274	31.99230274	0	0.182813159	0.182813159	0	0		17.5882	0.749884098	3.975359595	0	1.619067939	3.026620313	0.327079551	1.595087305	5.14204177	9.734599884	6.007887817	0.979985539	0.57348373	2.603533347	4.610795324	3.696022485	0.350957625	3.197788	14.28675076	0	5.627263014	0	0	0	0.882	0	0.4725	0	0	0	0.839328791	0.009400651	2.036617039	0.431183356	0.804421123	0	0.852504425	1.751938382	0	0	93.7723		8.80320436	17.5882	0.749884098	3.975359595	0	1.619067939	3.026620313	0.327079551	1.595087305	5.14204177	9.734599884	6.007887817	0.979985539	0.57348373	2.603533347	4.610795324	3.696022485	0.350957625	3.197788	14.28675076	0	5.627263014	0	0	0	0.882	0	0.4725	0	0	0	0.839328791	0.009400651	2.036617039	0.431183356	0.804421123	0	0.852504425	1.751938382	0	0	93.7723	YES																																									5000																								0	0	0	0	0													0			17.5882	0.749884098	3.975359595	0	1.619067939	3.026620313	0.327079551	1.595087305	5.14204177	9.734599884	6.007887817	0.979985539	0.57348373	2.603533347	4.610795324	3.696022485	0.350957625	3.197788	14.28675076	0	5.627263014	0	0	0	0.882	0	0.4725	0	0	0	0.839328791	0.009400651	2.036617039	0.431183356	0.804421123	0	0.852504425	1.751938382	0	0	93.7723
H0540_090_0	2010	7	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1359.103135	32.98706194	772.0299212	26.29316089	148.411626	10.30520832	0.345113662	316.603031	374.3260541	4889.027244	886.8683197	66.25239895	0.019711025	866.0216597	2321.374508	1897.093864	21.01167698	1128.310422	2787.789385	0	45.80068242	0	0	0	302.4	0	162	0	0	0	26.2153889	19.84744158	1860.723576	293.8682867	450.2402274	0.060305415	1.618153567	15.95347854	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	93.72424008	250	0.2	35	25	35	40	42.8176592	78.74763846	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	144.7643474	83.08823462	116.5825644	0	112.0986196	0.179357791	0.179357791	44.83944785	224.1972392	31.38761349	84.0508635	224.1972392	0.179357791	31.38761349	22.41972392	31.38761349	35.87155828	38.39840393	70.62001256	0	0.179357791	0	0	0	35	0	35	0	0	0	179.3577914	31.38761349	31.38761349	31.38761349	31.38761349	31.38761349	0.179357791	0.179357791	0	0		16.3958	0.228403062	7.500435667	0	1.386394867	1.848319404	0.061898824	1.183025425	6.993572325	12.78790812	6.211837341	1.237800411	0.003535326	2.265196094	4.337047966	4.962104081	0.062810133	3.610443278	16.40614345	0	8.214709242	0	0	0	0.882	0	0.4725	0	0	0	0.391827854	0.051913652	4.866972701	0.768652017	1.177663853	0.000157737	0.29022845	2.861380676	0	0	107.4607		12.20974088	16.3958	0.228403062	7.500435667	0	1.386394867	1.848319404	0.061898824	1.183025425	6.993572325	12.78790812	6.211837341	1.237800411	0.003535326	2.265196094	4.337047966	4.962104081	0.062810133	3.610443278	16.40614345	0	8.214709242	0	0	0	0.882	0	0.4725	0	0	0	0.391827854	0.051913652	4.866972701	0.768652017	1.177663853	0.000157737	0.29022845	2.861380676	0	0	107.4607	YES																																									5000																								0	0	0	0	0													0			16.3958	0.228403062	7.500435667	0	1.386394867	1.848319404	0.061898824	1.183025425	6.993572325	12.78790812	6.211837341	1.237800411	0.003535326	2.265196094	4.337047966	4.962104081	0.062810133	3.610443278	16.40614345	0	8.214709242	0	0	0	0.882	0	0.4725	0	0	0	0.391827854	0.051913652	4.866972701	0.768652017	1.177663853	0.000157737	0.29022845	2.861380676	0	0	107.4607
H0540_091_0	2010	11	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1085.773134	74.80878755	692.2628233	17.3749442	134.0123011	14.58563223	1.243271548	318.7220152	326.2147845	4519.773643	829.3260496	65.21248379	0.082972092	581.4271919	2312.250952	1857.314024	42.00327941	945.96118	2579.652111	0	77.3905212	0	0	0	302.4	0	162	0	0	0	57.44183735	13.45879728	912.0236916	208.4993305	361.0127296	0.160879113	1.771340706	14.15766183	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	94.71339335	250	0.2	35	25	35	40	42.70403377	79.3916982	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	150.5712005	75.39558601	117.1033704	0	112.5993946	0.180159031	0.180159031	45.03975783	225.1987891	31.52783048	85.31736599	225.1987891	0.180159031	31.52783048	22.51987891	31.52783048	36.03180626	38.46758679	71.51565721	0	0.180159031	0	0	0	35	0	35	0	0	0	180.1590313	31.52783048	31.52783048	31.52783048	31.52783048	31.52783048	0.180159031	0.180159031	0	0		13.6238	0.470021031	6.755525814	0	1.257475331	2.627733373	0.223986598	1.196263532	6.121931207	11.8748881	5.896326175	1.223814365	0.014948172	1.527594829	4.339300954	4.879756808	0.126121169	3.032403649	15.37379301	0	13.94260133	0	0	0	0.882	0	0.4725	0	0	0	0.862388815	0.035360557	2.396177362	0.547794295	0.948495678	0.000422681	0.319123026	2.550630641	0	0	103.5232		11.24993138	13.6238	0.470021031	6.755525814	0	1.257475331	2.627733373	0.223986598	1.196263532	6.121931207	11.8748881	5.896326175	1.223814365	0.014948172	1.527594829	4.339300954	4.879756808	0.126121169	3.032403649	15.37379301	0	13.94260133	0	0	0	0.882	0	0.4725	0	0	0	0.862388815	0.035360557	2.396177362	0.547794295	0.948495678	0.000422681	0.319123026	2.550630641	0	0	103.5232	YES																																									5000																								0	0	0	0	0													0			13.6238	0.470021031	6.755525814	0	1.257475331	2.627733373	0.223986598	1.196263532	6.121931207	11.8748881	5.896326175	1.223814365	0.014948172	1.527594829	4.339300954	4.879756808	0.126121169	3.032403649	15.37379301	0	13.94260133	0	0	0	0.882	0	0.4725	0	0	0	0.862388815	0.035360557	2.396177362	0.547794295	0.948495678	0.000422681	0.319123026	2.550630641	0	0	103.5232
H0540_094_0	2010	7	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1273.011931	14.58607112	803.2398475	45.77008524	116.185601	8.927544711	0.242038696	338.0346283	347.2603245	4043.748827	1165.632392	60.02030301	0	1955.899715	2069.181394	1627.139514	9.247738075	935.4087063	2127.442144	0	96.88696215	0	0	0	302.4	0	162	0	0	0	11.90879028	24.5065059	2130.069351	197.6664121	382.2556569	0	1.340057369	17.35932068	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	90.67225174	250	0.2	35	25	35	40	45.14335146	77.77113671	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	149.5184793	140.5044864	118.2370343	0	113.6894561	0.18190313	0.18190313	45.47578243	227.3789121	31.8330477	82.46783184	227.3789121	0	31.8330477	22.73789121	31.8330477	36.38062594	41.05858458	70.73406584	0	0.18190313	0	0	0	35	0	35	0	0	0	181.9031297	31.8330477	31.8330477	31.8330477	31.8330477	0	0.18190313	0.18190313	0	0		15.8616	0.170784036	7.91439145	0	1.100756482	1.623948323	0.044027596	1.281032434	6.579972901	10.72707077	8.010598011	1.137279267	0	5.188520744	3.92073512	4.316400814	0.028036542	3.200546457	12.54021939	0	17.62404164	0	0	0	0.882	0	0.4725	0	0	0	0.180520519	0.065009731	5.650549938	0.52436036	1.014030213	0	0.243760629	3.157714761	0	0	113.4604		11.15126941	15.8616	0.170784036	7.91439145	0	1.100756482	1.623948323	0.044027596	1.281032434	6.579972901	10.72707077	8.010598011	1.137279267	0	5.188520744	3.92073512	4.316400814	0.028036542	3.200546457	12.54021939	0	17.62404164	0	0	0	0.882	0	0.4725	0	0	0	0.180520519	0.065009731	5.650549938	0.52436036	1.014030213	0	0.243760629	3.157714761	0	0	113.4604	YES																																									5000																								0	0	0	0	0													0			15.8616	0.170784036	7.91439145	0	1.100756482	1.623948323	0.044027596	1.281032434	6.579972901	10.72707077	8.010598011	1.137279267	0	5.188520744	3.92073512	4.316400814	0.028036542	3.200546457	12.54021939	0	17.62404164	0	0	0	0.882	0	0.4725	0	0	0	0.180520519	0.065009731	5.650549938	0.52436036	1.014030213	0	0.243760629	3.157714761	0	0	113.4604
H0540_095_0	2010	12	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1389.55608	16.73683836	1043.262925	41.84209591	130.3082416	9.361501182	0.215251405	330.7772468	354.386389	4163.56831	1146.5664	59.6305106	0	1943.652719	2094.389828	1616.676983	14.28742405	1024.664745	2201.362336	0	92.92729191	0	0	0	302.4	0	162	0	0	0	15.47374009	24.17871762	2046.277738	196.8570989	383.3532978	0	1.301936495	20.4389502	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	91.03028308	250	0.2	35	25	35	40	44.89452985	77.85405225	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	143.84773	135.9241096	120.4781881	0	115.8444116	0.185351059	0.185351059	46.33776464	231.6888232	32.43643525	84.36279664	231.6888232	0	32.43643525	23.16888232	32.43643525	37.07021171	41.60624316	72.15165499	0	0.185351059	0	0	0	35	0	35	0	0	0	185.3510585	32.43643525	32.43643525	32.43643525	32.43643525	0	0.185351059	0.185351059	0	0		16.657	0.189578321	10.47420224	0	1.257956797	1.735164154	0.039897076	1.277289851	6.842280451	11.25427616	8.060629004	1.151310236	0	5.253763797	4.043722621	4.369936522	0.044136486	3.552704212	13.23599465	0	17.22417192	0	0	0	0.882	0	0.4725	0	0	0	0.239006175	0.065355951	5.531162946	0.532111878	1.036217868	0	0.241315307	3.788381055	0	0	119.4521		9.332232958	16.657	0.189578321	10.47420224	0	1.257956797	1.735164154	0.039897076	1.277289851	6.842280451	11.25427616	8.060629004	1.151310236	0	5.253763797	4.043722621	4.369936522	0.044136486	3.552704212	13.23599465	0	17.22417192	0	0	0	0.882	0	0.4725	0	0	0	0.239006175	0.065355951	5.531162946	0.532111878	1.036217868	0	0.241315307	3.788381055	0	0	119.4521	YES																																									5000																								0	0	0	0	0													0			16.657	0.189578321	10.47420224	0	1.257956797	1.735164154	0.039897076	1.277289851	6.842280451	11.25427616	8.060629004	1.151310236	0	5.253763797	4.043722621	4.369936522	0.044136486	3.552704212	13.23599465	0	17.22417192	0	0	0	0.882	0	0.4725	0	0	0	0.239006175	0.065355951	5.531162946	0.532111878	1.036217868	0	0.241315307	3.788381055	0	0	119.4521
H0540_807_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	397.520407	4.759633243	56.01502199	15.07357642	9.32079088	21.20081457	5.047587357	17.43327403	53.50714364	10.52755115	32.98425488	0	0.357998316	44.22550471	49.51206655	143.1346521	1.496401734	7.136139023	37.52754995	44.57190321	49.10287596	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.077028392	0.077028392	0.17602132	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.077028392	0.077028392	0.17602132	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				30.6204	0.366626897	9.859838113	0	2.171744275	4.939789795	1.176087854	4.061952848	12.46716447	2.452919419	7.685331388	0	0.083413608	10.3045426	11.53631151	33.35037395	0.348661604	1.662720392	8.743919138	10.38525345	11.4409701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	163.658			30.6204	0.366626897	9.859838113	0	2.171744275	4.939789795	1.176087854	4.061952848	12.46716447	2.452919419	7.685331388	0	0.083413608	10.3045426	11.53631151	33.35037395	0.348661604	1.662720392	8.743919138	10.38525345	11.4409701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	163.658	NO																																																																																		0			30.6204	0.366626897	9.859838113	0	2.171744275	4.939789795	1.176087854	4.061952848	12.46716447	2.452919419	7.685331388	0	0.083413608	10.3045426	11.53631151	33.35037395	0.348661604	1.662720392	8.743919138	10.38525345	11.4409701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	163.658
H0540_808_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	367.019305	4.394434232	54.55484722	16.51561216	9.308549952	20.04279108	4.771879802	13.2599079	50.744688	8.892014393	27.85989494	0	0.3023805	37.35472938	54.51212852	157.5893534	1.64751846	7.856794407	41.31733471	49.07307422	46.73374562	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.077028392	0.077028392	0.17602132	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.077028392	0.077028392	0.17602132	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				28.2709	0.338496204	9.602816224	0	2.168892139	4.669970322	1.111847994	3.08955854	11.8235123	2.071839354	6.491355522	0	0.070454656	8.703651946	12.70132595	36.71831935	0.383871801	1.830633097	9.626938988	11.43402629	10.88896273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	161.9974			28.2709	0.338496204	9.602816224	0	2.168892139	4.669970322	1.111847994	3.08955854	11.8235123	2.071839354	6.491355522	0	0.070454656	8.703651946	12.70132595	36.71831935	0.383871801	1.830633097	9.626938988	11.43402629	10.88896273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	161.9974	NO																																																																																		0			28.2709	0.338496204	9.602816224	0	2.168892139	4.669970322	1.111847994	3.08955854	11.8235123	2.071839354	6.491355522	0	0.070454656	8.703651946	12.70132595	36.71831935	0.383871801	1.830633097	9.626938988	11.43402629	10.88896273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	161.9974
H0543_001_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	304.6748258	4.514072053	1085.894527	463.5046821	515.4091869	9.209250789	9.878361908	289.1840396	229.1546293	17394.42644	70.53783265	0	14.85707925	751.5342456	6943.580525	5505.708727	131.6918777	575.0996905	0	0	28.19465135	954.2594645	0	0	311.9181602	147.2493245	17.26887871	4.746277136	0	0												"$500 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$500 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$175 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $175 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$175 (14f)"	"$30 (7b); $0 n/c (7b1, 7f1); $10 (7d); $10/$30 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $10/$30 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											500	500	52.47946026	0	150	0.2	0.124157716	50	175	3	0.126447632	0	0	66.95051406	7.647975197	10.29222198	30	7.680683729	0	0	0.2	28.85844419	0	0	30	30	0	0	0	0											NO	500	500	52.47946026	0	150	0.2	0.124157716	50	175	3	0.126447632	0	0	66.95051406	7.647975197	10.29222198	30	7.680683729	0	0	0.2	28.85844419	0	0	30	30	0	0	0	0												12.6948	0.188086336	4.748929889	0	6.442614836	1.841850158	1.226474856	1.204933498	3.341838344	4.34860661	8.91934192	0	0	4.192967006	4.42536097	4.7221647	0.329229694	0.36809657	0	0	5.638930271	2.294870291	0	0	0.779795401	0.368123311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.077	0	0	12.6948	0.188086336	4.748929889	0	6.442614836	1.841850158	1.226474856	1.204933498	3.341838344	4.34860661	8.91934192	0	0	4.192967006	4.42536097	4.7221647	0.329229694	0.36809657	0	0	5.638930271	2.294870291	0	0	0.779795401	0.368123311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.077	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.6948	0.188086336	4.748929889	0	6.442614836	1.841850158	1.226474856	1.204933498	3.341838344	4.34860661	8.91934192	0	0	4.192967006	4.42536097	4.7221647	0.329229694	0.36809657	0	0	5.638930271	2.294870291	0	0	0.779795401	0.368123311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.077
H0543_004_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1265.277894	40.48987242	875.4722286	360.9791925	406.1710628	8.780388379	7.697176223	285.2491504	221.3554806	17323.6047	66.53709533	0	17.06015841	869.0153093	7137.648598	5718.556179	146.074531	609.5959091	0	0	25.95099107	937.9995919	0	0	340.0135467	164.4161572	17.35493555	4.769929488	0	0												"$175 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-40 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$150 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5, 9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$150 (14f)"	"$30 (7b); $0 n/c (7b1, 7f1); $10 (7d); $10/$30 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $10/$30 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											144.1013049	117.7704216	41.5738752	0	150	0.2	0.136899262	50	150	3	0.1281212	0	0	57.39567256	7.356669744	10.26884152	30	7.680683729	0	0	0.2	29.02631281	0	0	30	30	0	0	0	0											NO	144.1013049	117.7704216	41.5738752	0	150	0.2	0.136899262	50	150	3	0.1281212	0	0	57.39567256	7.356669744	10.26884152	30	7.680683729	0	0	0.2	29.02631281	0	0	30	30	0	0	0	0												15.194	0.397375779	3.033064431	0	5.077138286	1.756077676	1.053737747	1.188538127	2.766943508	4.330901174	8.524812526	0	0	4.156476512	4.375776957	4.89357893	0.365186327	0.390176115	0	0	5.190198214	2.268889131	0	0	0.850033867	0.411040393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.224	0	0	15.194	0.397375779	3.033064431	0	5.077138286	1.756077676	1.053737747	1.188538127	2.766943508	4.330901174	8.524812526	0	0	4.156476512	4.375776957	4.89357893	0.365186327	0.390176115	0	0	5.190198214	2.268889131	0	0	0.850033867	0.411040393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.224	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.194	0.397375779	3.033064431	0	5.077138286	1.756077676	1.053737747	1.188538127	2.766943508	4.330901174	8.524812526	0	0	4.156476512	4.375776957	4.89357893	0.365186327	0.390176115	0	0	5.190198214	2.268889131	0	0	0.850033867	0.411040393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.224
H0543_007_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1217.634732	40.44588203	859.1708944	342.1420552	424.9324877	8.183858725	6.737780207	278.9863708	230.104537	17070.86875	66.56197932	0	14.33866971	769.6558041	6920.125141	5463.672645	135.3439095	575.3218245	0	0	26.38607846	927.0799505	0	0	320.214076	152.3551184	17.22273317	4.733594231	514.3894815	0												"$200 Days 1-4 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-4 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$175 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $175 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$175 (14f)"	"$30 (7b); $0 n/c (7b1, 7f1); $10 (7d); $10/$30 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $10/$30 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											113.1598466	77.11816945	41.63519502	0	150	0.2	0.140362896	50	175	3	0.127967028	0	0	66.84972418	7.611596014	10.30020531	30	7.680683729	0	0	0.2	29.12983988	0	0	30	30	0	0	0	0											NO	113.1598466	77.11816945	41.63519502	0	150	0.2	0.140362896	50	175	3	0.127967028	0	0	66.84972418	7.611596014	10.30020531	30	7.680683729	0	0	0.2	29.12983988	0	0	30	30	0	0	0	0												11.4823	0.259926032	2.980978979	0	5.311656096	1.636771745	0.945734339	1.162443212	3.355691164	4.267717186	8.517738696	0	0	4.287606518	4.389433079	4.68974583	0.338359774	0.368238748	0	0	5.277215692	2.250474209	0	0	0.80053519	0.380887796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7034	0	0	11.4823	0.259926032	2.980978979	0	5.311656096	1.636771745	0.945734339	1.162443212	3.355691164	4.267717186	8.517738696	0	0	4.287606518	4.389433079	4.68974583	0.338359774	0.368238748	0	0	5.277215692	2.250474209	0	0	0.80053519	0.380887796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7034	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.4823	0.259926032	2.980978979	0	5.311656096	1.636771745	0.945734339	1.162443212	3.355691164	4.267717186	8.517738696	0	0	4.287606518	4.389433079	4.68974583	0.338359774	0.368238748	0	0	5.277215692	2.250474209	0	0	0.80053519	0.380887796	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7034
H0543_013_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1172.471448	45.13735089	762.8204214	335.2457523	355.8447457	8.187806145	6.647252212	355.2228274	212.2916329	16909.89679	63.8199453	0	18.63611821	880.6834905	7026.428693	5499.178008	148.1299656	614.5282526	0	0	27.46105227	907.5200178	0	0	345.5651711	169.1579827	17.21960823	4.732735355	0	0												"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$80 Days 11-40 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$200 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$30 (3, 9c, 9d); $150 (5); $200 (9a)"	"$20 (7a); $35 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$200 (14f)"	"$35 (7b, 7d); $0 n/c (7b1, 7f1); $20/$35 (7f)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $20/$35 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	36.95455574	0	150	0.2	0.139641639	50	200	3	0.129043316	0	0	77.34558655	13.82913807	34.99988378	30	30	0	0	0.2	33.88303808	0	0	30	30	0	0	0	0											NO	165.816167	126.2891031	36.95455574	0	150	0.2	0.139641639	50	200	3	0.129043316	0	0	77.34558655	13.82913807	34.99988378	30	30	0	0	0.2	33.88303808	0	0	30	30	0	0	0	0												16.2012	0.47502963	2.349140815	0	4.448059321	1.637561229	0.928233192	1.480095114	3.538193882	4.227474197	8.235537351	0	0	5.676415094	8.097454375	16.03921593	0.370324914	1.536320631	0	0	5.492210454	2.562461277	0	0	0.863912928	0.422894957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5818	0	0	16.2012	0.47502963	2.349140815	0	4.448059321	1.637561229	0.928233192	1.480095114	3.538193882	4.227474197	8.235537351	0	0	5.676415094	8.097454375	16.03921593	0.370324914	1.536320631	0	0	5.492210454	2.562461277	0	0	0.863912928	0.422894957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5818	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.2012	0.47502963	2.349140815	0	4.448059321	1.637561229	0.928233192	1.480095114	3.538193882	4.227474197	8.235537351	0	0	5.676415094	8.097454375	16.03921593	0.370324914	1.536320631	0	0	5.492210454	2.562461277	0	0	0.863912928	0.422894957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5818
H0543_019_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1262.493361	38.69465496	768.8144698	318.9726119	376.7980111	8.284824594	6.298399876	288.4812083	212.3277354	16450.36739	61.83094504	0	16.1644208	841.4841153	6795.604927	5320.11143	142.0057271	604.5334308	0	0	22.50533503	885.964858	0	0	308.2786777	156.8785885	17.16044343	4.716474166	7.754113876	0												"$200 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$185 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $185 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$185 (14f)"	"$20 (7b, 7d); $0 n/c (7b1, 7f1); $10/$20 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $10/$20 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											147.3921484	112.2569806	41.63519502	0	150	0.2	0.140782195	50	185	3	0.128914239	0	0	70.59462125	7.631251598	19.99993856	30	7.680683729	0	0	0.2	19.3898952	0	0	30	30	0	0	0	0											NO	147.3921484	112.2569806	41.63519502	0	150	0.2	0.140782195	50	185	3	0.128914239	0	0	70.59462125	7.631251598	19.99993856	30	7.680683729	0	0	0.2	19.3898952	0	0	30	30	0	0	0	0												15.5068	0.361978761	2.667478365	0	4.709975139	1.656964919	0.88670256	1.202005035	3.273385921	4.112591848	7.970889202	0	0	4.950354367	4.321580913	8.866825147	0.355014318	0.38693584	0	0	4.501067005	1.431563812	0	0	0.770696694	0.392196471	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.325	0	0	15.5068	0.361978761	2.667478365	0	4.709975139	1.656964919	0.88670256	1.202005035	3.273385921	4.112591848	7.970889202	0	0	4.950354367	4.321580913	8.866825147	0.355014318	0.38693584	0	0	4.501067005	1.431563812	0	0	0.770696694	0.392196471	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.325	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.5068	0.361978761	2.667478365	0	4.709975139	1.656964919	0.88670256	1.202005035	3.273385921	4.112591848	7.970889202	0	0	4.950354367	4.321580913	8.866825147	0.355014318	0.38693584	0	0	4.501067005	1.431563812	0	0	0.770696694	0.392196471	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.325
H0543_022_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1706.058311	27.20973873	1548.396188	588.0412551	444.1250261	5.721177378	4.059176694	467.3323742	354.6650296	16783.90496	51.34563107	0	5.798077606	523.801385	6265.756513	5422.050809	92.18104816	445.9502406	0	0	25.0657124	947.7351652	0	0	244.9696786	107.662165	17.22124568	4.733185402	0	0												"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$260 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $260 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$260 (14f)"	"$20 (7b, 7d); $0 n/c (7b1, 7f1); $10/$20 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $10/$20 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	52.47946026	0	150	0.2	0.169031601	50	260	3	0.118896505	0	0	99.61355446	8.533727856	19.99992438	30	7.680683729	0	0	0.2	19.10705033	0	0	30	30	0	0	0	0											NO	201.0053198	148.2134571	52.47946026	0	150	0.2	0.169031601	50	260	3	0.118896505	0	0	99.61355446	8.533727856	19.99992438	30	7.680683729	0	0	0.2	19.10705033	0	0	30	30	0	0	0	0												28.5772	0.336070787	6.771583018	0	5.551562826	1.144235476	0.686129135	1.947218226	7.684408974	4.19597624	6.104816107	0	0	4.348143149	4.455855075	9.036717182	0.23045262	0.285433563	0	0	5.013142481	1.509035292	0	0	0.612424197	0.269155413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7596	0	0	28.5772	0.336070787	6.771583018	0	5.551562826	1.144235476	0.686129135	1.947218226	7.684408974	4.19597624	6.104816107	0	0	4.348143149	4.455855075	9.036717182	0.23045262	0.285433563	0	0	5.013142481	1.509035292	0	0	0.612424197	0.269155413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7596	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.5772	0.336070787	6.771583018	0	5.551562826	1.144235476	0.686129135	1.947218226	7.684408974	4.19597624	6.104816107	0	0	4.348143149	4.455855075	9.036717182	0.23045262	0.285433563	0	0	5.013142481	1.509035292	0	0	0.612424197	0.269155413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7596
H0543_028_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	307.4442783	6.409007747	848.9214536	377.4531736	405.6549282	9.416808673	11.48831206	294.1403858	238.578619	18743.36391	82.0666837	0	21.68129763	991.1537678	7774.271798	6014.086119	172.2540906	673.0311983	0	0	36.8002491	1006.352295	0	0	367.2219298	180.1442397	17.42838283	4.790116157	1.43179564	0												"$200 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$40 (4a, 4a1, 4b)"	$0 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9a, 9d); $10 (5, 9c)"	"$10 (7a); $20 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"$20 (7b, 7d); $0 n/c (7b1, 7f1); $10/$20 (7f)"	"$10 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $10/$20 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											200	200	0	0	150	0.2	0.107985353	40	0	3	0.130453158	0	0	0.083293195	6.114071402	19.9999415	10	0	0	0	0.2	19.37107314	0	0	30	30	0	0	0	0											NO	200	200	0	0	150	0.2	0.107985353	40	0	3	0.130453158	0	0	0.083293195	6.114071402	19.9999415	10	0	0	0	0.2	19.37107314	0	0	30	30	0	0	0	0												5.1241	0.106816796	0	0	5.070686602	1.883361735	1.240569435	0.980467953	0	4.685840977	10.70585803	0	0	0.006879697	3.961037739	10.02344754	0.143545076	0	0	0	7.36004982	1.624510326	0	0	0.918054825	0.450360599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2856	0	0	5.1241	0.106816796	0	0	5.070686602	1.883361735	1.240569435	0.980467953	0	4.685840977	10.70585803	0	0	0.006879697	3.961037739	10.02344754	0.143545076	0	0	0	7.36004982	1.624510326	0	0	0.918054825	0.450360599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2856	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.1241	0.106816796	0	0	5.070686602	1.883361735	1.240569435	0.980467953	0	4.685840977	10.70585803	0	0	0.006879697	3.961037739	10.02344754	0.143545076	0	0	0	7.36004982	1.624510326	0	0	0.918054825	0.450360599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2856
H0543_029_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1718.609326	46.16704478	1659.524543	638.8290583	468.398787	9.765849546	12.74898025	348.2811392	347.7705355	19140.63801	70.86331246	0	23.49549551	435.1770388	7050.013516	5842.27846	127.8268627	515.1379481	0	0	40.60361969	1027.028756	0	0	261.9572408	115.1310205	17.25698884	4.743009256	0	0												"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$125 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$260 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $260 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$260 (14f)"	"$20 (7b, 7d); $0 n/c (7b1, 7f1); $10/$20 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $10/$20 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	43.36999481	0	150	0.2	0.117798599	50	260	3	0.123007728	0	0	95.90974555	8.418513964	19.99992187	30	7.680683729	0	0	0.2	19.58014003	0	0	30	30	0	0	0	0											NO	201.0053198	148.2134571	43.36999481	0	150	0.2	0.117798599	50	260	3	0.123007728	0	0	95.90974555	8.418513964	19.99992187	30	7.680683729	0	0	0.2	19.58014003	0	0	30	30	0	0	0	0												28.7875	0.570214776	5.997797568	0	5.854984838	1.953169909	1.501812009	1.451171413	7.535028269	4.785159501	8.716735042	0	0	3.478143256	4.945886436	9.737092729	0.319567157	0.329717638	0	0	8.120723938	1.675780571	0	0	0.654893102	0.287827551	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7032	0	0	28.7875	0.570214776	5.997797568	0	5.854984838	1.953169909	1.501812009	1.451171413	7.535028269	4.785159501	8.716735042	0	0	3.478143256	4.945886436	9.737092729	0.319567157	0.329717638	0	0	8.120723938	1.675780571	0	0	0.654893102	0.287827551	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7032	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.7875	0.570214776	5.997797568	0	5.854984838	1.953169909	1.501812009	1.451171413	7.535028269	4.785159501	8.716735042	0	0	3.478143256	4.945886436	9.737092729	0.319567157	0.329717638	0	0	8.120723938	1.675780571	0	0	0.654893102	0.287827551	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7032
H0543_032_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1319.774943	9.351940096	1388.780733	414.1843143	306.2270014	6.711328238	6.571152756	485.8472403	339.0664334	16258.23751	53.5418391	0	5.240342418	381.5006365	6042.430422	5226.405545	90.96634878	430.9316456	0	0	25.40767153	912.8394911	0	0	238.9915959	104.9768904	17.23446719	4.736819278	0	0												"$275 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-60 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$250 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $250 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$250 (14f)"	"$20 (7b, 7d); $0 n/c (7b1, 7f1); $10/$20 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 18a); $10/$20 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											190.6084929	140.5472438	48.63739071	0	150	0.2	0.149873896	50	250	3	0.120503117	0	0	94.81459706	8.481787222	19.99992447	30	7.680683729	0	0	0.2	19.1140973	0	0	30	30	0	0	0	0											NO	190.6084929	140.5472438	48.63739071	0	150	0.2	0.149873896	50	250	3	0.120503117	0	0	94.81459706	8.481787222	19.99992447	30	7.680683729	0	0	0.2	19.1140973	0	0	30	30	0	0	0	0												20.9634	0.10953245	5.628889262	0	3.827837518	1.342265648	0.984844267	2.024363501	7.063884029	4.064559377	6.451958484	0	0	3.014319094	4.270884095	8.710643013	0.227415872	0.275820807	0	0	5.081534307	1.454008571	0	0	0.59747899	0.262442226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.356	0	0	20.9634	0.10953245	5.628889262	0	3.827837518	1.342265648	0.984844267	2.024363501	7.063884029	4.064559377	6.451958484	0	0	3.014319094	4.270884095	8.710643013	0.227415872	0.275820807	0	0	5.081534307	1.454008571	0	0	0.59747899	0.262442226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.356	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.9634	0.10953245	5.628889262	0	3.827837518	1.342265648	0.984844267	2.024363501	7.063884029	4.064559377	6.451958484	0	0	3.014319094	4.270884095	8.710643013	0.227415872	0.275820807	0	0	5.081534307	1.454008571	0	0	0.59747899	0.262442226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.356
H0543_035_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1772.487838	21.45164884	1455.022824	487.0843105	510.660871	8.389896673	10.27373923	307.8246035	328.248552	17720.39285	59.77664362	0	14.42966574	978.934703	6578.198983	5350.232049	103.9883455	479.1453362	0	0	24.97774384	952.751644	0	0	204.5384186	121.1589168	17.19186886	4.72511131	27.03833096	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$225 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $225 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$225 (14f)"	"$30 (7b); $0 n/c (7b1, 7f1); $10 (7d); $10/$30 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $10/$30 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	52.47946026	0	150	0.2	0.120304481	50	225	3	0.120504389	0	0	87.35469619	8.209276688	10.28695727	30	7.680683729	0	0	0.2	29.67459279	0	0	30	30	0	0	0	0											NO	184.2401855	140.3212257	52.47946026	0	150	0.2	0.120304481	50	225	3	0.120504389	0	0	87.35469619	8.209276688	10.28695727	30	7.680683729	0	0	0.2	29.67459279	0	0	30	30	0	0	0	0												27.2136	0.250843472	6.36323437	0	6.383260888	1.677979335	1.235976868	1.282602514	6.154660351	4.430098212	7.203347894	0	0	7.126211964	4.500187964	4.586467373	0.259970864	0.306680316	0	0	4.995548768	2.356043089	0	0	0.511346047	0.302897292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.141	0	0	27.2136	0.250843472	6.36323437	0	6.383260888	1.677979335	1.235976868	1.282602514	6.154660351	4.430098212	7.203347894	0	0	7.126211964	4.500187964	4.586467373	0.259970864	0.306680316	0	0	4.995548768	2.356043089	0	0	0.511346047	0.302897292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.141	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.2136	0.250843472	6.36323437	0	6.383260888	1.677979335	1.235976868	1.282602514	6.154660351	4.430098212	7.203347894	0	0	7.126211964	4.500187964	4.586467373	0.259970864	0.306680316	0	0	4.995548768	2.356043089	0	0	0.511346047	0.302897292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.141
H0543_036_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	271.4971993	5.202471947	745.5526258	368.7471639	354.9835575	9.737524536	14.95664955	263.2163686	219.7170551	16973.16569	77.59286463	0	16.84636536	898.1818715	7391.549083	5402.911465	162.4168157	667.7473267	0	0	30.00726935	898.4064659	0	0	352.2602121	173.1295035	17.05490124	4.687466348	0	0												"$200 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$40 (4a, 4a1, 4b)"	$0 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9a, 9d); $10 (5, 9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"$10 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$10 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $10 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											200	200	0	0	150	0.2	0.107553385	40	0	3	0.129220465	0	0	0.068069642	5.738003833	10	10	0	0	0	0.2	9.67437434	0	0	30	30	0	0	0	0											NO	200	200	0	0	150	0.2	0.107553385	40	0	3	0.129220465	0	0	0.068069642	5.738003833	10	10	0	0	0	0.2	9.67437434	0	0	30	30	0	0	0	0												4.525	0.086707866	0	0	4.437294469	1.947504907	1.608638291	0.877387895	0	4.243291423	10.02658607	0	0	0.00509491	3.534394747	4.502426221	0.135347346	0	0	0	6.001453871	0.724293372	0	0	0.88065053	0.432823759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9688	0	0	4.525	0.086707866	0	0	4.437294469	1.947504907	1.608638291	0.877387895	0	4.243291423	10.02658607	0	0	0.00509491	3.534394747	4.502426221	0.135347346	0	0	0	6.001453871	0.724293372	0	0	0.88065053	0.432823759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9688	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.525	0.086707866	0	0	4.437294469	1.947504907	1.608638291	0.877387895	0	4.243291423	10.02658607	0	0	0.00509491	3.534394747	4.502426221	0.135347346	0	0	0	6.001453871	0.724293372	0	0	0.88065053	0.432823759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9688
H0543_046_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1682.105686	35.23809045	1540.736256	353.281103	369.4701565	8.949515674	12.01466526	315.0994398	352.8335233	17515.53209	66.36709515	0	10.91533491	420.3810537	6451.281688	5416.357924	171.8046395	466.7042979	0	0	36.40895659	971.6759966	0	0	205.796257	112.7773741	17.23973052	4.738265881	25.03684257	0												"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$260 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $260 (9a); $30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$260 (14f)"	"$30 (7b, 7d); $0 n/c (7b1, 7f1); $15/$30 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $15/$30 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	52.47946026	0	150	0.2	0.128193481	50	260	3	0.122282271	0	0	97.45184988	11.84635207	29.99988283	30	7.680683729	0	0	0.2	28.96605631	0	0	30	30	0	0	0	0											NO	201.0053198	148.2134571	52.47946026	0	150	0.2	0.128193481	50	260	3	0.122282271	0	0	97.45184988	11.84635207	29.99988283	30	7.680683729	0	0	0.2	28.96605631	0	0	30	30	0	0	0	0												28.176	0.435229934	6.738083927	0	4.618376957	1.789903135	1.540201759	1.312914332	7.644726339	4.378883022	8.115519084	0	0	3.413909278	6.368679516	13.54084193	0.429511599	0.298717342	0	0	7.281791317	2.345468469	0	0	0.514490642	0.281943435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2252	0	0	28.176	0.435229934	6.738083927	0	4.618376957	1.789903135	1.540201759	1.312914332	7.644726339	4.378883022	8.115519084	0	0	3.413909278	6.368679516	13.54084193	0.429511599	0.298717342	0	0	7.281791317	2.345468469	0	0	0.514490642	0.281943435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2252	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.176	0.435229934	6.738083927	0	4.618376957	1.789903135	1.540201759	1.312914332	7.644726339	4.378883022	8.115519084	0	0	3.413909278	6.368679516	13.54084193	0.429511599	0.298717342	0	0	7.281791317	2.345468469	0	0	0.514490642	0.281943435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2252
H0543_060_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1162.498152	41.05005449	740.8522861	332.7304786	348.4187715	8.32916897	6.552572536	486.6928812	211.5774754	16699.03378	65.84684577	0	16.95379949	877.6711575	6958.156228	5525.37444	146.647814	605.9352618	0	0	26.65049901	900.0815964	0	0	342.2075026	168.7946536	17.30007078	4.754850141	0	0												"$200 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$200 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$30 (3, 9c, 9d); $150 (5); $200 (9a)"	"$20 (7a); $40 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$200 (14f)"	"$40 (7b, 7d); $0 n/c (7b1, 7f1); $20/$40 (7f)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20/$40 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 18a); $20/$40 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											127.4858139	90.63925114	34.69599585	0	150	0.2	0.140301454	50	200	3	0.128957019	0	0	77.36179448	13.8263698	39.99048379	30	30	0	0	0.2	38.66562405	0	0	30	30	0	0	0	0											NO	127.4858139	90.63925114	34.69599585	0	150	0.2	0.140301454	50	200	3	0.128957019	0	0	77.36179448	13.8263698	39.99048379	30	30	0	0	0.2	38.66562405	0	0	30	30	0	0	0	0												12.3502	0.310062183	2.142050654	0	4.355234644	1.665833794	0.919335456	2.027887005	3.526291257	4.174758446	8.491412948	0	0	5.658184642	8.017170092	18.41353308	0.366619535	1.514838154	0	0	5.330099803	2.900184718	0	0	0.855518756	0.421986634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4412	0	0	12.3502	0.310062183	2.142050654	0	4.355234644	1.665833794	0.919335456	2.027887005	3.526291257	4.174758446	8.491412948	0	0	5.658184642	8.017170092	18.41353308	0.366619535	1.514838154	0	0	5.330099803	2.900184718	0	0	0.855518756	0.421986634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4412	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.3502	0.310062183	2.142050654	0	4.355234644	1.665833794	0.919335456	2.027887005	3.526291257	4.174758446	8.491412948	0	0	5.658184642	8.017170092	18.41353308	0.366619535	1.514838154	0	0	5.330099803	2.900184718	0	0	0.855518756	0.421986634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4412
H0543_065_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	329.7014776	7.363475811	1013.219769	455.4482027	527.2050132	9.303177001	9.784333129	295.868643	233.4333162	17880.93002	73.58396204	0	15.0248888	744.1789912	7056.042095	5734.967853	134.8039587	587.1933928	0	0	28.74493206	975.7814277	0	0	240.9578996	139.1424889	17.11382292	4.703660718	28.01200819	0												"$400 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$400 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-60 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$175 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $175 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$175 (14f)"	"$30 (7b); $0 n/c (7b1, 7f1); $20 (7d); $10/$30 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10/$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $10/$30 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											400	400	48.63739071	0	150	0.2	0.123117934	50	175	3	0.127452992	0	0	66.83139229	7.739757116	20.1448288	30	7.680683729	0	0	0.2	29.01429531	0	0	30	30	0	0	0	0											NO	400	400	48.63739071	0	150	0.2	0.123117934	50	175	3	0.127452992	0	0	66.83139229	7.739757116	20.1448288	30	7.680683729	0	0	0.2	29.01429531	0	0	30	30	0	0	0	0												10.99	0.245449194	4.106697149	0	6.590062664	1.8606354	1.204626878	1.232786012	3.404235861	4.470232504	9.378496108	0	0	4.144543175	4.551004335	9.627495462	0.337009897	0.375837228	0	0	5.748986412	2.359300875	0	0	0.602394749	0.347856222	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5777	0	0	10.99	0.245449194	4.106697149	0	6.590062664	1.8606354	1.204626878	1.232786012	3.404235861	4.470232504	9.378496108	0	0	4.144543175	4.551004335	9.627495462	0.337009897	0.375837228	0	0	5.748986412	2.359300875	0	0	0.602394749	0.347856222	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5777	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.99	0.245449194	4.106697149	0	6.590062664	1.8606354	1.204626878	1.232786012	3.404235861	4.470232504	9.378496108	0	0	4.144543175	4.551004335	9.627495462	0.337009897	0.375837228	0	0	5.748986412	2.359300875	0	0	0.602394749	0.347856222	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5777
H0543_070_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2172.743835	53.35325142	1616.546208	560.8211539	618.9630517	10.88250116	12.41784659	384.6238039	337.2944911	18866.88522	80.1571583	0	5.57384026	996.3004702	6945.066774	5671.628753	152.2182563	526.6282478	0	0	26.63021672	1045.172524	0	0	263.0301452	129.6985728	17.27325696	4.747480478	0	0												"$290 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$125 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$260 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $260 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$260 (14f)"	"$15 (7b, 7d); $0 n/c (7b1, 7f1); $10/$15 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10/$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $15 (16b, 18a); $10/$15 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.8544301	131.4269142	43.36999481	0	150	0.2	0.133090895	50	260	3	0.122741768	0	0	100.6723444	8.500009051	14.99996008	30	7.680683729	0	0	0.2	14.33732195	0	0	30	30	0	0	0	0											NO	184.8544301	131.4269142	43.36999481	0	150	0.2	0.133090895	50	260	3	0.122741768	0	0	100.6723444	8.500009051	14.99996008	30	7.680683729	0	0	0.2	14.33732195	0	0	30	30	0	0	0	0												33.4701	0.584337766	5.842466721	0	7.737038146	2.176500232	1.652702319	1.602599183	7.308047306	4.716721304	9.838631343	0	0	8.358325335	4.919427537	7.089517073	0.380545641	0.337072085	0	0	5.326043345	1.248747914	0	0	0.657575363	0.324246432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.5707	0	0	33.4701	0.584337766	5.842466721	0	7.737038146	2.176500232	1.652702319	1.602599183	7.308047306	4.716721304	9.838631343	0	0	8.358325335	4.919427537	7.089517073	0.380545641	0.337072085	0	0	5.326043345	1.248747914	0	0	0.657575363	0.324246432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.5707	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	33.4701	0.584337766	5.842466721	0	7.737038146	2.176500232	1.652702319	1.602599183	7.308047306	4.716721304	9.838631343	0	0	8.358325335	4.919427537	7.089517073	0.380545641	0.337072085	0	0	5.326043345	1.248747914	0	0	0.657575363	0.324246432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.5707
H0543_077_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1315.91253	47.38286934	841.287284	382.3119684	391.8686961	10.74271185	8.644777329	302.0208448	242.3931804	19164.63246	82.475668	0	20.19251168	1003.580557	7988.741265	6831.567343	169.3758508	695.4324357	0	0	26.67122972	1033.192575	636.1737639	0	378.6605895	182.7037875	18.51269353	10.36767995	0	702.0969745												"$150 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-50 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$140 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $140 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$140 (14f)"	$30 (7b); $10 (7b1); $15 (7d); $10/$30 (7f); $0 n/c (7f1)	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10/$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $10/$30 (17a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13d, 13e)"											115.7540853	90.52324186	45.93452832	0	150	0.2	0.138884424	50	140	3	0.129135253	0	0	53.63186532	7.229552809	14.68060692	30	7.680683729	0	0	0.2	29.01647305	0	0	30	30	0	0	0	10											NO	115.7540853	90.52324186	45.93452832	0	150	0.2	0.138884424	50	140	3	0.129135253	0	0	53.63186532	7.229552809	14.68060692	30	7.680683729	0	0	0.2	29.01647305	0	0	30	30	0	0	0	10												12.6935	0.357437578	3.220344548	0	4.898358701	2.14854237	1.200624923	1.258420187	2.827920438	4.791158114	10.65051622	0	0	4.485324773	4.812918904	8.357629568	0.423439627	0.445116383	0	0	5.334245944	2.498300376	0	0	0.946651474	0.456759469	0	0	0	0.585080812	0	0	0	0	0	0	0	0	0	0	72.3923	0	0	12.6935	0.357437578	3.220344548	0	4.898358701	2.14854237	1.200624923	1.258420187	2.827920438	4.791158114	10.65051622	0	0	4.485324773	4.812918904	8.357629568	0.423439627	0.445116383	0	0	5.334245944	2.498300376	0	0	0.946651474	0.456759469	0	0	0	0.585080812	0	0	0	0	0	0	0	0	0	0	72.3923	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.6935	0.357437578	3.220344548	0	4.898358701	2.14854237	1.200624923	1.258420187	2.827920438	4.791158114	10.65051622	0	0	4.485324773	4.812918904	8.357629568	0.423439627	0.445116383	0	0	5.334245944	2.498300376	0	0	0.946651474	0.456759469	0	0	0	0.585080812	0	0	0	0	0	0	0	0	0	0	72.3923
H0543_078_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2752.268704	171.4453357	1641.234131	839.1036372	634.2626699	16.37956068	12.74808183	712.5110715	377.6188013	28869.29565	81.78296696	0	37.2094859	1497.959905	14095.34091	15821.03249	518.1209689	1308.664417	0	0	39.17430412	1385.793931	682.1827278	225.9625949	759.7540144	409.3313271	0	0	12.67571905	0												"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$140 (9b)	$0/$0/$10 (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $140 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0/$140 (14f)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											126.1302083	98.22485799	39.07418398	0	150	0.2	0.135998501	50	140	0	0.127393247	0	0	54.05594787	1.092004963	0	30	12.04029841	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	126.1302083	98.22485799	39.07418398	0	150	0.2	0.135998501	50	140	0	0.127393247	0	0	54.05594787	1.092004963	0	30	12.04029841	0	0	0.2	0	0	0	0	0	0	0	0	0												28.9287	1.403349479	5.34415703	0	7.928283374	3.275912135	1.733720014	2.968796131	4.405552682	0	10.41859767	0	0	6.747803546	1.282681852	0	1.295302422	1.313059175	0	0	7.834860823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8808	0	0	28.9287	1.403349479	5.34415703	0	7.928283374	3.275912135	1.733720014	2.968796131	4.405552682	0	10.41859767	0	0	6.747803546	1.282681852	0	1.295302422	1.313059175	0	0	7.834860823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8808	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.9287	1.403349479	5.34415703	0	7.928283374	3.275912135	1.733720014	2.968796131	4.405552682	0	10.41859767	0	0	6.747803546	1.282681852	0	1.295302422	1.313059175	0	0	7.834860823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8808
H0543_079_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2136.441139	93.36849803	1138.958605	636.5340421	494.8033812	13.09106577	9.677910405	551.5404027	313.8723994	24401.35419	73.70687219	0	29.63087349	1291.379663	11217.9226	11846.67701	370.6719249	1052.788744	0	0	31.60004158	1200.420819	618.8995583	188.3772933	501.8749094	283.7243334	0	0	34.4796489	0												"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$140 (9b)	$0/$0/$10 (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $140 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0/$140 (14f)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											126.0194958	98.22485799	39.07418398	0	150	0.2	0.140995792	50	140	0	0.127922336	0	0	53.86865324	1.109027341	0	30	12.04029841	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	126.0194958	98.22485799	39.07418398	0	150	0.2	0.140995792	50	140	0	0.127922336	0	0	53.86865324	1.109027341	0	30	12.04029841	0	0	0.2	0	0	0	0	0	0	0	0	0												22.4361	0.764258955	3.708656505	0	6.185042265	2.618213155	1.364544643	2.298085011	3.66184466	0	9.428755294	0	0	5.797073606	1.036748573	0	0.926679812	1.05632422	0	0	6.320008315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6023	0	0	22.4361	0.764258955	3.708656505	0	6.185042265	2.618213155	1.364544643	2.298085011	3.66184466	0	9.428755294	0	0	5.797073606	1.036748573	0	0.926679812	1.05632422	0	0	6.320008315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6023	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.4361	0.764258955	3.708656505	0	6.185042265	2.618213155	1.364544643	2.298085011	3.66184466	0	9.428755294	0	0	5.797073606	1.036748573	0	0.926679812	1.05632422	0	0	6.320008315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6023
H0543_081_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2388.721601	214.7923116	1359.97454	666.1660745	662.4604825	12.0793493	9.629785329	633.4697491	330.3500136	26185.04867	71.67402264	0	30.59657704	1252.887018	12613.78266	14021.50645	437.3930965	1109.57708	0	0	35.54383117	1316.48184	673.4279865	215.3901823	618.7491492	431.977298	0	0	21.98005169	0												"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$140 (9b)	$0/$0/$10 (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $140 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0/$140 (14f)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											126.0194958	98.22485799	39.07418398	0	150	0.2	0.142904725	50	140	0	0.125392477	0	0	54.8191855	1.118062053	0	30	12.04029841	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	126.0194958	98.22485799	39.07418398	0	150	0.2	0.142904725	50	140	0	0.125392477	0	0	54.8191855	1.118062053	0	30	12.04029841	0	0	0.2	0	0	0	0	0	0	0	0	0												25.0855	1.758162025	4.428324616	0	8.280756031	2.41586986	1.376141828	2.639457288	3.854083491	0	8.987383256	0	0	5.723520487	1.175249312	0	1.093482741	1.113303262	0	0	7.108766234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.04	0	0	25.0855	1.758162025	4.428324616	0	8.280756031	2.41586986	1.376141828	2.639457288	3.854083491	0	8.987383256	0	0	5.723520487	1.175249312	0	1.093482741	1.113303262	0	0	7.108766234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.04	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.0855	1.758162025	4.428324616	0	8.280756031	2.41586986	1.376141828	2.639457288	3.854083491	0	8.987383256	0	0	5.723520487	1.175249312	0	1.093482741	1.113303262	0	0	7.108766234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.04
H0543_082_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1346.663054	36.59980508	1129.208166	420.8054699	350.8883485	7.83442333	10.57329269	312.0332224	399.8835372	16229.84428	58.15655419	0	15.03358295	366.6140007	6009.964985	4971.703904	152.020842	442.4669029	0	0	28.96024153	887.4544879	0	0	163.1145393	119.0522228	17.39768999	4.781680363	45.28131261	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$225 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $225 (9a); $30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$225 (14f)"	"$30 (7b, 7d); $0 n/c (7b1, 7f1); $15/$30 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $15/$30 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	52.47946026	0	150	0.2	0.121817581	50	225	3	0.121780483	0	0	83.8999617	11.56141746	29.99988309	30	7.680683729	0	0	0.2	29.07706602	0	0	30	30	0	0	0	0											NO	184.2401855	140.3212257	52.47946026	0	150	0.2	0.121817581	50	225	3	0.121780483	0	0	83.8999617	11.56141746	29.99988309	30	7.680683729	0	0	0.2	29.07706602	0	0	30	30	0	0	0	0												20.6758	0.427977459	4.938352925	0	4.386104356	1.566884666	1.28801294	1.300138427	7.497816323	4.05746107	7.082333262	0	0	2.563241718	5.79030951	12.42921132	0.380052105	0.283204028	0	0	5.792048306	2.150381061	0	0	0.407786348	0.297630557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3147	0	0	20.6758	0.427977459	4.938352925	0	4.386104356	1.566884666	1.28801294	1.300138427	7.497816323	4.05746107	7.082333262	0	0	2.563241718	5.79030951	12.42921132	0.380052105	0.283204028	0	0	5.792048306	2.150381061	0	0	0.407786348	0.297630557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3147	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.6758	0.427977459	4.938352925	0	4.386104356	1.566884666	1.28801294	1.300138427	7.497816323	4.05746107	7.082333262	0	0	2.563241718	5.79030951	12.42921132	0.380052105	0.283204028	0	0	5.792048306	2.150381061	0	0	0.407786348	0.297630557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3147
H0543_083_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1192.628035	42.09755108	748.7725281	345.5279507	353.3182445	7.916014751	6.426283369	266.1010689	214.7972484	17000.60309	66.36444558	0	17.27776211	895.5892503	7088.957619	5458.715227	149.8829762	617.2239291	0	0	20.55531549	915.9848374	0	0	347.1822637	169.6581349	18.61246867	9.42750956	0	0											4000	"$150 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-40 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	15% (11a)	"15% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$125 (9b)	$0/$10 (8a1); $10 (8a2)	"$10 (8b1); 15% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$10 (3, 9d); $20 (5, 9c); $125 (9a)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$125 (14f)"	"$35 (7b, 7d); $0 n/c (7b1, 7f1); $15/$35 (7f)"	"$20 (7e, 7h)"	"$10 (7c, 7i)"	Included in h.2.	$15/$35 (7g)	"15% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $15/$35 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											115.7540853	90.52324186	41.5738752	0	150	0.15	0.102205422	50	125	3	0.107100883	0	0	47.79500432	10.17130815	34.9998827	20	10	0	0	0.15	33.88106649	0	0	30	30	0	0	0	0											NO	103.4662862	80.91380645	37.16062773	0	134.0768483	0.134076848	0.091355872	44.69228277	111.7307069	2.681536966	0.095731659	0	0	42.72935462	10.06516575	34.9998827	20	8.938456554	0	0	0.134076848	33.88106649	0	0	30	30	0	0	0	0												10.2831	0.283856092	2.318738097	0	3.947649722	1.061354309	0.587078722	0.991055351	1.999954034	3.798978803	6.353178495	0	0	3.188995889	5.945961117	15.92119939	0.24980496	0.459752439	0	0	2.755991917	2.586211931	0	0	0.867955659	0.424145337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0249	0	4.578489245	10.2831	0.283856092	2.318738097	0	3.947649722	1.061354309	0.587078722	0.991055351	1.999954034	3.798978803	6.353178495	0	0	3.188995889	5.945961117	15.92119939	0.24980496	0.459752439	0	0	2.755991917	2.586211931	0	0	0.867955659	0.424145337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0249	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.2831	0.283856092	2.318738097	0	3.947649722	1.061354309	0.587078722	0.991055351	1.999954034	3.798978803	6.353178495	0	0	3.188995889	5.945961117	15.92119939	0.24980496	0.459752439	0	0	2.755991917	2.586211931	0	0	0.867955659	0.424145337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0249
H0543_084_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1133.005307	39.38228666	736.3145939	323.7972111	339.8115683	8.701415115	6.854438746	260.9348458	204.2036324	16186.71775	67.2695091	0	16.44790892	852.4960435	6751.236712	5211.404937	142.280641	588.6936689	0	0	24.85943972	871.991483	0	0	332.9843992	163.0510705	17.24952793	4.740958656	0	0												"$150 Days 1-5/$250 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-40 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$200 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$100 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$10 Visits 1-12/$20 Visits 13-Unlimited (3, 9d); $150 (5); $100 (9a); $30 (9c)"	"$5 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$100 (14f)"	"$10 (7b, 7d); $0 n/c (7b1, 7f1); $5/$10 (7f)"	"$30 (7e, 7h)"	"$10 Visits 1-12/$20 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$5/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $10 (16b, 18a); $5/$10 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											110.9126581	67.97943836	41.5738752	0	200	0.2	0.140299068	50	100	3	0.129091681	0	0	38.77208831	3.859249781	9.999970757	30	12.56022791	0	0	0.2	9.68158251	0	0	30	30	0	0	0	0											NO	110.9126581	67.97943836	41.5738752	0	200	0.2	0.140299068	50	100	3	0.129091681	0	0	38.77208831	3.859249781	9.999970757	30	12.56022791	0	0	0.2	9.68158251	0	0	30	30	0	0	0	0												10.4721	0.223098811	2.550954253	0	5.663526138	1.740283023	0.96167137	1.087228524	1.701696936	4.046679438	8.683933982	0	0	2.75442099	2.171225733	4.342824747	0.355701603	0.616177221	0	0	4.971887943	0.703521458	0	0	0.832460998	0.407627676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.287	0	0	10.4721	0.223098811	2.550954253	0	5.663526138	1.740283023	0.96167137	1.087228524	1.701696936	4.046679438	8.683933982	0	0	2.75442099	2.171225733	4.342824747	0.355701603	0.616177221	0	0	4.971887943	0.703521458	0	0	0.832460998	0.407627676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.287	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.4721	0.223098811	2.550954253	0	5.663526138	1.740283023	0.96167137	1.087228524	1.701696936	4.046679438	8.683933982	0	0	2.75442099	2.171225733	4.342824747	0.355701603	0.616177221	0	0	4.971887943	0.703521458	0	0	0.832460998	0.407627676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.287
H0543_085_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	O	Coin	Coin	V	V	Coin	V	V	Coin	O	T	V	P	P	P	P	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	NO	1321.505053	50.01379845	1042.722502	459.6910306	364.2806695	7.55904807	9.920612782	277.9247871	45.03091725	15290.47076	53.73028842	0	15.07382707	8.181532849	31.89192058	4678.859933	134.1705237	4.81350026	0	0	34.41094304	824.4494879	0	0	145.3654584	118.1605603	17.08718882	4.696340449	51.43430585	0												"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	20% (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"20% (3, 9a, 9d); $150 (5); $30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/20% (14f)"	"$10 (7b, 7d); $0 n/c (7b1, 7f1); $5/$10 (7f)"	"$30 (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	$5/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $10 (16b, 18a); $5/$10 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	52.47946026	0	150	0.2	0.116369753	50	0.2	3	0.121486549	0	0	0.156148342	0.059559721	9.999960933	30	0.2	0	0	0.2	9.781349577	0	0	30	30	0	0	0	0											NO	201.0053198	148.2134571	52.47946026	0	150	0.2	0.116369753	50	0.2	3	0.121486549	0	0	0.156148342	0.059559721	9.999960933	30	0.2	0	0	0.2	9.781349577	0	0	30	30	0	0	0	0												22.1358	0.617726497	4.560126175	0	4.553508369	1.511809614	1.154459257	1.158019946	9.00618345	3.82261769	6.527507323	0	0	1.277532793	1.899473892	3.899034711	0.335426309	0.962700052	0	0	6.882188608	0.672019054	0	0	0.363413646	0.295401401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6349	0	0	22.1358	0.617726497	4.560126175	0	4.553508369	1.511809614	1.154459257	1.158019946	9.00618345	3.82261769	6.527507323	0	0	1.277532793	1.899473892	3.899034711	0.335426309	0.962700052	0	0	6.882188608	0.672019054	0	0	0.363413646	0.295401401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6349	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.1358	0.617726497	4.560126175	0	4.553508369	1.511809614	1.154459257	1.158019946	9.00618345	3.82261769	6.527507323	0	0	1.277532793	1.899473892	3.899034711	0.335426309	0.962700052	0	0	6.882188608	0.672019054	0	0	0.363413646	0.295401401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6349
H0543_086_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1473.374334	33.02028275	1462.251094	470.5615781	466.6090973	9.05605619	10.96207245	373.7944674	355.9276219	17191.49458	64.89119201	0	14.91502454	478.179148	6506.454912	5316.71128	147.7281925	745.252164	0	0	35.62945626	1089.981804	0	0	182.9351118	126.3590876	17.33809746	4.76530161	46.52451721	0												"$190 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$190 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$125 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$185 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $185 (9a); $30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$185 (14f)"	"$25 (7b, 7d); $0 n/c (7b1, 7f1); $10/$25 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$10/$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 18a); $10/$25 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											140.022541	106.6441315	43.36999481	0	150	0.2	0.127091962	50	185	3	0.12602684	0	0	70.49108288	8.046070268	24.99987246	30	7.680683729	0	0	0.2	24.62618883	0	0	30	30	0	0	0	0											NO	140.022541	106.6441315	43.36999481	0	150	0.2	0.127091962	50	185	3	0.12602684	0	0	70.49108288	8.046070268	24.99987246	30	7.680683729	0	0	0.2	24.62618883	0	0	30	30	0	0	0	0												17.1921	0.293451615	5.284818529	0	5.832613716	1.811211238	1.393191299	1.557476947	5.487217505	4.297873644	8.17803187	0	0	2.808947163	4.362616118	11.07642532	0.369320481	0.477003848	0	0	7.125891252	2.236841477	0	0	0.45733778	0.315897719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5583	0	0	17.1921	0.293451615	5.284818529	0	5.832613716	1.811211238	1.393191299	1.557476947	5.487217505	4.297873644	8.17803187	0	0	2.808947163	4.362616118	11.07642532	0.369320481	0.477003848	0	0	7.125891252	2.236841477	0	0	0.45733778	0.315897719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5583	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.1921	0.293451615	5.284818529	0	5.832613716	1.811211238	1.393191299	1.557476947	5.487217505	4.297873644	8.17803187	0	0	2.808947163	4.362616118	11.07642532	0.369320481	0.477003848	0	0	7.125891252	2.236841477	0	0	0.45733778	0.315897719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5583
H0543_089_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	293.0015426	6.292300248	789.9397598	381.6367202	674.0004305	10.10447151	14.25659137	303.3583927	220.7713838	17762.82655	81.07836964	0	18.02618027	1013.5664	7592.879871	5758.543273	186.302137	646.5363826	0	0	27.81135368	936.4912422	0	0	353.5675604	191.892171	17.18216613	4.722444555	0	0												"$200 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$40 (4a, 4a1, 4b)"	$0 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 9a, 9d); $10 (5, 9c)"	"$10 (7a); $20 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"$10 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$10 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $10 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											200	200	0	0	150	0.2	0.115907915	40	0	3	0.13355591	0	0	0.080118109	5.828701006	10	10	0	0	0	0.2	9.683166292	0	0	30	30	0	0	0	0											NO	200	200	0	0	150	0.2	0.115907915	40	0	3	0.13355591	0	0	0.080118109	5.828701006	10	10	0	0	0	0.2	9.683166292	0	0	30	30	0	0	0	0												4.8834	0.104871671	0	0	8.425005381	2.020894302	1.652451774	1.011194642	0	4.440706637	10.82849545	0	0	0.006767085	3.688052211	4.79878606	0.155251781	0	0	0	5.562270737	0.755683369	0	0	0.883918901	0.479730428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6974	0	0	4.8834	0.104871671	0	0	8.425005381	2.020894302	1.652451774	1.011194642	0	4.440706637	10.82849545	0	0	0.006767085	3.688052211	4.79878606	0.155251781	0	0	0	5.562270737	0.755683369	0	0	0.883918901	0.479730428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6974	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.8834	0.104871671	0	0	8.425005381	2.020894302	1.652451774	1.011194642	0	4.440706637	10.82849545	0	0	0.006767085	3.688052211	4.79878606	0.155251781	0	0	0	5.562270737	0.755683369	0	0	0.883918901	0.479730428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6974
H0543_095_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	264.0676734	5.384351619	754.6703599	319.7644951	339.5018037	8.167340959	6.543855305	256.981354	202.2160775	16167.4653	62.05637643	0	15.99392852	831.3008686	6717.061899	5244.186971	140.0866592	581.8001249	0	0	22.62253505	870.9135891	0	0	327.4914107	159.8392093	17.15798137	4.715797477	511.071968	0												"$400 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$400 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$175 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $175 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$175 (14f)"	"$5 (7b, 7d); $0 n/c (7b1, 7f1); $0/$5 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0/$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $5 (16b, 18a); $0/$5 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											400	400	41.63519502	0	150	0.2	0.138622475	50	175	3	0.128708205	0	0	66.80600303	1.39044103	4.999970651	30	7.680683729	0	0	0.2	4.846034423	0	0	30	30	0	0	0	0											NO	400	400	41.63519502	0	150	0.2	0.138622475	50	175	3	0.128708205	0	0	66.80600303	1.39044103	4.999970651	30	7.680683729	0	0	0.2	4.846034423	0	0	30	30	0	0	0	0												8.8023	0.179478387	2.618403967	0	4.243772547	1.633468192	0.90712542	1.070755642	2.948984463	4.041866324	7.987164795	0	0	4.627990696	0.778306538	2.185065079	0.350216648	0.372385229	0	0	4.524507009	0.351706436	0	0	0.818728527	0.399598023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8418	0	0	8.8023	0.179478387	2.618403967	0	4.243772547	1.633468192	0.90712542	1.070755642	2.948984463	4.041866324	7.987164795	0	0	4.627990696	0.778306538	2.185065079	0.350216648	0.372385229	0	0	4.524507009	0.351706436	0	0	0.818728527	0.399598023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8418	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.8023	0.179478387	2.618403967	0	4.243772547	1.633468192	0.90712542	1.070755642	2.948984463	4.041866324	7.987164795	0	0	4.627990696	0.778306538	2.185065079	0.350216648	0.372385229	0	0	4.524507009	0.351706436	0	0	0.818728527	0.399598023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8418
H0543_121_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	236.4839552	4.03048351	614.3796084	270.8744222	310.495953	6.711762078	5.847243418	260.9417306	183.7003836	14153.80855	54.50947025	0	14.07496664	708.2113971	5805.900186	5049.356831	120.22906	501.1442154	0	0	17.22157391	761.5303378	0	598.0987459	297.8638855	210.5142496	18.18915546	4.183602905	11.46229632	113.4899034												"$50 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$50 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$85 Days 11-40 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $0 (9a); $30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1)"	"$10 (7b, 7b1, 7d); $5/$10 (7f); $0 n/c (7f1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$5/$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $10 (16b, 18a); $5/$10 (17a)"	$0 n/c (10b)	"$20 (16a1); $0 n/c (16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$10 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13d, 13e)"											49.90397822	50	39.26421547	0	150	0.2	0.14282858	50	0	0	0.12975767	0	0	0.746923392	3.094246157	9.999971551	30	7.680683729	0	0	0.2	9.705254034	0	20	10	0	0	0	0	10											NO	49.90397822	50	39.26421547	0	150	0.2	0.14282858	50	0	0	0.12975767	0	0	0.746923392	3.094246157	9.999971551	30	7.680683729	0	0	0.2	9.705254034	0	20	10	0	0	0	0	10												0.9835	0.016793681	2.01026111	0	3.881199412	1.342352416	0.835153474	1.087257211	0	0	7.07302186	0	0	0.044081638	1.497073695	4.207785388	0.30057265	0.320760852	0	0	3.444314783	0.615903782	0	0.996831243	0.248219905	0	0	0	0	0.094574919	0	0	0	0	0	0	0	0	0	0	28.9996	0	0	0.9835	0.016793681	2.01026111	0	3.881199412	1.342352416	0.835153474	1.087257211	0	0	7.07302186	0	0	0.044081638	1.497073695	4.207785388	0.30057265	0.320760852	0	0	3.444314783	0.615903782	0	0.996831243	0.248219905	0	0	0	0	0.094574919	0	0	0	0	0	0	0	0	0	0	28.9996	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0.9835	0.016793681	2.01026111	0	3.881199412	1.342352416	0.835153474	1.087257211	0	0	7.07302186	0	0	0.044081638	1.497073695	4.207785388	0.30057265	0.320760852	0	0	3.444314783	0.615903782	0	0.996831243	0.248219905	0	0	0	0	0.094574919	0	0	0	0	0	0	0	0	0	0	28.9996
H0543_122_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	882.8033251	33.10683429	562.5250754	254.8013012	259.8527672	6.109403305	4.8973751	202.2516241	161.7932531	12781.63459	50.80649602	0	12.98272645	669.2306754	5331.309914	4055.729141	113.0223781	463.0112812	0	0	18.18501023	689.6731548	0	0	282.0716575	141.9305801	17.03806504	4.682838989	0	0											5000	"$200 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$85 Days 11-40 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$200 (9b)	$0/$10 (8a1); $10 (8a2)	"$10 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$30 (3, 9c, 9d); $150 (5); $200 (9a)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$200 (14f)"	"$35 (7b, 7d); $0 n/c (7b1, 7f1); $20/$35 (7f)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $20/$35 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											154.3387804	120.6976558	39.26421547	0	150	0.2	0.138271921	50	200	3	0.139874265	0	0	77.27436399	13.82138829	34.99991104	30	30	0	0	0.2	33.88774765	0	0	30	30	0	0	0	0											NO	143.0098604	111.8380932	36.38210666	0	138.9895592	0.185319412	0.128122356	46.32985306	185.3194122	2.779791183	0.129607083	0	0	71.6105397	13.70450794	34.99991104	30	27.79791183	0	0	0.185319412	33.88774765	0	0	30	30	0	0	0	0												10.5208	0.308550435	1.705487275	0	3.00973513	1.13219103	0.627463235	0.780857335	2.498619214	2.960856262	6.584881762	0	0	3.993664154	6.088581589	11.82917993	0.282555945	1.072562231	0	0	3.370035407	1.947622486	0	0	0.705179144	0.35482645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7736	0	3.106513401	10.5208	0.308550435	1.705487275	0	3.00973513	1.13219103	0.627463235	0.780857335	2.498619214	2.960856262	6.584881762	0	0	3.993664154	6.088581589	11.82917993	0.282555945	1.072562231	0	0	3.370035407	1.947622486	0	0	0.705179144	0.35482645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7736	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.5208	0.308550435	1.705487275	0	3.00973513	1.13219103	0.627463235	0.780857335	2.498619214	2.960856262	6.584881762	0	0	3.993664154	6.088581589	11.82917993	0.282555945	1.072562231	0	0	3.370035407	1.947622486	0	0	0.705179144	0.35482645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7736
H0543_125_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1449.729461	20.98585804	937.334918	353.2861364	341.024788	7.354944667	9.210720769	273.39667	310.1622066	14866.47492	50.84514282	0	11.4495107	802.3376294	5528.275006	4501.551062	89.49816649	401.3045077	0	0	22.34567444	798.7885795	0	0	173.8934605	110.5701558	17.20245733	4.728021504	33.38007546	0												"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$260 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $260 (9a); $30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$260 (14f)"	"$30 (7b, 7d); $0 n/c (7b1, 7f1); $15/$30 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$15/$30 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 18a); $15/$30 (17a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	52.47946026	0	150	0.2	0.115301199	50	260	3	0.121090503	0	0	100.638592	11.68463522	29.99988094	30	7.680683729	0	0	0.2	29.64265688	0	0	30	30	0	0	0	0											NO	201.0053198	148.2134571	52.47946026	0	150	0.2	0.115301199	50	260	3	0.121090503	0	0	100.638592	11.68463522	29.99988094	30	7.680683729	0	0	0.2	29.64265688	0	0	30	30	0	0	0	0												24.2836	0.259198881	4.099235881	0	4.26280985	1.470988933	1.062007153	1.139152792	6.720181143	3.716618729	6.156863941	0	0	6.728844113	5.382989738	11.25383299	0.223745416	0.25685775	0	0	4.469134888	1.973184649	0	0	0.434733651	0.276425389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1704	0	0	24.2836	0.259198881	4.099235881	0	4.26280985	1.470988933	1.062007153	1.139152792	6.720181143	3.716618729	6.156863941	0	0	6.728844113	5.382989738	11.25383299	0.223745416	0.25685775	0	0	4.469134888	1.973184649	0	0	0.434733651	0.276425389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1704	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.2836	0.259198881	4.099235881	0	4.26280985	1.470988933	1.062007153	1.139152792	6.720181143	3.716618729	6.156863941	0	0	6.728844113	5.382989738	11.25383299	0.223745416	0.25685775	0	0	4.469134888	1.973184649	0	0	0.434733651	0.276425389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1704
H0543_127_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	967.2061948	39.2316506	645.016241	268.6447441	319.1976577	6.632778031	5.789797191	246.6558016	221.2827538	14067.69023	54.99048222	0	11.24229277	586.371016	5656.491023	4494.334201	109.3652843	464.456957	0	0	20.91423179	765.7164485	639.9500841	0	270.2112611	129.732525	17.31150646	4.75799319	512.9173976	0												"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$140 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $140 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$140 (14f)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											128.9681299	98.22485799	41.63519502	0	150	0.2	0.139168531	50	140	3	0.12785067	0	0	53.5392329	1.103614801	0	30	7.680683729	0	0	0.2	0	0	0	30	30	0	0	0	0											NO	128.9681299	98.22485799	41.63519502	0	150	0.2	0.139168531	50	140	3	0.12785067	0	0	53.5392329	1.103614801	0	30	7.680683729	0	0	0.2	0	0	0	30	30	0	0	0	0												10.3949	0.321126942	2.237948082	0	3.989970722	1.326555606	0.805757572	1.027732507	2.581632128	3.516922559	7.030570011	0	0	2.616154533	0.520215601	0	0.273413211	0.297278916	0	0	4.182846358	0	0	0	0.675528153	0.324331312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1229	0	0	10.3949	0.321126942	2.237948082	0	3.989970722	1.326555606	0.805757572	1.027732507	2.581632128	3.516922559	7.030570011	0	0	2.616154533	0.520215601	0	0.273413211	0.297278916	0	0	4.182846358	0	0	0	0.675528153	0.324331312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1229	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.3949	0.321126942	2.237948082	0	3.989970722	1.326555606	0.805757572	1.027732507	2.581632128	3.516922559	7.030570011	0	0	2.616154533	0.520215601	0	0.273413211	0.297278916	0	0	4.182846358	0	0	0	0.675528153	0.324331312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1229
H0543_129_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1028.571983	33.31420713	706.4018774	312.0732005	329.7373121	7.686404366	8.219938156	246.3505139	220.5907012	14249.90242	62.08949662	0	11.84375712	644.9832094	5744.71228	4508.925373	112.2149144	476.7177574	0	0	21.2176053	771.7491201	0	0	273.5972299	132.1698793	17.2800227	4.749340012	513.3372388	0												"$150 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$100 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $100 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$100 (14f)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											95.6143604	67.97943836	41.63519502	0	150	0.2	0.123796627	50	100	3	0.12838114	0	0	38.6466017	0.78211339	0	30	7.680683729	0	0	0.2	0	0	0	30	30	0	0	0	0											NO	95.6143604	67.97943836	41.63519502	0	150	0.2	0.123796627	50	100	3	0.12838114	0	0	38.6466017	0.78211339	0	30	7.680683729	0	0	0.2	0	0	0	30	30	0	0	0	0												8.1955	0.188723424	2.450931661	0	4.121716401	1.537280873	1.017600622	1.026460475	1.838255844	3.562475605	7.971120382	0	0	2.077200766	0.374418033	0	0.280537286	0.305126527	0	0	4.24352106	0	0	0	0.683993075	0.330424698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2053	0	0	8.1955	0.188723424	2.450931661	0	4.121716401	1.537280873	1.017600622	1.026460475	1.838255844	3.562475605	7.971120382	0	0	2.077200766	0.374418033	0	0.280537286	0.305126527	0	0	4.24352106	0	0	0	0.683993075	0.330424698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2053	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.1955	0.188723424	2.450931661	0	4.121716401	1.537280873	1.017600622	1.026460475	1.838255844	3.562475605	7.971120382	0	0	2.077200766	0.374418033	0	0.280537286	0.305126527	0	0	4.24352106	0	0	0	0.683993075	0.330424698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2053
H0543_133_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1296.635366	51.2357585	1225.891291	511.0450432	496.2062682	7.703506352	8.476145788	327.9277896	212.8478114	29161.8166	55.54700464	0	12.68691368	731.2851098	13803.23216	7556.898268	128.2831043	549.3638591	0	0	24.36238572	882.4005591	644.3191853	0	243.0657514	177.8128853	16.62258927	4.56864726	46.14769935	0												"$150 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$100 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $100 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$100 (14f)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											96.31523515	67.97943836	41.63519502	0	150	0.2	0.115591736	50	100	3	0.124789397	0	0	38.56994258	0.40018235	0	30	14.57483632	0	0	0.2	0	0	0	30	30	0	0	0	0											NO	96.31523515	67.97943836	41.63519502	0	150	0.2	0.115591736	50	100	3	0.124789397	0	0	38.56994258	0.40018235	0	30	14.57483632	0	0	0.2	0	0	0	30	30	0	0	0	0												10.4071	0.290248174	4.253351913	0	6.202578353	1.54070127	0.979772408	1.36636579	1.773731762	7.290454151	6.931677191	0	0	2.350468725	0.46031749	0	0.320707761	0.667240694	0	0	4.872477144	0	0	0	0.607664378	0.444532213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7594	0	0	10.4071	0.290248174	4.253351913	0	6.202578353	1.54070127	0.979772408	1.36636579	1.773731762	7.290454151	6.931677191	0	0	2.350468725	0.46031749	0	0.320707761	0.667240694	0	0	4.872477144	0	0	0	0.607664378	0.444532213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7594	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.4071	0.290248174	4.253351913	0	6.202578353	1.54070127	0.979772408	1.36636579	1.773731762	7.290454151	6.931677191	0	0	2.350468725	0.46031749	0	0.320707761	0.667240694	0	0	4.872477144	0	0	0	0.607664378	0.444532213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7594
H0543_134_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	297.8258077	6.185259696	1002.416891	448.7571374	410.384036	7.893928341	6.927712992	324.8892357	212.6860278	28441.20692	58.56759445	0	15.22936286	887.0377391	13119.04304	7413.940883	143.0876501	609.8930154	0	0	21.29850375	882.8643922	660.8649045	0	212.7107156	155.3081207	17.06916238	4.69138596	55.42737905	0												"$400 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$400 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$175 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $175 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$175 (14f)"	"$5 (7b, 7d); $0 n/c (7b1, 7f1); $0/$5 (7f)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0/$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $5 (16b, 18a); $0/$5 (17a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											400	400	41.63519502	0	150	0.2	0.127914713	50	175	3	0.127312642	0	0	66.69807228	0.768421447	4.999976607	30	14.57483632	0	0	0.2	4.816368389	0	0	30	30	0	0	0	0											NO	400	400	29.69518113	0	150	0.2	0.127914713	50	175	3	0.127312642	0	0	66.69807228	0.768421447	4.999976607	30	14.57483632	0	0	0.2	4.816368389	0	0	30	30	0	0	0	0												9.9275	0.206175323	2.480579261	0	5.12980045	1.578785668	0.886156416	1.353705149	3.101671238	7.11030173	7.456395168	0	0	4.930308936	0.840079503	3.089127582	0.357719125	0.740757573	0	0	4.25970075	0.354350013	0	0	0.531776789	0.388270302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7232	0	0	9.9275	0.206175323	2.480579261	0	5.12980045	1.578785668	0.886156416	1.353705149	3.101671238	7.11030173	7.456395168	0	0	4.930308936	0.840079503	3.089127582	0.357719125	0.740757573	0	0	4.25970075	0.354350013	0	0	0.531776789	0.388270302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7232	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.9275	0.206175323	2.480579261	0	5.12980045	1.578785668	0.886156416	1.353705149	3.101671238	7.11030173	7.456395168	0	0	4.930308936	0.840079503	3.089127582	0.357719125	0.740757573	0	0	4.25970075	0.354350013	0	0	0.531776789	0.388270302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7232
H0543_135_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1554.965046	45.21555874	1347.596329	499.1656047	639.0987004	7.626587945	7.43781498	391.9676005	243.400323	34268.70019	56.29823655	0	13.97784291	821.675179	16962.04085	9429.676651	154.9604146	588.2945513	0	0	30.32732562	1062.859606	684.480057	0	314.2049463	244.4438004	17.52143662	4.815691592	40.23096191	0												"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$140 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $140 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$140 (14f)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											128.9681299	98.22485799	41.63519502	0	150	0.2	0.122983811	50	140	3	0.12574254	0	0	53.57608359	0.563259201	0	30	14.57483632	0	0	0.2	0	0	0	30	30	0	0	0	0											NO	128.9681299	98.22485799	32.88083615	0	150	0.2	0.122983811	50	140	3	0.12574254	0	0	53.57608359	0.563259201	0	30	14.57483632	0	0	0.2	0	0	0	30	30	0	0	0	0												16.7117	0.370107653	3.69250784	0	7.988733755	1.525317589	0.914730831	1.633198335	2.839670435	8.567175047	7.079083279	0	0	3.668511506	0.796168798	0	0.387401036	0.714524733	0	0	6.065465124	0	0	0	0.785512366	0.611109501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.351	0	0	16.7117	0.370107653	3.69250784	0	7.988733755	1.525317589	0.914730831	1.633198335	2.839670435	8.567175047	7.079083279	0	0	3.668511506	0.796168798	0	0.387401036	0.714524733	0	0	6.065465124	0	0	0	0.785512366	0.611109501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.351	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.7117	0.370107653	3.69250784	0	7.988733755	1.525317589	0.914730831	1.633198335	2.839670435	8.567175047	7.079083279	0	0	3.668511506	0.796168798	0	0.387401036	0.714524733	0	0	6.065465124	0	0	0	0.785512366	0.611109501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.351
H0543_136_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1609.594016	51.98862183	1467.052731	521.0334789	418.8278029	9.909400139	11.96379409	338.2262227	291.4239857	17347.91812	56.53581999	0	17.86960964	577.113395	7996.008819	6716.402855	154.1441488	418.5002765	0	0	36.63864484	1075.643355	647.7356297	0	207.9662951	125.3663993	16.83373193	4.626678912	52.57292889	0												"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$125 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$260 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $260 (9a); $30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$260 (14f)"	"$15 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $15 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	43.36999481	0	150	0.2	0.117356497	50	260	3	0.121686862	0	0	101.2928772	11.83672807	15	30	14.57483632	0	0	0.2	0.042948545	0	0	30	30	0	0	0	0											NO	201.0053198	148.2134571	43.36999481	0	150	0.2	0.117356497	50	260	3	0.121686862	0	0	101.2928772	11.83672807	15	30	14.57483632	0	0	0.2	0.042948545	0	0	30	30	0	0	0	0												26.9614	0.642117781	5.302172443	0	5.235347536	1.981880028	1.404028962	1.409275928	6.314186356	4.336979531	6.879666513	0	0	4.871456356	7.887215169	8.395503568	0.385360372	0.508297752	0	0	7.327728969	0.003849776	0	0	0.519915738	0.313415998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6798	0	0	26.9614	0.642117781	5.302172443	0	5.235347536	1.981880028	1.404028962	1.409275928	6.314186356	4.336979531	6.879666513	0	0	4.871456356	7.887215169	8.395503568	0.385360372	0.508297752	0	0	7.327728969	0.003849776	0	0	0.519915738	0.313415998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6798	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.9614	0.642117781	5.302172443	0	5.235347536	1.981880028	1.404028962	1.409275928	6.314186356	4.336979531	6.879666513	0	0	4.871456356	7.887215169	8.395503568	0.385360372	0.508297752	0	0	7.327728969	0.003849776	0	0	0.519915738	0.313415998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6798
H0543_137_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1230.620774	52.40859947	1112.641509	431.2765938	415.2627166	6.959488555	6.163924753	321.71934	201.7519136	29289.46909	55.76449981	0	14.01963957	850.0464765	13575.06525	7201.585723	154.303262	629.8124236	0	0	19.08984943	793.7551752	649.5747633	0	228.4290881	147.1644843	16.8333433	4.6265721	51.55853139	0												"$200 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$130 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$200 (9b)	$0/$10 (8a1); $10 (8a2)	"$10 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$30 (3, 9c, 9d); $150 (5); $200 (9a)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$200 (14f)"	"$35 (7b, 7d); $0 n/c (7b1, 7f1); $20/$35 (7f)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $20/$35 (17a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											154.3387804	120.6976558	45.1047946	0	150	0.2	0.128363841	50	200	3	0.140096078	0	0	76.82779327	17.11747394	34.99979655	30	30	0	0	0.2	33.56933103	0	0	30	30	0	0	0	0											NO	154.3387804	120.6976558	28.64155649	0	150	0.2	0.128363841	50	200	3	0.140096078	0	0	76.82779327	17.11747394	34.99979655	30	30	0	0	0.2	33.56933103	0	0	30	30	0	0	0	0												15.8277	0.527132925	2.65564872	0	5.190783958	1.391897711	0.791225057	1.34049725	3.362531894	7.322367271	7.812387731	0	0	5.442266247	19.36423547	21.00450293	0.385758155	1.574531059	0	0	3.817969886	2.220485853	0	0	0.57107272	0.367911211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9709	0	0	15.8277	0.527132925	2.65564872	0	5.190783958	1.391897711	0.791225057	1.34049725	3.362531894	7.322367271	7.812387731	0	0	5.442266247	19.36423547	21.00450293	0.385758155	1.574531059	0	0	3.817969886	2.220485853	0	0	0.57107272	0.367911211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9709	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.8277	0.527132925	2.65564872	0	5.190783958	1.391897711	0.791225057	1.34049725	3.362531894	7.322367271	7.812387731	0	0	5.442266247	19.36423547	21.00450293	0.385758155	1.574531059	0	0	3.817969886	2.220485853	0	0	0.57107272	0.367911211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.9709
H0543_138_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	274.8926725	5.428245733	794.2397745	336.1979726	376.0217436	7.850754122	6.757624296	276.9820681	211.0533172	16684.82698	63.02189986	0	16.26525694	836.5622796	6728.386904	5960.198163	141.2257023	617.9221266	0	0	21.73881967	901.210713	656.1643797	0	197.3872875	140.3864531	17.48519291	4.805730164	48.17395855	438.8622141												"$100 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$100 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$75 (9b)	$0/$10 (8a1); $10 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $75 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$75 (14f)"	"$0 (7b, 7d, 7f); $10 (7b1); $0 n/c (7f1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13d, 13e)"											99.22542573	100	41.63519502	0	150	0.2	0.137363432	50	75	3	0.128105185	0	0	29.06766677	0.618788058	0.967979991	30	7.680683729	0	0	0.2	0	0	0	30	30	0	0	0	10											NO	99.22542573	100	41.63519502	0	150	0.2	0.137363432	50	75	3	0.128105185	0	0	29.06766677	0.618788058	0.967979991	30	7.680683729	0	0	0.2	0	0	0	30	30	0	0	0	10												2.273	0.045235381	2.755693992	0	4.700271795	1.570150824	0.928250465	1.154091951	1.319083232	4.171206746	8.07343217	0	0	2.026409464	0.346953789	0.48077938	0.353064256	0.395505369	0	0	4.347763935	0	0	0	0.493468219	0.350966133	0	0	0	0.365718512	0	0	0	0	0	0	0	0	0	0	36.1511	0	0	2.273	0.045235381	2.755693992	0	4.700271795	1.570150824	0.928250465	1.154091951	1.319083232	4.171206746	8.07343217	0	0	2.026409464	0.346953789	0.48077938	0.353064256	0.395505369	0	0	4.347763935	0	0	0	0.493468219	0.350966133	0	0	0	0.365718512	0	0	0	0	0	0	0	0	0	0	36.1511	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.273	0.045235381	2.755693992	0	4.700271795	1.570150824	0.928250465	1.154091951	1.319083232	4.171206746	8.07343217	0	0	2.026409464	0.346953789	0.48077938	0.353064256	0.395505369	0	0	4.347763935	0	0	0	0.493468219	0.350966133	0	0	0	0.365718512	0	0	0	0	0	0	0	0	0	0	36.1511
H0543_140_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1814.257201	44.55036025	1349.828061	468.2898189	516.8387343	8.400733142	9.585941123	321.2084043	281.6433992	15753.98895	61.87721798	0	0.075015787	831.9182747	5736.171431	4793.450141	127.1033718	439.7384889	0	0	20.55716246	872.7268016	0	0	118.6870119	0	17.27325696	4.747480478	78.33342788	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-80 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $200 (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$200 (14f)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0/$35 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	51.25498024	0	150	0.2	0.133090895	49.98818716	200	3	0.138448661	0	0.2	78.09080956	14.79043883	34.85952036	38.5	25	0	0	0.2	33.45375123	0	0	35	0	35	0	0	0											NO	184.2401855	140.3212257	51.25498024	0	150	0.2	0.133090895	49.98818716	200	3	0.138448661	0	0.2	78.09080956	14.79043883	34.85952036	38.5	25	0	0	0.2	33.45375123	0	0	35	0	35	0	0	0												27.8549	0.520946763	5.765450885	0	6.460484179	1.680146628	1.275801486	1.338052153	4.694056653	3.938497237	8.566817959	0	0.015003157	5.413764296	7.070041056	13.92478106	0.407789985	0.916121852	0	0	4.111432491	2.432998776	0	0	0.346170451	0	0.050380333	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7837	0	0	27.8549	0.520946763	5.765450885	0	6.460484179	1.680146628	1.275801486	1.338052153	4.694056653	3.938497237	8.566817959	0	0.015003157	5.413764296	7.070041056	13.92478106	0.407789985	0.916121852	0	0	4.111432491	2.432998776	0	0	0.346170451	0	0.050380333	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7837	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.8549	0.520946763	5.765450885	0	6.460484179	1.680146628	1.275801486	1.338052153	4.694056653	3.938497237	8.566817959	0	0.015003157	5.413764296	7.070041056	13.92478106	0.407789985	0.916121852	0	0	4.111432491	2.432998776	0	0	0.346170451	0	0.050380333	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7837
H0543_141_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2487.759795	154.9684494	1483.502058	762.7439904	573.3063664	15.25659386	11.61840639	644.1028426	341.3274549	26094.78971	76.80099441	0	33.63343953	1353.997312	12356.30361	14305.55461	468.3265532	1182.894213	0	0	36.37811183	1252.611135	749.8122217	194.1478074	133.8950396	204.0305365	0	0	88.37072613	0												"$200 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$120 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$200 (9b)	$0/$0/$10 (8a1); $0 (8a2)	"$10 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$30 (3, 9c, 9d); $150 (5); $200 (9a)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0/$200 (14f)"	"$35 (7b, 7d); $0 n/c (7b1); $20/$35 (7f); $0 (7f1)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20/$35 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 18a); $20/$35 (17a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											151.3274778	120.6976558	39.07418398	0	150	0.2	0.137890613	50	200	0	0.147609455	0	0	76.64894317	15.78949679	34.65579113	30	30	0	0	0.2	33.86919877	0	0	0	0	0	0	0	0											NO	151.3274778	120.6976558	32.2992953	0	150	0.2	0.137890613	50	200	0	0.147609455	0	0	76.64894317	15.78949679	34.65579113	30	30	0	0	0.2	33.86919877	0	0	0	0	0	0	0	0												31.3722	1.558694047	3.99300592	0	7.16632958	3.051318772	1.602069176	2.683761844	5.688790916	0	11.33655292	0	0	8.648538587	16.25831801	41.31419271	1.170816383	2.957235533	0	0	7.275622366	3.535411293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.6129	0	0	31.3722	1.558694047	3.99300592	0	7.16632958	3.051318772	1.602069176	2.683761844	5.688790916	0	11.33655292	0	0	8.648538587	16.25831801	41.31419271	1.170816383	2.957235533	0	0	7.275622366	3.535411293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.6129	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	31.3722	1.558694047	3.99300592	0	7.16632958	3.051318772	1.602069176	2.683761844	5.688790916	0	11.33655292	0	0	8.648538587	16.25831801	41.31419271	1.170816383	2.957235533	0	0	7.275622366	3.535411293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.6129
H0543_142_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1433.987384	22.87050906	1301.468177	494.2643142	373.2988962	4.204625258	2.984140141	392.8467936	298.1053899	14107.3185	37.89308941	0	0.055050021	440.2689949	5219.546941	4614.802583	77.48062259	374.8330375	0	0	18.75645642	796.5966119	0	0	118.329635	0	17.22124568	4.733185402	78.09755913	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-80 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $200 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14f1, 14h1); $0/$200 (14f)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	51.25498024	0	150	0.2	0.168966052	49.99862491	200	3	0.141300394	0	0.2	77.47782662	11.49123286	29.97046864	38.5	25	0	0	0.2	28.6605755	0	0	30	0	0	0	0	0											NO	184.2401855	140.3212257	51.25498024	0	150	0.2	0.168966052	49.99862491	200	3	0.141300394	0	0.2	77.47782662	11.49123286	29.97046864	38.5	25	0	0	0.2	28.6605755	0	0	30	0	0	0	0	0												22.0165	0.267434822	5.558893806	0	4.666236202	0.840925052	0.504218378	1.636816623	4.968423165	3.526829624	5.35430847	0	0.011010004	2.842590404	4.998252445	11.52564968	0.248583664	0.780902161	0	0	3.751291284	1.902576445	0	0	0.295824088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6973	0	0	22.0165	0.267434822	5.558893806	0	4.666236202	0.840925052	0.504218378	1.636816623	4.968423165	3.526829624	5.35430847	0	0.011010004	2.842590404	4.998252445	11.52564968	0.248583664	0.780902161	0	0	3.751291284	1.902576445	0	0	0.295824088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6973	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.0165	0.267434822	5.558893806	0	4.666236202	0.840925052	0.504218378	1.636816623	4.968423165	3.526829624	5.35430847	0	0.011010004	2.842590404	4.998252445	11.52564968	0.248583664	0.780902161	0	0	3.751291284	1.902576445	0	0	0.295824088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6973
H0543_802_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	350.1809232	4.187798923	21.81527206	346.7138216	12.99691609	8.50014139	7.987547195	26.27346406	45.41504676	35.8483452	64.17299791	0	0.259125072	11.90132219	31.83794033	167.0399803	1.593711363	6.31419844	0	0	25.15194579	12.16067072	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.066097541	0.066097541	0.145782264	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.066097541	0.066097541	0.145782264	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												23.1461	0.276803211	3.180279759	0	3.028281448	1.980532944	1.861098497	6.121717125	10.58170589	8.352664433	14.95230851	0	0.060376142	2.773008071	7.418240096	38.92031541	0.371334748	1.471208236	0	0	5.860403369	2.833436279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.1898	0	0	23.1461	0.276803211	3.180279759	0	3.028281448	1.980532944	1.861098497	6.121717125	10.58170589	8.352664433	14.95230851	0	0.060376142	2.773008071	7.418240096	38.92031541	0.371334748	1.471208236	0	0	5.860403369	2.833436279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.1898	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.1461	0.276803211	3.180279759	0	3.028281448	1.980532944	1.861098497	6.121717125	10.58170589	8.352664433	14.95230851	0	0.060376142	2.773008071	7.418240096	38.92031541	0.371334748	1.471208236	0	0	5.860403369	2.833436279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.1898
H0543_805_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	341.4594079	4.547427476	22.94914723	339.9884573	14.04755957	8.650081576	10.01841035	26.19064885	48.12452888	36.57506582	69.58840214	0	0.253045514	12.73850035	32.53306374	170.9981665	1.619148568	6.531711157	0	0	30.02233806	12.35063953	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.065243559	0.065243559	0.141997315	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065243559	0.065243559	0.141997315	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.278	0.296690352	3.258717281	0	3.273081379	2.015469007	2.334289612	6.102421182	11.21301523	8.521990336	16.2140977	0	0.058959605	2.968070581	7.580203851	39.84257279	0.377261616	1.5218887	0	0	6.995204768	2.87769901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.7297	0	0	22.278	0.296690352	3.258717281	0	3.273081379	2.015469007	2.334289612	6.102421182	11.21301523	8.521990336	16.2140977	0	0.058959605	2.968070581	7.580203851	39.84257279	0.377261616	1.5218887	0	0	6.995204768	2.87769901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.7297	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.278	0.296690352	3.258717281	0	3.273081379	2.015469007	2.334289612	6.102421182	11.21301523	8.521990336	16.2140977	0	0.058959605	2.968070581	7.580203851	39.84257279	0.377261616	1.5218887	0	0	6.995204768	2.87769901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.7297
H0543_806_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	311.8683996	3.205002533	26.95880882	328.2852901	11.44180579	8.132560194	9.881044018	21.16986405	44.94447081	33.94417046	64.43091471	0	0.18150572	12.59725446	30.33027812	158.8983032	1.681491	5.954708331	0	0	29.56138584	11.57127338	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.062749126	0.062749126	0.134888425	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.062749126	0.062749126	0.134888425	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.5695	0.201111109	3.636431252	0	2.665940748	1.894886525	2.302283256	4.932578323	10.4720617	7.908991716	15.01240313	0	0.042290833	2.93516029	7.066954801	37.02330464	0.391787403	1.387447041	0	0	6.8878029	2.696106697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.027	0	0	19.5695	0.201111109	3.636431252	0	2.665940748	1.894886525	2.302283256	4.932578323	10.4720617	7.908991716	15.01240313	0	0.042290833	2.93516029	7.066954801	37.02330464	0.391787403	1.387447041	0	0	6.8878029	2.696106697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.027	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5695	0.201111109	3.636431252	0	2.665940748	1.894886525	2.302283256	4.932578323	10.4720617	7.908991716	15.01240313	0	0.042290833	2.93516029	7.066954801	37.02330464	0.391787403	1.387447041	0	0	6.8878029	2.696106697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.027
H0544_002_0	2010	9	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	0	0	1030.677309	0	332.9760984	1687.386994	34.41896163	322.1751174	0	0	0	0	13.06932013	46.79898818	0	177.5968679	0	0	0	0	18.85147146	0	0	1400	0	493.1	0	0	0	2118.123984												1a:$0; Unlimited Add'l Days	1b:$0; 60 Add'l Days	"2:$0 Days 1-31, $25 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$50 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0; Therapeutic Shoes: $50; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$0	12:$25	5:$15; 9c:$15; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0	10b:$0 50 Plan Approved Location Trips	"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	"7g:Extended Care Assistance 12 visits $0 copay, visits 13-20 $20 copay 13c:OTC $25 per month Allowance 13e:Exercise/Strength Training 16 Weeks $0 then $10 per month"											0	0	1.480724818	0	14.19716935	1.091158499	0	50	0	0	0	0	25	15	0	0	0	0	0	0	0.175121025	0	0	22.2125	0	19.01237072	0	0	0	4.733059001											NO	0	0	1.480724818	0	14.19716935	1.091158499	0	50	0	0	0	0	25	15	0	0	0	0	0	0	0.175121025	0	0	22.2125	0	19.01237072	0	0	0	4.733059001												0	0	0.127179123	0	0.393943172	0.153433888	0	1.342396322	0	0	0	0	0.02722775	0.058498735	0	0	0	0	0	0	3.301288999	0	0	2.591458333	0	0.78125	0	0	0	0.835433816	0	0	0	0	0	0	0	0	0	0	9.6121	0	0	0	0	0.127179123	0	0.393943172	0.153433888	0	1.342396322	0	0	0	0	0.02722775	0.058498735	0	0	0	0	0	0	3.301288999	0	0	2.591458333	0	0.78125	0	0	0	0.835433816	0	0	0	0	0	0	0	0	0	0	9.6121	NO																																																																																		0	0	0	0	0	0.127179123	0	0.393943172	0.153433888	0	1.342396322	0	0	0	0	0.02722775	0.058498735	0	0	0	0	0	0	3.301288999	0	0	2.591458333	0	0.78125	0	0	0	0.835433816	0	0	0	0	0	0	0	0	0	0	9.6121
H0544_003_0	2010	9	N/A																															D	D	D	V	Coin	Coin	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	0	0	0	0	19.57058415	6.317745288	0	236.0349802	0	0	0	0	0	0	0	134.192661	0	0	0	0	17.13269482	0	0	1400	0	493.1	0	0	0	126.5994996												1a:$0; Unlimited Add'l Days	1b:$0; 60 Add'l Days	2: 3 Day Waiver	6:$0; Respite Care up to 40 hours	10a: (waived if admitted)	11a:$0-$499 0%; >=$500 20%	11b:$0; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$0	12:$0	5:$0; 9c:$0; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0	10b:$0 50 Plan Approved Location Trips	"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$150 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	7g:Extended Care Assistance 12 visits $0 copay 13c:OTC $30 per month Allowance 13e:Exercise/Strength Training 16 Weeks $0 then $10 per month											0	0	0	0	0.056788677	0.035493981	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.176138167	0	0	22.2125	0	19.01237072	0	0	0	10											NO	0	0	0	0	0.056788677	0.035493981	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.176138167	0	0	22.2125	0	19.01237072	0	0	0	10												0	0	0	0	1.11138759	0.224241933	0	0.983479084	0	0	0	0	0	0	0	0	0	0	0	0	3.017721458	0	0	2.591458333	0	0.78125	0	0	0	0.105499583	0	0	0	0	0	0	0	0	0	0	8.815	0	0	0	0	0	0	1.11138759	0.224241933	0	0.983479084	0	0	0	0	0	0	0	0	0	0	0	0	3.017721458	0	0	2.591458333	0	0.78125	0	0	0	0.105499583	0	0	0	0	0	0	0	0	0	0	8.815	NO																																																																																		0	0	0	0	0	0	0	1.11138759	0.224241933	0	0.983479084	0	0	0	0	0	0	0	0	0	0	0	0	3.017721458	0	0	2.591458333	0	0.78125	0	0	0	0.105499583	0	0	0	0	0	0	0	0	0	0	8.815
H0544_004_0	2010	8	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	0	0	1691.737751	0	565.1512012	4309.42219	0	449.9467145	0	0	0	0	0	67.28490226	0	244.1566419	0	0	0	0	20.05250955	0	0	1400	0	493.1	0	0	0	5223.476781												1a:$0; Unlimited Add'l Days	1b:$0; 60 Add'l Days	"2:$0 Days 1-31, $25 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$50 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$0	12:$0	5:$15; 9c:$15; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits; Self Referral	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0	"10b:$0 50 Plan Approved Location Trips, Unlimited CCC"	"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 14a:Newsletters 14a:Enhanced Nutritional Training $0 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	"7g:Extended Care Assistance 24 visits $0 copay, visits 25-35 $20 copay 13c:OTC $25 per month Allowance 13e:Exercise/Strength Training 16 Weeks $0 then $10 per month 13e:Electronic Health Monitoring $0"											0	0	1.480724818	0	14.19716935	1.091158499	0	50	0	0	0	0	0	15	0	0	0	0	0	0	0.174882939	0	0	22.2125	0	19.01237072	0	0	0	0.451928072											NO	0	0	1.480724818	0	14.19716935	1.091158499	0	50	0	0	0	0	0	15	0	0	0	0	0	0	0.174882939	0	0	22.2125	0	19.01237072	0	0	0	0.451928072												0	0	0.208749839	0	0.668628943	0.391855221	0	1.874777977	0	0	0	0	0	0.084106128	0	0	0	0	0	0	3.506841815	0	0	2.591458333	0	0.78125	0	0	0	0.196719649	0	0	0	0	0	0	0	0	0	0	10.3044	0	0	0	0	0.208749839	0	0.668628943	0.391855221	0	1.874777977	0	0	0	0	0	0.084106128	0	0	0	0	0	0	3.506841815	0	0	2.591458333	0	0.78125	0	0	0	0.196719649	0	0	0	0	0	0	0	0	0	0	10.3044	NO																																																																																		0	0	0	0	0	0.208749839	0	0.668628943	0.391855221	0	1.874777977	0	0	0	0	0	0.084106128	0	0	0	0	0	0	3.506841815	0	0	2.591458333	0	0.78125	0	0	0	0.196719649	0	0	0	0	0	0	0	0	0	0	10.3044
H0544_005_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	0	0	0	0	1397.196383	5488.49369	0	256.2339995	0	0	0	0	0	0	0	97.64287702	0	0	0	0	7.071673906	0	0	0	0	493.1	0	0	0	0												1a:$0; Unlimited Add'l Days	1b:$0; 60 Add'l Days	2:$0; 3 Day Waiver; 50 Add'l SNF Days	6:$0; Respite Care up to 80 hours	10a:$50 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$0	12:$0	5:$0; 9c:$0; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0; Acupuncture	15:20% for drugs above $50 capped at $550 copay	17b:$0	10b:$0 12 Plan Approved Location Trips		17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$500 Allowance	14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Comprehensive Health Assessment $0	7g:Extended Care Assistance 24 visits $0 copay 13c:OTC $40 per month Allowance											0	0	0	0	14.19716935	1.091158499	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.176266794	0	0	0	0	19.01237072	0	0	0	0											NO	0	0	0	0	14.19716935	1.091158499	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.176266794	0	0	0	0	19.01237072	0	0	0	0												0	0	0	0	1.653019472	0.499068044	0	1.067641664	0	0	0	0	0	0	0	0	0	0	0	0	1.246501288	0	0	0	0	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.2475	0	0	0	0	0	0	1.653019472	0.499068044	0	1.067641664	0	0	0	0	0	0	0	0	0	0	0	0	1.246501288	0	0	0	0	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.2475	NO																																																																																		0	0	0	0	0	0	0	1.653019472	0.499068044	0	1.067641664	0	0	0	0	0	0	0	0	0	0	0	0	1.246501288	0	0	0	0	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.2475
H0544_007_0	2010	4	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	442.1398218	26.67503765	345.8180761	0	117.1714686	323.914504	13.82182494	278.4662032	195.1994802	0	298.1957332	29.36178546	1.798190677	33.74498131	3666.106508	2872.303032	264.5709761	752.4847135	0	0	7.122202839	0	0	1400	0	493.1	0	0	0	0												1a:$100 Days 1-4; Unlimited Add'l Days	1b:$100 Days 1-4; 60 Add'l Days	"2:$0 Days 1-20, $50 Days 21-100; 3 Day Waiver"	6:$0	10a:$50 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0; Therapeutic Shoes: $50; 11c:$0	4a:$50 (waived if admitted) ;4b:$15; Worldwide Coverage	9a:$75; 9b:$75	8a:$0	8b: X-Rays $0; Diagnostic $10; Therapeutic $10	9a:$75	12:$25	5:$30; 9c:$30; 9d:$20; First 3 Pints of Blood	"7a:$5; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$20; 7d:$20; 7f:$20; 16b:$0-$20; 17a:$0-$20	7e:$20; 7h:$20	3:$20; 7c:$20; 7i:$20	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0		"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0												76.66609618	44.56521739	5.814531888	0	14.19716935	1.091158499	0	38.15653934	75	0	10	75	25	26.08125447	5	19.01186621	20	20	0	0	0.174793976	0	0	22.2125	0	19.01237072	0	0	0	0											NO	76.66609618	44.56521739	5.814531888	0	14.19716935	1.091158499	0	38.15653934	75	0	10	75	25	26.08125447	5	19.01186621	20	20	0	0	0.174793976	0	0	22.2125	0	19.01237072	0	0	0	0												2.8248	0.099064904	0.167564186	0	0.138625265	0.029453505	0	0.88544222	1.219996751	0	0.248496444	0.183511159	0.003746231	0.07334262	1.527544378	4.550653414	0.440951627	1.254141189	0	0	1.24491815	0	0	2.591458333	0	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2649	0	0	2.8248	0.099064904	0.167564186	0	0.138625265	0.029453505	0	0.88544222	1.219996751	0	0.248496444	0.183511159	0.003746231	0.07334262	1.527544378	4.550653414	0.440951627	1.254141189	0	0	1.24491815	0	0	2.591458333	0	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2649	NO																																																																																		0	0	0	2.8248	0.099064904	0.167564186	0	0.138625265	0.029453505	0	0.88544222	1.219996751	0	0.248496444	0.183511159	0.003746231	0.07334262	1.527544378	4.550653414	0.440951627	1.254141189	0	0	1.24491815	0	0	2.591458333	0	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2649
H0544_008_0	2010	8	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	1086.614966	33.43808173	1039.853056	0	303.9784791	1590.810952	6286.93513	378.6122048	188.2068649	0	379.0189625	8.726810453	16.86666292	51.77574614	0	3485.408948	506.8424815	1081.95939	0	0	10.87527766	0	0	1400	0	493.1	0	0	0	2336.488657												1a:$75 Days 1-4; Unlimited Add'l Days	1b:$75 Days 1-4; 60 Add'l Days	"2:$0 Days 1-31, $30 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 30 hours	10a:$90 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; Therapeutic Shoes: $50; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$75; 9b:$75	8a:$0	8b: X-Rays $0; Diagnostic $10; Therapeutic $10	9a:$75	12:$25	5:$30; 9c:$30; 9d:$10; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$10; 7d:$10; 7f:$10; 16b:$0-$10; 17a:$0-$10; 6 Routine Footcare Visits	7e:$10; 7h:$10	3:$10; 7c:$10; 7i:$10	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0		"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	13c:OTC $15 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $2 per visit											57.49957214	33.42391304	1.776869781	0	25.55490483	1.091158499	0.238664561	50	75	0	10	75	25	25.0442223	0	9.509621193	10	10	0	0	0.175233914	0	0	22.2125	0	19.01237072	0	0	0	2											NO	57.49957214	33.42391304	1.776869781	0	25.55490483	1.091158499	0.238664561	50	75	0	10	75	25	25.0442223	0	9.509621193	10	10	0	0	0.175233914	0	0	22.2125	0	19.01237072	0	0	0	2												5.2067	0.093135961	0.153973623	0	0.647345092	0.144652241	0.125039051	1.577550853	1.176292906	0	0.315849135	0.054542565	0.035138881	0.108056941	0	2.762076566	0.422368735	0.901632825	0	0	1.905717465	0	0	2.591458333	0	0.78125	0	0	0	0.389414776	0	0	0	0	0	0	0	0	0	0	19.3922	0	0	5.2067	0.093135961	0.153973623	0	0.647345092	0.144652241	0.125039051	1.577550853	1.176292906	0	0.315849135	0.054542565	0.035138881	0.108056941	0	2.762076566	0.422368735	0.901632825	0	0	1.905717465	0	0	2.591458333	0	0.78125	0	0	0	0.389414776	0	0	0	0	0	0	0	0	0	0	19.3922	NO																																																																																		0	0	0	5.2067	0.093135961	0.153973623	0	0.647345092	0.144652241	0.125039051	1.577550853	1.176292906	0	0.315849135	0.054542565	0.035138881	0.108056941	0	2.762076566	0.422368735	0.901632825	0	0	1.905717465	0	0	2.591458333	0	0.78125	0	0	0	0.389414776	0	0	0	0	0	0	0	0	0	0	19.3922
H0544_009_0	2010	8	N/A																															D	D	D	V	Coin	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	0	0	0	0	22.30053004	5.755518239	4.4271977	231.0182301	0	0	0	0	0	0	0	120.0311313	0	0	0	0	16.05310813	0	0	1400	0	493.1	0	0	0	1099.346163												1a:$0; Unlimited Add'l Days	1b:$0; 60 Add'l Days	2: 3 Day Waiver	6:$0; Respite Care up to 40 hours	10a: (waived if admitted)	11a:$0-$499 0%; >=$500 20%	11b:$0-$499 0%;>=$500 20%; 11c:0%	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$0	12:$0	5:$0; 9c:$0; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 9 Routine Footcare Visits	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0	10b:$0 24 Plan Approved Location Trips	"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	13c:OTC $35 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $2 per visit											0	0	0	0	0.056788677	0.035493981	0.05085018	50	0	0	0	0	0	0	0	0	0	0	0	0	0.176127674	0	0	22.2125	0	19.01237072	0	0	0	2											NO	0	0	0	0	0.056788677	0.035493981	0.05085018	50	0	0	0	0	0	0	0	0	0	0	0	0	0.176127674	0	0	22.2125	0	19.01237072	0	0	0	2												0	0	0	0	1.266417606	0.204286257	0.225123799	0.962575959	0	0	0	0	0	0	0	0	0	0	0	0	2.827396602	0	0	2.591458333	0	0.78125	0	0	0	0.183224361	0	0	0	0	0	0	0	0	0	0	9.0417	0	0	0	0	0	0	1.266417606	0.204286257	0.225123799	0.962575959	0	0	0	0	0	0	0	0	0	0	0	0	2.827396602	0	0	2.591458333	0	0.78125	0	0	0	0.183224361	0	0	0	0	0	0	0	0	0	0	9.0417	NO																																																																																		0	0	0	0	0	0	0	1.266417606	0.204286257	0.225123799	0.962575959	0	0	0	0	0	0	0	0	0	0	0	0	2.827396602	0	0	2.591458333	0	0.78125	0	0	0	0.183224361	0	0	0	0	0	0	0	0	0	0	9.0417
H0544_010_0	2010	9	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	1347.958473	27.032332	1235.923377	0	457.3577201	4083.76809	4388.219556	529.9908415	0	0	0	0	0	41.19992083	0	246.0434073	0	0	0	0	11.60850997	0	0	1400	0	493.1	0	0	0	2521.938951												1a:$75 Days 1-4; Unlimited Add'l Days	1b:$75 Days 1-4; 60 Add'l Days	"2:$0 Days 1-31, $30 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$90 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$0	12:$0	5:$30; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0	10b:$0 24 Plan Approved Location Trips	"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	7g:Consult with Nutritionist $0 14a:Newsletters 14a:Enhanced Nutritional Training $0 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	13c:OTC $30 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $2 per visit 13e:Electronic Health Monitoring $0											57.49957214	33.42391304	1.776869781	0	25.55490483	1.091158499	0.46235697	50	0	0	0	0	0	30	0	0	0	0	0	0	0.174907395	0	0	22.2125	0	19.01237072	0	0	0	2											NO	57.49957214	33.42391304	1.776869781	0	25.55490483	1.091158499	0.46235697	50	0	0	0	0	0	30	0	0	0	0	0	0	0.174907395	0	0	22.2125	0	19.01237072	0	0	0	2												6.4589	0.07529386	0.183006242	0	0.973977751	0.371336521	0.169076991	2.208295173	0	0	0	0	0	0.102999802	0	0	0	0	0	0	2.03041424	0	0	2.591458333	0	0.78125	0	0	0	0.420323159	0	0	0	0	0	0	0	0	0	0	16.3664	0	0	6.4589	0.07529386	0.183006242	0	0.973977751	0.371336521	0.169076991	2.208295173	0	0	0	0	0	0.102999802	0	0	0	0	0	0	2.03041424	0	0	2.591458333	0	0.78125	0	0	0	0.420323159	0	0	0	0	0	0	0	0	0	0	16.3664	NO																																																																																		0	0	0	6.4589	0.07529386	0.183006242	0	0.973977751	0.371336521	0.169076991	2.208295173	0	0	0	0	0	0.102999802	0	0	0	0	0	0	2.03041424	0	0	2.591458333	0	0.78125	0	0	0	0.420323159	0	0	0	0	0	0	0	0	0	0	16.3664
H0544_012_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	1000.634607	39.48901205	1020.331133	0	366.4239607	1425.301037	4085.189196	487.8511898	294.2643053	0	458.6765041	14.32678746	0	45.49587447	0	4074.609574	638.4441086	933.902515	0	0	16.62720106	0	0	0	331.7075837	493.1	0	0	0	125.2265101												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $50 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$75 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; Therapeutic Shoes: $50; 11c:$0	4a:$50 (waived if admitted) ;4b:$15; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	5:$15; 9c:$30; 9d:$20; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$20; 7d:$20; 7f:$0; 16b:$0-$20; 17a:$0-$20; 6 Routine Footcare Visits	7e:$20; 7h:$20	3:$20; 7c:$20; 7i:$20	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $20 per month											82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.123754187	41.99614634	100	0	25	100	0	20.591137	0	19.18485553	20	19.9777825	0	0	0.17491445	0	0	0	20	19.01237072	0	0	0	20											NO	82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.123754187	41.99614634	100	0	25	100	0	20.591137	0	19.18485553	20	19.9777825	0	0	0.17491445	0	0	0	20	19.01237072	0	0	0	20												6.8656	0.178845163	0.251804938	0	0.650272878	0.129602445	0.042129939	1.707322497	2.452202544	0	0.95557605	0.119389896	0	0.078067649	0	6.514232999	1.064073514	1.55477511	0	0	2.908337724	0	0	0	0.552845973	0.78125	0	0	0	0.20871085	0	0	0	0	0	0	0	0	0	0	27.015	0	0	6.8656	0.178845163	0.251804938	0	0.650272878	0.129602445	0.042129939	1.707322497	2.452202544	0	0.95557605	0.119389896	0	0.078067649	0	6.514232999	1.064073514	1.55477511	0	0	2.908337724	0	0	0	0.552845973	0.78125	0	0	0	0.20871085	0	0	0	0	0	0	0	0	0	0	27.015	NO																																																																																		0	0	0	6.8656	0.178845163	0.251804938	0	0.650272878	0.129602445	0.042129939	1.707322497	2.452202544	0	0.95557605	0.119389896	0	0.078067649	0	6.514232999	1.064073514	1.55477511	0	0	2.908337724	0	0	0	0.552845973	0.78125	0	0	0	0.20871085	0	0	0	0	0	0	0	0	0	0	27.015
H0544_013_0	2010	7	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	0	0	1888.551121	0	626.8932715	4185.227311	0	424.3852301	0	0	0	0	0	24.31624173	0	161.7436002	0	0	0	0	24.72501581	0	0	1400	0	493.1	0	0	0	3184.446077												1a:$0; Unlimited Add'l Days	1b:$0; 60 Add'l Days	"2:$0 Days 1-31, $25 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$50 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$0	12:$0	5:$15; 9c:$15; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits; Self Referral	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0	"10b:$0 50 Plan Approved Location Trips, Unlimited CCC"	"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 14a:Newsletters 14a:Enhanced Nutritional Training $0 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	"7g:Extended Care Assistance 24 visits $0 copay, visits 25-35 $20 copay 13c:OTC $25 per month Allowance 13e:Exercise/Strength Training 16 Weeks $0 then $10 per month 13e:Electronic Health Monitoring $0"											0	0	1.480724818	0	14.19716935	1.091158499	0	50	0	0	0	0	0	15	0	0	0	0	0	0	0.175899046	0	0	22.2125	0	19.01237072	0	0	0	0.570264533											NO	0	0	1.480724818	0	14.19716935	1.091158499	0	50	0	0	0	0	0	15	0	0	0	0	0	0	0.175899046	0	0	22.2125	0	19.01237072	0	0	0	0.570264533												0	0	0.233035376	0	0.741675828	0.380562196	0	1.768271792	0	0	0	0	0	0.030395302	0	0	0	0	0	0	4.349106698	0	0	2.591458333	0	0.78125	0	0	0	0.151331388	0	0	0	0	0	0	0	0	0	0	11.0271	0	0	0	0	0.233035376	0	0.741675828	0.380562196	0	1.768271792	0	0	0	0	0	0.030395302	0	0	0	0	0	0	4.349106698	0	0	2.591458333	0	0.78125	0	0	0	0.151331388	0	0	0	0	0	0	0	0	0	0	11.0271	NO																																																																																		0	0	0	0	0	0.233035376	0	0.741675828	0.380562196	0	1.768271792	0	0	0	0	0	0.030395302	0	0	0	0	0	0	4.349106698	0	0	2.591458333	0	0.78125	0	0	0	0.151331388	0	0	0	0	0	0	0	0	0	0	11.0271
H0544_014_0	2010	7	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	0	0	2307.796848	0	699.9135161	9500.298226	0	481.6206404	0	0	0	0	0	43.50736429	0	142.3894212	0	0	0	0	26.93118414	0	0	1400	0	493.1	0	0	0	3574.450804												1a:$0; Unlimited Add'l Days	1b:$0; 60 Add'l Days	"2:$0 Days 1-31, $25 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$50 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$0	12:$0	5:$15; 9c:$15; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 12 Routine Footcare Visits; Self Referral	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0	"10b:$0 50 Plan Approved Location Trips, Unlimited CCC"	"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 7g:Health Alert Call $0 14a:Newsletters 14a:Enhanced Nutritional Training $0 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	"7g:Extended Care Assistance 24 visits $0 copay, visits 25-35 $20 copay 13c:OTC $25 per month Allowance 13e:Exercise/Strength Training 16 Weeks $0 then $10 per month"											0	0	1.480724818	0	14.19716935	1.091158499	0	50	0	0	0	0	0	15	0	0	0	0	0	0	0.175350655	0	0	22.2125	0	19.01237072	0	0	0	0.608532042											NO	0	0	1.480724818	0	14.19716935	1.091158499	0	50	0	0	0	0	0	15	0	0	0	0	0	0	0.175350655	0	0	22.2125	0	19.01237072	0	0	0	0.608532042												0	0	0.284767672	0	0.828065893	0.863860929	0	2.006752668	0	0	0	0	0	0.054384205	0	0	0	0	0	0	4.722400782	0	0	2.591458333	0	0.78125	0	0	0	0.181263987	0	0	0	0	0	0	0	0	0	0	12.3142	0	0	0	0	0.284767672	0	0.828065893	0.863860929	0	2.006752668	0	0	0	0	0	0.054384205	0	0	0	0	0	0	4.722400782	0	0	2.591458333	0	0.78125	0	0	0	0.181263987	0	0	0	0	0	0	0	0	0	0	12.3142	NO																																																																																		0	0	0	0	0	0.284767672	0	0.828065893	0.863860929	0	2.006752668	0	0	0	0	0	0.054384205	0	0	0	0	0	0	4.722400782	0	0	2.591458333	0	0.78125	0	0	0	0.181263987	0	0	0	0	0	0	0	0	0	0	12.3142
H0544_016_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	447.1239806	29.95553066	325.4087567	0	124.4643496	347.1513125	1055.387231	294.7155186	153.6317287	0	212.5482386	27.89602319	3.208216031	36.21616614	3583.472917	2495.931328	243.1942451	621.1367956	0	0	5.260004327	0	0	0	0	493.1	0	0	0	0												1a:$150 Days 1-6; Unlimited Add'l Days	1b:$150 Days 1-6; 60 Add'l Days	"2:$0 Days 1-31, $50 Days 32-100; 3 Day Waiver"	6:$0	10a:$90 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; Therapeutic Shoes: $50; 11c:$0	4a:$50 (waived if admitted) ;4b:$15; Worldwide Coverage	9a:$150; 9b:$150	8a:$0	8b: X-Rays $0; Diagnostic $50; Therapeutic $0	9a:$150	12:$25	5:$30; 9c:$30; 9d:$30; First 3 Pints of Blood	"7a:$5; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$20; 7d:$20; 7f:$20; 16b:$0-$20; 17a:$0-$20	7e:$20; 7h:$20	3:$15; 7c:$15; 7i:$15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0		"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0												129.3804552	94.86166008	2.961449636	0	25.55490483	1.091158499	0.312585696	40.72830355	150	0	50	150	25	30	5	19.05278391	20	15	0	0	0.174938005	0	0	0	0	19.01237072	0	0	0	0											NO	129.3804552	94.86166008	2.961449636	0	25.55490483	1.091158499	0.312585696	40.72830355	150	0	50	150	25	30	5	19.05278391	20	15	0	0	0.174938005	0	0	0	0	19.01237072	0	0	0	0												4.8208	0.236802614	0.080306804	0	0.265056217	0.031566425	0.027491579	1.000271925	1.920396609	0	0.885617661	0.34870029	0.006683783	0.090540415	1.493113716	3.962870019	0.405323742	0.776420995	0	0	0.920174661	0	0	0	0	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.0533	0	0	4.8208	0.236802614	0.080306804	0	0.265056217	0.031566425	0.027491579	1.000271925	1.920396609	0	0.885617661	0.34870029	0.006683783	0.090540415	1.493113716	3.962870019	0.405323742	0.776420995	0	0	0.920174661	0	0	0	0	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.0533	NO																																																																																		0	0	0	4.8208	0.236802614	0.080306804	0	0.265056217	0.031566425	0.027491579	1.000271925	1.920396609	0	0.885617661	0.34870029	0.006683783	0.090540415	1.493113716	3.962870019	0.405323742	0.776420995	0	0	0.920174661	0	0	0	0	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.0533
H0544_019_0	2010	10	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	2042.993522	37.94943147	1742.929493	0	634.4470332	7562.545699	5157.310815	594.1684615	0	0	0	0	0	43.49088525	0	167.6058904	0	0	0	0	14.82085588	0	0	1400	0	493.1	0	0	0	2103.325683												1a:$75 Days 1-4; Unlimited Add'l Days	1b:$75 Days 1-4; 60 Add'l Days	"2:$0 Days 1-31, $30 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$90 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$0; 9b:$0	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$0	12:$0	5:$30; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 9 Routine Footcare Visits	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0	10b:$0 24 Plan Approved Location Trips	"16a:$5-20 Oral Exams/$35-40 Prophylaxis/$5-10 Fluoride/$5-15 Dental X-Rays ;16b:$5-55 Emergency/$5-20 Diagnostic/$30-435 Restorative/$28-378 Endodontics,Periodontics,Extractions/$5-530 Prosthodontics,Other Oral,Maxillofacial Surgery,Other Services"	17a: 1 Routine Eye Exam Per Year $0 copay	17b:$100 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	7g:Consult with Nutritionist $0 7g:Health Alert Call $0 14a:Newsletters 14a:Enhanced Nutritional Training $0 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	13c:OTC $30 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $2 per visit											57.49957214	33.42391304	1.776869781	0	25.55490483	1.091158499	0.309389559	50	0	0	0	0	0	30	0	0	0	0	0	0	0.175279587	0	0	22.2125	0	19.01237072	0	0	0	2											NO	57.49957214	33.42391304	1.776869781	0	25.55490483	1.091158499	0.309389559	50	0	0	0	0	0	30	0	0	0	0	0	0	0.175279587	0	0	22.2125	0	19.01237072	0	0	0	2												9.7893	0.105701541	0.258079896	0	1.351102796	0.687661334	0.132968177	2.475701923	0	0	0	0	0	0.108727213	0	0	0	0	0	0	2.597793499	0	0	2.591458333	0	0.78125	0	0	0	0.350554281	0	0	0	0	0	0	0	0	0	0	21.2303	0	0	9.7893	0.105701541	0.258079896	0	1.351102796	0.687661334	0.132968177	2.475701923	0	0	0	0	0	0.108727213	0	0	0	0	0	0	2.597793499	0	0	2.591458333	0	0.78125	0	0	0	0.350554281	0	0	0	0	0	0	0	0	0	0	21.2303	NO																																																																																		0	0	0	9.7893	0.105701541	0.258079896	0	1.351102796	0.687661334	0.132968177	2.475701923	0	0	0	0	0	0.108727213	0	0	0	0	0	0	2.597793499	0	0	2.591458333	0	0.78125	0	0	0	0.350554281	0	0	0	0	0	0	0	0	0	0	21.2303
H0544_021_0	2010	5	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	397.9817581	24.01090754	320.0196829	0	120.5322474	255.759557	798.8070253	284.130757	206.6039573	0	268.9691743	31.08366464	1.571815659	10.10616617	3593.725854	2424.872021	231.8339218	625.8418787	0	0	6.643158612	0	0	0	326.8789136	0	0	0	0	0												1a:$200 Days 1-5; Unlimited Add'l Days	1b:$200 Days 1-5; 60 Add'l Days	"2:$0 Days 1-20, $50 Days 21-100; 3 Day Waiver"	6:$0	10a:$100 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; Therapeutic Shoes: $50; 11c:$0	4a:$50 (waived if admitted) ;4b:$30; Worldwide Coverage	9a:$150; 9b:$150	8a:$0	8b: X-Rays $0; Diagnostic $50; Therapeutic $25	9a:$150	12:$15	5:$30; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$15; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$30; 7d:$30; 7f:$0; 16b:$0-$30; 17a:$0-$30	7e:$30; 7h:$30	3:$30; 7c:$30; 7i:$30	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay		18a:$0		14a:Newsletters 14a:Additional Smoking Cessation $0												164.6688345	108.6956522	5.814531888	0	28.3943387	1.091158499	0.163066075	44.15890056	150	0	45.94504398	150	15	30	15	28.46533244	30	29.98006821	0	0	0.174801615	0	0	0	20	0	0	0	0	0											NO	164.6688345	108.6956522	5.814531888	0	28.3943387	1.091158499	0.163066075	44.15890056	150	0	45.94504398	150	15	30	15	28.46533244	30	29.98006821	0	0	0.174801615	0	0	0	20	0	0	0	0	0												5.4613	0.217490105	0.155063721	0	0.285202788	0.023256185	0.010854861	1.045575154	2.582549467	0	1.029816712	0.388545808	0.00196477	0.025265415	4.492157318	5.752065685	0.579584804	1.563565184	0	0	1.161234856	0	0	0	0.544798189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.3203	0	0	5.4613	0.217490105	0.155063721	0	0.285202788	0.023256185	0.010854861	1.045575154	2.582549467	0	1.029816712	0.388545808	0.00196477	0.025265415	4.492157318	5.752065685	0.579584804	1.563565184	0	0	1.161234856	0	0	0	0.544798189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.3203	NO																																																																																		0	0	0	5.4613	0.217490105	0.155063721	0	0.285202788	0.023256185	0.010854861	1.045575154	2.582549467	0	1.029816712	0.388545808	0.00196477	0.025265415	4.492157318	5.752065685	0.579584804	1.563565184	0	0	1.161234856	0	0	0	0.544798189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.3203
H0544_022_0	2010	5	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	2871.287129	0	0	0	1237.812367	4576.100786	2698.551174	93.61111841	41.91611117	0	0	2.58841816	0	0	0	103.5382882	0	0	0	0	5.483722396	0	0	0	313.4817271	493.1	0	0	0	0												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	2:$0; 3 Day Waiver; 50 Add'l SNF Days	6:$0	10a:$50 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$100	12:$0	5:$0; 9c:$0; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0		14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Comprehensive Health Assessment $0	13c:OTC $40 per month Allowance											82.33441725	0	0	0	14.19716935	1.091158499	0.432964776	50	100	0	0	100	0	0	0	0	0	0	0	0	0.176268682	0	0	0	20	19.01237072	0	0	0	0											NO	82.33441725	0	0	0	14.19716935	1.091158499	0.432964776	50	100	0	0	100	0	0	0	0	0	0	0	0	0.176268682	0	0	0	20	19.01237072	0	0	0	0												19.7005	0	0	0	1.46445265	0.416104272	0.0973648	0.390046327	0.349300926	0	0	0.021570151	0	0	0	0	0	0	0	0	0.966608519	0	0	0	0.522469545	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.7096	0	0	19.7005	0	0	0	1.46445265	0.416104272	0.0973648	0.390046327	0.349300926	0	0	0.021570151	0	0	0	0	0	0	0	0	0.966608519	0	0	0	0.522469545	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.7096	NO																																																																																		0	0	0	19.7005	0	0	0	1.46445265	0.416104272	0.0973648	0.390046327	0.349300926	0	0	0.021570151	0	0	0	0	0	0	0	0	0.966608519	0	0	0	0.522469545	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.7096
H0544_024_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	2271.330704	40.03425966	2169.39649	0	716.4787214	8079.452204	4441.603509	653.6149766	354.3487124	0	576.3250576	15.03885592	0	22.8112781	0	4395.898155	695.6107462	899.0533353	0	0	28.43668648	0	0	0	328.8453645	493.1	0	0	0	185.8410365												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $50 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$75 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$15; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	5:$15; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 9 Routine Footcare Visits	7e:$15; 7h:$15	3:$20; 7c:$15; 7i:$15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 7g:Health Alert Call $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $20 per month											82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.141749194	43.21866539	100	0	25	100	0	21.99231595	0	14.56690891	15	14.99263479	0	0	0.175470723	0	0	0	20	19.01237072	0	0	0	20											NO	82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.141749194	43.21866539	100	0	25	100	0	21.99231595	0	14.56690891	15	14.99263479	0	0	0.175470723	0	0	0	20	19.01237072	0	0	0	20												15.5841	0.181314582	0.53537987	0	1.271496218	0.734663578	0.052466143	2.354030581	2.952905937	0	1.200677203	0.125323799	0	0.04180607	0	5.336220665	0.869513433	1.12326486	0	0	4.989805946	0	0	0	0.548075608	0.78125	0	0	0	0.309735061	0	0	0	0	0	0	0	0	0	0	38.992	0	0	15.5841	0.181314582	0.53537987	0	1.271496218	0.734663578	0.052466143	2.354030581	2.952905937	0	1.200677203	0.125323799	0	0.04180607	0	5.336220665	0.869513433	1.12326486	0	0	4.989805946	0	0	0	0.548075608	0.78125	0	0	0	0.309735061	0	0	0	0	0	0	0	0	0	0	38.992	NO																																																																																		0	0	0	15.5841	0.181314582	0.53537987	0	1.271496218	0.734663578	0.052466143	2.354030581	2.952905937	0	1.200677203	0.125323799	0	0.04180607	0	5.336220665	0.869513433	1.12326486	0	0	4.989805946	0	0	0	0.548075608	0.78125	0	0	0	0.309735061	0	0	0	0	0	0	0	0	0	0	38.992
H0544_025_0	2010	7	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	1303.322388	28.77211483	1552.142822	0	539.9618747	3424.132302	3458.372432	603.1448725	342.7105835	0	445.4660598	16.00926211	0	34.81839305	0	4320.896518	772.9149266	941.5372679	0	0	18.17257906	0	0	0	331.9573004	493.1	0	0	0	157.0462377												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $50 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$75 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$15; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	5:$15; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 12 Routine Footcare Visits	7e:$15; 7h:$15	3:$20; 7c:$15; 7i:$15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $20 per month 13e:Electronic Health Monitoring $0											82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.224071107	43.76707479	100	0	25	100	0	20.2073886	0	14.30271668	15	15	0	0	0.175055394	0	0	0	20	19.01237072	0	0	0	20											NO	82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.224071107	43.76707479	100	0	25	100	0	20.2073886	0	14.30271668	15	15	0	0	0.175055394	0	0	0	20	19.01237072	0	0	0	20												8.9424	0.130308491	0.3830494	0	0.958241272	0.311355922	0.064576778	2.199823895	2.855921529	0	0.928054291	0.133410518	0	0.0586324	0	5.150046557	0.966143658	1.176921585	0	0	3.181207986	0	0	0	0.553262167	0.78125	0	0	0	0.261743729	0	0	0	0	0	0	0	0	0	0	29.0363	0	0	8.9424	0.130308491	0.3830494	0	0.958241272	0.311355922	0.064576778	2.199823895	2.855921529	0	0.928054291	0.133410518	0	0.0586324	0	5.150046557	0.966143658	1.176921585	0	0	3.181207986	0	0	0	0.553262167	0.78125	0	0	0	0.261743729	0	0	0	0	0	0	0	0	0	0	29.0363	NO																																																																																		0	0	0	8.9424	0.130308491	0.3830494	0	0.958241272	0.311355922	0.064576778	2.199823895	2.855921529	0	0.928054291	0.133410518	0	0.0586324	0	5.150046557	0.966143658	1.176921585	0	0	3.181207986	0	0	0	0.553262167	0.78125	0	0	0	0.261743729	0	0	0	0	0	0	0	0	0	0	29.0363
H0544_027_0	2010	8	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	963.4794232	38.02272108	913.4637082	0	385.2895039	1921.48252	5469.61293	515.2251096	274.3906694	0	456.4969318	12.25249543	0	23.48690736	0	3547.60793	547.5345773	798.0071856	0	0	16.92409425	0	0	0	330.4950871	493.1	0	0	0	175.0973138												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $50 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$75 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; Therapeutic Shoes: $50; 11c:$0	4a:$50 (waived if admitted) ;4b:$15; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	5:$15; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$20; 7d:$20; 7f:$0; 16b:$0-$20; 17a:$0-$20; 6 Routine Footcare Visits	7e:$20; 7h:$20	3:$20; 7c:$20; 7i:$20	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $20 per month											82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.151063019	43.54494051	100	0	25	100	0	20.55508633	0	19.20831381	20	19.97542843	0	0	0.175536667	0	0	0	20	19.01237072	0	0	0	20											NO	82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.151063019	43.54494051	100	0	25	100	0	20.55508633	0	19.20831381	20	19.97542843	0	0	0.175536667	0	0	0	20	19.01237072	0	0	0	20												6.6106	0.172204353	0.225431397	0	0.683752542	0.174720165	0.068854687	1.869620562	2.286588911	0	0.951035275	0.102104129	0	0.040231284	0	5.678630533	0.912557629	1.328377952	0	0	2.970799105	0	0	0	0.550825145	0.78125	0	0	0	0.291828856	0	0	0	0	0	0	0	0	0	0	25.6994	0	0	6.6106	0.172204353	0.225431397	0	0.683752542	0.174720165	0.068854687	1.869620562	2.286588911	0	0.951035275	0.102104129	0	0.040231284	0	5.678630533	0.912557629	1.328377952	0	0	2.970799105	0	0	0	0.550825145	0.78125	0	0	0	0.291828856	0	0	0	0	0	0	0	0	0	0	25.6994	NO																																																																																		0	0	0	6.6106	0.172204353	0.225431397	0	0.683752542	0.174720165	0.068854687	1.869620562	2.286588911	0	0.951035275	0.102104129	0	0.040231284	0	5.678630533	0.912557629	1.328377952	0	0	2.970799105	0	0	0	0.550825145	0.78125	0	0	0	0.291828856	0	0	0	0	0	0	0	0	0	0	25.6994
H0544_028_0	2010	5	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	402.9332699	24.30964056	301.2519638	0	133.2630057	362.5482627	1120.191161	310.5127187	202.5692065	0	284.2355013	27.95187738	1.397567336	9.860102221	4491.365377	2220.244674	209.0866483	561.1189838	0	0	5.29621167	0	0	0	326.9154653	0	0	0	0	0												1a:$200 Days 1-5; Unlimited Add'l Days	1b:$200 Days 1-5; 60 Add'l Days	"2:$0 Days 1-20, $50 Days 21-100; 3 Day Waiver"	6:$0	10a:$100 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; Therapeutic Shoes: $50; 11c:$0	4a:$50 (waived if admitted) ;4b:$30; Worldwide Coverage	9a:$150; 9b:$150	8a:$0	8b: X-Rays $0; Diagnostic $50; Therapeutic $25	9a:$150	12:$15	5:$30; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$15; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$30; 7d:$30; 7f:$0; 16b:$0-$30; 17a:$0-$30	7e:$30; 7h:$30	3:$30; 7c:$30; 7i:$30	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay		18a:$0		14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0												164.6688345	108.6956522	5.814531888	0	28.3943387	1.091158499	0.192725084	45.21277505	150	0	46.5494438	150	15	30	15	28.46805991	30	29.97832835	0	0	0.175008449	0	0	0	20	0	0	0	0	0											NO	164.6688345	108.6956522	5.814531888	0	28.3943387	1.091158499	0.192725084	45.21277505	150	0	46.5494438	150	15	30	15	28.46805991	30	29.97832835	0	0	0.175008449	0	0	0	20	0	0	0	0	0												5.5292	0.22019602	0.145969929	0	0.315326243	0.032966468	0.017990745	1.169928475	2.532115081	0	1.102583708	0.349398467	0.001746959	0.024650256	5.614206722	5.267171532	0.522716621	1.401784095	0	0	0.926881791	0	0	0	0.544859109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.7197	0	0	5.5292	0.22019602	0.145969929	0	0.315326243	0.032966468	0.017990745	1.169928475	2.532115081	0	1.102583708	0.349398467	0.001746959	0.024650256	5.614206722	5.267171532	0.522716621	1.401784095	0	0	0.926881791	0	0	0	0.544859109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.7197	NO																																																																																		0	0	0	5.5292	0.22019602	0.145969929	0	0.315326243	0.032966468	0.017990745	1.169928475	2.532115081	0	1.102583708	0.349398467	0.001746959	0.024650256	5.614206722	5.267171532	0.522716621	1.401784095	0	0	0.926881791	0	0	0	0.544859109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.7197
H0544_031_0	2010	5	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	2181.978872	38.45935273	2001.531709	0	821.3776017	10896.01464	5949.250084	757.0360914	319.311715	0	608.5647181	13.58564727	0	20.16766189	0	3841.962739	598.3497863	761.1423784	0	0	19.86372202	0	0	0	327.606316	493.1	0	0	0	156.5820753												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $50 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$75 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$15; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	5:$15; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 9 Routine Footcare Visits	7e:$15; 7h:$15	3:$20; 7c:$15; 7i:$15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 7g:Health Alert Call $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $20 per month											82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.173138655	45.02831842	100	0	25	100	0	21.62700282	0	14.58478238	15	14.990962	0	0	0.17559822	0	0	0	20	19.01237072	0	0	0	20											NO	82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.173138655	45.02831842	100	0	25	100	0	21.62700282	0	14.58478238	15	14.990962	0	0	0.17559822	0	0	0	20	19.01237072	0	0	0	20												14.971	0.174181851	0.493952946	0	1.457654614	0.990773248	0.085837097	2.840671848	2.660930958	0	1.267843163	0.113213727	0	0.036347173	0	4.669515873	0.747937233	0.950854706	0	0	3.488034224	0	0	0	0.546010527	0.78125	0	0	0	0.260970125	0	0	0	0	0	0	0	0	0	0	36.537	0	0	14.971	0.174181851	0.493952946	0	1.457654614	0.990773248	0.085837097	2.840671848	2.660930958	0	1.267843163	0.113213727	0	0.036347173	0	4.669515873	0.747937233	0.950854706	0	0	3.488034224	0	0	0	0.546010527	0.78125	0	0	0	0.260970125	0	0	0	0	0	0	0	0	0	0	36.537	NO																																																																																		0	0	0	14.971	0.174181851	0.493952946	0	1.457654614	0.990773248	0.085837097	2.840671848	2.660930958	0	1.267843163	0.113213727	0	0.036347173	0	4.669515873	0.747937233	0.950854706	0	0	3.488034224	0	0	0	0.546010527	0.78125	0	0	0	0.260970125	0	0	0	0	0	0	0	0	0	0	36.537
H0544_032_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	1478.181503	32.6323006	1469.319097	0	639.9022969	4487.780539	4366.129396	689.6137874	301.9625758	0	478.9483681	13.19303732	0	27.23550488	0	4079.002254	721.3460436	854.657958	0	0	15.08995231	0	0	0	331.3553822	493.1	0	0	0	129.0679841												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-31, $50 Days 32-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$75 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$15; Worldwide Coverage	9a:$100; 9b:$100	8a:$0	8b: X-Rays $0; Diagnostic $25; Therapeutic $25	9a:$100	12:$0	5:$15; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 12 Routine Footcare Visits	7e:$15; 7h:$15	3:$20; 7c:$15; 7i:$15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$100 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $20 per month 13e:Electronic Health Monitoring $0											82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.215008534	44.94008359	100	0	25	100	0	21.14585713	0	14.31810363	15	14.98106671	0	0	0.175193107	0	0	0	20	19.01237072	0	0	0	20											NO	82.33441725	54.34782609	2.961449636	0	21.29575403	1.091158499	0.215008534	44.94008359	100	0	25	100	0	21.14585713	0	14.31810363	15	14.98106671	0	0	0.175193107	0	0	0	20	19.01237072	0	0	0	20												10.1421	0.147791216	0.362609542	0	1.13560016	0.408073323	0.07822959	2.582608437	2.516354799	0	0.9978091	0.109941978	0	0.047993175	0	4.866964749	0.901682554	1.06697399	0	0	2.643655632	0	0	0	0.55225897	0.78125	0	0	0	0.215113307	0	0	0	0	0	0	0	0	0	0	29.557	0	0	10.1421	0.147791216	0.362609542	0	1.13560016	0.408073323	0.07822959	2.582608437	2.516354799	0	0.9978091	0.109941978	0	0.047993175	0	4.866964749	0.901682554	1.06697399	0	0	2.643655632	0	0	0	0.55225897	0.78125	0	0	0	0.215113307	0	0	0	0	0	0	0	0	0	0	29.557	NO																																																																																		0	0	0	10.1421	0.147791216	0.362609542	0	1.13560016	0.408073323	0.07822959	2.582608437	2.516354799	0	0.9978091	0.109941978	0	0.047993175	0	4.866964749	0.901682554	1.06697399	0	0	2.643655632	0	0	0	0.55225897	0.78125	0	0	0	0.215113307	0	0	0	0	0	0	0	0	0	0	29.557
H0545_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	O																																																			0	NO	1175.641081	47.34304467	1008.857407		328.555576	5.06200587	12.15009998	251.2754323	337.0268584		323.8670193	27.56075058		1581.638243		6229.340975	135.2416729	2389.346732			25.75923985																					"1a: $75 days 1-6 ($1,000 OOPM)"	1b: $75 days 1-6	2: $40 days 21-100		10a: $50	11a: 20%	"11b: 20%, 11c: 0%"	"4a: $50, 4b: $30"	9b: $50		8b: $0-$50	9a: $50		"3, 5, 9c, 9d: $10; 9a: $50"		"7b, 7d, 7f, 7g, 14f, 16b, 17a, 18a: $10, 7b1: $25"	"7e, 7h: $10"	"7c, 7i: $10"	$0 (incl in i.2.)		15: 10%																				56.80041393	47.62280982	7.314662273		50	0.2	0.2	49.98058843	50		32.82149859	50		39.80644398		10.63527682	10	10			0.1																				NO	56.80041393	47.62280982	7.314662273		50	0.2	0.2	49.98058843	50		32.82149859	50		39.80644398		10.63527682	10	10			0.1																					5.5647	0.187884068	0.614954268	0	1.368981567	1.012401174	2.430019997	1.046574497	1.404278577	0	0.885816743	0.114836461	0	5.246616176	0	5.520897138	0.112701394	1.991122277	0	0	2.575923985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0777	0	0	5.5647	0.187884068	0.614954268	0	1.368981567	1.012401174	2.430019997	1.046574497	1.404278577	0	0.885816743	0.114836461	0	5.246616176	0	5.520897138	0.112701394	1.991122277	0	0	2.575923985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0777	NO																																																																																		0	0	0	5.5647	0.187884068	0.614954268	0	1.368981567	1.012401174	2.430019997	1.046574497	1.404278577	0	0.885816743	0.114836461	0	5.246616176	0	5.520897138	0.112701394	1.991122277	0	0	2.575923985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0777
H0545_009_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	P	P	P	P	P	P	P	Coin	P	T	P	P	P	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	0	0	0	0	0	0	0	0	0	NO	1744.227888	33.79567715	1268.182354	0	376.3544751	13.13961113	29.80248244	310.8087004	402.3957477	0	282.1454146	38.68090068	0	1610.890313	0	11376.49774	385.1549048	2986.973517	0	0	37.99370218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		"1a: $75 days 1-6 ($1,000 OOPM)"	1b: $75 days 1-6	2: $40 days 21-100		10a: $50	11a: 0%-20%	11b: 0%-20%; 11c: 0%	"4a: $50, 4b: $30"	"9a, 9b: $50"		8b: 0$-$50	9a: $50		"3, 5, 9c, 9d: $10; 9a: $50"		"7b, 7d, 7f, 7g, 17a, 18a: $10"	"7e, 7h: $10"	"7c, 7i: $10"			15: 10%																				54.50199856	30.08366564	7.143132699	0	50	0.071068526	0.071068526	47.21201824	50	0	34.93986038	50	0	22.57831777	0	10	10	10	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	54.50199856	30.08366564	7.143132699	0	50	0.071068526	0.071068526	47.21201824	50	0	34.93986038	50	0	22.57831777	0	10	10	10	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		7.922	0.084724821	0.75489957	0	1.568143646	0.933812794	2.118018495	1.222825503	1.676648949	0	0.821510116	0.16117042	0	3.030932781	0	9.480414787	0.320962421	2.489144597	0	0	3.799370218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3846	0	0	7.922	0.084724821	0.75489957	0	1.568143646	0.933812794	2.118018495	1.222825503	1.676648949	0	0.821510116	0.16117042	0	3.030932781	0	9.480414787	0.320962421	2.489144597	0	0	3.799370218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3846	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.922	0.084724821	0.75489957	0	1.568143646	0.933812794	2.118018495	1.222825503	1.676648949	0	0.821510116	0.16117042	0	3.030932781	0	9.480414787	0.320962421	2.489144597	0	0	3.799370218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3846
H0545_011_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	Coin	P	P	P	P	P	P																																																			0	NO	908.5484395	36.58722891	779.6561701		253.9113856	4.045797849	9.710942586	193.9999601	260.4580864		250.2880171	21.29925309		1150.318091		4870.723542	104.5162617	1918.503049			20.58801981	2.077523478		6.579750525						187.7907915												"1a: $75 days 1-6 ($1,000 OOPM)"	1b: $912 per Admit	2: $40 days 21-100		10a: $50	11a: 20%	"11b: 20%, 11c: 0%"	"4a: $50, 4b: $30"	"9a, 9b: $50"		8b: $0-$50	9a: $50		"3, 5, 9c, 9d: $10; 9a: $50"	"7a, 14c: $0"	"7d, 7f, 7g, 14f, 16b, 17a: $10; 7b:$10/$20"	"7e, 7h: $10"	"7c, 7i: $10"			15: 10%	18a: $10		"16a, 16b: $0-$580"						13b: $20											56.80041393	133.4180334	7.314662273		50	0.2	0.2	48.00194304	50		32.82149859	50		48.27938043		10.54165202	10	10			0.1	10		0.36440013						20											NO	56.80041393	133.4180334	7.314662273		50	0.2	0.2	48.00194304	50		32.82149859	50		48.27938043		10.54165202	10	10			0.1	10		0.36440013						20												4.3005	0.406783011	0.475243464	0	1.057964107	0.80915957	1.942188517	0.776031253	1.085242027	0	0.684568983	0.088746888	0	4.628053727	0	4.27878939	0.087096885	1.59875254	0	0	2.058801981	0.00173127	0	2.397661948	0	0	0	0	0	0.312984652	0	0	0	0	0	0	0	0	0	0	26.9903	0	0	4.3005	0.406783011	0.475243464	0	1.057964107	0.80915957	1.942188517	0.776031253	1.085242027	0	0.684568983	0.088746888	0	4.628053727	0	4.27878939	0.087096885	1.59875254	0	0	2.058801981	0.00173127	0	2.397661948	0	0	0	0	0	0.312984652	0	0	0	0	0	0	0	0	0	0	26.9903	NO																																																																																		0	0	0	4.3005	0.406783011	0.475243464	0	1.057964107	0.80915957	1.942188517	0.776031253	1.085242027	0	0.684568983	0.088746888	0	4.628053727	0	4.27878939	0.087096885	1.59875254	0	0	2.058801981	0.00173127	0	2.397661948	0	0	0	0	0	0.312984652	0	0	0	0	0	0	0	0	0	0	26.9903
H0545_012_0	2010	5	N/A																															0	A	0	0	T	Coin	Coin	V	0	0	V	0	0	0	0	0	V	0	0	0	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	0	0	0	0	0	0	NO	0	1.903701692	0	0	312.5334153	1.538034177	1.939828776	153.4117508	0	0	11.76201025	0	0	0	0	0	10.29425644	0	0	0	10.91376809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	copay $912/stay	0	0	$100 copay/trip	10% coinsurance	20% coinsurance	$50 copay/visit INN ER;  $0 copay/visit INN Urgent Care	0	0	$15 copay/visit	0	0	0	0	0	$20 copay/visit	0	0	0	20% coinsurance	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	912	0	0	100	0.1	0.2	50	0	0	15	0	0	0	0	0	20	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	912	0	0	100	0.1	0.2	50	0	0	15	0	0	0	0	0	20	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0.144681329	0	0	2.604445127	0.153803418	0.387965755	0.639215628	0	0	0.014702513	0	0	0	0	0	0.017157094	0	0	0	2.182753618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.1447	0	0	0	0.144681329	0	0	2.604445127	0.153803418	0.387965755	0.639215628	0	0	0.014702513	0	0	0	0	0	0.017157094	0	0	0	2.182753618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.1447	NO	0	0	0	0	0	0	0	"$50 copay/visit OON Urgent Care; $50 copay/visit Worldwide Coverage ER (max $20,000/year)"	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.144681329	0	0	2.604445127	0.153803418	0.387965755	0.639215628	0	0	0.014702513	0	0	0	0	0	0.017157094	0	0	0	2.182753618	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.1447
H0545_801_0	2010	3	N/A																															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																																																			0	NO	274.6651436	4.563316536	49.93414673		17.34431586	5.315106164	18.62539469	3.992979387	13.6740559	2.003139722	5.040847907	0.742764173	0.450005185	7.5520588	29.49473619	76.83623805	1.295052058	18.69512273	46.59686367	56.87716866	27.04720184	0.019958173																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing										0.067094984	0.067094984	0.147727279		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.067094984	0.067094984	0.147727279		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				18.4287	0.30617565	7.376635609	0	4.041225596	1.238419736	4.339716963	0.930364197	3.186055024	0.466731555	1.174517562	0.173064052	0.104851208	1.7596297	6.872273533	17.90284347	0.30174713	4.355963595	10.85706924	13.2523803	6.301998028	0.004650254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.375	0	0	18.4287	0.30617565	7.376635609	0	4.041225596	1.238419736	4.339716963	0.930364197	3.186055024	0.466731555	1.174517562	0.173064052	0.104851208	1.7596297	6.872273533	17.90284347	0.30174713	4.355963595	10.85706924	13.2523803	6.301998028	0.004650254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.375	NO																																																																																		0	0	0	18.4287	0.30617565	7.376635609	0	4.041225596	1.238419736	4.339716963	0.930364197	3.186055024	0.466731555	1.174517562	0.173064052	0.104851208	1.7596297	6.872273533	17.90284347	0.30174713	4.355963595	10.85706924	13.2523803	6.301998028	0.004650254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.375
H0545_802_0	2010	3	N/A																															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																																																			0	NO	274.6651436	4.563316536	49.93414673		17.34431586	5.315106164	18.62539469	3.992979387	13.6740559	2.003139722	5.040847907	0.742764173	0.450005185	7.5520588	29.49473619	76.83623805	1.295052058	18.69512273	46.59686367	56.87716866	27.04720184	0.019958173																				Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing										0.067094984	0.067094984	0.147727279		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.067094984	0.067094984	0.147727279		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				18.4287	0.30617565	7.376635609	0	4.041225596	1.238419736	4.339716963	0.930364197	3.186055024	0.466731555	1.174517562	0.173064052	0.104851208	1.7596297	6.872273533	17.90284347	0.30174713	4.355963595	10.85706924	13.2523803	6.301998028	0.004650254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.375	0	0	18.4287	0.30617565	7.376635609	0	4.041225596	1.238419736	4.339716963	0.930364197	3.186055024	0.466731555	1.174517562	0.173064052	0.104851208	1.7596297	6.872273533	17.90284347	0.30174713	4.355963595	10.85706924	13.2523803	6.301998028	0.004650254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.375	NO																																																																																		0	0	0	18.4287	0.30617565	7.376635609	0	4.041225596	1.238419736	4.339716963	0.930364197	3.186055024	0.466731555	1.174517562	0.173064052	0.104851208	1.7596297	6.872273533	17.90284347	0.30174713	4.355963595	10.85706924	13.2523803	6.301998028	0.004650254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.375
H0562_002_0	2010	4	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	285.2709281	7.15283731	72.83862891	217.3649377	355.8076591	13.60947471	0.415276959	261.4372874	165.7977859	1.019248684	6.354410172	0.169874781	434.1999393	56.05867761	7181.607014	6375.693066	257.1490522	16336.10376	3357.848689	231.4238427	13.11001132	0	0	0	875.7364967	0	79.60561998	0	510.5406377	0	0	0	0	0	0	0	0	0	0	0		"$100 per day days 1-4, $0 per day days 5-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$100 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$8 per office visit	$10 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $10 per visit		Hearing exams - $10 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	295.6141354	900	297.25	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	8	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	295.6141354	900	297.25	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	8	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0		7.0275	0.536462798	1.804273537	0	5.337114886	2.721894941	0.083055392	1.089322031	1.381648216	0	0.058461033	0	0.904583207	0	4.78773801	5.313077555	0.535727192	0	0	0.192853202	2.622002264	0	0	0	0.729780414	0	0.066338017	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1918			7.0275	0.536462798	1.804273537	0	5.337114886	2.721894941	0.083055392	1.089322031	1.381648216	0	0.058461033	0	0.904583207	0	4.78773801	5.313077555	0.535727192	0	0	0.192853202	2.622002264	0	0	0	0.729780414	0	0.066338017	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1918	NO																																																																																		0			7.0275	0.536462798	1.804273537	0	5.337114886	2.721894941	0.083055392	1.089322031	1.381648216	0	0.058461033	0	0.904583207	0	4.78773801	5.313077555	0.535727192	0	0	0.192853202	2.622002264	0	0	0	0.729780414	0	0.066338017	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1918
H0562_009_0	2010	5	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	288.9438137	7.31389372	41.70057712	284.8252382	318.9321917	14.1783119	0.471260103	284.1662201	326.8509916	3.590307882	5.702487217	0.265948732	392.2743797	158.6384186	6007.173634	5333.05362	262.9391327	7873.983834	2843.216888	290.6416824	13.42607982	0	0	-18.19459086	2190.28092	0	118.2072883	0	514.1351364	0	0	0	0	0	0	0	0	0	0	0		"$250 per day days 1-7, $0 per day days 9-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$10 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $10 per visit		Hearing exams - $10 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0		22.8656	0.548542029	1.032958046	0	4.783982876	2.835662379	0.094252021	1.184025917	6.809395658	0	0.052463294	0	0.817238291	0	5.005978028	4.44421135	0.54778986	0	0	0.242201402	2.685215964	0	0	0	1.8252341	0	0.098506074	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8733			22.8656	0.548542029	1.032958046	0	4.783982876	2.835662379	0.094252021	1.184025917	6.809395658	0	0.052463294	0	0.817238291	0	5.005978028	4.44421135	0.54778986	0	0	0.242201402	2.685215964	0	0	0	1.8252341	0	0.098506074	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8733	NO																																																																																		0			22.8656	0.548542029	1.032958046	0	4.783982876	2.835662379	0.094252021	1.184025917	6.809395658	0	0.052463294	0	0.817238291	0	5.005978028	4.44421135	0.54778986	0	0	0.242201402	2.685215964	0	0	0	1.8252341	0	0.098506074	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8733
H0562_010_0	2010	4	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	300.982591	5.338269838	83.14605724	181.3259034	330.1297328	21.75777067	0.594507231	323.9620495	294.1651487	110.6289191	2.686170438	46.28029279	475.3556648	83.05093637	7579.76427	6729.169446	191.9141971	16663.16371	3736.5428	207.8746384	13.57295766	0	0	0	1777.565248	0	90.0943061	0	513.6967833	0	0	0	0	0	0	0	0	0	0	0		"$100 per day days 1-4, $0 per day days 5-90"	$900 per admission	$0 per visit	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$100 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$15 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $15 per visit		Hearing exams - $15 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	295.6141354	900	0	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	10	15	25	0	0	10	0.2	0	0	0	15	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	295.6141354	900	0	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	10	15	25	0	0	10	0.2	0	0	0	15	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0		7.4146	0.400370238	0	0	4.951945992	4.351554133	0.118901446	1.349841873	2.451376239	0	0.024712962	0	0.990324302	0	6.316470225	8.411461808	0.399821244	0	0	0.173228865	2.714591532	0	0	0	2.22195656	0	0.112617883	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4037			7.4146	0.400370238	0	0	4.951945992	4.351554133	0.118901446	1.349841873	2.451376239	0	0.024712962	0	0.990324302	0	6.316470225	8.411461808	0.399821244	0	0	0.173228865	2.714591532	0	0	0	2.22195656	0	0.112617883	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4037	NO																																																																																		0			7.4146	0.400370238	0	0	4.951945992	4.351554133	0.118901446	1.349841873	2.451376239	0	0.024712962	0	0.990324302	0	6.316470225	8.411461808	0.399821244	0	0	0.173228865	2.714591532	0	0	0	2.22195656	0	0.112617883	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4037
H0562_011_0	2010	5	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	267.8354531	7.244806355	59.53599501	164.8335903	332.881206	14.89559319	0.542173318	354.5165352	344.8709025	60.08754834	13.13931257	96.14007735	362.4227916	64.35692678	6677.50152	5928.157869	260.4553979	15447.5075	4026.646889	397.456952	18.93717311	0	0	-31.94735685	1444.567491	0	73.09375518	0	509.550881	0	0	0	0	0	0	0	0	0	0	0		"$250 per day days 1-7, $0 per day days 9-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$20 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $20 per visit		Hearing exams - $20 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0		21.1952	0.543360477	1.47475621	0	4.993218091	2.979118639	0.108434664	1.47715223	7.184810468	0	0.120882625	0	0.755047482	0	5.5645846	9.880263115	0.542615412	0	0	0.331214127	3.787434621	0	0	0	2.407612485	0	0.121822925	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4675			21.1952	0.543360477	1.47475621	0	4.993218091	2.979118639	0.108434664	1.47715223	7.184810468	0	0.120882625	0	0.755047482	0	5.5645846	9.880263115	0.542615412	0	0	0.331214127	3.787434621	0	0	0	2.407612485	0	0.121822925	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4675	NO																																																																																		0			21.1952	0.543360477	1.47475621	0	4.993218091	2.979118639	0.108434664	1.47715223	7.184810468	0	0.120882625	0	0.755047482	0	5.5645846	9.880263115	0.542615412	0	0	0.331214127	3.787434621	0	0	0	2.407612485	0	0.121822925	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4675
H0562_012_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	235.2550809	7.075944492	70.75014426	207.9099331	272.1493279	14.51981574	0.127456956	262.341178	200.4555668	2.242232291	0	0.448446458	160.0953856	27.8036804	6754.106545	5996.166342	254.3847065	15854.6631	4062.753095	490.7675697	13.527124	0	0	0	1231.58796	0	90.61388532	0	514.0605954	0	0	0	0	0	0	0	0	0	0	0		"$200 per day days 1-5, $0 per day days 6-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$200 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$15 per office visit	$25 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $25 per visit		Hearing exams - $25 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	662.6029277	900	297.25	0	180	0.2	0.2	50	200	0	110.4008667	0	25	0	15	25	25	0	0	10	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	662.6029277	900	297.25	0	180	0.2	0.2	50	200	0	110.4008667	0	25	0	15	25	25	0	0	10	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0		12.9901	0.530695837	1.752540032	0	4.082239919	2.903963147	0.025491391	1.093088242	3.340926113	0	0	0	0.333532053	0	8.442633181	12.49201321	0.529968139	0	0	0.408972975	2.7054248	0	0	0	2.565808251	0	0.188778928	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3861			12.9901	0.530695837	1.752540032	0	4.082239919	2.903963147	0.025491391	1.093088242	3.340926113	0	0	0	0.333532053	0	8.442633181	12.49201321	0.529968139	0	0	0.408972975	2.7054248	0	0	0	2.565808251	0	0.188778928	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3861	NO																																																																																		0			12.9901	0.530695837	1.752540032	0	4.082239919	2.903963147	0.025491391	1.093088242	3.340926113	0	0	0	0.333532053	0	8.442633181	12.49201321	0.529968139	0	0	0.408972975	2.7054248	0	0	0	2.565808251	0	0.188778928	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3861
H0562_017_0	2010	4	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	318.9291372	7.237606667	121.659074	506.6736378	285.4213659	12.78658622	1.167054615	316.6090361	409.7219807	187.0709319	0	3.959786512	1156.257661	108.8941291	7826.004249	6947.77658	260.1965646	16751.66509	2907.574656	251.8857844	8.363941641	0	0	0	1684.3597	0	84.25649855	0	508.2049024	0	0	0	0	0	0	0	0	0	0	0		"$200 per day days 1-5, $0 per day days 6-90"	$900 per admission	"$0 per day days 1-20, $100 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$200 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$15 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $15 per visit		Hearing exams - $15 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	662.6029277	900	396.3333333	0	180	0.2	0.2	50	200	0	110.4008667	0	25	0	10	15	25	0	0	10	0.2	0	0	0	15	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	662.6029277	900	396.3333333	0	180	0.2	0.2	50	200	0	110.4008667	0	25	0	10	15	25	0	0	10	0.2	0	0	0	15	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0		17.6103	0.5428205	4.018128862	0	4.281320489	2.557317244	0.233410923	1.319204317	6.828699679	0	0	0	2.408870128	0	6.521670208	8.684720726	0.542076176	0	0	0.20990482	1.672788328	0	0	0	2.105449625	0	0.105320623	0	0	0	0	0	0	0	0	0	0	0	0	0	59.642			17.6103	0.5428205	4.018128862	0	4.281320489	2.557317244	0.233410923	1.319204317	6.828699679	0	0	0	2.408870128	0	6.521670208	8.684720726	0.542076176	0	0	0.20990482	1.672788328	0	0	0	2.105449625	0	0.105320623	0	0	0	0	0	0	0	0	0	0	0	0	0	59.642	NO																																																																																		0			17.6103	0.5428205	4.018128862	0	4.281320489	2.557317244	0.233410923	1.319204317	6.828699679	0	0	0	2.408870128	0	6.521670208	8.684720726	0.542076176	0	0	0.20990482	1.672788328	0	0	0	2.105449625	0	0.105320623	0	0	0	0	0	0	0	0	0	0	0	0	0	59.642
H0562_036_0	2010	4	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	201.511663	2.726251078	34.27069099	159.0160062	145.3077298	12.59976949	0.038158988	236.5212668	346.9922777	1.416295011	2.771663586	0	136.5625641	114.7198959	7228.814893	6417.603315	98.01046081	14405.83545	3370.930857	275.0066588	16.16446528	0	0	0	1652.664062	0	138.5529731	0	515.3864536	0	0	0	0	0	0	0	0	0	0	0		"$250 per day days 1-7, $0 per day days 9-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$10 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $15 per visit		Hearing exams - $15 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	10	25	0	0	10	0.2	0	0	0	15	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	10	25	0	0	10	0.2	0	0	0	15	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0		15.9467	0.204468831	0.848913575	0	2.179615947	2.519953898	0.007631798	0.985505278	7.229005785	0	0.025499505	0	0.284505342	0	6.02401241	5.348002763	0.20418846	0	0	0.229172216	3.232893057	0	0	0	2.065830077	0	0.173191216	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5091			15.9467	0.204468831	0.848913575	0	2.179615947	2.519953898	0.007631798	0.985505278	7.229005785	0	0.025499505	0	0.284505342	0	6.02401241	5.348002763	0.20418846	0	0	0.229172216	3.232893057	0	0	0	2.065830077	0	0.173191216	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5091	NO																																																																																		0			15.9467	0.204468831	0.848913575	0	2.179615947	2.519953898	0.007631798	0.985505278	7.229005785	0	0.025499505	0	0.284505342	0	6.02401241	5.348002763	0.20418846	0	0	0.229172216	3.232893057	0	0	0	2.065830077	0	0.173191216	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5091
H0562_037_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	213.7198464	2.670333054	44.20115005	240.4348272	223.4343849	14.99991143	0.635156603	247.9076901	376.378072	23.58635918	2.165985091	7.527561441	341.249452	108.8987222	8025.310211	7124.716594	96.00017226	15348.04625	3366.587123	218.0265946	15.58899807	0	0	0	1488.480387	0	131.0724586	0	509.3420798	0	0	0	0	0	0	0	0	0	0	0		"$100 per day days 1-4, $0 per day days 5-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$100 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$15 per office visit	$20 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $25 per visit		Hearing exams - $25 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	295.6141354	900	297.25	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	15	20	25	0	0	10	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	295.6141354	900	297.25	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	15	20	25	0	0	10	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0		5.2649	0.200274979	1.094899321	0	3.351515773	2.999982285	0.127031321	1.032948709	3.136483934	0	0.019927219	0	0.710936358	0	10.03163776	11.87452766	0.200000359	0	0	0.181688829	3.117799613	0	0	0	3.101000805	0	0.273067622	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7186			5.2649	0.200274979	1.094899321	0	3.351515773	2.999982285	0.127031321	1.032948709	3.136483934	0	0.019927219	0	0.710936358	0	10.03163776	11.87452766	0.200000359	0	0	0.181688829	3.117799613	0	0	0	3.101000805	0	0.273067622	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7186	NO																																																																																		0			5.2649	0.200274979	1.094899321	0	3.351515773	2.999982285	0.127031321	1.032948709	3.136483934	0	0.019927219	0	0.710936358	0	10.03163776	11.87452766	0.200000359	0	0	0.181688829	3.117799613	0	0	0	3.101000805	0	0.273067622	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7186
H0562_039_0	2010	5	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	304.2057227	4.818827601	65.77421032	217.8770717	456.3085841	63.17435488	1.523657083	305.8010902	216.6091056	0	110.3324156	0	3903.211138	89.19198465	7035.407379	6245.899832	173.2399182	14303.57231	3507.931982	141.6195278	11.36893288	0	0	0	1402.358887	0	108.2494092	0	511.89964	0	0	0	0	0	0	0	0	0	0	0		"$175 per day days 1-4, $0 per day days 9-90"	$900 per admission	$0 per visit	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$15 per office visit	$20 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $20 per visit		Hearing exams - $20 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	517.324737	900	0	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	15	20	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	517.324737	900	0	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	15	20	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0		13.1144	0.36141207	0	0	6.844628761	12.63487098	0.304731417	1.274171209	4.5126897	0	1.015066192	0	8.131689871	0	8.794259224	10.40983305	0.360916496	0	0	0.118016273	2.273786575	0	0	0	2.337264812	0	0.180415682	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6682			13.1144	0.36141207	0	0	6.844628761	12.63487098	0.304731417	1.274171209	4.5126897	0	1.015066192	0	8.131689871	0	8.794259224	10.40983305	0.360916496	0	0	0.118016273	2.273786575	0	0	0	2.337264812	0	0.180415682	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6682	NO																																																																																		0			13.1144	0.36141207	0	0	6.844628761	12.63487098	0.304731417	1.274171209	4.5126897	0	1.015066192	0	8.131689871	0	8.794259224	10.40983305	0.360916496	0	0	0.118016273	2.273786575	0	0	0	2.337264812	0	0.180415682	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6682
H0562_040_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	272.8452672	7.164986356	58.69977859	296.1719913	287.2032761	15.54392425	2.105924018	414.653367	257.8893152	8.984699643	1.735680613	1.123087455	151.6168065	105.5702208	8522.664466	7566.258169	257.5858182	22859.2306	5735.681383	487.973466	22.0683725	0	0	0	1348.139812	0	163.4017521	0	517.5766901	0	0	0	0	0	0	0	0	0	0	0		"$200 per day days 1-5, $0 per day days 6-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$200 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$15 per office visit	$25 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $25 per visit		Hearing exams - $25 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	662.6029277	900	297.25	0	180	0.2	0.2	50	200	0	110.4008667	0	25	0	15	25	25	0	0	10	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	662.6029277	900	297.25	0	180	0.2	0.2	50	200	0	110.4008667	0	25	0	15	25	25	0	0	10	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0		15.0657	0.537373977	1.454042432	0	4.308049142	3.108784849	0.421184804	1.727722362	4.298155253	0	0.015968387	0	0.315868347	0	10.65333058	15.76303785	0.536637121	0	0	0.406644555	4.413674499	0	0	0	2.808624608	0	0.340420317	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1752			15.0657	0.537373977	1.454042432	0	4.308049142	3.108784849	0.421184804	1.727722362	4.298155253	0	0.015968387	0	0.315868347	0	10.65333058	15.76303785	0.536637121	0	0	0.406644555	4.413674499	0	0	0	2.808624608	0	0.340420317	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1752	NO																																																																																		0			15.0657	0.537373977	1.454042432	0	4.308049142	3.108784849	0.421184804	1.727722362	4.298155253	0	0.015968387	0	0.315868347	0	10.65333058	15.76303785	0.536637121	0	0	0.406644555	4.413674499	0	0	0	2.808624608	0	0.340420317	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1752
H0562_044_0	2010	2	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	270.4532461	7.231304659	61.54063702	176.3090246	307.7466472	12.37192446	0.247158802	191.1781093	141.5976948	0.612305487	3.817361041	0.102050915	302.8381398	46.80055249	7218.911742	6408.811488	259.9700034	16420.1388	3380.1755	233.117772	11.93384549	0	0	1548.42396	879.219446	0	82.325706	0	516.1413201	0	0	0	0	0	0	0	0	0	0	0		"$100 per day days 1-4, $0 per day days 5-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$125 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$100 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$7 per office visit	$10 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate			"One time annual $35 deductible, $500 annual max"	Vision exams - $10 per visit	$100 Max	Hearing exams - $10 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	295.6141354	900	297.25	0	125	0.2	0.2	50	100	0	110.4008667	0	25	0	7	10	25	0	0	10	0.2	0	0	23.33333333	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	295.6141354	900	297.25	0	125	0.2	0.2	50	100	0	110.4008667	0	25	0	7	10	25	0	0	10	0.2	0	0	23.33333333	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0		6.6625	0.542347849	1.524412863	0	3.205694241	2.474384891	0.04943176	0.796575455	1.17998079	0	0.035119997	0	0.630912791	0	4.21103185	5.34067624	0.541604174	0	0	0.19426481	2.386769097	0	0	3.010824368	0.732682872	0	0.068604755	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5878			6.6625	0.542347849	1.524412863	0	3.205694241	2.474384891	0.04943176	0.796575455	1.17998079	0	0.035119997	0	0.630912791	0	4.21103185	5.34067624	0.541604174	0	0	0.19426481	2.386769097	0	0	3.010824368	0.732682872	0	0.068604755	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5878	NO																																																																																		0			6.6625	0.542347849	1.524412863	0	3.205694241	2.474384891	0.04943176	0.796575455	1.17998079	0	0.035119997	0	0.630912791	0	4.21103185	5.34067624	0.541604174	0	0	0.19426481	2.386769097	0	0	3.010824368	0.732682872	0	0.068604755	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5878
H0562_045_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	223.5583275	5.339768237	55.10124728	129.8095946	264.2550113	18.84533069	0.312757729	300.5895562	311.4158051	88.05831252	1.659058966	28.17166244	247.7137292	87.8775826	7520.87976	6676.892907	191.9680655	16528.61656	3696.433071	211.2659175	12.86558776	0	0	0	1763.227005	0	90.59158631	0	513.8409728	0	0	0	0	0	0	0	0	0	0	0		"$250 per day days 1-7, $0 per day days 9-90"	$900 per admission	$0 per visit	$0 per visit	$125 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$10 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $10 per visit		Hearing exams - $10 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	949.6225984	900	0	0	125	0.2	0.2	50	250	0	110.4008667	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	949.6225984	900	0	0	125	0.2	0.2	50	250	0	110.4008667	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0		17.6913	0.400482618	0	0	2.752656367	3.769066138	0.062551546	1.252456484	6.487829273	0	0.015263462	0	0.516070269	0	6.2673998	5.564077423	0.39993347	0	0	0.176054931	2.573117551	0	0	0	1.469355837	0	0.075492989	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4731			17.6913	0.400482618	0	0	2.752656367	3.769066138	0.062551546	1.252456484	6.487829273	0	0.015263462	0	0.516070269	0	6.2673998	5.564077423	0.39993347	0	0	0.176054931	2.573117551	0	0	0	1.469355837	0	0.075492989	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4731	NO																																																																																		0			17.6913	0.400482618	0	0	2.752656367	3.769066138	0.062551546	1.252456484	6.487829273	0	0.015263462	0	0.516070269	0	6.2673998	5.564077423	0.39993347	0	0	0.176054931	2.573117551	0	0	0	1.469355837	0	0.075492989	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4731
H0562_048_0	2010	2	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	228.902441	7.09049306	59.20106464	189.9961373	243.7492512	15.4032812	0.106616432	252.630093	213.2638533	1.876215804	0	0.375243161	133.9618084	31.54328696	6742.832833	5986.157757	254.9077368	15823.67112	4050.735467	491.8083351	13.45274802	0	0	1545.352605	1228.627054	0	89.91774204	0	515.1175349	0	0	0	0	0	0	0	0	0	0	0		"$200 per day days 1-5, $0 per day days 6-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$125 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$200 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$12 per office visit	$25 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate			"One time annual $35 deductible, $500 annual max"	Vision exams - $25 per visit	$100 Max	Hearing exams - $25 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	662.6029277	900	297.25	0	125	0.2	0.2	50	200	0	110.4008667	0	25	0	12	25	25	0	0	10	0.2	0	0	23.33333333	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	662.6029277	900	297.25	0	125	0.2	0.2	50	200	0	110.4008667	0	25	0	12	25	25	0	0	10	0.2	0	0	23.33333333	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0		12.6393	0.53178698	1.466459705	0	2.5390547	3.08065624	0.021323286	1.052625388	3.554397555	0	0	0	0.279087101	0	6.742832833	12.47116199	0.531057785	0	0	0.409840279	2.690549604	0	0	3.004852287	2.559639695	0	0.187328629	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7619			12.6393	0.53178698	1.466459705	0	2.5390547	3.08065624	0.021323286	1.052625388	3.554397555	0	0	0	0.279087101	0	6.742832833	12.47116199	0.531057785	0	0	0.409840279	2.690549604	0	0	3.004852287	2.559639695	0	0.187328629	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7619	NO																																																																																		0			12.6393	0.53178698	1.466459705	0	2.5390547	3.08065624	0.021323286	1.052625388	3.554397555	0	0	0	0.279087101	0	6.742832833	12.47116199	0.531057785	0	0	0.409840279	2.690549604	0	0	3.004852287	2.559639695	0	0.187328629	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7619
H0562_053_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	189.5867423	7.098986426	28.65660803	130.3787562	207.223976	14.3298903	0.379279831	295.407691	357.9485264	140.5349046	5.896924136	7.707556366	81.69963726	127.3767842	7469.686974	6631.444932	255.2130787	17712.96076	4447.236989	462.014422	12.37235851	0	0	0	1448.247644	0	70.73014554	0	508.6649176	0	0	0	0	0	0	0	0	0	0	0		"$150 per day days 1-4, $0 per day days 5-90"	$900 per admission	$0 per visit	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$150 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$20 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $25 per visit		Hearing exams - $25 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	443.4212031	900	0	0	180	0.2	0.2	50	150	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	443.4212031	900	0	0	180	0.2	0.2	50	150	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0		7.0056	0.532423982	0	0	3.10835964	2.865978059	0.075855966	1.230865379	4.47435658	0	0.054252128	0	0.170207578	0	6.224739145	11.05240822	0.531693914	0	0	0.385012018	2.474471701	0	0	0	3.017182592	0	0.14735447	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3507			7.0056	0.532423982	0	0	3.10835964	2.865978059	0.075855966	1.230865379	4.47435658	0	0.054252128	0	0.170207578	0	6.224739145	11.05240822	0.531693914	0	0	0.385012018	2.474471701	0	0	0	3.017182592	0	0.14735447	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3507	NO																																																																																		0			7.0056	0.532423982	0	0	3.10835964	2.865978059	0.075855966	1.230865379	4.47435658	0	0.054252128	0	0.170207578	0	6.224739145	11.05240822	0.531693914	0	0	0.385012018	2.474471701	0	0	0	3.017182592	0	0.14735447	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3507
H0562_055_0	2010	5	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	353.6946084	8.547484452	63.04815927	272.88549	414.8579605	17.40818534	0.093796703	478.8501125	225.3438179	0.484312211	7.549724025	0.484312211	354.6851328	47.85996062	6445.279764	5721.995845	307.2875043	14163.05447	2997.865871	62.54198391	18.06146888	0	6000	1500	569.9664547	246	59.01432695	0	517.7284963	0	0	0	0	0	0	0	0	0	0	0		$0 per visit	$900 per admission	"$0 per day days 1-20, $50 per day days 21-100"	$0 per visit	$50 per trip	15% based on Medicare Allowable cost	15% based on Medicare Allowable cost	"$20 per visit, waived if admitted"	$0 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	$0 per visit	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$0 per office visit	$0 per office visit	$10 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $0 per visit	20% of contracted rate		"$0 per trip, 48 trips per year"	$0 per visit	Vision exams - $0 per visit	$100 Max	Hearing exams - $0 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	0	900	198.1666667	0	50	0.15	0.15	20	0	0	0	0	25	0	0	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	900	198.1666667	0	50	0.15	0.15	20	0	0	0	0	25	0	0	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0.641061334	1.041170297	0	1.728574835	2.611227801	0.014069505	0.798083521	0	0	0	0	0.73892736	0	0	0	0.25607292	0	0	0	3.612293776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.4415			0	0.641061334	1.041170297	0	1.728574835	2.611227801	0.014069505	0.798083521	0	0	0	0	0.73892736	0	0	0	0.25607292	0	0	0	3.612293776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.4415	NO																																																																																		0			0	0.641061334	1.041170297	0	1.728574835	2.611227801	0.014069505	0.798083521	0	0	0	0	0.73892736	0	0	0	0.25607292	0	0	0	3.612293776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.4415
H0562_058_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	279.0050093	2.631607018	61.19440723	152.4674214	290.414136	18.88761987	0.495566146	380.4161506	307.5477049	71.79685096	8.895483708	1.07159479	352.5546861	76.08323012	7957.828311	7064.807456	94.60794663	19336.46986	3679.44673	373.0883543	7.85068334	0	0	0	1795.487705	0	61.38126417	0	513.169029	0	0	0	0	0	0	0	0	0	0	0		"$100 per day days 1-4, $0 per day days 5-90"	$900 per admission	$0 per visit	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$100 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$15 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $15 per visit		Hearing exams - $15 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	295.6141354	900	0	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	10	15	25	0	0	10	0.2	0	0	0	15	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	295.6141354	900	0	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	10	15	25	0	0	10	0.2	0	0	0	15	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0		6.8732	0.197370526	0	0	4.35621204	3.777523973	0.099113229	1.585067294	2.562897541	0	0.081839093	0	0.734488929	0	6.631523592	8.83100932	0.197099889	0	0	0.310906962	1.570136668	0	0	0	2.244359631	0	0.07672658	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1294			6.8732	0.197370526	0	0	4.35621204	3.777523973	0.099113229	1.585067294	2.562897541	0	0.081839093	0	0.734488929	0	6.631523592	8.83100932	0.197099889	0	0	0.310906962	1.570136668	0	0	0	2.244359631	0	0.07672658	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1294	NO																																																																																		0			6.8732	0.197370526	0	0	4.35621204	3.777523973	0.099113229	1.585067294	2.562897541	0	0.081839093	0	0.734488929	0	6.631523592	8.83100932	0.197099889	0	0	0.310906962	1.570136668	0	0	0	2.244359631	0	0.07672658	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1294
H0562_059_0	2010	5	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	237.1432009	7.111433656	50.3480642	171.7064623	242.2191164	21.7372667	0.504422684	378.3545159	341.2997076	60.37630206	3.722403167	3.909256968	300.8847792	98.99294344	7315.482026	6494.544735	255.6605646	17494.53926	4207.333139	484.1381731	13.60569862	0	0	0	1463.631059	0	75.16847954	0	509.5568012	0	0	0	0	0	0	0	0	0	0	0		"$250 per day days 1-7, $0 per day days 9-90"	$900 per admission	$0 per visit	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$20 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $25 per visit		Hearing exams - $25 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	949.6225984	900	0	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	949.6225984	900	0	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0		18.7664	0.533357524	0	0	3.633286746	4.34745334	0.100884537	1.57647715	7.110410574	0	0.034246378	0	0.62684329	0	6.096235021	10.82424122	0.532626176	0	0	0.403448478	2.721139724	0	0	0	3.049231374	0	0.156600999	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5129			18.7664	0.533357524	0	0	3.633286746	4.34745334	0.100884537	1.57647715	7.110410574	0	0.034246378	0	0.62684329	0	6.096235021	10.82424122	0.532626176	0	0	0.403448478	2.721139724	0	0	0	3.049231374	0	0.156600999	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5129	NO																																																																																		0			18.7664	0.533357524	0	0	3.633286746	4.34745334	0.100884537	1.57647715	7.110410574	0	0.034246378	0	0.62684329	0	6.096235021	10.82424122	0.532626176	0	0	0.403448478	2.721139724	0	0	0	3.049231374	0	0.156600999	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5129
H0562_060_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	184.0474118	6.955597596	26.58849912	85.28386509	140.7183774	26.12910913	0.517073247	215.8081642	239.1996454	72.04496361	10.12400234	4.664781817	62.45624543	63.75201816	7026.603426	6238.083851	250.058159	16919.44971	3924.778152	489.9085119	13.18586134	0	0	0	1441.428486	0	76.83681657	0	498.3906527	0	0	0	0	0	0	0	0	0	0	0		"$100 per day days 1-4, $0 per day days 5-90"	$900 per admission	$0 per visit	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$100 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$10 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $20 per visit		Hearing exams - $20 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	295.6141354	900	0	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	10	10	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	295.6141354	900	0	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	10	10	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0		4.5339	0.52166982	0	0	2.110775661	5.225821825	0.103414649	0.899200684	1.993330378	0	0.093141553	0	0.130117178	0	5.855502855	5.198403209	0.520954498	0	0	0.408257093	2.637172268	0	0	0	2.402380809	0	0.128061361	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7621			4.5339	0.52166982	0	0	2.110775661	5.225821825	0.103414649	0.899200684	1.993330378	0	0.093141553	0	0.130117178	0	5.855502855	5.198403209	0.520954498	0	0	0.408257093	2.637172268	0	0	0	2.402380809	0	0.128061361	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7621	NO																																																																																		0			4.5339	0.52166982	0	0	2.110775661	5.225821825	0.103414649	0.899200684	1.993330378	0	0.093141553	0	0.130117178	0	5.855502855	5.198403209	0.520954498	0	0	0.408257093	2.637172268	0	0	0	2.402380809	0	0.128061361	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7621
H0562_061_0	2010	5	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	253.526378	7.152759045	41.82226172	147.1808191	214.092607	15.96561197	1.375903968	274.9560622	416.1796383	154.5752755	2.802941801	9.818072746	40.01002116	94.62456232	7502.228339	6660.334533	257.1462386	17811.28396	4445.331861	468.5765407	13.60757878	0	0	0	1461.063203	0	71.88581702	0	512.5178965	0	0	0	0	0	0	0	0	0	0	0		"$250 per day days 1-7, $0 per day days 9-90"	$900 per admission	$0 per visit	$0 per visit	$125 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$20 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $20 per visit		Hearing exams - $20 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	949.6225984	900	0	0	125	0.2	0.2	50	250	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	949.6225984	900	0	0	125	0.2	0.2	50	250	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0		20.0629	0.536456928	0	0	2.230131323	3.193122395	0.275180794	1.145650259	8.670409132	0	0.025787267	0	0.083354211	0	6.251856949	11.10055755	0.53572133	0	0	0.390480451	2.721515757	0	0	0	2.435105338	0	0.119809695	0	0	0	0	0	0	0	0	0	0	0	0	0	59.778			20.0629	0.536456928	0	0	2.230131323	3.193122395	0.275180794	1.145650259	8.670409132	0	0.025787267	0	0.083354211	0	6.251856949	11.10055755	0.53572133	0	0	0.390480451	2.721515757	0	0	0	2.435105338	0	0.119809695	0	0	0	0	0	0	0	0	0	0	0	0	0	59.778	NO																																																																																		0			20.0629	0.536456928	0	0	2.230131323	3.193122395	0.275180794	1.145650259	8.670409132	0	0.025787267	0	0.083354211	0	6.251856949	11.10055755	0.53572133	0	0	0.390480451	2.721515757	0	0	0	2.435105338	0	0.119809695	0	0	0	0	0	0	0	0	0	0	0	0	0	59.778
H0562_062_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	287.8289428	7.045436333	63.92211593	146.5512503	289.8607786	14.87628272	0.933045761	290.0676714	446.557434	76.7108976	4.540034138	6.70564577	156.0145201	99.15895872	7365.983554	6539.379024	253.2879188	17508.72758	4343.574875	464.5623923	12.37616062	0	0	0	1440.958696	0	71.41782612	0	504.8278834	0	0	0	0	0	0	0	0	0	0	0		"$150 per day days 1-4, $0 per day days 5-90"	$900 per admission	$0 per visit	$0 per visit	$125 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$150 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$20 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $20 per visit		Hearing exams - $20 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	443.4212031	900	0	0	125	0.2	0.2	50	150	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	443.4212031	900	0	0	125	0.2	0.2	50	150	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0		10.6358	0.528407725	0	0	3.01938311	2.975256543	0.186609152	1.208615297	5.581967925	0	0.041768642	0	0.32503025	0	6.138319628	10.89896504	0.527683164	0	0	0.387135327	2.475232124	0	0	0	2.401597827	0	0.11902971	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4508			10.6358	0.528407725	0	0	3.01938311	2.975256543	0.186609152	1.208615297	5.581967925	0	0.041768642	0	0.32503025	0	6.138319628	10.89896504	0.527683164	0	0	0.387135327	2.475232124	0	0	0	2.401597827	0	0.11902971	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4508	NO																																																																																		0			10.6358	0.528407725	0	0	3.01938311	2.975256543	0.186609152	1.208615297	5.581967925	0	0.041768642	0	0.32503025	0	6.138319628	10.89896504	0.527683164	0	0	0.387135327	2.475232124	0	0	0	2.401597827	0	0.11902971	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4508
H0562_068_0	2010	4	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	302.3800387	6.699695378	69.82297692	341.4809058	377.9750484	14.22558887	0.300438245	290.4791156	308.7542918	70.98463156	14.30807436	11.15747596	252.5821714	125.81016	7906.018244	7018.811471	240.8583115	15979.11234	3570.856294	403.1387536	18.09301059	0	0	0	1372.897895	0	121.0459761	0	509.9162079	0	0	0	0	0	0	0	0	0	0	0		"$250 per day days 1-7, $0 per day days 9-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$20 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $20 per visit		Hearing exams - $20 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	20	25	0	0	10	0.2	0	0	0	20	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0		23.9289	0.502477153	1.729573324	0	5.669625726	2.845117774	0.060087649	1.210329648	6.432381078	0	0.131635318	0	0.526212857	0	6.588348536	11.69801912	0.501788149	0	0	0.335948961	3.618602117	0	0	0	2.288163159	0	0.201743293	0	0	0	0	0	0	0	0	0	0	0	0	0	68.269			23.9289	0.502477153	1.729573324	0	5.669625726	2.845117774	0.060087649	1.210329648	6.432381078	0	0.131635318	0	0.526212857	0	6.588348536	11.69801912	0.501788149	0	0	0.335948961	3.618602117	0	0	0	2.288163159	0	0.201743293	0	0	0	0	0	0	0	0	0	0	0	0	0	68.269	NO																																																																																		0			23.9289	0.502477153	1.729573324	0	5.669625726	2.845117774	0.060087649	1.210329648	6.432381078	0	0.131635318	0	0.526212857	0	6.588348536	11.69801912	0.501788149	0	0	0.335948961	3.618602117	0	0	0	2.288163159	0	0.201743293	0	0	0	0	0	0	0	0	0	0	0	0	0	68.269
H0562_070_0	2010	5	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	376.1473482	0	44.97413844	11.34356332	19.21835649	19.59966209	0.482210337	48.59735313	24.61702534	0.142982889	1.567890548	0.167608606	7.719701354	3.90547235	94.43438816	260.0495518	19.01128335	71.29231256	61.63744576	5.716701947	17.49820282	1.555395806	6000	1500	566.9432837	246	0	0	523.4746879	0	0	0	0	0	0	0	0	0	0	0		Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	"$0 per trip, unlimited trips per year"	$0 per visit	Vision exams - $0 per visit	$100 Max			$0 per visit		0	0	0	0	0	0	0	0	0	0	0.06503431	0.06503431	0.146871558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.06503431	0.06503431	0.146871558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		24.4625	0	6.605421789	0	4.477877063	4.566721266	0.112355009	11.32318328	5.735766903	0.033315013	0.365318498	0.039052805	1.798690415	0.909975058	22.00321244	60.59154556	4.42962902	16.61110883	14.36152486	1.331991554	4.077081257	0.362407223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.1987			24.4625	0	6.605421789	0	4.477877063	4.566721266	0.112355009	11.32318328	5.735766903	0.033315013	0.365318498	0.039052805	1.798690415	0.909975058	22.00321244	60.59154556	4.42962902	16.61110883	14.36152486	1.331991554	4.077081257	0.362407223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.1987	NO																																																																																		0			24.4625	0	6.605421789	0	4.477877063	4.566721266	0.112355009	11.32318328	5.735766903	0.033315013	0.365318498	0.039052805	1.798690415	0.909975058	22.00321244	60.59154556	4.42962902	16.61110883	14.36152486	1.331991554	4.077081257	0.362407223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	184.1987
H0562_071_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	239.3100299	7.220034056	43.12025926	150.4022789	212.0449862	13.22038595	0.545517961	257.0454634	187.3875207	0.612377519	0.013917671	0.15309438	109.9217646	39.19216119	5830.496658	5176.203186	259.564818	11144.8124	2599.253445	593.5107196	12.52677672	0	0	0	1382.369831	0	89.58652371	0	506.9710018	0	0	0	0	0	0	0	0	0	0	0		$0 per visit	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$0 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$0 per office visit	$0 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $0 per visit	20% of contracted rate				Vision exams - $30 per visit		Hearing exams - $30 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	0	900	297.25	0	180	0.2	0.2	50	0	0	110.4008667	0	25	0	0	0	25	0	0	0	0.2	0	0	0	30	0	30	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	900	297.25	0	180	0.2	0.2	50	0	0	110.4008667	0	25	0	0	0	25	0	0	0	0.2	0	0	0	30	0	30	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0.541502554	1.068124755	0	3.180674794	2.64407719	0.109103592	1.071022764	0	0	0.000128044	0	0.229003676	0	0	0	0.540760038	0	0	0	2.505355343	0	0	0	3.455924578	0	0.223966309	0	0	0	0	0	0	0	0	0	0	0	0	0	15.5696			0	0.541502554	1.068124755	0	3.180674794	2.64407719	0.109103592	1.071022764	0	0	0.000128044	0	0.229003676	0	0	0	0.540760038	0	0	0	2.505355343	0	0	0	3.455924578	0	0.223966309	0	0	0	0	0	0	0	0	0	0	0	0	0	15.5696	NO																																																																																		0			0	0.541502554	1.068124755	0	3.180674794	2.64407719	0.109103592	1.071022764	0	0	0.000128044	0	0.229003676	0	0	0	0.540760038	0	0	0	2.505355343	0	0	0	3.455924578	0	0.223966309	0	0	0	0	0	0	0	0	0	0	0	0	0	15.5696
H0562_076_0	2010	4	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	287.1834047	7.267572939	41.80437739	282.6229272	320.2468668	14.15603398	0.466800064	284.4057805	325.2408489	3.533803992	5.61274207	0.261763259	386.1008065	156.5344287	5957.363244	5288.83291	261.2738711	7806.317232	2821.916674	289.1418227	13.40441685	0	0	0	2171.315574	0	116.9878822	0	510.8789855	0	0	0	0	0	0	0	0	0	0	0		"$250 per day days 1-7, $0 per day days 9-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$10 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $10 per visit		Hearing exams - $10 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	10	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0		22.7263	0.54506797	1.035529265	0	4.803703002	2.831206796	0.093360013	1.185024085	6.775851018	0	0.051637632	0	0.80437668	0	4.96446937	4.407360759	0.544320565	0	0	0.240951519	2.680883371	0	0	0	1.809429645	0	0.097489902	0	0	0	0	0	0	0	0	0	0	0	0	0	55.597			22.7263	0.54506797	1.035529265	0	4.803703002	2.831206796	0.093360013	1.185024085	6.775851018	0	0.051637632	0	0.80437668	0	4.96446937	4.407360759	0.544320565	0	0	0.240951519	2.680883371	0	0	0	1.809429645	0	0.097489902	0	0	0	0	0	0	0	0	0	0	0	0	0	55.597	NO																																																																																		0			22.7263	0.54506797	1.035529265	0	4.803703002	2.831206796	0.093360013	1.185024085	6.775851018	0	0.051637632	0	0.80437668	0	4.96446937	4.407360759	0.544320565	0	0	0.240951519	2.680883371	0	0	0	1.809429645	0	0.097489902	0	0	0	0	0	0	0	0	0	0	0	0	0	55.597
H0562_077_0	2010	4	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	267.313448	7.072267803	57.50966609	296.068281	282.2233614	15.51759829	2.09229927	407.1174178	255.2736241	8.802538763	1.700490443	1.100317345	148.5428416	103.4298305	8404.93275	7461.738208	254.2525272	22510.43466	5651.287243	485.7144171	22.03207213	0	0	0	1336.524171	0	160.2857576	0	510.8789855	0	0	0	0	0	0	0	0	0	0	0		"$250 per day days 1-7, $0 per day days 9-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$15 per office visit	$25 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $30 per visit		Hearing exams - $30 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	15	25	25	0	0	10	0.2	0	0	0	30	0	30	0	0	10	0	0	0	0	0	0	0	0	0	0	NO	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	15	25	25	0	0	10	0.2	0	0	0	30	0	30	0	0	10	0	0	0	0	0	0	0	0	0	0		21.1539	0.530420085	1.424562354	0	4.233350421	3.103519659	0.418459854	1.696322574	5.318200502	0	0.015644635	0	0.309464253	0	10.50616594	15.54528793	0.529692765	0	0	0.404762014	4.406414426	0	0	0	3.341310428	0	0.400714394	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3382			21.1539	0.530420085	1.424562354	0	4.233350421	3.103519659	0.418459854	1.696322574	5.318200502	0	0.015644635	0	0.309464253	0	10.50616594	15.54528793	0.529692765	0	0	0.404762014	4.406414426	0	0	0	3.341310428	0	0.400714394	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3382	NO																																																																																		0			21.1539	0.530420085	1.424562354	0	4.233350421	3.103519659	0.418459854	1.696322574	5.318200502	0	0.015644635	0	0.309464253	0	10.50616594	15.54528793	0.529692765	0	0	0.404762014	4.406414426	0	0	0	3.341310428	0	0.400714394	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3382
H0562_079_0	2010	5	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	284.3040301	7.156981034	72.11770775	214.7505075	352.7357217	13.53983432	0.405178363	256.9756601	164.2524838	0.993462604	6.193649277	0.165577101	425.8643028	55.4683287	7118.469188	6319.640513	257.2980218	16191.14865	3336.252941	230.1872033	13.04583077	0	0	0	866.3077126	0	82.64816727	0	510.8364	0	0	0	0	0	0	0	0	0	0	0		"$250 per day days 1-7, $0 per day days 9-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$250 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$8 per office visit	$10 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $10 per visit		Hearing exams - $10 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	8	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	949.6225984	900	297.25	0	180	0.2	0.2	50	250	0	110.4008667	0	25	0	8	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0		22.4985	0.536773578	1.786415719	0	5.291035825	2.707966864	0.081035673	1.070731917	3.421926746	0	0.056982021	0	0.887217297	0	4.745646125	5.266367095	0.536037545	0	0	0.191822669	2.609166154	0	0	0	0.721923094	0	0.068873473	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4784			22.4985	0.536773578	1.786415719	0	5.291035825	2.707966864	0.081035673	1.070731917	3.421926746	0	0.056982021	0	0.887217297	0	4.745646125	5.266367095	0.536037545	0	0	0.191822669	2.609166154	0	0	0	0.721923094	0	0.068873473	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4784	NO																																																																																		0			22.4985	0.536773578	1.786415719	0	5.291035825	2.707966864	0.081035673	1.070731917	3.421926746	0	0.056982021	0	0.887217297	0	4.745646125	5.266367095	0.536037545	0	0	0.191822669	2.609166154	0	0	0	0.721923094	0	0.068873473	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4784
H0562_081_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	Coin	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	285.6072789	7.070280059	48.82789432	175.5650024	355.258834	15.24555387	0.332329587	469.6060314	136.8756916	1.669215752	2.153628	1.669215752	46.36710421	56.75333555	5627.663269	4996.131591	254.1810665	12351.93793	2613.753716	69.40379389	14.42766892	0	6000	1500	582.9234905	0	56.18402362	0	503.6254736	0	0	0	0	0	0	0	0	0	0	0		"$50 per day days 1-8, $0 per day days 9-90"	$900 per admission	"$0 per day days 1-20, $20 per day days 21-100"	$0 per visit	$125 per trip	10% based on Medicare Allowable cost	10% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$25 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	10% advanced radiology	Outpatient observation services - $0 per visit	$0 per office visit	$0 per office visit	$10 per office visit	$10 per office visit	$25 per visit	"Occupational therapy services - $10 per visit, physical/speech therapy - $10 per visit"	$0 per visit	Chiropractic services - $10 per visit	10% of contracted rate		"$0 per trip, 48 trips per year"	$0 per visit	Vision exams - $10 per visit		Hearing exams - $0 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	198.2873971	900	79.26666667	0	125	0.1	0.1	50	25	0	0.1	0	25	0	10	10	25	10	0	10	0.2	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	198.2873971	900	79.26666667	0	125	0.1	0.1	50	25	0	0.1	0	25	0	10	10	25	10	0	10	0.2	0	0	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		4.7194	0.530271004	0.322535369	0	3.700612854	1.524555387	0.033232959	1.956691798	0.285157691	0	0.2153628	0	0.096598134	0	4.689719391	4.163442993	0.529543889	10.29328161	0	0.057836495	2.885533783	0	0	0	0.485769575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4895			4.7194	0.530271004	0.322535369	0	3.700612854	1.524555387	0.033232959	1.956691798	0.285157691	0	0.2153628	0	0.096598134	0	4.689719391	4.163442993	0.529543889	10.29328161	0	0.057836495	2.885533783	0	0	0	0.485769575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4895	NO																																																																																		0			4.7194	0.530271004	0.322535369	0	3.700612854	1.524555387	0.033232959	1.956691798	0.285157691	0	0.2153628	0	0.096598134	0	4.689719391	4.163442993	0.529543889	10.29328161	0	0.057836495	2.885533783	0	0	0	0.485769575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4895
H0562_082_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	245.3976349	7.275689657	45.09725478	152.0384057	219.9480145	13.20923	0.513530391	261.847394	188.2794477	0.54494775	0.012385176	0.136236938	106.5372852	40.87108127	6826.235662	6060.20119	261.5656723	14819.45983	3089.42232	353.7569129	12.64826616	0	0	0	883.4894223	0	70.09475721	0	510.8789855	0	0	0	0	0	0	0	0	0	0	0		$0 per visit	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$0 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$0 per office visit	$0 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $0 per visit	20% of contracted rate				Vision exams - $30 per visit		Hearing exams - $30 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	0	900	297.25	0	180	0.2	0.2	50	0	0	110.4008667	0	25	0	0	0	25	0	0	0	0.2	0	0	0	30	0	30	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	900	297.25	0	180	0.2	0.2	50	0	0	110.4008667	0	25	0	0	0	25	0	0	0	0.2	0	0	0	30	0	30	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0.545676724	1.117096582	0	3.299220218	2.641845999	0.102706078	1.091030808	0	0	0.000113945	0	0.221952677	0	0	0	0.544928484	0	0	0	2.529653232	0	0	0	2.208723556	0	0.175236893	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4782			0	0.545676724	1.117096582	0	3.299220218	2.641845999	0.102706078	1.091030808	0	0	0.000113945	0	0.221952677	0	0	0	0.544928484	0	0	0	2.529653232	0	0	0	2.208723556	0	0.175236893	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4782	NO																																																																																		0			0	0.545676724	1.117096582	0	3.299220218	2.641845999	0.102706078	1.091030808	0	0	0.000113945	0	0.221952677	0	0	0	0.544928484	0	0	0	2.529653232	0	0	0	2.208723556	0	0.175236893	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4782
H0562_083_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	284.3277309	7.157577671	72.12371979	214.76841	352.7651272	13.53983432	0.405178363	256.9970827	164.2661766	0.993545423	6.194165606	0.165590904	425.8998046	55.47295278	7119.062614	6320.167346	257.3194712	16192.49842	3336.531066	230.2063927	13.04583077	0	0	0	866.3799318	0	82.65505718	0	510.8789855	0	0	0	0	0	0	0	0	0	0	0		"$100 per day days 1-4, $0 per day days 5-90"	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$100 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$8 per office visit	$10 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $10 per visit		Hearing exams - $10 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	295.6141354	900	297.25	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	8	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	295.6141354	900	297.25	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	8	10	25	0	0	10	0.2	0	0	0	10	0	10	0	0	0	0	0	0	0	0	0	0	0	0	0		7.0043	0.536818325	1.786564642	0	5.291476909	2.707966864	0.081035673	1.070821178	1.368884805	0	0.056986771	0	0.88729126	0	4.746041743	5.266806122	0.536082232	0	0	0.191838661	2.609166154	0	0	0	0.721983276	0	0.068879214	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9329			7.0043	0.536818325	1.786564642	0	5.291476909	2.707966864	0.081035673	1.070821178	1.368884805	0	0.056986771	0	0.88729126	0	4.746041743	5.266806122	0.536082232	0	0	0.191838661	2.609166154	0	0	0	0.721983276	0	0.068879214	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9329	NO																																																																																		0			7.0043	0.536818325	1.786564642	0	5.291476909	2.707966864	0.081035673	1.070821178	1.368884805	0	0.056986771	0	0.88729126	0	4.746041743	5.266806122	0.536082232	0	0	0.191838661	2.609166154	0	0	0	0.721983276	0	0.068879214	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9329
H0562_084_0	2010	4	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	288.1184671	5.308987652	78.62937477	172.8710803	318.7754074	21.40183179	0.558495944	318.790573	295.0352497	106.752317	2.522735349	43.40478823	439.7960839	83.2902693	7429.864644	6596.091431	190.8614839	16324.57895	3642.972897	212.6517312	13.49055235	0	0	0	1741.47246	0	90.4380926	0	510.8789855	0	0	0	0	0	0	0	0	0	0	0		"$100 per day days 1-4, $0 per day days 5-90"	$900 per admission	$0 per visit	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$100 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$10 per office visit	$15 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $10 per visit	20% of contracted rate				Vision exams - $15 per visit		Hearing exams - $15 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	295.6141354	900	0	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	10	15	25	0	0	10	0.2	0	0	0	15	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	295.6141354	900	0	0	180	0.2	0.2	50	100	0	110.4008667	0	25	0	10	15	25	0	0	10	0.2	0	0	0	15	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0		7.0977	0.398174074	0	0	4.781631112	4.280366359	0.111699189	1.328294054	2.458627081	0	0.023209347	0	0.916241842	0	6.19155387	8.245114289	0.397628091	0	0	0.177209776	2.698110469	0	0	0	2.176840575	0	0.113047616	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3954			7.0977	0.398174074	0	0	4.781631112	4.280366359	0.111699189	1.328294054	2.458627081	0	0.023209347	0	0.916241842	0	6.19155387	8.245114289	0.397628091	0	0	0.177209776	2.698110469	0	0	0	2.176840575	0	0.113047616	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3954	NO																																																																																		0			7.0977	0.398174074	0	0	4.781631112	4.280366359	0.111699189	1.328294054	2.458627081	0	0.023209347	0	0.916241842	0	6.19155387	8.245114289	0.397628091	0	0	0.177209776	2.698110469	0	0	0	2.176840575	0	0.113047616	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3954
H0562_085_0	2010	3	N/A																															A	BP	A	V	T	Coin	Coin	V	V	V	V	O	V	O	V	V	V	V	P	V	Coin	O	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	284.3277309	7.157577671	72.12371979	214.76841	352.7651272	13.53983432	0.405178363	256.9970827	164.2661766	0.993545423	6.194165606	0.165590904	425.8998046	55.47295278	7119.062614	6320.167346	257.3194712	16192.49842	3336.531066	230.2063927	13.04583077	0	6000	0	866.3799318	0	82.65505718	0	510.8789855	0	0	0	0	0	0	0	0	0	0	0		$0 per visit	$900 per admission	"$0 per day days 1-20, $75 per day days 21-100"	$0 per visit	$180 per trip	20% based on Medicare Allowable cost	20% based on Medicare Allowable cost	"$50 per visit, waived if admitted"	$0 per surgical visit (hospital facility & ASC)	Outpatient lab services - $0 per visit	"$0 copay <$1K, $100 copay $1K-$2K, $250 copay $2K+"	Outpatient observation services - $0 per visit	$25 per office visit	$0 per office visit	$0 per office visit	$0 per office visit	$25 per visit	"Occupational therapy services - $0 per visit, physical/speech therapy - $0 per visit"	$0 per visit	Chiropractic services - $0 per visit	20% of contracted rate		"$0 per trip, 48 trips per year"		Vision exams - $25 per visit		Hearing exams - $25 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	0	900	297.25	0	180	0.2	0.2	50	0	0	110.4008667	0	25	0	0	0	25	0	0	0	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	900	297.25	0	180	0.2	0.2	50	0	0	110.4008667	0	25	0	0	0	25	0	0	0	0.2	0	0	0	25	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0.536818325	1.786564642	0	5.291476909	2.707966864	0.081035673	1.070821178	0	0	0.056986771	0	0.88729126	0	0	0	0.536082232	0	0	0	2.609166154	0	0	0	1.804958191	0	0.172198036	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5414			0	0.536818325	1.786564642	0	5.291476909	2.707966864	0.081035673	1.070821178	0	0	0.056986771	0	0.88729126	0	0	0	0.536082232	0	0	0	2.609166154	0	0	0	1.804958191	0	0.172198036	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5414	NO																																																																																		0			0	0.536818325	1.786564642	0	5.291476909	2.707966864	0.081035673	1.070821178	0	0	0.056986771	0	0.88729126	0	0	0	0.536082232	0	0	0	2.609166154	0	0	0	1.804958191	0	0.172198036	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5414
H0562_801_0	2010	5	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	252.7580663	0	30.51190379	13.11429787	9.677662412	14.0265954	0.629722183	17.79682707	44.64676898	6.466491722	6.710020672	1.824209649	17.61538796	12.99118737	62.13886209	180.1785384	12.48417776	46.81566659	39.7127429	4.085120504	13.93243996	1.548048884	0	0	0	0	0	0	520.2	0	0	0	0	0	0	0	0	0	0	0		Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits				Vision exams - $0 per visit		Hearing exams - $0 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	0.06292239	0.06292239	0.134050225	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.06292239	0.06292239	0.134050225	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		15.9041	0	4.090127578	0	2.254895342	3.268196729	0.146725269	4.146660707	10.40269717	1.506692571	1.563434817	0.425040848	4.104385394	3.026946658	14.47835487	41.98159944	2.908813418	10.90805032	9.253069096	0.951833078	3.24625851	0.36069539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.9286			15.9041	0	4.090127578	0	2.254895342	3.268196729	0.146725269	4.146660707	10.40269717	1.506692571	1.563434817	0.425040848	4.104385394	3.026946658	14.47835487	41.98159944	2.908813418	10.90805032	9.253069096	0.951833078	3.24625851	0.36069539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.9286	NO																																																																																		0			15.9041	0	4.090127578	0	2.254895342	3.268196729	0.146725269	4.146660707	10.40269717	1.506692571	1.563434817	0.425040848	4.104385394	3.026946658	14.47835487	41.98159944	2.908813418	10.90805032	9.253069096	0.951833078	3.24625851	0.36069539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.9286
H0562_803_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	255.0599128	0	30.78977314	13.23372868	9.765796072	14.15433443	0.63545701	17.95890128	45.05336336	6.52538152	6.771128267	1.840822574	17.77580982	13.10949703	62.67997021	181.7475415	12.59289056	47.22333961	40.05856333	4.120693925	14.0537643	1.561529366	0	0	0	0	0	0	520.2	0	0	0	0	0	0	0	0	0	0	0		Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits				Vision exams - $0 per visit		Hearing exams - $0 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	0.062922392	0.062922392	0.134049285	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.062922392	0.062922392	0.134049285	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		16.049	0	4.127347074	0	2.275430485	3.297959922	0.148061483	4.184423998	10.49743366	1.520413894	1.577672886	0.42891166	4.141763688	3.054512808	14.60443306	42.34717718	2.934143501	11.00303813	9.333645256	0.960121685	3.274527081	0.363836342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.1238			16.049	0	4.127347074	0	2.275430485	3.297959922	0.148061483	4.184423998	10.49743366	1.520413894	1.577672886	0.42891166	4.141763688	3.054512808	14.60443306	42.34717718	2.934143501	11.00303813	9.333645256	0.960121685	3.274527081	0.363836342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.1238	NO																																																																																		0			16.049	0	4.127347074	0	2.275430485	3.297959922	0.148061483	4.184423998	10.49743366	1.520413894	1.577672886	0.42891166	4.141763688	3.054512808	14.60443306	42.34717718	2.934143501	11.00303813	9.333645256	0.960121685	3.274527081	0.363836342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.1238
H0562_804_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	256.7605247	0	30.99506395	13.32196456	9.830909517	14.24870845	0.639693919	18.07864225	45.35375666	6.568889501	6.816274765	1.853096258	17.89433003	13.1969046	63.07974272	182.9067264	12.67320795	47.52452981	40.31405663	4.146975689	14.14339913	1.571488792	0	0	0	0	0	0	520.2	0	0	0	0	0	0	0	0	0	0	0		Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits	Medicare level benefits				Vision exams - $0 per visit		Hearing exams - $0 per visit		$0 per visit		0	0	0	0	0	0	0	0	0	0	0.062922433	0.062922433	0.134050574	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.062922433	0.062922433	0.134050574	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		16.156	0	4.154906127	0	2.290601917	3.31994907	0.149048683	4.212323645	10.5674253	1.530551254	1.58819202	0.431771428	4.169378897	3.074878772	14.69758005	42.61726724	2.952857452	11.07321545	9.393175194	0.966245335	3.295411997	0.366156889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0069			16.156	0	4.154906127	0	2.290601917	3.31994907	0.149048683	4.212323645	10.5674253	1.530551254	1.58819202	0.431771428	4.169378897	3.074878772	14.69758005	42.61726724	2.952857452	11.07321545	9.393175194	0.966245335	3.295411997	0.366156889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0069	NO																																																																																		0			16.156	0	4.154906127	0	2.290601917	3.31994907	0.149048683	4.212323645	10.5674253	1.530551254	1.58819202	0.431771428	4.169378897	3.074878772	14.69758005	42.61726724	2.952857452	11.07321545	9.393175194	0.966245335	3.295411997	0.366156889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.0069
H0564_006_0	2010	8	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	"CORF, PH and CR"	ASC	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo-Radiation	D	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	904.6187921	14.53938606	302.5701816	460.4095274	316.0493625	8.067175802	1.982762471	308.9365662	212.3395837	10903.39069	500.2317254	93.96869048	0.672079915	173.5767996	4510.983056	3823.52061	49.41080925	2184.374195	5345.022805	0	46.00833948	0	0	1065.67984	378	179.4	162	0	0	0	1.342646548	168.2805414	239.940763	892.1705881	368.627529	126.0544023	1.178988892	484.5374521	1.812546961	19.76572124		$150/day (days 1-5); $1500 yrly max	$1068/admit	$130/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$125 copay	$0 copay	$30/$150 copay for Lower/Higher Tier	$125 copay	10% coinsurance	$30 copay	$5 coapy	$30 copay	$40 copay	$50/$30 OP/PR copay	$30/$150 copay for Lower/Higher Tier		20% coinsurance			1 exam/cleaning 1/yr. $20 annually	$20 copay	$100/$80 glasses/contacts	$30 copay		SilverSneakers		$30 copay	$30 copay	$75 copay	$30 copay	$30 copay	$0 copay	20% coinsurance	$20 copay	$30 copay	20% coinsurance	150	1068	130	0	100	0.2	0.2	50	125	0	68.97974494	125	0.1	30	5	30	40	35.64820787	41.90560349	0	0.2	0	0	10	20	0	30	0	0	0	30	30	75	30	30	0	0.2	20	30	0.2	NO	133.9636844	953.8214327	116.1018598	0	89.30912291	0.178618246	0.178618246	44.65456146	111.6364036	0	61.60520519	111.6364036	0.089309123	26.79273687	4.465456146	26.79273687	35.72364917	31.83710178	37.42552693	0	0.178618246	0	0	10	20	0	30	0	0	0	26.79273687	26.79273687	66.98184218	26.79273687	26.79273687	0	0.178618246	17.86182458	26.79273687	0.178618246		10.0988	1.155664837	2.9274134	0	2.35217428	1.440944791	0.354157554	1.149618907	1.97540229	0	2.568073174	0.874193888	0.060022868	0.387549793	1.678633084	8.536881804	0.147094535	5.795345298	16.67002458	0	8.217928891	0	0	0.888066534	0.63	0	0.405	0	0	0	0.002997765	0.375724689	1.339306194	1.991974318	0.823045032	0	0.210588928	0.721226914	0.004046924	3.530518455	77.3125		9.022777876	10.0988	1.155664837	2.9274134	0	2.35217428	1.440944791	0.354157554	1.149618907	1.97540229	0	2.568073174	0.874193888	0.060022868	0.387549793	1.678633084	8.536881804	0.147094535	5.795345298	16.67002458	0	8.217928891	0	0	0.888066534	0.63	0	0.405	0	0	0	0.002997765	0.375724689	1.339306194	1.991974318	0.823045032	0	0.210588928	0.721226914	0.004046924	3.530518455	77.3125	YES																																									3350																																									0			10.0988	1.155664837	2.9274134	0	2.35217428	1.440944791	0.354157554	1.149618907	1.97540229	0	2.568073174	0.874193888	0.060022868	0.387549793	1.678633084	8.536881804	0.147094535	5.795345298	16.67002458	0	8.217928891	0	0	0.888066534	0.63	0	0.405	0	0	0	0.002997765	0.375724689	1.339306194	1.991974318	0.823045032	0	0.210588928	0.721226914	0.004046924	3.530518455	77.3125
H0564_047_0	2010	8	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	"CORF, PH and CR"	ASC	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo-Radiation	D	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	1055.915111	6.852274603	322.6315068	525.2633233	272.9044479	8.280623556	1.351861243	332.3325073	195.2390286	9525.694655	527.9996243	65.89585613	1.27190746	116.6781263	4567.80453	3418.470289	47.3279657	1949.279923	4917.264397	0	40.31724853	0	0	1065.67984	378	179.4	162	0	0	0	8.004936977	48.47875688	255.2065656	670.6309623	273.9300862	127.392694	1.018351251	472.4762568	0.367425274	20.45609934		$175/day (days 1-7); no yrly max	$1225/admit	$130/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$150 copay	$10 copay	$35/$150 copay for Lower/Higher Tier	$150 copay	10% coinsurance	$35 copay	$10 coapy	$35 copay	$40 copay	$50/$35 OP/PR copay	$35/$150 copay for Lower/Higher Tier		20% coinsurance			1 exam/cleaning 1/yr. $20 annually	$20 copay	$100/$80 glasses/contacts	$35 copay		SilverSneakers		$30 copay	$35 copay	$75 copay	$35 copay	$35 copay	$0 copay	20% coinsurance	$35 copay	$35 copay	20% coinsurance	175	1225	130	0	100	0.2	0.2	50	150	10	66.52306519	150	0.1	35	10	35	40	39.03754807	50.45881016	0	0.2	0	0	10	20	0	35	0	0	0	30	35	75	35	35	0	0.2	20	35	0.2	NO	154.4538232	1081.176762	114.7371258	0	88.25932753	0.176518655	0.176518655	44.12966377	132.3889913	8.825932753	58.71280999	132.3889913	0.088259328	30.89076464	8.825932753	30.89076464	35.30373101	34.45427741	44.53460653	0	0.176518655	0	0	10	20	0	35	0	0	0	26.47779826	30.89076464	66.19449565	30.89076464	30.89076464	0	0.176518655	17.65186551	30.89076464	0.176518655		13.5908	0.617376672	3.084817648	0	2.007196921	1.461684533	0.238628728	1.222143484	2.153958172	7.006095038	2.583361802	0.726990494	0.112257697	0.300356378	3.359594634	8.799930093	0.139237814	5.596752603	18.24903626	0	7.116746487	0	0	0.888066534	0.63	0	0.4725	0	0	0	0.017662759	0.124795489	1.407772491	1.726358601	0.705159152	0	0.179757993	0.695007278	0.000945837	3.610883144	88.8259		11.54925223	13.5908	0.617376672	3.084817648	0	2.007196921	1.461684533	0.238628728	1.222143484	2.153958172	7.006095038	2.583361802	0.726990494	0.112257697	0.300356378	3.359594634	8.799930093	0.139237814	5.596752603	18.24903626	0	7.116746487	0	0	0.888066534	0.63	0	0.4725	0	0	0	0.017662759	0.124795489	1.407772491	1.726358601	0.705159152	0	0.179757993	0.695007278	0.000945837	3.610883144	88.8259	YES																																									3350																																									0			13.5908	0.617376672	3.084817648	0	2.007196921	1.461684533	0.238628728	1.222143484	2.153958172	7.006095038	2.583361802	0.726990494	0.112257697	0.300356378	3.359594634	8.799930093	0.139237814	5.596752603	18.24903626	0	7.116746487	0	0	0.888066534	0.63	0	0.4725	0	0	0	0.017662759	0.124795489	1.407772491	1.726358601	0.705159152	0	0.179757993	0.695007278	0.000945837	3.610883144	88.8259
H0564_801_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	367.1220112	4.395663965	59.01651623	8.212453663	8.843533763	6.569013585	1.074622153	24.74192524	34.52191989	3.71502204	11.63967119	0	0.126332479	15.60654727	66.20822584	191.4016529	2.001009266	9.542544616	50.18236312	59.60217054	25.76033765	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.06564435	0.06564435	0.155046469	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.06564435	0.06564435	0.155046469	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				24.0995	0.288550505	9.150302462	0	2.060543367	1.530580165	0.250386962	5.764868581	8.043607334	0.865600135	2.712043387	0	0.029435468	3.636325514	15.42651662	44.59658512	0.466235159	2.223412895	11.69249061	13.88730574	6.002158673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7264			24.0995	0.288550505	9.150302462	0	2.060543367	1.530580165	0.250386962	5.764868581	8.043607334	0.865600135	2.712043387	0	0.029435468	3.636325514	15.42651662	44.59658512	0.466235159	2.223412895	11.69249061	13.88730574	6.002158673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7264	NO																																																																																		0			24.0995	0.288550505	9.150302462	0	2.060543367	1.530580165	0.250386962	5.764868581	8.043607334	0.865600135	2.712043387	0	0.029435468	3.636325514	15.42651662	44.59658512	0.466235159	2.223412895	11.69249061	13.88730574	6.002158673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7264
H0564_810_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	367.2311947	4.396971253	58.92219007	8.199301459	8.816301167	6.537569047	1.069478154	24.77598219	34.48232494	3.690667211	11.56336419	0	0.125504272	15.50423434	66.30298641	191.6755966	2.003873212	9.556202389	50.25418666	59.68747618	25.64893816	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.06564435	0.06564435	0.155046469	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.06564435	0.06564435	0.155046469	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				24.1067	0.288636321	9.135677525	0	2.054198172	1.523253588	0.24918841	5.772803851	8.034381711	0.85992546	2.694263855	0	0.029242495	3.612486601	15.44859583	44.66041401	0.466902458	2.226595157	11.70922549	13.90718195	5.976202592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7558			24.1067	0.288636321	9.135677525	0	2.054198172	1.523253588	0.24918841	5.772803851	8.034381711	0.85992546	2.694263855	0	0.029242495	3.612486601	15.44859583	44.66041401	0.466902458	2.226595157	11.70922549	13.90718195	5.976202592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7558	NO																																																																																		0			24.1067	0.288636321	9.135677525	0	2.054198172	1.523253588	0.24918841	5.772803851	8.034381711	0.85992546	2.694263855	0	0.029242495	3.612486601	15.44859583	44.66041401	0.466902458	2.226595157	11.70922549	13.90718195	5.976202592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7558
H0564_811_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	367.2311947	4.396971253	58.92219007	8.199301459	8.816301167	6.537569047	1.069478154	24.77598219	34.48232494	3.690667211	11.56336419	0	0.125504272	15.50423434	66.30298641	191.6755966	2.003873212	9.556202389	50.25418666	59.68747618	25.64893816	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.06564435	0.06564435	0.155046469	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.06564435	0.06564435	0.155046469	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				24.1067	0.288636321	9.135677525	0	2.054198172	1.523253588	0.24918841	5.772803851	8.034381711	0.85992546	2.694263855	0	0.029242495	3.612486601	15.44859583	44.66041401	0.466902458	2.226595157	11.70922549	13.90718195	5.976202592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7558			24.1067	0.288636321	9.135677525	0	2.054198172	1.523253588	0.24918841	5.772803851	8.034381711	0.85992546	2.694263855	0	0.029242495	3.612486601	15.44859583	44.66041401	0.466902458	2.226595157	11.70922549	13.90718195	5.976202592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7558	NO																																																																																		0			24.1067	0.288636321	9.135677525	0	2.054198172	1.523253588	0.24918841	5.772803851	8.034381711	0.85992546	2.694263855	0	0.029242495	3.612486601	15.44859583	44.66041401	0.466902458	2.226595157	11.70922549	13.90718195	5.976202592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.7558
H0571_001_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	564.4025486	11.46455339	231.6838947	0	101.884061	9.700590879	6.055528931	185.1129656	282.7025112	0	0	0	0	283.378592	3184.710694	2892.652974	133.3287526	387.1298255	0	916.0306914	0	0	0	0	359.2629533	0	153.9698371	0	0	862.4162666											3400	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$100/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Exam for PCP - Routine Physicals;	$15/Visit for Speclst - Office Visits; $15/Consult for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	$15/Visit for Acupuncture;											250	250	100	0	100	0.2	0.2	47.05864671	200	0	0	0	0	25	15	15	15	25	0	15	0	0	0	0	15	0	15	0	0	15											NO	247.3557154	247.3557154	98.94228615	0	98.94228615	0.197884572	0.197884572	46.56090089	197.8232581	0	0	0	0	24.73557153	14.84134292	14.84134292	14.84134293	24.73557153	0	14.84134292	0	0	0	0	14.84134292	0	14.84134292	0	0	14.84134292												11.634	0.236318567	1.910277851	0	0.840053493	1.919597277	1.198295753	0.718252204	4.660427654	0	0	0	0	0.584127619	3.93878196	3.577571229	0.164898145	0.797989791	0	1.132927135	0	0	0	0	0.444328724	0	0.190426596	0	0	1.066617963	0	0	0	0	0	0	0	0	0	0	35.0149	0	0.368217051	11.634	0.236318567	1.910277851	0	0.840053493	1.919597277	1.198295753	0.718252204	4.660427654	0	0	0	0	0.584127619	3.93878196	3.577571229	0.164898145	0.797989791	0	1.132927135	0	0	0	0	0.444328724	0	0.190426596	0	0	1.066617963	0	0	0	0	0	0	0	0	0	0	35.0149	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.634	0.236318567	1.910277851	0	0.840053493	1.919597277	1.198295753	0.718252204	4.660427654	0	0	0	0	0.584127619	3.93878196	3.577571229	0.164898145	0.797989791	0	1.132927135	0	0	0	0	0.444328724	0	0.190426596	0	0	1.066617963	0	0	0	0	0	0	0	0	0	0	35.0149
H0571_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	564.4025486	11.46455339	231.6838947	0	101.884061	9.700590879	6.055528931	185.1129656	282.7025112	0	0	0	0	283.378592	3184.710694	2892.652974	133.3287526	387.1298255	0	916.0306914	0	0	0	0	359.2629533	0	153.9698371	0	0	862.4162666											3400	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$100/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Exam for PCP - Routine Physicals;	$15/Visit for Speclst - Office Visits; $15/Consult for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	$15/Visit for Acupuncture;											250	250	100	0	100	0.2	0.2	47.05864671	200	0	0	0	0	25	15	15	15	25	0	15	0	0	0	0	15	0	15	0	0	15											NO	247.3557154	247.3557154	98.94228615	0	98.94228615	0.197884572	0.197884572	46.56090089	197.8232581	0	0	0	0	24.73557153	14.84134292	14.84134292	14.84134293	24.73557153	0	14.84134292	0	0	0	0	14.84134292	0	14.84134292	0	0	14.84134292												11.634	0.236318567	1.910277851	0	0.840053493	1.919597277	1.198295753	0.718252204	4.660427654	0	0	0	0	0.584127619	3.93878196	3.577571229	0.164898145	0.797989791	0	1.132927135	0	0	0	0	0.444328724	0	0.190426596	0	0	1.066617963	0	0	0	0	0	0	0	0	0	0	35.0149	0	0.368217051	11.634	0.236318567	1.910277851	0	0.840053493	1.919597277	1.198295753	0.718252204	4.660427654	0	0	0	0	0.584127619	3.93878196	3.577571229	0.164898145	0.797989791	0	1.132927135	0	0	0	0	0.444328724	0	0.190426596	0	0	1.066617963	0	0	0	0	0	0	0	0	0	0	35.0149	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.634	0.236318567	1.910277851	0	0.840053493	1.919597277	1.198295753	0.718252204	4.660427654	0	0	0	0	0.584127619	3.93878196	3.577571229	0.164898145	0.797989791	0	1.132927135	0	0	0	0	0.444328724	0	0.190426596	0	0	1.066617963	0	0	0	0	0	0	0	0	0	0	35.0149
H0571_005_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H0571_006_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	520.3244753	10.71554104	204.3661131	0	88.68353423	8.868169541	5.528040714	163.9610816	250.8981096	0	0	0	0	251.0553022	2804.272334	2544.856224	117.5285864	342.9456721	0	813.8079181	0	0	0	0	359.2629533	0	153.9698371	0	0	862.4162666											3400	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$100/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Exam for PCP - Routine Physicals;	$15/Visit for Speclst - Office Visits; $15/Consult for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	$15/Visit for Acupuncture;											250	250	100	0	100	0.2	0.2	47.0824908	200	0	0	0	0	25	15	15	15	25	0	15	0	0	0	0	15	0	15	0	0	15											NO	247.8483661	247.8483661	99.13934644	0	99.13934645	0.198278693	0.198278693	46.67727367	198.2122574	0	0	0	0	24.78483661	14.87090197	14.87090197	14.87090196	24.78483661	0	14.87090197	0	0	0	0	14.87090197	0	14.87090197	0	0	14.87090197												10.7468	0.221319112	1.688393574	0	0.732668969	1.758369065	1.096092687	0.637771356	4.144256723	0	0	0	0	0.518530387	3.475171581	3.153692286	0.145646341	0.708321037	0	1.008504814	0	0	0	0	0.44521368	0	0.190805863	0	0	1.068742313	0	0	0	0	0	0	0	0	0	0	31.7403	0	0.271143522	10.7468	0.221319112	1.688393574	0	0.732668969	1.758369065	1.096092687	0.637771356	4.144256723	0	0	0	0	0.518530387	3.475171581	3.153692286	0.145646341	0.708321037	0	1.008504814	0	0	0	0	0.44521368	0	0.190805863	0	0	1.068742313	0	0	0	0	0	0	0	0	0	0	31.7403	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.7468	0.221319112	1.688393574	0	0.732668969	1.758369065	1.096092687	0.637771356	4.144256723	0	0	0	0	0.518530387	3.475171581	3.153692286	0.145646341	0.708321037	0	1.008504814	0	0	0	0	0.44521368	0	0.190805863	0	0	1.068742313	0	0	0	0	0	0	0	0	0	0	31.7403
H0571_801_0	2010	1	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	564.4025486	11.46455339	231.6838947	0	101.884061	9.700590879	6.055528931	185.1129656	283.4443234	0	0	0	0	283.378592	3184.710694	2892.652974	133.3287526	387.1298255	0	916.0306914	0	0	0	0	359.2629533	0	153.9698371	0	0	862.4162666											3400	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$100/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care;	$175/Case for OP Fac - Surgery; $175/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Exam for PCP - Routine Physicals;	$15/Visit for Speclst - Office Visits; $15/Consult for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	$15/Visit for Acupuncture;											250	250	100	0	100	0.2	0.2	47.05864671	175	0	0	0	0	25	15	15	15	25	0	15	0	0	0	0	15	0	15	0	0	15											NO	247.3557154	247.3557154	98.94228615	0	98.94228615	0.197884572	0.197884572	46.56090089	173.1490008	0	0	0	0	24.73557153	14.84134292	14.84134292	14.84134293	24.73557153	0	14.84134292	0	0	0	0	14.84134292	0	14.84134292	0	0	14.84134292												11.634	0.236318567	1.910277851	0	0.840053493	1.919597277	1.198295753	0.718252204	4.089841781	0	0	0	0	0.584127619	3.93878196	3.577571229	0.164898145	0.797989791	0	1.132927135	0	0	0	0	0.444328724	0	0.190426596	0	0	1.066617963	0	0	0	0	0	0	0	0	0	0	34.4443	0	0.368217051	11.634	0.236318567	1.910277851	0	0.840053493	1.919597277	1.198295753	0.718252204	4.089841781	0	0	0	0	0.584127619	3.93878196	3.577571229	0.164898145	0.797989791	0	1.132927135	0	0	0	0	0.444328724	0	0.190426596	0	0	1.066617963	0	0	0	0	0	0	0	0	0	0	34.4443	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.634	0.236318567	1.910277851	0	0.840053493	1.919597277	1.198295753	0.718252204	4.089841781	0	0	0	0	0.584127619	3.93878196	3.577571229	0.164898145	0.797989791	0	1.132927135	0	0	0	0	0.444328724	0	0.190426596	0	0	1.066617963	0	0	0	0	0	0	0	0	0	0	34.4443
H0609_002_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1360.014098	97.48531133	1304.430452	455.5065018	269.550711	17.89457782	16.58758202	299.2709124	358.588332	15037.56249	36.25346261	0	0.030794043	1126.396768	6580.61675	5236.618788	422.9896639	1071.43245	0	0	27.15933209	3598.347974	0	0	235.2416809	108.3418401	17.37355456	4.775046842	949.6850219	0												"$200 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$95 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	"$0 (8a1, 8a2)"	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $150 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$150 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											127.4858139	90.63925114	45.05417382	0	150	0.2	0.102500791	49.9950293	150	0	0.152976028	0	0.2	57.78401725	7.921835661	30	38.5	25	0	0	0.2	28.27954747	0	0	30	30	0	0	0	0											NO	127.4858139	90.63925114	45.05417382	0	150	0.2	0.102500791	49.9950293	150	0	0.152976028	0	0.2	57.78401725	7.921835661	30	38.5	25	0	0	0.2	28.27954747	0	0	30	30	0	0	0	0												14.4485	0.736332968	4.897503026	0	3.369383888	3.578915564	1.700240276	1.24683817	4.48235415	0	5.545910725	0	0.006158809	5.423977521	4.344213703	13.09154697	1.357091838	2.232150937	0	0	5.431866419	8.47997103	0	0	0.588104202	0.2708546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.232	0	0	14.4485	0.736332968	4.897503026	0	3.369383888	3.578915564	1.700240276	1.24683817	4.48235415	0	5.545910725	0	0.006158809	5.423977521	4.344213703	13.09154697	1.357091838	2.232150937	0	0	5.431866419	8.47997103	0	0	0.588104202	0.2708546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.232	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.4485	0.736332968	4.897503026	0	3.369383888	3.578915564	1.700240276	1.24683817	4.48235415	0	5.545910725	0	0.006158809	5.423977521	4.344213703	13.09154697	1.357091838	2.232150937	0	0	5.431866419	8.47997103	0	0	0.588104202	0.2708546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.232
H0609_006_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1678.60823	156.1222109	1920.24836	771.7906288	640.9818795	21.78820155	18.70615627	414.9206904	431.5659464	19195.11259	66.4054116	0	0.095303254	840.2633708	8335.232074	6924.606293	652.0574368	1082.604259	0	0	47.53882791	3787.300983	0	0	180.4052549	99.63761461	17.4332411	4.791451434	957.3741346	0												"$150 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$95 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	"$0 (8a1, 8a2)"	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$15 (3, 9d); $60 (5); $125 (9a); $40/$30 (9c)"	"$10 (7a); $20 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$125 (14f, 14f1)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											95.6143604	67.97943836	45.05417382	0	150	0.2	0.104445655	49.99628608	125	0	0.155480657	0	0.2	47.51229534	6.997966497	20	38.5	15	0	0	0.2	18.98533648	0	0	20	30	0	0	0	0											NO	95.6143604	67.97943836	45.05417382	0	150	0.2	0.104445655	49.99628608	125	0	0.155480657	0	0.2	47.51229534	6.997966497	20	38.5	15	0	0	0.2	18.98533648	0	0	20	30	0	0	0	0												13.3749	0.884425018	7.209600283	0	8.012273494	4.357640309	1.953776744	1.728707795	4.495478608	0	10.32475701	0	0.019060651	3.326903453	4.860806233	11.54101049	2.09201761	1.353255323	0	0	9.507765581	5.991931958	0	0	0.300675425	0.249094037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5841	0	0	13.3749	0.884425018	7.209600283	0	8.012273494	4.357640309	1.953776744	1.728707795	4.495478608	0	10.32475701	0	0.019060651	3.326903453	4.860806233	11.54101049	2.09201761	1.353255323	0	0	9.507765581	5.991931958	0	0	0.300675425	0.249094037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5841	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.3749	0.884425018	7.209600283	0	8.012273494	4.357640309	1.953776744	1.728707795	4.495478608	0	10.32475701	0	0.019060651	3.326903453	4.860806233	11.54101049	2.09201761	1.353255323	0	0	9.507765581	5.991931958	0	0	0.300675425	0.249094037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.5841
H0609_007_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1183.795887	144.8421932	1325.53787	532.7423024	403.5301132	17.92545653	15.44860752	328.5491247	355.7338951	15553.36074	52.53530376	0	0.120855138	638.6523564	6757.843414	5517.67834	646.9575143	919.1757994	0	0	37.81684779	3612.590204	0	0	164.7139174	94.56680622	17.37892599	4.776523157	950.6152521	0												"$200 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$95 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	"$0 (8a1, 8a2)"	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$175 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											127.4858139	90.63925114	45.05417382	0	150	0.2	0.113151925	49.98727658	175	0	0.155597678	0	0.2	66.0106476	7.424513411	30	38.5	25	0	0	0.2	28.46903595	0	0	30	30	0	0	0	0											NO	127.4858139	90.63925114	45.05417382	0	150	0.2	0.113151925	49.98727658	175	0	0.155597678	0	0.2	66.0106476	7.424513411	30	38.5	25	0	0	0.2	28.46903595	0	0	30	30	0	0	0	0												12.5764	1.094032327	4.976751132	0	5.044126415	3.585091307	1.748039673	1.368606331	5.18778597	0	8.174371294	0	0.024171028	3.513154636	4.181141588	13.79419585	2.075655358	1.914949582	0	0	7.563369559	8.570580033	0	0	0.411784794	0.236417016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0407	0	0	12.5764	1.094032327	4.976751132	0	5.044126415	3.585091307	1.748039673	1.368606331	5.18778597	0	8.174371294	0	0.024171028	3.513154636	4.181141588	13.79419585	2.075655358	1.914949582	0	0	7.563369559	8.570580033	0	0	0.411784794	0.236417016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0407	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.5764	1.094032327	4.976751132	0	5.044126415	3.585091307	1.748039673	1.368606331	5.18778597	0	8.174371294	0	0.024171028	3.513154636	4.181141588	13.79419585	2.075655358	1.914949582	0	0	7.563369559	8.570580033	0	0	0.411784794	0.236417016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0407
H0609_012_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	886.5814626	139.6010156	655.0186781	287.674139	262.2004307	12.89801869	13.67402109	280.0909825	327.3897141	11855.78681	45.03363638	0	0.144073279	676.0144956	5459.215675	4189.99531	633.2582613	729.4060676	0	0	25.74711958	3358.79967	0	0	146.2800676	85.79811429	17.24195194	4.738876427	931.1917837	0												"$250 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$225 (9b)	"$0 (8a1, 8a2)"	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $225 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$225 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											159.3572673	113.2990639	52.47946026	0	150	0.2	0.107868753	49.95363063	225	0	0.158108615	0	0.2	85.02638488	10.92638986	30	38.5	25	0	0	0.2	28.37900088	0	0	30	30	0	0	0	0											NO	159.3572673	113.2990639	52.47946026	0	150	0.2	0.107868753	49.95363063	225	0	0.158108615	0	0.2	85.02638488	10.92638986	30	38.5	25	0	0	0.2	28.37900088	0	0	30	30	0	0	0	0												11.7736	1.318055365	2.864585557	0	3.277505384	2.579603738	1.474999603	1.165963457	6.138557139	0	7.120205893	0	0.028814656	4.789922391	4.970793231	10.47498828	2.031703588	1.519595974	0	0	5.149423915	7.943281565	0	0	0.365700169	0.214495286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2018	0	0	11.7736	1.318055365	2.864585557	0	3.277505384	2.579603738	1.474999603	1.165963457	6.138557139	0	7.120205893	0	0.028814656	4.789922391	4.970793231	10.47498828	2.031703588	1.519595974	0	0	5.149423915	7.943281565	0	0	0.365700169	0.214495286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2018	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.7736	1.318055365	2.864585557	0	3.277505384	2.579603738	1.474999603	1.165963457	6.138557139	0	7.120205893	0	0.028814656	4.789922391	4.970793231	10.47498828	2.031703588	1.519595974	0	0	5.149423915	7.943281565	0	0	0.365700169	0.214495286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2018
H0609_015_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1227.690423	92.28224278	1155.920205	409.5723976	237.8686025	16.43701019	14.71549349	262.4297101	333.3252418	13451.5885	32.30366546	0	0.018451836	922.6095406	5885.52215	5304.270451	402.4053515	1026.978913	0	0	23.03543495	3389.577412	0	459.3249838	177.2974537	173.1570123	17.24971258	2.44572529	635.2571955	476.1944401												"$100 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$100 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$50 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$50 (9b)	"$0 (8a1, 8a2)"	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$15 (3, 9d); $60 (5); $50 (9a); $40/$30 (9c)"	"$5 (7a); $20 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$50 (14f, 14f1)"	"$20 (7b, 7d, 7f, 7f1); $10 (7b1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 n/c (10b)	"$20 (16a1); $0 n/c (16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13d, 13e)"											63.74290693	45.31962557	29.1552557	0	150	0.2	0.114672472	49.98026334	50	0	0.152434771	0	0.2	19.78204583	3.772254601	18.84479443	38.5	15	0	0	0.2	18.88366413	0	20	20	0	0	0	0	10											NO	63.74290693	45.31962557	29.1552557	0	150	0.2	0.114672472	49.98026334	50	0	0.152434771	0	0.2	19.78204583	3.772254601	18.84479443	38.5	15	0	0	0.2	18.88366413	0	20	20	0	0	0	0	10												6.5214	0.348516391	2.808429095	0	2.973357532	3.287402039	1.687462008	1.093025501	1.388855174	0	4.924201834	0	0.003690367	1.520925351	1.850140667	8.329823857	1.291050503	1.283723641	0	0	4.60708699	5.333970116	0	0.76554164	0.295495756	0	0	0	0	0.3968287	0	0	0	0	0	0	0	0	0	0	50.7109	0	0	6.5214	0.348516391	2.808429095	0	2.973357532	3.287402039	1.687462008	1.093025501	1.388855174	0	4.924201834	0	0.003690367	1.520925351	1.850140667	8.329823857	1.291050503	1.283723641	0	0	4.60708699	5.333970116	0	0.76554164	0.295495756	0	0	0	0	0.3968287	0	0	0	0	0	0	0	0	0	0	50.7109	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.5214	0.348516391	2.808429095	0	2.973357532	3.287402039	1.687462008	1.093025501	1.388855174	0	4.924201834	0	0.003690367	1.520925351	1.850140667	8.329823857	1.291050503	1.283723641	0	0	4.60708699	5.333970116	0	0.76554164	0.295495756	0	0	0	0	0.3968287	0	0	0	0	0	0	0	0	0	0	50.7109
H0609_018_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	808.9255074	140.6308081	675.2629397	273.4728015	266.1992818	14.27712171	11.92257994	264.5833299	347.6571348	12745.97484	42.95463248	0	0.0926065	638.749582	5776.895217	4577.328447	642.181376	807.3814083	0	0	29.76348909	3466.68614	0	0	138.7142209	119.8524287	0	0	719.0967628	0												"$250 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$225 (9b)	"$0 (8a1, 8a2)"	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $225 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$225 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											159.3572673	113.2990639	52.47946026	0	150	0.2	0.120039412	49.94392329	225	0	0.156883539	0	0.2	83.22115834	11.17770151	30	38.5	25	0	0	0.2	28.44294478	0	0	30	30	0	0	0	0											NO	159.3572673	113.2990639	52.47946026	0	150	0.2	0.120039412	49.94392329	225	0	0.156883539	0	0.2	83.22115834	11.17770151	30	38.5	25	0	0	0.2	28.44294478	0	0	30	30	0	0	0	0												10.7423	1.327778243	2.953119551	0	3.327491023	2.855424341	1.431179482	1.101194127	6.518571278	0	6.738874776	0	0.0185213	4.429790009	5.381034198	11.44332112	2.060331915	1.682044601	0	0	5.952697818	8.216896869	0	0	0.346785552	0.299631072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.827	0	0	10.7423	1.327778243	2.953119551	0	3.327491023	2.855424341	1.431179482	1.101194127	6.518571278	0	6.738874776	0	0.0185213	4.429790009	5.381034198	11.44332112	2.060331915	1.682044601	0	0	5.952697818	8.216896869	0	0	0.346785552	0.299631072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.827	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.7423	1.327778243	2.953119551	0	3.327491023	2.855424341	1.431179482	1.101194127	6.518571278	0	6.738874776	0	0.0185213	4.429790009	5.381034198	11.44332112	2.060331915	1.682044601	0	0	5.952697818	8.216896869	0	0	0.346785552	0.299631072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.827
H0609_020_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1052.878899	114.8913441	821.851069	374.6298254	161.2907824	14.30866074	16.56658906	297.1330914	276.8658971	10025.70464	28.9720419	0	0.004291338	727.4642132	5784.643391	3922.867052	512.0166159	827.0474413	0	0	18.14847079	3336.17361	0	0	174.2812411	97.64248194	17.33667907	4.764911772	849.6673606	0												"$250 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$95 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$190 (9b)	"$0 (8a1, 8a2)"	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $190 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$190 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											159.3572673	113.2990639	45.05417382	0	150	0.2	0.099259447	49.99783125	190	0	0.149880619	0	0.2	72.77981646	11.1462924	30	38.5	25	0	0	0.2	28.41136659	0	0	30	30	0	0	0	0											NO	159.3572673	113.2990639	45.05417382	0	150	0.2	0.099259447	49.99783125	190	0	0.149880619	0	0.2	72.77981646	11.1462924	30	38.5	25	0	0	0.2	28.41136659	0	0	30	30	0	0	0	0												13.982	1.084756811	3.085651743	0	2.016134779	2.861732149	1.644390468	1.238000847	4.383710038	0	4.342347585	0	0.000858268	4.412059326	5.373110555	9.807167629	1.642719976	1.723015503	0	0	3.629694159	7.898770954	0	0	0.435703103	0.244106205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8059	0	0	13.982	1.084756811	3.085651743	0	2.016134779	2.861732149	1.644390468	1.238000847	4.383710038	0	4.342347585	0	0.000858268	4.412059326	5.373110555	9.807167629	1.642719976	1.723015503	0	0	3.629694159	7.898770954	0	0	0.435703103	0.244106205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8059	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.982	1.084756811	3.085651743	0	2.016134779	2.861732149	1.644390468	1.238000847	4.383710038	0	4.342347585	0	0.000858268	4.412059326	5.373110555	9.807167629	1.642719976	1.723015503	0	0	3.629694159	7.898770954	0	0	0.435703103	0.244106205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8059
H0609_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	200.5622368	13.89729248	39.06059175	437.6848489	7.796794502	19.8730331	19.81079051	14.38457691	51.95713277	23.26207395	67.61440499	0	0.072696464	21.01492818	31.67550935	137.2924501	4.976716359	6.978610693	0	0	54.19464838	29.04084297	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076523041	0.076523041	0.148079593	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076523041	0.076523041	0.148079593	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												15.3476	1.063463076	5.78407653	0	1.816653119	4.630416713	4.61591419	3.351606421	12.10601194	5.42006323	15.75415636	0	0.016938276	4.896478267	7.380393679	31.98914088	1.159574912	1.626016292	0	0	12.62735307	6.766516413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3524	0	0	15.3476	1.063463076	5.78407653	0	1.816653119	4.630416713	4.61591419	3.351606421	12.10601194	5.42006323	15.75415636	0	0.016938276	4.896478267	7.380393679	31.98914088	1.159574912	1.626016292	0	0	12.62735307	6.766516413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3524	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.3476	1.063463076	5.78407653	0	1.816653119	4.630416713	4.61591419	3.351606421	12.10601194	5.42006323	15.75415636	0	0.016938276	4.896478267	7.380393679	31.98914088	1.159574912	1.626016292	0	0	12.62735307	6.766516413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.3524
H0609_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	207.4942448	14.13411504	48.63322435	461.5497012	7.964916154	16.1761574	19.97096923	15.70094396	49.90338439	21.91707926	53.88999363	0	0.085873026	19.11851253	31.06823634	134.2185037	4.85480789	7.115930088	0	0	41.68974162	28.28278518	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077488035	0.077488035	0.147897095	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077488035	0.077488035	0.147897095	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.0783	1.095224802	7.192712587	0	1.855825464	3.769044673	4.65323583	3.658319942	11.62748856	5.106679468	12.55636852	0	0.020008415	4.454613419	7.238899066	31.27291137	1.131170238	1.65801171	0	0	9.713709798	6.589888947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6724	0	0	16.0783	1.095224802	7.192712587	0	1.855825464	3.769044673	4.65323583	3.658319942	11.62748856	5.106679468	12.55636852	0	0.020008415	4.454613419	7.238899066	31.27291137	1.131170238	1.65801171	0	0	9.713709798	6.589888947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6724	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.0783	1.095224802	7.192712587	0	1.855825464	3.769044673	4.65323583	3.658319942	11.62748856	5.106679468	12.55636852	0	0.020008415	4.454613419	7.238899066	31.27291137	1.131170238	1.65801171	0	0	9.713709798	6.589888947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6724
H0609_805_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	205.1495667	14.08444851	48.4781682	460.0792853	7.939541594	15.60618989	19.79834313	15.59985835	49.40466339	20.75994936	52.16512406	0	0.081369293	18.75081975	29.96450331	128.7955135	4.839239466	6.854718231	0	0	40.22061785	27.62735603	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077488032	0.077488032	0.147897095	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077488032	0.077488032	0.147897095	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												15.8966	1.091376201	7.169780231	0	1.849913191	3.636242245	4.613013949	3.634766996	11.51128657	4.8370682	12.15447391	0	0.018959045	4.368941002	6.98172927	30.00935463	1.127542795	1.597149348	0	0	9.371403959	6.437173954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3068	0	0	15.8966	1.091376201	7.169780231	0	1.849913191	3.636242245	4.613013949	3.634766996	11.51128657	4.8370682	12.15447391	0	0.018959045	4.368941002	6.98172927	30.00935463	1.127542795	1.597149348	0	0	9.371403959	6.437173954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3068	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.8966	1.091376201	7.169780231	0	1.849913191	3.636242245	4.613013949	3.634766996	11.51128657	4.8370682	12.15447391	0	0.018959045	4.368941002	6.98172927	30.00935463	1.127542795	1.597149348	0	0	9.371403959	6.437173954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3068
H0609_806_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	205.1495535	14.08444761	48.47816508	460.0792705	7.939541083	15.60618889	19.79834185	15.59985735	49.40466021	20.75994802	52.1651207	0	0.081369288	18.75081854	29.96450138	128.7955052	4.839239154	6.85471779	0	0	40.22061526	27.62735425	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077488035	0.077488035	0.147897095	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077488035	0.077488035	0.147897095	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												15.8966	1.09137617	7.16977977	0	1.849913072	3.636242011	4.613013652	3.634766762	11.51128583	4.837067889	12.15447312	0	0.018959044	4.368940721	6.981728821	30.0093527	1.127542723	1.597149245	0	0	9.371403356	6.43717354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3068	0	0	15.8966	1.09137617	7.16977977	0	1.849913072	3.636242011	4.613013652	3.634766762	11.51128583	4.837067889	12.15447312	0	0.018959044	4.368940721	6.981728821	30.0093527	1.127542723	1.597149245	0	0	9.371403356	6.43717354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3068	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.8966	1.09137617	7.16977977	0	1.849913072	3.636242011	4.613013652	3.634766762	11.51128583	4.837067889	12.15447312	0	0.018959044	4.368940721	6.981728821	30.0093527	1.127542723	1.597149245	0	0	9.371403356	6.43717354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.3068
H0620_002_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1400.831855	598.125661	7501.698065	84.53427003	689.9432933	518.3229848	742.5060322	161.8227968	81.68880813	26355.37324	4173.25976	0	0.464537893	182.9185757	191.0014737	8937.217613	2115.008409	20.90822835	0	0	100.1142055	750.8326974	353.5842526	126.8370738	111.0636697	71.83692676	16.16378467	9.353766505	0	0											800	"$75 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$75 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$75 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $10 (4b)	$25 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$25 (3, 5, 9a); $0 (9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $10 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											62.15007373	51.92515401	0	0	75	0	0	49.88787832	25	0	0	0	0	9.25656404	0.152922154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	56.67168657	57.36000665	0	0	57.36000665	0	0	38.15425376	19.12000222	0	0	0	0	7.079420998	0.116954877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												6.6156	2.859040991	0	0	3.297929324	0	0	0.514519005	0.130157516	0	0	0	0	0.107913134	0.001861546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.527	0	4.159989341	6.6156	2.859040991	0	0	3.297929324	0	0	0.514519005	0.130157516	0	0	0	0	0.107913134	0.001861546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.527	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $10 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.8112	0.341	0	0.0415	0.9243	0.2833	0.7496	0.1281	0.5794	0.5341	1.6419	0	0	0.1614	0.0186	3.142	0.2619	0	0	0	0.0235	0.0849	0	0	0.0133	0	0.0014	0	0	0											11.7413	0	0	9.4268	3.200030087	0	0.041504554	4.222186916	0.283295745	0.749596459	0.642661798	0.709542028	0.534126302	1.641888931	0	0	0.269271093	0.020455022	3.142009295	0.261944846	0	0	0	0.023519728	0.084871418	0	0	0.013292195	0	0.00135047	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2683
H0621_001_0	2010	3	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0													0	NO	252.5929025	71.97111039	33.37496927	6.115285363	25.33330115	45.72836539	0.046971323	80.14041034	38.49519009	19.6849459	20.26515188	0	0	43.71040122	72.85201487	94.63410907	17.95998	5.326232552	4.054051407	7.669979922	30.57403549	0.077615224	9.579784673	22.64556317	1.296665589	6.118099434	0	0.108811487														FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	$0 copay	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	24 trips per year	250 annual dental benefit max	Exam every 2 years	$100 every 2 years	Exam every 3 years	$500 every 3 years													0.090929054	0.090325035	0.112138052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233																			NO	0.090929054	0.090325035	0.112138052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233																				22.968	6.500793072	3.742604038	0	5.902659167	10.65470913	0.010944318	18.67271561	8.969379292	4.586592395	4.721780389	0	0	10.18452348	16.97451946	22.04974741	0	1.241012185	0.944593978	1.787105322	7.12375027	0.018084347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.0535			22.968	6.500793072	3.742604038	0	5.902659167	10.65470913	0.010944318	18.67271561	8.969379292	4.586592395	4.721780389	0	0	10.18452348	16.97451946	22.04974741	0	1.241012185	0.944593978	1.787105322	7.12375027	0.018084347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.0535	NO																																																																																		0			22.968	6.500793072	3.742604038	0	5.902659167	10.65470913	0.010944318	18.67271561	8.969379292	4.586592395	4.721780389	0	0	10.18452348	16.97451946	22.04974741	0	1.241012185	0.944593978	1.787105322	7.12375027	0.018084347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.0535
H0621_004_0	2010	3	N/A																															A	A	D	V	Coin	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	V	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	YES	136.4329608	173.690797	437.6993295	100.5200081	24.11147462	18.73458622	0.107410396	1512.562103	26.49368284	4405.029476	13.51664401	0	0	22.62046923	6560.869399	5573.790793	8745.496285	506.6415154	2.695855961	774.2980735	8.203909595	16.42568263	5379.197117	57.98158433	165.9395756	258.1403076	0	2.576681932													3400	PBP(1A)-800 per admit	PBP(1B)-800 per admit	PBP(2)-30 per day	PBP(6)-0 per visit	PBP(10A)-10% of allowed cost	PBP(11A)-10% of allowed cost	PBP(11B)-10% of allowed cost	PBP(4A)-50 per visitPBP(4B)-30 per visit	PBP(9A)-10% of allowed costPBP(9B)-10% of allowed cost	PBP(8A)-0 per visit	PBP(8B)-10% of allowed cost	PBP(9A)-10% of allowed cost	PBP(9A)-10% of allowed cost	PBP(9A)-10% of allowed cost	PBP(7A)-10 per visit	PBP(7D)-30 per visit	PBP(7E)-10 per visitPBP(7H)-10 per visit	PBP(7C)-30 per visitPBP(7I)-30 per visitPBP(9D)-30 per visit	PBP(7D)-10% of allowed cost excl IPF/SNF based	PBP(7B)-10 per visitPBP(7F)-10 per visit	PBP(15)-20% of allowed cost	PBP(14A)-0 per visit	48 trips per year	50% coins. Annual max $1000	every 2 years	$250 every 2 years	every 3 years	$600 every 3 years													800	800	30	0	0.1	0.1	0.1	49.3981446	0.1	0	0.1	0	0	0.100014372	9.55385671	27.9630869	10	30	0.081805525	2.702539648	0.2	0	0	0.5	0	0	0	0													NO	683.3722329	683.3722329	25.62645873	0	0.085421529	0.085421529	0.085421529	42.19665047	0.085421529	0	0.085421529	0	0	0.085433806	8.16105049	23.88649641	8.542152911	25.62645873	0.06987953	2.308550692	0.170843058	0	0	0.5	0	0	0	0														7.7695	9.89128898	0.93472365	0	2.059639031	1.600337002	0.00917516	5.318754529	2.2631309	0	1.1546124	0	0	1.932552777	4.461965535	11.09486115	6.225447213	1.081952324	0.188385148	0.148958863	1.401581005	0	0	28.99079217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.5277		14.76725549	7.7695	9.89128898	0.93472365	0	2.059639031	1.600337002	0.00917516	5.318754529	2.2631309	0	1.1546124	0	0	1.932552777	4.461965535	11.09486115	6.225447213	1.081952324	0.188385148	0.148958863	1.401581005	0	0	28.99079217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.5277	NO																																																																																		0			7.7695	9.89128898	0.93472365	0	2.059639031	1.600337002	0.00917516	5.318754529	2.2631309	0	1.1546124	0	0	1.932552777	4.461965535	11.09486115	6.225447213	1.081952324	0.188385148	0.148958863	1.401581005	0	0	28.99079217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.5277
H0621_005_0	2010	3	N/A																															A	A	D	V	Coin	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	V	V	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	YES	295.4783976	42.49258747	1196.007467	704.9547716	22.73171087	62.63513657	0.173737476	1365.069228	49.53263214	4820.716481	25.16444105	0	0	42.91916666	10413.89475	8006.342924	2511.350395	762.2339215	4.385999189	1129.506859	13.90399173	26.72199793	5294.768137	61.3788933	199.0089553	298.4767119	0	13.01523757													3400	PBP(1A)-800 per admit	PBP(1B)-800 per admit	PBP(2)-30 per day	PBP(6)-0 per visit	PBP(10A)-10% of allowed cost	PBP(11A)-10% of allowed cost	PBP(11B)-10% of allowed cost	PBP(4A)-50 per visitPBP(4B)-30 per visit	PBP(9A)-10% of allowed costPBP(9B)-10% of allowed cost	PBP(8A)-0 per visit	PBP(8B)-10% of allowed cost	PBP(9A)-10% of allowed cost	PBP(9A)-10% of allowed cost	PBP(9A)-10% of allowed cost	PBP(7A)-10 per visit	PBP(7D)-30 per visit	PBP(7E)-30 per visitPBP(7H)-30 per visit	PBP(7C)-30 per visitPBP(7I)-30 per visitPBP(9D)-30 per visit	PBP(7D)-10% of allowed cost excl IPF/SNF based	PBP(7B)-10 per visitPBP(7F)-10 per visit	PBP(15)-20% of allowed cost	PBP(14A)-0 per visit	48 trips per year	50% coins. Annual max $1000	every 2 years	$250 every 2 years	every 3 years	$600 every 3 years													800	800	30	0	0.1	0.1	0.1	49.60933197	0.1	0	0.1	0	0	0.10314962	9.643483004	28.06825914	30	30	0.076940879	3.178369723	0.2	0	0	0.5	0	0	0	0													NO	631.5405622	631.5405622	23.68277108	0	0.07894257	0.07894257	0.07894257	39.16288175	0.07894257	0	0.07894257	0	0	0.081428962	7.612813348	22.1578052	23.68277108	23.68277108	0.060739108	2.509086753	0.157885141	0	0	0.5	0	0	0	0														15.5505	2.236316048	2.360397587	0	1.794499683	4.944578671	0.013715283	4.455003731	3.910233294	0	1.986545657	0	0	3.494863174	6.606586411	14.78358224	4.956311375	1.504317623	0.266401677	0.236169225	2.195233689	0	0	30.68944665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848		27.20378534	15.5505	2.236316048	2.360397587	0	1.794499683	4.944578671	0.013715283	4.455003731	3.910233294	0	1.986545657	0	0	3.494863174	6.606586411	14.78358224	4.956311375	1.504317623	0.266401677	0.236169225	2.195233689	0	0	30.68944665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848	NO																																																																																		0			15.5505	2.236316048	2.360397587	0	1.794499683	4.944578671	0.013715283	4.455003731	3.910233294	0	1.986545657	0	0	3.494863174	6.606586411	14.78358224	4.956311375	1.504317623	0.266401677	0.236169225	2.195233689	0	0	30.68944665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9848
H0621_006_0	2010	3	N/A																															A	A	D	V	Coin	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	V	Coin	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	YES	159.0340207	65.96886976	423.4473487	280.0450283	14.37075513	24.97079624	0.047090533	977.3441871	29.07249896	3112.464564	13.85578704	0	0	23.98595308	5992.280094	4721.234967	3106.217869	496.5713644	2.390794343	378.8855833	6.958794676	10.48240303	1765.978517	3820.453395	169.3996175	248.8652523	0	2.460907869													3400	PBP(1A)-1100 per admit	PBP(1B)-1100 per admit	PBP(2)-40 per day	PBP(6)-0 per visit	PBP(10A)-20% of allowed cost	PBP(11A)-20% of allowed cost	PBP(11B)-20% of allowed cost	PBP(4A)-50 per visitPBP(4B)-40 per visit	PBP(9A)-20% of allowed costPBP(9B)-20% of allowed cost	PBP(8A)-0 per visit	PBP(8B)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(7A)-20 per visit	PBP(7D)-40 per visit	PBP(7E)-20 per visitPBP(7H)-20 per visit	PBP(7C)-40 per visitPBP(7I)-40 per visitPBP(9D)-40 per visit	PBP(7D)-20% of allowed cost excl IPF/SNF based	PBP(7B)-20 per visitPBP(7F)-20 per visit	PBP(15)-20% of allowed cost	PBP(14A)-0 per visit	24 trips/year	$350Annual Max Comp. Dental	Every 2 years	$100 every 2 years	Every 3 years	$400 every 3 years													1100	1100	40	0	0.2	0.2	0.2	49.68916706	0.2	0	0.2	0.2	0.2	0.202929293	19.09175647	36.7428115	20	40	0.160999692	10.02782392	0.2	0																			NO	898.9124022	898.9124022	32.68772372	0	0.163438619	0.163438619	0.163438619	40.60564411	0.163438619	0	0.163438619	0.163438619	0.163438619	0.165832417	15.60165151	30.02597178	16.34386186	32.68772372	0.131567837	8.194668441	0.163438619	0																				11.9131	4.941686266	1.153460829	0	2.348736367	4.081192443	0.007696412	3.307140853	4.751569068	0	2.264570693	0	0	3.977648567	7.790788817	11.81330566	4.230632979	1.352648964	0.314551639	0.258736811	1.137335789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6448		14.68481594	11.9131	4.941686266	1.153460829	0	2.348736367	4.081192443	0.007696412	3.307140853	4.751569068	0	2.264570693	0	0	3.977648567	7.790788817	11.81330566	4.230632979	1.352648964	0.314551639	0.258736811	1.137335789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6448	NO																																																																																		0			11.9131	4.941686266	1.153460829	0	2.348736367	4.081192443	0.007696412	3.307140853	4.751569068	0	2.264570693	0	0	3.977648567	7.790788817	11.81330566	4.230632979	1.352648964	0.314551639	0.258736811	1.137335789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.6448
H0621_007_0	2010	6	N/A																															A	A	D	V	Coin	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	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	YES	149.1950011	61.71432755	355.009511	275.1859362	13.61540225	22.44218864	0.047735293	954.8520451	26.78584388	3047.009246	12.74069292	0	0	22.19238832	5866.167331	4605.77486	3059.323556	491.3808948	2.310442526	362.2510705	5.809273597	10.03684781																			3400	PBP(1A)-1100 per admit	PBP(1B)-1100 per admit	PBP(2)-50 per day	PBP(6)-0 per visit	PBP(10A)-25% of allowed cost	PBP(11A)-25% of allowed cost	PBP(11B)-25% of allowed cost	PBP(4A)-50 per visitPBP(4B)-50 per visit	PBP(9A)-25% of allowed costPBP(9B)-25% of allowed cost	PBP(8A)-0 per visit	PBP(8B)-20% of allowed cost for diagnostics and 20% for ther radiology	PBP(9A)-25% of allowed cost	PBP(9A)-25% of allowed cost	PBP(9A)-25% of allowed cost	PBP(7A)-35 per visit	PBP(7D)-50 per visit	PBP(7E)-50 per visitPBP(7H)-50 per visit	PBP(7C)-50 per visitPBP(7I)-50 per visitPBP(9D)-50 per visit	PBP(7D)-25% of allowed cost excl IPF/SNF based	PBP(7B)-35 per visitPBP(7F)-35 per visit	PBP(15)-20% of allowed cost	PBP(14A)-0 per visit																			1100	1100	50	0	0.25	0.25	0.25	50	0.25	0	0.2	0	0	0.254248189	33.36551838	45.83020287	50	50	0.202524514	17.60671258	0.2	0																			NO	841.5801305	841.5801305	38.2536423	0	0.191268211	0.191268211	0.191268211	38.2536423	0.191268211	0	0.153014569	0	0	0.194518385	25.5270521	35.06344374	38.2536423	38.2536423	0.154946007	13.47041771	0.153014569	0																				10.4633	4.32812932	1.131700571	0	2.604193637	4.292477282	0.009130244	3.043880715	5.123280452	0	1.949511639	0	0	4.316827543	12.47882992	13.45786064	9.752522417	1.566425748	0.357993843	0.406639436	0.888903497	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1716		23.38963919	10.4633	4.32812932	1.131700571	0	2.604193637	4.292477282	0.009130244	3.043880715	5.123280452	0	1.949511639	0	0	4.316827543	12.47882992	13.45786064	9.752522417	1.566425748	0.357993843	0.406639436	0.888903497	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1716	NO																																																																																		0			10.4633	4.32812932	1.131700571	0	2.604193637	4.292477282	0.009130244	3.043880715	5.123280452	0	1.949511639	0	0	4.316827543	12.47882992	13.45786064	9.752522417	1.566425748	0.357993843	0.406639436	0.888903497	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1716
H0621_009_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	NO	204.0501839	68.86773805	27.42617855	4.967385703	24.8294715	46.83737379	0.05543808	78.75650165	38.41394603	19.87669979	18.8554195	0	0	39.09818177	64.41767344	81.59933881	19.77025511	4.720231709	3.626208012	5.137408395	33.09019162	0.066765842	7.472796351	15.00994088	1.660982769	8.23742534	0	0.233562354	0													FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	$0 copay	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	48 one way trips per year.	750 annual dental benefit max	every 2 years	$100 every 2 years	every 3 years	$500 every 3 years	"smoking cessation, nutritional therapy"												0.094901148	0.093931978	0.115611255	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0												NO	0.094901148	0.093931978	0.115611255	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0													19.3646	6.468882876	3.170774935	1.157400869	5.78526686	10.91310809	0.012917073	18.35026488	8.950449425	4.631271052	4.393312742	0	0	9.109876352	15.00931791	19.01264594	0	1.099813988	0.844906467	1.197016156	7.710014649	0.015556441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.1974		0	19.3646	6.468882876	3.170774935	1.157400869	5.78526686	10.91310809	0.012917073	18.35026488	8.950449425	4.631271052	4.393312742	0	0	9.109876352	15.00931791	19.01264594	0	1.099813988	0.844906467	1.197016156	7.710014649	0.015556441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.1974	NO																																																																																		0			19.3646	6.468882876	3.170774935	1.157400869	5.78526686	10.91310809	0.012917073	18.35026488	8.950449425	4.631271052	4.393312742	0	0	9.109876352	15.00931791	19.01264594	0	1.099813988	0.844906467	1.197016156	7.710014649	0.015556441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.1974
H0623_001_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	YES	916.032937	48.410659	399.812939	229.644835	1.624798	13.409468	3.10957	333.477161	61.265874	8.702401	32.783572	12.530657	0.039112	21.945444	3521.141065	4597.784486	108.716672	1.140708			35.514155	0							0.04	0.25	625.152527	440.308188	0	0.05	0.55	3.77	1169.873948	0.32	0.35	0.82	5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: Nutritional benefit 14a$0: LifeSynch Member Assistance 14a	158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.237807	0.25	0.234414	0.25	0.2	0.230373	15	35	35	0.25			0.2	0							0	0	0	7.752833	0	0	0	0	35	0	0	0	NO	139.181096	123.086627	32.60996	0	0.169547	0.169547	0.169547	42.38685	0.201598	0.211934	0.198721	0.211934	0.169547	0.195296	12.716055	29.670795	29.670795	0.211934			0.169547	0							0	0	0	6.572363	0	0	0	0	29.670795	0	0	0		10.6245	0.496558727	1.086490329	0	0.275479627	2.273535071	0.527218265	1.177920533	12.35107767	1.844334654	6.514784211	2.655672261	0.006631322	4.285857431	3.731251954	11.36832674	0.268809174	0.241754809	0	0	6.021318438	0	0	0	0	0	0	0	0	0	0	0.241155437	0	0	0	0	2.892590841	0	0	0	68.8853	0	12.264533	10.6245	0.496558727	1.086490329	0	0.275479627	2.273535071	0.527218265	1.177920533	12.35107767	1.844334654	6.514784211	2.655672261	0.006631322	4.285857431	3.731251954	11.36832674	0.268809174	0.241754809	0	0	6.021318438	0	0	0	0	0	0	0	0	0	0	0.241155437	0	0	0	0	2.892590841	0	0	0	68.8853	YES	$250/Day(Days 1-15)	$250/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	20% Coins	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	30% Coins	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	30% Coins	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: Nutritional benefit 14a	7500	2.8678	0.1456	0.4895	1.3014	1.2829	2.6178	0.607	0.242	3.3686	0.4785	1.8026	0.689	0.0014	1.2069	1.9947	3.5948	0.0544	0.0627			1.7772	0							0	0	0.0794	0.5986	1.1717	0	0	0	0.4832	0	0	0	26.9179	500	5.796753	13.4924	0.642174727	1.576034329	1.301446	1.558348627	4.891330071	1.134268265	1.419923533	15.71972267	2.322827654	8.317357211	3.344658261	0.008065322	5.492785431	5.725957954	14.96311574	0.323252174	0.304475809	0	0	7.798546438	0	0	0	0	0	0	0	0	0	0.079402	0.839718437	1.171686	0	0	0	3.375785841	0	0	0	95.8032
H0623_005_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin		Coin	Coin				O	O	V	V	V	O	O	O	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	0	0	0	YES	1240.706589	53.609946	413.376228	581.93141	1.341877	8.357641	3.567269	305.758449	45.443435	5.922951	18.417688	5.92847	0.790962	13.060123	3429.390271	4274.520277	102.253655	1.661603			24.992708	0		1.89	1.72				0.55	0.35	1319.436805	396.43736	0	3.77	0.04	0.32	598.724274	0.4	0.42	0.3	5000	$200/Day(Days 1-8):1a	$200/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15			"DEN767: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"				$0: Health Education Materials 14a	$0: OTC items 13c	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Membership in health club/fitness class 14a	$0: Nurse hotline 14a	$0: LifeSynch Wellness Program 14a	$35/Visit:7i	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	$0: Additional Smoking Cessation 14a$0: Member Incentive Program 14a	148.2254	133.6122	48.2281	0	0.2	0.2	0.2	50	0.23801	0.25	0.229123	0.25	0.2	0.230778	15	35	35	0.25			0.2	0		0	0				0	0	0	17.65635	0	0	0	0	35	0	0	0	NO	133.589179	120.418931	34.14781	0	0.175115	0.175115	0.175115	43.77875	0.208396	0.218894	0.200614	0.218894	0.175115	0.202063	13.133625	30.645125	30.645125	0.218894			0.175115	0		0	0				0	0	0	15.459459	0	0	0	0	30.645125	0	0	0		13.8121	0.537971032	1.176324408	0	0.234982791	1.463548304	0.624682311	1.115476892	9.47023008	1.296498436	3.69484606	1.297706512	0.138509311	2.638967634	3.753360483	10.91610068	0.261131337	0.363714927	0	0	4.376598061	0	0	0	0	0	0	0	0	0	0	0.510725593	0	0	0	0	1.528998351	0	0	0	59.2125	0	8.265334	13.8121	0.537971032	1.176324408	0	0.234982791	1.463548304	0.624682311	1.115476892	9.47023008	1.296498436	3.69484606	1.297706512	0.138509311	2.638967634	3.753360483	10.91610068	0.261131337	0.363714927	0	0	4.376598061	0	0	0	0	0	0	0	0	0	0	0.510725593	0	0	0	0	1.528998351	0	0	0	59.2125	YES	$250/Day(Days 1-10)	$250/Day(Days 1-10)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	20% Coins	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5							30% Coins	30% Coins	30% Coins				30% Coins				7500	3.173	0.127	0.489	1.684	0.9012	1.8505	0.7899	0.1887	2.1255	0.277	0.8614	0.2773	0.0247	0.6109	1.4873	2.787	0.0333	0.0777			1.0547	0		0	0				0	0	0.0563	0.5707	0.7449	0	0	0	0.1894	0	0	0	20.3816	0	4.084652	16.9851	0.664945032	1.665350408	1.684048	1.136230791	3.314073304	1.414537311	1.304223892	11.59570608	1.573526436	4.55627606	1.574992512	0.163172311	3.249903634	5.240697483	13.70310468	0.294436337	0.441431927	0	0	5.431336061	0	0	0	0	0	0	0	0	0	0.056273	1.081442593	0.74487	0	0	0	1.718438351	0	0	0	79.5941
H0623_006_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin		Coin	Coin				O	O	V	V	V	O	O	O	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	0	0	0	YES	1067.035301	46.105747	355.512763	500.473974	1.146976	7.14373	3.049139	262.959076	38.842972	5.062668	15.742597	5.067386	0.676078	11.163196	2949.352015	3676.182643	87.940421	1.420262			21.362625	0		1.89	1.72				0.55	0.35	1134.745039	340.944959	0	3.77	0.04	0.32	514.916211	0.4	0.42	0.3	5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15			"DEN767: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"				$0: Health Education Materials 14a	$0: OTC items 13c	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Membership in health club/fitness class 14a	$0: Nurse hotline 14a	$0: LifeSynch Wellness Program 14a	$35/Visit:7i	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	$0: Additional Smoking Cessation 14a$0: Member Incentive Program 14a	158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.23801	0.25	0.229123	0.25	0.2	0.230778	15	35	35	0.25			0.2	0		0	0				0	0	0	17.65635	0	0	0	0	35	0	0	0	NO	146.668725	129.708411	37.370797	0	0.179041	0.179041	0.179041	44.76025	0.213068	0.223801	0.205112	0.223801	0.179041	0.206593	13.428075	31.332175	31.332175	0.223801			0.179041	0		0	0				0	0	0	15.806053	0	0	0	0	31.332175	0	0	0		13.0417	0.498358598	1.107149608	0	0.20535573	1.279020563	0.545920896	0.980842832	8.276194358	1.133030161	3.228995556	1.134086054	0.121045681	2.306238151	3.300343338	9.598566492	0.229613722	0.317856056	0	0	3.824785743	0	0	0	0	0	0	0	0	0	0	0.449082841	0	0	0	0	1.344453736	0	0	0	52.9227	0	5.918268	13.0417	0.498358598	1.107149608	0	0.20535573	1.279020563	0.545920896	0.980842832	8.276194358	1.133030161	3.228995556	1.134086054	0.121045681	2.306238151	3.300343338	9.598566492	0.229613722	0.317856056	0	0	3.824785743	0	0	0	0	0	0	0	0	0	0	0.449082841	0	0	0	0	1.344453736	0	0	0	52.9227	YES	$250/Day(Days 1-15)	$250/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	20% Coins	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5							30% Coins	30% Coins	30% Coins				30% Coins				7500	3.5372	0.1468	0.4844	1.9416	1.0391	1.3334	0.5692	0.219	2.4505	0.3194	0.9932	0.3197	0.0284	0.7044	1.7148	3.2132	0.0384	0.0896			1.216	0		0	0				0	0	0.0649	0.658	0.8588	0	0	0	0.2184	0	0	0	22.1583	500	2.89697	16.5789	0.645205598	1.591586608	1.941578	1.24442573	2.612466563	1.115071896	1.199794832	10.72670636	1.452422161	4.222159556	1.453775054	0.149480681	3.010600151	5.015129338	12.81176949	0.268012722	0.407457056	0	0	5.040818743	0	0	0	0	0	0	0	0	0	0.064878	1.107074841	0.858779	0	0	0	1.562863736	0	0	0	75.081
H0623_009_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	YES	1095.958228	47.355484	365.149248	514.03976	1.225502	7.632815	3.257894	270.086812	41.502296	5.409275	16.82039	5.414317	0.722365	11.927467	3029.296786	3775.828795	90.324123	1.517498			22.825183	0							0.04	0.25	1165.503298	350.186571	0	0.05	0.55	3.77	528.873466	0.32	0.35	0.82	5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: Nutritional benefit 14a$0: LifeSynch Member Assistance 14a	158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.23801	0.25	0.229123	0.25	0.2	0.230778	15	35	35	0.25			0.2	0							0	0	0	17.65635	0	0	0	0	35	0	0	0	NO	145.692686	128.845237	36.503945	0	0.177879	0.177879	0.177879	44.46965	0.211685	0.222348	0.20378	0.222348	0.177879	0.205252	13.340895	31.128755	31.128755	0.222348			0.177879	0							0	0	0	15.703434	0	0	0	0	31.128755	0	0	0		13.3061	0.508460713	1.110782339	0	0.21799107	1.357717499	0.579510927	1.000888833	8.785413529	1.202741478	3.427659074	1.203862556	0.128493564	2.448136457	3.367794195	9.794737457	0.234306458	0.337412645	0	0	4.060120727	0	0	0	0	0	0	0	0	0	0	0.458260975	0	0	0	0	1.371931046	0	0	0	54.9023	0	6.567171	13.3061	0.508460713	1.110782339	0	0.21799107	1.357717499	0.579510927	1.000888833	8.785413529	1.202741478	3.427659074	1.203862556	0.128493564	2.448136457	3.367794195	9.794737457	0.234306458	0.337412645	0	0	4.060120727	0	0	0	0	0	0	0	0	0	0	0.458260975	0	0	0	0	1.371931046	0	0	0	54.9023	YES	$250/Day(Days 1-15)	$250/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	20% Coins	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	30% Coins	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	30% Coins	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: Nutritional benefit 14a	7500	3.5828	0.1487	0.4901	2.0287	1.0857	1.3933	0.5947	0.2199	2.5605	0.3337	1.0377	0.334	0.0297	0.736	1.7917	3.3574	0.0401	0.0936			1.2706	0							0	0	0.0678	0.6875	0.8973	0	0	0	0.2282	0	0	0	23.0097	500	3.313695	16.8888	0.657197713	1.600893339	2.028687	1.30367807	2.750988499	1.174196927	1.220808833	11.34586653	1.536462478	4.465381074	1.537894556	0.158204564	3.184099457	5.159513195	13.15209946	0.274427458	0.431033645	0	0	5.330710727	0	0	0	0	0	0	0	0	0	0.067789	1.145773975	0.897307	0	0	0	1.600140046	0	0	0	77.912
H0623_801_0	2010	4	N/A																															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	NO	245.403277	0.837097	42.609031	13.768495	1.614641	7.465889	3.64942	18.000418	51.254804	11.065292	26.380505	9.325662	0.81932	16.884627	31.335737	68.722428	0.330244	5.114119			22.336436	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																			0.081164437	0.081164437	0.14627748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.081164437	0.081164437	0.14627748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.918	0.067942506	6.232741667	0	0.376211353	1.739552137	0.85031486	4.194097394	11.94236933	2.578213036	6.146657665	2.172879246	0.19090156	3.934118091	7.301226721	16.01232572	0.076946852	1.191589727	0	0	5.204389588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1305	0	0	19.918	0.067942506	6.232741667	0	0.376211353	1.739552137	0.85031486	4.194097394	11.94236933	2.578213036	6.146657665	2.172879246	0.19090156	3.934118091	7.301226721	16.01232572	0.076946852	1.191589727	0	0	5.204389588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1305	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7078	0.0127	1.1603	0	1.5048	1.1469	0.5606	1.1058	2.8777	0.6798	1.4737	0.5729	0.0503	1.0296	1.3756	3.017	0.0144	0.2558			0.9806	0																			21.5265	0	0	23.6258	0.080604159	7.393014636	0	1.881041853	2.886494637	1.41091286	5.299915394	14.82003583	3.257990536	7.620382665	2.745826246	0.24122956	4.963745091	8.676858721	19.02932622	0.091392852	1.447423727	0	0	6.184970088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.657
H0623_802_0	2010	4	N/A																															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	NO	245.403277	0.837097	42.609031	13.768495	1.614641	7.465889	3.64942	18.000418	51.254804	11.065292	26.380505	9.325662	0.81932	16.884627	31.335737	68.722428	0.330244	5.114119			22.336436	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																			0.081164437	0.081164437	0.14627748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.081164437	0.081164437	0.14627748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.918	0.067942506	6.232741667	0	0.376211353	1.739552137	0.85031486	4.194097394	11.94236933	2.578213036	6.146657665	2.172879246	0.19090156	3.934118091	7.301226721	16.01232572	0.076946852	1.191589727	0	0	5.204389588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1305	0	0	19.918	0.067942506	6.232741667	0	0.376211353	1.739552137	0.85031486	4.194097394	11.94236933	2.578213036	6.146657665	2.172879246	0.19090156	3.934118091	7.301226721	16.01232572	0.076946852	1.191589727	0	0	5.204389588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1305	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7078	0.0127	1.1603	0	1.5048	1.1469	0.5606	1.1058	2.8777	0.6798	1.4737	0.5729	0.0503	1.0296	1.3756	3.017	0.0144	0.2558			0.9806	0																			21.5265	0	0	23.6258	0.080604159	7.393014636	0	1.881041853	2.886494637	1.41091286	5.299915394	14.82003583	3.257990536	7.620382665	2.745826246	0.24122956	4.963745091	8.676858721	19.02932622	0.091392852	1.447423727	0	0	6.184970088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.657
H0623_803_0	2010	5	N/A																															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	NO	245.403277	0.837097	42.609031	13.768495	1.614641	7.465889	3.64942	18.000418	51.254804	11.065292	26.380505	9.325662	0.81932	16.884627	31.335737	68.722428	0.330244	5.114119			22.336436	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																			0.081164437	0.081164437	0.14627748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.081164437	0.081164437	0.14627748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.918	0.067942506	6.232741667	0	0.376211353	1.739552137	0.85031486	4.194097394	11.94236933	2.578213036	6.146657665	2.172879246	0.19090156	3.934118091	7.301226721	16.01232572	0.076946852	1.191589727	0	0	5.204389588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1305	0	0	19.918	0.067942506	6.232741667	0	0.376211353	1.739552137	0.85031486	4.194097394	11.94236933	2.578213036	6.146657665	2.172879246	0.19090156	3.934118091	7.301226721	16.01232572	0.076946852	1.191589727	0	0	5.204389588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1305	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7078	0.0127	1.1603	0	1.5048	1.1469	0.5606	1.1058	2.8777	0.6798	1.4737	0.5729	0.0503	1.0296	1.3756	3.017	0.0144	0.2558			0.9806	0																			21.5265	0	0	23.6258	0.080604159	7.393014636	0	1.881041853	2.886494637	1.41091286	5.299915394	14.82003583	3.257990536	7.620382665	2.745826246	0.24122956	4.963745091	8.676858721	19.02932622	0.091392852	1.447423727	0	0	6.184970088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.657
H0624_001_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.532	1.1947	0.4975	0	1.2018	0	1.6301	0	0.0025	0.8244	1.2981	4.6429	0.3669	0.2443	0	0	1.0666	0.185	0	0	0	0	0	0	0	0											13.6869	NO	356.8385632	21.77786757	68.83778717	1806.791334	15.52442038	34.86231607	14.51919554	34.27967453	35.0693279	15.64506662	47.56887166	0	0.074331555	24.05700252	41.27620983	135.6446662	10.70568335	7.128931222	0	0	31.12448758	6.325385519	503.9509588	167.8188201	276.0368393	183.9704225	0	0	76.38649741	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076826356	0.077759469	0.149333888	0	0.193146273	0.193146273	0.193146273	0.092013331	0.193146273	0	0.16095432	0	0.193146273	0.144718208	0.161710994	0.192919673	0.193146273	0	0	0	0.193146273	0.193963331	0	0	0	0	0	0	0	0											NO	0.076826356	0.077759469	0.149333888	0	0.193146273	0.193146273	0.193146273	0.092013331	0.193146273	0	0.16095432	0	0.193146273	0.144718208	0.161710994	0.192919673	0.193146273	0	0	0	0.193146273	0.193963331	0	0	0	0	0	0	0	0												27.4146	1.693435426	10.27981441	0	2.998483936	6.733526415	2.804328504	3.154187052	6.773509978	0	7.65641541	0	0.014356863	3.481486294	6.674816935	26.16852471	2.067762838	0	0	0	6.011578773	1.226892847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.1537	146	0	27.4146	1.693435426	10.27981441	0	3.530484057	7.928219249	3.301878025	3.154187052	7.975289629	0	9.286540777	0	0.01690408	4.305884229	7.97296342	30.8114113	2.434641932	0.244301022	0	0	7.078171233	1.41190201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8406	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	27.4146	1.693435426	10.27981441	0	3.530484057	7.928219249	3.301878025	3.154187052	7.975289629	0	9.286540777	0	0.01690408	4.305884229	7.97296342	30.8114113	2.434641932	0.244301022	0	0	7.078171233	1.41190201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8406
H0624_004_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1225.483692	567.726324	6847.53388	82.16655073	670.6186803	503.8052829	721.7091901	157.2903042	79.40078733	25617.18593	4056.37098	0	0.451526657	178.3317546	199.0514215	7999.7262	1794.050018	18.67076031	0	0	89.40060843	670.4832708	2717.065352	126.8370738	108.1098487	71.83692676	15.73389678	9.353766505	0	0											800	"$75 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$75 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$75 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $10 (4b)	$25 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$25 (3, 5, 9a); $0 (9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $10 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											62.15007373	51.92515401	0	0	75	0	0	49.88787832	25	0	0	0	0	9.224871684	0.134614974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	57.48541763	58.18362108	0	0	58.18362108	0	0	38.70209878	19.39454036	0	0	0	0	7.156485848	0.104431822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												5.8706	2.752697776	0	0	3.251585265	0	0	0.507288741	0.128328481	0	0	0	0	0.10635239	0.001732275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.6186	0	3.647061502	5.8706	2.752697776	0	0	3.251585265	0	0	0.507288741	0.128328481	0	0	0	0	0.10635239	0.001732275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.6186	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $10 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.9238	0.8618	0.3675	0.0241	0.5356	0.1642	0.4344	0.0808	0.3358	0.3095	0.9515	0	0	0.0941	0.0293	3.7548	0.3739	0	0	0	0.0281	0.1013	0	0	0.0188	0	0.0019	0	0	0											14.3911	0	0	11.7945	3.614475053	0.3675036	0.024051715	3.787188657	0.164168694	0.434387999	0.588108661	0.464079372	0.309523948	0.951467738	0	0	0.200471178	0.031044057	3.75475265	0.373850355	0	0	0	0.028085203	0.101346026	0	0	0.018830609	0	0.001913166	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0097
H0624_005_0	2010	3	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2327.860596	240.5634319	59.56521684	1282.481803	306.5247116	27.97678271	15.14501166	550.0860775	51.96865417	15009.07889	58.48251747	0	0.274892802	31.88689048	9291.408436	6195.591409	1071.448813	473.9272081	0	0	43.60514249	1122.990098	666.9974205	0	245.2169713	195.8403558	17.33433418	4.764267289	78.61041027	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	0.149365555	0	150	0.2	0.100592836	49.54959182	0.2	3	0.172237597	0	0.2	0.14988519	10.45336275	30	38.5	30	0	0	0.2	29.69809372	0	0	30	30	0	0	0	0											NO	184.2401855	140.3212257	0.149365555	0	150	0.2	0.100592836	49.54959182	0.2	3	0.172237597	0	0.2	0.14988519	10.45336275	30	38.5	30	0	0	0.2	29.69809372	0	0	30	30	0	0	0	0												35.7405	2.813012969	8.89699165	0	3.831558895	5.595356541	1.523479667	2.271378384	10.39373083	3.752269723	10.0728883	0	0.05497856	4.779372648	8.0938719	15.48897852	3.437564942	1.18481802	0	0	8.721028499	2.779222097	0	0	0.613042428	0.489600889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.5336	0	0	35.7405	2.813012969	8.89699165	0	3.831558895	5.595356541	1.523479667	2.271378384	10.39373083	3.752269723	10.0728883	0	0.05497856	4.779372648	8.0938719	15.48897852	3.437564942	1.18481802	0	0	8.721028499	2.779222097	0	0	0.613042428	0.489600889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.5336	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	35.7405	2.813012969	8.89699165	0	3.831558895	5.595356541	1.523479667	2.271378384	10.39373083	3.752269723	10.0728883	0	0.05497856	4.779372648	8.0938719	15.48897852	3.437564942	1.18481802	0	0	8.721028499	2.779222097	0	0	0.613042428	0.489600889	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.5336
H0630_013_0	2010	4	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	S	S	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	YES	499.9792736	16.20128769	303.1266649	274.5880221	6.7176387	10.14300252	0.920757439	208.3560952	56.13934572	0	305.1870472	0.460302879	0.753548265	133.754817	3885.813682	3895.063784	332.6182511	531.4954441	1486.568476	4050.388414	0	4.945821977	0	0	194.7569539	0	36.50334149	0	69.80397753	0	56.33102157	22.35683142	0.174062857								3400	$210/day days 1-5; $0 days 6-90	$210/day days 1-5; $0 days 6-90	"$0 days 1-20, $100/day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance	$50/visit waived if admitted to hospital	$275/visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $225/procedure, Radiation Therapy $35/visit"	Partial hospital-20% Coinsurance	$0 Copay	Pulmonary Rehab $5; $0-$275/visit	Primary Care OV $0-$30/visit	Specialty Care OV $0-$35/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$35"		$0 Copay			$15/visit; $35/specialty visit		$15/visit		$0-$150 copay	$3 copay	$10 Generic copay	$35 Brand copay	20% coinsurance								130.63	130.63	37.25	0	0.2	0.2	0.2	45.35	275	0	273.24	0.2	0	14.61	14.79	32	12.98	15	0	15	0	0	0	0	23.82	0	15	0	0	0.01	10	35	0.2								NO	118.81	118.81	12.01	0	0.19	0.19	0.19	43.12	261.49	0	212.62	0.19	0	13.89	14.06	30.43	12.34	14.26	0	14.26	0	0	0	0	22.65	0	14.26	0	0	0.01	9.51	33.28	0.19									4.9502	0.160406249	0.30337927	0	1.276351353	1.927170479	0.174943913	0.748692902	1.223323126	0	5.407405831	0.087457547	0	0.154821201	4.552878364	9.877232579	0.342042435	0.631593753	0	4.813211565	0	0	0	0	0.36760375	0	0.043378137	0	0	0	0.044642335	0.062002946	0.033071943	0	0	0	0	0	0	0	37.1818	0	4.054848319	4.9502	0.160406249	0.30337927	0	1.276351353	1.927170479	0.174943913	0.748692902	1.223323126	0	5.407405831	0.087457547	0	0.154821201	4.552878364	9.877232579	0.342042435	0.631593753	0	4.813211565	0	0	0	0	0.36760375	0	0.043378137	0	0	0	0.044642335	0.062002946	0.033071943	0	0	0	0	0	0	0	37.1818	NO																																																																																		0	0	0	4.9502	0.160406249	0.30337927	0	1.276351353	1.927170479	0.174943913	0.748692902	1.223323126	0	5.407405831	0.087457547	0	0.154821201	4.552878364	9.877232579	0.342042435	0.631593753	0	4.813211565	0	0	0	0	0.36760375	0	0.043378137	0	0	0	0.044642335	0.062002946	0.033071943	0	0	0	0	0	0	0	37.1818
H0630_014_0	2010	4	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	S	S	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	YES	1688.347022	308.5944931	1485.792944	1873.391104	28.90458094	46.63362566	1.407805348	666.3725937	81.39234163	0	587.5917711	1.621450444	1.741012655	189.3351262	7325.121609	6894.12734	1795.215799	780.50925	2865.5776	6916.834682	0	4.945821977	0	0	186.2253226	0	81.97478314	0	106.4781151	0	208.8566943	89.17356552	0.398452041								3350	$190/day days 1-5; $0 days 6-90	$190/day days 1-5; $0 days 6-90	"$0 days 1-20, $0-$100/day days 21-100"	$0 Copay	"0%-20% Coinsurance, max $500/trip"	0%-20% Coinsurance; 0% Diabetic Supplies	0%-20% Coinsurance	$50/visit waived if admitted to hospital	$0-$200/visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $0-$125/procedure, Radiation Therapy $0-$30/visit"	Partial hospitalizaton 0%-20% coin	$0 Copay	Pulmonary Rehab $0-$30/visit; $0 - $200/visit	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$0-$10 Group Visit, $0-$15 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			$0-$15/visit; $0-$30/specialty visit		$0-$15/visit		$0-$150 copay	$0-$3 copay	0%-20% coinsurance	0%-20% coinsurance	0%-20% coinsurance								118.19	118.19	37.25	0	0.2	0.2	0.2	0.04	0	0	1	0.2	0	2	2	2	2	2	0	2	0	0	0	0	2	0	2	0	0	0	1	3	0								NO	112.28	112.28	14.02	0	0.19	0.19	0.19	0.04	0	0	0.96	0.19	0	1.93	1.93	1.93	1.93	1.93	0	1.93	0	0	0	0	1.93	0	1.93	0	0	0	0.96	2.89	0									15.7973	2.887415807	1.735901423	0	5.491870379	8.860388874	0.267483016	0.002221242	0	0	0.047007342	0.308075584	0	0.030451399	1.178123725	1.10880548	0.288730541	0.125531904	0	1.112457578	0	0	0	0	0.029951239	0	0.013184278	0	0	0	0.016708536	0.021475967	0	0	0	0	0	0	0	0	39.3231	0	4.78987592	15.7973	2.887415807	1.735901423	0	5.491870379	8.860388874	0.267483016	0.002221242	0	0	0.047007342	0.308075584	0	0.030451399	1.178123725	1.10880548	0.288730541	0.125531904	0	1.112457578	0	0	0	0	0.029951239	0	0.013184278	0	0	0	0.016708536	0.021475967	0	0	0	0	0	0	0	0	39.3231	NO																																																																																		0	0	0	15.7973	2.887415807	1.735901423	0	5.491870379	8.860388874	0.267483016	0.002221242	0	0	0.047007342	0.308075584	0	0.030451399	1.178123725	1.10880548	0.288730541	0.125531904	0	1.112457578	0	0	0	0	0.029951239	0	0.013184278	0	0	0	0.016708536	0.021475967	0	0	0	0	0	0	0	0	39.3231
H0630_015_0	2010	5	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	S	S	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	YES	855.9523946	33.58271002	705.767343	696.3312087	10.21559403	18.40365305	0.767503032	289.8493877	81.76828242	0	481.7395208	0.985012851	1.200765872	195.1825557	4875.847438	5432.436191	234.2134347	695.5477301	1939.363316	5394.397805	0	4.945821977	0	0	218.9738237	0	73.78422703	0	77.94722748	0	83.74668945	45.31886111	0.44164521								3400	$155/day days 1-5; $0 days 6-90	$155/day days 1-5; $0 days 6-90	"$0 days 1-20, $100/day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance	$50/visit waived if admitted to hospital	$225 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $150/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$30/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $15 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			$15/visit; $30/specialty visit		$15/visit		$0-$150 copay	$3 copay	$10 Generic copay	$35 Brand copay	20% coinsurance								96.42	96.42	37.25	0	0.2	0.15	0.2	43.02	225	0	198.72	0.2	0	14.61	14.8	27.75	14.02	15	0	15	0	0	0	0	21.59	0	15	0	0	0.01	9	35	0.2								NO	91.97	91.97	15	0	0.19	0.14	0.19	41.67	217.9	0	144.39	0.19	0	14.15	14.33	26.87	13.58	14.53	0	14.53	0	0	0	0	20.91	0	14.53	0	0	0.01	8.72	33.9	0.19									6.5602	0.257383487	0.882209179	0	1.940962866	2.576511428	0.145825576	1.006501999	1.484775728	0	5.796530784	0.187152442	0	0.230152764	5.822574482	12.16413004	0.265051537	0.842192377	0	6.531716676	0	0	0	0	0.381561888	0	0.089340402	0	0	0	0.060855928	0.128025783	0.08391259	0	0	0	0	0	0	0	47.4375	0	5.074025689	6.5602	0.257383487	0.882209179	0	1.940962866	2.576511428	0.145825576	1.006501999	1.484775728	0	5.796530784	0.187152442	0	0.230152764	5.822574482	12.16413004	0.265051537	0.842192377	0	6.531716676	0	0	0	0	0.381561888	0	0.089340402	0	0	0	0.060855928	0.128025783	0.08391259	0	0	0	0	0	0	0	47.4375	NO																																																																																		0	0	0	6.5602	0.257383487	0.882209179	0	1.940962866	2.576511428	0.145825576	1.006501999	1.484775728	0	5.796530784	0.187152442	0	0.230152764	5.822574482	12.16413004	0.265051537	0.842192377	0	6.531716676	0	0	0	0	0.381561888	0	0.089340402	0	0	0	0.060855928	0.128025783	0.08391259	0	0	0	0	0	0	0	47.4375
H0630_016_0	2010	4	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	S	S	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	YES	1525.711577	64.9165108	1420.261215	1239.219662	19.55527895	38.5310936	1.0642997	442.2654265	90.77897098	0	622.6083536	1.71845845	3.645044724	257.5831605	6346.774522	7549.190443	479.5814236	841.2650073	2560.549318	7387.613584	0	4.945821977	0	0	222.6153744	0	89.54361427	0	92.56393459	0	142.7433011	69.78498143	0.908884351								2350	$110/day days 1-5; $0 days 6-90	$110/day days 1-5; $0 days 6-90	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance	$50/visit waived if admitted to hospital	$150 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $125/procedure, Radiation Therapy $25/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$150/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$25/visit	"$10 Group Visit, $15 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$25"		$0 Copay			$15/visit; $25/specialty visit		$15/visit		$0-$150 copay	$3 copay	$8 Generic copay	$30 Brand copay	20% coinsurance								68.42	68.42	37.25	0	0.2	0.16	0.2	42	150	0	173.52	0.2	0	14.66	14.93	23.65	14.21	15	0	15	0	0	0	0	19.38	0	15	0	0	0.01	8	30	0.2								NO	63.76	63.76	10.9	0	0.19	0.15	0.19	40.15	143.4	0	118.55	0.19	0	14.01	14.27	22.61	13.59	14.34	0	14.34	0	0	0	0	18.52	0	14.34	0	0	0.01	7.65	28.68	0.19									8.1066	0.344923061	1.290070604	0	3.715503001	5.779664041	0.202216943	1.479746406	1.084808703	0	6.150851693	0.326507106	0	0.30072834	7.547372703	14.22393299	0.543125962	1.005311684	0	8.828198233	0	0	0	0	0.343569728	0	0.107004619	0	0	0	0.090998854	0.166786106	0.172688027	0	0	0	0	0	0	0	61.8106	0	8.851680679	8.1066	0.344923061	1.290070604	0	3.715503001	5.779664041	0.202216943	1.479746406	1.084808703	0	6.150851693	0.326507106	0	0.30072834	7.547372703	14.22393299	0.543125962	1.005311684	0	8.828198233	0	0	0	0	0.343569728	0	0.107004619	0	0	0	0.090998854	0.166786106	0.172688027	0	0	0	0	0	0	0	61.8106	NO																														"Travel Benefit for certain routine, follow-up and diag care"																																									0.0314											0.0314	0	0	8.1066	0.344923061	1.290070604	0	3.715503001	5.779664041	0.202216943	1.479746406	1.084808703	0	6.150851693	0.326507106	0	0.30072834	7.547372703	14.22393299	0.543125962	1.005311684	0	8.828198233	0	0	0	0	0.343569728	0	0.107004619	0	0	0.031375622	0.090998854	0.166786106	0.172688027	0	0	0	0	0	0	0	61.842
H0630_017_0	2010	3	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	S	S	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	YES	685.1318974	26.61558278	543.1183652	534.0016207	6.956749888	12.40429819	0.549947946	235.0360695	66.10023855	0	387.4468408	0.604522282	0.965180474	157.7631357	3831.601612	4236.556406	194.9515861	544.880186	1519.609337	4220.526285	0	4.945821977	0	0	176.1401789	0	42.05833085	0	62.73605908	0	56.33102157	22.35683142	0.174062857								3350	$210/day days 1-5; $0 days 6-90	$210/day days 1-5; $0 days 6-90	"$0 days 1-20, $100/day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance	$50/visit waived if admitted to hospital	$275/visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $225/procedure, Radiation Therapy $35/visit"	Partial hospital-20% Coinsurance	$0 Copay	"Pulmonary Rehab $5, OV $0-$275/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$35/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$35"		$0 Copay			$20/visit; $35/specialty visit		$20/visit		$0-$150 copay	$3 copay	$9 Generic copay	$35 Brand copay	20% coinsurance								130.63	130.63	37.25	0	0.2	0.2	0.2	45.35	275	0	223.6	0.2	0	19.42	19.63	32.75	17.98	20	0	20	0	0	0	0	26.62	0	20	0	0	0.01	9	35	0.2								NO	117.95	117.95	11.64	0	0.19	0.19	0.19	42.98	260.68	0	211.96	0.19	0	18.4	18.61	31.04	17.04	18.96	0	18.96	0	0	0	0	25.23	0	18.96	0	0	0.01	8.53	33.18	0.19									6.7343	0.261608999	0.526824814	0	1.321782479	2.356816656	0.10449011	0.841820855	1.435917515	0	6.843602697	0.114859233	0	0.241903475	5.942175501	10.95855924	0.276831252	0.860910694	0	6.668431531	0	0	0	0	0.370334726	0	0.066452163	0	0	0	0.040041968	0.061816639	0.033071943	0	0	0	0	0	0	0	46.0625	0	4.019926874	6.7343	0.261608999	0.526824814	0	1.321782479	2.356816656	0.10449011	0.841820855	1.435917515	0	6.843602697	0.114859233	0	0.241903475	5.942175501	10.95855924	0.276831252	0.860910694	0	6.668431531	0	0	0	0	0.370334726	0	0.066452163	0	0	0	0.040041968	0.061816639	0.033071943	0	0	0	0	0	0	0	46.0625	NO																																																																																		0	0	0	6.7343	0.261608999	0.526824814	0	1.321782479	2.356816656	0.10449011	0.841820855	1.435917515	0	6.843602697	0.114859233	0	0.241903475	5.942175501	10.95855924	0.276831252	0.860910694	0	6.668431531	0	0	0	0	0.370334726	0	0.066452163	0	0	0	0.040041968	0.061816639	0.033071943	0	0	0	0	0	0	0	46.0625
H0630_018_0	2010	4	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	S	S	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	YES	784.6800688	30.48276895	622.0322799	611.5908923	7.967550484	14.20661568	0.629854184	269.1862981	75.70445914	0	443.7420222	0.692358051	1.105419094	180.6857755	4388.324975	4852.118817	223.2776267	624.0500894	1740.405262	4833.759556	0	4.945821977	0	0	201.732963	0	67.03236976	0	71.85147173	0	83.74668945	45.31886111	0.44164521								2850	$155/day days 1-5; $0 days 6-90	$155/day days 1-5; $0 days 6-90	"$0 days 1-20, $100/day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance	$50/visit waived if admitted to hospital	$225 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $150/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$225/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $15 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			$15/visit; $30/specialty visit		$15/visit		$0-$150 copay	$3 copay	$8 Generic copay	$35 Brand copay	20% coinsurance								96.42	96.42	37.25	0	0.2	0.15	0.2	43.02	225	0	149.09	0.2	0	14.61	14.8	27.75	14.02	15	0	15	0	0	0	0	21.59	0	15	0	0	0.01	8	35	0.2								NO	89.2	89.2	11.68	0	0.19	0.14	0.19	41.12	215.05	0	142.5	0.19	0	13.97	14.15	26.52	13.4	14.34	0	14.34	0	0	0	0	20.64	0	14.34	0	0	0.01	7.65	33.45	0.19									5.8328	0.226588583	0.605444752	0	1.513834592	1.988926196	0.119672295	0.922411715	1.356686995	0	5.269436514	0.13154803	0	0.210348357	5.174566533	10.72318259	0.249326683	0.745739857	0	5.776342669	0	0	0	0	0.346980696	0	0.080103682	0	0	0	0.053388515	0.126326325	0.08391259	0	0	0	0	0	0	0	41.5376	0	3.4887136	5.8328	0.226588583	0.605444752	0	1.513834592	1.988926196	0.119672295	0.922411715	1.356686995	0	5.269436514	0.13154803	0	0.210348357	5.174566533	10.72318259	0.249326683	0.745739857	0	5.776342669	0	0	0	0	0.346980696	0	0.080103682	0	0	0	0.053388515	0.126326325	0.08391259	0	0	0	0	0	0	0	41.5376	NO																																																																																		0	0	0	5.8328	0.226588583	0.605444752	0	1.513834592	1.988926196	0.119672295	0.922411715	1.356686995	0	5.269436514	0.13154803	0	0.210348357	5.174566533	10.72318259	0.249326683	0.745739857	0	5.776342669	0	0	0	0	0.346980696	0	0.080103682	0	0	0	0.053388515	0.126326325	0.08391259	0	0	0	0	0	0	0	41.5376
H0630_019_0	2010	4	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	S	S	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	YES	856.6280267	33.60921799	705.767343	696.3312087	10.21559403	18.40365305	0.767503032	289.8493877	82.3074757	0	481.7395208	0.985012851	1.200765872	195.1825557	4875.847438	5432.436191	234.2134347	695.5477301	1939.363316	5394.397805	0	4.945821977	0	0	218.9738237	0	73.78422703	0	77.94722748	0	83.74668945	45.31886111	0.44164521								3400	$150/day days 1-5; $0 days 6-90	$150/day days 1-5; $0 days 6-90	"$0 days 1-20, $100/day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance (0% for Diabetic Supplies)	20% Coinsurance	$50/visit waived if admitted to hospital	$150 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $150/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$30/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $15 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			$15/visit; $30/specialty visit		$15/visit		$0-$150 copay	"$3 copay, 30% coinsurance OON"	$10 Generic copay	$35 Brand copay	20% coinsurance								93.31	93.31	37.25	0	0.2	0.15	0.2	43.02	150	0	198.72	0.2	0	14.61	14.8	27.75	14.02	15	0	15	0	0	0	0	21.59	0	15	0	0	0.01	10	35	0.2								NO	89.44	89.44	15.38	0	0.19	0.14	0.19	41.79	145.69	0	144.81	0.19	0	14.19	14.38	26.95	13.62	14.57	0	14.57	0	0	0	0	20.97	0	14.57	0	0	0.01	9.71	34	0.19									6.3847	0.250500705	0.904558478	0	1.940962866	2.576511428	0.145825576	1.009400493	0.999281345	0	5.813391668	0.187152442	0	0.230803372	5.842890513	12.20034628	0.265832248	0.844510869	0	6.549698002	0	0	0	0	0.382656757	0	0.089586349	0	0	0	0.06776503	0.12840344	0.08391259	0	0	0	0	0	0	0	46.8987	0	4.890419695	6.3847	0.250500705	0.904558478	0	1.940962866	2.576511428	0.145825576	1.009400493	0.999281345	0	5.813391668	0.187152442	0	0.230803372	5.842890513	12.20034628	0.265832248	0.844510869	0	6.549698002	0	0	0	0	0.382656757	0	0.089586349	0	0	0	0.06776503	0.12840344	0.08391259	0	0	0	0	0	0	0	46.8987	NO																														30% coinsurance OON Physician Benefits																																									4.3243											4.3243	0	0	6.3847	0.250500705	0.904558478	0	1.940962866	2.576511428	0.145825576	1.009400493	0.999281345	0	5.813391668	0.187152442	0	0.230803372	5.842890513	12.20034628	0.265832248	0.844510869	0	6.549698002	0	0	0	0	0.382656757	0	0.089586349	0	0	4.324285714	0.06776503	0.12840344	0.08391259	0	0	0	0	0	0	0	51.223
H0630_805_0	2010	2	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	684.8411226	23.26521223	757.1291466	640.6415756	9.715520603	13.59139722	0.73126262	278.9939342	82.79791501	0	430.5448824	0.505094719	0.86763732	174.6379319	4367.377021	5382.349494	164.3512359	772.5734434	1810.234533	5051.691887	0	4.945821977	0	0	220.6634295	0	95.40130687	0	71.88938606	0	2.113455165	4.02930982	0.261833938								2500	"$250/day days 1-2, $500 Max"	"$250/day days 1-2, $500 Max"	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	$200 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $100/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$200/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			"$20/routine visit, $30/specialty"		$20/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	20% coinsurance								84.99	84.99	37.25	0	0.2	0.2	0.2	44	200	0	99.33	0.2	0	19.37	24.43	29.09	21.62	25	25	25	0	0	0	0	27.2	0	25	0	0	0.01	0.25	0.25	0.2								NO	77.04	77.04	10.54	0	0.19	0.19	0.19	41.43	188.32	0	93.53	0.19	0	18.24	23.01	27.39	20.36	23.54	23.54	23.54	0	0	0	0	25.62	0	23.54	0	0	0.01	0.24	0.24	0.19									4.3967	0.149362662	0.665011767	0	1.845948915	2.582365472	0.138939898	0.963226558	1.29937528	0	3.355738571	0.095967997	0	0.265449656	8.374445437	12.28521272	0.278849264	1.515531571	3.551076742	9.909735585	0	0	0	0	0.471116422	0	0.187145564	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	53.8552	0	5.094813416	4.3967	0.149362662	0.665011767	0	1.845948915	2.582365472	0.138939898	0.963226558	1.29937528	0	3.355738571	0.095967997	0	0.265449656	8.374445437	12.28521272	0.278849264	1.515531571	3.551076742	9.909735585	0	0	0	0	0.471116422	0	0.187145564	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	53.8552	NO																																																																																		0	0	0	4.3967	0.149362662	0.665011767	0	1.845948915	2.582365472	0.138939898	0.963226558	1.29937528	0	3.355738571	0.095967997	0	0.265449656	8.374445437	12.28521272	0.278849264	1.515531571	3.551076742	9.909735585	0	0	0	0	0.471116422	0	0.187145564	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	53.8552
H0630_806_0	2010	2	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	825.1100715	20.2986512	607.2701015	646.7559705	9.446082779	17.63671205	1.031090966	321.6659499	83.95967046	0	468.3738464	1.018527742	1.807577751	192.7935977	4761.737418	5812.091238	194.1964817	817.0593727	1943.498184	5469.025719	0	4.945821977	0	0	237.2762275	0	91.65234274	0	85.9212509	0	2.113455165	4.02930982	0.261833938								2500	"$250/day days 1-2, $500 Max"	"$250/day days 1-2, $500 Max"	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	$200 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $100/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$200/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			"$20/routine visit, $30/specialty"		$20/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	20% coinsurance								84.99	84.99	37.25	0	0.2	0.2	0.2	44	200	0	99.33	0.2	0	19.37	24.43	29.09	21.62	25	25	25	0	0	0	0	27.2	0	25	0	0	0.01	0.25	0.25	0.2								NO	77.04	77.04	10.54	0	0.19	0.19	0.19	41.43	188.32	0	93.53	0.19	0	18.24	23.01	27.39	20.36	23.54	23.54	23.54	0	0	0	0	25.62	0	23.54	0	0	0.01	0.24	0.24	0.19									5.2972	0.130317341	0.533385573	0	1.794755728	3.35097529	0.195907284	1.110551692	1.317607095	0	3.650583821	0.193520271	0	0.293046268	9.130631499	13.26609825	0.329486697	1.602798136	3.812495605	10.72840545	0	0	0	0	0.506584746	0	0.179791346	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	58.9482	0	5.113182585	5.2972	0.130317341	0.533385573	0	1.794755728	3.35097529	0.195907284	1.110551692	1.317607095	0	3.650583821	0.193520271	0	0.293046268	9.130631499	13.26609825	0.329486697	1.602798136	3.812495605	10.72840545	0	0	0	0	0.506584746	0	0.179791346	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	58.9482	NO																																																																																		0	0	0	5.2972	0.130317341	0.533385573	0	1.794755728	3.35097529	0.195907284	1.110551692	1.317607095	0	3.650583821	0.193520271	0	0.293046268	9.130631499	13.26609825	0.329486697	1.602798136	3.812495605	10.72840545	0	0	0	0	0.506584746	0	0.179791346	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	58.9482
H0630_807_0	2010	3	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	850.9644478	21.04992478	612.1348384	659.9616469	9.685305738	18.48578364	1.087140972	265.1535367	86.55955614	0	495.617175	1.001560722	1.935082771	189.0245487	4820.449228	5843.798304	200.7011752	818.0612734	1967.325352	5533.983668	0	4.945821977	0	0	241.404608	0	91.40234506	0	86.86121375	0	2.113455165	4.02930982	0.261833938								2500	"$250/day days 1-2, $500 Max"	"$250/day days 1-2, $500 Max"	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	$200 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $100/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$200/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			"$20/routine visit, $30/specialty"		$20/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	20% coinsurance								84.99	84.99	37.25	0	0.2	0.2	0.2	44	200	0	99.33	0.2	0	19.37	24.43	29.09	21.62	25	25	25	0	0	0	0	27.2	0	25	0	0	0.01	0.25	0.25	0.2								NO	77.04	77.04	10.54	0	0.19	0.19	0.19	41.43	188.32	0	93.53	0.19	0	18.24	23.01	27.39	20.36	23.54	23.54	23.54	0	0	0	0	25.62	0	23.54	0	0	0.01	0.24	0.24	0.19									5.4632	0.135140517	0.537658433	0	1.84020809	3.512298891	0.206556785	0.915442586	1.358407968	0	3.862922865	0.190296537	0	0.287317314	9.243211394	13.33846963	0.340522994	1.604763531	3.859236566	10.8558313	0	0	0	0	0.515398838	0	0.179300934	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	59.7702	0	5.179710499	5.4632	0.135140517	0.537658433	0	1.84020809	3.512298891	0.206556785	0.915442586	1.358407968	0	3.862922865	0.190296537	0	0.287317314	9.243211394	13.33846963	0.340522994	1.604763531	3.859236566	10.8558313	0	0	0	0	0.515398838	0	0.179300934	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	59.7702	NO																																																																																		0	0	0	5.4632	0.135140517	0.537658433	0	1.84020809	3.512298891	0.206556785	0.915442586	1.358407968	0	3.862922865	0.190296537	0	0.287317314	9.243211394	13.33846963	0.340522994	1.604763531	3.859236566	10.8558313	0	0	0	0	0.515398838	0	0.179300934	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	59.7702
H0630_808_0	2010	3	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	574.0696637	6.089595359	418.2441459	445.8274476	5.678412485	12.68236104	0.69000122	235.6073231	74.24161196	0	457.5309119	1.670989194	0.542273325	265.0350967	4149.446804	4997.054488	115.1789401	835.2882924	1673.516739	4778.796946	0	4.945821977	0	0	185.8420958	0	92.69408709	0	81.98187895	0	2.113455165	4.02930982	0.261833938								2500	"$250/day days 1-2, $500 Max"	"$250/day days 1-2, $500 Max"	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	$200 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $100/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$200/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			"$20/routine visit, $30/specialty"		$20/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	20% coinsurance								84.99	84.99	37.25	0	0.2	0.2	0.2	44	200	0	99.33	0.2	0	19.37	24.43	29.09	21.62	25	25	25	0	0	0	0	27.2	0	25	0	0	0.01	0.25	0.25	0.2								NO	77.04	77.04	10.54	0	0.19	0.19	0.19	41.43	188.32	0	93.53	0.19	0	18.24	23.01	27.39	20.36	23.54	23.54	23.54	0	0	0	0	25.62	0	23.54	0	0	0.01	0.24	0.24	0.19									3.6855	0.039095202	0.367357775	0	1.078898372	2.409648598	0.131100232	0.813434283	1.165098364	0	3.566072183	0.317487947	0	0.402853347	7.956564247	11.40577687	0.195420268	1.6385572	3.282882003	9.374406676	0	0	0	0	0.396772874	0	0.181834901	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	49.9328	0	4.088812326	3.6855	0.039095202	0.367357775	0	1.078898372	2.409648598	0.131100232	0.813434283	1.165098364	0	3.566072183	0.317487947	0	0.402853347	7.956564247	11.40577687	0.195420268	1.6385572	3.282882003	9.374406676	0	0	0	0	0.396772874	0	0.181834901	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	49.9328	NO																																																																																		0	0	0	3.6855	0.039095202	0.367357775	0	1.078898372	2.409648598	0.131100232	0.813434283	1.165098364	0	3.566072183	0.317487947	0	0.402853347	7.956564247	11.40577687	0.195420268	1.6385572	3.282882003	9.374406676	0	0	0	0	0.396772874	0	0.181834901	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	49.9328
H0630_809_0	2010	2	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	Coin		Coin	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	825.1100715	20.2986512	607.2701015	646.7559705	9.446082779	17.63671205	1.031090966	321.6659499	26.28678772	0	13.16937783	1.018527742	1.807577751	192.7935977	4761.737418	5812.091238	194.1964817	817.0593727	1943.498184	5469.025719	0	4.945821977	0	0	237.2762275	0	91.65234274	0	85.9212509	0	2.113455165	4.02930982	0.261833938								2950	$250/day days 1-3; $750 max	$250/day days 1-3; $750 max	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	20% Coinsurance	$0 Copay	"MRI,CT,PET, Nuclear medicine 20% of cost/procedure; colonoscopies 0%"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$25/visit"	Primary Care OV $0-$40/visit	Specialty Care OV $0-$40/visit	"$10 Group Visit, $25 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$40"		$0 Copay			"$25/routine visit, $40/specialty"		$25/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	0% coinsurance								115.4	115.4	37.25	0	0.2	0.2	0.2	44	0.2	0	0.2	0.2	0	24.16	24.52	37.26	21.62	25	25	25	0	0	0	0	31.61	0	25	0	0	0.01	0.25	0.25	0.2								NO	105.06	105.06	11.43	0	0.19	0.19	0.19	41.07	0.19	0	0.19	0.19	0	22.55	22.89	34.78	20.18	23.33	23.33	23.33	0	0	0	0	29.5	0	23.33	0	0	0.01	0.23	0.23	0.19									7.2238	0.177714691	0.578424772	0	1.794755728	3.35097529	0.195907284	1.100901714	4.994489668	0	2.502181787	0.193520271	0	0.362291302	9.083014125	16.84537777	0.32657375	1.588499597	3.778484387	10.6326975	0	0	0	0	0.583304059	0	0.17818743	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	66.9537	0	6.021900818	7.2238	0.177714691	0.578424772	0	1.794755728	3.35097529	0.195907284	1.100901714	4.994489668	0	2.502181787	0.193520271	0	0.362291302	9.083014125	16.84537777	0.32657375	1.588499597	3.778484387	10.6326975	0	0	0	0	0.583304059	0	0.17818743	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	66.9537	NO																																																																																		0	0	0	7.2238	0.177714691	0.578424772	0	1.794755728	3.35097529	0.195907284	1.100901714	4.994489668	0	2.502181787	0.193520271	0	0.362291302	9.083014125	16.84537777	0.32657375	1.588499597	3.778484387	10.6326975	0	0	0	0	0.583304059	0	0.17818743	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	66.9537
H0630_810_0	2010	2	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	Coin		Coin	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	788.3674869	19.58146785	571.8005095	616.4759498	9.038661782	16.96939047	0.997962544	304.4338455	25.71483919	0	12.76593414	0.935566635	1.807577751	176.5694852	4419.647712	5365.566221	184.0136568	750.0426753	1803.749937	5073.854552	0	4.945821977	0	0	221.3327582	0	83.80259725	0	81.13781991	0	2.113455165	4.02930982	0.261833938								2950	$250/day days 1-3; $750 max	$250/day days 1-3; $750 max	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	20% Coinsurance	$0 Copay	"MRI,CT,PET, Nuclear medicine 20% of cost/procedure; colonoscopies 0%"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$25/visit"	Primary Care OV $0-$40/visit	Specialty Care OV $0-$40/visit	"$10 Group Visit, $25 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$40"		$0 Copay			"$25/routine visit, $40/specialty"		$25/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	0% coinsurance								115.4	115.4	37.25	0	0.2	0.2	0.2	44	0.2	0	0.2	0.2	0	24.16	24.52	37.26	21.62	25	25	25	0	0	0	0	31.61	0	25	0	0	0.01	0.25	0.25	0.2								NO	105.06	105.06	11.43	0	0.19	0.19	0.19	41.07	0.19	0	0.19	0.19	0	22.55	22.89	34.78	20.18	23.33	23.33	23.33	0	0	0	0	29.5	0	23.33	0	0	0.01	0.23	0.23	0.19									6.9022	0.171435751	0.544639985	0	1.717345739	3.22418419	0.189612883	1.041924836	4.885819446	0	2.425527486	0.177757661	0	0.331803491	8.430478011	15.55119943	0.309449633	1.458207968	3.506790503	9.864418892	0	0	0	0	0.544109697	0	0.162926216	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	62.9024	0	5.657621543	6.9022	0.171435751	0.544639985	0	1.717345739	3.22418419	0.189612883	1.041924836	4.885819446	0	2.425527486	0.177757661	0	0.331803491	8.430478011	15.55119943	0.309449633	1.458207968	3.506790503	9.864418892	0	0	0	0	0.544109697	0	0.162926216	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	62.9024	NO																																																																																		0	0	0	6.9022	0.171435751	0.544639985	0	1.717345739	3.22418419	0.189612883	1.041924836	4.885819446	0	2.425527486	0.177757661	0	0.331803491	8.430478011	15.55119943	0.309449633	1.458207968	3.506790503	9.864418892	0	0	0	0	0.544109697	0	0.162926216	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	62.9024
H0630_811_0	2010	1	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	1029.343539	25.32302802	739.4357421	787.515275	9.954857997	18.58664254	1.08662653	401.2855724	104.7415943	0	584.3070026	0.985406156	2.254994265	240.5143883	5714.084902	6974.509486	233.035778	980.4712472	2332.197821	6562.830862	0	4.945821977	0	0	288.9167817	0	111.5994644	0	104.6210636	0	2.113455165	4.02930982	0.261833938								2500	"$250/day days 1-2, $500 Max"	"$250/day days 1-2, $500 Max"	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	$200 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $100/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$200/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			"$20/routine visit, $30/specialty"		$20/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	20% coinsurance								84.99	84.99	37.25	0	0.2	0.2	0.2	44	200	0	99.33	0.2	0	19.37	24.43	29.09	21.62	25	25	25	0	0	0	0	27.2	0	25	0	0	0.01	0.25	0.25	0.2								NO	77.04	77.04	10.54	0	0.19	0.19	0.19	41.43	188.32	0	93.53	0.19	0	18.24	23.01	27.39	20.36	23.54	23.54	23.54	0	0	0	0	25.62	0	23.54	0	0	0.01	0.24	0.24	0.19									6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896	0	6.149541396	6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896	NO																																																																																		0	0	0	6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896
H0630_812_0	2010	1	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	1029.343539	25.32302802	739.4357421	787.515275	9.954857997	18.58664254	1.08662653	401.2855724	104.7415943	0	584.3070026	0.985406156	2.254994265	240.5143883	5714.084902	6974.509486	233.035778	980.4712472	2332.197821	6562.830862	0	4.945821977	0	0	288.9167817	0	111.5994644	0	104.6210636	0	2.113455165	4.02930982	0.261833938								2500	"$250/day days 1-2, $500 Max"	"$250/day days 1-2, $500 Max"	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	$200 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $100/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$200/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			"$20/routine visit, $30/specialty"		$20/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	20% coinsurance								84.99	84.99	37.25	0	0.2	0.2	0.2	44	200	0	99.33	0.2	0	19.37	24.43	29.09	21.62	25	25	25	0	0	0	0	27.2	0	25	0	0	0.01	0.25	0.25	0.2								NO	77.04	77.04	10.54	0	0.19	0.19	0.19	41.43	188.32	0	93.53	0.19	0	18.24	23.01	27.39	20.36	23.54	23.54	23.54	0	0	0	0	25.62	0	23.54	0	0	0.01	0.24	0.24	0.19									6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896	0	6.149541396	6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896	NO																																																																																		0	0	0	6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896
H0630_813_0	2010	1	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	1029.343539	25.32302802	739.4357421	787.515275	9.954857997	18.58664254	1.08662653	401.2855724	104.7415943	0	584.3070026	0.985406156	2.254994265	240.5143883	5714.084902	6974.509486	233.035778	980.4712472	2332.197821	6562.830862	0	4.945821977	0	0	288.9167817	0	111.5994644	0	104.6210636	0	2.113455165	4.02930982	0.261833938								2500	"$250/day days 1-2, $500 Max"	"$250/day days 1-2, $500 Max"	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	$200 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $100/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$200/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			"$20/routine visit, $30/specialty"		$20/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	20% coinsurance								84.99	84.99	37.25	0	0.2	0.2	0.2	44	200	0	99.33	0.2	0	19.37	24.43	29.09	21.62	25	25	25	0	0	0	0	27.2	0	25	0	0	0.01	0.25	0.25	0.2								NO	77.04	77.04	10.54	0	0.19	0.19	0.19	41.43	188.32	0	93.53	0.19	0	18.24	23.01	27.39	20.36	23.54	23.54	23.54	0	0	0	0	25.62	0	23.54	0	0	0.01	0.24	0.24	0.19									6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896	0	6.149541396	6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896	NO																																																																																		0	0	0	6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896
H0630_814_0	2010	1	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	V		P	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	1029.343539	25.32302802	739.4357421	787.515275	9.954857997	18.58664254	1.08662653	401.2855724	104.7415943	0	584.3070026	0.985406156	2.254994265	240.5143883	5714.084902	6974.509486	233.035778	980.4712472	2332.197821	6562.830862	0	4.945821977	0	0	288.9167817	0	111.5994644	0	104.6210636	0	2.113455165	4.02930982	0.261833938								2500	"$250/day days 1-2, $500 Max"	"$250/day days 1-2, $500 Max"	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	$200 per visit;colonoscopies $0	$0 Copay	"MRI,CT,PET $100/procedure, Radiation Therapy $30/visit"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$200/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$30/visit	"$10 Group Visit, $20 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$30"		$0 Copay			"$20/routine visit, $30/specialty"		$20/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	20% coinsurance								84.99	84.99	37.25	0	0.2	0.2	0.2	44	200	0	99.33	0.2	0	19.37	24.43	29.09	21.62	25	25	25	0	0	0	0	27.2	0	25	0	0	0.01	0.25	0.25	0.2								NO	77.04	77.04	10.54	0	0.19	0.19	0.19	41.43	188.32	0	93.53	0.19	0	18.24	23.01	27.39	20.36	23.54	23.54	23.54	0	0	0	0	25.62	0	23.54	0	0	0.01	0.24	0.24	0.19									6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896	0	6.149541396	6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896	NO																																																																																		0	0	0	6.6084	0.16257384	0.64947106	0	1.891423019	3.531462082	0.206459041	1.385438439	1.643744753	0	4.554186163	0.18722717	0	0.36558187	10.9567578	15.9193179	0.395384037	1.923357763	4.574994726	12.87408654	0	0	0	0	0.616837329	0	0.218920949	0	0	0	0.507229239	0.967034357	0.049748448	0	0	0	0	0	0	0	70.1896
H0630_815_0	2010	1	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	Coin		Coin	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	1024.144834	25.19513394	739.4357421	787.515275	9.954857997	18.58664254	1.08662653	401.2855724	26.28303906	0	13.13024915	0.985406156	2.254994265	240.5143883	5608.534407	6809.342793	228.7311445	962.3599964	2289.117497	6441.602345	0	4.945821977	0	0	283.5799151	0	109.5380007	0	104.6210636	0	2.113455165	4.02930982	0.261833938								2950	$250/day days 1-3; $750 max	$250/day days 1-3; $750 max	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	20% Coinsurance	$0 Copay	"MRI,CT,PET, Nuclear medicine 20% of cost/procedure; colonoscopies 0%"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$25/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$40/visit	"$10 Group Visit, $25 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$40"		$0 Copay			"$25/routine visit, $40/specialty"		$25/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	0% coinsurance								115.4	115.4	37.25	0	0.2	0.2	0.2	44	0.2	0	0.2	0.2	0	24.16	24.52	37.26	21.62	25	25	25	0	0	0	0	31.61	0	25	0	0	0.01	0.25	0.25	0.2								NO	105.06	105.06	11.43	0	0.19	0.19	0.19	41.07	0.19	0	0.19	0.19	0	22.55	22.89	34.78	20.18	23.33	23.33	23.33	0	0	0	0	29.5	0	23.33	0	0	0.01	0.23	0.23	0.19									8.9664	0.220583398	0.704312544	0	1.891423019	3.531462082	0.206459041	1.373399872	4.993777421	0	2.494747338	0.18722717	0	0.451966621	10.69827938	19.7357452	0.384649541	1.870988226	4.450425933	12.52354856	0	0	0	0	0.697133958	0	0.21296013	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	77.0581	0	7.061790228	8.9664	0.220583398	0.704312544	0	1.891423019	3.531462082	0.206459041	1.373399872	4.993777421	0	2.494747338	0.18722717	0	0.451966621	10.69827938	19.7357452	0.384649541	1.870988226	4.450425933	12.52354856	0	0	0	0	0.697133958	0	0.21296013	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	77.0581	NO																																																																																		0	0	0	8.9664	0.220583398	0.704312544	0	1.891423019	3.531462082	0.206459041	1.373399872	4.993777421	0	2.494747338	0.18722717	0	0.451966621	10.69827938	19.7357452	0.384649541	1.870988226	4.450425933	12.52354856	0	0	0	0	0.697133958	0	0.21296013	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	77.0581
H0630_816_0	2010	1	N/A	j.	j.	j.								Part B Rx	Part B Rx	Part B Rx								Generic	Brand	Office Administered								D	D	D		Coin	Coin	Coin	V	Coin		Coin	Coin		V	V	V	V	V		V		V			V		V		O	O	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	YES	1024.144834	25.19513394	739.4357421	787.515275	9.954857997	18.58664254	1.08662653	401.2855724	26.28303906	0	13.13024915	0.985406156	2.254994265	240.5143883	5608.534407	6809.342793	228.7311445	962.3599964	2289.117497	6441.602345	0	4.945821977	0	0	283.5799151	0	109.5380007	0	104.6210636	0	2.113455165	4.02930982	0.261833938								2950	$250/day days 1-3; $750 max	$250/day days 1-3; $750 max	"$0 days 1-20, $100 /day days 21-100"	$0 Copay	"20% Coinsurance, max $500/trip"	20% Coinsurance; 0% Diabetic Supplies	20% Coinsurance	$50/visit waived if admitted to hospital	20% Coinsurance	$0 Copay	"MRI,CT,PET, Nuclear medicine 20% of cost/procedure; colonoscopies 0%"	Partial hospitalizaton 20% coin	$0 Copay	"Pulmonary Rehab $5, OV $0-$25/visit"	Primary Care OV $0-$30/visit	Specialty Care OV $0-$40/visit	"$10 Group Visit, $25 OV"	Therapies=Primary Care OV	$0 Copay	"PA, NP $0-$40"		$0 Copay			"$25/routine visit, $40/specialty"		$25/routine visit/test		$0-$150 copay	$3 copay	25% Generic copay	25% Brand copay	0% coinsurance								115.4	115.4	37.25	0	0.2	0.2	0.2	44	0.2	0	0.2	0.2	0	24.16	24.52	37.26	21.62	25	25	25	0	0	0	0	31.61	0	25	0	0	0.01	0.25	0.25	0.2								NO	105.06	105.06	11.43	0	0.19	0.19	0.19	41.07	0.19	0	0.19	0.19	0	22.55	22.89	34.78	20.18	23.33	23.33	23.33	0	0	0	0	29.5	0	23.33	0	0	0.01	0.23	0.23	0.19									8.9664	0.220583398	0.704312544	0	1.891423019	3.531462082	0.206459041	1.373399872	4.993777421	0	2.494747338	0.18722717	0	0.451966621	10.69827938	19.7357452	0.384649541	1.870988226	4.450425933	12.52354856	0	0	0	0	0.697133958	0	0.21296013	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	77.0581	0	7.061790228	8.9664	0.220583398	0.704312544	0	1.891423019	3.531462082	0.206459041	1.373399872	4.993777421	0	2.494747338	0.18722717	0	0.451966621	10.69827938	19.7357452	0.384649541	1.870988226	4.450425933	12.52354856	0	0	0	0	0.697133958	0	0.21296013	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	77.0581	NO																																																																																		0	0	0	8.9664	0.220583398	0.704312544	0	1.891423019	3.531462082	0.206459041	1.373399872	4.993777421	0	2.494747338	0.18722717	0	0.451966621	10.69827938	19.7357452	0.384649541	1.870988226	4.450425933	12.52354856	0	0	0	0	0.697133958	0	0.21296013	0	0	0	0.486094688	0.926741259	0.049748448	0	0	0	0	0	0	0	77.0581
H0710_001_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	338.6442861	35.51208841	13084.37685	43.90693292	31.22203365	35.34348111	23.95840344	19.12414796	7.443250728	33.47893091	32.65639955	0	0.020550461	7.397458444	2.089584431	142.6297346	15.92083851	61.10399564	0	0	1.010231199	7.652119593	1102.560634	0	103.7188176	192.1860301	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.067898712	0.068723393	0	0	0.2	0.2	0.103077796	0.042049306	0.2	0	0.073662019	0	0.2	0.14991889	0.002581436	0.198055966	0.2	0	0	0	0.2	0.194856032	0	0	0	0	0	0	0	0											NO	0.067898712	0.068723393	0	0	0.2	0.2	0.103077796	0.042049306	0.2	0	0.073662019	0	0.2	0.14991889	0.002581436	0.198055966	0.2	0	0	0	0.2	0.194856032	0	0	0	0	0	0	0	0												22.9935	2.440511211	0	0	6.244406731	7.068696222	2.469579433	0.804157147	1.488650146	0	2.405536332	0	0.004110092	1.109018755	0.005394129	28.24866995	3.184167701	0	0	0	0.20204624	1.491061659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1595	0	0	22.9935	2.440511211	0	0	6.244406731	7.068696222	2.469579433	0.804157147	1.488650146	0	2.405536332	0	0.004110092	1.109018755	0.005394129	28.24866995	3.184167701	0	0	0	0.20204624	1.491061659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1595	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.0626	0.7406	0	0.0291	1.7181	1.9449	1.3184	0.1475	0.4096	0.5527	1.4257	0	0.0008	0.3051	0.0884	6.1127	0.6823	0	0	0	0.0433	0.3195	0	0	0.0278	0	0	0	0	0											22.9292	0	0	30.0561	3.181137653	0	0.029075758	7.962542311	9.013633348	3.788000451	0.951665263	1.89824915	0.55269951	3.831205478	0	0.004864014	1.414162969	0.093791863	34.36137286	3.866489351	0	0	0	0.245341863	1.810574871	0	0	0.027781826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.0887
H0710_002_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.7178	0.6037	0.6162	0	0.9117	0	2.2767	0	0.0028	1.2715	0.8739	3.4759	0.2739	0.1637	0	0	0.5848	0.2231	0	0	0	0	0	0	0	0											11.9957	NO	359.8506915	20.35056624	2163.190961	2808.880168	23.74357315	19.68220784	20.27612966	63.47939931	29.8385392	23.72675536	75.51721056	0	0.092488911	42.09061462	32.5229252	113.7423221	9.210214188	5.407207486	0	0	18.98883254	7.857192893	535.6399166	439.9377806	258.591663	214.967411	0	0	77.37746442	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.068659794	0.069493718	43.47002967	0	0.193917744	0.193917744	0.193917744	0.055519441	0.193917744	0	0.162333028	0	0.193917744	0.145769992	0.152607259	0.193790334	0.193917744	0	0	0	0.193917744	0.194125165	0	0	0	0	0	0	0	0											NO	0.068659794	0.069493718	43.47002967	0	0.193917744	0.193917744	0.193917744	0.055519441	0.193917744	0	0.162333028	0	0.193917744	0.145769992	0.152607259	0.193790334	0.193917744	0	0	0	0.193917744	0.194125165	0	0	0	0	0	0	0	0												24.7073	1.414236516	7.836164605	0	4.60430014	3.816729342	3.93190132	3.524340787	5.786222206	0	12.25893746	0	0.017935241	6.13554856	4.963234483	22.04216256	1.786023957	0	0	0	3.682271568	1.525278868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0326	146	0	24.7073	1.414236516	7.836164605	0	5.322144697	4.420390291	4.548150428	3.524340787	6.697887158	0	14.53565372	0	0.020758455	7.407048112	5.837095113	25.51803757	2.059968879	0.163705838	0	0	4.267048813	1.748344344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.0282	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												10.6769	0.6038	4.2614	0.51	0.6629	0.5502	0.5664	0.3063	0.8339	0.1857	1.7967	0	0.0018	0.9107	2.0211	7.2237	0.5834	0.0323	0	0	1.2068	0.4961	0	0.0965	0.0779	0.0359	0	0	0	0											33.6403	146	0	35.3842	2.018044525	12.09760673	0.50998004	5.985029983	4.970635351	5.114510844	3.830618306	7.531763985	0.185687651	16.33231367	0	0.022563157	8.317730655	7.858233014	32.74170687	2.643408038	0.196004695	0	0	5.473876029	2.244448893	0	0.096477583	0.077901176	0.03585711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.6686
H0710_003_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2043.659561	225.5891385	54.23968422	2049.654067	340.8453987	13.49786755	18.61321585	450.2714821	38.72666895	13247.99373	88.30620158	0	0.099154722	35.48404635	7445.67273	6166.130695	880.6270746	499.4741497	0	0	31.32107449	1746.017602	672.457367	0	314.5449058	0	15.29170176	4.563103562	79.25390397	0											3800	"$275 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											190.6084929	140.5472438	0.16137045	0	150	0.2	0.084179589	49.63521008	0.2	3	0.165049711	0	0.2	0.149479872	9.841484122	34.90245125	38.5	35	0	0	0.2	34.83180011	0	0	35	0	0	0	0	0											NO	131.9861451	97.32141853	0.11174037	0	103.8669446	0.138489259	0.058289845	34.36971743	0.138489259	2.077338891	0.114288061	0	0.138489259	0.103732631	9.724264186	34.90245125	38.5	24.2356204	0	0	0.138489259	34.83180011	0	0	35	0	0	0	0	0												22.4779	1.82955458	6.060762403	0	2.950214178	1.869309681	1.084961462	1.289641967	5.363227703	2.29338105	10.09234456	0	0.013731864	3.680853488	6.033640723	17.934423	2.825345198	1.008755491	0	0	4.33763241	5.068078009	0	0	0.917422642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1312	0	28.6435595	22.4779	1.82955458	6.060762403	0	2.950214178	1.869309681	1.084961462	1.289641967	5.363227703	2.29338105	10.09234456	0	0.013731864	3.680853488	6.033640723	17.934423	2.825345198	1.008755491	0	0	4.33763241	5.068078009	0	0	0.917422642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1312	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												9.0981	0.274	2.2189	0.7436	0.6936	0.6592	0.909	0.3032	1.8913	0.5392	3.5225	0	0.0032	1.3103	1.7948	5.9377	0.456	0.3174	0	0	1.3423	0.4819	0	0	0.071	0	0.0029	0.003	0	0											32.5731	0	0	31.576	2.103580958	8.279658575	0.743632251	3.643794931	2.528507864	1.99397898	1.592830412	7.254530141	2.832543586	13.61487712	0	0.016960157	4.991152981	7.828430048	23.8720819	3.281384219	1.326176537	0	0	5.679964174	5.549938526	0	0	0.988382894	0	0.002859409	0.003002042	0	0	0	0	0	0	0	0	0	0	0	0	129.7043
H0712_001_0	2010	6	N/A																															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	V	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	Yes	1542.867667	91.30985802	985.7705023	153.5547972	489.524875	5.358251629	5.33297357	1427.659636	273.6518665	5843.870099	995.0297102	50.33649631	1.071744106	347.2392417	7545.334406	21874.35632	60.82368079	929.5719338	3699.227078	2044.27098	9.951903971	6.726488863	0	338.5714286	288	172.8	16.8	12.8	2040	0.632172862											3250	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 20, $133.5 days 21 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $20.00 and $150.00	Copay between $0.00 and $10.00	Copay between $0.00 and $30.00	Copay between $20.00 and $30.00	$30.00 copayment	Copay between $0.00 and $80.00	Copay between $0.00 and $30.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	$0.00 copayment											121.8266755	108.6607722	32.31	0.095264213	45.63600266	0.2	0.07565652	24.55241978	100.3115971	0	60.55337945	56.85959902	0.2	26.12168521	5.616589134	4.249194024	21.20849207	13.75277768	19.94123876	7.426922444	0.2	0	0	0	0	0	0	0	0	0											NO	114.6202067	102.233112	30.39875185	0.089629005	42.93647541	0.188169309	0.071181176	23.10005931	94.37781955	0	56.97143782	53.49615726	0.188169309	24.57649727	5.284348479	3.997839515	19.95393648	12.93925336	18.76164558	6.987594318	0.188169309	0	0	0	0	0	0	0	0	0												14.737	0.777907579	2.49718274	0.001146914	1.751539396	1.008258506	0.379607329	2.748251856	2.152222206	0	4.724022772	0.22440076	0.201669348	0.711160356	3.322681366	7.287513839	0.101139322	1.002330564	5.783632281	1.190378023	1.872642893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4747	0	3.299218355	14.737	0.777907579	2.49718274	0.001146914	1.751539396	1.008258506	0.379607329	2.748251856	2.152222206	0	4.724022772	0.22440076	0.201669348	0.711160356	3.322681366	7.287513839	0.101139322	1.002330564	5.783632281	1.190378023	1.872642893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4747	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.4927	0	0.1516	0.013	0.1574	0.0887	0.0877	0	0.3937	0.108	0.3643	0	0	0.1396	0	1.2137	0	0.0585	0.5191	0.2388	0	0.0028	0	0	0	0	0	0	0	0											5.0297	0	0	16.2297	0.777907579	2.648806544	0.014163515	1.908919988	1.096986544	0.467293322	2.748251856	2.545970023	0.108018788	5.088348079	0.22440076	0.201669348	0.850782633	3.322681366	8.501200614	0.101139322	1.060861587	6.302763297	1.429128582	1.872642893	0.002793905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5044
H0712_005_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	342.6278866	40.35392521	1179.511123	749.0069026	39.3740251	16.17839276	8.320204398	57.72418513	28.64913024	15563.37246	31.41614762	1.830240575	0.015174476	13.00676409	7189.858804	102.7289561	9.325325218	10.12438091	32.3563095	13.84287387	15.77865031	0.378988252	1450	338.5714286	0.96	172.8	0.056	0.224	2040	6958.847032												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	$0.00 copayment											558.4846103	404.6998315	46.54180999	0	0.166348767	0.170000766	0.07337168	0.140565688	0.17	0	0.170085629	0.248626401	0.17	0.170008586	0	0.09440155	0.383274035	0.170000438	0.167395127	0.095506548	0.17000087	0.17	0	0	0	0	0	0	0	0											NO	558.4846103	404.6998315	46.54180999	0	0.166348767	0.170000766	0.07337168	0.140565688	0.17	0	0.170085629	0.248626401	0.17	0.170008586	0	0.09440155	0.383274035	0.170000438	0.167395127	0.095506548	0.17000087	0.17	0	0	0	0	0	0	0	0												15.946	1.360935561	4.574715215	0	6.549820528	2.750339167	0.610467373	8.114039771	4.870352141	0	5.343435213	0.455046127	0.002579661	2.211261565	0	9.697772727	3.574155024	1.721149191	5.416288542	1.322085104	2.682384287	0.064428003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2673	0	0	15.946	1.360935561	4.574715215	0	6.549820528	2.750339167	0.610467373	8.114039771	4.870352141	0	5.343435213	0.455046127	0.002579661	2.211261565	0	9.697772727	3.574155024	1.721149191	5.416288542	1.322085104	2.682384287	0.064428003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2673	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.946	1.360935561	4.574715215	0	6.549820528	2.750339167	0.610467373	8.114039771	4.870352141	0	5.343435213	0.455046127	0.002579661	2.211261565	0	9.697772727	3.574155024	1.721149191	5.416288542	1.322085104	2.682384287	0.064428003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2673
H0712_018_0	2010	5	N/A																															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	V	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	Yes	1313.642636	70.8912469	947.1522441	1011.032827	939.2825228	10.26156907	3.982994774	1495.891169	329.5463776	9132.95987	1489.811458	96.31178695	0.05805014	873.8401909	8283.658151	24314.85814	758.4861539	4354.090862	3954.259104	2768.699842	24.10160662	23.98689558	0	338.5714286	288	172.8	16.8	12.8	2040	0											1750	"$50 days 1 - 7, $0 after day 7, unlimited coverage"	"$50 days 1 - 7, $0 after day 7, unlimited coverage"	$0 days 1 - 100	Copay between $0.00 and $15.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	$25.00 copayment	$0.00 copayment	Copay between $0.00 and $75.00	$50.00 copayment	20% coinsurance	Copay between $5.00 and $25.00	$0.00 copayment	Copay between $0.00 and $20.00	Copay between $5.00 and $15.00	$15.00 copayment	Copay between $0.00 and $65.00	Copay between $0.00 and $15.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											40.07872318	26.47362921	0	0.874619953	32.72651261	0.2	0.2	18.81983555	16.73956855	0	44.31997784	14.27545985	0.2	3.002351508	0	3.534211571	10.12688483	3.868746924	36.48310795	4.111656576	0.2	0	0	0	0	0	0	0	0	0											NO	35.09895021	23.18428632	0	0.765948607	28.66025026	0.175150042	0.175150042	16.48147492	14.65968066	0	38.81322986	12.50173695	0.175150042	2.629309961	0	3.095086523	8.86862151	3.388055928	31.95008942	3.600784106	0.175150042	0	0	0	0	0	0	0	0	0												3.8423	0.13696358	0	0.064533265	2.243339347	1.797314252	0.697621701	2.054541065	0.402587055	0	4.818699547	0.100338719	0.010167484	0.191466393	0	6.271382478	0.560560552	1.22932528	10.52824433	0.830790865	4.221397407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0016	0	5.67534646	3.8423	0.13696358	0	0.064533265	2.243339347	1.797314252	0.697621701	2.054541065	0.402587055	0	4.818699547	0.100338719	0.010167484	0.191466393	0	6.271382478	0.560560552	1.22932528	10.52824433	0.830790865	4.221397407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0016	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.8783	0	0.2612	0.1407	0.2691	0.1699	0.066	0	0.5315	0.1784	0.5471	0	0	0.2511	0	1.758	0	0.2473	0.5435	0.3548	0	0.0077	0	0	0	0	0	0	0	0											7.2047	0	0	5.7206	0.13696358	0.261196782	0.205256167	2.512474602	1.967237008	0.763576668	2.054541065	0.93413542	0.178369779	5.365765618	0.100338719	0.010167484	0.442598312	0	8.029418346	0.560560552	1.476618869	11.07171903	1.185635797	4.221397407	0.007738556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2063
H0747_801_0	2010	2	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	193.7280789	2.024046986	54.81790209	53.95125882	8.467639432	11.18752996	7.846639548	13.81492888	45.31096701	6.497285456	20.99963725	1.026378436	0.17943679	36.80332217	49.2124319	88.45374508	0.963827497	6.665537088	21.88612904	21.87962282	9.51	4.709027042	0	0	0	0	6.137234992	0.120619219	0.247900896	0												1A IP Acute:  Standard Medicare	1B IP Psych:  Standard Medicare	2 SNF:  Standard Medicare	6 Home Health:  Standard Medicare	10A Ambulance:  Standard Medicare	11A DME:  Standard Medicare	"11B Prosthetics/Medical Supplies:  Standard Medicare, 11C Diabetes Monitoring Supplies:  Standard Medicare"	"4A ER:  Standard Medicare, 4B Urgent Care:  Standard Medicare"	9B ASC Services:  Standard Medicare	8A OP Diagnostic Procedures/Tests:  Standard Medicare	8B OP Radiology:  Standard Medicare	9A OP Hospital:  Standard Medicare	12 Renal Dialysis:  Standard Medicare	"3 CORF:  Standard Medicare, 5 Partial Hosp:  Standard Medicare, 9C OP Substance Abuse:  Standard Medicare, 9D Cardiac Rehab:  Standard Medicare"	"7A PCP:  Standard Medicare, 14B Immunizations:  Standard Medicare, 14C Physical Exams:  Standard Medicare, 14D Pap Smears and Pelvic Exams:  Standard Medicare, 14E Prostate Screening:  Standard Medicare, 14F Colorectal Screening:  Standard Medicare, 14G Bone Mass Measurement:  Standard Medicare, 14H Mammography:  Standard Medicare, 14I Diabetes Monitoring:  Standard Medicare, 14J Nutrition Therapy:  Standard Medicare"	"7B Chiropractic:  Standard Medicare, 7D Physician Specialist (excl. Radiology):  Standard Medicare, 7F Podiatry:  Standard Medicare"	"7E Mental Health:  Standard Medicare, 7H Psychiatric:  Standard Medicare"	"7C Occupational Therapy:  Standard Medicare, 7I Physical and Speech Therapy:  Standard Medicare"	7D Physician Specialist (Radiology):  Standard Medicare	"7G Other Health Care:  Standard Medicare, 18A Hearing Exams (Medicare Covered):  Standard Medicare"	15 Part B Drugs:  Standard Medicare	"13A Blood:  Standard Medicare, 16B Comprehensive Dental (Medicare Covered):  Standard Medicare, 17A Routine Eye Exams (Medicare Covered):  Standard Medicare"	10B Transportation:  Standard Medicare	"16A Preventative Dental Services (Non Medicare Covered):  Not Covered, 16B Comprehensive Dental (Non Medicare Covered):  Not Covered"	17A Routine Eye Exams (Non Medicare Covered):  Not Covered	17B Eye Wear (Medicare Covered):  Standard Medicare	18A Routine Hearing Exams (Non Medicare Covered):  Not Covered	18B Hearing Aids (Non Medicare Covered):  Not Covered	14A Health Education/Wellness Program:  Standard Medicare	"13B Acupuncture:  Standard Medicare, 13C Other 1 Copay Standard Medicare, 13D Other 2 Copay Standard Medicare, 13E Other 3 Copay Standard Medicare"											0.082286802	0.082232816	0.16887131	0	0.232933658	0.233000001	0.233098386	0.233019969	0.232999233	0.23295888	0.232997743	0.232999923	0.233000014	0.232979228	0.232998229	0.232998053	0.232989139	0.233020898	0.233002384	0.233040679	0.232999244	0.233015791	0	0	0	0	0	0	0	0											NO	0.082286802	0.082232816	0.16887131	0	0.232933658	0.233000001	0.233098386	0.233019969	0.232999233	0.23295888	0.232997743	0.232999923	0.233000014	0.232979228	0.232998229	0.232998053	0.232989139	0.233020898	0.233002384	0.233040679	0.232999244	0.233015791	0	0	0	0	0	0	0	0												15.9413	0.166443083	9.257170957	0	1.972398228	2.606694491	1.829039018	3.2191543	10.55742054	1.513600344	4.89286808	0.239146096	0.041808774	8.574409584	11.46640945	20.60955042	0.224561339	1.553209435	5.099520237	5.098842153	2.215822812	1.097277663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1766	0	0	15.9413	0.166443083	9.257170957	0	1.972398228	2.606694491	1.829039018	3.2191543	10.55742054	1.513600344	4.89286808	0.239146096	0.041808774	8.574409584	11.46640945	20.60955042	0.224561339	1.553209435	5.099520237	5.098842153	2.215822812	1.097277663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1766	NO	1A IP Acute:  Standard Medicare	1B IP Psych:  Standard Medicare	2 SNF:  Standard Medicare	6 Home Health:  Standard Medicare	10A Ambulance:  Standard Medicare	11A DME:  Standard Medicare	"11B Prosthetics/Medical Supplies:  Standard Medicare, 11C Diabetes Monitoring Supplies:  Standard Medicare"	"4A ER:  Standard Medicare, 4B Urgent Care:  Standard Medicare"	9B ASC Services:  Standard Medicare	8A OP Diagnostic Procedures/Tests:  Standard Medicare	8B OP Radiology:  Standard Medicare	9A OP Hospital:  Standard Medicare	12 Renal Dialysis:  Standard Medicare	"3 CORF:  Standard Medicare, 5 Partial Hosp:  Standard Medicare, 9C OP Substance Abuse:  Standard Medicare, 9D Cardiac Rehab:  Standard Medicare"	"7A PCP:  Standard Medicare, 14B Immunizations:  Standard Medicare, 14C Physical Exams:  Standard Medicare, 14D Pap Smears and Pelvic Exams:  Standard Medicare, 14E Prostate Screening:  Standard Medicare, 14F Colorectal Screening:  Standard Medicare, 14G Bone Mass Measurement:  Standard Medicare, 14H Mammography:  Standard Medicare, 14I Diabetes Monitoring:  Standard Medicare, 14J Nutrition Therapy:  Standard Medicare"	"7B Chiropractic:  Standard Medicare, 7D Physician Specialist (excl. Radiology):  Standard Medicare, 7F Podiatry:  Standard Medicare"	"7E Mental Health:  Standard Medicare, 7H Psychiatric:  Standard Medicare"	"7C Occupational Therapy:  Standard Medicare, 7I Physical and Speech Therapy:  Standard Medicare"	7D Physician Specialist (Radiology):  Standard Medicare	"7G Other Health Care:  Standard Medicare, 18A Hearing Exams (Medicare Covered):  Standard Medicare"	15 Part B Drugs:  Standard Medicare	"13A Blood:  Standard Medicare, 16B Comprehensive Dental (Medicare Covered):  Standard Medicare, 17A Routine Eye Exams (Medicare Covered):  Standard Medicare"	10B Transportation:  Standard Medicare	"16A Preventative Dental Services (Non Medicare Covered):  Not Covered, 16B Comprehensive Dental (Non Medicare Covered):  Not Covered"	17A Routine Eye Exams (Non Medicare Covered):  Not Covered	17B Eye Wear (Medicare Covered):  Standard Medicare	18A Routine Hearing Exams (Non Medicare Covered):  Not Covered	18B Hearing Aids (Non Medicare Covered):  Not Covered	14A Health Education/Wellness Program:  Standard Medicare	"13B Acupuncture:  Standard Medicare, 13C Other 1 Copay Standard Medicare, 13D Other 2 Copay Standard Medicare, 13E Other 3 Copay Standard Medicare"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.9413	0.166443083	9.257170957	0	1.972398228	2.606694491	1.829039018	3.2191543	10.55742054	1.513600344	4.89286808	0.239146096	0.041808774	8.574409584	11.46640945	20.60955042	0.224561339	1.553209435	5.099520237	5.098842153	2.215822812	1.097277663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1766
H0747_802_0	2010	2	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	189.3726074	1.248095316	65.27619187	53.67834941	5.263790867	5.491707013	3.497099004	12.56976562	34.97686253	4.41847033	16.56686655	0.203504964	0.034492367	43.23440676	70.3166909	75.02343384	0.513354091	9.356778409	29.39881723	26.69603551	7.99	4.497811364	0	0	0	0	7.432744525	0.104792977	0.124555185	0												1A IP Acute:  Standard Medicare	1B IP Psych:  Standard Medicare	2 SNF:  Standard Medicare	6 Home Health:  Standard Medicare	10A Ambulance:  Standard Medicare	11A DME:  Standard Medicare	"11B Prosthetics/Medical Supplies:  Standard Medicare, 11C Diabetes Monitoring Supplies:  Standard Medicare"	"4A ER:  Standard Medicare, 4B Urgent Care:  Standard Medicare"	9B ASC Services:  Standard Medicare	8A OP Diagnostic Procedures/Tests:  Standard Medicare	8B OP Radiology:  Standard Medicare	9A OP Hospital:  Standard Medicare	12 Renal Dialysis:  Standard Medicare	"3 CORF:  Standard Medicare, 5 Partial Hosp:  Standard Medicare, 9C OP Substance Abuse:  Standard Medicare, 9D Cardiac Rehab:  Standard Medicare"	"7A PCP:  Standard Medicare, 14B Immunizations:  Standard Medicare, 14C Physical Exams:  Standard Medicare, 14D Pap Smears and Pelvic Exams:  Standard Medicare, 14E Prostate Screening:  Standard Medicare, 14F Colorectal Screening:  Standard Medicare, 14G Bone Mass Measurement:  Standard Medicare, 14H Mammography:  Standard Medicare, 14I Diabetes Monitoring:  Standard Medicare, 14J Nutrition Therapy:  Standard Medicare"	"7B Chiropractic:  Standard Medicare, 7D Physician Specialist (excl. Radiology):  Standard Medicare, 7F Podiatry:  Standard Medicare"	"7E Mental Health:  Standard Medicare, 7H Psychiatric:  Standard Medicare"	"7C Occupational Therapy:  Standard Medicare, 7I Physical and Speech Therapy:  Standard Medicare"	7D Physician Specialist (Radiology):  Standard Medicare	"7G Other Health Care:  Standard Medicare, 18A Hearing Exams (Medicare Covered):  Standard Medicare"	15 Part B Drugs:  Standard Medicare	"13A Blood:  Standard Medicare, 16B Comprehensive Dental (Medicare Covered):  Standard Medicare, 17A Routine Eye Exams (Medicare Covered):  Standard Medicare"	10B Transportation:  Standard Medicare	"16A Preventative Dental Services (Non Medicare Covered):  Not Covered, 16B Comprehensive Dental (Non Medicare Covered):  Not Covered"	17A Routine Eye Exams (Non Medicare Covered):  Not Covered	17B Eye Wear (Medicare Covered):  Standard Medicare	18A Routine Hearing Exams (Non Medicare Covered):  Not Covered	18B Hearing Aids (Non Medicare Covered):  Not Covered	14A Health Education/Wellness Program:  Standard Medicare	"13B Acupuncture:  Standard Medicare, 13C Other 1 Copay Standard Medicare, 13D Other 2 Copay Standard Medicare, 13E Other 3 Copay Standard Medicare"											0.083226696	0.083243709	0.158332472	0	0.233107274	0.233000002	0.232996288	0.233062055	0.232999988	0.233103219	0.233011579	0.232999917	0.23300001	0.23297342	0.232992743	0.232998469	0.233000576	0.232973073	0.233014125	0.233000343	0.233002738	0.233005536	0	0	0	0	0	0	0	0											NO	0.083226696	0.083243709	0.158332472	0	0.233107274	0.233000002	0.232996288	0.233062055	0.232999988	0.233103219	0.233011579	0.232999917	0.23300001	0.23297342	0.232992743	0.232998469	0.233000576	0.232973073	0.233014125	0.233000343	0.233002738	0.233005536	0	0	0	0	0	0	0	0												15.7609	0.103896083	10.33534084	0	1.227027937	1.279567746	0.814811087	2.929535406	8.149608535	1.029959656	3.860271734	0.04741664	0.008036722	10.07246761	16.38327869	17.48034525	0.119611799	2.179877421	6.850339661	6.22018544	1.86169188	1.048014947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7621	0	0	15.7609	0.103896083	10.33534084	0	1.227027937	1.279567746	0.814811087	2.929535406	8.149608535	1.029959656	3.860271734	0.04741664	0.008036722	10.07246761	16.38327869	17.48034525	0.119611799	2.179877421	6.850339661	6.22018544	1.86169188	1.048014947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7621	NO	1A IP Acute:  Standard Medicare	1B IP Psych:  Standard Medicare	2 SNF:  Standard Medicare	6 Home Health:  Standard Medicare	10A Ambulance:  Standard Medicare	11A DME:  Standard Medicare	"11B Prosthetics/Medical Supplies:  Standard Medicare, 11C Diabetes Monitoring Supplies:  Standard Medicare"	"4A ER:  Standard Medicare, 4B Urgent Care:  Standard Medicare"	9B ASC Services:  Standard Medicare	8A OP Diagnostic Procedures/Tests:  Standard Medicare	8B OP Radiology:  Standard Medicare	9A OP Hospital:  Standard Medicare	12 Renal Dialysis:  Standard Medicare	"3 CORF:  Standard Medicare, 5 Partial Hosp:  Standard Medicare, 9C OP Substance Abuse:  Standard Medicare, 9D Cardiac Rehab:  Standard Medicare"	"7A PCP:  Standard Medicare, 14B Immunizations:  Standard Medicare, 14C Physical Exams:  Standard Medicare, 14D Pap Smears and Pelvic Exams:  Standard Medicare, 14E Prostate Screening:  Standard Medicare, 14F Colorectal Screening:  Standard Medicare, 14G Bone Mass Measurement:  Standard Medicare, 14H Mammography:  Standard Medicare, 14I Diabetes Monitoring:  Standard Medicare, 14J Nutrition Therapy:  Standard Medicare"	"7B Chiropractic:  Standard Medicare, 7D Physician Specialist (excl. Radiology):  Standard Medicare, 7F Podiatry:  Standard Medicare"	"7E Mental Health:  Standard Medicare, 7H Psychiatric:  Standard Medicare"	"7C Occupational Therapy:  Standard Medicare, 7I Physical and Speech Therapy:  Standard Medicare"	7D Physician Specialist (Radiology):  Standard Medicare	"7G Other Health Care:  Standard Medicare, 18A Hearing Exams (Medicare Covered):  Standard Medicare"	15 Part B Drugs:  Standard Medicare	"13A Blood:  Standard Medicare, 16B Comprehensive Dental (Medicare Covered):  Standard Medicare, 17A Routine Eye Exams (Medicare Covered):  Standard Medicare"	10B Transportation:  Standard Medicare	"16A Preventative Dental Services (Non Medicare Covered):  Not Covered, 16B Comprehensive Dental (Non Medicare Covered):  Not Covered"	17A Routine Eye Exams (Non Medicare Covered):  Not Covered	17B Eye Wear (Medicare Covered):  Standard Medicare	18A Routine Hearing Exams (Non Medicare Covered):  Not Covered	18B Hearing Aids (Non Medicare Covered):  Not Covered	14A Health Education/Wellness Program:  Standard Medicare	"13B Acupuncture:  Standard Medicare, 13C Other 1 Copay Standard Medicare, 13D Other 2 Copay Standard Medicare, 13E Other 3 Copay Standard Medicare"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.7609	0.103896083	10.33534084	0	1.227027937	1.279567746	0.814811087	2.929535406	8.149608535	1.029959656	3.860271734	0.04741664	0.008036722	10.07246761	16.38327869	17.48034525	0.119611799	2.179877421	6.850339661	6.22018544	1.86169188	1.048014947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7621
H0747_804_0	2010	2	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	189.47	2.39	44.43	40.25	10.61	14.91	10.57	14.71	51.94	11	23.91	0.66	0.11	28.67	29.37	96.88	1.24	4.11	16.95	27.63	7.65	4.94	0	0	0	0	12.66389839	0	0	0												1A IP Acute:  Standard Medicare	1B IP Psych:  Standard Medicare	2 SNF:  Standard Medicare	6 Home Health:  Standard Medicare	10A Ambulance:  Standard Medicare	11A DME:  Standard Medicare	"11B Prosthetics/Medical Supplies:  Standard Medicare, 11C Diabetes Monitoring Supplies:  Standard Medicare"	"4A ER:  Standard Medicare, 4B Urgent Care:  Standard Medicare"	9B ASC Services:  Standard Medicare	8A OP Diagnostic Procedures/Tests:  Standard Medicare	8B OP Radiology:  Standard Medicare	9A OP Hospital:  Standard Medicare	12 Renal Dialysis:  Standard Medicare	"3 CORF:  Standard Medicare, 5 Partial Hosp:  Standard Medicare, 9C OP Substance Abuse:  Standard Medicare, 9D Cardiac Rehab:  Standard Medicare"	"7A PCP:  Standard Medicare, 14B Immunizations:  Standard Medicare, 14C Physical Exams:  Standard Medicare, 14D Pap Smears and Pelvic Exams:  Standard Medicare, 14E Prostate Screening:  Standard Medicare, 14F Colorectal Screening:  Standard Medicare, 14G Bone Mass Measurement:  Standard Medicare, 14H Mammography:  Standard Medicare, 14I Diabetes Monitoring:  Standard Medicare, 14J Nutrition Therapy:  Standard Medicare"	"7B Chiropractic:  Standard Medicare, 7D Physician Specialist (excl. Radiology):  Standard Medicare, 7F Podiatry:  Standard Medicare"	"7E Mental Health:  Standard Medicare, 7H Psychiatric:  Standard Medicare"	"7C Occupational Therapy:  Standard Medicare, 7I Physical and Speech Therapy:  Standard Medicare"	7D Physician Specialist (Radiology):  Standard Medicare	"7G Other Health Care:  Standard Medicare, 18A Hearing Exams (Medicare Covered):  Standard Medicare"	15 Part B Drugs:  Standard Medicare	"13A Blood:  Standard Medicare, 16B Comprehensive Dental (Medicare Covered):  Standard Medicare, 17A Routine Eye Exams (Medicare Covered):  Standard Medicare"	10B Transportation:  Standard Medicare	"16A Preventative Dental Services (Non Medicare Covered):  Not Covered, 16B Comprehensive Dental (Non Medicare Covered):  Not Covered"	17A Routine Eye Exams (Non Medicare Covered):  Not Covered	17B Eye Wear (Medicare Covered):  Standard Medicare	18A Routine Hearing Exams (Non Medicare Covered):  Not Covered	18B Hearing Aids (Non Medicare Covered):  Not Covered	14A Health Education/Wellness Program:  Standard Medicare	"13B Acupuncture:  Standard Medicare, 13C Other 1 Copay Standard Medicare, 13D Other 2 Copay Standard Medicare, 13E Other 3 Copay Standard Medicare"											0.083057879	0.083273861	0.160511321	0	0.233111345	0.232999996	0.232930864	0.232927984	0.233001326	0.232912266	0.233036508	0.232999792	0.233000027	0.233033452	0.233007611	0.232996839	0.232995912	0.232981207	0.232995064	0.232980274	0.232999813	0.232997103	0	0	0	0	0	0	0	0											NO	0.083057879	0.083273861	0.160511321	0	0.233111345	0.232999996	0.232930864	0.232927984	0.233001326	0.232912266	0.233036508	0.232999792	0.233000027	0.233033452	0.233007611	0.232996839	0.232995912	0.232981207	0.232995064	0.232980274	0.232999813	0.232997103	0	0	0	0	0	0	0	0												15.737	0.199024528	7.131517972	0	2.473311368	3.474029941	2.462079233	3.42637065	12.10208889	2.562034923	5.571902901	0.153779863	0.025630003	6.681069058	6.843433526	22.57273374	0.28891493	0.95755276	3.94926633	6.437244969	1.78244857	1.15100569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9824	0	0	15.737	0.199024528	7.131517972	0	2.473311368	3.474029941	2.462079233	3.42637065	12.10208889	2.562034923	5.571902901	0.153779863	0.025630003	6.681069058	6.843433526	22.57273374	0.28891493	0.95755276	3.94926633	6.437244969	1.78244857	1.15100569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9824	NO	1A IP Acute:  Standard Medicare	1B IP Psych:  Standard Medicare	2 SNF:  Standard Medicare	6 Home Health:  Standard Medicare	10A Ambulance:  Standard Medicare	11A DME:  Standard Medicare	"11B Prosthetics/Medical Supplies:  Standard Medicare, 11C Diabetes Monitoring Supplies:  Standard Medicare"	"4A ER:  Standard Medicare, 4B Urgent Care:  Standard Medicare"	9B ASC Services:  Standard Medicare	8A OP Diagnostic Procedures/Tests:  Standard Medicare	8B OP Radiology:  Standard Medicare	9A OP Hospital:  Standard Medicare	12 Renal Dialysis:  Standard Medicare	"3 CORF:  Standard Medicare, 5 Partial Hosp:  Standard Medicare, 9C OP Substance Abuse:  Standard Medicare, 9D Cardiac Rehab:  Standard Medicare"	"7A PCP:  Standard Medicare, 14B Immunizations:  Standard Medicare, 14C Physical Exams:  Standard Medicare, 14D Pap Smears and Pelvic Exams:  Standard Medicare, 14E Prostate Screening:  Standard Medicare, 14F Colorectal Screening:  Standard Medicare, 14G Bone Mass Measurement:  Standard Medicare, 14H Mammography:  Standard Medicare, 14I Diabetes Monitoring:  Standard Medicare, 14J Nutrition Therapy:  Standard Medicare"	"7B Chiropractic:  Standard Medicare, 7D Physician Specialist (excl. Radiology):  Standard Medicare, 7F Podiatry:  Standard Medicare"	"7E Mental Health:  Standard Medicare, 7H Psychiatric:  Standard Medicare"	"7C Occupational Therapy:  Standard Medicare, 7I Physical and Speech Therapy:  Standard Medicare"	7D Physician Specialist (Radiology):  Standard Medicare	"7G Other Health Care:  Standard Medicare, 18A Hearing Exams (Medicare Covered):  Standard Medicare"	15 Part B Drugs:  Standard Medicare	"13A Blood:  Standard Medicare, 16B Comprehensive Dental (Medicare Covered):  Standard Medicare, 17A Routine Eye Exams (Medicare Covered):  Standard Medicare"	10B Transportation:  Standard Medicare	"16A Preventative Dental Services (Non Medicare Covered):  Not Covered, 16B Comprehensive Dental (Non Medicare Covered):  Not Covered"	17A Routine Eye Exams (Non Medicare Covered):  Not Covered	17B Eye Wear (Medicare Covered):  Standard Medicare	18A Routine Hearing Exams (Non Medicare Covered):  Not Covered	18B Hearing Aids (Non Medicare Covered):  Not Covered	14A Health Education/Wellness Program:  Standard Medicare	"13B Acupuncture:  Standard Medicare, 13C Other 1 Copay Standard Medicare, 13D Other 2 Copay Standard Medicare, 13E Other 3 Copay Standard Medicare"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.737	0.199024528	7.131517972	0	2.473311368	3.474029941	2.462079233	3.42637065	12.10208889	2.562034923	5.571902901	0.153779863	0.025630003	6.681069058	6.843433526	22.57273374	0.28891493	0.95755276	3.94926633	6.437244969	1.78244857	1.15100569	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9824
H0752_002_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1719.825157	124.5906783	1677.124883	3033.521758	299.4722884	7.116058364	8.047757048	331.809261	432.4438407	8768.536937	48.8774278	0	0.027854105	408.6254978	6695.418779	5528.763994	445.1488441	462.6078196	0	0	31.8945745	1438.576252	0	0	84.1914029	8.156526103	16.95814045	3.728697647	52.3658397	0												"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$85 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $150 (9a); $40 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0/$30 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											128.9681299	98.22485799	49.56393469	0	150	0.2	0.113123263	49.69706305	150	3	0.165535011	0	0.2	58.65243109	6.388154084	30	40	30	0	0	0.2	28.96230981	0	0	0	0	0	0	0	0											NO	128.9681299	98.22485799	49.56393469	0	150	0.2	0.113123263	49.69706305	150	3	0.165535011	0	0.2	58.65243109	6.388154084	30	40	30	0	0	0.2	28.96230981	0	0	0	0	0	0	0	0												18.4836	1.01982514	6.92707568	0	3.743403605	1.423211673	0.910388539	1.374162147	5.405548009	2.192134234	8.09092557	0	0.005570821	1.997239904	3.564280568	13.82190999	1.48382948	1.156519549	0	0	6.3789149	3.472040924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4505	0	0	18.4836	1.01982514	6.92707568	0	3.743403605	1.423211673	0.910388539	1.374162147	5.405548009	2.192134234	8.09092557	0	0.005570821	1.997239904	3.564280568	13.82190999	1.48382948	1.156519549	0	0	6.3789149	3.472040924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4505	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.4836	1.01982514	6.92707568	0	3.743403605	1.423211673	0.910388539	1.374162147	5.405548009	2.192134234	8.09092557	0	0.005570821	1.997239904	3.564280568	13.82190999	1.48382948	1.156519549	0	0	6.3789149	3.472040924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4505
H0752_801_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	253.2359683	6.136814878	42.07348964	3183.320996	12.00839907	7.467458553	8.445165725	18.17997215	41.70607799	16.07286162	51.29105856	0	0.029229577	17.49139385	32.01602294	111.762586	3.078117589	4.72895699	0	0	33.46956994	8.448554006	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.065939709	0.065939709	0.16137045	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065939709	0.065939709	0.16137045	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.6983	0.404659786	6.789417944	0	2.797956982	1.739917843	1.967723614	4.235933512	9.717516171	3.744976758	11.95081665	0	0.006810492	4.075494768	7.459733344	26.04068253	0.717201398	1.101846979	0	0	7.798409796	1.968513083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2159	0	0	16.6983	0.404659786	6.789417944	0	2.797956982	1.739917843	1.967723614	4.235933512	9.717516171	3.744976758	11.95081665	0	0.006810492	4.075494768	7.459733344	26.04068253	0.717201398	1.101846979	0	0	7.798409796	1.968513083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2159	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.6983	0.404659786	6.789417944	0	2.797956982	1.739917843	1.967723614	4.235933512	9.717516171	3.744976758	11.95081665	0	0.006810492	4.075494768	7.459733344	26.04068253	0.717201398	1.101846979	0	0	7.798409796	1.968513083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2159
H0752_802_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	253.2359683	6.136814878	42.07348964	3183.320996	12.00839907	7.467458553	8.445165725	18.17997215	41.70607799	16.07286162	51.29105856	0	0.029229577	17.49139385	32.01602294	111.762586	3.078117589	4.72895699	0	0	33.46956994	8.448554006	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.065939709	0.065939709	0.16137045	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065939709	0.065939709	0.16137045	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.6983	0.404659786	6.789417944	0	2.797956982	1.739917843	1.967723614	4.235933512	9.717516171	3.744976758	11.95081665	0	0.006810492	4.075494768	7.459733344	26.04068253	0.717201398	1.101846979	0	0	7.798409796	1.968513083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2159	0	0	16.6983	0.404659786	6.789417944	0	2.797956982	1.739917843	1.967723614	4.235933512	9.717516171	3.744976758	11.95081665	0	0.006810492	4.075494768	7.459733344	26.04068253	0.717201398	1.101846979	0	0	7.798409796	1.968513083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2159	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.6983	0.404659786	6.789417944	0	2.797956982	1.739917843	1.967723614	4.235933512	9.717516171	3.744976758	11.95081665	0	0.006810492	4.075494768	7.459733344	26.04068253	0.717201398	1.101846979	0	0	7.798409796	1.968513083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2159
H0752_803_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	253.2359683	6.136814878	42.07348964	3183.320996	12.00839907	7.467458553	8.445165725	18.17997215	41.70607799	16.07286162	51.29105856	0	0.029229577	17.49139385	32.01602294	111.762586	3.078117589	4.72895699	0	0	33.46956994	8.448554006	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.065939709	0.065939709	0.16137045	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065939709	0.065939709	0.16137045	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.6983	0.404659786	6.789417944	0	2.797956982	1.739917843	1.967723614	4.235933512	9.717516171	3.744976758	11.95081665	0	0.006810492	4.075494768	7.459733344	26.04068253	0.717201398	1.101846979	0	0	7.798409796	1.968513083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2159	0	0	16.6983	0.404659786	6.789417944	0	2.797956982	1.739917843	1.967723614	4.235933512	9.717516171	3.744976758	11.95081665	0	0.006810492	4.075494768	7.459733344	26.04068253	0.717201398	1.101846979	0	0	7.798409796	1.968513083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2159	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.6983	0.404659786	6.789417944	0	2.797956982	1.739917843	1.967723614	4.235933512	9.717516171	3.744976758	11.95081665	0	0.006810492	4.075494768	7.459733344	26.04068253	0.717201398	1.101846979	0	0	7.798409796	1.968513083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2159
H0755_001_0	2010	5	N/A																															A	A	D	coin	T	coin	coin	V	V	coin	P	O	coin	coin	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	323.6325156	4.828334376	815.3278083	14.89451996	367.6565259	10.52766005	3.012343346	370.0672048	353.9599299	12.01785403	839.8670698	0	0.086449035	15.93525235	4156.945558	7004.264502	450.1846105	168.6450184	37.8193699	57.28777098	15.12674805	0	0	0	888.5937389	0	80.51584451	0	500	0												1a: Acute - $50/$100/$0 days 1-3/4-10/11-90 /1a:  Additional Days - $0/admit for 91-999	1a: Acute - $50/$100/$0 days 1-3/4-10/11-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $125/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $75/visit/9b:  Ambulatory Surgical Center Services - $75/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $50/visit/8b:  Outpatient Therapeutic Radiological Services - $20/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $10-$20/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												274.6603022	504.2183617	100	0	125	0.2	0.059485369	29.55726169	75	0	26.05421569	0	0.2	0.043037698	10.00301375	19.98132469	20	10	0	20	0	0	0	0	20	0	20	0	0	0											NO	237.4869583	435.9759458	100	0	125	0.2	0.059485369	29.55726169	75	0	26.05421569	0	0.2	0.043037698	10.00301375	19.98132469	20	10	0	20	0	0	0	0	20	0	20	0	0	0												6.4049	0.175419804	6.794398403	0	3.829755478	2.10553201	0.179190355	0.911514435	2.212249562	0	1.823506483	0	0.017289807	0.685816573	3.465165299	11.6628736	0.750307684	0.140537515	0	0.095479618	0	0	0	0	1.480989565	0	0.134193074	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8691	0	0	6.4049	0.175419804	6.794398403	0	3.829755478	2.10553201	0.179190355	0.911514435	2.212249562	0	1.823506483	0	0.017289807	0.685816573	3.465165299	11.6628736	0.750307684	0.140537515	0	0.095479618	0	0	0	0	1.480989565	0	0.134193074	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8691	NO																																																																																		0			6.4049	0.175419804	6.794398403	0	3.829755478	2.10553201	0.179190355	0.911514435	2.212249562	0	1.823506483	0	0.017289807	0.685816573	3.465165299	11.6628736	0.750307684	0.140537515	0	0.095479618	0	0	0	0	1.480989565	0	0.134193074	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8691
H0755_020_0	2010	7	N/A																															A	A	D	coin	T	coin	coin	V	V	coin	P	O	coin	coin	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	219.0741357	5.161516673	425.7828134	7.968569816	215.7229244	9.451485822	2.480825694	339.9130689	389.5572606	15.17379138	995.6716237	0	0.021570294	18.0068653	3945.30718	6827.063364	475.2047523	334.682216	37.65091601	71.63441187	22.80782113	0	0	0	823.9765691	0	119.7111718	0	500	0												1a: Acute - $100/$150/$0 days 1-3/4-5/6-90 /1a:  Additional Days - $0/admit for 91-999	1a: Acute - $100/$150/$0 days 1-3/4-5/6-90	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $125/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $20/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $20-$35/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $35/visit		18a:  Routine Hearing Test - $35/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												343.0728761	495.499389	100	0	125	0.2	0.046821433	40.0451532	100	0	35.90533644	0	0.2	0.169071272	20.00441168	34.95939011	35	35	0	32.80113888	0	0	0	0	35	0	35	0	0	0											NO	312.8282882	451.8171981	100	0	125	0.2	0.046821433	40.0451532	100	0	35.90533644	0	0.2	0.169071272	20.00441168	34.95939011	35	35	0	32.80113888	0	0	0	0	35	0	35	0	0	0												5.711	0.1943385	3.548190112	0	2.247113795	1.890297164	0.116155814	1.134322577	3.246310505	0	2.979160386	0	0.004314059	3.044443628	6.576962419	19.88916429	1.386013861	0.976156463	0	0.195807524	0	0	0	0	2.403264993	0	0.349157584	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8922	0	0	5.711	0.1943385	3.548190112	0	2.247113795	1.890297164	0.116155814	1.134322577	3.246310505	0	2.979160386	0	0.004314059	3.044443628	6.576962419	19.88916429	1.386013861	0.976156463	0	0.195807524	0	0	0	0	2.403264993	0	0.349157584	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8922	NO	1a:  Acute - 0/day for 1-/1-90/1a:  Additional Days - $0/day for 91-999	Not Covered	Not Covered	Not Covered	10a:  Ambulance - $125/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $45/visit/8a:  Outpatient Lab Services - $45/visit	8b:  Outpatient Diagnostic Radiological Services - $200/visit/8b:  Outpatient Therapeutic Radiological Services - $45/visit/8b:  Outpatient X-Ray Services - $45/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5: Partial Hospitalization - Not Covered	7a:  Primary Care - $45/visit/17a:  Vision Exams - $45/visit/18a:  Hearing Exams - $45/visit/:  Routine Exams - $45/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $45/visit/18a:  Hearing Exams - $45/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	Not Covered	7c:  Occupational Therapy Services - $45/visit/7i:  Physical/Speech Therapy - $45/visit		/7g:  Other Health Care Professional Services - $45/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%			17a:  Routine Eye Exams - $45/visit		18a:  Routine Hearing Test - $45/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $45/visit/14c:  Routine Exams - $45/visit													0.8377	0	0	0	0.1698	0.1087	0.0263	0.0634	0.4278	0.3966	0.4764		0.0002	0.4843	0.8217	1.295	0	0.0522	0	0.0094	0.1943	0.0348			0.1654		0.024		0.0455												5.6335	0	0	6.5487	0.1943385	3.548190112	0	2.416916448	1.998965492	0.142494497	1.197675549	3.674152144	0.39664614	3.455591867	0	0.004501956	3.528736675	7.3986586	21.18415989	1.386013861	1.028376778	0	0.205176418	0.194341248	0.034773839	0	0	2.568637548	0	0.373183683	0	0.045470385	0	0	0	0	0	0	0	0	0	0	0	61.5257
H0755_022_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	P	O	coin	coin	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	714.4025433	30.49962696	426.2824429	9.461039964	240.253213	6.647336126	4.3126564	379.4398014	334.9946179	10.79777731	875.7833333	0	0.106461995	12.61194729	3108.482429	5578.174099	450.7939207	127.7199695	27.85217594	44.47917526	9.239865855	0	0	0	693.7217764	0	72.24490002	0	500	0												1a:  Acute - $250/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-7/8-190	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $125/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $125/visit/9b:  Ambulatory Surgical Center Services - $125/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $20/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - $30/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $20-$30/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - $30/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												250	250	100	0	125	0.2	0.2	36.50896511	125	0	45.94616487	0	0.2	0.377859825	20.00314641	29.97988491	30	30	0	29.87608938	0	0	0	0	30	0	30	0	0	0											NO	234.8570719	234.8570719	100	0	125	0.2	0.2	36.50896511	125	0	45.94616487	0	0.2	0.377859825	20.00314641	29.97988491	30	30	0	29.87608938	0	0	0	0	30	0	30	0	0	0												13.9819	0.59692109	3.552353691	0	2.502637636	1.329467225	0.86253128	1.154412873	3.48952727	0	3.353240452	0	0.021292399	4.765548192	5.181619094	13.93608479	1.126984802	0.319299924	0	0.110738651	0	0	0	0	1.734304441	0	0.18061225	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1995	0	0	13.9819	0.59692109	3.552353691	0	2.502637636	1.329467225	0.86253128	1.154412873	3.48952727	0	3.353240452	0	0.021292399	4.765548192	5.181619094	13.93608479	1.126984802	0.319299924	0	0.110738651	0	0	0	0	1.734304441	0	0.18061225	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1995	NO																																																																																		0			13.9819	0.59692109	3.552353691	0	2.502637636	1.329467225	0.86253128	1.154412873	3.48952727	0	3.353240452	0	0.021292399	4.765548192	5.181619094	13.93608479	1.126984802	0.319299924	0	0.110738651	0	0	0	0	1.734304441	0	0.18061225	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1995
H0755_023_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	P	O	coin	coin	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1060.804187	32.77732883	574.5926704	9.432010235	306.1351828	5.814778483	1.22673957	304.101411	303.3560402	12.75501823	695.7528519	0	0.098335011	12.95875089	2848.041899	5064.687675	450.8892755	102.3842732	23.70400968	40.31040292	14.62350464	0	0	0	552.1548603	0	64.90879811	0	500	0												1a:  Acute - $200/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $125/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $125/visit/9b:  Ambulatory Surgical Center Services - $125/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b: Outpatient Diagnostic Radiology: CT/MRI - $175/$200/visit/8b:  Outpatient Therapeutic Radiological Services - $20/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - $30/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $20-$30/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $30/visit		18a:  Routine Hearing Test - $30/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												200	200	100	0	125	0.2	0.2	36.61594387	125	0	52.6341413	0	0.2	0.32792227	20.00273422	29.99256388	30	30	0	29.845781	0	0	0	0	30	0	30	0	0	0											NO	180.5797386	180.5795589	100	0	125	0.2	0.2	36.61594387	125	0	52.6341413	0	0.2	0.32792227	20.00273422	29.99256388	30	30	0	29.845781	0	0	0	0	30	0	30	0	0	0												15.9633	0.493242965	4.788272253	0	3.188908154	1.162955697	0.245347914	0.92791335	3.159958752	0	3.05169616	0	0.019667002	4.249463014	4.747385429	12.65858072	1.127223189	0.255960683	0	0.100257955	0	0	0	0	1.380387151	0	0.162271995	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6828	0	0	15.9633	0.493242965	4.788272253	0	3.188908154	1.162955697	0.245347914	0.92791335	3.159958752	0	3.05169616	0	0.019667002	4.249463014	4.747385429	12.65858072	1.127223189	0.255960683	0	0.100257955	0	0	0	0	1.380387151	0	0.162271995	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6828	NO																																																																																		0			15.9633	0.493242965	4.788272253	0	3.188908154	1.162955697	0.245347914	0.92791335	3.159958752	0	3.05169616	0	0.019667002	4.249463014	4.747385429	12.65858072	1.127223189	0.255960683	0	0.100257955	0	0	0	0	1.380387151	0	0.162271995	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6828
H0755_028_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	P	O	coin	coin	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	771.1032049	35.18156994	393.8319157	6.088792258	211.7477612	7.091545883	1.637453744	319.7857483	317.7538835	11.10068362	735.5714989	0	0.056163937	13.15089784	3311.306008	5673.595047	433.8922161	137.1162951	29.0752426	44.20435155	6.5074129	0	0	0	676.5490474	0	72.02776111	0	500	0												1a:  Acute - $100/$0/day for 1-10/11-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-10/11-190	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $125/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $20/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $25/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $15-$25/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												100	100	100	0	125	0.2	0.02587303	33.13444976	100	0	35.88038311	0	0.2	0.140172176	15.00287792	24.98376344	25	25	0	24.94772531	0	0	0	0	25	0	25	0	0	0											NO	93.89793761	93.89793761	100	0	125	0.2	0.02587303	33.13444976	100	0	35.88038311	0	0.2	0.140172176	15.00287792	24.98376344	25	25	0	24.94772531	0	0	0	0	25	0	25	0	0	0												6.0338	0.275289738	3.28193263	0	2.205705846	1.418309177	0.04236589	0.882993734	2.647949029	0	2.199382265	0	0.011232787	1.843389965	4.13992665	11.81231304	0.903942117	0.285658948	0	0.091899835	0	0	0	0	1.409477182	0	0.150057836	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6356	0	0	6.0338	0.275289738	3.28193263	0	2.205705846	1.418309177	0.04236589	0.882993734	2.647949029	0	2.199382265	0	0.011232787	1.843389965	4.13992665	11.81231304	0.903942117	0.285658948	0	0.091899835	0	0	0	0	1.409477182	0	0.150057836	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6356	NO																																																																																		0			6.0338	0.275289738	3.28193263	0	2.205705846	1.418309177	0.04236589	0.882993734	2.647949029	0	2.199382265	0	0.011232787	1.843389965	4.13992665	11.81231304	0.903942117	0.285658948	0	0.091899835	0	0	0	0	1.409477182	0	0.150057836	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6356
H0755_029_0	2010	7	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	P	O	coin	coin	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	731.0416791	35.45409961	390.5555732	6.13260998	193.721994	6.64913115	1.535299197	306.595157	302.6699495	10.99196787	705.903196	0	0.054423325	12.59257436	3169.74424	5423.967425	434.9524722	131.1275576	27.73897622	42.42102368	6.419642668	0	0	0	647.2395725	0	68.90301812	0	500	0												1a:  Acute - $100/$0/day for 1-10/11-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-10/11-190	2:  Skilled Nursing Services - $0/$100/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$100/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $25/visit/8b:  Outpatient X-Ray Services - $25/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $25/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $25/visit	15:  Medicare Part B Rx Drugs - Chemo - $0/service/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $25/visit		18a:  Routine Hearing Test - $25/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												100	100	100	0	150	0.2	0.02587303	33.13407174	100	0	39.99011756	0	0.2	0.137873006	15.00287554	24.98375798	25	25	0	24.95925257	0	0	0	0	25	0	25	0	0	0											NO	93.88798356	93.88798356	100	0	150	0.2	0.02587303	33.13407174	100	0	39.99011756	0	0.2	0.137873006	15.00287554	24.98375798	25	25	0	24.95925257	0	0	0	0	25	0	25	0	0	0												5.7197	0.277392827	3.254629777	0	2.421524925	1.32982623	0.039722842	0.846562161	2.522249579	0	2.352429316	0	0.010884665	1.736176085	3.96293986	11.29259078	0.906150984	0.273182412	0	0.088233087	0	0	0	0	1.348415776	0	0.143547954	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5261	0	0	5.7197	0.277392827	3.254629777	0	2.421524925	1.32982623	0.039722842	0.846562161	2.522249579	0	2.352429316	0	0.010884665	1.736176085	3.96293986	11.29259078	0.906150984	0.273182412	0	0.088233087	0	0	0	0	1.348415776	0	0.143547954	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5261	NO	1a:  Acute - $100/$0/day for 1-10/11-90/1a:  Additional Days - $0/day for 91-999	Not Covered	Not Covered	Not Covered	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - 20.0%/5: Partial Hospitalization - Not Covered	7a:  Primary Care - $50/visit/17a:  Vision Exams - $50/visit/18a:  Hearing Exams - $50/visit/:  Routine Exams - $50/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $50/visit/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - $50/visit/18a:  Hearing Exams - $50/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	Not Covered	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	/7g:  Other Health Care Professional Services - $50/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%			17a:  Routine Eye Exams - $50/visit		18a:  Routine Hearing Test - $50/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $50/visit/14c:  Routine Exams - $50/visit													1.7972	0	0	0	0.2268	0.1217	0.0257	0.0636	0.6332	0.1397	0.312		0.0007	0.2154	0.8058	1.6555	0	0.0135	0.2383	0.285	0.082	0.0141			0.1532		0.0141		0.0378												6.8353	1200	0	7.5168	0.277392827	3.254629777	0	2.648325914	1.451529342	0.065377746	0.910148344	3.155462281	0.139690483	2.66438305	0	0.011627884	1.95156519	4.768734069	12.94809449	0.906150984	0.2867092	0.238274754	0.373230442	0.082018309	0.014083042	0	0	1.501594908	0	0.157690683	0	0.037843952	0	0	0	0	0	0	0	0	0	0	0	45.3614
H0755_801_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	277.5841983	3.867783333	54.66992687	13.68532111	12.30694488	10.43631637	2.333964018	10.85473713	40.19386129	11.34057704	30.28010267	0	0.03546245	15.73827343	49.27580556	143.5884779	3.975699071	1.751655888	34.53298153	29.28388542	15.4737386	2.705664194	0	0	0	0	0	0	0	0												Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share											0.066587445	0.066587445	0.155245778	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.066587445	0.066587445	0.155245778	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.4836	0.257545808	8.487275344	0	2.867518157	2.431661715	0.543813616	2.52915375	9.365169682	2.64235445	7.055263922	0	0.008262751	3.667017709	11.4812627	33.45611535	0.926337884	0.408135822	8.046184698	6.823145304	3.605381093	0.630419757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.7156	0	0	18.4836	0.257545808	8.487275344	0	2.867518157	2.431661715	0.543813616	2.52915375	9.365169682	2.64235445	7.055263922	0	0.008262751	3.667017709	11.4812627	33.45611535	0.926337884	0.408135822	8.046184698	6.823145304	3.605381093	0.630419757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.7156	NO																																																																																		0			18.4836	0.257545808	8.487275344	0	2.867518157	2.431661715	0.543813616	2.52915375	9.365169682	2.64235445	7.055263922	0	0.008262751	3.667017709	11.4812627	33.45611535	0.926337884	0.408135822	8.046184698	6.823145304	3.605381093	0.630419757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.7156
H0755_803_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	310.0957155	3.875579722	70.96698105	18.33886742	13.68605233	13.07876534	3.692119008	12.49571403	42.02514173	8.773874505	20.53169575	0	0.146090729	14.17229841	54.85765064	157.4615776	4.120407246	1.552187006	42.26497321	32.91892862	24.56323265	4.33333819	0	0	0	0	0	0	0	0												Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share											0.065678602	0.065678602	0.149312608	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065678602	0.065678602	0.149312608	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.3667	0.254542659	10.596265	0	3.188850193	3.047352324	0.860263729	2.91150137	9.791858024	2.04431276	4.783885109	0	0.03403914	3.30214553	12.7818326	36.68854758	0.960054888	0.361659572	9.847738759	7.670110368	5.723233207	1.009667798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.2245	0	0	20.3667	0.254542659	10.596265	0	3.188850193	3.047352324	0.860263729	2.91150137	9.791858024	2.04431276	4.783885109	0	0.03403914	3.30214553	12.7818326	36.68854758	0.960054888	0.361659572	9.847738759	7.670110368	5.723233207	1.009667798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.2245	NO																																																																																		0			20.3667	0.254542659	10.596265	0	3.188850193	3.047352324	0.860263729	2.91150137	9.791858024	2.04431276	4.783885109	0	0.03403914	3.30214553	12.7818326	36.68854758	0.960054888	0.361659572	9.847738759	7.670110368	5.723233207	1.009667798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.2245
H0755_804_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	277.5841983	3.867783333	54.66992687	13.68532111	12.30694488	10.43631637	2.333964018	10.85473713	40.19386129	11.34057704	30.28010267	0	0.03546245	15.73827343	49.27580556	143.5884779	3.975699071	1.751655888	34.53298153	29.28388542	15.4737386	2.705664194	0	0	0	0	0	0	0	0												Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share											0.066587445	0.066587445	0.155245778	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.066587445	0.066587445	0.155245778	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.4836	0.257545808	8.487275344	0	2.867518157	2.431661715	0.543813616	2.52915375	9.365169682	2.64235445	7.055263922	0	0.008262751	3.667017709	11.4812627	33.45611535	0.926337884	0.408135822	8.046184698	6.823145304	3.605381093	0.630419757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.7156	0	0	18.4836	0.257545808	8.487275344	0	2.867518157	2.431661715	0.543813616	2.52915375	9.365169682	2.64235445	7.055263922	0	0.008262751	3.667017709	11.4812627	33.45611535	0.926337884	0.408135822	8.046184698	6.823145304	3.605381093	0.630419757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.7156	NO																																																																																		0			18.4836	0.257545808	8.487275344	0	2.867518157	2.431661715	0.543813616	2.52915375	9.365169682	2.64235445	7.055263922	0	0.008262751	3.667017709	11.4812627	33.45611535	0.926337884	0.408135822	8.046184698	6.823145304	3.605381093	0.630419757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.7156
H0806_001_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	Coin	V	P	V	P	O	P																																																			0	YES	836.350843	44.27686009	937.6531383		73.12696401	10.40818986	18.74252564	257.110477	337.1065004	1398.636181	533.2913478	5.792076646	0.058888425	690.8137297	3109.785927	4061.167541	235.5363025	724.5412024	3018.74983	5025.231629	18.10238917	0.120488112			149.2988203		258.1625435														3450	1a: $150/d (1-10) then $0;1a1: $150/d (1-10) then $0	1b: $150/d (1-10) then $0	"2: $0 (1-22),$100d (23-100)"	6: $0/visit	10a: $150/trip	11a: 20%	11b: 20%;11c: $20/visit	4a: $50/visit;4a1: $50/visit;4b: $35/visit	9a: $300/visit;9b: $300/visit	8a: $30/visit	8b: $75/visit;8b: $30/visit	9a: $300/visit	12a: 20%	3: $25/visit;5: $60/visit;9a: $300/visit;9c: $40/visit;9d: 25%;7i: $40/visit;7e: $40/visit;7c: $40/visit	7a: $20/visit;14b: $0/visit;14c: $20/visit;14d: $0/visit;14d1: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $40/visit;7d: $40/visit;7f: $40/visit;14c1: $20/visit;16b: 20%;17a: $40/visit;18a: $40/visit	7e: $40/visit;7h: $40/visit;7a: $20/visit;7d: $40/visit	7c: $40/visit;7i: $40/visit;7a: $20/visit;7d: $40/visit	14h: $0/visit;7a: $20/visit;7d: $40/visit	7g: $40/visit;14b: $0/visit;14i: 20%;14j: 20%7a: $20/visit;7d: $40/visit;8a: $30/visit;12a: 20%	15: 20%	13a: 20%;17b: 20%		16a: $0/visit	17a1: $40/visit		18a1: $40/visit		14a: $0												134.4157503	113.7769862	15.95536271		150	0.2	0.199891746	47.1901429	276.5937968	30	71.84035087	300	0.2	121.8361657	20	40	39.96462595	39.46333807	10.28249611	9.766907029	0.2	0.2			40		40														NO	126.908209	107.4221846	15.06420565		141.6220295	0.188829373	0.188727165	44.5544254	261.1451656	28.3244059	67.82784193	283.244059	0.188829373	115.6345202	20	40	39.96462595	39.46333807	10.28249611	9.766907029	0.188829373	0.188829373			40		40															8.845	0.396359753	1.177083309	0	0.863032421	1.965371962	3.537223729	0.954617464	7.336144407	3.301294908	3.014333437	0.136714275	0.011119864	6.65682618	5.182976545	13.53722514	0.784426685	2.382734535	2.586690282	4.090080843	3.41826279	0.022751695	0	0	0.497662734	0	0.860541812	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5585	0	2.426294072	8.845	0.396359753	1.177083309	0	0.863032421	1.965371962	3.537223729	0.954617464	7.336144407	3.301294908	3.014333437	0.136714275	0.011119864	6.65682618	5.182976545	13.53722514	0.784426685	2.382734535	2.586690282	4.090080843	3.41826279	0.022751695	0	0	0.497662734	0	0.860541812	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5585	NO	OON: 30%		OON: 30%	OON: 30%	OON: $150/trip	OON: 30%	OON: 30%	OON: $50/visit;OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%		OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%			OON: 30%		OON: 30%															1.8085		0.3623	0.4458	0.0361	1.154	0.3258	0.0567	0.4034	0.0558	0.1853	0.0081	0.0006	0.2677	0.4676	1.0338		0.0598	0.2048	0.1045	0.2087				0.0123		0.0163			0.0025											7.2206	500	0	10.6535	0.396359753	1.539426077	0.445822029	0.899139827	3.119383921	3.863047651	1.011343944	7.739536398	3.357140393	3.199599639	0.144854691	0.011687821	6.924536783	5.650616246	14.57103956	0.784426685	2.442518432	2.791489447	4.194624041	3.626980532	0.022751695	0	0	0.509926701	0	0.876818665	0	0	0.002498229	0	0	0	0	0	0	0	0	0	0	78.7791
H0838_020_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	O	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	217.0961701	39.71171972	23.4307514	0	25.53722564	1.955235597	0	924.5748206	7.957665183	0	1.585512152	0	0	0	0	0	0	0	17.40772865	0	3.009432941	0	0	0	0	0	0	0	0	0											3400	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	20% Coinsurance	20% Coinsurance	20% Coinsurance	"$50 ER Copay, 20% Coinsurance for Worldwide coverage"	20% Coinsurance	No Cost-Sharing	"20% Coinsurance, except for mammography"	No Cost-Sharing	20% Coinsurance	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	"20% Coinsurance, except for mammography"	No Cost-Sharing	20% Coinsurance for chemotherapy drugs only	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.066180704	0.066180704	0.152264007	0	0.2	0.2	0	50.49139491	0.2	0	0.177463593	0	0	0	0	0	0	0	0.177463593	0	0.022381625	0	0	0	0	0	0	0	0	0											NO	0.061473998	0.061473998	0.141435142	0	0.185776198	0.185776198	0	46.90049686	0.185776198	0	0.164842558	0	0	0	0	0	0	0	0.164842558	0	0.020789866	0	0	0	0	0	0	0	0	0												13.3458	2.441238178	3.313931648	0	4.744208684	0.363236235	0	3.613584873	1.478344782	0	0.261359879	0	0	0	0	0	0	0	2.86953452	0	0.062565709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4938	0	2.487859143	13.3458	2.441238178	3.313931648	0	4.744208684	0.363236235	0	3.613584873	1.478344782	0	0.261359879	0	0	0	0	0	0	0	2.86953452	0	0.062565709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4938	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.3458	2.441238178	3.313931648	0	4.744208684	0.363236235	0	3.613584873	1.478344782	0	0.261359879	0	0	0	0	0	0	0	2.86953452	0	0.062565709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4938
H0901_004_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	12.30803476	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$225/day 1-7	$225/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$125 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$45 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$0 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$45 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											162.6423925	162.6423925	47.8866492	0	125	0.2	0.2	48.5	250	0	43.5	35	25	35	0	35	35	35	45	35	45	0	0	0	0	0	0	0	0	0											NO	162.6423925	162.6423925	47.8866492	0	125	0.2	0.2	48.5	250	0	43.5	35	25	35	0	35	35	35	45	35	45	0	0	0	0	0	0	0	0	0												23.2171	1.032030028	4.659178734	0	2.44527831	2.461606951	0	0.978035432	8.364532289	0	10.49627122	0.157116481	0.000725633	0	0	17.11452885	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2188	0	0	23.2171	1.032030028	4.659178734	0	2.44527831	2.461606951	0	0.978035432	8.364532289	0	10.49627122	0.157116481	0.000725633	0	0	17.11452885	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2188	NO																																																																																		0			23.2171	1.032030028	4.659178734	0	2.44527831	2.461606951	0	0.978035432	8.364532289	0	10.49627122	0.157116481	0.000725633	0	0	17.11452885	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2188
H0901_007_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	12.30803476	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$100/day 1-8	$100/day 1-8	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$0 per visit	$25 X-ray; $140 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$10 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											76.18318861	76.18318861	47.8866492	0	100	0.2	0.2	48.5	200	0	35.5	25	25	25	10	25	25	25	25	25	45	0	0	0	0	0	0	0	0	0											NO	76.18318861	76.18318861	47.8866492	0	100	0.2	0.2	48.5	200	0	35.5	25	25	25	10	25	25	25	25	25	45	0	0	0	0	0	0	0	0	0												10.8751	0.483412332	4.659178734	0	1.956222648	2.461606951	0	0.978035432	6.691625831	0	8.565922492	0.112226058	0.000725633	0	3.851098073	12.22466346	0.451502326	1.155572891	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5094	0	0	10.8751	0.483412332	4.659178734	0	1.956222648	2.461606951	0	0.978035432	6.691625831	0	8.565922492	0.112226058	0.000725633	0	3.851098073	12.22466346	0.451502326	1.155572891	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5094	NO																																																																																		0			10.8751	0.483412332	4.659178734	0	1.956222648	2.461606951	0	0.978035432	6.691625831	0	8.565922492	0.112226058	0.000725633	0	3.851098073	12.22466346	0.451502326	1.155572891	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5094
H0901_801_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	425.5535125	6.539591799	56.99146031	8.832834376	11.29988584	14.26681356	0	14.2591963	48.75718071	16.87149337	74.14056634	0.989538477	0.01882531	32.50478717	25.82011852	162.748154	3.132910466	8.080687486	0	-1.28E-08	84.71244352	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.066973886	0.066973886	0.14528928	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.066973886	0.066973886	0.14528928	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												28.501	0.437981878	8.280248237	0	2.632873401	3.32416756	0	3.322392738	11.3604231	3.931057956	17.27475196	0.230562465	0.004386297	7.57361541	6.016087616	37.92031988	0.729968139	1.882800184	0	-2.98E-09	19.73799934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1606			28.501	0.437981878	8.280248237	0	2.632873401	3.32416756	0	3.322392738	11.3604231	3.931057956	17.27475196	0.230562465	0.004386297	7.57361541	6.016087616	37.92031988	0.729968139	1.882800184	0	-2.98E-09	19.73799934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1606	NO																																																																																		0			28.501	0.437981878	8.280248237	0	2.632873401	3.32416756	0	3.322392738	11.3604231	3.931057956	17.27475196	0.230562465	0.004386297	7.57361541	6.016087616	37.92031988	0.729968139	1.882800184	0	-2.98E-09	19.73799934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1606
H0901_802_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	425.5552223	6.539618075	56.9916893	8.832869866	11.29993124	14.26687089	0	14.25925359	48.75737661	16.87156116	74.14086424	0.989542453	0.018825386	32.50491777	25.82022227	162.7488079	3.132923054	8.080719954	0	-1.28E-08	84.71278389	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.066973886	0.066973886	0.14528928	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.066973886	0.066973886	0.14528928	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												28.5011	0.437983638	8.280281507	0	2.63288398	3.324180917	0	3.322406087	11.36046875	3.931073751	17.27482137	0.230563392	0.004386315	7.573645841	6.016111788	37.92047225	0.729971072	1.882807749	0	-2.98E-09	19.73807865	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1612			28.5011	0.437983638	8.280281507	0	2.63288398	3.324180917	0	3.322406087	11.36046875	3.931073751	17.27482137	0.230563392	0.004386315	7.573645841	6.016111788	37.92047225	0.729971072	1.882807749	0	-2.98E-09	19.73807865	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1612	NO																																																																																		0			28.5011	0.437983638	8.280281507	0	2.63288398	3.324180917	0	3.322406087	11.36046875	3.931073751	17.27482137	0.230563392	0.004386315	7.573645841	6.016111788	37.92047225	0.729971072	1.882807749	0	-2.98E-09	19.73807865	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1612
H0908_001_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	243.1015933	18.08743634	70.9633751	0	11.57369091	16.28896548	12.497368	15.64918774	22.23846899	7.281283304	14.75473548	0	2.603858818	26.90901108	41.49639488	77.91562735	6.020511355	3.375890325	14.56553678	21.75549494	6.494310089	0.494115866	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.079668566	0.079668566	0.169881895	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079668566	0.079668566	0.169881895	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.3676	1.441000115	12.05539264	0	2.696669981	3.795328958	2.911886744	3.646260743	5.181563275	1.69653901	3.437853368	0	0.606699105	6.269799582	9.668660008	18.15434117	1.402779146	0.786582446	3.393770069	5.069030321	1.513174251	0.115128997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.21	0	0	19.3676	1.441000115	12.05539264	0	2.696669981	3.795328958	2.911886744	3.646260743	5.181563275	1.69653901	3.437853368	0	0.606699105	6.269799582	9.668660008	18.15434117	1.402779146	0.786582446	3.393770069	5.069030321	1.513174251	0.115128997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.21	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.3676	1.441000115	12.05539264	0	2.696669981	3.795328958	2.911886744	3.646260743	5.181563275	1.69653901	3.437853368	0	0.606699105	6.269799582	9.668660008	18.15434117	1.402779146	0.786582446	3.393770069	5.069030321	1.513174251	0.115128997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.21
H0913_002_0	2010	5	N/A																															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	V	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	Yes	2327.776228	107.8235225	882.9910047	222.1140707	638.5439107	4.701477269	3.035906506	1195.700278	279.672255	3542.644163	1011.289338	89.0121102	0.056963256	321.246384	8900.282922	15603.77472	206.2026808	1689.932774	4439.836263	1654.023953	10.5205133	8.963922407	0	0	361.2	216.72	16.8	12.8	0	0											3400	"$200 days 1 - 8, $0 after day 8, unlimited coverage"	"$200 days 1 - 8, $0 after day 8, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $15.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											124.8451181	87.00681829	54.67	1.42076383	42.79280743	0.2	0.075388888	19.61195275	105.5478185	0	69.28122751	97.94136655	0.2	45.00379744	8.572849156	8.380229396	23.52365312	14.17393864	26.27627261	7.870315525	0.2	0	0	0	0	0	0	0	0	0											NO	112.2975879	78.26221782	49.17540409	1.277970285	38.49192605	0.179899046	0.067811945	17.6408579	94.939759	0	62.31813351	88.09779179	0.179899046	40.48070102	7.711236903	7.537976348	21.15941372	12.74939016	23.63538181	7.079311254	0.179899046	0	0	0	0	0	0	0	0	0												21.7836	0.703209	3.618453289	0.023654599	2.048232083	0.845791273	0.205870724	1.757764891	2.212668041	0	5.251805332	0.653480863	0.010247635	1.083689902	5.719349176	9.801740395	0.363593986	1.79546769	8.74476877	0.975779199	1.892630301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4918	0	7.764644947	21.7836	0.703209	3.618453289	0.023654599	2.048232083	0.845791273	0.205870724	1.757764891	2.212668041	0	5.251805332	0.653480863	0.010247635	1.083689902	5.719349176	9.801740395	0.363593986	1.79546769	8.74476877	0.975779199	1.892630301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4918	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.7836	0.703209	3.618453289	0.023654599	2.048232083	0.845791273	0.205870724	1.757764891	2.212668041	0	5.251805332	0.653480863	0.010247635	1.083689902	5.719349176	9.801740395	0.363593986	1.79546769	8.74476877	0.975779199	1.892630301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4918
H0913_003_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	412.0498701	43.53766685	804.7886531	553.6579549	25.46802289	8.879217612	4.790342708	28.87834618	18.35956067	5330.290044	20.04962815	0.589305511	0.640632436	8.61133673	8717.388672	104.3411905	9.528325638	12.57636985	32.46992932	11.12344591	10.48322589	0.037836019	2320	0	0	0	0	0	2040	6415.891836												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	$0.00 copayment	$0.00 copayment											606.2354557	439.3518757	54.8650213	0	0.163988018	0.170000695	0.17	0.118221192	0.17	0	0.170067074	0.248627341	0.17	0.170006977	0	0.095396999	0.38290756	0.17000019	0.163681791	0.099743602	0.170000705	0.17	0	0	0	0	0	0	0	0											NO	606.2354557	439.3518757	54.8650213	0	0.163988018	0.170000695	0.17	0.118221192	0.17	0	0.170067074	0.248627341	0.17	0.170006977	0	0.095396999	0.38290756	0.17000019	0.163681791	0.099743602	0.170000705	0.17	0	0	0	0	0	0	0	0												20.8166	1.594029633	3.679562216	0	4.176450605	1.509473165	0.81435826	3.414032514	3.121125314	0	3.409781584	0.146517462	0.108907514	1.463987323	0	9.953836494	3.648467925	2.137985262	5.314736192	1.109492562	1.782155789	0.006432123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2079	0	0	20.8166	1.594029633	3.679562216	0	4.176450605	1.509473165	0.81435826	3.414032514	3.121125314	0	3.409781584	0.146517462	0.108907514	1.463987323	0	9.953836494	3.648467925	2.137985262	5.314736192	1.109492562	1.782155789	0.006432123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2079	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.8166	1.594029633	3.679562216	0	4.176450605	1.509473165	0.81435826	3.414032514	3.121125314	0	3.409781584	0.146517462	0.108907514	1.463987323	0	9.953836494	3.648467925	2.137985262	5.314736192	1.109492562	1.782155789	0.006432123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2079
H0913_008_0	2010	6	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	323.0974708	10.86900706	734.5818533	711.71145	9.486980538	7.410849702	2.790431756	13.61352964	22.00690713	3836.679112	17.91450191	0.878991147	0.201995683	9.994252317	7285.292187	131.5704517	4.682888929	13.26088354	41.38382705	18.50329297	18.57629713	0.37962938	2320	0	0	0	0	0	2040	4115.38289												"Medicare FFS cost sharing, Unlimited Days"	"Medicare FFS cost sharing, Unlimited Days"	"$0 days 1 - 20, $133.5 days 21 - 100"	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	$0.00 copayment	$0.00 copayment											747.6	747.6	32.31	0	0.195000338	0.2	0.2	0.127528661	0.2	0	0.2	0.2925	0.2	0.2	0	0.124012862	0.45	0.2	0.198185123	0.117028114	0.2	0.2	0	0	0	0	0	0	0	0											NO	747.6	747.6	32.31	0	0.195000338	0.2	0.2	0.127528661	0.2	0	0.2	0.2925	0.2	0.2	0	0.124012862	0.45	0.2	0.198185123	0.117028114	0.2	0.2	0	0	0	0	0	0	0	0												20.129	0.67713914	1.97786164	0	1.849964408	1.48216994	0.558086351	1.736115205	4.401381425	0	3.582900382	0.25710491	0.040399137	1.998850463	0	16.31642824	2.107300018	2.652176707	8.201658852	2.165405487	3.715259426	0.075925876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9251	0	0	20.129	0.67713914	1.97786164	0	1.849964408	1.48216994	0.558086351	1.736115205	4.401381425	0	3.582900382	0.25710491	0.040399137	1.998850463	0	16.31642824	2.107300018	2.652176707	8.201658852	2.165405487	3.715259426	0.075925876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9251	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.129	0.67713914	1.97786164	0	1.849964408	1.48216994	0.558086351	1.736115205	4.401381425	0	3.582900382	0.25710491	0.040399137	1.998850463	0	16.31642824	2.107300018	2.652176707	8.201658852	2.165405487	3.715259426	0.075925876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9251
H0913_009_0	2010	5	N/A																															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	V	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	Yes	1984.959275	125.8595207	721.092993	694.9246691	632.705638	7.410849702	2.790431756	1096.784612	248.2363115	3836.679112	998.3540126	34.27849166	0.201995683	542.7426763	6980.61474	26574.1958	589.7491004	4283.074327	4152.095421	2415.974623	18.57629713	18.32852743	0	338.5714286	361.2	216.72	16.8	12.8	0	0											3000	"$150 days 1 - 8, $0 after day 8, unlimited coverage"	"$150 days 1 - 8, $0 after day 8, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $50.00 and $100.00	$0.00 copayment	Copay between $0.00 and $150.00	$150.00 copayment	20% coinsurance	Copay between $15.00 and $100.00	Copay between $0.00 and $5.00	Copay between $0.00 and $25.00	Copay between $15.00 and $25.00	$25.00 copayment	Copay between $0.00 and $75.00	Copay between $0.00 and $25.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											104.7254926	61.12208981	54.67	1.684053773	33.28316832	0.2	0.2	17.5859654	60.84266866	0	55.97016586	42.82637954	0.2	8.658132055	2.316526787	5.555426862	16.77861326	6.642210406	40.27221746	7.150649557	0.2	0	0	0	0	0	0	0	0	0											NO	93.97176228	54.84577204	49.05621464	1.511126822	29.86548837	0.179463013	0.179463013	15.7801517	54.59504323	0	50.22287306	38.42875558	0.179463013	7.769072334	2.078654386	4.98496822	15.05570246	5.960155467	36.13686746	6.416385577	0.179463013	0	0	0	0	0	0	0	0	0												15.5442	0.575238549	2.947841054	0.087509942	1.574671906	1.329973417	0.500779291	1.442285629	1.12937268	0	4.17835057	0.109773315	0.036250754	0.351383926	1.209190454	11.03929346	0.739923915	2.127315739	12.50364349	1.291818727	3.333758256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0526	0	7.101031119	15.5442	0.575238549	2.947841054	0.087509942	1.574671906	1.329973417	0.500779291	1.442285629	1.12937268	0	4.17835057	0.109773315	0.036250754	0.351383926	1.209190454	11.03929346	0.739923915	2.127315739	12.50364349	1.291818727	3.333758256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0526	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.5442	0.575238549	2.947841054	0.087509942	1.574671906	1.329973417	0.500779291	1.442285629	1.12937268	0	4.17835057	0.109773315	0.036250754	0.351383926	1.209190454	11.03929346	0.739923915	2.127315739	12.50364349	1.291818727	3.333758256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0526
H0974_001_0	2010	3	N/A																															Coin		Coin	Coin	Coin	Coin		V	Coin					Coin						Coin	Coin	Coin																																																											0	NO	306.5673358		31.84547838	7.701354603	12.2446727	42.84588091		1033.73341	47.81535372					112.0021049						239.6416668	36.69125462	4.42654429																				traditional Medicare	included in a.1	traditional Medicare	traditional Medicare	traditional Medicare	traditional Medicare	included in e.1	$50 Copay (max for MA)	traditional Medicare	included in h.5	included in h.5	included in h.5	included in h.5	traditional Medicare	included in i.6	included in i.6	included in i.6	included in i.6	included in i.6	traditional Medicare	traditional Medicare	traditional Medicare																			0.081152749		0.13356103	0	0.233	0.233		50	0.233					0.233						0.233	0.233	0.233																			NO	0.081152749		0.13356103	0	0.233	0.233		50	0.233					0.233						0.233	0.233	0.233																				24.8788	0	4.253314887	0	2.85300874	9.983090253	0	4.307222542	11.14097742	0	0	0	0	26.09649044	0	0	0	0	0	55.83650836	8.549062325	1.031384819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.9298			24.8788	0	4.253314887	0	2.85300874	9.983090253	0	4.307222542	11.14097742	0	0	0	0	26.09649044	0	0	0	0	0	55.83650836	8.549062325	1.031384819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.9298	NO																																																																																		0			24.8788	0	4.253314887	0	2.85300874	9.983090253	0	4.307222542	11.14097742	0	0	0	0	26.09649044	0	0	0	0	0	55.83650836	8.549062325	1.031384819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.9298
H0979_004_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	1654.605786	69.25637762	916.2700611	7693.893049	286.909047	21.25423896	2.396348086	294.4466229	252.4769558	1104.241346	13.42832922	45.44321678	0	1996.945924	5095.554158	5769.49112	558.013276	2506.018971	7376.496265	5754.57866	19.29716316	0	0																		3400	$350 for 1st 7 days	$300 for 1st 7 days	$100 for days 10-100	$10 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/medical supplies; 20% diabetic monitoring supplies	$50 Copay; $15-35 UC	$250 OP hospital; $100 ASC	$15 Copay	20% Coinsurance	$350 Copay	20% Coinsurance	$35 Copay	$15 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												262.9246013	183.9156534	40.74391478	10	80	0.3	0.25	35.5	175	15	0.2	350	0.2	35	14.25	29.14285714	35	35	35	30	0.2	0	0	4.166666667	0	10	0	0	0												NO	183.6840248	128.4869019	28.46445794	6.986186304	55.88949043	0.209585589	0.174654658	24.80096138	122.2582603	10.47927946	0.139723726	244.5165206	0.139723726	24.45165206	9.955315483	20.35974294	24.45165206	24.45165206	24.45165206	20.95855891	0.139723726	0	0	2.91091096	0	6.986186304	0	0	0													25.3271	0.741544783	2.173427551	4.47924752	1.336266703	4.454582194	0.418533355	0.60854661	2.572282782	0.964304471	1.876256193	0.925968104	0	4.069052243	4.227320767	9.788779675	1.137028873	5.106358662	15.03062668	10.05063966	2.69627154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9841	0	42.26995779	25.3271	0.741544783	2.173427551	4.47924752	1.336266703	4.454582194	0.418533355	0.60854661	2.572282782	0.964304471	1.876256193	0.925968104	0	4.069052243	4.227320767	9.788779675	1.137028873	5.106358662	15.03062668	10.05063966	2.69627154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9841	NO																																																																																		0	0	0	25.3271	0.741544783	2.173427551	4.47924752	1.336266703	4.454582194	0.418533355	0.60854661	2.572282782	0.964304471	1.876256193	0.925968104	0	4.069052243	4.227320767	9.788779675	1.137028873	5.106358662	15.03062668	10.05063966	2.69627154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9841
H0979_005_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	1660.752992	42.93017516	880.2932621	7135.874376	247.1308112	22.35783651	1.880758151	230.5362477	226.8322321	1089.169982	13.26886055	54.90968183	0	2275.553248	5193.659326	5149.489631	399.7309248	2273.680658	7369.932002	5913.757068	20.47719084	0	0																		3400	$350 for 1st 7 days	$300 for 1st 7 days	$100 for days 10-100	$10 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/medical supplies; 20% diabetic monitoring supplies	$50 Copay; $15-35 UC	$250 OP hospital; $100 ASC	$15 Copay	20% Coinsurance	$350 Copay	20% Coinsurance	$35 Copay	$10 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												262.9246013	183.9156534	40.74391478	10	80	0.3	0.25	35.5	175	15	0.2	350	0.2	35	9.5	29.14285714	35	35	35	30	0.2	0	0	4.166666667	0	10	0	0	0												NO	184.5793938	129.1132121	28.60320812	7.020240512	56.1619241	0.210607215	0.175506013	24.92185382	122.854209	10.53036077	0.14040481	245.7084179	0.14040481	24.57084179	6.669228487	20.45898664	24.57084179	24.57084179	24.57084179	21.06072154	0.14040481	0	0	2.925100214	0	7.020240512	0	0	0													25.5451	0.461904401	2.098267615	4.174629532	1.156611822	4.708721689	0.330084364	0.478782555	2.322274537	0.955779404	1.863011848	1.124314254	0	4.659354904	2.886475061	8.779444962	0.818477109	4.655520645	15.09045277	10.37899924	2.875096095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3633	0	40.47718901	25.5451	0.461904401	2.098267615	4.174629532	1.156611822	4.708721689	0.330084364	0.478782555	2.322274537	0.955779404	1.863011848	1.124314254	0	4.659354904	2.886475061	8.779444962	0.818477109	4.655520645	15.09045277	10.37899924	2.875096095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3633	NO																																																																																		0	0	0	25.5451	0.461904401	2.098267615	4.174629532	1.156611822	4.708721689	0.330084364	0.478782555	2.322274537	0.955779404	1.863011848	1.124314254	0	4.659354904	2.886475061	8.779444962	0.818477109	4.655520645	15.09045277	10.37899924	2.875096095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3633
H0979_006_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	2270.52067	38.74804343	870.2276585	6292.133857	353.3659291	20.3347697	2.825208821	286.3268998	228.0953803	1122.877004	12.97826265	53.07900062	0	2211.765359	4233.743268	9845.133002	408.4544071	2638.454639	7437.151236	5837.92156	20.70034529	0	0																		3400	$225 for 1st 7 days	$225 for 1st 7 days	$100 for days 10-100	$0 Copay	$100 Copay	30% Coinsurance	30% prosthetics/medical supplies; 20% diabetic monitoring supplies	$50 Copay; $10-$30 UC	$150 OP hospital; $75 ASC	$15 Copay	20% Coinsurance	$150 Copay	20% Coinsurance	$30 Copay	$10 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												169.022958	118.2314915	40.74391478	0	80	0.3	0.25	34	112.5	15	0.2	150	0.2	30	9.5	25.14285714	30	30	30	30	0.2	0	0	4.166666667	0	10	0	0	0												NO	129.2608961	90.41794511	31.15905081	0	61.18027879	0.229426045	0.191188371	26.00161848	86.03476704	11.47130227	0.152950697	114.7130227	0.152950697	22.94260455	7.265158106	19.22808762	22.94260455	22.94260455	22.94260455	22.94260455	0.152950697	0	0	3.186472853	0	7.647534848	0	0	0													24.4575	0.291959872	2.259622319	0	1.801585505	4.665325798	0.540147073	0.620413568	1.635344409	1.073405127	1.985034317	0.507404384	0	4.228638164	2.563234519	15.77525666	0.780917328	5.044418449	14.21896831	11.16142714	3.166132239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7767	0	29.76956767	24.4575	0.291959872	2.259622319	0	1.801585505	4.665325798	0.540147073	0.620413568	1.635344409	1.073405127	1.985034317	0.507404384	0	4.228638164	2.563234519	15.77525666	0.780917328	5.044418449	14.21896831	11.16142714	3.166132239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7767	NO																																																																																		0	0	0	24.4575	0.291959872	2.259622319	0	1.801585505	4.665325798	0.540147073	0.620413568	1.635344409	1.073405127	1.985034317	0.507404384	0	4.228638164	2.563234519	15.77525666	0.780917328	5.044418449	14.21896831	11.16142714	3.166132239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7767
H0979_007_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	1759.334873	36.36143769	700.1274477	7016.420199	257.6353843	22.47108203	1.882941682	273.1106255	220.6288252	1119.279428	14.5561892	56.98765274	0	2353.422485	4733.585717	7578.11662	350.5763017	1841.352102	7800.62513	4996.200617	17.15216377	0	0																		3400	$225 for 1st 7 days	$225 for 1st 7 days	$100 for days 10-100	$0 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/medical supplies; 20% diabetic monitoring supplies	$50 Copay; $10-$30 UC	$150 OP hospital; $75 ASC	$15 Copay	20% Coinsurance	$150 Copay	20% Coinsurance	$30 Copay	$5 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												169.022958	118.2314915	40.74391478	0	80	0.3	0.25	34	112.5	15	0.2	150	0.2	30	4.75	25.14285714	30	30	30	30	0.2	0	0	4.166666667	0	10	0	0	0												NO	134.0779399	93.78746529	32.32022574	0	63.46022647	0.237975849	0.198313208	26.97059625	89.24094347	11.89879246	0.158650566	118.9879246	0.158650566	23.79758492	3.767950946	19.9446426	23.79758492	23.79758492	23.79758492	23.79758492	0.158650566	0	0	3.305220128	0	7.932528308	0	0	0													19.6573	0.284187256	1.885689763	0	1.362466653	5.347574831	0.373412205	0.613829701	1.640760377	1.109839468	2.309347658	0.565070211	0	4.667147621	1.486326565	12.59523563	0.695239109	3.651644419	15.46966992	9.908125707	2.721200494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3441	0	22.50404621	19.6573	0.284187256	1.885689763	0	1.362466653	5.347574831	0.373412205	0.613829701	1.640760377	1.109839468	2.309347658	0.565070211	0	4.667147621	1.486326565	12.59523563	0.695239109	3.651644419	15.46966992	9.908125707	2.721200494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3441	NO																																																																																		0	0	0	19.6573	0.284187256	1.885689763	0	1.362466653	5.347574831	0.373412205	0.613829701	1.640760377	1.109839468	2.309347658	0.565070211	0	4.667147621	1.486326565	12.59523563	0.695239109	3.651644419	15.46966992	9.908125707	2.721200494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3441
H0979_021_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	1742.796574	52.12368409	786.9400656	6232.868056	373.7484428	19.99289045	1.316385586	303.372238	44.68844159	1201.158642	13.54797488	77.19583968	0	2805.453803	5235.300434	4954.638432	420.2323019	2240.189737	5789.644846	7324.518934	19.8957404	0	0																		3400	$295 for 1st 7 days	$295 for 1st 7 days	$100 for days 10-100	$0 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/medical supplies; 20% diabetic supplies	$50 Copay ER; $10-35 Urgent Care	$150 OP hospital; $75 ASC	$15 Copay	20% Coinsurance	$250 Copay	20% Coinsurance	$35 Copay	$10 per Visit	$35 per Visit	$35 per Visit	$30 per Visit	$35 per Visit	$35 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												221.6078782	155.0146221	40.74391478	0	80	0.3	0.25	34.75	112.5	15	0.2	250	0.2	35	9.5	29.14285714	35	30	35	35	0.2	0	0	4.166666667	0	10	0	0	0												NO	165.366021	115.6734655	30.40351778	0	59.69680222	0.223863008	0.186552507	25.93079847	83.94862813	11.19315042	0.149242006	186.5525069	0.149242006	26.11735097	7.088995264	21.74669224	26.11735097	22.38630083	26.11735097	26.11735097	0.149242006	0	0	3.109208449	0	7.462100278	0	0	0													24.0166	0.502443931	1.99381219	0	1.859298906	4.475668602	0.245575031	0.65555703	0.31262778	1.120395779	2.021926942	1.200089785	0	6.105918467	3.092751665	8.978916428	0.914612877	4.179130116	12.60084887	15.94141931	2.969280199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1869	0	31.69335188	24.0166	0.502443931	1.99381219	0	1.859298906	4.475668602	0.245575031	0.65555703	0.31262778	1.120395779	2.021926942	1.200089785	0	6.105918467	3.092751665	8.978916428	0.914612877	4.179130116	12.60084887	15.94141931	2.969280199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1869	NO																																																																																		0	0	0	24.0166	0.502443931	1.99381219	0	1.859298906	4.475668602	0.245575031	0.65555703	0.31262778	1.120395779	2.021926942	1.200089785	0	6.105918467	3.092751665	8.978916428	0.914612877	4.179130116	12.60084887	15.94141931	2.969280199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1869
H0979_022_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	1699.07413	43.65878888	692.5113614	6022.458475	344.3951897	20.00228893	0.847675802	289.7291357	245.8433419	1262.98388	14.38639513	78.8553241	0	2809.460781	5225.936409	4795.183502	376.2003554	1932.385228	5577.81847	6778.862559	21.05789667	0	0																		3400	$295 for 1st 7 days	$295 for 1st 7 days	$100 for days 10-100	$0 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/medical supplies; 20% diabetic monitoring supplies	$50 Copay ER; $10-35 Urgent Care	$150 OP hospital; $75 ASC	$15 Copay	20% Coinsurance	$250 Copay	20% Coinsurance	$35 copay	$5 per Visit	$35 per Visit	$35 per Visit	$30 per Visit	$35 per Visit	$35 per Visit	20% Coinsurance			$0-75 detal X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												221.6078782	155.0146221	40.74391478	0	80	0.3	0.25	34.75	112.5	15	0.2	250	0.2	35	4.75	29.14285714	35	30	35	35	0.2	0	0	4.166666667	0	10	0	0	0												NO	166.1780727	116.2414953	30.55281827	0	59.98995126	0.224962317	0.187468598	26.05813508	84.36086897	11.24811586	0.149974878	187.4685977	0.149974878	26.24560368	3.561903356	21.85348225	26.24560368	22.49623172	26.24560368	26.24560368	0.149974878	0	0	3.124476628	0	7.498743908	0	0	0													23.5291	0.422913575	1.763181148	0	1.721687554	4.499761269	0.158912594	0.62915008	1.728296496	1.183849085	2.157597857	1.231908086	0	6.144666185	1.551190036	8.732621461	0.822800453	3.62261549	12.19943441	14.82627834	3.158155488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0841	0	30.04815016	23.5291	0.422913575	1.763181148	0	1.721687554	4.499761269	0.158912594	0.62915008	1.728296496	1.183849085	2.157597857	1.231908086	0	6.144666185	1.551190036	8.732621461	0.822800453	3.62261549	12.19943441	14.82627834	3.158155488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0841	NO																																																																																		0	0	0	23.5291	0.422913575	1.763181148	0	1.721687554	4.499761269	0.158912594	0.62915008	1.728296496	1.183849085	2.157597857	1.231908086	0	6.144666185	1.551190036	8.732621461	0.822800453	3.62261549	12.19943441	14.82627834	3.158155488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0841
H1013_011_0	2010	8	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1387.215626	0	822.6522362	0	275.8844418	0	0	185.3538621	330.2425123	0	1521.038237	58.03199802	7.342553407	72.66967445	8110.047414	12064.3586	0	0	0	0	710.6176259	0	0	701.3173445	0	0	0	0	0	0												$0 copay	$0 copay	$30 per day (days 11 through 100)  PBP L.2	$0 copay	$0 copay	$0 copay	$0 copay	$50 copay PBP L.4a	$100 copay @ Hospital PBP L.9a	$0 copay	$50 copay (Diag); $25 copay (Therap.)  PBP L.8a/8b	$100 copay PBP L.9a	$25 copay @ Hospital PBP L.12	"$25 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0		13.27710634		0			50	31.39026907		2.803962964	50	0	25	0	0					84.17474123			79.65242276																	NO	0	0	13.27710634	0	0	0	0	50	31.39026907	0	2.803962964	50	0	25	0	0	0	0	0	0	84.17474123	0	0	79.65242276	0	0	0	0	0	0												0	0	0.910203435	0	0	0	0	0.772307759	0.863866777	0	0.35541124	0.241799992	0	0.151395155	0	0	0	0	0	0	4.984671231	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.9348			0	0	0.910203435	0	0	0	0	0.772307759	0.863866777	0	0.35541124	0.241799992	0	0.151395155	0	0	0	0	0	0	4.984671231	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.9348	NO																																																																																		0			0	0	0.910203435	0	0	0	0	0.772307759	0.863866777	0	0.35541124	0.241799992	0	0.151395155	0	0	0	0	0	0	4.984671231	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.9348
H1013_021_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1397.141924	0	903.8992727	0	365.8454442	0	0	279.3160761	250.3718029	0	1209.425489	70.04018977	0	65.39487295	23018.32541	11579.9669	0	0	0	0	718.171432	0	0	701.3173445	0	0	0	0	0	0												$75 copay (days 1-7) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$0 copay	$0 copay	$0 copay	$50 copay PBP L.4a	$150 copay @ Hospital PBP L.9a	$0 copay	$150 diag copay (hosp); $50 diag copay (freest); $50 therap. Copay PBP L.8a/8b	$150 copay PBP L.9a	$25 copay @ Hospital; $15 copay @ Freestanding facility PBP L.12	"$50 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$15 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											59.96823876	0	28.86922876	0	0	0	0	50	62.83780874	0	55.94544586	49.90659187	15	50	0	8.458159397	0	0	0	0	126.7094189	0	0	79.65242276	0	0	0	0	0	0											NO	59.96823876	0	28.86922876	0	0	0	0	50	62.83780874	0	55.94544586	49.90659187	15	50	0	8.458159397	0	0	0	0	126.7094189	0	0	79.65242276	0	0	0	0	0	0												6.982	0	2.174572907	0	0	0	0	1.163816984	1.311067956	0	5.638487349	0.29128893	0	0.272478637	0	8.162100486	0	0	0	0	7.583257065	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2342			6.982	0	2.174572907	0	0	0	0	1.163816984	1.311067956	0	5.638487349	0.29128893	0	0.272478637	0	8.162100486	0	0	0	0	7.583257065	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2342	NO	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	"20% coinsurance, $4000 benefit limit"	"20% coinsurance, $4000 benefit limit"	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered												0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.8882	1.9561	0	0	0	0	0	0	0	0	0	0	0	0	0	0											5.8443			6.982	0	2.174572907	0	0	0	0	1.163816984	1.311067956	0	5.638487349	0.29128893	0	0.272478637	3.888227781	10.11817454	0	0	0	0	7.583257065	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0785
H1013_024_0	2010	7	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H1013_802_0	2010	5	N/A																															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																																																			0	NO	331.016283	0	24.38027388	5.2	9.743875549	9.719069049	0	18.54573358	51.55748428	0	0	0	0	71.37440564	0	0	0	0	0	345.6975113	54.08161256	0	0	0	0	0	0	0	0	0												Medicare FFS cost sharing	included in a.1	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	included in e.1.	Medicare FFS cost sharing	Medicare FFS cost sharing	included in h.5	included in h.5	included in h.5	included in h.5	Medicare FFS cost sharing	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	Medicare FFS cost sharing	Medicare FFS cost sharing	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered											0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841
H1013_803_0	2010	4	N/A																															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																																																			0	NO	331.016283	0	24.38027388	5.2	9.743875549	9.719069049	0	18.54573358	51.55748428	0	0	0	0	71.37440564	0	0	0	0	0	345.6975113	54.08161256	0	0	0	0	0	0	0	0	0												Medicare FFS cost sharing	included in a.1	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	included in e.1.	Medicare FFS cost sharing	Medicare FFS cost sharing	included in h.5	included in h.5	included in h.5	included in h.5	Medicare FFS cost sharing	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	Medicare FFS cost sharing	Medicare FFS cost sharing	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered											0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841
H1013_805_0	2010	4	N/A																															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																																																			0	NO	331.016283	0	24.38027388	5.2	9.743875549	9.719069049	0	18.54573358	51.55748428	0	0	0	0	71.37440564	0	0	0	0	0	345.6975113	54.08161256	0	0	0	0	0	0	0	0	0												Medicare FFS cost sharing	included in a.1	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	included in e.1.	Medicare FFS cost sharing	Medicare FFS cost sharing	included in h.5	included in h.5	included in h.5	included in h.5	Medicare FFS cost sharing	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	Medicare FFS cost sharing	Medicare FFS cost sharing	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered											0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841
H1016_001_0	2010	7	N/A																															D	D	D	P	T	Coin	P	V	V	P	P	V	P	P	V	V	V	V	P	P	S	V	T	V	V	P	V	P	P	V	V																																																		0	YES	1495.654713	2.716365951	708.6936131		247.5069792			186.5466755	437.9909572		1102.037384		30.68167091	27.56111727		7414.03165	3.991345192				1547.26895	1.535132766			0.159429334																3400	"$100/Day for days 4-23, Unlimited days"	$100/Day for days 1-10	$133.50 for Days 21-100	No Cost Sharing	$75/Trip	No Cost Sharing	No Cost Sharing	$50 per ER Visit; $25 per Urgent Care Visit	$100/$0 Per Episode	No Cost Sharing	$25/$100/20% copayments	No Cost Sharing	20% coinsurance	20% Chemo	No Cost Sharing	$5/Visit Copayment	$5/Visit Copayment for Individual; $0/Visit Copayment for Group	No Cost Sharing	No Cost Sharing	No Cost Sharing	20%/Script	$5 for Nutrition Therapy	Not Covered	Not Covered	$5/Visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing										54.09386776	59.61630695	53.76817969		75			49.59970888	95		76.77434767		132.538308	81.17141064		5	5				80.97049583	5			5																NO	50.1390374	55.25772823	49.83716055		69.51671161			45.97344877	88.05450137		71.1613358		122.8483644	75.23692725		4.640956136	4.63444744				75.05070143	4.63444744			4.63444744																	6.2492	0.012508351	2.943273115	0	1.433822608	0	0	0.714682836	3.213922945	0	6.535204361	0	0.314099424	0.172801148	0	2.86734964	0.001541473	0	0	0	9.676968332	0.000592874	0	0	6.16E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1361	0	2.688220127	6.2492	0.012508351	2.943273115	0	1.433822608	0	0	0.714682836	3.213922945	0	6.535204361	0	0.314099424	0.172801148	0	2.86734964	0.001541473	0	0	0	9.676968332	0.000592874	0	0	6.16E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1361	NO																																																																																		0	0	0	6.2492	0.012508351	2.943273115	0	1.433822608	0	0	0.714682836	3.213922945	0	6.535204361	0	0.314099424	0.172801148	0	2.86734964	0.001541473	0	0	0	9.676968332	0.000592874	0	0	6.16E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1361
H1016_002_0	2010	7	N/A																															D	D	D	P	T	Coin	P	V	V	P	P	V	P	P	V	V	V	V	P	P	S	V	T	V	V	P	V	P	P	V	V																																																		0	YES	1505.366978	3.478606535	940.7170522		295.3177968	0.000429096		183.2799529	426.9712889		1023.744294		10.37401829	603.1510992		6656.80813	3.661862812				1446.462328				0.13524224																3400	"$125/Day for Days 4-23, unlimited days"	$100/Day for Days 1-10	$133.50 for Days 21-100	No Cost Sharing	$100/Trip	20%/Device	No Cost Sharing	$50 per ER Visit; $25 per Urgent Care Visit	$200/$50 Per Episode	No Cost Sharing	$25/$200/20%	No Cost Sharing	20% coinsurance	$25 Copayment for Cadiac Rehab and CORF; $25/$15 Copayment for OP MH Ind/Grp	No Cost Sharing	$25/Visit Copayment	"$15/individual, $25/group"	No Cost Sharing	No Cost Sharing	No Cost Sharing	20%/Script	No Cost Sharing	Not Covered	Not Covered	$25/Visit Copayment	No Cost Sharing	No Cost Sharing	No Cost Sharing	N/A	No Cost Sharing	No Cost Sharing										66.55384131	62.86523929	48.17615932		100	0.2		48.63755745	192.5		72.40664512		86.55219634	25		24.99538424	24				146.5982024				25																NO	55.86239041	52.76633882	40.43696603		83.93563663	0.167871273		40.82424349	161.5761005		60.77497854		84.41848156	20.98390916		20.98003489	24				123.0481344				20.98390916																	7.0078	0.015296111	3.169978624	0	2.065640607	7.20E-05	0	0.623522119	5.749029657	0	5.184836457	0	0.072979906	1.054705656	0	11.6383389	0.007323726	0	0	0	14.83204092	0	0	0	0.000236493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4218	0	9.828042809	7.0078	0.015296111	3.169978624	0	2.065640607	7.20E-05	0	0.623522119	5.749029657	0	5.184836457	0	0.072979906	1.054705656	0	11.6383389	0.007323726	0	0	0	14.83204092	0	0	0	0.000236493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4218	NO																																																																																		0	0	0	7.0078	0.015296111	3.169978624	0	2.065640607	7.20E-05	0	0.623522119	5.749029657	0	5.184836457	0	0.072979906	1.054705656	0	11.6383389	0.007323726	0	0	0	14.83204092	0	0	0	0.000236493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4218
H1019_001_0	2010	8	N/A	r.	s.	t.								Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																		D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V				O	O	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	YES	1814.574589	33.590327	2004.331187	2007.799036	928.044954	1.215421	205.47691	368.61085	1180.550292	6085.503788	2946.7359	0	0.594561	436.704042	7629.974727	14389.38281	283.423275	764.323913			551.619621	0	0.53	3.28	1.38				0.05	0.45	2.11	0.6	1.29								5000	$90/Day(Days 1-10):1a	$90/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $25 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$25/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$10-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $25 OP Other,5. $10 Partial Hospitalization,7h. $10 Psych -- OP,8b. $25 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$10/Visit:7b, 7d, 7f"	$10/Visit:7e	$10/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN817: Dental 16a, 16b"	"VIS115: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a	$0: OTC items 13c								71.58465	66.29634	44.44425	0	150	0.2	0	50	22.163976	0	7.777274	0	0	27.712754	0	10	10	10			0	0	0	0	0				0	0	0	0	0								NO	66.727846	61.798332	23.503719	0	138.6996	0.184933	0	46.2332	20.49423	0	7.191365	0	0	25.624986	0	9.24664	9.24664	9.24664			0	0	0	0	0				0	0	0	0	0									10.0902	0.172985515	3.92576975	0	10.72662199	0.224771452	0	1.420171596	2.016205768	0	1.765921118	0	0	0.93254458	0	11.08778689	0.218392749	0.588952339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.1703	0	6.605882	10.0902	0.172985515	3.92576975	0	10.72662199	0.224771452	0	1.420171596	2.016205768	0	1.765921118	0	0	0.93254458	0	11.08778689	0.218392749	0.588952339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.1703	NO																																																																																		0	0	0	10.0902	0.172985515	3.92576975	0	10.72662199	0.224771452	0	1.420171596	2.016205768	0	1.765921118	0	0	0.93254458	0	11.08778689	0.218392749	0.588952339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.1703
H1019_002_0	2010	5	N/A	r.	s.	t.								Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																		D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V				O	O	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	YES	1709.594814	32.132438	1697.399852	1623.709452	891.167485	1.479692	150.218682	288.553127	874.23799	5526.632882	4235.564117	0	1.718258	985.124313	7577.588298	13383.00608	0	863.207257			377.10868	0	0.86	5.7	1.38				0.05	0.45	2.11	0.6	2.11								3400	$0/Day(Days 1-1):1a	$0/Day(Days 1-1):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$25/Visit:9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $25 Surgery OP -- Facility"	$0/Visit:8a	"$0-$25/Visit:14h. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,9a. $25 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$0/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$0-$25/Visit:9d. $0 Cardiac Rehab,8b. $25 Nuclear Medicine,9a. $25 OP Other,5. $0 Partial Hospitalization,7h. $0 Psych -- OP,8b. $25 Rad therapy,3. $0 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN818: Dental 16a, 16b"	"VIS115: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a	$0: OTC items 13c								0	0	44.44425	0	100	0.2	0	50	0	0	0.001014	0	0	23.573233	0	0	0	0			0	0	0	0	0				0	0	0	0	0								NO	0	0	23.827629	0	94.9644	0.189929	0	47.4822	0	0	0.000963	0	0	22.386179	0	0	0	0			0	0	0	0	0				0	0	0	0	0									0	0	3.370417828	0	7.052432126	0.281036422	0	1.141761441	0	0	0.000339904	0	0	1.837764101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.6838	0	3.463099	0	0	3.370417828	0	7.052432126	0.281036422	0	1.141761441	0	0	0.000339904	0	0	1.837764101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.6838	NO																																																																																		0	0	0	0	0	3.370417828	0	7.052432126	0.281036422	0	1.141761441	0	0	0.000339904	0	0	1.837764101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.6838
H1019_004_0	2010	8	N/A	r.	s.									Health & Education (Non-Covered)	Other Non-Covered																			D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin			V				O	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	YES	1105.492063	18.449539	786.785199	895.57335	293.688967	0.642661	121.504918	219.49397	810.335665	4124.952663	2026.923038	0	0.081045	276.006019	5285.881649	9252.910777	38.633456	490.964561			36.126804	0			1.38				0.05	0.45	2.11	0.6									5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	0% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$150/Visit:9a	$0/Proc:12	"$0-$100/Visit:9d. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $25 OP Other,5. $0 Partial Hospitalization,7h. $25 Psych -- OP,8b. $50 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	$25/Visit:7i			20% Coins:15				"VIS115: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a									158.7573	140.3991	50.7565	0	150	0	0	50	31.700243	0	14.309619	0	0	34.158187	0	25	25	25			0.2	0			0				0	0	0	0									NO	149.335372	132.066694	36.635889	0	138.0879	0	0	46.0293	29.1828	0	13.173235	0	0	31.445549	0	23.01465	23.01465	23.01465			0.184117	0			0				0	0	0	0										13.7574	0.203047468	2.402047935	0	3.379574392	0	0	0.841929483	1.970655304	0	2.225094459	0	0	0.7232634	0	17.74604192	0.074094622	0.941614794	0	0	6.651558772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9163	0	4.787397	13.7574	0.203047468	2.402047935	0	3.379574392	0	0	0.841929483	1.970655304	0	2.225094459	0	0	0.7232634	0	17.74604192	0.074094622	0.941614794	0	0	6.651558772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9163	NO																																																																																		0	0	0	13.7574	0.203047468	2.402047935	0	3.379574392	0	0	0.841929483	1.970655304	0	2.225094459	0	0	0.7232634	0	17.74604192	0.074094622	0.941614794	0	0	6.651558772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9163
H1019_005_0	2010	10	N/A	r.	s.	t.								Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																		D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin							O	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	YES	1140.631035	14.500224	1091.478749	787.569479	442.075636	0.633478	90.003907	195.715547	698.149636	3739.411786	2852.548035	0	0.692025	710.246061	5014.927411	10026.17462	0	358.975286			234.977647	0							0.05	0.45	2.11	0.6									3400	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	0% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$0-$50/Visit:14h. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $25 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$100/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$0-$50/Visit:9d. $0 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $25 OP Other,5. $0 Partial Hospitalization,7h. $0 Psych -- OP,8b. $25 Rad therapy,3. $0 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15								$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a									119.30775	110.4939	50.7565	0	100	0	0	50	20.189141	0	3.108133	0	0	20.969543	0	0	0	0			0	0							0	0	0	0									NO	112.949005	104.604907	29.256859	0	94.8379	0	0	47.41895	19.146958	0	2.947688	0	0	19.887074	0	0	0	0			0	0							0	0	0	0										10.7361	0.126399549	2.661103322	0	3.493793747	0	0	0.773385478	1.11395348	0	0.700701801	0	0	1.177059664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7825	0	2.962173	10.7361	0.126399549	2.661103322	0	3.493793747	0	0	0.773385478	1.11395348	0	0.700701801	0	0	1.177059664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7825	NO																																																																																		0	0	0	10.7361	0.126399549	2.661103322	0	3.493793747	0	0	0.773385478	1.11395348	0	0.700701801	0	0	1.177059664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.7825
H1019_006_0	2010	4	N/A	r.	s.	t.								Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																		D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V				O	O	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	YES	1471.961433	17.227578	1253.541824	1042.586948	381.690884	0.90315	111.435397	188.721739	871.201407	5656.102498	3459.408417	0	0	1378.678541	5732.073552	21233.57462	0	81.654634			178.206561	0	0.89	5.7	2.58				0.05	0.45	2.11	0.6	3.21								3400	$0/Day(Days 1-1):1a	$0/Day(Days 1-1):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$25/Visit:9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $25 Surgery OP -- Facility"	$0/Visit:8a	"$0-$25/Visit:14h. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,9a. $25 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$0/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$0-$25/Visit:9d. $0 Cardiac Rehab,8b. $25 Nuclear Medicine,9a. $25 OP Other,5. $0 Partial Hospitalization,7h. $0 Psych -- OP,8b. $0 Rad therapy,3. $0 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN818: Dental 16a, 16b"	"VIS116: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a	$0: OTC items 13c								0	0	44.44425	0	100	0.2	0	50	0.005147	0	0	0	0	11.3178	0	0	0	0			0	0	0	0	0				0	0	0	0	0								NO	0	0	29.253116	0	96.2517	0.192503	0	48.12585	0.004955	0	0	0	0	10.893575	0	0	0	0			0	0	0	0	0				0	0	0	0	0									0	0	3.055833699	0	3.061533038	0.173859084	0	0.756866175	0.000359734	0	0	0	0	1.251561507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3	0	1.791117	0	0	3.055833699	0	3.061533038	0.173859084	0	0.756866175	0.000359734	0	0	0	0	1.251561507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3	NO																																																																																		0	0	0	0	0	3.055833699	0	3.061533038	0.173859084	0	0.756866175	0.000359734	0	0	0	0	1.251561507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.3
H1019_010_0	2010	8	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Part B Rx	Other Non-Covered	Other Non-Covered																	D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin	T	Coin	V				O	O	O	S	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	YES	1758.635434	32.068461	1411.579577	1468.216698	607.838335	2.766644	197.455061	310.949973	983.337138	5836.475055	4463.436311	0	0	885.088986	7663.339972	13350.59676	209.392414	842.813543			24.620316	0	0.37	3.28	1.38				0.05	0.45	2.11	0	0.6	1.23							7500	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-10) $50(Days 11-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$25-$125/Visit:9d. $25 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $25 Partial Hospitalization,7h. $25 Psych -- OP,8b. $25 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	$25/Visit:7i			0% Coins:15		$0: Other - Transportation 10b	"DEN817: Dental 16a, 16b"	"VIS115: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0/Script:15	$0: Nutritional benefit 14a	$0: OTC items 13c							119.30775	110.4939	29.6295	0	150	0.2	0	50	35.559687	0	1.146545	0	0	34.605928	0	25	25	25			0	0	0	0	0				0	0	0	0	0	0							NO	113.624525	105.230523	25.069164	0	140.35485	0.18714	0	46.78495	33.273164	0	1.072821	0	0	32.380732	0	23.392475	23.392475	23.392475			0	0	0	0	0				0	0	0	0	0	0								16.652	0.281215077	2.94892666	0	7.109421528	0.517749758	0	1.212314912	2.726561488	0	0.399039017	0	0	2.388319104	0	26.02529174	0.408183901	1.642957895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.312	0	5.067884	16.652	0.281215077	2.94892666	0	7.109421528	0.517749758	0	1.212314912	2.726561488	0	0.399039017	0	0	2.388319104	0	26.02529174	0.408183901	1.642957895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.312	NO																																																																																		0	0	0	16.652	0.281215077	2.94892666	0	7.109421528	0.517749758	0	1.212314912	2.726561488	0	0.399039017	0	0	2.388319104	0	26.02529174	0.408183901	1.642957895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.312
H1019_011_0	2010	9	N/A	r.	s.	t.								OP Facility - Other	Health & Education (Non-Covered)	Other Non-Covered								Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	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	YES	1278.646772	21.018541	863.719162	1045.345386	391.17164	1.944211	3.411124	202.911814	723.934257	4408.359875	3050.208389	0	0	536.58823	5410.141176	9590.67272	103.783471	542.997098			34.796711	0							0.05	0.45	0	2.11	0.6								7500	$250/Day(Days 1-7):1a	$250/Day(Days 1-7):1b	"$0/Day(Days 1-13) $50(Days 14-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $35 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $35 SMAM -- OP,8b. $25 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $35 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$100/Visit:9d. $35 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $35 OP Other,5. $35 Partial Hospitalization,7h. $35 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$35/Visit:7i			20% Coins:15								$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a								176.397	155.999	25.37825	0	150	0.2	0.2	50	24.229204	0	2.47046	0	0	67.846422	0	35	35	35			0.2	0							0	0	0	0	0								NO	168.506939	149.021321	23.465263	0	140.15895	0.186879	0.186879	46.71965	22.639598	0	2.30838	0	0	63.395222	0	32.703755	32.703755	32.703755			0.186879	0							0	0	0	0	0									17.9551	0.261017562	1.688949775	0	4.568850528	0.363332207	0.637467442	0.789997411	1.36579838	0	0.586753337	0	0	2.83476083	0	26.13758424	0.282842434	1.479837005	0	0	6.502774555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.455	0	4.694033	17.9551	0.261017562	1.688949775	0	4.568850528	0.363332207	0.637467442	0.789997411	1.36579838	0	0.586753337	0	0	2.83476083	0	26.13758424	0.282842434	1.479837005	0	0	6.502774555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.455	NO																																																																																		0	0	0	17.9551	0.261017562	1.688949775	0	4.568850528	0.363332207	0.637467442	0.789997411	1.36579838	0	0.586753337	0	0	2.83476083	0	26.13758424	0.282842434	1.479837005	0	0	6.502774555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.455
H1019_014_0	2010	6	N/A	r.	s.									OP Facility - Other	Health & Education (Non-Covered)									Renal Dialysis										D	D	D	V	T	O	Coin	V	V	V	V	V	Coin	V	V	V	V	V			S	Coin			V				O	O	P	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	YES	1921.599248	50.402951	1694.816717	844.055427	500.50924	1647.039953	5.256283	313.353722	1477.573393	4841.828522	4389.687595	0	0	919.656859	7455.347853	13665.25089	229.827534	858.845951			1188.28507	0			2.58				0.05	0.45	0	2.11									7500	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	$0/Service:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $100 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$95/Visit:9a	20% Coins:12	"$30-$100/Visit:9d. $30 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $30 Psych -- OP,8b. $100 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			$0/Script:15				"VIS116: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Membership in health club/fitness class 14a									119.30775	110.4939	50.7565	0	150	0	0.2	50	22.575855	0	15.340923	0	0	93.93386	0	30	30	30			0	0			0				0	0	0	0									NO	111.112501	102.904074	31.825645	0	136.98915	0	0.182652	45.66305	20.617648	0	14.010267	0	0	85.786131	0	27.39783	27.39783	27.39783			0	0			0				0	0	0	0										17.7928	0.432222417	4.494886265	0	5.713694613	0	0.960070603	1.192390556	2.538674009	0	5.125057938	0	0	6.574483648	0	31.19985174	0.524731309	1.96087628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5097	0	9.31667	17.7928	0.432222417	4.494886265	0	5.713694613	0	0.960070603	1.192390556	2.538674009	0	5.125057938	0	0	6.574483648	0	31.19985174	0.524731309	1.96087628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5097	NO																																																																																		0	0	0	17.7928	0.432222417	4.494886265	0	5.713694613	0	0.960070603	1.192390556	2.538674009	0	5.125057938	0	0	6.574483648	0	31.19985174	0.524731309	1.96087628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5097
H1019_021_0	2010	9	N/A	r.	s.									Health & Education (Non-Covered)	Other Non-Covered																			D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin			V				O	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	YES	1161.974741	17.866351	939.721117	956.764108	384.559322	1.541385	163.482348	224.577998	693.305707	4128.956271	3019.580227	0	0	621.455895	5472.628592	9173.584653	124.58183	469.558011			14.834221	0			1.38				0.05	0.45	2.11	0.6									7500	$200/Day(Days 1-8):1a	$200/Day(Days 1-8):1b	"$0/Day(Days 1-13) $50(Days 14-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $30 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $30 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$150/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$30-$100/Visit:9d. $30 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $30 Psych -- OP,8b. $100 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15				"VIS115: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a									148.2254	133.6122	25.37825	0	100	0.2	0	50	26.239053	0	3.032026	0	0	96.969773	0	30	30	30			0.2	0			0				0	0	0	0									NO	142.894325	128.806704	24.10614	0	94.7027	0.189405	0	47.35135	24.849092	0	2.87141	0	0	91.832994	0	28.41081	28.41081	28.41081			0.189405	0			0				0	0	0	0										13.8366	0.191775482	1.887754067	0	3.034900509	0.291946026	0	0.886172615	1.435668108	0	0.722537738	0	0	4.75584629	0	21.71908088	0.294955892	1.111710286	0	0	2.809675629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9787	0	3.213692	13.8366	0.191775482	1.887754067	0	3.034900509	0.291946026	0	0.886172615	1.435668108	0	0.722537738	0	0	4.75584629	0	21.71908088	0.294955892	1.111710286	0	0	2.809675629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9787	NO																																																																																		0	0	0	13.8366	0.191775482	1.887754067	0	3.034900509	0.291946026	0	0.886172615	1.435668108	0	0.722537738	0	0	4.75584629	0	21.71908088	0.294955892	1.111710286	0	0	2.809675629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9787
H1019_023_0	2010	6	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																	D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V				O	O	O	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	NO	995.444039	31.628017	706.900158	2736.336292	3113.052496	1495.391396	756.741975	1037.138537	1302.538892	9897.589338	5248.863889	0	0.170998	713.432794	9517.50887	16346.77981	81.513717	375.671032			1118.063157	0	3.37	5.7	2.45				0.05	0.45	2.11	5.15	0.6	4.38								$0/Day(Days 1-10):1a	$0/Day(Days 1-10):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$25/Trip:10a	$0/Service:11a	$0/Service:11b	$50/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN818: Dental 16a, 16b"	"VIS140: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional Training/Nutritional benefit 14a	$0: Nutritional benefit 14a	$0: OTC items 13c							0	0	0	0	25	0	0	50	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0							NO	0	0	0	0	25	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	0	0	6.485526033	0	0	4.321410571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8069	0	0	0	0	0	0	6.485526033	0	0	4.321410571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8069	NO																																																																																		0	0	0	0	0	0	0	6.485526033	0	0	4.321410571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8069
H1019_024_0	2010	5	N/A	r.	s.	t.	u.	v.						Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered																D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V				O	O	O	O	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	NO	400.642306	0	123.292935	1387.532905	872.746297	0	182.917001	396.929087	990.661524	8715.526604	5799.686614	0	0	744.753393	7357.05711	28765.57729	0	171.069305			235.703482	0	2.11	5.7	2.37				0.05	0.45	2.11	5.15	0.6	0.65	6.09							$0/Day(Days 1-1):1a	$0/Day(Days 1-1):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	$0/Service:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN818: Dental 16a, 16b"	"VIS140: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional Training/Nutritional benefit 14a	$0: Nutritional benefit 14a	Acupuncture (6 Visits) 13b	$0: OTC items 13c						0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0						NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0							0	0	0	0	0	0	0	0.826935598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8269	0	0	0	0	0	0	0	0	0	0.826935598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8269	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0.826935598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8269
H1019_025_0	2010	6	N/A	r.	s.	t.								Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																		D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin		Coin					O	O	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	NO	1087.724377	18.197919	822.575685	995.135506	856.97261	854.655565	112.050001	442.416472	2112.106243	5303.439665	5670.838487	0	0	502.262243	7223.522451	11308.56182	118.824101	478.272159			1163.788092	0		5.7					0.05	0.45	2.11	0.6	2.4									$0/Day(Days 1-100):1a	$0/Day(Days 1-100):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$25/Trip:10a	$0/Service:11a	$0/Service:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15			"DEN818: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a	$0: OTC items 13c								0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0		0					0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0		0					0	0	0	0	0									0	0	0	0	1.785359604	0	0	0.921700983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7071	0	0	0	0	0	0	1.785359604	0	0	0.921700983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7071	NO																																																																																		0	0	0	0	0	0	0	1.785359604	0	0	0.921700983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7071
H1019_026_0	2010	6	N/A	r.	s.	t.								Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																		D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T						O	O	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	NO	963.895614	44.300858	558.91009	705.255882	1885.838709	8277.629787	367.334489	436.108401	1153.878388	5822.951027	4083.405129	0	0	730.973986	6884.864523	14685.5466	75.791634	1245.996231			1001.326437	0	2.32						0.05	0.45	2.11	0.6	1.36									$0/Day(Days 1-1):1a	$0/Day(Days 1-1):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$25/Trip:10a	$0/Service:11a	$0/Service:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a	$0: OTC items 13c								0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0						0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0						0	0	0	0	0									0	0	0	0	3.928830644	0	0	0.908559169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8374	0	0	0	0	0	0	3.928830644	0	0	0.908559169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8374	NO																																																																																		0	0	0	0	0	0	0	3.928830644	0	0	0.908559169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8374
H1019_027_0	2010	7	N/A	r.	s.									Health & Education (Non-Covered)	Other Non-Covered																			D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			S	Coin							O	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	YES	1533.054327	23.927674	1041.375108	1064.79745	540.777735	2.833044	2.935982	286.777777	786.525283	4328.122417	3306.641057	0	0	674.979051	6541.092151	10685.72134	114.968226	558.136976			744.419595	0							0.05	0.45	2.11										5000	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $100 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$95/Visit:9a	$0/Proc:12	"$25-$150/Visit:9d. $30 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $30 Psych -- OP,8b. $25 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			$0/Script:15								$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a										119.30775	110.4939	50.7565	0	150	0.2	0.2	50	47.399554	0	7.559648	0	0	55.357949	0	30	30	30			0	0							0	0	0	0									NO	109.915367	101.795378	31.629268	0	135.2454	0.180327	0.180327	45.0818	42.737145	0	6.81605	0	0	49.91272	0	27.04908	27.04908	27.04908			0	0							0	0	0	0										14.0422	0.202977218	2.744827698	0	6.094808423	0.510874325	0.529436826	1.077371532	2.801153755	0	1.878185898	0	0	2.807503365	0	24.08657761	0.259148729	1.258090976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2931	0	7.383117	14.0422	0.202977218	2.744827698	0	6.094808423	0.510874325	0.529436826	1.077371532	2.801153755	0	1.878185898	0	0	2.807503365	0	24.08657761	0.259148729	1.258090976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2931	NO																																																																																		0	0	0	14.0422	0.202977218	2.744827698	0	6.094808423	0.510874325	0.529436826	1.077371532	2.801153755	0	1.878185898	0	0	2.807503365	0	24.08657761	0.259148729	1.258090976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2931
H1019_028_0	2010	6	N/A	r.	s.									Health & Education (Non-Covered)	Other Non-Covered																			D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin							O	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	NO	1192.940675	19.11706	858.774632	1359.85274	1003.142958	1403.730219	134.669107	370.451086	921.909445	5194.978542	4273.720026	0	0	957.680193	7655.787026	12312.33894	124.825675	781.354185			784.021811	0							0.05	0.45	2.11	0.6										$0/Day(Days 1-7):1a	$0/Day(Days 1-7):1b	$0/Day(Days 1-100) $0(Days 101-100):2	$0/Visit:6	$25/Trip:10a	$0/Service:11a	$0/Service:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15								$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a									0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0							0	0	0	0									NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0							0	0	0	0										0	0	0	0	2.089881163	0	0	0.771773096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8617	0	0	0	0	0	0	2.089881163	0	0	0.771773096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8617	NO																																																																																		0	0	0	0	0	0	0	2.089881163	0	0	0.771773096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8617
H1019_031_0	2010	7	N/A	r.	s.	t.								OP Facility - Other	Health & Education (Non-Covered)	Other Non-Covered								Renal Dialysis										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	P	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	YES	1106.711724	26.994334	1251.250084	1149.378176	554.920589	0.63316	123.965763	236.707489	842.475423	4080.099092	2022.528213	0	0	274.210965	5441.189558	9496.710458	147.646251	400.197203			30.201099	0			1.38				0.05	0.45	0.30973	2.11	0.6								5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	0% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $30 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $30 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$100/Visit:9d. $30 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $30 Psych -- OP,8b. $100 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15				"VIS115: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a								158.7573	140.3991	50.7565	0	150	0	0	50	20.309984	0	48.939562	0	0	96.270731	0	30	30	30			0.2	0			0				0	0	0	0	0								NO	144.516929	127.805441	28.671839	0	133.66695	0	0	44.55565	18.098491	0	43.61068	0	0	85.7881	0	26.73339	26.73339	26.73339			0.178223	0			0				0	0	0	0	0									13.3282	0.287501897	2.989636746	0	6.181211885	0	0	0.878888003	1.270627822	0	7.350319224	0	0	1.960336474	0	21.15660537	0.328923734	0.891552325	0	0	5.382530467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0063	0	9.192092	13.3282	0.287501897	2.989636746	0	6.181211885	0	0	0.878888003	1.270627822	0	7.350319224	0	0	1.960336474	0	21.15660537	0.328923734	0.891552325	0	0	5.382530467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0063	NO																																																																																		0	0	0	13.3282	0.287501897	2.989636746	0	6.181211885	0	0	0.878888003	1.270627822	0	7.350319224	0	0	1.960336474	0	21.15660537	0.328923734	0.891552325	0	0	5.382530467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0063
H1019_032_0	2010	5	N/A	r.	s.									Health & Education (Non-Covered)	Other Non-Covered																			D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V				O	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	YES	2500.371073	38.630772	2650.493483	2684.854057	1424.833872	1.572581	291.743521	545.100987	1623.821029	8381.093342	4051.139872	0	0.683778	545.271856	10568.87846	19480.41982	325.952761	888.237966			704.329716	0	0	1.67	1.38				0.05	0.45	2.11	0.6									5000	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $75 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $25 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$100/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$10-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $10 OP Other,5. $10 Partial Hospitalization,7h. $10 Psych -- OP,8b. $25 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$10/Visit:7b, 7d, 7f"	$10/Visit:7e	$10/Visit:7i			$0/Script:15			"DEN819: Dental 16a, 16b"	"VIS115: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a									119.30775	110.4939	44.44425	0	150	0.2	0	50	17.113675	0	5.241929	0	0	14.830749	0	10	10	10			0	0	0	0	0				0	0	0	0									NO	104.842998	97.09773	17.052637	0	132.2511	0.176335	0	44.0837	15.088682	0	4.621673	0	0	13.075886	0	8.81674	8.81674	8.81674			0	0	0	0	0				0	0	0	0										21.8455	0.312580022	3.766491936	0	15.70298724	0.277301071	0	2.002505698	2.041776594	0	1.560253647	0	0	0.594159386	0	14.31281639	0.239486729	0.6526136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3085	0	14.124314	21.8455	0.312580022	3.766491936	0	15.70298724	0.277301071	0	2.002505698	2.041776594	0	1.560253647	0	0	0.594159386	0	14.31281639	0.239486729	0.6526136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3085	NO																																																																																		0	0	0	21.8455	0.312580022	3.766491936	0	15.70298724	0.277301071	0	2.002505698	2.041776594	0	1.560253647	0	0	0.594159386	0	14.31281639	0.239486729	0.6526136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3085
H1019_035_0	2010	5	N/A	r.	s.	t.								Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																		D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V				O	O	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	YES	2967.221962	33.814883	2490.532043	3044.08145	1232.567941	2.376816	226.263886	391.411196	1169.323972	7858.786549	6008.213928	0	1.808225	1234.744421	9824.308834	19183.51778	0	991.983288			474.650012	0	0.58	5.7	1.38				0.05	0.45	2.11	0.6	1.63								3400	$75/Day(Days 1-10):1a	$75/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	0% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$25/Visit:9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $25 Surgery OP -- Facility"	$0/Visit:8a	"$0-$25/Visit:14h. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,9a. $25 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$25/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$0-$25/Visit:9d. $0 Cardiac Rehab,8b. $25 Nuclear Medicine,9a. $25 OP Other,5. $0 Partial Hospitalization,7h. $0 Psych -- OP,8b. $25 Rad therapy,3. $0 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN818: Dental 16a, 16b"	"VIS115: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a	$0: OTC items 13c								59.653875	55.24695	44.44425	0	150	0	0	50	0	0	0.000752	0	0	22.899958	0	0	0	0			0	0	0	0	0				0	0	0	0	0								NO	53.662538	49.698223	14.860202	0	136.10865	0	0	45.36955	0	0	0.000683	0	0	20.779216	0	0	0	0			0	0	0	0	0				0	0	0	0	0									13.2691	0.140044966	3.084150771	0	13.98026321	0	0	1.479845819	0	0	0.000341968	0	0	2.138085086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0918	0	9.433226	13.2691	0.140044966	3.084150771	0	13.98026321	0	0	1.479845819	0	0	0.000341968	0	0	2.138085086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0918	NO																																																																																		0	0	0	13.2691	0.140044966	3.084150771	0	13.98026321	0	0	1.479845819	0	0	0.000341968	0	0	2.138085086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0918
H1019_039_0	2010	7	N/A	r.	s.									Health & Education (Non-Covered)	Other Non-Covered																			D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	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	YES	1451.991137	38.085276	1280.630628	637.781786	378.19279	0.776498	3.971732	236.775086	1116.478097	3658.5631	3316.918181	0	0	694.907438	5633.380124	10325.68222	173.661362	648.957742			17.681687	0							0.05	0.45	2.11	0.6									7500	$275/Day(Days 1-5):1a	$275/Day(Days 1-5):1b	"$0/Day(Days 1-20) $124(Days 21-100):2. $0 SNF 1,2. $124 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $150 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	"$0-$20/Proc:12. $0 Dialysis -- Dialysis Center,12. $20 Dialysis -- OP Hosp"	"$35-$150/Visit:9d. $35 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $35 OP Other,5. $35 Partial Hospitalization,7h. $35 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$35/Visit:7i			20% Coins:15								$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a									166.834525	139.3458	44.457596	0	150	0.2	0.2	50	37.841929	0	21.505622	0	0	58.384832	5	35	35	35			0.2	0							0	0	0	0									NO	157.164129	131.26876	32.791967	0	138.0945	0.184126	0.184126	46.0315	34.838415	0	19.798721	0	0	53.750828	4.60315	32.22205	32.22205	32.22205			0.184126	0							0	0	0	0										19.0167	0.416617246	3.499533108	0	4.352195353	0.142973471	0.731299126	0.908259364	3.241360607	0	5.47256147	0	0	3.112654181	2.160941143	27.72622073	0.466310424	1.742562401	0	0	3.255658301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2459	0	7.036952	19.0167	0.416617246	3.499533108	0	4.352195353	0.142973471	0.731299126	0.908259364	3.241360607	0	5.47256147	0	0	3.112654181	2.160941143	27.72622073	0.466310424	1.742562401	0	0	3.255658301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2459	NO																																																																																		0	0	0	19.0167	0.416617246	3.499533108	0	4.352195353	0.142973471	0.731299126	0.908259364	3.241360607	0	5.47256147	0	0	3.112654181	2.160941143	27.72622073	0.466310424	1.742562401	0	0	3.255658301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2459
H1019_043_0	2010	9	N/A	r.	s.	t.								OP Facility - Other	Health & Education (Non-Covered)	Other Non-Covered								Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	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	YES	1502.098008	27.390539	1205.668229	1254.043524	519.171133	2.363066	3.109832	265.590767	839.8948	4985.09093	3812.341467	0	0	755.978399	6545.46558	11403.10516	178.847715	719.869803			21.028877	0		3.28	1.38				0.05	0.45	0	2.11	0.6								7500	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-13) $50(Days 14-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $75 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$25-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $25 Partial Hospitalization,7h. $25 Psych -- OP,8b. $75 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN817: Dental 16a, 16b"	"VIS115: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a								119.30775	110.4939	25.37825	0	150	0.2	0.2	50	38.680691	0	2.288282	0	0	102.786979	0	25	25	26.429457			0.2	0		0	0				0	0	0	0	0								NO	113.663658	105.266765	22.690389	0	139.16955	0.185559	0.185559	46.38985	35.887829	0	2.123061	0	0	95.365451	0	23.194925	23.194925	24.521171			0.185559	0		0	0				0	0	0	0	0									14.2278	0.240276119	2.27975676	0	6.021067746	0.438488164	0.577057316	1.02672632	2.511833413	0	0.674486124	0	0	6.007851747	0	22.04118074	0.345696611	1.471004211	0	0	3.902097387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7654	0	5.563653	14.2278	0.240276119	2.27975676	0	6.021067746	0.438488164	0.577057316	1.02672632	2.511833413	0	0.674486124	0	0	6.007851747	0	22.04118074	0.345696611	1.471004211	0	0	3.902097387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7654	NO																																																																																		0	0	0	14.2278	0.240276119	2.27975676	0	6.021067746	0.438488164	0.577057316	1.02672632	2.511833413	0	0.674486124	0	0	6.007851747	0	22.04118074	0.345696611	1.471004211	0	0	3.902097387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7654
H1019_044_0	2010	7	N/A	r.	s.	t.								OP Facility - Other	Health & Education (Non-Covered)	Other Non-Covered								Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	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	YES	1407.544974	25.666378	1129.774653	1175.104853	486.490705	2.214317	2.914077	248.872542	787.025678	4671.292848	3572.364813	0	0	708.391591	6133.446107	10685.31032	167.589732	674.555932			19.705165	0							0.05	0.45	0	2.11									7500	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $50(Days 14-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $75 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$150/Visit:9d. $40 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $40 OP Other,5. $40 Partial Hospitalization,7h. $40 Psych -- OP,8b. $75 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	$40/Visit:7i			20% Coins:15								$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$25/Proc:12	$0: Membership in health club/fitness class 14a									158.7573	140.3991	25.37825	0	150	0.2	0.2	50	38.680691	0	2.285878	0	0	59.64224	10	40	40	40			0.2	0							0	0	0	0	0								NO	149.219161	131.963922	22.051796	0	137.5182	0.183358	0.183358	45.8394	35.461993	0	2.095666	0	0	54.67929	9.16788	36.67152	36.67152	36.67152			0.183358	0							0	0	0	0	0									17.5027	0.282252992	2.076130014	0	5.575110506	0.406012736	0.534319331	0.950680667	2.32579159	0	0.623873623	0	0	3.227862436	4.685891491	32.65388093	0.512147517	2.061415946	0	0	3.613099644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0312	0	7.598198	17.5027	0.282252992	2.076130014	0	5.575110506	0.406012736	0.534319331	0.950680667	2.32579159	0	0.623873623	0	0	3.227862436	4.685891491	32.65388093	0.512147517	2.061415946	0	0	3.613099644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0312	NO																																																																																		0	0	0	17.5027	0.282252992	2.076130014	0	5.575110506	0.406012736	0.534319331	0.950680667	2.32579159	0	0.623873623	0	0	3.227862436	4.685891491	32.65388093	0.512147517	2.061415946	0	0	3.613099644	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0312
H1019_045_0	2010	7	N/A	r.	s.									Health & Education (Non-Covered)	Other Non-Covered																			D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin							O	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	NO	1520.540818	27.726841	1220.471464	1269.440712	525.545534	1302.176318	170.72241	268.8517	850.207056	5046.298043	3859.149523	0	0	765.260328	6625.831026	11543.11286	181.043613	728.708388			811.379135	0							0.05	0.45	2.11	0.6										$0/Day(Days 1-7):1a	$0/Day(Days 1-7):1b	$0/Day(Days 1-100) $0(Days 101-100):2	$0/Visit:6	$25/Trip:10a	$0/Service:11a	$0/Service:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15								$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a									0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0							0	0	0	0									NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0							0	0	0	0										0	0	0	0	1.094886529	0	0	0.560107708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.655	0	0	0	0	0	0	1.094886529	0	0	0.560107708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.655	NO																																																																																		0	0	0	0	0	0	0	1.094886529	0	0	0.560107708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.655
H1019_046_0	2010	6	N/A	r.	s.	t.								Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																		A	A	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T						O	O	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	NO	475.837205	33.709847	559.114866	736.25683	2010.447299	8837.640512	383.097305	460.231874	1202.305317	6129.425434	4274.71079	0	0	762.041	7206.133153	15423.94637	75.819403	1315.78405			1045.581852	0	2.32						0.05	0.45	2.11	0.6	1.36									$0/Admit:1a	$0/Admit:1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$25/Trip:10a	$0/Service:11a	$0/Service:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b						$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a	$0: OTC items 13c								0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0						0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0						0	0	0	0	0									0	0	0	0	4.188431873	0	0	0.958816404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.1472	0	0	0	0	0	0	4.188431873	0	0	0.958816404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.1472	NO																																																																																		0	0	0	0	0	0	0	4.188431873	0	0	0.958816404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.1472
H1019_047_0	2010	6	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																	D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V				O	O	O	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	NO	995.444039	31.628017	706.900158	2736.336292	3113.052496	1495.391396	756.741975	1037.138537	1302.538892	9897.589338	5248.863889	0	0.170998	713.432794	9517.50887	16346.77981	81.513717	375.671032			1118.063157	0	3.37	5.7	2.45				0.05	0.45	2.11	5.15	0.6	4.38								$0/Day(Days 1-10):1a	$0/Day(Days 1-10):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$25/Trip:10a	$0/Service:11a	$0/Service:11b	$50/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN818: Dental 16a, 16b"	"VIS140: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional Training/Nutritional benefit 14a	$0: Nutritional benefit 14a	$0: OTC items 13c							0	0	0	0	25	0	0	50	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0							NO	0	0	0	0	25	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	0	0	6.485526033	0	0	4.321410571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8069	0	0	0	0	0	0	6.485526033	0	0	4.321410571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8069	NO																																																																																		0	0	0	0	0	0	0	6.485526033	0	0	4.321410571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.8069
H1019_048_0	2010	6	N/A	r.	s.	t.	u.	v.						Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered																D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V				O	O	O	O	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	NO	400.642306	0	123.292935	1387.532905	872.746297	0	182.917001	396.929087	990.661524	8715.526604	5799.686614	0	0	744.753393	7357.05711	28765.57729	0	171.069305			235.703482	0	2.11	5.7	2.37				0.05	0.45	2.11	5.15	0.6	0.65	6.09							$0/Day(Days 1-1):1a	$0/Day(Days 1-1):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	$0/Service:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN818: Dental 16a, 16b"	"VIS140: Vision 7a, 7b"				$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional Training/Nutritional benefit 14a	$0: Nutritional benefit 14a	Acupuncture (6 Visits) 13b	$0: OTC items 13c						0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0						NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0							0	0	0	0	0	0	0	0.826935598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8269	0	0	0	0	0	0	0	0	0	0.826935598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8269	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0.826935598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8269
H1019_049_0	2010	6	N/A	r.	s.									Health & Education (Non-Covered)	Other Non-Covered																			D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin							O	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	NO	1192.940675	19.11706	858.774632	1359.85274	1003.142958	1403.730219	134.669107	370.451086	921.909445	5194.978542	4273.720026	0	0	957.680193	7655.787026	12312.33894	124.825675	781.354185			784.021811	0							0.05	0.45	2.11	0.6										$0/Day(Days 1-7):1a	$0/Day(Days 1-7):1b	$0/Day(Days 1-100) $0(Days 101-100):2	$0/Visit:6	$25/Trip:10a	$0/Service:11a	$0/Service:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15								$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a									0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0							0	0	0	0									NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0							0	0	0	0										0	0	0	0	2.089881163	0	0	0.771773096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8617	0	0	0	0	0	0	2.089881163	0	0	0.771773096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8617	NO																																																																																		0	0	0	0	0	0	0	2.089881163	0	0	0.771773096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.8617
H1019_050_0	2010	6	N/A	r.	s.	t.								Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																		D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin		Coin					O	O	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	NO	1087.724377	18.197919	822.575685	995.135506	856.97261	854.655565	112.050001	442.416472	2112.106243	5303.439665	5670.838487	0	0	502.262243	7223.522451	11308.56182	118.824101	478.272159			1163.788092	0		5.7					0.05	0.45	2.11	0.6	2.4									$0/Day(Days 1-100):1a	$0/Day(Days 1-100):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$25/Trip:10a	$0/Service:11a	$0/Service:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15			"DEN818: Dental 16a, 16b"					$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a	$0: OTC items 13c								0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0		0					0	0	0	0	0								NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0		0					0	0	0	0	0									0	0	0	0	1.785359604	0	0	0.921700983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7071	0	0	0	0	0	0	1.785359604	0	0	0.921700983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7071	NO																																																																																		0	0	0	0	0	0	0	1.785359604	0	0	0.921700983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.7071
H1026_001_0	2010	8	N/A	r.	s1.	s2.	s3.	s4.						OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional		ASC	AIXIDTF	IDTF	OP MH	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine		D	D	D		T	Coin		V	V	V	V		V	V		V	V	V			Coin									O	V	V	V	V	V	V	V	O																																											0	NO	1735.843422	30.43067014	611.5436544		153.9766828	0.025270389		152.9593463	150.5370239	123.5835379	70.80889638		47.01576696	637.859043		4273.347752	6.445893559	429.2725874			81.93256499									231.1473024	149.693424	61.97021702	32.82805018	110.2524791	237.814109	16.23758403	2.083002368	144.426385				$200 for days 1-8	$200 for days 1-8	$75 for days 7-25		$100 per transport	20% coinsurance per electric wheelchair		$50 per visit	$175 per visit	$15 per visit	$50 per visit		$15 per visit	$175 per visit		$15 per visit	$15 per visit	$15 per visit			20% coinsurance									"$0/visit IP Acute, $50/visit OP ER, $0/visit Phys Exam, $15/visit Podiatry & Rehab, $25/visit Urgent Care ER"	$100 per visit	$100 per visit	$75 per visit	$15 per visit	$15 per visit	$25 per visit	$100 per visit	$5 per shot			128.1794088	61.87966424	31.01202793		100	0.2		50	175	15	50		15	175		15	15	15			0.2									7.596131734	100	100	75	15	15	25	100	5			NO	128.1794088	61.87966424	31.01202793		100	0.2		50	175	15	50		15	175		15	15	15			0.2									7.596131734	100	100	75	15	15	25	100	5				18.5416	0.156919971	1.580434074	0	1.283139023	0.005054078	0	0.63733061	2.195331598	0.154479422	0.295037068	0	0.058769709	9.302111043	0	5.34168469	0.008057367	0.536590734	0	0	16.386513	0	0	0	0	0	0	0	0	0.14631878	1.2474452	0.516418475	0.205175314	0.137815599	0.297267636	0.0338283	0.017358353	0.06017766	0	0	59.1449		0	18.5416	0.156919971	1.580434074	0	1.283139023	0.005054078	0	0.63733061	2.195331598	0.154479422	0.295037068	0	0.058769709	9.302111043	0	5.34168469	0.008057367	0.536590734	0	0	16.386513	0	0	0	0	0	0	0	0	0.14631878	1.2474452	0.516418475	0.205175314	0.137815599	0.297267636	0.0338283	0.017358353	0.06017766	0	0	59.1449	NO																																																																																		0			18.5416	0.156919971	1.580434074	0	1.283139023	0.005054078	0	0.63733061	2.195331598	0.154479422	0.295037068	0	0.058769709	9.302111043	0	5.34168469	0.008057367	0.536590734	0	0	16.386513	0	0	0	0	0	0	0	0	0.14631878	1.2474452	0.516418475	0.205175314	0.137815599	0.297267636	0.0338283	0.017358353	0.06017766	0	0	59.1449
H1026_033_0	2010	6	N/A	g.1.	h.6.	h.7.	h.8.	h.9.	f.1.	i.7.	i.8.	i.9.		OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional		ASC	AIXIDTF	IDTF	OP MH	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine		D	D	D		T	Coin		V	V	V	V		V	V	V	V	V	V			Coin									O	V	V	V	V	V	V	V	O	O																																										0	NO	1800.154511	10.16756094	676.4667768		171.7297789	0.029578276		119.960201	34.75135814	36.32187892	0		0	171.0237554	3590.586749	1953.225189	25.04276117	8.366323157			101.3794698									92.132694	66.40444577	50.90143453	11.63854827	96.77382589	5.300277696	49.84784863	0.833162093	41.21334661	0			$330 for days 1-3	$330 for days 1-3	$100 for days 7-25		$100 per transport	20% coinsurance per electric wheelchair		$50 per visit	$200 per visit	$15 per visit	$50 per visit		$15 per visit	$200 per visit	$20 per visit	$60 per visit	$40 per visit	$60 per visit			20% coinsurance									"$0/visit IP Acute, $50/visit OP ER, $20/visit Phys Exam, $60/visit Podiatry & Rehab, $25/visit Urgent Care ER"	$100 per visit	$175 per visit	$75 per visit	$40 per visit	$60 per visit	$25 per visit	$175 per visit	$5 per shot	$5 per use		132.4541878	49.60429836	25.8045627		100	0.2		50	200	15	50		15	200	20	60	40	60			0.2									23.12911541	100	175	75	40	60	25	175	5	5		NO	132.4541878	49.60429836	25.8045627		100	0.2		50	200	15	50		15	200	20	60	40	60			0.2									23.12911541	100	175	75	40	60	25	175	5	5			19.8698	0.042029561	1.45466078	0	1.431081491	0.005915655	0	0.499834171	0.579189302	0.045402349	0	0	0	2.850395923	5.984311248	9.766125947	0.083475871	0.041831616	0	0	20.27589396	0	0	0	0	0	0	0	0	0.177578976	0.553370381	0.742312587	0.072740927	0.32257942	0.026501388	0.103849685	0.012150281	0.017172228	0	0	64.9582		0	19.8698	0.042029561	1.45466078	0	1.431081491	0.005915655	0	0.499834171	0.579189302	0.045402349	0	0	0	2.850395923	5.984311248	9.766125947	0.083475871	0.041831616	0	0	20.27589396	0	0	0	0	0	0	0	0	0.177578976	0.553370381	0.742312587	0.072740927	0.32257942	0.026501388	0.103849685	0.012150281	0.017172228	0	0	64.9582	NO																																																																																		0			19.8698	0.042029561	1.45466078	0	1.431081491	0.005915655	0	0.499834171	0.579189302	0.045402349	0	0	0	2.850395923	5.984311248	9.766125947	0.083475871	0.041831616	0	0	20.27589396	0	0	0	0	0	0	0	0	0.177578976	0.553370381	0.742312587	0.072740927	0.32257942	0.026501388	0.103849685	0.012150281	0.017172228	0	0	64.9582
H1026_038_0	2010	6	N/A	g.1.	h.6.	h.7.	h.8.	h.9.	f.1.	i.7.	i.8.	i.9.		OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional		ASC	AIXIDTF	IDTF	OP MH	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine		D	D	D		T	Coin		V	V	V	V		V	V	V	V	V	V			Coin									O	V	V	V	V	V	V	V	O	V																																										0	NO	1800.038051	26.59660445	1177.318776		214.2429704	0.024200648		142.733243	127.2581739	30.96752178	57.23940499		17.20939318	394.2288363	5450.881757	6463.824349	6.826005788	856.508083			106.5336792									68.67296779	310.7899623	170.5830417	75.11679213	110.9808692	189.5022158	89.39732401	0.508902725	121.2025335	0			$450 for days 1-2	$450 for days 1-2	$75 for days 7-25		$100 per transport	20% coinsurance per electric wheelchair		$50 per visit	$300 per visit	$15 per visit	$50 per visit		$15 per visit	$300 per visit	$20 per visit	$60 per visit	$40 per visit	$60 per visit			20% coinsurance									"$0/visit IP Acute, $50/visit OP ER, $20/visit Phys Exam, $60/visit Podiatry & Rehab, $25/visit Urgent Care ER"	$150 per visit	$175 per visit	$100 per visit	$40 per visit	$60 per visit	$25 per visit	$175 per visit	$5 per shot	$5 per visit		141.1962435	67.89841449	32.88553917		100	0.2		50	300	15	50		15	300	20	60	40	60			0.2									32.07094178	150	175	100	40	60	25	175	5	5		NO	141.1962435	67.89841449	32.88553917		100	0.2		50	300	15	50		15	300	20	60	40	60			0.2									32.07094178	150	175	100	40	60	25	175	5	5			21.1799	0.150488939	3.226396894	0	1.785358087	0.00484013	0	0.594721846	3.181454346	0.038709402	0.238497521	0	0.021511741	9.855720907	9.084802929	32.31912175	0.022753353	4.282540415	0	0	21.30673584	0	0	0	0	0	0	0	0	0.183533896	3.884874528	2.487669358	0.625973268	0.369936231	0.947511079	0.186244425	0.007421498	0.050501056	0	0	116.0372		0	21.1799	0.150488939	3.226396894	0	1.785358087	0.00484013	0	0.594721846	3.181454346	0.038709402	0.238497521	0	0.021511741	9.855720907	9.084802929	32.31912175	0.022753353	4.282540415	0	0	21.30673584	0	0	0	0	0	0	0	0	0.183533896	3.884874528	2.487669358	0.625973268	0.369936231	0.947511079	0.186244425	0.007421498	0.050501056	0	0	116.0372	NO																																																																																		0			21.1799	0.150488939	3.226396894	0	1.785358087	0.00484013	0	0.594721846	3.181454346	0.038709402	0.238497521	0	0.021511741	9.855720907	9.084802929	32.31912175	0.022753353	4.282540415	0	0	21.30673584	0	0	0	0	0	0	0	0	0.183533896	3.884874528	2.487669358	0.625973268	0.369936231	0.947511079	0.186244425	0.007421498	0.050501056	0	0	116.0372
H1026_040_0	2010	6	N/A	g.1.	h.6.	h.7.	h.8.	h.9.	f.1.	i.7.	i.8.	i.9.		OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional		ASC	AIXIDTF	IDTF	OP MH	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine		D	D	D		T	Coin		V	V	V	V		V	V	V	V	V	V			Coin									O	V	V	V	V	V	V	V	O	O																																										0	NO	1678.345519	25.76016867	773.8782903		238.9263309	0.02421216		220.2638507	202.8146954	37.190066	43.29769956		42.4137156	671.5562993	4187.495885	5450.235951	6.818273294	335.5174933			75.49131599									75.12621028	163.8502634	79.47933907	43.59191125	114.1727569	239.5549269	30.81202041	0.238654037	108.1749329	0			$325 for days 1-3	$325 for days 1-3	$75 for days 7-25		$100 per transport	20% coinsurance per electric wheelchair		$50 per visit	$200 per visit	$15 per visit	$50 per visit		$15 per visit	$200 per visit	$15 per visit	$45 per visit	$40 per visit	$45 per visit			20% coinsurance									"$0/visit IP Acute, $50/visit OP ER, $15/visit Phys Exam, $45/visit Podiatry & Rehab, $25/visit Urgent Care ER"	$125 per visit	$150 per visit	$75 per visit	$40 per visit	$45 per visit	$25 per visit	$150 per visit	$5 per shot	$5 per use		138.907794	72.16885943	33.06925851		100	0.2		50	200	15	50		15	200	15	45	40	45			0.2									21.48734568	125	150	75	40	45	25	150	5	5		NO	138.907794	72.16885943	33.06925851		100	0.2		50	200	15	50		15	200	15	45	40	45			0.2									21.48734568	125	150	75	40	45	25	150	5	5			19.4279	0.154923499	2.13263177	0	1.991052757	0.004842432	0	0.917766045	3.380244923	0.046487583	0.180407082	0	0.053017144	11.19260499	5.234369856	20.43838482	0.022727578	1.2581906	0	0	15.0982632	0	0	0	0	0	0	0	0	0.134521904	1.706773577	0.993491738	0.272449445	0.380575856	0.898330976	0.064191709	0.002983175	0.045072889	0	0	86.0322		0	19.4279	0.154923499	2.13263177	0	1.991052757	0.004842432	0	0.917766045	3.380244923	0.046487583	0.180407082	0	0.053017144	11.19260499	5.234369856	20.43838482	0.022727578	1.2581906	0	0	15.0982632	0	0	0	0	0	0	0	0	0.134521904	1.706773577	0.993491738	0.272449445	0.380575856	0.898330976	0.064191709	0.002983175	0.045072889	0	0	86.0322	NO																																																																																		0			19.4279	0.154923499	2.13263177	0	1.991052757	0.004842432	0	0.917766045	3.380244923	0.046487583	0.180407082	0	0.053017144	11.19260499	5.234369856	20.43838482	0.022727578	1.2581906	0	0	15.0982632	0	0	0	0	0	0	0	0	0.134521904	1.706773577	0.993491738	0.272449445	0.380575856	0.898330976	0.064191709	0.002983175	0.045072889	0	0	86.0322
H1026_801_0	2010	2	N/A	g.1.	h.6.	h.7.	h.8.	h.9.	f.1.	i.7.	i.8.	i.9.		OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional		ASC	AIXIDTF	IDTF	OP MH	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine		Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																			0		0		0	0		0	0					0						0	0	0																			0	NO	278.4882089		24.99368712		7.419537586	4.520612499		10.48690351	57.74440888					117.2211907						323.5235567	94.11456488	0																				7.6% coinsurance		16% coinsurance		23.3% coinsurance	23.3% coinsurance		23.3% coinsurance	23.3% coinsurance					23.3% coinsurance						23.3% coinsurance	23.3% coinsurance	23.3% coinsurance																																																											NO	0.076066257		0.159529212		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																				21.1836	0	3.987223201	0	1.728752258	1.053302712	0	2.443448518	13.45444727	0	0	0	0	27.31253742	0	0	0	0	0	75.38098872	21.92869362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.4729		0	21.1836	0	3.987223201	0	1.728752258	1.053302712	0	2.443448518	13.45444727	0	0	0	0	27.31253742	0	0	0	0	0	75.38098872	21.92869362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.4729	NO																																																																																		0			21.1836	0	3.987223201	0	1.728752258	1.053302712	0	2.443448518	13.45444727	0	0	0	0	27.31253742	0	0	0	0	0	75.38098872	21.92869362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.4729
H1026_802_0	2010	2	N/A																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																			0		0		0	0		0	0					0						0	0	0																			0	NO	278.4882089		24.99368712		7.419537586	4.520612499		10.48690351	57.74440888					117.2211907						323.5235567	94.11456488	0																				7.6% coinsurance		16% coinsurance		23.3% coinsurance	23.3% coinsurance		23.3% coinsurance	23.3% coinsurance					23.3% coinsurance						23.3% coinsurance	23.3% coinsurance	23.3% coinsurance																																																											NO	0.076066257		0.159529212		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																				21.1836	0	3.987223201	0	1.728752258	1.053302712	0	2.443448518	13.45444727	0	0	0	0	27.31253742	0	0	0	0	0	75.38098872	21.92869362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.4729		0	21.1836	0	3.987223201	0	1.728752258	1.053302712	0	2.443448518	13.45444727	0	0	0	0	27.31253742	0	0	0	0	0	75.38098872	21.92869362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.4729	NO																																																																																		0			21.1836	0	3.987223201	0	1.728752258	1.053302712	0	2.443448518	13.45444727	0	0	0	0	27.31253742	0	0	0	0	0	75.38098872	21.92869362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	168.4729
H1032_002_0	2010	6	N/A																															D	D	D	V	T	P	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	Yes	2064.198327	77.36813709	985.5265425	1119.1486	574.4897712	1354.09139	6.957246926	854.1544962	278.0304254	5173.294977	505.5653742	59.83281139	0.068945947	368.5498838	13345.10315	13618.88046	44.69991936	223.6544277	5160.015844	769.7102399	27.51696985	54.43351471	0	310.2857143	288	172.8	16.8	12.8	2040	0											3400	"$50 days 1 - 5, $0 after day 5, unlimited coverage"	"$50 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $20.00	Copay between $0.00 and $100.00	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	$25.00 copayment	$0.00 copayment	Copay between $0.00 and $75.00	$50.00 copayment	20% coinsurance	Copay between $10.00 and $25.00	$0.00 copayment	Copay between $0.00 and $20.00	Copay between $10.00 and $20.00	$20.00 copayment	Copay between $0.00 and $70.00	Copay between $0.00 and $20.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											27.57867345	38.30303463	54.67	0.461897107	43.86202742	0	0.110428013	9.706873955	10.57395001	0	34.96750603	14.27545985	0.2	7.826626776	0	5.070744616	15.83475361	7.963614864	21.56739843	0.652701051	0.2	0	0	0	0	0	0	0	0	0											NO	27.02267075	37.53082234	53.56781982	0.452584983	42.97774249	0	0.108201718	9.51117752	10.3607728	0	34.26254001	13.98765796	0.195967879	7.668837258	0	4.968515346	15.51551543	7.803063584	21.13258666	0.639542204	0.195967879	0	0	0	0	0	0	0	0	0												4.6483	0.241974151	4.399375688	0.042209154	2.057522787	0	0.75278607	0.677001254	0.240050839	0	1.443496155	0.069743408	0.013511191	0.23552909	0	5.638801379	0.057795191	0.145432477	9.087040167	0.041021849	5.392442228	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1841	0	0.723927068	4.6483	0.241974151	4.399375688	0.042209154	2.057522787	0	0.75278607	0.677001254	0.240050839	0	1.443496155	0.069743408	0.013511191	0.23552909	0	5.638801379	0.057795191	0.145432477	9.087040167	0.041021849	5.392442228	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1841	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.8091	0	0.0769	0.0298	0.0633	0.0898	0.0414	0	0.0981	0.0293	0.0867	0	0	0.0319	0	0.4078	0	0.0047	0.2614	0.0454	0	0.0037	0	0	0	0	0	0	0	0											2.0793	0	0	5.4575	0.241974151	4.476258594	0.07196316	2.120814781	0.089830203	0.794203157	0.677001254	0.33818273	0.029341048	1.530181607	0.069743408	0.013511191	0.26745058	0	6.046583247	0.057795191	0.150139366	9.348414717	0.08642312	5.392442228	0.00368931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2634
H1032_008_0	2010	6	N/A																															A	A	D	V	T	P	P	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	NO	341.5853197	15.70070372	676.6233542	2476.86865	515.5539377	793.0235713	1575.762597	1183.952622	218.5620681	5328.229077	641.6309145	39.74653407	0.302738776	244.8267521	14229.0629	13159.86726	52.13309022	233.8775865	6154.508684	780.0122322	36.8115586	19.58221167	2170	0	288	172.8	16.8	12.8	2040	4427.707568												"$0 per admission, unlimited coverage"	"$0 per admission, unlimited coverage"	"$0 days 1 - 7, $80 days 8 - 100"	$0.00 copayment	$0.00 copayment	$0.00 copayment	$0.00 copayment	$0.00 copayment	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $70.00	$0.00 copayment	20% coinsurance	Copay between $0.00 and $20.00	$0.00 copayment	Copay between $0.00 and $20.00	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $50.00	$0.00 copayment	20% coinsurance	$0.00 copayment	$0.00 copayment	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	$0.00 copayment											0	0	51.4857322	0	0	0	0	0	0	0	32.89345686	0	0.2	0.875760702	0	0.15544811	0	0	22.2974796	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	51.4857322	0	0	0	0	0	0	0	32.89345686	0	0.2	0.875760702	0	0.15544811	0	0	22.2974796	0	0.2	0	0	0	0	0	0	0	0	0												0	0	2.903037401	0	0	0	0	0	0	0	1.758788234	0	0.060547755	0.017867471	0	0.170473041	0	0	11.43583599	0	7.362311719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7089	0	0	0	0	2.903037401	0	0	0	0	0	0	0	1.758788234	0	0.060547755	0.017867471	0	0.170473041	0	0	11.43583599	0	7.362311719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7089	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	2.903037401	0	0	0	0	0	0	0	1.758788234	0	0.060547755	0.017867471	0	0.170473041	0	0	11.43583599	0	7.362311719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7089
H1032_012_0	2010	6	N/A																															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	V	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	Yes	1675.214965	94.78655688	748.1083279	936.0596054	377.4645415	18.07308707	7.036108886	900.6713794	315.0144284	4502.999897	489.784806	74.95847797	0.162936324	346.2276815	14391.61098	11334.09316	21.35978722	129.4377078	4570.52755	1021.130165	12.23033424	27.37021872	0	0	288	172.8	16.8	12.8	0	0											3400	"$175 days 1 - 7, $0 after day 7, unlimited coverage"	"$175 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $75.00 and $125.00	$0.00 copayment	Copay between $0.00 and $175.00	$175.00 copayment	20% coinsurance	Copay between $25.00 and $125.00	Copay between $0.00 and $5.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											116.5002626	107.1111647	54.67	0.188087465	45.78196178	0.2	0.064251802	9.972418776	51.64148226	0	46.27301641	49.94276709	0.2	14.68798215	2.200042346	10.61748695	24.90256942	17.63211353	25.52766329	1.871608108	0.2	0	0	0	0	0	0	0	0	0											NO	110.1457252	101.268758	51.68801048	0.177828185	43.28477265	0.189090947	0.060747171	9.428470573	48.82468404	0	43.74904257	47.21862573	0.189090947	13.8868223	2.080040458	10.03835333	23.54425222	16.67036526	24.13525019	1.769520752	0.189090947	0	0	0	0	0	0	0	0	0												15.3765	0.799909741	3.222352591	0.013871482	1.361538905	3.417457157	0.427423707	0.7076628	1.281706661	0	1.785634694	0.294953026	0.030809784	0.400666857	2.494594425	9.481302659	0.041908351	0.179814489	9.192568828	0.150575918	2.312645489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9739	0	3.056173915	15.3765	0.799909741	3.222352591	0.013871482	1.361538905	3.417457157	0.427423707	0.7076628	1.281706661	0	1.785634694	0.294953026	0.030809784	0.400666857	2.494594425	9.481302659	0.041908351	0.179814489	9.192568828	0.150575918	2.312645489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9739	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.6112	0	0.0559	0.0152	0.0398	0.0575	0.0443	0	0.1065	0.0402	0.0817	0	0	0.048	0	0.4279	0	0.0032	0.1878	0.0544	0	0.0023	0	0	0	0	0	0	0	0											1.7758	0	0	15.9877	0.799909741	3.278234513	0.029040793	1.401376007	3.474984562	0.471704004	0.7076628	1.388226573	0.040197063	1.867300907	0.294953026	0.030809784	0.448623409	2.494594425	9.909191228	0.041908351	0.183060616	9.380354454	0.204958408	2.312645489	0.002262685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7497
H1032_014_0	2010	6	N/A																															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	V	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	Yes	2005.336743	93.46252186	940.2310557	856.7753986	518.898532	16.30807867	6.919188535	1066.457446	260.587855	4782.277744	629.3745806	118.6610645	3.296990099	205.6926627	15915.8241	12286.35569	27.18640636	179.3072287	4774.696066	841.0132385	13.03030966	43.27471917	0	0	0	0	16.8	12.8	2040	0											3400	"$175 days 1 - 10, $0 after day 10, unlimited coverage"	"$175 days 1 - 10, $0 after day 10, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $75.00 and $125.00	$0.00 copayment	Copay between $0.00 and $175.00	$175.00 copayment	20% coinsurance	Copay between $20.00 and $125.00	$0.00 copayment	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											124.1407569	96.67839451	54.67	0.328765354	43.99731988	0.2	0.068457275	9.225841953	54.47017379	0	46.29093563	49.9506483	0.2	13.10561049	0	9.515425322	25.48375771	12.05165737	24.56390808	0.624773459	0.2	0	0	0	0	0	0	0	0	0											NO	116.4353617	90.67758333	51.27664258	0.308358946	41.26641387	0.187586035	0.064208144	8.653195543	51.08921955	0	43.41766528	46.85022023	0.187586035	12.29214752	0	8.924804522	23.90198529	11.30361309	23.03923056	0.585993879	0.187586035	0	0	0	0	0	0	0	0	0												19.4577	0.706246301	4.017657649	0.022016197	1.784423465	3.059167811	0.444268255	0.769022068	1.109435845	0	2.277164573	0.463274751	0.618469299	0.21070038	0	9.1377769	0.054150757	0.168901628	9.167110294	0.041069051	2.44430412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9528	0	3.702815913	19.4577	0.706246301	4.017657649	0.022016197	1.784423465	3.059167811	0.444268255	0.769022068	1.109435845	0	2.277164573	0.463274751	0.618469299	0.21070038	0	9.1377769	0.054150757	0.168901628	9.167110294	0.041069051	2.44430412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9528	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.6767	0	0.0654	0.0211	0.056	0.0496	0.043	0	0.1108	0.0505	0.1119	0	0	0.0213	0	0.449	0	0.0049	0.183	0.0527	0	0.0036	0	0	0	0	0	0	0	0											1.8992	0	0	20.1344	0.706246301	4.083012581	0.043107593	1.840380995	3.108744308	0.487294837	0.769022068	1.220238682	0.05050409	2.389031632	0.463274751	0.618469299	0.2319529	0	9.586727853	0.054150757	0.173764264	9.350076373	0.093790425	2.44430412	0.003570503	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8521
H1032_025_0	2010	6	N/A																															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	V	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	Yes	1334.055436	155.9244403	495.8596379	1619.738415	532.1674635	15.43996495	7.813036998	1657.691246	276.726677	11201.73092	1781.130153	166.8653955	0.141237625	621.9666932	9355.688208	22698.63819	470.5325061	3887.750644	4520.939836	2419.130391	25.80487029	25.05680989	0	0	288	172.8	16.8	12.8	2040	0											2500	"$150 days 1 - 5, $0 after day 5, unlimited coverage"	"$150 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $50.00 and $100.00	$0.00 copayment	Copay between $0.00 and $150.00	$150.00 copayment	20% coinsurance	Copay between $25.00 and $100.00	Copay between $0.00 and $10.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											96.71325159	52.5749766	54.67	1.306997718	38.38103254	0.2	0.123694237	19.49916982	61.69794596	0	57.33891561	42.81800271	0.2	8.148392138	4.403513497	9.344589619	26.55630768	8.851458347	40.04652689	8.865083892	0.2	0	0	0	0	0	0	0	0	0											NO	80.66829751	43.85266532	45.60011945	1.090163747	32.0135297	0.166819533	0.103173074	16.26421205	51.46211278	0	47.82625574	35.71439616	0.166819533	6.796554871	3.672960334	7.7943004	22.15055428	7.382980756	33.40271465	7.394345792	0.166819533	0	0	0	0	0	0	0	0	0												8.968	0.569808525	1.88427156	0.147148342	1.419713241	2.575687749	0.806095047	2.246753495	1.186744955	0	7.098732185	0.496624737	0.023561195	0.35226923	2.863589307	14.74333373	0.868546318	2.391932349	12.58430527	1.490657219	4.304756421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0225	0	13.33080575	8.968	0.569808525	1.88427156	0.147148342	1.419713241	2.575687749	0.806095047	2.246753495	1.186744955	0	7.098732185	0.496624737	0.023561195	0.35226923	2.863589307	14.74333373	0.868546318	2.391932349	12.58430527	1.490657219	4.304756421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0225	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.5438	0	0.0422	0.0724	0.0512	0.0909	0.0491	0	0.1351	0.0653	0.1976	0	0	0.0673	0	0.714	0	0.0824	0.2324	0.1073	0	0.0016	0	0	0	0	0	0	0	0											2.4525	0	0	9.5118	0.569808525	1.926443509	0.219571027	1.47092531	2.6665909	0.855215311	2.246753495	1.321889221	0.065255925	7.29628327	0.496624737	0.023561195	0.419615272	2.863589307	15.45730966	0.868546318	2.474284505	12.81666609	1.597924095	4.304756421	0.001558346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.475
H1032_032_0	2010	6	N/A																															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	V	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	Yes	900.8370957	74.87694018	367.1159424	791.1198107	247.508238	12.34367243	3.475234759	718.6029735	245.2941148	3969.618581	402.3977699	35.15493256	0.028128994	128.4692002	17802.95615	8727.453256	20.06978966	172.0702318	3877.56982	877.6874431	7.583330713	15.3070769	0	0	0	0	16.8	12.8	0	0											3400	"$200 days 1 - 8, $0 after day 8, unlimited coverage"	"$200 days 1 - 8, $0 after day 8, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $10.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											154.4158956	105.0099178	54.67	0.135436956	47.89530006	0.2	0.102537222	9.567518212	96.47970729	0	48.56447381	73.46719317	0.2	29.13333435	4.108500723	11.02494295	27.01424515	18.61256749	29.92352019	0.776769759	0.2	0	0	0	0	0	0	0	0	0											NO	148.3792583	100.9047265	52.53276561	0.130142269	46.0229115	0.192181327	0.098528697	9.193491708	92.70799065	0	46.665925	70.5951132	0.192181327	27.99441421	3.947885595	10.5939408	25.95816735	17.88493955	28.75370902	0.746403214	0.192181327	0	0	0	0	0	0	0	0	0												11.1388	0.629619764	1.607134646	0.008579844	0.949254145	2.372223342	0.342410353	0.550539207	1.895060375	0	1.564855346	0.20681387	0.005405867	0.299701667	5.857002845	7.704843596	0.04341458	0.256455475	9.291209526	0.054592394	1.457374556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2353	0	1.881028781	11.1388	0.629619764	1.607134646	0.008579844	0.949254145	2.372223342	0.342410353	0.550539207	1.895060375	0	1.564855346	0.20681387	0.005405867	0.299701667	5.857002845	7.704843596	0.04341458	0.256455475	9.291209526	0.054592394	1.457374556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2353	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.3554	0	0.0256	0.0059	0.0274	0.035	0.0215	0	0.092	0.0299	0.0655	0	0	0.02	0	0.3566	0	0.0066	0.1748	0.0606	0	0.0023	0	0	0	0	0	0	0	0											1.2792	0	0	11.4942	0.629619764	1.632737309	0.014492839	0.97668878	2.407175528	0.363933161	0.550539207	1.987044133	0.029886039	1.630375878	0.20681387	0.005405867	0.319704993	5.857002845	8.061429415	0.04341458	0.263078845	9.466040064	0.115164168	1.457374556	0.002349238	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5145
H1032_035_0	2010	6	N/A																															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	V	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	Yes	1646.307334	80.8989211	879.4890814	494.0253893	423.1587777	17.17819879	4.835633498	1019.78896	404.1602457	3959.343148	591.7484464	89.62939332	0.411753797	313.5742976	12456.93855	11871.18755	18.36937309	222.3791734	4577.068133	1080.026403	11.59744088	28.24207396	0	0	288	172.8	16.8	12.8	2040	0											3400	"$50 days 1 - 7, $0 after day 7, unlimited coverage"	"$50 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $20.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	$25.00 copayment	$0.00 copayment	Copay between $0.00 and $75.00	$50.00 copayment	20% coinsurance	Copay between $10.00 and $25.00	$0.00 copayment	Copay between $0.00 and $20.00	Copay between $10.00 and $20.00	$20.00 copayment	Copay between $0.00 and $70.00	Copay between $0.00 and $20.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											35.04179716	29.1261972	54.67	0.202612028	47.65798455	0.2	0.083438394	10.30755881	10.56403153	0	34.66606991	14.27545985	0.2	4.591303088	0	6.185755275	13.04505803	5.01154556	21.61879882	0.982545007	0.2	0	0	0	0	0	0	0	0	0											NO	34.38905277	28.5836462	53.6516294	0.198837853	46.77023093	0.196274481	0.081884138	10.11555379	10.36724903	0	34.02032442	14.00954237	0.196274481	4.505778155	0	6.070529534	12.80205998	4.918192521	21.2160926	0.964242557	0.196274481	0	0	0	0	0	0	0	0	0												4.7179	0.192698845	3.932168522	0.008185912	1.649269479	3.371642053	0.39596168	0.859644173	0.34916916	0	1.677622844	0.104638899	0.080816763	0.117741352	0	6.005366221	0.019597151	0.091141966	8.092291778	0.086783952	2.27628169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0289	0	0.645908934	4.7179	0.192698845	3.932168522	0.008185912	1.649269479	3.371642053	0.39596168	0.859644173	0.34916916	0	1.677622844	0.104638899	0.080816763	0.117741352	0	6.005366221	0.019597151	0.091141966	8.092291778	0.086783952	2.27628169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.0289	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.6107	0	0.0644	0.0073	0.0474	0.0597	0.0304	0	0.1368	0.0506	0.1009	0	0	0.0412	0	0.4927	0	0.006	0.1917	0.0632	0	0.0031	0	0	0	0	0	0	0	0											1.906	0	0	5.3286	0.192698845	3.996518661	0.01546821	1.696632679	3.431303319	0.426355715	0.859644173	0.485924835	0.050631298	1.77847344	0.104638899	0.080816763	0.158945802	0	6.498020538	0.019597151	0.097191054	8.284025592	0.150004306	2.27628169	0.00313987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.9349
H1032_037_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	NO	273.093176	8.285534508	541.3718918	1030.159907	390.5744552	15.57236421	3.665450832	876.9389513	309.4099509	4743.979588	619.3130887	52.96839533	0.284321037	406.9178653	13781.21989	14733.15044	58.30000113	469.4263178	4826.523191	867.383959	20.13060671	25.94598898	0	310.2857143	288	172.8	16.8	12.8	2040	0												"$0 per admission, unlimited coverage"	"$0 per admission, unlimited coverage"	$0 days 1 - 100	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $70.00	$0.00 copayment	20% coinsurance	Copay between $0.00 and $20.00	$0.00 copayment	Copay between $0.00 and $20.00	Copay between $5.00 and $15.00	$15.00 copayment	Copay between $0.00 and $65.00	Copay between $0.00 and $15.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											0	0	0	0	43.42692122	0.2	0.1679999	11.30409497	0	0	32.05765164	0	0.2	2.085149118	0	3.577507883	11.36935255	3.826849029	23.19869693	1.374349286	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	43.42692122	0.2	0.1679999	11.30409497	0	0	32.05765164	0	0.2	2.085149118	0	3.577507883	11.36935255	3.826849029	23.19869693	1.374349286	0.2	0	0	0	0	0	0	0	0	0												0	0	0	0	1.413453841	3.114472842	0.615795371	0.826083433	0	0	1.654476938	0	0.056864207	0.070707036	0	4.392330153	0.055236106	0.149701971	9.330754062	0.09934071	4.026121342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.8053	0	0	0	0	0	0	1.413453841	3.114472842	0.615795371	0.826083433	0	0	1.654476938	0	0.056864207	0.070707036	0	4.392330153	0.055236106	0.149701971	9.330754062	0.09934071	4.026121342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.8053	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	1.413453841	3.114472842	0.615795371	0.826083433	0	0	1.654476938	0	0.056864207	0.070707036	0	4.392330153	0.055236106	0.149701971	9.330754062	0.09934071	4.026121342	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.8053
H1032_040_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	NO	186.3562762	12.98708174	389.8283354	2491.409041	334.9333314	11.96111474	5.647979019	936.3651143	191.1235181	4722.90823	620.2909327	29.43467897	0.285386152	146.7321731	14439.30574	9766.837235	43.25372625	162.1315718	4868.667508	729.2090312	39.30043712	23.40337729	0	420	288	172.8	0	0	2040	0												"$0 per admission, unlimited coverage"	"$0 per admission, unlimited coverage"	"$0 days 1 - 7, $80 days 8 - 100"	$0.00 copayment	$0.00 copayment	20% coinsurance	"$0.00 copayment, 20% coinsurance"	$0.00 copayment	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $70.00	$0.00 copayment	20% coinsurance	Copay between $0.00 and $20.00	$0.00 copayment	Copay between $0.00 and $20.00	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $50.00	$0.00 copayment	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	$0.00 copayment	Not Covered											0	0	51.50327539	0	0	0.2	0.086718167	0	0	0	35.39549239	0	0.2	0.884663498	0	0.158319231	0	0	24.97888067	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	51.50327539	0	0	0.2	0.086718167	0	0	0	35.39549239	0	0.2	0.884663498	0	0.158319231	0	0	24.97888067	0	0.2	0	0	0	0	0	0	0	0	0												0	0	1.673119676	0	0	2.392222947	0.489782388	0	0	0	1.829625249	0	0.05707723	0.010817383	0	0.128856514	0	0	10.13448872	0	7.860087424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5761	0	0	0	0	1.673119676	0	0	2.392222947	0.489782388	0	0	0	1.829625249	0	0.05707723	0.010817383	0	0.128856514	0	0	10.13448872	0	7.860087424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5761	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	1.673119676	0	0	2.392222947	0.489782388	0	0	0	1.829625249	0	0.05707723	0.010817383	0	0.128856514	0	0	10.13448872	0	7.860087424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5761
H1032_061_0	2010	6	N/A																															A	A	D	V	T	P	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	NO	390.7409864	31.62179434	835.9453842	1073.402691	836.0989229	1674.525446	9.521089275	1735.143763	354.1484273	6987.74633	1103.836426	131.4793995	0.012757098	434.7432045	17257.52073	17751.01102	67.07939494	430.8901589	6423.426837	986.7721034	18.31608619	44.93560633	2460	454.6666667	288	172.8	16.8	12.8	2040	1584												"$0 per admission, unlimited coverage"	"$0 per admission, unlimited coverage"	$0 days 1 - 100	$0.00 copayment	Copay between $0.00 and $100.00	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $70.00	$0.00 copayment	20% coinsurance	Copay between $0.00 and $20.00	$0.00 copayment	Copay between $0.00 and $20.00	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $50.00	$0.00 copayment	20% coinsurance	$0.00 copayment	$0.00 copayment	"$0.00 copayment, $750 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	$0.00 copayment											0	0	0	0	47.43335738	0	0.109934992	10.34447782	0	0	31.01158672	0	0.2	0.664300418	0	0.116549056	0	0	16.37874864	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	47.43335738	0	0.109934992	10.34447782	0	0	31.01158672	0	0.2	0.664300418	0	0.116549056	0	0	16.37874864	0	0.2	0	0	0	0	0	0	0	0	0												0	0	0	0	3.304914918	0	1.046700874	1.495763015	0	0	2.852643255	0	0.00255142	0.024066674	0	0.172405298	0	0	8.767307799	0	3.663217239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3296	0	0	0	0	0	0	3.304914918	0	1.046700874	1.495763015	0	0	2.852643255	0	0.00255142	0.024066674	0	0.172405298	0	0	8.767307799	0	3.663217239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3296	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.9254	0	0.0598	0.0342	0.0863	0.1379	0.0588	0	0.1337	0.0654	0.1674	0	0	0.0295	0	0.5998	0	0.0152	0.3121	0.0673	0	0.0028	0	0	0	0	0	0	0	0											2.6957	0	0	0.9254	0	0.059774313	0.034211304	3.391238193	0.137879635	1.105538026	1.495763015	0.133740798	0.065433796	3.020020991	0	0.00255142	0.053548301	0	0.772182262	0	0.015236113	9.079440142	0.067260724	3.663217239	0.002831399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.0253
H1032_073_0	2010	6	N/A																															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	V	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	NO	2143.32049	107.9715401	997.4934867	891.6162979	415.0697641	18.19701202	7.834051064	917.0540949	252.3054288	4821.494735	685.6558693	35.21420127	0.726224552	188.0888115	10894.31097	14701.44281	32.13701062	102.8850612	5839.666858	1011.234786	32.05494441	16.98972402	0	0	0	0	0	0	2040	0												"$200 days 1 - 8, $0 after day 8, unlimited coverage"	"$200 days 1 - 8, $0 after day 8, unlimited coverage"	"$0 days 1 - 7, $80 days 8 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $15.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	$0.00 copayment	Not Covered											120.7516232	101.6859561	51.47340099	0	47.4830977	0.2	0.100440166	9.683195469	63.99490272	0	51.11305567	57.04150391	0.2	19.58561102	7.221213392	9.047050415	25.4902066	15.11559547	24.75494228	1.139793716	0.2	0	0	0	0	0	0	0	0	0											NO	120.7516232	101.6859561	51.47340099	0	47.4830977	0.2	0.100440166	9.683195469	63.99490272	0	51.11305567	57.04150391	0.2	19.58561102	7.221213392	9.047050415	25.4902066	15.11559547	24.75494228	1.139793716	0.2	0	0	0	0	0	0	0	0	0												21.5675	0.914932441	4.278698519	0	1.642399847	3.639402405	0.786853388	0.740001171	1.345521781	0	2.920497218	0.16738925	0.14524491	0.306986191	6.555845355	11.08372452	0.06826492	0.129597414	12.046718	0.096049921	6.410988882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8466	0	0	21.5675	0.914932441	4.278698519	0	1.642399847	3.639402405	0.786853388	0.740001171	1.345521781	0	2.920497218	0.16738925	0.14524491	0.306986191	6.555845355	11.08372452	0.06826492	0.129597414	12.046718	0.096049921	6.410988882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8466	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.6832	0	0.0794	0.0111	0.0458	0.0684	0.0483	0	0.1004	0.0342	0.1069	0	0	0.0182	0	0.5743	0	0.002	0.3764	0.0541	0	0.0013	0	0	0	0	0	0	0	0											2.2039	0	0	22.2506	0.914932441	4.358095318	0.01105011	1.688185262	3.707756811	0.83511963	0.740001171	1.445948606	0.034244855	3.027446752	0.16738925	0.14524491	0.325213572	6.555845355	11.65803683	0.06826492	0.13155103	12.42310102	0.150133076	6.410988882	0.001328249	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0505
H1032_079_0	2010	6	N/A																															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	V	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	Yes	1330.900917	131.730543	308.1551364	1016.566474	327.0522531	14.30321217	5.093098231	1502.545338	232.1332587	8802.143096	1553.183089	75.42476847	0.087443784	541.5908077	7760.394446	13282.34443	176.5747653	1765.121	3456.89102	1568.352278	11.81232938	19.21110406	0	0	288	172.8	16.8	12.8	0	0											3400	"$200 days 1 - 8, $0 after day 8, unlimited coverage"	"$200 days 1 - 8, $0 after day 8, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $15.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											154.5698423	95.6351947	54.67	1.042093977	47.60301185	0.2	0.127990825	20.43036495	97.24746064	0	62.79942302	57.07639385	0.2	13.74471899	7.0424356	10.07235595	26.11914188	16.33591714	33.84150356	6.62377174	0.2	0	0	0	0	0	0	0	0	0											NO	141.6193899	87.62251242	50.08953837	0.954783359	43.6146495	0.183243235	0.117267264	18.71863085	89.09969655	0	57.53784724	52.29431534	0.183243235	12.59313388	6.452393419	9.228455454	23.93078031	14.96723154	31.006133	6.068806817	0.183243235	0	0	0	0	0	0	0	0	0												15.7068	0.961880095	1.286279044	0.080883396	1.188689115	2.620966874	0.597253694	2.343799293	1.723583576	0	7.447234275	0.328690552	0.016023482	0.568360462	4.172759837	10.21462699	0.352130993	2.201581226	8.93206856	0.793168916	2.164529452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7013	0	5.825194835	15.7068	0.961880095	1.286279044	0.080883396	1.188689115	2.620966874	0.597253694	2.343799293	1.723583576	0	7.447234275	0.328690552	0.016023482	0.568360462	4.172759837	10.21462699	0.352130993	2.201581226	8.93206856	0.793168916	2.164529452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7013	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.7068	0.961880095	1.286279044	0.080883396	1.188689115	2.620966874	0.597253694	2.343799293	1.723583576	0	7.447234275	0.328690552	0.016023482	0.568360462	4.172759837	10.21462699	0.352130993	2.201581226	8.93206856	0.793168916	2.164529452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7013
H1032_085_0	2010	6	N/A																															A	A	D	V	Coin	P	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	355.8616501	53.55557343	681.1964064	1391.318291	15.59577368	1264.891067	5.420824066	34.40773623	13.05342562	8313.6973	29.6781748	3.229052262	0.20195822	8.512630676	13759.17996	92.95188941	5.807334062	2.322810449	29.603663	6.442284044	14.11860645	0.254639539	2460	420	0.96	172.8	0.056	0.224	0	0												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											640.9602748	292.5208056	44.70906422	0	0.168374876	0	0.077664613	0.102949933	0.170007537	0	0.170169969	0.248635021	0.17	0.170085292	0	0.098347786	0.436918166	0.170002292	0.156126764	0.016389936	0.17013804	0.17	0	0	0	0	0	0	0	0											NO	640.9602748	292.5208056	44.70906422	0	0.168374876	0	0.077664613	0.102949933	0.170007537	0	0.170169969	0.248635021	0.17	0.170085292	0	0.098347786	0.436918166	0.170002292	0.156126764	0.016389936	0.17013804	0.17	0	0	0	0	0	0	0	0												19.0078	1.305509957	2.537971157	0	2.625936458	0	0.421006204	3.542274129	2.219180744	0	5.050334087	0.802855477	0.034332897	1.447873274	0	9.141612488	2.537329749	0.394883101	4.621924095	0.105588626	2.40211203	0.043288722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2418	0	0	19.0078	1.305509957	2.537971157	0	2.625936458	0	0.421006204	3.542274129	2.219180744	0	5.050334087	0.802855477	0.034332897	1.447873274	0	9.141612488	2.537329749	0.394883101	4.621924095	0.105588626	2.40211203	0.043288722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2418	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.0078	1.305509957	2.537971157	0	2.625936458	0	0.421006204	3.542274129	2.219180744	0	5.050334087	0.802855477	0.034332897	1.447873274	0	9.141612488	2.537329749	0.394883101	4.621924095	0.105588626	2.40211203	0.043288722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2418
H1032_091_0	2010	6	N/A																															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	V	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	NO	1813.462014	99.26421773	732.5361271	1146.535261	450.3574755	18.81439064	6.799450126	945.8294402	301.4098498	5396.392702	581.7002314	76.62938633	0.081474979	336.6125007	14000.69486	13131.75691	40.92530534	158.3230708	5020.066138	958.7328946	21.21295005	34.94845394	0	0	288	172.8	16.8	12.8	2040	0												"$75 days 1 - 8, $0 after day 8, unlimited coverage"	"$75 days 1 - 8, $0 after day 8, unlimited coverage"	"$0 days 1 - 7, $80 days 8 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $25.00 and $50.00	$0.00 copayment	Copay between $0.00 and $100.00	$75.00 copayment	20% coinsurance	Copay between $20.00 and $50.00	$0.00 copayment	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											54.56644294	73.61457477	51.48174547	0	45.43980885	0.2	0.112611742	9.9743015	20.75794563	0	36.84441619	21.41318977	0.2	8.774410811	0	9.264077695	27.25864564	12.73387385	26.47275004	0.383520126	0.2	0	0	0	0	0	0	0	0	0											NO	54.56644294	73.61457477	51.48174547	0	45.43980885	0.2	0.112611742	9.9743015	20.75794563	0	36.84441619	21.41318977	0.2	8.774410811	0	9.264077695	27.25864564	12.73387385	26.47275004	0.383520126	0.2	0	0	0	0	0	0	0	0	0												8.2462	0.608941098	3.142686537	0	1.705346467	3.762878128	0.765697926	0.786165667	0.52138744	0	1.786033785	0.136739966	0.016294996	0.246131364	0	10.13780135	0.092964033	0.168005501	11.07457967	0.030641113	4.242590011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4711	0	0	8.2462	0.608941098	3.142686537	0	1.705346467	3.762878128	0.765697926	0.786165667	0.52138744	0	1.786033785	0.136739966	0.016294996	0.246131364	0	10.13780135	0.092964033	0.168005501	11.07457967	0.030641113	4.242590011	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4711	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.6769	0	0.055	0.0191	0.0493	0.06	0.0401	0	0.1075	0.0356	0.098	0	0	0.0297	0	0.4262	0	0.0032	0.2383	0.0622	0	0.002	0	0	0	0	0	0	0	0											1.9033	0	0	8.9231	0.608941098	3.197711666	0.019129406	1.754600514	3.822926336	0.805833654	0.786165667	0.628859748	0.035637456	1.88404753	0.136739966	0.016294996	0.275810509	0	10.56403047	0.092964033	0.171243427	11.312928	0.092844771	4.242590011	0.002026166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3744
H1032_101_0	2010	6	N/A																															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	V	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	Yes	2146.490809	169.4925513	679.6795135	1463.781054	610.5645802	13.70781632	6.191873478	1654.894424	251.6222935	7321.678044	1248.725407	105.857611	0.153203509	447.6605173	14502.219	21169.83954	236.5598408	2378.510353	6133.761767	1866.144681	37.10779594	21.60395504	2460	0	288	172.8	16.8	12.8	2040	0											3400	"$100 days 1 - 5, $0 after day 5, unlimited coverage"	"$100 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $50.00 and $75.00	$0.00 copayment	Copay between $0.00 and $125.00	$100.00 copayment	20% coinsurance	Copay between $15.00 and $75.00	$0.00 copayment	Copay between $0.00 and $25.00	Copay between $15.00 and $25.00	$25.00 copayment	Copay between $0.00 and $75.00	Copay between $0.00 and $25.00	20% coinsurance	$0.00 copayment	$0.00 copayment	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											59.46732459	40.20856352	58.57	1.082377925	42.48745321	0.2	0.14547154	17.94893848	41.27224122	0	50.88788016	28.55091969	0.2	6.432699688	0	6.419564803	18.48804957	7.218654342	30.15034705	4.594505751	0.2	0	0	0	0	0	0	0	0	0											NO	54.90447566	37.12341378	54.0760016	0.999328502	39.22744729	0.184654265	0.134309702	16.57174024	38.1054769	0	46.98332062	26.3602455	0.184654265	5.939127174	0	5.927000112	17.06948605	6.664776571	27.83695092	4.241975419	0.184654265	0	0	0	0	0	0	0	0	0												9.821	0.524345176	3.062862538	0.121899844	1.995907491	2.531206753	0.831628682	2.285373377	0.799015624	0	4.889105513	0.232536051	0.028289681	0.221559395	0	10.45613677	0.336496242	1.321020006	14.22876877	0.659678322	6.852112797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1989	0	5.085951738	9.821	0.524345176	3.062862538	0.121899844	1.995907491	2.531206753	0.831628682	2.285373377	0.799015624	0	4.889105513	0.232536051	0.028289681	0.221559395	0	10.45613677	0.336496242	1.321020006	14.22876877	0.659678322	6.852112797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1989	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.7405	0	0.057	0.0495	0.0636	0.0596	0.0386	0	0.1183	0.0687	0.143	0	0	0.0526	0	0.6876	0	0.0502	0.3501	0.0874	0	0.0016	0	0	0	0	0	0	0	0											2.5681	0	0	10.5615	0.524345176	3.119816097	0.17138631	2.059504427	2.590787915	0.870180501	2.285373377	0.917320529	0.068718056	5.032086007	0.232536051	0.028289681	0.274155797	0	11.14371199	0.336496242	1.371217029	14.5788272	0.747099096	6.852112797	0.001592225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7671
H1032_106_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	NO	348.745691	33.17016219	828.1899174	1014.836651	687.2081492	22.05055494	6.346011931	1807.469893	342.1058691	6441.431058	1346.898735	100.9855877	0.02814077	514.9876361	16783.81263	23058.835	95.1301142	534.5794749	5964.583646	1156.010091	11.14757003	30.74645205	2460	420	288	172.8	16.8	12.8	2040	0												"$0 per admission, unlimited coverage"	"$0 per admission, unlimited coverage"	"$0 days 1 - 7, $80 days 8 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $70.00	$0.00 copayment	20% coinsurance	Copay between $0.00 and $20.00	$0.00 copayment	Copay between $0.00 and $20.00	Copay between $5.00 and $10.00	$10.00 copayment	Copay between $0.00 and $60.00	Copay between $0.00 and $10.00	20% coinsurance	$0.00 copayment	$0.00 copayment	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											0	0	55.19878662	0	47.62658936	0.2	0.091252749	11.96932403	0	0	31.7725438	0	0.2	2.152579159	0	1.948756026	7.063522079	2.558648925	18.18698046	1.205558913	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	55.19878662	0	47.62658936	0.2	0.091252749	11.96932403	0	0	31.7725438	0	0.2	2.152579159	0	1.948756026	7.063522079	2.558648925	18.18698046	1.205558913	0.2	0	0	0	0	0	0	0	0	0												0	0	3.809589877	0	2.727448361	4.410110988	0.579091036	1.802849402	0	0	3.566199921	0	0.005628154	0.092379304	0	3.744670305	0.055996138	0.113983433	9.039813854	0.116136522	2.229514005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2934	0	0	0	0	3.809589877	0	2.727448361	4.410110988	0.579091036	1.802849402	0	0	3.566199921	0	0.005628154	0.092379304	0	3.744670305	0.055996138	0.113983433	9.039813854	0.116136522	2.229514005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2934	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.7322	0	0.065	0.0185	0.0739	0.0875	0.0399	0	0.1413	0.0782	0.2041	0	0	0.0358	0	0.6651	0	0.0113	0.272	0.0581	0	0.001	0	0	0	0	0	0	0	0											2.4838	0	0	0.7322	0	3.874557018	0.018485443	2.801393047	4.497630856	0.619022095	1.802849402	0.141259328	0.078180436	3.770266765	0	0.005628154	0.128223945	0	4.409728912	0.055996138	0.125285208	9.311856609	0.174205733	2.229514005	0.000950474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7772
H1032_107_0	2010	6	N/A																															A	A	D	V	T	P	P	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	NO	274.1894348	27.39843244	282.2517389	3460.554849	495.5750681	1067.896834	1252.105555	1484.26433	217.730947	5983.960538	788.8030396	20.37820313	0.132235772	365.3615859	13441.12376	16268.91791	409.5568662	2823.096432	5173.051986	1146.646936	48.40624832	17.49925447	2460	530.6666667	288	172.8	16.8	12.8	2040	6871.715515												"$0 per admission, unlimited coverage"	"$0 per admission, unlimited coverage"	$0 days 1 - 100	$0.00 copayment	$0.00 copayment	$0.00 copayment	$0.00 copayment	$0.00 copayment	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $70.00	$0.00 copayment	20% coinsurance	Copay between $0.00 and $20.00	$0.00 copayment	Copay between $0.00 and $20.00	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $50.00	$0.00 copayment	20% coinsurance	$0.00 copayment	$0.00 copayment	"$0.00 copayment, $1,000 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	$0.00 copayment											0	0	0	0	0	0	0	0	0	0	36.51450822	0	0.2	0.256497356	0	0.133870429	0	0	25.3855623	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	36.51450822	0	0.2	0.256497356	0	0.133870429	0	0	25.3855623	0	0.2	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	2.40022959	0	0.026447154	0.007809523	0	0.181493918	0	0	10.94340279	0	9.681249664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2406	0	0	0	0	0	0	0	0	0	0	0	0	2.40022959	0	0.026447154	0.007809523	0	0.181493918	0	0	10.94340279	0	9.681249664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2406	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	2.40022959	0	0.026447154	0.007809523	0	0.181493918	0	0	10.94340279	0	9.681249664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2406
H1032_113_0	2010	6	N/A																															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	V	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	NO	2220.556554	93.04103742	790.1578687	1503.669682	568.8166419	14.2496271	8.938957837	1069.239779	384.1751391	4275.891759	626.3969727	93.78643989	0.263227676	180.9883163	25085.75212	16450.47822	31.49878147	789.5407238	7128.166083	1073.175951	20.45573953	79.51788194	0	310.2857143	0	0	16.8	12.8	2040	0												"$100 days 1 - 7, $0 after day 7, unlimited coverage"	"$100 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $80 days 8 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $50.00 and $75.00	$0.00 copayment	Copay between $0.00 and $125.00	$100.00 copayment	20% coinsurance	Copay between $20.00 and $75.00	$0.00 copayment	Copay between $0.00 and $30.00	Copay between $20.00 and $30.00	$30.00 copayment	Copay between $0.00 and $80.00	Copay between $0.00 and $30.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											64.97151043	49.28552816	51.47739511	0	47.37522586	0.2	0.096209039	8.570861743	33.79320963	0	42.36123083	28.55091969	0.2	10.62660767	0	8.602038663	21.9044158	7.677016161	26.84802761	1.621336871	0.2	0	0	0	0	0	0	0	0	0											NO	64.97151043	49.28552816	51.47739511	0	47.37522586	0.2	0.096209039	8.570861743	33.79320963	0	42.36123083	28.55091969	0.2	10.62660767	0	8.602038663	21.9044158	7.677016161	26.84802761	1.621336871	0.2	0	0	0	0	0	0	0	0	0												12.0227	0.382131389	3.389605734	0	2.245651407	2.849925421	0.86000854	0.763692193	1.081875917	0	2.211245563	0.223140759	0.052645535	0.160274319	0	11.79230414	0.057496867	0.505109741	15.94809998	0.144998312	4.091147907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7821	0	0	12.0227	0.382131389	3.389605734	0	2.245651407	2.849925421	0.86000854	0.763692193	1.081875917	0	2.211245563	0.223140759	0.052645535	0.160274319	0	11.79230414	0.057496867	0.505109741	15.94809998	0.144998312	4.091147907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7821	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.7655	0	0.0587	0.0145	0.0595	0.0773	0.0562	0	0.1792	0.065	0.0941	0	0	0.0269	0	0.6414	0	0.0441	0.4738	0.0769	0	0.0127	0	0	0	0	0	0	0	0											2.6458	0	0	12.7883	0.382131389	3.448303595	0.014469075	2.305189521	2.927268952	0.916183773	0.763692193	1.261097974	0.064962872	2.305306577	0.223140759	0.052645535	0.187138018	0	12.43367002	0.057496867	0.549259257	16.42190423	0.22188155	4.091147907	0.012739411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4279
H1032_123_0	2010	6	N/A																															A	A	D	V	Coin	P	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	372.4472285	66.48622736	976.1612097	2335.954432	14.63346476	1593.677221	6.276797398	29.3964442	17.87396886	8008.912498	24.18558046	3.82013566	0.273950491	6.37959984	7482.436679	116.2640778	11.97888585	10.8746177	43.75332367	8.885101277	79.29967477	0.098300326	0	0	0.96	172.8	0.056	0.224	2040	0												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											702.6728988	356.3353159	50.76350717	0	0.161461419	0	0.10625357	0.097821635	0.170003898	0	0.170147303	0.248630934	0.170001068	0.17008002	0	0.098057791	0.401106046	0.170000342	0.16226474	0.04292643	0.170017233	0.17	0	0	0	0	0	0	0	0											NO	702.6728988	356.3353159	50.76350717	0	0.161461419	0	0.10625357	0.097821635	0.170003898	0	0.170147303	0.248630934	0.170001068	0.17008002	0	0.098057791	0.401106046	0.170000342	0.16226474	0.04292643	0.170017233	0.17	0	0	0	0	0	0	0	0												21.809	1.974282569	4.129447214	0	2.362739982	0	0.666932129	2.875608237	3.038644386	0	4.115111292	0.949803898	0.046571876	1.085042466	0	11.40059861	4.804803545	1.848688724	7.099621677	0.381405674	13.48231129	0.016711055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.0874	0	0	21.809	1.974282569	4.129447214	0	2.362739982	0	0.666932129	2.875608237	3.038644386	0	4.115111292	0.949803898	0.046571876	1.085042466	0	11.40059861	4.804803545	1.848688724	7.099621677	0.381405674	13.48231129	0.016711055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.0874	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.809	1.974282569	4.129447214	0	2.362739982	0	0.666932129	2.875608237	3.038644386	0	4.115111292	0.949803898	0.046571876	1.085042466	0	11.40059861	4.804803545	1.848688724	7.099621677	0.381405674	13.48231129	0.016711055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.0874
H1032_124_0	2010	6	N/A																															A	A	D	V	Coin	P	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	411.2459533	46.15404901	604.4253623	3139.692671	13.72259556	929.5757896	6.944323891	31.43230939	20.35847562	7902.457976	25.09862434	2.576344543	0.048224871	5.665843422	7942.18556	106.0520718	5.614198921	1.613729419	43.07961017	7.812745926	42.58699933	0.078852509	2460	530.6666667	0.96	172.8	0.056	0.224	2040	5699.38289												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, $1,000 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	$0.00 copayment											626.0860104	270.5477721	43.36680653	0	0.169561814	0	0.091860085	0.101838645	0.170004804	0	0.170199681	0.248637462	0.170197378	0.170127223	0	0.108159984	0.43841272	0.170003272	0.150118952	0.009362142	0.170045413	0.17	0	0	0	0	0	0	0	0											NO	626.0860104	270.5477721	43.36680653	0	0.169561814	0	0.091860085	0.101838645	0.170004804	0	0.170199681	0.248637462	0.170197378	0.170127223	0	0.108159984	0.43841272	0.170003272	0.150118952	0.009362142	0.170045413	0.17	0	0	0	0	0	0	0	0												21.4563	1.040572928	2.184333146	0	2.326828196	0	0.637906186	3.201023805	3.461038652	0	4.271777846	0.640575768	0.008207747	0.963914207	0	11.4705904	2.461336218	0.274339281	6.467065929	0.07314404	7.241723905	0.013404926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1941	0	0	21.4563	1.040572928	2.184333146	0	2.326828196	0	0.637906186	3.201023805	3.461038652	0	4.271777846	0.640575768	0.008207747	0.963914207	0	11.4705904	2.461336218	0.274339281	6.467065929	0.07314404	7.241723905	0.013404926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1941	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.4563	1.040572928	2.184333146	0	2.326828196	0	0.637906186	3.201023805	3.461038652	0	4.271777846	0.640575768	0.008207747	0.963914207	0	11.4705904	2.461336218	0.274339281	6.467065929	0.07314404	7.241723905	0.013404926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1941
H1032_131_0	2010	6	N/A																															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	V	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	Yes	1264.689696	83.95869278	424.3455804	1012.707161	274.605078	15.02710282	3.746304805	805.1694169	297.001533	4173.195858	442.7831289	42.54984435	0.267542681	214.4024693	20401.97483	10303.65222	28.84953367	301.8611377	4416.333341	848.462071	15.19024216	14.24398524	0	0	0	0	0	0	0	0											3400	"$250 days 1 - 5, $0 after day 5, unlimited coverage"	"$250 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$250.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $15.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											133.8191806	113.9181799	54.67	0.143960541	45.40163608	0.2	0.106093752	12.4711507	57.60179322	0	50.33244063	71.32667082	0.2	15.6989835	5.73961116	8.712185247	25.57913711	10.8569195	28.14277913	1.794381471	0.2	0	0	0	0	0	0	0	0	0											NO	126.2124091	107.442654	51.56235733	0.135777298	42.8208411	0.188631269	0.100062996	11.7622449	54.3274967	0	47.47136069	67.27220208	0.188631269	14.80659588	5.413350678	8.216952787	24.12512544	10.23977251	26.54304067	1.692382268	0.188631269	0	0	0	0	0	0	0	0	0												13.3016	0.751728732	1.823354871	0.011458553	0.979901701	2.834581472	0.374866482	0.789216656	1.344612484	0	1.751626468	0.238535144	0.050466915	0.26454756	9.203587021	7.055385319	0.057999885	0.257582448	9.768576293	0.11966018	2.865354651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8447	0	3.245196779	13.3016	0.751728732	1.823354871	0.011458553	0.979901701	2.834581472	0.374866482	0.789216656	1.344612484	0	1.751626468	0.238535144	0.050466915	0.26454756	9.203587021	7.055385319	0.057999885	0.257582448	9.768576293	0.11966018	2.865354651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8447	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.4503	0	0.0313	0.0083	0.0338	0.0411	0.023	0	0.1096	0.0321	0.064	0	0	0.0355	0	0.3386	0	0.0081	0.1875	0.052	0	0.0009	0	0	0	0	0	0	0	0											1.4161	0	0	13.7519	0.751728732	1.854636548	0.019742413	1.013685472	2.875704374	0.397847335	0.789216656	1.454253026	0.032063942	1.815647043	0.238535144	0.050466915	0.300083264	9.203587021	7.393988754	0.057999885	0.265677567	9.956077458	0.171643899	2.865354651	0.000870015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2608
H1032_132_0	2010	6	N/A																															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	V	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	NO	1788.389815	111.1998958	519.5515122	867.7531186	342.2878504	16.27154943	4.911264627	1164.431272	293.7232118	3513.43253	1044.15517	171.626663	0.027475826	471.5787923	18873.63594	21210.64768	29.63114489	195.9757505	5162.273734	812.0499597	15.36754965	13.52233977	0	0	288	172.8	16.8	12.8	2040	0												"$100 days 1 - 7, $0 after day 7, unlimited coverage"	"$100 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $80 days 8 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $50.00 and $75.00	$0.00 copayment	Copay between $0.00 and $125.00	$100.00 copayment	20% coinsurance	Copay between $25.00 and $75.00	Copay between $0.00 and $5.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											68.36358035	67.95641492	51.49557127	0	48.54989239	0.2	0.097369216	10.44528374	31.19318493	0	43.31701004	28.55091969	0.2	11.23777964	1.948205261	5.152691027	24.59911711	11.75243673	23.64097277	1.32249231	0.2	0	0	0	0	0	0	0	0	0											NO	68.36358035	67.95641492	51.49557127	0	48.54989239	0.2	0.097369216	10.44528374	31.19318493	0	43.31701004	28.55091969	0.2	11.23777964	1.948205261	5.152691027	24.59911711	11.75243673	23.64097277	1.32249231	0.2	0	0	0	0	0	0	0	0	0												10.1884	0.629728855	2.22955016	0	1.384836525	3.254309887	0.478205987	1.013567919	0.763513539	0	3.769140001	0.408341589	0.005495165	0.441624879	3.06414307	9.107659497	0.060741667	0.191932717	10.17009773	0.089494152	3.07350993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3243	0	0	10.1884	0.629728855	2.22955016	0	1.384836525	3.254309887	0.478205987	1.013567919	0.763513539	0	3.769140001	0.408341589	0.005495165	0.441624879	3.06414307	9.107659497	0.060741667	0.191932717	10.17009773	0.089494152	3.07350993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3243	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.6119	0	0.0395	0.005	0.0411	0.0467	0.0307	0	0.1076	0.0607	0.1522	0	0	0.0431	0	0.5081	0	0.0048	0.2242	0.0563	0	0.0007	0	0	0	0	0	0	0	0											1.9325	0	0	10.8003	0.629728855	2.26907995	0.005002106	1.425916045	3.300996457	0.508915412	1.013567919	0.871101466	0.060658282	3.921346672	0.408341589	0.005495165	0.484749794	3.06414307	9.615729775	0.060741667	0.196731087	10.39431139	0.145746875	3.07350993	0.000664664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2568
H1032_133_0	2010	6	N/A																															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	V	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	Yes	1912.950296	106.9257591	680.1748681	1028.31869	375.2183257	11.40667784	6.323490984	976.250101	253.9251074	3556.351314	749.5049598	15.7548085	0.240256745	166.9834345	15813.36793	22084.93073	19.14182577	285.5608876	5145.465848	1086.546842	12.55967164	30.09336438	0	0	288	172.8	16.8	12.8	2040	0											3400	"$175 days 1 - 5, $0 after day 5, unlimited coverage"	"$175 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $75.00 and $125.00	$0.00 copayment	Copay between $0.00 and $175.00	$175.00 copayment	20% coinsurance	Copay between $20.00 and $125.00	$0.00 copayment	Copay between $0.00 and $30.00	Copay between $20.00 and $30.00	$30.00 copayment	Copay between $0.00 and $80.00	Copay between $0.00 and $30.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											85.50855653	95.70330722	54.67	0.180433681	46.00503559	0.2	0.098289932	13.86056647	89.44184984	0	52.6614812	78.83847399	0.2	26.09774732	0	5.208281773	20.45509649	13.09434949	25.3528035	0.919058819	0.2	0	0	0	0	0	0	0	0	0											NO	81.50108475	91.21804495	52.10781803	0.171977417	43.84894866	0.190626735	0.093683444	13.21097266	85.25003907	0	50.19343112	75.14360447	0.190626735	24.87464182	0	4.964188749	19.4964413	12.48066546	24.16461078	0.87598591	0.190626735	0	0	0	0	0	0	0	0	0												12.9923	0.812796559	2.953535688	0.014737299	1.371077425	2.174417755	0.592406411	1.074767783	1.80392711	0	3.135018798	0.098656092	0.045799359	0.34613776	0	9.136147053	0.03109979	0.296999159	10.36151496	0.079316644	2.394209199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7149	0	2.444518288	12.9923	0.812796559	2.953535688	0.014737299	1.371077425	2.174417755	0.592406411	1.074767783	1.80392711	0	3.135018798	0.098656092	0.045799359	0.34613776	0	9.136147053	0.03109979	0.296999159	10.36151496	0.079316644	2.394209199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7149	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.5999	0	0.0519	0.017	0.0468	0.027	0.0398	0	0.142	0.0276	0.0818	0	0	0.017	0	0.6273	0	0.0069	0.2061	0.0693	0	0.0008	0	0	0	0	0	0	0	0											1.9612	0	0	13.5922	0.812796559	3.005481966	0.031785828	1.417842472	2.201412214	0.632220288	1.074767783	1.945926223	0.027591518	3.21684101	0.098656092	0.045799359	0.363113322	0	9.76340934	0.03109979	0.303864063	10.56757044	0.148635228	2.394209199	0.000793404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6761
H1035_002_0	2010	5	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	Coin	Coin	V	V	V	V	V																																												0	NO	1603.247057	33.00754465	943.8934811	18.14388461	0.550500546	12.51608102	3.209757238	306.6288043	56.78019921	6.113151604	42.68811286	0	0.072400902	567.2514915	3559.643331	6610.425467	191.9477588	609.1007156	805.6066006	80.27366693	15.37311027	8.397683932	377.7215698	64.22594355	50.7833042	0	10.49397679	0	489.8555837	12580.48488	9.149226441	4.730988057	0.497875531	348.4298927	1016.827794	44.14496378	78.91327172					175 days 1-10; $0 copay days 11-90	175 days 1-10; $0 Copay days 11-90	"$0 Copay days 1-7, $50 days 8-65"	$0 	$100 per trip	0.15	0.15	"$50 Copay, waived if admitted, Worldwide Coverage"	$150 	$0 	$0 	$150 	$0 	$150 	10	Endocrinology $15 other $35	$35 	$35 	"Varies, $10-25"	35	0.2	Chemo	0		$15 routine (Medicare covered included with Specialist)	0	0	0	0	0	0	$0 - $10	35	100	$0 - $100 Copay	20	35				137.8885788	142.0552677	25.21275963	0	100	0.15	0.15	50	100	0	0	150	0	150	10	34.67	35	35	13.31023454	35	0.2	0	0	0	0.124682662	0	0	0	0	0	0	5	35	100	100	20	35				NO	137.8885788	142.0552677	25.21275963	0	100	0.15	0.15	50	100	0	0	150	0	150	10	34.67	35	35	13.31023454	35	0.2	0	0	0	0.124682662	0	0	0	0	0	0	5	35	100	100	20	35					18.4225	0.390741299	1.983179954	0	0.004587505	1.877412154	0.481463586	1.277620018	0.473168327	0	0	0	0	7.090643644	2.966369443	19.09862091	0.55984763	1.776543754	0.893567734	0.234131529	3.074622055	0	0	0	0.00052765	0	0	0	0	0	0	0.236549403	0.001452137	2.903582439	8.473564946	0.07357494	0.230163709	0	0	0	72.5244	0	0	18.4225	0.390741299	1.983179954	0	0.004587505	1.877412154	0.481463586	1.277620018	0.473168327	0	0	0	0	7.090643644	2.966369443	19.09862091	0.55984763	1.776543754	0.893567734	0.234131529	3.074622055	0	0	0	0.00052765	0	0	0	0	0	0	0.236549403	0.001452137	2.903582439	8.473564946	0.07357494	0.230163709	0	0	0	72.5244	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			18.4225	0.390741299	1.983179954	0	0.004587505	1.877412154	0.481463586	1.277620018	0.473168327	0	0	0	0	7.090643644	2.966369443	19.09862091	0.55984763	1.776543754	0.893567734	0.234131529	3.074622055	0	0	0	0.00052765	0	0	0	0	0	0	0.236549403	0.001452137	2.903582439	8.473564946	0.07357494	0.230163709	0	0	0	72.5244
H1035_006_0	2010	5	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	V	O	V	V	V	V	V																																												0	NO	1235.159362	58.74658837	808.1675667	329.9356294	102.6048692	12.54811419	1.829094288	293.6296026	34.51684539	237.3624163	473.7791655	0	5.674001982	438.3166531	3029.302805	5060.613417	195.8972831	492.2807372	7.61258872	64.45325116	20.36587177	0.004399945	48.39380717	56.37629083	125.7241176	0	15.19872909	0	2945.212165	12545.96978	57.37410128	0	0	264.9186764	1455.805457	54.38066991	55.37848037					175 days 1-10; $0 copay days 11-90	175 days 1-10; $0 Copay days 11-90	"$0 Copay days 1-7, $50 days 8-65"	$0 	$100 per trip	0.15	0.15	"$50 Copay, waived if admitted, Worldwide Coverage"	$150 	$0 	0	$150 	0	$150 	10	Endocrinology $15 other $35	$35 	$35 	"Varies, $10-25"	35	0.2	Chemo	0		$15 routine (Medicare covered included with Specialist)	0	0	0	0	0	0	$0-$10	35	100	$0 - $100 Copay	20	35				137.8885788	142.0552677	25.21275963	0	100	0.15	0.15	50	100	0	0	150	0	150	10	34.67	35	35	13.31023454	0	0.2	0	0	0	0.155794061	0	0	0	0	0	0	5	35	100	100	35	35				NO	137.8885788	142.0552677	25.21275963	0	100	0.15	0.15	50	100	0	0	150	0	150	10	34.67	35	35	13.31023454	0	0.2	0	0	0	0.155794061	0	0	0	0	0	0	5	35	100	100	35	35					14.1929	0.695438528	1.698011216	0	0.855040577	1.882217129	0.274364143	1.223456677	0.287640378	0	0	0	0	5.478958164	2.524419004	14.6209556	0.571367076	1.435818817	0.008443778	0	4.073174353	0	0	0	0.001632256	0	0	0	0	0	0	0	0	2.207655636	12.13171214	0.158610287	0.161520568	0	0	0	64.4833	0	0	14.1929	0.695438528	1.698011216	0	0.855040577	1.882217129	0.274364143	1.223456677	0.287640378	0	0	0	0	5.478958164	2.524419004	14.6209556	0.571367076	1.435818817	0.008443778	0	4.073174353	0	0	0	0.001632256	0	0	0	0	0	0	0	0	2.207655636	12.13171214	0.158610287	0.161520568	0	0	0	64.4833	NO																																																																																		0			14.1929	0.695438528	1.698011216	0	0.855040577	1.882217129	0.274364143	1.223456677	0.287640378	0	0	0	0	5.478958164	2.524419004	14.6209556	0.571367076	1.435818817	0.008443778	0	4.073174353	0	0	0	0.001632256	0	0	0	0	0	0	0	0	2.207655636	12.13171214	0.158610287	0.161520568	0	0	0	64.4833
H1035_007_0	2010	4	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	Coin	O	V	V	V	V	V																																												0	NO	1555.882421	25.07653503	851.0930082	50.77122107	29.18343034	14.80945157	1.819618877	289.6214534	48.14232486	6.25857469	13.19007248	0	0.234699366	587.340999	3215.503158	6242.707661	143.7148873	596.7750529	110.8401549	78.82316451	9.352545914	0	224.2775048	52.05846077	69.13882734	0	12.66433579	0	8510.329971	12237.21293	4.15574721	39.6131621	0.295620613	332.1957744	3173.982587	47.09679692	64.95628936					175 days 1-10; $0 copay days 11-90	175 days 1-10; $0 Copay days 11-90	"$0 Copay days 1-7, $50 days 8-65"	0	$100 per trip	0.15	0.15	"$50 Copay, waived if admitted, Worldwide Coverage"	$150 	0	0	$150 	$0 	$150 	10	Endocrinology $15 other $35	$35 	$35 	"Varies, $5-30"	35	0.2	Chemo	0		$15 routine (Medicare covered included with Specialist)	0	0	0			0	$0 to $10 Copay	35	100	100	20	35				137.8885788	142.0552677	25.21275963	0	100	0.15	0.15	50	100	0	0	150	0	150	10	34.67	35	35	18.31023454	35	0.2	0	0	0	0.129184282	0	0	0	0	0	0	5	35	100	100	20	35				NO	137.8885788	142.0552677	25.21275963	0	100	0.15	0.15	50	100	0	0	150	0	150	10	34.67	35	35	18.31023454	35	0.2	0	0	0	0.129184282	0	0	0	0	0	0	5	35	100	100	20	35					17.8782	0.296854491	1.788200286	0	0.243195253	2.221417735	0.272942832	1.206756056	0.40118604	0	0	0	0	7.341762488	2.679585965	18.03622288	0.419168421	1.740593904	0.169125769	0.229900896	1.870509183	0	0	0	0.000744304	0	0	0	0	0	0	0.016505484	0.000862227	2.76829812	26.44985489	0.078494662	0.189455844	0	0	0	86.2998	0	0	17.8782	0.296854491	1.788200286	0	0.243195253	2.221417735	0.272942832	1.206756056	0.40118604	0	0	0	0	7.341762488	2.679585965	18.03622288	0.419168421	1.740593904	0.169125769	0.229900896	1.870509183	0	0	0	0.000744304	0	0	0	0	0	0	0.016505484	0.000862227	2.76829812	26.44985489	0.078494662	0.189455844	0	0	0	86.2998	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25	25	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			17.8782	0.296854491	1.788200286	0	0.243195253	2.221417735	0.272942832	1.206756056	0.40118604	0	0	0	0	7.341762488	2.679585965	18.03622288	0.419168421	1.740593904	0.169125769	0.229900896	1.870509183	0	0	0	0.000744304	0	0	0	0	0	0	0.016505484	0.000862227	2.76829812	26.44985489	0.078494662	0.189455844	0	0	0	86.2998
H1035_801_0	2010	3	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin					Coin						Coin	Coin																																																											0	NO	260.0856464		25.36566705	18.14388411	6.308469484	17.27580739		21.80761666	48.34806787	62.98419318					297.8934129						15.3731102	8.397684179																				Medicare FFS		Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS		Medicare FFS	Medicare FFS	Medicare FFS					Medicare FFS						Medicare FFS	Medicare FFS																			0.083193404		0.163080667	0	0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			NO	0.083193404		0.163080667	0	0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																				21.6374	0	4.136649912	0	1.46987339	4.025263122	0	5.081174681	11.26509981	14.67531701	0	0	0	0	69.4091652	0	0	0	0	0	3.581934676	1.956660414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.2385			21.6374	0	4.136649912	0	1.46987339	4.025263122	0	5.081174681	11.26509981	14.67531701	0	0	0	0	69.4091652	0	0	0	0	0	3.581934676	1.956660414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.2385	NO																																																																																		0			21.6374	0	4.136649912	0	1.46987339	4.025263122	0	5.081174681	11.26509981	14.67531701	0	0	0	0	69.4091652	0	0	0	0	0	3.581934676	1.956660414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.2385
H1035_802_0	2010	4	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin					Coin						Coin	Coin																																																											0	NO	260.0856464		25.36566705	18.14388411	6.308469484	17.27580739		21.80761666	48.34806787	62.98419318					297.8934129						15.3731102	8.397684179																				Medicare FFS		Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS		Medicare FFS	Medicare FFS	Medicare FFS					Medicare FFS						Medicare FFS	Medicare FFS																			0.083193404		0.163080667	0	0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			NO	0.083193404		0.163080667	0	0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																				21.6374	0	4.136649912	0	1.46987339	4.025263122	0	5.081174681	11.26509981	14.67531701	0	0	0	0	69.4091652	0	0	0	0	0	3.581934676	1.956660414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.2385			21.6374	0	4.136649912	0	1.46987339	4.025263122	0	5.081174681	11.26509981	14.67531701	0	0	0	0	69.4091652	0	0	0	0	0	3.581934676	1.956660414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.2385	NO																																																																																		0			21.6374	0	4.136649912	0	1.46987339	4.025263122	0	5.081174681	11.26509981	14.67531701	0	0	0	0	69.4091652	0	0	0	0	0	3.581934676	1.956660414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.2385
H1036_011_0	2010	3	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered																	D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin			V				O	O	O	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	YES	1649.964538	1.729328	903.445367	97.030309	415.424097	5.730128	2560.684296	357.801416	223.519884	667.774597	1548.821752	74.394184	77.22006	184.555179	5677.7782	5722.145432	0	288.758972			66.133906	0			1.05				0.04	0.25	0.05	0.55	2.49	0.84							7500	$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$195/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $195 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$195/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$30-$100/Visit:9d. $50 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			"0%-20% Coins:15. 0% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 0% Part B Rx - Chemo"				"VIS830: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							144.519765	143.64207	44.44425	0	150	0.2	0	50	145.647522	4.464695	18.41875	195	0.851282	55.900506	0	30	0	35.846575			0.087654	0			0				0	0	0	0	0	0							NO	139.445242	138.598366	38.49392	0	142.1964	0.189595	0	47.3988	138.070355	4.232423	17.460533	184.85532	0.806995	52.992338	0	28.43928	0	33.981693			0.083094	0			0				0	0	0	0	0	0								19.1733	0.019973503	2.89809614	0	4.922650922	1.086403618	0	1.413279813	2.571789144	0.23552538	2.253604443	1.146013391	0.005193017	0.815000869	0	13.56114135	0	0.817709895	0	0	5.495330785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.415	0	3.030088	19.1733	0.019973503	2.89809614	0	4.922650922	1.086403618	0	1.413279813	2.571789144	0.23552538	2.253604443	1.146013391	0.005193017	0.815000869	0	13.56114135	0	0.817709895	0	0	5.495330785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.415	NO																																																																																		0	0	0	19.1733	0.019973503	2.89809614	0	4.922650922	1.086403618	0	1.413279813	2.571789144	0.23552538	2.253604443	1.146013391	0.005193017	0.815000869	0	13.56114135	0	0.817709895	0	0	5.495330785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.415
H1036_025_0	2010	4	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered																	D	D	D	V	T	O	O	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	O	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	YES	1366.268311	53.284811	631.379189	683.259231	228.111325	145.524437	5590.619445	236.106764	214.043029	156.496258	2172.716869	41.47909	0.695412	149.974512	6228.937091	3817.446535	70.881299	378.505727			24.323104	0		3.16	2.58				0.04	0.25	0.05	0.55	2.87	0.42							5000	$125/Day(Days 1-10):1a	$125/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	$0/Service:11a	$0/Service:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $100 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,12. 20% Dialysis -- OP Hosp"	"$25-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $25 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN824: Dental 16a, 16b"	"VIS120: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							99.423125	92.07825	44.44425	0	150	0	0	50	68.175691	22.402662	11.603167	100	0.007482	44.098907	0	25	25	29.415435			0.2	0		0	0				0	0	0	0	0	0							NO	96.17358	89.068764	38.791253	0	142.7328	0	0	47.5776	64.872715	21.317297	11.041016	95.1552	0.00712	41.962403	0	23.7888	23.7888	27.990316			0.19031	0		0	0				0	0	0	0	0	0								10.9499	0.395501021	2.040999155	0	2.713247344	0	0	0.936116098	1.157129368	0.278006434	1.999083476	0.328912592	0.004951333	0.524440909	0	7.567706011	0.140515087	0.882874576	0	0	4.628929922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5483	0	1.758227	10.9499	0.395501021	2.040999155	0	2.713247344	0	0	0.936116098	1.157129368	0.278006434	1.999083476	0.328912592	0.004951333	0.524440909	0	7.567706011	0.140515087	0.882874576	0	0	4.628929922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5483	NO																																																																																		0	0	0	10.9499	0.395501021	2.040999155	0	2.713247344	0	0	0.936116098	1.157129368	0.278006434	1.999083476	0.328912592	0.004951333	0.524440909	0	7.567706011	0.140515087	0.882874576	0	0	4.628929922	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5483
H1036_034_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				Part B Rx	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V					O	S	O	O	O	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	YES	1811.118052	9.506084	900.778351	71.825484	349.425975	641.627376	4175.407244	303.716666	326.839862	369.224578	1821.670716	72.319657	5.24404	373.068011	5450.376994	6328.151005	0.835434	664.686479			35.960659	0		3.16	1.05					0.04	990.483913	0.05	0.25	0.55	0.84	1.73	2.49				5000	$100/Day(Days 1-5):1a	$100/Day(Days 1-5):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$100/Trip:10a	:11a	:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $25 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$25/Visit:8a. $0 Lab -- FSL,8a. $25 Lab -- OP"	"$0-$100/Visit:14h. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $10 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$150/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$10-$50/Visit:9d. $40 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $25 OP Other,5. $10 Partial Hospitalization,7h. $25 Psych -- OP,8b. $25 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$10/Visit:7b, 7d, 7f"	$10/Visit:7e	"$10-$40/Visit:7i. $40 Therapy (AT,PT,ST,OT) -- OP,7i. $10 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN824: Dental 16a, 16b"	"VIS830: Vision 7a, 7b"					$0: Nurse hotline 14a	$0/Script:15	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	$0: Membership in health club/fitness class 14a				60.6671	50.6712	44.44425	0	100	0	0	50	83.0077	9.488707	9.034988	150	0	26.471872	0	10	10	14.500355			0.2	0		0	0					0	0	0	0	0	0	0	0				NO	58.402397	48.779644	35.500111	0	94.9184	0	0	47.4592	78.789581	9.006529	8.575866	142.3776	0	25.126678	0	9.49184	9.49184	13.763505			0.189837	0		0	0					0	0	0	0	0	0	0	0					8.8145	0.038641949	2.664810954	0	2.763912872	0	0	1.201179166	2.145964648	0.277119322	1.301866996	0.858058266	0	0.781163315	0	5.00548307	0.000660817	0.762367973	0	0	6.826663623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4424	0	2.18845	8.8145	0.038641949	2.664810954	0	2.763912872	0	0	1.201179166	2.145964648	0.277119322	1.301866996	0.858058266	0	0.781163315	0	5.00548307	0.000660817	0.762367973	0	0	6.826663623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4424	NO																																																																																		0	0	0	8.8145	0.038641949	2.664810954	0	2.763912872	0	0	1.201179166	2.145964648	0.277119322	1.301866996	0.858058266	0	0.781163315	0	5.00548307	0.000660817	0.762367973	0	0	6.826663623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4424
H1036_035_0	2010	4	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	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	YES	1512.220744	6.804836	1080.183287	0	327.029344	5.686106	1569.944768	237.695337	218.961447	115.038665	1815.133997	25.068187	0.129152	170.39177	7089.866124	5711.123255	0.449515	193.689233			59.914996	0							0.04	0.25	37.704524	0.05	0.55	2.49							7500	$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-6) $75(Days 7-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$195/Visit:9a	20% Coins:12	"$40-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $40 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			"0%-20% Coins:15. 0% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 0% Part B Rx - Chemo"								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a							144.519765	143.64207	54.868125	0	150	0.2	0	50	133.924751	17.055902	15.573562	195	0.2	54.05294	0	40	40	40.845517			0.117423	0							0	0	0	0	0	0							NO	138.382589	137.542166	42.580683	0	141.39225	0.188523	0	47.13075	126.239479	16.077149	14.679873	183.809925	0.188523	50.951112	0	37.7046	37.7046	38.501597			0.110685	0							0	0	0	0	0	0								17.4388	0.07799599	3.832911844	0	3.853284564	1.071961761	0	0.933563292	2.303464916	0.15412448	2.220494713	0.383981798	0.024348122	0.723470846	0	17.94463482	0.001412399	0.621445399	0	0	6.631691332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2175	0	4.127374	17.4388	0.07799599	3.832911844	0	3.853284564	1.071961761	0	0.933563292	2.303464916	0.15412448	2.220494713	0.383981798	0.024348122	0.723470846	0	17.94463482	0.001412399	0.621445399	0	0	6.631691332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2175	NO																																																																																		0	0	0	17.4388	0.07799599	3.832911844	0	3.853284564	1.071961761	0	0.933563292	2.303464916	0.15412448	2.220494713	0.383981798	0.024348122	0.723470846	0	17.94463482	0.001412399	0.621445399	0	0	6.631691332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2175
H1036_040_0	2010	4	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	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	YES	1243.236745	56.944885	633.679367	488.988173	220.417841	2.939951	8606.162311	274.21207	273.01081	185.049382	1845.383302	51.642121	0.005743	227.644006	7286.174122	4578.196482	97.311369	472.365107			38.110737	0		3.16	2.58				0.04	0.25	13.735331	0.05	0.55	2.87	0.42						5000	$125/Day(Days 1-10):1a	$125/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $100 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$25-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $25 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN824: Dental 16a, 16b"	"VIS120: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						99.423125	92.07825	50.7565	0	150	0.2	0	50	65.864998	25.487677	33.984023	125	0.2	66.096747	0	25	25	28.875442			0.2	0		0	0				0	0	0	0	0	0	0						NO	95.120092	88.093103	41.467401	0	140.49525	0.187327	0	46.83175	61.691463	23.87265	31.830626	117.079375	0.187327	61.908527	0	23.415875	23.415875	27.04575			0.187327	0		0	0				0	0	0	0	0	0	0							9.8547	0.418037635	2.189753035	0	2.580638306	0.550732201	0	1.070152592	1.403536357	0.368134927	4.894975476	0.503852271	0.001075819	1.174425424	0	8.933539712	0.189885904	1.064622383	0	0	7.13917003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3373	0	2.976323	9.8547	0.418037635	2.189753035	0	2.580638306	0.550732201	0	1.070152592	1.403536357	0.368134927	4.894975476	0.503852271	0.001075819	1.174425424	0	8.933539712	0.189885904	1.064622383	0	0	7.13917003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3373	NO																																																																																		0	0	0	9.8547	0.418037635	2.189753035	0	2.580638306	0.550732201	0	1.070152592	1.403536357	0.368134927	4.894975476	0.503852271	0.001075819	1.174425424	0	8.933539712	0.189885904	1.064622383	0	0	7.13917003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3373
H1036_044_0	2010	4	N/A	r.	s.	t.	u.	v.						DME/Prosthetics/Supplies	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Prosthetics/Supplies										D	D	D	V	T	O	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	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	YES	1244.108198	25.001178	815.396807	1118.257593	181.059427	275.113139	1.771573	356.896606	240.087299	185.073419	2043.547227	62.912565	8.17961	347.988523	6582.195872	6126.375753	41.799599	82.25112			20.000936	0							0.04	0.25	2741.723757	0.05	0.55	4.1	0.42						4000	$175/Day(Days 1-10):1a	$175/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	$0/Service:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$150/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$30-$150/Visit:9d. $150 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$150/Visit:7i. $150 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						139.192375	128.90955	50.7565	0	150	0	0.2	50	127.598163	0	45.514802	150	1.276091	54.564889	5	30	30	48.67351			0.2	0							0	0	0	0	0	0	0						NO	126.657406	117.3006	30.700932	0	133.7052	0	0.178274	44.5684	113.736919	0	40.570438	133.7052	1.137466	48.637396	4.45684	26.74104	26.74104	43.386009			0.178274	0							0	0	0	0	0	0	0							13.1313	0.244387765	2.08612016	0	2.017382242	0	0.315825405	1.325525891	2.275565807	0	6.908967173	0.70097809	0.000775336	1.410437966	2.444649488	13.65213826	0.093147062	0.297378986	0	0	3.565646864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4702	0	6.953045	13.1313	0.244387765	2.08612016	0	2.017382242	0	0.315825405	1.325525891	2.275565807	0	6.908967173	0.70097809	0.000775336	1.410437966	2.444649488	13.65213826	0.093147062	0.297378986	0	0	3.565646864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4702	NO																																																																																		0	0	0	13.1313	0.244387765	2.08612016	0	2.017382242	0	0.315825405	1.325525891	2.275565807	0	6.908967173	0.70097809	0.000775336	1.410437966	2.444649488	13.65213826	0.093147062	0.297378986	0	0	3.565646864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4702
H1036_047_0	2010	7	N/A	r.	s.	t.								Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)																		D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	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	YES	1161.012768	34.353059	571.928912	1033.363531	191.816434	3.349656	3421.394188	248.845101	298.383675	84.443072	1641.671829	65.065167	0.456592	174.260109	5854.684353	5310.213219	64.306473	492.942134			20.96259	0							0.04	0.25	0.05	0.55	2.7								5000	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$150/Visit:14h. $100 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $100 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$150/Visit:9a	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,12. 20% Dialysis -- OP Hosp"	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a								119.30775	110.4939	50.7565	0	150	0.2	0	50	150	87.40774	49.755588	150	0.003252	66.541753	0	30	30	35.450918			0.2	0							0	0	0	0	0								NO	113.624048	105.230081	41.581755	0	139.40505	0.185873	0	46.46835	139.40505	81.233869	46.241202	139.40505	0.003023	61.84171	0	27.88101	27.88101	32.946913			0.185873	0							0	0	0	0	0									10.9932	0.301247932	1.981817325	0	2.228348298	0.62261061	0	0.963618437	3.466349261	0.571636454	6.326073222	0.755867738	0.001380278	0.89804526	0	12.33784232	0.149410785	1.353410134	0	0	3.896379491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8473	0	3.553685	10.9932	0.301247932	1.981817325	0	2.228348298	0.62261061	0	0.963618437	3.466349261	0.571636454	6.326073222	0.755867738	0.001380278	0.89804526	0	12.33784232	0.149410785	1.353410134	0	0	3.896379491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8473	NO																																																																																		0	0	0	10.9932	0.301247932	1.981817325	0	2.228348298	0.62261061	0	0.963618437	3.466349261	0.571636454	6.326073222	0.755867738	0.001380278	0.89804526	0	12.33784232	0.149410785	1.353410134	0	0	3.896379491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8473
H1036_052_0	2010	5	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	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	YES	1153.117621	59.102176	736.013134	491.639203	206.528734	2.727824	5455.722356	208.540615	205.865275	253.743194	1532.073182	30.134696	0.003933	143.79093	6243.749289	3130.033659	93.993222	414.278123			44.815322	0		3.16	2.58				0.04	0.25	19.187799	0.05	0.55	2.87	0.42						5000	$125/Day(Days 1-10):1a	$125/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$25-$100/Visit:9d. $50 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $25 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN824: Dental 16a, 16b"	"VIS120: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						99.423125	92.07825	44.44425	0	150	0.2	0	50	65.387751	8.531722	14.863224	100	0.2	41.443739	0	25	25	27.036019			0.2	0		0	0				0	0	0	0	0	0	0						NO	95.900961	88.816286	37.390325	0	142.2927	0.189724	0	47.4309	62.027997	8.093345	14.099522	94.8618	0.189724	39.314277	0	23.71545	23.71545	25.646854			0.189724	0		0	0				0	0	0	0	0	0	0							9.2154	0.437436314	2.29331419	0	2.448960932	0.517533681	0	0.824272421	1.064117555	0.171135934	1.800124961	0.238219292	0.000746184	0.471086371	0	6.185846395	0.18575763	0.885410878	0	0	8.502542151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2419	0	2.048987	9.2154	0.437436314	2.29331419	0	2.448960932	0.517533681	0	0.824272421	1.064117555	0.171135934	1.800124961	0.238219292	0.000746184	0.471086371	0	6.185846395	0.18575763	0.885410878	0	0	8.502542151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2419	NO																																																																																		0	0	0	9.2154	0.437436314	2.29331419	0	2.448960932	0.517533681	0	0.824272421	1.064117555	0.171135934	1.800124961	0.238219292	0.000746184	0.471086371	0	6.185846395	0.18575763	0.885410878	0	0	8.502542151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2419
H1036_053_0	2010	5	N/A	r.	s.	t.	u.	v.						Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Part B Rx	Other Non-Covered																D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin			V				O	O	O	O	O	S	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	YES	1338.945843	6.998302	602.630855	5.369879	292.341388	4.76082	2608.426	268.775795	231.360286	187.398428	1448.136166	48.845544	0.437683	123.968466	6420.962434	6757.926519	0.417461	578.088004			39.906552	0			1.05				0.04	0.25	0.05	0.55	2.49	639.131773	0.84						5000	$25/Day(Days 1-10):1a	$25/Day(Days 1-10):1b	$0/Day(Days 1-10) $50(Days 11-100):2	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $25 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$100/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$10-$50/Visit:9d. $25 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $25 OP Other,5. $10 Partial Hospitalization,7h. $25 Psych -- OP,8b. $50 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$10/Visit:7b, 7d, 7f"	$10/Visit:7e	"$10-$25/Visit:7i. $25 Therapy (AT,PT,ST,OT) -- OP,7i. $10 Therapy (AT,PT,ST,OT) - Specialist"			"0%-20% Coins:15. $0 Part B Rx,15. 20% Part B Rx at Pharmacy,15. 0% Part B Rx - Chemo"				"VIS830: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0/Script:15	$0: Nutritional benefit 14a						19.884625	18.41565	29.6295	0	150	0.2	0	50	59.35574	10.890835	6.338585	100	0	38.168287	0	10	10	11.612333			0	0			0				0	0	0	0	0	0	0						NO	19.519305	18.077318	29.111606	0	145.1541	0.193539	0	48.3847	57.438194	10.538996	6.13381	96.7694	0	36.935222	0	9.67694	9.67694	11.237185			0	0			0				0	0	0	0	0	0	0							2.1779	0.010542544	1.461962668	0	3.536212589	0.921404342	0	1.083719684	1.107409749	0.164582607	0.740216008	0.393896165	0	0.381566901	0	5.449670787	0.000336645	0.541340154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9708	0	0.545043	2.1779	0.010542544	1.461962668	0	3.536212589	0.921404342	0	1.083719684	1.107409749	0.164582607	0.740216008	0.393896165	0	0.381566901	0	5.449670787	0.000336645	0.541340154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9708	NO																																																																																		0	0	0	2.1779	0.010542544	1.461962668	0	3.536212589	0.921404342	0	1.083719684	1.107409749	0.164582607	0.740216008	0.393896165	0	0.381566901	0	5.449670787	0.000336645	0.541340154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.9708
H1036_054_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin		Coin	V					O	O	O	O	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	YES	1540.757447	3.597727	620.809809	11.422131	340.079725	6.208629	1513.270797	264.23132	308.188947	290.44777	2289.147289	43.352874	20.67107	354.020978	10602.88862	6959.144538	1.546884	800.475279			2950.188377	0		7.37	1.05					0.04	0.05	0.25	0.55	0.84	1.73	2.49					3400	$0/Day(Days 1-10):1a	$0/Day(Days 1-10):1b	"$0/Day(Days 1-6) $50(Days 7-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	:11b	$50/Visit:4a	"$0-$25/Visit:9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $25 Surgery OP -- Facility"	"$0-$15/Visit:8a. $0 Lab -- FSL,8a. $15 Lab -- OP"	"$0-$50/Visit:14h. $15 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $15 Radiology OP -- Facility"	$20/Visit:9a	"$0-$15/Proc:12. $0 Dialysis -- Dialysis Center,12. $15 Dialysis -- OP Hosp"	"$0-$50/Visit:9d. $0 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $15 OP Other,5. $0 Partial Hospitalization,7h. $15 Psych -- OP,8b. $25 Rad therapy,3. $0 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	"$0-$15/Visit:7i. $15 Therapy (AT,PT,ST,OT) -- OP,7i. $0 Therapy (AT,PT,ST,OT) - Specialist"			$0/Script:15			"DEN825: Dental 16a, 16b"	"VIS830: Vision 7a, 7b"					$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	$0: Membership in health club/fitness class 14a					0	0	36.57875	0	100	0.2	0	50	9.531959	2.909687	1.840089	20	2.270546	23.810898	0	0	0	1.152237			0	0		0	0					0	0	0	0	0	0	0					NO	0	0	33.991937	0	97.0737	0.194147	0	48.53685	9.253026	2.824541	1.786243	19.41474	2.204103	23.11412	0	0	0	1.118519			0	0		0	0					0	0	0	0	0	0	0						0	0	1.758543993	0	2.751066433	1.205386694	0	1.068746329	0.237640028	0.068365136	0.340747777	0.070140398	0.003796764	0.681906947	0	0	0	0.074612234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.261	0	0.329845	0	0	1.758543993	0	2.751066433	1.205386694	0	1.068746329	0.237640028	0.068365136	0.340747777	0.070140398	0.003796764	0.681906947	0	0	0	0.074612234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.261	NO																																																																																		0	0	0	0	0	1.758543993	0	2.751066433	1.205386694	0	1.068746329	0.237640028	0.068365136	0.340747777	0.070140398	0.003796764	0.681906947	0	0	0	0.074612234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.261
H1036_056_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1139.01281	38.276774	919.02896	944.16442	156.320926	0.940912	0.165186	266.44028	220.01653	174.138013	1380.097856	20.952543	0	194.966258	5428.420599	5288.808418	25.116579	72.888947			4.969895	0							0.04	0.25	3504.537778	0.05	0.55	4.1	0.42	0.45					4500	$135/Day(Days 1-10):1a	$135/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $75 Surgery OP -- Facility"	$0/Visit:8a	"$0-$75/Visit:14h. $25 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $75 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$100/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$25-$75/Visit:9d. $50 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $50 OP Other,5. $25 Partial Hospitalization,7h. $50 Psych -- OP,8b. $25 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a	$0: OTC items 13c					107.376975	99.44451	50.7565	0	150	0.2	0.2	50	75	0	29.372245	100	0	41.705258	0	25	25	46.682689			0.2	0							0	0	0	0	0	0	0	0					NO	102.501201	94.928934	36.080918	0	141.5529	0.188737	0.188737	47.1843	70.77645	0	27.718176	94.3686	0	39.356668	0	23.59215	23.59215	44.0538			0.188737	0							0	0	0	0	0	0	0	0						9.7292	0.302797779	2.763284045	0	1.843973367	0.177584908	0.03117671	1.047649842	1.297665745	0	3.187816272	0.164771846	0	0.639435191	0	10.39786346	0.049379508	0.267586258	0	0	0.938003073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8382	0	2.797191	9.7292	0.302797779	2.763284045	0	1.843973367	0.177584908	0.03117671	1.047649842	1.297665745	0	3.187816272	0.164771846	0	0.639435191	0	10.39786346	0.049379508	0.267586258	0	0	0.938003073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8382	NO																																																																																		0	0	0	9.7292	0.302797779	2.763284045	0	1.843973367	0.177584908	0.03117671	1.047649842	1.297665745	0	3.187816272	0.164771846	0	0.639435191	0	10.39786346	0.049379508	0.267586258	0	0	0.938003073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8382
H1036_062_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin						O	O	O	O	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	YES	1397.014862	6.092446	1090.04187	4.67574	331.602951	7.144317	2936.815504	260.14129	305.479921	142.823669	2227.33784	42.849937	22.748115	209.261736	10709.1808	7509.054711	0	547.831394			57.368149	0		3.16						0.04	0.05	0.25	0.55	0.84	1.73	2.49					5000	$125/Day(Days 1-10):1a	$125/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$25/Visit:8a. $0 Lab -- FSL,8a. $25 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$75/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$20-$100/Visit:9d. $50 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $20 Partial Hospitalization,7h. $50 Psych -- OP,8b. $25 Rad therapy,3. $20 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$20/Visit:7b, 7d, 7f"	$20/Visit:7e	"$20-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $20 Therapy (AT,PT,ST,OT) - Specialist"			"0%-20% Coins:15. 0% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 0% Part B Rx - Chemo"			"DEN824: Dental 16a, 16b"						$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	$0: Membership in health club/fitness class 14a					99.423125	92.07825	44.44425	0	150	0.2	0	50	91.054855	6.734248	15.275655	75	0.172149	33.897216	0	20	0	23.201613			0.117418	0		0						0	0	0	0	0	0	0					NO	94.094642	87.143408	31.251419	0	139.46505	0.185953	0	46.48835	84.659799	6.261281	14.2028	69.732525	0.160059	31.516513	0	18.59534	0	21.572094			0.109171	0		0						0	0	0	0	0	0	0						10.9543	0.044243042	2.838779601	0	3.853918512	1.328507179	0	1.007794945	2.155155726	0.074521594	2.636202823	0.249002859	0.00030342	0.549600019	0	11.63611879	0	0.984822527	0	0	6.262938194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5762	0	4.14319	10.9543	0.044243042	2.838779601	0	3.853918512	1.328507179	0	1.007794945	2.155155726	0.074521594	2.636202823	0.249002859	0.00030342	0.549600019	0	11.63611879	0	0.984822527	0	0	6.262938194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5762	NO																																																																																		0	0	0	10.9543	0.044243042	2.838779601	0	3.853918512	1.328507179	0	1.007794945	2.155155726	0.074521594	2.636202823	0.249002859	0.00030342	0.549600019	0	11.63611879	0	0.984822527	0	0	6.262938194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5762
H1036_063_0	2010	1	N/A	r.	s.	t.	u.	v.	w.					Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V					O	O	O	O	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	YES	990.381804	0	839.199201	0.770465	240.531485	4.196082	2651.566961	214.79541	277.36639	69.403261	1554.386501	31.40765	0	273.519786	7730.643664	5960.886219	0	569.757802			22.104917	0		3.16	1.05					0.04	0.05	0.25	0.55	0.84	1.73	2.49					7500	$95/Day(Days 1-10):1a	$95/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	0% Coins:11a	:11b	$50/Visit:4a	"$0-$50/Visit:9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $50 Surgery OP -- Facility"	"$0-$25/Visit:8a. $0 Lab -- FSL,8a. $25 Lab -- OP"	"$0-$50/Visit:14h. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$95/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$15-$50/Visit:9d. $25 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $25 OP Other,5. $15 Partial Hospitalization,7h. $25 Psych -- OP,8b. $25 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	"$15-$25/Visit:7i. $25 Therapy (AT,PT,ST,OT) -- OP,7i. $15 Therapy (AT,PT,ST,OT) - Specialist"			"0%-20% Coins:15. 20% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 0% Part B Rx - Chemo"			"DEN824: Dental 16a, 16b"	"VIS830: Vision 7a, 7b"					$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	$0: Membership in health club/fitness class 14a					75.561575	0	44.44425	0	150	0	0	50	16.067658	5.12833	1.568996	95	0	25.307255	0	15	0	15.308147			0.026737	0		0	0					0	0	0	0	0	0	0					NO	74.150387	0	42.717724	0	145.56015	0	0	48.52005	15.592071	4.976537	1.522555	92.188095	0	24.558185	0	14.556015	0	14.855041			0.025945	0		0	0					0	0	0	0	0	0	0						6.1198	0	2.987389987	0	2.91764992	0	0	0.868490336	0.360393037	0.028782325	0.197219912	0.241284285	0	0.559762459	0	7.230562435	0	0.705314626	0	0	0.573512072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7901	0	0.654568	6.1198	0	2.987389987	0	2.91764992	0	0	0.868490336	0.360393037	0.028782325	0.197219912	0.241284285	0	0.559762459	0	7.230562435	0	0.705314626	0	0	0.573512072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7901	NO																																																																																		0	0	0	6.1198	0	2.987389987	0	2.91764992	0	0	0.868490336	0.360393037	0.028782325	0.197219912	0.241284285	0	0.559762459	0	7.230562435	0	0.705314626	0	0	0.573512072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.7901
H1036_065_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				Part B Rx	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V					O	S	O	O	O	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	YES	1477.192803	11.019779	801.734348	26.640766	354.09965	5.785665	4012.927114	318.169398	247.784566	284.7703	1770.11094	42.948073	34.795519	87.832552	8004.771147	7065.88426	0.323813	554.18173			57.295211	0		3.16	1.05					0.04	576.562132	0.05	0.25	0.55	0.84	1.73	2.49				5000	$90/Day(Days 1-10):1a	$90/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $25 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$25/Visit:8a. $0 Lab -- FSL,8a. $25 Lab -- OP"	"$0-$150/Visit:14h. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$75/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$10-$100/Visit:9d. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $25 OP Other,5. $10 Partial Hospitalization,7h. $25 Psych -- OP,8b. $25 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$10/Visit:7b, 7d, 7f"	$10/Visit:7e	"$10-$25/Visit:7i. $25 Therapy (AT,PT,ST,OT) -- OP,7i. $10 Therapy (AT,PT,ST,OT) - Specialist"			"0%-20% Coins:15. $0 Part B Rx,15. 20% Part B Rx at Pharmacy,15. 0% Part B Rx - Chemo"			"DEN824: Dental 16a, 16b"	"VIS830: Vision 7a, 7b"					$0: Nurse hotline 14a	$0/Script:15	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	$0: Membership in health club/fitness class 14a				71.58465	66.29634	44.44425	0	150	0.2	0	50	66.521137	3.762327	22.151504	75	1.318867	34.860661	0	10	10	12.22614			0.100818	0		0	0					0	0	0	0	0	0	0	0				NO	69.025714	63.926445	36.80975	0	142.3428	0.18979	0	47.4476	63.125366	3.570268	21.020714	71.1714	1.251541	33.081094	0	9.48952	9.48952	11.60202			0.095671	0		0	0					0	0	0	0	0	0	0	0					8.497	0.058704608	2.45930341	0	4.200294638	1.09806136	0	1.258031194	1.303457618	0.084725524	3.100749652	0.254722874	0.003629002	0.242133076	0	5.587654167	0.000256069	0.535802293	0	0	5.481490132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.166	0	2.072636	8.497	0.058704608	2.45930341	0	4.200294638	1.09806136	0	1.258031194	1.303457618	0.084725524	3.100749652	0.254722874	0.003629002	0.242133076	0	5.587654167	0.000256069	0.535802293	0	0	5.481490132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.166	NO																																																																																		0	0	0	8.497	0.058704608	2.45930341	0	4.200294638	1.09806136	0	1.258031194	1.303457618	0.084725524	3.100749652	0.254722874	0.003629002	0.242133076	0	5.587654167	0.000256069	0.535802293	0	0	5.481490132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.166
H1036_067_0	2010	5	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	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	YES	1148.094575	99.515266	555.155246	181.356614	178.996549	4.422822	6049.928867	307.958104	276.015742	114.394724	1868.871525	24.492923	0	337.959272	7777.860416	3543.442878	57.116142	517.832413			13.927953	0		3.16	2.58				0.04	0.25	178.638747	0.05	0.55	2.87	0.42						5000	$100/Day(Days 1-10):1a	$100/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $75 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$25-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $25 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN824: Dental 16a, 16b"	"VIS120: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						79.5385	73.6626	44.44425	0	150	0.2	0	50	56.470369	20.883801	17.338719	100	0	30.294718	0	25	25	25.412565			0.2	0		0	0				0	0	0	0	0	0	0						NO	77.362804	71.647633	40.850266	0	143.47755	0.191303	0	47.82585	54.014868	19.97571	16.58478	95.6517	0	28.977413	0	23.912925	23.912925	24.307551			0.191303	0		0	0				0	0	0	0	0	0	0							7.4017	0.594169438	1.889853289	0	2.140165526	0.846099117	0	1.227363174	1.242412823	0.190426319	2.582901924	0.195232477	0	0.816098783	0	7.061173649	0.113817835	1.048936482	0	0	2.664459193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0148	0	1.306202	7.4017	0.594169438	1.889853289	0	2.140165526	0.846099117	0	1.227363174	1.242412823	0.190426319	2.582901924	0.195232477	0	0.816098783	0	7.061173649	0.113817835	1.048936482	0	0	2.664459193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0148	NO																																																																																		0	0	0	7.4017	0.594169438	1.889853289	0	2.140165526	0.846099117	0	1.227363174	1.242412823	0.190426319	2.582901924	0.195232477	0	0.816098783	0	7.061173649	0.113817835	1.048936482	0	0	2.664459193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0148
H1036_068_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	P	O	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	YES	1142.879198	65.011147	521.715791	586.695307	157.813499	2.954655	1.646857	284.12599	468.402549	172.480857	2152.438371	28.723461	0	353.114056	9265.377666	6473.597393	17.193166	471.27648			38.030846	0							0.04	0.14	341.046728	10.76288	0.05	0.55	2.61	0.25					5000	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$35-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: OTC items 13c	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a					119.30775	110.4939	50.7565	0	150	0.2	0.2	50	100	92.240579	38.351266	125	0	67.950287	0	35	35	50.315118			0.2	0							0	0	0	0	0	0	0	0					NO	112.13294	103.849128	40.673721	0	136.6617	0.182216	0.182216	45.5539	91.1078	84.038363	34.940994	113.88475	0	61.908011	0	31.88773	31.88773	45.840997			0.182216	0							0	0	0	0	0	0	0	0						10.6795	0.562612577	1.768343544	0	1.797255088	0.538385415	0.300083695	1.078587245	3.556260479	1.207917406	6.267361351	0.272597015	0	1.821715739	0	17.20236048	0.045687586	1.800315309	0	0	6.929828635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8288	0	5.336798	10.6795	0.562612577	1.768343544	0	1.797255088	0.538385415	0.300083695	1.078587245	3.556260479	1.207917406	6.267361351	0.272597015	0	1.821715739	0	17.20236048	0.045687586	1.800315309	0	0	6.929828635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8288	NO																																																																																		0	0	0	10.6795	0.562612577	1.768343544	0	1.797255088	0.538385415	0.300083695	1.078587245	3.556260479	1.207917406	6.267361351	0.272597015	0	1.821715739	0	17.20236048	0.045687586	1.800315309	0	0	6.929828635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8288
H1036_074_0	2010	4	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	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	YES	1359.356707	103.910174	1228.454475	419.956253	211.863143	2.464963	1804.025937	279.840188	266.131975	1070.717886	2294.060443	5.430651	0	203.264658	7018.192011	3903.472756	112.134728	212.872724			14.108547	0		3.16	2.58				0.04	0.25	0	0.05	0.55	2.87	0.42						5000	$100/Day(Days 1-10):1a	$100/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $100 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$30-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN824: Dental 16a, 16b"	"VIS120: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						79.5385	73.6626	44.44425	0	150	0.2	0	50	65.961575	4.208767	12.724515	100	0	60.595352	0	30	30	30			0.2	0		0	0				0	0	0	0	0	0	0						NO	76.010093	70.394853	31.448796	0	141.80355	0.189071	0	47.26785	62.357236	3.978788	12.02921	94.5357	0	57.28424	0	28.36071	28.36071	28.36071			0.189071	0		0	0				0	0	0	0	0	0	0							8.6104	0.609561785	3.219451182	0	2.503578816	0.466053019	0	1.102287003	1.382937864	0.35501329	2.299644568	0.042782533	0	0.970321788	0	9.225438235	0.265018375	0.503101799	0	0	2.66751709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2231	0	3.017483	8.6104	0.609561785	3.219451182	0	2.503578816	0.466053019	0	1.102287003	1.382937864	0.35501329	2.299644568	0.042782533	0	0.970321788	0	9.225438235	0.265018375	0.503101799	0	0	2.66751709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2231	NO																																																																																		0	0	0	8.6104	0.609561785	3.219451182	0	2.503578816	0.466053019	0	1.102287003	1.382937864	0.35501329	2.299644568	0.042782533	0	0.970321788	0	9.225438235	0.265018375	0.503101799	0	0	2.66751709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2231
H1036_077_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V					O	O	O	O	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	NO	3502.993403	17.007017	1114.841487	12.175753	803.158802	1066.824353	2881.035682	656.817316	392.43991	409.918264	2999.365356	11920.79337	37.036025	752.07869	13400.14151	7349.980354	4.087667	1204.943316			4526.805081	0	3.04	7.37	2.15					0.04	0.05	0.55	0.84	2.49	5.15	6.21						$0/Day(Days 1-10):1a	$0/Day(Days 1-10):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$0/Trip:10a	:11a	:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN825: Dental 16a, 16b"	"VIS829: Vision 7a, 7b"					$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional Training/Nutritional benefit 14a	$0: OTC items 13c					0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0					0	0	0	0	0	0	0					NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0					0	0	0	0	0	0	0						0	0	0	0	0	0	0	1.368369408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.3684	0	0	0	0	0	0	0	0	0	1.368369408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.3684	NO																																																																																		0	0	0	0	0	0	0	0	0	0	1.368369408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.3684
H1036_081_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered					Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	P	O	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	YES	875.363365	45.3345	860.391984	408.9347	271.912357	3.843309	1.11339	229.814959	90.35398	163.941447	679.493719	24.427799	0.00191	165.425565	6729.691346	3138.341086	80.592886	191.941807			17.201702	0							0.04	0.14	4117.756418	17.467218	0.05	0.55	2.61	0.25					7500	$195/Day(Days 1-8):1a	$195/Day(Days 1-8):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$175/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $75 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $175 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$200/Visit:9a	20% Coins:12	"$40-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $40 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: OTC items 13c	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a					144.519765	130.271895	50.7565	0	150	0.2	0.2	50	176.969933	33.25681	70.50172	200	0.2	66.491229	5	40	40	45.791577			0.2	0							0	0	0	0	0	0	0	0					NO	140.474079	126.625064	45.535585	0	143.58225	0.191443	0.191443	47.86075	169.398274	31.833917	67.485304	191.443	0.191443	63.646402	4.786075	38.2886	38.2886	43.832385			0.191443	0							0	0	0	0	0	0	0	0						10.2472	0.478373664	3.264871027	0	3.253482335	0.735774605	0.213150722	0.916593025	1.275484022	0.434908201	3.821320016	0.389710927	0.000365656	0.877395168	2.684067292	10.01355721	0.257149065	0.701105599	0	0	3.293145436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8576	0	1.973521	10.2472	0.478373664	3.264871027	0	3.253482335	0.735774605	0.213150722	0.916593025	1.275484022	0.434908201	3.821320016	0.389710927	0.000365656	0.877395168	2.684067292	10.01355721	0.257149065	0.701105599	0	0	3.293145436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8576	NO																																																																																		0	0	0	10.2472	0.478373664	3.264871027	0	3.253482335	0.735774605	0.213150722	0.916593025	1.275484022	0.434908201	3.821320016	0.389710927	0.000365656	0.877395168	2.684067292	10.01355721	0.257149065	0.701105599	0	0	3.293145436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8576
H1036_102_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V					O	O	O	O	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	NO	2928.042227	665.821422	1575.484992	1213.109063	581.795759	824.159209	18033.23223	871.619329	367.437683	402.498262	2757.360975	103.357637	3.903299	739.831359	8945.113636	4976.139081	424.383796	1144.474346			4080.646094	0	0.96	3.16	2.58					0.04	0.05	0.25	0.42	0.55	1.22	2.87						$0/Day(Days 1-10):1a	$0/Day(Days 1-10):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$25/Trip:10a	:11a	:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN824: Dental 16a, 16b"	"VIS120: Vision 7a, 7b"					$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: OTC items 13c	$0: Membership in health club/fitness class 14a					0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0					0	0	0	0	0	0	0					NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0					0	0	0	0	0	0	0						0	0	0	0	1.212074498	0	0	1.815873602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0279	0	0	0	0	0	0	1.212074498	0	0	1.815873602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0279	NO																																																																																		0	0	0	0	0	0	0	1.212074498	0	0	1.815873602	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0279
H1036_103_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V					O	O	O	O	O	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	NO	2402.402915	27.602403	1221.774875	90.103767	723.200154	2300.962414	3796.150756	933.906959	290.283203	1706.110388	2786.862146	221.292554	24.25618	89.91352	6690.804767	5713.459255	3.069194	816.670351			3078.70524	0	0.96	7.37	2.1					0.04	0.05	0.25	0.55	0.84	2.35	2.49	5.15					$0/Day(Days 1-10):1a	$0/Day(Days 1-10):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$25/Trip:10a	:11a	:11b	$50/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN825: Dental 16a, 16b"	"VIS829: Vision 7a, 7b"					$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	$0: Membership in health club/fitness class 14a	$0: Nutritional Training/Nutritional benefit 14a				0	0	0	0	25	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				NO	0	0	0	0	25	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					0	0	0	0	1.506666988	0	0	3.891278996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3979	0	0	0	0	0	0	1.506666988	0	0	3.891278996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3979	NO																																																																																		0	0	0	0	0	0	0	1.506666988	0	0	3.891278996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3979
H1036_104_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin		Coin						O	O	O	O	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	NO	2928.333374	56.269716	1947.933185	1.423551	624.553697	1418.822329	4632.411891	556.3654	329.440333	139.637693	2626.219396	38.217725	7.584012	400.721198	8740.377763	7693.87985	0.010832	1202.125071			2541.03677	0		7.37						0.04	0.05	0.25	0.55	0.84	1.75	2.49						$0/Day(Days 1-100):1a	$0/Day(Days 1-100):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$25/Trip:10a	:11a	:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15			"DEN825: Dental 16a, 16b"						$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	$0: Membership in health club/fitness class 14a					0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0		0						0	0	0	0	0	0	0					NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0		0						0	0	0	0	0	0	0						0	0	0	0	1.301153535	0	0	1.159094583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4602	0	0	0	0	0	0	1.301153535	0	0	1.159094583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4602	NO																																																																																		0	0	0	0	0	0	0	1.301153535	0	0	1.159094583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.4602
H1036_119_0	2010	4	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered																	D	D	D	V	T	Coin	O	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	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	YES	698.719118	43.449267	382.739096	310.273845	134.445417	1.88689	3595.400908	142.798525	134.344926	122.583945	1026.684166	21.581989	0.327328	98.463964	3787.152766	2022.249514	43.359175	208.504271			28.298197	0							0.04	0.25	0.05	0.55	2.87	0.42							7500	$275/Day(Days 1-5):1a	$275/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $150 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$225/Visit:9a	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,12. 20% Dialysis -- OP Hosp"	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$150/Visit:7i. $150 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							166.834525	139.3458	45.891712	0	150	0.2	0	50	115.502158	28.083247	26.218887	225	0.00309	77.153873	10	35	35	41.012563			0.2	0							0	0	0	0	0	0							NO	163.557394	136.60863	45.244914	0	144.82665	0.193102	0	48.27555	111.518604	27.114684	25.314623	217.239975	0.002983	74.492913	9.65511	33.792885	33.792885	39.598081			0.193102	0							0	0	0	0	0	0								9.5234	0.494628737	1.443083124	0	1.622606613	0.364362233	0	0.574473111	1.24849655	0.276985411	2.16584355	0.390705896	0.000976419	0.611238959	3.047114712	5.694803772	0.122102635	0.688030751	0	0	5.464438437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7333	0	1.016939	9.5234	0.494628737	1.443083124	0	1.622606613	0.364362233	0	0.574473111	1.24849655	0.276985411	2.16584355	0.390705896	0.000976419	0.611238959	3.047114712	5.694803772	0.122102635	0.688030751	0	0	5.464438437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7333	NO																																																																																		0	0	0	9.5234	0.494628737	1.443083124	0	1.622606613	0.364362233	0	0.574473111	1.24849655	0.276985411	2.16584355	0.390705896	0.000976419	0.611238959	3.047114712	5.694803772	0.122102635	0.688030751	0	0	5.464438437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7333
H1036_121_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				Part B Rx	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V					O	S	O	O	O	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	YES	2110.801665	10.376777	894.373299	33.192917	438.985031	9.076071	5510.249023	466.544999	350.886858	416.551993	2479.5282	52.609914	38.360532	116.103245	11315.92178	9345.675807	0.312461	605.262617			52.658699	0		3.16	1.05					0.04	1288.190448	0.05	0.25	0.55	0.84	1.73	2.49				5000	$175/Day(Days 1-10):1a	$175/Day(Days 1-10):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $25 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$25/Visit:8a. $0 Lab -- FSL,8a. $25 Lab -- OP"	"$0-$150/Visit:14h. $25 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$175/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$10-$100/Visit:9d. $25 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $25 OP Other,5. $10 Partial Hospitalization,7h. $25 Psych -- OP,8b. $25 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$10/Visit:7b, 7d, 7f"	$10/Visit:7e	"$10-$25/Visit:7i. $25 Therapy (AT,PT,ST,OT) -- OP,7i. $10 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN824: Dental 16a, 16b"	"VIS830: Vision 7a, 7b"					$0: Nurse hotline 14a	$0/Script:15	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	$0: Membership in health club/fitness class 14a				139.192375	128.90955	44.44425	0	150	0.2	0	50	69.263583	6.879709	23.024916	175	1.225095	36.218785	0	10	10	12.098555			0.2	0		0	0					0	0	0	0	0	0	0	0				NO	128.113636	118.649252	29.63747	0	136.1085	0.181478	0	45.3695	62.849083	6.242579	20.892578	158.79325	1.111639	32.864563	0	9.0739	9.0739	10.978108			0.181478	0		0	0					0	0	0	0	0	0	0	0					22.5352	0.102599736	2.208913485	0	4.979132841	1.647107213	0	1.763909444	1.837743105	0.21669656	4.316978027	0.696174936	0.003553589	0.317973534	0	7.066810642	0.00023627	0.553719865	0	0	9.556395377	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8032	0	6.424786	22.5352	0.102599736	2.208913485	0	4.979132841	1.647107213	0	1.763909444	1.837743105	0.21669656	4.316978027	0.696174936	0.003553589	0.317973534	0	7.066810642	0.00023627	0.553719865	0	0	9.556395377	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8032	NO																																																																																		0	0	0	22.5352	0.102599736	2.208913485	0	4.979132841	1.647107213	0	1.763909444	1.837743105	0.21669656	4.316978027	0.696174936	0.003553589	0.317973534	0	7.066810642	0.00023627	0.553719865	0	0	9.556395377	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8032
H1036_125_0	2010	2	N/A	r.	s.	t.	u.	v.	w.	x.				Part B Rx	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V					O	S	O	O	O	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	YES	2681.651099	4.597092	870.605194	26.313582	478.977014	9.199911	3965.995332	376.607672	391.920676	341.736614	3065.586397	57.116696	35.171908	438.193879	13980.74144	9266.62058	1.544029	952.028953			62.644317	0		7.37	1.05					0.04	937.130799	0.05	0.25	0.55	0.84	1.73	2.49				3400	$100/Day(Days 1-10):1a	$100/Day(Days 1-10):1b	"$0/Day(Days 1-6) $75(Days 7-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	:11b	$50/Visit:4a	"$0-$25/Visit:9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $25 Surgery OP -- Facility"	"$0-$15/Visit:8a. $0 Lab -- FSL,8a. $15 Lab -- OP"	"$0-$50/Visit:14h. $15 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $0 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $15 Radiology OP -- Facility"	$20/Visit:9a	"$0-$15/Proc:12. $0 Dialysis -- Dialysis Center,12. $15 Dialysis -- OP Hosp"	"$0-$50/Visit:9d. $0 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $15 OP Other,5. $0 Partial Hospitalization,7h. $15 Psych -- OP,8b. $25 Rad therapy,3. $0 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	"$0-$15/Visit:7i. $15 Therapy (AT,PT,ST,OT) -- OP,7i. $0 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN825: Dental 16a, 16b"	"VIS830: Vision 7a, 7b"					$0: Nurse hotline 14a	$0/Script:15	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	$0: Membership in health club/fitness class 14a				71.58465	73.6626	54.868125	0	150	0.2	0	50	9.704642	4.143617	3.072065	20	1.238878	23.581833	0	0	0	1.120168			0.2	0		0	0					0	0	0	0	0	0	0	0				NO	65.218985	67.112153	29.106608	0	135.64125	0.180855	0	45.21375	8.775665	3.746969	2.777992	18.0855	1.120286	21.324462	0	0	0	1.01294			0.180855	0		0	0					0	0	0	0	0	0	0	0					14.5745	0.025710062	2.111697009	0	5.414086742	1.663849904	0	1.418987094	0.286613713	0.106706375	0.709681207	0.086082	0.00328355	0.778687393	0	0	0	0.080362351	0	0	11.32953795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5898	0	5.610013	14.5745	0.025710062	2.111697009	0	5.414086742	1.663849904	0	1.418987094	0.286613713	0.106706375	0.709681207	0.086082	0.00328355	0.778687393	0	0	0	0.080362351	0	0	11.32953795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5898	NO																																																																																		0	0	0	14.5745	0.025710062	2.111697009	0	5.414086742	1.663849904	0	1.418987094	0.286613713	0.106706375	0.709681207	0.086082	0.00328355	0.778687393	0	0	0	0.080362351	0	0	11.32953795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5898
H1036_130_0	2010	3	N/A	r.	s.	t.	u.	v.						Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																D	D	D	V	T	Coin	O	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V				O	O	O	O	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	YES	1934.309413	6.482863	1485.573346	4.578382	462.384227	15.601426	4208.848952	404.360884	404.848923	159.911083	3015.306114	84.1297	24.391471	262.028091	14801.65026	10376.97631	0.034837	714.98316			83.266004	0		3.16	0				0.04	0.25	0.05	0.55	2.49	0.84	1.73						7500	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	$0/Service:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$25/Visit:8a. $0 Lab -- FSL,8a. $25 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$225/Visit:9a	"$0-$25/Proc:12. $0 Dialysis -- Dialysis Center,12. $25 Dialysis -- OP Hosp"	"$20-$100/Visit:9d. $50 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $20 Partial Hospitalization,7h. $50 Psych -- OP,8b. $25 Rad therapy,3. $20 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$20/Visit:7b, 7d, 7f"	$20/Visit:7e	"$20-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $20 Therapy (AT,PT,ST,OT) - Specialist"			"0%-20% Coins:15. 0% Part B Rx,15. 20% Part B Rx at Pharmacy,15. 0% Part B Rx - Chemo"			"DEN824: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a	$0: OTC items 13c						158.7573	140.3991	44.44425	0	150	0.2	0	50	92.672991	8.106761	15.843938	225	0.403258	37.187257	0	20	20	22.843582			0.127783	0		0	0				0	0	0	0	0	0	0						NO	149.369346	132.09674	30.997375	0	138.67065	0.184894	0	46.22355	85.673492	7.494466	14.647261	208.005975	0.3728	34.378541	0	18.48942	18.48942	21.118229			0.118132	0		0	0				0	0	0	0	0	0	0							24.0772	0.071363756	3.837406175	0	5.343260109	2.884610059	0	1.557582962	2.890401747	0.099870681	3.680497971	1.458290023	0.000757762	0.750678622	0	15.98868944	5.37E-05	1.258264842	0	0	9.836379585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7353	0	6.920153	24.0772	0.071363756	3.837406175	0	5.343260109	2.884610059	0	1.557582962	2.890401747	0.099870681	3.680497971	1.458290023	0.000757762	0.750678622	0	15.98868944	5.37E-05	1.258264842	0	0	9.836379585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7353	NO																																																																																		0	0	0	24.0772	0.071363756	3.837406175	0	5.343260109	2.884610059	0	1.557582962	2.890401747	0.099870681	3.680497971	1.458290023	0.000757762	0.750678622	0	15.98868944	5.37E-05	1.258264842	0	0	9.836379585	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7353
H1036_801_0	2010	4	N/A																															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	NO	295.382865	1.397599	30.167925	9.186548	7.129465	2.359995	2.741248	35.687144	59.749353	6.638023	44.691254	5.619789	3.069559	11.088327	76.204447	85.678472	0.510214	4.957473			40.398459	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																			0.084364075	0.084364075	0.161772508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.084364075	0.084364075	0.161772508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				24.9197	0.117907146	4.880340896	0	1.661165345	0.549878835	0.638710784	8.315104552	13.92159925	1.546659359	10.41306218	1.309410837	0.715207247	2.583580191	17.75563615	19.96308398	0.118879862	1.155091209	0	0	9.412840947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9779	0	0	24.9197	0.117907146	4.880340896	0	1.661165345	0.549878835	0.638710784	8.315104552	13.92159925	1.546659359	10.41306218	1.309410837	0.715207247	2.583580191	17.75563615	19.96308398	0.118879862	1.155091209	0	0	9.412840947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9779	NO																																																																																		0	0	0	24.9197	0.117907146	4.880340896	0	1.661165345	0.549878835	0.638710784	8.315104552	13.92159925	1.546659359	10.41306218	1.309410837	0.715207247	2.583580191	17.75563615	19.96308398	0.118879862	1.155091209	0	0	9.412840947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9779
H1036_806_0	2010	4	N/A																															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	NO	337.533886	1.519274	36.245628	12.481657	8.672148	6.015431	3.992607	34.950628	77.909035	9.556127	45.905422	7.583851	0.962257	20.916024	98.367017	122.120896	0.47433	7.405335			23.978877	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																			0.080894335	0.080894335	0.160941154	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080894335	0.080894335	0.160941154	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				27.3046	0.12290066	5.833413198	0	2.020610484	1.401595423	0.930277431	8.143496324	18.15280516	2.226577591	10.69596333	1.767037283	0.224205881	4.873433592	22.91951496	28.45416877	0.11051889	1.725443055	0	0	5.587078341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.4936	0	0	27.3046	0.12290066	5.833413198	0	2.020610484	1.401595423	0.930277431	8.143496324	18.15280516	2.226577591	10.69596333	1.767037283	0.224205881	4.873433592	22.91951496	28.45416877	0.11051889	1.725443055	0	0	5.587078341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.4936	NO																																																																																		0	0	0	27.3046	0.12290066	5.833413198	0	2.020610484	1.401595423	0.930277431	8.143496324	18.15280516	2.226577591	10.69596333	1.767037283	0.224205881	4.873433592	22.91951496	28.45416877	0.11051889	1.725443055	0	0	5.587078341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.4936
H1036_807_0	2010	4	N/A																															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	NO	317.320917	1.952731	30.338186	14.475368	7.050865	6.862097	2.900408	28.328319	79.9366	11.516015	37.715816	5.845492	1.236795	20.639885	97.298826	120.678137	0.416153	8.085197			30.364884	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																			0.083882685	0.083882685	0.161697955	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083882685	0.083882685	0.161697955	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				26.6177	0.163800319	4.905622641	0	1.642851545	1.598868601	0.675795064	6.600498327	18.6252278	2.683231495	8.787785128	1.361999636	0.288173235	4.809093205	22.67062646	28.11800592	0.096963649	1.883850901	0	0	7.075017972	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.6051	0	0	26.6177	0.163800319	4.905622641	0	1.642851545	1.598868601	0.675795064	6.600498327	18.6252278	2.683231495	8.787785128	1.361999636	0.288173235	4.809093205	22.67062646	28.11800592	0.096963649	1.883850901	0	0	7.075017972	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.6051	NO																																																																																		0	0	0	26.6177	0.163800319	4.905622641	0	1.642851545	1.598868601	0.675795064	6.600498327	18.6252278	2.683231495	8.787785128	1.361999636	0.288173235	4.809093205	22.67062646	28.11800592	0.096963649	1.883850901	0	0	7.075017972	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.6051
H1045_001_0	2010	6	N/A																																						V													Coin																																																												0	NO								325.2935132													6.906706995																												"$50 ER (WIA), $0 UC"													20% coinsurance																											28													0.134634083																				NO								28													0.134634083																					0	0	0	0	0	0	0	0.759018197	0	0	0	0	0	0	0	0	0	0	0	0	0.929878163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6889	0	0	0	0	0	0	0	0	0	0.759018197	0	0	0	0	0	0	0	0	0	0	0	0	0.929878163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6889	NO																																																																																		0			0	0	0	0	0	0	0	0.759018197	0	0	0	0	0	0	0	0	0	0	0	0	0.929878163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6889
H1045_005_0	2010	6	N/A																															D		D		T			V	V		P										Coin																																																												0	NO	3051.59482		428.0967226		490.7368548			692.4700378	479.199798		0										17.84399297																					$50/day for days 1-5		$25 for days 7-21		$100 per trip			$50 ER/$0 UC; waived if admitted	$100 OP $25ASC		$40 per radiation therapy										20% on non-cancer drugs																				32.42207341		13.59281081		80			28	62.5		8.977108222										0.134634083																				NO	32.42207341		13.59281081		80			28	62.5		8.977108222										0.134634083																					8.2449	0	0.484919813	0	3.271579032	0	0	1.615763421	2.495832281	0	0	0	0	0	0	0	0	0	0	0	2.402409631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.5154	0	0	8.2449	0	0.484919813	0	3.271579032	0	0	1.615763421	2.495832281	0	0	0	0	0	0	0	0	0	0	0	2.402409631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.5154	NO																																																																																		0			8.2449	0	0.484919813	0	3.271579032	0	0	1.615763421	2.495832281	0	0	0	0	0	0	0	0	0	0	0	2.402409631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.5154
H1045_008_0	2010	5	N/A																																						V													Coin																																																												0	NO								321.773976													11.12046549																												"$50 ER (WIA), $0 UC"													$0-$20 or $20 coinsurance																											28													0.134634083																				NO								28													0.134634083																					0	0	0	0	0	0	0	0.750805944	0	0	0	0	0	0	0	0	0	0	0	0	1.497193674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.248	0	0	0	0	0	0	0	0	0	0.750805944	0	0	0	0	0	0	0	0	0	0	0	0	1.497193674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.248	NO																																																																																		0			0	0	0	0	0	0	0	0.750805944	0	0	0	0	0	0	0	0	0	0	0	0	1.497193674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.248
H1045_010_0	2010	9	N/A	x.7.										Podiatry																				D		D		T	Coin		V	V		P	V				V		V	V	V	Coin										V																																																		0	NO	1663.315262		154.3904822		522.881801	5.595682209		216.173385	436.9111669		0	971.5216762				24765.07007		0	2240.360862	692.7044324	0.489431897										0											$150 copay day (1-7)		$75/day days 11-100		$150 per trip	20% on high-cost only		"$50 ER, waived if admitted"	$150 at either hospital or ASC		$0-$100	150				$25/visit		$25/visit	$25/visit	$25/visit	20%coinsurance										$25/visit										112.681972		42.03445813		120	0.2		28	150		25.06349597	150				7.5		25	25	25	0.134634083										25										NO	112.681972		42.03445813		120	0.2		28	150		25.06349597	150				7.5		25	25	25	0.134634083										25											15.6188	0	0.540810022	0	5.22881801	1.119136442	0	0.504404565	5.461389587	0	0	12.14402095	0	0	0	15.47816879	0	0	4.667418462	1.443134234	0.065894215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.272	0	0	15.6188	0	0.540810022	0	5.22881801	1.119136442	0	0.504404565	5.461389587	0	0	12.14402095	0	0	0	15.47816879	0	0	4.667418462	1.443134234	0.065894215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.272	NO	20% Coinsurance		20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance		20% Coinsurance		20% Coinsurance	20% Coinsurance	20% Coinsurance																						1.8169		0.2764	0.2132	0.0358	0.1679	0.0026	0.0711	0.1191	0.8693	0	0	0	0		2.7373		0.0792	0.0539	0																					6.4426	0	0	17.4357	0	0.817226506	0.213163819	5.264638547	1.287006908	0.002604905	0.575500708	5.580450549	0.869267112	0	12.14402095	0	0	0	18.21545586	0	0.079184182	4.721357189	1.443134234	0.065894215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7146
H1045_012_0	2010	6	N/A																																																																																																															0	NO																																																																																																																										NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H1045_016_0	2010	5	N/A																																						V																																																																									0	NO								349.7820322																																									"$50 copay, waived if admitted"																																								36.1																																	NO								36.1																																		0	0	0	0	0	0	0	1.052260947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0523	0	0	0	0	0	0	0	0	0	1.052260947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0523	NO																																																																																		0			0	0	0	0	0	0	0	1.052260947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0523
H1045_017_0	2010	5	N/A																																						V													Coin																																																												0	NO								777.6221248													16.79922715																												$50 ER; waived if admitted													20% Coinsurance																											28													0.134634083																				NO								28													0.134634083																					0	0	0	0	0	0	0	1.814451625	0	0	0	0	0	0	0	0	0	0	0	0	2.261748542	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.0762	0	0	0	0	0	0	0	0	0	1.814451625	0	0	0	0	0	0	0	0	0	0	0	0	2.261748542	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.0762	NO	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0			0	0	0	0	0	0	0	1.814451625	0	0	0	0	0	0	0	0	0	0	0	0	2.261748542	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.0762
H1045_018_0	2010	4	N/A																																																																																																															0	NO																																																																																																																										NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H1076_003_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1278.700468	0	850.7289689	0	352.0566913	0	0	243.4984334	245.4011629	0	1325.534459	68.04052899	0	58.04412763	23202.54572	12365.77942	0	0	0	0	944.8670829	0	0	701.3173445	0	0	0	0	0	0												$150 copay (days 1-5) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$0 copay	$0 copay	$0 copay	$50 copay PBP L.4a	$150 copay @ Hospital PBP L.9a	$0 copay	$150 diag copay (hosp); $50 diag copay (freest); $50 therap. Copay PBP L.8a/8b	$150 copay PBP L.9a	$25 copay @ Hospital; $15 copay @ Freestanding facility PBP L.12	"$50 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$15 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											104.6154622	0	28.86922876	0	0	0	0	50	62.86053299	0	55.03116536	50	15	50	0	8.066157992	0	0	0	0	103.7692796	0	0	79.65242276	0	0	0	0	0	0											NO	104.6154622	0	28.86922876	0	0	0	0	50	62.86053299	0	55.03116536	50	15	50	0	8.066157992	0	0	0	0	103.7692796	0	0	79.65242276	0	0	0	0	0	0												11.1477	0	2.046657435	0	0	0	0	1.014576806	1.285503992	0	6.078808834	0.283502204	0	0.241850532	0	8.31202754	0	0	0	0	8.170681375	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2364			11.1477	0	2.046657435	0	0	0	0	1.014576806	1.285503992	0	6.078808834	0.283502204	0	0.241850532	0	8.31202754	0	0	0	0	8.170681375	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2364	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			11.1477	0	2.046657435	0	0	0	0	1.014576806	1.285503992	0	6.078808834	0.283502204	0	0.241850532	0	8.31202754	0	0	0	0	8.170681375	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2364
H1076_010_0	2010	4	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	861.6967511	0	462.2685239	0	201.7078046	0	0	190.1406127	301.512586	0	1220.553358	36.72065401	0.653279135	70.38693939	4954.213701	9885.134005	0	0	0	0	554.8639825	0	0	701.3173445	0	0	0	0	0	0												$150 copay (days 1-7) PBP L.1a	$0 copay	$30 per day (days 8 through 100)  PBP L.2	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$50 copay PBP L.4a	"$100 copay (hosp.); $50 copay (ASC) PBP Lines 9a, 9b"	$0 copay	$0 copay	$100 copay PBP L.9a	$0 copay	$0 copay	$0 copay	$20 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											119.9364775	0	17.32153726	0	100	0	0	50	67.99516064	0	7.135799324	50	0	45.88635966	0	10.80354933	0	0	0	0	141.8374925	0	0	79.65242276	0	0	0	0	0	0											NO	119.9364775	0	17.32153726	0	100	0	0	50	67.99516064	0	7.135799324	50	0	45.88635966	0	10.80354933	0	0	0	0	141.8374925	0	0	79.65242276	0	0	0	0	0	0												8.6124	0	0.667266788	0	1.680898372	0	0	0.792252553	1.708449727	0	0.725801985	0.153002725	0	0.269150035	0	8.899544403	0	0	0	0	6.558376332	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7223			8.6124	0	0.667266788	0	1.680898372	0	0	0.792252553	1.708449727	0	0.725801985	0.153002725	0	0.269150035	0	8.899544403	0	0	0	0	6.558376332	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7223	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			8.6124	0	0.667266788	0	1.680898372	0	0	0.792252553	1.708449727	0	0.725801985	0.153002725	0	0.269150035	0	8.899544403	0	0	0	0	6.558376332	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.7223
H1076_011_0	2010	7	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2100.591872	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.60651183	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.60651183	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.132303906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1323			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.132303906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1323	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.132303906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1323
H1076_016_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1530.532561	0	1263.895805	0	359.8447943	0	0	242.7646111	399.5072329	0	1684.512722	48.07865447	1.733249175	41.39104452	10578.9988	13536.09038	0	0	0	0	854.1018051	0	0	701.3173445	0	0	0	0	0	0												$150 copay (days 1-7) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$50 copay PBP L.4a	"$300 copay (hosp.); $75 copay (ASC) PBP Lines 9a, 9b"	$0 copay	$200 diag copay (hosp); $100 diag copay (freest); $100 therap. Copay PBP L.8a/8b	$300 copay PBP L.9a	$25 copay @ Hospital; $0 copay @ Freestanding facility PBP L.12	"$100 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$25 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											119.9364775	0	28.86922876	0	100	0	0	50	143.1890797	0	103.2142188	50	0	100	0	12.16595539	0	0	0	0	110.7706109	0	0	79.65242276	0	0	0	0	0	0											NO	119.9364775	0	28.86922876	0	100	0	0	50	143.1890797	0	103.2142188	50	0	100	0	12.16595539	0	0	0	0	110.7706109	0	0	79.65242276	0	0	0	0	0	0												15.2972	0	3.040641427	0	2.998706619	0	0	1.011519213	4.767089419	0	14.48880539	0.200327727	0	0.344925371	0	13.72328931	0	0	0	0	7.884114891	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4118			15.2972	0	3.040641427	0	2.998706619	0	0	1.011519213	4.767089419	0	14.48880539	0.200327727	0	0.344925371	0	13.72328931	0	0	0	0	7.884114891	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4118	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			15.2972	0	3.040641427	0	2.998706619	0	0	1.011519213	4.767089419	0	14.48880539	0.200327727	0	0.344925371	0	13.72328931	0	0	0	0	7.884114891	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4118
H1076_802_0	2010	3	N/A																															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																																																			0	NO	331.016283	0	24.38027388	5.2	9.743875549	9.719069049	0	18.54573358	51.55748428	0	0	0	0	71.37440564	0	0	0	0	0	345.6975113	54.08161256	0	0	0	0	0	0	0	0	0												Medicare FFS cost sharing	included in a.1	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	included in e.1.	Medicare FFS cost sharing	Medicare FFS cost sharing	included in h.5	included in h.5	included in h.5	included in h.5	Medicare FFS cost sharing	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	Medicare FFS cost sharing	Medicare FFS cost sharing	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered											0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841
H1076_803_0	2010	3	N/A																															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																																																			0	NO	331.016283	0	24.38027388	5.2	9.743875549	9.719069049	0	18.54573358	51.55748428	0	0	0	0	71.37440564	0	0	0	0	0	345.6975113	54.08161256	0	0	0	0	0	0	0	0	0												Medicare FFS cost sharing	included in a.1	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	included in e.1.	Medicare FFS cost sharing	Medicare FFS cost sharing	included in h.5	included in h.5	included in h.5	included in h.5	Medicare FFS cost sharing	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	Medicare FFS cost sharing	Medicare FFS cost sharing	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered											0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841
H1076_805_0	2010	3	N/A																															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																																																			0	NO	331.016283	0	24.38027388	5.2	9.743875549	9.719069049	0	18.54573358	51.55748428	0	0	0	0	71.37440564	0	0	0	0	0	345.6975113	54.08161256	0	0	0	0	0	0	0	0	0												Medicare FFS cost sharing	included in a.1	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	included in e.1.	Medicare FFS cost sharing	Medicare FFS cost sharing	included in h.5	included in h.5	included in h.5	included in h.5	Medicare FFS cost sharing	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	Medicare FFS cost sharing	Medicare FFS cost sharing	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered											0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076305799	0	0.159060395	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			25.2585	0	3.877935985	0	2.270323003	2.264543088	0	4.321155923	12.01289384	0	0	0	0	16.63023651	0	0	0	0	0	80.54752014	12.60101573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.7841
H1080_004_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1148.434111	100.6201055	1064.13315	1799.384212	197.1652518	7.450151499	7.378108352	223.8892814	46.47196481	10481.78547	60.10004086	0	0.264580118	13.19674187	6304.474093	6179.413615	441.2312416	547.1657902	0	0	26.01690959	1837.389606	0	271.073061	182.2867445	0	16.95769248	2.519831978	611.2748745	0											4200	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$115 Days 1-20 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20%/30% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20%/30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20%/30% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	74.85352709	0	150	0.2	0.139310492	49.6317303	0.285	3	0.193825292	0	0.2	0.221910148	10.5053435	34.98379325	38.5	35	0	0	0.2	34.21774456	0	0	32.93681192	0	0	0	0	0											NO	159.3902436	117.5281284	59.35624954	0	118.944795	0.15859306	0.110468386	39.35623989	0.22599511	2.378895899	0.153696731	0	0.15859306	0.176201815	10.460549	34.98379325	38.5	27.75378549	0	0	0.15859306	34.21774456	0	0	32.93681192	0	0	0	0	0												15.2541	0.98547439	5.2635794	0	1.954315037	1.181542323	0.815047723	0.734286689	10.50243682	2.077923039	9.2371798	0	0.04196057	2.325289871	5.495688345	18.01494403	1.4156169	1.265493497	0	0	4.126101302	5.239277351	0	0	0.500328685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.4306	0	14.57919718	15.2541	0.98547439	5.2635794	0	1.954315037	1.181542323	0.815047723	0.734286689	10.50243682	2.077923039	9.2371798	0	0.04196057	2.325289871	5.495688345	18.01494403	1.4156169	1.265493497	0	0	4.126101302	5.239277351	0	0	0.500328685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.4306	NO	"$325 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$40 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$40 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.1363	0.1887	0.6199	0.3327	0.1855	0.1682	0.1666	0.0697	1.0494	0.1972	1.1304	0	0.004	0.2209	1.0244	1.314	0.1021	0.1164	0	0	0.4982	0.3859	0	0.0476	0.0319	0	0.0036	0	0	0											9.9937	0	0	17.3904	1.174171509	5.883464983	0.332677998	2.139819978	1.349771551	0.981650169	0.803985692	11.55180377	2.275160938	10.36755244	0	0.045943497	2.546221175	6.520065255	19.32897708	1.517710299	1.381911751	0	0	4.624297443	5.625218007	0	0.047556677	0.532264558	0	0.00360802	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4243
H1080_036_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5282	0.7774	0.5308	0	1.4282	0	1.8235	0	0.0048	0.9947	1.0506	4.953	0.322	0.1781	0	0	0.8576	0.2167	0	0	0	0	0	0	0	0											13.6656	NO	461.5488099	22.46883789	76.00106901	2346.961067	17.31291188	25.41944825	17.31893113	49.2559648	47.01698875	20.52605032	60.04649589	0	0.158867473	32.58497793	37.39165758	163.1429893	10.91878996	5.890027539	0	0	28.0429886	7.486364125	604.476928	210.9008972	179.8694801	184.5520887	0	0	78.1181721	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08459411	0.085621569	0.159609957	0	0.193916212	0.193916212	0.193916212	0.065358259	0.193916212	0	0.162085466	0	0.193916212	0.144649256	0.162396614	0.193772561	0.193916212	0	0	0	0.193916212	0.193870067	0	0	0	0	0	0	0	0											NO	0.08459411	0.085621569	0.159609957	0	0.193916212	0.193916212	0.193916212	0.065358259	0.193916212	0	0.162085466	0	0.193916212	0.144649256	0.162396614	0.193772561	0.193916212	0	0	0	0.193916212	0.193870067	0	0	0	0	0	0	0	0												39.0443	1.923817143	12.13052736	0	3.357254284	4.929243105	3.358421513	3.219284117	9.117356339	0	9.732664245	0	0.030806979	4.713392826	6.072278587	31.6126349	2.117330385	0	0	0	5.437990111	1.451381911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.2487	146	0	39.0443	1.923817143	12.13052736	0	3.885500035	5.706613547	3.889181573	3.219284117	10.54559807	0	11.55620226	0	0.035616774	5.708105656	7.12284683	36.56567366	2.439347056	0.17810452	0	0	6.295574037	1.668036627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.9143	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	39.0443	1.923817143	12.13052736	0	3.885500035	5.706613547	3.889181573	3.219284117	10.54559807	0	11.55620226	0	0.035616774	5.708105656	7.12284683	36.56567366	2.439347056	0.17810452	0	0	6.295574037	1.668036627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.9143
H1080_042_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1261.964448	78.68355005	1163.109938	1987.895746	217.821165	8.447326975	8.365641117	247.3215509	395.5811246	11579.90418	68.14421108	0	0.299993197	279.7661685	6865.617603	6803.637712	404.0789368	598.0585871	0	0	29.18535656	2008.288259	0	172.739377	119.1306048	0	17.33781578	4.765224192	78.62619918	0											3200	"$175 Days 1-19 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$85 Days 1-34 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											161.6707145	122.8528282	70.72621662	0	150	0.2	0.139310492	49.6316955	175	3	0.168221609	0	0.2	67.39711223	7.054650745	25	38.5	25	0	0	0.2	24.44438102	0	0	25	0	0	0	0	0											NO	134.6276906	95.65871917	55.0706027	0	116.796724	0.155728965	0.108473394	38.64546295	136.2628447	2.335934481	0.130984885	0	0.155728965	52.57977954	7.016996674	25	38.5	19.46612067	0	0	0.155728965	24.44438102	0	0	25	0	0	0	0	0												14.1579	0.627230635	5.337763774	0	2.120066542	1.31549349	0.907449485	0.796487986	4.491917446	2.254158121	8.925861671	0	0.04671763	1.225836955	4.01466799	14.17424523	1.296419922	0.970156719	0	0	4.545005381	4.090946949	0	0	0.24818876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5466	0	13.58506847	14.1579	0.627230635	5.337763774	0	2.120066542	1.31549349	0.907449485	0.796487986	4.491917446	2.254158121	8.925861671	0	0.04671763	1.225836955	4.01466799	14.17424523	1.296419922	0.970156719	0	0	4.545005381	4.090946949	0	0	0.24818876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5466	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.1579	0.627230635	5.337763774	0	2.120066542	1.31549349	0.907449485	0.796487986	4.491917446	2.254158121	8.925861671	0	0.04671763	1.225836955	4.01466799	14.17424523	1.296419922	0.970156719	0	0	4.545005381	4.090946949	0	0	0.24818876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5466
H1080_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	236.2590885	4.88	32.09994236	1794.556631	6.515876477	7.395120581	8.503731917	19.17120432	58.14311642	24.41122878	69.50502329	0	0.215031028	19.85834442	32.55702528	148.6540788	2.4	6.550789574	0	0	29.44371981	9.803844223	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085438337	0.085438337	0.159666014	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085438337	0.085438337	0.159666014	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.1856	0.416939083	5.125269858	0	1.518199219	1.723063095	1.981369537	4.466890606	13.54734612	5.687816307	16.19467043	0	0.05010223	4.626994251	7.58578689	34.63640036	0.5592	1.526333971	0	0	6.860386717	2.284295704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.9766	0	0	20.1856	0.416939083	5.125269858	0	1.518199219	1.723063095	1.981369537	4.466890606	13.54734612	5.687816307	16.19467043	0	0.05010223	4.626994251	7.58578689	34.63640036	0.5592	1.526333971	0	0	6.860386717	2.284295704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.9766	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.1856	0.416939083	5.125269858	0	1.518199219	1.723063095	1.981369537	4.466890606	13.54734612	5.687816307	16.19467043	0	0.05010223	4.626994251	7.58578689	34.63640036	0.5592	1.526333971	0	0	6.860386717	2.284295704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.9766
H1080_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	235.7172504	4.88	32.02632414	1790.440983	6.500932925	7.378160564	8.484229404	19.12723695	58.00977062	24.35524392	69.34562003	0	0.214537875	19.81284704	32.48235879	148.3131546	2.4	6.535765951	0	0	29.3761934	9.781360023	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085438337	0.085438337	0.159666014	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085438337	0.085438337	0.159666014	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.1393	0.416939083	5.113515523	0	1.514717371	1.719111412	1.976825451	4.45664621	13.51627655	5.674771832	16.15752947	0	0.049987325	4.61639336	7.568389597	34.55696502	0.5592	1.522833467	0	0	6.844653062	2.279056885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6831	0	0	20.1393	0.416939083	5.113515523	0	1.514717371	1.719111412	1.976825451	4.45664621	13.51627655	5.674771832	16.15752947	0	0.049987325	4.61639336	7.568389597	34.55696502	0.5592	1.522833467	0	0	6.844653062	2.279056885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6831	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.1393	0.416939083	5.113515523	0	1.514717371	1.719111412	1.976825451	4.45664621	13.51627655	5.674771832	16.15752947	0	0.049987325	4.61639336	7.568389597	34.55696502	0.5592	1.522833467	0	0	6.844653062	2.279056885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6831
H1080_807_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	235.7172509	4.88	32.02632421	1790.440984	6.500932938	7.37816058	8.484229422	19.12723699	58.00977074	24.35524397	69.34562018	0	0.214537875	19.81284708	32.48235886	148.3131549	2.39	6.535765965	0	0	29.37619346	9.781360044	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085438337	0.085438337	0.159666013	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085438337	0.085438337	0.159666013	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.1393	0.416939083	5.113515511	0	1.514717375	1.719111415	1.976825455	4.45664622	13.51627658	5.674771845	16.1575295	0	0.049987325	4.61639337	7.568389613	34.55696509	0.55687	1.52283347	0	0	6.844653076	2.27905689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6808	0	0	20.1393	0.416939083	5.113515511	0	1.514717375	1.719111415	1.976825455	4.45664622	13.51627658	5.674771845	16.1575295	0	0.049987325	4.61639337	7.568389613	34.55696509	0.55687	1.52283347	0	0	6.844653076	2.27905689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6808	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.1393	0.416939083	5.113515511	0	1.514717375	1.719111415	1.976825455	4.45664622	13.51627658	5.674771845	16.1575295	0	0.049987325	4.61639337	7.568389613	34.55696509	0.55687	1.52283347	0	0	6.844653076	2.27905689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6808
H1080_808_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	235.7172516	4.88	32.02632431	1790.440987	6.500932959	7.378160603	8.484229448	19.12723705	58.00977092	24.35524404	69.34562039	0	0.214537876	19.81284714	32.48235896	148.3131554	2.39	6.535765985	0	0	29.37619355	9.781360075	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085438337	0.085438337	0.159666012	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085438337	0.085438337	0.159666012	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.1393	0.416939082	5.113515494	0	1.514717379	1.719111421	1.976825461	4.456646233	13.51627662	5.674771862	16.15752955	0	0.049987325	4.616393384	7.568389637	34.5569652	0.55687	1.522833475	0	0	6.844653097	2.279056897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6808	0	0	20.1393	0.416939082	5.113515494	0	1.514717379	1.719111421	1.976825461	4.456646233	13.51627662	5.674771862	16.15752955	0	0.049987325	4.616393384	7.568389637	34.5569652	0.55687	1.522833475	0	0	6.844653097	2.279056897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6808	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.1393	0.416939082	5.113515494	0	1.514717379	1.719111421	1.976825461	4.456646233	13.51627662	5.674771862	16.15752955	0	0.049987325	4.616393384	7.568389637	34.5569652	0.55687	1.522833475	0	0	6.844653097	2.279056897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6808
H1099_001_0	2010	6	N/A	X1	X3	X5	X6	X7	X8	X9				Professional	OP Facility - Emergency	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional				Non-Facility Lab	Urgent Care	OT/ST/PT & Other	MH/SA	MRI/PET/CAT	Chiroprictic (covered)	Podiatry (Covered)				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	V	V	V	V	P	V	V	V	V	V	V	V																																												0	YES	1622.820283	15.78857288	1003.893214	4400.787618	180.8392365	14.18408509	0.774756273	276.835968	269.2676879	461.6096673	118.1395851	4.749966564	0.554162766	2746.106086	4630.903232	7489.818612	170.4215578	433.3103283	12643.41572	16425.27817	54.54237813	0	0	433.3439571	208.8318602	363.7949269	0.646694279	22.78547504	11880	0	10729.5964	0.079166109	140.0131811	0	296.7383279	311.0229733	257.5073069				3350	"$200/day, 1-10"	"$200/day, 1-10"	"$75/day, 15-100"	0	150	0.2	Prosthetic 0.2; Diabetic Supplies 0	50 WIA	300	0	0	200	0	0	10	25	25	25	0	0	0.2  (excludes chemo)		0	$100 limit	0	$100 limit	15	$250 limit	0	0	0	10	"$15 PH&Corf, $25 OP Facility-OT/ST/PT"	25	175	25	25				167.824463	125.3501616	28.7925	0	150	0.2	0.1	50	300	0	0	200	0	0	10	25	25	25	0	0	0.1246	0	0	0	0	0	15	0	0	0	0	10	24.75	25	175	25	25				YES	140.1579075	104.6856701	24.04593753	0	125.2718808	0.167029174	0.083514587	41.75729361	250.5437617	0	0	167.0291744	0	0	8.351458722	20.87864681	20.87864681	20.87864681	0	0	0.104059176	0	0	0	0	0	12.52718808	0	0	0	0	8.351458722	20.66986034	20.87864681	146.1505276	20.87864681	20.87864681				10000	18.9543	0.137736444	2.011629458	0	1.887839273	2.369156023	0.06470345	0.963326733	5.621944952	0	0	0.066115249	0	0	3.222899765	13.03143979	0.296514293	0.753911109	0	0	5.675634908	0	0	0	0	0	0.000675105	0	0	0	0	5.51E-05	0.241171075	0	3.614038599	0.541144901	0.448033676	0	0	0	59.9022	0	11.78268229	18.9543	0.137736444	2.011629458	0	1.887839273	2.369156023	0.06470345	0.963326733	5.621944952	0	0	0.066115249	0	0	3.222899765	13.03143979	0.296514293	0.753911109	0	0	5.675634908	0	0	0	0	0	0.000675105	0	0	0	0	5.51E-05	0.241171075	0	3.614038599	0.541144901	0.448033676	0	0	0	59.9022	NO	0.2	0.2	0.2	0.2	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2  (excludes chemo)	0.2	0	0	0.2	0	0.2	0	0	0	0.2	10	0.2	0.2	0.2	0.2	0.2					0.3909	0.0047	0.0784	0.033	0.0113	0.0254	0.0014	0.0103	0.0584	0.0586	0.0062	0.0033	0	0.0357	0.0606	0.3466	0.0017	0.0048	0.1045	0.0404	0.0978	0	0	0	0.0017	0	0	0	0	0	0.0182	0	0.0053	0	0.0369	0.002	0.0024				1.4408	0	0.182843594	19.3452	0.142436347	2.090029694	0.032994601	1.899174573	2.394583875	0.066092358	0.973665997	5.680316267	0.058624058	0.006237188	0.069460542	0	0.035744061	3.283517898	13.3780833	0.298204412	0.758755701	0.104542482	0.040379353	5.773413191	0	0	0	0.001695253	0	0.000676151	0	0	0	0.018163286	5.58E-05	0.246473721	0	3.650922871	0.54316072	0.450481806	0	0	0	61.343
H1099_006_0	2010	6	N/A	X1	X3	X5	X6	X7	X8	X9	X10			Professional	OP Facility - Emergency	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional			Non-Facility Lab	Urgent Care	OT/ST/PT & Other	MH/SA	MRI/PET/CAT	Chiroprictic (covered)	Podiatry (Covered)	Specialist - 15% Coins			D	D	D	V	Coin	Coin	Coin	V	Coin	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	P	P	V	V	V	V	V	V	Coin																																											0	YES	1128.329673	18.15380394	538.7328857	2921.463734	4.631018212	9.123777749	1.11804628	234.2086371	36.93208478	1.794104464	103.356018	2.379138528	0.468027251	2508.431056	4018.077571	5296.065188	174.3513796	298.4131386	11239.28836	14371.3976	33.66897062	0	0	2.110226451	67.61000042	50.14891096	0.331015914	0.331015914	12000	0	7798.005382	0	104.4870839	0.156009084	208.5841451	312.6793992	361.8327691	45.23658471			3400	"$250/day, 1-10"	"$250/day, 1-10"	"$100/day, 15-100"	0	0.15	0.2	"Prosthetics 0.2, Diabetic Supplies 0"	50 WIA	0.15	0	X-ray: 35	250	0	0	10	30	30	30	0	0	0.2 (excludes chemo)	0	0	0	0	0	0	0	0	0	0	10	"$15 PH&Corf,  $30 OP Facility-OT/ST/PT"	30	200	30	30	0.15			209.7805787	156.687702	38.39	0	0.12	0.2	0.1	50	0.15	0	35	250	0	0	10	30	30	30	0	0	0.1254	0	0	0	0	0	0	0	0	0	0	10	29.625	30	200	25	25	0.15			NO	180.0962545	134.5161141	32.95774687	0	0.103019787	0.171699645	0.085849823	42.92491126	0.128774734	0	30.04743788	214.6245563	0	0	8.584982252	25.75494676	25.75494676	25.75494676	0	0	0.107655677	0	0	0	0	0	0	0	0	0	0	8.584982252	25.43300992	25.75494676	171.699645	21.46245563	21.46245563	0.128774734				16.934	0.203498263	1.479618506	0	0.47708651	1.566549401	0.095984075	0.83778208	4.755919385	0	0.258798628	0.042551796	0	0	2.87459372	11.36665641	0.374200875	0.640467875	0	0	3.624655841	0	0	0	0	0	0	0	0	0	0	0	0.221451753	0.000334834	2.984485306	0.559238978	0.647151646	5.825329153	0	0	55.7704	0	9.191984041	16.934	0.203498263	1.479618506	0	0.47708651	1.566549401	0.095984075	0.83778208	4.755919385	0	0.258798628	0.042551796	0	0	2.87459372	11.36665641	0.374200875	0.640467875	0	0	3.624655841	0	0	0	0	0	0	0	0	0	0	0	0.221451753	0.000334834	2.984485306	0.559238978	0.647151646	5.825329153	0	0	55.7704	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	16.934	0.203498263	1.479618506	0	0.47708651	1.566549401	0.095984075	0.83778208	4.755919385	0	0.258798628	0.042551796	0	0	2.87459372	11.36665641	0.374200875	0.640467875	0	0	3.624655841	0	0	0	0	0	0	0	0	0	0	0	0.221451753	0.000334834	2.984485306	0.559238978	0.647151646	5.825329153	0	0	55.7704
H1099_009_0	2010	2	N/A	X1	X3	X5	X6	X7	X8	X9				Professional	OP Facility - Emergency	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional				Non-Facility Lab	Urgent Care	OT/ST/PT & Other	MH/SA	MRI/PET/CAT	Chiroprictic (covered)	Podiatry (Covered)				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	P	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	0	0	0	0				0	YES	1464.859667	13.57784926	740.9196747	3957.109777	166.400691	10.53027292	0.545742255	249.5366565	233.9892821	397.2674684	261.0872889	4.486575228	0.371844887	2308.606827	4213.817718	6589.947394	94.16743946	362.1995346	11861.74861	14424.23203	46.72675486	0	0	284.5422741	177.3470873	273.2926843	0.394485283	17.29649126	12000	0	9610.016714	0.053120698	139.3207514	0	261.5132501	292.2898532	412.2924886				3350	"$200/day, 1-10"	"$200/day, 1-10"	"$75/day, 15-100"	0	150	0.2	0.2	50 WIA	300	0	0	200	0	0	10	25	25	25	0	0	0.20 (excludes chemo)	0	0	$100 limit	0	$100 limit	15	$250 limit	0	0	0	10	"$15 PH&Corf, $25 OP Facility - OT/PT/ST"	25	75	25	25				167.824463	125.3501616	28.7925	0	150	0.2	0.1	50	300	0	0	200	0	0	10	25	25	25	0	0	0.1254	0	0	0	0	0	15	0	0	0	0	10	24.125	25	75	25	25				NO	145.6259943	108.7698515	24.98405993	0	130.1592078	0.17354561	0.086772805	43.38640259	260.3184155	0	0	173.5456104	0	0	8.677280518	21.69320129	21.69320129	21.69320129	0	0	0.108813098	0	0	0	0	0	13.01592078	0	0	0	0	8.677280518	20.93393925	21.69320129	65.07960388	21.69320129	21.69320129					17.7768	0.123071721	1.542598463	0	1.804881843	1.827482642	0.047355586	0.902208153	5.075976596	0	0	0.064885453	0	0	3.047039866	11.91308794	0.170232768	0.654772284	0	0	5.084482941	0	0	0	0	0	0.000427882	0	0	0	0	3.84E-05	0.243044346	0	1.418264894	0.528391885	0.745328662	0	0	0	52.9704	0	8.074528461	17.7768	0.123071721	1.542598463	0	1.804881843	1.827482642	0.047355586	0.902208153	5.075976596	0	0	0.064885453	0	0	3.047039866	11.91308794	0.170232768	0.654772284	0	0	5.084482941	0	0	0	0	0	0.000427882	0	0	0	0	3.84E-05	0.243044346	0	1.418264894	0.528391885	0.745328662	0	0	0	52.9704	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	17.7768	0.123071721	1.542598463	0	1.804881843	1.827482642	0.047355586	0.902208153	5.075976596	0	0	0.064885453	0	0	3.047039866	11.91308794	0.170232768	0.654772284	0	0	5.084482941	0	0	0	0	0	0.000427882	0	0	0	0	3.84E-05	0.243044346	0	1.418264894	0.528391885	0.745328662	0	0	0	52.9704
H1099_802_0	2010	1	N/A	X1	X3	X5	X6	X7	X8	X9	X10			Professional	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional			Non-Facility Lab	Urgent Care	OT/ST/PT & Other	MH/SA	MRI/PET/CAT	Chiroprictic (covered)	Podiatry (Covered)	Specialist - 15% Coins			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			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	NO	194.2687996	2.692454259	35.29253237	20.03725289	5.230879223	13.92531664	0.486372567	18.3449415	31.401099	40.54180159	2.927030436	1.52193143	0.007915255	18.78733814	28.27785826	175.7323042	0.521802944	3.491581167	53.63956557	20.07844161	39.28777831	0	0	0	0	0	0	0	0	0	9.875601739	7.61E-05	3.985775291	0	10.56461211	2.293111995	3.037210111	0				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0	0	0	0	0	0	0	0	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS			0.087895136	0.087895136	0.147652602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			NO	0.087895136	0.087895136	0.147652602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233				17.0753	0.236653632	5.21103422	0	1.218794859	3.244598778	0.113324808	4.27437137	7.316456066	9.446239772	0.681998092	0.354610023	0.001844254	4.377449787	6.588740975	40.94562687	0.121580086	0.813538412	12.49801878	4.678276896	9.154052347	0	0	0	0	0	0	0	0	0	2.301015205	1.77E-05	0.928685643	0	2.461554621	0.534295095	0.707669956	0	0	0	135.2857	0	0	17.0753	0.236653632	5.21103422	0	1.218794859	3.244598778	0.113324808	4.27437137	7.316456066	9.446239772	0.681998092	0.354610023	0.001844254	4.377449787	6.588740975	40.94562687	0.121580086	0.813538412	12.49801878	4.678276896	9.154052347	0	0	0	0	0	0	0	0	0	2.301015205	1.77E-05	0.928685643	0	2.461554621	0.534295095	0.707669956	0	0	0	135.2857	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	17.0753	0.236653632	5.21103422	0	1.218794859	3.244598778	0.113324808	4.27437137	7.316456066	9.446239772	0.681998092	0.354610023	0.001844254	4.377449787	6.588740975	40.94562687	0.121580086	0.813538412	12.49801878	4.678276896	9.154052347	0	0	0	0	0	0	0	0	0	2.301015205	1.77E-05	0.928685643	0	2.461554621	0.534295095	0.707669956	0	0	0	135.2857
H1099_803_0	2010	2	N/A	X1	X3	X5	X6	X7	X8	X9	X10			Professional	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional			Non-Facility Lab	Urgent Care	OT/ST/PT & Other	MH/SA	MRI/PET/CAT	Chiroprictic (covered)	Podiatry (Covered)	Specialist - 15% Coins			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			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	NO	152.2380558	2.138442722	28.98951407	15.49507858	4.14683453	9.479588751	0.528464372	16.58719879	27.55884518	28.22188298	2.207051986	1.111285733	0.028788388	16.22426224	26.79449979	157.4375121	0.581596398	1.69655221	46.53603922	14.16726093	33.90844565	0	0	0	0	0	0	0	0	0	7.881847917	0.000276841	2.923035463	0	15.35021656	1.886768963	1.143406137	0				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0	0	0	0	0	0	0	0	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS			0.087895136	0.087895136	0.147652602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			NO	0.087895136	0.087895136	0.147652602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233				13.381	0.187958713	4.28037717	0	0.966212445	2.208744179	0.123132199	3.864817318	6.421210926	6.575698734	0.514243113	0.258929576	0.006707695	3.780253102	6.243118452	36.68294032	0.135511961	0.395296665	10.84289714	3.300971796	7.900667835	0	0	0	0	0	0	0	0	0	1.836470565	6.45E-05	0.681067263	0	3.576600459	0.439617168	0.26641363	0	0	0	114.8709	0	0	13.381	0.187958713	4.28037717	0	0.966212445	2.208744179	0.123132199	3.864817318	6.421210926	6.575698734	0.514243113	0.258929576	0.006707695	3.780253102	6.243118452	36.68294032	0.135511961	0.395296665	10.84289714	3.300971796	7.900667835	0	0	0	0	0	0	0	0	0	1.836470565	6.45E-05	0.681067263	0	3.576600459	0.439617168	0.26641363	0	0	0	114.8709	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	13.381	0.187958713	4.28037717	0	0.966212445	2.208744179	0.123132199	3.864817318	6.421210926	6.575698734	0.514243113	0.258929576	0.006707695	3.780253102	6.243118452	36.68294032	0.135511961	0.395296665	10.84289714	3.300971796	7.900667835	0	0	0	0	0	0	0	0	0	1.836470565	6.45E-05	0.681067263	0	3.576600459	0.439617168	0.26641363	0	0	0	114.8709
H1099_804_0	2010	1	N/A	X1	X3	X5	X6	X7	X8	X9	X10			Professional	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional			Non-Facility Lab	Urgent Care	OT/ST/PT & Other	MH/SA	MRI/PET/CAT	Chiroprictic (covered)	Podiatry (Covered)	Specialist - 15% Coins			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			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	NO	148.8847461	1.856914596	30.45109023	13.02844343	4.285160389	9.198471281	0.563533352	16.46695095	22.55139205	21.86705399	2.343010841	1.18503083	0.03069879	13.77830454	23.6672467	132.2494892	0.574489384	1.681350282	42.46075238	12.82168879	35.54107771	0	0	0	0	0	0	0	0	0	6.984237647	0.000295212	2.034505541	0	14.05114975	0.744510789	1.040740881	0				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0	0	0	0	0	0	0	0	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS			0.087957633	0.087957633	0.147441567	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			NO	0.087957633	0.087957633	0.147441567	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233				13.0955	0.163329813	4.48975645	0	0.998442371	2.143243809	0.131303271	3.836799571	5.254474349	5.09502358	0.545921526	0.276112183	0.007152818	3.210344957	5.514468481	30.81413098	0.133856026	0.391754616	9.893355304	2.987453489	8.281071107	0	0	0	0	0	0	0	0	0	1.627327372	6.88E-05	0.474039791	0	3.273917892	0.173471014	0.242492625	0	0	0	103.0549	0	0	13.0955	0.163329813	4.48975645	0	0.998442371	2.143243809	0.131303271	3.836799571	5.254474349	5.09502358	0.545921526	0.276112183	0.007152818	3.210344957	5.514468481	30.81413098	0.133856026	0.391754616	9.893355304	2.987453489	8.281071107	0	0	0	0	0	0	0	0	0	1.627327372	6.88E-05	0.474039791	0	3.273917892	0.173471014	0.242492625	0	0	0	103.0549	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0	0	0	0	0	0	0	0	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS				3.7584	0.0469	1.2886	0	0.2866	0.6151	0.0377	1.1012	1.508	1.4623	0.1567	0.0792	0.0021	0.9214	1.5827	8.8437	0.0384	0.1124	2.8394	0.8574	2.3767	0	0	0	0	0	0	0	0	0	0.467	0	0.1361	0	0.9396	0.0498	0.0696	0			29.5769	0	0	16.854	0.210205679	5.778322329	0	1.284996616	2.75835754	0.168987479	4.937965985	6.762515249	6.557301905	0.702601707	0.355356735	0.009205686	4.131718091	7.097128033	39.65782623	0.172272878	0.504188695	12.73276101	3.844856485	10.65774917	0	0	0	0	0	0	0	0	0	2.094372422	8.85E-05	0.610089821	0	4.213536541	0.223257418	0.312088321	0	0	0	132.6317
H1108_001_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	355.5332027	36.41915758	11547.27388	19.27960872	42.25682139	10.96590437	27.8085783	17.29958864	10.80860639	41.2389431	40.70984064	0	0.037604912	5.537408541	2.615926869	136.5774779	16.88648312	200.9045542	0	0	1.879535838	8.262091673	1312.282832	0	19.40508436	68.32401012	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079517346	0.080483144	0	0	0.2	0.2	0.091079577	0.051163187	0.2	0	0.035733368	0	0.2	0.151651232	0	0.199775072	0.2	0	0	0	0.2	0.199912343	0	0	0	0	0	0	0	0											NO	0.079517346	0.080483144	0	0	0.2	0.2	0.091079577	0.051163187	0.2	0	0.035733368	0	0.2	0.151651232	0	0.199775072	0.2	0	0	0	0.2	0.199912343	0	0	0	0	0	0	0	0												28.2711	2.931128292	0	0	8.451364278	2.193180873	2.532793562	0.885102089	2.161721279	0	1.454699732	0	0.007520982	0.839754826	0	27.28477552	3.377296624	0	0	0	0.375907168	1.651694107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.418	0	0	28.2711	2.931128292	0	0	8.451364278	2.193180873	2.532793562	0.885102089	2.161721279	0	1.454699732	0	0.007520982	0.839754826	0	27.28477552	3.377296624	0	0	0	0.375907168	1.651694107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.418	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.2077	0.6359	0.4981	0.003	1.4086	0.3655	0.927	0.0983	0.3603	0.4124	1.0463	0	0.0008	0.14	0.0591	3.084	0.3813	0	0	0	0.0424	0.1865	0	0	0.0014	0	0	0	0	0											15.8585	0	0	34.4788	3.567018344	0.498130128	0.002953899	9.859924991	2.558711019	3.459746171	0.983446765	2.522008159	0.412389431	2.500969273	0	0.008356647	0.979713964	0.059069316	30.36878308	3.758604308	0	0	0	0.4183483	1.8381757	0	0	0.001365567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2765
H1108_002_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5304	0.7885	0.9796	0	1.1171	0	1.5326	0	0.0045	0.971	0.7495	3.3923	0.2609	0.1872	0	0	0.6713	0.1173	0	0	0	0	0	0	0	0											11.3022	NO	381.4286088	20.01056077	35.93651654	1265.14322	16.69436794	24.81593858	30.84929242	60.41073823	35.16164607	20.67004804	48.24439237	0	0.142487271	30.56537097	25.78254831	106.7945501	8.222730432	5.896322959	0	0	21.12584282	3.964572765	517.1786735	431.5495937	139.8214397	196.0038632	0	0	75.90212707	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079232527	0.080194866	0.174295418	0	0.193646082	0.193646082	0.193646082	0.057317372	0.193646082	0	0.161813965	0	0.193646082	0.14547762	0.162542059	0.193589488	0.193646082	0	0	0	0.193646082	0.193917007	0	0	0	0	0	0	0	0											NO	0.079232527	0.080194866	0.174295418	0	0.193646082	0.193646082	0.193646082	0.057317372	0.193646082	0	0.161813965	0	0.193646082	0.14547762	0.162542059	0.193589488	0.193646082	0	0	0	0.193646082	0.193917007	0	0	0	0	0	0	0	0												30.2216	1.604744237	6.263570185	0	3.232798941	4.805509273	5.973844605	3.462584777	6.808914993	0	7.806616412	0	0.027592102	4.446577422	4.190748486	20.67430225	1.59229953	0	0	0	4.090936688	0.768798084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9714	146	0	30.2216	1.604744237	6.263570185	0	3.763179785	5.593964724	6.953478332	3.462584777	7.925984506	0	9.33917902	0	0.032117471	5.417548151	4.940285605	24.06663752	1.853226478	0.187240059	0	0	4.762252375	0.886075513	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.2736	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"23% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												12.7143	0.667	2.1313	0.2967	0.4997	0.7429	0.9234	0.3215	1.0525	0.1728	1.2302	0	0.003	0.7098	2.7333	11.471	0.8831	0.0624	0	0	2.2692	0.4232	0	0.0946	0.0823	0.032	0	0	0	0											39.5163	146	0	42.9358	2.271762929	8.394899436	0.296696332	4.262919268	6.336825124	7.876898259	3.784049802	8.97853322	0.172815156	10.56934719	0	0.035101037	6.127347446	7.673620586	35.53762274	2.736346857	0.249649798	0	0	7.031479659	1.309269375	0	0.094638069	0.082289971	0.031970912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	156.7899
H1108_006_0	2010	3	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2224.049837	202.9773679	30.7717766	1105.686571	362.0155823	17.02581196	28.52700104	526.1170694	28.96412411	12680.79236	49.7419677	0	0.112285633	30.9574186	5112.028704	5910.575754	751.5748473	688.2049456	0	0	21.61238411	762.8564486	665.6759445	0	193.8556787	207.6943372	13.14799305	4.517086766	78.45466489	0											3380	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$5 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	0.171900362	0	150	0.2	0.128971096	49.88921415	0.2	3	0.174276899	0	0.2	0.149852595	3.516234899	25	38.5	25	0	0	0.2	24.74404411	0	0	25	30	0	0	0	0											NO	114.6435122	87.31492589	0.118850059	0	103.7083846	0.138277846	0.089169227	34.4928654	0.138277846	2.074167693	0.120493171	0	0.138277846	0.103964589	3.485017121	25	38.5	17.28473077	0	0	0.138277846	24.74404411	0	0	25	30	0	0	0	0												21.2477	1.47691282	3.657227472	0	3.128670938	2.354292607	2.543730629	1.512273772	4.005096698	2.19184082	5.993567441	0	0.015526616	3.218475311	1.48462563	12.31369949	2.411302635	0.991286433	0	0	2.988513926	1.573012801	0	0	0.403865997	0.519235843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0309	0	24.6923822	21.2477	1.47691282	3.657227472	0	3.128670938	2.354292607	2.543730629	1.512273772	4.005096698	2.19184082	5.993567441	0	0.015526616	3.218475311	1.48462563	12.31369949	2.411302635	0.991286433	0	0	2.988513926	1.573012801	0	0	0.403865997	0.519235843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0309	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												16.0993	0.4865	2.2362	0.3347	0.5309	0.5992	1.004	0.2566	1.0194	0.3719	1.4985	0	0.0026	0.8234	2.4353	10.2016	0.8604	0.7793	0	0	2.0475	0.4531	0	0	0.1017	0.0357	0.0054	0.003	0	0											42.1864	0	0	37.347	1.963406036	5.893437325	0.334678214	3.659559711	2.953525095	3.547753571	1.768884065	5.024504418	2.563763501	7.492088002	0	0.018161251	4.041907165	3.919933265	22.51533355	3.271658052	1.770585876	0	0	5.036002947	2.026078762	0	0	0.505609239	0.554962929	0.005434701	0.002971768	0	0	0	0	0	0	0	0	0	0	0	0	116.2173
H1108_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	215.9904837	5.21683076	50.39513876	759.4011576	6.31089848	9.204411765	9.112462012	16.52193958	23.87195918	14.27734687	28.72921006	0	0.028715343	23.51216671	24.65028654	84.6783962	2.191140218	2.834976788	0	0	13.37595253	4.959962616	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.1905	0.41520209	8.556466664	0	1.470439346	2.144627941	2.123203649	3.849611921	5.562166488	3.326621822	6.693905945	0	0.006690675	5.478334844	5.743516763	19.73006631	0.510535671	0.660549592	0	0	3.116596939	1.155671289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7347	0	0	17.1905	0.41520209	8.556466664	0	1.470439346	2.144627941	2.123203649	3.849611921	5.562166488	3.326621822	6.693905945	0	0.006690675	5.478334844	5.743516763	19.73006631	0.510535671	0.660549592	0	0	3.116596939	1.155671289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7347	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.2338	0.054	3.4106	0	0.5033	0.7341	0.7267	1.3177	1.9038	1.1386	2.2912	0	0.0023	1.8751	1.8638	6.4025	0.1657	0.2144	0	0	1.0113	0.375	0	0	0	0	0	0	0	0											26.2239	0	0	19.4242	0.469154903	11.96708624	0	1.973744089	2.878695223	2.849937784	5.167264324	7.465995286	4.46526419	8.98510865	0	0.008980772	7.35346959	7.60730697	26.13253816	0.676206187	0.874900121	0	0	4.127942965	1.53069045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9585
H1108_802_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	215.9904837	5.21683076	50.39513876	759.4011576	6.31089848	9.204411765	9.112462012	16.52193958	23.87195918	14.27734687	28.72921006	0	0.028715343	23.51216671	24.65028654	84.6783962	2.191140218	2.834976788	0	0	13.37595253	4.959962616	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.1905	0.41520209	8.556466664	0	1.470439346	2.144627941	2.123203649	3.849611921	5.562166488	3.326621822	6.693905945	0	0.006690675	5.478334844	5.743516763	19.73006631	0.510535671	0.660549592	0	0	3.116596939	1.155671289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7347	0	0	17.1905	0.41520209	8.556466664	0	1.470439346	2.144627941	2.123203649	3.849611921	5.562166488	3.326621822	6.693905945	0	0.006690675	5.478334844	5.743516763	19.73006631	0.510535671	0.660549592	0	0	3.116596939	1.155671289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7347	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.2338	0.054	3.4106	0	0.5033	0.7341	0.7267	1.3177	1.9038	1.1386	2.2912	0	0.0023	1.8751	1.8638	6.4025	0.1657	0.2144	0	0	1.0113	0.375	0	0	0	0	0	0	0	0											26.2239	0	0	19.4242	0.469154903	11.96708624	0	1.973744089	2.878695223	2.849937784	5.167264324	7.465995286	4.46526419	8.98510865	0	0.008980772	7.35346959	7.60730697	26.13253816	0.676206187	0.874900121	0	0	4.127942965	1.53069045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9585
H1108_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	215.9904837	5.21683076	50.39513876	759.4011576	6.31089848	9.204411765	9.112462012	16.52193958	23.87195918	14.27734687	28.72921006	0	0.028715343	23.51216671	24.65028654	84.6783962	2.191140218	2.834976788	0	0	13.37595253	4.959962616	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.1905	0.41520209	8.556466664	0	1.470439346	2.144627941	2.123203649	3.849611921	5.562166488	3.326621822	6.693905945	0	0.006690675	5.478334844	5.743516763	19.73006631	0.510535671	0.660549592	0	0	3.116596939	1.155671289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7347	0	0	17.1905	0.41520209	8.556466664	0	1.470439346	2.144627941	2.123203649	3.849611921	5.562166488	3.326621822	6.693905945	0	0.006690675	5.478334844	5.743516763	19.73006631	0.510535671	0.660549592	0	0	3.116596939	1.155671289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.7347	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.2338	0.054	3.4106	0	0.5033	0.7341	0.7267	1.3177	1.9038	1.1386	2.2912	0	0.0023	1.8751	1.8638	6.4025	0.1657	0.2144	0	0	1.0113	0.375	0	0	0	0	0	0	0	0											26.2239	0	0	19.4242	0.469154903	11.96708624	0	1.973744089	2.878695223	2.849937784	5.167264324	7.465995286	4.46526419	8.98510865	0	0.008980772	7.35346959	7.60730697	26.13253816	0.676206187	0.874900121	0	0	4.127942965	1.53069045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9585
H1109_001_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1380.457723	73.31730985	1016.764219	561.5612444	206.9803912	7.068295231	0	271.2629581	398.4721337	2334.90264	2573.549167	34.77975595	0.216476425	83.51413798	3624.400381	5098.629445	181.4815164	556.8352678	0	0	278	0	0	0	721.6449697	0	43.47023609	0	100.9998019	0												$230/day 1-7	$230/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$225 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$0 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											166.2566679	166.2566679	47.56208437	0	100	0.2	0.2	47.5	225	5.25	45.5	35	25	35	0	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	166.2566679	166.2566679	47.56208437	0	100	0.2	0.2	47.5	225	5.25	45.5	35	25	35	0	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												19.1259	1.01579097	4.029952132	0	1.724836593	1.413659046	0	1.073749209	7.471352506	1.021519905	9.758040591	0.101440955	0.000450993	0.243582902	0	14.87100255	0.529321089	1.624102864	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0472	0	0	19.1259	1.01579097	4.029952132	0	1.724836593	1.413659046	0	1.073749209	7.471352506	1.021519905	9.758040591	0.101440955	0.000450993	0.243582902	0	14.87100255	0.529321089	1.624102864	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0472	NO																																																																					0	0	0											0			19.1259	1.01579097	4.029952132	0	1.724836593	1.413659046	0	1.073749209	7.471352506	1.021519905	9.758040591	0.101440955	0.000450993	0.243582902	0	14.87100255	0.529321089	1.624102864	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0472
H1109_003_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1485.667228	207.5173623	939.070926	949.4421362	201.4602075	10.4771325	0	273.6801556	408.1428825	3157.276071	2861.79401	79.33140364	0.189150793	239.3112649	3954.468393	5837.796798	278.1685449	686.364234	0	0	278	0	0	0	718.4648575	0	55.07282975	0	88.44305602	0												$0 	$0 	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$25 per visit	$25 X-ray; $175 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$0 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											0	0	47.56208437	0	100	0.2	0.2	47.5	150	3.75	42.5	25	25	25	0	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											NO	0	0	47.56208437	0	100	0.2	0.2	47.5	150	3.75	42.5	25	25	25	0	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0												0	0	3.722014218	0	1.678835062	2.095426499	0	1.083317282	5.101786031	0.986648772	10.13552045	0.165273758	0.000394064	0.498565135	0	12.16207666	0.579517802	1.429925488	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6818	0	0	0	0	3.722014218	0	1.678835062	2.095426499	0	1.083317282	5.101786031	0.986648772	10.13552045	0.165273758	0.000394064	0.498565135	0	12.16207666	0.579517802	1.429925488	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6818	NO																												0	0																																								0	0	0											0			0	0	3.722014218	0	1.678835062	2.095426499	0	1.083317282	5.101786031	0.986648772	10.13552045	0.165273758	0.000394064	0.498565135	0	12.16207666	0.579517802	1.429925488	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6818
H1109_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	331.6985129	5.097297545	44.42210457	6.884769931	8.807717994	11.12029558	0	11.11435829	38.00387932	13.15051832	57.78900862	0.771297691	0.014673425	25.33591957	20.12554159	126.8543651	2.441953156	6.298507575	0	-9.96E-09	66.02927884	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												26.3995	0.405688566	7.542319879	0	2.052198293	2.591028869	0	2.589645481	8.854903881	3.064070769	13.46483901	0.179712362	0.003418908	5.90326926	4.689251192	29.55706708	0.568975085	1.467552265	0	-2.32E-09	15.38482197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7183			26.3995	0.405688566	7.542319879	0	2.052198293	2.591028869	0	2.589645481	8.854903881	3.064070769	13.46483901	0.179712362	0.003418908	5.90326926	4.689251192	29.55706708	0.568975085	1.467552265	0	-2.32E-09	15.38482197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7183	NO																																																																																		0			26.3995	0.405688566	7.542319879	0	2.052198293	2.591028869	0	2.589645481	8.854903881	3.064070769	13.46483901	0.179712362	0.003418908	5.90326926	4.689251192	29.55706708	0.568975085	1.467552265	0	-2.32E-09	15.38482197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.7183
H1109_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	279.6245272	3.817971101	32.41153231	7.096812853	8.32353564	9.708728524	0	12.43293638	35.87268062	14.40783002	65.64192162	0.480294807	0.009137289	23.91512081	27.02977611	116.0748172	2.047947499	5.903080233	0	-6.20E-09	67.01053991	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.255	0.303868316	5.503074354	0	1.939383804	2.262133746	0	2.896874175	8.358334584	3.357024395	15.29456774	0.11190869	0.002128988	5.572223149	6.297937833	27.04543241	0.477171767	1.375417694	0	-1.45E-09	15.6134558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.666			22.255	0.303868316	5.503074354	0	1.939383804	2.262133746	0	2.896874175	8.358334584	3.357024395	15.29456774	0.11190869	0.002128988	5.572223149	6.297937833	27.04543241	0.477171767	1.375417694	0	-1.45E-09	15.6134558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.666	NO																																																																																		0			22.255	0.303868316	5.503074354	0	1.939383804	2.262133746	0	2.896874175	8.358334584	3.357024395	15.29456774	0.11190869	0.002128988	5.572223149	6.297937833	27.04543241	0.477171767	1.375417694	0	-1.45E-09	15.6134558	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.666
H1110_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	9.714015394	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0												$125/day 1-10	$125/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$10 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											102.4559256	102.4559256	47.56208437	0	100	0.2	0.2	47.5	150	5.25	45.5	35	25	35	10	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											YES	102.4559256	102.4559256	47.56208437	0	100	0.2	0.2	47.5	150	5.25	45.5	35	25	35	10	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											5000	12.8705	0.572108411	4.072287893	0	1.721475931	1.942803079	0	0.842925383	4.416473049	0.842488183	9.661395397	0.138262504	0.000638557	0	3.388966304	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4284	0	0	12.8705	0.572108411	4.072287893	0	1.721475931	1.942803079	0	0.842925383	4.416473049	0.842488183	9.661395397	0.138262504	0.000638557	0	3.388966304	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4284	NO	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$100 copay	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$50 copay	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$25 copay	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP	$0 ded; 35% coinsurance; $5000 max OOP		0	0	$0 ded; 35% coinsurance; $5000 max OOP	0	$0 ded; 35% coinsurance; $5000 max OOP	0	0	$Not Covered copay												6.3023	0	0.844	0.1308	0.107	0.2113	0	0.0551	0.7221	0.2499	1.098	0.0147	0	0.4814	0.3824	2.4103	0.0464	0.1197	0	0	1.2546	0	0	0	0.1539	0	0.01	0	0	0											14.5937	0	13.58622528	19.1728	0.572108411	4.916315379	0.130811791	1.828457241	2.154090572	0	0.89806611	5.138553172	1.092350251	10.75939632	0.15291729	0.00067824	0.481386749	3.771354992	17.47103974	0.602648388	1.543338509	0	-1.89E-10	2.171967445	0	0	0	0.153860241	0	0.009967632	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0221
H1110_003_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1598.393271	169.9526038	807.8561168	574.5220634	207.9368269	10.12071865	0	254.2659901	357.1513385	2494.165887	2704.847581	49.21038153	0.237913102	161.1726423	3994.649036	5560.045361	381.4330679	629.6573345	0	0	244.64	0	0	0	808.5192694	0	56.39905892	0	159.0643652	0												$100/day 1-8	$100/day 1-8	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$5 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											76.18318861	76.18318861	47.56208437	0	100	0.2	0.2	47.5	150	4.5	44	30	25	30	5	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											YES	76.18318861	76.18318861	47.56208437	0	100	0.2	0.2	47.5	150	4.5	44	30	25	30	5	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											3500	10.1476	1.078960939	3.201943399	0	1.732806891	2.024143731	0	1.006469544	4.464391731	0.935312207	9.917774464	0.123025954	0.000495652	0.402931606	1.664437098	13.9001134	0.95358267	1.574143336	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0455	0	0	10.1476	1.078960939	3.201943399	0	1.732806891	2.024143731	0	1.006469544	4.464391731	0.935312207	9.917774464	0.123025954	0.000495652	0.402931606	1.664437098	13.9001134	0.95358267	1.574143336	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0455	NO	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$100 copay	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$50 copay	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$25 copay	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP	$0 ded; 35% coinsurance; $3500 max OOP		0	0	$0 ded; 35% coinsurance; $3500 max OOP	0	$0 ded; 35% coinsurance; $3500 max OOP	0	0	$Not Covered copay												5.3585	0	0.6146	0.0982	0.0894	0.1827	0	0.0546	0.5938	0.2745	1.0167	0.0117	0	0.3959	0.4873	2.2462	0.0812	0.1098	0	0	1.0307	0	0	0	0.1267	0	0.0083	0	0	0											12.7807	0	16.96044799	15.506	1.078960939	3.816573974	0.098226145	1.822163946	2.206809882	0	1.061102628	5.058185064	1.209825325	10.93447093	0.134717992	0.000521212	0.798793807	2.151738054	16.14632332	1.03481247	1.683949718	0	-1.25E-10	1.948092018	0	0	0	0.126651679	0	0.008261124	0	0	0	0	0	0	0	0	0	0	0	0	0	66.8262
H1110_801_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	323.6135433	4.97305371	43.3393401	6.716957435	8.593034692	10.84924446	0	10.84345189	37.07755558	12.82998164	56.38043318	0.752497732	0.014315768	24.71837041	19.63499254	123.7623595	2.382431885	6.144984903	0	-9.72E-09	64.41985133	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.7561	0.39580013	7.358479963	0	2.002177083	2.52787396	0	2.52652429	8.639070449	2.989385722	13.13664093	0.175331972	0.003335574	5.759380305	4.574953262	28.83662975	0.555106629	1.431781482	0	-2.26E-09	15.00982536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.6784			25.7561	0.39580013	7.358479963	0	2.002177083	2.52787396	0	2.52652429	8.639070449	2.989385722	13.13664093	0.175331972	0.003335574	5.759380305	4.574953262	28.83662975	0.555106629	1.431781482	0	-2.26E-09	15.00982536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.6784	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.5122	0.054	1.0034	0	0.273	0.3447	0	0.3445	1.1781	0.4076	1.7914	0.0239	0.0005	0.7854	0.6239	3.9323	0.0757	0.1952	0	0	2.0468	0	0	0	0	0	0	0	0												16.5925			29.2683	0.449772875	8.361909049	0	2.275201231	2.872584045	0	2.87105033	9.81712551	3.39702923	14.92800106	0.199240877	0.003790425	6.544750346	5.198810525	32.76889745	0.630802988	1.627024412	0	-2.57E-09	17.05661973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.2709
H1110_802_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	323.6135433	4.97305371	43.3393401	6.716957435	8.593034692	10.84924446	0	10.84345189	37.07755558	12.82998164	56.38043318	0.752497732	0.014315768	24.71837041	19.63499254	123.7623595	2.382431885	6.144984903	0	-9.72E-09	64.41985133	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.7561	0.39580013	7.358479963	0	2.002177083	2.52787396	0	2.52652429	8.639070449	2.989385722	13.13664093	0.175331972	0.003335574	5.759380305	4.574953262	28.83662975	0.555106629	1.431781482	0	-2.26E-09	15.00982536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.6784			25.7561	0.39580013	7.358479963	0	2.002177083	2.52787396	0	2.52652429	8.639070449	2.989385722	13.13664093	0.175331972	0.003335574	5.759380305	4.574953262	28.83662975	0.555106629	1.431781482	0	-2.26E-09	15.00982536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.6784	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.5122	0.054	1.0034	0	0.273	0.3447	0	0.3445	1.1781	0.4076	1.7914	0.0239	0.0005	0.7854	0.6239	3.9323	0.0757	0.1952	0	0	2.0468	0	0	0	0	0	0	0	0												16.5925			29.2683	0.449772875	8.361909049	0	2.275201231	2.872584045	0	2.87105033	9.81712551	3.39702923	14.92800106	0.199240877	0.003790425	6.544750346	5.198810525	32.76889745	0.630802988	1.627024412	0	-2.57E-09	17.05661973	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.2709
H1110_804_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	324.0085242	4.979123485	43.39223719	6.725155702	8.603522773	10.86248632	0	10.85668668	37.12280995	12.84564105	56.44924735	0.75341618	0.014333241	24.74853999	19.65895769	123.9134155	2.385339721	6.152485059	0	-9.73E-09	64.49847788	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.7875	0.396283217	7.367461229	0	2.004620806	2.530959313	0	2.529607996	8.649614718	2.993034366	13.15267463	0.17554597	0.003339645	5.766409818	4.580537143	28.87182581	0.555784155	1.433529019	0	-2.27E-09	15.02814535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8269			25.7875	0.396283217	7.367461229	0	2.004620806	2.530959313	0	2.529607996	8.649614718	2.993034366	13.15267463	0.17554597	0.003339645	5.766409818	4.580537143	28.87182581	0.555784155	1.433529019	0	-2.27E-09	15.02814535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8269	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.5165	0.054	1.0047	0	0.2734	0.3451	0	0.3449	1.1795	0.4081	1.7935	0.0239	0.0005	0.7863	0.6246	3.9371	0.0758	0.1955	0	0	2.0493	0	0	0	0	0	0	0	0												16.6128			29.304	0.450321837	8.372115033	0	2.277978189	2.876090128	0	2.874554541	9.829107635	3.401175415	14.94622117	0.199484057	0.003795051	6.552738429	5.205155844	32.80889296	0.631572903	1.629010249	0	-2.58E-09	17.07743789	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.4396
H1110_805_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	302.9654434	4.655748974	40.57408184	6.288383257	8.044757766	10.15701051	0	10.15158753	34.71182927	12.01136713	52.78309048	0.704484759	0.013402353	23.14121954	18.38218562	115.8657259	2.230421276	5.752905323	0	-9.10E-09	60.30955511	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.874428559	2.366583448	0	2.365319894	8.08785622	2.798648541	12.29846008	0.164144949	0.003122748	5.391904152	4.283049249	26.99671414	0.519688157	1.34042694	0	-2.12E-09	14.05212634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5425			0	0	0	0	1.874428559	2.366583448	0	2.365319894	8.08785622	2.798648541	12.29846008	0.164144949	0.003122748	5.391904152	4.283049249	26.99671414	0.519688157	1.34042694	0	-2.12E-09	14.05212634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5425	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2556	0.3227	0	0.3225	1.1029	0.3816	1.6771	0.0224	0.0004	0.7353	0.5841	3.6814	0.0709	0.1828	0	0	1.9162	0	0	0	0	0	0	0	0												11.2558			0	0	0	0	2.130032454	2.689299373	0	2.687863516	9.190745705	3.180282433	13.97552282	0.186528351	0.003548578	6.127163809	4.867101419	30.67808425	0.590554724	1.523212432	0	-2.41E-09	15.96832539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7983
H1110_806_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	302.9654434	4.655748974	40.57408184	6.288383257	8.044757766	10.15701051	0	10.15158753	34.71182927	12.01136713	52.78309048	0.704484759	0.013402353	23.14121954	18.38218562	115.8657259	2.230421276	5.752905323	0	-9.10E-09	60.30955511	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.874428559	2.366583448	0	2.365319894	8.08785622	2.798648541	12.29846008	0.164144949	0.003122748	5.391904152	4.283049249	26.99671414	0.519688157	1.34042694	0	-2.12E-09	14.05212634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5425			0	0	0	0	1.874428559	2.366583448	0	2.365319894	8.08785622	2.798648541	12.29846008	0.164144949	0.003122748	5.391904152	4.283049249	26.99671414	0.519688157	1.34042694	0	-2.12E-09	14.05212634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5425	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2556	0.3227	0	0.3225	1.1029	0.3816	1.6771	0.0224	0.0004	0.7353	0.5841	3.6814	0.0709	0.1828	0	0	1.9162	0	0	0	0	0	0	0	0												11.2558			0	0	0	0	2.130032454	2.689299373	0	2.687863516	9.190745705	3.180282433	13.97552282	0.186528351	0.003548578	6.127163809	4.867101419	30.67808425	0.590554724	1.523212432	0	-2.41E-09	15.96832539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7983
H1110_807_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	302.9654434	4.655748974	40.57408184	6.288383257	8.044757766	10.15701051	0	10.15158753	34.71182927	12.01136713	52.78309048	0.704484759	0.013402353	23.14121954	18.38218562	115.8657259	2.230421276	5.752905323	0	-9.10E-09	60.30955511	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.874428559	2.366583448	0	2.365319894	8.08785622	2.798648541	12.29846008	0.164144949	0.003122748	5.391904152	4.283049249	26.99671414	0.519688157	1.34042694	0	-2.12E-09	14.05212634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5425			0	0	0	0	1.874428559	2.366583448	0	2.365319894	8.08785622	2.798648541	12.29846008	0.164144949	0.003122748	5.391904152	4.283049249	26.99671414	0.519688157	1.34042694	0	-2.12E-09	14.05212634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5425	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2556	0.3227	0	0.3225	1.1029	0.3816	1.6771	0.0224	0.0004	0.7353	0.5841	3.6814	0.0709	0.1828	0	0	1.9162	0	0	0	0	0	0	0	0												11.2558			0	0	0	0	2.130032454	2.689299373	0	2.687863516	9.190745705	3.180282433	13.97552282	0.186528351	0.003548578	6.127163809	4.867101419	30.67808425	0.590554724	1.523212432	0	-2.41E-09	15.96832539	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7983
H1111_002_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1361.999094	101.7294054	602.7252828	610.3006839	151.423752	8.13939275	7.390816118	279.7294106	232.800712	7901.644399	24.8358887	0	0.019820458	382.3563857	4847.895232	3749.249321	427.9967302	279.1717682	0	0	23.88954772	778.5123931	0	0	88.02885733	150.7615125	13.33773508	4.778855492	479.2431817	0											3380	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $150 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	69.22791329	0	150	0.2	0.119678196	49.64725956	150	3	0.17807577	0	0.2	58.55450719	6.933890242	30	38.5	30	0	0	0.2	28.52718791	0	0	30	30	0	0	0	0											NO	134.6332086	102.5395019	56.20909144	0	121.791389	0.162388519	0.097171825	40.31072467	121.791389	2.43582778	0.144587302	0	0.162388519	47.63806738	6.854842683	30	38.5	24.3582778	0	0	0.162388519	28.52718791	0	0	30	30	0	0	0	0												15.2809	0.869273547	2.823220044	0	1.536842424	1.321743931	0.718179088	0.939674604	2.362760173	1.603920411	3.590954142	0	0.003218615	1.517893272	2.769296597	9.373123301	1.373156176	0.566678624	0	0	3.879388265	1.850730777	0	0	0.220072143	0.376903781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9779	0	8.601306958	15.2809	0.869273547	2.823220044	0	1.536842424	1.321743931	0.718179088	0.939674604	2.362760173	1.603920411	3.590954142	0	0.003218615	1.517893272	2.769296597	9.373123301	1.373156176	0.566678624	0	0	3.879388265	1.850730777	0	0	0.220072143	0.376903781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9779	NO	"$275 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$140 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.0072	0.3017	2.156	0.5222	0.6479	0.8358	0.7589	0.3961	2.4419	0.6761	2.2196	0	0.0014	0.9636	1.6173	3.5244	0.5035	0.2642	0	0	2.3257	0.7195	0	0	0.0833	0	0.0126	0	0	0											24.979	0	0	19.288	1.171010961	4.979195184	0.522181106	2.184712504	2.157533925	1.477101817	1.335803089	4.804667682	2.280067834	5.810597318	0	0.004575452	2.481461471	4.386591608	12.89752911	1.876619217	0.830905766	0	0	6.205059467	2.570278759	0	0	0.303388639	0.376903781	0.012623739	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9569
H1111_004_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	335.2495751	18.51511183	1345.13108	1103.910181	10.9008382	16.75568538	15.73155493	25.38880476	26.6289133	12.4912677	31.42427705	0	0.090044284	16.09838189	24.89401292	93.64374848	7.822905439	3.115529222	0	0	17.30031285	4.278750077	568.1459765	161.0251142	100.5506842	183.3023217	0	0	73.2941899	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076800843	0.077733647	43.47002967	0	0.2	0.2	0.2	0.11960918	0.2	0	0.166929672	0	0.2	0.149871443	0.169220018	0.199750517	0.2	0	0	0	0.2	0.199267671	0	0	0	0	0	0	0	0											NO	0.076800843	0.077733647	43.47002967	0	0.2	0.2	0.2	0.11960918	0.2	0	0.166929672	0	0.2	0.149871443	0.169220018	0.199750517	0.2	0	0	0	0.2	0.199267671	0	0	0	0	0	0	0	0												25.7474	1.439247158	4.872740663	0	2.180167641	3.351137075	3.146310985	3.036734116	5.32578266	0	5.245644251	0	0.018008857	2.412687726	4.212565324	18.70538717	1.564581088	0	0	0	3.460062571	0.852616563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5711	0	0	25.7474	1.439247158	4.872740663	0	2.180167641	3.351137075	3.146310985	3.036734116	5.32578266	0	5.245644251	0	0.018008857	2.412687726	4.212565324	18.70538717	1.564581088	0	0	0	3.460062571	0.852616563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5711	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												17.0566	0.942	3.5916	0.5084	0.6462	0.9933	0.9326	0.5997	1.5786	0.2222	1.5548	0	0.0036	0.7151	2.2591	8.6299	0.7209	0	0	0	1.5943	0.3929	0	0	0.0531	0	0	0	0	0											42.9949	0	0	42.804	2.381244076	8.464368226	0.508426685	2.826384995	4.344438185	4.07890017	3.636405021	6.904382909	0.22215009	6.8004909	0	0.021567493	3.127825704	6.471653656	27.33530125	2.28551551	0	0	0	5.054405128	1.245488901	0	0	0.05308925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.566
H1111_005_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2153.581853	214.609893	29.57305141	967.9210822	247.802019	15.28030695	17.72902688	517.126515	40.89331281	12331.74256	39.98852189	0	0.145772771	25.32006643	7127.061203	5511.2607	831.8997359	327.8048982	0	0	25.94876415	1038.423399	674.6059606	0	144.6880833	199.7047974	14.72693841	4.818614004	79.50713107	0											3380	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	0.190113277	0	150	0.2	0.114331111	49.64780642	0.2	3	0.177333005	0	0.2	0.149503139	6.95014326	30	38.5	30	0	0	0.2	29.75849854	0	0	30	30	0	0	0	0											NO	118.1650729	89.99702109	0.135479849	0	106.8940457	0.142525394	0.081475434	35.38036593	0.142525394	2.137880914	0.126372282	0	0.142525394	0.10685702	6.823191746	30	38.5	21.37880914	0	0	0.142525394	29.75849854	0	0	30	30	0	0	0	0												21.2065	1.609520923	4.006552537	0	2.207380029	2.177831772	1.444480151	1.524677111	5.828335532	2.196983088	5.053440776	0	0.020776322	2.705626839	4.052442098	13.77815175	2.669011653	0.58400653	0	0	3.698357841	2.5751601	0	0	0.361720208	0.499261993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.2002	0	21.94675912	21.2065	1.609520923	4.006552537	0	2.207380029	2.177831772	1.444480151	1.524677111	5.828335532	2.196983088	5.053440776	0	0.020776322	2.705626839	4.052442098	13.77815175	2.669011653	0.58400653	0	0	3.698357841	2.5751601	0	0	0.361720208	0.499261993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.2002	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												11.1709	0.3388	1.5046	0.2853	0.3828	0.5666	0.6574	0.2644	1.5163	0.381	1.2858	0	0.0036	0.7112	1.8421	6.6427	0.5744	0.2082	0	0	1.4828	0.3472	0	0	0.0467	0	0.0037	0	0	0											30.2165	0	0	32.3774	1.94832972	5.511146381	0.285273008	2.590220227	2.744404951	2.101848564	1.789111725	7.344604434	2.578020077	6.339230769	0	0.024379693	3.416867379	5.894552969	20.4208799	3.243418613	0.792207695	0	0	5.181144364	2.922364663	0	0	0.408380412	0.499261993	0.003671738	0	0	0	0	0	0	0	0	0	0	0	0	0	108.4168
H1111_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	247.7289957	6.832565345	25.56968757	857.8583117	6.494036217	11.3949119	10.3469265	16.18117217	33.29223985	16.15834994	34.76951812	0	0.027748062	17.64674247	29.56161115	106.9776377	4.267757381	3.719831741	0	0	33.00169268	5.69928296	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078780698	0.078780698	0.190177924	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078780698	0.078780698	0.190177924	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7	0	0	19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7
H1111_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	247.7289957	6.832565345	25.56968757	857.8583117	6.494036217	11.3949119	10.3469265	16.18117217	33.29223985	16.15834994	34.76951812	0	0.027748062	17.64674247	29.56161115	106.9776377	4.267757381	3.719831741	0	0	33.00169268	5.69928296	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078780698	0.078780698	0.190177924	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078780698	0.078780698	0.190177924	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7	0	0	19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7
H1111_805_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	247.7289957	6.832565345	25.56968757	857.8583117	6.494036217	11.3949119	10.3469265	16.18117217	33.29223985	16.15834994	34.76951812	0	0.027748062	17.64674247	29.56161115	106.9776377	4.267757381	3.719831741	0	0	33.00169268	5.69928296	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078780698	0.078780698	0.190177924	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078780698	0.078780698	0.190177924	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7	0	0	19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7
H1111_807_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	247.7289957	6.832565345	25.56968757	857.8583117	6.494036217	11.3949119	10.3469265	16.18117217	33.29223985	16.15834994	34.76951812	0	0.027748062	17.64674247	29.56161115	106.9776377	4.267757381	3.719831741	0	0	33.00169268	5.69928296	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078780698	0.078780698	0.190177924	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078780698	0.078780698	0.190177924	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7	0	0	19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5163	0.538274266	4.862790087	0	1.513110439	2.655014473	2.410833875	3.770213115	7.757091886	3.764895535	8.101297722	0	0.006465299	4.111690996	6.887855398	24.92578958	0.99438747	0.866720796	0	0	7.689394394	1.32793293	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7
H1112_001_0	2010	5	N/A																															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	V	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	Yes	1832.637958	104.75777	401.2353812	566.3234528	326.3630699	5.225496117	6.465217303	1114.326956	243.2051593	3116.301811	997.771279	19.24080155	0.086430396	292.4112794	9439.567679	19171.44958	35.67919153	679.295983	4202.778609	1879.369253	14.35803308	22.59018288	0	375.3333333	288	172.8	16.8	12.8	0	0											3150	"$250 days 1 - 5, $0 after day 5, unlimited coverage"	"$250 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 20, $133.5 days 21 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$250.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $10.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											108.6640084	107.1209903	32.31	7.688635196	53.62442528	0.2	0.092998366	19.89937218	106.3455801	0	69.80659416	70.46953696	0.2	29.23498422	4.906811882	5.980913696	18.64921296	12.55181519	18.9556816	5.579778785	0.2	0	0	0	0	0	0	0	0	0											NO	101.3734438	99.93395102	30.14223401	7.172783699	50.0266164	0.186581455	0.086758852	18.56426905	99.2105652	0	65.12307945	65.7415436	0.186581455	27.27352943	4.577600496	5.579637891	17.39798642	11.70967969	17.68389324	5.205416214	0.186581455	0	0	0	0	0	0	0	0	0												15.4817	0.872404821	1.00784423	0.338509636	1.360570009	0.974980667	0.560914834	1.723888785	2.010710109	0	5.41482819	0.10541	0.016126309	0.664590636	3.600880807	8.91414554	0.051728841	0.662861531	6.193457353	0.815241598	2.678942699	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4498	0	3.843995004	15.4817	0.872404821	1.00784423	0.338509636	1.360570009	0.974980667	0.560914834	1.723888785	2.010710109	0	5.41482819	0.10541	0.016126309	0.664590636	3.600880807	8.91414554	0.051728841	0.662861531	6.193457353	0.815241598	2.678942699	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4498	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.4817	0.872404821	1.00784423	0.338509636	1.360570009	0.974980667	0.560914834	1.723888785	2.010710109	0	5.41482819	0.10541	0.016126309	0.664590636	3.600880807	8.91414554	0.051728841	0.662861531	6.193457353	0.815241598	2.678942699	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4498
H1112_003_0	2010	4	N/A																															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	V	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	Yes	1296.904224	88.27145565	374.5702379	546.9361948	392.5347875	7.71762438	3.407623179	1188.04331	232.5362615	3574.768057	1032.922872	34.24175505	0.034778392	294.4891214	7647.543196	18300.41656	240.3071394	1691.331506	3969.599748	1860.845503	27.60013298	18.07302955	0	486.6666667	288	172.8	16.8	12.8	2040	0											3150	"$250 days 1 - 5, $0 after day 5, unlimited coverage"	"$250 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 20, $133.5 days 21 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$250.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $10.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											153.312701	105.9492265	32.31	8.156856324	50.92847619	0.2	0.166137917	20.96258317	112.9930759	0	69.27561608	76.03182003	0.2	24.37511022	4.346443215	8.120834233	24.90571083	15.52797542	34.19199027	8.164166525	0.2	0	0	0	0	0	0	0	0	0											NO	138.6398896	95.80934239	29.21776737	7.37620336	46.05435994	0.180858975	0.150237667	18.9563565	102.1790593	0	62.6455845	68.75518509	0.180858975	22.04228722	3.930466319	7.343628767	22.52210663	14.04186857	30.91964153	7.382813937	0.180858975	0	0	0	0	0	0	0	0	0												14.9836	0.704769177	0.91200884	0.336192716	1.506494866	1.395801633	0.511953355	1.87674771	1.980028037	0	5.39233809	0.196191517	0.006289984	0.540934483	2.504867579	11.19928879	0.451018585	1.979121226	10.22821677	1.144856343	4.991731753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8424	0	6.650862021	14.9836	0.704769177	0.91200884	0.336192716	1.506494866	1.395801633	0.511953355	1.87674771	1.980028037	0	5.39233809	0.196191517	0.006289984	0.540934483	2.504867579	11.19928879	0.451018585	1.979121226	10.22821677	1.144856343	4.991731753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8424	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.9836	0.704769177	0.91200884	0.336192716	1.506494866	1.395801633	0.511953355	1.87674771	1.980028037	0	5.39233809	0.196191517	0.006289984	0.540934483	2.504867579	11.19928879	0.451018585	1.979121226	10.22821677	1.144856343	4.991731753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8424
H1112_005_0	2010	5	N/A																															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	V	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	NO	1785.670917	197.7720521	437.9686138	1222.626351	476.9005176	9.270838285	6.151233318	1806.764763	424.2771504	5610.326808	1734.535731	56.28723801	0.06797207	444.2773088	12497.54229	36109.88924	428.7685859	2818.993827	6157.821971	2682.22691	55.4971456	74.04213314	0	486.6666667	288	172.8	16.8	12.8	2040	0												"$125 days 1 - 5, $0 after day 5, unlimited coverage"	"$125 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 7, $50 days 8 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $75.00 and $100.00	$0.00 copayment	Copay between $0.00 and $150.00	$125.00 copayment	20% coinsurance	Copay between $10.00 and $100.00	$0.00 copayment	Copay between $0.00 and $20.00	Copay between $10.00 and $20.00	$20.00 copayment	Copay between $0.00 and $70.00	Copay between $0.00 and $20.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											83.91215247	50.02042576	34.45	0	44.63950723	0.2	0.153896456	21.33783562	77.83022646	0	60.77664486	93.42048215	0.2	8.247667586	0	4.382809733	13.60402186	8.189353472	32.34331753	4.127221634	0.2	0	0	0	0	0	0	0	0	0											NO	83.91215247	50.02042576	34.45	0	44.63950723	0.2	0.153896456	21.33783562	77.83022646	0	60.77664486	93.42048215	0.2	8.247667586	0	4.382809733	13.60402186	8.189353472	32.34331753	4.127221634	0.2	0	0	0	0	0	0	0	0	0												12.4866	0.824386854	1.257334895	0	1.774050342	1.854167657	0.946653009	3.212704126	2.751798891	0	8.784938511	0.43819841	0.013594414	0.305354297	0	13.1885645	0.486081435	1.923811407	16.59703261	0.922512077	11.09942912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8672	0	0	12.4866	0.824386854	1.257334895	0	1.774050342	1.854167657	0.946653009	3.212704126	2.751798891	0	8.784938511	0.43819841	0.013594414	0.305354297	0	13.1885645	0.486081435	1.923811407	16.59703261	0.922512077	11.09942912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8672	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.4866	0.824386854	1.257334895	0	1.774050342	1.854167657	0.946653009	3.212704126	2.751798891	0	8.784938511	0.43819841	0.013594414	0.305354297	0	13.1885645	0.486081435	1.923811407	16.59703261	0.922512077	11.09942912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8672
H1112_006_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	317.9981177	23.75501138	181.7513156	356.5952351	16.79060884	11.16460015	5.29941565	30.6545803	24.29927659	6470.310044	21.49712525	0.762506813	0.024305886	6.94127148	10207.65203	124.7662176	3.447471949	5.123455289	34.00304429	12.05950146	25.54472853	0.57710674	0	724.2	0.96	172.8	0.056	0.224	2040	0												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	Not Covered	"$0.00 copayment, $1,000 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											656.987252	358.8645274	62.29755262	0	0.169516544	0.170000494	0.103611674	0.102942523	0.17	0	0.170175542	0.248687173	0.17	0.170297457	0	0.099012772	0.421212158	0.170016011	0.156039754	0.076292247	0.170009941	0.17	0	0	0	0	0	0	0	0											NO	656.987252	358.8645274	62.29755262	0	0.169516544	0.170000494	0.103611674	0.102942523	0.17	0	0.170175542	0.248687173	0.17	0.170297457	0	0.099012772	0.421212158	0.170016011	0.156039754	0.076292247	0.170009941	0.17	0	0	0	0	0	0	0	0												17.4101	0.710402578	0.943555179	0	2.84628598	1.897987542	0.549081328	3.155659834	4.13087702	0	3.658284939	0.189625664	0.004132001	1.18208088	0	12.35344911	1.452117099	0.871069432	5.305826672	0.920046469	4.34285778	0.098108146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0215	0	0	17.4101	0.710402578	0.943555179	0	2.84628598	1.897987542	0.549081328	3.155659834	4.13087702	0	3.658284939	0.189625664	0.004132001	1.18208088	0	12.35344911	1.452117099	0.871069432	5.305826672	0.920046469	4.34285778	0.098108146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0215	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.4101	0.710402578	0.943555179	0	2.84628598	1.897987542	0.549081328	3.155659834	4.13087702	0	3.658284939	0.189625664	0.004132001	1.18208088	0	12.35344911	1.452117099	0.871069432	5.305826672	0.920046469	4.34285778	0.098108146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0215
H1112_027_0	2010	5	N/A																															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	V	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	Yes	1822.473495	126.3744593	366.4240356	786.8340543	551.8892895	7.402304668	3.732147426	1739.559945	250.8286308	5147.795514	1377.939479	46.67200815	0.039966754	704.7928106	10607.28942	21802.63633	292.8518272	2174.640801	4714.711638	2415.913703	43.54559353	122.696649	0	375.3333333	288	172.8	16.8	12.8	2040	0											3250	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $15.00 and $150.00	Copay between $0.00 and $10.00	Copay between $0.00 and $30.00	Copay between $15.00 and $25.00	$25.00 copayment	Copay between $0.00 and $75.00	Copay between $0.00 and $25.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											143.3665085	103.0950728	54.67	8.502814033	45.0653457	0.2	0.136995324	21.98997667	135.0560631	0	66.91589506	61.88477457	0.2	17.03275197	4.12419764	6.331960937	17.45173082	14.53316834	31.32375308	7.222173308	0.2	0	0	0	0	0	0	0	0	0											NO	125.585795	90.30893484	47.88967439	7.448271363	39.47621606	0.175195443	0.120004783	19.26271853	118.3060341	0	58.61679944	54.20965252	0.175195443	14.92030264	3.612703166	5.546653512	15.28731857	12.73072434	27.43889401	6.326459266	0.175195443	0	0	0	0	0	0	0	0	0												19.0731	0.951061901	1.462327313	0.488379463	1.815541736	1.296850047	0.44787554	2.792387799	2.472878379	0	6.730866841	0.210839445	0.007001993	0.87631017	3.193415673	10.07763911	0.373076598	2.307062715	10.78053941	1.273681636	7.628989557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2598	0	10.51386476	19.0731	0.951061901	1.462327313	0.488379463	1.815541736	1.296850047	0.44787554	2.792387799	2.472878379	0	6.730866841	0.210839445	0.007001993	0.87631017	3.193415673	10.07763911	0.373076598	2.307062715	10.78053941	1.273681636	7.628989557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2598	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.0731	0.951061901	1.462327313	0.488379463	1.815541736	1.296850047	0.44787554	2.792387799	2.472878379	0	6.730866841	0.210839445	0.007001993	0.87631017	3.193415673	10.07763911	0.373076598	2.307062715	10.78053941	1.273681636	7.628989557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2598
H1170_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	Coin	T	V	V	P	V	P	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	YES	1266.316313	41.17232391	446.5034309	0	260.9113419	9.055876608	0.739425711	245.9618865	187.5208061	575.9330988	842.8799322	0	0	311.9091607	7453.915018	3567.576818	251.959228	393.5535065	42.56846225	0	747.3225021	0	0	351.17	141.8921456	0	47.70008393	0	0	0											2700	"$150 per Day, days 1-7, $0 per Day, days 8-365"	"$150 per Day, days 1-7, $0 per Day, days 8-365"	$125/day for days 21-100	0	$200 per trip	"20% coinsurance, 0% diabetic monitoring supplies"	20% coinsurance	$50 per visit	$200 per visit	$0-50 per visit	$0-50 per visit	0	0	$30-$50 per visit	"$15 per visit, $0 per preventive service visit"	$30 per visit	$15 Group Therapy & $30 Individual Therapy	$30 per visit	$0-30 per visit	0	"$8 generic Kaiser retail, $40 brand Kaiser retail, $24 Generic community pharmacy, $60 Brand community pharmacy"	20% coinsurance Medicare covered Optical	0	20% coinsurance	$30 per visit	0	$30 per visit	0	$0 - $75 copay (varies by class)	0											107.6789378	107.6789378	46.56217243	0	200	0.136764706	0.2	50	200	6.05228471	6.848869367	0	0	35.69832402	13.80100141	30.06554272	27.75	30	10.95684681	0	24	0.059713974	0	0.2	30	0	30	0	37.5	0											NO	78.5789972	78.5789972	7.563155598	0	176.0728993	0.120402791	0.176072899	44.01822484	176.0728993	5.328216583	6.029501434	0	0	31.42753706	12.14991166	26.46863639	24.43011478	26.4109349	9.646018929	0	24	0.052570063	0	0.176072899	26.4109349	0	26.4109349	0	33.01366863	0												8.2922	0.26960666	0.281414577	0	3.828284704	1.090352823	0.130192829	0.902233802	2.751444335	0.255724691	0.423512147	0	0	0.816878059	7.547034083	7.869074465	0.512949405	0.866176337	0.034218016	0	1.494645004	0	0	0.005152627	0.312292018	0	0.104983651	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7883	0	8.352088456	8.2922	0.26960666	0.281414577	0	3.828284704	1.090352823	0.130192829	0.902233802	2.751444335	0.255724691	0.423512147	0	0	0.816878059	7.547034083	7.869074465	0.512949405	0.866176337	0.034218016	0	1.494645004	0	0	0.005152627	0.312292018	0	0.104983651	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7883	NO																																																																																		0	0	0	8.2922	0.26960666	0.281414577	0	3.828284704	1.090352823	0.130192829	0.902233802	2.751444335	0.255724691	0.423512147	0	0	0.816878059	7.547034083	7.869074465	0.512949405	0.866176337	0.034218016	0	1.494645004	0	0	0.005152627	0.312292018	0	0.104983651	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7883
H1170_008_0	2010	7	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	Coin	T	V	V	P	V	P	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	YES	408.5619952	10.69223723	715.0049678	0	454.6246125	20.01497955	2.025365926	380.9092824	232.8387972	920.0459065	1181.976617	1.614964211	49.88091276	529.9119645	10158.6569	4729.509017	429.287306	535.5834288	56.50134042	1105.063687	1051.175316	0	0	0	202.5166247	0	66.76252157	0	0	0											2700	$12.50 per admit	$12.50 per admit	0	0	$25 per trip	0	0	$50.00 per visit	$3 per visit	$0-3 per visit	$0 per visit	$50 per visit	$0 per visit	$3 per visit	$0 per visit	$3 per visit	$3 per visit	$3 per visit	$0-3 per visit	$3 per visit	$3 per script	0	0	0	$3 per visit	0	$3 per visit	0	$2 per visit	0											12.5	12.5	0	0	25	0	0	50	3	0.395256917	0.481751825	50	0	3	0	3.015037051	2.55	3	0.868575045	3	3	0	0	0	3	0	3	0	1.5	0											NO	12.49496677	12.49496677	0	0	24.98993354	0	0	49.97986709	2.998792025	0.395097764	0.481557843	49.97986709	0	2.998792025	0	3.013823022	2.548973222	2.998792025	0.868225306	2.998792025	3	0	0	0	2.998792025	0	2.998792025	0	1.499396013	0												0.4254	0.011133262	0	0	0.946753238	0	0	1.586482942	0.058186261	0.03029234	0.047432509	0.006726308	0	0.132424648	0	1.187825263	0.091186821	0.133841943	0.004087991	0.276154681	0.262793829	0	0	0	0.05060877	0	0.01668391	0	0	0	0	0	0	0	0	0	0	0	0	0	5.268	0	0.002016211	0.4254	0.011133262	0	0	0.946753238	0	0	1.586482942	0.058186261	0.03029234	0.047432509	0.006726308	0	0.132424648	0	1.187825263	0.091186821	0.133841943	0.004087991	0.276154681	0.262793829	0	0	0	0.05060877	0	0.01668391	0	0	0	0	0	0	0	0	0	0	0	0	0	5.268	NO																																																																																		0	0	0	0.4254	0.011133262	0	0	0.946753238	0	0	1.586482942	0.058186261	0.03029234	0.047432509	0.006726308	0	0.132424648	0	1.187825263	0.091186821	0.133841943	0.004087991	0.276154681	0.262793829	0	0	0	0.05060877	0	0.01668391	0	0	0	0	0	0	0	0	0	0	0	0	0	5.268
H1170_009_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	Coin	T	V	V	P	V	P	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	YES	767.3208242	29.32097814	236.0965489	0	158.7850752	5.10060884	0.331854259	169.9851502	123.3681901	373.4949073	539.145721	0	0	219.9708901	5176.95017	2357.008527	157.7717121	247.6741251	28.65261239	0	449.5446354	0	0	0	95.44321956	0	25.90880617	0	0	0											3250	"$200 per Day, days 1-7, $0 per Day, days 8-365"	"$200 per Day, days 1-7, $0 per Day, days 8-365"	$125/day for days 21-100	0	$200 per trip	"20% coinsurance, 0% diabetic monitoring supplies"	20% coinsurance	$50 per visit	$200 per visit	$0-50 per visit	$0-50 per visit	0	0	$40-$50 per visit	"$25 per visit, $0 per preventive service visit"	$40 per visit	$20 Group Therapy & $40 Individual Therapy	$40 per visit	$0-40 per visit	0	"$10 generic Kaiser retail, $40 brand Kaiser retail, $24 Generic community pharmacy, $60 Brand community pharmacy"	20% coinsurance Medicare covered Optical	0	0	$40 per visit	0	$40 per visit	0	$0 - $75 copay (varies by class)	0											143.5719171	143.5719171	46.56217243	0	200	0.037090909	0.2	50	200	7.317073171	10.8490566	0	0	41.96078431	22.33624454	40	37	40	17.93986357	0	40	0.059713974	0	0	40	0	40	0	37.5	0											NO	102.4019785	102.4019785	8.06549419	0	174.9069261	0.032437284	0.174906926	43.72673151	174.9069261	6.39903388	9.487875706	0	0	36.696159	19.53381936	34.98138521	32.35778132	34.98138521	15.68903195	0	40	0.052221938	0	0	34.98138521	0	34.98138521	0	32.79504863	0												6.5479	0.250210514	0.158686279	0	2.314384118	0.1654499	0.058043608	0.619407919	1.798162575	0.199167214	0.426278966	0	0	0.672673896	8.427134121	6.870951937	0.425428546	0.721998665	0.037460979	0	1.498482118	0	0	0	0.278228002	0	0.075527161	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5456	0	6.80320863	6.5479	0.250210514	0.158686279	0	2.314384118	0.1654499	0.058043608	0.619407919	1.798162575	0.199167214	0.426278966	0	0	0.672673896	8.427134121	6.870951937	0.425428546	0.721998665	0.037460979	0	1.498482118	0	0	0	0.278228002	0	0.075527161	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5456	NO																																																																																		0	0	0	6.5479	0.250210514	0.158686279	0	2.314384118	0.1654499	0.058043608	0.619407919	1.798162575	0.199167214	0.426278966	0	0	0.672673896	8.427134121	6.870951937	0.425428546	0.721998665	0.037460979	0	1.498482118	0	0	0	0.278228002	0	0.075527161	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5456
H1170_801_0	2010	4	N/A	i.2.										Professional																				Coin	Coin	Coin	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin	T	V	V	P	V	P	V	V	Coin										19.92	0.16	1.31	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.67										23.06	YES	196.0906256	1.532101942	12.88849464	0	178.6994447	13.52752905	1.094705027	220.2430186	223.6736101	497.1547686	789.0176692	0	0	324.1427029	7959.607307	4133.058779	249.4554912	507.7445023	44.77169766	0	803.372762	0	0	0	140.2056981	0	42.69044449	0	0	0	16.48341797										3400	10% Coinsurance	10% Coinsurance	10% coinsurance	0	$150 per trip	"20% coinsurance, 0% diabetic monitoring supplies"	20% coinsurance	$50 per visit	$300 per visit	$0-$300 per visit	$0-$300 per visit	0	0	$50-$300 per visit	"$35 per visit, $0 per preventive service visit"	$50 per visit	$25 Group Therapy & $50 Individual Therapy	$50 per visit	$0-$300 per visit	0	"$20 generic Kaiser retail, $40 brand Kaiser retail"	20% coinsurance Medicare covered Optical	0	0	$50 per visit	0	$50 per visit	0	0	0	10% coinsurance										0.1	0.1	0.037249738	0	150	0.131114809	0.2	50	300	47.42857143	45.53928096	0	0	128.7337662	32.71949158	50.07491724	46.25	50	101.2352669	0	30	0.059713974	0	0	50	0	50	0	0	0	0.1										NO	0.016163977	0.016163977	0.016163977	0	63.58005221	0.055575243	0.084773403	21.19335074	127.1601044	20.10340699	19.30259907	0	0	54.56599719	13.86871322	21.22510569	19.60384943	21.19335074	42.91029037	0	30	0.025310784	0	0	21.19335074	0	21.19335074	0	0	0	0.042386701											3.1696	0.02476486	0.208329325	0	0.946810002	0.751795708	0.09280187	0.388973962	2.370196635	0.832875387	1.269174311	0	0	1.473930818	9.199125925	7.310384116	0.407523991	0.896733944	0.160097212	0	2.008431905	0	0	0	0.247619045	0	0.07539613	0	0	0	0.698677717	0	0	0	0	0	0	0	0	0	32.5332	500	53.70487639	23.0896	0.18476486	1.518329325	0	0.946810002	0.751795708	0.09280187	0.388973962	2.370196635	0.832875387	1.269174311	0	0	1.473930818	9.199125925	7.310384116	0.407523991	0.896733944	0.160097212	0	2.008431905	0	0	0	0.247619045	0	0.07539613	0	0	0	2.368677717	0	0	0	0	0	0	0	0	0	55.5932	NO																																																																																		0	0	0	23.0896	0.18476486	1.518329325	0	0.946810002	0.751795708	0.09280187	0.388973962	2.370196635	0.832875387	1.269174311	0	0	1.473930818	9.199125925	7.310384116	0.407523991	0.896733944	0.160097212	0	2.008431905	0	0	0	0.247619045	0	0.07539613	0	0	0	2.368677717	0	0	0	0	0	0	0	0	0	55.5932
H1170_802_0	2010	4	N/A	i.2.										Professional										0										Coin	Coin	Coin	V	T	Coin	Coin	V	V	V	V	Coin	V	V	V	V	V	V	V	V	S	Coin	T	V	V	P	V	P	V	V	Coin	0	0	0	0	0	0	0	0	0	19.75	0.08	1.97	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.06	0	0	0	0	0	0	0	0	0	23.86	YES	233.8131984	0.965971767	23.2841655	0	229.4998198	15.33229336	0.629275669	242.6527806	230.2082063	729.3938057	948.2831264	0	0	391.7249895	8418.677294	4271.789353	254.8645212	687.6078472	49.64082378	0	861.2653544	0	0	0	160.4029442	0	44.2034888	0	0	0	24.3575464	0	0	0	0	0	0	0	0	0	3400	10% Coinsurance	10% Coinsurance	10% coinsurance	0	$150 per trip	"20% coinsurance, 0% diabetic monitoring supplies"	20% coinsurance	$50 per visit	$300 per visit	$0-$300 per visit	$0-$300 per visit	0	0	$50-$300 per visit	"$35 per visit, $0 per preventive service visit"	$50 per visit	$25 Group Therapy & $50 Individual Therapy	$50 per visit	$0-$300 per visit	0	"$20 generic Kaiser retail, $40 brand Kaiser retail"	20% coinsurance Medicare covered Optical	0	0	$50 per visit	0	$50 per visit	0	0	0	10% coinsurance	0	0	0	0	0	0	0	0	0	0.1	0.1	0.037249738	0	150	0.140043447	0.2	50	300	34.83358548	41.75900277	0	0	131.9362951	32.71320647	50.06382793	46.25	50	101.4453961	0	30	0.059713974	0	0	50	0	50	0	0	0	0.1	0	0	0	0	0	0	0	0	0	NO	0.016163977	0.016163977	0.016163977	0	63.58005221	0.059359798	0.084773403	21.19335074	127.1601044	14.76480789	17.70026384	0	0	55.92344352	13.86604917	21.22040529	19.60384943	21.19335074	42.99935721	0	30	0.025310784	0	0	21.19335074	0	21.19335074	0	0	0	0.042386701	0	0	0	0	0	0	0	0	0		3.7794	0.015613945	0.376364704	0	1.215967544	0.910121832	0.05334584	0.428552124	2.43944163	0.897446618	1.398738461	0	0	1.825550861	9.727816109	7.554091783	0.416360475	1.214392856	0.177876959	0	2.153163386	0	0	0	0.283289655	0	0.078068337	0	0	0	1.032436048	0	0	0	0	0	0	0	0	0	35.978	0	1.378176229	23.5294	0.095613945	2.346364704	0	1.215967544	0.910121832	0.05334584	0.428552124	2.43944163	0.897446618	1.398738461	0	0	1.825550861	9.727816109	7.554091783	0.416360475	1.214392856	0.177876959	0	2.153163386	0	0	0	0.283289655	0	0.078068337	0	0	0	3.092436048	0	0	0	0	0	0	0	0	0	59.838	NO																																																																																		0	0	0	23.5294	0.095613945	2.346364704	0	1.215967544	0.910121832	0.05334584	0.428552124	2.43944163	0.897446618	1.398738461	0	0	1.825550861	9.727816109	7.554091783	0.416360475	1.214392856	0.177876959	0	2.153163386	0	0	0	0.283289655	0	0.078068337	0	0	0	3.092436048	0	0	0	0	0	0	0	0	0	59.838
H1170_805_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	V	V	S	Coin	T	Coin	V	P	V	P	V	V											17.6	0.07	1.65	0	0	1.01	0.04	0	2.56	0.05	0.92	0	0	1	0	0	0	0.32	0	0	0	0	0	0	0	0	0	0	0	0											25.22	YES	1258.27707	17.49588668	0	0	229.4998198	13.51385435	0.573384595	242.6527806	34.26651995	0.614309642	12.30822752	0	0	364.4470901	8418.677294	4271.789353	254.8645212	4.252593049	49.64082378	0	861.2653544	0	0	0	160.4029442	0	44.2034888	0	0	0											2500	"$250 per Day, days 1-3 after the $500 deductible is met, $0 per Day, days 4-365"	"$250 per Day, days 1-3 after the $500 deductible is met, $0 per Day, days 4-365"	0	0	$125 per trip	"20% coinsurance, 0% diabetic monitoring supplies"	20% coinsurance	$50 per visit	20% coinsurance	20% coinsurance	20% coinsurance	0	0	$15 - 20% coinsurance	"$20 per visit, $0 per preventive service visit"	$30 per visit	$15 Group Therapy & $30 Individual Therapy	20% coinsurance	$0 per visti -20% coinsurance	0	"$20 generic Kaiser retail, $30 brand Kaiser retail"	20% coinsurance Medicare covered Optical	0	$30 - 20% coinsurance	$30 per visit	0	$30 per visit	0	0	0											250	250	0	0	125	0.076140613	0.2	50	0.2	0.024597057	0.02824342	0	0	155.5747029	18.34306746	30.03829676	27.75	0.2	60.15713397	0	25	0.059713974	0	0	30	0	30	0	0	0											NO	52.55132404	52.55132404	0	0	86.9343495	0.052953878	0.139094959	34.7737398	0.139094959	0.017106633	0.019642587	0	0	108.1982847	12.7571411	20.89087831	19.29942559	0.139094959	41.83777048	0	25	0.041529564	0	0	20.86424388	0	20.86424388	0	0	0												5.5103	0.076619334	0	0	1.662618128	0.715610988	0.079754907	0.703162055	4.766300194	0.01050877	0.241765426	0	0	3.286045836	8.949854508	7.436785962	0.409894905	0.591514257	0.173071783	0	1.794302822	0	0	0	0.278890512	0	0.076856031	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7639	500	33.85731509	23.1103	0.146619334	1.65	0	1.662618128	1.725610988	0.119754907	0.703162055	7.326300194	0.06050877	1.161765426	0	0	4.286045836	8.949854508	7.436785962	0.409894905	0.911514257	0.173071783	0	1.794302822	0	0	0	0.278890512	0	0.076856031	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9839	NO																																																																																		0			23.1103	0.146619334	1.65	0	1.662618128	1.725610988	0.119754907	0.703162055	7.326300194	0.06050877	1.161765426	0	0	4.286045836	8.949854508	7.436785962	0.409894905	0.911514257	0.173071783	0	1.794302822	0	0	0	0.278890512	0	0.076856031	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9839
H1216_001_0	2010	5	N/A																															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	V	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	Yes	2663.319174	146.9844695	769.32466	573.1601009	755.5402289	7.775717957	2.773132136	1640.671784	277.6646788	5699.063738	1639.261869	54.22285828	0.031019606	565.8260196	7881.949085	16554.36827	358.9177483	2257.623312	4655.628025	1658.642056	13.28011589	16.74371602	1030	516.6666667	288	172.8	16.8	12.8	2040	0											2500	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $5.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	$0.00 copayment	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											118.2447517	118.0139174	54.67	2.116542301	29.52357571	0.2	0.1452666	19.95076649	110.9544745	0	65.19033168	56.97174177	0.2	15.41736452	2.329882919	7.208332377	24.45919713	15.44185507	22.16438267	10.03850106	0.2	0	0	0	0	0	0	0	0	0											NO	99.36704995	99.17306825	45.94196819	1.778637627	24.81015505	0.168070123	0.122074877	16.76563891	93.24066101	0	54.78273541	47.87623831	0.168070123	12.95599178	1.957918547	6.057526556	20.55430138	12.97657242	18.62585264	8.435860551	0.168070123	0	0	0	0	0	0	0	0	0												22.0538	1.214741735	2.945357422	0.084953677	1.562089185	1.306865875	0.338529763	2.292242559	2.157469849	0	7.483604102	0.216332207	0.005213469	0.610903105	1.286017858	8.356543784	0.614775298	2.441351034	7.22625346	1.166006091	2.231990714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5951	0	12.46172166	22.0538	1.214741735	2.945357422	0.084953677	1.562089185	1.306865875	0.338529763	2.292242559	2.157469849	0	7.483604102	0.216332207	0.005213469	0.610903105	1.286017858	8.356543784	0.614775298	2.441351034	7.22625346	1.166006091	2.231990714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5951	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												2.468	0	0.1591	0.0945	0.1496	0.1288	0.0459	0	0.3134	0.118	0.441	0	0	0.1253	0	1.2668	0	0.1586	0.2631	0.1673	0	0.0033	0	0	0	0	0	0	0	0											5.9025	0	0	24.5218	1.214741735	3.104409798	0.179447643	1.711669451	1.435625076	0.384427797	2.292242559	2.470829033	0.118044684	7.92462697	0.216332207	0.005213469	0.736199604	1.286017858	9.623297854	0.614775298	2.599915935	7.489346511	1.333268678	2.231990714	0.003296465	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4975
H1216_003_0	2010	6	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	496.0596895	96.8257205	794.6281499	1132.935753	20.84643034	12.77269226	3.738862577	43.64434019	24.34420371	8430.927949	21.30932325	0.432850878	0.193171654	7.406389981	6637.859498	81.15941473	22.29995594	12.94849247	17.73750499	6.931004601	8.836191272	0.052544651	1030	867.2727273	0.96	172.8	0.056	0.224	2040	0												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	Copay between $0.00 and $10.00	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"Copay between $0.00 and $10.00, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, $1,000 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											673.9062095	540.9340071	54.47541985	0	0.163291958	0.170000618	0.17	0.119387757	0.17	0	0.170080019	0.248628433	0.17	0.170008738	3.58943553	0.082300579	0.382687582	0.170000199	0.169024799	0.080012313	0.170000901	0.17	0	0	0	0	0	0	0	0											NO	673.9062095	540.9340071	54.47541985	0	0.163291958	0.170000618	0.17	0.119387757	0.17	0	0.170080019	0.248628433	0.17	0.170008738	3.58943553	0.082300579	0.382687582	0.170000199	0.169024799	0.080012313	0.170000901	0.17	0	0	0	0	0	0	0	0												27.8581	4.364693748	3.607308507	0	3.404054433	2.17136558	0.635606638	5.21059989	4.13851463	0	3.624290113	0.107619035	0.032839181	1.259151012	1.985514061	6.679466799	8.533916209	2.201246291	2.998078214	0.554565706	1.502160475	0.008932591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8781	0	0	27.8581	4.364693748	3.607308507	0	3.404054433	2.17136558	0.635606638	5.21059989	4.13851463	0	3.624290113	0.107619035	0.032839181	1.259151012	1.985514061	6.679466799	8.533916209	2.201246291	2.998078214	0.554565706	1.502160475	0.008932591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8781	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.8581	4.364693748	3.607308507	0	3.404054433	2.17136558	0.635606638	5.21059989	4.13851463	0	3.624290113	0.107619035	0.032839181	1.259151012	1.985514061	6.679466799	8.533916209	2.201246291	2.998078214	0.554565706	1.502160475	0.008932591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8781
H1230_001_0	2010	7	N/A																															D	Coin	D	V	Coin	Coin	Coin	V	V	O	O	Coin	O	V	V	V	Coin	V	V	V	O	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	YES	1292.053482	2.089501655	522.938229	321.4786917	14.42084977	6.345602437	0.269939403	256.8481125	145.4842079	0	205.5098091	0.976365854	2.313230287	155.7543741	8642.74586	3620.695252	4.972382874	370.2431087	3314.849635	7451.465274	1224.533991	0.442606582	0	0	287.118256	0	59.28150713	0	0.417682292	3749.688486											3000	0	"$0 SMI, non-SMI 20% days 191-220"	$50/day 21 to 100	0	0.2	0.2	0-20%	$10-$50/visit	$10/visit	$0-$10/test	$10/$50 (routine/advanced)	0.2	0	$0-$10/visit	$0-$10/visit	$0-$10/visit	"SMI $10/visit, NON-SMI 20% for 1st 20 visit & 50% for vis 21+"	$10/visit	$10/$50 (routine/advanced)	$0-$10/test	"$10/generic & $40/brand, 0-20% DMS"	0-20%			$10/visit		$10/visit		$0-$10/visit	$0-$10/visit											0	0	9.03887114	0	0.2	0.2	0.2	46.05194488	10	0	17.34513352	0.2	0	9.995	9.817077939	8.382728649	0.142915338	10	17.10285573	0	3.507550605	0	0	0	10	0	10	0	10	0											NO	0	0	2.824551942	0	0.198400994	0.198400994	0.198400994	45.6837581	9.920049677	0	17.20645862	0.198400994	0	9.915089652	9.738590083	8.315708462	0.141772725	9.920049677	16.96611785	0	3.479507625	0	0	0	9.920049677	0	9.920049677	0	9.920049677	0												0	0	0.123088849	0	2.861110922	1.258973828	0.053556246	0.977815586	0.120267547	0	0.294674669	0.193711955	0	0.128693215	7.014013261	2.509053846	0.704948269	0.306069169	4.686677463	0	0.355064613	0	0	0	0.23735228	0	0.049006291	0	0.000345286	0	0	0	0	0	0	0	0	0	0	0	21.8744	0	0.446112941	0	0	0.123088849	0	2.861110922	1.258973828	0.053556246	0.977815586	0.120267547	0	0.294674669	0.193711955	0	0.128693215	7.014013261	2.509053846	0.704948269	0.306069169	4.686677463	0	0.355064613	0	0	0	0.23735228	0	0.049006291	0	0.000345286	0	0	0	0	0	0	0	0	0	0	0	21.8744	NO																																																																																		0	0	0	0	0	0.123088849	0	2.861110922	1.258973828	0.053556246	0.977815586	0.120267547	0	0.294674669	0.193711955	0	0.128693215	7.014013261	2.509053846	0.704948269	0.306069169	4.686677463	0	0.355064613	0	0	0	0.23735228	0	0.049006291	0	0.000345286	0	0	0	0	0	0	0	0	0	0	0	21.8744
H1230_003_0	2010	7	N/A																															D	Coin	D	V	Coin	Coin	Coin	V	V	O	O	Coin	O	V	V	V	Coin	V	V	V	O	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	YES	816.7705154	1.012156946	486.8265055	279.1839996	7.550552462	3.799863811	0.22415062	144.2747662	85.86152584	0	163.7745645	1.263557843	1.124194219	108.293256	5544.719755	2132.489367	3.543663193	212.0719702	2179.624301	4978.081843	868.6181094	0.42797636	0	0	197.9316906	0	48.4299663	0	0.202987147	2638.454984											3400	$175/day days 1-12	"SMI $175/day days 1-12, NON-SMI $175/day days 1-12 20% days 191-220"	$50/day 21 to 100	0	0.2	0.2	0-20%	$25-$50/visit	$25-175/visit	$0-$25/test	"$25/$100 (routine/advanced), 20% rad therapy"	0.2	0	$0-$25/visit	$0-$25/visit	$0-$25/visit	"SMI $25/visit, NON-SMI 20% for 1st 20 visit & 50% for vis 21+"	$25/visit	"$25/$100 (routine/advanced), 20% rad therapy"	$0-$25/test	"$10/generic & $40/brand, 0-20% DMS"	0-20%			$30/visit		$30/visit		$0-$25/visit	$0-$25/visit											175	175	6.855776355	0	0.2	0.2	0.2	47.00549079	93.08067016	0	38.74720841	0.2	0	24.995	24.55717549	21.09859923	0.162089051	25	38.05322042	0	3.298017227	0	0	0	30	0	30	0	25	0											NO	121.7097377	121.7097377	0.98111584	0	0.189196118	0.189196118	0.189196118	44.46628188	88.05250723	0	36.65410705	0.189196118	0	23.64478483	23.23061134	19.95886534	0.153333096	23.64951474	35.99760789	0	3.119860281	0	0	0	28.37941768	0	28.37941768	0	23.64951474	0												8.2841	1.231893565	0.039802766	0	1.428535214	0.718919482	0.042408427	0.534613535	0.630026885	0	0.500250868	0.239060239	0	0.213380895	10.7339358	3.546839009	0.543360848	0.417949932	6.53843841	0	0.225830595	0	0	0	0.468098843	0	0.11453452	0	0.000400046	0	0	0	0	0	0	0	0	0	0	0	36.4524	0	181.2969663	8.2841	1.231893565	0.039802766	0	1.428535214	0.718919482	0.042408427	0.534613535	0.630026885	0	0.500250868	0.239060239	0	0.213380895	10.7339358	3.546839009	0.543360848	0.417949932	6.53843841	0	0.225830595	0	0	0	0.468098843	0	0.11453452	0	0.000400046	0	0	0	0	0	0	0	0	0	0	0	36.4524	NO																																																																																		0	0	0	8.2841	1.231893565	0.039802766	0	1.428535214	0.718919482	0.042408427	0.534613535	0.630026885	0	0.500250868	0.239060239	0	0.213380895	10.7339358	3.546839009	0.543360848	0.417949932	6.53843841	0	0.225830595	0	0	0	0.468098843	0	0.11453452	0	0.000400046	0	0	0	0	0	0	0	0	0	0	0	36.4524
H1230_801_0	2010	5	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	Coin	V	Coin	Coin	O	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	YES	233.046694	1.133891252	313.523953	330.2211572	7.623823196	6.111038644	0.419563014	205.5313558	144.1515697	0	6.355125074	1.101642767	1.530673381	141.0194018	7720.002466	3326.070226	3.13551099	424.8726494	37.81887987	33.09313961	1140.687065	0.511039499	0	0	244.6173807	0	63.76277626	0	0.42114651	3100.661878											3000	10% Room & Board	"SMI 10% Room & Board, NON-SMI 20% up to 220 days"	0	0	0.2	0.2	0-20%	$25-$50/visit	$25/visit	20% OP Lab	20% OP Radiology	0.2	0	$0-$25/visit	$0-$25/visit	$25-$200/visit	"SMI $25/visit, NON-SMI 20% for 1st 20 visit & 50% for vis 21+"	$25/visit	20% OP Radiology	20% OP Lab	"$10/generic & $40/brand, 20% DMS"	0-20%			$25/visit		$25/visit		$0-$25/visit	$0-$25/visit											0.071634071	0.071634071	0	0	0.2	0.2	0.2	47.06194576	25	0.2	0.199072848	0.2	0	24.995	24.80719418	23.47436339	0.168965682	25	0.194210726	0.197787998	6.329861359	0	0	0	25	0	25	0	25	0											NO	0.047335453	0.047335453	0	0	0.186478935	0.186478935	0.186478935	43.88030768	23.30986691	0.186478935	0.185614463	0.186478935	0	23.30520493	23.13009579	21.88737146	0.157542702	23.30986691	0.181081047	0.184416476	5.901929032	0	0	0	23.30986691	0	23.30986691	0	23.30986691	0												11.0314	0.053673256	0	0	1.421682432	1.13957998	0.078239664	0.751564927	0.280012825	0	1.17960313	0.20543317	0	0.273873838	14.88036638	6.066577878	0.493976873	0.825310409	6.848282356	6.102920193	0.561021175	0	0	0	0.475166549	0	0.123858486	0	0.000818072	0	0	0	0	0	0	0	0	0	0	0	52.7933	0	8.714415735	11.0314	0.053673256	0	0	1.421682432	1.13957998	0.078239664	0.751564927	0.280012825	0	1.17960313	0.20543317	0	0.273873838	14.88036638	6.066577878	0.493976873	0.825310409	6.848282356	6.102920193	0.561021175	0	0	0	0.475166549	0	0.123858486	0	0.000818072	0	0	0	0	0	0	0	0	0	0	0	52.7933	NO																																																																																		0	0	0	11.0314	0.053673256	0	0	1.421682432	1.13957998	0.078239664	0.751564927	0.280012825	0	1.17960313	0.20543317	0	0.273873838	14.88036638	6.066577878	0.493976873	0.825310409	6.848282356	6.102920193	0.561021175	0	0	0	0.475166549	0	0.123858486	0	0.000818072	0	0	0	0	0	0	0	0	0	0	0	52.7933
H1230_802_0	2010	2	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	Coin	V	Coin	Coin	O	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	YES	248.1807796	1.643828053	405.8020275	356.859479	10.5691736	6.633480001	0.571203243	245.8933712	144.1701949	0	9.630190166	0.991638942	2.092909553	147.9692606	8111.259631	3360.136751	3.327266257	408.6459012	37.91682778	34.02691409	1341.799022	0.601022005	0	0	270.8378487	0	61.73140383	0	0.575839082	3346.547693											3000	10% Room & Board	"SMI 10% Room & Board, NON-SMI 20% up to 220 days"	0	0	0.2	0.2	0-20%	$25-$50/visit	$25/visit	20% OP Lab	20% OP Radiology	0.2	0	$0-$25/visit	$0-$25/visit	$25-$200/visit	"SMI $25/visit, NON-SMI 20% for 1st 20 visit & 50% for vis 21+"	$25/visit	20% OP Radiology	20% OP Lab	"$10/generic & $40/brand, 20% DMS"	0-20%			$25/visit		$25/visit		$0-$25/visit	$0-$25/visit											0.071634071	0.071634071	0	0	0.2	0.2	0.2	45.98276036	25	0.2	0.199072848	0.2	0	24.995	24.76579368	23.47436339	0.169186711	25	0.194210726	0.197166292	7.385177663	0	0	0	25	0	25	0	25	0											NO	0.047335453	0.047335453	0	0	0.186478935	0.186478935	0.186478935	42.87408096	23.30986691	0.186478935	0.185614463	0.186478935	0	23.30520493	23.09149418	21.88737146	0.157748789	23.30986691	0.181081047	0.183836801	6.885900336	0	0	0	23.30986691	0	23.30986691	0	23.30986691	0												11.7477	0.077811345	0	0	1.970928239	1.237004287	0.106517373	0.878537692	0.280049005	0	1.78750258	0.184919774	0	0.287371162	15.60842538	6.128713435	0.524872222	0.793790131	6.866018865	6.25539904	0.769957861	0	0	0	0.526099517	0	0.119912567	0	0.001118561	0	0	0	0	0	0	0	0	0	0	0	56.1527	0	9.284429288	11.7477	0.077811345	0	0	1.970928239	1.237004287	0.106517373	0.878537692	0.280049005	0	1.78750258	0.184919774	0	0.287371162	15.60842538	6.128713435	0.524872222	0.793790131	6.866018865	6.25539904	0.769957861	0	0	0	0.526099517	0	0.119912567	0	0.001118561	0	0	0	0	0	0	0	0	0	0	0	56.1527	NO																																																																																		0	0	0	11.7477	0.077811345	0	0	1.970928239	1.237004287	0.106517373	0.878537692	0.280049005	0	1.78750258	0.184919774	0	0.287371162	15.60842538	6.128713435	0.524872222	0.793790131	6.866018865	6.25539904	0.769957861	0	0	0	0.526099517	0	0.119912567	0	0.001118561	0	0	0	0	0	0	0	0	0	0	0	56.1527
H1230_803_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	Coin	V	Coin	Coin	O	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	YES	248.7666889	1.669013682	407.9000986	354.7371872	10.67120672	6.643961014	0.578778159	246.2868284	144.2501186	0	9.787840529	0.978494797	1.139787917	147.9462719	8124.737574	3355.837888	3.341691135	408.7911304	37.95132387	34.06627265	1348.316871	0.603149173	0	0	272.0899626	0	61.51933309	0	0.583548067	3352.544828											3000	10% Room & Board	"SMI 10% Room & Board, NON-SMI 20% up to 220 days"	0	0	0.2	0.2	0-20%	$25-$50/visit	$25/visit	20% OP Lab	20% OP Radiology	0.2	0	$0-$25/visit	$0-$25/visit	$25-$200/visit	"SMI $25/visit, NON-SMI 20% for 1st 20 visit & 50% for vis 21+"	$25/visit	20% OP Radiology	20% OP Lab	"$10/generic & $40/brand, 20% DMS"	0-20%			$25/visit		$25/visit		$0-$25/visit	$0-$25/visit											0.071634071	0.071634071	0	0	0.2	0.2	0.2	46.01847805	25	0.2	0.199072848	0.2	0	24.995	24.76469064	23.47436339	0.169197334	25	0.194210726	0.197139911	7.407221191	0	0	0	25	0	25	0	25	0											NO	0.047335453	0.047335453	0	0	0.186478935	0.186478935	0.186478935	42.90738394	23.30986691	0.186478935	0.185614463	0.186478935	0	23.30520493	23.09046571	21.88737146	0.157758694	23.30986691	0.181081047	0.183812204	6.906453604	0	0	0	23.30986691	0	23.30986691	0	23.30986691	0												11.7755	0.079003518	0	0	1.989955267	1.238958776	0.107929935	0.880626959	0.280204255	0	1.816764767	0.182468668	0	0.287326515	15.63366453	6.120872533	0.527180828	0.794072237	6.872265454	6.261796648	0.776007326	0	0	0	0.528531734	0	0.119500622	0	0.001133536	0	0	0	0	0	0	0	0	0	0	0	56.2737	0	9.305957626	11.7755	0.079003518	0	0	1.989955267	1.238958776	0.107929935	0.880626959	0.280204255	0	1.816764767	0.182468668	0	0.287326515	15.63366453	6.120872533	0.527180828	0.794072237	6.872265454	6.261796648	0.776007326	0	0	0	0.528531734	0	0.119500622	0	0.001133536	0	0	0	0	0	0	0	0	0	0	0	56.2737	NO																																																																																		0	0	0	11.7755	0.079003518	0	0	1.989955267	1.238958776	0.107929935	0.880626959	0.280204255	0	1.816764767	0.182468668	0	0.287326515	15.63366453	6.120872533	0.527180828	0.794072237	6.872265454	6.261796648	0.776007326	0	0	0	0.528531734	0	0.119500622	0	0.001133536	0	0	0	0	0	0	0	0	0	0	0	56.2737
H1230_804_0	2010	2	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	Coin	V	Coin	Coin	O	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	YES	248.1807796	1.643828053	405.8020275	356.859479	10.5691736	6.633480001	0.571203243	245.8933712	144.1701949	0	9.630190166	0.991638942	2.092909553	147.9692606	8111.259631	3360.136751	3.327266257	408.6459012	37.91682778	34.02691409	1341.799022	0.601022005	0	0	270.8378487	0	61.73140383	0	0.575839082	3346.547693											3000	10% Room & Board	"SMI 10% Room & Board, NON-SMI 20% up to 220 days"	0	0	0.2	0.2	0-20%	$25-$50/visit	$25/visit	20% OP Lab	20% OP Radiology	0.2	0	$0-$25/visit	$0-$25/visit	$25-$200/visit	"SMI $25/visit, NON-SMI 20% for 1st 20 visit & 50% for vis 21+"	$25/visit	20% OP Radiology	20% OP Lab	"$10/generic & $40/brand, 20% DMS"	0-20%			$25/visit		$25/visit		$0-$25/visit	$0-$25/visit											0.071634071	0.071634071	0	0	0.2	0.2	0.2	45.98276036	25	0.2	0.199072848	0.2	0	24.995	24.76579368	23.47436339	0.169186711	25	0.194210726	0.197166292	7.385177663	0	0	0	25	0	25	0	25	0											NO	0.047335453	0.047335453	0	0	0.186478935	0.186478935	0.186478935	42.87408096	23.30986691	0.186478935	0.185614463	0.186478935	0	23.30520493	23.09149418	21.88737146	0.157748789	23.30986691	0.181081047	0.183836801	6.885900336	0	0	0	23.30986691	0	23.30986691	0	23.30986691	0												11.7477	0.077811345	0	0	1.970928239	1.237004287	0.106517373	0.878537692	0.280049005	0	1.78750258	0.184919774	0	0.287371162	15.60842538	6.128713435	0.524872222	0.793790131	6.866018865	6.25539904	0.769957861	0	0	0	0.526099517	0	0.119912567	0	0.001118561	0	0	0	0	0	0	0	0	0	0	0	56.1527	0	9.284429288	11.7477	0.077811345	0	0	1.970928239	1.237004287	0.106517373	0.878537692	0.280049005	0	1.78750258	0.184919774	0	0.287371162	15.60842538	6.128713435	0.524872222	0.793790131	6.866018865	6.25539904	0.769957861	0	0	0	0.526099517	0	0.119912567	0	0.001118561	0	0	0	0	0	0	0	0	0	0	0	56.1527	NO																																																																																		0	0	0	11.7477	0.077811345	0	0	1.970928239	1.237004287	0.106517373	0.878537692	0.280049005	0	1.78750258	0.184919774	0	0.287371162	15.60842538	6.128713435	0.524872222	0.793790131	6.866018865	6.25539904	0.769957861	0	0	0	0.526099517	0	0.119912567	0	0.001118561	0	0	0	0	0	0	0	0	0	0	0	56.1527
H1230_805_0	2010	1	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	V	V	Coin	Coin	O	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	YES	248.7666889	1.669013682	407.9000986	354.7371872	10.67120672	6.643961014	0.578778159	246.2868284	144.2501186	0	9.787840529	0.978494797	1.139787917	147.9462719	8124.737574	3355.837888	130.369282	408.7911304	37.95132387	34.06627265	1348.316871	0.603149173	0	0	272.0899626	0	61.51933309	0	0.583548067	3352.544828											2500	10% Room & Board	10% Room & Board	0	0	0.2	0.2	0-20%	$25-$50/visit	$30/visit	50% OP Lab	50% OP Radiology	10% Room & Board	$25/visit	$0-$25/visit	$0-$25/visit	$0-$25/visit	$25/visit	$25/visit	50% OP Radiology	50% OP Lab	"$10/generic & $40/brand, 20% DMS"	0-20%			$25/visit		$25/visit		$0-$25/visit	$0-$25/visit											0.071634071	0.071634071	0	0	0.2	0.2	0.2	45.98276036	30	0.5	0.497682119	0.1	25	24.995	24.76579368	21.06831503	25	25	0.485526814	0.492915731	7.385177663	0	0	0	25	0	25	0	25	0											NO	0.034724463	0.034724463	0	0	0.168393411	0.168393411	0.168393411	38.71596923	25.25901159	0.420983527	0.419031947	0.084196705	21.04917633	21.04496649	20.85198232	17.73882712	21.04917633	21.04917633	0.408797581	0.415018805	6.218076273	0	0	0	21.04917633	0	21.04917633	0	21.04917633	0												8.6383	0.057955604	0	0	1.796960895	1.118799255	0.097462428	0.794602772	0.303634618	0	4.101417876	0.082386038	0.0019993	0.259460361	14.11807369	4.96071901	0.2286805	0.717059715	15.5144094	14.13814377	0.698661429	0	0	0	0.477272467	0	0.107910941	0	0.001023601	0	0	0	0	0	0	0	0	0	0	0	68.2149	0	20.4148377	8.6383	0.057955604	0	0	1.796960895	1.118799255	0.097462428	0.794602772	0.303634618	0	4.101417876	0.082386038	0.0019993	0.259460361	14.11807369	4.96071901	0.2286805	0.717059715	15.5144094	14.13814377	0.698661429	0	0	0	0.477272467	0	0.107910941	0	0.001023601	0	0	0	0	0	0	0	0	0	0	0	68.2149	NO																																																																																		0	0	0	8.6383	0.057955604	0	0	1.796960895	1.118799255	0.097462428	0.794602772	0.303634618	0	4.101417876	0.082386038	0.0019993	0.259460361	14.11807369	4.96071901	0.2286805	0.717059715	15.5144094	14.13814377	0.698661429	0	0	0	0.477272467	0	0.107910941	0	0.001023601	0	0	0	0	0	0	0	0	0	0	0	68.2149
H1230_806_0	2010	2	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	V	V	Coin	Coin	Coin	O	V	V	V	V	V	Coin	Coin	O	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	YES	248.1807796	1.643828053	405.8020275	356.859479	10.5691736	6.633480001	0.571203243	245.8933712	144.1701949	0	9.630190166	0.991638942	2.092909553	147.9692606	8111.259631	3360.136751	129.773131	408.6459012	37.91682778	34.02691409	1341.799022	0.601022005	0	0	270.8378487	0	61.73140383	0	0.575839082	3346.547693											2500	10% Room & Board	10% Room & Board	0	0	0.2	0.2	0-20%	$25-$50/visit	$30/visit	50% OP Lab	50% OP Radiology	10% Room & Board	$25/visit	$0-$25/visit	$0-$25/visit	$0-$25/visit	$25/visit	$25/visit	50% OP Radiology	50% OP Lab	"$10/generic & $40/brand, 20% DMS"	0-20%			$25/visit		$25/visit		$0-$25/visit	$0-$25/visit											0.071634071	0.071634071	0	0	0.2	0.2	0.2	45.98276036	30	0.5	0.497682119	0.1	25	24.995	24.76579368	21.06831503	25	25	0.485526814	0.492915731	7.385177663	0	0	0	25	0	25	0	25	0											NO	0.034724463	0.034724463	0	0	0.168393411	0.168393411	0.168393411	38.71596923	25.25901159	0.420983527	0.419031947	0.084196705	21.04917633	21.04496649	20.85198232	17.73882712	21.04917633	21.04917633	0.408797581	0.415018805	6.218076273	0	0	0	21.04917633	0	21.04917633	0	21.04917633	0												8.6179	0.057081047	0	0	1.77977919	1.117034322	0.096186862	0.79333335	0.303466385	0	4.035357338	0.083492732	0.003671169	0.259500678	14.09465353	4.967073743	0.227634793	0.716804969	15.50030748	14.12180922	0.695284055	0	0	0	0.475076136	0	0.108282934	0	0.001010078	0	0	0	0	0	0	0	0	0	0	0	68.0548	0	20.36620801	8.6179	0.057081047	0	0	1.77977919	1.117034322	0.096186862	0.79333335	0.303466385	0	4.035357338	0.083492732	0.003671169	0.259500678	14.09465353	4.967073743	0.227634793	0.716804969	15.50030748	14.12180922	0.695284055	0	0	0	0.475076136	0	0.108282934	0	0.001010078	0	0	0	0	0	0	0	0	0	0	0	68.0548	NO																																																																																		0	0	0	8.6179	0.057081047	0	0	1.77977919	1.117034322	0.096186862	0.79333335	0.303466385	0	4.035357338	0.083492732	0.003671169	0.259500678	14.09465353	4.967073743	0.227634793	0.716804969	15.50030748	14.12180922	0.695284055	0	0	0	0.475076136	0	0.108282934	0	0.001010078	0	0	0	0	0	0	0	0	0	0	0	68.0548
H1254_801_0	2010	5	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T	V																	0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0	0																	0	NO	462.0878097	6.952293895	2504.983411		380.9931038	22.51986983	0	1705.027447	1329.711597		7844.854117	1845.107516		4804.561237	11102.48709	9780.180602	28.87994373	1752.91385			1295.27963	1402.497721	51.46554075																			"1a:  $300 per Admit,"	"1b:  $300 per Admit,"	"2:  $50 per day, day 11 - 100"		10a:  $100 per Trip	11a:  20% Coinsurance	"11b:  20% Coinsurance, supplies paid 100%"	"4a,:  $50 Copay"	"9a,b:  $150 Copay,"		8b:  $10/$60 Copay depending on type of Service	"9a:  $300 Observation copay- no PBP code,"		"7c,i:  $30 Copay"	"7a, 14c:  $15"	"7a,b,d,f,g 14a, 16b, 17a, 18a:  $30 Copay"	"7e,h 9c:  $30 Copay"	"7c,i:  $30 Copay"			15:  20% Coinsurance	11c:  $25/$75 Copay per 31/90 day supply	10a:  $100 per Trip																		291.2840467	279.3103448	23.47676702		23.98599611	0.180401914	0	6.791462179	34.5		1.665591618	3.474628495		0.669680701	5.665477223	16.18167584	0	11.01839048			97.71955814	30.34762025	21.08086331																		NO	291.2840467	279.3103448	23.47676702		23.98599611	0.180401914	0	6.791462179	34.5		1.665591618	3.474628495		0.669680701	5.665477223	16.18167584	0	11.01839048			97.71955814	30.34762025	21.08086331																			11.2166	0.161820634	4.90074266	0	0.761541592	4.062627624	0	0.964969118	3.822920842	0	1.088860272	0.534255263	0	0.268126828	5.241740642	13.18830934	0	1.609524106	0	0	10.54784609	3.546872352	0.090411502	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0071	0	0	11.2166	0.161820634	4.90074266	0	0.761541592	4.062627624	0	0.964969118	3.822920842	0	1.088860272	0.534255263	0	0.268126828	5.241740642	13.18830934	0	1.609524106	0	0	10.54784609	3.546872352	0.090411502	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0071	NO																																																																																		0	0	0	11.2166	0.161820634	4.90074266	0	0.761541592	4.062627624	0	0.964969118	3.822920842	0	1.088860272	0.534255263	0	0.268126828	5.241740642	13.18830934	0	1.609524106	0	0	10.54784609	3.546872352	0.090411502	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0071
H1264_004_0	2010	5	N/A																															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	V	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	Yes	2750.128255	110.2347782	431.8978214	169.7509389	227.9389313	5.465936111	3.959276459	1621.452427	255.5677264	4232.325723	1010.950473	20.13762698	0.11097134	228.8054644	10685.80303	19079.66829	61.63360764	846.2663976	4273.201609	1480.336979	5.663143425	10.9679482	0	412.2857143	0	0	0	0	0	0											3250	"$125 days 1 - 6, $0 after day 6, unlimited coverage"	"$125 days 1 - 6, $0 after day 6, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $75.00 and $100.00	$0.00 copayment	Copay between $0.00 and $150.00	$125.00 copayment	20% coinsurance	Copay between $15.00 and $100.00	$0.00 copayment	Copay between $0.00 and $25.00	Copay between $15.00 and $25.00	$25.00 copayment	Copay between $0.00 and $75.00	Copay between $0.00 and $25.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											56.26061243	52.93263457	54.67	1.388483417	46.07405378	0.2	0.078721109	23.18564954	98.85642218	0	61.64240585	38.47452294	0.2	26.09459032	0	3.328923991	18.22654737	9.97677728	17.38464843	5.489750514	0.2	0	0	0	0	0	0	0	0	0											NO	54.41101022	51.19244168	52.87269015	1.342836172	44.55934094	0.193424877	0.076133104	22.42340706	95.60645654	0	59.61587387	37.20964936	0.193424877	25.23671462	0	3.219483569	17.62733842	9.648784595	16.81311743	5.309271592	0.193424877	0	0	0	0	0	0	0	0	0												12.4698	0.470265621	1.902966641	0.018995642	0.846400713	1.05724802	0.301432006	3.029873983	2.036160394	0	5.022391325	0.062442837	0.021464618	0.481191517	0	5.118889879	0.090536372	0.680453515	5.987153371	0.654959256	1.095392821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.348	0	1.405548863	12.4698	0.470265621	1.902966641	0.018995642	0.846400713	1.05724802	0.301432006	3.029873983	2.036160394	0	5.022391325	0.062442837	0.021464618	0.481191517	0	5.118889879	0.090536372	0.680453515	5.987153371	0.654959256	1.095392821	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.348	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												2.4548	0	0.0902	0.0264	0.0816	0.0905	0.0654	0	0.3427	0.0806	0.2319	0	0	0.1391	0	1.1406	0	0.0831	0.3913	0.1526	0	0.0051	0	0	0	0	0	0	0	0											5.3759	0	0	14.9246	0.470265621	1.99314158	0.045426031	0.927988539	1.147759221	0.366829961	3.029873983	2.378866144	0.080580127	5.254327558	0.062442837	0.021464618	0.620276933	0	6.259525181	0.090536372	0.763602001	6.378443828	0.807543734	1.095392821	0.005053758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7239
H1264_007_0	2010	6	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	442.1170458	50.48212353	938.4923201	1958.937445	12.5355327	12.00205283	4.3955943	33.25644563	22.58243213	7397.054933	17.86777856	1.011168236	0.415212726	8.534423669	10200.08393	92.03653518	11.01398494	9.080978937	31.66240223	9.670311549	65.07340853	0.268666366	0	834.6	0	0	0	0	0	0												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	Copay between $0.00 and $5.00	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"Copay between $0.00 and $5.00, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	Not Covered	"$0.00 copayment, $750 benefit limit"	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											749.2738254	403.1700291	68.94194792	0	0.158204475	0.17000086	0.17	0.126252194	0.17	0	0.170122173	0.248626105	0.170000019	0.170005704	1.213925342	0.085071734	0.382785696	0.170000213	0.165231708	0.098632266	0.170000092	0.17	0	0	0	0	0	0	0	0											NO	749.2738254	403.1700291	68.94194792	0	0.158204475	0.17000086	0.17	0.126252194	0.17	0	0.170122173	0.248626105	0.170000019	0.170005704	1.213925342	0.085071734	0.382785696	0.170000213	0.165231708	0.098632266	0.170000092	0.17	0	0	0	0	0	0	0	0												27.6056	1.696073268	5.391790721	0	1.983177368	2.040359303	0.747251031	4.198699227	3.839013461	0	3.039705309	0.25140282	0.070586171	1.450900705	1.031845031	7.829707679	4.215995889	1.543768353	5.231632797	0.953804739	11.06248544	0.045673282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2294	0	0	27.6056	1.696073268	5.391790721	0	1.983177368	2.040359303	0.747251031	4.198699227	3.839013461	0	3.039705309	0.25140282	0.070586171	1.450900705	1.031845031	7.829707679	4.215995889	1.543768353	5.231632797	0.953804739	11.06248544	0.045673282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2294	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.6056	1.696073268	5.391790721	0	1.983177368	2.040359303	0.747251031	4.198699227	3.839013461	0	3.039705309	0.25140282	0.070586171	1.450900705	1.031845031	7.829707679	4.215995889	1.543768353	5.231632797	0.953804739	11.06248544	0.045673282	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2294
H1264_008_0	2010	5	N/A																															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	V	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	Yes	1814.292001	54.09769823	425.0501005	810.6985116	421.3404293	8.406785041	3.219609566	1158.091043	214.4442431	3983.29227	1052.206182	58.1481722	0.383742324	347.4865087	7025.136197	18542.49283	400.3381263	1709.741596	3732.12838	1884.494334	19.11938172	16.21622103	0	0	288	172.8	16.8	12.8	0	0											3000	"$150 days 1 - 5, $0 after day 5, unlimited coverage"	"$150 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $50.00 and $100.00	$0.00 copayment	Copay between $0.00 and $150.00	$150.00 copayment	20% coinsurance	Copay between $25.00 and $100.00	Copay between $0.00 and $15.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											72.05186944	60.48763106	54.67	1.583852631	37.39852339	0.2	0.16945604	20.93766563	88.45793052	0	60.0494546	92.06717192	0.2	14.23398538	7.303028146	6.58419789	22.86331931	9.379501317	35.88236579	8.645742222	0.2	0	0	0	0	0	0	0	0	0											NO	66.3677477	55.71580402	50.35712182	1.458903601	34.44817995	0.184222139	0.156087771	19.28590779	81.47954606	0	55.312195	84.80405691	0.184222139	13.1110762	6.726897347	6.064775109	21.05964799	8.639558998	33.05163097	7.963685646	0.184222139	0	0	0	0	0	0	0	0	0												10.0342	0.251174729	1.783691641	0.098560915	1.209534244	1.548715926	0.502541681	1.861236422	1.456068299	0	4.849986125	0.410933409	0.070693832	0.379660174	3.938114171	9.371337413	0.702581668	1.230951116	10.27941083	1.250626706	3.522213404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7522	0	4.68930169	10.0342	0.251174729	1.783691641	0.098560915	1.209534244	1.548715926	0.502541681	1.861236422	1.456068299	0	4.849986125	0.410933409	0.070693832	0.379660174	3.938114171	9.371337413	0.702581668	1.230951116	10.27941083	1.250626706	3.522213404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7522	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.9333	0	0.1058	0.1359	0.0897	0.1392	0.0532	0	0.31	0.074	0.2796	0	0	0.1172	0	1.3526	0	0.1194	0.4615	0.2226	0	0.0078	0	0	0	0	0	0	0	0											5.4019	0	0	11.9675	0.251174729	1.889497844	0.234479222	1.299245676	1.687925055	0.555746086	1.861236422	1.766104902	0.073977167	5.129549047	0.410933409	0.070693832	0.496891606	3.938114171	10.72391955	0.702581668	1.350395739	10.74088689	1.473220919	3.522213404	0.00784774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1542
H1264_014_0	2010	5	N/A																															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	V	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	Yes	1617.616455	93.37399759	489.3612793	1915.502303	522.2900692	11.94739573	3.141098467	1607.281667	243.1886162	3555.251821	919.1219224	42.2591307	0.153627252	471.367469	8174.75996	20475.47916	422.0080549	2710.545339	4214.113745	2145.824111	25.03976905	28.48623851	0	412.2857143	0	0	16.8	12.8	0	0											3000	"$225 days 1 - 5, $0 after day 5, unlimited coverage"	"$225 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$225.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $15.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											132.1591299	87.17848793	54.67	1.188021545	26.23690244	0.2	0.2	20.0999546	99.7348311	0	68.89130369	64.23956931	0.2	11.85687485	6.170825361	7.632123203	25.61487438	8.392112225	42.41694656	8.775994374	0.2	0	0	0	0	0	0	0	0	0											NO	116.0516584	76.55322875	48.00685485	1.043226227	23.03916531	0.175624126	0.175624126	17.6501848	87.57921273	0	60.494875	56.41009108	0.175624126	10.41176642	5.418729054	6.701924836	22.49294963	7.369286875	37.24719584	7.706381709	0.175624126	0	0	0	0	0	0	0	0	0												15.6439	0.595673416	1.957724658	0.166525187	1.002760603	2.098250934	0.551652673	2.364068204	1.774855629	0	4.633513817	0.198653451	0.026980652	0.408980665	3.691400775	11.43542686	0.79101716	1.664565516	13.08032666	1.378044973	4.397587555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8619	0	9.418944552	15.6439	0.595673416	1.957724658	0.166525187	1.002760603	2.098250934	0.551652673	2.364068204	1.774855629	0	4.633513817	0.198653451	0.026980652	0.408980665	3.691400775	11.43542686	0.79101716	1.664565516	13.08032666	1.378044973	4.397587555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8619	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.9953	0	0.1242	0.2254	0.1022	0.1978	0.052	0	0.3812	0.0729	0.2409	0	0	0.1755	0	1.565	0	0.173	0.6014	0.2634	0	0.0098	0	0	0	0	0	0	0	0											6.1801	0	0	17.6392	0.595673416	2.081893296	0.391887221	1.104973846	2.29608953	0.603666562	2.364068204	2.15608876	0.072932847	4.874372966	0.198653451	0.026980652	0.584484318	3.691400775	13.00041015	0.79101716	1.837615159	13.68171869	1.64145128	4.397587555	0.009827123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.042
H1286_002_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1013.691261	59.09243945	693.2908178	387.7703525	111.2844204	6.88774829	7.013763533	239.9825392	218.1905215	6915.58421	22.07157882	0	0.035691829	286.0073554	5000.368541	3930.857592	151.1093439	383.6318183	0	0	15.64989257	756.3862625	0	309.8196446	221.3160157	163.85572	13.54670896	6.084633646	77.0656905	0											2700	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $150 (9a); $40/$30 (9c)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$25 (16a1, 16a2); $0 n/c (16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	69.22791329	0	150	0.2	0.12883682	49.59824558	150	3	0.174837536	0	0.2	58.75359277	6.662908569	25	38.5	25	0	0	0.2	24.24326694	0	25	25	0	0	0	0	0											YES	132.4753545	100.8960345	55.3081917	0	119.839359	0.159785812	0.10293148	39.62547973	119.839359	2.396787181	0.139682788	0	0.159785812	47.02801289	6.588160696	25	38.5	19.97322651	0	0	0.159785812	24.24326694	0	25	25	0	0	0	0	0											3300	11.1908	0.496849401	3.195388455	0	1.111354468	1.100564454	0.72193706	0.792451937	2.178984354	1.381265298	3.083019664	0	0.005703048	1.120863133	2.745269291	8.189286651	0.484809145	0.638530434	0	0	2.500630792	1.528106173	0	0.645457593	0.461075033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5723	0	7.457556063	11.1908	0.496849401	3.195388455	0	1.111354468	1.100564454	0.72193706	0.792451937	2.178984354	1.381265298	3.083019664	0	0.005703048	1.120863133	2.745269291	8.189286651	0.484809145	0.638530434	0	0	2.500630792	1.528106173	0	0.645457593	0.461075033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5723	NO	"$225 Days 1-10/$325 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-22 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); $200 (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.7608	0.1643	1.5087	0.3086	0.5036	0.7481	0.7618	0.4951	1.3165	0.6259	2.0555	0	0.0026	0.6783	2.1744	3.644	0.1545	0.2592	0	0	0.9517	0.6952	0	0	0.2081	0	0.0127	0	0	0											19.0296	0	4.660887088	12.9515	0.661159684	4.704053901	0.308603031	1.614966728	1.848648573	1.4837078	1.287572524	3.495531885	2.007188133	5.138518784	0	0.008287394	1.799134084	4.919685633	11.83330778	0.639308763	0.897739504	0	0	3.45230751	2.223312404	0	0.645457593	0.669149919	0	0.012736222	0	0	0	0	0	0	0	0	0	0	0	0	0	62.6019
H1286_003_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1013.219902	67.61424218	692.9684426	387.5900421	111.232674	6.884545536	7.010502184	239.8709491	218.0890645	6912.368513	22.0613157	0	0.035675233	285.8758769	4998.043406	3929.029772	308.9261039	383.4534323	0	0	15.64261548	756.0345484	0	309.6755807	221.2131054	163.7795283	13.54040984	6.081804336	77.02985551	0											2400	"$175 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 1-32 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$20 (3, 9d); $60 (5); $125 (9a); $40/$30 (9c)"	"$13 (7a); $20 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$13 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 n/c (10b)	"$25 (16a1, 16a2); $0 n/c (16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$20/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											154.5484949	122.8528282	60.89045471	0	150	0.2	0.12883682	49.59824558	125	3	0.174837536	0	0.2	49.01677122	8.475906758	20	38.5	20	0	0	0.2	19.39461355	0	25	20	0	0	0	0	0											YES	133.6065292	94.93314046	57.95540597	0	115.9108119	0.154547749	0.099557203	38.32648611	96.59234329	2.318216239	0.135103738	0	0.154547749	37.97673456	8.408319486	20	38.5	15.45477493	0	0	0.154547749	19.39461355	0	25	20	0	0	0	0	0											3000	11.2811	0.534902696	3.346772285	0	1.074422463	1.063991017	0.69794599	0.76611755	1.755477816	1.335363745	2.980566216	0	0.005513527	0.904719358	3.50209548	6.548382953	0.991137917	0.493848874	0	0	2.417531015	1.221916491	0	0.64515746	0.368688509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9356	0	8.453423563	11.2811	0.534902696	3.346772285	0	1.074422463	1.063991017	0.69794599	0.76611755	1.755477816	1.335363745	2.980566216	0	0.005513527	0.904719358	3.50209548	6.548382953	0.991137917	0.493848874	0	0	2.417531015	1.221916491	0	0.64515746	0.368688509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9356	NO	"$175 Days 1-18/$300 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$300 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$120 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $75 (5); $175 (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $30 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.689	0.1711	1.1895	0.3041	0.4963	0.7373	0.7508	0.4947	1.1353	0.6169	2.0258	0	0.0025	0.5847	2.1699	2.7705	0.3159	0.1916	0	0	0.9379	0.5227	0	0	0.156	0	0.0095	0	0	0											17.2719	0	4.560299458	12.97	0.706016837	4.536254454	0.304141157	1.570753348	1.801259114	1.448702822	1.260845096	2.890801249	1.952236801	5.006346318	0	0.008060508	1.489377743	5.672011754	9.318852665	1.306995055	0.685444886	0	0	3.355448107	1.744612997	0	0.64515746	0.524672109	0	0.009547725	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2076
H1286_004_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1197.23846	86.69954076	734.6580741	466.9706135	147.941161	6.492690763	5.620847016	283.0714758	17.17020103	6064.268895	19.30441115	0	0.017321147	10.75680127	4675.149697	3398.964415	176.0447697	270.9611609	0	0	14.74545275	739.584082	0	0	166.6275816	0	13.45750609	4.670336467	77.06055171	0											3300	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$85 Days 1-20 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	55.32652002	0	150	0.2	0.120009417	49.68344557	0.2	3	0.177563484	0	0.2	0.149303722	10.0674945	25	38.5	25	0	0	0.2	22.45248678	0	0	25	0	0	0	0	0											YES	151.2802044	115.2182063	45.42878217	0	123.1654787	0.164220638	0.098540115	40.79523573	0.164220638	2.463309575	0.145797943	0	0.164220638	0.122767349	10.00138516	25	38.5	20.52757979	0	0	0.164220638	22.45248678	0	0	25	0	0	0	0	0											3900	15.0932	0.832447131	2.781218468	0	1.518436993	1.066233821	0.553878912	0.962330632	2.819701374	1.244847636	2.814543439	0	0.00284449	1.32058398	3.896497735	7.081175866	0.564810303	0.463514738	0	0	2.421507664	1.383791819	0	0	0.347140795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1687	0	7.40837612	15.0932	0.832447131	2.781218468	0	1.518436993	1.066233821	0.553878912	0.962330632	2.819701374	1.244847636	2.814543439	0	0.00284449	1.32058398	3.896497735	7.081175866	0.564810303	0.463514738	0	0	2.421507664	1.383791819	0	0	0.347140795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1687	NO	"$375 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-22 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.7785	0.2769	0.9088	0.3547	0.6666	0.7021	0.6078	0.5861	1.8567	0.5465	1.8089	0	0.0012	0.8692	2.047	3.1594	0.18	0.1823	0	0	0.8928	0.6517	0	0	0.1567	0	0.0127	0	0	0											20.2466	0	5.438077837	18.8717	1.109394189	3.690022081	0.354656153	2.185013763	1.768330813	1.161697754	1.548454848	4.67642718	1.791321754	4.623475979	0	0.004093189	2.189753069	5.943539041	10.24057107	0.744804795	0.645795923	0	0	3.314269099	2.035524326	0	0	0.503799205	0	0.012652356	0	0	0	0	0	0	0	0	0	0	0	0	0	67.4153
H1286_008_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1027.636052	69.33774247	702.8280368	393.1046951	112.8152988	7.081846635	7.211413018	243.2758422	221.1920481	7010.718084	24.00978758	0	0.038826096	289.8970445	5069.674058	3984.324203	308.9261039	388.9092295	0	0	16.09091017	766.7914508	0	0	91.07763422	0	13.25509298	4.670647909	77.0656905	0											3350	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $200 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	74.36970205	0	150	0.2	0.12883682	49.59823236	200	3	0.173014752	0	0.2	78.10671165	9.881828029	30	38.5	30	0	0	0.2	29.09192033	0	0	30	0	0	0	0	0											YES	151.7967473	115.6116163	61.27370551	0	123.5860246	0.164781366	0.106149536	40.86432243	164.7813661	2.471720492	0.142548036	0	0.164781366	64.42873955	9.803281157	30	38.5	24.71720492	0	0	0.164781366	29.09192033	0	0	30	0	0	0	0	0											3800	12.9993	0.668020707	3.588739846	0	1.161866191	1.166956363	0.765488148	0.828441871	3.037360655	1.444044629	3.42254806	0	0.006397817	1.556475098	4.141620014	9.960810508	0.991137917	0.801062427	0	0	2.65148216	1.858952983	0	0	0.227694086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2784	0	7.318743463	12.9993	0.668020707	3.588739846	0	1.161866191	1.166956363	0.765488148	0.828441871	3.037360655	1.444044629	3.42254806	0	0.006397817	1.556475098	4.141620014	9.960810508	0.991137917	0.801062427	0	0	2.65148216	1.858952983	0	0	0.227694086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2784	NO	"$275 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$250 (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); $250 (9a); $45/$35 (9c)"	"$20 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.4063	0.1643	1.5406	0.3196	0.5143	0.7748	0.789	0.502	1.6805	0.6392	2.2314	0	0.0028	0.8618	1.823	3.7003	0.3159	0.2647	0	0	0.9856	0.7049	0	0	0.0856	0	0.0125	0	0	0											20.3191	0	5.127487318	15.4056	0.832350021	5.129339368	0.319619025	1.676138463	1.941744337	1.554451305	1.330442981	4.717879439	2.083216437	5.6539478	0	0.009229658	2.418321575	5.964646698	13.6610928	1.306995055	1.065758202	0	0	3.63713024	2.56386201	0	0	0.313322631	0	0.012462053	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5975
H1286_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	171.0583239	4.044245911	23.27297595	397.9861505	3.630993777	6.913161061	7.039641246	10.25273774	20.34969346	10.01401086	22.43900585	0	0.036285993	8.926370038	25.51499483	78.63141465	1.776013867	4.106345399	0	0	15.96012059	4.641688227	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078336849	0.078336849	0.142690052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078336849	0.078336849	0.142690052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												13.4002	0.31681348	3.320822146	0	0.84602155	1.610766527	1.64023641	2.388887893	4.741478575	2.333264531	5.228288363	0	0.008454636	2.079844219	5.944993796	18.32111961	0.413811231	0.956778478	0	0	3.718708098	1.081513357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.352	0	0	13.4002	0.31681348	3.320822146	0	0.84602155	1.610766527	1.64023641	2.388887893	4.741478575	2.333264531	5.228288363	0	0.008454636	2.079844219	5.944993796	18.32111961	0.413811231	0.956778478	0	0	3.718708098	1.081513357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.352	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.9143	0.0453	0.8044	0	0.4262	0.8114	0.8263	1.2034	2.3886	1.1754	2.6338	0	0.0043	1.0477	1.6768	5.1675	0.1167	0.2699	0	0	1.0489	0.305	0	0	0	0	0	0	0	0											21.8659	0	0	15.3145	0.362072548	4.125244902	0	1.272212857	2.422205304	2.466520918	3.592312622	7.130042971	3.508668468	7.862087764	0	0.012713739	3.127585292	7.621786917	23.48861489	0.530527219	1.226639074	0	0	4.767574484	1.386555586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2178
H1286_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	171.0583239	4.044245911	23.27297595	397.9861505	3.630993777	6.913161061	7.039641246	10.25273774	20.34969346	10.01401086	22.43900585	0	0.036285993	8.926370038	25.51499483	78.63141465	1.776013867	4.106345399	0	0	15.96012059	4.641688227	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078336849	0.078336849	0.142690052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078336849	0.078336849	0.142690052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												13.4002	0.31681348	3.320822146	0	0.84602155	1.610766527	1.64023641	2.388887893	4.741478575	2.333264531	5.228288363	0	0.008454636	2.079844219	5.944993796	18.32111961	0.413811231	0.956778478	0	0	3.718708098	1.081513357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.352	0	0	13.4002	0.31681348	3.320822146	0	0.84602155	1.610766527	1.64023641	2.388887893	4.741478575	2.333264531	5.228288363	0	0.008454636	2.079844219	5.944993796	18.32111961	0.413811231	0.956778478	0	0	3.718708098	1.081513357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.352	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.9143	0.0453	0.8044	0	0.4262	0.8114	0.8263	1.2034	2.3886	1.1754	2.6338	0	0.0043	1.0477	1.6768	5.1675	0.1167	0.2699	0	0	1.0489	0.305	0	0	0	0	0	0	0	0											21.8659	0	0	15.3145	0.362072548	4.125244902	0	1.272212857	2.422205304	2.466520918	3.592312622	7.130042971	3.508668468	7.862087764	0	0.012713739	3.127585292	7.621786917	23.48861489	0.530527219	1.226639074	0	0	4.767574484	1.386555586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2178
H1286_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	171.0583239	4.044245911	23.27297595	397.9861505	3.630993777	6.913161061	7.039641246	10.25273774	20.34969346	10.01401086	22.43900585	0	0.036285993	8.926370038	25.51499483	78.63141465	1.776013867	4.106345399	0	0	15.96012059	4.641688227	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078336849	0.078336849	0.142690052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078336849	0.078336849	0.142690052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												13.4002	0.31681348	3.320822146	0	0.84602155	1.610766527	1.64023641	2.388887893	4.741478575	2.333264531	5.228288363	0	0.008454636	2.079844219	5.944993796	18.32111961	0.413811231	0.956778478	0	0	3.718708098	1.081513357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.352	0	0	13.4002	0.31681348	3.320822146	0	0.84602155	1.610766527	1.64023641	2.388887893	4.741478575	2.333264531	5.228288363	0	0.008454636	2.079844219	5.944993796	18.32111961	0.413811231	0.956778478	0	0	3.718708098	1.081513357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.352	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.9143	0.0453	0.8044	0	0.4262	0.8114	0.8263	1.2034	2.3886	1.1754	2.6338	0	0.0043	1.0477	1.6768	5.1675	0.1167	0.2699	0	0	1.0489	0.305	0	0	0	0	0	0	0	0											21.8659	0	0	15.3145	0.362072548	4.125244902	0	1.272212857	2.422205304	2.466520918	3.592312622	7.130042971	3.508668468	7.862087764	0	0.012713739	3.127585292	7.621786917	23.48861489	0.530527219	1.226639074	0	0	4.767574484	1.386555586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2178
H1302_001_0	2010	5	N/A																															A	A	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	Coin	V	T	V	V	V	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	NO	133.4762454	8.47406724	423.3772049	20.85978115	71.56886208	4.819708289	2.796064481	189.507359	28.96053989	3.242106744	8.350984394	0	0.218720391	428.9307447	1573.091917	3456.980528	61.67366524	683.4843371	14.13681957	6.921882754	5.082052291	0	0	0	245.2700092	0	0	0	0	0												$500/Admit for IP Medical; $500/Admit for IP Surgical;	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse;	$50/Days Custom for SNF	10% Coinsurance for Home Health	$150/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	10% Coinsurance for OP Fac - Surgery; 10% Coinsurance for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Visit for PCP - Consults; $25/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; 10% Coinsurance for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											500	500	50	0.1	150	0.1	0.1	48.42027672	0.1	0.1	0.1	0	0.1	25	25	25	25	25	0.1	0.070310249	0.1	0	0	0	25	0	0	0	0	0											NO	475.1022814	475.1022815	47.51022814	0.095020456	142.5306844	0.095020456	0.095020456	46.00916786	0.095020456	0.095020456	0.095020456	0	0.095020457	23.75511407	23.75511407	23.75511407	23.75511405	23.75511407	0.095020456	0.06680912	0.095020456	0	0	0	23.75511407	0	0	0	0	0												5.2846	0.335504057	1.676228966	1.982105923	0.850063241	0.457970881	0.265683323	0.726589658	2.751843714	0.308066462	0.793514348	0	0.020782911	0.849108231	3.114081494	6.843413898	0.122088746	1.353020699	1.343287045	0.462444893	0.482898927	0	0	0	0.485534754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.5088	0	1.518872204	5.2846	0.335504057	1.676228966	1.982105923	0.850063241	0.457970881	0.265683323	0.726589658	2.751843714	0.308066462	0.793514348	0	0.020782911	0.849108231	3.114081494	6.843413898	0.122088746	1.353020699	1.343287045	0.462444893	0.482898927	0	0	0	0.485534754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.5088	YES	$750/Admit for IP Medical; $750/Admit for IP Surgical;	$750/Admit for IP Psych; $750/Admit for IP Substance Abuse;	$50/Days Custom for SNF	25% Coinsurance for Home Health	$150/Run for Ambulance	25% Coinsurance for DME	25% Coinsurance for Prosthetics/Supplies; 25% Coinsurance for Diabetes Monitoring Supplies; 25% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	25% Coinsurance for OP Fac - Surgery; 25% Coinsurance for OP Fac - ASC	25% Coinsurance for OP Fac - Pathology	25% Coinsurance for OP Fac - Radiology; 25% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	25% Coinsurance for OP Fac - Cardiovascular; 25% Coinsurance for OP Fac - Occ Therapy; 25% Coinsurance for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for Prof - CORF; 25% Coinsurance for Prof - CORF;	25% Coinsurance for PCP - Office Visits; 25% Coinsurance for PCP - Consults; 25% Coinsurance for PCP - Routine Physicals; 25% Coinsurance for PCP - Tx Injections; 25% Coinsurance for PCP - Allergy Testing; 25% Coinsurance for PCP - Allergy Tx; 25% Coinsurance for PCP - Cardio; 25% Coinsurance for PCP - Immunizations;	25% Coinsurance for Speclst - Office Visits; 25% Coinsurance for Speclst - Tx Injections; 25% Coinsurance for Speclst - Allergy Testing; 25% Coinsurance for Speclst - Allergy Tx; 25% Coinsurance for Speclst - Consults; 25% Coinsurance for Speclst - Cardio; 25% Coinsurance for Speclst - Immunizations;	25% Coinsurance for OP Psych - Non-Physician; 25% Coinsurance for OP Psych - Psychiatrist; 25% Coinsurance for OP Substance Abuse;	25% Coinsurance for PT/ST (PCP); 25% Coinsurance for Occ Therapy (PCP); 25% Coinsurance for PT/ST (Specialist); 25% Coinsurance for Occ Therapy (Specialist);	25% Coinsurance for Prof Radiology (IP); 25% Coinsurance for Prof Radiology (OP); 25% Coinsurance for Prof Radiology (Office);	25% Coinsurance for Chiropractor; 25% Coinsurance for Vision Exams; 25% Coinsurance for Hearing/Speech Exams; 25% Coinsurance for Misc. Medical (PCP); 25% Coinsurance for Misc. Medical; 25% Coinsurance for Prof Path (IP); 25% Coinsurance for Prof Path (OP); 25% Coinsurance for Prof Path (Office); 25% Coinsurance for Prof Path (Labs)	25% Coinsurance for Part B Rx	25% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	25% Coinsurance for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											3000	1.364	0.0157	0.3142	0.4119	0.3504	0.1419	0.0933	0.2298	1.6907	0.1219	0.447	0	0.0032	0.544	0.3043	0.8134	0.0132	0.0728	0.3825	0.4371	0.1286	0.0319	0	0	0	0	0	0	0	0											7.9117	0	0.079940642	6.6486	0.351203423	1.990476472	2.394009029	1.200499795	0.599905375	0.358935348	0.95640101	4.442545091	0.429931557	1.2404767	0	0.023986121	1.393073728	3.418373023	7.65676962	0.135287916	1.425813359	1.725781278	0.899501345	0.611548649	0.03187563	0	0	0.485534754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4205
H1302_004_0	2010	4	N/A																															A	A	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	Coin	V	T	V	V	V	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	NO	165.5936366	6.079820639	641.6810972	21.45241164	95.01182765	5.990770333	3.798794274	149.7939359	26.28046319	3.459163348	10.07375951	0	0.306328121	405.4251466	2111.642855	2583.56861	84.80457293	740.0887848	15.15315944	9.291739568	5.182949507	0	0	0	279.9193642	0	0	0	0	0												$500/Admit for IP Medical; $500/Admit for IP Surgical;	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse;	$50/Days Custom for SNF	10% Coinsurance for Home Health	$150/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	10% Coinsurance for OP Fac - Surgery; 10% Coinsurance for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Visit for PCP - Consults; $25/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	10% Coinsurance for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											500	500	50	0.1	150	0.1	0.1	48.11945363	0.1	0.1	0.1	0	0.1	25	25	25	25	25	0.1	0.068634424	0.1	0	0	0	25	0	0	0	0	0											NO	473.0373858	473.0373857	47.30373858	0.094607477	141.9112157	0.094607477	0.094607477	45.52460109	0.094607477	0.094607477	0.094607477	0	0.094607477	23.65186929	23.65186929	23.65186929	23.65186929	23.65186929	0.094607477	0.064933297	0.094607477	0	0	0	23.65186929	0	0	0	0	0												6.5277	0.239665205	2.529492906	2.029558544	1.123603664	0.566771667	0.359394343	0.568275765	2.486328321	0.327262717	0.953052973	0	0.028980931	0.799088548	4.162025065	5.092185588	0.167148889	1.458706933	1.433602186	0.603343283	0.490345777	0	0	0	0.551718018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4982	0	1.759744692	6.5277	0.239665205	2.529492906	2.029558544	1.123603664	0.566771667	0.359394343	0.568275765	2.486328321	0.327262717	0.953052973	0	0.028980931	0.799088548	4.162025065	5.092185588	0.167148889	1.458706933	1.433602186	0.603343283	0.490345777	0	0	0	0.551718018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4982	YES	$750/Admit for IP Medical; $750/Admit for IP Surgical;	$750/Admit for IP Psych; $750/Admit for IP Substance Abuse;	$50/Days Custom for SNF	25% Coinsurance for Home Health	$150/Run for Ambulance	25% Coinsurance for DME	25% Coinsurance for Prosthetics/Supplies; 25% Coinsurance for Diabetes Monitoring Supplies; 25% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	25% Coinsurance for OP Fac - Surgery; 25% Coinsurance for OP Fac - ASC	25% Coinsurance for OP Fac - Pathology	25% Coinsurance for OP Fac - Radiology; 25% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	25% Coinsurance for OP Fac - Cardiovascular; 25% Coinsurance for OP Fac - Occ Therapy; 25% Coinsurance for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for Prof - CORF; 25% Coinsurance for Prof - CORF;	25% Coinsurance for PCP - Office Visits; 25% Coinsurance for PCP - Consults; 25% Coinsurance for PCP - Routine Physicals; 25% Coinsurance for PCP - Tx Injections; 25% Coinsurance for PCP - Allergy Testing; 25% Coinsurance for PCP - Allergy Tx; 25% Coinsurance for PCP - Cardio; 25% Coinsurance for PCP - Immunizations;	25% Coinsurance for Speclst - Office Visits; 25% Coinsurance for Speclst - Tx Injections; 25% Coinsurance for Speclst - Allergy Testing; 25% Coinsurance for Speclst - Allergy Tx; 25% Coinsurance for Speclst - Consults; 25% Coinsurance for Speclst - Immunizations;	25% Coinsurance for OP Psych - Non-Physician; 25% Coinsurance for OP Psych - Psychiatrist; 25% Coinsurance for OP Substance Abuse;	25% Coinsurance for PT/ST (PCP); 25% Coinsurance for Occ Therapy (PCP); 25% Coinsurance for PT/ST (Specialist); 25% Coinsurance for Occ Therapy (Specialist);	25% Coinsurance for Prof Radiology (IP); 25% Coinsurance for Prof Radiology (OP); 25% Coinsurance for Prof Radiology (Office);	25% Coinsurance for Chiropractor; 25% Coinsurance for Vision Exams; 25% Coinsurance for Hearing/Speech Exams; 25% Coinsurance for Misc. Medical (PCP); 25% Coinsurance for Misc. Medical; 25% Coinsurance for Prof Path (IP); 25% Coinsurance for Prof Path (OP); 25% Coinsurance for Prof Path (Office); 25% Coinsurance for Prof Path (Labs)	25% Coinsurance for Part B Rx	25% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	25% Coinsurance for Vision (Refractions)	$50/Service for Vision Hardware	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											3000	1.7181	0.0205	0.4371	0.5326	0.3212	0.1915	0.1258	0.1675	0.9812	0.1727	0.3566	0	0.0045	0.2968	0.398	0.7025	0.018	0.058	0.5286	0.5925	0.1816	0.0202	0	0	0.0613	0.1041	0	0	0	0											7.9908	0	0.092618142	8.2457	0.260158594	2.966604084	2.562144545	1.444831665	0.758289707	0.485223129	0.735753497	3.467538856	0.499916199	1.309648305	0	0.033525914	1.095869656	4.559977653	5.794695071	0.185197084	1.51672497	1.962158193	1.195803062	0.671931837	0.020248114	0	0	0.613012959	0.104082968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4891
H1303_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1072.372043	117.9107175	782.1080774	396.2974411	130.1772669	8.365261397	6.579702046	429.0784637	301.7976314	6849.993035	31.35131913	0	0.020040916	850.786796	3914.352003	3168.000124	383.3005186	308.6609041	0	0	7.908996931	579.6762017	0	0	211.6310444	193.8491627	11.97900887	4.364351847	356.5562017	0											2800	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-30 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	71.250509	0	150	0.2	0.111269505	49.83299658	175	3	0.176631432	0	0.2	69.15980137	9.76368671	30	38.5	30	0	0	0.2	29.16884546	0	0	30	0	0	0	0	0											YES	130.6442166	99.5014011	56.13726996	0	118.1828819	0.157577176	0.087667672	39.26271434	137.8800289	2.363657639	0.139165411	0	0.157577176	54.54453145	9.698952866	30	38.5	23.63657639	0	0	0.157577176	29.16884546	0	0	30	0	0	0	0	0											3400	11.6749	0.977690133	3.658784356	0	1.282060381	1.318174267	0.576827158	1.403898763	3.467655512	1.349253197	4.363019218	0	0.003157991	3.867147262	3.163759632	7.92000031	1.22975583	0.60797392	0	0	1.246277401	1.409040462	0	0	0.529077611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0485	0	9.653417032	11.6749	0.977690133	3.658784356	0	1.282060381	1.318174267	0.576827158	1.403898763	3.467655512	1.349253197	4.363019218	0	0.003157991	3.867147262	3.163759632	7.92000031	1.22975583	0.60797392	0	0	1.246277401	1.409040462	0	0	0.529077611	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0485	NO	"$325 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-20 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.883	0.0983	1.9206	0.1136	0.2176	0.3357	0.264	0.3635	1.0003	0.2291	1.0909	0	0.0005	0.6079	2.5866	4.5669	0.6098	0.2949	0	0	0.68	0.83	0	0	0.3096	0.0344	0.0175	0.0055	0	0											17.0601	0	4.240354682	12.5579	1.075954892	5.579413706	0.113602879	1.499705657	1.653838336	0.84084396	1.767366317	4.468000072	1.578305268	5.453955312	0	0.003694098	4.475084021	5.750394515	12.48686067	1.839520774	0.90282903	0	0	1.926249278	2.239040724	0	0	0.838657796	0.0343804	0.01752325	0.005509742	0	0	0	0	0	0	0	0	0	0	0	0	67.1086
H1303_004_0	2010	5	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	316.495596	20.60684391	1671.516092	871.8918401	10.69848302	24.23370237	16.19728283	30.41573864	27.71297816	12.44388549	27.54712866	0	0.046119219	31.50969601	25.90618639	95.57102043	8.647078804	6.477238483	0	0	14.16979694	4.22866005	606.6691339	461.0423872	202.9880238	216.1043857	0	0	81.08940055	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083022115	0.084030481	43.47002967	0	0.2	0.2	0.2	0.122169139	0.2	0	0.166676415	0	0.2	0.15007857	0.167614286	0.199837937	0.2	0	0	0	0.2	0.199632311	0	0	0	0	0	0	0	0											NO	0.083022115	0.084030481	43.47002967	0	0.2	0.2	0.2	0.122169139	0.2	0	0.166676415	0	0.2	0.15007857	0.167614286	0.199837937	0.2	0	0	0	0.2	0.199632311	0	0	0	0	0	0	0	0												26.2761	1.731603011	6.055071177	0	2.139696603	4.846740473	3.239456565	3.715864609	5.542595633	0	4.591456648	0	0.009223844	4.728930128	4.342246944	19.09871561	1.729415761	0	0	0	2.833959388	0.844177177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7253	0	0	26.2761	1.731603011	6.055071177	0	2.139696603	4.846740473	3.239456565	3.715864609	5.542595633	0	4.591456648	0	0.009223844	4.728930128	4.342246944	19.09871561	1.729415761	0	0	0	2.833959388	0.844177177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7253	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												16.1024	1.0484	4.8895	0.388	0.6342	1.4366	0.9602	0.7338	1.6429	0.2213	1.3609	0	0.0018	1.4017	2.3578	8.8075	0.7969	0	0	0	1.3058	0.389	0	0.1011	0.0967	0.0362	0	0	0	0											44.7128	0	0	42.3785	2.780021385	10.94460633	0.387955495	2.773918052	6.283349176	4.199654769	4.449692166	7.185460805	0.221307425	5.952397391	0	0.01104652	6.130618998	6.700003748	27.90624102	2.526303415	0	0	0	4.139803419	1.233160778	0	0.101105787	0.096652146	0.036211213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4381
H1303_006_0	2010	5	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1759.151549	200.7643208	33.98170052	886.4904907	232.9554371	15.64204159	14.85241737	582.6159171	38.92675153	12061.10221	38.29590133	0	0.155782392	28.6991318	7249.461555	5333.778195	846.9010221	473.9588927	0	0	21.74814338	1031.159965	670.8241038	0	174.7714017	200.6072787	14.64437885	4.552020704	79.06141223	0											2800	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	0.166717839	0	150	0.2	0.101652304	49.68870712	0.2	3	0.178076645	0	0.2	0.149766269	10.17130627	30	38.5	30	0	0	0.2	29.75453875	0	0	30	0	0	0	0	0											NO	114.1540914	86.94217269	0.114774836	0	103.2656467	0.137687529	0.069981273	34.20757649	0.137687529	2.065312934	0.122594666	0	0.137687529	0.103415648	10.036669	30	38.5	20.65312934	0	0	0.137687529	29.75453875	0	0	30	0	0	0	0	0												16.7345	1.454573854	3.900244105	0	2.004691156	2.153714054	1.039391067	1.660823213	5.359728226	2.075829199	4.69487323	0	0.021449293	2.967939299	6.063370502	13.33444549	2.717140779	0.815727859	0	0	2.99444812	2.556807428	0	0	0.436928504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9867	0	21.73623627	16.7345	1.454573854	3.900244105	0	2.004691156	2.153714054	1.039391067	1.660823213	5.359728226	2.075829199	4.69487323	0	0.021449293	2.967939299	6.063370502	13.33444549	2.717140779	0.815727859	0	0	2.99444812	2.556807428	0	0	0.436928504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9867	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												9.7011	0.3324	1.7289	0.2444	0.3599	0.58	0.5507	0.2982	1.4434	0.3727	1.2349	0	0.0039	0.8053	1.9681	6.7339	0.5848	0.27	0	0	1.2428	0.361	0	0	0.0509	0.0348	0.0037	0.003	0	0											28.9085	0	0	26.4356	1.786991155	5.62913764	0.244409476	2.364594219	2.733699866	1.590098678	1.958991516	6.803079687	2.448503705	5.929738151	0	0.025300093	3.773199686	8.031517934	20.06835873	3.301905771	1.085724958	0	0	4.23719917	2.91783295	0	0	0.487827174	0.034792098	0.003651154	0.00299475	0	0	0	0	0	0	0	0	0	0	0	0	101.8952
H1303_801_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	195.7546485	5.587554505	27.40086022	417.2235613	4.364528439	8.801183273	6.922576694	16.98087976	26.22924709	13.13330572	32.98506675	0	0.021085267	21.2364681	19.53645356	65.2732941	1.995196864	3.490298367	0	0	8.321142423	3.775957897	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.084030481	0.084030481	0.166717839	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.084030481	0.084030481	0.166717839	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.4494	0.469524894	4.568212189	0	1.016935126	2.050675703	1.61296037	3.956544984	6.111414571	3.060060233	7.685520552	0	0.004912867	4.948097067	4.551993679	15.20867753	0.464880869	0.813239519	0	0	1.938826184	0.87979819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7916	0	0	16.4494	0.469524894	4.568212189	0	1.016935126	2.050675703	1.61296037	3.956544984	6.111414571	3.060060233	7.685520552	0	0.004912867	4.948097067	4.551993679	15.20867753	0.464880869	0.813239519	0	0	1.938826184	0.87979819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7916	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.7751	0.0221	1.178	0	0.2083	0.42	0.3304	0.8104	1.2517	0.6268	1.5741	0	0.001	1.0135	1.9976	6.6743	0.204	0.3569	0	0	0.8509	0.3861	0	0	0	0	0	0	0	0											18.6812	0	0	17.2245	0.491649104	5.746178853	0	1.225223044	2.470693618	1.943325747	4.766921668	7.363150086	3.686819558	9.259663315	0	0.005919117	5.961562731	6.549631192	21.88298925	0.668893337	1.170128805	0	0	2.789677963	1.265896676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4728
H1303_803_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	195.7546485	5.587554505	27.40086022	417.2235613	4.364528439	8.801183273	6.922576694	16.98087976	26.22924709	13.13330572	32.98506675	0	0.021085267	21.2364681	19.53645356	65.2732941	1.995196864	3.490298367	0	0	8.321142423	3.775957897	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.084030481	0.084030481	0.166717839	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.084030481	0.084030481	0.166717839	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.4494	0.469524894	4.568212189	0	1.016935126	2.050675703	1.61296037	3.956544984	6.111414571	3.060060233	7.685520552	0	0.004912867	4.948097067	4.551993679	15.20867753	0.464880869	0.813239519	0	0	1.938826184	0.87979819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7916	0	0	16.4494	0.469524894	4.568212189	0	1.016935126	2.050675703	1.61296037	3.956544984	6.111414571	3.060060233	7.685520552	0	0.004912867	4.948097067	4.551993679	15.20867753	0.464880869	0.813239519	0	0	1.938826184	0.87979819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7916	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.7751	0.0221	1.178	0	0.2083	0.42	0.3304	0.8104	1.2517	0.6268	1.5741	0	0.001	1.0135	1.9976	6.6743	0.204	0.3569	0	0	0.8509	0.3861	0	0	0	0	0	0	0	0											18.6812	0	0	17.2245	0.491649104	5.746178853	0	1.225223044	2.470693618	1.943325747	4.766921668	7.363150086	3.686819558	9.259663315	0	0.005919117	5.961562731	6.549631192	21.88298925	0.668893337	1.170128805	0	0	2.789677963	1.265896676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4728
H1304_001_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	553.7905126	22.75686883	0	0	120.6633522	0	0	283.4703136	281.3130712	0	0	0	0	381.0744845	3503.895216	4042.361079	60.45468673	1210.341264	0	1018.261237	0	0	0	0	260.6385412	0	0	0	0	0											2000	$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical;	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals; $10/Procedure for PCP - Cardio;	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											125	125	0	0	100	0	0	49.3360816	100	0	0	0	0	10	10	10	10	10	0	10	0	0	0	0	10	0	0	0	0	0											YES	123.032657	123.032657	0	0	98.42612562	0	0	48.55959365	98.42612561	0	0	0	0	9.842612564	9.842612561	9.842612561	9.84261258	9.84261256	0	9.842612561	0	0	0	0	9.842612563	0	0	0	0	0											3500	5.6779	0.233319836	0	0	0.989702189	0	0	1.14710027	2.307379641	0	0	0	0	0.312564042	2.873956922	3.315616161	0.049586005	0.992743344	0	0.835195904	0	0	0	0	0.213780348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9488	0	0.302999208	5.6779	0.233319836	0	0	0.989702189	0	0	1.14710027	2.307379641	0	0	0	0	0.312564042	2.873956922	3.315616161	0.049586005	0.992743344	0	0.835195904	0	0	0	0	0.213780348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9488	NO	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical;	$225/Days 1-5 for IP Psych; $225/Days 1-5 for IP Substance Abuse;	$25/Days Custom for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.2994	0.0218	0.6547	0.1238	0.5414	0.0971	0.0339	0.1225	0.11	0.2303	0.1375	0	0	0.0857	0.6843	0.6719	0.1045	0.0189	0.2559	0.5821	0	0	0	0	0.0435	0	0	0	0	0											4.8194	0	0.08620985	5.9773	0.25515121	0.654701021	0.123791877	1.531142357	0.097141852	0.033875796	1.269633861	2.417367692	0.230319145	0.137477842	0	0	0.398271019	3.558235955	3.987546808	0.154129031	1.011686181	0.255868001	1.417280448	0	0	0	0	0.25731755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7682
H1304_002_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	O											1.0542	0.0166	0.2771	0.0664	0	0.1041	0.0125	0.1057	0.3915	0.0226	0.1275	0	0.0008	0.1139	0.222	0.3933	0.0059	0.0735	0.1174	0.128	0.24	0.0027	0	0	0.0108	0.0044	0	0	0	0											3.4911	YES	685.2984102	12.29266989	1372.155514	12.5771886	0.45677148	19.69995102	2.160739686	359.2786493	668.3687049	4.285728912	0	0	0.160720871	399.7177461	3487.116911	3489.736059	107.5084648	1919.807326	0	955.1671007	45.43896212	0	0	0	185.6647297	0	0	0	0	0											2500	$175/Days 1-5 for IP Medical; $175/Days 1-5 for IP Surgical;	$175/Days 1-5 for IP Psych; $175/Days 1-5 for IP Substance Abuse;	$10/Day for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $35/Visit for Urgent Care; $35/Visit for Urgent Care - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams;	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											175	175	10	0.1	100	0.072006851	0.1	50	200	0.1	0	0	0.1	25	25	25	25	25	0	25	0.000332356	0	0	0	25	0	0	0	0	0											YES	166.8214071	166.8214071	9.532651835	0.095326518	95.32651732	0.068641624	0.095326518	47.66325918	190.6530367	0.095326518	0	0	0.095326518	23.83162959	23.83162959	23.83162959	23.83162959	23.83162959	0	23.83162959	0.000316824	0	0	0	23.83162959	0	0	0	0	0											4000	9.5269	0.170890041	1.090023398	1.1989396	0.003628536	1.352236627	0.205975791	1.427032615	10.61887694	0.408543616	0	0	0.015320961	0.793827105	6.925306547	6.930508094	0.213508493	3.81267809	0	1.896932378	0.014396146	0	0	0	0.368724422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9742	50	2.302959952	10.581	0.187510414	1.367159285	1.265380167	0.003643953	1.456304074	0.218476118	1.53274941	11.01039275	0.431183513	0.12745916	0	0.016169989	0.907758937	7.14728355	7.323832555	0.219369536	3.886217526	0.117378208	2.024963092	0.254433128	0.002661386	0	0	0.379562642	0.004437149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4654	NO	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$30/Days Custom for SNF	20% Coinsurance for Home Health	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$300/Case for OP Fac - Surgery; $300/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Case for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; $35/Procedure for PCP - Cardio;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults; $35/Procedure for Speclst - Cardio;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.3848	0.0182	1.2691	0.2251	1.4264	0.2564	0.0075	0.1647	0.3264	0.3374	0.1645	0	0	0.3751	1.3057	0.7935	0.4037	0.1739	0.5898	1.6331	0.0146	0	0	0.0512	0.0429	0.0051	0	0	0	0											9.9694	50	0.361150788	10.9659	0.205760061	2.636286196	1.490474637	1.430008334	1.712692259	0.226007776	1.697422443	11.33680005	0.768584719	0.292005313	0	0.016169989	1.282908854	8.452941894	8.117374755	0.623052713	4.060111743	0.707222707	3.658030348	0.269082458	0.002661386	0	0.051222108	0.422476859	0.009585714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4347
H1304_004_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	667.9470523	13.19745341	0	0	45.35677092	0	0	343.7912359	333.3167593	0	0	0	0	474.7852667	4038.340232	3838.363344	230.4315648	2031.673108	0	1012.418435	0	0	0	0	226.1482715	0	0	0	0	0											2000	$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical;	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals; $10/Procedure for PCP - Cardio;	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											125	125	0	0	100	0	0	49.79682419	100	0	0	0	0	10	10	10	10	10	0	10	0	0	0	0	10	0	0	0	0	0											YES	122.4215986	122.4215986	0	0	97.93727885	0	0	48.76965457	97.93727885	0	0	0	0	9.793727887	9.793727885	9.793727885	9.793727889	9.793727885	0	9.793727884	0	0	0	0	9.793727884	0	0	0	0	0											3500	6.8143	0.134637779	0	0	0.37017656	0	0	1.397214985	2.7203447	0	0	0	0	0.387493142	3.295867112	3.132657176	0.188065337	1.658137798	0	0.826279221	0	0	0	0	0.184569553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1097	0	0.444605328	6.8143	0.134637779	0	0	0.37017656	0	0	1.397214985	2.7203447	0	0	0	0	0.387493142	3.295867112	3.132657176	0.188065337	1.658137798	0	0.826279221	0	0	0	0	0.184569553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1097	NO	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical;	$225/Days 1-5 for IP Psych; $225/Days 1-5 for IP Substance Abuse;	$25/Days Custom for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.3881	0.11	1.4102	0.0808	1.0501	0.1683	0.0438	0.1558	0.3621	0.1752	0.3768	0	0	0.1179	1.1651	0.7402	0.2232	0.0778	0.3539	0.9037	0	0	0	0	0.0425	0	0	0	0	0											7.9454	0	0.23140048	7.2024	0.244615808	1.410193272	0.080789788	1.420251882	0.168325216	0.043772881	1.553034634	3.082479745	0.175150124	0.376768996	0	0	0.505389333	4.460944413	3.872893863	0.411258292	1.735893302	0.353880516	1.730017976	0	0	0	0	0.22705155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.0551
H1350_001_0	2010	4	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	201.4170986	4.528649976	117.75564	0	159.8560338	0	0	365.9460579	0	0	0	0	0	152.2706119	3263.499554	5826.678458	240.9969844	1064.094723	0	0	0	0	0	0	184.0265539	0	0	0	0	0											3000	$100/Admit for IP Medical; $100/Admit for IP Surgical;	$100/Admit for IP Psych; $100/Admit for IP Substance Abuse;	$50/Days Custom for SNF	No Cost-Sharing	$150/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Case for OP Fac - Cardiovascular; $15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Visit for Prof - CORF; $15/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $15/Visit for Occ Therapy (Specialist);	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	50	0	150	0	0	48.86202664	0	0	0	0	0	15	15	25	25	15	0	0	0	0	0	0	25	0	0	0	0	0											NO	98.89260657	98.89260666	49.44630328	0	148.3389098	0	0	48.32093177	0	0	0	0	0	14.83389098	14.83389098	24.72315164	24.72315165	14.83389099	0	0	0	0	0	0	24.72315164	0	0	0	0	0												1.6599	0.037320833	0.485215091	0	1.976072482	0	0	1.473571208	0	0	0	0	0	0.188230471	4.034199717	12.00448792	0.496517083	1.31538876	0	0	0	0	0	0	0.379143033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.05	0	0.269310841	1.6599	0.037320833	0.485215091	0	1.976072482	0	0	1.473571208	0	0	0	0	0	0.188230471	4.034199717	12.00448792	0.496517083	1.31538876	0	0	0	0	0	0	0.379143033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.05	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.6599	0.037320833	0.485215091	0	1.976072482	0	0	1.473571208	0	0	0	0	0	0.188230471	4.034199717	12.00448792	0.496517083	1.31538876	0	0	0	0	0	0	0.379143033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.05
H1350_006_0	2010	2	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	168.7810722	1.592274276	57.10962492	0	106.7930042	0	0	302.8007866	0	0	0	0	0	40.34729616	2354.593129	4526.962678	136.8226946	789.2867651	0	0	0	0	0	0	188.0763748	0	0	0	0	0											3000	$100/Admit for IP Medical; $100/Admit for IP Surgical;	$100/Admit for IP Psych; $100/Admit for IP Substance Abuse;	$50/Days Custom for SNF	No Cost-Sharing	$150/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Case for OP Fac - Cardiovascular; $15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Visit for Prof - CORF; $15/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $15/Visit for Occ Therapy (Specialist);	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	50	0	150	0	0	48.86202664	0	0	0	0	0	15	15	25	25	15	0	0	0	0	0	0	25	0	0	0	0	0											NO	99.42290237	99.42290169	49.71145118	0	149.1343535	0	0	48.58004504	0	0	0	0	0	14.91343536	14.91343535	24.85572559	24.85572558	14.91343535	0	0	0	0	0	0	24.85572559	0	0	0	0	0												1.3984	0.013192377	0.236583528	0	1.327208804	0	0	1.225839654	0	0	0	0	0	0.050143066	2.926256034	9.376745174	0.283402279	0.980914762	0	0	0	0	0	0	0.389564564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2082	0	0.105689266	1.3984	0.013192377	0.236583528	0	1.327208804	0	0	1.225839654	0	0	0	0	0	0.050143066	2.926256034	9.376745174	0.283402279	0.980914762	0	0	0	0	0	0	0.389564564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2082	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.3984	0.013192377	0.236583528	0	1.327208804	0	0	1.225839654	0	0	0	0	0	0.050143066	2.926256034	9.376745174	0.283402279	0.980914762	0	0	0	0	0	0	0.389564564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2082
H1350_009_0	2010	4	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3000	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H1355_001_0	2010	4	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	809.647081	2.991968729	603.6858076	48.77888691	200.9195332	14.09242652	3.484316135	198.5190963	294.0606061	2.723761729	127.3934933	0	0.048819529	889.3565542	0.377828668	4231.104389	150.6915432	577.0765112	29.79704591	66.54496122	6.691254608	0	0	0	0	0	0	0	0	0												1a:  Acute - $100/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $75/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $15/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $15/visit/7i:  Physical/Speech Therapy - $15/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $15/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $15/visit/17a:  Vision Exams - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $15/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $15/visit/7h:  Psychiatric Services - Individual - $15/visit/7h:  Psychiatric Services - Group - $15/visit	7c:  Occupational Therapy Services - $15/visit/7i:  Physical/Speech Therapy - $15/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $15/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $15/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit												100	0.071774782	85	0	75	0.2	0.2	25.92889346	97.95031435	0	100	0	0.2	26.27652435	15	15	15	15	0	15.05092045	0.2	0	0	0	0	0	0	0	0	0											NO	96.12247014	0.068991693	81.70409962	0	72.09185261	0.19224494	0.19224494	24.92349287	94.15226166	0	96.12247014	0	0.19224494	25.25764427	14.41837052	14.41837052	14.41837052	14.41837052	0	14.46731652	0.19224494	0	0	0	0	0	0	0	0	0												6.4854	0.206420988	4.110300447	0	1.207055114	2.709197694	0.669842147	0.412315773	2.307205928	0	1.020448104	0	0.009385307	1.871920956	0.000453973	5.083802566	0.181060542	0.693375246	0	0.080227251	1.286359842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.3348		1.14301139	6.4854	0.206420988	4.110300447	0	1.207055114	2.709197694	0.669842147	0.412315773	2.307205928	0	1.020448104	0	0.009385307	1.871920956	0.000453973	5.083802566	0.181060542	0.693375246	0	0.080227251	1.286359842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.3348	YES	1a:  Acute - 20.0% for 1-90/1a:  Additional Days - 20.0% for 91-999	1b:  Psych - 30.0% for 1-190	2:  Skilled Nursing Services - 20.0% for 1-100/2:  Non-Medicare Covered Stay - 20.0% for 1-100	6:  Home Health Services - 20.0%	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - 30.0%/3:  Rehab Services (CORF) - 30.0%/5:  Partial Hospitalization - 30.0%7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - 20.0%/17a:  Vision Exams - 20.0%/18a:  Hearing Exams - 20.0%/14c:  Routine Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/18a:  Hearing Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - 20.0%7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14c:  Routine Exams - 20.0%												4000	3.8845	0.0664	0.7842	0.4833	0.1198	0.3165	0.0782	0.0426	0.5745	0.0888	0.2758	0	0.0009	0.3773	0.4011	1.21	0.0283	0.0762	0.3922	0.4982	0.1082	0.0188	0	0	0	0	0	0	0.0102	0											9.8358		5.808	10.3699	0.272799225	4.894480839	0.483258803	1.326851329	3.02568104	0.748091839	0.454942175	2.881689841	0.088782251	1.296242395	0	0.010240082	2.249217522	0.401515665	6.293798105	0.20935677	0.769538223	0.392185534	0.578432477	1.39455284	0.018799517	0	0	0	0	0	0	0.010215106	0	0	0	0	0	0	0	0	0	0	0	38.1706
H1355_801_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	277.5110572	3.17731735	54.9857525	39.55964607	8.915360595	15.78317538	3.902349432	9.538869433	40.43218134	6.22284415	19.39531489	0	0.058497284	23.75941339	40.31108445	101.2649634	1.320135008	5.215728198	29.05683522	34.83836363	7.596301837	1.329044592	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.2406	0.243190824	9.063332482	0	2.077279019	3.677479862	0.909247418	2.222556578	9.420698253	1.449922687	4.519108369	0	0.013629867	5.535943321	9.392482676	23.59473647	0.307591457	1.21526467	6.770242605	8.117338726	1.769938328	0.30966739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8503		0	21.2406	0.243190824	9.063332482	0	2.077279019	3.677479862	0.909247418	2.222556578	9.420698253	1.449922687	4.519108369	0	0.013629867	5.535943321	9.392482676	23.59473647	0.307591457	1.21526467	6.770242605	8.117338726	1.769938328	0.30966739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8503	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				2.5927	0.0297	1.1328	0	0.2437	0.4309	0.1065	0.2765	1.1729	0.18	0.5592	0	0.0017	0.6863	1.1889	2.9604	0.0391	0.1545	0.8622	1.0275	0.2196	0.0384	0	0	0	0	0	0	0	0											13.9038		0	23.8333	0.27287598	10.19618145	0	2.321007235	4.108337521	1.015775863	2.49903769	10.59364805	1.629947841	5.078340747	0	0.015363106	6.222290325	10.58139447	26.55515138	0.34667347	1.369730385	7.632471991	9.144819476	1.989559756	0.348057636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.754
H1355_802_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	277.5110572	3.17731735	54.9857525	39.55964607	8.915360595	15.78317538	3.902349432	9.538869433	40.43218134	6.22284415	19.39531489	0	0.058497284	23.75941339	40.31108445	101.2649634	1.320135008	5.215728198	29.05683522	34.83836363	7.596301837	1.329044592	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.2406	0.243190824	9.063332482	0	2.077279019	3.677479862	0.909247418	2.222556578	9.420698253	1.449922687	4.519108369	0	0.013629867	5.535943321	9.392482676	23.59473647	0.307591457	1.21526467	6.770242605	8.117338726	1.769938328	0.30966739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8503		0	21.2406	0.243190824	9.063332482	0	2.077279019	3.677479862	0.909247418	2.222556578	9.420698253	1.449922687	4.519108369	0	0.013629867	5.535943321	9.392482676	23.59473647	0.307591457	1.21526467	6.770242605	8.117338726	1.769938328	0.30966739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8503	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				2.5927	0.0297	1.1328	0	0.2437	0.4309	0.1065	0.2765	1.1729	0.18	0.5592	0	0.0017	0.6863	1.1889	2.9604	0.0391	0.1545	0.8622	1.0275	0.2196	0.0384	0	0	0	0	0	0	0	0											13.9038		0	23.8333	0.27287598	10.19618145	0	2.321007235	4.108337521	1.015775863	2.49903769	10.59364805	1.629947841	5.078340747	0	0.015363106	6.222290325	10.58139447	26.55515138	0.34667347	1.369730385	7.632471991	9.144819476	1.989559756	0.348057636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.754
H1364_003_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5092	0.8761	0.5423	0	0.9875	0	1.0823	0	0.1164	1.1607	1.4663	2.7271	0.2824	0.0447	0	0	0.5417	0.0835	0	0	0	0	0	0	0	0											10.4202	NO	218.1812762	12.80150491	23.41391789	1619.676941	5.823399653	14.63327962	8.699503626	18.39996262	36.91378257	14.23528404	35.16268519	0	0.454044693	30.88646494	34.45916523	72.88412804	6.525755149	1.938783914	0	0	23.08491999	4.430962592	519.1921649	120.260166	82.93804551	127.3691413	0	2.322265274	2764.601517	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14c, 14e, 14f, 14g, 14h, 14i); $0/20% (14b, 14d); $0 (14b1, 14j); $0 n/c (14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1); $0 (16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 (14a1); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080784368	0.080784368	0.172578989	0	0.192359848	0.169276666	0.169276666	0.112228517	0.192359848	0	0.163023741	0	0.192359848	0.145012259	0.187512124	0.192058867	0.432809657	0.192359848	0	0	0.192359848	0.026864096	0	0	0	0	0	0	0	0											NO	0.080784368	0.080784368	0.172578989	0	0.192359848	0.169276666	0.169276666	0.112228517	0.192359848	0	0.163023741	0	0.192359848	0.145012259	0.187512124	0.192058867	0.432809657	0.192359848	0	0	0.192359848	0.026864096	0	0	0	0	0	0	0	0												17.6256	1.034161482	4.040750287	0	1.12018827	2.477072786	1.472622969	2.065000519	7.10072959	0	5.732352479	0	0.087339968	4.47891605	6.461511259	13.99804308	2.824409849	0.372944178	0	0	4.440611693	0.119033805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4513	146	0	17.6256	1.034161482	4.040750287	0	1.629406542	3.35316243	2.014927102	2.065000519	8.088205915	0	6.814607188	0	0.203774873	5.639608716	7.927770746	16.72518576	3.10685255	0.417651345	0	0	4.982300674	0.202485147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8715	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	17.6256	1.034161482	4.040750287	0	1.629406542	3.35316243	2.014927102	2.065000519	8.088205915	0	6.814607188	0	0.203774873	5.639608716	7.927770746	16.72518576	3.10685255	0.417651345	0	0	4.982300674	0.202485147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8715
H1365_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	1320.810882	14.16803002	1170.573008		171.3582032	4.252182988	6.115554619	241.161265	295.409659		13.61052747	42.23657825	3.032335319	75.30640818	2521.337312	3272.529008	199.6731251	393.7247468		127.7394163	22.70977407	629.4798908																			3400	$150 per day for days 1-7	$150 per day for days 1-7	"$0 per day for days 1-20, $150 per day for days 21-100"	No cost sharing	$150 per Trip	20% Coinsurance	20% Coinsurance	"ER- $50 per visit, UC- $35 per visit"	$125 per visit	0% Coinsurance	"PET, MRI, CAT, Thera Rad- 20% Coinsurance"	$50 per visit	$100 per visit	"OP Rehab- $25 per visit, OP Partial Hosp- $50 per visit"	$20 per visit	$25 per visit	"Individual- $25 per visit, Group- $15 per visit"	$25 per visit	No cost sharing	$25 per visit	20% Coinsurance	"$25 Eye Exam, $25 Hearing Exam"	No cost sharing	$100 every 6 months	1 Routine Eye Exam- $0 Copay		1 Routine Hearing Exam- $0 Copay														78.64036554	84.19273542	63.33804314		150	0.2	0.2	50	125		0.2	50	30.26721287	27.0864671	20	24.99943669	24	24.32951717		25	0.2	25																			YES	69.28943391	74.18158519	55.80667286		132.1638705	0.176218494	0.176218494	44.05462349	110.1365587		0.176218494	44.05462349	26.66821334	23.8656822	17.6218494	22.02681542	21.14621928	21.43655437		22.02731175	0.176218494	22.02731175																			5000	7.6265	0.08758391	5.44381541	0	1.887280281	0.749313282	1.077673825	0.885355728	2.711283605	0	2.398426653	0.155059713	0.006738914	0.1497699	3.702552199	6.006949368	0.351860974	0.703341829	0	0.234479662	4.001882185	1.155479149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3354	0	5.308490801	7.6265	0.08758391	5.44381541	0	1.887280281	0.749313282	1.077673825	0.885355728	2.711283605	0	2.398426653	0.155059713	0.006738914	0.1497699	3.702552199	6.006949368	0.351860974	0.703341829	0	0.234479662	4.001882185	1.155479149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3354	NO	30% Coinsurance	8% Coinsurance	14% Coinsurance	20% Coinsurance	$150 per Trip	30% Coinsurance	30% Coinsurance	"ER- $50 per visit, UC- 30% Coinsurance per visit"	30% Coinsurance	0% Coinsurance	"PET, MRI, CAT, Thera Rad- 30% Coinsurance"	30% Coinsurance	20% Coinsurance	"OP Rehab- 30% Coinsurance, 30% Coinsurance"	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	No cost sharing	30% Coinsurance	20% Coinsurance	20% Coinsurance	No cost sharing		30% Coinsurance	30% Coinsurance	30% Coinsurance															4.7419	0.0164	0.4483	0.3576	0.1439	0.1218	0.1751	0.1267	0.8858		0.5168	0.2566	0.0072	1.0375	0.6002	0.9266	0.0746	0.0875	0.3966	0.8012	0.1893	0.2113																			12.1231	0	6.231006582	12.3685	0.104009749	5.892147525	0.357645569	2.031208602	0.871090238	1.252815305	1.012063837	3.597084399	0	2.915236295	0.411692802	0.013893511	1.187279269	4.302766832	6.933540013	0.426494882	0.790851209	0.396618155	1.035653035	4.191185976	1.366751867	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4585
H1365_801_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	NO	1434.466819	29.00360544	898.4292103		121.3479762	6.501930713	6.961215539	149.3209106	337.6726606	1639.894727	9.036513459	5.497801517	3.98602286	286.2172393	7158.152327	6109.308255	190.7075758	349.3725703	2563.221675	8763.980978	42.96555378	642.6076448																				Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing																			147.8395166	57.88878836	55.3920953		150.0846131	0.233	0.233	124.514229	293.6695218	3.244830345	0.233	175.6791422	43.99470364	30.74982865	11.43083801	15.01947623	19.6107775	20.98166264	19.49215247	10.91742462	0.233	17.17274289																			NO	147.8395166	57.88878836	55.3920953		150.0846131	0.233	0.233	124.514229	293.6695218	3.244830345	0.233	175.6791422	43.99470364	30.74982865	11.43083801	15.01947623	19.6107775	20.98166264	19.49215247	10.91742462	0.233	17.17274289																				17.6726	0.139915298	4.14715637	0	1.517705338	1.514949856	1.62196322	1.549381505	8.263680732	0.443431681	2.105507636	0.080487421	0.014613658	0.733427589	6.818639976	7.646550842	0.31166032	0.610868117	4.163558976	7.973341811	10.01097403	0.919611322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.26	0	0	17.6726	0.139915298	4.14715637	0	1.517705338	1.514949856	1.62196322	1.549381505	8.263680732	0.443431681	2.105507636	0.080487421	0.014613658	0.733427589	6.818639976	7.646550842	0.31166032	0.610868117	4.163558976	7.973341811	10.01097403	0.919611322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.26	NO	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing	Medicare Cost-sharing																				1.9456	0.0386	0.4622		0.1829	0.219	0.2344	0.2964	0.9438	0.142	0.4012	0.0805	0.0073	0.6297	0.7603	1.4383	0.0718	0.1145	0.7067	1.4207	0.6317	0.1869																			10.9145	0	0	19.6182	0.178511875	4.609330351	0	1.700588735	1.73390192	1.856381669	1.845820993	9.207494734	0.585474749	2.506724778	0.160938669	0.021950821	1.363146284	7.578940152	9.084806261	0.383506458	0.725341417	4.870302647	9.394027079	10.64267525	1.106511951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.1745
H1406_013_0	2010	4	N/A	r.	s.	t.	u.							OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)							Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	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	NO	1915.654822	142.726654	798.651972	797.179671	384.838054	2.830368	2.017932	421.252651	410.071355	476.358229	742.004084	20.592053	0.036384	283.821365	6773.63773	5432.384703	157.867216	236.361194			14.232656	0			1.5				0.04	0.49	41.652937	0.05	0.55	2.09								$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"VIS734: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Nutritional benefit 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a							158.7573	140.3991	50.7565	0	100	0.2	0.119712	50	88.571447	16.333595	21.831558	100	0.2	55.837225	5	35	35	39.114597			0.2	0			0				0	0	0	0	0	0							NO	153.871862	136.078598	50.7565	0	100	0.2	0.119712	50	88.571447	16.333595	21.831558	100	0.2	55.837225	5	35	35	39.114597			0.2	0			0				0	0	0	0	0	0								24.5638	1.618503581	3.378064901	0	3.206983783	0.5660736	0.241570676	1.755219379	3.026717774	0.648386866	1.349925433	0.171600442	0.0072768	1.320649785	2.822349054	15.84445538	0.460446047	0.770431071	0	0	2.8465312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.599	0	0.831288	24.5638	1.618503581	3.378064901	0	3.206983783	0.5660736	0.241570676	1.755219379	3.026717774	0.648386866	1.349925433	0.171600442	0.0072768	1.320649785	2.822349054	15.84445538	0.460446047	0.770431071	0	0	2.8465312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.599	NO																																																																																		0	0	0	24.5638	1.618503581	3.378064901	0	3.206983783	0.5660736	0.241570676	1.755219379	3.026717774	0.648386866	1.349925433	0.171600442	0.0072768	1.320649785	2.822349054	15.84445538	0.460446047	0.770431071	0	0	2.8465312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.599
H1406_022_0	2010	4	N/A	r.	s.	t.	u.							OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)							Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	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	NO	1816.327343	568.005702	666.801728	557.435806	471.877413	3.084606	1.424554	1053.100282	19.442464	220.463109	2148.151227	3.624663	0	1322.593695	6166.943998	4980.145169	284.844958	3.273754			12.032769	0			1.5				0.04	0.49	0	0.05	0.55	2.09								$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"VIS734: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Nutritional benefit 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a							158.7573	140.3991	50.7565	0	100	0.2	0	50	200	50	3.582068	100	0	63.246757	5	35	35	50			0.2	0			0				0	0	0	0	0	0							NO	151.167113	133.686619	50.7565	0	100	0.2	0	50	200	50	3.582068	100	0	63.246757	5	35	35	50			0.2	0			0				0	0	0	0	0	0								22.8807	6.327896823	2.820376826	0	3.932311775	0.6169212	0	4.387917842	0.324041067	0.918596288	0.641235314	0.030205525	0	6.970813503	2.569559999	14.52542341	0.830797794	0.013640642	0	0	2.4065538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.197	0	1.466582	22.8807	6.327896823	2.820376826	0	3.932311775	0.6169212	0	4.387917842	0.324041067	0.918596288	0.641235314	0.030205525	0	6.970813503	2.569559999	14.52542341	0.830797794	0.013640642	0	0	2.4065538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.197	NO																																																																																		0	0	0	22.8807	6.327896823	2.820376826	0	3.932311775	0.6169212	0	4.387917842	0.324041067	0.918596288	0.641235314	0.030205525	0	6.970813503	2.569559999	14.52542341	0.830797794	0.013640642	0	0	2.4065538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.197
H1406_801_0	2010	4	N/A																															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	NO	270.008719	4.829907	31.975675	7.482078	12.451777	2.812625	1.1986	35.862516	74.616986	6.231753	18.10138	10.824305	0.062037	15.141029	70.804293	76.564017	0.716811	3.875912			27.526424	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																			0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.4156	0.347306331	5.208755836	0	2.901264041	0.655341625	0.2792738	8.355966228	17.38575774	1.451998449	4.21762154	2.522063065	0.014454621	3.527859757	16.49740027	17.83941596	0.167016963	0.903087496	0	0	6.413656792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1039	0	0	19.4156	0.347306331	5.208755836	0	2.901264041	0.655341625	0.2792738	8.355966228	17.38575774	1.451998449	4.21762154	2.522063065	0.014454621	3.527859757	16.49740027	17.83941596	0.167016963	0.903087496	0	0	6.413656792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1039	NO																																																																																		0	0	0	19.4156	0.347306331	5.208755836	0	2.901264041	0.655341625	0.2792738	8.355966228	17.38575774	1.451998449	4.21762154	2.522063065	0.014454621	3.527859757	16.49740027	17.83941596	0.167016963	0.903087496	0	0	6.413656792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1039
H1406_802_0	2010	5	N/A																															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	NO	270.008719	4.829907	31.975675	7.482078	12.451777	2.812625	1.1986	35.862516	74.616986	6.231753	18.10138	10.824305	0.062037	15.141029	70.804293	76.564017	0.716811	3.875912			27.526424	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																			0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.4156	0.347306331	5.208755836	0	2.901264041	0.655341625	0.2792738	8.355966228	17.38575774	1.451998449	4.21762154	2.522063065	0.014454621	3.527859757	16.49740027	17.83941596	0.167016963	0.903087496	0	0	6.413656792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1039	0	0	19.4156	0.347306331	5.208755836	0	2.901264041	0.655341625	0.2792738	8.355966228	17.38575774	1.451998449	4.21762154	2.522063065	0.014454621	3.527859757	16.49740027	17.83941596	0.167016963	0.903087496	0	0	6.413656792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1039	NO																																																																																		0	0	0	19.4156	0.347306331	5.208755836	0	2.901264041	0.655341625	0.2792738	8.355966228	17.38575774	1.451998449	4.21762154	2.522063065	0.014454621	3.527859757	16.49740027	17.83941596	0.167016963	0.903087496	0	0	6.413656792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1039
H1406_803_0	2010	6	N/A																															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	NO	270.008719	4.829907	31.975675	7.482078	12.451777	2.812625	1.1986	35.862516	74.616986	6.231753	18.10138	10.824305	0.062037	15.141029	70.804293	76.564017	0.716811	3.875912			27.526424	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																			0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.4156	0.347306331	5.208755836	0	2.901264041	0.655341625	0.2792738	8.355966228	17.38575774	1.451998449	4.21762154	2.522063065	0.014454621	3.527859757	16.49740027	17.83941596	0.167016963	0.903087496	0	0	6.413656792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1039	0	0	19.4156	0.347306331	5.208755836	0	2.901264041	0.655341625	0.2792738	8.355966228	17.38575774	1.451998449	4.21762154	2.522063065	0.014454621	3.527859757	16.49740027	17.83941596	0.167016963	0.903087496	0	0	6.413656792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1039	NO																																																																																		0	0	0	19.4156	0.347306331	5.208755836	0	2.901264041	0.655341625	0.2792738	8.355966228	17.38575774	1.451998449	4.21762154	2.522063065	0.014454621	3.527859757	16.49740027	17.83941596	0.167016963	0.903087496	0	0	6.413656792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1039
H1415_005_0	2010	11	N/A																															D	D	COIN		COIN	COIN	COIN	V	P	COIN	COIN	COIN	COIN	COIN	V	V	V	V	V		COIN																																																												0	NO	2060.396951	434.2	38.22777573		19.35477987	10.05	9.91	843.0371417	443.8326492	18.37	12.2	8.24	1.37	46.75139193							19.4053434																					Standard Medicare	$100 days 1-7	20% Coinsurance		20% Coinsurance	20% Coinsurance	20% Coinsurance	$50/visit	$50/visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	None	None	None	None	None	None	20% Coinsurance																				153.57	100	0.2		0.2	0.2	0.2	50	50	0.2	0.2	0.2	0.2	0.2							0.2																				NO	153.57	100	0.1		0.2	0.2	0.2	50	50	0.2	0.2	0.2	0.2	0.2							0.2																					26.3679	3.618333333	3.822777573	0	3.870955974	2.01	1.982	3.512654757	1.849302705	3.674	2.44	1.648	0.274	9.350278386	0	0	0	0	0	0	3.881068681	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3013	0		26.3679	3.618333333	3.822777573	0	3.870955974	2.01	1.982	3.512654757	1.849302705	3.674	2.44	1.648	0.274	9.350278386	0	0	0	0	0	0	3.881068681	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3013	NO																																																																																		0	0	0	26.3679	3.618333333	3.822777573	0	3.870955974	2.01	1.982	3.512654757	1.849302705	3.674	2.44	1.648	0.274	9.350278386	0	0	0	0	0	0	3.881068681	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3013
H1415_013_0	2010	5	N/A																															D	D	D	V	T	COIN	COIN	V	V	P	P	V	V	V	V	V	COIN	V	P	V	COIN																																																												0	NO	629.7932005	56.45	277.7079629	741.543595	127.2534135	4.510832572	1.127708143	302.9025544	175.0620418	47.67173724	1455.074998	9.985150178	42.35907819	1405.806383	5417.544472	4838.853974	0.820723757	1379.727164	1151.890865	4175.945433	6.862734169																					$175/day 1-3	$275 days 1-7	$0/days 0-5; $125/days 6-20; $0 days 21-100	No Cost Share	$100 COPAY	20% Coinsurance	20% Coinsurance	$50 COPAY	$100 COPAY	No Cost Share	$0- $100 Copay	$100 COPAY	$30 Copay	No Cost Share	$5 Copay	$30 Copay	20% Coinsurance	$15 Copay	$0 for all x-rays; $100 for diagnostic radiology services	No Cost Share	20% Coinsurance				$30 copay for routine eye exams up to 1 per plan year; $100 annually for eyeware		$30 copay for routine hearing exams up to 1 per plan year; $500 annually toward hearing aid														175	275	125	0	100	0.2	0.2	50	100	0	3.32	3.32	6.63	0	5	30	0.2	15	11.64	0	0.2																				NO	165.9	260.7	118.5	0	94.8	0.1896	0.1896	50	94.8	0	3.14736	3.14736	6.28524	0	5	30	0.1896	15	11.64	0	0.1896																					8.7069	1.22637625	2.742366134	0	1.005301966	0.855253856	0.213813464	1.262093977	1.38299013	0	0.381637071	0.002618905	0.022186414	0	2.257310197	12.09713493	0.155609224	1.724658954	1.117334139	0	1.301174398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4548	0		8.7069	1.22637625	2.742366134	0	1.005301966	0.855253856	0.213813464	1.262093977	1.38299013	0	0.381637071	0.002618905	0.022186414	0	2.257310197	12.09713493	0.155609224	1.724658954	1.117334139	0	1.301174398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4548	NO																																																																																		0	0	0	8.7069	1.22637625	2.742366134	0	1.005301966	0.855253856	0.213813464	1.262093977	1.38299013	0	0.381637071	0.002618905	0.022186414	0	2.257310197	12.09713493	0.155609224	1.724658954	1.117334139	0	1.301174398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4548
H1415_015_0	2010	9	N/A																															D	D	D	V	T	COIN	COIN	V	V	P	P	V	V	V	V	V	COIN	V	P	V	COIN																																																												0	NO	1291.638409	88.89	369.5772431	1306.817051	213.3459379	8.543155754	2.135788938	211.9432359	110.1708229	122.0779222	3726.160252	25.57000137	108.4732496	5058.347087	9751.657741	8269.745443	2.101711765	972.4064157	388.9625663	194.4812831	18.80761147																					$275/day 1-5	$275 days 1-7	$0/days 0-5; $125/days 6-20; 21 - 100 $0	No Cost Sharing	$150 COPAY	20% Coinsurance	20% Coinsurance	$50 COPAY	$200 COPAY	No Cost Sharing	$0- $200 Copay	$200 COPAY	$30 Copay	No Cost Sharing	$10 Copay	$40 Copay	20% Coinsurance	$15 Copay	$0 for all x-rays; $100 for diagnostic radiology services	No Cost Sharing	20% Coinsurance				$35 copay for routine eye exams up to 1 per plan year		discounts														275	275	125	0	150	0.2	0.2	50	200	0	6.63	6.63	6.63	0	10	40	0.2	15	11.64	0	0.2																				NO	260.7	260.7	118.5	0	142.2	0.1896	0.1896	50	189.6	0	6.28524	6.28524	6.28524	0	10	40	0.19	15	11.64	0	0.1896																					28.0608	1.93113525	3.649575275	0	2.528149364	1.619782331	0.404945583	0.883096816	1.740699001	0	1.951650955	0.0133928	0.056815034	0	8.126381451	27.56581814	0.399325235	1.21550802	0.377293689	0	3.565923135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0903	0		28.0608	1.93113525	3.649575275	0	2.528149364	1.619782331	0.404945583	0.883096816	1.740699001	0	1.951650955	0.0133928	0.056815034	0	8.126381451	27.56581814	0.399325235	1.21550802	0.377293689	0	3.565923135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0903	NO																																																																																		0	0	0	28.0608	1.93113525	3.649575275	0	2.528149364	1.619782331	0.404945583	0.883096816	1.740699001	0	1.951650955	0.0133928	0.056815034	0	8.126381451	27.56581814	0.399325235	1.21550802	0.377293689	0	3.565923135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0903
H1415_017_0	2010	8	N/A																															D	D	D	V	T	COIN	COIN	V	V	P	P	V	V	V	V	V	COIN	V	P	V	COIN																																																												0	NO	706.86	66.35	311.6906479	840.8735344	142.4843901	7.694187991	1.923546998	314.3035792	271.0882191	97.47652619	2975.256712	20.41708168	86.61349542	2102.503885	6988.005526	5804.731267	1.678170452	776.4450585	310.5780234	155.2890117	11.18847039																					$175/day 1-3	$275 days 1-7	$0/days 0-5; $125/days 6-20; $0 21 -100	No Cost Share	$100 COPAY	20% Coinsurance	20% Coinsurance	$50 COPAY	$100 COPAY	No Cost Share	$0- $100 Copay	$100 COPAY	$30 Copay	No Cost Share	No Cost Share	$15 Copay	20% Coinsurance	$15 Copay	$0 for all x-rays; $100 for diagnostic radiology services	No Cost Sharing	20% Coinsurance				$30 copay for routine eye exams up to 1 per plan year; $100 annually for eyeware		$30 copay for routine hearing exams up to 1 per plan year; $500 annually toward hearing aid														175	275	125	0	100	0.2	0.2	50	100	0	3.31	3.31	6.63	0	0	15	0.2	15	11.64	0	0.2																				NO	165.9	260.7	118.5	0	94.8	0.1896	0.1896	50	94.8	0	3.13788	3.13788	6.28524	0	0	15	0.1896	15	11.64	0	0.1896																					9.7723	1.44145375	3.077945148	0	1.125626682	1.458818043	0.364704511	1.309598247	2.141596931	0	0.777999878	0.005338863	0.04536555	0	0	7.255914084	0.318181118	0.970556323	0.301260683	0	2.121333987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.488	0	0.38	9.7723	1.44145375	3.077945148	0	1.125626682	1.458818043	0.364704511	1.309598247	2.141596931	0	0.777999878	0.005338863	0.04536555	0	0	7.255914084	0.318181118	0.970556323	0.301260683	0	2.121333987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.488	NO	30% Coinsurance	Included in line a.1	30% Coinsurance	30% Coinsurance	$100 Copay	30% Coinsurance	Included in line e.1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h.1	Included in line h.1	Included in line h.1	Included in line h.1	30% Coinsurance	Included in line i.1	Included in line i.1	Included in line i.1	Included in line i.1	Included in line i.1	30% Coinsurance	30% Coinsurance																				0.9819		0.091	0.0353	0.0226	0.0291		0.0218	0.0314	0.2478					0.4122						0.0339	0																			1.907	0	0	10.7542	1.44145375	3.168921809	0.035278728	1.148226926	1.487962695	0.364704511	1.331416093	2.173023613	0.247779147	0.777999878	0.005338863	0.04536555	0	0.412160146	7.255914084	0.318181118	0.970556323	0.301260683	0	2.155238443	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.395
H1415_021_0	2010	9	N/A																															D	D	D	V	T	COIN	COIN	V	V	P	P	V	V	V	V	V	COIN	V	P	V	COIN																																																												0	NO	889.0358378	81.11	331.3379262	961.0066757	162.8407179	4.89456	0.903743421	389.6722659	232.0195719	96.91983373	2958.264898	20.30047888	86.11884218	3077.375947	7338.971212	5882.637273	1.762454908	815.4412458	326.1764983	163.0882492	25.83294847																					$200/day 1-5	$270 days 1-7	$0/days 0-5; $125/days 6-20; 21 - 100 $0	No Cost Sharing	$100 COPAY	20% Coinsurance	20% Coinsurance	$50 COPAY	$100 COPAY	No Cost Sharing	$0- $100 Copay	$100 COPAY	$30 Copay	No Cost Sharing	$5 Copay	$38 Copay	20% Coinsurance	$15 Copay	$0 for all x-rays; $100 for diagnostic radiology services	No Cost Sharing	20% Coinsurance				$35 copay for routine eye exams up to 1 per plan year		discounts														200	270	125	0	100	0.2	0.2	50	100	0	3.315	3.315	3.315	0	5	38	0.2	15	11.64	0	0.2																				NO	189.6	255.96	118.5	0	94.8	0.1896	0.1896	50	94.8	0	3.14262	3.14262	3.14262	0	5	38	0.1896	15	11.64	0	0.1896																					14.0468	1.7300763	3.271962022	0	1.286441672	0.928008576	0.171349753	1.623634441	1.832954618	0	0.774725203	0.005316391	0.022553233	0	3.057904672	18.62835136	0.334161451	1.019301557	0.316391203	0	4.897927029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9478	0	0.38	14.0468	1.7300763	3.271962022	0	1.286441672	0.928008576	0.171349753	1.623634441	1.832954618	0	0.774725203	0.005316391	0.022553233	0	3.057904672	18.62835136	0.334161451	1.019301557	0.316391203	0	4.897927029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9478	NO	30% Coinsurance	Included in line a.1	30% Coinsurance	30% Coinsurance	$100 Copay	30% Coinsurance	Included in line e.1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h.1	Included in line h.1	Included in line h.1	Included in line h.1	30% Coinsurance	Included in line i.1	Included in line i.1	Included in line i.1	Included in line i.1	Included in line i.1	30% Coinsurance	30% Coinsurance																				0.9514		0.0981	0.0393	0.0139	0.0174		0.0467	0.098	0.1078					0.5956						0.0783	0																			2.0467	0	0	14.9981	1.7300763	3.370097112	0.039311462	1.300372502	0.945430872	0.171349753	1.670362929	1.930986664	0.107809176	0.774725203	0.005316391	0.022553233	0	3.653550555	18.62835136	0.334161451	1.019301557	0.316391203	0	4.976208691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9945
H1415_022_0	2010	10	N/A																															D	D	D	V	T	COIN	COIN	V	V	P	P	V	V	V	V	V	COIN	V	P	V	COIN																																																												0	NO	1337.368025	109.33	498.4284424	641.5859959	250.7531849	6.277466123	1.569366531	333.285079	274.3758601	149.9686193	1577.462479	372.2942392	133.2557369	1103.242879	6848.202591	5149.621597	2.581882177	1632.536473	1087.319402	1286.373605	28.2564711																					$175/day 1-3	$275 days 1-7	$0/days 0-5; $125/days 6-20; $0 21-100	No Cost Sharing	$100 COPAY	20% Coinsurance	20% Coinsurance	$50 COPAY	$100 COPAY	No Cost Sharing	$0- $100 Copay	$100 COPAY	$30 Copay	No Cost Sharing	$5 Copay	$30 Copay	20% Coinsurance	$15 Copay	$0 for all x-rays; $100 for diagnostic radiology services	No Cost Sharing	20% Coinsurance				$35 copay for routine eye exams up to 1 per plan year		discounts														175	275	35	0	100	0.2	0.2	50	100	0	4.578947368	9.157894737	9.157894737	0	5	30	0.2	15	11.64	0	0.2																				NO	165.9	260.7	33.18	0	94.8	0.1896	0.1896	50	94.8	0	4.340842105	8.681684211	8.681684211	0	5	30	0.1896	15	11.64	0	0.1896																					18.4891	2.37519425	1.378154643	0	1.980950161	1.190207577	0.297551894	1.388687829	2.167569294	0	0.570626296	0.269345085	0.096407019	0	2.853417746	12.87405399	0.489524861	2.040670592	1.05469982	0	5.35742692	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8736	0	0.38	18.4891	2.37519425	1.378154643	0	1.980950161	1.190207577	0.297551894	1.388687829	2.167569294	0	0.570626296	0.269345085	0.096407019	0	2.853417746	12.87405399	0.489524861	2.040670592	1.05469982	0	5.35742692	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8736	NO	30% Coinsurance	Included in line a.1	30% Coinsurance	30% Coinsurance	$100 Copay	30% Coinsurance	Included in line e.1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h.1	Included in line h.1	Included in line h.1	Included in line h.1	30% Coinsurance	Included in line i.1	Included in line i.1	Included in line i.1	Included in line i.1	Included in line i.1	30% Coinsurance	30% Coinsurance																				1.1526		0.123	0.0498	0.0244	0.0262		0.0474	0.1188	0.1622					0.6828						0.0856	0																			2.4728	0	0	19.6417	2.37519425	1.501168758	0.0498005	2.005341708	1.216363686	0.297551894	1.436119344	2.286373388	0.162193461	0.570626296	0.269345085	0.096407019	0	3.536170169	12.87405399	0.489524861	2.040670592	1.05469982	0	5.44305259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3464
H1415_023_0	2010	10	N/A																															D	D	D	V	T	COIN	COIN	V	V	P	P	V	V	V	V	V	COIN	V	P	V	COIN																																																												0	NO	846.1233	73.11	315.3447	645.7016521	160.1719795	4.370684933	1.092671233	353.3202929	304.7403062	94.88184311	2896.059714	19.87360871	84.30797039	3012.666145	6801.995002	5650.21778	1.6335	755.7772225	302.310889	151.1554445	25.25095185																					$275/day 1-5	$275 days 1-7	$0/days 0-5; $125/days 6-20; 21 - 100 $0	No Cost Sharing	$150 COPAY	20% Coinsurance	20% Coinsurance	$50 COPAY	$200 COPAY	No Cost Sharing	$0- $200 Copay	$200 COPAY	$30 Copay	No Cost Sharing	$10 Copay	$43 Copay	20% Coinsurance	$15 Copay	$0 for all x-rays; $100 for diagnostic radiology services	No Cost Sharing	20% Coinsurance				$35 copay for routine eye exams up to 1 per plan year		discounts														275	275	125	0	150	0.2	0.2	50	200	0	6.63	6.63	6.63	0	10	43	0.2	15	11.64	0	0.2																				NO	260.7	260.7	118.5	0	142.2	0.1896	0.1896	50	189.6	0	6.28524	6.28524	6.28524	0	10	43	0.19	15	11.64	0	0.1896																					18.382	1.58831475	3.114028913	0	1.898037957	0.828681863	0.207170466	1.472167887	4.814896838	0	1.516869196	0.0104092	0.044157986	0	5.668329169	20.24661371	0.310365	0.944721528	0.293241562	0	4.787580471	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1276	0	0.38	18.382	1.58831475	3.114028913	0	1.898037957	0.828681863	0.207170466	1.472167887	4.814896838	0	1.516869196	0.0104092	0.044157986	0	5.668329169	20.24661371	0.310365	0.944721528	0.293241562	0	4.787580471	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1276	NO	30% Coinsurance	Included in line a.1	30% Coinsurance	30% Coinsurance	$100 Copay	30% Coinsurance	Included in line e.1	30% Coinsurance	30% Coinsurance	30% Coinsurance	Included in line h.1	Included in line h.1	Included in line h.1	Included in line h.1	30% Coinsurance	Included in line i.1	Included in line i.1	Included in line i.1	Included in line i.1	Included in line i.1	30% Coinsurance	30% Coinsurance																				0.8721		0.0899	0.0374	0.0132	0.0166		0.0444	0.0932	0.1024					0.5487						0.0744	0																			1.8923	0	0	19.2542	1.58831475	3.203972551	0.037355914	1.911275798	0.845237488	0.207170466	1.516571867	4.908052282	0.102446211	1.516869196	0.0104092	0.044157986	0	6.21702147	20.24661371	0.310365	0.944721528	0.293241562	0	4.861975476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.02
H1415_802_0	2010	1	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	NO	315.7593843	9.765754152	32.98866942	12.78093773	4.835373781	5.632360012	0.296440001	15.90327708	30.74957548	10.64632674	12.42071454	0	1.774387791	10.64632674	87.09139937	67.73775507	3.870728861	5.806093291	19.3536443	9.676822152	23.94603448	0																				Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS																			0.0719	0.0719	0.1628	0	0.233	0.233	0.233	0.233	0.2329	0.233	0.233	0.233	0.233	0.233	0.23065	0.23065	0.23065	0.23065	0.23065	0.23065	0.233	0.231																			NO	0.0719	0.0719	0.1628	0	0.233	0.233	0.233	0.233	0.2329	0.233	0.233	0.233	0.233	0.233	0.23065	0.23065	0.23065	0.23065	0.23065	0.23065	0.233	0.231																				22.7031	0.702157724	5.370555381	0	1.126642091	1.312339883	0.06907052	3.705463561	7.161576129	2.480594131	2.894026487	0	0.413432355	2.480594131	20.08763126	15.62371321	0.892783612	1.339175418	4.463918059	2.231959029	5.579426033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6382	0	0.38	22.7031	0.702157724	5.370555381	0	1.126642091	1.312339883	0.06907052	3.705463561	7.161576129	2.480594131	2.894026487	0	0.413432355	2.480594131	20.08763126	15.62371321	0.892783612	1.339175418	4.463918059	2.231959029	5.579426033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6382	NO																																																																																		0	0	0	22.7031	0.702157724	5.370555381	0	1.126642091	1.312339883	0.06907052	3.705463561	7.161576129	2.480594131	2.894026487	0	0.413432355	2.480594131	20.08763126	15.62371321	0.892783612	1.339175418	4.463918059	2.231959029	5.579426033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6382
H1415_804_0	2010	2	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																																																												0	NO	315.7593843	9.765754152	32.98866942	12.78093773	4.835373781	5.632360012	0.296440001	15.90327708	30.74957548	10.64632674	12.42071454	0	1.774387791	10.64632674	87.09139937	67.73775507	3.870728861	5.806093291	19.3536443	9.676822152	23.94603448	0																				Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS	Equiv to Medicare FFS																			0.0719	0.0719	0.1628	0	0.233	0.233	0.233	0.233	0.2329	0.233	0.233	0.233	0.233	0.233	0.23065	0.23065	0.23065	0.23065	0.23065	0.23065	0.233	0.231																			NO	0.0719	0.0719	0.1628	0	0.233	0.233	0.233	0.233	0.2329	0.233	0.233	0.233	0.233	0.233	0.23065	0.23065	0.23065	0.23065	0.23065	0.23065	0.233	0.231																				22.7031	0.702157724	5.370555381	0	1.126642091	1.312339883	0.06907052	3.705463561	7.161576129	2.480594131	2.894026487	0	0.413432355	2.480594131	20.08763126	15.62371321	0.892783612	1.339175418	4.463918059	2.231959029	5.579426033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6382	0	0.38	22.7031	0.702157724	5.370555381	0	1.126642091	1.312339883	0.06907052	3.705463561	7.161576129	2.480594131	2.894026487	0	0.413432355	2.480594131	20.08763126	15.62371321	0.892783612	1.339175418	4.463918059	2.231959029	5.579426033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6382	NO																																																																																		0	0	0	22.7031	0.702157724	5.370555381	0	1.126642091	1.312339883	0.06907052	3.705463561	7.161576129	2.480594131	2.894026487	0	0.413432355	2.480594131	20.08763126	15.62371321	0.892783612	1.339175418	4.463918059	2.231959029	5.579426033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6382
H1416_007_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	414.4260021	120.5558142	449.0181314	518.7785228	18.73609735	9.72063467	4.602188574	32.88403263	13.30780848	7896.970876	19.10716334	0.328962334	0.51020848	7.364596421	5991.113658	63.42467312	11.61098526	8.122600125	17.02204365	4.964964087	5.386065244	0.082935177	770	409.7142857	0.96	172.8	0.056	0.224	2040	0												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											675.8057627	335.9369163	56.95398033	0	0.167355882	0.170000266	0.070162861	0.108750634	0.17	0	0.170200923	0.248625	0.170015222	0.170104741	0	0.07279653	0.407290973	0.17	0.166890797	0.067255904	0.170012994	0.17	0	0	0	0	0	0	0	0											NO	675.8057627	335.9369163	56.95398033	0	0.167355882	0.170000266	0.070162861	0.108750634	0.17	0	0.170200923	0.248625	0.170015222	0.170104741	0	0.07279653	0.407290973	0.17	0.166890797	0.067255904	0.170012994	0.17	0	0	0	0	0	0	0	0												23.3393	3.374929038	2.131114152	0	3.135596089	1.652510478	0.322902719	3.576159402	2.262327441	0	3.252056835	0.08178826	0.086743208	1.252752769	0	4.617096095	4.729049486	1.380842021	2.840822427	0.333923147	0.915701076	0.01409898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2997	0	0	23.3393	3.374929038	2.131114152	0	3.135596089	1.652510478	0.322902719	3.576159402	2.262327441	0	3.252056835	0.08178826	0.086743208	1.252752769	0	4.617096095	4.729049486	1.380842021	2.840822427	0.333923147	0.915701076	0.01409898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2997	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.3393	3.374929038	2.131114152	0	3.135596089	1.652510478	0.322902719	3.576159402	2.262327441	0	3.252056835	0.08178826	0.086743208	1.252752769	0	4.617096095	4.729049486	1.380842021	2.840822427	0.333923147	0.915701076	0.01409898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.2997
H1416_009_0	2010	5	N/A																															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	V	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	Yes	1746.374802	154.2888609	570.7637622	535.4514579	492.3552162	7.559390078	6.393997908	1539.208506	231.8679131	5634.710891	1277.425688	41.73607119	0.198723155	541.5845125	7024.59662	15178.74638	404.4233383	2467.70619	3469.529874	1631.469253	12.638282	12.39525266	1026.666667	409.7142857	288	172.8	16.8	12.8	2040	0											2500	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $3.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $5.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	$3.00 copayment	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											139.7140294	125.3320387	54.67	2.857897373	34.62010387	0.2	0.065812102	20.51745527	147.7690615	0	74.06821698	160.2073747	0.2	36.62847815	2.48665054	7.54152071	25.91834194	17.86105759	27.69166431	7.62241395	0.2	0	3	0	0	0	0	0	0	0											NO	120.2093799	107.8351739	47.03784459	2.458923221	29.7869959	0.172079183	0.056624464	17.65313467	127.1398966	0	63.72799121	137.8417705	0.172079183	31.51499292	2.139503963	6.4886936	22.30003549	15.36758096	23.82579481	6.558293813	0.172079183	0	3	0	0	0	0	0	0	0												17.4942	1.386480513	2.237291429	0.109719502	1.222148567	1.300813666	0.362056701	2.264321254	2.456638542	0	6.783981085	0.479414496	0.034196118	1.422336006	1.252429359	8.207519541	0.751554566	3.160222889	6.888692238	0.891637892	2.174785237	0	0.256666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1371	0	9.878197613	17.4942	1.386480513	2.237291429	0.109719502	1.222148567	1.300813666	0.362056701	2.264321254	2.456638542	0	6.783981085	0.479414496	0.034196118	1.422336006	1.252429359	8.207519541	0.751554566	3.160222889	6.888692238	0.891637892	2.174785237	0	0.256666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1371	NO	25% conisurance	Not covered OON	25% conisurance	25% conisurance	25% conisurance	25% conisurance	25% conisurance	Same as in-network	25% conisurance	25% conisurance	25% conisurance	Not covered OON	Not covered OON	25% conisurance	Not covered OON	25% conisurance	Not covered OON	25% conisurance	25% conisurance	25% conisurance	Not covered OON	25% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.1613	0	0.0834	0.061	0.0653	0.0754	0.0638	0	0.1757	0.0683	0.2041	0	0	0.0793	0	0.6981	0	0.1024	0.2116	0.1094	0	0.0022	0	0	0	0	0	0	0	0											3.1613	0	0	18.6555	1.386480513	2.320739432	0.17067358	1.287443812	1.376211728	0.425813405	2.264321254	2.632361667	0.06828459	6.988069087	0.479414496	0.034196118	1.50159225	1.252429359	8.905661194	0.751554566	3.262644527	7.100326929	1.001057339	2.174785237	0.002231573	0.256666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2985
H1416_018_0	2010	5	N/A																															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	V	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	Yes	1566.526193	93.43116806	579.4746305	303.6246286	743.1775839	12.45343633	5.109960144	1794.706944	285.8400578	5255.157315	1322.845935	67.07269238	1.169697413	602.5908302	9202.635649	17969.53973	253.6971553	2391.118994	4247.826787	1873.536287	30.58036466	13.46378288	1030	0	288	172.8	16.8	12.8	2040	0											3250	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$200 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $5.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	$0.00 copayment	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											160.6189708	102.6549128	54.67	2.480097121	37.50412565	0.2	0.162938867	20.77518591	135.7836772	0	70.48707304	57.10183939	0.2	12.15589574	2.131095614	8.569043315	23.56041641	8.566865083	31.47249366	8.589713316	0.2	0	0	0	0	0	0	0	0	0											NO	142.1449455	90.84778037	48.38198211	2.194842044	33.19048722	0.176996459	0.144198013	18.38567172	120.1661504	0	62.37981172	50.53411692	0.176996459	10.75775252	1.88598189	7.583451626	20.85055141	7.58152393	27.8525997	7.601744211	0.176996459	0	0	0	0	0	0	0	0	0												18.5561	0.70733452	2.336344267	0.055534008	2.055535509	2.204214135	0.736846099	2.749741059	2.862358282	0	6.876573362	0.28245494	0.2070323	0.540210252	1.446333681	11.35592794	0.440810465	1.510693822	9.859418258	1.186845302	5.412616265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.383	0	9.277367117	18.5561	0.70733452	2.336344267	0.055534008	2.055535509	2.204214135	0.736846099	2.749741059	2.862358282	0	6.876573362	0.28245494	0.2070323	0.540210252	1.446333681	11.35592794	0.440810465	1.510693822	9.859418258	1.186845302	5.412616265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.383	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.6225	0	0.1182	0.0518	0.1752	0.2062	0.0846	0	0.3226	0.1168	0.3372	0	0	0.1626	0	1.3046	0	0.1432	0.3393	0.1923	0	0.0039	0	0	0	0	0	0	0	0											5.1809	0	0	20.1787	0.70733452	2.454535387	0.107365566	2.23070312	2.410432327	0.821449366	2.749741059	3.184923279	0.116778252	7.213729183	0.28245494	0.2070323	0.702848019	1.446333681	12.66052869	0.440810465	1.653939441	10.19868921	1.379104486	5.412616265	0.003857429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.5639
H1416_019_0	2010	5	N/A																															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	V	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	Yes	1808.809092	140.6288216	629.5024328	685.8224054	553.4198988	8.112183909	5.428045899	1789.410722	246.2667991	6502.05877	1525.432326	48.85120657	0.334718168	648.1547352	7697.567406	17309.46234	490.039649	3032.380716	3967.012856	1783.900666	10.9897921	15.10098266	1026.666667	504.6666667	288	172.8	16.8	12.8	2040	6044.234161											2500	"$175 days 1 - 7, $0 after day 7, unlimited coverage"	"$175 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $3.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $75.00 and $125.00	$0.00 copayment	Copay between $0.00 and $175.00	$175.00 copayment	20% coinsurance	Copay between $25.00 and $125.00	Copay between $0.00 and $5.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	$3.00 copayment	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	$0.00 copayment											129.7254263	107.1283518	54.67	1.825847383	34.39989362	0.2	0.091866572	19.46169333	81.52502178	0	64.90505498	159.7707279	0.2	27.8719219	2.428396106	7.380458585	26.07946755	18.03048876	30.76295302	7.785343227	0.2	0	3	0	0	0	0	0	0	0											NO	110.5209537	91.26913618	46.57668669	1.555550055	29.30735444	0.170392123	0.078266701	16.58059617	69.45610749	0	55.2965504	136.1183672	0.170392123	23.74577965	2.068897834	6.287860016	22.21867915	15.36126624	26.20882429	6.632805784	0.170392123	0	3	0	0	0	0	0	0	0												16.6593	1.069589256	2.443344798	0.08890259	1.351606094	1.382252234	0.424835244	2.472458047	1.425394439	0	7.029262123	0.554128873	0.057033339	1.282578293	1.327123378	9.069956345	0.907336144	3.881767294	8.664228576	0.986022221	1.872574002	0	0.256666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2063	0	10.93833479	16.6593	1.069589256	2.443344798	0.08890259	1.351606094	1.382252234	0.424835244	2.472458047	1.425394439	0	7.029262123	0.554128873	0.057033339	1.282578293	1.327123378	9.069956345	0.907336144	3.881767294	8.664228576	0.986022221	1.872574002	0	0.256666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2063	NO	25% conisurance	Not covered OON	25% conisurance	25% conisurance	25% conisurance	25% conisurance	25% conisurance	Same as in-network	25% conisurance	25% conisurance	25% conisurance	Not covered OON	Not covered OON	25% conisurance	Not covered OON	25% conisurance	Not covered OON	25% conisurance	25% conisurance	25% conisurance	Not covered OON	25% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.2487	0	0.0936	0.0775	0.0719	0.0809	0.0541	0	0.1917	0.0777	0.2509	0	0	0.0918	0	0.8068	0	0.1213	0.247	0.1219	0	0.0025	0	0	0	0	0	0	0	0											3.5383	0	0	17.9079	1.069589256	2.53694706	0.1664285	1.423476752	1.463163913	0.478957563	2.472458047	1.617131674	0.077718137	7.280127337	0.554128873	0.057033339	1.374422483	1.327123378	9.876734764	0.907336144	4.003064852	8.911182459	1.107938995	1.872574002	0.002455147	0.256666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7446
H1416_020_0	2010	5	N/A																															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	V	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	Yes	1987.916693	89.52698892	672.453451	359.802161	757.7965389	14.25614841	4.198771074	1933.377131	310.7366156	5394.8477	1438.5246	79.51645528	1.382134263	636.2964163	9478.465161	20318.53277	295.2434219	2780.091032	5332.718456	1897.021028	12.16542836	16.07090965	1030	504.6666667	288	172.8	16.8	12.8	2040	3710.636153											3250	"$175 days 1 - 7, $0 after day 7, unlimited coverage"	"$175 days 1 - 7, $0 after day 7, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $75.00 and $125.00	$0.00 copayment	Copay between $0.00 and $175.00	$175.00 copayment	20% coinsurance	Copay between $20.00 and $125.00	Copay between $0.00 and $5.00	Copay between $0.00 and $30.00	Copay between $20.00 and $30.00	$30.00 copayment	Copay between $0.00 and $80.00	Copay between $0.00 and $30.00	20% coinsurance	$0.00 copayment	$0.00 copayment	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	$0.00 copayment											129.5389979	89.78196571	54.67	2.5114684	39.47047516	0.2	0.176570594	20.42863907	100.6023371	0	67.341497	49.96410947	0.2	8.078241482	2.173789439	7.212782752	20.05485718	10.30247062	30.70185693	8.409319504	0.2	0	0	0	0	0	0	0	0	0											NO	114.6653517	79.47321534	48.39279969	2.223102016	34.93848177	0.177036033	0.156296788	18.08302613	89.05119344	0	59.60935751	44.22723872	0.177036033	7.150699138	1.924195297	6.384612235	17.75216181	9.119542656	27.17667482	7.443762837	0.177036033	0	0	0	0	0	0	0	0	0												18.9954	0.592916472	2.71182543	0.066656409	2.206355046	2.523851965	0.656254432	2.913442432	2.305955539	0	7.145793929	0.293066104	0.244687567	0.379163686	1.519868174	10.81049608	0.436767417	2.112763229	12.07712962	1.176747886	2.15371918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3229	0	9.251543149	18.9954	0.592916472	2.71182543	0.066656409	2.206355046	2.523851965	0.656254432	2.913442432	2.305955539	0	7.145793929	0.293066104	0.244687567	0.379163686	1.519868174	10.81049608	0.436767417	2.112763229	12.07712962	1.176747886	2.15371918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.3229	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.998	0	0.139	0.061	0.1751	0.2361	0.0695	0	0.377	0.112	0.3482	0	0	0.1544	0	1.4879	0	0.1651	0.5905	0.2021	0	0.0046	0	0	0	0	0	0	0	0											6.1206	0	0	20.9934	0.592916472	2.850798273	0.12765396	2.381468082	2.759921519	0.725774491	2.913442432	2.682911441	0.112047075	7.494030089	0.293066104	0.244687567	0.533552571	1.519868174	12.29841872	0.436767417	2.277883374	12.66766722	1.378868504	2.15371918	0.004606036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4435
H1417_001_0	2010	3	N/A																															A	A	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	O	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	YES	296.1325261	4.447583283	1221.300024	382.6873547	167.176059	17.4311003	1.401047419	384.1058689	359.3087726	1085.723492	447.636789	0	9.205335017	240.7550233	4088.91993	8690.609986	173.0682546	218.0364562	277.6972343	844.0466832	1996.932776	0	0	0	32.05042136	1.974159892	0.564322527	0	118.3331931	0											1500	1A IP Acute: $250 per Admit	1B IP Psych: $250 per Admit	2 SNF: $50 for days 21-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	"11B Prosthetics/Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 10%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $20, 5 Partial Hosp: $20, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $20"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears: $0, 14D Pelvic Exams: $20, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $20, 14J Nutrition Therapy: $20"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $20	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $20	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											250	250	23.5	0	50	0.1	0.1	48.77	100	0	0	0	0	20	20	20	20	20	20	20	0	0	0	0	20	0	20	0	0	0											NO	196.7102231	196.7102231	18.49076098	0	39.34204463	0.078684089	0.078684089	38.37423033	78.68408926	0	0	0	0	15.73681785	15.73681785	15.73681785	15.73681785	15.73681785	15.73681785	15.73681785	0	0	0	0	15.73681785	0	15.73681785	0	0	0												4.8544	0.072907092	1.881897235	0	0.548087331	1.371550252	0.11024014	1.228313924	2.355990295	0	0	0	0	0.315726496	5.362215679	11.39687886	0.226961967	0.285933333	0.364172566	1.106884076	0	0	0	0	0.04203097	0	0.000740053	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5249	0	8.540248856	4.8544	0.072907092	1.881897235	0	0.548087331	1.371550252	0.11024014	1.228313924	2.355990295	0	0	0	0	0.315726496	5.362215679	11.39687886	0.226961967	0.285933333	0.364172566	1.106884076	0	0	0	0	0.04203097	0	0.000740053	0	0	0	0	0	0	0	0	0	0	0	0	0	31.5249	NO	1A IP Acute: $175 per Day for days 1-5	1B IP Psych: $175 per Day for days 1-5	2 SNF: $100 for days 21-100	6 Home Health: $30	10A Ambulance: $50	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $30	8B OP Radiology: $30	9A OP Hospital: $30	12 Renal Dialysis: $0	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $30"	"7A PCP: $30, 14B Immunizations: $30, 14C Physical Exams: $30, 14D Pap Smears and Pelvic Exams: $30, 14E Prostate Screening: $30, 14F Colorectal Screening: $30, 14G Bone Mass Measurement: $30, 14H Mammography: $30, 14I Diabetes Monitoring: $30, 14J Nutrition Therapy: $30"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: $30	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $30	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $30	13B Acupuncture: Not Covered												0.5771	0.0012	0.4846	0.0953	0.2398	0.4748	0.1518	0.153	0.2876	0.1845	0.11	0	0.0004	0.0822	0.4622	3.3317	0.0812	0.2809	0.0595	0.1236	0.2398	0	0	0	0.006	0	0	0	0.0004	0											7.4279	110	0	5.4315	0.074152821	2.366540202	0.095327283	0.787885688	1.846316162	0.262058276	1.381362317	2.643609481	0.184520973	0.109969925	0	0.000448634	0.397931857	5.824380871	14.72857083	0.308206834	0.566804194	0.423675868	1.230481571	0.239845373	0	0	0	0.048064357	1.37E-05	0.000740671	0	0.000369169	0	0	0	0	0	0	0	0	0	0	0	38.9527
H1417_002_0	2010	5	N/A																															A	A	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	O	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	YES	328.7382562	5.483494976	1520.90825	406.1183396	190.5643361	15.19828298	2.543895518	402.1584345	325.4329869	993.3730476	475.7623593	0	3.624435066	289.5683417	4380.01656	9169.749778	213.0226104	191.4177148	310.1401412	903.415516	2469.08629	0	0	0	35.16270454	2.783910196	0.659221533	0	120.1211304	0											1500	1A IP Acute: $250 per Admit	1B IP Psych: $250 per Admit	2 SNF: $50 for days 21-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	"11B Prosthetics/Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 10%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $20, 5 Partial Hosp: $20, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $20"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears: $0, 14D Pelvic Exams: $20, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $20, 14J Nutrition Therapy: $20"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $20	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $20	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											250	250	23.5	0	50	0.1	0.1	48.77	100	0	0	0	0	20	20	20	20	20	20	20	0	0	0	0	20	0	20	0	0	0											NO	196.039653	196.039653	18.42772739	0	39.20793061	0.078415861	0.078415861	38.24341552	78.41586122	0	0	0	0	15.68317224	15.68317224	15.68317224	15.68317224	15.68317224	15.68317224	15.68317224	0	0	0	0	15.68317224	0	15.68317224	0	0	0												5.3705	0.089581871	2.335573551	0	0.622636106	1.191786449	0.199481758	1.281659343	2.126592328	0	0	0	0	0.378445848	5.724379512	11.98423043	0.278405858	0.250169749	0.405331771	1.180701762	0	0	0	0	0.045955229	0	0.000861557	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4663	0	9.2116649	5.3705	0.089581871	2.335573551	0	0.622636106	1.191786449	0.199481758	1.281659343	2.126592328	0	0	0	0	0.378445848	5.724379512	11.98423043	0.278405858	0.250169749	0.405331771	1.180701762	0	0	0	0	0.045955229	0	0.000861557	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4663	NO	1A IP Acute: $175 per Day for days 1-5	1B IP Psych: $175 per Day for days 1-5	2 SNF: $100 for days 21-100	6 Home Health: $30	10A Ambulance: $50	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $30	8B OP Radiology: $30	9A OP Hospital: $30	12 Renal Dialysis: $0	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $30"	"7A PCP: $30, 14B Immunizations: $30, 14C Physical Exams: $30, 14D Pap Smears and Pelvic Exams: $30, 14E Prostate Screening: $30, 14F Colorectal Screening: $30, 14G Bone Mass Measurement: $30, 14H Mammography: $30, 14I Diabetes Monitoring: $30, 14J Nutrition Therapy: $30"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: $30	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $30	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $30	13B Acupuncture: Not Covered												0.6437	0.0016	0.5997	0.1006	0.2734	0.4138	0.2756	0.1614	0.2557	0.169	0.1153	0	0.0001	0.0973	0.495	3.5174	0.1001	0.2469	0.0668	0.1332	0.2934	0	0	0	0.0065	0	0.0002	0	0	0											7.9667	110	0	6.0142	0.091217567	2.935232479	0.100620076	0.89601782	1.605592684	0.475106483	1.443091485	2.382309044	0.169025059	0.115295304	0	0.000108271	0.475753737	6.219363542	15.50166149	0.378478504	0.497028463	0.472102302	1.313856031	0.293445059	0	0	0	0.05240924	0	0.00102576	1.75E-05	5.85E-07	0	0	0	0	0	0	0	0	0	0	0	41.4329
H1417_003_0	2010	11	N/A																															A	A	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	O	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	YES	300.4902913	4.043489451	1195.773546	405.655443	165.9883895	15.25165574	1.967672137	376.9012318	318.8123195	1090.813042	469.4816323	0	13.2260769	261.6448284	4137.487976	8222.855882	202.373495	225.1990472	283.4861736	817.1950243	2271.453996	0	0	0	31.23109001	2.836441095	0.972971407	0	115.312722	0											3000	1A IP Acute: $150 per day for days 1-5	1B IP Psych: $150 per day for days 1-5	2 SNF: $150 for days 21-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: $150	8A OP Diagnostic Procedures/Tests: $40	8B OP Radiology: $40	9A OP Hospital: $40	12 Renal Dialysis: $0	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $40"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears: $0, 14D Pelvic Exams: $20, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $40, 14J Nutrition Therapy: $40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $40	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: $40	"13A Blood: $40, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $40	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											445.6710507	399.825	70.5	0	100	0.2	0.2	49.59	150	40	40	40	0	40	20	40	40	40	40	40	40	40	0	0	40	0	0	0	0	0											YES	324.6240264	291.2300477	51.3517623	0	72.83937915	0.145678758	0.145678758	36.12104812	109.2590687	29.13575166	29.13575166	29.13575166	0	29.13575166	14.56787583	29.13575166	29.13575166	29.13575166	29.13575166	29.13575166	29.13575166	29.13575166	0	0	29.13575166	0	0	0	0	0											5000	8.1289	0.098132135	5.117089907	0	1.007540937	2.221842271	0.286648034	1.134505627	2.902761427	2.648471492	1.139891687	0	0	0.635268229	5.02286759	19.96492391	0.491358658	0.546778626	0.688298563	1.984132607	5.515043294	0	0	0	0.07582844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6102	0	22.22769262	8.1289	0.098132135	5.117089907	0	1.007540937	2.221842271	0.286648034	1.134505627	2.902761427	2.648471492	1.139891687	0	0	0.635268229	5.02286759	19.96492391	0.491358658	0.546778626	0.688298563	1.984132607	5.515043294	0	0	0	0.07582844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6102	NO	1A IP Acute: $200 per day for days 1-5	1B IP Psych: $200 per day for days 1-5	2 SNF: $200 for days 21-100	6 Home Health: $50	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $50	8B OP Radiology: $50	9A OP Hospital: $50	12 Renal Dialysis: $0	"3 CORF: $50, 5 Partial Hosp: $50, 9C OP Substance Abuse: $50, 9D Cardiac Rehab: $50"	"7A PCP: $50, 14B Immunizations: $50, 14C Physical Exams: $50, 14D Pap Smears and Pelvic Exams: $50, 14E Prostate Screening: $50, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $50, 14H Mammography: $50, 14I Diabetes Monitoring: $50, 14J Nutrition Therapy: $50"	"7B Chiropractic: $50, 7D Physician Specialist (excl. Radiology): $50, 7F Podiatry: $50"	"7E Mental Health: $50, 7H Psychiatric: $50"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): $50	"7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: $50	"13A Blood: $50, 16B Comprehensive Dental (Medicare Covered): $50, 17A Routine Eye Exams (Medicare Covered): $50"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $50	17B Eye Wear (Medicare Covered): $50	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $50	13B Acupuncture: Not Covered												0.6479	0.0022	0.663	0.118	0.3299	0.3108	0.1554	0.1207	0.2029	0.215	0.1384	0	0.0012	0.7686	0.5481	3.6447	0.1093	0.3327	0.4988	0.9616	0.3275	0	0	0	0	0	0.0003	0	0	0											10.0971	200	3.598331129	8.7767	0.100347539	5.780102043	0.118016199	1.337403205	2.532634758	0.442049903	1.255219781	3.105694339	2.86350095	1.278241801	0	0.001185347	1.403829728	5.570982703	23.60966672	0.600686114	0.879501768	1.187072625	2.945741988	5.842554121	0	0	0	0.07582844	0	0.000277002	3.61E-05	1.96E-06	0	0	0	0	0	0	0	0	0	0	0	69.7073
H1417_004_0	2010	11	N/A																															A	A	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	O	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	YES	313.6418041	4.220460238	1248.108784	423.409703	173.2531781	15.91917264	2.053790944	393.3970106	332.7657297	1138.554491	490.0293633	0	13.80494059	273.0961978	4318.572782	8582.744362	211.2307449	235.0552995	295.8934697	852.9610744	2370.868377	0	0	0	32.59797637	2.96058318	1.015555298	0	120.3595964	0											3000	1A IP Acute: $150 per day for days 1-5	1B IP Psych: $150 per day for days 1-5	2 SNF: $150 for days 21-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: $150	8A OP Diagnostic Procedures/Tests: $40	8B OP Radiology: $40	9A OP Hospital: $40	12 Renal Dialysis: $0	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $40"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears: $0, 14D Pelvic Exams: $20, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $40, 14J Nutrition Therapy: $40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $40	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: $40	"13A Blood: $40, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $40	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											445.6710507	399.825	70.5	0	100	0.2	0.2	49.59	150	40	40	40	0	40	20	40	40	40	40	40	40	40	0	0	40	0	0	0	0	0											YES	349.9930917	313.9894047	55.3648547	0	78.53170879	0.157063418	0.157063418	38.94387439	117.7975632	31.41268352	31.41268352	31.41268352	0	31.41268352	15.70634176	31.41268352	31.41268352	31.41268352	31.41268352	31.41268352	31.41268352	31.41268352	0	0	31.41268352	0	0	0	0	0											5000	9.1477	0.11043165	5.758446792	0	1.133822344	2.50031966	0.322575425	1.276700314	3.266582673	2.98042099	1.282761442	0	0	0.714890369	5.652415002	22.4672527	0.552943712	0.615309811	0.774567327	2.232816357	6.206278166	0	0	0	0.085332493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0816	0	18.33815611	9.1477	0.11043165	5.758446792	0	1.133822344	2.50031966	0.322575425	1.276700314	3.266582673	2.98042099	1.282761442	0	0	0.714890369	5.652415002	22.4672527	0.552943712	0.615309811	0.774567327	2.232816357	6.206278166	0	0	0	0.085332493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0816	NO	1A IP Acute: $200 per day for days 1-5	1B IP Psych: $200 per day for days 1-5	2 SNF: $200 for days 21-100	6 Home Health: $50	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $50	8B OP Radiology: $50	9A OP Hospital: $50	12 Renal Dialysis: $0	"3 CORF: $50, 5 Partial Hosp: $50, 9C OP Substance Abuse: $50, 9D Cardiac Rehab: $50"	"7A PCP: $50, 14B Immunizations: $50, 14C Physical Exams: $50, 14D Pap Smears and Pelvic Exams: $50, 14E Prostate Screening: $50, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $50, 14H Mammography: $50, 14I Diabetes Monitoring: $50, 14J Nutrition Therapy: $50"	"7B Chiropractic: $50, 7D Physician Specialist (excl. Radiology): $50, 7F Podiatry: $50"	"7E Mental Health: $50, 7H Psychiatric: $50"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): $50	"7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: $50	"13A Blood: $50, 16B Comprehensive Dental (Medicare Covered): $50, 17A Routine Eye Exams (Medicare Covered): $50"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $50	17B Eye Wear (Medicare Covered): $50	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $50	13B Acupuncture: Not Covered												0.5678	0.0015	0.6841	0.1231	0.347	0.3121	0.1581	0.1192	0.1983	0.2259	0.1406	0	0.0008	0.8	0.5708	3.844	0.1158	0.3536	0.5162	0.9948	0.3309	0	0	0	0.007	0	0.0002	0	0	0											10.4118	200	4.085747926	9.7155	0.111967688	6.442523602	0.123140518	1.480831753	2.812399454	0.480672785	1.395933378	3.464896915	3.206360641	1.423326581	0	0.000821854	1.514882998	6.223165098	26.31124549	0.668708983	0.968943295	1.29073808	3.22759686	6.537179082	0	0	0	0.092311101	0	0.000192058	2.51E-05	1.36E-06	0	0	0	0	0	0	0	0	0	0	0	77.4934
H1417_005_0	2010	10	N/A																															A	A	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	O	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	YES	321.9683069	2.56524932	980.7790352	561.4754443	163.4223452	19.72716305	1.899657961	396.1249872	340.5533412	1244.504563	476.0621468	0	42.77932509	295.7112757	4506.745064	9212.104341	251.7329225	244.1068794	315.5020183	921.9109151	2752.20006	0	0	0	32.89104026	4.869193186	1.684894373	0	119.0939933	0											1500	1A IP Acute: $250 per Admit	1B IP Psych: $250 per Admit	2 SNF: $50 for days 21-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	"11B Prosthetics/Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 10%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $20, 5 Partial Hosp: $20, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $20"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears: $0, 14D Pelvic Exams: $20, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $20, 14J Nutrition Therapy: $20"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $20	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $20	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											250	250	23.5	0	50	0.1	0.1	48.77	100	0	0	0	0	20	20	20	20	20	20	20	0	0	0	0	20	0	20	0	0	0											NO	196.039653	196.039653	18.42772739	0	39.20793061	0.078415861	0.078415861	38.24341552	78.41586122	0	0	0	0	15.68317224	15.68317224	15.68317224	15.68317224	15.68317224	15.68317224	15.68317224	0	0	0	0	15.68317224	0	15.68317224	0	0	0												5.2599	0.041907549	1.506127391	0	0.533954331	1.54692248	0.148963315	1.26243104	2.225398629	0	0	0	0	0.386474239	5.890004925	12.03958492	0.328997565	0.319030853	0.412339375	1.204873973	0	0	0	0	0.042986321	0	0.002202041	0	0	0	0	0	0	0	0	0	0	0	0	0	33.1521	0	9.125182753	5.2599	0.041907549	1.506127391	0	0.533954331	1.54692248	0.148963315	1.26243104	2.225398629	0	0	0	0	0.386474239	5.890004925	12.03958492	0.328997565	0.319030853	0.412339375	1.204873973	0	0	0	0	0.042986321	0	0.002202041	0	0	0	0	0	0	0	0	0	0	0	0	0	33.1521	NO	1A IP Acute: $175 per Day for days 1-5	1B IP Psych: $175 per Day for days 1-5	2 SNF: $100 for days 21-100	6 Home Health: $30	10A Ambulance: $50	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $30	8B OP Radiology: $30	9A OP Hospital: $30	12 Renal Dialysis: $0	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $30"	"7A PCP: $30, 14B Immunizations: $30, 14C Physical Exams: $30, 14D Pap Smears and Pelvic Exams: $30, 14E Prostate Screening: $30, 14F Colorectal Screening: $30, 14G Bone Mass Measurement: $30, 14H Mammography: $30, 14I Diabetes Monitoring: $30, 14J Nutrition Therapy: $30"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: $30	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $30	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $30	13B Acupuncture: Not Covered												0.6164	0.0008	0.3875	0.1406	0.2356	0.5371	0.2058	0.1584	0.2701	0.2118	0.1189	0	0.0022	0.106	0.5104	3.54	0.1183	0.3153	0.0738	0.1335	0.3237	0	0	0	0.006	0	0.0002	0	0	0											8.0125	110	0	5.8763	0.042660441	1.893652403	0.140628782	0.769534274	2.084037302	0.35478651	1.420799299	2.495483525	0.21182338	0.118882071	0	0.002194818	0.492513279	6.400366699	15.57955415	0.447305001	0.63430745	0.486161997	1.338396203	0.323735473	0	0	0	0.049035028	0	0.00235963	3.63E-05	2.09E-06	0	0	0	0	0	0	0	0	0	0	0	41.1646
H1417_006_0	2010	11	N/A																															A	A	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	O	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	YES	313.6418041	4.220460238	1248.108784	423.409703	173.2531781	15.91917264	2.053790944	393.3970106	332.7657297	1138.554491	490.0293633	0	13.80494059	273.0961978	4318.572782	8582.744362	211.2307449	235.0552995	295.8934697	852.9610744	2370.868377	0	0	0	32.59797637	2.96058318	1.015555298	0	120.3595964	0											3000	1A IP Acute: $150 per day for days 1-5	1B IP Psych: $150 per day for days 1-5	2 SNF: $150 for days 21-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: $150	8A OP Diagnostic Procedures/Tests: $40	8B OP Radiology: $40	9A OP Hospital: $40	12 Renal Dialysis: $0	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $40"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears: $0, 14D Pelvic Exams: $20, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $40, 14J Nutrition Therapy: $40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $40	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: $40	"13A Blood: $40, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $40	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											445.6710507	399.825	70.5	0	100	0.2	0.2	49.59	150	40	40	40	0	40	20	40	40	40	40	40	40	40	0	0	40	0	0	0	0	0											YES	349.9930917	313.9894047	55.3648547	0	78.53170879	0.157063418	0.157063418	38.94387439	117.7975632	31.41268352	31.41268352	31.41268352	0	31.41268352	15.70634176	31.41268352	31.41268352	31.41268352	31.41268352	31.41268352	31.41268352	31.41268352	0	0	31.41268352	0	0	0	0	0											5000	9.1477	0.11043165	5.758446792	0	1.133822344	2.50031966	0.322575425	1.276700314	3.266582673	2.98042099	1.282761442	0	0	0.714890369	5.652415002	22.4672527	0.552943712	0.615309811	0.774567327	2.232816357	6.206278166	0	0	0	0.085332493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0816	0	18.33815611	9.1477	0.11043165	5.758446792	0	1.133822344	2.50031966	0.322575425	1.276700314	3.266582673	2.98042099	1.282761442	0	0	0.714890369	5.652415002	22.4672527	0.552943712	0.615309811	0.774567327	2.232816357	6.206278166	0	0	0	0.085332493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0816	NO	1A IP Acute: $200 per day for days 1-5	1B IP Psych: $200 per day for days 1-5	2 SNF: $200 for days 21-100	6 Home Health: $50	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $50	8B OP Radiology: $50	9A OP Hospital: $50	12 Renal Dialysis: $0	"3 CORF: $50, 5 Partial Hosp: $50, 9C OP Substance Abuse: $50, 9D Cardiac Rehab: $50"	"7A PCP: $50, 14B Immunizations: $50, 14C Physical Exams: $50, 14D Pap Smears and Pelvic Exams: $50, 14E Prostate Screening: $50, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $50, 14H Mammography: $50, 14I Diabetes Monitoring: $50, 14J Nutrition Therapy: $50"	"7B Chiropractic: $50, 7D Physician Specialist (excl. Radiology): $50, 7F Podiatry: $50"	"7E Mental Health: $50, 7H Psychiatric: $50"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): $50	"7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $50"	15 Part B Drugs: $50	"13A Blood: $50, 16B Comprehensive Dental (Medicare Covered): $50, 17A Routine Eye Exams (Medicare Covered): $50"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $50	17B Eye Wear (Medicare Covered): $50	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $50	13B Acupuncture: Not Covered												0.5678	0.0015	0.6841	0.1231	0.347	0.3121	0.1581	0.1192	0.1983	0.2259	0.1406	0	0.0008	0.8	0.5708	3.844	0.1158	0.3536	0.5162	0.9948	0.3309	0	0	0	0.007	0	0.0002	0	0	0											10.4118	200	4.085747926	9.7155	0.111967688	6.442523602	0.123140518	1.480831753	2.812399454	0.480672785	1.395933378	3.464896915	3.206360641	1.423326581	0	0.000821854	1.514882998	6.223165098	26.31124549	0.668708983	0.968943295	1.29073808	3.22759686	6.537179082	0	0	0	0.092311101	0	0.000192058	2.51E-05	1.36E-06	0	0	0	0	0	0	0	0	0	0	0	77.4934
H1417_801_0	2010	5	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	V	V	O	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	NO	246.5156648	1.721435638	44.07377319	4.880111821	6.765016509	15.96550505	1.994156988	17.80027806	36.3120991	6.007370318	12.86631562	0	0.913685052	35.58947528	27.57992405	75.57848763	1.308474562	1.112312721	32.80020792	62.9654657	36.29572506	0	0	0	0	0	0	0	0	0												1A IP Acute: Medicare FFS Cost Sharing	1B IP Psych: Medicare FFS Cost Sharing	2 SNF: Medicare FFS Cost Sharing	6 Home Health: Medicare FFS Cost Sharing	10A Ambulance: Medicare FFS Cost Sharing	11A DME: Medicare FFS Cost Sharing	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Medicare FFS Cost Sharing"	"4A ER, 4B Urgent Care: Medicare FFS Cost Sharing"	9B ASC Services: Medicare FFS Cost Sharing	8A OP Diagnostic Procedures/Tests: Medicare FFS Cost Sharing	8B OP Radiology: Medicare FFS Cost Sharing	9A OP Hospital: Medicare FFS Cost Sharing	12 Renal Dialysis: Medicare FFS Cost Sharing	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Medicare FFS Cost Sharing"	"7A PCP, 14B Immunizations, 14C Physical Exams, 14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Medicare FFS Cost Sharing"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Medicare FFS Cost Sharing"	"7E Mental Health, 7H Psychiatric: Medicare FFS Cost Sharing"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Medicare FFS Cost Sharing"	7D Physician Specialist (Radiology): Medicare FFS Cost Sharing	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Medicare FFS Cost Sharing"	15 Part B Drugs: Medicare FFS Cost Sharing	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Medicare FFS Cost Sharing"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered), 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	13B Acupuncture: Not Covered											0.084509523	0.084509523	0.186379137	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.084509523	0.084509523	0.186379137	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.8329	0.145477705	8.214431808	0	1.576248847	3.719962677	0.464638578	4.147464787	8.46071909	1.399717284	2.997851539	0	0.212888617	8.292347741	6.426122303	17.60978762	0.304874573	0.259168864	7.642448445	14.67095351	8.456903939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8349	0	0	20.8329	0.145477705	8.214431808	0	1.576248847	3.719962677	0.464638578	4.147464787	8.46071909	1.399717284	2.997851539	0	0.212888617	8.292347741	6.426122303	17.60978762	0.304874573	0.259168864	7.642448445	14.67095351	8.456903939	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8349	NO	1A IP Acute: Medicare FFS Cost Sharing	1B IP Psych: Medicare FFS Cost Sharing	2 SNF: Medicare FFS Cost Sharing	6 Home Health: Medicare FFS Cost Sharing	10A Ambulance: Medicare FFS Cost Sharing	11A DME: Medicare FFS Cost Sharing	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Medicare FFS Cost Sharing"	"4A ER, 4B Urgent Care: Medicare FFS Cost Sharing"	9B ASC Services: Medicare FFS Cost Sharing	8A OP Diagnostic Procedures/Tests: Medicare FFS Cost Sharing	8B OP Radiology: Medicare FFS Cost Sharing	9A OP Hospital: Medicare FFS Cost Sharing	12 Renal Dialysis: Medicare FFS Cost Sharing	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Medicare FFS Cost Sharing"	"7A PCP, 14B Immunizations, 14C Physical Exams, 14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Medicare FFS Cost Sharing"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Medicare FFS Cost Sharing"	"7E Mental Health, 7H Psychiatric: Medicare FFS Cost Sharing"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Medicare FFS Cost Sharing"	7D Physician Specialist (Radiology): Medicare FFS Cost Sharing	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Medicare FFS Cost Sharing"	15 Part B Drugs: Medicare FFS Cost Sharing	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Medicare FFS Cost Sharing"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered), 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	13B Acupuncture: Not Covered												0.7725	0	0.8267	0	0.5664	0.4947	0.2497	0.3976	0.3854	0.0994	0.2874	0	0	0.8536	0.2987	2.8438	0.0607	0.1427	0.4631	0.5939	0.3898	0	0	0	0	0	0	0	0	0											9.726	0	0	21.6054	0.145477705	9.041154781	0	2.142630946	4.214666972	0.714364924	4.545031217	8.846132617	1.499151991	3.285278266	0	0.212888617	9.145971353	6.724802201	20.45357742	0.365581224	0.401834312	8.10551366	15.26480941	8.846670489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.5609
H1417_802_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	V	V	O	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	NO	228.4543218	1.336928776	40.72338237	4.526058255	6.025539638	15.98892873	1.626972081	16.55046591	33.65426192	6.724267714	15.1871449	0	0.709600644	34.22690446	28.26667477	75.49540177	1.23356156	2.182346944	29.96701662	62.56664789	44.65155579	0	0	0	0	0	0	0	0	0												1A IP Acute: Medicare FFS Cost Sharing	1B IP Psych: Medicare FFS Cost Sharing	2 SNF: Medicare FFS Cost Sharing	6 Home Health: Medicare FFS Cost Sharing	10A Ambulance: Medicare FFS Cost Sharing	11A DME: Medicare FFS Cost Sharing	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Medicare FFS Cost Sharing"	"4A ER, 4B Urgent Care: Medicare FFS Cost Sharing"	9B ASC Services: Medicare FFS Cost Sharing	8A OP Diagnostic Procedures/Tests: Medicare FFS Cost Sharing	8B OP Radiology: Medicare FFS Cost Sharing	9A OP Hospital: Medicare FFS Cost Sharing	12 Renal Dialysis: Medicare FFS Cost Sharing	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Medicare FFS Cost Sharing"	"7A PCP, 14B Immunizations, 14C Physical Exams, 14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Medicare FFS Cost Sharing"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Medicare FFS Cost Sharing"	"7E Mental Health, 7H Psychiatric: Medicare FFS Cost Sharing"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Medicare FFS Cost Sharing"	7D Physician Specialist (Radiology): Medicare FFS Cost Sharing	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Medicare FFS Cost Sharing"	15 Part B Drugs: Medicare FFS Cost Sharing	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Medicare FFS Cost Sharing"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered), 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	13B Acupuncture: Not Covered											0.083939585	0.083939585	0.18804584	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083939585	0.083939585	0.18804584	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.1764	0.112221247	7.657862637	0	1.403950736	3.725420394	0.379084495	3.856258557	7.841443027	1.566754377	3.538604761	0	0.16533695	7.97486874	6.586135221	17.59042861	0.287419843	0.508486838	6.982314872	14.57802896	10.4038125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3348	0	0	19.1764	0.112221247	7.657862637	0	1.403950736	3.725420394	0.379084495	3.856258557	7.841443027	1.566754377	3.538604761	0	0.16533695	7.97486874	6.586135221	17.59042861	0.287419843	0.508486838	6.982314872	14.57802896	10.4038125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3348	NO	1A IP Acute: Medicare FFS Cost Sharing	1B IP Psych: Medicare FFS Cost Sharing	2 SNF: Medicare FFS Cost Sharing	6 Home Health: Medicare FFS Cost Sharing	10A Ambulance: Medicare FFS Cost Sharing	11A DME: Medicare FFS Cost Sharing	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Medicare FFS Cost Sharing"	"4A ER, 4B Urgent Care: Medicare FFS Cost Sharing"	9B ASC Services: Medicare FFS Cost Sharing	8A OP Diagnostic Procedures/Tests: Medicare FFS Cost Sharing	8B OP Radiology: Medicare FFS Cost Sharing	9A OP Hospital: Medicare FFS Cost Sharing	12 Renal Dialysis: Medicare FFS Cost Sharing	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Medicare FFS Cost Sharing"	"7A PCP, 14B Immunizations, 14C Physical Exams, 14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Medicare FFS Cost Sharing"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Medicare FFS Cost Sharing"	"7E Mental Health, 7H Psychiatric: Medicare FFS Cost Sharing"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Medicare FFS Cost Sharing"	7D Physician Specialist (Radiology): Medicare FFS Cost Sharing	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Medicare FFS Cost Sharing"	15 Part B Drugs: Medicare FFS Cost Sharing	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Medicare FFS Cost Sharing"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered), 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	13B Acupuncture: Not Covered												0.7111	0	0.7707	0	0.5045	0.4954	0.2037	0.3697	0.3572	0.1113	0.3393	0	0	0.8209	0.3061	2.8407	0.0572	0.2799	0.4231	0.5901	0.4795	0	0	0	0	0	0	0	0	0											9.6604	0	0	19.8874	0.112221247	8.42857096	0	1.908422201	4.220850491	0.582828631	4.225910629	8.198646496	1.678055256	3.877877593	0	0.16533695	8.795810706	6.892252363	20.43109215	0.344650908	0.788395086	7.405381794	15.16812343	10.88330927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9952
H1418_002_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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		0	YES	1541.571559	41.29988	882.939193	557.300673	53.331307	6.716501	3.539735	256.632769	236.042254	1140.865996	86.024587	64.082639	0.026915	838.994222	2969.746334	2981.270242	164.459165	279.846408			24.395408	0		1.54					0.04	0.25	779.028909	131.065517	0.05	0.55	2.09	671.678746	0.32	0.4	0.49		5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$35/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		158.7573	140.3991	50.7565	0	100	0.2	0.2	50	139.550353	38.622232	35	50	0.2	42.415914	10	35	35	50			0.2	0		0					0	0	50	0	0	0	0	35	0	0	0		NO	142.615334	126.123741	29.334821	0	88.8653	0.177731	0.177731	44.43265	124.01184	34.321763	31.102855	44.43265	0.177731	37.693029	8.88653	31.102855	31.102855	44.43265			0.177731	0		0					0	0	44.43265	0	0	0	0	31.102855	0	0	0			18.321	0.434074614	2.158405265	0	0.394941883	1.193730439	0.629120641	0.9502395	2.439336186	3.263044361	0.222967521	0.237280122	0.00478363	2.635352795	2.199228324	7.727168004	0.426262464	1.036193125	0	0	4.335820259	0	0	0	0	0	0	0	0	0	2.884526571	0	0	0	0	1.74092722	0	0	0	0	53.2344	0	7.748733	18.321	0.434074614	2.158405265	0	0.394941883	1.193730439	0.629120641	0.9502395	2.439336186	3.263044361	0.222967521	0.237280122	0.00478363	2.635352795	2.199228324	7.727168004	0.426262464	1.036193125	0	0	4.335820259	0	0	0	0	0	0	0	0	0	2.884526571	0	0	0	0	1.74092722	0	0	0	0	53.2344	YES	$250/Day(Days 1-10)	$250/Day(Days 1-10)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$40/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		10000	4.0749	0.1011	0.9599	1.5555	1.5663	1.1705	0.6169	0.1663	2.3499	0.4736	0.0446	0.2583	0.0009	1.1652	1.5391	1.5451	0.0852	0.1549			1.0609	0		0					0	0	1.2943	0	0	0	0	0.3481	0	0	0		20.5316	0	3.862813	22.3959	0.535178614	3.118355265	1.555532	1.961201883	2.364245439	1.246006641	1.1164955	4.789246186	3.736626361	0.267551521	0.495581122	0.00566463	3.800532795	3.738351324	9.272264004	0.511496464	1.191137125	0	0	5.396735259	0	0	0	0	0	0	0	0	0	4.178869571	0	0	0	0	2.08903622	0	0	0	0	73.766
H1418_007_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered			Radiology				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin					O	O	V	O	O	O	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	YES	1184.477092	53.992469	545.808461	484.777841	39.100548	9.249365	3.937837	329.509764	395.047456	1515.14325	162.454334	77.380665	27.912964	614.990258	3583.915797	4270.972617	90.757615	215.565514			23.73529	0		1.54					0.04	0.25	946.427	0.05	0.55	2.09	599.112133	0.32	0.4	0.42			4000	$175/Day(Days 1-10):1a	$175/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			139.192375	128.90955	50.7565	0	100	0.2	0.2	50	100	0	30	50	10.382864	42.978944	10	30	30	30			0.2	0		0					0	0	39.443039	0	0	0	30	0	0	0			NO	125.386858	116.123914	30.536227	0	87.1005	0.174201	0.174201	43.55025	87.1005	0	26.13015	43.55025	9.043526	37.434875	8.71005	26.13015	26.13015	26.13015			0.174201	0		0					0	0	34.355084	0	0	0	26.13015	0	0	0				12.3765	0.522484736	1.388910922	0	0.28380644	1.611248632	0.685975143	1.195852717	2.867402578	0	0.353746343	0.280828942	0.021035968	1.918506953	2.601340482	9.300096261	0.197625841	0.469396601	0	0	4.134711253	0	0	0	0	0	0	0	0	0	2.709548257	0	0	0	1.304574159	0	0	0	0	0	44.2236	0	6.773368	12.3765	0.522484736	1.388910922	0	0.28380644	1.611248632	0.685975143	1.195852717	2.867402578	0	0.353746343	0.280828942	0.021035968	1.918506953	2.601340482	9.300096261	0.197625841	0.469396601	0	0	4.134711253	0	0	0	0	0	0	0	0	0	2.709548257	0	0	0	1.304574159	0	0	0	0	0	44.2236	YES	$200/Day(Days 1-10)	$200/Day(Days 1-10)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			6000	2.3223	0.098	0.475	1.6603	1.0556	1.4817	0.6308	0.1962	2.9758	0.3982	0.0677	0.2386	0.0035	0.7517	1.494	1.7804	0.0378	0.0851			0.9583	0		0					0	0	1.1648	0	0	0	0.2497	0	0	0			18.1257	0	4.876826	14.6988	0.620523736	1.863952922	1.660259	1.33938044	3.092982632	1.316810143	1.392078717	5.843208578	0.398213	0.421466343	0.519471942	0.024487968	2.670200953	4.095317482	11.08047726	0.235458841	0.554472601	0	0	5.093012253	0	0	0	0	0	0	0	0	0	3.874394257	0	0	0	1.554318159	0	0	0	0	0	62.3493
H1418_008_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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		0	YES	1276.420127	55.153099	425.275196	598.682211	37.375267	7.788672	3.324418	314.559656	386.305453	1804.507958	205.746294	70.958034	0.110037	563.408969	3528.104713	4397.561648	105.19701	225.739902			23.29126	0		1.48					0.04	0.25	979.673211	18.003449	0.05	0.55	2.91	615.958455	0.32	0.4	0.42		3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-9):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		175.3412	141.0078	48.2281	0	100	0.2	0.2	50	150	12.38818	30	50	0.2	43.521955	10	30	30	50			0.2	0		0					0	0	39.685211	0	0	0	0	30	0	0	0		NO	142.049868	114.235213	24.783215	0	82.6562	0.165312	0.165312	41.3281	123.9843	10.239599	24.79686	41.3281	0.165312	35.973594	8.26562	24.79686	24.79686	41.3281			0.165312	0		0					0	0	32.802287	0	0	0	0	24.79686	0	0	0			15.1096	0.525035501	0.878307218	0	0.257441462	1.287560946	0.549566188	1.083346077	3.991317598	1.53978649	0.425155171	0.24438006	0.018190437	1.688987126	2.430164406	9.087143377	0.217379627	0.777450104	0	0	3.850324773	0	0	0	0	0	0	0	0	0	2.677960153	0	0	0	0	1.272819631	0	0	0	0	47.9119	0	11.08354	15.1096	0.525035501	0.878307218	0	0.257441462	1.287560946	0.549566188	1.083346077	3.991317598	1.53978649	0.425155171	0.24438006	0.018190437	1.688987126	2.430164406	9.087143377	0.217379627	0.777450104	0	0	3.850324773	0	0	0	0	0	0	0	0	0	2.677960153	0	0	0	0	1.272819631	0	0	0	0	47.9119	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		5000	6.0124	0.0901	0.2084	1.6978	1.1315	1.3992	0.5972	0.2101	2.8937	0.336	0.0962	0.2795	0.0037	0.6159	1.6493	2.0557	0.0492	0.0784			1.0633	0		0					0	0	1.1548	0	0	0	0	0.2879	0	0	0		21.9103	500	12.50238	21.122	0.615097501	1.086696218	1.697778	1.388932462	2.686770946	1.146787188	1.293410077	6.885066598	1.87580449	0.521334171	0.52392706	0.021902437	2.304904126	4.079423406	11.14284138	0.266555627	0.855800104	0	0	4.913662773	0	0	0	0	0	0	0	0	0	3.832792153	0	0	0	0	1.560757631	0	0	0	0	69.8223
H1418_009_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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		0	YES	1101.744242	47.605493	367.077022	516.753587	32.260526	6.722806	2.869478	271.512712	333.440221	1557.564168	177.590269	61.24755	0.094979	486.307428	3045.289691	3795.76295	90.800982	194.847787			20.103893	0		1.48					0.04	0.25	845.606625	15.539708	0.05	0.55	2.91	531.665607	0.32	0.4	0.42		3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-9):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		175.3412	141.0078	48.2281	0	100	0.2	0.2	50	150	12.38818	30	50	0.2	43.521955	10	30	30	50			0.2	0		0					0	0	39.685211	0	0	0	0	30	0	0	0		NO	150.500963	121.031507	28.607655	0	85.5808	0.171162	0.171162	42.7904	128.3712	10.601903	25.67424	42.7904	0.171162	37.246437	8.55808	25.67424	25.67424	42.7904			0.171162	0		0					0	0	33.962921	0	0	0	0	25.67424	0	0	0			13.8178	0.480147047	0.875101067	0	0.230073469	1.150688921	0.491145593	0.968178129	3.567010108	1.376095352	0.379957932	0.218400597	0.016256796	1.509434915	2.1718194	8.121110747	0.194270517	0.694801229	0	0	3.441022534	0	0	0	0	0	0	0	0	0	2.393272583	0	0	0	0	1.137509199	0	0	0	0	43.2341	0	7.68797	13.8178	0.480147047	0.875101067	0	0.230073469	1.150688921	0.491145593	0.968178129	3.567010108	1.376095352	0.379957932	0.218400597	0.016256796	1.509434915	2.1718194	8.121110747	0.194270517	0.694801229	0	0	3.441022534	0	0	0	0	0	0	0	0	0	2.393272583	0	0	0	0	1.137509199	0	0	0	0	43.2341	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		5000	5.8774	0.088	0.2185	1.5775	1.0514	1.3001	0.5549	0.1952	2.6888	0.3122	0.0894	0.2597	0.0034	0.5723	1.5325	1.9101	0.0457	0.0728			0.988	0		0					0	0	1.073	0	0	0	0	0.2675	0	0	0		20.6786	500	9.587926	19.6952	0.568187047	1.093638067	1.577533	1.281426469	2.450798921	1.046068593	1.163364129	6.255809108	1.688314352	0.469324932	0.478148597	0.019705796	2.081728915	3.7042694	10.03121375	0.239963517	0.767602229	0	0	4.429049534	0	0	0	0	0	0	0	0	0	3.466313583	0	0	0	0	1.405054199	0	0	0	0	63.9127
H1418_010_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered			Radiology				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin					V		O	O	V	O	O	O	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	YES	1150.840067	52.459179	530.30848	471.01102	37.990163	8.370523	3.563677	320.152278	383.828816	1472.115899	157.840922	75.183193	27.120285	597.525638	3482.139016	4149.684655	88.180262	209.44384			21.480045	0					0.77		0.04	0.25	919.55017	0.05	0.55	2.09	582.098423	0.32	0.4	0.49			4000	$175/Day(Days 1-10):1a	$175/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15						"HER723: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			139.192375	128.90955	50.7565	0	100	0.2	0.2	50	100	0	30	50	10.382863	42.978944	10	30	30	30			0.2	0					0		0	0	39.443039	0	0	0	30	0	0	0			NO	126.345615	117.011843	31.418933	0	87.7197	0.175439	0.175439	43.85985	87.7197	0	26.31591	43.85985	9.107816	37.701	8.77197	26.31591	26.31591	26.31591			0.175439	0					0		0	0	34.599316	0	0	0	26.31591	0	0	0				12.117	0.511528768	1.388477217	0	0.277707142	1.468516185	0.625207929	1.170152574	2.805779049	0	0.346143958	0.274793631	0.02058388	1.877276173	2.545434915	9.100227326	0.193378653	0.45930877	0	0	3.768437615	0	0	0	0	0	0	0	0	0	2.651317242	0	0	0	1.276537476	0	0	0	0	0	42.8778	0	6.178998	12.117	0.511528768	1.388477217	0	0.277707142	1.468516185	0.625207929	1.170152574	2.805779049	0	0.346143958	0.274793631	0.02058388	1.877276173	2.545434915	9.100227326	0.193378653	0.45930877	0	0	3.768437615	0	0	0	0	0	0	0	0	0	2.651317242	0	0	0	1.276537476	0	0	0	0	0	42.8778	YES	$200/Day(Days 1-10)	$200/Day(Days 1-10)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			30% Coins	0% Coins					"HER723: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			6000	2.2991	0.0971	0.4718	1.5266	1.042	1.3624	0.58	0.1937	2.7362	0.3661	0.0669	0.2194	0.0034	0.6912	1.4748	1.7575	0.0373	0.0782			0.9577	0					0		0	0	1.071	0	0	0	0.2465	0	0	0			17.279	0	4.22516	14.416	0.608586768	1.860279217	1.526565	1.319727142	2.830931185	1.205244929	1.363858574	5.541955049	0.366147	0.412994958	0.494219631	0.02399088	2.568439173	4.020227915	10.85774733	0.230725653	0.53753377	0	0	4.726157615	0	0	0	0	0	0	0	0	0	3.722363242	0	0	0	1.523074476	0	0	0	0	0	60.1568
H1418_011_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered			Radiology				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin					V		O	O	V	O	O	O	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	YES	1164.072474	53.062357	536.405989	476.426724	38.426975	8.162351	3.475051	323.833402	388.242096	1489.042349	159.655784	76.047653	27.432116	604.396011	3522.176795	4197.397901	89.194162	211.852034			20.945844	0					0.77		0.04	0.25	930.123196	0.05	0.55	2.09	588.791415	0.32	0.4	0.49			4000	$175/Day(Days 1-10):1a	$175/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15						"HER723: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			139.192375	128.90955	50.7565	0	100	0.2	0.2	50	100	0	30	50	10.382863	42.978944	10	30	30	30			0.2	0					0		0	0	39.443039	0	0	0	30	0	0	0			NO	126.162577	116.842327	31.168399	0	87.6207	0.175241	0.175241	43.81035	87.6207	0	26.28621	43.81035	9.097537	37.658451	8.76207	26.28621	26.28621	26.28621			0.175241	0					0		0	0	34.560267	0	0	0	26.28621	0	0	0				12.2385	0.516660772	1.393242991	0	0.280583204	1.430378552	0.608971412	1.182271224	2.834837018	0	0.349728789	0.277639525	0.020797058	1.89671813	2.571796636	9.194473557	0.195381373	0.464065588	0	0	3.670570648	0	0	0	0	0	0	0	0	0	2.6787755	0	0	0	1.289757898	0	0	0	0	0	43.0952	0	6.282604	12.2385	0.516660772	1.393242991	0	0.280583204	1.430378552	0.608971412	1.182271224	2.834837018	0	0.349728789	0.277639525	0.020797058	1.89671813	2.571796636	9.194473557	0.195381373	0.464065588	0	0	3.670570648	0	0	0	0	0	0	0	0	0	2.6787755	0	0	0	1.289757898	0	0	0	0	0	43.0952	YES	$200/Day(Days 1-10)	$200/Day(Days 1-10)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			30% Coins	0% Coins					"HER723: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			6000	2.3307	0.0984	0.4686	1.4918	1.0563	1.3314	0.5668	0.1964	2.6739	0.3578	0.0678	0.2144	0.0035	0.6754	1.495	1.7816	0.0379	0.0764			0.9359	0					0		0	0	1.0467	0	0	0	0.2499	0	0	0			17.1566	0	4.128001	14.5692	0.615051772	1.861803991	1.491829	1.336870204	2.761793552	1.175810412	1.378630224	5.508753018	0.357815	0.417494789	0.492072525	0.024251058	2.57215513	4.066783636	10.97605756	0.233239373	0.540510588	0	0	4.606498648	0	0	0	0	0	0	0	0	0	3.7254505	0	0	0	1.539669898	0	0	0	0	0	60.2517
H1418_012_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered			Radiology				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin					V		O	O	V	O	O	O	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	YES	1230.825371	56.10518	567.165803	503.747071	40.630542	8.265544	3.518983	342.403395	410.50556	1574.430408	168.81113	80.40855	29.005191	639.054668	3724.153484	4438.094657	94.308937	224.000536			21.210654	0					0.77		0.04	0.25	983.46044	0.05	0.55	2.09	622.555234	0.32	0.4	0.49			4000	$175/Day(Days 1-10):1a	$175/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15						"HER723: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			139.192375	128.90955	50.7565	0	100	0.2	0.2	50	100	0	30	50	10.382864	42.978944	10	30	30	30			0.2	0					0		0	0	39.443039	0	0	0	30	0	0	0			NO	124.703562	115.491097	31.627644	0	86.781	0.173562	0.173562	43.3905	86.781	0	26.0343	43.3905	9.010353	37.297557	8.6781	26.0343	26.0343	26.0343			0.173562	0					0		0	0	34.229064	0	0	0	26.0343	0	0	0				12.7907	0.539970732	1.494843176	0	0.293829922	1.434584348	0.610761727	1.238087876	2.968673584	0	0.366239967	0.290747266	0.021778917	1.986264825	2.693214696	9.628557311	0.204605597	0.485974763	0	0	3.68136353	0	0	0	0	0	0	0	0	0	2.805244195	0	0	0	1.350649144	0	0	0	0	0	44.8861	0	7.031947	12.7907	0.539970732	1.494843176	0	0.293829922	1.434584348	0.610761727	1.238087876	2.968673584	0	0.366239967	0.290747266	0.021778917	1.986264825	2.693214696	9.628557311	0.204605597	0.485974763	0	0	3.68136353	0	0	0	0	0	0	0	0	0	2.805244195	0	0	0	1.350649144	0	0	0	0	0	44.8861	YES	$200/Day(Days 1-10)	$200/Day(Days 1-10)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			30% Coins	0% Coins					"HER723: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			6000	2.8398	0.1199	0.4572	1.9243	1.4227	1.7174	0.7312	0.2645	3.4491	0.4616	0.0913	0.2766	0.0047	0.8713	2.0135	2.3995	0.051	0.0986			1.2073	0					0		0	0	1.3501	0	0	0	0.3366	0	0	0			22.088	500	4.729271	15.6305	0.659856732	1.952018176	1.924326	1.716491922	3.151990348	1.341932727	1.502553876	6.417785584	0.46155	0.457510967	0.567346266	0.026430917	2.857516825	4.706739696	12.02808731	0.255595597	0.584581763	0	0	4.88862653	0	0	0	0	0	0	0	0	0	4.155361195	0	0	0	1.687244144	0	0	0	0	0	66.9741
H1418_013_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered			Radiology				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin					V		O	O	V	O	O	O	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	YES	1168.821896	53.278852	538.594528	478.370548	38.583758	7.977312	3.396271	325.154644	389.826126	1495.117649	160.30718	76.357927	27.544039	606.861952	3536.547294	4214.523304	89.558075	212.716391			20.471006	0					0.77		0.04	0.25	933.918104	0.05	0.55	2.09	591.193687	0.32	0.4	0.49			4000	$175/Day(Days 1-10):1a	$175/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15						"HER723: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			139.192375	128.90955	50.7565	0	100	0.2	0.2	50	100	0	30	50	10.382864	42.978944	10	30	30	30			0.2	0					0		0	0	39.443039	0	0	0	30	0	0	0			NO	126.130145	116.812291	32.886405	0	87.6126	0.175225	0.175225	43.8063	87.6126	0	26.28378	43.8063	9.096697	37.65497	8.76126	26.28378	26.28378	26.28378			0.175225	0					0		0	0	34.557072	0	0	0	26.28378	0	0	0				12.2853	0.518635397	1.476036482	0	0.281701946	1.397824495	0.595111586	1.186985157	2.846140037	0	0.351123221	0.278746521	0.020879981	1.904280716	2.582050862	9.231133611	0.196160395	0.465915902	0	0	3.587032026	0	0	0	0	0	0	0	0	0	2.689456264	0	0	0	1.294900401	0	0	0	0	0	43.1894	0	6.215516	12.2853	0.518635397	1.476036482	0	0.281701946	1.397824495	0.595111586	1.186985157	2.846140037	0	0.351123221	0.278746521	0.020879981	1.904280716	2.582050862	9.231133611	0.196160395	0.465915902	0	0	3.587032026	0	0	0	0	0	0	0	0	0	2.689456264	0	0	0	1.294900401	0	0	0	0	0	43.1894	YES	$200/Day(Days 1-10)	$200/Day(Days 1-10)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins					"HER723: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			6000	2.349	0.0992	0.4671	1.4631	1.0643	1.3058	0.5559	0.1979	2.6225	0.3509	0.0683	0.2103	0.0035	0.6624	1.5064	1.7951	0.0381	0.075			0.8445	0					0		0	0	1.0265	0	0	0	0.2518	0	0	0			16.9579	0	3.989976	14.6343	0.617802397	1.943166482	1.463137	1.346028946	2.703632495	1.151047586	1.384838157	5.468629037	0.350934	0.419405221	0.489055521	0.024359981	2.566726716	4.088415862	11.02627761	0.234307395	0.540890902	0	0	4.431554026	0	0	0	0	0	0	0	0	0	3.716000264	0	0	0	1.546714401	0	0	0	0	0	60.1473
H1418_014_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered			Radiology				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin					V		O	O	V	O	O	O	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	YES	1161.503215	52.945242	535.222071	475.375189	38.342162	7.920409	3.372045	323.11866	387.385196	1485.75584	159.303403	75.879806	27.371569	603.062032	3514.402894	4188.133699	88.997299	211.384449			20.324982	0					0.77		0.04	0.25	928.070294	0.05	0.55	2.09	587.491876	0.32	0.4	0.49			4000	$175/Day(Days 1-10):1a	$175/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15						"HER723: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			139.192375	128.90955	50.7565	0	100	0.2	0.2	50	100	0	30	50	10.382863	42.978944	10	30	30	30			0.2	0					0		0	0	39.443039	0	0	0	30	0	0	0			NO	126.2827	116.953576	33.040096	0	87.7097	0.175419	0.175419	43.85485	87.7097	0	26.31291	43.85485	9.106778	37.696702	8.77097	26.31291	26.31291	26.31291			0.175419	0					0		0	0	34.595371	0	0	0	26.31291	0	0	0				12.2231	0.516011282	1.473649051	0	0.280248294	1.389390226	0.591520762	1.180860031	2.831453277	0	0.349311342	0.277308126	0.020772234	1.894454142	2.568726863	9.183498757	0.19514816	0.463511665	0	0	3.565388017	0	0	0	0	0	0	0	0	0	2.675578011	0	0	0	1.288218405	0	0	0	0	0	42.9682	0	6.121833	12.2231	0.516011282	1.473649051	0	0.280248294	1.389390226	0.591520762	1.180860031	2.831453277	0	0.349311342	0.277308126	0.020772234	1.894454142	2.568726863	9.183498757	0.19514816	0.463511665	0	0	3.565388017	0	0	0	0	0	0	0	0	0	2.675578011	0	0	0	1.288218405	0	0	0	0	0	42.9682	YES	$200/Day(Days 1-10)	$200/Day(Days 1-10)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins					"HER723: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			6000	2.3385	0.0987	0.4674	1.4549	1.0593	1.2985	0.5528	0.1969	2.6077	0.349	0.068	0.2091	0.0035	0.6587	1.4992	1.7866	0.038	0.0746			0.8398	0					0		0	0	1.0208	0	0	0	0.2506	0	0	0			16.8724	0	3.933722	14.5616	0.614733282	1.941040051	1.454898	1.339510294	2.687845226	1.144326762	1.377772031	5.439175277	0.348958	0.417268342	0.486433126	0.024236234	2.553169142	4.067924863	10.97010076	0.23311316	0.538063665	0	0	4.405155017	0	0	0	0	0	0	0	0	0	3.696342011	0	0	0	1.538834405	0	0	0	0	0	59.8405
H1418_801_0	2010	4	N/A																															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	NO	357.9823308	1.221087731	46.91358966	13.830009	3.338764797	9.446310935	4.617432428	22.49303856	53.12551314	13.71516312	32.92716977	11.55896999	1.015474869	20.94004962	34.23461636	75.08003358	0.360801087	5.544199125			28.74538551	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																			0.085280493	0.085280493	0.183752541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.085280493	0.085280493	0.183752541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				30.5289	0.104134963	8.620491309	0	0.777932198	2.200990448	1.075861756	5.240877985	12.37824456	3.195633008	7.672030555	2.693240007	0.236605644	4.87903156	7.976665613	17.49364783	0.084066653	1.291798396	0	0	6.697674825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1478	0	0	30.5289	0.104134963	8.620491309	0	0.777932198	2.200990448	1.075861756	5.240877985	12.37824456	3.195633008	7.672030555	2.693240007	0.236605644	4.87903156	7.976665613	17.49364783	0.084066653	1.291798396	0	0	6.697674825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1478	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.5306	0.0018	0.3641	0	1.3186	0.4624	0.2261	0.4277	0.9218	0.2608	0.5684	0.2198	0.0193	0.3952	0.4628	1.0148	0.0049	0.0855			0.0131	0																			7.2978	0	0	31.0595	0.105947301	8.984543696	0	2.096535864	2.663418601	1.301912403	5.668609934	13.30004985	3.456452619	8.240447014	2.913046393	0.255930014	5.274231083	8.439416266	18.50849038	0.088942054	1.377346586	0	0	6.710774897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4456
H1418_802_0	2010	4	N/A																															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	NO	357.9823308	1.221087731	46.91358966	13.830009	3.338764797	9.446310935	4.617432428	22.49303856	53.12551314	13.71516312	32.92716977	11.55896999	1.015474869	20.94004962	34.23461636	75.08003358	0.360801087	5.544199125			28.74538551	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																			0.085280493	0.085280493	0.183752541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.085280493	0.085280493	0.183752541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				30.5289	0.104134963	8.620491309	0	0.777932198	2.200990448	1.075861756	5.240877985	12.37824456	3.195633008	7.672030555	2.693240007	0.236605644	4.87903156	7.976665613	17.49364783	0.084066653	1.291798396	0	0	6.697674825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1478	0	0	30.5289	0.104134963	8.620491309	0	0.777932198	2.200990448	1.075861756	5.240877985	12.37824456	3.195633008	7.672030555	2.693240007	0.236605644	4.87903156	7.976665613	17.49364783	0.084066653	1.291798396	0	0	6.697674825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1478	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.5306	0.0018	0.3641	0	1.3186	0.4624	0.2261	0.4277	0.9218	0.2608	0.5684	0.2198	0.0193	0.3952	0.4628	1.0148	0.0049	0.0855			0.0131	0																			7.2978	0	0	31.0595	0.105947301	8.984543696	0	2.096535864	2.663418601	1.301912403	5.668609934	13.30004985	3.456452619	8.240447014	2.913046393	0.255930014	5.274231083	8.439416266	18.50849038	0.088942054	1.377346586	0	0	6.710774897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4456
H1418_803_0	2010	4	N/A																															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	NO	357.9823308	1.221087731	46.91358966	13.830009	3.338764797	9.446310935	4.617432428	22.49303856	53.12551314	13.71516312	32.92716977	11.55896999	1.015474869	20.94004962	34.23461636	75.08003358	0.360801087	5.544199125			28.74538551	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																			0.085280493	0.085280493	0.183752541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.085280493	0.085280493	0.183752541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				30.5289	0.104134963	8.620491309	0	0.777932198	2.200990448	1.075861756	5.240877985	12.37824456	3.195633008	7.672030555	2.693240007	0.236605644	4.87903156	7.976665613	17.49364783	0.084066653	1.291798396	0	0	6.697674825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1478	0	0	30.5289	0.104134963	8.620491309	0	0.777932198	2.200990448	1.075861756	5.240877985	12.37824456	3.195633008	7.672030555	2.693240007	0.236605644	4.87903156	7.976665613	17.49364783	0.084066653	1.291798396	0	0	6.697674825	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.1478	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.5306	0.0018	0.3641	0	1.3186	0.4624	0.2261	0.4277	0.9218	0.2608	0.5684	0.2198	0.0193	0.3952	0.4628	1.0148	0.0049	0.0855			0.0131	0																			7.2978	0	0	31.0595	0.105947301	8.984543696	0	2.096535864	2.663418601	1.301912403	5.668609934	13.30004985	3.456452619	8.240447014	2.913046393	0.255930014	5.274231083	8.439416266	18.50849038	0.088942054	1.377346586	0	0	6.710774897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4456
H1419_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1954.372892	69.84148033	1519.590655	641.1999916	252.1091908	8.910103019	0	268.9298507	404.9838884	2297.940592	2333.029071	34.15590518	0.171902434	81.21202819	3678.588102	4660.302136	169.1783263	457.1275829	0	0	278	0	0	0	560.6833573	0	35.74463302	0	60.41132045	0											5000	$200/day 1-8	$200/day 1-8	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$250 per procedure	$50 per visit	$50 X-ray; $250 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	$25 PCP visit; $50 if no PCP selected	$50 per visit	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Yrs	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											152.3663772	152.3663772	47.56208437	0	150	0.2	0.2	47.5	250	7.5	44	50	25	50	25	50	40	50	50	50	$45 	0	0	0	0	0	0	0	0	0											NO	106.9949632	106.9949632	33.39912361	0	150	0.140444323	0.140444323	47.5	175.5554033	7.5	44	50	25	50	25	50	40	50	50	50	$45 	0	0	0	0	0	0	0	0	0												17.4257	0.622723885	4.229416344	0	3.151364885	1.251373383	0	1.064513992	5.924759155	1.43621287	8.554439925	0.142316272	0.00035813	0.338383451	7.663725212	19.41792557	0.563927754	1.904698262	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7343	0	12.49	17.4257	0.622723885	4.229416344	0	3.151364885	1.251373383	0	1.064513992	5.924759155	1.43621287	8.554439925	0.142316272	0.00035813	0.338383451	7.663725212	19.41792557	0.563927754	1.904698262	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7343	NO																																																																																		0			17.4257	0.622723885	4.229416344	0	3.151364885	1.251373383	0	1.064513992	5.924759155	1.43621287	8.554439925	0.142316272	0.00035813	0.338383451	7.663725212	19.41792557	0.563927754	1.904698262	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7343
H1419_003_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1987.848906	146.0498656	1728.428183	694.2332112	268.3365556	10.77545912	0	260.6305471	402.5328005	2680.929584	2839.323006	43.20804498	0.238436145	225.3626688	4784.085974	5685.844392	274.135841	682.678183	0	0	278	0	0	0	795.4328977	0	43.30470861	0	105.9785736	0											3500	$150/day 1-5	$150/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$30 per visit	$50 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$5 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$50 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											91.92581111	91.92581111	47.56208437	0	100	0.2	0.2	47.5	150	4.5	36.875	30	25	30	5	30	30	30	50	30	$45 	0	0	0	0	0	0	0	0	0											NO	50.47702212	50.47702212	26.11662988	0	100	0.109821217	0.109821217	47.5	82.36591254	4.5	36.875	30	25	30	5	30	30	30	50	30	$45 	0	0	0	0	0	0	0	0	0												8.3617	0.614346858	3.761726594	0	2.236137964	1.183374031	0	1.031662582	2.76291512	1.005348594	8.725002987	0.108020112	0.000496742	0.563406672	1.993369156	14.21461098	0.685339603	1.706695458	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9967	0	13.7	8.3617	0.614346858	3.761726594	0	2.236137964	1.183374031	0	1.031662582	2.76291512	1.005348594	8.725002987	0.108020112	0.000496742	0.563406672	1.993369156	14.21461098	0.685339603	1.706695458	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9967	NO																																																																																		0			8.3617	0.614346858	3.761726594	0	2.236137964	1.183374031	0	1.031662582	2.76291512	1.005348594	8.725002987	0.108020112	0.000496742	0.563406672	1.993369156	14.21461098	0.685339603	1.706695458	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9967
H1419_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	429.2340169	6.59615107	57.48436499	8.90922732	11.39761569	14.39020362	0	14.38252047	49.1788692	17.01741064	74.7817893	0.998096745	0.018988126	32.78591283	26.04343018	164.1557215	3.160006214	8.150575302	0	-1.29E-08	85.44509996	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.072984419	0.072984419	0.164804722	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072984419	0.072984419	0.164804722	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												31.3274	0.481416254	9.473694789	0	2.655644455	3.352917442	0	3.35112727	11.45867652	3.96505668	17.42415691	0.232556542	0.004424233	7.639117689	6.068119232	38.24828311	0.736281448	1.899084045	0	-3.00E-09	19.90870829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	158.2267			31.3274	0.481416254	9.473694789	0	2.655644455	3.352917442	0	3.35112727	11.45867652	3.96505668	17.42415691	0.232556542	0.004424233	7.639117689	6.068119232	38.24828311	0.736281448	1.899084045	0	-3.00E-09	19.90870829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	158.2267	NO																																																																																		0			31.3274	0.481416254	9.473694789	0	2.655644455	3.352917442	0	3.35112727	11.45867652	3.96505668	17.42415691	0.232556542	0.004424233	7.639117689	6.068119232	38.24828311	0.736281448	1.899084045	0	-3.00E-09	19.90870829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	158.2267
H1419_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	427.6994047	6.572568284	57.27884492	8.877374745	11.35686654	14.33875527	0	14.33109959	49.00304322	16.95656941	74.51442688	0.994528315	0.018920239	32.66869551	25.95031881	163.5688263	3.148708452	8.121435086	0	-1.28E-08	85.13961371	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.073405471	0.073405471	0.16553816	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073405471	0.073405471	0.16553816	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												31.3955	0.48246247	9.481834622	0	2.646149904	3.340929977	0	3.339146205	11.41770907	3.950880673	17.36186146	0.231725097	0.004408416	7.611806053	6.046424284	38.11153654	0.733649069	1.892294375	0	-2.99E-09	19.83752999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.8858			31.3955	0.48246247	9.481834622	0	2.646149904	3.340929977	0	3.339146205	11.41770907	3.950880673	17.36186146	0.231725097	0.004408416	7.611806053	6.046424284	38.11153654	0.733649069	1.892294375	0	-2.99E-09	19.83752999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.8858	NO																																																																																		0			31.3955	0.48246247	9.481834622	0	2.646149904	3.340929977	0	3.339146205	11.41770907	3.950880673	17.36186146	0.231725097	0.004408416	7.611806053	6.046424284	38.11153654	0.733649069	1.892294375	0	-2.99E-09	19.83752999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.8858
H1463_001_0	2010	1	N/A																															A	A	A	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	O	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	YES	276.885024	1.163662544	1284.081352	292.4811681	217.4957145	10.14982084	0.641089986	460.4418877	285.5095336	331.4786572	171.7147503	0	31.44958797	211.6518133	4199.921329	4760.351232	94.34854161	87.47548291	287.2689219	934.2603897	1954.442108	0	0	0	31.38309338	0	6.760526965	0	125.0876006	0											1500	1A IP Acute: $250 Per Admit	1B IP Psych: $250 Per Admit	2 SNF: $50 for days 21-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	"11B Prosthetics/Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 10%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $20, 5 Partial Hosp: $20, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $20"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears: $0, 14D Pelvic Exams: $20, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $20, 14J Nutrition Therapy: $20"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $20	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $20	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											250	250	23.5	0	50	0.1	0.1	48.77	100	0	0	0	0	20	20	20	20	20	20	20	0	0	0	0	20	0	20	0	0	0											NO	199.9337093	199.9337093	18.79376868	0	39.98674187	0.079973484	0.079973484	39.00306802	79.97348374	0	0	0	0	15.99469675	15.99469675	15.99469675	15.99469675	15.99469675	15.99469675	15.99469675	0	0	0	0	15.99469675	0	15.99469675	0	0	0												4.6132	0.019387947	2.011060658	0	0.724745416	0.811716532	0.0512702	1.496553856	1.902766003	0	0	0	0	0.282108881	5.598039002	6.345031198	0.125756359	0.116595319	0.382898274	1.245267635	0	0	0	0	0.041830255	0	0.009011048	0	0	0	0	0	0	0	0	0	0	0	0	0	25.7773	0	6.454998339	4.6132	0.019387947	2.011060658	0	0.724745416	0.811716532	0.0512702	1.496553856	1.902766003	0	0	0	0	0.282108881	5.598039002	6.345031198	0.125756359	0.116595319	0.382898274	1.245267635	0	0	0	0	0.041830255	0	0.009011048	0	0	0	0	0	0	0	0	0	0	0	0	0	25.7773	NO																																																																																		0			4.6132	0.019387947	2.011060658	0	0.724745416	0.811716532	0.0512702	1.496553856	1.902766003	0	0	0	0	0.282108881	5.598039002	6.345031198	0.125756359	0.116595319	0.382898274	1.245267635	0	0	0	0	0.041830255	0	0.009011048	0	0	0	0	0	0	0	0	0	0	0	0	0	25.7773
H1463_003_0	2010	3	N/A																															A	A	A	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	O	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	YES	353.4560442	3.199899484	2329.60716	503.3837221	322.8390661	15.99211773	2.49906012	548.838599	308.1897868	576.0536912	237.3885656	0	21.91633987	354.2003014	5463.951719	5349.466599	175.3537611	160.2384109	358.9325581	1123.285981	3199.776235	0	0	0	32.76791294	0.226283138	6.544931732	0	124.2031051	0											1500	1A IP Acute: $250 Per Admit	1B IP Psych: $250 Per Admit	2 SNF: $50 for days 21-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	"11B Prosthetics/Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 10%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $20, 5 Partial Hosp: $20, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $20"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears: $0, 14D Pelvic Exams: $20, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $20, 14J Nutrition Therapy: $20"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $20	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $20	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											250	250	23.5	0	50	0.1	0.1	48.77	100	0	0	0	0	20	20	20	20	20	20	20	0	0	0	0	20	0	20	0	0	0											NO	194.9113013	194.9113013	18.32166232	0	38.98226026	0.077964521	0.077964521	38.02329666	77.96452052	0	0	0	0	15.5929041	15.5929041	15.5929041	15.5929041	15.5929041	15.5929041	15.5929041	0	0	0	0	15.5929041	0	15.5929041	0	0	0												5.741	0.051974714	3.556856311	0	1.048749708	1.246817791	0.194838024	1.739054406	2.002322413	0	0	0	0	0.460250945	7.099906266	6.951143307	0.227856198	0.208215181	0.46640008	1.459607548	0	0	0	0	0.04257891	0	0.008504541	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5061	0	9.187358992	5.741	0.051974714	3.556856311	0	1.048749708	1.246817791	0.194838024	1.739054406	2.002322413	0	0	0	0	0.460250945	7.099906266	6.951143307	0.227856198	0.208215181	0.46640008	1.459607548	0	0	0	0	0.04257891	0	0.008504541	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5061	NO																																																																																		0			5.741	0.051974714	3.556856311	0	1.048749708	1.246817791	0.194838024	1.739054406	2.002322413	0	0	0	0	0.460250945	7.099906266	6.951143307	0.227856198	0.208215181	0.46640008	1.459607548	0	0	0	0	0.04257891	0	0.008504541	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5061
H1463_005_0	2010	2	N/A																															A	A	A	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	O	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	YES	349.6163926	1.771128721	2076.889494	620.8179008	299.3326947	21.44445201	1.751794703	518.1451286	343.9465985	634.9752546	224.6617414	0	45.44594355	356.1899501	5373.729078	5934.529224	167.0102221	162.6700417	369.5339819	1191.734892	3397.426054	0	0	0	33.54425132	0.104385706	7.357862703	0	125.8801565	0											1500	1A IP Acute: $250 Per Admit	1B IP Psych: $250 Per Admit	2 SNF: $50 for days 21-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	"11B Prosthetics/Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 10%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $20, 5 Partial Hosp: $20, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $20"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears: $0, 14D Pelvic Exams: $20, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $20, 14J Nutrition Therapy: $20"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $20	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $20	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											250	250	23.5	0	50	0.1	0.1	48.77	100	0	0	0	0	20	20	20	20	20	20	20	0	0	0	0	20	0	20	0	0	0											NO	194.9113013	194.9113013	18.32166232	0	38.98226026	0.077964521	0.077964521	38.02329666	77.96452052	0	0	0	0	15.5929041	15.5929041	15.5929041	15.5929041	15.5929041	15.5929041	15.5929041	0	0	0	0	15.5929041	0	15.5929041	0	0	0												5.6787	0.02876775	3.171005666	0	0.972388751	1.671906419	0.136577834	1.641798828	2.23463597	0	0	0	0	0.462836311	6.982670183	7.711378758	0.217014532	0.211374863	0.480175662	1.548550658	0	0	0	0	0.043587691	0	0.009560871	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2029	0	9.384295591	5.6787	0.02876775	3.171005666	0	0.972388751	1.671906419	0.136577834	1.641798828	2.23463597	0	0	0	0	0.462836311	6.982670183	7.711378758	0.217014532	0.211374863	0.480175662	1.548550658	0	0	0	0	0.043587691	0	0.009560871	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2029	NO																																																																																		0			5.6787	0.02876775	3.171005666	0	0.972388751	1.671906419	0.136577834	1.641798828	2.23463597	0	0	0	0	0.462836311	6.982670183	7.711378758	0.217014532	0.211374863	0.480175662	1.548550658	0	0	0	0	0.043587691	0	0.009560871	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2029
H1463_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	V	V	O	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	NO	246.556873	1.298224324	61.45332823	4.282947299	11.28511476	13.29410414	1.793403784	22.22797386	33.76268135	3.165967187	6.20318196	0	0.674581533	24.19351731	28.74667308	71.26552119	0.847206851	0.552730545	37.02981528	60.89102362	40.29233388	0	0	0	0	0	0	0	0	0												1A IP Acute: Medicare FFS Cost Sharing	1B IP Psych: Medicare FFS Cost Sharing	2 SNF: Medicare FFS Cost Sharing	6 Home Health: Medicare FFS Cost Sharing	10A Ambulance: Medicare FFS Cost Sharing	11A DME: Medicare FFS Cost Sharing	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Medicare FFS Cost Sharing"	"4A ER, 4B Urgent Care: Medicare FFS Cost Sharing"	9B ASC Services: Medicare FFS Cost Sharing	8A OP Diagnostic Procedures/Tests: Medicare FFS Cost Sharing	8B OP Radiology: Medicare FFS Cost Sharing	9A OP Hospital: Medicare FFS Cost Sharing	12 Renal Dialysis: Medicare FFS Cost Sharing	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Medicare FFS Cost Sharing"	"7A PCP, 14B Immunizations, 14C Physical Exams, 14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Medicare FFS Cost Sharing"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Medicare FFS Cost Sharing"	"7E Mental Health, 7H Psychiatric: Medicare FFS Cost Sharing"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Medicare FFS Cost Sharing"	7D Physician Specialist (Radiology): Medicare FFS Cost Sharing	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Medicare FFS Cost Sharing"	15 Part B Drugs: Medicare FFS Cost Sharing	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Medicare FFS Cost Sharing"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered), 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	13B Acupuncture: Not Covered											0.085262069	0.085262069	0.184116274	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085262069	0.085262069	0.184116274	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.0219	0.110689292	11.31455781	0	2.62943174	3.097526264	0.417863082	5.179117909	7.866704754	0.737670355	1.445341397	0	0.157177497	5.637089534	6.697974827	16.60486644	0.197399196	0.128786217	8.62794696	14.1876085	9.388113793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.4478	0	0	21.0219	0.110689292	11.31455781	0	2.62943174	3.097526264	0.417863082	5.179117909	7.866704754	0.737670355	1.445341397	0	0.157177497	5.637089534	6.697974827	16.60486644	0.197399196	0.128786217	8.62794696	14.1876085	9.388113793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.4478	NO																																																																																		0			21.0219	0.110689292	11.31455781	0	2.62943174	3.097526264	0.417863082	5.179117909	7.866704754	0.737670355	1.445341397	0	0.157177497	5.637089534	6.697974827	16.60486644	0.197399196	0.128786217	8.62794696	14.1876085	9.388113793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.4478
H1463_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	V	V	O	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	NO	318.6140846	3.08095054	71.08220229	4.665523917	12.99429133	17.46194427	2.966880206	22.8674656	34.85530649	2.935940513	6.064354815	0	0.516053949	25.49043288	32.44243683	80.75566674	0.777735955	0.480466871	48.25574547	71.33111901	50.33626987	0	0	0	0	0	0	0	0	0												1A IP Acute: Medicare FFS Cost Sharing	1B IP Psych: Medicare FFS Cost Sharing	2 SNF: Medicare FFS Cost Sharing	6 Home Health: Medicare FFS Cost Sharing	10A Ambulance: Medicare FFS Cost Sharing	11A DME: Medicare FFS Cost Sharing	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Medicare FFS Cost Sharing"	"4A ER, 4B Urgent Care: Medicare FFS Cost Sharing"	9B ASC Services: Medicare FFS Cost Sharing	8A OP Diagnostic Procedures/Tests: Medicare FFS Cost Sharing	8B OP Radiology: Medicare FFS Cost Sharing	9A OP Hospital: Medicare FFS Cost Sharing	12 Renal Dialysis: Medicare FFS Cost Sharing	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Medicare FFS Cost Sharing"	"7A PCP, 14B Immunizations, 14C Physical Exams, 14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Medicare FFS Cost Sharing"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Medicare FFS Cost Sharing"	"7E Mental Health, 7H Psychiatric: Medicare FFS Cost Sharing"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Medicare FFS Cost Sharing"	7D Physician Specialist (Radiology): Medicare FFS Cost Sharing	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Medicare FFS Cost Sharing"	15 Part B Drugs: Medicare FFS Cost Sharing	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Medicare FFS Cost Sharing"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered), 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	13B Acupuncture: Not Covered											0.085257101	0.085257101	0.184131452	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085257101	0.085257101	0.184131452	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												27.1641	0.26267291	13.08846911	0	3.02766988	4.068633014	0.691283088	5.328119484	8.121286411	0.684074139	1.412994672	0	0.12024057	5.93927086	7.559087781	18.81607035	0.181212477	0.111948781	11.24358869	16.62015073	11.72835088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.1692	0	0	27.1641	0.26267291	13.08846911	0	3.02766988	4.068633014	0.691283088	5.328119484	8.121286411	0.684074139	1.412994672	0	0.12024057	5.93927086	7.559087781	18.81607035	0.181212477	0.111948781	11.24358869	16.62015073	11.72835088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.1692	NO																																																																																		0			27.1641	0.26267291	13.08846911	0	3.02766988	4.068633014	0.691283088	5.328119484	8.121286411	0.684074139	1.412994672	0	0.12024057	5.93927086	7.559087781	18.81607035	0.181212477	0.111948781	11.24358869	16.62015073	11.72835088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.1692
H1468_007_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin			V		O	O	P	O	O	O	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	YES	2370.515703	73.178194	1098.356638	1880.704501	316.397538	14.560013	5.21589	507.089223	428.003701	1791.991761	1953.701548	87.604947	0.05949	488.612421	6633.150711	6314.780934	108.646012	995.156679			42.810133	0		1.3			0.77		0.04	0.25	28.703543	0.05	0.55	2.09	0.32	0.4	0.49				3400	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-13) $75(Days 14-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$50/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$0-$50/Visit:14h. $20 DMAM -- OP,8b. $20 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $20 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $20 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$20-$100/Visit:9d. $20 Cardiac Rehab,8b. $20 Nuclear Medicine,9a. $100 OP Other,5. $20 Partial Hospitalization,7h. $100 Psych -- OP,8b. $20 Rad therapy,3. $20 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$20/Visit:7b, 7d, 7f"	$20/Visit:7e	$20/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"			"HER831: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				119.30775	110.4939	38.067375	0	50	0.2	0.082363	50	100	0	23.691576	100	0.2	44.807261	10	20	20	20			0.2	0		0			0		0	0	0	0	0	0	0	0	0				NO	95.37044	88.324956	17.41453	0	41.2778	0.165111	0.067995	41.2778	82.5556	0	19.558723	82.5556	0.165111	36.990903	8.25556	16.51112	16.51112	16.51112			0.165111	0		0			0		0	0	0	0	0	0	0	0	0					18.8398	0.53862173	1.593947052	0	1.088349525	2.404018306	0.354654441	1.744293961	2.944508528	0	3.184325617	0.602689914	0.009822453	1.506184556	4.563364474	8.688675481	0.149488945	1.369262612	0	0	7.06842387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6504	0	14.29314	18.8398	0.53862173	1.593947052	0	1.088349525	2.404018306	0.354654441	1.744293961	2.944508528	0	3.184325617	0.602689914	0.009822453	1.506184556	4.563364474	8.688675481	0.149488945	1.369262612	0	0	7.06842387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6504	NO																																																																																		0	0	0	18.8398	0.53862173	1.593947052	0	1.088349525	2.404018306	0.354654441	1.744293961	2.944508528	0	3.184325617	0.602689914	0.009822453	1.506184556	4.563364474	8.688675481	0.149488945	1.369262612	0	0	7.06842387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6504
H1509_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1049.079089	92.07753317	983.356492	179.3484496	124.5692933	6.482748282	7.406378016	219.2485044	23.59695619	6545.200457	22.35277528	0	0.054117543	12.64607462	3796.910152	2955.700237	372.3390706	300.9407138	0	0	16.76369536	557.3251693	0	0	239.6727635	212.849413	11.54951102	1.400244159	372.578943	0											3000	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	66.93273185	0	150	0.2	0.111818065	49.46273843	0.2	3	0.174933929	0	0.2	0.149147133	9.775814682	25	38.5	25	0	0	0.2	24.61294951	0	0	25	15	0	0	0	0											YES	142.9440035	108.8691792	51.93021614	0	116.3785222	0.155171363	0.086754808	38.37600269	0.155171363	2.327570445	0.135723681	0	0.155171363	0.115993031	9.65995058	25	38.5	19.39642037	0	0	0.155171363	24.61294951	0	0	25	15	0	0	0	0											3800	12.4966	0.835367122	4.255492931	0	1.20809919	1.005936887	0.6425389	0.701156766	3.661571853	1.269534595	3.033800943	0	0.008397493	1.466856526	3.056497035	6.157708827	1.194587852	0.486431049	0	0	2.601245457	1.143118021	0	0	0.499318257	0.266061766	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9904	0	9.76022519	12.4966	0.835367122	4.255492931	0	1.20809919	1.005936887	0.6425389	0.701156766	3.661571853	1.269534595	3.033800943	0	0.008397493	1.466856526	3.056497035	6.157708827	1.194587852	0.486431049	0	0	2.601245457	1.143118021	0	0	0.499318257	0.266061766	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9904	NO	"$275 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$185 Days 1-21 (2a, 2a2); $0 n/c (2a1)"	"25% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25%/25%/$10 (8a1); $10 (8a2)	"$21 (8b1); 25% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$20 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.8118	0.3386	6.4928	0.0874	0.4041	0.5047	0.5766	0.3381	1.5309	0.4246	1.2797	0	0.0028	0.6155	2.1237	4.5636	0.6352	0.323	0	0	1.6191	0.8634	0	0	0.376	0.038	0.0181	0.0005	0	0											26.9681	0	8.412683238	16.3084	1.173993367	10.74832237	0.087408829	1.612174775	1.510623761	1.219131051	1.039242634	5.192439312	1.694158615	4.313455186	0	0.011206221	2.082376406	5.180158635	10.72132726	1.829754502	0.809390254	0	0	4.220365279	2.006489874	0	0	0.875275534	0.304062032	0.01811688	0.000534967	0	0	0	0	0	0	0	0	0	0	0	0	72.9585
H1509_004_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	352.8796789	19.90998509	2357.094443	862.8611314	11.69647624	25.22697287	20.87005869	29.08313111	28.89131159	13.53977695	34.38941916	0	0.051978657	21.65260449	26.09048335	101.3817408	8.405075957	3.661429404	0	0	24.22353344	3.891834751	576.8971626	447.7337951	120.9156715	163.0453754	0	0	78.74864884	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077775969	0.078720617	43.47002967	0	0.2	0.2	0.2	0.102848965	0.2	0	0.166795337	0	0.2	0.149860989	0.167531689	0.19984997	0.2	0	0	0	0.2	0.199621878	0	0	0	0	0	0	0	0											NO	0.077775969	0.078720617	43.47002967	0	0.2	0.2	0.2	0.102848965	0.2	0	0.166795337	0	0.2	0.149860989	0.167531689	0.19984997	0.2	0	0	0	0.2	0.199621878	0	0	0	0	0	0	0	0												27.4456	1.567326308	8.538580449	0	2.339295248	5.045394575	4.174011738	2.991169922	5.778262318	0	5.73599475	0	0.010395731	3.244880719	4.370982753	20.26113781	1.681015191	0	0	0	4.844706688	0.77689536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.8056	0	0	27.4456	1.567326308	8.538580449	0	2.339295248	5.045394575	4.174011738	2.991169922	5.778262318	0	5.73599475	0	0.010395731	3.244880719	4.370982753	20.26113781	1.681015191	0	0	0	4.844706688	0.77689536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.8056	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												17.9535	1.013	7.133	0.3895	0.6934	1.4955	1.2372	0.5906	1.7127	0.2408	1.7002	0	0.0021	0.9618	2.369	9.343	0.7746	0	0	0	2.2324	0.358	0	0.0982	0.0552	0.0274	0	0	0	0											50.381	0	0	45.3991	2.580290462	15.67160072	0.389454247	3.032679169	6.540885781	5.41121881	3.581807185	7.490980789	0.240797231	7.436184811	0	0.012449978	4.206686681	6.740004496	29.60416098	2.455600623	0	0	0	7.077071534	1.134876555	0	0.098187236	0.055223276	0.027392718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.1866
H1509_005_0	2010	5	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1786.129322	206.0114447	34.36021568	783.9993645	219.5052947	16.30333062	16.35215866	443.2253156	46.29793917	12600.39448	41.24071125	0	0.256646402	23.07923607	7485.535162	5301.69233	837.7559888	358.8322585	0	0	25.51229578	974.8771808	672.78807	0	143.5742192	149.2405582	14.68725308	4.565347618	79.29287968	0											2800	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	0.187907189	0	150	0.2	0.096275435	49.59082486	0.2	3	0.176218993	0	0.2	0.149327704	9.840955748	25	38.5	25	0	0	0.2	24.71141802	0	0	25	15	0	0	0	0											NO	123.4697721	94.03719234	0.125927239	0	100.5234866	0.134031315	0.064519616	33.23361745	0.134031315	2.010469732	0.118094318	0	0.134031315	0.100482013	9.727179115	25	38.5	16.75391443	0	0	0.134031315	24.71141802	0	0	25	15	0	0	0	0												18.3777	1.61439482	4.326887088	0	1.838786463	2.185156849	1.055034992	1.227498382	6.20537369	2.111059309	4.870293648	0	0.034398655	2.319048101	6.067761774	11.04519235	2.687800464	0.500987079	0	0	3.419446564	2.007549795	0	0	0.299112957	0.186550698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3801	0	24.70869943	18.3777	1.61439482	4.326887088	0	1.838786463	2.185156849	1.055034992	1.227498382	6.20537369	2.111059309	4.870293648	0	0.034398655	2.319048101	6.067761774	11.04519235	2.687800464	0.500987079	0	0	3.419446564	2.007549795	0	0	0.299112957	0.186550698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3801	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												9.9608	0.3382	1.7482	0.2185	0.3391	0.6045	0.6063	0.2264	1.7167	0.3893	1.3179	0	0.0063	0.6494	1.9126	6.4497	0.5785	0.2644	0	0	1.4578	0.3374	0	0	0.0367	0.0299	0.0037	0.003	0	0											29.1953	0	0	28.3385	1.952590966	6.075038413	0.218502924	2.177909811	2.789662366	1.661350988	1.453883213	7.92203885	2.500397341	6.18817478	0	0.040742723	2.968433365	7.980373926	17.49492292	3.266251028	0.765384849	0	0	4.877292037	2.344965373	0	0	0.335803992	0.216499489	0.003661844	0.003003518	0	0	0	0	0	0	0	0	0	0	0	0	101.5754
H1509_006_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	298.7497116	34.89998426	11102.84979	103.9418836	26.6584284	17.48561868	15.78305062	19.3767239	5.571221851	43.45247993	25.64887189	0	0.022452648	10.94310386	1.065686478	109.8464653	16.30040279	31.0986503	0	0	1.387051711	11.72230973	1916.729831	0	106.7711973	189.1931161	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07429429	0.07519665	0	0	0.2	0.2	0.017113646	0.040707949	0.2	0	0.07287301	0	0.2	0.151077001	0.00473646	0.198833595	0.2	0	0	0	0.2	0.189287003	0	0	0	0	0	0	0	0											NO	0.07429429	0.07519665	0	0	0.2	0.2	0.017113646	0.040707949	0.2	0	0.07287301	0	0.2	0.151077001	0.00473646	0.198833595	0.2	0	0	0	0.2	0.189287003	0	0	0	0	0	0	0	0												22.1954	2.624361894	0	0	5.33168568	3.497123736	0.270105539	0.788786688	1.11424437	0	1.869110498	0	0.00449053	1.653251317	0.005047582	21.84116763	3.260080558	0	0	0	0.277410342	2.218880874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9511	0	0	22.1954	2.624361894	0	0	5.33168568	3.497123736	0.270105539	0.788786688	1.11424437	0	1.869110498	0	0.00449053	1.653251317	0.005047582	21.84116763	3.260080558	0	0	0	0.277410342	2.218880874	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9511	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.2669	0.8489	0.5867	0.0667	0.9885	0.6483	0.5852	0.0975	0.2066	0.4833	0.754	0	0.0006	0.3065	0.029	3.0613	0.4543	0	0	0	0.0387	0.3092	0	0	0.0186	0	0	0	0	0											16.7507	0	0	29.4623	3.47328043	0.586654468	0.066691603	6.320144261	4.1454669	0.855319776	0.886277178	1.320817765	0.48334781	2.623146804	0	0.005045539	1.959752965	0.034043689	24.90246257	3.714354079	0	0	0	0.316065882	2.528069193	0	0	0.018597442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7018
H1509_007_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1091.61731	82.56970684	922.9621942	116.4177091	121.5227684	7.243927814	8.997839256	263.9733546	29.85073361	6526.651364	27.15208909	0	0.035467557	14.53497932	4119.746304	3289.724762	156.6478724	276.5540224	0	0	13.47749062	679.3745884	0	0	152.0513162	0	11.71695636	4.523062278	415.3536781	0											3800	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-30 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	71.250509	0	150	0.2	0.110107533	49.46485628	0.2	3	0.172067507	0	0.2	0.149272514	9.737222489	30	38.5	30	0	0	0.2	26.60707237	0	0	30	0	0	0	0	0											NO	137.0469337	104.377846	58.88849057	0	123.974884	0.165299845	0.091003791	40.88266545	0.165299845	2.479497679	0.142213661	0	0.165299845	0.123512089	9.619185041	30	38.5	24.79497679	0	0	0.165299845	26.60707237	0	0	30	0	0	0	0	0												12.4669	0.718204012	4.529320872	0	1.255480925	1.197420147	0.818837482	0.899327862	4.934321648	1.348568076	3.861397996	0	0.005862782	1.795245666	3.302383502	8.224311905	0.502578591	0.571429214	0	0	2.227827115	1.506347404	0	0	0.38012829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5459	0	7.727579496	12.4669	0.718204012	4.529320872	0	1.255480925	1.197420147	0.818837482	0.899327862	4.934321648	1.348568076	3.861397996	0	0.005862782	1.795245666	3.302383502	8.224311905	0.502578591	0.571429214	0	0	2.227827115	1.506347404	0	0	0.38012829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5459	NO	"$295 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$145 Days 1-30 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.2192	0.4742	5.5272	0.1045	0.5762	0.8243	1.0239	0.4127	3.3968	0.6189	2.6051	0	0.0027	1.2305	2.9244	5.0721	0.2672	0.4338	0	0	1.9027	1.0078	0	0	0.2385	0	0.0184	0.003	0	0											34.8843	0	0	18.6861	1.192453353	10.05647714	0.104547423	1.831666465	2.021729174	1.842729535	1.312061898	8.331129266	1.967474671	6.466532122	0	0.008553424	3.025725628	6.226792593	13.29640375	0.769801432	1.005239445	0	0	4.130531674	2.514169591	0	0	0.618640159	0	0.018379539	0.002975699	0	0	0	0	0	0	0	0	0	0	0	0	85.4301
H1509_009_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1114.256919	82.02000089	1044.451068	190.4911201	132.3086109	7.25181646	8.285019204	232.8349455	26.39633499	6951.84469	25.00455311	0	0.060537672	14.13576783	4041.354172	3166.485369	340.214371	319.6377432	0	0	17.51199092	591.9510096	0	0	80.52216284	0	11.71888976	4.499767924	78.15386394	0											3800	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-32 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	73.06854565	0	150	0.2	0.111818065	49.46265729	0.2	3	0.173366243	0	0.2	0.149099067	9.858304693	30	38.5	30	0	0	0.2	29.53553942	0	0	30	0	0	0	0	0											NO	135.8118078	103.4371479	59.84682589	0	122.8575689	0.163810092	0.091584637	40.51241218	0.163810092	2.457151378	0.141995701	0	0.163810092	0.12226739	9.746298352	30	38.5	24.57151378	0	0	0.163810092	29.53553942	0	0	30	0	0	0	0	0												12.6108	0.706992914	5.208923434	0	1.354592857	1.187920721	0.75878048	0.786058773	4.32398606	1.423477897	3.550539056	0	0.009916682	1.72834344	3.282353626	7.916213423	1.091521107	0.654498601	0	0	2.868640842	1.456966031	0	0	0.201305407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1218	0	8.247751653	12.6108	0.706992914	5.208923434	0	1.354592857	1.187920721	0.75878048	0.786058773	4.32398606	1.423477897	3.550539056	0	0.009916682	1.72834344	3.282353626	7.916213423	1.091521107	0.654498601	0	0	2.868640842	1.456966031	0	0	0.201305407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1218	NO	"$295 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$155 Days 1-32 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.3482	0.4711	6.8567	0.1715	0.6273	0.8252	0.9428	0.364	3.0037	0.6592	2.414	0	0.0046	1.1955	2.9295	4.8796	0.5804	0.5014	0	0	2.4723	0.9183	0	0	0.1263	0	0.0184	0.003	0	0											36.3129	0	0	18.959	1.178084951	12.06557559	0.171505197	1.981918167	2.013127421	1.701558527	1.150090343	7.327706938	2.082704548	5.964569026	0	0.014509195	2.923875286	6.211838357	12.79577399	1.671886799	1.15589114	0	0	5.340921913	2.375219567	0	0	0.327614682	0	0.018382572	0.002960374	0	0	0	0	0	0	0	0	0	0	0	0	87.4347
H1509_801_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	260.8256124	1.792861397	28.22947039	93.03186078	5.69940739	12.1118735	8.90462465	12.78913418	37.14658513	18.80404935	38.41206533	0	0.099018866	20.08086677	20.04214889	89.82833732	0.909996836	6.474326707	0	0	24.52122588	4.684438119	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.7685	0.13588488	4.559555544	0	1.327961922	2.822066525	2.074777544	2.979868264	8.655154335	4.381343498	8.950011223	0	0.023071396	4.678841958	4.669820692	20.9300026	0.212029263	1.508518123	0	0	5.71344563	1.091474082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4824	0	0	19.7685	0.13588488	4.559555544	0	1.327961922	2.822066525	2.074777544	2.979868264	8.655154335	4.381343498	8.950011223	0	0.023071396	4.678841958	4.669820692	20.9300026	0.212029263	1.508518123	0	0	5.71344563	1.091474082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4824	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.6371	0.0319	2.8544	0	0.5037	1.0704	0.787	1.1303	3.283	1.6619	3.3948	0	0.0088	1.7747	2.1976	9.8494	0.0998	0.7099	0	0	2.6887	0.5136	0	0	0	0	0	0	0	0											37.1969	0	0	24.4056	0.167759112	7.413911454	0	1.831671616	3.892505551	2.861762129	4.110163122	11.93814391	6.043232411	12.34484307	0	0.031822615	6.453575115	6.86738337	30.77941558	0.311807739	2.218409004	0	0	8.402125927	1.605108944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.6792
H1509_803_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	260.8256124	1.792861397	28.22947039	93.03186078	5.69940739	12.1118735	8.90462465	12.78913418	37.14658513	18.80404935	38.41206533	0	0.099018866	20.08086677	20.04214889	89.82833732	0.909996836	6.474326707	0	0	24.52122588	4.684438119	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.7685	0.13588488	4.559555544	0	1.327961922	2.822066525	2.074777544	2.979868264	8.655154335	4.381343498	8.950011223	0	0.023071396	4.678841958	4.669820692	20.9300026	0.212029263	1.508518123	0	0	5.71344563	1.091474082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4824	0	0	19.7685	0.13588488	4.559555544	0	1.327961922	2.822066525	2.074777544	2.979868264	8.655154335	4.381343498	8.950011223	0	0.023071396	4.678841958	4.669820692	20.9300026	0.212029263	1.508518123	0	0	5.71344563	1.091474082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4824	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.6371	0.0319	2.8544	0	0.5037	1.0704	0.787	1.1303	3.283	1.6619	3.3948	0	0.0088	1.7747	2.1976	9.8494	0.0998	0.7099	0	0	2.6887	0.5136	0	0	0	0	0	0	0	0											37.1969	0	0	24.4056	0.167759112	7.413911454	0	1.831671616	3.892505551	2.861762129	4.110163122	11.93814391	6.043232411	12.34484307	0	0.031822615	6.453575115	6.86738337	30.77941558	0.311807739	2.218409004	0	0	8.402125927	1.605108944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.6792
H1509_804_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	273.866893	1.882504467	29.64094391	97.68345382	5.984377759	12.71746717	9.349855883	13.42859089	39.00391438	19.74425181	40.3326686	0	0.10396981	21.08491011	21.04425634	94.31975419	0.955496677	6.798043043	0	0	25.74728718	4.918660025	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.757	0.142679124	4.787533321	0	1.394360018	2.963169851	2.178516421	3.128861677	9.087912052	4.600410673	9.397511784	0	0.024224966	4.912784056	4.903311726	21.97650273	0.222630726	1.583944029	0	0	5.999117912	1.146047786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2065	0	0	20.757	0.142679124	4.787533321	0	1.394360018	2.963169851	2.178516421	3.128861677	9.087912052	4.600410673	9.397511784	0	0.024224966	4.912784056	4.903311726	21.97650273	0.222630726	1.583944029	0	0	5.999117912	1.146047786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2065	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.8689	0.0335	2.9971	0	0.5289	1.124	0.8263	1.1868	3.4471	1.745	3.5646	0	0.0092	1.8635	2.3074	10.3419	0.1048	0.7454	0	0	2.8231	0.5393	0	0	0	0	0	0	0	0											39.0567	0	0	25.6259	0.176147067	7.784607027	0	1.923255197	4.087130829	3.004850235	4.315671278	12.53505111	6.345394031	12.96208522	0	0.033413746	6.776253871	7.210752539	32.31838636	0.327398126	2.329329454	0	0	8.822232223	1.685364391	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.2632
H1509_806_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	260.8256124	1.792861397	28.22947039	93.03186078	5.69940739	12.1118735	8.90462465	12.78913418	37.14658513	18.80404935	38.41206533	0	0.099018866	20.08086677	20.04214889	89.82833732	0.909996836	6.474326707	0	0	24.52122588	4.684438119	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.7685	0.13588488	4.559555544	0	1.327961922	2.822066525	2.074777544	2.979868264	8.655154335	4.381343498	8.950011223	0	0.023071396	4.678841958	4.669820692	20.9300026	0.212029263	1.508518123	0	0	5.71344563	1.091474082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4824	0	0	19.7685	0.13588488	4.559555544	0	1.327961922	2.822066525	2.074777544	2.979868264	8.655154335	4.381343498	8.950011223	0	0.023071396	4.678841958	4.669820692	20.9300026	0.212029263	1.508518123	0	0	5.71344563	1.091474082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4824	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.6371	0.0319	2.8544	0	0.5037	1.0704	0.787	1.1303	3.283	1.6619	3.3948	0	0.0088	1.7747	2.1976	9.8494	0.0998	0.7099	0	0	2.6887	0.5136	0	0	0	0	0	0	0	0											37.1969	0	0	24.4056	0.167759112	7.413911454	0	1.831671616	3.892505551	2.861762129	4.110163122	11.93814391	6.043232411	12.34484307	0	0.031822615	6.453575115	6.86738337	30.77941558	0.311807739	2.218409004	0	0	8.402125927	1.605108944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.6792
H1509_807_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	260.8256124	1.792861397	28.22947039	93.03186078	5.69940739	12.1118735	8.90462465	12.78913418	37.14658513	18.80404935	38.41206533	0	0.099018866	20.08086677	20.04214889	89.82833732	0.909996836	6.474326707	0	0	24.52122588	4.684438119	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.7685	0.13588488	4.559555544	0	1.327961922	2.822066525	2.074777544	2.979868264	8.655154335	4.381343498	8.950011223	0	0.023071396	4.678841958	4.669820692	20.9300026	0.212029263	1.508518123	0	0	5.71344563	1.091474082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4824	0	0	19.7685	0.13588488	4.559555544	0	1.327961922	2.822066525	2.074777544	2.979868264	8.655154335	4.381343498	8.950011223	0	0.023071396	4.678841958	4.669820692	20.9300026	0.212029263	1.508518123	0	0	5.71344563	1.091474082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4824	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.6371	0.0319	2.8544	0	0.5037	1.0704	0.787	1.1303	3.283	1.6619	3.3948	0	0.0088	1.7747	2.1976	9.8494	0.0998	0.7099	0	0	2.6887	0.5136	0	0	0	0	0	0	0	0											37.1969	0	0	24.4056	0.167759112	7.413911454	0	1.831671616	3.892505551	2.861762129	4.110163122	11.93814391	6.043232411	12.34484307	0	0.031822615	6.453575115	6.86738337	30.77941558	0.311807739	2.218409004	0	0	8.402125927	1.605108944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.6792
H1509_808_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	260.8256124	1.792861397	28.22947039	93.03186078	5.69940739	12.1118735	8.90462465	12.78913418	37.14658513	18.80404935	38.41206533	0	0.099018866	20.08086677	20.04214889	89.82833732	0.909996836	6.474326707	0	0	24.52122588	4.684438119	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075792184	0.075792184	0.161517573	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.7685	0.13588488	4.559555544	0	1.327961922	2.822066525	2.074777544	2.979868264	8.655154335	4.381343498	8.950011223	0	0.023071396	4.678841958	4.669820692	20.9300026	0.212029263	1.508518123	0	0	5.71344563	1.091474082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4824	0	0	19.7685	0.13588488	4.559555544	0	1.327961922	2.822066525	2.074777544	2.979868264	8.655154335	4.381343498	8.950011223	0	0.023071396	4.678841958	4.669820692	20.9300026	0.212029263	1.508518123	0	0	5.71344563	1.091474082	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4824	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.6371	0.0319	2.8544	0	0.5037	1.0704	0.787	1.1303	3.283	1.6619	3.3948	0	0.0088	1.7747	2.1976	9.8494	0.0998	0.7099	0	0	2.6887	0.5136	0	0	0	0	0	0	0	0											37.1969	0	0	24.4056	0.167759112	7.413911454	0	1.831671616	3.892505551	2.861762129	4.110163122	11.93814391	6.043232411	12.34484307	0	0.031822615	6.453575115	6.86738337	30.77941558	0.311807739	2.218409004	0	0	8.402125927	1.605108944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.6792
H1510_001_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	O	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	YES	1024.874348	68.479625	781.696249	305.760894	38.256298	8.286367	5.012571	421.962691	413.448821	1468.173786	1023.686195	202.272671	0.005329	477.875814	3398.500811	3648.073398	78.067363	769.152364			24.102878	0		1.5					0.04	0.25	18.115811	0.05	0.55	2.53	0.32	0.4	0.42				4900	$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	143.64207	50.7565	0	150	0.2	0.2	50	133.528172	106.671264	112.911873	150	0.2	117.363099	10	35	35	71.289526			0.2	0		0					0	0	0	0	0	0	0	0	0				NO	125.538828	124.776408	26.797046	0	124.7625	0.16635	0.16635	41.5875	111.062057	88.723824	93.91445	124.7625	0.16635	97.616758	8.3175	29.11125	29.11125	59.295063			0.16635	0		0					0	0	0	0	0	0	0	0	0					10.7218	0.712053469	1.745595862	0	0.397745948	1.37843715	0.833841186	1.462364451	3.82653971	10.85516605	8.011577165	2.103003676	0.000886479	3.887390641	2.355585875	8.849998059	0.189386543	3.800578157	0	0	4.009513755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.1415	0	13.800601	10.7218	0.712053469	1.745595862	0	0.397745948	1.37843715	0.833841186	1.462364451	3.82653971	10.85516605	8.011577165	2.103003676	0.000886479	3.887390641	2.355585875	8.849998059	0.189386543	3.800578157	0	0	4.009513755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.1415	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.2534	0.0935	0.3449	1.792	1.9221	1.647	0.9963	0.3118	3.9561	0.6359	1.5574	0.4636	0.0002	0.841	1.705	4.7448	0.0374	0.3578			1.2225	0		0					0	0	0	0	0	0	0	0	0				28.8828	1000	14.666682	16.9752	0.805531469	2.090446862	1.791988	2.319858948	3.02546615	1.830158186	1.774139451	7.78266771	11.49109705	9.569000165	2.566590676	0.001085479	4.728431641	4.060584875	13.59483606	0.226752543	4.158392157	0	0	5.232046755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0242
H1510_004_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	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	YES	1205.169997	54.897683	655.533443	511.411749	43.02676	9.132292	4.278837	336.914156	418.337496	1433.683147	1040.282601	95.837077	0.042835	589.092466	3656.550406	4205.114048	79.256647	686.982788			18.121765	0							0.04	0.25	9.453095	0.05	0.55	2.53	0.32	0.4	0.42				4600	$195/Day(Days 1-8):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	121.67922	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	115.154619	10	35	35	54.138383			0.2	0							0	0	0	0	0	0	0	0	0				NO	124.351743	104.698641	27.389578	0	124.32255	0.165763	0.165763	41.44085	109.272956	64.539049	84.912475	124.32255	0.165763	95.442106	8.28817	29.008595	29.008595	44.870812			0.165763	0							0	0	0	0	0	0	0	0	0					12.4887	0.478976067	1.496232031	0	0.445766377	1.513796119	0.709272858	1.16350075	3.809414566	7.71071224	7.361080863	0.992892483	0.007100458	4.685352132	2.525509282	10.16537086	0.191593664	2.568789627	0	0	3.003918132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.318	0	13.05685	12.4887	0.478976067	1.496232031	0	0.445766377	1.513796119	0.709272858	1.16350075	3.809414566	7.71071224	7.361080863	0.992892483	0.007100458	4.685352132	2.525509282	10.16537086	0.191593664	2.568789627	0	0	3.003918132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.318	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	7.0813	0.0962	0.3107	2.0612	2.2607	1.8982	0.8894	0.2603	3.6602	0.4855	1.558	0.2608	0.0017	1.06	1.862	3.1971	0.0317	0.3084			0.924	0							0	0	0	0	0	0	0	0	0				28.2074	1000	14.462449	19.57	0.575186067	1.806976031	2.061228	2.706465377	3.412009119	1.598659858	1.42382475	7.469623566	8.19618624	8.919127863	1.253670483	0.008772458	5.745352132	4.387532282	13.36243086	0.223326664	2.877214627	0	0	3.927868132	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5255
H1510_005_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	P	O	O	O	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	YES	1176.404229	53.58735	639.886752	499.205046	41.99977	8.143379	3.815491	328.872474	408.35235	1399.46308	1015.452471	93.549576	0.038197	575.031631	3569.273524	4104.743698	77.364898	670.585443			16.159405	0			2.69				0.04	0.25	9.227463	0.05	0.55	2.53	0.32	0.4	0.42				3700	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0			0				0	0	0	0	0	0	0	0	0				NO	102.251061	90.427067	26.076304	0	123.105	0.16414	0.16414	41.035	108.202794	63.906987	84.080887	123.105	0.16414	93.572605	8.207	24.621	24.621	41.536092			0.16414	0			0				0	0	0	0	0	0	0	0	0					10.024	0.403812241	1.390490123	0	0.43086514	1.336654229	0.626274693	1.124606831	3.682072101	7.452955738	7.115012039	0.959701713	0.006269656	4.483933973	2.441085651	8.421907882	0.158733429	2.321124888	0	0	2.652404737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.032	0	12.921782	10.024	0.403812241	1.390490123	0	0.43086514	1.336654229	0.626274693	1.124606831	3.682072101	7.452955738	7.115012039	0.959701713	0.006269656	4.483933973	2.441085651	8.421907882	0.158733429	2.321124888	0	0	2.652404737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.032	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins			"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.9002	0.0938	0.3256	1.6401	1.9691	1.5104	0.7077	0.2267	2.9123	0.3863	1.2397	0.2075	0.0013	0.8434	1.4816	2.5438	0.0252	0.2454			0.7352	0			0				0	0	0	0	0	0	0	0	0				23.9952	500	11.315568	16.9243	0.497562241	1.716132123	1.640057	2.39992614	2.847005229	1.333932693	1.351347831	6.594390101	7.839232738	8.354703039	1.167194713	0.007599656	5.327343973	3.922640651	10.96571188	0.183982429	2.566529888	0	0	3.387563737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.0271
H1510_805_0	2010	4	N/A																															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	NO	232.113293	0.791764	40.30151	13.022853	1.5272	7.061569	3.451784	17.025593	48.479064	10.466043	24.95185	8.820625	0.774949	15.970228	29.638728	65.000718	0.312359	4.837161			21.12679	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																			0.080691071	0.080691071	0.188993872	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080691071	0.080691071	0.188993872	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				18.7295	0.063888285	7.616738421	0	0.3558376	1.645345577	0.804265672	3.966963169	11.29562191	2.438588019	5.81378105	2.055205625	0.180563117	3.721063124	6.905823624	15.14516729	0.072779647	1.127058513	0	0	4.92254207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8607	0	0	18.7295	0.063888285	7.616738421	0	0.3558376	1.645345577	0.804265672	3.966963169	11.29562191	2.438588019	5.81378105	2.055205625	0.180563117	3.721063124	6.905823624	15.14516729	0.072779647	1.127058513	0	0	4.92254207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8607	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.4865	0.0119	1.4178	0	1.4234	1.0848	0.5303	1.0459	2.7218	0.643	1.3939	0.5418	0.0476	0.9738	1.3012	2.8537	0.0137	0.242			0.9275	0																			20.6608	0	0	22.216	0.075790218	9.034570449	0	1.7792346	2.730193577	1.334573672	5.012900169	14.01741141	3.081551519	7.20770355	2.597047125	0.228211617	4.694886624	8.207012124	17.99883479	0.086526647	1.369029013	0	0	5.84999857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5215
H1510_806_0	2010	4	N/A																															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	NO	232.113293	0.791764	40.30151	13.022853	1.5272	7.061569	3.451784	17.025593	48.479064	10.466043	24.95185	8.820625	0.774949	15.970228	29.638728	65.000718	0.312359	4.837161			21.12679	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																			0.080691071	0.080691071	0.188993872	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080691071	0.080691071	0.188993872	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				18.7295	0.063888285	7.616738421	0	0.3558376	1.645345577	0.804265672	3.966963169	11.29562191	2.438588019	5.81378105	2.055205625	0.180563117	3.721063124	6.905823624	15.14516729	0.072779647	1.127058513	0	0	4.92254207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8607	0	0	18.7295	0.063888285	7.616738421	0	0.3558376	1.645345577	0.804265672	3.966963169	11.29562191	2.438588019	5.81378105	2.055205625	0.180563117	3.721063124	6.905823624	15.14516729	0.072779647	1.127058513	0	0	4.92254207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8607	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.4865	0.0119	1.4178	0	1.4234	1.0848	0.5303	1.0459	2.7218	0.643	1.3939	0.5418	0.0476	0.9738	1.3012	2.8537	0.0137	0.242			0.9275	0																			20.6608	0	0	22.216	0.075790218	9.034570449	0	1.7792346	2.730193577	1.334573672	5.012900169	14.01741141	3.081551519	7.20770355	2.597047125	0.228211617	4.694886624	8.207012124	17.99883479	0.086526647	1.369029013	0	0	5.84999857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5215
H1510_807_0	2010	4	N/A																															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	NO	232.113293	0.791764	40.30151	13.022853	1.5272	7.061569	3.451784	17.025593	48.479064	10.466043	24.95185	8.820625	0.774949	15.970228	29.638728	65.000718	0.312359	4.837161			21.12679	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																			0.080691071	0.080691071	0.188993872	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080691071	0.080691071	0.188993872	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				18.7295	0.063888285	7.616738421	0	0.3558376	1.645345577	0.804265672	3.966963169	11.29562191	2.438588019	5.81378105	2.055205625	0.180563117	3.721063124	6.905823624	15.14516729	0.072779647	1.127058513	0	0	4.92254207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8607	0	0	18.7295	0.063888285	7.616738421	0	0.3558376	1.645345577	0.804265672	3.966963169	11.29562191	2.438588019	5.81378105	2.055205625	0.180563117	3.721063124	6.905823624	15.14516729	0.072779647	1.127058513	0	0	4.92254207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.8607	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.4865	0.0119	1.4178	0	1.4234	1.0848	0.5303	1.0459	2.7218	0.643	1.3939	0.5418	0.0476	0.9738	1.3012	2.8537	0.0137	0.242			0.9275	0																			20.6608	0	0	22.216	0.075790218	9.034570449	0	1.7792346	2.730193577	1.334573672	5.012900169	14.01741141	3.081551519	7.20770355	2.597047125	0.228211617	4.694886624	8.207012124	17.99883479	0.086526647	1.369029013	0	0	5.84999857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.5215
H1517_001_0	2010	10	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13	I.14	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies\Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Partial Hosp	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	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	0	0	0	0	0	0	0	0	0	0	NO	796.4269324	48.26783164	233.016777	291.5511465	54.73378438	7.475426661	0.681059522	204.2319649	270.0731026	2733.035355	589.138814	47.12856174	0.000228462	101.1989837	2157.555931	2217.614947	24.90208211	815.9427955	1294.720428	0	26.5846906	0	0	0	302.4	239.2	129.6	0	0	0	0.017047798	50.15652694	175.8692024	267.7162384	73.95768899	0.698401759	402.9185704	18.23232099	2.953618991	8.602675571		$220/day (days 1-7) w/$1540 yrly max	$220/day (days 1-7) w/$1540 yrly max	$128/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$30 copay	$20 coapy	$30 copay	$40 copay	$50/$30 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$30 copay/ $50 limit	$30 copay/ $75 limit	$30 copay/ $50 limit		Silver Sneakers		$30 copay	$0 copay	$30 copay	$30 copay	$0 copay	20% coinsurance	$30 copay	$30 copay	$40 copay	20% coinsurance	220	220	128	0	125	0.2	0.2	50	200	0	93.05758272	200	0.2	30	20	30	40	41.88961841	80.74411016	0	0.2	0	0	0	30	30	30	0	0	0	30	0	30	30	0	0.2	30	30	40	0.2	NO	133.1973916	143.5131589	115.2335931	0	112.5328058	0.180052489	0.180052489	45.01312231	180.0524892	0	83.77624706	180.0524892	0.180052489	27.00787339	18.00524892	27.00787339	36.01049785	37.71165034	72.69089013	0	0.180052489	0	0	0	30	30	30	0	0	0	27.00787339	0	27.00787339	27.00787339	0	0.180052489	27.00787339	27.00787339	36.01049785	0.180052489		8.8402	0.577255749	2.237613372	0	0.513278861	1.345969179	0.122626462	0.766093201	4.052277868	0	4.11298657	0.707134571	4.11E-05	0.227764112	3.237277633	4.991088643	0.074728031	2.56421245	7.842865031	0	4.786639718	0	0	0	0.756	0.598	0.324	0	0	0	3.84E-05	0	0.395821096	0.602537189	0	0.125748975	0.906831145	0.041034685	0.008863441	1.548933151	52.3078		5.774743424	8.8402	0.577255749	2.237613372	0	0.513278861	1.345969179	0.122626462	0.766093201	4.052277868	0	4.11298657	0.707134571	4.11E-05	0.227764112	3.237277633	4.991088643	0.074728031	2.56421245	7.842865031	0	4.786639718	0	0	0	0.756	0.598	0.324	0	0	0	3.84E-05	0	0.395821096	0.602537189	0	0.125748975	0.906831145	0.041034685	0.008863441	1.548933151	52.3078	YES	$300/day (Days 1-7)	$300/day (Days 1-7)	30% Coinsurance	$0 copay	$125 copay	30% Coinsurance	30% Coinsurance	$50 copay	$275 copay	$0 copay	30% Coinsurance	$275 copay	20% Coinsurance	$40 copay	$25 copay	$40 copay	$50 copay	$80/$40 OP/PR copay	30% Coinsurance		20% Coinsurance				$40 copay / $50 limit	$40 copay / $75 limit	$40 copay / $50 limit		Silver Sneakers		$40 copay	$0 copay	$40 copay	$40 copay	$0 copay	20% Coinsurance	$40 copay	$40 copay	$50 copay	20% coinsurance	4500	8.8535	0.7405	1.4494		0.9714	1.3813	0.0368	0.5881	2.4127		2.5512	0.9489	0.0008	0.1093	2.6327	4.2209	0.0858	2.7446	7.15		1.4237			0	0.252	0.1993	0.108	0			0.001		0.8537	0.332		0.2858	0.8975	0.0653		1.6718	42.9678		4.709399432	17.6936	1.317710332	3.686973168	0	1.484634809	2.727284996	0.159464197	1.354172888	6.464998248	0	6.664181434	1.656027926	0.000822705	0.337024691	5.869961562	9.21196729	0.160524942	5.308861421	14.99286833	0	6.210343323	0	0	0	1.008	0.797333333	0.432	0	0	0	0.001010377	0	1.249537626	0.934491709	0	0.411580567	1.804312106	0.10638197	0.008863441	3.22068505	95.2757
H1517_003_0	2010	10	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	1252.253666	78.19032939	395.1109896	534.6880514	91.59899979	11.65029692	1.0795585	285.2724691	371.3919962	4242.550056	808.782555	84.36817514	0.000426919	120.1670091	3184.340907	3353.143725	45.72947161	1400.493288	2091.922437	0	43.40607043	0	0	1101.053247	302.4	239.2	129.6	0	0	0	0.031856582	0.005445028	228.3725293	368.2910849	103.691234	0.98783668	596.8044315	25.44237301	12.64812655	0		$175/day (days 1-5) w/$875 yrly max	$175/day (days 1-5) w/$875 yrly max	$115/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$150 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$150 copay	20% coinsurance	$15 copay	$5 copay	$15 copay	$40 copay	$30/$15 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance			$0 deduct 1 exam & 2 cleanings/yr	$15 copay; $100 limit	$15 copay; $125 limit	$15 copay; $100 limit		Silver Sneakers		$15 copay	$0 copay	$15 copay	$15 copay	$0 copay	20% coinsurance	$15 copay	$15 copay	20% coinsurance		175	175	115	0	100	0.2	0.2	50	150	0	93.03477439	150	0.2	15	5	15	40	25.11582986	80.33904962	0	0.2	0	0	0	15	15	15	0	0	0	15	0	15	15	0	0.2	15	15	0.2	0	NO	75.86137972	60.31503722	104.0078072	0	90.44157144	0.180883143	0.180883143	45.22078572	135.6623572	0	84.14211194	135.6623572	0.180883143	13.56623572	4.522078572	13.56623572	36.17662858	22.7151512	72.65989896	0	0.180883143	0	0	0	15	15	15	0	0	0	13.56623572	0	13.56623572	13.56623572	0	0.180883143	13.56623572	13.56623572	0.180883143	0		7.9165	0.393004386	3.424552301	0	0.690363124	2.107342322	0.195273934	1.075020433	4.198659469	0	5.671056023	0.953798792	7.72E-05	0.135851164	1.199986649	3.790794847	0.137861509	2.651034733	12.66657274	0	7.85142644	0	0	0	0.378	0.299	0.162	0	0	0	3.60E-05	0	0.25817963	0.416360306	0	0.178683003	0.674699133	0.028763102	2.287832882	0	59.7427		6.303825757	7.9165	0.393004386	3.424552301	0	0.690363124	2.107342322	0.195273934	1.075020433	4.198659469	0	5.671056023	0.953798792	7.72E-05	0.135851164	1.199986649	3.790794847	0.137861509	2.651034733	12.66657274	0	7.85142644	0	0	0	0.378	0.299	0.162	0	0	0	3.60E-05	0	0.25817963	0.416360306	0	0.178683003	0.674699133	0.028763102	2.287832882	0	59.7427	YES	$250/day (days 1-5)	$250/day (days 1-5)	25% Coinsurance	$0 copay	$100 copay	25% Coinsurance	25% Coinsurance	$50 copay	$225 copay	$0 copay	25% Coinsurance	$225 copay	20% Coinsurance	$25 copay	$15 copay	$25 copay	$50 copay	$50/$25 OP/PR copay	25% Coinsurance		20% Coinsurance			20% Coinsurance	$25 copay; $100 limit	$25 copay; $125 limit	$25 copay; $100 limit		Silver Sneakers		$25 copay	$0 copay	$25 copay	$25 copay	$0 copay	25% coinsurance	$25 copay	$25 copay	20% coinsurance		3850	3.8243	0.2155	0.9834		0.9408	0.6935	0.0378	0.2452	1.2137		1.1277	0.2656	0.0015	0.068	0.7954	0.9784	0.041	0.753	3.3531		1.1243			0.3921	0.1575	0.1246	0.0675	0			0.0011		0.5096	0.1724		0.3482	0.1389	0.0182	0.4124		19.0049		1.934528062	11.7408	0.60854363	4.407985397	0	1.631127742	2.800865916	0.233041172	1.320219097	5.412392855	0	6.79877451	1.219383159	0.00154445	0.203851026	1.995405724	4.769160613	0.178896367	3.404072267	16.01971136	0	8.975744886	0	0	0.392064777	0.5355	0.423583333	0.2295	0	0	0	0.001176473	0	0.767765226	0.588800014	0	0.526858723	0.813629491	0.047000492	2.70019564	0	78.7476
H1517_801_0	2010	6	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	221.5947346	2.537112583	45.72125726	24.77973611	7.372423719	13.01570651	3.218099888	7.661264209	29.06105739	4.691268872	17.43061667	0	0.039190558	23.95008414	28.81080661	74.60746201	0.89402251	3.5133293	18.27433515	25.48197017	7.893145376	1.374842388	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.082766731	0.082766731	0.183326746	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082766731	0.082766731	0.183326746	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.3407	0.209988514	8.381929314	0	1.717774726	3.032659617	0.749817274	1.785074561	6.771226373	1.093065647	4.061333685	0	0.0091314	5.580369605	6.71291794	17.38353865	0.208307245	0.818605727	4.257920091	5.937299049	1.839102873	0.320338276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2111	0	0	18.3407	0.209988514	8.381929314	0	1.717774726	3.032659617	0.749817274	1.785074561	6.771226373	1.093065647	4.061333685	0	0.0091314	5.580369605	6.71291794	17.38353865	0.208307245	0.818605727	4.257920091	5.937299049	1.839102873	0.320338276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2111	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.6855	0.088	3.4539	0	0.6679	1.1811	0.292	0.757	3.2153	0.4935	1.533	0	0.0048	1.8806	3.2543	8.1108	0.1069	0.4229	2.3614	2.8138	0.6014	0.1052	0	0	0	0	0	0	0	0											39.0293	0	0	26.0262	0.297982889	11.83580311	0	2.385649871	4.213741967	1.041836841	2.542109137	9.986558112	1.586557007	5.594321385	0	0.013882617	7.46096547	9.967168116	25.49434342	0.315213904	1.241527608	6.619365333	8.751055394	2.440512315	0.425574986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2404
H1517_802_0	2010	5	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	221.5947346	2.537112583	45.72125726	24.77973611	7.372423719	13.01570651	3.218099888	7.661264209	29.06105739	4.691268872	17.43061667	0	0.039190558	23.95008414	28.81080661	74.60746201	0.89402251	3.5133293	18.27433515	25.48197017	7.893145376	1.374842388	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.082766731	0.082766731	0.183326746	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082766731	0.082766731	0.183326746	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.3407	0.209988514	8.381929314	0	1.717774726	3.032659617	0.749817274	1.785074561	6.771226373	1.093065647	4.061333685	0	0.0091314	5.580369605	6.71291794	17.38353865	0.208307245	0.818605727	4.257920091	5.937299049	1.839102873	0.320338276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2111	0	0	18.3407	0.209988514	8.381929314	0	1.717774726	3.032659617	0.749817274	1.785074561	6.771226373	1.093065647	4.061333685	0	0.0091314	5.580369605	6.71291794	17.38353865	0.208307245	0.818605727	4.257920091	5.937299049	1.839102873	0.320338276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2111	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.6855	0.088	3.4539	0	0.6679	1.1811	0.292	0.757	3.2153	0.4935	1.533	0	0.0048	1.8806	3.2543	8.1108	0.1069	0.4229	2.3614	2.8138	0.6014	0.1052	0	0	0	0	0	0	0	0											39.0293	0	0	26.0262	0.297982889	11.83580311	0	2.385649871	4.213741967	1.041836841	2.542109137	9.986558112	1.586557007	5.594321385	0	0.013882617	7.46096547	9.967168116	25.49434342	0.315213904	1.241527608	6.619365333	8.751055394	2.440512315	0.425574986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2404
H1517_803_0	2010	5	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	221.5947346	2.537112583	45.72125726	24.77973611	7.372423719	13.01570651	3.218099888	7.661264209	29.06105739	4.691268872	17.43061667	0	0.039190558	23.95008414	28.81080661	74.60746201	0.89402251	3.5133293	18.27433515	25.48197017	7.893145376	1.374842388	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.082766731	0.082766731	0.183326746	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082766731	0.082766731	0.183326746	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.3407	0.209988514	8.381929314	0	1.717774726	3.032659617	0.749817274	1.785074561	6.771226373	1.093065647	4.061333685	0	0.0091314	5.580369605	6.71291794	17.38353865	0.208307245	0.818605727	4.257920091	5.937299049	1.839102873	0.320338276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2111	0	0	18.3407	0.209988514	8.381929314	0	1.717774726	3.032659617	0.749817274	1.785074561	6.771226373	1.093065647	4.061333685	0	0.0091314	5.580369605	6.71291794	17.38353865	0.208307245	0.818605727	4.257920091	5.937299049	1.839102873	0.320338276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.2111	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.6855	0.088	3.4539	0	0.6679	1.1811	0.292	0.757	3.2153	0.4935	1.533	0	0.0048	1.8806	3.2543	8.1108	0.1069	0.4229	2.3614	2.8138	0.6014	0.1052	0	0	0	0	0	0	0	0											39.0293	0	0	26.0262	0.297982889	11.83580311	0	2.385649871	4.213741967	1.041836841	2.542109137	9.986558112	1.586557007	5.594321385	0	0.013882617	7.46096547	9.967168116	25.49434342	0.315213904	1.241527608	6.619365333	8.751055394	2.440512315	0.425574986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2404
H1595_001_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	T	P	P	P	P	P	O																																																				0	NO	305.7642232	9.912769386	832.9831084		173.0159253	9.769977187	14.55940584	288.1457986	371.7815324					3.610009759	4641.569905	5760.508418	476.2209653	601.0513174							146.4791849		252.8396045															1A IP Acute: $400 per admit	1B IP Psych: $400 per admit	2 SNF: $0 per day for days 1-20 plus $100 per day for days 21-100	6 HH: $0	10A Ambulance: $50	11A DME: 20%	11B Prosthetics/Supplies: 20%	"4A ER: $50, 4B UC $35"	"9A Outpatient Hospital: $200, 9B ASC Services: $100"	8A OP Lab: $0	8B OP Radiology: $0	9A Outpatient Hospital: $0	12 Renal Dialysis: $0	3 CORF: $25	"7A PCP: $15, 14C Routine Physical Exams: $15, Urgently needed care: $35"	"7B Chiropractic: $35,  7D Physician Specialist: $35, 7F Podiatry: $35, 17A Medicare Covered Eye Exams: $35, 18A Medicare Covered Hearing Exams: $35"	"7E Mental Health: $35, 7H Psychiatric: $35, 9C Outpatient Substance Abuse: $35"	"7C Occupational Therapy: $35,  7I PT and ST: $35"	8B Prof Radiology: $0	Other Prof: $0	15 Part B: $0	Other Part B: $0			17A Routine Eye Exams: $35		18A Routine Hearing Exams: $35														400	400	31.01658425		50	0.2	0.2	47	185.0954329					35	15.03770109	35	35	35							35		35														NO	400	400	31.01658425		50	0.2	0.2	47	185.0954329					35	15.03770109	35	35	35							35		35															10.1921	0.330425646	2.15302423	0	0.720899689	1.953995437	2.911881169	1.128571044	5.734588641	0	0	0	0	0.010529195	5.816545067	16.80148288	1.388977815	1.753066342	0	0	0	0	0	0	0.427230956	0	0.737448846	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0608	0	0	10.1921	0.330425646	2.15302423	0	0.720899689	1.953995437	2.911881169	1.128571044	5.734588641	0	0	0	0	0.010529195	5.816545067	16.80148288	1.388977815	1.753066342	0	0	0	0	0	0	0.427230956	0	0.737448846	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0608	NO	1A IP Acute: $600 per admit	1B IP Psych: $600 per admit	"2 SNF: $100 Days 1-20, Medicare Cost Share Days 21-100"	6 HH: $0	10A Ambulance: $50	11A DME: 50%	11B Prosthetics/Supplies: 50%	"4A ER: $50, 4B UC: $35"	"9A Outpatient Hospital: 30%, 9B ASC Services: 30%"	8A OP Lab: 30%	8B OP Radiology: 30%	9A Outpatient Hospital: 30%	12 Renal Dialysis: $0	3 CORF: 30%	"7A PCP: 30%, 14C Routine Physical Exams: 30%, Urgently needed Care: $35"	"7B Chiropractic: 30%,  7D Physician Specialist: 30%, 7F Podiatry: 30%, 17A Medicare Covered Eye Exams: 30%, 18A Medicare Covered Hearing Exams: 30%"	"7E Mental Health: 30%, 7H Psychiatric: 30%, 9C Outpatient Substance Abuse: 30%"	"7C Occupational Therapy: 30%,  7I PT and ST: 30%"	8B Prof Radiology: 30%	Other Prof: 30%	15 Part B: 30%	"13A: $0, 16B: 30%, 17B: 30%"			17A 30%		18A Routine Hearing Exams: 30%															1.5679	0.0389	0.5127	0.1004	0.0563	0.2689	0.4709	0.1007	0.8708	0.1294	0.2373	0.0387	0.0004	0.2234	0.7919	1.3134	0.0645	0.2321	0.717	1.2183	0.4654	0.0141			0.0185		0.0245														9.4764	500	0	11.76	0.369365803	2.665732971	0.100443436	0.777247143	2.222926451	3.382749629	1.229252899	6.605359695	0.129399104	0.237251087	0.03865916	0.000424292	0.233928507	6.608421815	18.11492015	1.453452028	1.985126829	0.716996973	1.218277621	0.465433927	0.014085329	0	0	0.445751724	0	0.761980753	0	0	0	0	0	0	0	0	0	0	0	0	0	61.5372
H1595_002_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	T	P	P	P	P	P	O	O																																																			0	NO	305.7642232	9.912769386	832.9831084		173.0159253	9.769977187	14.55940584	288.1457986	371.7815324					3.610009759	4641.569905	5760.508418	476.2209653	601.0513174							146.4791849		252.8396045															1A IP Acute: $300 per admit	1B IP Psych: $300 per admit	2 SNF: $0 per day for days 1-20 plus $50 per day for days 21-100	6 HH: $0	10A Ambulance: $25	11A DME: 20%	11B Prosthetics/Supplies: 20%	"4A ER: $50, 4B UC: $25"	"9A Outpatient Hospital: $100, 9B ASC Services: $50"	8A OP Lab: $0	8B OP Radiology: $0	9A Outpatient Hospital: $0	12 Renal Dialysis: $0	3 CORF: $25	"7A PCP: $10, 14C Routine Physical Exams: $10, 4B Urgent Care: $20"	"7B Chiropractic: $25,  7D Physician Specialist: $25, 7F Podiatry: $25, 17A Medicare Covered Eye Exams: $25, 18A Medicare Covered Hearing Exams: $25"	"7E Mental Health: $25, 7H Psychiatric: $25, 9C Outpatient Substance Abuse: $25"	"7C Occupational Therapy: $25,  7I PT and ST: $25"	8B Prof Radiology: $0	Other Prof: $0	15 Part B: $0	Other Part B: $0		16A: $0	17A Routine Eye Exams: $25	17B Eyewear $50 per item	18A Routine Hearing Exams: $25														300	300	15.50829212		25	0.2	0.2	45	92.54771646					25	10.02827581	25	25	25							25		25														NO	300	300	15.50829212		25	0.2	0.2	45	92.54771646					25	10.02827581	25	25	25							25		25															7.6441	0.247819235	1.076512115	0	0.360449844	1.953995437	2.911881169	1.080546745	2.867294321	0	0	0	0	0.007520854	3.878911935	12.0010592	0.992127011	1.252190245	0	0	0	0	0	0	0.305164969	0	0.526749176	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1063	0	0	7.6441	0.247819235	1.076512115	0	0.360449844	1.953995437	2.911881169	1.080546745	2.867294321	0	0	0	0	0.007520854	3.878911935	12.0010592	0.992127011	1.252190245	0	0	0	0	0	0	0.305164969	0	0.526749176	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1063	NO	1A IP Acute: $500 per admit	1B IP Psych: $500 per admit	2 SNF: Medicare Cost Share	6 HH: $0	10A Ambulance: $25	11A DME: 50%	11B Prosthetics/Supplies: 20%	4A ER: $50	"9A Outpatient Hospital: 20%, 9B ASC Services: 20%"	8A OP Lab: 20%	8B OP Radiology: 20%	9A Outpatient Hospital: 20%	12 Renal Dialysis: $0	3 CORF: 20%	"7A PCP: 20%, 14C Routine Physical Exams: 20%, 4B Urgent Care: $20"	"7B Chiropractic: 20%,  7D Physician Specialist: 20%, 7F Podiatry: 20%, 17A Medicare Covered Eye Exams: 20%, 18A Medicare Covered Hearing Exams: 20%"	"7E Mental Health: 20%, 7H Psychiatric: 20%, 9C Outpatient Substance Abuse: 20%"	"7C Occupational Therapy: 20%,  7I PT and ST: 20%"	8B Prof Radiology: 20%	Other Prof: 20%	15 Part B: 20%	"13A: $0, 16B, 17B:20%"		16A: $0	17A: 20%	17B: 20%	18A: 20%															0.745	0.0242	0.4546		0.019	0.2571	0.4253	0.0585	0.5242	0.0779	0.1428	0.0233	0.0003	0.1341	0.4767	0.7908	0.0388	0.1397	0.4317	0.7335	0.2802	0.0064			0.0112		0.0148														5.8101	0	0	8.3891	0.271973156	1.531079364	0	0.379431668	2.2111001	3.337228494	1.139080517	3.39154138	0.077904634	0.142836839	0.023274718	0.000255444	0.141667413	4.355660737	12.79181312	1.030943662	1.391902086	0.431667489	0.733463127	0.280214146	0.00641318	0	0	0.316315383	0	0.541518592	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9164
H1595_801_0	2010	8	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																												0	NO	265.786667	4.19660737	29.38736654		8.311149556	9.769960801	18.56885599	14.40867175	47.31321772	7.030881391	12.8910031	2.100539803	0.023660497	12.33537112	43.17958493	73.39764904	3.584994292	12.68807788	39.98313413	67.93690817	26.62029925	12.90905119																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.073577153	0.073577153	0.166012311		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	81.51398733																			NO	0.073577153	0.073577153	0.166012311		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	81.51398733																				19.5558	0.308774422	4.878664624	0	1.936497847	2.276400867	4.326543446	3.357220518	11.02397973	1.638195364	3.003603723	0.489425774	0.005512896	2.87414147	10.06084329	17.10165223	0.83530367	2.956322146	9.316070253	15.8292996	6.202529726	0.08768902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0645	0	0	19.5558	0.308774422	4.878664624	0	1.936497847	2.276400867	4.326543446	3.357220518	11.02397973	1.638195364	3.003603723	0.489425774	0.005512896	2.87414147	10.06084329	17.10165223	0.83530367	2.956322146	9.316070253	15.8292996	6.202529726	0.08768902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0645	NO	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																				1.1436	0.0181	0.2853		0.102	0.1198	0.2277	0.186	0.6107	0.0908	0.1664	0.0271	0.0003	0.1592	0.5432	0.9212	0.0452	0.1628	0.5029	0.8545	0.3264	0.0049																			6.4981	0	0	20.6994	0.326831405	5.163966649	0	2.038464837	2.396211438	4.554256259	3.543216114	11.63472653	1.72895411	3.170008361	0.516540775	0.005810488	3.033373685	10.6040686	18.022879	0.880524993	3.119086168	9.818962034	16.68378271	6.528978658	0.092547137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.5626
H1595_802_0	2010	8	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																												0	NO	265.7870682	4.196613705	29.3874109		8.311162102	9.769975549	18.56888402	14.4086935	47.31328914	7.030892005	12.89102256	2.100542974	0.023660533	12.33538974	43.17965011	73.39775984	3.584999703	12.68809703	39.98319449	67.93701073	26.62033944	12.90906093																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.073577057	0.073577057	0.16601227		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	81.51404886																			NO	0.073577057	0.073577057	0.16601227		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	81.51404886																				19.5558	0.308774484	4.878670784	0	1.93650077	2.276404303	4.326549977	3.357225585	11.02399637	1.638197837	3.003608257	0.489426513	0.005512904	2.874145809	10.06085848	17.10167804	0.835304931	2.956326608	9.316084316	15.8293235	6.202539088	0.087689152	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0646	0	0	19.5558	0.308774484	4.878670784	0	1.93650077	2.276404303	4.326549977	3.357225585	11.02399637	1.638197837	3.003608257	0.489426513	0.005512904	2.874145809	10.06085848	17.10167804	0.835304931	2.956326608	9.316084316	15.8293235	6.202539088	0.087689152	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0646	NO	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																				1.1436	0.0181	0.2853		0.102	0.1198	0.2277	0.186	0.6107	0.0908	0.1664	0.0271	0.0003	0.1592	0.5432	0.9212	0.0452	0.1628	0.5029	0.8545	0.3264	0.0049																			6.4981	0	0	20.6994	0.326831472	5.163973169	0	2.038467915	2.396215056	4.554263133	3.543221463	11.63474409	1.72895672	3.170013146	0.516541555	0.005810497	3.033378264	10.60408461	18.0229062	0.880526322	3.119090876	9.818976856	16.6838079	6.528988514	0.092547277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.5628
H1607_001_0	2010	10	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13	I.14	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies\Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Partial Hosp	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	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	0	0	0	0	0	0	0	0	0	0	NO	968.8543601	58.97060734	371.1075567	378.6330346	29.71328031	9.97918612	0.546738016	275.3795307	283.3311576	3438.229565	724.5877877	144.9287451	0	45.38990661	2500.056282	2828.282449	38.25156818	1324.893205	1517.61348	0	35.3419621	0	0	0	302.4	239.2	129.6	0	0	0	0	46.52693345	321.0118539	226.9354135	103.471285	1.406660696	508.4479619	30.30925319	2.061008557	7.120102412		$250/day (days 1-7) w/$1750 yrly max	$250/day (days 1-7) w/$1750 yrly max	$128/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$30 copay	$15 coapy	$30 copay	$40 copay	$50/$30 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$30 copay/ $50 limit	$30 copay/ $75 limit	$30 copay/ $50 limit		Silver Sneakers		$30 copay	$0 copay	$30 copay	$30 copay	$0 copay	20% coinsurance	$30 copay	$30 copay	$40 copay	20% coinsurance	250	250	128	0	100	0.2	0.2	50	200	0	92.61517615	200	0.2	30	15	30	40	45.9263392	80.40261528	0	0.2	0	0	0	30	30	30	0	0	0	30	0	30	30	0	0.2	30	30	40	0.2	NO	135.949874	151.9389797	115.1736931	0	89.97944772	0.179958895	0.179958895	44.98972386	179.9588954	0	83.33462401	179.9588954	0	26.99383432	13.49691716	26.99383432	35.99177909	41.32426637	72.34582918	0	0.179958895	0	0	0	30	30	30	0	0	0	0	0	26.99383432	26.99383432	0	0.179958895	26.99383432	26.99383432	35.99177909	0.179958895		10.9763	0.746661159	3.561818986	0	0.222798713	1.795843312	0.098390369	1.03243742	4.248996847	0	5.03193757	2.17343474	0	0.102103968	2.811921044	6.362182319	0.114728499	4.562519975	9.149417132	0	6.360100462	0	0	0	0.756	0.598	0.324	0	0	0	0	0	0.722111733	0.510488079	0	0.253141105	1.14374667	0.068180247	0.006181614	1.281325766	65.0148		7.219876972	10.9763	0.746661159	3.561818986	0	0.222798713	1.795843312	0.098390369	1.03243742	4.248996847	0	5.03193757	2.17343474	0	0.102103968	2.811921044	6.362182319	0.114728499	4.562519975	9.149417132	0	6.360100462	0	0	0	0.756	0.598	0.324	0	0	0	0	0	0.722111733	0.510488079	0	0.253141105	1.14374667	0.068180247	0.006181614	1.281325766	65.0148	YES	$300/day (Days 1-7)	$300/day (Days 1-7)	30% Coinsurance	$0 copay	$100 copay	30% Coinsurance	30% Coinsurance	$50 copay	$275 copay	$0 copay	30% Coinsurance	$275 copay	20% Coinsurance	$40 copay	$30 copay	$40 copay	$50 copay	$80/$40 OP/PR copay	30% Coinsurance		20% Coinsurance				$40 copay / $50 limit	$40 copay / $75 limit	$40 copay / $50 limit		Silver Sneakers		$40 copay	$0 copay	$40 copay	$40 copay	$0 copay	20% Coinsurance	$40 copay	$40 copay	$50 copay	20% coinsurance	4500	6.7057	0.0991	0.6463		1.0832	1.4649	0.0205	0.3006	3.3451		1.6006	0.0673		0.1258	2.3477	2.5623	0.0729	1.2602	4.9084		1.5254			0	0.252	0.1993	0.108	0					0.5712	0.1824		0.451	0.3239	0.035		0.4411	30.7001		3.364986419	17.682	0.845760154	4.208135255	0	1.306012921	3.260751738	0.118848008	1.33304622	7.594143612	0	6.632586632	2.240722175	0	0.22794021	5.159664527	8.924438547	0.187592358	5.822750575	14.05786401	0	7.88554811	0	0	0	1.008	0.797333333	0.432	0	0	0	0	0	1.293351637	0.692839527	0	0.704100811	1.467602841	0.103191725	0.006181614	1.722420155	95.7148
H1607_004_0	2010	8	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	968.7918209	58.96680081	371.0836018	378.6085939	29.71136233	9.978541966	0.546702724	275.3620273	283.3128687	3438.007629	724.5410157	144.9193899	0	45.38697671	2499.894904	2828.099884	40.34992387	1324.807683	1517.515518	0	35.33934148	0	0	1101.053247	302.4	239.2	129.6	0	0	0	0	0.003876994	320.9911327	226.9207648	103.4646059	1.406569896	508.4151417	30.30729674	7.119642812	0		$185/day (days 1-7) w/$1295 yrly max	$185/day (days 1-7) w/$1295 yrly max	$120/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$150 copay	$0 copay	$50/$100 copay for Lower/Higher Tier	$150 copay	20% coinsurance	$20 copay	$10 copay	$20 copay	$40 copay	$40/$20 OP/PR copay	$50/$100 copay for Lower/Higher Tier		20% coinsurance			$0 deduct 1 exam/2cleanings/yr	$20 copay; $100 limit	$20 copay; $125 limit	$20 copay; $100 limit		Silver Sneakers		$30 copay	$0 copay	$20 copay	$20 copay	$0 copay	20% coinsurance	$20 copay	$20 copay	20% coinsurance		185	185	120	0	100	0.2	0.2	50	150	0	67.61081161	150	0.2	20	10	20	40	35.92402016	55.39903906	0	0.2	0	0	0	20	20	20	0	0	0	30	0	20	20	0	0.2	20	20	0.2	0	NO	101.2458537	113.1534091	108.6724157	0	90.56034642	0.181120693	0.181120693	45.28017321	135.8405196	0	61.22858521	135.8405196	0	18.11206928	9.056034642	18.11206928	36.22413857	32.53291711	50.16956168	0	0.181120693	0	0	0	20	20	20	0	0	0	0	0	18.11206928	18.11206928	0	0.181120693	18.11206928	18.11206928	0.181120693	0		8.1738	0.556024544	3.360545953	0	0.224222605	1.807320434	0.099019176	1.039036691	3.207113941	0	3.69688511	1.64049377	0	0.068504339	1.886594571	4.268561754	0.121803436	3.591654879	6.344424034	0	6.400686014	0	0	0	0.504	0.398666667	0.216	0	0	0	0	0	0.48448447	0.342500385	0	0.254758914	0.767370856	0.045743988	1.289514639	0	50.7898		5.281460141	8.1738	0.556024544	3.360545953	0	0.224222605	1.807320434	0.099019176	1.039036691	3.207113941	0	3.69688511	1.64049377	0	0.068504339	1.886594571	4.268561754	0.121803436	3.591654879	6.344424034	0	6.400686014	0	0	0	0.504	0.398666667	0.216	0	0	0	0	0	0.48448447	0.342500385	0	0.254758914	0.767370856	0.045743988	1.289514639	0	50.7898	YES	$275/day (days 1-7)	$275/day (days 1-7)	25% Coinsurance	$0 copay	$100 copay	25% Coinsurance	25% Coinsurance	$50 copay	$225 copay	$0 copay	25% Coinsurance	$225 copay	20% Coinsurance	$30 copay	$20 copay	$30 copay	$50 copay	$60/$30 OP/PR copay	25% Coinsurance		20% Coinsurance			20% Coinsurance	$30 copay; $100 limit	$30 copay; $125 limit	$30 copay; $100 limit		Silver Sneakers		$30 copay	$0 copay	$30 copay	$30 copay	$0 copay	25% coinsurance	$30 copay	$30 copay	20% coinsurance		3850	6.8562	0.0914	0.542		1.0901	1.2286	0.0172	0.3025	2.7544		1.3424	0.0554		0.095	1.5752	1.934	0.0733	0.9512	4.1165		1.5352			0.3957	0.189	0.1495	0.081	0					0.4312	0.1376		0.5673	0.2444	0.0264	0.4439		27.2266		2.758934856	15.03	0.647439946	3.902584983	0	1.314359568	3.035879239	0.116176161	1.341566663	5.961543805	0	5.039284035	1.695898968	0	0.163484679	3.461759748	6.20253534	0.195132963	4.54280697	10.46093774	0	7.935882703	0	0	0.395708502	0.693	0.548166667	0.297	0	0	0	0	0	0.915652466	0.480138018	0	0.822061116	1.011815293	0.072170414	1.733428035	0	78.0164
H1607_804_0	2010	8	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	212.7766769	2.436151676	57.13773882	21.25556566	6.665638953	11.77289274	2.910817387	8.225642818	40.33931907	5.052405599	17.97514151	0	0.042498632	19.28544607	31.80938048	80.403942	0.959368252	3.789887765	21.15347564	27.8265395	7.893869647	1.378675535	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.076758443	0.076758443	0.185350621	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076758443	0.076758443	0.185350621	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.3324	0.186995209	10.59051539	0	1.553093876	2.743084009	0.678220451	1.916574776	9.399061344	1.177210505	4.188207973	0	0.009902181	4.493508934	7.411585653	18.73411849	0.223532803	0.883043849	4.928759823	6.483583703	1.839271628	0.3212314	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0939	0	0	16.3324	0.186995209	10.59051539	0	1.553093876	2.743084009	0.678220451	1.916574776	9.399061344	1.177210505	4.188207973	0	0.009902181	4.493508934	7.411585653	18.73411849	0.223532803	0.883043849	4.928759823	6.483583703	1.839271628	0.3212314	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0939	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				6.8503	0.0784	3.3561	0	0.6421	1.1351	0.2807	0.7284	3.0902	0.4743	1.4733	0	0.0046	1.8082	3.1321	7.7992	0.103	0.4069	2.2715	2.7069	0.5786	0.1011	0	0	0	0	0	0	0	0											37.021	0	0	23.1827	0.265426126	13.94662943	0	2.19520196	3.878205141	0.958876225	2.644949203	12.48927009	1.651497899	5.661540238	0	0.014468507	6.301701214	10.54366752	26.53335141	0.326488371	1.289974555	7.200277334	9.19044081	2.417854644	0.422372877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.1149
H1607_805_0	2010	7	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	212.7766769	2.436151676	57.13773882	21.25556566	6.665638953	11.77289274	2.910817387	8.225642818	40.33931907	5.052405599	17.97514151	0	0.042498632	19.28544607	31.80938048	80.403942	0.959368252	3.789887765	21.15347564	27.8265395	7.893869647	1.378675535	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.076758443	0.076758443	0.185350621	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076758443	0.076758443	0.185350621	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.3324	0.186995209	10.59051539	0	1.553093876	2.743084009	0.678220451	1.916574776	9.399061344	1.177210505	4.188207973	0	0.009902181	4.493508934	7.411585653	18.73411849	0.223532803	0.883043849	4.928759823	6.483583703	1.839271628	0.3212314	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0939	0	0	16.3324	0.186995209	10.59051539	0	1.553093876	2.743084009	0.678220451	1.916574776	9.399061344	1.177210505	4.188207973	0	0.009902181	4.493508934	7.411585653	18.73411849	0.223532803	0.883043849	4.928759823	6.483583703	1.839271628	0.3212314	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0939	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				6.8503	0.0784	3.3561	0	0.6421	1.1351	0.2807	0.7284	3.0902	0.4743	1.4733	0	0.0046	1.8082	3.1321	7.7992	0.103	0.4069	2.2715	2.7069	0.5786	0.1011	0	0	0	0	0	0	0	0											37.021	0	0	23.1827	0.265426126	13.94662943	0	2.19520196	3.878205141	0.958876225	2.644949203	12.48927009	1.651497899	5.661540238	0	0.014468507	6.301701214	10.54366752	26.53335141	0.326488371	1.289974555	7.200277334	9.19044081	2.417854644	0.422372877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.1149
H1607_806_0	2010	7	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	212.7766769	2.436151676	57.13773882	21.25556566	6.665638953	11.77289274	2.910817387	8.225642818	40.33931907	5.052405599	17.97514151	0	0.042498632	19.28544607	31.80938048	80.403942	0.959368252	3.789887765	21.15347564	27.8265395	7.893869647	1.378675535	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.076758443	0.076758443	0.185350621	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076758443	0.076758443	0.185350621	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.3324	0.186995209	10.59051539	0	1.553093876	2.743084009	0.678220451	1.916574776	9.399061344	1.177210505	4.188207973	0	0.009902181	4.493508934	7.411585653	18.73411849	0.223532803	0.883043849	4.928759823	6.483583703	1.839271628	0.3212314	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0939	0	0	16.3324	0.186995209	10.59051539	0	1.553093876	2.743084009	0.678220451	1.916574776	9.399061344	1.177210505	4.188207973	0	0.009902181	4.493508934	7.411585653	18.73411849	0.223532803	0.883043849	4.928759823	6.483583703	1.839271628	0.3212314	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0939	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				6.8503	0.0784	3.3561	0	0.6421	1.1351	0.2807	0.7284	3.0902	0.4743	1.4733	0	0.0046	1.8082	3.1321	7.7992	0.103	0.4069	2.2715	2.7069	0.5786	0.1011	0	0	0	0	0	0	0	0											37.021	0	0	23.1827	0.265426126	13.94662943	0	2.19520196	3.878205141	0.958876225	2.644949203	12.48927009	1.651497899	5.661540238	0	0.014468507	6.301701214	10.54366752	26.53335141	0.326488371	1.289974555	7.200277334	9.19044081	2.417854644	0.422372877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.1149
H1608_001_0	2010	8	N/A																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	V	COIN	COIN	COIN	P	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	YES	764.5473967	32.7079892	352.7346166	0	92.25839315	5.183107107	3.884195641	231.7556148	284.1437552	6.801222718	14.48883722	1.274475108	0.446890085	6.552674711	2960.645209	83.01930665	158.4130559	666.5686833	7.538119914	1139.535813	13.72431016	0	0	0	0	0	0	0	0	126.4713557											5000	1a $175 days 1-9	1b $175 days 1-9	2 $100 days 7-22	6 $0	"10a $150, 10b $0"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $260, 9b $260"	"8a $0, 8b 20%, 11c $0, 11c 20%"	8b 20%/$260 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0"	7a $15	"17a $40, 18a $40, 7b $40,7d $40,7f $40, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b 20% Ther., $260 Adv. Imaging, 14h $0"	"7g $40, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0	14c $15											162.8134796	158.8235294	47.92899408	0	29.272274	0.2	0.2	49.71319615	260	0.071232805	0.462355069	0.2	0.2	0.1942751	15	0.166404243	40	40	0.295163264	0.00367196	0.235799697	0	0	0	0	0	0	0	0	15											NO	145.0441008	141.4896117	42.69804849	0	26.07751317	0.178172104	0.178172104	44.28752366	231.6237346	0.063458493	0.411893876	0.178172104	0.178172104	0.173072017	13.36290777	0.14824297	35.63442071	35.63442071	0.262949298	0.003271204	0.21006464	0	0	0	0	0	0	0	0	13.36290777												9.2411	0.385653391	1.25508998	0	0.200489122	0.923485096	0.692055308	0.855323523	5.484536479	0.431595346	5.967863327	0.227075911	0.079623347	1.134084626	3.296902405	12.30702857	0.470413123	1.979399075	1.982143339	0.000310638	2.882992271	0	0	0	0	0	0	0	0	0.140835422	0	0	0	0	0	0	0	0	0	0	49.938	0	6.117912264	9.2411	0.385653391	1.25508998	0	0.200489122	0.923485096	0.692055308	0.855323523	5.484536479	0.431595346	5.967863327	0.227075911	0.079623347	1.134084626	3.296902405	12.30702857	0.470413123	1.979399075	1.982143339	0.000310638	2.882992271	0	0	0	0	0	0	0	0	0.140835422	0	0	0	0	0	0	0	0	0	0	49.938	NO	0.2	0.2	0.2	0.2	$150/$0	0.2	0.2	$50/$40	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																				3.9872	0.069	0.2864	0.1195	0.1025	0.1425	0.1068	0.1309	0.908	0.1869	0.3982	0.035	0.0123	0.1801	0.5618	2.2642	0.0446	0.1325	0.2056	0.1612	0.4413	0	0	0	0	0	0	0	0	0											10.4765	0	0	13.2283	0.454671619	1.541509066	0.119499521	0.302999571	1.065936234	0.798807508	0.986247527	6.392578033	0.618518343	6.366070676	0.262103246	0.091905555	1.314176595	3.858717982	14.57119148	0.515057878	2.111887906	2.187728428	0.161473001	3.324290658	0	0	0	0	0	0	0	0	0.140835422	0	0	0	0	0	0	0	0	0	0	60.4145
H1608_003_0	2010	7	N/A																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	V	COIN	COIN	COIN	P	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	YES	991.3640957	26.43040291	617.3341254	0	127.2093033	7.989200465	4.577739319	285.6030928	377.9279596	8.214930242	18.33116761	1.869216661	0.884688187	9.219596804	3486.827446	98.17937142	134.8516762	780.0929098	10.07089007	1506.754932	22.98907957	0	0	0	0	0	0	0	0	137.5994765											5000	1a $175 days 1-9	1b $175 days 1-9	2 $100 days 7-22	6 $0	"10a $150, 10b $0"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $260, 9b $260"	"8a $0, 8b 20%, 11c $0, 11c 20%"	8b 20%/$260 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0"	7a $15	"17a $40, 18a $40, 7b $40,7d $40,7f $40, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b 20% Ther., $260 Adv. Imaging, 14h $0"	"7g $40, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0	14c $15											162.8134796	158.8235294	47.92899408	0	30.01437561	0.2	0.2	49.53927492	260	0.073116817	0.476146846	0.2	0.2	0.191945028	15	0.146635017	40	40	0.274270869	0.005434783	0.223398292	0	0	0	0	0	0	0	0	15											NO	138.3953844	135.0038305	40.74080093	0	25.51294316	0.170004824	0.170004824	42.10957848	221.0062707	0.062151058	0.404736303	0.170004824	0.170004824	0.163157903	12.75036177	0.124643301	34.00096472	34.00096472	0.233136854	0.004619696	0.189893936	0	0	0	0	0	0	0	0	12.75036177												11.4334	0.29735047	2.095890559	0	0.270456977	1.358202616	0.778237766	1.002218821	6.960370746	0.510566604	7.419289009	0.317775849	0.150401259	1.504250079	3.704859281	12.23740098	0.382090591	2.210325959	2.347895623	0.000580063	4.365486812	0	0	0	0	0	0	0	0	0.146203592	0	0	0	0	0	0	0	0	0	0	59.4932	0	10.49681496	11.4334	0.29735047	2.095890559	0	0.270456977	1.358202616	0.778237766	1.002218821	6.960370746	0.510566604	7.419289009	0.317775849	0.150401259	1.504250079	3.704859281	12.23740098	0.382090591	2.210325959	2.347895623	0.000580063	4.365486812	0	0	0	0	0	0	0	0	0.146203592	0	0	0	0	0	0	0	0	0	0	59.4932	NO	0.2	0.2	0.2	0.2	$150/$0	0.2	0.2	$50/$40	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																				4.9852	0.0773	0.5279	0.2009	0.1457	0.2196	0.1258	0.1548	1.2564	0.2258	0.5038	0.0514	0.0243	0.2534	0.653	2.6776	0.0514	0.1469	0.2747	0.1939	0.1624	0	0	0	0	0	0	0	0	0											12.9122	0	0	16.4185	0.374671469	2.62376515	0.200863649	0.41614992	1.577775677	0.904051136	1.157016913	8.216778824	0.736343562	7.923097945	0.369148902	0.174715794	1.757639025	4.357874893	14.9150202	0.433479105	2.357262177	2.622556262	0.194519492	4.527907218	0	0	0	0	0	0	0	0	0.146203592	0	0	0	0	0	0	0	0	0	0	72.4054
H1608_801_0	2010	5	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	181.8326243	2.820247287	18.8688991	0	5.064676475	8.419310897	4.824188691	13.71657591	46.15233944	8.293591058	18.50669491	1.887115061	0.893159384	9.307877652	25.23296139	103.4650032	1.985686682	5.677714064	10.61307134	7.493949672	26.45355833	0	0	0	0	0	0	0	0	0												FFS Medicare  9.1%	FFS Medicare  9.1%	FFS Medicare  12.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												16.5996	0.257461285	2.286098415	0	1.180069619	1.961699439	1.124035965	3.195962187	10.75349509	1.932406716	4.312059915	0.439697809	0.208106136	2.168735493	5.879280003	24.10734574	0.462664997	1.322907377	2.472845623	1.746090273	6.16367909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5742	0	0	16.5996	0.257461285	2.286098415	0	1.180069619	1.961699439	1.124035965	3.195962187	10.75349509	1.932406716	4.312059915	0.439697809	0.208106136	2.168735493	5.879280003	24.10734574	0.462664997	1.322907377	2.472845623	1.746090273	6.16367909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5742	NO	FFS Medicare  9.1%	FFS Medicare  9.1%	FFS Medicare  12.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																				2.3442	0.0364	0.3228	0	0.1622	0.2696	0.1545	0.4392	1.4777	0.2655	0.5926	0.0604	0.0286	0.298	0.8017	3.2874	0.0631	0.1804	0.3372	0.2381	0.8405	0	0	0	0	0	0	0	0	0											12.2	0	0	18.9437	0.293819693	2.608938802	0	1.342233217	2.231273567	1.278499493	3.635147061	12.23122609	2.197955478	4.904617454	0.500120497	0.236703805	2.46676024	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7742
H1608_802_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	181.8326243	2.820247287	18.8688991	0	5.064676475	8.419310897	4.824188691	13.71657591	46.15233944	8.293591058	18.50669491	1.887115061	0.893159384	9.307877652	25.23296139	103.4650032	1.985686682	5.677714064	10.61307134	7.493949672	26.45355833	0	0	0	0	0	0	0	0	0												FFS Medicare  9.1%	FFS Medicare  9.1%	FFS Medicare  12.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												16.5996	0.257461285	2.286098415	0	1.180069619	1.961699439	1.124035965	3.195962187	10.75349509	1.932406716	4.312059915	0.439697809	0.208106136	2.168735493	5.879280003	24.10734574	0.462664997	1.322907377	2.472845623	1.746090273	6.16367909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5742	0	0	16.5996	0.257461285	2.286098415	0	1.180069619	1.961699439	1.124035965	3.195962187	10.75349509	1.932406716	4.312059915	0.439697809	0.208106136	2.168735493	5.879280003	24.10734574	0.462664997	1.322907377	2.472845623	1.746090273	6.16367909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5742	NO	FFS Medicare  9.1%	FFS Medicare  9.1%	FFS Medicare  12.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																				2.3442	0.0364	0.3228	0	0.1622	0.2696	0.1545	0.4392	1.4777	0.2655	0.5926	0.0604	0.0286	0.298	0.8017	3.2874	0.0631	0.1804	0.3372	0.2381	0.8405	0	0	0	0	0	0	0	0	0											12.2	0	0	18.9437	0.293819693	2.608938802	0	1.342233217	2.231273567	1.278499493	3.635147061	12.23122609	2.197955478	4.904617454	0.500120497	0.236703805	2.46676024	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7742
H1608_803_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	181.8326243	2.820247287	18.8688991	0	5.064676475	8.419310897	4.824188691	13.71657591	46.15233944	8.293591058	18.50669491	1.887115061	0.893159384	9.307877652	25.23296139	103.4650032	1.985686682	5.677714064	10.61307134	7.493949672	26.45355833	0	0	0	0	0	0	0	0	0												FFS Medicare  9.1%	FFS Medicare  9.1%	FFS Medicare  12.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												16.5996	0.257461285	2.286098415	0	1.180069619	1.961699439	1.124035965	3.195962187	10.75349509	1.932406716	4.312059915	0.439697809	0.208106136	2.168735493	5.879280003	24.10734574	0.462664997	1.322907377	2.472845623	1.746090273	6.16367909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5742	0	0	16.5996	0.257461285	2.286098415	0	1.180069619	1.961699439	1.124035965	3.195962187	10.75349509	1.932406716	4.312059915	0.439697809	0.208106136	2.168735493	5.879280003	24.10734574	0.462664997	1.322907377	2.472845623	1.746090273	6.16367909	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5742	NO	FFS Medicare  9.1%	FFS Medicare  9.1%	FFS Medicare  12.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																				2.3442	0.0364	0.3228	0	0.1622	0.2696	0.1545	0.4392	1.4777	0.2655	0.5926	0.0604	0.0286	0.298	0.8017	3.2874	0.0631	0.1804	0.3372	0.2381	0.8405	0	0	0	0	0	0	0	0	0											12.2	0	0	18.9437	0.293819693	2.608938802	0	1.342233217	2.231273567	1.278499493	3.635147061	12.23122609	2.197955478	4.904617454	0.500120497	0.236703805	2.46676024	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7742
H1609_001_0	2010	8	N/A																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	COIN	COIN	COIN	COIN	P	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	YES	942.2127331	21.03544707	471.1063666	0	112.1219509	7.120111802	4.155022891	278.772305	370.0869902	7.848313314	17.91316635	1.848075987	1.403845524	9.101140385	3611.144912	96.20819995	115.742482	698.2260552	11.1562968	1427.992053	20.41385718	0	0	0	0	0	0	0	0	150.4071891											4600	1a $160 days 1-9	1b $160 days 1-9	2 $100 days 7-22	6 $0	"10a $150, 10b $0"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $260, 9b $260"	"8a $0, 8b 20%, 11c $0, 11c 20%"	8b 20%/$260 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0"	7a $10	"17a $40, 18a $40, 7b $40,7d $40,7f $40, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b 20% Ther., $260 Adv. Imaging, 14h $0"	"7g $40, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0	14c $10											148.8580385	145.210084	47.92899408	0	28.77356585	0.2	0.2	49.54005935	260	0.070404439	0.466702869	0.2	0.2	0.191046821	10	0.135338129	40	40	0.269627744	0.011360409	0.226714962	0	0	0	0	0	0	0	0	10											NO	127.0353103	123.9221494	40.90255856	0	24.55533408	0.170679812	0.170679812	42.27744014	221.8837559	0.060083082	0.398283791	0.170679812	0.170679812	0.163039177	8.533990613	0.115497432	34.13596245	34.13596245	0.230100064	0.009694962	0.193478336	0	0	0	0	0	0	0	0	8.533990613												9.9745	0.217229818	1.605787979	0	0.229432663	1.215259346	0.709178527	0.982148286	6.843024284	0.471550851	7.134523792	0.315429262	0.23960809	1.483842442	2.568123065	11.11180002	0.329248418	1.9862182	2.567064606	0.001153694	3.949639121	0	0	0	0	0	0	0	0	0.106964462	0	0	0	0	0	0	0	0	0	0	54.0418	0	9.283548297	9.9745	0.217229818	1.605787979	0	0.229432663	1.215259346	0.709178527	0.982148286	6.843024284	0.471550851	7.134523792	0.315429262	0.23960809	1.483842442	2.568123065	11.11180002	0.329248418	1.9862182	2.567064606	0.001153694	3.949639121	0	0	0	0	0	0	0	0	0.106964462	0	0	0	0	0	0	0	0	0	0	54.0418	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.9745	0.217229818	1.605787979	0	0.229432663	1.215259346	0.709178527	0.982148286	6.843024284	0.471550851	7.134523792	0.315429262	0.23960809	1.483842442	2.568123065	11.11180002	0.329248418	1.9862182	2.567064606	0.001153694	3.949639121	0	0	0	0	0	0	0	0	0.106964462	0	0	0	0	0	0	0	0	0	0	54.0418
H1609_007_0	2010	7	N/A																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	V	COIN	COIN	COIN	P	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	YES	1099.952663	29.32544379	671.2544379	0	138.3202481	9.067857668	5.195800101	310.5487541	406.7011559	8.932453521	19.93228156	2.03248116	0.96196022	10.02487148	3835.199422	107.9885582	148.324825	858.0326737	11.07708149	1657.296133	25.86527145	0	0	0	0	0	0	0	0	142.1402592											4600	1a $160 days 1-9	1b $160 days 1-9	2 $100 days 7-22	6 $0	"10a $150, 10b $0"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $260, 9b $260"	"8a $0, 8b 20%, 11c $0, 11c 20%"	8b 20%/$260 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0"	7a $10	"17a $40, 18a $40, 7b $40,7d $40,7f $40, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b 20% Ther., $260 Adv. Imaging, 14h $0"	"7g $40, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0	14c $10											148.8580385	145.210084	47.92899408	0	30.01437561	0.2	0.2	49.53927492	260	0.073116817	0.476146846	0.2	0.2	0.191945028	10	0.146635017	40	40	0.274270869	0.005434783	0.22030543	0	0	0	0	0	0	0	0	10											NO	122.0894262	119.0974704	39.31009333	0	24.61699706	0.16403471	0.16403471	40.63080309	213.2451236	0.059968479	0.39052305	0.16403471	0.16403471	0.157428235	8.201735523	0.120266163	32.80694209	32.80694209	0.224949713	0.004457465	0.180688687	0	0	0	0	0	0	0	0	8.201735523												11.191	0.291048848	2.198922884	0	0.283752428	1.487443407	0.852291565	1.051487106	7.227253187	0.535665655	7.784015398	0.333397459	0.157794866	1.578197824	2.621274278	12.98736956	0.405506995	2.345785687	2.491786302	0.000615612	4.673561935	0	0	0	0	0	0	0	0	0.097149734	0	0	0	0	0	0	0	0	0	0	60.5954	0	13.28578577	11.191	0.291048848	2.198922884	0	0.283752428	1.487443407	0.852291565	1.051487106	7.227253187	0.535665655	7.784015398	0.333397459	0.157794866	1.578197824	2.621274278	12.98736956	0.405506995	2.345785687	2.491786302	0.000615612	4.673561935	0	0	0	0	0	0	0	0	0.097149734	0	0	0	0	0	0	0	0	0	0	60.5954	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.191	0.291048848	2.198922884	0	0.283752428	1.487443407	0.852291565	1.051487106	7.227253187	0.535665655	7.784015398	0.333397459	0.157794866	1.578197824	2.621274278	12.98736956	0.405506995	2.345785687	2.491786302	0.000615612	4.673561935	0	0	0	0	0	0	0	0	0.097149734	0	0	0	0	0	0	0	0	0	0	60.5954
H1609_801_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	206.6279822	3.204826462	21.4419308	0	5.755314177	9.567398747	5.482032603	15.58701808	52.44584027	9.424535293	21.03033513	2.144448933	1.014953845	10.5771337	28.67381976	117.5738673	2.256462139	6.4519478	12.06030834	8.5158519	30.06086174	0	0	0	0	0	0	0	0	0												FFS Medicare  9.1%	FFS Medicare  9.1%	FFS Medicare  12.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												18.8631	0.292569642	2.597839108	0	1.340988203	2.229203908	1.277313597	3.631775212	12.21988078	2.195916723	4.900068085	0.499656601	0.236484246	2.464472151	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6525	0	0	18.8631	0.292569642	2.597839108	0	1.340988203	2.229203908	1.277313597	3.631775212	12.21988078	2.195916723	4.900068085	0.499656601	0.236484246	2.464472151	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6525	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.8631	0.292569642	2.597839108	0	1.340988203	2.229203908	1.277313597	3.631775212	12.21988078	2.195916723	4.900068085	0.499656601	0.236484246	2.464472151	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6525
H1609_802_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	206.6279822	3.204826462	21.4419308	0	5.755314177	9.567398747	5.482032603	15.58701808	52.44584027	9.424535293	21.03033513	2.144448933	1.014953845	10.5771337	28.67381976	117.5738673	2.256462139	6.4519478	12.06030834	8.5158519	30.06086174	0	0	0	0	0	0	0	0	0												FFS Medicare  9.1%	FFS Medicare  9.1%	FFS Medicare  12.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												18.8631	0.292569642	2.597839108	0	1.340988203	2.229203908	1.277313597	3.631775212	12.21988078	2.195916723	4.900068085	0.499656601	0.236484246	2.464472151	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6525	0	0	18.8631	0.292569642	2.597839108	0	1.340988203	2.229203908	1.277313597	3.631775212	12.21988078	2.195916723	4.900068085	0.499656601	0.236484246	2.464472151	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6525	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.8631	0.292569642	2.597839108	0	1.340988203	2.229203908	1.277313597	3.631775212	12.21988078	2.195916723	4.900068085	0.499656601	0.236484246	2.464472151	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6525
H1609_803_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	206.6279822	3.204826462	21.4419308	0	5.755314177	9.567398747	5.482032603	15.58701808	52.44584027	9.424535293	21.03033513	2.144448933	1.014953845	10.5771337	28.67381976	117.5738673	2.256462139	6.4519478	12.06030834	8.5158519	30.06086174	0	0	0	0	0	0	0	0	0												FFS Medicare  9.1%	FFS Medicare  9.1%	FFS Medicare  12.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.091290323	0.091290323	0.121156958	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												18.8631	0.292569642	2.597839108	0	1.340988203	2.229203908	1.277313597	3.631775212	12.21988078	2.195916723	4.900068085	0.499656601	0.236484246	2.464472151	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6525	0	0	18.8631	0.292569642	2.597839108	0	1.340988203	2.229203908	1.277313597	3.631775212	12.21988078	2.195916723	4.900068085	0.499656601	0.236484246	2.464472151	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6525	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.8631	0.292569642	2.597839108	0	1.340988203	2.229203908	1.277313597	3.631775212	12.21988078	2.195916723	4.900068085	0.499656601	0.236484246	2.464472151	6.681000004	27.39471107	0.525755678	1.503303837	2.810051844	1.984193493	7.004180785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6525
H1643_001_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	815.4149342	0	114.4127149	0	212.5631955	12.98661258	0	492.5819189	421.9352394	3502.182022	1375.399495	0	0	464.5782791	2751.518243	4105.937106	0	0	0	1813.464887	24.38763286	0	0	0	339.6803805	0	221.6499075	0	0	0											3400	"$150 days 1-4; PBP 1a, 1b"		$50 days 11-100; PBP 2	$0; PBP 6	$100; PBP 10a	"20%; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$100; PBP 9a, 9b"	$30-$75; PBP 8a	$0-$75; PBP 8b			"$0-$30; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$30; PBP 7a, 14c-j"	"$0-$30; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$30; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	20%; PBP 15			"$0; PBP 16a, 16b"	"$0-$30; PBP 17a, 17b"		"$0-$30; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											150	0	50	0	100	0.2	0	50	100	23	34	0	0	30	30	30	0	0	0	30	0.2	0	0	0	30	0	30	0	0	0											NO	138.9308425	0	46.31028084	0	92.62056169	0.185241123	0	46.31028084	92.62056169	21.30272919	31.49099097	0	0	27.78616851	27.78616851	27.78616851	0	0	0	27.78616851	0.185241123	0	0	0	30	0	30	0	0	0												9.4405	0	0.441540413	0	1.640643547	2.405654703	0	1.90096725	3.256656572	6.217169598	3.60939109	0	0	1.075737529	6.371179128	9.507355026	0	0	0	4.199103411	4.517592507	0	0	0	0.849200951	0	0.554124769	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9868	0	4.348879669	9.4405	0	0.441540413	0	1.640643547	2.405654703	0	1.90096725	3.256656572	6.217169598	3.60939109	0	0	1.075737529	6.371179128	9.507355026	0	0	0	4.199103411	4.517592507	0	0	0	0.849200951	0	0.554124769	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9868	NO																																																																																		0		0	9.4405	0	0.441540413	0	1.640643547	2.405654703	0	1.90096725	3.256656572	6.217169598	3.60939109	0	0	1.075737529	6.371179128	9.507355026	0	0	0	4.199103411	4.517592507	0	0	0	0.849200951	0	0.554124769	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9868
H1643_002_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	1028.37042	0	197.2285955	0	311.3604336	15.30549705	0	508.3175569	538.134977	4363.634502	1507.690711	0	0	611.1266635	3501.094892	4725.377243	0	0	0	1421.959435	34.37375965	0	0	0	412.4526421	0	295.2493142	0	0	0											3400	"$125 days 1-4; PBP 1a, 1b"		$35 days 11-100; PBP 2	$0; PBP 6	$100; PBP 10a	"20%; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$200; PBP 9a, 9b"	$25-$75; PBP 8a	$0-$75; PBP 8b			"$0-$35; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$35; PBP 7a, 14c-j"	"$0-$35; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$35; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	20%; PBP 15			"$0; PBP 16a, 16b"	"$0-$35; PBP 17a, 17b"		"$0-$35; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											125	0	35	0	100	0.2	0	50	200	19	30	0	0	35	35	35	0	0	0	35	0.2	0	0	0	35	0	35	0	0	0											NO	112.0985501	0	31.38759402	0	89.67884006	0.17935768	0	44.83942003	179.3576801	17.03897961	26.90365202	0	0	31.38759402	31.38759402	31.38759402	0	0	0	31.38759402	0.17935768	0	0	0	35	0	35	0	0	0												9.6066	0	0.51587759	0	2.326870211	2.745158444	0	1.899388704	8.043220088	6.195989943	3.380198853	0	0	1.598482967	9.157578759	12.35985188	0	0	0	3.719323788	6.165197787	0	0	0	1.202986873	0	0.861143833	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7778	0	7.793187495	9.6066	0	0.51587759	0	2.326870211	2.745158444	0	1.899388704	8.043220088	6.195989943	3.380198853	0	0	1.598482967	9.157578759	12.35985188	0	0	0	3.719323788	6.165197787	0	0	0	1.202986873	0	0.861143833	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7778	NO																																																																																		0		0	9.6066	0	0.51587759	0	2.326870211	2.745158444	0	1.899388704	8.043220088	6.195989943	3.380198853	0	0	1.598482967	9.157578759	12.35985188	0	0	0	3.719323788	6.165197787	0	0	0	1.202986873	0	0.861143833	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7778
H1643_801_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	332.1401882	0	44.14087808	12.78406779	14.42474167	33.33848112	0	24.7179976	63.37787786	27.87734999	52.61145091	0	0	29.84477234	29.59519728	55.59030236	0	0	0	114.9224836	46.47663067	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.082227364	0	0.184558392	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.082227364	0	0.184558392	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												27.311	0	8.146569499	0	3.36096481	7.767866102	0	5.759293441	14.76704554	6.495422547	12.25846806	0	0	6.953831955	6.895680965	12.95254045	0	0	0	26.77693868	10.82905495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.2747		0	27.311	0	8.146569499	0	3.36096481	7.767866102	0	5.759293441	14.76704554	6.495422547	12.25846806	0	0	6.953831955	6.895680965	12.95254045	0	0	0	26.77693868	10.82905495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.2747	NO																																																																																		0		0	27.311	0	8.146569499	0	3.36096481	7.767866102	0	5.759293441	14.76704554	6.495422547	12.25846806	0	0	6.953831955	6.895680965	12.95254045	0	0	0	26.77693868	10.82905495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.2747
H1643_802_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	282.8868704	0	31.27350001	10.08413238	11.92905971	30.0765369	0	24.00793493	56.087475	24.43048532	48.64651603	0	0	28.08463122	26.23638332	46.80586198	0	0	0	98.56009525	37.54622141	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.077198036	0	0.181178503	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.077198036	0	0.181178503	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												21.8383	0	5.666085903	0	2.779470913	7.007833098	0	5.593848839	13.06838168	5.692303079	11.33463823	0	0	6.543719074	6.113077313	10.90576584	0	0	0	22.96450219	8.748269588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2562		0	21.8383	0	5.666085903	0	2.779470913	7.007833098	0	5.593848839	13.06838168	5.692303079	11.33463823	0	0	6.543719074	6.113077313	10.90576584	0	0	0	22.96450219	8.748269588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2562	NO																																																																																		0		0	21.8383	0	5.666085903	0	2.779470913	7.007833098	0	5.593848839	13.06838168	5.692303079	11.33463823	0	0	6.543719074	6.113077313	10.90576584	0	0	0	22.96450219	8.748269588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2562
H1643_803_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	282.8868704	0	31.27350001	10.08413238	11.92905971	30.0765369	0	24.00793493	56.087475	24.43048532	48.64651603	0	0	28.08463122	26.23638332	46.80586198	0	0	0	98.56009525	37.54622141	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.077198036	0	0.181178503	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.077198036	0	0.181178503	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												21.8383	0	5.666085903	0	2.779470913	7.007833098	0	5.593848839	13.06838168	5.692303079	11.33463823	0	0	6.543719074	6.113077313	10.90576584	0	0	0	22.96450219	8.748269588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2562		0	21.8383	0	5.666085903	0	2.779470913	7.007833098	0	5.593848839	13.06838168	5.692303079	11.33463823	0	0	6.543719074	6.113077313	10.90576584	0	0	0	22.96450219	8.748269588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2562	NO																																																																																		0		0	21.8383	0	5.666085903	0	2.779470913	7.007833098	0	5.593848839	13.06838168	5.692303079	11.33463823	0	0	6.543719074	6.113077313	10.90576584	0	0	0	22.96450219	8.748269588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.2562
H1657_002_0	2010	5	N/A																															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	V	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	Yes	2649.925232	74.96492922	561.1188738	798.3987282	444.6581179	8.172418618	3.662940771	1278.740052	257.7681887	6761.933865	1330.943893	55.62001573	0.504623075	489.2077641	7476.161698	14566.34909	122.7428809	1702.844504	4157.316466	1358.069392	13.8970592	8.926114613	0	417.4285714	288	172.8	16.8	12.8	2040	0											3400	"$200 days 1 - 8, $0 after day 8, unlimited coverage"	"$200 days 1 - 8, $0 after day 8, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $25.00 and $150.00	Copay between $0.00 and $15.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											132.4441615	108.7939313	54.67	1.48684155	41.89749797	0.2	0.140210729	20.33460739	111.0286681	0	67.63104359	57.00308725	0.2	23.68898325	7.494425048	7.609605866	26.0654751	18.19506173	26.22174884	5.957969744	0.2	0	0	0	0	0	0	0	0	0											NO	118.6676612	97.47746697	48.98336751	1.332184124	37.53942822	0.179196515	0.12562637	18.21945394	99.47975217	0	60.59623675	51.07377304	0.179196515	21.22491627	6.714874271	6.818074277	23.35421156	16.30245831	23.49423011	5.338237088	0.179196515	0	0	0	0	0	0	0	0	0												26.205	0.608949284	2.290457668	0.088634509	1.391017625	1.464468939	0.460161953	1.941495457	2.136892961	0	6.720849267	0.236727005	0.090426697	0.865282819	4.183457153	8.276204167	0.238880267	2.313379294	8.139412473	0.604141366	2.490304584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7462	0	8.213145448	26.205	0.608949284	2.290457668	0.088634509	1.391017625	1.464468939	0.460161953	1.941495457	2.136892961	0	6.720849267	0.236727005	0.090426697	0.865282819	4.183457153	8.276204167	0.238880267	2.313379294	8.139412473	0.604141366	2.490304584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7462	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												2.5745	0	0.1281	0.1137	0.108	0.1353	0.0606	0	0.3553	0.1201	0.37	0	0	0.1578	0	1.0509	0	0.1044	0.2731	0.1263	0	0.0033	0	0	0	0	0	0	0	0											5.6814	0	0	28.7795	0.608949284	2.418602397	0.202340646	1.499043331	1.599797162	0.520806845	1.941495457	2.492180321	0.120087879	7.090854697	0.236727005	0.090426697	1.02308392	4.183457153	9.327060359	0.238880267	2.41775232	8.41250229	0.730459733	2.490304584	0.003278584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4276
H1657_004_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	492.9610503	53.08246167	1261.597747	2067.48013	24.80817088	18.37674837	3.989906946	27.06710423	24.5177746	10770.25384	24.04157464	2.22691316	1.077669449	7.942938276	7554.95809	77.19073443	8.361940721	17.73767978	17.16868015	5.197421685	19.95061181	0.050548286	2230	895.6363636	0.96	172.8	0.056	0.224	0	0												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, $1,000 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											572.1903677	380.3064058	47.01297396	0	0.163452165	0.170000206	0.156995108	0.119408221	0.17	0	0.170035984	0.248625719	0.17	0.170008776	0	0.093296685	0.383038858	0.170000156	0.167085014	0.077909891	0.17000043	0.17	0	0	0	0	0	0	0	0											NO	572.1903677	380.3064058	47.01297396	0	0.163452165	0.170000206	0.156995108	0.119408221	0.17	0	0.170035984	0.248625719	0.17	0.170008776	0	0.093296685	0.383038858	0.170000156	0.167085014	0.077909891	0.17000043	0.17	0	0	0	0	0	0	0	0												23.5056	1.682300018	4.942621838	0	4.054949234	3.124051	0.626395872	3.232034774	4.168021682	0	4.087932798	0.553667885	0.183203806	1.350369217	0	7.2016396	3.202948228	3.015408332	2.868629167	0.404930559	3.391612581	0.008593209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6049	0	0	23.5056	1.682300018	4.942621838	0	4.054949234	3.124051	0.626395872	3.232034774	4.168021682	0	4.087932798	0.553667885	0.183203806	1.350369217	0	7.2016396	3.202948228	3.015408332	2.868629167	0.404930559	3.391612581	0.008593209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6049	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.5056	1.682300018	4.942621838	0	4.054949234	3.124051	0.626395872	3.232034774	4.168021682	0	4.087932798	0.553667885	0.183203806	1.350369217	0	7.2016396	3.202948228	3.015408332	2.868629167	0.404930559	3.391612581	0.008593209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.6049
H1657_008_0	2010	5	N/A																															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	V	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	Yes	2136.425563	42.89920883	571.4849304	1196.303416	493.8331612	9.246080377	3.865263442	1350.801315	322.0153212	7664.535344	1464.637609	86.68204163	0.803066335	629.3945954	7062.067506	15459.84524	189.2360851	2467.965779	3933.599208	1398.749919	22.83757198	15.49367691	2973.333333	417.4285714	288	172.8	16.8	12.8	2040	0											3400	"$150 days 1 - 5, $0 after day 5, unlimited coverage"	"$150 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 7, $85 days 8 - 100"	Copay between $0.00 and $25.00	Copay between $3.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $50.00 and $100.00	$0.00 copayment	Copay between $0.00 and $150.00	$150.00 copayment	20% coinsurance	Copay between $25.00 and $100.00	Copay between $0.00 and $10.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	$3.00 copayment	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											94.35772519	67.78217642	54.67	1.778111697	39.26645802	0.2	0.2	19.00951174	72.64431782	0	58.35701322	42.82637954	0.2	7.766331048	4.763946233	9.198618904	26.98512179	8.871344544	41.41239147	6.709829772	0.2	0	3	0	0	0	0	0	0	0											NO	85.93806004	61.73388279	49.79172329	1.619448428	35.76265981	0.182153734	0.182153734	17.31326776	66.16216886	0	53.14973942	39.00492481	0.182153734	7.073331013	4.338852983	8.377813922	24.57720353	8.079742687	37.71710877	6.11110275	0.182153734	0	3	0	0	0	0	0	0	0												15.3	0.220694561	2.371268293	0.161445974	1.471732279	1.684208069	0.70407217	1.948898738	1.775436005	0	6.487092271	0.28175221	0.146281532	0.370993026	2.553439389	10.79330889	0.387574482	1.661710704	12.36366577	0.712325373	4.159949019	0	0.743333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2992	0	6.422747766	15.3	0.220694561	2.371268293	0.161445974	1.471732279	1.684208069	0.70407217	1.948898738	1.775436005	0	6.487092271	0.28175221	0.146281532	0.370993026	2.553439389	10.79330889	0.387574482	1.661710704	12.36366577	0.712325373	4.159949019	0	0.743333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2992	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												2.5302	0	0.1272	0.1749	0.1165	0.1531	0.064	0	0.412	0.133	0.4378	0	0	0.2082	0	1.1841	0	0.1376	0.2627	0.1469	0	0.0057	0	0	0	0	0	0	0	0											6.0938	0	0	17.8302	0.220694561	2.498471722	0.336355469	1.588253596	1.837315206	0.768077608	1.948898738	2.187460325	0.133008804	6.924893596	0.28175221	0.146281532	0.579177697	2.553439389	11.97736503	0.387574482	1.799290115	12.62633048	0.85920249	4.159949019	0.005690998	0.743333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.393
H1681_001_0	2010	7	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1057.259226	59.326835	397.089771	237.076382	38.911956	7.500737	3.309784	323.693835	384.554263	729.096987	946.712758	71.085818	0.441473	544.928961	3744.470957	4809.269301	75.250241	920.898989			24.234645	0							0.04	0.25	0.05	0.55	1.74	0.32	0.4	0.42					4900	$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$225/Visit:9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $225 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					144.519765	143.64207	58.254672	0	100	0.2	0.2	50	225	48.853712	92.020516	50	0.2	63.922072	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	131.087231	130.291114	40.362623	0	87.8622	0.175724	0.175724	43.9311	197.68995	42.923946	80.85125	43.9311	0.175724	56.163339	13.17933	30.75177	30.75177	13.17933			0.175724	0							0	0	0	0	0	0	0	0						11.5494	0.644146619	1.33563206	0	0.284907505	1.318059509	0.581608484	1.185018853	6.335209419	2.607976642	6.378575823	0.260239848	0.077577401	2.550419164	4.112468201	12.32446195	0.192839842	1.011402639	0	0	4.258608758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0086	0	7.848037	11.5494	0.644146619	1.33563206	0	0.284907505	1.318059509	0.581608484	1.185018853	6.335209419	2.607976642	6.378575823	0.260239848	0.077577401	2.550419164	4.112468201	12.32446195	0.192839842	1.011402639	0	0	4.258608758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0086	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					7000	7.7298	0.1342	0.3231	1.7674	1.4665	1.3979	0.6168	0.2691	3.871	0.431	1.7618	0.2992	0.0185	0.7808	2.3347	4.1286	0.0348	0.4476			1.3844	0							0	0	0	0	0	0	0	0					29.1972	1000	10.407767	19.2792	0.778379619	1.65868506	1.767351	1.751429505	2.715973509	1.198453484	1.454123853	10.20623942	3.038958642	8.140394823	0.559419848	0.096116401	3.331199164	6.447146201	16.45305795	0.227672842	1.458964639	0	0	5.643001758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2058
H1681_002_0	2010	5	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1071.748939	60.139907	402.531877	240.325509	39.445243	8.249855	3.640341	328.130052	389.824571	739.089245	959.687435	72.060047	0.485563	552.397198	3795.788844	4875.180224	76.281543	933.519888			26.655025	0							0.04	0.25	0.05	0.55	1.74	0.32	0.4	0.42					5900	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $250 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	250	48.853712	92.020516	50	0.2	63.922072	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	147.05006	130.045649	44.458568	0	88.6085	0.177217	0.177217	44.30425	221.52125	43.288541	81.537999	44.30425	0.177217	56.640389	13.291275	31.012975	31.012975	13.291275			0.177217	0							0	0	0	0	0	0	0	0						13.1334	0.651744436	1.491332569	0	0.291265318	1.462014554	0.645130311	1.211462988	7.196202187	2.66617459	6.520916093	0.266047195	0.086050018	2.607332681	4.204239447	12.59948687	0.197143132	1.033972462	0	0	4.723723565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9876	0	7.436893	13.1334	0.651744436	1.491332569	0	0.291265318	1.462014554	0.645130311	1.211462988	7.196202187	2.66617459	6.520916093	0.266047195	0.086050018	2.607332681	4.204239447	12.59948687	0.197143132	1.033972462	0	0	4.723723565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9876	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					7000	7.8736	0.1367	0.3145	1.8381	1.4057	1.7446	0.7698	0.2579	4.0259	0.4482	1.8323	0.3111	0.0193	0.812	2.4281	4.2938	0.0362	0.4655			1.4398	0							0	0	0	0	0	0	0	0					30.4532	1000	12.638763	21.007	0.788474436	1.805798569	1.83806	1.696971318	3.206625554	1.414959311	1.469408988	11.22210619	3.11439959	8.353223093	0.577197195	0.105330018	3.419350681	6.632324447	16.89326187	0.233370132	1.499441462	0	0	6.163504565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4408
H1681_003_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1062.075762	59.597109	398.898786	238.156427	39.089226	7.74049	3.415577	325.168481	386.30617	732.418521	951.02568	71.409662	0.455585	547.411484	3761.529572	4831.178798	75.593057	925.094311			25.009281	0							0.04	0.25	0.05	0.55	1.74	0.32	0.4	0.42					5900	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	175	48.853712	70.085961	50	0.2	60.445636	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	148.400926	131.240305	45.729976	0	89.6962	0.179392	0.179392	44.8481	156.96835	43.819923	62.864443	44.8481	0.179392	54.217438	13.45443	31.39367	31.39367	13.45443			0.179392	0							0	0	0	0	0	0	0	0						13.1344	0.65179523	1.520135993	0	0.292179586	1.388581982	0.612727189	1.215265713	5.053153508	2.674543599	4.982141638	0.266882305	0.081728304	2.473270683	4.21743636	12.63903607	0.197761957	1.037218054	0	0	4.486464937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9247	0	6.15932	13.1344	0.65179523	1.520135993	0	0.292179586	1.388581982	0.612727189	1.215265713	5.053153508	2.674543599	4.982141638	0.266882305	0.081728304	2.473270683	4.21743636	12.63903607	0.197761957	1.037218054	0	0	4.486464937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9247	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					7000	7.7909	0.1353	0.3209	1.7973	1.4517	1.4216	0.6273	0.2664	3.9366	0.4383	1.7916	0.3042	0.0189	0.794	2.3742	4.1985	0.0354	0.4551			1.4078	0							0	0	0	0	0	0	0	0					29.5661	1000	11.050532	20.9254	0.78708923	1.841070993	1.79727	1.743918586	2.810160982	1.240015189	1.481658713	8.989715508	3.112821599	6.773787638	0.571126305	0.100581304	3.267268683	6.59163736	16.83752407	0.233184957	1.492357054	0	0	5.894293937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.4908
H1681_004_0	2010	5	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1067.545809	59.904054	400.953249	239.383012	39.290549	7.495841	3.307624	326.843208	388.295777	736.190723	955.923783	71.777446	0.441184	550.230837	3780.902715	4856.060995	75.982386	929.858858			24.218825	0							0.04	0.25	0.05	0.55	1.74	0.32	0.4	0.42					4900	$195/Day(Days 1-5):1a	$195/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					118.300845	98.80884	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	0.2	60.445636	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	109.283363	91.277136	42.561912	0	88.2911	0.176582	0.176582	44.14555	110.363875	43.13348	61.879665	44.14555	0.176582	53.368117	13.243665	30.901885	30.901885	13.243665			0.176582	0							0	0	0	0	0	0	0	0						9.7221	0.455655874	1.422111408	0	0.289083816	1.323630595	0.584066861	1.202389432	3.571152216	2.646205652	4.929353621	0.264054569	0.077905153	2.447065307	4.172750746	12.50511987	0.19566658	1.026228268	0	0	4.276608556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1111	0	6.60402	9.7221	0.455655874	1.422111408	0	0.289083816	1.323630595	0.584066861	1.202389432	3.571152216	2.646205652	4.929353621	0.264054569	0.077905153	2.447065307	4.172750746	12.50511987	0.19566658	1.026228268	0	0	4.276608556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1111	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	35% Coins	35% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					6000	6.763	0.1174	0.2628	1.4126	1.1844	1.5643	0.6903	0.2173	3.0941	0.3445	1.4082	0.2391	0.0148	0.6241	1.8661	3.2999	0.0278	0.3577			1.1065	0							0	0	0	0	0	0	0	0					24.595	500	11.890142	16.4851	0.573099874	1.684941408	1.412624	1.473435816	2.887902595	1.274319861	1.419716432	6.665222216	2.990684652	6.337556621	0.503185569	0.092723153	3.071133307	6.038832746	15.80505987	0.22350858	1.383960268	0	0	5.383138556	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7061
H1681_005_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1036.44039	58.158611	389.270547	232.408034	38.145728	7.531791	3.323487	317.319874	376.981881	714.740101	928.07073	69.686044	0.4433	534.198588	3670.737361	4714.568414	73.768464	902.765267			24.33498	0							0.04	0.25	0.05	0.55	1.74	0.32	0.4	0.42					4900	$195/Day(Days 1-5):1a	$195/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					118.300845	98.80884	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	0.2	60.445636	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	109.660743	91.592336	43.328951	0	88.6283	0.177257	0.177257	44.31415	110.785375	43.298214	62.115995	44.31415	0.177257	53.571939	13.294245	31.019905	31.019905	13.294245			0.177257	0							0	0	0	0	0	0	0	0						9.4714	0.44390692	1.405557038	0	0.281732585	1.335062677	0.589111335	1.171813375	3.480339921	2.578914154	4.804003069	0.257339817	0.078578028	2.384837848	4.066640151	12.18712203	0.190690895	1.000131886	0	0	4.31354555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0407	0	6.233458	9.4714	0.44390692	1.405557038	0	0.281732585	1.335062677	0.589111335	1.171813375	3.480339921	2.578914154	4.804003069	0.257339817	0.078578028	2.384837848	4.066640151	12.18712203	0.190690895	1.000131886	0	0	4.31354555	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0407	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	35% Coins	35% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					6000	6.7734	0.1176	0.2627	1.4179	1.1486	1.5701	0.6928	0.2108	3.1056	0.3458	1.4135	0.24	0.0149	0.6264	1.8731	3.3123	0.0279	0.3591			1.1107	0							0	0	0	0	0	0	0	0					24.6231	500	11.969128	16.2448	0.56153192	1.668227038	1.4179	1.430361585	2.905176677	1.281941335	1.382585375	6.585966921	2.924680154	6.217465069	0.497363817	0.093451028	3.011236848	5.939692151	15.49938703	0.218636895	1.359199886	0	0	5.42420855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.6638
H1681_006_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1050.908759	58.970486	394.704637	235.652374	38.67823	7.1565	3.157887	321.749556	382.244424	724.717639	941.026292	70.658838	0.421212	541.655824	3721.979653	4780.382247	74.798247	915.367575			23.122426	0							0.04	0.25	0.05	0.55	1.74	0.32	0.4	0.42					4900	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					137.58966	121.67922	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	0.2	60.445636	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	126.742229	112.086152	42.187975	0	88.1798	0.17636	0.17636	44.0899	110.22475	43.079106	61.80166	44.0899	0.17636	53.300841	13.22697	30.86293	30.86293	13.22697			0.17636	0							0	0	0	0	0	0	0	0						11.0995	0.550814571	1.387649113	0	0.284219882	1.26212034	0.556924951	1.182158812	3.51106634	2.601682333	4.846415579	0.259611758	0.074284948	2.405892579	4.102542768	12.29471689	0.192374422	1.008961621	0	0	4.077871049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6989	0	6.707932	11.0995	0.550814571	1.387649113	0	0.284219882	1.26212034	0.556924951	1.182158812	3.51106634	2.601682333	4.846415579	0.259611758	0.074284948	2.405892579	4.102542768	12.29471689	0.192374422	1.008961621	0	0	4.077871049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6989	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					6000	6.7863	0.1178	0.2694	1.6605	1.4354	1.3134	0.5795	0.2634	3.6369	0.4049	1.6553	0.2811	0.0174	0.7336	2.1935	3.8789	0.0327	0.4205			1.3007	0							0	0	0	0	0	0	0	0					26.9812	1000	11.167868	17.8858	0.668662571	1.657064113	1.660463	1.719648882	2.57548934	1.136463951	1.445558812	7.14797934	3.006599333	6.501682579	0.540697758	0.091702948	3.139451579	6.296021768	16.17361989	0.225100422	1.429455621	0	0	5.378537049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.68
H1681_007_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	NO	199.869301	9.00676	408.382947	243.8188	40.018606	7.771998	3.429481	332.899641	395.490931	749.8324	973.637134	73.107488	0.457439	560.426661	3850.963168	4946.044223	77.390346	947.089223			25.111083	0							0.04	0.25	0.05	0.55	1.74	0.32	0.4	0.42						$0/Admit:1a	$0/Admit:1b	$0/Day(Days 1-20) $0(Days 21-100):2	$0/Visit:6	$0/Trip:10a	20% Coins:11a	0% Coins:11b	$0/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	20% Coins:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					0	0	0	0	0	0.2	0	0	0	0	0	0	0.2	0	0	0	0	0			0.2	0							0	0	0	0	0	0	0	0					NO	0	0	0	0	0	0.194273	0	0	0	0	0	0	0.194273	0	0	0	0	0			0.194273	0							0	0	0	0	0	0	0	0						0	0	0	0	0	1.509889367	0	0	0	0	0	0	0.088868047	0	0	0	0	0	0	0	4.878405428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4772	0	0.190943	0	0	0	0	0	1.509889367	0	0	0	0	0	0	0.088868047	0	0	0	0	0	0	0	4.878405428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4772	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$0/Trip	30% Coins	30% Coins	$0/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					5000	5.9611	0.1035	0.209	1.723	0	1.6354	0.7216	0	3.7738	0.4202	1.7176	0.2917	0.0181	0.7612	2.2761	4.0249	0.034	0.4363			1.3496	0							0	0	0	0	0	0	0	0					25.457	1000	14.297488	5.9611	0.103518	0.209042	1.722971	0	3.145262367	0.721627	0	3.773824	0.42016	1.717579	0.291667	0.106941047	0.761173	2.276052	4.024923	0.033959	0.436323	0	0	6.228034428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9342
H1681_801_0	2010	5	N/A																															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	NO	267.7548922	0.913361238	20.79382044	13.467443	2.839348301	10.95123018	5.353150357	24.8654327	75.04231911	10.88971945	26.14375327	9.177697245	0.806336544	16.62613272	41.31195695	90.60110506	0.435368906	6.69022352	0	0	31.41171413	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																			0.090394341	0.090394341	0.175131052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.090394341	0.090394341	0.175131052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				24.2035	0.082562687	3.641643656	0	0.661568154	2.551636632	1.247284033	5.793645819	17.48486035	2.537304633	6.091494513	2.138403458	0.187876415	3.873888924	9.625685969	21.11005748	0.101440955	1.55882208	0	0	7.318929393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2106	0	0	24.2035	0.082562687	3.641643656	0	0.661568154	2.551636632	1.247284033	5.793645819	17.48486035	2.537304633	6.091494513	2.138403458	0.187876415	3.873888924	9.625685969	21.11005748	0.101440955	1.55882208	0	0	7.318929393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2106	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.4483	0.0015	0.1449	0	1.1208	0.5358	0.2619	0.4726	1.3014	0.207	0.4511	0.1744	0.0153	0.3136	0.5581	1.224	0.0059	0.1032	0	0	0.0134	0																			7.3532	0	0	24.6518	0.084089932	3.786500133	0	1.782352123	3.087457167	1.50918735	6.266267932	18.78627293	2.744270832	6.542574239	2.312830673	0.203197254	4.187508403	10.18378057	22.33405702	0.107325666	1.662027835	0	0	7.332351501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5638
H1681_802_0	2010	5	N/A																															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	NO	267.7548922	0.913361238	20.79382044	13.467443	2.839348301	10.95123018	5.353150357	24.8654327	75.04231911	10.88971945	26.14375327	9.177697245	0.806336544	16.62613272	41.31195695	90.60110506	0.435368906	6.69022352	0	0	31.41171413	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																			0.090394341	0.090394341	0.175131052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.090394341	0.090394341	0.175131052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				24.2035	0.082562687	3.641643656	0	0.661568154	2.551636632	1.247284033	5.793645819	17.48486035	2.537304633	6.091494513	2.138403458	0.187876415	3.873888924	9.625685969	21.11005748	0.101440955	1.55882208	0	0	7.318929393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2106	0	0	24.2035	0.082562687	3.641643656	0	0.661568154	2.551636632	1.247284033	5.793645819	17.48486035	2.537304633	6.091494513	2.138403458	0.187876415	3.873888924	9.625685969	21.11005748	0.101440955	1.55882208	0	0	7.318929393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2106	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.4483	0.0015	0.1449	0	1.1208	0.5358	0.2619	0.4726	1.3014	0.207	0.4511	0.1744	0.0153	0.3136	0.5581	1.224	0.0059	0.1032	0	0	0.0134	0																			7.3532	0	0	24.6518	0.084089932	3.786500133	0	1.782352123	3.087457167	1.50918735	6.266267932	18.78627293	2.744270832	6.542574239	2.312830673	0.203197254	4.187508403	10.18378057	22.33405702	0.107325666	1.662027835	0	0	7.332351501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5638
H1681_803_0	2010	5	N/A																															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	NO	267.7548922	0.913361238	20.79382044	13.467443	2.839348301	10.95123018	5.353150357	24.8654327	75.04231911	10.88971945	26.14375327	9.177697245	0.806336544	16.62613272	41.31195695	90.60110506	0.435368906	6.69022352	0	0	31.41171413	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																			0.090394341	0.090394341	0.175131052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.090394341	0.090394341	0.175131052	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				24.2035	0.082562687	3.641643656	0	0.661568154	2.551636632	1.247284033	5.793645819	17.48486035	2.537304633	6.091494513	2.138403458	0.187876415	3.873888924	9.625685969	21.11005748	0.101440955	1.55882208	0	0	7.318929393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2106	0	0	24.2035	0.082562687	3.641643656	0	0.661568154	2.551636632	1.247284033	5.793645819	17.48486035	2.537304633	6.091494513	2.138403458	0.187876415	3.873888924	9.625685969	21.11005748	0.101440955	1.55882208	0	0	7.318929393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2106	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.4483	0.0015	0.1449	0	1.1208	0.5358	0.2619	0.4726	1.3014	0.207	0.4511	0.1744	0.0153	0.3136	0.5581	1.224	0.0059	0.1032	0	0	0.0134	0																			7.3532	0	0	24.6518	0.084089932	3.786500133	0	1.782352123	3.087457167	1.50918735	6.266267932	18.78627293	2.744270832	6.542574239	2.312830673	0.203197254	4.187508403	10.18378057	22.33405702	0.107325666	1.662027835	0	0	7.332351501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5638
H1689_012_0	2010	7	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1393.159591	134.307869	272.5994461	56.34101286	145.1207907	18.60647899	0.562045649	412.0612414	315.3062876	4489.206957	997.6614332	73.30197456	0.998580386	625.7617093	2781.247411	2260.155909	36.09971244	1008.699211	2652.020904	0	29.88376243	0	0	0	302.4	0	162	0	0	0	53.89851071	3.13910543	908.8545206	294.2252894	323.2494475	0	5.368243017	15.02334525	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	94.07077256	250	0.2	35	25	35	40	41.34076763	77.87038864	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	137.08216	82.94632394	118.0330806	0	113.4933468	0.181589355	0.181589355	45.39733871	226.9866935	31.7781371	85.41125448	226.9866935	0.181589355	31.7781371	22.69866935	31.7781371	36.31787097	37.53521661	70.70216816	0	0.181589355	0	0	0	35	0	35	0	0	0	181.5893548	31.7781371	31.7781371	31.7781371	31.7781371	0	0.181589355	0.181589355	0	0		15.9148	0.928362001	2.6813127	0	1.372520352	3.378738516	0.102061507	1.558873645	5.964194307	11.88821951	7.100959547	1.386547736	0.181331568	1.657128449	5.260884614	5.985295362	0.109255392	3.155145283	15.62530233	0	5.42657314	0	0	0	0.882	0	0.4725	0	0	0	0.815616315	0.00831291	2.40680863	0.779160965	0.856022105	0	0.974815786	2.728079571	0	0	99.6008		9.95905389	15.9148	0.928362001	2.6813127	0	1.372520352	3.378738516	0.102061507	1.558873645	5.964194307	11.88821951	7.100959547	1.386547736	0.181331568	1.657128449	5.260884614	5.985295362	0.109255392	3.155145283	15.62530233	0	5.42657314	0	0	0	0.882	0	0.4725	0	0	0	0.815616315	0.00831291	2.40680863	0.779160965	0.856022105	0	0.974815786	2.728079571	0	0	99.6008	YES																																									5000																								0	0	0	0	0													0			15.9148	0.928362001	2.6813127	0	1.372520352	3.378738516	0.102061507	1.558873645	5.964194307	11.88821951	7.100959547	1.386547736	0.181331568	1.657128449	5.260884614	5.985295362	0.109255392	3.155145283	15.62530233	0	5.42657314	0	0	0	0.882	0	0.4725	0	0	0	0.815616315	0.00831291	2.40680863	0.779160965	0.856022105	0	0.974815786	2.728079571	0	0	99.6008
H1689_013_0	2010	13	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1128.980101	43.45039844	160.291806	32.49651648	106.9829138	16.4636517	0.572363475	340.1295258	303.6187776	4278.327467	942.3247938	60.1704639	0.578859709	514.2154012	2694.755468	2033.150706	58.07083906	1009.358457	2502.416793	0	30.12866726	0	0	0	302.4	0	162	0	0	0	60.86207842	7.049061389	494.3852058	252.3044145	271.6562726	0.365129399	3.271410698	9.636082557	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	92.72477064	250	0.2	35	25	35	40	41.01097439	78.51441985	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	146.2469235	95.43283761	119.833279	0	115.2243068	0.184358891	0.184358891	46.08972271	230.4486135	32.2628059	85.47317934	230.4486135	0.184358891	32.2628059	23.04486135	32.2628059	36.87177817	37.80368876	72.37415679	0	0.184358891	0	0	0	35	0	35	0	0	0	184.3588908	32.2628059	32.2628059	32.2628059	32.2628059	32.2628059	0.184358891	0.184358891	0	0		13.7592	0.345549568	1.60069106	0	1.027252673	3.035220566	0.105520295	1.306372961	5.830710528	11.50257072	6.711958008	1.155516665	0.106717934	1.38250264	5.175022179	5.466262216	0.178431258	3.179789412	15.09252544	0	5.554487677	0	0	0	0.882	0	0.4725	0	0	0	0.935038773	0.018951875	1.329187828	0.678337363	0.730366133	0.000981675	0.603113648	1.776497492	0	0	89.9432		7.514386125	13.7592	0.345549568	1.60069106	0	1.027252673	3.035220566	0.105520295	1.306372961	5.830710528	11.50257072	6.711958008	1.155516665	0.106717934	1.38250264	5.175022179	5.466262216	0.178431258	3.179789412	15.09252544	0	5.554487677	0	0	0	0.882	0	0.4725	0	0	0	0.935038773	0.018951875	1.329187828	0.678337363	0.730366133	0.000981675	0.603113648	1.776497492	0	0	89.9432	YES																																									5000																								0	0	0	0	0													0			13.7592	0.345549568	1.60069106	0	1.027252673	3.035220566	0.105520295	1.306372961	5.830710528	11.50257072	6.711958008	1.155516665	0.106717934	1.38250264	5.175022179	5.466262216	0.178431258	3.179789412	15.09252544	0	5.554487677	0	0	0	0.882	0	0.4725	0	0	0	0.935038773	0.018951875	1.329187828	0.678337363	0.730366133	0.000981675	0.603113648	1.776497492	0	0	89.9432
H1689_801_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	387.0776303	4.634598688	57.27996317	8.472574991	8.230505804	19.4208039	3.011463353	18.89025338	57.7848118	11.17351405	35.00814482	0	0.379964833	46.93914957	41.64016683	120.3777424	1.25848954	6.001567701	31.56106277	37.48543769	61.89788368	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.079576513	0.079576513	0.16902334	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.079576513	0.079576513	0.16902334	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				30.8023	0.368805204	9.68165069	0	1.917707852	4.525047308	0.701670961	4.401429037	13.46386115	2.603428774	8.156897742	0	0.088531806	10.93682185	9.702158871	28.04801399	0.293228063	1.398365274	7.353727626	8.734106982	14.4222069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.5999			30.8023	0.368805204	9.68165069	0	1.917707852	4.525047308	0.701670961	4.401429037	13.46386115	2.603428774	8.156897742	0	0.088531806	10.93682185	9.702158871	28.04801399	0.293228063	1.398365274	7.353727626	8.734106982	14.4222069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.5999	NO																																																																																		0			30.8023	0.368805204	9.68165069	0	1.917707852	4.525047308	0.701670961	4.401429037	13.46386115	2.603428774	8.156897742	0	0.088531806	10.93682185	9.702158871	28.04801399	0.293228063	1.398365274	7.353727626	8.734106982	14.4222069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.5999
H1689_802_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	291.3728111	3.488695657	48.91496867	9.634484281	7.277689135	16.75408074	0.462321318	9.507440184	47.24431393	7.117834544	22.30114728	0	0.242048008	29.90152416	45.80995769	132.4322093	1.384513007	6.602556699	34.72154558	41.23917951	52.4357203	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.075937689	0.075937689	0.165996812	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.075937689	0.075937689	0.165996812	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				22.1262	0.264923484	8.119728883	0	1.695701568	3.903700813	0.107720867	2.215233563	11.00792515	1.658455449	5.196167317	0	0.056397186	6.967055129	10.67372014	30.85670476	0.322591531	1.538395711	8.090120119	9.608728825	12.21752283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.627			22.1262	0.264923484	8.119728883	0	1.695701568	3.903700813	0.107720867	2.215233563	11.00792515	1.658455449	5.196167317	0	0.056397186	6.967055129	10.67372014	30.85670476	0.322591531	1.538395711	8.090120119	9.608728825	12.21752283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.627	NO																																																																																		0			22.1262	0.264923484	8.119728883	0	1.695701568	3.903700813	0.107720867	2.215233563	11.00792515	1.658455449	5.196167317	0	0.056397186	6.967055129	10.67372014	30.85670476	0.322591531	1.538395711	8.090120119	9.608728825	12.21752283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.627
H1716_001_0	2010	9	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	P	O	O	O	O	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	YES	1092.995982	44.503702	566.939819	655.464422	34.946549	7.186299	2.728697	306.117811	450.927793	978.585868	982.357752	36.423608	0.100795	737.599625	3424.196204	4157.155398	120.553344	773.744834			22.872612	0							0.04	0.25	31.00041	0.05	0.55	3.57	0.25	0.32	0.4	0.73			5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $80(Days 15-100):2. $0 SNF 1,2. $80 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$0-$100/Visit:9d. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			158.7573	140.3991	38.58248	0	150	0.2	0.2	50	100	0	46.484509	100	0.2	36.629028	10	35	35	40.074012			0.2	0							0	0	0	0	0	0	0	0	0	0			NO	147.876868	130.776848	29.256169	0	134.87655	0.179835	0.179835	44.95885	89.9177	0	41.797801	89.9177	0.179835	32.935979	8.99177	31.471195	31.471195	36.03363			0.179835	0							0	0	0	0	0	0	0	0	0	0				13.4691	0.485004489	1.382207263	0	0.392789164	1.292348081	0.490715225	1.146892062	3.378865834	0	3.421699486	0.272927255	0.018126469	2.024463813	2.565798725	10.90255401	0.31616315	2.323402922	0	0	4.113296179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9963	0	5.12944	13.4691	0.485004489	1.382207263	0	0.392789164	1.292348081	0.490715225	1.146892062	3.378865834	0	3.421699486	0.272927255	0.018126469	2.024463813	2.565798725	10.90255401	0.31616315	2.323402922	0	0	4.113296179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9963	YES	$265/Day(Days 1-15)	$265/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			7500	3.5971	0.1407	0.5927	1.9906	1.8122	1.4743	0.5598	0.2334	3.7436	0.5138	1.7413	0.2491	0.0039	1.0729	2.0625	3.4032	0.0471	0.3211			1.1776	0							0	0	0	0	0	0	0	0	0	0			24.7371	500	5.010501	17.0662	0.625726489	1.974926263	1.990579	2.205038164	2.766628081	1.050511225	1.380342062	7.122498834	0.513783	5.163016486	0.522056255	0.022009469	3.097373813	4.628306725	14.30573801	0.36323215	2.644468922	0	0	5.290941179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7334
H1716_002_0	2010	9	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	O	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	YES	1171.340552	50.612694	390.264986	549.396501	34.298398	7.665469	3.271832	288.663954	354.503375	1655.954261	1087.831431	65.116509	0.108296	517.027082	3237.658225	4035.538285	96.536807	772.406669			22.922835	0							0.04	0.25	16.521339	0.05	0.55	3.57	0.25	0.32	0.4	0.42			4000	$215/Day(Days 1-8):1a	$215/Day(Days 1-8):1b	"$0/Day(Days 1-14) $80(Days 15-100):2. $0 SNF 1,2. $80 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	$0/Visit:8a	"$0-$75/Visit:14h. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $75 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $35 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$75/Visit:9d. $0 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $35 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			159.342305	143.633115	38.58248	0	150	0.2	0.2	50	188.394497	0	39.577765	50	0.2	38.110219	10	35	35	39.022936			0.2	0							0	0	0	0	0	0	0	0	0	0			NO	142.200738	128.181495	26.882304	0	129.31665	0.172422	0.172422	43.10555	162.416968	0	34.120427	43.10555	0.172422	32.855239	8.62111	30.173885	30.173885	33.642102			0.172422	0							0	0	0	0	0	0	0	0	0	0				13.8805	0.540634232	0.8742685	0	0.369612827	1.321695496	0.564135817	1.036918209	4.798113609	0	3.093106077	0.233906911	0.018672613	1.415587362	2.326017308	10.14732234	0.242740876	2.165448662	0	0	3.952401056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.981	0	7.186819	13.8805	0.540634232	0.8742685	0	0.369612827	1.321695496	0.564135817	1.036918209	4.798113609	0	3.093106077	0.233906911	0.018672613	1.415587362	2.326017308	10.14732234	0.242740876	2.165448662	0	0	3.952401056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.981	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	2.8076	0.1166	0.3105	1.4134	1.3174	1.1648	0.4972	0.1631	2.409	0.2797	1.2019	0.2327	0.0031	0.5127	1.2483	2.339	0.028	0.2242			0.8852	0							0	0	0	0	0	0	0	0	0	0			17.1543	0	5.592123	16.6881	0.657191232	1.1847625	1.413357	1.687043827	2.486502496	1.061306817	1.199974209	7.207086609	0.279726	4.295052077	0.466621911	0.021762613	1.928322362	3.574283308	12.48634934	0.270692876	2.389662662	0	0	4.837603056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1354
H1716_004_0	2010	9	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	O	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			0	YES	1161.844309	47.962073	724.60509	469.956024	40.27675	7.631459	2.790071	341.566195	405.753891	1541.570169	1135.947036	51.068026	0.076966	833.210116	3543.381908	4088.242465	109.024851	883.131921			19.589658	0		1.44	1.72				0.04	0.25	12.956963	0.05	0.55	3.2	0.25	0.32	0.4	0.42			4000	$215/Day(Days 1-8):1a	$215/Day(Days 1-8):1b	"$0/Day(Days 1-14) $80(Days 15-100):2. $0 SNF 1,2. $80 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	$0/Visit:8a	"$0-$75/Visit:14h. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $75 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $35 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$75/Visit:9d. $0 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $35 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			159.342305	143.633115	38.58248	0	150	0.2	0.2	50	191.930019	0	38.909607	50	0.2	39.460834	10	35	35	41.62129			0.2	0		0	0				0	0	0	0	0	0	0	0	0	0			NO	139.425632	125.679981	21.663792	0	127.42605	0.169901	0.169901	42.47535	163.045895	0	33.053983	42.47535	0.169901	33.522255	8.49507	29.732745	29.732745	35.357578			0.169901	0		0	0				0	0	0	0	0	0	0	0	0	0				13.4992	0.502322702	1.308141163	0	0.427692263	1.296592516	0.474035853	1.209011973	5.513042192	0	3.128964501	0.180761023	0.0130766	2.327590165	2.508439779	10.12955589	0.270134008	2.602117148	0	0	3.328302484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.719	0	8.940281	13.4992	0.502322702	1.308141163	0	0.427692263	1.296592516	0.474035853	1.209011973	5.513042192	0	3.128964501	0.180761023	0.0130766	2.327590165	2.508439779	10.12955589	0.270134008	2.602117148	0	0	3.328302484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.719	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	2.757	0.1094	0.3753	1.3003	1.5405	1.1547	0.4222	0.1921	2.5689	0.3179	1.279	0.1658	0.0022	0.5896	1.2791	2.1189	0.029	0.2311			0.7267	0		0	0				0	0	0	0	0	0	0	0	0	0			17.1595	0	6.201074	16.2563	0.611672702	1.683415163	1.300268	1.968161263	2.451287516	0.896193853	1.401127973	8.081954192	0.317897	4.407923501	0.346590023	0.0152636	2.917206165	3.787511779	12.24845389	0.299088008	2.833249148	0	0	4.054988484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8785
H1716_006_0	2010	11	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	O	O	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	YES	1525.703294	94.402625	489.611091	518.690302	48.778132	9.959288	3.230383	372.238005	323.720498	1732.324373	1050.799465	85.195776	0.035657	647.094017	3385.435481	4134.936684	100.171353	678.108826			28.666137	0		1.44					0.04	0.25	15.05983	0.05	0.55	3.2	0.25	0.32	0.4	0.42			4000	$215/Day(Days 1-8):1a	$215/Day(Days 1-8):1b	"$0/Day(Days 1-14) $80(Days 15-100):2. $0 SNF 1,2. $80 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	$0/Visit:8a	"$0-$75/Visit:14h. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $75 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $35 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$75/Visit:9d. $0 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $35 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			159.342305	143.633115	38.58248	0	150	0.2	0.2	50	190.135366	0	38.271077	50	0.2	38.948604	10	35	35	39.611484			0.2	0		0					0	0	0	0	0	0	0	0	0	0			NO	134.598198	121.328472	22.824238	0	125.03085	0.166708	0.166708	41.67695	158.485243	0	31.900435	41.67695	0.166708	32.465181	8.33539	29.173865	29.173865	33.017717			0.166708	0		0					0	0	0	0	0	0	0	0	0	0				17.1131	0.954477187	0.931250006	0	0.508230942	1.660292984	0.538530689	1.29281206	4.275410149	0	2.793413336	0.295891675	0.005944307	1.750668699	2.351577088	10.05267372	0.243532127	1.865800443	0	0	4.778874367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4125	0	10.437564	17.1131	0.954477187	0.931250006	0	0.508230942	1.660292984	0.538530689	1.29281206	4.275410149	0	2.793413336	0.295891675	0.005944307	1.750668699	2.351577088	10.05267372	0.243532127	1.865800443	0	0	4.778874367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4125	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	3.3225	0.1975	0.3	1.5843	1.7758	1.4343	0.4652	0.1993	2.4061	0.469	1.1816	0.218	0.001	0.6901	1.2877	2.2009	0.0429	0.1927			1.0337	0		0					0	0	0	0	0	0	0	0	0	0			19.0025	0	7.899454	20.4356	1.151997187	1.231242006	1.584318	2.283986942	3.094617984	1.003766689	1.49209506	6.681483149	0.469	3.974993336	0.513879675	0.006908307	2.440800699	3.639293088	12.25354872	0.286397127	2.058471443	0	0	5.812544367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.415
H1716_801_0	2010	4	N/A																															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	NO	243.567291	0.830834	42.290251	13.665487	1.602561	7.410033	3.622117	17.865748	50.87134	10.982505	26.183139	9.255893	0.81319	16.758306	31.101298	68.208283	0.327773	5.075857			22.169326	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																			0.083786721	0.083786721	0.172724728	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083786721	0.083786721	0.172724728	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.4077	0.069612857	7.304572118	0	0.373396713	1.726537689	0.843953261	4.162719284	11.85302222	2.558923665	6.100671387	2.156623069	0.18947327	3.904685298	7.246602434	15.89252994	0.076371109	1.182674681	0	0	5.165452958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2155	0	0	20.4077	0.069612857	7.304572118	0	0.373396713	1.726537689	0.843953261	4.162719284	11.85302222	2.558923665	6.100671387	2.156623069	0.18947327	3.904685298	7.246602434	15.89252994	0.076371109	1.182674681	0	0	5.165452958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2155	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7989	0.0129	1.3598	0	1.4935	1.1383	0.5564	1.0975	2.8561	0.6747	1.4627	0.5686	0.05	1.0219	1.3654	2.9944	0.0144	0.254			0.9732	0																			21.6929	0	0	24.2066	0.082557905	8.664347543	0	1.866926713	2.864859189	1.400357261	5.260265784	14.70913622	3.233575165	7.563328887	2.725259569	0.23945177	4.926623298	8.611982434	18.88692944	0.090817109	1.436644681	0	0	6.138693958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9084
H1716_802_0	2010	4	N/A																															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	NO	243.567291	0.830834	42.290251	13.665487	1.602561	7.410033	3.622117	17.865748	50.87134	10.982505	26.183139	9.255893	0.81319	16.758306	31.101298	68.208283	0.327773	5.075857			22.169326	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																			0.083786721	0.083786721	0.172724728	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083786721	0.083786721	0.172724728	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.4077	0.069612857	7.304572118	0	0.373396713	1.726537689	0.843953261	4.162719284	11.85302222	2.558923665	6.100671387	2.156623069	0.18947327	3.904685298	7.246602434	15.89252994	0.076371109	1.182674681	0	0	5.165452958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2155	0	0	20.4077	0.069612857	7.304572118	0	0.373396713	1.726537689	0.843953261	4.162719284	11.85302222	2.558923665	6.100671387	2.156623069	0.18947327	3.904685298	7.246602434	15.89252994	0.076371109	1.182674681	0	0	5.165452958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2155	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7989	0.0129	1.3598	0	1.4935	1.1383	0.5564	1.0975	2.8561	0.6747	1.4627	0.5686	0.05	1.0219	1.3654	2.9944	0.0144	0.254			0.9732	0																			21.6929	0	0	24.2066	0.082557905	8.664347543	0	1.866926713	2.864859189	1.400357261	5.260265784	14.70913622	3.233575165	7.563328887	2.725259569	0.23945177	4.926623298	8.611982434	18.88692944	0.090817109	1.436644681	0	0	6.138693958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9084
H1716_803_0	2010	4	N/A																															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	NO	243.567291	0.830834	42.290251	13.665487	1.602561	7.410033	3.622117	17.865748	50.87134	10.982505	26.183139	9.255893	0.81319	16.758306	31.101298	68.208283	0.327773	5.075857			22.169326	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																			0.083786721	0.083786721	0.172724728	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083786721	0.083786721	0.172724728	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.4077	0.069612857	7.304572118	0	0.373396713	1.726537689	0.843953261	4.162719284	11.85302222	2.558923665	6.100671387	2.156623069	0.18947327	3.904685298	7.246602434	15.89252994	0.076371109	1.182674681	0	0	5.165452958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2155	0	0	20.4077	0.069612857	7.304572118	0	0.373396713	1.726537689	0.843953261	4.162719284	11.85302222	2.558923665	6.100671387	2.156623069	0.18947327	3.904685298	7.246602434	15.89252994	0.076371109	1.182674681	0	0	5.165452958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2155	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7989	0.0129	1.3598	0	1.4935	1.1383	0.5564	1.0975	2.8561	0.6747	1.4627	0.5686	0.05	1.0219	1.3654	2.9944	0.0144	0.254			0.9732	0																			21.6929	0	0	24.2066	0.082557905	8.664347543	0	1.866926713	2.864859189	1.400357261	5.260265784	14.70913622	3.233575165	7.563328887	2.725259569	0.23945177	4.926623298	8.611982434	18.88692944	0.090817109	1.436644681	0	0	6.138693958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9084
H1717_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1406.271685	160.6315052	797.8438662	877.0928171	181.888231	9.870979759	7.934892626	269.0651122	23.1723168	8212.703773	23.666895	0	0.032148418	13.92070021	4714.111525	3637.281566	377.2079822	226.562893	0	0	16.4381689	753.3698994	0	0	95.99210235	0	12.71370565	4.406334704	82.63178893	0												"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$25 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	81.80667226	0	150	0.2	0.113144895	49.61253747	0.2	3	0.177874797	0	0.2	0.149342149	17.07815901	30	38.5	30	0	0	0.2	28.19600123	0	0	30	0	0	0	0	0											NO	125.8055307	95.81615547	62.06711928	0	113.805728	0.151740971	0.085843581	37.64127296	0.151740971	2.27611456	0.134954472	0	0.151740971	0.113573914	16.96804616	30	38.5	22.7611456	0	0	0.151740971	28.19600123	0	0	30	0	0	0	0	0												14.7431	1.282591106	4.126655867	0	1.724993545	1.49783205	0.681159596	0.843996111	3.516189843	1.557754553	3.193953312	0	0.004878232	1.581028409	6.66577183	9.093203916	1.210208943	0.429735916	0	0	2.494343704	1.770168218	0	0	0.239980256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6575	0	12.02135333	14.7431	1.282591106	4.126655867	0	1.724993545	1.49783205	0.681159596	0.843996111	3.516189843	1.557754553	3.193953312	0	0.004878232	1.581028409	6.66577183	9.093203916	1.210208943	0.429735916	0	0	2.494343704	1.770168218	0	0	0.239980256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6575	YES	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$35 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$35 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											3900	6.7256	0.1662	2.1653	0.5218	0.5904	0.769	0.6182	0.3779	1.8053	0.5332	1.6011	0	0.0017	0.8087	3.2899	3.9004	0.4437	0.1859	0	0	1.2141	0.7819	0	0	0.1038	0	0.0138	0.0029	0	0											26.6209	0	5.710518245	21.4687	1.448767744	6.291994074	0.521827884	2.315427577	2.266853203	1.299345473	1.221886154	5.321481944	2.090945709	4.795016139	0	0.006547963	2.389728122	9.955700577	12.99362713	1.653927935	0.61567022	0	0	3.708477892	2.552035327	0	0	0.343812773	0	0.013752132	0.002898904	0	0	0	0	0	0	0	0	0	0	0	0	83.2784
H1717_006_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	333.9775077	18.69572145	1623.731192	1428.501298	12.43697152	19.51495921	14.08322303	27.67807524	25.84619776	12.10399889	32.6964659	0	0.077306317	21.00965952	28.27749653	102.4061633	7.862256318	3.096952269	0	0	21.51590405	4.72907186	625.0183356	418.8180901	85.38196906	161.5693657	0	0	73.66287527	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081715908	0.082708409	43.47002967	0	0.2	0.2	0.2	0.104197713	0.2	0	0.166964733	0	0.2	0.149667362	0.167379864	0.199770717	0.2	0	0	0	0.2	0.199402147	0	0	0	0	0	0	0	0											NO	0.081715908	0.082708409	43.47002967	0	0.2	0.2	0.2	0.104197713	0.2	0	0.166964733	0	0.2	0.149667362	0.167379864	0.199770717	0.2	0	0	0	0.2	0.199402147	0	0	0	0	0	0	0	0												27.2913	1.54629338	5.881970257	0	2.487394304	3.902991842	2.816644607	2.883992141	5.169239551	0	5.459156696	0	0.015461263	3.144460307	4.73308352	20.45775261	1.572451264	0	0	0	4.30318081	0.942987085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.6083	0	0	27.2913	1.54629338	5.881970257	0	2.487394304	3.902991842	2.816644607	2.883992141	5.169239551	0	5.459156696	0	0.015461263	3.144460307	4.73308352	20.45775261	1.572451264	0	0	0	4.30318081	0.942987085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.6083	NO	"30% (1a); 25% (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												16.9579	0.9512	4.4168	0.6535	0.7373	1.1569	0.8349	0.5695	1.5322	0.2153	1.6181	0	0.0031	0.932	2.552	9.4374	0.7246	0	0	0	1.9828	0.4345	0	0.0918	0.0492	0.0298	0	0	0	0											45.8807	0	0	44.2491	2.497479208	10.29872036	0.653526472	3.22467585	5.059866669	3.651518307	3.453478477	6.701439298	0.215262735	7.077289969	0	0.018516483	4.076500937	7.285086332	29.89518334	2.29701214	0	0	0	6.286019027	1.377500741	0	0.091846072	0.04917834	0.029762778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.489
H1717_007_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	356.8749711	18.77888411	1678.469945	1476.658518	13.289649	20.8529028	15.04876735	29.57473297	27.6182104	12.9338478	34.93813223	0	0.08260643	22.43758605	30.18343265	109.4191926	7.86332516	3.309278997	0	0	22.99103221	5.053296538	625.6695211	419.2544425	85.47092565	161.7376993	0	0	73.73962213	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.084991857	0.086024147	43.47002967	0	0.2	0.2	0.2	0.10082085	0.2	0	0.166964733	0	0.2	0.149639336	0.167561566	0.199785188	0.2	0	0	0	0.2	0.199402147	0	0	0	0	0	0	0	0											NO	0.084991857	0.086024147	43.47002967	0	0.2	0.2	0.2	0.10082085	0.2	0	0.166964733	0	0.2	0.149639336	0.167561566	0.199785188	0.2	0	0	0	0.2	0.199402147	0	0	0	0	0	0	0	0												30.3315	1.61543749	6.080261525	0	2.657929801	4.170580559	3.00975347	2.981749709	5.523642081	0	5.833435916	0	0.016521286	3.35754547	5.057583237	21.86033402	1.572665032	0	0	0	4.598206442	1.007638182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6748	0	0	30.3315	1.61543749	6.080261525	0	2.657929801	4.170580559	3.00975347	2.981749709	5.523642081	0	5.833435916	0	0.016521286	3.35754547	5.057583237	21.86033402	1.572665032	0	0	0	4.598206442	1.007638182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.6748	NO	"30% (1a); 25% (1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												18.1205	0.9554	4.7196	0.6983	0.7878	1.2362	0.8921	0.5888	1.6372	0.23	1.7291	0	0.0033	0.9952	2.7239	10.0837	0.7247	0	0	0	2.1188	0.4643	0	0.0919	0.0492	0.0298	0	0	0	0											48.8799	0	0	48.4519	2.570854401	10.79982355	0.698332179	3.445759293	5.406770605	3.901866026	3.570552987	7.160889284	0.230021126	7.562508238	0	0.019785971	4.352746073	7.781531475	31.94406353	2.297324409	0	0	0	6.716987842	1.47194205	0	0.091941764	0.049229577	0.029793787	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.5547
H1717_009_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	292.675873	35.28676244	11029.90551	103.2589989	26.30929421	17.25661691	15.57634666	18.99167055	5.460510791	42.58899428	25.13917871	0	0.02200647	10.72805076	1.05321862	108.1434961	16.30040279	30.89433619	0	0	1.365421856	11.53951059	1916.729831	0	106.7711973	189.1931161	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.084991857	0.086024147	0	0	0.2	0.2	0.090268188	0.041259915	0.2	0	0.07287301	0	0.2	0.151087981	0.004717794	0.198815228	0.2	0	0	0	0.2	0.189287003	0	0	0	0	0	0	0	0											NO	0.084991857	0.086024147	0	0	0.2	0.2	0.090268188	0.041259915	0.2	0	0.07287301	0	0.2	0.151087981	0.004717794	0.198815228	0.2	0	0	0	0.2	0.189287003	0	0	0	0	0	0	0	0												24.8751	3.035513644	0	0	5.261858843	3.451323382	1.406048582	0.78359472	1.092102158	0	1.831967622	0	0.004401294	1.620879533	0.004968869	21.50057378	3.260080558	0	0	0	0.273084371	2.184279374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5857	0	0	24.8751	3.035513644	0	0	5.261858843	3.451323382	1.406048582	0.78359472	1.092102158	0	1.831967622	0	0.004401294	1.620879533	0.004968869	21.50057378	3.260080558	0	0	0	0.273084371	2.184279374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5857	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.1191	0.8583	0.5747	0.0658	0.9755	0.6399	0.5775	0.0968	0.2025	0.4737	0.7391	0	0.0005	0.3005	0.0287	3.0138	0.4543	0	0	0	0.0381	0.3044	0	0	0.0186	0	0	0	0	0											16.4819	0	0	31.9942	3.893840297	0.574727278	0.065818171	6.237371999	4.09117547	1.983598514	0.880443505	1.294570536	0.473742745	2.571019753	0	0.004945274	1.921379671	0.03362848	24.51440892	3.714354079	0	0	0	0.311137111	2.488646172	0	0	0.018597442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0676
H1717_010_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2136.648625	205.7421228	35.0531599	1004.185094	254.6035647	18.79236467	17.52208302	478.8584582	40.08506163	13201.33558	42.81452172	0	0.184571634	24.79514782	7873.816791	5520.203673	826.5693156	308.4978198	0	0	28.98300717	1095.99157	676.8221373	0	126.6099472	0	14.7753185	4.592721646	79.76832332	0											2800	"$175 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											158.6613559	122.8528282	0.169496057	0	150	0.2	0.092139791	49.55905036	0.2	3	0.176814213	0	0.2	0.149834692	10.05277632	34.84885061	38.5	35	0	0	0.2	34.73720257	0	0	35	0	0	0	0	0											NO	113.2976261	80.50279812	0.111067096	0	98.29175194	0.131055669	0.06037721	32.47497256	0.131055669	1.965835039	0.115862525	0	0.131055669	0.098585331	9.89354036	34.84885061	38.5	22.93474212	0	0	0.131055669	34.73720257	0	0	35	0	0	0	0	0												20.1731	1.380234715	3.893252666	0	2.085452535	2.462845928	1.057934482	1.295909608	5.253374578	2.162637336	4.960598599	0	0.024189159	2.444437863	6.491660351	16.03106276	2.651909888	0.589609828	0	0	3.798387402	3.172640098	0	0	0.369279013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2985	0	27.22495092	20.1731	1.380234715	3.893252666	0	2.085452535	2.462845928	1.057934482	1.295909608	5.253374578	2.162637336	4.960598599	0	0.024189159	2.444437863	6.491660351	16.03106276	2.651909888	0.589609828	0	0	3.798387402	3.172640098	0	0	0.369279013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2985	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												11.3098	0.3327	1.7834	0.2906	0.3933	0.6968	0.6497	0.2444	1.4863	0.4079	1.3724	0	0.0046	0.6978	2.1139	7.4264	0.5707	0.2299	0	0	1.6562	0.3884	0	0	0.0366	0	0.0037	0.003	0	0											32.0985	0	0	31.4829	1.712904881	5.676659047	0.290645341	2.478800739	3.159641472	1.707629695	1.540337955	6.739674616	2.570543772	6.33295149	0	0.028751604	3.142275238	8.605555702	23.45744705	3.22263632	0.819551637	0	0	5.45455924	3.561024297	0	0	0.405888186	0	0.0036838	0.003021527	0	0	0	0	0	0	0	0	0	0	0	0	112.3971
H1717_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	235.8222006	4.720575942	25.05148704	920.6324123	6.123520338	10.36098316	8.328787099	12.0674645	24.3226093	11.61141937	24.84173877	0	0.033744292	14.59590766	25.05618399	84.53147508	1.984396699	2.960504017	0	0	17.25417287	4.914511794	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.082708409	0.082708409	0.176560705	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082708409	0.082708409	0.176560705	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.5045	0.390431327	4.423108205	0	1.426780239	2.414109076	1.940607394	2.811719229	5.667167967	2.705460713	5.788125132	0	0.00786242	3.400846485	5.83809087	19.69583369	0.462364431	0.689797436	0	0	4.020222278	1.145081248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3321	0	0	19.5045	0.390431327	4.423108205	0	1.426780239	2.414109076	1.940607394	2.811719229	5.667167967	2.705460713	5.788125132	0	0.00786242	3.400846485	5.83809087	19.69583369	0.462364431	0.689797436	0	0	4.020222278	1.145081248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3321	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.5345	0.0507	1.7631	0	0.4884	0.8263	0.6642	0.9624	1.9398	0.926	1.9812	0	0.0027	1.164	1.8945	6.3914	0.15	0.2238	0	0	1.3046	0.3716	0	0	0	0	0	0	0	0											23.6392	0	0	22.039	0.441165341	6.186165322	0	1.91514126	3.240414867	2.60484214	3.77411977	7.606936868	3.631490889	7.76929548	0	0.010553584	4.564894611	7.732570689	26.08719695	0.61240322	0.913638988	0	0	5.324797719	1.516663905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9713
H1717_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	235.8222006	4.720575942	25.05148704	920.6324123	6.123520338	10.36098316	8.328787099	12.0674645	24.3226093	11.61141937	24.84173877	0	0.033744292	14.59590766	25.05618399	84.53147508	1.984396699	2.960504017	0	0	17.25417287	4.914511794	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.082708409	0.082708409	0.176560705	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082708409	0.082708409	0.176560705	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.5045	0.390431327	4.423108205	0	1.426780239	2.414109076	1.940607394	2.811719229	5.667167967	2.705460713	5.788125132	0	0.00786242	3.400846485	5.83809087	19.69583369	0.462364431	0.689797436	0	0	4.020222278	1.145081248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3321	0	0	19.5045	0.390431327	4.423108205	0	1.426780239	2.414109076	1.940607394	2.811719229	5.667167967	2.705460713	5.788125132	0	0.00786242	3.400846485	5.83809087	19.69583369	0.462364431	0.689797436	0	0	4.020222278	1.145081248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3321	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.5345	0.0507	1.7631	0	0.4884	0.8263	0.6642	0.9624	1.9398	0.926	1.9812	0	0.0027	1.164	1.8945	6.3914	0.15	0.2238	0	0	1.3046	0.3716	0	0	0	0	0	0	0	0											23.6392	0	0	22.039	0.441165341	6.186165322	0	1.91514126	3.240414867	2.60484214	3.77411977	7.606936868	3.631490889	7.76929548	0	0.010553584	4.564894611	7.732570689	26.08719695	0.61240322	0.913638988	0	0	5.324797719	1.516663905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9713
H1717_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	235.8222006	4.720575942	25.05148704	920.6324123	6.123520338	10.36098316	8.328787099	12.0674645	24.3226093	11.61141937	24.84173877	0	0.033744292	14.59590766	25.05618399	84.53147508	1.984396699	2.960504017	0	0	17.25417287	4.914511794	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.082708409	0.082708409	0.176560705	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082708409	0.082708409	0.176560705	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.5045	0.390431327	4.423108205	0	1.426780239	2.414109076	1.940607394	2.811719229	5.667167967	2.705460713	5.788125132	0	0.00786242	3.400846485	5.83809087	19.69583369	0.462364431	0.689797436	0	0	4.020222278	1.145081248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3321	0	0	19.5045	0.390431327	4.423108205	0	1.426780239	2.414109076	1.940607394	2.811719229	5.667167967	2.705460713	5.788125132	0	0.00786242	3.400846485	5.83809087	19.69583369	0.462364431	0.689797436	0	0	4.020222278	1.145081248	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.3321	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.5345	0.0507	1.7631	0	0.4884	0.8263	0.6642	0.9624	1.9398	0.926	1.9812	0	0.0027	1.164	1.8945	6.3914	0.15	0.2238	0	0	1.3046	0.3716	0	0	0	0	0	0	0	0											23.6392	0	0	22.039	0.441165341	6.186165322	0	1.91514126	3.240414867	2.60484214	3.77411977	7.606936868	3.631490889	7.76929548	0	0.010553584	4.564894611	7.732570689	26.08719695	0.61240322	0.913638988	0	0	5.324797719	1.516663905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9713
H1777_007_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	P	P	S	V	T	V	V	P	V	P	P	P																																																			0	YES	3519.172383	121.7200399				7.418854298	18.73832344	135.6743869	62.18194159				60.18113755	711.7972812																											1500	"1a (IP Acute) , 1a1 (Additional Days) - $175/day for days 1-8"	1b (IP Mental Health) - $175/day for days 1-8				11a (DME) - 20%	11b (Prosthetics/Med Supplies) - 20%	4a (ER) - $50; 4b (Urgent Care - $35	9b (OP Surgery/ASC) - $35				12 (Renal Dialysis) - $35	5 (Partial Hospital) - $25; 9a (OP Hospital) - $35; 9d (Cardiac Rehab) - $35								16b (Med Covered Comp Dental) - $15; 18a (Med Covered Hearing Exams) - $15																			134.8545527	134.8545527				0.2	0.2	47.78001324	35				35	35																											NO	91.71181233	91.71181233				0.136015893	0.136015893	32.49420593	23.80278134				23.80278134	23.80278134																												26.8958	0.930263788	0	0	0	1.009082095	2.548709803	0.367385956	0.12334193	0	0	0	0.119373205	1.411896254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4059	0	15.71466408	26.8958	0.930263788	0	0	0	1.009082095	2.548709803	0.367385956	0.12334193	0	0	0	0.119373205	1.411896254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4059	NO																																																																																		0	0	0	26.8958	0.930263788	0	0	0	1.009082095	2.548709803	0.367385956	0.12334193	0	0	0	0.119373205	1.411896254	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4059
H1777_008_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	P	P	S	V	T	V	V	P	V	P	P	P																																																			0	YES	2035.084955	217.3917963				4.692812656	12.53856335	182.7744511	66.63790867				46.58269803	503.4641011																											1500	"1a (IP Acute) , 1a1 (Additional Days) - $175/day for days 1-8"	1b (IP Mental Health) - $175/day for days 1-8				11a (DME) - 20%	11b (Prosthetics/Med Supplies) - 20%	4a (ER) - $50; 4b (Urgent Care - $35	9b (OP Surgery/ASC) - $35				12 (Renal Dialysis) - $35	5 (Partial Hospital) - $25; 9a (OP Hospital) - $35; 9d (Cardiac Rehab) - $35								16b (Med Covered Comp Dental) - 15; 18a (Med Covered Hearing Exams) - $15																			134.8545527	134.8545527				0.2	0.2	47.50871883	35				35	34.99976076																											NO	108.2204217	108.2204217				0.160499471	0.160499471	38.12562114	28.08740738				28.08740738	28.08740738																												18.3531	1.960519323	0	0	0	0.753193948	2.012432782	0.580699123	0.155973841	0	0	0	0.109032268	1.178416776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.1034	0	6.178191904	18.3531	1.960519323	0	0	0	0.753193948	2.012432782	0.580699123	0.155973841	0	0	0	0.109032268	1.178416776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.1034	NO																																																																																		0	0	0	18.3531	1.960519323	0	0	0	0.753193948	2.012432782	0.580699123	0.155973841	0	0	0	0.109032268	1.178416776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.1034
H1777_009_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	P	P	S	V	T	V	V	P	V	P	P	P																																																			0	YES	4844.305044	375.3777012				30.26526958	23.70966347	477.3377105	279.547879				95.93265316	1031.991812								0.004516612																			1500	"1a (IP Acute) , 1a1 (Additional Days) - $175/day for days 1-8"	1b (IP Mental Health) - $175/day for days 1-8				11a (DME) - 20%	11b (Prosthetics/Med Supplies) - 20%	4a (ER) - $50; 4b (Urgent Care) - $35	9b (OP Surgery/ASC) - $35				12 (Renal Dialysis) - $35	5 (Partial Hospital) - $25; 9a (OP Hospital) - $35; 9d (Cardiac Rehab) - $35								16b (Med Covered Comp Dental) - $15; 18a (Med Covered Hearing Exams) - $15																			134.8545527	134.8545527				0.2	0.2	47	35				35	34.99529423								15																			NO	86.15202474	86.15202474				0.127770287	0.127770287	30.02601752	22.35980028				22.35980028	22.35679399								9.582771548																				34.7789	2.694962417	0	0	0	3.86700219	3.029390513	1.194379205	0.520886229	0	0	0	0.178752914	1.922669029	0	0	0	0	0	0	0	3.61E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1869	0	27.24051633	34.7789	2.694962417	0	0	0	3.86700219	3.029390513	1.194379205	0.520886229	0	0	0	0.178752914	1.922669029	0	0	0	0	0	0	0	3.61E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1869	NO																																																																																		0	0	0	34.7789	2.694962417	0	0	0	3.86700219	3.029390513	1.194379205	0.520886229	0	0	0	0.178752914	1.922669029	0	0	0	0	0	0	0	3.61E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1869
H1777_010_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	P	P	S	V	T	V	V	P	V	P	P	P																																																			0	YES	3635.021347	117.7149988				13.61141272	11.82866676	320.8789136	322.9459671				17.4221116	1104.296625								0.022775676																			1500	"1a (IP Acute) , 1a1 (Additional Days) - $175/day for days 1-8"	1b (IP Mental Health) - $175/day for days 1-8				11a (DME) - 20%	11b (Prosthetics/Med Supplies) - 20%	4a (ER) - $50; 4b (Urgent Care - $35	9b (OP Surgery/ASC) - $35				12 (Renal Dialysis) - $35	5 (Partial Hospital) - $25; 9a (OP Hospital) - $35; 9d (Cardiac Rehab) - $35								16b (Med Covered Comp Dental) - $15; 18a (Med Covered Hearing Exams) - $15																			134.8545527	134.8545527				0.2	0.2	47	35				35	34.71259056								15																			NO	90.35843005	90.35843005				0.13400872	0.13400872	31.49204922	23.45152601				23.45152601	23.4515199								10.05065401																				27.3712	0.88637854	0	0	0	1.824047998	1.585144492	0.842094545	0.631131312	0	0	0	0.034047925	2.158119524	0	0	0	0	0	0	0	1.91E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3322	0	17.37255659	27.3712	0.88637854	0	0	0	1.824047998	1.585144492	0.842094545	0.631131312	0	0	0	0.034047925	2.158119524	0	0	0	0	0	0	0	1.91E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3322	NO																																																																																		0	0	0	27.3712	0.88637854	0	0	0	1.824047998	1.585144492	0.842094545	0.631131312	0	0	0	0.034047925	2.158119524	0	0	0	0	0	0	0	1.91E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3322
H1804_128_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	YES	2017.582468	123.740967	564.060938	1966.215189	8.250556	23.86913	18.232046	525.681338	39.082329	12.858031	18.014744	8.405048	2.305165	38.898395	3570.554895	3627.091855	74.578883	3.652852			20.765043	0							0.04	0.25	485.199554	343.9683	0	0	0.05	0.55	1.61	519.545525	0.32	0.4	3500	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $75(Days 8-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	"20% Coins, up to $50 maximum:4a"	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	158.7573	140.3991	52.0131	0	0.2	0.2	0.2	50	0.234283	0.25	0.24294	0.25	0.2	0.221591	15	35	35	0.25			0.2	0							0	0	0	16.234077	0	0	0	0	0	15	0	0	NO	114.835505	101.556285	24.334953	0	0.155404	0.155404	0.155404	38.8511	0.182043	0.194256	0.18877	0.194256	0.155404	0.172181	11.65533	27.19577	27.19577	0.194256			0.155404	0							0	0	0	12.614235	0	0	0	0	0	11.65533	0	0		19.3075	1.047222743	1.143866368	0	1.282169405	3.709358279	2.833332877	1.701941519	7.114664418	2.49774967	3.400643225	1.632731004	0.358231862	6.697564549	3.467999632	8.220129655	0.169019179	0.709588418	0	0	3.226970742	0	0	0	0	0	0	0	0	0	0	0.361574747	0	0	0	0	0	0.504622879	0	0	69.3869	0	22.82847	19.3075	1.047222743	1.143866368	0	1.282169405	3.709358279	2.833332877	1.701941519	7.114664418	2.49774967	3.400643225	1.632731004	0.358231862	6.697564549	3.467999632	8.220129655	0.169019179	0.709588418	0	0	3.226970742	0	0	0	0	0	0	0	0	0	0	0.361574747	0	0	0	0	0	0.504622879	0	0	69.3869	NO																																																																																		0	0	0	19.3075	1.047222743	1.143866368	0	1.282169405	3.709358279	2.833332877	1.701941519	7.114664418	2.49774967	3.400643225	1.632731004	0.358231862	6.697564549	3.467999632	8.220129655	0.169019179	0.709588418	0	0	3.226970742	0	0	0	0	0	0	0	0	0	0	0.361574747	0	0	0	0	0	0.504622879	0	0	69.3869
H1804_290_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional			Lab	Radiology						Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	O	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	YES	1013.381173	50.657448	502.06533	436.3472	6.100827	16.023048	5.95435	363.61279	41.402932	10.025762	16.049783	5.160436	0.238365	18.526272	3071.273298	3889.752531	54.928425	2.046662			20.54811	0							0.04	0.25	755.636313	388.734927	0	0.05	0.55	1.67	2.4	661.070275			5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i			158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.23702	0.25	0.236326	0.25	0.2	0.234541	15	35	35	0.25			0.2	0							0	0	0	17.038033	0	0	0	0	0	35			NO	147.276925	130.246279	42.562436	0	0.177861	0.177861	0.177861	44.46535	0.210784	0.222327	0.210166	0.222327	0.177861	0.208579	13.339605	31.125745	31.125745	0.222327			0.177861	0							0	0	0	15.152042	0	0	0	0	0	31.125745				12.4373	0.549828675	1.78076029	0	1.085099191	2.84987534	1.059046645	1.347347498	8.727075619	2.228997588	3.373118694	1.147304255	0.042395837	3.864191287	3.414131054	10.08928712	0.142474012	0.455028222	0	0	3.654707393	0	0	0	0	0	0	0	0	0	0	0.490843995	0	0	0	0	0	1.714692067	0	0	60.4535	0	7.355445	12.4373	0.549828675	1.78076029	0	1.085099191	2.84987534	1.059046645	1.347347498	8.727075619	2.228997588	3.373118694	1.147304255	0.042395837	3.864191287	3.414131054	10.08928712	0.142474012	0.455028222	0	0	3.654707393	0	0	0	0	0	0	0	0	0	0	0.490843995	0	0	0	0	0	1.714692067	0	0	60.4535	YES																																									5000																																									0	0	0	12.4373	0.549828675	1.78076029	0	1.085099191	2.84987534	1.059046645	1.347347498	8.727075619	2.228997588	3.373118694	1.147304255	0.042395837	3.864191287	3.414131054	10.08928712	0.142474012	0.455028222	0	0	3.654707393	0	0	0	0	0	0	0	0	0	0	0.490843995	0	0	0	0	0	1.714692067	0	0	60.4535
H1804_801_0	2010	6	N/A																															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	NO	300.999364	2.311476	53.386621	21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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																			0.079194837	0.079194837	0.160193508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079194837	0.079194837	0.160193508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.8376	0.183056966	8.552190088	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6464	0	0	23.8376	0.183056966	8.552190088	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6464	NO																																																																																		0	0	0	23.8376	0.183056966	8.552190088	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6464
H1804_804_0	2010	5	N/A																															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	NO	309.035572	3.3377	70.263952	34.761029	11.455516	16.978698	6.483453	23.385311	79.577837	17.163601	36.265953	6.734856	0.914055	24.716698	41.132348	87.776039	0.646603	12.130245			29.385551	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																			0.079940358	0.079940358	0.179337266	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079940358	0.079940358	0.179337266	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				24.7044	0.266816934	12.60094503	0	2.669135228	3.956036634	1.510644549	5.448777463	18.54163602	3.999119033	8.449967049	1.569221448	0.212974815	5.758990634	9.583837084	20.45181709	0.150658499	2.826347085	0	0	6.846833383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.5482	0	0	24.7044	0.266816934	12.60094503	0	2.669135228	3.956036634	1.510644549	5.448777463	18.54163602	3.999119033	8.449967049	1.569221448	0.212974815	5.758990634	9.583837084	20.45181709	0.150658499	2.826347085	0	0	6.846833383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.5482	NO																																																																																		0	0	0	24.7044	0.266816934	12.60094503	0	2.669135228	3.956036634	1.510644549	5.448777463	18.54163602	3.999119033	8.449967049	1.569221448	0.212974815	5.758990634	9.583837084	20.45181709	0.150658499	2.826347085	0	0	6.846833383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.5482
H1804_805_0	2010	5	N/A																															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	NO	300.999364	2.311476	53.386621	21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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																			0.079182523	0.079182523	0.160171602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079182523	0.079182523	0.160171602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415	0	0	23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415	NO																																																																																		0	0	0	23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415
H1804_807_0	2010	6	N/A																																		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	NO				21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	NO																																																																																		0	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735
H1804_808_0	2010	6	N/A																																		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	NO				21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	NO																																																																																		0	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735
H1804_809_0	2010	6	N/A																																		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	NO				21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	NO																																																																																		0	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735
H1806_001_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	O	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	YES	1369.539501	77.620786	798.514956	615.070226	49.165774	10.394335	3.934321	305.651095	408.141056	1286.770424	924.513123	47.389443	0.019794	544.627603	3449.298153	4200.456829	112.463051	558.033381			13.747314	0		1.56					0.04	0.25	16.710922	0.05	0.55	2.08	0.32	0.4	0.42				4700	$195/Day(Days 1-8):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	121.67922	50.7565	0	150	0.2	0.2	50	135.406716	54.058959	100.927602	150	0.2	114.775257	10	35	35	50.887978			0.2	0		0					0	0	0	0	0	0	0	0	0				NO	125.65719	105.79777	25.949616	0	126.43485	0.16858	0.16858	42.14495	114.134185	45.566243	85.071774	126.43485	0.16858	96.74395	8.42899	29.501465	29.501465	42.893426			0.16858	0		0					0	0	0	0	0	0	0	0	0					14.341	0.684342172	1.72676304	0	0.518022272	1.752276994	0.663247834	1.073470843	3.881903899	4.886107819	6.554164288	0.499306426	0.003336873	4.390785466	2.422841637	10.32663584	0.276485397	1.994663628	0	0	2.317522194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3129	0	11.652373	14.341	0.684342172	1.72676304	0	0.518022272	1.752276994	0.663247834	1.073470843	3.881903899	4.886107819	6.554164288	0.499306426	0.003336873	4.390785466	2.422841637	10.32663584	0.276485397	1.994663628	0	0	2.317522194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3129	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	7.3717	0.1167	0.3305	1.5904	2.2412	1.8744	0.7095	0.2049	2.8975	0.2899	1.2405	0.2319	0.0007	1.0729	1.4621	2.0214	0.0314	0.2064			0.5922	0		0					0	0	0	0	0	0	0	0	0				24.4861	500	14.259282	21.7127	0.801069172	2.05724204	1.590399	2.759209272	3.626723994	1.372737834	1.278365843	6.779387899	5.175969819	7.794713288	0.731194426	0.004006873	5.463657466	3.884972637	12.34800084	0.307866397	2.201017628	0	0	2.909770194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.799
H1806_002_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	O	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	YES	1070.568634	37.89889	332.470731	552.242987	38.742974	10.737804	4.135922	360.80486	453.951375	1884.984848	891.664249	35.5136	0	459.844021	3915.696272	4304.092936	75.782926	883.605726			16.480918	0		3.52					0.04	0.25	0	0.05	0.55	2.08	0.32	0.4	0.42				4500	$195/Day(Days 1-8):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	121.67922	50.7565	0	150	0.2	0.2	50	127.048517	57.577378	102.403651	150	0	89.109885	10	30	30	45.346842			0.2	0		0					0	0	0	0	0	0	0	0	0				NO	128.534	108.219916	35.454227	0	127.27545	0.169701	0.169701	42.42515	107.801048	48.854578	86.889805	127.27545	0	75.610005	8.48503	25.45509	25.45509	38.476931			0.169701	0		0					0	0	0	0	0	0	0	0	0					11.467	0.341784558	0.982291064	0	0.410919121	1.822216077	0.701870099	1.275600026	4.078036164	7.674178274	6.456377727	0.376667452	0	2.897400727	2.768733362	9.130089421	0.1607551	2.833203046	0	0	2.796828266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.174	0	9.638473	11.467	0.341784558	0.982291064	0	0.410919121	1.822216077	0.701870099	1.275600026	4.078036164	7.674178274	6.456377727	0.376667452	0	2.897400727	2.768733362	9.130089421	0.1607551	2.833203046	0	0	2.796828266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.174	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.7793	0.0905	0.2656	2.17	1.7842	1.9562	0.7535	0.2443	3.441	0.4783	1.2416	0.104	0	0.5883	1.7843	2.4414	0.0251	0.3838			0.7348	0		0					0	0	0	0	0	0	0	0	0				25.2665	500	11.536247	18.2464	0.432310558	1.247916064	2.169997	2.195095121	3.778452077	1.455361099	1.519948026	7.519055164	8.152481274	7.697976727	0.480646452	0	3.485669727	4.553040362	11.57150842	0.1858931	3.217040046	0	0	3.531663266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4404
H1806_005_0	2010	9	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	O	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	YES	1136.547848	51.771819	618.207495	482.292062	40.576824	8.526634	3.995062	317.730329	394.517439	1352.049502	981.049109	90.380132	0.039994	555.549654	3448.347126	3965.675659	74.743788	647.866119			16.919921	0		3.52					0.04	0.25	8.914838	0.05	0.55	2.08	0.32	0.4	0.42				4500	$195/Day(Days 1-8):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	121.67922	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0					0	0	0	0	0	0	0	0	0				NO	126.498728	106.506308	28.739041	0	126.2034	0.168271	0.168271	42.0678	110.926124	65.515447	86.197098	126.2034	0.168271	95.927712	8.41356	25.24068	25.24068	42.581504			0.168271	0		0					0	0	0	0	0	0	0	0	0					11.981	0.459502108	1.480557545	0	0.426744429	1.43478523	0.672253078	1.113851328	3.64685753	7.381677291	7.046965516	0.950523329	0.00672983	4.441050601	2.41773962	8.341362524	0.157215336	2.298926145	0	0	2.847132027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1049	0	11.049187	11.981	0.459502108	1.480557545	0	0.426744429	1.43478523	0.672253078	1.113851328	3.64685753	7.381677291	7.046965516	0.950523329	0.00672983	4.441050601	2.41773962	8.341362524	0.157215336	2.298926145	0	0	2.847132027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1049	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.9419	0.0943	0.321	1.2885	1.4273	1.1866	0.5559	0.1644	2.288	0.3035	0.9739	0.163	0.001	0.6626	1.1639	1.9985	0.0198	0.1928			0.5776	0		0					0	0	0	0	0	0	0	0	0				20.3245	0	11.640222	18.9229	0.553819108	1.801570545	1.288457	1.854087429	2.62134223	1.228201078	1.278212328	5.93482453	7.685142291	8.020888516	1.113533329	0.00777483	5.103647601	3.58167462	10.33981852	0.177051336	2.491720145	0	0	3.424685027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4293
H1806_006_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	O	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	YES	1155.270781	52.624683	628.391542	490.237105	41.245267	8.379042	3.925909	322.964462	401.016527	1374.322504	997.210431	91.86901	0.039302	564.701506	3505.153508	4031.004257	75.975081	658.538748			16.627046	0		3.52					0.04	0.25	9.061696	0.05	0.55	2.08	0.32	0.4	0.42				4500	$195/Day(Days 1-8):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	121.67922	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0					0	0	0	0	0	0	0	0	0				NO	126.048694	106.127399	28.334968	0	125.83755	0.167783	0.167783	41.94585	110.604561	65.325524	85.947222	125.83755	0.167783	95.649627	8.38917	25.16751	25.16751	42.458065			0.167783	0		0					0	0	0	0	0	0	0	0	0					12.135	0.465410061	1.483787853	0	0.432516946	1.405860804	0.65870079	1.12891824	3.696188077	7.481528143	7.142288858	0.963380928	0.006594207	4.501124035	2.450444055	8.454194996	0.159341968	2.330023414	0	0	2.789735659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6851	0	11.392516	12.135	0.465410061	1.483787853	0	0.432516946	1.405860804	0.65870079	1.12891824	3.696188077	7.481528143	7.142288858	0.963380928	0.006594207	4.501124035	2.450444055	8.454194996	0.159341968	2.330023414	0	0	2.789735659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6851	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.9494	0.0944	0.3226	1.6693	1.9129	1.5373	0.7203	0.2203	2.9643	0.3932	1.2618	0.2112	0.0014	0.8585	1.508	2.5892	0.0257	0.2498			0.7483	0		0					0	0	0	0	0	0	0	0	0				24.2379	500	11.876413	19.0844	0.559828061	1.806404853	1.669349	2.345383946	2.943186804	1.37899779	1.34918924	6.660521077	7.874704143	8.404120858	1.174579928	0.007948207	5.359598035	3.958461055	11.043432	0.185041968	2.579811414	0	0	3.538024659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.923
H1806_801_0	2010	4	N/A																															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	NO	244.079316	0.832581	42.379154	13.694214	1.605931	7.425611	3.629732	17.903305	50.978282	11.005593	26.23818	9.275351	0.8149	16.793534	31.166679	68.351669	0.328462	5.086528			22.21593	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																			0.081246248	0.081246248	0.194905333	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.081246248	0.081246248	0.194905333	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.8305	0.067644082	8.259923133	0	0.374181923	1.730167363	0.845727556	4.171470065	11.87793971	2.564303169	6.11349594	2.161156783	0.1898717	3.912893422	7.261836207	15.92593888	0.076531646	1.185161024	0	0	5.17631169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7251	0	0	19.8305	0.067644082	8.259923133	0	0.374181923	1.730167363	0.845727556	4.171470065	11.87793971	2.564303169	6.11349594	2.161156783	0.1898717	3.912893422	7.261836207	15.92593888	0.076531646	1.185161024	0	0	5.17631169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7251	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.6915	0.0126	1.5376	0	1.4967	1.1408	0.5576	1.0999	2.8622	0.676	1.4657	0.5698	0.0501	1.024	1.3683	3.0007	0.0144	0.2544			0.9753	0																			21.7976	0	0	23.522	0.080237251	9.797531307	0	1.870857423	2.870935363	1.403296556	5.271346565	14.74011171	3.240352669	7.57918244	2.730958283	0.2399667	4.936928422	8.630128707	18.92662938	0.090977646	1.439597024	0	0	6.15164969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.5227
H1806_803_0	2010	4	N/A																															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	NO	244.079316	0.832581	42.379154	13.694214	1.605931	7.425611	3.629732	17.903305	50.978282	11.005593	26.23818	9.275351	0.8149	16.793534	31.166679	68.351669	0.328462	5.086528			22.21593	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																			0.081246248	0.081246248	0.194905333	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.081246248	0.081246248	0.194905333	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.8305	0.067644082	8.259923133	0	0.374181923	1.730167363	0.845727556	4.171470065	11.87793971	2.564303169	6.11349594	2.161156783	0.1898717	3.912893422	7.261836207	15.92593888	0.076531646	1.185161024	0	0	5.17631169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7251	0	0	19.8305	0.067644082	8.259923133	0	0.374181923	1.730167363	0.845727556	4.171470065	11.87793971	2.564303169	6.11349594	2.161156783	0.1898717	3.912893422	7.261836207	15.92593888	0.076531646	1.185161024	0	0	5.17631169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7251	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.6915	0.0126	1.5376	0	1.4967	1.1408	0.5576	1.0999	2.8622	0.676	1.4657	0.5698	0.0501	1.024	1.3683	3.0007	0.0144	0.2544			0.9753	0																			21.7976	0	0	23.522	0.080237251	9.797531307	0	1.870857423	2.870935363	1.403296556	5.271346565	14.74011171	3.240352669	7.57918244	2.730958283	0.2399667	4.936928422	8.630128707	18.92662938	0.090977646	1.439597024	0	0	6.15164969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.5227
H1806_804_0	2010	4	N/A																															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	NO	244.079316	0.832581	42.379154	13.694214	1.605931	7.425611	3.629732	17.903305	50.978282	11.005593	26.23818	9.275351	0.8149	16.793534	31.166679	68.351669	0.328462	5.086528			22.21593	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																			0.081246248	0.081246248	0.194905333	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.081246248	0.081246248	0.194905333	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.8305	0.067644082	8.259923133	0	0.374181923	1.730167363	0.845727556	4.171470065	11.87793971	2.564303169	6.11349594	2.161156783	0.1898717	3.912893422	7.261836207	15.92593888	0.076531646	1.185161024	0	0	5.17631169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7251	0	0	19.8305	0.067644082	8.259923133	0	0.374181923	1.730167363	0.845727556	4.171470065	11.87793971	2.564303169	6.11349594	2.161156783	0.1898717	3.912893422	7.261836207	15.92593888	0.076531646	1.185161024	0	0	5.17631169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7251	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.6915	0.0126	1.5376	0	1.4967	1.1408	0.5576	1.0999	2.8622	0.676	1.4657	0.5698	0.0501	1.024	1.3683	3.0007	0.0144	0.2544			0.9753	0																			21.7976	0	0	23.522	0.080237251	9.797531307	0	1.870857423	2.870935363	1.403296556	5.271346565	14.74011171	3.240352669	7.57918244	2.730958283	0.2399667	4.936928422	8.630128707	18.92662938	0.090977646	1.439597024	0	0	6.15164969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.5227
H1807_001_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	354.4900688	17.45103575	53.87898699	34.79345569	26.55640043	46.1321021	8.647600584	46.90353518	56.35313393	6.743155455	23.27238157	0	0.037538019	35.31885994	52.83290152	121.2927853	6.79287494	1.373539171	22.2606651	32.59246501	3.144704611	0	0	0	0	0	0	0	0	0												Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible	Medicare cost sharing less Part B deductible																			0.080019572	0.080019572	0.186413455	0	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0	0	0	0	0	0	0	0	0											NO	0.080019572	0.080019572	0.186413455	0	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0.209585277	0	0	0	0	0	0	0	0	0												28.3661	1.396424416	10.04376814	0	5.565830529	9.668609379	1.81240976	9.830290394	11.81078716	1.413266101	4.877548528	0	0.007867416	7.402313029	11.07299828	25.42118195	1.423686573	0.287873587	4.665507652	6.830900794	0.659083786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.5565			28.3661	1.396424416	10.04376814	0	5.565830529	9.668609379	1.81240976	9.830290394	11.81078716	1.413266101	4.877548528	0	0.007867416	7.402313029	11.07299828	25.42118195	1.423686573	0.287873587	4.665507652	6.830900794	0.659083786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.5565	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			28.3661	1.396424416	10.04376814	0	5.565830529	9.668609379	1.81240976	9.830290394	11.81078716	1.413266101	4.877548528	0	0.007867416	7.402313029	11.07299828	25.42118195	1.423686573	0.287873587	4.665507652	6.830900794	0.659083786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.5565
H1837_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	681.5176136	15.04024168	543.9651899	389.7770858	160.5622274	5.411922778	1.739176565	738.7997614	199.5808857	10.9865543	1829.467463	0	0.170756021	2023.587021	3788.082594	4974.11612	31.56975732	441.9582374	0	3134.348899	17.38180695	9.960688897	165.7668739	326.4295468	225.7867131	282.2296634	46.15859415	0	0	0											2600	1a: $280 Days 1-10	1b: $275	2: $130 Days 4-23	6: none	10a: $175	11a: 30%	11b: 30%; 11c: 20%	4a: $50; 4b: $30	9b: $100	8a: 30%	8b: $40; 8b: $15; 8b: 20%	5. $0	12: 30%	9a: 30%; 9a: $100; 9a: $40; 9d: $25	7a: $5	7d: $25	7h: $30	7c: $25; 7i: $25	7d. 0%	14c: $5; 7b: $25; 7f: $25	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $25	18b. $0	14a. $0	13b. $0											257.7531162	118.9748676	91.48686873	0	140.0704446	0.300950295	0.242284935	13.86774974	65.51489809	0.007424846	23.30475948	0	0.147688665	12.35219308	4.129525906	13.71676408	14.41124548	22.74025463	0	1.709048025	0.18242162	0	0	19.99966119	8.748931945	17.41145266	24.3938458	0	0	0											NO	194.9368804	78.54316302	43.60731151	0	105.0352601	0.254731551	0.202612406	12.84694849	64.08458642	0.006473552	17.97576908	0	0.031538591	10.26985977	3.991145057	12.95692507	13.644448	21.13441396	0	1.653961285	0.12870664	0	0	19.99966119	8.748931945	17.41145266	23.53913053	0	0	0												11.0711	0.098442346	1.976738291	0	1.405391276	1.378587483	0.352378747	0.79094354	1.06583821	0.071122027	2.740507054	0	0.005385404	1.731829579	1.259898927	5.37077082	0.035895993	0.778377362	0	0.432007644	2.237153971	0	0	0.544040028	0.164616049	0.409502369	0.090544431	0	0	0	0	0	0	0	0	0	0	0	0	0	34.011	0	9.896903354	11.0711	0.098442346	1.976738291	0	1.405391276	1.378587483	0.352378747	0.79094354	1.06583821	0.071122027	2.740507054	0	0.005385404	1.731829579	1.259898927	5.37077082	0.035895993	0.778377362	0	0.432007644	2.237153971	0	0	0.544040028	0.164616049	0.409502369	0.090544431	0	0	0	0	0	0	0	0	0	0	0	0	0	34.011	NO																																																																																		0		0	11.0711	0.098442346	1.976738291	0	1.405391276	1.378587483	0.352378747	0.79094354	1.06583821	0.071122027	2.740507054	0	0.005385404	1.731829579	1.259898927	5.37077082	0.035895993	0.778377362	0	0.432007644	2.237153971	0	0	0.544040028	0.164616049	0.409502369	0.090544431	0	0	0	0	0	0	0	0	0	0	0	0	0	34.011
H1837_002_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	693.1825383	11.07759983	529.6930306	298.7513378	195.8931567	7.451051496	1.046610388	803.7962172	137.0161456	15.14129776	1504.368696	0	0.125756544	1663.163201	4800.649125	4721.293423	38.25862107	485.0606	0	2719.563466	14.21900996	10.34103496	166.540499	293.0737441	304.5162938	347.4379958	26.06636593	0	0	0											1550	1a: $550 Days 1-1	1b: $275	2: $130 Days 4-14	6: none	10a: $100	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $30	9b: $70	8a: 20%	8b: $40; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: $70; 9a: $40; 9d: $25	7a: $10	7d: $25	7h: $30	7c: $25; 7i: $25	7d. 0%	14c: $10; 7b: $25; 7f: $25	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $25	18b. $0	14a. $0	13b. $0											155.0346349	90.21985758	80.67979016	0	86.20231323	0.200646974	0.19611973	14.15068227	63.46903871	0.004247821	24.07661607	0	0.072732443	11.66435869	8.338591625	13.58970027	27.21483135	22.82864298	0	2.664874145	0.19302738	0	0	19.99974974	9.417813907	15.6605085	22.22944727	0	0	0											NO	129.9838114	47.29904048	28.78259818	0	61.61545502	0.169523183	0.180779984	11.19574892	62.68459023	0.00381162	18.88033643	0	0.019931078	9.49083684	7.993338245	12.92303333	26.3845163	21.72443516	0	2.623023996	0.144776305	0	0	19.99974974	9.417813907	15.6605085	21.88024032	0	0	0												7.5085	0.04366332	1.270495138	0	1.005837165	1.263125964	0.189206209	0.749925052	0.715733412	0.057712869	2.366915592	0	0.002506464	1.315400881	3.197767688	5.084452689	0.084119601	0.878138963	0	0.594456686	2.058575724	0	0	0.488450128	0.238989816	0.453421307	0.047528196	0	0	0	0	0	0	0	0	0	0	0	0	0	29.615	0	7.427732598	7.5085	0.04366332	1.270495138	0	1.005837165	1.263125964	0.189206209	0.749925052	0.715733412	0.057712869	2.366915592	0	0.002506464	1.315400881	3.197767688	5.084452689	0.084119601	0.878138963	0	0.594456686	2.058575724	0	0	0.488450128	0.238989816	0.453421307	0.047528196	0	0	0	0	0	0	0	0	0	0	0	0	0	29.615	NO																																																																																		0		0	7.5085	0.04366332	1.270495138	0	1.005837165	1.263125964	0.189206209	0.749925052	0.715733412	0.057712869	2.366915592	0	0.002506464	1.315400881	3.197767688	5.084452689	0.084119601	0.878138963	0	0.594456686	2.058575724	0	0	0.488450128	0.238989816	0.453421307	0.047528196	0	0	0	0	0	0	0	0	0	0	0	0	0	29.615
H1837_003_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1295.318483	30.89384669	998.0176256	771.4248385	299.1783895	9.311570318	4.877006783	1117.257015	224.9044475	14.18722918	2699.823318	0	0.38147613	2707.517683	6208.308401	8530.61535	61.72673565	719.2429566	0	4245.859359	48.14908907	20.46004328	319.8914672	457.9919385	315.433517	403.9094948	50.77173322	0	0	0											1250	1a: $275 Days 1-1	1b: $70	2: $50 Days 4-13	6: none	10a: $125	11a: 30%	11b: 30%; 11c: 20%	4a: $50; 4b: $25	9b: $50	8a: 30%	8b: $40; 8b: $15; 8b: 20%	5. $0	12: 30%	9a: $50; 9a: $40; 9d: $20	7a: none	7d: none	7h: $30	7c: $20; 7i: $20	7d. 0%	7f: none	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $25	18b. $0	14a. $0	13b. $0											48.73789387	60.57242671	17.21987422	0	85.1306041	0.301006303	0.13479896	13.33508797	37.44758305	0.010338754	23.22314755	0	0.301006303	10.07193185	0	0	19.75580478	18.12375614	0	0	0.143107005	0	0	19.99962439	8.696549201	16.71010449	22.469691	0	0	0											NO	42.47599857	34.65595027	11.17665802	0	69.45640266	0.209074217	0.11418942	12.50786215	36.62405587	0.0087054	14.36315657	0	0.107044257	7.38499643	0	0	18.37413778	16.73767442	0	0	0.063184451	0	0	19.99962439	8.696549201	16.71010449	21.85888287	0	0	0												4.585	0.089221301	0.929541808	0	1.731654557	1.946809273	0.556902578	1.164541394	0.686409421	0.123505504	3.231498752	0	0.040834829	1.666250702	0	0	0.094514629	1.003204536	0	0	3.042273765	0	0	0.763305562	0.228598592	0.562447489	0.092484447	0	0	0	0	0	0	0	0	0	0	0	0	0	22.539	0	9.483871772	4.585	0.089221301	0.929541808	0	1.731654557	1.946809273	0.556902578	1.164541394	0.686409421	0.123505504	3.231498752	0	0.040834829	1.666250702	0	0	0.094514629	1.003204536	0	0	3.042273765	0	0	0.763305562	0.228598592	0.562447489	0.092484447	0	0	0	0	0	0	0	0	0	0	0	0	0	22.539	NO																																																																																		0		0	4.585	0.089221301	0.929541808	0	1.731654557	1.946809273	0.556902578	1.164541394	0.686409421	0.123505504	3.231498752	0	0.040834829	1.666250702	0	0	0.094514629	1.003204536	0	0	3.042273765	0	0	0.763305562	0.228598592	0.562447489	0.092484447	0	0	0	0	0	0	0	0	0	0	0	0	0	22.539
H1837_005_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1242.791472	40.72251529	938.9006396	667.2672554	303.5710548	8.8564794	1.449248194	1024.378956	135.6360246	12.61565464	2516.626196	0	0.462286122	3381.271955	5888.606554	6401.32917	81.36467955	480.6641445	0	3590.381582	34.47993691	26.96926782	0	496.2463541	342.0725261	398.1309259	36.42892429	0	0	0											1600	1a: $550 Days 1-1	1b: $275	2: $125 Days 4-15	6: none	10a: $125	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9b: $50	8a: 20%	8b: $50; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: 20%; 9a: $100; 9a: $50; 9d: $25	7a: none	7d: $30	7h: $30	7c: $25; 7i: $25	7d. 0%	7b: $30; 7f: $30	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $20	18b. $0	14a. $0	13b. $0											103.9379618	209.6821832	64.97360024	0	88.51749985	0.200649744	0.132185695	14.30973965	42.49732217	0.009285514	19.95570386	0	0.200649744	9.702876424	0	15.29071747	29.82888815	23.12455006	0	1.888649483	0.182479122	0	0	19.99930961	8.451154515	17.67361128	19.10212561	0	0	0											NO	83.23320953	99.24960825	21.86432664	0	62.15394164	0.134947613	0.110582129	12.89818032	41.16149923	0.00872692	13.98763614	0	0.045405673	7.843094047	0	13.95081255	26.93439896	19.93215068	0	1.816037656	0.073111977	0	0	19.99930961	8.451154515	17.67361128	18.20830743	0	0	0												8.6201	0.336807807	1.710702522	0	1.572344802	1.195160752	0.160260951	1.101052041	0.46524851	0.110095804	2.933470961	0	0.020990412	2.209969495	0	7.441978608	0.182625728	0.79838918	0	0.543355679	2.520896339	0	0	0.827048706	0.240908981	0.586367602	0.055275754	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6331	0	14.10538097	8.6201	0.336807807	1.710702522	0	1.572344802	1.195160752	0.160260951	1.101052041	0.46524851	0.110095804	2.933470961	0	0.020990412	2.209969495	0	7.441978608	0.182625728	0.79838918	0	0.543355679	2.520896339	0	0	0.827048706	0.240908981	0.586367602	0.055275754	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6331	NO																																																																																		0		0	8.6201	0.336807807	1.710702522	0	1.572344802	1.195160752	0.160260951	1.101052041	0.46524851	0.110095804	2.933470961	0	0.020990412	2.209969495	0	7.441978608	0.182625728	0.79838918	0	0.543355679	2.520896339	0	0	0.827048706	0.240908981	0.586367602	0.055275754	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6331
H1837_006_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1891.209341	61.96920648	1428.765566	1015.409339	461.9571567	14.23738559	2.090827401	1558.841604	206.403184	20.28051232	3829.658538	0	0.743155996	5145.427253	8960.946368	9741.178468	123.8161393	731.4473434	0	5463.638384	53.86219619	41.0402971	0	755.1594631	520.5465048	605.8529878	55.43546402	0	0	0											950	1a: $275 Days 1-1	1b: $275	2: $50 Days 11-29	6: none	10a: $125	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $30	9b: $50	8a: 20%	8b: $50; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: 20%; 9a: $100; 9a: $50; 9d: $25	7a: none	7d: $25	7h: $30	7c: $25; 7i: $25	7d. 0%	7b: $25; 7f: $25	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $20	18b. $0	14a. $0	13b. $0											34.15095559	68.89539497	19.48956714	0	88.53189416	0.200668149	0.147305177	14.08390154	42.49732217	0.009286366	20.36587163	0	0.200668149	9.981539198	0	12.80244077	29.8235558	23.13466012	0	1.594401126	0.187803877	0	0	19.99943297	8.451154515	17.67393091	19.10591829	0	0	0											NO	23.87832552	29.76778788	4.696382356	0	51.3564597	0.096883167	0.100918434	11.54968988	38.80983981	0.007642306	11.43403412	0	0.018187539	6.600637747	0	10.59356838	23.8774408	16.82009698	0	1.360805733	0.04978855	0	0	19.99943297	8.451154515	17.67393091	17.25226819	0	0	0												3.7632	0.153723849	0.559169116	0	1.977040342	1.379363002	0.211003026	1.500344758	0.667539542	0.15498989	3.649037198	0	0.013516178	2.830258446	0	8.599486686	0.246367711	1.025251271	0	0.619579203	2.681720635	0	0	1.258563422	0.366601579	0.892316987	0.079698958	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6288	0	21.50867167	3.7632	0.153723849	0.559169116	0	1.977040342	1.379363002	0.211003026	1.500344758	0.667539542	0.15498989	3.649037198	0	0.013516178	2.830258446	0	8.599486686	0.246367711	1.025251271	0	0.619579203	2.681720635	0	0	1.258563422	0.366601579	0.892316987	0.079698958	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6288	NO																																																																																		0		0	3.7632	0.153723849	0.559169116	0	1.977040342	1.379363002	0.211003026	1.500344758	0.667539542	0.15498989	3.649037198	0	0.013516178	2.830258446	0	8.599486686	0.246367711	1.025251271	0	0.619579203	2.681720635	0	0	1.258563422	0.366601579	0.892316987	0.079698958	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6288
H1837_007_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1327.437993	43.49612563	1002.849158	712.7148253	324.247278	10.22439382	1.697724658	1094.149403	144.8741937	14.56418691	2688.033595	0	0.533687841	3611.570373	5982.334147	6837.323672	88.27743232	513.4021774	0	3834.773019	38.57779989	28.80614453	333.329606	530.0456911	365.3710844	425.2476216	38.91009816	0	0	0											1575	1a: $500 Days 1-1	1b: $275	2: $125 Days 4-15	6: none	10a: $175	11a: 30%	11b: 30%	4a: $50; 4b: $25	9b: $100	8a: 30%	8b: $40; 8b: $15; 8b: 20%	5. $0	12: 30%	9a: 30%; 9a: $100; 9a: $40; 9d: $25	7a: $5	7d: $20	7h: $30	7c: $25; 7i: $25	7d. 0%	14c: $5; 7b: $20; 7f: $20	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $25	18b. $0	14a. $0	13b. $0											88.36407895	178.2637708	59.90534725	0	123.7081368	0.300983951	0.178605868	13.85593589	84.77422845	0.013928703	18.65870227	0	0.300983951	12.7531351	4.125972359	10.28746166	29.35811198	23.13775569	0	1.468867091	0.188292105	0	0	19.9994862	8.451154515	17.67406881	23.84427856	0	0	0											NO	69.76362301	84.48847413	19.16184822	0	83.96998121	0.181948028	0.143689715	12.32965951	81.80528373	0.012887625	12.14406115	0	0.043563623	9.665016076	3.932789331	9.316757635	26.34641865	19.68755426	0	1.413804077	0.07093713	0	0	19.9994862	8.451154515	17.67406881	22.70690894	0	0	0												7.7172	0.30624344	1.601370279	0	2.26891982	1.860308298	0.243945572	1.124207466	0.987622876	0.187697773	2.720303696	0	0.023249376	2.90882381	1.960604992	5.30847396	0.193816182	0.842302769	0	0.451801477	2.73659841	0	0	0.88338679	0.257317291	0.626321311	0.073627338	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2842	0	16.56875895	7.7172	0.30624344	1.601370279	0	2.26891982	1.860308298	0.243945572	1.124207466	0.987622876	0.187697773	2.720303696	0	0.023249376	2.90882381	1.960604992	5.30847396	0.193816182	0.842302769	0	0.451801477	2.73659841	0	0	0.88338679	0.257317291	0.626321311	0.073627338	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2842	NO																																																																																		0		0	7.7172	0.30624344	1.601370279	0	2.26891982	1.860308298	0.243945572	1.124207466	0.987622876	0.187697773	2.720303696	0	0.023249376	2.90882381	1.960604992	5.30847396	0.193816182	0.842302769	0	0.451801477	2.73659841	0	0	0.88338679	0.257317291	0.626321311	0.073627338	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2842
H1837_008_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1327.437993	43.49612563	1002.849158	712.7148253	324.247278	10.22428358	1.34912515	1094.149403	144.8741937	14.56402987	2688.033595	0	0.533682087	2744.804224	5982.334147	6837.323672	88.27743232	513.4021774	0	3834.773019	37.68105685	28.80614453	333.329606	530.0456911	365.3710844	425.2476216	38.91009816	0	0	0											1575	1a: $500 Days 1-1	1b: $275	2: $125 Days 4-15	6: none	10a: $100	11a: 20%	11b: 20%	4a: $50; 4b: $25	9b: $70	8a: 20%	8b: $40; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: $70; 9a: $40; 9d: $25	7a: $5	7d: $20	7h: $30	7c: $25; 7i: $25	7d. 0%	14c: $5; 7b: $20; 7f: $20	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $25	18b. $0	14a. $0	13b. $0											88.36407895	178.2637708	59.90534725	0	70.8356305	0.200658131	0.149837143	13.85593589	59.46278988	0.009285902	18.65870227	0	0.200658131	13.86677138	4.125972359	10.28746166	29.35811198	23.13775569	0	1.468867091	0.192773127	0	0	19.9994862	8.451154515	17.67406881	23.84427856	0	0	0											NO	71.39633211	87.75855575	21.85228127	0	50.25782824	0.132824742	0.124729693	12.4738228	57.77559091	0.008766646	12.31178541	0	0.040076605	10.23626485	3.95218199	9.384913352	26.58342819	19.91454294	0	1.419856583	0.073903177	0	0	19.9994862	8.451154515	17.67406881	22.67806807	0	0	0												7.8979	0.31809643	1.826211823	0	1.357997	1.358037833	0.168275965	1.137352147	0.697516012	0.127677691	2.7578744	0	0.021388166	2.341378584	1.970272773	5.347307518	0.195559732	0.852014142	0	0.453735643	2.784749799	0	0	0.88338679	0.257317291	0.626321311	0.073533821	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4539	0	14.66365547	7.8979	0.31809643	1.826211823	0	1.357997	1.358037833	0.168275965	1.137352147	0.697516012	0.127677691	2.7578744	0	0.021388166	2.341378584	1.970272773	5.347307518	0.195559732	0.852014142	0	0.453735643	2.784749799	0	0	0.88338679	0.257317291	0.626321311	0.073533821	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4539	NO																																																																																		0		0	7.8979	0.31809643	1.826211823	0	1.357997	1.358037833	0.168275965	1.137352147	0.697516012	0.127677691	2.7578744	0	0.021388166	2.341378584	1.970272773	5.347307518	0.195559732	0.852014142	0	0.453735643	2.784749799	0	0	0.88338679	0.257317291	0.626321311	0.073533821	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4539
H1837_009_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1736.274127	56.89244842	1311.715542	932.2230623	424.1118323	13.373082	2.011484684	1431.135246	189.4938335	19.04935091	3515.918037	0	0.698041506	4723.893869	8226.83084	8943.143296	115.4658994	671.5243363	0	5016.035909	50.90439736	37.67811657	0	693.2938671	477.9013135	556.2191581	50.89397551	0	0	0											1575	1a: $500 Days 1-1	1b: $275	2: $125 Days 4-15	6: none	10a: $125	11a: 20%	11b: 20%	4a: $50; 4b: $30	9b: $50	8a: 20%	8b: $50; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: 20%; 9a: $100; 9a: $50; 9d: $25	7a: none	7d: $25	7h: $30	7c: $25; 7i: $25	7d. 0%	7b: $25; 7f: $25	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $20	18b. $0	14a. $0	13b. $0											67.63344065	136.442232	51.20291828	0	88.53608472	0.200660639	0.131449531	14.08489088	42.49732217	0.009286018	20.54273011	0	0.200660639	10.1017722	0	12.80824922	29.35811198	23.13775569	0	1.596199853	0.186645841	0	0	19.9994862	8.451154515	17.67406881	19.10686069	0	0	0											NO	52.38746788	63.7056759	15.25716915	0	59.10661037	0.121263182	0.103079893	12.38480792	40.78695282	0.00857155	13.11182727	0	0.032544607	7.699366776	0	11.4253199	25.67105636	19.26771441	0	1.503715391	0.063587732	0	0	19.9994862	8.451154515	17.67406881	18.06341331	0	0	0												7.5799	0.30203099	1.667755492	0	2.088984402	1.621662477	0.207343627	1.477027928	0.644073004	0.16328247	3.841675832	0	0.022717486	3.030915959	0	8.514856093	0.247010968	1.078228261	0	0.628557533	3.236895202	0	0	1.155460094	0.336568154	0.819221306	0.07660991	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7408	0	20.04606183	7.5799	0.30203099	1.667755492	0	2.088984402	1.621662477	0.207343627	1.477027928	0.644073004	0.16328247	3.841675832	0	0.022717486	3.030915959	0	8.514856093	0.247010968	1.078228261	0	0.628557533	3.236895202	0	0	1.155460094	0.336568154	0.819221306	0.07660991	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7408	NO																																																																																		0		0	7.5799	0.30203099	1.667755492	0	2.088984402	1.621662477	0.207343627	1.477027928	0.644073004	0.16328247	3.841675832	0	0.022717486	3.030915959	0	8.514856093	0.247010968	1.078228261	0	0.628557533	3.236895202	0	0	1.155460094	0.336568154	0.819221306	0.07660991	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7408
H1837_801_0	2010	5	N/A																															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																																																			0	NO	167.991759	5.45495482	20.86233559	5.789900397	5.206023829	6.646402787	0.73288738	8.629276973	5.670869761	9.467500389	22.87355288	0	0.346925639	32.6588907	27.53897174	33.93377865	1.306247982	3.56082894	0	11.65281552	23.54998765	0.560548975	0.493138688	4.120645972	0.620410556	1.511314106	0.202522335	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.072173519	0.072173519	0.143202742	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072173519	0.072173519	0.143202742	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												12.1246	0.393703284	2.987543663	0	1.213003552	1.548611849	0.17076276	2.010621535	1.321312654	2.205927591	5.329537822	0	0.080833674	7.609521532	6.416580416	7.906570425	0.30435578	0.829673143	0	2.715106017	5.487147122	0.130607911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.786	0	0	12.1246	0.393703284	2.987543663	0	1.213003552	1.548611849	0.17076276	2.010621535	1.321312654	2.205927591	5.329537822	0	0.080833674	7.609521532	6.416580416	7.906570425	0.30435578	0.829673143	0	2.715106017	5.487147122	0.130607911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.786	NO																																																																																		0		0	12.1246	0.393703284	2.987543663	0	1.213003552	1.548611849	0.17076276	2.010621535	1.321312654	2.205927591	5.329537822	0	0.080833674	7.609521532	6.416580416	7.906570425	0.30435578	0.829673143	0	2.715106017	5.487147122	0.130607911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.786
H1837_803_0	2010	5	N/A																															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																																																			0	NO	167.991759	5.45495482	20.86233559	5.789900397	5.206023829	6.646402787	0.73288738	8.629276973	5.670869761	9.467500389	22.87355288	0	0.346925639	32.6588907	27.53897174	33.93377865	1.306247982	3.56082894	0	11.65281552	23.54998765	0.560548975	0.493138688	4.120645972	0.620410556	1.511314106	0.202522335	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.072173519	0.072173519	0.143202742	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072173519	0.072173519	0.143202742	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												12.1246	0.393703284	2.987543663	0	1.213003552	1.548611849	0.17076276	2.010621535	1.321312654	2.205927591	5.329537822	0	0.080833674	7.609521532	6.416580416	7.906570425	0.30435578	0.829673143	0	2.715106017	5.487147122	0.130607911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.786	0	0	12.1246	0.393703284	2.987543663	0	1.213003552	1.548611849	0.17076276	2.010621535	1.321312654	2.205927591	5.329537822	0	0.080833674	7.609521532	6.416580416	7.906570425	0.30435578	0.829673143	0	2.715106017	5.487147122	0.130607911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.786	NO																																																																																		0		0	12.1246	0.393703284	2.987543663	0	1.213003552	1.548611849	0.17076276	2.010621535	1.321312654	2.205927591	5.329537822	0	0.080833674	7.609521532	6.416580416	7.906570425	0.30435578	0.829673143	0	2.715106017	5.487147122	0.130607911	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.786
H1846_001_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	P	V	Coin	V	T	V	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	0	0	0	0	0											0	NO	196.5893851	1.795032909	57.63970402	98.36770234	217.9095018	14.83681384	0	445.0256112	423.9610302	6277.460723	1219.04634	193.5539106	13.30494727	1976.350245	8848.427349	5927.15214	21.91419941	848.8956415	1669.757643	9472.644737	30.22544252	250.6183557	0	0	142.3394947	0	59.11568889	0	0	0												1A IP Acute: $200	1B IP Psych: $200	2 SNF: $300 per Admit	6 Home Health: $0	10A Ambulance: $100	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $100	"8A OP Diagnostic Procedures/Tests: $0, 9A OP Hospital: $0"	"8B OP Radiology: $0/$50, 9A OP Hospital: $0"	9A OP Hospital: $0	"12 Renal Dialysis: $0, 9A OP Hospital: $0"	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0, 9A OP Hospital: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 15%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											200	200	300	0	100	0	0	0	100	0	6.181285906	0	0	0	0	0	0	0	0	0	0.15	0	0	0	0	0	0	0	0	0											NO	200	200	300	0	100	0	0	0	100	0	6.181285906	0	0	0	0	0	0	0	0	0	0.15	0	0	0	0	0	0	0	0	0												3.2765	0.029917215	1.4409926	0	1.815912515	0	0	0	3.533008585	0	0.627939497	0	0	0	0	0	0	0	0	0	4.533816379	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2581	0	0	3.2765	0.029917215	1.4409926	0	1.815912515	0	0	0	3.533008585	0	0.627939497	0	0	0	0	0	0	0	0	0	4.533816379	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2581	YES	1A IP Acute: $600	1B IP Psych: $600	2 SNF: $500 for days 100 days	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 50%"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $250	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $35	9A OP Hospital: $35	12 Renal Dialysis: $0	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35, 9D Cardiac Rehab: $35"	"7A PCP: $15, 14B Immunizations: $15, 14C Physical Exams: $15, 14D Pap Smears and Pelvic Exams: $15, 14E Prostate Screening: $15, 14F Colorectal Screening: $15, 14G Bone Mass Measurement: $15, 14H Mammography: $15, 14I Diabetes Monitoring: $15, 14J Nutrition Therapy: $15"	"7B Chiropractic: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): $35	"7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $35, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $35	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $35	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											3350	1.474	0.0256	0.8407	0	0.2088	0.2432	0.1736	0	0.8709	0	0.301	0.0128	0	0.0902	0.4714	1.0865	0.0407	0.1447	0.1743	2.0879	0.2231	0.1726	0	0	0.0993	0	0.0428	0	0	0											8.7842	0	0.43	4.7505	0.055537349	2.281692792	0	2.024722733	0.243228731	0.173566706	0	4.403944322	0	0.928986848	0.012795587	0	0.090229654	0.471353808	1.086477585	0.040658654	0.144672801	0.174340981	2.087870426	4.756920313	0.172616935	0	0	0.099348394	0	0.042771528	0	0	0	0	0	0	0	0	0	0	0	0	0	24.0422
H1846_801_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	192.6604232	0.718417639	22.06309785	21.00887883	6.390584257	13.02778705	0	12.04531815	49.70462127	6.058228812	40.79422705	49.07075336	0.299889944	21.27161354	42.83712835	42.6959072	0.384910761	1.71898647	21.03102127	104.5257164	29.40924459	2.363980974	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing																			0.077367273	0.077367273	0.157554835	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077367273	0.077367273	0.157554835	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												14.9056	0.055582014	3.47614774	0	1.489006132	3.035474383	0	2.806559129	11.58117676	1.411567313	9.505054903	11.43348553	0.069874357	4.956285955	9.981050905	9.948146377	0.089684207	0.400523848	4.900227956	24.35449193	6.85235399	0.550807567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8031	0	0	14.9056	0.055582014	3.47614774	0	1.489006132	3.035474383	0	2.806559129	11.58117676	1.411567313	9.505054903	11.43348553	0.069874357	4.956285955	9.981050905	9.948146377	0.089684207	0.400523848	4.900227956	24.35449193	6.85235399	0.550807567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8031	NO	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing																				2.4501	0.0309	1.5283	0	0.2246	0.3157	0.2237	0.3872	1.12	0.2253	0.7326	0.0165	0.0028	0.5774	1.0389	2.5497	0.0301	0.1	0.6887	0.8796	0.2605	0.157	0	0	0	0	0	0	0	0											13.5397	0	0	17.3557	0.086528923	5.004429639	0	1.713618132	3.351189383	0.22368	3.193805129	12.70120776	1.636878313	10.2376069	11.45002853	0.072670357	5.533659955	11.0199979	12.49786538	0.119741207	0.500480848	5.588975956	25.23406693	7.11284799	0.707849567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3428
H1846_802_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	192.6604232	0.718417639	22.06309785	21.00887883	6.390584257	13.02778705	0	12.04531815	49.70462127	6.058228812	40.79422705	49.07075336	0.299889944	21.27161354	42.83712835	42.6959072	0.384910761	1.71898647	21.03102127	104.5257164	29.40924459	2.363980974	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing																			0.077367273	0.077367273	0.157554835	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077367273	0.077367273	0.157554835	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												14.9056	0.055582014	3.47614774	0	1.489006132	3.035474383	0	2.806559129	11.58117676	1.411567313	9.505054903	11.43348553	0.069874357	4.956285955	9.981050905	9.948146377	0.089684207	0.400523848	4.900227956	24.35449193	6.85235399	0.550807567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8031	0	0	14.9056	0.055582014	3.47614774	0	1.489006132	3.035474383	0	2.806559129	11.58117676	1.411567313	9.505054903	11.43348553	0.069874357	4.956285955	9.981050905	9.948146377	0.089684207	0.400523848	4.900227956	24.35449193	6.85235399	0.550807567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8031	NO	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing																				2.4501	0.0309	1.5283	0	0.2246	0.3157	0.2237	0.3872	1.12	0.2253	0.7326	0.0165	0.0028	0.5774	1.0389	2.5497	0.0301	0.1	0.6887	0.8796	0.2605	0.157	0	0	0	0	0	0	0	0											13.5397	0	0	17.3557	0.086528923	5.004429639	0	1.713618132	3.351189383	0.22368	3.193805129	12.70120776	1.636878313	10.2376069	11.45002853	0.072670357	5.533659955	11.0199979	12.49786538	0.119741207	0.500480848	5.588975956	25.23406693	7.11284799	0.707849567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3428
H1849_005_0	2010	7	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Partial Hospitalization	Ambulatory Surgical Center	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	3071.873399	83.84656598	755.5016892	2454.497895	475.5925123	18.72983562	1.380653871	404.4199151	242.571357	4990.181052	801.6289121	528.8382278	0.025157921	183.3578102	4115.401756	4575.615875	10.21926088	1859.853343	2945.635611	0	45.533076	0	0	0	302.4	239.2	162	0	0	0	0	0	167.693132	49.04647054	512.3604512	70.94221632	1.517157968	561.4069217	33.7194485	11.74456675		$280/day (days 1-8) w/no yrly max	$280/day (days 1-8) w/no yrly max	$128/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$40 copay	$20 coapy	$40 copay	$40 copay	$50/$40 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$40 copay 1/yr $50 limit	$40 copay 1/yr $75 limit	$40 copay 1/yr $50 limit		Silver Sneakers		$40 copay	$40 copay	$200 copay	$40 copay	$40 copay	$0 copay	20% coinsurance	$40 copay	$40 copay	20% coinsurance	280	280	128	0	100	0.2	0.2	50	200	0	91.50534896	200	0.2	40	20	40	40	48.1074522	79.44244334	0	0.2	0	0	0	40	40	40	0	0	0	40	40	200	40	40	0	0.2	40	40	0.2	NO	178.4909323	202.6275638	106.6645531	0	83.33168208	0.166663364	0.166663364	41.66584104	166.6633642	0	76.25294648	166.6633642	0.166663364	33.33267283	16.66633642	33.33267283	33.33267283	40.08874913	66.20072433	0	0.166663364	0	0	0	40	40	40	0	0	0	0	0	166.6633642	33.33267283	33.33267283	0	0.166663364	33.33267283	33.33267283	0.166663364		45.6918	1.415802116	6.715437502	0	3.302660336	3.121577414	0.230104419	1.404207991	3.368979867	0	5.093880544	7.344829845	0.004192904	0.509317158	5.715722513	12.70979225	0.028386273	6.213266172	16.25026759	0	7.588695628	0	0	0	1.008	0.797333333	0.54	0	0	0	0	0	2.329025127	0.136237496	1.423195274	0	0.252854651	1.559432771	0.093663279	1.957389005	136.806		27.28333816	45.6918	1.415802116	6.715437502	0	3.302660336	3.121577414	0.230104419	1.404207991	3.368979867	0	5.093880544	7.344829845	0.004192904	0.509317158	5.715722513	12.70979225	0.028386273	6.213266172	16.25026759	0	7.588695628	0	0	0	1.008	0.797333333	0.54	0	0	0	0	0	2.329025127	0.136237496	1.423195274	0	0.252854651	1.559432771	0.093663279	1.957389005	136.806	YES																																									3400	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			45.6918	1.415802116	6.715437502	0	3.302660336	3.121577414	0.230104419	1.404207991	3.368979867	0	5.093880544	7.344829845	0.004192904	0.509317158	5.715722513	12.70979225	0.028386273	6.213266172	16.25026759	0	7.588695628	0	0	0	1.008	0.797333333	0.54	0	0	0	0	0	2.329025127	0.136237496	1.423195274	0	0.252854651	1.559432771	0.093663279	1.957389005	136.806
H1849_015_0	2010	6	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Partial Hospitalization	Ambulatory Surgical Center	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	2058.990649	120.0086072	611.6141138	1199.75547	424.8480186	17.30669962	2.045530147	390.3062043	334.9972816	6067.734854	763.9161756	41.60696831	0	113.8072957	4090.253801	4085.285881	40.33039227	1903.672707	2906.564159	0	44.00288816	0	0	0	302.4	239.2	162	0	0	0	0	10.3463445	85.62597594	284.4349283	316.5855891	94.48357479	1.284315105	726.6705492	28.86998119	18.09700879		$280/day (days 1-8) w/$2240 yrly max	$280/day (days 1-8) w/$2240 yrly max	$128/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$40 copay	$0 coapy	$40 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$40 copay 1/yr $50 limit	$40 copay 1/yr $75 limit	$40 copay 1/yr $50 limit		Silver Sneakers		$40 copay	$40 copay	$200 copay	$40 copay	$40 copay	$0 copay	20% coinsurance	$40 copay	$40 copay	20% coinsurance	280	280	128	0	100	0.2	0.2	50	200	0	96.96010048	200	0.2	40	0	40	40	48.14402545	78.79505021	0	0.2	0	0	0	40	40	40	0	0	0	40	40	200	40	40	0	0.2	40	40	0.2	NO	147.4524637	85.48580613	110.8333958	0	86.58859046	0.173177181	0.173177181	43.29429523	173.1771809	0	83.95638431	173.1771809	0	34.63543618	0	34.63543618	34.63543618	41.68723303	68.22752333	0	0.173177181	0	0	0	40	40	40	0	0	0	0	34.63543618	173.1771809	34.63543618	34.63543618	0	0.173177181	34.63543618	34.63543618	0.173177181		25.3003	0.854919377	5.648939096	0	3.065582591	2.997125451	0.354239144	1.408169336	4.834490404	0	5.344636668	0.600448123	0	0.328480444	0	11.79130487	0.116405061	6.613237311	16.52563949	0	7.620296124	0	0	0	1.008	0.797333333	0.54	0	0	0	0	0.029862513	1.235705427	0.820960651	0.913756664	0	0.222414069	2.097379286	0.083327033	3.133988966	104.2869		16.10156634	25.3003	0.854919377	5.648939096	0	3.065582591	2.997125451	0.354239144	1.408169336	4.834490404	0	5.344636668	0.600448123	0	0.328480444	0	11.79130487	0.116405061	6.613237311	16.52563949	0	7.620296124	0	0	0	1.008	0.797333333	0.54	0	0	0	0	0.029862513	1.235705427	0.820960651	0.913756664	0	0.222414069	2.097379286	0.083327033	3.133988966	104.2869	YES																																									3400																								0	0	0	0	0													0			25.3003	0.854919377	5.648939096	0	3.065582591	2.997125451	0.354239144	1.408169336	4.834490404	0	5.344636668	0.600448123	0	0.328480444	0	11.79130487	0.116405061	6.613237311	16.52563949	0	7.620296124	0	0	0	1.008	0.797333333	0.54	0	0	0	0	0.029862513	1.235705427	0.820960651	0.913756664	0	0.222414069	2.097379286	0.083327033	3.133988966	104.2869
H1849_801_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	346.0976215	4.143932526	50.65211094	9.472161786	10.0704837	17.12101095	0.620645865	11.65071859	47.82026082	6.667105304	20.88895105	0	0.226720577	28.00804221	40.00887123	115.6618228	1.209186941	5.766450224	30.32462626	36.01690781	41.10374701	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.0795909	0.0795909	0.180806696	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.0795909	0.0795909	0.180806696	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				27.5462	0.329819321	9.158240831	0	2.346422703	3.989195552	0.144610487	2.714617431	11.14212077	1.553435536	4.867125594	0	0.052825894	6.525873834	9.322066997	26.94920471	0.281740557	1.343582902	7.065637919	8.391939519	9.577173053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3019			27.5462	0.329819321	9.158240831	0	2.346422703	3.989195552	0.144610487	2.714617431	11.14212077	1.553435536	4.867125594	0	0.052825894	6.525873834	9.322066997	26.94920471	0.281740557	1.343582902	7.065637919	8.391939519	9.577173053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3019	NO																																																																																		0			27.5462	0.329819321	9.158240831	0	2.346422703	3.989195552	0.144610487	2.714617431	11.14212077	1.553435536	4.867125594	0	0.052825894	6.525873834	9.322066997	26.94920471	0.281740557	1.343582902	7.065637919	8.391939519	9.577173053	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3019
H1849_803_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	345.9229492	4.141841122	50.58573991	9.468395843	10.06525383	17.11706074	0.620502668	11.65909196	47.85523932	6.664966434	20.88224967	0	0.226647843	27.99905696	40.00743906	115.6576825	1.209143656	5.766243806	30.32354075	36.01561853	41.13792021	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.0795909	0.0795909	0.180806696	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.0795909	0.0795909	0.180806696	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				27.5323	0.329652865	9.146240505	0	2.345204142	3.988275152	0.144577122	2.716568428	11.15027076	1.552937179	4.865564174	0	0.052808947	6.523780272	9.3217333	26.94824002	0.281730472	1.343534807	7.065384994	8.391639117	9.585135409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.2856			27.5323	0.329652865	9.146240505	0	2.345204142	3.988275152	0.144577122	2.716568428	11.15027076	1.552937179	4.865564174	0	0.052808947	6.523780272	9.3217333	26.94824002	0.281730472	1.343534807	7.065384994	8.391639117	9.585135409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.2856	NO																																																																																		0			27.5323	0.329652865	9.146240505	0	2.345204142	3.988275152	0.144577122	2.716568428	11.15027076	1.552937179	4.865564174	0	0.052808947	6.523780272	9.3217333	26.94824002	0.281730472	1.343534807	7.065384994	8.391639117	9.585135409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.2856
H1849_804_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	345.9229492	4.141841122	50.58573991	9.468395843	10.06525383	17.11706074	0.620502668	11.65909196	47.85523932	6.664966434	20.88224967	0	0.226647843	27.99905696	40.00743906	115.6576825	1.209143656	5.766243806	30.32354075	36.01561853	41.13792021	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.0795909	0.0795909	0.180806696	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.0795909	0.0795909	0.180806696	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				27.5323	0.329652865	9.146240505	0	2.345204142	3.988275152	0.144577122	2.716568428	11.15027076	1.552937179	4.865564174	0	0.052808947	6.523780272	9.3217333	26.94824002	0.281730472	1.343534807	7.065384994	8.391639117	9.585135409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.2856			27.5323	0.329652865	9.146240505	0	2.345204142	3.988275152	0.144577122	2.716568428	11.15027076	1.552937179	4.865564174	0	0.052808947	6.523780272	9.3217333	26.94824002	0.281730472	1.343534807	7.065384994	8.391639117	9.585135409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.2856	NO																																																																																		0			27.5323	0.329652865	9.146240505	0	2.345204142	3.988275152	0.144577122	2.716568428	11.15027076	1.552937179	4.865564174	0	0.052808947	6.523780272	9.3217333	26.94824002	0.281730472	1.343534807	7.065384994	8.391639117	9.585135409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.2856
H1903_005_0	2010	3	N/A																															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	V	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	Yes	2307.217297	117.3774922	317.1035751	1712.908071	485.8013732	20.72741603	6.05982262	1160.302267	361.2101877	8355.626124	1260.187252	79.03457114	0.093349243	637.8346952	9621.071894	20303.32643	419.2865087	3844.445152	5065.941064	2040.263248	31.71545731	23.08356072	0	0	0	0	0	0	0	0											3350	"$25 days 1 - 5, $0 after day 5, unlimited coverage"	"$25 days 1 - 5, $0 after day 5, unlimited coverage"	$0 days 1 - 100	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	20% coinsurance	Copay between $0.00 and $50.00	$25.00 copayment	$0.00 copayment	Copay between $0.00 and $75.00	$25.00 copayment	20% coinsurance	Copay between $15.00 and $25.00	$0.00 copayment	Copay between $0.00 and $25.00	Copay between $15.00 and $25.00	$25.00 copayment	Copay between $0.00 and $75.00	Copay between $0.00 and $25.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											12.53039587	7.769962302	0	2.77846205	39.39727745	0.2	0.188276309	21.52436097	14.20986256	0	42.64856699	7.137729924	0.2	4.112803005	0	6.364117882	12.53964117	6.326333714	32.6751315	5.500731924	0.2	0	0	0	0	0	0	0	0	0											NO	11.9450368	7.40698751	0	2.648665837	37.55682855	0.190656974	0.179480957	20.51884767	13.54604699	0	40.65623368	6.804289949	0.190656974	3.920672882	0	6.066817293	11.95385021	6.030798218	31.14870851	5.243764522	0.190656974	0	0	0	0	0	0	0	0	0												2.2966	0.072451135	0	0.378076757	1.520429907	3.951826422	1.087622761	1.984005456	0.407747515	0	4.269538949	0.044814512	0.017797684	0.208395099	0	10.26471432	0.41767401	1.932089414	13.14979346	0.891555003	6.046773125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.942	0	2.398369914	2.2966	0.072451135	0	0.378076757	1.520429907	3.951826422	1.087622761	1.984005456	0.407747515	0	4.269538949	0.044814512	0.017797684	0.208395099	0	10.26471432	0.41767401	1.932089414	13.14979346	0.891555003	6.046773125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.942	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.2966	0.072451135	0	0.378076757	1.520429907	3.951826422	1.087622761	1.984005456	0.407747515	0	4.269538949	0.044814512	0.017797684	0.208395099	0	10.26471432	0.41767401	1.932089414	13.14979346	0.891555003	6.046773125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.942
H1903_011_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	507.4436836	51.56267358	576.598947	2598.942399	15.72088757	31.45678686	7.905320639	24.02336871	19.67603571	9507.058804	24.24407819	0.566365831	0.04416441	7.123994505	10451.07698	107.6728622	25.36875381	15.64169658	43.83336291	7.653979748	21.83286133	0.139735301	0	381.4285714	0.96	172.8	0.056	0.224	0	4310.51926												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	$0.00 copayment											687.6952777	513.714182	47.98453213	0	0.16230519	0.170000339	0.108813159	0.113942835	0.17	0	0.170094279	0.248627937	0.17	0.170010171	0	0.073609746	0.382684613	0.170000184	0.164848014	0.050283977	0.170000408	0.17	0	0	0	0	0	0	0	0											NO	687.6952777	513.714182	47.98453213	0	0.16230519	0.170000339	0.108813159	0.113942835	0.17	0	0.170094279	0.248627937	0.17	0.170010171	0	0.073609746	0.382684613	0.170000184	0.164848014	0.050283977	0.170000408	0.17	0	0	0	0	0	0	0	0												29.0806	2.207373056	2.305652558	0	2.551581642	5.34766444	0.860202909	2.737290747	3.34492607	0	4.123778991	0.140814368	0.00750795	1.211151522	0	7.925772006	9.708231742	2.659091298	7.225842839	0.384872542	3.711595337	0.023755001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5577	0	0	29.0806	2.207373056	2.305652558	0	2.551581642	5.34766444	0.860202909	2.737290747	3.34492607	0	4.123778991	0.140814368	0.00750795	1.211151522	0	7.925772006	9.708231742	2.659091298	7.225842839	0.384872542	3.711595337	0.023755001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5577	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.0806	2.207373056	2.305652558	0	2.551581642	5.34766444	0.860202909	2.737290747	3.34492607	0	4.123778991	0.140814368	0.00750795	1.211151522	0	7.925772006	9.708231742	2.659091298	7.225842839	0.384872542	3.711595337	0.023755001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5577
H1903_022_0	2010	5	N/A																															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	V	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	Yes	2925.005042	89.17651124	380.4734498	1109.491556	440.7424484	25.07636708	6.823882276	1231.566647	462.9574034	8135.41696	1091.341676	13.5692327	2.805058622	427.4558865	11553.55911	15480.06602	50.87739562	2324.97732	4949.277018	901.6160645	29.36161204	15.55580956	0	381.4285714	288	172.8	16.8	12.8	0	0											3350	"$75 days 1 - 8, $0 after day 8, unlimited coverage"	"$75 days 1 - 8, $0 after day 8, unlimited coverage"	"$0 days 1 - 20, $133.5 days 21 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $25.00 and $50.00	$0.00 copayment	Copay between $0.00 and $100.00	$75.00 copayment	20% coinsurance	Copay between $15.00 and $50.00	Copay between $0.00 and $5.00	Copay between $0.00 and $25.00	Copay between $15.00 and $25.00	$25.00 copayment	Copay between $0.00 and $75.00	Copay between $0.00 and $25.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Not Covered											39.59313678	31.55377856	32.31	2.451248075	43.96969398	0.2	0.092919205	15.43674856	20.56859588	0	39.75074929	21.41318977	0.2	6.783010591	2.082166478	5.166822833	13.99426791	6.62719308	18.22329714	1.233583628	0.2	0	0	0	0	0	0	0	0	0											NO	37.94819487	30.24284093	30.96764429	2.349408185	42.14292301	0.191690772	0.089058771	14.79541127	19.71405016	0	38.09925919	20.52355444	0.191690772	6.501202699	1.995660502	4.9521613	13.41286013	6.351858803	17.46618953	1.182332992	0.191690772	0	0	0	0	0	0	0	0	0												9.2499	0.22474592	0.981863871	0.217220712	1.547847923	4.806908175	0.607726566	1.518461255	0.760563789	0	3.464942447	0.023207407	0.537703854	0.231581447	1.921415131	6.388315321	0.056867616	1.230660638	7.203750869	0.088834202	5.628350091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6909	0	2.023910383	9.2499	0.22474592	0.981863871	0.217220712	1.547847923	4.806908175	0.607726566	1.518461255	0.760563789	0	3.464942447	0.023207407	0.537703854	0.231581447	1.921415131	6.388315321	0.056867616	1.230660638	7.203750869	0.088834202	5.628350091	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6909	NO	30% conisurance	Not covered OON	30% conisurance	30% conisurance	30% conisurance	30% conisurance	30% conisurance	Same as in-network	30% conisurance	30% conisurance	30% conisurance	Not covered OON	Not covered OON	30% conisurance	Not covered OON	30% conisurance	Not covered OON	30% conisurance	30% conisurance	30% conisurance	Not covered OON	30% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0.8589	0	0.0293	0.0617	0.0653	0.1775	0.0483	0	0.1616	0.1226	0.1248	0	0	0.035	0	0.5396	0	0.084	0.2886	0.0679	0	0.0013	0	0	0	0	0	0	0	0											2.6665	0	0	10.1088	0.22474592	1.011211688	0.27887695	1.613175796	4.984415043	0.656016139	1.518461255	0.922206977	0.122565752	3.589694281	0.023207407	0.537703854	0.266619396	1.921415131	6.927871814	0.056867616	1.314656467	7.492330301	0.156768488	5.628350091	0.001332422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3573
H1906_001_0	2010	10	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	YES	2029.473302	112.112366	439.898659	2414.931925	12.023206	20.568025	10.773769	515.723895	56.492414	13.210747	22.032099	3.814815	0.707109	29.441153	3408.168007	7167.626884	59.199966	2.210099			33.002652	0							0.04	0.25	244.693946	377.065085	0	0	0.05	0.55	2.87	615.494519	0.32	0.4	5900	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	"20% Coins, up to $50 maximum:4a"	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.242811	0.25	0.24118	0.25	0.2	0.233686	15	35	35	0.25			0.2	0							0	0	0	17.155804	0	0	0	0	0	15	0	0	NO	139.095685	123.011093	41.011464	0	0.172112	0.172112	0.172112	43.0281	0.208954	0.215141	0.20755	0.215141	0.172112	0.201102	12.90843	30.11967	30.11967	0.215141			0.172112	0							0	0	0	14.763633	0	0	0	0	0	12.90843	0	0		23.5242	1.14925539	1.503407335	0	2.069338031	3.540003919	1.85429493	1.849218277	11.80431587	2.84217332	4.572762147	0.820723114	0.121701944	5.920674751	3.666174846	17.99054637	0.148590287	0.475482909	0	0	5.680152441	0	0	0	0	0	0	0	0	0	0	0.463904211	0	0	0	0	0	0.662088993	0	0	90.6591	0	14.567912	23.5242	1.14925539	1.503407335	0	2.069338031	3.540003919	1.85429493	1.849218277	11.80431587	2.84217332	4.572762147	0.820723114	0.121701944	5.920674751	3.666174846	17.99054637	0.148590287	0.475482909	0	0	5.680152441	0	0	0	0	0	0	0	0	0	0	0.463904211	0	0	0	0	0	0.662088993	0	0	90.6591	NO																																																																																		0	0	0	23.5242	1.14925539	1.503407335	0	2.069338031	3.540003919	1.85429493	1.849218277	11.80431587	2.84217332	4.572762147	0.820723114	0.121701944	5.920674751	3.666174846	17.99054637	0.148590287	0.475482909	0	0	5.680152441	0	0	0	0	0	0	0	0	0	0	0.463904211	0	0	0	0	0	0.662088993	0	0	90.6591
H1906_009_0	2010	5	N/A	r.	s.	t.	u.	v.						Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	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	YES	324.453971	5.455332	636.295654	33.658782	9.807751	23.971951	13.600212	454.699161	79.3228	13.519457	36.107593	7.456603	0.649043	26.472964	51.503555	77.080523	0.874366	6.804739			29.275264	0							0.04	0.25	0.05	0.55	2.87								4900	Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	"0%-20% Coins:8a. 0% Lab -- FSL,8a. 20% Lab -- OP"	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a								0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0.169381	0.187398	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0	0	0								NO	0.061256	0.061256	28.913935	0	0.166	0.166	0.166	41.4999	0.166	0.140586	0.15554	0.166	0.166	0.166	0.166	0.166	0.166	0.166			0.166	0							0	0	0	0	0									19.8748	0.334171817	1.533150932	0	1.628086666	3.979343866	2.257635192	1.572497476	13.1675848	1.900646382	5.616175015	1.237796098	0.107741138	4.394512024	8.54959013	12.79536682	0.145144756	1.129586674	0	0	4.859693824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0835	0	17.984951	19.8748	0.334171817	1.533150932	0	1.628086666	3.979343866	2.257635192	1.572497476	13.1675848	1.900646382	5.616175015	1.237796098	0.107741138	4.394512024	8.54959013	12.79536682	0.145144756	1.129586674	0	0	4.859693824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0835	NO																																																																																		0	0	0	19.8748	0.334171817	1.533150932	0	1.628086666	3.979343866	2.257635192	1.572497476	13.1675848	1.900646382	5.616175015	1.237796098	0.107741138	4.394512024	8.54959013	12.79536682	0.145144756	1.129586674	0	0	4.859693824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0835
H1906_801_0	2010	5	N/A																															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	NO	256.63578	2.754445	39.780169	40.404371	8.28206	15.389769	6.972601	19.427664	87.840337	15.289838	43.230227	3.338226	0.511339	20.184993	36.734698	96.604778	0.328586	11.598298			37.01665	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																			0.079120909	0.079120909	0.203407269	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079120909	0.079120909	0.203407269	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.3053	0.217934193	8.091575524	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4555	0	0	20.3053	0.217934193	8.091575524	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4555	NO																																																																																		0	0	0	20.3053	0.217934193	8.091575524	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4555
H1906_802_0	2010	5	N/A																															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	NO	256.63578	2.754445	39.780169	40.404371	8.28206	15.389769	6.972601	19.427664	87.840337	15.289838	43.230227	3.338226	0.511339	20.184993	36.734698	96.604778	0.328586	11.598298			37.01665	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																			0.078740295	0.078740295	0.210515634	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.078740295	0.078740295	0.210515634	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.2076	0.216885811	8.374347498	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6396	0	0	20.2076	0.216885811	8.374347498	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6396	NO																																																																																		0	0	0	20.2076	0.216885811	8.374347498	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6396
H1906_803_0	2010	5	N/A																															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	NO	256.63578	2.754445	39.780169	40.404371	8.28206	15.389769	6.972601	19.427664	87.840337	15.289838	43.230227	3.338226	0.511339	20.184993	36.734698	96.604778	0.328586	11.598298			37.01665	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																			0.078740295	0.078740295	0.210515634	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.078740295	0.078740295	0.210515634	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.2076	0.216885811	8.374347498	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6396	0	0	20.2076	0.216885811	8.374347498	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6396	NO																																																																																		0	0	0	20.2076	0.216885811	8.374347498	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6396
H1906_805_0	2010	6	N/A																																		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	NO				40.404371	8.28206	15.389769	6.972601	19.427664	87.840337	15.289838	43.230227	3.338226	0.511339	20.184993	36.734698	96.604778	0.328586	11.598298			37.01665	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8408	0	0	0	0	0	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8408	NO																																																																																		0	0	0	0	0	0	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8408
H1906_806_0	2010	6	N/A																																		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	NO				40.404371	8.28206	15.389769	6.972601	19.427664	87.840337	15.289838	43.230227	3.338226	0.511339	20.184993	36.734698	96.604778	0.328586	11.598298			37.01665	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8408	0	0	0	0	0	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8408	NO																																																																																		0	0	0	0	0	0	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8408
H1906_807_0	2010	6	N/A																																		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	NO				40.404371	8.28206	15.389769	6.972601	19.427664	87.840337	15.289838	43.230227	3.338226	0.511339	20.184993	36.734698	96.604778	0.328586	11.598298			37.01665	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8408	0	0	0	0	0	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8408	NO																																																																																		0	0	0	0	0	0	0	1.92971998	3.585816177	1.624616033	4.526645712	20.46679852	3.562532254	10.07264289	0.777806658	0.119141987	4.703103369	8.559184634	22.50891327	0.076560538	2.702403434	0	0	8.62487945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8408
H1944_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1620.809088	118.465532	775.2411206	858.6025804	195.5757521	10.23978938	9.321764968	314.0692013	27.14044345	9137.765742	35.49408844	0	0.036008077	21.47551463	5604.048734	4273.087239	508.7945943	319.8657828	0	0	16.98362778	906.1366743	0	0	100.850217	0	13.24147545	4.784986653	84.11552369	0											3750	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$85 Days 1-30 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$5 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	67.29214739	0	150	0.2	0.124455075	49.5096539	0.2	3	0.173999639	0	0.2	0.149063147	3.662009845	25	38.5	25	0	0	0.2	23.94185018	0	0	25	0	0	0	0	0											YES	143.3489137	109.1775674	52.35696113	0	116.7081818	0.155610909	0.096832836	38.52121124	0.155610909	2.334163635	0.13538121	0	0.155610909	0.116175788	3.55704375	25	38.5	19.45136363	0	0	0.155610909	23.94185018	0	0	25	0	0	0	0	0											6000	19.3618	1.077814884	3.382439101	0	1.902107535	1.593422933	0.902652943	1.008193837	4.223349076	1.777420042	4.805232632	0	0.00560325	2.494934827	1.661153877	8.902265082	1.632382657	0.518485471	0	0	2.642837758	1.807882375	0	0	0.210104619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9101	0	13.07877097	19.3618	1.077814884	3.382439101	0	1.902107535	1.593422933	0.902652943	1.008193837	4.223349076	1.777420042	4.805232632	0	0.00560325	2.494934827	1.661153877	8.902265082	1.632382657	0.518485471	0	0	2.642837758	1.807882375	0	0	0.210104619	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9101	NO	"$350 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$140 Days 1-30 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.5292	0.3351	2.1299	0.5318	0.6245	0.7847	0.7143	0.4391	2.0798	0.5835	2.3215	0	0.0018	1.2257	1.8323	4.0371	0.5985	0.2259	0	0	1.2338	0.8348	0	0	0.0955	0	0.0125	0	0	0											25.1712	0	6.002207967	23.891	1.412876122	5.512336492	0.531762713	2.526560513	2.37809284	1.616975101	1.447260244	6.3031076	2.360938701	7.126690491	0	0.00744277	3.720650126	3.493459731	12.93938042	2.230890205	0.744410594	0	0	3.876685759	2.642661304	0	0	0.305556121	0	0.012532633	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0812
H1944_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	267.858248	5.876443513	27.96385143	995.5854049	6.957656143	11.90079074	10.1146865	15.2608597	26.74895132	14.70188913	32.04139838	0	0.042350877	19.76325828	30.55107201	101.8557333	2.495510945	3.544043535	0	0	19.84718592	6.036312361	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.073829927	0.073829927	0.148989623	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073829927	0.073829927	0.148989623	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.776	0.433857398	4.166323686	0	1.621133881	2.772884242	2.356721955	3.555780311	6.232505656	3.425540167	7.465645823	0	0.009867754	4.604839179	7.118399779	23.73238587	0.58145405	0.825762144	0	0	4.624394319	1.40646078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7099	0	0	19.776	0.433857398	4.166323686	0	1.621133881	2.772884242	2.356721955	3.555780311	6.232505656	3.425540167	7.465645823	0	0.009867754	4.604839179	7.118399779	23.73238587	0.58145405	0.825762144	0	0	4.624394319	1.40646078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7099	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.5698	0.0564	1.6607	0	0.5549	0.9491	0.8067	1.2171	2.1333	1.1725	2.5554	0	0.0034	1.5762	2.3099	7.7012	0.1887	0.268	0	0	1.5006	0.4564	0	0	0	0	0	0	0	0											27.6801	0	0	22.3457	0.490234349	5.827026135	0	2.176018633	3.721992272	3.163385174	4.772859478	8.365779405	4.598040493	10.02100111	0	0.013245308	6.180992187	9.428344078	31.43362367	0.770137815	1.093724694	0	0	6.125025588	1.86286196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.39
H1944_802_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	267.858248	5.876443513	27.96385143	995.5854049	6.957656143	11.90079074	10.1146865	15.2608597	26.74895132	14.70188913	32.04139838	0	0.042350877	19.76325828	30.55107201	101.8557333	2.495510945	3.544043535	0	0	19.84718592	6.036312361	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.073829927	0.073829927	0.148989623	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073829927	0.073829927	0.148989623	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.776	0.433857398	4.166323686	0	1.621133881	2.772884242	2.356721955	3.555780311	6.232505656	3.425540167	7.465645823	0	0.009867754	4.604839179	7.118399779	23.73238587	0.58145405	0.825762144	0	0	4.624394319	1.40646078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7099	0	0	19.776	0.433857398	4.166323686	0	1.621133881	2.772884242	2.356721955	3.555780311	6.232505656	3.425540167	7.465645823	0	0.009867754	4.604839179	7.118399779	23.73238587	0.58145405	0.825762144	0	0	4.624394319	1.40646078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7099	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.5698	0.0564	1.6607	0	0.5549	0.9491	0.8067	1.2171	2.1333	1.1725	2.5554	0	0.0034	1.5762	2.3099	7.7012	0.1887	0.268	0	0	1.5006	0.4564	0	0	0	0	0	0	0	0											27.6801	0	0	22.3457	0.490234349	5.827026135	0	2.176018633	3.721992272	3.163385174	4.772859478	8.365779405	4.598040493	10.02100111	0	0.013245308	6.180992187	9.428344078	31.43362367	0.770137815	1.093724694	0	0	6.125025588	1.86286196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.39
H1944_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	267.858248	5.876443513	27.96385143	995.5854049	6.957656143	11.90079074	10.1146865	15.2608597	26.74895132	14.70188913	32.04139838	0	0.042350877	19.76325828	30.55107201	101.8557333	2.495510945	3.544043535	0	0	19.84718592	6.036312361	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.073829927	0.073829927	0.148989623	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073829927	0.073829927	0.148989623	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.776	0.433857398	4.166323686	0	1.621133881	2.772884242	2.356721955	3.555780311	6.232505656	3.425540167	7.465645823	0	0.009867754	4.604839179	7.118399779	23.73238587	0.58145405	0.825762144	0	0	4.624394319	1.40646078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7099	0	0	19.776	0.433857398	4.166323686	0	1.621133881	2.772884242	2.356721955	3.555780311	6.232505656	3.425540167	7.465645823	0	0.009867754	4.604839179	7.118399779	23.73238587	0.58145405	0.825762144	0	0	4.624394319	1.40646078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.7099	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.5698	0.0564	1.6607	0	0.5549	0.9491	0.8067	1.2171	2.1333	1.1725	2.5554	0	0.0034	1.5762	2.3099	7.7012	0.1887	0.268	0	0	1.5006	0.4564	0	0	0	0	0	0	0	0											27.6801	0	0	22.3457	0.490234349	5.827026135	0	2.176018633	3.721992272	3.163385174	4.772859478	8.365779405	4.598040493	10.02100111	0	0.013245308	6.180992187	9.428344078	31.43362367	0.770137815	1.093724694	0	0	6.125025588	1.86286196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.39
H1951_001_0	2010	5	N/A	r.	s.	t.	u.	v.	w.			z.	aa.	DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Part B Rx			Other Non-Covered	Other Non-Covered	Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V		V		O	O	O	P	O	O	O	S			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	0	0	YES	1752.368217	55.680719	464.578195	2514.764345	202.254404	10.635862	1.029771	412.795303	517.375652	3191.960733	1557.250845	118.365056	0.004955	659.124767	9113.786617	2885.454913	34.300783	1479.079046			8.71669	0		0.94	2.47		0.33		0.04	0.25	10539.36895	29.811145	0.05	0.55	2.87	71.895885			0.45	0.67	7500	$20/Day(Days 1-10):1a	$20/Day(Days 1-10):1b	"$0/Day(Days 1-7) $50(Days 8-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$50/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $50 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $20 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$20/Visit:7b, 7d, 7f"	$20/Visit:7e	$10/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"	"VIS735: Vision 7a, 7b"		"HER751: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$50/Script:15			$0: OTC items 13c	$0: Nutritional benefit 14a	15.9077	14.73252	34.6754	0	100	0.2	0.2	50	50	0	27.695407	50	0.2	31.126943	10	20	20	10			0.2	0		0	0		0		0	0	0	0	0	0	0	50			0	0	NO	15.600395	14.447917	34.399384	0	96.3625	0.192725	0.192725	48.18125	48.18125	0	26.687986	48.18125	0.192725	29.9947	9.63625	19.2725	19.2725	9.63625			0.192725	0		0	0		0		0	0	0	0	0	0	0	48.18125			0	0		2.2781	0.067039201	1.331766977	0	1.624145	2.049796504	0.198462616	1.657416141	2.077317136	0	3.463324062	0.47524803	0.000954952	1.647520804	7.318560524	4.634160818	0.055088487	1.187731288	0	0	1.67992408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.288669467	0	0	0	0	32.0353	0	1.127355	2.2781	0.067039201	1.331766977	0	1.624145	2.049796504	0.198462616	1.657416141	2.077317136	0	3.463324062	0.47524803	0.000954952	1.647520804	7.318560524	4.634160818	0.055088487	1.187731288	0	0	1.67992408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.288669467	0	0	0	0	32.0353	NO																																																																																		0	0	0	2.2781	0.067039201	1.331766977	0	1.624145	2.049796504	0.198462616	1.657416141	2.077317136	0	3.463324062	0.47524803	0.000954952	1.647520804	7.318560524	4.634160818	0.055088487	1.187731288	0	0	1.67992408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.288669467	0	0	0	0	32.0353
H1951_005_0	2010	4	N/A	r.	s.	t.	u.	v.	w.			z.	aa.	DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Part B Rx			Other Non-Covered	Other Non-Covered	Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V		V		O	O	O	P	O	O	O	S			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	0	0	YES	1848.227386	82.197344	392.703626	2734.609332	213.759443	13.037949	1.79254	349.914217	517.12682	2133.591681	908.4879	35.673467	0.011202	238.292176	9312.638038	3937.610902	37.745926	1470.338256			12.788364	0		0.94	2.47		0.33		0.04	0.25	13811.87949	18.914205	0.05	0.55	2.87	284.79104			0.45	0.67	7500	$10/Day(Days 1-10):1a	$10/Day(Days 1-10):1b	"$0/Day(Days 1-15) $50(Days 16-100):2. $0 SNF 1,2. $50 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$50/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $50 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$100/Visit:9d. $5 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $15 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3. $5 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	$5/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"	"VIS735: Vision 7a, 7b"		"HER751: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$50/Script:15			$0: OTC items 13c	$0: Nutritional benefit 14a	7.95385	7.36626	22.9285	0	100	0.2	0.2	50	50	0	48.362476	50	0.2	32.182558	5	15	15	5			0.2	0		0	0		0		0	0	0	0	0	0	0	50			0	0	NO	7.810211	7.233233	22.817939	0	96.623	0.193246	0.193246	48.3115	48.3115	0	46.729276	48.3115	0.193246	31.095753	4.83115	14.49345	14.49345	4.83115			0.193246	0		0	0		0		0	0	0	0	0	0	0	48.3115			0	0		1.2029	0.049546045	0.746723949	0	1.721173222	2.519531492	0.346401185	1.408740058	2.08193103	0	3.537748485	0.143619892	0.002164742	0.617489554	3.749229271	4.755797227	0.045589058	0.591952055	0	0	2.47130019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.146556861	0	0	0	0	27.1384	0	0.905276	1.2029	0.049546045	0.746723949	0	1.721173222	2.519531492	0.346401185	1.408740058	2.08193103	0	3.537748485	0.143619892	0.002164742	0.617489554	3.749229271	4.755797227	0.045589058	0.591952055	0	0	2.47130019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.146556861	0	0	0	0	27.1384	NO																																																																																		0	0	0	1.2029	0.049546045	0.746723949	0	1.721173222	2.519531492	0.346401185	1.408740058	2.08193103	0	3.537748485	0.143619892	0.002164742	0.617489554	3.749229271	4.755797227	0.045589058	0.591952055	0	0	2.47130019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.146556861	0	0	0	0	27.1384
H1951_013_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Part B Rx	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	O	P	O	O	O	S	O	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	0	0	YES	2109.784363	66.06112	646.997469	1324.516793	145.552492	9.807926	1.700866	380.818236	466.167338	1925.075899	1221.549327	88.684773	0	596.927538	4319.208143	4626.864593	28.65123	749.994436			10.452726	0		0.94					0.04	0.25	8086.473552	0	0.05	0.55	2.87	129.939051	0.32	0.4	0.42	0.45	4900	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $250 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$10-$150/Visit:9d. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $25 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	$10/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$50/Script:15	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	123.4779	109.1993	58.254672	0	100	0.2	0.2	50	250	0	78.026873	50	0	42.492076	10	25	25	10			0.2	0		0					0	0	0	0	0	0	0	50	0	0	0	0	NO	112.95536	99.893554	38.8741	0	89.8732	0.179746	0.179746	44.9366	224.683	0	70.125248	44.9366	0	38.188988	8.98732	22.4683	22.4683	8.98732			0.179746	0		0					0	0	0	0	0	0	0	44.9366	0	0	0	0		19.8593	0.549923338	2.095953692	0	1.090105685	1.762935467	0.30572386	1.426056395	8.728323	0	7.138454125	0.332099348	0	1.899671549	3.234842144	8.663148478	0.053645369	0.561703333	0	0	1.878835688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.48658493	0	0	0	0	60.0673	0	7.178639	19.8593	0.549923338	2.095953692	0	1.090105685	1.762935467	0.30572386	1.426056395	8.728323	0	7.138454125	0.332099348	0	1.899671549	3.234842144	8.663148478	0.053645369	0.561703333	0	0	1.878835688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.48658493	0	0	0	0	60.0673	NO																																																																																		0	0	0	19.8593	0.549923338	2.095953692	0	1.090105685	1.762935467	0.30572386	1.426056395	8.728323	0	7.138454125	0.332099348	0	1.899671549	3.234842144	8.663148478	0.053645369	0.561703333	0	0	1.878835688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.48658493	0	0	0	0	60.0673
H1951_017_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	O	T	Coin	V				O	O	O	O	O	O	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				0	NO	4141.252643	296.570777	1098.827717	2485.69266	673.956193	1930.223002	20180.23878	938.2244	461.931421	1493.991528	2306.942118	118.90994	8.280365	1086.159915	6791.586316	4677.046784	119.386239	1185.536941			5321.843073	0	6.46	2.42	2.47				0.04	0.25	0.05	0.55	2.87	0.32	0.4	0.45	0.67					$0/Day(Days 1-7):1a	$0/Day(Days 1-1):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	$0/Service:11b	$0/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS735: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: OTC items 13c	$0: Nutritional benefit 14a				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0				NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H1951_019_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														A	A	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V				O	O	O	O	O	O	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				0	NO	602.004304	47.837135	1104.636583	2999.243567	655.721482	3891.422842	21470.08615	1002.243028	587.074638	1406.708143	2489.594153	225.162121	8.041314	680.913199	7486.185201	5583.400995	107.737495	1425.664812			5882.990096	0	6.46	2.42	2.47				0.04	0.25	0.05	0.55	2.87	0.32	0.4	0.45	0.67					$0/Admit:1a	$0/Admit:1b	$0/Day(Days 1-1) $0(Days 1-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	$0/Service:11b	$0/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS735: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: OTC items 13c	$0: Nutritional benefit 14a				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0				NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H1951_024_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	YES	2093.624381	66.523981	555.050147	3004.489521	8.911215	12.808492	6.122513	493.183055	88.252392	23.79584	34.444464	6.743181	1.197372	37.341453	10888.60531	3447.368366	40.980517	5.267801			13.44553	0							0.04	0.25	32.157918	314.821431	0	0.05	0.55	2.87	1174.091645	0.32	0.4	0.67	5900	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 25% Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.243258	0.25	0.237206	0.25	0.2	0.219568	15	35	35	0.25			0.2	0							0	0	0	0	0	0	0	0	35	0	0	0	NO	135.406959	119.74892	37.498008	0	0.168629	0.168629	0.168629	42.1572	0.205101	0.210786	0.199999	0.210786	0.168629	0.185128	12.64716	29.51004	29.51004	0.210786			0.168629	0							0	0	0	0	0	0	0	0	29.51004	0	0	0		23.6243	0.663847907	1.734439571	0	1.502689274	2.159883197	1.032433245	1.732601391	18.10065385	5.01582993	6.888858356	1.42136815	0.201911643	6.912948511	11.47582779	8.477664865	0.100778058	1.110378702	0	0	2.267306278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.887290951	0	0	0	97.311	0	18.410752	23.6243	0.663847907	1.734439571	0	1.502689274	2.159883197	1.032433245	1.732601391	18.10065385	5.01582993	6.888858356	1.42136815	0.201911643	6.912948511	11.47582779	8.477664865	0.100778058	1.110378702	0	0	2.267306278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.887290951	0	0	0	97.311	NO																																																																																		0	0	0	23.6243	0.663847907	1.734439571	0	1.502689274	2.159883197	1.032433245	1.732601391	18.10065385	5.01582993	6.888858356	1.42136815	0.201911643	6.912948511	11.47582779	8.477664865	0.100778058	1.110378702	0	0	2.267306278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.887290951	0	0	0	97.311
H1951_025_0	2010	3	N/A	r.	s.	t.	u.	v.	w.			z.		DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Part B Rx			Other Non-Covered		Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	O	P	O	O	O	S			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	YES	2042.77136	64.28669	629.633981	1283.654651	141.378267	8.754784	1.520027	368.719192	452.330905	1876.062192	1185.60939	85.708505	0	580.09193	4189.196091	4491.089299	27.881909	729.275435			9.340054	0		0.94					0.04	0.25	7867.639921	0	0.05	0.55	2.87	126.444115			0.42		4900	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $250 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$50/Script:15			$0: Nutritional benefit 14a		123.4779	109.1993	58.254672	0	100	0.2	0.2	50	250	0	78.11163	50	0	44.700244	15	35	35	15			0.2	0		0					0	0	0	0	0	0	0	50			0		NO	112.289567	99.304751	38.747105	0	89.1766	0.178353	0.178353	44.5883	222.9415	0	69.657296	44.5883	0	39.862158	13.37649	31.21181	31.21181	13.37649			0.178353	0		0					0	0	0	0	0	0	0	44.5883			0			19.1152	0.531997812	2.033041164	0	1.050636097	1.561441991	0.271101376	1.370046829	8.403610871	0	6.882195352	0.318466378	0	1.926976347	4.669728302	11.68125216	0.072520404	0.812928797	0	0	1.665826651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.469827344	0	0	0	0	62.8368	0	7.976348	19.1152	0.531997812	2.033041164	0	1.050636097	1.561441991	0.271101376	1.370046829	8.403610871	0	6.882195352	0.318466378	0	1.926976347	4.669728302	11.68125216	0.072520404	0.812928797	0	0	1.665826651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.469827344	0	0	0	0	62.8368	NO																																																																																		0	0	0	19.1152	0.531997812	2.033041164	0	1.050636097	1.561441991	0.271101376	1.370046829	8.403610871	0	6.882195352	0.318466378	0	1.926976347	4.669728302	11.68125216	0.072520404	0.812928797	0	0	1.665826651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.469827344	0	0	0	0	62.8368
H1951_801_0	2010	3	N/A																															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	NO	308.773312	1.972588	16.868355	21.093132	5.527807	9.449194	3.076935	20.386858	93.857797	17.771391	32.134182	5.677032	0.137302	28.73792	96.261142	67.822959	0.128503	10.757644			16.200168	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																			0.077353076	0.077353076	0.210263148	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.077353076	0.077353076	0.210263148	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.8846	0.152585749	3.546793423	0	1.287979031	2.201662202	0.716925855	4.750137914	21.8688667	4.140734103	7.487264406	1.322748456	0.031991366	6.69593536	22.42884609	15.80274945	0.029941199	2.506531052	0	0	3.774639144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6309	0	0	23.8846	0.152585749	3.546793423	0	1.287979031	2.201662202	0.716925855	4.750137914	21.8688667	4.140734103	7.487264406	1.322748456	0.031991366	6.69593536	22.42884609	15.80274945	0.029941199	2.506531052	0	0	3.774639144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6309	NO																																																																																		0	0	0	23.8846	0.152585749	3.546793423	0	1.287979031	2.201662202	0.716925855	4.750137914	21.8688667	4.140734103	7.487264406	1.322748456	0.031991366	6.69593536	22.42884609	15.80274945	0.029941199	2.506531052	0	0	3.774639144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6309
H1951_804_0	2010	2	N/A																															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	NO	294.252293	1.810771	28.678993	13.33048	6.493196	6.319359	2.671009	26.835942	75.393799	10.908367	35.636911	5.537542	1.151061	19.541451	99.559423	123.32258	0.383238	7.496524			28.701957	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																			0.077353172	0.077353172	0.210262503	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.077353172	0.077353172	0.210262503	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.7613	0.140068881	6.030116847	0	1.512914668	1.472410647	0.622345097	6.252774486	17.56675517	2.541649511	8.303400263	1.290247286	0.268197213	4.553158083	23.19734556	28.73416114	0.089294454	1.746690092	0	0	6.687555981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.7704	0	0	22.7613	0.140068881	6.030116847	0	1.512914668	1.472410647	0.622345097	6.252774486	17.56675517	2.541649511	8.303400263	1.290247286	0.268197213	4.553158083	23.19734556	28.73416114	0.089294454	1.746690092	0	0	6.687555981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.7704	NO																																																																																		0	0	0	22.7613	0.140068881	6.030116847	0	1.512914668	1.472410647	0.622345097	6.252774486	17.56675517	2.541649511	8.303400263	1.290247286	0.268197213	4.553158083	23.19734556	28.73416114	0.089294454	1.746690092	0	0	6.687555981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.7704
H1951_805_0	2010	2	N/A																															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	NO	294.252293	1.810771	28.678993	13.33048	6.493196	6.319359	2.671009	26.835942	75.393799	10.908367	35.636911	5.537542	1.151061	19.541451	99.559423	123.32258	0.383238	7.496524			28.701957	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																			0.077353172	0.077353172	0.210262503	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.077353172	0.077353172	0.210262503	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.7613	0.140068881	6.030116847	0	1.512914668	1.472410647	0.622345097	6.252774486	17.56675517	2.541649511	8.303400263	1.290247286	0.268197213	4.553158083	23.19734556	28.73416114	0.089294454	1.746690092	0	0	6.687555981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.7704	0	0	22.7613	0.140068881	6.030116847	0	1.512914668	1.472410647	0.622345097	6.252774486	17.56675517	2.541649511	8.303400263	1.290247286	0.268197213	4.553158083	23.19734556	28.73416114	0.089294454	1.746690092	0	0	6.687555981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.7704	NO																																																																																		0	0	0	22.7613	0.140068881	6.030116847	0	1.512914668	1.472410647	0.622345097	6.252774486	17.56675517	2.541649511	8.303400263	1.290247286	0.268197213	4.553158083	23.19734556	28.73416114	0.089294454	1.746690092	0	0	6.687555981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.7704
H1961_001_0	2010	7	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	NO	327.075319	7.129739896	35.44035736	0	278.586448	22.23439649	1.600411005	425.3286932	443.7748984	0	1320.724845	0	0	78.67875024	3752.054668	4717.35376	114.7901637	539.4698659	3445.498112	1159.004406	33.94539552	0	191.6148562	0	529.3881635	0	0	0	0	0												"$50/day for 10 days, $0 Copay afterwards"	"$50/day for 10 days, $0 Copay afterwards"	"$0 Copay days 1-20, $50 Copay 21+, Per Medicare Benefit Period"	Choice 2: 10% for MC services $500 max OOP	"$100 Copay, per Trip"	"0% for Infusion Supplies, 20% otherwise"	"0% for Diabetic Supplies, 20% otherwise"	"ER: $50 Copay, MC & WW, Urgent Care: $25 Copay, Worldwide: $50 Copay"	"Choice 1: $50 Copay per visit, Choice 2: $150 Copay per visit"	$0 Copay per visit	"Choice 1:  $75 Copay per visit, Choice 2:  $80 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise"	- zero -	- zero -	"$10 Copay per visit for PT/OT/ST, $0 Otherwise"	"Office Visit:  Choice 1: $5 Copay, Choice 2: $25 Copay, Routine Physical Choice 1: $5 Copay, Choice 2: NA"	"Office Visit:  Choice 1: $15 Copay, Choice 2: $25 Copay"	"$15 Copay Days 1-20, 45% coins after"	$10 Copay per visit	"Choice 1:  $75 Copay per visit, Choice 2:  $80 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise"	"Chiropractor, Podiatrist, Hearing, Speech, and Vision Exams: Choice 1: $15 Copay, Choice 2: $25 Copay"	"Non-Chemo Drugs: Choice 1: 10% of MA, Choice 2: 20% of MA, Chemo Drugs: $50 Copay per Service"	- zero -	"$5 Copay, 12 one-way trips"	Varies by Service	"$15 Copay, 1 Exam per BP"	- zero -	- zero -	- zero -	- zero -	- zero -											257.0075674	257.0075674	258.3960913	0	100	0.189650911	0.2	50	53.77940931	0	22.88167889	0	0	10	5.185035093	15.91829139	15	10	10.14627464	16.68536129	0.072417517	0	5	0	15	0	0	0	0	0											NO	257.0075674	257.0075674	258.3960913	0	100	0.189650911	0.2	50	53.77940931	0	22.88167889	0	0	10	5.185035093	15.91829139	15	10	10.14627464	16.68536129	0.072417517	0	5	0	15	0	0	0	0	0												7.0051	0.152699759	0.763137485	0	2.321553733	4.216773541	0.320082201	1.772202888	1.988829325	0	2.518366817	0	0	0.065565625	1.621211261	6.257684313	0.143487705	0.449558222	2.91324751	1.611533937	2.458241262	0	0.079839523	0	0.661735204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3208	0	0	7.0051	0.152699759	0.763137485	0	2.321553733	4.216773541	0.320082201	1.772202888	1.988829325	0	2.518366817	0	0	0.065565625	1.621211261	6.257684313	0.143487705	0.449558222	2.91324751	1.611533937	2.458241262	0	0.079839523	0	0.661735204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3208	NO	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.0051	0.152699759	0.763137485	0	2.321553733	4.216773541	0.320082201	1.772202888	1.988829325	0	2.518366817	0	0	0.065565625	1.621211261	6.257684313	0.143487705	0.449558222	2.91324751	1.611533937	2.458241262	0	0.079839523	0	0.661735204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3208
H1961_002_0	2010	5	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	NO	324.4079607	6.253938265	25.18959549	0	130.0408907	17.70917012	1.349896056	411.8017841	528.095415	0	1033.288282	0	0	63.82541928	4114.105287	4006.700202	118.462218	539.608055	3262.820395	1075.824234	35.97593803	0	111.0022428	0	531.1767299	0	0	0	0	0												"$50/day for 10 days, $0 Copay afterwards"	"$50/day for 10 days, $0 Copay afterwards"	"$0 Copay days 1-20, $50 Copay 21+, Per Medicare Benefit Period"	Choice 2: 10% for MC services $500 max OOP	"$100 Copay, per Trip"	"0% for Infusion Supplies, 20% otherwise"	"0% for Diabetic Supplies, 20% otherwise"	"ER: $50 Copay, MC & WW, Urgent Care: $25 Copay, Worldwide: $50 Copay"	"Choice 1: $50 Copay per visit, Choice 2: $150 Copay per visit"	$0 Copay per visit	"Choice 1:  $75 Copay per visit, Choice 2:  $80 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise"	- zero -	- zero -	"$10 Copay per visit for PT/OT/ST, $0 Otherwise"	"Office Visit:  Choice 1: $5 Copay, Choice 2: $25 Copay, Routine Physical Choice 1: $5 Copay, Choice 2: NA"	"Office Visit:  Choice 1: $15 Copay, Choice 2: $25 Copay"	"$15 Copay Days 1-20, 45% coins after"	$10 Copay per visit	"Choice 1:  $75 Copay per visit, Choice 2:  $80 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise"	"Chiropractor, Podiatrist, Hearing, Speech, and Vision Exams: Choice 1: $15 Copay, Choice 2: $25 Copay"	"Non-Chemo Drugs: Choice 1: 10% of MA, Choice 2: 20% of MA, Chemo Drugs: $50 Copay per Service"	- zero -	"$5 Copay, 12 one-way trips"	Varies by Service	"$15 Copay, 1 Exam per BP"	- zero -	- zero -	- zero -	- zero -	- zero -											241.4510941	241.4510941	283.0401031	0	100	0.190527839	0.2	50	53.54926781	0	21.86	0	0	10	5.369424299	15.70993008	15	10	9.990026121	16.02350602	0.077981234	0	5	0	15	0	0	0	0	0											NO	241.4510941	241.4510941	283.0401031	0	100	0.190527839	0.2	50	53.54926781	0	21.86	0	0	10	5.369424299	15.70993008	15	10	9.990026121	16.02350602	0.077981234	0	5	0	15	0	0	0	0	0												6.5274	0.12583502	0.594138809	0	1.08367409	3.374089907	0.269979211	1.715840767	2.356593567	0	1.88230682	0	0	0.053187849	1.840864742	5.245415003	0.148077773	0.449673379	2.716305082	1.436539674	2.805448045	0	0.046250935	0	0.663970912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3356	0	0	6.5274	0.12583502	0.594138809	0	1.08367409	3.374089907	0.269979211	1.715840767	2.356593567	0	1.88230682	0	0	0.053187849	1.840864742	5.245415003	0.148077773	0.449673379	2.716305082	1.436539674	2.805448045	0	0.046250935	0	0.663970912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.3356	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	20% of MA services	20% of MA services	"$100 Copay, per Trip"	20% of MA services	20% of MA services	"ER: $50 Copay, MC & WW, Urgent Care:  $25 Copay, Worldwide:  $50 Copay, $5,000 Annual Max for WW"	20% of MA services	20% of MA services	20% of MA services	- zero -	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	- zero -	- zero -	- zero -	- zero -	- zero -	- zero -	- zero -	- zero -												0.296	0	0	0.0061	0.8478	0.5013	0.0677	0.0166	0.4193	0.0658	0.1621	0	0.006	0.1818	0.2654	1.2387	0.0011	0.293	0.5547	0.9823	0.182	0	0	0	0	0	0	0	0	0											6.0878	0	0	6.8234	0.12583502	0.594138809	0.00614384	1.931490642	3.875431108	0.337641734	1.732454918	2.775891692	0.065759407	2.044397728	0	0.005983836	0.235003292	2.106215353	6.484129591	0.149225318	0.74268248	3.271024025	2.418881941	2.987490126	0	0.046250935	0	0.663970912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4234
H1961_003_0	2010	5	N/A																															A	A	A	V	T	Coin	P	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	532.9648661	0	31.55013913	0	541.0569377	43.19800154	0	767.8021799	503.7521781	0	0	0	0	0	4728.308613	4104.535181	481.2572549	0	0	1042.548364	0	0	634.5640994	0	506.6220994	0	0	0	0	0												"Choice 1: $0, Choice 2: $150 copay days 1-3, $0 Copay afterwards"	- zero -	"$0 Copay days 1-20, $50 Copay 21+"	Choice 2: 10% for MC services $500 max OOP	"$25 Copay, per Trip"	"Choice 2: 0% for Infusion Supplies, 5% otherwise"	"Choice 1:  0%, Choice 2:  0% for Diabetic Supplies, 5% otherwise"	"ER: $50 Copay, MC & WW, Urgent Care: $10 Copay, Worldwide: $10 Copay"	Choice 2: $150 Copay per visit	- zero -	- zero -	- zero -	- zero -	- zero -	Office Visit:  Choice 2: $25 Copay	Office Visit:  Choice 2: $25 Copay	"$10 Copay Days 1-20, 45% coins after"	- zero -	- zero -	"Chiropractor & Podiatrist: Choice 2: $25 Copay, Vision Exams: Choice 2: $15 Copay"	- zero -	- zero -	"$5 Copay, 48 one-way trips"	Varies by Service	$15 Copay	- zero -	- zero -	- zero -	- zero -	- zero -											7.801610922	0	65.82054054	0	25	9.40E-05	0	49.83440563	7.605633803	0	0	0	0	0	0.383435583	2.928406876	10	0	0	4.391958188	0	0	5	0	15	0	0	0	0	0											NO	7.801610922	0	65.82054054	0	25	9.40E-05	0	49.83440563	7.605633803	0	0	0	0	0	0.383435583	2.928406876	10	0	0	4.391958188	0	0	5	0	15	0	0	0	0	0												0.3465	0	0.173053934	0	1.127201953	0.004060761	0	3.188580439	0.319279549	0	0	0	0	0	0.151083481	1.001645754	0.401047712	0	0	0.381569069	0	0	0.264401708	0	0.633277624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.9917	0	0	0.3465	0	0.173053934	0	1.127201953	0.004060761	0	3.188580439	0.319279549	0	0	0	0	0	0.151083481	1.001645754	0.401047712	0	0	0.381569069	0	0	0.264401708	0	0.633277624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.9917	NO	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0.3465	0	0.173053934	0	1.127201953	0.004060761	0	3.188580439	0.319279549	0	0	0	0	0	0.151083481	1.001645754	0.401047712	0	0	0.381569069	0	0	0.264401708	0	0.633277624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.9917
H1961_007_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	NO	400.7226486	7.693866114	27.93147287	0	219.5014367	20.80721374	6.183509109	455.8660483	445.3804177	0	1142.241593	0	0	152.2559793	4535.518903	4369.717779	174.0025581	534.8947147	4269.890606	1022.869867	31.29123087	0	111.0022903	0	531.1865843	0	0	0	0	0												"$50/day for 10 days, $0 Copay afterwards"	"$50/day for 10 days, $0 Copay afterwards"	"$0 Copay days 1-20, $50 Copay 21+, Per Medicare Benefit Period"	Choice 2: 10% for MC services $500 max OOP	"$100 Copay, per Trip"	"0% for Infusion Supplies, 20% otherwise"	"0% for Diabetic Supplies, 20% otherwise"	"ER: $50 Copay, MC & WW, Urgent Care: $25 Copay, Worldwide: $50 Copay"	"Choice 1: $50 Copay per visit, Choice 2: $150 Copay per visit"	$0 Copay per visit	"Choice 1:  $75 Copay per visit, Choice 2:  $80 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise"	- zero -	- zero -	"$10 Copay per visit for PT/OT/ST, $0 Otherwise"	"Office Visit:  Choice 1: $5 Copay, Choice 2: $25 Copay, Routine Physical Choice 1: $5 Copay, Choice 2: NA"	"Office Visit:  Choice 1: $15 Copay, Choice 2: $25 Copay"	"$15 Copay Days 1-20, 45% coins after"	$10 Copay per visit	"Choice 1:  $75 Copay per visit, Choice 2:  $80 Copay per visit --  for Advanced Imaging and Nuclear Medicine Only, $0 Otherwise"	"Chiropractor, Podiatrist, Hearing, Speech, and Vision Exams: Choice 1: $15 Copay, Choice 2: $25 Copay"	"Non-Chemo Drugs: Choice 1: 10% of MA, Choice 2: 20% of MA, Chemo Drugs: $50 Copay per Service"	- zero -	"$5 Copay, 12 one-way trips"	Varies by Service	"$15 Copay, 1 Exam per BP"	- zero -	- zero -	- zero -	- zero -	- zero -											262.1943487	262.1943487	355.168	0	100	0.190527839	0.2	49.73621568	53.54926781	0	21.86	0	0	10	5.373084234	15.7063259	15	10	9.990026121	15.94459393	0.079314497	0	5	0	15	0	0	0	0	0											NO	262.1943487	262.1943487	355.168	0	100	0.190527839	0.2	49.73621568	53.54926781	0	21.86	0	0	10	5.373084234	15.7063259	15	10	9.990026121	15.94459393	0.079314497	0	5	0	15	0	0	0	0	0												8.7556	0.168107351	0.826697113	0	1.829178639	3.964353463	1.236701822	1.889421008	1.987482939	0	2.080783435	0	0	0.126879983	2.030810426	5.719350962	0.217503198	0.445745596	3.554693224	1.359103722	2.481848248	0	0.046250954	0	0.66398323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3845	0	0	8.7556	0.168107351	0.826697113	0	1.829178639	3.964353463	1.236701822	1.889421008	1.987482939	0	2.080783435	0	0	0.126879983	2.030810426	5.719350962	0.217503198	0.445745596	3.554693224	1.359103722	2.481848248	0	0.046250954	0	0.66398323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3845	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	20% of MA services	20% of MA services	"$100 Copay, per Trip"	20% of MA services	20% of MA services	"ER: $50 Copay, MC & WW, Urgent Care:  $25 Copay, Worldwide:  $50 Copay, $5,000 Annual Max for WW"	20% of MA services	20% of MA services	20% of MA services	- zero -	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	20% of MA services	- zero -	- zero -	- zero -	- zero -	- zero -	- zero -	- zero -	- zero -												1.8158	0.0055	0.1508	0.314	0.5823	0.5563	0.2122	0.0289	1.3572	0.0864	0.3951	0	0.033	0.1551	0.4566	1.8604	0.0049	0.1424	0.4739	1.1124	0.1423	0.0029	0	0	0	0	0	0	0	0											9.8883	0	0	10.5714	0.173563	0.977484122	0.313966871	2.411498352	4.520695722	1.448942596	1.918280808	3.344648734	0.086355849	2.475893311	0	0.033024256	0.281955034	2.487402455	7.579769098	0.222430112	0.588182512	4.028567782	2.471499786	2.62416282	0.002890073	0.046250954	0	0.66398323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2728
H1961_801_0	2010	3	N/A																															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	NO	231.9815176	2.406542409	27.34435265	0	7.516410071	13.99934594	4.868734558	9.369913903	35.94618647	4.997334791	22.16424021	0	0.263951874	20.11176467	36.08089753	101.5964473	0.889485416	3.487602658	24.45632573	32.35566637	8.764914153	0.585803284	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	21% Coinsurance for SNF		23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET		23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products																			0.077870445	0.077870445	0.208708744	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077870445	0.077870445	0.208708744	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.0645	0.187398529	5.707005498	0	1.751323547	3.261847603	1.134415152	2.183189939	8.375461447	1.164379006	5.16426797	0	0.061500787	4.686041168	8.406849124	23.67197222	0.207250102	0.812611419	5.698323896	7.538870263	2.042224998	0.136492165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2559	0	0	18.0645	0.187398529	5.707005498	0	1.751323547	3.261847603	1.134415152	2.183189939	8.375461447	1.164379006	5.16426797	0	0.061500787	4.686041168	8.406849124	23.67197222	0.207250102	0.812611419	5.698323896	7.538870263	2.042224998	0.136492165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2559	NO	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	21% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET		23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products																				0.9755	0.0095	0.4384	0	0.0958	0.1342	0.0871	0.1468	0.4854	0.0746	0.2124	0	0.0047	0.2679	0.4958	1.2494	0.0159	0.0475	0.3468	0.4905	0.094	0.0105	0	0	0	0	0	0	0	0											5.6827	0	0	19.04	0.196875101	6.145425744	0	1.847134483	3.396021904	1.221562531	2.329959376	8.860909175	1.238955067	5.376652748	0	0.066225364	4.953908145	8.902666655	24.92138235	0.223171348	0.860100291	6.045075474	8.029369031	2.13625966	0.146977687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9386
H1961_802_0	2010	3	N/A																															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	NO	231.9815176	2.406542409	27.34435265	0	7.516410071	13.99934594	4.868734558	9.369913903	35.94618647	4.997334791	22.16424021	0	0.263951874	20.11176467	36.08089753	101.5964473	0.889485416	3.487602658	24.45632573	32.35566637	8.764914153	0.585803284	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	21% Coinsurance for SNF		23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET		23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products																			0.077870445	0.077870445	0.208708744	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077870445	0.077870445	0.208708744	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.0645	0.187398529	5.707005498	0	1.751323547	3.261847603	1.134415152	2.183189939	8.375461447	1.164379006	5.16426797	0	0.061500787	4.686041168	8.406849124	23.67197222	0.207250102	0.812611419	5.698323896	7.538870263	2.042224998	0.136492165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2559	0	0	18.0645	0.187398529	5.707005498	0	1.751323547	3.261847603	1.134415152	2.183189939	8.375461447	1.164379006	5.16426797	0	0.061500787	4.686041168	8.406849124	23.67197222	0.207250102	0.812611419	5.698323896	7.538870263	2.042224998	0.136492165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2559	NO	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	21% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET		23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products																				0.9755	0.0095	0.4384	0	0.0958	0.1342	0.0871	0.1468	0.4854	0.0746	0.2124	0	0.0047	0.2679	0.4958	1.2494	0.0159	0.0475	0.3468	0.4905	0.094	0.0105	0	0	0	0	0	0	0	0											5.6827	0	0	19.04	0.196875101	6.145425744	0	1.847134483	3.396021904	1.221562531	2.329959376	8.860909175	1.238955067	5.376652748	0	0.066225364	4.953908145	8.902666655	24.92138235	0.223171348	0.860100291	6.045075474	8.029369031	2.13625966	0.146977687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9386
H1961_803_0	2010	3	N/A																															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	NO	244.5085637	2.528239064	29.44498456	0	7.927615805	14.57520131	5.242757643	9.999825647	38.02965311	5.317403719	23.07576287	0	0.284229031	21.26140835	38.20886977	106.9587225	0.957816946	3.691417556	25.94452993	34.46081129	9.168496394	0.630805523	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	21% Coinsurance for SNF		23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET		23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products																			0.077870445	0.077870445	0.208708744	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077870445	0.077870445	0.208708744	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.04	0.196875101	6.145425744	0	1.847134483	3.396021905	1.221562531	2.329959376	8.860909175	1.238955067	5.376652748	0	0.066225364	4.953908145	8.902666656	24.92138235	0.223171348	0.860100291	6.045075474	8.029369031	2.13625966	0.146977687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9386	0	0	19.04	0.196875101	6.145425744	0	1.847134483	3.396021905	1.221562531	2.329959376	8.860909175	1.238955067	5.376652748	0	0.066225364	4.953908145	8.902666656	24.92138235	0.223171348	0.860100291	6.045075474	8.029369031	2.13625966	0.146977687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9386	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing		No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.04	0.196875101	6.145425744	0	1.847134483	3.396021905	1.221562531	2.329959376	8.860909175	1.238955067	5.376652748	0	0.066225364	4.953908145	8.902666656	24.92138235	0.223171348	0.860100291	6.045075474	8.029369031	2.13625966	0.146977687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9386
H1961_804_0	2010	3	N/A																															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	NO	244.5085637	2.528239064	29.44498456	0	7.927615805	14.57520131	5.242757643	9.999825647	38.02965311	5.317403719	23.07576287	0	0.284229031	21.26140835	38.20886977	106.9587225	0.957816946	3.691417556	25.94452993	34.46081129	9.168496394	0.630805523	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	21% Coinsurance for SNF		23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET		23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products																			0.077870445	0.077870445	0.208708744	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077870445	0.077870445	0.208708744	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.04	0.196875101	6.145425744	0	1.847134483	3.396021905	1.221562531	2.329959376	8.860909175	1.238955067	5.376652748	0	0.066225364	4.953908145	8.902666656	24.92138235	0.223171348	0.860100291	6.045075474	8.029369031	2.13625966	0.146977687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9386	0	0	19.04	0.196875101	6.145425744	0	1.847134483	3.396021905	1.221562531	2.329959376	8.860909175	1.238955067	5.376652748	0	0.066225364	4.953908145	8.902666656	24.92138235	0.223171348	0.860100291	6.045075474	8.029369031	2.13625966	0.146977687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9386	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing		No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.04	0.196875101	6.145425744	0	1.847134483	3.396021905	1.221562531	2.329959376	8.860909175	1.238955067	5.376652748	0	0.066225364	4.953908145	8.902666656	24.92138235	0.223171348	0.860100291	6.045075474	8.029369031	2.13625966	0.146977687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9386
H2001_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1101.938686	122.5573757	867.2699514	417.9347715	161.4055541	7.465306903	6.556348384	453.7970317	21.47351901	6639.454689	22.12851967	0	0.018650936	15.59277094	4081.301826	2932.305156	422.7133992	355.4868143	0	0	9.850171635	761.4795979	0	0	93.08826717	0	11.29458197	3.653236816	85.22721477	0											3375	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$80 Days 1-22 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$25 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	54.81246091	0	150	0.2	0.112218875	49.82463928	0.2	3	0.174414643	0	0.2	0.15027835	15.58234603	30	38.5	30	0	0	0.2	28.70877555	0	0	30	0	0	0	0	0											NO	151.5812435	115.4474841	45.09624738	0	123.4105712	0.164547428	0.092326636	40.99258127	0.164547428	2.468211423	0.143497405	0	0.164547428	0.123868843	15.51499635	30	38.5	24.68211423	0	0	0.164547428	28.70877555	0	0	30	0	0	0	0	0												13.9194	1.17907839	3.259218356	0	1.659929301	1.228397052	0.605325591	1.550192642	3.533412327	1.365631492	3.175385145	0	0.003068964	1.931458495	5.276781912	7.33076289	1.356205489	0.731180513	0	0	1.62082041	1.821762239	0	0	0.232720668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7808	0	7.723779355	13.9194	1.17907839	3.259218356	0	1.659929301	1.228397052	0.605325591	1.550192642	3.533412327	1.365631492	3.175385145	0	0.003068964	1.931458495	5.276781912	7.33076289	1.356205489	0.731180513	0	0	1.62082041	1.821762239	0	0	0.232720668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7808	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"25% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$35 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$35 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.722	0.1855	0.7346	0.2752	0.5691	0.6317	0.5548	0.5314	1.817	0.4682	1.5965	0	0.0011	0.9876	3.8824	4.3237	0.6884	0.5324	0	0	1.3276	1.1078	0	0	0.1394	0	0.0169	0.004	0	0											25.0972	0	0	18.6414	1.364624365	3.993862172	0.275184737	2.228987344	1.860076866	1.160093531	2.081630692	5.350402397	1.833798169	4.771838035	0	0.004121068	2.919022729	9.15917447	11.65445036	2.044646333	1.263552071	0	0	2.948452239	2.929542285	0	0	0.372128218	0	0.016914591	0.004005742	0	0	0	0	0	0	0	0	0	0	0	0	76.8779
H2001_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	176.3117344	5.873030594	25.04089392	440.1209197	5.895857099	7.862548824	6.905223046	15.12896785	22.61616218	12.50242794	23.30601656	0	0.019643385	16.39847818	19.61554417	60.95481962	2.191659331	3.804361579	0	0	10.37431634	4.942724216	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08004872	0.08004872	0.139763007	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08004872	0.08004872	0.139763007	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.1135	0.470128583	3.499790636	0	1.373734704	1.831973876	1.60891697	3.525049509	5.269565787	2.913065711	5.430301859	0	0.004576909	3.820845417	4.570421792	14.20247297	0.510656624	0.886416248	0	0	2.417215708	1.151654742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6003	0	0	14.1135	0.470128583	3.499790636	0	1.373734704	1.831973876	1.60891697	3.525049509	5.269565787	2.913065711	5.430301859	0	0.004576909	3.820845417	4.570421792	14.20247297	0.510656624	0.886416248	0	0	2.417215708	1.151654742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6003	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.3111	0.0437	0.4326	0	0.3875	0.5167	0.4538	0.9942	1.4863	0.8216	1.5316	0	0.0013	1.0777	2.0534	6.3808	0.2294	0.3982	0	0	1.086	0.5174	0	0	0	0	0	0	0	0											19.7233	0	0	15.4246	0.51380173	3.932349029	0	1.761198339	2.348684456	2.062714064	4.519294242	6.755853574	3.734699629	6.96192546	0	0.005867832	4.898519765	6.623799698	20.58329416	0.740082064	1.284661229	0	0	3.503211171	1.669064844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3236
H2001_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	176.3117344	5.873030594	25.04089392	440.1209197	5.895857099	7.862548824	6.905223046	15.12896785	22.61616218	12.50242794	23.30601656	0	0.019643385	16.39847818	19.61554417	60.95481962	2.191659331	3.804361579	0	0	10.37431634	4.942724216	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08004872	0.08004872	0.139763007	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08004872	0.08004872	0.139763007	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.1135	0.470128583	3.499790636	0	1.373734704	1.831973876	1.60891697	3.525049509	5.269565787	2.913065711	5.430301859	0	0.004576909	3.820845417	4.570421792	14.20247297	0.510656624	0.886416248	0	0	2.417215708	1.151654742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6003	0	0	14.1135	0.470128583	3.499790636	0	1.373734704	1.831973876	1.60891697	3.525049509	5.269565787	2.913065711	5.430301859	0	0.004576909	3.820845417	4.570421792	14.20247297	0.510656624	0.886416248	0	0	2.417215708	1.151654742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6003	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.3111	0.0437	0.4326	0	0.3875	0.5167	0.4538	0.9942	1.4863	0.8216	1.5316	0	0.0013	1.0777	2.0534	6.3808	0.2294	0.3982	0	0	1.086	0.5174	0	0	0	0	0	0	0	0											19.7233	0	0	15.4246	0.51380173	3.932349029	0	1.761198339	2.348684456	2.062714064	4.519294242	6.755853574	3.734699629	6.96192546	0	0.005867832	4.898519765	6.623799698	20.58329416	0.740082064	1.284661229	0	0	3.503211171	1.669064844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3236
H2001_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	176.3117344	5.873030594	25.04089392	440.1209197	5.895857099	7.862548824	6.905223046	15.12896785	22.61616218	12.50242794	23.30601656	0	0.019643385	16.39847818	19.61554417	60.95481962	2.191659331	3.804361579	0	0	10.37431634	4.942724216	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08004872	0.08004872	0.139763007	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08004872	0.08004872	0.139763007	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.1135	0.470128583	3.499790636	0	1.373734704	1.831973876	1.60891697	3.525049509	5.269565787	2.913065711	5.430301859	0	0.004576909	3.820845417	4.570421792	14.20247297	0.510656624	0.886416248	0	0	2.417215708	1.151654742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6003	0	0	14.1135	0.470128583	3.499790636	0	1.373734704	1.831973876	1.60891697	3.525049509	5.269565787	2.913065711	5.430301859	0	0.004576909	3.820845417	4.570421792	14.20247297	0.510656624	0.886416248	0	0	2.417215708	1.151654742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6003	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.3111	0.0437	0.4326	0	0.3875	0.5167	0.4538	0.9942	1.4863	0.8216	1.5316	0	0.0013	1.0777	2.0534	6.3808	0.2294	0.3982	0	0	1.086	0.5174	0	0	0	0	0	0	0	0											19.7233	0	0	15.4246	0.51380173	3.932349029	0	1.761198339	2.348684456	2.062714064	4.519294242	6.755853574	3.734699629	6.96192546	0	0.005867832	4.898519765	6.623799698	20.58329416	0.740082064	1.284661229	0	0	3.503211171	1.669064844	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3236
H2012_001_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.			Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1691.597231	45.101315	1033.139023	1079.221745	210.936702	9.71804	2.790194	349.850951	295.949159	262.574836	737.293277	42.249169	25.420038	544.21417	3959.61453	3775.085375	80.572861	484.408345			20.461522	0							0.04	0.25	0.05	0.55	2.4	0.25	0.45	0.73					3400	$150/Day(Days 1-15):1a	$150/Day(Days 1-15):1b	"$0/Day(Days 1-14) $70(Days 15-100):2. $0 SNF 1,2. $70 SNF 2"	$5/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $35 Radiology OP -- Facility"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$0-$100/Visit:9d. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $35 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$35/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: OTC items 13c	$0: Nutritional benefit 14a					131.5059	126.3489	33.75967	5	100	0.2	0.060428	50	166.825412	0	42.740888	50	3.125701	31.583223	5	35	35	35			0.2	0							0	0	0	0	0	0	0	0					NO	115.428778	110.902242	18.861528	4.374205	87.4841	0.174968	0.052865	43.74205	145.94571	0	37.391481	43.74205	2.734492	27.630298	4.374205	30.619435	30.619435	30.619435			0.174968	0							0	0	0	0	0	0	0	0						16.2716	0.416819746	1.623881718	0.393394763	1.537800628	1.700346023	0.147503606	1.275266483	3.599375845	0	2.297373963	0.154005439	0.005792574	1.253066641	1.44334714	9.632581772	0.20559129	1.236025819	0	0	3.580111581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7739	0	7.678895	16.2716	0.416819746	1.623881718	0.393394763	1.537800628	1.700346023	0.147503606	1.275266483	3.599375845	0	2.297373963	0.154005439	0.005792574	1.253066641	1.44334714	9.632581772	0.20559129	1.236025819	0	0	3.580111581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7739	NO																																																																																		0	0	0	16.2716	0.416819746	1.623881718	0.393394763	1.537800628	1.700346023	0.147503606	1.275266483	3.599375845	0	2.297373963	0.154005439	0.005792574	1.253066641	1.44334714	9.632581772	0.20559129	1.236025819	0	0	3.580111581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7739
H2012_002_0	2010	3	N/A	r.	s.	t.	u.			x.				DME/Prosthetics/Supplies	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)			Other Non-Covered				Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	O	O	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	YES	1663.705436	51.35885	770.862604	1319.939917	222.058138	11.679327	1.723008	369.711561	312.051429	1306.51578	1424.416092	63.871524	0.932023	353.232297	4907.766905	4656.622578	76.251324	703.627129			35.413251	0		0.87	1.5				0.04	0.25	7268.467007	0.05	0.55	1.74			0.42				4900	$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$225/Visit:9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $225 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"	"VIS734: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a			$0: Nutritional benefit 14a				144.519765	143.64207	58.254672	0	100	0.2	0.2	50	225	0	54.043328	50	0.2	34.380747	15	35	35	15			0.2	0		0	0				0	0	0	0	0	0			0				NO	130.868573	130.073784	36.154306	0	88.8719	0.177744	0.177744	44.43595	199.961775	0	48.029332	44.43595	0.177744	30.554823	13.330785	31.105165	31.105165	13.330785			0.177744	0		0	0				0	0	0	0	0	0			0					18.1439	0.55670333	2.322500206	0	1.64456072	2.075930298	0.306254334	1.36904037	5.199863136	0	5.701146116	0.236515987	0.165661496	0.899412526	5.45203212	12.0704178	0.197650835	0.781658498	0	0	6.294492886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4177	0	8.678845	18.1439	0.55670333	2.322500206	0	1.64456072	2.075930298	0.306254334	1.36904037	5.199863136	0	5.701146116	0.236515987	0.165661496	0.899412526	5.45203212	12.0704178	0.197650835	0.781658498	0	0	6.294492886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4177	NO																																																																																		0	0	0	18.1439	0.55670333	2.322500206	0	1.64456072	2.075930298	0.306254334	1.36904037	5.199863136	0	5.701146116	0.236515987	0.165661496	0.899412526	5.45203212	12.0704178	0.197650835	0.781658498	0	0	6.294492886	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4177
H2012_003_0	2010	3	N/A	r.	s.	t.	u.			x.				DME/Prosthetics/Supplies	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)			Other Non-Covered				Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	O	O	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	YES	1671.125628	51.587912	774.300682	1325.826902	223.048526	11.317029	1.66956	371.36049	313.44319	1312.342892	1430.769046	64.156394	0.903111	354.807726	4929.655742	4677.391302	76.591408	706.765335			34.314715	0			1.5				0.04	0.25	7300.884661	0.05	0.55	1.74			0.42				4400	$150/Day(Days 1-5):1a	$150/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15				"VIS734: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a			$0: Nutritional benefit 14a				91.00065	76.0068	58.254672	0	100	0.2	0.2	50	175	0	54.043328	50	0.2	34.380747	15	35	35	15			0.2	0			0				0	0	0	0	0	0			0				NO	83.127001	69.430464	35.98461	0	89.0979	0.178196	0.178196	44.54895	155.921325	0	48.15147	44.54895	0.178196	30.632523	13.364685	31.184265	31.184265	13.364685			0.178196	0			0				0	0	0	0	0	0			0					11.5763	0.298481056	2.321909005	0	1.656096272	2.0166493	0.297508914	1.378643325	4.072706458	0	5.741136066	0.238174999	0.160930768	0.905721319	5.490274679	12.15508416	0.19903723	0.787141339	0	0	6.114744954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4105	0	7.604702	11.5763	0.298481056	2.321909005	0	1.656096272	2.0166493	0.297508914	1.378643325	4.072706458	0	5.741136066	0.238174999	0.160930768	0.905721319	5.490274679	12.15508416	0.19903723	0.787141339	0	0	6.114744954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4105	NO																																																																																		0	0	0	11.5763	0.298481056	2.321909005	0	1.656096272	2.0166493	0.297508914	1.378643325	4.072706458	0	5.741136066	0.238174999	0.160930768	0.905721319	5.490274679	12.15508416	0.19903723	0.787141339	0	0	6.114744954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4105
H2012_006_0	2010	5	N/A	r.	s.	t.	u.	v.	w.			z.		DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Part B Rx			Other Non-Covered		Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	P	O	O	O	S			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	YES	1628.254662	50.264479	754.436815	1291.81421	217.326451	10.709091	1.579872	361.833628	305.402136	1278.676119	1394.064174	62.510529	0.045455	345.705509	4803.190621	4557.397758	74.626536	688.634015			13.894881	0							0.04	0.25	7113.588161	20.48142	0.05	0.55	2.22	485.437565			0.42		3900	$150/Day(Days 1-5):1a	$150/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	$0/Visit:8a	"$0-$175/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $175 Advanced Imaging -- FSR,8b. $175 Advanced Imaging -- Office,9a. $175 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$175/Visit:9d. $15 Cardiac Rehab,8b. $175 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$50/Script:15			$0: Nutritional benefit 14a		91.00065	76.0068	58.254672	0	100	0.2	0.2	50	175	0	63.050549	50	0.2	35.59295	15	35	35	15			0.2	0							0	0	0	0	0	0	0	50			0		NO	82.043729	68.525679	33.606712	0	88.0876	0.176175	0.176175	44.0438	154.1533	0	55.539716	44.0438	0.176175	31.352975	13.21314	30.83066	30.83066	13.21314			0.176175	0							0	0	0	0	0	0	0	44.0438			0			11.1323	0.287033963	2.112845064	0	1.59531379	1.886674107	0.27833395	1.328043995	3.923228924	0	6.452160692	0.229433436	0.008008035	0.903241348	5.288769177	11.70896506	0.191732113	0.758251471	0	0	2.44793066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.781709585	0	0	0	0	52.314	0	8.040896	11.1323	0.287033963	2.112845064	0	1.59531379	1.886674107	0.27833395	1.328043995	3.923228924	0	6.452160692	0.229433436	0.008008035	0.903241348	5.288769177	11.70896506	0.191732113	0.758251471	0	0	2.44793066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.781709585	0	0	0	0	52.314	NO																																																																																		0	0	0	11.1323	0.287033963	2.112845064	0	1.59531379	1.886674107	0.27833395	1.328043995	3.923228924	0	6.452160692	0.229433436	0.008008035	0.903241348	5.288769177	11.70896506	0.191732113	0.758251471	0	0	2.44793066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.781709585	0	0	0	0	52.314
H2012_007_0	2010	4	N/A	r.	s.	t.	u.	v.	w.			z.		DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Part B Rx			Other Non-Covered		Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	O	P	O	O	O	S			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	YES	1672.70119	51.63655	775.030704	1327.076911	223.25882	10.28732	1.51765	371.710614	313.738709	1313.580188	1432.117995	64.216881	0.043664	355.142243	4934.303493	4681.801213	76.663619	707.431683			13.347639	0		0.93	1.5				0.04	0.25	7307.76804	21.040502	0.05	0.55	2.22	498.688572			0.42		3900	$150/Day(Days 1-5):1a	$150/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$150/Visit:9d. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$10/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"	"VIS734: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$50/Script:15			$0: Nutritional benefit 14a		91.00065	76.0068	58.254672	0	100	0.2	0.2	50	175	0	54.043328	50	0.2	32.019126	10	30	30	10			0.2	0		0	0				0	0	0	0	0	0	0	50			0		NO	82.751441	69.116784	33.897753	0	89.0379	0.178076	0.178076	44.51895	155.816325	0	48.119044	44.51895	0.178076	28.509157	8.90379	26.71137	26.71137	8.90379			0.178076	0		0	0				0	0	0	0	0	0	0	44.51895			0			11.5349	0.297412689	2.189316614	0	1.656541374	1.831924796	0.270257041	1.379013853	4.073801054	0	5.742679068	0.23823901	0.00777551	0.84373383	3.661166841	10.42144371	0.170649191	0.524901929	0	0	2.376894163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.850090967	0	0	0	0	49.0707	0	7.067781	11.5349	0.297412689	2.189316614	0	1.656541374	1.831924796	0.270257041	1.379013853	4.073801054	0	5.742679068	0.23823901	0.00777551	0.84373383	3.661166841	10.42144371	0.170649191	0.524901929	0	0	2.376894163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.850090967	0	0	0	0	49.0707	NO																																																																																		0	0	0	11.5349	0.297412689	2.189316614	0	1.656541374	1.831924796	0.270257041	1.379013853	4.073801054	0	5.742679068	0.23823901	0.00777551	0.84373383	3.661166841	10.42144371	0.170649191	0.524901929	0	0	2.376894163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.850090967	0	0	0	0	49.0707
H2012_008_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			Part B Rx	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered													D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V					O	S	O			O	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	YES	1674.350797	57.591105	769.411481	1135.575463	226.506619	9.093958	3.441712	373.076873	300.9493	1181.240672	1428.492432	61.498079	20.959703	335.887212	4839.421223	4607.346659	71.358037	682.61785			12.564338	0		2.51	2.69					0.04	470.892258	0.05			0.42	0.45	0.55	1.67			3400	$150/Day(Days 1-7):1a	$150/Day(Days 1-7):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$150/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$35-$125/Visit:9d. $75 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"					$0: Nurse hotline 14a	$35/Script:15	$0: Additional Smoking Cessation 14a			$0: Nutritional benefit 14a	$0: Member Incentive Program 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a			105.8382	93.5994	44.44425	0	100	0.2	0.2	50	103.529919	19.016477	69.842539	50	2.125333	83.825433	5	35	35	42.414724			0.2	0		0	0					0	35	0			0	0	0	0			NO	91.921641	81.292108	24.705403	0	85.7411	0.171482	0.171482	42.87055	88.767692	16.304937	59.883761	42.87055	1.822284	71.872849	4.287055	30.009385	30.009385	36.366851			0.171482	0		0	0					0	30.009385	0			0	0	0	0				12.8258	0.390141861	1.584051726	0	1.618410556	1.559450106	0.590191657	1.332834228	2.226214564	1.605004562	7.128624949	0.219704706	0.003182878	2.011764239	1.728905413	11.52196998	0.1784509	2.068721803	0	0	2.154557809	0	0	0	0	0	0	0	0	0	1.177598922	0	0	0	0	0	0	0	0	0	51.9255	0	9.440494	12.8258	0.390141861	1.584051726	0	1.618410556	1.559450106	0.590191657	1.332834228	2.226214564	1.605004562	7.128624949	0.219704706	0.003182878	2.011764239	1.728905413	11.52196998	0.1784509	2.068721803	0	0	2.154557809	0	0	0	0	0	0	0	0	0	1.177598922	0	0	0	0	0	0	0	0	0	51.9255	NO																																																																																		0	0	0	12.8258	0.390141861	1.584051726	0	1.618410556	1.559450106	0.590191657	1.332834228	2.226214564	1.605004562	7.128624949	0.219704706	0.003182878	2.011764239	1.728905413	11.52196998	0.1784509	2.068721803	0	0	2.154557809	0	0	0	0	0	0	0	0	0	1.177598922	0	0	0	0	0	0	0	0	0	51.9255
H2012_009_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.			Part B Rx	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered													D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V					O	S	O	O	O	O	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	YES	1760.448161	60.552517	808.975652	1193.968276	238.153893	10.63676	4.025603	392.260986	316.424517	1241.981652	1501.94743	64.660393	22.037479	353.158984	5088.270753	4844.262603	75.027363	717.718976			14.695894	0		2.37	2.69					0.04	495.106169	0.05	0.32	0.4	0.45	0.49	0.55	2.53			3900	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$150/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$35-$125/Visit:9d. $75 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"					$0: Nurse hotline 14a	$35/Script:15	$0: Additional Smoking Cessation 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a			123.4779	109.1993	44.44425	0	100	0.2	0.2	50	103.52992	19.016477	69.842539	50	2.125332	83.825433	5	35	35	42.414724			0.2	0		0	0					0	35	0	0	0	0	0	0	0			NO	107.813864	95.346604	25.653177	0	86.318	0.172636	0.172636	43.159	89.364956	16.414643	60.286683	43.159	1.834544	72.356438	4.3159	30.2113	30.2113	36.611541			0.172636	0		0	0					0	30.2113	0	0	0	0	0	0	0				15.8167	0.481123072	1.729399632	0	1.713080645	1.836287699	0.694964	1.410799325	2.356438587	1.698890453	7.54561905	0.232556492	0.00336906	2.129443844	1.830038979	12.1959559	0.188889514	2.189733143	0	0	2.537040357	0	0	0	0	0	0	0	0	0	1.246483417	0	0	0	0	0	0	0	0	0	57.8368	0	9.944766	15.8167	0.481123072	1.729399632	0	1.713080645	1.836287699	0.694964	1.410799325	2.356438587	1.698890453	7.54561905	0.232556492	0.00336906	2.129443844	1.830038979	12.1959559	0.188889514	2.189733143	0	0	2.537040357	0	0	0	0	0	0	0	0	0	1.246483417	0	0	0	0	0	0	0	0	0	57.8368	NO																																																																																		0	0	0	15.8167	0.481123072	1.729399632	0	1.713080645	1.836287699	0.694964	1.410799325	2.356438587	1.698890453	7.54561905	0.232556492	0.00336906	2.129443844	1.830038979	12.1959559	0.188889514	2.189733143	0	0	2.537040357	0	0	0	0	0	0	0	0	0	1.246483417	0	0	0	0	0	0	0	0	0	57.8368
H2012_801_0	2010	2	N/A																															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	NO	248.712998	1.530532	23.955643	11.588165	5.644526	5.493409	2.321903	22.739282	64.289171	9.244324	30.308972	4.692205	1.000454	16.559403	76.767594	95.231583	0.333148	6.476711			24.481279	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																			0.08128248	0.08128248	0.185477805	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.08128248	0.08128248	0.185477805	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.216	0.124405437	4.443240082	0	1.315174558	1.279964297	0.541003399	5.298252706	14.97937684	2.153927492	7.061990476	1.093283765	0.233105782	3.858340899	17.8868494	22.18895884	0.077623484	1.509073663	0	0	5.704138007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9647	0	0	20.216	0.124405437	4.443240082	0	1.315174558	1.279964297	0.541003399	5.298252706	14.97937684	2.153927492	7.061990476	1.093283765	0.233105782	3.858340899	17.8868494	22.18895884	0.077623484	1.509073663	0	0	5.704138007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9647	NO																																																																																		0	0	0	20.216	0.124405437	4.443240082	0	1.315174558	1.279964297	0.541003399	5.298252706	14.97937684	2.153927492	7.061990476	1.093283765	0.233105782	3.858340899	17.8868494	22.18895884	0.077623484	1.509073663	0	0	5.704138007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9647
H2012_802_0	2010	2	N/A																															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	NO	248.712998	1.530532	23.955643	11.588165	5.644526	5.493409	2.321903	22.739282	64.289171	9.244324	30.308972	4.692205	1.000454	16.559403	76.767594	95.231583	0.333148	6.476711			24.481279	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																			0.08128248	0.08128248	0.185477805	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.08128248	0.08128248	0.185477805	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.216	0.124405437	4.443240082	0	1.315174558	1.279964297	0.541003399	5.298252706	14.97937684	2.153927492	7.061990476	1.093283765	0.233105782	3.858340899	17.8868494	22.18895884	0.077623484	1.509073663	0	0	5.704138007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9647	0	0	20.216	0.124405437	4.443240082	0	1.315174558	1.279964297	0.541003399	5.298252706	14.97937684	2.153927492	7.061990476	1.093283765	0.233105782	3.858340899	17.8868494	22.18895884	0.077623484	1.509073663	0	0	5.704138007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9647	NO																																																																																		0	0	0	20.216	0.124405437	4.443240082	0	1.315174558	1.279964297	0.541003399	5.298252706	14.97937684	2.153927492	7.061990476	1.093283765	0.233105782	3.858340899	17.8868494	22.18895884	0.077623484	1.509073663	0	0	5.704138007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9647
H2012_803_0	2010	2	N/A																															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	NO	248.712998	1.530532	23.955643	11.588165	5.644526	5.493409	2.321903	22.739282	64.289171	9.244324	30.308972	4.692205	1.000454	16.559403	76.767594	95.231583	0.333148	6.476711			24.481279	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																			0.08128248	0.08128248	0.185477805	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.08128248	0.08128248	0.185477805	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.216	0.124405437	4.443240082	0	1.315174558	1.279964297	0.541003399	5.298252706	14.97937684	2.153927492	7.061990476	1.093283765	0.233105782	3.858340899	17.8868494	22.18895884	0.077623484	1.509073663	0	0	5.704138007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9647	0	0	20.216	0.124405437	4.443240082	0	1.315174558	1.279964297	0.541003399	5.298252706	14.97937684	2.153927492	7.061990476	1.093283765	0.233105782	3.858340899	17.8868494	22.18895884	0.077623484	1.509073663	0	0	5.704138007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9647	NO																																																																																		0	0	0	20.216	0.124405437	4.443240082	0	1.315174558	1.279964297	0.541003399	5.298252706	14.97937684	2.153927492	7.061990476	1.093283765	0.233105782	3.858340899	17.8868494	22.18895884	0.077623484	1.509073663	0	0	5.704138007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9647
H2029_001_0	2010	3	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Skilled Nursing Facility																	D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	O		Coin	V		V		O	O	O	O	O	D							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0		0	0		0		0	0	0	0	0	0							0	YES	941.812085	7.918726	93.366493	97.984132	33.937682	1748.256412	18280.32788	392.170132	203.524964	2432.515472	1870.641682	20.311643	126.695392	220.705911	4548.719693	4807.945977	16.095811	933.746017			1463.417803	0		5.9	1.72		0.47		0.04	0.09	0.05	0.55	1.42	93.366493							1500	$15/Day(Days 1-5):1a	$15/Day(Days 1-5):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$10/Trip:10a	$0/Service:11a	$0/Service:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0-$10/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $5 Advanced Imaging -- Office,9a. $10 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$0/Visit:9a	$0/Proc:12	"$0-$5/Visit:9d. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a. $0 OP Other,5. $5 Partial Hospitalization,7h. $0 Psych -- OP,8b. $0 Rad therapy,3. $0 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$5/Visit:7b, 7d, 7f"	$5/Visit:7e	"$0-$5/Visit:7i. $0 Therapy (AT,PT,ST,OT) -- OP,7i. $5 Therapy (AT,PT,ST,OT) - Specialist"			$0/Script:15			"DEN842: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"		"HER810: Hearing 18a, 18b"		$0: Nurse hotline 14a	Assist America: Emergency Care 4a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0/Day(Days 1-101) $0(Days 101-100):2							9.100065	7.60068	0	0	10	0	0	25	0	0	0.948632	0	0	0.539963	0	5	5	4.57825			0	0		0	0		0		0	0	0	0	0	0							NO	8.94358	7.469979	0	0	9.68937	0	0	24.223425	0	0	0.919164	0	0	0.52319	0	4.844685	4.844685	4.436036			0	0		0	0		0		0	0	0	0	0	0								0.7019	0.004929393	0	0	0.027402896	0	0	0.791641982	0	0	0.143285541	0	0	0.009622594	0	1.94108198	0.006498261	0.345177579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9716	0	0.117031	0.7019	0.004929393	0	0	0.027402896	0	0	0.791641982	0	0	0.143285541	0	0	0.009622594	0	1.94108198	0.006498261	0.345177579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9716	YES	$250/Admit	$300/Admit	$0/Day(Days 1-100) $0(Days 100-100)	$0/Visit	$10/Trip	$0/Service	$0/Service	$25/Visit	$0-$10/Visit	$0-$10/Visit	$0-$15/Visit	$10/Visit	$0/Proc	$10/Visit	$10/Visit	$10/Visit	$10/Visit	$10/Visit			$0/Script	$0/Service		20%-80%	"VIS751: Vision 7a, 7b"		0		$0: Nurse hotline 14a	Assist America: Emergency Care 4a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a								3400	0.5617	0.005	0	0	0.1088	0	0	0.1387	0.0202	0.0409	0.0795	0.0029	0	0.0312	0.6434	0.6801	0.0023	0.1321			0	0		0	0		0		0	0	0	0	0								2.4467	0	0.085501	1.2637	0.009932393	0	0	0.136211896	0	0	0.930319982	0.02016	0.040867	0.222832541	0.002873	0	0.040840594	0.643402	2.62114998	0.008775261	0.477252579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4183
H2029_801_0	2010	5	N/A																															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	NO	131.609139	0.448933	22.851112	7.384008	0.865928	4.003937	1.957173	9.653577	27.487818	5.934288	14.147794	5.001329	0.4394	9.055183	16.805275	36.85566	0.177109	2.742689			11.978971	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																			0.152800568	0.152800568	0.15217774	0	0.233	0.232999976	0.232999976	0.232999962	0.233	0.233000022	0.233000022	0.233000022	0.233000022	0.233000022	0.233000003	0.233000003	0.233000003	0.233000003			0.232999984	0.233																			NO	0.152800568	0.152800568	0.15217774	0	0.233	0.232999976	0.232999976	0.232999962	0.233	0.233000022	0.233000022	0.233000022	0.233000022	0.233000022	0.233000003	0.233000003	0.233000003	0.233000003			0.232999984	0.233																				20.11	0.068597217	3.47743058	0	0.201761224	0.932917227	0.456021263	2.249283072	6.404661594	1.382689232	3.296436306	1.165309765	0.102380209	2.109857834	3.915629133	8.587368908	0.041266398	0.639046546	0	0	2.791100047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9317	0	0	20.11	0.068597217	3.47743058	0	0.201761224	0.932917227	0.456021263	2.249283072	6.404661594	1.382689232	3.296436306	1.165309765	0.102380209	2.109857834	3.915629133	8.587368908	0.041266398	0.639046546	0	0	2.791100047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9317	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7435	0.0128	0.6474	0	0.807	0.6151	0.3007	0.593	1.5433	0.3645	0.7903	0.3072	0.027	0.5522	0.7378	1.6181	0.0078	0.1372			0.5259	0																			13.3308	0	0	23.8535	0.081356065	4.124794686	0	1.008756724	1.548037164	0.756707732	2.842267975	7.947937094	1.747217765	4.086772379	1.472520293	0.129408212	2.662067885	4.653423644	10.20543743	0.049071898	0.776283549	0	0	3.31698101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2625
H2029_802_0	2010	5	N/A																															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	NO	131.609139	0.448933	22.851112	7.384008	0.865928	4.003937	1.957173	9.653577	27.487818	5.934288	14.147794	5.001329	0.4394	9.055183	16.805275	36.85566	0.177109	2.742689			11.978971	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																			0.152800568	0.152800568	0.15217774	0	0.233	0.232999976	0.232999976	0.232999962	0.233	0.233000022	0.233000022	0.233000022	0.233000022	0.233000022	0.233000003	0.233000003	0.233000003	0.233000003			0.232999984	0.233																			NO	0.152800568	0.152800568	0.15217774	0	0.233	0.232999976	0.232999976	0.232999962	0.233	0.233000022	0.233000022	0.233000022	0.233000022	0.233000022	0.233000003	0.233000003	0.233000003	0.233000003			0.232999984	0.233																				20.11	0.068597217	3.47743058	0	0.201761224	0.932917227	0.456021263	2.249283072	6.404661594	1.382689232	3.296436306	1.165309765	0.102380209	2.109857834	3.915629133	8.587368908	0.041266398	0.639046546	0	0	2.791100047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9317	0	0	20.11	0.068597217	3.47743058	0	0.201761224	0.932917227	0.456021263	2.249283072	6.404661594	1.382689232	3.296436306	1.165309765	0.102380209	2.109857834	3.915629133	8.587368908	0.041266398	0.639046546	0	0	2.791100047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9317	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7435	0.0128	0.6474	0	0.807	0.6151	0.3007	0.593	1.5433	0.3645	0.7903	0.3072	0.027	0.5522	0.7378	1.6181	0.0078	0.1372			0.5259	0																			13.3308	0	0	23.8535	0.081356065	4.124794686	0	1.008756724	1.548037164	0.756707732	2.842267975	7.947937094	1.747217765	4.086772379	1.472520293	0.129408212	2.662067885	4.653423644	10.20543743	0.049071898	0.776283549	0	0	3.31698101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2625
H2029_803_0	2010	5	N/A																															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	NO	131.609139	0.448933	22.851112	7.384008	0.865928	4.003937	1.957173	9.653577	27.487818	5.934288	14.147794	5.001329	0.4394	9.055183	16.805275	36.85566	0.177109	2.742689			11.978971	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																			0.152800568	0.152800568	0.15217774	0	0.233	0.232999976	0.232999976	0.232999962	0.233	0.233000022	0.233000022	0.233000022	0.233000022	0.233000022	0.233000003	0.233000003	0.233000003	0.233000003			0.232999984	0.233																			NO	0.152800568	0.152800568	0.15217774	0	0.233	0.232999976	0.232999976	0.232999962	0.233	0.233000022	0.233000022	0.233000022	0.233000022	0.233000022	0.233000003	0.233000003	0.233000003	0.233000003			0.232999984	0.233																				20.11	0.068597217	3.47743058	0	0.201761224	0.932917227	0.456021263	2.249283072	6.404661594	1.382689232	3.296436306	1.165309765	0.102380209	2.109857834	3.915629133	8.587368908	0.041266398	0.639046546	0	0	2.791100047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9317	0	0	20.11	0.068597217	3.47743058	0	0.201761224	0.932917227	0.456021263	2.249283072	6.404661594	1.382689232	3.296436306	1.165309765	0.102380209	2.109857834	3.915629133	8.587368908	0.041266398	0.639046546	0	0	2.791100047	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9317	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7435	0.0128	0.6474	0	0.807	0.6151	0.3007	0.593	1.5433	0.3645	0.7903	0.3072	0.027	0.5522	0.7378	1.6181	0.0078	0.1372			0.5259	0																			13.3308	0	0	23.8535	0.081356065	4.124794686	0	1.008756724	1.548037164	0.756707732	2.842267975	7.947937094	1.747217765	4.086772379	1.472520293	0.129408212	2.662067885	4.653423644	10.20543743	0.049071898	0.776283549	0	0	3.31698101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2625
H2034_001_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	715.0212897	26.64668872	345.6905862	65.76467901	35.74238125	36.0245865	33.23509607	29.57728178	53.72753938	15.69495393	37.31621826	2.442160881	5.329337744	108.8443969	84.68328529	160.9112669	5.437878228	9.084838476	37.42475874	56.91862959	19.59155729	7.109401675	0	0	0	0	0	0	0	5.620361556												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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	0	0	0	0	0	0											0.078637859	0.078637859	0.153081954	0	0.233011222	0.232999984	0.233003328	0.233004019	0.233000029	0.232969268	0.232998011	0.232999801	0.232999997	0.233000639	0.233000181	0.233000244	0.233007665	0.233010921	0.233005776	0.23298235	0.23300246	0.232998744	0	0	0	0	0	0	0	0.2											NO	0.078637859	0.078637859	0.153081954	0	0.233011222	0.232999984	0.233003328	0.233004019	0.233000029	0.232969268	0.232998011	0.232999801	0.232999997	0.233000639	0.233000181	0.233000244	0.233007665	0.233010921	0.233005776	0.23298235	0.23300246	0.232998744	0	0	0	0	0	0	0	0.2												56.2277	2.095438541	52.91899041	0	8.328375936	8.393728065	7.743887981	6.891625526	12.51851824	3.656441921	8.69460464	0.569023	1.241735679	25.36081407	19.73122083	37.4923644	1.26706731	2.116866579	8.720184947	13.26103605	4.564881048	1.656481662	0	0	0	0	0	0	0	1.124072311	0	0	0	0	0	0	0	0	0	0	284.5751	0	0	56.2277	2.095438541	52.91899041	0	8.328375936	8.393728065	7.743887981	6.891625526	12.51851824	3.656441921	8.69460464	0.569023	1.241735679	25.36081407	19.73122083	37.4923644	1.26706731	2.116866579	8.720184947	13.26103605	4.564881048	1.656481662	0	0	0	0	0	0	0	1.124072311	0	0	0	0	0	0	0	0	0	0	284.5751	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	56.2277	2.095438541	52.91899041	0	8.328375936	8.393728065	7.743887981	6.891625526	12.51851824	3.656441921	8.69460464	0.569023	1.241735679	25.36081407	19.73122083	37.4923644	1.26706731	2.116866579	8.720184947	13.26103605	4.564881048	1.656481662	0	0	0	0	0	0	0	1.124072311	0	0	0	0	0	0	0	0	0	0	284.5751
H2034_002_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	562.1962888	61.40135157	209.4614252	45.6521274	29.4470332	32.46445864	31.05343235	38.23881237	48.32222329	17.11683426	38.55357977	2.963155202	4.678094843	107.3791004	76.94434881	146.2257395	13.32877138	7.131109772	31.7589455	48.36563949	22.07713436	5.459586324	0	0	0	0	0	0	0	5.620361556												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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	0	0	0	0	0	0											0.079132833	0.079132833	0.153480058	0	0.233011222	0.232999984	0.233003328	0.233004019	0.233000029	0.232969268	0.232998011	0.232999801	0.232999997	0.233000639	0.233000181	0.233000244	0.233007665	0.233010921	0.233005776	0.23298235	0.23300246	0.232998744	0	0	0	0	0	0	0	0.2											NO	0.079132833	0.079132833	0.153480058	0	0.233011222	0.232999984	0.233003328	0.233004019	0.233000029	0.232969268	0.232998011	0.232999801	0.232999997	0.233000639	0.233000181	0.233000244	0.233007665	0.233010921	0.233005776	0.23298235	0.23300246	0.232998744	0	0	0	0	0	0	0	0.2												44.4882	4.858862892	32.14815164	0	6.861489193	7.564218332	7.235553074	8.909796964	11.25907944	3.987696341	8.982907412	0.690414573	1.089996084	25.01939904	17.92804723	34.07063293	3.105705902	1.661626455	7.400017736	11.26834032	5.144026621	1.272076757	0	0	0	0	0	0	0	1.124072311	0	0	0	0	0	0	0	0	0	0	246.0703	0	0	44.4882	4.858862892	32.14815164	0	6.861489193	7.564218332	7.235553074	8.909796964	11.25907944	3.987696341	8.982907412	0.690414573	1.089996084	25.01939904	17.92804723	34.07063293	3.105705902	1.661626455	7.400017736	11.26834032	5.144026621	1.272076757	0	0	0	0	0	0	0	1.124072311	0	0	0	0	0	0	0	0	0	0	246.0703	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	44.4882	4.858862892	32.14815164	0	6.861489193	7.564218332	7.235553074	8.909796964	11.25907944	3.987696341	8.982907412	0.690414573	1.089996084	25.01939904	17.92804723	34.07063293	3.105705902	1.661626455	7.400017736	11.26834032	5.144026621	1.272076757	0	0	0	0	0	0	0	1.124072311	0	0	0	0	0	0	0	0	0	0	246.0703
H2108_001_0	2010	1	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	515.2445833	10.83380051	76.08258812	12.30300595	12.92787103	14.11472627	3.962966862	14.99458628	29.05179449	6.054048102	18.23503151	0	3.630256399	20.71876813	94.82659064	84.87971966	4.46755718	2.945249694	24.6645999	16.09766807	36.71954723	0.187244476	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS and 7f:  Routine Footcare - $0/visit	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											0.058851252	0.058851252	0.147028866	0	0.233	0.233	0.233	0.23065025	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232849947	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.058851252	0.058851252	0.147028866	0	0.233	0.233	0.233	0.23065025	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232849947	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0												30.3228	0.637582721	11.18633667	0	3.01219395	3.288731221	0.923371279	3.458505074	6.769068117	1.410593208	4.248762341	0	0.845849741	4.827472975	22.09459562	19.76423822	1.040940823	0.686243179	0	3.75075666	8.555654504	0.043627963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.8673		0	30.3228	0.637582721	11.18633667	0	3.01219395	3.288731221	0.923371279	3.458505074	6.769068117	1.410593208	4.248762341	0	0.845849741	4.827472975	22.09459562	19.76423822	1.040940823	0.686243179	0	3.75075666	8.555654504	0.043627963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.8673	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	30.3228	0.637582721	11.18633667	0	3.01219395	3.288731221	0.923371279	3.458505074	6.769068117	1.410593208	4.248762341	0	0.845849741	4.827472975	22.09459562	19.76423822	1.040940823	0.686243179	0	3.75075666	8.555654504	0.043627963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.8673
H2108_020_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	756.9655039	9.131405201	442.3817654	2.993201481	46.55234073	14.08611784	10.93034522	105.1615302	29.42815075	7.839784985	9.798864218	0	0.178325154	134.1214755	0	0	5.690717265	5.242695845	35.5080562	35.42001628	3.255627913	0.777282855	0	0	0	0	0	0	0	0												1a:  Acute - MC Cost Shares for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/7-12 Additional Visits/17a:  Vision Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/7f:  Routine Footcare - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7e:  Mental Hlth Spec-Non-Physician - Individual - 45.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 45.0%/7h:  Psychiatric Services - Individual - 45.0%/7h:  Psychiatric Services - Group - 45.0%	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											0.058441544	0.058441544	0	0	0.2	0.2	0.2	50	0.2	0	0.2	0	0.2	0.017647795	0	0	0.45	0	0	0.000273961	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.058441544	0.058441544	0	0	0.2	0.2	0.2	50	0.2	0	0.2	0	0.2	0.017647795	0	0	0.45	0	0	0.000273961	0.2	0.2	0	0	0	0	0	0	0	0												44.2382	0.533653417	0	0	9.310468146	2.817223568	2.186069043	0.438173043	5.885630149	0	1.959772844	0	0.035665031	2.366948242	0	0	2.560822769	0	0	0.009703708	0.651125583	0.155456571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1489		0	44.2382	0.533653417	0	0	9.310468146	2.817223568	2.186069043	0.438173043	5.885630149	0	1.959772844	0	0.035665031	2.366948242	0	0	2.560822769	0	0	0.009703708	0.651125583	0.155456571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1489	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	44.2382	0.533653417	0	0	9.310468146	2.817223568	2.186069043	0.438173043	5.885630149	0	1.959772844	0	0.035665031	2.366948242	0	0	2.560822769	0	0	0.009703708	0.651125583	0.155456571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1489
H2108_021_0	2010	1	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1114.185283	9.941578224	809.5032804	8.699476347	295.8644018	6.329737842	4.472388619	689.9178447	767.9621848	3.614733938	17.03553966	0	0.771391356	907.7678638	5797.906601	3555.846838	369.5279115	286.9283588	27.19623119	54.1911146	18.95741219	0	0	0	0	0	0	0	0	0												1a:  Acute - $250/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $40/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/7b:  Routine Chiropractic Care - $10/visit/14h:  Mammography - $0/7b:  Routine Chiropractic Care - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $40/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											250	0.0601483	85	0	100	0.2	0.2	43.41974892	241.7922577	0	0.2	0	0.2	63.0746889	10.0024319	35.36399403	40	40	0	39.64578328	0.2	0	0	0	0	0	0	0	0	0											NO	250	0.0601483	85	0	100	0.2	0.2	43.41974892	241.7922577	0	0.2	0	0.2	63.0746889	10.0024319	35.36399403	40	40	0	39.64578328	0.2	0	0	0	0	0	0	0	0	0												23.2122	0.597969027	5.733981569	0	2.465536682	1.265947568	0.894477724	2.4963383	15.47394254	0	3.407107932	0	0.154278271	4.7714313	4.83276383	10.47907886	1.231759705	0.956427863	0	0.179037432	3.791482438	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9438		0	23.2122	0.597969027	5.733981569	0	2.465536682	1.265947568	0.894477724	2.4963383	15.47394254	0	3.407107932	0	0.154278271	4.7714313	4.83276383	10.47907886	1.231759705	0.956427863	0	0.179037432	3.791482438	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9438	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	23.2122	0.597969027	5.733981569	0	2.465536682	1.265947568	0.894477724	2.4963383	15.47394254	0	3.407107932	0	0.154278271	4.7714313	4.83276383	10.47907886	1.231759705	0.956427863	0	0.179037432	3.791482438	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9438
H2108_022_0	2010	3	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1095.726589	10.66658003	804.999505	8.585462323	233.8313998	9.821515073	3.13066628	273.6069893	1105.885972	4.596550235	17.51450105	0	2.128176299	1324.307332	7062.190809	4222.45295	365.8870756	468.406802	39.92598253	76.41232546	28.49083011	0	0	0	0	0	0	0	0	0												1a:  Acute - $250/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $40/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $40/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit												250	0.058788632	85	0	150	0.2	0.2	43.41954858	245.9197396	0	0.2	0	0.2	60.46920155	10.00275746	39.21327798	40	40	0	39.65147866	0.2	0	0	0	0	0	0	0	0	0											NO	250	0.058788632	85	0	150	0.2	0.2	43.41954858	245.9197396	0	0.2	0	0.2	60.46920155	10.00275746	39.21327798	40	40	0	39.65147866	0.2	0	0	0	0	0	0	0	0	0												22.8276	0.627073645	5.702079827	0	2.922892497	1.964303015	0.626133256	0.989990997	22.66326585	0	3.502900211	0	0.42563526	6.67331725	5.886781818	13.79801844	1.219623585	1.561356007	0	0.252488474	5.698166022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3417		0	22.8276	0.627073645	5.702079827	0	2.922892497	1.964303015	0.626133256	0.989990997	22.66326585	0	3.502900211	0	0.42563526	6.67331725	5.886781818	13.79801844	1.219623585	1.561356007	0	0.252488474	5.698166022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3417	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	22.8276	0.627073645	5.702079827	0	2.922892497	1.964303015	0.626133256	0.989990997	22.66326585	0	3.502900211	0	0.42563526	6.67331725	5.886781818	13.79801844	1.219623585	1.561356007	0	0.252488474	5.698166022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3417
H2108_026_0	2010	2	N/A																															A	coin	D	coin	coin	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	376.3224818	10.65098087	862.5254952	8.81995692	5.923239366	9.482305867	3.623783238	1401.481325	1030.144716	4.546044532	189.4163547	0	1.196209963	1948.647969	0.692556155	4278.171337	374.3645818	361.018241	30.57307752	73.16320651	21.3929356	0	0	0	0	0	0	0	0	0												1a:  Acute - $150/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $0/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $50/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $50/visit/8b:  Outpatient Therapeutic Radiological Services - $50/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $20/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $20/visit/ Visits/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/7b:  Routine Chiropractic Care - $10/visit/14h:  Mammography - $0/7b:  Routine Chiropractic Care - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $20/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit												150	0.059000329	85	0	0	0.2	0.2	29.56235197	95.88153372	0	50	0	0.2	28.86001888	20	18.88006354	20	20	0	19.94747714	0.2	0	0	0	0	0	0	0	0	0											NO	138.2280762	0.058270455	78.32924318	0	0	0.184304102	0.185591293	27.24231361	88.35679967	0	46.0760254	0	0.184304102	26.59509926	18.43041016	17.48625779	19.98586992	18.43041016	0	18.38200927	0.184304102	0	0	0	0	0	0	0	0	0												4.3349	0.620637505	5.630080772	0	0	1.747627864	0.672542617	3.181632814	7.585024194	0	0.727296064	0	0.220466403	4.31870718	0.001063674	6.234100572	0.623500153	0.554476188	0	0.112073895	3.942805777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5069		3.312885705	4.3349	0.620637505	5.630080772	0	0	1.747627864	0.672542617	3.181632814	7.585024194	0	0.727296064	0	0.220466403	4.31870718	0.001063674	6.234100572	0.623500153	0.554476188	0	0.112073895	3.942805777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5069	YES	1a:  Acute - 20.0% for 1-90/1a:  Additional Days - 20.0% for 91-999		2:  Skilled Nursing Services - 20.0% for 1-100/2:  Non-Medicare Covered Stay - 20.0% for 1-100	6:  Home Health Services - 20.0%	10a:  Ambulance - 20.0%			4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - 20.0%/14c:  Routine Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/14e:  Prostate Cancer Screening - /visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/14e:  Prostate Cancer Screening - /visit/14h:  Mammography - $0/visit		7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%																			4000	5.0767	0	0.6536	0.1617	0.1236	0	0	0.3211	0.3336	0	0.4572	0	0.0183	0.024	0.389	0.7777	0	0.0399	0.3446	0.1439	0.4826	0.0057	0	0	0	0	0	0	0	0											9.353		5.718005884	9.4115	0.620637505	6.283729929	0.161681511	0.123557138	1.747627864	0.672542617	3.502690034	7.918642236	0	1.184447963	0	0.238759758	4.342736867	0.390075959	7.011762636	0.623500153	0.594352307	0.344550899	0.255982357	4.425398421	0.005732119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8599
H2108_028_0	2010	2	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	953.0109147	8.807066824	688.2185159	17.87900429	142.9798273	7.556028836	2.042765276	236.1490971	437.2965927	1.749505412	380.6007165	0	0.034271856	786.0424383	6322.861347	3826.148576	367.1054593	415.0449381	29.51428997	64.92254907	14.22750933	0	0	0	0	0	0	0	0	0												1a:  Acute - $100/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $50/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $5/visit/17a:  Vision Exams - $35/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $35/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											100	0.066973886	85	0	50	0.2	0.2	40.04299682	187.4685929	0	41.89926672	0	0.2	47.95809921	5.002369934	34.92255319	35	35	0	34.88845525	0.2	0	0	0	0	0	0	0	0	0											NO	92.93862549	0.066973886	78.78161106	0	46.40379969	0.185098804	0.187153209	37.15719004	174.2574164	0	38.85849813	0	0.184358823	44.49290293	4.829625226	32.36272238	35	32.38398412	0	32.34742826	0.186384034	0	0	0	0	0	0	0	0	0												7.381	0.589843492	4.518246954	0	0.552900605	1.398611897	0.382310077	0.73121974	6.350181206	0	1.232464353	0	0.006318319	2.914442492	2.544754222	10.31871535	1.070724256	1.12006739	0	0.175006458	2.651780581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9385		3.166462733	7.381	0.589843492	4.518246954	0	0.552900605	1.398611897	0.382310077	0.73121974	6.350181206	0	1.232464353	0	0.006318319	2.914442492	2.544754222	10.31871535	1.070724256	1.12006739	0	0.175006458	2.651780581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9385	YES																																									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	0											0		0	7.381	0.589843492	4.518246954	0	0.552900605	1.398611897	0.382310077	0.73121974	6.350181206	0	1.232464353	0	0.006318319	2.914442492	2.544754222	10.31871535	1.070724256	1.12006739	0	0.175006458	2.651780581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9385
H2108_029_0	2010	2	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1389.90711	9.488825335	1334.601566	32.49380632	175.5630211	14.96009869	9.518560598	264.9341579	392.52877	1.804649157	549.0486852	0	0.745288292	928.129657	6949.768179	5297.666843	340.8270414	494.9207728	37.73179566	70.80911635	17.12665194	0	0	0	0	0	0	0	0	0												1a:  Acute - $100/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $50/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $5/visit/17a:  Vision Exams - $35/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $35/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											100	0.066973886	85	0	50	0.2	0.050733794	40.04293924	187.4685929	0	45.14110532	0	0.2	50.2705842	5.002658225	34.83978601	35	35	0	34.82273913	0.2	0	0	0	0	0	0	0	0	0											NO	87.57530744	0.066711552	74.26238291	0	43.51732529	0.174483882	0.045191149	34.89323778	163.2095199	0	39.47940529	0	0.177226347	43.77817584	4.636933829	30.31922019	34.9782644	30.46469364	0	30.41311213	0.176452554	0	0	0	0	0	0	0	0	0												10.1435	0.633014268	8.259224376	0	0.636669425	2.610296092	0.430154693	0.770367547	5.338702677	0	1.806342964	0	0.132084721	3.385985277	2.685467931	13.38509396	0.993461531	1.256467477	0	0.179460466	3.022041484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6683		7.675	10.1435	0.633014268	8.259224376	0	0.636669425	2.610296092	0.430154693	0.770367547	5.338702677	0	1.806342964	0	0.132084721	3.385985277	2.685467931	13.38509396	0.993461531	1.256467477	0	0.179460466	3.022041484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6683	YES																																									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	0											0		0	10.1435	0.633014268	8.259224376	0	0.636669425	2.610296092	0.430154693	0.770367547	5.338702677	0	1.806342964	0	0.132084721	3.385985277	2.685467931	13.38509396	0.993461531	1.256467477	0	0.179460466	3.022041484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6683
H2108_030_0	2010	2	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1408.273076	9.4066898	1466.730771	30.61442614	183.9549425	17.16919369	10.81860565	254.1887591	532.6461345	2.561529652	19.27194247	0	0.802175991	1084.676575	7046.076611	5211.209439	369.2478	517.6136551	41.54485772	69.20168929	16.25388349	0	0	0	0	0	0	0	0	0												1a:  Acute - $250/$0/day for 1-5/6-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit	7a:  Primary Care - $10/visit/17a:  Vision Exams - $40/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $40/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											250	0.059424176	85	0	100	0.2	0.050580443	43.41975407	241.781268	0	0.2	0	0.2	61.6672148	10.00253163	39.74348514	40	40	0	39.40102613	0.2	0	0	0	0	0	0	0	0	0											NO	250	0.059424176	85	0	100	0.2	0.050580443	43.41975407	241.781268	0	0.2	0	0.2	61.6672148	10.00253163	39.74348514	40	40	0	39.40102613	0.2	0	0	0	0	0	0	0	0	0												29.339	0.558984794	10.38934296	0	1.532957854	3.433838737	0.547209865	0.91973445	10.73198815	0	3.854388495	0	0.160435198	5.574081944	5.873217016	17.25930207	1.230826	1.72537885	0	0.227218131	3.250776697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6087		0	29.339	0.558984794	10.38934296	0	1.532957854	3.433838737	0.547209865	0.91973445	10.73198815	0	3.854388495	0	0.160435198	5.574081944	5.873217016	17.25930207	1.230826	1.72537885	0	0.227218131	3.250776697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6087	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	29.339	0.558984794	10.38934296	0	1.532957854	3.433838737	0.547209865	0.91973445	10.73198815	0	3.854388495	0	0.160435198	5.574081944	5.873217016	17.25930207	1.230826	1.72537885	0	0.227218131	3.250776697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.6087
H2108_031_0	2010	2	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1052.682512	10.76013672	999.0235939	10.80878839	215.6983285	9.646291737	3.731927709	328.1528142	1137.500683	4.460095984	22.57891547	0	1.413844725	1359.775554	0.679804558	4143.178527	366.6765391	406.036697	33.51875978	73.56612461	25.2622872	0	0	0	0	0	0	0	0	0												1a:  Acute - $200/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $35/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $35/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit												200	0.058788632	85	0	100	0.2	0.2	40.04338769	191.7231306	0	0.2	0	0.2	49.92800603	35	34.67392654	35	35	0	34.89803505	0.2	0	0	0	0	0	0	0	0	0											NO	200	0.058788632	85	0	100	0.2	0.2	40.04338769	191.7231306	0	0.2	0	0.2	49.92800603	35	34.67392654	35	35	0	34.89803505	0.2	0	0	0	0	0	0	0	0	0												17.5447	0.632573715	7.076417124	0	1.797486071	1.929258347	0.746385542	1.095029197	18.17376601	0	4.515783094	0	0.282768945	5.657573505	0.001982763	11.97168899	1.069473239	1.1842737	0	0.213942766	5.05245744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9456		0	17.5447	0.632573715	7.076417124	0	1.797486071	1.929258347	0.746385542	1.095029197	18.17376601	0	4.515783094	0	0.282768945	5.657573505	0.001982763	11.97168899	1.069473239	1.1842737	0	0.213942766	5.05245744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9456	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	17.5447	0.632573715	7.076417124	0	1.797486071	1.929258347	0.746385542	1.095029197	18.17376601	0	4.515783094	0	0.282768945	5.657573505	0.001982763	11.97168899	1.069473239	1.1842737	0	0.213942766	5.05245744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9456
H2111_001_0	2010	6	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	590.5568143	36.16132629	9872.587521	85.94544971	14.84476753	7.310060816	17.91171173	14.03340433	24.7921085	47.14594368	56.49314066	0	0.07988849	7.038807772	1.430902918	179.076268	17.71688287	42.93026571	0	0	2.554774849	5.383147118	1040.367816	126.9461605	54.80382675	115.9319332	17.9457627	3.022745981	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.060793696	0.061532081	0	0	0.2	0.2	0.097190877	0.035999893	0.2	0	0.035969027	0	0.2	0.151425358	0.00111282	0.199969855	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.060793696	0.061532081	0	0	0.2	0.2	0.097190877	0.035999893	0.2	0	0.035969027	0	0.2	0.151425358	0.00111282	0.199969855	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0												35.9021	2.225081672	0	0	2.968953506	1.462012163	1.740854979	0.505201049	4.958421699	0	2.032003293	0	0.015977698	1.065853989	0.001592337	35.80985537	3.543376574	0	0	0	0.51095497	1.076629424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8189	0	0	35.9021	2.225081672	0	0	2.968953506	1.462012163	1.740854979	0.505201049	4.958421699	0	2.032003293	0	0.015977698	1.065853989	0.001592337	35.80985537	3.543376574	0	0	0	0.51095497	1.076629424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8189	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.4794	0.3355	0	0.0311	0.3873	0.1907	0.4673	0.0439	0.6468	0.369	1.1365	0	0.0014	0.139	0.0043	0.5427	0.0537	0	0	0	0.0077	0.0163	0	0	0.0005	0	0.0002	0	0	0											9.8533	0	0	41.3815	2.560599133	0	0.031129071	3.356208311	1.652709402	2.208117024	0.549131575	5.605172356	0.368968255	3.168485507	0	0.017367063	1.204878422	0.00590428	36.35251073	3.597064098	0	0	0	0.518696712	1.092941991	0	0	0.000545875	0	0.00021386	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6722
H2111_008_0	2010	5	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.515	0.797	0.5625	0	0.9375	0	1.215	0	0.0094	0.7211	0.9754	4.2806	0.2766	0.1049	0	0	0.7219	0.191	0	0	0	0	0	0	0	0											11.308	NO	532.6384205	19.6137	1962.963429	1465.899611	16.24997973	25.1506991	17.75132507	29.29218723	29.58401918	14.35570266	38.34071574	0	0.297491206	22.75514004	33.19279913	135.2023397	8.72865	3.310457574	0	0	22.77835852	6.417944057	623.5617285	450.3	105.9507565	161.8541175	0	0	79.2	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$125 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.0661702	0.066973886	40.70227498	0	0.193661916	0.193661916	0.193661916	0.098916646	0.193661916	0	0.161453066	0	0.193661916	0.145045135	0.164748489	0.193481113	0.193661916	0	0	0	0.193661916	0.193616976	0	0	0	0	0	0	0	0											NO	0.0661702	0.066973886	40.70227498	0	0.193661916	0.193661916	0.193661916	0.098916646	0.193661916	0	0.161453066	0	0.193661916	0.145045135	0.164748489	0.193481113	0.193661916	0	0	0	0.193661916	0.193616976	0	0	0	0	0	0	0	0												35.2448	1.313605714	6.658089771	0	3.147002209	4.870732576	3.437755624	2.897484908	5.729297837	0	6.190226091	0	0.057612717	3.300522362	5.468463487	26.15909918	1.690407083	0	0	0	4.411300554	1.24262292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.819	146	0	35.2448	1.313605714	6.658089771	0	3.661970894	5.667768798	4.000302574	2.897484908	6.666827834	0	7.405259481	0	0.067040338	4.02164231	6.443822096	30.439718	1.967021669	0.104909791	0	0	5.133156306	1.433607227	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.127	NO	"24% (1a); 30% (1a1); $0 n/c (1a2, 1a3)"	"24% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												21.7444	0.7983	5.9512	0.7406	1.0346	1.6012	1.1301	0.5721	1.8835	0.2553	2.0749	0	0.0132	1.1208	3.2119	13.3803	0.8639	0.0322	0	0	2.2544	0.6311	0	0.0988	0.0605	0.0298	0	0	0	0											59.4831	146	0	56.9891	2.111917714	12.6092976	0.740612463	4.696525242	7.268987109	5.130440016	3.469607086	8.550293301	0.255308005	9.480183394	0	0.08028783	5.142437611	9.655741675	43.82001441	2.830907844	0.137136982	0	0	7.387560943	2.064743716	0	0.09875	0.060478285	0.029759375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	182.6101
H2112_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1474.191411	38.16766292	894.031612	552.5020327	169.2320654	10.84192871	0	226.2666619	404.0568582	2287.696818	2647.062401	32.09729163	0.174587806	252.4390047	3716.048026	5252.052177	141.6134576	698.0114039	0	0	288.9724655	0	0	0	808.9161349	0	44.17863311	0	85.13080628	0												$250/day 1-7	$250/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$45 X-ray; $175 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	$15 PCP visit; $45 if no PCP selected	$45 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	97	45	25	45	15	45	40	45	45	45	45	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	97	45	25	45	15	45	40	45	45	45	45	0	0	0	0	0	0	0	0	0												22.2006	0.574785187	3.567681515	0	2.115400817	2.168385742	0	0.914494425	8.417851212	0	21.39708774	0.120364844	0.000363725	0.946646268	4.645060033	19.69519566	0.472044859	2.617542765	0	0	1.083646746	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9371	0	0	22.2006	0.574785187	3.567681515	0	2.115400817	2.168385742	0	0.914494425	8.417851212	0	21.39708774	0.120364844	0.000363725	0.946646268	4.645060033	19.69519566	0.472044859	2.617542765	0	0	1.083646746	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9371	NO																																																																																		0			22.2006	0.574785187	3.567681515	0	2.115400817	2.168385742	0	0.914494425	8.417851212	0	21.39708774	0.120364844	0.000363725	0.946646268	4.645060033	19.69519566	0.472044859	2.617542765	0	0	1.083646746	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9371
H2112_007_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1358.661455	96.32374943	741.982583	612.0571931	127.0088389	10.67906232	0	355.8162758	404.2614857	2100.948756	2499.364104	53.24325585	6.510939055	284.2850101	3311.000688	4600.721821	332.019462	805.4227003	0	0	298.5707843	0	0	0	725.4906807	0	47.83066458	0	44.02463424	0												$250/day 1-7	$250/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$125 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$45 X-ray; $175 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	$15 PCP visit; $45 if no PCP selected	$45 per visit	$40 per visit	$45 per visit	$40 per visit	$45 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											180.7137695	180.7137695	47.8866492	0	125	0.2	0.2	48.5	250	0	97	45	25	45	15	45	40	45	40	45	45	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.8866492	0	125	0.2	0.2	48.5	250	0	97	45	25	45	15	45	40	45	40	45	45	0	0	0	0	0	0	0	0	0												20.4607	1.450585654	2.960921639	0	1.323008738	2.135812463	0	1.438090781	8.422114284	0	20.20319318	0.199662209	0.013564456	1.066068788	4.13875086	17.25270683	1.10673154	3.020335126	0	0	1.119640441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3119	0	0	20.4607	1.450585654	2.960921639	0	1.323008738	2.135812463	0	1.438090781	8.422114284	0	20.20319318	0.199662209	0.013564456	1.066068788	4.13875086	17.25270683	1.10673154	3.020335126	0	0	1.119640441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3119	NO																																																																																		0			20.4607	1.450585654	2.960921639	0	1.323008738	2.135812463	0	1.438090781	8.422114284	0	20.20319318	0.199662209	0.013564456	1.066068788	4.13875086	17.25270683	1.10673154	3.020335126	0	0	1.119640441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.3119
H2112_014_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1756.28345	78.7899722	886.8452685	554.7848097	154.8466047	16.96183999	0	418.6862476	396.7288872	2629.235847	3050.700126	63.67329149	0	622.9977329	4014.768656	5946.096105	298.0892333	992.6949529	0	0	300	0	0	0	834.3963538	0	48.82106326	0	36.98565398	0												$150/day 1-10	$150/day 1-10	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$40 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$10 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											122.9471107	122.9471107	47.8866492	0	100	0.2	0.2	48.5	250	0	84	35	25	35	10	35	35	35	35	35	45	0	0	0	0	0	0	0	0	0											NO	122.9471107	122.9471107	47.8866492	0	100	0.2	0.2	48.5	250	0	84	35	25	35	10	35	35	35	35	35	45	0	0	0	0	0	0	0	0	0												17.9942	0.807249953	3.539004023	0	1.290388372	3.392367998	0	1.692190251	8.265185149	0	21.35490088	0.185713767	0	1.817076721	3.345640547	17.34278031	0.869426931	2.895360279	0	0	1.125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9164	0	0	17.9942	0.807249953	3.539004023	0	1.290388372	3.392367998	0	1.692190251	8.265185149	0	21.35490088	0.185713767	0	1.817076721	3.345640547	17.34278031	0.869426931	2.895360279	0	0	1.125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9164	NO																																																																																		0			17.9942	0.807249953	3.539004023	0	1.290388372	3.392367998	0	1.692190251	8.265185149	0	21.35490088	0.185713767	0	1.817076721	3.345640547	17.34278031	0.869426931	2.895360279	0	0	1.125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.9164
H2112_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	313.3671694	5.4847761	40.7831379	6.758838027	7.939859121	11.66733715	0	10.66692021	42.41820135	15.33785519	59.18702823	0.682486857	0.012983858	28.2788005	24.78157857	134.013415	2.221154479	8.217272493	0	-8.81E-09	61.18276874	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.063323541	0.063323541	0.148993195	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.063323541	0.063323541	0.148993195	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.8435	0.347315445	6.076410011	0	1.849987175	2.718489556	0	2.485392409	9.883440916	3.573720258	13.79057758	0.159019438	0.003025239	6.588960516	5.774107806	31.22512569	0.517528994	1.914624491	0	-2.05E-09	14.25558512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0068			19.8435	0.347315445	6.076410011	0	1.849987175	2.718489556	0	2.485392409	9.883440916	3.573720258	13.79057758	0.159019438	0.003025239	6.588960516	5.774107806	31.22512569	0.517528994	1.914624491	0	-2.05E-09	14.25558512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0068	NO																																																																																		0			19.8435	0.347315445	6.076410011	0	1.849987175	2.718489556	0	2.485392409	9.883440916	3.573720258	13.79057758	0.159019438	0.003025239	6.588960516	5.774107806	31.22512569	0.517528994	1.914624491	0	-2.05E-09	14.25558512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.0068
H2112_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	329.030906	3.814802347	40.83994196	6.809986065	7.639176617	11.55103204	0	10.22327891	40.24338522	15.15665786	54.24109812	0.589809694	0.010981548	26.82892254	26.45833803	128.2537503	2.017913116	9.593801801	0	-7.45E-09	52.07972691	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.061251096	0.061251096	0.149419649	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061251096	0.061251096	0.149419649	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.1535	0.233660825	6.102289786	0	1.779928152	2.691390466	0	2.382023986	9.376708755	3.531501281	12.63817586	0.137425659	0.002558701	6.251138951	6.164792762	29.88312381	0.470173756	2.23535582	0	-1.74E-09	12.13457637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.1683			20.1535	0.233660825	6.102289786	0	1.779928152	2.691390466	0	2.382023986	9.376708755	3.531501281	12.63817586	0.137425659	0.002558701	6.251138951	6.164792762	29.88312381	0.470173756	2.23535582	0	-1.74E-09	12.13457637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.1683	NO																																																																																		0			20.1535	0.233660825	6.102289786	0	1.779928152	2.691390466	0	2.382023986	9.376708755	3.531501281	12.63817586	0.137425659	0.002558701	6.251138951	6.164792762	29.88312381	0.470173756	2.23535582	0	-1.74E-09	12.13457637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.1683
H2165_004_0	2010	4	N/A																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	NO	836.9608299	48.5476353	254.634932	1077.085753	215.8421232	7.077080912	2.170238257	315.5652977	231.6008101	204.4547244	208.0979166	4.237483067	16.13750978	279.5128219	3078.129426	3522.407141	0.18324197	153.0716978	37.37819665	1145.512775	18.37392257																					$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $50 (6-20 Days)	No Cost Sharing	$125CP/Trip; 20% Coins on Air	20% Coins.	20% Coins.	$50 CP / Visit	$175 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.																				225	225	50	0	131.5445461	0.2	0.2	50	175	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2																				NO	213.3	213.3	47.4	0	124.7042297	0.1896	0.1896	50	165.9	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896																					14.877	0.862934218	1.005807981	0	2.243035476	1.341814541	0.411477173	1.314855407	3.201881199	0	1.643973541	0.058583203	3.059671855	3.864264762	3.847661782	8.806017853	0.036648394	0.191339622	0.093445492	0	3.483695719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3441		1.95	14.877	0.862934218	1.005807981	0	2.243035476	1.341814541	0.411477173	1.314855407	3.201881199	0	1.643973541	0.058583203	3.059671855	3.864264762	3.847661782	8.806017853	0.036648394	0.191339622	0.093445492	0	3.483695719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3441	NO																																																																																		0			14.877	0.862934218	1.005807981	0	2.243035476	1.341814541	0.411477173	1.314855407	3.201881199	0	1.643973541	0.058583203	3.059671855	3.864264762	3.847661782	8.806017853	0.036648394	0.191339622	0.093445492	0	3.483695719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3441
H2165_005_0	2010	6	N/A																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN			COIN																																																									0	NO	1060.013567	61.24124639	206.5254556	984.6119472	239.3838831	9.065837774	3.30070443	373.5537331	192.3969668	193.5814062	602.4010198	5.699158182	4.559326545	270.2815876	3748.047979	2854.097112	0.198162245	164.5783717	57.35182395	1024.038917	31.18320154			12.74654976																		$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $75 (6-20 Days)	No Cost Sharing	$125CP/Trip; 20% Coins on Air	20% Coins.	20% Coins.	$50 CP / Visit	$210 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.			Various cost sharing																	225	225	75	0	132.6076305	0.2	0.2	50	210	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2			0.242																	NO	213.3	213.3	71.1	0	125.7120337	0.1896	0.1896	50	199.08	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896			0.242																		18.8417	1.088563154	1.223663324	0	2.507786232	1.718882842	0.62581356	1.556473888	3.191865679	0	4.758968056	0.078790862	0.864448313	3.736642949	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	5.912335012	0	0	3.084665043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3997		2.42	18.8417	1.088563154	1.223663324	0	2.507786232	1.718882842	0.62581356	1.556473888	3.191865679	0	4.758968056	0.078790862	0.864448313	3.736642949	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	5.912335012	0	0	3.084665043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3997	NO																																																																																		0			18.8417	1.088563154	1.223663324	0	2.507786232	1.718882842	0.62581356	1.556473888	3.191865679	0	4.758968056	0.078790862	0.864448313	3.736642949	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	5.912335012	0	0	3.084665043	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3997
H2165_006_0	2010	6	N/A																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN			COIN																																																									0	NO	1060.013567	61.24124639	206.5154556	984.6119472	239.3838831	9.437460076	3.419255336	373.5537331	192.3969668	193.9735493	603.6213197	5.710703119	4.568562495	270.8291043	3748.047979	2854.097112	0.198162245	164.5783717	57.35182395	1024.038917	32.33476778			13.21726783																		$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $50 (6-20 Days)	No Cost Sharing	$125CP/Trip; 2 0% Coins on Air	20% Coins.	20% Coins.	$50 CP / Visit	$175 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.			Various cost sharing																	225	225	50	0	132.6076305	0.2	0.2	50	175	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2			0.242																	NO	213.3	213.3	47.4	0	125.7120337	0.1896	0.1896	50	165.9	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896			0.242																		18.8417	1.088563154	0.815736049	0	2.507786232	1.78934243	0.648290812	1.556473888	2.659888066	0	4.768608425	0.078950471	0.866199449	3.744212367	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	6.130671971	0	0	3.198578815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9041		2.42	18.8417	1.088563154	0.815736049	0	2.507786232	1.78934243	0.648290812	1.556473888	2.659888066	0	4.768608425	0.078950471	0.866199449	3.744212367	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	6.130671971	0	0	3.198578815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9041	NO																																																																																		0			18.8417	1.088563154	0.815736049	0	2.507786232	1.78934243	0.648290812	1.556473888	2.659888066	0	4.768608425	0.078950471	0.866199449	3.744212367	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	6.130671971	0	0	3.198578815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9041
H2165_010_0	2010	6	N/A																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	NO	1133.337288	77.09083154	347.7632521	1493.048731	260.9307196	10.38511458	4.386516306	424.9714513	270.6803178	199.5367033	344.4634335	10.34556275	5.272361168	450.5780945	4343.119916	3398.525315	0.175560486	117.722985	26.94816256	956.3779506	37.27961361																					$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $70 (6-20 Days)	No Cost Sharing	$125 CP/Trip; 20% Air Ambulance	20% Coins.	20% Coins.	$50 CP / Visit	$200 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.																				225	225	70	0	134.0777214	0.2	0.2	50	200	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2																				NO	213.3	213.3	66.36	0	127.1056799	0.1896	0.1896	50	189.6	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896																					20.1451	1.370289531	1.923130784	0	2.76381471	1.969017724	0.831683492	1.77071438	4.27674902	0	2.721261124	0.143027405	0.999639678	6.229242156	5.428899895	8.496313287	0.035112097	0.147153731	0.067370406	0	7.068214741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3867		2.7	20.1451	1.370289531	1.923130784	0	2.76381471	1.969017724	0.831683492	1.77071438	4.27674902	0	2.721261124	0.143027405	0.999639678	6.229242156	5.428899895	8.496313287	0.035112097	0.147153731	0.067370406	0	7.068214741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3867	NO																																																																																		0			20.1451	1.370289531	1.923130784	0	2.76381471	1.969017724	0.831683492	1.77071438	4.27674902	0	2.721261124	0.143027405	0.999639678	6.229242156	5.428899895	8.496313287	0.035112097	0.147153731	0.067370406	0	7.068214741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3867
H2169_001_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	345.6237032	9.08704962	1443.986799		170.1419194	10.69407521	7.789243415	346.7646118	438.4700488		1106.567929			222.5272309	4706.803742	6956.95865	304.4656075	396.7959374			31.09733796	0.166928917																			3400	1A: $275/stay - $825 annual max	1B: $275/stay - $825 annual max	"2: $25/day days 1-10, $60/day days 11-60, $0/day days 61-100 - $3250 annual max"	6: $0	10A: $100	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $20/60/50 for R30/R90/MO90"	4A: $50; 4B: $50	9A: $175 - $350 max; 9B: $175 - $350 max	8A: $0 labs	"8B: $20 x-rays, $60 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $40; 7I: $40; 9C: $40; 9D: $0	7A: $15; 14B: $0; 14C: $15; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $40; 7D: $40; 7F, 14A: $40; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $40"	7E: $40; 7H: $40	7I: $40			15: 10%	13A: $0; 16B: $40; 17A: $40			17A: $150 limit/2 yrs for glasses and exam	17B: $150 limit/2 yrs for glasses and exam			14A: $0												275	275	41.98		100	0.2	0.192740771	50	175		43.49272145			40	15	39.45121737	40	40			0.1	40																			NO	228.1518267	228.1518267	34.8284134		82.96430062	0.165928601	0.159906032	41.48215031	145.1875261		36.08343217			33.18572025	12.44464509	33.04205035	33.18572025	33.18572025			0.082964301	33.18572025																				6.5712	0.172768914	4.190980765	0	1.176308779	1.774452942	1.245547009	1.198711813	5.305031804	0	3.327397401	0	0	0.615393869	4.881208508	19.15601483	0.84199254	1.097329915	0	0	2.579968895	0.000461638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1348	0	10.89815463	6.5712	0.172768914	4.190980765	0	1.176308779	1.774452942	1.245547009	1.198711813	5.305031804	0	3.327397401	0	0	0.615393869	4.881208508	19.15601483	0.84199254	1.097329915	0	0	2.579968895	0.000461638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1348	NO																																																																																		0	0	0	6.5712	0.172768914	4.190980765	0	1.176308779	1.774452942	1.245547009	1.198711813	5.305031804	0	3.327397401	0	0	0.615393869	4.881208508	19.15601483	0.84199254	1.097329915	0	0	2.579968895	0.000461638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1348
H2169_002_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	345.6237032	9.08704962	1443.986799		170.1419194	10.69407521	7.789243415	346.7646118	438.4700488		1106.567929			222.5272309	4706.803742	6956.95865	304.4656075	396.7959374			31.09733796	0.166928917																			3400	1A: $275/stay - $825 annual max	1B: $275/stay - $825 annual max	"2: $25/day days 1-10, $60/day days 11-60, $0/day days 61-100 - $3250 annual max"	6: $0	10A: $100	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $20/60/50 for R30/R90/MO90"	4A: $50; 4B: $50	9A: $175 - $350 max; 9B: $175 - $350 max	8A: $0 labs	"8B: $20 x-rays, $60 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $40; 7I: $40; 9C: $40; 9D: $0	7A: $15; 14B: $0; 14C: $15; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $40; 7D: $40; 7F, 14A: $40; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $40"	7E: $40; 7H: $40	7I: $40			15: 10%	13A: $0; 16B: $40; 17A: $40			17A: $150 limit/2 yrs for glasses and exam	17B: $150 limit/2 yrs for glasses and exam			14A: $0												275	275	41.98		100	0.2	0.192740771	50	175		43.49272145			40	15	39.45121737	40	40			0.1	40																			NO	228.1518267	228.1518267	34.8284134		82.96430062	0.165928601	0.159906032	41.48215031	145.1875261		36.08343217			33.18572025	12.44464509	33.04205035	33.18572025	33.18572025			0.082964301	33.18572025																				6.5712	0.172768914	4.190980765	0	1.176308779	1.774452942	1.245547009	1.198711813	5.305031804	0	3.327397401	0	0	0.615393869	4.881208508	19.15601483	0.84199254	1.097329915	0	0	2.579968895	0.000461638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1348	0	10.89815463	6.5712	0.172768914	4.190980765	0	1.176308779	1.774452942	1.245547009	1.198711813	5.305031804	0	3.327397401	0	0	0.615393869	4.881208508	19.15601483	0.84199254	1.097329915	0	0	2.579968895	0.000461638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1348	NO																																																																																		0	0	0	6.5712	0.172768914	4.190980765	0	1.176308779	1.774452942	1.245547009	1.198711813	5.305031804	0	3.327397401	0	0	0.615393869	4.881208508	19.15601483	0.84199254	1.097329915	0	0	2.579968895	0.000461638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1348
H2169_003_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	345.6237032	9.08704962	1443.986799		170.1419194	10.69407521	7.789243415	346.7646118	438.4700488		1106.567929			222.5272309	4706.803742	6956.900382	304.4656075	396.7959374			31.09733796	0.166928917					266.205221														3200	1A: $125/stay - $250 annual max	1B: $125/stay - $250 annual max	"2: $25/day days 1-10, $60/day days 11-60, $0/day days 61-100 - $3200 annual max"	6: $0	10A: $100	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $15/45/37.50 for R30/R90/MO90"	4A: $50; 4B: $50	9A: $80 - $160 max; 9B: $80 - $160 max	8A: $0 labs	"8B: $20 x-rays, $50 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $30; 7I: $30; 9C: $30; 9D: $0	7A: $5; 14B: $0; 14C: $5; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $30; 7D: $30; 7F, 14A: $30; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $30"	7E: $30; 7H: $30	7I: $30			15: 10%	13A: $0; 16B: $30; 17A: $30			17A: $200 limit/2 yrs for glasses and exam	17B: $200 limit/2 yrs for glasses and exam	18a: $30	18b: $1000 limit	14A: $0												125	125	41.98		100	0.2	0.178885337	50	80		37.61954108			30	5	30	30	30			0.1	30					30														NO	110.8022322	110.8022322	37.21182167		88.64178579	0.177283572	0.158567157	44.32089289	70.91342863		33.34663302			26.59253574	4.432089289	26.59253574	26.59253574	26.59253574			0.088641786	26.59253574					26.59253574															3.1913	0.083905449	4.477781606	0	1.256806964	1.895883849	1.235118182	1.280743102	2.591117876	0	3.075026221	0	0	0.493130278	1.738414538	15.41680183	0.674709379	0.879317512	0	0	2.75652357	0.000369922	0	0	0	0	0.589922654	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6369	0	5.335190178	3.1913	0.083905449	4.477781606	0	1.256806964	1.895883849	1.235118182	1.280743102	2.591117876	0	3.075026221	0	0	0.493130278	1.738414538	15.41680183	0.674709379	0.879317512	0	0	2.75652357	0.000369922	0	0	0	0	0.589922654	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6369	NO																																																																																		0	0	0	3.1913	0.083905449	4.477781606	0	1.256806964	1.895883849	1.235118182	1.280743102	2.591117876	0	3.075026221	0	0	0.493130278	1.738414538	15.41680183	0.674709379	0.879317512	0	0	2.75652357	0.000369922	0	0	0	0	0.589922654	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6369
H2169_004_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	366.7845624	7.554383926	888.5297955		220.7495056	12.39137008	7.870839269	405.1794812	359.8614886		1120.976698			110.81166	3794.929429	5740.785505	251.9753156	570.7463119			18.96561317																				3400	1A: $275/stay - $825 annual max	1B: $275/stay - $825 annual max	"2: $25/day days 1-10, $60/day days 11-60, $0/day days 61-100 - $3250 annual max"	6: $0	10A: $100	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $20/60/50 for R30/R90/MO90"	4A: $50; 4B: $50	9A: $175 - $350 max; 9B: $175 - $350 max	8A: $0 labs	"8B: $20 x-rays, $60 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $40; 7I: $40; 9C: $40; 9D: $0	7A: $15; 14B: $0; 14C: $15; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $40; 7D: $40; 7F, 14A: $40; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $40"	7E: $40; 7H: $40	7I: $40			15: 10%	13A: $0; 16B: $40; 17A: $40			17A: $150 limit/2 yrs for glasses and exam	17B: $150 limit/2 yrs for glasses and exam			14A: $0												275	275	41.98		100	0.2	0.196493082	50	175		42.31919431			40	15	39.33495895	40	40			0.1																				NO	235.627219	235.627219	35.96956602		85.6826251	0.17136525	0.168360431	42.84131255	149.9445939		36.26019661			34.27305004	12.85239377	34.02060727	34.27305004	34.27305004			0.085682625																					7.202	0.148334873	2.663335928	0	1.576199761	2.123450234	1.325137888	1.446535066	4.496607065	0	3.387236289	0	0	0.316487797	4.064493944	16.27541743	0.71966355	1.630101409	0	0	1.625023523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0001	0	8.010594007	7.202	0.148334873	2.663335928	0	1.576199761	2.123450234	1.325137888	1.446535066	4.496607065	0	3.387236289	0	0	0.316487797	4.064493944	16.27541743	0.71966355	1.630101409	0	0	1.625023523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0001	NO																																																																																		0	0	0	7.202	0.148334873	2.663335928	0	1.576199761	2.123450234	1.325137888	1.446535066	4.496607065	0	3.387236289	0	0	0.316487797	4.064493944	16.27541743	0.71966355	1.630101409	0	0	1.625023523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0001
H2169_005_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	366.7845624	7.554383926	888.5297955		220.7495056	12.39137008	7.870839269	405.1794812	359.8614886		1120.976698			110.81166	3794.929429	5740.785505	251.9753156	570.7463119			18.96561317																				3400	1A: $275/stay - $825 annual max	1B: $275/stay - $825 annual max	"2: $25/day days 1-10, $60/day days 11-60, $0/day days 61-100 - $3250 annual max"	6: $0	10A: $100	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $20/60/50 for R30/R90/MO90"	4A: $50; 4B: $50	9A: $175 - $350 max; 9B: $175 - $350 max	8A: $0 labs	"8B: $20 x-rays, $60 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $40; 7I: $40; 9C: $40; 9D: $0	7A: $15; 14B: $0; 14C: $15; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $40; 7D: $40; 7F, 14A: $40; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $40"	7E: $40; 7H: $40	7I: $40			15: 10%	13A: $0; 16B: $40; 17A: $40			17A: $150 limit/2 yrs for glasses and exam	17B: $150 limit/2 yrs for glasses and exam			14A: $0												275	275	41.98		100	0.2	0.196493082	50	175		42.31919431			40	15	39.33495895	40	40			0.1																				NO	235.627219	235.627219	35.96956602		85.6826251	0.17136525	0.168360431	42.84131255	149.9445939		36.26019661			34.27305004	12.85239377	34.02060727	34.27305004	34.27305004			0.085682625																					7.202	0.148334873	2.663335928	0	1.576199761	2.123450234	1.325137888	1.446535066	4.496607065	0	3.387236289	0	0	0.316487797	4.064493944	16.27541743	0.71966355	1.630101409	0	0	1.625023523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0001	0	8.010594007	7.202	0.148334873	2.663335928	0	1.576199761	2.123450234	1.325137888	1.446535066	4.496607065	0	3.387236289	0	0	0.316487797	4.064493944	16.27541743	0.71966355	1.630101409	0	0	1.625023523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0001	NO																																																																																		0	0	0	7.202	0.148334873	2.663335928	0	1.576199761	2.123450234	1.325137888	1.446535066	4.496607065	0	3.387236289	0	0	0.316487797	4.064493944	16.27541743	0.71966355	1.630101409	0	0	1.625023523	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0001
H2169_006_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	366.7845624	7.554383926	888.5297955		220.7495056	12.39137008	7.870839269	405.1794812	359.8614886		1120.976698			110.81166	3794.929429	5740.785505	251.9753156	570.7463119			18.96561317						266.1469521														3200	1A: $125/stay - $250 annual max	1B: $125/stay - $250 annual max	"2: $25/day days 1-10, $60/day days 11-60, $0/day days 61-100 - $3200 annual max"	6: $0	10A: $100	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $15/45/37.50 for R30/R90/MO90"	4A: $50; 4B: $50	9A: $80 - $160 max; 9B: $80 - $160 max	8A: $0 labs	"8B: $20 x-rays, $50 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $30; 7I: $30; 9C: $30; 9D: $0	7A: $5; 14B: $0; 14C: $5; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $30; 7D: $30; 7F, 14A: $30; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $30"	7E: $30; 7H: $30	7I: $30			15: 10%	13A: $0; 16B: $30; 17A: $30			17A: $200 limit/2 yrs for glasses and exam	17B: $200 limit/2 yrs for glasses and exam	18a: $30	18b: $1000 limit	14A: $0												125	125	41.98		100	0.2	0.178598429	50	80		36.73939574			30	5	30	30	30			0.1						30														NO	113.7817915	113.7817915	38.21247684		91.02543317	0.182050866	0.162569994	45.51271658	72.82034654		33.44219411			27.30762995	4.551271658	27.30762995	27.30762995	27.30762995			0.091025433						27.30762995															3.4778	0.071629278	2.829410353	0	1.674484948	2.255859658	1.27956229	1.536734908	2.183769859	0	3.123993361	0	0	0.252166984	1.439312896	13.06393718	0.573404056	1.298810757	0	0	1.726353154	0	0	0	0	0	0.60565354	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3929	0	3.686714489	3.4778	0.071629278	2.829410353	0	1.674484948	2.255859658	1.27956229	1.536734908	2.183769859	0	3.123993361	0	0	0.252166984	1.439312896	13.06393718	0.573404056	1.298810757	0	0	1.726353154	0	0	0	0	0	0.60565354	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3929	NO																																																																																		0	0	0	3.4778	0.071629278	2.829410353	0	1.674484948	2.255859658	1.27956229	1.536734908	2.183769859	0	3.123993361	0	0	0.252166984	1.439312896	13.06393718	0.573404056	1.298810757	0	0	1.726353154	0	0	0	0	0	0.60565354	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3929
H2169_801_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	343.1981072	8.651013116	1319.030445		176.1183033	10.61461431	7.527021456	350.9687298	416.5835783		1089.286711			198.6117552	4461.791759	6622.662213	289.6482259	420.6896432			27.84270927	0.134120803		522			266.1937798														3200	1A: $150	1B: $150	"2: $0/day days 1-10, $50/day days 11-50, $0/day days 51-100"	6: $0	10A: $75	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $20 31-day/60 90-day"	4A: $50; 4B: $50	9A: $100; 9B: $100	8A: $0 labs	"8B: $10 x-rays, $50 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $25; 7I: $25; 9C: $25; 9D: $0	7A: $10; 14B: $0; 14C: $10; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $25; 7D: $25; 7F, 14A: $25; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $25"	7E: $25; 7H: $25	7I: $25			15: 20%	13A: $0; 16B: $25; 17A: $25		"16A: $25; 16B: $25 bitewing x-ray, 20% restorative"	17A: $200 limit/2 yrs for glasses and exam	17B: $200 limit/2 yrs for glasses and exam	18A: $25	"18B: $1,000 limit every 3 yrs"	14A: $0												150	150	29.16		75	0.2	0.206956667	50	100		33.27738199			25	10	25	25	25			0.2	25		31.98275862			25														NO	133.4300657	133.4300657	25.93880476		66.71503283	0.177906754	0.184094944	44.47668855	88.9533771		29.60135509			22.23834428	8.89533771	22.23834428	22.23834428	22.23834428			0.177906754	22.23834428		28.44974388			22.23834428															3.8161	0.096192104	2.851172765	0	0.979144866	1.888411579	1.385686595	1.300827241	3.088043011	0	2.687030228	0	0	0.368066382	3.307428707	12.27308686	0.536774747	0.779620093	0	0	4.953406034	0.000248552	0	1.237563859	0	0	0.493309077	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0421	0	5.220972447	3.8161	0.096192104	2.851172765	0	0.979144866	1.888411579	1.385686595	1.300827241	3.088043011	0	2.687030228	0	0	0.368066382	3.307428707	12.27308686	0.536774747	0.779620093	0	0	4.953406034	0.000248552	0	1.237563859	0	0	0.493309077	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0421	NO																																																																																		0	0	0	3.8161	0.096192104	2.851172765	0	0.979144866	1.888411579	1.385686595	1.300827241	3.088043011	0	2.687030228	0	0	0.368066382	3.307428707	12.27308686	0.536774747	0.779620093	0	0	4.953406034	0.000248552	0	1.237563859	0	0	0.493309077	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0421
H2169_802_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	343.1981072	8.651013116	1319.030445		176.1183033	10.61461431	7.527021456	350.9687298	416.5835783		1089.286711			198.6117552	4461.791759	6622.662213	289.6482259	420.6896432			27.84270927	0.134120803		522			266.1937798														3200	1A: $150	1B: $150	"2: $0/day days 1-10, $50/day days 11-50, $0/day days 51-100"	6: $0	10A: $75	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $20 31-day/60 90-day"	4A: $50; 4B: $50	9A: $100; 9B: $100	8A: $0 labs	"8B: $10 x-rays, $50 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $25; 7I: $25; 9C: $25; 9D: $0	7A: $10; 14B: $0; 14C: $10; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $25; 7D: $25; 7F, 14A: $25; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $25"	7E: $25; 7H: $25	7I: $25			15: 20%	13A: $0; 16B: $25; 17A: $25		"16A: $25; 16B: $25 bitewing x-ray, 20% restorative"	17A: $200 limit/2 yrs for glasses and exam	17B: $200 limit/2 yrs for glasses and exam	18A: $25	"18B: $1,000 limit every 3 yrs"	14A: $0												150	150	29.16		75	0.2	0.206956667	50	100		33.27738199			25	10	25	25	25			0.2	25		31.98275862			25														NO	133.4300657	133.4300657	25.93880476		66.71503283	0.177906754	0.184094944	44.47668855	88.9533771		29.60135509			22.23834428	8.89533771	22.23834428	22.23834428	22.23834428			0.177906754	22.23834428		28.44974388			22.23834428															3.8161	0.096192104	2.851172765	0	0.979144866	1.888411579	1.385686595	1.300827241	3.088043011	0	2.687030228	0	0	0.368066382	3.307428707	12.27308686	0.536774747	0.779620093	0	0	4.953406034	0.000248552	0	1.237563859	0	0	0.493309077	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0421	0	5.220972447	3.8161	0.096192104	2.851172765	0	0.979144866	1.888411579	1.385686595	1.300827241	3.088043011	0	2.687030228	0	0	0.368066382	3.307428707	12.27308686	0.536774747	0.779620093	0	0	4.953406034	0.000248552	0	1.237563859	0	0	0.493309077	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0421	NO																																																																																		0	0	0	3.8161	0.096192104	2.851172765	0	0.979144866	1.888411579	1.385686595	1.300827241	3.088043011	0	2.687030228	0	0	0.368066382	3.307428707	12.27308686	0.536774747	0.779620093	0	0	4.953406034	0.000248552	0	1.237563859	0	0	0.493309077	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0421
H2169_803_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	343.1981072	8.651013116	1319.030445		176.1183033	10.61461431	7.527021456	350.9687298	416.5835783		1089.286711			198.6117552	4461.791759	6622.662213	289.6482259	420.6896432			27.84270927	0.134120803		522			266.1937798														3200	1A: $150	1B: $150	"2: $0/day days 1-10, $50/day days 11-50, $0/day days 51-100"	6: $0	10A: $75	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $20 31-day/60 90-day"	4A: $50; 4B: $50	9A: $100; 9B: $100	8A: $0 labs	"8B: $10 x-rays, $50 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $25; 7I: $25; 9C: $25; 9D: $0	7A: $10; 14B: $0; 14C: $10; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $25; 7D: $25; 7F, 14A: $25; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $25"	7E: $25; 7H: $25	7I: $25			15: 20%	13A: $0; 16B: $25; 17A: $25		"16A: $25; 16B: $25 bitewing x-ray, 20% restorative"	17A: $200 limit/2 yrs for glasses and exam	17B: $200 limit/2 yrs for glasses and exam	18A: $25	"18B: $1,000 limit every 3 yrs"	14A: $0												150	150	29.16		75	0.2	0.206956667	50	100		33.27738199			25	10	25	25	25			0.2	25		31.98275862			25														NO	133.4300657	133.4300657	25.93880476		66.71503283	0.177906754	0.184094944	44.47668855	88.9533771		29.60135509			22.23834428	8.89533771	22.23834428	22.23834428	22.23834428			0.177906754	22.23834428		28.44974388			22.23834428															3.8161	0.096192104	2.851172765	0	0.979144866	1.888411579	1.385686595	1.300827241	3.088043011	0	2.687030228	0	0	0.368066382	3.307428707	12.27308686	0.536774747	0.779620093	0	0	4.953406034	0.000248552	0	1.237563859	0	0	0.493309077	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0421	0	5.220972447	3.8161	0.096192104	2.851172765	0	0.979144866	1.888411579	1.385686595	1.300827241	3.088043011	0	2.687030228	0	0	0.368066382	3.307428707	12.27308686	0.536774747	0.779620093	0	0	4.953406034	0.000248552	0	1.237563859	0	0	0.493309077	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0421	NO																																																																																		0	0	0	3.8161	0.096192104	2.851172765	0	0.979144866	1.888411579	1.385686595	1.300827241	3.088043011	0	2.687030228	0	0	0.368066382	3.307428707	12.27308686	0.536774747	0.779620093	0	0	4.953406034	0.000248552	0	1.237563859	0	0	0.493309077	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0421
H2174_001_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	322.738782	107.9704424	49.50568022	0	22.40987638	66.91670892	2.098341224	42.28026338	30.14839277	0.328116158	4.232602316	0	0.12438232	13.33565506	50.93970658	101.9540555	4.759648542	2.308314879	19.37327448	33.46202814	1.292372828	0.194597753	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.082225702	0.082225702	0.124309392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082225702	0.082225702	0.124309392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												26.5374	8.877945411	6.154021022	0	5.221501196	15.59159318	0.488913505	9.851301369	7.024575516	0.076451065	0.98619634	0	0.028981081	3.107207629	11.86895163	23.75529494	1.10899811	0.537837367	4.513972954	7.796652557	0.301122869	0.045341277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.8743	0	0	26.5374	8.877945411	6.154021022	0	5.221501196	15.59159318	0.488913505	9.851301369	7.024575516	0.076451065	0.98619634	0	0.028981081	3.107207629	11.86895163	23.75529494	1.10899811	0.537837367	4.513972954	7.796652557	0.301122869	0.045341277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.8743	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.5374	8.877945411	6.154021022	0	5.221501196	15.59159318	0.488913505	9.851301369	7.024575516	0.076451065	0.98619634	0	0.028981081	3.107207629	11.86895163	23.75529494	1.10899811	0.537837367	4.513972954	7.796652557	0.301122869	0.045341277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.8743
H2174_002_0	2010	8	N/A																															D	D	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	YES	586.8284277	20.42807387	0	0	190.3518705	11.5537266	0	260.30832	380.408397	0	89.34676501	0	0	349.8551675	4387.94782	3764.921061	160.6334949	1244.804627	212.249806	841.4793843	0	0	0	0	0	0	0	0	0	0											2500	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $50/Visit for Urgent Care; $50/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC	No Cost-Sharing	$100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $5/Visit for PCP - Allergy Tx;	$25/Visit for Speclst - Office Visits; $5/Visit for Speclst - Allergy Tx; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	$100/Procedure for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											250	250	0	0	100	0.2	0	50	100	0	100	0	0	25	24.81459818	24.16860093	25	25	100	25	0	0	0	0	0	0	0	0	0	0											NO	238.9065849	238.9065849	0	0	95.56263397	0.191125268	0	47.78131699	95.56263397	0	95.56263396	0	0	23.8906585	23.71348363	23.09615165	23.89065849	23.89065849	95.56263397	23.89065849	0	0	0	0	0	0	0	0	0	0												11.6831	0.406700114	0	0	1.515877177	2.208209092	0	1.036489529	3.029402367	0	0.711517683	0	0	0.696522527	8.6711274	7.246265647	0.319803331	2.478266853	1.690262543	1.675291383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3688	0	2.013793268	11.6831	0.406700114	0	0	1.515877177	2.208209092	0	1.036489529	3.029402367	0	0.711517683	0	0	0.696522527	8.6711274	7.246265647	0.319803331	2.478266853	1.690262543	1.675291383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3688	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.6831	0.406700114	0	0	1.515877177	2.208209092	0	1.036489529	3.029402367	0	0.711517683	0	0	0.696522527	8.6711274	7.246265647	0.319803331	2.478266853	1.690262543	1.675291383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3688
H2174_003_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	472.5441183	3.745669186	93.04972525	0	14.84534933	20.37987047	13.51569873	25.14534317	77.82896128	9.460260767	28.03731709	0	1.012195213	51.52406007	87.32314579	245.4513078	3.099491958	9.009241578	67.82296166	101.4004526	14.57871445	1.625628464	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.082225702	0.082225702	0.124309392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082225702	0.082225702	0.124309392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												38.8553	0.307990278	11.5669548	0	3.458966394	4.74850982	3.149157804	5.85886496	18.13414798	2.204240759	6.532694883	0	0.235841485	12.005106	20.34629297	57.19015471	0.722181626	2.099153288	15.80275007	23.62630547	3.396840466	0.378771432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	230.6202	0	0	38.8553	0.307990278	11.5669548	0	3.458966394	4.74850982	3.149157804	5.85886496	18.13414798	2.204240759	6.532694883	0	0.235841485	12.005106	20.34629297	57.19015471	0.722181626	2.099153288	15.80275007	23.62630547	3.396840466	0.378771432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	230.6202	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	38.8553	0.307990278	11.5669548	0	3.458966394	4.74850982	3.149157804	5.85886496	18.13414798	2.204240759	6.532694883	0	0.235841485	12.005106	20.34629297	57.19015471	0.722181626	2.099153288	15.80275007	23.62630547	3.396840466	0.378771432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	230.6202
H2174_004_0	2010	3	N/A																															D	D	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	YES	679.7047724	12.14456609	0	0	160.9145914	9.652882033	0	208.6086437	314.8567854	0	84.71389496	0	0	309.874093	3785.187614	3382.308993	122.1229047	1089.050605	175.6120489	898.7409353	0	0	0	0	0	0	0	0	0	0											2500	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $50/Visit for Urgent Care; $50/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC	No Cost-Sharing	$100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $5/Visit for PCP - Allergy Tx;	$25/Visit for Speclst - Office Visits; $5/Visit for Speclst - Allergy Tx; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	$100/Procedure for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											250	250	0	0	100	0.2	0	50	100	0	100	0	0	25	24.78423588	24.07094093	25	25	100	25	0	0	0	0	0	0	0	0	0	0											NO	239.6546264	239.6546264	0	0	95.86185057	0.191723701	0	47.93092529	95.86185058	0	95.86185058	0	0	23.96546264	23.75862716	23.07484943	23.96546264	23.96546264	95.86185058	23.96546264	0	0	0	0	0	0	0	0	0	0												13.5745	0.242541787	0	0	1.28546421	1.85068627	0	0.833233776	2.51522951	0	0.676735895	0	0	0.618856333	7.494238439	6.503855894	0.243894326	2.174966799	1.402874666	1.794895193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.212	0	1.779033447	13.5745	0.242541787	0	0	1.28546421	1.85068627	0	0.833233776	2.51522951	0	0.676735895	0	0	0.618856333	7.494238439	6.503855894	0.243894326	2.174966799	1.402874666	1.794895193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.212	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.5745	0.242541787	0	0	1.28546421	1.85068627	0	0.833233776	2.51522951	0	0.676735895	0	0	0.618856333	7.494238439	6.503855894	0.243894326	2.174966799	1.402874666	1.794895193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.212
H2174_005_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	488.5378804	3.872445374	96.19909293	0	15.34780609	21.06964903	13.97315204	25.99641426	80.46316588	9.780453432	28.98627014	0	1.046454045	51.62356953	87.29529175	251.283192	3.204397585	9.314169014	70.11850248	101.7119109	15.07214666	1.680649602	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.082225702	0.082225702	0.124309392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082225702	0.082225702	0.124309392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												40.1704	0.318414539	11.95845078	0	3.576038819	4.909228224	3.255744425	6.057164523	18.74791765	2.27884565	6.753800942	0	0.243823792	12.0282917	20.33980298	58.54898373	0.746624637	2.17020138	16.33761108	23.69887524	3.511810172	0.391591357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	236.0436	0	0	40.1704	0.318414539	11.95845078	0	3.576038819	4.909228224	3.255744425	6.057164523	18.74791765	2.27884565	6.753800942	0	0.243823792	12.0282917	20.33980298	58.54898373	0.746624637	2.17020138	16.33761108	23.69887524	3.511810172	0.391591357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	236.0436	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	40.1704	0.318414539	11.95845078	0	3.576038819	4.909228224	3.255744425	6.057164523	18.74791765	2.27884565	6.753800942	0	0.243823792	12.0282917	20.33980298	58.54898373	0.746624637	2.17020138	16.33761108	23.69887524	3.511810172	0.391591357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	236.0436
H2174_006_0	2010	4	N/A																															D	D	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	YES	1172.594691	79.90872457	0	0	1238.416563	6.297132176	0	294.6657132	117.4130369	0	76.00751556	0	0	241.221403	839.2884482	1094.067487	944.509184	64.20213456	59.01369646	413.496216	0	0	0	0	0	0	0	0	0	0											2500	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											250	250	0	0	100	0.2	0	50	100	0	100	0	0	25	24.9470696	24.84377077	25	25	100	25	0	0	0	0	0	0	0	0	0	0											NO	237.8731445	237.8731445	0	0	95.1492578	0.190298516	0	47.57462891	95.1492578	0	95.1492578	0	0	23.78731445	23.73695157	23.6386635	23.78731445	23.78731445	95.1492578	23.78731445	0	0	0	0	0	0	0	0	0	0												23.2441	1.584011632	0	0	9.819534737	1.198334906	0	1.168217663	0.930980277	0	0.602671558	0	0	0.478167447	1.660179104	2.155191097	1.87227808	0.127266364	0.467925785	0.819663709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1285	0	2.351646327	23.2441	1.584011632	0	0	9.819534737	1.198334906	0	1.168217663	0.930980277	0	0.602671558	0	0	0.478167447	1.660179104	2.155191097	1.87227808	0.127266364	0.467925785	0.819663709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1285	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.2441	1.584011632	0	0	9.819534737	1.198334906	0	1.168217663	0.930980277	0	0.602671558	0	0	0.478167447	1.660179104	2.155191097	1.87227808	0.127266364	0.467925785	0.819663709	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1285
H2174_007_0	2010	4	N/A																															D	D	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	YES	1263.318838	89.88469924	0	0	1400.735459	7.152932304	0	339.4842436	133.7460537	0	81.82176482	0	0	264.0475395	873.8584387	1180.420782	1029.606185	72.38511773	65.9374082	437.7279901	0	0	0	0	0	0	0	0	0	0											2500	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											250	250	0	0	100	0.2	0	50	100	0	100	0	0	25	24.94525382	24.8440634	25	25	100	25	0	0	0	0	0	0	0	0	0	0											NO	236.4863153	236.4863153	0	0	94.59452612	0.189189052	0	47.29726306	94.59452613	0	94.59452612	0	0	23.64863153	23.59684464	23.50112404	23.64863153	23.64863154	94.59452612	23.64863153	0	0	0	0	0	0	0	0	0	0												24.8965	1.771375111	0	0	11.04182558	1.353256483	0	1.338056298	1.054303714	0	0.644990923	0	0	0.520363581	1.718358485	2.311767935	2.029064774	0.142650748	0.51977649	0.862638996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2049	0	2.868889685	24.8965	1.771375111	0	0	11.04182558	1.353256483	0	1.338056298	1.054303714	0	0.644990923	0	0	0.520363581	1.718358485	2.311767935	2.029064774	0.142650748	0.51977649	0.862638996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2049	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.8965	1.771375111	0	0	11.04182558	1.353256483	0	1.338056298	1.054303714	0	0.644990923	0	0	0.520363581	1.718358485	2.311767935	2.029064774	0.142650748	0.51977649	0.862638996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2049
H2174_801_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	252.9312184	1.937934243	49.25929457	0	8.064377041	11.0159738	7.343780747	13.16064372	41.04192228	5.076121301	15.09463821	0	0.530222429	26.50384811	43.43959339	124.1890024	1.57480404	4.534237907	34.40156077	50.06971084	7.868262678	0.877366233	0	0	0	0	0	0	0	0												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost-Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost-Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.082225702	0.082225702	0.124309392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082225702	0.082225702	0.124309392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.7974	0.159348004	6.123392972	0	1.878999851	2.566721895	1.711100914	3.066429986	9.562767891	1.182736263	3.517050703	0	0.123541826	6.17539661	10.12142526	28.93603755	0.366929341	1.056477432	8.015563659	11.66624262	1.833305204	0.204426332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.0653	0	0	20.7974	0.159348004	6.123392972	0	1.878999851	2.566721895	1.711100914	3.066429986	9.562767891	1.182736263	3.517050703	0	0.123541826	6.17539661	10.12142526	28.93603755	0.366929341	1.056477432	8.015563659	11.66624262	1.833305204	0.204426332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.0653	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.7974	0.159348004	6.123392972	0	1.878999851	2.566721895	1.711100914	3.066429986	9.562767891	1.182736263	3.517050703	0	0.123541826	6.17539661	10.12142526	28.93603755	0.366929341	1.056477432	8.015563659	11.66624262	1.833305204	0.204426332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.0653
H2174_802_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	252.9312184	1.937934243	49.25929457	0	8.064377041	11.0159738	7.343780747	13.16064372	41.04192228	5.076121301	15.09463821	0	0.530222429	26.50384811	43.43959339	124.1890024	1.57480404	4.534237907	34.40156077	50.06971084	7.868262678	0.877366233	0	0	0	0	0	0	0	0												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost-Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost-Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.082225702	0.082225702	0.124309392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082225702	0.082225702	0.124309392	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.7974	0.159348004	6.123392972	0	1.878999851	2.566721895	1.711100914	3.066429986	9.562767891	1.182736263	3.517050703	0	0.123541826	6.17539661	10.12142526	28.93603755	0.366929341	1.056477432	8.015563659	11.66624262	1.833305204	0.204426332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.0653	0	0	20.7974	0.159348004	6.123392972	0	1.878999851	2.566721895	1.711100914	3.066429986	9.562767891	1.182736263	3.517050703	0	0.123541826	6.17539661	10.12142526	28.93603755	0.366929341	1.056477432	8.015563659	11.66624262	1.833305204	0.204426332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.0653	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.7974	0.159348004	6.123392972	0	1.878999851	2.566721895	1.711100914	3.066429986	9.562767891	1.182736263	3.517050703	0	0.123541826	6.17539661	10.12142526	28.93603755	0.366929341	1.056477432	8.015563659	11.66624262	1.833305204	0.204426332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.0653
H2182_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1402.440139	88.70553908	828.3086825	731.030156	184.5309794	8.924793648	8.83563721	325.9689978	227.5326668	8748.75416	27.95880895	0	0.027978297	417.6747693	5047.334901	3943.585565	382.3920251	242.090465	0	0	12.85784035	822.4177041	0	0	85.18167149	152.0663778	13.25067566	4.820217259	79.53358477	0											3380	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $150 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	69.22791329	0	150	0.2	0.126010336	49.58240212	150	3	0.176706805	0	0.2	58.98877385	6.99537348	30	38.5	30	0	0	0.2	28.58388637	0	0	30	30	0	0	0	0											NO	133.3007528	101.5246753	55.65279385	0	120.5860278	0.16078137	0.101300573	39.8596328	120.5860278	2.411720556	0.142055811	0	0.16078137	47.48947122	6.887154714	30	38.5	24.11720556	0	0	0.16078137	28.58388637	0	0	30	30	0	0	0	0												15.5789	0.750483421	3.841474363	0	1.854321485	1.434940553	0.895055111	1.08275038	2.286438373	1.758295854	3.971711284	0	0.004498389	1.652929495	2.896814696	9.858963913	1.22684108	0.486545459	0	0	2.067301191	1.958991183	0	0	0.212954179	0.380165945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2003	0	9.230165074	15.5789	0.750483421	3.841474363	0	1.854321485	1.434940553	0.895055111	1.08275038	2.286438373	1.758295854	3.971711284	0	0.004498389	1.652929495	2.896814696	9.858963913	1.22684108	0.486545459	0	0	2.067301191	1.958991183	0	0	0.212954179	0.380165945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2003	NO	"$275 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$140 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.1262	0.2631	2.9629	0.5804	0.7895	0.9164	0.9073	0.461	2.3856	0.7486	2.4822	0	0.0019	1.7435	1.7015	3.7088	0.4498	0.2291	0	0	1.2517	0.7626	0	0	0.0806	0	0.0125	0	0	0											26.5653	0	0	19.705	1.013591025	6.804371356	0.580398244	2.643841615	2.351379096	1.802338664	1.543756321	4.672027571	2.506930858	6.45389538	0	0.006413682	3.396395121	4.598292951	13.56775154	1.676658189	0.715676335	0	0	3.319024722	2.721564259	0	0	0.293575904	0.380165945	0.01254134	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7656
H2224_001_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	498.3307158	1.768994198	59.60275015	46.34783985	48.31925482	61.63439597	0	54.56226997	3.287245355	0	0	0	2.650255069	193.1191688	233.318045	1.229590359	20.82771997	2.691073658	1.021030139	41.02559771	7.002322467	3.512901184	0	0	0	0	0	0	0	0												59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing	59% of Standard Medicare Cost Sharing											0.04493884	0.04493884	0.089365734	0	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0	0	0	0	0	0	0	0											NO	0.04493884	0.04493884	0.089365734	0	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0.137624755	0	0	0	0	0	0	0	0												22.3944	0.079496547	5.326443519	0	6.649925612	8.482418651	0	7.509119042	0.452406337	0	0	0	0.364740705	26.57797831	32.1103388	0.169222072	2.86640986	0.370358353	0.140519023	5.646137838	0.963692915	0.483462165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.5871	0	0	22.3944	0.079496547	5.326443519	0	6.649925612	8.482418651	0	7.509119042	0.452406337	0	0	0	0.364740705	26.57797831	32.1103388	0.169222072	2.86640986	0.370358353	0.140519023	5.646137838	0.963692915	0.483462165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.5871	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.3944	0.079496547	5.326443519	0	6.649925612	8.482418651	0	7.509119042	0.452406337	0	0	0	0.364740705	26.57797831	32.1103388	0.169222072	2.86640986	0.370358353	0.140519023	5.646137838	0.963692915	0.483462165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.5871
H2225_001_0	2010	4	N/A																															Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																												0	NO	532.3523448		162.9634467		38.45083262	86.66090972		35.82975505	24.00288863	144.4459698					367.7389362						24.2615168																					Medicare FFS Cost Sharing		Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing						Medicare FFS Cost Sharing																				0.074472785		0.153973069		0.233	0.233		0.233	0.233	0.233					0.233						0.233																				NO	0.074472785		0.153973069		0.233	0.233		0.233	0.233	0.233					0.233						0.233																					39.6458	0	25.09198201	0	8.959044001	20.19199197	0	8.348332927	5.59267305	33.65591096	0	0	0	0	85.68317214	0	0	0	0	0	5.652933415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	232.8218	0	0	39.6458	0	25.09198201	0	8.959044001	20.19199197	0	8.348332927	5.59267305	33.65591096	0	0	0	0	85.68317214	0	0	0	0	0	5.652933415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	232.8218	NO																																																																																		0			39.6458	0	25.09198201	0	8.959044001	20.19199197	0	8.348332927	5.59267305	33.65591096	0	0	0	0	85.68317214	0	0	0	0	0	5.652933415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	232.8218
H2226_001_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.9618	0.8123	0.8206	0	1.4759	0	2.5514	0	0.0172	1.5282	1.8459	5.6091	0.5469	0.1654	0	0	0.8025	0.4794	0	0	0	0	0	0	0	0											17.6166	NO	502.6744318	36.22446691	209.2224666	2666.719618	29.80498196	24.22243159	25.06238656	61.7770576	44.38948431	45.11187233	78.2935028	0	0.545750532	46.70954717	61.40912202	169.2911499	16.72049141	4.983391249	0	0	23.40101132	16.71827211	0	0	0	0	106.2696785	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14b, 14c, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1); $0/20% (14d)"	"20% (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a); $0 (17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 20% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.072145053	0.072145053	0.149779807	0	0.193415103	0.193415103	0.193415103	0.058579341	0.193415103	0	0.160669089	0	0.193415103	0.145565162	0.19371044	0.193415103	0.193415103	0	0	0	0.193415103	0.189259817	0	0	0	0	0	0	0	0											NO	0.072145053	0.072145053	0.149779807	0	0.193415103	0.193415103	0.193415103	0.058579341	0.193415103	0	0.160669089	0	0.193415103	0.145565162	0.19371044	0.193415103	0.193415103	0	0	0	0.193415103	0.189259817	0	0	0	0	0	0	0	0												36.2655	2.613416091	31.33730072	0	5.76473366	4.684984105	4.847444082	3.618859299	8.585596688	0	12.57934574	0	0.105556396	6.799282784	11.89558802	32.74346523	3.233995572	0	0	0	4.526109019	3.164097124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.7652	146	0	36.2655	2.613416091	31.33730072	0	6.726523734	5.497264622	5.667999144	3.618859299	10.0615259	0	15.1307845	0	0.122736384	8.327458725	13.74151442	38.35253625	3.780918455	0.16542906	0	0	5.328576572	3.643528332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	190.3818	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	36.2655	2.613416091	31.33730072	0	6.726523734	5.497264622	5.667999144	3.618859299	10.0615259	0	15.1307845	0	0.122736384	8.327458725	13.74151442	38.35253625	3.780918455	0.16542906	0	0	5.328576572	3.643528332	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	190.3818
H2228_001_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	321.9535554	34.52268713	11648.14839	115.2067421	30.87569604	20.25178076	18.27987254	27.49282238	7.904773458	61.65290473	36.39211059	0	0.031857122	15.48344947	0.988282998	125.4072258	16.38947603	32.64027319	0	0	1.569971542	13.2682095	1441.106916	0	107.3546465	189.1931161	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07190558	0.072778928	0	0	0.2	0.2	0.090268188	0.031808303	0.2	0	0.07287301	0	0.2	0.150940305	0.005749557	0.197129863	0.2	0	0	0	0.2	0.189287003	0	0	0	0	0	0	0	0											NO	0.07190558	0.072778928	0	0	0.2	0.2	0.090268188	0.031808303	0.2	0	0.07287301	0	0.2	0.150940305	0.005749557	0.197129863	0.2	0	0	0	0.2	0.189287003	0	0	0	0	0	0	0	0												23.1503	2.512524145	0	0	6.175139207	4.050356151	1.650090963	0.874500022	1.580954692	0	2.652002639	0	0.006371424	2.337076586	0.00568219	24.7215092	3.277895206	0	0	0	0.313994308	2.511499609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8199	0	0	23.1503	2.512524145	0	0	6.175139207	4.050356151	1.650090963	0.874500022	1.580954692	0	2.652002639	0	0.006371424	2.337076586	0.00568219	24.7215092	3.277895206	0	0	0	0.313994308	2.511499609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8199	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												8.9725	0.9621	0	0.0364	0.5391	0.3536	0.3192	0.0509	0.138	0.3229	0.5038	0	0.0004	0.204	0.025	3.2715	0.4276	0	0	0	0.041	0.3276	0	0	0.0175	0	0	0	0	0											16.513	0	0	32.1227	3.474631819	0	0.036373205	6.714238662	4.403958673	1.969263341	0.925396849	1.718974546	0.322943787	3.155804115	0	0.006742248	2.541107082	0.03072233	27.99300205	3.705446755	0	0	0	0.354950088	2.839086514	0	0	0.017503475	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.3329
H2228_002_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	415.5523011	35.74191828	13040.26773	106.5697296	41.38929617	16.48942526	19.46153938	29.76468146	15.42411443	71.40211093	45.35247116	0	0.048489915	13.69123961	1.215858001	128.5372751	16.82950002	45.24929097	0	0	2.835051645	11.47418426	1487.541391	0	110.2368997	194.2725653	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079887163	0.080857452	0	0	0.2	0.2	0.091778847	0.051203655	0.2	0	0.060832881	0	0.2	0.151006906	0.002287406	0.196253858	0.2	0	0	0	0.2	0.188339863	0	0	0	0	0	0	0	0											NO	0.079887163	0.080857452	0	0	0.2	0.2	0.091778847	0.051203655	0.2	0	0.060832881	0	0.2	0.151006906	0.002287406	0.196253858	0.2	0	0	0	0.2	0.188339863	0	0	0	0	0	0	0	0												33.1973	2.890000445	0	0	8.277859235	3.297885051	1.786157646	1.524060488	3.084822886	0	2.758921495	0	0.009697983	2.067471728	0.002781161	25.22593617	3.365900005	0	0	0	0.567010329	2.161046291	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2168	0	0	33.1973	2.890000445	0	0	8.277859235	3.297885051	1.786157646	1.524060488	3.084822886	0	2.758921495	0	0.009697983	2.067471728	0.002781161	25.22593617	3.365900005	0	0	0	0.567010329	2.161046291	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2168	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												11.581	0.9961	0	0.0314	0.7227	0.2879	0.3398	0.0887	0.2693	0.374	0.6222	0	0.0006	0.1805	0.0314	3.3531	0.439	0	0	0	0.074	0.2819	0	0	0.018	0	0	0	0	0											19.6915	0	0	44.7783	3.886086692	0	0.031384873	9.000529485	3.585795651	2.125962301	1.612762421	3.354132821	0.374011057	3.381159165	0	0.010262416	2.247965292	0.034136435	28.57908248	3.80493044	0	0	0	0.640968198	2.442921894	0	0	0.017973408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9083
H2228_009_0	2010	5	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2414.441411	232.1556491	87.59605249	1138.786803	393.386161	13.54741077	20.10884741	576.510657	47.22502963	12815.03962	115.5047321	0	0.666822963	83.46722205	6426.324702	6300.941063	811.510387	488.9161809	0	0	13.98108868	1104.699325	664.1623852	0	231.520743	0	14.24004083	4.506816185	78.27628111	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$5 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	0.148989623	0	150	0.2	0.085461829	49.8302728	0.2	3	0.163417417	0	0.2	0.1493384	3.441501978	25	38.5	25	0	0	0.2	24.74683346	0	0	25	0	0	0	0	0											NO	184.2401855	140.3212257	0.148989623	0	150	0.2	0.085461829	49.8302728	0.2	3	0.163417417	0	0.2	0.1493384	3.441501978	25	38.5	25	0	0	0.2	24.74683346	0	0	25	0	0	0	0	0												37.0698	2.714697103	13.05090285	0	4.917327013	2.709482154	1.718538884	2.393973609	9.445005927	3.203759906	18.87548502	0	0.133364593	12.46486136	1.843017431	13.12696055	2.603595825	1.018575377	0	0	2.796217736	2.278150852	0	0	0.482334881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.846	0	0	37.0698	2.714697103	13.05090285	0	4.917327013	2.709482154	1.718538884	2.393973609	9.445005927	3.203759906	18.87548502	0	0.133364593	12.46486136	1.843017431	13.12696055	2.603595825	1.018575377	0	0	2.796217736	2.278150852	0	0	0.482334881	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.846	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.3739	0.1999	1.3831	0.1756	0.3139	0.2594	0.3851	0.1528	0.9043	0.2045	1.7897	0	0.0085	1.2067	2.3859	8.0724	0.624	0.4011	0	0	0.8897	0.5226	0	0	0.0798	0	0.004	0.003	0	0											27.3399	0	0	44.4437	2.914627771	14.43399842	0.175611054	5.23119895	2.968900658	2.10360192	2.546780435	10.34931501	3.408255219	20.66519995	0	0.141877226	13.67153602	4.228945254	21.19935188	3.22759813	1.419658496	0	0	3.685923379	2.800790638	0	0	0.562153577	0	0.003953792	0.002965011	0	0	0	0	0	0	0	0	0	0	0	0	160.1859
H2230_002_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V	V	S	V	V	V	V	V	V	V	V	V											0	0	0	0	0	1.3272	0.4735	0	0	7.9215	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											9.7222	NO	840.4760376	46.64631853	1009.15903	1344.155748	186.3638926	6.598765411	1.247176118	219.6050675	371.5801727	17.76276795	23.37382274	77.62713981	0.720070405	1716.646955	2260.513136	6118.986527	667.3910162	667.7632002	1538.273446	156.0955972	302.8927194	0.046146271	0	292.5096658	64.31180135	103.6504398	3.535800111	6.557180707	64.35637873	307.085893												"(1a) $100 days 1-5, $0 days 6+ ($500 annual max.)"	"(1b) $100 days 1-5, $0 days 6+ ($500 annual max.)"	"(2) $20/day, days 1-20 , $0 days 21-100 ($400 CY max.)"	(6) $0	(10a) $100 /day	(11a) 10% after ded.	(11b) (11c) 10% after ded.	(4a) (4b) $0-$50 /visit	(9a) (9b) $100 /visit	(8a) 10% after ded.*	"(8b) $0 copay; 10% PET, CT, MRI, Nuclear Cardiology, waived if same day ER/outpatient surgery"	(5) $0 copay	(12) $0 copay	"(3) (9c) (9d) $0-$100 /visit; cardiac rehab, $10 /visit, in 2009: $15 /visit"	"(7a) (14b) (14c) (14d) $0-$15 /POC visit, $0-$25 /non-POC visit"	(7d) (14e) (14f) (14g) (14h)$0-$25 /visit	"(7e) (7h) $25 /visit, all visits"	(7c) (7i) $10 /visit	(7d) $0 copay	(7b) (7f) (7g) (14i) (14j) $0-$25 /visit	(15) $0 copay	(13a) $0 copay	(10b) $0 copay	$25 /visit every 6 mos.	$25 /exam /12 mos.	All costs after $150 for routine eyewear every 24 mos.	$25 /exam /12 mos.	All costs after $400 every 36 mos.	(14a) $0 copay	(13b) (13c) (13d) (13e) $0-$100 /visit											46.94770248	28.05499256	12.18450411	0	30.05587168	0.1	0.1	44.5295495	85.14714051	0.1	0.034450299	0	0	16.37403565	10.62116279	19.66580213	23.29308352	10.68208073	0	4.181904987	0	0	0	25	25	0	24.2438955	0	0	40											NO	46.80786528	27.97142869	12.14821166	0	29.96634804	0.099702143	0.099702143	44.39691494	84.89352345	0.099702143	0.034347686	0	0	16.32526437	10.58952687	19.60722608	23.22370335	10.65026336	0	4.169448874	0	0	0	24.92553565	24.92553565	0	24.17168326	0	0	39.88085704												3.2784	0.108730348	1.021623125	0	0.465387106	0.65791105	0.124346131	0.812482292	2.628729175	1.770986023	0.802836733	0	0	2.335392948	1.994813717	9.998029352	1.291607582	0.592654495	0	0.054236051	0	0	0	0.607580009	0.133583841	0	0.007122187	0	0	1.020570716	0	0	0	0	0	0	0	0	0	0	29.707	250	0.087857391	3.2784	0.108730348	1.021623125	0	0.465387106	1.985088356	0.597828232	0.812482292	2.628729175	9.69250248	0.802836733	0	0	2.335392948	1.994813717	9.998029352	1.291607582	0.592654495	0	0.054236051	0	0	0	0.607580009	0.133583841	0	0.007122187	0	0	1.020570716	0	0	0	0	0	0	0	0	0	0	39.4292	YES	20%  /stay after ded.	20%  /stay after ded.	20%  /stay after ded. /benefit period	20%  /stay after ded.	$100 /day	20% after ded.	20% after ded.	$0-$50 /visit	20% after ded.	20% after ded.	20% after ded.	20% after ded.	0-20% after ded.	0-20% after ded.	$0-$40 /visit	$0-$40 /visit	20% after ded.	20% /visit after ded.	20% after ded.	20% after ded.	$0 copay	$0 copay	$0 Copay	$40 /covered visit every 6 mos.	$40 /exam /12 mos.	All costs after $150 every 24 mos.	$40 /exam /12 mos.	All costs after $400 every 36 mos.	$0 copay	$0-$40 /visit											3400	1.1604	0.0263	0.2894	0.0984	0.0149	0.0644	0.0122	0.026	0.2342	0.1733	0.1653	0.086	0.0007	0.1632	0.1701	0.5116	0.0361	0.0247	0.0843	0	0	0	0	0.031	0.0068	0	0.0004	0	0	0.013											3.3925	250	2.207531889	4.4388	0.135047718	1.311050755	0.098401246	0.480269884	2.049453412	0.60999332	0.838464949	2.862959062	9.865762398	0.968090126	0.085996967	0.000660336	2.49863862	2.164927983	10.50959815	1.327674187	0.617347542	0.084250694	0.054236051	0	0	0	0.638575434	0.140398562	0	0.007485522	0	0	1.033586708	0	0	0	0	0	0	0	0	0	0	42.8217
H2230_801_0	2010	8	N/A																															Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	V	S	V	V	V	V	V	V	V	V	Coin											4.165	0.0689	1.3253	0.3253	0	0.1765	0.0269	0	0.5108	0.4514	0.4304	0.369	0.004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0744											7.9278	NO	114.2482759	1.890609596	36.35400419	8.922056948	192.5130091	4.842803183	0.736676634	152.0889118	14.01108768	12.38277905	11.80699576	10.12098873	0.11033154	980.456999	2567.042881	3688.679186	190.8372908	437.3628956	1126.411514	66.71426519	447.5006792	0.071116738	0	234.1360269	125.3146538	84.25555504	1.668457068	7.360582356	25.08413644	3.280198662												(1a) 10% /stay after ded.	(1b) 10% /stay after ded.	(2) 10% /stay after ded. /benefit period	(6) 10% after ded.	(10a) $100 /day	(11a) 10% after ded.	(11b) (11c) 10% after ded.	(4a) (4b) $0 - $50 /visit	(9a) (9b) 10% after ded.	(8a) 10% after ded.*	(8b) 10% after ded. for all radiology services	(5) 10% after ded.	(12) 10% after ded.	"(3) (9c) (9d) $0-$100 /visit; cardiac rehab, $10 /visit"	"(7a) (14b) (14c) (14d) Direct-Pay Plan: $0-$15 /POC visit, $0-$25 /non-POC visit, EGWP Plans: $0-$25 /visit, all visits"	(7d) (14e) (14f) (14g) (14h)$0-$25 /visit	(7e) (7h) $25 /visit	(7c) (7i) $10 /visit	(7d) $25 /visit	(7b) (7f) (7g) (14i) (14j) $0-$25 /visit	(15) $0 copay	(13a) $0 copay	(10b) 0	(16a) $25 /visit every 6 mos.	$25 /exam /12 mos.	All costs after $150 for routine eyewear every 24 mos.	$25 /exam /12 mos.	All costs after $400 every 36 mos.	(14a) 0	(13b) (13c) (13d) (13e) 0-10% /visit											0.1	0.1	0.1	0.1	29.49890402	0.1	0.1	45.20265451	0.1	0.1	0.1	0.1	0.1	19.8692524	11.87924407	20.99448316	26.49872379	9.877558093	0	3.463693319	0	0	0	25	25	0	24.2438955	0	0	0.1											NO	0.1	0.1	0.1	0.1	23.26132235	0.1	0.1	35.64449435	0.1	0.1	0.1	0.1	0.1	15.66787311	9.36736244	16.55517236	20.89553414	7.788935572	0	2.731290856	0	0	0	19.71371745	19.71371745	0	19.11749223	0	0	0.07885487												11.4248	0.18906096	3.635400419	0.892205695	0.373175597	0.484280318	0.073667663	0.45176103	1.401108768	1.238277905	1.180699576	1.012098873	0.011033154	1.280139654	2.003868422	5.08889331	0.332303927	0.283882618	0	0.015184672	0	0	0	0.384640957	0.20586814	0	0.00265806	0	0	0.258659638	0	0	0	0	0	0	0	0	0	0	32.2237	250	8.412445311	15.5898	0.257984017	4.960702658	1.217463457	0.373175597	0.660826975	0.100523555	0.45176103	1.911889527	1.689697911	1.611129133	1.381064255	0.015055342	1.280139654	2.003868422	5.08889331	0.332303927	0.283882618	0	0.015184672	0	0	0	0.384640957	0.20586814	0	0.00265806	0	0	0.333016297	0	0	0	0	0	0	0	0	0	0	40.1515	YES	(1a) 30%  /stay after ded.	(1b) 30%  /stay after ded.	(2) 30%  /stay after ded. /benefit period	(6) 30%  /stay after ded.	(10a) $100 /day	(11a) 30% after ded.	(11b) (11c) 30% after ded.	(4a) (4b) $0-$50 /visit	(9a) (9b) 30% after ded.	(8a) 30% after ded.	(8b) 30% after ded.	(5) 30% after ded.	(12) 0-20% after ded.	(3) (9c) (9d) 20% after ded.	(7a) (14b) (14c) (14d) 20% after ded.	(7d) (14e) (14f) (14g) (14h) 20% after ded.	(7e) (7h) 20% after ded.	(7c) (7i) 20% after ded.	(7d) 20% after ded.	(7b) (7f) (7g) (14i) (14j) 20% after ded.	(15) $0 copay	(13a) $0 copay	(10b) 0	(16a) 20% after ded.	20% after ded.	All costs after $150 every 24 mos.	20% after ded.	All costs after $400 every 36 mos.	(14a) 0	(13b) (13c) (13d) (13e) 30% after ded.											3400	1.1907	0.0197	0.3789	0.093	0.0122	0.0505	0.0077	0.0147	0.146	0.1291	0.1231	0.1055	0.0009	0.1	0.1219	0.309	0.0104	0.0132	0.0484	0.0036	0	0	0	0.02	0.0004	0	0.0002	0	0	0.0341											2.9331	250	3.015553032	16.7805	0.277688794	5.339600316	1.310453117	0.385339697	0.711300831	0.108201528	0.466486715	2.057919336	1.818756761	1.734186913	1.486549717	0.015954934	1.380153557	2.125798206	5.397923677	0.342675186	0.297102671	0.048422196	0.01874222	0	0	0	0.404608779	0.206292305	0	0.002904555	0	0	0.367069214	0	0	0	0	0	0	0	0	0	0	43.0847
H2230_809_0	2010	7	N/A																															Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	V	S	V	V	V	V	V	V	V	V	Coin											4.165	0.0689	1.3253	0.3253	0	0.1765	0.0269	0	0.5108	0.4514	0.4304	0.369	0.004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0744											7.9278	NO	114.2482759	1.890609596	36.35400419	8.922056948	192.5130091	4.842803183	0.736676634	152.0889118	14.01108768	12.38277905	11.80699576	10.12098873	0.11033154	980.456999	2567.042881	3688.679186	190.8372908	437.3628956	1126.411514	66.71426519	447.5006792	0.071116738	0	234.1360269	125.3146538	84.25555504	1.668457068	7.360582356	25.08413644	3.280198662												(1a) 10% /stay after ded.	(1b) 10% /stay after ded.	(2) 10% /stay after ded. /benefit period	(6) 10% after ded.	(10a) $100 /day	(11a) 10% after ded.	(11b) (11c) 10% after ded.	(4a) (4b) $0 - $50 /visit	(9a) (9b) 10% after ded.	(8a) 10% after ded.*	(8b) 10% after ded. for all radiology services	(5) 10% after ded.	(12) 10% after ded.	"(3) (9c) (9d) $0-$100 /visit; cardiac rehab, $10 /visit"	"(7a) (14b) (14c) (14d) Direct-Pay Plan: $0-$15 /POC visit, $0-$25 /non-POC visit, EGWP Plans: $0-$25 /visit, all visits"	(7d) (14e) (14f) (14g) (14h)$0-$25 /visit	(7e) (7h) $25 /visit	(7c) (7i) $10 /visit	(7d) $25 /visit	(7b) (7f) (7g) (14i) (14j) $0-$25 /visit	(15) $0 copay	(13a) $0 copay	(10b) 0	(16a) $25 /visit every 6 mos.	$25 /exam /12 mos.	All costs after $150 for routine eyewear every 24 mos.	$25 /exam /12 mos.	All costs after $400 every 36 mos.	(14a) 0	(13b) (13c) (13d) (13e) 0-10% /visit											0.1	0.1	0.1	0.1	29.49890402	0.1	0.1	45.20265451	0.1	0.1	0.1	0.1	0.1	19.8692524	11.87924407	20.99448316	26.49872379	9.877558093	0	3.463693319	0	0	0	25	25	0	24.2438955	0	0	0.1											NO	0.1	0.1	0.1	0.1	23.26132235	0.1	0.1	35.64449435	0.1	0.1	0.1	0.1	0.1	15.66787311	9.36736244	16.55517236	20.89553414	7.788935572	0	2.731290856	0	0	0	19.71371745	19.71371745	0	19.11749223	0	0	0.07885487												11.4248	0.18906096	3.635400419	0.892205695	0.373175597	0.484280318	0.073667663	0.45176103	1.401108768	1.238277905	1.180699576	1.012098873	0.011033154	1.280139654	2.003868422	5.08889331	0.332303927	0.283882618	0	0.015184672	0	0	0	0.384640957	0.20586814	0	0.00265806	0	0	0.258659638	0	0	0	0	0	0	0	0	0	0	32.2237	250	8.412445311	15.5898	0.257984017	4.960702658	1.217463457	0.373175597	0.660826975	0.100523555	0.45176103	1.911889527	1.689697911	1.611129133	1.381064255	0.015055342	1.280139654	2.003868422	5.08889331	0.332303927	0.283882618	0	0.015184672	0	0	0	0.384640957	0.20586814	0	0.00265806	0	0	0.333016297	0	0	0	0	0	0	0	0	0	0	40.1515	YES	(1a) 30%  /stay after ded.	(1b) 30%  /stay after ded.	(2) 30%  /stay after ded. /benefit period	(6) 30%  /stay after ded.	(10a) $100 /day	(11a) 30% after ded.	(11b) (11c) 30% after ded.	(4a) (4b) $0-$50 /visit	(9a) (9b) 30% after ded.	(8a) 30% after ded.	(8b) 30% after ded.	(5) 30% after ded.	(12) 0-20% after ded.	(3) (9c) (9d) 20% after ded.	(7a) (14b) (14c) (14d) 20% after ded.	(7d) (14e) (14f) (14g) (14h) 20% after ded.	(7e) (7h) 20% after ded.	(7c) (7i) 20% after ded.	(7d) 20% after ded.	(7b) (7f) (7g) (14i) (14j) 20% after ded.	(15) $0 copay	(13a) $0 copay	(10b) 0	(16a) 20% after ded.	20% after ded.	All costs after $150 every 24 mos.	20% after ded.	All costs after $400 every 36 mos.	(14a) 0	(13b) (13c) (13d) (13e) 30% after ded.											3400	1.1907	0.0197	0.3789	0.093	0.0122	0.0505	0.0077	0.0147	0.146	0.1291	0.1231	0.1055	0.0009	0.1	0.1219	0.309	0.0104	0.0132	0.0484	0.0036	0	0	0	0.02	0.0004	0	0.0002	0	0	0.0341											2.9331	250	3.015553032	16.7805	0.277688794	5.339600316	1.310453117	0.385339697	0.711300831	0.108201528	0.466486715	2.057919336	1.818756761	1.734186913	1.486549717	0.015954934	1.380153557	2.125798206	5.397923677	0.342675186	0.297102671	0.048422196	0.01874222	0	0	0	0.404608779	0.206292305	0	0.002904555	0	0	0.367069214	0	0	0	0	0	0	0	0	0	0	43.0847
H2237_001_0	2010	7	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	395.1390779	38.17238675	35.42308966	9.496105226	19.58176901	19.0468713	10.92535074	19.38007927	2.461382009	13.23128797	8.34211667	0	1.107535212	67.04647532	102.2863347	69.10962796	13.44275192	5.682832108	16.40205825	5.093685595	109.0711302	0	0	0	0	0	0	0	0	0												Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	13C: Prepaid Wellness Benefit Card and Health Buddy: 0% Cost Share											0.075441967	0.075441967	0.153986331	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075441967	0.075441967	0.153986331	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												29.8101	2.879799933	5.454671612	0	4.562552178	4.437921013	2.545606723	4.515558471	0.573502008	3.082890098	1.943713184	0	0.258055704	15.62182875	23.83271599	16.10254332	3.132161196	1.324099881	3.821679572	1.186828744	25.41357333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.4998	0	0	29.8101	2.879799933	5.454671612	0	4.562552178	4.437921013	2.545606723	4.515558471	0.573502008	3.082890098	1.943713184	0	0.258055704	15.62182875	23.83271599	16.10254332	3.132161196	1.324099881	3.821679572	1.186828744	25.41357333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.4998	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.8101	2.879799933	5.454671612	0	4.562552178	4.437921013	2.545606723	4.515558471	0.573502008	3.082890098	1.943713184	0	0.258055704	15.62182875	23.83271599	16.10254332	3.132161196	1.324099881	3.821679572	1.186828744	25.41357333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.4998
H2237_007_0	2010	6	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	647.15	49.51	230.8	61.5	34.6	36.96	34.8	32.24	56.05	15.42	39.59	2.75	4.87	112.42	88.58	172.47	10.43	8.68	37.43	48.87	21.78	6.63	0	0	0	0	0	0	0	0												Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	13C: Prepaid Wellness Benefit Card and Health Buddy: 0% Cost Share											0.075393538	0.075393538	0.153993856	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075393538	0.075393538	0.153993856	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												48.7909	3.732734051	35.54178187	0	8.0618	8.61168	8.1084	7.51192	13.05965	3.59286	9.22447	0.64075	1.13471	26.19386	20.63914	40.18551	2.43019	2.02244	8.72119	11.38671	5.07474	1.54479	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	266.2103	0	0	48.7909	3.732734051	35.54178187	0	8.0618	8.61168	8.1084	7.51192	13.05965	3.59286	9.22447	0.64075	1.13471	26.19386	20.63914	40.18551	2.43019	2.02244	8.72119	11.38671	5.07474	1.54479	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	266.2103	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	48.7909	3.732734051	35.54178187	0	8.0618	8.61168	8.1084	7.51192	13.05965	3.59286	9.22447	0.64075	1.13471	26.19386	20.63914	40.18551	2.43019	2.02244	8.72119	11.38671	5.07474	1.54479	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	266.2103
H2241_001_0	2010	6	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T		P	P	P	P																																																					0	YES			788.7807686		130.5495334	6.939368989	6.676367723	186.8909768													39.25737511																				2950			"$0 Days 1-20, $50 Days 21-100"		50	20% for items over $500	20% for items over $500	"$50 ER, $25 UC"													0.2					$150 every 2 years		$400 every 2 years															15.5		50	0.02	0.02	45													0.2																				NO			15.37589114		49.59964885	0.01983986	0.01983986	44.63968397													0.198398595																					0	0	1.010683936	0	0.539600918	0.137676106	0.132458198	0.695229512	0	0	0	0	0	0	0	0	0	0	0	0	7.78860808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.3043	0	0.083172384	0	0	1.010683936	0	0.539600918	0.137676106	0.132458198	0.695229512	0	0	0	0	0	0	0	0	0	0	0	0	7.78860808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.3043	NO																																																																																		0	0	0	0	0	1.010683936	0	0.539600918	0.137676106	0.132458198	0.695229512	0	0	0	0	0	0	0	0	0	0	0	0	7.78860808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.3043
H2256_001_1	2010	6	N/A																															DED				T			V	V					V	V	V	V	V		V					V		V																																																						0	YES	261.1901441				573.9448444			328.7896713	426.9554911					4.497744567	3929.710718	4801.175784	284.9720795	1979.922755		44.2008477					195.6673737		39.36069086														3400	$300 deductible	No cost sharing	No cost sharing	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$50 per day	No cost sharing	No cost sharing	No cost sharing	No cost sharing	"$15 per visit, No copay for Cardiac Rehab (9d)"	"$10 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, includes 9c"	$15 per visit	No cost sharing	"$15 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$15 per visit	No cost sharing	$15 per visit	No cost sharing	No cost sharing	No cost sharing											300				50			50	50					15	10	15	15	15		15					15		15														NO	300				50			50	50					15	10	15	15	15		15					15		15															6.5298	0	0	0	2.391436852	0	0	1.369956964	1.778981213	0	0	0	0	0.005622181	3.274758932	6.00146973	0.356215099	2.474903444	0	0.05525106	0	0	0	0	0.244584217	0	0.049200864	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5321		0	6.5298	0	0	0	2.391436852	0	0	1.369956964	1.778981213	0	0	0	0	0.005622181	3.274758932	6.00146973	0.356215099	2.474903444	0	0.05525106	0	0	0	0	0.244584217	0	0.049200864	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5321	NO																																																																																		0			6.5298	0	0	0	2.391436852	0	0	1.369956964	1.778981213	0	0	0	0	0.005622181	3.274758932	6.00146973	0.356215099	2.474903444	0	0.05525106	0	0	0	0	0.244584217	0	0.049200864	0	0	0	0	0	0	0	0	0	0	0	0	0	24.5321
H2256_001_2	2010	6	N/A																															DED				T			V	V					V	V	V	V	V		V					V		V																																																						0	YES	244.2373608				574.0166044			271.9532695	411.6362745					5.717251393	4215.054245	4567.822952	270.513201	1979.92278		27.06226358					220.7119241		48.60461608														3400	$300 deductible	No cost sharing	No cost sharing	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$50 per day	No cost sharing	No cost sharing	No cost sharing	No cost sharing	"$15 per visit, No copay for Cardiac Rehab (9d)"	"$10 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, includes 9c"	$15 per visit	No cost sharing	"$15 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$15 per visit	No cost sharing	$15 per visit	No cost sharing	No cost sharing	No cost sharing											300				50			50	50					15	10	15	15	15		15					15		15														NO	300				50			50	50					15	10	15	15	15		15					15		15															6.1059	0	0	0	2.391735852	0	0	1.133138623	1.715151144	0	0	0	0	0.007146564	3.512545204	5.70977869	0.338141501	2.474903474	0	0.033827829	0	0	0	0	0.275889905	0	0.06075577	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7589		0	6.1059	0	0	0	2.391735852	0	0	1.133138623	1.715151144	0	0	0	0	0.007146564	3.512545204	5.70977869	0.338141501	2.474903474	0	0.033827829	0	0	0	0	0.275889905	0	0.06075577	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7589	NO																																																																																		0			6.1059	0	0	0	2.391735852	0	0	1.133138623	1.715151144	0	0	0	0	0.007146564	3.512545204	5.70977869	0.338141501	2.474903474	0	0.033827829	0	0	0	0	0.275889905	0	0.06075577	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7589
H2256_015_1	2010	7	N/A																															DED				T			V	V					V	V	V	V	V		V					V		V																																																						0	YES	254.0716187				573.9448444			291.7184822	428.6636536					10.921953	4116.515103	4762.694451	349.8175721	1979.922755		71.7264983					166.4024545		51.40094224														3400	$300 deductible	No cost sharing	No cost sharing	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$50 per day	No cost sharing	No cost sharing	No cost sharing	No cost sharing	"$15 per visit, No copay for Cardiac Rehab (9d)"	"$10 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, includes 9c"	$15 per visit	No cost sharing	"$15 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$15 per visit	No cost sharing	$15 per visit	No cost sharing	No cost sharing	No cost sharing											300				50			50	50					15	10	15	15	15		15					15		15														NO	300				50			50	50					15	10	15	15	15		15					15		15															6.3518	0	0	0	2.391436852	0	0	1.215493676	1.786098557	0	0	0	0	0.013652441	3.430429252	5.953368064	0.437271965	2.474903444	0	0.089658123	0	0	0	0	0.208003068	0	0.064251178	0	0	0	0	0	0	0	0	0	0	0	0	0	24.4164		0	6.3518	0	0	0	2.391436852	0	0	1.215493676	1.786098557	0	0	0	0	0.013652441	3.430429252	5.953368064	0.437271965	2.474903444	0	0.089658123	0	0	0	0	0.208003068	0	0.064251178	0	0	0	0	0	0	0	0	0	0	0	0	0	24.4164	NO																																																																																		0			6.3518	0	0	0	2.391436852	0	0	1.215493676	1.786098557	0	0	0	0	0.013652441	3.430429252	5.953368064	0.437271965	2.474903444	0	0.089658123	0	0	0	0	0.208003068	0	0.064251178	0	0	0	0	0	0	0	0	0	0	0	0	0	24.4164
H2256_015_2	2010	7	N/A																															DED				T			V	V					V	V	V	V	V		V					V		V																																																						0	YES	259.4121926				573.9448444			283.1563086	386.2031872					9.94182133	4169.378845	4531.932687	347.1955784	1979.922755		43.22149267					209.2570321		60.94307457														3400	$300 deductible	No cost sharing	No cost sharing	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$50 per day	No cost sharing	No cost sharing	No cost sharing	No cost sharing	"$15 per visit, No copay for Cardiac Rehab (9d)"	"$10 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, includes 9c"	$15 per visit	No cost sharing	"$15 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$15 per visit	No cost sharing	$15 per visit	No cost sharing	No cost sharing	No cost sharing											300				50			50	50					15	10	15	15	15		15					15		15														NO	300				50			50	50					15	10	15	15	15		15					15		15															6.4853	0	0	0	2.391436852	0	0	1.179817953	1.609179947	0	0	0	0	0.012427277	3.47448237	5.664915859	0.433994473	2.474903444	0	0.054026866	0	0	0	0	0.26157129	0	0.076178843	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1182		0	6.4853	0	0	0	2.391436852	0	0	1.179817953	1.609179947	0	0	0	0	0.012427277	3.47448237	5.664915859	0.433994473	2.474903444	0	0.054026866	0	0	0	0	0.26157129	0	0.076178843	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1182	NO																																																																																		0			6.4853	0	0	0	2.391436852	0	0	1.179817953	1.609179947	0	0	0	0	0.012427277	3.47448237	5.664915859	0.433994473	2.474903444	0	0.054026866	0	0	0	0	0.26157129	0	0.076178843	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1182
H2256_016_1	2010	4	N/A																															DED				T			V	V					V	V	V	V	V		V					V		V																																																						0	YES	240.4483345				573.9448444			270.6648299	415.3771106					5.678801774	3480.891515	4814.661418	130.1491648	1979.929411		30.98049596					181.8384864		32.12471276														3400	$300 deductible	No cost sharing	No cost sharing	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$50 per day	No cost sharing	No cost sharing	No cost sharing	No cost sharing	"$15 per visit, No copay for Cardiac Rehab (9d)"	"$10 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, includes 9c"	$15 per visit	No cost sharing	"$15 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$15 per visit	No cost sharing	$15 per visit	No cost sharing	No cost sharing	No cost sharing											300				50			50	50					15	10	15	15	15		15					15		15														NO	300				50			50	50					15	10	15	15	15		15					15		15															6.0112	0	0	0	2.391436852	0	0	1.127770124	1.730737961	0	0	0	0	0.007098502	2.900742929	6.018326773	0.162686456	2.474911764	0	0.03872562	0	0	0	0	0.227298108	0	0.040155891	0	0	0	0	0	0	0	0	0	0	0	0	0	23.1311		0	6.0112	0	0	0	2.391436852	0	0	1.127770124	1.730737961	0	0	0	0	0.007098502	2.900742929	6.018326773	0.162686456	2.474911764	0	0.03872562	0	0	0	0	0.227298108	0	0.040155891	0	0	0	0	0	0	0	0	0	0	0	0	0	23.1311	NO																																																																																		0			6.0112	0	0	0	2.391436852	0	0	1.127770124	1.730737961	0	0	0	0	0.007098502	2.900742929	6.018326773	0.162686456	2.474911764	0	0.03872562	0	0	0	0	0.227298108	0	0.040155891	0	0	0	0	0	0	0	0	0	0	0	0	0	23.1311
H2256_016_2	2010	4	N/A																															DED				T			V	V					V	V	V	V	V		V					V		V																																																						0	YES	228.4038545				573.9448444			219.1204868	376.9686063					14.46054127	3608.35649	4070.951286	133.9723473	1979.922755		18.16990388					218.7988201		40.05483165														3400	$300 deductible	No cost sharing	No cost sharing	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$50 per day	No cost sharing	No cost sharing	No cost sharing	No cost sharing	"$15 per visit, No copay for Cardiac Rehab (9d)"	"$10 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, includes 9c"	$15 per visit	No cost sharing	"$15 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$15 per visit	No cost sharing	$15 per visit	No cost sharing	No cost sharing	No cost sharing											300				50			50	50					15	10	15	15	15		15					15		15														NO	300				50			50	50					15	10	15	15	15		15					15		15															5.7101	0	0	0	2.391436852	0	0	0.913002028	1.570702526	0	0	0	0	0.018075677	3.006963742	5.088689108	0.167465434	2.474903444	0	0.02271238	0	0	0	0	0.273498525	0	0.05006854	0	0	0	0	0	0	0	0	0	0	0	0	0	21.6876		0	5.7101	0	0	0	2.391436852	0	0	0.913002028	1.570702526	0	0	0	0	0.018075677	3.006963742	5.088689108	0.167465434	2.474903444	0	0.02271238	0	0	0	0	0.273498525	0	0.05006854	0	0	0	0	0	0	0	0	0	0	0	0	0	21.6876	NO																																																																																		0			5.7101	0	0	0	2.391436852	0	0	0.913002028	1.570702526	0	0	0	0	0.018075677	3.006963742	5.088689108	0.167465434	2.474903444	0	0.02271238	0	0	0	0	0.273498525	0	0.05006854	0	0	0	0	0	0	0	0	0	0	0	0	0	21.6876
H2256_017_1	2010	7	N/A																															D	D	D		T			V	V		V			V	V	V	V	V		V					V		V																																																						0	YES	911.4152449		44.06749139		400.4591399			259.4608245	313.4684381		630.1860594			9.029519094	4158.274064	4376.781385	535.2291864	2368.093976		31.53747885					259.4960202		66.85690187														3400	$125 each day for days 1-5	$125 each day for days 1-5	$25/day for days 11-100	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$150 per day	No cost sharing	20% to $50 per day	No cost sharing	No cost sharing	"$20 per visit, No copay for Cardiac Rehab (9d)"	"$15 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, includes 9c"	$20 per visit	No cost sharing	"$20 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$20 per visit	No cost sharing	$20 per visit	No cost sharing	No cost sharing	No cost sharing											125	0	25		50			50	150		50			20	15	20	20	20		20					20		20														NO	124.1852785	0	24.83705569		49.67411138			49.67411138	149.0223341		49.67411138			19.86964455	14.90223341	19.86964455	19.86964455	19.86964455		19.86964455					19.86964455		19.86964455															9.432	0	0.091208895	0	1.657704327	0	0	1.074040491	3.892816527	0	2.608661042	0	0	0.014951111	5.163964225	7.247090868	0.886234474	3.921098797	0	0.052219875	0	0	0	0	0.429674474	0	0.110701906	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5824		0.24	9.432	0	0.091208895	0	1.657704327	0	0	1.074040491	3.892816527	0	2.608661042	0	0	0.014951111	5.163964225	7.247090868	0.886234474	3.921098797	0	0.052219875	0	0	0	0	0.429674474	0	0.110701906	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5824	NO																																																																																		0			9.432	0	0.091208895	0	1.657704327	0	0	1.074040491	3.892816527	0	2.608661042	0	0	0.014951111	5.163964225	7.247090868	0.886234474	3.921098797	0	0.052219875	0	0	0	0	0.429674474	0	0.110701906	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5824
H2256_017_7	2010	7	N/A																															D	D	D		T			V	V		V			V	V	V	V	V		V					V		V																																																						0	YES	851.9820613	0	41.19386017		374.3452893			242.5414423	293.0272316		589.0917679			8.440706181	3887.113945	4091.372454	500.3270113	2213.671099		29.48092693					242.574343		62.4971783														3400	$125 each day for days 1-5	$125 each day for days 1-5	$25/day for days 11-100	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$150 per day	No cost sharing	20% to $50 per day	No cost sharing	No cost sharing	"$20 per visit, No copay for Cardiac Rehab (9d)"	"$15 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, includes 9c"	$20 per visit	No cost sharing	"$20 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$20 per visit	No cost sharing	$20 per visit	No cost sharing	No cost sharing	No cost sharing											125	0	25		50			50	150		50			20	15	20	20	20		20					20		20														NO	124.1284445	0	24.8256889		49.65137781			49.65137781	148.9541334		49.65137781			19.86055112	14.89541334	19.86055112	19.86055112	19.86055112		19.86055112					19.86055112		19.86055112															8.8129	0	0.085222163	0	1.548896616	0	0	1.003543066	3.637301446	0	2.437434827	0	0	0.013969756	4.825014077	6.771409315	0.828064182	3.663727336	0	0.048792288	0	0	0	0	0.401471678	0	0.1034357	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1812		0.24	8.8129	0	0.085222163	0	1.548896616	0	0	1.003543066	3.637301446	0	2.437434827	0	0	0.013969756	4.825014077	6.771409315	0.828064182	3.663727336	0	0.048792288	0	0	0	0	0.401471678	0	0.1034357	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1812	NO																																																																																		0			8.8129	0	0.085222163	0	1.548896616	0	0	1.003543066	3.637301446	0	2.437434827	0	0	0.013969756	4.825014077	6.771409315	0.828064182	3.663727336	0	0.048792288	0	0	0	0	0.401471678	0	0.1034357	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1812
H2256_018_1	2010	6	N/A																															D	D	D		T			V	V		V			V	V	V	V	V		V					V		V																																																						0	YES	722.3966555		34.92832557		317.407839			205.6511923	248.4581562		499.4916468			7.156885329	3295.888776	3469.079821	424.2278987	1876.974494		24.99691482					205.6790888		52.99143566														3400	$125 each day for days 1-5	$125 each day for days 1-5	$25/day for days 11-100	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$150 per day	No cost sharing	20% to $50 per day	No cost sharing	No cost sharing	"$20 per visit, No copay for Cardiac Rehab (9d)"	"$15 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, includes 9c"	$20 per visit	No cost sharing	"$20 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$20 per visit	No cost sharing	$20 per visit	No cost sharing	No cost sharing	No cost sharing											125	0	25		50			50	150		50			20	15	20	20	20		20					20		20														NO	123.9721026	0	24.79442052		49.58884104			49.58884104	148.7665231		49.58884104			19.83553642	14.87665231	19.83553642	19.83553642	19.83553642		19.83553642					19.83553642		19.83553642															7.4631	0	0.072168966	0	1.31165724	0	0	0.849833691	3.080188004	0	2.06410099	0	0	0.011830055	4.085982616	5.734254927	0.701232328	3.102566327	0	0.041318935	0	0	0	0	0.339979588	0	0.087592796	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9458		0.24	7.4631	0	0.072168966	0	1.31165724	0	0	0.849833691	3.080188004	0	2.06410099	0	0	0.011830055	4.085982616	5.734254927	0.701232328	3.102566327	0	0.041318935	0	0	0	0	0.339979588	0	0.087592796	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9458	NO																																																																																		0			7.4631	0	0.072168966	0	1.31165724	0	0	0.849833691	3.080188004	0	2.06410099	0	0	0.011830055	4.085982616	5.734254927	0.701232328	3.102566327	0	0.041318935	0	0	0	0	0.339979588	0	0.087592796	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9458
H2256_018_7	2010	6	N/A																															D	D	D		T			V	V		V			V	V	V	V	V		V					V		V																																																						0	YES	676.472972	0	32.70788704		297.2298149			192.5776818	232.663352		467.7383212			6.701912934	3086.364893	3248.54596	397.2591861	1757.652814		23.40782883					192.6038049		49.62270201														3400	$125 each day for days 1-5	$125 each day for days 1-5	$25/day for days 11-100	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$150 per day	No cost sharing	20% to $50 per day	No cost sharing	No cost sharing	"$20 per visit, No copay for Cardiac Rehab (9d)"	"$15 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, includes 9c"	$20 per visit	No cost sharing	"$20 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$20 per visit	No cost sharing	$20 per visit	No cost sharing	No cost sharing	No cost sharing											125	0	25		50			50	150		50			20	15	20	20	20		20					20		20														NO	123.9023218	0	24.78046436		49.56092872			49.56092872	148.6827862		49.56092872			19.82437149	14.86827862	19.82437149	19.82437149	19.82437149		19.82437149					19.82437149		19.82437149															6.9847	0	0.067543052	0	1.227582139	0	0	0.79536073	2.882752951	0	1.931795466	0	0	0.011071768	3.824077761	5.366698492	0.656284474	2.90369686	0	0.038670458	0	0	0	0	0.318187448	0	0.08197824	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0904		0.24	6.9847	0	0.067543052	0	1.227582139	0	0	0.79536073	2.882752951	0	1.931795466	0	0	0.011071768	3.824077761	5.366698492	0.656284474	2.90369686	0	0.038670458	0	0	0	0	0.318187448	0	0.08197824	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0904	NO																																																																																		0			6.9847	0	0.067543052	0	1.227582139	0	0	0.79536073	2.882752951	0	1.931795466	0	0	0.011071768	3.824077761	5.366698492	0.656284474	2.90369686	0	0.038670458	0	0	0	0	0.318187448	0	0.08197824	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0904
H2256_019_1	2010	4	N/A																															D	D	D		T			V	V		V			V	V	V	V	V		V					V		V																																																						0	YES	844.9456435	0	40.85364501		371.2536163			240.5383216	290.6071548		584.2265295			8.370995399	3855.010737	4057.582298	496.1948704	2195.388654		29.23744749					240.5709505		61.98102159														3400	$125 each day for days 1-5	$125 each day for days 1-5	$25/day for days 11-100	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$150 per day	No cost sharing	20% to $50 per day	No cost sharing	No cost sharing	"$20 per visit, No copay for Cardiac Rehab (9d)"	"$15 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, includes 9c"	$20 per visit	No cost sharing	"$20 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$20 per visit	No cost sharing	$20 per visit	No cost sharing	No cost sharing	No cost sharing											125	0	25		50			50	150		50			20	15	20	20	20		20					20		20														NO	124.1211865	0	24.8242373		49.6484746			49.6484746	148.9454238		49.6484746			19.85938984	14.89454238	19.85938984	19.85938984	19.85938984		19.85938984					19.85938984		19.85938984															8.7396	0	0.084513382	0	1.536014645	0	0	0.995196729	3.607050486	0	2.417163001	0	0	0.013853572	4.784885066	6.715092389	0.821177281	3.633256595	0	0.048386489	0	0	0	0	0.398132691	0	0.102575439	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8969		0.24	8.7396	0	0.084513382	0	1.536014645	0	0	0.995196729	3.607050486	0	2.417163001	0	0	0.013853572	4.784885066	6.715092389	0.821177281	3.633256595	0	0.048386489	0	0	0	0	0.398132691	0	0.102575439	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8969	NO																																																																																		0			8.7396	0	0.084513382	0	1.536014645	0	0	0.995196729	3.607050486	0	2.417163001	0	0	0.013853572	4.784885066	6.715092389	0.821177281	3.633256595	0	0.048386489	0	0	0	0	0.398132691	0	0.102575439	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8969
H2256_019_7	2010	4	N/A																															D	D	D		T			V	V		V			V	V	V	V	V		V					V		V																																																						0	YES	698.1253525	0	33.75479304		306.7434737			198.7416609	240.1103834		482.7095743			6.916426115	3185.152501	3352.52462	409.9745605	1813.911333		24.15706086					198.7686201		51.21101325														3400	$125 each day for days 1-5	$125 each day for days 1-5	$25/day for days 11-100	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$150 per day	No cost sharing	20% to $50 per day	No cost sharing	No cost sharing	"$20 per visit, No copay for Cardiac Rehab (9d)"	"$15 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$20 per visit, includes 9c"	$20 per visit	No cost sharing	"$20 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$20 per visit	No cost sharing	$20 per visit	No cost sharing	No cost sharing	No cost sharing											125	0	25		50			50	150		50			20	15	20	20	20		20					20		20														NO	123.9363663	0	24.78727326		49.57454653			49.57454653	148.7236396		49.57454653			19.82981861	14.87236396	19.82981861	19.82981861	19.82981861		19.82981861					19.82981861		19.82981861															7.2103	0	0.069724107	0	1.267222384	0	0	0.821043976	2.975840843	0	1.994175687	0	0	0.01142929	3.947562271	5.539996259	0.677476764	2.997461059	0	0.039919178	0	0	0	0	0.32846214	0	0.084625425	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9652		0.24	7.2103	0	0.069724107	0	1.267222384	0	0	0.821043976	2.975840843	0	1.994175687	0	0	0.01142929	3.947562271	5.539996259	0.677476764	2.997461059	0	0.039919178	0	0	0	0	0.32846214	0	0.084625425	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9652	NO																																																																																		0			7.2103	0	0.069724107	0	1.267222384	0	0	0.821043976	2.975840843	0	1.994175687	0	0	0.01142929	3.947562271	5.539996259	0.677476764	2.997461059	0	0.039919178	0	0	0	0	0.32846214	0	0.084625425	0	0	0	0	0	0	0	0	0	0	0	0	0	27.9652
H2256_023_0	2010	6	N/A																															D	D	D		T	O	O	V	V		V			V	V	V	V	V		V					V		V																																																						0	YES	774.9252942	0	57.15569464		307.4728209	219.6138116	0	207.3563577	290.8296651		546.2459125			1.458896735	2941.106165	3189.706642	296.4098695	795.7021617		3.569371754					168.9864293		43.35750374														3400	$200 each day for days 1-10	$200 each day for days 1-10	$100/day for days 11-100	No cost sharing	$150/day	20% up to $50/item	20% up to $50/item	4a $50 per visit	$150 per day	No cost sharing	$0-$50/visit	No cost sharing	No cost sharing	"$30 per visit, No copay for Cardiac Rehab (9d)"	"$20 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$30 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$30 per visit, includes 9c"	$30 per visit	No cost sharing	"$30 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$30 per visit	No cost sharing	$30 per visit	No cost sharing	No cost sharing	No cost sharing											200	0	100		150	50	50	50	150		50			30	20	30	30	30		30					30		30														NO	196.7089396	0	98.35446978		147.5317047	49.17723489	49.17723489	49.17723489	147.5317047		49.17723489			29.50634093	19.67089396	29.50634093	29.50634093	29.50634093		29.50634093					29.50634093		29.50634093															12.7029	0	0.468459837	0	3.780165784	0.9	0	0.849767692	3.575549688	0	2.238571962	0	0	0.003587225	4.821182289	7.843047638	0.728830889	1.956521605	0	0.008776592	0	0	0	0	0.415514266	0	0.106610107	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3995		0.7	12.7029	0	0.468459837	0	3.780165784	0.9	0	0.849767692	3.575549688	0	2.238571962	0	0	0.003587225	4.821182289	7.843047638	0.728830889	1.956521605	0	0.008776592	0	0	0	0	0.415514266	0	0.106610107	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3995	NO																																																																																		0			12.7029	0	0.468459837	0	3.780165784	0.9	0	0.849767692	3.575549688	0	2.238571962	0	0	0.003587225	4.821182289	7.843047638	0.728830889	1.956521605	0	0.008776592	0	0	0	0	0.415514266	0	0.106610107	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3995
H2256_024_0	2010	6	N/A																															D	D	D		T	O	O	V	V		V			V	V	V	V	V		V					V		V																																																						0	YES	698.2342048	0	51.4992365		277.0435321	571.9810269	0	186.8351732	262.0474792		492.1862575			1.314515875	2650.037287	2874.034823	267.0754343	716.9548733		3.21612608					152.2625548		39.06659439														3400	$200 each day for days 1-10	$200 each day for days 1-10	$100/day for days 11-100	No cost sharing	$150/day	20% up to $50/item	20% up to $50/item	4a $50 per visit	$150 per day	No cost sharing	$0-$50/visit	No cost sharing	No cost sharing	"$30 per visit, No copay for Cardiac Rehab (9d)"	"$20 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$30 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$30 per visit, includes 9c"	$30 per visit	No cost sharing	"$30 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$30 per visit	No cost sharing	$30 per visit	No cost sharing	No cost sharing	No cost sharing											200	0	100		150	50	50	50	150		50			30	20	30	30	30		30					30		30														NO	196.3701499	0	98.18507496		147.2776124	49.09253748	49.09253748	49.09253748	147.2776124		49.09253748			29.45552249	19.63701499	29.45552249	29.45552249	29.45552249		29.45552249					29.45552249		29.45552249															11.426	0	0.421371366	0	3.400192496	2.34	0	0.764351062	3.216143924	0	2.013556024	0	0	0.003226646	4.336568494	7.054683114	0.655570539	1.7598567	0	0.00789439	0	0	0	0	0.373747759	0	0.095893912	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8691		0.7	11.426	0	0.421371366	0	3.400192496	2.34	0	0.764351062	3.216143924	0	2.013556024	0	0	0.003226646	4.336568494	7.054683114	0.655570539	1.7598567	0	0.00789439	0	0	0	0	0.373747759	0	0.095893912	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8691	NO																																																																																		0			11.426	0	0.421371366	0	3.400192496	2.34	0	0.764351062	3.216143924	0	2.013556024	0	0	0.003226646	4.336568494	7.054683114	0.655570539	1.7598567	0	0.00789439	0	0	0	0	0.373747759	0	0.095893912	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8691
H2256_025_0	2010	4	N/A																															D	D	D		T	O	O	V	V		V			V	V	V	V	V		V					V		V																																																						0	YES	653.8073675	0	48.22247322		259.4159684	572.6521743	0	174.9473341	245.3740756		460.8697184			1.230876628	2481.422265	2691.167418	250.0821149	671.3368883	0	3.011492292					142.5744821		36.58088799														3400	$200 each day for days 1-10	$200 each day for days 1-10	$100/day for days 11-100	No cost sharing	$150/day	20% up to $50/item	20% up to $50/item	4a $50 per visit	$150 per day	No cost sharing	$0-$50/visit	No cost sharing	No cost sharing	"$30 per visit, No copay for Cardiac Rehab (9d)"	"$20 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$30 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$30 per visit, includes 9c"	$30 per visit	No cost sharing	"$30 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$30 per visit	No cost sharing	$30 per visit	No cost sharing	No cost sharing	No cost sharing											200	0	100		150	50	50	50	150		50			30	20	30	30	30	0	30					30		30														NO	196.1400044	0	98.07000221		147.1050033	49.0350011	49.0350011	49.0350011	147.1050033		49.0350011			29.42100066	19.61400044	29.42100066	29.42100066	29.42100066	0	29.42100066					29.42100066		29.42100066															10.6865	0	0.394098171	0	3.180115574	2.34	0	0.71487856	3.007979517	0	1.883228929	0	0	0.003017802	4.055884784	6.598069865	0.613138839	1.645950253	0	0.007383426	0	0	0	0	0.349556994	0	0.089687194	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5695		0.7	10.6865	0	0.394098171	0	3.180115574	2.34	0	0.71487856	3.007979517	0	1.883228929	0	0	0.003017802	4.055884784	6.598069865	0.613138839	1.645950253	0	0.007383426	0	0	0	0	0.349556994	0	0.089687194	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5695	NO																																																																																		0			10.6865	0	0.394098171	0	3.180115574	2.34	0	0.71487856	3.007979517	0	1.883228929	0	0	0.003017802	4.055884784	6.598069865	0.613138839	1.645950253	0	0.007383426	0	0	0	0	0.349556994	0	0.089687194	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5695
H2256_801_0	2010	4	N/A																															DED				T			V	V					V	V	V	V	V		V					V		V																																																						0	YES	224.5651797				575.9856646			224.6470669	409.2813432					7.67713475	3928.758854	4789.463179	348.6484782	1986.96292		24.53738684					224.8195371		51.36938709														3400	$300 deductible	No cost sharing	No cost sharing	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$50 per day	No cost sharing	No cost sharing	No cost sharing	No cost sharing	"$15 per visit, No copay for Cardiac Rehab (9d)"	"$10 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, includes 9c"	$15 per visit	No cost sharing	"$15 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$15 per visit	No cost sharing	$15 per visit	No cost sharing	No cost sharing	No cost sharing											300				50			50	50					15	10	15	15	15		15					15		15														NO	300				50			50	50					15	10	15	15	15		15					15		15															5.6141	0	0	0	2.399940269	0	0	0.936029445	1.70533893	0	0	0	0	0.009596418	3.273965712	5.986828974	0.435810598	2.48370365	0	0.030671734	0	0	0	0	0.281024421	0	0.064211734	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2213		0	5.6141	0	0	0	2.399940269	0	0	0.936029445	1.70533893	0	0	0	0	0.009596418	3.273965712	5.986828974	0.435810598	2.48370365	0	0.030671734	0	0	0	0	0.281024421	0	0.064211734	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2213	NO																																																																																		0			5.6141	0	0	0	2.399940269	0	0	0.936029445	1.70533893	0	0	0	0	0.009596418	3.273965712	5.986828974	0.435810598	2.48370365	0	0.030671734	0	0	0	0	0.281024421	0	0.064211734	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2213
H2256_802_0	2010	4	N/A																															DED				T			V	V					V	V	V	V	V		V					V		V																																																						0	YES	224.5651797				575.9856646			224.6470669	409.2813432					7.67713475	3928.758854	4789.463179	348.6484782	1986.96292		24.53738684					224.8195371		51.36938709														3400	$300 deductible	No cost sharing	No cost sharing	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$50 per day	No cost sharing	No cost sharing	No cost sharing	No cost sharing	"$15 per visit, No copay for Cardiac Rehab (9d)"	"$10 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, includes 9c"	$15 per visit	No cost sharing	"$15 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$15 per visit	No cost sharing	$15 per visit	No cost sharing	No cost sharing	No cost sharing											300				50			50	50					15	10	15	15	15		15					15		15														NO	300				50			50	50					15	10	15	15	15		15					15		15															5.6141	0	0	0	2.399940269	0	0	0.936029445	1.70533893	0	0	0	0	0.009596418	3.273965712	5.986828974	0.435810598	2.48370365	0	0.030671734	0	0	0	0	0.281024421	0	0.064211734	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2213		0	5.6141	0	0	0	2.399940269	0	0	0.936029445	1.70533893	0	0	0	0	0.009596418	3.273965712	5.986828974	0.435810598	2.48370365	0	0.030671734	0	0	0	0	0.281024421	0	0.064211734	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2213	NO																																																																																		0			5.6141	0	0	0	2.399940269	0	0	0.936029445	1.70533893	0	0	0	0	0.009596418	3.273965712	5.986828974	0.435810598	2.48370365	0	0.030671734	0	0	0	0	0.281024421	0	0.064211734	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2213
H2256_803_0	2010	4	N/A																															DED				T			V	V					V	V	V	V	V		V					V		V																																																						0	YES	198.6251777				509.4523342			198.6976059	362.0043839					6.790332571	3474.939555	4236.222091	308.3753503	1757.444603		21.70302105					198.8501538		45.43559982														3400	$300 deductible	No cost sharing	No cost sharing	No cost sharing	$50 per day	No cost sharing	No cost sharing	4a $50 per visit	$50 per day	No cost sharing	No cost sharing	No cost sharing	No cost sharing	"$15 per visit, No copay for Cardiac Rehab (9d)"	"$10 per visit, No add'l copay for the services provided in 14b, d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, No add'l copay for the services provided in 14d, e, f, i, or j, no cost sharing for 14 g or h, includes 4b"	"$15 per visit, includes 9c"	$15 per visit	No cost sharing	"$15 per visit, includes 4b"	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$15 per visit	No cost sharing	$15 per visit	No cost sharing	No cost sharing	No cost sharing											300				50			50	50					15	10	15	15	15		15					15		15														NO	300				50			50	50					15	10	15	15	15		15					15		15															4.9656	0	0	0	2.122718059	0	0	0.827906691	1.508351599	0	0	0	0	0.008487916	2.895782962	5.295277613	0.385469188	2.196805754	0	0.027128776	0	0	0	0	0.248562692	0	0.0567945	0	0	0	0	0	0	0	0	0	0	0	0	0	20.5389		0	4.9656	0	0	0	2.122718059	0	0	0.827906691	1.508351599	0	0	0	0	0.008487916	2.895782962	5.295277613	0.385469188	2.196805754	0	0.027128776	0	0	0	0	0.248562692	0	0.0567945	0	0	0	0	0	0	0	0	0	0	0	0	0	20.5389	NO																																																																																		0			4.9656	0	0	0	2.122718059	0	0	0.827906691	1.508351599	0	0	0	0	0.008487916	2.895782962	5.295277613	0.385469188	2.196805754	0	0.027128776	0	0	0	0	0.248562692	0	0.0567945	0	0	0	0	0	0	0	0	0	0	0	0	0	20.5389
H2261_005_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V	V	S	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	YES	1790.379911	75.97756835	2564.619556	2476.975879	440.1525365	14.44508067	2.147860793	347.728814	412.4939733	35.08569297	33.4570964	149.8278531	2.537191807	2221.022099	5691.473304	7308.244827	337.6041627	565.6104033	2318.708973	113.0454685	1023.14415	0.162597908	0	346.699389	225.9297929	192.6378713	3.008061295	16.82888346	38.49505468	365.8655299											3400	"(1a) $100 /day, days 1-5, $0 after day 5, unlimited coverage"	"(1b) $100 /day, days 1-5, $0 after day 5, unlimited coverage"	"(2) $20 /day, days 1-20; $0, days 21-100; $400 max. /CY"	(6) $0 copay	(10a) $0-$50 /day	(11a) 10%	(11b) (11c) 10%	(4a) (4b) $0-$50 /visit	(9a) (9b) $0-$100 /visit	(8a) 10%	"(8b) $0 copay; 10% PET, CT, MRI, nuclear cardiology, waived if same day as ER/outpatient surgery visit"	(5) $0 copay	(12) $0 copay	"(3) (9c) (9d) $0-$100 /visit; cardiac rehab, $10 /visit"	"(7a) (14b) (14c) (14d) $15 /visit, $0-$25 /visit"	(7d) (14e) (14f) (14g) (14h) $25 /visit	"(7e) (7h) $25 /visit, all visits"	(7c) (7i) $10 /visit	(7d) $0 copay	(7b) (7f) (7g) (14i) (14j) $0-$25 /visit	(15) $0 copay	(13a) $0 copay	(10b) 0	$25 /visit every 6 mos.	$25 /exam /12 mos.	All costs after $150 for routine eyewear every 24 mos.	$25 /exam /12 mos.	All costs after $400 every 36 mos.	(14a) $0 copay	(13b) (13c) (13d) (13e) $0-$25 /visit											45.76192165	26.09427835	12.7025603	0	14.75433432	0.1	0.1	45.20969353	96.75609306	0.1	0.034657001	0	0	18.76403082	12.13343959	21.83184015	27.95409462	11.07071621	0	3.25249802	0	0	0	25	25	0	24.2438955	0	0	16.58019253											NO	45.62645951	26.01703538	12.66495882	0	14.71065928	0.099703985	0.099703985	45.07586607	96.46968052	0.099703985	0.034554411	0	0	18.70848648	12.09752279	21.76721463	27.87134631	11.03794523	0	3.242870139	0	0	0	24.92599625	24.92599625	0	24.17212994	0	0	16.53111267												6.8074	0.164725924	2.706733422	0	0.539577833	1.440232107	0.21415028	1.306181454	3.316096819	3.498183406	1.156090261	0	0	3.462663492	5.737727333	13.25667781	0.784123545	0.520264721	0	0.030549315	0	0	0	0.720152306	0.469293764	0	0.006059271	0	0	0.504013692	0	0	0	0	0	0	0	0	0	0	46.6409	0	0.133428153	6.8074	0.164725924	2.706733422	0	0.539577833	1.440232107	0.21415028	1.306181454	3.316096819	3.498183406	1.156090261	0	0	3.462663492	5.737727333	13.25667781	0.784123545	0.520264721	0	0.030549315	0	0	0	0.720152306	0.469293764	0	0.006059271	0	0	0.504013692	0	0	0	0	0	0	0	0	0	0	46.6409	NO																																																																																		0			6.8074	0.164725924	2.706733422	0	0.539577833	1.440232107	0.21415028	1.306181454	3.316096819	3.498183406	1.156090261	0	0	3.462663492	5.737727333	13.25667781	0.784123545	0.520264721	0	0.030549315	0	0	0	0.720152306	0.469293764	0	0.006059271	0	0	0.504013692	0	0	0	0	0	0	0	0	0	0	46.6409
H2261_801_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V	V	S	V	T	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	YES	1580.190034	72.41830447	1511.930545	2062.735404	349.0696466	12.25254014	1.913064124	321.0647608	481.3918569	40.26085967	41.39108742	137.7458149	7.595521836	3092.198525	5233.536523	7736.062858	345.0812845	718.4286128	2375.918013	94.80902185	919.9235952	0	0	195.3440235	228.3387914	182.9709855	1.687232449	12.93544877	56.05361135	387.4803502											3400	"1a:  $100 /day, days 1-5, $0 after day 5, unlimited coverage"	"1b : $100 /day, days 1-5, $0 after day 5, unlimited coverage"	"2:  $20 /day, days 1-20; $0, days 21-100; $400 max. /CY"	6:  $0 copay	10a:  $0-$50 /day	11a:  10% Coins	"11b, 11c : 10% Coins"	"4a, 4b:   0-$50/visit"	"9a, 9b:   0-$100/visit"	8a:  10% Coins	"8b:  $0 copay; 10% PET, CT, MRI, Nuclear Cardiology, waived if same day as ER/outpatient surgery visit"	5: $0 copay	$0 copay	"3, 5, 9c, 9d, 12: 0-$100, Cardiac Rehab, $10 /visit"	"7a, 14b, 14c, 14d:  $15 /visit, $0-$25 /visit"	"7b, 7d, 7f, 7g, 14d : $25/visit"	"7e, 7h: $25 /visit, all visits"	"7c, 7i: $10/visit"	7d: $0 copay	"7b, 7d, 7f, 7g, 14d: $0-$25 /visit"	14j: $0 Copay	"13a,14a: $0 Copay"	$0 copay	16a: $25/visit/6months	25/exam/12 mnths	All cost after $150 for routineey eware every 24 mnths	$25/exam/12 mnths	All cost after $400 every 36 mnths	"13b, 13c, 13d, 13d, 13e: $0 copay"	14a: 0-$25/visit											43.68067831	16.3255095	13.99037029	0	14.93411442	0.1	0.1	44.73180882	96.66979353	0.1	0.036314319	0	0	16.04220352	12.01201466	22.22451429	28.26990101	11.07574218	0	5.192519926	0	0	0	25	25	0	24.2438955	0	0	16.65780033											NO	43.55137696	16.27718355	13.94895669	0	14.88990721	0.099703985	0.099703985	44.59939597	96.38363646	0.099703985	0.036206823	0	0	15.9947162	11.9764573	22.15872639	28.18621787	11.04295633	0	5.177149289	0	0	0	24.92599625	24.92599625	0	24.17212994	0	0	16.60849075												5.735	0.098230503	1.757487808	0	0.433134554	1.221627079	0.190740117	1.193274533	3.866524811	4.014168149	1.498639763	0	0	4.121569819	5.22326889	14.28510835	0.810544689	0.661131316	0	0.040903372	0	0	0	0.405762033	0.474297655	0	0.003398667	0	0	0.536288651	0	0	0	0	0	0	0	0	0	0	46.5711		0.134051449	5.735	0.098230503	1.757487808	0	0.433134554	1.221627079	0.190740117	1.193274533	3.866524811	4.014168149	1.498639763	0	0	4.121569819	5.22326889	14.28510835	0.810544689	0.661131316	0	0.040903372	0	0	0	0.405762033	0.474297655	0	0.003398667	0	0	0.536288651	0	0	0	0	0	0	0	0	0	0	46.5711	NO																																																																																		0			5.735	0.098230503	1.757487808	0	0.433134554	1.221627079	0.190740117	1.193274533	3.866524811	4.014168149	1.498639763	0	0	4.121569819	5.22326889	14.28510835	0.810544689	0.661131316	0	0.040903372	0	0	0	0.405762033	0.474297655	0	0.003398667	0	0	0.536288651	0	0	0	0	0	0	0	0	0	0	46.5711
H2261_809_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V	V	S	V	T	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	YES	1580.190034	72.41830447	1511.930545	2062.735404	349.0696466	12.25254014	1.913064124	321.0647608	481.3918569	40.26085967	41.39108742	137.7458149	7.595521836	3092.198525	5233.536523	7736.062858	345.0812845	718.4286128	2375.918013	94.80902185	919.9235952	0	0	195.3440235	228.3387914	182.9709855	1.687232449	12.93544877	56.05361135	387.4803502											3400	"1a:  $100 /day, days 1-5, $0 after day 5, unlimited coverage"	"1b : $100 /day, days 1-5, $0 after day 5, unlimited coverage"	"2:  $20 /day, days 1-20; $0, days 21-100; $400 max. /CY"	6:  $0 copay	10a:  $0-$50 /day	11a:  10% Coins	"11b, 11c : 10% Coins"	"4a, 4b:   0-$50/visit"	"9a, 9b:   0-$100/visit"	8a:  10% Coins	"8b:  $0 copay; 10% PET, CT, MRI, Nuclear Cardiology, waived if same day as ER/outpatient surgery visit"	5: $0 copay	$0 copay	"3, 5, 9c, 9d, 12: 0-$100, Cardiac Rehab, $10 /visit"	"7a, 14b, 14c, 14d:  $15 /visit, $0-$25 /visit"	"7b, 7d, 7f, 7g, 14d : $25/visit"	"7e, 7h: $25 /visit, all visits"	"7c, 7i: $10/visit"	7d: $0 copay	"7b, 7d, 7f, 7g, 14d: $0-$25 /visit"	14j: $0 Copay	"13a,14a: $0 Copay"	$0 copay	16a: $25/visit/6months	25/exam/12 mnths	All cost after $150 for routineey eware every 24 mnths	$25/exam/12 mnths	All cost after $400 every 36 mnths	"13b, 13c, 13d, 13d, 13e: $0 copay"	14a: 0-$25/visit											43.68067831	16.3255095	13.99037029	0	14.93411442	0.1	0.1	44.73180882	96.66979353	0.1	0.036314319	0	0	16.04220352	12.01201466	22.22451429	28.26990101	11.07574218	0	5.192519926	0	0	0	25	25	0	24.2438955	0	0	16.65780033											NO	43.55137696	16.27718355	13.94895669	0	14.88990721	0.099703985	0.099703985	44.59939597	96.38363646	0.099703985	0.036206823	0	0	15.9947162	11.9764573	22.15872639	28.18621787	11.04295633	0	5.177149289	0	0	0	24.92599625	24.92599625	0	24.17212994	0	0	16.60849075												5.735	0.098230503	1.757487808	0	0.433134554	1.221627079	0.190740117	1.193274533	3.866524811	4.014168149	1.498639763	0	0	4.121569819	5.22326889	14.28510835	0.810544689	0.661131316	0	0.040903372	0	0	0	0.405762033	0.474297655	0	0.003398667	0	0	0.536288651	0	0	0	0	0	0	0	0	0	0	46.5711		0.134051449	5.735	0.098230503	1.757487808	0	0.433134554	1.221627079	0.190740117	1.193274533	3.866524811	4.014168149	1.498639763	0	0	4.121569819	5.22326889	14.28510835	0.810544689	0.661131316	0	0.040903372	0	0	0	0.405762033	0.474297655	0	0.003398667	0	0	0.536288651	0	0	0	0	0	0	0	0	0	0	46.5711	NO																																																																																		0			5.735	0.098230503	1.757487808	0	0.433134554	1.221627079	0.190740117	1.193274533	3.866524811	4.014168149	1.498639763	0	0	4.121569819	5.22326889	14.28510835	0.810544689	0.661131316	0	0.040903372	0	0	0	0.405762033	0.474297655	0	0.003398667	0	0	0.536288651	0	0	0	0	0	0	0	0	0	0	46.5711
H2291_002_0	2010	11	N/A																															D	D	D	V	T	O	O	V	V	V	O	V	V	O	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	V																																																			0	NO								924.8874028	174.1809768		2534.865238					8123.598786	792.2787964	4314.775824				754.984885			264.229461		45.47570147															PBP: 1A IP Acute: $0 per admit	1B IP Psych: $0 per admit	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetic Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: 0%"	"4A ER/World Wide Coverage: $25, 4B Urgent Care: $0"	9B ASC Services: $25	8A OP C/D/T: $0	8B OP X-Ray: $0; $25for  MRI/ CAT Scan/ PET Scan	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0"	"7B Chiropractic: $5, 7D Physician Specialist (excl. Radiology): $5, 7F Podiatry: $5"	"7E Mental Health: $5, 7H Psychiatric: $5"	"7C Occupational Therapy: $5, 7I Physical and Speech Therapy: $5"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Medicare Covered Comprehensive Dental Services: $0, 17A Medicare Covered Eye Exams: $0"	10B Transportation: Not Covered	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: $0"	17A Routine Eye Exams: $15	17B Eye Wear: Medicare Covered: $0	18A Routine Hearing Exams: $15	18B Hearing Aids: $0	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered																		25	25		10					5	5	5				5			15		15														NO								25	25		10					5	5	5				5			15		15															0	0	0	0	0	0	0	1.926848756	0.362877035	0	2.112387699	0	0	0	0	3.384832827	0.330116165	1.79782326	0	0	0	0.314577035	0	0	0.330286826	0	0.056844627	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6166	0	0	0	0	0	0	0	0	0	1.926848756	0.362877035	0	2.112387699	0	0	0	0	3.384832827	0.330116165	1.79782326	0	0	0	0.314577035	0	0	0.330286826	0	0.056844627	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6166	NO																																																																																		0	0	0	0	0	0	0	0	0	0	1.926848756	0.362877035	0	2.112387699	0	0	0	0	3.384832827	0.330116165	1.79782326	0	0	0	0.314577035	0	0	0.330286826	0	0.056844627	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6166
H2291_004_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	O	V	V	O	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	V																																																			0	NO						40.26548691	22.75143504	366.1919761	193.6943967		717.656176					7776.591666	506.3832243	1647.570749			29.86676082				318.8571429																	PBP: 1A IP Acute: $0 per admit	1B IP Psych: $0 per admit	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	"11B Prosthetic Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 0%"	"4A ER/World Wide Coverage: $25, 4B Urgent Care: $0"	9B ASC Services: $50; OutP Surg $50	8A OP C/D/T: $0	8B OP X-Ray: $0; PET/CAT/MRI $25	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0"	"7B Chiropractic: $12, 7D Physician Specialist (excl. Radiology): $12, 7F Podiatry: $12"	"7E Mental Health: $12, 7H Psychiatric: $12"	"7C Occupational Therapy: $12, 7I Physical and Speech Therapy: $12"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $12, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: 10%	"13A Blood: $0, 16B Medicare Covered Comprehensive Dental Services: $0, 17A Medicare Covered Eye Exams: $0"	10B Transportation: Not Covered	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: $0"	17A Routine Eye Exams: $15	17B Eye Wear: Medicare Covered: $0	18A Routine Hearing Exams: $0	18B Hearing Aids: $0	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered																0.1	0.1	25	50		10					9	9	9			0.1				15																NO						0.1	0.1	25	50		10					9	9	9			0.1				15																	0	0	0	0	0	4.026548691	2.275143504	0.76289995	0.807059986	0	0.598046813	0	0	0	0	5.832443749	0.379787418	1.235678062	0	0	2.986676082	0	0	0	0.398571429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3029	0	0	0	0	0	0	0	4.026548691	2.275143504	0.76289995	0.807059986	0	0.598046813	0	0	0	0	5.832443749	0.379787418	1.235678062	0	0	2.986676082	0	0	0	0.398571429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3029	NO																																																																																		0	0	0	0	0	0	0	0	4.026548691	2.275143504	0.76289995	0.807059986	0	0.598046813	0	0	0	0	5.832443749	0.379787418	1.235678062	0	0	2.986676082	0	0	0	0.398571429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.3029
H2312_004_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	V	V	V	P	V	P	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	NO	292.6518602	6.27635047	478.8400607	1.061363471	350.8112685	18.88583073	0	448.8556861	252.7520385	0	587.0824691	0	0	1484.764437	2784.286294	3064.629953	139.3546156	7.560389745	0	701.1916564	0.26579305	0	0	0	35.80789035	0	0	0	0	0												1A IP Acute: $250 per admit	1B IP Psych: $250 per admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $50	8A OP Diagnostic Procedures/Tests: $50	8B OP Radiology: $50	9A OP Hospital: $50	12 Renal Dialysis: $25	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $50, 14E Prostate Screening: $50, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $50, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											250	250	139	0	75	0.2	0.2	50	50	0	50	0	0	44.5	15	30	30	15	0	30	0	0	0	0	0	0	0	0	0	0											NO	250	250	139	0	75	0.2	0.2	50	50	0	50	0	0	44.5	15	30	30	15	0	30	0	0	0	0	0	0	0	0	0	0												6.0969	0.130757301	5.546564036	0	2.192570428	3.777166146	0	1.870232025	1.053133494	0	2.446176955	0	0	5.506001454	3.480357867	7.661574883	0.348386539	0.009450487	0	1.752979141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8723	0	0	6.0969	0.130757301	5.546564036	0	2.192570428	3.777166146	0	1.870232025	1.053133494	0	2.446176955	0	0	5.506001454	3.480357867	7.661574883	0.348386539	0.009450487	0	1.752979141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8723	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 21-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.0969	0.130757301	5.546564036	0	2.192570428	3.777166146	0	1.870232025	1.053133494	0	2.446176955	0	0	5.506001454	3.480357867	7.661574883	0.348386539	0.009450487	0	1.752979141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8723
H2312_006_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	V	V	V	P	V	P	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	NO	268.6205943	7.379280894	391.4118726	0.372777379	322.7312366	14.87776576	0	388.1877402	251.3706732	0	512.0541619	0	0	1357.0127	2411.669206	2961.361003	137.3643731	10.79992013	0	593.7600495	0.124259126	0	0	0	32.96065416	0	0	0	0	0												1A IP Acute: $250 per admit	1B IP Psych: $250 per admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $50	8A OP Diagnostic Procedures/Tests: $50	8B OP Radiology: $50	9A OP Hospital: $50	12 Renal Dialysis: $25	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $50, 14E Prostate Screening: $50, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $50, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											250	250	139	0	75	0.2	0.2	50	50	0	50	0	0	44.5	15	30	30	15	0	30	0	0	0	0	0	0	0	0	0	0											NO	250	250	139	0	75	0.2	0.2	50	50	0	50	0	0	44.5	15	30	30	15	0	30	0	0	0	0	0	0	0	0	0	0												5.5963	0.153735019	4.533854191	0	2.017070229	2.975553152	0	1.617448918	1.047377805	0	2.133559008	0	0	5.032255429	3.014586507	7.403402508	0.343410933	0.0134999	0	1.484400124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3664	0	0	5.5963	0.153735019	4.533854191	0	2.017070229	2.975553152	0	1.617448918	1.047377805	0	2.133559008	0	0	5.032255429	3.014586507	7.403402508	0.343410933	0.0134999	0	1.484400124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3664	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 21-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.5963	0.153735019	4.533854191	0	2.017070229	2.975553152	0	1.617448918	1.047377805	0	2.133559008	0	0	5.032255429	3.014586507	7.403402508	0.343410933	0.0134999	0	1.484400124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3664
H2312_007_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	V	V	V	P	V	P	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	NO	272.2367186	5.280851482	556.2156108	0.595857872	203.4276129	12.9840011	0	323.6766258	211.5078376	0	360.0199988	0	0	621.5601951	3589.033789	3226.99061	226.451432	111.7359958	0	805.2962323	1.023182218	0	0	0	34.47221872	0	0	0	0	0												1A IP Acute: $250 per admit	1B IP Psych: $250 per admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $75	8A OP Diagnostic Procedures/Tests: $75	8B OP Radiology: $75	9A OP Hospital: $75	12 Renal Dialysis: $25	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $75, 14E Prostate Screening: $75, 14F Colorectal Screening: $75, 14G Bone Mass Measurement: $75, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											250	250	139	0	75	0.2	0.2	50	75	0	75	0	0	47.5	15	30	30	15	0	30	0	0	0	0	0	0	0	0	0	0											NO	250	250	139	0	75	0.2	0.2	50	75	0	75	0	0	47.5	15	30	30	15	0	30	0	0	0	0	0	0	0	0	0	0												5.6716	0.110017739	6.442830825	0	1.271422581	2.596800219	0	1.348652608	1.321923985	0	2.250124992	0	0	2.460342439	4.486292237	8.067476524	0.56612858	0.139669995	0	2.013240581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7465	0	0	5.6716	0.110017739	6.442830825	0	1.271422581	2.596800219	0	1.348652608	1.321923985	0	2.250124992	0	0	2.460342439	4.486292237	8.067476524	0.56612858	0.139669995	0	2.013240581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7465	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 21-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.6716	0.110017739	6.442830825	0	1.271422581	2.596800219	0	1.348652608	1.321923985	0	2.250124992	0	0	2.460342439	4.486292237	8.067476524	0.56612858	0.139669995	0	2.013240581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7465
H2312_008_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	V	V	V	P	V	P	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	NO	271.4740919	2.908847768	313.923529	1.398315443	171.9365401	15.34343881	0	335.8818538	196.0866034	0	330.6480826	0	0	588.0577565	3366.572537	3333.530559	162.305541	87.19233075	0	807.2776807	0.349578861	0	0	0	21.01841621	0	0	0	0	0												1A IP Acute: $250 per admit	1B IP Psych: $250 per admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $75	8A OP Diagnostic Procedures/Tests: $75	8B OP Radiology: $75	9A OP Hospital: $75	12 Renal Dialysis: $25	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $75, 14E Prostate Screening: $75, 14F Colorectal Screening: $75, 14G Bone Mass Measurement: $75, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											250	250	139	0	75	0.2	0.2	50	75	0	75	0	0	40.5	15	30	30	15	0	30	0	0	0	0	0	0	0	0	0	0											NO	250	250	139	0	75	0.2	0.2	50	75	0	75	0	0	40.5	15	30	30	15	0	30	0	0	0	0	0	0	0	0	0	0												5.6557	0.060600995	3.636280877	0	1.074603376	3.068687762	0	1.399507724	1.225541271	0	2.066550516	0	0	1.984694928	4.208215671	8.333826398	0.405763853	0.108990413	0	2.018194202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2472	0	0	5.6557	0.060600995	3.636280877	0	1.074603376	3.068687762	0	1.399507724	1.225541271	0	2.066550516	0	0	1.984694928	4.208215671	8.333826398	0.405763853	0.108990413	0	2.018194202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2472	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 21-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.6557	0.060600995	3.636280877	0	1.074603376	3.068687762	0	1.399507724	1.225541271	0	2.066550516	0	0	1.984694928	4.208215671	8.333826398	0.405763853	0.108990413	0	2.018194202	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.2472
H2312_009_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	V	V	V	P	V	P	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	NO	326.7585009	12.88742179	582.6054001	0	407.304497	26.67716998	0	489.4118985	301.3508449	0	668.1697531	0	0	1883.636292	3032.369992	3997.640535	307.1098401	5.00047271	0	741.116655	0.453159165	0	0	0	44.44864631	0	0	0	0	0												1A IP Acute: $300 per admit	1B IP Psych: $300 per admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $50	8A OP Diagnostic Procedures/Tests: $50	8B OP Radiology: $50	9A OP Hospital: $50	12 Renal Dialysis: $25	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $35, 9D Cardiac Rehab: $0"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $50, 14E Prostate Screening: $50, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $50, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $35	"7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											300	300	139	0	75	0.2	0.2	50	50	0	50	0	0	43.6	20	35	35	20	0	35	0	0	0	0	0	0	0	0	0	0											NO	300	300	139	0	75	0.2	0.2	50	50	0	50	0	0	43.6	20	35	35	20	0	35	0	0	0	0	0	0	0	0	0	0												8.169	0.322185545	6.748512552	0	2.545653106	5.335433996	0	2.039216244	1.255628521	0	2.784040638	0	0	6.843878527	5.053949987	11.65978489	0.895737034	0.008334121	0	2.161590244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8229	0	0	8.169	0.322185545	6.748512552	0	2.545653106	5.335433996	0	2.039216244	1.255628521	0	2.784040638	0	0	6.843878527	5.053949987	11.65978489	0.895737034	0.008334121	0	2.161590244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8229	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 21-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.169	0.322185545	6.748512552	0	2.545653106	5.335433996	0	2.039216244	1.255628521	0	2.784040638	0	0	6.843878527	5.053949987	11.65978489	0.895737034	0.008334121	0	2.161590244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8229
H2312_010_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	V	V	V	P	V	P	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	NO	347.6630949	4.152649093	463.9328781	3.774653178	261.4415843	27.15648835	0	370.1878564	275.2509726	0	445.6759978	0	0	839.7868113	4336.560408	4441.898126	242.1651333	126.5177113	0	1017.797658	0.150388393	0	0	0	25.08359656	0	0	0	0	0												1A IP Acute: $400 per admit	1B IP Psych: $400 per admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $75	8A OP Diagnostic Procedures/Tests: $75	8B OP Radiology: $75	9A OP Hospital: $75	12 Renal Dialysis: $25	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $35, 9D Cardiac Rehab: $0"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $75, 14E Prostate Screening: $75, 14F Colorectal Screening: $75, 14G Bone Mass Measurement: $75, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $35	"7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											400	400	139	0	75	0.2	0.2	50	75	0	75	0	0	45	20	35	35	15	0	35	0	0	0	0	0	0	0	0	0	0											NO	400	400	139	0	75	0.2	0.2	50	75	0	75	0	0	45	20	35	35	15	0	35	0	0	0	0	0	0	0	0	0	0												11.5888	0.138421636	5.373889171	0	1.634009902	5.43129767	0	1.542449402	1.720318579	0	2.785474987	0	0	3.149200542	7.227600679	12.9555362	0.706314972	0.158147139	0	2.968576501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.38	0	0	11.5888	0.138421636	5.373889171	0	1.634009902	5.43129767	0	1.542449402	1.720318579	0	2.785474987	0	0	3.149200542	7.227600679	12.9555362	0.706314972	0.158147139	0	2.968576501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.38	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 21-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.5888	0.138421636	5.373889171	0	1.634009902	5.43129767	0	1.542449402	1.720318579	0	2.785474987	0	0	3.149200542	7.227600679	12.9555362	0.706314972	0.158147139	0	2.968576501	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.38
H2312_801_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	240.401475	2.751480681	59.35319294	20.47819608	13.06359718	21.17920406	0	32.94858669	38.55860719	2.229540604	26.67438903	0	0	158.5163606	18.73418673	90.05653968	1.746245062	0.383113097	0	57.5898879	0.387813402	0.220457993	0	0	0	0	0	0	0	0												1AIP Acute: 7%	1B IP Psych: 7%	2 SNF: 17%	6 Home Health: $0	10A Ambulance: 23%	11A DME: 23%	"11B Prosthetics/Medical Supplies: 23%, 11C Diabetes Monitoring Supplies: 23%"	"4A ER: 23%, 4B Urgent Care: 23%"	9B ASC Services: 23%	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: 23%	9A OP Hospital: 23%	12 Renal Dialysis: 23%	"3 CORF: 23%, 5 Partial Hosp: 23%, 9C OP Substance Abuse: 23%, 9D Cardiac Rehab: 23%"	"7A PCP: 23%, 14B Immunizations: 23%, 14C Physical Exams: 23%, 14D Pap Smears and Pelvic Exams: 23%, 14E Prostate Screening: 23%, 14F Colorectal Screening: 23%, 14G Bone Mass Measurement: 23%, 14H Mammography: 23%, 14I Diabetes Monitoring: 23%, 14J Nutrition Therapy: 23%"	"7B Chiropractic: 23%, 7D Physician Specialist (excl. Radiology): 23%, 7F Podiatry: 23%"	"7E Mental Health: 23%, 7H Psychiatric: 23%"	"7C Occupational Therapy: 23%, 7I Physical and Speech Therapy: 23%"	7D Physician Specialist (Radiology): 23%	"7G Other Health Care: 23%, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 23%	"13A Blood: 23%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.8637	0.193010728	9.837740951	0	3.043818142	4.934754547	0	7.677020699	8.984155474	0.519482961	6.215132644	0	0	36.93431202	4.365065507	20.98317374	0.4068751	0.089265352	0	13.41844388	0.090360523	0.051366712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.6076	0	0	16.8637	0.193010728	9.837740951	0	3.043818142	4.934754547	0	7.677020699	8.984155474	0.519482961	6.215132644	0	0	36.93431202	4.365065507	20.98317374	0.4068751	0.089265352	0	13.41844388	0.090360523	0.051366712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.6076	NO	1AIP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.8637	0.193010728	9.837740951	0	3.043818142	4.934754547	0	7.677020699	8.984155474	0.519482961	6.215132644	0	0	36.93431202	4.365065507	20.98317374	0.4068751	0.089265352	0	13.41844388	0.090360523	0.051366712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.6076
H2312_803_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	135.5732827	1.374490403	23.80448262	10.92039065	7.734580643	12.19409842	0	16.72843199	18.10650861	1.029036295	12.17777262	0	0	72.7207421	11.58273284	50.26385468	1.140116048	0.271058937	0	32.49864624	1.386127427	0.787963667	0	0	0	0	0	0	0	0												1A IP Acute: 7%	1B IP Psych: 7%	2 SNF: 17%	6 Home Health: $0	10A Ambulance: 23%	11A DME: 23%	"11B Prosthetics/Medical Supplies: 23%, 11C Diabetes Monitoring Supplies: 23%"	"4A ER: 23%, 4B Urgent Care: 23%"	9B ASC Services: 23%	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: 23%	9A OP Hospital: 23%	12 Renal Dialysis: 23%	"3 CORF: 23%, 5 Partial Hosp: 23%, 9C OP Substance Abuse: 23%, 9D Cardiac Rehab: 23%"	"7A PCP: 23%, 14B Immunizations: 23%, 14C Physical Exams: 23%, 14D Pap Smears and Pelvic Exams: 23%, 14E Prostate Screening: 23%, 14F Colorectal Screening: 23%, 14G Bone Mass Measurement: 23%, 14H Mammography: 23%, 14I Diabetes Monitoring: 23%, 14J Nutrition Therapy: 23%"	"7B Chiropractic: 23%, 7D Physician Specialist (excl. Radiology): 23%, 7F Podiatry: 23%"	"7E Mental Health: 23%, 7H Psychiatric: 23%"	"7C Occupational Therapy: 23%, 7I Physical and Speech Therapy: 23%"	7D Physician Specialist (Radiology): 23%	"7G Other Health Care: 23%, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 23%	"13A Blood: 23%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												9.5102	0.096417683	3.945572629	0	1.80215729	2.841224931	0	3.897724654	4.218816505	0.239765457	2.83742102	0	0	16.94393291	2.698776751	11.71147814	0.265647039	0.063156732	0	7.572184575	0.32296769	0.183595534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.151	0	0	9.5102	0.096417683	3.945572629	0	1.80215729	2.841224931	0	3.897724654	4.218816505	0.239765457	2.83742102	0	0	16.94393291	2.698776751	11.71147814	0.265647039	0.063156732	0	7.572184575	0.32296769	0.183595534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.151	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.5102	0.096417683	3.945572629	0	1.80215729	2.841224931	0	3.897724654	4.218816505	0.239765457	2.83742102	0	0	16.94393291	2.698776751	11.71147814	0.265647039	0.063156732	0	7.572184575	0.32296769	0.183595534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.151
H2312_805_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	269.7072774	2.061567437	40.80446298	21.6833658	15.83287278	24.3750181	0	32.53500066	30.88837099	1.759863298	21.19645186	0	0	130.0670718	23.16345697	94.92410523	2.141317305	0.52666138	0	64.59341147	0	2.448699439	0	0	0	0	0	0	0	0												1A IP Acute: 7%	1B IP Psych: 7%	2 SNF: 17%	6 Home Health: $0	10A Ambulance: 23%	11A DME: 23%	"11B Prosthetics/Medical Supplies: 23%, 11C Diabetes Monitoring Supplies: 23%"	"4A ER: 23%, 4B Urgent Care: 23%"	9B ASC Services: 23%	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: 23%	9A OP Hospital: 23%	12 Renal Dialysis: 23%	"3 CORF: 23%, 5 Partial Hosp: 23%, 9C OP Substance Abuse: 23%, 9D Cardiac Rehab: 23%"	"7A PCP: 23%, 14B Immunizations: 23%, 14C Physical Exams: 23%, 14D Pap Smears and Pelvic Exams: 23%, 14E Prostate Screening: 23%, 14F Colorectal Screening: 23%, 14G Bone Mass Measurement: 23%, 14H Mammography: 23%, 14I Diabetes Monitoring: 23%, 14J Nutrition Therapy: 23%"	"7B Chiropractic: 23%, 7D Physician Specialist (excl. Radiology): 23%, 7F Podiatry: 23%"	"7E Mental Health: 23%, 7H Psychiatric: 23%"	"7C Occupational Therapy: 23%, 7I Physical and Speech Therapy: 23%"	7D Physician Specialist (Radiology): 23%	"7G Other Health Care: 23%, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 23%	"13A Blood: 23%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											0.070357234	0.070357234	0.165832448	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070357234	0.070357234	0.165832448	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.9759	0.145046183	6.766704001	0	3.689059357	5.679379217	0	7.580655153	7.196990441	0.410048148	4.938773284	0	0	30.30562774	5.397085474	22.11731652	0.498926932	0.122712102	0	15.05026487	0	0.570546969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.445	0	0	18.9759	0.145046183	6.766704001	0	3.689059357	5.679379217	0	7.580655153	7.196990441	0.410048148	4.938773284	0	0	30.30562774	5.397085474	22.11731652	0.498926932	0.122712102	0	15.05026487	0	0.570546969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.445	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.9759	0.145046183	6.766704001	0	3.689059357	5.679379217	0	7.580655153	7.196990441	0.410048148	4.938773284	0	0	30.30562774	5.397085474	22.11731652	0.498926932	0.122712102	0	15.05026487	0	0.570546969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.445
H2312_807_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	273.6111007	4.219630773	39.91801657	20.60879861	15.23140228	24.89830713	0	30.83308058	41.67911611	2.240885821	24.61191009	0	0	139.6336738	25.27446541	113.3502787	2.925941726	0.729849935	0	65.55771939	13.29058031	0.9674438	0	0	0	0	0	0	0	0												1A IP Acute: 7%	1B IP Psych: 7%	2 SNF: 17%	6 Home Health: $0	10A Ambulance: 23%	11A DME: 23%	"11B Prosthetics/Medical Supplies: 23%, 11C Diabetes Monitoring Supplies: 23%"	"4A ER: 23%, 4B Urgent Care: 23%"	9B ASC Services: 23%	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: 23%	9A OP Hospital: 23%	12 Renal Dialysis: 23%	"3 CORF: 23%, 5 Partial Hosp: 23%, 9C OP Substance Abuse: 23%, 9D Cardiac Rehab: 23%"	"7A PCP: 23%, 14B Immunizations: 23%, 14C Physical Exams: 23%, 14D Pap Smears and Pelvic Exams: 23%, 14E Prostate Screening: 23%, 14F Colorectal Screening: 23%, 14G Bone Mass Measurement: 23%, 14H Mammography: 23%, 14I Diabetes Monitoring: 23%, 14J Nutrition Therapy: 23%"	"7B Chiropractic: 23%, 7D Physician Specialist (excl. Radiology): 23%, 7F Podiatry: 23%"	"7E Mental Health: 23%, 7H Psychiatric: 23%"	"7C Occupational Therapy: 23%, 7I Physical and Speech Therapy: 23%"	7D Physician Specialist (Radiology): 23%	"7G Other Health Care: 23%, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 23%	"13A Blood: 23%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											0.07033832	0.07033832	0.165816831	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07033832	0.07033832	0.165816831	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.2453	0.296801742	6.619079008	0	3.548916732	5.80130556	0	7.184107775	9.711234054	0.522126396	5.734575052	0	0	32.534646	5.88895044	26.41061494	0.681744422	0.170055035	0	15.27494862	3.096705213	0.225414405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.9466	0	0	19.2453	0.296801742	6.619079008	0	3.548916732	5.80130556	0	7.184107775	9.711234054	0.522126396	5.734575052	0	0	32.534646	5.88895044	26.41061494	0.681744422	0.170055035	0	15.27494862	3.096705213	0.225414405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.9466	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.2453	0.296801742	6.619079008	0	3.548916732	5.80130556	0	7.184107775	9.711234054	0.522126396	5.734575052	0	0	32.534646	5.88895044	26.41061494	0.681744422	0.170055035	0	15.27494862	3.096705213	0.225414405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.9466
H2319_008_10	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	246.9642387	0.285838239	460.0488028	182.9334932	190.6106173	16.41110202	0.172379527	313.9928522	151.0818886	8589.477231	1639.204055	0	8.696838199	859.3144782	6087.514902	1361.334409	256.3440002	285.7566992	2909.561237	8786.934988	138.8495202	1868.73755	0	0	0	0	0	0	0	0											4000	"$700 copay per admit (PBP Section B-01, #1a)"	"$700 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$25 copay (PBP Section B-08,#8a)"	"$35 copay (PBP Section B-08,#8b)"	"$35 copay (PBP Section B-05,#5)"	"$35 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7e & #7h)"	"$35 copay (PBP Section B-07,#7c & #7i)"	"$35 copay (PBP Section B-07,#7d)"	"$35 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											700	700	130	0	50	0.036852082	1.00E-17	48.06263795	100	0	0	0	0	30.62717261	23.71788976	33.4484263	35	35	4.505001661	4.456386216	0	10.67958279	0	0	0	0	0	0	0	0											NO	680.8578416	680.8578416	126.4450277	0	48.63270297	0.035844328	9.73E-18	46.74831991	97.26540594	0	0	0	0	29.78964377	23.06930175	32.53374762	34.04289208	34.04289208	4.381808153	4.334522144	0	10.38753955	0	0	0	0	0	0	0	0												14.0123	0.016217934	4.847573635	0	0.772492461	0.588244916	1.68E-18	1.223219859	1.224586769	0	0	0	0	2.133222683	11.70289318	3.690775841	0.727224261	0.810665373	1.062428263	3.173930357	0	1.617632101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6034	0	1.338358489	14.0123	0.016217934	4.847573635	0	0.772492461	0.588244916	1.68E-18	1.223219859	1.224586769	0	0	0	0	2.133222683	11.70289318	3.690775841	0.727224261	0.810665373	1.062428263	3.173930357	0	1.617632101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6034	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.0123	0.016217934	4.847573635	0	0.772492461	0.588244916	1.68E-18	1.223219859	1.224586769	0	0	0	0	2.133222683	11.70289318	3.690775841	0.727224261	0.810665373	1.062428263	3.173930357	0	1.617632101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6034
H2319_008_3	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	174.9680021	0.249458169	329.3109707	85.2736186	96.78057001	8.697767648	0.107932352	273.0270703	159.5795189	8713.344263	1500.743627	0	18.61641452	1152.537861	5120.719916	1273.287058	137.0388349	284.3731692	2282.39035	6828.646562	185.23197	1570.74399	0	0	0	0	0	0	0	0											4000	"$700 copay per admit (PBP Section B-01, #1a)"	"$700 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$25 copay (PBP Section B-08,#8a)"	"$35 copay (PBP Section B-08,#8b)"	"$35 copay (PBP Section B-05,#5)"	"$35 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7e & #7h)"	"$35 copay (PBP Section B-07,#7c & #7i)"	"$35 copay (PBP Section B-07,#7d)"	"$35 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											700	700	130	0	50	0.036859109	1.00E-17	48.00862687	100	0	0	0	0	31.82073349	23.83125482	33.67701574	35	35	4.79807579	5.201922529	0	11.68128815	0	0	0	0	0	0	0	0											NO	686.8394063	686.8394063	127.5558897	0	49.05995759	0.036166127	9.81E-18	47.10602397	98.11991519	0	0	0	0	31.22247672	23.38320702	33.04385928	34.34197032	34.34197032	4.707867895	5.104121974	0	11.46167002	0	0	0	0	0	0	0	0												10.0146	0.014278142	3.500462822	0	0.395670888	0.314564566	1.06E-18	1.07176831	1.304827405	0	0	0	0	2.998757211	9.978237821	3.506193198	0.392181967	0.813827911	0.895432688	2.904520414	0	1.500279109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6056	0	0.758886179	10.0146	0.014278142	3.500462822	0	0.395670888	0.314564566	1.06E-18	1.07176831	1.304827405	0	0	0	0	2.998757211	9.978237821	3.506193198	0.392181967	0.813827911	0.895432688	2.904520414	0	1.500279109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6056	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.0146	0.014278142	3.500462822	0	0.395670888	0.314564566	1.06E-18	1.07176831	1.304827405	0	0	0	0	2.998757211	9.978237821	3.506193198	0.392181967	0.813827911	0.895432688	2.904520414	0	1.500279109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6056
H2319_008_4	2010	8	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	217.5419182	0.931828097	287.4059463	96.02932011	146.8480307	13.26578681	0.088786121	208.3890767	186.4863808	10042.6452	1800.62518	0	4.500901993	1202.386449	5834.010263	1636.981283	179.375094	379.6648495	2812.80871	8419.688348	255.5334025	1557.467145	0	0	0	0	0	0	0	0											4000	"$700 copay per admit (PBP Section B-01, #1a)"	"$700 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$25 copay (PBP Section B-08,#8a)"	"$35 copay (PBP Section B-08,#8b)"	"$35 copay (PBP Section B-05,#5)"	"$35 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7e & #7h)"	"$35 copay (PBP Section B-07,#7c & #7i)"	"$35 copay (PBP Section B-07,#7d)"	"$35 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											700	700	130	0	50	0.036910551	1.00E-17	48.4171064	100	0	0	0	0	32.03315806	23.9952252	33.7271721	35	35	3.830794122	4.849736697	0	14.21683298	0	0	0	0	0	0	0	0											NO	682.4474731	682.4474731	126.740245	0	48.74624808	0.035985018	9.75E-18	47.20304559	97.49249615	0	0	0	0	31.22992539	23.393544	32.88146196	34.12237365	34.12237365	3.734736812	4.728129363	0	13.86034534	0	0	0	0	0	0	0	0												12.3717	0.052993644	3.035491671	0	0.596524211	0.477369574	8.66E-19	0.819716591	1.51508523	0	0	0	0	3.129203256	11.37318132	4.48552815	0.510058665	1.079588822	0.87542502	3.317447976	0	1.798919374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4383	0	1.168671037	12.3717	0.052993644	3.035491671	0	0.596524211	0.477369574	8.66E-19	0.819716591	1.51508523	0	0	0	0	3.129203256	11.37318132	4.48552815	0.510058665	1.079588822	0.87542502	3.317447976	0	1.798919374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4383	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.3717	0.052993644	3.035491671	0	0.596524211	0.477369574	8.66E-19	0.819716591	1.51508523	0	0	0	0	3.129203256	11.37318132	4.48552815	0.510058665	1.079588822	0.87542502	3.317447976	0	1.798919374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4383
H2319_008_5	2010	8	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	212.3245227	0.131803882	252.6849892	100.5449803	139.5448764	14.64083687	0.104658011	289.0560531	220.6548902	9679.749449	1406.500393	0	20.07708015	1145.287991	5377.123641	1449.197371	242.3191947	321.2195146	2670.913152	8381.013202	273.1943388	1763.324068	0	0	0	0	0	0	0	0											4000	"$700 copay per admit (PBP Section B-01, #1a)"	"$700 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$25 copay (PBP Section B-08,#8a)"	"$35 copay (PBP Section B-08,#8b)"	"$35 copay (PBP Section B-05,#5)"	"$35 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7e & #7h)"	"$35 copay (PBP Section B-07,#7c & #7i)"	"$35 copay (PBP Section B-07,#7d)"	"$35 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											700	700	130	0	50	0.036850935	1.00E-17	49.15277518	100	0	0	0	0	31.73710576	23.99038579	33.58223559	35	35	5.089205613	4.548290957	0	11.69650648	0	0	0	0	0	0	0	0											NO	683.8063623	683.8063623	126.9926101	0	48.8433116	0.035998434	9.77E-18	48.01568628	97.68662319	0	0	0	0	31.00290692	23.43539777	32.80535194	34.19031812	34.19031812	4.97147311	4.443071849	0	11.42592221	0	0	0	0	0	0	0	0												12.0991	0.007510694	2.674093861	0	0.567986157	0.527047193	1.02E-18	1.156602064	1.796252593	0	0	0	0	2.958938081	10.50125262	3.961785815	0.690414196	0.915216449	1.106531076	3.103120319	0	1.67896697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7448	0	1.035947182	12.0991	0.007510694	2.674093861	0	0.567986157	0.527047193	1.02E-18	1.156602064	1.796252593	0	0	0	0	2.958938081	10.50125262	3.961785815	0.690414196	0.915216449	1.106531076	3.103120319	0	1.67896697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7448	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.0991	0.007510694	2.674093861	0	0.567986157	0.527047193	1.02E-18	1.156602064	1.796252593	0	0	0	0	2.958938081	10.50125262	3.961785815	0.690414196	0.915216449	1.106531076	3.103120319	0	1.67896697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.7448
H2319_008_7	2010	8	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	237.0104005	0.269330001	255.2474924	105.9641757	191.2136906	12.5746116	0.091721879	188.6148935	194.0018939	9079.293147	1452.415635	0	11.58541655	987.8060997	7008.542426	1626.364446	373.7260404	647.627844	2895.369023	14010.2104	325.2366333	2531.510876	0	0	0	0	0	0	0	0											4000	"$700 copay per admit (PBP Section B-01, #1a)"	"$700 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$25 copay (PBP Section B-08,#8a)"	"$35 copay (PBP Section B-08,#8b)"	"$35 copay (PBP Section B-05,#5)"	"$35 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7e & #7h)"	"$35 copay (PBP Section B-07,#7c & #7i)"	"$35 copay (PBP Section B-07,#7d)"	"$35 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											700	700	130	0	50	0.036340689	1.00E-17	48.48942676	100	0	0	0	0	32.02641343	24.72389943	33.42523349	35	35	7.131275404	3.990341007	0	11.93843232	0	0	0	0	0	0	0	0											NO	677.5066866	677.5066866	125.8226704	0	48.39333476	0.035172943	9.68E-18	46.93130123	96.78666951	0	0	0	0	30.99729892	23.92943884	32.35117028	33.87533433	33.87533433	6.902123957	3.862118163	0	11.55481103	0	0	0	0	0	0	0	0												13.3813	0.015206073	2.676326758	0	0.771122345	0.442286092	8.88E-19	0.737661865	1.564733099	0	0	0	0	2.551610079	13.97587394	4.384566095	1.055007881	1.828217478	1.665349658	4.509090671	0	2.43759415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.996	0	1.726273899	13.3813	0.015206073	2.676326758	0	0.771122345	0.442286092	8.88E-19	0.737661865	1.564733099	0	0	0	0	2.551610079	13.97587394	4.384566095	1.055007881	1.828217478	1.665349658	4.509090671	0	2.43759415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.996	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.3813	0.015206073	2.676326758	0	0.771122345	0.442286092	8.88E-19	0.737661865	1.564733099	0	0	0	0	2.551610079	13.97587394	4.384566095	1.055007881	1.828217478	1.665349658	4.509090671	0	2.43759415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.996
H2319_008_9	2010	8	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	243.2881556	0.281583513	453.2009383	180.210513	187.7733625	15.61073097	0.16397256	309.3190427	148.8330222	8461.622153	1614.804367	0	8.567385044	846.5235112	5996.90174	1341.070834	252.5282985	281.5031871	2866.252178	8656.140735	136.7827336	1840.921237	0	0	0	0	0	0	0	0											4000	"$700 copay per admit (PBP Section B-01, #1a)"	"$700 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$25 copay (PBP Section B-08,#8a)"	"$35 copay (PBP Section B-08,#8b)"	"$35 copay (PBP Section B-05,#5)"	"$35 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7e & #7h)"	"$35 copay (PBP Section B-07,#7c & #7i)"	"$35 copay (PBP Section B-07,#7d)"	"$35 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											700	700	130	0	50	0.036852082	1.00E-17	48.06263795	100	0	0	0	0	30.62717261	23.71788976	33.4484263	35	35	4.505001661	4.456386216	0	10.67958279	0	0	0	0	0	0	0	0											NO	681.3510068	681.3510068	126.5366155	0	48.66792905	0.035870291	9.73E-18	46.78218108	97.33585811	0	0	0	0	29.81122128	23.08601152	32.55731276	34.06755034	34.06755034	4.384982025	4.337661764	0	10.39506355	0	0	0	0	0	0	0	0												13.8137	0.015988101	4.778876074	0	0.761545057	0.559961457	1.60E-18	1.205884955	1.207232494	0	0	0	0	2.102991642	11.53704522	3.638471881	0.716918377	0.799177	1.047372023	3.128950891	0	1.59470777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9088	0	1.283923661	13.8137	0.015988101	4.778876074	0	0.761545057	0.559961457	1.60E-18	1.205884955	1.207232494	0	0	0	0	2.102991642	11.53704522	3.638471881	0.716918377	0.799177	1.047372023	3.128950891	0	1.59470777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9088	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.8137	0.015988101	4.778876074	0	0.761545057	0.559961457	1.60E-18	1.205884955	1.207232494	0	0	0	0	2.102991642	11.53704522	3.638471881	0.716918377	0.799177	1.047372023	3.128950891	0	1.59470777	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9088
H2319_009_1	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	258.3944606	0.567721665	537.6046079	244.0597936	179.8453156	15.71406748	0.331478577	389.1580111	132.9096192	9873.476098	1737.329328	0	12.44938373	974.1751878	6698.941874	1818.318266	215.5145853	346.4692783	3210.126304	10134.15081	178.7977356	2137.654485	0	0	0	0	0	0	0	0											3500	"$500 copay per admit (PBP Section B-01, #1a)"	"$500 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$15 copay (PBP Section B-08,#8a)"	"$30 copay (PBP Section B-08,#8b)"	"$30 copay (PBP Section B-05,#5)"	"$30 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$15 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7e & #7h)"	"$30 copay (PBP Section B-07,#7c & #7i)"	"$30 copay (PBP Section B-07,#7d)"	"$30 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											500	500	130	0	50	0.036893342	1.00E-17	45.88253575	100	0	0	0	0	26.8622405	16.85278677	27.77105578	30	30	3.612223575	4.438544062	0	9.743914138	0	0	0	0	0	0	0	0											NO	485.6259319	485.6259319	126.2627423	0	48.56259319	0.035832727	9.71E-18	44.56349836	97.12518639	0	0	0	0	26.09000116	16.36830056	26.97268969	29.13755592	29.13755592	3.50837888	4.310944193	0	9.463794768	0	0	0	0	0	0	0	0												10.4569	0.02297503	5.656619339	0	0.727812908	0.563077891	3.22E-18	1.445186866	1.075739295	0	0	0	0	2.118019315	9.137524503	4.087077862	0.523297357	0.841272331	0.938528277	3.640646548	0	1.685860278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9206	0	1.270407923	10.4569	0.02297503	5.656619339	0	0.727812908	0.563077891	3.22E-18	1.445186866	1.075739295	0	0	0	0	2.118019315	9.137524503	4.087077862	0.523297357	0.841272331	0.938528277	3.640646548	0	1.685860278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9206	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.4569	0.02297503	5.656619339	0	0.727812908	0.563077891	3.22E-18	1.445186866	1.075739295	0	0	0	0	2.118019315	9.137524503	4.087077862	0.523297357	0.841272331	0.938528277	3.640646548	0	1.685860278	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9206
H2319_009_2	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	284.1351225	1.660221918	387.404626	110.23069	205.7585139	15.77965349	0.14628251	274.2397595	208.4297233	10780.9374	1560.405374	0	10.11290734	794.6922148	7756.392426	1694.424166	189.0509945	481.756542	3142.564907	9779.09589	268.1441947	2019.507608	0	0	0	0	0	0	0	0											3500	"$500 copay per admit (PBP Section B-01, #1a)"	"$500 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$15 copay (PBP Section B-08,#8a)"	"$30 copay (PBP Section B-08,#8b)"	"$30 copay (PBP Section B-05,#5)"	"$30 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$15 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7e & #7h)"	"$30 copay (PBP Section B-07,#7c & #7i)"	"$30 copay (PBP Section B-07,#7d)"	"$30 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											500	500	130	0	50	0.036763985	1.00E-17	46.9428358	100	0	0	0	0	26.05041608	17.5765267	28.00678698	30	30	5.034776107	4.165722881	0	9.530632984	0	0	0	0	0	0	0	0											NO	485.0471006	485.0471006	126.1122461	0	48.50471006	0.035664529	9.70E-18	45.53897279	97.00942011	0	0	0	0	25.27135757	17.05088662	27.16922164	29.10282603	29.10282603	4.884207105	4.041143611	0	9.245611791	0	0	0	0	0	0	0	0												11.4849	0.067107152	4.071372296	0	0.831688088	0.562773903	1.42E-18	1.040716412	1.684970549	0	0	0	0	1.67357926	11.02111399	3.836348811	0.458493184	1.168373069	1.279078154	3.293227573	0	1.555965279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0297	0	1.357336097	11.4849	0.067107152	4.071372296	0	0.831688088	0.562773903	1.42E-18	1.040716412	1.684970549	0	0	0	0	1.67357926	11.02111399	3.836348811	0.458493184	1.168373069	1.279078154	3.293227573	0	1.555965279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0297	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.4849	0.067107152	4.071372296	0	0.831688088	0.562773903	1.42E-18	1.040716412	1.684970549	0	0	0	0	1.67357926	11.02111399	3.836348811	0.458493184	1.168373069	1.279078154	3.293227573	0	1.555965279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0297
H2319_009_3	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	253.0335115	2.527176145	262.8670762	137.0527864	159.4002558	14.8063684	0.078324164	300.6545785	259.6174577	12353.47914	1913.826065	0	30.30651296	1887.98174	6014.663558	1384.373421	136.4038657	346.0668985	3090.463755	7989.876177	338.2791834	1895.59959	0	0	0	0	0	0	0	0											3500	"$500 copay per admit (PBP Section B-01, #1a)"	"$500 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$15 copay (PBP Section B-08,#8a)"	"$30 copay (PBP Section B-08,#8b)"	"$30 copay (PBP Section B-05,#5)"	"$30 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$15 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7e & #7h)"	"$30 copay (PBP Section B-07,#7c & #7i)"	"$30 copay (PBP Section B-07,#7d)"	"$30 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											500	500	130	0	50	0.036935005	1.00E-17	48.06660975	100	0	0	0	0	27.53853482	17.61349678	27.64503132	30	30	2.900451172	4.605984176	0	10.27635423	0	0	0	0	0	0	0	0											NO	487.2959915	487.2959915	126.6969578	0	48.72959915	0.03599656	9.75E-18	46.84533251	97.45919829	0	0	0	0	26.83883526	17.16597276	26.94262589	29.23775949	29.23775949	2.826756459	4.488955252	0	10.01525245	0	0	0	0	0	0	0	0												10.2752	0.102623567	2.775371572	0	0.647292548	0.532978329	7.63E-19	1.173688642	2.108509108	0	0	0	0	4.222602576	8.603962566	3.108221265	0.332345285	0.843185062	0.727999032	2.988849719	0	1.582075702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0249	0	1.043465467	10.2752	0.102623567	2.775371572	0	0.647292548	0.532978329	7.63E-19	1.173688642	2.108509108	0	0	0	0	4.222602576	8.603962566	3.108221265	0.332345285	0.843185062	0.727999032	2.988849719	0	1.582075702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0249	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.2752	0.102623567	2.775371572	0	0.647292548	0.532978329	7.63E-19	1.173688642	2.108509108	0	0	0	0	4.222602576	8.603962566	3.108221265	0.332345285	0.843185062	0.727999032	2.988849719	0	1.582075702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0249
H2319_009_4	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	273.5605528	0.238500918	320.7194267	109.0674805	190.6278048	18.18556513	0.123459004	223.009064	213.5772127	11710.38545	1979.469978	0	12.71182756	1442.027359	6801.729886	2005.864929	227.6953427	542.4226059	3132.227974	9634.980017	413.8387918	1777.953424	0	0	0	0	0	0	0	0											3500	"$500 copay per admit (PBP Section B-01, #1a)"	"$500 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$15 copay (PBP Section B-08,#8a)"	"$30 copay (PBP Section B-08,#8b)"	"$30 copay (PBP Section B-05,#5)"	"$30 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$15 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7e & #7h)"	"$30 copay (PBP Section B-07,#7c & #7i)"	"$30 copay (PBP Section B-07,#7d)"	"$30 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											500	500	130	0	50	0.036668862	1.00E-17	47.77313332	100	0	0	0	0	27.57208465	17.37990155	28.16023855	30	30	3.508142714	4.326048671	0	14.09335499	0	0	0	0	0	0	0	0											NO	485.095002	485.095002	126.1247005	0	48.5095002	0.035575764	9.70E-18	46.34901641	97.01900041	0	0	0	0	26.75016092	16.86180675	27.32078195	29.10570012	29.10570012	3.403564994	4.197089177	0	13.67323214	0	0	0	0	0	0	0	0												11.0586	0.0096413	3.370886804	0	0.770604962	0.646965367	1.20E-18	0.861354231	1.726753974	0	0	0	0	3.214538658	9.557454576	4.566816528	0.552269364	1.315632476	0.888395124	3.369905863	0	2.025864159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9357	0	1.349964114	11.0586	0.0096413	3.370886804	0	0.770604962	0.646965367	1.20E-18	0.861354231	1.726753974	0	0	0	0	3.214538658	9.557454576	4.566816528	0.552269364	1.315632476	0.888395124	3.369905863	0	2.025864159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9357	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.0586	0.0096413	3.370886804	0	0.770604962	0.646965367	1.20E-18	0.861354231	1.726753974	0	0	0	0	3.214538658	9.557454576	4.566816528	0.552269364	1.315632476	0.888395124	3.369905863	0	2.025864159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9357
H2319_009_5	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	279.2656786	2.258974144	398.0028629	124.0127742	154.0493067	22.05320855	0.090719323	296.2735921	240.3843954	11620.27265	1947.708589	0	27.39117101	1394.102877	6754.83156	1775.078083	171.8306156	412.5330681	3260.028034	10079.58703	322.201831	2182.30968	0	0	0	0	0	0	0	0											3500	"$500 copay per admit (PBP Section B-01, #1a)"	"$500 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$15 copay (PBP Section B-08,#8a)"	"$30 copay (PBP Section B-08,#8b)"	"$30 copay (PBP Section B-05,#5)"	"$30 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$15 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7e & #7h)"	"$30 copay (PBP Section B-07,#7c & #7i)"	"$30 copay (PBP Section B-07,#7d)"	"$30 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											500	500	130	0	50	0.036813313	1.00E-17	48.58468495	100	0	0	0	0	27.49144991	17.56646836	27.91098471	30	30	4.746799209	4.104492761	0	9.56318993	0	0	0	0	0	0	0	0											NO	484.7899894	484.7899894	126.0453972	0	48.47899894	0.035693451	9.70E-18	47.1067378	96.95799787	0	0	0	0	26.65515942	17.03209602	27.06193196	29.08739936	29.08739936	4.602401476	3.979634004	0	9.272277489	0	0	0	0	0	0	0	0												11.2821	0.091260671	4.180535747	0	0.622346348	0.787155127	8.80E-19	1.163040202	1.942265808	0	0	0	0	3.096669536	9.587411641	4.003086859	0.416508811	0.999959509	1.25032982	3.342755607	0	1.68624841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4517	0	1.394646047	11.2821	0.091260671	4.180535747	0	0.622346348	0.787155127	8.80E-19	1.163040202	1.942265808	0	0	0	0	3.096669536	9.587411641	4.003086859	0.416508811	0.999959509	1.25032982	3.342755607	0	1.68624841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4517	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.2821	0.091260671	4.180535747	0	0.622346348	0.787155127	8.80E-19	1.163040202	1.942265808	0	0	0	0	3.096669536	9.587411641	4.003086859	0.416508811	0.999959509	1.25032982	3.342755607	0	1.68624841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4517
H2319_009_6	2010	13	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	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	0	0	0	0	0											0	YES	313.247953	1.621246337	462.5295281	142.7009092	259.2301892	15.1295639	0.123876437	212.5721137	220.7665103	10511.34066	1579.95298	0	12.34436931	1239.909008	8221.9141	2225.387211	360.1532177	679.982572	3400.875283	16976.12424	276.8952231	3194.86768	0	0	0	0	0	0	0	0											3500	"$500 copay per admit (PBP Section B-01, #1a)"	"$500 copay per admit (PBP Section B-01,#1b)"	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"50% on non-contracted DME (PBP Section B-11,#11a)"	"50% on non-contracted DME (PBP Section B-11,#11b & #11c)"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$100 copay (PBP Section B-09,#9a & #9b)"	"$15 copay (PBP Section B-08,#8a)"	"$30 copay (PBP Section B-08,#8b)"	"$30 copay (PBP Section B-05,#5)"	"$30 copay (PBP Section B-12, #12)"	"$30 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$15 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$30 copay (PBP Section B-07,#7b, #7d & #7f)"	"$30 copay (PBP Section B-07,#7e & #7h)"	"$30 copay (PBP Section B-07,#7c & #7i)"	"$30 copay (PBP Section B-07,#7d)"	"$30 copay (PBP Section B-07,#7g); $0 copay (PBP Section-14, #14d, #14e, #14f, #14g, #14h, #14i & #14j)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"not covered (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	"Full body skin exam (once per lifetime PBP Section B-14, #14c)"											500	500	130	0	50	0.036731137	1.00E-17	48.33806722	100	0	0	0	0	27.73940903	18.04384153	27.77071495	30	30	5.59052228	3.473698342	0	9.986224609	0	0	0	0	0	0	0	0											NO	479.2282758	479.2282758	124.5993517	0	47.92282758	0.035205199	9.58E-18	46.32993722	95.84565515	0	0	0	0	26.58701832	17.29423813	26.61702368	28.75369655	28.75369655	5.358272706	3.329388934	0	9.571362401	0	0	0	0	0	0	0	0												12.5098	0.064745591	4.802573279	0	1.035253638	0.532639306	1.19E-18	0.82070439	1.763292568	0	0	0	0	2.747123627	11.84931169	4.936098675	0.862978028	1.629334378	1.5185681	4.710010016	0	2.548269699	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3307	0	2.268226703	12.5098	0.064745591	4.802573279	0	1.035253638	0.532639306	1.19E-18	0.82070439	1.763292568	0	0	0	0	2.747123627	11.84931169	4.936098675	0.862978028	1.629334378	1.5185681	4.710010016	0	2.548269699	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3307	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.5098	0.064745591	4.802573279	0	1.035253638	0.532639306	1.19E-18	0.82070439	1.763292568	0	0	0	0	2.747123627	11.84931169	4.936098675	0.862978028	1.629334378	1.5185681	4.710010016	0	2.548269699	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3307
H2319_801_0	2010	7	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	274.6166503	0.901180411	56.28993589	33.26862375	8.459076722	24.61828253	0.215423231	16.66659764	54.755775	15.01978168	26.83768539	0	0.204122825	27.49169582	50.04182154	24.52270252	2.449076207	7.592619554	33.96868734	156.6553846	11.29677735	35.70051966	0	0	0	0	0	0	0	0												FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits											0.075104753	0.075104753	0.167136397	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075104753	0.075104753	0.167136397	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.625	0.067682933	9.408097061	0	1.970964876	5.736059831	0.050193613	3.883317251	12.75809557	3.499609131	6.253180696	0	0.047560618	6.405565126	11.65974442	5.713789686	0.570634756	1.769080356	7.914704149	36.50070462	2.632149122	8.318221081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.7844	0	0	20.625	0.067682933	9.408097061	0	1.970964876	5.736059831	0.050193613	3.883317251	12.75809557	3.499609131	6.253180696	0	0.047560618	6.405565126	11.65974442	5.713789686	0.570634756	1.769080356	7.914704149	36.50070462	2.632149122	8.318221081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.7844	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.625	0.067682933	9.408097061	0	1.970964876	5.736059831	0.050193613	3.883317251	12.75809557	3.499609131	6.253180696	0	0.047560618	6.405565126	11.65974442	5.713789686	0.570634756	1.769080356	7.914704149	36.50070462	2.632149122	8.318221081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.7844
H2319_802_0	2010	6	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	313.6506114	0.81808087	61.70372022	37.26880172	9.757852083	29.4931063	0.260866397	19.19859976	57.85554804	16.75126284	26.98694727	0	0.17069376	29.42834338	52.91930414	24.26170547	4.411581186	6.686100198	34.73776195	161.8345255	10.79776594	35.86255289	0	0	0	0	0	0	0	0												FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits											0.075558331	0.075558331	0.16824496	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075558331	0.075558331	0.16824496	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.6989	0.061812825	10.38133995	0	2.273579535	6.871893767	0.06078187	4.473273745	13.48034269	3.903044242	6.287958713	0	0.039771646	6.856804009	12.33019786	5.652977376	1.027898416	1.557861346	8.093898535	37.70744444	2.515879464	8.355974824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.6317	0	0	23.6989	0.061812825	10.38133995	0	2.273579535	6.871893767	0.06078187	4.473273745	13.48034269	3.903044242	6.287958713	0	0.039771646	6.856804009	12.33019786	5.652977376	1.027898416	1.557861346	8.093898535	37.70744444	2.515879464	8.355974824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.6317	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.6989	0.061812825	10.38133995	0	2.273579535	6.871893767	0.06078187	4.473273745	13.48034269	3.903044242	6.287958713	0	0.039771646	6.856804009	12.33019786	5.652977376	1.027898416	1.557861346	8.093898535	37.70744444	2.515879464	8.355974824	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.6317
H2319_803_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	274.6166503	0.901180411	56.28993589	33.26862375	8.459076722	24.61828253	0.215423231	16.66659764	54.755775	15.01978168	26.83768539	0	0.204122825	27.49169582	50.04182154	24.52270252	2.449076207	7.592619554	33.96868734	156.6553846	11.29677735	35.70051966	0	0	0	0	0	0	0	0												FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits											0.075104753	0.075104753	0.167136397	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075104753	0.075104753	0.167136397	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.625	0.067682933	9.408097061	0	1.970964876	5.736059831	0.050193613	3.883317251	12.75809557	3.499609131	6.253180696	0	0.047560618	6.405565126	11.65974442	5.713789686	0.570634756	1.769080356	7.914704149	36.50070462	2.632149122	8.318221081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.7844	0	0	20.625	0.067682933	9.408097061	0	1.970964876	5.736059831	0.050193613	3.883317251	12.75809557	3.499609131	6.253180696	0	0.047560618	6.405565126	11.65974442	5.713789686	0.570634756	1.769080356	7.914704149	36.50070462	2.632149122	8.318221081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.7844	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.625	0.067682933	9.408097061	0	1.970964876	5.736059831	0.050193613	3.883317251	12.75809557	3.499609131	6.253180696	0	0.047560618	6.405565126	11.65974442	5.713789686	0.570634756	1.769080356	7.914704149	36.50070462	2.632149122	8.318221081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.7844
H2320_007_0	2010	6	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	774.0099322	36.12069114	585.2558961	588.58757	95.16400306	0	12.91184522	916.3179291	306.5431614	3625.652931	1557.093679	4.088323649	0	1869.86077	3610.006171	5373.75257	178.9092859	0	2104.561534	3088.155016	27.36246943	0	0	0	0	285.1919201	105.1461644	20.23722114	0	0											3400	"$75 days 1-5, $0 days 6+, unlimited coverage"	"$75 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$50 copay	$10 - $20 copay	$15 - $20 copay	$50 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$10 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$30 Specialist, $0 Screening/Exams"	$40 copay	$20 copay	$15 - $20 copay	$0 - $30 copay	0% - 20% coinsurance	$30 copay	Not Covered	Not Covered	$30 copay	$100 every two years	$30 copay	$350 every three years	Not Covered	Not Covered											61.26108682	26.87136243	51.60168196	0	50	0	0.157451974	19.99923185	44.18418122	3.343937081	10.86575056	0	0	7.619945681	9.145090155	22.04787555	22.20594769	0	2.983802315	3.887466059	0.179855541	0	0	0	0	0	30	0	0	0											YES	59.06151483	25.90654938	49.74892975	0	48.20475599	0	0.15179868	19.28116182	42.59775348	3.22387342	10.47561709	0	0	7.346352444	8.816736788	21.25624921	21.40864579	0	2.876669251	3.747887055	0.17339785	0	0	0	0	0	28.92285359	0	0	0											3400	3.8095	0.077980206	2.426321205	0	0.382279796	0	1.960001063	1.472306189	1.088170835	0.974053843	1.359293096	0	0	1.144721353	2.652372851	9.518818654	0.319183794	0	0.504510621	0.964504684	4.744593363	0	0	0	0	0	0.25342726	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6521	0	1.253271586	3.8095	0.077980206	2.426321205	0	0.382279796	0	1.960001063	1.472306189	1.088170835	0.974053843	1.359293096	0	0	1.144721353	2.652372851	9.518818654	0.319183794	0	0.504510621	0.964504684	4.744593363	0	0	0	0	0	0.25342726	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6521	NO	"$175 days 1-5, $0 days 6+, unlimited coverage"	"$175 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$20 - $25 copay	$20 - $25 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay for other"	"$35 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams"	"$35 Specialist, $10 Screening/Exams"	$50 copay	$25 copay	$20 - $25 copay	$0 - $35 copay	20% coinsurance	$35 copay	Not Covered	Not Covered	$35 copay	$100 every two years	$35 copay	$350 every three years	Not Covered	Not Covered												0.2904	0.8808	0.1228	0	0.167	0	0.7477	0.1991	0.0553	0.0517	0.0361	0	0	0.0689	0	2.1174	0.1397	0	0.0295	0.1343	0.192	0	0	0	0	0	0	0	0	0											5.2329	400	0.194883413	4.0999	0.958731229	2.549159793	0	0.549314187	0	2.707749882	1.671375634	1.143513778	1.025794889	1.395391847	0	0	1.213660776	2.652372851	11.63626529	0.458838636	0	0.534000965	1.098778182	4.936627494	0	0	0	0	0	0.25342726	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8849
H2320_008_0	2010	6	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	819.3071648	49.07642537	688.5367722	579.1043768	122.8238149	0	14.82372339	649.4570813	277.7079302	3232.543601	1538.694411	4.999692605	0	1778.046336	3825.944384	5999.501764	196.3803417	0	2411.673666	3637.075523	24.21208201	0	0	0	0	316.2088194	116.5816496	22.43818058	0	0											3400	"$75 days 1-5, $0 days 6+, unlimited coverage"	"$75 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$50 copay	$10 - $20 copay	$15 - $20 copay	$50 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$10 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$30 Specialist, $0 Screening/Exams"	$40 copay	$20 copay	$15 - $20 copay	$0 - $30 copay	0% - 20% coinsurance	$30 copay	Not Covered	Not Covered	$30 copay	$100 every two years	$30 copay	$350 every three years	Not Covered	Not Covered											61.26108682	26.87136243	51.60168196	0	50	0	0.157451974	19.99923185	46.39043418	3.343937081	10.72087131	0	0	7.477656772	9.148751493	22.10263137	22.20594769	0	2.847212195	3.890537795	0.179855541	0	0	0	0	0	30	0	0	0											YES	59.06151483	25.90654938	49.74892975	0	48.20475599	0	0.15179868	19.28116182	44.7247912	3.22387342	10.33593971	0	0	7.209172401	8.820266666	21.30903904	21.40864579	0	2.744983382	3.750848501	0.17339785	0	0	0	0	0	28.92285359	0	0	0											3400	4.0325	0.10595007	2.854497292	0	0.493391002	0	2.250221645	1.043523924	1.035035766	0.868442616	1.325321056	0	0	1.068186881	2.812154143	10.65363477	0.350353098	0	0.551667011	1.136843273	4.198322957	0	0	0	0	0	0.280989499	0	0	0	0	0	0	0	0	0	0	0	0	0	35.061	0	1.305743394	4.0325	0.10595007	2.854497292	0	0.493391002	0	2.250221645	1.043523924	1.035035766	0.868442616	1.325321056	0	0	1.068186881	2.812154143	10.65363477	0.350353098	0	0.551667011	1.136843273	4.198322957	0	0	0	0	0	0.280989499	0	0	0	0	0	0	0	0	0	0	0	0	0	35.061	NO	"$175 days 1-5, $0 days 6+, unlimited coverage"	"$175 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$20 - $25 copay	$20 - $25 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay for other"	"$35 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams"	"$35 Specialist, $10 Screening/Exams"	$50 copay	$25 copay	$20 - $25 copay	$0 - $35 copay	20% coinsurance	$35 copay	Not Covered	Not Covered	$35 copay	$100 every two years	$35 copay	$350 every three years	Not Covered	Not Covered												0.3946	0.2604	0.1752	0	0.0609	0	0.8227	0.1536	0.0322	0.0572	0.0394	0	0	0.0843	0	2.054	0.1182	0	0.0262	0.1601	0.109	0	0	0	0	0	0	0	0	0											4.5481	400	0.169379152	4.4271	0.366364165	3.029724678	0	0.554301319	0	3.072913398	1.197077512	1.067230548	0.925642532	1.364678553	0	0	1.152494278	2.812154143	12.70765974	0.468559094	0	0.577909275	1.296944543	4.307362992	0	0	0	0	0	0.280989499	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6091
H2320_009_0	2010	6	N/A																															A	A	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	166.6066219	6.847846295	492.2770814	764.8681149	87.77851252	0	19.06355185	1103.501796	365.606001	4073.745832	1829.869092	7.255041817	0	2156.180306	3857.617675	5887.429066	200.1473241	0	2554.501478	3377.305032	35.59601117	0	0	0	0	313.4277661	115.5563152	22.24083701	0	0											3400	"$250 copay per admit, unlimited coverage"	$250 copay per admit	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$50 copay	$10 - $20 copay	$15 - $20 copay	$50 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$15 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$30 Specialist, $0 Screening/Exams"	$40 copay	$20 copay	$15 - $20 copay	$0 - $30 copay	0% - 20% coinsurance	$30 copay	Not Covered	Not Covered	$30 copay	$100 every two yearx	$30 copay	$350 every three years	Not Covered	Not Covered											250	250	51.60168196	0	50	0	0.157451974	19.99923185	42.09236056	3.343937081	11.36878189	0	0	6.739687681	13.71211147	22.02307706	22.20594769	0	2.961537709	3.862906554	0.179855541	0	0	0	0	0	30	0	0	0											YES	241.0237799	241.0237799	49.74892975	0	48.20475599	0	0.15179868	19.28116182	40.5810394	3.22387342	10.96058714	0	0	6.497700002	13.21977975	21.23234111	21.40864579	0	2.855204052	3.724209357	0.17339785	0	0	0	0	0	28.92285359	0	0	0											3400	3.3463	0.13754115	2.040854828	0	0.352611815	0	2.89382201	1.773066392	1.236389294	1.094436742	1.67136997	0	0	1.167517731	4.249738002	10.41699185	0.357073597	0	0.607801914	1.04814925	6.172271795	0	0	0	0	0	0.278518199	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8445	0	1.446648914	3.3463	0.13754115	2.040854828	0	0.352611815	0	2.89382201	1.773066392	1.236389294	1.094436742	1.67136997	0	0	1.167517731	4.249738002	10.41699185	0.357073597	0	0.607801914	1.04814925	6.172271795	0	0	0	0	0	0.278518199	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8445	NO	"$500 copay per admit, unlimited coverage"	$500 copay per admit	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$20 - $25 copay	$20 - $25 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay for other"	"$35 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams"	"$35 Specialist, $10 Screening/Exams"	$50 copay	$25 copay	$20 - $25 copay	$0 - $35 copay	20% coinsurance	$35 copay	Not Covered	Not Covered	$35 copay	$100 every two year	$35 copay	$350 every three years	Not Covered	Not Covered												0.2441	0.2898	0.1163	0	0.1345	0	0.6541	0.1705	0.0249	0.0509	0.0474	0	0	0.0653	0	2.0653	0.0853	0	0.0309	0.1371	0.078	0	0	0	0	0	0	0	0	0											4.1944	300	0.156207756	3.5905	0.427308268	2.157167588	0	0.487088448	0	3.547919408	1.943611776	1.261316867	1.145304252	1.718787169	0	0	1.232794732	4.249738002	12.4822698	0.442413636	0	0.638686207	1.185254097	6.25023499	0	0	0	0	0	0.278518199	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0389
H2320_010_0	2010	6	N/A																															A	A	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	215.1588267	8.441255228	923.5250841	672.4920266	137.9120355	0	18.38204194	756.1003389	252.1478191	3647.848585	1746.887057	4.063778586	0	2249.886243	4305.331604	6678.326424	271.3894031	0	2558.676666	3515.144326	23.04741033	0	0	0	0	344.6257471	127.0585627	24.45464602	0	0											3400	"$250 copay per admit, unlimited coverage"	$250 copay per admit	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$50 copay	$10 - $20 copay	$15 - $20 copay	$50 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$15 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$30 Specialist, $0 Screening/Exams"	$40 copay	$20 copay	$15 - $20 copay	$0 - $30 copay	0% - 20% coinsurance	$30 copay	Not Covered	Not Covered	$30 copay	$100 every two yearx	$30 copay	$350 every three years	Not Covered	Not Covered											250	250	51.60168196	0	50	0	0.157451974	19.99923185	45.33962011	3.343937081	11.2909744	0	0	7.093994149	13.74695586	22.26778903	22.20594769	0	2.812079146	3.836701548	0.179855541	0	0	0	0	0	30	0	0	0											YES	241.0237799	241.0237799	49.74892975	0	48.20475599	0	0.15179868	19.28116182	43.71170648	3.22387342	10.88557332	0	0	6.839285139	13.25337306	21.46826673	21.40864579	0	2.711111781	3.698945238	0.17339785	0	0	0	0	0	28.92285359	0	0	0											3400	4.3215	0.16954527	3.828698711	0	0.554001335	0	2.790369705	1.214874416	0.918484288	0.980016841	1.584655595	0	0	1.282301129	4.755013824	11.94767442	0.4841733	0	0.578071538	1.083527197	3.996371392	0	0	0	0	0	0.30624135	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7956	0	1.519310096	4.3215	0.16954527	3.828698711	0	0.554001335	0	2.790369705	1.214874416	0.918484288	0.980016841	1.584655595	0	0	1.282301129	4.755013824	11.94767442	0.4841733	0	0.578071538	1.083527197	3.996371392	0	0	0	0	0	0.30624135	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7956	NO	"$500 copay per admit, unlimited coverage"	$500 copay per admit	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$20 - $25 copay	$20 - $25 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay for other"	"$35 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams"	"$35 Specialist, $10 Screening/Exams"	$50 copay	$25 copay	$20 - $25 copay	$0 - $35 copay	20% coinsurance	$35 copay	Not Covered	Not Covered	$35 copay	$100 every two year	$35 copay	$350 every three years	Not Covered	Not Covered												0.4021	0.3572	0.4712	0	0.1164	0	0.8051	0.202	0.0406	0.0547	0.0355	0	0	0.0685	0	2.4832	0.0961	0	0.0243	0.2526	0.1333	0	0	0	0	0	0	0	0	0											5.5429	300	0.206430583	4.7236	0.526737604	4.299940647	0	0.670434103	0	3.595463748	1.416882012	0.959127639	1.034749835	1.620143896	0	0	1.35082666	4.755013824	14.43085659	0.580251806	0	0.602371202	1.336151574	4.129709938	0	0	0	0	0	0.30624135	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3385
H2320_011_0	2010	6	N/A																															A	A	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	169.5599345	10.1566248	682.6750957	672.4076644	121.0989332	0	14.54958749	751.1151295	319.5548188	3689.592749	1746.067797	5.708151346	0	2052.532884	3654.574262	5781.907361	193.6224657	0	2364.996108	3523.841999	23.76432669	0	0	0	0	0	0	0	0	0											3400	"$600 copay per admit, unlimited coverage"	$600 copay per admit	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$10 - $35 copay	$10 - $35 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$15 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$40 Specialist, $0 Screening/Exams"	$40 copay	$30 copay	$10 - $35 copay	$0 - $40 copay	0% - 20% coinsurance	$40 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											600	600	51.60168196	0	50	0	0.157451974	19.99923185	69.58565128	3.343937081	11.65115581	0	0	11.12521609	13.72222077	29.47786734	22.20594769	0	2.730531425	4.430484224	0.179855541	0	0	0	0	0	0	0	0	0											YES	578.4570718	578.4570718	49.74892975	0	48.20475599	0	0.15179868	19.28116182	67.0871868	3.22387342	11.23282245	0	0	10.72576654	13.22952607	28.41946804	21.40864579	0	2.632492021	4.271408219	0.17339785	0	0	0	0	0	0	0	0	0											3400	8.1736	0.48959762	2.830196281	0	0.486462044	0	2.208608177	1.206864363	1.786502818	0.991231666	1.634439129	0	0	1.834582378	4.02902379	13.69322762	0.345432899	0	0.518819449	1.254313973	4.120683148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6036	0	1.698370905	8.1736	0.48959762	2.830196281	0	0.486462044	0	2.208608177	1.206864363	1.786502818	0.991231666	1.634439129	0	0	1.834582378	4.02902379	13.69322762	0.345432899	0	0.518819449	1.254313973	4.120683148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6036	NO	"$700 copay per admit, unlimited coverage"	$700 copay per admit	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$100 copay	$20 - $40 copay	$20 - $40 copay	$100 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay"	"$45 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams"	"$45 Specialist, $10 Screening/Exams"	$50 copay	$35 copay	$20 - $40 copay	$0 - $45 copay	20% coinsurance	$45 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.3999	0.6017	0.1737	0	0.0601	0	0.8075	0.1776	0.0494	0.0653	0.0529	0	0	0.1358	0	2.549	0.1165	0	0.0301	0.177	0.107	0	0	0	0	0	0	0	0	0											5.5034	500	0.204959253	8.5735	1.091287273	3.003931915	0	0.546516964	0	3.016085848	1.384453348	1.835897627	1.056519075	1.687293141	0	0	1.970398337	4.02902379	16.24225871	0.461978864	0	0.548881077	1.431281183	4.2277067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.107
H2320_012_0	2010	6	N/A																															A	A	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	172.1583106	10.3122673	688.5367722	579.1043768	122.8238149	0	14.82372339	649.4570813	276.3053648	3190.23282	1509.750037	4.935593982	0	1774.737272	3706.628462	5864.262389	196.3803417	0	2398.682106	3574.034104	24.21208201	0	0	0	0	0	0	0	0	0											3400	"$600 copay per admit, unlimited coverage"	$600 copay per admit	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$10 - $35 copay	$10 - $35 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$15 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$40 Specialist, $0 Screening/Exams"	$40 copay	$30 copay	$10 - $35 copay	$0 - $40 copay	0% - 20% coinsurance	$40 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											600	600	51.60168196	0	50	0	0.157451974	19.99923185	69.58565128	3.343937081	11.65115581	0	0	11.1274466	13.72222077	29.47786734	22.20594769	0	2.730531425	4.430484224	0.179855541	0	0	0	0	0	0	0	0	0											YES	578.4570718	578.4570718	49.74892975	0	48.20475599	0	0.15179868	19.28116182	67.0871868	3.22387342	11.23282245	0	0	10.72791696	13.22952607	28.41946804	21.40864579	0	2.632492021	4.271408219	0.17339785	0	0	0	0	0	0	0	0	0											3400	8.2988	0.497100329	2.854497292	0	0.493391002	0	2.250221645	1.043523924	1.544712469	0.857075566	1.41322951	0	0	1.58660284	4.08641149	13.88826813	0.350353098	0	0.526209292	1.272179887	4.198322957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1609	0	1.681886387	8.2988	0.497100329	2.854497292	0	0.493391002	0	2.250221645	1.043523924	1.544712469	0.857075566	1.41322951	0	0	1.58660284	4.08641149	13.88826813	0.350353098	0	0.526209292	1.272179887	4.198322957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1609	NO	"$700 copay per admit, unlimited coverage"	$700 copay per admit	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$100 copay	$20 - $40 copay	$20 - $40 copay	$100 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay"	"$45 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams"	"$45 Specialist, $10 Screening/Exams"	$50 copay	$35 copay	$20 - $40 copay	$0 - $45 copay	20% coinsurance	$45 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.406	0.6109	0.1752	0	0.0609	0	0.8227	0.1536	0.0427	0.0565	0.0457	0	0	0.1174	0	2.5853	0.1182	0	0.0305	0.1795	0.109	0	0	0	0	0	0	0	0	0											5.5142	500	0.205359629	8.7049	1.108010415	3.029724678	0	0.554301319	0	3.072913398	1.197077512	1.587422044	0.913526792	1.45893011	0	0	1.704037083	4.08641149	16.47360653	0.468559094	0	0.556699105	1.451667743	4.307362992	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6751
H2320_013_0	2010	8	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	722.8003884	55.42383334	764.7124878	688.5093787	117.8554531	0	11.54235299	540.0704031	235.4026177	2605.874712	1293.354623	4.835881529	0	1415.795328	3756.215971	5754.773706	191.9877094	0	2394.173263	3533.998958	22.31909816	0	0	0	0	302.6306507	111.5755738	21.47467361	0	0											3400	"$75 days 1-5, $0 days 6+, unlimited coverage"	"$75 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$50 copay	$10 - $20 copay	$15 - $20 copay	$50 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$10 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$30 Specialist, $0 Screening/Exams"	$40 copay	$20 copay	$15 - $20 copay	$0 - $30 copay	0% - 20% coinsurance	$30 copay	Not Covered	Not Covered	$30 copay	$100 every two years	$30 copay	$350 every three years	Not Covered	Not Covered											61.26108682	26.87136243	51.60168196	0	50	0	0.157451974	19.99923185	46.38281537	3.343937081	10.47054278	0	0	7.192343924	9.141245122	22.12032549	22.20594769	0	2.843080616	3.900190964	0.179855541	0	0	0	0	0	30	0	0	0											YES	59.06151483	25.90654938	49.74892975	0	48.20475599	0	0.15179868	19.28116182	44.71744594	3.22387342	10.09459919	0	0	6.934103677	8.813029811	21.32609786	21.40864579	0	2.741000147	3.760155075	0.17339785	0	0	0	0	0	28.92285359	0	0	0											3400	3.5575	0.119653356	3.170302319	0	0.47343278	0	1.75211395	0.867765403	0.877216986	0.700084185	1.087991378	0	0	0.818105966	2.758636944	10.22723893	0.342516406	0	0.546869105	1.107365343	3.870083628	0	0	0	0	0	0.268923666	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5458	0	1.212071403	3.5575	0.119653356	3.170302319	0	0.47343278	0	1.75211395	0.867765403	0.877216986	0.700084185	1.087991378	0	0	0.818105966	2.758636944	10.22723893	0.342516406	0	0.546869105	1.107365343	3.870083628	0	0	0	0	0	0.268923666	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5458	NO	"$175 days 1-5, $0 days 6+, unlimited coverage"	"$175 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$20 - $25 copay	$20 - $25 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay for other"	"$35 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams"	"$35 Specialist, $10 Screening/Exams"	$50 copay	$25 copay	$20 - $25 copay	$0 - $35 copay	20% coinsurance	$35 copay	Not Covered	Not Covered	$35 copay	$100 every two years	$35 copay	$350 every three years	Not Covered	Not Covered												0.2007	0.3461	0.2656	0	0.0537	0	0.2633	0.1365	0.0222	0.0459	0.0338	0	0	0.0769	0	1.9568	0.1497	0	0.0232	0.1512	0.1127	0	0	0	0	0	0	0	0	0											3.8381	400	0.142938972	3.7581	0.465721451	3.435860454	0	0.527102593	0	2.015364033	1.0042732	0.89946411	0.746021272	1.121812279	0	0	0.89499531	2.758636944	12.18400434	0.492213998	0	0.570034478	1.25856329	3.982747545	0	0	0	0	0	0.268923666	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3839
H2320_014_0	2010	6	N/A																															A	A	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	188.2177997	6.280790908	950.1561414	1061.767778	145.8157616	0	21.49261867	604.4744434	249.2846087	3152.766364	1392.680271	3.258622336	0	1783.990634	4231.010584	7126.773653	225.8391695	0	2677.312294	4210.904311	27.97605204	0	0	0	0	377.0200788	139.0018874	26.75334808	0	0											3400	"$250 copay per admit, unlimited coverage"	$250 copay per admit	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$50 copay	$10 - $20 copay	$15 - $20 copay	$50 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$15 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$30 Specialist, $0 Screening/Exams"	$40 copay	$20 copay	$15 - $20 copay	$0 - $30 copay	0% - 20% coinsurance	$30 copay	Not Covered	Not Covered	$30 copay	$100 every two yearx	$30 copay	$350 every three years	Not Covered	Not Covered											250	250	51.60168196	0	50	0	0.157451974	19.99923185	46.40522876	3.343937081	11.19517002	0	0	7.94137295	13.7423554	22.07325055	22.20594769	0	2.854750054	3.871661319	0.179855541	0	0	0	0	0	30	0	0	0											YES	241.0237799	241.0237799	49.74892975	0	48.20475599	0	0.15179868	19.28116182	44.73905458	3.22387342	10.79320878	0	0	7.656238905	13.24893777	21.28071313	21.40864579	0	2.752250595	3.732649783	0.17339785	0	0	0	0	0	28.92285359	0	0	0											3400	3.7804	0.126151664	3.93910426	0	0.585751101	0	3.262551147	0.971247463	0.929396476	0.847009973	1.252624078	0	0	1.138221541	4.67136633	12.63856881	0.402909232	0	0.614052863	1.309819255	4.850987266	0	0	0	0	0	0.335027603	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6552	0	1.551325216	3.7804	0.126151664	3.93910426	0	0.585751101	0	3.262551147	0.971247463	0.929396476	0.847009973	1.252624078	0	0	1.138221541	4.67136633	12.63856881	0.402909232	0	0.614052863	1.309819255	4.850987266	0	0	0	0	0	0.335027603	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6552	NO	"$500 copay per admit, unlimited coverage"	$500 copay per admit	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$20 - $25 copay	$20 - $25 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay for other"	"$35 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams"	"$35 Specialist, $10 Screening/Exams"	$50 copay	$25 copay	$20 - $25 copay	$0 - $35 copay	20% coinsurance	$35 copay	Not Covered	Not Covered	$35 copay	$100 every two year	$35 copay	$350 every three years	Not Covered	Not Covered												0.5294	0.0951	0.0959	0	0.0821	0	1.9687	0.1248	0.0393	0.0561	0.0341	0	0	0.0645	0	2.4677	0.0657	0	0.035	0.1942	0.101	0	0	0	0	0	0	0	0	0											5.9539	300	0.221734438	4.3098	0.221282427	4.035024007	0	0.667885941	0	5.23128472	1.096034873	0.96866675	0.903153046	1.286739386	0	0	1.202744092	4.67136633	15.10623864	0.468651997	0	0.649074632	1.504068304	4.951995729	0	0	0	0	0	0.335027603	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6091
H2320_015_0	2010	6	N/A																															A	A	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	170.6901746	10.22432608	826.8166093	812.0383786	127.2236423	0	14.82357295	562.1143673	239.1462343	2761.19201	1306.710191	4.271826989	0	1536.060423	3839.408293	6074.333557	203.4151306	0	2484.608335	3702.064105	24.21183628	0	0	0	0	0	0	0	0	0											3400	"$600 copay per admit, unlimited coverage"	$600 copay per admit	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$10 - $35 copay	$10 - $35 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$15 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$40 Specialist, $0 Screening/Exams"	$40 copay	$30 copay	$10 - $35 copay	$0 - $40 copay	0% - 20% coinsurance	$40 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											600	600	51.60168196	0	50	0	0.157451974	19.99923185	69.58565128	3.343937081	11.65115581	0	0	11.12672306	13.72222077	29.47786734	22.20594769	0	2.730531425	4.430484224	0.179855541	0	0	0	0	0	0	0	0	0											YES	578.4570718	578.4570718	49.74892975	0	48.20475599	0	0.15179868	19.28116182	67.0871868	3.22387342	11.23282245	0	0	10.72721941	13.22952607	28.41946804	21.40864579	0	2.632492021	4.271408219	0.17339785	0	0	0	0	0	0	0	0	0											3400	8.2281	0.492861144	3.427770118	0	0.511065386	0	2.250198808	0.90318484	1.336970675	0.741811127	1.223170298	0	0	1.373138098	4.23279601	14.38577737	0.36290354	0	0.545059302	1.317752254	4.198280349	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5308	0	1.695661058	8.2281	0.492861144	3.427770118	0	0.511065386	0	2.250198808	0.90318484	1.336970675	0.741811127	1.223170298	0	0	1.373138098	4.23279601	14.38577737	0.36290354	0	0.545059302	1.317752254	4.198280349	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5308	NO	"$700 copay per admit, unlimited coverage"	$700 copay per admit	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$100 copay	$20 - $40 copay	$20 - $40 copay	$100 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay"	"$45 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams"	"$45 Specialist, $10 Screening/Exams"	$50 copay	$35 copay	$20 - $40 copay	$0 - $45 copay	20% coinsurance	$45 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.4026	0.6057	0.2104	0	0.0631	0	0.8227	0.1329	0.037	0.0489	0.0396	0	0	0.1016	0	2.678	0.1224	0	0.0316	0.1859	0.109	0	0	0	0	0	0	0	0	0											5.5913	500	0.208232276	8.6307	1.098561495	3.638188673	0	0.574157649	0	3.072882211	1.036087661	1.373936421	0.790670468	1.26272482	0	0	1.47477911	4.23279601	17.06372845	0.485343943	0	0.576641329	1.503669771	4.307319277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1221
H2320_016_0	2010	6	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	953.431179	57.11044174	668.5433363	656.7437349	131.2032966	0	15.32824452	840.6349837	359.4556254	4184.09363	1991.633302	6.471430727	0	2301.442229	4086.96405	6408.809319	209.7781139	0	2576.206704	3885.209877	25.03613321	0	0	0	0	337.7817206	124.5352684	23.96899384	0	0											3400	"$75 days 1-5, $0 days 6+, unlimited coverage"	"$75 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$50 copay	$10 - $20 copay	$15 - $20 copay	$50 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$10 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$30 Specialist, $0 Screening/Exams"	$40 copay	$20 copay	$15 - $20 copay	$0 - $30 copay	0% - 20% coinsurance	$30 copay	Not Covered	Not Covered	$30 copay	$100 every two years	$30 copay	$350 every three years	Not Covered	Not Covered											61.26108682	26.87136243	51.60168196	0	50	0	0.157451974	19.99923185	46.39043418	3.343937081	10.72087131	0	0	7.459850763	9.148751493	22.10263137	22.20594769	0	2.847212195	3.890537795	0.179855541	0	0	0	0	0	30	0	0	0											YES	59.06151483	25.90654938	49.74892975	0	48.20475599	0	0.15179868	19.28116182	44.7247912	3.22387342	10.33593971	0	0	7.192005715	8.820266666	21.30903904	21.40864579	0	2.744983382	3.750848501	0.17339785	0	0	0	0	0	28.92285359	0	0	0											3400	4.6926	0.12329454	2.771609622	0	0.527051908	0	2.326807287	1.350701596	1.339714816	1.124082354	1.715450145	0	0	1.379332139	3.004009398	11.380464	0.374255445	0	0.589303716	1.214402804	4.341211664	0	0	0	0	0	0.300159611	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5544	0	1.435846515	4.6926	0.12329454	2.771609622	0	0.527051908	0	2.326807287	1.350701596	1.339714816	1.124082354	1.715450145	0	0	1.379332139	3.004009398	11.380464	0.374255445	0	0.589303716	1.214402804	4.341211664	0	0	0	0	0	0.300159611	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5544	NO	"$175 days 1-5, $0 days 6+, unlimited coverage"	"$175 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$20 - $25 copay	$20 - $25 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay for other"	"$35 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams"	"$35 Specialist, $10 Screening/Exams"	$50 copay	$25 copay	$20 - $25 copay	$0 - $35 copay	20% coinsurance	$35 copay	Not Covered	Not Covered	$35 copay	$100 every two years	$35 copay	$350 every three years	Not Covered	Not Covered												0.4592	0.303	0.1701	0	0.0651	0	0.8507	0.1988	0.0417	0.074	0.0509	0	0	0.1091	0	2.1942	0.1263	0	0.028	0.171	0.1128	0	0	0	0	0	0	0	0	0											4.9549	400	0.184530497	5.1518	0.426339513	2.94174883	0	0.592117746	0	3.177499116	1.549456098	1.381386638	1.198119964	1.76639314	0	0	1.488456743	3.004009398	13.57462192	0.500525878	0	0.617336321	1.385426757	4.453962845	0	0	0	0	0	0.300159611	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5093
H2320_017_0	2010	6	N/A																															A	A	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	192.5443874	11.53339146	668.5433363	656.7437349	131.2032966	0	15.32824452	840.6349837	359.4556254	4151.234256	1975.992203	6.471430727	0	2301.442229	3959.507967	6408.809319	209.7781139	0	2555.974714	3869.667851	25.03613321	0	0	0	0	337.7817206	124.5352684	23.96899384	0	0											3400	"$250 copay per admit, unlimited coverage"	$250 copay per admit	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$50 copay	$10 - $20 copay	$15 - $20 copay	$50 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$15 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$30 Specialist, $0 Screening/Exams"	$40 copay	$20 copay	$15 - $20 copay	$0 - $30 copay	0% - 20% coinsurance	$30 copay	Not Covered	Not Covered	$30 copay	$100 every two yearx	$30 copay	$350 every three years	Not Covered	Not Covered											250	250	51.60168196	0	50	0	0.157451974	19.99923185	46.39043418	3.343937081	10.72087131	0	0	7.459850763	13.72222077	22.10263137	22.20594769	0	2.847212195	3.888256315	0.179855541	0	0	0	0	0	30	0	0	0											YES	241.0237799	241.0237799	49.74892975	0	48.20475599	0	0.15179868	19.28116182	44.7247912	3.22387342	10.33593971	0	0	7.192005715	13.22952607	21.30903904	21.40864579	0	2.744983382	3.748648937	0.17339785	0	0	0	0	0	28.92285359	0	0	0											3400	3.8673	0.2316518	2.771609622	0	0.527051908	0	2.326807287	1.350701596	1.339714816	1.115254482	1.701978023	0	0	1.379332139	4.365201157	11.380464	0.374255445	0	0.584675676	1.208835523	4.341211664	0	0	0	0	0	0.300159611	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1662	0	1.458630367	3.8673	0.2316518	2.771609622	0	0.527051908	0	2.326807287	1.350701596	1.339714816	1.115254482	1.701978023	0	0	1.379332139	4.365201157	11.380464	0.374255445	0	0.584675676	1.208835523	4.341211664	0	0	0	0	0	0.300159611	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1662	NO	"$500 copay per admit, unlimited coverage"	$500 copay per admit	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$20 - $25 copay	$20 - $25 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay for other"	"$35 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams"	"$35 Specialist, $10 Screening/Exams"	$50 copay	$25 copay	$20 - $25 copay	$0 - $35 copay	20% coinsurance	$35 copay	Not Covered	Not Covered	$35 copay	$100 every two year	$35 copay	$350 every three years	Not Covered	Not Covered												0.3244	0.488	0.1701	0	0.0651	0	0.8507	0.1988	0.0417	0.0735	0.0505	0	0	0.1091	0	2.1942	0.1263	0	0.0278	0.1703	0.1128	0	0	0	0	0	0	0	0	0											5.0032	300	0.186329073	4.1917	0.719688106	2.94174883	0	0.592117746	0	3.177499116	1.549456098	1.381386638	1.188710645	1.752520943	0	0	1.488456743	4.365201157	13.57462192	0.500525878	0	0.61248813	1.379181728	4.453962845	0	0	0	0	0	0.300159611	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1694
H2320_018_0	2010	6	N/A																															A	A	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	191.1898038	11.45225203	668.5433363	656.7437349	131.2032966	0	15.32824452	840.6349837	357.640193	4129.328007	1954.168697	6.388463666	0	2297.15909	3959.507967	6264.343428	209.7781139	0	2562.328814	3817.867546	25.03613321	0	0	0	0	0	0	0	0	0											3400	"$600 copay per admit, unlimited coverage"	$600 copay per admit	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$10 - $35 copay	$10 - $35 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$15 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$40 Specialist, $0 Screening/Exams"	$40 copay	$30 copay	$10 - $35 copay	$0 - $40 copay	0% - 20% coinsurance	$40 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											600	600	51.60168196	0	50	0	0.157451974	19.99923185	69.58565128	3.343937081	11.65115581	0	0	11.10960739	13.72222077	29.47786734	22.20594769	0	2.730531425	4.430484224	0.179855541	0	0	0	0	0	0	0	0	0											YES	578.4570718	578.4570718	49.74892975	0	48.20475599	0	0.15179868	19.28116182	67.0871868	3.22387342	11.23282245	0	0	10.71071827	13.22952607	28.41946804	21.40864579	0	2.632492021	4.271408219	0.17339785	0	0	0	0	0	0	0	0	0											3400	9.2163	0.552053014	2.771609622	0	0.527051908	0	2.326807287	1.350701596	1.999422869	1.109369234	1.829235835	0	0	2.050351986	4.365201157	14.83577565	0.374255445	0	0.56210918	1.358972568	4.341211664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5704	0	1.846102908	9.2163	0.552053014	2.771609622	0	0.527051908	0	2.326807287	1.350701596	1.999422869	1.109369234	1.829235835	0	0	2.050351986	4.365201157	14.83577565	0.374255445	0	0.56210918	1.358972568	4.341211664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.5704	NO	"$700 copay per admit, unlimited coverage"	$700 copay per admit	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$100 copay	$20 - $40 copay	$20 - $40 copay	$100 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay"	"$45 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams"	"$45 Specialist, $10 Screening/Exams"	$50 copay	$35 copay	$20 - $40 copay	$0 - $45 copay	20% coinsurance	$45 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.4509	0.6784	0.1701	0	0.0651	0	0.8507	0.1988	0.0553	0.0731	0.0592	0	0	0.152	0	2.7617	0.1263	0	0.0326	0.1917	0.1128	0	0	0	0	0	0	0	0	0											5.9786	500	0.222654132	9.6672	1.230497052	2.94174883	0	0.592117746	0	3.177499116	1.549456098	2.05470468	1.182437765	1.888389125	0	0	2.202354843	4.365201157	17.59749513	0.500525878	0	0.594679118	1.550705729	4.453962845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.549
H2320_019_0	2010	6	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	1212.660525	72.63825623	1042.595181	932.254414	172.3111702	0	22.04912907	559.2469843	239.1340813	2783.540764	1324.968553	4.305231388	0	1531.074308	5367.468473	8416.781148	275.504604	0	3383.369193	5102.501825	35.57587044	0	0	0	0	443.6135757	163.5539531	31.4788232	0	0											3400	"$75 days 1-5, $0 days 6+, unlimited coverage"	"$75 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$50 copay	$10 - $20 copay	$15 - $20 copay	$50 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$10 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$30 Specialist, $0 Screening/Exams"	$40 copay	$20 copay	$15 - $20 copay	$0 - $30 copay	0% - 20% coinsurance	$30 copay	Not Covered	Not Covered	$30 copay	$100 every two years	$30 copay	$350 every three years	Not Covered	Not Covered											61.26108682	26.87136243	51.60168196	0	50	0	0.157451974	19.99923185	46.39043418	3.343937081	10.72087131	0	0	7.492863415	9.148751493	22.10263137	22.20594769	0	2.847212195	3.890537795	0.179855541	0	0	0	0	0	30	0	0	0											YES	59.06151483	25.90654938	49.74892975	0	48.20475599	0	0.15179868	19.28116182	44.7247912	3.22387342	10.33593971	0	0	7.223833052	8.820266666	21.30903904	21.40864579	0	2.744983382	3.750848501	0.17339785	0	0	0	0	0	28.92285359	0	0	0											3400	5.9685	0.156817214	4.322332867	0	0.692184826	0	3.347028691	0.898577634	0.891268488	0.747815257	1.141232924	0	0	0.921685433	3.945208604	14.9461265	0.49151504	0	0.773941018	1.59489261	6.168779435	0	0	0	0	0	0.39420392	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4021	0	1.765350505	5.9685	0.156817214	4.322332867	0	0.692184826	0	3.347028691	0.898577634	0.891268488	0.747815257	1.141232924	0	0	0.921685433	3.945208604	14.9461265	0.49151504	0	0.773941018	1.59489261	6.168779435	0	0	0	0	0	0.39420392	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4021	NO	"$175 days 1-5, $0 days 6+, unlimited coverage"	"$175 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$20 - $25 copay	$20 - $25 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay for other"	"$35 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams"	"$35 Specialist, $10 Screening/Exams"	$50 copay	$25 copay	$20 - $25 copay	$0 - $35 copay	20% coinsurance	$35 copay	Not Covered	Not Covered	$35 copay	$100 every two years	$35 copay	$350 every three years	Not Covered	Not Covered												0.5894	0.389	0.2678	0	0.0862	0	1.1863	0.1334	0.028	0.0497	0.0342	0	0	0.0733	0	2.9082	0.1674	0	0.0372	0.2267	0.1617	0	0	0	0	0	0	0	0	0											6.3384	400	0.236053657	6.5579	0.545807001	4.590108947	0	0.778423672	0	4.533335183	1.032020201	0.919246696	0.79752366	1.175435742	0	0	0.99495103	3.945208604	17.85428312	0.658875007	0	0.811095684	1.821569293	6.330472206	0	0	0	0	0	0.39420392	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7404
H2320_020_0	2010	6	N/A																															A	A	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	221.9475594	13.29463881	1042.595181	932.254414	172.3111702	0	22.04912907	559.2469843	239.1340813	2761.680496	1314.563041	4.305231388	0	1531.074308	5200.078571	8416.781148	275.504604	0	3356.798231	5082.09026	35.57587044	0	0	0	0	443.6135757	163.5539531	31.4788232	0	0											3400	"$250 copay per admit, unlimited coverage"	$250 copay per admit	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$50 copay	$10 - $20 copay	$15 - $20 copay	$50 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$15 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$30 Specialist, $0 Screening/Exams"	$40 copay	$20 copay	$15 - $20 copay	$0 - $30 copay	0% - 20% coinsurance	$30 copay	Not Covered	Not Covered	$30 copay	$100 every two yearx	$30 copay	$350 every three years	Not Covered	Not Covered											250	250	51.60168196	0	50	0	0.157451974	19.99923185	46.39043418	3.343937081	10.72087131	0	0	7.492863415	13.72222077	22.10263137	22.20594769	0	2.847212195	3.888256315	0.179855541	0	0	0	0	0	30	0	0	0											YES	241.0237799	241.0237799	49.74892975	0	48.20475599	0	0.15179868	19.28116182	44.7247912	3.22387342	10.33593971	0	0	7.223833052	13.22952607	21.30903904	21.40864579	0	2.744983382	3.748648937	0.17339785	0	0	0	0	0	28.92285359	0	0	0											3400	4.4579	0.267027008	4.322332867	0	0.692184826	0	3.347028691	0.898577634	0.891268488	0.741942362	1.132270362	0	0	0.921685433	5.732881253	14.9461265	0.49151504	0	0.767862947	1.587581021	6.168779435	0	0	0	0	0	0.39420392	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7612	0	1.778723381	4.4579	0.267027008	4.322332867	0	0.692184826	0	3.347028691	0.898577634	0.891268488	0.741942362	1.132270362	0	0	0.921685433	5.732881253	14.9461265	0.49151504	0	0.767862947	1.587581021	6.168779435	0	0	0	0	0	0.39420392	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7612	NO	"$500 copay per admit, unlimited coverage"	$500 copay per admit	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$20 - $25 copay	$20 - $25 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay for other"	"$35 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams"	"$35 Specialist, $10 Screening/Exams"	$50 copay	$25 copay	$20 - $25 copay	$0 - $35 copay	20% coinsurance	$35 copay	Not Covered	Not Covered	$35 copay	$100 every two year	$35 copay	$350 every three years	Not Covered	Not Covered												0.3773	0.5677	0.2678	0	0.0862	0	1.1863	0.1334	0.028	0.0493	0.0339	0	0	0.0733	0	2.9082	0.1674	0	0.0369	0.2258	0.1617	0	0	0	0	0	0	0	0	0											6.3032	300	0.234744148	4.8352	0.834771415	4.590108947	0	0.778423672	0	4.533335183	1.032020201	0.919246696	0.791260385	1.166204571	0	0	0.99495103	5.732881253	17.85428312	0.658875007	0	0.804725823	1.81335941	6.330472206	0	0	0	0	0	0.39420392	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0644
H2320_021_0	2010	6	N/A																															A	A	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	220.3861193	13.20110869	1042.595181	932.254414	172.3111702	0	22.04912907	559.2469843	237.9263334	2747.106985	1300.044575	4.250036114	0	1528.224876	5200.078571	8227.052023	275.504604	0	3365.143162	5014.060176	35.57587044	0	0	0	0	0	0	0	0	0											3400	"$600 copay per admit, unlimited coverage"	$600 copay per admit	"$0 copay days 1-20, $120 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	20% coinsurance	"20% coinsurance, 0% Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$75 copay	$10 - $35 copay	$10 - $35 copay	$75 copay	$10 copay	"40% for Partial Hosp, $0 - $40 copay for other"	"$15 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$40 Specialist, $0 Screening/Exams"	$40 copay	$30 copay	$10 - $35 copay	$0 - $40 copay	0% - 20% coinsurance	$40 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											600	600	51.60168196	0	50	0	0.157451974	19.99923185	69.58565128	3.343937081	11.65115581	0	0	11.14268159	13.72222077	29.47786734	22.20594769	0	2.730531425	4.430484224	0.179855541	0	0	0	0	0	0	0	0	0											YES	578.4570718	578.4570718	49.74892975	0	48.20475599	0	0.15179868	19.28116182	67.0871868	3.22387342	11.23282245	0	0	10.74260495	13.22952607	28.41946804	21.40864579	0	2.632492021	4.271408219	0.17339785	0	0	0	0	0	0	0	0	0											3400	10.6237	0.636356223	4.322332867	0	0.692184826	0	3.347028691	0.898577634	1.330150698	0.738027099	1.216930825	0	0	1.368093009	5.732881253	19.48403684	0.49151504	0	0.738226044	1.784758154	6.168779435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5735	0	2.21864077	10.6237	0.636356223	4.322332867	0	0.692184826	0	3.347028691	0.898577634	1.330150698	0.738027099	1.216930825	0	0	1.368093009	5.732881253	19.48403684	0.49151504	0	0.738226044	1.784758154	6.168779435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5735	NO	"$700 copay per admit, unlimited coverage"	$700 copay per admit	"$0 copay days 1-20, $135 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$50 copay	30% coinsurance	"30% coinsurance, $10 Diab Mon Supp"	"$50 ER, $40 Urgent Care"	$100 copay	$20 - $40 copay	$20 - $40 copay	$100 copay	$10 copay	"40% for Partial Hosp, $0 - $50 copay"	"$45 PCP, $20 Physical Exam, $10 Immun/Screenings/Exams"	"$45 Specialist, $10 Screening/Exams"	$50 copay	$35 copay	$20 - $40 copay	$0 - $45 copay	20% coinsurance	$45 copay	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.5246	0.7893	0.2678	0	0.0862	0	1.1863	0.1334	0.0371	0.0491	0.0397	0	0	0.1021	0	3.6604	0.1674	0	0.0432	0.2541	0.1617	0	0	0	0	0	0	0	0	0											7.5023	500	0.279400259	11.1482	1.425606539	4.590108947	0	0.778423672	0	4.533335183	1.032020201	1.36726657	0.787084868	1.256645986	0	0	1.470146806	5.732881253	23.14444463	0.658875007	0	0.781394532	2.038883008	6.330472206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.0758
H2320_802_0	2010	5	N/A																															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	NO	214.1584213	1.426683592	37.73396534	15.42518252	4.06685122	0	18.73776399	10.01416165	29.98388302	15.01178811	32.21074908	0.094851832	0.019383122	38.13475824	39.66676163	66.06660342	1.172920536	0	17.58735993	69.84829129	28.57744484	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												16.4213	0.109395566	6.391335533	0	0.947576334	0	4.36589901	2.333299663	6.986244744	3.49774663	7.505104536	0.022100477	0.004516267	8.88539867	9.242355461	15.3935186	0.273290485	0	4.097854864	16.27465187	6.658544648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4101	146		16.4213	0.109395566	6.391335533	0	0.947576334	0	4.36589901	2.333299663	6.986244744	3.49774663	7.505104536	0.022100477	0.004516267	8.88539867	9.242355461	15.3935186	0.273290485	0	4.097854864	16.27465187	6.658544648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4101	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				2.2696	0.1074	0.1395	0	0.7519	0	0.2269	0.2272	0.473	0.1781	0.2771	0.0006	0	0.4131	0.0027	2.8373	0.1312	0	0.2641	2.7429	0.3816	0	0	0	0	0	0	0	0	0											11.4243			18.6909	0.21679882	6.530840668	0	1.699513594	0	4.59275465	2.56045571	7.459206824	3.675858815	7.782213026	0.022747452	0.004516267	9.298492621	9.245083104	18.23084547	0.404538107	0	4.361984197	19.01759534	7.040109671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8344
H2320_803_0	2010	5	N/A																															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	NO	155.7273994	0.922739241	24.1557259	8.663604682	3.02505356	0	17.77972735	7.406672187	33.83935501	12.60857022	25.7529878	0.013572544	0.081418241	25.09924594	34.58573027	57.35664386	1.135283793	0	18.39927442	67.51744496	26.71420728	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												11.9409	0.070754008	4.091468996	0	0.704837479	0	4.142676472	1.72575462	7.884569718	2.93779686	6.000446156	0.003162403	0.01897045	5.848124304	8.058475152	13.36409802	0.264521124	0	4.287030941	15.73156467	6.224410295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2996	146		11.9409	0.070754008	4.091468996	0	0.704837479	0	4.142676472	1.72575462	7.884569718	2.93779686	6.000446156	0.003162403	0.01897045	5.848124304	8.058475152	13.36409802	0.264521124	0	4.287030941	15.73156467	6.224410295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2996	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.8391	0.0272	0.3773	0	0.3211	0	0.3634	0.222	0.1632	0.099	0.1453	0.0027	0	0.1958	0	1.9491	0.0407	0	0.245	1.8864	0.1569	0	0	0	0	0	0	0	0	0											7.0342			12.78	0.097921383	4.468814449	0	1.025965738	0	4.506035464	1.947733991	8.047772684	3.03675414	6.145766811	0.005880004	0.01897045	6.043934716	8.058475152	15.31322686	0.305239091	0	4.532068377	17.61791936	6.381310394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3338
H2320_804_0	2010	4	N/A																															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	NO	181.6996856	1.565574415	28.8622809	10.20019821	4.770338003	0	19.06452834	8.833518693	33.61202911	13.5313826	27.71589006	0.041119191	0.066400842	28.90051842	35.49987612	67.61399154	1.384284073	0	19.00929076	75.93436852	27.78297566	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												13.9324	0.120045468	4.888659854	0	1.111488755	0	4.442035104	2.058209855	7.831602783	3.152812145	6.457802384	0.009580771	0.015471396	6.733820792	8.271471136	15.75406003	0.322538189	0	4.429164746	17.69270786	6.473433328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6973	146		13.9324	0.120045468	4.888659854	0	1.111488755	0	4.442035104	2.058209855	7.831602783	3.152812145	6.457802384	0.009580771	0.015471396	6.733820792	8.271471136	15.75406003	0.322538189	0	4.429164746	17.69270786	6.473433328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6973	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			13.9324	0.120045468	4.888659854	0	1.111488755	0	4.442035104	2.058209855	7.831602783	3.152812145	6.457802384	0.009580771	0.015471396	6.733820792	8.271471136	15.75406003	0.322538189	0	4.429164746	17.69270786	6.473433328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6973
H2320_805_0	2010	4	N/A																															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	NO	181.6996856	1.565574415	28.8622809	10.20019821	4.770338003	0	19.06452834	8.833518693	33.61202911	13.5313826	27.71589006	0.041119191	0.066400842	28.90051842	35.49987612	67.61399154	1.384284073	0	19.00929076	75.93436852	27.78297566	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												13.9324	0.120045468	4.888659854	0	1.111488755	0	4.442035104	2.058209855	7.831602783	3.152812145	6.457802384	0.009580771	0.015471396	6.733820792	8.271471136	15.75406003	0.322538189	0	4.429164746	17.69270786	6.473433328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6973	146		13.9324	0.120045468	4.888659854	0	1.111488755	0	4.442035104	2.058209855	7.831602783	3.152812145	6.457802384	0.009580771	0.015471396	6.733820792	8.271471136	15.75406003	0.322538189	0	4.429164746	17.69270786	6.473433328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6973	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			13.9324	0.120045468	4.888659854	0	1.111488755	0	4.442035104	2.058209855	7.831602783	3.152812145	6.457802384	0.009580771	0.015471396	6.733820792	8.271471136	15.75406003	0.322538189	0	4.429164746	17.69270786	6.473433328	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6973
H2322_001_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	V	V	V	P	V	P	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	NO	224.5538231	2.200667635	299.7651106	35.74219047	187.5983674	12.86849218	0	269.1412228	185.9954081	2.809194021	296.5225838	0	0	503.4344901	2828.513966	3139.655251	234.458024	58.71866776	0	1104.36867	31.12811131	0.285782665	0	0	26.42299904	0.653217519	0	0	0	0												1A IP Acute: $100 per day up to 5 days	1B IP Psych: $100 per day up to 5 days	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $75	8A OP Diagnostic Procedures/Tests: $75	8B OP Radiology: $75	9A OP Hospital: $75	12 Renal Dialysis: $25	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $75, 14E Prostate Screening: $75, 14F Colorectal Screening: $75, 14G Bone Mass Measurement: $75, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											309	309	139	0	75	0.2	0.2	50	75	0	75	0	0	46	15	30	30	15	0	30	0	0	0	0	0	0	0	0	0	0											NO	309	309	139	0	75	0.2	0.2	50	75	0	75	0	0	46	15	30	30	15	0	30	0	0	0	0	0	0	0	0	0	0												5.7823	0.056667192	3.472279197	0	1.172489797	2.573698436	0	1.121421762	1.162471301	0	1.853266149	0	0	1.929832212	3.535642457	7.849138128	0.58614506	0.073398335	0	2.760921674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9296	0	0	5.7823	0.056667192	3.472279197	0	1.172489797	2.573698436	0	1.121421762	1.162471301	0	1.853266149	0	0	1.929832212	3.535642457	7.849138128	0.58614506	0.073398335	0	2.760921674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9296	NO	1A IP Acute: $200 per day up to 5 days	1B IP Psych: $200 per day up to 5 days	"2 SNF: 100 for days 0-20, $145 for days 21-100 for days 21-100"	6 Home Health: 20%	10A Ambulance: 20%	11A DME: 50%	"11B Prosthetics/Medical Supplies: 50%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 20%, 9C OP Substance Abuse: 20%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: 20%, 14C Physical Exams: 20%, 14D Pap Smears and Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: 20%"	"7B Chiropractic: 20%, 7D Physician Specialist (excl. Radiology): 20%, 7F Podiatry: 20%"	"7E Mental Health: 20%, 7H Psychiatric: 20%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: 20%	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered):  50% of lens cost up to a retail maximum of $120 and Frames at 0% up to $68.	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: 20%, 13C Other 1 Copay20%, 13D Other 2 Copay20%, 13E Other 3 Copay20%"												1.6521	0.0162	0.434	0.5323	0.4968	0.9192	0	0.6348	0.9758	0.0264	0.4115	0	0	1.6902	0.8644	3.3674	0.0641	0.0356	0	1.9365	0.1811	0.1103	0	0	0	0	0	0	0	0											14.3486	0	0	7.4343	0.072857818	3.906237217	0.532282937	1.669320828	3.492876448	0	1.756205024	2.138286496	0.026397472	2.2647618	0	0	3.620011439	4.400010079	11.21653554	0.650224619	0.108977626	0	4.697468235	0.181095851	0.110316565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2782
H2322_004_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	V	V	V	P	V	P	O	O											7.0571	0.0335	0	0.4121	0.4853	0.4483	0	0.6328	1.0887	0.0261	0.428	0	0	1.7228	0.787	3.9579	0.0763	0.0307	0	1.9554	0.2473	0.0342	0	0	0	0	0	0	0.0018	0											19.4254	NO	275.8573928	3.544257838	530.6885873	21.74280622	278.9733477	18.82387507	0	310.9434097	260.6588882	5.557601725	350.9527597	0	0	618.7873383	3436.888168	4165.832759	329.6292583	67.38939029	0	1482.558455	69.68694625	1.571483341	0	0	20.15911053	1.27691032	0	0	0	0												1A IP Acute: $100 per day up to 5 days	1B IP Psych: $100 per day up to 5 days	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $75	8A OP Diagnostic Procedures/Tests: $75	8B OP Radiology: $75	9A OP Hospital: $75	12 Renal Dialysis: $25	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $35, 9D Cardiac Rehab: $0"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $75, 14E Prostate Screening: $75, 14F Colorectal Screening: $75, 14G Bone Mass Measurement: $75, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $35	"7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											309	309	139	0	75	0.2	0.2	50	75	0	75	0	0	49.6	20	35	35	15	0	35	0	0	0	0	0	0	0	0	0	0											NO	309	309	139	0	75	0.2	0.2	50	75	0	75	0	0	49.6	20	35	35	15	0	35	0	0	0	0	0	0	0	0	0	0												7.1033	0.091264639	6.147142803	0	1.743583423	3.764775014	0	1.295597541	1.629118051	0	2.193454748	0	0	2.557654332	5.728146947	12.15034555	0.96141867	0.084236738	0	4.324128827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7742	250	0	14.1604	0.124772877	6.147142803	0.412125099	2.228840006	4.213078676	0	1.928405946	2.717796542	0.026107713	2.621490485	0	0	4.280470216	6.515196422	16.10825127	1.037758424	0.114922363	0	6.279557899	0.247256737	0.034233871	0	0	0	0	0	0	0.001760069	0	0	0	0	0	0	0	0	0	0	0	69.1996	NO	1A IP Acute: $200 per day up to 5 days	1B IP Psych: $200 per day up to 5 days	"2 SNF: 100 for days 0-20, $145 for days 21-100 for days 21-100"	6 Home Health: 20%	10A Ambulance: 20%	11A DME: 25%	"11B Prosthetics/Medical Supplies: 25%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 20%, 9C OP Substance Abuse: 20%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: 20%, 14C Physical Exams: 20%, 14D Pap Smears and Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: 20%"	"7B Chiropractic: 20%, 7D Physician Specialist (excl. Radiology): 20%, 7F Podiatry: 20%"	"7E Mental Health: 20%, 7H Psychiatric: 20%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: 20%	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered):  50% of lens cost up to a retail maximum of $120 and Frames at 0% up to $68.	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: 20%, 13C Other 1 Copay20%, 13D Other 2 Copay20%, 13E Other 3 Copay20%"												3.0377	0.0309	0.7683	0.5533	0.6515	0.7363	0	0.8496	1.4616	0.0351	0.5747	0	0	2.313	1.0567	5.3137	0.1025	0.0412	0	2.6253	0.332	0.046	0	0	0	0	0.001	0	0.0003	0											20.5302	250	0	17.1981	0.155635379	6.915399548	0.96542209	2.880319392	4.949403308	0	2.777980472	4.179397722	0.061158525	3.196148241	0	0	6.593430152	7.571846712	21.42192261	1.14024807	0.156119233	0	8.90481179	0.579210331	0.080194425	0	0	0	0	0.001043781	0	0.002011508	0	0	0	0	0	0	0	0	0	0	0	89.7298
H2322_801_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	270.2107582	2.739493258	47.4446526	21.76540228	15.41577263	24.30402594	0	33.34139443	36.08803536	2.050969571	24.27148703	0	0	144.9395225	23.08551479	100.1807584	2.272362339	0.540246865	0	64.77296757	2.762686981	1.570488342	0	0	0	0	0	0	0	0												1A IP Acute: 7%	1B IP Psych: 7%	2 SNF: 17%	6 Home Health: $0	10A Ambulance: 23%	11A DME: 23%	"11B Prosthetics/Medical Supplies: 23%, 11C Diabetes Monitoring Supplies: 23%"	"4A ER: 23%, 4B Urgent Care: 23%"	9B ASC Services: 23%	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: 23%	9A OP Hospital: 23%	12 Renal Dialysis: 23%	"3 CORF: 23%, 5 Partial Hosp: 23%, 9C OP Substance Abuse: 23%, 9D Cardiac Rehab: 23%"	"7A PCP: 23%, 14B Immunizations: 23%, 14C Physical Exams: 23%, 14D Pap Smears and Pelvic Exams: 23%, 14E Prostate Screening: 23%, 14F Colorectal Screening: 23%, 14G Bone Mass Measurement: 23%, 14H Mammography: 23%, 14I Diabetes Monitoring: 23%, 14J Nutrition Therapy: 23%"	"7B Chiropractic: 23%, 7D Physician Specialist (excl. Radiology): 23%, 7F Podiatry: 23%"	"7E Mental Health: 23%, 7H Psychiatric: 23%"	"7C Occupational Therapy: 23%, 7I Physical and Speech Therapy: 23%"	7D Physician Specialist (Radiology): 23%	"7G Other Health Care: 23%, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 23%	"13A Blood: 23%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.9547	0.192169835	7.863910578	0	3.591875022	5.662838044	0	7.768544903	8.408512238	0.47787591	5.655256478	0	0	33.77090875	5.378924945	23.34211672	0.529460425	0.125877519	0	15.09210144	0.643706067	0.365923784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8247	0	0	18.9547	0.192169835	7.863910578	0	3.591875022	5.662838044	0	7.768544903	8.408512238	0.47787591	5.655256478	0	0	33.77090875	5.378924945	23.34211672	0.529460425	0.125877519	0	15.09210144	0.643706067	0.365923784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8247	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.9547	0.192169835	7.863910578	0	3.591875022	5.662838044	0	7.768544903	8.408512238	0.47787591	5.655256478	0	0	33.77090875	5.378924945	23.34211672	0.529460425	0.125877519	0	15.09210144	0.643706067	0.365923784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8247
H2322_803_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	270.2107582	2.739493258	47.4446526	21.76540228	15.41577263	24.30402594	0	33.34139443	36.08803536	2.050969571	24.27148703	0	0	144.9395225	23.08551479	100.1807584	2.272362339	0.540246865	0	64.77296757	2.762686981	1.570488342	0	0	0	0	0	0	0	0												1A IP Acute: 7%	1B IP Psych: 7%	2 SNF: 17%	6 Home Health: $0	10A Ambulance: 23%	11A DME: 23%	"11B Prosthetics/Medical Supplies: 23%, 11C Diabetes Monitoring Supplies: 23%"	"4A ER: 23%, 4B Urgent Care: 23%"	9B ASC Services: 23%	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: 23%	9A OP Hospital: 23%	12 Renal Dialysis: 23%	"3 CORF: 23%, 5 Partial Hosp: 23%, 9C OP Substance Abuse: 23%, 9D Cardiac Rehab: 23%"	"7A PCP: 23%, 14B Immunizations: 23%, 14C Physical Exams: 23%, 14D Pap Smears and Pelvic Exams: 23%, 14E Prostate Screening: 23%, 14F Colorectal Screening: 23%, 14G Bone Mass Measurement: 23%, 14H Mammography: 23%, 14I Diabetes Monitoring: 23%, 14J Nutrition Therapy: 23%"	"7B Chiropractic: 23%, 7D Physician Specialist (excl. Radiology): 23%, 7F Podiatry: 23%"	"7E Mental Health: 23%, 7H Psychiatric: 23%"	"7C Occupational Therapy: 23%, 7I Physical and Speech Therapy: 23%"	7D Physician Specialist (Radiology): 23%	"7G Other Health Care: 23%, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 23%	"13A Blood: 23%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.9547	0.192169835	7.863910578	0	3.591875022	5.662838044	0	7.768544903	8.408512238	0.47787591	5.655256478	0	0	33.77090875	5.378924945	23.34211672	0.529460425	0.125877519	0	15.09210144	0.643706067	0.365923784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8247	0	0	18.9547	0.192169835	7.863910578	0	3.591875022	5.662838044	0	7.768544903	8.408512238	0.47787591	5.655256478	0	0	33.77090875	5.378924945	23.34211672	0.529460425	0.125877519	0	15.09210144	0.643706067	0.365923784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8247	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.9547	0.192169835	7.863910578	0	3.591875022	5.662838044	0	7.768544903	8.408512238	0.47787591	5.655256478	0	0	33.77090875	5.378924945	23.34211672	0.529460425	0.125877519	0	15.09210144	0.643706067	0.365923784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8247
H2323_005_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	518.416093	31.50684646	309.9571152	3.260097163	60.25723896	8.627902944	41.89182343	18.16287228	25.29049267	14.87763407	7.912430298	0.468465294	0.720715837	84.42671236	112.3123268	156.2305105	11.78771439	1.200707441	29.97150496	47.65884919	3.866613174	5.02991543	19.88764119	0	0	0	0	0	0	0												1A IP Acute: Medicare Cost Sharing	1B IP Psych: Medicare Cost Sharing	2 SNF: $0	6 Home Health: Medicare Cost Sharing	10A Ambulance: Medicare Cost Sharing	11A DME: Medicare Cost Sharing	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Medicare Cost Sharing"	"4A ER, 4B Urgent Care: Medicare Cost Sharing"	9B ASC Services: Medicare Cost Sharing	8A OP Diagnostic Procedures/Tests: Medicare Cost Sharing	8B OP Radiology: Medicare Cost Sharing	9A OP Hospital: Medicare Cost Sharing	12 Renal Dialysis: Medicare Cost Sharing	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Medicare Cost Sharing"	"7A PCP, 14C Physical Exams: $0, 14B Immunizations,14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Medicare Cost Sharing"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Medicare Cost Sharing"	"7E Mental Health, 7H Psychiatric: Medicare Cost Sharing"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Medicare Cost Sharing"	7D Physician Specialist (Radiology): Medicare Cost Sharing	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Medicare Cost Sharing"	15 Part B Drugs: Medicare Cost Sharing	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Medicare Cost Sharing"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											0.072078451	0.072063068	0	0	0.23300294	0.232999984	0.232991228	0.233027349	0.233000022	0.233031445	0.233040363	0.233000207	0.233000013	0.233001388	0	0.232998115	0.233010557	0.233008736	0.233017081	0.232004549	0.233005352	0.232994197	0	0	0	0	0	0	0	0											NO	0.072078451	0.072063068	0	0	0.23300294	0.232999984	0.232991228	0.233027349	0.233000022	0.233031445	0.233040363	0.233000207	0.233000013	0.233001388	0	0.232998115	0.233010557	0.233008736	0.233017081	0.232004549	0.233005352	0.232994197	0	0	0	0	0	0	0	0												37.3666	2.270480016	0	0	14.04011386	2.010301245	9.760427387	4.232445981	5.89268534	3.466956569	1.84391563	0.109152511	0.1679268	19.67154112	0	36.40141442	2.746661896	0.279775323	6.983872609	11.05706981	0.900941565	1.171941107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.3743	0	0	37.3666	2.270480016	0	0	14.04011386	2.010301245	9.760427387	4.232445981	5.89268534	3.466956569	1.84391563	0.109152511	0.1679268	19.67154112	0	36.40141442	2.746661896	0.279775323	6.983872609	11.05706981	0.900941565	1.171941107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.3743	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	37.3666	2.270480016	0	0	14.04011386	2.010301245	9.760427387	4.232445981	5.89268534	3.466956569	1.84391563	0.109152511	0.1679268	19.67154112	0	36.40141442	2.746661896	0.279775323	6.983872609	11.05706981	0.900941565	1.171941107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.3743
H2323_006_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	2017.66	189.04	0	0	1372.88	0	0	332.28	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	1A IP Acute: $25 Per Day for days 1-20	1B IP Psych: $25 Per Day for days 1-20	2 SNF: $0	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	13B Acupuncture: Not Covered											25	25	0	0	50	0	0	49.59191044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	20.89421619	20.89421619	0	0	41.78843238	0	0	41.44736392	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												3.5131	0.329153552	0	0	4.780875254	0	0	1.147677507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7708	0	1.92	3.5131	0.329153552	0	0	4.780875254	0	0	1.147677507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7708	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.5131	0.329153552	0	0	4.780875254	0	0	1.147677507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.7708
H2323_007_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1864.77	167.63	0	0	1299.67	0	0	310.52	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	1A IP Acute: $25 Per Day for days 1-20	1B IP Psych: $25 Per Day for days 1-20	2 SNF: $0	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											25	25	0	0	50	0	0	49.57683885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	21.08958434	21.08958434	0	0	42.17916869	0	0	41.82219698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												3.2773	0.294603919	0	0	4.568250014	0	0	1.082219051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2223	0	1.71	3.2773	0.294603919	0	0	4.568250014	0	0	1.082219051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2223	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.2773	0.294603919	0	0	4.568250014	0	0	1.082219051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2223
H2323_008_0	2010	7	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	2716.31	156.47	1242.62	0	725.9	0	0	389.06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	1A IP Acute: $25 Per Day for days	1B IP Psych: $25 Per Day for days	2 SNF: $25 for days 100 days	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not covered	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											25	25	25	0	50	0	0	46.38898884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	18.43628779	18.43628779	18.43628779	0	36.87257558	0	0	34.20962994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												4.1732	0.240393829	1.909108328	0	2.230483551	0	0	1.109133219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6623	0	3.44	4.1732	0.240393829	1.909108328	0	2.230483551	0	0	1.109133219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6623	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 100 days	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.1732	0.240393829	1.909108328	0	2.230483551	0	0	1.109133219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6623
H2354_001_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	T	P	P	P	P	P	O																																																				0	NO	350.3268169	8.898128907	1391.236697		601.5126041	18.01482573	4.474608274	216.0685693	415.7217552					1.49189032	4821.849661	6118.071318	385.4780226	1298.011075							53.79531008		92.9468258															1A IP Acute: $400 per admit	1B IP Psych: $400 per admit	2 SNF: $0 per day for days 1-20 plus $100 per day for days 21-100	6 HH: $0	10A Ambulance: $50	11A DME: 20%	11B Prosthetics/Supplies: 20%	"4A ER: $50, 4B UC $35"	"9A Outpatient Hospital: $200, 9B ASC Services: $100"	8A OP Lab: $0	8B OP Radiology: $0	9A Outpatient Hospital: $0	12 Renal Dialysis: $0	3 CORF: $35	"7A PCP: $15, 14C Routine Physical Exams: $15, $35 Urgently needed care"	"7B Chiropractic: $35,  7D Physician Specialist: $35, 7F Podiatry: $35, 17A Medicare Covered Eye Exams: $35, 18A Medicare Covered Hearing Exams: $35"	"7E Mental Health: $35, 7H Psychiatric: $35, 9C Outpatient Substance Abuse: $35"	"7C Occupational Therapy: $35,  7I PT and ST: $35"	8B Prof Radiology: $0	Other Prof: $0	15 Part B: $0	Other Part B: $0			17A Routine Eye Exams: $35		18A Routine Hearing Exams: $35														400	400	31.02		50	0.2	0.2	48.69407513	192.726459					35	15.00749582	35	35	33.26726934							35		35														NO	400	400	31.02		50	0.2	0.2	48.69407513	192.726459					35	15.00749582	35	35	33.26726934							35		35															11.6776	0.296604297	3.596346862	0	2.506302517	3.602965146	0.894921655	0.876771596	6.67671515	0	0	0	0	0.004351347	6.030324053	17.84437468	1.124310899	3.598440336	0	0	0	0	0	0	0.156902988	0	0.271094909	0	0	0	0	0	0	0	0	0	0	0	0	0	59.158	0	0	11.6776	0.296604297	3.596346862	0	2.506302517	3.602965146	0.894921655	0.876771596	6.67671515	0	0	0	0	0.004351347	6.030324053	17.84437468	1.124310899	3.598440336	0	0	0	0	0	0	0.156902988	0	0.271094909	0	0	0	0	0	0	0	0	0	0	0	0	0	59.158	NO																																																																																		0	0	0	11.6776	0.296604297	3.596346862	0	2.506302517	3.602965146	0.894921655	0.876771596	6.67671515	0	0	0	0	0.004351347	6.030324053	17.84437468	1.124310899	3.598440336	0	0	0	0	0	0	0.156902988	0	0.271094909	0	0	0	0	0	0	0	0	0	0	0	0	0	59.158
H2354_013_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	T	P	P	P	P	P	O	O																																																			0	NO	342.1344795	5.506154634	1131.076259		408.7784114	24.92076916	6.099605628	266.3080558	455.7390469					1.963548446	5532.566291	7054.106064	405.9975666	1908.818742							62.4816255		114.07942															1A IP Acute: $300 per admit	1B IP Psych: $300 per admit	2 SNF: $0 per day for days 1-20 plus $50 per day for days 21-100	6 HH: $0	10A Ambulance: $25	11A DME: 20%	11B Prosthetics/Supplies: 20%	"4A ER: $50, 4B UC: $25"	"9A Outpatient Hospital: $100, 9B ASC Services: $50"	8A OP Lab: $0	8B OP Radiology: $0	9A Outpatient Hospital: $0	12 Renal Dialysis: $0	3 CORF: $25	"7A PCP: $10, 14C Routine Physical Exams: $10, 4B Urgent Care: $20"	"7B Chiropractic: $25,  7D Physician Specialist: $25, 7F Podiatry: $25, 17A Medicare Covered Eye Exams: $25, 18A Medicare Covered Hearing Exams: $25"	"7E Mental Health: $25, 7H Psychiatric: $25, 9C Outpatient Substance Abuse: $25"	"7C Occupational Therapy: $25,  7I PT and ST: $25"	8B Prof Radiology: $0	Other Prof: $0	15 Part B: $0	Other Part B: $0			17A Routine Eye Exams: $25	17B: $0	18A Routine Hearing Exams: $25														300	300	15.51		25	0.2	0.2	47.67577077	96.31230128					25	10.00618815	25	25	25							25		25														NO	300	300	15.51		25	0.2	0.2	47.67577077	96.31230128					25	10.00618815	25	25	25							25		25															8.5534	0.137653866	1.461916064	0	0.85162169	4.984153832	1.219921126	1.058036819	3.657773033	0	0	0	0	0.004090726	4.613324937	14.6960543	0.845828264	3.976705713	0	0	0	0	0	0	0.130170053	0	0.237665458	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4283	0	0	8.5534	0.137653866	1.461916064	0	0.85162169	4.984153832	1.219921126	1.058036819	3.657773033	0	0	0	0	0.004090726	4.613324937	14.6960543	0.845828264	3.976705713	0	0	0	0	0	0	0.130170053	0	0.237665458	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4283	NO																																																																																		0	0	0	8.5534	0.137653866	1.461916064	0	0.85162169	4.984153832	1.219921126	1.058036819	3.657773033	0	0	0	0	0.004090726	4.613324937	14.6960543	0.845828264	3.976705713	0	0	0	0	0	0	0.130170053	0	0.237665458	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4283
H2354_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	257.1949745	1.680668299	33.17980762		7.606317375	22.92204033	0.479450034	9.280807919	67.73440457	10.04511976	3.865864279	0.522359267	0.049970336	29.07962611	43.89880346	83.89481725	1.769079752	8.869339205	52.96905103	74.18020443	48.41625005	0.598610951																				Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																			0.070465499	0.070465499	0.163529545		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.070465499	0.070465499	0.163529545		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				18.1234	0.118429131	5.425878837	0	1.772271948	5.340835396	0.111711858	2.162428245	15.78211627	2.340512905	0.900746377	0.121709709	0.011643088	6.775552882	10.22842121	19.54749242	0.412195582	2.066556035	12.34178889	17.28398763	11.28098626	0.139476352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2881	0	0	18.1234	0.118429131	5.425878837	0	1.772271948	5.340835396	0.111711858	2.162428245	15.78211627	2.340512905	0.900746377	0.121709709	0.011643088	6.775552882	10.22842121	19.54749242	0.412195582	2.066556035	12.34178889	17.28398763	11.28098626	0.139476352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2881	NO																																																																																		0	0	0	18.1234	0.118429131	5.425878837	0	1.772271948	5.340835396	0.111711858	2.162428245	15.78211627	2.340512905	0.900746377	0.121709709	0.011643088	6.775552882	10.22842121	19.54749242	0.412195582	2.066556035	12.34178889	17.28398763	11.28098626	0.139476352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2881
H2354_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	325.1170539	3.867171975	12.21945293		5.306766008	9.606845697	0.362738425	15.30702202	48.64358534	6.189898686	0.22679524		0.547098257	91.93803524	52.89270361	71.07313231	6.172447466	10.44900661	39.13261082	68.69990821	35.84796974	0.312285431																				Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																			0.066137718	0.066137718	0.159304417		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.066137718	0.066137718	0.159304417		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				21.5025	0.255765928	1.946612829	0	1.23647648	2.238395047	0.084518053	3.566536131	11.33395538	1.442246394	0.052843291	0	0.127473894	21.42156221	12.32399994	16.56003983	1.43818026	2.434618541	9.11789832	16.00707861	8.35257695	0.072762505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.516	0	0	21.5025	0.255765928	1.946612829	0	1.23647648	2.238395047	0.084518053	3.566536131	11.33395538	1.442246394	0.052843291	0	0.127473894	21.42156221	12.32399994	16.56003983	1.43818026	2.434618541	9.11789832	16.00707861	8.35257695	0.072762505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.516	NO																																																																																		0	0	0	21.5025	0.255765928	1.946612829	0	1.23647648	2.238395047	0.084518053	3.566536131	11.33395538	1.442246394	0.052843291	0	0.127473894	21.42156221	12.32399994	16.56003983	1.43818026	2.434618541	9.11789832	16.00707861	8.35257695	0.072762505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.516
H2406_001_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	417.9868257	36.63885345	7036.379364	131.4981811	30.47209264	4.908937509	13.88058408	14.68899724	21.40379311	38.49987316	32.47577836	0	0.048593311	6.235665692	1.806047051	148.6185553	16.5057741	32.49886052	0	0	5.202155615	10.23534744	961.1121752	0	1.952391222	191.4722742	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.0781181	0.079066903	0	0	0.2	0.2	0.103510399	0.071748458	0.2	0	0.063882856	0	0.2	0.151537983	0.024406803	0.19995752	0.2	0	0	0	0.2	0.187632099	0	0	0	0	0	0	0	0											NO	0.0781181	0.079066903	0	0	0.2	0.2	0.103510399	0.071748458	0.2	0	0.063882856	0	0.2	0.151537983	0.024406803	0.19995752	0.2	0	0	0	0.2	0.187632099	0	0	0	0	0	0	0	0												32.6523	2.896920679	0	0	6.094418529	0.981787502	1.4367848	1.053912903	4.280758622	0	2.074645472	0	0.009718662	0.9449402	0.044079835	29.71739769	3.30115482	0	0	0	1.040431123	1.920479725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.4498	0	0	32.6523	2.896920679	0	0	6.094418529	0.981787502	1.4367848	1.053912903	4.280758622	0	2.074645472	0	0.009718662	0.9449402	0.044079835	29.71739769	3.30115482	0	0	0	1.040431123	1.920479725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.4498	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.548	0.3987	0.4319	0.0175	0.7949	0.1281	0.3621	0.0916	0.5584	0.3013	0.6672	0	0.0008	0.1233	0.0442	4.1418	0.46	0	0	0	0.145	0.2676	0	0	0.0003	0	0	0	0	0											13.4828	0	0	37.2004	3.295581779	0.431887052	0.017524226	6.889342685	1.109846741	1.798886993	1.145557503	4.839118443	0.301303355	2.741877127	0	0.010563763	1.068193269	0.088270022	33.85922628	3.761151803	0	0	0	1.18540923	2.188087555	0	0	0.000340068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9325
H2409_801_0	2010	3	N/A																															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																																																			0	NO	178.8283904	4.776919372	38.01319055		7.964894296	1.082142918	1.90264012	4.762865439	21.09174262	8.272509637	15.70619737	1.198811238	0.02945629	47.04202695	37.18460142	37.92333049	0.299493181	3.281315867	21.91613569	55.73435153	24.99069775	6.904195904																				FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins		FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins																			0.084423724	0.084423724	0.151735376		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.084423724	0.084423724	0.151735376		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				15.0974	0.403285322	5.767945746	0	1.855820371	0.2521393	0.443315148	1.109747647	4.914376031	1.927494745	3.659543988	0.279323019	0.006863316	10.96079228	8.664012131	8.836136005	0.069781911	0.764546597	5.106459616	12.98610391	5.822832577	1.608677646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5366	0	0	15.0974	0.403285322	5.767945746	0	1.855820371	0.2521393	0.443315148	1.109747647	4.914376031	1.927494745	3.659543988	0.279323019	0.006863316	10.96079228	8.664012131	8.836136005	0.069781911	0.764546597	5.106459616	12.98610391	5.822832577	1.608677646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5366	NO																																																																																		0	0	0	15.0974	0.403285322	5.767945746	0	1.855820371	0.2521393	0.443315148	1.109747647	4.914376031	1.927494745	3.659543988	0.279323019	0.006863316	10.96079228	8.664012131	8.836136005	0.069781911	0.764546597	5.106459616	12.98610391	5.822832577	1.608677646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5366
H2409_802_0	2010	3	N/A																															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																																																			0	NO	186.2700336	3.608464743	40.81573297		7.194477592	0.749063616	1.400427586	3.948161041	16.56212355	9.084465627	15.35916259	0.789953962	0.01988536	47.75973651	41.84593052	39.48082243	0.20752405	3.667665827	21.93416887	59.42724644	46.28656946	8.047151159																				FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins		FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins																			0.083975148	0.083975148	0.151588445		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.083975148	0.083975148	0.151588445		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				15.6421	0.30302136	6.187193508	0	1.676313279	0.174531823	0.326299627	0.919921523	3.858974787	2.116680491	3.578684885	0.184059273	0.004633289	11.12801861	9.750101812	9.199031625	0.048353104	0.854566138	5.110661348	13.84654842	10.78477069	1.87498622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5694	0	0	15.6421	0.30302136	6.187193508	0	1.676313279	0.174531823	0.326299627	0.919921523	3.858974787	2.116680491	3.578684885	0.184059273	0.004633289	11.12801861	9.750101812	9.199031625	0.048353104	0.854566138	5.110661348	13.84654842	10.78477069	1.87498622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5694	NO																																																																																		0	0	0	15.6421	0.30302136	6.187193508	0	1.676313279	0.174531823	0.326299627	0.919921523	3.858974787	2.116680491	3.578684885	0.184059273	0.004633289	11.12801861	9.750101812	9.199031625	0.048353104	0.854566138	5.110661348	13.84654842	10.78477069	1.87498622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5694
H2409_803_0	2010	3	N/A																															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																																																			0	NO	174.8457069	4.670532698	37.16659956		7.787508298	1.058042535	1.860266461	4.65679176	20.62200885	8.088272743	15.35640497	1.172112538	0.02880027	45.99435493	36.35646392	37.07874077	0.292823175	3.208237748	21.42804188	54.49309292	24.43413043	6.750432698																				FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins		FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins																			0.084423717	0.084423717	0.151735408		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.084423717	0.084423717	0.151735408		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				14.7611	0.39430373	5.639489156	0	1.814489433	0.246523911	0.433442085	1.08503248	4.804928063	1.884567549	3.578042358	0.273102221	0.006710463	10.7166847	8.471056093	8.639346599	0.0682278	0.747519395	4.992733757	12.69689065	5.693152391	1.572850819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5202	0	0	14.7611	0.39430373	5.639489156	0	1.814489433	0.246523911	0.433442085	1.08503248	4.804928063	1.884567549	3.578042358	0.273102221	0.006710463	10.7166847	8.471056093	8.639346599	0.0682278	0.747519395	4.992733757	12.69689065	5.693152391	1.572850819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5202	NO																																																																																		0	0	0	14.7611	0.39430373	5.639489156	0	1.814489433	0.246523911	0.433442085	1.08503248	4.804928063	1.884567549	3.578042358	0.273102221	0.006710463	10.7166847	8.471056093	8.639346599	0.0682278	0.747519395	4.992733757	12.69689065	5.693152391	1.572850819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.5202
H2410_001_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P			Coin	P					P																																																						0	YES	193.088289	6.59223997	802.4391371		12.53857134	0.674999171	1.300064041	47.41955254	15.82521241	7.628804156	13.09943058	0.788394216		39.22702608	4180.258793	1014.099797	24.97590868	731.1975559			14.78915481	488.3669927					182.2630635														3350	$550 (1a); $0 (1a1)	$550 (1b)	"$120 days 21-100 (2a, 2a2)"	$0 (6a)	20% (10a)	20% (11a)	"20% (11b, 11c)"	"$50 (4a, 4a1);"	20% (9b)	"20% (8a1, 8a2)"	"20% (8b1, 8b2, 8b3)"	20% (9a)	0% (12)	"20% (5, 9a); $30 (3, 9c, 9d)"	"$15 (7a, 14c); $0 (14b, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7g, 16b, 17a, 18a)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"			"20% (15, 15a1)"	"$0 (13a, 13a1); $30 (17b)"					$30 (18a1)		$0 (14a)												550	550	37.21990109		0.2	0.2	0.2	46.79471875	0.2	0.2	0.2	0.2		0.199992673	14.98771885	30	31.15327192	15.37636911			0.2	29.99965859					30														NO	496.6885416	496.6885416	33.6121789		0.180614015	0.180614015	0.180614015	42.2589102	0.180614015	0.180614015	0.180614015	0.180614015		0.180607399	13.5349604	27.09210227	28.13358763	13.88593881			0.180614015	27.09179395					27.09210227															7.9921	0.272857505	2.247643986	0	2.264641714	0.12191431	0.234809786	0.166991551	2.858255154	1.377868949	2.365940753	0.142395045	0	7.084691131	4.714969767	2.289507951	0.05855516	0.84611371	0	0	2.671128631	1.102561495	0	0	0	0	0.411490796	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2244	0	4.210103004	7.9921	0.272857505	2.247643986	0	2.264641714	0.12191431	0.234809786	0.166991551	2.858255154	1.377868949	2.365940753	0.142395045	0	7.084691131	4.714969767	2.289507951	0.05855516	0.84611371	0	0	2.671128631	1.102561495	0	0	0	0	0.411490796	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2244	NO																																																																																		0	0	0	7.9921	0.272857505	2.247643986	0	2.264641714	0.12191431	0.234809786	0.166991551	2.858255154	1.377868949	2.365940753	0.142395045	0	7.084691131	4.714969767	2.289507951	0.05855516	0.84611371	0	0	2.671128631	1.102561495	0	0	0	0	0.411490796	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2244
H2410_009_0	2010	4	N/A																															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																																																			0	NO	443.2023608	20.24649257	130.936973		35.22801525	4.477163836	1.526956887	11.05735407	29.99817328	19.46236031	28.34783183	3.614825715	0.070032586	100.7494201	69.5377977	80.11561791		13.20850551	36.21178395	89.08990468	49.43947942	12.64957161																				FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins		FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins																			0.080842466	0.080842466	0.127604491		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233																			NO	0.080842466	0.080842466	0.127604491		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233																				35.8296	1.636776378	16.70814585	0	8.208127554	1.043179174	0.355780955	2.576363498	6.989574374	4.534729953	6.605044817	0.842254392	0.016317592	23.47461488	16.20230686	18.66693897	0	3.077581785	8.437345659	20.75794779	11.5193987	2.947350184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	190.4294	0	0	35.8296	1.636776378	16.70814585	0	8.208127554	1.043179174	0.355780955	2.576363498	6.989574374	4.534729953	6.605044817	0.842254392	0.016317592	23.47461488	16.20230686	18.66693897	0	3.077581785	8.437345659	20.75794779	11.5193987	2.947350184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	190.4294	NO																																																																																		0	0	0	35.8296	1.636776378	16.70814585	0	8.208127554	1.043179174	0.355780955	2.576363498	6.989574374	4.534729953	6.605044817	0.842254392	0.016317592	23.47461488	16.20230686	18.66693897	0	3.077581785	8.437345659	20.75794779	11.5193987	2.947350184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	190.4294
H2410_015_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	P	P	P	P			Coin	P																																																											0	YES	158.4295217	7.256273861	626.3195574		8.157761845	0.394710994	0.901105895	34.1586587	15.98937513	6.846919396	14.56862005	0.570639215		36.45397216	4164.098357	904.2334497	14.74545471	560.1119776			11.91920315	615.4949428																			3350	$550 (1a)	$550 (1b)	"$120 days 21-100 (2a, 2a2)"	$0 (6a)	20% (10a)	25% (11a)	"25% (11b, 11c)"	"$50 (4a, 4a1);"	20% (9b)	"20% (8a1, 8a2)"	"20% (8b1, 8b2, 8b3)"	20% (9a)	0% (12)	"20% (5, 9a); $30 (3, 9c, 9d)"	"$15 (7a, 14c); $0 (14b, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7g, 16b, 17a, 18a)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"			"20% (15, 15a1)"	$0 (13a); $30 (17b)							$0 (14a)												550	550	37.21990109		0.2	0.25	0.25	46.86343889	0.2	0.2	0.2	0.2		0.199461218	14.9925154	30	31.11900302	15.29007527			0.2	29.99984007																			NO	505.3664591	505.3664591	34.19943568		0.183769621	0.229712027	0.229712027	43.06038213	0.183769621	0.183769621	0.183769621	0.183769621		0.183274562	13.7758444	27.56544322	28.59363703	14.04925673			0.183769621	27.56529627																				6.6721	0.305589786	1.784981285	0	1.499148807	0.090669862	0.206994862	0.122573741	2.938361416	1.258255786	2.677269792	0.104866152	0	6.681085789	4.78033092	2.077132985	0.035135515	0.655763081	0	0	2.190387451	1.413858371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4945	0	3.134843183	6.6721	0.305589786	1.784981285	0	1.499148807	0.090669862	0.206994862	0.122573741	2.938361416	1.258255786	2.677269792	0.104866152	0	6.681085789	4.78033092	2.077132985	0.035135515	0.655763081	0	0	2.190387451	1.413858371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4945	NO																																																																																		0	0	0	6.6721	0.305589786	1.784981285	0	1.499148807	0.090669862	0.206994862	0.122573741	2.938361416	1.258255786	2.677269792	0.104866152	0	6.681085789	4.78033092	2.077132985	0.035135515	0.655763081	0	0	2.190387451	1.413858371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4945
H2410_801_0	2010	2	N/A																															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																																																			0	NO	276.5532566	5.693525527	61.56103292		10.75804893	0.972425785	2.008252278	5.565832276	30.84738263	10.61440137	19.13426249	2.014008668	0.02552981	73.16163118	56.08756548	61.62400867	0.258876031	6.120872841	37.94642658	88.83423642	33.01303486	9.724311543																				FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins		FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins																			0.080887583	0.080887583	0.1495576		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080887583	0.080887583	0.1495576		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				22.3697	0.460535516	9.206920308	0	2.506625401	0.226575208	0.467922781	1.29683892	7.187440152	2.473155518	4.45828316	0.46926402	0.005948446	17.04666007	13.06840276	14.35839402	0.060318115	1.426163372	8.841517394	20.69837709	7.692037122	2.26576459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5869	0	0	22.3697	0.460535516	9.206920308	0	2.506625401	0.226575208	0.467922781	1.29683892	7.187440152	2.473155518	4.45828316	0.46926402	0.005948446	17.04666007	13.06840276	14.35839402	0.060318115	1.426163372	8.841517394	20.69837709	7.692037122	2.26576459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5869	NO																																																																																		0	0	0	22.3697	0.460535516	9.206920308	0	2.506625401	0.226575208	0.467922781	1.29683892	7.187440152	2.473155518	4.45828316	0.46926402	0.005948446	17.04666007	13.06840276	14.35839402	0.060318115	1.426163372	8.841517394	20.69837709	7.692037122	2.26576459	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5869
H2410_802_0	2010	2	N/A																															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																																																			0	NO	223.1907922	5.836284687	47.60269398		9.932096347	1.349611117	2.377369956	5.941361777	26.37603698	10.32561567	19.62138736	1.499722207	0.036384887	58.66900925	46.46270248	47.37605962	0.368948109	4.105563715	27.41194324	69.65242608	31.22132573	8.64171693																				FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins		FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins																			0.080820394	0.080820394	0.127152043		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080820394	0.080820394	0.127152043		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				18.0384	0.471690827	6.05277979	0	2.314178449	0.31445939	0.5539272	1.384337294	6.145616617	2.405868452	4.571783256	0.349435274	0.008477679	13.66987916	10.82580968	11.03862189	0.085964909	0.956596346	6.386982775	16.22901528	7.274568896	2.013520045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0919	0	0	18.0384	0.471690827	6.05277979	0	2.314178449	0.31445939	0.5539272	1.384337294	6.145616617	2.405868452	4.571783256	0.349435274	0.008477679	13.66987916	10.82580968	11.03862189	0.085964909	0.956596346	6.386982775	16.22901528	7.274568896	2.013520045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0919	NO																																																																																		0	0	0	18.0384	0.471690827	6.05277979	0	2.314178449	0.31445939	0.5539272	1.384337294	6.145616617	2.405868452	4.571783256	0.349435274	0.008477679	13.66987916	10.82580968	11.03862189	0.085964909	0.956596346	6.386982775	16.22901528	7.274568896	2.013520045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.0919
H2410_803_0	2010	2	N/A																															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																																																			0	NO	199.5671603	5.218543069	42.5641863		8.880833498	1.206761513	2.125737206	5.312498273	23.58426505	9.232700768	17.5445614	1.340984093	0.032533728	52.45918731	41.54485722	42.36154006	0.329896793	3.671010278	24.5105258	62.28006426	27.91670416	7.727034305																				FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins		FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins																			0.08119594	0.08119594	0.13433462		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.08119594	0.08119594	0.13433462		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				16.204	0.423724508	5.7178438	0	2.069234205	0.281175433	0.495296769	1.237812098	5.495133757	2.151219279	4.087882806	0.312449294	0.007580359	12.22299064	9.679951732	9.870238834	0.076865953	0.855345395	5.710952512	14.51125497	6.50459207	1.800398993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.716	0	0	16.204	0.423724508	5.7178438	0	2.069234205	0.281175433	0.495296769	1.237812098	5.495133757	2.151219279	4.087882806	0.312449294	0.007580359	12.22299064	9.679951732	9.870238834	0.076865953	0.855345395	5.710952512	14.51125497	6.50459207	1.800398993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.716	NO																																																																																		0	0	0	16.204	0.423724508	5.7178438	0	2.069234205	0.281175433	0.495296769	1.237812098	5.495133757	2.151219279	4.087882806	0.312449294	0.007580359	12.22299064	9.679951732	9.870238834	0.076865953	0.855345395	5.710952512	14.51125497	6.50459207	1.800398993	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.716
H2411_002_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	230.6231094	0.143565677	95.97133023	0	369.4709526	35.72283711	1.322324401	1172.992335	865.7338022	0	2909.113114	35.01471119	0	0	7249.94482	3210.989887	351.0866855	450.4797472	0	1172.861202	138.9766744	159.3668777	0	0	108.7517243	0	0	0	5.015243138	0											3400	PBP: 1A IP Acute: $350 Per Admit	1B IP Psych: $350 Per Admit	"2 SNF: $50 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $20	9B ASC Services: $0-75	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $0-75	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $20; 14B Immunizations: $0; 14C Routine Physical Exams: $20; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $20	7B Chiropractic: $25; 7D Physician Specialist: $25; 7F Podiatry: $25	7E Mental Health: $25; 7H Psychiatric: $25; 9C OP Substance Abuse: $25	7C Occupational Therapy: $25; 7I Physical and Speech Therapy: $25	Included in h.2.	7G Other Health Care: $20-25; 18A Medicare Covered Hearing Exams: $25; 17A Medicare Covered Eye Exams: $25	15 Part B Drugs: $10-65	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-25	10B Transportation: Not Covered	16A Preventive Dental Services: Not Covered; 16B Non-Medicare Covered Comprehensive Dental Services: Not Covered	17A Routine Eye Exams: $25	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-20	13B Acupuncture: Not Covered											350	350	617.5	0	50	0.1	0.1	48.40159429	75	0	75	75	0	0	20	25	25	25	0	22.50437627	17.39130435	25	0	0	20	0	0	0	20	0											YES	348.25	348.25	614.4125	0	49.75	0.0995	0.0995	48.15958632	74.625	0	74.625	74.625	0	0	19.9	24.875	24.875	24.875	0	22.39185439	17.30434783	24.875	0	0	19.9	0	0	0	19.9	0											7500	6.6929	0.004166396	4.913832078	0	1.531764991	3.554422292	0.131571278	4.707568799	5.383782082	0	18.09104718	0.217747735	0	0	12.02282516	6.656114454	0.727773442	0.933806976	0	2.18854477	0.200408393	0.330354257	0	0	0.180346609	0	0	0	0.008316945	0	0	0	0	0	0	0	0	0	0	0	68.4773	0	0.348373616	6.6929	0.004166396	4.913832078	0	1.531764991	3.554422292	0.131571278	4.707568799	5.383782082	0	18.09104718	0.217747735	0	0	12.02282516	6.656114454	0.727773442	0.933806976	0	2.18854477	0.200408393	0.330354257	0	0	0.180346609	0	0	0	0.008316945	0	0	0	0	0	0	0	0	0	0	0	68.4773	NO	0.2	0.2	0.2	0.2	50	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	40	40	40	40	0.2	40	25	0.2	0.2	0.2	0.2	0.2	0.2		15	0.2												0.5676	0.0119	0.1656	0.0753	0.0305	0.0391	0.0028	0.0553	0.1032	0.1334	0.1195	0.1308	0.0008	0.0018	0.2751	0.1005	0.0114	0.0167		0.0447	0.0038	0.0098			0.0007	0.0047			0.2735	0.002											2.1806	500	0.010957774	7.2605	0.016106426	5.079415037	0.075331951	1.562268591	3.593491285	0.134398207	4.762849851	5.487001713	0.133394643	18.21054269	0.348592574	0.000795027	0.001812526	12.29797454	6.756614468	0.739136033	0.950537436	0	2.233270036	0.204225238	0.340113353	0	0	0.181070751	0.004653726	0	0	0.281794153	0.001980483	0	0	0	0	0	0	0	0	0	0	70.6579
H2411_801_0	2010	2	N/A																															A	A	A	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	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	YES	167.8333607	0	66.77777944	0	318.2920415	0	0	842.5071506	619.9037684	0	2507.596302	437.2001096	0	0	6691.526543	2654.330658	314.5379917	531.0172368	0	1041.058083	119.3402528	0	0	0	90.15314867	0	0	0	0	0											3400	PBP: 1A IP Acute: $450 Per Admit	1B IP Psych: $450 Per Admit	2 SNF: $450 per admit	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	11B Prosthetic Medical Supplies: 0%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $25	9B ASC Services: $225	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $225	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $25; 14B Immunizations: $0; 14C Routine Physical Exams: $25; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $25	7B Chiropractic: $35; 7D Physician Specialist: $35; 7F Podiatry: $35	7E Mental Health: $35; 7H Psychiatric: $35; 9C OP Substance Abuse: $35	7C Occupational Therapy: $35; 7I Physical and Speech Therapy: $35	Included in h.2.	7G Other Health Care: $25-35; 18A Medicare Covered Hearing Exams: $35; 17A Medicare Covered Eye Exams: $35	15 Part B Drugs: $10-65	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $25-35	10B Transportation: Not Covered	16A Preventive Dental Services: Not Covered; 16B Non-Medicare Covered Comprehensive Dental Services: Not Covered	17A Routine Eye Exams: Not Covered	17B Eye Wear: Not Covered	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-25	13B Acupuncture: Not Covered											450	450	450	0	50	0	0	48.4375	225	0	75	225	0	0	25	35	35	35	0	30	15	0	0	0	35	0	0	0	0	0											YES	447.75	447.75	447.75	0	49.75	0	0	48.1953125	223.875	0	74.625	223.875	0	0	24.875	34.825	34.825	34.825	0	29.85	14.925	0	0	0	34.825	0	0	0	0	0											7500	6.2623	0	2.491645895	0	1.319585755	0	0	3.383741284	11.56507968	0	15.5941145	8.156514544	0	0	13.8709769	7.703088764	0.912815464	1.541056273	0	2.589631982	0.148429439	0	0	0	0.26163195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8006	0	0.380907511	6.2623	0	2.491645895	0	1.319585755	0	0	3.383741284	11.56507968	0	15.5941145	8.156514544	0	0	13.8709769	7.703088764	0.912815464	1.541056273	0	2.589631982	0.148429439	0	0	0	0.26163195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8006	NO	0.2	0.2	0.2	0.2	50	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	0.2	0.2	0.2	0.2	0.2		15	0.2												0.4764	0.009	0.1254	0.0609	0.0245	0.0338	0.0028	0.0436	0.0822	0.1188	0.0787	0.0968	0.0001	0.0022	0.1085	0.0547	0.0093	0.0059		0.0284	0.0055	0.0028			0.0005	0.0042			0.198	0.0018											1.575	500	0.007914656	6.7386	0.009045746	2.61706887	0.060871126	1.344134143	0.033813808	0.002829459	3.427380603	11.64725463	0.118803333	15.67280118	8.253336688	7.17E-05	0.00217292	13.97951884	7.75782517	0.92207622	1.546951951	0	2.618080515	0.153943825	0.002832855	0	0	0.262180258	0.004217691	0	0	0.197995358	0.001765738	0	0	0	0	0	0	0	0	0	0	77.3756
H2411_803_0	2010	2	N/A																															A	A	A	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	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	YES	222.7657099	0	94.53822769	0	445.1202999	0	0	996.3815775	804.3772295	0	3112.41945	780.380111	0	0	7873.143037	3442.843953	332.0944392	702.9305433	0	1260.928688	187.1969722	0	0	0	120.2097458	0	0	0	6.004261455	0											3400	PBP: 1A IP Acute: $450 Per Admit	1B IP Psych: $450 Per Admit	2 SNF: $450 per admit	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	11B Prosthetic Medical Supplies: 0%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $25	9B ASC Services: $225	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $225	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $25; 14B Immunizations: $0; 14C Routine Physical Exams: $25; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $25	7B Chiropractic: $35; 7D Physician Specialist: $35; 7F Podiatry: $35	7E Mental Health: $35; 7H Psychiatric: $35; 9C OP Substance Abuse: $35	7C Occupational Therapy: $35; 7I Physical and Speech Therapy: $35	Included in h.2.	7G Other Health Care: $25-35; 18A Medicare Covered Hearing Exams: $35; 17A Medicare Covered Eye Exams: $35	15 Part B Drugs: $10-65	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $25-35	10B Transportation: Not Covered	16A Preventive Dental Services: Not Covered; 16B Non-Medicare Covered Comprehensive Dental Services: Not Covered	17A Routine Eye Exams: Not Covered	17B Eye Wear: Not Covered	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-25	13B Acupuncture: Not Covered											450	450	450	0	50	0	0	49.34640523	225	0	75	225	0	0	25	35	35	35	0	29.95850622	12.83844509	0	0	0	35	0	0	0	25	0											YES	447.75	447.75	447.75	0	49.75	0	0	49.0996732	223.875	0	74.625	223.875	0	0	24.875	34.825	34.825	34.825	0	29.80871369	12.77425287	0	0	0	34.825	0	0	0	24.875	0											7500	8.3119	0	3.527457621	0	1.845394577	0	0	4.076834153	15.00666269	0	19.35535846	14.55896645	0	0	16.32036942	9.991420056	0.963765737	2.039963014	0	3.132221854	0.199275122	0	0	0	0.3488587	0	0	0	0.012446334	0	0	0	0	0	0	0	0	0	0	0	99.6909	0	0.502454449	8.3119	0	3.527457621	0	1.845394577	0	0	4.076834153	15.00666269	0	19.35535846	14.55896645	0	0	16.32036942	9.991420056	0.963765737	2.039963014	0	3.132221854	0.199275122	0	0	0	0.3488587	0	0	0	0.012446334	0	0	0	0	0	0	0	0	0	0	0	99.6909	NO	0.2	0.2	0.2	0.2	50	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	0.2	0.2	0.2	0.2	0.2		15	0.2												0.5677	0.0108	0.1495	0.0725	0.0293	0.0403	0.0034	0.052	0.0979	0.1416	0.0938	0.1154	0.0001	0.0026	0.1293	0.0652	0.011	0.007		0.0339	0.0066	0.0034			0.0007	0.005			0.2812	0.0021											1.9221	500	0.00965884	8.8796	0.010779474	3.676919437	0.072537818	1.874647962	0.040294637	0.003371759	4.128837479	15.10458747	0.141573439	19.44912639	14.67434573	8.54E-05	0.002589387	16.44971475	10.05664736	0.97480143	2.046988671	0	3.166122894	0.205846407	0.003375806	0	0	0.349512097	0.005026063	0	0	0.293611374	0.002104164	0	0	0	0	0	0	0	0	0	0	101.613
H2416_001_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																												0	NO	422.102627	12.25162812	235.2635714		23.10183418	39.203919	14.23544648	31.80026166	40.37882525	31.81943541	46.26770301	9.620972381		36.81614196	143.1866319		4.179782254	1.233884863	14.67546005		6.743730205																					Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS	Same As Medicare FFS																				0.08138379	0.08138379	0.13755679		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233		0.233	0.233	0.233		0.233																				NO	0.08138379	0.08138379	0.13755679		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233		0.233	0.233	0.233		0.233																					34.3523	0.997083924	32.36210157	0	5.382727364	9.134513128	3.31685903	7.409460967	9.408266284	7.41392845	10.7803748	2.241686565	0	8.578161078	33.36248522	0	0.973889265	0.287495173	3.419382191	0	1.571289138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.992			34.3523	0.997083924	32.36210157	0	5.382727364	9.134513128	3.31685903	7.409460967	9.408266284	7.41392845	10.7803748	2.241686565	0	8.578161078	33.36248522	0	0.973889265	0.287495173	3.419382191	0	1.571289138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.992	NO																																																																																		0			34.3523	0.997083924	32.36210157	0	5.382727364	9.134513128	3.31685903	7.409460967	9.408266284	7.41392845	10.7803748	2.241686565	0	8.578161078	33.36248522	0	0.973889265	0.287495173	3.419382191	0	1.571289138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.992
H2417_001_0	2010	5	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																												0	NO	424.4427872	19.1842046	97.08459707		15.04236769	38.13769395	14.69432273	30.28880337	86.70523056	27.70222412	45.81279694	1.082465161		62.99147192	164.0113131		3.521944447	0.487769059	15.43262501	0.049381844	11.92355565																					Same as Medicare FFS	Same as Medicare FFS	Same as Medicare FFS		Same as Medicare FFS	Same as Medicare FFS	Same as Medicare FFS	Same as Medicare FFS	Same as Medicare FFS	Same as Medicare FFS	Same as Medicare FFS	Same as Medicare FFS		Same as Medicare FFS	Same as Medicare FFS		Same as Medicare FFS	Same as Medicare FFS	Same as Medicare FFS	Same as Medicare FFS	Same as Medicare FFS																				0.08138379	0.08138379	0.13755679		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233		0.233	0.233	0.233		0.233																				NO	0.08138379	0.08138379	0.13755679		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233		0.233	0.233	0.233		0.233																					34.5428	1.561283269	13.35464548	0	3.504871672	8.88608269	3.423777196	7.057291186	20.20231872	6.45461822	10.67438169	0.252214382	0	14.67701296	38.21463594	0	0.820613056	0.113650191	3.595801628	0	2.778188466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.1141			34.5428	1.561283269	13.35464548	0	3.504871672	8.88608269	3.423777196	7.057291186	20.20231872	6.45461822	10.67438169	0.252214382	0	14.67701296	38.21463594	0	0.820613056	0.113650191	3.595801628	0	2.778188466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.1141	NO																																																																																		0			34.5428	1.561283269	13.35464548	0	3.504871672	8.88608269	3.423777196	7.057291186	20.20231872	6.45461822	10.67438169	0.252214382	0	14.67701296	38.21463594	0	0.820613056	0.113650191	3.595801628	0	2.778188466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.1141
H2419_001_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	O	O																																																			0	NO	427.6578818		331.846021		28.08151534	48.62332337		39.8802696	42.53882946					99.57958219						157.8962839	4.166192152	0.892999234																				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																			0.08138379		0.13755679		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																			NO	0.08138379		0.13755679		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																				34.8044	0	45.64767326	0	6.542993074	11.32923435	0	9.292102816	9.911547263	0	0	0	0	23.20204265	0	0	0	0	0	36.78983415	0.970722771	0.208068822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	178.6986	0	0	34.8044	0	45.64767326	0	6.542993074	11.32923435	0	9.292102816	9.911547263	0	0	0	0	23.20204265	0	0	0	0	0	36.78983415	0.970722771	0.208068822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	178.6986	NO																																																																																		0	0	0	34.8044	0	45.64767326	0	6.542993074	11.32923435	0	9.292102816	9.911547263	0	0	0	0	23.20204265	0	0	0	0	0	36.78983415	0.970722771	0.208068822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	178.6986
H2422_002_0	2010	4	N/A																															Coin		Coin	Coin	Coin	Coin		Coin	Coin	Coin					Coin						Coin	Coin																																																											0	NO	498.7376172		162.5182759	48.2468415	42.67821525	60.90024836		25.40494816	36.64589823	63.56058969					323.4246557						33.89270303	0.733810127																				Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing					Medicare FFS Cost Sharing						Medicare FFS Cost Sharing	Medicare FFS Cost Sharing		"16a. 100% coverage 16b. Crowns 100% with $2000 max, all other 100%"		17b. 100% coverage				13e. 100% coverage											0.074		0.177	0	0.22	0.22		0.22	0.22	0.22					0.227						0.22	0.22																			NO	0.074		0.177	0	0.22	0.22		0.22	0.22	0.22					0.227						0.22	0.22																				36.9066	0	28.76573483	0	9.389207354	13.39805464	0	5.589088595	8.06209761	13.98332973	0	0	0	0	73.41739684	0	0	0	0	0	7.456394666	0.161438228	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	197.1293			36.9066	0	28.76573483	0	9.389207354	13.39805464	0	5.589088595	8.06209761	13.98332973	0	0	0	0	73.41739684	0	0	0	0	0	7.456394666	0.161438228	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	197.1293	NO																																																																																		0			36.9066	0	28.76573483	0	9.389207354	13.39805464	0	5.589088595	8.06209761	13.98332973	0	0	0	0	73.41739684	0	0	0	0	0	7.456394666	0.161438228	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	197.1293
H2425_001_0	2010	2	N/A																															Coin		Coin	Coin	Coin	Coin		V	Coin					Coin						Coin	Coin	Coin																																																											0	NO	467.7659651		275.6952057	15.99985037	28.03357902	48.87699378		545	43.83403321					119.9198995						241.2772639	26.70340678	2.255306355																				traditional Medicare	included in a.1	traditional Medicare	traditional Medicare	traditional Medicare	traditional Medicare	included in e.1	$50 Copay (max for MA)	traditional Medicare	included in h.5	included in h.5	included in h.5	included in h.5	traditional Medicare	included in i.6	included in i.6	included in i.6	included in i.6	included in i.6	traditional Medicare	traditional Medicare	traditional Medicare																			0.081261095		0.135477898	0	0.233	0.233		50	0.233					0.233						0.233	0.233	0.233																			NO	0.081261095		0.135477898	0	0.233	0.233		50	0.233					0.233						0.233	0.233	0.233																				38.0112	0	37.35060705	0	6.531823912	11.38833955	0	2.270833333	10.21332974	0	0	0	0	27.94133659	0	0	0	0	0	56.21760248	6.221893781	0.525486381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	196.6724			38.0112	0	37.35060705	0	6.531823912	11.38833955	0	2.270833333	10.21332974	0	0	0	0	27.94133659	0	0	0	0	0	56.21760248	6.221893781	0.525486381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	196.6724	NO																																																																																		0			38.0112	0	37.35060705	0	6.531823912	11.38833955	0	2.270833333	10.21332974	0	0	0	0	27.94133659	0	0	0	0	0	56.21760248	6.221893781	0.525486381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	196.6724
H2456_002_0	2010	6	N/A																															Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																												0	NO	427.4622144		164.118282		19.17073184	58.49479332		44.11420613	85.36178654	36.76033086					278.4975097						24.05543645																					FFS Medicare Actl. Equiv. cost sharing		FFS Medicare Actl. Equiv. cost sharing		FFS Medicare Actl. Equiv. cost sharing	"#11A, 11B, 11C 20% coinsurance"		FFS Medicare Actl. Equiv. cost sharing	FFS Medicare Actl. Equiv. cost sharing	FFS Medicare Actl. Equiv. cost sharing					FFS Medicare Actl. Equiv. cost sharing						#15 20% coinsurance																				0.08102403		0.131177931		0.233	0.233		0.233	0.233	0.233					0.233						0.233																				NO	0.08102403		0.131177931		0.233	0.233		0.233	0.233	0.233					0.233						0.233																					34.6347	0	21.52869668	0	4.466780519	13.62928684	0	10.27861003	19.88929626	8.565157091	0	0	0	0	64.88991977	0	0	0	0	0	5.604916692	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.4874			34.6347	0	21.52869668	0	4.466780519	13.62928684	0	10.27861003	19.88929626	8.565157091	0	0	0	0	64.88991977	0	0	0	0	0	5.604916692	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.4874	NO																																																																																		0			34.6347	0	21.52869668	0	4.466780519	13.62928684	0	10.27861003	19.88929626	8.565157091	0	0	0	0	64.88991977	0	0	0	0	0	5.604916692	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.4874
H2457_002_0	2010	4	N/A																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	574.4575711	23.40124411	91.22263873		26.67030125	37.51288777	8.589372999	20.16011598	52.44503276	30.46319257	45.69718559			57.03588282		193.8741442	4.37597672	0.97613252	24.47754572	0.043220783	17.75561575	1.213985373																				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																			0.080820393	0.080820393	0.12715202		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080820393	0.080820393	0.12715202		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233																				46.4279	1.891297751	11.59914277	0	6.214180192	8.74050285	2.001323909	4.697307024	12.21969263	7.097923869	10.64744424	0	0	13.2893607	0	45.17267559	1.019602576	0.227438877	5.703268154	0.010070442	4.137058469	0.282858592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	181.379		0	46.4279	1.891297751	11.59914277	0	6.214180192	8.74050285	2.001323909	4.697307024	12.21969263	7.097923869	10.64744424	0	0	13.2893607	0	45.17267559	1.019602576	0.227438877	5.703268154	0.010070442	4.137058469	0.282858592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	181.379	NO																																																																																		0			46.4279	1.891297751	11.59914277	0	6.214180192	8.74050285	2.001323909	4.697307024	12.21969263	7.097923869	10.64744424	0	0	13.2893607	0	45.17267559	1.019602576	0.227438877	5.703268154	0.010070442	4.137058469	0.282858592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	181.379
H2458_002_0	2010	6	N/A																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	382.459531	42.40364883	168.4505824		38.94434876	14.67444355	1.806871248	21.09331748	36.17697458	43.10727053	45.08466524	5.884293561	0.16907131	104.2641677	40.62317927	79.41637278		3.958226572	27.89287777	67.39674516	25.76642786	10.57220677																				FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins		FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins	FFS Mcare effective coins																			0.081035819	0.081035819	0.13140118		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233																			NO	0.081035819	0.081035819	0.13140118		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233																				30.9929	3.436214401	22.13460536	0	9.074033261	3.419145348	0.421001001	4.914742973	8.429235078	10.04399403	10.504727	1.3710404	0.039393615	24.29355106	9.465200771	18.50401486	0	0.922266791	6.499040521	15.70344162	6.003577691	2.463324177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.6355	0	0	30.9929	3.436214401	22.13460536	0	9.074033261	3.419145348	0.421001001	4.914742973	8.429235078	10.04399403	10.504727	1.3710404	0.039393615	24.29355106	9.465200771	18.50401486	0	0.922266791	6.499040521	15.70344162	6.003577691	2.463324177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.6355	NO																																																																																		0	0	0	30.9929	3.436214401	22.13460536	0	9.074033261	3.419145348	0.421001001	4.914742973	8.429235078	10.04399403	10.504727	1.3710404	0.039393615	24.29355106	9.465200771	18.50401486	0	0.922266791	6.499040521	15.70344162	6.003577691	2.463324177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.6355
H2459_001_0	2010	5	N/A																															A	A	D		T	Coin	Coin	V	V	V	V			V		V	V	V		V	Coin																																																												0	YES	259.8097417	0.787919559	504.1770041		130.62889	6.439434894	1.192999772	165.3842712	476.7996421	1179.135058	379.8887008			1143.316599		1287.885448	35.11891477	283.1890797		186.5332522	13.36924529																				3400	#1A $300	#1B $300	#2 $125/day days 21-100		#10A $100	#11A 20%	#11B 20%/10%	#4A $50	"#9A $200, #9B $200"	#8A $25	#8B $25			"#4B $25, #7A $25, #9A $25, #9C $25, #9D $25"		#7D $30	"#7E $30, #7H $30"	#7I $30		#7F $30	"#15 20%, 11c 0%"																				300	300	125		100	0.2	0.19	50	200	25	25			25		30	30	30		30	0.2																				NO	294	294	122.5		98	0.196	0.1862	49	196	24.5	24.5			24.5		29.4	29.4	29.4		29.4	0.196																					6.3653	0.019304029	5.146806917	0	1.066802602	1.262129239	0.222136558	0.675319107	7.787727488	2.407400744	0.775606097	0	0	2.334271389	0	3.155319348	0.086041341	0.693813245	0	0.457006468	2.620372076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0754		0.715824394	6.3653	0.019304029	5.146806917	0	1.066802602	1.262129239	0.222136558	0.675319107	7.787727488	2.407400744	0.775606097	0	0	2.334271389	0	3.155319348	0.086041341	0.693813245	0	0.457006468	2.620372076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0754	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0674	0.0075							0.2397						0.2449																					0.5595		0	6.3653	0.019304029	5.146806917	0	1.066802602	1.329490361	0.229621127	0.675319107	7.787727488	2.407400744	0.775606097	0	0	2.574005906	0	3.155319348	0.086041341	0.693813245	0	0.701932077	2.620372076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.6349
H2459_002_0	2010	8	N/A																															A	A	D		T	Coin	Coin	V	V					V		V	V	V		V	Coin																																																												0	YES	332.1129379	4.499989596	878.2691627		192.6143781	10.66189035	2.112016561	249.4007159	801.4447728					113.5370936		2260.545931	212.0063245	748.3066578		393.4156342	33.07434122																				3400	#1A $150	#1B $150	#2 $75/day days 21-100		#10A $100	#11A 20%	#11B 10%/10%	#4A $50	"#9A $100, #9B $100"					"#4B $20, #7A $20"		#7D $15	"#7E $15, #7H $15"	#7I $15		#7F $15	"#15 20%, 11c 0%"																				150	150	75		100	0.2	0.1	50	100					20		15	15	15		15	0.2																				NO	148.5	148.5	74.25		99	0.198	0.099	49.5	99					19.8		14.85	14.85	14.85		14.85	0.198																					4.1099	0.055687371	5.434290444	0	1.589068619	2.111054289	0.20908964	1.028777953	6.611919376	0	0	0	0	0.187336204	0	2.797425589	0.262357827	0.926029489	0	0.486851847	6.548719562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3585		0.326853594	4.1099	0.055687371	5.434290444	0	1.589068619	2.111054289	0.20908964	1.028777953	6.611919376	0	0	0	0	0.187336204	0	2.797425589	0.262357827	0.926029489	0	0.486851847	6.548719562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3585	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0781	0.0087							0.2779						0.284																					0.6487		0	4.1099	0.055687371	5.434290444	0	1.589068619	2.189152926	0.217767266	1.028777953	6.611919376	0	0	0	0	0.465284941	0	2.797425589	0.262357827	0.926029489	0	0.770819148	6.548719562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0072
H2459_005_0	2010	5	N/A																															A	A	D		T	Coin	Coin	V	V	V	V			V		V	V	V		V	Coin																																																												0	YES	226.9234251	0.955788675	361.6399013		92.0377089	4.67020147	0.809012151	151.1388038	493.7573868	1164.8657	549.8322032			1348.112194		1184.305633	32.52070681	217.9295689		178.6691906	14.48337339																				3400	#1A $300	#1B $300	#2 $125/day days 21-100		#10A $100	#11A 20%	#11B 20%/10%	#4A $50	"#9A $200, #9B $200"	#8A $25	#8B $25			"#4B $25, #7A $25, #9A $25, #9C $25, #9D $25"		#7D $30	"#7E $30, #7H $30"	#7I $30		#7F $30	"#15 20%, 11c 0%"																				300	300	125		100	0.2	0.19	50	200	25	25			25		30	30	30		30	0.2																				NO	294	294	122.5		98	0.196	0.1862	49	196	24.5	24.5			24.5		29.4	29.4	29.4		29.4	0.196																					5.5596	0.023416823	3.69174066	0	0.751641289	0.915359488	0.150638063	0.617150115	8.064703984	2.37826747	1.122574082	0	0	2.752395729	0	2.9015488	0.079675732	0.533927444	0	0.437739517	2.838741185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8191		0.669778455	5.5596	0.023416823	3.69174066	0	0.751641289	0.915359488	0.150638063	0.617150115	8.064703984	2.37826747	1.122574082	0	0	2.752395729	0	2.9015488	0.079675732	0.533927444	0	0.437739517	2.838741185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8191	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.1103	0.0123							0.3908						0.6649																					1.1783		0	5.5596	0.023416823	3.69174066	0	0.751641289	1.02568235	0.162896158	0.617150115	8.064703984	2.37826747	1.122574082	0	0	3.14322535	0	2.9015488	0.079675732	0.533927444	0	1.102607547	2.838741185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9974
H2459_006_0	2010	7	N/A																															A	A	D		T	Coin	Coin	V	V					V		V	V	V		V	Coin																																																												0	YES	255.186689	7.577623493	578.0735066		81.37142044	8.850344004	1.306376942	170.6470618	1154.496117					0		1825.832862	189.4732215	1.900617436		244.8922666	44.63118789																				3400	#1A $150	#1B $150	#2 $75/day days 21-100		#10A $100	#11A 20%	#11B 10%/10%	#4A $50	"#9A $100, #9B $100"					"#4B $20, #7A $20"		#7D $15	"#7E $15, #7H $15"	#7I $15		#7F $15	"#15 20%, 11c 0%"																				150	150	75		100	0.2	0.1	50	100					20		15	15	15		15	0.2																				NO	148.5	148.5	74.25		99	0.198	0.099	49.5	99					19.8		14.85	14.85	14.85		14.85	0.198																					3.1579	0.093773091	3.576829822	0	0.671314219	1.752368113	0.129331317	0.70391913	9.524592968	0	0	0	0	0	0	2.259468167	0.234473112	0.002352014	0	0.30305418	8.836975201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2464		0.315620067	3.1579	0.093773091	3.576829822	0	0.671314219	1.752368113	0.129331317	0.70391913	9.524592968	0	0	0	0	0	0	2.259468167	0.234473112	0.002352014	0	0.30305418	8.836975201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2464	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.1211	0.0135							0.429						0.7299																					1.2935		0	3.1579	0.093773091	3.576829822	0	0.671314219	1.873478098	0.142787982	0.70391913	9.524592968	0	0	0	0	0.429044073	0	2.259468167	0.234473112	0.002352014	0	1.032931528	8.836975201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5399
H2459_013_0	2010	7	N/A																															A	A	D		T	Coin	Coin	V	V	V	V			V		V	V	V		V	Coin																																																												0	YES	262.6679201	9.457016069	576.2260275		131.4617735	9.877812712	1.689454442	213.9563883	604.362974	1857.434779	445.0409817			1482.329977		1496.592933	155.762259	457.3085873		256.8710938	23.84959754																				3400	#1A $300	#1B $300	#2 $125/day days 21-100		#10A $100	#11A 20%	#11B 20%/10%	#4A $50	"#9A $200, #9B $200"	#8A $25	#8B $25			"#4B $25, #7A $25, #9A $25, #9C $25, #9D $25"		#7D $30	"#7E $30, #7H $30"	#7I $30		#7F $30	"#15 20%, 11c 0%"																				300	300	125		100	0.2	0.19	50	200	25	25			25		30	30	30		30	0.2																				NO	294	294	122.5		98	0.196	0.1862	49	196	24.5	24.5			24.5		29.4	29.4	29.4		29.4	0.196																					6.4354	0.231696894	5.882307364	0	1.073604484	1.936051291	0.314576417	0.873655252	9.871261909	3.792262673	0.908625338	0	0	3.026423704	0	3.666652686	0.381617535	1.120406039	0	0.62933418	4.674521119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.8184		0.914660427	6.4354	0.231696894	5.882307364	0	1.073604484	1.936051291	0.314576417	0.873655252	9.871261909	3.792262673	0.908625338	0	0	3.026423704	0	3.666652686	0.381617535	1.120406039	0	0.62933418	4.674521119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.8184	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0667	0.0074							0.2373						0.2425																					0.5539		0	6.4354	0.231696894	5.882307364	0	1.073604484	2.002741319	0.32198642	0.873655252	9.871261909	3.792262673	0.908625338	0	0	3.263769833	0	3.666652686	0.381617535	1.120406039	0	0.871819683	4.674521119	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3723
H2459_014_0	2010	7	N/A																															A	A	D		T	Coin	Coin	V	V	V	V			V		V	V	V		V	Coin																																																												0	YES	239.2835419	4.428951102	427.1018549		105.7920292	11.7737779	1.391267852	169.4289031	729.4802571	1725.193114	568.8987571			1654.416875		1278.395559	102.6735922	320.6197037		177.615467	22.40221285																				3400	#1A $300	#1B $300	#2 $125/day days 21-100		#10A $100	#11A 20%	#11B 20%/10%	#4A $50	"#9A $200, #9B $200"	#8A $25	#8B $25			"#4B $25, #7A $25, #9A $25, #9C $25, #9D $25"		#7D $30	"#7E $30, #7H $30"	#7I $30		#7F $30	"#15 20%, 11c 0%"																				300	300	125		100	0.2	0.19	50	200	25	25			25		30	30	30		30	0.2																				NO	294	294	122.5		98	0.196	0.1862	49	196	24.5	24.5			24.5		29.4	29.4	29.4		29.4	0.196																					5.8624	0.108509302	4.359998102	0	0.863968238	2.307660469	0.259054074	0.691834688	11.9148442	3.522269275	1.161501629	0	0	3.377767786	0	3.132069119	0.251550301	0.785518274	0	0.435157894	4.390833719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.425		0.88622416	5.8624	0.108509302	4.359998102	0	0.863968238	2.307660469	0.259054074	0.691834688	11.9148442	3.522269275	1.161501629	0	0	3.377767786	0	3.132069119	0.251550301	0.785518274	0	0.435157894	4.390833719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.425	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.108	0.012							0.3827						0.6511																					1.1538		0	5.8624	0.108509302	4.359998102	0	0.863968238	2.415695153	0.271057928	0.691834688	11.9148442	3.522269275	1.161501629	0	0	3.760491312	0	3.132069119	0.251550301	0.785518274	0	1.086236068	4.390833719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5788
H2459_016_0	2010	5	N/A																															Coin		Coin		Coin	Coin		Coin	Coin	Coin					Coin						Coin																																																												0	NO	329.4288733		19.63165547		13.6282407	32.64529139		23.18378176	27.43794736	118.7765974					163.5360036						39.52795653																					FFS Medicare Actl. Equiv. cost sharing		FFS Medicare Actl. Equiv. cost sharing		FFS Medicare Actl. Equiv. cost sharing	"#11A, 11B, 11C 20% coinsurance"		FFS Medicare Actl. Equiv. cost sharing	FFS Medicare Actl. Equiv. cost sharing	FFS Medicare Actl. Equiv. cost sharing					FFS Medicare Actl. Equiv. cost sharing						#15 20% coinsurance																				0.081128366		0.133118653		0.233	0.233		0.233	0.233	0.233					0.233					.	0.233																				NO	0.081128366		0.133118653		0.233	0.233		0.233	0.233	0.233					0.233						0.233																					26.726	0	2.61333953	0	3.175380082	7.606352895	0	5.40182115	6.393041736	27.6749472	0	0	0	0	38.10388884	0	0	0	0	0	9.210013871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.9048			26.726	0	2.61333953	0	3.175380082	7.606352895	0	5.40182115	6.393041736	27.6749472	0	0	0	0	38.10388884	0	0	0	0	0	9.210013871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.9048	NO																																																																																		0			26.726	0	2.61333953	0	3.175380082	7.606352895	0	5.40182115	6.393041736	27.6749472	0	0	0	0	38.10388884	0	0	0	0	0	9.210013871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.9048
H2459_801_0	2010	5	N/A																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	Coin																																																												0	YES	323.3294607	4.157244596	830.9469234		159.7074209	11.5615881	1.963544727	233.2121149	816.4609419	1536.020255	496.128414			2108.550163	2858.7542	2185.731486	271.4268606	920.6586957		212.6349738	39.63016497																					#1A $300	#1B $300	#2 $125/day days 21-100		#10A $100	#11A 20%	#11B 20%/10%	#4A $50	"#9A $200, #9B $200"	#8A $25	#8B $25			"#9A $25, #9C $25, #9D $25"	#7A $25	#7D $30	"#7E $30, #7H $30"	#7I $30		"#4B $25, #7A $25, #7F $30"	"#15 20%, 11c 0%"																				300	300	125		100	0.2	0.19	50	200	25	25			25	30	30	30	30		30	0.2																				NO	294	294	122.5		98	0.196	0.1862	49	196	24.5	24.5			24.5	29.4	29.4	29.4	29.4		29.4	0.196																					7.9216	0.101852493	8.482583176	0	1.304277271	2.266071268	0.365612028	0.952282803	13.33552872	3.136041355	1.012928845	0	0	4.304956583	7.003947791	5.355042141	0.664995808	2.255613805	0	0.520955686	7.767512335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7518		1.3622811	7.9216	0.101852493	8.482583176	0	1.304277271	2.266071268	0.365612028	0.952282803	13.33552872	3.136041355	1.012928845	0	0	4.304956583	7.003947791	5.355042141	0.664995808	2.255613805	0	0.520955686	7.767512335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7518	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0599	0.0067							0.3585						0.5247																					0.9497		0	7.9216	0.101852493	8.482583176	0	1.304277271	2.325922825	0.372262201	0.952282803	13.33552872	3.136041355	1.012928845	0	0	4.663479303	7.003947791	5.355042141	0.664995808	2.255613805	0	1.04563484	7.767512335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7015
H2459_803_0	2010	5	N/A																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	Coin																																																												0	YES	243.242773	2.267385634	464.764442		103.168345	7.039315502	2.345998211	183.1889978	680.0318172	1406.840513	423.0997953			1835.506061	2325.963937	2125.683811	243.2592455	926.6865126		136.0439903	39.79956688																				3400	#1A $300	#1B $300	#2 $125/day days 21-100		#10A $100	#11A 20%	#11B 20%/10%	#4A $50	"#9A $200, #9B $200"	#8A $25	#8B $25			"#9A $25, #9C $25, #9D $25"	#7A $25	#7D $30	"#7E $30, #7H $30"	#7I $30		"#4B $25, #7A $25, #7F $30"	"#15 20%, 11c 0%"																				300	300	125		100	0.2	0.19	50	200	25	25			25	30	30	30	30		30	0.2																				NO	294	294	122.5		98	0.196	0.1862	49	196	24.5	24.5			24.5	29.4	29.4	29.4	29.4		29.4	0.196																					5.9594	0.055550948	4.744470345	0	0.842541484	1.379705838	0.436824867	0.748021741	11.10718635	2.87229938	0.863828749	0	0	3.747491541	5.698611645	5.207925338	0.595985151	2.270381956	0	0.333307776	7.800715108	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6643		1.115597881	5.9594	0.055550948	4.744470345	0	0.842541484	1.379705838	0.436824867	0.748021741	11.10718635	2.87229938	0.863828749	0	0	3.747491541	5.698611645	5.207925338	0.595985151	2.270381956	0	0.333307776	7.800715108	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6643	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0481	0.0053							0.2884						0.422																					0.7638		0	5.9594	0.055550948	4.744470345	0	0.842541484	1.427842917	0.442173431	0.748021741	11.10718635	2.87229938	0.863828749	0	0	4.03584221	5.698611645	5.207925338	0.595985151	2.270381956	0	0.755293822	7.800715108	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4281
H2481_003_0	2010	7	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	602.3453773	10.90552187	226.4848134	0	183.7959629	0	0	198.4447664	279.562882	0	0	0	0	351.7470319	2758.862595	2571.712719	121.5991603	385.8679367	0	838.6216018	0	0	0	0	255.7062323	0	0	0	0	656.5485296											2000	$200/Days 1-5 for IP Medical; $200/Days 1-5 for IP Surgical;	$200/Days 1-5 for IP Psych; $200/Days 1-5 for IP Substance Abuse;	$150/Days 1-5 for SNF	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults;	$20/Visit for Speclst - Office Visits; $20/Consult for Speclst - Consults;	$10/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Visit for Acupuncture; $10/Service for Care Coordination Counseling;											200	200	150	0	100	0	0	48.40392799	74.90237739	0	0	0	0	10	10	20	14.41223798	10	0	15.61483508	0	0	0	0	10	0	0	0	0	10											YES	194.2134849	194.213485	145.6601137	0	97.10674247	0	0	47.0034777	72.73525871	0	0	0	0	9.710674249	9.710674247	19.42134849	13.99525482	9.710674245	0	15.16305769	0	0	0	0	9.710674249	0	0	0	0	9.710674245											4000	9.7486	0.176499951	2.749150306	0	1.487318936	0	0	0.777299513	1.694506546	0	0	0	0	0.284641737	2.232534663	4.162177413	0.141817603	0.312253153	0	1.05967231	0	0	0	0	0.206923327	0	0	0	0	0.531294075	0	0	0	0	0	0	0	0	0	0	25.5647	0	0.761690937	9.7486	0.176499951	2.749150306	0	1.487318936	0	0	0.777299513	1.694506546	0	0	0	0	0.284641737	2.232534663	4.162177413	0.141817603	0.312253153	0	1.05967231	0	0	0	0	0.206923327	0	0	0	0	0.531294075	0	0	0	0	0	0	0	0	0	0	25.5647	YES	$400/Days 1-10 for IP Medical; $400/Days 1-10 for IP Surgical;	$400/Days 1-10 for IP Psych; $400/Days 1-10 for IP Substance Abuse;	$300/Days 1-10 for SNF	20% Coinsurance for Home Health	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults;	$40/Visit for Speclst - Office Visits; $20/Consult for Speclst - Consults;	$20/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Visit for Acupuncture; $20/Service for Care Coordination Counseling;											6000	3.3206	0.0976	1.5922	0.8427	0.1954	0.3145	0.1878	0.1526	0.8496	0.2131	0.5978	0	0	0.0996	0.6332	1.0406	0.0449	0.1094	0	0.2451	0.1864	0	0	0	0.0591	0	0	0	0	0.1643											10.9465	0	3.152824048	13.0692	0.274107191	4.341317727	0.842675372	1.682761379	0.314484477	0.187810203	0.929864312	2.544067765	0.213094299	0.597801427	0	0	0.384275552	2.865737686	5.202811949	0.186765229	0.421638273	0	1.304747386	0.186368487	0	0	0	0.265993891	0	0	0	0	0.695618744	0	0	0	0	0	0	0	0	0	0	36.5112
H2481_004_0	2010	7	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	522.6092872	10.37795863	215.9485139	0	148.9731923	0	0	196.8655454	270.2992183	0	0	0	0	340.1261286	2738.949815	2679.939931	116.2149164	373.3034424	0	870.3417993	0	0	0	0	289.2887957	0	0	0	0	623.3720689											2000	$200/Days 1-5 for IP Medical; $200/Days 1-5 for IP Surgical;	$200/Days 1-5 for IP Psych; $200/Days 1-5 for IP Substance Abuse;	$150/Days 1-5 for SNF	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults;	$20/Visit for Speclst - Office Visits; $20/Consult for Speclst - Consults;	$10/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Visit for Acupuncture; $10/Service for Care Coordination Counseling;											200	200	150	0	100	0	0	48.45394976	74.90248524	0	0	0	0	10	10	20	14.41295468	10	0	15.88549134	0	0	0	0	10	0	0	0	0	10											YES	189.6000801	189.6000803	142.2000601	0	94.80004007	0	0	45.9343638	71.00758603	0	0	0	0	9.480004005	9.480004008	18.96000801	13.66348681	9.480004009	0	15.05945216	0	0	0	0	9.480004008	0	0	0	0	9.480004007											4000	8.2572	0.163971816	2.558990971	0	1.176888717	0	0	0.753574465	1.59944125	0	0	0	0	0.268699755	2.163771269	4.234306882	0.132325081	0.294909844	0	1.092239224	0	0	0	0	0.228538245	0	0	0	0	0.492464143	0	0	0	0	0	0	0	0	0	0	23.4174	0	1.284485653	8.2572	0.163971816	2.558990971	0	1.176888717	0	0	0.753574465	1.59944125	0	0	0	0	0.268699755	2.163771269	4.234306882	0.132325081	0.294909844	0	1.092239224	0	0	0	0	0.228538245	0	0	0	0	0.492464143	0	0	0	0	0	0	0	0	0	0	23.4174	YES	$400/Days 1-10 for IP Medical; $400/Days 1-10 for IP Surgical;	$400/Days 1-10 for IP Psych; $400/Days 1-10 for IP Substance Abuse;	$300/Days 1-10 for SNF	20% Coinsurance for Home Health	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults;	$40/Visit for Speclst - Office Visits; $20/Consult for Speclst - Consults;	$20/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Visit for Acupuncture; $20/Service for Care Coordination Counseling;											6000	3.1386	0.0916	1.4713	0.7527	0.1914	0.3008	0.1796	0.1497	0.8027	0.2056	0.5907	0	0	0.0939	0.5905	0.9705	0.0416	0.1013	0	0.2278	0.186	0	0	0	0.0551	0	0	0	0	0.1529											10.2943	0	2.871170454	11.3958	0.255527993	4.030253884	0.752723187	1.368286847	0.300806748	0.17964186	0.903259874	2.402136139	0.205640201	0.59066579	0	0	0.362569241	2.754317126	5.204836699	0.173958735	0.396230038	0	1.319992876	0.18600286	0	0	0	0.283629385	0	0	0	0	0.645327832	0	0	0	0	0	0	0	0	0	0	33.7116
H2486_002_0	2010	9	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	P	O	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	YES	1267.905407	71.515681	727.879222	894.728369	163.193255	11.612364	2.723709	376.929839	307.887149	954.709333	1051.605141	42.714374	0.025346	321.48595	4527.572876	3583.790938	52.030402	494.99819			23.758722	0							0.04	0.25	11.377559	0.05	0.55	2.76	0.42						5000	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$40/Visit:9b. $0 Surgery ASC -- Physician,9b. $40 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $40 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						119.30775	110.4939	45.891712	0	100	0.2	0.2	50	40	19.14189	31.688093	50	0.2	46.977145	10	30	30	30			0.2	0							0	0	0	0	0	0	0						NO	113.767814	105.363226	36.435679	0	93.4396	0.186879	0.186879	46.7198	37.37584	17.886106	29.609228	46.7198	0.186879	43.895257	9.34396	28.03188	28.03188	28.03188			0.186879	0							0	0	0	0	0	0	0							12.0206	0.627926905	2.210064474	0	1.270726039	2.170106972	0.509004014	1.467507224	0.958961735	1.423002694	2.594768032	0.166300584	0.004736635	1.1759757	3.525454988	8.371699793	0.121542499	1.156310822	0	0	4.440006209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2147	0	3.250583	12.0206	0.627926905	2.210064474	0	1.270726039	2.170106972	0.509004014	1.467507224	0.958961735	1.423002694	2.594768032	0.166300584	0.004736635	1.1759757	3.525454988	8.371699793	0.121542499	1.156310822	0	0	4.440006209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2147	NO																																																																																		0	0	0	12.0206	0.627926905	2.210064474	0	1.270726039	2.170106972	0.509004014	1.467507224	0.958961735	1.423002694	2.594768032	0.166300584	0.004736635	1.1759757	3.525454988	8.371699793	0.121542499	1.156310822	0	0	4.440006209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2147
H2486_801_0	2010	2	N/A																															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	NO	238.027009	1.464772	22.926385	11.090278	5.402008	5.257384	2.222142	21.762284	61.526976	8.84714	29.006744	4.490603	0.957469	15.847926	73.469263	91.139944	0.318834	6.198438			23.429435	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																			0.082959544	0.082959544	0.16171643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.082959544	0.082959544	0.16171643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.7466	0.121516817	3.707573125	0	1.258667864	1.224970472	0.517759086	5.070612172	14.33578541	2.06138362	6.758571352	1.046310499	0.223090277	3.692566758	17.11833828	21.23560695	0.074288322	1.444236054	0	0	5.459058355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0969	0	0	19.7466	0.121516817	3.707573125	0	1.258667864	1.224970472	0.517759086	5.070612172	14.33578541	2.06138362	6.758571352	1.046310499	0.223090277	3.692566758	17.11833828	21.23560695	0.074288322	1.444236054	0	0	5.459058355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0969	NO																																																																																		0	0	0	19.7466	0.121516817	3.707573125	0	1.258667864	1.224970472	0.517759086	5.070612172	14.33578541	2.06138362	6.758571352	1.046310499	0.223090277	3.692566758	17.11833828	21.23560695	0.074288322	1.444236054	0	0	5.459058355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0969
H2486_802_0	2010	2	N/A																															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	NO	238.027009	1.464772	22.926385	11.090278	5.402008	5.257384	2.222142	21.762284	61.526976	8.84714	29.006744	4.490603	0.957469	15.847926	73.469263	91.139944	0.318834	6.198438			23.429435	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																			0.082959544	0.082959544	0.16171643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.082959544	0.082959544	0.16171643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.7466	0.121516817	3.707573125	0	1.258667864	1.224970472	0.517759086	5.070612172	14.33578541	2.06138362	6.758571352	1.046310499	0.223090277	3.692566758	17.11833828	21.23560695	0.074288322	1.444236054	0	0	5.459058355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0969	0	0	19.7466	0.121516817	3.707573125	0	1.258667864	1.224970472	0.517759086	5.070612172	14.33578541	2.06138362	6.758571352	1.046310499	0.223090277	3.692566758	17.11833828	21.23560695	0.074288322	1.444236054	0	0	5.459058355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0969	NO																																																																																		0	0	0	19.7466	0.121516817	3.707573125	0	1.258667864	1.224970472	0.517759086	5.070612172	14.33578541	2.06138362	6.758571352	1.046310499	0.223090277	3.692566758	17.11833828	21.23560695	0.074288322	1.444236054	0	0	5.459058355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0969
H2486_803_0	2010	2	N/A																															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	NO	238.027009	1.464772	22.926385	11.090278	5.402008	5.257384	2.222142	21.762284	61.526976	8.84714	29.006744	4.490603	0.957469	15.847926	73.469263	91.139944	0.318834	6.198438			23.429435	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																			0.082959544	0.082959544	0.16171643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.082959544	0.082959544	0.16171643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.7466	0.121516817	3.707573125	0	1.258667864	1.224970472	0.517759086	5.070612172	14.33578541	2.06138362	6.758571352	1.046310499	0.223090277	3.692566758	17.11833828	21.23560695	0.074288322	1.444236054	0	0	5.459058355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0969	0	0	19.7466	0.121516817	3.707573125	0	1.258667864	1.224970472	0.517759086	5.070612172	14.33578541	2.06138362	6.758571352	1.046310499	0.223090277	3.692566758	17.11833828	21.23560695	0.074288322	1.444236054	0	0	5.459058355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0969	NO																																																																																		0	0	0	19.7466	0.121516817	3.707573125	0	1.258667864	1.224970472	0.517759086	5.070612172	14.33578541	2.06138362	6.758571352	1.046310499	0.223090277	3.692566758	17.11833828	21.23560695	0.074288322	1.444236054	0	0	5.459058355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.0969
H2491_001_0	2010	6	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	246.8877879	4.035790755	373.0167796	550.2154361	6.726048602	9.437685456	3.262802453	21.45006957	26.35793356	4168.439956	27.21026877	0.163636808	0.126777736	7.86362653	9491.797765	112.6359647	2.6474113	13.08739673	25.86480129	20.42773942	28.52386074	0.412646394	1050	1027.636364	0.96	172.8	0.056	0.224	1520	4602.173676												"Medicare FFS cost sharing, Unlimited Days"	"Medicare FFS cost sharing, Unlimited Days"	"$0 days 1 - 20, $133.5 days 21 - 100"	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, $1,000 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	$0.00 copayment											747.6	747.6	32.31	0	0.198828592	0.2	0.2	0.162932113	0.2	0	0.2	0.2925	0.2	0.2	0	0.127542373	0.45	0.2	0.198798378	0.108474298	0.2	0.2	0	0	0	0	0	0	0	0											NO	747.6	747.6	32.31	0	0.198828592	0.2	0.2	0.162932113	0.2	0	0.2	0.2925	0.2	0.2	0	0.127542373	0.45	0.2	0.198798378	0.108474298	0.2	0.2	0	0	0	0	0	0	0	0												15.3811	0.251429764	1.004347679	0	1.337330774	1.887537091	0.652560491	3.494905161	5.271586712	0	5.442053754	0.047863766	0.025355547	1.572725306	0	14.3658582	1.191335085	2.617479346	5.141880549	2.215884701	5.704772147	0.082529279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6885	0	0	15.3811	0.251429764	1.004347679	0	1.337330774	1.887537091	0.652560491	3.494905161	5.271586712	0	5.442053754	0.047863766	0.025355547	1.572725306	0	14.3658582	1.191335085	2.617479346	5.141880549	2.215884701	5.704772147	0.082529279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6885	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.3811	0.251429764	1.004347679	0	1.337330774	1.887537091	0.652560491	3.494905161	5.271586712	0	5.442053754	0.047863766	0.025355547	1.572725306	0	14.3658582	1.191335085	2.617479346	5.141880549	2.215884701	5.704772147	0.082529279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6885
H2491_002_0	2010	5	N/A																															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	V	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	Yes	1493.052274	25.22200056	383.9364814	520.1451192	237.8856375	8.777047474	3.117736245	2453.22499	330.7532743	4015.60239	1647.588705	4.038816312	0.131125599	600.2286524	9272.533196	26163.7979	283.8943002	2520.719177	4016.538089	2724.555638	27.72157546	37.49727209	0	317.1428571	288	172.8	16.8	12.8	1520	0											3000	"$175 days 1 - 5, $0 after day 5, unlimited coverage"	"$175 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 20, $133.5 days 21 - 100"	Copay between $0.00 and $25.00	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $75.00 and $125.00	$0.00 copayment	Copay between $0.00 and $175.00	$175.00 copayment	20% coinsurance	Copay between $25.00 and $125.00	Copay between $0.00 and $5.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Not Covered											102.1653449	104.2957378	32.31	3.289673607	41.71112712	0.2	0.2	20.02230159	82.67050258	0	62.52948004	49.96410947	0.2	8.479539477	3.063142329	7.007769565	26.6761142	9.419981639	35.86184033	8.271868091	0.2	0	0	0	0	0	0	0	0	0											NO	90.88335547	92.77849179	28.7420477	2.926399125	37.10502028	0.177914254	0.177914254	17.81126423	73.54130388	0	55.62442891	44.44663626	0.177914254	7.543154692	2.724883408	6.233910464	23.73030476	8.37974502	31.90166281	7.358416194	0.177914254	0	0	0	0	0	0	0	0	0												11.3078	0.195004931	0.919593389	0.126846018	0.735562617	1.561561852	0.554689718	3.64125321	2.027002254	0	7.637181734	0.014959317	0.023329113	0.377301465	2.105547655	13.5918978	0.561408189	1.760248664	10.67785365	1.670701194	4.932063411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4218	0	7.997131384	11.3078	0.195004931	0.919593389	0.126846018	0.735562617	1.561561852	0.554689718	3.64125321	2.027002254	0	7.637181734	0.014959317	0.023329113	0.377301465	2.105547655	13.5918978	0.561408189	1.760248664	10.67785365	1.670701194	4.932063411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4218	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.9283	0	0.107	0.1611	0.1045	0.1453	0.0516	0	0.4262	0.0792	0.4321	0	0	0.1392	0	1.6253	0	0.2122	0.3106	0.3207	0	0.0067	0	0	0	0	0	0	0	0											6.0502	0	0	13.2361	0.195004931	1.026600704	0.287983166	0.840049372	1.706902208	0.606316748	3.64125321	2.45324744	0.079213221	8.069295931	0.014959317	0.023329113	0.516539182	2.105547655	15.21718893	0.561408189	1.972446633	10.9884314	1.991378371	4.932063411	0.00668607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.472
H2542_001_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	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	YES	1140.985494	51.973962	620.621283	484.175169	40.735256	7.94387	3.722014	318.970905	396.057831	1357.328574	984.879612	90.733021	0.037261	557.718795	3461.811184	3981.159624	75.035625	650.39571			15.763508	0		3.57	2.69				0.04	0.25	8.949646	0.05	0.55	1.67	0.32	0.4	0.42				3400	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	100.247015	88.654762	24.848707	0	121.4901	0.161987	0.161987	40.4967	106.783382	63.068651	82.977908	121.4901	0.161987	92.345113	8.09934	24.29802	24.29802	40.991218			0.161987	0		0	0				0	0	0	0	0	0	0	0	0					9.5317	0.383978269	1.285136368	0	0.41241086	1.28680367	0.602917882	1.076439087	3.524366222	7.133740177	6.81027082	0.918596983	0.006035798	4.291883762	2.33653215	8.061191347	0.15193476	2.221709361	0	0	2.55348337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5891	0	13.35027	9.5317	0.383978269	1.285136368	0	0.41241086	1.28680367	0.602917882	1.076439087	3.524366222	7.133740177	6.81027082	0.918596983	0.006035798	4.291883762	2.33653215	8.061191347	0.15193476	2.221709361	0	0	2.55348337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5891	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.8102	0.0925	0.3287	1.2272	1.4649	1.1302	0.5295	0.1687	2.1792	0.289	0.9276	0.1553	0.001	0.6311	1.1086	1.9035	0.0189	0.1836			0.5501	0		0	0				0	0	0	0	0	0	0	0	0				19.6998	0	10.24366	16.3419	0.476505269	1.613798368	1.227215	1.87733986	2.41696267	1.132440882	1.245129087	5.703583222	7.422782177	7.73790182	1.073858983	0.007030798	4.922987762	3.44514415	9.964658347	0.17082776	2.405339361	0	0	3.10358537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.289
H2542_002_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	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	YES	1244.27718	56.679086	676.805186	528.006813	44.422957	8.378895	3.92584	347.846857	431.912346	1480.205471	1074.039269	98.946943	0.039301	608.208231	3775.203698	4341.567964	81.828487	709.275046			16.626755	0		3.57	2.69				0.04	0.25	9.759843	0.05	0.55	1.67	0.32	0.4	0.42				3400	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	96.959416	85.747331	22.99107	0	118.92615	0.158568	0.158568	39.64205	104.529806	61.737638	81.226726	118.92615	0.158568	90.396245	7.92841	23.78523	23.78523	40.126132			0.158568	0		0	0				0	0	0	0	0	0	0	0	0					10.0537	0.405006696	1.296706284	0	0.440254271	1.328624622	0.622512597	1.149113541	3.762309478	7.615365795	7.270057785	0.980614915	0.006231881	4.581645022	2.494280229	8.605432715	0.162192449	2.371705343	0	0	2.636471287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7822	0	15.93008	10.0537	0.405006696	1.296706284	0	0.440254271	1.328624622	0.622512597	1.149113541	3.762309478	7.615365795	7.270057785	0.980614915	0.006231881	4.581645022	2.494280229	8.605432715	0.162192449	2.371705343	0	0	2.636471287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7822	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.8926	0.0936	0.3219	1.2707	1.5683	1.1702	0.5483	0.1806	2.2565	0.2993	0.9605	0.1608	0.001	0.6535	1.1479	1.971	0.0196	0.1901			0.5696	0		0	0				0	0	0	0	0	0	0	0	0				20.2763	0	11.388215	16.9463	0.498653696	1.618652284	1.270743	2.008580271	2.498869622	1.170817597	1.329709541	6.018820478	7.914659795	8.230590785	1.141383915	0.007262881	5.235133022	3.642214229	10.57641372	0.181755449	2.561849343	0	0	3.206084287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.0585
H2542_801_0	2010	4	N/A																															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	NO	255.089092	0.870136	44.290766	14.311924	1.67837	7.76056	3.793459	18.710876	53.27778	11.502027	27.421716	9.693737	0.851657	17.551045	32.572525	71.434833	0.343278	5.315968			23.218033	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																			0.081132248	0.081132248	0.184119014	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.081132248	0.081132248	0.184119014	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.696	0.07059609	8.15477216	0	0.39106021	1.80821048	0.883875947	4.359634108	12.41372274	2.679972291	6.389259828	2.258640721	0.198436081	4.089393485	7.589398325	16.64431609	0.079983774	1.238620544	0	0	5.409801689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3556	0	0	20.696	0.07059609	8.15477216	0	0.39106021	1.80821048	0.883875947	4.359634108	12.41372274	2.679972291	6.389259828	2.258640721	0.198436081	4.089393485	7.589398325	16.64431609	0.079983774	1.238620544	0	0	5.409801689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3556	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.8526	0.0131	1.5181	0	1.5642	1.1923	0.5827	1.1494	2.9913	0.7066	1.5319	0.5955	0.0523	1.0703	1.43	3.1361	0.015	0.266			1.0193	0																			22.6866	0	0	24.5486	0.083739514	9.67283343	0	1.95530571	3.00047148	1.466608947	5.509023108	15.40497674	3.386544791	7.921118328	2.854188721	0.250744581	5.159678985	9.019435825	19.78037959	0.095012274	1.504590044	0	0	6.429060189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0423
H2542_802_0	2010	3	N/A																															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	NO	255.089092	0.870136	44.290766	14.311924	1.67837	7.76056	3.793459	18.710876	53.27778	11.502027	27.421716	9.693737	0.851657	17.551045	32.572525	71.434833	0.343278	5.315968			23.218033	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																			0.08108711	0.08108711	0.184219613	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.08108711	0.08108711	0.184219613	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.6844	0.070556814	8.159227783	0	0.39106021	1.80821048	0.883875947	4.359634108	12.41372274	2.679972291	6.389259828	2.258640721	0.198436081	4.089393485	7.589398325	16.64431609	0.079983774	1.238620544	0	0	5.409801689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3485	0	0	20.6844	0.070556814	8.159227783	0	0.39106021	1.80821048	0.883875947	4.359634108	12.41372274	2.679972291	6.389259828	2.258640721	0.198436081	4.089393485	7.589398325	16.64431609	0.079983774	1.238620544	0	0	5.409801689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3485	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.8505	0.0131	1.5189	0	1.5642	1.1923	0.5827	1.1494	2.9913	0.7066	1.5319	0.5955	0.0523	1.0703	1.43	3.1361	0.015	0.266			1.0193	0																			22.6853	0	0	24.5349	0.083692925	9.678118495	0	1.95530571	3.00047148	1.466608947	5.509023108	15.40497674	3.386544791	7.921118328	2.854188721	0.250744581	5.159678985	9.019435825	19.78037959	0.095012274	1.504590044	0	0	6.429060189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0338
H2542_803_0	2010	3	N/A																															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	NO	255.089092	0.870136	44.290766	14.311924	1.67837	7.76056	3.793459	18.710876	53.27778	11.502027	27.421716	9.693737	0.851657	17.551045	32.572525	71.434833	0.343278	5.315968			23.218033	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																			0.08108711	0.08108711	0.184219613	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.08108711	0.08108711	0.184219613	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.6844	0.070556814	8.159227783	0	0.39106021	1.80821048	0.883875947	4.359634108	12.41372274	2.679972291	6.389259828	2.258640721	0.198436081	4.089393485	7.589398325	16.64431609	0.079983774	1.238620544	0	0	5.409801689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3485	0	0	20.6844	0.070556814	8.159227783	0	0.39106021	1.80821048	0.883875947	4.359634108	12.41372274	2.679972291	6.389259828	2.258640721	0.198436081	4.089393485	7.589398325	16.64431609	0.079983774	1.238620544	0	0	5.409801689	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.3485	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.8505	0.0131	1.5189	0	1.5642	1.1923	0.5827	1.1494	2.9913	0.7066	1.5319	0.5955	0.0523	1.0703	1.43	3.1361	0.015	0.266			1.0193	0																			22.6853	0	0	24.5349	0.083692925	9.678118495	0	1.95530571	3.00047148	1.466608947	5.509023108	15.40497674	3.386544791	7.921118328	2.854188721	0.250744581	5.159678985	9.019435825	19.78037959	0.095012274	1.504590044	0	0	6.429060189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.0338
H2593_001_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	885.3902433	34.94101219	570.994734	0	290.0745991	1289.936946	3671.807662	330.7338675	233.6574441	0	389.6483098	12.51698971	0	19.27833261	0	3817.203181	598.4707401	20.70039777	0	0	15.1849185	0	0	0	395.1860267	678.0584574	0	0	0	149.4984577												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-20, $75 Days 21-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$100 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; Therapeutic Shoes: $50; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$75; 9b:$75	8a:$0	8b: X-Rays $0; Diagnostic $30; Therapeutic $0	9a:$75	12:$0	5:$30; 9c:$25; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$25; 7d:$25; 7f:$0; 16b:$0-$25; 17a:$0-$25; 4 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$25; 7h:$25	3:$15; 7c:$15; 7i:PT $0;SP $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $20 per month											82.33441725	54.34782609	8.721797833	0	28.3943387	1.091158499	0.103898593	50	75	0	30	75	0	27.49246571	0	23.97770938	20.43320743	11.29517942	0	0	0.175146987	0	0	0	20	19.01622718	0	0	0	20											NO	82.33441725	54.34782609	8.721797833	0	28.3943387	1.091158499	0.103898593	50	75	0	30	75	0	27.49246571	0	23.97770938	20.43320743	11.29517942	0	0	0.175146987	0	0	0	20	19.01622718	0	0	0	20												6.0748	0.158247338	0.415008386	0	0.686373035	0.117293805	0.031791304	1.378057781	1.460359025	0	0.974120775	0.078231186	0	0.044167408	0	7.62731571	1.019056398	0.019484559	0	0	2.659592716	0	0	0	0.658643378	1.074509472	0	0	0	0.249164096	0	0	0	0	0	0	0	0	0	0	24.7263	0	0	6.0748	0.158247338	0.415008386	0	0.686373035	0.117293805	0.031791304	1.378057781	1.460359025	0	0.974120775	0.078231186	0	0.044167408	0	7.62731571	1.019056398	0.019484559	0	0	2.659592716	0	0	0	0.658643378	1.074509472	0	0	0	0.249164096	0	0	0	0	0	0	0	0	0	0	24.7263	NO																																																																																		0	0	0	6.0748	0.158247338	0.415008386	0	0.686373035	0.117293805	0.031791304	1.378057781	1.460359025	0	0.974120775	0.078231186	0	0.044167408	0	7.62731571	1.019056398	0.019484559	0	0	2.659592716	0	0	0	0.658643378	1.074509472	0	0	0	0.249164096	0	0	0	0	0	0	0	0	0	0	24.7263
H2593_003_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	2871.287129	0	0	0	988.6124193	3850.41335	2289.098877	77.96102128	31.13084162	0	0	2.53063777	0	0	0	107.9991064	0	0	0	0	5.984616984	0	0	0	378.6402004	678.0584574	0	0	0	0												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	2:$0; 3 Day Waiver; 50 Add'l SNF Days	6:$0	10a:$50 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; Therapeutic Shoes: $0; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$75; 9b:$75	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$75	12:$0	5:$0; 9c:$0; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0		14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Comprehensive Health Assessment $0	13c:OTC $40 per month Allowance											82.33441725	0	0	0	14.19716935	1.091158499	0.388171745	50	75	0	0	75	0	0	0	0	0	0	0	0	0.176268682	0	0	0	20	19.01622718	0	0	0	0											NO	82.33441725	0	0	0	14.19716935	1.091158499	0.388171745	50	75	0	0	75	0	0	0	0	0	0	0	0	0.176268682	0	0	0	20	19.01622718	0	0	0	0												19.7005	0	0	0	1.169624828	0.350117604	0.074046959	0.324837589	0.19456776	0	0	0.015816486	0	0	0	0	0	0	0	0	1.054900547	0	0	0	0.631067001	1.074509472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.59	0	0	19.7005	0	0	0	1.169624828	0.350117604	0.074046959	0.324837589	0.19456776	0	0	0.015816486	0	0	0	0	0	0	0	0	1.054900547	0	0	0	0.631067001	1.074509472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.59	NO																																																																																		0	0	0	19.7005	0	0	0	1.169624828	0.350117604	0.074046959	0.324837589	0.19456776	0	0	0.015816486	0	0	0	0	0	0	0	0	1.054900547	0	0	0	0.631067001	1.074509472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.59
H2593_005_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	2172.534543	38.29288789	1313.80176	0	616.216084	8247.198852	4506.170534	533.3822254	252.7052957	0	539.261332	15.07585548	0	19.65137642	0	4472.827561	707.833118	25.4703857	0	0	23.72913233	0	0	0	393.9840101	678.0584574	0	0	0	0												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-20, $75 Days 21-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$100 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$75; 9b:$75	8a:$0	8b: X-Rays $0; Diagnostic $30; Therapeutic $0	9a:$75	12:$0	5:$30; 9c:$25; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$25; 7d:$25; 7f:$0; 16b:$0-$25; 17a:$0-$25; 9 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$25; 7h:$25	3:$15; 7c:$15; 7i:PT $0;SP $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0	10b:$0 24 Plan Approved Location Trips		17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 7g:Health Alert Call $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $0 per month											82.33441725	54.34782609	8.721797833	0	28.3943387	1.091158499	0.131906167	50	75	0	30	75	0	27.23338984	0	24.27458755	20.43171744	14.39405579	0	0	0.175407814	0	0	0	20	19.01622718	0	0	0	0											NO	82.33441725	54.34782609	8.721797833	0	28.3943387	1.091158499	0.131906167	50	75	0	30	75	0	27.23338984	0	24.27458755	20.43171744	14.39405579	0	0	0.175407814	0	0	0	20	19.01622718	0	0	0	0												14.9062	0.173427934	0.954892778	0	1.45808735	0.74991676	0.04953264	2.222425939	1.579408098	0	1.34815333	0.094224097	0	0.0445978	0	9.048003685	1.205187189	0.030551846	0	0	4.162275222	0	0	0	0.656640017	1.074509472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.758	0	0	14.9062	0.173427934	0.954892778	0	1.45808735	0.74991676	0.04953264	2.222425939	1.579408098	0	1.34815333	0.094224097	0	0.0445978	0	9.048003685	1.205187189	0.030551846	0	0	4.162275222	0	0	0	0.656640017	1.074509472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.758	NO																																																																																		0	0	0	14.9062	0.173427934	0.954892778	0	1.45808735	0.74991676	0.04953264	2.222425939	1.579408098	0	1.34815333	0.094224097	0	0.0445978	0	9.048003685	1.205187189	0.030551846	0	0	4.162275222	0	0	0	0.656640017	1.074509472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.758
H2593_006_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	1201.01606	26.5136027	961.4470762	0	480.2258601	3546.323983	3427.564903	483.8667639	296.0730236	0	432.8941908	15.02737843	0	22.17454042	0	4311.082476	769.0874586	13.89468233	0	0	14.94279586	0	0	0	396.8022109	678.0584574	0	0	0	0												1a:$100 Days 1-5; Unlimited Add'l Days	1b:$100 Days 1-5; 60 Add'l Days	"2:$0 Days 1-20, $75 Days 21-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$100 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$75; 9b:$75	8a:$0	8b: X-Rays $0; Diagnostic $30; Therapeutic $0	9a:$75	12:$0	5:$30; 9c:$25; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$25; 7d:$25; 7f:$0; 16b:$0-$25; 17a:$0-$25; 12 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$25; 7h:$25	3:$15; 7c:$15; 7i:PT $0;SP $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0	10b:$0 24 Plan Approved Location Trips		17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $0 per month 13e:Electronic Health Monitoring $0											82.33441725	54.34782609	8.721797833	0	28.3943387	1.091158499	0.161799054	50	75	0	30	75	0	27.28225847	0	23.83854903	20.29683256	9.758421118	0	0	0.175034585	0	0	0	20	19.01622718	0	0	0	0											NO	82.33441725	54.34782609	8.721797833	0	28.3943387	1.091158499	0.161799054	50	75	0	30	75	0	27.28225847	0	23.83854903	20.29683256	9.758421118	0	0	0.175034585	0	0	0	20	19.01622718	0	0	0	0												8.2404	0.120079722	0.698795585	0	1.136307977	0.322466796	0.04621473	2.016111516	1.850456398	0	1.082235477	0.093921115	0	0.050414295	0	8.56416258	1.300836614	0.01129918	0	0	2.61550607	0	0	0	0.661337018	1.074509472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8851	0	0	8.2404	0.120079722	0.698795585	0	1.136307977	0.322466796	0.04621473	2.016111516	1.850456398	0	1.082235477	0.093921115	0	0.050414295	0	8.56416258	1.300836614	0.01129918	0	0	2.61550607	0	0	0	0.661337018	1.074509472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8851	NO																																																																																		0	0	0	8.2404	0.120079722	0.698795585	0	1.136307977	0.322466796	0.04621473	2.016111516	1.850456398	0	1.082235477	0.093921115	0	0.050414295	0	8.56416258	1.300836614	0.01129918	0	0	2.61550607	0	0	0	0.661337018	1.074509472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8851
H2610_005_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1040.179925	35.9626272	641.659814	542.792332	271.7935057	6.800985678	1.438990162	950.3320903	128.6820231	11.49424469	2550.977992	0	0.640569147	3464.647993	5674.754916	6381.546434	82.66458607	454.0124863	0	3688.823205	42.2117437	24.46486264	255.3186724	438.4103769	287.23592	328.7642717	27.34666634	0	0	0											1125	1a: $125 Days 1-10	1b: $275	2: $75 Days 4-18	6: none	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $25	9b: $75	8a: 20%	8b: $40; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: 20%; 9a: $75; 9a: $40; 9d: $20	7a: $5	7d: $20	7h: $25; 7h: $35	7c: $20; 7i: $20	7d. 0%	14c: $5; 7b: $20; 7f: $20	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $20	18b. $0	14a. $0	13b. $0											107.8321437	107.966457	46.14910865	0	103.9032421	0.200659566	0.089733195	13.83585176	67.12554496	0.011101636	17.36101796	0	0.200659566	8.422887406	4.111362483	10.07371821	34.66340803	18.64002542	0	1.252027125	0.176533175	0	0	19.99913351	8.34206563	18.2335555	19.35664679	0	0	0											NO	69.58294166	65.96616756	12.17545675	0	64.51466074	0.120157683	0.076527158	12.34056795	64.5034337	0.010061422	11.20352088	0	0.014718933	6.214071947	3.897464687	8.920954657	29.72266906	14.946937	0	1.19257781	0.050198655	0	0	19.99913351	8.34206563	18.2335555	18.16673508	0	0	0												6.0316	0.197693058	0.651041776	0	1.461222151	0.817190683	0.110121828	0.977303144	0.691702695	0.115648445	2.381661268	0	0.009428494	1.794130992	1.843096408	4.744123865	0.204751011	0.565508003	0	0.366600725	2.118972747	0	0	0.730652305	0.199678408	0.499545133	0.04139997	0	0	0	0	0	0	0	0	0	0	0	0	0	26.553	0	15.4414621	6.0316	0.197693058	0.651041776	0	1.461222151	0.817190683	0.110121828	0.977303144	0.691702695	0.115648445	2.381661268	0	0.009428494	1.794130992	1.843096408	4.744123865	0.204751011	0.565508003	0	0.366600725	2.118972747	0	0	0.730652305	0.199678408	0.499545133	0.04139997	0	0	0	0	0	0	0	0	0	0	0	0	0	26.553	NO																																																																																		0		0	6.0316	0.197693058	0.651041776	0	1.461222151	0.817190683	0.110121828	0.977303144	0.691702695	0.115648445	2.381661268	0	0.009428494	1.794130992	1.843096408	4.744123865	0.204751011	0.565508003	0	0.366600725	2.118972747	0	0	0.730652305	0.199678408	0.499545133	0.04139997	0	0	0	0	0	0	0	0	0	0	0	0	0	26.553
H2610_006_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1706.31991	120.7446587	1000.328485	901.3106095	441.0563033	13.58185344	1.768206208	1457.92013	154.8786346	19.06736066	4011.823549	0	0.254341803	5519.704474	7771.061229	10089.76779	310.4404472	793.6654036	0	4511.91029	74.77386658	24.61834974	287.5668899	504.9302021	352.469745	381.866486	34.15528441	0	0	0											850	1a: $75 Days 1-6	1b: $275	2: $50 Days 4-9	6: none	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $25	9b: $50	8a: 20%	8b: $40; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: 20%; 9a: $50; 9a: $40; 9d: $15	7a: $5	7d: $15	7h: $25; 7h: $35	7c: $15; 7i: $15	7d. 0%	14c: $5; 7b: $15; 7f: $15	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $20	18b. $0	14a. $0	13b. $0											53.36425214	61.86556405	17.03395957	0	105.3703718	0.200669161	0.146578619	13.59530731	43.66172487	0.018070403	18.17844221	0	0.068948608	8.056755627	4.016307953	7.878420882	34.90421295	13.89074373	0	1.444125512	0.185562846	0	0	19.99980262	7.388756374	17.99894425	19.69275783	0	0	0											NO	33.10328674	22.20110215	6.778208302	0	56.36773457	0.119132024	0.117702292	11.11521166	41.29967732	0.016469224	9.332138192	0	0.00431631	4.697815731	3.639884543	6.354943574	29.93677656	11.21642928	0	1.310640947	0.053768615	0	0	19.99980262	7.388756374	17.99894425	18.54521579	0	0	0												4.7071	0.223388708	0.565036237	0	2.07177872	1.618033685	0.208121923	1.350424236	0.53303647	0.314024634	3.119907647	0	0.001097818	2.160879542	2.357147137	5.343325415	0.774465525	0.74184099	0	0.492791198	4.020487222	0	0	0.841542032	0.21702609	0.572766133	0.05278476	0	0	0	0	0	0	0	0	0	0	0	0	0	32.287	0	23.48682026	4.7071	0.223388708	0.565036237	0	2.07177872	1.618033685	0.208121923	1.350424236	0.53303647	0.314024634	3.119907647	0	0.001097818	2.160879542	2.357147137	5.343325415	0.774465525	0.74184099	0	0.492791198	4.020487222	0	0	0.841542032	0.21702609	0.572766133	0.05278476	0	0	0	0	0	0	0	0	0	0	0	0	0	32.287	NO																																																																																		0		0	4.7071	0.223388708	0.565036237	0	2.07177872	1.618033685	0.208121923	1.350424236	0.53303647	0.314024634	3.119907647	0	0.001097818	2.160879542	2.357147137	5.343325415	0.774465525	0.74184099	0	0.492791198	4.020487222	0	0	0.841542032	0.21702609	0.572766133	0.05278476	0	0	0	0	0	0	0	0	0	0	0	0	0	32.287
H2610_010_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1648.777724	45.12793339	901.8187623	767.4475874	378.8392819	13.37676433	10.96330016	1305.093505	145.3741604	17.04161353	3173.612113	0	0.360496899	4442.286395	7775.379096	8158.602742	91.94924195	553.8760424	0	4735.343628	68.69369562	20.71509737	437.1911444	407.401556	304.0465322	368.2256632	29.79603173	0	0	0											1025	1a: $100 Days 1-11	1b: $275	2: $75 Days 4-16	6: none	10a: $150	11a: 20%	11b: 20%	4a: $50; 4b: $25	9b: $75	8a: 20%	8b: $40; 8b: 20%; 8b: $15	5. $0	12: 20%	9a: 20%; 9a: $75; 9a: $40; 9d: $20	7a: none	7d: $20	7h: $25; 7h: $35	7c: $20; 7i: $20	7d. 0%	7b: $20; 7f: $20	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $20	18b. $0	14a. $0	13b. $0											88.11654207	92.40468521	43.79875956	0	113.5663994	0.200657716	0.040022543	13.60954337	67.23267033	0.006990899	34.70882169	0	0.200657716	9.624857385	0	10.35373423	34.91435013	18.72575027	0	1.680037069	0.142447949	0	0	19.99978818	8.628269898	18.24013357	18.75921992	0	0	0											NO	53.50390213	40.90384372	10.38374642	0	65.82570084	0.100506036	0.030150897	11.51168956	63.17531396	0.004220408	24.10013878	0	0.003801598	6.544639459	0	8.955710514	27.24451075	14.64957628	0	1.413801689	0.064243085	0	0	19.99978818	8.628269898	18.24013357	17.15652689	0	0	0												7.3513	0.153825495	0.780354779	0	2.078113437	1.344445559	0.330553339	1.25198594	0.765338185	0.071922569	6.373707696	0	0.001370464	2.422763569	0	6.088840363	0.208759343	0.676170778	0	0.557903068	4.413094952	0	0	0.678995402	0.218616295	0.559707107	0.042599702	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3704	0	22.20637614	7.3513	0.153825495	0.780354779	0	2.078113437	1.344445559	0.330553339	1.25198594	0.765338185	0.071922569	6.373707696	0	0.001370464	2.422763569	0	6.088840363	0.208759343	0.676170778	0	0.557903068	4.413094952	0	0	0.678995402	0.218616295	0.559707107	0.042599702	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3704	NO																																																																																		0		0	7.3513	0.153825495	0.780354779	0	2.078113437	1.344445559	0.330553339	1.25198594	0.765338185	0.071922569	6.373707696	0	0.001370464	2.422763569	0	6.088840363	0.208759343	0.676170778	0	0.557903068	4.413094952	0	0	0.678995402	0.218616295	0.559707107	0.042599702	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3704
H2610_011_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1356.705395	44.4551298	1024.960013	728.4287878	331.3962938	10.65158187	1.254726463	1118.273249	148.0683852	15.17269699	2747.299458	0	0.555985991	3691.198409	6114.232869	6987.837593	88.82254361	524.7216873	0	3919.322235	38.26721986	29.44126346	340.6788694	541.7321579	373.4267994	434.6234967	39.76798943	0	0	0											2650	1a: $250 Days 1-10	1b: $275	2: $125 Days 4-24	6: none	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $25	9b: $200	8a: 20%	8b: $40; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: 20%; 9a: $200; 9a: $40; 9d: $25	7a: $5	7d: $20	7h: $25; 7h: $35	7c: $25; 7i: $25	7d. 0%	14c: $5; 7b: $20; 7f: $20	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $25	18b. $0	14a. $0	13b. $0											206.2783531	216.2270554	80.08887932	0	106.1792591	0.200643553	0.183619061	13.85678013	168.2756672	0.009285227	18.80661652	0	0.200643553	14.90366617	4.125972359	10.28905185	29.81929179	23.14014646	0	1.469000492	0.197738997	0	0	19.99953162	8.451154515	17.67418649	23.85034882	0	0	0											NO	146.1843964	123.3647392	24.97688452	0	69.31571727	0.136882436	0.155817572	12.41692268	162.9192092	0.008542986	13.33865128	0	0.034193506	12.57270343	3.938688267	9.434978441	27.47544749	20.10711103	0	1.415884132	0.088412364	0	0	19.99953162	8.451154515	17.67418649	22.78064801	0	0	0												16.5274	0.457016291	2.13335899	0	1.914247651	1.458014469	0.19550843	1.157126039	2.010265351	0.129620137	3.053772452	0	0.01901111	3.867361909	2.006838105	5.494174754	0.203369928	0.879219769	0	0.46244218	3.38329537	0	0	0.902865785	0.262990632	0.640134728	0.075495047	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2336	0	21.23141223	16.5274	0.457016291	2.13335899	0	1.914247651	1.458014469	0.19550843	1.157126039	2.010265351	0.129620137	3.053772452	0	0.01901111	3.867361909	2.006838105	5.494174754	0.203369928	0.879219769	0	0.46244218	3.38329537	0	0	0.902865785	0.262990632	0.640134728	0.075495047	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2336	NO																																																																																		0		0	16.5274	0.457016291	2.13335899	0	1.914247651	1.458014469	0.19550843	1.157126039	2.010265351	0.129620137	3.053772452	0	0.01901111	3.867361909	2.006838105	5.494174754	0.203369928	0.879219769	0	0.46244218	3.38329537	0	0	0.902865785	0.262990632	0.640134728	0.075495047	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2336
H2610_803_0	2010	4	N/A																															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																																																			0	NO	199.8654228	2.101168956	19.61793612	6.135820958	5.717309472	7.961893298	1.388553382	11.185256	7.5769703	12.57537505	34.93981986	0	0.460810123	50.84651631	161.6151259	65.93821751	1.614453306	7.000542401	0	20.51990783	37.63251241	0.615541345	0.502580291	3.634622718	0.654250438	1.610541335	0.604917594	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.083554009	0.083554009	0.177187219	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083554009	0.083554009	0.177187219	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.6996	0.175561091	3.476047544	0	1.332133107	1.855121138	0.323532938	2.606164647	1.76543408	2.930062386	8.140978027	0	0.107368759	11.8472383	37.65632433	15.36360468	0.37616762	1.631126379	0	4.781138525	8.768375392	0.143421133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9794	0	0	16.6996	0.175561091	3.476047544	0	1.332133107	1.855121138	0.323532938	2.606164647	1.76543408	2.930062386	8.140978027	0	0.107368759	11.8472383	37.65632433	15.36360468	0.37616762	1.631126379	0	4.781138525	8.768375392	0.143421133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9794	NO																																																																																		0		0	16.6996	0.175561091	3.476047544	0	1.332133107	1.855121138	0.323532938	2.606164647	1.76543408	2.930062386	8.140978027	0	0.107368759	11.8472383	37.65632433	15.36360468	0.37616762	1.631126379	0	4.781138525	8.768375392	0.143421133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9794
H2610_804_0	2010	4	N/A																															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																																																			0	NO	199.8654228	2.101168956	19.61793612	6.135820958	5.717309472	7.961893298	1.388553382	11.185256	7.5769703	12.57537505	34.93981986	0	0.460810123	50.84651631	161.6151259	65.93821751	1.614453306	7.000542401	0	20.51990783	37.63251241	0.615541345	0.502580291	3.634622718	0.654250438	1.610541335	0.604917594	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.083554009	0.083554009	0.177187219	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083554009	0.083554009	0.177187219	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.6996	0.175561091	3.476047544	0	1.332133107	1.855121138	0.323532938	2.606164647	1.76543408	2.930062386	8.140978027	0	0.107368759	11.8472383	37.65632433	15.36360468	0.37616762	1.631126379	0	4.781138525	8.768375392	0.143421133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9794	0	0	16.6996	0.175561091	3.476047544	0	1.332133107	1.855121138	0.323532938	2.606164647	1.76543408	2.930062386	8.140978027	0	0.107368759	11.8472383	37.65632433	15.36360468	0.37616762	1.631126379	0	4.781138525	8.768375392	0.143421133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9794	NO																																																																																		0		0	16.6996	0.175561091	3.476047544	0	1.332133107	1.855121138	0.323532938	2.606164647	1.76543408	2.930062386	8.140978027	0	0.107368759	11.8472383	37.65632433	15.36360468	0.37616762	1.631126379	0	4.781138525	8.768375392	0.143421133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9794
H2611_001_0	2010	7	N/A																															Coin	Coin	Coin	V	T	Coin	Coin	V	P	P	Coin	Coin	P	P	V	V	V	V	Coin	Coin	Coin	Coin	T	P	P	P	P	P	P	P											15.7683	0.2361	1.1173	0.0411	0.2858	0.482	0.2346	0.7931	2.5015	0.3834	1.4204	0.3681	0.1405	2.0703	2.3265	4.3781	0.1671	0.2355	1.4324	5.1458	2.5081	0.3657			0.0505	0.0116	0.0977	0.033	0.2311	0.2848											43.1101	NO						5.597010451	2.686279478	220.0699249			16.49200254		9.206660816	69.16367649	5233.765294	5582.555182	300.6896853	432.7908849	16.63131901		29.12110056	4.054123005			309.4749341					497.5523857												Full Coverage	Full Coverage	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	$50 Copay for ER and $25 for Urgent Care	Full Coverage	Full Coverage	20% Coinsurance	Full Coverage	20% Coinsurance	$0 copay	$15 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	15% Coinsurance	20% Coinsurance	Full Coverage	N/A	Full Coverage	$150 Limit Every Two Years	Full Coverage	N/A	$350 Limit	N/A																0.200145554	0.200145554	46.21255156			0.200145554		425.6909915	32.01733604	14.6801639	28.81206228	30.02183315	30.02183315	0.416612311		0.150109166	0.538196398			22.74384943					18.44484486											NO						0.193939554	0.193939554	46.21255156			0.193939554		412.4914066	31.02456064	14.6801639	28.79908219	29.09093317	29.09093317	0.403694232		0.150109166	0.538080117			22.74384943					18.44484486												0	0	0	0	0	1.085481713	0.520975845	0.847499396	0	0	3.198451625	0	0.316472372	0.17881439	6.402711029	13.39770546	0.728945295	1.049190892	6.713967563	0	4.371344111	2.181442981	0	0	0.586554275	0	0	0	0	0.764773047	0	0	0	0	0	0	0	0	0	0	42.3443	400	0.447858826	15.7683	0.236066654	1.117263882	0.04109943	0.285766036	1.567524049	0.755536562	1.640566165	2.501518552	0.383400822	4.618824786	0.368103428	0.457011895	2.249144428	8.729210596	17.77579925	0.896008353	1.284665484	8.14633935	5.145758348	6.879397911	2.547173198	0	0	0.637034504	0.011562365	0.097680495	0.033030327	0.23112406	1.049546124	0	0	0	0	0	0	0	0	0	0	85.4545	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay for ER and $25 for Urgent Care	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	N/A	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance											3000			0.0826		0.7313	0.1428	0.0455	0.1176	1.5546	0.0268	0.0961	0.0071	0.0069	0.2095	0.2424	0.9933	0.035	0.1065	0.2345	1.5907	0.1125	0.1075			0.0078	0.0739	0.01	0.1848		0.0176											6.7374	400	0.081438775	15.7683	0.236066654	1.199907225	0.04109943	1.017088879	1.710332913	0.800998346	1.7581749	4.056111016	0.410204452	4.714887345	0.375251534	0.463908032	2.458674725	8.97161164	18.76907239	0.931010436	1.391132488	8.380797256	6.736415272	6.991902891	2.654630049	0	0	0.644855781	0.085479989	0.107722141	0.217864751	0.23112406	1.067190359	0	0	0	0	0	0	0	0	0	0	92.1918
H2611_002_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P																																																			0	NO		12.28463282				14.29621218	2.568811749	308.3735732			781.6454034		7.086598136	9.408739301		4608.467189	199.9842249				1057.197694	717.7666817								144.8222243												Full Coverage	"$100/day, days 1-10"	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	$40 Copay for ER	Full Coverage	Full Coverage	20% Coinsurance	Full Coverage	20% Coinsurance	$0 copay	Full Coverage	$5 Copay	"$5 Copay Individual, $0 Copay Group"	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	$5 Copay	$0 Copay	$150 limit per 2 years	Full Coverage	Full Coverage	$300 Limit	N/A												67.29738379				0.2	0.2	40			98.73660153		30.14253875	103.3703043		5	4.5				57.04097612	5								5											NO		66.50977065				0.197659305	0.197659305	39.53186106			97.58104033		29.78976635	102.1605127		4.941482633	4.447334369				56.37339857	4.941482633								4.941482633												0	0.068087343	0	0	0	2.825779368	0.507749546	1.015881771	0	0	6.356147636	0	0.017592342	0.080100136	0	1.897721715	0.074116393	0	0	0	4.96648558	0.295569299	0	0	0	0	0	0	0	0.059636376	0	0	0	0	0	0	0	0	0	0	18.1649	0	0.215109574	0	0.068087343	0	0	0	2.825779368	0.507749546	1.015881771	0	0	6.356147636	0	0.017592342	0.080100136	0	1.897721715	0.074116393	0	0	0	4.96648558	0.295569299	0	0	0	0	0	0	0	0.059636376	0	0	0	0	0	0	0	0	0	0	18.1649	YES	$25/day for days 1-10	$100/day for days 1-10	$25 per day days 21-30	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	$40 Copay for ER	Full Coverage	Full Coverage	20% Coinsurance	Full Coverage	20% Coinsurance	"$0 copay for OP Rehab, 20% Coinsurance for OP Partial Hospitalization"	$5 Copay	$15 Copay	$15 Copay	$15 Copay	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	$15 Copay	$15 Copay	$15 Copay	$15 Copay	$15 Copay	20% Coinsurance	20% Coinsurance											4800	0.0877	0.001	0.0106			0.1664	0.0205	0.0575			0.3534		0.0006	0.0087	0.07	0.6467	0.0477	0.2478			0.1409	0.1525			0.0226		0.0101			0.0055											2.0501	0	0.02427724	0.0877	0.069037877	0.010620275	0	0	2.992213506	0.528221722	1.073348925	0	0	6.709546569	0	0.018209374	0.088848674	0.06997383	2.544430281	0.1217767	0.247763027	0	0	5.10736725	0.448026138	0	0	0.022610589	0	0.010125356	0	0	0.065169647	0	0	0	0	0	0	0	0	0	0	20.215
H2611_005_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P																																																			0	NO		6.103703634				7.163990126	1.586347645	278.2780084			598.3011424		16.14933639	4.81335447		3379.079092	114.9521468				657.8890095	688.418006								144.7742637												Full Coverage	"$100/day, days 1-10"	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	$40 Copay for ER	Full Coverage	Full Coverage	20% Coinsurance	Full Coverage	20% Coinsurance	"$0 Copay for OP Rehab, $25 copay for OP Partial Hospitalization"	Full Coverage	$5 Copay	$5 Copay	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	$5 Copay	$0 Copay	$150 limit per 2 years	Full Coverage	N/A	$200 Limit	N/A												67.29738379				0.2	0.2	40			127.8960178		32.88890388	73.97818345		5	5				50.48533654	5								5											NO		66.86970829				0.198728998	0.198728998	39.74579963			127.0832374		32.67989459	73.50805141		4.968224954	4.968224954				50.16450176	4.968224954								4.968224954												0	0.03401274	0	0	0	1.423692581	0.315253278	0.921698497	0	0	6.33617051	0	0.043979884	0.029485026	0	1.399002089	0.047592344	0	0	0	2.750222865	0.28501796	0	0	0	0	0	0	0	0.059939259	0	0	0	0	0	0	0	0	0	0	13.6461	0	0.087275519	0	0.03401274	0	0	0	1.423692581	0.315253278	0.921698497	0	0	6.33617051	0	0.043979884	0.029485026	0	1.399002089	0.047592344	0	0	0	2.750222865	0.28501796	0	0	0	0	0	0	0	0.059939259	0	0	0	0	0	0	0	0	0	0	13.6461	YES	$25/day for days 1-10	$25/day for days 1-10	$25 per day days 21-30	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	$5 Copay	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	"$0 copay for OP Rehab, 20% Coinsurance for OP Partial Hospitalization"	20% Coinsurance	$15 Copay	$15 Copay	$15 Copay	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	N/A	$15 Copay	$15 Copay	$15 Copay	$15 Copay	20% Coinsurance	20% Coinsurance											4800	0.0943	0.0067	0.0074			0.2813	0.0719	0.0584			0.3516		0.0001	0.0104	0.0456	0.3572	0.0153	-0.0054			0.1472	0.054			0.0083		0.0102			0.0056											1.5201	0	0.009722276	0.0943	0.040743631	0.007355261	0	0	1.705040456	0.387145139	0.980100199	0	0	6.68773959	0	0.044128258	0.039879025	0.045578364	1.756160184	0.06290703	-0.005351455	0	0	2.897437554	0.339054851	0	0	0.008289275	0	0.010176781	0	0	0.065500634	0	0	0	0	0	0	0	0	0	0	15.1662
H2611_008_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	P	P	P	S	V	T	Coin	V	V	V	P	P	V																																																			0	NO	1282.460439	90.00552583	458.9149242		84.92845895	9.152921088	9.52889678	232.332238	1747.479402		10.13065225		0.446535572	128.8165278	2758.443739	3192.322085	168.7539394	287.199072			1293.94741	882.6957202			154.6880152					146.0240811												$250/day days 1-5	$150/day days 1-10	"$0/day days 1-20, $130/day days 21-100"	$0 copay	$125/trip	20% coins	20% coins	"$50 copay ER, $25 copay Urgent Care"	$300 copay	$0 copay	20% coinsurance	$0 copay	20% coins	"$0 Copay for OP Rehab, $150 copay for OP Partial Hospitalization"	$15 copay	$30 copay	$30 copay	$0 copay	20% coins	$15 copay for chiro; $30 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit to 1/yr)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit to 1/yr)	N/A	Fitness benefit limited to $200/year	N/A											107.080499	100.9460757	54.89297072		125	0.2	0.2	45	170.8901147		0.2		0.2	29.734588	15	27.60102857	30	30			44.89847025	15			15					15											NO	99.76764009	94.05215556	51.14415975		116.4633629	0.186341381	0.186341381	45	169.5676226		0.186341381		0.186341381	27.7039209	15	27.43719538	27.95120709	27.95120709			44.89847025	15			15					13.97560355												10.6623	0.705434476	1.955901516	0	0.824254495	1.705567952	1.775627782	0.871245893	24.69299397	0	1.887759726	0	0.083208055	0.297393575	3.448054673	7.299030396	0.393073026	0.668963395	0	0	4.84135494	1.10336965	0	0	0.193360019	0	0	0	0	0.170064556	0	0	0	0	0	0	0	0	0	0	63.579	0	1.784945222	10.6623	0.705434476	1.955901516	0	0.824254495	1.705567952	1.775627782	0.871245893	24.69299397	0	1.887759726	0	0.083208055	0.297393575	3.448054673	7.299030396	0.393073026	0.668963395	0	0	4.84135494	1.10336965	0	0	0.193360019	0	0	0	0	0.170064556	0	0	0	0	0	0	0	0	0	0	63.579	YES	$200/day	20% coins	20% coins	20% coins	$125/trip	20% coins	20% coins	$50 copay	20% coins	20% coins	20% coins	20% coins	20% coins	20% coins	20% coins	20% coins	20% coins	20% coins	20% coins	20% coins for chiro; 20% coins for podiatry	20% coins	20% coins	N/A	20% coins	20% coins	$150 max benefit every 2 years (combined with IN allowance)	20% coins	N/A	20% coins	N/A											4800	0.7924	0.0384	0.0991	0.1403	0.0322	0.0666	0.0856	0.034	0.2302	0.0229	0.0776	0.0186	0.0032	0.1144	0.1832	0.3193	0.0088	0.0163	0.1744	0.3356	0.1891	0.041			0.0069		0.0085		0.0034	0.0147											3.0568	0	0.130472165	11.4548	0.743811488	2.054997056	0.140333312	0.856441877	1.772170887	1.861276871	0.905268303	24.92320936	0.02287863	1.965402886	0.018564785	0.086457354	0.411791827	3.63127965	7.6183634	0.401851023	0.685297813	0.174443468	0.335622487	5.030411287	1.14439	0	0	0.200211357	0	0.008466572	0	0.003387901	0.184725934	0	0	0	0	0	0	0	0	0	0	66.6358
H2611_012_0	2010	8	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P																																																			0	NO		6.521012909				8.314260115	3.2270148	310.6011537			974.053323		8.744366647	86.32873101	5040.580139	7477.824558	426.3555715	859.5173197			1498.030851	1272.046206								616.227753												$500 per stay	$100/day days 1-10; $0/day days 11-90	$0 copay	$0 copay	$0 copay	20% coins	20% coins	$50 copay	$0 copay	$0 copay	20% coins	$0 copay	20% coins	"$0 copay for OP Rehab, $25 copay for OP Partial Hospitalization"	$10 copay	$20 copay	$5 copay	$20 copay	$0 copay	$20 copay for chiro; $20 copay for podiatry	20% coins	20% coins	N/A	$20 copay	$0 copay (limit 1 per year)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1/yr)	N/A	Fitness benefit limited to $300/year	N/A												67.29738379				0.2	0.2	46.94692773			64.56990062		567.6034973	24.24583044	9.416376299	18.505025	5	20			79.13093052	19.99830045								8.524044389											NO		67.01129344				0.199149773	0.2	46.94692773			64.29540517		565.1905375	24.14275811	9.416376299	18.49638698	4.978744318	19.91497727			79.13093052	19.99717834								8.504069465												0	0.036415126	0	0	0	1.655783012	0.64540296	1.215147493	0	0	5.218929421	0	0.411852774	0.173684473	3.955333279	11.5260614	0.176892948	1.426438991	0	0	9.878381269	2.119777904	0	0	0	0	0	0	0	0.436703635	0	0	0	0	0	0	0	0	0	0	38.8768	0	0.045377987	0	0.036415126	0	0	0	1.655783012	0.64540296	1.215147493	0	0	5.218929421	0	0.411852774	0.173684473	3.955333279	11.5260614	0.176892948	1.426438991	0	0	9.878381269	2.119777904	0	0	0	0	0	0	0	0.436703635	0	0	0	0	0	0	0	0	0	0	38.8768	YES	$250 per stay	20% coinsurance	$0 copay for days 1-20; $25 copay for days 21-30; $0 copay for days 31-100)	$0 copay	$0 copay	20% coins	20% coins	$50 copay	$0 copay	20% coins	20% coins	$0 copay	20% coins	"$0 copay for OP Rehab, 20% Coinsurance for OP Partial Hospitalization"	$15 copay	$30 copay	$30 copay	$30 copay	$0 copay	$30 copay for chiro; $30 copay for podiatry	20% coins	20% coins	N/A	$30 copay	20% coins	$150 max benefit every 2 years (combined with IN allowance)	N/A	N/A	20% coins	N/A											4800	0.5119	0.0231	0.0059			0.2746	0.0227	0.0705		0.0413	0.199		0.0159	0.0006	0.1441	0.9729	0.1312	0.3912			0.4569	0.2008			0.0206		0.0205			0.0234											3.5273	0	0.009083108	0.5119	0.059556316	0.005926303	0	0	1.930347815	0.6680781	1.285620963	0	0.041253328	5.417967676	0	0.427774917	0.174298214	4.099417743	12.49901086	0.308130357	1.817668119	0	0	10.33530344	2.320607217	0	0	0.020597355	0	0.020483737	0	0	0.460121352	0	0	0	0	0	0	0	0	0	0	42.4041
H2611_016_0	2010	9	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	Coin	Coin	Coin	P	P	P	P	P	P	P	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	NO		72.56557088	369.9930993		79.21980524	12.23290604	8.160996738	270.0534847	359.5432953		12.35095562	2.08280412	0.364470808	143.8794443	2896.571544	3476.991415	136.0552682	362.8706295			29.4553887	4.900475083			211.5710117		209.2471336			114.348697												$0 copay	$150/day days 1-10; $0/day days 11-90	$0 copay for days 1-20; $25 copay for days 21-100	$0 copay	$100/trip	20% coins	20% coins	$50 copay	$100/visit for OP Surgery; $150/visit for ASC	$0 copay	10% Coinsurance	20% coins	20% coins	"$0 copay for OP Rehab, $25 copay for OP Partial Hospitalization"	$5 copay	$15 copay	$15 copay	$15 copay	$0 copay	$5 copay for chiro; $5 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit 1/yr)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1/yr)	N/A	Fitness benefit limited to $200/year	N/A												100.9460757	42.22536209		100	0.15	0.2	46.53190379	116.8626598		0.1	0.2	0.2	14.80487785	5	12.08426675	15	15			0.2	0.083930062			5		5			5											NO		99.09355046	41.45045779		98.16483681	0.147247255	0.196329674	45.67796742	114.7180393		0.098164837	0.196329674	0.196329674	14.53318418	4.90824184	11.86250074	14.72472552	14.72472552			0.2	0.082389808			4.90824184		4.90824184			4.90824184												0	0.599231672	1.278031946	0	0.648049938	1.801261838	1.602245826	1.027957856	3.437175157	0	1.212429543	0.408916253	0.071556435	0.174252205	1.184756137	3.437151103	0.16694804	0.445264202	0	0	5.891077739	0.403749202	0	0	0.086536808	0	0.085586295	0	0	0.046770922	0	0	0	0	0	0	0	0	0	0	24.0089	0	0.338708358	0	0.599231672	1.278031946	0	0.648049938	1.801261838	1.602245826	1.027957856	3.437175157	0	1.212429543	0.408916253	0.071556435	0.174252205	1.184756137	3.437151103	0.16694804	0.445264202	0	0	5.891077739	0.403749202	0	0	0.086536808	0	0.085586295	0	0	0.046770922	0	0	0	0	0	0	0	0	0	0	24.0089	YES	$150/day days 1-5	$150/day days 1-10	$0 copay for days 1-20; $25 copay for days 21-100	$0 copay	$100/trip	20% coins	20% coins	$50 copay	$100/visit	20% coins	20% coins	20% coins	20% coins	"$0 copay for OP Rehab, 20% Coinsurance for OP Partial Hospitalization"	$15 copay	$15 copay	$30 copay	$30 copay	20% coins	$15 copay for chiro; $15 copay for podiatry	20% coins	20% coins	N/A	N/A	$15 copay	$150 max benefit every 2 years (combined with IN allowance)	$15 copay	N/A	20% coins	N/A											4800	0.2973	0.0239	0.0509		0.232	0.3667	0.084	0.125	0.5336		0.2528	0.0163	0.0029	0.0242	0.83	2.6465	0.2806	0.5414			0.2717	0.3432			0.0798		0.0079		0.0028	0.0055											7.019	0	0.123016604	0.2973	0.623114324	1.328968493	0	0.880097623	2.167920168	1.686207424	1.152949802	3.970739924	0	1.465185966	0.425213797	0.074408349	0.198444173	2.014774767	6.083700879	0.44750981	0.98669966	0	0	6.162797252	0.746956572	0	0	0.166382925	0	0.093527291	0	0.002819339	0.052241697	0	0	0	0	0	0	0	0	0	0	31.028
H2611_018_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P																																																			0	YES	306.2112439	7.750575053	223.9427442		116.4098338	8.787960159	1.747861501	281.8642023	396.428873		551.5532147		20.50667123	305.2367857	3215.501541	2792.622531	135.1256977	45.5798801			689.7116994	697.8756642								427.2343826											3000	$625 per admit	$625 per admit	"$0 days 1-20, $120 days 21-100"	$15 copay	$100 copay	20% Coinsurance	20% Coinsurance	"$50 Copay for ER, $25 Urgent Care"	Full Coverage	Full Coverage	20% Coinsurance	Full Coverage	20% Coinsurance	"$0 copay for OP Rehab, $35 copay for OP Partial Hospitalization"	$10 Copay	$35 Copay	$35 Copay	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	N/A	$35 Copay	$0 Copay	$150 routine eyewear per 2 CY	Full Coverage	Full Coverage	$300 Limit	N/A											625	625	50.67043451		100	0.2	0.2	49.98915778	150		105.0172779		32.86389625	35.52040661	10	33.9980044	30.24425538	31.65697674			39.69732262	34.97963081								16.9336954											YES	538.7486747	538.7486747	43.67780711		86.19978796	0.172399576	0.172399576	43.090548	129.2996819		90.5246709		28.32860888	30.61851518	8.619978796	29.96783436	26.07048401	31.47243902			39.69732262	34.68067425								15.92247559											6000	13.7476	0.34796767	0.815110665	0	0.836208583	1.515040605	0.301330581	1.012140245	4.2715106	0	4.160764437	0	0.048410456	0.778824763	2.309796259	6.974070786	0.293566028	0.1195425	0	0	2.281642321	2.016899882	0	0	0	0	0	0	0	0.566885752	0	0	0	0	0	0	0	0	0	0	42.3973	0	5.865015897	13.7476	0.34796767	0.815110665	0	0.836208583	1.515040605	0.301330581	1.012140245	4.2715106	0	4.160764437	0	0.048410456	0.778824763	2.309796259	6.974070786	0.293566028	0.1195425	0	0	2.281642321	2.016899882	0	0	0	0	0	0	0	0.566885752	0	0	0	0	0	0	0	0	0	0	42.3973	YES	30% Coinsurance	30% Coinsurance	25% Coinsurance	25% Coinsurance	$100 copay	25% Coinsurance	25% Coinsurance	"$50 Copay for ER , 25% Coins Urgent Care"	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance	25% Coinsurance												2.0122	0.0258	0.2154	0.1532	0.071	0.0716	0.1198	0.0383	0.2836	0.0442	0.1714	0.0277	0.0002	0.2988	0.1908	0.3251	0.0143	0.0155	0.1241	0.4183	0.1627	0.0416			0.0076		0.0098			0.017											4.8601	0	0.778074199	15.7598	0.373722552	1.030549577	0.153162814	0.90722926	1.586622101	0.421167561	1.050431244	4.555110718	0.044232041	4.332208118	0.027727478	0.048616131	1.07765076	2.500620727	7.29918604	0.307856805	0.13500354	0.124087026	0.418254654	2.444350448	2.058484043	0	0	0.007609166	0	0.009817955	0	0	0.583857931	0	0	0	0	0	0	0	0	0	0	47.2573
H2611_801_0	2010	5	N/A																															A	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P											22.1438	0.2842	2.3414	0.0378	0.7293	0.5917	0.2128	1.0931	2.8236	0.4001	1.6603	0.2027	0.1955	2.4258	3.0247	5.5794	0.135	0.2821	1.8048	6.3799	3.0118	0.5406			0.065	0.0348	0.1258	0.0726		0.3263											56.5249	NO						6.792149982	2.432001477	267.6960294			701.7919626		10.07433008	2.936368044	4212.612639	5377.564158	210.0636132				1263.833035	1081.901057								556.2288332												Full Coverage	Full Coverage	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	"$50 copay ER, $25 copay Urgent Care"	Full Coverage	Full Coverage	20% Coinsurance	Full Coverage	20% Coinsurance	"$0 copay for OP Rehab, $25 copay for OP Partial Hospitalization"	$15 copay	$30 Copay	$30 Copay	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	$30 Copay	$30 Copay	$150 limit per 2 years	Full Coverage	$30 Copay	$200 Limit	N/A																0.182576826	0.182576826	43.19861113			59.50027345		488.0719156	64.5466318	13.459792	25.75779282	27.38652386				59.93362369	27.38223857								17.2573201											NO						0.181994007	0.182576826	43.19861113			59.31033754		486.5138996	64.34058699	13.459792	25.75574487	27.299101				59.93362369	27.38067568								17.23456583												0	0	0	0	0	1.236130589	0.44402711	0.963674723	0	0	3.468626516	0	0.408441801	0.01574397	4.725074159	11.54193088	0.477878983	0	0	0	6.312174462	2.468598496	0	0	0	0	0	0	0	0.798863537	0	0	0	0	0	0	0	0	0	0	32.8612	0	0.020068704	22.1438	0.284154506	2.341411746	0.037774612	0.72927428	1.827834652	0.656836108	2.056794967	2.823609221	0.400145552	5.128969218	0.202654152	0.603952434	2.441536144	7.749793427	17.1213647	0.612871513	0.282066316	1.804800862	6.379933998	9.324005647	3.00921631	0	0	0.064951548	0.034792115	0.125799771	0.072559003	0	1.125169805	0	0	0	0	0	0	0	0	0	0	89.3861	YES	20% OON	20% OON	20% OON	20% OON	20% OON	20% Coinsurance	20% Coinsurance	$50 copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	Full Coverage	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance											4800	2.6368	0.0339	0.2796	0.0045	0.0871	0.0707	0.0255	0.0756	0.3372	0.0478	0.1983	0.0242	0.0233	0.2897	0.3027	0.6677	0.0161	0.0337	0.216	0.7635	0.3605	0.0647			0.0078	0.0042	0.012	0.0087		0.0359											6.6276	0	0.008912138	24.7806	0.318089395	2.621009618	0.042285811	0.816367187	1.898498363	0.682305667	2.132366132	3.160816142	0.447932565	5.327254111	0.226855937	0.62730111	2.731234131	8.052458518	17.78909908	0.628992871	0.315751825	2.020795784	7.143469791	9.684469783	3.073904436	0	0	0.072725125	0.038947132	0.137844617	0.081243062	0	1.161040607	0	0	0	0	0	0	0	0	0	0	96.0136
H2611_802_0	2010	4	N/A																															A	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P											13.269	0.1442	0.9418	0.0061	0.2525	0.6058	0.1254	1.1267	4.0119	0.2015	1.6637	0.0651	0.0194	1.6444	1.7304	2.8306	0.0674	0.0346	0.8399	4.5537	0.7864	0.3052			0.066	0.0034	0.1016	0.0428		0.3533											35.7926	NO						8.787394254	1.747748946	281.5122884			551.0983414		20.48975911	6.107029492		3316.079188	135.2790385				689.142885	697.3001168								144.7742637												Full Coverage	Full Coverage	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	Full Coverage	20% Coinsurance	$0 copay	Full Coverage	$30 Copay	$5 Copay	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	$5 Copay	$0 Copay	$150 limit per 2 years	Full Coverage	Full Coverage	$200 Limit	N/A																0.186212123	0.186212123	37.24242465			97.85185482		30.62156312	68.87817308		24.68420873	4.655303082				36.98873868	26.47569773								4.655303082											NO						0.183105751	0.183105751	36.62115023			96.21949991		30.11073724	67.72915424		24.27242921	4.577643778				36.37169622	26.03412933								4.577643778												0	0	0	0	0	1.609022426	0.320022884	0.85910865	0	0	4.418867234	0	0.051413479	0.034468662	0	6.707441447	0.051604937	0	0	0	2.088774639	1.512800118	0	0	0	0	0	0	0	0.055227084	0	0	0	0	0	0	0	0	0	0	17.7088	0	0.300421626	13.269	0.144166085	0.941775475	0.006093894	0.252469123	2.21481997	0.445462197	1.985775623	4.011859321	0.201495024	6.082572398	0.065092465	0.070770674	1.678868118	1.730388849	9.538030322	0.119009186	0.034591858	0.839925682	4.553717969	2.87519907	1.818023549	0	0	0.065964421	0.003354	0.101552989	0.042840842	0	0.408484607	0	0	0	0	0	0	0	0	0	0	53.5013	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance											4800	1.9211	0.0245	0.2464	0.1751	0.0941	0.0818	0.137	0.0681	0.3243	0.0506	0.196	0.0317	0.0002	0.3417	0.2182	0.3717	0.0163	0.0177	0.1419	0.4782	0.186	0.0475			0.0089		0.0115			0.0216											5.2125	0	0.063856247	15.1902	0.16870677	1.188202317	0.181224354	0.346611088	2.296668168	0.582487006	2.053853416	4.336135285	0.252071122	6.278605691	0.096796804	0.071005849	2.020553758	1.948582652	9.909775802	0.135349641	0.052270426	0.981810108	5.031961531	3.061243896	1.865571991	0	0	0.074858456	0.003354	0.11303593	0.042840842	0	0.430112865	0	0	0	0	0	0	0	0	0	0	58.7139
H2611_807_0	2010	5	N/A																															A	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P											21.981	0.2818	2.3219	0.0375	0.7232	0.5868	0.211	1.0841	2.8001	0.3968	1.6465	0.201	0.1939	2.4056	3.064	5.5329	0.1339	0.2797	1.7897	6.3267	2.9867	0.5361			0.0688	0.0368	0.1329	0.0768		0.3452											56.1813	NO						6.376956799	2.283337146	251.0379751			658.0794836		9.446830814	2.753470643	4233.312223	5042.612103	196.979392				1185.112734	1014.512743								556.7371916												Full Coverage	Full Coverage	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	$50 copay	Full Coverage	Full Coverage	20% Coinsurance	Full Coverage	20% Coinsurance	"$0 copay for OP Rehab, $25 copay for OP Partial Hospitalization"	$15 copay	$30 Copay	$30 Copay	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	$30 Copay	$30 Copay	$150 limit per 2 years	Full Coverage	$30 Copay	$200 Limit	N/A																0.181597191	0.181597191	42.96697868			59.25413759		486.0528997	64.27962058	13.40402961	25.62139586	27.23957862				59.68569518	27.23531867								17.16148726											NO						0.181070766	0.181597191	42.96697868			59.08236832		484.6439018	64.09328315	13.40402961	25.61954607	27.16061497				59.68569518	27.233907								17.1409535												0	0	0	0	0	1.154680456	0.414647611	0.898861944	0	0	3.240074536	0	0.381529079	0.014706581	4.728620197	10.76578609	0.445840119	0	0	0	5.894523114	2.302428807	0	0	0	0	0	0	0	0.795250526	0	0	0	0	0	0	0	0	0	0	31.0369	0	0.017074276	21.981	0.281784823	2.321948625	0.037459594	0.723192559	1.741450053	0.625681906	1.982927338	2.80006197	0.396808572	4.88657095	0.200964135	0.575409267	2.420269065	7.792597639	16.2986907	0.57970689	0.279714048	1.789749877	6.326729076	8.881237387	2.838538184	0	0	0.068773138	0.036839198	0.132872986	0.076828198	0	1.14041141	0	0	0	0	0	0	0	0	0	0	87.2182	YES	20% OON	20% OON	20% OON	20% OON	20% OON	20% Coinsurance	20% Coinsurance	$50 copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance											4800	2.5142	0.0323	0.2664	0.0043	0.083	0.0673	0.0243	0.073	0.3213	0.0455	0.1889	0.0231	0.0222	0.276	0.2883	0.636	0.0154	0.0321	0.2057	0.7273	0.3433	0.0616			0.0079	0.0042	0.0122	0.0088		0.0365											6.3212	0	0.007559629	24.4952	0.314115928	2.58833829	0.04175759	0.806169401	1.808774153	0.649941994	2.055906936	3.121332282	0.442337141	5.075484776	0.224022128	0.59765447	2.696275746	8.080892242	16.93471929	0.595066342	0.311807559	1.99548876	7.054010258	9.224584193	2.900155984	0	0	0.076679163	0.041066012	0.14509284	0.085660216	0	1.176864592	0	0	0	0	0	0	0	0	0	0	93.5394
H2611_809_0	2010	5	N/A																															A	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P											13.2482	0.1439	0.94	0.0061	0.252	0.6046	0.1252	1.1245	4.0041	0.2011	1.6605	0.065	0.0193	1.6412	1.727	2.8251	0.0673	0.0345	0.8383	4.5449	0.7849	0.3046			0.0659	0.0033	0.1026	0.0428		0.47											35.8467	NO						8.683810739	1.727146937	279.790662			547.7281173		20.36445465	6.069682151		3295.945959	134.4517439				684.928454	693.0358006								144.7742637												Full Coverage	Full Coverage	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	Full Coverage	20% Coinsurance	$0 Copay	Full Coverage	$30 Copay	$5 Copay	Full Coverage	Full Coverage	Full Coverage	20% Coinsurance	20% Coinsurance	Full Coverage	$5 Copay	$0 Copay	$150 limit per 2 years	Full Coverage	$5 Copay	$200 Limit	N/A																0.186074777	0.186074777	37.21495538			97.22163556		30.42434357	68.43456012		24.6651147	4.651869422				36.75051105	26.45613678								4.651869422											NO						0.18299522	0.18299522	36.59904401			95.61260742		29.92081753	67.30196105		24.25690449	4.574880501				36.14228628	26.01838014								4.574880501												0	0	0	0	0	1.589095857	0.316059634	0.853339229	0	0	4.364142788	0	0.050776761	0.034041793	0	6.662453862	0.051258388	0	0	0	2.062906689	1.502639076	0	0	0	0	0	0	0	0.055193746	0	0	0	0	0	0	0	0	0	0	17.5419	0	0.295200495	13.2482	0.143885859	0.939954051	0.006082049	0.251978379	2.193715867	0.441255121	1.977825135	4.004061169	0.201103363	6.024614083	0.064965939	0.070096329	1.675244906	1.727025362	9.487565308	0.118531618	0.034524619	0.838293055	4.544866565	2.847802488	1.80726922	0	0	0.065863247	0.003348856	0.102564597	0.042775135	0	0.525155654	0	0	0	0	0	0	0	0	0	0	53.3886	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance											4800	1.9501	0.0249	0.2501	0.1778	0.0956	0.0831	0.1391	0.0691	0.3292	0.0513	0.199	0.0322	0.0002	0.3468	0.2215	0.3774	0.0166	0.0179	0.144	0.4855	0.1889	0.0483			0.0089		0.0115			0.0217											5.2907	0	0.06410455	15.1984	0.168796875	1.190098465	0.183855322	0.347540998	2.276799198	0.580347708	2.046968932	4.333230631	0.252442682	6.223605624	0.097148715	0.070335053	2.022086766	1.948511827	9.864920628	0.13511866	0.052469966	0.982318594	5.03032708	3.036654831	1.855535194	0	0	0.074780714	0.003348856	0.11407379	0.042775135	0	0.546833009	0	0	0	0	0	0	0	0	0	0	58.6793
H2613_001_0	2010	7	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1430.131712	46.59908081	303.0364141	43.90549738	118.7909926	18.46050666	1.128014288	410.9320569	317.2435696	4019.11393	1006.713816	94.12696807	0.026586372	780.2500662	3055.527207	2043.57321	25.35315622	1246.339162	2624.608928	0	35.89174557	0	0	0	302.4	0	162	0	0	0	112.9372574	38.9454308	1039.959857	257.172099	348.5436991	0	4.354797414	16.14547727	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	93.49510129	250	0.2	35	25	35	40	43.48059618	79.50935241	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	150.9993224	64.15842383	117.4364491	0	112.9196626	0.18067146	0.18067146	45.16786504	225.8393252	31.61750553	84.45948235	225.8393252	0.18067146	31.61750553	22.58393252	31.61750553	36.13429203	39.278514	71.82535399	0	0.18067146	0	0	0	35	0	35	0	0	0	180.6714602	31.61750553	31.61750553	31.61750553	31.61750553	0	0.18067146	0.18067146	0	0		17.9957	0.249143631	2.965626702	0	1.1178199	3.335286694	0.203799989	1.546743641	5.97050614	10.58952974	7.085543981	1.771464246	0.004803399	2.055796732	5.750485021	5.384390607	0.076343196	4.079529186	15.70945544	0	6.48461408	0	0	0	0.882	0	0.4725	0	0	0	1.700378267	0.102613114	2.740078044	0.677595022	0.918340195	0	0.786787608	2.917026954	0	0	103.5739		10.93376222	17.9957	0.249143631	2.965626702	0	1.1178199	3.335286694	0.203799989	1.546743641	5.97050614	10.58952974	7.085543981	1.771464246	0.004803399	2.055796732	5.750485021	5.384390607	0.076343196	4.079529186	15.70945544	0	6.48461408	0	0	0	0.882	0	0.4725	0	0	0	1.700378267	0.102613114	2.740078044	0.677595022	0.918340195	0	0.786787608	2.917026954	0	0	103.5739	YES																																									5000																								0	0	0	0	0													0			17.9957	0.249143631	2.965626702	0	1.1178199	3.335286694	0.203799989	1.546743641	5.97050614	10.58952974	7.085543981	1.771464246	0.004803399	2.055796732	5.750485021	5.384390607	0.076343196	4.079529186	15.70945544	0	6.48461408	0	0	0	0.882	0	0.4725	0	0	0	1.700378267	0.102613114	2.740078044	0.677595022	0.918340195	0	0.786787608	2.917026954	0	0	103.5739
H2613_004_0	2010	15	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1411.965916	74.96741591	417.3345319	39.15495608	141.8173409	14.53560178	0.39974621	360.1499386	280.8353662	3825.420874	899.4871874	61.05116656	0.218148371	693.2699137	2972.288072	1781.353566	26.77737002	854.242001	2373.967493	0	22.2760678	0	0	0	302.4	0	162	0	0	0	117.5800245	31.16710281	559.1518728	241.614729	334.2496251	0	3.222157415	11.87545988	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	93.47662142	250	0.2	35	25	35	40	42.98561151	79.0772929	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	133.5251242	88.47081802	119.4239018	0	114.8306748	0.18372908	0.18372908	45.93226994	229.6613497	32.15258896	85.87186816	229.6613497	0.18372908	32.15258896	22.96613497	32.15258896	36.74581595	39.48853423	72.64399127	0	0.18372908	0	0	0	35	0	35	0	0	0	183.7290798	32.15258896	32.15258896	32.15258896	32.15258896	0	0.18372908	0.18372908	0	0		15.7111	0.552702384	4.153309847	0	1.357081747	2.670612738	0.073445003	1.378542017	5.374752437	10.24976541	6.436720431	1.168424443	0.040080199	1.857535214	5.68849742	4.772927417	0.081996359	2.811063708	14.37120615	0	4.092761437	0	0	0	0.882	0	0.4725	0	0	0	1.800239142	0.083508587	1.498181694	0.647378256	0.895582567	0	0.592004017	2.181867316	0	0	91.8958		8.016679633	15.7111	0.552702384	4.153309847	0	1.357081747	2.670612738	0.073445003	1.378542017	5.374752437	10.24976541	6.436720431	1.168424443	0.040080199	1.857535214	5.68849742	4.772927417	0.081996359	2.811063708	14.37120615	0	4.092761437	0	0	0	0.882	0	0.4725	0	0	0	1.800239142	0.083508587	1.498181694	0.647378256	0.895582567	0	0.592004017	2.181867316	0	0	91.8958	YES																																									5000																								0	0	0	0	0													0			15.7111	0.552702384	4.153309847	0	1.357081747	2.670612738	0.073445003	1.378542017	5.374752437	10.24976541	6.436720431	1.168424443	0.040080199	1.857535214	5.68849742	4.772927417	0.081996359	2.811063708	14.37120615	0	4.092761437	0	0	0	0.882	0	0.4725	0	0	0	1.800239142	0.083508587	1.498181694	0.647378256	0.895582567	0	0.592004017	2.181867316	0	0	91.8958
H2613_803_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	315.33672	3.775622857	46.66370332	6.902269203	6.705065083	5.424539881	12.8501343	15.38913663	47.07498338	9.102616619	28.51974047	0	0.309542207	38.23945458	33.92258451	98.06694957	1.025241276	4.889238037	25.7115401	30.53789225	50.42573913	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.081274253	0.081274253	0.189889734	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.081274253	0.081274253	0.189889734	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				25.6288	0.306860926	8.860958188	0	1.562280164	1.263917792	2.994081291	3.585668835	10.96847113	2.120909672	6.645099529	0	0.072123334	8.909792917	7.90396219	22.84959925	0.238881217	1.139192463	5.990788843	7.115328894	11.74919722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9059			25.6288	0.306860926	8.860958188	0	1.562280164	1.263917792	2.994081291	3.585668835	10.96847113	2.120909672	6.645099529	0	0.072123334	8.909792917	7.90396219	22.84959925	0.238881217	1.139192463	5.990788843	7.115328894	11.74919722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9059	NO																																																																																		0			25.6288	0.306860926	8.860958188	0	1.562280164	1.263917792	2.994081291	3.585668835	10.96847113	2.120909672	6.645099529	0	0.072123334	8.909792917	7.90396219	22.84959925	0.238881217	1.139192463	5.990788843	7.115328894	11.74919722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9059
H2613_804_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	249.5510371	2.987950784	41.89402956	8.251612548	6.233096576	4.376893863	10.36837689	8.142803542	40.46316983	6.096186483	19.10018444	0	0.207305998	25.60965224	39.23469183	113.4237441	1.18578894	5.654868296	29.73783887	35.31997367	44.90943521	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.081274253	0.081274253	0.189889734	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.081274253	0.081274253	0.189889734	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				20.2821	0.242843467	7.95524611	0	1.452311502	1.01981627	2.415831815	1.897273225	9.42791857	1.42041145	4.450342975	0	0.048302297	5.967048972	9.141683196	26.42773238	0.276288823	1.317584313	6.928916457	8.229553865	10.4638984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.3651			20.2821	0.242843467	7.95524611	0	1.452311502	1.01981627	2.415831815	1.897273225	9.42791857	1.42041145	4.450342975	0	0.048302297	5.967048972	9.141683196	26.42773238	0.276288823	1.317584313	6.928916457	8.229553865	10.4638984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.3651	NO																																																																																		0			20.2821	0.242843467	7.95524611	0	1.452311502	1.01981627	2.415831815	1.897273225	9.42791857	1.42041145	4.450342975	0	0.048302297	5.967048972	9.141683196	26.42773238	0.276288823	1.317584313	6.928916457	8.229553865	10.4638984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.3651
H2643_001_0	2010	3	N/A																															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																																																			0	YES	458.6771759		96.08893821		17.27370243	22.71615126	14.96663464	10.43932712	24.4278112	3.084036398	9.952640591	2.815249665	7.051972215	21.48049135	77.03425607	104.3388879	19.09122913	23.26265262	31.3823282	75.6375415	25.64059426	7.366084261																			3400	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.06516254		0.155546936		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.2292586	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.06516254		0.155546936		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.2292586	0.233	0.233	0.233	0.233	0.233	0.233																				29.8886	0	14.94633988	0	4.024772666	5.292863244	3.487225872	2.432363219	5.69168001	0.718580481	2.318965258	0.655953172	1.643109526	5.004954483	17.94898167	23.92058733	4.448256387	5.420198061	7.31208247	17.62354717	5.974258463	1.716297633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.4696	0	0	29.8886	0	14.94633988	0	4.024772666	5.292863244	3.487225872	2.432363219	5.69168001	0.718580481	2.318965258	0.655953172	1.643109526	5.004954483	17.94898167	23.92058733	4.448256387	5.420198061	7.31208247	17.62354717	5.974258463	1.716297633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.4696	NO																																																																																		0	0	0	29.8886	0	14.94633988	0	4.024772666	5.292863244	3.487225872	2.432363219	5.69168001	0.718580481	2.318965258	0.655953172	1.643109526	5.004954483	17.94898167	23.92058733	4.448256387	5.420198061	7.31208247	17.62354717	5.974258463	1.716297633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.4696
H2649_004_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V				O	O	O	O	O	O	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	YES	1672.103991	48.059556	1088.561814	1173.571783	231.707429	11.864036	3.62269	388.005101	332.143951	288.671779	725.769214	27.445205	30.875374	599.870087	4208.326247	4152.356877	95.317783	546.190871			24.397725	0		1.04	3.15				0.04	0.25	0.05	0.55	3.2	0.25	0.32	0.4	0.73				3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-12):1b	"$0/Day(Days 1-14) $70(Days 15-100):2. $0 SNF 1,2. $70 SNF 2"	$5/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $200 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $35 Radiology OP -- Facility"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$0-$100/Visit:9d. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $35 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$35/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"	Discover Vision				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				175.3412	157.5978	33.75967	5	100	0.2	0.060358	50	200	0	43.754781	50	2.5411	30.844612	10	35	35	35			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	142.090372	127.711741	16.489708	4.177385	83.5477	0.167095	0.050428	41.77385	167.0954	0	36.556113	41.77385	2.12303	25.769964	8.35477	29.241695	29.241695	29.241695			0.167095	0		0	0				0	0	0	0	0	0	0	0	0					19.7992	0.511480797	1.495838871	0.40853843	1.613218564	1.982421095	0.182685011	1.350705574	4.624977196	0	2.210941783	0.09554099	0.005462445	1.288219212	2.92996649	10.11849611	0.232271128	1.330962238	0	0	4.076737859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2576	0	12.709865	19.7992	0.511480797	1.495838871	0.40853843	1.613218564	1.982421095	0.182685011	1.350705574	4.624977196	0	2.210941783	0.09554099	0.005462445	1.288219212	2.92996649	10.11849611	0.232271128	1.330962238	0	0	4.076737859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2576	NO																																																																																		0	0	0	19.7992	0.511480797	1.495838871	0.40853843	1.613218564	1.982421095	0.182685011	1.350705574	4.624977196	0	2.210941783	0.09554099	0.005462445	1.288219212	2.92996649	10.11849611	0.232271128	1.330962238	0	0	4.076737859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2576
H2649_011_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V				O	O	O	O	O	O	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	YES	1874.53786	12.131261	1261.529692	1168.449897	215.551586	13.426585	2.744224	349.973954	279.054998	209.139775	1211.164318	153.266933	11.27664	509.460377	4845.77434	3656.041244	50.419757	374.386639			31.352568	0		1.04	3.15				0.04	0.25	0.05	0.55	3.57	0.25	0.32	0.4	0.73				3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-12):1b	"$0/Day(Days 1-14) $70(Days 15-100):2. $0 SNF 1,2. $70 SNF 2"	$5/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $200 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $35 Radiology OP -- Facility"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$0-$100/Visit:9d. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $35 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$35/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"	Discover Vision				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				175.3412	157.5978	33.75967	5	100	0.2	0.07185	50	200	0	38.998331	50	11.20962	36.057366	10	35	35	35			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	137.463994	123.553523	15.032641	4.116465	82.3293	0.164659	0.059153	41.16465	164.6586	0	32.107053	41.16465	9.228802	29.685777	8.23293	28.815255	28.815255	28.815255			0.164659	0		0	0				0	0	0	0	0	0	0	0	0					21.4735	0.124905003	1.580343581	0.400823592	1.478850932	2.21080806	0.162329082	1.200546277	3.829067108	0	3.240576412	0.525764971	0.00867249	1.260310595	3.324576745	8.779146728	0.121071513	0.899003873	0	0	5.162482494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7827	0	14.91794	21.4735	0.124905003	1.580343581	0.400823592	1.478850932	2.21080806	0.162329082	1.200546277	3.829067108	0	3.240576412	0.525764971	0.00867249	1.260310595	3.324576745	8.779146728	0.121071513	0.899003873	0	0	5.162482494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7827	NO																																																																																		0	0	0	21.4735	0.124905003	1.580343581	0.400823592	1.478850932	2.21080806	0.162329082	1.200546277	3.829067108	0	3.240576412	0.525764971	0.00867249	1.260310595	3.324576745	8.779146728	0.121071513	0.899003873	0	0	5.162482494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7827
H2649_012_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.			Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered													D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V				O	O	O	O	O	O	O	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			0	YES	1388.270624	80.424711	1018.436575	1013.052494	198.461584	8.587734	2.426962	300.495456	249.454559	333.357235	662.936323	21.591547	22.553541	500.44451	3585.421761	3951.172774	63.931658	562.988674			17.83027	0		1.04	3.15				0.04	0.25	0.05	0.55	3.2	0.25	0.32	0.4	0.73	1.73			2900	$200/Day(Days 1-15):1a	$200/Day(Days 1-9):1b	"$0/Day(Days 1-14) $70(Days 15-100):2. $0 SNF 1,2. $70 SNF 2"	$5/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $200 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$0-$100/Visit:9d. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $15 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	"$15-$35/Visit:7i. $35 Therapy (AT,PT,ST,OT) -- OP,7i. $15 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN756: Dental 16a, 16b"	Discover Vision				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	$0: OTC items 13c			175.3412	141.0078	33.75967	5	100	0.2	0.030484	50	200	0	43.94288	50	3.435835	31.214952	0	15	15	21.53847			0.2	0		0	0				0	0	0	0	0	0	0	0	0	0			NO	149.903751	120.551234	17.023449	4.35536	87.1072	0.174214	0.026554	43.5536	174.2144	0	38.277412	43.5536	2.99286	27.190471	0	13.06608	13.06608	18.761558			0.174214	0		0	0				0	0	0	0	0	0	0	0	0	0				17.3422	0.807941513	1.444775258	0.367684026	1.440619407	1.496103491	0.064445549	1.090638241	3.621548027	0	2.114623897	0.0783658	0.005624966	1.133943495	0	4.302194963	0.069611346	0.880212055	0	0	3.106282658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3669	0	7.426795	17.3422	0.807941513	1.444775258	0.367684026	1.440619407	1.496103491	0.064445549	1.090638241	3.621548027	0	2.114623897	0.0783658	0.005624966	1.133943495	0	4.302194963	0.069611346	0.880212055	0	0	3.106282658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3669	NO																																																																																		0	0	0	17.3422	0.807941513	1.444775258	0.367684026	1.440619407	1.496103491	0.064445549	1.090638241	3.621548027	0	2.114623897	0.0783658	0.005624966	1.133943495	0	4.302194963	0.069611346	0.880212055	0	0	3.106282658	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.3669
H2649_015_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		DME/Prosthetics/Supplies	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered		Prosthetics/Supplies										D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			S	O		Coin	V				O	O	O	O	O	O	O	O	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	0		0	NO	3557.406668	357.81953	1338.351573	1592.321348	740.909544	18.260882	2.33066	1022.493944	483.139324	1009.550722	2403.009818	130.13209	10.357877	1452.513472	8051.877087	4071.651981	273.873981	981.384985			6271.549891	0		2.68	3.15				0.04	0.14	158.184512	0.05	0.55	3.2	0.25	0.25	0.32	0.4	0.73			$0/Day(Days 1-5):1a	$0/Day(Days 1-5):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$0/Trip:10a	0% Coins:11a	0% Coins:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15			"DEN766: Dental 16a, 16b"	Discover Vision				$0: Nurse hotline 14a	$0: OTC items 13c	$0/Service:11b	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Member Incentive Program 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0		0	0				0	0	0	0	0	0	0	0	0	0	0		NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0		0	0				0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	2.130195717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1302	0	0	0	0	0	0	0	0	0	2.130195717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1302	NO																																																																																		0	0	0	0	0	0	0	0	0	0	2.130195717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.1302
H2649_016_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V				O	O	O	O	O	O	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	YES	1634.303443	43.57375	1079.59577	1127.750676	220.421808	11.720365	3.365091	365.582558	309.256986	274.381933	770.446847	44.148971	26.563091	563.109055	4137.664925	3944.838122	84.195948	506.190541			24.677459	0		1.04	3.15				0.04	0.25	0.05	0.55	3.2	0.25	0.32	0.4	0.73				3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-12):1b	"$0/Day(Days 1-14) $70(Days 15-100):2. $0 SNF 1,2. $70 SNF 2"	$5/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $200 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $35 Radiology OP -- Facility"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$0-$100/Visit:9d. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $35 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$35/Visit:7i			20% Coins:15			"DEN756: Dental 16a, 16b"	Discover Vision				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				175.3412	157.5978	33.75967	5	100	0.2	0.060428	50	200	0	42.740888	50	3.125702	31.549386	10	35	35	35			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	143.827126	129.272747	16.78281	4.206505	84.1301	0.16826	0.050838	42.06505	168.2602	0	35.957952	42.06505	2.629656	26.54253	8.41301	29.445535	29.445535	29.445535			0.16826	0		0	0				0	0	0	0	0	0	0	0	0					19.5881	0.469408197	1.509887557	0.395324071	1.545342396	1.972068615	0.171074496	1.281520715	4.336303526	0	2.308640895	0.154760723	0.005820983	1.245528249	2.900851366	9.679822416	0.206599561	1.242087608	0	0	4.152229251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1654	0	11.882654	19.5881	0.469408197	1.509887557	0.395324071	1.545342396	1.972068615	0.171074496	1.281520715	4.336303526	0	2.308640895	0.154760723	0.005820983	1.245528249	2.900851366	9.679822416	0.206599561	1.242087608	0	0	4.152229251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1654	NO																																																																																		0	0	0	19.5881	0.469408197	1.509887557	0.395324071	1.545342396	1.972068615	0.171074496	1.281520715	4.336303526	0	2.308640895	0.154760723	0.005820983	1.245528249	2.900851366	9.679822416	0.206599561	1.242087608	0	0	4.152229251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1654
H2649_801_0	2010	2	N/A																															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	NO	230.993951	0.561405	35.393623	9.280897	5.566436	8.717362	2.685994	20.737109	54.640177	4.528223	28.117203	1.698735	0.059881	13.243706	45.197101	88.708425	0.49801	7.057138			33.154594	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																			0.086008944	0.086008944	0.16956153	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.086008944	0.086008944	0.16956153	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.8675	0.048285851	6.001396854	0	1.296979588	2.031145346	0.625836602	4.831746397	12.73116124	1.055075959	6.551308299	0.395805255	0.013952273	3.085783498	10.53092453	20.66906303	0.11603633	1.644313154	0	0	7.725020402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2214	0	0	19.8675	0.048285851	6.001396854	0	1.296979588	2.031145346	0.625836602	4.831746397	12.73116124	1.055075959	6.551308299	0.395805255	0.013952273	3.085783498	10.53092453	20.66906303	0.11603633	1.644313154	0	0	7.725020402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2214	NO																																																																																		0	0	0	19.8675	0.048285851	6.001396854	0	1.296979588	2.031145346	0.625836602	4.831746397	12.73116124	1.055075959	6.551308299	0.395805255	0.013952273	3.085783498	10.53092453	20.66906303	0.11603633	1.644313154	0	0	7.725020402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2214
H2649_802_0	2010	2	N/A																															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	NO	272.397376	1.67628	26.236886	12.69168	6.182041	6.016533	2.543014	24.904691	70.411282	10.124641	33.195226	5.139033	1.095725	18.136319	84.077998	104.30027	0.364874	7.093473			26.812574	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																			0.085904009	0.085904009	0.170014189	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.085904009	0.085904009	0.170014189	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.4	0.143999173	4.460642889	0	1.440415553	1.401852189	0.592522262	5.802793003	16.40582871	2.359041353	7.734487658	1.197394689	0.255303925	4.225762327	19.59017353	24.30196291	0.085015642	1.652779209	0	0	6.247329742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2973	0	0	23.4	0.143999173	4.460642889	0	1.440415553	1.401852189	0.592522262	5.802793003	16.40582871	2.359041353	7.734487658	1.197394689	0.255303925	4.225762327	19.59017353	24.30196291	0.085015642	1.652779209	0	0	6.247329742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2973	NO																																																																																		0	0	0	23.4	0.143999173	4.460642889	0	1.440415553	1.401852189	0.592522262	5.802793003	16.40582871	2.359041353	7.734487658	1.197394689	0.255303925	4.225762327	19.59017353	24.30196291	0.085015642	1.652779209	0	0	6.247329742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2973
H2649_803_0	2010	2	N/A																															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	NO	279.49707	1.71997	26.920716	13.022473	6.343168	6.173347	2.609294	25.5538	72.246466	10.388526	34.060419	5.272975	1.124284	18.609015	86.269385	107.018725	0.374383	7.278356			27.511411	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																			0.085151976	0.085151976	0.173297163	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.085151976	0.085151976	0.173297163	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.7997	0.146458845	4.665283716	0	1.477958144	1.438389851	0.607965502	5.9540354	16.83342658	2.420526558	7.936077627	1.228603175	0.261958172	4.335900495	20.10076671	24.93536293	0.087231239	1.695856948	0	0	6.410158763	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.3357	0	0	23.7997	0.146458845	4.665283716	0	1.477958144	1.438389851	0.607965502	5.9540354	16.83342658	2.420526558	7.936077627	1.228603175	0.261958172	4.335900495	20.10076671	24.93536293	0.087231239	1.695856948	0	0	6.410158763	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.3357	NO																																																																																		0	0	0	23.7997	0.146458845	4.665283716	0	1.477958144	1.438389851	0.607965502	5.9540354	16.83342658	2.420526558	7.936077627	1.228603175	0.261958172	4.335900495	20.10076671	24.93536293	0.087231239	1.695856948	0	0	6.410158763	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.3357
H2654_004_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1562.915653	117.6070911	869.9806199	1048.940283	239.4627958	6.468973619	5.133956412	290.9262498	30.02667166	6162.610534	38.68551202	0	0.075060373	20.28803302	4867.789574	2694.902955	531.5899353	218.5860699	0	0	16.39259085	2768.037193	357.8660916	0	218.5663483	188.0117094	18.27621469	5.80851686	112.7933062	0											4500	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$85 Days 1-34 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$10 (17b1, 17b3); $0 n/c (17b2, 17b5); $5 (17b4)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											183.6772749	135.4364349	70.72621662	0	150	0.2	0.097372194	49.58576352	0.2	3	0.169307369	0	0.2	0.148662704	11.09700698	34.99790896	38.5	35	0	0	0.2	33.10560436	0	0	35	13.09380843	0	0	0	0											NO	159.2153589	117.3991753	61.30698513	0	130.0231825	0.173364243	0.084404283	42.98199186	0.173364243	2.60046365	0.14675922	0	0.173364243	0.129005973	11.04627887	34.99790896	38.5	30.33874258	0	0	0.173364243	33.10560436	0	0	35	13.09380843	0	0	0	0												20.7367	1.150581291	4.444657411	0	2.5946429	1.121488716	0.433327912	1.042049142	5.205551212	1.33547039	5.677455567	0	0.013012785	2.617277441	4.480913427	7.859664022	1.705517709	0.552635542	0	0	2.841889109	7.636462015	0	0	0.637485183	0.205149109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2919	0	7.663434921	20.7367	1.150581291	4.444657411	0	2.5946429	1.121488716	0.433327912	1.042049142	5.205551212	1.33547039	5.677455567	0	0.013012785	2.617277441	4.480913427	7.859664022	1.705517709	0.552635542	0	0	2.841889109	7.636462015	0	0	0.637485183	0.205149109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2919	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.7367	1.150581291	4.444657411	0	2.5946429	1.121488716	0.433327912	1.042049142	5.205551212	1.33547039	5.677455567	0	0.013012785	2.617277441	4.480913427	7.859664022	1.705517709	0.552635542	0	0	2.841889109	7.636462015	0	0	0.637485183	0.205149109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2919
H2654_010_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	769.1634792	80.96432095	713.766755	1010.281685	10.37380607	7.950869638	4.537543975	386.9614457	30.06121841	6160.903591	30.55922102	0	0.029543646	30.04096226	4602.598195	3030.754755	526.9187936	307.9015524	0	0	5.445609854	595.6926795	302.8121963	0	323.5340752	194.615839	18.01095644	9.930354976	528.4669037	0											2750	"$175 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$10 (17b1, 17b3); $0 n/c (17b2, 17b5); $5 (17b4)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											158.1968537	122.8528282	76.29725738	0	150	0.2	0.082780459	49.41483278	0.2	3	0.172488615	0	0.2	0.150830245	11.79328772	34.88878163	38.5	35	0	0	0.2	34.65692146	0	0	35	13.01501005	0	0	0	0											YES	140.2353486	99.64319949	81.10777825	0	121.6616674	0.162215556	0.067141391	40.07927299	0.162215556	2.433233347	0.139901683	0	0.162215556	0.122466676	11.65028583	34.88878163	38.5	28.38772239	0	0	0.162215556	34.65692146	0	0	35	13.01501005	0	0	0	0											2750	8.9887	0.672295332	4.824336307	0	0.105174545	1.289754743	0.304657015	1.292427785	4.876397273	1.249243006	4.275286461	0	0.004792439	3.679016786	4.468465378	8.811611735	1.690531129	0.728385316	0	0	0.883362633	1.720406201	0	0	0.943641053	0.211077258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0195	0	7.77705701	8.9887	0.672295332	4.824336307	0	0.105174545	1.289754743	0.304657015	1.292427785	4.876397273	1.249243006	4.275286461	0	0.004792439	3.679016786	4.468465378	8.811611735	1.690531129	0.728385316	0	0	0.883362633	1.720406201	0	0	0.943641053	0.211077258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0195	NO	"$225 Days 1-13 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-13 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-19 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$30 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$30 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.8541	0.3041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3.1582	0	0.540227261	11.8427	0.97637361	4.824336307	0	0.105174545	1.289754743	0.304657015	1.292427785	4.876397273	1.249243006	4.275286461	0	0.004792439	3.679016786	4.468465378	8.811611735	1.690531129	0.728385316	0	0	0.883362633	1.720406201	0	0	0.943641053	0.211077258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1777
H2654_013_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	981.9036826	103.4728314	598.8915106	763.3490958	176.7839852	4.027382895	4.564936484	275.3089876	25.16179599	5754.896293	33.01338153	0	0.012337414	14.84401364	4704.138215	2376.040053	546.601725	209.0460062	0	0	14.63029123	2701.44818	351.0142604	0	214.5988864	183.6930902	17.92873739	9.924762857	110.6488188	0											3100	"$190 Days 1-9/$270 Days 1-12/$325 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$190 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$95 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$10 (17b1, 17b3); $0 n/c (17b2, 17b5); $5 (17b4)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											229.6828901	121.6705336	73.07390847	0	150	0.2	0.107496806	49.72415045	0.2	3	0.170013507	0	0.2	0.147658215	6.959797728	34.99385252	38.5	35	0	0	0.2	33.14096936	0	0	35	13.09621361	0	0	0	0											YES	186.4846902	98.7870353	59.33034531	0	121.7883645	0.162384486	0.087279068	40.37215305	0.162384486	2.435767289	0.13803778	0	0.162384486	0.120156796	6.913081935	34.99385252	38.5	28.41728504	0	0	0.162384486	33.14096936	0	0	35	13.09621361	0	0	0	0											3100	15.2592	0.851814521	2.961036677	0	1.794186034	0.653984501	0.398423401	0.926234715	4.085885307	1.168132345	4.557093882	0	0.002003405	1.783609114	2.710007743	6.9288996	1.753680535	0.495043329	0	0	2.375732321	7.460717613	0	0	0.625913419	0.200473662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.992	0	8.656590166	15.2592	0.851814521	2.961036677	0	1.794186034	0.653984501	0.398423401	0.926234715	4.085885307	1.168132345	4.557093882	0	0.002003405	1.783609114	2.710007743	6.9288996	1.753680535	0.495043329	0	0	2.375732321	7.460717613	0	0	0.625913419	0.200473662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.992	NO	"$365 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	35% (9b)	35%/35%/$10 (8a1); $10 (8a2)	"$21 (8b1); 35% (8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"35% (3, 9a, 9d); $0 n/c (5); $45/$35 (9c)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"35% (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.1962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											5.1962	0	1.725377422	20.4554	0.851814521	2.961036677	0	1.794186034	0.653984501	0.398423401	0.926234715	4.085885307	1.168132345	4.557093882	0	0.002003405	1.783609114	2.710007743	6.9288996	1.753680535	0.495043329	0	0	2.375732321	7.460717613	0	0	0.625913419	0.200473662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1883
H2654_020_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1449.157332	123.9435135	802.2927675	959.3423076	221.5186204	6.065838194	4.580438329	309.1124803	29.30303531	6109.127116	38.3686858	0	0.058931328	18.53826673	4766.422006	2574.642685	527.4757361	241.5271721	0	0	13.68783554	2742.810453	354.2356964	0	216.9707556	192.3630356	18.09130836	7.118187358	111.6521402	0											3800	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$85 Days 1-34 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$10 (17b1, 17b3); $0 n/c (17b2, 17b5); $5 (17b4)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											183.6772749	135.4364349	70.72621662	0	150	0.2	0.103191458	49.57712006	0.2	3	0.168779413	0	0.2	0.148976669	11.07099948	34.99359784	38.5	35	0	0	0.2	33.13286119	0	0	35	13.0745044	0	0	0	0											NO	155.2093494	114.4453006	59.76444321	0	126.7516758	0.169002234	0.087197935	41.89322033	0.169002234	2.535033517	0.14262049	0	0.169002234	0.126068377	11.0056028	34.99359784	38.5	29.57539103	0	0	0.169002234	33.13286119	0	0	35	13.0745044	0	0	0	0												18.7436	1.182062722	3.995715045	0	2.339821364	1.025140208	0.399404764	1.079143104	4.952278443	1.290570166	5.472160764	0	0.009959526	2.337089193	4.371445615	7.50800089	1.692317987	0.595271713	0	0	2.313274791	7.573096501	0	0	0.63283137	0.209587613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7227	0	8.41062378	18.7436	1.182062722	3.995715045	0	2.339821364	1.025140208	0.399404764	1.079143104	4.952278443	1.290570166	5.472160764	0	0.009959526	2.337089193	4.371445615	7.50800089	1.692317987	0.595271713	0	0	2.313274791	7.573096501	0	0	0.63283137	0.209587613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7227	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.7436	1.182062722	3.995715045	0	2.339821364	1.025140208	0.399404764	1.079143104	4.952278443	1.290570166	5.472160764	0	0.009959526	2.337089193	4.371445615	7.50800089	1.692317987	0.595271713	0	0	2.313274791	7.573096501	0	0	0.63283137	0.209587613	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7227
H2654_022_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	949.1047314	108.9566008	624.7576866	643.7433583	164.5494669	4.336275963	4.259666653	283.3255591	27.00672235	5712.146363	31.57213513	0	0.00994284	15.84087176	4616.584718	2383.011511	539.6051013	213.6637744	0	0	14.21651696	2745.71989	354.2335549	0	218.5309676	187.6861154	18.09316913	0	111.6636241	0											2500	"$190 Days 1-9/$270 Days 1-10/$325 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$190 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$95 Days 1-27 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$10 (17b1, 17b3); $0 n/c (17b2, 17b5); $5 (17b4)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											219.0137932	121.6705336	71.04268966	0	150	0.2	0.114582543	49.74463248	0.2	3	0.169158481	0	0.2	0.147869838	6.970106751	34.99017688	38.5	35	0	0	0.2	33.17041226	0	0	35	13.08888094	35	0	0	0											YES	167.944597	93.29964312	72.84809091	0	115.0233014	0.153364402	0.087864416	38.14527905	0.153364402	2.300466029	0.129714446	0	0.153364402	0.113704784	6.913881385	34.99017688	38.5	26.83877034	0	0	0.153364402	33.17041226	0	0	35	13.08888094	35	0	0	0											2500	13.2831	0.847134331	3.792700396	0	1.577251911	0.66503037	0.374273124	0.900627709	4.14186982	1.095049888	4.09536202	0	0.001524878	1.801182899	2.659876595	6.948499522	1.731233033	0.477872748	0	0	2.18030762	7.589721726	0	0	0.637381989	0.204716768	0.052771743	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0575	0	10.72898471	13.2831	0.847134331	3.792700396	0	1.577251911	0.66503037	0.374273124	0.900627709	4.14186982	1.095049888	4.09536202	0	0.001524878	1.801182899	2.659876595	6.948499522	1.731233033	0.477872748	0	0	2.18030762	7.589721726	0	0	0.637381989	0.204716768	0.052771743	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0575	NO	"$365 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	35% (9b)	35%/35%/$10 (8a1); $10 (8a2)	"$21 (8b1); 35% (8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"35% (3, 9a, 9d); $0 n/c (5); $45/$35 (9c)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$45/$35 (7e, 7h)"	"35% (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.7021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											4.7021	0	1.988289844	17.9852	0.847134331	3.792700396	0	1.577251911	0.66503037	0.374273124	0.900627709	4.14186982	1.095049888	4.09536202	0	0.001524878	1.801182899	2.659876595	6.948499522	1.731233033	0.477872748	0	0	2.18030762	7.589721726	0	0	0.637381989	0.204716768	0.052771743	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7596
H2654_024_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5621	0.7785	0.535	0	1.4458	0	1.8236	0	0.0047	1.1168	0.8294	4.7153	0.4464	0.1893	0	0	0.9772	0.115	0	0	0	0	0	0	0	0											13.5391	NO	377.2794369	22.07887935	50.6736014	1291.471415	13.55775353	18.74532285	12.87170037	32.01921488	34.95457	15.30352005	44.08659005	0	0.11260977	26.98696805	22.81272427	113.741042	10.9029095	4.578929376	0	0	23.55110436	3.465546467	313.6293109	169.6875003	422.2379499	1045.435857	0	0	77.23706909	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08256416	0.083566964	0.177101718	0	0.191710099	0.191710099	0.191710099	0.099615781	0.191710099	0	0.159782614	0	0.191710099	0.144027627	0.148758992	0.191588699	0.191710099	0	0	0	0.191710099	0.192972135	0	0	0	0	0	0	0	0											NO	0.079141917	0.080103155	0.16976094	0	0.191710099	0.191710099	0.191710099	0.095486756	0.191710099	0	0.159782614	0	0.191710099	0.144027627	0.148758992	0.191588699	0.191710099	0	0	0	0.191710099	0.19212139	0	0	0	0	0	0	0	0												29.8586	1.768587887	8.602398192	0	2.599158273	3.593667702	2.467634954	3.057410961	6.701144078	0	7.044270606	0	0.02158843	3.886868964	3.393597859	21.79149827	2.090197861	0	0	0	4.51498455	0.665805604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.0574	146	0	29.8586	1.768587887	8.602398192	0	3.161271592	4.372180312	3.002598497	3.057410961	8.146965093	0	8.867874205	0	0.026242875	5.003692007	4.222980481	26.50683016	2.53655035	0.189328793	0	0	5.492150157	0.780854115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5965	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	29.8586	1.768587887	8.602398192	0	3.161271592	4.372180312	3.002598497	3.057410961	8.146965093	0	8.867874205	0	0.026242875	5.003692007	4.222980481	26.50683016	2.53655035	0.189328793	0	0	5.492150157	0.780854115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5965
H2654_026_0	2010	5	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2654.185528	235.5234012	44.03627126	1220.733179	271.5595476	13.43428913	15.05426186	558.2158385	48.02099661	10803.14513	59.45995648	0	0.174610444	29.53452365	6047.642819	5504.352719	1074.316031	357.985174	0	0	28.23507858	1057.15386	320.9471788	0	594.545686	1119.841729	17.42889309	9.979700833	79.0392306	0											4200	"$265 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$265 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$10 (17b1, 17b3); $0 n/c (17b2, 17b5); $5 (17b4)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											183.6772749	135.4364349	0.177155979	0	150	0.2	0.097358075	49.59699339	0.2	3	0.169814891	0	0.2	0.149790014	9.49734662	34.81799811	38.5	35	0	0	0.2	34.76774572	0	0	35	12.95935391	0	0	0	0											NO	136.2239918	100.4462409	0.131387482	0	111.2472883	0.148329718	0.072205479	36.78354016	0.148329718	2.224945767	0.125942974	0	0.148329718	0.111380625	9.349485781	34.81799811	38.5	25.95770061	0	0	0.148329718	34.76774572	0	0	35	12.95935391	0	0	0	0												30.1303	1.971453357	5.785814786	0	2.517521942	1.992704315	1.087000189	1.711096226	7.122940876	2.003034335	7.488563771	0	0.025899918	3.289573697	4.711862545	15.97087855	3.446763933	0.774372664	0	0	4.188101238	3.062904716	0	0	1.734091584	1.209368775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2243	0	24.47811912	30.1303	1.971453357	5.785814786	0	2.517521942	1.992704315	1.087000189	1.711096226	7.122940876	2.003034335	7.488563771	0	0.025899918	3.289573697	4.711862545	15.97087855	3.446763933	0.774372664	0	0	4.188101238	3.062904716	0	0	1.734091584	1.209368775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2243	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	30.1303	1.971453357	5.785814786	0	2.517521942	1.992704315	1.087000189	1.711096226	7.122940876	2.003034335	7.488563771	0	0.025899918	3.289573697	4.711862545	15.97087855	3.446763933	0.774372664	0	0	4.188101238	3.062904716	0	0	1.734091584	1.209368775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2243
H2654_027_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1998.989903	222.2711094	30.38893383	966.2998805	201.6780572	18.24388457	15.08527036	564.5612901	42.91378024	13477.76302	44.51332424	0	0.162663108	33.18450252	8479.140159	5551.832105	1036.651813	394.929344	0	0	26.0614495	1135.401734	321.6055122	0	358.7133437	1355.242561	17.46464359	10.0001714	79.20135748	0											2750	"$175 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$10 (17b1, 17b3); $0 n/c (17b2, 17b5); $5 (17b4)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											158.1968537	122.8528282	0.191399066	0	150	0.2	0.093673529	49.51073567	0.2	3	0.177002582	0	0.2	0.150373878	13.18337242	34.84048954	38.5	35	0	0	0.2	34.74994494	0	0	35	12.97580881	0	0	0	0											NO	118.254773	84.02506252	0.13090719	0	102.5923421	0.136789789	0.064067911	33.86281553	0.136789789	2.051846841	0.12106073	0	0.136789789	0.103153371	13.02496548	34.84048954	38.5	23.93821315	0	0	0.136789789	34.74994494	0	0	35	12.97580881	0	0	0	0												19.6992	1.556361989	3.978129932	0	1.724218686	2.495577128	0.966481765	1.593136235	5.870166963	2.304525458	5.388815513	0	0.022250652	3.4230933	9.203375654	16.1190457	3.325924568	0.787825235	0	0	3.564940189	3.28792898	0	0	1.046247252	1.465447363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8227	0	24.76142681	19.6992	1.556361989	3.978129932	0	1.724218686	2.495577128	0.966481765	1.593136235	5.870166963	2.304525458	5.388815513	0	0.022250652	3.4230933	9.203375654	16.1190457	3.325924568	0.787825235	0	0	3.564940189	3.28792898	0	0	1.046247252	1.465447363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8227	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.6992	1.556361989	3.978129932	0	1.724218686	2.495577128	0.966481765	1.593136235	5.870166963	2.304525458	5.388815513	0	0.022250652	3.4230933	9.203375654	16.1190457	3.325924568	0.787825235	0	0	3.564940189	3.28792898	0	0	1.046247252	1.465447363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8227
H2654_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	239.310226	5.527189779	28.11120987	1053.62648	6.200189901	6.89849649	7.046357561	12.65420446	41.55406274	16.68834691	57.52730921	0	0.067030616	26.05906737	127.384008	182.0854193	6.313659631	9.115187895	0	0	25.82737314	30.40333701	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08359833	0.08359833	0.17689446	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08359833	0.08359833	0.17689446	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.0059	0.462063834	4.97271729	0	1.444644247	1.607349682	1.641801312	2.948429639	9.682096618	3.888384829	13.40386305	0	0.015618133	6.071762697	29.68047387	42.4259027	1.471082694	2.123838779	0	0	6.017777941	7.083977524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.9477	0	0	20.0059	0.462063834	4.97271729	0	1.444644247	1.607349682	1.641801312	2.948429639	9.682096618	3.888384829	13.40386305	0	0.015618133	6.071762697	29.68047387	42.4259027	1.471082694	2.123838779	0	0	6.017777941	7.083977524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.9477	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.0059	0.462063834	4.97271729	0	1.444644247	1.607349682	1.641801312	2.948429639	9.682096618	3.888384829	13.40386305	0	0.015618133	6.071762697	29.68047387	42.4259027	1.471082694	2.123838779	0	0	6.017777941	7.083977524	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.9477
H2654_802_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	261.2980361	5.53	23.42856026	1083.567581	6.319315914	7.387046529	5.883602336	13.04552998	39.103101	16.82668993	60.74570548	0	0.030438243	38.7540743	125.892558	184.9350206	6.173165258	9.038562473	0	0	30.34617122	30.44980702	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083595717	0.083595717	0.176911739	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083595717	0.083595717	0.176911739	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.8434	0.462284314	4.144787333	0	1.472400608	1.721181841	1.370879344	3.039608484	9.111022532	3.920618753	14.15374938	0	0.007092111	9.029699313	29.33296601	43.0898598	1.438347505	2.105985056	0	0	7.070657893	7.094805036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.4093	0	0	21.8434	0.462284314	4.144787333	0	1.472400608	1.721181841	1.370879344	3.039608484	9.111022532	3.920618753	14.15374938	0	0.007092111	9.029699313	29.33296601	43.0898598	1.438347505	2.105985056	0	0	7.070657893	7.094805036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.4093	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.8434	0.462284314	4.144787333	0	1.472400608	1.721181841	1.370879344	3.039608484	9.111022532	3.920618753	14.15374938	0	0.007092111	9.029699313	29.33296601	43.0898598	1.438347505	2.105985056	0	0	7.070657893	7.094805036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	160.4093
H2654_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	181.4943783	5.462991064	19.37974852	947.4839911	0.471623495	8.902490891	5.092130075	17.58114608	34.86834893	15.1395695	33.16896809	0	0.146471594	29.46755587	18.96005021	76.94919627	2.701805363	6.123069258	0	0	5.650784816	4.266458722	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081271472	0.081271472	0.191399066	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081271472	0.081271472	0.191399066	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.7503	0.443985324	3.709265774	0	0.109888274	2.074280378	1.186466307	4.096407036	8.124325301	3.527519693	7.728369565	0	0.034127881	6.865940519	4.4176917	17.92916273	0.62952065	1.426675137	0	0	1.316632862	0.994084882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3647	0	0	14.7503	0.443985324	3.709265774	0	0.109888274	2.074280378	1.186466307	4.096407036	8.124325301	3.527519693	7.728369565	0	0.034127881	6.865940519	4.4176917	17.92916273	0.62952065	1.426675137	0	0	1.316632862	0.994084882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3647	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.7503	0.443985324	3.709265774	0	0.109888274	2.074280378	1.186466307	4.096407036	8.124325301	3.527519693	7.728369565	0	0.034127881	6.865940519	4.4176917	17.92916273	0.62952065	1.426675137	0	0	1.316632862	0.994084882	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3647
H2654_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	185.1724475	5.462991064	19.77248827	966.6851993	0.481181167	9.08290407	5.195324493	17.9374363	35.57497247	15.44638002	33.84115288	0	0.14943991	30.06432867	19.34428458	78.50860804	2.701805363	6.247156146	0	0	5.765300637	4.352920521	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081271472	0.081271472	0.191399066	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081271472	0.081271472	0.191399066	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												15.0492	0.443985324	3.784435795	0	0.112115212	2.116316648	1.210510607	4.179422657	8.288968586	3.599006544	7.88498862	0	0.034819499	7.004988581	4.507218306	18.29250567	0.62952065	1.455587382	0	0	1.343315048	1.014230481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9512	0	0	15.0492	0.443985324	3.784435795	0	0.112115212	2.116316648	1.210510607	4.179422657	8.288968586	3.599006544	7.88498862	0	0.034819499	7.004988581	4.507218306	18.29250567	0.62952065	1.455587382	0	0	1.343315048	1.014230481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9512	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.0492	0.443985324	3.784435795	0	0.112115212	2.116316648	1.210510607	4.179422657	8.288968586	3.599006544	7.88498862	0	0.034819499	7.004988581	4.507218306	18.29250567	0.62952065	1.455587382	0	0	1.343315048	1.014230481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9512
H2654_805_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	237.8212978	5.527189779	27.93630898	1047.07108	6.161613875	6.855575776	7.002516892	12.57547317	41.29552379	16.5845162	57.16938873	0	0.066613568	25.89705876	126.5914567	180.9525295	2.718617758	9.058475483	0	0	25.6666817	30.21417508	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08359833	0.08359833	0.17689446	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08359833	0.08359833	0.17689446	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.8815	0.462063834	4.941778294	0	1.435656033	1.597349156	1.631586436	2.930085249	9.621857042	3.864192274	13.32046757	0	0.015520961	6.034014692	29.49580941	42.16193937	0.633437938	2.110624788	0	0	5.980336836	7.039902794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1581	0	0	19.8815	0.462063834	4.941778294	0	1.435656033	1.597349156	1.631586436	2.930085249	9.621857042	3.864192274	13.32046757	0	0.015520961	6.034014692	29.49580941	42.16193937	0.633437938	2.110624788	0	0	5.980336836	7.039902794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1581	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.8815	0.462063834	4.941778294	0	1.435656033	1.597349156	1.631586436	2.930085249	9.621857042	3.864192274	13.32046757	0	0.015520961	6.034014692	29.49580941	42.16193937	0.633437938	2.110624788	0	0	5.980336836	7.039902794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1581
H2654_807_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	185.1724468	5.453094341	19.7724882	966.6851975	0.481181166	9.082904038	5.195324475	17.93743623	35.57497235	15.44637996	33.84115276	0	0.149439909	30.06432857	19.34428451	78.50860776	2.69190864	6.247156124	0	0	5.765300617	4.352920505	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081271472	0.081271472	0.191399066	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081271472	0.081271472	0.191399066	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												15.0492	0.443181002	3.784435781	0	0.112115212	2.116316641	1.210510603	4.179422642	8.288968557	3.599006531	7.884988592	0	0.034819499	7.004988556	4.50721829	18.29250561	0.627214713	1.455587377	0	0	1.343315044	1.014230478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9481	0	0	15.0492	0.443181002	3.784435781	0	0.112115212	2.116316641	1.210510603	4.179422642	8.288968557	3.599006531	7.884988592	0	0.034819499	7.004988556	4.50721829	18.29250561	0.627214713	1.455587377	0	0	1.343315044	1.014230478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9481	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.0492	0.443181002	3.784435781	0	0.112115212	2.116316641	1.210510603	4.179422642	8.288968557	3.599006531	7.884988592	0	0.034819499	7.004988556	4.50721829	18.29250561	0.627214713	1.455587377	0	0	1.343315044	1.014230478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.9481
H2663_002_0	2010	9	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	P	COIN	V	T	V	V	V	V	V	P	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	YES	2413.567052	8.697254003	1513.480328	0	348.5377708	9.023760111	27.15598741	323.7307578	436.0879906	0	60.1476873	1.893614882	0.047486397	24.11722304	3585.451053	101.8027699	1.559578756	7.783561331	39.77500452	1143.347667	13.16025833	0	0	0	101.7041527	124.286004	0.574197316	0	0	405.9971206											2900	1a $280 days 1-5	1b $280 days 1-5	2 $100 days 6-34	6 0%	10a $100	11a 20%	11b 20%	4a $50	"9a $275,9b $275"	8a $0	"8a 20%, 8b $15"	9a 20%	12 20%	"9a 20%,9d 20%, 4b $30, 3 20%"	"14c $15,7a $15"	"17a $25,17b $15,18a $30,7b $30,7d $30,7f $30,8a 20%, 14d-j $10"	"7h $30,9c $30, 7e $30"	"7c 20%,7i 20%"	"8a 20%, 8b $15, 14h $10"	7g $30	15 20%				17a $25	17b $15	18a $30			7f $30											189.8320803	211.4893617	64.26861247	0	100	0.2	0.2	47.60923376	275	0	0.203052902	0.2	0.2	0.199947217	15	0.137516172	0.059178533	0.2	0.195959975	0.028005372	0.235631388	0	0	0	25	15	9.83385	0	0	26.69970686											NO	114.4562971	127.5142177	38.74975921	0	60.29344297	0.120586886	0.120586886	28.7052462	165.8069682	0	0.122427586	0.120586886	0.120586886	0.120555062	15	0.127302966	0.035680775	0.120586886	0.119390073	0.028005372	0.142070276	0	0	0	25	15	9.83385	0	0	26.69970686												23.0207	0.092418628	4.887249858	0	1.75121185	1.088147131	3.274655957	0.774397592	6.025535631	0	7.363736155	0.228345122	0.005726237	2.907453308	4.481813816	12.95979456	0.055646979	0.938595422	4.748740674	0.002668323	1.869681538	0	0	0	0.211883651	0.155357505	0.000470548	0	0	0.903333675	0	0	0	0	0	0	0	0	0	0	77.7475	0	39.83395514	23.0207	0.092418628	4.887249858	0	1.75121185	1.088147131	3.274655957	0.774397592	6.025535631	0	7.363736155	0.228345122	0.005726237	2.907453308	4.481813816	12.95979456	0.055646979	0.938595422	4.748740674	0.002668323	1.869681538	0	0	0	0.211883651	0.155357505	0.000470548	0	0	0.903333675	0	0	0	0	0	0	0	0	0	0	77.7475	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.0207	0.092418628	4.887249858	0	1.75121185	1.088147131	3.274655957	0.774397592	6.025535631	0	7.363736155	0.228345122	0.005726237	2.907453308	4.481813816	12.95979456	0.055646979	0.938595422	4.748740674	0.002668323	1.869681538	0	0	0	0.211883651	0.155357505	0.000470548	0	0	0.903333675	0	0	0	0	0	0	0	0	0	0	77.7475
H2663_005_0	2010	10	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	P	COIN	V	T	V	V	V	V	V	P	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	YES	1841.090725	6.243759567	946.1403684	0	251.3080943	6.511278025	16.89807029	327.6631342	366.9413888	0	26.6858288	1.467813559	0.902426078	10.04599492	2833.934525	93.98020834	1.783783897	8.546883023	43.14981248	866.3628858	11.52366414	0	0	0	101.9596311	120.5520584	0	0	0	210.5754389											3400	1a $320 days 1-5	1b $320 days 1-5	2 $100 days 6-39	6 0%	10a $100	11a 20%	11b 20%	4a $50	"9a $275,9b $275"	8a $0	"8a 20%, 8b $15"	9a 20%	12 20%	"9a 20%,9d 20%, 4b $30, 3 20%"	"14c $15,7a $15"	"17a $25,17b $15,18a $30,7b $40,7d $40,7f $40,8a 20%, 14d-j $10"	"7h $30,9c $30, 7e $30"	"7c 20%,7i 20%"	"8a 20%, 8b $15, 14h $10"	7g $40	15 20%				17a $25	17b $15	18a $30			7f $40											216.9509489	241.7021277	67.27283092	0	100	0.2	0.2	47.48518972	275	0	0.198502947	0.2	0.191352335	0.2	15	0.109414356	0.02951415	0.156695237	0.122813217	0.104768739	0.242841937	0	0	0	25	15	0	0	0	29.09924551											NO	155.2467732	173.1066482	48.77342415	0	72.10155581	0.146740355	0.145772176	34.0028184	197.4483628	0	0.144057129	0.146177893	0.134513298	0.144577227	15	0.10911843	0.020961232	0.114181405	0.090630027	0.104768739	0.177607953	0	0	0	25	15	0	0	0	29.09924551												23.8186	0.090069691	3.845542125	0	1.509975382	0.955467246	2.463268475	0.928455837	6.037664706	0	3.844283891	0.214561894	0.121388308	1.452422086	3.542418156	10.25497279	0.037390309	0.975895116	3.910668659	0.007563979	2.046694396	0	0	0	0.212415898	0.150690073	0	0	0	0.510632199	0	0	0	0	0	0	0	0	0	0	66.9311	0	23.62022437	23.8186	0.090069691	3.845542125	0	1.509975382	0.955467246	2.463268475	0.928455837	6.037664706	0	3.844283891	0.214561894	0.121388308	1.452422086	3.542418156	10.25497279	0.037390309	0.975895116	3.910668659	0.007563979	2.046694396	0	0	0	0.212415898	0.150690073	0	0	0	0.510632199	0	0	0	0	0	0	0	0	0	0	66.9311	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.8186	0.090069691	3.845542125	0	1.509975382	0.955467246	2.463268475	0.928455837	6.037664706	0	3.844283891	0.214561894	0.121388308	1.452422086	3.542418156	10.25497279	0.037390309	0.975895116	3.910668659	0.007563979	2.046694396	0	0	0	0.212415898	0.150690073	0	0	0	0.510632199	0	0	0	0	0	0	0	0	0	0	66.9311
H2663_006_0	2010	9	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	P	COIN	V	T	V	V	V	V	V	P	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	YES	1621.228831	4.194038366	808.0513919	0	227.2183104	6.21586571	28.86412557	326.3618811	293.3103284	0	32.81624121	0.972561707	0.006529142	14.00207461	2637.425564	79.03724108	1.780845485	5.88996331	31.73346426	835.665851	5.270030847	0	0	0	78.62047449	108.5896653	0	0	0	206.2176078											4500	1a $320 days 1-5	1b $320 days 1-5	2 $100 days 6-50	6 0%	10a $100	11a 20%	11b 20%	4a $50	"9a $275,9b $275"	8a $0	"8a 20%, 8b $15"	9a 20%	12 20%	"9a 20%,9d 20%, 4b $30, 3 20%"	"14c $15,7a $15"	"17a $25,17b $15,18a $30,7b $30,7d $30,7f $30,8a 20%, 14d-j $10"	"7h $30,9c $30, 7e $30"	"7c 20%,7i 20%"	"8a 20%, 8b $15, 14h $10"	7g $30	15 20%				17a $25	17b $15	18a $30			7f $30											216.9509489	241.7021277	70.94402007	0	100	0.2	0.2	47.67045651	275	0	0.203541284	0.2	0.2	0.2	15	0.134833097	0.01569282	0.10108195	0.196219698	0.057651873	0.290664011	0	0	0	25	15	0	0	0	24.4378056											NO	172.8981143	192.6234585	56.53852798	0	79.69456471	0.159389129	0.159389129	37.99076281	219.1600529	0	0.16221134	0.159389129	0.159389129	0.159389129	15	0.130278058	0.012506325	0.08055682	0.157146583	0.057651873	0.231643418	0	0	0	25	15	0	0	0	24.4378056												23.359	0.067322515	3.807169685	0	1.509005362	0.990741424	4.600627846	1.033228068	5.356825593	0	5.32316646	0.155015764	0.001040674	2.231778482	3.296781954	10.29681828	0.022271832	0.474476713	4.986805468	0.004014808	1.220767959	0	0	0	0.163792655	0.135737082	0	0	0	0.419958818	0	0	0	0	0	0	0	0	0	0	69.4563	0	14.37830624	23.359	0.067322515	3.807169685	0	1.509005362	0.990741424	4.600627846	1.033228068	5.356825593	0	5.32316646	0.155015764	0.001040674	2.231778482	3.296781954	10.29681828	0.022271832	0.474476713	4.986805468	0.004014808	1.220767959	0	0	0	0.163792655	0.135737082	0	0	0	0.419958818	0	0	0	0	0	0	0	0	0	0	69.4563	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.359	0.067322515	3.807169685	0	1.509005362	0.990741424	4.600627846	1.033228068	5.356825593	0	5.32316646	0.155015764	0.001040674	2.231778482	3.296781954	10.29681828	0.022271832	0.474476713	4.986805468	0.004014808	1.220767959	0	0	0	0.163792655	0.135737082	0	0	0	0.419958818	0	0	0	0	0	0	0	0	0	0	69.4563
H2663_012_0	2010	11	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	V	COIN	COIN	V	V	COIN	V	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	NO	500.3858139	3.221006785	56.7124885	0	14.93870503	11.68184259	38.74511108	14.01815912	61.6120519	5.640408046	71.76374122	2.238623427	0.050036877	29.06315343	35.35065514	136.1962901	6.528819114	10.35912244	53.51426418	6.659384231	15.69561392	0	0	0	105.9508409	132.8347883	0	0	0	0												FFS Medicare 8.3%	FFS Medicare 8.3%	FFS Medicare 17.9%	FFS Medicare .%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	"FFS Medicare 23.3%, 8a $0"	"7h $30, 9c $30, 7e $30"	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%		16a $0	17a $25	17b $15															0.08335315	0.08335315	0.178505546	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.228987969	30	0.233	0.233	0.233	0.233	0	0	0	25	15	0	0	0	0											NO	0.08335315	0.08335315	0.178505546	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.228987969	30	0.233	0.233	0.233	0.233	0	0	0	25	15	0	0	0	0												41.7087	0.268481061	10.1234937	0	3.480718273	2.721869325	9.027610882	3.266231075	14.35560809	1.314215075	16.72095171	0.521599258	0.011658592	6.771714748	8.236702648	31.18731188	0.016322048	2.413675529	12.46882355	1.551636526	3.657078043	0	0	0	0.220730918	0.166043485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.2112	0	0	41.7087	0.268481061	10.1234937	0	3.480718273	2.721869325	9.027610882	3.266231075	14.35560809	1.314215075	16.72095171	0.521599258	0.011658592	6.771714748	8.236702648	31.18731188	0.016322048	2.413675529	12.46882355	1.551636526	3.657078043	0	0	0	0.220730918	0.166043485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.2112	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	41.7087	0.268481061	10.1234937	0	3.480718273	2.721869325	9.027610882	3.266231075	14.35560809	1.314215075	16.72095171	0.521599258	0.011658592	6.771714748	8.236702648	31.18731188	0.016322048	2.413675529	12.46882355	1.551636526	3.657078043	0	0	0	0.220730918	0.166043485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.2112
H2663_013_0	2010	8	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	P	COIN	COIN	COIN	COIN	COIN	COIN	V	COIN	V	V	V	V	V	COIN	O											18.1574	0.1169	2.1759	0	1.6225	1.1045	4.4103	2.1876	10.1716	0.9312	11.7974	0.3696	0.009	4.7981	0	18.239	0.0819	1.9703	10.8133	0	1.7968	0	0	0	0	0	0	0	0	0											90.7531	YES	0	0	0	0	0	0	0	307.8466906	0	0	0	0	0	0	3260.298496	93.57880894	0	0	0	0	0	0	0	0	92.80229107	116.3499278	0.419564992	0	0	345.1525166											1725	1a subject to deductible	1b subject to deductible	2 subject to deductible	6 0%	10a subject to deductible	11a subject to deductible	11b subject to deductible	4a subject to deductible	9a subject to deductible	8a subject to deductible	8a subject to deductible	9a subject to deductible	12 subject to deductible	"3 9a 9d subject to deductible, 4b $30"	"14c $15,7a $15"	"17a $25,17b $15,18a $30,7b $30,7d $30,7f $30"	"7h $30,9c $30, 7e $30"	7c 7i subject to deductible	8a 8b subject to deductible	7g $30	15 subject to deductible				17a $25	17b $15	18a $30			7f $30											0	0	0	0	0	0	0	25.59358896	0	0	0	0	0	0	15.0942975	0.110009426	0	0	0	0	0	0	0	0	25	15	9.83385	0	0	26.38192815											NO	0	0	0	0	0	0	0	25.59358896	0	0	0	0	0	0	15.0942975	0.110009426	0	0	0	0	0	0	0	0	25	15	9.83385	0	0	26.38192815												0	0	0	0	0	0	0	0.656575139	0	0	0	0	0	0	4.100992953	10.29455109	0	0	0	0	0	0	0	0	0.193338106	0.14543741	0.000343828	0	0	0.758815741	0	0	0	0	0	0	0	0	0	0	16.1501	1725	0	18.1574	0.116880167	2.175941599	0	1.622485947	1.104456429	4.41034512	2.844137222	10.17158527	0.93117969	11.79743423	0.369576217	0.008987375	4.79806035	4.100992953	28.53350604	0.081925351	1.970256212	10.81326875	0	1.796762209	0	0	0	0.193338106	0.14543741	0.000343828	0	0	0.758815741	0	0	0	0	0	0	0	0	0	0	106.9031	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.1574	0.116880167	2.175941599	0	1.622485947	1.104456429	4.41034512	2.844137222	10.17158527	0.93117969	11.79743423	0.369576217	0.008987375	4.79806035	4.100992953	28.53350604	0.081925351	1.970256212	10.81326875	0	1.796762209	0	0	0	0.193338106	0.14543741	0.000343828	0	0	0.758815741	0	0	0	0	0	0	0	0	0	0	106.9031
H2663_802_0	2010	8	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	306.1470283	1.308539934	28.91949622	0	7.640270159	8.333639871	34.20618871	8.244997352	47.50553494	4.299580638	45.25410636	1.6012751	0	20.62122258	27.62636074	107.111281	2.433732988	9.541486337	37.57714197	7.288285565	15.12065044	0	0	0	0	0	0	0	0	0												FFS Medicare 8.4%	FFS Medicare 8.4%	FFS Medicare 17.7%		FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			0.083574885	0.083574885	0.177065233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.083574885	0.083574885	0.177065233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												25.5862	0.109361075	5.120637334	0	1.780182947	1.94173809	7.970041969	1.921084383	11.06878964	1.001802289	10.54420678	0.373097098	0	4.804744861	6.436942052	24.95692848	0.567059786	2.223166316	8.755474079	1.698170537	3.523111553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.3827	0	0	25.5862	0.109361075	5.120637334	0	1.780182947	1.94173809	7.970041969	1.921084383	11.06878964	1.001802289	10.54420678	0.373097098	0	4.804744861	6.436942052	24.95692848	0.567059786	2.223166316	8.755474079	1.698170537	3.523111553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.3827	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.5862	0.109361075	5.120637334	0	1.780182947	1.94173809	7.970041969	1.921084383	11.06878964	1.001802289	10.54420678	0.373097098	0	4.804744861	6.436942052	24.95692848	0.567059786	2.223166316	8.755474079	1.698170537	3.523111553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.3827
H2663_804_0	2010	8	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	380.773662	1.854300886	29.13889277	0	8.966292764	7.359203887	24.94688796	9.411129308	53.49862579	4.651909236	42.35572928	1.822004126	0.050209289	14.7118777	27.94763758	112.1240757	1.953441751	7.871735291	50.60729892	4.850922518	17.37688773	0	0	0	0	0	0	0	0	0												FFS Medicare 9.%	FFS Medicare 9.%	FFS Medicare 17.4%		FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			0.089967234	0.089967234	0.174413836	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.089967234	0.089967234	0.174413836	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												34.2572	0.166826322	5.082226068	0	2.089146214	1.714694506	5.812624895	2.192793129	12.46517981	1.083894852	9.868884922	0.424526961	0.011698764	3.427867505	6.511799556	26.12490963	0.455151928	1.834114323	11.79150065	1.130264947	4.048814842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4941	0	0	34.2572	0.166826322	5.082226068	0	2.089146214	1.714694506	5.812624895	2.192793129	12.46517981	1.083894852	9.868884922	0.424526961	0.011698764	3.427867505	6.511799556	26.12490963	0.455151928	1.834114323	11.79150065	1.130264947	4.048814842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4941	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	34.2572	0.166826322	5.082226068	0	2.089146214	1.714694506	5.812624895	2.192793129	12.46517981	1.083894852	9.868884922	0.424526961	0.011698764	3.427867505	6.511799556	26.12490963	0.455151928	1.834114323	11.79150065	1.130264947	4.048814842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4941
H2663_805_0	2010	8	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	303.1613157	2.910203683	27.7558943	0	7.912361953	6.950151714	36.83989947	8.136069539	48.38536945	4.723517563	42.51672364	1.514854109	0.011315943	18.99029748	28.634844	108.1535437	1.986214619	8.695667648	44.66213713	6.221006564	21.0146305	0	0	0	0	0	0	0	0	0												FFS Medicare 8.4%	FFS Medicare 8.4%	FFS Medicare 17.7%		FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			0.083578039	0.083578039	0.177028574	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.083578039	0.083578039	0.177028574	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												25.3376	0.243229118	4.913586384	0	1.843580335	1.619385349	8.583696577	1.895704203	11.27379108	1.100579592	9.906396608	0.352961007	0.002636615	4.424739313	6.671918653	25.19977568	0.462788006	2.026090562	10.40627795	1.449494529	4.896408907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6107	0	0	25.3376	0.243229118	4.913586384	0	1.843580335	1.619385349	8.583696577	1.895704203	11.27379108	1.100579592	9.906396608	0.352961007	0.002636615	4.424739313	6.671918653	25.19977568	0.462788006	2.026090562	10.40627795	1.449494529	4.896408907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6107	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.3376	0.243229118	4.913586384	0	1.843580335	1.619385349	8.583696577	1.895704203	11.27379108	1.100579592	9.906396608	0.352961007	0.002636615	4.424739313	6.671918653	25.19977568	0.462788006	2.026090562	10.40627795	1.449494529	4.896408907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6107
H2667_001_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	Coin	P	Coin	P	P	P	P	P	P	P	Coin	Coin	T	V	V	P	P	P	P	P																																																			0	YES	320.1770462	19.1214313	234.0403884		121.522554	9.19120055	1.828063088	294.3436143	414.3039675		25.24184518		0.293688635	208.6211467	4087.755423	3452.014139	141.4955034	47.63509029			11.93168367	4.435315123																			3000	$500 annual deductible	$500 annual deductible	$0 /day days 1-30; $100/day days 31-100	$0 copay	$75/copay	20% coins	20% coins	"$50 copay for ER, $15 for Urgent Care"	$100 copay	$0 copay	20% coins; maximum $2400	$0 copay	20% coins	"$0 copay for OP Rehab, $30 copay for OP Partial Hospitalization"	$10 copay	$30 copay	$30/day	$30 copay	$0 copay	$30 copay for chiro; $10 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit 1 per year)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1 per year)	N/A	Fitness benefit limited to $250/year; $10 copay for nutritional training and smoking cessation; $0 copay others	N/A											321.209662	55.58444676	28.29719571		75	0.2	0.2	49.98480903	100		0.2		0.2	31.34654573	10	29.79319744	29.96085413	27.3255814			0.2	0.371768841																			NO	289.1419667	50.03522046	25.47216908		67.51243835	0.180033169	0.180033169	44.99461784	90.01658446		0.180033169		0.180033169	28.21708981	9.001658446	26.91900493	26.96973757	24.59755506			0.180033169	0.334662117																				7.7147	0.079728753	0.496793029	0	0.683690328	1.654720961	0.329111991	1.103656536	3.10785234	0	4.544369377	0	0.052873696	0.490556803	3.066381511	7.743732136	0.318008049	0.09764223	0	0	2.148098822	1.484331949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1163	0	3.862560221	7.7147	0.079728753	0.496793029	0	0.683690328	1.654720961	0.329111991	1.103656536	3.10785234	0	4.544369377	0	0.052873696	0.490556803	3.066381511	7.743732136	0.318008049	0.09764223	0	0	2.148098822	1.484331949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1163	NO																																																																																		0	0	0	7.7147	0.079728753	0.496793029	0	0.683690328	1.654720961	0.329111991	1.103656536	3.10785234	0	4.544369377	0	0.052873696	0.490556803	3.066381511	7.743732136	0.318008049	0.09764223	0	0	2.148098822	1.484331949	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1163
H2667_003_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P																																																			0	YES	1786.289848	45.53368902	809.2394615		271.9986702	8.055109124	2.884217419	316.8545797	290.6284405		831.475658		11.9359592	3.478977649	4254.764247	5676.270132	248.8811362	547.9445993			944.1308531	1258.909244																			3500	$175/day days 1-20; $0/day days 21-90	"$175/day days 1-12; $0/day days 13-90; category-specific $1,950 OOPM"	$100/day days 1-25; $0/day days 26-100	$0 copay	$150 copay	20% coins	20% coins	$50 copay for ER and $35 for Urgent Care	20% coins	0% coins	20% coins	$0 copay	20% coins	"$0 copay for OP Rehab, $30 copay for Partial Hospitalization"	$15 copay	$30 copay	$30/day for individual; $15/day for group	20% coins	20% coins	$30 copay for chiro; $30 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit 1 per year)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1 per year)	N/A	Fitness benefit limited to $250/year	N/A											142.0800419	123.5018802	64.76115207		150	0.2	0.2	48.3910473	290.105357		65.24185739		535.1692769	3179.006424	15	29.83577091	28.48426573	16.81871046			104.226116	29.99176617																			NO	126.7866313	123.5018802	57.79030045		150	0.17847212	0.17847212	48.3910473	258.8785901		58.21926293		535.1692769	3179.006424	15	29.83577091	28.48426573	16.81871046			93.00727931	29.99176617																				18.8731	0.468624684	3.897182635	0	3.399983377	1.4376124	0.514752397	1.277743746	6.269790075	0	4.033991663	0	0.532313221	0.921641025	5.318455308	14.11299128	0.590766368	0.767976797	0	0	7.31758683	3.146409305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.881	0	5.107675941	18.8731	0.468624684	3.897182635	0	3.399983377	1.4376124	0.514752397	1.277743746	6.269790075	0	4.033991663	0	0.532313221	0.921641025	5.318455308	14.11299128	0.590766368	0.767976797	0	0	7.31758683	3.146409305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.881	NO																																																																																		0	0	0	18.8731	0.468624684	3.897182635	0	3.399983377	1.4376124	0.514752397	1.277743746	6.269790075	0	4.033991663	0	0.532313221	0.921641025	5.318455308	14.11299128	0.590766368	0.767976797	0	0	7.31758683	3.146409305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.881
H2667_012_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P																																																			0	YES	335.4164867	9.208959035	269.6069363		111.530886	7.96459121	1.490049596	282.8485863	440.0082717		569.5631994		14.21940484	178.9523971	3824.932873	3236.574027	78.97319491	34.47181134			583.8289545	636.4450099																			3000	$500 out of pocket limit	$500 out of pocket limit	$0/day days 1-30; $100/day days 31-100	$0 copay	$75 copay	20% coins	20% coins	$50 copay for ER and $15 for urgent care	$100 copay	0% coins;	20% coins; $2400 max	$0 copay	20% coins	"$0 copay for OP Rehab, $30 copay for OP Partial Hospitalization"	$10 copay	$30 copay	$30/day	$30 copay	20% coins; $2400 max	$30 copay for chiro; $10 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit 1 per year)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1 per year)	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	N/A											321.209662	55.58444676	28.29719571		75	0.2	0.2	49.87980496	100		106.7737557		26.79107594	34.90133535	10	29.75390406	29.96971457	24.371091			49.25825625	30																			NO	290.5625552	50.28104939	25.59731684		67.8441349	0.180917693	0.180917693	45.12069622	90.45884653		96.58630782		24.23489827	31.57134539	9.076048978	27.03779314	27.11025811	22.04580781			44.55845042	27.13765396																				8.1216	0.038586344	0.575101181	0	0.630559706	1.440935468	0.269576335	1.063527095	3.316886727	0	4.584333875	0	0.028717152	0.470813995	2.892939841	7.292484918	0.178415308	0.063329911	0	0	2.167876127	1.439302037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.575	0	3.599571872	8.1216	0.038586344	0.575101181	0	0.630559706	1.440935468	0.269576335	1.063527095	3.316886727	0	4.584333875	0	0.028717152	0.470813995	2.892939841	7.292484918	0.178415308	0.063329911	0	0	2.167876127	1.439302037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.575	NO																																																																																		0	0	0	8.1216	0.038586344	0.575101181	0	0.630559706	1.440935468	0.269576335	1.063527095	3.316886727	0	4.584333875	0	0.028717152	0.470813995	2.892939841	7.292484918	0.178415308	0.063329911	0	0	2.167876127	1.439302037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.575
H2667_803_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P																																																			0	NO	255.5122432	7.612465368	214.8408359		74.52897003	4.828049505	1.303223368	219.8813963	329.9492018		462.2028451		37.92239384	178.52769	3420.636753	2898.46439	84.83023389	34.2517949			603.9733153	515.1412739								0.253716137												$150/day days 1-90; $750 max per stay	$150/day days 1-90; $750 max per stay	$0/day days 1-5; $125/day days 6-100	$0 copay	$75 copay	20% coins	20% coins	$50 copay for ER and $15 for urgent care	$150 copay	0% coins;	20% coins; $2400 max	$0 copay	20% coins	"$0 copay for OP Rehab, $30 copay for OP Partial Hospitalization"	$15 copay	$30 copay	$30/day	$30 copay	20% coins; $2400 max	$30 copay for chiro; $15 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit 1 per year)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1 per year)	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	N/A											519.4100182	551.3102358	100.0704374		75	0.2	0.2	49.99048061	150		106.1723821		17.88564766	30.5624005	14.30891903	29.55639584	29.97707567	28.69415428			32.83730808	30								50											NO	519.4100182	551.3102358	100.0704374		75	0.2	0.2	49.99048061	150		106.1723821		17.88564766	30.5624005	14.30891903	29.55639584	29.97707567	28.69415428			32.83730808	30								50												11.0596	0.34973584	1.791601369	0	0.465806063	0.965609901	0.260644674	0.915998056	4.124365023	0	4.089431422	0	0.056522215	0.45468623	4.078801195	7.139013403	0.211913528	0.081902191	0	0	1.652738152	1.287853185	0	0	0	0	0	0	0	0.001057151	0	0	0	0	0	0	0	0	0	0	38.9873	0	0	11.0596	0.34973584	1.791601369	0	0.465806063	0.965609901	0.260644674	0.915998056	4.124365023	0	4.089431422	0	0.056522215	0.45468623	4.078801195	7.139013403	0.211913528	0.081902191	0	0	1.652738152	1.287853185	0	0	0	0	0	0	0	0.001057151	0	0	0	0	0	0	0	0	0	0	38.9873	NO																																																																																		0	0	0	11.0596	0.34973584	1.791601369	0	0.465806063	0.965609901	0.260644674	0.915998056	4.124365023	0	4.089431422	0	0.056522215	0.45468623	4.078801195	7.139013403	0.211913528	0.081902191	0	0	1.652738152	1.287853185	0	0	0	0	0	0	0	0.001057151	0	0	0	0	0	0	0	0	0	0	38.9873
H2667_804_0	2010	3	N/A																															A	A	D	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	S	O	P	P	P	P	P	P	P	P																																																			0	NO	295.2676785	6.378419697	531.1896689		181.5641001	825.8947318	343.3890676	279.7394759	303.1887118		860.6860381	112.2921155	0.715973171	232.1804623	4104.713047	6328.060164	179.2127011	907.8539813			818.4796202	1040.309018								536.3306403												$150/day days 1-90; maximum $750 per stay	$150/day days 1-90; maximum $750 per stay (covered under 1a)	$0 /day days 1-5; $125/day days 6-100	$0 copay	$75/copay	20% coins	20% coins	"$50 copay for ER, $15 for Urgent Care"	$150/copay	$0 copay	20% coins; maximum $2400	$0 copay	20% coins	$0 copay	$15 copay	$30 copay	$30/day	$30 copay	$0 copay	$30 copay for chiro; $15 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit 1 per year)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1 per year)	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	N/A											519.4100182	551.3102358	100.0704374		75	23.18197073	15.31726952	44.83471074	150		63.00206654	94.53823897	21.37900597	30.05195634	15	29.15413909	30	30			86.15795149	30								18.03904924											NO	519.4100182	551.3102358	100.0704374		75	23.18197073	15.31726952	44.83471074	150		63.00206654	94.53823897	21.37900597	30.05195634	15	29.15413909	30	30			86.15795149	30								18.03904924												12.7804	0.293040672	4.429698544	0	1.134775626	1.595488958	0.438315242	1.045169874	3.789858898	0	4.51874992	0.884658237	0.001275566	0.581456426	5.130891309	15.37409552	0.448031753	2.269634953	0	0	5.876543951	2.600772545	0	0	0	0	0	0	0	0.806241236	0	0	0	0	0	0	0	0	0	0	63.9991	0	0	12.7804	0.293040672	4.429698544	0	1.134775626	1.595488958	0.438315242	1.045169874	3.789858898	0	4.51874992	0.884658237	0.001275566	0.581456426	5.130891309	15.37409552	0.448031753	2.269634953	0	0	5.876543951	2.600772545	0	0	0	0	0	0	0	0.806241236	0	0	0	0	0	0	0	0	0	0	63.9991	NO																																																																																		0	0	0	12.7804	0.293040672	4.429698544	0	1.134775626	1.595488958	0.438315242	1.045169874	3.789858898	0	4.51874992	0.884658237	0.001275566	0.581456426	5.130891309	15.37409552	0.448031753	2.269634953	0	0	5.876543951	2.600772545	0	0	0	0	0	0	0	0.806241236	0	0	0	0	0	0	0	0	0	0	63.9991
H2667_807_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P																																																			0	NO	309.9471862	9.592982808	256.2142718		107.705181	10.30924473	3.594849463	277.8605891	450.7604511		641.321422		12.33860058	213.5647613	4227.135252	3710.247598	129.3389274	94.25341485			843.6119448	704.8905849								0.143493872												$150/day days 1-90; maximum $750 per stay	$150/day days 1-90; maximum $750 per stay (covered under 1a)	$0 /day days 1-5; $125/day days 6-100	$0 copay	$75/copay	20% coins	20% coins	"$50 copay for ER, $15 for Urgent Care"	$150/copay	$0 copay	20% coins; maximum $2400	$0 copay	20% coins	$0 copay	$15 copay	$30 copay	$30/day	$30 copay	20% coins; maximum $2400	$30 copay for chiro; $15 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit 1 per year)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1 per year)	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	N/A											519.4100182	551.3102358	100.0704374		75	0.2	0.2	49.99073533	150		119.1894748		33.67503788	30.78433835	14.35392482	29.85956244	29.98150827	29.41637019			49.91946971	30								50											NO	519.4100182	551.3102358	100.0704374		75	0.2	0.2	49.99073533	150		119.1894748		33.67503788	30.78433835	14.35392482	29.85956244	29.98150827	29.41637019			49.91946971	30								50												13.4158	0.440725801	2.136622855	0	0.673157382	2.061848946	0.718969893	1.15753793	5.634505639	0	6.369896955	0	0.034625237	0.547870823	5.056331802	9.232197486	0.32314801	0.231049445	0	0	3.509388411	1.762226462	0	0	0	0	0	0	0	0.000597891	0	0	0	0	0	0	0	0	0	0	53.3065	0	0	13.4158	0.440725801	2.136622855	0	0.673157382	2.061848946	0.718969893	1.15753793	5.634505639	0	6.369896955	0	0.034625237	0.547870823	5.056331802	9.232197486	0.32314801	0.231049445	0	0	3.509388411	1.762226462	0	0	0	0	0	0	0	0.000597891	0	0	0	0	0	0	0	0	0	0	53.3065	NO																																																																																		0	0	0	13.4158	0.440725801	2.136622855	0	0.673157382	2.061848946	0.718969893	1.15753793	5.634505639	0	6.369896955	0	0.034625237	0.547870823	5.056331802	9.232197486	0.32314801	0.231049445	0	0	3.509388411	1.762226462	0	0	0	0	0	0	0	0.000597891	0	0	0	0	0	0	0	0	0	0	53.3065
H2667_808_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	V	P	P	P	P	P																																																			0	NO	258.426282	8.039192895	165.2387369		91.77368645	6.911515416	1.22420573	225.0419516	361.7130873		523.0531425		15.13108391	170.1343993	3832.795733	3202.742175	100.7859405	33.63164028			730.3030748	633.1101334																				$150/day days 1-90; maximum $750 per stay	$150/day days 1-90; maximum $750 per stay (covered under 1a)	$0 /day days 1-5; $125/day days 6-100	$0 copay	$75/copay	20% coins	20% coins	"$50 copay for ER, $15 for Urgent Care"	$150/copay	$0 copay	20% coins; maximum $2400	$0 copay	20% coins	$0 copay	$15 copay	$30 copay	$30/day	$30 copay	20% coins; maximum $2400	$30 copay for chiro; $15 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit 1 per year)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1 per year)	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	N/A											519.4100182	551.3102358	100.0704374		75	0.2	0.2	49.98597194	150		107.1198391		29.67875721	30.97435423	14.22981392	29.57314698	29.9708988	27.99418605			55.81171379	30																			NO	519.4100182	551.3102358	100.0704374		75	0.2	0.2	49.98597194	150		107.1198391		29.67875721	30.97435423	14.22981392	29.57314698	29.9708988	27.99418605			55.81171379	30																				11.1858	0.369340778	1.377959391	0	0.57358554	1.382303083	0.244841146	0.937411723	4.521413591	0	4.669114037	0	0.037422647	0.439150263	4.544997505	7.892930424	0.251720435	0.078457533	0	0	3.396622182	1.582775334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4858	0	0	11.1858	0.369340778	1.377959391	0	0.57358554	1.382303083	0.244841146	0.937411723	4.521413591	0	4.669114037	0	0.037422647	0.439150263	4.544997505	7.892930424	0.251720435	0.078457533	0	0	3.396622182	1.582775334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4858	NO																																																																																		0	0	0	11.1858	0.369340778	1.377959391	0	0.57358554	1.382303083	0.244841146	0.937411723	4.521413591	0	4.669114037	0	0.037422647	0.439150263	4.544997505	7.892930424	0.251720435	0.078457533	0	0	3.396622182	1.582775334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.4858
H2667_809_0	2010	3	N/A																															A	A	D	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	S	V	P	P	P	P	P	P	P	P																																																			0	NO	313.7441209	6.777550767	564.4289838		192.9255152	877.5752833	364.8767169	297.2442376	322.1608147		914.5436636	119.3188203	0.760775356	247.0601455	4172.156589	7038.900856	190.4269769	964.6631516			869.6961694	1105.406593								533.3913292												$150/day days 1-90; maximum $750 per stay	$150/day days 1-90; maximum $750 per stay (covered under 1a)	$0 /day days 1-5; $125/day days 6-100	$0 copay	$75/copay	20% coins	20% coins	"$50 copay for ER, $15 for Urgent Care"	$150/copay	$0 copay	20% coins; maximum $2400	20% coinsurance	20% coins	"$0 copay for OP Rehab, 20% Coinsurance for OPPartial Hospitalization"	$15 copay	$30 copay	$30/day	$30 copay	$0 copay	$30 copay for chiro; $15 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit 1 per year)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1 per year)	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	N/A											519.4100182	551.3102358	100.0704374		75	23.05492405	15.23332463	44.83471074	150		62.65678946	94.02013078	21.26184028	30.12065677	15	28.9340286	30	30			85.6857707	30								18.03904924											NO	519.4100182	551.3102358	100.0704374		75	23.05492405	15.23332463	44.83471074	150		62.65678946	94.02013078	21.26184028	30.12065677	15	28.9340286	30	30			85.6857707	30								18.03904924												13.5802	0.311377759	4.706887943	0	1.20578447	1.686035959	0.463190456	1.110571618	4.027010184	0	4.775197482	0.934864257	0.001347957	0.620134487	5.215195737	16.97197989	0.476067442	2.411657879	0	0	6.21004888	2.763516481	0	0	0	0	0	0	0	0.801822704	0	0	0	0	0	0	0	0	0	0	68.2728	0	0	13.5802	0.311377759	4.706887943	0	1.20578447	1.686035959	0.463190456	1.110571618	4.027010184	0	4.775197482	0.934864257	0.001347957	0.620134487	5.215195737	16.97197989	0.476067442	2.411657879	0	0	6.21004888	2.763516481	0	0	0	0	0	0	0	0.801822704	0	0	0	0	0	0	0	0	0	0	68.2728	NO																																																																																		0	0	0	13.5802	0.311377759	4.706887943	0	1.20578447	1.686035959	0.463190456	1.110571618	4.027010184	0	4.775197482	0.934864257	0.001347957	0.620134487	5.215195737	16.97197989	0.476067442	2.411657879	0	0	6.21004888	2.763516481	0	0	0	0	0	0	0	0.801822704	0	0	0	0	0	0	0	0	0	0	68.2728
H2667_810_0	2010	2	N/A																															A	A	D	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	P	S	O	P	P	P	P	P	P	P	P																																																			0	NO	296.5012349	7.270882779	678.2353023		161.6868037	1056.100755	413.2764148	277.6213043	355.9402315		828.0680194	103.3078495	14.07172085	150.0320097	4064.965965	6500.492893	196.0519367	727.8142348			983.3322957	250.9001061								544.1636546												$150/day days 1-90; maximum $750 per stay	$150/day days 1-90; maximum $750 per stay (covered under 1a)	$0 /day days 1-5; $125/day days 6-100	$0 copay	$75/copay	20% coins	20% coins	"$50 copay for ER, $15 for Urgent Care"	$150/copay	$0 copay	20% coins; maximum $2400	$0 copay	20% coins	$0 copay	$15 copay	$30 copay	$30/day	$30 copay	20% coins; maximum $2400	$30 copay for chiro; $15 copay for podiatry	20% coins	20% coins	N/A	N/A	$0 copay (limit 1 per year)	"$150 limit every 2 years (1 contact pair, 1 eyeglasses pair every 2 years)"	$0 copay (limit 1 per year)	N/A	Fitness benefit limited to $200/year; $10 copay for nutritional training and smoking cessation; $0 copay others	N/A											519.4100182	551.3102358	100.0704374		75	24.59973296	18.28894742	46.05039812	150		67.24970417	67.99131589	18.03289395	30.12473186	15	28.74368227	30	30			104.8612742	30								18.97962349											NO	519.4100182	551.3102358	100.0704374		75	24.59973296	18.28894742	46.05039812	150		67.24970417	67.99131589	18.03289395	30.12473186	15	28.74368227	30	30			104.8612742	30								18.97962349												12.8338	0.334042675	5.655941949	0	1.010542523	2.164983046	0.629865885	1.065380966	4.449252894	0	4.640610778	0.585336386	0.021146154	0.376639505	5.081207457	15.57067519	0.490129842	1.819535587	0	0	8.592789794	0.627250265	0	0	0	0	0	0	0	0.86066844	0	0	0	0	0	0	0	0	0	0	66.8098	0	0	12.8338	0.334042675	5.655941949	0	1.010542523	2.164983046	0.629865885	1.065380966	4.449252894	0	4.640610778	0.585336386	0.021146154	0.376639505	5.081207457	15.57067519	0.490129842	1.819535587	0	0	8.592789794	0.627250265	0	0	0	0	0	0	0	0.86066844	0	0	0	0	0	0	0	0	0	0	66.8098	NO																																																																																		0	0	0	12.8338	0.334042675	5.655941949	0	1.010542523	2.164983046	0.629865885	1.065380966	4.449252894	0	4.640610778	0.585336386	0.021146154	0.376639505	5.081207457	15.57067519	0.490129842	1.819535587	0	0	8.592789794	0.627250265	0	0	0	0	0	0	0	0.86066844	0	0	0	0	0	0	0	0	0	0	66.8098
H2672_001_0	2010	9	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	YES	1940.601434	38.03976413	1471.316907	0	325.4813023	12.51545817	3.394204832	583.8513267	595.4013035	513.781709	24.75300281	0	0	705.8960814	6042.794785	12954.64487	169.4252194	803.7262854	3690.861277	874.9092476	20.20658919	0	0	0	478.3885074	0	0.180933626	0	0	490.8729276											5000	1a $250 days 1-7	1b $195 days 1-10	2 $200 days 5-18	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $250, 9b $250"	8a $10	"8b 20% Ther., $400 Diag."	5 $0	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, 14b $0"	"7a $20, 14b $0, 14c $10, 14d - 14g $10, 14i - 14j $10"	"17a $40, 18a $40, 7b $40,7d $40,7f $40, 14d - 14g $10, 14i - 14j $10"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b $400, 14h $10"	7g $40	15 20%				17a $20	17b $0	18a $20	18b $0	14a $0	"14c $20,7f $20"											197.1152007	179.4801027	88.5335074	0	144.6223094	0.2	0.2	49.94394988	250	10	0.378562883	0	0	2.694313403	12.2027175	15.71501467	40	40	34.4071705	0.764669802	0.230512287	0	0	0	27.69288956	0	20	0	0	16.66420936											NO	150.3918882	136.9369356	67.54791767	0	110.3416789	0.152592888	0.152592888	38.10545763	190.7411094	7.629644375	0.288830017	0	0	2.05566531	9.310239497	11.98999733	30.5185775	30.5185775	26.25144748	0.583415865	0.175872677	0	0	0	21.12868991	0	15.25928875	0	0	12.71419912												24.3209	0.434087394	8.282032776	0	2.992846112	1.909769901	0.517931516	1.853993499	9.463958763	0.326664311	7.149410217	0	0	0.120923841	4.688322223	12.94384645	0.430884724	2.044048578	8.074204249	0.042536328	3.553786933	0	0	0	0.842310202	0	0.000230077	0	0	0.520088012	0	0	0	0	0	0	0	0	0	0	90.5128	0	28.12024262	24.3209	0.434087394	8.282032776	0	2.992846112	1.909769901	0.517931516	1.853993499	9.463958763	0.326664311	7.149410217	0	0	0.120923841	4.688322223	12.94384645	0.430884724	2.044048578	8.074204249	0.042536328	3.553786933	0	0	0	0.842310202	0	0.000230077	0	0	0.520088012	0	0	0	0	0	0	0	0	0	0	90.5128	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.3209	0.434087394	8.282032776	0	2.992846112	1.909769901	0.517931516	1.853993499	9.463958763	0.326664311	7.149410217	0	0	0.120923841	4.688322223	12.94384645	0.430884724	2.044048578	8.074204249	0.042536328	3.553786933	0	0	0	0.842310202	0	0.000230077	0	0	0.520088012	0	0	0	0	0	0	0	0	0	0	90.5128
H2672_003_0	2010	12	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	YES	1116.793978	30.63020033	722.7783601	0	173.8781857	8.180052057	2.41365423	466.1248463	455.8739066	1843.925553	15.1331438	0	0	524.5025582	4558.276171	8930.504961	173.7379719	642.3303263	2580.103297	618.0267916	12.27114685	0	0	0	0	0	0	0	0	326.153211											7500	1a $250 days 1-7	1b $195 days 1-10	2 $200 days 3-11	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $300, 9b $300"	8a $10	"8b 20% Ther., $300 Diag."	5 $0	12 $0	"3 $40, 9d $40, 13a $0, 14b$0"	"7a $25, 14b $0, 14c - 14g $10, 14i - 14j $10"	"17a $40, 18a $40, 7b $40, 7d $40, 7f $40, 14d - 14g $10, 14i - 14j $10"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $300, 14h $10"	7g $40	15 20%								14a $0	"14c $25, 7f $25"											197.0986124	179.4801027	71.38816362	0	144.5896206	0.2	0.2	49.80291969	300	10	0.33707664	0	0	3.077117402	15.58700409	17.5461752	40	40	33.15083165	0.692710978	0.231737632	0	0	0	0	0	0	0	0	19.74678737											NO	181.3784313	165.1651378	65.69439009	0	133.0574489	0.18404841	0.18404841	45.83074095	276.0726152	9.202420508	0.310192099	0	0	2.831692828	14.34381661	16.14672825	36.80968203	36.80968203	30.50678931	0.637461771	0.213254714	0	0	0	0	0	0	0	0	18.1718241												16.8802	0.421586771	3.956873628	0	1.927982318	1.505525576	0.444229224	1.780237257	10.48785847	1.414048193	4.694181637	0	0	0.123769178	5.448589787	12.01653639	0.532936625	1.970331256	6.559222305	0.032830704	2.616879907	0	0	0	0	0	0	0	0	0.493899898	0	0	0	0	0	0	0	0	0	0	73.3077	0	6.353625043	16.8802	0.421586771	3.956873628	0	1.927982318	1.505525576	0.444229224	1.780237257	10.48785847	1.414048193	4.694181637	0	0	0.123769178	5.448589787	12.01653639	0.532936625	1.970331256	6.559222305	0.032830704	2.616879907	0	0	0	0	0	0	0	0	0.493899898	0	0	0	0	0	0	0	0	0	0	73.3077	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.8802	0.421586771	3.956873628	0	1.927982318	1.505525576	0.444229224	1.780237257	10.48785847	1.414048193	4.694181637	0	0	0.123769178	5.448589787	12.01653639	0.532936625	1.970331256	6.559222305	0.032830704	2.616879907	0	0	0	0	0	0	0	0	0.493899898	0	0	0	0	0	0	0	0	0	0	73.3077
H2672_008_0	2010	10	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	YES	1520.987663	25.25947923	868.7659874	0	212.2608221	10.54341185	3.135275234	611.3026665	499.0948621	1399.705513	20.5678576	0	0	611.4826802	5909.920611	11031.24242	141.3640529	584.5604314	3187.42432	748.131209	33.08088169	0	0	0	0	0	0	0	0	346.6177037											4250	1a $250 days 1-7	1b $250 days 1-7	2 $150 days 6-23	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $200, 9b $200"	8a $10	"8b 20% Ther., $400 Diag."	5 $0	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, $14b $0"	"7a $20, 14b $0, 14c $20, 14d - 14g $10, 14i - 14j $10"	"17a $40, 18a $40, 7b $40, 7d $40, 7f $40, 14d - 14g $10, 14i - 14j $10"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $400, 14h $10"	7g $40	15 20%								14a $0	"14c $20, 7f $20"											197.106096	204.7496791	73.50685379	0	145.0427469	0.2	0.2	49.5567596	200	10	0.312134455	0	0	3.062709502	12.47662928	16.72492479	40	40	38.8311827	0.381617004	0.217583078	0	0	0	0	0	0	0	0	15.81650969											NO	152.4618856	158.3742095	56.85767085	0	112.1908004	0.154700325	0.154700325	38.33223408	154.700325	7.73501625	0.241436508	0	0	2.369010777	9.65069302	12.9367565	30.940065	30.940065	30.03598292	0.295181373	0.168300864	0	0	0	0	0	0	0	0	12.23409594												19.3244	0.333370838	4.116334213	0	1.98447596	1.63106924	0.485028098	1.952716409	6.434178115	0.902228741	4.965831724	0	0	0.120717422	4.752902465	11.89237476	0.364484415	1.507194812	7.978118536	0.018402866	5.567540984	0	0	0	0	0	0	0	0	0.35337952	0	0	0	0	0	0	0	0	0	0	74.6847	0	21.86934181	19.3244	0.333370838	4.116334213	0	1.98447596	1.63106924	0.485028098	1.952716409	6.434178115	0.902228741	4.965831724	0	0	0.120717422	4.752902465	11.89237476	0.364484415	1.507194812	7.978118536	0.018402866	5.567540984	0	0	0	0	0	0	0	0	0.35337952	0	0	0	0	0	0	0	0	0	0	74.6847	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.3244	0.333370838	4.116334213	0	1.98447596	1.63106924	0.485028098	1.952716409	6.434178115	0.902228741	4.965831724	0	0	0.120717422	4.752902465	11.89237476	0.364484415	1.507194812	7.978118536	0.018402866	5.567540984	0	0	0	0	0	0	0	0	0.35337952	0	0	0	0	0	0	0	0	0	0	74.6847
H2672_801_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	306.7323126	6.25800764	45.65105874	0	8.588374365	12.8529208	4.13236717	16.09984686	70.22400404	4.078463766	23.89622111	0.363048806	0.10175409	12.97612985	38.13702196	131.1016591	1.406540013	7.207972319	37.50320141	2.625091946	31.93527494	0	0	0	0	0	0	0	0	0												FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												26.3864	0.53833977	7.737674439	0	2.001091227	2.994730546	0.962841551	3.751264318	16.36219294	0.950282057	5.567819519	0.084590372	0.023708703	3.023438256	8.885926116	30.54668656	0.327723823	1.67945755	8.738245927	0.611646423	7.440919062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.615	0	0	26.3864	0.53833977	7.737674439	0	2.001091227	2.994730546	0.962841551	3.751264318	16.36219294	0.950282057	5.567819519	0.084590372	0.023708703	3.023438256	8.885926116	30.54668656	0.327723823	1.67945755	8.738245927	0.611646423	7.440919062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.615	NO	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.3864	0.53833977	7.737674439	0	2.001091227	2.994730546	0.962841551	3.751264318	16.36219294	0.950282057	5.567819519	0.084590372	0.023708703	3.023438256	8.885926116	30.54668656	0.327723823	1.67945755	8.738245927	0.611646423	7.440919062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.615
H2672_802_0	2010	2	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	305.64281	5.379248716	47.59850323	0	11.11450326	16.40816456	3.315220938	17.90887611	55.51973706	7.619563291	21.67390057	0.270775482	0.219441299	8.271414977	44.21268687	122.074013	2.084592328	6.152518416	35.67739314	2.66789266	28.11909441	0	0	0	0	0	0	0	0	0												FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												26.2927	0.462745283	8.067758601	0	2.589679259	3.823102343	0.772446478	4.172768133	12.93609873	1.775358247	5.050018834	0.063090687	0.051129823	1.92723969	10.30155604	28.44324502	0.485710013	1.433536791	8.312832602	0.62161899	6.551748998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.1343	0	0	26.2927	0.462745283	8.067758601	0	2.589679259	3.823102343	0.772446478	4.172768133	12.93609873	1.775358247	5.050018834	0.063090687	0.051129823	1.92723969	10.30155604	28.44324502	0.485710013	1.433536791	8.312832602	0.62161899	6.551748998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.1343	NO	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.2927	0.462745283	8.067758601	0	2.589679259	3.823102343	0.772446478	4.172768133	12.93609873	1.775358247	5.050018834	0.063090687	0.051129823	1.92723969	10.30155604	28.44324502	0.485710013	1.433536791	8.312832602	0.62161899	6.551748998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.1343
H2672_803_0	2010	2	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	265.0612665	6.316175782	36.96707844	0	9.056435994	14.04270477	3.505618115	17.79769886	61.28103116	12.5374422	24.33157766	0.372053577	0.377002477	9.617369683	38.7881555	114.9816522	2.290072417	5.931869705	35.75556896	2.742632044	24.09141962	0	0	0	0	0	0	0	0	0												FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												22.8017	0.543343635	6.265774022	0	2.110149586	3.271950212	0.816809021	4.146863834	14.27848026	2.921224033	5.669257594	0.086688484	0.087841577	2.240847136	9.037640232	26.79072496	0.533586873	1.382125641	8.331047567	0.639033266	5.613300772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5684	0	0	22.8017	0.543343635	6.265774022	0	2.110149586	3.271950212	0.816809021	4.146863834	14.27848026	2.921224033	5.669257594	0.086688484	0.087841577	2.240847136	9.037640232	26.79072496	0.533586873	1.382125641	8.331047567	0.639033266	5.613300772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5684	NO	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.8017	0.543343635	6.265774022	0	2.110149586	3.271950212	0.816809021	4.146863834	14.27848026	2.921224033	5.669257594	0.086688484	0.087841577	2.240847136	9.037640232	26.79072496	0.533586873	1.382125641	8.331047567	0.639033266	5.613300772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5684
H2701_001_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	253.8363199	1.034342185	1487.330839		42.30892112	14.41816099	4.121005876	163.2487335	161.6737756	2746.454847	1068.514537	89.95126694	1.330020388	570.2188846	2897.562792	4310.762004	318.1372075	620.7813688		1659.548563	12.42789752			500	158		217															$600 per admission	"$600 per admission, 190 day limit"	"$0 per day for days 1-20, $75 per day for days 21-100"	No cost sharing	$100 per segment	20% Coinsurance	"Prosthetic Medical Supplies: 20% coinsurance, Diabetes Monitoring Supplies: 10% coinsurance"	ER - $50 per Visit; UC - $30 per Visit	$90 Per visit	OP diag Procs/Tests/lab Services $20 copay	"$50 Copay for CT/MRI/PET, $50 for Therapeutic Radiology, $20 Copay for X-ray services"	OP observation $20 Copay	OP Dialysis: 20% coinsurance	"OP Partial Hospitalization: $20 copay OP PT/OT/ST $20 copay, Cardiac Rehab: $20 copay"	"Primary Care: $10 copay, Immunizations: $0 copay, Physical Exam: $0 copay, Prostate Screening, Colorectal Screening, Bone Mass meas, Mammography: $0 copay"	"Specialist: $20 copay, Immunizations: $0 copay, Physical Exam: $0 copay, Prostate Screening, Colorectal Screening, Bone Mass meas, Mammography: $0 copay"	"$10 copay for PCP,$20 Copay for specialist"	"$10 copay for PCP,$20 Copay for specialist"	No cost sharing for test performing in PCP or specialist office	"$10 copay for PCP,$20 Copay for specialist"	10% Coinsurance	Medicare covered hearing exam: $20 copay	not covered	$200 annual allowance	$20 Copay	$100 annual allowance	$20 Copay	not covered	No cost sharing												600	600	31.66902157		100	0.2	0.189990952	49.06942726	90	15	23.53259119	20	56.64213527	15.04549968	7.5	15.82477286	18.32749606	14.83050701		12.0185669	0.1			15	15		15														YES	582.4561859	582.4561859	30.74302919		97.94106868	0.2	0.189990952	49.06942726	87.64103435	15	22.89025106	19.4152062	55.17290951	14.7979624	7.5	15.82477286	18.20493261	14.83050701		12.0185669	0.1			15	15		15															12.3207	0.050204917	3.810421283	0	0.345315079	2.883632197	0.782953831	0.667543488	1.18077141	3.433068558	2.038213835	0.1455352	0.006115091	0.703173134	1.810976745	5.684735797	0.482638869	0.767208537	0	1.662116286	1.242789752	0	0	0.625	0.1975	0	0.27125	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1119	0	0.60318365	12.3207	0.050204917	3.810421283	0	0.345315079	2.883632197	0.782953831	0.667543488	1.18077141	3.433068558	2.038213835	0.1455352	0.006115091	0.703173134	1.810976745	5.684735797	0.482638869	0.767208537	0	1.662116286	1.242789752	0	0	0.625	0.1975	0	0.27125	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1119	YES	$800 per admission	$800 per admission	$100 per day	$30 copay	$100 per segment	50% Coinsurance	50% Coinsurance	ER - $50 per Visit; UC - $30 per Visit ???	$150 Per Visit	$30 Copay	"$150 Copay for CT/MRI/PET, $30 Copay for other Radiology"	$30 Copay	20% Coinsurance	$30 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	not covered	$200 annual limit	$30 copay	$100 annual limit	$30 Copay	not covered	$30 Copay												3400	1.3483	0.0023	0.1335		0.5791	0.3327	0.2382	0.0477	0.0564	0.3113	0.1983	0.0039	0.0071	0.0173	1.2517	2.75	0.3157	0.2207		1.8664	0.4465																				10.1272	0	0.049351412	13.669	0.052505257	3.943932446	0	0.92436719	3.216369539	1.021192424	0.715238589	1.237130875	3.74441824	2.236467054	0.149436552	0.013250387	0.720508965	3.062670093	8.434783563	0.798353865	0.987915137	0	3.528531866	1.689247497	0	0	0.625	0.1975	0	0.27125	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2391
H2701_003_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	217.4542076	6.968881739	807.8684998		88.12062006	5.932849995	10.62067084	207.1320643	203.8170123	4266.729803	969.3495009	71.20808543	0.621075686	474.1095666	2246.274504	3379.51802	98.23036979	620.0879191		2941.405446	13.49093437				158		217															$750 per admission	$750 per admission up to 190 days in lifetime	"$0 per day for days 1-20, $125 per day for days 21-100"	No Cost Sharing	$100 per segment	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $45 per Visit	$250 copay per visit	OP diag Procs/Tests/lab Services $40 copay	"$100 copay for CT/MRI/PET, $40 copay for others"	$40 copay	20% Coinsurance	"OP Partial Hospitalization: $40 copay OP PT/OT/ST $40 copay, Cardiac Rehab: $40 copay"	"$20 copay for Primary physician services, no copay for immunizations, physical exams, pap smears, pelvic exams, prostate cancer screening, colorectal  screening, bone mass measurement and mammography screening.  $40 copay for diabetes monitoring and nutrition therapy for diabetes or renal disease."	$40 copay for specialist physician services	$40 copay	$40 copay	No cost sharing for test performing in PCP or specialist office	"$20 copay for PCP, $40 copay for specialist"	20% Coinsurance	Medicare covered hearing exam: $40 copay	not covered	not covered	$40 copay for routine vision	not covered	$40 copay for Hearing routine	not covered	No cost sharing												750	750	52.78170262		100	0.2	0.2	49.12158354	250	22.53887743	45.90711353	40	68.15034811	33.51334628	15	31.12602659	39.56254763	30		19.68601476	0.2				26		30														YES	722.6623896	722.6623896	50.85780178		98.83539602	0.2	0.2	49.12158354	240.8874632	22.53887743	44.23379248	38.54199411	65.66625789	32.29177988	15	31.12602659	39.35482706	30		19.68601476	0.2				26		30															13.0955	0.419679061	3.423868003	0	0.725786365	1.186569999	2.124134169	0.847887917	4.091413588	8.013941673	3.573167055	0.228708467	0.003398643	1.275820147	2.80784313	8.76591398	0.322153268	1.550219798	0	4.825379252	2.698186873	0	0	0	0.342333333	0	0.5425	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8644	0	0.998026988	13.0955	0.419679061	3.423868003	0	0.725786365	1.186569999	2.124134169	0.847887917	4.091413588	8.013941673	3.573167055	0.228708467	0.003398643	1.275820147	2.80784313	8.76591398	0.322153268	1.550219798	0	4.825379252	2.698186873	0	0	0	0.342333333	0	0.5425	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8644	YES	$1000 per admission	$1000 per admission	$130 per day	$45 Copay	$100 per segment	50% Coinsurance	50% Coinsurance	ER - $50 per Visit; UC - $45 per Visit	$450 copay per visit	$45 Copay	"$200 copay for CT/MRI/PET, $45 copay for others"	$45 Copay	20% Coinsurance	$45 Copay	$45 Copay	$45 Copay	$45 Copay	$45 Copay	No cost sharing	$45 Copay	30% Coinsurance	No cost sharing	not covered	not covered	$45 copay for routine vision	not covered	$45 copay for Hearing routine	not covered	No cost sharing												5000	0.9873	0.0137	0.2071		0.1863	0.0781	0.2899	0.0578	0.2798	0.6881	0.2648	0.0081	0.0001	0.0538	0.7999	1.0815	0.1182	0.0768		0.7034	0.1539																				6.0484	0	0.069005019	14.0828	0.433352313	3.630983769	0	0.912132481	1.264691747	2.41403305	0.905700024	4.371177922	8.70203051	3.837982037	0.236828663	0.003515435	1.329575857	3.607741704	9.847367529	0.440364398	1.62698334	0	5.528738691	2.852052439	0	0	0	0.342333333	0	0.5425	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9128
H2701_805_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	NO	1250.55495	60.97488629	1128.285087		153.4987863	8.054964458	18.00625376	311.6718085	286.9944923	6781.239187	1133.838259	111.6093254	3.647834753	4452.974069	5849.589042	9169.002605	247.3401179	597.7211366	3357.244313	8336.352917	23.6965238	28.30305717																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	not covered	not covered	not covered	not covered	Same as Original Medicare coverage	not covered	Same as Original Medicare coverage												193.3063992	60.21691995	60.51819509		151.079783	0.233	0.233	132.7366104	352.8998713	4.697616656	50.02631478	275.0983139	47.33239928	30.41550516	12.11111239	14.85599138	19.57067412	23.55511045	14.83201462	17.06065961	0.233	79.08728078																			NO	193.3063992	60.21691995	60.51819509		151.079783	0.233	0.233	132.7366104	352.8998713	4.697616656	50.02631478	275.0983139	47.33239928	30.41550516	12.11111239	14.85599138	19.57067412	23.55511045	14.83201462	17.06065961	0.233	79.08728078																				20.145	0.305976654	5.690148087	0	1.932546943	1.876806719	4.195457127	3.447521619	8.440026616	2.654638513	4.726812472	2.558628102	0.014388398	11.28662131	5.903752525	11.35121864	0.403384404	1.173282283	4.149558061	11.85197329	5.521290045	0.186534319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8156	0	0	20.145	0.305976654	5.690148087	0	1.932546943	1.876806719	4.195457127	3.447521619	8.440026616	2.654638513	4.726812472	2.558628102	0.014388398	11.28662131	5.903752525	11.35121864	0.403384404	1.173282283	4.149558061	11.85197329	5.521290045	0.186534319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8156	NO	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	not covered	not covered	not covered	not covered	Same as Original Medicare coverage	not covered	Same as Original Medicare coverage																																																					0	0	0	20.145	0.305976654	5.690148087	0	1.932546943	1.876806719	4.195457127	3.447521619	8.440026616	2.654638513	4.726812472	2.558628102	0.014388398	11.28662131	5.903752525	11.35121864	0.403384404	1.173282283	4.149558061	11.85197329	5.521290045	0.186534319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8156
H2701_806_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	NO	1250.594611	60.9768201	1128.320871		153.5036544	8.055475389	18.00739591	311.6816931	287.0035943	6781.454253	1133.874219	111.612865	3.647950443	4453.115294	5849.774561	9169.293398	247.3479623	597.7400932	3357.350787	8336.617302	23.69802688	28.3039548																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	not covered	not covered	not covered	not covered	Same as Original Medicare coverage	not covered	Same as Original Medicare coverage												193.284388	60.21882971	60.52011441		151.0845745	0.233	0.233	132.7408201	352.9110635	4.69776564	50.02790135	275.1070386	47.33390041	30.41646978	12.11149649	14.85646253	19.5712948	23.5558575	14.83248501	17.06120068	0.233	79.08978901																			NO	193.284388	60.21882971	60.52011441		151.0845745	0.233	0.233	132.7408201	352.9110635	4.69776564	50.02790135	275.1070386	47.33390041	30.41646978	12.11149649	14.85646253	19.5712948	23.5558575	14.83248501	17.06120068	0.233	79.08978901																				20.1434	0.305996062	5.690509016	0	1.932669526	1.876925766	4.195723247	3.447740298	8.440561972	2.654806898	4.727112296	2.558790397	0.01438931	11.28733723	5.904127003	11.35193865	0.403409991	1.173356705	4.14982127	11.85272507	5.521640264	0.186546151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8195	0	0	20.1434	0.305996062	5.690509016	0	1.932669526	1.876925766	4.195723247	3.447740298	8.440561972	2.654806898	4.727112296	2.558790397	0.01438931	11.28733723	5.904127003	11.35193865	0.403409991	1.173356705	4.14982127	11.85272507	5.521640264	0.186546151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8195	NO	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	not covered	not covered	not covered	not covered	Same as Original Medicare coverage	not covered	Same as Original Medicare coverage																																																					0	0	0	20.1434	0.305996062	5.690509016	0	1.932669526	1.876925766	4.195723247	3.447740298	8.440561972	2.654806898	4.727112296	2.558790397	0.01438931	11.28733723	5.904127003	11.35193865	0.403409991	1.173356705	4.14982127	11.85272507	5.521640264	0.186546151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8195
H2701_807_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	NO	1250.554977	60.97488758	1128.285111		153.4987895	8.0549648	18.00625453	311.6718151	286.9944984	6781.239331	1133.838283	111.6093277	3.64783483	4452.974163	5849.589166	9169.0028	247.3401232	597.7211492	3357.244384	8336.353093	23.6965248	28.30305777																				Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	not covered	not covered	not covered	not covered	Same as Original Medicare coverage	not covered	Same as Original Medicare coverage												193.3040806	60.21692122	60.51819637		151.0797862	0.233	0.233	132.7366132	352.8998788	4.697616755	50.02631584	275.0983197	47.33240028	30.41550581	12.11111264	14.85599169	19.57067454	23.55511095	14.83201493	17.06065997	0.233	79.08728245																			NO	193.3040806	60.21692122	60.51819637		151.0797862	0.233	0.233	132.7366132	352.8998788	4.697616755	50.02631584	275.0983197	47.33240028	30.41550581	12.11111264	14.85599169	19.57067454	23.55511095	14.83201493	17.06065997	0.233	79.08728245																				20.1448	0.305976667	5.690148328	0	1.932547025	1.876806798	4.195457305	3.447521765	8.440026974	2.654638625	4.726812672	2.55862821	0.014388398	11.28662179	5.903752775	11.35121912	0.403384421	1.173282332	4.149558237	11.85197379	5.521290279	0.186534327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8154	0	0	20.1448	0.305976667	5.690148328	0	1.932547025	1.876806798	4.195457305	3.447521765	8.440026974	2.654638625	4.726812672	2.55862821	0.014388398	11.28662179	5.903752775	11.35121912	0.403384421	1.173282332	4.149558237	11.85197379	5.521290279	0.186534327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8154	NO	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	Same as Original Medicare coverage	not covered	not covered	not covered	not covered	Same as Original Medicare coverage	not covered	Same as Original Medicare coverage																																																					0	0	0	20.1448	0.305976667	5.690148328	0	1.932547025	1.876806798	4.195457305	3.447521765	8.440026974	2.654638625	4.726812672	2.55862821	0.014388398	11.28662179	5.903752775	11.35121912	0.403384421	1.173282332	4.149558237	11.85197379	5.521290279	0.186534327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.8154
H2762_012_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1600.507723	41.33450877	1481.513525	2396.579226	279.449892	14.23111154	8.763441589	280.9190403	357.3212035	6.854221858	20.06574314	1.00049713	40.01988521	119.4014883	5301.317992	8367.902362	182.038036	899.6268642	42.14025016	0	9.845785646	0	0	13.81887852	413.6186418	0	177.2651322	0	0	43.87312022											3600	"$250 Copay/Day, up to 6 days; Unlimited"	"$250 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$40 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	$40 Copay	$15 Copay	$40 Copay	$15 Copay Group Session; $40 for Indiv.	$40 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$40/Exam	0	$40/Exam			$15/Routine Physical											152.8181818	142.7096774	28.10077519	0	150	0.15	0.15	49.56090468	250	0.15	0.15	40	40	40	15	40	27.5	40	0.15	0	0.2	0	0	0.25	40	0	40	0	0	15											NO	111.9939503	104.5858571	20.59386379	0	109.9286247	0.109928625	0.109928625	36.32108059	183.2143744	0.109928625	0.109928625	29.31429991	29.31429991	29.31429991	10.99286247	29.31429991	20.15358119	29.31429991	0.109928625	0	0.1465715	0	0	0.25	29.31429991	0	29.31429991	0	0	10.99286247												14.9373	0.360250419	2.542507311	0	2.559961857	1.564406519	0.963353081	0.850273592	5.45553173	0.753475182	2.205799546	0.002444073	0.09776291	0.29168092	4.856388298	20.44159995	0.305726528	2.197660975	4.632419742	0	1.443111566	0	0	3.454719629	1.010411743	0	0.433033604	0	0	0.040190931	0	0	0	0	0	0	0	0	0	0	71.4	0	24.76752395	14.9373	0.360250419	2.542507311	0	2.559961857	1.564406519	0.963353081	0.850273592	5.45553173	0.753475182	2.205799546	0.002444073	0.09776291	0.29168092	4.856388298	20.44159995	0.305726528	2.197660975	4.632419742	0	1.443111566	0	0	3.454719629	1.010411743	0	0.433033604	0	0	0.040190931	0	0	0	0	0	0	0	0	0	0	71.4	YES																																									3600																																									0	0	0	14.9373	0.360250419	2.542507311	0	2.559961857	1.564406519	0.963353081	0.850273592	5.45553173	0.753475182	2.205799546	0.002444073	0.09776291	0.29168092	4.856388298	20.44159995	0.305726528	2.197660975	4.632419742	0	1.443111566	0	0	3.454719629	1.010411743	0	0.433033604	0	0	0.040190931	0	0	0	0	0	0	0	0	0	0	71.4
H2762_013_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1689.811286	43.64085124	1662.914587	2148.249217	289.2893146	14.60705048	8.994942758	299.4846282	381.0288203	7.206485097	21.09699422	1.066878309	42.67513234	127.3235615	5306.736098	8094.792755	165.251206	816.6668214	39.04432533	0	10.35179616	0	0	13.81887852	437.8672443	0	187.6573904	0	0	46.44520413											3600	"$250 Copay/Day, up to 6 days; Unlimited"	"$250 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$40 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	$40 Copay	$15 Copay	$40 Copay	$15 Copay Group Session; $40 for Indiv.	$40 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$40/Exam	0	$40/Exam			$15/Routine Physical											152.8181818	142.7096774	28.10077519	0	150	0.15	0.15	49.56090468	250	0.15	0.15	40	40	40	15	40	27.5	40	0.15	0	0.2	0	0	0.25	40	0	40	0	0	15											NO	111.5284921	104.1511877	20.5082736	0	109.4717501	0.10947175	0.10947175	36.17012649	182.4529169	0.10947175	0.10947175	29.1924667	29.1924667	29.1924667	10.94717501	29.1924667	20.06982086	29.1924667	0.10947175	0	0.145962334	0	0	0.25	29.1924667	0	29.1924667	0	0	10.94717501												15.7052	0.378770541	2.841958943	0	2.639083963	1.59905938	0.984692126	0.90269974	5.793318306	0.788906536	2.309524879	0.002595401	0.103816032	0.309740736	4.841147401	19.69224733	0.276380175	1.986709916	4.274250626	0	1.510972324	0	0	3.454719629	1.065202079	0	0.456515177	0	0	0.042370315	0	0	0	0	0	0	0	0	0	0	71.9599	0	25.36173323	15.7052	0.378770541	2.841958943	0	2.639083963	1.59905938	0.984692126	0.90269974	5.793318306	0.788906536	2.309524879	0.002595401	0.103816032	0.309740736	4.841147401	19.69224733	0.276380175	1.986709916	4.274250626	0	1.510972324	0	0	3.454719629	1.065202079	0	0.456515177	0	0	0.042370315	0	0	0	0	0	0	0	0	0	0	71.9599	YES																																									3600																																									0	0	0	15.7052	0.378770541	2.841958943	0	2.639083963	1.59905938	0.984692126	0.90269974	5.793318306	0.788906536	2.309524879	0.002595401	0.103816032	0.309740736	4.841147401	19.69224733	0.276380175	1.986709916	4.274250626	0	1.510972324	0	0	3.454719629	1.065202079	0	0.456515177	0	0	0.042370315	0	0	0	0	0	0	0	0	0	0	71.9599
H2762_014_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1698.804256	43.87310254	1682.054304	2359.016775	290.6544324	14.4178131	8.8784114	305.1897977	388.3149497	7.334906397	21.47294773	1.087279425	43.49117701	129.7582749	5339.595063	8270.599522	173.8481398	859.1526272	36.24364965	0	10.53626766	0	0	13.81887852	438.5888417	0	187.9666465	0	0	46.521745											3600	"$250 Copay/Day, up to 6 days; Unlimited"	"$250 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$40 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	$40 Copay	$15 Copay	$40 Copay	$15 Copay Group Session; $40 for Indiv.	$40 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$40/Exam	0	$40/Exam			$15/Routine Physical											152.8181818	142.7096774	28.10077519	0	150	0.15	0.15	49.56090468	250	0.15	0.15	40	40	40	15	40	27.5	40	0.15	0	0.2	0	0	0.25	40	0	40	0	0	15											NO	111.1394799	103.7879075	20.43674059	0	109.0899118	0.109089912	0.109089912	36.04396481	181.8165197	0.109089912	0.109089912	29.09064315	29.09064315	29.09064315	10.90899118	29.09064315	19.99981717	29.09064315	0.109089912	0	0.145453216	0	0	0.25	29.09064315	0	29.09064315	0	0	10.90899118												15.7337	0.379458126	2.864642288	0	2.642288866	1.572837959	0.968545117	0.916687527	5.883506059	0.800164292	2.342481975	0.002635805	0.105432193	0.314562639	4.854132954	20.04975494	0.289744251	2.082775208	3.953816545	0	1.532534014	0	0	3.454719629	1.063235957	0	0.455672553	0	0	0.042292109	0	0	0	0	0	0	0	0	0	0	72.3056	0	25.81994788	15.7337	0.379458126	2.864642288	0	2.642288866	1.572837959	0.968545117	0.916687527	5.883506059	0.800164292	2.342481975	0.002635805	0.105432193	0.314562639	4.854132954	20.04975494	0.289744251	2.082775208	3.953816545	0	1.532534014	0	0	3.454719629	1.063235957	0	0.455672553	0	0	0.042292109	0	0	0	0	0	0	0	0	0	0	72.3056	YES																																									3600																																									0	0	0	15.7337	0.379458126	2.864642288	0	2.642288866	1.572837959	0.968545117	0.916687527	5.883506059	0.800164292	2.342481975	0.002635805	0.105432193	0.314562639	4.854132954	20.04975494	0.289744251	2.082775208	3.953816545	0	1.532534014	0	0	3.454719629	1.063235957	0	0.455672553	0	0	0.042292109	0	0	0	0	0	0	0	0	0	0	72.3056
H2762_015_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1814.941732	46.8724542	1595.411406	2656.062346	354.7601812	16.39424168	10.09548544	314.0726609	399.6473018	7.439743672	21.77985899	1.11900994	44.76039761	133.545063	5456.157041	8552.455346	183.7481637	908.0782675	38.7506064	0	10.68686176	0	0	13.81887852	413.0423852	0	177.0181651	0	0	43.81199585											3600	"$250 Copay/Day, up to 6 days; Unlimited"	"$250 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$40 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	$40 Copay	$15 Copay	$40 Copay	$15 Copay Group Session; $40 for Indiv.	$40 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$40/Exam	0	$40/Exam			$15/Routine Physical											152.8181818	142.7096774	28.10077519	0	150	0.15	0.15	49.56090468	250	0.15	0.15	40	40	40	15	40	27.5	40	0.15	0	0.2	0	0	0.25	40	0	40	0	0	15											NO	109.0615034	101.8473835	20.05463456	0	107.0502562	0.107050256	0.107050256	35.37005029	178.4170937	0.107050256	0.107050256	28.54673499	28.54673499	28.54673499	10.70502562	28.54673499	19.6258803	28.54673499	0.107050256	0	0.142733675	0	0	0.25	28.54673499	0	28.54673499	0	0	10.70502562												16.495	0.397819735	2.666282727	0	3.164764024	1.755007772	1.080724303	0.925730484	5.941992507	0.796426466	2.331539485	0.002662007	0.106480267	0.317689627	4.867358409	20.34538969	0.300518289	2.160222471	4.148262343	0	1.525375052	0	0	3.454719629	0.982584292	0	0.421107554	0	0	0.039084045	0	0	0	0	0	0	0	0	0	0	74.2268	0	28.39452498	16.495	0.397819735	2.666282727	0	3.164764024	1.755007772	1.080724303	0.925730484	5.941992507	0.796426466	2.331539485	0.002662007	0.106480267	0.317689627	4.867358409	20.34538969	0.300518289	2.160222471	4.148262343	0	1.525375052	0	0	3.454719629	0.982584292	0	0.421107554	0	0	0.039084045	0	0	0	0	0	0	0	0	0	0	74.2268	YES																																									3600																																									0	0	0	16.495	0.397819735	2.666282727	0	3.164764024	1.755007772	1.080724303	0.925730484	5.941992507	0.796426466	2.331539485	0.002662007	0.106480267	0.317689627	4.867358409	20.34538969	0.300518289	2.160222471	4.148262343	0	1.525375052	0	0	3.454719629	0.982584292	0	0.421107554	0	0	0.039084045	0	0	0	0	0	0	0	0	0	0	74.2268
H2762_016_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1630.108733	42.09898071	1494.229389	2396.579226	279.449892	14.23111154	8.763441589	280.9190403	367.919727	6.854221858	20.06574314	1.032339163	41.29356651	119.4014883	5470.992839	8830.933915	192.1109731	941.105381	42.14025016	0	10.1591397	0	0	13.81887852	413.6186418	1.905971931	177.2651322	0	0	43.87312022											3400	"$100 Copay/Day, up to 6 days; Unlimited"	"$100 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $100 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$100/Trip	15% Coinsurance	15% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$100/Visit	15% Coinsurance	15% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$75 Allowance	$20/Exam			$10 Copay											61.12727273	57.08387097	22.48062016	0	100	0.15	0.15	48.68271405	100	0.15	0.15	20	20	20	10	20	15	20	0.15	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	51.60680109	48.19315247	18.97930074	0	84.42516538	0.126637748	0.126637748	41.10046184	84.42516538	0.126637748	0.126637748	16.88503308	16.88503308	16.88503308	8.442516538	16.88503308	12.66377481	16.88503308	0.126637748	0	0.168850331	0	0	0.25	16.88503308	0	16.88503308	0	0	8.442516538												7.0104	0.16907355	2.363285746	0	1.966050279	1.802195918	1.109782508	0.962158525	2.58847365	0.868003221	2.541080524	0.00145259	0.058103603	0.168008173	3.84907896	12.42588427	0.202737508	1.32421629	5.336546383	0	1.715374098	0	0	3.454719629	0.581997037	0	0.249427302	0	0	0.030866629	0	0	0	0	0	0	0	0	0	0	50.7789	0	8.730411147	7.0104	0.16907355	2.363285746	0	1.966050279	1.802195918	1.109782508	0.962158525	2.58847365	0.868003221	2.541080524	0.00145259	0.058103603	0.168008173	3.84907896	12.42588427	0.202737508	1.32421629	5.336546383	0	1.715374098	0	0	3.454719629	0.581997037	0	0.249427302	0	0	0.030866629	0	0	0	0	0	0	0	0	0	0	50.7789	YES																																									3400																																									0	0	0	7.0104	0.16907355	2.363285746	0	1.966050279	1.802195918	1.109782508	0.962158525	2.58847365	0.868003221	2.541080524	0.00145259	0.058103603	0.168008173	3.84907896	12.42588427	0.202737508	1.32421629	5.336546383	0	1.715374098	0	0	3.454719629	0.581997037	0	0.249427302	0	0	0.030866629	0	0	0	0	0	0	0	0	0	0	50.7789
H2762_017_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1721.063945	44.44797844	1677.18742	2148.249217	289.2893146	14.60705048	8.994942758	299.4846282	392.3305367	7.206485097	21.09699422	1.100833003	44.0333201	127.3235615	5476.584359	8542.711994	174.3952566	854.3203529	39.04432533	0	10.68125461	0	0	13.81887852	437.8672443	1.905971931	187.6573904	0	0	46.44520413											3400	"$100 Copay/Day, up to 6 days; Unlimited"	"$100 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $100 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$100/Trip	15% Coinsurance	15% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$100/Visit	15% Coinsurance	15% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$75 Allowance	$20/Exam			$10 Copay											61.12727273	57.08387097	22.48062016	0	100	0.15	0.15	48.68271405	100	0.15	0.15	20	20	20	10	20	15	20	0.15	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	51.46561123	48.06130193	18.92737571	0	84.19418851	0.126291283	0.126291283	40.98801604	84.19418851	0.126291283	0.126291283	16.8388377	16.8388377	16.8388377	8.419418851	16.8388377	12.62912828	16.8388377	0.126291283	0	0.168388377	0	0	0.25	16.8388377	0	16.8388377	0	0	8.419418851												7.3813	0.178018976	2.64539637	0	2.029706591	1.844743142	1.135982859	1.022940062	2.752662597	0.910116247	2.664366462	0.001544729	0.061789161	0.178665066	3.842471466	11.98744507	0.183538339	1.198813481	4.93095793	0	1.798599128	0	0	3.454719629	0.614431288	0	0.263327695	0	0	0.032586802	0	0	0	0	0	0	0	0	0	0	51.1141	0	8.947120585	7.3813	0.178018976	2.64539637	0	2.029706591	1.844743142	1.135982859	1.022940062	2.752662597	0.910116247	2.664366462	0.001544729	0.061789161	0.178665066	3.842471466	11.98744507	0.183538339	1.198813481	4.93095793	0	1.798599128	0	0	3.454719629	0.614431288	0	0.263327695	0	0	0.032586802	0	0	0	0	0	0	0	0	0	0	51.1141	YES																																									3400																																									0	0	0	7.3813	0.178018976	2.64539637	0	2.029706591	1.844743142	1.135982859	1.022940062	2.752662597	0.910116247	2.664366462	0.001544729	0.061789161	0.178665066	3.842471466	11.98744507	0.183538339	1.198813481	4.93095793	0	1.798599128	0	0	3.454719629	0.614431288	0	0.263327695	0	0	0.032586802	0	0	0	0	0	0	0	0	0	0	51.1141
H2762_018_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1730.223238	44.68452517	1696.491414	2359.016775	290.6544324	14.4178131	8.8784114	305.1897977	399.8327804	7.334906397	21.47294773	1.12188341	44.87533638	129.7582749	5510.495012	8728.246895	183.4678953	898.7650244	36.24364965	0	10.87159714	0	0	13.81887852	438.5888417	1.905971931	187.9666465	0	0	46.521745											3400	"$100 Copay/Day, up to 6 days; Unlimited"	"$100 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $100 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$100/Trip	15% Coinsurance	15% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$100/Visit	15% Coinsurance	15% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$75 Allowance	$20/Exam			$10 Copay											61.12727273	57.08387097	22.48062016	0	100	0.15	0.15	48.68271405	100	0.15	0.15	20	20	20	10	20	15	20	0.15	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	51.40032022	48.00032974	18.9033638	0	84.08737692	0.126131065	0.126131065	40.93601726	84.08737692	0.126131065	0.126131065	16.81747538	16.81747538	16.81747538	8.408737692	16.81747538	12.61310654	16.81747538	0.126131065	0	0.168174754	0	0	0.25	16.81747538	0	16.81747538	0	0	8.408737692												7.4112	0.178739329	2.672449532	0	2.036697401	1.818534127	1.119843489	1.041104569	2.80174081	0.925159558	2.708405775	0.001572271	0.062890822	0.181850549	3.861358926	12.23225644	0.192841676	1.25957989	4.571450144	0	1.828328173	0	0	3.454719629	0.614663088	0	0.263427038	0	0	0.032599096	0	0	0	0	0	0	0	0	0	0	51.2714	0	9.048784049	7.4112	0.178739329	2.672449532	0	2.036697401	1.818534127	1.119843489	1.041104569	2.80174081	0.925159558	2.708405775	0.001572271	0.062890822	0.181850549	3.861358926	12.23225644	0.192841676	1.25957989	4.571450144	0	1.828328173	0	0	3.454719629	0.614663088	0	0.263427038	0	0	0.032599096	0	0	0	0	0	0	0	0	0	0	51.2714	YES																																									3400																																									0	0	0	7.4112	0.178739329	2.672449532	0	2.036697401	1.818534127	1.119843489	1.041104569	2.80174081	0.925159558	2.708405775	0.001572271	0.062890822	0.181850549	3.861358926	12.23225644	0.192841676	1.25957989	4.571450144	0	1.828328173	0	0	3.454719629	0.614663088	0	0.263427038	0	0	0.032599096	0	0	0	0	0	0	0	0	0	0	51.2714
H2762_019_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1848.508648	47.73934913	1609.104859	2656.062346	354.7601812	16.39424168	10.09548544	314.0726609	411.5012621	7.439743672	21.77985899	1.154623787	46.18495146	133.545063	5630.787693	9025.698999	193.9157295	949.9464477	38.7506064	0	11.02698407	0	0	13.81887852	413.0423852	1.905971931	177.0181651	0	0	43.81199585											3400	"$100 Copay/Day, up to 6 days; Unlimited"	"$100 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $100 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$100/Trip	15% Coinsurance	15% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$100/Visit	15% Coinsurance	15% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$75 Allowance	$20/Exam			$10 Copay											61.12727273	57.08387097	22.48062016	0	100	0.15	0.15	48.68271405	100	0.15	0.15	20	20	20	10	20	15	20	0.15	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	50.7513305	47.39426892	18.66468652	0	83.02567453	0.124538512	0.124538512	40.41915171	83.02567453	0.124538512	0.124538512	16.60513491	16.60513491	16.60513491	8.302567453	16.60513491	12.45385118	16.60513491	0.124538512	0	0.166051349	0	0	0.25	16.60513491	0	16.60513491	0	0	8.302567453												7.8179	0.188547629	2.502786481	0	2.454516945	2.041714461	1.257276733	1.057879211	2.847097488	0.926534605	2.712431225	0.001597724	0.063908946	0.184794482	3.895832886	12.48941246	0.201249803	1.314499076	4.825942852	0	1.831045581	0	0	3.454719629	0.571552044	0	0.244950876	0	0	0.030312671	0	0	0	0	0	0	0	0	0	0	52.9165	0	10.11228976	7.8179	0.188547629	2.502786481	0	2.454516945	2.041714461	1.257276733	1.057879211	2.847097488	0.926534605	2.712431225	0.001597724	0.063908946	0.184794482	3.895832886	12.48941246	0.201249803	1.314499076	4.825942852	0	1.831045581	0	0	3.454719629	0.571552044	0	0.244950876	0	0	0.030312671	0	0	0	0	0	0	0	0	0	0	52.9165	YES																																									3400																																									0	0	0	7.8179	0.188547629	2.502786481	0	2.454516945	2.041714461	1.257276733	1.057879211	2.847097488	0.926534605	2.712431225	0.001597724	0.063908946	0.184794482	3.895832886	12.48941246	0.201249803	1.314499076	4.825942852	0	1.831045581	0	0	3.454719629	0.571552044	0	0.244950876	0	0	0.030312671	0	0	0	0	0	0	0	0	0	0	52.9165
H2762_020_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1591.259883	41.09567525	1416.520494	2266.040855	269.9047465	8.68245506	5.346608911	267.435151	343.9962114	7.13032123	20.8740244	0.95805531	38.32221239	113.6483773	5401.749933	8183.873836	171.7086021	847.1184152	29.48306083	0	6.407285014	0	0	13.81887852	427.2135527	0	183.0915226	0	0	45.31515184											3000	"$175 Copay/Day, up to 6 days; Unlimited"	"$175 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$35 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$175/Visit	15% Coinsurance	15% Coinsurance	$35 Copay	$35 Copay	$35 Copay	$10 Copay	$35 Copay	$10 Copay Group Session; $35 for Indiv.	$35 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$35/Exam		$35/Exam			$10/Routine Physical											106.9727273	99.89677419	28.10077519	0	150	0.15	0.15	49.34135702	175	0.15	0.15	35	35	35	10	35	22.5	35	0.15	0	0.2	0	0	0.25	35	0	35	0	0	10											NO	79.288961	74.04421328	20.8284983	0	111.1810875	0.111181087	0.111181087	36.57217155	129.7112687	0.111181087	0.111181087	25.94225375	25.94225375	25.94225375	7.4120725	25.94225375	16.67716312	25.94225375	0.111181087	0	0.14824145	0	0	0.25	25.94225375	0	25.94225375	0	0	7.4120725												10.5141	0.253574745	2.458666225	0	2.500691936	0.965324796	0.594441793	0.815057018	3.718348752	0.792756869	2.320796733	0.002071176	0.082847046	0.245691254	3.336513511	17.69234431	0.238634364	1.83134674	3.277958766	0	0.949825221	0	0	3.454719629	0.923573532	0	0.395817228	0	0	0.027989933	0	0	0	0	0	0	0	0	0	0	57.3931	0	18.83260409	10.5141	0.253574745	2.458666225	0	2.500691936	0.965324796	0.594441793	0.815057018	3.718348752	0.792756869	2.320796733	0.002071176	0.082847046	0.245691254	3.336513511	17.69234431	0.238634364	1.83134674	3.277958766	0	0.949825221	0	0	3.454719629	0.923573532	0	0.395817228	0	0	0.027989933	0	0	0	0	0	0	0	0	0	0	57.3931	YES																																									3000																																									0	0	0	10.5141	0.253574745	2.458666225	0	2.500691936	0.965324796	0.594441793	0.815057018	3.718348752	0.792756869	2.320796733	0.002071176	0.082847046	0.245691254	3.336513511	17.69234431	0.238634364	1.83134674	3.277958766	0	0.949825221	0	0	3.454719629	0.923573532	0	0.395817228	0	0	0.027989933	0	0	0	0	0	0	0	0	0	0	57.3931
H2762_021_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1618.273833	41.79333408	1444.317614	2048.635616	292.3037928	9.020458201	5.554749419	251.5607391	323.4933097	7.832412609	22.9293978	0.900953187	36.03812749	106.8746937	5568.336899	8555.877187	184.2121065	908.8040197	34.43012682	0	7.107398159	0	0	13.81887852	443.1907814	0	189.9389063	0	0	47.00987932											3000	"$175 Copay/Day, up to 6 days; Unlimited"	"$175 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$35 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$175/Visit	15% Coinsurance	15% Coinsurance	$35 Copay	$35 Copay	$35 Copay	$10 Copay	$35 Copay	$10 Copay Group Session; $35 for Indiv.	$35 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$35/Exam		$35/Exam			$10/Routine Physical											106.9727273	99.89677419	28.10077519	0	150	0.15	0.15	49.34135702	175	0.15	0.15	35	35	35	10	35	22.5	35	0.15	0	0.2	0	0	0.25	35	0	35	0	0	10											NO	78.23125229	73.0564691	20.55064772	0	109.6979402	0.10969794	0.10969794	36.08430156	127.9809303	0.10969794	0.10969794	25.59618606	25.59618606	25.59618606	7.313196016	25.59618606	16.45469104	25.59618606	0.10969794	0	0.14626392	0	0	0.25	25.59618606	0	25.59618606	0	0	7.313196016												10.55	0.254439452	2.473471874	0	2.672093666	0.989525685	0.60934457	0.756449464	3.450081226	0.85919953	2.515307709	0.001921747	0.076869885	0.227965379	3.393528269	18.2498187	0.252596108	1.938493065	3.776913994	0	1.039555918	0	0	3.454719629	0.945332808	0	0.405142632	0	0	0.028649372	0	0	0	0	0	0	0	0	0	0	58.9214	0	20.3779662	10.55	0.254439452	2.473471874	0	2.672093666	0.989525685	0.60934457	0.756449464	3.450081226	0.85919953	2.515307709	0.001921747	0.076869885	0.227965379	3.393528269	18.2498187	0.252596108	1.938493065	3.776913994	0	1.039555918	0	0	3.454719629	0.945332808	0	0.405142632	0	0	0.028649372	0	0	0	0	0	0	0	0	0	0	58.9214	YES																																									3000																																									0	0	0	10.55	0.254439452	2.473471874	0	2.672093666	0.989525685	0.60934457	0.756449464	3.450081226	0.85919953	2.515307709	0.001921747	0.076869885	0.227965379	3.393528269	18.2498187	0.252596108	1.938493065	3.776913994	0	1.039555918	0	0	3.454719629	0.945332808	0	0.405142632	0	0	0.028649372	0	0	0	0	0	0	0	0	0	0	58.9214
H2762_022_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1643.701957	42.45003759	1495.335777	1800.932072	281.8385006	10.64809502	6.55703938	261.8790416	336.821414	6.552904527	19.18363627	0.93807296	37.52291839	111.2779905	5417.819804	8023.102347	161.0642561	794.6049049	32.53612987	0	7.940310515	0	0	13.81887852	425.8329717	0	182.499845	0	0	45.16871164											3000	"$175 Copay/Day, up to 6 days; Unlimited"	"$175 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$35 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$175/Visit	15% Coinsurance	15% Coinsurance	$35 Copay	$35 Copay	$35 Copay	$10 Copay	$35 Copay	$10 Copay Group Session; $35 for Indiv.	$35 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$35/Exam		$35/Exam			$10/Routine Physical											106.9727273	99.89677419	28.10077519	0	150	0.15	0.15	49.34135702	175	0.15	0.15	35	35	35	10	35	22.5	35	0.15	0	0.2	0	0	0.25	35	0	35	0	0	10											NO	79.00813563	73.78196374	20.754728	0	110.7873067	0.110787307	0.110787307	36.44264036	129.2518578	0.110787307	0.110787307	25.85037156	25.85037156	25.85037156	7.385820447	25.85037156	16.618096	25.85037156	0.110787307	0	0.147716409	0	0	0.25	25.85037156	0	25.85037156	0	0	7.385820447												10.8222	0.261003928	2.586273943	0	2.6020107	1.179673769	0.726436733	0.795296977	3.62789946	0.725978644	2.125303396	0.002020795	0.080831782	0.239714783	3.334587024	17.28334806	0.223048439	1.711736003	3.604590199	0	1.172914155	0	0	3.454719629	0.917328378	0	0.393140734	0	0	0.027800666	0	0	0	0	0	0	0	0	0	0	57.8978	0	19.26989912	10.8222	0.261003928	2.586273943	0	2.6020107	1.179673769	0.726436733	0.795296977	3.62789946	0.725978644	2.125303396	0.002020795	0.080831782	0.239714783	3.334587024	17.28334806	0.223048439	1.711736003	3.604590199	0	1.172914155	0	0	3.454719629	0.917328378	0	0.393140734	0	0	0.027800666	0	0	0	0	0	0	0	0	0	0	57.8978	YES																																									3000																																									0	0	0	10.8222	0.261003928	2.586273943	0	2.6020107	1.179673769	0.726436733	0.795296977	3.62789946	0.725978644	2.125303396	0.002020795	0.080831782	0.239714783	3.334587024	17.28334806	0.223048439	1.711736003	3.604590199	0	1.172914155	0	0	3.454719629	0.917328378	0	0.393140734	0	0	0.027800666	0	0	0	0	0	0	0	0	0	0	57.8978
H2762_023_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1707.854155	44.10682408	1395.923928	2328.460651	284.8444288	14.7338858	9.073047261	273.191303	351.4302276	7.041162838	20.61301309	0.978759604	39.15038415	116.104404	5631.267287	8555.071327	180.418656	890.0891632	38.4332297	0	10.16537329	0	0	13.81887852	436.0647603	0	186.8848973	0	0	46.25401208											3000	"$175 Copay/Day, up to 6 days; Unlimited"	"$175 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$35 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$175/Visit	15% Coinsurance	15% Coinsurance	$35 Copay	$35 Copay	$35 Copay	$10 Copay	$35 Copay	$10 Copay Group Session; $35 for Indiv.	$35 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$35/Exam		$35/Exam			$10/Routine Physical											106.9727273	99.89677419	28.10077519	0	150	0.15	0.15	49.34135702	175	0.15	0.15	35	35	35	10	35	22.5	35	0.15	0	0.2	0	0	0.25	35	0	35	0	0	10											NO	77.72181381	72.58072859	20.4168228	0	108.9835921	0.108983592	0.108983592	35.84932217	127.1475241	0.108983592	0.108983592	25.42950482	25.42950482	25.42950482	7.265572805	25.42950482	16.34753881	25.42950482	0.108983592	0	0.145311456	0	0	0.25	25.42950482	0	25.42950482	0	0	7.265572805												11.0615	0.266775452	2.375027624	0	2.586947419	1.605751799	0.988813282	0.816143586	3.723623611	0.767371218	2.24648021	0.002074114	0.082964574	0.246039792	3.409531871	18.12926896	0.245783415	1.886210555	4.188591427	0	1.477145194	0	0	3.454719629	0.92407591	0	0.396032533	0	0	0.028005158	0	0	0	0	0	0	0	0	0	0	60.9088	0	21.62364207	11.0615	0.266775452	2.375027624	0	2.586947419	1.605751799	0.988813282	0.816143586	3.723623611	0.767371218	2.24648021	0.002074114	0.082964574	0.246039792	3.409531871	18.12926896	0.245783415	1.886210555	4.188591427	0	1.477145194	0	0	3.454719629	0.92407591	0	0.396032533	0	0	0.028005158	0	0	0	0	0	0	0	0	0	0	60.9088	YES																																									3000																																									0	0	0	11.0615	0.266775452	2.375027624	0	2.586947419	1.605751799	0.988813282	0.816143586	3.723623611	0.767371218	2.24648021	0.002074114	0.082964574	0.246039792	3.409531871	18.12926896	0.245783415	1.886210555	4.188591427	0	1.477145194	0	0	3.454719629	0.92407591	0	0.396032533	0	0	0.028005158	0	0	0	0	0	0	0	0	0	0	60.9088
H2762_024_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1620.025509	41.83857265	1449.145529	2266.040855	269.9047465	9.079429582	5.591063677	267.435151	358.0217657	7.808312449	22.85884455	0.982598059	39.30392236	113.6483773	5401.749933	8547.576217	179.3395637	878.5413226	37.39065949	0	8.477199095	0	0	13.81887852	427.2135527	1.905971931	183.0915226	0	0	45.31515184											2500	"$50 Copay/Day, up to 6 days; Unlimited"	"$50 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $50 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$100/Trip	15% Coinsurance	15% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$50/Visit	15% Coinsurance	15% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$75 Allowance	$20/Exam			$10/Routine Physical											30.56363636	28.54193548	11.24031008	0	100	0.15	0.15	48.68271405	50	0.15	0.15	20	20	20	10	20	15	20	0.15	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	25.02291317	23.36771596	9.202612533	0	81.8715184	0.122807278	0.122807278	39.85727719	40.9357592	0.122807278	0.122807278	16.37430368	16.37430368	16.37430368	8.18715184	16.37430368	12.28072776	16.37430368	0.122807278	0	0.163743037	0	0	0.25	16.37430368	0	16.37430368	0	0	8.18715184												3.3781	0.081472657	1.111327067	0	1.841459285	1.115020029	0.686623309	0.888269745	1.221324399	0.958917595	2.807232468	0.00134078	0.053631197	0.155076087	3.685412242	11.66338406	0.18353503	1.198791868	4.5918451	0	1.388082323	0	0	3.454719629	0.582943704	0	0.249833016	0	0	0.030916836	0	0	0	0	0	0	0	0	0	0	41.3293	0	8.386417347	3.3781	0.081472657	1.111327067	0	1.841459285	1.115020029	0.686623309	0.888269745	1.221324399	0.958917595	2.807232468	0.00134078	0.053631197	0.155076087	3.685412242	11.66338406	0.18353503	1.198791868	4.5918451	0	1.388082323	0	0	3.454719629	0.582943704	0	0.249833016	0	0	0.030916836	0	0	0	0	0	0	0	0	0	0	41.3293	YES																																									2500																																									0	0	0	3.3781	0.081472657	1.111327067	0	1.841459285	1.115020029	0.686623309	0.888269745	1.221324399	0.958917595	2.807232468	0.00134078	0.053631197	0.155076087	3.685412242	11.66338406	0.18353503	1.198791868	4.5918451	0	1.388082323	0	0	3.454719629	0.582943704	0	0.249833016	0	0	0.030916836	0	0	0	0	0	0	0	0	0	0	41.3293
H2762_025_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1647.527798	42.54884325	1477.582867	2048.635616	292.3037928	10.81163994	6.657749457	251.5607391	336.6829113	6.576454971	19.25258023	0.924033137	36.96132547	106.8746937	5568.336899	8936.111898	192.3987408	942.5150853	41.23114576	0	8.11636264	0	0	13.81887852	443.1907814	1.905971931	189.9389063	0	0	47.00987932											2500	"$50 Copay/Day, up to 6 days; Unlimited"	"$50 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $50 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$100/Trip	15% Coinsurance	15% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$50/Visit	15% Coinsurance	15% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$75 Allowance	$20/Exam			$10/Routine Physical											30.56363636	28.54193548	11.24031008	0	100	0.15	0.15	48.68271405	50	0.15	0.15	20	20	20	10	20	15	20	0.15	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	24.62107488	22.99245818	9.054829498	0	80.55675898	0.120835138	0.120835138	39.21721662	40.27837949	0.120835138	0.120835138	16.1113518	16.1113518	16.1113518	8.055675898	16.1113518	12.08351385	16.1113518	0.120835138	0	0.161113518	0	0	0.25	16.1113518	0	16.1113518	0	0	8.055675898												3.3803	0.081525208	1.114938411	0	1.962253849	1.306426009	0.804490078	0.822126	1.130086839	0.794666847	2.326388198	0.001240619	0.049624743	0.143491316	3.738059779	11.99773687	0.193737737	1.265432676	4.982171207	0	1.307655738	0	0	3.454719629	0.595033549	0	0.255014378	0	0	0.031558029	0	0	0	0	0	0	0	0	0	0	41.7387	0	9.240251572	3.3803	0.081525208	1.114938411	0	1.962253849	1.306426009	0.804490078	0.822126	1.130086839	0.794666847	2.326388198	0.001240619	0.049624743	0.143491316	3.738059779	11.99773687	0.193737737	1.265432676	4.982171207	0	1.307655738	0	0	3.454719629	0.595033549	0	0.255014378	0	0	0.031558029	0	0	0	0	0	0	0	0	0	0	41.7387	YES																																									2500																																									0	0	0	3.3803	0.081525208	1.114938411	0	1.962253849	1.306426009	0.804490078	0.822126	1.130086839	0.794666847	2.326388198	0.001240619	0.049624743	0.143491316	3.738059779	11.99773687	0.193737737	1.265432676	4.982171207	0	1.307655738	0	0	3.454719629	0.595033549	0	0.255014378	0	0	0.031558029	0	0	0	0	0	0	0	0	0	0	41.7387
H2762_026_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1673.415593	43.21741816	1529.776071	1800.932072	281.8385006	13.31207127	8.197501559	261.8790416	350.5544346	7.046836462	20.62962264	0.962103816	38.48415264	111.2779905	5417.819804	8379.659826	168.2221687	824.0798825	35.31813271	0	10.44462778	0	0	13.81887852	425.8329717	1.905971931	182.499845	0	0	45.16871164											2500	"$50 Copay/Day, up to 6 days; Unlimited"	"$50 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $50 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$100/Trip	15% Coinsurance	15% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$50/Visit	15% Coinsurance	15% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$75 Allowance	$20/Exam			$10/Routine Physical											30.56363636	28.54193548	11.24031008	0	100	0.15	0.15	48.68271405	50	0.15	0.15	20	20	20	10	20	15	20	0.15	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	24.914413	23.26639279	9.162709706	0	81.51652084	0.122274781	0.122274781	39.68445474	40.75826042	0.122274781	0.122274781	16.30330417	16.30330417	16.30330417	8.151652084	16.30330417	12.22747813	16.30330417	0.122274781	0	0.163033042	0	0	0.25	16.30330417	0	16.30330417	0	0	8.151652084												3.4743	0.083792786	1.168074504	0	1.914541167	1.627730603	1.00234771	0.866043914	1.190665745	0.861650387	2.522482595	0.001307123	0.052284904	0.151183244	3.680348508	11.38467858	0.171411074	1.119602082	4.318516952	0	1.702819436	0	0	3.454719629	0.578540372	0	0.247945874	0	0	0.030683302	0	0	0	0	0	0	0	0	0	0	41.6057	0	8.650555393	3.4743	0.083792786	1.168074504	0	1.914541167	1.627730603	1.00234771	0.866043914	1.190665745	0.861650387	2.522482595	0.001307123	0.052284904	0.151183244	3.680348508	11.38467858	0.171411074	1.119602082	4.318516952	0	1.702819436	0	0	3.454719629	0.578540372	0	0.247945874	0	0	0.030683302	0	0	0	0	0	0	0	0	0	0	41.6057	YES																																									2500																																									0	0	0	3.4743	0.083792786	1.168074504	0	1.914541167	1.627730603	1.00234771	0.866043914	1.190665745	0.861650387	2.522482595	0.001307123	0.052284904	0.151183244	3.680348508	11.38467858	0.171411074	1.119602082	4.318516952	0	1.702819436	0	0	3.454719629	0.578540372	0	0.247945874	0	0	0.030683302	0	0	0	0	0	0	0	0	0	0	41.6057
H2762_027_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1738.727487	44.90415482	1428.074587	2328.460651	284.8444288	14.7338858	9.073047261	273.191303	365.7588847	7.041162838	20.61301309	1.00383274	40.15330961	116.104404	5631.267287	8935.270224	188.4367042	923.1060223	38.4332297	0	10.43621849	0	0	13.81887852	436.0647603	1.905971931	186.8848973	0	0	46.25401208											2500	"$50 Copay/Day, up to 6 days; Unlimited"	"$50 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $50 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$100/Trip	15% Coinsurance	15% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$50/Visit	15% Coinsurance	15% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$75 Allowance	$20/Exam			$10/Routine Physical											30.56363636	28.54193548	11.24031008	0	100	0.15	0.15	48.68271405	50	0.15	0.15	20	20	20	10	20	15	20	0.15	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	24.52688338	22.90449718	9.020188931	0	80.24857739	0.120372866	0.120372866	39.06718546	40.12428869	0.120372866	0.120372866	16.04971548	16.04971548	16.04971548	8.024857739	16.04971548	12.03728661	16.04971548	0.120372866	0	0.160497155	0	0	0.25	16.04971548	0	16.04971548	0	0	8.024857739												3.5538	0.085708924	1.073458548	0	1.904863349	1.773560062	1.092148703	0.889401275	1.22298459	0.847564951	2.481247465	0.001342602	0.0537041	0.155286888	3.765843239	11.95071207	0.189022218	1.234632418	4.626318011	0	1.674983374	0	0	3.454719629	0.583226278	0	0.249954119	0	0	0.030931822	0	0	0	0	0	0	0	0	0	0	42.8954	0	9.707459061	3.5538	0.085708924	1.073458548	0	1.904863349	1.773560062	1.092148703	0.889401275	1.22298459	0.847564951	2.481247465	0.001342602	0.0537041	0.155286888	3.765843239	11.95071207	0.189022218	1.234632418	4.626318011	0	1.674983374	0	0	3.454719629	0.583226278	0	0.249954119	0	0	0.030931822	0	0	0	0	0	0	0	0	0	0	42.8954	YES																																									2500																																									0	0	0	3.5538	0.085708924	1.073458548	0	1.904863349	1.773560062	1.092148703	0.889401275	1.22298459	0.847564951	2.481247465	0.001342602	0.0537041	0.155286888	3.765843239	11.95071207	0.189022218	1.234632418	4.626318011	0	1.674983374	0	0	3.454719629	0.583226278	0	0.249954119	0	0	0.030931822	0	0	0	0	0	0	0	0	0	0	42.8954
H2762_028_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1603.179007	41.40349704	1481.513525	2396.579226	279.449892	14.23111154	8.763441589	280.9190403	357.3212035	6.854221858	20.06574314	0.995184844	39.80739375	119.4014883	5301.317992	8316.751771	180.9252896	895.0447776	42.14025016	0	9.793508	0	0	13.81887852	413.6186418	0	177.2651322	0	0	43.87312022											3800	"$230 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$230 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$45 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$45 Copay	$45 Copay	$45 Copay	$15 Copay	$45 Copay	$15 Copay Group Session; $40 for Indiv.	$45 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$45/Exam	0	$45/Exam			$15/Routine Physical											140.5927273	131.2929032	28.10077519	0	150	0.15	0.15	49.78045234	250	0.15	0.15	45	45	45	15	45	27.5	45	0.15	0	0.2	0	0	0.25	45	0	45	0	0	15											NO	104.0722578	97.18816288	20.80129732	0	111.0358905	0.111035891	0.111035891	36.84944572	185.0598176	0.111035891	0.111035891	33.31076716	33.31076716	33.31076716	11.10358905	33.31076716	20.35657993	33.31076716	0.111035891	0	0.148047854	0	0	0.25	33.31076716	0	33.31076716	0	0	11.10358905												13.9039	0.335327484	2.568116943	0	2.585747302	1.580164143	0.973056541	0.862642577	5.510483061	0.761064628	2.228017659	0.002762531	0.110501235	0.331446265	4.905304702	23.08644848	0.306918343	2.484552349	4.679080204	0	1.449907843	0	0	3.454719629	1.148162856	0	0.492069795	0	0	0.040595758	0	0	0	0	0	0	0	0	0	0	73.801	0	24.68551989	13.9039	0.335327484	2.568116943	0	2.585747302	1.580164143	0.973056541	0.862642577	5.510483061	0.761064628	2.228017659	0.002762531	0.110501235	0.331446265	4.905304702	23.08644848	0.306918343	2.484552349	4.679080204	0	1.449907843	0	0	3.454719629	1.148162856	0	0.492069795	0	0	0.040595758	0	0	0	0	0	0	0	0	0	0	73.801	YES																																									3800																																									0	0	0	13.9039	0.335327484	2.568116943	0	2.585747302	1.580164143	0.973056541	0.862642577	5.510483061	0.761064628	2.228017659	0.002762531	0.110501235	0.331446265	4.905304702	23.08644848	0.306918343	2.484552349	4.679080204	0	1.449907843	0	0	3.454719629	1.148162856	0	0.492069795	0	0	0.040595758	0	0	0	0	0	0	0	0	0	0	73.801
H2762_030_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1692.631621	43.71368885	1662.914587	2148.249217	289.2893146	14.60705048	8.994942758	299.4846282	381.0288203	7.206485097	21.09699422	1.061213561	42.44854246	127.3235615	5306.736098	8045.311604	164.2410727	812.5072768	39.04432533	0	10.29683178	0	0	13.81887852	437.8672443	0	187.6573904	0	0	46.44520413											3800	"$230 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$230 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$45 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$45 Copay	$45 Copay	$45 Copay	$15 Copay	$45 Copay	$15 Copay Group Session; $40 for Indiv.	$45 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$45/Exam	0	$45/Exam			$15/Routine Physical											140.5927273	131.2929032	28.10077519	0	150	0.15	0.15	49.78045234	250	0.15	0.15	45	45	45	15	45	27.5	45	0.15	0	0.2	0	0	0.25	45	0	45	0	0	15											NO	103.7205745	96.85974242	20.7310051	0	110.6606755	0.110660676	0.110660676	36.72492323	184.4344592	0.110660676	0.110660676	33.19820266	33.19820266	33.19820266	11.06606755	33.19820266	20.28779051	33.19820266	0.110660676	0	0.147547567	0	0	0.25	33.19820266	0	33.19820266	0	0	11.06606755												14.6301	0.352841387	2.872824232	0	2.667745915	1.616426073	0.995386442	0.916545832	5.856237034	0.797474509	2.334607631	0.002935865	0.11743461	0.352242783	4.893725012	22.25749042	0.27767404	2.247815103	4.320671416	0	1.519272481	0	0	3.454719629	1.211367126	0	0.51915734	0	0	0.042830481	0	0	0	0	0	0	0	0	0	0	74.2575	0	25.17003421	14.6301	0.352841387	2.872824232	0	2.667745915	1.616426073	0.995386442	0.916545832	5.856237034	0.797474509	2.334607631	0.002935865	0.11743461	0.352242783	4.893725012	22.25749042	0.27767404	2.247815103	4.320671416	0	1.519272481	0	0	3.454719629	1.211367126	0	0.51915734	0	0	0.042830481	0	0	0	0	0	0	0	0	0	0	74.2575	YES																																									3800																																									0	0	0	14.6301	0.352841387	2.872824232	0	2.667745915	1.616426073	0.995386442	0.916545832	5.856237034	0.797474509	2.334607631	0.002935865	0.11743461	0.352242783	4.893725012	22.25749042	0.27767404	2.247815103	4.320671416	0	1.519272481	0	0	3.454719629	1.211367126	0	0.51915734	0	0	0.042830481	0	0	0	0	0	0	0	0	0	0	74.2575
H2762_032_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1701.6396	43.94632778	1682.054304	2359.016775	290.6544324	14.4178131	8.8784114	305.1897977	388.3149497	7.334906397	21.47294773	1.081506355	43.26025422	129.7582749	5339.595063	8220.043714	172.7854559	854.7766888	36.24364965	0	10.4803238	0	0	13.81887852	438.5888417	0	187.9666465	0	0	46.521745											3800	"$230 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$230 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$45 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$45 Copay	$45 Copay	$45 Copay	$15 Copay	$45 Copay	$15 Copay Group Session; $40 for Indiv.	$45 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$45/Exam	0	$45/Exam			$15/Routine Physical											140.5927273	131.2929032	28.10077519	0	150	0.15	0.15	49.78045234	250	0.15	0.15	45	45	45	15	45	27.5	45	0.15	0	0.2	0	0	0.25	45	0	45	0	0	15											NO	103.3969996	96.5575711	20.66633102	0	110.3154497	0.11031545	0.11031545	36.61035325	183.8590829	0.11031545	0.11031545	33.09463492	33.09463492	33.09463492	11.03154497	33.09463492	20.22449912	33.09463492	0.11031545	0	0.147087266	0	0	0.25	33.09463492	0	33.09463492	0	0	11.03154497												14.662	0.353612556	2.896824253	0	2.671972868	1.590507536	0.979425946	0.931092192	5.949602543	0.809153498	2.368797886	0.002982671	0.11930686	0.357858561	4.908665256	22.66994548	0.291208275	2.357376871	3.998234511	0	1.541522178	0	0	3.454719629	1.209578133	0	0.518390628	0	0	0.042767227	0	0	0	0	0	0	0	0	0	0	74.6856	0	25.62437735	14.662	0.353612556	2.896824253	0	2.671972868	1.590507536	0.979425946	0.931092192	5.949602543	0.809153498	2.368797886	0.002982671	0.11930686	0.357858561	4.908665256	22.66994548	0.291208275	2.357376871	3.998234511	0	1.541522178	0	0	3.454719629	1.209578133	0	0.518390628	0	0	0.042767227	0	0	0	0	0	0	0	0	0	0	74.6856	YES																																									3800																																									0	0	0	14.662	0.353612556	2.896824253	0	2.671972868	1.590507536	0.979425946	0.931092192	5.949602543	0.809153498	2.368797886	0.002982671	0.11930686	0.357858561	4.908665256	22.66994548	0.291208275	2.357376871	3.998234511	0	1.541522178	0	0	3.454719629	1.209578133	0	0.518390628	0	0	0.042767227	0	0	0	0	0	0	0	0	0	0	74.6856
H2762_034_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1817.970912	46.95068543	1595.411406	2656.062346	354.7601812	16.39424168	10.09548544	314.0726609	399.6473018	7.439743672	21.77985899	1.113068393	44.5227357	133.545063	5456.157041	8500.176635	182.6249638	903.4531352	38.7506064	0	10.63011829	0	0	13.81887852	413.0423852	0	177.0181651	0	0	43.81199585											3800	"$230 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$230 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$45 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$45 Copay	$45 Copay	$45 Copay	$15 Copay	$45 Copay	$15 Copay Group Session; $40 for Indiv.	$45 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$45/Exam	0	$45/Exam			$15/Routine Physical											140.5927273	131.2929032	28.10077519	0	150	0.15	0.15	49.78045234	250	0.15	0.15	45	45	45	15	45	27.5	45	0.15	0	0.2	0	0	0.25	45	0	45	0	0	15											NO	101.6579171	94.93352414	20.31873433	0	108.4600026	0.108460003	0.108460003	35.99458659	180.766671	0.108460003	0.108460003	32.53800077	32.53800077	32.53800077	10.84600026	32.53800077	19.8843338	32.53800077	0.108460003	0	0.144613337	0	0	0.25	32.53800077	0	32.53800077	0	0	10.84600026												15.4009	0.371432836	2.701395043	0	3.206440847	1.778119495	1.094956377	0.942076299	6.020242692	0.806914618	2.362243562	0.003018085	0.120723401	0.362107447	4.931456723	23.04822949	0.302614645	2.449713234	4.20289087	0	1.537256877	0	0	3.454719629	1.119964454	0	0.479984766	0	0	0.039598743	0	0	0	0	0	0	0	0	0	0	76.737	0	28.06700014	15.4009	0.371432836	2.701395043	0	3.206440847	1.778119495	1.094956377	0.942076299	6.020242692	0.806914618	2.362243562	0.003018085	0.120723401	0.362107447	4.931456723	23.04822949	0.302614645	2.449713234	4.20289087	0	1.537256877	0	0	3.454719629	1.119964454	0	0.479984766	0	0	0.039598743	0	0	0	0	0	0	0	0	0	0	76.737	YES																																									3800																																									0	0	0	15.4009	0.371432836	2.701395043	0	3.206440847	1.778119495	1.094956377	0.942076299	6.020242692	0.806914618	2.362243562	0.003018085	0.120723401	0.362107447	4.931456723	23.04822949	0.302614645	2.449713234	4.20289087	0	1.537256877	0	0	3.454719629	1.119964454	0	0.479984766	0	0	0.039598743	0	0	0	0	0	0	0	0	0	0	76.737
H2762_036_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1641.105694	42.38298682	1515.635467	2396.579226	279.449892	14.23111154	8.763441589	280.9190403	376.1455525	6.943734037	20.06574314	1.032339163	41.29356651	120.9608028	5470.992839	8830.933915	192.1109731	943.0646529	42.31508601	0	10.1591397	0	0	13.81887852	413.6186418	2.541295908	177.2651322	0	0	43.87312022											3000	"$50 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$50 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $50 Copay Days 21-100; 100 day limit	$0/Visit; Unlimited Days	$100/Trip	10% Coinsurance	10% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$50/Visit	10% Coinsurance	10% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	10% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$100 Allowance	$20/Exam			$10/Routine Physical											30.56363636	28.54193548	11.24031008	0	100	0.1	0.1	48.68271405	50	0.1	0.1	20	20	20	10	20	15	20	0.1	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	26.5040295	24.7508605	9.747318884	0	86.71752662	0.086717527	0.086717527	42.21644551	43.35876331	0.086717527	0.086717527	17.34350532	17.34350532	17.34350532	8.671752662	17.34350532	13.00762899	17.34350532	0.086717527	0	0.173435053	0	0	0.25	17.34350532	0	17.34350532	0	0	8.671752662												3.6247	0.08741795	1.231115184	0	2.019433621	1.234086794	0.759943979	0.988283613	1.359100499	0.602143441	1.740051615	0.001492032	0.059681266	0.174823694	3.953591393	12.76327912	0.208242355	1.363003902	3.669459598	0	1.761950934	0	0	3.454719629	0.59779976	0	0.256199897	0	0	0.031704737	0	0	0	0	0	0	0	0	0	0	41.9422	0	5.895102723	3.6247	0.08741795	1.231115184	0	2.019433621	1.234086794	0.759943979	0.988283613	1.359100499	0.602143441	1.740051615	0.001492032	0.059681266	0.174823694	3.953591393	12.76327912	0.208242355	1.363003902	3.669459598	0	1.761950934	0	0	3.454719629	0.59779976	0	0.256199897	0	0	0.031704737	0	0	0	0	0	0	0	0	0	0	41.9422	YES																																									3000																																									0	0	0	3.6247	0.08741795	1.231115184	0	2.019433621	1.234086794	0.759943979	0.988283613	1.359100499	0.602143441	1.740051615	0.001492032	0.059681266	0.174823694	3.953591393	12.76327912	0.208242355	1.363003902	3.669459598	0	1.761950934	0	0	3.454719629	0.59779976	0	0.256199897	0	0	0.031704737	0	0	0	0	0	0	0	0	0	0	41.9422
H2762_038_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1732.674503	44.74783124	1701.214524	2148.249217	289.2893146	14.60705048	8.994942758	299.4846282	401.1021309	7.30059763	21.09699422	1.100833003	44.0333201	128.9863337	5476.584359	8542.711994	174.3952566	856.0989485	39.20525974	0	10.68125461	0	0	13.81887852	437.8672443	2.541295908	187.6573904	0	0	46.44520413											3000	"$50 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$50 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $50 Copay Days 21-100; 100 day limit	$0/Visit; Unlimited Days	$100/Trip	10% Coinsurance	10% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$50/Visit	10% Coinsurance	10% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	10% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$100 Allowance	$20/Exam			$10/Routine Physical											30.56363636	28.54193548	11.24031008	0	100	0.1	0.1	48.68271405	50	0.1	0.1	20	20	20	10	20	15	20	0.1	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	26.48944592	24.73724158	9.741955518	0	86.66981116	0.086669811	0.086669811	42.19321633	43.33490558	0.086669811	0.086669811	17.33396223	17.33396223	17.33396223	8.666981116	17.33396223	13.00047167	17.33396223	0.086669811	0	0.173339622	0	0	0.25	17.33396223	0	17.33396223	0	0	8.666981116												3.8248	0.092244826	1.381096352	0	2.089387522	1.265990307	0.77958999	1.053018309	1.448476914	0.632741418	1.828472505	0.00159015	0.063605992	0.186320353	3.955454435	12.33992059	0.188935049	1.236632237	3.397912458	0	1.85148464	0	0	3.454719629	0.632497856	0	0.27107051	0	0	0.033544976	0	0	0	0	0	0	0	0	0	0	42.0095	0	5.929891572	3.8248	0.092244826	1.381096352	0	2.089387522	1.265990307	0.77958999	1.053018309	1.448476914	0.632741418	1.828472505	0.00159015	0.063605992	0.186320353	3.955454435	12.33992059	0.188935049	1.236632237	3.397912458	0	1.85148464	0	0	3.454719629	0.632497856	0	0.27107051	0	0	0.033544976	0	0	0	0	0	0	0	0	0	0	42.0095	YES																																									3000																																									0	0	0	3.8248	0.092244826	1.381096352	0	2.089387522	1.265990307	0.77958999	1.053018309	1.448476914	0.632741418	1.828472505	0.00159015	0.063605992	0.186320353	3.955454435	12.33992059	0.188935049	1.236632237	3.397912458	0	1.85148464	0	0	3.454719629	0.632497856	0	0.27107051	0	0	0.033544976	0	0	0	0	0	0	0	0	0	0	42.0095
H2762_040_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1741.895586	44.98597375	1720.795064	2359.016775	290.6544324	14.4178131	8.8784114	305.1897977	408.7721073	7.430696038	21.47294773	1.12188341	44.87533638	131.452843	5510.495012	8728.246895	183.4678953	900.6361486	36.39494859	0	10.87159714	0	0	13.81887852	438.5888417	2.541295908	187.9666465	0	0	46.521745											3000	"$50 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$50 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $50 Copay Days 21-100; 100 day limit	$0/Visit; Unlimited Days	$100/Trip	10% Coinsurance	10% Coinsurance	$20 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$50/Visit	10% Coinsurance	10% Coinsurance	$20 Copay	$20 Copay	$20 Copay	$10 Copay	$20 Copay	$10 Copay Group Session; $20 for Indiv.	$20 Copay	10% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$20/Exam	$100 Allowance	$20/Exam			$10/Routine Physical											30.56363636	28.54193548	11.24031008	0	100	0.1	0.1	48.68271405	50	0.1	0.1	20	20	20	10	20	15	20	0.1	0	0.2	0	0	0.25	20	0	20	0	0	10											NO	26.4446901	24.69544624	9.725495784	0	86.52337629	0.086523376	0.086523376	42.12192786	43.26168814	0.086523376	0.086523376	17.30467526	17.30467526	17.30467526	8.652337629	17.30467526	12.97850644	17.30467526	0.086523376	0	0.173046753	0	0	0.25	17.30467526	0	17.30467526	0	0	8.652337629												3.8387	0.092579058	1.394632095	0	2.095700235	1.247477868	0.76819013	1.07126522	1.473680952	0.642928909	1.857911937	0.001617819	0.06471276	0.189562397	3.973221946	12.58662317	0.198428272	1.298768006	3.149013832	0	1.88129458	0	0	3.454719629	0.63246979	0	0.271058481	0	0	0.033543487	0	0	0	0	0	0	0	0	0	0	42.2181	0	6.037662276	3.8387	0.092579058	1.394632095	0	2.095700235	1.247477868	0.76819013	1.07126522	1.473680952	0.642928909	1.857911937	0.001617819	0.06471276	0.189562397	3.973221946	12.58662317	0.198428272	1.298768006	3.149013832	0	1.88129458	0	0	3.454719629	0.63246979	0	0.271058481	0	0	0.033543487	0	0	0	0	0	0	0	0	0	0	42.2181	YES																																									3000																																									0	0	0	3.8387	0.092579058	1.394632095	0	2.095700235	1.247477868	0.76819013	1.07126522	1.473680952	0.642928909	1.857911937	0.001617819	0.06471276	0.189562397	3.973221946	12.58662317	0.198428272	1.298768006	3.149013832	0	1.88129458	0	0	3.454719629	0.63246979	0	0.271058481	0	0	0.033543487	0	0	0	0	0	0	0	0	0	0	42.2181
H2762_042_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1582.585995	40.87166453	1416.520494	2266.040855	269.9047465	13.35105221	8.221505812	267.435151	340.1044285	6.542292144	19.15256851	0.952290268	38.09161073	113.6483773	5401.749933	8099.401932	169.9362687	839.8202699	33.32257729	0	9.397712449	0	0	13.81887852	427.2135527	0	183.0915226	0	0	45.31515184											3500	"$230 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$230 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$40 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	$40 Copay	$10 Copay	$40 Copay	$10 Copay Group Session; $40 for Indiv.	$40 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$40/Exam		$40/Exam			$10/Routine Physical											140.5927273	131.2929032	28.10077519	0	150	0.15	0.15	49.56090468	250	0.15	0.15	40	40	40	10	40	25	40	0.15	0	0.2	0	0	0.25	40	0	40	0	0	10											NO	105.1083199	98.15569228	21.00837878	0	112.1412771	0.112141277	0.112141277	37.0521543	186.9021285	0.112141277	0.112141277	29.90434056	29.90434056	29.90434056	7.47608514	29.90434056	18.69021285	29.90434056	0.112141277	0	0.149521703	0	0	0.25	29.90434056	0	29.90434056	0	0	7.47608514												13.8619	0.334315544	2.479899924	0	2.52228858	1.497204046	0.921970161	0.82575404	5.2971868	0.733660996	2.147793492	0.002373134	0.094925375	0.283214982	3.365328534	20.18393948	0.264678753	2.092855947	3.736836374	0	1.405161968	0	0	3.454719629	1.064628298	0	0.45626927	0	0	0.028231661	0	0	0	0	0	0	0	0	0	0	67.0551	0	21.47140757	13.8619	0.334315544	2.479899924	0	2.52228858	1.497204046	0.921970161	0.82575404	5.2971868	0.733660996	2.147793492	0.002373134	0.094925375	0.283214982	3.365328534	20.18393948	0.264678753	2.092855947	3.736836374	0	1.405161968	0	0	3.454719629	1.064628298	0	0.45626927	0	0	0.028231661	0	0	0	0	0	0	0	0	0	0	67.0551	YES																																									3500																																									0	0	0	13.8619	0.334315544	2.479899924	0	2.52228858	1.497204046	0.921970161	0.82575404	5.2971868	0.733660996	2.147793492	0.002373134	0.094925375	0.283214982	3.365328534	20.18393948	0.264678753	2.092855947	3.736836374	0	1.405161968	0	0	3.454719629	1.064628298	0	0.45626927	0	0	0.028231661	0	0	0	0	0	0	0	0	0	0	67.0551
H2762_044_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1609.452694	41.56552046	1444.317614	2048.635616	292.3037928	14.225535	8.760007588	251.5607391	319.8334854	6.710786996	19.6458374	0.895531754	35.82127017	106.8746937	5568.336899	8467.565557	182.3107151	900.9744369	39.62832774	0	9.639747829	0	0	13.81887852	443.1907814	0	189.9389063	0	0	47.00987932											3500	"$230 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$230 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$40 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	$40 Copay	$10 Copay	$40 Copay	$10 Copay Group Session; $40 for Indiv.	$40 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$40/Exam		$40/Exam			$10/Routine Physical											140.5927273	131.2929032	28.10077519	0	150	0.15	0.15	49.56090468	250	0.15	0.15	40	40	40	10	40	25	40	0.15	0	0.2	0	0	0.25	40	0	40	0	0	10											NO	103.7996137	96.93355342	20.74680296	0	110.7450034	0.110745003	0.110745003	36.59081705	184.5750057	0.110745003	0.110745003	29.53200091	29.53200091	29.53200091	7.383000226	29.53200091	18.45750057	29.53200091	0.110745003	0	0.147660005	0	0	0.25	29.53200091	0	29.53200091	0	0	7.383000226												13.9217	0.3357578	2.497081079	0	2.69759871	1.575406922	0.97012707	0.767067748	4.919438947	0.743186129	2.17567833	0.002203904	0.088156149	0.263018629	3.425919382	20.83867948	0.280416677	2.217298157	4.38863929	0	1.423405208	0	0	3.454719629	1.090692547	0	0.467439663	0	0	0.028922829	0	0	0	0	0	0	0	0	0	0	68.5726	0	23.08186238	13.9217	0.3357578	2.497081079	0	2.69759871	1.575406922	0.97012707	0.767067748	4.919438947	0.743186129	2.17567833	0.002203904	0.088156149	0.263018629	3.425919382	20.83867948	0.280416677	2.217298157	4.38863929	0	1.423405208	0	0	3.454719629	1.090692547	0	0.467439663	0	0	0.028922829	0	0	0	0	0	0	0	0	0	0	68.5726	YES																																									3500																																									0	0	0	13.9217	0.3357578	2.497081079	0	2.69759871	1.575406922	0.97012707	0.767067748	4.919438947	0.743186129	2.17567833	0.002203904	0.088156149	0.263018629	3.425919382	20.83867948	0.280416677	2.217298157	4.38863929	0	1.423405208	0	0	3.454719629	1.090692547	0	0.467439663	0	0	0.028922829	0	0	0	0	0	0	0	0	0	0	68.5726
H2762_046_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1634.74221	42.2186443	1495.335777	1800.932072	281.8385006	13.31207127	8.197501559	261.8790416	333.0108029	7.046836462	20.62962264	0.932428161	37.29712643	111.2779905	5417.819804	7940.289886	159.4017911	787.7591772	35.31813271	0	10.12246798	0	0	13.81887852	425.8329717	0	182.499845	0	0	45.16871164											3500	"$230 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$230 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$40 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	$40 Copay	$10 Copay	$40 Copay	$10 Copay Group Session; $40 for Indiv.	$40 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$40/Exam		$40/Exam			$10/Routine Physical											140.5927273	131.2929032	28.10077519	0	150	0.15	0.15	49.56090468	250	0.15	0.15	40	40	40	10	40	25	40	0.15	0	0.2	0	0	0.25	40	0	40	0	0	10											NO	104.7683117	97.83817469	20.94042012	0	111.7785184	0.111778518	0.111778518	36.93229665	186.2975307	0.111778518	0.111778518	29.80760491	29.80760491	29.80760491	7.451901229	29.80760491	18.62975307	29.80760491	0.111778518	0	0.149038025	0	0	0.25	29.80760491	0	29.80760491	0	0	7.451901229												14.2724	0.344216258	2.609413282	0	2.625290836	1.488003604	0.916304579	0.805982871	5.16992419	0.787684939	2.305948654	0.002316121	0.092644834	0.276410865	3.364421505	19.72341865	0.247468001	1.95676786	3.947808548	0	1.508632632	0	0	3.454719629	1.057755082	0	0.453323606	0	0	0.028049398	0	0	0	0	0	0	0	0	0	0	67.4389	0	21.87872632	14.2724	0.344216258	2.609413282	0	2.625290836	1.488003604	0.916304579	0.805982871	5.16992419	0.787684939	2.305948654	0.002316121	0.092644834	0.276410865	3.364421505	19.72341865	0.247468001	1.95676786	3.947808548	0	1.508632632	0	0	3.454719629	1.057755082	0	0.453323606	0	0	0.028049398	0	0	0	0	0	0	0	0	0	0	67.4389	YES																																									3500																																									0	0	0	14.2724	0.344216258	2.609413282	0	2.625290836	1.488003604	0.916304579	0.805982871	5.16992419	0.787684939	2.305948654	0.002316121	0.092644834	0.276410865	3.364421505	19.72341865	0.247468001	1.95676786	3.947808548	0	1.508632632	0	0	3.454719629	1.057755082	0	0.453323606	0	0	0.028049398	0	0	0	0	0	0	0	0	0	0	67.4389
H2762_048_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1698.544717	43.86639972	1395.923928	2328.460651	284.8444288	14.7338858	9.073047261	273.191303	347.4543404	7.041162838	20.61301309	0.972869975	38.91479901	116.104404	5631.267287	8466.768015	178.5564196	882.4208138	38.4332297	0	10.11431807	0	0	13.81887852	436.0647603	0	186.8848973	0	0	46.25401208											3500	"$230 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$230 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $125 Copay Days 21-100; 100 day limit	$0/Visit; 365 Day Limit	$150/Trip	15% Coinsurance	15% Coinsurance	$40 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$250/Visit	15% Coinsurance	15% Coinsurance	$40 Copay	$40 Copay	$40 Copay	$10 Copay	$40 Copay	$10 Copay Group Session; $40 for Indiv.	$40 Copay	15% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$40/Exam		$40/Exam			$10/Routine Physical											140.5927273	131.2929032	28.10077519	0	150	0.15	0.15	49.56090468	250	0.15	0.15	40	40	40	10	40	25	40	0.15	0	0.2	0	0	0.25	40	0	40	0	0	10											NO	103.1080631	96.28774701	20.60858025	0	110.0071801	0.11000718	0.11000718	36.34703579	183.3453002	0.11000718	0.11000718	29.33524803	29.33524803	29.33524803	7.333812007	29.33524803	18.33453002	29.33524803	0.11000718	0	0.14667624	0	0	0.25	29.33524803	0	29.33524803	0	0	7.333812007												14.5945	0.351983067	2.397334191	0	2.611244365	1.620833229	0.998100344	0.827474505	5.308676695	0.774578468	2.267579444	0.002378282	0.095131273	0.283829291	3.441554637	20.69789498	0.272812336	2.157169453	4.227931221	0	1.483530146	0	0	3.454719629	1.066005658	0	0.456859568	0	0	0.028268186	0	0	0	0	0	0	0	0	0	0	69.4204	0	23.9816345	14.5945	0.351983067	2.397334191	0	2.611244365	1.620833229	0.998100344	0.827474505	5.308676695	0.774578468	2.267579444	0.002378282	0.095131273	0.283829291	3.441554637	20.69789498	0.272812336	2.157169453	4.227931221	0	1.483530146	0	0	3.454719629	1.066005658	0	0.456859568	0	0	0.028268186	0	0	0	0	0	0	0	0	0	0	69.4204	YES																																									3500																																									0	0	0	14.5945	0.351983067	2.397334191	0	2.611244365	1.620833229	0.998100344	0.827474505	5.308676695	0.774578468	2.267579444	0.002378282	0.095131273	0.283829291	3.441554637	20.69789498	0.272812336	2.157169453	4.227931221	0	1.483530146	0	0	3.454719629	1.066005658	0	0.456859568	0	0	0.028268186	0	0	0	0	0	0	0	0	0	0	69.4204
H2762_050_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1620.025509	41.83857265	1449.145529	2266.040855	269.9047465	13.35105221	8.221505812	267.435151	363.9036446	6.627730701	19.15256851	1.013870432	40.55481729	115.1325595	5700.651683	9020.549887	189.2631829	921.2339963	33.47789029	0	10.00541862	0	0	13.81887852	427.2135527	2.541295908	183.0915226	0	0	45.31515184											2000	"$30 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$30 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $30 Copay Days 21-100; 100 day limit	$0/Visit; Unlimited Days	$100/Trip	10% Coinsurance	10% Coinsurance	$10 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$30/Visit	10% Coinsurance	10% Coinsurance	$10 Copay	$10 Copay	$10 Copay	$5 Copay	$10 Copay	$5 Copay Group Session; $10 for Indiv.	$10 Copay	10% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$10/Exam	$100 Allowance	$10/Exam			$5/Routine Physical											18.33818182	17.12516129	6.744186047	0	100	0.1	0.1	48.24361873	30	0.1	0.1	10	10	10	5	10	7.5	10	0.1	0	0.2	0	0	0.25	10	0	10	0	0	5											NO	15.96578527	14.90969228	5.871695859	0	87.06307654	0.087063077	0.087063077	42.0023787	26.11892296	0.087063077	0.087063077	8.706307654	8.706307654	8.706307654	4.353153827	8.706307654	6.52973074	8.706307654	0.087063077	0	0.174126153	0	0	0.25	8.706307654	0	8.706307654	0	0	4.353153827												2.1554	0.051983354	0.709078483	0	1.958228133	1.162383681	0.71578959	0.936076041	0.792064272	0.577030625	1.667481538	0.000735589	0.02942356	0.083531624	2.067984474	6.54464021	0.102986469	0.668378883	2.914688124	0	1.742205054	0	0	3.454719629	0.309954385	0	0.132837594	0	0	0.016438652	0	0	0	0	0	0	0	0	0	0	28.7941	0	3.765236128	2.1554	0.051983354	0.709078483	0	1.958228133	1.162383681	0.71578959	0.936076041	0.792064272	0.577030625	1.667481538	0.000735589	0.02942356	0.083531624	2.067984474	6.54464021	0.102986469	0.668378883	2.914688124	0	1.742205054	0	0	3.454719629	0.309954385	0	0.132837594	0	0	0.016438652	0	0	0	0	0	0	0	0	0	0	28.7941	YES																																									2000																																									0	0	0	2.1554	0.051983354	0.709078483	0	1.958228133	1.162383681	0.71578959	0.936076041	0.792064272	0.577030625	1.667481538	0.000735589	0.02942356	0.083531624	2.067984474	6.54464021	0.102986469	0.668378883	2.914688124	0	1.742205054	0	0	3.454719629	0.309954385	0	0.132837594	0	0	0.016438652	0	0	0	0	0	0	0	0	0	0	28.7941
H2762_052_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1647.527798	42.54884325	1477.582867	2048.635616	292.3037928	14.225535	8.760007588	251.5607391	342.2142178	6.798425999	19.6458374	0.95344161	38.13766441	108.2704155	5876.456613	9430.584896	203.0449797	988.3165609	39.80319984	0	10.2631053	0	0	13.81887852	443.1907814	2.541295908	189.9389063	0	0	47.00987932											2000	"$30 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$30 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $30 Copay Days 21-100; 100 day limit	$0/Visit; Unlimited Days	$100/Trip	10% Coinsurance	10% Coinsurance	$10 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$30/Visit	10% Coinsurance	10% Coinsurance	$10 Copay	$10 Copay	$10 Copay	$5 Copay	$10 Copay	$5 Copay Group Session; $10 for Indiv.	$10 Copay	10% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$10/Exam	$100 Allowance	$10/Exam			$5/Routine Physical											18.33818182	17.12516129	6.744186047	0	100	0.1	0.1	48.24361873	30	0.1	0.1	10	10	10	5	10	7.5	10	0.1	0	0.2	0	0	0.25	10	0	10	0	0	5											NO	15.77454196	14.73109919	5.801362796	0	86.02020698	0.086020207	0.086020207	41.49926069	25.80606209	0.086020207	0.086020207	8.602020698	8.602020698	8.602020698	4.301010349	8.602020698	6.451515523	8.602020698	0.086020207	0	0.172040414	0	0	0.25	8.602020698	0	8.602020698	0	0	4.301010349												2.1657	0.052232603	0.714332856	0	2.095336063	1.223683465	0.753537666	0.869965391	0.735933446	0.584802012	1.689939	0.00068346	0.027338415	0.07761203	2.106225059	6.760173873	0.10916232	0.708459959	3.423879489	0	1.765668884	0	0	3.454719629	0.31769469	0	0.136154867	0	0	0.016849165	0	0	0	0	0	0	0	0	0	0	29.7901	0	4.279966946	2.1657	0.052232603	0.714332856	0	2.095336063	1.223683465	0.753537666	0.869965391	0.735933446	0.584802012	1.689939	0.00068346	0.027338415	0.07761203	2.106225059	6.760173873	0.10916232	0.708459959	3.423879489	0	1.765668884	0	0	3.454719629	0.31769469	0	0.136154867	0	0	0.016849165	0	0	0	0	0	0	0	0	0	0	29.7901	YES																																									2000																																									0	0	0	2.1657	0.052232603	0.714332856	0	2.095336063	1.223683465	0.753537666	0.869965391	0.735933446	0.584802012	1.689939	0.00068346	0.027338415	0.07761203	2.106225059	6.760173873	0.10916232	0.708459959	3.423879489	0	1.765668884	0	0	3.454719629	0.31769469	0	0.136154867	0	0	0.016849165	0	0	0	0	0	0	0	0	0	0	29.7901
H2762_054_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	Coin	Coin	P	P	P	V	V	V	V	Coin	V	Coin	O	T	Coin	V	Coin	V	Coin	O	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	YES	1673.415593	43.21741816	1529.776071	1800.932072	281.8385006	13.31207127	8.197501559	261.8790416	356.313634	7.138864077	20.62962264	0.992723935	39.7089574	112.7312168	5717.610769	8843.341969	177.5306153	864.1260051	35.48503702	0	10.77704071	0	0	13.81887852	425.8329717	2.541295908	182.499845	0	0	45.16871164											2000	"$30 Copay/Day, up to 6 days; 25% coinsurance on days 151 and beyond"	"$30 Copay/Day, up to 6 days; 190 day limit"	$0 Copay Days 1-20; $30 Copay Days 21-100; 100 day limit	$0/Visit; Unlimited Days	$100/Trip	10% Coinsurance	10% Coinsurance	$10 Copay for UC; $50 Copay for ER; $50 Copay for Worldwide Covg	$30/Visit	10% Coinsurance	10% Coinsurance	$10 Copay	$10 Copay	$10 Copay	$5 Copay	$10 Copay	$5 Copay Group Session; $10 for Indiv.	$10 Copay	10% Coinsurance	No charge for IP physician services	20% Coinsurance	No charge for blood		"25% Coinsurance; limited to semi-annual cleanings, exams, and annual x-rays"	$10/Exam	$100 Allowance	$10/Exam			$5/Routine Physical											18.33818182	17.12516129	6.744186047	0	100	0.1	0.1	48.24361873	30	0.1	0.1	10	10	10	5	10	7.5	10	0.1	0	0.2	0	0	0.25	10	0	10	0	0	5											NO	15.89588368	14.84441449	5.845988331	0	86.68189594	0.086681896	0.086681896	41.81848338	26.00456878	0.086681896	0.086681896	8.668189594	8.668189594	8.668189594	4.334094797	8.668189594	6.501142195	8.668189594	0.086681896	0	0.173363792	0	0	0.25	8.668189594	0	8.668189594	0	0	4.334094797												2.2167	0.053461439	0.745254421	0	2.035857965	1.153915577	0.710574977	0.912615362	0.772148534	0.618810273	1.788214803	0.000717093	0.028683731	0.081431297	2.06505559	6.387980402	0.096179314	0.62420067	3.075910287	0	1.868348642	0	0	3.454719629	0.307600078	0	0.131828605	0	0	0.01631379	0	0	0	0	0	0	0	0	0	0	29.1465	0	3.947377039	2.2167	0.053461439	0.745254421	0	2.035857965	1.153915577	0.710574977	0.912615362	0.772148534	0.618810273	1.788214803	0.000717093	0.028683731	0.081431297	2.06505559	6.387980402	0.096179314	0.62420067	3.075910287	0	1.868348642	0	0	3.454719629	0.307600078	0	0.131828605	0	0	0.01631379	0	0	0	0	0	0	0	0	0	0	29.1465	YES																																									2000																																									0	0	0	2.2167	0.053461439	0.745254421	0	2.035857965	1.153915577	0.710574977	0.912615362	0.772148534	0.618810273	1.788214803	0.000717093	0.028683731	0.081431297	2.06505559	6.387980402	0.096179314	0.62420067	3.075910287	0	1.868348642	0	0	3.454719629	0.307600078	0	0.131828605	0	0	0.01631379	0	0	0	0	0	0	0	0	0	0	29.1465
H2762_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	264.2313133	29.35903481	55.12233157	39.04135283	7.328041517	18.79887727	2.088764141	15.75279366	42.9709845	15.37882735	15.37882735	12.30306188	15.37882735	3.07576547	81.30079371	81.30079371	27.10026457	27.10026457	27.10026457	27.10026457	10.88115073	0.800170504																				Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share																			0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131	0	0	19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131	NO																																																																																		0	0	0	19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131
H2762_803_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	254.5776053	28.28640059	65.22918943	44.57143026	9.003485677	6.118640386	0.679848932	8.057728322	38.41810491	19.67073832	19.67073832	15.73659066	19.67073832	3.934147664	78.20365725	78.20365725	26.06788575	26.06788575	26.06788575	26.06788575	23.69936095	2.934133751																				Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share																			0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.2461	2.13845735	10.72384891	0	2.097812163	1.42564321	0.158404801	1.877450699	8.951418443	4.583282029	4.583282029	3.666625623	4.583282029	0.916656406	18.22145214	18.22145214	6.07381738	6.07381738	6.07381738	6.07381738	5.521951102	0.683653164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.8961	0	0	19.2461	2.13845735	10.72384891	0	2.097812163	1.42564321	0.158404801	1.877450699	8.951418443	4.583282029	4.583282029	3.666625623	4.583282029	0.916656406	18.22145214	18.22145214	6.07381738	6.07381738	6.07381738	6.07381738	5.521951102	0.683653164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.8961	NO																																																																																		0	0	0	19.2461	2.13845735	10.72384891	0	2.097812163	1.42564321	0.158404801	1.877450699	8.951418443	4.583282029	4.583282029	3.666625623	4.583282029	0.916656406	18.22145214	18.22145214	6.07381738	6.07381738	6.07381738	6.07381738	5.521951102	0.683653164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.8961
H2762_804_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	264.2313133	29.35903481	55.12233157	39.04135283	7.328041517	18.79887727	2.088764141	15.75279366	42.9709845	15.37882735	15.37882735	12.30306188	15.37882735	3.07576547	81.30079371	81.30079371	27.10026457	27.10026457	27.10026457	27.10026457	10.88115073	0.800170504																				Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share																			0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131	0	0	19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131	NO																																																																																		0	0	0	19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131
H2762_808_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	264.2313133	29.35903481	55.12233157	39.04135283	7.328041517	18.79887727	2.088764141	15.75279366	42.9709845	15.37882735	15.37882735	12.30306188	15.37882735	3.07576547	81.30079371	81.30079371	27.10026457	27.10026457	27.10026457	27.10026457	10.88115073	0.800170504																				Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share																			0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131	0	0	19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131	NO																																																																																		0	0	0	19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131
H2762_809_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	264.2313133	29.35903481	55.12233157	39.04135283	7.328041517	18.79887727	2.088764141	15.75279366	42.9709845	15.37882735	15.37882735	12.30306188	15.37882735	3.07576547	81.30079371	81.30079371	27.10026457	27.10026457	27.10026457	27.10026457	10.88115073	0.800170504																				Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share																			0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131	0	0	19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131	NO																																																																																		0	0	0	19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131
H2762_810_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	264.2313133	29.35903481	55.12233157	39.04135283	7.328041517	18.79887727	2.088764141	15.75279366	42.9709845	15.37882735	15.37882735	12.30306188	15.37882735	3.07576547	81.30079371	81.30079371	27.10026457	27.10026457	27.10026457	27.10026457	10.88115073	0.800170504																				Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share	Medicare FFS cost share																			0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.075600193	0.075600193	0.164402609	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131	0	0	19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131	NO																																																																																		0	0	0	19.9759	2.219548704	9.062255112	0	1.707433674	4.380138403	0.486682045	3.670400922	10.01223939	3.583266773	3.583266773	2.866613418	3.583266773	0.716653355	18.94308493	18.94308493	6.314361645	6.314361645	6.314361645	6.314361645	2.53530812	0.186439728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7131
H2773_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	O	T	V	V	P	V	P	O	O																																																			0	NO	2271.236348	181.7294467	1320.817506		163.613586		7.312769682	166.506152	222.384656	552.3510574	187.8004234	64.16196029	0.61163302	586.755922		10112.25992	897.1393005	2916.631833	5405.394548	0.157391425	33.09301071				153.9163096																	"1a: Days 1-7, $100 copay, Days 8-90, $0 copay"	"1b: Days 1-7, $100 copay, Days 8-90, $0 copay"	"2: Days 1-10, $0 copay, 11-100, $75 copay"	6: $0/visit	10a: $100/trip	11a: $0 for capitated DME and 20% for electronic items	11b: 20%;11c: 20%	4a: $50/visit;4b: $15/visit	9a: $175/visit;9b: $150/visit	8a: $0 (stand alone facility) to $100 Hospital outpatient	"8b: $5/visit;8b: $40 Ultrasounds and CT; $200 MRI and PET;8b: 20% therapuetic radiation, $200 Nuclear Medicine"	9a: $200/visit	12a: 20%	3: $30/visit;5: $30/visit;7c: $20/visit;7e: $30/visit;7i: $20/visit;9a: $200/visit;9c: $30/visit;9d: $30/visit;13a: 0%	7a: $0/visit;14c: $0/visit;14c1: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit;14h: $0/visit;14j: 20%	7b: $15/visit;7d: $15/visit;7f: $15/visit;14j: 20%;16b: $0/visit;17a: $15/visit;18a: $15/visit	7e: $30/visit;7h: $30/visit	7c: $20/visit;7i: $20/visit	"8b: $5/visit;8b: $40 Ultrasounds and CT; $200 MRI and PET;8b: 20% therapuetic radiation, $200 Nuclear Medicine"	7g: $30/visit;8a: $0 (stand alone facility) to $100 Hospital outpatient;12a: 20%;14b: $0/visit;14i: 20%	15: 20%	17b: $30/visit	10b: $10 allowance per trip	16a: $0/visit	17a1: $30/visit	17b1: $75 allowance	18a1: $15/visit	18b: $500 allowance	14a: $0 copay	13b: 4 visits/year;13c: $30/quarter allowance											72.00781211	42.86848883	32.91310149		100		0.2	43	160.7712999	10	153.5998863	200	0.2	125.9486904		14.99687886	22.95000896	20	6.048525132	0.2	0.2				30																NO	72.00781211	42.86848883	32.91310149		100		0.2	43	160.7712999	10	153.5998863	200	0.2	125.9486904		14.99687886	22.95000896	20	6.048525132	0.2	0.2				30																	13.6289	0.649205563	3.622683385	0	1.36344655	0	1.462553936	0.596647045	2.979422519	0.460292548	2.403843639	1.069366005	0.122326604	6.158428332	0	12.63769475	1.715779582	4.861053056	2.724555397	0.031478285	6.618602142	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4911	0	0	13.6289	0.649205563	3.622683385	0	1.36344655	0	1.462553936	0.596647045	2.979422519	0.460292548	2.403843639	1.069366005	0.122326604	6.158428332	0	12.63769475	1.715779582	4.861053056	2.724555397	0.031478285	6.618602142	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4911	NO																																																																																		0	0	0	13.6289	0.649205563	3.622683385	0	1.36344655	0	1.462553936	0.596647045	2.979422519	0.460292548	2.403843639	1.069366005	0.122326604	6.158428332	0	12.63769475	1.715779582	4.861053056	2.724555397	0.031478285	6.618602142	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4911
H2773_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	O	T	V	V	P	V	P	O	O																																																			0	NO	2245.931989	179.7047577	1306.101979		161.79073		7.265162685	164.6510692	219.9070181	546.197189	185.7080963	63.44711734	0.604061058	580.2187412		9999.596941	887.1440682	2884.136977	5345.171822	0.155442934	32.68332223				153.9163096																	"1a: Days 1-7, $200 copay, Days 8-90, $0 copay"	"1b: Days 1-7, $200 copay, Days 8-90, $0 copay"	"2: Days 1-10, $0 copay, 11-100, $90 copay"	6: $0/visit	10a: $100/trip	11a: $0 for capitated DME and 20% for electronic items	11b: 20%;11c: 20%	4a: $50/visit;4b: $15/visit	9a: $175/visit;9b: $150/visit	8a: $0 (stand alone facility) to $100 Hospital outpatient	"8b: $5/visit;8b: $40 Ultrasounds and CT; $250 MRI and PET;8b: 20% therapuetic radiation, $250 Nuclear Medicine"	9a: $200/visit	12a: 20%	3: $30/visit;5: $30/visit;7c: $30/visit;7e: $30/visit;7i: $30/visit;9a: $200/visit;9c: $30/visit;9d: $30/visit;13a: 0%	7a: $0/visit;14c: $0/visit;14c1: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit;14h: $0/visit;14j: 20%	7b: $15/visit;7d: $20/visit;7f: $15/visit;14j: 20%;16b: $0/visit;17a: $15/visit;18a: $15/visit	7e: $30/visit;7h: $30/visit	7c: $30/visit;7i: $30/visit	"8b: $5/visit;8b: $40 Ultrasounds and CT; $250 MRI and PET;8b: 20% therapuetic radiation, $250 Nuclear Medicine"	7g: $30/visit;8a: $0 (stand alone facility) to $100 Hospital outpatient;12a: 20%;14b: $0/visit;14i: 20%	15: 20%	17b: $30/visit		16a: $0/visit	17a1: $30/visit	17b1: $75 allowance	18a1: $15/visit	18b: $500 allowance	14a: $0 copay	13b: 4 visits/year;13c: $30/quarter allowance											144.0156242	85.73697766	39.49572179		100		0.2	43	160.7712999	10	161.5003735	200	0.2	126.9324094		18.45292895	27.62747057	30	6.046787326	0.2	0.2				30																NO	144.0156242	85.73697766	39.49572179		100		0.2	43	160.7712999	10	161.5003735	200	0.2	126.9324094		18.45292895	27.62747057	30	6.046787326	0.2	0.2				30																	26.9541	1.283945233	4.298786698	0	1.348256083	0	1.453032537	0.589999665	2.946228097	0.455164324	2.499327243	1.057451956	0.120812212	6.137380233	0	15.37682099	2.04246222	7.210342442	2.693426436	0.031088587	6.536664445	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4201	0	0	26.9541	1.283945233	4.298786698	0	1.348256083	0	1.453032537	0.589999665	2.946228097	0.455164324	2.499327243	1.057451956	0.120812212	6.137380233	0	15.37682099	2.04246222	7.210342442	2.693426436	0.031088587	6.536664445	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4201	NO																																																																																		0	0	0	26.9541	1.283945233	4.298786698	0	1.348256083	0	1.453032537	0.589999665	2.946228097	0.455164324	2.499327243	1.057451956	0.120812212	6.137380233	0	15.37682099	2.04246222	7.210342442	2.693426436	0.031088587	6.536664445	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.4201
H2773_003_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	O	T	V	V	P	V	P	O	O	P																																																		0	NO	3914.42833	248.499668	2305.865893		271.5576056		9.4183649	221.5475752	271.400361	745.9613468	226.8108867	95.51998107	1.179518765	740.7419872		13369.52903	857.6775687	3580.145378	7522.622788	0.302600497	49.16950089				153.9163096																	"1a: Days 1-7, $200 copay, Days 8-90, $0 copay"	"1b: Days 1-7, $200 copay, Days 8-90, $0 copay"	"2: Days 1-10, $0 copay, 11-100, $75 copay"	6: $0/visit	10a: $100/trip	11a: $0 for capitated DME and 20% for electronic items	11b: 20%;11c: 20%	4a: $50/visit;4b: $15/visit	9a: $200/visit;9b: $150/visit	8a: $0 (stand alone facility) to $100 Hospital outpatient;8a: $20/visit	"8b: $5/visit;8b: $40 Ultrasounds and CT; $250 MRI and PET;8b: 20% therapuetic radiation, $250 Nuclear Medicine"	9a: $300/visit	12a: 20%	3: $30/visit;5: $30/visit;7c: $30/visit;7e: $30/visit;7i: $30/visit;9a: $200-$300/visit;9c: $30/visit;9d: $50/visit;13a: 0%	7a: $0/visit;14c: $0/visit;14c1: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit;14h: $0/visit;14j: 20%	7b: $20/visit;7d: $20/visit;7f: $20/visit;14j: 20%;16b: $0/visit;17a: $15/visit;18a: $15/visit	7e: $30/visit;7h: $30/visit	7c: $30/visit;7i: $30/visit	"8b: $5/visit;8b: $40 Ultrasounds and CT; $250 MRI and PET;8b: 20% therapuetic radiation, $250 Nuclear Medicine"	7g: $30/visit;8a: $0 (stand alone facility) to $100 Hospital outpatient;12a: 20%;14b: $0/visit;14i: 20%	15: 20%	17b: $30/visit		16a: $0/visit	17a1: $30/visit	17b1: $75 allowance	18a1: $15/visit	18b: $500 allowance	14a: $0 copay	13b: 4 visits/year;13c: $30/quarter allowance											140.2122444	81.91396237	32.7937661		100		0.2	43	180.8709693	10	159.9617352	300	0.2	161.6305236		19.46035182	23.13778647	30	6.0509047	0.2	0.2				30																NO	140.2122444	81.91396237	32.7937661		100		0.2	43	180.8709693	10	159.9617352	300	0.2	161.6305236		19.46035182	23.13778647	30	6.0509047	0.2	0.2				30																	45.7376	1.696299372	6.301502228	0	2.262980047	0	1.88367298	0.793878811	4.090703863	0.621634456	3.023421916	2.387999527	0.235903753	9.977209606	0	21.68131156	1.653730037	8.950363446	3.793222798	0.060520099	9.833900177	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.3706	0	0	45.7376	1.696299372	6.301502228	0	2.262980047	0	1.88367298	0.793878811	4.090703863	0.621634456	3.023421916	2.387999527	0.235903753	9.977209606	0	21.68131156	1.653730037	8.950363446	3.793222798	0.060520099	9.833900177	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.3706	NO																																																																																		0	0	0	45.7376	1.696299372	6.301502228	0	2.262980047	0	1.88367298	0.793878811	4.090703863	0.621634456	3.023421916	2.387999527	0.235903753	9.977209606	0	21.68131156	1.653730037	8.950363446	3.793222798	0.060520099	9.833900177	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.3706
H2773_004_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	O	O																																																			0	NO	425.8854059	2.140653658	59.67395239		14.5144755	7.214710109	9.407311649	17.60365514	28.88262828	1.852486736	14.27666817	3.887717622	10.38722348	34.649267	78.11758076	147.9261973	0.563526977	22.54983667	43.21014325	7.934040575	14.56756046																					MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	10b: $10/trip	16a: $0/visit;16b1: $1500/year	17a1: $0/visit	17b1: $0 copay	18a: $0/visit	18b: $1000/year	14a: $0 copay	13b: 4 visits/year;13c: $30/month allowance											0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					26.2205	0.131793867	8.631163428	0	3.38187279	1.681027455	2.191903614	4.101651647	6.729652389	0.431629409	3.326463683	0.905838206	2.42022307	8.073279211	18.20139632	34.46680397	0.131301786	5.254111945	10.06796338	1.848631454	3.394241586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5915	0	0	26.2205	0.131793867	8.631163428	0	3.38187279	1.681027455	2.191903614	4.101651647	6.729652389	0.431629409	3.326463683	0.905838206	2.42022307	8.073279211	18.20139632	34.46680397	0.131301786	5.254111945	10.06796338	1.848631454	3.394241586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5915	NO																																																																																		0	0	0	26.2205	0.131793867	8.631163428	0	3.38187279	1.681027455	2.191903614	4.101651647	6.729652389	0.431629409	3.326463683	0.905838206	2.42022307	8.073279211	18.20139632	34.46680397	0.131301786	5.254111945	10.06796338	1.848631454	3.394241586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5915
H2773_005_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	V	T	V	V	P	V	P	O	O																																																			0	NO	1998.343357	127.1131887	1154.4011		65.66880592		8.340969067	213.1134731	235.4592258	768.996065	318.0709289	30.518339	0.251967981	400.4880777		9303.881852	887.1011774	2330.812878	5485.384958	0.138741403	46.19335177				153.9163096																	"1a: Day 1, $300 copay, Days 2-10, $40 copay"	"1b: Day 1, $300 copay, Days 2-10, $40 copay"	"2: Days 1-10, $0 copay, 11-100, $75 copay"	6: $0/visit	10a: $100/trip	11a: $0 for capitated DME and 20% for electronic items	11b: 20%;11c: 20%	4a: $50/visit;4b: $15/visit	9a: $200/visit;9b: $150/visit	8a: $0 (stand alone facility) to $100 Hospital outpatient;8a: $20/visit	"8b: $5/visit;8b: $40 Ultrasounds and CT; $250 MRI and PET;8b: 20% therapuetic radiation, $250 Nuclear Medicine"	9a: $300/visit	12a: 20%	3: $30/visit;5: $30/visit;7c: $30/visit;7e: $30/visit;7i: $30/visit;9a: $200-$300/visit;9c: $30/visit;9d: $50/visit;13a: 0%	7a: $0/visit;14c: $0/visit;14c1: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit;14h: $0/visit;14j: 20%	7b: $20/visit;7d: $20/visit;7f: $20/visit;14j: 20%;16b: $0/visit;17a: $15/visit;18a: $15/visit	7e: $30/visit;7h: $30/visit	7c: $30/visit;7i: $30/visit	"8b: $5/visit;8b: $40 Ultrasounds and CT; $250 MRI and PET;8b: 20% therapuetic radiation, $250 Nuclear Medicine"	7g: $30/visit;8a: $0 (stand alone facility) to $100 Hospital outpatient;12a: 20%;14b: $0/visit;14i: 20%	15: 20%	17b: $30/visit		16a: $0/visit	17a1: $30/visit	17b1: $75 allowance	18a1: $15/visit	18b: $500 allowance	14a: $0 copay	13b: 4 visits/year											91.12720424	54.58087544	32.76315557		100		0.2	43	183.4380813	10	114.1006558	300	0.2	199.9282344		19.43099081	23.47270668	30	6.428842099	0.2	0.2				30																NO	91.12720424	54.58087544	32.76315557		100		0.2	43	183.4380813	10	114.1006558	300	0.2	199.9282344		19.43099081	23.47270668	30	6.428842099	0.2	0.2				30																	15.1753	0.578162427	3.151818568	0	0.547240049	0	1.668193813	0.763656612	3.599349049	0.640830054	3.024341798	0.762958475	0.050393596	6.672406189	0	15.06530357	1.735222144	5.827032196	2.938722812	0.027748281	9.238670353	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8521	0	0	15.1753	0.578162427	3.151818568	0	0.547240049	0	1.668193813	0.763656612	3.599349049	0.640830054	3.024341798	0.762958475	0.050393596	6.672406189	0	15.06530357	1.735222144	5.827032196	2.938722812	0.027748281	9.238670353	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8521	NO																																																																																		0	0	0	15.1753	0.578162427	3.151818568	0	0.547240049	0	1.668193813	0.763656612	3.599349049	0.640830054	3.024341798	0.762958475	0.050393596	6.672406189	0	15.06530357	1.735222144	5.827032196	2.938722812	0.027748281	9.238670353	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8521
H2773_006_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	V	T	V	V	P	V	P	O	O	P																																																		0	NO	3483.94152	140.3706305	2137.284835		113.258159		10.24564335	271.2017582	301.1483287	1052.223621	399.7017938	52.79843407	0.453690964	502.8595822	6258.176782	12399.93389	844.474153	2668.726651	7698.568935	0.275376569	65.08909284				153.9163096																	"1a: Days 1-7, $200 copay, Days 8-90, $0 copay"	"1b: Days 1-7, $200 copay, Days 8-90, $0 copay"	"2: Days 1-10, $0 copay, 11-100, $75 copay"	6: $0/visit	10a: $100/trip	11a: $0 for capitated DME and 20% for electronic items	11b: 20%;11c: 20%	4a: $50/visit;4b: $25/visit	9a: $200/visit;9b: $150/visit	8a: $0 (stand alone facility) to $100 Hospital outpatient;8a: $20/visit	"8b: $5/visit;8b: $40 Ultrasounds and CT; $250 MRI and PET;8b: 20% therapuetic radiation, $250 Nuclear Medicine"	9a: $300/visit	12a: 20%	3: $30/visit;5: $30/visit;7c: $30/visit;7e: $30/visit;7i: $30/visit;9a: $200-$300/visit;9c: $30/visit;9d: $50/visit;13a: 0%	7a: $5/visit;14c: $0/visit;14c1: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit;14h: $0/visit;14j: 20%	7b: $20/visit;7d: $25/visit;7f: $20/visit;14j: 20%;16b: $0/visit;17a: $15/visit;18a: $15/visit	7e: $30/visit;7h: $30/visit	7c: $30/visit;7i: $30/visit	"8b: $5/visit;8b: $40 Ultrasounds and CT; $250 MRI and PET;8b: 20% therapuetic radiation, $250 Nuclear Medicine"	7g: $30/visit;8a: $0 (stand alone facility) to $100 Hospital outpatient;12a: 20%;14b: $0/visit;14i: 20%	15: 20%	17b: $30/visit		16a: $0/visit	17a1: $30/visit	17b1: $75 allowance	18a1: $15/visit	18b: $500 allowance	14a: $0 copay	13b: 4 visits/year											145.7796573	101.1324663	32.98920471		100		0.2	45	184.6900899	10	108.8958741	300	0.2	199.7968127	5	23.88022652	26.63064344	30	6.245693382	0.2	0.2				30																NO	145.7796573	101.1324663	32.98920471		100		0.2	45	184.6900899	10	108.8958741	300	0.2	199.7968127	5	23.88022652	26.63064344	30	6.245693382	0.2	0.2				30																	42.324	1.183002338	5.875610578	0	0.943817992	0	2.049128669	1.017006593	4.634925991	0.876853017	3.627156352	1.319960852	0.090738193	8.372478482	2.607573659	24.67610251	1.874074172	6.671816627	4.00690842	0.055075314	13.01781857	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6088	0	0	42.324	1.183002338	5.875610578	0	0.943817992	0	2.049128669	1.017006593	4.634925991	0.876853017	3.627156352	1.319960852	0.090738193	8.372478482	2.607573659	24.67610251	1.874074172	6.671816627	4.00690842	0.055075314	13.01781857	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6088	NO																																																																																		0	0	0	42.324	1.183002338	5.875610578	0	0.943817992	0	2.049128669	1.017006593	4.634925991	0.876853017	3.627156352	1.319960852	0.090738193	8.372478482	2.607573659	24.67610251	1.874074172	6.671816627	4.00690842	0.055075314	13.01781857	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6088
H2775_076_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1127.144196	30.30931644	1275.127294	2016.134858	144.3262531	12.53951296	0.857733167	208.6655432	284.7924225	1432.035578	13.89706692	0	35.39773025	1349.377637	3733.974672	12135.7849	1.036670202	1424.903858	21.6155598	13735.33603	7.978947291	0	0	0	917.8502944	0	197.7149053	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.84297394	112.5	0	0.2	0	0	4.170667634	8.818710116	8.996242618	0.5	0	0.034142599	0	0.2	0	0	0	20	0	20	0	0	0											NO	93.7352628	60.7009156	21.27927168	0	127.2058342	0.169607779	0.169607779	42.26878052	95.40437564	0	0.169607779	0	0	3.53688837	7.478609179	7.629163646	0.424019447	0	0.028954252	0	0.169607779	0	0	0	16.96077789	0	16.96077789	0	0	0												8.8044	0.153316938	2.261148343	0	1.529928451	2.126798942	0.145478217	0.735003171	2.264203605	0	2.357050654	0	0	0.397716506	2.327078105	7.715490746	0.439568326	0	0.62586237	0	1.353291528	0	0	0	1.297287915	0	0.279449883	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8131	0	7.782702685	8.8044	0.153316938	2.261148343	0	1.529928451	2.126798942	0.145478217	0.735003171	2.264203605	0	2.357050654	0	0	0.397716506	2.327078105	7.715490746	0.439568326	0	0.62586237	0	1.353291528	0	0	0	1.297287915	0	0.279449883	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8131	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													2.7152	0.0269	0.8583	1.3113	0.3051	0.6373	0.044	0.2104	1.2837	0.2877	0.725	0	0.0693	2.4893	0.9954	4.5639	0.123	0.1755	1.0788	1.362	0.3793	0	0	0	0.2324	0	0.0109	0	0	0											19.8848	0	0	11.5196	0.180239154	3.119416554	1.311345346	1.835075355	2.764124958	0.18943941	0.945356685	3.547871264	0.287718421	3.082085058	0	0.069271616	2.887027287	3.322521173	12.27939689	0.562589075	0.175514484	1.70464034	1.362044461	1.732631515	0	0	0	1.529664948	0	0.29034199	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6979
H2775_077_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1207.910027	33.03667846	1189.72078	1818.877398	145.4765439	12.64579801	0.852922834	209.6872142	329.952966	2088.660503	16.7016609	0	33.75118825	1400.081987	3827.884167	12550.93902	0.95833384	1376.674356	20.20047286	11989.17235	7.376649708	0	0	0	935.6777529	0	203.7894607	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.76625251	112.5	0	0.2	0	0	5.143056691	8.886160431	8.913200654	0.5	0	0.033272832	0	0.2	0	0	0	20	0	20	0	0	0											NO	95.2443653	61.67817752	21.62185995	0	129.2538003	0.1723384	0.1723384	42.88318176	96.94035023	0	0.1723384	0	0	4.431730817	7.657133373	7.680433716	0.430846001	0	0.028670933	0	0.1723384	0	0	0	17.23384004	0	17.23384004	0	0	0												9.5872	0.16980351	2.143664674	0	1.56694968	2.1793566	0.146991357	0.74933791	2.665479674	0	2.878337524	0	0	0.517065541	2.442551634	8.033054603	0.412894302	0	0.57916641	0	1.271280011	0	0	0	1.343776727	0	0.292672914	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9796	0	7.404032367	9.5872	0.16980351	2.143664674	0	1.56694968	2.1793566	0.146991357	0.74933791	2.665479674	0	2.878337524	0	0	0.517065541	2.442551634	8.033054603	0.412894302	0	0.57916641	0	1.271280011	0	0	0	1.343776727	0	0.292672914	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9796	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													2.9004	0.0291	0.7983	1.2327	0.2987	0.624	0.0425	0.2106	1.5372	0.4445	0.8994	0	0.0663	2.5406	1.0019	4.6694	0.1174	0.1669	1.0131	1.235	0.3615	0	0	0	0.233	0	0.0111	0	0	0											20.4336	0	0	12.4876	0.198914934	2.94199656	1.232679351	1.865622586	2.803403633	0.189443644	0.959932237	4.202647906	0.44454356	3.777749862	0	0.066279879	3.057649169	3.444422081	12.70240619	0.5302699	0.166935551	1.592308656	1.234979184	1.632826862	0	0	0	1.576755657	0	0.303812728	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4132
H2775_078_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1404.962581	39.36737167	1287.719504	2264.005247	149.7817194	13.94501979	0.92194725	227.6189185	330.342469	1504.308672	17.29257513	0	37.1261489	1483.75513	4084.300996	14111.46897	1.149869014	1594.6491	23.76370142	14586.22824	7.931659645	0	0	0	976.1452889	0	215.7242224	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.79166832	112.5	0	0.2	0	0	5.019773919	8.84126788	8.560001	0.5	0	0.034086108	0	0.2	0	0	0	20	0	20	0	0	0											NO	96.02435069	62.18327908	21.79892801	0	130.3122994	0.173749733	0.173749733	43.25644527	97.73422456	0	0.173749733	0	0	4.36092188	7.680839648	7.436489422	0.434374331	0	0.029612261	0	0.173749733	0	0	0	17.37497326	0	17.37497326	0	0	0												11.2426	0.203999355	2.339242063	0	1.626533356	2.422943459	0.160188088	0.820498774	2.690480421	0	3.004580305	0	0	0.539211684	2.614238419	8.744982477	0.499473584	0	0.703696921	0	1.378123742	0	0	0	1.413374857	0	0.312350216	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7165	0	7.673772984	11.2426	0.203999355	2.339242063	0	1.626533356	2.422943459	0.160188088	0.820498774	2.690480421	0	3.004580305	0	0	0.539211684	2.614238419	8.744982477	0.499473584	0	0.703696921	0	1.378123742	0	0	0	1.413374857	0	0.312350216	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7165	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.1272	0.0319	0.8333	1.5433	0.316	0.6615	0.0441	0.2207	1.4996	0.3016	0.8667	0	0.0689	2.6156	1.0339	4.8557	0.1309	0.1869	1.135	1.3963	0.3619	0	0	0	0.2328	0	0.0114	0	0	0											21.4752	0	0	14.3697	0.235854178	3.172540621	1.543274459	1.942554004	3.084445994	0.204310175	1.041158668	4.190059984	0.301647745	3.871265709	0	0.068941114	3.154828728	3.648154947	13.60067978	0.630388203	0.186912874	1.838726101	1.396305532	1.739975498	0	0	0	1.646126877	0	0.323776188	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1916
H2775_079_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1277.469352	35.24134843	1246.321662	1983.445975	188.369908	14.28889363	0.920568246	255.1616696	295.8596286	2162.855228	16.68013287	0	36.30477768	1665.325725	3862.448068	11863.04179	0.834475027	1135.994534	20.95491204	11073.68086	8.238495704	0	0	0	954.8337788	0	209.0074842	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.77557536	112.5	0	0.2	0	0	3.962878808	9.041082619	9.401149195	0.5	0	0.032724577	0	0.2	0	0	0	20	0	20	0	0	0											NO	92.74981769	60.0627628	21.05556127	0	125.8685107	0.167824681	0.167824681	41.76785027	94.40138304	0	0.167824681	0	0	3.325344358	7.586584031	7.888724322	0.419561702	0	0.027459959	0	0.167824681	0	0	0	16.7824681	0	16.7824681	0	0	0												9.8738	0.176391063	2.186833509	0	1.975819982	2.398029015	0.154494072	0.888129534	2.327463177	0	2.799337978	0	0	0.461481792	2.441898903	7.79868886	0.350113763	0	0.575421019	0	1.382622913	0	0	0	1.335372286	0	0.29230512	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4182	0	8.967253325	9.8738	0.176391063	2.186833509	0	1.975819982	2.398029015	0.154494072	0.888129534	2.327463177	0	2.799337978	0	0	0.461481792	2.441898903	7.79868886	0.350113763	0	0.575421019	0	1.382622913	0	0	0	1.335372286	0	0.29230512	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4182	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.0682	0.031	0.8294	1.085	0.3507	0.7334	0.0477	0.2554	1.2765	0.43	0.9031	0	0.0898	3.223	1.0542	4.7926	0.1027	0.1441	1.0338	1.1653	0.4054	0	0	0	0.2502	0	0.0121	0	0	0											21.2836	0	0	12.9419	0.207398256	3.016262898	1.08502402	2.32654213	3.131470133	0.202182025	1.143483718	3.603976318	0.430014461	3.702432164	0	0.089752473	3.684529398	3.496071795	12.59133136	0.452780474	0.144077136	1.609203406	1.165332028	1.788060694	0	0	0	1.58553441	0	0.304376754	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7017
H2775_080_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1487.332342	41.83184594	1294.206243	2163.877408	136.6651214	14.06261047	0.946858729	207.1232089	315.4193149	1333.341426	19.7203617	0	36.4568446	1272.662297	4483.808657	15930.95054	1.4530075	1870.610999	25.00232195	16657.27316	6.461687768	0	0	0	1056.991314	0	235.2025995	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.68866431	112.5	0	0.2	0	0	5.929557361	8.792392074	8.391263068	0.5	0	0.034015811	0	0.2	0	0	0	20	0	20	0	0	0											NO	97.92286668	63.41271671	22.22991883	0	132.8887291	0.177184972	0.177184972	44.020423	99.6665468	0	0.177184972	0	0	5.253142277	7.789398721	7.434028563	0.44296243	0	0.030135453	0	0.177184972	0	0	0	17.71849721	0	17.71849721	0	0	0												12.137	0.221055916	2.39750831	0	1.513437857	2.491683244	0.167769137	0.759804272	2.619729492	0	3.494151737	0	0	0.55712301	2.910514452	9.869261778	0.643627733	0	0.753456291	0	1.144913967	0	0	0	1.56069147	0	0.347286384	0	0	0	0	0	0	0	0	0	0	0	0	0	43.589	0	7.015862376	12.137	0.221055916	2.39750831	0	1.513437857	2.491683244	0.167769137	0.759804272	2.619729492	0	3.494151737	0	0	0.55712301	2.910514452	9.869261778	0.643627733	0	0.753456291	0	1.144913967	0	0	0	1.56069147	0	0.347286384	0	0	0	0	0	0	0	0	0	0	0	0	0	43.589	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.2591	0.0333	0.8132	1.5413	0.3094	0.6479	0.044	0.1939	1.4002	0.2599	0.9574	0	0.048	1.9156	1.1796	5.5257	0.16	0.2292	1.1524	1.6705	0.2851	0	0	0	0.2606	0	0.013	0	0	0											21.8993	0	0	15.3961	0.254381424	3.210701999	1.541276039	1.82286336	3.139561274	0.211768149	0.953711351	4.019918892	0.259941498	4.451539612	0	0.047992854	2.472687173	4.090099381	15.39493004	0.803625212	0.229210291	1.905880542	1.6705354	1.43003608	0	0	0	1.82127526	0	0.360241371	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4883
H2775_081_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1297.205848	36.1135946	1364.036516	1940.950949	164.4194535	15.74809268	1.023883766	264.1729662	351.1502388	2399.000867	18.89866584	0	38.20402059	1734.122111	3844.860634	12938.20855	0.976907383	1462.517552	18.65222478	11635.43483	8.839077171	0	0	0	925.5304282	0	203.6044642	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.81097166	112.5	0	0.2	0	0	5.174430268	8.85629872	8.755649541	0.5	0	0.033551855	0	0.2	0	0	0	20	0	20	0	0	0											NO	95.79839868	62.03695748	21.74763361	0	130.0056655	0.173340887	0.173340887	43.17139013	97.50424911	0	0.173340887	0	0	4.48470167	7.675793391	7.588560301	0.433352218	0	0.029079542	0	0.173340887	0	0	0	17.33408873	0	17.33408873	0	0	0												10.3559	0.186698128	2.472047198	0	1.781288372	2.729788359	0.17748092	0.950392849	2.853220029	0	3.275911505	0	0	0.648085027	2.459362987	8.181864646	0.423344982	0	0.542398148	0	1.53217348	0	0	0	1.336935547	0	0.294108154	0	0	0	0	0	0	0	0	0	0	0	0	0	40.201	0	7.703869219	10.3559	0.186698128	2.472047198	0	1.781288372	2.729788359	0.17748092	0.950392849	2.853220029	0	3.275911505	0	0	0.648085027	2.459362987	8.181864646	0.423344982	0	0.542398148	0	1.53217348	0	0	0	1.336935547	0	0.294108154	0	0	0	0	0	0	0	0	0	0	0	0	0	40.201	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.2976	0.0337	0.9041	1.3769	0.365	0.765	0.0502	0.2637	1.5133	0.4741	1.0221	0	0.0786	3.0441	0.9722	4.597	0.1197	0.1706	0.9397	1.2091	0.4333	0	0	0	0.2208	0	0.0108	0	0	0											21.8614	0	0	13.6535	0.220379673	3.376105293	1.376855794	2.146315336	3.494792421	0.227671301	1.214078119	4.366508854	0.474143317	4.298036693	0	0.078577922	3.692138202	3.431514897	12.77882326	0.543064024	0.17060167	1.482065685	1.209110661	1.965461576	0	0	0	1.557752261	0	0.304858325	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0623
H2775_082_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1050.373916	29.57828879	1192.085768	1784.277611	130.0585301	11.35303657	0.728642381	190.9856498	258.1218027	1470.869413	12.73259756	0	31.65808489	1219.852496	3429.763093	11075.41204	0.954195907	1313.564953	19.44950514	12821.14364	7.25595244	0	0	0	771.3982757	0	172.1838998	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.84753798	112.5	0	0.2	0	0	4.079312458	0	9.193341125	0.5	0	0.034530671	0	0.2	0	0	0	20	0	20	0	0	0											NO	98.12383297	63.5428581	19.49109847	0	116.5162736	0.155355031	0.155355031	38.72032915	87.38720518	0	0.155355031	0	0	3.168708576	0	7.141158997	0.388387579	0	0.026822568	0	0.155355031	0	0	0	15.53550314	0	15.53550314	0	0	0												8.5889	0.156624084	1.93625509	0	1.262827939	1.763751354	0.11319826	0.616252269	1.879711911	0	1.978073095	0	0	0.322113089	0	6.590939864	0.370597838	0	0.521685667	0	1.127248719	0	0	0	0.998671695	0	0.222913626	0	0	0	0	0	0	0	0	0	0	0	0	0	28.4498	0	8.157051461	8.5889	0.156624084	1.93625509	0	1.262827939	1.763751354	0.11319826	0.616252269	1.879711911	0	1.978073095	0	0	0.322113089	0	6.590939864	0.370597838	0	0.521685667	0	1.127248719	0	0	0	0.998671695	0	0.222913626	0	0	0	0	0	0	0	0	0	0	0	0	0	28.4498	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	3.7136	0.0677	0.8372	0	0.546	0.7853	0.0504	0.2662	0.8127	0	0.8514	0	0	0.1393	0.8082	2.7227	0.1528	0	0.2244	0	0.4656	0	0	0	0.4318	0	0.0964	0	0	0											12.9716	0	3.495879197	12.3025	0.224343593	2.773433138	0	1.808836486	2.54906878	0.163600243	0.882410188	2.692442401	0	2.829457673	0	0	0.461385031	0.808225584	9.313596074	0.523421723	0	0.746035855	0	1.592884007	0	0	0	1.430467083	0	0.319294726	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4214
H2775_083_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1125.128101	32.01786201	1095.697263	1579.137977	130.7583576	11.41538958	0.725794293	191.0185985	303.2657284	2193.251799	15.46094861	0	29.88304016	1266.885828	3533.959953	11466.61642	0.873218228	1256.227015	18.11702988	10855.49429	6.630945795	0	0	0	792.699224	0	178.4035105	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.76764028	112.5	0	0.2	0	0	5.192846317	0	9.124273073	0.5	0	0.033621902	0	0.2	0	0	0	20	0	20	0	0	0											NO	100.2423777	64.91478155	19.91192145	0	119.0319207	0.158709228	0.158709228	39.49291874	89.27394052	0	0.158709228	0	0	4.12076314	0	7.240531659	0.396773069	0	0.02668053	0	0.158709228	0	0	0	15.87092276	0	15.87092276	0	0	0												9.3988	0.17320271	1.818119819	0	1.297034871	1.811727663	0.115190252	0.628656832	2.256143883	0	2.453795211	0	0	0.435044702	0	6.918699933	0.346469476	0	0.483371965	0	1.052392285	0	0	0	1.04840568	0	0.235952361	0	0	0	0	0	0	0	0	0	0	0	0	0	30.473	0	7.909290824	9.3988	0.17320271	1.818119819	0	1.297034871	1.811727663	0.115190252	0.628656832	2.256143883	0	2.453795211	0	0	0.435044702	0	6.918699933	0.346469476	0	0.483371965	0	1.052392285	0	0	0	1.04840568	0	0.235952361	0	0	0	0	0	0	0	0	0	0	0	0	0	30.473	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	4.0455	0.0746	0.7826	0	0.5583	0.7823	0.0497	0.2705	0.9711	0	1.087	0	0	0.1873	0.853	2.8405	0.1472	0	0.2138	0	0.4475	0	0	0	0.4513	0	0.1016	0	0	0											13.8635	0	3.389696068	13.4442	0.247753101	2.600679997	0	1.855308219	2.59398127	0.164926198	0.89916691	3.227239593	0	3.540794677	0	0	0.622297849	0.852992885	9.759236992	0.49371743	0	0.69713405	0	1.499858712	0	0	0	1.499663361	0	0.337511631	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3365
H2775_084_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1312.977008	37.95928342	1181.028634	2017.499061	133.9390333	12.51771757	0.784684252	206.9934799	300.2250053	1517.852165	15.80942448	0	33.06687917	1338.620757	3787.637759	12936.54021	1.052312596	1461.066358	21.27906859	13557.37916	7.087962595	0	0	0	832.2882461	0	189.389676	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.78945382	112.5	0	0.2	0	0	5.04734337	0	8.754709546	0.5	0	0.03439521	0	0.2	0	0	0	20	0	20	0	0	0											NO	104.6731905	67.78407944	20.79204818	0	124.2932499	0.165724333	0.165724333	41.25662018	93.21993745	0	0.165724333	0	0	4.182338073	0	7.254342011	0.414310833	0	0.028500616	0	0.165724333	0	0	0	16.57243332	0	16.57243332	0	0	0												11.4528	0.21441959	2.046333688	0	1.387309812	2.074490398	0.130041275	0.711654282	2.332246351	0	2.62000633	0	0	0.466547046	0	7.82050726	0.435984508	0	0.60646657	0	1.174647875	0	0	0	1.149420122	0	0.261553982	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8844	0	7.198320815	11.4528	0.21441959	2.046333688	0	1.387309812	2.074490398	0.130041275	0.711654282	2.332246351	0	2.62000633	0	0	0.466547046	0	7.82050726	0.435984508	0	0.60646657	0	1.174647875	0	0	0	1.149420122	0	0.261553982	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8844	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	4.702	0.088	0.8401	0	0.5696	0.8517	0.0534	0.2919	0.9575	0	1.0672	0	0	0.1915	0.9038	3.0605	0.1703	0	0.2468	0	0.4598	0	0	0	0.4719	0	0.1074	0	0	0											15.0334	0	3.084994635	16.1548	0.302450662	2.886466568	0	1.95687703	2.92618316	0.183430392	1.003506185	3.289762153	0	3.68722156	0	0	0.658090349	0.903783073	10.88099833	0.606314992	0	0.853231918	0	1.634424327	0	0	0	1.621320498	0	0.368936321	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9178
H2775_085_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1191.714584	34.10418723	1149.874288	1744.903673	174.101574	13.2520674	0.812910768	236.7623496	267.6543191	2265.638208	15.46669631	0	32.42288722	1533.573415	3570.662002	10744.39057	0.739131778	1007.832292	18.76116291	9921.365181	7.509078492	0	0	0	812.0536791	0	183.4706716	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.77945652	112.5	0	0.2	0	0	3.878749412	0	9.704710511	0.5	0	0.033070211	0	0.2	0	0	0	20	0	20	0	0	0											NO	97.44619183	63.10403245	19.35649335	0	115.7116146	0.154282153	0.154282153	38.40040859	86.78371097	0	0.154282153	0	0	2.992109048	0	7.486318152	0.385705382	0	0.025510717	0	0.154282153	0	0	0	15.42821528	0	15.42821528	0	0	0												9.6773	0.179342645	1.854794501	0	1.678797853	2.044557488	0.125417623	0.75764758	1.935669589	0	2.386235204	0	0	0.382384908	0	6.702993846	0.285087105	0	0.478610715	0	1.158516795	0	0	0	1.044044915	0	0.235885418	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9273	0	9.164339897	9.6773	0.179342645	1.854794501	0	1.678797853	2.044557488	0.125417623	0.75764758	1.935669589	0	2.386235204	0	0	0.382384908	0	6.702993846	0.285087105	0	0.478610715	0	1.158516795	0	0	0	1.044044915	0	0.235885418	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9273	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	4.1327	0.0766	0.7921	0	0.7169	0.9191	0.0564	0.3236	0.8266	0	1.0593	0	0	0.1633	0.8467	2.7245	0.1217	0	0.2121	0	0.4947	0	0	0	0.4459	0	0.1007	0	0	0											14.0129	0	3.927574241	13.81	0.255930497	2.646880102	0	2.395724503	2.96363479	0.181795833	1.081199187	2.762292706	0	3.445515952	0	0	0.545681477	0.846688518	9.427536844	0.406832878	0	0.690703077	0	1.653258651	0	0	0	1.489901825	0	0.336619728	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9402
H2775_086_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1383.640491	40.08652072	1182.814456	1909.532876	120.3280656	12.43211742	0.791527758	185.748035	284.1583747	1325.569484	18.10079171	0	32.27301637	1122.932164	4192.592341	14715.37031	1.342567889	1730.205355	22.27598953	15645.335	5.623573618	0	0	0	909.297119	0	208.0131454	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.67406625	112.5	0	0.2	0	0	6.079870981	0	8.580722813	0.5	0	0.034325254	0	0.2	0	0	0	20	0	20	0	0	0											NO	106.1908536	68.76688506	21.09351339	0	126.0953856	0.168127181	0.168127181	41.75780358	94.57153917	0	0.168127181	0	0	5.110957837	0	7.213263677	0.420317952	0	0.028855041	0	0.168127181	0	0	0	16.81271808	0	16.81271808	0	0	0												12.2442	0.229718764	2.079142713	0	1.264401152	2.090176853	0.13307733	0.646369163	2.239441238	0	3.04323508	0	0	0.478271579	0	8.845487182	0.564305385	0	0.642774592	0	0.945475578	0	0	0	1.273979676	0	0.291438864	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0115	0	7.016471304	12.2442	0.229718764	2.079142713	0	1.264401152	2.090176853	0.13307733	0.646369163	2.239441238	0	3.04323508	0	0	0.478271579	0	8.845487182	0.564305385	0	0.642774592	0	0.945475578	0	0	0	1.273979676	0	0.291438864	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0115	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	4.8549	0.0911	0.8244	0	0.5013	0.8288	0.0528	0.2559	0.8879	0	1.193	0	0	0.1896	0.9735	3.343	0.2121	0	0.2516	0	0.356	0	0	0	0.5051	0	0.1156	0	0	0											15.4367	0	3.00705913	17.099	0.320803264	2.903531944	0	1.76574177	2.918941169	0.185843077	0.902306708	3.12738954	0	4.236261749	0	0	0.667908363	0.973549594	12.18852384	0.776390283	0	0.89432712	0	1.301511706	0	0	0	1.779118221	0	0.406995656	0	0	0	0	0	0	0	0	0	0	0	0	0	52.4482
H2775_087_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1202.026911	34.58091668	1260.252235	1700.325516	148.9803267	14.31926563	0.886122703	244.1077703	321.8286717	2499.502382	17.51918847	0	34.24258399	1592.83983	3546.220291	11786.33618	0.888908103	1332.416474	16.67259374	10428.29207	8.055103183	0	0	0	784.9418773	0	177.8933773	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.81723884	112.5	0	0.2	0	0	5.211007161	0	8.966005984	0.5	0	0.033871332	0	0.2	0	0	0	20	0	20	0	0	0											NO	101.4223345	65.67889587	20.14630542	0	120.4330499	0.1605774	0.1605774	39.9976134	90.3247874	0	0.1605774	0	0	4.183849902	0	7.198689639	0.4014435	0	0.027194852	0	0.1605774	0	0	0	16.05773998	0	16.05773998	0	0	0												10.1594	0.189269702	2.115785536	0	1.495179593	2.299350443	0.14229128	0.813644019	2.422425529	0	2.813185731	0	0	0.55535023	0	7.07051468	0.35684638	0	0.453408723	0	1.293467524	0	0	0	1.050366047	0	0.238047133	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4685	0	8.187989074	10.1594	0.189269702	2.115785536	0	1.495179593	2.299350443	0.14229128	0.813644019	2.422425529	0	2.813185731	0	0	0.55535023	0	7.07051468	0.35684638	0	0.453408723	0	1.293467524	0	0	0	1.050366047	0	0.238047133	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4685	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	4.3025	0.0802	0.896	0	0.6332	0.9738	0.0603	0.3446	1.0259	0	1.2393	0	0	0.2352	0.8478	2.855	0.1511	0	0.1994	0	0.5478	0	0	0	0.4448	0	0.1008	0	0	0											14.9378	0	3.509138174	14.4619	0.269425924	3.011826337	0	2.128392126	3.27313147	0.202552015	1.158224424	3.448329182	0	4.052533158	0	0	0.79054253	0.847849733	9.925532051	0.507971771	0	0.65276243	0	1.84125446	0	0	0	1.495198861	0	0.338860727	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4063
H2775_088_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	973.4419184	26.21961393	1111.90724	1763.106938	126.0962417	10.95296746	0.751613572	182.1609006	246.3648038	1247.740583	12.24443355	0	30.64740234	1163.878914	3256.953758	10508.00935	0.90472375	1169.900998	19.01658012	11928.63864	6.96760209	0	0	0	804.7098939	0	173.0414991	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.84273395	195	0	0.2	0	0	9.795749362	8.825937684	11.63853081	0.5	0	0.034198096	0	0.2	0	0	0	20	0	20	0	0	0											NO	128.895053	83.4696303	17.06894981	0	102.0368569	0.136049143	0.136049143	33.90530608	132.647914	0	0.136049143	0	0	6.663516506	6.00380627	7.917060683	0.340122856	0	0.023263108	0	0.136049143	0	0	0	13.60491425	0	13.60491425	0	0	0												10.456	0.182378457	1.58159074	0	1.072205347	1.490141831	0.102256382	0.514685091	2.723314775	0	1.665844686	0	0	0.646293863	1.629509949	6.932712307	0.307717226	0	0.442384757	0	0.94793629	0	0	0	0.912334092	0	0.196184563	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8035	0	14.83026041	10.456	0.182378457	1.58159074	0	1.072205347	1.490141831	0.102256382	0.514685091	2.723314775	0	1.665844686	0	0	0.646293863	1.629509949	6.932712307	0.307717226	0	0.442384757	0	0.94793629	0	0	0	0.912334092	0	0.196184563	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8035	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	4.5348	0.0791	0.6859	0	0.465	0.6655	0.0457	0.223	1.1811	0	0.6973	0	0	0.2803	1.3789	2.9431	0.1273	0	0.1851	0	0.3927	0	0	0	0.3957	0	0.0851	0	0	0											14.3656	0	6.35582589	14.9908	0.261477077	2.267536039	0	1.537227175	2.155684022	0.14792716	0.73765154	3.904432571	0	2.363112511	0	0	0.92659535	3.008385776	9.875811328	0.435003119	0	0.627483654	0	1.340662652	0	0	0	1.308018807	0	0.281270974	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1691
H2775_089_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1043.173756	28.59906255	1038.474435	1592.090685	127.1315441	11.04885984	0.747256876	183.1272388	285.1073794	1818.727703	14.71855913	0	29.23461164	1207.742285	3338.207916	10868.66325	0.836937222	1130.458229	17.77925241	10418.15955	6.446302207	0	0	0	819.9222418	0	178.3117177	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.76618551	195	0	0.2	0	0	12.05074173	8.892584878	11.52972437	0.5	0	0.033330872	0	0.2	0	0	0	20	0	20	0	0	0											NO	132.6443821	85.89761419	17.56545536	0	105.0049286	0.140006571	0.140006571	34.83796503	136.5064071	0	0.140006571	0	0	8.435915165	6.2251016	8.071185894	0.350016429	0	0.023332705	0	0.140006571	0	0	0	14.00065714	0	14.00065714	0	0	0												11.5309	0.204715937	1.520106361	0	1.112453226	1.546912984	0.104620873	0.531648362	3.243248668	0	2.060695	0	0	0.849034288	1.73172362	7.310250129	0.292941777	0	0.414838058	0	0.90252467	0	0	0	0.956620849	0	0.208040102	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5213	0	14.68068431	11.5309	0.204715937	1.520106361	0	1.112453226	1.546912984	0.104620873	0.531648362	3.243248668	0	2.060695	0	0	0.849034288	1.73172362	7.310250129	0.292941777	0	0.414838058	0	0.90252467	0	0	0	0.956620849	0	0.208040102	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5213	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	4.9741	0.0883	0.6557	0	0.4799	0.6694	0.0453	0.2293	1.399	0	0.8863	0	0	0.3662	1.456	3.0835	0.1248	0	0.1783	0	0.3846	0	0	0	0.4127	0	0.0897	0	0	0											15.523	0	6.291721846	16.505	0.293023765	2.175831034	0	1.592329534	2.216293166	0.149892417	0.76091517	4.642281148	0	2.947012833	0	0	1.215280194	3.187743304	10.39370206	0.417713999	0	0.593157519	0	1.287098234	0	0	0	1.369276115	0	0.297781867	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0443
H2775_090_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1219.577031	34.30888418	1125.201854	1979.960531	130.9766106	12.19285697	0.807333796	198.9426354	285.7319406	1313.881607	15.26331013	0	32.13519576	1279.32529	3560.927278	12216.18428	1.004814317	1305.692231	20.93127661	12668.09527	6.935930033	0	0	0	854.7519101	0	188.7406431	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.79173424	195	0	0.2	0	0	11.77615365	8.849396295	11.07654577	0.5	0	0.034156683	0	0.2	0	0	0	20	0	20	0	0	0											NO	141.2777544	91.48839817	18.7087312	0	111.8393427	0.149119124	0.149119124	37.12449888	145.3911456	0	0.149119124	0	0	8.78024856	6.598071102	8.258623989	0.372797809	0	0.025467073	0	0.149119124	0	0	0	14.91191237	0	14.91191237	0	0	0												14.3583	0.261572071	1.754258253	0	1.220694837	1.818188146	0.120388908	0.61547047	3.461907847	0	2.27605143	0	0	0.93606617	1.957937614	8.407406047	0.374592576	0	0.533058354	0	1.034279808	0	0	0	1.062165465	0	0.234540327	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4268	0	13.68233091	14.3583	0.261572071	1.754258253	0	1.220694837	1.818188146	0.120388908	0.61547047	3.461907847	0	2.27605143	0	0	0.93606617	1.957937614	8.407406047	0.374592576	0	0.533058354	0	1.034279808	0	0	0	1.062165465	0	0.234540327	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4268	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	5.8738	0.107	0.7177	0	0.4994	0.7438	0.0492	0.2515	1.4162	0	0.8949	0	0	0.3829	1.5591	3.3606	0.1458	0	0.2095	0	0.4033	0	0	0	0.4345	0	0.0959	0	0	0											17.1453	0	5.863856104	20.2321	0.36857881	2.47190924	0	1.720069916	2.561992266	0.169638908	0.8669656	4.878142645	0	3.170905618	0	0	1.319002267	3.517081463	11.76799904	0.520416479	0	0.74255708	0	1.437621324	0	0	0	1.49668763	0	0.330488628	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5721
H2775_091_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1103.338242	30.5233174	1088.05728	1735.123797	164.4368468	12.47154204	0.805188123	222.7037783	255.9408904	1884.481175	14.66272017	0	31.46080075	1438.282939	3368.956743	10288.09246	0.729791825	936.9690944	18.44049153	9637.700497	7.195953983	0	0	0	836.4562491	0	182.8569864	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.77540333	195	0	0.2	0	0	9.282858532	9.044971235	12.14796755	0.5	0	0.032711157	0	0.2	0	0	0	20	0	20	0	0	0											NO	129.0090508	83.54345282	17.08404599	0	102.1271007	0.136169468	0.136169468	33.88945086	132.7652309	0	0.136169468	0	0	6.320209521	6.158244589	8.270911372	0.340423669	0	0.022271304	0	0.136169468	0	0	0	13.61694676	0	13.61694676	0	0	0												11.8617	0.212501944	1.549035051	0	1.399454868	1.698243241	0.109642038	0.628942396	2.831670951	0	1.9966148	0	0	0.757520794	1.728904969	7.090991743	0.248438411	0	0.410693798	0	0.979869223	0	0	0	0.949165018	0	0.207496154	0	0	0	0	0	0	0	0	0	0	0	0	0	34.6609	0	16.17277961	11.8617	0.212501944	1.549035051	0	1.399454868	1.698243241	0.109642038	0.628942396	2.831670951	0	1.9966148	0	0	0.757520794	1.728904969	7.090991743	0.248438411	0	0.410693798	0	0.979869223	0	0	0	0.949165018	0	0.207496154	0	0	0	0	0	0	0	0	0	0	0	0	0	34.6609	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	5.0702	0.0908	0.6621	0	0.5982	0.7641	0.0493	0.2688	1.2104	0	0.8619	0	0	0.3238	1.4398	2.9606	0.1062	0	0.1772	0	0.4188	0	0	0	0.4057	0	0.0887	0	0	0											15.4966	0	6.931191262	16.9319	0.303333756	2.211154454	0	1.997637731	2.462345281	0.15897402	0.897777477	4.042040129	0	2.858527466	0	0	1.081315414	3.168664914	10.05155716	0.354630903	0	0.587865419	0	1.398704436	0	0	0	1.354876028	0	0.296188292	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1575
H2775_092_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1284.451574	36.24980611	1130.418721	1892.748286	119.5521914	12.29969998	0.829977678	181.052523	272.8437194	1164.386276	17.39704704	0	31.53157458	1095.121714	3907.120989	13774.7894	1.268539222	1527.55178	22.01985103	14452.12913	5.655194983	0	0	0	925.4890926	0	205.7139985	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.6892623	195	0	0.2	0	0	13.93416863	8.801420573	10.86351336	0.5	0	0.034082217	0	0.2	0	0	0	20	0	20	0	0	0											NO	146.6079569	94.9401213	19.4145842	0	116.0588772	0.15474517	0.15474517	38.44586661	150.8765403	0	0.15474517	0	0	10.78122644	6.809886595	8.405381082	0.386862924	0	0.026370292	0	0.15474517	0	0	0	15.47451696	0	15.47451696	0	0	0												15.6926	0.286796749	1.82888412	0	1.156257758	1.903319159	0.128435036	0.580060096	3.43047637	0	2.692108995	0	0	0.983896265	2.217254237	9.648529518	0.490750793	0	0.58066991	0	0.875114107	0	0	0	1.193458055	0	0.265277063	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9539	0	12.76133516	15.6926	0.286796749	1.82888412	0	1.156257758	1.903319159	0.128435036	0.580060096	3.43047637	0	2.692108995	0	0	0.983896265	2.217254237	9.648529518	0.490750793	0	0.58066991	0	0.875114107	0	0	0	1.193458055	0	0.265277063	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9539	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	6.1822	0.113	0.7205	0	0.4555	0.7498	0.0506	0.2282	1.3515	0	1.0155	0	0	0.3876	1.6994	3.7134	0.1833	0	0.2189	0	0.3274	0	0	0	0.4702	0	0.1045	0	0	0											17.9715	0	5.469143639	21.8748	0.399783209	2.54939139	0	1.611777117	2.65315086	0.179033309	0.808259908	4.781946994	0	3.707565697	0	0	1.371512081	3.916633255	13.36196347	0.674007858	0	0.799566623	0	1.202485941	0	0	0	1.663632843	0	0.369785627	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9253
H2775_093_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1120.713785	31.30013899	1190.925451	1698.254205	143.667265	13.75849774	0.896280189	230.6451886	303.4564549	2091.35668	16.61953657	0	33.06810897	1495.519377	3352.813455	11202.53008	0.853461254	1198.469809	16.41827004	10104.73942	7.721447568	0	0	0	810.8117627	0	178.164084	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.81071254	195	0	0.2	0	0	12.11803036	8.863866635	11.32827453	0.5	0	0.033541508	0	0.2	0	0	0	20	0	20	0	0	0											NO	136.0416658	88.09762119	18.01534126	0	107.6943115	0.143592415	0.143592415	35.76220261	140.002605	0	0.143592415	0	0	8.700286242	6.363920096	8.133271508	0.358981038	0	0.024081531	0	0.143592415	0	0	0	14.35924153	0	14.35924153	0	0	0												12.7053	0.229788982	1.7879107	0	1.289345599	1.975615921	0.128699037	0.687364997	3.540391181	0	2.386439397	0	0	1.084287221	1.778086411	7.592768223	0.306376407	0	0.395377072	0	1.108741306	0	0	0	0.970220162	0	0.21319176	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1799	0	14.87114191	12.7053	0.229788982	1.7879107	0	1.289345599	1.975615921	0.128699037	0.687364997	3.540391181	0	2.386439397	0	0	1.084287221	1.778086411	7.592768223	0.306376407	0	0.395377072	0	1.108741306	0	0	0	0.970220162	0	0.21319176	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1799	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	5.3801	0.0973	0.7571	0	0.546	0.8366	0.0545	0.2911	1.4992	0	1.0209	0	0	0.4591	1.4662	3.1422	0.1297	0	0.169	0	0.4695	0	0	0	0.4108	0	0.0903	0	0	0											16.8196	0	6.373346531	18.0854	0.327093125	2.545001474	0	1.835318984	2.812190469	0.183196644	0.9784297	5.039569802	0	3.407335792	0	0	1.543428638	3.24432795	10.73498939	0.436111495	0	0.564384789	0	1.578237805	0	0	0	1.381059882	0	0.303467809	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9995
H2775_801_0	2010	5	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	237.7932347	2.760379267	42.37526482	38.47730519	7.179474209	15.06761194	0.959838315	8.25652233	34.19425995	5.474904641	16.7350813	0	0.363932518	20.52071398	20.99562125	103.6629479	1.094865926	3.928620016	27.19881123	32.71628101	8.30634306	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	0	0	18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.6669	0.0542	1.8684	0	0.4182	0.8777	0.0559	0.4809	1.9918	0.3086	0.9748	0	0.0212	1.1953	1.223	5.9734	0.1288	0.2288	1.5843	1.902	0.4838	0																			24.4381	0	0	23.3345	0.270874828	9.341871808	0	2.091021864	4.388441979	0.279552909	2.404712129	9.959078211	1.584281092	4.874092428	0	0.105995346	5.976657947	6.11497469	30.12684094	0.383872347	1.14421058	7.921653771	9.524855158	2.419222416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2468
H2775_802_0	2010	5	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	237.7932347	2.760379267	42.37526482	38.47730519	7.179474209	15.06761194	0.959838315	8.25652233	34.19425995	5.474904641	16.7350813	0	0.363932518	20.52071398	20.99562125	103.6629479	1.094865926	3.928620016	27.19881123	32.71628101	8.30634306	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	0	0	18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.6669	0.0542	1.8684	0	0.4182	0.8777	0.0559	0.4809	1.9918	0.3086	0.9748	0	0.0212	1.1953	1.223	5.9734	0.1288	0.2288	1.5843	1.902	0.4838	0																			24.4381	0	0	23.3345	0.270874828	9.341871808	0	2.091021864	4.388441979	0.279552909	2.404712129	9.959078211	1.584281092	4.874092428	0	0.105995346	5.976657947	6.11497469	30.12684094	0.383872347	1.14421058	7.921653771	9.524855158	2.419222416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2468
H2775_803_0	2010	6	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	237.7932347	2.760379267	42.37526482	38.47730519	7.179474209	15.06761194	0.959838315	8.25652233	34.19425995	5.474904641	16.7350813	0	0.363932518	20.52071398	20.99562125	103.6629479	1.094865926	3.928620016	27.19881123	32.71628101	8.30634306	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	0	0	18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.6669	0.0542	1.8684	0	0.4182	0.8777	0.0559	0.4809	1.9918	0.3086	0.9748	0	0.0212	1.1953	1.223	5.9734	0.1288	0.2288	1.5843	1.902	0.4838	0																			24.4381	0	0	23.3345	0.270874828	9.341871808	0	2.091021864	4.388441979	0.279552909	2.404712129	9.959078211	1.584281092	4.874092428	0	0.105995346	5.976657947	6.11497469	30.12684094	0.383872347	1.14421058	7.921653771	9.524855158	2.419222416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2468
H2802_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1607.082393	98.78738145	1812.131679	1366.325758	150.7766984	7.802271332	6.851256388	238.2268958	29.61167278	6680.492289	29.64283138	0	0.009805349	16.70940548	5301.195661	4272.559996	492.2416214	324.6314012	0	0	31.87867512	1145.937834	0	0	270.0195974	187.5349396	16.18421056	6.488258538	105.2426116	0											4200	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-20 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	65.09002355	0	150	0.2	0.116819698	49.8413291	0.2	3	0.180145606	0	0.2	0.150216451	12.62286069	39.71997944	38.5	40	0	0	0.2	39.32893686	0	0	40	15	0	0	0	0											YES	156.2057027	115.1799725	50.58290436	0	116.5683348	0.155424446	0.090783185	38.7328049	0.155424446	2.331366695	0.139995156	0	0.155424446	0.116971359	12.59304251	39.71997944	38.5	31.08488927	0	0	0.155424446	39.32893686	0	0	40	15	0	0	0	0											5000	20.9196	0.94819399	7.638573617	0	1.464649054	1.212663702	0.621978873	0.76893299	4.602377846	1.297889769	4.149852793	0	0.001523991	1.954521867	5.563181858	14.14216627	1.579275202	0.840927597	0	0	4.95472543	3.755709726	0	0	0.900065325	0.234418674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5512	0	14.74282549	20.9196	0.94819399	7.638573617	0	1.464649054	1.212663702	0.621978873	0.76893299	4.602377846	1.297889769	4.149852793	0	0.001523991	1.954521867	5.563181858	14.14216627	1.579275202	0.840927597	0	0	4.95472543	3.755709726	0	0	0.900065325	0.234418674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5512	NO	"$375 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-40 (2a, 2a2); $0 n/c (2a1)"	"25% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	25% (11a)	"25% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25%/25%/$10 (8a1); $10 (8a2)	"$21 (8b1); 25% (8b2, 8b3)"	Included in h.5.	20% (12)	"$43 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$23 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$43 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$43 (7c, 7i)"	Included in h.2.	$23 (7g)	"25% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $43 (16b, 17a, 18a); 25% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$43 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$43 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												9.1633	0.5701	1.2558	0.4453	0.2963	0.3066	0.2693	0.2164	1.1638	0.2626	1.0596	0	0.0003	0.4917	0.8318	1.7784	0.2093	0.0977	0	0	0.6696	0.4738	0	0	0.1135	0	0.0068	0	0	0											19.6821	0	6.387295488	30.0829	1.518305001	8.894422989	0.445310769	1.760943899	1.519312249	0.891250183	0.985346983	5.766189775	1.560449628	5.20945703	0	0.001832291	2.446213233	6.394950099	15.92052766	1.788615389	0.938665991	0	0	5.624344383	4.229468749	0	0	1.01357915	0.234418674	0.006803697	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2334
H2803_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1149.01008	95.99344531	1250.653494	944.8647105	105.5827842	7.306515875	7.052767136	228.5100402	29.23439678	5867.413606	28.25804267	0	0.019729147	14.20636217	4908.664154	3814.978739	476.690836	376.0266973	0	0	27.32864638	1029.438397	0	0	173.1784058	174.2956716	15.73403722	1.672854794	99.36758984	0											4200	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-20 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	65.09002355	0	150	0.2	0.110349866	49.70337806	0.2	3	0.177592459	0	0.2	0.150689908	12.43480107	39.01160332	38.5	40	0	0	0.2	39.6373196	0	0	40	15	0	0	0	0											YES	166.1054778	122.4796793	53.78867324	0	123.9560311	0.165274708	0.09119021	41.07355653	0.165274708	2.479120623	0.146757709	0	0.165274708	0.124733951	12.38981672	39.01160332	38.5	33.05494164	0	0	0.165274708	39.6373196	0	0	40	15	0	0	0	0											5000	15.9047	0.979770533	5.60591601	0	1.090635241	1.207582279	0.643143314	0.782143338	4.831706396	1.212168839	4.147085614	0	0.003260729	1.772015677	5.068120768	12.40236977	1.529383099	1.035795045	0	0	4.516734055	3.40034823	0	0	0.577261353	0.217869589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.928	0	9.203352852	15.9047	0.979770533	5.60591601	0	1.090635241	1.207582279	0.643143314	0.782143338	4.831706396	1.212168839	4.147085614	0	0.003260729	1.772015677	5.068120768	12.40236977	1.529383099	1.035795045	0	0	4.516734055	3.40034823	0	0	0.577261353	0.217869589	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.928	NO	"$375 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-40 (2a, 2a2); $0 n/c (2a1)"	"25% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	25% (11a)	"25% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25%/25%/$10 (8a1); $10 (8a2)	"$21 (8b1); 25% (8b2, 8b3)"	Included in h.5.	20% (12)	"$43 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$23 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$43 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$43 (7c, 7i)"	Included in h.2.	$23 (7g)	"25% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $43 (16b, 17a, 18a); 25% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$43 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$43 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.0555	0.5966	0.9334	0.3673	0.2234	0.3093	0.2985	0.2066	1.2374	0.2483	1.0712	0	0.0007	0.4516	0.7743	1.5509	0.2027	0.1219	0	0	0.6182	0.429	0	0	0.0728	0	0.0066	0	0	0											16.7763	0	4.035748744	22.9603	1.576379224	6.539331151	0.367261103	1.314081464	1.516839776	0.941660575	0.98877216	6.069089099	1.460514518	5.218303204	0	0.003928778	2.22360268	5.842430126	13.95325101	1.732109858	1.157717414	0	0	5.1349435	3.829322732	0	0	0.650064006	0.217869589	0.006614449	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7043
H2803_002_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1186.631728	97.79511548	1301.816808	928.7687789	114.2767479	7.601974533	6.715615115	234.8226717	27.88087658	6200.806376	31.23140028	0	0.299071649	17.65446134	4798.382302	3683.298343	487.2544405	357.0465378	0	0	27.44317288	970.4152419	0	0	254.0744269	188.3207798	15.69934517	4.027484669	90.37159205	0											4200	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-20 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	65.09002355	0	150	0.2	0.104968377	49.80620361	0.2	3	0.176981168	0	0.2	0.150518617	12.39699506	39.22152601	38.5	40	0	0	0.2	39.23454995	0	0	40	15	0	0	0	0											YES	164.8573481	121.5593573	53.38450088	0	123.0246157	0.164032821	0.086091295	40.84926038	0.164032821	2.460492313	0.145153601	0	0.164032821	0.123625717	12.36499376	39.22152601	38.5	32.80656418	0	0	0.164032821	39.23454995	0	0	40	15	0	0	0	0											5000	16.3021	0.990659282	5.791403376	0	1.171571082	1.246973327	0.578156002	0.799361038	4.573378834	1.271419702	4.533350219	0	0.049057566	2.18254545	4.944330603	12.03871515	1.563274663	0.976122513	0	0	4.501581062	3.172817107	0	0	0.846914756	0.235400975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7691	0	9.86899019	16.3021	0.990659282	5.791403376	0	1.171571082	1.246973327	0.578156002	0.799361038	4.573378834	1.271419702	4.533350219	0	0.049057566	2.18254545	4.944330603	12.03871515	1.563274663	0.976122513	0	0	4.501581062	3.172817107	0	0	0.846914756	0.235400975	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7691	NO	"$375 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-40 (2a, 2a2); $0 n/c (2a1)"	"25% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	25% (11a)	"25% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25%/25%/$10 (8a1); $10 (8a2)	"$21 (8b1); 25% (8b2, 8b3)"	Included in h.5.	20% (12)	"$43 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$23 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$43 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$43 (7c, 7i)"	Included in h.2.	$23 (7g)	"25% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $43 (16b, 17a, 18a); 25% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$43 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$43 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.237	0.6037	0.965	0.4231	0.2402	0.3196	0.2823	0.2132	1.1721	0.2607	1.1714	0	0.0101	0.5571	0.7572	1.5075	0.2072	0.115	0	0	0.6166	0.4009	0	0	0.1068	0	0.0066	0	0	0											17.1732	0	4.289357469	23.5391	1.594335539	6.756401902	0.423102558	1.411773136	1.566550131	0.860471446	1.012526356	5.745453455	1.532093278	5.704783904	0	0.059115623	2.739617025	5.701533981	13.54624909	1.770493905	1.091104147	0	0	5.118162961	3.57367598	0	0	0.953725374	0.235400975	0.006599864	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9423
H2803_010_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	336.5304973	21.86323253	1653.38139	1633.33248	11.93655191	22.42520901	17.06888651	28.09103819	27.23588356	13.9826861	34.61616451	0	0.061398536	21.42976099	28.8706992	102.2719245	9.201649322	4.214175824	0	0	27.08849176	5.043577086	692.0955813	0	219.4863141	155.8220996	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080079144	0.081051765	43.47002967	0	0.2	0.2	0.2	0.103872746	0.2	0	0.166981579	0	0.2	0.149897857	0.167833395	0.199731061	0.2	0	0	0	0.2	0.198940403	0	0	0	0	0	0	0	0											NO	0.080079144	0.081051765	43.47002967	0	0.2	0.2	0.2	0.103872746	0.2	0	0.166981579	0	0.2	0.149897857	0.167833395	0.199731061	0.2	0	0	0	0.2	0.198940403	0	0	0	0	0	0	0	0												26.9491	1.772053589	5.989378175	0	2.387310383	4.485041802	3.413777301	2.917893286	5.447176712	0	5.780261791	0	0.012279707	3.212275253	4.84546746	20.42687997	1.840329864	0	0	0	5.417698352	1.003371261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9003	0	0	26.9491	1.772053589	5.989378175	0	2.387310383	4.485041802	3.413777301	2.917893286	5.447176712	0	5.780261791	0	0.012279707	3.212275253	4.84546746	20.42687997	1.840329864	0	0	0	5.417698352	1.003371261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.9003	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												17.1217	1.1123	4.485	0.6907	0.7076	1.3294	1.0119	0.5761	1.6146	0.2487	1.7133	0	0.0024	0.9521	2.6048	9.4251	0.848	0	0	0	2.4964	0.4623	0	0	0	0	0	0	0	0											47.4025	0	0	44.0708	2.88439349	10.47440757	0.690704949	3.094926334	5.81444042	4.425645423	3.494009341	7.061759031	0.248674118	7.493572921	0	0.014706236	4.16441672	7.450244986	29.85193968	2.688324998	0	0	0	7.914088769	1.465708998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.3028
H2803_012_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	284.3680329	19.1027882	1294.711519	1147.619856	10.50916978	17.5064579	13.07427581	22.85105664	24.8016065	11.10752322	27.63785963	0	0.057952843	19.18413267	23.72392792	84.62779599	7.958470309	3.003452861	0	0	18.09636937	3.57337092	611.6480509	0	148.0449287	115.0365133	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$110 Days 21-50 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.090194839	0.091290323	28.83525662	0	0.2	0.2	0.2	0.113681509	0.2	0	0.16691153	0	0.2	0.149199349	0.166707464	0.1997189	0.2	0	0	0	0.2	0.199434163	0	0	0	0	0	0	0	0											NO	0.090194839	0.091290323	28.83525662	0	0.2	0.2	0.2	0.113681509	0.2	0	0.16691153	0	0.2	0.149199349	0.166707464	0.1997189	0.2	0	0	0	0.2	0.199434163	0	0	0	0	0	0	0	0												25.6485	1.743899697	3.111111576	0	2.101833956	3.501291581	2.614855162	2.597742596	4.960321301	0	4.613077448	0	0.011590569	2.862260113	3.954955852	16.90177029	1.591694062	0	0	0	3.619273874	0.712652238	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5469	0	0	25.6485	1.743899697	3.111111576	0	2.101833956	3.501291581	2.614855162	2.597742596	4.960321301	0	4.613077448	0	0.011590569	2.862260113	3.954955852	16.90177029	1.591694062	0	0	0	3.619273874	0.712652238	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5469	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"25% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												14.4678	0.9719	2.809	0.4847	0.623	1.0378	0.7751	0.5129	1.4703	0.1975	1.3673	0	0.0023	0.8484	2.1477	7.799	0.7334	0	0	0	1.6677	0.3284	0	0	0	0	0	0	0	0											38.2443	0	0	40.1164	2.715795939	5.920106725	0.484701094	2.724832643	4.539099565	3.389917022	3.110659331	6.430596178	0.197540982	5.980426752	0	0.013880921	3.710654578	6.102687085	24.70080247	2.325121718	0	0	0	5.286978502	1.041031211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7912
H2803_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	224.4206787	4.413436248	46.62856198	1237.170113	4.456475037	7.993916801	7.324060099	10.04025084	31.0268273	14.4170168	30.57790152	0	0.015078959	16.39503327	23.91497397	101.726675	2.457864085	4.988765576	0	0	31.45455141	7.346834007	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081003487	0.081003487	0.16063694	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081003487	0.081003487	0.16063694	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.1789	0.357503724	7.490269525	0	1.038358684	1.862582615	1.706506003	2.339378446	7.22925076	3.359164915	7.124651053	0	0.003513398	3.820042751	5.572188935	23.70231527	0.572682332	1.162382379	0	0	7.328910478	1.711812324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5604	0	0	18.1789	0.357503724	7.490269525	0	1.038358684	1.862582615	1.706506003	2.339378446	7.22925076	3.359164915	7.124651053	0	0.003513398	3.820042751	5.572188935	23.70231527	0.572682332	1.162382379	0	0	7.328910478	1.711812324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5604	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.6876	0.0922	0.6958	0	0.2279	0.4089	0.3746	0.5135	1.5869	0.7374	1.5639	0	0.0008	0.8385	0.6537	2.7807	0.0672	0.1364	0	0	0.8598	0.2008	0	0	0	0	0	0	0	0											16.4267	0	0	22.8665	0.449690219	8.186086912	0	1.266291078	2.271442213	2.081104882	2.852900544	8.816159463	4.096542579	8.688598846	0	0.004284631	4.658588721	6.225909425	26.48303382	0.639868527	1.298751262	0	0	8.188726791	1.912639468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9871
H2803_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	224.420669	4.413436248	46.62855997	1237.170087	4.456474844	7.993916455	7.324059782	10.04025041	31.02682595	14.41701618	30.57790019	0	0.015078959	16.39503256	23.91497294	101.7266706	2.457864085	4.98876536	0	0	31.45455005	7.346833689	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081003494	0.081003494	0.160636898	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081003494	0.081003494	0.160636898	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.1789	0.357503757	7.49026721	0	1.038358639	1.862582534	1.706505929	2.339378344	7.229250447	3.359164769	7.124650745	0	0.003513397	3.820042586	5.572188694	23.70231425	0.572682332	1.162382329	0	0	7.328910161	1.71181225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5604	0	0	18.1789	0.357503757	7.49026721	0	1.038358639	1.862582534	1.706505929	2.339378344	7.229250447	3.359164769	7.124650745	0	0.003513397	3.820042586	5.572188694	23.70231425	0.572682332	1.162382329	0	0	7.328910161	1.71181225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5604	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.6876	0.0922	0.6958	0	0.2279	0.4089	0.3746	0.5135	1.5869	0.7374	1.5639	0	0.0008	0.8385	0.6537	2.7807	0.0672	0.1364	0	0	0.8598	0.2008	0	0	0	0	0	0	0	0											16.4267	0	0	22.8665	0.44969026	8.186084383	0	1.266291023	2.271442115	2.081104792	2.85290042	8.816159082	4.096542402	8.68859847	0	0.004284631	4.658588519	6.225909156	26.48303268	0.639868527	1.298751206	0	0	8.188726437	1.912639385	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.9871
H2803_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	222.5160371	4.421261489	46.23282884	1231.909042	4.418653265	7.926073023	7.261901345	9.955039977	30.76350492	14.29466065	30.31838914	0	0.014950985	16.25602684	23.71200936	100.8633282	2.457864085	4.946426293	0	0	31.18759897	7.284481973	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081968054	0.081968054	0.155068893	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081968054	0.081968054	0.155068893	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.2392	0.362402199	7.16927358	0	1.029546211	1.846775014	1.692023013	2.319524315	7.167896645	3.330655932	7.064184669	0	0.00348358	3.787654253	5.524898182	23.50115548	0.572682332	1.152517326	0	0	7.266710559	1.6972843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7279	0	0	18.2392	0.362402199	7.16927358	0	1.029546211	1.846775014	1.692023013	2.319524315	7.167896645	3.330655932	7.064184669	0	0.00348358	3.787654253	5.524898182	23.50115548	0.572682332	1.152517326	0	0	7.266710559	1.6972843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7279	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.7032	0.0934	0.666	0	0.226	0.4054	0.3714	0.5092	1.5734	0.7311	1.5507	0	0.0008	0.8314	0.6482	2.7571	0.0672	0.1352	0	0	0.8525	0.1991	0	0	0	0	0	0	0	0											16.3214	0	0	22.9424	0.455851823	7.835271672	0	1.255544159	2.252164652	2.063442699	2.828688189	8.741337373	4.061775526	8.614859352	0	0.004248268	4.619090553	6.173070594	26.25827428	0.639868527	1.287728856	0	0	8.119229675	1.896407039	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.0493
H2810_001_0	2010	13	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	YES	532.6451447	12.0396829	795.3471212	0	184.2416177	8.749583217	5.797289091	274.6586398	362.2632062	0	165.6907544	0	0	258.9936276	3081.412689	3618.027776	148.7494819	485.0077243	381.2571899	1002.840028	0	0	0	0	303.2027495	0	129.9440355	0	0	0											3200	$200/Days 1-5 for IP Medical; $200/Days 1-5 for IP Surgical;	$200/Days 1-5 for IP Psych; $200/Days 1-5 for IP Substance Abuse;	$50/Day for SNF	No Cost-Sharing	$150/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care; $20/Visit for Urgent Care - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	No Cost-Sharing	$75/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults; $20/Procedure for PCP - Cardio;	$40/Visit for Speclst - Office Visits; $40/Consult for Speclst - Consults; $20/Procedure for Speclst - Cardio;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	$75/Procedure for Prof Radiology (OP); $75/Procedure for Prof Radiology (Office);	$20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Exam for Vision (Refractions)	No Cost-Sharing	$20/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											200	200	50	0	150	0.2	0.2	48.4917052	200	0	75	0	0	20	20	33.16102475	20	20	75	20	0	0	0	0	20	0	20	0	0	0											YES	198.4538113	198.4538112	49.61345281	0	148.8403584	0.198453811	0.198453811	48.11681855	198.4538113	0	74.42017923	0	0	19.84538113	19.84538113	32.90465873	19.84538112	19.84538113	74.42017922	19.84538113	0	0	0	0	19.84538113	0	19.84538113	0	0	0											3200	8.8088	0.19911008	3.288326406	0	2.285215702	1.736388136	1.150494115	1.101308328	5.991042829	0	1.027561303	0	0	0.428318937	5.095984102	9.92083077	0.24599918	0.802096928	2.3644357	1.658478547	0	0	0	0	0.501431177	0	0.214899076	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8207	0	0.364788428	8.8088	0.19911008	3.288326406	0	2.285215702	1.736388136	1.150494115	1.101308328	5.991042829	0	1.027561303	0	0	0.428318937	5.095984102	9.92083077	0.24599918	0.802096928	2.3644357	1.658478547	0	0	0	0	0.501431177	0	0.214899076	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8207	YES	$400/Days 1-5 for IP Medical; $400/Days 1-5 for IP Surgical;	$400/Days 1-5 for IP Psych; $400/Days 1-5 for IP Substance Abuse;	$75/Day for SNF	20% Coinsurance for Home Health	$150/Run for Ambulance	40% Coinsurance for DME	40% Coinsurance for Prosthetics/Supplies; 40% Coinsurance for Diabetes Monitoring Supplies; 40% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $35/Visit for Urgent Care; $35/Visit for Urgent Care - Worldwide;	$400/Case for OP Fac - Surgery; $400/Case for OP Fac - ASC	No Cost-Sharing	$150/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Visit for Prof - CORF; $35/Visit for Prof - CORF;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; $35/Procedure for PCP - Cardio;	$55/Visit for Speclst - Office Visits; $55/Consult for Speclst - Consults; $55/Procedure for Speclst - Cardio;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	$150/Procedure for Prof Radiology (OP); $150/Procedure for Prof Radiology (Office);	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											3200	1.9941	0.0504	0.5409	0.3198	0.2846	0.4349	0.2857	0.1429	1.4758	0	0.2663	0	0	0.0187	0.9354	1.778	0.0488	0.1665	0.5666	0.3409	0	0	0	0	0.0885	0	0.0379	0	0	0											9.7768	0	0.156523968	10.8029	0.249552453	3.829255544	0.319821767	2.569786531	2.171240794	1.436195568	1.244205984	7.466800033	0	1.293869706	0	0	0.446997858	6.031418969	11.69884949	0.294789068	0.968590765	2.930988131	1.999365114	0	0	0	0	0.58997445	0	0.252846193	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5975
H2810_002_0	2010	13	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	YES	559.9686615	12.56520436	859.1706481	0	196.9862841	9.296202419	6.15947204	292.6609686	390.3024366	0	176.063909	0	0	276.1724908	3435.247058	3928.959563	167.0998531	545.8250801	407.6536666	1135.311715	0	0	0	0	0	0	136.7949539	0	0	0											2500	$100/Days 1-5 for IP Medical; $100/Days 1-5 for IP Surgical;	$100/Days 1-5 for IP Psych; $100/Days 1-5 for IP Substance Abuse;	$25/Day for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $10/Visit for Urgent Care; $10/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC	No Cost-Sharing	$50/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Procedure for PCP - Cardio;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	$50/Procedure for Prof Radiology (OP); $50/Procedure for Prof Radiology (Office);	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	25	0	100	0.2	0.2	47.88787056	100	0	50	0	0	10	10	23.1779478	10	10	50	10	0	0	0	0	0	0	10	0	0	0											YES	99.42989575	99.42989572	24.85747394	0	99.42989576	0.198859792	0.198859792	47.61485978	99.42989575	0	49.71494788	0	0	9.942989573	9.942989575	23.04580934	9.94298958	9.942989578	49.71494788	9.942989577	0	0	0	0	0	0	9.942989573	0	0	0											2500	4.6398	0.10411308	1.779734333	0	1.632193808	1.848640875	1.224871326	1.161250915	3.233977549	0	0.729417338	0	0	0.228831683	2.846385474	7.545504416	0.138456008	0.45226109	1.688873399	0.940699379	0	0	0	0	0	0	0.1133459	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3084	0	0.173779967	4.6398	0.10411308	1.779734333	0	1.632193808	1.848640875	1.224871326	1.161250915	3.233977549	0	0.729417338	0	0	0.228831683	2.846385474	7.545504416	0.138456008	0.45226109	1.688873399	0.940699379	0	0	0	0	0	0	0.1133459	0	0	0	0	0	0	0	0	0	0	0	0	0	30.3084	YES	$300/Days 1-5 for IP Medical; $300/Days 1-5 for IP Surgical;	$300/Days 1-5 for IP Psych; $300/Days 1-5 for IP Substance Abuse;	$50/Day for SNF	20% Coinsurance for Home Health	$100/Run for Ambulance	40% Coinsurance for DME	40% Coinsurance for Prosthetics/Supplies; 40% Coinsurance for Diabetes Monitoring Supplies; 40% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$300/Case for OP Fac - Surgery; $300/Case for OP Fac - ASC	No Cost-Sharing	$100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$45/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults; $30/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	$100/Procedure for Prof Radiology (OP); $100/Procedure for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	$25/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											2500	1.5788	0.0396	0.3909	0.3396	0.2029	0.4618	0.3034	0.1507	1.1757	0	0.1886	0	0	0.0145	0.7304	1.3358	0.0379	0.1293	0.4034	0.2648	0	0	0	0	0.0647	0	0.0277	0	0	0											7.8406	0	0.128764825	6.2186	0.143708636	2.170681985	0.339620104	1.835111284	2.310465541	1.528293591	1.311918307	4.409714335	0	0.917997043	0	0	0.243337141	3.576765731	8.881292149	0.176344692	0.581554935	2.092246115	1.205544551	0	0	0	0	0.06470987	0	0.141078701	0	0	0	0	0	0	0	0	0	0	0	0	0	38.149
H2899_001_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1917.463967	39.24256197	621.9011779	700.7719178	236.9992358	10.0552983	4.757025501	498.5709071	256.1378981	3.601159265	8.044609017	0.172409604	0	11.12874636	4839.094139	2925.278733	73.25963573	71.02802357	18.79536759	82.94573487	13.54281332	0	0	0	295	10.2610981	0	0	0	0											4950	1a (IP Acute): $185 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 15% Coinsurance; 11c (Diabetic Supplies): 15% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $300 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $55 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $7 Copay per visit;	7d (SPC w/Copay): $33 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											111.2007506	181.0047223	59.28761237	0	150	0.2	0.15	48.60479884	300	0	0.193239741	0.2	0	0.197347649	5.657200425	33	40	40	0.2	0.027333718	0.2	0	0	0	25	0	0	0	0	0											NO	102.6996835	167.1672861	54.75519718	0	138.5328106	0.184710414	0.138532811	44.88906262	277.0656212	0	0.178466963	0.184710414	0	0.18226083	5.224719167	30.47721834	36.94208283	36.94208283	0.184710414	0.025244112	0.184710414	0	0	0	25	0	0	0	0	0												16.4102	0.546672715	2.837693468	0	2.736014188	1.857318313	0.659004113	1.865031722	5.913917154	0	1.435696937	0.031845849	0	2.028334552	2.106908991	7.429529886	0.225530294	0.218660261	3.471700131	2.09389142	2.501498657	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9841	0	4.49981956	16.4102	0.546672715	2.837693468	0	2.736014188	1.857318313	0.659004113	1.865031722	5.913917154	0	1.435696937	0.031845849	0	2.028334552	2.106908991	7.429529886	0.225530294	0.218660261	3.471700131	2.09389142	2.501498657	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9841	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.4102	0.546672715	2.837693468	0	2.736014188	1.857318313	0.659004113	1.865031722	5.913917154	0	1.435696937	0.031845849	0	2.028334552	2.106908991	7.429529886	0.225530294	0.218660261	3.471700131	2.09389142	2.501498657	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9841
H2899_002_0	2010	10	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	458.9874611	18.35958099	44.88987196	1762.858845	23.57627863	15.92902179	7.305315123	29.86571386	24.52070905	5.194522597	17.26802563	0.362806352	0	10.43225014	5386.534356	4006.120622	455.9889828	2.282390866	16.09053835	121.1157728	27.40581859	0	0	0	358	0.086931509	0	0	0	0												1a (IP Acute): 7.93% Coin MC CS; 1a1 (Add'l Days): 7.93% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.93% Coin MC CS;	2a (SNF): 18.30% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $25 Copay per visit;	7h (Psych): $25 Copay per visit; 7e (MH Non-Phys): 25 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 25 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): 20.00% Coin MC CS; 7b (Chiro): $25 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $25 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 25 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): 20.00% Coin MC CS;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 20.00% Coin MC CS; 18a1 (Routine Hearing Exam): 20.00% Coin MC CS (1 exam per year);	18b (Hearing Aids): 700 allowance (every 3 years);		13c (OTC Rx): $18.0 OTC per month											0.0793	0.0793	0.183	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	25	25	0.2	0.2	0.156116807	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0793	0.0793	0.183	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	25	25	0.2	0.2	0.156116807	0.2	0	0	0	5	0.2	0	0	0	0												36.3977	1.455914773	8.214846569	0	4.715255725	3.185804358	1.461063025	5.973142772	4.90414181	0	3.453605127	0.07256127	0	2.086450028	0	8.34608463	0.949977048	0.456478173	3.21810767	18.90820777	5.481163717	0	0	0	0.149166667	0.017386302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4471	0	0	36.3977	1.455914773	8.214846569	0	4.715255725	3.185804358	1.461063025	5.973142772	4.90414181	0	3.453605127	0.07256127	0	2.086450028	0	8.34608463	0.949977048	0.456478173	3.21810767	18.90820777	5.481163717	0	0	0	0.149166667	0.017386302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4471	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	36.3977	1.455914773	8.214846569	0	4.715255725	3.185804358	1.461063025	5.973142772	4.90414181	0	3.453605127	0.07256127	0	2.086450028	0	8.34608463	0.949977048	0.456478173	3.21810767	18.90820777	5.481163717	0	0	0	0.149166667	0.017386302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.4471
H2899_003_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1666.593751	38.97659806	588.0186237	641.7784159	214.2504268	9.545244511	4.208740119	456.2114284	228.2579036	3.500146945	8.73217612	0.247665717	0	10.85786963	4511.595155	2753.948242	60.72446352	68.20035889	14.36947025	72.76315641	10.0831746	0	0	0	401	10.64479739	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $50 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): $15 Copay per visit;	10a (Ambulance): $100 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 0% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 0% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 30 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 10 (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											93.08476114	169.0545177	32.71570554	15	100	0.2	0.092496623	48.28527132	200	0	0.184883994	0.2	0	0.197980746	4.077617381	30	40	30	0.2	0.02183422	0.2	0	0	0	5	0	0	0	0	0											NO	83.76853101	152.1349836	29.44140975	13.49875049	89.99166994	0.17998334	0.083239256	43.45272199	179.9833399	0	0.166380194	0.17998334	0	0.178166179	3.669515975	26.99750098	35.99666798	26.99750098	0.17998334	0.019648979	0.17998334	0	0	0	5	0	0	0	0	0												11.634	0.494142009	1.44267477	0.721933892	1.606729475	1.717984987	0.350332394	1.651969031	3.423551653	0	1.452861155	0.044575703	0	1.934505147	1.379614208	6.19581003	0.182156529	0.153436605	2.586265249	1.429721741	1.814803441	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3842	0	4.472537242	11.634	0.494142009	1.44267477	0.721933892	1.606729475	1.717984987	0.350332394	1.651969031	3.423551653	0	1.452861155	0.044575703	0	1.934505147	1.379614208	6.19581003	0.182156529	0.153436605	2.586265249	1.429721741	1.814803441	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3842	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.634	0.494142009	1.44267477	0.721933892	1.606729475	1.717984987	0.350332394	1.651969031	3.423551653	0	1.452861155	0.044575703	0	1.934505147	1.379614208	6.19581003	0.182156529	0.153436605	2.586265249	1.429721741	1.814803441	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3842
H2899_004_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1655.996553	38.72876159	584.2796504	637.6976057	212.8880947	9.602618536	4.23403778	453.3105639	226.8065036	3.521185434	8.784662998	0.249154372	0	10.92313351	4482.90774	2736.436995	60.33834115	67.76670031	14.45584147	73.20051715	10.14378198	0	0	0	295	10.57711141	0	0	0	0											5900	1a (IP Acute): $185 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 15% Coinsurance; 11c (Diabetic Supplies): 15% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $275 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $7 Copay per visit;	7d (SPC w/Copay): $33 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): $40 Copay per visit; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											133.565573	216.4519082	58.88826997	0	150	0.2	0.15	48.28527132	275	0	0.192441997	0.2	0	0.198229691	5.708664334	33	40	40	0.2	0.191499983	0.2	0	0	0	25	0	0	0	0	0											NO	122.3012312	198.1972919	53.92188838	0	137.3496498	0.183132866	0.13734965	44.2131007	251.8076912	0	0.176212273	0.183132866	0	0.181511858	5.227220313	30.21692295	36.62657327	36.62657327	0.183132866	0.175349704	0.183132866	0	0	0	25	0	0	0	0	0												16.8775	0.639661306	2.625455174	0	2.436675438	1.758555057	0.581543606	1.670188801	4.759301836	0	1.547965431	0.045628354	0	1.982678259	1.9527622	6.890558821	0.184165556	0.206838501	2.647339683	12.835689	1.857659871	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1148	0	5.658733228	16.8775	0.639661306	2.625455174	0	2.436675438	1.758555057	0.581543606	1.670188801	4.759301836	0	1.547965431	0.045628354	0	1.982678259	1.9527622	6.890558821	0.184165556	0.206838501	2.647339683	12.835689	1.857659871	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1148	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.8775	0.639661306	2.625455174	0	2.436675438	1.758555057	0.581543606	1.670188801	4.759301836	0	1.547965431	0.045628354	0	1.982678259	1.9527622	6.890558821	0.184165556	0.206838501	2.647339683	12.835689	1.857659871	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1148
H2899_006_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	1757.670984	40.62750045	488.1657577	685.1544553	218.2892172	12.43554282	4.505180308	444.1187486	212.4797752	3.691100661	10.87831943	0.153550433	0	9.511121844	4808.724248	2954.535682	51.21896795	57.9523107	11.9130496	79.23758383	6.503003497	0	0	0	295	11.33564833	0	0	0	0												1a (IP Acute): $185 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 15% Coinsurance; 11c (Diabetic Supplies): 15% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $275 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $7 Copay per visit;	7d (SPC w/Copay): $35 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											137.5553073	190.7564451	54.88284511	0	150	0.2	0.15	47.65619129	275	0	0.192213584	0.2	0	0.198475684	5.778557704	35	40	40	0.2	0.025256138	0.2	0	0	0	25	0	0	0	0	0											NO	137.5553073	190.7564451	54.88284511	0	150	0.2	0.15	47.65619129	275	0	0.192213584	0.2	0	0.198475684	5.778557704	35	40	40	0.2	0.025256138	0.2	0	0	0	25	0	0	0	0	0												20.1481	0.645829797	2.232660473	0	2.728615215	2.487108564	0.675777046	1.76375067	4.869328181	0	2.090960769	0.030710087	0	1.887726413	2.315624212	8.617395738	0.170729893	0.193174369	2.382609919	2.001235371	1.300600699	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1565	0	0	20.1481	0.645829797	2.232660473	0	2.728615215	2.487108564	0.675777046	1.76375067	4.869328181	0	2.090960769	0.030710087	0	1.887726413	2.315624212	8.617395738	0.170729893	0.193174369	2.382609919	2.001235371	1.300600699	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1565	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.1481	0.645829797	2.232660473	0	2.728615215	2.487108564	0.675777046	1.76375067	4.869328181	0	2.090960769	0.030710087	0	1.887726413	2.315624212	8.617395738	0.170729893	0.193174369	2.382609919	2.001235371	1.300600699	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1565
H2899_007_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	404.8357737	9.957143661	38.26051209	2677.982867	15.12493649	17.32267325	6.545986885	28.80605378	25.61702673	5.933668138	12.15769805	0.695855672	0	12.14611247	4781.919569	3403.007063	354.8903615	1.445541411	21.22123831	103.5052192	16.70719792	0	0	0	358	0.042054236	0	0	0	0												1a (IP Acute): 8.41% Coin MC CS; 1a1 (Add'l Days): 8.41% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.41% Coin MC CS;	2a (SNF): 19.88% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 700 allowance (every 3 years);		13c (OTC Rx): $18.5 OTC per month (cumulative benefit)											0.0841	0.0841	0.1988	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.152044158	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0841	0.0841	0.1988	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.152044158	0.2	0	0	0	5	0.2	0	0	0	0												34.0467	0.837395782	7.606189803	0	3.024987298	3.46453465	1.309197377	5.761210756	5.123405345	0	2.431539611	0.139171134	0	2.429222494	0	2.835839219	0.295741968	0.289108282	4.244247662	15.73736395	3.341439585	0	0	0	0.149166667	0.008410847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0749	0	0	34.0467	0.837395782	7.606189803	0	3.024987298	3.46453465	1.309197377	5.761210756	5.123405345	0	2.431539611	0.139171134	0	2.429222494	0	2.835839219	0.295741968	0.289108282	4.244247662	15.73736395	3.341439585	0	0	0	0.149166667	0.008410847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0749	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	34.0467	0.837395782	7.606189803	0	3.024987298	3.46453465	1.309197377	5.761210756	5.123405345	0	2.431539611	0.139171134	0	2.429222494	0	2.835839219	0.295741968	0.289108282	4.244247662	15.73736395	3.341439585	0	0	0	0.149166667	0.008410847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0749
H2899_008_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	304.4513414	6.32351653	26.84352864	1689.193387	10.55499173	12.34414265	4.846528624	20.02071462	22.05691886	4.298008451	9.27798702	0.454834642	0	9.914091706	4027.72657	2729.050054	216.5443401	1.208848045	15.93101175	78.51152695	12.17062544	0	0	0	358	0.066472221	0	0	0	0												1a (IP Acute): 8.39% Coin MC CS; 1a1 (Add'l Days): 8.39% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.39% Coin MC CS;	2a (SNF): 19.82% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 700 allowance (every 3 years);		13c (OTC Rx): $18.0 OTC per month											0.0839	0.0839	0.1982	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.154633985	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0839	0.0839	0.1982	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.154633985	0.2	0	0	0	5	0.2	0	0	0	0												25.5435	0.530543037	5.320387377	0	2.110998347	2.46882853	0.969305725	4.004142924	4.411383771	0	1.855597404	0.090966928	0	1.982818341	0	2.274208378	0.180453617	0.241769609	3.18620235	12.14055027	2.434125088	0	0	0	0.149166667	0.013294444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9082	0	0	25.5435	0.530543037	5.320387377	0	2.110998347	2.46882853	0.969305725	4.004142924	4.411383771	0	1.855597404	0.090966928	0	1.982818341	0	2.274208378	0.180453617	0.241769609	3.18620235	12.14055027	2.434125088	0	0	0	0.149166667	0.013294444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9082	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.5435	0.530543037	5.320387377	0	2.110998347	2.46882853	0.969305725	4.004142924	4.411383771	0	1.855597404	0.090966928	0	1.982818341	0	2.274208378	0.180453617	0.241769609	3.18620235	12.14055027	2.434125088	0	0	0	0.149166667	0.013294444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9082
H2899_009_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1328.252796	43.69209271	727.5478963	589.6280668	201.2682981	8.781804976	4.223167754	463.0422505	228.000697	4.304760455	10.94013863	0.587219578	0	15.46441757	4333.191331	2683.583569	55.61224629	85.27117129	12.76050424	70.09774133	10.15897298	0	0	0	295	12.62568652	0	0	0	0											4450	1a (IP Acute): $185 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $50 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 15% Coinsurance; 11c (Diabetic Supplies): 15% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $55 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $7 Copay per visit;	7d (SPC w/Copay): $32 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											121.4713587	171.0821091	33.8811265	0	150	0.2	0.15	48.20342279	200	0	0.191466232	0.2	0	0.19921738	5.746499661	32	40	40	0.2	0.026287828	0.2	0	0	0	25	0	0	0	0	0											NO	111.3551425	156.8342764	31.05948358	0	137.5078994	0.183343866	0.137507899	44.18900943	183.3438659	0	0.175520796	0.183343866	0	0.182626423	5.267927317	29.33501855	36.66877319	36.66877319	0.183343866	0.02409856	0.183343866	0	0	0	25	0	0	0	0	0												12.3256	0.571034812	1.883105161	0	2.306331742	1.610090074	0.580718927	1.705114864	3.483544102	0	1.92022184	0.107663108	0	2.824211266	1.902244748	6.560247814	0.16993607	0.26056577	2.339560178	1.689254619	1.86258538	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7167	0	4.006436692	12.3256	0.571034812	1.883105161	0	2.306331742	1.610090074	0.580718927	1.705114864	3.483544102	0	1.92022184	0.107663108	0	2.824211266	1.902244748	6.560247814	0.16993607	0.26056577	2.339560178	1.689254619	1.86258538	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7167	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.3256	0.571034812	1.883105161	0	2.306331742	1.610090074	0.580718927	1.705114864	3.483544102	0	1.92022184	0.107663108	0	2.824211266	1.902244748	6.560247814	0.16993607	0.26056577	2.339560178	1.689254619	1.86258538	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7167
H2899_801_0	2010	3	N/A																															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	NO	298.4780116	3.863664141	21.99690586	16.79561956	8.223080637	10.23222513	4.613040436	15.38071156	28.77470306	3.766476496	9.455449092	0.26452354	0	11.63173659	29.01277433	26.50853118	0.453785824	1.482476266	15.42188626	78.9723088	10.7711728	0	0	0	0	0	0	0	0	0												FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.3939	0.315768384	3.708625864	0	1.915977788	2.384108455	1.074838422	3.583705793	6.704505813	0.877589024	2.203119638	0.061633985	0	2.710194626	6.759976419	6.176487764	0.105732097	0.34541697	3.593299499	18.40054795	2.509683262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8251		0	24.3939	0.315768384	3.708625864	0	1.915977788	2.384108455	1.074838422	3.583705793	6.704505813	0.877589024	2.203119638	0.061633985	0	2.710194626	6.759976419	6.176487764	0.105732097	0.34541697	3.593299499	18.40054795	2.509683262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8251	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	24.3939	0.315768384	3.708625864	0	1.915977788	2.384108455	1.074838422	3.583705793	6.704505813	0.877589024	2.203119638	0.061633985	0	2.710194626	6.759976419	6.176487764	0.105732097	0.34541697	3.593299499	18.40054795	2.509683262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8251
H2905_001_0	2010	9	N/A	h.2.	h.2.	h.1.	h.1.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Complex diag xray	PET Scans	Chemotherapy	Genetic Testing							D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	V	Coin	Coin	Coin	Coin																																															0	YES	350.4733234	68.37542213	1753.259291	6385.78354	143.4012652	10.68242979	4.49372437	347.5878129	350.4179585	5054.443697	1269.671429	0	0	24.65268282	105.459592	6261.130509	90.83448829	719.5116033	47.2164472	184.5540692	1.91669045	0							32.47472064		8.716171356	5.058953543	0.114547588	0							3350	"$175/Day,days 1-20"	"$175/Day,days 1-11"	"$50/day, days 11-40"	No Cost Sharing	$100/trip	20% Coinsurance	20% Coinsurance	$50/visit	$150/visit	$10/visit	$15/visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	$5/visit	$25/visit	$25/visit	$25/visit	$25/visit	$25/visit	20% Coinsurance	20% Coinsurance							$0 to $25 /visit		20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance							147.3155971	116.7770922	14.01024842	0	100	0.2	0.2	50	150	10	15	0.2	0.2	0.2	5	25	25	25	25	25	0.2	25							15		0.2	0.2	0.2	0.2							YES	118.6535736	94.05670263	11.28438588	0	80.54379576	0.161087592	0.161087592	40.27189788	120.8156936	8.054379576	12.08156936	0.161087592	0.161087592	0.161087592	5	25	25	25	25	25	0.161087592	20.13594894							15		0.161087592	0.161087592	0.161087592	0.161087592							3350	3.4654	0.535930562	1.648704532	0	0.962506851	1.720806886	0.723883236	1.166501742	3.527999061	3.392534007	1.278301953	0	0	3.971241301	0.043941497	13.04402189	0.189238517	1.498982507	0.098367598	0.384487644	0.308755048	0	0	0	0	0	0	0	0.040593401	0	1.404067051	0.814934642	0.018452195	0	0	0	0	0	0	0	40.2397		6.139376746	3.4654	0.535930562	1.648704532	0	0.962506851	1.720806886	0.723883236	1.166501742	3.527999061	3.392534007	1.278301953	0	0	3.971241301	0.043941497	13.04402189	0.189238517	1.498982507	0.098367598	0.384487644	0.308755048	0	0	0	0	0	0	0	0.040593401	0	1.404067051	0.814934642	0.018452195	0	0	0	0	0	0	0	40.2397	NO	"$225/Day,days 1-15"	"$225/Day,days 1-15"	30% Coinsurance	30% Coinsurance	$100/trip or 40%	30% Coinsurance	30% Coinsurance	$50/visit	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	$10/visit	$30/visit	$30/visit	$30/visit	$30/visit	$30/visit	20% Coinsurance	$30/visit									30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance								0.4375	0	1.7071	0	0	0.431	0.0845	0.4823	1.8551	1.0436	0.3933	0	0	0.6217	0	3.5913	0	1.1887	0.1152	0.2791	0	0									0	0	0	0							12.2306		0.225693592	3.9029	0.535930562	3.35580832	0	0.962506851	2.15183388	0.808365727	1.648784928	5.383142204	4.436152543	1.671618828	0	0	4.592976322	0.043941497	16.63534362	0.189238517	2.687664837	0.213580709	0.663626795	0.308755048	0	0	0	0	0	0	0	0.040593401	0	1.404067051	0.814934642	0.018452195	0	0	0	0	0	0	0	52.4702
H2906_003_0	2010	6	N/A																															D	D	D	V	COIN	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V	T	COIN	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	YES	2272.204809	21.85181396	1309.855357	688.3482844	11.08114555	4.903574302	1.353164513	489.3381185	656.0037449	220.8776369	770.8854502	0	0.777448409	1116.553096	2339.393843	6569.611974	109.2084403	0	2968.137736	9504.516819	19.21418441	934.2898531	0	44.44491606	307.1093777	199.3041852	0	0.331711408	0	1000											2500	PBP: 1A IP Acute: $100 per stay	1B IP Psych: $100 per stay	2 SNF: $0 per stay plus $50 per day for days 36-100 only	"6 Home Health: $0, 13C Custodial Care: $0 per episode"	11A DME: 15%	11A DME: 10%	11B Prosthetic Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $15/30"	"9B ASC Services: $50, 9A HOP - Surgery $50"	8A OP Lab: $0	"8B: $25 Routine Imaging,  $50 Radiation Theray, $50 CT, $75 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $20	12 Renal Dialysis: 10%	"3 CORF: 10%, 9D Cardiac Rehab: $10, 7C Occupational Therapy: 10%, 7I Physical and Speech Therapy: 10%"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $0, separate office visit copay applies, 14H Mammography: $0, 14I Diabetes Monitoring: $0, separate office visit copay may apply"	"7B Chiropractic: $25, 7D Physician Specialist: $25, 7F Podiatry: $25"	"7E Mental Health: $25, 7H Psychiatric: $25, 9C OP Substance Abuse: $25,"		7D Physician Specialist: $25	"7G Other Health Care: $25, 18A Medicare Covered Hearing Exams: $25"	"15 Part B Drugs: 20%, 11C Diabetes Monitoring Supplies: 0-10%"	"13A Blood: 10%, 17A Medicare Covered Eye Exams: $15"	10B Transportation: $0	"16A Preventive Dental Services: $0, 16B Additional Comprehensive Dental Coverage 20%-50% with $50 deductible"	17A Routine Eye Exams non-Medicare-covered: $15	17B Eye Wear: $150 Allowance	18A Routine Hearing Test (non-Medicare covered): Not Covered	18B Hearing Aids: $600 allowance every 36 months	19 POS: N/A	"14A Health Education/Wellness Programs: $0, Membership in Health Club $0"											18.00433719	18.00433719	16.80888546	0	0.14925	0.1	0.1	32.53893353	50	0	40.05436405	0	0.1	3.238300151	9.075181049	25	25	0	0	0.179678981	0.19	68.63215657	0	0.37	15	0	0	0	0	0											NO	17.65773938	17.65773938	16.48530105	0	0.146376819	0.09807492	0.09807492	31.91253317	49.03746023	0	39.28328568	0	0.09807492	3.175960297	8.900476595	24.51873011	24.51873011	0	0	0.176220018	0.186342349	67.31093296	0	0.362877206	14.71123807	0	0	0	0	0												3.3435	0.03215447	1.799446658	0	1.622022835	0.48091766	0.132711502	1.301334912	2.680729796	0	2.523576114	0	0.076248191	0.295510692	1.735143345	13.42321191	0.223137689	0	0	0.139573844	3.580416254	5.240660139	0	16.12804695	0.376496597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1348		1.082223175	3.3435	0.03215447	1.799446658	0	1.622022835	0.48091766	0.132711502	1.301334912	2.680729796	0	2.523576114	0	0.076248191	0.295510692	1.735143345	13.42321191	0.223137689	0	0	0.139573844	3.580416254	5.240660139	0	16.12804695	0.376496597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1348	NO	"20% Coinsurance, $500 combined IP Acute and IP Psych Deductible"	"20% Coinsurance, $500 combined IP Acute and IP Psych Deductible"	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance												0	1.7123	0	0	0	0	0.0363	0.4425	0.1058	0.0828	0.1651	0	0	0.2562	0.7378	1.1267	0.1741	0	0.1591	1.8058	0.6876	0.1595	0	0	0	0	0	0	0	0											7.6516			3.3435	1.744469593	1.799446658	0	1.622022835	0.48091766	0.168975445	1.74385861	2.786524529	0.082825117	2.688628622	0	0.076248191	0.551733183	2.472967705	14.54993426	0.397264419	0	0.159092727	1.945346517	4.267992621	5.400186456	0	16.12804695	0.376496597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7865
H2906_801_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	180.4865048	5.800366338	61.81087101	12.27399273	11.97409443	10.39074188	1.741207773	18.11331617	38.56895944	1.452675834	35.20911918	0	0.104803449	5.958109065	17.38253384	50.62794054	0.482162288	0	27.61244453	124.780386	21.03399172	10.32551429	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.072861461	0.072861461	0.150081441	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072861461	0.072861461	0.150081441	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												13.1505	0.422623166	9.2766646	0	2.789964002	2.421042858	0.405701411	4.220402669	8.986567549	0.338473469	8.203724769	0	0.024419204	1.388239412	4.050130386	11.79631015	0.112343813	0	6.433699575	29.07382993	4.900920071	2.405844829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4014		0	13.1505	0.422623166	9.2766646	0	2.789964002	2.421042858	0.405701411	4.220402669	8.986567549	0.338473469	8.203724769	0	0.024419204	1.388239412	4.050130386	11.79631015	0.112343813	0	6.433699575	29.07382993	4.900920071	2.405844829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.4014	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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	0.3039	0	0	0	0	0.0541	0.6988	0.1301	0.0534	0.1726	0	0	0.1617	1.0019	1.1636	0.0955	0	0.1816	1.4818	0.9106	0.1412	0	0	0	0	0	0	0	0											6.5508			13.1505	0.726569376	9.2766646	0	2.789964002	2.421042858	0.459794933	4.919238568	9.116654509	0.391892766	8.376310458	0	0.024419204	1.54991481	5.052046691	12.95991723	0.207836054	0	6.615295934	30.55558299	5.811522981	2.547055058	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.9522
H2926_001_0	2010	3	N/A																															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																																																			0	NO	248.2348134	14.71961198	129.6952884		16.68717651	32.05983339	11.37195754	25.09958609	31.02877226	22.62578645	30.25248975	5.272766071		34.97085199	109.0762842	1.292924717	15.92820081	1.005796623	11.33870439	0	3.636674457																					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	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare	Same as Medicare											0.08138379	0.08138379	0.13755679		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.08138379	0.08138379	0.13755679		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					20.2023	1.197937803	17.84046748	0	3.888112127	7.469941181	2.649666107	5.848203559	7.229703936	5.271808243	7.048830112	1.228554495	0	8.148208514	25.41477423	0.301251459	3.711270789	0.234350613	2.641918122	0	0.847345148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1746			20.2023	1.197937803	17.84046748	0	3.888112127	7.469941181	2.649666107	5.848203559	7.229703936	5.271808243	7.048830112	1.228554495	0	8.148208514	25.41477423	0.301251459	3.711270789	0.234350613	2.641918122	0	0.847345148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1746	NO																																																																																		0			20.2023	1.197937803	17.84046748	0	3.888112127	7.469941181	2.649666107	5.848203559	7.229703936	5.271808243	7.048830112	1.228554495	0	8.148208514	25.41477423	0.301251459	3.711270789	0.234350613	2.641918122	0	0.847345148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1746
H2931_002_0	2010	9	N/A	h.1.	h.1.									OP Facility - Other	OP Facility - Other									Chemotherapy	Genetic Testing									D	D	D	V	Coin	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin				V	V			V		Coin	Coin																																																	0	YES	1341.6834	16.35079896	2623.130762	21110.90319	18.28451813	25.52504562	2.888750898	237.5822299	406.7377185	1991.474777	1127.135728	0	8.783066409	236.6819944	4599.556093	2099.510105	239.6391833	1008.613401	3.030418774	114.7920962	19.66508979				224.8978075	0			125.1		0.031417183	0									3350	"$125/day, max 5 days"	"$125/day, max 5 days"	"$50/day, days 11 - 100"	None	20% coinsurance	None	20% coinsurance	50	$100Hospital/$70ASC	$5/procedure	$5/procedure	$100/visit	20% coinsurance	$10/visit	$14/visit Office/$25 urgently needed care	$30/visit	$30/visit	$30/visit	$30/visit	$30/visit	0.2				20	Max benefit $30/2-yrs			Smoking Cess $35/Nursing HL $0		20% coinsurance	0.5									45.41566986	45.41566986	26.02585365	0	0.2	0	0.2	50	85.62103654	5	5	100	0.2	10	14	30	30	30	30	30	0.2				20	0			0		0.2	0.5									NO	37.6472194	37.6472194	21.574074	0	0.165789559	0	0.165789559	41.44738976	43.81481253	4.144738976	4.144738976	82.89477951	0.165789559	8.289477951	14	30	30	30	30	30	0.165789559				20	0			0		0.165789559	0.414473898										4.2092	0.051296843	4.715968098	0	3.031382198	0	0.478924737	0.82059694	1.48509474	0.687845261	0.389306949	0	1.456140707	0.163497514	5.366148776	5.248775262	0.599097958	2.521533504	0.007576047	0.286980241	3.260266564	0	0	0	0.374829679	0	0	0	0	0	0.005208641	0	0	0	0	0	0	0	0	0	35.1597	0	5.457371671	4.2092	0.051296843	4.715968098	0	3.031382198	0	0.478924737	0.82059694	1.48509474	0.687845261	0.389306949	0	1.456140707	0.163497514	5.366148776	5.248775262	0.599097958	2.521533504	0.007576047	0.286980241	3.260266564	0	0	0	0.374829679	0	0	0	0	0	0.005208641	0	0	0	0	0	0	0	0	0	35.1597	NO	"$200/day, max 5-days"	"$200/day, max 5-days"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	35	35	35	35	35	35	35																					0.0398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5115	0	0	0.4045																				0.9558	0	0	4.249	0.051296843	4.715968098	0	3.031382198	0	0.478924737	0.82059694	1.48509474	0.687845261	0.389306949	0	1.456140707	0.163497514	5.366148776	5.248775262	0.599097958	3.033066877	0.007576047	0.286980241	3.664766475	0	0	0	0.374829679	0	0	0	0	0	0.005208641	0	0	0	0	0	0	0	0	0	36.1155
H2931_004_0	2010	7	N/A																															D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	V	V	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	YES	1343.788573	25.70851735	2623.96829	4157.170347	16.63770647	23.36333729	3.360900649	392.6413672	20.25376127	1.976247981	13.21328284	0	14.94965482	21.56720747	5383.907175	3847.97898	85.17791326	244.6593887	86.50888751	328.6506576	9.134061356	0							125.0889115												3000	"$125/day, max 5 days"	"$125/day, max 5 days"	"$50/day, days 11 - 100"	None	20% coinsurance	20% coinsurance	20% coinsurance	$50/visit	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	$10/visit	$35/visit	$35/visit	$35/visit	$35/visit	$35/visit	20% coinsurance	20% coinsurance							"NC Nursing HL, $10 -$60 Smoking Cessation"												45.41566986	45.41566986	26.02585365	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	10	35	35	35	35	35	0.2	0.2							0.001458333												NO	35.02052844	35.02052844	20.06882538	0	0.154222226	0.154222226	0.154222226	38.55555643	0.154222226	0.154222226	0.154222226	0.154222226	0.154222226	0.154222226	10	35	35	35	35	35	0.154222226	0.154222226							0													3.9217	0.075027155	4.388330118	0	2.565904123	3.603145877	0.518325578	1.261542199	3.123580142	0.304781362	2.037781888	0	2.305569039	3.326142738	4.486589312	11.22327203	0.24843558	0.713589884	0.252317589	0.958564418	1.408675272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7233	0	8.560776945	3.9217	0.075027155	4.388330118	0	2.565904123	3.603145877	0.518325578	1.261542199	3.123580142	0.304781362	2.037781888	0	2.305569039	3.326142738	4.486589312	11.22327203	0.24843558	0.713589884	0.252317589	0.958564418	1.408675272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7233	NO																																																																																		0	0	0	3.9217	0.075027155	4.388330118	0	2.565904123	3.603145877	0.518325578	1.261542199	3.123580142	0.304781362	2.037781888	0	2.305569039	3.326142738	4.486589312	11.22327203	0.24843558	0.713589884	0.252317589	0.958564418	1.408675272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7233
H2931_016_0	2010	7	N/A	h.1.	h.1.									OP Facility - Other	OP Facility - Other									Chemotherapy	Genetic Testing									D	D	D	V	Coin	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin		T		V	V					Coin	Coin																																																	0	YES	1439.430556	29.38547651	2847.944247	191.6530975	11.69449812	22.31089636	14.24111081	345.7701797	286.8289734	10269.70936	157.2550338	0	125.0500757	71.14534321	4556.387694	1530.462737	23.31681788	59.22190764	4.383954406	26.14938635	22.818492		0		180.3022904	0					0.84892985	0.01505524									3400	"$150/day, max 5 days"	"$150/day, max 5 days"	"$50/day, days 11 - 100"	None	20% coinsurance	"None, except Insulin pumps 20%"	20% coinsurance	$50/visit	$100Hospital/$70ASC	$5/procedure	$5/procedure	$100/visit	$10/visit	$10/visit	$10/visit Office/$25 urgently needed care	$20/visit	$20/visit	$20/visit	$20/visit	$20/visit	20% coinsurance		None		$ 20/ visit	Max benefit $30/2-yrs					20% coinsurance	50% coinsurance									54.49880383	54.49880383	26.02585365	0	0.2	0.2	0.2	50	66.70617849	5	5	100	10	10	10	20	10	20	20	20	0.2				20	0					0.2	0.5									NO	45.2654088	45.2654088	21.61645434	0	0.166115238	0.166115238	0.166115238	41.52880946	61.04532964	4.152880946	4.152880946	83.05761891	8.305761891	8.305761891	10	20	10	20	20	20	0.166115238				20	0					0.166115238	0.415288095										5.4297	0.110845467	5.130204733	0	1.942634337	3.706179855	2.365665509	1.196618659	1.459130769	3.55407336	0.054421786	0	0.086553013	0.049243023	3.796989745	2.550771228	0.019430682	0.098703179	0.007306591	0.043582311	3.790499225	0	0	0	0.300503817	0	0	0	0	0	0.141020184	0.006252262	0	0	0	0	0	0	0	0	35.8403	0	5.479282534	5.4297	0.110845467	5.130204733	0	1.942634337	3.706179855	2.365665509	1.196618659	1.459130769	3.55407336	0.054421786	0	0.086553013	0.049243023	3.796989745	2.550771228	0.019430682	0.098703179	0.007306591	0.043582311	3.790499225	0	0	0	0.300503817	0	0	0	0	0	0.141020184	0.006252262	0	0	0	0	0	0	0	0	35.8403	NO																																																																																		0			5.4297	0.110845467	5.130204733	0	1.942634337	3.706179855	2.365665509	1.196618659	1.459130769	3.55407336	0.054421786	0	0.086553013	0.049243023	3.796989745	2.550771228	0.019430682	0.098703179	0.007306591	0.043582311	3.790499225	0	0	0	0.300503817	0	0	0	0	0	0.141020184	0.006252262	0	0	0	0	0	0	0	0	35.8403
H2931_801_0	2010	4	N/A	h.1.	h.1.	h.2.	h.2.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Chemotherapy	Genetic Testing	Complex diag xray	PET Scans							D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	Coin	V	V	V	V	V	V	Coin				V				V		Coin	Coin	V	V																																															0	YES	1355.711175	25.8958407	2677.708414	1123.855869	2857.987379	3.698037057	32.78844973	304.7752635	357.1637352	8734.669573	2.164337424	0	15.12400779	66.22049174	4273.212442	1439.593192	60.40493629	123.305643	78.3828088	25.15583415	19.6196878				161.4776154				112.2179046		0.694742511	0.012320824	13.11215931	0.460968342							3350	"$125/day, max 5 days"	"$125/day, max 5 days"	"$50/day, days 21 - 100"	None	$150/Trip	"None ,except insulin pumps 20% coins"	20% coinsurance	$50/visit	$100/visit OH - $50/visit ASC	$5/procedure	$5/procedure	$100/visit	20% coinsurance	$10/visit	$10/visit OV - $25 Urgently Needed SVC	$35/visit	$10/visit	$10/visit	$20/visit	$20/visit	20% coinsurance				$35/visit				$10-$60/visit		20% coinsurance	50% coinsurance	$50/visit	$200/visit							45.41566986	45.41566986	26.02585365	0	150	0.169337477	0.2	50	74.66027056	5	5	100	0.2	10	10	35	10	10	20	20	0.2				35				15		0.2	0.5	50	200							NO	29.19750538	29.19750538	16.73189021	0	96.43424439	0.108866211	0.128578993	32.14474813	47.99871185	3.214474813	3.214474813	64.28949626	0.128578993	6.428949626	10	35	10	10	20	20	0.128578993				35				15		0.128578993	0.321447481	32.14474813	128.5789925								3.2986	0.063007829	3.7335936	0	22.96732112	0.402591283	4.215905832	0.81641034	1.428616601	2.339781279	0.000579767	0	1.944629684	4.257282056	3.561010369	4.198813475	0.050337447	0.102754703	0.130638015	0.04192639	2.522679692	0	0	0	0.470976378	0	0	0	0.140272381	0	0.089329292	0.003960498	0.035123922	0.004939237	0	0	0	0	0	0	56.8211		24.32813672	3.2986	0.063007829	3.7335936	0	22.96732112	0.402591283	4.215905832	0.81641034	1.428616601	2.339781279	0.000579767	0	1.944629684	4.257282056	3.561010369	4.198813475	0.050337447	0.102754703	0.130638015	0.04192639	2.522679692	0	0	0	0.470976378	0	0	0	0.140272381	0	0.089329292	0.003960498	0.035123922	0.004939237	0	0	0	0	0	0	56.8211	NO																																																																																		0			3.2986	0.063007829	3.7335936	0	22.96732112	0.402591283	4.215905832	0.81641034	1.428616601	2.339781279	0.000579767	0	1.944629684	4.257282056	3.561010369	4.198813475	0.050337447	0.102754703	0.130638015	0.04192639	2.522679692	0	0	0	0.470976378	0	0	0	0.140272381	0	0.089329292	0.003960498	0.035123922	0.004939237	0	0	0	0	0	0	56.8211
H2931_803_0	2010	4	N/A	h.1.	h.1.	h.2.	h.2.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Chemotherapy	Genetic Testing	Complex diag xray	PET Scans							D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin				V				V		Coin	Coin	V	V																																															0	YES	1509.315269	30.81214873	2986.212651	15377.93885	1809.074986	3.522133675	34.56180488	345.4983012	313.8673479	10885.75286	133.6598723	0	7.860621201	75.41310041	4464.705522	1499.667256	22.84764434	58.03026341	4.295741881	25.62321679	23.67897638				202.7360782				112.2179046		0.907708287	0.016097639	26.42266731	6.605666828							3350	"$125/day, max 5 days"	"$125/day, max 5 days"	"$50/day, days 21 - 100"	None	$150/Trip	"None ,except insulin pumps 20% coins"	20% coinsurance	$50/visit	$100/visit OH - $50/visit ASC	$5/procedure	$5/procedure	$100/visit	20% coinsurance	$10/visit	$10/visit OV - $25 Urgently Needed SVC	$35/visit	$10/visit	$10/visit	$20/visit	$20/visit	20% coinsurance				$35/visit				$10 - $60/visit		20% coinsurance	50% coinsurance	$50/visit	$200/visit							45.41566986	45.41566986	26.02585365	0	150	0.169383738	0.2	50	66.70617849	5	5	100	0.2	10	10	35	10	10	20	20	0.2				35				15		0.2	0.5	50	200							NO	29.16106378	29.16106378	16.71100703	0	96.31388418	0.108760038	0.128418512	32.10462806	54.74764738	3.210462806	3.210462806	64.20925612	0.128418512	6.420925612	10	35	10	10	20	20	0.128418512				35				15		0.128418512	0.321046281	32.10462806	128.4185122								3.6678	0.074876253	4.158551717	0	14.51991989	0.383067394	4.438375563	0.924341205	1.431958241	2.912358722	0.035759171	0	1.00944928	0.040351826	3.720587935	4.374029497	0.019039704	0.048358553	0.00715957	0.042705361	3.040818918	0	0	0	0.591313561	0	0	0	0.140272381	0	0.116566548	0.005168087	0.070690826	0.070690826	0	0	0	0	0	0	45.8442		4.584353822	3.6678	0.074876253	4.158551717	0	14.51991989	0.383067394	4.438375563	0.924341205	1.431958241	2.912358722	0.035759171	0	1.00944928	0.040351826	3.720587935	4.374029497	0.019039704	0.048358553	0.00715957	0.042705361	3.040818918	0	0	0	0.591313561	0	0	0	0.140272381	0	0.116566548	0.005168087	0.070690826	0.070690826	0	0	0	0	0	0	45.8442	NO																																																																																		0			3.6678	0.074876253	4.158551717	0	14.51991989	0.383067394	4.438375563	0.924341205	1.431958241	2.912358722	0.035759171	0	1.00944928	0.040351826	3.720587935	4.374029497	0.019039704	0.048358553	0.00715957	0.042705361	3.040818918	0	0	0	0.591313561	0	0	0	0.140272381	0	0.116566548	0.005168087	0.070690826	0.070690826	0	0	0	0	0	0	45.8442
H2931_804_0	2010	4	N/A	h.1.	h.1.	h.2.	h.2.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Chemotherapy	Genetic Testing	Complex diag xray	PET Scans							D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	Coin	V	V	V	V	V	V	Coin				V				V		Coin	Coin	V	V																																															0	YES	581.2522544	196.2711864	1109.956995	312.1783807	981.4205872	9.385860051	5.048374171	125.3549414	193.7950269	3871.266872	89.54665264	0	2.881056464	1.678771502	1725.126669	586.1719299	22.10242263	27.59593449	28.75434944	120.8350139	8.836798915				161.4776154				112.2179046		0.694742511	0.012320824	13.11215931	0.460968342							3350	"$125/day, max 5 days"	"$125/day, max 5 days"	"$50/day, days 21 - 100"	None	$150/Trip	"None ,except insulin pumps 20% coins"	20% coinsurance	$50/visit	$100/visit OH - $50/visit ASC	$5/procedure	$5/procedure	$100/visit	20% coinsurance	20% coinsurance	$10/visit OV - $25 Urgently Needed SVC	$35/visit	$10/visit	$10/visit	$20/visit	$20/visit	20% coinsurance				$35/visit				$10 - $60/visit		20% coinsurance	50% coinsurance	$50/visit	$200/visit							45.41566986	45.41566986	26.02585365	0	150	0.169421638	0.2	50	79.2276923	5	5	100	0.2	0.2	10	35	10	10	20	20	0.2				35				15		0.2	0.5	50	200							NO	38.36500877	38.36500877	21.98540959	0	126.7129018	0.143119383	0.168950536	42.23763393	66.9278053	4.223763393	4.223763393	84.47526787	0.168950536	0.168950536	8.447526787	29.56634375	8.447526787	8.447526787	16.89505357	16.89505357	0.168950536				35				15		0.128578993	0.321447481	32.14474813	128.5789925								1.8583	0.627495482	2.033571597	0	10.36322087	1.343298496	0.852925521	0.441224677	1.080856319	1.362609609	0.031518656	0	0.486756033	0.283629345	1.214421145	1.444246731	0.015559234	0.01942645	0.040483856	0.170126169	1.492981911	0	0	0	0.470976378	0	0	0	0.140272381	0	0.089329292	0.003960498	0.035123922	0.004939237	0	0	0	0	0	0	25.9073		4.651438014	1.8583	0.627495482	2.033571597	0	10.36322087	1.343298496	0.852925521	0.441224677	1.080856319	1.362609609	0.031518656	0	0.486756033	0.283629345	1.214421145	1.444246731	0.015559234	0.01942645	0.040483856	0.170126169	1.492981911	0	0	0	0.470976378	0	0	0	0.140272381	0	0.089329292	0.003960498	0.035123922	0.004939237	0	0	0	0	0	0	25.9073	NO																																																																																		0			1.8583	0.627495482	2.033571597	0	10.36322087	1.343298496	0.852925521	0.441224677	1.080856319	1.362609609	0.031518656	0	0.486756033	0.283629345	1.214421145	1.444246731	0.015559234	0.01942645	0.040483856	0.170126169	1.492981911	0	0	0	0.470976378	0	0	0	0.140272381	0	0.089329292	0.003960498	0.035123922	0.004939237	0	0	0	0	0	0	25.9073
H2944_002_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1020.55824	48.893021	851.223273	243.9933778	6.898531	5.696239	4.938761	313.841942	42.908024	13.982155	15.847273	3.415186	0.177999	25.757785	2745.365211	3207.714268	68.036786	3.3024			18.723015	0							0.04	0.25	97.193509	374.556963	0	0.05	0.55	3.01	304.6195	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.243668	0.25	0.247963	0.25	0.2	0.235107	15	35	35	0.25			0.2	0							0	0	0	22.536538	0	0	0	0	35	0	0		NO	146.572677	129.623469	31.422585	0	0.177665	0.177665	0.177665	44.41625	0.216457	0.222081	0.220271	0.222081	0.177665	0.208851	13.324875	31.091375	31.091375	0.222081			0.177665	0							0	0	0	20.01977	0	0	0	0	31.091375	0	0			12.4655	0.528140249	2.228969637	0	1.22562751	1.012022302	0.877444973	1.16164018	9.287742151	3.105170965	3.490694671	0.758447922	0.031624192	5.379539155	3.048470689	8.3110206	0.176279769	0.733400294	0	0	3.32642446	0	0	0	0	0	0	0	0	0	0	0.624878688	0	0	0	0	0.789253259	0	0	0	58.5623	0	7.72068	12.4655	0.528140249	2.228969637	0	1.22562751	1.012022302	0.877444973	1.16164018	9.287742151	3.105170965	3.490694671	0.758447922	0.031624192	5.379539155	3.048470689	8.3110206	0.176279769	0.733400294	0	0	3.32642446	0	0	0	0	0	0	0	0	0	0	0.624878688	0	0	0	0	0.789253259	0	0	0	58.5623	YES						20% Coins																									$0/Visit										5000						0.6695																									0										0.6695	0	0.028014	12.4655	0.528140249	2.228969637	0	1.22562751	1.681507302	0.877444973	1.16164018	9.287742151	3.105170965	3.490694671	0.758447922	0.031624192	5.379539155	3.048470689	8.3110206	0.176279769	0.733400294	0	0	3.32642446	0	0	0	0	0	0	0	0	0	0	0.624878688	0	0	0	0	0.789253259	0	0	0	59.2318
H2944_003_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1063.648902	50.957413	887.164166	254.2954222	116.899472	5.910135	5.124214	327.093177	364.764392	101.297275	889.765387	56.585934	0.184682	1221.251564	2861.281776	3343.152431	70.909479	767.870719			19.426074	0							0.04	0.25	1390.548721	0.05	0.55	3.01	0.32	0.4						$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	48.2281	0	100	0.2	0.2	50	113.229938	0	77.803062	125	0.2	117.862721	15	35	35	87.788892			0.2	0							0	0	125	0	0	0	0	0					NO	142.312584	125.856	28.543753	0	85.7171	0.171434	0.171434	42.85855	97.057419	0	66.690529	107.146375	0.171434	101.028506	12.857565	30.000985	30.000985	75.250092			0.171434	0							0	0	107.146375	0	0	0	0	0						12.6142	0.534441348	2.110249569	0	0.835023644	1.013198084	0.878464503	1.168228273	2.950257536	0	4.944910362	0.505248142	0.031660774	10.28176841	3.065759702	8.358155495	0.177279518	4.815195187	0	0	3.33028957	0	0	0	0	0	0	0	0	0	12.41602123	0	0	0	0	0	0	0	0	0	70.0304	0	12.101124	12.6142	0.534441348	2.110249569	0	0.835023644	1.013198084	0.878464503	1.168228273	2.950257536	0	4.944910362	0.505248142	0.031660774	10.28176841	3.065759702	8.358155495	0.177279518	4.815195187	0	0	3.33028957	0	0	0	0	0	0	0	0	0	12.41602123	0	0	0	0	0	0	0	0	0	70.0304	YES						20% Coins				$0/Visit																															5000						0.694				0																															0.694	0	0.029645	12.6142	0.534441348	2.110249569	0	0.835023644	1.707243084	0.878464503	1.168228273	2.950257536	0	4.944910362	0.505248142	0.031660774	10.28176841	3.065759702	8.358155495	0.177279518	4.815195187	0	0	3.33028957	0	0	0	0	0	0	0	0	0	12.41602123	0	0	0	0	0	0	0	0	0	70.7244
H2944_004_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1211.429978	53.07275	584.313344	361.5716356	6.531739	8.093989	5.366751	422.950904	50.742032	13.322661	17.381839	5.700351	0.111351	22.017171	3283.802719	3692.69197	124.480225	3.708056			20.585736	0							0.04	0.25	365.8934781	341.403795	0	0.05	0.55	2.91	326.327027	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.24635	0.25	0.247461	0.25	0.2	0.235987	15	35	35	0.25			0.2	0							0	0	0	15.369563	0	0	0	0	35	0	0		NO	145.222288	128.429234	33.971825	0	0.175204	0.175204	0.175204	43.801	0.215807	0.219005	0.216781	0.219005	0.175204	0.206729	13.1403	30.6607	30.6607	0.219005			0.175204	0							0	0	0	13.464044	0	0	0	0	30.6607	0	0			14.6606	0.568007719	1.654182556	0	1.1443868	1.418099249	0.940276242	1.543806046	10.9504857	2.917729372	3.76805244	1.248405371	0.019509141	4.551587744	3.595846072	9.43504339	0.318054236	0.812082804	0	0	3.60670329	0	0	0	0	0	0	0	0	0	0	0.38305631	0	0	0	0	0.83378459	0	0	0	64.3697	0	8.834165	14.6606	0.568007719	1.654182556	0	1.1443868	1.418099249	0.940276242	1.543806046	10.9504857	2.917729372	3.76805244	1.248405371	0.019509141	4.551587744	3.595846072	9.43504339	0.318054236	0.812082804	0	0	3.60670329	0	0	0	0	0	0	0	0	0	0	0.38305631	0	0	0	0	0.83378459	0	0	0	64.3697	YES						20% Coins																																			5000						0.946																																			0.946	0	0.045053	14.6606	0.568007719	1.654182556	0	1.1443868	2.364147249	0.940276242	1.543806046	10.9504857	2.917729372	3.76805244	1.248405371	0.019509141	4.551587744	3.595846072	9.43504339	0.318054236	0.812082804	0	0	3.60670329	0	0	0	0	0	0	0	0	0	0	0.38305631	0	0	0	0	0.83378459	0	0	0	65.3157
H2944_005_0	2010	5	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1195.451709	52.372742	576.606488	356.8026533	129.564474	7.975406	5.288125	417.372354	381.648238	345.404995	1003.543157	101.911779	0.10972	1198.912733	3240.490694	3643.986862	122.838381	872.300718			20.28414	0							0.04	0.25	1524.022442	0.05	0.55	2.91	0.32	0.4						$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	48.2281	0	100	0.2	0.2	50	117.267124	0	84.643469	125	0.2	116.150181	15	35	35	91.775149			0.2	0							0	0	125	0	0	0	0	0					NO	140.374951	124.142429	31.570597	0	84.3312	0.168662	0.168662	42.1656	98.892773	0	71.380853	105.414	0.168662	97.950842	12.64968	29.51592	29.51592	77.395084			0.168662	0							0	0	105.414	0	0	0	0	0						13.9843	0.541806617	1.516984255	0	0.910527297	1.345147927	0.891905739	1.466562977	3.145187714	0	5.969480547	0.895244023	0.018505595	9.786209307	3.41593086	8.962968725	0.302140652	5.625982279	0	0	3.421163621	0	0	0	0	0	0	0	0	0	13.38777514	0	0	0	0	0	0	0	0	0	75.5878	0	13.766075	13.9843	0.541806617	1.516984255	0	0.910527297	1.345147927	0.891905739	1.466562977	3.145187714	0	5.969480547	0.895244023	0.018505595	9.786209307	3.41593086	8.962968725	0.302140652	5.625982279	0	0	3.421163621	0	0	0	0	0	0	0	0	0	13.38777514	0	0	0	0	0	0	0	0	0	75.5878	YES						20% Coins				$0/Visit																															5000						0.9326				0																															0.9326	0	0.043963	13.9843	0.541806617	1.516984255	0	0.910527297	2.277765927	0.891905739	1.466562977	3.145187714	0	5.969480547	0.895244023	0.018505595	9.786209307	3.41593086	8.962968725	0.302140652	5.625982279	0	0	3.421163621	0	0	0	0	0	0	0	0	0	13.38777514	0	0	0	0	0	0	0	0	0	76.5204
H2944_006_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1069.880913	65.54334	650.922217	400.3489889	6.185202	14.080347	6.551413	387.809778	49.134346	12.397613	19.809796	5.189194	0.070195	17.719545	3542.004605	3795.806742	62.950572	2.748917			21.239879	0							0.04	0.25	434.650074	349.111	0	0.05	0.55	3.77	726.433255	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.235391	0.25	0.236496	0.25	0.2	0.231219	15	35	35	0.25			0.2	0							0	0	0	11.28631	0	0	0	0	35	0	0		NO	145.320558	128.516141	33.216573	0	0.175156	0.175156	0.175156	43.78895	0.206151	0.218945	0.207118	0.218945	0.175156	0.202497	13.136685	30.652265	30.652265	0.218945			0.175156	0							0	0	0	9.884313	0	0	0	0	30.652265	0	0			12.9563	0.701948094	1.801783778	0	1.083375242	2.466257259	1.147519295	1.415148582	10.12909456	2.714395378	4.102965328	1.13614808	0.012295075	3.588154704	3.877516564	9.695839512	0.160798135	0.601861633	0	0	3.720292246	0	0	0	0	0	0	0	0	0	0	0.2875602	0	0	0	0	1.85556872	0	0	0	63.4548	0	8.884761	12.9563	0.701948094	1.801783778	0	1.083375242	2.466257259	1.147519295	1.415148582	10.12909456	2.714395378	4.102965328	1.13614808	0.012295075	3.588154704	3.877516564	9.695839512	0.160798135	0.601861633	0	0	3.720292246	0	0	0	0	0	0	0	0	0	0	0.2875602	0	0	0	0	1.85556872	0	0	0	63.4548	YES						20% Coins																									$0/Visit										5000						1.6295																									0										1.6295	0	0.094618	12.9563	0.701948094	1.801783778	0	1.083375242	4.095763259	1.147519295	1.415148582	10.12909456	2.714395378	4.102965328	1.13614808	0.012295075	3.588154704	3.877516564	9.695839512	0.160798135	0.601861633	0	0	3.720292246	0	0	0	0	0	0	0	0	0	0	0.2875602	0	0	0	0	1.85556872	0	0	0	65.0843
H2944_007_0	2010	5	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1139.527065	69.810022	693.29537	426.4105489	133.709579	14.996937	6.977891	413.055072	443.305951	462.944536	1239.241646	112.555354	0.074764	957.708627	3772.578857	4042.902779	67.048472	1171.461075			22.622533	0							0.04	0.25	1859.844406	0.05	0.55	3.77	0.32	0.4						$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	48.2281	0	100	0.2	0.2	50	98.543071	0	82.614378	125	0.2	105.514207	15	35	35	65.557157			0.2	0							0	0	125	0	0	0	0	0					NO	138.210771	122.228508	29.029892	0	83.0765	0.166153	0.166153	41.53825	81.866134	0	68.633134	103.845625	0.166153	87.65751	12.461475	29.076775	29.076775	54.462592			0.166153	0							0	0	103.845625	0	0	0	0	0						13.1246	0.711064569	1.67719081	0	0.925676987	2.491786073	1.159397523	1.429798737	3.024312032	0	7.087753162	0.974031757	0.012422263	6.995862796	3.917658093	9.796214538	0.162462778	5.316733881	0	0	3.758801726	0	0	0	0	0	0	0	0	0	16.0947254	0	0	0	0	0	0	0	0	0	78.6605	0	16.029781	13.1246	0.711064569	1.67719081	0	0.925676987	2.491786073	1.159397523	1.429798737	3.024312032	0	7.087753162	0.974031757	0.012422263	6.995862796	3.917658093	9.796214538	0.162462778	5.316733881	0	0	3.758801726	0	0	0	0	0	0	0	0	0	16.0947254	0	0	0	0	0	0	0	0	0	78.6605	YES						20% Coins				$0/Visit																															5000						1.7302				0																															1.7302	0	0.106188	13.1246	0.711064569	1.67719081	0	0.925676987	4.221958073	1.159397523	1.429798737	3.024312032	0	7.087753162	0.974031757	0.012422263	6.995862796	3.917658093	9.796214538	0.162462778	5.316733881	0	0	3.758801726	0	0	0	0	0	0	0	0	0	16.0947254	0	0	0	0	0	0	0	0	0	80.3906
H2944_008_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1361.251738	66.630352	673.028918	614.3736	7.013235	9.146429	6.602074	404.964101	43.428652	10.940847	17.065271	5.347508	0.258138	21.101512	3484.347	3692.931687	90.678064	2.78744			20.666049	0							0.04	0.25	496.418884	410.241706	0	0.05	0.55	1.65	401.423401	0.32	0.4			$175/Day(Days 1-15):1a	$175/Day(Days 1-11):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		153.42355	133.708575	48.2281	0	0.2	0.2	0.2	50	0.241196	0.25	0.242276	0.25	0.2	0.234408	15	35	35	0.25			0.2	0							0	0	0	19.576153	0	0	0	0	35	0	0		NO	139.765632	121.805704	32.23354	0	0.175037	0.175037	0.175037	43.75915	0.211091	0.218796	0.212036	0.218796	0.175037	0.20515	13.127745	30.631405	30.631405	0.218796			0.175037	0							0	0	0	17.132716	0	0	0	0	30.631405	0	0			15.8547	0.676329744	1.807842046	0	1.227575615	1.600963493	1.155607227	1.476740403	9.167397579	2.39381356	3.618451802	1.17001336	0.045183701	4.328975187	3.811801576	9.426640512	0.231466375	0.609880722	0	0	3.617323219	0	0	0	0	0	0	0	0	0	0	0.585712887	0	0	0	0	1.024680231	0	0	0	63.8311	0	9.000492	15.8547	0.676329744	1.807842046	0	1.227575615	1.600963493	1.155607227	1.476740403	9.167397579	2.39381356	3.618451802	1.17001336	0.045183701	4.328975187	3.811801576	9.426640512	0.231466375	0.609880722	0	0	3.617323219	0	0	0	0	0	0	0	0	0	0	0.585712887	0	0	0	0	1.024680231	0	0	0	63.8311	YES						20% Coins																									$0/Visit										5000						1.0746																									0										1.0746	0	0.045396	15.8547	0.676329744	1.807842046	0	1.227575615	2.675538493	1.155607227	1.476740403	9.167397579	2.39381356	3.618451802	1.17001336	0.045183701	4.328975187	3.811801576	9.426640512	0.231466375	0.609880722	0	0	3.617323219	0	0	0	0	0	0	0	0	0	0	0.585712887	0	0	0	0	1.024680231	0	0	0	64.9057
H2944_009_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1430.487391	81.545167	468.712099	668.7017044	8.342098	12.820286	9.17827	420.546389	44.108724	8.322934	15.468487	3.953651	0.42429	18.181167	3592.993958	3236.346217	68.387279	2.493781			20.994134	0							0.04	0.25	584.744819	431.685218	0	0.05	0.55	2.4	323.35402	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.238743	0.25	0.238087	0.25	0.2	0.233237	15	35	35	0.25			0.2	0							0	0	0	24.012437	0	0	0	0	35	0	0		NO	145.050671	128.277463	35.359155	0	0.175481	0.175481	0.175481	43.87015	0.209474	0.219351	0.208898	0.219351	0.175481	0.204643	13.161045	30.709105	30.709105	0.219351			0.175481	0							0	0	0	21.068584	0	0	0	0	30.709105	0	0			17.2911	0.871700595	1.381105313	0	1.463879699	2.249716608	1.610611998	1.537452764	9.239630851	1.825643896	3.231335997	0.867237301	0.074454833	3.720648558	3.940629597	8.282107983	0.175009344	0.547013356	0	0	3.684071628	0	0	0	0	0	0	0	0	0	0	0.757916356	0	0	0	0	0.827492713	0	0	0	63.5788	0	8.371815	17.2911	0.871700595	1.381105313	0	1.463879699	2.249716608	1.610611998	1.537452764	9.239630851	1.825643896	3.231335997	0.867237301	0.074454833	3.720648558	3.940629597	8.282107983	0.175009344	0.547013356	0	0	3.684071628	0	0	0	0	0	0	0	0	0	0	0.757916356	0	0	0	0	0.827492713	0	0	0	63.5788	YES						20% Coins																									$0/Visit										5000						1.5001																									0										1.5001	0	0.069705	17.2911	0.871700595	1.381105313	0	1.463879699	3.749842608	1.610611998	1.537452764	9.239630851	1.825643896	3.231335997	0.867237301	0.074454833	3.720648558	3.940629597	8.282107983	0.175009344	0.547013356	0	0	3.684071628	0	0	0	0	0	0	0	0	0	0	0.757916356	0	0	0	0	0.827492713	0	0	0	65.0789
H2944_010_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1459.027014	83.172073	478.063364	682.0429578	8.251995	12.681815	9.079136	428.9367	43.632308	8.233038	15.301412	3.910949	0.419708	17.984795	3664.677702	3300.914489	69.751672	2.466846			20.767377	0							0.04	0.25	596.41105	440.29776	0	0.05	0.55	2.4	329.805249	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.238743	0.25	0.238087	0.25	0.2	0.233237	15	35	35	0.25			0.2	0							0	0	0	24.012437	0	0	0	0	35	0	0		NO	144.781736	128.039627	35.05744	0	0.175274	0.175274	0.175274	43.81855	0.209228	0.219093	0.208652	0.219093	0.175274	0.204402	13.145565	30.672985	30.672985	0.219093			0.175274	0							0	0	0	21.043803	0	0	0	0	30.672985	0	0			17.6034	0.887443434	1.396639808	0	1.446360172	2.222792442	1.591336483	1.56628202	9.129100538	1.803800995	3.192670217	0.856861549	0.0735639	3.676128068	4.014521578	8.437408384	0.178290999	0.540468691	0	0	3.639981236	0	0	0	0	0	0	0	0	0	0	0.772128277	0	0	0	0	0.843009288	0	0	0	63.8722	0	8.514481	17.6034	0.887443434	1.396639808	0	1.446360172	2.222792442	1.591336483	1.56628202	9.129100538	1.803800995	3.192670217	0.856861549	0.0735639	3.676128068	4.014521578	8.437408384	0.178290999	0.540468691	0	0	3.639981236	0	0	0	0	0	0	0	0	0	0	0.772128277	0	0	0	0	0.843009288	0	0	0	63.8722	YES						20% Coins																									$0/Visit										5000						1.4844																									0										1.4844	0	0.06846	17.6034	0.887443434	1.396639808	0	1.446360172	3.707207442	1.591336483	1.56628202	9.129100538	1.803800995	3.192670217	0.856861549	0.0735639	3.676128068	4.014521578	8.437408384	0.178290999	0.540468691	0	0	3.639981236	0	0	0	0	0	0	0	0	0	0	0.772128277	0	0	0	0	0.843009288	0	0	0	65.3566
H2944_011_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1247.563429	61.065553	616.819242	563.0626667	7.227948	9.426451	6.804198	371.142521	44.758238	11.275805	17.587731	5.511224	0.26604	21.747545	3193.343134	3384.507356	83.104861	2.872779			21.298748	0							0.04	0.25	454.959232	375.979353	0	0.05	0.55	3.57	367.897532	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.241196	0.25	0.242276	0.25	0.2	0.234408	15	35	35	0.25			0.2	0							0	0	0	19.576153	0	0	0	0	35	0	0		NO	145.424862	128.608384	33.573799	0	0.175763	0.175763	0.175763	43.9408	0.211967	0.219704	0.212916	0.219704	0.175763	0.206001	13.18224	30.75856	30.75856	0.219704			0.175763	0							0	0	0	17.203836	0	0	0	0	30.75856	0	0			15.1189	0.654461841	1.725747104	0	1.270405824	1.656821307	1.195926253	1.359024941	9.487269434	2.477339462	3.744709334	1.210837958	0.046759989	4.480016018	3.5079513	8.675214382	0.213015488	0.631161037	0	0	3.743531845	0	0	0	0	0	0	0	0	0	0	0.539023927	0	0	0	0	0.942999859	0	0	0	62.6811	0	8.429704	15.1189	0.654461841	1.725747104	0	1.270405824	1.656821307	1.195926253	1.359024941	9.487269434	2.477339462	3.744709334	1.210837958	0.046759989	4.480016018	3.5079513	8.675214382	0.213015488	0.631161037	0	0	3.743531845	0	0	0	0	0	0	0	0	0	0	0.539023927	0	0	0	0	0.942999859	0	0	0	62.6811	YES						20% Coins																									$0/Visit										5000						1.1067																									0										1.1067	0	0.047533	15.1189	0.654461841	1.725747104	0	1.270405824	2.763547307	1.195926253	1.359024941	9.487269434	2.477339462	3.744709334	1.210837958	0.046759989	4.480016018	3.5079513	8.675214382	0.213015488	0.631161037	0	0	3.743531845	0	0	0	0	0	0	0	0	0	0	0.539023927	0	0	0	0	0.942999859	0	0	0	63.7878
H2944_012_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1304.867817	63.87048	645.151628	265.016632	7.745833	10.101858	7.291721	388.190227	47.965175	12.08372	18.847896	5.906105	0.285103	23.305761	3340.023109	3539.968084	86.92212	3.078614			22.824807	0							0.04	0.25	475.856895	393.24923	0	0.05	0.55	3.57	384.796186	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.241196	0.25	0.242276	0.25	0.2	0.234408	15	35	35	0.25			0.2	0							0	0	0	19.576153	0	0	0	0	35	0	0		NO	144.017002	127.363324	32.292427	0	0.174063	0.174063	0.174063	43.51565	0.209916	0.217578	0.210856	0.217578	0.174063	0.204008	13.054695	30.460955	30.460955	0.217578			0.174063	0							0	0	0	17.03738	0	0	0	0	30.460955	0	0			15.6603	0.677896387	1.736125988	0	1.348262929	1.758359709	1.269218832	1.407695838	10.06865768	2.62915163	3.974191959	1.285038514	0.049625883	4.75456169	3.633581915	8.985900709	0.220644232	0.669838677	0	0	3.972954381	0	0	0	0	0	0	0	0	0	0	0.558328047	0	0	0	0	0.976771609	0	0	0	65.6371	0	9.616394	15.6603	0.677896387	1.736125988	0	1.348262929	1.758359709	1.269218832	1.407695838	10.06865768	2.62915163	3.974191959	1.285038514	0.049625883	4.75456169	3.633581915	8.985900709	0.220644232	0.669838677	0	0	3.972954381	0	0	0	0	0	0	0	0	0	0	0.558328047	0	0	0	0	0.976771609	0	0	0	65.6371	YES				$0/Visit		20% Coins																									$0/Visit										5000				0		1.184																									0										1.184	0	0.052918	15.6603	0.677896387	1.736125988	0	1.348262929	2.942403709	1.269218832	1.407695838	10.06865768	2.62915163	3.974191959	1.285038514	0.049625883	4.75456169	3.633581915	8.985900709	0.220644232	0.669838677	0	0	3.972954381	0	0	0	0	0	0	0	0	0	0	0.558328047	0	0	0	0	0.976771609	0	0	0	66.8211
H2944_013_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1163.588802	59.280544	552.67532	306.0895911	8.857858	9.310041	6.972458	423.559696	49.527215	12.101994	19.464723	5.662269	0.533315	31.697072	3090.657562	2887.924763	54.253878	3.122678			15.74089	0							0.04	0.25	609.029128	352.771928	0	0.05	0.55	3.2	214.347223	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.242	0.25	0.246585	0.25	0.2	0.234955	15	35	35	0.25			0.2	0							0	0	0	14.309279	0	0	0	0	35	0	0		NO	145.830487	128.967103	34.87234	0	0.175873	0.175873	0.175873	43.96825	0.212806	0.219841	0.216838	0.219841	0.175873	0.206611	13.190475	30.777775	30.777775	0.219841			0.175873	0							0	0	0	12.583079	0	0	0	0	30.777775	0	0			14.1406	0.637103335	1.606090139	0	1.55785806	1.637384841	1.226267106	1.55193155	10.53968852	2.660514463	4.220691606	1.244798879	0.093795709	6.548963743	3.397270109	7.406991548	0.139151137	0.686492654	0	0	2.768397547	0	0	0	0	0	0	0	0	0	0	0.369913087	0	0	0	0	0.549760883	0	0	0	62.9836	0	8.31782	14.1406	0.637103335	1.606090139	0	1.55785806	1.637384841	1.226267106	1.55193155	10.53968852	2.660514463	4.220691606	1.244798879	0.093795709	6.548963743	3.397270109	7.406991548	0.139151137	0.686492654	0	0	2.768397547	0	0	0	0	0	0	0	0	0	0	0.369913087	0	0	0	0	0.549760883	0	0	0	62.9836	YES						20% Coins																									$0/Visit										5000						1.0877																									0										1.0877	0	0.05226	14.1406	0.637103335	1.606090139	0	1.55785806	2.725129841	1.226267106	1.55193155	10.53968852	2.660514463	4.220691606	1.244798879	0.093795709	6.548963743	3.397270109	7.406991548	0.139151137	0.686492654	0	0	2.768397547	0	0	0	0	0	0	0	0	0	0	0.369913087	0	0	0	0	0.549760883	0	0	0	64.0714
H2944_014_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1135.70722	57.860081	539.432273	134.439822	8.288154	8.711254	6.524015	413.41048	46.341807	11.323639	18.212822	5.298093	0.499015	29.658432	3016.60011	2818.725138	52.953863	2.921839			14.728494	0							0.04	0.25	594.435746	344.318909	0	0.05	0.55	3.2	209.211096	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.242	0.25	0.246585	0.25	0.2	0.234955	15	35	35	0.25			0.2	0							0	0	0	14.309279	0	0	0	0	35	0	0		NO	146.773505	129.801074	35.702877	0	0.177195	0.177195	0.177195	44.29885	0.214406	0.221494	0.218469	0.221494	0.177195	0.208165	13.289655	31.009195	31.009195	0.221494			0.177195	0							0	0	0	12.677692	0	0	0	0	31.009195	0	0			13.891	0.625858388	1.604940341	0	1.468619448	1.543590653	1.156022838	1.52613407	9.935961472	2.508118097	3.97893701	1.173495811	0.088422963	6.173847497	3.340797895	7.283866455	0.136838055	0.647169807	0	0	2.609815494	0	0	0	0	0	0	0	0	0	0	0.36376409	0	0	0	0	0.540622306	0	0	0	60.5978	0	7.472274	13.891	0.625858388	1.604940341	0	1.468619448	1.543590653	1.156022838	1.52613407	9.935961472	2.508118097	3.97893701	1.173495811	0.088422963	6.173847497	3.340797895	7.283866455	0.136838055	0.647169807	0	0	2.609815494	0	0	0	0	0	0	0	0	0	0	0.36376409	0	0	0	0	0.540622306	0	0	0	60.5978	YES				$0/Visit		20% Coins																									$0/Visit										5000				0		1.0199																									0										1.0199	0	0.046804	13.891	0.625858388	1.604940341	0	1.468619448	2.563470653	1.156022838	1.52613407	9.935961472	2.508118097	3.97893701	1.173495811	0.088422963	6.173847497	3.340797895	7.283866455	0.136838055	0.647169807	0	0	2.609815494	0	0	0	0	0	0	0	0	0	0	0.36376409	0	0	0	0	0.540622306	0	0	0	61.6177
H2944_015_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1124.446907	55.039263	555.948076	507.4965	5.933711	7.73855	5.585838	334.516106	36.743825	9.256759	14.438472	4.524384	0.218403	17.853429	2878.20621	3050.505278	74.903609	2.358379			17.484993	0							0.04	0.25	410.061316	338.875613	0	0.05	0.55	2.41	331.59135	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.241196	0.25	0.242276	0.25	0.2	0.234408	15	35	35	0.25			0.2	0							0	0	0	19.576153	0	0	0	0	35	0	0		NO	148.339328	131.18583	36.534618	0	0.179806	0.179806	0.179806	44.9514	0.216842	0.224757	0.217813	0.224757	0.179806	0.210739	13.48542	31.46598	31.46598	0.224757			0.179806	0							0	0	0	17.59951	0	0	0	0	31.46598	0	0			13.9	0.601697617	1.692612549	0	1.06691684	1.391437721	1.004367187	1.253080607	7.967604501	2.080521383	3.144886902	1.016886975	0.03927017	3.762413774	3.234484966	7.998928172	0.196409622	0.530062189	0	0	3.143906651	0	0	0	0	0	0	0	0	0	0	0.497003728	0	0	0	0	0.869487232	0	0	0	55.392	0	5.962593	13.9	0.601697617	1.692612549	0	1.06691684	1.391437721	1.004367187	1.253080607	7.967604501	2.080521383	3.144886902	1.016886975	0.03927017	3.762413774	3.234484966	7.998928172	0.196409622	0.530062189	0	0	3.143906651	0	0	0	0	0	0	0	0	0	0	0.497003728	0	0	0	0	0.869487232	0	0	0	55.392	YES						20% Coins																									$0/Visit										5000						0.9124																									0										0.9124	0	0.035201	13.9	0.601697617	1.692612549	0	1.06691684	2.303814721	1.004367187	1.253080607	7.967604501	2.080521383	3.144886902	1.016886975	0.03927017	3.762413774	3.234484966	7.998928172	0.196409622	0.530062189	0	0	3.143906651	0	0	0	0	0	0	0	0	0	0	0.497003728	0	0	0	0	0.869487232	0	0	0	56.3043
H2944_016_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1360.320199	66.584755	672.568347	613.9531667	7.423487	9.681467	6.988275	404.686974	45.969094	11.580852	18.063537	5.660321	0.273238	22.335885	3481.962573	3690.404521	90.61601	2.950497			21.87495	0							0.04	0.25	496.079172	409.960966	0	0.05	0.55	2.41	401.148697	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.241196	0.25	0.242276	0.25	0.2	0.234408	15	35	35	0.25			0.2	0							0	0	0	19.576153	0	0	0	0	35	0	0		NO	143.726476	127.106394	31.724396	0	0.173982	0.173982	0.173982	43.49555	0.209819	0.217478	0.210759	0.217478	0.173982	0.203914	13.048665	30.446885	30.446885	0.217478			0.173982	0							0	0	0	17.029511	0	0	0	0	30.446885	0	0			16.2928	0.705279009	1.778068715	0	1.291553115	1.684400992	1.215834061	1.466840209	9.645189334	2.518580531	3.807052995	1.23099529	0.047538494	4.554599654	3.78624693	9.363443505	0.229914603	0.641668187	0	0	3.805847551	0	0	0	0	0	0	0	0	0	0	0.581786232	0	0	0	0	1.017810687	0	0	0	65.6655	0	9.714602	16.2928	0.705279009	1.778068715	0	1.291553115	1.684400992	1.215834061	1.466840209	9.645189334	2.518580531	3.807052995	1.23099529	0.047538494	4.554599654	3.78624693	9.363443505	0.229914603	0.641668187	0	0	3.805847551	0	0	0	0	0	0	0	0	0	0	0.581786232	0	0	0	0	1.017810687	0	0	0	65.6655	YES						20% Coins																									$0/Visit										5000						1.1359																									0										1.1359	0	0.049551	16.2928	0.705279009	1.778068715	0	1.291553115	2.820335992	1.215834061	1.466840209	9.645189334	2.518580531	3.807052995	1.23099529	0.047538494	4.554599654	3.78624693	9.363443505	0.229914603	0.641668187	0	0	3.805847551	0	0	0	0	0	0	0	0	0	0	0.581786232	0	0	0	0	1.017810687	0	0	0	66.8014
H2944_017_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1210.020298	59.227897	598.257199	546.1183289	6.944647	9.056979	6.537506	359.973668	43.003927	10.833847	16.898375	5.295211	0.255614	20.895145	3097.245334	3282.656818	80.603972	2.760179			20.46394	0							0.04	0.25	441.268069	364.664945	0	0.05	0.55	2.63	356.826331	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.241196	0.25	0.242276	0.25	0.2	0.234408	15	35	35	0.25			0.2	0							0	0	0	19.576153	0	0	0	0	35	0	0		NO	146.210076	129.302798	34.378437	0	0.17677	0.17677	0.17677	44.1926	0.213182	0.220963	0.214136	0.220963	0.17677	0.207182	13.25778	30.93482	30.93482	0.220963			0.17677	0							0	0	0	17.302422	0	0	0	0	30.93482	0	0			14.7431	0.6381944	1.713928952	0	1.22760525	1.601002178	1.155634936	1.325681027	9.167663166	2.393879335	3.618550429	1.170045708	0.045184887	4.329097931	3.421883104	8.462366482	0.207789114	0.609897432	0	0	3.617410674	0	0	0	0	0	0	0	0	0	0	0.525798897	0	0	0	0	0.919863193	0	0	0	60.8946	0	7.766164	14.7431	0.6381944	1.713928952	0	1.22760525	1.601002178	1.155634936	1.325681027	9.167663166	2.393879335	3.618550429	1.170045708	0.045184887	4.329097931	3.421883104	8.462366482	0.207789114	0.609897432	0	0	3.617410674	0	0	0	0	0	0	0	0	0	0	0.525798897	0	0	0	0	0.919863193	0	0	0	60.8946	YES						20% Coins																									$0/Visit										5000						1.0643																									0										1.0643	0	0.044715	14.7431	0.6381944	1.713928952	0	1.22760525	2.665305178	1.155634936	1.325681027	9.167663166	2.393879335	3.618550429	1.170045708	0.045184887	4.329097931	3.421883104	8.462366482	0.207789114	0.609897432	0	0	3.617410674	0	0	0	0	0	0	0	0	0	0	0.525798897	0	0	0	0	0.919863193	0	0	0	61.9589
H2944_019_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1115.214398	54.587352	551.383347	503.3295933	5.801715	7.566406	5.46158	331.769491	35.926456	9.050842	14.117285	4.423739	0.213546	17.456277	2854.574091	3025.458461	74.288597	2.305917			17.096038	0							0.04	0.25	406.694421	336.093203	0	0.05	0.55	1.34	328.86875	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.241196	0.25	0.242276	0.25	0.2	0.234408	15	35	35	0.25			0.2	0							0	0	0	19.576153	0	0	0	0	35	0	0		NO	148.591911	131.409205	36.793603	0	0.18019	0.18019	0.18019	45.04745	0.217305	0.225237	0.218278	0.225237	0.18019	0.211189	13.514235	31.533215	31.533215	0.225237			0.18019	0							0	0	0	17.637115	0	0	0	0	31.533215	0	0			13.8093	0.597773377	1.690614998	0	1.045411026	1.363390697	0.9841221	1.245447463	7.806998521	2.0385845	3.081492735	0.996389701	0.038478854	3.686573683	3.214782091	7.950202677	0.195213192	0.519377827	0	0	3.080535087	0	0	0	0	0	0	0	0	0	0	0.493976206	0	0	0	0	0.86419075	0	0	0	54.7029	0	5.755296	13.8093	0.597773377	1.690614998	0	1.045411026	1.363390697	0.9841221	1.245447463	7.806998521	2.0385845	3.081492735	0.996389701	0.038478854	3.686573683	3.214782091	7.950202677	0.195213192	0.519377827	0	0	3.080535087	0	0	0	0	0	0	0	0	0	0	0.493976206	0	0	0	0	0.86419075	0	0	0	54.7029	YES						20% Coins																									$0/Visit										5000						0.8924																									0										0.8924	0	0.034061	13.8093	0.597773377	1.690614998	0	1.045411026	2.255828697	0.9841221	1.245447463	7.806998521	2.0385845	3.081492735	0.996389701	0.038478854	3.686573683	3.214782091	7.950202677	0.195213192	0.519377827	0	0	3.080535087	0	0	0	0	0	0	0	0	0	0	0.493976206	0	0	0	0	0.86419075	0	0	0	55.5953
H2944_020_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1441.61623	70.564021	712.762661	650.6444956	7.502223	9.784152	7.062394	428.872048	46.456656	11.703682	18.255125	5.720355	0.276137	22.572789	3690.053093	3910.952036	96.031443	2.981791			22.106961	0							0.04	0.25	525.726065	434.461228	0	0.05	0.55	1.34	425.122315	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.241196	0.25	0.242276	0.25	0.2	0.234408	15	35	35	0.25			0.2	0							0	0	0	19.576153	0	0	0	0	35	0	0		NO	142.416887	125.948242	30.505961	0	0.172739	0.172739	0.172739	43.1848	0.20832	0.215924	0.209253	0.215924	0.172739	0.202457	12.95544	30.22936	30.22936	0.215924			0.172739	0							0	0	0	16.907845	0	0	0	0	30.22936	0	0			17.1092	0.740617866	1.811959162	0	1.295926499	1.690104632	1.219950877	1.543396135	9.677850578	2.527105832	3.819939672	1.235161933	0.047699629	4.570019143	3.98385512	9.85213142	0.241914088	0.64384024	0	0	3.818734336	0	0	0	0	0	0	0	0	0	0	0.612150258	0	0	0	0	1.070931292	0	0	0	67.5125	0	10.652219	17.1092	0.740617866	1.811959162	0	1.295926499	1.690104632	1.219950877	1.543396135	9.677850578	2.527105832	3.819939672	1.235161933	0.047699629	4.570019143	3.98385512	9.85213142	0.241914088	0.64384024	0	0	3.818734336	0	0	0	0	0	0	0	0	0	0	0.612150258	0	0	0	0	1.070931292	0	0	0	67.5125	YES						20% Coins																									$0/Visit										5000						1.1477																									0										1.1477	0	0.050373	17.1092	0.740617866	1.811959162	0	1.295926499	2.837791632	1.219950877	1.543396135	9.677850578	2.527105832	3.819939672	1.235161933	0.047699629	4.570019143	3.98385512	9.85213142	0.241914088	0.64384024	0	0	3.818734336	0	0	0	0	0	0	0	0	0	0	0.612150258	0	0	0	0	1.070931292	0	0	0	68.6602
H2944_021_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1450.249343	70.986593	717.031037	654.5408778	9.158705	11.94448	8.621762	431.440346	56.714226	14.287841	22.285833	6.983403	0.337107	27.556829	3712.15096	3934.372756	96.606527	3.640167			26.988151	0							0.04	0.25	528.874374	437.062997	0	0.05	0.55	1.58	427.668158	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.241196	0.25	0.242276	0.25	0.2	0.234408	15	35	35	0.25			0.2	0							0	0	0	19.576153	0	0	0	0	35	0	0		NO	139.695629	123.541661	29.198353	0	0.169353	0.169353	0.169353	42.3383	0.204237	0.211692	0.205151	0.211692	0.169353	0.198489	12.70149	29.63681	29.63681	0.211692			0.169353	0							0	0	0	16.576421	0	0	0	0	29.63681	0	0			16.8828	0.730816801	1.744677111	0	1.551054168	2.022833521	1.46012126	1.522204233	11.58314338	3.024621637	4.571960926	1.478330548	0.057090082	5.469727431	3.929154025	9.71685482	0.23859244	0.770594233	0	0	4.570524336	0	0	0	0	0	0	0	0	0	0	0.60374502	0	0	0	0	1.056226662	0	0	0	72.9851	0	13.244981	16.8828	0.730816801	1.744677111	0	1.551054168	2.022833521	1.46012126	1.522204233	11.58314338	3.024621637	4.571960926	1.478330548	0.057090082	5.469727431	3.929154025	9.71685482	0.23859244	0.770594233	0	0	4.570524336	0	0	0	0	0	0	0	0	0	0	0.60374502	0	0	0	0	1.056226662	0	0	0	72.9851	YES						20% Coins																									$0/Visit										5000						1.3928																									0										1.3928	0	0.069813	16.8828	0.730816801	1.744677111	0	1.551054168	3.415610521	1.46012126	1.522204233	11.58314338	3.024621637	4.571960926	1.478330548	0.057090082	5.469727431	3.929154025	9.71685482	0.23859244	0.770594233	0	0	4.570524336	0	0	0	0	0	0	0	0	0	0	0.60374502	0	0	0	0	1.056226662	0	0	0	74.3778
H2944_022_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1291.984928	63.23989	638.782081	583.1114178	8.767526	11.434317	8.253516	384.357647	54.291894	13.67759	21.333977	6.685134	0.322709	26.379844	3307.047243	3505.018172	86.063943	3.48469			25.835455	0							0.04	0.25	471.158786	389.366702	0	0.05	0.55	1.58	380.997114	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.241196	0.25	0.242276	0.25	0.2	0.234408	15	35	35	0.25			0.2	0							0	0	0	19.576153	0	0	0	0	35	0	0		NO	142.632321	126.138763	31.721743	0	0.172169	0.172169	0.172169	43.0423	0.207633	0.215212	0.208562	0.215212	0.172169	0.201789	12.91269	30.12961	30.12961	0.215212			0.172169	0							0	0	0	16.852053	0	0	0	0	30.12961	0	0			15.3566	0.664750125	1.688606751	0	1.509496184	1.968634924	1.420999596	1.378636429	11.27278883	2.943581499	4.449456911	1.438721058	0.055560486	5.323162341	3.558572989	8.800402547	0.21608942	0.749947104	0	0	4.448064452	0	0	0	0	0	0	0	0	0	0	0.546802358	0	0	0	0	0.956607871	0	0	0	68.7474	0	10.940033	15.3566	0.664750125	1.688606751	0	1.509496184	1.968634924	1.420999596	1.378636429	11.27278883	2.943581499	4.449456911	1.438721058	0.055560486	5.323162341	3.558572989	8.800402547	0.21608942	0.749947104	0	0	4.448064452	0	0	0	0	0	0	0	0	0	0	0.546802358	0	0	0	0	0.956607871	0	0	0	68.7474	YES						20% Coins																									$0/Visit										5000						1.3352																									0										1.3352	0	0.064909	15.3566	0.664750125	1.688606751	0	1.509496184	3.303846924	1.420999596	1.378636429	11.27278883	2.943581499	4.449456911	1.438721058	0.055560486	5.323162341	3.558572989	8.800402547	0.21608942	0.749947104	0	0	4.448064452	0	0	0	0	0	0	0	0	0	0	0.546802358	0	0	0	0	0.956607871	0	0	0	70.0827
H2944_023_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	O							O	O	V	V	O	O	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	NO	308.262303	4.678951	705.364189	643.8893802	9.066367	11.824057	8.534839	424.420358	76.168703	14.143792	34.07757	6.912998	0.333708	27.279006	39.490734	60.673587	0.785231	6.775169			26.716059	0							0.04	0.25	520.269032	189.471617	0.05	0.55	1.58	0.32	0.4					Medicare FFS Cost Sharing:1a	Medicare FFS Cost Sharing:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	20% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.083	0.083	47.863622	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							0	0	0	0	0	0	0	0	0				NO	0.070239	0.070239	26.97072	0	0.165215	0.165215	0.165215	41.30375	0.165215	0.165215	0.165215	0.165215	0.165215	0.165215	0.165215	0.165215	0.165215	0.165215			0.165215	0							0	0	0	0	0	0	0	0	0					21.652	0.328644839	1.585348337	0	1.497899824	1.953511577	1.410083425	1.46084603	12.58421227	2.336766595	5.630125728	1.142130965	0.055133567	4.506900976	6.524461618	10.02418668	0.12973194	1.119359546	0	0	4.413893688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3553	0	16.75707	21.652	0.328644839	1.585348337	0	1.497899824	1.953511577	1.410083425	1.46084603	12.58421227	2.336766595	5.630125728	1.142130965	0.055133567	4.506900976	6.524461618	10.02418668	0.12973194	1.119359546	0	0	4.413893688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.3553	YES						20% Coins																									$0/Visit										5000						1.3792																									0										1.3792	0	0.068623	21.652	0.328644839	1.585348337	0	1.497899824	3.332732577	1.410083425	1.46084603	12.58421227	2.336766595	5.630125728	1.142130965	0.055133567	4.506900976	6.524461618	10.02418668	0.12973194	1.119359546	0	0	4.413893688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.7345
H2944_024_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1763.73915	70.331343	606.169789	1593.784902	8.523173	11.205901	9.080259	377.272955	48.64951	8.805703	19.574515	7.284685	0.609612	17.083831	3736.629204	4306.696237	103.695032	2.321353			26.130358	0							0.04	0.25	1296.185476	428.555258	0	0.05	0.55	1.93	427.077198	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.239211	0.25	0.232598	0.25	0.2	0.230368	15	35	35	0.25			0.2	0							0	0	0	20.426728	0	0	0	0	35	0	0		NO	139.061393	122.980766	30.235016	0	0.169741	0.169741	0.169741	42.43515	0.203019	0.212176	0.197407	0.212176	0.169741	0.195514	12.730545	29.704605	29.704605	0.212176			0.169741	0							0	0	0	17.336225	0	0	0	0	29.704605	0	0			20.439	0.720783536	1.527296106	0	1.446731908	1.902100842	1.541292243	1.334136203	9.876774871	1.86835884	3.864146283	1.545635325	0.10347615	3.340128134	3.964110519	10.66072588	0.256684997	0.492535394	0	0	4.435393097	0	0	0	0	0	0	0	0	0	0	0.619127531	0	0	0	0	1.057179956	0	0	0	70.9956	0	12.517748	20.439	0.720783536	1.527296106	0	1.446731908	1.902100842	1.541292243	1.334136203	9.876774871	1.86835884	3.864146283	1.545635325	0.10347615	3.340128134	3.964110519	10.66072588	0.256684997	0.492535394	0	0	4.435393097	0	0	0	0	0	0	0	0	0	0	0.619127531	0	0	0	0	1.057179956	0	0	0	70.9956	YES						20% Coins																									$0/Visit										5000						1.3229																									0										1.3229	0	0.049275	20.439	0.720783536	1.527296106	0	1.446731908	3.224976842	1.541292243	1.334136203	9.876774871	1.86835884	3.864146283	1.545635325	0.10347615	3.340128134	3.964110519	10.66072588	0.256684997	0.492535394	0	0	4.435393097	0	0	0	0	0	0	0	0	0	0	0.619127531	0	0	0	0	1.057179956	0	0	0	72.3185
H2944_026_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1852.766325	73.881414	636.767048	753.40503	9.147508	12.02675	9.745403	396.31633	52.21316	9.450733	21.00838	7.8183	0.654267	18.335249	3925.240734	4524.08269	108.929182	2.491395			28.044447	0							0.04	0.25	1361.612232	450.187177	0	0.05	0.55	1.93	448.634511	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.239211	0.25	0.232598	0.25	0.2	0.230368	15	35	35	0.25			0.2	0							0	0	0	20.426728	0	0	0	0	35	0	0		NO	136.564458	120.772569	28.800278	0	0.167373	0.167373	0.167373	41.84335	0.200188	0.209217	0.194654	0.209217	0.167373	0.192787	12.553005	29.290345	29.290345	0.209217			0.167373	0							0	0	0	17.094455	0	0	0	0	29.290345	0	0			21.0852	0.743570681	1.528255667	0	1.531045856	2.012953228	1.631117336	1.381933576	10.45244807	1.977254006	4.089365201	1.635721271	0.109506631	3.534797649	4.106130547	11.0426619	0.26588111	0.521242188	0	0	4.693883228	0	0	0	0	0	0	0	0	0	0	0.641308703	0	0	0	0	1.095054967	0	0	0	74.0793	0	14.465719	21.0852	0.743570681	1.528255667	0	1.531045856	2.012953228	1.631117336	1.381933576	10.45244807	1.977254006	4.089365201	1.635721271	0.109506631	3.534797649	4.106130547	11.0426619	0.26588111	0.521242188	0	0	4.693883228	0	0	0	0	0	0	0	0	0	0	0.641308703	0	0	0	0	1.095054967	0	0	0	74.0793	YES				$0/Visit		20% Coins																									$0/Visit										5000				0		1.418																									0										1.418	0	0.054708	21.0852	0.743570681	1.528255667	0	1.531045856	3.430908228	1.631117336	1.381933576	10.45244807	1.977254006	4.089365201	1.635721271	0.109506631	3.534797649	4.106130547	11.0426619	0.26588111	0.521242188	0	0	4.693883228	0	0	0	0	0	0	0	0	0	0	0.641308703	0	0	0	0	1.095054967	0	0	0	75.4973
H2944_027_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	2053.104344	81.870148	705.620118	834.870065	10.525403	13.838346	11.213359	439.169672	60.078059	10.874303	24.172884	8.995974	0.75282	21.097096	4349.673619	5013.267836	120.707601	2.866676			32.268799	0							0.04	0.25	1508.842184	498.865527	0	0.05	0.55	1.93	497.144972	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.239211	0.25	0.232598	0.25	0.2	0.230368	15	35	35	0.25			0.2	0							0	0	0	20.426728	0	0	0	0	35	0	0		NO	131.012398	115.862532	25.908811	0	0.162301	0.162301	0.162301	40.57525	0.194121	0.202876	0.188755	0.202876	0.162301	0.186945	12.172575	28.402675	28.402675	0.202876			0.162301	0							0	0	0	16.576392	0	0	0	0	28.402675	0	0			22.4152	0.790473554	1.523481523	0	1.708283432	2.245977394	1.819939379	1.484951603	11.66241289	2.206135095	4.562752719	1.825067221	0.122183439	3.943996612	4.412227363	11.86585142	0.285701563	0.58157976	0	0	5.237258346	0	0	0	0	0	0	0	0	0	0	0.689115878	0	0	0	0	1.176687256	0	0	0	80.5593	0	19.194873	22.4152	0.790473554	1.523481523	0	1.708283432	2.245977394	1.819939379	1.484951603	11.66241289	2.206135095	4.562752719	1.825067221	0.122183439	3.943996612	4.412227363	11.86585142	0.285701563	0.58157976	0	0	5.237258346	0	0	0	0	0	0	0	0	0	0	0.689115878	0	0	0	0	1.176687256	0	0	0	80.5593	YES				$0/Visit		20% Coins																									$0/Visit										5000				0		1.6268																									0										1.6268	0	0.067684	22.4152	0.790473554	1.523481523	0	1.708283432	3.872784394	1.819939379	1.484951603	11.66241289	2.206135095	4.562752719	1.825067221	0.122183439	3.943996612	4.412227363	11.86585142	0.285701563	0.58157976	0	0	5.237258346	0	0	0	0	0	0	0	0	0	0	0.689115878	0	0	0	0	1.176687256	0	0	0	82.1861
H2944_028_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1113.792074	51.137327	426.515135	129.01317	8.332094	8.883616	5.243205	377.294743	45.512847	5.44393	18.036489	4.451039	0.205608	12.059939	4196.66471	5793.058457	74.650726	1.524867			23.292204	0							0.04	0.25	1367.32453	515.193617	0	0.05	0.55	2.68	1068.48712	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$20/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$40/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.233942	0.25	0.221531	0.25	0.2	0.232606	20	40	40	0.25			0.2	0							0	0	0	21.864915	0	0	0	0	40	0	0		NO	147.933704	130.827111	46.540065	0	0.177967	0.177967	0.177967	44.49165	0.208169	0.222458	0.197126	0.222458	0.177967	0.206981	17.79666	35.59332	35.59332	0.222458			0.177967	0							0	0	0	19.456123	0	0	0	0	35.59332	0	0			13.7306	0.557512396	1.654170176	0	1.482837773	1.580990489	0.933117464	1.398872138	9.474363847	1.21104578	3.555460931	0.990169234	0.036591439	2.496178234	6.223884581	17.18284862	0.221422265	0.339218863	0	0	4.145243669	0	0	0	0	0	0	0	0	0	0	0.835305865	0	0	0	0	3.169250332	0	0	0	71.2191	0	8.305388	13.7306	0.557512396	1.654170176	0	1.482837773	1.580990489	0.933117464	1.398872138	9.474363847	1.21104578	3.555460931	0.990169234	0.036591439	2.496178234	6.223884581	17.18284862	0.221422265	0.339218863	0	0	4.145243669	0	0	0	0	0	0	0	0	0	0	0.835305865	0	0	0	0	3.169250332	0	0	0	71.2191	YES				$0/Visit		20% Coins																									$0/Visit										6000				0		1.0405																									0										1.0405	0	0.047284	13.7306	0.557512396	1.654170176	0	1.482837773	2.621496489	0.933117464	1.398872138	9.474363847	1.21104578	3.555460931	0.990169234	0.036591439	2.496178234	6.223884581	17.18284862	0.221422265	0.339218863	0	0	4.145243669	0	0	0	0	0	0	0	0	0	0	0.835305865	0	0	0	0	3.169250332	0	0	0	72.2596
H2944_029_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1191.18187	54.69051	456.150755	137.977413	10.434743	11.125445	6.566356	403.510375	56.998263	6.817735	22.588095	5.574283	0.257493	15.103331	4488.262247	6195.57848	79.837695	1.909675			29.170116	0							0.04	0.25	1462.330563	550.990898	0	0.05	0.55	2.68	1142.728984	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$20/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$40/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.233942	0.25	0.221531	0.25	0.2	0.232606	20	40	40	0.25			0.2	0							0	0	0	21.864915	0	0	0	0	40	0	0		NO	145.4609	128.640254	43.772561	0	0.174392	0.174392	0.174392	43.59795	0.203988	0.21799	0.193166	0.21799	0.174392	0.202823	17.43918	34.87836	34.87836	0.21799			0.174392	0							0	0	0	19.06531	0	0	0	0	34.87836	0	0			14.4392	0.586283425	1.663907229	0	1.819735701	1.940188604	1.145119956	1.466018763	11.62696167	1.486198053	4.363251959	1.215137951	0.044904719	3.063302903	6.522634434	18.00763472	0.232050656	0.416290053	0	0	5.087034869	0	0	0	0	0	0	0	0	0	0	0.875401023	0	0	0	0	3.321376074	0	0	0	79.3226	0	11.121206	14.4392	0.586283425	1.663907229	0	1.819735701	1.940188604	1.145119956	1.466018763	11.62696167	1.486198053	4.363251959	1.215137951	0.044904719	3.063302903	6.522634434	18.00763472	0.232050656	0.416290053	0	0	5.087034869	0	0	0	0	0	0	0	0	0	0	0.875401023	0	0	0	0	3.321376074	0	0	0	79.3226	YES				$0/Visit		20% Coins																									$0/Visit										6000				0		1.2931																									0										1.2931	0	0.069249	14.4392	0.586283425	1.663907229	0	1.819735701	3.233239604	1.145119956	1.466018763	11.62696167	1.486198053	4.363251959	1.215137951	0.044904719	3.063302903	6.522634434	18.00763472	0.232050656	0.416290053	0	0	5.087034869	0	0	0	0	0	0	0	0	0	0	0.875401023	0	0	0	0	3.321376074	0	0	0	80.6157
H2944_030_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1155.421544	53.048653	442.456709	133.83521	10.901012	11.622577	6.859769	391.396639	59.545186	7.12238	23.597426	5.823366	0.268999	15.778211	4353.520671	6009.581771	77.440897	1.995007			30.473559	0							0.04	0.25	1418.430115	534.449668	0	0.05	0.55	2.68	1108.423256	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$20/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$40/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.233942	0.25	0.221531	0.25	0.2	0.232606	20	40	40	0.25			0.2	0							0	0	0	21.864915	0	0	0	0	40	0	0		NO	145.549963	128.719018	44.158148	0	0.174376	0.174376	0.174376	43.594	0.203969	0.21797	0.193149	0.21797	0.174376	0.202805	17.4376	34.8752	34.8752	0.21797			0.174376	0							0	0	0	19.063582	0	0	0	0	34.8752	0	0			14.0143	0.569030877	1.628172403	0	1.900874869	2.026698487	1.196179079	1.421878757	12.14537204	1.552465169	4.557819234	1.269319087	0.04690697	3.199900082	6.326246004	17.46544718	0.225063898	0.434851676	0	0	5.313857324	0	0	0	0	0	0	0	0	0	0	0.849043756	0	0	0	0	3.221373561	0	0	0	79.3648	0	11.12324	14.0143	0.569030877	1.628172403	0	1.900874869	2.026698487	1.196179079	1.421878757	12.14537204	1.552465169	4.557819234	1.269319087	0.04690697	3.199900082	6.326246004	17.46544718	0.225063898	0.434851676	0	0	5.313857324	0	0	0	0	0	0	0	0	0	0	0.849043756	0	0	0	0	3.221373561	0	0	0	79.3648	YES				$0/Visit		20% Coins																									$0/Visit										6000				0		1.3484																									0										1.3484	0	0.074796	14.0143	0.569030877	1.628172403	0	1.900874869	3.375075487	1.196179079	1.421878757	12.14537204	1.552465169	4.557819234	1.269319087	0.04690697	3.199900082	6.326246004	17.46544718	0.225063898	0.434851676	0	0	5.313857324	0	0	0	0	0	0	0	0	0	0	0.849043756	0	0	0	0	3.221373561	0	0	0	80.7132
H2944_031_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1215.802341	55.820905	465.578909	140.82926	10.500486	11.19554	6.607726	411.850508	57.357373	6.860689	22.730407	5.609404	0.259117	15.198487	4581.029884	6323.63454	81.487855	1.921707			29.353899	0							0.04	0.25	1492.55539	562.379298	0	0.05	0.55	2.68	1166.347984	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$20/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$40/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.233942	0.25	0.221531	0.25	0.2	0.232606	20	40	40	0.25			0.2	0							0	0	0	21.864915	0	0	0	0	40	0	0		NO	145.119413	128.338256	43.279959	0	0.173969	0.173969	0.173969	43.49235	0.203494	0.217462	0.192698	0.217462	0.173969	0.202332	17.39694	34.79388	34.79388	0.217462			0.173969	0							0	0	0	19.019131	0	0	0	0	34.79388	0	0			14.703	0.596996466	1.679186341	0	1.826759049	1.947676898	1.149539484	1.492695537	11.67188126	1.491939151	4.380103968	1.219832213	0.045078325	3.075140272	6.641325169	18.33531511	0.236273221	0.417898248	0	0	5.106668455	0	0	0	0	0	0	0	0	0	0	0.891330462	0	0	0	0	3.381814316	0	0	0	80.2905	0	11.491953	14.703	0.596996466	1.679186341	0	1.826759049	1.947676898	1.149539484	1.492695537	11.67188126	1.491939151	4.380103968	1.219832213	0.045078325	3.075140272	6.641325169	18.33531511	0.236273221	0.417898248	0	0	5.106668455	0	0	0	0	0	0	0	0	0	0	0.891330462	0	0	0	0	3.381814316	0	0	0	80.2905	YES				$0/Visit		20% Coins																									$0/Visit										6000				0		1.3009																									0										1.3009	0	0.070003	14.703	0.596996466	1.679186341	0	1.826759049	3.248556898	1.149539484	1.492695537	11.67188126	1.491939151	4.380103968	1.219832213	0.045078325	3.075140272	6.641325169	18.33531511	0.236273221	0.417898248	0	0	5.106668455	0	0	0	0	0	0	0	0	0	0	0.891330462	0	0	0	0	3.381814316	0	0	0	81.5914
H2944_032_0	2010	6	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1254.453637	62.708309	621.501263	540.1494978	148.293887	14.275255	8.552715	450.112356	461.545782	748.31524	1403.777035	123.381493	0.342384	1218.589832	3801.896129	4815.082753	67.995305	1177.567561			29.514917	0							0.04	0.25	1546.777948	0.05	0.55	2.43	0.32	0.4						$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	100.959119	0	75.927126	125	0.2	113.561078	15	35	35	62.455937			0.2	0							0	0	125	0	0	0	0	0					NO	135.474907	119.80901	32.863325	0	81.8038	0.163608	0.163608	40.9019	82.588395	0	62.111274	102.25475	0.163608	92.897277	12.27057	28.63133	28.63133	51.09133			0.163608	0							0	0	102.25475	0	0	0	0	0						14.1622	0.626085035	1.702049833	0	1.010916956	2.33554592	1.399292596	1.534204214	3.176527113	0	7.265865005	1.051361977	0.056016761	9.433639764	3.887619382	11.48851861	0.162233001	5.013624405	0	0	4.828876541	0	0	0	0	0	0	0	0	0	13.18044936	0	0	0	0	0	0	0	0	0	82.3151	0	18.498399	14.1622	0.626085035	1.702049833	0	1.010916956	2.33554592	1.399292596	1.534204214	3.176527113	0	7.265865005	1.051361977	0.056016761	9.433639764	3.887619382	11.48851861	0.162233001	5.013624405	0	0	4.828876541	0	0	0	0	0	0	0	0	0	13.18044936	0	0	0	0	0	0	0	0	0	82.3151	YES						20% Coins				$0/Visit																															5000						1.6477				0																															1.6477	0	0.100249	14.1622	0.626085035	1.702049833	0	1.010916956	3.98328692	1.399292596	1.534204214	3.176527113	0	7.265865005	1.051361977	0.056016761	9.433639764	3.887619382	11.48851861	0.162233001	5.013624405	0	0	4.828876541	0	0	0	0	0	0	0	0	0	13.18044936	0	0	0	0	0	0	0	0	0	83.9628
H2944_033_0	2010	10	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1170.322383	58.50271	579.819626	503.9238044	8.445802	13.75835	8.243024	419.925097	57.316979	13.879365	22.218836	7.143953	0.329987	25.647217	3546.917962	4492.154158	63.435128	2.833338			28.446188	0							0.04	0.25	698.128691	448.937871	0	0.05	0.55	2.43	763.44949	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.23702	0.25	0.236326	0.25	0.2	0.234541	15	35	35	0.25			0.2	0							0	0	0	17.038033	0	0	0	0	35	0	0		NO	141.582777	125.210585	36.805244	0	0.170441	0.170441	0.170441	42.61025	0.20199	0.213051	0.201398	0.213051	0.170441	0.199877	12.783075	29.827175	29.827175	0.213051			0.170441	0							0	0	0	14.519897	0	0	0	0	29.827175	0	0			13.8081	0.610429879	1.778366901	0	1.439510939	2.344986932	1.404949254	1.49109278	11.57745659	2.957012593	4.474829133	1.522026331	0.056243314	5.126288792	3.778376527	11.16568902	0.157674222	0.603645494	0	0	4.848396729	0	0	0	0	0	0	0	0	0	0	0.543210971	0	0	0	0	1.897628462	0	0	0	71.5859	0	12.391356	13.8081	0.610429879	1.778366901	0	1.439510939	2.344986932	1.404949254	1.49109278	11.57745659	2.957012593	4.474829133	1.522026331	0.056243314	5.126288792	3.778376527	11.16568902	0.157674222	0.603645494	0	0	4.848396729	0	0	0	0	0	0	0	0	0	0	0.543210971	0	0	0	0	1.897628462	0	0	0	71.5859	YES						20% Coins																									$0/Visit										5000						1.591																									0										1.591	0	0.093708	13.8081	0.610429879	1.778366901	0	1.439510939	3.935974932	1.404949254	1.49109278	11.57745659	2.957012593	4.474829133	1.522026331	0.056243314	5.126288792	3.778376527	11.16568902	0.157674222	0.603645494	0	0	4.848396729	0	0	0	0	0	0	0	0	0	0	0.543210971	0	0	0	0	1.897628462	0	0	0	73.1769
H2944_034_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1170.322383	58.50271	579.819626	503.9238044	138.348401	13.75835	8.243024	419.925097	430.591729	698.128691	1309.631251	115.106784	0.329987	1136.863822	3546.917962	4492.154158	63.435128	1098.592753			28.446188	0							0.04	0.25	1443.041656	0.05	0.55	2.43	0.32	0.4						$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	100.959119	0	75.927126	125	0.2	113.561078	15	35	35	62.455937			0.2	0							0	0	125	0	0	0	0	0					NO	138.250143	122.263327	34.960376	0	83.1504	0.166301	0.166301	41.5752	83.947911	0	63.133709	103.938	0.166301	94.426491	12.47256	29.10264	29.10264	51.932362			0.166301	0							0	0	103.938	0	0	0	0	0						13.4831	0.59606133	1.689226011	0	0.95864374	2.288027363	1.370823134	1.454872491	3.012273012	0	6.890156525	0.99699741	0.054877168	8.945838455	3.686595591	10.89446211	0.153844141	4.754376378	0	0	4.730629511	0	0	0	0	0	0	0	0	0	12.4989053	0	0	0	0	0	0	0	0	0	78.4597	0	15.917725	13.4831	0.59606133	1.689226011	0	0.95864374	2.288027363	1.370823134	1.454872491	3.012273012	0	6.890156525	0.99699741	0.054877168	8.945838455	3.686595591	10.89446211	0.153844141	4.754376378	0	0	4.730629511	0	0	0	0	0	0	0	0	0	12.4989053	0	0	0	0	0	0	0	0	0	78.4597	YES						20% Coins				$0/Visit																															5000						1.591				0																															1.591	0	0.093708	13.4831	0.59606133	1.689226011	0	0.95864374	3.879015363	1.370823134	1.454872491	3.012273012	0	6.890156525	0.99699741	0.054877168	8.945838455	3.686595591	10.89446211	0.153844141	4.754376378	0	0	4.730629511	0	0	0	0	0	0	0	0	0	12.4989053	0	0	0	0	0	0	0	0	0	80.0507
H2944_035_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1141.056942	57.039773	565.320479	491.3225311	6.386861	10.404303	6.233517	409.424321	43.344089	10.495815	16.802271	5.40238	0.24954	19.394871	3458.222642	4379.821972	61.84885	2.142619			21.511498	0							0.04	0.25	680.67107	437.711593	0	0.05	0.55	1.54	744.358438	0.32	0.4			$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		197.25885	150.313725	58.254672	0	0.2	0.2	0.2	50	0.23702	0.25	0.236326	0.25	0.2	0.234541	15	35	35	0.25			0.2	0							0	0	0	17.038033	0	0	0	0	35	0	0		NO	157.253769	119.82935	26.031508	0	0.158211	0.158211	0.158211	39.5528	0.187496	0.197764	0.186947	0.197764	0.158211	0.185535	11.86584	27.68696	27.68696	0.197764			0.158211	0							0	0	0	13.478038	0	0	0	0	27.68696	0	0			14.953	0.569586577	1.226345381	0	1.010471666	1.646075182	0.986210958	1.349489857	8.126843311	2.075694358	3.141134157	1.068396278	0.039479973	3.598427391	3.419559713	10.10532965	0.142700553	0.423732904	0	0	3.40335561	0	0	0	0	0	0	0	0	0	0	0.491624457	0	0	0	0	1.717418525	0	0	0	59.4948	0	16.757566	14.953	0.569586577	1.226345381	0	1.010471666	1.646075182	0.986210958	1.349489857	8.126843311	2.075694358	3.141134157	1.068396278	0.039479973	3.598427391	3.419559713	10.10532965	0.142700553	0.423732904	0	0	3.40335561	0	0	0	0	0	0	0	0	0	0	0.491624457	0	0	0	0	1.717418525	0	0	0	59.4948	YES						20% Coins																									$0/Visit										3400						1.196																									0										1.196	0	0.078046	14.953	0.569586577	1.226345381	0	1.010471666	2.842025182	0.986210958	1.349489857	8.126843311	2.075694358	3.141134157	1.068396278	0.039479973	3.598427391	3.419559713	10.10532965	0.142700553	0.423732904	0	0	3.40335561	0	0	0	0	0	0	0	0	0	0	0.491624457	0	0	0	0	1.717418525	0	0	0	60.6908
H2944_036_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	954.432446	47.710687	472.860019	410.9647356	5.862833	9.550651	5.722071	342.461311	39.787798	9.634656	15.423679	4.959126	0.229066	17.803562	2892.616287	3663.484305	51.73322	1.966821			19.746526	0							0.04	0.25	569.344553	366.122084	0	0.05	0.55	2.87	622.615593	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.23702	0.25	0.236326	0.25	0.2	0.234541	15	35	35	0.25			0.2	0							0	0	0	17.038033	0	0	0	0	35	0	0		NO	148.030069	130.912333	43.901595	0	0.178815	0.178815	0.178815	44.7038	0.211914	0.223519	0.211293	0.223519	0.178815	0.209697	13.41114	31.29266	31.29266	0.223519			0.178815	0							0	0	0	15.233297	0	0	0	0	31.29266	0	0			11.7737	0.520493112	1.72994242	0	1.048362483	1.707799659	1.023192126	1.27577683	8.431591425	2.153528674	3.258915407	1.108458884	0.040960437	3.733353541	3.232773499	9.553347398	0.134905839	0.439621863	0	0	3.530975047	0	0	0	0	0	0	0	0	0	0	0.464770537	0	0	0	0	1.623608172	0	0	0	56.7861	0	6.522649	11.7737	0.520493112	1.72994242	0	1.048362483	1.707799659	1.023192126	1.27577683	8.431591425	2.153528674	3.258915407	1.108458884	0.040960437	3.733353541	3.232773499	9.553347398	0.134905839	0.439621863	0	0	3.530975047	0	0	0	0	0	0	0	0	0	0	0.464770537	0	0	0	0	1.623608172	0	0	0	56.7861	YES						20% Coins																									$0/Visit										5000						1.1194																									0										1.1194	0	0.050076	11.7737	0.520493112	1.72994242	0	1.048362483	2.827190659	1.023192126	1.27577683	8.431591425	2.153528674	3.258915407	1.108458884	0.040960437	3.733353541	3.232773499	9.553347398	0.134905839	0.439621863	0	0	3.530975047	0	0	0	0	0	0	0	0	0	0	0.464770537	0	0	0	0	1.623608172	0	0	0	57.9055
H2944_037_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	963.517007	48.164811	477.360836	414.8764156	113.901126	9.568163	5.732562	345.720955	354.502707	574.763737	1078.208877	94.766489	0.229488	935.970841	2920.149034	3698.354394	52.225631	904.462579			19.782732	0							0.04	0.25	1188.044591	0.05	0.55	2.87	0.32	0.4						$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	100.959119	0	75.927126	125	0.2	113.561078	15	35	35	62.455937			0.2	0							0	0	125	0	0	0	0	0					NO	144.732045	127.995682	41.111196	0	86.799	0.173598	0.173598	43.3995	87.631505	0	65.903986	108.49875	0.173598	98.56988	13.01985	30.37965	30.37965	54.211129			0.173598	0							0	0	108.49875	0	0	0	0	0						11.621	0.513740653	1.635406241	0	0.82387532	1.66101396	0.995161298	1.250343049	2.588800478	0	5.921521895	0.856837133	0.039838658	7.688211123	3.1683252	9.362892672	0.132216366	4.085994795	0	0	3.43424271	0	0	0	0	0	0	0	0	0	10.74177942	0	0	0	0	0	0	0	0	0	66.5212	0	9.880634	11.621	0.513740653	1.635406241	0	0.82387532	1.66101396	0.995161298	1.250343049	2.588800478	0	5.921521895	0.856837133	0.039838658	7.688211123	3.1683252	9.362892672	0.132216366	4.085994795	0	0	3.43424271	0	0	0	0	0	0	0	0	0	10.74177942	0	0	0	0	0	0	0	0	0	66.5212	YES						20% Coins				$0/Visit																															5000						1.1214				0																															1.1214	0	0.050219	11.621	0.513740653	1.635406241	0	0.82387532	2.78240696	0.995161298	1.250343049	2.588800478	0	5.921521895	0.856837133	0.039838658	7.688211123	3.1683252	9.362892672	0.132216366	4.085994795	0	0	3.43424271	0	0	0	0	0	0	0	0	0	10.74177942	0	0	0	0	0	0	0	0	0	67.6426
H2944_038_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1029.368015	51.456607	509.985784	443.2309022	6.623687	10.790095	6.464657	369.349052	44.951296	10.885002	17.425298	5.602702	0.258794	20.114033	3119.724918	3951.116268	55.794961	2.222067			22.309149	0							0.04	0.25	614.04563	394.867509	0	0.05	0.55	2.87	671.49915	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.23702	0.25	0.236326	0.25	0.2	0.234541	15	35	35	0.25			0.2	0							0	0	0	17.038033	0	0	0	0	35	0	0		NO	146.179912	129.276122	41.471268	0	0.1762	0.1762	0.1762	44.05005	0.208815	0.22025	0.208203	0.22025	0.1762	0.206631	13.215015	30.835035	30.835035	0.22025			0.1762	0							0	0	0	15.010524	0	0	0	0	30.835035	0	0			12.5394	0.55434255	1.76247976	0	1.167093649	1.901214739	1.139072563	1.355820351	9.386504874	2.397421691	3.627999319	1.233995116	0.045599503	4.156182753	3.435600966	10.15273403	0.143369965	0.489410257	0	0	3.930872054	0	0	0	0	0	0	0	0	0	0	0.493930685	0	0	0	0	1.725474983	0	0	0	61.6385	0	8.158871	12.5394	0.55434255	1.76247976	0	1.167093649	1.901214739	1.139072563	1.355820351	9.386504874	2.397421691	3.627999319	1.233995116	0.045599503	4.156182753	3.435600966	10.15273403	0.143369965	0.489410257	0	0	3.930872054	0	0	0	0	0	0	0	0	0	0	0.493930685	0	0	0	0	1.725474983	0	0	0	61.6385	YES						20% Coins																									$0/Visit										5000						1.26																									0										1.26	0	0.061246	12.5394	0.55434255	1.76247976	0	1.167093649	3.161204739	1.139072563	1.355820351	9.386504874	2.397421691	3.627999319	1.233995116	0.045599503	4.156182753	3.435600966	10.15273403	0.143369965	0.489410257	0	0	3.930872054	0	0	0	0	0	0	0	0	0	0	0.493930685	0	0	0	0	1.725474983	0	0	0	62.8985
H2944_039_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1029.634717	51.469939	510.117918	443.34574	121.71716	10.752764	6.44229	369.444748	378.829114	614.204725	1152.196884	101.269481	0.257899	1000.198301	3120.533218	3952.139976	55.809417	966.527902			22.231965	0							0.04	0.25	1269.569657	0.05	0.55	2.87	0.32	0.4						$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	100.959119	0	75.927126	125	0.2	113.561078	15	35	35	62.455937			0.2	0							0	0	125	0	0	0	0	0					NO	142.842833	126.324933	39.074671	0	85.6502	0.1713	0.1713	42.8251	86.471687	0	65.031735	107.06275	0.1713	97.265291	12.84753	29.97757	29.97757	53.493635			0.1713	0							0	0	107.06275	0	0	0	0	0						12.2563	0.54182805	1.661057485	0	0.868758258	1.841948473	1.103564277	1.318459023	2.729832714	0	6.244113536	0.903515761	0.044178099	8.107048234	3.340928678	9.872962732	0.139419225	4.308590901	0	0	3.808335605	0	0	0	0	0	0	0	0	0	11.32696823	0	0	0	0	0	0	0	0	0	70.4178	0	11.616501	12.2563	0.54182805	1.661057485	0	0.868758258	1.841948473	1.103564277	1.318459023	2.729832714	0	6.244113536	0.903515761	0.044178099	8.107048234	3.340928678	9.872962732	0.139419225	4.308590901	0	0	3.808335605	0	0	0	0	0	0	0	0	0	11.32696823	0	0	0	0	0	0	0	0	0	70.4178	YES						20% Coins				$0/Visit																															5000						1.2558				0																															1.2558	0	0.060898	12.2563	0.54182805	1.661057485	0	0.868758258	3.097715473	1.103564277	1.318459023	2.729832714	0	6.244113536	0.903515761	0.044178099	8.107048234	3.340928678	9.872962732	0.139419225	4.308590901	0	0	3.808335605	0	0	0	0	0	0	0	0	0	11.32696823	0	0	0	0	0	0	0	0	0	71.6736
H2944_040_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1495.276463	83.988602	844.530086	480.6544444	8.22361	9.395842	7.439862	448.194305	52.088474	15.793443	19.690668	5.846824	0.86333	24.001056	3525.417459	4219.86149	106.567383	3.792864			26.759265	0							0.04	0.25	598.718719	361.957925	0	0.05	0.55	2.09	519.115403	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.24286	0.25	0.243873	0.25	0.2	0.235003	15	35	35	0.25			0.2	0							0	0	0	14.429233	0	0	0	0	35	0	0		NO	139.095367	123.010812	30.701727	0	0.169548	0.169548	0.169548	42.387	0.205882	0.211935	0.206741	0.211935	0.169548	0.199221	12.7161	29.6709	29.6709	0.211935			0.169548	0							0	0	0	12.232238	0	0	0	0	29.6709	0	0			17.3322	0.860958844	2.160711012	0	1.394296628	1.593046219	1.261413722	1.583134334	10.7240792	3.347183342	4.070868393	1.239146644	0.146375875	4.781514377	3.735796746	10.43392402	0.263495847	0.803840632	0	0	4.536979862	0	0	0	0	0	0	0	0	0	0	0.368962957	0	0	0	0	1.283551768	0	0	0	71.9214	0	13.772712	17.3322	0.860958844	2.160711012	0	1.394296628	1.593046219	1.261413722	1.583134334	10.7240792	3.347183342	4.070868393	1.239146644	0.146375875	4.781514377	3.735796746	10.43392402	0.263495847	0.803840632	0	0	4.536979862	0	0	0	0	0	0	0	0	0	0	0.368962957	0	0	0	0	1.283551768	0	0	0	71.9214	YES						20% Coins																									$0/Visit										5000						1.099																									0										1.099	0	0.051479	17.3322	0.860958844	2.160711012	0	1.394296628	2.692078219	1.261413722	1.583134334	10.7240792	3.347183342	4.070868393	1.239146644	0.146375875	4.781514377	3.735796746	10.43392402	0.263495847	0.803840632	0	0	4.536979862	0	0	0	0	0	0	0	0	0	0	0.368962957	0	0	0	0	1.283551768	0	0	0	73.0205
H2944_041_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1457.25402	81.852909	823.055063	468.4321867	7.861914	8.982589	7.112638	436.797454	49.797491	15.098808	18.824622	5.589666	0.825358	22.945429	3435.771838	4112.557289	103.857549	3.626045			25.582324	0							0.04	0.25	583.494278	352.753925	0	0.05	0.55	2.09	505.915144	0.32	0.4			$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		197.25885	150.313725	58.254672	0	0.2	0.2	0.2	50	0.24286	0.25	0.243873	0.25	0.2	0.235003	15	35	35	0.25			0.2	0							0	0	0	14.429233	0	0	0	0	35	0	0		NO	144.489938	110.10315	19.427409	0	0.151384	0.151384	0.151384	37.8459	0.183825	0.18923	0.184592	0.18923	0.151384	0.177878	11.35377	26.49213	26.49213	0.18923			0.151384	0							0	0	0	10.921746	0	0	0	0	26.49213	0	0			17.5465	0.751021926	1.332485612	0	1.190167989	1.359820253	1.076739591	1.37758273	9.154023783	2.857147438	3.474874624	1.057732497	0.124945995	4.08148702	3.250746935	9.079200194	0.229283974	0.686156495	0	0	3.872754536	0	0	0	0	0	0	0	0	0	0	0.321057397	0	0	0	0	1.11689748	0	0	0	63.9407	0	23.575717	17.5465	0.751021926	1.332485612	0	1.190167989	1.359820253	1.076739591	1.37758273	9.154023783	2.857147438	3.474874624	1.057732497	0.124945995	4.08148702	3.250746935	9.079200194	0.229283974	0.686156495	0	0	3.872754536	0	0	0	0	0	0	0	0	0	0	0.321057397	0	0	0	0	1.11689748	0	0	0	63.9407	YES						20% Coins																									$0/Visit										3400						1.0364																									0										1.0364	0	0.0635	17.5465	0.751021926	1.332485612	0	1.190167989	2.396229253	1.076739591	1.37758273	9.154023783	2.857147438	3.474874624	1.057732497	0.124945995	4.08148702	3.250746935	9.079200194	0.229283974	0.686156495	0	0	3.872754536	0	0	0	0	0	0	0	0	0	0	0.321057397	0	0	0	0	1.11689748	0	0	0	64.9771
H2944_042_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1539.0868	86.449397	869.274105	494.7372156	8.388575	9.584322	7.589104	461.32602	53.133366	16.110259	20.08566	5.964111	0.880648	24.482514	3628.709212	4343.499867	109.689718	3.868948			27.296054	0							0.04	0.25	616.260672	372.562986	0	0.05	0.55	2.09	534.325046	0.32	0.4			$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		197.25885	150.313725	58.254672	0	0.2	0.2	0.2	50	0.24286	0.25	0.243873	0.25	0.2	0.235003	15	35	35	0.25			0.2	0							0	0	0	14.429233	0	0	0	0	35	0	0		NO	139.799517	106.52899	18.106368	0	0.14852	0.14852	0.14852	37.1301	0.180348	0.185651	0.181101	0.185651	0.14852	0.174514	11.13903	25.99107	25.99107	0.185651			0.14852	0							0	0	0	10.715177	0	0	0	0	25.99107	0	0			17.9303	0.767447246	1.311616403	0	1.245871159	1.423463503	1.127133726	1.427423438	9.582496291	2.990885694	3.637533112	1.107243171	0.130793841	4.272541448	3.368358398	9.407684091	0.237579428	0.718274065	0	0	4.05400994	0	0	0	0	0	0	0	0	0	0	0.332673195	0	0	0	0	1.157306639	0	0	0	66.2306	0	26.614379	17.9303	0.767447246	1.311616403	0	1.245871159	1.423463503	1.127133726	1.427423438	9.582496291	2.990885694	3.637533112	1.107243171	0.130793841	4.272541448	3.368358398	9.407684091	0.237579428	0.718274065	0	0	4.05400994	0	0	0	0	0	0	0	0	0	0	0.332673195	0	0	0	0	1.157306639	0	0	0	66.2306	YES						20% Coins																									$0/Visit										3400						1.1015																									0										1.1015	0	0.072061	17.9303	0.767447246	1.311616403	0	1.245871159	2.524993503	1.127133726	1.427423438	9.582496291	2.990885694	3.637533112	1.107243171	0.130793841	4.272541448	3.368358398	9.407684091	0.237579428	0.718274065	0	0	4.05400994	0	0	0	0	0	0	0	0	0	0	0.332673195	0	0	0	0	1.157306639	0	0	0	67.3322
H2944_043_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1197.929449	67.2868347	795.986944	203.862007	7.759175	8.865206	7.01969	422.432334	42.26619554	11.9211976	15.79182955	4.413296	0.814572	19.4751988	3322.77833	3977.306085	100.441947	3.2207931			25.248015	0							0.04	0.25	564.304684	289.9798596	0	0.05	0.55	2.09	489.276924	0.32	0.4			$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,9a. 25% Advanced Imaging -- OP,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8a. $0 Radiology OP -- Physician"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		197.25885	150.313725	58.254672	0	0.2	0.2	0.2	50	0.24286	0.25	0.243873	0.25	0.2	0.235003	15	35	35	0.25			0.2	0							0	0	0	14.429233	0	0	0	0	35	0	0		NO	146.636311	111.738714	20.145805	0	0.152601	0.152601	0.152601	38.1502	0.185303	0.190751	0.186076	0.190751	0.152601	0.179308	11.44506	26.70514	26.70514	0.190751			0.152601	0							0	0	0	11.009562	0	0	0	0	26.70514	0	0			14.6383	0.626545365	1.33631648	0	1.184057864	1.352839301	1.071211714	1.342989836	7.832052832	2.273980363	2.938480475	0.841840625	0.124304502	3.492058946	3.169116446	8.851209652	0.223526355	0.614369505	0	0	3.852872337	0	0	0	0	0	0	0	0	0	0	0.266045937	0	0	0	0	1.08885073	0	0	0	57.121	0	22.324854	14.6383	0.626545365	1.33631648	0	1.184057864	1.352839301	1.071211714	1.342989836	7.832052832	2.273980363	2.938480475	0.841840625	0.124304502	3.492058946	3.169116446	8.851209652	0.223526355	0.614369505	0	0	3.852872337	0	0	0	0	0	0	0	0	0	0	0.266045937	0	0	0	0	1.08885073	0	0	0	57.121	YES	$225/Day(Days 1-15)	$225/Day(Days 1-8)		$0/Visit		20% Coins			25% Coins:9a. 25% Surgery OP -- Facility	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,9a. 25% Advanced Imaging -- OP,8a. 25% Radiology OP -- Facility"	25% Coins:9a		"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,"				25% Coins:7i													$0/Visit	"$0-$35/Visit:14h. $0 SMAM -- OP,8a. $0 Radiology OP -- Physician"	"$0/Visit:9a, 9b"								3400	2.583	0.111		0		1.0237			1.2754	0.568	0.519	0.21		0.5684				0.068													0	0.0465	0								6.973	0	0.061882	17.2213	0.737545365	1.33631648	0	1.184057864	2.376493301	1.071211714	1.342989836	9.107452832	2.841980363	3.457480475	1.051840625	0.124304502	4.060458946	3.169116446	8.851209652	0.223526355	0.682369505	0	0	3.852872337	0	0	0	0	0	0	0	0	0	0	0.312545937	0	0	0	0	1.08885073	0	0	0	64.094
H2944_044_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1366.743456	83.305491	813.623712	553.6825822	8.138978	11.417291	8.11212	497.773743	50.237048	17.317041	19.102962	5.325631	0.576133	26.846368	3500.03795	3735.730093	123.192736	3.914626			23.738633	0							0.04	0.25	195.840119	415.536291	0	0.05	0.55	1.66	502.042331	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$20/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$40/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	0.2	0.2	0.2	50	0.243166	0.25	0.248028	0.25	0.2	0.235732	20	40	40	0.25			0.2	0							0	0	0	6.762343	0	0	0	0	40	0	0		NO	145.161007	128.37504	33.864026	0	0.175354	0.175354	0.175354	43.83855	0.213201	0.219193	0.217464	0.219193	0.175354	0.206683	17.53542	35.07084	35.07084	0.219193			0.175354	0							0	0	0	5.929026	0	0	0	0	35.07084	0	0			16.5332	0.891195478	2.296047878	0	1.427202348	2.002067646	1.42249269	1.81847326	10.71058887	3.795774168	4.154206528	1.167341036	0.101027226	5.548687877	5.114552956	10.9179327	0.360039394	0.858058617	0	0	4.162664251	0	0	0	0	0	0	0	0	0	0	0.205310456	0	0	0	0	1.467253855	0	0	0	74.9541	0	10.54039	16.5332	0.891195478	2.296047878	0	1.427202348	2.002067646	1.42249269	1.81847326	10.71058887	3.795774168	4.154206528	1.167341036	0.101027226	5.548687877	5.114552956	10.9179327	0.360039394	0.858058617	0	0	4.162664251	0	0	0	0	0	0	0	0	0	0	0.205310456	0	0	0	0	1.467253855	0	0	0	74.9541	YES						20% Coins																									$0/Visit										6000						1.345																									0										1.345	0	0.053014	16.5332	0.891195478	2.296047878	0	1.427202348	3.347089646	1.42249269	1.81847326	10.71058887	3.795774168	4.154206528	1.167341036	0.101027226	5.548687877	5.114552956	10.9179327	0.360039394	0.858058617	0	0	4.162664251	0	0	0	0	0	0	0	0	0	0	0.205310456	0	0	0	0	1.467253855	0	0	0	76.2991
H2944_046_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1469.611745	89.5755	874.861304	595.3556422	9.358411	13.127902	9.32753	535.238808	57.763881	19.91159	21.965088	6.123551	0.662454	30.868663	3763.469184	4016.900755	132.464868	4.50114			27.295305	0							0.04	0.25	210.580075	446.811734	0	0.05	0.55	1.66	539.828673	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	0.2	0.2	0.2	50	0.243166	0.25	0.248028	0.25	0.2	0.235732	15	35	35	0.25			0.2	0							0	0	0	5.91705	0	0	0	0	35	0	0		NO	143.453414	126.864908	32.015728	0	0.17336	0.17336	0.17336	43.3399	0.210776	0.2167	0.214991	0.2167	0.17336	0.204332	13.00197	30.33793	30.33793	0.2167			0.17336	0							0	0	0	5.128887	0	0	0	0	30.33793	0	0			17.5684	0.946998964	2.334110129	0	1.622374131	2.275853091	1.617020601	1.933099701	12.17523978	4.314841553	4.722296234	1.326973502	0.114843025	6.307455648	4.077709452	10.15537116	0.334892491	0.975397038	0	0	4.731914075	0	0	0	0	0	0	0	0	0	0	0.190970574	0	0	0	0	1.364773708	0	0	0	79.0905	0	12.291524	17.5684	0.946998964	2.334110129	0	1.622374131	2.275853091	1.617020601	1.933099701	12.17523978	4.314841553	4.722296234	1.326973502	0.114843025	6.307455648	4.077709452	10.15537116	0.334892491	0.975397038	0	0	4.731914075	0	0	0	0	0	0	0	0	0	0	0.190970574	0	0	0	0	1.364773708	0	0	0	79.0905	YES						20% Coins																									$0/Visit										6000						1.5419																									0										1.5419	0	0.06564	17.5684	0.946998964	2.334110129	0	1.622374131	3.817711091	1.617020601	1.933099701	12.17523978	4.314841553	4.722296234	1.326973502	0.114843025	6.307455648	4.077709452	10.15537116	0.334892491	0.975397038	0	0	4.731914075	0	0	0	0	0	0	0	0	0	0	0.190970574	0	0	0	0	1.364773708	0	0	0	80.6324
H2944_047_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1327.0909	80.888596	790.018506	537.6189022	7.749519	10.870962	7.723946	483.332114	47.833151	16.488401	18.188863	5.070794	0.548565	25.561741	3398.493324	3627.347464	119.618615	3.727307			22.602714	0							0.04	0.25	190.15832	403.480571	0	0.05	0.55	1.66	487.47686	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	0.2	0.2	0.2	50	0.243166	0.25	0.248028	0.25	0.2	0.235732	15	35	35	0.25			0.2	0							0	0	0	5.91705	0	0	0	0	35	0	0		NO	146.700159	129.73621	35.191156	0	0.177582	0.177582	0.177582	44.3954	0.215909	0.221977	0.220226	0.221977	0.177582	0.209308	13.31862	31.07678	31.07678	0.221977			0.177582	0							0	0	0	5.253796	0	0	0	0	31.07678	0	0			16.2237	0.87451499	2.316805374	0	1.376175083	1.930487174	1.371633779	1.788143544	10.3276078	3.660045789	4.005660543	1.12559964	0.09741527	5.350276885	3.771936763	9.393856594	0.309780115	0.827376426	0	0	4.013835158	0	0	0	0	0	0	0	0	0	0	0.176650384	0	0	0	0	1.262434261	0	0	0	70.2039	0	8.841764	16.2237	0.87451499	2.316805374	0	1.376175083	1.930487174	1.371633779	1.788143544	10.3276078	3.660045789	4.005660543	1.12559964	0.09741527	5.350276885	3.771936763	9.393856594	0.309780115	0.827376426	0	0	4.013835158	0	0	0	0	0	0	0	0	0	0	0.176650384	0	0	0	0	1.262434261	0	0	0	70.2039	YES						20% Coins																									$0/Visit										6000						1.2819																									0										1.2819	0	0.049277	16.2237	0.87451499	2.316805374	0	1.376175083	3.212348174	1.371633779	1.788143544	10.3276078	3.660045789	4.005660543	1.12559964	0.09741527	5.350276885	3.771936763	9.393856594	0.309780115	0.827376426	0	0	4.013835158	0	0	0	0	0	0	0	0	0	0	0.176650384	0	0	0	0	1.262434261	0	0	0	71.4858
H2944_049_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1377.446686	83.957872	819.995355	558.0185778	8.409252	11.79643	8.381503	501.671904	51.905292	17.892095	19.737322	5.502481	0.595265	27.73787	3527.447418	3764.985311	124.157482	4.04462			24.52693	0							0.04	0.25	197.373781	418.790436	0	0.05	0.55	1.66	505.97392	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	0.2	0.2	0.2	50	0.243166	0.25	0.248028	0.25	0.2	0.235732	15	35	35	0.25			0.2	0							0	0	0	5.91705	0	0	0	0	35	0	0		NO	145.499795	128.674652	33.986958	0	0.175921	0.175921	0.175921	43.98025	0.21389	0.219901	0.218167	0.219901	0.175921	0.207351	13.194075	30.786175	30.786175	0.219901			0.175921	0							0	0	0	5.204667	0	0	0	0	30.786175	0	0			16.7015	0.90027083	2.322428974	0	1.479364021	2.075239762	1.474482389	1.83863798	11.10202291	3.934489583	4.306032329	1.210001074	0.104719614	5.751475082	3.878450483	9.659124721	0.318527831	0.889415983	0	0	4.314802053	0	0	0	0	0	0	0	0	0	0	0.18163873	0	0	0	0	1.298083471	0	0	0	73.7407	0	10.115812	16.7015	0.90027083	2.322428974	0	1.479364021	2.075239762	1.474482389	1.83863798	11.10202291	3.934489583	4.306032329	1.210001074	0.104719614	5.751475082	3.878450483	9.659124721	0.318527831	0.889415983	0	0	4.314802053	0	0	0	0	0	0	0	0	0	0	0.18163873	0	0	0	0	1.298083471	0	0	0	73.7407	YES						20% Coins																									$0/Visit										6000						1.3888																									0										1.3888	0	0.05571	16.7015	0.90027083	2.322428974	0	1.479364021	3.463990762	1.474482389	1.83863798	11.10202291	3.934489583	4.306032329	1.210001074	0.104719614	5.751475082	3.878450483	9.659124721	0.318527831	0.889415983	0	0	4.314802053	0	0	0	0	0	0	0	0	0	0	0.18163873	0	0	0	0	1.298083471	0	0	0	75.1295
H2944_051_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1143.846484	69.71951685	801.097561	245.321261	7.540684	10.57801	7.515801	490.110263	39.562519	12.835256	14.86691556	3.9473168	0.533782	21.1419667	3446.153086	3678.216629	121.296121	3.2641767			21.993614	0							0.04	0.25	192.825061	343.6766743	0	0.05	0.55	1.66	494.313134	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,9a. 25% Advanced Imaging -- OP,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8a. $0 Radiology OP -- Physician,"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	0.2	0.2	0.2	50	0.243166	0.25	0.248028	0.25	0.2	0.235732	15	35	35	0.25			0.2	0							0	0	0	5.91705	0	0	0	0	35	0	0		NO	146.747469	129.778048	35.061118	0	0.177752	0.177752	0.177752	44.43795	0.216116	0.22219	0.220437	0.22219	0.177752	0.209509	13.331385	31.106565	31.106565	0.22219			0.177752	0							0	0	0	5.258831	0	0	0	0	31.106565	0	0			13.988	0.754005234	2.340614676	0	1.340371662	1.880262434	1.335948659	1.814957947	8.550093356	2.851865531	3.277218265	0.87705432	0.094880818	4.429432301	3.828499463	9.534723721	0.314425473	0.725267421	0	0	3.909408876	0	0	0	0	0	0	0	0	0	0	0.150611462	0	0	0	0	1.281365303	0	0	0	63.2791	0	8.74452	13.988	0.754005234	2.340614676	0	1.340371662	1.880262434	1.335948659	1.814957947	8.550093356	2.851865531	3.277218265	0.87705432	0.094880818	4.429432301	3.828499463	9.534723721	0.314425473	0.725267421	0	0	3.909408876	0	0	0	0	0	0	0	0	0	0	0.150611462	0	0	0	0	1.281365303	0	0	0	63.2791	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)		$0/Visit		20% Coins			"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,9a. 25% Advanced Imaging -- OP,8a. 25% Radiology OP -- Facility"	25% Coins:9a		"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,"				25% Coins:7i													$0/Visit	"$0-$35/Visit:14h. $0 SMAM -- OP,8a. $0 Radiology OP -- Physician,"	"$0/Visit:9a, 9b"								6000	2.469	0.1335		0		1.2479			1.509	0.712	0.624	0.22		0.7815				0.081													0	0.0288	0								7.8067	0	0.047339	16.457	0.887505234	2.340614676	0	1.340371662	3.128190434	1.335948659	1.814957947	10.05909336	3.563865531	3.901218265	1.09705432	0.094880818	5.210932301	3.828499463	9.534723721	0.314425473	0.806267421	0	0	3.909408876	0	0	0	0	0	0	0	0	0	0	0.179411462	0	0	0	0	1.281365303	0	0	0	71.0858
H2944_052_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1009.0976	50.443318	499.943094	434.5027556	6.378794	10.391161	6.225645	362.075795	43.289344	10.482559	16.781047	5.395557	0.249226	19.370373	3058.290992	3873.310503	54.696242	2.139913			21.484329	0							0.04	0.25	601.953783	387.09174	0	0.05	0.55	2.55	658.275924	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.23702	0.25	0.236326	0.25	0.2	0.234541	15	35	35	0.25			0.2	0							0	0	0	17.038033	0	0	0	0	35	0	0		NO	146.774934	129.802338	42.184247	0	0.177007	0.177007	0.177007	44.25185	0.209772	0.221259	0.209157	0.221259	0.177007	0.207577	13.275555	30.976295	30.976295	0.221259			0.177007	0							0	0	0	15.07929	0	0	0	0	30.976295	0	0			12.3425	0.545638384	1.757476914	0	1.12909119	1.839308235	1.101982745	1.335210314	9.08089227	2.319360522	3.509873447	1.193815546	0.044114747	4.020843916	3.383375856	9.998400731	0.141190577	0.47347501	0	0	3.802876623	0	0	0	0	0	0	0	0	0	0	0.486422384	0	0	0	0	1.699245768	0	0	0	60.2051	0	7.639696	12.3425	0.545638384	1.757476914	0	1.12909119	1.839308235	1.101982745	1.335210314	9.08089227	2.319360522	3.509873447	1.193815546	0.044114747	4.020843916	3.383375856	9.998400731	0.141190577	0.47347501	0	0	3.802876623	0	0	0	0	0	0	0	0	0	0	0.486422384	0	0	0	0	1.699245768	0	0	0	60.2051	YES						20% Coins																									$0/Visit										5000						1.2149																									0										1.2149	0	0.057533	12.3425	0.545638384	1.757476914	0	1.12909119	3.054162235	1.101982745	1.335210314	9.08089227	2.319360522	3.509873447	1.193815546	0.044114747	4.020843916	3.383375856	9.998400731	0.141190577	0.47347501	0	0	3.802876623	0	0	0	0	0	0	0	0	0	0	0.486422384	0	0	0	0	1.699245768	0	0	0	61.42
H2944_053_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1340.642012	67.01674	664.202071	259.767432	158.482553	17.452281	10.456163	481.037734	493.256703	799.728918	1500.224809	131.858531	0.418583	1302.31415	4063.108851	5145.907382	72.666984	1258.473409			36.083605	0							0.04	0.25	1653.05073	0.05	0.55	1.11	0.32	0.4						$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	100.959119	0	75.927126	125	0.2	113.561078	15	35	35	62.455937			0.2	0							0	0	125	0	0	0	0	0					NO	131.962402	116.70268	30.587431	0	80.0926	0.160185	0.160185	40.0463	80.860783	0	60.812009	100.11575	0.160185	90.95402	12.01389	28.03241	28.03241	50.022584			0.160185	0							0	0	100.11575	0	0	0	0	0						14.7429	0.651752764	1.693019585	0	1.05777331	2.795593632	1.67492047	1.605315117	3.323760269	0	7.602640382	1.100092977	0.067050718	9.87089227	4.067811899	12.02101546	0.169752557	5.246007651	0	0	5.780052267	0	0	0	0	0	0	0	0	0	13.7913678	0	0	0	0	0	0	0	0	0	87.2617	0	22.099354	14.7429	0.651752764	1.693019585	0	1.05777331	2.795593632	1.67492047	1.605315117	3.323760269	0	7.602640382	1.100092977	0.067050718	9.87089227	4.067811899	12.02101546	0.169752557	5.246007651	0	0	5.780052267	0	0	0	0	0	0	0	0	0	13.7913678	0	0	0	0	0	0	0	0	0	87.2617	YES				$0/Visit		20% Coins				$0/Visit																															5000				0		1.9883				0																															1.9883	0	0.148732	14.7429	0.651752764	1.693019585	0	1.05777331	4.783875632	1.67492047	1.605315117	3.323760269	0	7.602640382	1.100092977	0.067050718	9.87089227	4.067811899	12.02101546	0.169752557	5.246007651	0	0	5.780052267	0	0	0	0	0	0	0	0	0	13.7913678	0	0	0	0	0	0	0	0	0	89.25
H2944_054_0	2010	5	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1111.736278	55.574076	550.793971	478.6974778	131.422708	11.293264	6.76612	398.90373	409.036392	663.180508	1244.071373	109.344561	0.270862	1079.952645	3369.359955	4267.277815	60.259578	1043.597419			23.349477	0							0.04	0.25	1370.803278	0.05	0.55	0.93	0.32	0.4						$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					197.25885	150.313725	58.254672	0	100	0.2	0.2	50	100.959119	0	75.927126	125	0.2	113.561078	15	35	35	62.455937			0.2	0							0	0	125	0	0	0	0	0					NO	147.482552	112.38356	23.904397	0	74.9624	0.149925	0.149925	37.4812	75.681378	0	56.916796	93.703	0.149925	85.12811	11.24436	26.23684	26.23684	46.818469			0.149925	0							0	0	93.703	0	0	0	0	0						13.6635	0.520467709	1.097199812	0	0.820980134	1.693142605	1.014410541	1.245949207	2.57970315	0	5.900713046	0.853826117	0.040608985	7.661193963	3.157191359	9.329990439	0.131751742	4.071636117	0	0	3.500670339	0	0	0	0	0	0	0	0	0	10.70403163	0	0	0	0	0	0	0	0	0	67.9869	0	23.967677	13.6635	0.520467709	1.097199812	0	0.820980134	1.693142605	1.014410541	1.245949207	2.57970315	0	5.900713046	0.853826117	0.040608985	7.661193963	3.157191359	9.329990439	0.131751742	4.071636117	0	0	3.500670339	0	0	0	0	0	0	0	0	0	10.70403163	0	0	0	0	0	0	0	0	0	67.9869	YES						20% Coins				$0/Visit																															3400						1.291				0																															1.291	0	0.091815	13.6635	0.520467709	1.097199812	0	0.820980134	2.984176605	1.014410541	1.245949207	2.57970315	0	5.900713046	0.853826117	0.040608985	7.661193963	3.157191359	9.329990439	0.131751742	4.071636117	0	0	3.500670339	0	0	0	0	0	0	0	0	0	10.70403163	0	0	0	0	0	0	0	0	0	69.278
H2944_055_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	841.409781	22.996995	661.930801	915.7372756	5.025686	14.053875	5.58159	383.984581	47.028684	11.604823	13.651437	4.154726	0.491699	16.43006	2953.303798	3149.013927	56.181667	2.403519			19.930977	0							0.04	0.25	166.166094	322.964374	0	0.05	0.55	2.76	438.70655	0.32	0.4			$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		197.25885	150.313725	58.254672	0	0.2	0.2	0.2	50	0.238101	0.25	0.247139	0.25	0.2	0.234039	15	35	35	0.25			0.2	0							0	0	0	13.631291	0	0	0	0	35	0	0		NO	166.993425	127.25109	26.987351	0	0.164255	0.164255	0.164255	41.0638	0.195546	0.205319	0.202969	0.205319	0.164255	0.192211	12.31914	28.74466	28.74466	0.205319			0.164255	0							0	0	0	11.195052	0	0	0	0	28.74466	0	0			11.7092	0.243866057	1.488646572	0	0.825494054	2.308419238	0.916804065	1.313988836	9.196271041	2.382690654	2.770818516	0.853044188	0.080764019	3.158038263	3.031846913	7.543111222	0.13457691	0.493488118	0	0	3.273762627	0	0	0	0	0	0	0	0	0	0	0.301300247	0	0	0	0	1.050872552	0	0	0	53.077	0	12.516405	11.7092	0.243866057	1.488646572	0	0.825494054	2.308419238	0.916804065	1.313988836	9.196271041	2.382690654	2.770818516	0.853044188	0.080764019	3.158038263	3.031846913	7.543111222	0.13457691	0.493488118	0	0	3.273762627	0	0	0	0	0	0	0	0	0	0	0.301300247	0	0	0	0	1.050872552	0	0	0	53.077	YES						20% Coins																									$0/Visit										3400						1.6274																									0										1.6274	0	0.093511	11.7092	0.243866057	1.488646572	0	0.825494054	3.935791238	0.916804065	1.313988836	9.196271041	2.382690654	2.770818516	0.853044188	0.080764019	3.158038263	3.031846913	7.543111222	0.13457691	0.493488118	0	0	3.273762627	0	0	0	0	0	0	0	0	0	0	0.301300247	0	0	0	0	1.050872552	0	0	0	54.7043
H2944_056_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	841.408893	22.996971	661.930103	915.7363067	93.176203	14.053861	5.581584	383.984175	396.445699	166.165918	921.757486	59.252476	0.491699	677.690696	2953.30068	3149.010603	56.181608	750.891127			19.930955	0							0.04	0.25	1510.333625	0.05	0.55	2.76	0.32	0.4						$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					197.25885	150.313725	58.254672	0	100	0.2	0.2	50	102.506779	0	84.19337	125	0.2	112.592647	15	35	35	72.417746			0.2	0							0	0	125	0	0	0	0	0					NO	159.100112	121.236286	24.808276	0	78.5982	0.157196	0.157196	39.2991	80.568483	0	66.174473	98.24775	0.157196	88.495794	11.78973	27.50937	27.50937	56.919045			0.157196	0							0	0	98.24775	0	0	0	0	0						11.1557	0.232338946	1.368445391	0	0.610290153	2.209210734	0.877402678	1.257519374	2.66175238	0	5.083067989	0.485118537	0.077293116	4.997731352	2.901551469	7.218941484	0.128793387	3.561667154	0	0	3.133066402	0	0	0	0	0	0	0	0	0	12.36557337	0	0	0	0	0	0	0	0	0	60.3255	0	17.528992	11.1557	0.232338946	1.368445391	0	0.610290153	2.209210734	0.877402678	1.257519374	2.66175238	0	5.083067989	0.485118537	0.077293116	4.997731352	2.901551469	7.218941484	0.128793387	3.561667154	0	0	3.133066402	0	0	0	0	0	0	0	0	0	12.36557337	0	0	0	0	0	0	0	0	0	60.3255	YES						20% Coins				$0/Visit																															3400						1.6274				0																															1.6274	0	0.093511	11.1557	0.232338946	1.368445391	0	0.610290153	3.836580734	0.877402678	1.257519374	2.66175238	0	5.083067989	0.485118537	0.077293116	4.997731352	2.901551469	7.218941484	0.128793387	3.561667154	0	0	3.133066402	0	0	0	0	0	0	0	0	0	12.36557337	0	0	0	0	0	0	0	0	0	61.9528
H2944_057_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	790.8620805	21.6154507	731.959179	455.677597	5.981634	16.727096	6.643277	424.607886	49.81696502	11.0497632	13.64841324	3.9560056	0.585227	16.81752446	3265.745935	3482.161041	62.125356	2.63184216			23.722094	0							0.04	0.25	183.745487	357.132102	0	0.05	0.55	2.76	485.119118	0.32	0.4			$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		197.25885	150.313725	58.254672	0	0.2	0.2	0.2	50	0.238101	0.25	0.247139	0.25	0.2	0.234039	15	35	35	0.25			0.2	0							0	0	0	13.631291	0	0	0	0	35	0	0		NO	159.554202	121.582309	23.733361	0	0.158503	0.158503	0.158503	39.62575	0.188698	0.198129	0.195861	0.198129	0.158503	0.18548	11.887725	27.738025	27.738025	0.198129			0.158503	0							0	0	0	10.803003	0	0	0	0	27.738025	0	0			10.5154	0.219004701	1.447654286	0	0.948106934	2.651294897	1.052979334	1.402117162	9.400361665	2.189278533	2.673191866	0.783799434	0.092760235	3.119314437	3.2351908	8.049022501	0.14360289	0.521444255	0	0	3.760023065	0	0	0	0	0	0	0	0	0	0	0.321508264	0	0	0	0	1.121353852	0	0	0	53.6475	0	15.5	10.5154	0.219004701	1.447654286	0	0.948106934	2.651294897	1.052979334	1.402117162	9.400361665	2.189278533	2.673191866	0.783799434	0.092760235	3.119314437	3.2351908	8.049022501	0.14360289	0.521444255	0	0	3.760023065	0	0	0	0	0	0	0	0	0	0	0.321508264	0	0	0	0	1.121353852	0	0	0	53.6475	YES	$225/Day(Days 1-15)	$225/Day(Days 1-8):1b		$0/Visit		20% Coins			"9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Lab -- OP	"14h. 25% DMAM -- OP,14h. $0 SMAM -- OP,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins: Observation9a		"9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP"				25% Coins: Therapy (PT/OT/ST) -- OP7i													$0/Visit										3400	1.8555	0.039		0		1.9181			1.1616	0.548	0.5088	0.196		0.5082				0.0456													0										6.7808	0	1.35	12.3709	0.258004701	1.447654286	0	0.948106934	4.569371897	1.052979334	1.402117162	10.56196167	2.737278533	3.181991866	0.979799434	0.092760235	3.627514437	3.2351908	8.049022501	0.14360289	0.567044255	0	0	3.760023065	0	0	0	0	0	0	0	0	0	0	0.321508264	0	0	0	0	1.121353852	0	0	0	60.4282
H2944_058_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	790.8620805	21.6154507	731.959179	455.677597	103.033805	16.727096	6.643277	424.607886	390.1651233	183.745487	856.1910605	52.4168864	0.585227	644.4729645	3265.745935	3482.161041	62.125356	763.9053112			23.722094	0							0.04	0.25	1670.119785	0.05	0.55	2.76	0.32	0.4						$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					197.25885	150.313725	58.254672	0	100	0.2	0.2	50	102.506779	0	84.19337	125	0.2	112.592647	15	35	35	72.417746			0.2	0							0	0	125	0	0	0	0	0					NO	152.230178	116.00131	22.010771	0	76.1176	0.152235	0.152235	38.0588	78.0257	0	64.085973	95.147	0.152235	85.702821	11.41764	26.64116	26.64116	55.12265			0.152235	0							0	0	95.147	0	0	0	0	0						10.0328	0.208951716	1.342582156	0	0.653557163	2.54644946	1.011339274	1.346672218	2.536908905	0	4.572486432	0.415609124	0.089092032	4.602762593	3.107259285	7.73073412	0.137924296	3.509040425	0	0	3.61133298	0	0	0	0	0	0	0	0	0	13.2422406	0	0	0	0	0	0	0	0	0	60.6977	0	20.65	10.0328	0.208951716	1.342582156	0	0.653557163	2.54644946	1.011339274	1.346672218	2.536908905	0	4.572486432	0.415609124	0.089092032	4.602762593	3.107259285	7.73073412	0.137924296	3.509040425	0	0	3.61133298	0	0	0	0	0	0	0	0	0	13.2422406	0	0	0	0	0	0	0	0	0	60.6977	YES	$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b		$0/Visit		20% Coins			"9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit	"14h. $125 DMAM -- OP,14h. $0 SMAM -- OP,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a		"9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,7h. $125 Psych -- OP"				"7i. $125 Therapy (AT,PT,ST,OT) -- OP"													$125/Visit Lab -- OP										3400	1.77	0.0375		0		1.9181			0.3135	0	0.8704	0.104		0.749				0.3048																							6.0673	0	1.4	11.8028	0.246451716	1.342582156	0	0.653557163	4.46452646	1.011339274	1.346672218	2.850408905	0	5.442886432	0.519609124	0.089092032	5.351762593	3.107259285	7.73073412	0.137924296	3.813840425	0	0	3.61133298	0	0	0	0	0	0	0	0	0	13.2422406	0	0	0	0	0	0	0	0	0	66.765
H2944_059_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1179.093226	58.941152	584.165016	507.7004022	7.929487	12.917266	7.739107	423.072176	53.813041	13.030882	20.86054	6.707224	0.309813	24.079336	3573.499918	4525.820075	63.910535	2.660128			26.707198	0							0.04	0.25	703.360734	452.302382	0	0.05	0.55	1.67	769.171072	0.32	0.4			$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		197.25885	150.313725	58.254672	0	0.2	0.2	0.2	50	0.23702	0.25	0.236326	0.25	0.2	0.234541	15	35	35	0.25			0.2	0							0	0	0	17.038033	0	0	0	0	35	0	0		NO	150.495681	114.679602	24.046189	0	0.153067	0.153067	0.153067	38.26675	0.1814	0.191334	0.180869	0.191334	0.153067	0.179502	11.480025	26.786725	26.786725	0.191334			0.153067	0							0	0	0	13.039803	0	0	0	0	26.786725	0	0			14.7874	0.563278988	1.170578532	0	1.213742787	1.977207155	1.184601891	1.349133099	9.761685637	2.493250777	3.773025009	1.283319997	0.047422146	4.322288971	3.4186557	10.10265815	0.142662827	0.508972931	0	0	4.087990676	0	0	0	0	0	0	0	0	0	0	0.491494496	0	0	0	0	1.716964499	0	0	0	64.3963	0	21.114484	14.7874	0.563278988	1.170578532	0	1.213742787	1.977207155	1.184601891	1.349133099	9.761685637	2.493250777	3.773025009	1.283319997	0.047422146	4.322288971	3.4186557	10.10265815	0.142662827	0.508972931	0	0	4.087990676	0	0	0	0	0	0	0	0	0	0	0.491494496	0	0	0	0	1.716964499	0	0	0	64.3963	YES						20% Coins																									$0/Visit										3400						1.4617																									0										1.4617	0	0.12001	14.7874	0.563278988	1.170578532	0	1.213742787	3.438903155	1.184601891	1.349133099	9.761685637	2.493250777	3.773025009	1.283319997	0.047422146	4.322288971	3.4186557	10.10265815	0.142662827	0.508972931	0	0	4.087990676	0	0	0	0	0	0	0	0	0	0	0.491494496	0	0	0	0	1.716964499	0	0	0	65.858
H2944_060_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1179.093226	58.941152	584.165016	507.7004022	139.385237	12.917266	7.739107	423.072176	433.818747	703.360734	1319.446127	115.969438	0.309813	1145.383913	3573.499918	4525.820075	63.910535	1106.826026			26.707198	0							0.04	0.25	1453.856361	0.05	0.55	1.67	0.32	0.4						$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					197.25885	150.313725	58.254672	0	100	0.2	0.2	50	100.959119	0	75.927126	125	0.2	113.561078	15	35	35	62.455937			0.2	0							0	0	125	0	0	0	0	0					NO	142.520308	108.602268	22.243323	0	73.3294	0.146659	0.146659	36.6647	74.032716	0	55.676906	91.66175	0.146659	83.273657	10.99941	25.66529	25.66529	45.798564			0.146659	0							0	0	91.66175	0	0	0	0	0						14.0037	0.533428565	1.082814261	0	0.851752983	1.894433314	1.135009694	1.292651201	2.676398341	0	6.121889832	0.885830136	0.045436865	7.948358925	3.275532561	9.679707059	0.136690201	4.224253549	0	0	3.916850951	0	0	0	0	0	0	0	0	0	11.10525152	0	0	0	0	0	0	0	0	0	70.81	0	27.409553	14.0037	0.533428565	1.082814261	0	0.851752983	1.894433314	1.135009694	1.292651201	2.676398341	0	6.121889832	0.885830136	0.045436865	7.948358925	3.275532561	9.679707059	0.136690201	4.224253549	0	0	3.916850951	0	0	0	0	0	0	0	0	0	11.10525152	0	0	0	0	0	0	0	0	0	70.81	YES						20% Coins				$0/Visit																															3400						1.4617				0																															1.4617	0	0.12001	14.0037	0.533428565	1.082814261	0	0.851752983	3.356129314	1.135009694	1.292651201	2.676398341	0	6.121889832	0.885830136	0.045436865	7.948358925	3.275532561	9.679707059	0.136690201	4.224253549	0	0	3.916850951	0	0	0	0	0	0	0	0	0	11.10525152	0	0	0	0	0	0	0	0	0	72.2717
H2944_061_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1068.696335	53.422572	529.470442	460.1651044	6.888644	11.221716	6.723253	383.460505	46.749414	11.320418	18.122339	5.826818	0.269146	20.918625	3238.917995	4102.073715	57.926679	2.310954			23.201548	0							0.04	0.25	637.506028	409.953927	0	0.05	0.55	1.67	697.154633	0.32	0.4			$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		197.25885	150.313725	58.254672	0	0.2	0.2	0.2	50	0.23702	0.25	0.236326	0.25	0.2	0.234541	15	35	35	0.25			0.2	0							0	0	0	17.038033	0	0	0	0	35	0	0		NO	158.601244	120.856143	27.081781	0	0.158561	0.158561	0.158561	39.64035	0.187912	0.198202	0.187361	0.198202	0.158561	0.185946	11.892105	27.748245	27.748245	0.198202			0.158561	0							0	0	0	13.507872	0	0	0	0	27.748245	0	0			14.1247	0.538037167	1.19491688	0	1.092270281	1.779326511	1.066045719	1.266709052	8.784775884	2.243729488	3.395419557	1.154886981	0.042676059	3.889734644	3.209796074	9.485445538	0.133946973	0.458035705	0	0	3.678860652	0	0	0	0	0	0	0	0	0	0	0.461467098	0	0	0	0	1.61206813	0	0	0	59.6129	0	16.384364	14.1247	0.538037167	1.19491688	0	1.092270281	1.779326511	1.066045719	1.266709052	8.784775884	2.243729488	3.395419557	1.154886981	0.042676059	3.889734644	3.209796074	9.485445538	0.133946973	0.458035705	0	0	3.678860652	0	0	0	0	0	0	0	0	0	0	0.461467098	0	0	0	0	1.61206813	0	0	0	59.6129	YES						20% Coins																									$0/Visit										3400						1.2834																									0										1.2834	0	0.090675	14.1247	0.538037167	1.19491688	0	1.092270281	3.062739511	1.066045719	1.266709052	8.784775884	2.243729488	3.395419557	1.154886981	0.042676059	3.889734644	3.209796074	9.485445538	0.133946973	0.458035705	0	0	3.678860652	0	0	0	0	0	0	0	0	0	0	0.461467098	0	0	0	0	1.61206813	0	0	0	60.8963
H2944_062_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1068.696335	53.422572	529.470442	460.1651044	126.334787	11.221716	6.723253	383.460505	393.200889	637.506028	1195.908186	105.111378	0.269146	1038.14318	3238.917995	4102.073715	57.926679	1003.195415			23.201548	0							0.04	0.25	1317.733773	0.05	0.55	1.67	0.32	0.4						$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					197.25885	150.313725	58.254672	0	100	0.2	0.2	50	100.959119	0	75.927126	125	0.2	113.561078	15	35	35	62.455937			0.2	0							0	0	125	0	0	0	0	0					NO	150.300986	114.531242	24.946631	0	75.8664	0.151733	0.151733	37.9332	76.594049	0	57.603177	94.833	0.151733	86.154702	11.37996	26.55324	26.55324	47.383071			0.151733	0							0	0	94.833	0	0	0	0	0						13.3855	0.50987946	1.100708645	0	0.79871379	1.702704634	1.020139347	1.212157002	2.509737347	0	5.740675909	0.830668942	0.04083833	7.453409692	3.071563102	9.076945654	0.128178417	3.961206631	0	0	3.520440483	0	0	0	0	0	0	0	0	0	10.41372057	0	0	0	0	0	0	0	0	0	66.4772	0	22.187382	13.3855	0.50987946	1.100708645	0	0.79871379	1.702704634	1.020139347	1.212157002	2.509737347	0	5.740675909	0.830668942	0.04083833	7.453409692	3.071563102	9.076945654	0.128178417	3.961206631	0	0	3.520440483	0	0	0	0	0	0	0	0	0	10.41372057	0	0	0	0	0	0	0	0	0	66.4772	YES						20% Coins				$0/Visit																															3400						1.2834				0																															1.2834	0	0.090675	13.3855	0.50987946	1.100708645	0	0.79871379	2.986117634	1.020139347	1.212157002	2.509737347	0	5.740675909	0.830668942	0.04083833	7.453409692	3.071563102	9.076945654	0.128178417	3.961206631	0	0	3.520440483	0	0	0	0	0	0	0	0	0	10.41372057	0	0	0	0	0	0	0	0	0	67.7606
H2944_063_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1159.449455	57.959188	574.432788	224.658936	7.353023	11.978195	7.176481	416.023765	49.90089	12.083551	19.344004	6.219616	0.287289	22.328794	3513.965174	4450.419615	62.845782	2.46674			24.765614	0							0.04	0.25	691.642698	444.766995	0	0.05	0.55	1.67	756.356631	0.32	0.4			$225/Day(Days 1-15):1a	$225/Day(Days 1-15):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		197.25885	189.52335	58.254672	0	0.2	0.2	0.2	50	0.23702	0.25	0.236326	0.25	0.2	0.234541	15	35	35	0.25			0.2	0							0	0	0	17.038033	0	0	0	0	35	0	0		NO	152.905	146.908835	24.793188	0	0.154933	0.154933	0.154933	38.7333	0.183612	0.193667	0.183074	0.193667	0.154933	0.181691	11.61999	27.11331	27.11331	0.193667			0.154933	0							0	0	0	13.198785	0	0	0	0	27.11331	0	0			14.7738	0.709559732	1.186835009	0	1.139225912	1.855817686	1.111873731	1.342831108	9.162402215	2.340185072	3.541384188	1.204534372	0.044510547	4.056940911	3.402686682	10.05546722	0.141996431	0.477726136	0	0	3.837010874	0	0	0	0	0	0	0	0	0	0	0.489198662	0	0	0	0	1.708944317	0	0	0	62.5829	0	19.448151	14.7738	0.709559732	1.186835009	0	1.139225912	1.855817686	1.111873731	1.342831108	9.162402215	2.340185072	3.541384188	1.204534372	0.044510547	4.056940911	3.402686682	10.05546722	0.141996431	0.477726136	0	0	3.837010874	0	0	0	0	0	0	0	0	0	0	0.489198662	0	0	0	0	1.708944317	0	0	0	62.5829	YES				$0/Visit		20% Coins																									$0/Visit										3400				0		1.3637																									0										1.3637	0	0.103021	14.7738	0.709559732	1.186835009	0	1.139225912	3.219514686	1.111873731	1.342831108	9.162402215	2.340185072	3.541384188	1.204534372	0.044510547	4.056940911	3.402686682	10.05546722	0.141996431	0.477726136	0	0	3.837010874	0	0	0	0	0	0	0	0	0	0	0.489198662	0	0	0	0	1.708944317	0	0	0	63.9466
H2944_064_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1159.447129	57.959072	574.431636	224.658485	137.062795	11.978171	7.176468	416.022931	426.590442	691.64131	1297.461464	114.037151	0.287289	1126.299481	3513.958125	4450.410687	62.845656	1088.384049			24.765563	0							0.04	0.25	1429.63215	0.05	0.55	1.67	0.32	0.4						$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					197.25885	150.313725	58.254672	0	100	0.2	0.2	50	100.959119	0	75.927126	125	0.2	113.561078	15	35	35	62.455937			0.2	0							0	0	125	0	0	0	0	0					NO	144.152033	109.845663	22.756896	0	73.8829	0.147766	0.147766	36.94145	74.591525	0	56.097162	92.353625	0.147766	83.902218	11.082435	25.859015	25.859015	46.144258			0.147766	0							0	0	92.353625	0	0	0	0	0						13.9281	0.530546058	1.08935675	0	0.843883065	1.769966416	1.06043797	1.280707525	2.651669302	0	6.065325495	0.877645357	0.042451546	7.874918716	3.245267709	9.590269726	0.13542723	4.185222863	0	0	3.659508182	0	0	0	0	0	0	0	0	0	11.00264262	0	0	0	0	0	0	0	0	0	69.8333	0	26.21542	13.9281	0.530546058	1.08935675	0	0.843883065	1.769966416	1.06043797	1.280707525	2.651669302	0	6.065325495	0.877645357	0.042451546	7.874918716	3.245267709	9.590269726	0.13542723	4.185222863	0	0	3.659508182	0	0	0	0	0	0	0	0	0	11.00264262	0	0	0	0	0	0	0	0	0	69.8333	YES				$0/Visit		20% Coins				$0/Visit																															3400				0		1.3637				0																															1.3637	0	0.103021	13.9281	0.530546058	1.08935675	0	0.843883065	3.133660416	1.06043797	1.280707525	2.651669302	0	6.065325495	0.877645357	0.042451546	7.874918716	3.245267709	9.590269726	0.13542723	4.185222863	0	0	3.659508182	0	0	0	0	0	0	0	0	0	11.00264262	0	0	0	0	0	0	0	0	0	71.197
H2944_065_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1139.497971	44.446586	831.890948	224.4136844	6.110767	5.891133	4.314214	349.93819	54.107438	16.140748	19.798093	4.224377	0.407243	25.570042	2755.371745	3668.08834	104.261118	3.710704			26.351074	0							0.04	0.25	572.470058	361.175956	0	0.05	0.55	3.45	450.944935	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	0.2	0.2	0.2	50	0.244888	0.25	0.247882	0.25	0.2	0.234725	15	35	35	0.25			0.2	0							0	0	0	19.829554	0	0	0	0	35	0	0		NO	147.796061	130.705385	35.703949	0	0.178999	0.178999	0.178999	44.74965	0.219173	0.223748	0.221852	0.223748	0.178999	0.210078	13.424895	31.324755	31.324755	0.223748			0.178999	0							0	0	0	17.747312	0	0	0	0	31.324755	0	0			14.0344	0.484117345	2.475149332	0	1.093821182	1.054506916	0.772239992	1.304967627	11.85888951	3.611460084	4.392246528	0.945195905	0.07289609	5.371703283	3.08254803	9.575164047	0.272162831	0.830262599	0	0	4.716815895	0	0	0	0	0	0	0	0	0	0	0.534158532	0	0	0	0	1.177144967	0	0	0	67.6599	0	8.064791	14.0344	0.484117345	2.475149332	0	1.093821182	1.054506916	0.772239992	1.304967627	11.85888951	3.611460084	4.392246528	0.945195905	0.07289609	5.371703283	3.08254803	9.575164047	0.272162831	0.830262599	0	0	4.716815895	0	0	0	0	0	0	0	0	0	0	0.534158532	0	0	0	0	1.177144967	0	0	0	67.6599	YES						20% Coins																									$0/Visit										6000						0.6945																									0										0.6945	0	0.026823	14.0344	0.484117345	2.475149332	0	1.093821182	1.749046916	0.772239992	1.304967627	11.85888951	3.611460084	4.392246528	0.945195905	0.07289609	5.371703283	3.08254803	9.575164047	0.272162831	0.830262599	0	0	4.716815895	0	0	0	0	0	0	0	0	0	0	0.534158532	0	0	0	0	1.177144967	0	0	0	68.3544
H2944_066_0	2010	6	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	O	O	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	NO	1223.089664	47.707114	892.917097	240.8763044	142.064829	6.323296	4.630697	375.609079	437.109106	614.465518	1069.361483	81.978653	0.437117	1295.385615	2957.501275	3937.173255	111.909542	1049.026385			28.284146	0							0.04	0.25	1771.839823	0.05	0.55	3.45	0.32	0.4						$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	$0/Visit:8a	"$0-$125/Visit:14h. $125 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $125 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$50-$125/Visit:9d. $125 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $125 OP Other,5. $50 Partial Hospitalization,7h. $125 Psych -- OP,8b. $125 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$125/Visit:7i. $125 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$125/Visit:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	50.7565	0	100	0.2	0.2	50	115.047203	0	83.564618	125	0.2	114.794841	15	35	35	83.473593			0.2	0							0	0	125	0	0	0	0	0					NO	143.013656	126.476002	31.78372	0	85.9536	0.171907	0.171907	42.9768	98.887212	0	71.826798	107.442	0.171907	98.670298	12.89304	30.08376	30.08376	71.748559			0.171907	0							0	0	107.442	0	0	0	0	0						14.5765	0.502817087	2.365018916	0	1.017581957	1.087018845	0.796049229	1.345206356	3.602041736	0	6.400734269	0.73399587	0.075143472	10.65134039	3.17759852	9.870414607	0.280554984	6.272177623	0	0	4.862242686	0	0	0	0	0	0	0	0	0	15.86416786	0	0	0	0	0	0	0	0	0	83.4806	0	13.863312	14.5765	0.502817087	2.365018916	0	1.017581957	1.087018845	0.796049229	1.345206356	3.602041736	0	6.400734269	0.73399587	0.075143472	10.65134039	3.17759852	9.870414607	0.280554984	6.272177623	0	0	4.862242686	0	0	0	0	0	0	0	0	0	15.86416786	0	0	0	0	0	0	0	0	0	83.4806	YES						20% Coins				$0/Visit																															6000						0.7444				0																															0.7444	0	0.029844	14.5765	0.502817087	2.365018916	0	1.017581957	1.831455845	0.796049229	1.345206356	3.602041736	0	6.400734269	0.73399587	0.075143472	10.65134039	3.17759852	9.870414607	0.280554984	6.272177623	0	0	4.862242686	0	0	0	0	0	0	0	0	0	15.86416786	0	0	0	0	0	0	0	0	0	84.2251
H2944_067_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1113.3928	43.428343	812.832858	219.2725111	5.969469	5.754913	4.214457	341.921329	52.856326	15.76753	19.340308	4.126698	0.397827	24.978793	2692.247938	3584.054778	101.872563	3.624902			25.741766	0							0.04	0.25	559.355135	352.901645	0	0.05	0.55	3.45	440.614075	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	0.2	0.2	0.2	50	0.244888	0.25	0.247882	0.25	0.2	0.234725	15	35	35	0.25			0.2	0							0	0	0	19.829554	0	0	0	0	35	0	0		NO	148.224229	131.084041	36.281	0	0.179589	0.179589	0.179589	44.8972	0.219896	0.224486	0.222584	0.224486	0.179589	0.21077	13.46916	31.42804	31.42804	0.224486			0.179589	0							0	0	0	17.805829	0	0	0	0	31.42804	0	0			13.7526	0.474396891	2.45753241	0	1.072050968	1.033519071	0.756870118	1.279275858	11.62289466	3.53958974	4.304843116	0.926385927	0.071445353	5.264780201	3.021859853	9.38665141	0.266804582	0.81373975	0	0	4.622938014	0	0	0	0	0	0	0	0	0	0	0.523642195	0	0	0	0	1.153969731	0	0	0	66.3458	0	7.635769	13.7526	0.474396891	2.45753241	0	1.072050968	1.033519071	0.756870118	1.279275858	11.62289466	3.53958974	4.304843116	0.926385927	0.071445353	5.264780201	3.021859853	9.38665141	0.266804582	0.81373975	0	0	4.622938014	0	0	0	0	0	0	0	0	0	0	0.523642195	0	0	0	0	1.153969731	0	0	0	66.3458	YES						20% Coins																									$0/Visit										6000						0.6788																									0										0.6788	0	0.025921	13.7526	0.474396891	2.45753241	0	1.072050968	1.712281071	0.756870118	1.279275858	11.62289466	3.53958974	4.304843116	0.926385927	0.071445353	5.264780201	3.021859853	9.38665141	0.266804582	0.81373975	0	0	4.622938014	0	0	0	0	0	0	0	0	0	0	0.523642195	0	0	0	0	1.153969731	0	0	0	67.0246
H2944_069_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1003.431122	39.1392428	861.829753	104.620535	5.988873	5.773619	4.228157	362.532065	44.54363508	12.6550264	16.4926979	3.3120896	0.399119	21.55158882	2854.534428	3800.098651	108.013357	3.23664965			25.825438	0							0.04	0.25	593.072602	318.0481261	0	0.05	0.55	3.45	467.173929	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. 20% Surgery ASC -- Facility,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,8b. 20% Advanced Imaging -- FSR,9a. 25% Advanced Imaging -- OP,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8a. $0 Radiology OP -- Physician,"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	0.2	0.2	0.2	50	0.244888	0.25	0.247882	0.25	0.2	0.234725	15	35	35	0.25			0.2	0							0	0	0	19.829554	0	0	0	0	35	0	0		NO	147.565069	130.501104	35.11086	0	0.178821	0.178821	0.178821	44.7052	0.218955	0.223526	0.221632	0.223526	0.178821	0.209869	13.41156	31.29364	31.29364	0.223526			0.178821	0							0	0	0	17.729684	0	0	0	0	31.29364	0	0			12.3393	0.425642866	2.521631983	0	1.070936259	1.032444323	0.756083263	1.350589039	9.753051619	2.828727431	3.655309621	0.74033814	0.071370859	4.523010394	3.190313313	9.909909929	0.281677592	0.72347535	0	0	4.618130649	0	0	0	0	0	0	0	0	0	0	0.469907731	0	0	0	0	1.218297729	0	0	0	61.4801	0	8.243482	12.3393	0.425642866	2.521631983	0	1.070936259	1.032444323	0.756083263	1.350589039	9.753051619	2.828727431	3.655309621	0.74033814	0.071370859	4.523010394	3.190313313	9.909909929	0.281677592	0.72347535	0	0	4.618130649	0	0	0	0	0	0	0	0	0	0	0.469907731	0	0	0	0	1.218297729	0	0	0	61.4801	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)		$0/Visit		20% Coins			25% Coins:9a. 25% Surgery OP -- Facility	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,9a. 25% Advanced Imaging -- OP,8a. 25% Radiology OP -- Facility"	25% Coins:9a		"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,7h. 25% Psych -- OP,"				25% Coins:7i													$0/Visit	"$0-$35/Visit:14h. $0 SMAM -- OP,8b. $35 Advanced Imaging -- Office,8a. $0 Radiology OP -- Physician,"	"$0/Visit:9a, 9b"								6000	2.178	0.075		0		0.6809			1.8576	0.708	0.645	0.186		0.7364				0.0891													0	0.0825	0								7.2385	0	0.026046	14.5173	0.500642866	2.521631983	0	1.070936259	1.713372323	0.756083263	1.350589039	11.61065162	3.536727431	4.300309621	0.92633814	0.071370859	5.259410394	3.190313313	9.909909929	0.281677592	0.81257535	0	0	4.618130649	0	0	0	0	0	0	0	0	0	0	0.552407731	0	0	0	0	1.218297729	0	0	0	68.7187
H2944_070_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1212.054747	47.276693	884.861051	238.7030778	7.357169	7.092736	5.194175	372.220271	65.143628	19.432946	23.836272	5.086015	0.490308	30.785513	2930.818209	3901.651425	110.899876	4.467569			31.725851	0							0.04	0.25	608.921708	384.173595	0	0.05	0.55	3.45	479.658554	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	0.2	0.2	0.2	50	0.244888	0.25	0.247882	0.25	0.2	0.234725	15	35	35	0.25			0.2	0							0	0	0	19.829554	0	0	0	0	35	0	0		NO	145.486936	128.66328	33.399807	0	0.175581	0.175581	0.175581	43.8952	0.214988	0.219476	0.217616	0.219476	0.175581	0.206066	13.16856	30.72664	30.72664	0.219476			0.175581	0							0	0	0	17.408445	0	0	0	0	30.72664	0	0			14.6948	0.506897866	2.462849027	0	1.29177909	1.24534968	0.911998441	1.361556937	14.0050983	4.265065256	5.187154168	1.116258228	0.086088769	6.343847522	3.216221286	9.990386562	0.283965047	0.980524174	0	0	5.570456644	0	0	0	0	0	0	0	0	0	0	0.557322075	0	0	0	0	1.228191309	0	0	0	75.3059	0	10.683021	14.6948	0.506897866	2.462849027	0	1.29177909	1.24534968	0.911998441	1.361556937	14.0050983	4.265065256	5.187154168	1.116258228	0.086088769	6.343847522	3.216221286	9.990386562	0.283965047	0.980524174	0	0	5.570456644	0	0	0	0	0	0	0	0	0	0	0.557322075	0	0	0	0	1.228191309	0	0	0	75.3059	YES						20% Coins																									$0/Visit										6000						0.8329																									0										0.8329	0	0.03559	14.6948	0.506897866	2.462849027	0	1.29177909	2.07825768	0.911998441	1.361556937	14.0050983	4.265065256	5.187154168	1.116258228	0.086088769	6.343847522	3.216221286	9.990386562	0.283965047	0.980524174	0	0	5.570456644	0	0	0	0	0	0	0	0	0	0	0.557322075	0	0	0	0	1.228191309	0	0	0	76.1388
H2944_071_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1029.46573	51.461491	510.034195	443.2729778	7.083139	11.538551	6.913078	369.384114	48.069346	11.640041	18.634006	5.991334	0.276746	21.509245	3120.021064	3951.491336	55.800258	2.376202			23.856626	0							0.04	0.25	614.103919	394.904993	0	0.05	0.55	1.3	671.562894	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.23702	0.25	0.236326	0.25	0.2	0.234541	15	35	35	0.25			0.2	0							0	0	0	17.038033	0	0	0	0	35	0	0		NO	145.576951	128.742886	41.001153	0	0.175266	0.175266	0.175266	43.8165	0.207708	0.219083	0.2071	0.219083	0.175266	0.205535	13.14495	30.67155	30.67155	0.219083			0.175266	0							0	0	0	14.93094	0	0	0	0	30.67155	0	0			12.4889	0.552108406	1.742665839	0	1.24143344	2.02231568	1.211627529	1.348759919	9.984387719	2.550135102	3.859102643	1.312599427	0.048504164	4.420902671	3.417710074	10.09986367	0.142623367	0.520585463	0	0	4.181255413	0	0	0	0	0	0	0	0	0	0	0.491358563	0	0	0	0	1.716489573	0	0	0	63.3533	0	8.768315	12.4889	0.552108406	1.742665839	0	1.24143344	2.02231568	1.211627529	1.348759919	9.984387719	2.550135102	3.859102643	1.312599427	0.048504164	4.420902671	3.417710074	10.09986367	0.142623367	0.520585463	0	0	4.181255413	0	0	0	0	0	0	0	0	0	0	0.491358563	0	0	0	0	1.716489573	0	0	0	63.3533	YES						20% Coins																									$0/Visit										5000						1.3443																									0										1.3443	0	0.068606	12.4889	0.552108406	1.742665839	0	1.24143344	3.36659368	1.211627529	1.348759919	9.984387719	2.550135102	3.859102643	1.312599427	0.048504164	4.420902671	3.417710074	10.09986367	0.142623367	0.520585463	0	0	4.181255413	0	0	0	0	0	0	0	0	0	0	0.491358563	0	0	0	0	1.716489573	0	0	0	64.6976
H2944_072_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Lab	Radiology				Therapy (PT/OT/ST)					D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	O	O	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	NO	1386.03547	69.781153	731.3206	248.88391	7.907667	10.918471	8.913968	430.308334	49.268782	12.230859	18.311956	5.708228	0.427909	23.441503	3719.176383	3864.996036	100.551335	2.838317			24.504813	0							0.04	0.25	462.043083	390.129901	0	0.05	0.55	442.665755	0.32	0.4	2.43			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Fitness Program		158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.241162	0.25	0.24298	0.25	0.2	0.231563	15	35	35	0.25			0.2	0							0	0	0	17.555124	0	0	0	35	0	0	0		NO	141.510224	125.146423	33.813051	0	0.171759	0.171759	0.171759	42.9398	0.207109	0.214699	0.208671	0.214699	0.171759	0.198865	12.88194	30.05786	30.05786	0.214699			0.171759	0							0	0	0	15.07627	0	0	0	30.05786	0	0	0			16.3448	0.727738474	2.060681729	0	1.358212976	1.87534566	1.53105423	1.539779483	10.20400817	2.625953196	3.82117417	1.225550843	0.073497222	4.661694494	3.992517251	9.681125813	0.251863163	0.609383822	0	0	4.208922176	0	0	0	0	0	0	0	0	0	0	0.490141977	0	0	0	1.108798774	0	0	0	0	68.3923	0	11.669553	16.3448	0.727738474	2.060681729	0	1.358212976	1.87534566	1.53105423	1.539779483	10.20400817	2.625953196	3.82117417	1.225550843	0.073497222	4.661694494	3.992517251	9.681125813	0.251863163	0.609383822	0	0	4.208922176	0	0	0	0	0	0	0	0	0	0	0.490141977	0	0	0	1.108798774	0	0	0	0	68.3923	YES						20% Coins																									$0/Visit										5000						1.279																									0										1.279	0	0.057979	16.3448	0.727738474	2.060681729	0	1.358212976	3.15432266	1.53105423	1.539779483	10.20400817	2.625953196	3.82117417	1.225550843	0.073497222	4.661694494	3.992517251	9.681125813	0.251863163	0.609383822	0	0	4.208922176	0	0	0	0	0	0	0	0	0	0	0.490141977	0	0	0	1.108798774	0	0	0	0	69.6713
H2944_073_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	273.242343	4.273088	897.759397	9.053309	8.107798	10.661683	9.668521	462.305279	65.705467	1.265949	28.163375	4.9777	0.451417	23.761076	35.877996	54.795307	0.879909	5.574331			24.892847	0							0.04	0.25	13.106121	191.500512	0.05	0.55	2.43	0.32	0.4					7% Coins:1a	7% Coins:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.064786	0.064786	27.049264	0	0.170419	0.170419	0.170419	42.60465	0.170419	0	0.170419	0.170419	0.170419	0.170419	0.170419	0.170419	0.170419	0.170419			0.170419	0							0	0	0.170419	0	0	0	0	0	0					17.7023	0.276836279	2.023644245	0	1.381722827	1.816953355	1.64769968	1.641362884	11.19745998	0	4.799574204	0.848294656	0.076930034	4.049338811	6.1142922	9.338161424	0.149953212	0.949971915	0	0	4.242214093	0	0	0	0	0	0	0	0	0	2.233532035	0	0	0	0	0	0	0	0	0	70.4902	0	12.711239	17.7023	0.276836279	2.023644245	0	1.381722827	1.816953355	1.64769968	1.641362884	11.19745998	0	4.799574204	0.848294656	0.076930034	4.049338811	6.1142922	9.338161424	0.149953212	0.949971915	0	0	4.242214093	0	0	0	0	0	0	0	0	0	2.233532035	0	0	0	0	0	0	0	0	0	70.4902	YES				$0/Visit		20% Coins				$0/Visit																															5000				0		1.2498				0																															1.2498	0	0.055752	17.7023	0.276836279	2.023644245	0	1.381722827	3.066714355	1.64769968	1.641362884	11.19745998	0	4.799574204	0.848294656	0.076930034	4.049338811	6.1142922	9.338161424	0.149953212	0.949971915	0	0	4.242214093	0	0	0	0	0	0	0	0	0	2.233532035	0	0	0	0	0	0	0	0	0	71.74
H2944_074_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1447.645591	73.318898	728.97284	178.852751	187.930686	8.16868	7.986163	377.010285	43.341946	17.434099	18.586325	2.565039	0.627302	25.230622	4105.776269	3663.119285	107.464649	3.088549			19.339885	0							0.04	0.25	401.267022	358.838312	0	0.05	0.55	2.68	560.243319	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.237603	0.25	0.244537	0.25	0.2	0.227703	15	35	35	0.25			0.2	0							0	0	0	32.227317	0	0	0	0	35	0	0		NO	134.123013	133.308459	36.484077	0	133.7904	0.178387	0.178387	44.5968	0.211927	0.222984	0.218111	0.222984	0.178387	0.203097	13.37904	31.21776	31.21776	0.222984			0.178387	0							0	0	0	28.744704	0	0	0	0	31.21776	0	0			16.1802	0.814502442	2.216325102	0	2.095276804	1.457186319	1.424627659	1.401121023	9.18532859	3.887525131	4.053881932	0.571962656	0.111902522	5.124263636	4.577612078	9.529531558	0.279567135	0.68869701	0	0	3.449984065	0	0	0	0	0	0	0	0	0	0	0.859558422	0	0	0	0	1.45746179	0	0	0	69.3665	0	8.261062	16.1802	0.814502442	2.216325102	0	2.095276804	1.457186319	1.424627659	1.401121023	9.18532859	3.887525131	4.053881932	0.571962656	0.111902522	5.124263636	4.577612078	9.529531558	0.279567135	0.68869701	0	0	3.449984065	0	0	0	0	0	0	0	0	0	0	0.859558422	0	0	0	0	1.45746179	0	0	0	69.3665	YES				$0/Visit		20% Coins																									$0/Visit										6000				0		0.9633																									0										0.9633	0	0.036901	16.1802	0.814502442	2.216325102	0	2.095276804	2.420532319	1.424627659	1.401121023	9.18532859	3.887525131	4.053881932	0.571962656	0.111902522	5.124263636	4.577612078	9.529531558	0.279567135	0.68869701	0	0	3.449984065	0	0	0	0	0	0	0	0	0	0	0.859558422	0	0	0	0	1.45746179	0	0	0	70.3299
H2944_075_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1787.896565	90.551587	900.308781	220.889851	232.101441	11.970174	11.702719	465.621833	63.512176	25.547483	27.235925	3.758744	0.919232	36.972308	5070.787585	4524.089618	132.72287	4.525881			28.340173	0							0.04	0.25	495.579812	443.178765	0	0.05	0.55	2.68	691.921498	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.237603	0.25	0.244537	0.25	0.2	0.227703	15	35	35	0.25			0.2	0							0	0	0	32.227316	0	0	0	0	35	0	0		NO	145.719833	128.869245	35.361546	0	132.05715	0.176076	0.176076	44.01905	0.209181	0.220095	0.215285	0.220095	0.176076	0.200466	13.205715	30.813335	30.813335	0.220095			0.176076	0							0	0	0	28.372317	0	0	0	0	30.813335	0	0			21.711	0.972442888	2.653025864	0	2.554221234	2.107660357	2.060567951	1.708019229	13.28554049	5.622873271	5.863486114	0.827280761	0.161854694	7.411690696	5.580281306	11.61685741	0.340802855	0.996123779	0	0	4.990024301	0	0	0	0	0	0	0	0	0	0	1.047834034	0	0	0	0	1.776700743	0	0	0	93.2883	0	12.417236	21.711	0.972442888	2.653025864	0	2.554221234	2.107660357	2.060567951	1.708019229	13.28554049	5.622873271	5.863486114	0.827280761	0.161854694	7.411690696	5.580281306	11.61685741	0.340802855	0.996123779	0	0	4.990024301	0	0	0	0	0	0	0	0	0	0	1.047834034	0	0	0	0	1.776700743	0	0	0	93.2883	YES				$0/Visit		20% Coins																									$0/Visit										7500				0		1.4071																									0										1.4071	0	0.058666	21.711	0.972442888	2.653025864	0	2.554221234	3.514730357	2.060567951	1.708019229	13.28554049	5.622873271	5.863486114	0.827280761	0.161854694	7.411690696	5.580281306	11.61685741	0.340802855	0.996123779	0	0	4.990024301	0	0	0	0	0	0	0	0	0	0	1.047834034	0	0	0	0	1.776700743	0	0	0	94.6954
H2944_076_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1543.83035	78.190367	777.4074	190.736121	200.417214	10.331613	10.10077	402.059678	54.818186	22.050365	23.507683	3.24422	0.793402	31.911281	4378.57308	3906.504992	114.604837	3.906347			24.460771	0							0.04	0.25	427.928086	382.680319	0	0.05	0.55	2.68	597.467118	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.237603	0.25	0.244537	0.25	0.2	0.227703	15	35	35	0.25			0.2	0							0	0	0	32.227317	0	0	0	0	35	0	0		NO	131.557643	130.758669	33.871589	0	130.791	0.174388	0.174388	43.597	0.207176	0.217985	0.213221	0.217985	0.174388	0.198544	13.0791	30.5179	30.5179	0.217985			0.174388	0							0	0	0	28.100286	0	0	0	0	30.5179	0	0			16.9252	0.852005693	2.194335328	0	2.18439732	1.801709328	1.761453079	1.460716315	11.3570125	4.806648815	5.012331677	0.707191297	0.138359788	6.335793375	4.772316264	9.934860725	0.291458246	0.851525051	0	0	4.265664933	0	0	0	0	0	0	0	0	0	0	0.896118868	0	0	0	0	1.51945348	0	0	0	78.0686	0	11.378013	16.9252	0.852005693	2.194335328	0	2.18439732	1.801709328	1.761453079	1.460716315	11.3570125	4.806648815	5.012331677	0.707191297	0.138359788	6.335793375	4.772316264	9.934860725	0.291458246	0.851525051	0	0	4.265664933	0	0	0	0	0	0	0	0	0	0	0.896118868	0	0	0	0	1.51945348	0	0	0	78.0686	YES				$0/Visit		20% Coins																									$0/Visit										6000				0		1.2123																									0										1.2123	0	0.052756	16.9252	0.852005693	2.194335328	0	2.18439732	3.014049328	1.761453079	1.460716315	11.3570125	4.806648815	5.012331677	0.707191297	0.138359788	6.335793375	4.772316264	9.934860725	0.291458246	0.851525051	0	0	4.265664933	0	0	0	0	0	0	0	0	0	0	0.896118868	0	0	0	0	1.51945348	0	0	0	79.2809
H2944_077_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1285.347229	65.0989738	761.466209	186.824966	196.307543	8.823394	8.626248	393.81521	41.77238137	15.0651424	17.11142517	2.2165	0.677579	24.10231463	4288.787895	3826.399837	112.254799	3.058204476			20.889961	0							0.04	0.25	419.153172	374.833237	0	0.05	0.55	2.68	585.215707	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.237603	0.25	0.244537	0.25	0.2	0.227703	15	35	35	0.25			0.2	0							0	0	0	32.227317	0	0	0	0	35	0	0		NO	133.071198	132.263032	35.167149	0	132.5943	0.176792	0.176792	44.1981	0.210032	0.220991	0.216161	0.220991	0.176792	0.201281	13.25943	30.93867	30.93867	0.220991			0.176792	0							0	0	0	28.487723	0	0	0	0	30.93867	0	0			14.2536	0.717515638	2.231549636	0	2.169105104	1.559905472	1.525051636	1.450490336	8.773536804	3.329260884	3.698822777	0.489826552	0.119790547	4.851337992	4.738906907	9.865310154	0.289417849	0.675835665	0	0	3.693177985	0	0	0	0	0	0	0	0	0	0	0.889845452	0	0	0	0	1.508816303	0	0	0	66.8311	0	9.459096	14.2536	0.717515638	2.231549636	0	2.169105104	1.559905472	1.525051636	1.450490336	8.773536804	3.329260884	3.698822777	0.489826552	0.119790547	4.851337992	4.738906907	9.865310154	0.289417849	0.675835665	0	0	3.693177985	0	0	0	0	0	0	0	0	0	0	0.889845452	0	0	0	0	1.508816303	0	0	0	66.8311	YES	25% Coins	25% Coins		$0/Visit		20% Coins			25% Surgery OP -- Facility	25% Lab -- OP	"25% Coins:  25% DMAM -- OP,$0 SMAM -- OP,25% Advanced Imaging -- OP,25% Radiology OP -- Facility"	25% Coins		"25% Coins:25% Cardiac Rehab,25% Nuclear Medicine,25% OP Other,25% Psych -- OP"				25% Coins: Therapy (PT/OT/ST) -- OP													$0/Visit										6000	10.204	0.1719		0		1.039			1.052	0.8266	0.6364	0.1216		0.6298				0.061													0										14.7423	0	0.041404	24.4576	0.889377782	2.231549636	0	2.169105104	2.598917472	1.525051636	1.450490336	9.825546699	4.155866416	4.335252416	0.611443136	0.119790547	5.481130164	4.738906907	9.865310154	0.289417849	0.736825469	0	0	3.693177985	0	0	0	0	0	0	0	0	0	0	0.889845452	0	0	0	0	1.508816303	0	0	0	81.5734
H2944_078_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1547.783841	73.641268	845.455596	260.866619	154.979924	10.74095	10.820469	503.127221	43.237785	10.827508	15.748759	3.488929	0.262917	23.714333	4041.80718	3499.411955	176.411142	2.128768			25.153257	0							0.04	0.25	307.376926	263.369675	0	0.05	0.55	1.67	414.732691	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.243543	0.25	0.245717	0.25	0.2	0.228352	15	35	35	0.25			0.2	0							0	0	0	27.009935	0	0	0	0	35	0	0		NO	125.848678	125.084376	26.710151	0	126.54915	0.168732	0.168732	42.18305	0.205468	0.210915	0.207302	0.210915	0.168732	0.192652	12.654915	29.528135	29.528135	0.210915			0.168732	0							0	0	0	22.787229	0	0	0	0	29.528135	0	0			16.2322	0.767614338	1.881853886	0	1.634381471	1.812341975	1.825759375	1.76862006	8.883981208	2.28368385	3.264749238	0.73586746	0.044362511	4.568613681	4.262393859	8.610925719	0.434091001	0.448989103	0	0	4.24415936	0	0	0	0	0	0	0	0	0	0	0.500122091	0	0	0	0	1.020523574	0	0	0	65.2252	0	12.804231	16.2322	0.767614338	1.881853886	0	1.634381471	1.812341975	1.825759375	1.76862006	8.883981208	2.28368385	3.264749238	0.73586746	0.044362511	4.568613681	4.262393859	8.610925719	0.434091001	0.448989103	0	0	4.24415936	0	0	0	0	0	0	0	0	0	0	0.500122091	0	0	0	0	1.020523574	0	0	0	65.2252	YES						20% Coins																									$0/Visit										4500						1.2594																									0										1.2594	0	0.055825	16.2322	0.767614338	1.881853886	0	1.634381471	3.071735975	1.825759375	1.76862006	8.883981208	2.28368385	3.264749238	0.73586746	0.044362511	4.568613681	4.262393859	8.610925719	0.434091001	0.448989103	0	0	4.24415936	0	0	0	0	0	0	0	0	0	0	0.500122091	0	0	0	0	1.020523574	0	0	0	66.4846
H2944_079_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1438.433322	68.438532	924.381626	285.219366	169.447804	12.20593	12.296293	550.095784	41.47228733	9.8434344	14.99364295	3.1718328	0.298777	23.76044541	4419.123027	3826.093444	192.879696	2.213722252			28.583959	0							0.04	0.25	336.071562	287.956092	0	0.05	0.55	1.67	453.449336	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.243543	0.25	0.245717	0.25	0.2	0.228352	15	35	35	0.25			0.2	0							0	0	0	27.009935	0	0	0	0	35	0	0		NO	125.955479	125.190528	26.945255	0	126.5448	0.168726	0.168726	42.1816	0.205461	0.210908	0.207295	0.210908	0.168726	0.192645	12.65448	29.52712	29.52712	0.210908			0.168726	0							0	0	0	22.786446	0	0	0	0	29.52712	0	0			15.0982	0.713987996	2.075641552	0	1.786894872	2.059457745	2.074704333	1.933660027	8.520937627	2.076059062	3.108107215	0.668964912	0.050411448	4.577331006	4.660141997	9.414460021	0.474598494	0.466891733	0	0	4.822857066	0	0	0	0	0	0	0	0	0	0	0.546791328	0	0	0	0	1.115754413	0	0	0	66.2459	0	14.191664	15.0982	0.713987996	2.075641552	0	1.786894872	2.059457745	2.074704333	1.933660027	8.520937627	2.076059062	3.108107215	0.668964912	0.050411448	4.577331006	4.660141997	9.414460021	0.474598494	0.466891733	0	0	4.822857066	0	0	0	0	0	0	0	0	0	0	0.546791328	0	0	0	0	1.115754413	0	0	0	66.2459	YES	25% Coins	25% Coins		$0/Visit		20% Coins			25% Surgery OP -- Facility	25% Lab -- OP	"25% Coins:  25% DMAM -- OP,$0 SMAM -- OP,25% Advanced Imaging -- OP,25% Radiology OP -- Facility"	25% Coins		"25% Coins:25% Cardiac Rehab,25% Nuclear Medicine,25% OP Other,25% Psych -- OP"				25% Coins: Therapy (PT/OT/ST) -- OP													$0/Visit										5000	9.9952	0.1551		0		1.4304			1.5599	0.5142	0.5963	0.1657		0.6086				0.0429													0										15.0683	0	0.064216	25.0935	0.869089994	2.075641552	0	1.786894872	3.489845745	2.074704333	1.933660027	10.08085775	2.590299762	3.704373442	0.834667801	0.050411448	5.185896849	4.660141997	9.414460021	0.474598494	0.509812244	0	0	4.822857066	0	0	0	0	0	0	0	0	0	0	0.546791328	0	0	0	0	1.115754413	0	0	0	81.3142
H2944_080_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1648.891	81.158816	989.387531	257.439533	213.6826	11.036614	10.008526	509.489603	50.063025	13.567014	18.902094	5.152747	0.467291	24.596661	4305.232407	4117.236372	135.761903	2.67685			25.768235	0							0.04	0.25	540.260032	362.869784	0	0.05	0.55	1.17	445.717696	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.241304	0.25	0.243918	0.25	0.2	0.229246	15	35	35	0.25			0.2	0							0	0	0	31.379879	0	0	0	0	35	0	0		NO	126.025715	125.260338	26.252632	0	126.5931	0.168791	0.168791	42.1977	0.203649	0.210989	0.205856	0.210989	0.168791	0.193473	12.65931	29.53839	29.53839	0.210989			0.168791	0							0	0	0	26.483174	0	0	0	0	29.53839	0	0			17.3169	0.84716506	2.16450223	0	2.254228563	1.862881114	1.689349112	1.791607452	10.19528498	2.862490717	3.891109462	1.087172937	0.078874515	4.758789794	4.541772639	10.13471114	0.334182336	0.564785905	0	0	4.349446154	0	0	0	0	0	0	0	0	0	0	0.800828636	0	0	0	0	1.097148595	0	0	0	72.6232	0	14.355078	17.3169	0.84716506	2.16450223	0	2.254228563	1.862881114	1.689349112	1.791607452	10.19528498	2.862490717	3.891109462	1.087172937	0.078874515	4.758789794	4.541772639	10.13471114	0.334182336	0.564785905	0	0	4.349446154	0	0	0	0	0	0	0	0	0	0	0.800828636	0	0	0	0	1.097148595	0	0	0	72.6232	YES						20% Coins																									$0/Visit										5000						1.2925																									0										1.2925	0	0.058946	17.3169	0.84716506	2.16450223	0	2.254228563	3.155357114	1.689349112	1.791607452	10.19528498	2.862490717	3.891109462	1.087172937	0.078874515	4.758789794	4.541772639	10.13471114	0.334182336	0.564785905	0	0	4.349446154	0	0	0	0	0	0	0	0	0	0	0.800828636	0	0	0	0	1.097148595	0	0	0	73.9157
H2944_081_0	2010	10	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1666.744905	82.037589	1000.100447	260.227043	215.996318	11.237429	10.190635	515.006268	50.973943	13.813872	19.246027	5.246503	0.475793	25.04421	4351.848715	4161.817091	137.23191	2.725556			26.237099	0							0.04	0.25	546.109873	366.798875	0	0.05	0.55	1.17	450.54385	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.241304	0.25	0.243918	0.25	0.2	0.229246	15	35	35	0.25			0.2	0							0	0	0	31.379878	0	0	0	0	35	0	0		NO	125.589988	124.827257	25.93175	0	126.2187	0.168292	0.168292	42.0729	0.203047	0.210365	0.205247	0.210365	0.168292	0.192901	12.62187	29.45103	29.45103	0.210365			0.168292	0							0	0	0	26.40485	0	0	0	0	29.45103	0	0			17.4439	0.853377267	2.161196231	0	2.271897872	1.891169401	1.715002345	1.805650601	10.3501062	2.905955183	3.950189304	1.103680604	0.080072156	4.831053153	4.577372395	10.21415	0.336801758	0.573361588	0	0	4.415493865	0	0	0	0	0	0	0	0	0	0	0.807105773	0	0	0	0	1.10574837	0	0	0	73.3933	0	14.800447	17.4439	0.853377267	2.161196231	0	2.271897872	1.891169401	1.715002345	1.805650601	10.3501062	2.905955183	3.950189304	1.103680604	0.080072156	4.831053153	4.577372395	10.21415	0.336801758	0.573361588	0	0	4.415493865	0	0	0	0	0	0	0	0	0	0	0.807105773	0	0	0	0	1.10574837	0	0	0	73.3933	YES				$0/Visit		20% Coins																									$0/Visit										5000				0		1.3153																									0										1.3153	0	0.060738	17.4439	0.853377267	2.161196231	0	2.271897872	3.206443401	1.715002345	1.805650601	10.3501062	2.905955183	3.950189304	1.103680604	0.080072156	4.831053153	4.577372395	10.21415	0.336801758	0.573361588	0	0	4.415493865	0	0	0	0	0	0	0	0	0	0	0.807105773	0	0	0	0	1.10574837	0	0	0	74.7085
H2944_082_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1331.81965	65.55248705	940.158285	244.630038	203.050332	11.153145	10.114202	484.138779	43.83327267	10.9682104	16.24228875	4.1657216	0.472225	21.82287055	4091.015694	3912.373831	129.006758	2.449572322			26.040311	0							0.04	0.25	513.378155	344.814366	0	0.05	0.55	1.17	423.53999	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.241304	0.25	0.243918	0.25	0.2	0.229246	15	35	35	0.25			0.2	0							0	0	0	31.379878	0	0	0	0	35	0	0		NO	127.007872	126.236529	27.298571	0	127.2624	0.169683	0.169683	42.4208	0.204726	0.212104	0.206944	0.212104	0.169683	0.194496	12.72624	29.69456	29.69456	0.212104			0.169683	0							0	0	0	26.623191	0	0	0	0	29.69456	0	0			14.096	0.689593203	2.138748141	0	2.153389381	1.892499103	1.716208138	1.71146286	8.97381058	2.326401299	3.361244203	0.883566214	0.080128555	4.244461031	4.338603964	9.681351622	0.319233243	0.519564088	0	0	4.418598091	0	0	0	0	0	0	0	0	0	0	0.765004894	0	0	0	0	1.04806947	0	0	0	65.3579	0	13.501143	14.096	0.689593203	2.138748141	0	2.153389381	1.892499103	1.716208138	1.71146286	8.97381058	2.326401299	3.361244203	0.883566214	0.080128555	4.244461031	4.338603964	9.681351622	0.319233243	0.519564088	0	0	4.418598091	0	0	0	0	0	0	0	0	0	0	0.765004894	0	0	0	0	1.04806947	0	0	0	65.3579	YES	25% Coins	25% Coins		$0/Visit		20% Coins			25% Surgery OP -- Facility	25% Lab -- OP	"25% Coins:  25% DMAM -- OP,$0 SMAM -- OP,25% Advanced Imaging -- OP,25% Radiology OP -- Facility"	25% Coins		"25% Coins:25% Cardiac Rehab,25% Nuclear Medicine,25% OP Other,25% Psych -- OP"				25% Coins: Therapy (PT/OT/ST) -- OP													$0/Visit										5000	9.8062	0.1534		0		1.3057			1.3795	0.5799	0.59	0.2202		0.5882				0.054													0										14.6771	0	0.059985	23.9022	0.842947122	2.138748141	0	2.153389381	3.198205103	1.716208138	1.71146286	10.35329065	2.906265904	3.95120993	1.103798542	0.080128555	4.832701495	4.338603964	9.681351622	0.319233243	0.573603531	0	0	4.418598091	0	0	0	0	0	0	0	0	0	0	0.765004894	0	0	0	0	1.04806947	0	0	0	80.035
H2944_084_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	O	O	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	NO	266.809954	4.486112	564.533315	11.353502	8.06526	12.22704	11.183933	403.417536	65.229939	1.254151	29.69255	6.131828	0.533731	21.769652	42.353191	63.386036	0.719023	5.595777			24.074082	0							0.04	0.25	9.415465	0.05	0.55	1.61	0.32	0.4						Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.187398	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0					NO	0.064772	0.064772	31.109487	0	0.169581	0.169581	0.169581	42.3953	0.169581	0	0.158896	0.169581	0.169581	0.169581	0.169581	0.169581	0.169581	0.169581			0.169581	0							0	0	0.169581	0	0	0	0	0						17.2818	0.290574446	1.463528485	0	1.367714856	2.07347367	1.896582542	1.425250622	11.06175829	0	4.718027425	1.039841524	0.090510637	3.691719356	7.182296483	10.74906737	0.121932639	0.948937459	0	0	4.0825069	0	0	0	0	0	0	0	0	0	1.59668397	0	0	0	0	0	0	0	0	0	71.0822	0	12.464825	17.2818	0.290574446	1.463528485	0	1.367714856	2.07347367	1.896582542	1.425250622	11.06175829	0	4.718027425	1.039841524	0.090510637	3.691719356	7.182296483	10.74906737	0.121932639	0.948937459	0	0	4.0825069	0	0	0	0	0	0	0	0	0	1.59668397	0	0	0	0	0	0	0	0	0	71.0822	YES						20% Coins				0% Coins																															4900						1.4328				0																															1.4328	0	0.064346	17.2818	0.290574446	1.463528485	0	1.367714856	3.50631667	1.896582542	1.425250622	11.06175829	0	4.718027425	1.039841524	0.090510637	3.691719356	7.182296483	10.74906737	0.121932639	0.948937459	0	0	4.0825069	0	0	0	0	0	0	0	0	0	1.59668397	0	0	0	0	0	0	0	0	0	72.5151
H2944_085_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1318.906366	69.731189	564.526449	257.395617	8.065162	12.226891	11.183797	403.412629	47.550026	9.415352	16.111801	6.131754	0.533725	21.769387	3736.751109	3653.627495	89.633174	2.480535			24.07379	0							0.04	0.25	293.737805	385.036509	0	0	0.05	0.55	1.61	366.407711	0.32	0.4		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.241287	0.25	0.243732	0.25	0.2	0.228263	15	35	35	0.25			0.2	0							0	0	0	18.899673	0	0	0	0	0	15	0	0	NO	142.977301	126.443851	37.514319	0	0.173013	0.173013	0.173013	43.25315	0.208728	0.216266	0.210843	0.216266	0.173013	0.197462	12.975945	30.277205	30.277205	0.216266			0.173013	0							0	0	0	16.349408	0	0	0	0	0	12.975945	0	0		15.7145	0.734756673	1.764818774	0	1.395377873	2.115411093	1.93494227	1.454072246	9.925021827	2.036220516	3.397060458	1.326089911	0.092341363	4.298626696	4.040656406	9.218469055	0.226153499	0.536455382	0	0	4.165078629	0	0	0	0	0	0	0	0	0	0	0.524593248	0	0	0	0	0	0.396207192	0	0	65.2968	0	10.135376	15.7145	0.734756673	1.764818774	0	1.395377873	2.115411093	1.93494227	1.454072246	9.925021827	2.036220516	3.397060458	1.326089911	0.092341363	4.298626696	4.040656406	9.218469055	0.226153499	0.536455382	0	0	4.165078629	0	0	0	0	0	0	0	0	0	0	0.524593248	0	0	0	0	0	0.396207192	0	0	65.2968	YES						20% Coins																									0% Coins										4900						1.4328																									0										1.4328	0	0.064343	15.7145	0.734756673	1.764818774	0	1.395377873	3.548238093	1.93494227	1.454072246	9.925021827	2.036220516	3.397060458	1.326089911	0.092341363	4.298626696	4.040656406	9.218469055	0.226153499	0.536455382	0	0	4.165078629	0	0	0	0	0	0	0	0	0	0	0.524593248	0	0	0	0	0	0.396207192	0	0	66.7297
H2944_086_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1275.695382	67.446605	546.031017	248.962632	6.881836	10.432955	9.542905	390.195727	40.573459	8.033926	13.747869	5.232099	0.455416	18.575371	3614.324912	3533.924656	86.696545	2.11659			20.54167	0							0.04	0.25	284.11415	372.421659	0	0	0.05	0.55	1.61	354.403192	0.32	0.4		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $75(Days 8-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	158.7573	140.3991	52.0131	0	0.2	0.2	0.2	50	0.241287	0.25	0.243732	0.25	0.2	0.228263	15	35	35	0.25			0.2	0							0	0	0	18.899673	0	0	0	0	0	15	0	0	NO	145.51837	128.691079	36.453745	0	0.176068	0.176068	0.176068	44.0169	0.212414	0.220085	0.214566	0.220085	0.176068	0.200949	13.20507	30.81183	30.81183	0.220085			0.176068	0							0	0	0	16.638101	0	0	0	0	0	13.20507	0	0		15.4698	0.723314698	1.658739621	0	1.211671101	1.836909521	1.680200198	1.431267191	8.61837072	1.768146604	2.94982526	1.151506508	0.080184184	3.732702227	3.977284455	9.073890478	0.222606601	0.46582971	0	0	3.616730754	0	0	0	0	0	0	0	0	0	0	0.516365765	0	0	0	0	0	0.389993247	0	0	60.5753	0	7.988487	15.4698	0.723314698	1.658739621	0	1.211671101	1.836909521	1.680200198	1.431267191	8.61837072	1.768146604	2.94982526	1.151506508	0.080184184	3.732702227	3.977284455	9.073890478	0.222606601	0.46582971	0	0	3.616730754	0	0	0	0	0	0	0	0	0	0	0.516365765	0	0	0	0	0	0.389993247	0	0	60.5753	YES						20% Coins																									0% Coins										4900						1.2271																									0										1.2271	0	0.050368	15.4698	0.723314698	1.658739621	0	1.211671101	3.064046521	1.680200198	1.431267191	8.61837072	1.768146604	2.94982526	1.151506508	0.080184184	3.732702227	3.977284455	9.073890478	0.222606601	0.46582971	0	0	3.616730754	0	0	0	0	0	0	0	0	0	0	0.516365765	0	0	0	0	0	0.389993247	0	0	61.8024
H2944_087_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	O	O	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	NO	227.663775	3.827912	546.038456	9.687724	6.881931	10.433097	9.543034	390.201043	55.659445	1.070143	25.336077	5.232171	0.455422	18.575625	36.139158	54.086079	0.613528	4.77477			20.541949	0							0.04	0.25	8.034035	0.05	0.55	1.61	0.32	0.4						Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.187398	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0					NO	0.066974	0.066974	33.897591	0	0.174752	0.174752	0.174752	43.68805	0.174752	0	0.163741	0.174752	0.174752	0.174752	0.174752	0.174752	0.174752	0.174752			0.174752	0							0	0	0.174752	0	0	0	0	0						15.2476	0.256370578	1.542449021	0	1.202631206	1.823204567	1.667664278	1.420593556	9.726599333	0	4.148554584	0.914332347	0.079585905	3.24612762	6.315390139	9.451650477	0.107215245	0.834400607	0	0	3.589746672	0	0	0	0	0	0	0	0	0	1.403963684	0	0	0	0	0	0	0	0	0	62.978	0	8.75913	15.2476	0.256370578	1.542449021	0	1.202631206	1.823204567	1.667664278	1.420593556	9.726599333	0	4.148554584	0.914332347	0.079585905	3.24612762	6.315390139	9.451650477	0.107215245	0.834400607	0	0	3.589746672	0	0	0	0	0	0	0	0	0	1.403963684	0	0	0	0	0	0	0	0	0	62.978	YES						20% Coins				0% Coins																															4900						1.2272				0																															1.2272	0	0.050369	15.2476	0.256370578	1.542449021	0	1.202631206	3.050357567	1.667664278	1.420593556	9.726599333	0	4.148554584	0.914332347	0.079585905	3.24612762	6.315390139	9.451650477	0.107215245	0.834400607	0	0	3.589746672	0	0	0	0	0	0	0	0	0	1.403963684	0	0	0	0	0	0	0	0	0	64.2052
H2944_088_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered				Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin								O	Coin	O	O	O	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	NO	276.328606	4.646157	588.492741	11.758547	8.352994	12.663249	11.582929	420.539028	67.557068	1.298893	30.751852	6.350586	0.552773	22.546302	43.864174	65.647382	0.744674	5.795413			24.932944	0								0.04	9.75137	0.05	0.25	0.32	0.4	0.55	1.61					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15									$0: Nurse hotline 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.187398	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0								0	0.2	0	0	0	0	0	0				NO	0.064133	0.064133	30.120098	0	0.168227	0.168227	0.168227	42.05685	0.168227	0	0.157628	0.168227	0.168227	0.168227	0.168227	0.168227	0.168227	0.168227			0.168227	0								0	0.168227	0	0	0	0	0	0					17.7218	0.297971987	1.477121586	0	1.405199122	2.13030039	1.948561397	1.473878902	11.36492288	0	4.847352927	1.068340031	0.092991343	3.792896747	7.379138399	11.04366213	0.125274273	0.974944943	0	0	4.19439437	0	0	0	0	0	0	0	0	0	1.640443721	0	0	0	0	0	0	0	0	0	72.9792	0	13.57513	17.7218	0.297971987	1.477121586	0	1.405199122	2.13030039	1.948561397	1.473878902	11.36492288	0	4.847352927	1.068340031	0.092991343	3.792896747	7.379138399	11.04366213	0.125274273	0.974944943	0	0	4.19439437	0	0	0	0	0	0	0	0	0	1.640443721	0	0	0	0	0	0	0	0	0	72.9792	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.4824				0																															1.4824	0	0.068182	17.7218	0.297971987	1.477121586	0	1.405199122	3.61272039	1.948561397	1.473878902	11.36492288	0	4.847352927	1.068340031	0.092991343	3.792896747	7.379138399	11.04366213	0.125274273	0.974944943	0	0	4.19439437	0	0	0	0	0	0	0	0	0	1.640443721	0	0	0	0	0	0	0	0	0	74.4616
H2944_089_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1374.88337	72.690719	588.486072	268.319998	8.3529	12.663105	11.582798	420.534262	49.246452	9.75126	16.686617	6.350514	0.552765	22.546046	3895.346243	3808.694698	93.437383	2.569033			24.932663	0							0.04	0.25	306.20462	401.378223	0	0	0.05	0.55	1.61	381.958782	0.32	0.4		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $75(Days 8-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	158.7573	140.3991	52.0131	0	0.2	0.2	0.2	50	0.241287	0.25	0.243732	0.25	0.2	0.228263	15	35	35	0.25			0.2	0							0	0	0	18.899673	0	0	0	0	0	15	0	0	NO	141.993005	125.573376	33.66964	0	0.171877	0.171877	0.171877	42.96925	0.207358	0.214846	0.209459	0.214846	0.171877	0.196166	12.890775	30.078475	30.078475	0.214846			0.171877	0							0	0	0	16.242096	0	0	0	0	0	12.890775	0	0		16.2687	0.760668249	1.651176182	0	1.435671393	2.176496498	1.990816572	1.50583682	10.21164579	2.095019206	3.49516211	1.364382531	0.09500759	4.42276766	4.184502664	9.546644021	0.234204499	0.551946464	0	0	4.285351318	0	0	0	0	0	0	0	0	0	0	0.543268636	0	0	0	0	0	0.41031206	0	0	67.2295	0	10.853864	16.2687	0.760668249	1.651176182	0	1.435671393	2.176496498	1.990816572	1.50583682	10.21164579	2.095019206	3.49516211	1.364382531	0.09500759	4.42276766	4.184502664	9.546644021	0.234204499	0.551946464	0	0	4.285351318	0	0	0	0	0	0	0	0	0	0	0.543268636	0	0	0	0	0	0.41031206	0	0	67.2295	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.4824																									0										1.4824	0	0.06818	16.2687	0.760668249	1.651176182	0	1.435671393	3.658900498	1.990816572	1.50583682	10.21164579	2.095019206	3.49516211	1.364382531	0.09500759	4.42276766	4.184502664	9.546644021	0.234204499	0.551946464	0	0	4.285351318	0	0	0	0	0	0	0	0	0	0	0.543268636	0	0	0	0	0	0.41031206	0	0	68.7119
H2944_090_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1431.907266	68.644082	745.325432	378.652288	9.807637	13.704675	8.667173	424.355092	44.375046	7.309301	15.544585	4.660959	0.601187	19.040027	4111.301919	3684.038244	140.838529	2.577537			27.424696	0							0.04	0.25	263.881285	407.329316	0	0	0.05	0.55	2.01	393.681779	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	130.271895	58.254672	0	0.2	0.2	0.2	50	0.237631	0.25	0.242362	0.25	0.2	0.230401	15	35	35	0.25			0.2	0							0	0	0	19.923816	0	0	0	0	0	15	0	0	NO	129.546072	116.774424	33.774952	0	0.172618	0.172618	0.172618	43.15455	0.205097	0.215773	0.20918	0.215773	0.172618	0.198857	12.946365	30.208185	30.208185	0.215773			0.172618	0							0	0	0	17.196066	0	0	0	0	0	12.946365	0	0		15.4582	0.667989428	2.097777558	0	1.692974684	2.365673589	1.496110069	1.526071086	9.101188809	1.577149805	3.25161629	1.005709106	0.103775698	3.786242649	4.435534606	9.274009068	0.354539695	0.556162891	0	0	4.733996174	0	0	0	0	0	0	0	0	0	0	0.58370515	0	0	0	0	0	0.424729	0	0	64.4931	0	10.723914	15.4582	0.667989428	2.097777558	0	1.692974684	2.365673589	1.496110069	1.526071086	9.101188809	1.577149805	3.25161629	1.005709106	0.103775698	3.786242649	4.435534606	9.274009068	0.354539695	0.556162891	0	0	4.733996174	0	0	0	0	0	0	0	0	0	0	0.58370515	0	0	0	0	0	0.424729	0	0	64.4931	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.6099																									0										1.6099	0	0.068239	15.4582	0.667989428	2.097777558	0	1.692974684	3.975558589	1.496110069	1.526071086	9.101188809	1.577149805	3.25161629	1.005709106	0.103775698	3.786242649	4.435534606	9.274009068	0.354539695	0.556162891	0	0	4.733996174	0	0	0	0	0	0	0	0	0	0	0.58370515	0	0	0	0	0	0.424729	0	0	66.103
H2944_091_0	2010	3	N/A	r.	s.	t.			w.	x.				OP Facility - Other	Other Non-Covered	Other Non-Covered			Other Non-Covered	Other Non-Covered				Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin								O	Coin	O	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	NO	255.858835	3.946522	745.335799	14.634258	9.807773	13.704866	8.667292	424.360994	62.71346	1.022709	28.949494	4.661024	0.601196	19.040291	42.478915	55.438244	0.976899	5.695156			27.425078	0								0.04	7.309403	0.05	0.25			0.55	2.01					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15									$0: Nurse hotline 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a			$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.186556	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0								0	0.2	0	0			0	0				NO	0.06494	0.06494	28.862195	0	0.170204	0.170204	0.170204	42.5511	0.170204	0	0.158763	0.170204	0.170204	0.170204	0.170204	0.170204	0.170204	0.170204			0.170204	0								0	0.170204	0	0			0	0					16.6155	0.256287139	1.792668931	0	1.669322196	2.332623013	1.475207768	1.504752258	10.67408175	0	4.596108516	0.793324929	0.102325964	3.240733689	7.230081249	9.435810882	0.166272117	0.969338332	0	0	4.667857976	0	0	0	0	0	0	0	0	0	1.244089628	0	0	0	0	0	0	0	0	0	68.7664	0	12.148967	16.6155	0.256287139	1.792668931	0	1.669322196	2.332623013	1.475207768	1.504752258	10.67408175	0	4.596108516	0.793324929	0.102325964	3.240733689	7.230081249	9.435810882	0.166272117	0.969338332	0	0	4.667857976	0	0	0	0	0	0	0	0	0	1.244089628	0	0	0	0	0	0	0	0	0	68.7664	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.6099				0																															1.6099	0	0.06824	16.6155	0.256287139	1.792668931	0	1.669322196	3.942530013	1.475207768	1.504752258	10.67408175	0	4.596108516	0.793324929	0.102325964	3.240733689	7.230081249	9.435810882	0.166272117	0.969338332	0	0	4.667857976	0	0	0	0	0	0	0	0	0	1.244089628	0	0	0	0	0	0	0	0	0	70.3763
H2944_092_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1614.837405	77.413554	840.542831	427.026171	10.652763	14.88561	9.414025	478.567636	48.198852	7.939145	16.884064	5.062595	0.652991	20.680708	4636.532182	4154.684384	158.831044	2.799645			29.787888	0							0.04	0.25	297.592853	459.36677	0	0	0.05	0.55	2.01	443.975722	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	130.271895	58.254672	0	0.2	0.2	0.2	50	0.237631	0.25	0.242362	0.25	0.2	0.230401	15	35	35	0.25			0.2	0							0	0	0	19.923816	0	0	0	0	0	15	0	0	NO	126.208822	113.766185	30.295983	0	0.16899	0.16899	0.16899	42.2474	0.200786	0.211237	0.204783	0.211237	0.16899	0.194677	12.67422	29.57318	29.57318	0.211237			0.16899	0							0	0	0	16.834588	0	0	0	0	0	12.67422	0	0		16.9839	0.733920392	2.122089277	0	1.800210419	2.515519234	1.590876085	1.684853195	9.677654698	1.677041172	3.457569278	1.06940738	0.110348949	4.026058191	4.897035743	10.23893576	0.391428254	0.591388611	0	0	5.033855193	0	0	0	0	0	0	0	0	0	0	0.644437526	0	0	0	0	0	0.468920498	0	0	69.7154	0	13.681347	16.9839	0.733920392	2.122089277	0	1.800210419	2.515519234	1.590876085	1.684853195	9.677654698	1.677041172	3.457569278	1.06940738	0.110348949	4.026058191	4.897035743	10.23893576	0.391428254	0.591388611	0	0	5.033855193	0	0	0	0	0	0	0	0	0	0	0.644437526	0	0	0	0	0	0.468920498	0	0	69.7154	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.7452																									0										1.7452	0	0.077535	16.9839	0.733920392	2.122089277	0	1.800210419	4.260712234	1.590876085	1.684853195	9.677654698	1.677041172	3.457569278	1.06940738	0.110348949	4.026058191	4.897035743	10.23893576	0.391428254	0.591388611	0	0	5.033855193	0	0	0	0	0	0	0	0	0	0	0.644437526	0	0	0	0	0	0.468920498	0	0	71.4606
H2944_093_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered				Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin								O	Coin	O	O	O	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	NO	277.905703	4.286586	840.552905	15.895263	10.65289	14.885789	9.414137	478.573371	68.117358	1.110835	31.444016	5.062656	0.652999	20.680957	46.139242	60.215252	1.061077	6.185896			29.788244	0								0.04	7.93924	0.05	0.25	0.32	0.4	0.55	2.01					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15									$0: Nurse hotline 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.186556	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0								0	0.2	0	0	0	0	0	0				NO	0.063421	0.063421	26.321019	0	0.167004	0.167004	0.167004	41.75105	0.167004	0	0.155778	0.167004	0.167004	0.167004	0.167004	0.167004	0.167004	0.167004			0.167004	0								0	0.167004	0	0	0	0	0	0					17.6251	0.271859571	1.843684082	0	1.779075242	2.485986306	1.572198536	1.665078395	11.37587126	0	4.898285924	0.845483803	0.109053445	3.453802543	7.705437971	10.05618795	0.177204103	1.033069376	0	0	4.974755901	0	0	0	0	0	0	0	0	0	1.325884837	0	0	0	0	0	0	0	0	0	73.198	0	14.886729	17.6251	0.271859571	1.843684082	0	1.779075242	2.485986306	1.572198536	1.665078395	11.37587126	0	4.898285924	0.845483803	0.109053445	3.453802543	7.705437971	10.05618795	0.177204103	1.033069376	0	0	4.974755901	0	0	0	0	0	0	0	0	0	1.325884837	0	0	0	0	0	0	0	0	0	73.198	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.7452				0																															1.7452	0	0.077537	17.6251	0.271859571	1.843684082	0	1.779075242	4.231199306	1.572198536	1.665078395	11.37587126	0	4.898285924	0.845483803	0.109053445	3.453802543	7.705437971	10.05618795	0.177204103	1.033069376	0	0	4.974755901	0	0	0	0	0	0	0	0	0	1.325884837	0	0	0	0	0	0	0	0	0	74.9432
H2944_094_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	282.852052	4.423369	989.390361	9.371706	8.392943	11.036645	10.008554	509.49106	68.016273	1.310472	29.153859	5.152761	0.467293	24.596734	37.139794	56.722413	0.910854	5.770375			25.768309	0							0.04	0.25	13.567053	211.046258	0.05	0.55	1.17	0.32	0.4					7% Coins:1a	7% Coins:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.0641	0.0641	25.431569	0	0.169002	0.169002	0.169002	42.25055	0.169002	0	0.169002	0.169002	0.169002	0.169002	0.169002	0.169002	0.169002	0.169002			0.169002	0							0	0	0.169002	0	0	0	0	0	0					18.1308	0.283537953	2.096812436	0	1.418424153	1.865215078	1.691465643	1.793856459	11.49488617	0	4.927060479	0.870826915	0.078973452	4.156897239	6.276699466	9.586201242	0.153936148	0.975204916	0	0	4.354895758	0	0	0	0	0	0	0	0	0	2.292859091	0	0	0	0	0	0	0	0	0	72.4486	0	14.047401	18.1308	0.283537953	2.096812436	0	1.418424153	1.865215078	1.691465643	1.793856459	11.49488617	0	4.927060479	0.870826915	0.078973452	4.156897239	6.276699466	9.586201242	0.153936148	0.975204916	0	0	4.354895758	0	0	0	0	0	0	0	0	0	2.292859091	0	0	0	0	0	0	0	0	0	72.4486	YES						20% Coins				$0/Visit																															5000						1.2925				0																															1.2925	0	0.058946	18.1308	0.283537953	2.096812436	0	1.418424153	3.157695078	1.691465643	1.793856459	11.49488617	0	4.927060479	0.870826915	0.078973452	4.156897239	6.276699466	9.586201242	0.153936148	0.975204916	0	0	4.354895758	0	0	0	0	0	0	0	0	0	2.292859091	0	0	0	0	0	0	0	0	0	73.741
H2944_095_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	287.998673	4.503855	1000.103312	9.542229	8.545657	11.237462	10.190665	515.007743	69.25386	1.334316	29.684327	5.246518	0.475795	25.044281	37.81557	57.754503	0.927428	5.87537			26.237176	0							0.04	0.25	13.813912	213.331431	0.05	0.55	1.17	0.32	0.4					7% Coins:1a	7% Coins:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.063809	0.063809	25.064264	0	0.168372	0.168372	0.168372	42.09305	0.168372	0	0.168372	0.168372	0.168372	0.168372	0.168372	0.168372	0.168372	0.168372			0.168372	0							0	0	0.168372	0	0	0	0	0	0					18.3769	0.287386484	2.088904453	0	1.43884936	1.892073952	1.715822647	1.806520556	11.66041092	0	4.998009506	0.883366729	0.080110556	4.216755681	6.367083152	9.724241179	0.156152907	0.989247798	0	0	4.417605797	0	0	0	0	0	0	0	0	0	2.325875991	0	0	0	0	0	0	0	0	0	73.4253	0	14.599639	18.3769	0.287386484	2.088904453	0	1.43884936	1.892073952	1.715822647	1.806520556	11.66041092	0	4.998009506	0.883366729	0.080110556	4.216755681	6.367083152	9.724241179	0.156152907	0.989247798	0	0	4.417605797	0	0	0	0	0	0	0	0	0	2.325875991	0	0	0	0	0	0	0	0	0	73.4253	YES				$0/Visit		20% Coins				$0/Visit																															5000				0		1.3153				0																															1.3153	0	0.060739	18.3769	0.287386484	2.088904453	0	1.43884936	3.207350952	1.715822647	1.806520556	11.66041092	0	4.998009506	0.883366729	0.080110556	4.216755681	6.367083152	9.724241179	0.156152907	0.989247798	0	0	4.417605797	0	0	0	0	0	0	0	0	0	2.325875991	0	0	0	0	0	0	0	0	0	74.7406
H2944_096_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	242.9611262	3.79953655	940.154552	9.470594	8.481502	11.1531	10.114161	484.136856	59.55204458	1.324299	25.05130304	4.1657056	0.40138955	21.82278286	37.531682	57.32093	0.920465	5.280407139			26.040208	0							0.04	0.25	10.9681664	200.543797	0.05	0.55	1.17	0.32	0.4					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.064034	0.064034	25.888619	0	0.168797	0.168797	0.168797	42.19925	0.168797	0	0.168797	0.168797	0.168797	0.168797	0.168797	0.168797	0.168797	0.168797			0.168797	0							0	0	0.168797	0	0	0	0	0	0					15.5578	0.243299523	2.02827525	0	1.431652093	1.882609821	1.707240034	1.702517685	10.05220647	0	4.228584799	0.703158608	0.067753352	3.683620279	6.335235327	9.675601021	0.155371731	0.891316884	0	0	4.39550899	0	0	0	0	0	0	0	0	0	1.851393584	0	0	0	0	0	0	0	0	0	66.5931	0	14.111102	15.5578	0.243299523	2.02827525	0	1.431652093	1.882609821	1.707240034	1.702517685	10.05220647	0	4.228584799	0.703158608	0.067753352	3.683620279	6.335235327	9.675601021	0.155371731	0.891316884	0	0	4.39550899	0	0	0	0	0	0	0	0	0	1.851393584	0	0	0	0	0	0	0	0	0	66.5931	YES	25% Coins	25% Coins		$0/Visit		20% Coins			25% Coins	$0/Visit	25% Coins	25% Coins	20% Coins	25% Coins				25% Coins													25% Coins										5000	9.3511	0.1462		0		1.3057			1.9373	0	0.9305	0.2197	0.012	0.6401				0.1162													0.5786										15.2375	0	0.059985	24.9089	0.389536615	2.02827525	0	1.431652093	3.188310821	1.707240034	1.702517685	11.98955619	0	5.159115389	0.922895673	0.079709826	4.323674056	6.335235327	9.675601021	0.155371731	1.007545194	0	0	4.39550899	0	0	0	0	0	0	0	0	0	2.429954079	0	0	0	0	0	0	0	0	0	81.8306
H2944_097_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	261.788422	4.062324	845.424965	10.171356	6.398153	10.740561	10.820076	503.108993	58.610973	1.224317	24.518251	3.488804	0.262908	23.713472	37.739795	49.5401	1.162449	5.184733			25.152347	0							0.04	0.25	10.827117	168.515599	0.05	0.55	1.67	0.32	0.4					7% Coins:1a	7% Coins:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.065593	0.065593	28.450376	0	0.172231	0.172231	0.172231	43.0577	0.172231	0	0.172231	0.172231	0.172231	0.172231	0.172231	0.172231	0.172231	0.172231			0.172231	0							0	0	0.172231	0	0	0	0	0	0					17.1715	0.266460018	2.004388178	0	1.101960289	1.849857562	1.86355251	1.805226341	10.09462649	0	4.222802888	0.600880202	0.045280908	4.084194996	6.499962633	8.532340963	0.200209754	0.892971749	0	0	4.332013876	0	0	0	0	0	0	0	0	0	1.864765188	0	0	0	0	0	0	0	0	0	67.433	0	11.180718	17.1715	0.266460018	2.004388178	0	1.101960289	1.849857562	1.86355251	1.805226341	10.09462649	0	4.222802888	0.600880202	0.045280908	4.084194996	6.499962633	8.532340963	0.200209754	0.892971749	0	0	4.332013876	0	0	0	0	0	0	0	0	0	1.864765188	0	0	0	0	0	0	0	0	0	67.433	YES						20% Coins				$0/Visit																															5000						1.2625				0																															1.2625	0	0.052711	17.1715	0.266460018	2.004388178	0	1.101960289	3.112317562	1.86355251	1.805226341	10.09462649	0	4.222802888	0.600880202	0.045280908	4.084194996	6.499962633	8.532340963	0.200209754	0.892971749	0	0	4.332013876	0	0	0	0	0	0	0	0	0	1.864765188	0	0	0	0	0	0	0	0	0	68.6954
H2944_098_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	252.8688044	3.92391365	924.34335	11.558586	7.270773	12.205425	12.295783	550.073006	56.2174647	1.391297	23.74785042	3.1717024	0.2539494	23.83241979	42.886977	56.296678	1.320991	5.401078778			28.582777	0							0.04	0.25	9.8430272	184.246124	0.05	0.55	1.67	0.32	0.4					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.063507	0.063507	25.618812	0	0.167705	0.167705	0.167705	41.92635	0.167705	0	0.167705	0.167705	0.167705	0.167705	0.167705	0.167705	0.167705	0.167705			0.167705	0							0	0	0.167705	0	0	0	0	0	0					16.0589	0.249195984	1.973381542	0	1.219344986	2.0469108	2.062064288	1.921879448	9.427949918	0	3.982633254	0.531910351	0.042588584	3.99681596	7.192360478	9.441234384	0.221536796	0.905787917	0	0	4.793474617	0	0	0	0	0	0	0	0	0	1.650724877	0	0	0	0	0	0	0	0	0	67.7187	0	14.91353	16.0589	0.249195984	1.973381542	0	1.219344986	2.0469108	2.062064288	1.921879448	9.427949918	0	3.982633254	0.531910351	0.042588584	3.99681596	7.192360478	9.441234384	0.221536796	0.905787917	0	0	4.793474617	0	0	0	0	0	0	0	0	0	1.650724877	0	0	0	0	0	0	0	0	0	67.7187	YES	25% Coins	25% Coins		$0/Visit		20% Coins			25% Coins	$0/Visit	25% Coins	25% Coins	20% Coins	25% Coins				25% Coins													25% Coins										5000	9.6524	0.1498		0		1.4303			2.1775	0	0.8625	0.1662	0.0075	0.6531				0.1029													0.5159										15.718	0	0.064212	25.7113	0.39897719	1.973381542	0	1.219344986	3.4772408	2.062064288	1.921879448	11.60543778	0	4.845129081	0.698132336	0.050104217	4.64986787	7.192360478	9.441234384	0.221536796	1.008670578	0	0	4.793474617	0	0	0	0	0	0	0	0	0	2.166576401	0	0	0	0	0	0	0	0	0	83.4367
H2944_099_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	264.559142	4.455873	728.979577	7.14149	7.372753	8.168755	7.986238	377.013769	62.291931	0.97457	29.618629	2.565063	0.627308	25.230856	33.762928	52.14716	0.78932	7.527875			19.340064	0							0.04	0.25	17.434261	204.648258	0.05	0.55	2.68	0.32	0.4					7% Coins:1a	7% Coins:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.065735	0.065735	30.035858	0	0.172408	0.172408	0.172408	43.102	0.172408	0	0.172408	0.172408	0.172408	0.172408	0.172408	0.172408	0.172408	0.172408			0.172408	0							0	0	0.172408	0	0	0	0	0	0					17.3908	0.292906812	1.824627255	0	1.271121599	1.408358712	1.376891321	1.354170623	10.73962724	0	5.106488589	0.442237382	0.108152918	4.350001421	5.820998891	8.990587561	0.136085083	1.297865873	0	0	3.334381754	0	0	0	0	0	0	0	0	0	3.00580607	0	0	0	0	0	0	0	0	0	68.2511	0	10.945677	17.3908	0.292906812	1.824627255	0	1.271121599	1.408358712	1.376891321	1.354170623	10.73962724	0	5.106488589	0.442237382	0.108152918	4.350001421	5.820998891	8.990587561	0.136085083	1.297865873	0	0	3.334381754	0	0	0	0	0	0	0	0	0	3.00580607	0	0	0	0	0	0	0	0	0	68.2511	YES				$0/Visit		20% Coins				$0/Visit																															5000				0		0.9597				0																															0.9597	0	0.040547	17.3908	0.292906812	1.824627255	0	1.271121599	2.368067712	1.376891321	1.354170623	10.73962724	0	5.106488589	0.442237382	0.108152918	4.350001421	5.820998891	8.990587561	0.136085083	1.297865873	0	0	3.334381754	0	0	0	0	0	0	0	0	0	3.00580607	0	0	0	0	0	0	0	0	0	69.2108
H2944_100_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	334.60499	5.63563	777.402725	9.032303	9.324795	10.331551	10.100709	402.05726	78.78462	1.232601	37.460588	3.244201	0.793396	31.911089	42.70215	65.953873	0.998304	9.520988			24.460624	0							0.04	0.25	22.050232	218.242209	0.05	0.55	2.68	0.32	0.4					7% Coins:1a	7% Coins:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.061577	0.061577	25.747852	0	0.16368	0.16368	0.16368	40.91995	0.16368	0	0.16368	0.16368	0.16368	0.16368	0.16368	0.16368	0.16368	0.16368			0.16368	0							0	0	0.16368	0	0	0	0	0	0					20.604	0.347025189	1.668037526	0	1.526282446	1.691068268	1.653284049	1.371013581	12.8954666	0	6.131549044	0.53101082	0.129863057	5.223207048	6.989487912	10.79532993	0.163402399	1.558395316	0	0	4.003714936	0	0	0	0	0	0	0	0	0	3.609181974	0	0	0	0	0	0	0	0	0	80.8913	0	18.38592	20.604	0.347025189	1.668037526	0	1.526282446	1.691068268	1.653284049	1.371013581	12.8954666	0	6.131549044	0.53101082	0.129863057	5.223207048	6.989487912	10.79532993	0.163402399	1.558395316	0	0	4.003714936	0	0	0	0	0	0	0	0	0	3.609181974	0	0	0	0	0	0	0	0	0	80.8913	YES				$0/Visit		20% Coins				$0/Visit																															5000				0		1.206				0																															1.206	0	0.059091	20.604	0.347025189	1.668037526	0	1.526282446	2.897065268	1.653284049	1.371013581	12.8954666	0	6.131549044	0.53101082	0.129863057	5.223207048	6.989487912	10.79532993	0.163402399	1.558395316	0	0	4.003714936	0	0	0	0	0	0	0	0	0	3.609181974	0	0	0	0	0	0	0	0	0	82.0973
H2944_101_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	242.8977604	4.0910381	761.469857	7.713841	7.963638	8.823436	8.626288	393.817097	60.03585511	1.052676	27.2681523	2.2165104	0.5759447	24.10243137	36.468837	56.326462	0.852579	7.453881026			20.890062	0							0.04	0.25	15.0652144	213.769335	0.05	0.55	2.68	0.32	0.4					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.064539	0.064539	28.394711	0	0.169762	0.169762	0.169762	42.44055	0.169762	0	0.169762	0.169762	0.169762	0.169762	0.169762	0.169762	0.169762	0.169762			0.169762	0							0	0	0.169762	0	0	0	0	0	0					15.6764	0.264031508	1.80180971	0	1.351923114	1.497884142	1.464415903	1.39281785	10.19180683	0	4.629096071	0.376279239	0.097773524	4.091676955	6.191022707	9.562092842	0.144735516	1.265385751	0	0	3.546338705	0	0	0	0	0	0	0	0	0	2.557500927	0	0	0	0	0	0	0	0	0	66.103	0	13.035618	15.6764	0.264031508	1.80180971	0	1.351923114	1.497884142	1.464415903	1.39281785	10.19180683	0	4.629096071	0.376279239	0.097773524	4.091676955	6.191022707	9.562092842	0.144735516	1.265385751	0	0	3.546338705	0	0	0	0	0	0	0	0	0	2.557500927	0	0	0	0	0	0	0	0	0	66.103	YES	25% Coins	25% Coins		$0/Visit		20% Coins			25% Coins	$0/Visit	25% Coins	25% Coins	20% Coins	25% Coins				25% Coins													25% Coins										5000	9.4224	0.1587		0		1.0347			1.5381	0	1.0025	0.1176	0.0173	0.6686				0.1437													0.7992										14.9028	0	0.045675	25.0988	0.422729722	1.80180971	0	1.351923114	2.532630142	1.464415903	1.39281785	11.72994072	0	5.631592607	0.493866501	0.115027675	4.760228491	6.191022707	9.562092842	0.144735516	1.409112833	0	0	3.546338705	0	0	0	0	0	0	0	0	0	3.356719967	0	0	0	0	0	0	0	0	0	81.0058
H2944_102_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1464.729322	74.184138	737.575482	180.9634	190.148465	8.290849	8.105602	381.4594	43.990157	17.69484	18.864299	2.603401	0.636684	25.607966	4154.228721	3706.347922	108.732845	3.134741			19.629129	0							0.04	0.25	406.002392	363.072979	0	0.05	0.55	2.68	566.854776	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.237603	0.25	0.244537	0.25	0.2	0.227703	15	35	35	0.25			0.2	0							0	0	0	32.227317	0	0	0	0	35	0	0		NO	129.762418	128.974347	31.365081	0	129.4671	0.172623	0.172623	43.1557	0.205079	0.215779	0.211063	0.215779	0.172623	0.196534	12.94671	30.20899	30.20899	0.215779			0.172623	0							0	0	0	27.815848	0	0	0	0	30.20899	0	0			15.8389	0.797320896	1.927842895	0	2.051497528	1.431191227	1.399213334	1.371845619	9.021457407	3.81817488	3.98155554	0.561759264	0.109906302	5.03283599	4.48196621	9.330418943	0.273725786	0.676411278	0	0	3.388439135	0	0	0	0	0	0	0	0	0	0	0.841598566	0	0	0	0	1.427009188	0	0	0	67.7631	0	10.886588	15.8389	0.797320896	1.927842895	0	2.051497528	1.431191227	1.399213334	1.371845619	9.021457407	3.81817488	3.98155554	0.561759264	0.109906302	5.03283599	4.48196621	9.330418943	0.273725786	0.676411278	0	0	3.388439135	0	0	0	0	0	0	0	0	0	0	0.841598566	0	0	0	0	1.427009188	0	0	0	67.7631	YES				$0/Visit		20% Coins																									$0/Visit										5000				0		0.9737																									0										0.9737	0	0.041479	15.8389	0.797320896	1.927842895	0	2.051497528	2.404918227	1.399213334	1.371845619	9.021457407	3.81817488	3.98155554	0.561759264	0.109906302	5.03283599	4.48196621	9.330418943	0.273725786	0.676411278	0	0	3.388439135	0	0	0	0	0	0	0	0	0	0	0.841598566	0	0	0	0	1.427009188	0	0	0	68.7368
H2944_104_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1553.400573	73.908504	848.523658	261.813274	155.542329	10.795665	10.875587	504.953013	43.458038	10.882664	15.828983	3.506702	0.264256	23.835133	4056.474439	3512.110923	177.051318	2.139612			25.28139	0							0.04	0.25	308.492362	264.325414	0	0.05	0.55	1.67	416.237709	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.243543	0.25	0.245717	0.25	0.2	0.228352	15	35	35	0.25			0.2	0							0	0	0	27.009935	0	0	0	0	35	0	0		NO	125.712541	124.949066	26.60671	0	126.43515	0.16858	0.16858	42.14505	0.205283	0.210725	0.207115	0.210725	0.16858	0.192478	12.643515	29.501535	29.501535	0.210725			0.16858	0							0	0	0	22.766701	0	0	0	0	29.501535	0	0			16.2735	0.769566545	1.881368575	0	1.638834808	1.819933206	1.833406456	1.773439165	8.921196415	2.293249371	3.278419814	0.738949779	0.044548276	4.58773873	4.274007951	8.63438861	0.435273805	0.450869739	0	0	4.261936726	0	0	0	0	0	0	0	0	0	0	0.501484806	0	0	0	0	1.023304278	0	0	0	65.4354	0	12.926039	16.2735	0.769566545	1.881368575	0	1.638834808	1.819933206	1.833406456	1.773439165	8.921196415	2.293249371	3.278419814	0.738949779	0.044548276	4.58773873	4.274007951	8.63438861	0.435273805	0.450869739	0	0	4.261936726	0	0	0	0	0	0	0	0	0	0	0.501484806	0	0	0	0	1.023304278	0	0	0	65.4354	YES						20% Coins																									$0/Visit										4500						1.2657																									0										1.2657	0	0.056263	16.2735	0.769566545	1.881368575	0	1.638834808	3.085588206	1.833406456	1.773439165	8.921196415	2.293249371	3.278419814	0.738949779	0.044548276	4.58773873	4.274007951	8.63438861	0.435273805	0.450869739	0	0	4.261936726	0	0	0	0	0	0	0	0	0	0	0.501484806	0	0	0	0	1.023304278	0	0	0	66.7011
H2944_106_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1496.171989	73.641949	897.751222	233.595682	193.891483	10.661585	9.668432	462.301069	48.361864	13.106002	18.259795	4.977654	0.451411	23.760858	3906.485104	3735.901116	123.187741	2.585889			24.89262	0							0.04	0.25	490.221565	329.261065	0	0.05	0.55	2.43	404.435667	0.32	0.4			$195/Day(Days 1-8):1a	$225/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	165.74085	50.7565	0	150	0.2	0.2	50	0.241304	0.25	0.243918	0.25	0.2	0.229246	15	35	35	0.25			0.2	0							0	0	0	31.379878	0	0	0	0	35	0	0		NO	136.558316	156.610352	38.942823	0	136.80855	0.182411	0.182411	45.60285	0.220083	0.228014	0.222467	0.228014	0.182411	0.209086	13.680855	31.921995	31.921995	0.228014			0.182411	0							0	0	0	28.620238	0	0	0	0	31.921995	0	0			17.0262	0.961090963	2.913413911	0	2.210501054	1.944790381	1.76362835	1.756853859	10.64362411	2.98835194	4.062201814	1.134974799	0.082342332	4.968062756	4.453671356	9.938118062	0.327699871	0.589618894	0	0	4.540687707	0	0	0	0	0	0	0	0	0	0	0.78529417	0	0	0	0	1.075866112	0	0	0	74.167	0	7.068566	17.0262	0.961090963	2.913413911	0	2.210501054	1.944790381	1.76362835	1.756853859	10.64362411	2.98835194	4.062201814	1.134974799	0.082342332	4.968062756	4.453671356	9.938118062	0.327699871	0.589618894	0	0	4.540687707	0	0	0	0	0	0	0	0	0	0	0.78529417	0	0	0	0	1.075866112	0	0	0	74.167	YES				$0/Visit		20% Coins																									$0/Visit										7500				0		1.26																									0										1.26	0	0.045506	17.0262	0.961090963	2.913413911	0	2.210501054	3.204785381	1.76362835	1.756853859	10.64362411	2.98835194	4.062201814	1.134974799	0.082342332	4.968062756	4.453671356	9.938118062	0.327699871	0.589618894	0	0	4.540687707	0	0	0	0	0	0	0	0	0	0	0.78529417	0	0	0	0	1.075866112	0	0	0	75.427
H2944_107_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1724.010293	90.018455	544.983959	314.976856	7.94762	12.878995	13.140881	453.062296	52.91009	9.739198	14.531315	2.613997	0.864656	16.766984	4180.445094	3865.709512	66.218661	1.964976			26.590521	0							0.04	0.25	352.217155	375.796938	0	0	0.05	0.55	1.74	393.785129	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	130.271895	58.254672	0	0.2	0.2	0.2	50	0.242486	0.25	0.244594	0.25	0.2	0.227266	15	35	35	0.25			0.2	0							0	0	0	18.408313	0	0	0	0	0	15	0	0	NO	127.748824	115.154363	36.227241	0	0.170768	0.170768	0.170768	42.69205	0.207045	0.21346	0.208845	0.21346	0.170768	0.194049	12.807615	29.884435	29.884435	0.21346			0.170768	0							0	0	0	15.717772	0	0	0	0	0	12.807615	0	0		18.3534	0.86383482	1.645272102	0	1.357199172	2.199320218	2.244041967	1.611846516	10.95476958	2.078929205	3.034792481	0.5579838	0.147655576	3.253616478	4.461794274	9.627045387	0.164908939	0.419443777	0	0	4.54081009	0	0	0	0	0	0	0	0	0	0	0.492224216	0	0	0	0	0	0.42028736	0	0	68.4291	0	11.665606	18.3534	0.86383482	1.645272102	0	1.357199172	2.199320218	2.244041967	1.611846516	10.95476958	2.078929205	3.034792481	0.5579838	0.147655576	3.253616478	4.461794274	9.627045387	0.164908939	0.419443777	0	0	4.54081009	0	0	0	0	0	0	0	0	0	0	0.492224216	0	0	0	0	0	0.42028736	0	0	68.4291	YES						20% Coins																									0% Coins										4900						1.5113																									0										1.5113	0	0.065768	18.3534	0.86383482	1.645272102	0	1.357199172	3.710572218	2.244041967	1.611846516	10.95476958	2.078929205	3.034792481	0.5579838	0.147655576	3.253616478	4.461794274	9.627045387	0.164908939	0.419443777	0	0	4.54081009	0	0	0	0	0	0	0	0	0	0	0.492224216	0	0	0	0	0	0.42028736	0	0	69.9404
H2944_108_0	2010	2	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	O	O	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	NO	290.408257	5.41677	544.990772	12.953667	7.947719	12.879156	13.141044	453.06796	71.186409	1.566907	29.624146	2.614029	0.864667	16.767196	41.290902	60.698255	0.392939	5.072907			26.590853	0							0.04	0.25	9.739319	0.05	0.55	1.74	0.32	0.4						Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.187952	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0					NO	0.064176	0.064176	30.747447	0	0.168622	0.168622	0.168622	42.15555	0.168622	0	0.158464	0.168622	0.168622	0.168622	0.168622	0.168622	0.168622	0.168622			0.168622	0							0	0	0.168622	0	0	0	0	0						18.6372	0.347626632	1.396422906	0	1.340160273	2.171709043	2.215869121	1.591610753	12.00359466	0	4.694360672	0.440782798	0.145801879	2.827318124	6.962554477	10.23506115	0.06625816	0.855403724	0	0	4.483802815	0	0	0	0	0	0	0	0	0	1.642263448	0	0	0	0	0	0	0	0	0	72.0578	0	13.122229	18.6372	0.347626632	1.396422906	0	1.340160273	2.171709043	2.215869121	1.591610753	12.00359466	0	4.694360672	0.440782798	0.145801879	2.827318124	6.962554477	10.23506115	0.06625816	0.855403724	0	0	4.483802815	0	0	0	0	0	0	0	0	0	1.642263448	0	0	0	0	0	0	0	0	0	72.0578	YES						20% Coins				0% Coins																															4900						1.5113				0																															1.5113	0	0.065769	18.6372	0.347626632	1.396422906	0	1.340160273	3.682980043	2.215869121	1.591610753	12.00359466	0	4.694360672	0.440782798	0.145801879	2.827318124	6.962554477	10.23506115	0.06625816	0.855403724	0	0	4.483802815	0	0	0	0	0	0	0	0	0	1.642263448	0	0	0	0	0	0	0	0	0	73.5691
H2944_109_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1643.900577	85.835561	519.660148	300.340802	7.402434	11.99553	12.239451	432.009816	49.280598	9.071114	13.534503	2.434684	0.805342	15.616814	3986.192038	3686.081298	63.141674	1.830184			24.76648	0							0.04	0.25	335.850654	358.334753	0	0	0.05	0.55	1.74	375.487086	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	130.271895	58.254672	0	0.2	0.2	0.2	50	0.242486	0.25	0.244594	0.25	0.2	0.227266	15	35	35	0.25			0.2	0							0	0	0	18.408313	0	0	0	0	0	15	0	0	NO	129.533932	116.763481	37.894839	0	0.172808	0.172808	0.172808	43.202	0.209518	0.21601	0.211339	0.21601	0.172808	0.196367	12.9606	30.2414	30.2414	0.21601			0.172808	0							0	0	0	15.905518	0	0	0	0	0	12.9606	0	0		17.7451	0.835204908	1.64103647	0	1.279199815	2.072923548	2.115075048	1.555307339	10.32517233	1.959451335	2.86036833	0.525916091	0.13916954	3.066626915	4.305286711	9.289354914	0.159124385	0.395338046	0	0	4.279845876	0	0	0	0	0	0	0	0	0	0	0.474958322	0	0	0	0	0	0.405544827	0	0	65.43	0	10.144997	17.7451	0.835204908	1.64103647	0	1.279199815	2.072923548	2.115075048	1.555307339	10.32517233	1.959451335	2.86036833	0.525916091	0.13916954	3.066626915	4.305286711	9.289354914	0.159124385	0.395338046	0	0	4.279845876	0	0	0	0	0	0	0	0	0	0	0.474958322	0	0	0	0	0	0.405544827	0	0	65.43	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.4099																									0										1.4099	0	0.058952	17.7451	0.835204908	1.64103647	0	1.279199815	3.482812548	2.115075048	1.555307339	10.32517233	1.959451335	2.86036833	0.525916091	0.13916954	3.066626915	4.305286711	9.289354914	0.159124385	0.395338046	0	0	4.279845876	0	0	0	0	0	0	0	0	0	0	0.474958322	0	0	0	0	0	0.405544827	0	0	66.8399
H2944_110_0	2010	2	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered				Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin								O	Coin	O	O	O	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	NO	270.487147	5.045196	519.666895	12.065086	7.40253	11.995685	12.23961	432.015424	66.30324	1.459422	27.592024	2.434715	0.805353	15.617014	38.458474	56.534544	0.365984	4.724922			24.766803	0								0.04	9.071232	0.05	0.25	0.32	0.4	0.55	1.74					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15									$0: Nurse hotline 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.187952	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0								0	0.2	0	0	0	0	0	0				NO	0.065377	0.065377	32.368492	0	0.171209	0.171209	0.171209	42.8022	0.171209	0	0.160895	0.171209	0.171209	0.171209	0.171209	0.171209	0.171209	0.171209			0.171209	0								0	0.171209	0	0	0	0	0	0					17.6836	0.329839779	1.401736144	0	1.267379759	2.053769233	2.095531388	1.540934215	11.35171142	0	4.439418701	0.41684512	0.137883682	2.67377335	6.584436875	9.679222744	0.062659755	0.808949171	0	0	4.240299575	0	0	0	0	0	0	0	0	0	1.553076559	0	0	0	0	0	0	0	0	0	68.3211	0	11.105854	17.6836	0.329839779	1.401736144	0	1.267379759	2.053769233	2.095531388	1.540934215	11.35171142	0	4.439418701	0.41684512	0.137883682	2.67377335	6.584436875	9.679222744	0.062659755	0.808949171	0	0	4.240299575	0	0	0	0	0	0	0	0	0	1.553076559	0	0	0	0	0	0	0	0	0	68.3211	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.4099				0																															1.4099	0	0.058952	17.6836	0.329839779	1.401736144	0	1.267379759	3.463676233	2.095531388	1.540934215	11.35171142	0	4.439418701	0.41684512	0.137883682	2.67377335	6.584436875	9.679222744	0.062659755	0.808949171	0	0	4.240299575	0	0	0	0	0	0	0	0	0	1.553076559	0	0	0	0	0	0	0	0	0	69.731
H2944_111_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1714.429596	89.518203	541.955366	313.226462	7.821626	12.674824	12.932559	450.544531	52.071306	9.584802	14.300948	2.572556	0.850948	16.501177	4157.213461	3844.226932	65.85067	1.933826			26.16898	0							0.04	0.25	350.259809	373.708554	0	0	0.05	0.55	1.74	391.596781	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	130.271895	58.254672	0	0.2	0.2	0.2	50	0.242486	0.25	0.244594	0.25	0.2	0.227266	15	35	35	0.25			0.2	0							0	0	0	18.408312	0	0	0	0	0	15	0	0	NO	128.053038	115.428585	36.479076	0	0.171131	0.171131	0.171131	42.7828	0.207485	0.213914	0.209289	0.213914	0.171131	0.194461	12.83484	29.94796	29.94796	0.213914			0.171131	0							0	0	0	15.751183	0	0	0	0	0	12.83484	0	0		18.2948	0.861079959	1.647502582	0	1.338522679	2.169055306	2.213161754	1.60629638	10.80401493	2.050323335	2.993031106	0.550305744	0.145623582	3.208835381	4.446430801	9.593896199	0.164341103	0.413672455	0	0	4.478323716	0	0	0	0	0	0	0	0	0	0	0.490529319	0	0	0	0	0	0.418840169	0	0	67.8886	0	11.389761	18.2948	0.861079959	1.647502582	0	1.338522679	2.169055306	2.213161754	1.60629638	10.80401493	2.050323335	2.993031106	0.550305744	0.145623582	3.208835381	4.446430801	9.593896199	0.164341103	0.413672455	0	0	4.478323716	0	0	0	0	0	0	0	0	0	0	0.490529319	0	0	0	0	0	0.418840169	0	0	67.8886	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.4879																									0										1.4879	0	0.064138	18.2948	0.861079959	1.647502582	0	1.338522679	3.656936306	2.213161754	1.60629638	10.80401493	2.050323335	2.993031106	0.550305744	0.145623582	3.208835381	4.446430801	9.593896199	0.164341103	0.413672455	0	0	4.478323716	0	0	0	0	0	0	0	0	0	0	0.490529319	0	0	0	0	0	0.418840169	0	0	69.3765
H2944_112_0	2010	2	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered				Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin								O	Coin	O	O	O	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	NO	285.804305	5.330896	541.96195	12.748308	7.82172	12.674977	12.932715	450.550004	70.057862	1.542066	29.154503	2.572588	0.850959	16.501378	40.636302	59.735984	0.386709	4.992485			26.169298	0								0.04	9.584919	0.05	0.25	0.32	0.4	0.55	1.74					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15									$0: Nurse hotline 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.187952	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0								0	0.2	0	0	0	0	0	0				NO	0.064473	0.064473	31.075743	0	0.16924	0.16924	0.16924	42.31005	0.16924	0	0.159045	0.16924	0.16924	0.16924	0.16924	0.16924	0.16924	0.16924			0.16924	0								0	0.16924	0	0	0	0	0	0					18.4267	0.343698858	1.403489189	0	1.323747893	2.145113107	2.188732687	1.5885661	11.85659256	0	4.63687793	0.435384793	0.144016301	2.792693213	6.87728775	10.10971793	0.065446631	0.844928161	0	0	4.428891994	0	0	0	0	0	0	0	0	0	1.622151692	0	0	0	0	0	0	0	0	0	71.234	0	12.637491	18.4267	0.343698858	1.403489189	0	1.323747893	2.145113107	2.188732687	1.5885661	11.85659256	0	4.63687793	0.435384793	0.144016301	2.792693213	6.87728775	10.10971793	0.065446631	0.844928161	0	0	4.428891994	0	0	0	0	0	0	0	0	0	1.622151692	0	0	0	0	0	0	0	0	0	71.234	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.4879				0																															1.4879	0	0.064139	18.4267	0.343698858	1.403489189	0	1.323747893	3.633012107	2.188732687	1.5885661	11.85659256	0	4.63687793	0.435384793	0.144016301	2.792693213	6.87728775	10.10971793	0.065446631	0.844928161	0	0	4.428891994	0	0	0	0	0	0	0	0	0	1.622151692	0	0	0	0	0	0	0	0	0	72.7219
H2944_113_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered				Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin								O	Coin	O	O	O	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	NO	265.737397	3.85776	501.179794	9.756128	7.357126	11.225108	9.583045	438.943692	72.605318	1.199611	30.46784	5.181616	0.653155	21.032607	41.079621	75.493813	0.521775	6.267847			27.769096	0								0.04	10.360407	0.05	0.25	0.32	0.4	0.55	2.18					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15									$0: Nurse hotline 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.185511	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0								0	0.2	0	0	0	0	0	0				NO	0.064381	0.064381	31.644698	0	0.168364	0.168364	0.168364	42.09105	0.168364	0	0.156167	0.168364	0.168364	0.168364	0.168364	0.168364	0.168364	0.168364			0.168364	0								0	0.168364	0	0	0	0	0	0					17.1084	0.248366447	1.321640269	0	1.238675162	1.889904083	1.613439788	1.539633407	12.22412176	0	4.758071169	0.872397596	0.109967788	3.541133845	6.91632931	12.71044033	0.087848126	1.055279792	0	0	4.675316079	0	0	0	0	0	0	0	0	0	1.744319564	0	0	0	0	0	0	0	0	0	73.6553	0	13.439129	17.1084	0.248366447	1.321640269	0	1.238675162	1.889904083	1.613439788	1.539633407	12.22412176	0	4.758071169	0.872397596	0.109967788	3.541133845	6.91632931	12.71044033	0.087848126	1.055279792	0	0	4.675316079	0	0	0	0	0	0	0	0	0	1.744319564	0	0	0	0	0	0	0	0	0	73.6553	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.3123				0																															1.3123	0	0.062166	17.1084	0.248366447	1.321640269	0	1.238675162	3.202241083	1.613439788	1.539633407	12.22412176	0	4.758071169	0.872397596	0.109967788	3.541133845	6.91632931	12.71044033	0.087848126	1.055279792	0	0	4.675316079	0	0	0	0	0	0	0	0	0	1.744319564	0	0	0	0	0	0	0	0	0	74.9677
H2944_114_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1455.775302	67.557141	501.17495	188.273428	7.357055	11.224998	9.582951	438.939449	52.771595	10.360308	15.925434	5.181565	0.65315	21.032402	4027.475043	4751.573858	67.801182	2.387455			27.768826	0							0.04	0.25	305.107269	454.062719	0	0	0.05	0.55	2.18	502.067516	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	143.64207	58.254672	0	0.2	0.2	0.2	50	0.240386	0.25	0.240661	0.25	0.2	0.229346	15	35	35	0.25			0.2	0							0	0	0	18.971272	0	0	0	0	0	15	0	0	NO	129.017563	128.234016	38.102808	0	0.171232	0.171232	0.171232	42.80795	0.205809	0.21404	0.206044	0.21404	0.171232	0.196357	12.842385	29.965565	29.965565	0.21404			0.171232	0							0	0	0	16.242425	0	0	0	0	0	12.842385	0	0		15.6517	0.721926958	1.591347741	0	1.259763242	1.922078858	1.640907866	1.565841499	10.8608692	2.217520324	3.281340123	1.109062173	0.111840181	4.12985936	4.310198757	11.86529961	0.169308394	0.511010868	0	0	4.754911614	0	0	0	0	0	0	0	0	0	0	0.614589972	0	0	0	0	0	0.537312028	0	0	68.8267	0	11.354159	15.6517	0.721926958	1.591347741	0	1.259763242	1.922078858	1.640907866	1.565841499	10.8608692	2.217520324	3.281340123	1.109062173	0.111840181	4.12985936	4.310198757	11.86529961	0.169308394	0.511010868	0	0	4.754911614	0	0	0	0	0	0	0	0	0	0	0.614589972	0	0	0	0	0	0.537312028	0	0	68.8267	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.3123																									0										1.3123	0	0.062166	15.6517	0.721926958	1.591347741	0	1.259763242	3.234402858	1.640907866	1.565841499	10.8608692	2.217520324	3.281340123	1.109062173	0.111840181	4.12985936	4.310198757	11.86529961	0.169308394	0.511010868	0	0	4.754911614	0	0	0	0	0	0	0	0	0	0	0.614589972	0	0	0	0	0	0.537312028	0	0	70.139
H2944_115_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1488.670764	69.083698	512.499762	192.527753	7.898586	12.051238	10.288326	448.857955	56.655962	11.1229	17.097659	5.562965	0.701226	22.580537	4118.481981	4858.942914	69.333253	2.563188			29.812812	0							0.04	0.25	312.001633	464.32296	0	0	0.05	0.55	2.18	513.412497	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	143.64207	58.254672	0	0.2	0.2	0.2	50	0.240386	0.25	0.240661	0.25	0.2	0.229346	15	35	35	0.25			0.2	0							0	0	0	18.971272	0	0	0	0	0	15	0	0	NO	127.756917	126.981026	37.049272	0	0.169648	0.169648	0.169648	42.412	0.203905	0.21206	0.204139	0.21206	0.169648	0.194541	12.7236	29.6884	29.6884	0.21206			0.169648	0							0	0	0	16.092192	0	0	0	0	0	12.7236	0	0		15.849	0.731026571	1.582311924	0	1.339979318	2.044468424	1.745393929	1.586413632	11.55243393	2.358722174	3.490299011	1.179682358	0.118961588	4.392840249	4.366826444	12.02118673	0.171532779	0.543549647	0	0	5.05768393	0	0	0	0	0	0	0	0	0	0	0.622664519	0	0	0	0	0	0.544371271	0	0	71.2993	0	12.587921	15.849	0.731026571	1.582311924	0	1.339979318	2.044468424	1.745393929	1.586413632	11.55243393	2.358722174	3.490299011	1.179682358	0.118961588	4.392840249	4.366826444	12.02118673	0.171532779	0.543549647	0	0	5.05768393	0	0	0	0	0	0	0	0	0	0	0.622664519	0	0	0	0	0	0.544371271	0	0	71.2993	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.4057																									0										1.4057	0	0.069946	15.849	0.731026571	1.582311924	0	1.339979318	3.450184424	1.745393929	1.586413632	11.55243393	2.358722174	3.490299011	1.179682358	0.118961588	4.392840249	4.366826444	12.02118673	0.171532779	0.543549647	0	0	5.05768393	0	0	0	0	0	0	0	0	0	0	0.622664519	0	0	0	0	0	0.544371271	0	0	72.7051
H2944_116_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered				Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin								O	Coin	O	O	O	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	NO	285.297443	4.141717	512.504489	10.474244	7.89866	12.05135	10.288421	448.862096	77.949552	1.287911	32.710475	5.563017	0.701232	22.580747	44.103355	81.050664	0.560181	6.729202			29.813088	0								0.04	11.123002	0.05	0.25	0.32	0.4	0.55	2.18					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15									$0: Nurse hotline 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.185511	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0								0	0.2	0	0	0	0	0	0				NO	0.063021	0.063021	30.222287	0	0.165541	0.165541	0.165541	41.38535	0.165541	0	0.153549	0.165541	0.165541	0.165541	0.165541	0.165541	0.165541	0.165541			0.165541	0								0	0.165541	0	0	0	0	0	0					17.9797	0.261015147	1.290754813	0	1.307552075	1.99499253	1.703155501	1.548026245	12.90384679	0	5.022660726	0.920907397	0.116082647	3.738039439	7.30091349	13.41720797	0.092732923	1.113958828	0	0	4.935288401	0	0	0	0	0	0	0	0	0	1.841312874	0	0	0	0	0	0	0	0	0	77.4882	0	15.821655	17.9797	0.261015147	1.290754813	0	1.307552075	1.99499253	1.703155501	1.548026245	12.90384679	0	5.022660726	0.920907397	0.116082647	3.738039439	7.30091349	13.41720797	0.092732923	1.113958828	0	0	4.935288401	0	0	0	0	0	0	0	0	0	1.841312874	0	0	0	0	0	0	0	0	0	77.4882	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.4057				0																															1.4057	0	0.069947	17.9797	0.261015147	1.290754813	0	1.307552075	3.40072153	1.703155501	1.548026245	12.90384679	0	5.022660726	0.920907397	0.116082647	3.738039439	7.30091349	13.41720797	0.092732923	1.113958828	0	0	4.935288401	0	0	0	0	0	0	0	0	0	1.841312874	0	0	0	0	0	0	0	0	0	78.8939
H2944_117_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered				Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin								O	Coin	O	O	O	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	NO	291.185334	4.227193	517.960761	10.690409	8.061669	12.300062	10.500751	453.640812	79.558255	1.31449	33.385544	5.677825	0.715704	23.046762	45.013548	82.723365	0.571742	6.868078			30.42836	0								0.04	11.352556	0.05	0.25	0.32	0.4	0.55	2.18					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15									$0: Nurse hotline 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.185511	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0								0	0.2	0	0	0	0	0	0				NO	0.062602	0.062602	29.76921	0	0.164699	0.164699	0.164699	41.17475	0.164699	0	0.152768	0.164699	0.164699	0.164699	0.164699	0.164699	0.164699	0.164699			0.164699	0								0	0.164699	0	0	0	0	0	0					18.2288	0.264630736	1.284940222	0	1.327748823	2.025807911	1.729463189	1.556545585	13.10316504	0	5.100242786	0.9351321	0.117875733	3.795778655	7.413686342	13.62445549	0.094165336	1.131165579	0	0	5.011520464	0	0	0	0	0	0	0	0	0	1.869754621	0	0	0	0	0	0	0	0	0	78.6149	0	16.581649	18.2288	0.264630736	1.284940222	0	1.327748823	2.025807911	1.729463189	1.556545585	13.10316504	0	5.100242786	0.9351321	0.117875733	3.795778655	7.413686342	13.62445549	0.094165336	1.131165579	0	0	5.011520464	0	0	0	0	0	0	0	0	0	1.869754621	0	0	0	0	0	0	0	0	0	78.6149	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.4337				0																															1.4337	0	0.072435	18.2288	0.264630736	1.284940222	0	1.327748823	3.459502911	1.729463189	1.556545585	13.10316504	0	5.100242786	0.9351321	0.117875733	3.795778655	7.413686342	13.62445549	0.094165336	1.131165579	0	0	5.011520464	0	0	0	0	0	0	0	0	0	1.869754621	0	0	0	0	0	0	0	0	0	80.0486
H2944_118_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1504.520097	69.819207	517.956159	194.577525	8.061598	12.299953	10.500656	453.636781	57.825233	11.352455	17.450524	5.677775	0.715698	23.046555	4162.329951	4910.674301	70.071418	2.616088			30.428091	0							0.04	0.25	315.3234	469.266436	0	0	0.05	0.55	2.18	518.878612	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	143.64207	58.254672	0	0.2	0.2	0.2	50	0.240386	0.25	0.240661	0.25	0.2	0.229346	15	35	35	0.25			0.2	0							0	0	0	18.971272	0	0	0	0	0	15	0	0	NO	127.291419	126.518355	36.635548	0	0.169097	0.169097	0.169097	42.2742	0.203243	0.211371	0.203475	0.211371	0.169097	0.193909	12.68226	29.59194	29.59194	0.211371			0.169097	0							0	0	0	16.039907	0	0	0	0	0	12.68226	0	0		15.9594	0.736117601	1.581300644	0	1.363192037	2.079885152	1.775629428	1.598094334	11.75257383	2.399579766	3.550745371	1.20011698	0.121022385	4.468934433	4.39897922	12.10969827	0.172795766	0.552965137	0	0	5.145298904	0	0	0	0	0	0	0	0	0	0	0.627249166	0	0	0	0	0	0.548379455	0	0	72.1419	0	13.036902	15.9594	0.736117601	1.581300644	0	1.363192037	2.079885152	1.775629428	1.598094334	11.75257383	2.399579766	3.550745371	1.20011698	0.121022385	4.468934433	4.39897922	12.10969827	0.172795766	0.552965137	0	0	5.145298904	0	0	0	0	0	0	0	0	0	0	0.627249166	0	0	0	0	0	0.548379455	0	0	72.1419	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.4337																									0										1.4337	0	0.072435	15.9594	0.736117601	1.581300644	0	1.363192037	3.513567152	1.775629428	1.598094334	11.75257383	2.399579766	3.550745371	1.20011698	0.121022385	4.468934433	4.39897922	12.10969827	0.172795766	0.552965137	0	0	5.145298904	0	0	0	0	0	0	0	0	0	0	0.627249166	0	0	0	0	0	0.548379455	0	0	73.5756
H2944_119_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	254.698111	4.282331	1075.329582	6.311912	6.949065	10.137506	7.886757	431.712436	71.180116	1.291443	28.760432	5.873867	0.799611	21.552244	31.440437	50.941327	0.75099	5.425313			26.878631	0							0.04	0.25	13.290225	221.005919	0.05	0.55	2.53	0.32	0.4					7% Coins:1a	7% Coins:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.065124	0.065124	25.496185	0	0.171308	0.171308	0.171308	42.82705	0.171308	0	0.171308	0.171308	0.171308	0.171308	0.171308	0.171308	0.171308	0.171308			0.171308	0							0	0	0.171308	0	0	0	0	0	0					16.587	0.278882524	2.284733497	0	1.190430427	1.736635878	1.351064568	1.540747507	12.19372331	0	4.926892085	1.006240408	0.136979761	3.692071815	5.385998382	8.726656846	0.128650595	0.929399519	0	0	4.604524519	0	0	0	0	0	0	0	0	0	2.276721864	0	0	0	0	0	0	0	0	0	68.9773	0	12.492896	16.587	0.278882524	2.284733497	0	1.190430427	1.736635878	1.351064568	1.540747507	12.19372331	0	4.926892085	1.006240408	0.136979761	3.692071815	5.385998382	8.726656846	0.128650595	0.929399519	0	0	4.604524519	0	0	0	0	0	0	0	0	0	2.276721864	0	0	0	0	0	0	0	0	0	68.9773	YES						20% Coins				$0/Visit																															5000						1.1829				0																															1.1829	0	0.058414	16.587	0.278882524	2.284733497	0	1.190430427	2.919548878	1.351064568	1.540747507	12.19372331	0	4.926892085	1.006240408	0.136979761	3.692071815	5.385998382	8.726656846	0.128650595	0.929399519	0	0	4.604524519	0	0	0	0	0	0	0	0	0	2.276721864	0	0	0	0	0	0	0	0	0	70.1602
H2944_120_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	293.949609	3.538641	671.080505	10.246814	10.340433	12.914871	9.547785	481.078015	72.07503	1.626686	29.03127	7.589106	0.615175	20.466507	35.712118	55.697993	0.603385	4.068961			25.217734	0							0.04	0.25	10.995678	166.35968	0.05	0.55	2.08	0.32	0.4					7% Coins:1a	7% Coins:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.064431	0.064431	29.411669	0	0.169425	0.169425	0.169425	42.3563	0.169425	0	0.169425	0.169425	0.169425	0.169425	0.169425	0.169425	0.169425	0.169425			0.169425	0							0	0	0.169425	0	0	0	0	0	0					18.9395	0.227998178	1.644799807	0	1.751927861	2.188102019	1.617633474	1.698057061	12.21131196	0	4.91862292	1.285784284	0.104226024	3.467537948	6.050525592	9.436632464	0.102228504	0.689383717	0	0	4.272514583	0	0	0	0	0	0	0	0	0	1.862942745	0	0	0	0	0	0	0	0	0	72.4697	0	13.022354	18.9395	0.227998178	1.644799807	0	1.751927861	2.188102019	1.617633474	1.698057061	12.21131196	0	4.91862292	1.285784284	0.104226024	3.467537948	6.050525592	9.436632464	0.102228504	0.689383717	0	0	4.272514583	0	0	0	0	0	0	0	0	0	1.862942745	0	0	0	0	0	0	0	0	0	72.4697	YES						20% Coins				$0/Visit																															5000						1.5104				0																															1.5104	0	0.071039	18.9395	0.227998178	1.644799807	0	1.751927861	3.698476019	1.617633474	1.698057061	12.21131196	0	4.91862292	1.285784284	0.104226024	3.467537948	6.050525592	9.436632464	0.102228504	0.689383717	0	0	4.272514583	0	0	0	0	0	0	0	0	0	1.862942745	0	0	0	0	0	0	0	0	0	73.9801
H2944_121_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	294.714379	4.001736	1258.832318	10.422839	9.610612	10.683423	9.886131	481.989492	67.612846	1.245516	30.209027	5.528409	0.273704	22.646476	37.465969	60.480267	0.711839	5.757269			27.066996	0							0.04	0.25	14.027823	223.14712	0.05	0.55	2.34	0.32	0.4					7% Coins:1a	7% Coins:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.063307	0.063307	22.244044	0	0.167695	0.167695	0.167695	41.92385	0.167695	0	0.167695	0.167695	0.167695	0.167695	0.167695	0.167695	0.167695	0.167695			0.167695	0							0	0	0.167695	0	0	0	0	0	0					18.6575	0.253337901	2.333460123	0	1.611651579	1.79155662	1.657854738	1.683904597	11.33833621	0	5.065902783	0.927086547	0.045898792	3.797700793	6.282855671	10.14223837	0.119371841	0.965465225	0	0	4.538999894	0	0	0	0	0	0	0	0	0	2.352395778	0	0	0	0	0	0	0	0	0	73.5655	0	15.781526	18.6575	0.253337901	2.333460123	0	1.611651579	1.79155662	1.657854738	1.683904597	11.33833621	0	5.065902783	0.927086547	0.045898792	3.797700793	6.282855671	10.14223837	0.119371841	0.965465225	0	0	4.538999894	0	0	0	0	0	0	0	0	0	2.352395778	0	0	0	0	0	0	0	0	0	73.5655	YES				$0/Visit		20% Coins				$0/Visit																															5000				0		1.2533				0																															1.2533	0	0.05487	18.6575	0.253337901	2.333460123	0	1.611651579	3.04486062	1.657854738	1.683904597	11.33833621	0	5.065902783	0.927086547	0.045898792	3.797700793	6.282855671	10.14223837	0.119371841	0.965465225	0	0	4.538999894	0	0	0	0	0	0	0	0	0	2.352395778	0	0	0	0	0	0	0	0	0	74.8188
H2944_122_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	338.82916	4.600742	1383.384213	11.982998	11.049192	12.282588	11.365952	529.678691	77.733582	1.431954	34.730912	6.355938	0.314672	26.036349	43.07412	69.533349	0.818392	6.619054			31.118563	0							0.04	0.25	16.127599	245.225832	0.05	0.55	2.34	0.32	0.4					7% Coins:1a	7% Coins:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.060516	0.060516	19.560761	0	0.162091	0.162091	0.162091	40.52285	0.162091	0	0.162091	0.162091	0.162091	0.162091	0.162091	0.162091	0.162091	0.162091			0.162091	0							0	0	0.162091	0	0	0	0	0	0					20.5046	0.278418503	2.255003997	0	1.79097458	1.990896972	1.842318526	1.788674179	12.59991404	0	5.629568257	1.030240346	0.051005499	4.220257846	6.981927185	11.27073007	0.132653978	1.072889082	0	0	5.044038995	0	0	0	0	0	0	0	0	0	2.61413865	0	0	0	0	0	0	0	0	0	81.0982	0	21.26636	20.5046	0.278418503	2.255003997	0	1.79097458	1.990896972	1.842318526	1.788674179	12.59991404	0	5.629568257	1.030240346	0.051005499	4.220257846	6.981927185	11.27073007	0.132653978	1.072889082	0	0	5.044038995	0	0	0	0	0	0	0	0	0	2.61413865	0	0	0	0	0	0	0	0	0	81.0982	YES				$0/Visit		20% Coins				$0/Visit																															5000				0		1.4352				0																															1.4352	0	0.068789	20.5046	0.278418503	2.255003997	0	1.79097458	3.426097972	1.842318526	1.788674179	12.59991404	0	5.629568257	1.030240346	0.051005499	4.220257846	6.981927185	11.27073007	0.132653978	1.072889082	0	0	5.044038995	0	0	0	0	0	0	0	0	0	2.61413865	0	0	0	0	0	0	0	0	0	82.5334
H2944_123_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	270.7804311	3.67675235	1292.33204	11.266345	10.388387	11.548018	10.686203	494.816073	64.15264283	1.346315	27.7263628	4.7806528	0.25147505	21.45519332	40.498038	65.374852	0.769447	5.568167155			29.257494	0							0.04	0.25	12.1304608	229.085454	0.05	0.55	2.34	0.32	0.4					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.061841	0.061841	21.029504	0	0.164691	0.164691	0.164691	41.17285	0.164691	0	0.164691	0.164691	0.164691	0.164691	0.164691	0.164691	0.164691	0.164691			0.164691	0							0	0	0.164691	0	0	0	0	0	0					16.7453	0.227374042	2.264758484	0	1.710873843	1.901854632	1.759921458	1.697748996	10.5653629	0	4.566282416	0.78733049	0.041415677	3.533477244	6.669662376	10.76664975	0.126720996	0.917027017	0	0	4.818445944	0	0	0	0	0	0	0	0	0	1.99777772	0	0	0	0	0	0	0	0	0	71.098	0	18.510855	16.7453	0.227374042	2.264758484	0	1.710873843	1.901854632	1.759921458	1.697748996	10.5653629	0	4.566282416	0.78733049	0.041415677	3.533477244	6.669662376	10.76664975	0.126720996	0.917027017	0	0	4.818445944	0	0	0	0	0	0	0	0	0	1.99777772	0	0	0	0	0	0	0	0	0	71.098	YES	25% Coins	25% Coins		$0/Visit		20% Coins			25% Coins	$0/Visit	25% Coins	25% Coins	20% Coins	25% Coins				25% Coins													25% Coins										5000	10.0649	0.1367		0		1.3519			1.8388	0	1.0144	0.246	0.0073	0.6225				0.1348													0.6243										16.0417	0	0.0621	26.8102	0.364038998	2.264758484	0	1.710873843	3.253797632	1.759921458	1.697748996	12.40414207	0	5.580663322	1.033371268	0.048724326	4.156015333	6.669662376	10.76664975	0.126720996	1.051873917	0	0	4.818445944	0	0	0	0	0	0	0	0	0	2.622083257	0	0	0	0	0	0	0	0	0	87.1397
H2944_124_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1403.07358	73.035993	1075.327358	152.640453	169.700409	10.137485	7.886742	431.711543	53.453623	13.290198	18.459444	5.873855	0.79961	21.552201	3631.532988	3886.821372	107.632939	3.092896			26.878575	0							0.04	0.25	827.771379	414.202664	0	0.05	0.55	2.53	357.062274	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.240405	0.25	0.243861	0.25	0.2	0.230314	15	35	35	0.25			0.2	0							0	0	0	34.982368	0	0	0	0	35	0	0		NO	128.338465	127.559042	26.452258	0	128.40735	0.17121	0.17121	42.80245	0.205798	0.214012	0.208757	0.214012	0.17121	0.19716	12.840735	29.961715	29.961715	0.214012			0.17121	0							0	0	0	29.946621	0	0	0	0	29.961715	0	0			15.0057	0.776366775	2.370403059	0	1.815898318	1.735638807	1.350289098	1.539859311	11.00064871	2.844261854	3.853538151	1.257075456	0.136901228	4.249231949	3.885962729	9.70465285	0.268738954	0.661916859	0	0	4.601880826	0	0	0	0	0	0	0	0	0	0	1.033664183	0	0	0	0	0.891516508	0	0	0	68.9841	0	12.715492	15.0057	0.776366775	2.370403059	0	1.815898318	1.735638807	1.350289098	1.539859311	11.00064871	2.844261854	3.853538151	1.257075456	0.136901228	4.249231949	3.885962729	9.70465285	0.268738954	0.661916859	0	0	4.601880826	0	0	0	0	0	0	0	0	0	0	1.033664183	0	0	0	0	0.891516508	0	0	0	68.9841	YES						20% Coins																									$0/Visit										5000						1.1829																									0										1.1829	0	0.058413	15.0057	0.776366775	2.370403059	0	1.815898318	2.918550807	1.350289098	1.539859311	11.00064871	2.844261854	3.853538151	1.257075456	0.136901228	4.249231949	3.885962729	9.70465285	0.268738954	0.661916859	0	0	4.601880826	0	0	0	0	0	0	0	0	0	0	1.033664183	0	0	0	0	0.891516508	0	0	0	70.1671
H2944_125_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1655.071788	86.153579	1268.460897	180.055352	200.179352	12.863401	10.007444	509.248841	67.82702	16.863862	23.423091	7.453303	1.01462	27.347472	4283.77234	4584.911644	126.96429	3.92456			34.106083	0							0.04	0.25	976.442771	488.59529	0	0.05	0.55	2.53	421.192234	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.240405	0.25	0.243861	0.25	0.2	0.230314	15	35	35	0.25			0.2	0							0	0	0	34.982368	0	0	0	0	35	0	0		NO	128.045812	127.268167	26.538848	0	127.9929	0.170657	0.170657	42.6643	0.205134	0.213322	0.208083	0.213322	0.170657	0.196523	12.79929	29.86501	29.86501	0.213322			0.170657	0							0	0	0	29.849965	0	0	0	0	29.86501	0	0			17.6604	0.91371734	2.805290912	0	2.135127982	2.195229424	1.707840371	1.810562111	13.91362792	3.59743277	4.873947045	1.589953503	0.173152005	5.37440724	4.569103706	11.41070267	0.315982483	0.837194988	0	0	5.820441807	0	0	0	0	0	0	0	0	0	0	1.215379359	0	0	0	0	1.048242523	0	0	0	83.9678	0	15.711058	17.6604	0.91371734	2.805290912	0	2.135127982	2.195229424	1.707840371	1.810562111	13.91362792	3.59743277	4.873947045	1.589953503	0.173152005	5.37440724	4.569103706	11.41070267	0.315982483	0.837194988	0	0	5.820441807	0	0	0	0	0	0	0	0	0	0	1.215379359	0	0	0	0	1.048242523	0	0	0	83.9678	YES						20% Coins																									$0/Visit										6000						1.4979																									0										1.4979	0	0.077207	17.6604	0.91371734	2.805290912	0	2.135127982	3.693132424	1.707840371	1.810562111	13.91362792	3.59743277	4.873947045	1.589953503	0.173152005	5.37440724	4.569103706	11.41070267	0.315982483	0.837194988	0	0	5.820441807	0	0	0	0	0	0	0	0	0	0	1.215379359	0	0	0	0	1.048242523	0	0	0	85.4657
H2944_127_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1643.785323	60.25239	671.072997	303.612351	229.452104	12.914727	9.547678	481.072632	54.427733	10.995554	17.890547	7.589022	0.615168	20.46628	4158.031307	4023.244896	103.82817	1.99238			25.217453	0							0.04	0.25	675.975271	375.263766	0	0.05	0.55	2.08	310.690381	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.242856	0.25	0.241558	0.25	0.2	0.230741	15	35	35	0.25			0.2	0							0	0	0	41.751822	0	0	0	0	35	0	0		NO	132.484014	131.679415	35.852412	0	131.8521	0.175803	0.175803	43.9507	0.213474	0.219754	0.212333	0.219754	0.175803	0.202825	13.18521	30.76549	30.76549	0.219754			0.175803	0							0	0	0	36.700436	0	0	0	0	30.76549	0	0			18.1479	0.661166622	2.004965464	0	2.521145147	2.270447751	1.678510435	1.761956577	11.61890587	2.416316974	3.798753516	1.667717941	0.10814838	4.151073241	4.568709664	10.31475838	0.26619371	0.437833475	0	0	4.43330389	0	0	0	0	0	0	0	0	0	0	1.147695319	0	0	0	0	0.796545151	0	0	0	74.7721	0	9.968913	18.1479	0.661166622	2.004965464	0	2.521145147	2.270447751	1.678510435	1.761956577	11.61890587	2.416316974	3.798753516	1.667717941	0.10814838	4.151073241	4.568709664	10.31475838	0.26619371	0.437833475	0	0	4.43330389	0	0	0	0	0	0	0	0	0	0	1.147695319	0	0	0	0	0.796545151	0	0	0	74.7721	YES						20% Coins																									$0/Visit										6000						1.5175																									0										1.5175	0	0.063857	18.1479	0.661166622	2.004965464	0	2.521145147	3.787985751	1.678510435	1.761956577	11.61890587	2.416316974	3.798753516	1.667717941	0.10814838	4.151073241	4.568709664	10.31475838	0.26619371	0.437833475	0	0	4.43330389	0	0	0	0	0	0	0	0	0	0	1.147695319	0	0	0	0	0.796545151	0	0	0	76.2896
H2944_128_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1788.656586	65.562597	730.216482	330.370532	249.67434	14.973589	11.069767	523.470869	63.104589	12.748462	20.742655	8.798861	0.713238	23.729008	4524.489892	4377.824389	112.978829	2.310004			29.237612	0							0.04	0.25	735.550806	408.33678	0	0.05	0.55	2.08	338.072368	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.242856	0.25	0.241558	0.25	0.2	0.230741	15	35	35	0.25			0.2	0							0	0	0	41.751822	0	0	0	0	35	0	0		NO	147.495533	130.439609	38.4381	0	133.7793	0.178372	0.178372	44.5931	0.216594	0.222966	0.215436	0.222966	0.178372	0.20579	13.37793	31.21517	31.21517	0.222966			0.178372	0							0	0	0	37.236864	0	0	0	0	31.21517	0	0			21.9849	0.712663293	2.33901118	0	2.783438203	2.670869017	1.974536479	1.945265734	13.66807535	2.842473578	4.468714623	1.961846842	0.127221689	4.883192556	5.044025755	11.38787771	0.293887779	0.515052352	0	0	5.215171328	0	0	0	0	0	0	0	0	0	0	1.267098429	0	0	0	0	0.879415537	0	0	0	86.9647	0	9.991398	21.9849	0.712663293	2.33901118	0	2.783438203	2.670869017	1.974536479	1.945265734	13.66807535	2.842473578	4.468714623	1.961846842	0.127221689	4.883192556	5.044025755	11.38787771	0.293887779	0.515052352	0	0	5.215171328	0	0	0	0	0	0	0	0	0	0	1.267098429	0	0	0	0	0.879415537	0	0	0	86.9647	YES						20% Coins																									$0/Visit										7500						1.7624																									0										1.7624	0	0.07112	21.9849	0.712663293	2.33901118	0	2.783438203	4.433250017	1.974536479	1.945265734	13.66807535	2.842473578	4.468714623	1.961846842	0.127221689	4.883192556	5.044025755	11.38787771	0.293887779	0.515052352	0	0	5.215171328	0	0	0	0	0	0	0	0	0	0	1.267098429	0	0	0	0	0.879415537	0	0	0	88.7271
H2944_129_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1568.600996	69.39259	1258.797712	280.913841	248.012518	10.68313	9.88586	481.976242	49.514263	14.027437	20.565665	5.528257	0.273695	22.645856	4212.354956	4126.001382	79.754004	2.904329			27.066253	0							0.04	0.25	558.834709	347.033403	0	0.05	0.55	2.34	389.395271	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 13-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	100	0	150	0.2	0.2	50	0.239846	0.25	0.24372	0.25	0.2	0.230463	15	35	35	0.25			0.2	0							0	0	0	26.775322	0	0	0	0	35	0	0		NO	145.23737	128.442572	45.8116	0	133.8255	0.178434	0.178434	44.6085	0.213984	0.223043	0.217439	0.223043	0.178434	0.205612	13.38255	31.22595	31.22595	0.223043			0.178434	0							0	0	0	23.888139	0	0	0	0	31.22595	0	0			18.985	0.742746895	4.805628105	0	2.765866602	1.906233618	1.763973543	1.791686433	10.59526005	3.128721631	4.471777632	1.233039026	0.048836494	4.656259744	4.697670901	10.73652607	0.207532878	0.647790253	0	0	4.829539788	0	0	0	0	0	0	0	0	0	0	0.690831847	0	0	0	0	1.013269772	0	0	0	79.7181	0	14.190552	18.985	0.742746895	4.805628105	0	2.765866602	1.906233618	1.763973543	1.791686433	10.59526005	3.128721631	4.471777632	1.233039026	0.048836494	4.656259744	4.697670901	10.73652607	0.207532878	0.647790253	0	0	4.829539788	0	0	0	0	0	0	0	0	0	0	0.690831847	0	0	0	0	1.013269772	0	0	0	79.7181	YES				$0/Visit		20% Coins																									$0/Visit										7500				0		1.2631																									0										1.2631	0	0.045066	18.985	0.742746895	4.805628105	0	2.765866602	3.169305618	1.763973543	1.791686433	10.59526005	3.128721631	4.471777632	1.233039026	0.048836494	4.656259744	4.697670901	10.73652607	0.207532878	0.647790253	0	0	4.829539788	0	0	0	0	0	0	0	0	0	0	0.690831847	0	0	0	0	1.013269772	0	0	0	80.9812
H2944_131_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1723.835056	76.259915	1383.372591	308.714025	272.556676	12.282485	11.365857	529.674241	56.926969	16.127464	23.644521	6.355884	0.31467	26.036131	4629.223849	4534.324433	87.64673	3.339132			31.118302	0							0.04	0.25	614.138882	381.377002	0	0.05	0.55	2.34	427.931144	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.239846	0.25	0.24372	0.25	0.2	0.230463	15	35	35	0.25			0.2	0							0	0	0	26.775323	0	0	0	0	35	0	0		NO	139.722141	123.565108	25.036811	0	127.80345	0.170405	0.170405	42.60115	0.204355	0.213006	0.207655	0.213006	0.170405	0.19636	12.780345	29.820805	29.820805	0.213006			0.170405	0							0	0	0	22.813191	0	0	0	0	29.820805	0	0			20.0715	0.785255386	2.886269842	0	2.902806959	2.092996856	1.936798862	1.880394316	11.63331075	3.435246597	4.909903008	1.353841427	0.053621341	5.112454683	4.930256489	11.26810039	0.217808004	0.711255151	0	0	5.302714252	0	0	0	0	0	0	0	0	0	0	0.725035532	0	0	0	0	1.0634376	0	0	0	83.273	0	16.14542	20.0715	0.785255386	2.886269842	0	2.902806959	2.092996856	1.936798862	1.880394316	11.63331075	3.435246597	4.909903008	1.353841427	0.053621341	5.112454683	4.930256489	11.26810039	0.217808004	0.711255151	0	0	5.302714252	0	0	0	0	0	0	0	0	0	0	0.725035532	0	0	0	0	1.0634376	0	0	0	83.273	YES				$0/Visit		20% Coins																									$0/Visit										6000				0		1.4424																									0										1.4424	0	0.061615	20.0715	0.785255386	2.886269842	0	2.902806959	3.535359856	1.936798862	1.880394316	11.63331075	3.435246597	4.909903008	1.353841427	0.053621341	5.112454683	4.930256489	11.26810039	0.217808004	0.711255151	0	0	5.302714252	0	0	0	0	0	0	0	0	0	0	0.725035532	0	0	0	0	1.0634376	0	0	0	84.7154
H2944_132_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1368.827431	60.5549027	1292.329424	288.396792	254.619048	11.547995	10.686182	494.815071	46.98148051	12.1304352	18.87600105	4.7806424	0.295853	21.455153	4324.563193	4235.909342	81.878482	2.809005318			29.257434	0							0.04	0.25	573.720885	356.27764	0	0.05	0.55	2.34	399.767939	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.239846	0.25	0.24372	0.25	0.2	0.230463	15	35	35	0.25			0.2	0							0	0	0	26.775322	0	0	0	0	35	0	0		NO	129.932663	129.143558	27.250657	0	129.9687	0.173292	0.173292	43.3229	0.207817	0.216615	0.211173	0.216615	0.173292	0.199686	12.99687	30.32603	30.32603	0.216615			0.173292	0							0	0	0	23.199692	0	0	0	0	30.32603	0	0			14.8213	0.651689632	2.934735489	0	2.757708889	2.00117515	1.851829851	1.786401987	9.763550335	2.627634221	3.986101769	1.035558853	0.051268958	4.284293683	4.683815469	10.70485948	0.206920775	0.608472687	0	0	5.070079253	0	0	0	0	0	0	0	0	0	0	0.688794293	0	0	0	0	1.010281209	0	0	0	71.5265	0	13.325896	14.8213	0.651689632	2.934735489	0	2.757708889	2.00117515	1.851829851	1.786401987	9.763550335	2.627634221	3.986101769	1.035558853	0.051268958	4.284293683	4.683815469	10.70485948	0.206920775	0.608472687	0	0	5.070079253	0	0	0	0	0	0	0	0	0	0	0.688794293	0	0	0	0	1.010281209	0	0	0	71.5265	YES	25% Coins	25% Coins		$0/Visit		20% Coins			25% Surgery OP -- Facility	25% Lab -- OP	"25% Coins:  25% DMAM -- OP,$0 SMAM -- OP,25% Advanced Imaging -- OP,25% Radiology OP -- Facility"	25% Coins		"25% Coins:25% Cardiac Rehab,25% Nuclear Medicine,25% OP Other,25% Psych -- OP"				25% Coins: Therapy (PT/OT/ST) -- OP													$0/Visit										6000	11.0603	0.1502		0		1.358			1.3477	0.6512	0.7023	0.2567		0.5987				0.071													0										16.196	0	0.056035	25.8816	0.801870634	2.934735489	0	2.757708889	3.35918015	1.851829851	1.786401987	11.11121476	3.278877863	4.688390001	1.292216007	0.051268958	4.882944593	4.683815469	10.70485948	0.206920775	0.679435121	0	0	5.070079253	0	0	0	0	0	0	0	0	0	0	0.688794293	0	0	0	0	1.010281209	0	0	0	87.7224
H2944_133_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1362.249572	74.93202	754.201122	218.798728	8.037073	12.123162	11.374235	459.69175	43.650425	8.784699	15.980827	8.225026	0.399874	19.631779	4373.087142	3785.042448	94.17643	2.624022			20.249545	0							0.04	0.25	355.871331	402.092579	0	0	0.05	0.55	2.14	304.762694	0.32	0.4		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.244163	0.25	0.246329	0.25	0.2	0.229156	15	35	35	0.25			0.2	0							0	0	0	19.927181	0	0	0	0	0	15	0	0	NO	146.648881	129.690861	39.004474	0	0.177943	0.177943	0.177943	44.4857	0.217235	0.222429	0.219162	0.222429	0.177943	0.203883	13.34571	31.13999	31.13999	0.222429			0.177943	0							0	0	0	17.729492	0	0	0	0	0	13.34571	0	0		16.6477	0.809833183	2.451434838	0	1.430140881	2.157231816	2.023965499	1.70414244	9.482400075	1.953971814	3.502390007	1.829484308	0.071154779	4.002585998	4.863496067	9.822181998	0.244387757	0.583658589	0	0	3.603264786	0	0	0	0	0	0	0	0	0	0	0.594074764	0	0	0	0	0	0.338939544	0	0	68.1164	0	8.626937	16.6477	0.809833183	2.451434838	0	1.430140881	2.157231816	2.023965499	1.70414244	9.482400075	1.953971814	3.502390007	1.829484308	0.071154779	4.002585998	4.863496067	9.822181998	0.244387757	0.583658589	0	0	3.603264786	0	0	0	0	0	0	0	0	0	0	0.594074764	0	0	0	0	0	0.338939544	0	0	68.1164	YES						20% Coins																									0% Coins										5900						1.4251																									0										1.4251	0	0.059374	16.6477	0.809833183	2.451434838	0	1.430140881	3.582326816	2.023965499	1.70414244	9.482400075	1.953971814	3.502390007	1.829484308	0.071154779	4.002585998	4.863496067	9.822181998	0.244387757	0.583658589	0	0	3.603264786	0	0	0	0	0	0	0	0	0	0	0.594074764	0	0	0	0	0	0.338939544	0	0	69.5415
H2944_134_0	2010	6	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	O	O	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	NO	251.912518	4.137105	754.209772	9.460416	8.037165	12.123301	11.374366	459.697023	59.472301	1.387696	28.310244	8.22512	0.39988	19.632003	43.670223	57.431521	0.647134	4.846889			20.249778	0							0.04	0.25	8.7848	0.05	0.55	2.14	0.32	0.4						Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.188679	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0					NO	0.065271	0.065271	29.088446	0	0.171048	0.171048	0.171048	42.762	0.171048	0	0.161366	0.171048	0.171048	0.171048	0.171048	0.171048	0.171048	0.171048			0.171048	0							0	0	0.171048	0	0	0	0	0						16.4426	0.27003298	1.828232519	0	1.374740999	2.073666389	1.945562556	1.638130341	10.17261814	0	4.568310833	1.406890326	0.068398674	3.358014849	7.469704304	9.823546804	0.110690976	0.82905067	0	0	3.463684027	0	0	0	0	0	0	0	0	0	1.50262247	0	0	0	0	0	0	0	0	0	68.3465	0	11.691774	16.4426	0.27003298	1.828232519	0	1.374740999	2.073666389	1.945562556	1.638130341	10.17261814	0	4.568310833	1.406890326	0.068398674	3.358014849	7.469704304	9.823546804	0.110690976	0.82905067	0	0	3.463684027	0	0	0	0	0	0	0	0	0	1.50262247	0	0	0	0	0	0	0	0	0	68.3465	YES						20% Coins				0% Coins																															4900						1.4184				0																															1.4184	0	0.066079	16.4426	0.27003298	1.828232519	0	1.374740999	3.492073389	1.945562556	1.638130341	10.17261814	0	4.568310833	1.406890326	0.068398674	3.358014849	7.469704304	9.823546804	0.110690976	0.82905067	0	0	3.463684027	0	0	0	0	0	0	0	0	0	1.50262247	0	0	0	0	0	0	0	0	0	69.7649
H2944_135_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1378.820103	75.8435	763.375295	221.460216	8.33673	12.575166	11.798317	465.283484	45.277906	9.112231	16.576664	8.531691	0.414785	20.363738	4426.281782	3831.084057	95.322001	2.721857			21.004539	0							0.04	0.25	360.200183	406.98367	0	0	0.05	0.55	2.14	308.469856	0.32	0.4		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.244163	0.25	0.246329	0.25	0.2	0.229156	15	35	35	0.25			0.2	0							0	0	0	19.927181	0	0	0	0	0	15	0	0	NO	146.226586	129.317399	38.509542	0	0.17732	0.17732	0.17732	44.3299	0.216474	0.22165	0.218395	0.22165	0.17732	0.203169	13.29897	31.03093	31.03093	0.22165			0.17732	0							0	0	0	17.667399	0	0	0	0	0	13.29897	0	0		16.8017	0.817323679	2.449769415	0	1.478268964	2.229828435	2.09207757	1.71883086	9.801489423	2.019726001	3.620260534	1.89104931	0.073549676	4.137280286	4.905415719	9.906841766	0.246494195	0.603299604	0	0	3.724524855	0	0	0	0	0	0	0	0	0	0	0.59919524	0	0	0	0	0	0.341860947	0	0	69.4588	0	9.083233	16.8017	0.817323679	2.449769415	0	1.478268964	2.229828435	2.09207757	1.71883086	9.801489423	2.019726001	3.620260534	1.89104931	0.073549676	4.137280286	4.905415719	9.906841766	0.246494195	0.603299604	0	0	3.724524855	0	0	0	0	0	0	0	0	0	0	0.59919524	0	0	0	0	0	0.341860947	0	0	69.4588	YES				$0/Visit		20% Coins																									$0/Visit										5900				0		1.477																									0										1.477	0	0.062818	16.8017	0.817323679	2.449769415	0	1.478268964	3.706826435	2.09207757	1.71883086	9.801489423	2.019726001	3.620260534	1.89104931	0.073549676	4.137280286	4.905415719	9.906841766	0.246494195	0.603299604	0	0	3.724524855	0	0	0	0	0	0	0	0	0	0	0.59919524	0	0	0	0	0	0.341860947	0	0	70.9358
H2944_136_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered				Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin								O	Coin	O	O	O	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	NO	261.304837	4.291353	763.383778	9.813138	8.336823	12.575306	11.798448	465.288654	61.689666	1.439435	29.365762	8.531786	0.414789	20.363965	45.298426	59.5728	0.671262	5.0276			21.00477	0								0.04	9.112333	0.05	0.25	0.32	0.4	0.55	2.14					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15									$0: Nurse hotline 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.188679	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0								0	0.2	0	0	0	0	0	0				NO	0.064721	0.064721	28.409979	0	0.169808	0.169808	0.169808	42.452	0.169808	0	0.160196	0.169808	0.169808	0.169808	0.169808	0.169808	0.169808	0.169808			0.169808	0								0	0.169808	0	0	0	0	0	0					16.9119	0.277740658	1.807309758	0	1.41565924	2.135387561	2.003470858	1.646036162	10.4753988	0	4.704277609	1.448765517	0.070434491	3.457964169	7.692035122	10.11593802	0.113985658	0.853726701	0	0	3.566777984	0	0	0	0	0	0	0	0	0	1.547347042	0	0	0	0	0	0	0	0	0	70.2442	0	12.654482	16.9119	0.277740658	1.807309758	0	1.41565924	2.135387561	2.003470858	1.646036162	10.4753988	0	4.704277609	1.448765517	0.070434491	3.457964169	7.692035122	10.11593802	0.113985658	0.853726701	0	0	3.566777984	0	0	0	0	0	0	0	0	0	1.547347042	0	0	0	0	0	0	0	0	0	70.2442	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.4696				0																															1.4696	0	0.070211	16.9119	0.277740658	1.807309758	0	1.41565924	3.605009561	2.003470858	1.646036162	10.4753988	0	4.704277609	1.448765517	0.070434491	3.457964169	7.692035122	10.11593802	0.113985658	0.853726701	0	0	3.566777984	0	0	0	0	0	0	0	0	0	1.547347042	0	0	0	0	0	0	0	0	0	71.7138
H2944_137_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1480.845983	81.455545	819.861298	237.847178	9.014388	13.597348	12.757352	499.712164	48.958352	9.852926	17.924111	9.225197	0.448501	22.019021	4753.804781	4114.565364	102.375359	2.943106			22.711908	0							0.04	0.25	386.853219	437.098453	0	0	0.05	0.55	2.14	331.295102	0.32	0.4		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	158.7573	140.3991	58.254672	0	0.2	0.2	0.2	50	0.244163	0.25	0.246329	0.25	0.2	0.229156	15	35	35	0.25			0.2	0							0	0	0	19.927181	0	0	0	0	0	15	0	0	NO	144.496767	127.78761	36.288699	0	0.175175	0.175175	0.175175	43.79375	0.213856	0.218969	0.215753	0.218969	0.175175	0.200712	13.138125	30.655625	30.655625	0.218969			0.175175	0							0	0	0	17.45372	0	0	0	0	0	13.138125	0	0		17.8315	0.867417451	2.479308322	0	1.579095418	2.381915436	2.234769137	1.823689132	10.47003733	2.157485353	3.867180721	2.020032162	0.078566163	4.419481743	5.204673453	10.5112144	0.261531718	0.644448978	0	0	3.978558484	0	0	0	0	0	0	0	0	0	0	0.635749501	0	0	0	0	0	0.362716372	0	0	73.8093	0	10.804814	17.8315	0.867417451	2.479308322	0	1.579095418	2.381915436	2.234769137	1.823689132	10.47003733	2.157485353	3.867180721	2.020032162	0.078566163	4.419481743	5.204673453	10.5112144	0.261531718	0.644448978	0	0	3.978558484	0	0	0	0	0	0	0	0	0	0	0.635749501	0	0	0	0	0	0.362716372	0	0	73.8093	YES				$0/Visit		20% Coins																									$0/Visit										5900				0		1.5941																									0										1.5941	0	0.070887	17.8315	0.867417451	2.479308322	0	1.579095418	3.976010436	2.234769137	1.823689132	10.47003733	2.157485353	3.867180721	2.020032162	0.078566163	4.419481743	5.204673453	10.5112144	0.261531718	0.644448978	0	0	3.978558484	0	0	0	0	0	0	0	0	0	0	0.635749501	0	0	0	0	0	0.362716372	0	0	75.4034
H2944_138_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Lab	Radiology	Radiology	Radiology	Other						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	Coin	V	V	Coin	Coin	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	0	NO	1478.172994	74.419897	779.935568	265.428615	183.227836	12.28921	10.033055	458.913334	9.801678	13.766359	2.893637	6.424857	0.48163	0.616789	3966.410825	4121.923927	107.235544	3.194649			11.118101	0							0.55	0.32	492.757669	17.717261	165.801597	250.26242	25.767633	45.652458	0	2.59	0.04	0.7		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	25% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	25% Coins:9a	20% Coins:12	"25% Coins:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Health Education Materials 14a	$0: LifeSynch Wellness Program 14a	$0/Visit:8a	"25% Coins:14h, 8a, 8b, 9a"	"$0/Visit:14h, 8a, 8b, 9a"	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	"25% Coins:9a, 9b"	"$0/Visit:9a, 9b"	$0: Membership in health club/fitness class 14a	$0: Nurse hotline 14a	$0: LifeSynch Member Assistance 14a$0: Additional Smoking Cessation 14a$0: Member Incentive Program 14a	158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.2	0.25	0.2	0.25	0.2	0.25	15	35	35	0.25			0.2	0							0	0	0	0.25	0	62.540542	0.231121	0.25	0	0	0	0	NO	144.533281	127.819902	33.793018	0	130.96575	0.174621	0.174621	43.65525	0.174621	0.218276	0.174621	0.218276	0.174621	0.218276	13.096575	30.558675	30.558675	0.218276			0.174621	0							0	0	0	0.218276	0	54.60446	0.201793	0.218276	0	0	0	0		17.8038	0.792695328	2.196364724	0	1.999714247	2.145954139	1.751982097	1.669498027	1.711578814	3.004865777	0.505289787	1.402392087	0.084102712	0.134630236	4.328866404	10.49671114	0.273081345	0.697315205	0	0	1.941453915	0	0	0	0	0	0	0	0	0	0	3.867252862	0	1.138787025	5.199727966	9.964835922	0	0	0	0	73.1109	0	11.129005	17.8038	0.792695328	2.196364724	0	1.999714247	2.145954139	1.751982097	1.669498027	1.711578814	3.004865777	0.505289787	1.402392087	0.084102712	0.134630236	4.328866404	10.49671114	0.273081345	0.697315205	0	0	1.941453915	0	0	0	0	0	0	0	0	0	0	3.867252862	0	1.138787025	5.199727966	9.964835922	0	0	0	0	73.1109	YES				$0/Visit		20% Coins						25% Coins		20% Coins				20% Coins													$0/Visit	20%-25% Coins	0% Coins			20% Coins					6000				0		1.4419						0		0				0													0	0	0			0					1.4419	0	0.062927	17.8038	0.792695328	2.196364724	0	1.999714247	3.587828139	1.751982097	1.669498027	1.711578814	3.004865777	0.505289787	1.402392087	0.084102712	0.134630236	4.328866404	10.49671114	0.273081345	0.697315205	0	0	1.941453915	0	0	0	0	0	0	0	0	0	0	3.867252862	0	1.138787025	5.199727966	9.964835922	0	0	0	0	74.5527
H2944_139_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Lab	Radiology	Radiology	Radiology	Other						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	Coin	V	V	Coin	Coin	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	0	NO	1225.354733	61.6915431	802.691483	258.860261	178.69364	12.132537	9.905145	447.556965	9.676718	13.590853	2.856747	6.342947	0.47549	1.190693	3868.25716	4019.9219	104.58187	3.153921			10.97636	0							0.55	0.32	480.563781	17.491385	161.698634	244.069372	24.857358	45.070442	0	2.59	0.04	0.7		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	25% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	25% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Health Education Materials 14a	$0: LifeSynch Wellness Program 14a	$0/Visit:8a	"25% Coins:14h, 8a, 8b, 9a"	"$0/Visit:14h, 8a, 8b, 9a"	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	"25% Coins:9a, 9b"	"$0/Visit:9a, 9b"	$0: Membership in health club/fitness class 14a	$0: Nurse hotline 14a	$0: LifeSynch Member Assistance 14a$0: Additional Smoking Cessation 14a$0: Member Incentive Program 14a	158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.2	0.25	0.2	0.25	0.2	0.2	15	35	35	0.25			0.2	0							0	0	0	0.25	0	62.540542	0.233074	0.25	0	0	0	0	NO	144.889691	128.135098	33.76495	0	131.32035	0.175094	0.175094	43.77345	0.175094	0.218867	0.175094	0.218867	0.175094	0.175094	13.132035	30.641415	30.641415	0.218867			0.175094	0							0	0	0	0.218867	0	54.752305	0.204049	0.218867	0	0	0	0		14.7951	0.65873766	2.258569816	0	1.955509279	2.124334433	1.734331459	1.632592702	1.694335261	2.974589224	0.500199259	1.388261781	0.083255446	0.2084832	4.233174035	10.2646746	0.267044707	0.690289228	0	0	1.921894778	0	0	0	0	0	0	0	0	0	0	3.828286961	0	1.113613391	5.072119043	9.864432429	0	0	0	0	69.2638	0	10.781676	14.7951	0.65873766	2.258569816	0	1.955509279	2.124334433	1.734331459	1.632592702	1.694335261	2.974589224	0.500199259	1.388261781	0.083255446	0.2084832	4.233174035	10.2646746	0.267044707	0.690289228	0	0	1.921894778	0	0	0	0	0	0	0	0	0	0	3.828286961	0	1.113613391	5.072119043	9.864432429	0	0	0	0	69.2638	YES	$225/Day(Days 1-10)	$225/Day(Days 1-10)		$0/Visit		20% Coins				25% Coins		25% Coins						25% Coins													0% Coins	25% Coins	0% Coins		25% Coins	25% Coins					6000	2.8967	0.1351		0		1.4239				0		0						0													0	0	0		0	0					4.4558	0	0.061674	17.6918	0.793802874	2.258569816	0	1.955509279	3.548277433	1.734331459	1.632592702	1.694335261	2.974589224	0.500199259	1.388261781	0.083255446	0.2084832	4.233174035	10.2646746	0.267044707	0.690289228	0	0	1.921894778	0	0	0	0	0	0	0	0	0	0	3.828286961	0	1.113613391	5.072119043	9.864432429	0	0	0	0	73.7196
H2944_140_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Lab	Radiology	Radiology	Radiology	Other						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	Coin	V	V	Coin	Coin	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	0	NO	1557.02665	78.389852	866.965457	279.587997	193.002189	14.731453	12.02693	483.394227	11.749572	16.502156	3.468691	7.701673	0.577344	0.739363	4178.000399	4341.809402	112.956062	3.829524			13.32761	0							0.55	0.32	519.044	21.238224	174.646341	263.612757	30.888455	54.725002	0	2.59	0.04	0.7		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	25% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	25% Coins:9a	20% Coins:12	"25% Coins:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Health Education Materials 14a	$0: LifeSynch Wellness Program 14a	$0/Visit:8a	"25% Coins:14h, 8a, 8b, 9a"	"$0/Visit:14h, 8a, 8b, 9a"	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	"25% Coins:9a, 9b"	"$0/Visit:9a, 9b"	$0: Membership in health club/fitness class 14a	$0: Nurse hotline 14a	$0: LifeSynch Member Assistance 14a$0: Additional Smoking Cessation 14a$0: Member Incentive Program 14a	158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.2	0.25	0.2	0.25	0.2	0.25	15	35	35	0.25			0.2	0							0	0	0	0.25	0	62.540541	0.231121	0.25	0	0	0	0	NO	141.304792	124.964746	31.01684	0	128.09835	0.170798	0.170798	42.69945	0.170798	0.213497	0.170798	0.213497	0.170798	0.213497	12.809835	29.889615	29.889615	0.213497			0.170798	0							0	0	0	0.213497	0	53.408934	0.197375	0.213497	0	0	0	0		18.3346	0.816330662	2.240877405	0	2.06027183	2.516102709	2.05417559	1.720055636	2.006803398	3.5231608	0.592445485	1.64428408	0.098609201	0.157851782	4.459957978	10.81458429	0.2813511	0.817591885	0	0	2.276329133	0	0	0	0	0	0	0	0	0	0	4.534297109	0	1.173273028	6.096608806	11.68362375	0	0	0	0	79.9032	0	14.583535	18.3346	0.816330662	2.240877405	0	2.06027183	2.516102709	2.05417559	1.720055636	2.006803398	3.5231608	0.592445485	1.64428408	0.098609201	0.157851782	4.459957978	10.81458429	0.2813511	0.817591885	0	0	2.276329133	0	0	0	0	0	0	0	0	0	0	4.534297109	0	1.173273028	6.096608806	11.68362375	0	0	0	0	79.9032	YES				$0/Visit		20% Coins						25% Coins		20% Coins				20% Coins													$0/Visit	20%-25% Coins	0% Coins			20% Coins					6000				0		1.7194						0		0				0													0	0	0			0					1.7194	0	0.084467	18.3346	0.816330662	2.240877405	0	2.06027183	4.235486709	2.05417559	1.720055636	2.006803398	3.5231608	0.592445485	1.64428408	0.098609201	0.157851782	4.459957978	10.81458429	0.2813511	0.817591885	0	0	2.276329133	0	0	0	0	0	0	0	0	0	0	4.534297109	0	1.173273028	6.096608806	11.68362375	0	0	0	0	81.6226
H2944_141_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Lab	Radiology	Radiology	Radiology	Other						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	Coin	V	V	Coin	Coin	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	0	NO	1268.940291	63.88589545	831.243016	268.067855	185.049728	13.322928	10.876994	463.476453	10.626155	14.924329	3.137038	6.96529	0.522143	1.307518	4005.850088	4162.909504	108.301821	3.46337			12.053311	0							0.55	0.32	497.657313	19.207563	167.450214	252.750857	27.296254	49.492557	0	2.59	0.04	0.7		$195/Day(Days 1-10):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	25% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	25% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Health Education Materials 14a	$0: LifeSynch Wellness Program 14a	$0/Visit:8a	"25% Coins:14h, 8a, 8b, 9a"	"$0/Visit:14h, 8a, 8b, 9a"	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	"25% Coins:9a, 9b"	"$0/Visit:9a, 9b"	$0: Membership in health club/fitness class 14a	$0: Nurse hotline 14a	$0: LifeSynch Member Assistance 14a$0: Additional Smoking Cessation 14a$0: Member Incentive Program 14a	155.100075	143.64207	50.7565	0	150	0.2	0.2	50	0.2	0.25	0.2	0.25	0.2	0.2	15	35	35	0.25			0.2	0							0	0	0	0.25	0	62.540542	0.233074	0.25	0	0	0	0	NO	129.505461	119.938256	24.904134	0	121.8288	0.162438	0.162438	40.6096	0.162438	0.203048	0.162438	0.203048	0.162438	0.162438	12.18288	28.42672	28.42672	0.203048			0.162438	0							0	0	0	0.203048	0	50.794928	0.189301	0.203048	0	0	0	0		13.6946	0.63853024	1.725115621	0	1.878698859	2.164149778	1.766837151	1.568466114	1.726091366	3.030355155	0.509574179	1.414288204	0.084815865	0.212390609	4.066899243	9.861488571	0.256555462	0.703230352	0	0	1.957915732	0	0	0	0	0	0	0	0	0	0	3.900057252	0	1.069871799	5.167208178	10.04936471	0	0	0	0	67.4465	0	17.937777	13.6946	0.63853024	1.725115621	0	1.878698859	2.164149778	1.766837151	1.568466114	1.726091366	3.030355155	0.509574179	1.414288204	0.084815865	0.212390609	4.066899243	9.861488571	0.256555462	0.703230352	0	0	1.957915732	0	0	0	0	0	0	0	0	0	0	3.900057252	0	1.069871799	5.167208178	10.04936471	0	0	0	0	67.4465	YES	$195/Day(Days 1-10)	$195/Day(Days 1-10)		$0/Visit		20% Coins				25% Coins		25% Coins						25% Coins													$0/Visit	25% Coins	0% Coins		25% Coins	25% Coins					4500	2.3932	0.1116		0		1.5434				0		0						0													0	0	0		0	0					4.0483	0	0.087961	16.0878	0.75011921	1.725115621	0	1.878698859	3.707567778	1.766837151	1.568466114	1.726091366	3.030355155	0.509574179	1.414288204	0.084815865	0.212390609	4.066899243	9.861488571	0.256555462	0.703230352	0	0	1.957915732	0	0	0	0	0	0	0	0	0	0	3.900057252	0	1.069871799	5.167208178	10.04936471	0	0	0	0	71.4947
H2944_142_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Lab	Radiology	Radiology	Radiology	Other						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	Coin	V	V	Coin	Coin	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	0	NO	1478.172994	74.419897	779.935568	265.428615	183.227836	12.28921	10.033055	458.913334	9.801678	13.766359	2.893637	6.424857	0.48163	0.616789	3966.410825	4121.923927	107.235544	3.194649			11.118101	0							0.55	0.32	492.757669	17.717261	165.801597	250.26242	25.767633	45.652458	0	2.59	0.04	0.7		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	25% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	25% Coins:9a	20% Coins:12	"25% Coins:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Health Education Materials 14a	$0: LifeSynch Wellness Program 14a	$0/Visit:8a	"25% Coins:14h, 8a, 8b, 9a"	"$0/Visit:14h, 8a, 8b, 9a"	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	"25% Coins:9a, 9b"	"$0/Visit:9a, 9b"	$0: Membership in health club/fitness class 14a	$0: Nurse hotline 14a	$0: LifeSynch Member Assistance 14a$0: Additional Smoking Cessation 14a$0: Member Incentive Program 14a	158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.2	0.25	0.2	0.25	0.2	0.25	15	35	35	0.25			0.2	0							0	0	0	0.25	0	62.540542	0.231121	0.25	0	0	0	0	NO	152.667846	135.013812	45.309109	0	139.6758	0.186234	0.186234	46.5586	0.186234	0.232793	0.186234	0.232793	0.186234	0.232793	13.96758	32.59102	32.59102	0.232793			0.186234	0							0	0	0	0.232793	0	58.236001	0.215214	0.232793	0	0	0	0		18.8058	0.837309499	2.944848805	0	2.132707881	2.288668735	1.868495965	1.780530196	1.825405701	3.204712011	0.538893593	1.495661736	0.089695881	0.143584162	4.616763376	11.19480876	0.29124298	0.743691925	0	0	2.070568422	0	0	0	0	0	0	0	0	0	0	4.12445434	0	1.214523545	5.545555368	10.62757266	0	0	0	0	78.3855	0	5.58325	18.8058	0.837309499	2.944848805	0	2.132707881	2.288668735	1.868495965	1.780530196	1.825405701	3.204712011	0.538893593	1.495661736	0.089695881	0.143584162	4.616763376	11.19480876	0.29124298	0.743691925	0	0	2.070568422	0	0	0	0	0	0	0	0	0	0	4.12445434	0	1.214523545	5.545555368	10.62757266	0	0	0	0	78.3855	YES				$0/Visit		20% Coins						25% Coins		20% Coins				20% Coins													$0/Visit	20%-25% Coins	0% Coins			20% Coins					10000				0		1.455						0		0				0													0	0	0			0					1.455	0	0.049789	18.8058	0.837309499	2.944848805	0	2.132707881	3.743680735	1.868495965	1.780530196	1.825405701	3.204712011	0.538893593	1.495661736	0.089695881	0.143584162	4.616763376	11.19480876	0.29124298	0.743691925	0	0	2.070568422	0	0	0	0	0	0	0	0	0	0	4.12445434	0	1.214523545	5.545555368	10.62757266	0	0	0	0	79.8405
H2944_143_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Lab	Radiology	Radiology	Radiology	Other						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	Coin	V	V	Coin	Coin	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	0	NO	1225.354733	61.6915431	760.635112	258.860261	178.69364	12.132537	9.905145	447.556965	9.676718	13.590853	2.856747	6.342947	0.47549	1.190693	3868.25716	4019.9219	104.58187	3.153921			10.97636	0							0.55	0.32	480.563781	17.491385	161.698634	244.069372	24.857358	45.070442	0	2.59	0.04	0.7		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	25% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	25% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Health Education Materials 14a	$0: LifeSynch Wellness Program 14a	$0/Visit:8a	"25% Coins:14h, 8a, 8b, 9a"	"$0/Visit:14h, 8a, 8b, 9a"	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	"25% Coins:9a, 9b"	"$0/Visit:9a, 9b"	$0: Membership in health club/fitness class 14a	$0: Nurse hotline 14a	$0: LifeSynch Member Assistance 14a$0: Additional Smoking Cessation 14a$0: Member Incentive Program 14a	158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.2	0.25	0.2	0.25	0.2	0.2	15	35	35	0.25			0.2	0							0	0	0	0.25	0	62.540542	0.233074	0.25	0	0	0	0	NO	152.845496	135.170918	45.656994	0	139.8873	0.186516	0.186516	46.6291	0.186516	0.233146	0.186516	0.233146	0.186516	0.186516	13.98873	32.64037	32.64037	0.233146			0.186516	0							0	0	0	0.233146	0	58.324183	0.217361	0.233146	0	0	0	0		15.6075	0.694908543	2.894026062	0	2.083080902	2.262912271	1.847468025	1.739098206	1.804862734	3.168653014	0.532829023	1.478832721	0.088686493	0.222083296	4.509333748	10.93431152	0.284465911	0.735324065	0	0	2.047266762	0	0	0	0	0	0	0	0	0	0	4.078046447	0	1.186262226	5.403020192	10.50799327	0	0	0	0	74.111	0	5.344613	15.6075	0.694908543	2.894026062	0	2.083080902	2.262912271	1.847468025	1.739098206	1.804862734	3.168653014	0.532829023	1.478832721	0.088686493	0.222083296	4.509333748	10.93431152	0.284465911	0.735324065	0	0	2.047266762	0	0	0	0	0	0	0	0	0	0	4.078046447	0	1.186262226	5.403020192	10.50799327	0	0	0	0	74.111	YES	$225/Day(Days 1-10)	$225/Day(Days 1-10)		$0/Visit		20% Coins				25% Coins		25% Coins						25% Coins													$0/Visit	25% Coins	0% Coins		25% Coins	25% Coins					10000	3.0839	0.1438		0		1.4367				0		0						0													0	0	0		0	0					4.6643	0	0.04895	18.6914	0.838699277	2.894026062	0	2.083080902	3.699579271	1.847468025	1.739098206	1.804862734	3.168653014	0.532829023	1.478832721	0.088686493	0.222083296	4.509333748	10.93431152	0.284465911	0.735324065	0	0	2.047266762	0	0	0	0	0	0	0	0	0	0	4.078046447	0	1.186262226	5.403020192	10.50799327	0	0	0	0	78.7753
H2944_144_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Lab	Radiology	Radiology	Radiology	Other						D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	Coin	V	V	Coin	Coin	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	0	NO	1557.02665	78.389852	821.541504	279.587997	193.002189	14.731453	12.02693	483.394227	11.749572	16.502156	3.468691	7.701673	0.577344	0.739363	4178.000399	4341.809402	112.956062	3.829524			13.32761	0							0.55	0.32	519.044	21.238224	174.646341	263.612757	30.888455	54.725002	0	2.59	0.04	0.7		$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	25% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	25% Coins:9a	20% Coins:12	"25% Coins:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Health Education Materials 14a	$0: LifeSynch Wellness Program 14a	$0/Visit:8a	"25% Coins:14h, 8a, 8b, 9a"	"$0/Visit:14h, 8a, 8b, 9a"	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	"25% Coins:9a, 9b"	"$0/Visit:9a, 9b"	$0: Membership in health club/fitness class 14a	$0: Nurse hotline 14a	$0: LifeSynch Member Assistance 14a$0: Additional Smoking Cessation 14a$0: Member Incentive Program 14a	158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.2	0.25	0.2	0.25	0.2	0.25	15	35	35	0.25			0.2	0							0	0	0	0.25	0	62.540541	0.231121	0.25	0	0	0	0	NO	151.63005	134.096023	43.893714	0	138.1977	0.184264	0.184264	46.0659	0.184264	0.23033	0.184264	0.23033	0.184264	0.23033	13.81977	32.24613	32.24613	0.23033			0.184264	0							0	0	0	0.23033	0	57.619727	0.212936	0.23033	0	0	0	0		19.6743	0.875980616	3.005042318	0	2.222704885	2.714476456	2.21613023	1.855665843	2.165023135	3.800941591	0.639154878	1.773926342	0.106383715	0.17029748	4.811583715	11.66721253	0.303532988	0.882054263	0	0	2.455798729	0	0	0	0	0	0	0	0	0	0	4.891800134	0	1.265774591	6.577264054	12.60480971	0	0	0	0	86.6799	0	7.251394	19.6743	0.875980616	3.005042318	0	2.222704885	2.714476456	2.21613023	1.855665843	2.165023135	3.800941591	0.639154878	1.773926342	0.106383715	0.17029748	4.811583715	11.66721253	0.303532988	0.882054263	0	0	2.455798729	0	0	0	0	0	0	0	0	0	0	4.891800134	0	1.265774591	6.577264054	12.60480971	0	0	0	0	86.6799	YES				$0/Visit		20% Coins						25% Coins		20% Coins				20% Coins													$0/Visit	20%-25% Coins	0% Coins			20% Coins					10000				0		1.7401						0		0				0													0	0	0			0					1.7401	0	0.063739	19.6743	0.875980616	3.005042318	0	2.222704885	4.454588456	2.21613023	1.855665843	2.165023135	3.800941591	0.639154878	1.773926342	0.106383715	0.17029748	4.811583715	11.66721253	0.303532988	0.882054263	0	0	2.455798729	0	0	0	0	0	0	0	0	0	0	4.891800134	0	1.265774591	6.577264054	12.60480971	0	0	0	0	88.42
H2944_146_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1546.634288	86.73037	543.316442	209.614843	7.491502	11.996347	12.116663	450.795073	52.263527	9.976889	16.063265	3.773308	0.22252	26.03573	4355.688227	4558.352201	158.882299	2.090674			25.540217	0							0.04	0.25	342.722424	554.102487	0	0	0.05	0.55	2.22	535.742775	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-15):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	164.25357	58.254672	0	0.2	0.2	0.2	50	0.239514	0.25	0.242831	0.25	0.2	0.225537	15	35	35	0.25			0.2	0							0	0	0	16.855909	0	0	0	0	0	15	0	0	NO	127.739864	145.182416	36.359537	0	0.170086	0.170086	0.170086	42.5215	0.20369	0.212608	0.206511	0.212608	0.170086	0.191803	12.75645	29.76505	29.76505	0.212608			0.170086	0							0	0	0	14.334771	0	0	0	0	0	12.75645	0	0		16.4639	1.049310388	1.646227856	0	1.274199609	2.040410676	2.060874743	1.597373558	10.64555781	2.121166417	3.317240918	0.802235467	0.037847537	4.993731121	4.630259924	11.30663177	0.394094964	0.444494018	0	0	4.344033349	0	0	0	0	0	0	0	0	0	0	0.661911022	0	0	0	0	0	0.56951466	0	0	70.401	0	12.304015	16.4639	1.049310388	1.646227856	0	1.274199609	2.040410676	2.060874743	1.597373558	10.64555781	2.121166417	3.317240918	0.802235467	0.037847537	4.993731121	4.630259924	11.30663177	0.394094964	0.444494018	0	0	4.344033349	0	0	0	0	0	0	0	0	0	0	0.661911022	0	0	0	0	0	0.56951466	0	0	70.401	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.3997																									0										1.3997	0	0.069246	16.4639	1.049310388	1.646227856	0	1.274199609	3.440105676	2.060874743	1.597373558	10.64555781	2.121166417	3.317240918	0.802235467	0.037847537	4.993731121	4.630259924	11.30663177	0.394094964	0.444494018	0	0	4.344033349	0	0	0	0	0	0	0	0	0	0	0.661911022	0	0	0	0	0	0.56951466	0	0	71.8007
H2944_147_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1418.484454	79.544132	498.298746	192.246738	6.955749	11.138433	11.250144	413.443441	48.52592	9.263396	14.914507	3.503461	0.206606	24.173794	3994.787962	4180.65976	145.717752	1.94116			23.713718	0							0.04	0.25	314.325393	508.191089	0	0	0.05	0.55	2.22	491.352612	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	143.64207	58.254672	0	0.2	0.2	0.2	50	0.239514	0.25	0.242831	0.25	0.2	0.225537	15	35	35	0.25			0.2	0							0	0	0	16.855909	0	0	0	0	0	15	0	0	NO	130.331393	129.539866	39.011523	0	0.172979	0.172979	0.172979	43.2447	0.207154	0.216224	0.210023	0.216224	0.172979	0.195065	12.97341	30.27129	30.27129	0.216224			0.172979	0							0	0	0	14.578575	0	0	0	0	0	12.97341	0	0		15.4061	0.858678017	1.619949416	0	1.203198506	1.926715002	1.946038659	1.489936464	10.05233843	2.002968537	3.132389504	0.757532351	0.035738499	4.715461127	4.318835175	10.54616367	0.367588694	0.41972538	0	0	4.101975226	0	0	0	0	0	0	0	0	0	0	0.617391825	0	0	0	0	0	0.531209908	0	0	66.0499	0	10.093656	15.4061	0.858678017	1.619949416	0	1.203198506	1.926715002	1.946038659	1.489936464	10.05233843	2.002968537	3.132389504	0.757532351	0.035738499	4.715461127	4.318835175	10.54616367	0.367588694	0.41972538	0	0	4.101975226	0	0	0	0	0	0	0	0	0	0	0.617391825	0	0	0	0	0	0.531209908	0	0	66.0499	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.3026																									0										1.3026	0	0.061242	15.4061	0.858678017	1.619949416	0	1.203198506	3.229363002	1.946038659	1.489936464	10.05233843	2.002968537	3.132389504	0.757532351	0.035738499	4.715461127	4.318835175	10.54616367	0.367588694	0.41972538	0	0	4.101975226	0	0	0	0	0	0	0	0	0	0	0.617391825	0	0	0	0	0	0.531209908	0	0	67.3526
H2944_148_0	2010	2	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	O	O	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	NO	257.583599	4.356631	498.304142	8.896901	6.955825	11.138554	11.250265	413.447918	65.718318	1.310994	29.298175	3.503499	0.206608	24.174057	41.926726	66.469097	1.087519	5.772645			23.713974	0							0.04	0.25	9.263495	0.05	0.55	2.22	0.32	0.4						Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.186446	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0					NO	0.065175	0.065175	32.516534	0	0.17027	0.17027	0.17027	42.5674	0.17027	0	0.15873	0.17027	0.17027	0.17027	0.17027	0.17027	0.17027	0.17027			0.17027	0							0	0	0.17027	0	0	0	0	0						16.788	0.283943425	1.350260298	0	1.184368323	1.89656159	1.915582622	1.466616909	11.18985801	0	4.650499318	0.596540775	0.035179144	4.116116685	7.138863636	11.31769315	0.18517186	0.982908264	0	0	4.037778353	0	0	0	0	0	0	0	0	0	1.577295294	0	0	0	0	0	0	0	0	0	70.7132	0	11.922113	16.788	0.283943425	1.350260298	0	1.184368323	1.89656159	1.915582622	1.466616909	11.18985801	0	4.650499318	0.596540775	0.035179144	4.116116685	7.138863636	11.31769315	0.18517186	0.982908264	0	0	4.037778353	0	0	0	0	0	0	0	0	0	1.577295294	0	0	0	0	0	0	0	0	0	70.7132	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.3027				0																															1.3027	0	0.061242	16.788	0.283943425	1.350260298	0	1.184368323	3.19922459	1.915582622	1.466616909	11.18985801	0	4.650499318	0.596540775	0.035179144	4.116116685	7.138863636	11.31769315	0.18517186	0.982908264	0	0	4.037778353	0	0	0	0	0	0	0	0	0	1.577295294	0	0	0	0	0	0	0	0	0	72.0159
H2944_149_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1438.497929	80.666424	505.329271	194.959158	7.2479	11.606263	11.722665	419.276737	50.564076	9.652471	15.540937	3.650611	0.215283	25.189126	4051.150645	4239.644919	147.773692	2.022693			24.709726	0							0.04	0.25	318.760228	515.361185	0	0	0.05	0.55	2.22	498.285133	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	143.64207	58.254672	0	0.2	0.2	0.2	50	0.239514	0.25	0.242831	0.25	0.2	0.225537	15	35	35	0.25			0.2	0							0	0	0	16.855909	0	0	0	0	0	15	0	0	NO	129.620066	128.83286	38.398159	0	0.172078	0.172078	0.172078	43.0194	0.206075	0.215097	0.208929	0.215097	0.172078	0.194049	12.90582	30.11358	30.11358	0.215097			0.172078	0							0	0	0	14.502622	0	0	0	0	0	12.90582	0	0		15.5382	0.866040509	1.616976141	0	1.247204136	1.997182525	2.017212748	1.503086138	10.41999196	2.076217555	3.246952426	0.785235474	0.037045468	4.887924711	4.356951751	10.63924054	0.370832908	0.435075196	0	0	4.252000231	0	0	0	0	0	0	0	0	0	0	0.622840705	0	0	0	0	0	0.535898186	0	0	67.4521	0	10.742793	15.5382	0.866040509	1.616976141	0	1.247204136	1.997182525	2.017212748	1.503086138	10.41999196	2.076217555	3.246952426	0.785235474	0.037045468	4.887924711	4.356951751	10.63924054	0.370832908	0.435075196	0	0	4.252000231	0	0	0	0	0	0	0	0	0	0	0.622840705	0	0	0	0	0	0.535898186	0	0	67.4521	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.3556																									0										1.3556	0	0.065567	15.5382	0.866040509	1.616976141	0	1.247204136	3.352790525	2.017212748	1.503086138	10.41999196	2.076217555	3.246952426	0.785235474	0.037045468	4.887924711	4.356951751	10.63924054	0.370832908	0.435075196	0	0	4.252000231	0	0	0	0	0	0	0	0	0	0	0.622840705	0	0	0	0	0	0.535898186	0	0	68.8077
H2944_150_0	2010	2	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	O	O	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	NO	268.402317	4.539613	505.334468	9.270577	7.247975	11.606382	11.722786	419.28105	68.478542	1.366058	30.528725	3.650649	0.215286	25.189386	43.687683	69.260854	1.133196	6.015102			24.709982	0							0.04	0.25	9.652569	0.05	0.55	2.22	0.32	0.4						Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.186446	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0					NO	0.064527	0.064527	31.711181	0	0.168823	0.168823	0.168823	42.20585	0.168823	0	0.157382	0.168823	0.168823	0.168823	0.168823	0.168823	0.168823	0.168823			0.168823	0							0	0	0.168823	0	0	0	0	0						17.3192	0.292927608	1.335396065	0	1.223624883	1.959424228	1.979075901	1.474676092	11.5607529	0	4.804671798	0.616313516	0.036345228	4.252547713	7.375485707	11.69282515	0.191309548	1.015487565	0	0	4.171613291	0	0	0	0	0	0	0	0	0	1.629575656	0	0	0	0	0	0	0	0	0	72.9312	0	13.071331	17.3192	0.292927608	1.335396065	0	1.223624883	1.959424228	1.979075901	1.474676092	11.5607529	0	4.804671798	0.616313516	0.036345228	4.252547713	7.375485707	11.69282515	0.191309548	1.015487565	0	0	4.171613291	0	0	0	0	0	0	0	0	0	1.629575656	0	0	0	0	0	0	0	0	0	72.9312	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.3556				0																															1.3556	0	0.06557	17.3192	0.292927608	1.335396065	0	1.223624883	3.315044228	1.979075901	1.474676092	11.5607529	0	4.804671798	0.616313516	0.036345228	4.252547713	7.375485707	11.69282515	0.191309548	1.015487565	0	0	4.171613291	0	0	0	0	0	0	0	0	0	1.629575656	0	0	0	0	0	0	0	0	0	74.2869
H2944_151_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Lab	Radiology	Other					Therapy (PT/OT/ST)			D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O							O	O	V	V	V	V	O	O	O	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	0	0	0	0	0	0	0	0	NO	1531.464258	85.879683	537.987369	207.558854	7.157829	11.46203	11.576986	446.373488	49.935711	9.532518	15.347808	3.605244	0.212609	24.876101	4312.965833	4513.641994	157.323916	1.997556			24.402655	0							0.04	0.25	339.360861	548.667621	0	0	0.05	0.55	2.22	530.487988	0.32	0.4		$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$15/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$15/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	144.519765	143.64207	58.254672	0	0.2	0.2	0.2	50	0.239514	0.25	0.242831	0.25	0.2	0.225537	15	35	35	0.25			0.2	0							0	0	0	16.855909	0	0	0	0	0	15	0	0	NO	128.557412	127.77666	36.988571	0	0.171072	0.171072	0.171072	42.7681	0.204871	0.213841	0.207709	0.213841	0.171072	0.192916	12.83043	29.93767	29.93767	0.213841			0.171072	0							0	0	0	14.417904	0	0	0	0	0	12.83043	0	0		16.4068	0.914451588	1.658282	0	1.224504123	1.960832396	1.980498149	1.590878831	10.23037905	2.038443182	3.187877852	0.770948982	0.036371447	4.798997901	4.611433851	11.26066038	0.392492623	0.427159373	0	0	4.174610996	0	0	0	0	0	0	0	0	0	0	0.659219757	0	0	0	0	0	0.567199083	0	0	68.892	0	11.54409	16.4068	0.914451588	1.658282	0	1.224504123	1.960832396	1.980498149	1.590878831	10.23037905	2.038443182	3.187877852	0.770948982	0.036371447	4.798997901	4.611433851	11.26066038	0.392492623	0.427159373	0	0	4.174610996	0	0	0	0	0	0	0	0	0	0	0.659219757	0	0	0	0	0	0.567199083	0	0	68.892	YES				$0/Visit		20% Coins																									$0/Visit										4900				0		1.3393																									0										1.3393	0	0.064225	16.4068	0.914451588	1.658282	0	1.224504123	3.300121396	1.980498149	1.590878831	10.23037905	2.038443182	3.187877852	0.770948982	0.036371447	4.798997901	4.611433851	11.26066038	0.392492623	0.427159373	0	0	4.174610996	0	0	0	0	0	0	0	0	0	0	0.659219757	0	0	0	0	0	0.567199083	0	0	70.2313
H2944_152_0	2010	2	N/A	r.	s.	t.	u.							OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)							Lab										Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	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	NO	265.066742	4.483198	537.992682	9.155367	7.157901	11.462143	11.577102	446.377896	67.627523	1.349081	30.149328	3.60528	0.212611	24.876345	43.144753	68.400111	1.119112	5.940349			24.402898	0							0.04	0.25	9.532612	0.05	0.55	2.22								Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"0%-20% Coins:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. 0% SMAM -- FSR,14h. 0% SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. 20% Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a							0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.186446	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0							NO	0.06465	0.06465	31.369387	0	0.169138	0.169138	0.169138	42.2846	0.169138	0	0.157676	0.169138	0.169138	0.169138	0.169138	0.169138	0.169138	0.169138			0.169138	0							0	0	0.169138	0	0	0								17.1366	0.289838751	1.406375054	0	1.210673059	1.938683943	1.958127878	1.572909232	11.43838399	0	4.753825442	0.609789849	0.035960599	4.207535241	7.297417233	11.56905797	0.189284365	1.004738749	0	0	4.127457362	0	0	0	0	0	0	0	0	0	1.612326928	0	0	0	0	0	0	0	0	0	72.359	0	12.864584	17.1366	0.289838751	1.406375054	0	1.210673059	1.938683943	1.958127878	1.572909232	11.43838399	0	4.753825442	0.609789849	0.035960599	4.207535241	7.297417233	11.56905797	0.189284365	1.004738749	0	0	4.127457362	0	0	0	0	0	0	0	0	0	1.612326928	0	0	0	0	0	0	0	0	0	72.359	YES				0% Coins		20% Coins				0% Coins																															4900				0		1.3393				0																															1.3393	0	0.064227	17.1366	0.289838751	1.406375054	0	1.210673059	3.277984943	1.958127878	1.572909232	11.43838399	0	4.753825442	0.609789849	0.035960599	4.207535241	7.297417233	11.56905797	0.189284365	1.004738749	0	0	4.127457362	0	0	0	0	0	0	0	0	0	1.612326928	0	0	0	0	0	0	0	0	0	73.6983
H2949_002_0	2010	6	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)					Radiology	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	Coin	V	V	V	V			Coin	O	T						O		V	P	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	YES	1641.680833	45.669372	669.817528	1408.240393	253.017034	14.250399	4.875949	359.314725	341.569482	3370.891667	4.452148	89.677776	0.03983	2.992431	5563.47367	5284.880198	65.370983	715.4314			53.995332	0	2.95						0.04		2047.154656	22.295172	176.739016	0.05	0.55	2.45					3400	$195/Day(Days 1-5):1a	$195/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0-$175/Visit:8a. $0 Lab -- FSL,8a. $175 Lab -- OP"	"20% Coins:14h, 8a, 8b, 9a"	$175/Visit:9a	20% Coins:12	"20% Coins:8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15		$0: Other - Transportation 10b						$0: Nurse hotline 14a		"$0-$65/Visit:14h. 20% DMAM -- OP,8b. $65 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $65 Advanced Imaging -- FSR,8b. $65 Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	$0/Proc:12	"$30-$150/Visit:9d. $30 Cardiac Rehab,9a. $30 OP Other,5. $150 Partial Hospitalization,7h. $30 Psych -- OP,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a					118.300845	98.80884	45.891712	0	100	0.2	0.082333	50	112.543692	5.154105	0.2	175	0.2	0.2	0	30	30	30			0.2	0	0						0		53.442267	0	104.521317	0	0	0					NO	98.981726	82.672862	24.983127	0	83.3402	0.16668	0.068617	41.6701	93.794138	4.295441	0.16668	145.84535	0.16668	0.16668	0	25.00206	25.00206	25.00206			0.16668	0	0						0		44.538892	0	87.108274	0	0	0						13.5414	0.314634807	1.394511364	0	1.757207518	2.375256505	0.334572993	1.247723377	2.669767928	1.206622189	0.742084029	1.089923886	0.006638864	0.498778399	0	11.01107432	0.13620077	1.490604899	0	0	8.999941938	0	0	0	0	0	0	0	0	0	7.598166678	0	1.282952553	0	0	0	0	0	0	0	57.698	0	12.356783	13.5414	0.314634807	1.394511364	0	1.757207518	2.375256505	0.334572993	1.247723377	2.669767928	1.206622189	0.742084029	1.089923886	0.006638864	0.498778399	0	11.01107432	0.13620077	1.490604899	0	0	8.999941938	0	0	0	0	0	0	0	0	0	7.598166678	0	1.282952553	0	0	0	0	0	0	0	57.698	NO																																																																																		0	0	0	13.5414	0.314634807	1.394511364	0	1.757207518	2.375256505	0.334572993	1.247723377	2.669767928	1.206622189	0.742084029	1.089923886	0.006638864	0.498778399	0	11.01107432	0.13620077	1.490604899	0	0	8.999941938	0	0	0	0	0	0	0	0	0	7.598166678	0	1.282952553	0	0	0	0	0	0	0	57.698
H2949_007_0	2010	5	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)					Radiology	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	Coin	V	V	V	V			Coin	O	T						O		V	P	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	YES	1548.209579	43.069127	631.680588	1328.060378	238.611177	14.095255	4.822865	338.856669	322.121775	3178.965524	2.672897	84.571854	0.039396	2.959852	5246.709992	4983.978604	61.649	674.697374			53.407486	0	2.95						0.04		1983.709766	21.025767	166.676148	0.05	0.55	1.11					3400	$100/Day(Days 1-5):1a	$100/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"20% Coins:14h, 8a, 8b, 9a"	$100/Visit:9a	20% Coins:12	"20% Coins:8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15		$0: Other - Transportation 10b						$0: Nurse hotline 14a		"$0-$65/Visit:14h. 20% DMAM -- OP,8b. $15 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $65 Advanced Imaging -- FSR,8b. $65 Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $15 Radiology OP -- Facility"	$0/Proc:12	"$30-$150/Visit:9d. $30 Cardiac Rehab,9a. $30 OP Other,5. $150 Partial Hospitalization,7h. $30 Psych -- OP,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a					60.6671	50.6712	45.891712	0	100	0.2	0.082333	50	84.385923	2.945203	0.2	100	0.2	0.2	0	30	30	30			0.2	0	0						0		27.90033	0	104.521317	0	0	0					NO	55.142997	46.057283	29.997209	0	88.0086	0.176017	0.07246	44.0043	74.266869	2.592032	0.176017	88.0086	0.176017	0.176017	0	26.40258	26.40258	26.40258			0.176017	0	0						0		24.55469	0	91.987748	0	0	0						7.1144	0.165303914	1.579054552	0	1.749986303	2.481004499	0.349464798	1.242595877	1.993581305	0.68666503	0.470475311	0.620254206	0.006934366	0.520984269	0	10.96582448	0.135641055	1.484479283	0	0	9.400625463	0	0	0	0	0	0	0	0	0	4.059114863	0	1.277680292	0	0	0	0	0	0	0	46.3041	0	6.667977	7.1144	0.165303914	1.579054552	0	1.749986303	2.481004499	0.349464798	1.242595877	1.993581305	0.68666503	0.470475311	0.620254206	0.006934366	0.520984269	0	10.96582448	0.135641055	1.484479283	0	0	9.400625463	0	0	0	0	0	0	0	0	0	4.059114863	0	1.277680292	0	0	0	0	0	0	0	46.3041	NO																																																																																		0	0	0	7.1144	0.165303914	1.579054552	0	1.749986303	2.481004499	0.349464798	1.242595877	1.993581305	0.68666503	0.470475311	0.620254206	0.006934366	0.520984269	0	10.96582448	0.135641055	1.484479283	0	0	9.400625463	0	0	0	0	0	0	0	0	0	4.059114863	0	1.277680292	0	0	0	0	0	0	0	46.3041
H2949_009_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)					Radiology	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	Coin	V	V	V	V			Coin	O	T						O	O	V	P	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	YES	1631.173266	45.377066	665.530366	1399.22696	251.3976	14.159345	4.844794	357.014934	339.383269	3349.316298	2.685051	89.103794	0.039575	2.973308	5527.864694	5251.054357	64.952576	710.852286			53.650319	0	2.95						0.04	0.42	2090.01054	22.152472	175.607799	0.05	0.55	2.45					3400	$50/Day(Days 1-5):1a	$50/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"20% Coins:14h, 8a, 8b, 9a"	$0/Visit:9a	20% Coins:12	"20% Coins:8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15		$0: Other - Transportation 10b						$0: Nurse hotline 14a	$0: Nutritional benefit 14a	"$0-$65/Visit:14h. 20% DMAM -- OP,8b. $15 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $65 Advanced Imaging -- FSR,8b. $65 Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $15 Radiology OP -- Facility"	$0/Proc:12	"$30-$150/Visit:9d. $30 Cardiac Rehab,9a. $30 OP Other,5. $150 Partial Hospitalization,7h. $30 Psych -- OP,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a					30.33355	25.3356	45.891712	0	100	0.2	0.082333	50	0	0	0.2	0	0.2	0.2	0	30	30	30			0.2	0	0						0	0	27.90033	0	104.521317	0	0	0					NO	28.053498	23.431224	31.274422	0	89.3628	0.178726	0.073575	44.6814	0	0	0.178726	0	0.178726	0.178726	0	26.80884	26.80884	26.80884			0.178726	0	0						0	0	24.932516	0	93.403175	0	0	0						3.8133	0.08860335	1.73450646	0	1.872132787	2.530643094	0.356455719	1.329327256	0	0	0.479888425	0	0.007073081	0.531407446	0	11.73122301	0.145108601	1.588093767	0	0	9.588706914	0	0	0	0	0	0	0	0	0	4.342435102	0	1.366860498	0	0	0	0	0	0	0	41.5058	0	5.397485	3.8133	0.08860335	1.73450646	0	1.872132787	2.530643094	0.356455719	1.329327256	0	0	0.479888425	0	0.007073081	0.531407446	0	11.73122301	0.145108601	1.588093767	0	0	9.588706914	0	0	0	0	0	0	0	0	0	4.342435102	0	1.366860498	0	0	0	0	0	0	0	41.5058	NO																																																																																		0	0	0	3.8133	0.08860335	1.73450646	0	1.872132787	2.530643094	0.356455719	1.329327256	0	0	0.479888425	0	0.007073081	0.531407446	0	11.73122301	0.145108601	1.588093767	0	0	9.588706914	0	0	0	0	0	0	0	0	0	4.342435102	0	1.366860498	0	0	0	0	0	0	0	41.5058
H2949_012_0	2010	5	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)					Radiology	Renal Dialysis	Other								D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	Coin	V	V	V	V			Coin	O	T						O		V	P	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	YES	1646.233434	45.79602	671.675022	1412.145633	253.718684	14.289917	4.889472	360.311153	342.516699	3380.239602	2.709811	89.926465	0.03994	3.000728	5578.901928	5299.535879	65.552265	717.415387			54.145068	0	2.95						0.04		2109.307025	22.356999	177.229138	0.05	0.55	2.45					3400	$100/Day(Days 1-5):1a	$100/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"20% Coins:14h, 8a, 8b, 9a"	$100/Visit:9a	20% Coins:12	"20% Coins:8b. 20% Nuclear Medicine,8b. 20% Rad therapy"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15		$0: Other - Transportation 10b						$0: Nurse hotline 14a		"$0-$65/Visit:14h. 20% DMAM -- OP,8b. $15 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $65 Advanced Imaging -- FSR,8b. $65 Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $15 Radiology OP -- Facility"	$0/Proc:12	"$30-$150/Visit:9d. $30 Cardiac Rehab,9a. $30 OP Other,5. $150 Partial Hospitalization,7h. $30 Psych -- OP,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a					60.6671	50.6712	45.891712	0	100	0.2	0.082333	50	84.385923	2.945203	0.2	100	0.2	0.2	0	30	30	30			0.2	0	0						0		27.90033	0	104.521316	0	0	0					NO	54.717478	45.701875	28.817655	0	87.3743	0.174749	0.071938	43.68715	73.73161	2.57335	0.174749	87.3743	0.174749	0.174749	0	26.21229	26.21229	26.21229			0.174749	0	0						0		24.377718	0	91.324769	0	0	0						7.5065	0.174413665	1.613008255	0	1.847374368	2.497148706	0.351738837	1.311747282	2.104525639	0.724878298	0.473536762	0.654771828	0.006979475	0.524374217	0	11.57608094	0.143189582	1.567091681	0	0	9.461796488	0	0	0	0	0	0	0	0	0	4.285007653	0	1.348784174	0	0	0	0	0	0	0	48.1729	0	7.408919	7.5065	0.174413665	1.613008255	0	1.847374368	2.497148706	0.351738837	1.311747282	2.104525639	0.724878298	0.473536762	0.654771828	0.006979475	0.524374217	0	11.57608094	0.143189582	1.567091681	0	0	9.461796488	0	0	0	0	0	0	0	0	0	4.285007653	0	1.348784174	0	0	0	0	0	0	0	48.1729	NO																																																																																		0	0	0	7.5065	0.174413665	1.613008255	0	1.847374368	2.497148706	0.351738837	1.311747282	2.104525639	0.724878298	0.473536762	0.654771828	0.006979475	0.524374217	0	11.57608094	0.143189582	1.567091681	0	0	9.461796488	0	0	0	0	0	0	0	0	0	4.285007653	0	1.348784174	0	0	0	0	0	0	0	48.1729
H2949_805_0	2010	3	N/A																															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	NO	300.577805	1.849697	28.951179	14.004677	6.821594	6.638965	2.806097	27.481166	77.695569	11.172068	36.629385	5.670683	1.209081	20.01258	92.776151	115.090487	0.402621	7.827316			29.586425	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																			0.071148442	0.071148442	0.147547588	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.071148442	0.071148442	0.147547588	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.3856	0.131603059	4.271676628	0	1.589431402	1.546878845	0.653820601	6.403111678	18.10306758	2.603091844	8.534646705	1.321269139	0.281715873	4.66293114	21.61684318	26.81608347	0.093810693	1.823764628	0	0	6.893637025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.733	0	0	21.3856	0.131603059	4.271676628	0	1.589431402	1.546878845	0.653820601	6.403111678	18.10306758	2.603091844	8.534646705	1.321269139	0.281715873	4.66293114	21.61684318	26.81608347	0.093810693	1.823764628	0	0	6.893637025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.733	NO																																																																																		0	0	0	21.3856	0.131603059	4.271676628	0	1.589431402	1.546878845	0.653820601	6.403111678	18.10306758	2.603091844	8.534646705	1.321269139	0.281715873	4.66293114	21.61684318	26.81608347	0.093810693	1.823764628	0	0	6.893637025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.733
H2949_807_0	2010	3	N/A																															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	NO	300.577805	1.849697	28.951179	14.004677	6.821594	6.638965	2.806097	27.481166	77.695569	11.172068	36.629385	5.670683	1.209081	20.01258	92.776151	115.090487	0.402621	7.827316			29.586425	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																			0.071148442	0.071148442	0.147547588	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.071148442	0.071148442	0.147547588	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.3856	0.131603059	4.271676628	0	1.589431402	1.546878845	0.653820601	6.403111678	18.10306758	2.603091844	8.534646705	1.321269139	0.281715873	4.66293114	21.61684318	26.81608347	0.093810693	1.823764628	0	0	6.893637025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.733	0	0	21.3856	0.131603059	4.271676628	0	1.589431402	1.546878845	0.653820601	6.403111678	18.10306758	2.603091844	8.534646705	1.321269139	0.281715873	4.66293114	21.61684318	26.81608347	0.093810693	1.823764628	0	0	6.893637025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.733	NO																																																																																		0	0	0	21.3856	0.131603059	4.271676628	0	1.589431402	1.546878845	0.653820601	6.403111678	18.10306758	2.603091844	8.534646705	1.321269139	0.281715873	4.66293114	21.61684318	26.81608347	0.093810693	1.823764628	0	0	6.893637025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.733
H2949_808_0	2010	3	N/A																															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	NO	300.577805	1.849697	28.951179	14.004677	6.821594	6.638965	2.806097	27.481166	77.695569	11.172068	36.629385	5.670683	1.209081	20.01258	92.776151	115.090487	0.402621	7.827316			29.586425	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																			0.071148442	0.071148442	0.147547588	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.071148442	0.071148442	0.147547588	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.3856	0.131603059	4.271676628	0	1.589431402	1.546878845	0.653820601	6.403111678	18.10306758	2.603091844	8.534646705	1.321269139	0.281715873	4.66293114	21.61684318	26.81608347	0.093810693	1.823764628	0	0	6.893637025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.733	0	0	21.3856	0.131603059	4.271676628	0	1.589431402	1.546878845	0.653820601	6.403111678	18.10306758	2.603091844	8.534646705	1.321269139	0.281715873	4.66293114	21.61684318	26.81608347	0.093810693	1.823764628	0	0	6.893637025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.733	NO																																																																																		0	0	0	21.3856	0.131603059	4.271676628	0	1.589431402	1.546878845	0.653820601	6.403111678	18.10306758	2.603091844	8.534646705	1.321269139	0.281715873	4.66293114	21.61684318	26.81608347	0.093810693	1.823764628	0	0	6.893637025	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.733
H2960_004_0	2010	6	N/A																															D	D	D	V	COIN	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V	T	COIN	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	YES	1729.64786	260.0530068	1553.071552	722.0909812	12.18914041	9.573056449	1.345547036	726.9906883	384.1810627	173.1991923	665.2763678	0	0.150255215	397.4758751	3262.199579	5998.787739	87.45868783	0	2931.512754	13656.57663	27.33919515	764.8908488	0	4.466666667	293.82189	189.2219732	0	0.715875706	0	1000											3250	PBP: 1A IP Acute: $200 per day (days 1-4)	1B IP Psych: $200 per day (days 1-4)	2 SNF: $50 per day for days 16-100 only	"6 Home Health: $0, 13C Custodial Care: $150 per episode"	10A Ambulance: 30%	11A DME: 20%	11B Prosthetic Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $25/$50"	"9B ASC Services: $200, 9A OP Hosp - Surgery $200"	8A OP Lab: $0	"8B: $50 Routine Imaging, $75 Radiation Theray, $75 CT, $100 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $40	12 Renal Dialysis: 20%	"3 CORF: $50, 9D Cardiac Rehab: $15, 7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $0, separate office visit copay applies, 14H Mammography: $0, 14I Diabetes Monitoring: $0, separate office visit copay may apply"	"7B Chiropractic: $40, 7D Physician Specialist: $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40, 9C OP Substance Abuse: $40"		7D Physician Specialist: $40	"7G Other Health Care: $40, 18A Medicare Covered Hearing Exams: $40"	"15 Part B Drugs: 20%, 11C Diabetes Monitoring Supplies: 0-15%"	"13A Blood: 20%, 17A Medicare Covered Eye Exams: $20"	10B Transportation: $0	"16A Preventive Dental Services: $0, 16B Additional Comprehensive Dental Coverage: Not Covered"	17A Routine Eye Exams: $20	17B Eye Wear: $125 allowance	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: $300 allowance every 36 months	19 POS: N/A	"14A Health Education/Wellness Programs: $0, Membership in Health Club $0"											108.1716057	35.17415418	30.5310263	6.75	0.2985	0.2	0.2	34.35613475	200	0	60.80594633	0	0.2	11.36920693	9.040907171	40	40	0	0	0.168505944	0.195	22.39441658	0	0	20	0	0	0	0	0											NO	106.2905916	34.56250495	30.0001172	6.632623125	0.293309334	0.196522167	0.196522167	33.7587102	196.5221667	0	59.7485816	0	0.196522167	11.17150589	8.88369333	39.30443334	39.30443334	0	0	0.165575766	0.191609113	22.00499634	0	0	19.65221667	0	0	0	0	0												15.3204	0.749006945	3.882694048	0.399113112	3.575188653	1.881317795	0.264429819	2.045188997	6.291674571	0	3.312443279	0	0.02952848	0.370033673	2.41503172	19.64824606	0.286459514	0	0	0.188433178	5.238438919	1.402618361	0	0	0.48118762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7815		1.199522067	15.3204	0.749006945	3.882694048	0.399113112	3.575188653	1.881317795	0.264429819	2.045188997	6.291674571	0	3.312443279	0	0.02952848	0.370033673	2.41503172	19.64824606	0.286459514	0	0	0.188433178	5.238438919	1.402618361	0	0	0.48118762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7815	NO																																																																																		0			15.3204	0.749006945	3.882694048	0.399113112	3.575188653	1.881317795	0.264429819	2.045188997	6.291674571	0	3.312443279	0	0.02952848	0.370033673	2.41503172	19.64824606	0.286459514	0	0	0.188433178	5.238438919	1.402618361	0	0	0.48118762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7815
H2960_009_0	2010	6	N/A																															D	D	D	V	COIN	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V	T	COIN	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	YES	1328.698955	78.26999272	1176.878418	516.9228824	9.603030549	3.753430907	1.310070113	382.5796385	285.5179859	112.8180476	328.0652231	0	0.046882771	343.376258	2124.054505	4491.207061	75.9005015	0	2126.705075	8985.475409	12.95598709	590.5070438	0	0	227.7484708	96.68201714	0	0.215990612	0	0											3400	PBP: 1A IP Acute: $250 per day (days 1-4)	1B IP Psych: $250 per day (days 1-4)	2 SNF: $0 per stay plus $50 per day for days 16-100 only	"6 Home Health: $0, 13C Custodial Care: $150 per episode"	10A Ambulance: 30%	11A DME: 20%	11B Prosthetic Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $25/50"	"9B ASC Services: $250, 9A OP Hosp - Surgery $250"	8A OP Lab: $0	"8B: $50 Routine Imaging,  $75 Radiation Theray, $75 CT, $100 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $40	12 Renal Dialysis: 20%	"3 CORF: $50,  9D Cardiac Rehab: $15, 7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	"7A PCP: $15, 14B Immunizations: $0, separate office visit copay applies,  14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $0, separate office visit copay applies, 14H Mammography: $0, 14I Diabetes Monitoring: $0, separate office visit copay may apply"	"7B Chiropractic: $45, 7D Physician Specialist: $45, 7F Podiatry: $45"	"7E Mental Health: $45, 7H Psychiatric: $45, 9C OP Substance Abuse: $45,"		7D Physician Specialist: $45	"18A Medicare Covered Hearing Exams: $45, All other services: $0"	"15 Part B Drugs: 20%, 11C Diabetes Monitoring Supplies: 0-20%"	"13A Blood: 20%, 17A Medicare Covered Eye Exams: $20"	10B Transportation: $0	"16A Preventive Dental Services: Not Covered, 16B Additional Comprehensive Dental Coverage: Not Covered"	17A Routine Eye Exams: $20	17B Eye Wear: Discount Program Only	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	19 POS: N/A	14A Health Education/Wellness Programs: $0											135.2310194	135.2145071	30.5310263	6.75	0.2985	0.2	0.2	34.30967808	250	0	60.80594633	0	0.2	12.32255907	13.45403969	45	45	0	0	0.252672313	0.2	23.42489016	0	0	20	0	0	0	0	0											NO	132.8794646	132.8632395	30.0001172	6.632623125	0.293309334	0.196522167	0.196522167	33.71306137	245.6527083	0	59.7485816	0	0.196522167	12.10828004	13.22008515	44.2174875	44.2174875	0	0	0.248278552	0.196522167	23.01755085	0	0	19.65221667	0	0	0	0	0												14.7131	0.866600399	2.942207539	0.285712889	2.816658492	0.737632374	0.257457817	1.074827569	5.844855542	0	1.633452646	0	0.009213504	0.346474658	2.340015119	16.54915768	0.279677456	0	0	0.185908402	2.546138654	1.132668826	0	0	0.372980191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9347		0.972174068	14.7131	0.866600399	2.942207539	0.285712889	2.816658492	0.737632374	0.257457817	1.074827569	5.844855542	0	1.633452646	0	0.009213504	0.346474658	2.340015119	16.54915768	0.279677456	0	0	0.185908402	2.546138654	1.132668826	0	0	0.372980191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9347	NO																																																																																		0			14.7131	0.866600399	2.942207539	0.285712889	2.816658492	0.737632374	0.257457817	1.074827569	5.844855542	0	1.633452646	0	0.009213504	0.346474658	2.340015119	16.54915768	0.279677456	0	0	0.185908402	2.546138654	1.132668826	0	0	0.372980191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9347
H2960_010_0	2010	6	N/A																															D	D	D	V	COIN	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V	T	COIN	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	YES	1577.317864	42.17414213	1442.763778	842.1447849	11.05107158	13.22047196	3.217245486	821.4608269	561.6759697	202.8429861	810.5070602	0	0.033233587	659.8082496	3287.603638	7423.10243	87.20070426	0	3216.631401	16444.04732	30.14937494	984.0727254	0	47.23503182	338.3238877	241.7640309	0	0.107941666	0	1000											3000	PBP: 1A IP Acute: $100 per day (days 1-3)	1B IP Psych: $100 per day (days 1-3)	2 SNF: $0 per stay plus $50 per day for days 21-100 only	"6 Home Health: $0, 13C Custodial Care: $150 per episode"	10A Ambulance: 20%	11A DME: 20%	11B Prosthetic Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $20/40"	"9B ASC Services: $100, 9A OP Hospital - Surgery $100"	8A OP Lab: $0	"8B: $25 Routine Imaging, $50 Radiation Theray, $50 CT, $75 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $30	12 Renal Dialysis: 20%	"3 CORF: $50, 9D Cardiac Rehab: $15, 7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	"7A PCP: $10, 14B Immunizations: $0, separate office visit copay applies,  14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $0, separate office visit copay applies, 14H Mammography: $0, 14I Diabetes Monitoring: $0, separate office visit copay may apply"	"7B Chiropractic: $35, 7D Physician Specialist: $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35,9C OP Substance Abuse: $35,"		7D Physician Specialist: $35	"7G Other Health Care: $35, 18A Medicare Covered Hearing Exams: $35"	"15 Part B Drugs: 20%, 11C Diabetes Monitoring Supplies: 0-10%"	"13A Blood: 10%, 17A Medicare Covered Eye Exams: $15"	10B Transportation: $0	"16A Preventive Dental Services: $0, 16B Additional Comprehensive Dental Coverage 20%-50%with $50 deductible"	17A Routine Eye Exams: $15	17B Eye Wear: $150 allowance	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: $600 allowance every 36 months	19 POS: N/A	"14A Health Education/Wellness Programs: $0, Membership in Health Club $0"											45.17971482	45.17971482	26.45180194	6.75	0.199	0.2	0.2	30.31602474	100	0	40.05436405	0	0.2	11.75023854	9.070195767	35	35	0	0	0.151813511	0.19	39.75198947	0	0.37	15	0	0	0	0	0											NO	44.39407723	44.39407723	25.99182715	6.632623125	0.195539556	0.196522167	0.196522167	29.78885434	98.26108334	0	39.35785204	0	0.196522167	11.54591169	8.912472622	34.39137917	34.39137917	0	0	0.149173601	0.186696058	39.0607355	0	0.363566008	14.7391625	0	0	0	0	0												5.8353	0.15602351	3.125005562	0.465469081	2.160921627	2.598115794	0.632260054	2.039198076	4.599240772	0	2.65831808	0	0.006531136	0.634840648	2.441723118	21.27422752	0.249912707	0	0	0.204418146	5.628769463	3.203217037	0	17.17305197	0.415550897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5021		1.336153059	5.8353	0.15602351	3.125005562	0.465469081	2.160921627	2.598115794	0.632260054	2.039198076	4.599240772	0	2.65831808	0	0.006531136	0.634840648	2.441723118	21.27422752	0.249912707	0	0	0.204418146	5.628769463	3.203217037	0	17.17305197	0.415550897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5021	NO																																																																																		0			5.8353	0.15602351	3.125005562	0.465469081	2.160921627	2.598115794	0.632260054	2.039198076	4.599240772	0	2.65831808	0	0.006531136	0.634840648	2.441723118	21.27422752	0.249912707	0	0	0.204418146	5.628769463	3.203217037	0	17.17305197	0.415550897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5021
H2960_012_0	2010	7	N/A																															D	D	D	V	COIN	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V	T	COIN	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	YES	717.7972731	51.17969057	1456.582714	738.5371318	10.6915882	8.564739407	1.405795662	746.9140016	383.9385736	214.8244976	662.2689075	0	0.071488684	451.2625908	2903.390841	6023.867563	67.59182903	0	2690.115427	12110.63147	19.89364099	711.0084314	0	0	293.2790709	152.6915163	0	0.341117563	0	0											3400	PBP: 1A IP Acute: $250 per day (days 1-4)	1B IP Psych: $250 per day (days 1-4)	2 SNF: $0 per stay plus $50 per day for days 16-100 only	"6 Home Health: $0, 13C Custodial Care: $150 per episode"	"10A Ambulance: 30%, 10B Transportation: $0"	11A DME: 20%	11B Prosthetic Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $25/50"	"9B ASC Services: $250, 9A OP Hospital - Surgery $250"	8A OP Lab: $0	"8B: $50 Routine Imaging, $75 Radiation Theray, $75 CT, $100 PET, MRI, and Nuclear Medicine"	5 Partial Hosp: $40	12 Renal Dialysis: 20%	"3 CORF: $50, 9D Cardiac Rehab: $15, 7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	"7A PCP: $15, 14B Immunizations: $0, separate office visit copay applies,  14D Pap/Pelvic: $0, separate office visit copay applies, 14E Prostate Screening: $0, separate office visit copay applies, 14F Colorectal Screening: $50, 14G Bone Mass Measurement: $0, separate office visit copay applies, 14H Mammography: $0, 14I Diabetes Monitoring: $0, separate office visit copay may apply"	"7B Chiropractic: $45, 7D Physician Specialist: $45, 7F Podiatry: $45"	"7E Mental Health: $45, 7H Psychiatric: $45, 9C OP Substance Abuse: $45,"		7D Physician Specialist: $45	"7G Other Health Care: $45, 18A Medicare Covered Hearing Exams: $45"	"15 Part B Drugs: 20%, 11C Diabetes Monitoring Supplies: 0-20%"	"13A Blood: 20%, 17A Medicare Covered Eye Exams: $20"		"16A Preventive Dental Services: Not Covered, 16B Additional Comprehensive Dental Coverage: Not Covered"	17A Routine Eye Exams: $20	17B Eye Wear: Discount Program Only	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	19 POS: N/A	14A Health Education/Wellness Programs: $0											135.2145071	136.8567886	30.5310263	6.75	0.2985	0.2	0.2	33.71196057	250	0	60.80594633	0	0.2	11.00442805	13.6098445	45	45	0	0	0.206192295	0.2	41.26893489	0	0	20	0	0	0	0	0											NO	132.8632395	134.4769631	30.0001172	6.632623125	0.293309334	0.196522167	0.196522167	33.12573767	245.6527083	0	59.7485816	0	0.196522167	10.81307022	13.37318065	44.2174875	44.2174875	0	0	0.202606783	0.196522167	40.55130251	0	0	19.65221667	0	0	0	0	0												7.9474	0.57354078	3.641471011	0.408203205	3.135942611	1.683161145	0.276270009	2.061839773	7.859629204	0	3.297468988	0	0.014049111	0.40662784	3.235630852	22.19669072	0.249061738	0	0	0.204474673	3.90954143	2.402693165	0	0	0.480298654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.984		1.132318526	7.9474	0.57354078	3.641471011	0.408203205	3.135942611	1.683161145	0.276270009	2.061839773	7.859629204	0	3.297468988	0	0.014049111	0.40662784	3.235630852	22.19669072	0.249061738	0	0	0.204474673	3.90954143	2.402693165	0	0	0.480298654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.984	NO																																																																																		0			7.9474	0.57354078	3.641471011	0.408203205	3.135942611	1.683161145	0.276270009	2.061839773	7.859629204	0	3.297468988	0	0.014049111	0.40662784	3.235630852	22.19669072	0.249061738	0	0	0.204474673	3.90954143	2.402693165	0	0	0.480298654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.984
H2960_803_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	202.165823	10.62177854	61.81087101	12.27433414	11.97409443	10.39074188	1.97336881	23.54347195	43.36674915	1.866037136	40.65511606	0	0.104803449	7.34474095	21.68260382	55.62196237	0.892000233	0	28.39182804	131.1398412	24.94215872	11.54798356	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.072863869	0.072863869	0.150084731	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072863869	0.072863869	0.150084731	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												14.7306	0.773943881	9.276867941	0	2.789964002	2.421042858	0.459794933	5.485628964	10.10445255	0.434786653	9.472642042	0	0.024419204	1.711324641	5.052046691	12.95991723	0.207836054	0	6.615295934	30.55558299	5.811522981	2.69068017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5783		0	14.7306	0.773943881	9.276867941	0	2.789964002	2.421042858	0.459794933	5.485628964	10.10445255	0.434786653	9.472642042	0	0.024419204	1.711324641	5.052046691	12.95991723	0.207836054	0	6.615295934	30.55558299	5.811522981	2.69068017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5783	NO																																																																																		0			14.7306	0.773943881	9.276867941	0	2.789964002	2.421042858	0.459794933	5.485628964	10.10445255	0.434786653	9.472642042	0	0.024419204	1.711324641	5.052046691	12.95991723	0.207836054	0	6.615295934	30.55558299	5.811522981	2.69068017	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5783
H2961_002_0	2010	13	N/A		h.1.	h.1.	h.2.	h.2.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Chemotherapy	Genetic Testing	Complex diag xray	PET Scans						D	D	D	V	Coin	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin					V	V		V			Coin	Coin	V	V																	0	0	0	0	0	0	0	0	0												0	0	0	0						0	YES	1294.84172	26.28298891	2547.677672	18217.69807	10.57544504	21.10269401	11.53411111	297.9922098	257.9764984	7372.182559	63.99465961	0	6.776493914	53.0485148	3845.08951	1261.451457	451.3692814	275.6556279	2.950790719	535.6911003	20.42383812					180.2793574	90.1396787		125.1			0.078454715	0.013884704	473.3897061	5.697588771						3000	"$100/day, max 5 days"	"$100/day, max 5 days"	"$50/day, days 11 - 100"	None	0.2	"20% Insulin pumps, zero others"	0.2	50	$100/visit OH - $70/visit ASC	$5/procedure	$5/procedure	$100/visit	0.2	150	$10/visit OV - $25 Urgently Needed SVC	$20/visit	$10/visit	$10/visit	$20/visit	$20/visit	0.2					$20/visit	Max benefit $30/2-yrs		"NC Nursing HL, $35 smoking cessation"			0.2	0.5	$50 per visit	$200 per visit						96.8	67.93478261	26.02585365	0	0.2	0.170115559	0.2	50	79.03690866	5	5	100	0.2	10	10.72412651	20	10	10	20	20	0.2					20	0		0			0.2	0.5	50	200						NO	74.16786835	52.05142576	19.94093065	0	0.153239397	0.130342029	0.153239397	38.30984936	60.55784129	3.830984936	3.830984936	76.61969871	0.153239397	7.661969871	10.72412651	20	10	10	20	20	0.153239397					20	0		0			0.153239397	0.383098494	38.30984936	153.2393974							8.003	0.114005587	4.233588648	0	1.620574826	2.750567949	1.767480236	0.951336389	1.301874987	2.353560027	0.020430215	0	1.038425844	0.033871344	3.436268862	2.102419095	0.376141068	0.229713023	0.004917985	0.892818501	3.129736646	0	0	0	0	0.300465596	0	0	0	0	0	0.012022353	0.005319209	1.511290694	0.072757923	0	0	0	0	0	36.2626	0	8.824805755	8.003	0.114005587	4.233588648	0	1.620574826	2.750567949	1.767480236	0.951336389	1.301874987	2.353560027	0.020430215	0	1.038425844	0.033871344	3.436268862	2.102419095	0.376141068	0.229713023	0.004917985	0.892818501	3.129736646	0	0	0	0	0.300465596	0	0	0	0	0	0.012022353	0.005319209	1.511290694	0.072757923	0	0	0	0	0	36.2626	NO	"$275/day, max 5-days"	"$275/day, max 5-days"	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	35	35	35	35	35	35	0.2											0.2	0.2	0.2	0.2							0.0823	0.0012	0.1488	0.0364	0.0003	0.1344	0.0164	0	0.2692	0.0603	0.0974	0	0.0009	0.1561	0.0153	0.0833	0.0473	0.2197	0.0021	0.1061	0											0	0	0	0						1.4776	0	0	8.0853	0.115211201	4.382415968	0.036401648	1.62087065	2.884969273	1.78385873	0.951351819	1.571041017	2.413856086	0.117826556	0	1.039345991	0.1900193	3.451616791	2.185710965	0.423421683	0.44938772	0.007013004	0.998947605	3.129736646	0	0	0	0	0.300465596	0	0	0	0	0	0.012022353	0.005319209	1.511290694	0.072757923	0	0	0	0	0	37.7401
H2961_011_0	2010	10	N/A																															D	D	D	V	Coin	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin								V																																																				0	YES	1330.184706	146.9963629	1262.264168	21125.4797	11.41344967	21.95016263	2.887779379	435.292838	466.4888154	3.552969804	16.1111929	0	1.726929384	606.2901157	8263.85107	6137.025565	164.5579487	542.0361285	374.1237552	798.2113416	3.212777048								125.1												3000	"$125/day, max 5 days"	"$125/day, max 5 days"	"$50/day, days 11 - 100"	None	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50/visit	$100/visit	20% Coinsurance	20% Coinsurance	$100/visit	205 coinsurance	$10/visit	$10/visit OV - $25/visit Urgently needed services	$35/visit	$35/visit	$35/visit	$35/visit	$35/visit	20% Coinsurance								"NC Nursing HL, $35 smoking cessation"												96.19718893	96.19718893	26.02585365	0	0.2	0.2	0.2	50	100	0.2	0.2	100	0.2	10	10.71973574	35	35	35	35	35	0.2								0												NO	76.74087818	76.74087818	20.76200861	0	0.159549107	0.159549107	0.159549107	39.88727687	79.77455374	0.159549107	0.159549107	79.77455374	0.159549107	7.977455374	10.71973574	35	35	35	35	35	0.159549107								0													8.5066	0.940052498	2.183928294	0	1.821005708	3.502128856	0.460742622	1.446887162	3.101161423	0.566873161	2.570526448	0	0.275530042	0.403054362	7.382191638	17.8996579	0.479960684	1.580938708	1.091194286	2.328116413	0.512595711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0532	0	6.665653459	8.5066	0.940052498	2.183928294	0	1.821005708	3.502128856	0.460742622	1.446887162	3.101161423	0.566873161	2.570526448	0	0.275530042	0.403054362	7.382191638	17.8996579	0.479960684	1.580938708	1.091194286	2.328116413	0.512595711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0532	NO	"$275/day, max 5-days"	"$275/day, max 5-days"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$35/visit	$45/visit	45	$45/visit	$45/visit	$45/visit	30% coinsurance																					0	0	0.0296	0.0003	0.0006	0.0046	0.021	0	0.0051	0.0008	0	0	0	0.0013	0.0006	0.0098	0	0.0011	0.0006	0.012	0																				0.0875	0	0	8.5066	0.940052498	2.213519838	0.000281048	1.821600396	3.506753805	0.481740659	1.446887162	3.106264489	0.567642322	2.570526448	0	0.275530042	0.404385898	7.382755841	17.90950635	0.479960684	1.58208084	1.091826126	2.34016023	0.512595711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1407
H2961_801_0	2010	5	N/A	h.1.	h.1.	h.2.	h.2.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Chemotherapy	Genetic Testing	Complex diag xray	PET Scans							D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin				V				V		Coin	Coin	V	V																																															0	YES	1331.813552	369.1933494	2594.695439	15377.93885	1809.074986	3.522133675	29.49517415	133.2321836	237.0737189	3791.360087	217.4213698	0	1673.032626	34.06790854	3871.843786	1273.932671	312.0656641	318.0335967	0.994791484	175.1681344	18.42826533				260.7998009				1.875152607		0.014061223	0	386.1570493	8.372921291							3000	"$125/day, max 5 days"	"$125/day, max 5 days"	"$50/day, days 11 - 100"	None	$150/Trip	"None, except Insulin pumps 20%"	20% Coinsurance	$50/visit	$100/visit OH/ $50/visit ASC	$5/Procedure	$5/procedure	$25/visit	$10/visit	$25/visit	"$10/visit PCP, $25 Urgently needed"	$20/visit	$10/visit	$10/visit	$10/visit	$10/visit	20% Coinsurance				$20/visit				$10 - $60 /visit		20% Coinsurance	50% coinsurance	$50 per visit	$200 per visit							45.41566986	45.41566986	26.02585365	0	150	0.169783542	0.2	50	61.1833132	5	5	25	10	25	10.57525144	20	10	10	10	10	0.2				20				15		0.2	0.5	50	200							NO	31.41605303	31.41605303	18.00324868	0	103.7617186	0.117446881	0.138348958	34.58723952	42.32323817	3.458723952	3.458723952	17.29361976	6.917447905	17.29361976	10.57525144	20	10	10	10	10	0.138348958				20				15		0.138348958	0.345872395	34.58723952	138.3489581								3.4867	0.96654982	3.892745603	0	15.64272746	0.413663615	4.080626612	0.384011121	0.836143956	1.092772329	0.062666708	0	0.964426336	0.049096455	3.412143465	2.123221119	0.26005472	0.265027997	0.000828993	0.145973445	2.549531308	0	0	0	0.434666335	0	0	0	0.002343941	0	0.001945356	0	1.113008863	0.096532078	0	0	0	0	0	0	42.2774	0	15.69449839	3.4867	0.96654982	3.892745603	0	15.64272746	0.413663615	4.080626612	0.384011121	0.836143956	1.092772329	0.062666708	0	0.964426336	0.049096455	3.412143465	2.123221119	0.26005472	0.265027997	0.000828993	0.145973445	2.549531308	0	0	0	0.434666335	0	0	0	0.002343941	0	0.001945356	0	1.113008863	0.096532078	0	0	0	0	0	0	42.2774	NO																																																																																		0			3.4867	0.96654982	3.892745603	0	15.64272746	0.413663615	4.080626612	0.384011121	0.836143956	1.092772329	0.062666708	0	0.964426336	0.049096455	3.412143465	2.123221119	0.26005472	0.265027997	0.000828993	0.145973445	2.549531308	0	0	0	0.434666335	0	0	0	0.002343941	0	0.001945356	0	1.113008863	0.096532078	0	0	0	0	0	0	42.2774
H2961_805_0	2010	4	N/A	h.1.	h.1.	h.2.	h.2.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Chemotherapy	Genetic Testing	Complex diag xray	PET Scans							D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin										Coin	Coin	V	V																																															0	YES	1297.76296	0.229310012	2495.313101	295.7812719	6674.358563	21.04950267	2.125374259	204.7350525	375.0665262	6973.3889	682.064797	0	113.9621454	63.53293467	3838.950668	1286.981494	413.7216878	303.1495046	576.6604731	184.1655878	15.53351583										0.058871516	0	15.4365279	0.159422763							3000	"$125/day, max 5 days"	"$125/day, max 5 days"	"$50/day, days 11 - 100"	None	$150/Trip	None	20% Coinsurance	$50/visit	$100/visit OH/ $50/visit ASC	$5/Procedure	$5/procedure	$25/visit	$10/visit	$25/visit	$10/visit	$20/visit	$10/visit	$10/visit	$10/visit	$10/visit	20% Coinsurance										20% Coinsurance	50% coinsurance	$50 per visit	$200 per visit							45.41566986	45.41566986	26.02585365	0	150	0	0.2	50	66.52773018	5	5	25	10	25	10	20	10	10	10	10	0.2										0.2	0.5	50	200							NO	30.85365974	30.85365974	17.6809642	0	101.9042321	0	0.135872309	33.96807735	45.1963817	3.396807735	3.396807735	16.98403868	6.793615471	16.98403868	10	20	10	10	10	10	0.135872309										0.135872309	0.339680774	33.96807735	135.8723094								3.3367	0.000589588	3.676628467	0	56.67878199	0	0.288779509	0.579538008	1.41263749	1.973938446	0.193070248	0	0.064517916	0.089920485	3.199125556	2.144969156	0.344768073	0.252624587	0.480550394	0.153471323	2.11057467	0	0	0	0	0	0	0	0	0	0.007999009	0	0.043695764	0.001805095	0	0	0	0	0	0	77.0347	0	17.08601758	3.3367	0.000589588	3.676628467	0	56.67878199	0	0.288779509	0.579538008	1.41263749	1.973938446	0.193070248	0	0.064517916	0.089920485	3.199125556	2.144969156	0.344768073	0.252624587	0.480550394	0.153471323	2.11057467	0	0	0	0	0	0	0	0	0	0.007999009	0	0.043695764	0.001805095	0	0	0	0	0	0	77.0347	NO																																																																																		0			3.3367	0.000589588	3.676628467	0	56.67878199	0	0.288779509	0.579538008	1.41263749	1.973938446	0.193070248	0	0.064517916	0.089920485	3.199125556	2.144969156	0.344768073	0.252624587	0.480550394	0.153471323	2.11057467	0	0	0	0	0	0	0	0	0	0.007999009	0	0.043695764	0.001805095	0	0	0	0	0	0	77.0347
H2961_806_0	2010	4	N/A	h.1.	h.1.	h.2.	h.2.	n.1.						OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Vision (Non-Covered)						Chemotherapy	Genetic Testing	Complex diag xray	PET Scans	Professional						D	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	V	V	Coin				V				V		Coin	Coin	V	V	V																																														0	YES	939.9721094	3.218209866	1849.152894	10158.77468	1509.709642	2.332632533	16.81210628	167.0865774	216.281213	4610.527194	96.73671531	0	5705.443666	37.78021072	2767.223806	889.9326852	368.3023079	199.509793	1.866990685	237.9299876	14.76541301				1.684499251				0		0.066814567	0	101.925563	0.081312117	1.684499251						3000	"$125/day, max 5 days"	"$125/day, max 5 days"	"$50/day, days 11 - 100"	None	$150/Trip	"None, except insulin pumps 20%"	20% Coinsurance	$50/visit	$100/visit OH/ $50/visit ASC	$5/Procedure	$5/procedure	$25/visit	$10/visit	$25/visit	$10/visit - $25 urgently needed care	$20/visit	$10/visit	$10/visit	$10/visit	$10/visit	20% Coinsurance				$20/visit				$10 - $60 / visit		20% Coinsurance	50% coinsurance	$50 per visit	$200 per visit	$20/visit						45.41566986	45.41566986	26.02585365	0	150	0.169665658	0.2	50	69.85837329	5	5	25	10	25	10.21575304	20	10	10	10	10	0.2				20				15		0.2	0.5	50	200	20						NO	33.66116665	33.66116665	19.28983101	0	111.1769355	0.12575272	0.148235914	37.05897849	51.77759906	3.705897849	3.705897849	18.52948924	7.411795697	18.52948924	10.21575304	20	10	10	10	10	0.148235914				20				15		0.148235914	0.370589785	37.05897849	148.2359139	20							2.6367	0.009027392	2.972487236	0	13.98707429	0.293334885	2.492157939	0.516004823	0.933210161	1.423845234	0.029874699	0	3.523965234	0.058337334	2.355772917	1.483221142	0.30691859	0.166258161	0.001555826	0.19827499	2.188764492	0	0	0	0.002807499	0	0	0	0	0	0.009904318	0	0.314771437	0.001004448	0.002807499	0	0	0	0	0	35.9081	0	10.85914406	2.6367	0.009027392	2.972487236	0	13.98707429	0.293334885	2.492157939	0.516004823	0.933210161	1.423845234	0.029874699	0	3.523965234	0.058337334	2.355772917	1.483221142	0.30691859	0.166258161	0.001555826	0.19827499	2.188764492	0	0	0	0.002807499	0	0	0	0	0	0.009904318	0	0.314771437	0.001004448	0.002807499	0	0	0	0	0	35.9081	NO																																																																																		0			2.6367	0.009027392	2.972487236	0	13.98707429	0.293334885	2.492157939	0.516004823	0.933210161	1.423845234	0.029874699	0	3.523965234	0.058337334	2.355772917	1.483221142	0.30691859	0.166258161	0.001555826	0.19827499	2.188764492	0	0	0	0.002807499	0	0	0	0	0	0.009904318	0	0.314771437	0.001004448	0.002807499	0	0	0	0	0	35.9081
H2997_001_0	2010	13	N/A	H.6	H.7	H.8	H.9	I.7	I.8	I.9	I.10	I.11	I.12	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Cardiac Rehab Services	ASC	Urgent Care	Office Visit (Clinic)	Chiropractic	Podiatric	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Radiation/Chemo	D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	Coin	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	V	Coin	V	V	Coin	4.3533	0.1944	0.7173	0.2534	0.3542	0.7129	0.1682	0.2848	0.9474	0.5182	1.2906	0.2747	0.0002	0.0167	1.5594	2.5522	0.0234	1.2625	3.5081	0.0535	1.6324	0	0	0	0.1503	0	0.1127	0	0	0	0.0409	0.5999	0.0049	0.0784	0.2979	0.2527	0.1017	0.3839	0.0136	0.5908	23.3053	NO	1394.125702	74.31375824	281.7674026	4.769606936	160.0171637	13.41843081	3.165207047	261.5741198	190.2098251	19.50837541	24.29225788	55.16259112	0.004135399	21.56385936	3522.346406	3294.096632	26.38385418	1374.378009	66.03138698	2.015280895	30.72609318	0	0	0	302.4	143.52	129.6	0	0	0	52.74060835	135.4916673	4.921795951	101.1627637	384.5159483	326.1852568	1.913707136	495.5052532	17.49722453	11.11990589		$280/day (for days 1-6) w/$1680 yrly max	$280/day (for days 1-6) w/$1680 yrly max	$115/day (for days 21-100)	20% Coinsurance	$100 copay	20% Coinsurance	20% Coinsurance	$50 copay	$225 copay	10% Coinsurance	20% Coinsurance	$225 copay	20% Coinsurance	$35 copay	$20 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	20% Coinsurance	10% Coinsurance	20% Coinsurance				$20 copay	$100/$80 glasses/contacts	$35 copay		Silver Sneakers		$35 copay	$200 copay	$45 copay	$35 copay	$35 copay	$35 copay	20% Coinsurance	$35 copay	$35 copay	20% Coinsurance	280	280	115	0.2	100	0.2	0.2	50	225	0.1	0.2	225	0.2	35	20	35	40	41.49730419	0.2	0.1	0.2	0	0	0	20	0	35	0	0	0	35	200	45	35	35	35	0.2	35	35	0.2	NO	125.6315349	105.2267228	90.60198295	0.178121101	89.06055035	0.178121101	0.178121101	44.53027517	200.3862383	0.08906055	0.178121101	200.3862383	0.178121101	31.17119262	17.81211007	31.17119262	35.62422014	36.9577275	0.178121101	0.08906055	0.178121101	0	0	0	20	0	35	0	0	0	31.17119262	178.1211007	40.07724766	31.17119262	31.17119262	31.17119262	0.178121101	31.17119262	31.17119262	0.178121101		14.5955	0.651649436	2.127390451	0.849567637	1.187601389	2.390105665	0.563790163	0.970663961	3.176285945	1.73742665	4.326963713	0.921152011	0.000736602	0.056014268	5.228368491	8.556743386	0.078325352	4.232823993	11.76158333	0.179482026	5.472965537	0	0	0	0.504	0	0.378	0	0	0	0.136998972	2.01116041	0.01643767	0.262780333	0.998818391	0.847298622	0.340871622	1.287124141	0.04545078	1.980689877	77.8748		9.489307968	18.9488	0.846012931	2.844678166	1.102962984	1.541819997	3.102987875	0.73194841	1.255509411	4.123657342	2.255638279	5.617540735	1.195898391	0.000956304	0.072721301	6.787802008	11.10891094	0.101686977	5.495322537	15.26963891	0.233015032	7.10535352	0	0	0	0.654325	0	0.49074375	0	0	0	0.177860818	2.611016934	0.021340433	0.341158217	1.296729848	1.100017204	0.442541317	1.671026792	0.059007106	2.571458141	101.1801	YES	$350/day (for days 1-6)	$350/day (for days 1-6)	30% Coinsurance	20% Coinsurance	$100 copay	30% Coinsurance	30% Coinsurance	$50 copay	$325 copay	20% Coinsurance	30% Coinsurance	$325 copay	20% Coinsurance	$45 copay	$35 copay	$45 copay	$45 copay	$90/$45 OP/PR copay	20% Coinsurance	20% Coinsurance	25% Coinsurance				$40 copay	Multiple amts	$45 copay		Silver Sneakers		$45 copay	$300 copay	$45 copay	$45 copay	$45 copay	$45 copay	30% Coinsurance	$45 copay	$45 copay	25% Coinsurance	4000	5.556	0.2481	2.0801	0.2587	0.3617	1.0918	0.2575	0.2908	1.3972	1.0582	1.9765	0.4052	0.0002	0.3562	2.7864	3.3503	0.0268	1.289	3.5818	0.1147	2.0564			0	0	0	0.1215	0			0.0536	0.9187	0.005	0.1029	0.4168	0.3318	0.1557	0.504	0.0178	0.754	31.9253		3.010246293	24.5048	1.094072278	4.924781866	1.361682697	1.903481477	4.194779904	0.989485813	1.546340059	5.520836167	3.313838953	7.594082845	1.601093045	0.001180622	0.42888111	9.574152833	14.45921742	0.12852104	6.784348811	18.85140606	0.347736085	9.161778921	0	0	0	0.654325	0	0.61224375	0	0	0	0.231501382	3.529708077	0.026346213	0.444047203	1.713535871	1.431768425	0.598250299	2.174987254	0.0768029	3.325435066	133.1055
H2997_002_0	2010	14	N/A	H.6	H.7	H.8	H.9	I.7	I.8	I.9	I.10	I.11	I.12	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Cardiac Rehab Services	ASC	Urgent Care	Office Visit (Clinic)	Chiropractic	Podiatric	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Radiation/Chemo	D	D	D	Coin	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	V	Coin	V	V	Coin	5.2052	0.2989	0.9514	0	0.4421	0.7219	0.0611	0.3365	0.9699	0	0.9859	0.3475	0.0004	0.0066	0.7865	1.5668	0.0413	1.1103	1.753	0.0739	2.3762	0	0	0	0.1677	0	0.0898	0	0	0	0.0433	0.5319	0.0053	0.067	0.2013	0.1879	0.1184	0.2739	0.0143	0.7322	20.4683	NO	1325.355141	83.72792198	352.972722	5.253337957	180.420962	12.2756336	1.039758484	278.8507776	226.1833387	4062.878097	774.7392226	81.02860052	0.006920016	13.52254108	3209.855523	3197.028371	42.09906371	1358.581962	2201.320647	2.513759979	40.40519055	0	0	745.9758882	302.4	143.52	129.6	0	0	0	88.25408082	144.7004515	6.204650338	136.7811681	410.7132261	383.3223982	2.013819159	558.9974444	29.27917436	12.45101625		$250/day (for days 1-5) $2500 yrly max	$250/day (for days 1-5) no yrly max	$110/day (for days 21-100)	0% Coinsurance	$100 copay	20% Coinsurance	20% Coinsurance	$50 copay	$175 copay	$0 copay	$25/$100 copay for Lower/Higher Tier	$175 copay	20% Coinsurance	$20 copay	$10 copay	$20 copay	$40 copay	$40/$20 OP/PR copay	$25/$100 copay for Lower/Higher Tier	10% Coinsurance	20% Coinsurance			$0 deduct 1 exam/ 2 cleanings	$20 copay	$175/$80 glasses/contacts	$25 copay		Silver Sneakers		$20 copay	$150 copay	$35 copay	$20 copay	$20 copay	$20 copay	20% Coinsurance	$20 copay	$20 copay	20% Coinsurance	250	250	110	0	100	0.2	0.2	50	175	0	51.93269551	175	0.2	20	10	20	40	33.35077346	32.49861463	0.1	0.2	0	0	10	20	0	25	0	0	0	20	150	35	20	20	20	0.2	20	20	0.2	NO	141.678242	128.7938355	82.27541621	0	88.39507527	0.176790151	0.176790151	44.19753763	154.6913817	0	45.90594528	154.6913817	0.176790151	17.67901505	8.839507527	17.67901505	35.35803011	29.48044131	28.72717487	0.088395075	0.176790151	0	0	10	20	0	25	0	0	0	17.67901505	132.5926129	30.93827634	17.67901505	17.67901505	17.67901505	0.176790151	17.67901505	17.67901505	0.176790151		15.6478	0.898636684	2.420081468	0	1.329027043	2.170211112	0.183819059	1.027043145	2.915717766	0	2.963761363	1.044535514	0.001223391	0.019922101	2.364461838	4.710026058	0.124044997	3.337632983	5.269810263	0.222204003	7.14323972	0	0	0.621646573	0.504	0	0.27	0	0	0	0.130020435	1.598850913	0.015996766	0.201513028	0.605083776	0.564730204	0.356023392	0.823543686	0.04313558	2.201217038	61.729		7.976575416	20.853	1.197564698	3.371481423	0	1.771122744	2.892123438	0.244965757	1.363517253	3.885619993	0	3.949645107	1.39199621	0.001630347	0.02654911	3.150990915	6.276797992	0.165308085	4.447883674	7.022792246	0.296119304	9.519410759	0	0	0.621646573	0.671653649	0	0.359814455	0	0	0	0.17327123	2.130702479	0.021318028	0.268545556	0.806362551	0.75258552	0.474453195	1.097492305	0.057484464	2.933443364	82.1973	YES	$300/day (for days 1-5)	$300/day (for days 1-5)	30% Coinsurance	0% Coinsurance	$100 copay	30% Coinsurance	30% Coinsurance	$50 copay	$275 copay	$25 copay	$35/$150 copay for Lower/Higher Tier	$275 copay	20% Coinsurance	$35 copay	$25 copay	$35 copay	$45 copay	$70/$35 OP/PR copay	$35/$150 copay for Lower/Higher Tier	20% Coinsurance	20% Coinsurance			20% Coinsurance	$40 copay	$50/$25/$$35/$45/$5 frames/lens/bi/tri/contacts	$35 copay		Silver Sneakers		$35 copay	$250 copay	$35 copay	$35 copay	$35 copay	$35 copay	30% Coinsurance	$35 copay	$35 copay	20% Coinsurance	3400	7.1582	0.3933	2.4768		0.4154	1.0176	0.0862	0.3162	1.4323	2.3389	1.3611	0.5131	0.0004	0.575	1.8478	2.5766	0.0436	1.8258	2.3569	0.1456	2.1714			0.6372	0	0	0.0945	0			0.0711	0.0833	0.005	0.1102	0.3528	0.3089	0.1669	0.4505	0.0236	0.6881	32.0444		3.086511575	28.0112	1.590839031	5.848299786	0	2.186571288	3.909722425	0.331157412	1.679710508	5.317885563	2.338859042	5.310755464	1.905095342	0.002012774	0.601506968	4.99879423	8.853384822	0.208931052	6.273712466	9.379733063	0.441719377	11.69082912	0	0	1.258856807	0.671653649	0	0.454314455	0	0	0	0.244398	2.214001547	0.026318553	0.378781849	1.159146167	1.061517231	0.641390431	1.548006122	0.081081482	3.621535017	114.2417
H2997_803_0	2010	6	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	249.3034833	2.854359358	35.57308452	37.18707709	9.280500236	16.45870599	4.069372635	7.420965286	41.66725731	1.713636608	7.918589656	0	0.067799898	11.5327916	42.83849388	103.2055951	1.522986069	6.029357744	43.50316051	39.71532334	3.615568846	0.635218348	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.070374227	0.070374227	0.146259658	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070374227	0.070374227	0.146259658	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.5445	0.200873333	5.202907181	0	2.162356555	3.834878495	0.948163824	1.729084912	9.708470953	0.39927733	1.84503139	0	0.015797376	2.687140442	9.981369074	24.04690365	0.354855754	1.404840354	10.1362364	9.253670338	0.842427541	0.148005875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4468	0	0	17.5445	0.200873333	5.202907181	0	2.162356555	3.834878495	0.948163824	1.729084912	9.708470953	0.39927733	1.84503139	0	0.015797376	2.687140442	9.981369074	24.04690365	0.354855754	1.404840354	10.1362364	9.253670338	0.842427541	0.148005875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4468	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				6.1426	0.0703	2.5902	0	0.6285	1.1102	0.2745	0.7143	3.0224	0.4639	1.441	0	0.0045	1.7703	3.0738	7.6375	0.1012	0.3991	2.2266	2.6536	0.5672	0.0989	0	0	0	0	0	0	0	0											34.9908	0	0	23.6872	0.271202562	7.793077334	0	2.790893156	4.945083766	1.222659216	2.443346012	12.73091166	0.863154136	3.286024074	0	0.020263471	4.457469094	13.05518053	31.6844536	0.45604178	1.803932995	12.36286281	11.9073144	1.409663817	0.246927301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.4376
H2997_804_0	2010	5	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	249.3034833	2.854359358	35.57308452	37.18707709	9.280500236	16.45870599	4.069372635	7.420965286	41.66725731	1.713636608	7.918589656	0	0.067799898	11.5327916	42.83849388	103.2055951	1.522986069	6.029357744	43.50316051	39.71532334	3.615568846	0.635218348	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.070374227	0.070374227	0.146259658	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070374227	0.070374227	0.146259658	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.5445	0.200873333	5.202907181	0	2.162356555	3.834878495	0.948163824	1.729084912	9.708470953	0.39927733	1.84503139	0	0.015797376	2.687140442	9.981369074	24.04690365	0.354855754	1.404840354	10.1362364	9.253670338	0.842427541	0.148005875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4468	0	0	17.5445	0.200873333	5.202907181	0	2.162356555	3.834878495	0.948163824	1.729084912	9.708470953	0.39927733	1.84503139	0	0.015797376	2.687140442	9.981369074	24.04690365	0.354855754	1.404840354	10.1362364	9.253670338	0.842427541	0.148005875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4468	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				6.1426	0.0703	2.5902	0	0.6285	1.1102	0.2745	0.7143	3.0224	0.4639	1.441	0	0.0045	1.7703	3.0738	7.6375	0.1012	0.3991	2.2266	2.6536	0.5672	0.0989	0	0	0	0	0	0	0	0											34.9908	0	0	23.6872	0.271202562	7.793077334	0	2.790893156	4.945083766	1.222659216	2.443346012	12.73091166	0.863154136	3.286024074	0	0.020263471	4.457469094	13.05518053	31.6844536	0.45604178	1.803932995	12.36286281	11.9073144	1.409663817	0.246927301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.4376
H2997_805_0	2010	5	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	249.3034833	2.854359358	35.57308452	37.18707709	9.280500236	16.45870599	4.069372635	7.420965286	41.66725731	1.713636608	7.918589656	0	0.067799898	11.5327916	42.83849388	103.2055951	1.522986069	6.029357744	43.50316051	39.71532334	3.615568846	0.635218348	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.070374227	0.070374227	0.146259658	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070374227	0.070374227	0.146259658	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.5445	0.200873333	5.202907181	0	2.162356555	3.834878495	0.948163824	1.729084912	9.708470953	0.39927733	1.84503139	0	0.015797376	2.687140442	9.981369074	24.04690365	0.354855754	1.404840354	10.1362364	9.253670338	0.842427541	0.148005875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4468	0	0	17.5445	0.200873333	5.202907181	0	2.162356555	3.834878495	0.948163824	1.729084912	9.708470953	0.39927733	1.84503139	0	0.015797376	2.687140442	9.981369074	24.04690365	0.354855754	1.404840354	10.1362364	9.253670338	0.842427541	0.148005875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4468	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				6.1426	0.0703	2.5902	0	0.6285	1.1102	0.2745	0.7143	3.0224	0.4639	1.441	0	0.0045	1.7703	3.0738	7.6375	0.1012	0.3991	2.2266	2.6536	0.5672	0.0989	0	0	0	0	0	0	0	0											34.9908	0	0	23.6872	0.271202562	7.793077334	0	2.790893156	4.945083766	1.222659216	2.443346012	12.73091166	0.863154136	3.286024074	0	0.020263471	4.457469094	13.05518053	31.6844536	0.45604178	1.803932995	12.36286281	11.9073144	1.409663817	0.246927301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.4376
H3028_001_0	2010	7	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	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	YES	1538.880456	42.809603	627.874239	1320.057818	237.173366	9.482036	3.244395	336.814804	320.180749	3159.809874	2004.237292	84.062245	0.026502	178.324999	5215.094631	4953.946397	61.277519	670.631817			35.92781	0		1.1	2.47				0.04	0.25	20.899071	0.05	0.55	1.65	0.35	0.42					5000	$200/Day(Days 1-7):1a	$200/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$50/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $100 DMAM -- OP,8b. $20 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$20-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $20 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $100 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$20/Visit:7b, 7d, 7f"	$20/Visit:7e	"$20-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $20 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN756: Dental 16a, 16b"	"VIS735: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: OTC items 13c	$0: Nutritional benefit 14a					141.1176	124.7992	48.2281	0	50	0.2	0.082333	50	84.385923	0	60.364009	100	0.2	55.139103	0	20	20	29.959315			0.2	0		0	0				0	0	0	0	0	0	0	0					NO	132.874639	117.509429	37.063005	0	46.06165	0.184247	0.075848	46.06165	77.739097	0	55.609317	92.1233	0.184247	50.795961	0	18.42466	18.42466	27.59951			0.184247	0		0	0				0	0	0	0	0	0	0	0						17.0398	0.419211	1.939242172	0	0.910383048	1.747036687	0.246080872	1.292853801	2.074213525	0	9.287855576	0.645340951	0.004882914	0.754849141	0	7.606231502	0.094084788	1.542425795	0	0	6.619591209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2241	0	4.473932	17.0398	0.419211	1.939242172	0	0.910383048	1.747036687	0.246080872	1.292853801	2.074213525	0	9.287855576	0.645340951	0.004882914	0.754849141	0	7.606231502	0.094084788	1.542425795	0	0	6.619591209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2241	NO																																																																																		0	0	0	17.0398	0.419211	1.939242172	0	0.910383048	1.747036687	0.246080872	1.292853801	2.074213525	0	9.287855576	0.645340951	0.004882914	0.754849141	0	7.606231502	0.094084788	1.542425795	0	0	6.619591209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2241
H3028_801_0	2010	3	N/A																															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	NO	195.107704	1.200654	18.792466	9.090559	4.427957	4.309411	1.821461	17.838267	50.432879	7.251888	23.776457	3.68089	0.784825	12.990342	60.221818	74.706249	0.261345	5.080781			19.20481	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																			0.07663397	0.07663397	0.169101008	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.07663397	0.07663397	0.169101008	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				14.9519	0.092010882	3.177824944	0	1.031713981	1.004092763	0.424400413	4.156316211	11.75086081	1.689689904	5.539914481	0.85764737	0.182864225	3.026749686	14.03168359	17.40655602	0.060893385	1.183821973	0	0	4.47472073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0436	0	0	14.9519	0.092010882	3.177824944	0	1.031713981	1.004092763	0.424400413	4.156316211	11.75086081	1.689689904	5.539914481	0.85764737	0.182864225	3.026749686	14.03168359	17.40655602	0.060893385	1.183821973	0	0	4.47472073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0436	NO																																																																																		0	0	0	14.9519	0.092010882	3.177824944	0	1.031713981	1.004092763	0.424400413	4.156316211	11.75086081	1.689689904	5.539914481	0.85764737	0.182864225	3.026749686	14.03168359	17.40655602	0.060893385	1.183821973	0	0	4.47472073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0436
H3028_803_0	2010	3	N/A																															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	NO	195.107704	1.200654	18.792466	9.090559	4.427957	4.309411	1.821461	17.838267	50.432879	7.251888	23.776457	3.68089	0.784825	12.990342	60.221818	74.706249	0.261345	5.080781			19.20481	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																			0.07663397	0.07663397	0.169101008	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.07663397	0.07663397	0.169101008	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				14.9519	0.092010882	3.177824944	0	1.031713981	1.004092763	0.424400413	4.156316211	11.75086081	1.689689904	5.539914481	0.85764737	0.182864225	3.026749686	14.03168359	17.40655602	0.060893385	1.183821973	0	0	4.47472073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0436	0	0	14.9519	0.092010882	3.177824944	0	1.031713981	1.004092763	0.424400413	4.156316211	11.75086081	1.689689904	5.539914481	0.85764737	0.182864225	3.026749686	14.03168359	17.40655602	0.060893385	1.183821973	0	0	4.47472073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0436	NO																																																																																		0	0	0	14.9519	0.092010882	3.177824944	0	1.031713981	1.004092763	0.424400413	4.156316211	11.75086081	1.689689904	5.539914481	0.85764737	0.182864225	3.026749686	14.03168359	17.40655602	0.060893385	1.183821973	0	0	4.47472073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0436
H3028_804_0	2010	3	N/A																															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	NO	195.107704	1.200654	18.792466	9.090559	4.427957	4.309411	1.821461	17.838267	50.432879	7.251888	23.776457	3.68089	0.784825	12.990342	60.221818	74.706249	0.261345	5.080781			19.20481	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																			0.07663397	0.07663397	0.169101008	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.07663397	0.07663397	0.169101008	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				14.9519	0.092010882	3.177824944	0	1.031713981	1.004092763	0.424400413	4.156316211	11.75086081	1.689689904	5.539914481	0.85764737	0.182864225	3.026749686	14.03168359	17.40655602	0.060893385	1.183821973	0	0	4.47472073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0436	0	0	14.9519	0.092010882	3.177824944	0	1.031713981	1.004092763	0.424400413	4.156316211	11.75086081	1.689689904	5.539914481	0.85764737	0.182864225	3.026749686	14.03168359	17.40655602	0.060893385	1.183821973	0	0	4.47472073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0436	NO																																																																																		0	0	0	14.9519	0.092010882	3.177824944	0	1.031713981	1.004092763	0.424400413	4.156316211	11.75086081	1.689689904	5.539914481	0.85764737	0.182864225	3.026749686	14.03168359	17.40655602	0.060893385	1.183821973	0	0	4.47472073	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0436
H3044_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	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	YES	1130.307561	25.38540569	653.5568168	0	202.5864465	4.990214066	3.101311949	115.3826943	263.6473772	2.95912227	7.089802212	0	0	383.0301618	4815.441952	4472.275095	227.2259077	604.1100701	36.56871326	13316.42116	32.25714706	0.535742554	0	0	9.681945552	95.63654069	90.0243327	0	0	0											3400	"$150/Days 1-5, $80/Days 6-10 for IP Medical; $150/Days 1-5, $80/Days 6-10 for IP Surgical;"	"$150/Days 1-5, $80/Days 6-10 for IP Psych; $150/Days 1-5, $80/Days 6-10 for IP Substance Abuse;"	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $50/Visit for Urgent Care; $50/Visit for Urgent Care - Worldwide;	$125/Case for OP Fac - Surgery; $125/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Case for OP Fac - Cardiovascular; $50/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - CORF; $35/Visit for Prof - CORF; $35/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults; $20/Procedure for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - Tx Injections; $35/Procedure for PCP - Cardio;	$35/Visit for Speclst - Office Visits; $35/Procedure for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Tx Injections; $35/Consult for Speclst - Consults; $35/Procedure for Speclst - Cardio;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $50/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $50/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$35/Visit for Chiropractor; $25/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	20% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											135.7056382	127.6858507	75	0	100	0.199243865	0.199952584	50	125	0.169671374	0.150411533	0	0	39.28604992	20.96294396	35	35	42.37268518	0.156860852	4.013382237	0.171260277	0.2	0	0	25	25	35	0	0	0											NO	122.2516699	115.0269708	67.56443851	0	90.08591801	0.179490665	0.180129121	45.042959	112.6073975	0.152850015	0.13549961	0	0	35.39119873	18.88466051	31.53007131	31.5300713	38.17182243	0.141309539	3.615492232	0.154281393	0.180171836	0	0	22.52147951	22.5214795	31.5300713	0	0	0												11.5152	0.24333386	3.679766613	0	1.520848834	0.895696841	0.558636594	0.433098164	2.474053751	0.452301883	0.960665437	0	0	1.129658048	7.578165539	11.75092939	0.597037423	1.921665194	5.167508002	4.012118104	4.976677586	0.09652572	0	0	0.018170978	0.179489699	0.236539469	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3981	0	6.646890651	11.5152	0.24333386	3.679766613	0	1.520848834	0.895696841	0.558636594	0.433098164	2.474053751	0.452301883	0.960665437	0	0	1.129658048	7.578165539	11.75092939	0.597037423	1.921665194	5.167508002	4.012118104	4.976677586	0.09652572	0	0	0.018170978	0.179489699	0.236539469	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3981	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.5152	0.24333386	3.679766613	0	1.520848834	0.895696841	0.558636594	0.433098164	2.474053751	0.452301883	0.960665437	0	0	1.129658048	7.578165539	11.75092939	0.597037423	1.921665194	5.167508002	4.012118104	4.976677586	0.09652572	0	0	0.018170978	0.179489699	0.236539469	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3981
H3044_002_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	Coin	T	V	V	P	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	YES	1067.492206	29.20554812	709.3215737	0	114.5432317	7.269166488	4.74972987	168.3657296	220.3663277	4.36209697	9.771986252	0	0	533.0990469	4334.153018	4637.479287	143.9469028	770.9992008	27.96921756	10378.81058	40.34512979	0.877351079	0	0	8.973811632	106.1700635	122.9945611	0	0	0											3400	"$150/Days 1-5, $80/Days 6-10 for IP Medical; $150/Days 1-5, $80/Days 6-10 for IP Surgical;"	"$150/Days 1-5, $80/Days 6-10 for IP Psych; $150/Days 1-5, $80/Days 6-10 for IP Substance Abuse;"	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $50/Visit for Urgent Care; $50/Visit for Urgent Care - Worldwide;	$125/Case for OP Fac - Surgery; $125/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Case for OP Fac - Cardiovascular; $50/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - CORF; $35/Visit for Prof - CORF; $35/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults; $20/Procedure for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - Tx Injections; $35/Procedure for PCP - Cardio;	$35/Visit for Speclst - Office Visits; $35/Procedure for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Tx Injections; $35/Consult for Speclst - Consults; $35/Procedure for Speclst - Cardio;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $50/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $50/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$35/Visit for Chiropractor; $25/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	20% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											135.647059	127.5539469	75	0	100	0.199978356	0.017604634	50	125	0.2	0.2	0	0	39.95848977	21.08564748	35	35	42.3760741	0.176630615	5.066776529	0.163761736	0.2	0	0	25	25	35	0	0	0											NO	121.986281	114.708212	67.44688118	0	89.92917491	0.179838886	0.015831702	44.96458745	112.4114686	0.17985835	0.17985835	0	0	35.93434016	18.9621488	31.47521122	31.47521122	38.1084538	0.158842454	4.556510327	0.147269578	0.17985835	0	0	22.48229366	22.48229372	31.47521122	0	0	0												10.8516	0.279176351	3.986793992	0	0.858398193	1.307278802	0.075196308	0.630874631	2.064308545	0.784559563	1.757573322	0	0	1.596380207	6.848737872	12.16380334	0.377563264	2.448465619	4.442699164	3.940929798	5.941610223	0.157798917	0	0	0.016812656	0.198912213	0.322606649	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0521	0	6.836991304	10.8516	0.279176351	3.986793992	0	0.858398193	1.307278802	0.075196308	0.630874631	2.064308545	0.784559563	1.757573322	0	0	1.596380207	6.848737872	12.16380334	0.377563264	2.448465619	4.442699164	3.940929798	5.941610223	0.157798917	0	0	0.016812656	0.198912213	0.322606649	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0521	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.8516	0.279176351	3.986793992	0	0.858398193	1.307278802	0.075196308	0.630874631	2.064308545	0.784559563	1.757573322	0	0	1.596380207	6.848737872	12.16380334	0.377563264	2.448465619	4.442699164	3.940929798	5.941610223	0.157798917	0	0	0.016812656	0.198912213	0.322606649	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0521
H3044_003_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	0	V	Coin	V	T	V	V	P	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	YES	266.0347722	4.062146055	417.2051067	0	184.7457695	9.601538642	6.430856599	252.7690222	375.2365763	0	571.2770252	0	0	583.8399943	4578.702299	6839.16773	170.805475	532.2697578	1830.639108	1180.29008	45.89353328	0	0	0	476.5360154	383.9777873	171.8853445	0	0	0											3000	$400/Admit for IP Medical; $400/Admit for IP Surgical;	$400/Admit for IP Psych; $400/Admit for IP Substance Abuse;	$50/Days 21-100 for SNF	No Cost-Sharing	$50/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; $5/Unit for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $35/Visit for Urgent Care; $35/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC	No Cost-Sharing	$35/Case for OP Fac - Radiology; $55/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Procedure for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - Tx Injections; $5/Visit for PCP - Allergy Tx; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Procedure for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Tx Injections; $5/Visit for Speclst - Allergy Tx; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	$35/Case for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$25/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											400	400	50	0	50	0.2	0.193019654	48.87946442	100	0	39.68676174	0	0	25	15.90592663	24.35307524	25	25	37.24269667	25	0.2	0	0	0	25	25	25	0	0	0											NO	357.4048799	357.4048799	44.67560999	0	44.67560999	0.17870244	0.172465416	43.67439778	89.35121998	0	35.46060578	0	0	22.337805	14.21213949	21.75976983	22.337805	22.337805	33.27680383	22.33780499	0.17870244	0	0	0	22.33780499	22.33780499	22.337805	0	0	0												7.9235	0.120985902	1.553241053	0	0.687802496	1.715818383	1.109100357	0.919961235	2.793987156	0	1.688152449	0	0	1.086808662	5.42276298	12.40155963	0.317951616	0.990811505	5.076484875	2.197090805	8.201286375	0	0	0	0.887064049	0.714768411	0.319961776	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1291	0	6.689405555	7.9235	0.120985902	1.553241053	0	0.687802496	1.715818383	1.109100357	0.919961235	2.793987156	0	1.688152449	0	0	1.086808662	5.42276298	12.40155963	0.317951616	0.990811505	5.076484875	2.197090805	8.201286375	0	0	0	0.887064049	0.714768411	0.319961776	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1291	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.9235	0.120985902	1.553241053	0	0.687802496	1.715818383	1.109100357	0.919961235	2.793987156	0	1.688152449	0	0	1.086808662	5.42276298	12.40155963	0.317951616	0.990811505	5.076484875	2.197090805	8.201286375	0	0	0	0.887064049	0.714768411	0.319961776	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1291
H3044_004_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	0	V	Coin	V	T	V	V	P	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	YES	202.3584205	3.089858859	429.1290406	0	142.5164546	7.40701782	4.961026655	259.9906158	289.4697772	0	440.6872992	0	0	450.4004435	3532.220652	5276.052617	131.7683973	410.6219697	1412.220144	1084.378129	41.90942537	0	0	0	476.5418807	383.9777873	171.8873047	0	0	0											3000	$400/Admit for IP Medical; $400/Admit for IP Surgical;	$400/Admit for IP Psych; $400/Admit for IP Substance Abuse;	$50/Days 21-100 for SNF	No Cost-Sharing	$50/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; $5/Unit for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $35/Visit for Urgent Care; $35/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC	No Cost-Sharing	$35/Case for OP Fac - Radiology; $55/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Procedure for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - Tx Injections; $5/Visit for PCP - Allergy Tx; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Procedure for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Tx Injections; $5/Visit for Speclst - Allergy Tx; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	$35/Case for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$25/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											400	400	50	0	50	0.2	0.19301937	48.87943957	100	0	39.68675218	0	0	25	15.90593635	24.35307041	25	25	37.24269662	25	0.2	0	0	0	25	25	25	0	0	0											YES	351.6467205	351.6467207	43.95584007	0	43.95584006	0.17582336	0.169686571	42.97073657	87.91168013	0	34.88929063	0	0	21.97792003	13.98317588	21.40919336	21.97792003	21.97792003	32.74068033	21.97792003	0.17582336	0	0	0	21.97792003	21.97792003	21.97792003	0	0	0											5000	5.9299	0.090544895	1.571893956	0	0.522035874	1.302326763	0.841819603	0.930999022	2.120647872	0	1.281272271	0	0	0.824905411	4.115971886	9.413002554	0.241332942	0.752051401	3.853087357	1.986031317	7.368655995	0	0	0	0.872783279	0.703252759	0.314810453	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0373	0	6.192868471	5.9299	0.090544895	1.571893956	0	0.522035874	1.302326763	0.841819603	0.930999022	2.120647872	0	1.281272271	0	0	0.824905411	4.115971886	9.413002554	0.241332942	0.752051401	3.853087357	1.986031317	7.368655995	0	0	0	0.872783279	0.703252759	0.314810453	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0373	NO	$200/Days 1-5 for IP Medical; $200/Days 1-5 for IP Surgical;	$200/Days 1-5 for IP Psych; $200/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	20% Coinsurance for Home Health	20% Coinsurance for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	No Cost-Sharing	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for OP Fac - Cardiovascular; 20% Coinsurance for OP Fac - Occ Therapy; 20% Coinsurance for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; 20% Coinsurance for Prof - CORF; 20% Coinsurance for Prof - CORF;	$25/Procedure for PCP - Office Visits; $25/Consult for PCP - Consults; 20% Coinsurance for PCP - Routine Physicals; $25/Procedure for PCP - Asst Surgeon (OP); $35/Visit for PCP - Allergy Tx; $35/Procedure for PCP - Cardio; 20% Coinsurance for PCP - Immunizations;	$35/Procedure for Speclst - Office Visits; $35/Procedure for Speclst - Asst Surgeon (OP); $35/Visit for Speclst - Allergy Tx; $35/Procedure for Speclst - Consults; $35/Procedure for Speclst - Cardio; 20% Coinsurance for Speclst - Immunizations;	20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse;	20% Coinsurance for PT/ST (PCP); 20% Coinsurance for Occ Therapy (PCP); 20% Coinsurance for PT/ST (Specialist); 20% Coinsurance for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$35/Procedure for Chiropractor; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)		20% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												3.8063	0.0959	0	1.92	0.4578	0.6035	0.3965	0	2.2148	0.3706	0.8185	0	0	0.9321	2.3277	4.7406	0.0873	0.2806	1.6668	1.0355	1.1345	0.0751	0	0	0	0	0	0	0	0											22.964	0	4.141152472	9.7362	0.186410917	1.571893956	1.920048416	0.979873688	1.90579066	1.238299904	0.930999022	4.33546843	0.37055061	2.09979838	0	0	1.756961829	6.44367463	14.15363942	0.328606925	1.032603852	5.519927401	3.021485556	8.503124426	0.075108448	0	0	0.872783279	0.703252759	0.314810453	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0013
H3044_801_0	2010	1	N/A																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	Coin	T	P	V	P	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	YES	173.3549145	2.644723098	429.3434724	0	125.9380478	6.418064891	4.296449595	263.8907898	252.6571844	4.067893463	9.823822518	0	0	383.958587	3037.075228	4501.958279	111.3457174	337.185886	17.93778906	5451.935649	39.23847373	0.778184313	0	1000	483.3514971	397.5398944	168.6235625	0	0	0											4000	$1000/Admit for IP Medical; $1000/Admit for IP Surgical;	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $50/Visit for Urgent Care; $50/Visit for Urgent Care - Worldwide;	$125/Case for OP Fac - Surgery; $125/Case for OP Fac - ASC	15% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$30/Case for OP Fac - Cardiovascular; $50/Case for OP Fac - Occ Therapy; $40/Case for OP Fac - Physical/Speech Therapy; $50/Case for OP Fac - CORF; $50/Visit for Prof - CORF; $50/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Procedure for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - Tx Injections; $5/Visit for PCP - Allergy Tx; $15/Procedure for PCP - Cardio;	$30/Visit for Speclst - Office Visits; $30/Procedure for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Tx Injections; $5/Visit for Speclst - Allergy Tx; $30/Consult for Speclst - Consults; $30/Procedure for Speclst - Cardio;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$40/Visit for PT/ST (PCP); $50/Visit for Occ Therapy (PCP); $40/Visit for PT/ST (Specialist); $50/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical; 15% Coinsurance for Prof Path (IP); 15% Coinsurance for Prof Path (OP); 15% Coinsurance for Prof Path (Office); 15% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	20% Coinsurance for Blood Products	No Cost-Sharing	$20/Procedure for Dental - Preventive;	$30/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											1000	1000	75	0	100	0.2	0.2	50	125	0.15	0.2	0	0	42.3811821	14.87363919	29.19812948	30	44.95523273	0.2	7.619573094	0.2	0.2	0	20	30	25	30	0	0	0											YES	872.726568	872.7265679	65.4544926	0	87.27265679	0.174545314	0.174545314	43.6363284	109.090821	0.130908985	0.174545314	0	0	36.9871836	12.98062009	25.48198333	26.18179704	39.23362598	0.174545314	6.649803875	0.174545314	0.174545314	0	17.45453136	26.18179704	21.8181642	26.18179704	0	0	0											8000	12.6076	0.192343343	2.341871595	0	0.915912335	1.120243149	0.749925142	0.959602097	2.296881639	0.532523805	1.714702182	0	0	1.183462229	3.285259975	9.559902152	0.242935915	1.102418745	3.130957016	3.021191901	6.848891701	0.135828425	0	1.45454428	1.054584233	0.722799224	0.367905657	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5423	0	8.099971122	12.6076	0.192343343	2.341871595	0	0.915912335	1.120243149	0.749925142	0.959602097	2.296881639	0.532523805	1.714702182	0	0	1.183462229	3.285259975	9.559902152	0.242935915	1.102418745	3.130957016	3.021191901	6.848891701	0.135828425	0	1.45454428	1.054584233	0.722799224	0.367905657	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5423	NO	$1500/Admit for IP Medical; $1500/Admit for IP Surgical;	$1500/Admit for IP Psych; $1500/Admit for IP Substance Abuse;	No Cost-Sharing	20% Coinsurance for Home Health	20% Coinsurance for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	No Cost-Sharing	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for OP Fac - Cardiovascular; 20% Coinsurance for OP Fac - Occ Therapy; 20% Coinsurance for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; 20% Coinsurance for OP Fac - Other; 20% Coinsurance for Prof - CORF; 20% Coinsurance for Prof - CORF;	20% Coinsurance for PCP - Office Visits; 20% Coinsurance for PCP - Consults; 20% Coinsurance for PCP - Routine Physicals; 20% Coinsurance for PCP - Primary Surgeon (IP); 20% Coinsurance for PCP - Asst Surgeon (IP); 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - IP Visits; 20% Coinsurance for PCP - Allergy Testing; 20% Coinsurance for PCP - Allergy Tx; 20% Coinsurance for PCP - ER Visits; 20% Coinsurance for PCP - Cardio; 20% Coinsurance for PCP - Immunizations;	20% Coinsurance for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (IP); 20% Coinsurance for Speclst - Asst Surgeon (IP); 20% Coinsurance for Speclst - Anesthesia (IP); 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); 20% Coinsurance for Speclst - IP Visits; 20% Coinsurance for Speclst - Allergy Testing; 20% Coinsurance for Speclst - Allergy Tx; 20% Coinsurance for Speclst - ER Visits; 20% Coinsurance for Speclst - Consults; 20% Coinsurance for Speclst - Cardio; 20% Coinsurance for Speclst - Immunizations;	20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse;	20% Coinsurance for PT/ST (PCP); 20% Coinsurance for Occ Therapy (PCP); 20% Coinsurance for PT/ST (Specialist); 20% Coinsurance for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	20% Coinsurance for Chiropractor; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	No Cost-Sharing	20% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												12.4382	0.2089	0	2.6061	0.6559	0.8646	0.568	0	3.2225	0.5515	1.2529	0	0	2.202	2.896	7.2188	0.1203	0.3867	2.6348	1.0717	0	0.1064	0	0	0	0	0	0	0	0											39.0053	0	4.69333578	25.0458	0.401256111	2.341871595	2.606140038	1.57185744	1.984827018	1.31796322	0.959602097	5.519334909	1.084002714	2.967577782	0	0	3.38548518	6.181250499	16.77871409	0.363218821	1.489082249	5.765734893	4.092860324	6.848891701	0.242274781	0	1.45454428	1.054584233	0.722799224	0.367905657	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5476
H3044_802_0	2010	1	N/A																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	Coin	T	P	V	P	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	YES	173.3549145	2.644723098	429.3434724	0	125.9380478	6.418064891	4.296449595	263.8907898	252.6571844	4.067893463	9.823822518	0	0	383.958587	3037.075228	4501.958279	111.3457174	337.185886	17.93778906	5451.935649	39.23847373	0.778184313	0	1000	483.3514971	397.5398944	168.6235625	0	0	0											4000	$1000/Admit for IP Medical; $1000/Admit for IP Surgical;	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $50/Visit for Urgent Care; $50/Visit for Urgent Care - Worldwide;	$125/Case for OP Fac - Surgery; $125/Case for OP Fac - ASC	15% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$30/Case for OP Fac - Cardiovascular; $50/Case for OP Fac - Occ Therapy; $40/Case for OP Fac - Physical/Speech Therapy; $50/Case for OP Fac - CORF; $50/Visit for Prof - CORF; $50/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Procedure for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - Tx Injections; $5/Visit for PCP - Allergy Tx; $15/Procedure for PCP - Cardio;	$30/Visit for Speclst - Office Visits; $30/Procedure for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Tx Injections; $5/Visit for Speclst - Allergy Tx; $30/Consult for Speclst - Consults; $30/Procedure for Speclst - Cardio;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$40/Visit for PT/ST (PCP); $50/Visit for Occ Therapy (PCP); $40/Visit for PT/ST (Specialist); $50/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical; 15% Coinsurance for Prof Path (IP); 15% Coinsurance for Prof Path (OP); 15% Coinsurance for Prof Path (Office); 15% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	20% Coinsurance for Blood Products	No Cost-Sharing	$20/Procedure for Dental - Preventive;	$30/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											1000	1000	75	0	100	0.2	0.2	50	125	0.15	0.2	0	0	42.3811821	14.87363919	29.19812948	30	44.95523273	0.2	7.619573094	0.2	0.2	0	20	30	25	30	0	0	0											YES	872.726568	872.7265679	65.4544926	0	87.27265679	0.174545314	0.174545314	43.6363284	109.090821	0.130908985	0.174545314	0	0	36.9871836	12.98062009	25.48198333	26.18179704	39.23362598	0.174545314	6.649803875	0.174545314	0.174545314	0	17.45453136	26.18179704	21.8181642	26.18179704	0	0	0											8000	12.6076	0.192343343	2.341871595	0	0.915912335	1.120243149	0.749925142	0.959602097	2.296881639	0.532523805	1.714702182	0	0	1.183462229	3.285259975	9.559902152	0.242935915	1.102418745	3.130957016	3.021191901	6.848891701	0.135828425	0	1.45454428	1.054584233	0.722799224	0.367905657	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5423	0	8.099971122	12.6076	0.192343343	2.341871595	0	0.915912335	1.120243149	0.749925142	0.959602097	2.296881639	0.532523805	1.714702182	0	0	1.183462229	3.285259975	9.559902152	0.242935915	1.102418745	3.130957016	3.021191901	6.848891701	0.135828425	0	1.45454428	1.054584233	0.722799224	0.367905657	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5423	NO	$1500/Admit for IP Medical; $1500/Admit for IP Surgical;	$1500/Admit for IP Psych; $1500/Admit for IP Substance Abuse;	No Cost-Sharing	20% Coinsurance for Home Health	20% Coinsurance for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	No Cost-Sharing	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for OP Fac - Cardiovascular; 20% Coinsurance for OP Fac - Occ Therapy; 20% Coinsurance for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; 20% Coinsurance for OP Fac - Other; 20% Coinsurance for Prof - CORF; 20% Coinsurance for Prof - CORF;	20% Coinsurance for PCP - Office Visits; 20% Coinsurance for PCP - Consults; 20% Coinsurance for PCP - Routine Physicals; 20% Coinsurance for PCP - Primary Surgeon (IP); 20% Coinsurance for PCP - Asst Surgeon (IP); 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - IP Visits; 20% Coinsurance for PCP - Allergy Testing; 20% Coinsurance for PCP - Allergy Tx; 20% Coinsurance for PCP - ER Visits; 20% Coinsurance for PCP - Cardio; 20% Coinsurance for PCP - Immunizations;	20% Coinsurance for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (IP); 20% Coinsurance for Speclst - Asst Surgeon (IP); 20% Coinsurance for Speclst - Anesthesia (IP); 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); 20% Coinsurance for Speclst - IP Visits; 20% Coinsurance for Speclst - Allergy Testing; 20% Coinsurance for Speclst - Allergy Tx; 20% Coinsurance for Speclst - ER Visits; 20% Coinsurance for Speclst - Consults; 20% Coinsurance for Speclst - Cardio; 20% Coinsurance for Speclst - Immunizations;	20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse;	20% Coinsurance for PT/ST (PCP); 20% Coinsurance for Occ Therapy (PCP); 20% Coinsurance for PT/ST (Specialist); 20% Coinsurance for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	20% Coinsurance for Chiropractor; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	No Cost-Sharing	20% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												12.4382	0.2089	0	2.6061	0.6559	0.8646	0.568	0	3.2225	0.5515	1.2529	0	0	2.202	2.896	7.2188	0.1203	0.3867	2.6348	1.0717	0	0.1064	0	0	0	0	0	0	0	0											39.0053	0	4.69333578	25.0458	0.401256111	2.341871595	2.606140038	1.57185744	1.984827018	1.31796322	0.959602097	5.519334909	1.084002714	2.967577782	0	0	3.38548518	6.181250499	16.77871409	0.363218821	1.489082249	5.765734893	4.092860324	6.848891701	0.242274781	0	1.45454428	1.054584233	0.722799224	0.367905657	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5476
H3044_803_0	2010	1	N/A																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	Coin	T	P	V	P	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	YES	173.3549145	2.644723098	429.3434724	0	125.9380478	6.418064891	4.296449595	263.8907898	252.6571844	4.067893463	9.823822518	0	0	383.958587	3037.075228	4501.958279	111.3457174	337.185886	17.93778906	5451.935649	39.23847373	0.778184313	0	1000	483.3514971	397.5398944	168.6235625	0	0	0											4000	$1000/Admit for IP Medical; $1000/Admit for IP Surgical;	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $50/Visit for Urgent Care; $50/Visit for Urgent Care - Worldwide;	$125/Case for OP Fac - Surgery; $125/Case for OP Fac - ASC	15% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$30/Case for OP Fac - Cardiovascular; $50/Case for OP Fac - Occ Therapy; $40/Case for OP Fac - Physical/Speech Therapy; $50/Case for OP Fac - CORF; $50/Visit for Prof - CORF; $50/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Procedure for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - Tx Injections; $5/Visit for PCP - Allergy Tx; $15/Procedure for PCP - Cardio;	$30/Visit for Speclst - Office Visits; $30/Procedure for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Tx Injections; $5/Visit for Speclst - Allergy Tx; $30/Consult for Speclst - Consults; $30/Procedure for Speclst - Cardio;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$40/Visit for PT/ST (PCP); $50/Visit for Occ Therapy (PCP); $40/Visit for PT/ST (Specialist); $50/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical; 15% Coinsurance for Prof Path (IP); 15% Coinsurance for Prof Path (OP); 15% Coinsurance for Prof Path (Office); 15% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	20% Coinsurance for Blood Products	No Cost-Sharing	$20/Procedure for Dental - Preventive;	$30/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											1000	1000	75	0	100	0.2	0.2	50	125	0.15	0.2	0	0	42.3811821	14.87363919	29.19812948	30	44.95523273	0.2	7.619573094	0.2	0.2	0	20	30	25	30	0	0	0											YES	872.726568	872.7265679	65.4544926	0	87.27265679	0.174545314	0.174545314	43.6363284	109.090821	0.130908985	0.174545314	0	0	36.9871836	12.98062009	25.48198333	26.18179704	39.23362598	0.174545314	6.649803875	0.174545314	0.174545314	0	17.45453136	26.18179704	21.8181642	26.18179704	0	0	0											8000	12.6076	0.192343343	2.341871595	0	0.915912335	1.120243149	0.749925142	0.959602097	2.296881639	0.532523805	1.714702182	0	0	1.183462229	3.285259975	9.559902152	0.242935915	1.102418745	3.130957016	3.021191901	6.848891701	0.135828425	0	1.45454428	1.054584233	0.722799224	0.367905657	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5423	0	8.099971122	12.6076	0.192343343	2.341871595	0	0.915912335	1.120243149	0.749925142	0.959602097	2.296881639	0.532523805	1.714702182	0	0	1.183462229	3.285259975	9.559902152	0.242935915	1.102418745	3.130957016	3.021191901	6.848891701	0.135828425	0	1.45454428	1.054584233	0.722799224	0.367905657	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5423	NO	$1500/Admit for IP Medical; $1500/Admit for IP Surgical;	$1500/Admit for IP Psych; $1500/Admit for IP Substance Abuse;	No Cost-Sharing	20% Coinsurance for Home Health	20% Coinsurance for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	No Cost-Sharing	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for OP Fac - Cardiovascular; 20% Coinsurance for OP Fac - Occ Therapy; 20% Coinsurance for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; 20% Coinsurance for OP Fac - Other; 20% Coinsurance for Prof - CORF; 20% Coinsurance for Prof - CORF;	20% Coinsurance for PCP - Office Visits; 20% Coinsurance for PCP - Consults; 20% Coinsurance for PCP - Routine Physicals; 20% Coinsurance for PCP - Primary Surgeon (IP); 20% Coinsurance for PCP - Asst Surgeon (IP); 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - IP Visits; 20% Coinsurance for PCP - Allergy Testing; 20% Coinsurance for PCP - Allergy Tx; 20% Coinsurance for PCP - ER Visits; 20% Coinsurance for PCP - Cardio; 20% Coinsurance for PCP - Immunizations;	20% Coinsurance for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (IP); 20% Coinsurance for Speclst - Asst Surgeon (IP); 20% Coinsurance for Speclst - Anesthesia (IP); 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); 20% Coinsurance for Speclst - IP Visits; 20% Coinsurance for Speclst - Allergy Testing; 20% Coinsurance for Speclst - Allergy Tx; 20% Coinsurance for Speclst - ER Visits; 20% Coinsurance for Speclst - Consults; 20% Coinsurance for Speclst - Cardio; 20% Coinsurance for Speclst - Immunizations;	20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse;	20% Coinsurance for PT/ST (PCP); 20% Coinsurance for Occ Therapy (PCP); 20% Coinsurance for PT/ST (Specialist); 20% Coinsurance for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	20% Coinsurance for Chiropractor; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	No Cost-Sharing	20% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												12.4382	0.2089	0	2.6061	0.6559	0.8646	0.568	0	3.2225	0.5515	1.2529	0	0	2.202	2.896	7.2188	0.1203	0.3867	2.6348	1.0717	0	0.1064	0	0	0	0	0	0	0	0											39.0053	0	4.69333578	25.0458	0.401256111	2.341871595	2.606140038	1.57185744	1.984827018	1.31796322	0.959602097	5.519334909	1.084002714	2.967577782	0	0	3.38548518	6.181250499	16.77871409	0.363218821	1.489082249	5.765734893	4.092860324	6.848891701	0.242274781	0	1.45454428	1.054584233	0.722799224	0.367905657	0	0	0	0	0	0	0	0	0	0	0	0	0	94.5476
H3044_804_0	2010	1	N/A																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	Coin	T	P	V	P	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	YES	174.2326116	2.659464949	428.4657619	0	124.4733777	6.467860719	4.330740018	261.8405745	252.4115006	3.956521361	9.65546903	0	0	385.4303582	3063.823226	4542.333515	112.7461172	341.799916	18.32850989	5539.901134	39.61104979	0.773512371	0	1000	487.6771063	397.5398944	170.0001673	0	0	0											4000	$1000/Admit for IP Medical; $1000/Admit for IP Surgical;	$1000/Admit for IP Psych; $1000/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $50/Visit for Urgent Care; $50/Visit for Urgent Care - Worldwide;	$125/Case for OP Fac - Surgery; $125/Case for OP Fac - ASC	15% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$30/Case for OP Fac - Cardiovascular; $50/Case for OP Fac - Occ Therapy; $40/Case for OP Fac - Physical/Speech Therapy; $50/Case for OP Fac - CORF; $50/Visit for Prof - CORF; $50/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Procedure for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - Tx Injections; $5/Visit for PCP - Allergy Tx; $15/Procedure for PCP - Cardio;	$30/Visit for Speclst - Office Visits; $30/Procedure for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Tx Injections; $5/Visit for Speclst - Allergy Tx; $30/Consult for Speclst - Consults; $30/Procedure for Speclst - Cardio;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$40/Visit for PT/ST (PCP); $50/Visit for Occ Therapy (PCP); $40/Visit for PT/ST (Specialist); $50/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical; 15% Coinsurance for Prof Path (IP); 15% Coinsurance for Prof Path (OP); 15% Coinsurance for Prof Path (Office); 15% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	20% Coinsurance for Blood Products	No Cost-Sharing	$20/Procedure for Dental - Preventive;	$30/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											1000	1000	75	0	100	0.2	0.2	50	125	0.15	0.2	0	0	42.45519537	14.87321412	29.19565488	30	44.95503353	0.2	7.599648666	0.2	0.2	0	20	30	25	30	0	0	0											YES	871.6971008	871.6971007	65.37728256	0	87.16971008	0.17433942	0.17433942	43.58485504	108.9621376	0.130754565	0.17433942	0	0	37.00807072	12.96493763	25.44976771	26.15091301	39.18717239	0.17433942	6.624591709	0.17433942	0.17433942	0	17.43394202	26.15091302	21.79242752	26.15091303	0	0	0											8000	12.6565	0.193187324	2.334327265	0	0.904192354	1.127603087	0.755018704	0.951023624	2.291941388	0.51733323	1.683328872	0	0	1.188669496	3.310189753	9.633444403	0.245701159	1.11618102	3.195381787	3.058298594	6.905767451	0.134853698	0	1.452828501	1.062766799	0.721946611	0.370471632	0	0	0	0	0	0	0	0	0	0	0	0	0	55.811	0	8.214674822	12.6565	0.193187324	2.334327265	0	0.904192354	1.127603087	0.755018704	0.951023624	2.291941388	0.51733323	1.683328872	0	0	1.188669496	3.310189753	9.633444403	0.245701159	1.11618102	3.195381787	3.058298594	6.905767451	0.134853698	0	1.452828501	1.062766799	0.721946611	0.370471632	0	0	0	0	0	0	0	0	0	0	0	0	0	55.811	NO	$1500/Admit for IP Medical; $1500/Admit for IP Surgical;	$1500/Admit for IP Psych; $1500/Admit for IP Substance Abuse;	No Cost-Sharing	20% Coinsurance for Home Health	20% Coinsurance for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	No Cost-Sharing	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for OP Fac - Cardiovascular; 20% Coinsurance for OP Fac - Occ Therapy; 20% Coinsurance for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; 20% Coinsurance for OP Fac - Other; 20% Coinsurance for Prof - CORF; 20% Coinsurance for Prof - CORF;	20% Coinsurance for PCP - Office Visits; 20% Coinsurance for PCP - Consults; 20% Coinsurance for PCP - Routine Physicals; 20% Coinsurance for PCP - Primary Surgeon (IP); 20% Coinsurance for PCP - Asst Surgeon (IP); 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - IP Visits; 20% Coinsurance for PCP - Allergy Testing; 20% Coinsurance for PCP - Allergy Tx; 20% Coinsurance for PCP - ER Visits; 20% Coinsurance for PCP - Cardio; 20% Coinsurance for PCP - Immunizations;	20% Coinsurance for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (IP); 20% Coinsurance for Speclst - Asst Surgeon (IP); 20% Coinsurance for Speclst - Anesthesia (IP); 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); 20% Coinsurance for Speclst - IP Visits; 20% Coinsurance for Speclst - Allergy Testing; 20% Coinsurance for Speclst - Allergy Tx; 20% Coinsurance for Speclst - ER Visits; 20% Coinsurance for Speclst - Consults; 20% Coinsurance for Speclst - Cardio; 20% Coinsurance for Speclst - Immunizations;	20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse;	20% Coinsurance for PT/ST (PCP); 20% Coinsurance for Occ Therapy (PCP); 20% Coinsurance for PT/ST (Specialist); 20% Coinsurance for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	20% Coinsurance for Chiropractor; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	No Cost-Sharing	20% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												12.5212	0.2103	0	2.6914	0.6565	0.8653	0.5685	0	3.1998	0.5327	1.2234	0	0	2.187	2.9529	7.3159	0.123	0.3955	2.6912	1.1021	0	0.1057	0	0	0	0	0	0	0	0											39.3424	0	4.777949509	25.1777	0.403493669	2.334327265	2.691437134	1.560702842	1.992932173	1.323546395	0.951023624	5.491740983	1.050034872	2.906682741	0	0	3.37567857	6.263126407	16.94932963	0.368717844	1.511632577	5.886603635	4.16041016	6.905767451	0.24052588	0	1.452828501	1.062766799	0.721946611	0.370471632	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1534
H3059_001_0	2010	3	N/A																															D	A	D	V	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	562.9483582	2.886065962	211.977832	0	173.1077076	10.5695958	5.925814979	207.755938	281.9145653	0	13.57814242	0	0	385.7903901	0	2571.684494	135.3266581	396.365448	21.87121863	0	5.735444006	0	0	0	0	0	0	0	0	0											3350	$50/Days 1-5 for IP Medical; $50/Days 1-5 for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	No Cost-Sharing	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	No Cost-Sharing	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $300 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $800 every three years	No Cost-Sharing	Max Plan Benefit of $100 every three months											50	900	75	0	100	0.2	0.2	48.76063303	50	0	0.2	0	0	10	0	10	10	10	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	49.86301602	897.5342884	74.79452403	0	99.72603204	0.199452064	0.199452064	48.62704452	49.86301602	0	0.199452064	0	0	9.972603202	0	9.972603204	9.972603198	9.972603204	0.199452064	0	0.199452064	0	0	0	0	0	0	0	0	0												2.3392	0.21586193	1.321231754	0	1.438612066	2.108127698	1.181916029	0.84187977	1.171425874	0	2.708188532	0	0	0.320611207	0	2.137199086	0.112463255	0.329399611	4.3622597	0	1.143946145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7323	0	0.059703147	2.3392	0.21586193	1.321231754	0	1.438612066	2.108127698	1.181916029	0.84187977	1.171425874	0	2.708188532	0	0	0.320611207	0	2.137199086	0.112463255	0.329399611	4.3622597	0	1.143946145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7323	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.3392	0.21586193	1.321231754	0	1.438612066	2.108127698	1.181916029	0.84187977	1.171425874	0	2.708188532	0	0	0.320611207	0	2.137199086	0.112463255	0.329399611	4.3622597	0	1.143946145	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7323
H3059_002_0	2010	4	N/A																															D	A	D	V	T	Coin	Coin	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	635.1740083	1.779745177	197.1932572	0	104.2601359	11.16450363	3.680356267	223.5088977	30.79561436	0	10.45187646	0	0	235.8971856	0	1995.38665	57.26635722	364.1603888	20.74285969	167.5996182	5.597172058	0	0	0	281.6850564	0	0	0	0	0											3350	$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$30/Case for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $30/Visit for Prof - CORF; $30/Visit for Prof - CORF;	No Cost-Sharing	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $800 every three years	No Cost-Sharing	No Cost-Sharing											150	900	75	0	100	0.118924427	0.2	48.87046536	0.056084212	0	0.026425726	0	0	30	0	30	30	30	0.172245067	30	0.003556881	0	0	0	10	0	0	0	0	0											NO	149.3933306	896.3599841	74.6966653	0	99.59555374	0.118443442	0.199191107	48.67281058	0.055857381	0	0.026318849	0	0	29.87866611	0	29.87866612	29.8786661	29.87866612	0.171548428	29.87866612	0.003542496	0	0	0	9.959555375	0	0	0	0	0												7.9076	0.13294103	1.227473228	0	0.865320497	1.322362232	0.733094241	0.906567187	1.720162372	0	0.275081353	0	0	0.587357771	0	4.968290957	0.142586864	0.906718889	3.558404977	0.417304419	0.019827957	0	0	0	0.23378816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.9248	0	0.105277861	7.9076	0.13294103	1.227473228	0	0.865320497	1.322362232	0.733094241	0.906567187	1.720162372	0	0.275081353	0	0	0.587357771	0	4.968290957	0.142586864	0.906718889	3.558404977	0.417304419	0.019827957	0	0	0	0.23378816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.9248	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.9076	0.13294103	1.227473228	0	0.865320497	1.322362232	0.733094241	0.906567187	1.720162372	0	0.275081353	0	0	0.587357771	0	4.968290957	0.142586864	0.906718889	3.558404977	0.417304419	0.019827957	0	0	0	0.23378816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.9248
H3059_004_0	2010	3	N/A																															D	A	D	V	T	Coin	O	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	0	2.427176356	82.05756737	0	139.2554247	17.46241579	0	268.0603925	0	0	16.18156153	0	0	622.0452029	0	3532.573366	31.28936222	1300.285872	30.97419882	0	8.299532331	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	10% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$5/Case for OP Fac - Cardiovascular; $5/Case for OP Fac - Occ Therapy; $5/Case for OP Fac - Physical/Speech Therapy; $5/Case for OP Fac - CORF; $5/Visit for Prof - CORF; $5/Visit for Prof - CORF;	No Cost-Sharing	$5/Visit for Speclst - Office Visits; $5/Consult for Speclst - Consults;	$5/Visit for OP Psych - Non-Physician; $5/Visit for OP Psych - Psychiatrist; $5/Visit for OP Substance Abuse;	$5/Visit for PT/ST (PCP); $5/Visit for Occ Therapy (PCP); $5/Visit for PT/ST (Specialist); $5/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	No Cost-Sharing	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $300 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $800 every three years	No Cost-Sharing	Max Plan Benefit of $100 every three months											0	900	75	0	100	0.07320798	0	48.8807241	0	0	0.026782401	0	0	5	0	5	5	5	0.082239674	0	0.021598283	0	0	0	0	0	0	0	0	0											NO	0	899.7184343	74.97653619	0	99.96871491	0.073185077	0	48.86543172	0	0	0.026774022	0	0	4.998435744	0	4.998435745	4.99843575	4.998435745	0.082213946	0	0.021591526	0	0	0	0	0	0	0	0	0												0	0.181981276	0.512699347	0	1.160098821	1.277988245	0	1.0915739	0	0	0.433245487	0	0	0.259104415	0	1.471445082	0.013033156	0.541616282	2.546511094	0	0.179199568	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6685	0	0.003025744	0	0.181981276	0.512699347	0	1.160098821	1.277988245	0	1.0915739	0	0	0.433245487	0	0	0.259104415	0	1.471445082	0.013033156	0.541616282	2.546511094	0	0.179199568	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6685	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.181981276	0.512699347	0	1.160098821	1.277988245	0	1.0915739	0	0	0.433245487	0	0	0.259104415	0	1.471445082	0.013033156	0.541616282	2.546511094	0	0.179199568	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6685
H3059_005_0	2010	4	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	2.936331044	0	0	174.5092375	10.72429872	0	213.2669412	0	0	0	0	0	433.2743489	0	3230.950992	136.5360139	439.5024672	0	348.3604042	5.43069284	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$75/Run for Ambulance	10% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$5/Case for OP Fac - Cardiovascular; $5/Case for OP Fac - Occ Therapy; $5/Case for OP Fac - Physical/Speech Therapy; $5/Case for OP Fac - CORF; $5/Visit for Prof - CORF; $5/Visit for Prof - CORF;	No Cost-Sharing	$5/Visit for Speclst - Office Visits; $5/Consult for Speclst - Consults;	$5/Visit for OP Psych - Non-Physician; $5/Visit for OP Psych - Psychiatrist;	$5/Visit for PT/ST (PCP); $5/Visit for Occ Therapy (PCP); $5/Visit for PT/ST (Specialist); $5/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$5/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $275 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $800 every three years	No Cost-Sharing	Max Plan Benefit of $100 every three months											0	900	0	0	75	0.1	0	48.39814098	0	0	0	0	0	5	0	5	5	5	0	5	0.2	0	0	0	0	0	0	0	0	0											NO	0	899.9400603	0	0	74.99500505	0.09999334	0	48.39491769	0	0	0	0	0	4.999667005	0	4.999667004	4.999667007	4.999667	0	4.999667003	0.19998668	0	0	0	0	0	0	0	0	0												0	0.220210161	0	0	1.090610096	1.072358449	0	0.860086339	0	0	0	0	0	0.180518956	0	1.346139922	0.056886217	0.183113832	0	0.145140502	1.086066232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2411	0	0.000415683	0	0.220210161	0	0	1.090610096	1.072358449	0	0.860086339	0	0	0	0	0	0.180518956	0	1.346139922	0.056886217	0.183113832	0	0.145140502	1.086066232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2411	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.220210161	0	0	1.090610096	1.072358449	0	0.860086339	0	0	0	0	0	0.180518956	0	1.346139922	0.056886217	0.183113832	0	0.145140502	1.086066232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2411
H3107_004_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1538.644701	99.38484778	1221.246757	1926.763725	177.3800117	0.34274166	6.300957413	204.8077098	663.7402434	7809.584431	35.13696924	0	0.029325543	419.1287471	4226.461077	4047.869003	344.747646	436.0390379	0	0	34.60823386	1232.865733	0	0	60.42571697	51.56680804	30.85650171	14.81319055	6.566413461	0												"$150 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$80 Days 11-45 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $125 (9a); $40 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a3, 16a4); $0 n/c (16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0/$30 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											119.9949346	96.05568445	39.13907408	0	150	0.2	0.083956997	49.97341454	125	3	0.164197918	0	0.2	49.10718165	13.23197535	30	40	30	0	0	0.2	29.43336324	0	0	0	0	0	0	0	0											NO	119.9949346	96.05568445	39.13907408	0	150	0.2	0.083956997	49.97341454	125	3	0.164197918	0	0.2	49.10718165	13.23197535	30	40	30	0	0	0.2	29.43336324	0	0	0	0	0	0	0	0												15.3858	0.795539965	3.983205609	0	2.217250146	0.068548332	0.529009463	0.852911715	6.913960869	1.952396108	5.769417209	0	0.005865109	1.71518596	4.660369067	10.11967251	1.14915882	1.090097595	0	0	6.921646773	3.023948744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.154	0	0	15.3858	0.795539965	3.983205609	0	2.217250146	0.068548332	0.529009463	0.852911715	6.913960869	1.952396108	5.769417209	0	0.005865109	1.71518596	4.660369067	10.11967251	1.14915882	1.090097595	0	0	6.921646773	3.023948744	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.154	NO	"35% (1a, 1a1); $0 n/c (1a2, 1a3)"	"35% (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"50% (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 n/c (13a, 13a1); 30% (16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.3908	0.1179	0	0	0	0	0	0.0449	0	0	0.4555	0	0.0003	0	1.3733	7.0225	0.3936	0	0	0	2.5956	0.4025	0	0	0	0	0	0	0	0											16.7968	0	0	19.7766	0.91344708	3.983205609	0	2.217250146	0.068548332	0.529009463	0.897801806	6.913960869	1.952396108	6.224897515	0	0.006173799	1.71518596	6.033645747	17.14214611	1.542757973	1.090097595	0	0	9.517264313	3.426427862	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9508
H3107_005_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	O	Coin	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	O	O											22.0948	1.9239	0	0	1.8758	0.2199	0.9767	0	11.595	0	0	0	0.0286	2.9686	0	0	0	0	0	0	6.7804	0	0	0	0	0	0	0	0	0											48.4637	NO	1836.220757	119.9708527	1557.724173	2011.240796	189.1168358	43.94233769	995.3756982	215.3966085	644.0121519	6888.023063	38.61308442	0	9.801631976	408.7238011	4454.449593	4281.74859	314.0212649	574.6329789	0	0	1233.415656	1230.47334	0	0	64.42517133	51.22154885	30.64990582	15.15754252	8.973177727	0												"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$80 Days 11-43 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$0 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$35 (3, 9d); $0 (5, 9a); $40 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a3, 16a4); $0 n/c (16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0/$35 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	38.1490146	0	0	0	0	49.97332564	0	3	0.164236589	0	0	1.208539523	9.946007389	35	40	35	0	0	0	34.36286752	0	0	0	0	0	0	0	0											NO	0	0	38.1490146	0	0	0	0	49.97332564	0	3	0.164236589	0	0	1.208539523	9.946007389	35	40	35	0	0	0	34.36286752	0	0	0	0	0	0	0	0												0	0	4.95213685	0	0	0	0	0.897007071	0	1.722005766	6.341681291	0	0	0.041163239	3.691999047	12.48843339	1.04673755	1.676012855	0	0	0	3.523549363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3807	2300	0	22.0948	1.923906028	4.95213685	0	1.875831244	0.219882402	0.9767103	0.897007071	11.59497159	1.722005766	6.341681291	0	0.028638667	3.009723911	3.691999047	12.48843339	1.04673755	1.676012855	0	0	6.780415292	3.523549363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.8445	NO	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"50% (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 n/c (13a, 13a1); 30% (16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												0	0	0	0	0	0	0	0.0472	0	0	0.5007	0	0	0	1.4449	7.1565	0.3818	0	0	0	1.9143	0.3972	0	0	0	0	0	0	0	0											11.8425	0	0	22.0948	1.923906028	4.95213685	0	1.875831244	0.219882402	0.9767103	0.94421797	11.59497159	1.722005766	6.84234034	0	0.028638667	3.009723911	5.136886135	19.64492164	1.428534375	1.676012855	0	0	8.694724569	3.920740078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.687
H3107_008_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1690.623997	58.581963	1220.939593	1776.284579	191.6890386	0.237017277	4.851424407	199.5578568	599.6442772	7347.129515	38.84757116	0	0.020448307	399.7759005	3960.220439	4072.95952	314.267328	396.4355367	0	0	28.73344157	1167.380071	0	0	56.14809634	51.75581303	30.96959835	14.35125487	8.903995314	0												"$120 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$120 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$75 Days 11-50 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$75 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $75 (9a); $40 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a3, 16a4); $0 n/c (16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0/$25 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											98.81232333	80.75686055	38.2787736	0	150	0.2	0.106958593	49.97267286	75	3	0.164916048	0	0.2	29.81774849	9.910324605	24.97173373	40	25	0	0	0.2	24.55797802	0	0	0	0	0	0	0	0											NO	98.81232333	80.75686055	38.2787736	0	150	0.2	0.106958593	49.97267286	75	3	0.164916048	0	0.2	29.81774849	9.910324605	24.97173373	40	25	0	0	0.2	24.55797802	0	0	0	0	0	0	0	0												13.9212	0.394241285	3.89467252	0	2.396112982	0.047403455	0.518901531	0.831036624	3.747776733	1.836782379	6.406587903	0	0.004089661	0.993368105	3.270589171	8.475738385	1.04755776	0.825907368	0	0	5.746688314	2.389041177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7477	0	0	13.9212	0.394241285	3.89467252	0	2.396112982	0.047403455	0.518901531	0.831036624	3.747776733	1.836782379	6.406587903	0	0.004089661	0.993368105	3.270589171	8.475738385	1.04755776	0.825907368	0	0	5.746688314	2.389041177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7477	NO	"35% (1a, 1a1); $0 n/c (1a2, 1a3)"	"35% (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"50% (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 n/c (13a, 13a1); 30% (16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.1691	0.1096	0	0	0	0	0	0.0437	0	0	0.5058	0	0.0002	0	1.278	7.1194	0.3794	0	0	0	2.155	0.3821	0	0	0	0	0	0	0	0											17.1423	0	0	19.0903	0.50382785	3.89467252	0	2.396112982	0.047403455	0.518901531	0.874775394	3.747776733	1.836782379	6.912371159	0	0.004304907	0.993368105	4.548546989	15.59510541	1.426989659	0.825907368	0	0	7.901696432	2.771182016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.89
H3107_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	255.874863	6.3	33.54049641	2433.542429	6.345894482	1.390862193	6.761675629	7.429951167	44.0604965	17.24195781	35.76461544	0	0.022460022	9.55434076	24.0887998	126.3716884	3.17	6.584887728	0	0	39.2930786	8.036807996	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.061654775	0.061654775	0.144497969	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061654775	0.061654775	0.144497969	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												15.7759	0.388425083	4.846533623	0	1.478593414	0.324070891	1.575470422	1.731178622	10.26609569	4.01737617	8.333155396	0	0.005233185	2.226161397	5.612690354	29.4446034	0.73861	1.534278841	0	0	9.155287314	1.872576263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3262	0	0	15.7759	0.388425083	4.846533623	0	1.478593414	0.324070891	1.575470422	1.731178622	10.26609569	4.01737617	8.333155396	0	0.005233185	2.226161397	5.612690354	29.4446034	0.73861	1.534278841	0	0	9.155287314	1.872576263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3262	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.7759	0.388425083	4.846533623	0	1.478593414	0.324070891	1.575470422	1.731178622	10.26609569	4.01737617	8.333155396	0	0.005233185	2.226161397	5.612690354	29.4446034	0.73861	1.534278841	0	0	9.155287314	1.872576263	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3262
H3107_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	256.2452774	6.3	33.58905094	2437.06532	6.355081047	1.392875659	6.771464094	7.440707054	44.1242802	17.26691794	35.81638969	0	0.022492536	9.568143044	24.12367169	126.554629	3.17	6.594420268	0	0	39.34996079	8.048442393	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.061654775	0.061654775	0.144497969	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061654775	0.061654775	0.144497969	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												15.7987	0.388425083	4.853549654	0	1.480733884	0.324540029	1.577751134	1.733684744	10.28095729	4.023191881	8.345218797	0	0.005240761	2.229377329	5.620815503	29.48722856	0.73861	1.536499922	0	0	9.168540865	1.875287077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4684	0	0	15.7987	0.388425083	4.853549654	0	1.480733884	0.324540029	1.577751134	1.733684744	10.28095729	4.023191881	8.345218797	0	0.005240761	2.229377329	5.620815503	29.48722856	0.73861	1.536499922	0	0	9.168540865	1.875287077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4684	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.7987	0.388425083	4.853549654	0	1.480733884	0.324540029	1.577751134	1.733684744	10.28095729	4.023191881	8.345218797	0	0.005240761	2.229377329	5.620815503	29.48722856	0.73861	1.536499922	0	0	9.168540865	1.875287077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4684
H3107_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	256.2452774	6.3	33.58905094	2437.06532	6.355081047	1.392875659	6.771464094	7.440707054	44.1242802	17.26691794	35.81638969	0	0.022492536	9.568143044	24.12367169	126.554629	3.17	6.594420268	0	0	39.34996079	8.048442393	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.061654775	0.061654775	0.144497969	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061654775	0.061654775	0.144497969	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												15.7987	0.388425083	4.853549654	0	1.480733884	0.324540029	1.577751134	1.733684744	10.28095729	4.023191881	8.345218797	0	0.005240761	2.229377329	5.620815503	29.48722856	0.73861	1.536499922	0	0	9.168540865	1.875287077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4684	0	0	15.7987	0.388425083	4.853549654	0	1.480733884	0.324540029	1.577751134	1.733684744	10.28095729	4.023191881	8.345218797	0	0.005240761	2.229377329	5.620815503	29.48722856	0.73861	1.536499922	0	0	9.168540865	1.875287077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4684	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.7987	0.388425083	4.853549654	0	1.480733884	0.324540029	1.577751134	1.733684744	10.28095729	4.023191881	8.345218797	0	0.005240761	2.229377329	5.620815503	29.48722856	0.73861	1.536499922	0	0	9.168540865	1.875287077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4684
H3113_001_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	333.6480197	38.11745897	11480.94772	79.56982747	27.05101107	20.6410328	22.78993712	18.81322114	6.358143808	50.92441237	44.36661487	0	0.018662759	14.21553824	1.061077107	160.5488881	18.41903851	26.72304799	0	0	1.701940642	9.717694896	1335.921948	0	87.47104457	207.9503356	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.060828308	0.061567114	0	0	0.2	0.2	0.09254579	0.046359666	0.2	0	0.047982455	0	0.2	0.151024162	0.003198123	0.199417419	0.2	0	0	0	0.2	0.190192771	0	0	0	0	0	0	0	0											NO	0.060828308	0.061567114	0	0	0.2	0.2	0.09254579	0.046359666	0.2	0	0.047982455	0	0.2	0.151024162	0.003198123	0.199417419	0.2	0	0	0	0.2	0.190192771	0	0	0	0	0	0	0	0												20.2952	2.346781935	0	0	5.410202214	4.128206559	2.109112725	0.872174656	1.271628762	0	2.128819093	0	0.003732552	2.146889755	0.003393455	32.01624496	3.683807703	0	0	0	0.340388128	1.848235322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6049	0	0	20.2952	2.346781935	0	0	5.410202214	4.128206559	2.109112725	0.872174656	1.271628762	0	2.128819093	0	0.003732552	2.146889755	0.003393455	32.01624496	3.683807703	0	0	0	0.340388128	1.848235322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6049	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.2952	2.346781935	0	0	5.410202214	4.128206559	2.109112725	0.872174656	1.271628762	0	2.128819093	0	0.003732552	2.146889755	0.003393455	32.01624496	3.683807703	0	0	0	0.340388128	1.848235322	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6049
H3132_001_0	2010	6	N/A																																																																																																															0	NO																																																																																																																										NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H3152_022_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	V																																																			0	NO	1868.169411	34.94911212	1645.610034	1238.324505	379.0789301	11.87705318	0	269.5155456	444.3683121	1999.701989	2685.186311	10.29176308	0.214411731	165.0148451	4162.18021	6143.71443	126.797648	784.4811012	0	0	267	0	0	0	922.1221335	0	46.90469962	0	15.16315721	0												$250/day 1-7	$250/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$40 X-ray; $175 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	$25 PCP visit; $45 if no PCP selected	$45 per visit	$40 per visit	$45 per visit	$40 per visit	$45 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 hardware reimbursment/2 years	$0 per visit	Not Covered	Not Covered	0											180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	47	45	25	45	25	45	40	45	40	45	$45 	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	47	45	25	45	25	45	40	45	40	45	$45 	0	0	0	0	0	0	0	0	0												28.1337	0.526315483	6.566895868	0	4.738486627	2.375410637	0	1.089291997	9.257673169	0	10.51697972	0.038594112	0.000446691	0.618805669	8.67120877	23.03892911	0.422658827	2.941804129	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9384			28.1337	0.526315483	6.566895868	0	4.738486627	2.375410637	0	1.089291997	9.257673169	0	10.51697972	0.038594112	0.000446691	0.618805669	8.67120877	23.03892911	0.422658827	2.941804129	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9384	NO																																																																																		0			28.1337	0.526315483	6.566895868	0	4.738486627	2.375410637	0	1.089291997	9.257673169	0	10.51697972	0.038594112	0.000446691	0.618805669	8.67120877	23.03892911	0.422658827	2.941804129	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9384
H3152_041_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	V																																																			0	NO	1659.607018	94.07488676	1237.805549	652.7958693	236.0766708	10.59240557	0	238.8239834	410.9962924	2097.49176	2719.806153	30.22445236	0.169045719	63.77868768	4246.093201	5613.658392	163.4830052	569.8550378	0	0	272.3387391	0	0	0	851.1362211	0	46.07714239	0	74.88873515	0												$250/day 1-7	$250/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$45 X-ray; $175 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	$25 PCP visit; $45 if no PCP selected	$45 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											180.7137695	180.7137695	52.43074037	0	150	0.2	0.2	48.5	250	0	48.5	45	25	45	25	45	40	45	45	45	$45 	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	52.43074037	0	150	0.2	0.2	48.5	250	0	48.5	45	25	45	25	45	40	45	45	45	$45 	0	0	0	0	0	0	0	0	0												24.9928	1.41671895	5.408255112	0	2.950958384	2.118481114	0	0.965246933	8.562422758	0	10.99254987	0.113341696	0.000352179	0.239170079	8.846027502	21.05121897	0.544943351	2.136956392	0	0	1.021270272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3607			24.9928	1.41671895	5.408255112	0	2.950958384	2.118481114	0	0.965246933	8.562422758	0	10.99254987	0.113341696	0.000352179	0.239170079	8.846027502	21.05121897	0.544943351	2.136956392	0	0	1.021270272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3607	NO																																																																																		0			24.9928	1.41671895	5.408255112	0	2.950958384	2.118481114	0	0.965246933	8.562422758	0	10.99254987	0.113341696	0.000352179	0.239170079	8.846027502	21.05121897	0.544943351	2.136956392	0	0	1.021270272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3607
H3152_045_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1737.107713	76.41049676	1162.591076	544.2126501	229.8185738	8.794647259	0	204.3542347	412.8658096	2281.604137	3629.536885	65.53018231	0.104864597	226.2710315	4618.499123	6426.057381	124.1458817	478.1103136	0	0	278	0	0	0	886.7759482	0	46.53680059	0	57.74586952	0												$175/day 1-10	$175/day 1-10	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$10 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											143.4382958	143.4382958	52.43074037	0	150	0.2	0.2	47.5	150	4.5	26.78125	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											NO	143.4382958	143.4382958	52.43074037	0	150	0.2	0.2	47.5	150	4.5	26.78125	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0												20.764	0.913349286	5.079625904	0	2.872732173	1.758929452	0	0.808902179	5.160822621	0.855601551	8.100294559	0.163825456	0.000218468	0.565677579	3.848749269	16.06514345	0.310364704	1.195275784	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.506	0	0	20.764	0.913349286	5.079625904	0	2.872732173	1.758929452	0	0.808902179	5.160822621	0.855601551	8.100294559	0.163825456	0.000218468	0.565677579	3.848749269	16.06514345	0.310364704	1.195275784	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.506	NO																																																																																		0			20.764	0.913349286	5.079625904	0	2.872732173	1.758929452	0	0.808902179	5.160822621	0.855601551	8.100294559	0.163825456	0.000218468	0.565677579	3.848749269	16.06514345	0.310364704	1.195275784	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.506
H3152_046_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1485.605528	74.58148719	1197.206808	587.7581431	216.9158935	9.0534001	0	229.3753625	419.3505385	2560.713415	4198.387004	70.08451286	0.08652409	548.2948737	4573.625469	6472.075707	207.4883979	470.344953	0	0	278	0	0	0	997.5362331	0	48.97263491	0	6.489306746	0												$175/day 1-10	$175/day 1-10	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$110 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											143.4382958	143.4382958	52.43074037	0	150	0.2	0.2	47.5	150	5.25	28.875	35	25	35	15	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	143.4382958	143.4382958	52.43074037	0	150	0.2	0.2	47.5	150	5.25	28.875	35	25	35	15	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												17.7577	0.891486785	5.230869943	0	2.711448669	1.81068002	0	0.907944143	5.241881731	1.120312119	10.10236873	0.204413163	0.000180259	1.599193382	5.717031836	18.87688748	0.605174494	1.371839446	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1919	0	0	17.7577	0.891486785	5.230869943	0	2.711448669	1.81068002	0	0.907944143	5.241881731	1.120312119	10.10236873	0.204413163	0.000180259	1.599193382	5.717031836	18.87688748	0.605174494	1.371839446	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1919	NO																																																																																		0			17.7577	0.891486785	5.230869943	0	2.711448669	1.81068002	0	0.907944143	5.241881731	1.120312119	10.10236873	0.204413163	0.000180259	1.599193382	5.717031836	18.87688748	0.605174494	1.371839446	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1919
H3152_048_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1893.00531	47.12876291	1316.201617	867.7443048	256.585316	14.97716385	0	274.2072003	418.9291505	3491.656844	4778.714013	49.92867231	0	863.1293727	4753.160007	8568.019186	251.9181987	663.544045	0	0	278	0	0	0	1113.382693	0	62.47758994	0	20.02486857	0												$75/day 1-10	$75/day 1-10	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$10 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											61.47355533	61.47355533	52.43074037	0	150	0.2	0.2	47.5	100	4.5	26.78125	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											NO	61.47355533	61.47355533	52.43074037	0	150	0.2	0.2	47.5	100	4.5	26.78125	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0												9.6975	0.241431051	5.750785439	0	3.20731645	2.99543277	0	1.085403501	3.491076254	1.309371316	10.66499455	0.124821681	0	2.157823432	3.960966673	21.42004797	0.629795497	1.658860113	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4381	0	0	9.6975	0.241431051	5.750785439	0	3.20731645	2.99543277	0	1.085403501	3.491076254	1.309371316	10.66499455	0.124821681	0	2.157823432	3.960966673	21.42004797	0.629795497	1.658860113	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4381	NO																																																																																		0			9.6975	0.241431051	5.750785439	0	3.20731645	2.99543277	0	1.085403501	3.491076254	1.309371316	10.66499455	0.124821681	0	2.157823432	3.960966673	21.42004797	0.629795497	1.658860113	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4381
H3152_053_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	V																																																			0	NO	1720.001796	44.82507422	1197.308721	1335.475253	286.3146829	11.11137435	0	247.0734426	426.356444	2245.311586	2892.644446	32.78194083	0.003185583	488.8395013	3844.415094	6542.44568	225.4917326	919.9915308	0	0	267.1006059	0	0	0	846.848691	0	43.63841564	0	38.11010895	0												$200/day 1-8	$200/day 1-8	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$45 X-ray; $150 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$20 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$45 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 hardware reimbursement/2 years	$0 per visit	Not Covered	Not Covered	0											152.3663772	152.3663772	47.8866492	0	150	0.2	0.2	48.5	250	0	43.5	40	25	40	20	40	40	40	45	40	$45 	0	0	0	0	0	0	0	0	0											NO	152.3663772	152.3663772	47.8866492	0	150	0.2	0.2	48.5	250	0	43.5	40	25	40	20	40	40	40	45	40	$45 	0	0	0	0	0	0	0	0	0												21.8392	0.569152847	4.777925226	0	3.578933537	2.22227487	0	0.998588497	8.882425916	0	10.48583612	0.109273136	6.64E-06	1.629465004	6.407358491	21.80815227	0.751639109	3.066638436	0	0	1.001627272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1285			21.8392	0.569152847	4.777925226	0	3.578933537	2.22227487	0	0.998588497	8.882425916	0	10.48583612	0.109273136	6.64E-06	1.629465004	6.407358491	21.80815227	0.751639109	3.066638436	0	0	1.001627272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1285	NO																																																																																		0			21.8392	0.569152847	4.777925226	0	3.578933537	2.22227487	0	0.998588497	8.882425916	0	10.48583612	0.109273136	6.64E-06	1.629465004	6.407358491	21.80815227	0.751639109	3.066638436	0	0	1.001627272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1285
H3152_074_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	2052.994881	199.2775686	1459.343293	712.6593304	359.0356678	16.48297769	0	337.8294076	380.8314415	2374.060399	3406.182286	160.8298658	6.145327875	265.6358199	5000.195288	6557.460625	444.5004716	542.328956	0	0	253.6468845	0	0	0	842.6482084	0	33.72853694	0	0	0												$0 	$0 	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$0 per procedure	$0 per visit	$0 X-ray; $115 Complex Radiology	$0 per visit	$0 per visit	$0 per visit	$0 PCP visit; $0 if no PCP selected	$0 per visit	$0 per visit	$0 per visit	$0 per visit	$0 per visit	$45 per script	0	$0 per Trip/50 One Way Trips	Not Covered	$0 per visit	$200 Every 2 Yrs	$0 per visit	$800 Every 3 Yrs	Coaching Only	0											0	0	40.33133874	0	100	0.2	0.2	45.9375	0	0	23	0	0	0	0	0	0	0	0	0	$45 	0	0	0	0	0	0	0	0	0											NO	0	0	40.33133874	0	100	0.2	0.2	45.9375	0	0	23	0	0	0	0	0	0	0	0	0	$45 	0	0	0	0	0	0	0	0	0												0	0	4.904772391	0	2.991963898	3.296595539	0	1.293253201	0	0	6.528516049	0	0	0	0	0	0	0	0	0	0.951175817	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9663	0	0	0	0	4.904772391	0	2.991963898	3.296595539	0	1.293253201	0	0	6.528516049	0	0	0	0	0	0	0	0	0	0.951175817	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9663	NO																																																																																		0			0	0	4.904772391	0	2.991963898	3.296595539	0	1.293253201	0	0	6.528516049	0	0	0	0	0	0	0	0	0	0.951175817	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9663
H3152_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	348.1850173	4.835315363	53.98156857	9.867833805	11.72622025	9.569499379	0	12.4354403	41.49512329	18.18741608	88.30144838	0.428084396	0.000444225	27.66341564	43.42072689	162.5847115	2.349871821	8.351299862	0	-3.02E-10	82.52188583	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.065713743	0.065713743	0.145650156	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065713743	0.065713743	0.145650156	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.8805	0.317746669	7.862423871	0	2.732209319	2.229693355	0	2.89745759	9.668363726	4.237667947	20.57423747	0.099743664	0.000103504	6.445575844	10.11702937	37.88223779	0.547520134	1.945852868	0	-7.03E-11	19.2275994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.666			22.8805	0.317746669	7.862423871	0	2.732209319	2.229693355	0	2.89745759	9.668363726	4.237667947	20.57423747	0.099743664	0.000103504	6.445575844	10.11702937	37.88223779	0.547520134	1.945852868	0	-7.03E-11	19.2275994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.666	NO																																																																																		0			22.8805	0.317746669	7.862423871	0	2.732209319	2.229693355	0	2.89745759	9.668363726	4.237667947	20.57423747	0.099743664	0.000103504	6.445575844	10.11702937	37.88223779	0.547520134	1.945852868	0	-7.03E-11	19.2275994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.666
H3152_804_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	283.5941545	2.584296809	42.4688691	5.428605538	9.946297747	11.05353094	0	8.682911811	40.02190738	17.9110746	78.48249459	0.802590015	0.00874987	26.68127146	40.32430568	155.5238184	2.209838416	6.631830289	0	0	68.5738056	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.06427543	0.06427543	0.145260462	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06427543	0.06427543	0.145260462	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.2281	0.166106789	6.169047547	0	2.317487375	2.575472709	0	2.023118452	9.325104421	4.173280382	18.28642124	0.187003474	0.00203872	6.216736251	9.395563224	36.2370497	0.514892351	1.545216457	0	0	15.9776967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3404			18.2281	0.166106789	6.169047547	0	2.317487375	2.575472709	0	2.023118452	9.325104421	4.173280382	18.28642124	0.187003474	0.00203872	6.216736251	9.395563224	36.2370497	0.514892351	1.545216457	0	0	15.9776967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3404	NO																																																																																		0			18.2281	0.166106789	6.169047547	0	2.317487375	2.575472709	0	2.023118452	9.325104421	4.173280382	18.28642124	0.187003474	0.00203872	6.216736251	9.395563224	36.2370497	0.514892351	1.545216457	0	0	15.9776967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3404
H3154_004_0	2010	5	N/A	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D	V	T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	YES	2170.196326		1540.107089	89.31185584	369.9673214	12.38525623		237.9529506	129.2886784					1623.240708	8662.467567	3776.901167			700.5938152	2783.295414							10.28571429				155.5461823	185.6196556									10000	$150/day for the first 10 days of each IP stay		$0 copay each days 1-15; $85 copay days 16-30; $110 copay each day 31+	$0 copay	$150 /Trip	20% Coinsurance		$50 copay per visit	$125 Copay					$35-$125 Copay	$15 /PCP visit	$35 /visit			$35 /visit	$35 /visit							$35 /visit				$75 Copay	$35 Copay									132.9358127		45.83904983	0	150	0.2		50	125					123.25	15	35			35	35							35				75	35									NO	127.685746		44.028717	0	144.0760132	0.192101351		48.02533774	120.0633443					118.3824575	14.40760132	33.61773642			33.61773642	33.61773642							33.61773642				72.03800661	33.61773642										23.0919	0	5.65074493	0	4.441951391	2.379224453	0	0.952314235	1.293569259	0	0	0	0	16.01360202	10.40044826	10.58090566	0	0	1.962698185	7.797340966	0	0	0	0	0	0	0.028815203	0	0	0	0.933769742	0.520009388	0	0	0	0	0	0	0	0	86.0473	0	3.440197062	23.0919	0	5.65074493	0	4.441951391	2.379224453	0	0.952314235	1.293569259	0	0	0	0	16.01360202	10.40044826	10.58090566	0	0	1.962698185	7.797340966	0	0	0	0	0	0	0.028815203	0	0	0	0.933769742	0.520009388	0	0	0	0	0	0	0	0	86.0473	NO																																																																																		0	0	0	23.0919	0	5.65074493	0	4.441951391	2.379224453	0	0.952314235	1.293569259	0	0	0	0	16.01360202	10.40044826	10.58090566	0	0	1.962698185	7.797340966	0	0	0	0	0	0	0.028815203	0	0	0	0.933769742	0.520009388	0	0	0	0	0	0	0	0	86.0473
H3154_005_0	2010	3	N/A	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D	V	T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	NO	1862.356099		1151.011936	41.54625632	285.7659891	14.19603122		200.1445739	125.5419485					1449.964346	8553.961522	4379.878596			731.0334754	3351.157162							10.28571429				200.5058457	196.1705842										$75/day for the first 10 days of each IP stay		$0 copay each days 1-5; $50 copay days 6-22; $100 copay each day 23+	$0 copay	$150 /Trip	20% Coinsurance		$50 copay per visit	$125 Copay					$35-$125 Copay	$15 /PCP visit	$35 /visit			$35 /visit	$35 /visit							$35 /visit				$75 Copay	$35 Copay									65.61506174		55.80631121	0	150	0.2		50	125					123.25	15	35			35	35							35				75	35									YES	65.61506174		55.80631121	0	150	0.2		50	125					123.25	15	35			35	35							35				75	35									6200	10.1832	0	5.352810859	0	3.572074864	2.839206243	0	0.833935725	1.30772863	0	0	0	0	14.89234213	10.6924519	12.7746459	0	0	2.13218097	9.77420839	0	0	0	0	0	0	0.03	0	0	0	1.253161536	0.572164204	0	0	0	0	0	0	0	0	76.2101			10.1832	0	5.352810859	0	3.572074864	2.839206243	0	0.833935725	1.30772863	0	0	0	0	14.89234213	10.6924519	12.7746459	0	0	2.13218097	9.77420839	0	0	0	0	0	0	0.03	0	0	0	1.253161536	0.572164204	0	0	0	0	0	0	0	0	76.2101	NO	$900 deductible;35% coins		$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins					$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins	$900 deductible;35% coins											$900 deductible;35% coins	$900 deductible;35% coins										0.0936		0.0492	0	0.0328	0.0261			0.012					0.1389	0.0983	0.1175			0.0196	0.0899											0.0115	0.0053									0.6948	900	0.537490707	10.2769	0	5.402032378	0	3.60492171	2.86531403	0	0.833935725	1.319753787	0	0	0	0	15.03122837	10.79077384	12.89211456	0	0	2.151787339	9.864086661	0	0	0	0	0	0	0.03	0	0	0	1.264684923	0.577425513	0	0	0	0	0	0	0	0	76.9049
H3154_006_0	2010	5	N/A	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D	V	T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	NO	1966.196591		1148.994793	88.32296453	300.0653282	19.42845255		215.2948823	153.3708066					1782.384374	8750.578597	5237.698797			933.1486578	3923.756887							10.28571429				216.0298862	229.8112087										$75/day for the first 10 days of each IP stay		$0 copay each days 1-5; $50 copay days 6-22; $100 copay each day 23+	$0 copay	$150 /Trip	20% Coinsurance		$50 copay per visit	$125 Copay					$35-$125 Copay	$15 /PCP visit	$35 /visit			$35 /visit	$35 /visit							$35 /visit				$75 Copay	$35 Copay									65.61506174		55.80631121	0	150	0.2		50	125					123.25	15	35			35	35							35				75	35									YES	65.61506174		55.80631121	0	150	0.2		50	125					123.25	15	35			35	35							35				75	35									6200	10.751	0	5.343430083	0	3.750816602	3.88569051	0	0.89706201	1.597612569	0	0	0	0	18.30657284	10.93822325	15.27662149	0	0	2.721683585	11.44429092	0	0	0	0	0	0	0.03	0	0	0	1.350186789	0.670282692	0	0	0	0	0	0	0	0	86.9635			10.751	0	5.343430083	0	3.750816602	3.88569051	0	0.89706201	1.597612569	0	0	0	0	18.30657284	10.93822325	15.27662149	0	0	2.721683585	11.44429092	0	0	0	0	0	0	0.03	0	0	0	1.350186789	0.670282692	0	0	0	0	0	0	0	0	86.9635	NO	$900 deductible;35% coins		$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins					$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins	$900 deductible;35% coins											$900 deductible;35% coins	$900 deductible;35% coins										0.0866		0.0431	0	0.0302	0.0313			0.0129					0.1496	0.0881	0.1231			0.0219	0.0922											0.0109	0.0054									0.6953	900	0.537490707	10.8376	0	5.386480384	0	3.781035727	3.916996271	0	0.89706201	1.610484021	0	0	0	0	18.45615721	11.026349	15.39970033	0	0	2.743611316	11.5364939	0	0	0	0	0	0	0.03	0	0	0	1.36106481	0.675682944	0	0	0	0	0	0	0	0	87.6587
H3154_012_0	2010	5	N/A	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D	V	T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	NO	2884.463973		2192.698019	152.6728513	495.6076627	22.4840902		285.4455861	145.8288959					2000.961976	8920.292517	5354.921289			841.7012228	3703.843372							10.28571429				200.8964139	179.8380896										$75/day for the first 10 days of each IP stay		$0 copay each days 1-5; $50 copay days 6-22; $100 copay each day 23+	$0 copay	$150 /Trip	20% Coinsurance		$50 copay per visit	$125 Copay					$35-$125 Copay	$15 /PCP visit	$35 /visit			$35 /visit	$35 /visit							$35 /visit				$75 Copay	$35 Copay									65.61506174		55.80631121	0	150	0.2		50	125					123.25	15	35			35	35							35				75	35									YES	65.61506174		55.80631121	0	150	0.2		50	125					123.25	15	35			35	35							35				75	35									6200	15.772	0	10.197199	0	6.195095784	4.49681804	0	1.189356609	1.519050999	0	0	0	0	20.55154696	11.15036565	15.61852043	0	0	2.4549619	10.8028765	0	0	0	0	0	0	0.03	0	0	0	1.255602587	0.524527761	0	0	0	0	0	0	0	0	101.7579			15.772	0	10.197199	0	6.195095784	4.49681804	0	1.189356609	1.519050999	0	0	0	0	20.55154696	11.15036565	15.61852043	0	0	2.4549619	10.8028765	0	0	0	0	0	0	0.03	0	0	0	1.255602587	0.524527761	0	0	0	0	0	0	0	0	101.7579	NO	$900 deductible;35% coins		$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins					$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins	$900 deductible;35% coins											$900 deductible;35% coins	$900 deductible;35% coins										0.1086		0.0702	0	0.0427	0.031			0.0105					0.1435	0.0768	0.1076			0.0169	0.0744											0.0086	0.01									0.7007	900	0.537490707	15.8806	0	10.26741856	0	6.237756212	4.527783853	0	1.189356609	1.529511429	0	0	0	0	20.69507766	11.22714886	15.72607208	0	0	2.471867163	10.87726685	0	0	0	0	0	0	0.03	0	0	0	1.264248869	0.534527761	0	0	0	0	0	0	0	0	102.4587
H3154_013_0	2010	3	N/A	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D	V	T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	YES	1334.964511		959.721619	52.9805759	230.1732018	7.539232204		178.9704752	82.28675245					1105.15947	7394.812164	3224.193854			598.0697333	2375.991208							8.780514851				105.9013217	126.376402									10000	$175/day for the first 10 days of each IP stay		$0 copay each days 1-15; $85 copay days 16-30; $110 copay each day 31+	$0 copay	$150 /Trip	20% Coinsurance		$50 copay per visit	$200 Copay					$35-$200 Copay	$15 /PCP visit	$35 /visit			$35 /visit	$35 /visit							$35 /visit				$100 Copay	$35 Copay									155.0917815		45.83904983	0	150	0.2		50	200					197.2	15	35			35	35							35				100	35									NO	144.9048239		42.82818458	0	140.147488	0.186863317		46.71582933	186.8633173					184.2472309	14.0147488	32.70108053			32.70108053	32.70108053							32.70108053				93.43165867	32.70108053										16.1202	0	3.42526122	0	2.688183003	1.40880594	0	0.696729515	1.281364628	0	0	0	0	16.96854767	8.636369575	8.786218574	0	0	1.629793876	6.474789988	0	0	0	0	0	0	0.023927694	0	0	0	0.824544678	0.344387075	0	0	0	0	0	0	0	0	69.3092		4.773472469	16.1202	0	3.42526122	0	2.688183003	1.40880594	0	0.696729515	1.281364628	0	0	0	0	16.96854767	8.636369575	8.786218574	0	0	1.629793876	6.474789988	0	0	0	0	0	0	0.023927694	0	0	0	0.824544678	0.344387075	0	0	0	0	0	0	0	0	69.3092	NO																																																																																		0			16.1202	0	3.42526122	0	2.688183003	1.40880594	0	0.696729515	1.281364628	0	0	0	0	16.96854767	8.636369575	8.786218574	0	0	1.629793876	6.474789988	0	0	0	0	0	0	0.023927694	0	0	0	0.824544678	0.344387075	0	0	0	0	0	0	0	0	69.3092
H3154_016_0	2010	5	N/A	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D	V	T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	YES	1554.944587		977.6843378	58.08346191	243.1817939	14.3589765		222.8129943	155.4495604					1399.658539	9518.875202	5188.105145			907.011389	4226.673073							10.28571429				244.7900664	118.6405844									10000	$150/day for the first 10 days of each IP stay		$0 copay each days 1-15; $85 copay days 16-30; $110 copay each day 31+	$0 copay	$150 /Trip	20% Coinsurance		$50 copay per visit	$125 Copay					$35-$125 Copay	$15 /PCP visit	$35 /visit			$35 /visit	$35 /visit							$35 /visit				$75 Copay	$35 Copay									132.9358127		45.83904983	0	150	0.2		50	125					123.25	15	35			35	35							35				75	35									NO	127.685746		44.028717	0	144.0760132	0.192101351		48.02533774	120.0633443					118.3824575	14.40760132	33.61773642			33.61773642	33.61773642							33.61773642				72.03800661	33.61773642										16.5454	0	3.587182252	0	2.919721946	2.758378783	0	0.891722442	1.555316175	0	0	0	0	13.80791813	11.42867991	14.53436261	0	0	2.540972483	11.84093177	0	0	0	0	0	0	0.028815203	0	0	0	1.469515702	0.332368991	0	0	0	0	0	0	0	0	84.2412		3.350347863	16.5454	0	3.587182252	0	2.919721946	2.758378783	0	0.891722442	1.555316175	0	0	0	0	13.80791813	11.42867991	14.53436261	0	0	2.540972483	11.84093177	0	0	0	0	0	0	0.028815203	0	0	0	1.469515702	0.332368991	0	0	0	0	0	0	0	0	84.2412	NO																																																																																		0			16.5454	0	3.587182252	0	2.919721946	2.758378783	0	0.891722442	1.555316175	0	0	0	0	13.80791813	11.42867991	14.53436261	0	0	2.540972483	11.84093177	0	0	0	0	0	0	0.028815203	0	0	0	1.469515702	0.332368991	0	0	0	0	0	0	0	0	84.2412
H3154_801_0	2010	3	N/A	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D	V	T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	NO	1820.291909		901.1867876	214.4929957	264.0319185	15.46618535		184.9804459	162.3190237					2169.172408	8763.976329	6007.911918			1022.399046	4884.326987							10.28571429				249.8026534	328.854126										$150/day for the first 10 days of each IP stay		$0 copay each days 1-5; $50 copay days 6-20; $100 copay each day 21+	$35 copay	$150 /Trip	20% Coinsurance		$50 copay per visit	$200 Copay					$35-$200 Copay	$15 /PCP visit	$35 /visit			$35 /visit	$35 /visit							$35 /visit				$100 Copay	$35 Copay									131.2907387		53.27947337	35	150	0.2		50	200					197.2	15	35			35	35							35				100	35									YES	131.2907387		53.27947337	35	150	0.2		50	200					197.2	15	35			35	35							35				100	35									6200	19.9156	0	4.001229788	0.625604571	3.300398981	3.093237069	0	0.770751858	2.705317062	0	0	0	0	35.64673324	10.95497041	17.52307643	0	0	2.981997216	14.24595371	0	0	0	0	0	0	0.03	0	0	0	2.081688778	0.959157868	0	0	0	0	0	0	0	0	118.8357			19.9156	0	4.001229788	0.625604571	3.300398981	3.093237069	0	0.770751858	2.705317062	0	0	0	0	35.64673324	10.95497041	17.52307643	0	0	2.981997216	14.24595371	0	0	0	0	0	0	0.03	0	0	0	2.081688778	0.959157868	0	0	0	0	0	0	0	0	118.8357	NO	$900 deductible;35% coins		$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins					$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins	$900 deductible;35% coins											$900 deductible;35% coins	$900 deductible;35% coins										0.0972		0.0195	0.0031	0.0161	0.0151			0.0132					0.1764	0.0535	0.0855			0.0146	0.0695											0.0102	0.0047									0.5785	900	0.445441044	20.0128	0	4.020755596	0.628657491	3.316504769	3.108331917	0	0.770751858	2.718518879	0	0	0	0	35.82315752	11.00843014	17.6085882	0	0	2.996549219	14.31547328	0	0	0	0	0	0	0.03	0	0	0	2.091847319	0.963838512	0	0	0	0	0	0	0	0	119.4142
H3154_802_0	2010	3	N/A	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D	V	T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	NO	2189.138458		1290.298479	207.3798007	326.021241	19.32415736		219.6128789	166.7970495					2662.927516	9183.221372	6340.812165			1010.491089	5197.116448							10.28571429				251.651893	271.457829										$150/day for the first 10 days of each IP stay		$0 copay each days 1-5; $50 copay days 6-20; $100 copay each day 21+	$35 copay	$150 /Trip	20% Coinsurance		$50 copay per visit	$200 Copay					$35-$200 Copay	$15 /PCP visit	$35 /visit			$35 /visit	$35 /visit							$35 /visit				$100 Copay	$35 Copay									131.2907387		53.27947337	35	150	0.2		50	200					197.2	15	35			35	35							35				100	35									YES	131.2907387		53.27947337	35	150	0.2		50	200					197.2	15	35			35	35							35				100	35									6200	23.9511	0	5.728868622	0.604857752	4.075265513	3.864831472	0	0.915053662	2.779950824	0	0	0	0	43.76077551	11.47902672	18.49403548	0	0	2.947265676	15.15825631	0	0	0	0	0	0	0.03	0	0	0	2.097099108	0.791752001	0	0	0	0	0	0	0	0	136.6782			23.9511	0	5.728868622	0.604857752	4.075265513	3.864831472	0	0.915053662	2.779950824	0	0	0	0	43.76077551	11.47902672	18.49403548	0	0	2.947265676	15.15825631	0	0	0	0	0	0	0.03	0	0	0	2.097099108	0.791752001	0	0	0	0	0	0	0	0	136.6782	NO	$900 deductible;35% coins		$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins					$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins	$900 deductible;35% coins											$900 deductible;35% coins	$900 deductible;35% coins										0.1016		0.0243	0.0026	0.0173	0.0164			0.0118					0.1883	0.0487	0.0784			0.0125	0.0643											0.0089	0.0034									0.5784	900	0.445441044	24.0527	0	5.753168732	0.607423374	4.092551544	3.881224906	0	0.915053662	2.791742526	0	0	0	0	43.94903093	11.52771724	18.57248153	0	0	2.959767077	15.222553	0	0	0	0	0	0	0.03	0	0	0	2.105994362	0.795110371	0	0	0	0	0	0	0	0	137.2565
H3154_805_0	2010	3	N/A	r.	s.									OP Facility - Other	OP Facility - Other									ASC	Chemo/Therapeutic XRay									D		D	V	T	coin		V	V					V	V	V			V	V							V				P	V																																																	0	NO	2189.138458		1290.298479	207.3798007	326.021241	19.32415736		219.6128789	166.7970495					2662.927516	9183.221372	6340.812165			1010.491089	5197.116448							10.28571429				251.651893	271.457829										$150/day for the first 10 days of each IP stay		$0 copay each days 1-5; $50 copay days 6-20; $100 copay each day 21+	$35 copay	$150 /Trip	20% Coinsurance		$50 copay per visit	$200 Copay					$35-$200 Copay	$15 /PCP visit	$35 /visit			$35 /visit	$35 /visit							$35 /visit				$100 Copay	$35 Copay									131.2907387		53.27947337	35	150	0.2		50	200					197.2	15	35			35	35							35				100	35									YES	131.2907387		53.27947337	35	150	0.2		50	200					197.2	15	35			35	35							35				100	35									6200	23.9511	0	5.728868622	0.604857752	4.075265513	3.864831472	0	0.915053662	2.779950824	0	0	0	0	43.76077551	11.47902672	18.49403548	0	0	2.947265676	15.15825631	0	0	0	0	0	0	0.03	0	0	0	2.097099108	0.791752001	0	0	0	0	0	0	0	0	136.6782			23.9511	0	5.728868622	0.604857752	4.075265513	3.864831472	0	0.915053662	2.779950824	0	0	0	0	43.76077551	11.47902672	18.49403548	0	0	2.947265676	15.15825631	0	0	0	0	0	0	0.03	0	0	0	2.097099108	0.791752001	0	0	0	0	0	0	0	0	136.6782	NO	$900 deductible;35% coins		$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins					$900 deductible;35% coins	$900 deductible;35% coins	$900 deductible;35% coins			$900 deductible;35% coins	$900 deductible;35% coins											$900 deductible;35% coins	$900 deductible;35% coins										0.1016		0.0243	0.0026	0.0173	0.0164			0.0118					0.1883	0.0487	0.0784			0.0125	0.0643											0.0089	0.0034									0.5784	900	0.445441044	24.0527	0	5.753168732	0.607423374	4.092551544	3.881224906	0	0.915053662	2.791742526	0	0	0	0	43.94903093	11.52771724	18.57248153	0	0	2.959767077	15.222553	0	0	0	0	0	0	0.03	0	0	0	2.105994362	0.795110371	0	0	0	0	0	0	0	0	137.2565
H3156_027_0	2010	4	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	V	V	V	P	V	P	O	O											27.7157	0.3487	6.6234	0	0.7503	1.7238	0.0911	0	4.0115	0.3962	1.1019	0	0.486	0	0	0	0	0	4.6398	7.9891	2.6154	0	0	0	0	0	0	0	0	0											58.4927	NO	0	0	0	0	0	1269.729193	42.21186455	226.8555768	0	0	0	0	0	334.8588585	4225.440095	5913.41153	157.6478436	679.2524136	0	116.9989433	740.6119191	0	0	64.94334362	215.8736145	0	41.43053862	0	0	0												$0; PBP 1a	$0; PBP 1b	$0; PBP 2	$0; PBP 6	$0; PBP 10a	10% coins; PBP 11a	"0-10% coins; PBP 11b, 11c"	"$40-50 copay; PBP 4a, 4b"	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b	$25 copay; PBP 5	"$0; PBP 9a, 12"	"$15-40 copay; PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"$0-40 copay; PBP 4b, 7a, 14b-j"	"$0-40 copay; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$25 copay; PBP 7e, 7h"	"$15 copay; PBP 7c, 7i"	"$0; PBP 7d, 8b"	"$0-40; PBP 7d, 7g"	$25 copay; PBP 15	$0; PBP 7g	$0; PBP 10b	"$10: PBP 16a, 16b"	$40 copay; PBP 17a	$0; PBP 17b	$40 copay; PBP 18a	$0; PBP 18b	$0; PBP 14a	"$0; PBP 13b-e, 14a"											0	0	0	0	0	14.02171489	22.29957167	47.60743445	0	0	0	0	0	15	10	32.57619127	25	15	0	40	25	0	0	10	40	0	40	0	0	0											NO	0	0	0	0	0	14.02171489	22.29957167	47.60743445	0	0	0	0	0	15	10	32.57619127	25	15	0	40	25	0	0	10	40	0	40	0	0	0												0	0	0	0	0	1.483648393	0.078442208	0.900001	0	0	0	0	0	0.418573573	3.521200079	16.05303542	0.328433008	0.849065517	0	0.389996478	1.542941498	0	0	0.054119453	0.719578715	0	0.138101795	0	0	0	0	0	0	0	0	0	0	0	0	0	26.4771	1500	0	27.7157	0.348672069	6.623353657	0	0.750300579	3.207403347	0.169579128	0.900001	4.011541536	0.396186758	1.101878183	0	0.485955123	0.418573573	3.521200079	16.05303542	0.328433008	0.849065517	4.639753834	8.379090192	4.158298546	0	0	0.054119453	0.719578715	0	0.138101795	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9699	NO																																																																																		0			27.7157	0.348672069	6.623353657	0	0.750300579	3.207403347	0.169579128	0.900001	4.011541536	0.396186758	1.101878183	0	0.485955123	0.418573573	3.521200079	16.05303542	0.328433008	0.849065517	4.639753834	8.379090192	4.158298546	0	0	0.054119453	0.719578715	0	0.138101795	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9699
H3156_028_0	2010	5	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	V	V	V	P	V	P	O	O											25.7067	0.2314	3.9621	0	0.9106	0.8824	0.3671	0	4.0681	3.4221	0.7657	0	0.1919	0	0	0	0	0	4.3502	8.2012	4.6463	0	0	0	0	0	0	0	0	0											57.7057	NO	0	0	0	0	0	1221.481938	40.60789531	210.1183014	0	0	0	0	0	311.7228764	3974.782325	5530.382168	146.1825624	629.8523092	0	108.4899415	683.0960373	0	0	76.53998354	211.7391985	0	44.70135607	0	0	0												$0; PBP 1a	$0; PBP 1b	$0; PBP 2	$0; PBP 6	$0; PBP 10a	10% coins; PBP 11a	"0-10% coins; PBP 11b, 11c"	"$40-50 copay; PBP 4a, 4b"	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b	$25 copay; PBP 5	"$0; PBP 9a, 12"	"$15-40 copay; PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"$0-40 copay; PBP 4b, 7a, 14b-j"	"$0-40 copay; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$25 copay; PBP 7e, 7h"	"$15 copay; PBP 7c, 7i"	"$0; PBP 7d, 8b"	"$0-40; PBP 7d, 7g"	$25 copay; PBP 15	$0; PBP 7g	$0; PBP 10b	"$10: PBP 16a, 16b"	$40 copay; PBP 17a	$0; PBP 17b	$40 copay; PBP 18a	$0; PBP 18b	$0; PBP 14a	"$0; PBP 13b-e, 14a"											0	0	0	0	0	13.62165511	21.66333269	47.57008644	0	0	0	0	0	15	10	32.63933131	25	15	0	40	25	0	0	10	40	0	40	0	0	0											NO	0	0	0	0	0	13.62165511	21.66333269	47.57008644	0	0	0	0	0	15	10	32.63933131	25	15	0	40	25	0	0	10	40	0	40	0	0	0												0	0	0	0	0	1.386550474	0.073308529	0.83294548	0	0	0	0	0	0.389653596	3.312318604	15.04233132	0.304547005	0.787315387	0	0.361633138	1.423116744	0	0	0.06378332	0.705797328	0	0.14900452	0	0	0	0	0	0	0	0	0	0	0	0	0	24.8323	1500	0	25.7067	0.231378762	3.962138179	0	0.910621671	2.268921028	0.440422107	0.83294548	4.068081115	3.422085076	0.765742272	0	0.191886393	0.389653596	3.312318604	15.04233132	0.304547005	0.787315387	4.350157113	8.562811841	6.06940869	0	0	0.06378332	0.705797328	0	0.14900452	0	0	0	0	0	0	0	0	0	0	0	0	0	82.538	NO																																																																																		0			25.7067	0.231378762	3.962138179	0	0.910621671	2.268921028	0.440422107	0.83294548	4.068081115	3.422085076	0.765742272	0	0.191886393	0.389653596	3.312318604	15.04233132	0.304547005	0.787315387	4.350157113	8.562811841	6.06940869	0	0	0.06378332	0.705797328	0	0.14900452	0	0	0	0	0	0	0	0	0	0	0	0	0	82.538
H3156_801_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	314.2030035	5.219339565	49.95750388	23.11253355	10.61435829	9.11326245	9.11326245	11.55754089	51.32841159	16.76720622	3.35367085	0	3.798684039	15.05515145	27.3983729	71.17222646	5.192639637	3.032760685	51.17764785	102.980186	46.8254429	18.51944566	0	0	0	0	0	0	0	0												PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b"	"PBP 9a, 9b"	PBP 8a	PBP 8b		PBP 12	"PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"PBP 4b, 7a, 14b-i"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"	PBP 7d	"PBP 7d, 7g"	PBP 15	PBP 7g	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a												0.073830427	0.073830427	0.149115233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073830427	0.073830427	0.149115233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.1977	0.385346067	7.449424846	0	2.473145482	2.123390151	2.123390151	2.692907027	11.9595199	3.906759049	0.781405308	0	0.885093381	3.507850288	6.383820886	16.58312876	1.209885035	0.70663324	11.92439195	23.99438334	10.9103282	4.315030838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.5136	1500	0	23.1977	0.385346067	7.449424846	0	2.473145482	2.123390151	2.123390151	2.692907027	11.9595199	3.906759049	0.781405308	0	0.885093381	3.507850288	6.383820886	16.58312876	1.209885035	0.70663324	11.92439195	23.99438334	10.9103282	4.315030838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.5136	NO																																																																																		0			23.1977	0.385346067	7.449424846	0	2.473145482	2.123390151	2.123390151	2.692907027	11.9595199	3.906759049	0.781405308	0	0.885093381	3.507850288	6.383820886	16.58312876	1.209885035	0.70663324	11.92439195	23.99438334	10.9103282	4.315030838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.5136
H3156_803_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	370.8640617	3.445907856	72.17906415	26.64174259	15.31159643	8.43896956	8.43896956	12.08619596	46.76988422	18.3177814	7.261900127	0	0	10.42298184	20.34068813	72.15244002	6.724952449	2.174704802	54.1628151	111.5748303	33.78733939	22.89503479	0	0	0	0	0	0	0	0												PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b"	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 3, 5, 9a, 9c, 9d, 12, 13a, 13b"	"PBP 4b, 7a, 14b-i"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"	PBP 7d	"PBP 7d, 7g"	PBP 15	PBP 7g	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a												0.073678839	0.073678839	0.148506182	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073678839	0.073678839	0.148506182	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												27.3248	0.253890489	10.71903724	0	3.567601969	1.966279908	1.966279908	2.816083658	10.89738302	4.268043066	1.69202273	0	0	2.428554769	4.739380334	16.81151853	1.566913921	0.506706219	12.61993592	25.99693546	7.872450079	5.334543107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.3484	1500	0	27.3248	0.253890489	10.71903724	0	3.567601969	1.966279908	1.966279908	2.816083658	10.89738302	4.268043066	1.69202273	0	0	2.428554769	4.739380334	16.81151853	1.566913921	0.506706219	12.61993592	25.99693546	7.872450079	5.334543107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.3484	NO																																																																																		0			27.3248	0.253890489	10.71903724	0	3.567601969	1.966279908	1.966279908	2.816083658	10.89738302	4.268043066	1.69202273	0	0	2.428554769	4.739380334	16.81151853	1.566913921	0.506706219	12.61993592	25.99693546	7.872450079	5.334543107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.3484
H3164_003_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.6343	0.2832	0.2582	0	1.2113	0	1.2672	0	0.015	1.2828	2.6523	3.8188	0.1766	0.0421	0	0	0.3019	0.2228	0	0	0	0	0	0	0	0											12.1666	NO	337.0957942	5.371279347	32.91441028	1399.643963	14.94533221	4.00774066	3.872658867	18.31393529	32.96239181	23.81623168	33.68875711	0	0.133277685	33.37607919	69.35494889	100.6089098	3.924028226	1.329792317	0	2.504468797	9.321458405	6.839558563	10464.6547	437.5192927	110.7643779	189.0378716	0	0	3692.14593	415.3664171												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14e, 14f, 14g, 14h, 14i, 14j); $0/20% (14b, 14d); $0 n/c (14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14c)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 18a); $0 n/c (13a1); $0 (17a, 17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4); $0 (16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d); $0 (13e)"											0.062177914	0.062177914	0.143662406	0	0.192194335	0.192194335	0.192194335	0.106116105	0.192194335	0.104349499	0.161521295	0	0.192194335	0.144437743	0.187813927	0.191903393	0.432437254	0.192194335	0	0.2	0.192194335	0.005130406	0	0	0	0	0	0	0	0											NO	0.062177914	0.062177914	0.143662406	0	0.192194335	0.192194335	0.192194335	0.106116105	0.192194335	0.104349499	0.161521295	0	0.192194335	0.144437743	0.187813927	0.191903393	0.432437254	0.192194335	0	0.2	0.192194335	0.005130406	0	0	0	0	0	0	0	0												20.9599	0.333974947	4.728563377	0	2.872408183	0.770265051	0.744303095	1.943403485	6.33518497	2.485211844	5.441451662	0	0.025615216	4.820765556	13.02582532	19.30719112	1.696895989	0.25557855	0	0.500893759	1.791531498	0.035089714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0741	146	0	20.9599	0.333974947	4.728563377	0	3.506674369	1.053472151	1.002543774	1.943403485	7.546462459	2.485211844	6.708627472	0	0.040628205	6.103595572	15.67812083	23.12603104	1.873509484	0.297685459	0	0.500893759	2.093454246	0.257868597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2406	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	20.9599	0.333974947	4.728563377	0	3.506674369	1.053472151	1.002543774	1.943403485	7.546462459	2.485211844	6.708627472	0	0.040628205	6.103595572	15.67812083	23.12603104	1.873509484	0.297685459	0	0.500893759	2.093454246	0.257868597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2406
H3164_005_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.6342	0.2832	0.2582	0	1.2111	0	1.267	0	0.015	1.2826	2.6519	3.8182	0.1766	0.0421	0	0	0.3019	0.2227	0	0	0	0	0	0	0	0											12.1646	NO	336.5699147	5.36289999	32.86306282	1398.551794	14.92201704	4.001488465	3.866617403	18.28537001	32.91096949	23.77907765	33.63620164	0	0.133069768	33.32401151	69.2467531	100.4520117	3.917906624	1.327717802	0	2.500561751	9.306916651	6.828888647	10456.60049	437.5192927	110.7643779	189.0378716	0	0	3692.14593	415.3664171												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14e, 14f, 14g, 14h, 14i, 14j); $0/20% (14b, 14d); $0 n/c (14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14c)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 18a); $0 n/c (13a1); $0 (17a, 17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4); $0 (16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d); $0 (13e)"											0.062424297	0.062424297	0.143792195	0	0.192183403	0.192183403	0.192183403	0.106193272	0.192183403	0.104349499	0.161512108	0	0.192183403	0.144429528	0.187803494	0.191892023	0.432412658	0.192183403	0	0.2	0.192183403	0.005130405	0	0	0	0	0	0	0	0											NO	0.062424297	0.062424297	0.143792195	0	0.192183403	0.192183403	0.192183403	0.106193272	0.192183403	0.104349499	0.161512108	0	0.192183403	0.144429528	0.187803494	0.191892023	0.432412658	0.192183403	0	0.2	0.192183403	0.005130405	0	0	0	0	0	0	0	0												21.0101	0.334775261	4.725451951	0	2.86776402	0.769019672	0.743099692	1.941783274	6.324942124	2.48133484	5.432653821	0	0.025573801	4.812971252	13.00478218	19.27593975	1.694152415	0.255165326	0	0.50011235	1.788634917	0.035034967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0233	146	0	21.0101	0.334775261	4.725451951	0	3.501927602	1.052180958	1.001298595	1.941783274	7.536023667	2.48133484	6.699624643	0	0.040584361	6.095593747	15.65664864	23.09415496	1.870737341	0.297265424	0	0.50011235	2.090508823	0.257777812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1879	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	21.0101	0.334775261	4.725451951	0	3.501927602	1.052180958	1.001298595	1.941783274	7.536023667	2.48133484	6.699624643	0	0.040584361	6.095593747	15.65664864	23.09415496	1.870737341	0.297265424	0	0.50011235	2.090508823	0.257777812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1879
H3204_001_0	2010	7	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	159.5526385	1.967455922	242.9181379	0	186.9431593	623.0328415	45.74188426	325.0045065	251.4931707	0	0	0	0	84.41091394	2932.779277	2364.127727	249.8804162	801.5122349	0	956.8501009	44.83119975	0	0	0	195.3353394	0	24.36268809	0	0	0											2500	$600/Admit for IP Medical; $600/Admit for IP Surgical;	$600/Admit for IP Psych; $600/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$125/Run for Ambulance	$35/Unit for DME	$35/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$375/Case for OP Fac - Surgery; $375/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults;	$40/Visit for Speclst - Office Visits; $40/Consult for Speclst - Consults;	$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$40/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams;	9% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$40/Exam for Vision (Refractions)	No Cost-Sharing	$40/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											600	600	125	0	125	35	35	48.85819973	375	0	0	0	0	25	25	40	40	25	0	40	0.088	0	0	0	40	0	40	0	0	0											NO	567.6329339	567.632934	118.2568612	0	118.2568612	33.11192114	33.11192115	46.22253876	354.7705837	0	0	0	0	23.65137223	23.65137225	37.84219559	37.84219559	23.65137224	0	37.84219559	0.08325283	0	0	0	37.84219559	0	37.8421956	0	0	0												7.5473	0.093066065	2.39389471	0	1.842275937	1.719151193	0.126216805	1.251877783	7.435198246	0	0	0	0	0.166369496	5.780354532	7.45531532	0.788001965	1.579738685	0	3.017442389	3.732324265	0	0	0	0.615993177	0	0.076828134	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6213	0	2.601379166	7.5473	0.093066065	2.39389471	0	1.842275937	1.719151193	0.126216805	1.251877783	7.435198246	0	0	0	0	0.166369496	5.780354532	7.45531532	0.788001965	1.579738685	0	3.017442389	3.732324265	0	0	0	0.615993177	0	0.076828134	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6213	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.5473	0.093066065	2.39389471	0	1.842275937	1.719151193	0.126216805	1.251877783	7.435198246	0	0	0	0	0.166369496	5.780354532	7.45531532	0.788001965	1.579738685	0	3.017442389	3.732324265	0	0	0	0.615993177	0	0.076828134	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6213
H3204_007_0	2010	8	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	236.7469122	2.612292384	359.2960184	0	246.0499728	1767.598219	73.68048312	389.7388085	334.764342	0	0	0	0	106.2032934	3897.895206	3547.379434	428.6312614	1317.945296	0	1438.780222	71.2711306	0	0	0	238.5055846	0	36.08608965	0	0	0											2500	$450/Admit for IP Medical; $450/Admit for IP Surgical;	$450/Admit for IP Psych; $450/Admit for IP Substance Abuse;	$100/Days 21-100 for SNF	No Cost-Sharing	$125/Run for Ambulance	$15/Unit for DME	$15/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care; $20/Visit for Urgent Care - Worldwide;	$250/Case for OP Fac - Surgery; $250/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams;	9% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											450	450	100	0	125	15	15	48.60015271	250	0	0	0	0	20	20	35	35	20	0	35	0.088	0	0	0	35	0	35	0	0	0											NO	420.3073905	420.3073905	93.40164234	0	116.7520529	14.01024635	14.01024636	45.39334082	233.5041059	0	0	0	0	18.68032847	18.68032847	32.69057482	32.69057482	18.68032847	0	32.69057482	0.082193445	0	0	0	32.69057482	0	32.69057481	0	0	0												8.2922	0.09149715	2.79656985	0	2.393903287	2.063707208	0.086023477	1.474295547	6.514070695	0	0	0	0	0.165326034	6.067830233	9.663822735	1.167683527	2.051637586	0	3.919546043	5.858019772	0	0	0	0.649740388	0	0.098306251	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3542	0	3.769205702	8.2922	0.09149715	2.79656985	0	2.393903287	2.063707208	0.086023477	1.474295547	6.514070695	0	0	0	0	0.165326034	6.067830233	9.663822735	1.167683527	2.051637586	0	3.919546043	5.858019772	0	0	0	0.649740388	0	0.098306251	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3542	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.2922	0.09149715	2.79656985	0	2.393903287	2.063707208	0.086023477	1.474295547	6.514070695	0	0	0	0	0.165326034	6.067830233	9.663822735	1.167683527	2.051637586	0	3.919546043	5.858019772	0	0	0	0.649740388	0	0.098306251	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3542
H3204_008_0	2010	3	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	188.1114676	1.181396729	222.8448204	0	157.7186245	812.8640475	68.87019165	289.9148809	406.2727665	0	0	0	0	197.2767271	3233.052492	3139.270856	248.1554996	1415.678897	0	1265.494651	54.55072466	0	0	0	239.5365157	0	43.60502004	0	0	0											2500	$400/Admit for IP Medical; $400/Admit for IP Surgical;	$400/Admit for IP Psych; $400/Admit for IP Substance Abuse;	$100/Days 21-100 for SNF	No Cost-Sharing	$75/Run for Ambulance	$15/Unit for DME	$15/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$250/Case for OP Fac - Surgery; $250/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults;	$40/Visit for Speclst - Office Visits; $40/Consult for Speclst - Consults;	$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$40/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams;	9% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$40/Exam for Vision (Refractions)	No Cost-Sharing	$40/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											400	400	100	0	75	15	15	48.85217382	250	0	0	0	0	25	25	40	40	25	0	40	0.088	0	0	0	40	0	40	0	0	0											NO	376.7174516	376.717451	94.1793629	0	70.63452218	14.12690444	14.12690444	46.00866607	235.4484073	0	0	0	0	23.54484073	23.54484073	37.67174516	37.67174516	23.54484073	0	37.67174516	0.082877839	0	0	0	37.67174516	0	37.67174516	0	0	0												5.9054	0.03708773	1.748948601	0	0.928364973	0.956937726	0.081076885	1.111549745	7.971356315	0	0	0	0	0.38707076	6.343475498	9.855150974	0.779037562	2.777661179	0	3.972782667	4.521046195	0	0	0	0.751979881	0	0.136889767	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2658	0	2.983008469	5.9054	0.03708773	1.748948601	0	0.928364973	0.956937726	0.081076885	1.111549745	7.971356315	0	0	0	0	0.38707076	6.343475498	9.855150974	0.779037562	2.777661179	0	3.972782667	4.521046195	0	0	0	0.751979881	0	0.136889767	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2658	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.9054	0.03708773	1.748948601	0	0.928364973	0.956937726	0.081076885	1.111549745	7.971356315	0	0	0	0	0.38707076	6.343475498	9.855150974	0.779037562	2.777661179	0	3.972782667	4.521046195	0	0	0	0.751979881	0	0.136889767	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2658
H3204_801_0	2010	2	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	33.98363292	0.691044336	0	0	79.14031767	30.62624179	5.449416127	193.4497515	121.9305731	0	0	0	0	52.62775242	1757.266047	1843.611373	244.605515	783.1214768	0	741.5447774	71.17450501	0	0	0	105.4389646	0	23.90369998	0	0	0											2500	$550/Admit for IP Medical; $550/Admit for IP Surgical;	$550/Admit for IP Psych; $550/Admit for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$75/Run for Ambulance	$35/Unit for DME	$35/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$350/Case for OP Fac - Surgery; $350/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults;	$40/Visit for Speclst - Office Visits; $40/Consult for Speclst - Consults;	$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$40/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams;	9% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$40/Exam for Vision (Refractions)	No Cost-Sharing	$40/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											550	550	0	0	75	35	35	48.85245179	350	0	0	0	0	25	25	40	40	25	0	40	0.088	0	0	0	40	0	40	0	0	0											NO	527.1855531	527.185553	0	0	71.88893907	33.54817156	33.54817165	46.8260124	335.4817156	0	0	0	0	23.96297969	23.96297969	38.3407675	38.3407675	23.96297968	0	38.3407675	0.084349688	0	0	0	38.3407675	0	38.34076748	0	0	0												1.493	0.030359049	0	0	0.474109456	0.085621201	0.015234829	0.754873372	3.408789822	0	0	0	0	0.105093147	3.509110882	5.890456251	0.781530265	1.563827003	0	2.369282992	6.003547327	0	0	0	0.336884236	0	0.07637385	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8981	0	1.164038957	1.493	0.030359049	0	0	0.474109456	0.085621201	0.015234829	0.754873372	3.408789822	0	0	0	0	0.105093147	3.509110882	5.890456251	0.781530265	1.563827003	0	2.369282992	6.003547327	0	0	0	0.336884236	0	0.07637385	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8981	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.493	0.030359049	0	0	0.474109456	0.085621201	0.015234829	0.754873372	3.408789822	0	0	0	0	0.105093147	3.509110882	5.890456251	0.781530265	1.563827003	0	2.369282992	6.003547327	0	0	0	0.336884236	0	0.07637385	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8981
H3204_802_0	2010	2	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	33.98363292	0.691044336	0	0	79.14031767	30.62624179	5.449416127	193.4497515	121.9305731	0	0	0	0	52.62775242	1757.266047	1843.611373	244.605515	783.1214768	0	741.5447774	71.17450501	0	0	0	105.4389646	0	23.90369998	0	0	0											2500	$550/Admit for IP Medical; $550/Admit for IP Surgical;	$550/Admit for IP Psych; $550/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$75/Run for Ambulance	$35/Unit for DME	$35/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$350/Case for OP Fac - Surgery; $350/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults;	$40/Visit for Speclst - Office Visits; $40/Consult for Speclst - Consults;	$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$40/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams;	9% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$40/Exam for Vision (Refractions)	No Cost-Sharing	$40/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											550	550	0	0	75	35	35	48.85245179	350	0	0	0	0	25	25	40	40	25	0	40	0.088	0	0	0	40	0	40	0	0	0											NO	527.1855531	527.185553	0	0	71.88893907	33.54817156	33.54817165	46.8260124	335.4817156	0	0	0	0	23.96297969	23.96297969	38.3407675	38.3407675	23.96297968	0	38.3407675	0.084349688	0	0	0	38.3407675	0	38.34076748	0	0	0												1.493	0.030359049	0	0	0.474109456	0.085621201	0.015234829	0.754873372	3.408789822	0	0	0	0	0.105093147	3.509110882	5.890456251	0.781530265	1.563827003	0	2.369282992	6.003547327	0	0	0	0.336884236	0	0.07637385	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8981	0	1.164038957	1.493	0.030359049	0	0	0.474109456	0.085621201	0.015234829	0.754873372	3.408789822	0	0	0	0	0.105093147	3.509110882	5.890456251	0.781530265	1.563827003	0	2.369282992	6.003547327	0	0	0	0.336884236	0	0.07637385	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8981	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.493	0.030359049	0	0	0.474109456	0.085621201	0.015234829	0.754873372	3.408789822	0	0	0	0	0.105093147	3.509110882	5.890456251	0.781530265	1.563827003	0	2.369282992	6.003547327	0	0	0	0.336884236	0	0.07637385	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8981
H3204_803_0	2010	2	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	33.98363292	0.691044336	0	0	79.14031767	30.62624179	5.449416127	193.4497515	121.9305731	0	0	0	0	52.62775242	1757.266047	1843.611373	244.605515	783.1214768	0	741.5447774	71.17450501	0	0	0	105.4389646	0	23.90369998	0	0	0											2500	$550/Admit for IP Medical; $550/Admit for IP Surgical;	$550/Admit for IP Psych; $550/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$75/Run for Ambulance	$35/Unit for DME	$35/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$350/Case for OP Fac - Surgery; $350/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults;	$40/Visit for Speclst - Office Visits; $40/Consult for Speclst - Consults;	$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$40/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams;	9% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$40/Exam for Vision (Refractions)	No Cost-Sharing	$40/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											550	550	0	0	75	35	35	48.85245179	350	0	0	0	0	25	25	40	40	25	0	40	0.088	0	0	0	40	0	40	0	0	0											NO	527.1855531	527.185553	0	0	71.88893907	33.54817156	33.54817165	46.8260124	335.4817156	0	0	0	0	23.96297969	23.96297969	38.3407675	38.3407675	23.96297968	0	38.3407675	0.084349688	0	0	0	38.3407675	0	38.34076748	0	0	0												1.493	0.030359049	0	0	0.474109456	0.085621201	0.015234829	0.754873372	3.408789822	0	0	0	0	0.105093147	3.509110882	5.890456251	0.781530265	1.563827003	0	2.369282992	6.003547327	0	0	0	0.336884236	0	0.07637385	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8981	0	1.164038957	1.493	0.030359049	0	0	0.474109456	0.085621201	0.015234829	0.754873372	3.408789822	0	0	0	0	0.105093147	3.509110882	5.890456251	0.781530265	1.563827003	0	2.369282992	6.003547327	0	0	0	0.336884236	0	0.07637385	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8981	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.493	0.030359049	0	0	0.474109456	0.085621201	0.015234829	0.754873372	3.408789822	0	0	0	0	0.105093147	3.509110882	5.890456251	0.781530265	1.563827003	0	2.369282992	6.003547327	0	0	0	0.336884236	0	0.07637385	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8981
H3206_001_0	2010	7	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	87.98694497	0.744167333	75.55320048	0	35.5316874	507.8753595	18.26884569	275.0406283	263.9826387	0	0	0	0	228.5211277	3552.700817	2241.817129	278.9395272	1076.007746	0	889.3971617	34.82940691	0	0	0	121.4041137	0	11.39142971	0	0	0											2500	$650/Admit for IP Medical; $650/Admit for IP Surgical;	$650/Admit for IP Psych; $650/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$150/Run for Ambulance	$35/Unit for DME	$35/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care;	$375/Case for OP Fac - Surgery; $375/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams;	8% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											650	650	125	0	150	35	35	48.72350324	375	0	0	0	0	20	20	35	35	20	0	35	0.081	0	0	0	35	0	35	0	0	0											NO	626.4986052	626.498605	120.480501	0	144.5766012	33.73454028	33.73454028	46.96185664	361.441503	0	0	0	0	19.27688016	19.27688016	33.73454028	33.73454028	19.27688016	0	33.73454028	0.078071365	0	0	0	33.73454028	0	33.73454023	0	0	0												4.5936	0.03885165	0.758557287	0	0.42808755	1.427745148	0.051357593	1.076368213	7.95119014	0	0	0	0	0.367097866	5.707082325	6.302222518	0.78415806	1.72850603	0	2.500283698	2.719179327	0	0	0	0.341292664	0	0.03202372	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8076	0	1.380738917	4.5936	0.03885165	0.758557287	0	0.42808755	1.427745148	0.051357593	1.076368213	7.95119014	0	0	0	0	0.367097866	5.707082325	6.302222518	0.78415806	1.72850603	0	2.500283698	2.719179327	0	0	0	0.341292664	0	0.03202372	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8076	NO	$850/Admit for IP Medical; $850/Admit for IP Surgical;	$850/Admit for IP Psych; $850/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$150/Run for Ambulance	$50/Unit for DME	10% Coinsurance for Diabetes Monitoring Supplies; $50/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	13% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - CORF; $35/Visit for Prof - CORF; $35/Visit for Prof - CORF;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP);	$55/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); $55/Consult for Speclst - Consults;	50% Coinsurance for OP Psych - Non-Physician; 50% Coinsurance for OP Psych - Psychiatrist; 50% Coinsurance for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$55/Visit for Chiropractor; $55/Exam for Vision Exams; $55/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	18% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$55/Exam for Vision (Refractions)	No Cost-Sharing	$55/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												2.3284	0.2431	1.1739	0	0.5646	0.4259	0.0022	0.233	1.0202	0.4116	0.4102	0	0	0.0291	0.5321	1.0096	0.1599	0.1784	0.185	0.3995	0.0291	0	0	0	0.0371	0	0.0081	0	0	0											9.3809	0	0	6.922	0.28193693	1.932485134	0	0.99266829	1.853643472	0.053579643	1.309375542	8.9714187	0.411563389	0.41015578	0	0	0.396223297	6.239186519	7.311826697	0.944013162	1.906951692	0.185026555	2.899775082	2.748242918	0	0	0	0.378403716	0	0.040082545	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1886
H3206_002_0	2010	8	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	174.519017	1.76496625	127.6739733	0	57.338204	1142.849875	46.83072967	239.1379075	294.9801157	0	0	0	0	42.00697149	3633.795091	3068.572376	320.1712298	1292.227643	0	1201.465997	43.30942798	0	0	0	183.191295	0	39.05615025	0	0	0											2500	$500/Admit for IP Medical; $500/Admit for IP Surgical;	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	$20/Unit for DME	$20/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care;	$350/Case for OP Fac - Surgery; $350/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams;	8% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											500	500	125	0	100	20	20	48.71147582	350	0	0	0	0	20	20	35	35	20	0	35	0.081	0	0	0	35	0	35	0	0	0											NO	476.8141398	476.8141404	119.203535	0	95.36282796	19.07256559	19.07256558	46.45264089	333.7698979	0	0	0	0	19.07256557	19.07256559	33.37698979	33.37698978	19.07256559	0	33.37698979	0.077243891	0	0	0	33.37698979	0	33.37698977	0	0	0												6.9344	0.070130072	1.268265745	0	0.455661107	1.816423266	0.074431847	0.925715611	8.204623591	0	0	0	0	0.06676506	5.775482935	8.534975739	0.890529322	2.053841373	0	3.341776527	3.345388719	0	0	0	0.509531165	0	0.108631394	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3766	0	2.15788415	6.9344	0.070130072	1.268265745	0	0.455661107	1.816423266	0.074431847	0.925715611	8.204623591	0	0	0	0	0.06676506	5.775482935	8.534975739	0.890529322	2.053841373	0	3.341776527	3.345388719	0	0	0	0.509531165	0	0.108631394	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3766	NO	$850/Admit for IP Medical; $850/Admit for IP Surgical;	$850/Admit for IP Psych; $850/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	$50/Unit for DME	10% Coinsurance for Diabetes Monitoring Supplies;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	13% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - CORF; $35/Visit for Prof - CORF; $35/Visit for Prof - CORF;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP);	$55/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); $55/Consult for Speclst - Consults;	50% Coinsurance for OP Psych - Non-Physician; 50% Coinsurance for OP Psych - Psychiatrist; 50% Coinsurance for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$55/Visit for Chiropractor; $55/Exam for Vision Exams; $55/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	18% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$55/Exam for Vision (Refractions)	No Cost-Sharing	$55/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												2.5147	0.0127	1.705	0	0.3969	0.3902	0.0048	0.2848	1.1931	0.3477	0.6086	0	0	0.2362	0.9205	1.7829	0.2021	0.2804	0.3133	0.6831	0.0971	0	0	0	0.0585	0	0.0235	0	0	0											12.0563	0	0	9.4492	0.082866357	2.973296891	0	0.852584692	2.206645214	0.079214517	1.210515965	9.397696043	0.347675369	0.608635147	0	0	0.302946946	6.695989968	10.31791742	1.09258772	2.334271459	0.313311046	4.024878972	3.442471878	0	0	0	0.568050164	0	0.132170442	0	0	0	0	0	0	0	0	0	0	0	0	0	56.4329
H3206_003_0	2010	5	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	116.5604837	1.85122972	211.1084551	0	42.25791862	182.9268848	36.15446637	158.8449798	223.1887603	0	0	0	0	295.8600732	2065.03705	1937.8019	126.5446596	958.3598321	0	741.0465154	13.88345421	0	0	0	178.7622392	0	59.64736248	0	0	0											2500	$400/Admit for IP Medical; $400/Admit for IP Surgical;	$400/Admit for IP Psych; $400/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	$20/Unit for DME	$20/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care;	$350/Case for OP Fac - Surgery; $350/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams;	8% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											400	400	125	0	100	20	20	48.70050668	350	0	0	0	0	20	20	35	35	20	0	35	0.081	0	0	0	35	0	35	0	0	0											NO	390.0680319	390.068032	121.89626	0	97.51700797	19.5034016	19.5034016	47.49127699	341.3095279	0	0	0	0	19.5034016	19.5034016	34.13095279	34.1309528	19.5034016	0	34.13095279	0.078988776	0	0	0	34.13095279	0	34.1309528	0	0	0												3.7889	0.060175461	2.14444426	0	0.343405482	0.297308041	0.058761256	0.628645911	6.348037536	0	0	0	0	0.480856485	3.356270574	5.51158543	0.35992415	1.55760639	0	2.107718636	1.096637061	0	0	0	0.508443796	0	0.169651776	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8183	0	0.733776924	3.7889	0.060175461	2.14444426	0	0.343405482	0.297308041	0.058761256	0.628645911	6.348037536	0	0	0	0	0.480856485	3.356270574	5.51158543	0.35992415	1.55760639	0	2.107718636	1.096637061	0	0	0	0.508443796	0	0.169651776	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8183	NO	$750/Admit for IP Medical; $750/Admit for IP Surgical;	$750/Admit for IP Psych; $750/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	$50/Unit for DME	10% Coinsurance for Diabetes Monitoring Supplies; $50/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	13% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - CORF; $35/Visit for Prof - CORF; $35/Visit for Prof - CORF;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP);	$55/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); $55/Consult for Speclst - Consults;	50% Coinsurance for OP Psych - Non-Physician; 50% Coinsurance for OP Psych - Psychiatrist; 50% Coinsurance for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$55/Visit for Chiropractor; $55/Exam for Vision Exams; $55/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	18% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$55/Exam for Vision (Refractions)	No Cost-Sharing	$55/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												1.9759	0.1021	0.5392	0	0.2136	0.126	0.0304	0.1195	0.8429	0.3195	0.3139	0	0	0.0198	0.5937	1.5781	0.0503	0.2792	0.2529	0.5827	0.1202	0	0	0	0.1133	0	0.0486	0	0	0											8.2218	0	0	5.7648	0.162308428	2.683600802	0	0.557051986	0.423332838	0.089179115	0.7481211	7.190978411	0.319486421	0.313884254	0	0	0.500607697	3.949940708	7.089666897	0.410224387	1.836850251	0.252943713	2.690441233	1.216800348	0	0	0	0.621788713	0	0.218228169	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0402
H3206_801_0	2010	3	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	77.3577317	0.719815055	16.45611583	0	77.12617734	250.1021035	21.49481434	199.0630683	184.2823896	0	0	0	0	204.8787485	2076.194005	2813.583431	182.0303147	1156.144044	0	1111.421897	41.6942205	0	0	0	187.237888	0	45.75101772	0	0	0											2500	$550/Admit for IP Medical; $550/Admit for IP Surgical;	$550/Admit for IP Psych; $550/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	$35/Unit for DME	$35/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care;	$350/Case for OP Fac - Surgery; $350/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams;	8% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											550	550	125	0	100	35	35	48.72596811	350	0	0	0	0	20	20	35	35	20	0	35	0.081	0	0	0	35	0	35	0	0	0											NO	515.4982283	515.4982276	117.1586882	0	93.7269506	32.80443271	32.80443273	45.66936406	328.0443271	0	0	0	0	18.74539012	18.74539012	32.80443271	32.80443271	18.74539012	0	32.80443271	0.07591883	0	0	0	32.80443271	0	32.80443271	0	0	0												3.3231	0.030921949	0.160664745	0	0.602400118	0.683704802	0.058760433	0.757590311	5.037732708	0	0	0	0	0.320044339	3.24325555	7.691500694	0.497616767	1.806030929	0	3.038297069	3.165376438	0	0	0	0.511852725	0	0.125069682	0	0	0	0	0	0	0	0	0	0	0	0	0	31.054	0	2.078410404	3.3231	0.030921949	0.160664745	0	0.602400118	0.683704802	0.058760433	0.757590311	5.037732708	0	0	0	0	0.320044339	3.24325555	7.691500694	0.497616767	1.806030929	0	3.038297069	3.165376438	0	0	0	0.511852725	0	0.125069682	0	0	0	0	0	0	0	0	0	0	0	0	0	31.054	NO	$750/Admit for IP Medical; $750/Admit for IP Surgical;	$750/Admit for IP Psych; $750/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	$50/Unit for DME	10% Coinsurance for Diabetes Monitoring Supplies; $50/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	13% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - CORF; $35/Visit for Prof - CORF; $35/Visit for Prof - CORF;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP);	$55/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); $55/Consult for Speclst - Consults;	50% Coinsurance for OP Psych - Non-Physician; 50% Coinsurance for OP Psych - Psychiatrist; 50% Coinsurance for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$55/Visit for Chiropractor; $55/Exam for Vision Exams; $55/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	18% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$55/Exam for Vision (Refractions)	No Cost-Sharing	$55/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.6034	0.0095	0.2131	0	0.0836	0.0926	0.0109	0.1106	0.6016	0.1705	0.1139	0	0	0.0895	0.2607	1.306	0.1992	0.3015	0.2039	0.5268	0.1008	0	0	0	0.0748	0	0.029	0	0	0											5.1018	0	0	3.9265	0.040411717	0.373777042	0	0.686049667	0.776337722	0.069628991	0.868171243	5.639372651	0.170493762	0.113889464	0	0	0.40956851	3.503918961	8.997477536	0.696853399	2.107498788	0.203850148	3.565085399	3.26617445	0	0	0	0.586603909	0	0.1540609	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1558
H3206_802_0	2010	3	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	77.3577317	0.719815055	16.45611583	0	77.12617734	250.1021035	21.49481434	199.0630683	184.2823896	0	0	0	0	204.8787485	2076.194005	2813.583431	182.0303147	1156.144044	0	1111.421897	41.6942205	0	0	0	187.237888	0	45.75101772	0	0	0											2500	$550/Admit for IP Medical; $550/Admit for IP Surgical;	$550/Admit for IP Psych; $550/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	$35/Unit for DME	$35/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care;	$350/Case for OP Fac - Surgery; $350/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams;	8% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											550	550	125	0	100	35	35	48.72596811	350	0	0	0	0	20	20	35	35	20	0	35	0.081	0	0	0	35	0	35	0	0	0											NO	515.4982283	515.4982276	117.1586882	0	93.7269506	32.80443271	32.80443273	45.66936406	328.0443271	0	0	0	0	18.74539012	18.74539012	32.80443271	32.80443271	18.74539012	0	32.80443271	0.07591883	0	0	0	32.80443271	0	32.80443271	0	0	0												3.3231	0.030921949	0.160664745	0	0.602400118	0.683704802	0.058760433	0.757590311	5.037732708	0	0	0	0	0.320044339	3.24325555	7.691500694	0.497616767	1.806030929	0	3.038297069	3.165376438	0	0	0	0.511852725	0	0.125069682	0	0	0	0	0	0	0	0	0	0	0	0	0	31.054	0	2.078410404	3.3231	0.030921949	0.160664745	0	0.602400118	0.683704802	0.058760433	0.757590311	5.037732708	0	0	0	0	0.320044339	3.24325555	7.691500694	0.497616767	1.806030929	0	3.038297069	3.165376438	0	0	0	0.511852725	0	0.125069682	0	0	0	0	0	0	0	0	0	0	0	0	0	31.054	NO	$750/Admit for IP Medical; $750/Admit for IP Surgical;	$750/Admit for IP Psych; $750/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	$50/Unit for DME	10% Coinsurance for Diabetes Monitoring Supplies; $50/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	13% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - CORF; $35/Visit for Prof - CORF; $35/Visit for Prof - CORF;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP);	$55/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); $55/Consult for Speclst - Consults;	50% Coinsurance for OP Psych - Non-Physician; 50% Coinsurance for OP Psych - Psychiatrist; 50% Coinsurance for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$55/Visit for Chiropractor; $55/Exam for Vision Exams; $55/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	18% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$55/Exam for Vision (Refractions)	No Cost-Sharing	$55/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.6034	0.0095	0.2131	0	0.0836	0.0926	0.0109	0.1106	0.6016	0.1705	0.1139	0	0	0.0895	0.2607	1.306	0.1992	0.3015	0.2039	0.5268	0.1008	0	0	0	0.0748	0	0.029	0	0	0											5.1018	0	0	3.9265	0.040411717	0.373777042	0	0.686049667	0.776337722	0.069628991	0.868171243	5.639372651	0.170493762	0.113889464	0	0	0.40956851	3.503918961	8.997477536	0.696853399	2.107498788	0.203850148	3.565085399	3.26617445	0	0	0	0.586603909	0	0.1540609	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1558
H3206_803_0	2010	3	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	77.3577317	0.719815055	16.45611583	0	77.12617734	250.1021035	21.49481434	199.0630683	184.2823896	0	0	0	0	204.8787485	2076.194005	2813.583431	182.0303147	1156.144044	0	1111.421897	41.6942205	0	0	0	187.237888	0	45.75101772	0	0	0											2500	$550/Admit for IP Medical; $550/Admit for IP Surgical;	$550/Admit for IP Psych; $550/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	$35/Unit for DME	$35/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care;	$350/Case for OP Fac - Surgery; $350/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams;	8% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											550	550	125	0	100	35	35	48.72596811	350	0	0	0	0	20	20	35	35	20	0	35	0.081	0	0	0	35	0	35	0	0	0											NO	515.4982283	515.4982276	117.1586882	0	93.7269506	32.80443271	32.80443273	45.66936406	328.0443271	0	0	0	0	18.74539012	18.74539012	32.80443271	32.80443271	18.74539012	0	32.80443271	0.07591883	0	0	0	32.80443271	0	32.80443271	0	0	0												3.3231	0.030921949	0.160664745	0	0.602400118	0.683704802	0.058760433	0.757590311	5.037732708	0	0	0	0	0.320044339	3.24325555	7.691500694	0.497616767	1.806030929	0	3.038297069	3.165376438	0	0	0	0.511852725	0	0.125069682	0	0	0	0	0	0	0	0	0	0	0	0	0	31.054	0	2.078410404	3.3231	0.030921949	0.160664745	0	0.602400118	0.683704802	0.058760433	0.757590311	5.037732708	0	0	0	0	0.320044339	3.24325555	7.691500694	0.497616767	1.806030929	0	3.038297069	3.165376438	0	0	0	0.511852725	0	0.125069682	0	0	0	0	0	0	0	0	0	0	0	0	0	31.054	NO	$750/Admit for IP Medical; $750/Admit for IP Surgical;	$750/Admit for IP Psych; $750/Admit for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	$50/Unit for DME	10% Coinsurance for Diabetes Monitoring Supplies; $50/Unit for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	13% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy; $35/Case for OP Fac - CORF; $35/Visit for Prof - CORF; $35/Visit for Prof - CORF;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP);	$55/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); $55/Consult for Speclst - Consults;	50% Coinsurance for OP Psych - Non-Physician; 50% Coinsurance for OP Psych - Psychiatrist; 50% Coinsurance for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$55/Visit for Chiropractor; $55/Exam for Vision Exams; $55/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	18% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$55/Exam for Vision (Refractions)	No Cost-Sharing	$55/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.6034	0.0095	0.2131	0	0.0836	0.0926	0.0109	0.1106	0.6016	0.1705	0.1139	0	0	0.0895	0.2607	1.306	0.1992	0.3015	0.2039	0.5268	0.1008	0	0	0	0.0748	0	0.029	0	0	0											5.1018	0	0	3.9265	0.040411717	0.373777042	0	0.686049667	0.776337722	0.069628991	0.868171243	5.639372651	0.170493762	0.113889464	0	0	0.40956851	3.503918961	8.997477536	0.696853399	2.107498788	0.203850148	3.565085399	3.26617445	0	0	0	0.586603909	0	0.1540609	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1558
H3209_001_0	2010	5	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	245.976474	34.94495847	10111.72189	94.66321167	22.11137993	14.50314895	13.09098283	15.96135721	4.589231004	35.79348901	21.1279682	0	0.018495115	9.035614408	0.883177792	84.91783001	16.30930039	28.32253961	0	0	1.07042664	9.046434615	1916.729831	125.2665359	106.7711973	189.1931161	15.53907455	9.237945123	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075472562	0.076389233	0	0	0.2	0.2	0.090268188	0.045003044	0.2	0	0.07287301	0	0.2	0.151192634	0.004410618	0.198491183	0.2	0	0	0	0.2	0.189287003	0	0	0	0	0	0	0	0											NO	0.075472562	0.076389233	0	0	0.2	0.2	0.090268188	0.045003044	0.2	0	0.07287301	0	0.2	0.151192634	0.004410618	0.198491183	0.2	0	0	0	0.2	0.189287003	0	0	0	0	0	0	0	0												18.5645	2.669418579	0	0	4.422275985	2.90062979	1.181699294	0.718309659	0.917846201	0	1.539658638	0	0.003699023	1.366118346	0.00389536	16.85544057	3.261860078	0	0	0	0.214085328	1.712372495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3318	0	0	18.5645	2.669418579	0	0	4.422275985	2.90062979	1.181699294	0.718309659	0.917846201	0	1.539658638	0	0.003699023	1.366118346	0.00389536	16.85544057	3.261860078	0	0	0	0.214085328	1.712372495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3318	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.9832	0.85	0.483	0.0553	0.8199	0.5378	0.4854	0.0888	0.1702	0.3982	0.6211	0	0.0005	0.2533	0.0241	2.3666	0.4545	0	0	0	0.0298	0.2386	0	0	0.0186	0	0.0019	0	0	0											13.8806	0	0	24.5477	3.519431082	0.483023721	0.055316215	5.24213614	3.438386998	1.667095286	0.807089504	1.088008699	0.398152293	2.160787519	0	0.004156206	1.619387477	0.027965716	19.22200304	3.716381564	0	0	0	0.24391689	1.950981777	0	0	0.018597442	0	0.001889476	0	0	0	0	0	0	0	0	0	0	0	0	0	70.2124
H3209_002_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	244.5123119	16.78565413	1301.907487	983.8809157	10.36645377	17.50748973	12.05651712	31.39114877	23.96791237	12.33439693	32.04616247	0	0.060812221	17.51440672	21.95468767	74.35112411	7.101288491	3.506209816	0	0	16.90345018	4.290596646	0	321.0569166	0	0	0	0	66.5332326	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075588885	0.076506968	43.47002967	0	0.2	0.2	0.2	0.081319735	0.2	0	0.166573473	0	0.2	0.149960602	0.167469778	0.199796107	0.2	0	0	0	0.2	0.199627212	0	0	0	0	0	0	0	0											NO	0.075588885	0.076506968	43.47002967	0	0.2	0.2	0.2	0.081319735	0.2	0	0.166573473	0	0.2	0.149960602	0.167469778	0.199796107	0.2	0	0	0	0.2	0.199627212	0	0	0	0	0	0	0	0												18.4824	1.284219507	4.716163091	0	2.073290754	3.501497947	2.411303425	2.5527199	4.793582474	0	5.338040572	0	0.012162444	2.62647097	3.676746674	14.85506517	1.420257698	0	0	0	3.380690036	0.856519845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9811	0	0	18.4824	1.284219507	4.716163091	0	2.073290754	3.501497947	2.411303425	2.5527199	4.793582474	0	5.338040572	0	0.012162444	2.62647097	3.676746674	14.85506517	1.420257698	0	0	0	3.380690036	0.856519845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9811	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												12.4401	0.854	3.6436	0.43	0.6145	1.0379	0.7147	0.5041	1.4209	0.2194	1.5822	0	0.0024	0.7785	1.9727	6.852	0.6544	0	0	0	1.5578	0.3947	0	0.0666	0	0	0	0	0	0											35.7403	0	0	30.9225	2.138226472	8.359729099	0.429999652	2.687829032	4.539367099	3.126031086	3.056784387	6.214434764	0.219360233	6.920274155	0	0.014565802	3.404975839	5.649427057	21.70703151	2.074690167	0	0	0	4.938458974	1.251190754	0	0.066597482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.7215
H3214_002_0	2010	5	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				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	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	NO	2497.334402	263.2342357	1295.591081	729.8419049	219.1232766	22.33637122	1.526867362	324.5140119	200.0619324	473.0976396	1224.065664	19.06769619	0	25444.77674	5889.420742	13326.55779	1926.940404	5341.632185	8379.953617	30475.51255	43.11656951	0	430.5730195	1008.531987	321.0493492	268.9418632	79.13097129	16.80886645	3731.568352	1092.576319	16069.71828	3.416159832	0	14.02288723	333.9784124	0	1231.54641					0	$100 days 1-10	$50 days 11-100	0	50 Waived if admitted	0	0	50 Waived if admitted	"$0 Metropolitan, $50 elsewhere"	0	0	0	0	0	0	0	0	0	0	0	0.2		0	0	0	0	0	0	0		0	0	25 Waived if admitted	50	0	0	0				0	62.67508081	17.39689341	0	40	0	0	50	45	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	25	50	0	0	0				NO	0	62.67508081	17.39689341	0	40	0	0	50	45	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	25	50	0	0	0					0	1.37485225	1.878271662	0	0.730410922	0	0	1.352141716	0.750232247	0	0	0	0	0	0	0	0	0	0	0	8.623313903	0	0	0	0	0	0	0	0	0	0	0	0	0.058428697	0	0	0	0	0	0	14.7677	0	0	0	1.37485225	1.878271662	0	0.730410922	0	0	1.352141716	0.750232247	0	0	0	0	0	0	0	0	0	0	0	8.623313903	0	0	0	0	0	0	0	0	0	0	0	0	0.058428697	0	0	0	0	0	0	14.7677	NO	0	0.2	0.2	0.2	1	1	1	50	0.2	1	1	0.2	1	0.2	1	20	0.2	0.2	0.2	0.2	0.2	0	1	1	1	1	1	1	0	0	1	1	25	0.2	1	0.2	0.2					0	0.0522	0.2144	0.1063	0	0	0	0	0.0684	0	0	0.0043	0	0.1891	0	0.4533	0.0367	0.0497	0.1939	0.4757	0.176	0	0	0	0	0	0	0	0	0	0	0	0	0.0018	0	0	0.0201				2.0417	0	0	0	1.427004496	2.092664279	0.106254255	0.730410922	0	0	1.352141716	0.818607932	0	0	0.004304644	0	0.189148987	0	0.453284279	0.036652277	0.049666083	0.193870196	0.475658946	8.799299901	0	0	0	0	0	0	0	0	0	0	0	0	0.060223449	0	0	0.020146057	0	0	0	16.8093
H3214_003_0	2010	4	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	V	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	NO	2133.196216	245.2423543	1541.556755	864.3816605	198.8414627	25.0230097	1.165023535	333.0586249	219.0919798	547.4438943	1382.967513	22.68766457	0	30108.65064	6460.422786	13261.76836	2255.931748	6351.638838	9242.360858	130.8403139	51.29349286	0	375	207.5294118	374.36	313.6	92.27076923	19.6	4440	983.3333333	19120.52585	4.064711731	0	0.591488382	397.383623	0	1465.353317					$100 days 8-25	$100 days 1-10	$50 days 8-100	0	50	0-20%	0-20%	50 Waived if admitted	"$0 Metropolitan, $50 elsewhere"	0	0	0	0	0	0	0	25	20	0	0	0.2		0	0	0	0	0	0	0		0	0	25 Waived if admitted	50	0	25	0				22.8001219	62.67508081	25.25441885	0	50	0.1	0.1	50	45	0	0	0	0	0	0	0	25	20	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	25	50	0	25	0				NO	22.8001219	62.67508081	25.25441885	0	50	0.1	0.1	50	45	0	0	0	0	0	0	0	25	20	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	25	50	0	25	0					4.0531	1.280882031	3.244259998	0	0.828506095	2.50230097	0.116502354	1.38774427	0.821594924	0	0	0	0	0	0	0	4.699857807	10.58606473	0	0	10.25869857	0	0	0	0	0	0	0	0	0	0	0	0	0.002464535	0	0	0	0	0	0	39.782	0	0	4.0531	1.280882031	3.244259998	0	0.828506095	2.50230097	0.116502354	1.38774427	0.821594924	0	0	0	0	0	0	0	4.699857807	10.58606473	0	0	10.25869857	0	0	0	0	0	0	0	0	0	0	0	0	0.002464535	0	0	0	0	0	0	39.782	NO	$100 days 8-25	0.2	0.2	0.2	1	1	1	50	0.2	1	1	0.2	0	0.2	1	20	0.2	0.2	0.2	0.2	0.2	0	1	1	1	1	1	1	0	0	1	1	25	0.2	1	0.2	0.2					0.0827	0.0506	0.2551	0.1192	0	0	0	0	0.0685	0	0	0.0048	0	0.2051	0	0.4511	0.0419	0.0557	0.2035	0.534	0.2094	0	0	0.03	0.0382	0.0533	0.0102	0.02	0	0	0	0	0	0	0	0	0.024				2.4573	0	0	4.1358	1.331444765	3.499354675	0.11921433	0.828506095	2.50230097	0.116502354	1.38774427	0.890046833	0	0	0.004833003	0	0.2051368	0	0.451080557	4.741742252	10.64174265	0.203489413	0.534042097	10.46805977	0	0	0.03	0.0382	0.053333333	0.0102	0.02	0	0	0	0	0	0.002505391	0	0	0.02397075	0	0	0	42.2393
H3214_004_0	2010	9	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				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	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	NO	2425.432195	488.1851162	2498.038805	491.9226724	307.3573173	96.06758496	2.208453863	288.7441955	124.1044764	3146.481648	781.2128328	14.309496	0	48115.19443	8344.585219	7957.669651	5471.013046	8380.607938	12299.39711	36743.14154	112.119357	0	312.5	1200	382	320	94.15384615	20	4440	8183.333333	25204.68049	5.399394916	0	0	194.1152824	0	1494.448333					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0		0	0	0	0	0	0	0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0.2	0.2	0.2	1	1	1	0	0.2	1	1	0.2	0	0.2	1	5	0.2	0.2	0.2	0.2	0.2	0	1	1	1	1	1	1	0	0	1	1	0	0.2	1	0.2	0.2					0	0.1116	0.4097	0.1098	0	0	0	0	0.0299	0	0	0.0016	0	0.6197	0	0.0677	0.0794	0.0651	0.2253	0.581	0.4576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0277				2.7861	0	0	0	0.111647287	0.409704036	0.109838572	0	0	0	0	0.029935277	0	0	0.001578342	0	0.619733551	0	0.067667259	0.079408425	0.065051326	0.225252579	0.580990605	0.457630029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.027694146	0	0	0	2.7861
H3214_801_0	2010	3	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				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																																												0	NO	297.36074	12.70265314	64.0863125	32.59853466	10.12922778	27.36964412	1.274278351	4.341365582	18.71781626	5.379758262	14.26212887	1.321559247	0	56.09358427	18.01604656	73.54442334	11.453082	15.22483449	55.6431149	146.0310164	57.24872306	0	0	0	0	0	0	0	0	0	20.6432591	4.445896592	0	0.011171979	8.801116338	0	6.554676159					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS									Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS				0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233				NO	0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233					22.6191	0.966243279	10.2236389	0	2.360110073	6.377127081	0.296906856	1.011538181	4.361251188	1.253483675	3.323076028	0.307923305	0	13.06980513	4.19773885	17.13585064	2.668568106	3.547386436	12.96484577	34.02522681	13.33895247	0	0	0	0	0	0	0	0	0	4.809879369	1.035893906	0	0.002603071	2.050660107	0	1.527239545	0	0	0	163.4751	0	0	22.6191	0.966243279	10.2236389	0	2.360110073	6.377127081	0.296906856	1.011538181	4.361251188	1.253483675	3.323076028	0.307923305	0	13.06980513	4.19773885	17.13585064	2.668568106	3.547386436	12.96484577	34.02522681	13.33895247	0	0	0	0	0	0	0	0	0	4.809879369	1.035893906	0	0.002603071	2.050660107	0	1.527239545	0	0	0	163.4751	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0	0	0	0	0	0	0	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	22.6191	0.966243279	10.2236389	0	2.360110073	6.377127081	0.296906856	1.011538181	4.361251188	1.253483675	3.323076028	0.307923305	0	13.06980513	4.19773885	17.13585064	2.668568106	3.547386436	12.96484577	34.02522681	13.33895247	0	0	0	0	0	0	0	0	0	4.809879369	1.035893906	0	0.002603071	2.050660107	0	1.527239545	0	0	0	163.4751
H3214_802_0	2010	2	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				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																																												0	NO	297.36074	12.70265314	64.0863125	32.59853466	10.12922778	27.36964412	1.274278351	4.341365582	18.71781626	5.379758262	14.26212887	1.321559247	0	56.09358427	18.01604656	73.54442334	11.453082	15.22483449	55.6431149	146.0310164	57.24872306	0	0	0	0	0	0	0	0	0	20.6432591	4.445896592	0	0.011171979	8.801116338	0	6.554676159					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS									Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS				0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233				NO	0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233					22.6191	0.966243279	10.2236389	0	2.360110073	6.377127081	0.296906856	1.011538181	4.361251188	1.253483675	3.323076028	0.307923305	0	13.06980513	4.19773885	17.13585064	2.668568106	3.547386436	12.96484577	34.02522681	13.33895247	0	0	0	0	0	0	0	0	0	4.809879369	1.035893906	0	0.002603071	2.050660107	0	1.527239545	0	0	0	163.4751	0	0	22.6191	0.966243279	10.2236389	0	2.360110073	6.377127081	0.296906856	1.011538181	4.361251188	1.253483675	3.323076028	0.307923305	0	13.06980513	4.19773885	17.13585064	2.668568106	3.547386436	12.96484577	34.02522681	13.33895247	0	0	0	0	0	0	0	0	0	4.809879369	1.035893906	0	0.002603071	2.050660107	0	1.527239545	0	0	0	163.4751	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0	0	0	0	0	0	0	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	22.6191	0.966243279	10.2236389	0	2.360110073	6.377127081	0.296906856	1.011538181	4.361251188	1.253483675	3.323076028	0.307923305	0	13.06980513	4.19773885	17.13585064	2.668568106	3.547386436	12.96484577	34.02522681	13.33895247	0	0	0	0	0	0	0	0	0	4.809879369	1.035893906	0	0.002603071	2.050660107	0	1.527239545	0	0	0	163.4751
H3214_803_0	2010	2	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				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																																												0	NO	297.36074	12.70265314	64.0863125	32.59853466	10.12922778	27.36964412	1.274278351	4.341365582	18.71781626	5.379758262	14.26212887	1.321559247	0	56.09358427	18.01604656	73.54442334	11.453082	15.22483449	55.6431149	146.0310164	57.24872306	0	0	0	0	0	0	0	0	0	20.6432591	4.445896592	0	0.011171979	8.801116338	0	6.554676159					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS									Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS				0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233				NO	0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233					22.6191	0.966243279	10.2236389	0	2.360110073	6.377127081	0.296906856	1.011538181	4.361251188	1.253483675	3.323076028	0.307923305	0	13.06980513	4.19773885	17.13585064	2.668568106	3.547386436	12.96484577	34.02522681	13.33895247	0	0	0	0	0	0	0	0	0	4.809879369	1.035893906	0	0.002603071	2.050660107	0	1.527239545	0	0	0	163.4751	0	0	22.6191	0.966243279	10.2236389	0	2.360110073	6.377127081	0.296906856	1.011538181	4.361251188	1.253483675	3.323076028	0.307923305	0	13.06980513	4.19773885	17.13585064	2.668568106	3.547386436	12.96484577	34.02522681	13.33895247	0	0	0	0	0	0	0	0	0	4.809879369	1.035893906	0	0.002603071	2.050660107	0	1.527239545	0	0	0	163.4751	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	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	0	0	0	0	0	0	0	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	22.6191	0.966243279	10.2236389	0	2.360110073	6.377127081	0.296906856	1.011538181	4.361251188	1.253483675	3.323076028	0.307923305	0	13.06980513	4.19773885	17.13585064	2.668568106	3.547386436	12.96484577	34.02522681	13.33895247	0	0	0	0	0	0	0	0	0	4.809879369	1.035893906	0	0.002603071	2.050660107	0	1.527239545	0	0	0	163.4751
H3240_008_0	2010	7	N/A																															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	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	0	0	0	0	0											0	NO	1061.42	24.47	616.59	0	139.35	6.05	4.7	207.55	296.68	0	430.39	31.77	0.13	550.61	4392.38	5390.9	195.74	736.99	1571.18	96.22	7.23	695.47	0	0	0	0	0	0	0	0												1A IP Acute: $175 Per Day for days 1-10	1B IP Psych: $175 Per Day for days 1-10	2 SNF: $125 for days 20-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $175	8A OP Diagnostic Procedures/Tests: $150	8B OP Radiology: $100	9A OP Hospital: $150	12 Renal Dialysis: 20%	"3 CORF: $150, 5 Partial Hosp: $150, 9C OP Substance Abuse: $35, 9D Cardiac Rehab: $150"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $35"	"7B Chiropractic: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): $100	"7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $35, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: Not Covered, 13E PERS: $0"											175	175	125	0	100	0.20000001	0.159778119	48.3442544	175	0	100	106.2322946	0.199999997	92.17776648	15	35	35	35	100	35	0.200000519	35	0	0	0	0	0	0	0	0											NO	175	175	125	0	100	0.20000001	0.159778119	48.3442544	175	0	100	106.2322946	0.199999997	92.17776648	15	35	35	35	100	35	0.200000519	35	0	0	0	0	0	0	0	0												15.479	0.356854167	6.4228125	0	1.16125	1.21000006	0.750957159	0.836154167	4.326583333	0	3.586583333	0.28125	0.026	4.2295	5.490475	15.72345833	0.570908333	2.149554167	13.09316667	0.280641667	1.44600375	2.028454167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4496	0	0	15.479	0.356854167	6.4228125	0	1.16125	1.21000006	0.750957159	0.836154167	4.326583333	0	3.586583333	0.28125	0.026	4.2295	5.490475	15.72345833	0.570908333	2.149554167	13.09316667	0.280641667	1.44600375	2.028454167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4496	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.479	0.356854167	6.4228125	0	1.16125	1.21000006	0.750957159	0.836154167	4.326583333	0	3.586583333	0.28125	0.026	4.2295	5.490475	15.72345833	0.570908333	2.149554167	13.09316667	0.280641667	1.44600375	2.028454167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4496
H3240_010_0	2010	6	N/A																															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	V	V	V	O	O											24.7693	0.2695	2.8154	4.219	0	0	0	0	13.3204	1.7405	5.4215	0.2573	0	5.393	0	0	0	0	0	0	0	0.1842	0	0	0	0	0	0	0	0											58.39	YES	0	0	0	0	143.43	6.69	5.15	224.45	0	0	0	0	0.14	458.66	4883.42	6076.57	222.7	856.08	0	110.39	7.37	797.62	0	0	0	0	0	0	0	0											3400	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: 20%	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $25, 9D Cardiac Rehab: $0"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $25"	"7B Chiropractic: $25, 7D Physician Specialist (excl. Radiology): $25, 7F Podiatry: $25"	"7E Mental Health: $25, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $25, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): Not covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: Not Covered, 13E PERS: $0"											0	0	0	0	100	0.19999998	0.159370609	47.15972377	0	0	0	0	0.200000005	12.5	10	25	25	25	0	25	0.200001015	25	0	0	0	0	0	0	0	0											NO	0	0	0	0	100	0.19999998	0.159370609	47.15972377	0	0	0	0	0.200000005	12.5	10	25	25	25	0	25	0.200001015	25	0	0	0	0	0	0	0	0												0	0	0	0	1.19525	1.337999867	0.820758634	0.882083333	0	0	0	0	0.028000001	0.477770833	4.069516667	12.65952083	0.463958333	1.7835	0	0.229979167	1.47400748	1.661708333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0841	1200	0	24.7693	0.269471415	2.815351332	4.219037156	1.19525	1.337999867	0.820758634	0.882083333	13.32042167	1.740484281	5.421545014	0.257261363	0.028000001	5.870731252	4.069516667	12.65952083	0.463958333	1.7835	0	0.229979167	1.47400748	1.845920173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4741	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.7693	0.269471415	2.815351332	4.219037156	1.19525	1.337999867	0.820758634	0.882083333	13.32042167	1.740484281	5.421545014	0.257261363	0.028000001	5.870731252	4.069516667	12.65952083	0.463958333	1.7835	0	0.229979167	1.47400748	1.845920173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4741
H3240_013_0	2010	7	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	476.092638	30.4290735	111.6285408	68.54463193	16.06825877	16.63852044	10.98988227	20.52499828	35.94591938	8.443877303	14.912365	0.720780783	1.287687016	34.17492907	98.02006081	163.7653536	9.268919244	8.987358437	41.10107963	43.89508446	6.156745294	4.883492269	7.961	16.22973745	2.76	2.41	1.422683065	0	0.008095719	0.404933024												1A IP Acute: Std. Medicare	1B IP Psych: Std. Medicare	2 SNF: Std. Medicare	6 Home Health: Std. Medicare	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: 20%, 4B Urgent Care: 20%"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: Std. Medicare, 5 Partial Hosp: 20%, 9C OP Substance Abuse: 20%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: 20%"	"7B Chiropractic: 20%, 7D Physician Specialist (excl. Radiology): 20%, 7F Podiatry: 20%"	"7E Mental Health: 20%, 7H Psychiatric: 20%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 0%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): 20%, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): Not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: $0, 13E PERS: $0"											0.061536761	0.06156487	0.138394069	0	0.199957872	0.200000016	0.162649172	0.198903848	0.200000029	0.200069024	0.199936994	0.199999764	0.2	0.200002535	0.197979894	0.20000241	0.200008219	0.199988604	0.199994947	0.192128673	0	0.200001826	0	0	0	0	0	0	0	0											NO	0.061536761	0.06156487	0.138394069	0	0.199957872	0.200000016	0.162649172	0.198903848	0.200000029	0.200069024	0.199936994	0.199999764	0.2	0.200002535	0.197979894	0.20000241	0.200008219	0.199988604	0.199994947	0.192128673	0	0.200001826	0	0	0	0	0	0	0	0												29.2972	1.873361952	15.44872799	0	3.21297483	3.327704349	1.787495247	4.082501132	7.189184911	1.689358292	2.981533436	0.144155986	0.257537403	6.835072433	19.40600122	32.75346545	1.853860028	1.797369264	8.220008251	8.433504342	0	0.976707373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.5677	0	0	29.2972	1.873361952	15.44872799	0	3.21297483	3.327704349	1.787495247	4.082501132	7.189184911	1.689358292	2.981533436	0.144155986	0.257537403	6.835072433	19.40600122	32.75346545	1.853860028	1.797369264	8.220008251	8.433504342	0	0.976707373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.5677	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.2972	1.873361952	15.44872799	0	3.21297483	3.327704349	1.787495247	4.082501132	7.189184911	1.689358292	2.981533436	0.144155986	0.257537403	6.835072433	19.40600122	32.75346545	1.853860028	1.797369264	8.220008251	8.433504342	0	0.976707373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.5677
H3251_002_0	2010	8	N/A																															A	A	A	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	P	P	O	V	T	V	P	P	P	P	O	O																																																			0	YES	239.9870023	4.536475717	548.5802585	1153.35112	501.6356573	2049.512114	24.37491046	310.5501374	214.4770544	1136.281844	1172.32693	21.612691	61.96595458	1693.329209	8085.002007	12634.19502	267.7949776	1272.838091	4508.374212	11447.86623	1437.985656		5.051636773	0.865994875	16.76499381	484.8849639	0.391705463	0.216498719	15.01057784	68.84659259											3200	$200 Copay / Day to 3 days	$200 Copay / Day to 3 days	Various Copays	0	$75 Copay	0	0	$50 Copay	$150 Copay	Various Copays	CT $50; MRI $50 Copay	$30 Copay	0	$10 Copay	$10 Copay / Visit	$30 Copay / Visit	$30 Copay / Visit	$10 Copay / Visit	Various Copays	Various Copays	Various Copays		Various Copays	Various Copays	$30 Copay / Visit	Various Copays	$30 Copay / Visit	Various Copays	Various Copays	$15 Copays											241.7596096	325.1382439	5.622255763	0.00362297	18.8239664	0.00100649	0	47.11883237	91.65145467	0.018495419	6.910474061	1.528239203	0	2.998332697	5.275211215	12.99593957	27.44267089	2.992294131	0.94557271	0.05534212	0.003170416		21.7	0	48.69579439	0.025301384	18.96	5	0	0.476939203											NO	241.7596096	325.1382439	5.622255763	0.00362297	18.8239664	0.00100649	0	47.11883237	91.65145467	0.018495419	6.910474061	1.528239203	0	2.998332697	5.275211215	12.99593957	27.44267089	2.992294131	0.94557271	0.05534212	0.003170416	0	21.7	0	48.69579439	0.025301384	18.96	5	0	0.476939203												4.8349	0.122915146	0.257021543	0.000348213	0.78689773	0.000171901	0	1.219396655	1.638094502	0.001751334	0.675111237	0.002752447	0	0.423097028	3.554174438	13.68276958	0.612417453	0.317392162	0.355249635	0.052795765	0.000379918	0	0.009135043	0	0.068032058	0.001022355	0.000618895	9.02E-05	0	0.002736303	0	0	0	0	0	0	0	0	0	0	28.6193		0.02	4.8349	0.122915146	0.257021543	0.000348213	0.78689773	0.000171901	0	1.219396655	1.638094502	0.001751334	0.675111237	0.002752447	0	0.423097028	3.554174438	13.68276958	0.612417453	0.317392162	0.355249635	0.052795765	0.000379918	0	0.009135043	0	0.068032058	0.001022355	0.000618895	9.02E-05	0	0.002736303	0	0	0	0	0	0	0	0	0	0	28.6193	YES																																									3200																																									0			4.8349	0.122915146	0.257021543	0.000348213	0.78689773	0.000171901	0	1.219396655	1.638094502	0.001751334	0.675111237	0.002752447	0	0.423097028	3.554174438	13.68276958	0.612417453	0.317392162	0.355249635	0.052795765	0.000379918	0	0.009135043	0	0.068032058	0.001022355	0.000618895	9.02E-05	0	0.002736303	0	0	0	0	0	0	0	0	0	0	28.6193
H3251_021_0	2010	8	N/A																															A	A	D	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	P	P	O	V	T	V	P	P	P	P	O	O																																																			0	YES	340.5807781	5.083295195	829.3035196	2092.417541	716.3851307	3751.953181	36.2750196	376.6258825	270.3695405	1395.600729	1528.373799	31.15345768	180.6158797	2562.557332	10265.05905	16743.33975	474.7827484	1218.583953	5735.232526	15511.20134	1985.443934	0	11.49387192	0.389622777	15.3461741	496.3794179	0.201923343	0	22.20849829	36.23491826											3200	$200 Copay / Day to 3 days	$200 Copay / Day to 3 days	Various Copays	0	$75 Copay	0	0	$50 Copay	$150 Copay	Various Copays	CT $50; MRI $50 Copay	$30 Copay	0	$10 Copay	$10 Copay / Visit	$30 Copay / Visit	$30 Copay / Visit	$10 Copay / Visit	Various Copays	Various Copays	Various Copays		Various Copays	Various Copays	$30 Copay / Visit	Various Copays	$30 Copay / Visit	Various Copays	Various Copays	$15 Copay											225.8667111	311.2738222	5.37109375	0	16.80732277	0.00014081	0	47.37063516	92.4645679	0.02258836	7.4193157	0.952380952	0	2.925612562	5.315157262	12.68130842	27.9468636	3.139621505	0.892988019	0.055465204	0.000853095		13.62711864	0	51.05631579	0.015698587	34.8	0	0	0.215053763											NO	225.8667111	311.2738222	5.37109375	0	16.80732277	0.00014081	0	47.37063516	92.4645679	0.02258836	7.4193157	0.952380952	0	2.925612562	5.315157262	12.68130842	27.9468636	3.139621505	0.892988019	0.055465204	0.000853095	0	13.62711864	0	51.05631579	0.015698587	34.8	0	0	0.215053763												6.4105	0.13185806	0.371188913	0	1.003376344	4.40E-05	0	1.486750606	2.083300228	0.002627028	0.94495731	0.002472497	0	0.62475416	4.546700262	17.69395462	1.105724059	0.318824365	0.426791161	0.071694329	0.000141148	0	0.013052363	0	0.065293259	0.000649371	0.000585578	0	0	0.000649371	0	0	0	0	0	0	0	0	0	0	37.3059		0.02	6.4105	0.13185806	0.371188913	0	1.003376344	4.40E-05	0	1.486750606	2.083300228	0.002627028	0.94495731	0.002472497	0	0.62475416	4.546700262	17.69395462	1.105724059	0.318824365	0.426791161	0.071694329	0.000141148	0	0.013052363	0	0.065293259	0.000649371	0.000585578	0	0	0.000649371	0	0	0	0	0	0	0	0	0	0	37.3059	YES																																									3200																																									0			6.4105	0.13185806	0.371188913	0	1.003376344	4.40E-05	0	1.486750606	2.083300228	0.002627028	0.94495731	0.002472497	0	0.62475416	4.546700262	17.69395462	1.105724059	0.318824365	0.426791161	0.071694329	0.000141148	0	0.013052363	0	0.065293259	0.000649371	0.000585578	0	0	0.000649371	0	0	0	0	0	0	0	0	0	0	37.3059
H3251_023_0	2010	5	N/A																															A	A	A	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	P	P	O	V	T	V	P	P	P	P	O	O																																																			0	YES	242.8149485	3.442719965	649.8894113	1514.082196	514.6752149	2362.53259	20.25911481	316.5989311	208.1233373	1127.822569	1107.39393	17.81004828	69.75918698	1929.838687	7912.313965	12873.50616	272.5594952	1311.639647	4502.327733	11632.69196	1354.480804		4.983098416	0.540801378	12.00890637	464.0653753	0.248460132	0.11588601	17.6561444	57.95058419											3200	$0 Copay / Adm	$0 Copay / Adm	Various Copays	0	$50 Copay	0	0	$50 Copay	$50 Copay	Various Copays	CT $50; MRI $50 Copay	Various Copays	0	Various Copays	$5 Copay / Visit	$20 Copay / Visit	$20 Copay / Visit	$5 Copay / Visit	Various Copays	Various Copays	Various Copays		Various Copays	Various Copays	$30 Copay / Visit	Various Copays	$30 Copay / Visit	Various Copays	Various Copays	"$50 Outpatient, + Other Copays"											0	0	4.055275901	0.001582671	12.73015858	0.000480075	0	47.6218787	24.51361592	0.014534814	6.500503044	0.969714038	0	2.863722091	1.731152487	5.048191649	27.43716718	1.572919728	0.953688982	0.05038031	0.001715618		13.20943784	0	27.13559827	0.01662283	11.88225088	3.667708741	0	0.318511549											NO	0	0	4.055275901	0.001582671	12.73015858	0.000480075	0	47.6218787	24.51361592	0.014534814	6.500503044	0.969714038	0	2.863722091	1.731152487	5.048191649	27.43716718	1.572919728	0.953688982	0.05038031	0.001715618	0	13.20943784	0	27.13559827	0.01662283	11.88225088	3.667708741	0	0.318511549												0	0	0.219623406	0.000199691	0.545991425	9.45E-05	0	1.256419658	0.42515463	0.001366058	0.599884801	0.001439221	0	0.460543473	1.141451833	5.415660525	0.62318837	0.171925323	0.357818363	0.048838219	0.000193648	0	0.005485327	0	0.027155738	0.00064284	0.000246022	3.54E-05	0	0.001538161	0	0	0	0	0	0	0	0	0	0	11.3049		0	0	0	0.219623406	0.000199691	0.545991425	9.45E-05	0	1.256419658	0.42515463	0.001366058	0.599884801	0.001439221	0	0.460543473	1.141451833	5.415660525	0.62318837	0.171925323	0.357818363	0.048838219	0.000193648	0	0.005485327	0	0.027155738	0.00064284	0.000246022	3.54E-05	0	0.001538161	0	0	0	0	0	0	0	0	0	0	11.3049	YES																																									3200																																									0			0	0	0.219623406	0.000199691	0.545991425	9.45E-05	0	1.256419658	0.42515463	0.001366058	0.599884801	0.001439221	0	0.460543473	1.141451833	5.415660525	0.62318837	0.171925323	0.357818363	0.048838219	0.000193648	0	0.005485327	0	0.027155738	0.00064284	0.000246022	3.54E-05	0	0.001538161	0	0	0	0	0	0	0	0	0	0	11.3049
H3251_804_0	2010	5	N/A																															A	A	D	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	P	P	O	V	T	V	P	P	P	P	O	O																																																			0	YES	204.7425058	4.696726982	484.5326381	1030.930743	403.2283301	2017.860441	20.62549003	245.3540561	205.6039576	1321.166831	1203.802121	23.98694804	116.336698	1957.848966	8116.221202	12645.44869	202.4663312	1407.69761	4453.563525	12105.01665	1490.583733		15.72100976	1.279617073	9.663275223	562.3003025	0.37895197	0.731209756	24.12992196	31.07641464											3200	$400 Copay / Day to 3 days	$400 Copay / Day to 3 days	Various Copays	0	$150 Copay	0	0	$50 Copay	$300 Copay	Various Copays	CT $100; MRI $100 Copay	Various Copays	0	Various Copays	$30 Copay / Visit	$60 Copay / Visit	$60 Copay / Visit	$30 Copay / Visit	Various Copays	Various Copays	Various Copays		Various Copays	Various Copays	$30 Copay / Visit	Various Copays	$30 Copay / Visit	Various Copays	Various Copays	"$50 Outpatient, + Other Copays"											230.3058286	240.6587971	0.255087209	0.003334445	42.17908781	0.005754685	0	46.37207402	405.418075	0.010374789	12.57870766	2.142857143	0	3.190776232	4.279108249	12.35803109	27.88676976	9.865818609	0.906903218	0.050492291	0.004766919		0	90.85714286	0	0.328348505	17.085	3.75	0.303030303	0											NO	230.3058286	240.6587971	0.255087209	0.003334445	42.17908781	0.005754685	0	46.37207402	405.418075	0.010374789	12.57870766	2.142857143	0	3.190776232	4.279108249	12.35803109	27.88676976	9.865818609	0.906903218	0.050492291	0.004766919	0	0	90.85714286	0	0.328348505	17.085	3.75	0.303030303	0												3.9294	0.094192389	0.01029984	0.000286465	1.417316928	0.000967679	0	0.948131371	6.946296725	0.001142236	1.261856247	0.004283384	0	0.520588162	2.894182424	13.02273734	0.470510997	1.157340773	0.336579258	0.050934169	0.000592124	0	0	0.009688529	0	0.015385872	0.000539533	0.000228503	0.000609341	0	0	0	0	0	0	0	0	0	0	0	33.0941		0.5	3.9294	0.094192389	0.01029984	0.000286465	1.417316928	0.000967679	0	0.948131371	6.946296725	0.001142236	1.261856247	0.004283384	0	0.520588162	2.894182424	13.02273734	0.470510997	1.157340773	0.336579258	0.050934169	0.000592124	0	0	0.009688529	0	0.015385872	0.000539533	0.000228503	0.000609341	0	0	0	0	0	0	0	0	0	0	0	33.0941	YES																																									3200																																									0			3.9294	0.094192389	0.01029984	0.000286465	1.417316928	0.000967679	0	0.948131371	6.946296725	0.001142236	1.261856247	0.004283384	0	0.520588162	2.894182424	13.02273734	0.470510997	1.157340773	0.336579258	0.050934169	0.000592124	0	0	0.009688529	0	0.015385872	0.000539533	0.000228503	0.000609341	0	0	0	0	0	0	0	0	0	0	0	33.0941
H3251_805_0	2010	6	N/A																															A	A	D	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	P	P	O	V	T	V	P	P	P	P	O	O																																																			0	YES	204.7425058	4.696726982	484.5326381	1030.930743	403.2283301	2017.860441	20.62549003	245.3540561	205.6039576	1321.166831	1203.802121	23.98694804	116.336698	1957.848966	8116.221202	12645.44869	202.4663312	1407.69761	4453.563525	12105.01665	1490.583733		15.72100976	1.279617073	9.663275223	562.3003025	0.37895197	0.731209756	24.12992196	31.07641464											3200	$400 Copay / Day to 3 days	$400 Copay / Day to 3 days	Various Copays	0	$150 Copay	0	0	$50 Copay	$300 Copay	Various Copays	CT $100; MRI $100 Copay	Various Copays	0	Various Copays	$30 Copay / Visit	$60 Copay / Visit	$60 Copay / Visit	$30 Copay / Visit	Various Copays	Various Copays	Various Copays		Various Copays	Various Copays	$30 Copay / Visit	Various Copays	$30 Copay / Visit	Various Copays	Various Copays	"$50 Outpatient, + Other Copays"											230.3058286	240.6587971	0.255087209	0.003334445	42.17908781	0.005754685	0	46.37207402	405.418075	0.010374789	12.57870766	2.142857143	0	3.190776232	4.279108249	12.35803109	27.88676976	9.865818609	0.906903218	0.050492291	0.004766919		0	90.85714286	0	0.328348505	17.085	3.75	0.303030303	0											NO	230.3058286	240.6587971	0.255087209	0.003334445	42.17908781	0.005754685	0	46.37207402	405.418075	0.010374789	12.57870766	2.142857143	0	3.190776232	4.279108249	12.35803109	27.88676976	9.865818609	0.906903218	0.050492291	0.004766919	0	0	90.85714286	0	0.328348505	17.085	3.75	0.303030303	0												3.9294	0.094192389	0.01029984	0.000286465	1.417316928	0.000967679	0	0.948131371	6.946296725	0.001142236	1.261856247	0.004283384	0	0.520588162	2.894182424	13.02273734	0.470510997	1.157340773	0.336579258	0.050934169	0.000592124	0	0	0.009688529	0	0.015385872	0.000539533	0.000228503	0.000609341	0	0	0	0	0	0	0	0	0	0	0	33.0941		0.5	3.9294	0.094192389	0.01029984	0.000286465	1.417316928	0.000967679	0	0.948131371	6.946296725	0.001142236	1.261856247	0.004283384	0	0.520588162	2.894182424	13.02273734	0.470510997	1.157340773	0.336579258	0.050934169	0.000592124	0	0	0.009688529	0	0.015385872	0.000539533	0.000228503	0.000609341	0	0	0	0	0	0	0	0	0	0	0	33.0941	YES																																									3200																																									0			3.9294	0.094192389	0.01029984	0.000286465	1.417316928	0.000967679	0	0.948131371	6.946296725	0.001142236	1.261856247	0.004283384	0	0.520588162	2.894182424	13.02273734	0.470510997	1.157340773	0.336579258	0.050934169	0.000592124	0	0	0.009688529	0	0.015385872	0.000539533	0.000228503	0.000609341	0	0	0	0	0	0	0	0	0	0	0	33.0941
H3305_007_0	2010	4	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	311.5612937	4.695724095	2173.667621	66.78940437	268.1123232	8.62031582	3.30232463	287.5418094	46.83953407		519.9516356	44.12142916		35.72489148	4192.003261	5137.958736	100.2272951	696.8279209		9.229339869	19.62083398				3.972990157		2.224874488			0.25											3400	$300 per stay/$900 max	$300 per stay/$900 max	$0 days 1-15; $65/day days 16-100	"$0 days 1-20, $25 days 21+"	$50 Copay	20.00%	20.00%	$50 ER Copay;$25 UC Copay	20.0% for OP Surgery and Cardiac Cath.;$75 for ASC	$0 Copay	"$25 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$0 Copay for Preventive Services	$25 Copay	$25 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts	$25 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 Copay	$100 allowance	$25 exam	No coverage	No Cost Sharing	50.0% for Accupuncture											281.1217009	292.4791086	29.81552011	5.389854392	50	0.2	0.2	47.32093664	0.167719465		25	25		25	15.00056412	25	25	25		29.53822173	0.112983112				25		25			0.5											NO	250.7499319	260.8803104	26.59431704	4.807546403	44.59811021	0.178392441	0.178392441	42.20848695	0.149599423		22.2990551	22.2990551		22.2990551	13.37993624	22.2990551	22.2990551	22.2990551		26.34697736	0.100776665				22.2990551		22.2990551			0.5												6.5103	0.102085163	4.817267154	0.026757763	0.996441911	1.53779918	0.589109751	1.011392059	7.007167285	0	0.966202514	0.081988848	0	0.066385944	4.674061362	9.547635415	0.186247831	1.294883684	0	0.020263767	1.97732222	0	0	0	0.007382827	0	0.004134383	0	0	0.125	0	0	0	0	0	0	0	0	0	0	41.5499	0	5.017533889	6.5103	0.102085163	4.817267154	0.026757763	0.996441911	1.53779918	0.589109751	1.011392059	7.007167285	0	0.966202514	0.081988848	0	0.066385944	4.674061362	9.547635415	0.186247831	1.294883684	0	0.020263767	1.97732222	0	0	0	0.007382827	0	0.004134383	0	0	0.125	0	0	0	0	0	0	0	0	0	0	41.5499	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									0.056											0.056	0	0	6.5103	0.102085163	4.817267154	0.026757763	0.996441911	1.53779918	0.589109751	1.011392059	7.007167285	0	0.966202514	0.081988848	0	0.066385944	4.674061362	9.547635415	0.186247831	1.294883684	0	0.020263767	1.97732222	0	0	0	0.007382827	0	0.004134383	0	0	0.180963139	0	0	0	0	0	0	0	0	0	0	41.6058
H3305_011_0	2010	8	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	266.9498158	3.89381606	1820.426002	87.68284644	246.9100452	9.712866675	4.354357963	284.5997834	44.421256		477.778751	47.68096258		74.23499458	3994.36675	4914.045259	212.2536005	851.3754809		8.029594966	22.16749762				4.668166601		3.534468998			0.25											3400	$300 per stay/$900 max	$300 per stay/$900 max	$0 days 1-15; $65/day days 16-100	"$0 days 1-20, $25 days 21+"	$50 Copay	20.00%	20.00%	$50 ER Copay;$25 UC Copay	20.0% for OP Surgery and Cardiac Cath.;$75 for ASC	$0 Copay	"$25 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$0 Copay for Preventive Services	$25 Copay	$25 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts	$25 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 Copay	$100 allowance	$25 exam Copay	No coverage	No Cost Sharing	50.0% for Accupuncture											281.1217009	292.4791086	29.81552011	5.389854392	50	0.2	0.2	46.96367764	0.170343411		25	25		25	15	25	25	25		30.54951423	0.102003578				25		25			0.5											NO	252.8587543	263.0743299	26.81797688	4.847978165	44.97318306	0.179892732	0.179892732	42.24212143	0.153217709		22.48659153	22.48659153		22.48659153	13.49195492	22.48659153	22.48659153	22.48659153		27.47817791	0.091748512				22.48659153		22.48659153			0.5												5.625	0.085363588	4.068345203	0.03542371	0.925360889	1.747274124	0.783317351	1.001841551	6.806123055	0	0.895301301	0.089348527	0	0.139107667	4.490984676	9.208344042	0.397738335	1.595377723	0	0.018386553	2.033834915	0	0	0	0.008747596	0	0.00662318	0	0	0.125	0	0	0	0	0	0	0	0	0	0	40.0869	0	4.466686836	5.625	0.085363588	4.068345203	0.03542371	0.925360889	1.747274124	0.783317351	1.001841551	6.806123055	0	0.895301301	0.089348527	0	0.139107667	4.490984676	9.208344042	0.397738335	1.595377723	0	0.018386553	2.033834915	0	0	0	0.008747596	0	0.00662318	0	0	0.125	0	0	0	0	0	0	0	0	0	0	40.0869	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									0.0795											0.0795	0	0	5.625	0.085363588	4.068345203	0.03542371	0.925360889	1.747274124	0.783317351	1.001841551	6.806123055	0	0.895301301	0.089348527	0	0.139107667	4.490984676	9.208344042	0.397738335	1.595377723	0	0.018386553	2.033834915	0	0	0	0.008747596	0	0.00662318	0	0	0.204463117	0	0	0	0	0	0	0	0	0	0	40.1664
H3305_015_0	2010	10	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	269.7213255	3.934242195	1896.212284	91.33317713	244.3303692	9.913126328	4.444136012	296.4479768	44.95689576		497.6691915	49.66597205		77.32547682	4002.358948	4968.091774	216.1783233	886.8191529		8.363875595	22.62454656				4.508651688		3.463167238			0.25											3400	$500 per stay/$1500 max per yr	$500 per stay/$1500 max	$0 days 1-15; $65/day days 16-100	"$0 days 1-20, $40 days 21+"	$75 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	20.0% for OP Surgery and Cardiac Cath.;$150 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$0 Copay for Preventive Services	$40 Copay	$40 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts	$40 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$40 Copay	No coverage	$40 Copay	No coverage	No Cost Sharing	50.0% for Accupuncture											468.5361681	487.4651811	29.81552011	8.623767027	75	0.2	0.2	48.78547106	0.185749904		40	40		40	19.95670961	40	40	40		29.93323096	0.136017786				40		40			0.5											NO	392.559436	408.4189644	24.98070492	7.225357082	62.83817495	0.167568467	0.167568467	40.87453287	0.155629133		33.5136933	33.5136933		33.5136933	16.75684665	33.5136933	33.5136933	33.5136933		25.07932805	0.113961459				33.5136933		33.5136933			0.5												8.8235	0.133901594	3.947393294	0.054992902	1.279439541	1.661127377	0.744697057	1.009764381	6.996602716	0	1.389894388	0.138707513	0	0.215955193	5.588909595	13.87492534	0.603744502	2.476715426	0	0.017480032	2.578326344	0	0	0	0.012591797	0	0.00967196	0	0	0.125	0	0	0	0	0	0	0	0	0	0	51.6833	0	9.96425934	8.8235	0.133901594	3.947393294	0.054992902	1.279439541	1.661127377	0.744697057	1.009764381	6.996602716	0	1.389894388	0.138707513	0	0.215955193	5.588909595	13.87492534	0.603744502	2.476715426	0	0.017480032	2.578326344	0	0	0	0.012591797	0	0.00967196	0	0	0.125	0	0	0	0	0	0	0	0	0	0	51.6833	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									0.0773											0.0773	0	0	8.8235	0.133901594	3.947393294	0.054992902	1.279439541	1.661127377	0.744697057	1.009764381	6.996602716	0	1.389894388	0.138707513	0	0.215955193	5.588909595	13.87492534	0.603744502	2.476715426	0	0.017480032	2.578326344	0	0	0	0.012591797	0	0.00967196	0	0	0.202267777	0	0	0	0	0	0	0	0	0	0	51.7606
H3305_801_0	2010	4	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	238.050201	3.760666682	1284.450376	63.0345221	188.8529681	7.909648949	3.960483533	225.7161278			342.1902173	44.15357643		57.85641049	4097.639782	5447.989738	249.6158825	997.3271905		8.869806721	21.12767929				2.729133056					0.25											4000	$500 per stay/$1500 max	$500 per stay/$1500 max	$0 days 1-15; $65/day days 16-100	"$0 days 1-20, $40 days 21+"	$75 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	0.0% for OP Surgery and Cardiac Cath.;$0 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$0 Copay for Preventive Services	$40 Copay	$40 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts	$40 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$40 Copay	No Coverage	$40 Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture											468.5361681	487.4651811	29.81552011	8.623767027	75	0.2	0.2	48.9376054			40	40		40	19.96937604	40	40	40		27.15611692	0.119300953				40					0.5											NO	424.6128141	441.7673093	27.02043676	7.815324054	67.96905601	0.181250816	0.181250816	44.34990456			36.25016321	36.25016321		36.25016321	18.11074922	36.25016321	36.25016321	36.25016321		24.61034176	0.108116975				36.25016321					0.5												8.4233	0.138444967	2.892200847	0.041052935	1.069679831	1.433630327	0.717840872	0.834207394	0	0	1.033704269	0.133381196	0	0.17477536	6.184277208	16.4575431	0.754051373	3.012772786	0	0.018190748	2.284260777	0	0	0	0.008244293	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	0	45.7365	0	4.713149896	8.4233	0.138444967	2.892200847	0.041052935	1.069679831	1.433630327	0.717840872	0.834207394	0	0	1.033704269	0.133381196	0	0.17477536	6.184277208	16.4575431	0.754051373	3.012772786	0	0.018190748	2.284260777	0	0	0	0.008244293	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	0	45.7365	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									0.0454											0.0454	0	0	8.4233	0.138444967	2.892200847	0.041052935	1.069679831	1.433630327	0.717840872	0.834207394	0	0	1.033704269	0.133381196	0	0.17477536	6.184277208	16.4575431	0.754051373	3.012772786	0	0.018190748	2.284260777	0	0	0	0.008244293	0	0	0	0	0.170377967	0	0	0	0	0	0	0	0	0	0	45.7819
H3305_803_0	2010	3	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	265.6451164	4.131339291	1833.46208	77.80498388	237.1326512	9.054596713	4.562192819	264.4391668			352.0001432	48.70074049		48.64498693	4228.555274	5696.773581	187.7508502	995.0406688		7.578717308	21.14149433				4.856523495					0.25											4000	$500 per stay/$1500 max	$500 per stay/$1500 max	$0 days 1-15; $65/day days 16-100	"$0 days 1-20, $40 days 21+"	$75 Copay	20.00%	20.00%	$50 ER Copay;$40 UC Copay	0.0% for OP Surgery and Cardiac Cath.;$0 for ASC	$0 Copay	"$40 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$40 Copay	$0 Copay	"$40 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$20 Copay for Office Visits;$0 Copay for Preventive Services;$40 Copay for PCP Ophthalmology Services	$40 Copay for Office Visits;$0 Copay for Preventive Services	$40 Copay	$40 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts	$40 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$40 Copay	No Coverage	$40 Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture											468.5361681	487.4651811	29.81552011	8.623767027	75	0.2	0.2	48.65591398			40	40		40	19.95923762	40	40	40		29.83049529	0.14649878				40					0.5											NO	417.3726845	434.2346761	26.55970769	7.682063924	66.81010659	0.178160284	0.178160284	43.34275732			35.63205685	35.63205685		35.63205685	17.80307611	35.63205685	35.63205685	35.63205685		26.5730476	0.130501321				35.63205685					0.5												9.2394	0.149497565	4.058018076	0.049808572	1.320238142	1.613169524	0.812801569	0.955126886	0	0	1.045207426	0.144608963	0	0.144443412	6.273440949	16.91564667	0.557495747	2.95461214	0	0.016782468	2.758992944	0	0	0	0.01442066	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	0	49.1487	0	6.000316443	9.2394	0.149497565	4.058018076	0.049808572	1.320238142	1.613169524	0.812801569	0.955126886	0	0	1.045207426	0.144608963	0	0.144443412	6.273440949	16.91564667	0.557495747	2.95461214	0	0.016782468	2.758992944	0	0	0	0.01442066	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	0	49.1487	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									0.0727											0.0727	0	0	9.2394	0.149497565	4.058018076	0.049808572	1.320238142	1.613169524	0.812801569	0.955126886	0	0	1.045207426	0.144608963	0	0.144443412	6.273440949	16.91564667	0.557495747	2.95461214	0	0.016782468	2.758992944	0	0	0	0.01442066	0	0	0	0	0.197654906	0	0	0	0	0	0	0	0	0	0	49.2214
H3307_002_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2104.553633	100.2041724	2031.986366	3687.195042	240.8317449	0.434207586	6.230935972	176.3885569	468.5078136	6332.216046	49.77193647	0	0.296228029	308.7611248	5976.262655	7358.331593	605.9785396	924.8399544	0	0	42.77142389	2712.596914	0	0	78.25815829	63.92757375	33.57940952	19.5379312	12.03438867	0												"$125 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$85 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$190 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $190 (9a); $40 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a3, 16a4); $0 n/c (16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0/$35 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											96.46173776	75.43603488	40.31162921	0	150	0.2	0.088181993	49.95627386	190	3	0.163961746	0	0.2	73.2421723	10.17709279	34.98928309	40	35	0	0	0.2	34.64927813	0	0	0	0	0	0	0	0											NO	96.46173776	75.43603488	40.31162921	0	150	0.2	0.088181993	49.95627386	190	3	0.163961746	0	0.2	73.2421723	10.17709279	34.98928309	40	35	0	0	0.2	34.64927813	0	0	0	0	0	0	0	0												16.9174	0.62991712	6.826056743	0	3.010396812	0.086841517	0.54945635	0.734309588	7.418040382	1.583054012	8.160693617	0	0.059245606	1.884527959	5.068414964	21.45522893	2.019928465	2.697449867	0	0	8.554284779	7.83246041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4877	0	0	16.9174	0.62991712	6.826056743	0	3.010396812	0.086841517	0.54945635	0.734309588	7.418040382	1.583054012	8.160693617	0	0.059245606	1.884527959	5.068414964	21.45522893	2.019928465	2.697449867	0	0	8.554284779	7.83246041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4877	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.9174	0.62991712	6.826056743	0	3.010396812	0.086841517	0.54945635	0.734309588	7.418040382	1.583054012	8.160693617	0	0.059245606	1.884527959	5.068414964	21.45522893	2.019928465	2.697449867	0	0	8.554284779	7.83246041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4877
H3307_011_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	O	Coin	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	O	O											22.524	2.4477	0	0	1.8477	0.1673	0.8857	0	14.2664	0	0	0	0.0219	2.633	0	0	0	0	0	0	14.0241	0	0	0	0	0	0	0	0	0											58.8177	NO	1632.607975	131.5230124	1322.586232	2770.570724	166.7600324	27.92568601	712.3119514	179.4740914	474.8397273	6398.237015	59.5946925	0	6.477361955	354.3968613	6155.035759	6526.519171	713.4765036	1156.685698	0	0	1571.62289	2663.664793	0	0	81.28507292	62.65699882	33.02099365	18.46736833	19.28922601	0												"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$90 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$0 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$35 (3, 9d); $0 (5, 9a); $40 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a3, 16a4); $0 n/c (16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0/$35 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	42.68290151	0	0	0	0	49.96149436	0	3	0.163997294	0	0	2.147916412	13.01972339	34.98822264	40	35	0	0	0	34.69357336	0	0	0	0	0	0	0	0											NO	0	0	42.68290151	0	0	0	0	49.96149436	0	3	0.163997294	0	0	2.147916412	13.01972339	34.98822264	40	35	0	0	0	34.69357336	0	0	0	0	0	0	0	0												0	0	4.704318158	0	0	0	0	0.747232817	0	1.599559254	9.773368285	0	0	0.06343457	6.678071922	19.02927548	2.378255012	3.373666619	0	0	0	7.701004158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0482	2750	0	22.524	2.447670474	4.704318158	0	1.847695417	0.16726002	0.885721588	0.747232817	14.2664162	1.599559254	9.773368285	0	0.02188195	2.696389837	6.678071922	19.02927548	2.378255012	3.373666619	0	0	14.02409891	7.701004158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.8658	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.524	2.447670474	4.704318158	0	1.847695417	0.16726002	0.885721588	0.747232817	14.2664162	1.599559254	9.773368285	0	0.02188195	2.696389837	6.678071922	19.02927548	2.378255012	3.373666619	0	0	14.02409891	7.701004158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.8658
H3307_012_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1636.070388	114.5852719	876.4328104	1998.936696	173.8585149	0.299043048	5.37132796	274.8302292	726.6680421	7098.996106	42.85113175	0	0.095261388	358.7812526	5662.409166	5430.89852	579.9678031	716.7198216	0	0	33.73066508	1990.597906	0	42.56390883	90.78238088	56.44575841	31.40052992	16.94251225	22.42770498	0												"$150 Days 1-12 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$80 Days 11-42 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $125 (9a); $40 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a3, 16a4); $0 n/c (16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0/$35 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											128.98185	109.1967357	37.65398486	0	150	0.2	0.060731477	49.97685518	125	3	0.163862154	0	0.2	47.94884689	12.94153853	34.99620431	40	35	0	0	0.2	34.6362922	0	0	0	0	0	0	0	0											NO	128.98185	109.1967357	37.65398486	0	150	0.2	0.060731477	49.97685518	125	3	0.163862154	0	0.2	47.94884689	12.94153853	34.99620431	40	35	0	0	0.2	34.6362922	0	0	0	0	0	0	0	0												17.5853	1.042694804	2.750098981	0	2.173231436	0.05980861	0.326208678	1.144595881	7.569458772	1.774749027	7.021678742	0	0.019052278	1.433595612	6.106690533	15.83840285	1.93322601	2.090432813	0	0	6.746133016	5.74557756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3609	0	0	17.5853	1.042694804	2.750098981	0	2.173231436	0.05980861	0.326208678	1.144595881	7.569458772	1.774749027	7.021678742	0	0.019052278	1.433595612	6.106690533	15.83840285	1.93322601	2.090432813	0	0	6.746133016	5.74557756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3609	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.5853	1.042694804	2.750098981	0	2.173231436	0.05980861	0.326208678	1.144595881	7.569458772	1.774749027	7.021678742	0	0.019052278	1.433595612	6.106690533	15.83840285	1.93322601	2.090432813	0	0	6.746133016	5.74557756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3609
H3307_015_0	2010	4	N/A																															D	D	D	V	T	O	O	V	V	O	O	V	O	O	V	V	Coin	V	V	V	S	O	T	V	P	P	P	P	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	NO	932.0865328	76.67587449	782.3555503	1778.405931	101.6855558	10.82641829	951.1687419	68.18268117	309.1555787	5564.245258	3263.136072	0	2.757847378	144.9506744	8120.528638	7848.60569	4.705504141	4955.459922	0	0	1906.049626	3000.722424	0	0	71.29454883	61.94298286	32.39559984	22.63439946	315.030368	720.8953546												"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$0 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$10 (3, 9c, 9d); $0 (5, 9a)"	"$5 (7a); $10 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$10 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"50% (7e, 7h)"	$10 (7c); $15 (7i)	Included in h.2.	$5 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $10 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$10/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0/$10 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$5 (13b); $0 n/c (13c, 13d, 13e)"											0	0	0	0	0	0	0	49.88766819	0	0	0	0	0	0.938439671	3.168413797	10	0.5	14.64387956	0	0	0	9.763187356	0	0	0	0	0	0	0	5											NO	0	0	0	0	0	0	0	49.88766819	0	0	0	0	0	0.938439671	3.168413797	10	0.5	14.64387956	0	0	0	9.763187356	0	0	0	0	0	0	0	5												0	0	0	0	0	0	0	0.283456248	0	0	0	0	0	0.011335622	2.144099581	6.540504742	2.352752071	6.047263188	0	0	0	2.441384602	0	0	0	0	0	0	0	0.300373064	0	0	0	0	0	0	0	0	0	0	20.1212	0	0	0	0	0	0	0	0	0	0.283456248	0	0	0	0	0	0.011335622	2.144099581	6.540504742	2.352752071	6.047263188	0	0	0	2.441384602	0	0	0	0	0	0	0	0.300373064	0	0	0	0	0	0	0	0	0	0	20.1212	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0.283456248	0	0	0	0	0	0.011335622	2.144099581	6.540504742	2.352752071	6.047263188	0	0	0	2.441384602	0	0	0	0	0	0	0	0.300373064	0	0	0	0	0	0	0	0	0	0	20.1212
H3307_018_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2017.955125	110.2980064	1932.759276	3889.995848	227.1979043	0.536623018	3.186940623	187.4145729	582.7298868	7092.563869	65.21479846	0	0.569493238	377.9383484	6806.924978	8593.910927	544.562323	1292.288883	0	0	42.20264753	3288.681575	0	0	80.92864306	64.34351379	33.8474726	18.8155718	9.481789326	0												"$125 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$110 Days 15-40 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$190 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $190 (9a); $40 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a3, 16a4); $0 n/c (16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0/$30 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											96.46173776	75.43603488	38.83894234	0	150	0.2	0.184035039	49.95255721	190	3	0.164392587	0	0.2	73.31030194	10.09758129	29.99433544	40	30	0	0	0.2	29.68590561	0	0	0	0	0	0	0	0											NO	96.46173776	75.43603488	38.83894234	0	150	0.2	0.184035039	49.95255721	190	3	0.164392587	0	0.2	73.31030194	10.09758129	29.99433544	40	30	0	0	0.2	29.68590561	0	0	0	0	0	0	0	0												16.2213	0.693370355	6.255527172	0	2.839973804	0.107324604	0.586508742	0.780153098	9.226556541	1.773140967	10.72082941	0	0.113898648	2.30889787	5.727789859	21.48072059	1.815207743	3.230722208	0	0	8.440529507	8.135624234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4581	0	0	16.2213	0.693370355	6.255527172	0	2.839973804	0.107324604	0.586508742	0.780153098	9.226556541	1.773140967	10.72082941	0	0.113898648	2.30889787	5.727789859	21.48072059	1.815207743	3.230722208	0	0	8.440529507	8.135624234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4581	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.2213	0.693370355	6.255527172	0	2.839973804	0.107324604	0.586508742	0.780153098	9.226556541	1.773140967	10.72082941	0	0.113898648	2.30889787	5.727789859	21.48072059	1.815207743	3.230722208	0	0	8.440529507	8.135624234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.4581
H3307_020_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.1585	0.0062	0.1038	0	0.6874	0	0.7015	0	0.0028	0.1427	0.3545	2.2423	0.1201	0.1481	0	0	0.5543	0.1741	0	0	0	0	0	0	0	0											5.3963	NO	472.8426655	22.1776243	55.02709796	6527.206199	14.00222503	0.543958789	9.161987825	12.16519843	60.61248107	17.25694678	61.64190355	0	0.246568918	12.61606621	35.31483455	197.0095339	10.83395437	13.09165991	0	0	48.5913274	15.87763133	675.7547261	174.9722059	96.43637203	42.79515364	0	0	79.64252129	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.060828308	0.061567114	0.144638709	0	0.197726532	0.197726532	0.197726532	0.099869635	0.197726532	0	0.161998446	0	0.197726532	0.145577659	0.145378144	0.197643011	0.197726532	0	0	0	0.197726532	0.19599302	0	0	0	0	0	0	0	0											NO	0.060828308	0.061567114	0.144638709	0	0.197726532	0.197726532	0.197726532	0.099869635	0.197726532	0	0.161998446	0	0.197726532	0.145577659	0.145378144	0.197643011	0.197726532	0	0	0	0.197726532	0.19599302	0	0	0	0	0	0	0	0												28.7622	1.365412319	7.959048403	0	2.768611394	0.107555085	1.811568079	1.214933922	11.98469568	0	9.985892567	0	0.048753217	1.836617389	5.134005088	38.93755738	2.142160224	0	0	0	9.60779465	3.111904918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.7787	146	0	28.7622	1.365412319	7.959048403	0	2.927082237	0.113743594	1.915401956	1.214933922	12.67211526	0	10.68738971	0	0.051595134	1.97934221	5.488489787	41.17980935	2.262218687	0.148144647	0	0	10.16208129	3.285986059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.175	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	28.7622	1.365412319	7.959048403	0	2.927082237	0.113743594	1.915401956	1.214933922	12.67211526	0	10.68738971	0	0.051595134	1.97934221	5.488489787	41.17980935	2.262218687	0.148144647	0	0	10.16208129	3.285986059	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.175
H3307_021_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	Coin	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1945.464804	73.59364404	1861.620719	3537.081191	229.3993491	0.313265041	9.873603555	183.2483418	557.8945637	6926.150807	60.90817228	0	0.20338833	351.8195182	6288.18919	7719.804834	4.843523315	1105.244224	0	0	51.93146135	2779.40928	0	0	0	0	17.57146906	4.829442793	292.7437684	0												"$100 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$100 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$100 Days 11-33 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$75 (10a)	10% (11a)	"10% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$100 (9b)	"$0 (8a1, 8a2)"	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9c, 9d); $60 (5); $100 (9a)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"50% (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"10% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0/$25 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											69.31217923	51.10808865	40.7217853	0	75	0.1	0.059497588	49.95613859	100	0	0.163989981	0	0.2	39.19154541	6.879605618	25	0.5	25	0	0	0.1	24.72586453	0	0	0	0	0	0	0	0											NO	69.31217923	51.10808865	40.7217853	0	75	0.1	0.059497588	49.95613859	100	0	0.163989981	0	0.2	39.19154541	6.879605618	25	0.5	25	0	0	0.1	24.72586453	0	0	0	0	0	0	0	0												11.237	0.313435874	6.317376602	0	1.433745932	0.031326504	0.587455598	0.762864963	4.649121364	0	9.988330042	0	0.040677666	1.149029219	3.605021807	16.08292674	2.421761658	2.302592133	0	0	5.193146135	5.726941445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8428	0	0	11.237	0.313435874	6.317376602	0	1.433745932	0.031326504	0.587455598	0.762864963	4.649121364	0	9.988330042	0	0.040677666	1.149029219	3.605021807	16.08292674	2.421761658	2.302592133	0	0	5.193146135	5.726941445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8428	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.237	0.313435874	6.317376602	0	1.433745932	0.031326504	0.587455598	0.762864963	4.649121364	0	9.988330042	0	0.040677666	1.149029219	3.605021807	16.08292674	2.421761658	2.302592133	0	0	5.193146135	5.726941445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.8428
H3307_022_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2453.02073	170.1897818	51.92004401	4297.712223	280.7081052	0.504953402	7.246147738	205.5332371	49.48324955	7380.689654	57.88132096	0	0.344492716	9.237042546	6692.53733	8621.095058	871.2780153	1077.972803	0	0	49.74020884	3161.742403	670.8283947	0	119.7907848	8.385354933	17.43389586	4.79163139	117.6642128	0												"$195 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a5, 14a6, 14a8, 14a9, 14a10); $0/$35 (14a3); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											150.4803109	117.6802144	0.144638709	0	150	0.2	0.088181993	49.95626081	0.2	3	0.163961746	0	0.2	0.152231984	10.59263063	34.9932568	40	35	0	0	0.2	34.64927813	0	0	0	0	0	0	0	0											NO	150.4803109	117.6802144	0.144638709	0	150	0.2	0.088181993	49.95626081	0.2	3	0.163961746	0	0.2	0.152231984	10.59263063	34.9932568	40	35	0	0	0.2	34.64927813	0	0	0	0	0	0	0	0												30.7609	1.668997502	7.509648131	0	3.508851315	0.10099068	0.638979746	0.855639333	9.896649911	1.845172413	9.490322458	0	0.068898543	1.406173313	5.907631328	25.14001611	2.904260051	3.144087343	0	0	9.948041767	9.129340991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9246	0	0	30.7609	1.668997502	7.509648131	0	3.508851315	0.10099068	0.638979746	0.855639333	9.896649911	1.845172413	9.490322458	0	0.068898543	1.406173313	5.907631328	25.14001611	2.904260051	3.144087343	0	0	9.948041767	9.129340991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9246	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	30.7609	1.668997502	7.509648131	0	3.508851315	0.10099068	0.638979746	0.855639333	9.896649911	1.845172413	9.490322458	0	0.068898543	1.406173313	5.907631328	25.14001611	2.904260051	3.144087343	0	0	9.948041767	9.129340991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9246
H3307_802_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	318.8896329	6.23373012	35.40501233	3242.269485	7.509748239	0.364318297	6.225051747	7.160372001	57.5226157	13.68858835	58.16751217	0	0.132937231	8.986334837	25.0471488	157.8693718	3.131730871	10.84615807	0	0	40.29476023	13.96304089	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.061620706	0.061620706	0.144880127	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061620706	0.061620706	0.144880127	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.6502	0.384126853	5.129482696	0	1.74977134	0.084886163	1.450437057	1.668366676	13.40276946	3.189441085	13.55303034	0	0.030974375	2.093816017	5.835985671	36.78356362	0.729693293	2.527154831	0	0	9.388679134	3.253388528	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.9058	0	0	19.6502	0.384126853	5.129482696	0	1.74977134	0.084886163	1.450437057	1.668366676	13.40276946	3.189441085	13.55303034	0	0.030974375	2.093816017	5.835985671	36.78356362	0.729693293	2.527154831	0	0	9.388679134	3.253388528	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.9058	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.6502	0.384126853	5.129482696	0	1.74977134	0.084886163	1.450437057	1.668366676	13.40276946	3.189441085	13.55303034	0	0.030974375	2.093816017	5.835985671	36.78356362	0.729693293	2.527154831	0	0	9.388679134	3.253388528	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.9058
H3307_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	323.3584228	6.218540337	35.9011638	3285.675094	7.614986802	0.369423706	6.312287094	7.260714546	58.32871428	13.88041467	58.98264807	0	0.13480016	9.102206912	25.39814938	160.081689	3.124099756	10.99815173	0	0	40.85943464	14.15871328	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.061567116	0.061567116	0.144638717	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061567116	0.061567116	0.144638717	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.9082	0.382857592	5.192698284	0	1.774291925	0.086075724	1.470762893	1.691746489	13.59059043	3.234136617	13.742957	0	0.031408437	2.12081421	5.917768805	37.29903355	0.727915243	2.562569352	0	0	9.520248271	3.298980194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.5531	0	0	19.9082	0.382857592	5.192698284	0	1.774291925	0.086075724	1.470762893	1.691746489	13.59059043	3.234136617	13.742957	0	0.031408437	2.12081421	5.917768805	37.29903355	0.727915243	2.562569352	0	0	9.520248271	3.298980194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.5531	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.9082	0.382857592	5.192698284	0	1.774291925	0.086075724	1.470762893	1.691746489	13.59059043	3.234136617	13.742957	0	0.031408437	2.12081421	5.917768805	37.29903355	0.727915243	2.562569352	0	0	9.520248271	3.298980194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.5531
H3307_805_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	318.2137017	6.294973722	35.32996644	3259.432297	7.493830275	0.363546074	6.211856876	7.145194588	57.40068845	13.65957347	58.04421797	0	0.132655452	8.957914156	24.99405786	157.5347455	3.167470904	10.82316812	0	0	40.20934983	13.93344427	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.061926429	0.061926429	0.146256066	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061926429	0.061926429	0.146256066	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.7058	0.389825244	5.167221921	0	1.746062454	0.084706235	1.447362652	1.664830339	13.37436041	3.182680618	13.52430279	0	0.03090872	2.087193998	5.823615481	36.7055957	0.738020721	2.521798171	0	0	9.368778511	3.246492515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8096	0	0	19.7058	0.389825244	5.167221921	0	1.746062454	0.084706235	1.447362652	1.664830339	13.37436041	3.182680618	13.52430279	0	0.03090872	2.087193998	5.823615481	36.7055957	0.738020721	2.521798171	0	0	9.368778511	3.246492515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8096	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.7058	0.389825244	5.167221921	0	1.746062454	0.084706235	1.447362652	1.664830339	13.37436041	3.182680618	13.52430279	0	0.03090872	2.087193998	5.823615481	36.7055957	0.738020721	2.521798171	0	0	9.368778511	3.246492515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8096
H3312_002_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	2238.521647	96.12837889	1497.744636	736.9310024	302.7031225	8.677731548	0	191.3553462	407.4057476	2734.459292	2664.8618	87.67455695	0.024456176	29.51251611	5830.015021	6041.510752	409.367968	584.7391716	0	0	278	0	0	0	1130.497767	0	74.6158677	0	41.52233534	0												$150/day 1-7	$150/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$15 per visit	$15 X-ray; $175 Complex Radiology	$15 per visit	$15 per visit	$15 per visit	$5 PCP visit; $15 if no PCP selected	$15 per visit	$15 per visit	$15 per visit	$15 per visit	$15 per visit	$45 per script	0	Not Covered	0	$0 per visit	$140 Every 2 Years	$0 per visit	$800 Every 3 Yrs	Coaching Only	0											108.4282617	108.4282617	52.43074037	0	100	0.2	0.2	47.5	100	2.25	20.5	15	15	15	5	15	15	15	15	15	$45 	0	0	0	0	0	0	0	0	0											NO	108.4282617	108.4282617	52.43074037	0	100	0.2	0.2	47.5	100	2.25	20.5	15	15	15	5	15	15	15	15	15	$45 	0	0	0	0	0	0	0	0	0												20.2266	0.868586085	6.543988347	0	2.522526021	1.73554631	0	0.757448245	3.395047897	0.512711117	4.552472241	0.109593196	3.06E-05	0.036890645	2.429172925	7.55188844	0.51170996	0.730923964	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5276	0	0	20.2266	0.868586085	6.543988347	0	2.522526021	1.73554631	0	0.757448245	3.395047897	0.512711117	4.552472241	0.109593196	3.06E-05	0.036890645	2.429172925	7.55188844	0.51170996	0.730923964	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5276	NO																							0	0		0		0	0																																								0	0	0											0			20.2266	0.868586085	6.543988347	0	2.522526021	1.73554631	0	0.757448245	3.395047897	0.512711117	4.552472241	0.109593196	3.06E-05	0.036890645	2.429172925	7.55188844	0.51170996	0.730923964	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5276
H3312_018_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1975.900478	8.409518547	1758.598519	714.3984941	290.1283899	8.253472694	0	221.5215589	385.3132569	3641.0223	2886.473259	80.89462165	0.341327517	574.3114586	4533.240328	6427.515329	212.5326204	602.1017409	0	0	278	0	0	0	1099.074606	0	75.09205385	0	25.59956381	0												$175/day 1-10	$175/day 1-10	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$10 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$750 Every 3 Yrs	Coaching Only	0											143.4382958	143.4382958	52.43074037	0	150	0.2	0.2	48.5	175	5.25	28.875	35	25	35	10	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	143.4382958	143.4382958	52.43074037	0	150	0.2	0.2	48.5	175	5.25	28.875	35	25	35	10	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												23.6183	0.100520584	7.683718528	0	3.626604873	1.650694539	0	0.8953163	5.619151663	1.592947256	6.945576279	0.235942646	0.000711099	1.675075088	3.777700273	18.74691971	0.619886809	1.756130078	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5877	0	0	23.6183	0.100520584	7.683718528	0	3.626604873	1.650694539	0	0.8953163	5.619151663	1.592947256	6.945576279	0.235942646	0.000711099	1.675075088	3.777700273	18.74691971	0.619886809	1.756130078	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5877	NO																							0	0		0		0	0																																								0	0	0											0			23.6183	0.100520584	7.683718528	0	3.626604873	1.650694539	0	0.8953163	5.619151663	1.592947256	6.945576279	0.235942646	0.000711099	1.675075088	3.777700273	18.74691971	0.619886809	1.756130078	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5877
H3312_025_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	2161.257982	188.5575231	1777.544731	1460.742817	314.594088	8.820446363	0	190.5317219	431.8072763	2994.926657	3145.90174	142.9666314	0.032548904	105.6187833	5595.950775	6714.972677	414.5034416	704.1956252	0	0	278	0	0	0	1079.316601	0	91.52606668	0	45.50869151	0												$150/day 1-10	$150/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$150 per procedure	$25 per visit	$25 X-ray; $175 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$10 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											122.9471107	122.9471107	47.56208437	0	150	0.2	0.2	48.5	150	3.75	24.6875	25	25	25	10	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											NO	122.9471107	122.9471107	47.56208437	0	150	0.2	0.2	48.5	150	3.75	24.6875	25	25	25	10	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0												22.1434	1.931883555	7.045311041	0	3.9324261	1.764089273	0	0.770065709	5.397590953	0.93591458	6.472037433	0.297847149	6.78E-05	0.220039132	4.663292312	13.98952641	0.863548837	1.467074219	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9366	0	0	22.1434	1.931883555	7.045311041	0	3.9324261	1.764089273	0	0.770065709	5.397590953	0.93591458	6.472037433	0.297847149	6.78E-05	0.220039132	4.663292312	13.98952641	0.863548837	1.467074219	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9366	NO																							0	0		0		0	0																																								0	0	0											0			22.1434	1.931883555	7.045311041	0	3.9324261	1.764089273	0	0.770065709	5.397590953	0.93591458	6.472037433	0.297847149	6.78E-05	0.220039132	4.663292312	13.98952641	0.863548837	1.467074219	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9366
H3312_028_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1879.537847	90.75724991	1029.847656	632.1835918	242.9888012	13.46531762	0	214.8155726	412.4321981	2770.531993	3122.273187	31.64978897	0.204641654	341.6211054	5377.975784	6651.46406	230.1654091	642.6477395	0	0	278	0	0	0	989.2300209	0	61.03032033	0	100.6198938	0												$100/day 1-7	$100/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$15 per visit	$15 X-ray; $175 Complex Radiology	$15 per visit	$15 per visit	$15 per visit	$0 PCP visit; $15 if no PCP selected	$15 per visit	$15 per visit	$15 per visit	$15 per visit	$15 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$750 Every 3 Yrs	Coaching Only	0											72.2855078	72.2855078	52.43074037	0	100	0.2	0.2	47.5	100	2.25	20.5	15	15	15	0	15	15	15	15	15	$45 	0	0	0	0	0	0	0	0	0											NO	72.2855078	72.2855078	52.43074037	0	100	0.2	0.2	47.5	100	2.25	20.5	15	15	15	0	15	15	15	15	15	$45 	0	0	0	0	0	0	0	0	0												11.3219	0.546702825	4.499639589	0	2.024906676	2.693063523	0	0.850311642	3.436934984	0.519474749	5.333883361	0.039562236	0.000255802	0.427026382	0	8.314330075	0.287706761	0.803309674	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1416	0	0	11.3219	0.546702825	4.499639589	0	2.024906676	2.693063523	0	0.850311642	3.436934984	0.519474749	5.333883361	0.039562236	0.000255802	0.427026382	0	8.314330075	0.287706761	0.803309674	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1416	NO																							0	0		0		0	0																																								0	0	0											0			11.3219	0.546702825	4.499639589	0	2.024906676	2.693063523	0	0.850311642	3.436934984	0.519474749	5.333883361	0.039562236	0.000255802	0.427026382	0	8.314330075	0.287706761	0.803309674	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1416
H3312_040_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1784.500499	55.5550399	1559.933971	783.0069243	247.9767992	10.92828151	0	237.3391477	405.8545217	2878.276649	2946.864817	138.8885601	0.188501024	139.9363496	4486.943158	6548.481589	204.2883072	667.0172315	0	0	278	0	0	0	1032.447733	0	74.72077075	0	87.05414009	0												$175/day 1-10	$175/day 1-10	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$20 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											143.4382958	143.4382958	52.43074037	0	150	0.2	0.2	48.5	175	4.5	26.78125	30	25	30	20	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											NO	143.4382958	143.4382958	52.43074037	0	150	0.2	0.2	48.5	175	4.5	26.78125	30	25	30	20	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0												21.3305	0.66406002	6.815707751	0	3.09970999	2.185656302	0	0.959245722	5.918711774	1.079353744	6.576726948	0.3472214	0.00039271	0.349840874	7.478238597	16.37120397	0.510720768	1.667543079	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3973	0	0	21.3305	0.66406002	6.815707751	0	3.09970999	2.185656302	0	0.959245722	5.918711774	1.079353744	6.576726948	0.3472214	0.00039271	0.349840874	7.478238597	16.37120397	0.510720768	1.667543079	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3973	NO																							0	0		0		0	0																																								0	0	0											0			21.3305	0.66406002	6.815707751	0	3.09970999	2.185656302	0	0.959245722	5.918711774	1.079353744	6.576726948	0.3472214	0.00039271	0.349840874	7.478238597	16.37120397	0.510720768	1.667543079	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3973
H3312_043_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1544.903673	47.48747411	1065.224947	755.6754203	210.0407895	10.67412629	0	180.965388	413.2162924	2760.592343	3063.125028	40.03324575	0.166789931	157.3312259	4873.867695	6165.566341	291.2158615	661.6218954	0	0	278	0	0	0	1053.9826	0	72.24724553	0	78.99204195	0												$175/day 1-10	$175/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$15 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											143.4382958	143.4382958	47.56208437	0	150	0.2	0.2	48.5	175	4.5	26.78125	30	25	30	15	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											NO	143.4382958	143.4382958	47.56208437	0	150	0.2	0.2	48.5	175	4.5	26.78125	30	25	30	15	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0												18.4665	0.567626863	4.222026565	0	2.625509869	2.134825258	0	0.731401776	6.026070931	1.035222129	6.836193097	0.100083114	0.000347479	0.393328065	6.092334619	15.41391585	0.728039654	1.654054739	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.07	0	0	18.4665	0.567626863	4.222026565	0	2.625509869	2.134825258	0	0.731401776	6.026070931	1.035222129	6.836193097	0.100083114	0.000347479	0.393328065	6.092334619	15.41391585	0.728039654	1.654054739	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.07	NO																							0	0		0		0	0																																								0	0	0											0			18.4665	0.567626863	4.222026565	0	2.625509869	2.134825258	0	0.731401776	6.026070931	1.035222129	6.836193097	0.100083114	0.000347479	0.393328065	6.092334619	15.41391585	0.728039654	1.654054739	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.07
H3312_044_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1958.629161	91.92441928	1376.766851	954.4265517	259.0813445	15.50149537	0	234.4631935	417.8955011	3018.254342	3329.332799	192.2730257	0.152637839	163.0737302	5353.467777	7251.638758	359.4845838	756.5496538	0	0	278	0	0	0	1034.697953	0	77.90293912	0	74.36329146	0												$75/day 1-10	$75/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$150 per procedure	$25 per visit	$25 X-ray; $175 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$10 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											61.47355533	61.47355533	47.56208437	0	150	0.2	0.2	48.5	150	3.75	24.6875	25	25	25	10	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											NO	61.47355533	61.47355533	47.56208437	0	150	0.2	0.2	48.5	150	3.75	24.6875	25	25	25	10	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0												10.0337	0.470910073	5.456825094	0	3.238516806	3.100299074	0	0.947622074	5.223693764	0.943204482	6.849408624	0.400568804	0.000317995	0.339736938	4.461223147	15.10758075	0.748926216	1.576145112	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9411	0	0	10.0337	0.470910073	5.456825094	0	3.238516806	3.100299074	0	0.947622074	5.223693764	0.943204482	6.849408624	0.400568804	0.000317995	0.339736938	4.461223147	15.10758075	0.748926216	1.576145112	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9411	NO																							0	0		0		0	0																																								0	0	0											0			10.0337	0.470910073	5.456825094	0	3.238516806	3.100299074	0	0.947622074	5.223693764	0.943204482	6.849408624	0.400568804	0.000317995	0.339736938	4.461223147	15.10758075	0.748926216	1.576145112	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9411
H3312_048_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1662.606225	79.56628178	829.10781	1044.019407	225.8876044	10.51935366	0	282.1780201	406.650087	3255.219536	2968.866137	103.7823088	0.21897327	217.3836882	4239.520979	5773.502934	273.182897	952.7899421	0	0	278	0	0	0	864.8594049	0	47.35432919	0	108.4440162	0												$175/day 1-7	$175/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$75 per procedure	$20 per visit	$20 X-ray; $125 Complex Radiology	$20 per visit	$20 per visit	$20 per visit	$5 PCP visit; $20 if no PCP selected	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$45 per script	0	Not Covered	0	$0 per visit	$135 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Coaching Only	0											126.4996386	126.4996386	52.43074037	0	100	0.2	0.2	48.5	75	3	18.53125	20	20	20	5	20	20	20	20	20	$45 	0	0	0	0	0	0	0	0	0											NO	126.4996386	126.4996386	52.43074037	0	100	0.2	0.2	48.5	75	3	18.53125	20	20	20	5	20	20	20	20	20	$45 	0	0	0	0	0	0	0	0	0												17.5266	0.838758824	3.62256136	0	1.882396703	2.103870732	0	1.140469498	2.541563044	0.813804884	4.584733383	0.172970515	0.000364955	0.362306147	1.766467074	9.62250489	0.455304828	1.587983237	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0652	0	0	17.5266	0.838758824	3.62256136	0	1.882396703	2.103870732	0	1.140469498	2.541563044	0.813804884	4.584733383	0.172970515	0.000364955	0.362306147	1.766467074	9.62250489	0.455304828	1.587983237	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0652	NO																							0	0		0		0	0																																								0	0	0											0			17.5266	0.838758824	3.62256136	0	1.882396703	2.103870732	0	1.140469498	2.541563044	0.813804884	4.584733383	0.172970515	0.000364955	0.362306147	1.766467074	9.62250489	0.455304828	1.587983237	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0652
H3312_052_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1759.245427	78.02765017	952.4973209	689.2361454	184.5733821	9.995260044	0	229.591538	416.942005	3592.932296	3165.795068	158.8554659	0.17531679	298.9615151	4681.146267	7037.440771	307.6744913	697.2799067	0	0	278	0	0	0	1129.469905	0	77.92087277	0	84.51594189	0												$125/day 1-10	$125/day 1-10	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$10 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$750 Every 3 Yrs	Coaching Only	0											102.4559256	102.4559256	52.43074037	0	150	0.2	0.2	48.5	175	4.5	26.78125	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											NO	102.4559256	102.4559256	52.43074037	0	150	0.2	0.2	48.5	175	4.5	26.78125	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0												15.0204	0.666199593	4.161678311	0	2.307167276	1.999052009	0	0.927932466	6.080404239	1.347349611	7.065329096	0.397138665	0.000365243	0.747403788	3.900955223	17.59360193	0.769186228	1.743199767	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7699	0	0	15.0204	0.666199593	4.161678311	0	2.307167276	1.999052009	0	0.927932466	6.080404239	1.347349611	7.065329096	0.397138665	0.000365243	0.747403788	3.900955223	17.59360193	0.769186228	1.743199767	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7699	NO																							0	0		0		0	0																																								0	0	0											0			15.0204	0.666199593	4.161678311	0	2.307167276	1.999052009	0	0.927932466	6.080404239	1.347349611	7.065329096	0.397138665	0.000365243	0.747403788	3.900955223	17.59360193	0.769186228	1.743199767	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7699
H3312_055_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	9.205287848	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6320.254726	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$100/day 1-7	$100/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$75 per procedure	$10 per visit	$10 X-ray; $125 Complex Radiology	$10 per visit	$10 per visit	$10 per visit	$0 PCP visit; $10 if no PCP selected	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Coaching Only	0											72.2855078	72.2855078	52.43074037	0	100	0.2	0.2	48.5	75	1.5	14.34375	10	10	10	0	10	10	10	10	10	$45 	0	0	0	0	0	0	0	0	0											NO	72.2855078	72.2855078	52.43074037	0	100	0.2	0.2	48.5	75	1.5	14.34375	10	10	10	0	10	10	10	10	10	$45 	0	0	0	0	0	0	0	0	0												10.3187	0.458680012	5.101300562	0	1.956222648	1.84105757	0	0.978035432	2.509359687	0.273535124	3.461054951	0.044890423	0.000290253	0	0	5.266878939	0.18060093	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8954	0	0	10.3187	0.458680012	5.101300562	0	1.956222648	1.84105757	0	0.978035432	2.509359687	0.273535124	3.461054951	0.044890423	0.000290253	0	0	5.266878939	0.18060093	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8954	NO																							0	0		0		0	0																																								0	0	0											0			10.3187	0.458680012	5.101300562	0	1.956222648	1.84105757	0	0.978035432	2.509359687	0.273535124	3.461054951	0.044890423	0.000290253	0	0	5.266878939	0.18060093	0.462229156	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8954
H3312_057_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	12.30091646	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6320.254726	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$175/day 1-10	$175/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$25 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											143.4382958	143.4382958	47.56208437	0	150	0.2	0.2	48.5	175	5.25	28.875	35	25	35	25	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	143.4382958	143.4382958	47.56208437	0	150	0.2	0.2	48.5	175	5.25	28.875	35	25	35	25	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												20.4757	0.910172471	4.627599879	0	2.934333973	2.460183292	0	0.978035432	5.855172602	0.957372935	6.96735245	0.157116481	0.000725633	0	9.627745183	18.43407628	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.678	0	0	20.4757	0.910172471	4.627599879	0	2.934333973	2.460183292	0	0.978035432	5.855172602	0.957372935	6.96735245	0.157116481	0.000725633	0	9.627745183	18.43407628	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.678	NO																							0	0		0		0	0																																								0	0	0											0			20.4757	0.910172471	4.627599879	0	2.934333973	2.460183292	0	0.978035432	5.855172602	0.957372935	6.96735245	0.157116481	0.000725633	0	9.627745183	18.43407628	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.678
H3312_058_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	11.67006563	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6240.416562	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$175/day 1-10	$175/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											143.4382958	143.4382958	47.56208437	0	150	0.2	0.2	48.5	175	5.25	28.875	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	143.4382958	143.4382958	47.56208437	0	150	0.2	0.2	48.5	175	5.25	28.875	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												20.4757	0.910172471	4.627599879	0	2.934333973	2.334013126	0	0.978035432	5.855172602	0.957372935	6.96735245	0.157116481	0.000725633	0	7.702196146	18.20121497	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3935	0	0	20.4757	0.910172471	4.627599879	0	2.934333973	2.334013126	0	0.978035432	5.855172602	0.957372935	6.96735245	0.157116481	0.000725633	0	7.702196146	18.20121497	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3935	NO																							0	0		0		0	0																																								0	0	0											0			20.4757	0.910172471	4.627599879	0	2.934333973	2.334013126	0	0.978035432	5.855172602	0.957372935	6.96735245	0.157116481	0.000725633	0	7.702196146	18.20121497	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3935
H3312_059_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	11.74186006	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$100/day 1-10	$100/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$100 per procedure	$20 per visit	$20 X-ray; $125 Complex Radiology	$20 per visit	$20 per visit	$20 per visit	$5 PCP visit; $20 if no PCP selected	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$750 Every 3 Yrs	Coaching Only	0											81.96474044	81.96474044	47.56208437	0	150	0.2	0.2	48.5	100	3	31	20	20	20	5	20	20	20	20	20	45	0	0	0	0	0	0	0	0	0											NO	81.96474044	81.96474044	47.56208437	0	150	0.2	0.2	48.5	100	3	31	20	20	20	5	20	20	20	20	20	45	0	0	0	0	0	0	0	0	0												11.7004	0.520098555	4.627599879	0	2.934333973	2.348372011	0	0.978035432	3.345812916	0.547070249	7.480101331	0.089780847	0.000580506	0	1.925549037	9.779730769	0.361201861	0.924458313	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6056	0	0	11.7004	0.520098555	4.627599879	0	2.934333973	2.348372011	0	0.978035432	3.345812916	0.547070249	7.480101331	0.089780847	0.000580506	0	1.925549037	9.779730769	0.361201861	0.924458313	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6056	NO																							0	0		0		0	0																																								0	0	0											0			11.7004	0.520098555	4.627599879	0	2.934333973	2.348372011	0	0.978035432	3.345812916	0.547070249	7.480101331	0.089780847	0.000580506	0	1.925549037	9.779730769	0.361201861	0.924458313	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6056
H3312_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	296.0523522	1.369327381	40.60923491	6.834344016	8.342656184	11.70043718	0	9.502124967	34.14597794	20.37506541	80.17651958	0.323146822	0.035739207	22.76398477	41.14020922	172.6386316	3.157663287	7.061347638	0	-2.68E-09	78.12453439	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.064619165	0.064619165	0.152078993	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.064619165	0.064619165	0.152078993	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.1307	0.088484792	6.175811552	0	1.943838891	2.726201863	0	2.213995117	7.95601286	4.74739024	18.68112906	0.075293209	0.008327235	5.304008451	9.585668749	40.22480116	0.735735546	1.645294	0	-6.23E-10	18.20301651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.4457			19.1307	0.088484792	6.175811552	0	1.943838891	2.726201863	0	2.213995117	7.95601286	4.74739024	18.68112906	0.075293209	0.008327235	5.304008451	9.585668749	40.22480116	0.735735546	1.645294	0	-6.23E-10	18.20301651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.4457	NO																																																																																		0			19.1307	0.088484792	6.175811552	0	1.943838891	2.726201863	0	2.213995117	7.95601286	4.74739024	18.68112906	0.075293209	0.008327235	5.304008451	9.585668749	40.22480116	0.735735546	1.645294	0	-6.23E-10	18.20301651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.4457
H3312_804_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	294.1902121	3.379127275	47.66303881	7.137502	7.513362866	10.52171258	0	7.443258298	30.18414653	20.90808866	84.07107281	0.47473792	0.014704078	20.12276429	47.35112736	182.8544043	3.2038234	6.299211673	0	0	60.83186619	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.061993373	0.061993373	0.145789769	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061993373	0.061993373	0.145789769	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.2378	0.209483496	6.948783398	0	1.750613548	2.451559031	0	1.734279184	7.032906141	4.871584657	19.58855996	0.110613935	0.00342605	4.68860408	11.03281267	42.6050762	0.746490852	1.46771632	0	0	14.17382482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.6542			18.2378	0.209483496	6.948783398	0	1.750613548	2.451559031	0	1.734279184	7.032906141	4.871584657	19.58855996	0.110613935	0.00342605	4.68860408	11.03281267	42.6050762	0.746490852	1.46771632	0	0	14.17382482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.6542	NO																																																																																		0			18.2378	0.209483496	6.948783398	0	1.750613548	2.451559031	0	1.734279184	7.032906141	4.871584657	19.58855996	0.110613935	0.00342605	4.68860408	11.03281267	42.6050762	0.746490852	1.46771632	0	0	14.17382482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.6542
H3327_001_0	2010	9	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	V	P	V	P	P	P	P	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	1061.996267	16.02038164	1703.757257		864.0915165	6.089179849	3.309697936	250.4387091	371.9058461		548.4335345			432.9884581	5775.562815	6276.553099	543.1645289	1361.350737		399.4647321	14.22808922	681.8912413																			3400	1A IP Acute: $200 per admission	"1B IP Psych: $200 per admission, 190-day lifetime limit"	2 SNF: $0 copay days 1-15; $80 copay days 16-100	6 Home Health: $0 copay	10A Ambulance: $55 copay	11A DME:  20% Coin	"11B Prosthetic Medical Supplies: 20% coin, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $15 copay"	"9A Outpatient Hospital: $0 copay,   9B ASC Services: $100 copay"	8A OP C/D/T: $0 copay	8B OP X-Ray: $0 copay; Other Radiology: $20 copay	9A OP Observation: $0 copay	12 Renal Dialysis: $0 copay	"3 CORF: $20 copay,  5  Partial Hosp:  $0 copay, 9C OP SA: $20 copay, 9D Cardiac Rehab: $20 copay"	"7A PCP: $5 copay, 14B Immunizations: $0 copay, 14C Routine Physical:  $0 copay,  14D Pap Smears:  $0 copay, 14D Pelvic Exams:  $0 copay, 14E Prostate Screening:  $0 copay, 14F Colorectal Screening:  $0 copay, 14G Bone Mass Measurement:  $0 copay, 14H Mammography:  $0 copay, 14I Diabetes Monitoring:  $0 copay, 14J Nutrition Therapy: $0 copay"	"7D Physician Specialist: $20 copay, 7B Chiropractic:  $20 copay, 7F Podiatry:  $20 copay for medically necessary services,"	"7E Mental Health: $20 copay, 7H Psychiatric: $20 copay"	"7C Occupational Therapy:  $20 copay, 7I Physical and Speech Therapy:  $20 copay"	7D Physician Specialist: $0 copay	7G Other Health Care:  $20 copay	15 Part B Drugs: 20% coin	"13A Blood: $0 copay, 17A Medicare Covered Eye Exams: $20 copay"	10B Transportation: Not Covered	16A Preventive Dental: 16B Comp Dental: Capitated	17A1 Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	18A Routine Hearing Exams: $0 copay	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: $0 copay	"13B Acupuncture: Not Covered, 13C Other1: Not Covered"											200	200	27.26637346		55	0.2	0.2	49.82926829	81.90757636		8.003818623			4.237572642	5	19.99685165	18.89531331	20		20	0.2	20																			NO	174.0136096	174.0136096	23.72360033		47.85374264	0.17401361	0.17401361	43.3548542	72.59710754		6.963866846			4.237572642	4.35034024	17.39912846	16.44020836	17.40136096		17.40136096	0.17401361	17.40136096																				15.4002	0.232313703	3.368271352	0	3.445834421	1.059600165	0.575932485	0.904811143	2.249940725	0	0.318268176	0	0	0.15290167	2.093805277	9.100546141	0.744144836	1.974112964	0	0.579269166	2.475881162	0.988819636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6646	0	6.748758803	15.4002	0.232313703	3.368271352	0	3.445834421	1.059600165	0.575932485	0.904811143	2.249940725	0	0.318268176	0	0	0.15290167	2.093805277	9.100546141	0.744144836	1.974112964	0	0.579269166	2.475881162	0.988819636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6646	NO																																																																																		0	0	0	15.4002	0.232313703	3.368271352	0	3.445834421	1.059600165	0.575932485	0.904811143	2.249940725	0	0.318268176	0	0	0.15290167	2.093805277	9.100546141	0.744144836	1.974112964	0	0.579269166	2.475881162	0.988819636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6646
H3327_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	V	V	V	V	V	V	P	V	Coin	O	T	V	V	V	V	V	V	V																																																			0	YES						5.746650154	2.53725354	430.4259079			629.2673206			420.6837577		5265.340028	895.5584442	1137.069665		283.9166133	6.022648538	531.3497079																			3400	PBP: 1A IP Acute: $0 copay	"1B IP Psych: $0 copay, 190-day lifetime limit"	"2 SNF: $0 copay, up to 100 days"	6 Home Health: $0 copay	10A Ambulance: $0 copay	11A DME: 10% coin	"11B Prosthetic Medical Supplies: 10% coin, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $5 copay"	9B ASC Services: $0 copay	8A OP C/D/T: $0 copay	8B OP X-Ray: $0 copay; Other radiology: $5 copay	9A OP Observation: $0 copay	12 Renal Dialysis: $0 copay	"3 CORF: $5 copay,  5  Partial Hosp:  $0 copay, 9C OP SA: $5 copay, 9D Cardiac Rehab: $5 copay, 9A Outpatient Hospital: $0 copay,"	"7A PCP: $0 copay, 14B Immunizations: $0 copay, 14C Routine Physical:  $0 copay,  14D Pap Smears:  $0 copay, 14D Pelvic Exams:  $0 copay, 14E Prostate Screening:  $0 copay, 14F Colorectal Screening:  $0 copay, 14G Bone Mass Measurement:  $0 copay, 14H Mamm: $0 copay"	"7D Physician Specialist: $5 copay, 7B Chiropractic:  $5 copay, 7F Podiatry:  $5 copay for medically necessary services,"	"7E Mental Health: $5 copay, 7H Psychiatric: $5 copay"	"7C Occupational Therapy:  $5 copay, 7I Physical and Speech Therapy:  $5 copay"	7D Physician Specialist: $0 copay for radiology services	7G Other Health Care:  $5 copay	15 Part B Drugs: 10% coin	"13A Blood: $0 copay, 17A Medicare Covered Eye Exams: $5 copay"	10B Transportation: 21 Trips	16A Preventive Dental;16B Comp Dental:Capitated	17A1 Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	"18A Medicare Covered Hearing Exams:  $0 copay, 18A1 Routine Hearing Exams: $0 copay"	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: $0 copay	"13B Acupuncture: Not Covered, 13C Other1: $55 OTC"																0.1	0.1	49.76851852			2			4.11853364		5	5	5		5	0.1	5																			NO						0.099736888	0.099736888	49.63757166			1.994737764			4.11853364		4.986844409	4.986844409	4.986844409		4.986844409	0.099736888	4.986844409																				0	0	0	0	0	0.573153004	0.253057773	1.780441404	0	0	0.104601941	0	0	0.144383351	0	2.18811929	0.372167552	0.472532459	0	0.117987331	0.600680224	0.220813193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8279	0	0.017631612	0	0	0	0	0	0.573153004	0.253057773	1.780441404	0	0	0.104601941	0	0	0.144383351	0	2.18811929	0.372167552	0.472532459	0	0.117987331	0.600680224	0.220813193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8279	NO																																																																																		0	0	0	0	0	0	0	0	0.573153004	0.253057773	1.780441404	0	0	0.104601941	0	0	0.144383351	0	2.18811929	0.372167552	0.472532459	0	0.117987331	0.600680224	0.220813193	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8279
H3327_021_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	V	V	V	V	V	V	P	P	Coin	V	T	V	V	V	V	V	O	V																																																			0	YES	452.9741806	5.259859308	670.7016196		247.4611	8.870572595	7.229848742	322.7885014	1331.920035		1397.754738			812.8759267	14214.2344	8147.805467	503.3677979	1080.217737		498.2367191	29.96737894	554.6278653																			3400	PBP: 1A IP Acute: $275 per admit	1B IP Psych: $275 per admit	2 SNF: $0 copay 1-15 days; $80 for 16-100 days	6 Home Health: $0 copay	10A Ambulance: $75 copay	11A DME: 20% coin	"11B Prosthetic Medical Supplies: 20% coin, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $25 copay"	9B ASC Services: $100 copay	8A OP C/D/T: $0 copay	8B OP X-Ray: $0 copay; Other radiology: $25 copay	9A OP Observation: $0 copay	12 Renal Dialysis: $0 copay	"3 CORF: $25 copay,  5  Partial Hosp:  $0 copay, 9C OP SA: $25 copay, 9D Cardiac Rehab: $25 copay, 9A Outpatient Hospital: $0 copay"	"7A PCP: $5 copay, 14B Immunizations: $0 copay, 14C Routine Physical:  $0 copay,  14D Pap Smears:  $0 copay, 14D Pelvic Exams:  $0 copay, 14E Prostate Screening:  $0 copay, 14F Colorectal Screening:  $0 copay, 14G Bone Mass Measurement:  $0 copay, 14H Mammography:  $0 copay, 14I Diabetes Monitoring:  $0 copay, 14J Nutrition Therapy: $0 copay"	"7D Physician Specialist: $25 copay, 7B Chiropractic:  $25 copay, 7F Podiatry:  $25 copay for medically necessary services,"	"7E Mental Health: $25 copay, 7H Psychiatric: $25 copay"	"7C Occupational Therapy:  $25 copay, 7I Physical and Speech Therapy:  $25 copay"	7D Physician Specialist: $0 copay for radiology	7G Other Health Care:  $25 copay	15 Part B Drugs: 20% coin	"13A Blood: $0 copay, 17A Medicare Covered Eye Exams: $25 copay"	10B Transportation: Not Covered	16A Preventive Dental: 16B Comp Dental: Capitated	17A Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	18A Routine Hearing Exams: $0 copay	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: $0 copay	"13B Acupuncture: Not Covered, 13C Other1: Not Covered"											275	275	27.26637346		75	0.2	0.2	47.98688429	100		10			18.23019717	5	25	22.54586734	24.96687685		12.94290235	0.2	25																			NO	226.5674571	226.5674571	22.46426508		61.79112466	0.164776332	0.164776332	39.53551399	82.38816621		8.238816621			18.02498917	4.11940831	20.59704155	18.57512666	20.56975199		10.90592052	0.164776332	20.59704155																				8.5524	0.099309412	1.255568248	0	1.27424164	1.461660419	1.19130796	1.063467443	9.144537437	0	0.959653748	0	0	1.221006648	4.879519608	13.98505731	0.779176717	1.851650912	0	0.452810838	4.937914794	0.951974432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0613	0	11.29716508	8.5524	0.099309412	1.255568248	0	1.27424164	1.461660419	1.19130796	1.063467443	9.144537437	0	0.959653748	0	0	1.221006648	4.879519608	13.98505731	0.779176717	1.851650912	0	0.452810838	4.937914794	0.951974432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0613	NO																																																																																		0	0	0	8.5524	0.099309412	1.255568248	0	1.27424164	1.461660419	1.19130796	1.063467443	9.144537437	0	0.959653748	0	0	1.221006648	4.879519608	13.98505731	0.779176717	1.851650912	0	0.452810838	4.937914794	0.951974432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.0613
H3327_022_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	V	P	V	P	P	P	P	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	491.9400612	8.53099101	928.9938127		408.4804485	4.079878192	3.145618637	200.9242457			847.2805736			384.0750066	13197.06869	7375.232961	523.4359174	1321.88848		697.5923503	23.63909437	607.1408388																			2000	1A IP Acute: $150 per admission	"1B IP Psych: $150 per admission, 190-day lifetime limit"	2 SNF: $0 copay 1-20 day; $75 copay days 21-100	6 Home Health: $0 copay	10A Ambulance: $50 copay	11A DME:  20% Coin	"11B Prosthetic Medical Supplies: 20% coin, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $15 copay"	9B ASC Services: $0 copay	8A OP C/D/T: $0 copay	8B OP X-Ray: $0 copay; Other Radiology: $15 copay	9A OP Observation: $0 copay	12 Renal Dialysis: $0 copay	"3 CORF: $15 copay,  5  Partial Hosp:  $0 copay, 9C OP SA: $15 copay, 9D Cardiac Rehab: $15 copay"	"7A PCP: $5 copay, 14B Immunizations: $0 copay, 14C Routine Physical:  $0 copay,  14D Pap Smears:  $0 copay, 14D Pelvic Exams:  $0 copay, 14E Prostate Screening:  $0 copay, 14F Colorectal Screening:  $0 copay, 14G Bone Mass Measurement:  $0 copay, 14H Mammography:  $0 copay, 14I Diabetes Monitoring:  $0 copay, 14J Nutrition Therapy: $0 copay"	"7D Physician Specialist: $15 copay, 7B Chiropractic:  $15 copay, 7F Podiatry:  $15 copay for medically necessary services,"	"7E Mental Health: $15 copay, 7H Psychiatric: $15 copay"	"7C Occupational Therapy:  $15 copay, 7I Physical and Speech Therapy:  $15 copay"	7D Physician Specialist: $0 copay for radiology	7G Other Health Care:  $15 copay	15 Part B Drugs: 20% coin	"13A Blood: $0 copay, 17A Medicare Covered Eye Exams: $15 copay"	10B Transportation: Not Covered	16A Preventive Dental: 16B Comp Dental: Capitated	17A1 Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	18A Routine Hearing Exams: $0 copay	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: $0 copay	"13B Acupuncture: Not Covered, 13C Other1: $36 OTC"											150	150	14.85		50	0.2	0.2	47.24257468			6			15	5	15	14.87083138	14.58408039		9.445038914	0.2	14.99459575																			NO	124.9261523	124.9261523	12.36768907		41.64205075	0.166568203	0.166568203	39.34555385			4.99704609			12.49261523	4.164205075	12.49261523	12.3850383	12.14622032		7.866215796	0.166568203	12.48811435																				5.1213	0.08881199	0.957458886	0	1.417496964	0.679577979	0.523960044	0.658789644	0	0	0.352825006	0	0	0.399841773	4.579608369	7.677995632	0.540231157	1.337995726	0	0.45728433	3.937521469	0.631837018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3626	0	5.893345414	5.1213	0.08881199	0.957458886	0	1.417496964	0.679577979	0.523960044	0.658789644	0	0	0.352825006	0	0	0.399841773	4.579608369	7.677995632	0.540231157	1.337995726	0	0.45728433	3.937521469	0.631837018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3626	NO	PBP: 1A IP Acute: 20% coins	1B IP Psych: 20% coins	2 SNF: 20% coins	6 Home Health: 20% coins	10A Ambulance: 20% coins	11A DME:  20% coins	"11B Prosthetic Medical Supplies: 20% coins, 11C Diabetes Monitoring Supplies: 20% coins"	4A ER/4B Urgent Care: 20% coins	"9A Outpatient Hospital: 20% coins,   9B ASC Services: 20% coins"	8A OP C/D/T: 20% coins	8B OP X-Ray: 20% coins	9A OP Observation 20% coins	12 Renal Dialysis: Not Covered	"3 CORF: 20% coins,  5  Partial Hosp:  20% coins, 9C OP SA: 20% coins, 9D Cardiac Rehab: 20% coins"	"7A PCP: 20% coins, 14B Immunizations: 20% coins, 14C Routine Physical:  20% coins,  14D Pap Smears:  20% coins, 14D Pelvic Exams:  20% coins, 14E Prostate Screening:  20% coins, 14F Colorectal Screening:  20% coins, 14G Bone Mass Measurement:  20% coins, 14H Mammography:  20% coins, 14I Diabetes Monitoring:  20% coins, 14J Nutrition Therapy: 20% coins"	"7D Physician Specialist: 20% coins, 7B Chiropractic:  20% coins, 7F Podiatry:  20% coins for medically necessary services, 20% coins for 4 routine exams,"	"7E Mental Health: 20% coins, 7H Psychiatric: 20% coins"	"7C Occupational Therapy:  20% coins, 7I Physical and Speech Therapy:  20% coins"	7D Physician Specialist: 0% coins	7G Other Health Care:  20% coins	15 Part B Drugs: Not Covered	"13A Blood: 20% coins, 17A Medicare Covered Eye Exams: 20% coins; 14J Nutritional Therapy: 20% coin"	10B Transportation: Not Covered	"16A Preventive Dental: OPTIONAL SUPPLEMENTAL, 16B Comp Dental: Not Covered"	17A Routine Eye Exams: 20% coins	17B Eye Wear:  20% coins	18A Hearing Exams: 20% coins	18B Hearing Aids: 20% coins	14A Health Ed/Wellness: Not Covered	"13B Acupuncture: Not Covered, 13C Other1: Not Covered"												1.8858	0.0444	0.8353		0.1962	0.124	0.0662	0.0402	0.2115	0.0217	0.0704	0.0098	0.0031	0.1155	0.236	0.5617	0.1568	0.0888	0.2609	0.5145	0.1232	0.1021																			5.668	0	0	7.0071	0.133162602	1.792726663	0	1.613662252	0.803602785	0.590157788	0.699006583	0.211543165	0.021741733	0.423256768	0.009755291	0.00312636	0.515292573	4.815615537	8.239723292	0.697013436	1.426800614	0.260855775	0.971773347	4.060728184	0.733917546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0306
H3327_023_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	V	P	V	P	P	P	P	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	281.926649	3.46638167	795.1702088		90.50949598	4.815588453	3.970787842	184.0103887	725.1436767		956.8425152			622.7625609	14397.01384	6879.001122	475.2486597	1301.469553		595.2945128	21.39706217	533.5654503																			3400	1A IP Acute: $250 per admission	1B IP Psych: $250	2 SNF: $0 copay days 1-20; $75 copay days 21-100	6 Home Health: $0 copay	10A Ambulance: $50 copay	11A DME:  20% Coin	"11B Prosthetic Medical Supplies: 20% coin, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $20 copay"	9B ASC Services: $100 copay	8A OP C/D/T: $0 copay	8B OP X-Ray: $0 copay; Other Radiology: $20 copay	9A OP Observation: $0 copay	12 Renal Dialysis: $0 copay	"3 CORF: $20 copay,  5  Partial Hosp:  $0 copay, 9C OP SA: $20 copay, 9D Cardiac Rehab: $20 copay"	"7A PCP: $5 copay, 14B Immunizations: $0 copay, 14C Routine Physical:  $0 copay,  14D Pap Smears:  $0 copay, 14D Pelvic Exams:  $0 copay, 14E Prostate Screening:  $0 copay, 14F Colorectal Screening:  $0 copay, 14G Bone Mass Measurement:  $0 copay, 14H Mammography:  $0 copay, 14I Diabetes Monitoring:  $0 copay, 14J Nutrition Therapy: $0 copay"	"7D Physician Specialist: $20 copay, 7B Chiropractic:  $20 copay, 7F Podiatry:  $20 copay for medically necessary services,"	"7E Mental Health: $20 copay, 7H Psychiatric: $20 copay"	"7C Occupational Therapy:  $20 copay, 7I Physical and Speech Therapy:  $20 copay"	7D Physician Specialist: $0 copay for radiology	7G Other Health Care:  $20 copay	15 Part B Drugs: 20% coin	"13A Blood: $0 copay, 17A Medicare Covered Eye Exams: $20 copay"	10B Transportation: Not Covered	16A Preventive Dental: 16B Comp Dental: Capitated	17A1 Routine Eye Exams: $0 copay	17B Eye Wear:  $0 copay for eye wear	18A Routine Hearing Exams: $0 copay	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: $0 copay	"13B Acupuncture: Not Covered, 13C Other1: Not Covered"											250	250	17.1		50	0.2	0.2	47.73131781	100		8			13.0390005	5	20	19.81240659	19.44295774		11.4164133	0.2	19.99189123																			NO	214.7509388	214.7509388	14.68896421		42.95018776	0.171800751	0.171800751	41.00138124	85.90037552		6.872030042			12.96375803	4.295018776	17.1800751	17.01893166	16.70157371		9.806741894	0.171800751	17.17310964																				5.0453	0.06203406	0.973352228	0	0.323949987	0.827321713	0.682184334	0.628723341	5.190842844	0	0.547954209	0	0	0.672778596	5.15295373	9.84847966	0.674018705	1.811382472	0	0.486491636	3.676031351	0.763581498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3674	0	6.026935447	5.0453	0.06203406	0.973352228	0	0.323949987	0.827321713	0.682184334	0.628723341	5.190842844	0	0.547954209	0	0	0.672778596	5.15295373	9.84847966	0.674018705	1.811382472	0	0.486491636	3.676031351	0.763581498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.3674	NO	PBP: 1A IP Acute: 20% coins	1B IP Psych: 20% coins	2 SNF: 20% coins	6 Home Health: 20% coins	10A Ambulance: 20% coins	11A DME:  20% coins	"11B Prosthetic Medical Supplies: 20% coins, 11C Diabetes Monitoring Supplies: 20% coins"	4A ER/4B Urgent Care: 20% coins	"9A Outpatient Hospital: 20% coins,   9B ASC Services: 20% coins"	8A OP C/D/T: 20% coins	8B OP X-Ray: 20% coins	9A OP Observation 20% coins	12 Renal Dialysis: Not Covered	"3 CORF: 20% coins,  5  Partial Hosp:  20% coins, 9C OP SA: 20% coins, 9D Cardiac Rehab: 20% coins"	"7A PCP: 20% coins, 14B Immunizations: 20% coins, 14C Routine Physical:  20% coins,  14D Pap Smears:  20% coins, 14D Pelvic Exams:  20% coins, 14E Prostate Screening:  20% coins, 14F Colorectal Screening:  20% coins, 14G Bone Mass Measurement:  20% coins, 14H Mammography:  20% coins, 14I Diabetes Monitoring:  20% coins, 14J Nutrition Therapy: 20% coins"	"7D Physician Specialist: 20% coins, 7B Chiropractic:  20% coins, 7F Podiatry:  20% coins for medically necessary services, 20% coins for 4 routine exams,"	"7E Mental Health: 20% coins, 7H Psychiatric: 20% coins"	"7C Occupational Therapy:  20% coins, 7I Physical and Speech Therapy:  20% coins"	7D Physician Specialist: 0% coins	7G Other Health Care:  20% coins	15 Part B Drugs: Not Covered	"13A Blood: 20% coins, 17A Medicare Covered Eye Exams: 20% coins; 14J Nutritional Therapy: 20% coin"	10B Transportation: Not Covered	"16A Preventive Dental: OPTIONAL SUPPLEMENTAL, 16B Comp Dental: Not Covered"	17A Routine Eye Exams: 20% coins	17B Eye Wear:  20% coins	18A Hearing Exams: 20% coins	18B Hearing Aids: 20% coins	14A Health Ed/Wellness: Not Covered	"13B Acupuncture: Not Covered, 13C Other1: Not Covered"												8.9272	0.1841	0.9633		0.6493	0.2618	0.2399	0.1823	0.9606	0.1228	0.4142	0.0405	0.013	0.548	1.4355	2.9816	0.8211	0.4089	1.1429	2.6021	0.5793	0.4636																			23.9419	0	0	13.9725	0.246092548	1.936639033	0	0.973262365	1.089113256	0.92206601	0.811000375	6.151479679	0.122760485	0.962130076	0.040485217	0.012974636	1.220783444	6.588418712	12.83003083	1.495167774	2.220287519	1.142934675	3.088608658	4.255328792	1.22718492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3093
H3327_026_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	V																																																			0	NO								441.2779746						282.544624		7155.255594	1375.395903	1623.038508		319.4943259		590.3293967																				PBP: 1A IP Acute: $0 copay	"1B IP Psych: $0 copay, 190-day lifetime limit"	"2 SNF: $0 copay, up to 100 days"	6 Home Health: $0 copay	10A Ambulance: $0 copay	11A DME:  0% coins	"11B Prosthetic Medical Supplies: $0 copay, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $10 copay"	9B ASC Services: $0 copay	8A OP C/D/T: $0 copay	8B OP X-Ray: $0 copay; Other Radiology: $0 copay	9A OP Observation: $0 copay	12 Renal Dialysis: $0 copay	"3 CORF: $10 copay,  5  Partial Hosp:  $0 copay, 9C OP SA: $20 copay, 9D Cardiac Rehab: $10 copay"	"7A PCP: $0 copay, 14B Immunizations: $0 copay, 14C Routine Physical:  $0 copay,  14D Pap Smears:  $0 copay, 14D Pelvic Exams:  $0 copay, 14E Prostate Screening:  $0 copay, 14F Colorectal Screening:  $0 copay, 14G Bone Mass Measurement:  $0 copay, 14H Mammography:  $0 copay, 14I Diabetes Monitoring:  $0 copay, 14J Nutrition Therapy: $0 copay"	"7D Physician Specialist: $10 copay,7B Chiropractic:  $10 copay, 7F Podiatry:  $10 copay for medically necessary services,"	"7E Mental Health: $20 copay, 7H Psychiatric: $20 copay; Substance Abuse: $20 copay"	"7C Occupational Therapy:  $10 copay, 7I Physical and Speech Therapy:  $10 copay"	7D Physician Specialist: $0 copay for radiology services	"7G Other Health Care:  $10 copay,"	15 Part B Drugs: $0 copay	"13A Blood: $0 copay, 17A Medicare Covered Eye Exams: $0 copay"	10B Transportation: 15 Trips	"16A Preventive Dental: Not Covered, 16B Comp Dental: Not Covered"	17A1 Routine Eye Exams: $0 copay	17B Eye Wear:  $0 for eye wear every 2 yrs.	18A Routine Hearing Exams: $0 copay per yr.	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: $0 copay	"13B Acupuncture: Not Covered, 13C Other1: $55 OTC"																		47.92357801						10.16730669		10	20	10		10		10																			NO								47.92357801						10.16730669		10	20	10		10		10																				0	0	0	0	0	0	0	1.76230162	0	0	0	0	0	0.239393154	0	5.962712995	2.292326504	1.35253209	0	0.266245272	0	0.491941164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3675	0	0	0	0	0	0	0	0	0	1.76230162	0	0	0	0	0	0.239393154	0	5.962712995	2.292326504	1.35253209	0	0.266245272	0	0.491941164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3675	NO																																																																																		0	0	0	0	0	0	0	0	0	0	1.76230162	0	0	0	0	0	0.239393154	0	5.962712995	2.292326504	1.35253209	0	0.266245272	0	0.491941164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3675
H3327_027_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	V	V																																																			0	NO								334.3279142						292.8781375		8537.589776	806.2014211	1129.356868		277.7715825		558.4960835																				PBP: 1A IP Acute: $0 copay	"1B IP Psych: $0 copay, 190-day lifetime limit"	"2 SNF: $0 copay, up to 100 days"	6 Home Health: $0 copay	10A Ambulance: $0 copay	11A DME:  0% coins	"11B Prosthetic Medical Supplies: $0 copay, 11C Diabetes Monitoring Supplies: $0 copay"	"4A ER: $50 copay,  4B Urgent Care: $10 copay"	9B ASC Services: $0 copay	8A OP C/D/T: $0 copay	8B OP X-Ray: $0 copay; Other Radiology: $0 copay	9A OP Observation: $0 copay	12 Renal Dialysis: $0 copay	"3 CORF: $10 copay,  5  Partial Hosp:  $0 copay, 9C OP SA: $20 copay, 9D Cardiac Rehab: $10 copay"	"7A PCP: $0 copay, 14B Immunizations: $0 copay, 14C Routine Physical:  $0 copay,  14D Pap Smears:  $0 copay, 14D Pelvic Exams:  $0 copay, 14E Prostate Screening:  $0 copay, 14F Colorectal Screening:  $0 copay, 14G Bone Mass Measurement:  $0 copay, 14H Mammography:  $0 copay, 14I Diabetes Monitoring:  $0 copay, 14J Nutrition Therapy: $0 copay"	"7D Physician Specialist: $10 copay,7B Chiropractic:  $10 copay, 7F Podiatry:  $10 copay for medically necessary services,"	"7E Mental Health: $20 copay, 7H Psychiatric: $20 copay; Substance Abuse: $20 copay"	"7C Occupational Therapy:  $10 copay, 7I Physical and Speech Therapy:  $10 copay"	7D Physician Specialist: $0 copay for radiology services	"7G Other Health Care:  $10 copay,"	15 Part B Drugs: $0 copay	"13A Blood: $0 copay, 17A Medicare Covered Eye Exams: $10 copay"	10B Transportation: Not Covered	"16A Preventive Dental: Not Covered, 16B Comp Dental: Not Covered"	17A1 Routine Eye Exams: $0 copay	17B Eye Wear:  $0 for eye wear every 2 yrs.	18A Routine Hearing Exams: $0 copay per yr.	18B Hearing Aids: $0 copay	14A Health Ed/Wellness: $0 copay	"13B Acupuncture: Not Covered, 13C Other1: $28 OTC"																		44.6536406						10.12652886		10	20	10		10		10																			NO								44.6536406						10.12652886		10	20	10		10		10																				0	0	0	0	0	0	0	1.244079877	0	0	0	0	0	0.247153243	0	7.114658147	1.343669035	0.941130723	0	0.231476319	0	0.465413403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5876	0	0	0	0	0	0	0	0	0	1.244079877	0	0	0	0	0	0.247153243	0	7.114658147	1.343669035	0.941130723	0	0.231476319	0	0.465413403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5876	NO																																																																																		0	0	0	0	0	0	0	0	0	0	1.244079877	0	0	0	0	0	0.247153243	0	7.114658147	1.343669035	0.941130723	0	0.231476319	0	0.465413403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5876
H3327_801_0	2010	1	N/A																															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																																																			0	NO	256.5552801	5.277321507	44.81613043		8.562967743	10.19437528	13.34908791	13.57320292	42.91310154	6.446292251	18.20379731	3.47762183	0.347821472	29.68431735	44.02189802	61.9817461	3.271027848	5.306768033	29.8226973	61.15347749	27.56695666	7.89093568																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				17.9094	0.368394485	7.118046347	0	1.995171484	2.37528944	3.110337483	3.162556281	9.998752658	1.501986094	4.241484774	0.810285886	0.081042403	6.916445942	10.25710224	14.44174684	0.762149489	1.236476952	6.948688471	14.24876025	6.423100902	1.838588013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7458	0	0	17.9094	0.368394485	7.118046347	0	1.995171484	2.37528944	3.110337483	3.162556281	9.998752658	1.501986094	4.241484774	0.810285886	0.081042403	6.916445942	10.25710224	14.44174684	0.762149489	1.236476952	6.948688471	14.24876025	6.423100902	1.838588013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7458	NO																																																																																		0	0	0	17.9094	0.368394485	7.118046347	0	1.995171484	2.37528944	3.110337483	3.162556281	9.998752658	1.501986094	4.241484774	0.810285886	0.081042403	6.916445942	10.25710224	14.44174684	0.762149489	1.236476952	6.948688471	14.24876025	6.423100902	1.838588013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7458
H3327_802_0	2010	1	N/A																															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																																																			0	NO	256.5552801	5.277321507	44.81613043		8.562967743	10.19437528	13.34908791	13.57320292	42.91310154	6.446292251	18.20379731	3.47762183	0.347821472	29.68431735	44.02189802	61.9817461	3.271027848	5.306768033	29.8226973	61.15347749	27.56695666	7.89093568																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				17.9094	0.368394485	7.118046347	0	1.995171484	2.37528944	3.110337483	3.162556281	9.998752658	1.501986094	4.241484774	0.810285886	0.081042403	6.916445942	10.25710224	14.44174684	0.762149489	1.236476952	6.948688471	14.24876025	6.423100902	1.838588013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7458	0	0	17.9094	0.368394485	7.118046347	0	1.995171484	2.37528944	3.110337483	3.162556281	9.998752658	1.501986094	4.241484774	0.810285886	0.081042403	6.916445942	10.25710224	14.44174684	0.762149489	1.236476952	6.948688471	14.24876025	6.423100902	1.838588013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7458	NO																																																																																		0	0	0	17.9094	0.368394485	7.118046347	0	1.995171484	2.37528944	3.110337483	3.162556281	9.998752658	1.501986094	4.241484774	0.810285886	0.081042403	6.916445942	10.25710224	14.44174684	0.762149489	1.236476952	6.948688471	14.24876025	6.423100902	1.838588013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7458
H3327_803_0	2010	1	N/A																															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																																																			0	NO	256.5552801	5.277321507	44.81613043		8.562967743	10.19437528	13.34908791	13.57320292	42.91310154	6.446292251	18.20379731	3.47762183	0.347821472	29.68431735	44.02189802	61.9817461	3.271027848	5.306768033	29.8226973	61.15347749	27.56695666	7.89093568																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				17.9094	0.368394485	7.118046347	0	1.995171484	2.37528944	3.110337483	3.162556281	9.998752658	1.501986094	4.241484774	0.810285886	0.081042403	6.916445942	10.25710224	14.44174684	0.762149489	1.236476952	6.948688471	14.24876025	6.423100902	1.838588013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7458	0	0	17.9094	0.368394485	7.118046347	0	1.995171484	2.37528944	3.110337483	3.162556281	9.998752658	1.501986094	4.241484774	0.810285886	0.081042403	6.916445942	10.25710224	14.44174684	0.762149489	1.236476952	6.948688471	14.24876025	6.423100902	1.838588013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7458	NO																																																																																		0	0	0	17.9094	0.368394485	7.118046347	0	1.995171484	2.37528944	3.110337483	3.162556281	9.998752658	1.501986094	4.241484774	0.810285886	0.081042403	6.916445942	10.25710224	14.44174684	0.762149489	1.236476952	6.948688471	14.24876025	6.423100902	1.838588013	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.7458
H3327_805_0	2010	1	N/A																															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																																																			0	NO	230.8997521	4.749589356	40.33451739		7.706670969	9.174937751	12.01417912	12.21588263	38.62179138	5.801663026	16.38341758	3.129859647	0.313039325	26.71588561	39.61970821	55.78357149	2.943925064	4.77609123	26.84042757	55.03812974	24.81026099	7.101842112																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				16.1184	0.331555036	6.406241712	0	1.795654336	2.137760496	2.799303735	2.846300653	8.998877393	1.351787485	3.817336296	0.729257298	0.072938163	6.224801347	9.231392014	12.99757216	0.68593454	1.112829257	6.253819624	12.82388423	5.780790812	1.654729212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1712	0	0	16.1184	0.331555036	6.406241712	0	1.795654336	2.137760496	2.799303735	2.846300653	8.998877393	1.351787485	3.817336296	0.729257298	0.072938163	6.224801347	9.231392014	12.99757216	0.68593454	1.112829257	6.253819624	12.82388423	5.780790812	1.654729212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1712	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.3127	0.0476	0.9192		0.2494	0.2969	0.3888	0.3953	1.2498	0.1877	0.5302	0.1013	0.0102	0.8646	1.0303	1.9185	0.0998	0.1622	0.9137	1.8602	0.8029	0.2436																			14.5849	0	0	18.4311	0.379126638	7.32541092	0	2.045050771	2.434671676	3.188095921	3.241620188	10.24872147	1.539535747	4.347521893	0.830543034	0.08312092	7.08935709	10.26172313	14.91605244	0.785778074	1.275006562	7.167545848	14.6841023	6.583678424	1.898353667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7561
H3327_806_0	2010	1	N/A																															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																																																			0	NO	230.8997521	4.749589356	40.33451739		7.706670969	9.174937751	12.01417912	12.21588263	38.62179138	5.801663026	16.38341758	3.129859647	0.313039325	26.71588561	39.61970821	55.78357149	2.943925064	4.77609123	26.84042757	55.03812974	24.81026099	7.101842112																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				16.1184	0.331555036	6.406241712	0	1.795654336	2.137760496	2.799303735	2.846300653	8.998877393	1.351787485	3.817336296	0.729257298	0.072938163	6.224801347	9.231392014	12.99757216	0.68593454	1.112829257	6.253819624	12.82388423	5.780790812	1.654729212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1712	0	0	16.1184	0.331555036	6.406241712	0	1.795654336	2.137760496	2.799303735	2.846300653	8.998877393	1.351787485	3.817336296	0.729257298	0.072938163	6.224801347	9.231392014	12.99757216	0.68593454	1.112829257	6.253819624	12.82388423	5.780790812	1.654729212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1712	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.3127	0.0476	0.9192		0.2494	0.2969	0.3888	0.3953	1.2498	0.1877	0.5302	0.1013	0.0102	0.8646	1.0303	1.9185	0.0998	0.1622	0.9137	1.8602	0.8029	0.2436																			14.5849	0	0	18.4311	0.379126638	7.32541092	0	2.045050771	2.434671676	3.188095921	3.241620188	10.24872147	1.539535747	4.347521893	0.830543034	0.08312092	7.08935709	10.26172313	14.91605244	0.785778074	1.275006562	7.167545848	14.6841023	6.583678424	1.898353667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7561
H3327_807_0	2010	1	N/A																															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																																																			0	NO	230.8997521	4.749589356	40.33451739		7.706670969	9.174937751	12.01417912	12.21588263	38.62179138	5.801663026	16.38341758	3.129859647	0.313039325	26.71588561	39.61970821	55.78357149	2.943925064	4.77609123	26.84042757	55.03812974	24.81026099	7.101842112																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.069807095	0.069807095	0.158827776		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				16.1184	0.331555036	6.406241712	0	1.795654336	2.137760496	2.799303735	2.846300653	8.998877393	1.351787485	3.817336296	0.729257298	0.072938163	6.224801347	9.231392014	12.99757216	0.68593454	1.112829257	6.253819624	12.82388423	5.780790812	1.654729212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1712	0	0	16.1184	0.331555036	6.406241712	0	1.795654336	2.137760496	2.799303735	2.846300653	8.998877393	1.351787485	3.817336296	0.729257298	0.072938163	6.224801347	9.231392014	12.99757216	0.68593454	1.112829257	6.253819624	12.82388423	5.780790812	1.654729212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1712	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.3127	0.0476	0.9192		0.2494	0.2969	0.3888	0.3953	1.2498	0.1877	0.5302	0.1013	0.0102	0.8646	1.0303	1.9185	0.0998	0.1622	0.9137	1.8602	0.8029	0.2436																			14.5849	0	0	18.4311	0.379126638	7.32541092	0	2.045050771	2.434671676	3.188095921	3.241620188	10.24872147	1.539535747	4.347521893	0.830543034	0.08312092	7.08935709	10.26172313	14.91605244	0.785778074	1.275006562	7.167545848	14.6841023	6.583678424	1.898353667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.7561
H3328_001_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	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	YES	246.4942031	15.85931951	419.8279185	271.1525629	16.97434323	4.181436783	1.645980894	212.1214051	21.07345024	4007.912435	16.78134312	0.036277704	0.124421562	3.454146339	4364.054369	3130.120123	185.0705534	478.0985125	21.82997532	4182.603706	14.10234972	3.660919948																			3400	PBP(1A)-1100 per admit	PBP(1B)-1100 per admit	PBP(2)-75 per day 1 thru 40	PBP(6)-0 per visit	PBP(10A)-130 per trip	PBP(11A)-20% of allowed cost	PBP(11B)-20% of allowed cost	PBP(4A)-50 per visitPBP(4B)-35 per visit includes WW	PBP(9A)-20% of allowed costPBP(9B)-20% of allowed cost	PBP(8A)-0 per visit	PBP(8B)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(12)-20% of allowed cost	PBP(9C)-20% of allowed costPBP(9A)-20% of allowed costPBP(9D)-20% of allowed cost	PBP(7A)-10 per visit	PBP(7D)-35 per visit	PBP(7E)-35 per visitPBP(7H)-35 per visit	PBP(7C)-35 per visitPBP(7I)-35 per visit	PBP(7D)-20% of allowed cost excl IPF/SNF based	PBP(7B)-35 per visitPBP(7G)-35 per visit	PBP(15)-20% of allowed cost	PBP(13A)-0 per visit																			1100	1100	75	0	130	0.2	0.2	49.95147404	0.2	0	0.2	0.2	0.2	0.201398498	8.521262734	31.01498281	35	35	0.18	0.730283008	0.2	0																			YES	963.8116312	963.8116312	65.7144294	0	113.905011	0.175238478	0.175238478	43.76710152	0.175238478	0	0.175238478	0.175238478	0.175238478	0.176463831	7.466265578	27.17509198	30.66673372	30.66673372	0.157714631	0.639868416	0.175238478	0																			6800	19.7978	1.27378305	2.299062676	0	0.161121896	0.732748619	0.288439187	0.773661589	3.692879355	0	2.940737034	0.00635725	0.021803445	0.609531897	2.715265743	7.088441853	0.472959115	1.221809981	3.442906493	0.223026334	2.471274307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2336		7.098106595	19.7978	1.27378305	2.299062676	0	0.161121896	0.732748619	0.288439187	0.773661589	3.692879355	0	2.940737034	0.00635725	0.021803445	0.609531897	2.715265743	7.088441853	0.472959115	1.221809981	3.442906493	0.223026334	2.471274307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2336	NO	PBP (POS)-2200 per admit	PBP(POS)-2200 per admit	PBP(POS)-150 per day 1 thru 40	PBP(POS)0 per visit	PBP(POS)-130 per trip	PBP(POS)-30% of allowed cost	PBP(POS)-30% of allowed cost	PBP(POS)-50 per visit-35 per visit UC & WW	PBP(POS)30%of allowed cost	PBP(POS)20%per visit	PBP(POS)-30% of allowed cost	PBP(POS)-30% of allowed cost	PBP(POS)-20% of allowed cost	PBP(POS)-30% of allowed costs	PBP(POS)-30 per visit	PBP(POS)-55 per visit	PBP(POS)-55 per visit	PBP(POS)55 per visit	PBP(POS)30% of allowed cost excl IPF/SNF based	PBP(POS)55 per visit		PBP(POS)0 per visit																				0	0	0	0	1.9768	0.066	0	0.2578	2.4568	0.7766	0.7192	0	0	0.2363	2.7812	3.2023	2.8035	1.6018	1.2122	0.1637		0																			18.2544		0	19.7978	1.27378305	2.299062676	0	2.137925618	0.798771305	0.288439187	1.031509368	6.149692655	0.776636834	3.659937454	0.00635725	0.021803445	0.845854642	5.496497334	10.29075403	3.276457567	2.823607429	4.655059364	0.386769179	2.471274307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.488
H3328_002_0	2010	4	N/A																																																																																																															0	NO																																										$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$550 shared benefit max	$550 shared benefit max	$550 shared benefit max	$550 shared benefit max	$550 shared benefit max	$550 shared benefit max	$550 shared benefit max																																																				NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H3328_003_0	2010	5	N/A																															A	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	Coin	V	V	V	V	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	YES	309.2854048	120.9948468	1233.359896	512.8048594	58.41165125	8.270946395	0.0763004	304.6168457	24.16547493	5822.471043	20.15435333	0.050915661	0.18228228	5.480476659	5891.234157	4393.561447	650.3989677	1047.217522	23.3515363	5741.100193	26.6212725	4.113278847																			3400	PBP(1A)-450 per admit	PBP(1B)-75 per day 1 thru 10	PBP(2)-50 per day 1 thru 40	PBP(6)-0 per visit	PBP(10A)-50 per trip	PBP(11A)-10% of allowed cost	PBP(11B)-10% of allowed cost	PBP(4A)-50 per visitPBP(4B)-30 per visit includes WW	PBP(9A)-0 per visitPBP(9B)-0 per visit	PBP(8A)-0 per visit	PBP(8B)- 20% Radiation Therapy and 0% Diagnostic	PBP(9A)-0 per visit	PBP(12)-20% of allowed cost	20% for chemotherapy	PBP(7A)-0 per visit	PBP(7D)-0 per visit	PBP(7E)-0 per visitPBP(7H)-0 per visit	PBP(7C)-0 per visitPBP(7I)-0 per visitPBP(9D)-0 per visit	PBP(7D)-0 per visit excl IPF/SNF based	PBP(7B)-0 per visitPBP(7G)-0 per visit	PBP(15)-20% of allowed cost	PBP(13A)-0 per visit	$550 shared benefit limit	$550 shared benefit limit	$550 shared benefit limit	$550 shared benefit limit	$550 shared benefit limit	$550 shared benefit limit	$550 shared benefit limit												450	55.97335234	50	0	50	0.1	0.1	49.91675034	0	0	0.038	0	0.2	0.080227433	0	0	0	0	0	0	0.2	0																			YES	422.2230801	52.51831383	46.91367556	0	46.91367556	0.093827351	0.093827351	46.83556461	0	0	0.035654393	0	0.187654702	0.075275275	0	0	0	0	0	0	0.187654702	0																			6800	10.8823	0.529537111	4.821787167	0	0.228358771	0.776040992	0.007159064	1.188908497	0	0	0.718591243	0	0.034206127	0.412544388	0	0	0	0	0	0	4.995606965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.595		1.618040603	10.8823	0.529537111	4.821787167	0	0.228358771	0.776040992	0.007159064	1.188908497	0	0	0.718591243	0	0.034206127	0.412544388	0	0	0	0	0	0	4.995606965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.595	NO	PBP (POS)-900 per admit	PBP(POS)-150 per day 1 thru 10	PBP(POS)-100 per day 1 thru 40	PBP(POS)0 per visit	PBP(POS)-50 per trip	PBP(POS)-20% of allowed cost	PBP(POS)-20% of allowed cost	PBP(POS)-50 per visit-30 per visit UC & WW	PBP(POS)20%per visit	PBP(POS)20%per visit	PBP(POS)-20% diagnostic 30% therapeutic	PBP(POS)-20% per visit	PBP(POS)-20% of allowed cost	PBP(POS)-20% OP Other 30% Chemotherapy	PBP(POS)-10 per visit	PBP(POS)-30 per visit	PBP(POS)-30 per visit	PBP(POS)30 per visit	PBP(POS)0 per visit excl IPF/SNF based	PBP(POS)30 per visit		PBP(POS)0 per visit																				0	0	0	0	0.8744	0.2753	0.0097	0.1515	1.0427	0.6323	0.425	0	0	0.2294	0.7397	2.1045	0.8609	0.4068	0	0.1677		0																			7.9199		0	10.8823	0.529537111	4.821787167	0	1.102730711	1.051310436	0.016870024	1.340393582	1.042656349	0.632294984	1.143624161	0	0.034206127	0.641909911	0.739736371	2.104517494	0.860929899	0.406770343	0	0.167737503	4.995606965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5149
H3328_012_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	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	YES	248.7983434	25.5175863	464.65559	396.0970334	8.180665372	4.654643592	0.374760125	244.8810027	18.86898652	4181.428101	19.55702575	0	0.033386645	4.437031201	4798.951638	3102.80233	407.5237039	836.6072466	22.61031051	4405.452396	19.94242106	2.522461841																			3400	PBP(1A)-700 per admit	PBP(1B)-700 per admit	PBP(2)-75 per day 1 thru 40	PBP(6)-0 per visit	PBP(10A)-130 per trip	PBP(11A)-20% of allowed cost	PBP(11B)-20% of allowed cost	PBP(4A)-50 per visitPBP(4B)-3 per visit includes WW	PBP(9A)-20% of allowed costPBP(9B)-20% of allowed cost	PBP(8A)-0 per visit	PBP(8B)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(12)-20% of allowed cost	PBP(9C)-20% of allowed costPBP(9A)-20% of allowed costPBP(9D)-20% of allowed cost	PBP(7A)-3 per visit	PBP(7D)-3 per visit	PBP(7E)-3 per visitPBP(7H)-3 per visit	PBP(7C)-3 per visitPBP(7I)-3 per visit	PBP(7D)-20% of allowed cost excl IPF/SNF based	PBP(7B)-3 per visitPBP(7G)-3 per visit	PBP(15)-20% of allowed cost	PBP(13A)-0 per visit																			700	700	75	0	130	0.2	0.2	49.76437356	0.2	0	0.2	0.2	0.2	0.198955903	2.552348133	2.682780347	3	3	0.18	0.060923007	0.2	0																			YES	644.4319046	644.4319046	69.04627549	0	119.6802109	0.184123401	0.184123401	45.81392862	0.184123401	0	0.184123401	0.184123401	0.184123401	0.183162188	2.349735097	2.469813212	2.76185102	2.76185102	0.165711061	0.056086756	0.184123401	0																			6800	13.3611	1.370362228	2.67356149	0	0.081588646	0.85702881	0.069002109	0.934913398	3.474221977	0	3.6009061	0	0.006147263	0.812696343	0.939688758	0.638611849	0.093793313	0.192548715	3.746778547	0.020590628	3.671866395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5454		3.151241322	13.3611	1.370362228	2.67356149	0	0.081588646	0.85702881	0.069002109	0.934913398	3.474221977	0	3.6009061	0	0.006147263	0.812696343	0.939688758	0.638611849	0.093793313	0.192548715	3.746778547	0.020590628	3.671866395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5454	NO	PBP (POS)-1400 per admit	PBP(POS)-1400 per admit	PBP(POS)-150 per day 1 thru 40	PBP(POS)0 per visit	PBP(POS)-130 per trip	PBP(POS)-30% of allowed cost	PBP(POS)-30% of allowed cost	PBP(POS)-50 per visit-3 per visit UC & WW	PBP(POS)30%of allowed cost	PBP(POS)20%per visit	PBP(POS)-30% of allowed cost	PBP(POS)-30% of allowed cost	PBP(POS)-20% of allowed cost	PBP(POS)-30% of allowed costs	PBP(POS)-13 per visit	PBP(POS)-33 per visit	PBP(POS)-33 per visit	PBP(POS)33 per visit	PBP(POS)30% of allowed cost excl IPF/SNF based	PBP(POS)33 per visit		PBP(POS)0 per visit																				0	0	0	0	2.0531	0.3945	0.1124	0.32	1.8499	1.1077	0.9508	0.0952	0	0.2604	1.1569	2.4811	1.939	0.9519	1.3224	0.1721		0																			15.1674		0.01	13.3611	1.370362228	2.67356149	0	2.134708414	1.251490131	0.181430146	1.254929099	5.324166169	1.107735429	4.551744921	0.095210505	0.006147263	1.073076815	2.096575419	3.119681346	2.032764458	1.144442788	5.069129648	0.192690943	3.671866395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7128
H3328_013_0	2010	4	N/A																															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	NO	344.9401854	21.96148645	20.21832466	9.48701505	8.640373355	6.632179513	0.461249038	6.668199972	22.4367023	26.65446117	22.59263263	0.098726679	0.087940937	5.769711752	49.32141815	26.50780767	8.209180914	7.177087107	25.8692752	77.03332703	13.43491676	0.210481828																				FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	Comprehensive Non ER Trans	Comprehensive Dental	Comprehensive Vision Every 2 Years	Comprehensive Vision Every 2 Years	Comprehensive Hearing	Comprehensive Hearing	$1000 Flex Spend	$125 per QTR OTC Benefit											0.094507417	0.094507417	0.15506404	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.094507417	0.094507417	0.15506404	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				32.5994	2.075523355	3.135135114	0	2.013206992	1.545297827	0.107471026	1.553690593	5.227751637	6.210489452	5.264083402	0.023003316	0.020490238	1.344342838	11.49189043	6.176319187	1.912739153	1.672261296	6.02754112	17.9487652	3.130335606	0.049042266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5288			32.5994	2.075523355	3.135135114	0	2.013206992	1.545297827	0.107471026	1.553690593	5.227751637	6.210489452	5.264083402	0.023003316	0.020490238	1.344342838	11.49189043	6.176319187	1.912739153	1.672261296	6.02754112	17.9487652	3.130335606	0.049042266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5288	NO																																																																																		0			32.5994	2.075523355	3.135135114	0	2.013206992	1.545297827	0.107471026	1.553690593	5.227751637	6.210489452	5.264083402	0.023003316	0.020490238	1.344342838	11.49189043	6.176319187	1.912739153	1.672261296	6.02754112	17.9487652	3.130335606	0.049042266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.5288
H3328_014_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	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	YES	262.8567688	23.58547352	519.6415498	409.1795979	17.31123528	4.712267953	0.023644353	276.4086742	22.67334876	4500.811665	19.35636191	0	0.061567014	4.694999879	5402.959069	3337.863815	602.3392299	1064.54867	21.35027857	4206.470342	17.64187783	2.540427346																			3400	PBP(1A)-1100 per admit	PBP(1B)-1100 per admit	PBP(2)-75 per day 1 thru 40	PBP(6)-0 per visit	PBP(10A)-130 per trip	PBP(11A)-20% of allowed cost	PBP(11B)-20% of allowed cost	PBP(4A)-50 per visitPBP(4B)-35 per visit includes WW	PBP(9A)-20% of allowed costPBP(9B)-20% of allowed cost	PBP(8A)-0 per visit	PBP(8B)-20% of allowed cost	PBP(9A)-20% of allowed cost	PBP(12)-20% of allowed cost	PBP(9C)-20% of allowed costPBP(9A)-20% of allowed costPBP(9D)-20% of allowed cost	PBP(7A)-15 per visit	PBP(7D)-35 per visit	PBP(7E)-35 per visitPBP(7H)-35 per visit	PBP(7C)-35 per visitPBP(7I)-35 per visit	PBP(7D)-20% of allowed cost excl IPF/SNF based	PBP(7B)-35 per visitPBP(7G)-35 per visit	PBP(15)-20% of allowed cost	PBP(13A)-0 per visit																			1100	1100	75	0	130	0.2	0.2	49.94383179	0.2	0	0.2	0.2	0.2	0.203371699	12.92599929	31.05356123	35	35	0.18	0.486377591	0.2	0																			YES	929.1590775	929.1590775	63.35175528	0	109.8097092	0.168938014	0.168938014	42.1870588	0.168938014	0	0.168938014	0.168938014	0.168938014	0.171786055	10.91846325	26.23063482	29.56415247	29.56415247	0.152044213	0.410838322	0.168938014	0																			6800	20.353	1.826221401	2.743350358	0	0.158411809	0.79608119	0.00399443	0.971739083	3.830390512	0	3.270025341	0	0.010401009	0.806535507	4.916000835	7.296190568	1.483970736	2.622706598	3.246186295	0.144014935	2.980383806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4596		10.5648737	20.353	1.826221401	2.743350358	0	0.158411809	0.79608119	0.00399443	0.971739083	3.830390512	0	3.270025341	0	0.010401009	0.806535507	4.916000835	7.296190568	1.483970736	2.622706598	3.246186295	0.144014935	2.980383806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4596	NO	PBP (POS)-2200 per admit	PBP(POS)-2200 per admit	PBP(POS)-150 per day 1 thru 40	PBP(POS)0 per visit	PBP(POS)-130 per trip	PBP(POS)-30% of allowed cost	PBP(POS)-30% of allowed cost	PBP(POS)-50 per visit-35 per visit UC & WW	PBP(POS)30%of allowed cost	PBP(POS)20%per visit	PBP(POS)-20% diagnostic 30% therapeutic	PBP(POS)-30% of allowed cost	PBP(POS)-20% of allowed cost	PBP(POS)-30% of allowed costs	PBP(POS)-35 per visit	PBP(POS)-55 per visit	PBP(POS)-55 per visit	PBP(POS)55 per visit	PBP(POS)30% of allowed cost excl IPF/SNF based	PBP(POS)55 per visit		PBP(POS)0 per visit																				0	0	0	0	2.1403	0.2643	0.0044	0.1206	1.0855	0.5572	0.3716	0.0348	0	0.096	1.8579	2.4227	1.8463	0.6636	0.9652	0.1768		0																			12.607		0	20.353	1.826221401	2.743350358	0	2.29868848	1.060422181	0.008430908	1.09229262	4.915845122	0.557155256	3.641644072	0.034804417	0.010401009	0.902551946	6.773870192	9.718868484	3.330238318	3.286263516	4.211376099	0.320785569	2.980383806	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0666
H3328_801_0	2010	2	N/A																															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	NO	297.2589759	8.894931616	29.02137031	6.406792793	0.642337545	5.52207987	0.438413685	4.284549446	19.99312929	23.604109	17.40963108	0	0.099830299	4.675121524	35.47294021	26.50094111	3.422263143	5.429433318	22.59066345	68.74938423	17.13829086	0.141085476																				FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																			0.074731286	0.074731286	0.165833447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.074731286	0.074731286	0.165833447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				22.2145	0.664729681	4.812713864	0	0.149664648	1.28664461	0.102150389	0.998300021	4.658399124	5.499757398	4.056444041	0	0.02326046	1.089303315	8.265195068	6.174719278	0.797387312	1.265057963	5.263624584	16.01860653	3.99322177	0.032872916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3666			22.2145	0.664729681	4.812713864	0	0.149664648	1.28664461	0.102150389	0.998300021	4.658399124	5.499757398	4.056444041	0	0.02326046	1.089303315	8.265195068	6.174719278	0.797387312	1.265057963	5.263624584	16.01860653	3.99322177	0.032872916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3666	NO	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																				0	0	0	0	1.5522	0.2677	0.0842	0.2646	1.471	1.1808	0.7049	0.0352	0	0.1892	1.8329	1.7627	0.8951	0.3827	1.1833	4.1939	0.9054	0.0085																			16.9144			22.2145	0.664729681	4.812713864	0	1.701889684	1.554354715	0.186307303	1.262921895	6.129351701	6.680604942	4.76131416	0.035213709	0.02326046	1.27849837	10.09809653	7.937460099	1.692517714	1.647775702	6.44694495	20.21249089	4.898626003	0.04134923	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.281
H3328_802_0	2010	1	N/A																															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	NO	297.2589759	8.894931616	29.02137031	6.406792793	0.642337545	5.52207987	0.438413685	4.284549446	19.99312929	23.604109	17.40963108	0	0.099830299	4.675121524	35.47294021	26.50094111	3.422263143	5.429433318	22.59066345	68.74938423	17.13829086	0.141085476																				FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																			0.074731286	0.074731286	0.165833447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.074731286	0.074731286	0.165833447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				22.2145	0.664729681	4.812713864	0	0.149664648	1.28664461	0.102150389	0.998300021	4.658399124	5.499757398	4.056444041	0	0.02326046	1.089303315	8.265195068	6.174719278	0.797387312	1.265057963	5.263624584	16.01860653	3.99322177	0.032872916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3666			22.2145	0.664729681	4.812713864	0	0.149664648	1.28664461	0.102150389	0.998300021	4.658399124	5.499757398	4.056444041	0	0.02326046	1.089303315	8.265195068	6.174719278	0.797387312	1.265057963	5.263624584	16.01860653	3.99322177	0.032872916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3666	NO	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																				0	0	0	0	1.5522	0.2677	0.0842	0.2646	1.471	1.1808	0.7049	0.0352	0	0.1892	1.8329	1.7627	0.8951	0.3827	1.1833	4.1939	0.9054	0.0085																			16.9144			22.2145	0.664729681	4.812713864	0	1.701889684	1.554354715	0.186307303	1.262921895	6.129351701	6.680604942	4.76131416	0.035213709	0.02326046	1.27849837	10.09809653	7.937460099	1.692517714	1.647775702	6.44694495	20.21249089	4.898626003	0.04134923	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.281
H3328_803_0	2010	2	N/A																															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	NO	297.2589759	8.894931616	29.02137031	6.406792793	0.642337545	5.52207987	0.438413685	4.284549446	19.99312929	23.604109	17.40963108	0	0.099830299	4.675121524	35.47294021	26.50094111	3.422263143	5.429433318	22.59066345	68.74938423	17.13829086	0.141085476																				FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																			0.074731286	0.074731286	0.165833447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.074731286	0.074731286	0.165833447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				22.2145	0.664729681	4.812713864	0	0.149664648	1.28664461	0.102150389	0.998300021	4.658399124	5.499757398	4.056444041	0	0.02326046	1.089303315	8.265195068	6.174719278	0.797387312	1.265057963	5.263624584	16.01860653	3.99322177	0.032872916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3666			22.2145	0.664729681	4.812713864	0	0.149664648	1.28664461	0.102150389	0.998300021	4.658399124	5.499757398	4.056444041	0	0.02326046	1.089303315	8.265195068	6.174719278	0.797387312	1.265057963	5.263624584	16.01860653	3.99322177	0.032872916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3666	NO	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																				0	0	0	0	1.5522	0.2677	0.0842	0.2646	1.471	1.1808	0.7049	0.0352	0	0.1892	1.8329	1.7627	0.8951	0.3827	1.1833	4.1939	0.9054	0.0085																			16.9144			22.2145	0.664729681	4.812713864	0	1.701889684	1.554354715	0.186307303	1.262921895	6.129351701	6.680604942	4.76131416	0.035213709	0.02326046	1.27849837	10.09809653	7.937460099	1.692517714	1.647775702	6.44694495	20.21249089	4.898626003	0.04134923	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.281
H3330_021_1	2010	5	N/A																															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	V	V	V	O	O																																																			0	NO	2173.917667	101.1456414	1800.289589	227.1839215	575.645922	7.831276231	7.831276231	185.8461323	165.2563444	17.93521602	28.5851578	0	2.668552399	923.1612389	10242.89535	11939.24862	168.0319692	161.6185353	402.9774326	1123.847408	13.50636465	0	0	46.1634415	1416.549595	165.071786	137.6039274	3.211079736	0	0												$50-150 days 1-7	0	"$25 days 1-20, $50 days 21-100"	0	175	0.2	0.2	$50/$30	75	10	$10/$75	30	0	$5/$30	$0/15/$0/$0	$15/30/$30/$30	30	5	30	0	0.2	0	not covered	$5-$10	20	$40 per yr	30	not covered	0	0											59.27092489	0	30.96524729	0	175	0.2	0.2	48	75	10	33.4	30	0	10	12.6	21.75	30	5	30	0	0.2	0	0	7.5	20	40	30	0	0	0											NO	59.27092489	0	30.96524729	0	175	0.2	0.2	48	75	10	33.4	30	0	10	12.6	21.75	30	5	30	0	0.2	0	0	7.5	20	40	30	0	0	0												10.7375	0	4.645534361	0	8.394836363	1.566255246	1.566255246	0.743384529	1.032852153	0.014946013	0.079562023	0	0	0.769301032	10.75504011	21.63988813	0.420079923	0.067341056	1.007443582	0	2.70127293	0	0	0.028852151	2.360915991	0.550239287	0.344009819	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4255	0	0	10.7375	0	4.645534361	0	8.394836363	1.566255246	1.566255246	0.743384529	1.032852153	0.014946013	0.079562023	0	0	0.769301032	10.75504011	21.63988813	0.420079923	0.067341056	1.007443582	0	2.70127293	0	0	0.028852151	2.360915991	0.550239287	0.344009819	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4255	NO																																																																																		0	0	0	10.7375	0	4.645534361	0	8.394836363	1.566255246	1.566255246	0.743384529	1.032852153	0.014946013	0.079562023	0	0	0.769301032	10.75504011	21.63988813	0.420079923	0.067341056	1.007443582	0	2.70127293	0	0	0.028852151	2.360915991	0.550239287	0.344009819	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4255
H3330_021_2	2010	5	N/A																															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	V	V	V	O	O																																																			0	NO	2350.347756	109.3543858	1841.240791	199.3954089	265.030101	9.067014372	9.067014372	212.7094382	234.1786657	10.7695808	17.16456419	0	1.602388878	554.3317428	9375.205725	10927.8586	153.7977522	147.927609	368.8406652	1028.644762	21.39666758	0	0	47.09486435	1359.368471	158.4084188	205.2703442	4.790120855	0	0												$100-150 days 1-7	0	"$25 days 1-20, $50 days 21-100"	0	175	0.2	0.2	$50/$35	150	10	$10/$150	35	0	$10/$35	$5/$15/$0/$0	$20/$35/$35/$35	35	10	35	0	0.2	0	not covered	$5-$10	20	$40 per yr	35	not covered	0	0											76.42829788	0	30.96524729	0	175	0.2	0.2	48.5	150	10	60.4	35	0	15	9.1875	26.75	35	10	35	0	0.2	0	0	7.5	20	40	35	0	0	0											NO	76.42829788	0	30.96524729	0	175	0.2	0.2	48.5	150	10	60.4	35	0	15	9.1875	26.75	35	10	35	0	0.2	0	0	7.5	20	40	35	0	0	0												14.9694	0	4.751206368	0	3.865022306	1.813402874	1.813402874	0.859700646	2.927233321	0.008974651	0.086394973	0	0	0.692914679	7.177891883	24.36001814	0.448576777	0.123273007	1.075785273	0	4.279333516	0	0	0.02943429	2.265614119	0.528028063	0.59870517	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6743	0	0	14.9694	0	4.751206368	0	3.865022306	1.813402874	1.813402874	0.859700646	2.927233321	0.008974651	0.086394973	0	0	0.692914679	7.177891883	24.36001814	0.448576777	0.123273007	1.075785273	0	4.279333516	0	0	0.02943429	2.265614119	0.528028063	0.59870517	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6743	NO																																																																																		0	0	0	14.9694	0	4.751206368	0	3.865022306	1.813402874	1.813402874	0.859700646	2.927233321	0.008974651	0.086394973	0	0	0.692914679	7.177891883	24.36001814	0.448576777	0.123273007	1.075785273	0	4.279333516	0	0	0.02943429	2.265614119	0.528028063	0.59870517	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6743
H3330_021_3	2010	5	N/A																															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	V	V	V	O	O																																																			0	NO	2578.00588	119.9466117	1639.908338	257.8094186	167.42555	7.050369161	7.050369161	237.3437219	288.6615163	18.58488502	29.62060062	0	2.76521562	956.6009942	10330.59668	12041.47441	169.4706863	163.0023395	406.4277909	1133.469972	8.104677227	0	0	47.15690729	1055.72286	123.0243252	138.0053896	3.220448124	0	0												$100-150 days 1-7	0	"$25 days 1-20, $50 days 21-100"	0	175	0.2	0.2	$50/$30	150	10	$10/$150	30	0	$10/$30	$10/$20/$0/$0	$5/$20/$0/$0	30	10	30	0	0.2	0	not covered	$5-$10	20	$40 per yr	30	not covered	0	0											76.42829788	0	30.96524729	0	175	0.2	0.2	48	150	10	60.4	30	0	14	11.2875	24.5	30	10	30	0	0.2	0	0	7.5	20	40	30	0	0	0											NO	76.42829788	0	30.96524729	0	175	0.2	0.2	48	150	10	60.4	30	0	14	11.2875	24.5	30	10	30	0	0.2	0	0	7.5	20	40	30	0	0	0												16.4194	0	4.231680601	0	2.441622605	1.410073832	1.410073832	0.949374888	3.608268954	0.015487404	0.149090356	0	0	1.116034493	9.717217503	24.58467692	0.423676716	0.135835283	1.016069477	0	1.620935445	0	0	0.029473067	1.7595381	0.410081084	0.345013474	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7936	0	0	16.4194	0	4.231680601	0	2.441622605	1.410073832	1.410073832	0.949374888	3.608268954	0.015487404	0.149090356	0	0	1.116034493	9.717217503	24.58467692	0.423676716	0.135835283	1.016069477	0	1.620935445	0	0	0.029473067	1.7595381	0.410081084	0.345013474	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7936	NO																																																																																		0	0	0	16.4194	0	4.231680601	0	2.441622605	1.410073832	1.410073832	0.949374888	3.608268954	0.015487404	0.149090356	0	0	1.116034493	9.717217503	24.58467692	0.423676716	0.135835283	1.016069477	0	1.620935445	0	0	0.029473067	1.7595381	0.410081084	0.345013474	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7936
H3330_023_1	2010	4	N/A																															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	V	V	V	O	O																																																			0	NO	2133.480174	97.33609185	1480.101298	184.1949854	285.6878304	4.560565165	4.560565165	176.732919	170.8015977	16.99312892	44.47351365	0	0.082628213	1236.922458	7504.964096	8747.881261	123.1169365	118.4178168	295.2613554	823.4424113	14.48780761	0	0	2150.891775	833.9482239	97.18072934	80.80438723	1.885624453	0	0												$100 days 1-7	0	"$25 days 1-20, $50 days 21-100"	0	75	0.2	0.2	$50/$20	100	10	$10/$100	20	0	$5/$20	$10/10/$0/$0	$20/$20/$20/$20	20	5	20	0	0.2	0	not covered	$5-$10	20	40	20	not covered	0	0											62.39044725	0	30.96524729	0	75	0.2	0.2	47	100	10	42.4	20	0	8	9.5	20	20	5	20	0	0.2	0	0	7.5	20	40	20	0	0	0											NO	62.39044725	0	30.96524729	0	75	0.2	0.2	47	100	10	42.4	20	0	8	9.5	20	20	5	20	0	0.2	0	0	7.5	20	40	20	0	0	0												11.0924	0	3.81930856	0	1.78554894	0.912113033	0.912113033	0.692203933	1.423346647	0.014160941	0.157139748	0	0	0.824614972	5.941429909	14.5798021	0.205194894	0.049340757	0.492102259	0	2.897561521	0	0	1.344307359	1.389913706	0.323935764	0.134673979	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9912	0	0	11.0924	0	3.81930856	0	1.78554894	0.912113033	0.912113033	0.692203933	1.423346647	0.014160941	0.157139748	0	0	0.824614972	5.941429909	14.5798021	0.205194894	0.049340757	0.492102259	0	2.897561521	0	0	1.344307359	1.389913706	0.323935764	0.134673979	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9912	NO																																																																																		0	0	0	11.0924	0	3.81930856	0	1.78554894	0.912113033	0.912113033	0.692203933	1.423346647	0.014160941	0.157139748	0	0	0.824614972	5.941429909	14.5798021	0.205194894	0.049340757	0.492102259	0	2.897561521	0	0	1.344307359	1.389913706	0.323935764	0.134673979	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9912
H3330_023_2	2010	4	N/A																															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	V	V	V	O	O																																																			0	NO	1987.197884	90.6622326	693.1231996	129.6185144	116.7208993	5.121185824	5.121185824	234.2531336	241.3363458	8.143901121	21.31378508	0	0.039599299	592.7910178	9106.670365	10614.85039	149.3925011	143.6904973	358.2759092	999.181143	19.44749604	0	0	542.0509164	1146.071283	133.5527074	166.4786147	3.884889887	0	0												$100 days 1-7	0	"$25 days 1-20, $50 days 21-100"	0	75	0.2	0.2	$50/$20	100	10	$10/$100	20	0	$10/$20	$10/$10/$0/$0	$20/$20/$20/$20	20	10	20	0	0.2	0	not covered	$5-$10	20	$40 per yr	20	not covered	0	0											62.39044725	0	30.96524729	0	75	0.2	0.2	47	100	10	42.4	20	0	12	9.5	20	20	10	20	0	0.2	0	0	7.5	20	40	20	0	0	0											NO	62.39044725	0	30.96524729	0	75	0.2	0.2	47	100	10	42.4	20	0	12	9.5	20	20	10	20	0	0.2	0	0	7.5	20	40	20	0	0	0												10.3318	0	1.78856094	0	0.729505621	1.024237165	1.024237165	0.91749144	2.011136215	0.006786584	0.075308707	0	0	0.592791018	7.209447372	17.69141731	0.248987502	0.119742081	0.597126515	0	3.889499209	0	0	0.338781823	1.910118805	0.445175691	0.277464358	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2297	0	0	10.3318	0	1.78856094	0	0.729505621	1.024237165	1.024237165	0.91749144	2.011136215	0.006786584	0.075308707	0	0	0.592791018	7.209447372	17.69141731	0.248987502	0.119742081	0.597126515	0	3.889499209	0	0	0.338781823	1.910118805	0.445175691	0.277464358	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2297	NO																																																																																		0	0	0	10.3318	0	1.78856094	0	0.729505621	1.024237165	1.024237165	0.91749144	2.011136215	0.006786584	0.075308707	0	0	0.592791018	7.209447372	17.69141731	0.248987502	0.119742081	0.597126515	0	3.889499209	0	0	0.338781823	1.910118805	0.445175691	0.277464358	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2297
H3330_023_3	2010	4	N/A																															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	V	V	V	O	O																																																			0	NO	2152.418629	98.20012387	1192.781627	179.1103039	145.4015457	4.882137841	4.882137841	235.0894993	181.5018733	14.01136922	36.66981067	0	0.06812956	1019.881467	7991.445756	9314.930449	131.0975385	126.0938157	314.4005855	876.8190333	6.733362609	0	0	493.7437181	874.7565463	101.9361595	115.5745688	2.697009911	0	0												$150 days 1-7	0	"$25 days 1-20, $50 days 21-100"	0	75	0.2	0.2	$50/$20	100	10	$10/$100	20	0	$10/$20	$10/$10/$0/$0	$20/$20/$20/$20	20	10	20	0	0.2	0	not covered	$5-$10	20	$40 per yr	20	not covered	0	0											93.58567088	0	30.96524729	0	75	0.2	0.2	47	100	10	42.4	20	0	12	9.5	20	20	10	20	0	0.2	0	0	7.5	20	40	20	0	0	0											NO	93.58567088	0	30.96524729	0	75	0.2	0.2	47	100	10	42.4	20	0	12	9.5	20	20	10	20	0	0.2	0	0	7.5	20	40	20	0	0	0												16.7863	0	3.077898172	0	0.908759661	0.976427568	0.976427568	0.920767206	1.512515611	0.011676141	0.129566664	0	0	1.019881467	6.326561224	15.52488408	0.218495898	0.10507818	0.524000976	0	1.346672522	0	0	0.308589824	1.457927577	0.339787198	0.192624281	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6648	0	0	16.7863	0	3.077898172	0	0.908759661	0.976427568	0.976427568	0.920767206	1.512515611	0.011676141	0.129566664	0	0	1.019881467	6.326561224	15.52488408	0.218495898	0.10507818	0.524000976	0	1.346672522	0	0	0.308589824	1.457927577	0.339787198	0.192624281	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6648	NO																																																																																		0	0	0	16.7863	0	3.077898172	0	0.908759661	0.976427568	0.976427568	0.920767206	1.512515611	0.011676141	0.129566664	0	0	1.019881467	6.326561224	15.52488408	0.218495898	0.10507818	0.524000976	0	1.346672522	0	0	0.308589824	1.457927577	0.339787198	0.192624281	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6648
H3330_025_1	2010	3	N/A																															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	V	V	V	O	O																																																			0	NO	2265.106586	112.682775	1370.531582	235.4083912	537.7048086	6.37032757	6.37032757	228.4496097	61.34137561	25.9216633	54.78924729	0	0	1480.113736	8921.033773	10398.47002	146.3471823	140.761412	350.9725682	978.8131518	7.48215158	0	0	3374.134961	1146.213058	133.5692286	108.9130548	2.541559023	0	0												$50 days 1-7	0	"$25 days 1-20, $50 days 21-100"	0	100	0.2	0.2	$50/$20	100	20	$20/$100	20	0	$5/$20	$10/10/$0/$0	$20/$20/$20/$20	20	5	20	0	0.2	0	not covered	$5-$10	20	$40 per yr	20	not covered	0	0											31.19522363	0	30.96524729	0	100	0.2	0.2	47	100	20	48.8	20	0	8	9.5	20	20	5	20	0	0.2	0	0	7.5	20	40	20	0	0	0											NO	31.19522363	0	30.96524729	0	100	0.2	0.2	47	100	20	48.8	20	0	8	9.5	20	20	5	20	0	0.2	0	0	7.5	20	40	20	0	0	0												5.8884	0	3.53657078	0	4.480873405	1.274065514	1.274065514	0.894760971	0.51117813	0.043202772	0.222809606	0	0	0.986742491	7.06248507	17.33078337	0.24391197	0.058650588	0.58495428	0	1.496430316	0	0	2.10883435	1.910355096	0.445230762	0.181521758	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5358	0	0	5.8884	0	3.53657078	0	4.480873405	1.274065514	1.274065514	0.894760971	0.51117813	0.043202772	0.222809606	0	0	0.986742491	7.06248507	17.33078337	0.24391197	0.058650588	0.58495428	0	1.496430316	0	0	2.10883435	1.910355096	0.445230762	0.181521758	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5358	NO																																																																																		0	0	0	5.8884	0	3.53657078	0	4.480873405	1.274065514	1.274065514	0.894760971	0.51117813	0.043202772	0.222809606	0	0	0.986742491	7.06248507	17.33078337	0.24391197	0.058650588	0.58495428	0	1.496430316	0	0	2.10883435	1.910355096	0.445230762	0.181521758	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5358
H3330_025_2	2010	3	N/A																															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	V	V	V	O	O																																																			0	NO	2294.179891	114.1290914	1421.84655	195.4739076	191.7745623	7.523616122	7.523616122	182.9585057	193.339496	11.64252997	24.60819917	0	0	664.7825151	8403.295742	9794.988011	137.8538278	132.5922314	330.6036456	922.0070902	16.05997751	0	0	1490.419903	1186.194638	138.2283177	177.1231981	4.133288365	0	0												$100 days 1-7	0	"$25 days 1-20, $50 days 21-100"	0	150	0.2	0.2	$50/$20	100	20	$20/$100	20	0	$10/$20	$10/10/$0/$0	$20/$20/$20/$20	20	10	20	0	0.2	0	not covered	$5-$10	20	40	20	not covered	0	0											62.39044725	0	30.96524729	0	150	0.2	0.2	47	100	20	48.8	20	0	12	9.5	20	20	10	20	0	0.2	0	0	7.5	20	40	20	0	0	0											NO	62.39044725	0	30.96524729	0	150	0.2	0.2	47	100	20	48.8	20	0	12	9.5	20	20	10	20	0	0.2	0	0	7.5	20	40	20	0	0	0												11.9279	0	3.668985835	0	2.397182029	1.504723224	1.504723224	0.716587481	1.611162467	0.019404217	0.100073343	0	0	0.664782515	6.652609129	16.32498002	0.22975638	0.110493526	0.551006076	0	3.211995502	0	0	0.93151244	1.976991063	0.460761059	0.29520533	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8608	0	0	11.9279	0	3.668985835	0	2.397182029	1.504723224	1.504723224	0.716587481	1.611162467	0.019404217	0.100073343	0	0	0.664782515	6.652609129	16.32498002	0.22975638	0.110493526	0.551006076	0	3.211995502	0	0	0.93151244	1.976991063	0.460761059	0.29520533	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8608	NO																																																																																		0	0	0	11.9279	0	3.668985835	0	2.397182029	1.504723224	1.504723224	0.716587481	1.611162467	0.019404217	0.100073343	0	0	0.664782515	6.652609129	16.32498002	0.22975638	0.110493526	0.551006076	0	3.211995502	0	0	0.93151244	1.976991063	0.460761059	0.29520533	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8608
H3330_025_3	2010	3	N/A																															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	V	V	V	O	O																																																			0	NO	2154.990403	107.2048001	1344.600482	218.896444	152.0858218	8.106401462	8.106401462	207.303405	147.5262485	17.24981464	36.4600199	0	0	984.9556061	10427.82842	12154.80896	171.0657471	164.5365201	410.2530958	1144.138209	10.05141642	0	0	472.4853486	1182.657832	137.8161706	163.5742075	3.817113601	0	0												$100 days 1-7	0	"$25 days 1-20, $50 days 21-100"	0	150	0.2	0.2	$50/$30	100	25	$25/$100	30	0	$10/$30	$15/15/$0/$0	$30/$30/$30/$30	30	10	30	0	0.2	0	not covered	$5-$10	20	40	30	not covered	0	0											62.39044725	0	30.96524729	0	150	0.2	0.2	48	100	25	52	30	0	14	14.25	30	30	10	30	0	0.2	0	0	7.5	20	40	30	0	0	0											NO	62.39044725	0	30.96524729	0	150	0.2	0.2	48	100	25	52	30	0	14	14.25	30	30	10	30	0	0.2	0	0	7.5	20	40	30	0	0	0												11.2042	0	3.469657202	0	1.901072772	1.621280292	1.621280292	0.82921362	1.229385404	0.035937114	0.15799342	0	0	1.149114874	12.38304625	30.38702241	0.427664368	0.137113767	1.02563274	0	2.010283284	0	0	0.295303343	1.971096386	0.459387235	0.408935519	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7247	0	0	11.2042	0	3.469657202	0	1.901072772	1.621280292	1.621280292	0.82921362	1.229385404	0.035937114	0.15799342	0	0	1.149114874	12.38304625	30.38702241	0.427664368	0.137113767	1.02563274	0	2.010283284	0	0	0.295303343	1.971096386	0.459387235	0.408935519	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7247	NO																																																																																		0	0	0	11.2042	0	3.469657202	0	1.901072772	1.621280292	1.621280292	0.82921362	1.229385404	0.035937114	0.15799342	0	0	1.149114874	12.38304625	30.38702241	0.427664368	0.137113767	1.02563274	0	2.010283284	0	0	0.295303343	1.971096386	0.459387235	0.408935519	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7247
H3330_029_0	2010	3	N/A																															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	V	V	V	O	O																																																			0	NO	2632.164753	102.2585766	1557.192322	285.203165	585.4413278	12.16726945	12.16726945	341.5990961	107.0038667	27.11383427	52.17356866	0	0.083314094	1501.434498	10893.26286	12697.32523	178.701075	171.8804232	428.5642828	1195.205536	13.54366187	0	0	916.2332028	1296.689198	151.1043472	113.4152386	2.646620494	0	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-$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	0	0	0	0	0	7.5	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.5	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	0.572645752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.572645752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5726	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.572645752	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5726
H3330_031_1	2010	4	N/A																															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	V	V	V	O	O																																																			0	NO	2464.722033	107.3797358	1547.058426	356.1231905	1473.204957	8.476492165	8.476492165	357.7327188	52.47530466	50.11118758	82.93122014	0	0	1665.106474	9544.402856	11125.07693	156.573386	150.5973026	375.4972426	1047.209021	14.80236797	0	0	2014.956271	1479.103935	172.361299	157.7242763	3.680601543	0	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-$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	0	0	0	0	0	7.5	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.5	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	1.25934767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2593			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.25934767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2593	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.25934767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2593
H3330_031_2	2010	3	N/A																															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	V	V	V	O	O																																																			0	NO	2260.754936	98.49356818	1453.548094	364.5254674	320.3347184	7.784466592	7.784466592	313.4206883	132.2330521	25.54230351	42.2710875	0	0	848.7257433	9722.289499	11332.42385	159.491569	153.4041046	382.495684	1066.72669	17.0806237	0	0	2457.512231	1490.80323	173.7246283	225.6141288	5.264856685	0	1305												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	$5-$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	0	0	0	0	0	7.5	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.5	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	1.535945144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5359			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.535945144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5359	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.535945144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.5359
H3330_808_0	2010	3	N/A																															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																																																			0	NO	382.3498217	17.78955043	47.31526139	10.40238082	17.00080562	7.484977506	7.484977506	7.039607027	20.2187464	1.117750142	1.781470831	0	0.166308274	57.53282283	179.5258801	209.257641	2.945074233	2.83266682	7.062932481	19.69752576	15.23251713	0	0	0	0	0	0	0	0	0												Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	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	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	3.96118771	1.743999759	1.743999759	1.640228437	4.71096791	0.260435783	0.415082704	0	0.038749828	13.40514772	41.82953006	48.75703034	0.686202296	0.660011369	1.645663268	4.589523501	3.549176491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6369			0	0	0	0	3.96118771	1.743999759	1.743999759	1.640228437	4.71096791	0.260435783	0.415082704	0	0.038749828	13.40514772	41.82953006	48.75703034	0.686202296	0.660011369	1.645663268	4.589523501	3.549176491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6369	NO																																																																																		0			0	0	0	0	3.96118771	1.743999759	1.743999759	1.640228437	4.71096791	0.260435783	0.415082704	0	0.038749828	13.40514772	41.82953006	48.75703034	0.686202296	0.660011369	1.645663268	4.589523501	3.549176491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.6369
H3330_810_0	2010	3	N/A																															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																																																			0	NO	493.1204105	19.1575361	48.05326999	12.61808685	22.6601734	11.20226403	11.20226403	10.93000126	10.84195043	1.681825748	3.236239119	0	0.005167834	93.13146833	198.7502596	231.6658213	3.260445057	3.13600059	7.819260729	21.80681892	16.02754738	0	0	0	0	0	0	0	0	0												Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	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	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												30.36	1.179474205	6.950362929	0	5.279820401	2.610127518	2.610127518	2.546690294	2.526174451	0.391865399	0.754043715	0	0.001204105	21.69963212	46.30881049	53.97813637	0.759683698	0.730688137	1.82188775	5.080988807	3.73441854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	189.3241			30.36	1.179474205	6.950362929	0	5.279820401	2.610127518	2.610127518	2.546690294	2.526174451	0.391865399	0.754043715	0	0.001204105	21.69963212	46.30881049	53.97813637	0.759683698	0.730688137	1.82188775	5.080988807	3.73441854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	189.3241	NO																																																																																		0			30.36	1.179474205	6.950362929	0	5.279820401	2.610127518	2.610127518	2.546690294	2.526174451	0.391865399	0.754043715	0	0.001204105	21.69963212	46.30881049	53.97813637	0.759683698	0.730688137	1.82188775	5.080988807	3.73441854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	189.3241
H3330_814_0	2010	2	N/A																															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																																																			0	NO	357.7966346	16.64716684	43.43347011	9.548959118	15.60604256	6.87090248	6.87090248	6.58754774	18.92036823	1.045972082	1.667070917	0	0.15562853	53.83826335	164.8053979	192.0992604	2.703588646	2.600398239	6.483797197	18.08239887	13.98282622	0	0	0	0	0	0	0	0	0												Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	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	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.0285	1.024918016	6.28216104	0	3.636207916	1.600920278	1.600920278	1.534898623	4.408445797	0.243711495	0.388427524	0	0.036261448	12.54431536	38.39965772	44.75912768	0.629936154	0.60589279	1.510724747	4.213198936	3.257998509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.7062			22.0285	1.024918016	6.28216104	0	3.636207916	1.600920278	1.600920278	1.534898623	4.408445797	0.243711495	0.388427524	0	0.036261448	12.54431536	38.39965772	44.75912768	0.629936154	0.60589279	1.510724747	4.213198936	3.257998509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.7062	NO																																																																																		0			22.0285	1.024918016	6.28216104	0	3.636207916	1.600920278	1.600920278	1.534898623	4.408445797	0.243711495	0.388427524	0	0.036261448	12.54431536	38.39965772	44.75912768	0.629936154	0.60589279	1.510724747	4.213198936	3.257998509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.7062
H3330_815_0	2010	2	N/A																															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																																																			0	NO	349.661308	17.394681	38.83613679	9.67153487	15.17573124	6.723471426	6.723471426	7.389642832	8.451920719	1.026930015	2.170567602	0	0	58.63717941	150.8227064	175.800858	2.474206317	2.379770961	5.933688177	16.54822215	10.35238856	0	0	0	0	0	0	0	0	0												Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	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	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.5276	1.070940305	5.617208684	0	3.535945378	1.566568842	1.566568842	1.72178678	1.969297527	0.239274694	0.505742251	0	0	13.6624628	35.1416906	40.96159991	0.576490072	0.554486634	1.382549345	3.85573576	2.412106534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8681	0	0	21.5276	1.070940305	5.617208684	0	3.535945378	1.566568842	1.566568842	1.72178678	1.969297527	0.239274694	0.505742251	0	0	13.6624628	35.1416906	40.96159991	0.576490072	0.554486634	1.382549345	3.85573576	2.412106534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8681	NO																																																																																		0	0	0	21.5276	1.070940305	5.617208684	0	3.535945378	1.566568842	1.566568842	1.72178678	1.969297527	0.239274694	0.505742251	0	0	13.6624628	35.1416906	40.96159991	0.576490072	0.554486634	1.382549345	3.85573576	2.412106534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.8681
H3333_031_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1541.244036	20.94310521	475.2901511	4.857268919	238.6894884	20.16403324	18.79310812	81.46052252	1840.021831		11.61595131		4.10587392	0.060129227	6409.699464	4665.418141	1.425764803	752.4546317	19.17565467		2.778897996				1352.162344		18.6337531														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.77609084		0.2		50	0.5	10	34.99739521	0.5	15	0.2		0.2				20		20														NO	108.6032587	97.49377494	27.21227728	0.13159696	87.73130689	0.175462614	0.175462614	43.86565344	26.12295363		0.175462614		43.86565344	0.438656534	8.773130689	30.70367219	0.438656534	13.15969603	0.175462614		0.175462614				17.54626138		17.54626138															13.9487	0.170151865	1.077810615	0.639201825	1.745045063	3.538033976	3.297487872	0.297776587	4.005567082	0	2.038165178	0	0.015008904	0.026376078	4.686094256	11.93712244	0.625421047	0.825172853	3.36461049	0	0.487592706	0	0	0	1.97711616	0	0.027246059	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7297	0	7.653614757	13.9487	0.170151865	1.077810615	0.639201825	1.745045063	3.538033976	3.297487872	0.297776587	4.005567082	0	2.038165178	0	0.015008904	0.026376078	4.686094256	11.93712244	0.625421047	0.825172853	3.36461049	0	0.487592706	0	0	0	1.97711616	0	0.027246059	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7297	NO																																																																																		0	0	0	13.9487	0.170151865	1.077810615	0.639201825	1.745045063	3.538033976	3.297487872	0.297776587	4.005567082	0	2.038165178	0	0.015008904	0.026376078	4.686094256	11.93712244	0.625421047	0.825172853	3.36461049	0	0.487592706	0	0	0	1.97711616	0	0.027246059	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7297
H3333_032_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1727.813801	25.77864679	389.5275772	5.13269288	212.4200874	18.79476087	20.47894065	57.74220598	1774.374781		15.92789295		1.251320947	0.006191033	6152.911938	3819.198372	0.932057027	703.659479	16.99487163		2.740198248				1446.443593		18.01902163														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.57097317		0.2		50	0.5	10	34.99202743	0.5	15	0.2		0.2				20		20														NO	108.9463606	97.80177949	27.29824693	0.132012704	88.00846963	0.176016939	0.176016939	44.00423481	26.02496094		0.176016939		44.00423481	0.440042348	8.800846963	30.79594784	0.440042348	13.20127044	0.176016939		0.176016939				17.60169393		17.60169393															15.6866	0.210099794	0.886118332	0.677580668	1.557897234	3.308196282	3.604640452	0.211741799	3.848169532	0	2.803578966	0	0.004588618	0.002724317	4.512569695	9.801319487	0.410144563	0.774099924	2.991385287	0	0.482321308	0	0	0	2.121654784	0	0.026430442	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9218	0	7.347082254	15.6866	0.210099794	0.886118332	0.677580668	1.557897234	3.308196282	3.604640452	0.211741799	3.848169532	0	2.803578966	0	0.004588618	0.002724317	4.512569695	9.801319487	0.410144563	0.774099924	2.991385287	0	0.482321308	0	0	0	2.121654784	0	0.026430442	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9218	NO																																																																																		0	0	0	15.6866	0.210099794	0.886118332	0.677580668	1.557897234	3.308196282	3.604640452	0.211741799	3.848169532	0	2.803578966	0	0.004588618	0.002724317	4.512569695	9.801319487	0.410144563	0.774099924	2.991385287	0	0.482321308	0	0	0	2.121654784	0	0.026430442	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9218
H3333_033_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1965.074932	11.66668132	520.0503355	6.371368049	226.343869	15.73572494	21.84093637	49.96164944	1904.478716		14.89580351		1.838462862		6340.595773	4598.520893	1.541062987	651.6037658	21.06187469		3.698555922				1494.932944		15.232978														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.76038961		0.2		50		10	34.37629709	0.5	15	0.2		0.2				20		20														NO	107.1706091	96.20767706	26.85330408	0.129860987	86.57399148	0.173147983	0.173147983	43.28699574	25.76475717		0.173147983		43.28699574		8.657399148	30.2989192	0.432869957	12.98609872	0.173147983		0.173147983				17.3147983		17.3147983															17.5499	0.093535359	1.163755817	0.827392145	1.632957682	2.724609034	3.781714078	0.180224142	4.089035971	0	2.579178332	0	0.006631795	0	4.57442237	11.61085108	0.66707987	0.705149236	3.646821119	0	0.640397498	0	0	0	2.157038533	0	0.021979662	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6526	0	8.857793288	17.5499	0.093535359	1.163755817	0.827392145	1.632957682	2.724609034	3.781714078	0.180224142	4.089035971	0	2.579178332	0	0.006631795	0	4.57442237	11.61085108	0.66707987	0.705149236	3.646821119	0	0.640397498	0	0	0	2.157038533	0	0.021979662	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6526	NO																																																																																		0	0	0	17.5499	0.093535359	1.163755817	0.827392145	1.632957682	2.724609034	3.781714078	0.180224142	4.089035971	0	2.579178332	0	0.006631795	0	4.57442237	11.61085108	0.66707987	0.705149236	3.646821119	0	0.640397498	0	0	0	2.157038533	0	0.021979662	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6526
H3333_034_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2662.879945	20.7703403	253.4685149	5.870882557	231.4801	20.57470307	30.94607001	51.45793058	1906.731687		16.91674172		2.741412834	0.003169227	6661.446139	3843.819731	1.307061438	700.8037476	19.46621094		2.499481791				1654.281094		14.9464178														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.53469595		0.2		50	0.5	10	34.4773142	0.5	15	0.2		0.2				20		20														NO	104.9568598	94.2203815	26.29861392	0.127178538	84.78569232	0.169571385	0.169571385	42.39284616	25.04119643		0.169571385		42.39284616	0.423928462	8.478569232	29.66678922	0.423928462	12.71785385	0.169571385		0.169571385				16.95713846		16.95713846															23.2906	0.163082449	0.555489218	0.746650263	1.635516712	3.488880888	5.247567941	0.181787345	3.978903559	0	2.868595317	0	0.009684691	0.001343525	4.706627689	9.502815815	0.554100545	0.742726636	3.300912343	0	0.423840588	0	0	0	2.337656131	0	0.021120706	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7579	0	11.27666903	23.2906	0.163082449	0.555489218	0.746650263	1.635516712	3.488880888	5.247567941	0.181787345	3.978903559	0	2.868595317	0	0.009684691	0.001343525	4.706627689	9.502815815	0.554100545	0.742726636	3.300912343	0	0.423840588	0	0	0	2.337656131	0	0.021120706	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7579	NO																																																																																		0	0	0	23.2906	0.163082449	0.555489218	0.746650263	1.635516712	3.488880888	5.247567941	0.181787345	3.978903559	0	2.868595317	0	0.009684691	0.001343525	4.706627689	9.502815815	0.554100545	0.742726636	3.300912343	0	0.423840588	0	0	0	2.337656131	0	0.021120706	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7579
H3333_035_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2229.838723	19.91515096	851.7161172	10.04454037	275.0890215	22.9870362	25.65365812	70.80470692	2259.005782		18.44516942		2.6986107	0.007241056	7419.327575	4650.262613	2.016979864	774.0776948	20.33346854		3.079652028				1570.449235		19.63424544														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.57878869		0.2		50	0.5	10	34.26877164	0.5	15	0.2		0.2				20		20														NO	104.383373	93.70555911	26.15491767	0.126483632	84.32242129	0.168644843	0.168644843	42.16121064	24.94155081		0.168644843		42.16121064	0.421612106	8.432242129	29.50390427	0.421612106	12.64836319	0.168644843		0.168644843				16.86448426		16.86448426															19.3965	0.155513363	1.856380411	1.270469947	1.933014364	3.876645101	4.326357136	0.24876768	4.695258957	0	3.110682693	0	0.009481391	0.003052917	5.213463879	11.43340858	0.850383129	0.815901319	3.429134602	0	0.519367431	0	0	0	2.207068034	0	0.027593452	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3785	0	11.87617936	19.3965	0.155513363	1.856380411	1.270469947	1.933014364	3.876645101	4.326357136	0.24876768	4.695258957	0	3.110682693	0	0.009481391	0.003052917	5.213463879	11.43340858	0.850383129	0.815901319	3.429134602	0	0.519367431	0	0	0	2.207068034	0	0.027593452	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3785	NO																																																																																		0	0	0	19.3965	0.155513363	1.856380411	1.270469947	1.933014364	3.876645101	4.326357136	0.24876768	4.695258957	0	3.110682693	0	0.009481391	0.003052917	5.213463879	11.43340858	0.850383129	0.815901319	3.429134602	0	0.519367431	0	0	0	2.207068034	0	0.027593452	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3785
H3333_036_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2458.300299	89.0334848	389.5264772	6.7946529	285.8445782	25.87330705	22.01342649	63.19311969	2316.04386		19.81205877		3.676619996	0.033721419	7554.021491	4622.019393	1.385506055	846.4536862	20.20411291		4.503208764				1543.935165		22.17824623														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.70842767		0.2		50	0.5	10	34.32945012	0.5	15	0.2		0.2				20		20														NO	103.8337791	93.21218546	26.01720816	0.125817677	83.87845125	0.167756903	0.167756903	41.93922563	24.91896902		0.167756903		41.93922563	0.419392256	8.387845125	29.33562548	0.419392256	12.58176769	0.167756903		0.167756903				16.77569025		16.77569025															21.2712	0.691583808	0.84453262	0.854887443	1.99801671	4.340425849	3.692904242	0.220855875	4.809452099	0	3.323609612	0	0.01284955	0.014142502	5.280163528	11.29915249	0.58107051	0.887490303	3.3893794	0	0.755444354	0	0	0	2.158381507	0	0.031004616	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4566	0	12.52479007	21.2712	0.691583808	0.84453262	0.854887443	1.99801671	4.340425849	3.692904242	0.220855875	4.809452099	0	3.323609612	0	0.01284955	0.014142502	5.280163528	11.29915249	0.58107051	0.887490303	3.3893794	0	0.755444354	0	0	0	2.158381507	0	0.031004616	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4566	NO																																																																																		0	0	0	21.2712	0.691583808	0.84453262	0.854887443	1.99801671	4.340425849	3.692904242	0.220855875	4.809452099	0	3.323609612	0	0.01284955	0.014142502	5.280163528	11.29915249	0.58107051	0.887490303	3.3893794	0	0.755444354	0	0	0	2.158381507	0	0.031004616	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4566
H3333_037_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1493.140967	19.16927681	656.197606	6.908105841	261.2955701	19.35880023	18.34385402	76.52666955	1849.215777		11.20132607		1.462684222		5447.645201	3303.853755	1.357591362	543.4998604	17.59157596		3.411672968				1057.616627		14.33977545														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.65533006		0.2		48.6465662		20	44.31893043	0.5	35	0.2		0.2				20		20														NO	158.0758567	143.1184815	26.40561678	0.170261331	127.6959979	0.170261331	0.170261331	42.56533264	41.42060618		0.170261331		41.50433731		17.02613306	38.05482311	0.425653326	29.79573285	0.170261331		0.170261331				17.02613306		17.02613306															19.6691	0.228623149	1.443941876	1.176183292	2.780533215	3.296055086	3.123248994	0.271448595	6.382969869	0	1.90715268	0	0.005058978	0	7.729361003	10.47729752	0.577863279	1.349498054	2.995165129	0	0.580875979	0	0	0	1.500593451	0	0.02034591	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5153	0	11.33784021	19.6691	0.228623149	1.443941876	1.176183292	2.780533215	3.296055086	3.123248994	0.271448595	6.382969869	0	1.90715268	0	0.005058978	0	7.729361003	10.47729752	0.577863279	1.349498054	2.995165129	0	0.580875979	0	0	0	1.500593451	0	0.02034591	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5153	NO																																																																																		0	0	0	19.6691	0.228623149	1.443941876	1.176183292	2.780533215	3.296055086	3.123248994	0.271448595	6.382969869	0	1.90715268	0	0.005058978	0	7.729361003	10.47729752	0.577863279	1.349498054	2.995165129	0	0.580875979	0	0	0	1.500593451	0	0.02034591	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5153
H3333_038_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1614.446032	11.94602146	443.8106022	6.18919881	198.9002449	17.78998003	18.35412544	60.14887507	1447.851877		11.65093229		1.493311851		4865.859581	2426.21872	0.945575535	379.7912778	12.99943578		2.050282942				920.3717654		10.41633934														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.72034034		0.2		48.6465662		20	44.03167784	0.5	35	0.2		0.2				20		20														NO	161.423335	146.1492164	26.9647928	0.173866853	130.4001401	0.173866853	0.173866853	43.46671335	42.35426135		0.173866853		42.37026271		17.38668534	38.65738311	0.434667134	30.42669935	0.173866853		0.173866853				17.38668534		17.38668534															21.7174	0.145491806	0.997271744	1.076096522	2.161384982	3.09308785	3.191174038	0.217872826	5.110224733	0	2.025710937	0	0.005272668	0	7.050097454	7.81593888	0.411010607	0.962982919	2.260170996	0	0.356476244	0	0	0	1.333517857	0	0.015092135	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9463	0	8.922072474	21.7174	0.145491806	0.997271744	1.076096522	2.161384982	3.09308785	3.191174038	0.217872826	5.110224733	0	2.025710937	0	0.005272668	0	7.050097454	7.81593888	0.411010607	0.962982919	2.260170996	0	0.356476244	0	0	0	1.333517857	0	0.015092135	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9463	NO																																																																																		0	0	0	21.7174	0.145491806	0.997271744	1.076096522	2.161384982	3.09308785	3.191174038	0.217872826	5.110224733	0	2.025710937	0	0.005272668	0	7.050097454	7.81593888	0.411010607	0.962982919	2.260170996	0	0.356476244	0	0	0	1.333517857	0	0.015092135	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9463
H3333_039_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1547.387272	35.32372012	364.852866	7.38651318	234.8400459	19.71498	25.16929732	51.29497894	1509.338105		12.20671315		1.952738823		5166.238651	3142.314132	0.974643574	329.842507	14.32918564		2.376241837				926.9179643		11.8940948														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.48043154		0.2		48.6465662		20	43.88309899	0.5	35	0.2		0.2				20		20														NO	159.2594032	144.190039	26.60332106	0.171536112	128.6520841	0.171536112	0.171536112	42.88402805	41.58072372		0.171536112		41.81049701		17.15361122	37.99432779	0.42884028	30.01881963	0.171536112		0.171536112				17.15361122		17.15361122															20.5363	0.424444048	0.808858161	1.267053754	2.517721779	3.381831021	4.317443409	0.183311276	5.229947562	0	2.093892116	0	0.006803748	0	7.384970774	9.949176096	0.417966424	0.825123561	2.457972795	0	0.407611286	0	0	0	1.324999199	0	0.017002223	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5525	0	10.43668861	20.5363	0.424444048	0.808858161	1.267053754	2.517721779	3.381831021	4.317443409	0.183311276	5.229947562	0	2.093892116	0	0.006803748	0	7.384970774	9.949176096	0.417966424	0.825123561	2.457972795	0	0.407611286	0	0	0	1.324999199	0	0.017002223	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5525	NO																																																																																		0	0	0	20.5363	0.424444048	0.808858161	1.267053754	2.517721779	3.381831021	4.317443409	0.183311276	5.229947562	0	2.093892116	0	0.006803748	0	7.384970774	9.949176096	0.417966424	0.825123561	2.457972795	0	0.407611286	0	0	0	1.324999199	0	0.017002223	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5525
H3333_040_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2158.144554	27.0466364	611.430706	9.604578395	240.0436104	23.49362671	25.88506046	68.35883494	1552.752523		12.79536779		8.325045962		5740.060406	2918.653474	1.025811247	496.9795053	17.34332538		2.057660581				1040.056204		16.24138752														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.32904497		0.2		49.45034414		20	43.99642881	0.5	35	0.2		0.2				20		20														NO	153.8156381	139.2613712	25.693973	0.165672708	124.2545308	0.165672708	0.165672708	41.41817693	40.03401871		0.165672708		41.00561125		16.56727077	36.77417838	0.414181769	28.99272385	0.165672708		0.165672708				16.56727077		16.56727077															27.663	0.313879306	1.309173671	1.591216509	2.485542181	3.892252751	4.288448055	0.235941527	5.180243628	0	2.119843229	0	0.0284478	0	7.924761249	8.944256956	0.424872317	1.200732463	2.873315676	0	0.3408982	0	0	0	1.435907729	0	0.022422955	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2752	0	14.87870151	27.663	0.313879306	1.309173671	1.591216509	2.485542181	3.892252751	4.288448055	0.235941527	5.180243628	0	2.119843229	0	0.0284478	0	7.924761249	8.944256956	0.424872317	1.200732463	2.873315676	0	0.3408982	0	0	0	1.435907729	0	0.022422955	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2752	NO																																																																																		0	0	0	27.663	0.313879306	1.309173671	1.591216509	2.485542181	3.892252751	4.288448055	0.235941527	5.180243628	0	2.119843229	0	0.0284478	0	7.924761249	8.944256956	0.424872317	1.200732463	2.873315676	0	0.3408982	0	0	0	1.435907729	0	0.022422955	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2752
H3333_041_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1879.284254	36.33148556	355.8530245	11.52224228	265.8780289	25.02596439	25.98618637	79.31700558	1779.332916		13.85779251		4.541615643		6186.380604	3219.937851	1.296038367	494.9129776	16.12791748		2.764035593				991.9758263		15.17556083														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	154.1842389	139.5950944	25.75554553	0.166069723	124.5522919	0.166069723	0.166069723	41.51743064	40.20911957		0.166069723		40.49765394		16.60697225	36.74551852	0.415174306	29.06220145	0.166069723		0.166069723				16.60697225		16.60697225															24.1463	0.42264143	0.763765731	1.913495578	2.759643155	4.156054963	4.31551876	0.274419856	5.962117496	0	2.301359757	0	0.015327065	0	8.561420921	9.859857161	0.53808183	1.198605054	2.678358782	0	0.459022624	0	0	0	1.372809585	0	0.021001676	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7198	0	14.53381139	24.1463	0.42264143	0.763765731	1.913495578	2.759643155	4.156054963	4.31551876	0.274419856	5.962117496	0	2.301359757	0	0.015327065	0	8.561420921	9.859857161	0.53808183	1.198605054	2.678358782	0	0.459022624	0	0	0	1.372809585	0	0.021001676	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7198	NO																																																																																		0	0	0	24.1463	0.42264143	0.763765731	1.913495578	2.759643155	4.156054963	4.31551876	0.274419856	5.962117496	0	2.301359757	0	0.015327065	0	8.561420921	9.859857161	0.53808183	1.198605054	2.678358782	0	0.459022624	0	0	0	1.372809585	0	0.021001676	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7198
H3333_042_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2456.912445	47.49855102	465.2301654	15.06378845	347.5999102	32.71809639	33.973458	103.6963608	2326.239458		18.11720755		5.937554135		8087.864017	4209.637451	1.69439657	647.032428	21.08509189		3.613606314				1296.875525		19.84001312														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	143.9274266	130.3087971	24.04220701	0.155022251	116.2666883	0.155022251	0.155022251	38.75556278	37.53428461		0.155022251		37.84442261		15.50222511	34.4460573	0.387555628	27.12889395	0.155022251		0.155022251				15.50222511		15.50222511															29.4681	0.515789921	0.932096662	2.335222396	3.367857536	5.072032954	5.266641938	0.334900902	7.27614449	0	2.808570298	0	0.018725276	0	10.44832406	12.0837844	0.656672926	1.462772843	3.268658409	0	0.560189385	0	0	0	1.67537136	0	0.025630362	0	0	0	0	0	0	0	0	0	0	0	0	0	87.5775	0	25.18761402	29.4681	0.515789921	0.932096662	2.335222396	3.367857536	5.072032954	5.266641938	0.334900902	7.27614449	0	2.808570298	0	0.018725276	0	10.44832406	12.0837844	0.656672926	1.462772843	3.268658409	0	0.560189385	0	0	0	1.67537136	0	0.025630362	0	0	0	0	0	0	0	0	0	0	0	0	0	87.5775	NO																																																																																		0	0	0	29.4681	0.515789921	0.932096662	2.335222396	3.367857536	5.072032954	5.266641938	0.334900902	7.27614449	0	2.808570298	0	0.018725276	0	10.44832406	12.0837844	0.656672926	1.462772843	3.268658409	0	0.560189385	0	0	0	1.67537136	0	0.025630362	0	0	0	0	0	0	0	0	0	0	0	0	0	87.5775
H3333_049_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1463.116093	38.65162726	317.5351983	4.59083574	192.436049	17.57695421	19.00563662	70.7277988	1674.173585		12.31284938		0.899445989	0.051095984	6167.051425	4814.734381	1.975423519	1019.971752	17.8004166		2.118772222				1360.861782		17.53919679														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.67746016		0.2		50	0.5	10	34.88476788	0.5	15	0.2		0.2				20		20														NO	109.1944509	98.02449156	27.3604099	0.132313321	88.20888059	0.176417761	0.176417761	44.10444029	26.17815539		0.176417761		44.10444029	0.441044403	8.820888059	30.87310821	0.441044403	13.23133209	0.176417761		0.176417761				17.64177612		17.64177612															13.3137	0.315733843	0.723991099	0.607428722	1.414547372	3.10088691	3.352931863	0.259950832	3.652231354	0	2.172205321	0	0.003305797	0.022535598	4.53323919	12.38715129	0.871249486	1.124632081	3.140309644	0	0.373789052	0	0	0	2.00066824	0	0.025785215	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3963	0	7.091387049	13.3137	0.315733843	0.723991099	0.607428722	1.414547372	3.10088691	3.352931863	0.259950832	3.652231354	0	2.172205321	0	0.003305797	0.022535598	4.53323919	12.38715129	0.871249486	1.124632081	3.140309644	0	0.373789052	0	0	0	2.00066824	0	0.025785215	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3963	NO																																																																																		0	0	0	13.3137	0.315733843	0.723991099	0.607428722	1.414547372	3.10088691	3.352931863	0.259950832	3.652231354	0	2.172205321	0	0.003305797	0.022535598	4.53323919	12.38715129	0.871249486	1.124632081	3.140309644	0	0.373789052	0	0	0	2.00066824	0	0.025785215	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3963
H3333_050_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1365.364558	17.96532313	252.7310629	5.608664058	163.6441164	18.88858581	20.68566421	36.98639636	1906.259402		16.56442682		10.03436152		6611.077525	4540.367946	0.917566463	762.7570099	18.02182344		2.773077529				1498.641822		20.15414864														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.4255808		0.2		50		10	34.98861826	0.5	15	0.2		0.2				20		20														NO	109.3284064	98.14474426	27.3939746	0.132475638	88.31709187	0.176634184	0.176634184	44.15854594	25.98781723		0.176634184		44.15854594		8.831709187	30.90093013	0.441585459	13.24756378	0.176634184		0.176634184				17.66341837		17.66341837															12.4394	0.146933504	0.57694236	0.743011348	1.204381038	3.336369937	3.653795412	0.136105457	4.128293411	0	2.925844011	0	0.036925235	0	4.865592843	11.69179939	0.405184008	0.842056011	3.183270073	0	0.489820286	0	0	0	2.205928124	0	0.02966593	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0413	0	7.016503365	12.4394	0.146933504	0.57694236	0.743011348	1.204381038	3.336369937	3.653795412	0.136105457	4.128293411	0	2.925844011	0	0.036925235	0	4.865592843	11.69179939	0.405184008	0.842056011	3.183270073	0	0.489820286	0	0	0	2.205928124	0	0.02966593	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0413	NO																																																																																		0	0	0	12.4394	0.146933504	0.57694236	0.743011348	1.204381038	3.336369937	3.653795412	0.136105457	4.128293411	0	2.925844011	0	0.036925235	0	4.865592843	11.69179939	0.405184008	0.842056011	3.183270073	0	0.489820286	0	0	0	2.205928124	0	0.02966593	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0413
H3333_051_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1568.285088	9.729587559	359.3326284	7.663785501	170.8382801	17.9450031	23.82877548	49.34608193	2026.308346		16.16844857		2.224424876	0.003537633	6554.085755	4173.98477	1.567546324	699.8685013	20.47264919		2.759135147				1190.983713		16.12959899														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.7006211		0.2		50	0.5	10	34.89547649	0.5	15	0.2		0.2				20		20														NO	108.5659152	97.46025146	27.20292027	0.13155171	87.70114025	0.175402281	0.175402281	43.85057013	26.04778336		0.175402281		43.85057013	0.438505701	8.770114025	30.69033628	0.438505701	13.15517104	0.175402281		0.175402281				17.54022805		17.54022805															14.1885	0.079020671	0.814574737	1.008184091	1.24855933	3.147594467	4.179621561	0.180321152	4.398403402	0	2.835982751	0	0.008128525	0.001551272	4.790006617	10.67508302	0.687378	0.76724082	3.590949356	0	0.483958597	0	0	0	1.740843828	0	0.023576404	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8495	0	7.657528046	14.1885	0.079020671	0.814574737	1.008184091	1.24855933	3.147594467	4.179621561	0.180321152	4.398403402	0	2.835982751	0	0.008128525	0.001551272	4.790006617	10.67508302	0.687378	0.76724082	3.590949356	0	0.483958597	0	0	0	1.740843828	0	0.023576404	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8495	NO																																																																																		0	0	0	14.1885	0.079020671	0.814574737	1.008184091	1.24855933	3.147594467	4.179621561	0.180321152	4.398403402	0	2.835982751	0	0.008128525	0.001551272	4.790006617	10.67508302	0.687378	0.76724082	3.590949356	0	0.483958597	0	0	0	1.740843828	0	0.023576404	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8495
H3333_052_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1677.036289	16.51708698	313.9874533	6.847522729	193.9670971	16.1523123	21.04891202	52.80135497	1950.420381		14.96698838		2.238154647	0.006005536	6540.154159	4257.487939	1.224599157	725.8310738	18.98061817		2.398501879				1372.861188		15.23601882														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.47358975		0.2		50	0.5	10	34.99039222	0.5	15	0.2		0.2				20		20														NO	108.6169706	97.50608422	27.21571303	0.131613575	87.74238359	0.175484767	0.175484767	43.87119179	25.86083017		0.175484767		43.87119179	0.438711918	8.774238359	30.70140416	0.438711918	13.16135754	0.175484767		0.175484767				17.54847672		17.54847672															15.1796	0.134209706	0.712116035	0.901226949	1.418261286	2.834484763	3.693763425	0.193038198	4.203290852	0	2.626478471	0	0.008182543	0.0026347	4.782072625	10.89257149	0.537246245	0.796076856	3.33080936	0	0.420900544	0	0	0	2.007635216	0	0.022280743	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6968	0	7.641150549	15.1796	0.134209706	0.712116035	0.901226949	1.418261286	2.834484763	3.693763425	0.193038198	4.203290852	0	2.626478471	0	0.008182543	0.0026347	4.782072625	10.89257149	0.537246245	0.796076856	3.33080936	0	0.420900544	0	0	0	2.007635216	0	0.022280743	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6968	NO																																																																																		0	0	0	15.1796	0.134209706	0.712116035	0.901226949	1.418261286	2.834484763	3.693763425	0.193038198	4.203290852	0	2.626478471	0	0.008182543	0.0026347	4.782072625	10.89257149	0.537246245	0.796076856	3.33080936	0	0.420900544	0	0	0	2.007635216	0	0.022280743	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6968
H3333_053_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1805.988588	22.16950833	394.0198704	8.899442204	228.9622807	22.58095271	22.57103144	62.77890969	2221.886077		16.84507218		3.004088321	0.00806073	7433.810226	4890.541594	1.309840189	1020.549728	19.35048181		2.862971559				1606.141353		20.70849365														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.52753381		0.2		50	0.5	10	34.36327081	0.5	15	0.2		0.2				20		20														NO	106.2326507	95.36566639	26.61828366	0.128724442	85.81629493	0.17163259	0.17163259	42.90814747	25.3394355		0.17163259		42.90814747	0.429081475	8.581629493	30.02606911	0.429081475	12.87244424	0.17163259		0.17163259				17.16325899		17.16325899															15.9879	0.176184161	0.874011057	1.145575735	1.637391218	3.875627395	3.873924581	0.224477226	4.691778245	0	2.891163366	0	0.010741655	0.00345871	5.316183757	12.23697833	0.56202816	1.094747456	3.321173308	0	0.491379223	0	0	0	2.297218335	0	0.02961877	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7416	0	9.784438074	15.9879	0.176184161	0.874011057	1.145575735	1.637391218	3.875627395	3.873924581	0.224477226	4.691778245	0	2.891163366	0	0.010741655	0.00345871	5.316183757	12.23697833	0.56202816	1.094747456	3.321173308	0	0.491379223	0	0	0	2.297218335	0	0.02961877	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7416	NO																																																																																		0	0	0	15.9879	0.176184161	0.874011057	1.145575735	1.637391218	3.875627395	3.873924581	0.224477226	4.691778245	0	2.891163366	0	0.010741655	0.00345871	5.316183757	12.23697833	0.56202816	1.094747456	3.321173308	0	0.491379223	0	0	0	2.297218335	0	0.02961877	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7416
H3333_054_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1869.997798	24.62473167	349.9171647	8.54023423	223.2707205	21.92656238	22.5335531	64.42641918	1945.40125		14.4149895		3.336784366	0.008953438	6851.569131	4260.422908	1.26531916	727.9726756	18.24657905		2.754760484				1358.700562		20.18524173														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.54379242		0.2		50	0.5	10	34.5397289	0.5	15	0.2		0.2				20		20														NO	107.4541886	96.46224803	26.92435945	0.130204607	86.80307117	0.173606142	0.173606142	43.40153559	25.64491916		0.173606142		43.40153559	0.434015356	8.680307117	30.3686499	0.434015356	13.02046068	0.173606142		0.173606142				17.36061423		17.36061423															16.7449	0.197946415	0.78510796	1.11197784	1.615048687	3.80658591	3.911963226	0.233017127	4.157471483	0	2.502530719	0	0.012068464	0.00388593	4.956143691	10.78194098	0.549167945	0.7898783	3.167718201	0	0.478243341	0	0	0	1.96565636	0	0.02920235	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8005	0	8.629248176	16.7449	0.197946415	0.78510796	1.11197784	1.615048687	3.80658591	3.911963226	0.233017127	4.157471483	0	2.502530719	0	0.012068464	0.00388593	4.956143691	10.78194098	0.549167945	0.7898783	3.167718201	0	0.478243341	0	0	0	1.96565636	0	0.02920235	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8005	NO																																																																																		0	0	0	16.7449	0.197946415	0.78510796	1.11197784	1.615048687	3.80658591	3.911963226	0.233017127	4.157471483	0	2.502530719	0	0.012068464	0.00388593	4.956143691	10.78194098	0.549167945	0.7898783	3.167718201	0	0.478243341	0	0	0	1.96565636	0	0.02920235	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8005
H3333_055_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1371.462119	26.51395395	259.6940521	8.408690049	194.0321929	18.2634224	18.9641722	57.88388228	1298.519734		10.11312548		3.314375566		4514.690437	2349.842914	0.945821539	361.1770808	11.76981494		2.017135035				723.9230923		11.07480508														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	163.9461908	148.4333557	27.38622061	0.176584187	132.43814	0.176584187	0.176584187	44.14604666	42.75490177		0.176584187		43.02287483		17.65841866	38.93403764	0.441460467	30.90223266	0.176584187		0.176584187				17.65841866		17.65841866															18.7372	0.32796293	0.592669883	1.484841693	2.14143856	3.225031591	3.348772924	0.212945381	4.626506974	0	1.785818037	0	0.01188283	0	6.64352449	7.624072705	0.417542818	0.930098182	2.078363198	0	0.35619415	0	0	0	1.065278087	0	0.016296962	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6264	0	7.319690166	18.7372	0.32796293	0.592669883	1.484841693	2.14143856	3.225031591	3.348772924	0.212945381	4.626506974	0	1.785818037	0	0.01188283	0	6.64352449	7.624072705	0.417542818	0.930098182	2.078363198	0	0.35619415	0	0	0	1.065278087	0	0.016296962	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6264	NO																																																																																		0	0	0	18.7372	0.32796293	0.592669883	1.484841693	2.14143856	3.225031591	3.348772924	0.212945381	4.626506974	0	1.785818037	0	0.01188283	0	6.64352449	7.624072705	0.417542818	0.930098182	2.078363198	0	0.35619415	0	0	0	1.065278087	0	0.016296962	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6264
H3333_056_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1358.979549	15.71939341	238.2098879	8.443587492	181.6797202	15.38793018	15.02887899	45.59089252	1412.425138		11.16461738		4.625135997		4552.030122	2325.53413	1.168689786	508.0767515	13.02316184		1.556951794				785.652024		13.21628197														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.52662631		0.2		49.42498984		20	43.10841608	0.5	35	0.2		0.2				20		20														NO	164.1882473	148.6525085	27.42665469	0.176844902	132.6336768	0.176844902	0.176844902	44.2112256	42.90843247		0.176844902		43.73295366		17.68449024	38.42733737	0.442112256	30.94785792	0.176844902		0.176844902				17.68449024		17.68449024															18.594	0.194727272	0.544441695	1.493205406	2.008070774	2.721277011	2.657780637	0.167969103	5.050412388	0	1.974405671	0	0.016855905	0	6.708361022	7.447007048	0.516692078	1.310323926	2.303079784	0	0.275338988	0	0	0	1.157821296	0	0.019476934	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1613	0	7.154599145	18.594	0.194727272	0.544441695	1.493205406	2.008070774	2.721277011	2.657780637	0.167969103	5.050412388	0	1.974405671	0	0.016855905	0	6.708361022	7.447007048	0.516692078	1.310323926	2.303079784	0	0.275338988	0	0	0	1.157821296	0	0.019476934	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1613	NO																																																																																		0	0	0	18.594	0.194727272	0.544441695	1.493205406	2.008070774	2.721277011	2.657780637	0.167969103	5.050412388	0	1.974405671	0	0.016855905	0	6.708361022	7.447007048	0.516692078	1.310323926	2.303079784	0	0.275338988	0	0	0	1.157821296	0	0.019476934	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1613
H3333_057_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1435.126617	71.88996409	293.930665	9.044626451	201.7528272	18.49463285	19.52528947	46.6489718	1600.037592		11.46328223		2.568687477		5240.134851	2842.707902	2.260791437	367.2614403	12.72970872		2.330464452				876.2489699		12.38070054														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.61560472		0.2		48.6465662		20	43.96902757	0.5	35	0.2		0.2				20		20														NO	160.7166604	145.5094084	26.84674708	0.173105704	129.8292779	0.173105704	0.173105704	43.27642598	42.07819238		0.173105704		42.18746018		17.31057039	38.3254549	0.43276426	30.29349818	0.173105704		0.173105704				17.31057039		17.31057039															19.2207	0.871722178	0.657590185	1.565676428	2.182785323	3.201526438	3.379938977	0.168233398	5.610557468	0	1.98435954	0	0.009030533	0	7.5591436	9.079006126	0.978389733	0.927136148	2.203585188	0	0.403416689	0	0	0	1.264030789	0	0.017859749	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2847	0	9.447757215	19.2207	0.871722178	0.657590185	1.565676428	2.182785323	3.201526438	3.379938977	0.168233398	5.610557468	0	1.98435954	0	0.009030533	0	7.5591436	9.079006126	0.978389733	0.927136148	2.203585188	0	0.403416689	0	0	0	1.264030789	0	0.017859749	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2847	NO																																																																																		0	0	0	19.2207	0.871722178	0.657590185	1.565676428	2.182785323	3.201526438	3.379938977	0.168233398	5.610557468	0	1.98435954	0	0.009030533	0	7.5591436	9.079006126	0.978389733	0.927136148	2.203585188	0	0.403416689	0	0	0	1.264030789	0	0.017859749	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2847
H3333_058_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1388.585169	26.84498735	262.9363978	8.513674666	196.4547337	18.49144584	19.20094468	58.60657715	1314.732081		10.2393904		3.355756381		4571.057487	2379.181295	0.95763036	365.6864678	11.91676405		2.042319475				732.9614548		11.21307682														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	163.5844218	148.1058178	27.32578929	0.17619453	132.1458977	0.17619453	0.17619453	44.04863255	42.66055741		0.17619453		42.92929245		17.61945302	38.85293312	0.440486326	30.83404279	0.17619453		0.17619453				17.61945302		17.61945302															18.9292	0.331324901	0.598745384	1.500062908	2.163390595	3.258091613	3.383101427	0.215128299	4.673933618	0	1.804124582	0	0.012005021	0	6.711627721	7.70318098	0.421823078	0.939632683	2.099668643	0	0.35984552	0	0	0	1.076198327	0	0.016464023	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1976	0	7.534404161	18.9292	0.331324901	0.598745384	1.500062908	2.163390595	3.258091613	3.383101427	0.215128299	4.673933618	0	1.804124582	0	0.012005021	0	6.711627721	7.70318098	0.421823078	0.939632683	2.099668643	0	0.35984552	0	0	0	1.076198327	0	0.016464023	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1976	NO																																																																																		0	0	0	18.9292	0.331324901	0.598745384	1.500062908	2.163390595	3.258091613	3.383101427	0.215128299	4.673933618	0	1.804124582	0	0.012005021	0	6.711627721	7.70318098	0.421823078	0.939632683	2.099668643	0	0.35984552	0	0	0	1.076198327	0	0.016464023	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1976
H3333_059_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1631.470401	31.54059488	308.9280801	10.00284932	230.8177347	21.7258885	22.55948977	68.85778276	1544.699254		12.0304197		3.942730579		5370.606828	2795.33726	1.125134865	429.650742	14.00119218		2.399553047				861.1678599		13.17441907														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	158.8816819	143.8480582	26.54022499	0.171129274	128.3469553	0.171129274	0.171129274	42.78231843	41.4341478		0.171129274		41.71278809		17.11292737	37.79863206	0.427823184	29.9476229	0.171129274		0.171129274				17.11292737		17.11292737															21.6009	0.378087777	0.683251729	1.71178034	2.468729457	3.71793552	3.860589099	0.245491299	5.3336081	0	2.058756985	0	0.01370519	0	7.658900383	8.804993714	0.481358781	1.072251533	2.39601385	0	0.41063377	0	0	0	1.22809192	0	0.01878774	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1439	0	10.73585265	21.6009	0.378087777	0.683251729	1.71178034	2.468729457	3.71793552	3.860589099	0.245491299	5.3336081	0	2.058756985	0	0.01370519	0	7.658900383	8.804993714	0.481358781	1.072251533	2.39601385	0	0.41063377	0	0	0	1.22809192	0	0.01878774	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1439	NO																																																																																		0	0	0	21.6009	0.378087777	0.683251729	1.71178034	2.468729457	3.71793552	3.860589099	0.245491299	5.3336081	0	2.058756985	0	0.01370519	0	7.658900383	8.804993714	0.481358781	1.072251533	2.39601385	0	0.41063377	0	0	0	1.22809192	0	0.01878774	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1439
H3333_060_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1359.97094	26.29179938	257.5181329	8.33823549	192.4064399	18.11039722	18.80527559	57.39888599	1287.639724		10.02838983		3.286605144		4476.862842	2330.154098	0.937896709	358.1508577	11.67119825		2.000233906				717.8575004		10.98201173														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	164.1488515	148.6168404	27.42007386	0.17680247	132.6018523	0.17680247	0.17680247	44.20061742	42.80775288		0.17680247		43.07529908		17.68024697	38.97947188	0.442006174	30.94043219	0.17680247		0.17680247				17.68024697		17.68024697															18.6031	0.325617013	0.588430519	1.474220627	2.12612086	3.201962955	3.324819167	0.211422183	4.593413592	0	1.773044089	0	0.011797625	0	6.596003391	7.569014678	0.414556136	0.923445194	2.063496675	0	0.353646294	0	0	0	1.057658158	0	0.01618039	0	0	0	0	0	0	0	0	0	0	0	0	0	55.228	0	7.190697407	18.6031	0.325617013	0.588430519	1.474220627	2.12612086	3.201962955	3.324819167	0.211422183	4.593413592	0	1.773044089	0	0.011797625	0	6.596003391	7.569014678	0.414556136	0.923445194	2.063496675	0	0.353646294	0	0	0	1.057658158	0	0.01618039	0	0	0	0	0	0	0	0	0	0	0	0	0	55.228	NO																																																																																		0	0	0	18.6031	0.325617013	0.588430519	1.474220627	2.12612086	3.201962955	3.324819167	0.211422183	4.593413592	0	1.773044089	0	0.011797625	0	6.596003391	7.569014678	0.414556136	0.923445194	2.063496675	0	0.353646294	0	0	0	1.057658158	0	0.01618039	0	0	0	0	0	0	0	0	0	0	0	0	0	55.228
H3333_104_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1856.432733	15.23921663	216.5490997	7.549354364	208.1814426	20.7883484	22.91001	45.8518109	1766.140948		12.25578759		2.064996301	0.005540908	6175.628903	3868.699237	1.086369692	674.3859889	14.24896259		3.304620944				1366.391479		20.43060139														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.49852713		0.2		50	0.5	15	38.5718153	0.5	15	0.2		0.2				25		25														NO	133.414958	120.381573	26.74339518	0.129329474	129.3294743	0.172439299	0.172439299	43.10982475	25.4335267		0.172439299		43.10982475	0.431098248	12.93294743	33.87663435	0.431098248	12.93294743	0.172439299		0.172439299				21.55491238		21.55491238															20.6397	0.152876739	0.482604846	0.976354031	2.243666377	3.584728226	3.950586064	0.164721961	3.743266079	0	2.113379421	0	0.007418469	0.002388676	6.655756993	10.92154246	0.468332071	0.726816545	2.457081121	0	0.569846519	0	0	0	2.454370716	0	0.036698319	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3521	0	9.733750717	20.6397	0.152876739	0.482604846	0.976354031	2.243666377	3.584728226	3.950586064	0.164721961	3.743266079	0	2.113379421	0	0.007418469	0.002388676	6.655756993	10.92154246	0.468332071	0.726816545	2.457081121	0	0.569846519	0	0	0	2.454370716	0	0.036698319	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3521	NO																																																																																		0	0	0	20.6397	0.152876739	0.482604846	0.976354031	2.243666377	3.584728226	3.950586064	0.164721961	3.743266079	0	2.113379421	0	0.007418469	0.002388676	6.655756993	10.92154246	0.468332071	0.726816545	2.457081121	0	0.569846519	0	0	0	2.454370716	0	0.036698319	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3521
H3333_105_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1473.427575	19.40256759	275.7102709	6.729107716	175.9217239	17.27659876	17.75486502	50.7635157	1532.840225		11.3580043		2.629152881	0.007054683	5398.557635	3356.9155	0.996983067	573.5915921	14.37702908		2.170558737				1070.561086		15.90455979														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.54379242		0.2		50	0.5	15	38.77810224	0.5	15	0.2		0.2				25		25														NO	137.3175955	123.9029595	27.52568959	0.133112604	133.1126037	0.177483472	0.177483472	44.3708679	26.21767421		0.177483472		44.3708679	0.443708679	13.31126037	34.95955546	0.443708679	13.31126037	0.177483472		0.177483472				22.18543395		22.18543395															16.8606	0.200336296	0.632426278	0.895729049	1.951449892	3.066310725	3.151195082	0.187701771	3.348958804	0	2.015858033	0	0.009721483	0.003130224	5.988467191	9.779689467	0.44237004	0.636268919	2.551685033	0	0.3852383	0	0	0	1.979238522	0	0.02940413	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1158	0	6.69293504	16.8606	0.200336296	0.632426278	0.895729049	1.951449892	3.066310725	3.151195082	0.187701771	3.348958804	0	2.015858033	0	0.009721483	0.003130224	5.988467191	9.779689467	0.44237004	0.636268919	2.551685033	0	0.3852383	0	0	0	1.979238522	0	0.02940413	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1158	NO																																																																																		0	0	0	16.8606	0.200336296	0.632426278	0.895729049	1.951449892	3.066310725	3.151195082	0.187701771	3.348958804	0	2.015858033	0	0.009721483	0.003130224	5.988467191	9.779689467	0.44237004	0.636268919	2.551685033	0	0.3852383	0	0	0	1.979238522	0	0.02940413	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1158
H3333_106_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1796.78125	34.73648646	340.2306174	11.01640097	254.2056403	23.92729226	24.84535925	75.83488667	1701.217904		13.24941753		4.342232855		5914.790512	3078.578424	1.23914061	473.1856591	15.41988109		2.642690863				948.4268073		14.50933412														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		25	48.43330576	0.5	50	0.2		0.2				25		25														NO	177.3668503	160.9932662	25.39358684	0.163735841	122.8018811	0.163735841	0.163735841	40.93396037	39.64403582		0.163735841		39.93713416		20.46698019	40.04646692	0.409339604	40.93396037	0.163735841		0.163735841				20.46698019		20.46698019															26.5575	0.466028367	0.719972977	1.803779683	2.601410901	3.917755332	4.068075804	0.258685187	5.62026196	0	2.169404529	0	0.014451361	0	10.08815835	10.27384908	0.507229326	1.614113585	2.524787206	0	0.432703212	0	0	0	1.61761939	0	0.024746855	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2805	0	16.54922705	26.5575	0.466028367	0.719972977	1.803779683	2.601410901	3.917755332	4.068075804	0.258685187	5.62026196	0	2.169404529	0	0.014451361	0	10.08815835	10.27384908	0.507229326	1.614113585	2.524787206	0	0.432703212	0	0	0	1.61761939	0	0.024746855	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2805	NO																																																																																		0	0	0	26.5575	0.466028367	0.719972977	1.803779683	2.601410901	3.917755332	4.068075804	0.258685187	5.62026196	0	2.169404529	0	0.014451361	0	10.08815835	10.27384908	0.507229326	1.614113585	2.524787206	0	0.432703212	0	0	0	1.61761939	0	0.024746855	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2805
H3333_107_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1752.854513	33.8872676	331.9128431	10.74707795	247.9909581	23.34233074	24.23795333	73.98091633	1659.627448		12.92550293		4.236076292		5770.188909	3003.315001	1.20884677	461.6174718	15.04290417		2.578083784				925.2401811		14.15461776														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		25	48.43330576	0.5	50	0.2		0.2				25		25														NO	178.3468819	161.8828264	25.53389783	0.164640556	123.4804167	0.164640556	0.164640556	41.16013892	39.86308694		0.164640556		40.15441609		20.58006946	40.25570083	0.411601389	41.16013892	0.164640556		0.164640556				20.58006946		20.58006946															26.0513	0.457147221	0.706252385	1.769404886	2.551835571	3.843094304	3.990550104	0.253755399	5.513156104	0	2.128061985	0	0.014174764	0	9.895907377	10.07504585	0.49756301	1.583353272	2.476672101	0	0.424457147	0	0	0	1.586792266	0	0.024275251	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8428	0	15.7418658	26.0513	0.457147221	0.706252385	1.769404886	2.551835571	3.843094304	3.990550104	0.253755399	5.513156104	0	2.128061985	0	0.014174764	0	9.895907377	10.07504585	0.49756301	1.583353272	2.476672101	0	0.424457147	0	0	0	1.586792266	0	0.024275251	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8428	NO																																																																																		0	0	0	26.0513	0.457147221	0.706252385	1.769404886	2.551835571	3.843094304	3.990550104	0.253755399	5.513156104	0	2.128061985	0	0.014174764	0	9.895907377	10.07504585	0.49756301	1.583353272	2.476672101	0	0.424457147	0	0	0	1.586792266	0	0.024275251	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8428
H3333_112_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1491.237869	8.131031167	782.5227136	6.312925612	297.5216413	22.91538766	30.15823552	45.12368835	1904.261076		13.46853117		2.591982845	0.016092347	6097.319971	4246.346764	1.382266999	601.8438534	18.359583		1.433927856				1244.485437		15.10707058														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.18571549		0.2		44.34936897	0.5	15	39.08608735	0.5	15	0.2		0.2				25		25														NO	132.8426997	119.8652189	26.62868443	0.12877474	128.7747399	0.171699653	0.171699653	42.9249133	25.05588614		0.171699653		39.47065738	0.429249133	12.87747399	34.04189912	0.429249133	12.87747399	0.171699653		0.171699653				21.46245665		21.46245665															16.5083	0.081218986	1.736462533	0.812945354	3.192772664	3.934564113	5.178158579	0.161410868	3.976079059	0	2.31254213	0	0.008525606	0.006907626	6.543173277	12.04614235	0.593336911	0.645852381	3.152334033	0	0.246204916	0	0	0	2.225809562	0	0.027019571	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3898	0	10.2473	16.5083	0.081218986	1.736462533	0.812945354	3.192772664	3.934564113	5.178158579	0.161410868	3.976079059	0	2.31254213	0	0.008525606	0.006907626	6.543173277	12.04614235	0.593336911	0.645852381	3.152334033	0	0.246204916	0	0	0	2.225809562	0	0.027019571	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3898	NO																																																																																		0	0	0	16.5083	0.081218986	1.736462533	0.812945354	3.192772664	3.934564113	5.178158579	0.161410868	3.976079059	0	2.31254213	0	0.008525606	0.006907626	6.543173277	12.04614235	0.593336911	0.645852381	3.152334033	0	0.246204916	0	0	0	2.225809562	0	0.027019571	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3898
H3333_113_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2125.39486	21.57751029	346.1090394	8.632625033	264.0824042	20.65156473	26.35915169	65.39604493	2118.862907		16.2766362		10.90925448	0.006662018	7118.733211	4284.044304	2.109463324	610.7621694	18.62236038		2.307529497				1312.639997		21.76046107														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.50856983		0.2		50	0.5	15	39.01477833	0.5	15	0.2		0.2				25		25														NO	129.6718009	117.004087	25.99306903	0.125700941	125.7009415	0.167601255	0.167601255	41.90031383	24.72836673		0.167601255		41.90031383	0.419003138	12.57009415	33.2998028	0.419003138	12.57009415	0.167601255		0.167601255				20.95015691		20.95015691															22.967	0.210388074	0.749703013	1.085129094	2.766283903	3.461228173	4.417826912	0.2283429	4.366334919	0	2.72798466	0	0.038091766	0.002791407	7.45692889	11.88815254	0.883871753	0.639778164	3.121130976	0	0.38674484	0	0	0	2.291667825	0	0.037990423	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7274	0	13.22107533	22.967	0.210388074	0.749703013	1.085129094	2.766283903	3.461228173	4.417826912	0.2283429	4.366334919	0	2.72798466	0	0.038091766	0.002791407	7.45692889	11.88815254	0.883871753	0.639778164	3.121130976	0	0.38674484	0	0	0	2.291667825	0	0.037990423	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7274	NO																																																																																		0	0	0	22.967	0.210388074	0.749703013	1.085129094	2.766283903	3.461228173	4.417826912	0.2283429	4.366334919	0	2.72798466	0	0.038091766	0.002791407	7.45692889	11.88815254	0.883871753	0.639778164	3.121130976	0	0.38674484	0	0	0	2.291667825	0	0.037990423	0	0	0	0	0	0	0	0	0	0	0	0	0	69.7274
H3333_114_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1607.078784	31.06904106	304.3093905	9.853299771	227.3668491	21.40107136	22.22220971	67.82831102	1521.604926		11.85055656		3.883784015		5290.312521	2753.545024	1.108313316	423.2271646	13.79186462		2.36367806				848.2928016		12.97745234														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		25	48.43330576	0.5	50	0.2		0.2				25		25														NO	181.9831375	165.1834017	26.05450002	0.167997357	125.9980181	0.167997357	0.167997357	41.99933937	40.67584223		0.167997357		40.96060707		20.99966969	41.03203088	0.419993394	41.99933937	0.167997357		0.167997357				20.99966969		20.99966969															24.3718	0.427674158	0.660719085	1.655328324	2.387314364	3.595323436	3.733272508	0.237395354	5.157713493	0	1.990862186	0	0.013256846	0	9.25790129	9.415295371	0.465484271	1.481271776	2.316996812	0	0.397091668	0	0	0	1.484489053	0	0.022710184	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0719	0	13.06254836	24.3718	0.427674158	0.660719085	1.655328324	2.387314364	3.595323436	3.733272508	0.237395354	5.157713493	0	1.990862186	0	0.013256846	0	9.25790129	9.415295371	0.465484271	1.481271776	2.316996812	0	0.397091668	0	0	0	1.484489053	0	0.022710184	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0719	NO																																																																																		0	0	0	24.3718	0.427674158	0.660719085	1.655328324	2.387314364	3.595323436	3.733272508	0.237395354	5.157713493	0	1.990862186	0	0.013256846	0	9.25790129	9.415295371	0.465484271	1.481271776	2.316996812	0	0.397091668	0	0	0	1.484489053	0	0.022710184	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0719
H3333_115_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1687.643167	32.62656153	319.5647086	10.34725503	238.7649647	22.47392735	23.33623014	71.22860854	1597.884423		12.44463619		4.078481789		5555.520901	2891.582846	1.163874113	444.4439434	14.48326387		2.482171481				890.8185237		13.62802433														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		25	48.43330576	0.5	50	0.2		0.2				25		25														NO	179.8958729	163.2888225	25.75566664	0.166070503	124.5528776	0.166070503	0.166070503	41.51762587	40.20930865		0.166070503		40.49784149		20.75881293	40.58640592	0.415176259	41.51762587	0.166070503		0.166070503				20.75881293		20.75881293															25.3	0.443962735	0.685883509	1.718373852	2.478238619	3.73225643	3.875459488	0.246436893	5.35415233	0	2.066686997	0	0.013764142	0	9.610501596	9.779912928	0.4832129	1.537688114	2.405242923	0	0.412215468	0	0	0	1.541027924	0	0.023575134	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7086	0	14.54329936	25.3	0.443962735	0.685883509	1.718373852	2.478238619	3.73225643	3.875459488	0.246436893	5.35415233	0	2.066686997	0	0.013764142	0	9.610501596	9.779912928	0.4832129	1.537688114	2.405242923	0	0.412215468	0	0	0	1.541027924	0	0.023575134	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7086	NO																																																																																		0	0	0	25.3	0.443962735	0.685883509	1.718373852	2.478238619	3.73225643	3.875459488	0.246436893	5.35415233	0	2.066686997	0	0.013764142	0	9.610501596	9.779912928	0.4832129	1.537688114	2.405242923	0	0.412215468	0	0	0	1.541027924	0	0.023575134	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7086
H3333_120_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1799.352867	15.97915871	240.5825746	5.938615803	228.3839617	24.98238027	23.68168141	54.06792885	2142.737038		16.47476529		2.165262456	0.005809948	6927.600889	4015.818863	1.523346635	908.5491733	19.10762599		5.051478928				1272.263627		14.4003211														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.61106097		0.2		50	0.5	15	39.31678949	0.5	15	0.2		0.2				25		25														NO	131.5058791	118.6589931	26.36071505	0.127478856	127.4788559	0.169971808	0.169971808	42.49295195	25.16522782		0.169971808		42.49295195	0.42492952	12.74788559	33.97700481	0.42492952	12.74788559	0.169971808		0.169971808				21.24647598		21.24647598															19.7188	0.158005907	0.528494058	0.757047948	2.426177178	4.246300338	4.025218202	0.191458825	4.49353881	0	2.80024564	0	0.007667366	0.002468818	7.359355294	11.37045807	0.647314954	0.965173409	3.247757733	0	0.858609005	0	0	0	2.252593216	0	0.02549634	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0822	0	11.45265164	19.7188	0.158005907	0.528494058	0.757047948	2.426177178	4.246300338	4.025218202	0.191458825	4.49353881	0	2.80024564	0	0.007667366	0.002468818	7.359355294	11.37045807	0.647314954	0.965173409	3.247757733	0	0.858609005	0	0	0	2.252593216	0	0.02549634	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0822	NO																																																																																		0	0	0	19.7188	0.158005907	0.528494058	0.757047948	2.426177178	4.246300338	4.025218202	0.191458825	4.49353881	0	2.80024564	0	0.007667366	0.002468818	7.359355294	11.37045807	0.647314954	0.965173409	3.247757733	0	0.858609005	0	0	0	2.252593216	0	0.02549634	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0822
H3333_121_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2301.687749	30.3093636	430.6957215	10.51175168	274.8128807	26.98832055	27.73543538	79.29929108	2394.498126		17.74269722		4.107082748	0.011020344	8433.257377	5243.94372	1.557418736	896.025541	22.45881118		3.390698354				1672.357283		24.84501514														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.54379242		0.2		50	0.5	15	38.77810224	0.5	15	0.2		0.2				25		25														NO	125.689756	113.4110504	25.19485718	0.121840836	121.8408363	0.162454448	0.162454448	40.6136121	23.9976025		0.162454448		40.6136121	0.406136121	12.18408363	32.41080429	0.406136121	12.18408363	0.162454448		0.162454448				20.30680605		20.30680605															24.1082	0.286451397	0.904276433	1.280760616	2.790285934	4.384372727	4.505744855	0.268385887	4.788517852	0	2.882380089	0	0.013900289	0.00447576	8.562626096	14.16336947	0.632524004	0.909770844	3.648533782	0	0.550834031	0	0	0	2.830019582	0	0.042043575	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5575	0	17.4337687	24.1082	0.286451397	0.904276433	1.280760616	2.790285934	4.384372727	4.505744855	0.268385887	4.788517852	0	2.882380089	0	0.013900289	0.00447576	8.562626096	14.16336947	0.632524004	0.909770844	3.648533782	0	0.550834031	0	0	0	2.830019582	0	0.042043575	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5575	NO																																																																																		0	0	0	24.1082	0.286451397	0.904276433	1.280760616	2.790285934	4.384372727	4.505744855	0.268385887	4.788517852	0	2.882380089	0	0.013900289	0.00447576	8.562626096	14.16336947	0.632524004	0.909770844	3.648533782	0	0.550834031	0	0	0	2.830019582	0	0.042043575	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5575
H3333_122_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1957.252346	37.83881294	370.6167204	12.00027919	276.9088256	26.06424622	27.06430606	82.60772415	1853.154208		14.43272716		4.730039032		6443.042305	3353.527227	1.349808647	515.4460186	16.7970355		2.878710412				1033.131103		15.8051673														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		25	48.43330576	0.5	50	0.2		0.2				25		25														NO	173.4053198	157.3974435	24.82641507	0.160078763	120.0590721	0.160078763	0.160078763	40.01969069	38.7585769		0.160078763		39.05882676		20.00984534	39.2006916	0.400196907	40.01969069	0.160078763		0.160078763				20.00984534		20.00984534															28.2832	0.496311035	0.766757045	1.920989846	2.770451388	4.172332288	4.33242063	0.275494631	5.985468324	0	2.310373108	0	0.015395815	0	10.74369001	10.95504888	0.540189245	1.718999186	2.688848661	0	0.460820401	0	0	0	1.722732799	0	0.026354913	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1858	0	19.84521087	28.2832	0.496311035	0.766757045	1.920989846	2.770451388	4.172332288	4.33242063	0.275494631	5.985468324	0	2.310373108	0	0.015395815	0	10.74369001	10.95504888	0.540189245	1.718999186	2.688848661	0	0.460820401	0	0	0	1.722732799	0	0.026354913	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1858	NO																																																																																		0	0	0	28.2832	0.496311035	0.766757045	1.920989846	2.770451388	4.172332288	4.33242063	0.275494631	5.985468324	0	2.310373108	0	0.015395815	0	10.74369001	10.95504888	0.540189245	1.718999186	2.688848661	0	0.460820401	0	0	0	1.722732799	0	0.026354913	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1858
H3333_123_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1839.341352	35.55928468	348.2896117	11.2773449	260.2269732	24.49405463	25.43386774	77.63117686	1741.514411		13.5632546		4.445086708		6054.893314	3151.500273	1.268491958	484.3939406	15.78512963		2.705287906				970.8920584		14.85301466														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		25	48.43330576	0.5	50	0.2		0.2				25		25														NO	176.4619571	160.171908	25.2640334	0.162900491	122.1753684	0.162900491	0.162900491	40.7251228	39.4417792		0.162900491		39.73651108		20.3625614	39.85327483	0.407251228	40.7251228	0.162900491		0.162900491				20.3625614		20.3625614															27.0478	0.474633206	0.733266699	1.837085023	2.649443859	3.99009353	4.143189548	0.263461601	5.724035572	0	2.209460837	0	0.014719353	0	10.27442807	10.46646721	0.516594908	1.643916893	2.571405369	0	0.440692729	0	0	0	1.647487429	0	0.025203785	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6734	0	17.33146992	27.0478	0.474633206	0.733266699	1.837085023	2.649443859	3.99009353	4.143189548	0.263461601	5.724035572	0	2.209460837	0	0.014719353	0	10.27442807	10.46646721	0.516594908	1.643916893	2.571405369	0	0.440692729	0	0	0	1.647487429	0	0.025203785	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6734	NO																																																																																		0	0	0	27.0478	0.474633206	0.733266699	1.837085023	2.649443859	3.99009353	4.143189548	0.263461601	5.724035572	0	2.209460837	0	0.014719353	0	10.27442807	10.46646721	0.516594908	1.643916893	2.571405369	0	0.440692729	0	0	0	1.647487429	0	0.025203785	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6734
H3333_128_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2681.869597	20.86846251	307.5803053	10.09973485	283.5811365	26.45394861	39.82097833	70.33288339	2336.658167		18.36879475		2.827789573	0.007587676	8057.393266	5220.538486	2.355268942	1014.871407	23.1423634		3.38224435				1519.01033		21.66278596														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.52202201		0.2		50	0.5	15	38.94930851	0.5	15	0.2		0.2				25		25														NO	123.3022232	111.2567571	24.71626968	0.119526415	119.5264155	0.159368554	0.159368554	39.84213849	23.52440979		0.159368554		39.84213849	0.398421385	11.95264155	31.86385025	0.398421385	11.95264155	0.159368554		0.159368554				19.92106925		19.92106925															27.5567	0.193479789	0.633519815	1.207185104	2.824619728	4.215927537	6.346211734	0.233517707	4.580708689	0	2.927408258	0	0.009388765	0.003023092	8.02559446	13.86220471	0.938389514	1.010866179	3.68816499	0	0.539023391	0	0	0	2.521692498	0	0.035962155	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3536	0	20.28960572	27.5567	0.193479789	0.633519815	1.207185104	2.824619728	4.215927537	6.346211734	0.233517707	4.580708689	0	2.927408258	0	0.009388765	0.003023092	8.02559446	13.86220471	0.938389514	1.010866179	3.68816499	0	0.539023391	0	0	0	2.521692498	0	0.035962155	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3536	NO																																																																																		0	0	0	27.5567	0.193479789	0.633519815	1.207185104	2.824619728	4.215927537	6.346211734	0.233517707	4.580708689	0	2.927408258	0	0.009388765	0.003023092	8.02559446	13.86220471	0.938389514	1.010866179	3.68816499	0	0.539023391	0	0	0	2.521692498	0	0.035962155	0	0	0	0	0	0	0	0	0	0	0	0	0	81.3536
H3333_129_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1946.010822	82.07663589	507.1699243	8.654973465	215.6857254	24.29523955	25.89740353	62.77609459	1983.014115		14.98896958		2.897601229	0.007774998	7390.491685	4741.532477	1.588085867	767.5272596	20.43431048		2.903699475				1479.616685		22.36310778														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.5252534		0.2		50	0.5	15	38.80553186	0.5	15	0.2		0.2				25		25														NO	129.4058005	116.7640724	25.93974854	0.125443087	125.4430867	0.167257449	0.167257449	41.81436224	24.69159282		0.167257449		41.81436224	0.418143622	12.54430867	33.42915558	0.418143622	12.54430867	0.167257449		0.167257449				20.90718112		20.90718112															20.9854	0.798633521	1.096321692	1.085706587	2.254690263	4.06355979	4.331533649	0.218745197	4.080314756	0	2.507016815	0	0.010096779	0.003251066	7.725717412	13.20878557	0.664047977	0.802341572	3.417790642	0	0.485665367	0	0	0	2.577884502	0	0.038962462	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3565	0	13.31166933	20.9854	0.798633521	1.096321692	1.085706587	2.254690263	4.06355979	4.331533649	0.218745197	4.080314756	0	2.507016815	0	0.010096779	0.003251066	7.725717412	13.20878557	0.664047977	0.802341572	3.417790642	0	0.485665367	0	0	0	2.577884502	0	0.038962462	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3565	NO																																																																																		0	0	0	20.9854	0.798633521	1.096321692	1.085706587	2.254690263	4.06355979	4.331533649	0.218745197	4.080314756	0	2.507016815	0	0.010096779	0.003251066	7.725717412	13.20878557	0.664047977	0.802341572	3.417790642	0	0.485665367	0	0	0	2.577884502	0	0.038962462	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3565
H3333_130_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1901.082561	36.75290392	359.9806563	11.65589177	268.9620173	25.31624707	26.28760691	80.23702417	1799.971861		14.01853265		4.594295025		6258.138043	3257.286748	1.311071454	500.6536021	16.3149894		2.796096361				1003.482012		15.35158611														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		25	48.43330576	0.5	50	0.2		0.2				25		25														NO	174.8384645	158.6982877	25.0315982	0.161401767	121.0513255	0.161401767	0.161401767	40.35044183	39.0789053		0.161401767		39.37656799		20.17522092	39.50666385	0.403504418	40.35044183	0.161401767		0.161401767				20.17522092		20.17522092															27.6985	0.48605191	0.750907596	1.881281531	2.713184059	4.086087019	4.242866213	0.269799948	5.86174416	0	2.262615945	0	0.015075631	0	10.5216098	10.72371105	0.529023124	1.683466171	2.633268123	0	0.451294894	0	0	0	1.687122607	0	0.025810137	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5234	0	18.63688395	27.6985	0.48605191	0.750907596	1.881281531	2.713184059	4.086087019	4.242866213	0.269799948	5.86174416	0	2.262615945	0	0.015075631	0	10.5216098	10.72371105	0.529023124	1.683466171	2.633268123	0	0.451294894	0	0	0	1.687122607	0	0.025810137	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5234	NO																																																																																		0	0	0	27.6985	0.48605191	0.750907596	1.881281531	2.713184059	4.086087019	4.242866213	0.269799948	5.86174416	0	2.262615945	0	0.015075631	0	10.5216098	10.72371105	0.529023124	1.683466171	2.633268123	0	0.451294894	0	0	0	1.687122607	0	0.025810137	0	0	0	0	0	0	0	0	0	0	0	0	0	78.5234
H3333_131_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1619.050622	31.30048802	306.5763251	9.926701339	229.0606048	21.56049736	22.38775273	68.33359397	1532.940031		11.93883657		3.912716032		5329.722388	2774.057393	1.11656963	426.3799701	13.8946063		2.381286138				854.6121081		13.0741271														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		25	48.43330576	0.5	50	0.2		0.2				25		25														NO	181.6598303	164.8899405	26.00821217	0.167698897	125.7741728	0.167698897	0.167698897	41.92472427	40.60357843		0.167698897		40.88892691		20.96236213	40.96300572	0.419247243	41.92472427	0.167698897		0.167698897				20.96236213		20.96236213															24.5097	0.430094634	0.664458509	1.664696866	2.400825675	3.615671628	3.754401441	0.238738924	5.186904232	0	2.002129725	0	0.01333223	0	9.310297564	9.469477405	0.468118739	1.489655223	2.330110151	0	0.399339059	0	0	0	1.492890708	0	0.022838716	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4637	0	13.28258741	24.5097	0.430094634	0.664458509	1.664696866	2.400825675	3.615671628	3.754401441	0.238738924	5.186904232	0	2.002129725	0	0.01333223	0	9.310297564	9.469477405	0.468118739	1.489655223	2.330110151	0	0.399339059	0	0	0	1.492890708	0	0.022838716	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4637	NO																																																																																		0	0	0	24.5097	0.430094634	0.664458509	1.664696866	2.400825675	3.615671628	3.754401441	0.238738924	5.186904232	0	2.002129725	0	0.01333223	0	9.310297564	9.469477405	0.468118739	1.489655223	2.330110151	0	0.399339059	0	0	0	1.492890708	0	0.022838716	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4637
H3333_136_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2266.692866	14.98009778	481.0536518	8.57909602	276.1883864	26.01231018	24.71909487	71.00065913	2276.147486		23.15852649		2.029884295	0.005446694	7539.665729	4815.997944	2.193707033	1075.649951	23.10663205		2.705484261				1538.816418		17.24641858														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.40522004		0.2		50	0.5	15	38.92567887	0.5	15	0.2		0.2				25		25														NO	126.6474717	114.2752063	25.38683393	0.122769224	122.7692244	0.163692299	0.163692299	40.92307482	24.0670404		0.163692299		40.92307482	0.409230748	12.27692244	32.5858225	0.409230748	12.27692244	0.163692299		0.163692299				20.46153741		20.46153741															23.9226	0.14265448	1.017702431	1.053248965	2.8256195	4.258014863	4.046325476	0.24213044	4.565011125	0	3.790872449	0	0.006922426	0.002228955	7.713657618	13.07777118	0.89773237	1.100472586	3.782377729	0	0.442866939	0	0	0	2.623879142	0	0.029407353	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5415	0	16.39912933	23.9226	0.14265448	1.017702431	1.053248965	2.8256195	4.258014863	4.046325476	0.24213044	4.565011125	0	3.790872449	0	0.006922426	0.002228955	7.713657618	13.07777118	0.89773237	1.100472586	3.782377729	0	0.442866939	0	0	0	2.623879142	0	0.029407353	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5415	NO																																																																																		0	0	0	23.9226	0.14265448	1.017702431	1.053248965	2.8256195	4.258014863	4.046325476	0.24213044	4.565011125	0	3.790872449	0	0.006922426	0.002228955	7.713657618	13.07777118	0.89773237	1.100472586	3.782377729	0	0.442866939	0	0	0	2.623879142	0	0.029407353	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5415
H3333_137_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2482.457117	21.15583893	485.4334257	9.287554473	298.8349295	27.41599681	33.60768221	67.41897034	2473.224764		19.21743229		5.714505652	0.007692165	8378.18984	5689.295659	1.337658243	970.0037414	23.93593435		3.196122455				1799.506093		25.88506622														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.45585797		0.2		50	0.5	15	39.16500325	0.5	15	0.2		0.2				25		25														NO	123.4447835	111.3853906	24.74484627	0.11966461	119.6646102	0.159552814	0.159552814	39.8882034	23.49882508		0.159552814		39.8882034	0.398882034	11.96646102	31.90137941	0.398882034	11.96646102	0.159552814		0.159552814				19.9441017		19.9441017															25.5372	0.196370948	1.000997958	1.111391586	2.979997113	4.374299429	5.362200256	0.2241018	4.843156344	0	3.066195392	0	0.018995114	0.003068266	8.354773511	15.12469828	0.533567841	0.967292663	3.819045672	0	0.50995033	0	0	0	2.990794378	0	0.043021199	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0611	0	20.15885052	25.5372	0.196370948	1.000997958	1.111391586	2.979997113	4.374299429	5.362200256	0.2241018	4.843156344	0	3.066195392	0	0.018995114	0.003068266	8.354773511	15.12469828	0.533567841	0.967292663	3.819045672	0	0.50995033	0	0	0	2.990794378	0	0.043021199	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0611	NO																																																																																		0	0	0	25.5372	0.196370948	1.000997958	1.111391586	2.979997113	4.374299429	5.362200256	0.2241018	4.843156344	0	3.066195392	0	0.018995114	0.003068266	8.354773511	15.12469828	0.533567841	0.967292663	3.819045672	0	0.50995033	0	0	0	2.990794378	0	0.043021199	0	0	0	0	0	0	0	0	0	0	0	0	0	81.0611
H3333_138_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1827.008031	28.20251619	354.6302331	9.896706714	325.5567209	23.02903963	26.47641602	66.90304014	1859.389315		18.36256185		3.52545421		6266.968121	3231.872545	1.696700399	410.6049413	15.55846998		2.197869957				1092.801558		13.66768506														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.26648983		0.2		48.6465662		25	48.80152417	0.5	50	0.2		0.2				25		25														NO	175.2462365	159.0684164	25.08997886	0.161778201	121.3336509	0.161778201	0.161778201	40.44455031	39.04232952		0.161778201		39.46697476		20.22227515	39.81645983	0.404445503	40.44455031	0.161778201		0.161778201				20.22227515		20.22227515															26.6814	0.373844132	0.741472088	1.60107141	3.291748794	3.725596607	4.283306959	0.225488614	6.049574195	0	2.970662226	0	0.011594918	0	10.56102948	10.72347695	0.686222846	1.38389435	2.517021288	0	0.355567448	0	0	0	1.841577815	0	0.023032641	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0475	0	18.32585605	26.6814	0.373844132	0.741472088	1.60107141	3.291748794	3.725596607	4.283306959	0.225488614	6.049574195	0	2.970662226	0	0.011594918	0	10.56102948	10.72347695	0.686222846	1.38389435	2.517021288	0	0.355567448	0	0	0	1.841577815	0	0.023032641	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0475	NO																																																																																		0	0	0	26.6814	0.373844132	0.741472088	1.60107141	3.291748794	3.725596607	4.283306959	0.225488614	6.049574195	0	2.970662226	0	0.011594918	0	10.56102948	10.72347695	0.686222846	1.38389435	2.517021288	0	0.355567448	0	0	0	1.841577815	0	0.023032641	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0475
H3333_139_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1769.00434	64.80362137	432.1912842	10.09827141	283.3882115	21.76645353	23.03255013	67.70832072	1561.271653		13.73948169		3.609409836		6223.759496	3077.427803	1.303895464	765.3924008	19.13188185		2.333194422				994.2399627		14.54107655														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.02979269		0.2		48.6465662		25	48.43318322	0.5	50	0.2		0.2				25		25														NO	176.6456116	160.3386084	25.29032719	0.163070031	122.3025236	0.163070031	0.163070031	40.76750787	39.16109903		0.163070031		39.77722896		20.38375393	39.88746805	0.407675079	40.76750787	0.163070031		0.163070031				20.38375393		20.38375393															26.0406	0.865876873	0.910854916	1.646725436	2.888257786	3.549456262	3.755918674	0.230024958	5.095092819	0	2.240497712	0	0.01196436	0	10.57196518	10.2292336	0.531565686	2.600261727	3.119836576	0	0.380474088	0	0	0	1.688861896	0	0.024700144	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3821	0	17.17297191	26.0406	0.865876873	0.910854916	1.646725436	2.888257786	3.549456262	3.755918674	0.230024958	5.095092819	0	2.240497712	0	0.01196436	0	10.57196518	10.2292336	0.531565686	2.600261727	3.119836576	0	0.380474088	0	0	0	1.688861896	0	0.024700144	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3821	NO																																																																																		0	0	0	26.0406	0.865876873	0.910854916	1.646725436	2.888257786	3.549456262	3.755918674	0.230024958	5.095092819	0	2.240497712	0	0.01196436	0	10.57196518	10.2292336	0.531565686	2.600261727	3.119836576	0	0.380474088	0	0	0	1.688861896	0	0.024700144	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3821
H3333_144_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2040.139898	10.57348282	347.1806954	6.75753527	285.1658793	22.63183681	30.71215699	68.55038202	1915.594214		16.79256125		2.194454108	0.003844469	7643.109464	5554.024385	1.635207876	1324.866308	25.1321963		2.39255475				1449.446731		20.8542735														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.2056749		0.2		50	0.5	15	38.84211301	0.5	15	0.2		0.2				25		25														NO	127.4193417	114.9716719	25.54155741	0.123517458	123.517458	0.164689944	0.164689944	41.17248601	24.04940483		0.164689944		41.17248601	0.41172486	12.3517458	32.55121732	0.41172486	12.3517458	0.164689944		0.164689944				20.586243		20.586243															21.6628	0.10130425	0.738961305	0.834673579	2.935247044	3.727235938	5.057983417	0.235199137	3.839075062	0	2.765565973	0	0.007529261	0.001582864	7.867145436	15.06585457	0.673255734	1.363700988	4.139020002	0	0.394029708	0	0	0	2.486555218	0	0.035775928	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9325	0	15.53284128	21.6628	0.10130425	0.738961305	0.834673579	2.935247044	3.727235938	5.057983417	0.235199137	3.839075062	0	2.765565973	0	0.007529261	0.001582864	7.867145436	15.06585457	0.673255734	1.363700988	4.139020002	0	0.394029708	0	0	0	2.486555218	0	0.035775928	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9325	NO																																																																																		0	0	0	21.6628	0.10130425	0.738961305	0.834673579	2.935247044	3.727235938	5.057983417	0.235199137	3.839075062	0	2.765565973	0	0.007529261	0.001582864	7.867145436	15.06585457	0.673255734	1.363700988	4.139020002	0	0.394029708	0	0	0	2.486555218	0	0.035775928	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9325
H3333_145_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2157.039949	26.77250051	454.4508165	7.891280108	254.4842715	22.30255189	23.65442593	58.18085702	2390.689626		17.29589537		9.078893774	0.00616228	8122.63812	5474.513359	2.980378574	1741.068213	25.00410353		3.785855524				1501.461275		21.80537572														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.4305726		0.2		50	0.5	15	38.99072088	0.5	15	0.2		0.2				25		25														NO	126.3290593	113.9878998	25.32300729	0.122460563	122.4605626	0.16328075	0.16328075	40.82018754	24.02722986		0.16328075		40.82018754	0.408201875	12.24605626	32.59830614	0.408201875	12.24605626	0.16328075		0.16328075				20.41009377		20.41009377															22.7081	0.254311759	0.959005112	0.966370602	2.597023922	3.641577403	3.862312411	0.197912791	4.786804098	0	2.824086771	0	0.030883512	0.002515454	8.289190285	14.87165521	1.216596124	1.776768275	4.082688782	0	0.61815733	0	0	0	2.553747118	0	0.03708748	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2768	0	16.72531447	22.7081	0.254311759	0.959005112	0.966370602	2.597023922	3.641577403	3.862312411	0.197912791	4.786804098	0	2.824086771	0	0.030883512	0.002515454	8.289190285	14.87165521	1.216596124	1.776768275	4.082688782	0	0.61815733	0	0	0	2.553747118	0	0.03708748	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2768	NO																																																																																		0	0	0	22.7081	0.254311759	0.959005112	0.966370602	2.597023922	3.641577403	3.862312411	0.197912791	4.786804098	0	2.824086771	0	0.030883512	0.002515454	8.289190285	14.87165521	1.216596124	1.776768275	4.082688782	0	0.61815733	0	0	0	2.553747118	0	0.03708748	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2768
H3333_146_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2210.144722	29.32024167	496.8164586	10.31017871	320.0649478	25.54692237	32.30699432	85.73985136	1905.856433		16.17687422		5.107289901		7240.790389	3752.246369	1.581255083	690.7118785	21.22852455		2.318443036				1300.958222		41.08927309														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.18150749		0.2		49.02872709		25	48.61817814	0.5	50	0.2		0.2				25		25														NO	168.211133	152.682757	24.08276409	0.15528376	116.46282	0.15528376	0.15528376	38.82094	37.40902823		0.15528376		38.1652275		19.41047	38.22534745	0.3882094	38.82094	0.15528376		0.15528376				19.41047		19.41047															30.9809	0.373057945	0.997059464	1.601003317	3.106305534	3.967022162	5.016751552	0.277375135	5.941353093	0	2.512005854	0	0.016243407	0	11.71226205	11.95257677	0.613858087	2.234507033	3.296445111	0	0.360016552	0	0	0	2.104350878	0	0.066463509	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1296	0	24.89797073	30.9809	0.373057945	0.997059464	1.601003317	3.106305534	3.967022162	5.016751552	0.277375135	5.941353093	0	2.512005854	0	0.016243407	0	11.71226205	11.95257677	0.613858087	2.234507033	3.296445111	0	0.360016552	0	0	0	2.104350878	0	0.066463509	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1296	NO																																																																																		0	0	0	30.9809	0.373057945	0.997059464	1.601003317	3.106305534	3.967022162	5.016751552	0.277375135	5.941353093	0	2.512005854	0	0.016243407	0	11.71226205	11.95257677	0.613858087	2.234507033	3.296445111	0	0.360016552	0	0	0	2.104350878	0	0.066463509	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1296
H3333_147_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2008.750302	26.76903046	370.5490366	9.404720168	289.4666503	22.31226994	30.70850117	65.3372918	1590.321956		13.24670508		3.346261393		6431.039897	3059.002294	1.309060543	714.3359994	16.01740657		3.957899606				990.8622292		11.18134984														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.33033394		0.2		48.6465662		25	48.74983276	0.5	50	0.2		0.2				25		25														NO	174.0867784	158.0159934	24.9239794	0.16070785	120.5308874	0.16070785	0.16070785	40.17696246	38.83532025		0.16070785		39.20991233		20.08848123	39.64451886	0.401769625	40.17696246	0.16070785		0.16070785				20.08848123		20.08848123															29.1414	0.352494578	0.769629713	1.511412357	2.907472686	3.585756927	4.935097195	0.218754493	5.146721874	0	2.128849491	0	0.010933885	0	10.76581869	10.10605618	0.525940763	2.391654219	2.574122971	0	0.636065536	0	0	0	1.658743108	0	0.018718028	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3856	0	19.25952026	29.1414	0.352494578	0.769629713	1.511412357	2.907472686	3.585756927	4.935097195	0.218754493	5.146721874	0	2.128849491	0	0.010933885	0	10.76581869	10.10605618	0.525940763	2.391654219	2.574122971	0	0.636065536	0	0	0	1.658743108	0	0.018718028	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3856	NO																																																																																		0	0	0	29.1414	0.352494578	0.769629713	1.511412357	2.907472686	3.585756927	4.935097195	0.218754493	5.146721874	0	2.128849491	0	0.010933885	0	10.76581869	10.10605618	0.525940763	2.391654219	2.574122971	0	0.636065536	0	0	0	1.658743108	0	0.018718028	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3856
H3333_801_0	2010	3	N/A																															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																																																			0	NO	280.5059908	0.930899508	30.07214032		10.23566355	26.03718033	21.44013272	0.389945137	48.74791884	10.46076024	14.41523997	0.908370849	0.045707291	4.084192796	36.55635337	37.82112826	0.41894464	5.334943086	14.51794541	105.4295812	7.391142117																					Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.082412121	0.082412121	0.175100601		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.082412121	0.082412121	0.175100601		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					23.1171	0.076717403	5.265649847	0	2.384909608	6.066663017	4.995550924	0.090857217	11.35826509	2.437357136	3.358750912	0.211650408	0.010649799	0.951616922	8.517630335	8.812322885	0.097614101	1.243041739	3.38268128	24.56509242	1.722136113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6663	0	0	23.1171	0.076717403	5.265649847	0	2.384909608	6.066663017	4.995550924	0.090857217	11.35826509	2.437357136	3.358750912	0.211650408	0.010649799	0.951616922	8.517630335	8.812322885	0.097614101	1.243041739	3.38268128	24.56509242	1.722136113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6663	NO																																																																																		0	0	0	23.1171	0.076717403	5.265649847	0	2.384909608	6.066663017	4.995550924	0.090857217	11.35826509	2.437357136	3.358750912	0.211650408	0.010649799	0.951616922	8.517630335	8.812322885	0.097614101	1.243041739	3.38268128	24.56509242	1.722136113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.6663
H3333_805_0	2010	3	N/A																															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																																																			0	NO	262.7400869	0.469241317	23.14485766		8.235140431	19.4269495	16.64531793	0.372780476	48.86489495	8.249668877	12.5362389	0.481230353	0.023039812	4.564464358	32.99369077	48.74960253	0.57904713	6.572929704	17.19807528	115.7769077	4.704669204																					Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.086317361	0.086317361	0.180028865		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.086317361	0.086317361	0.180028865		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					22.679	0.040503672	4.166742451	0	1.91878772	4.526479232	3.878359079	0.086857851	11.38552052	1.922172848	2.920943664	0.112126672	0.005368276	1.063520195	7.687529949	11.35865739	0.134917981	1.531492621	4.00715154	26.9760195	1.096187925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4984	0	0	22.679	0.040503672	4.166742451	0	1.91878772	4.526479232	3.878359079	0.086857851	11.38552052	1.922172848	2.920943664	0.112126672	0.005368276	1.063520195	7.687529949	11.35865739	0.134917981	1.531492621	4.00715154	26.9760195	1.096187925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4984	NO																																																																																		0	0	0	22.679	0.040503672	4.166742451	0	1.91878772	4.526479232	3.878359079	0.086857851	11.38552052	1.922172848	2.920943664	0.112126672	0.005368276	1.063520195	7.687529949	11.35865739	0.134917981	1.531492621	4.00715154	26.9760195	1.096187925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4984
H3333_806_0	2010	3	N/A																															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																																																			0	NO	262.7400869	0.469241317	23.14485766		8.235140431	19.4269495	16.64531793	0.372780476	48.86489495	8.249668877	12.5362389	0.481230353	0.023039812	4.564464358	32.99369077	48.74960253	0.57904713	6.572929704	17.19807528	115.7769077	4.704669204																					Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.086317361	0.086317361	0.180028865		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.086317361	0.086317361	0.180028865		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					22.679	0.040503672	4.166742451	0	1.91878772	4.526479232	3.878359079	0.086857851	11.38552052	1.922172848	2.920943664	0.112126672	0.005368276	1.063520195	7.687529949	11.35865739	0.134917981	1.531492621	4.00715154	26.9760195	1.096187925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4984	0	0	22.679	0.040503672	4.166742451	0	1.91878772	4.526479232	3.878359079	0.086857851	11.38552052	1.922172848	2.920943664	0.112126672	0.005368276	1.063520195	7.687529949	11.35865739	0.134917981	1.531492621	4.00715154	26.9760195	1.096187925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4984	NO																																																																																		0	0	0	22.679	0.040503672	4.166742451	0	1.91878772	4.526479232	3.878359079	0.086857851	11.38552052	1.922172848	2.920943664	0.112126672	0.005368276	1.063520195	7.687529949	11.35865739	0.134917981	1.531492621	4.00715154	26.9760195	1.096187925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.4984
H3335_002_0	2010	5	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	Coin	P	0	P	V	V	Coin	V	Coin	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	YES	245.5638527	13.3206419	1386.443011	0	194.8456511	4.813260851	10.76413637	620.3093184	536.5027195	0	27.31144608	0	0	1096.901832	5759.139481	7936.858076	3.73920895	647.5868259	30.62989167	2187.017553	78.36085027	0	0	0	612.9299629	0	57.52147109	0	0	0	0	0	0	0	0	0	0	0	0	0	4000	$500 Copay	$500 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$40-$50 Copay	$125 Copay	$0 Copay	20% Coins	$125 Copay	$0 Copay	$40 Copay	$20 Copay	$40 Copay	45% -50% Coins	$40 Copay	20% Coins	$40 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$40 Copay	$0 Copay	$40 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0	472.4929669	505.3989779	45.05011257	0	103.5672839	0.216398817	0.062609354	20.33218074	80.77999567	0	0.133795853	0	0	15.82389279	12.12841975	22.81261631	0.428912488	37.47110015	0.211928595	2.523188825	0.105964298	0	0	0	39.04526288	0	25.09948365	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	445.8982675	476.9521335	42.51442572	0	97.73790448	0.204218611	0.059085329	19.18776532	76.23321962	0	0.126265031	0	0	14.93323049	11.44576054	21.5285873	0.404770756	35.36200495	0.2	2.381168831	0.1	0	0	0	36.84756449	0	23.68673622	0	0	0	0	0	0	0	0	0	0	0	0	0		9.1247	0.529442381	4.911985699	0	1.586983803	0.982957445	0.636002544	0.991862469	3.40827747	0	3.448480578	0	0	1.36502399	5.493144283	14.23911183	1.513522432	1.908330712	6.125978334	0.433971502	7.836085027	0	0	0	1.882081361	0	0.113541326	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5315		3.968136101	9.1247	0.529442381	4.911985699	0	1.586983803	0.982957445	0.636002544	0.991862469	3.40827747	0	3.448480578	0	0	1.36502399	5.493144283	14.23911183	1.513522432	1.908330712	6.125978334	0.433971502	7.836085027	0	0	0	1.882081361	0	0.113541326	0	0	0	0	0	0	0	0	0	0	0	0	0	66.5315	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$40-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	$25 Copay	$45 Copay	50% Coins	30% Coins	30% Coins	$45 Copay	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				3.4934	0.1331	0.4385	0.1417	0.1323	0.0688	0.1539	0.0473	0.5359	0.2434	0.3904	0	0	0.1136	0.4176	0.7117	0.0891	0.0442	0.4378	0.0877	1.12	0.0067	0	0	0.0569	0	0.005	0	0	0	0	0	0	0	0	0	0	0			8.8689			12.6181	0.662553837	5.350509351	0.141672691	1.719301647	1.051754291	0.789856376	1.039118727	3.944191574	0.243445977	3.838848231	0	0	1.478582773	5.910727203	14.95080562	1.602597798	1.952553978	6.563777156	0.521623781	8.956111448	0.006678991	0	0	1.939026385	0	0.118587011	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4004
H3335_005_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	237.4693622	5.912133537	567.7339603	0	120.4166915	8.51475423	2.117725522	328.3527385	478.7823419	0	1051.337742	3.180226351	0	644.2266934	7294.358413	10347.17305	457.2923048	906.2788129	2794.919834	6840.035561	38.26680118	0	0	0	804.513506	0	0	0	0	0	0	0	0	0	0	0	0	0			3500	$300 Copay	$300 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$50 Copay	$0 Copay	$30 Copay	$50 Copay	$0 Copay	$30 Copay	$15 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			302.2370457	302.5861816	24.2754853	0	101.7398808	0.214013078	0.086911188	24.70714585	36.71104927	0	26.13605406	2.000680653	0	20.17402716	9.179681946	14.24551394	29.47404557	28.96775549	12.74624155	2.037885879	0.102499823	0	0	0	25.96827562	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	292.998232	293.3366955	23.53342972	0	98.62988543	0.207471104	0.084254478	23.95189522	35.58886207	0	25.33712442	1.939523637	0	19.55734539	8.899076466	13.81005557	28.57307986	28.0822661	12.3566131	1.97559157	0.099366597	0	0	0	25.17447465	0	0	0	0	0	0	0	0	0	0	0	0	0				5.7982	0.144520476	1.113393938	0	0.989723707	1.766565458	0.178427858	0.655389199	1.419943227	0	2.219822932	0.00051401	0	1.049946996	5.409421108	11.90791958	1.088854129	2.120863565	2.877978586	1.126093049	3.802441819	0	0	0	1.687767072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3578		1.430219937	5.7982	0.144520476	1.113393938	0	0.989723707	1.766565458	0.178427858	0.655389199	1.419943227	0	2.219822932	0.00051401	0	1.049946996	5.409421108	11.90791958	1.088854129	2.120863565	2.877978586	1.126093049	3.802441819	0	0	0	1.687767072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.3578	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$30-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0		1.6811	0.2121	0.4114	0.0314	0.9386	0.9346	0.6331	0.0533	0.2903	0.2409	0.1825	0.0017	0	0.2298	0.4917	3.5903	0.4602	0.195	0.8452	1.7671	0.0603	0.0001	0	0	0.0393	0	0	0	0	0	0	0	0	0	0	0	0	0			13.2902			7.4793	0.356632726	1.524763676	0.031431345	1.928331806	2.701187298	0.811573467	0.708698162	1.710213661	0.240943112	2.402313087	0.002165347	0	1.279794201	5.901083669	15.49826511	1.549011994	2.315908029	3.723180242	2.893230619	3.86271523	6.96E-05	0	0	1.727112757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6479
H3335_006_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	274.7554515	18.66062506	929.1316985	0	184.6807644	6.506026068	2.998563947	265.6467333	476.5679694	0	1242.961687	7.813588943	0	621.7395569	7795.858347	11133.35676	252.5342308	889.0352486	3046.475469	7511.93163	48.45127489	0	0	0	890.2432598	0	0	0	0	0	0	0	0	0	0	0	0	0			3500	$100 Copay	$100 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$25-$50 Copay	$35 Copay	$0 Copay	$25 Copay	$35 Copay	$0 Copay	$25 Copay	$10 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$25 Copay	$0 Copay	$25 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			101.5512464	101.5512464	25.13917371	0	101.5512464	0.220097719	0.082979379	19.88893971	26.3201798	0	20.3925657	1.943144042	0	18.19071528	5.979475931	11.64863675	20.95334154	24.89421397	9.703629628	1.642887315	0.101551246	0	0	0	20.77713557	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	99.51586781	99.51586781	24.63531248	0	99.51586781	0.215686328	0.081316234	19.49030825	25.79264782	0	19.98384012	1.904197855	0	17.82612112	5.859630064	11.41516462	20.53337641	24.39526244	9.509141026	1.609959135	0.099515868	0	0	0	20.36070211	0	0	0	0	0	0	0	0	0	0	0	0	0				2.2785	0.154752358	1.907454144	0	1.531555545	1.403260875	0.243831928	0.431461393	1.02432915	0	2.06992897	0.001239885	0	0.923600387	3.806737162	10.59075835	0.432115035	1.807354018	2.414113739	1.007825246	4.821670667	0	0	0	1.510498152	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.361		0.784590663	2.2785	0.154752358	1.907454144	0	1.531555545	1.403260875	0.243831928	0.431461393	1.02432915	0	2.06992897	0.001239885	0	0.923600387	3.806737162	10.59075835	0.432115035	1.807354018	2.414113739	1.007825246	4.821670667	0	0	0	1.510498152	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.361	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$25-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				2.3932	0.1164	0.3283	0.0346	0.5963	0.6561	0.3916	0.0318	0.2931	0.1274	0.2133	0.0012	0	0.0667	0.504	2.554	0.202	0.0817	0.3185	1.7919	0.0302	0	0	0	0.0298	0	0	0	0	0	0	0	0	0	0	0	0	0			10.7619			4.6717	0.271134623	2.235795922	0.034599047	2.127808027	2.05931349	0.635427612	0.463258734	1.317407243	0.127445109	2.283180435	0.002445708	0	0.990315351	4.31074541	13.14478602	0.634080299	1.889023315	2.732606828	2.799699323	4.851850412	0	0	0	1.540281485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1229
H3335_008_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	210.2148726	13.14534015	333.848307	0	93.52788186	9.633855403	1.65783822	307.7794575	548.5411607	0	1725.201133	25.16286197	0	972.9667678	6972.252921	10155.04896	410.3481659	903.1119768	2788.08205	4836.62522	33.83712004	0	0	0	499.0289897	0	0	0	0	0	0	0	0	0	0	0	0	0			3500	$300 Copay	$300 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$50 Copay	$0 Copay	$30 Copay	$50 Copay	$0 Copay	$30 Copay	$15 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			295.0158165	307.4994676	25.62495564	0	100.9850468	0.2168818	0.122826699	21.59791071	28.98130347	0	26.74769851	1.400111611	0	17.82099438	9.042385508	14.19181421	28.51542259	29.50142538	7.462689783	3.221743995	0.102499823	0	0	0	26.87078482	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	285.9977421	298.0997917	24.84164931	0	97.89812534	0.210252134	0.11907212	20.93770351	28.09539994	0	25.93007206	1.357312853	0	17.27624035	8.76597692	13.75799735	27.64376016	28.59962272	7.234569499	3.123261387	0.099366597	0	0	0	26.04939585	0	0	0	0	0	0	0	0	0	0	0	0	0				5.0101	0.32655193	0.69111188	0	0.763017025	2.025538656	0.197402311	0.537016252	1.284290275	0	3.727882474	0.002846156	0	1.400767311	5.093217349	11.64276139	0.94529719	2.152388484	1.680881113	1.258837066	3.362279478	0	0	0	1.083283641	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.1855		1.361722693	5.0101	0.32655193	0.69111188	0	0.763017025	2.025538656	0.197402311	0.537016252	1.284290275	0	3.727882474	0.002846156	0	1.400767311	5.093217349	11.64276139	0.94529719	2.152388484	1.680881113	1.258837066	3.362279478	0	0	0	1.083283641	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.1855	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$30-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0		1.4918	0	0.4507	0.0244	0.4602	0.8348	0.3679	0.0255	0.4068	0.1191	0.241	0	0	0.27	0.3207	2.5326	0.5645	0.0342	0.3278	1.9724	0.0598	0	0	0	0.0389	0	0	0	0	0	0	0	0	0	0	0	0	0			10.5431			6.5019	0.32655193	1.141769643	0.024388207	1.223265636	2.860361628	0.56534517	0.562540791	1.691102374	0.119101967	3.968895457	0.002846156	0	1.670731168	5.413962522	14.17531372	1.509796231	2.186562528	2.008718959	3.23127014	3.422052269	0	0	0	1.122141757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7286
H3335_009_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	294.2132167	7.486315325	501.6923883	0	118.8855688	8.409910164	1.644171138	347.2917563	539.8374703	0	1736.421532	22.27798141	0	1167.293607	7454.490579	10561.39688	283.1951862	910.9033044	3011.207832	5322.467477	52.49743786	0	0	0	552.2833299	0	0	0	0	0	0	0	0	0	0	0	0	0			3500	$100 Copay	$100 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$25-$50 Copay	$35 Copay	$0 Copay	$25 Copay	$35 Copay	$0 Copay	$25 Copay	$10 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$25 Copay	$0 Copay	$25 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			101.5512464	80.17203663	25.3878116	0	101.5512464	0.222971925	0.132777387	21.09617758	19.47222978	0	24.00699981	0.958030626	0	17.65747854	5.96268574	11.83758594	24.05874068	24.81548005	6.311856195	2.165303538	0.101551246	0	0	0	23.15849161	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	99.51586781	78.5651588	24.87896695	0	99.51586781	0.218502928	0.130116147	20.6733496	19.08195038	0	23.5258306	0.938828942	0	17.30357197	5.843176396	11.60032673	23.57653443	24.31810657	6.185348472	2.121904638	0.099515868	0	0	0	22.69432894	0	0	0	0	0	0	0	0	0	0	0	0	0				2.4399	0.049013629	1.040132362	0	0.985916712	1.837589992	0.213933214	0.598306991	0.858429318	0	3.404229901	0.001742934	0	1.683195745	3.629825283	10.20963788	0.556396755	1.845953636	1.552114147	0.941147369	5.224328087	0	0	0	1.044474963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1163		0.779584736	2.4399	0.049013629	1.040132362	0	0.985916712	1.837589992	0.213933214	0.598306991	0.858429318	0	3.404229901	0.001742934	0	1.683195745	3.629825283	10.20963788	0.556396755	1.845953636	1.552114147	0.941147369	5.224328087	0	0	0	1.044474963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1163	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$25-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				2.0265	0.1333	0.9553	0.0257	0.6033	0.6112	0.7815	0.0346	0.3913	0.0887	0.2064	0.0035	0	0.0977	0.3494	2.0751	0.3116	0.0548	0.3912	1.316	0.0807	0	0	0	0.0564	0	0	0	0	0	0	0	0	0	0	0	0	0			10.5941			4.4664	0.182292103	1.995458079	0.0257171	1.589240816	2.448811024	0.995390603	0.632876938	1.249727675	0.088679657	3.610674563	0.005208764	0	1.780850439	3.979241079	12.28474474	0.867958515	1.900726804	1.94327614	2.257106965	5.305071622	0	0	0	1.100877643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7104
H3335_014_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	209.3863037	4.627321628	533.7356017	0	75.99185419	9.596331269	4.393525647	306.9716142	540.061633	0	842.488237	15.63210596	0	662.3132435	7407.183057	10181.36698	537.5174239	1324.204529	3105.451925	7995.936134	49.28824454	0	0	0	702.7760579	0	0	0	0	0	0	0	0	0	0	0	0	0			3500	$300 Copay	$300 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$50 Copay	$0 Copay	$30 Copay	$50 Copay	$0 Copay	$30 Copay	$15 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			284.7622699	281.874512	24.93186893	0	101.3416325	0.220843113	0.114201459	26.47716936	30.00806527	0	28.91201183	5.394727502	0	19.76741796	9.00312968	15.45676705	29.07430964	29.61979696	13.50815813	1.926594466	0.102499823	0	0	0	27.82080518	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	276.057627	273.2581424	24.16974895	0	98.24381081	0.214092358	0.110710537	25.66781247	29.09077558	0	28.02822643	5.229820906	0	19.16316546	8.727921068	14.98428297	28.18556309	28.7143759	13.09523934	1.867702125	0.099366597	0	0	0	26.97037589	0	0	0	0	0	0	0	0	0	0	0	0	0				4.8169	0.105371109	1.075021291	0	0.622144112	2.054501187	0.486409582	0.656607486	1.309234314	0	1.967787589	0.00681276	0	1.057668189	5.387442422	12.71337366	1.262519272	3.168642219	3.388886351	1.244502242	4.897605143	0	0	0	1.579511204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8009		1.507257877	4.8169	0.105371109	1.075021291	0	0.622144112	2.054501187	0.486409582	0.656607486	1.309234314	0	1.967787589	0.00681276	0	1.057668189	5.387442422	12.71337366	1.262519272	3.168642219	3.388886351	1.244502242	4.897605143	0	0	0	1.579511204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.8009	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$30-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0		1.671	0.2127	1.0251	0.0109	1.5279	0.5517	0.3241	0.0349	0.1346	0.1353	0.0914	0.0003	0	0.0491	0.6705	2.8835	0.9944	0.1196	0.9726	1.8637	0.2693	0.0017	0	0	0.0873	0	0	0	0	0	0	0	0	0	0	0	0	0			13.6313			6.4879	0.318023412	2.100079749	0.010872946	2.150063277	2.606220231	0.810490492	0.691500387	1.443786903	0.135251772	2.059212794	0.007109999	0	1.106723128	6.057905994	15.59688959	2.256909379	3.28824233	4.361449009	3.108221868	5.166909859	0.001665768	0	0	1.666832095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4323
H3335_015_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	226.257085	3.562931165	694.254581	0	82.31346189	9.098288371	1.680214816	328.4324449	534.1096774	0	739.2860146	0	0	709.8467148	7127.34938	9928.851081	294.9460356	1446.111404	3068.009412	7896.024889	24.24690627	0	0	0	783.1201204	0	0	0	0	0	0	0	0	0	0	0	0	0			3500	$100 Copay	$100 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$25-$50 Copay	$35 Copay	$0 Copay	$25 Copay	$35 Copay	$0 Copay	$25 Copay	$10 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$25 Copay	$0 Copay	$25 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			101.5512464	101.5512464	23.77884422	0	100.3277374	0.21313643	0.073790563	24.50999529	20.66699012	0	22.6876971	0	0	17.41532368	6.254575887	12.83179181	24.46882363	24.62819059	10.74974615	1.51660406	0.101551246	0	0	0	23.05448996	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	99.51586781	99.51586781	23.3022479	0	98.31688146	0.208864564	0.072311588	24.0187446	20.25276429	0	22.2329705	0	0	17.06627058	6.129216226	12.57460586	23.97839814	24.13457093	10.53429037	1.48620696	0.099515868	0	0	0	22.59241178	0	0	0	0	0	0	0	0	0	0	0	0	0				1.8763	0.029547349	1.348141029	0	0.67440024	1.900310037	0.121499001	0.657377918	0.901433117	0	1.369710346	0	0	1.009536342	3.640422122	10.40428241	0.589361123	2.908439855	2.693275167	0.977927262	2.412951919	0	0	0	1.474381019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9893		0.715630205	1.8763	0.029547349	1.348141029	0	0.67440024	1.900310037	0.121499001	0.657377918	0.901433117	0	1.369710346	0	0	1.009536342	3.640422122	10.40428241	0.589361123	2.908439855	2.693275167	0.977927262	2.412951919	0	0	0	1.474381019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9893	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$25-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				1.9864	0	0.5804	0.0461	1.6885	0.4819	0.2251	0.0516	0.135	0.1959	0.292	0.0023	0	0.1644	0.6468	2.8614	0.3665	0.0272	0.6063	1.9802	0.2385	0.0001	0	0	0.0829	0	0	0	0	0	0	0	0	0	0	0	0	0			12.6594			3.8628	0.029547349	1.928526448	0.046134142	2.362897598	2.382167905	0.346631544	0.708950949	1.036393267	0.195866715	1.661753393	0.002279321	0	1.173927785	4.28721544	13.26571563	0.955819535	2.935619499	3.299558441	2.958135911	2.651474411	0.00010334	0	0	1.557241367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6488
H3335_017_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	219.5612464	8.147851876	378.9406622	0	73.65962237	9.040928472	1.621048837	341.0367572	479.1192532	0	1459.632743	9.467078713	0	874.5515706	6727.115699	9415.655795	317.0351099	784.543518	2565.174879	5055.446675	39.55744464	0	0	0	613.9091294	0	0	0	0	0	0	0	0	0	0	0	0	0			3500	$300 Copay	$300 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$50 Copay	$0 Copay	$30 Copay	$50 Copay	$0 Copay	$30 Copay	$15 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			292.2716064	296.8866399	24.94701681	0	99.75519638	0.214973856	0.102587733	23.44569044	31.74521432	0	26.81677743	2.000680653	0	19.77670418	9.526362993	13.56089073	29.36369391	28.73260839	8.282615658	2.504379444	0.102499823	0	0	0	26.66076965	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	283.3374173	287.8113779	24.18443379	0	96.70586908	0.208402513	0.099451821	22.72900012	30.77482328	0	25.99703936	1.939523637	0	19.17216782	9.23516013	13.14636	28.46610144	27.85430701	8.029431795	2.427825311	0.099366597	0	0	0	25.84580044	0	0	0	0	0	0	0	0	0	0	0	0	0				5.1842	0.195420373	0.763705446	0	0.593609816	1.884152214	0.161216258	0.645952041	1.228734196	0	3.162177489	0.001530135	0	1.397254123	5.177165891	10.3151334	0.7520628	1.821076334	1.716408061	1.022811783	3.930688669	0	0	0	1.322247737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2755		1.301498347	5.1842	0.195420373	0.763705446	0	0.593609816	1.884152214	0.161216258	0.645952041	1.228734196	0	3.162177489	0.001530135	0	1.397254123	5.177165891	10.3151334	0.7520628	1.821076334	1.716408061	1.022811783	3.930688669	0	0	0	1.322247737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2755	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$30-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0		8.5793	0.0694	0.8472	0.1634	1.1555	0.8828	0.3524	0.0291	0.2937	0.2011	0.2131	0.001	0	0.0846	0.6063	3.1299	1.2053	0.05	0.664	2.3058	0.0835	0.0002	0	0	0.0846	0	0	0	0	0	0	0	0	0	0	0	0	0			21.0021			13.7634	0.264826383	1.610929825	0.163413463	1.749074569	2.76691992	0.513622773	0.675038297	1.52239342	0.201076068	3.375319824	0.002496333	0	1.481851105	5.783437583	13.44506996	1.957315736	1.871033956	2.380403997	3.328573019	4.014236728	0.000207249	0	0	1.406879743	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2776
H3335_018_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	223.7712027	6.835439677	397.9831984	0	62.35659103	10.24647505	2.696272716	299.6531195	490.5772824	0	1585.181266	18.47228612	0	1015.978409	7011.821887	9724.076995	253.9445055	671.2311648	2634.069357	4835.433719	27.05969194	0	0	0	689.1661768	0	0	0	0	0	0	0	0	0	0	0	0	0			3500	$100 Copay	$100 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$25-$50 Copay	$35 Copay	$0 Copay	$25 Copay	$35 Copay	$0 Copay	$25 Copay	$10 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$25 Copay	$0 Copay	$25 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			100.4369787	97.97573533	24.84267616	0	100.8824604	0.222646119	0.158805884	23.02799033	21.5149138	0	23.2802996	3.768948299	0	16.54824428	6.461399032	11.21148245	24.02554271	24.67369172	6.982500825	2.022785651	0.101551246	0	0	0	22.16835708	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	98.42393326	96.01202026	24.3447576	0	98.8604862	0.218183651	0.155622958	22.56644328	21.08369315	0	22.81369555	3.693407753	0	16.21656994	6.331894041	10.98677215	23.54400185	24.17916009	6.842551458	1.982243218	0.099515868	0	0	0	21.72403955	0	0	0	0	0	0	0	0	0	0	0	0	0				1.8354	0.054690364	0.807400374	0	0.513716909	2.235613338	0.419601936	0.56350876	0.861931741	0	3.013653567	0.005685474	0	1.372973744	3.699842769	8.903018191	0.498239159	1.352483816	1.501979593	0.798750475	2.692868726	0	0	0	1.247622774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.379		0.66224037	1.8354	0.054690364	0.807400374	0	0.513716909	2.235613338	0.419601936	0.56350876	0.861931741	0	3.013653567	0.005685474	0	1.372973744	3.699842769	8.903018191	0.498239159	1.352483816	1.501979593	0.798750475	2.692868726	0	0	0	1.247622774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.379	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$25-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				4.1841	0.3565	0.9022	0.2248	1.1375	0.4777	0.5053	0.039	0.6466	0.1952	0.2772	0.0008	0	0.1197	0.4397	4.7887	0.52	0.0468	0.5492	2.4015	0.0662	0.0002	0	0	0.0925	0	0	0	0	0	0	0	0	0	0	0	0	0			17.9715			6.0195	0.411183018	1.709605951	0.224833598	1.65121121	2.71327445	0.924910922	0.602511006	1.508533538	0.195223225	3.290899376	0.006519314	0	1.492716579	4.139534311	13.69172044	1.018235298	1.399254085	2.051139701	3.20028508	2.759080854	0.000179385	0	0	1.340141012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3505
H3335_020_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	208.8462996	6.007997884	369.8357901	0	74.85509383	6.509708428	1.766286958	272.8279637	491.3575636	0	1210.776882	10.37957348	0	798.8500072	6256.406539	8745.433524	413.61806	727.1177178	2390.207192	5106.02989	34.56258162	0	0	0	724.1623808	0	0	0	0	0	0	0	0	0	0	0	0	0			3500	$300 Copay	$300 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$50 Copay	$0 Copay	$30 Copay	$50 Copay	$0 Copay	$30 Copay	$15 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			302.8681974	291.7194316	24.86337429	0	101.7765462	0.225132553	0.099234527	22.86538062	31.11857659	0	28.38491551	2.000680653	0	20.42470398	9.379332407	14.03646748	29.301675	29.79435366	9.197378835	2.351910529	0.102499823	0	0	0	27.60701639	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	293.6100906	282.8021215	24.10334806	0	98.66543006	0.218250678	0.096201115	22.16642926	30.16734068	0	27.51724244	1.939523637	0	19.80035949	9.09262399	13.60739927	28.40597833	28.88359673	8.916232394	2.280017082	0.099366597	0	0	0	26.76312222	0	0	0	0	0	0	0	0	0	0	0	0	0				5.1099	0.141589546	0.742856731	0	0.615467502	1.420748275	0.169918776	0.50396848	1.235245918	0	2.776436749	0.001677619	0	1.318126443	4.740596016	9.916883816	0.979102137	1.750147911	1.775970233	0.970152947	3.434366127	0	0	0	1.615070525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2183		1.236629744	5.1099	0.141589546	0.742856731	0	0.615467502	1.420748275	0.169918776	0.50396848	1.235245918	0	2.776436749	0.001677619	0	1.318126443	4.740596016	9.916883816	0.979102137	1.750147911	1.775970233	0.970152947	3.434366127	0	0	0	1.615070525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2183	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$30-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0		2.3669	0.0761	0.387	0.0273	0.985	0.8901	0.329	0.0326	0.4162	0.1363	0.1945	0.0011	0	0.1757	0.4291	2.5675	0.4022	0.0904	0.4413	1.8193	0.0726	0.0002	0	0	0.0811	0	0	0	0	0	0	0	0	0	0	0	0	0			11.9215			7.4769	0.21768533	1.129841912	0.027333007	1.6005018	2.310846895	0.498937724	0.536595984	1.651442879	0.136299606	2.970962904	0.002736945	0	1.493786865	5.169697486	12.48436697	1.381277465	1.840547182	2.21729004	2.789450016	3.506933093	0.000227225	0	0	1.696165388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1398
H3335_021_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	302.106912	9.013781433	483.4219421	0	88.22004291	8.465466641	2.307740524	333.5977888	602.2169621	0	1679.346108	9.040762985	0	1223.919939	6906.132789	9872.606698	330.3107301	719.5701421	2791.659173	5746.02981	38.7105999	0	0	0	854.2993293	0	0	0	0	0	0	0	0	0	0	0	0	0			3500	$100 Copay	$100 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$25-$50 Copay	$35 Copay	$0 Copay	$25 Copay	$35 Copay	$0 Copay	$25 Copay	$10 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$25 Copay	$0 Copay	$25 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			100.6336559	98.53675939	24.88885973	0	101.0256914	0.213111164	0.124789242	21.008258	20.05797662	0	24.14490514	1.387515863	0	18.8068604	6.218521414	11.12946976	24.11104194	24.60585914	6.561271247	2.034328299	0.101551246	0	0	0	22.58926882	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	98.61666843	96.56179978	24.39001551	0	99.00084649	0.208839805	0.122288107	20.58719218	19.65595717	0	23.66097191	1.359706061	0	18.42991692	6.093884389	10.90640323	23.62778743	24.11268706	6.429764531	1.993554519	0.099515868	0	0	0	22.13651501	0	0	0	0	0	0	0	0	0	0	0	0	0				2.4827	0.072532247	0.982555722	0	0.727821577	1.767926401	0.282209221	0.572320149	0.986429234	0	3.311246757	0.001024398	0	1.879728565	3.507097899	8.972885798	0.650375976	1.445897471	1.495809261	0.954585308	3.852318942	0	0	0	1.575934161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5214		0.726512871	2.4827	0.072532247	0.982555722	0	0.727821577	1.767926401	0.282209221	0.572320149	0.986429234	0	3.311246757	0.001024398	0	1.879728565	3.507097899	8.972885798	0.650375976	1.445897471	1.495809261	0.954585308	3.852318942	0	0	0	1.575934161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5214	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$25-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				4.546	0.1989	0.3361	0.0237	0.7808	0.783	0.4803	0.0463	0.5149	0.2669	0.8711	0.008	0	0.2678	0.7521	3.2563	0.4607	0.0505	0.6931	2.4277	0.0644	0.0002	0	0	0.1516	0	0	0	0	0	0	0	0	0	0	0	0	0			16.9806			7.0288	0.271476236	1.31863022	0.023737154	1.508653157	2.550924183	0.762512257	0.618646845	1.501376288	0.266944449	4.182300743	0.009023115	0	2.147508117	4.259235245	12.22921826	1.11109412	1.496447327	2.188877789	3.382241442	3.916690159	0.000199436	0	0	1.727544858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.502
H3335_032_0	2010	4	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	Coin	P	0	P	V	V	Coin	V	Coin	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	227.7737693	5.815209848	1007.506339	0	202.2130281	12.50516956	2.470547792	404.344597	472.8921536	0	23.91975265	41.02604243	0	835.5931927	6390.369621	9914.021095	4.986016704	485.8955037	27.50451027	6905.756798	33.06046503	0	0	0	620.2966999	0	31.62579179	0	0	0	0	0	0	0	0	0	0	0			4000	$500 Copay	$500 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$40-$50 Copay	$125 Copay	$0 Copay	20% Coins	$125 Copay	$0 Copay	$40 Copay	$20 Copay	$40 Copay	45% -50% Coins	$40 Copay	20% Coins	$40 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$40 Copay	$0 Copay	$40 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			482.088516	505.8587004	49.19326362	0	105.436106	0.19285247	0.082110821	16.50345365	74.07245609	0	0.211209894	0.162404842	0	29.03141007	11.45851677	18.25175424	0.457158168	41.39262927	0.211209894	3.476191828	0.105604947	0	0	0	41.01341883	0	37.40236259	0	0	0	0	0	0	0	0	0	0	0			NO	456.5018307	479.0104206	46.58234775	0	99.84012022	0.182616891	0.077752817	15.62753842	70.14108548	0	0.2	0.153785259	0	27.49057777	10.85035986	17.28304854	0.432894652	39.19572944	0.2	3.29169412	0.1	0	0	0	38.83664547	0	35.41724482	0	0	0	0	0	0	0	0	0	0	0				8.6649	0.232128843	3.911000889	0	1.682414419	2.283655183	0.19209205	0.526575894	2.764097414	0	4.783950531	0.000525767	0	1.914244971	5.778150834	14.27870899	2.158419967	1.587085725	5.500902054	1.894303254	3.306046503	0	0	0	2.007520252	0	0.093341534	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5601		3.56250951	8.6649	0.232128843	3.911000889	0	1.682414419	2.283655183	0.19209205	0.526575894	2.764097414	0	4.783950531	0.000525767	0	1.914244971	5.778150834	14.27870899	2.158419967	1.587085725	5.500902054	1.894303254	3.306046503	0	0	0	2.007520252	0	0.093341534	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5601	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$40-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	$25 Copay	$45 Copay	50% Coins	30% Coins	30% Coins	$45 Copay	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0		5.5817	0.1818	1.0341	0.8177	0.3211	0.4092	0.0808	0.0574	1.2321	0.2128	0.7827	0.1326	0	0.2138	1.0337	1.5908	0.2719	0.0963	0.9	0.8475	1.0817	0	0	0	0.1063	0	0.0074	0	0	0	0	0	0	0	0	0	0	0			16.9935			14.2466	0.413897467	4.945098388	0.817743855	2.003532287	2.692825651	0.272928634	0.584007956	3.996175472	0.212828108	5.566607362	0.133145239	0	2.128078233	6.811887103	15.86952604	2.430324955	1.68336834	6.400852533	2.741762999	4.387788408	2.99E-06	0	0	2.11386664	0	0.100776973	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5536
H3335_036_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	Coin	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	201.1072706	5.111736548	437.956568	0	104.2054691	5.711005711	1.626508499	240.5267709	390.8546245	0	851.4449639	8.656984283	0	601.0379531	5594.838385	7451.425251	1.975106648	649.8196366	2140.9689	4994.392196	23.7313636	0	0	0	564.1593173	0	0	0	0	0	0	0	0	0	0	0	0	0			4000	$600 Copay	$600 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$40-$50 Copay	$100 Copay	$0 Copay	$40 Copay	$100 Copay	$0 Copay	$40 Copay	$20 Copay	$40 Copay	45%-50% Coins	$40 Copay	$40 Copay	$40 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$40 Copay	$0 Copay	$40 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			579.6903645	594.667151	46.89062657	0	101.8215959	0.220709654	0.091154909	22.84040727	70.75362092	0	37.18078745	4.078367551	0	27.33750615	12.21693969	19.15868689	0.437531891	39.77484824	15.43157109	2.914636894	0.104472433	0	0	0	36.31347141	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	554.8739977	569.2096326	44.88325323	0	97.46264463	0.211261141	0.087252595	21.86261643	67.7246801	0	35.58908934	3.903773886	0	26.1671959	11.69393624	18.33850938	0.418801285	38.07209918	14.77095026	2.789862182	0.1	0	0	0	34.75890283	0	0	0	0	0	0	0	0	0	0	0	0	0				9.2991	0.242470807	1.638076295	0	0.84634505	1.206513583	0.141917088	0.438212044	2.205875368	0	2.525179241	0.002816242	0	1.310623155	5.452140281	11.38733599	0.827177203	2.061666471	2.635345428	1.161138826	2.37313636	0	0	0	1.634129908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3892		2.119450086	9.2991	0.242470807	1.638076295	0	0.84634505	1.206513583	0.141917088	0.438212044	2.205875368	0	2.525179241	0.002816242	0	1.310623155	5.452140281	11.38733599	0.827177203	2.061666471	2.635345428	1.161138826	2.37313636	0	0	0	1.634129908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3892	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$40-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				1.331	0.0647	0.3241	0.0234	0.8665	0.4118	0.4972	0.0248	0.1813	0.1112	0.127	0.0009	0	0.1603	0.387	2.0777	0.5453	0.0851	0.3192	1.2685	0.081	0.0002	0	0	0.0398	0	0	0	0	0	0	0	0	0	0	0	0	0			8.9279			10.6301	0.307130951	1.962150901	0.02336646	1.712834989	1.618340361	0.639068238	0.463061862	2.387201032	0.111200353	2.652171026	0.003698619	0	1.470965267	5.839165965	13.46498876	1.372434339	2.146738567	2.954571965	2.429675534	2.454103414	0.000191351	0	0	1.673884163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3171
H3335_037_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	Coin	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	150.3859203	9.289427553	249.2841173	0	80.54468575	5.233975173	1.338554919	258.6268579	331.003939	0	918.0585448	6.958874632	0	554.6177358	4785.794713	6648.344427	2.136164408	538.8740086	1879.765282	3915.46326	22.00441864	0	0	0	476.280974	0	0	0	0	0	0	0	0	0	0	0	0	0			4000	$600 Copay	$600 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$40-$50 Copay	$100 Copay	$0 Copay	$40 Copay	$100 Copay	$0 Copay	$40 Copay	$20 Copay	$40 Copay	45%-50% Coins	$40 Copay	$40 Copay	$40 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$40 Copay	$0 Copay	$40 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			617.8677575	350.4332861	50.68374043	0	104.001013	0.216420671	0.115208105	23.16015845	68.3418981	0	37.0692109	4.078367551	0	23.58297863	12.70652942	19.54958075	0.438517066	40.53110064	14.69767132	3.751008975	0.104472433	0	0	0	36.70076186	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	591.4170282	335.4313446	48.51398505	0	99.54876151	0.207155768	0.110276081	22.16867917	65.4162024	0	35.48228935	3.903773886	0	22.57339854	12.16256679	18.7126692	0.419744285	38.79597665	14.06846852	3.590429431	0.1	0	0	0	35.1296135	0	0	0	0	0	0	0	0	0	0	0	0	0				7.4117	0.259663765	1.007813828	0	0.668176976	1.084248148	0.147610591	0.477784653	1.804418389	0	2.714568243	0.002263823	0	1.043300599	4.850628986	10.36735583	0.896642802	1.742178621	2.203784891	1.17151621	2.200441864	0	0	0	1.394297211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4484		1.853753109	7.4117	0.259663765	1.007813828	0	0.668176976	1.084248148	0.147610591	0.477784653	1.804418389	0	2.714568243	0.002263823	0	1.043300599	4.850628986	10.36735583	0.896642802	1.742178621	2.203784891	1.17151621	2.200441864	0	0	0	1.394297211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4484	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$40-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				2.424	0.052	0.2605	0.0188	0.6954	0.5235	0.485	0.0426	0.3376	0.0964	0.1231	0.002	0	0.0634	0.2861	1.9705	0.5025	0.0342	0.2652	1.1991	0.0536	0.0019	0	0	0.0579	0	0	0	0	0	0	0	0	0	0	0	0	0			9.4951			9.8357	0.311640507	1.268319621	0.018783015	1.363593879	1.607766724	0.632574083	0.520372006	2.141968722	0.096421763	2.837714818	0.004217358	0	1.106717505	5.136716269	12.33785751	1.399107062	1.776412089	2.468976667	2.370612408	2.254038413	0.001915979	0	0	1.452160953	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9436
H3335_038_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	Coin	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	132.1097305	3.247543231	286.7708327	0	61.56453971	6.178479044	1.707012508	220.5903711	348.4397878	0	734.1726223	5.499878652	0	447.6855419	5235.904831	6729.786845	1.401949245	716.5192048	2055.256425	5111.872903	28.63551161	0	0	0	575.6689035	0	0	0	0	0	0	0	0	0	0	0	0	0			4000	$600 Copay	$600 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$40-$50 Copay	$100 Copay	$0 Copay	$40 Copay	$100 Copay	$0 Copay	$40 Copay	$20 Copay	$40 Copay	45%-50% Coins	$40 Copay	$40 Copay	$40 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$40 Copay	$0 Copay	$40 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			618.7673405	594.667151	51.16962369	0	100.44011	0.208732357	0.100407802	25.89779159	65.33531292	0	34.0844958	4.078367551	0	25.48358038	12.58625241	20.44706028	0.446846756	40.18985373	15.71081715	2.805168219	0.104472433	0	0	0	35.65271523	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	592.2781004	569.2096326	48.97906779	0	96.14029966	0.199796589	0.096109375	24.78911507	62.53832821	0	32.62534898	3.903773886	0	24.39263612	12.04743881	19.5717279	0.427717383	38.46933841	15.03824189	2.685079828	0.1	0	0	0	34.12643343	0	0	0	0	0	0	0	0	0	0	0	0	0				6.5205	0.154044407	1.170480671	0	0.493236108	1.23443904	0.164059905	0.455686674	1.815903484	0	1.996053168	0.00178919	0	0.91001921	5.256603588	10.97612974	0.599638062	2.297001647	2.575620272	1.143815568	2.863551161	0	0	0	1.637127209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2657		1.890303881	6.5205	0.154044407	1.170480671	0	0.493236108	1.23443904	0.164059905	0.455686674	1.815903484	0	1.996053168	0.00178919	0	0.91001921	5.256603588	10.97612974	0.599638062	2.297001647	2.575620272	1.143815568	2.863551161	0	0	0	1.637127209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2657	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$40-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				0.8735	0.0411	0.2059	0.0148	0.7227	0.4203	0.2469	0.044	0.2268	0.1304	0.1427	0.0006	0	0.0497	0.3662	2.2552	2.6265	0.1125	0.4113	1.4695	0.1302	0.0001	0	0	0.0578	0	0	0	0	0	0	0	0	0	0	0	0	0			10.5486			7.394	0.195123718	1.376368882	0.014844973	1.215890039	1.654723916	0.410991041	0.499717026	2.042751367	0.130422365	2.138761329	0.002349774	0	0.95974541	5.622769039	13.23135489	3.22611253	2.409452069	2.986909043	2.613318107	2.993724655	0.000121568	0	0	1.694887723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8143
H3335_039_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	Coin	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	236.4927649	10.84140797	556.344028	0	94.22602074	9.140420756	2.064268105	305.1255608	487.1130324	0	1240.61309	12.91881375	0	969.0393057	6744.936828	9482.96675	2.271340891	834.6847245	2639.818434	5734.17358	42.27863791	0	0	0	647.7272814	0	0	0	0	0	0	0	0	0	0	0	0	0			4000	$600 Copay	$600 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$40-$50 Copay	$100 Copay	$0 Copay	$40 Copay	$100 Copay	$0 Copay	$40 Copay	$20 Copay	$40 Copay	45%-50% Coins	$40 Copay	$40 Copay	$40 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$40 Copay	$0 Copay	$40 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			607.7324345	604.2009069	48.90555095	0	103.7243365	0.215716064	0.107593797	23.51172645	64.2427136	0	37.41787666	4.078367551	0	27.83063061	12.7203958	19.23835759	0.444643355	39.39260914	13.82036999	3.288898558	0.104472433	0	0	0	35.13242355	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	581.7155953	578.3352513	46.81191931	0	99.28392947	0.206481326	0.10298774	22.50519665	61.49250272	0	35.81602883	3.903773886	0	26.63920984	12.17583955	18.4147694	0.425608309	37.70622362	13.22872419	3.148101819	0.1	0	0	0	33.62841526	0	0	0	0	0	0	0	0	0	0	0	0	0				11.4643	0.522497367	2.170294312	0	0.779594133	1.887326196	0.212594307	0.572242562	2.496149956	0	3.702819516	0.004202677	0	2.151203451	6.843772384	14.55222049	0.966701557	2.622734073	2.910119164	1.504313523	4.227863791	0	0	0	1.815170167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4061		2.746347185	11.4643	0.522497367	2.170294312	0	0.779594133	1.887326196	0.212594307	0.572242562	2.496149956	0	3.702819516	0.004202677	0	2.151203451	6.843772384	14.55222049	0.966701557	2.622734073	2.910119164	1.504313523	4.227863791	0	0	0	1.815170167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4061	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$40-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				3.837	0.0965	0.4836	0.0349	0.9758	0.5774	0.4239	0.0388	1.4842	0.37	0.2376	0.0013	0	0.1232	0.3986	3.5426	0.517	0.0847	0.4621	1.8695	0.0926	0.0003	0	0	0.0749	0	0	0	0	0	0	0	0	0	0	0	0	0			15.7265			15.3013	0.618989672	2.653910701	0.034869758	1.755424073	2.464768057	0.636465906	0.611016641	3.98034609	0.370029348	3.940414924	0.005519448	0	2.274369	7.24240997	18.09480718	1.483681081	2.707481439	3.37220886	3.373768777	4.320440233	0.000285553	0	0	1.890100629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.1326
H3335_040_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	Coin	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	222.6444747	7.60610274	461.4407561	0	90.37263428	7.007863733	2.040815758	355.3785923	497.572116	0	1162.916363	12.88131954	0	671.1453711	6339.766316	8837.573652	1.936861165	803.2681858	2526.552532	5559.323623	33.74017014	0	0	0	695.0332169	0	0	0	0	0	0	0	0	0	0	0	0	0			4000	$600 Copay	$600 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$40-$50 Copay	$100 Copay	$0 Copay	$40 Copay	$100 Copay	$0 Copay	$40 Copay	$20 Copay	$40 Copay	45%-50% Coins	$40 Copay	$40 Copay	$40 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$40 Copay	$0 Copay	$40 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			603.7590981	594.667151	50.68374043	0	103.6947023	0.222653762	0.110146587	24.25457868	61.52063409	0	37.14140101	4.078367551	0	27.68301424	12.63468176	19.46526216	0.440328718	39.99976707	13.54466801	3.079996741	0.104472433	0	0	0	36.82321779	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	577.9123562	569.2096326	48.51398505	0	99.2555639	0.213122022	0.105431245	23.21624761	58.8869546	0	35.55138902	3.903773886	0	26.49791289	12.0937949	18.63196026	0.421478381	38.28738931	12.96482493	2.948143025	0.1	0	0	0	35.24682713	0	0	0	0	0	0	0	0	0	0	0	0	0				10.7224	0.360788912	1.865527495	0	0.747498898	1.493530092	0.215165746	0.687546449	2.441708884	0	3.445274336	0.00419048	0	1.481995965	6.389319463	13.72177675	0.816345108	2.562920146	2.729692604	1.365806763	3.374017014	0	0	0	2.041476304	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.467		2.525448528	10.7224	0.360788912	1.865527495	0	0.747498898	1.493530092	0.215165746	0.687546449	2.441708884	0	3.445274336	0.00419048	0	1.481995965	6.389319463	13.72177675	0.816345108	2.562920146	2.729692604	1.365806763	3.374017014	0	0	0	2.041476304	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.467	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$40-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	30% Coins	30% Coins	50% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				1.9805	0.0962	0.4822	0.0348	0.7917	0.5472	0.3669	0.0324	0.2698	0.1264	0.1845	0.0013	0	0.1104	0.5323	2.2942	0.6817	0.0634	0.4608	1.5618	0.0923	0.0003	0	0	0.0517	0	0	0	0	0	0	0	0	0	0	0	0	0			10.7629			12.7029	0.457001167	2.347740286	0.034768556	1.539240215	2.040758677	0.582028881	0.719995609	2.711515753	0.126435409	3.629742561	0.005503429	0	1.592441876	6.921641231	16.0160234	1.498023923	2.626288472	3.190464175	2.927636845	3.466324772	0.000284724	0	0	2.093131748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2299
H3335_041_0	2010	5	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	Coin	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	252.0811742	9.714999489	587.0050229	0	114.9642496	8.872588382	2.525439676	326.8684071	534.4132595	0	1310.975577	16.3865007	0	858.1290833	7317.151456	10559.2741	2.463907268	1022.140634	2995.512727	6728.95279	42.29975691	0	0	0	742.0804955	0	0	0	0	0	0	0	0	0	0	0	0	0			4000	$400 Copay	$400 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$100 Copay	$0 Copay	$30 Copay	$100 Copay	$0 Copay	$30 Copay	$20 Copay	$30 Copay	45%-50% Coins	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			404.4746542	391.6198017	50.06688955	0	102.4326769	0.220009316	0.106072057	23.21845304	63.93010248	0	27.42516952	4.028731423	0	20.50957177	12.25561227	14.96307257	0.46775578	29.91002881	10.72919533	2.257041408	0.103200942	0	0	0	26.83118678	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	391.9292271	379.4730884	48.51398505	0	99.2555639	0.213185376	0.102782062	22.49829565	61.94720829	0	26.57453411	3.903773886	0	19.87343466	11.8754849	14.49896899	0.453247588	28.98232152	10.3964122	2.187035666	0.1	0	0	0	25.99897469	0	0	0	0	0	0	0	0	0	0	0	0	0				8.2332	0.307215072	2.373162742	0	0.950903452	1.891506086	0.259569899	0.612831838	2.758784125	0	2.903213765	0.005330766	0	1.421164356	7.241226799	12.75821564	1.116760025	2.468667376	2.595215423	1.226371645	4.229975691	0	0	0	1.607777669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9611		1.759271551	8.2332	0.307215072	2.373162742	0	0.950903452	1.891506086	0.259569899	0.612831838	2.758784125	0	2.903213765	0.005330766	0	1.421164356	7.241226799	12.75821564	1.116760025	2.468667376	2.595215423	1.226371645	4.229975691	0	0	0	1.607777669	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9611	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$30-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	$25 Copay	$35 Copay	50% Coins	30% Coins	30% Coins	$35 Copay	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				2.5329	0.123	0.6142	0.0443	1.0085	0.697	0.4673	0.0401	0.3437	0.1619	0.2388	0.0017	0	0.1414	0.4241	1.4222	0.6566	0.0817	0.5593	1.0244	0.1176	0.0004	0	0	0.0665	0	0	0	0	0	0	0	0	0	0	0	0	0			10.7675			10.7661	0.430262853	2.987387604	0.044286903	1.959394331	2.588545669	0.726866624	0.65296225	3.102454161	0.161909982	3.142020799	0.007003152	0	1.562564047	7.665330945	14.18041315	1.773358281	2.550333215	3.154487198	2.2507548	4.347553908	0.000365812	0	0	1.674262335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.7286
H3335_042_0	2010	5	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	Coin	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	222.5621576	8.57736106	518.2660103	0	101.5017941	7.833597333	2.229707573	288.5917133	471.8328074	0	1157.458719	14.46762125	0	757.6411087	6460.303991	9322.770068	2.175380686	902.4467048	2644.73449	5940.984115	37.34640318	0	0	0	655.1819538	0	0	0	0	0	0	0	0	0	0	0	0	0			4000	$400 Copay	$400 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$100 Copay	$0 Copay	$30 Copay	$100 Copay	$0 Copay	$30 Copay	$20 Copay	$30 Copay	45%-50% Coins	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			404.4746542	391.6198017	50.06688955	0	102.4326769	0.220009316	0.106072057	23.21845304	63.93010248	0	27.42516952	4.028731423	0	20.50957177	12.25561227	14.96307257	0.46775578	29.91002881	10.72919533	2.257041408	0.103200942	0	0	0	26.83118678	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	391.9292271	379.4730884	48.51398505	0	99.2555639	0.213185376	0.102782062	22.49829565	61.94720829	0	26.57453411	3.903773886	0	19.87343466	11.8754849	14.49896899	0.453247588	28.98232152	10.3964122	2.187035666	0.1	0	0	0	25.99897469	0	0	0	0	0	0	0	0	0	0	0	0	0				7.2691	0.271239808	2.095262456	0	0.839551484	1.67000839	0.229173943	0.541068474	2.4357271	0	2.563243851	0.004706527	0	1.254744256	6.393270205	11.26421284	0.985986048	2.17958338	2.291312494	1.082762012	3.734640318	0	0	0	1.419504919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.525		1.553258681	7.2691	0.271239808	2.095262456	0	0.839551484	1.67000839	0.229173943	0.541068474	2.4357271	0	2.563243851	0.004706527	0	1.254744256	6.393270205	11.26421284	0.985986048	2.17958338	2.291312494	1.082762012	3.734640318	0	0	0	1.419504919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.525	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$30-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	$25 Copay	$35 Copay	50% Coins	30% Coins	30% Coins	$35 Copay	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				2.2363	0.1086	0.5423	0.0391	0.8904	0.6154	0.4126	0.0354	0.3034	0.143	0.2108	0.0015	0	0.1248	0.3744	1.2557	0.5797	0.0721	0.4938	0.9044	0.1038	0.0003	0	0	0.0587	0	0	0	0	0	0	0	0	0	0	0	0	0			9.5066			9.5053	0.379878542	2.637560829	0.039100852	1.729946837	2.285423776	0.641749646	0.576499564	2.73915295	0.142950123	2.774086286	0.006183074	0	1.379585869	6.767711232	12.51986927	1.565695838	2.251686048	2.785092854	1.987188636	3.83844998	0.000322975	0	0	1.478204149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0317
H3335_043_0	2010	5	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	Coin	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	234.6583131	9.043536866	546.4335404	0	107.018372	8.259349908	2.350891201	304.2765461	497.4767132	0	1220.366092	15.25393011	0	798.8185701	6811.418675	9829.458527	2.293611671	951.4942868	2788.474648	6263.873992	39.37616379	0	0	0	690.7908052	0	0	0	0	0	0	0	0	0	0	0	0	0			4000	$400 Copay	$400 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$100 Copay	$0 Copay	$30 Copay	$100 Copay	$0 Copay	$30 Copay	$20 Copay	$30 Copay	45%-50% Coins	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			404.4746542	391.6198017	50.06688955	0	102.4326769	0.220009316	0.106072057	23.21845304	63.93010248	0	27.42516952	4.028731423	0	20.50957177	12.25561227	14.96307257	0.46775578	29.91002881	10.72919533	2.257041408	0.103200942	0	0	0	26.83118678	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	391.9292271	379.4730884	48.51398505	0	99.2555639	0.213185376	0.102782062	22.49829565	61.94720829	0	26.57453411	3.903773886	0	19.87343466	11.8754849	14.49896899	0.453247588	28.98232152	10.3964122	2.187035666	0.1	0	0	0	25.99897469	0	0	0	0	0	0	0	0	0	0	0	0	0				7.6641	0.285981572	2.20913905	0	0.885180739	1.760772612	0.241629446	0.570475308	2.568107798	0	2.702555028	0.004962325	0	1.322939055	6.740741632	11.87641786	1.039573957	2.298042779	2.415844322	1.141609652	3.937616379	0	0	0	1.496654388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1624		1.637677608	7.6641	0.285981572	2.20913905	0	0.885180739	1.760772612	0.241629446	0.570475308	2.568107798	0	2.702555028	0.004962325	0	1.322939055	6.740741632	11.87641786	1.039573957	2.298042779	2.415844322	1.141609652	3.937616379	0	0	0	1.496654388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1624	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$30-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	$25 Copay	$35 Copay	50% Coins	30% Coins	30% Coins	$35 Copay	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				2.3578	0.1145	0.5718	0.0412	0.9388	0.6489	0.435	0.0374	0.3199	0.1507	0.2223	0.0016	0	0.1316	0.3948	1.3239	0.6112	0.076	0.5206	0.9536	0.1095	0.0003	0	0	0.0619	0	0	0	0	0	0	0	0	0	0	0	0	0			10.0233			10.022	0.400524774	2.780911102	0.041225967	1.823968687	2.409635555	0.676628457	0.607832063	2.88802471	0.1507194	2.924856658	0.006519121	0	1.454565755	7.135533365	13.20031867	1.650790719	2.374064196	2.936461428	2.095191465	4.04706805	0.000340528	0	0	1.558543896	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.1857
H3335_044_0	2010	5	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	Coin	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	236.4849469	9.113933819	550.6871036	0	107.8514274	8.32364257	2.369191074	306.6451041	501.3491853	0	1229.8657	15.37267017	0	805.036756	6864.440311	9905.973272	2.311465667	958.9009353	2810.18077	6312.633415	39.68267682	0	0	0	696.1680783	0	0	0	0	0	0	0	0	0	0	0	0	0			4000	$400 Copay	$400 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$100 Copay	$0 Copay	$30 Copay	$100 Copay	$0 Copay	$30 Copay	$20 Copay	$30 Copay	45%-50% Coins	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			404.4746542	391.6198017	50.06688955	0	102.4326769	0.220009316	0.106072057	23.21845304	63.93010248	0	27.42516952	4.028731423	0	20.50957177	12.25561227	14.96307257	0.46775578	29.91002881	10.72919533	2.257041408	0.103200942	0	0	0	26.83118678	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	391.9292271	379.4730884	48.51398505	0	99.2555639	0.213185376	0.102782062	22.49829565	61.94720829	0	26.57453411	3.903773886	0	19.87343466	11.8754849	14.49896899	0.453247588	28.98232152	10.3964122	2.187035666	0.1	0	0	0	25.99897469	0	0	0	0	0	0	0	0	0	0	0	0	0				7.7238	0.288207718	2.226335492	0	0.892071187	1.774478867	0.243510345	0.574916018	2.588098534	0	2.723592332	0.005000952	0	1.333237114	6.793213102	11.96886661	1.047666238	2.315931268	2.434649805	1.150496202	3.968267682	0	0	0	1.508304687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5606		1.650425664	7.7238	0.288207718	2.226335492	0	0.892071187	1.774478867	0.243510345	0.574916018	2.588098534	0	2.723592332	0.005000952	0	1.333237114	6.793213102	11.96886661	1.047666238	2.315931268	2.434649805	1.150496202	3.968267682	0	0	0	1.508304687	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5606	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$30-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	$25 Copay	$35 Copay	50% Coins	30% Coins	30% Coins	$35 Copay	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				2.3762	0.1154	0.5762	0.0415	0.9461	0.6539	0.4384	0.0376	0.3224	0.1519	0.224	0.0016	0	0.1327	0.3979	1.3342	0.616	0.0766	0.5247	0.961	0.1103	0.0003	0	0	0.0624	0	0	0	0	0	0	0	0	0	0	0	0	0			10.1013			10.1	0.40364255	2.802558348	0.041546879	1.838166875	2.428392707	0.681895487	0.612563566	2.910505752	0.151892634	2.947624409	0.006569868	0	1.465888427	7.191077983	13.30307295	1.66364085	2.392544453	2.959319513	2.111500913	4.078571351	0.000343179	0	0	1.570675957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.662
H3335_045_0	2010	5	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	Coin	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0			0	YES	227.5921889	8.771214294	529.9791167	0	103.7957923	8.010641084	2.280100231	295.11405	482.4964969	0	1183.617944	14.79459771	0	774.7642282	6606.310532	9533.469969	2.224545526	922.8425131	2704.506992	6075.253731	38.19045311	0	0	0	669.9894382	0	0	0	0	0	0	0	0	0	0	0	0	0			4000	$400 Copay	$400 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$100 Copay	$0 Copay	$30 Copay	$100 Copay	$0 Copay	$30 Copay	$20 Copay	$30 Copay	45%-50% Coins	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0			404.4746542	391.6198017	50.06688955	0	102.4326769	0.220009316	0.106072057	23.21845304	63.93010248	0	27.42516952	4.028731423	0	20.50957177	12.25561227	14.96307257	0.46775578	29.91002881	10.72919533	2.257041408	0.103200942	0	0	0	26.83118678	0	0	0	0	0	0	0	0	0	0	0	0	0			NO	391.9292271	379.4730884	48.51398505	0	99.2555639	0.213185376	0.102782062	22.49829565	61.94720829	0	26.57453411	3.903773886	0	19.87343466	11.8754849	14.49896899	0.453247588	28.98232152	10.3964122	2.187035666	0.1	0	0	0	25.99897469	0	0	0	0	0	0	0	0	0	0	0	0	0				7.4333	0.277369981	2.142616578	0	0.858525825	1.707751528	0.234353404	0.553296929	2.490775916	0	2.621174618	0.004812897	0	1.283102189	6.537761744	11.51879045	1.008269893	2.228843202	2.343097458	1.107233049	3.819045311	0	0	0	1.451586537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6217		1.58836321	7.4333	0.277369981	2.142616578	0	0.858525825	1.707751528	0.234353404	0.553296929	2.490775916	0	2.621174618	0.004812897	0	1.283102189	6.537761744	11.51879045	1.008269893	2.228843202	2.343097458	1.107233049	3.819045311	0	0	0	1.451586537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6217	NO	30% Coins	30% Coins	30% Coins	30% Coins	$175 Copay	30% Coins	30% Coins	$30-$50 Copay	30% Coins	30% Coins	30% Coins	30% Coins	$0 Copay	30% Coins	$25 Copay	$35 Copay	50% Coins	30% Coins	30% Coins	$35 Copay	30% Coins	30% Coins	$0 Copay	$0 Copay	30% Coins	$0 Copay	30% Coins	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0				2.2868	0.1111	0.5546	0.04	0.9105	0.6293	0.4219	0.0362	0.3103	0.1462	0.2156	0.0015	0	0.1277	0.3829	1.284	0.5928	0.0737	0.5049	0.9249	0.1062	0.0003	0	0	0.06	0	0	0	0	0	0	0	0	0	0	0	0	0			9.7215			9.7202	0.388464013	2.697171203	0.039984554	1.769044618	2.337075652	0.656253552	0.589528782	2.801059363	0.146180877	2.836782213	0.006322815	0	1.410765294	6.920665351	12.80282543	1.601081453	2.302575432	2.848037535	2.032100228	3.92520113	0.000330274	0	0	1.511612403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3432
H3335_801_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	279.38245	6.440454585	1273.512917	1272.825893	148.6936599	6.882980125	17.80249393	437.5385359	585.227142	15267.7228	1691.183447	0	38.77904453	1263.835416	5434.498011	10248.53715	317.2132675	1081.98915	2948.386133	2482.695456	3112.57059	87.59294371																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			1058.203057	825.1355806	46.85524669	0	140.5057912	0.233	0.233	88.06332275	208.0923998	3.540447389	37.1460017	0	45.3970357	20.44350132	17.88403814	33.950728	19.31477699	13.14474346	36.43473992	17.58406129	71.12215257	175.1948347																			NO	1058.203057	825.1355806	46.85524669	0	140.5057912	0.233	0.233	88.06332275	208.0923998	3.540447389	37.1460017	0	45.3970357	20.44350132	17.88403814	33.950728	19.31477699	13.14474346	36.43473992	17.58406129	71.12215257	175.1948347																				24.6369	0.442854019	4.97256349	0	1.741026694	1.603734369	4.147981085	3.210924775	10.14844336	4.504547445	5.235058599	0	0.146704472	2.153101749	8.099230806	28.99544143	0.510575293	1.185205817	8.951973494	3.63798909	18.4477267	1.278819274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.0508			24.6369	0.442854019	4.97256349	0	1.741026694	1.603734369	4.147981085	3.210924775	10.14844336	4.504547445	5.235058599	0	0.146704472	2.153101749	8.099230806	28.99544143	0.510575293	1.185205817	8.951973494	3.63798909	18.4477267	1.278819274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.0508	NO	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.4186	0.0712	0.0847	0	0.3681	0.1867	0.1142	0.4562	0.2774	0.1137	0.1117	0	0.0049	0.1032	0.2426	1.0172	0.0182	0.0357	0.1706	0.2876	0.2195	0.0099																			4.3121			25.0555	0.514069676	5.05727689	0	2.109168123	1.790414196	4.262193621	3.667168557	10.42587488	4.618241512	5.34678045	0	0.151587507	2.256259011	8.341878427	30.01267899	0.52873269	1.220888989	9.122595992	3.925623386	18.66722649	1.288745353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.3629
H3335_811_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	329.1160868	9.048544303	592.7885067	729.4717863	193.1604409	11.25341067	2.761529658	338.0935943	511.2669747	2562.520005	1604.179226	19.12605839	0	1541.535578	8359.124789	12595.75399	308.8765907	669.2946198	3224.699621	7507.993173	2235.081895	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																			715.1873725	1254.474082	44.332328	0	95.55009046	0.233	0.233	59.97313717	188.3690863	20.34136452	70.97669107	96.80129008	0	17.9680025	15.3878719	21.00794904	16.675486	17.01607512	24.80147459	14.79821967	63.32001038	0																			NO	715.1873725	1254.474082	44.332328	0	95.55009046	0.233	0.233	59.97313717	188.3690863	20.34136452	70.97669107	96.80129008	0	17.9680025	15.3878719	21.00794904	16.675486	17.01607512	24.80147459	14.79821967	63.32001038	0																				19.615	0.945930359	2.189974543	0	1.538041467	2.622044686	0.64343641	1.689711126	8.025574409	4.343762793	9.488277781	0.154285594	0	2.308192927	10.71909512	22.05091316	0.429222272	0.949063961	6.664775475	9.258744352	11.79378407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.4298			19.615	0.945930359	2.189974543	0	1.538041467	2.622044686	0.64343641	1.689711126	8.025574409	4.343762793	9.488277781	0.154285594	0	2.308192927	10.71909512	22.05091316	0.429222272	0.949063961	6.664775475	9.258744352	11.79378407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.4298	NO	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				1.128	0	2.1925	0	0.7336	0.8121	0.2466	0.1016	0.6029	0.1437	0.1619	0.001	0	0.745	0.2253	2.0715	0.0775	0.1389	0.3662	1.8853	0.0754	0																			11.709			20.743	0.945930359	4.382428932	0	2.271627856	3.434121599	0.890070132	1.791350429	8.628462256	4.487511001	9.650145943	0.155282101	0	3.053216332	10.94440594	24.12244002	0.506673106	1.087960169	7.030959549	11.14408805	11.86915935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.1388
H3335_813_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	304.6562649	7.070091318	1626.700228	1446.700921	211.3185832	6.745160073	17.70236255	582.6280884	590.0828222	16417.5934	1806.963783	0	85.30221174	1299.949964	6108.243633	10742.60522	295.0160102	1082.543597	3152.561092	2644.290463	3719.716454	57.62164408																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			951.5562115	692.5652961	46.5383813	0	145.9585364	0.233	0.233	83.8392668	215.7366764	3.368738943	34.40667188	0	45.3970357	20.60276368	19.99629758	33.71402601	18.76199141	12.85214646	33.83212324	17.13324031	53.03831018	152.3684907																			NO	951.5562115	692.5652961	46.5383813	0	145.9585364	0.233	0.233	83.8392668	215.7366764	3.368738943	34.40667188	0	45.3970357	20.60276368	19.99629758	33.71402601	18.76199141	12.85214646	33.83212324	17.13324031	53.03831018	152.3684907																				24.1581	0.408041657	6.308666291	0	2.570312593	1.571622297	4.124650473	4.070592646	10.60854224	4.608882185	5.180967497	0	0.322705629	2.231880159	10.17852145	30.18137265	0.461257321	1.159417406	8.888152949	3.775438662	16.44062292	0.731643578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.9814			24.1581	0.408041657	6.308666291	0	2.570312593	1.571622297	4.124650473	4.070592646	10.60854224	4.608882185	5.180967497	0	0.322705629	2.231880159	10.17852145	30.18137265	0.461257321	1.159417406	8.888152949	3.775438662	16.44062292	0.731643578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.9814	NO	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.7034	0.0119	0.1837	0	0.0748	0.0458	0.1201	0.1185	0.3089	0.1342	0.1509	0	0.0094	0.065	0.2964	0.8788	0.0134	0.0338	0.2588	0.1099	0.4787	0.0213																			4.0177			24.8616	0.419923001	6.492361836	0	2.645154874	1.617384745	4.244751915	4.189120033	10.91744143	4.743083471	5.331826745	0	0.332102162	2.296867975	10.47489931	31.0601929	0.474688197	1.193177285	9.146957905	3.885371766	16.91934046	0.752947553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.9992
H3335_819_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	319.0448154	8.279233549	1022.871413	676.1942963	248.7594586	13.48562766	3.497117348	327.2443746	509.2039562	2397.635815	1495.020826	18.47065602	0	1568.485355	7829.892215	12492.06944	330.2394749	692.2395394	3159.793945	7546.074128	2082.449008	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																			714.3722586	1254.516194	47.04370431	0	100.632868	0.233	0.233	60.10367468	186.0519804	20.55014884	70.87275277	92.30638434	0	21.3751082	15.38544249	21.21386097	16.84579573	17.25636255	24.46101998	16.23734447	62.58467554	0																			NO	714.3722586	1254.516194	47.04370431	0	100.632868	0.233	0.233	60.10367468	186.0519804	20.55014884	70.87275277	92.30638434	0	21.3751082	15.38544249	21.21386097	16.84579573	17.25636255	24.46101998	16.23734447	62.58467554	0																				18.9931	0.865536047	4.009971691	0	2.086114813	3.142151246	0.814828342	1.639049119	7.894867041	4.105981071	8.829686784	0.142079956	0	2.793878681	10.03886303	22.08375203	0.463595561	0.995461372	6.440981903	10.21068375	10.86078296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.4113			18.9931	0.865536047	4.009971691	0	2.086114813	3.142151246	0.814828342	1.639049119	7.894867041	4.105981071	8.829686784	0.142079956	0	2.793878681	10.03886303	22.08375203	0.463595561	0.995461372	6.440981903	10.21068375	10.86078296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.4113	NO	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				1.7452	0.0795	0.3685	0	0.1917	0.2887	0.0749	0.1506	0.7254	0.3773	0.8113	0.0131	0	0.2567	0.9224	2.0292	0.0426	0.0915	0.5918	0.9382	0.9979	0																			10.6965			20.7382	0.94506621	4.378429717	0	2.277798397	3.430869205	0.889699205	1.789653874	8.620290397	4.483260961	9.641006465	0.155135036	0	3.050595461	10.96128841	24.11292737	0.506193245	1.086929781	7.032814379	11.14889695	11.85873081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.1078
H3335_820_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	319.0448154	8.279233549	1022.871413	676.1942963	248.7594586	13.48562766	3.497117348	327.2443746	509.2039562	2397.635815	1495.020826	18.47065602	0	1568.485355	7829.892215	12492.06944	330.2394749	692.2395394	3159.793945	7546.074128	2082.449008	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																			714.3722586	1254.516194	47.04370431	0	100.632868	0.233	0.233	60.10367468	186.0519804	20.55014884	70.87275277	92.30638434	0	21.3751082	15.38544249	21.21386097	16.84579573	17.25636255	24.46101998	16.23734447	62.58467554	0																			NO	714.3722586	1254.516194	47.04370431	0	100.632868	0.233	0.233	60.10367468	186.0519804	20.55014884	70.87275277	92.30638434	0	21.3751082	15.38544249	21.21386097	16.84579573	17.25636255	24.46101998	16.23734447	62.58467554	0																				18.9931	0.865536047	4.009971691	0	2.086114813	3.142151246	0.814828342	1.639049119	7.894867041	4.105981071	8.829686784	0.142079956	0	2.793878681	10.03886303	22.08375203	0.463595561	0.995461372	6.440981903	10.21068375	10.86078296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.4113			18.9931	0.865536047	4.009971691	0	2.086114813	3.142151246	0.814828342	1.639049119	7.894867041	4.105981071	8.829686784	0.142079956	0	2.793878681	10.03886303	22.08375203	0.463595561	0.995461372	6.440981903	10.21068375	10.86078296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.4113	NO	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				1.7452	0.0795	0.3685	0	0.1917	0.2887	0.0749	0.1506	0.7254	0.3773	0.8113	0.0131	0	0.2567	0.9224	2.0292	0.0426	0.0915	0.5918	0.9382	0.9979	0																			10.6965			20.7382	0.94506621	4.378429717	0	2.277798397	3.430869205	0.889699205	1.789653874	8.620290397	4.483260961	9.641006465	0.155135036	0	3.050595461	10.96128841	24.11292737	0.506193245	1.086929781	7.032814379	11.14889695	11.85873081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.1078
H3335_822_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	304.6562649	7.070091318	1626.700228	1446.700921	211.3185832	6.745160073	17.70236255	582.6280884	590.0828222	16417.5934	1806.963783	0	85.30221174	1299.949964	6108.243633	10742.60522	295.0160102	1082.543597	3152.561092	2644.290463	3719.716454	57.62164408																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			951.5562115	692.5652961	46.5383813	0	145.9585364	0.233	0.233	83.8392668	215.7366764	3.368738943	34.40667188	0	45.3970357	20.60276368	19.99629758	33.71402601	18.76199141	12.85214646	33.83212324	17.13324031	53.03831018	152.3684907																			NO	951.5562115	692.5652961	46.5383813	0	145.9585364	0.233	0.233	83.8392668	215.7366764	3.368738943	34.40667188	0	45.3970357	20.60276368	19.99629758	33.71402601	18.76199141	12.85214646	33.83212324	17.13324031	53.03831018	152.3684907																				24.1581	0.408041657	6.308666291	0	2.570312593	1.571622297	4.124650473	4.070592646	10.60854224	4.608882185	5.180967497	0	0.322705629	2.231880159	10.17852145	30.18137265	0.461257321	1.159417406	8.888152949	3.775438662	16.44062292	0.731643578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.9814			24.1581	0.408041657	6.308666291	0	2.570312593	1.571622297	4.124650473	4.070592646	10.60854224	4.608882185	5.180967497	0	0.322705629	2.231880159	10.17852145	30.18137265	0.461257321	1.159417406	8.888152949	3.775438662	16.44062292	0.731643578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.9814	NO	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																				0.7034	0.0119	0.1837	0	0.0748	0.0458	0.1201	0.1185	0.3089	0.1342	0.1509	0	0.0094	0.065	0.2964	0.8788	0.0134	0.0338	0.2588	0.1099	0.4787	0.0213																			4.0177			24.8616	0.419923001	6.492361836	0	2.645154874	1.617384745	4.244751915	4.189120033	10.91744143	4.743083471	5.331826745	0	0.332102162	2.296867975	10.47489931	31.0601929	0.474688197	1.193177285	9.146957905	3.885371766	16.91934046	0.752947553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.9992
H3337_001_0	2010	6	N/A																															0	0	A	0	T	Coin	Coin	V	0	0	0	0	Coin	V	0	0	V	V	0	0	Coin	0	0	0	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0	95.06563185	0	376.3210908	2.755557335	0.324640759	204.6743825	0	0	0	0	0.958757768	109.4487413	0	0	328.3462239	694.0017803	0	0	24.8815679	0	0	0	0	0	107.0948072	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	"1-20 days:$0, 21-100:$25/day"	0	$50 copay/trip	20% coinsurance	20% coinsurance	$50 copay/visit	0	0	0	0	20% coinsurance	$20 copay/visit	0	0	$20 copay/visit	$20 copay/visit	0	0	15% coinsurance	0	0	0	0	0	$20 copay/visit	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25	0	50	0.2	0.2	50	0	0	0	0	0.2	20	0	0	20	20	0	0	0.15	0	0	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0	25	0	50	0.2	0.2	50	0	0	0	0	0.2	20	0	0	20	20	0	0	0.15	0	0	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0.1980534	0	1.568004545	0.551111467	0.064928152	0.852809927	0	0	0	0	0.191751554	0.182414569	0	0	0.547243707	1.156669634	0	0	3.732235184	0	0	0	0	0	0.178491345	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2237	0	0	0	0	0.1980534	0	1.568004545	0.551111467	0.064928152	0.852809927	0	0	0	0	0.191751554	0.182414569	0	0	0.547243707	1.156669634	0	0	3.732235184	0	0	0	0	0	0.178491345	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2237	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.1980534	0	1.568004545	0.551111467	0.064928152	0.852809927	0	0	0	0	0.191751554	0.182414569	0	0	0.547243707	1.156669634	0	0	3.732235184	0	0	0	0	0	0.178491345	0	0	0	0	0	0	0	0	0	0	0	0	0	9.2237
H3337_002_0	2010	5	N/A																															0	0	0	0	0	0	0	V	0	0	0	0	0	V	0	V	V	V	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0	0	0	0	0	0	295.126594	0	0	0	0	0	109.4487413	0	19798.09714	328.3462239	1813.636429	0	186.2171472	43.66844763	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	$50 copay/visit	0	0	0	0	0	$20 copay/visit	0	$10 copay/visit	$20 copay/visit	$10 copay/visit	0	$10 copay/visit	20% coinsurance	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50	0	0	0	0	0	20	0	10	20	10	0	10	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0	0	0	0	0	0	50	0	0	0	0	0	20	0	10	20	10	0	10	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	1.229694142	0	0	0	0	0	0.182414569	0	16.49841429	0.547243707	1.511363691	0	0.155180956	8.733689527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.858	0	0	0	0	0	0	0	0	0	1.229694142	0	0	0	0	0	0.182414569	0	16.49841429	0.547243707	1.511363691	0	0.155180956	8.733689527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.858	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.229694142	0	0	0	0	0	0.182414569	0	16.49841429	0.547243707	1.511363691	0	0.155180956	8.733689527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.858
H3337_003_0	2010	5	N/A																															0	0	0	0	0	0	0	V	0	0	0	0	0	V	0	V	V	V	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0	0	0	0	0	0	284.1207313	0	0	0	0	0	109.4487413	0	17113.41401	328.3462239	1095.602288	0	200.9858033	26.38407681	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	$50 copay/visit	0	0	0	0	0	$20 copay/visit	0	$10 copay/visit	$20 copay/visit	$10 copay/visit	0	$10 copay/visit	20% coinsurance	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50	0	0	0	0	0	20	0	10	20	10	0	10	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0	0	0	0	0	0	50	0	0	0	0	0	20	0	10	20	10	0	10	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	1.18383638	0	0	0	0	0	0.182414569	0	14.26117834	0.547243707	0.913001906	0	0.167488169	5.276815363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.532	0	0	0	0	0	0	0	0	0	1.18383638	0	0	0	0	0	0.182414569	0	14.26117834	0.547243707	0.913001906	0	0.167488169	5.276815363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.532	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.18383638	0	0	0	0	0	0.182414569	0	14.26117834	0.547243707	0.913001906	0	0.167488169	5.276815363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.532
H3342_001_0	2010	12	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Cardiac Rehab	Therapy (PT/OT/ST)	Urgent Care	Chiropractic	Podiatric	Physical Exam	Diabetes Education/Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	1542.117018	53.14538788	721.5161982	1069.454036	131.9358274	7.974502833	1.46040798	170.910362	261.3152623	6598.214619	226.0671727	9.040560969	2.85645517	99.44617066	3976.870524	5097.649252	851.6831391	1318.641851	1796.882588	1.251220203	64.51855123	0	0	0	302.4	143.52	162	14.7	4196.545893	0	15.49810452	168.3165712	7.298279508	808.0896329	824.8753182	245.5463535	3.239622389	1096.577196	43.58175954	22.31092038		$125/day (days 1-7)	$125/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$75 copay	$0 copay	$90 copay - Tier 2	$75 copay	10% coinsurance	$30 copay	$15 coapy	$30 copay	$40 copay	$30 copay	$30 copay - Tier 1	0	20% coinsurance	0	0	0	$20 copay	$175/$80 frames/lens	$0 copay	$1000/ 3 yrs	Silver Sneakers	0	$0 copay	$50 copay	$30 copay	$30 copay	$30 copay	$0 copay	10% coinsurance	$30 copay	$0 copay	20% coinsurance	125	125	60	0	100	0.2	0.2	50	75	0	90	75	0.1	30	15	30	40	30	30	0	0.2	0	0	0	20	0	0	0	0	0	0	50	30	30	30	0	0.1	30	0	0.2	NO	70.89875525	76.64506008	52.94117321	0	88.23528868	0.176470577	0.176470577	44.11764434	66.17646651	0	79.41175981	66.17646651	0.088235289	26.4705866	13.2352933	26.4705866	35.29411547	26.4705866	26.4705866	0	0.176470577	0	0	0	20	0	0	0	0	0	0	44.11764434	26.4705866	26.4705866	26.4705866	0	0.088235289	26.4705866	0	0.176470577		9.1112	0.339444287	3.183159502	0	0.970116318	1.407265119	0.257719039	0.62834688	1.441076725	0	1.496032668	0.049856032	0.252040146	0.219366539	4.386253984	11.24481383	2.504950255	2.90876861	3.963711347	0	11.38562599	0	0	0	0.504	0	0	0	0	0	0	0.618810885	0.016099145	1.782550551	1.819577796	0	0.285849017	2.418920135	0	3.937221001	67.1328		8.881728293	9.1112	0.339444287	3.183159502	0	0.970116318	1.407265119	0.257719039	0.62834688	1.441076725	0	1.496032668	0.049856032	0.252040146	0.219366539	4.386253984	11.24481383	2.504950255	2.90876861	3.963711347	0	11.38562599	0	0	0	0.504	0	0	0	0	0	0	0.618810885	0.016099145	1.782550551	1.819577796	0	0.285849017	2.418920135	0	3.937221001	67.1328	YES	$250/day (days 1-7)	$250/day (days 1-7)	$150/day (for days 1-100)	$50 copay	$100 copay	20% Coinsurance	20% Coinsurance	$50 copay	$250 copay	$50 copay	$50/$150 copay - Tier 2	$250 copay	10% coinsurance	$50 copay	$30 copay	$50 copay	$100 copay	$50 copay	$50 copay - Tier 1	$50-$100 copay	20% Coinsurance			20% coinsurance	$40 copay	Mulitple amts	50% Coinsurance	50% Coinsurance; $1000 every 3 yrs	Silver Sneakers		$50/$100 copay	$100 copay	$30 copay	$50 copay	$50 copay	$30 copay	20% coinsurance	20% coinsurance	50% Coinsurance	20% coinsurance	4000	4.2744	0.1592	1.8667	0.9223	0.2276	0.3301	0.0605	0.1437	1.1268	5.6902	0.4265	0.039	0.0591	0.0858	2.0577	4.3961	1.469	1.1372	3.2455	0.1133	2.787			0	0	0	0	0			0.0267	0.2903	0.0038	0.7427	0.7114	0.1271	0.1341	0.6656	0.0696	0.9235	34.3122		4.574966648	13.3856	0.498689755	5.049827111	0.922277843	1.197674467	1.737364345	0.318171654	0.772023698	2.567844535	5.690181102	1.92256162	0.088838114	0.311160675	0.305127121	6.444002767	15.64093447	3.973902564	4.045941524	7.209208222	0.113276995	14.17264732	0	0	0	0.504	0	0	0	0	0	0.026730571	0.909117226	0.019875488	2.525279947	2.53093537	0.127052844	0.419951025	3.084496585	0.069564662	4.860766668	101.445
H3342_002_0	2010	11	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Cardiac Rehab	Therapy (PT/OT/ST)	Urgent Care	Chiropractic	Podiatric	Physical Exam	Diabetes Education/Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	1326.121255	57.54360606	573.7569121	1229.064446	137.040537	5.209772438	0.81635525	196.7417494	322.6051652	6513.711968	381.7326302	2.680301944	0.684008819	46.06479169	3880.267283	4864.049267	866.4188674	1151.134074	1486.030025	0.87251085	53.66001942	0	0	0	302.4	143.52	162	14.7	4196.545893	0	54.92320422	311.7748205	9.296522253	587.5371103	798.379207	302.9007278	4.227308754	1045.155406	46.54239091	23.87782481		$200/day (days 1-7)	$200/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$300 copay	$0 copay	$90 copay - Tier 2	$300 copay	10% coinsurance	$30 copay	$20 coapy	$30 copay	$40 copay	$30 copay	$30 copay - Tier 1	0	20% coinsurance	0	0	0	$20 copay	$175/$80 frames/lens	$0 copay	$1000/ 3 yrs	Silver Sneakers	0	$0 copay	$50 copay	$30 copay	$30 copay	$30 copay	$0 copay	10% coinsurance	$30 copay	$0 copay	20% coinsurance	200	200	60	0	100	0.2	0.2	50	300	0	90	300	0.1	30	20	30	40	30	30	0	0.2	0	0	0	20	0	0	0	0	0	0	50	30	30	30	0	0.1	30	0	0.2	NO	118.4987894	100.0869319	52.57535123	0	87.62558538	0.175251171	0.175251171	43.81279269	262.8767561	0	78.86302684	262.8767561	0.087625585	26.28767561	17.52511708	26.28767561	35.05023415	26.28767561	26.28767561	0	0.175251171	0	0	0	20	0	0	0	0	0	0	43.81279269	26.28767561	26.28767561	26.28767561	0	0.087625585	26.28767561	0	0.175251171		13.0953	0.479946915	2.513789264	0	1.000688106	0.913018719	0.143067213	0.718317123	7.067116611	0	2.508715889	0.058715757	0.059936673	0.100911358	5.666844869	10.65537911	2.530682015	2.521719927	3.255356272	0	9.403981226	0	0	0	0.504	0	0	0	0	0	0	1.138310465	0.02036533	1.287082081	1.748961134	0	0.370420404	2.289558856	0	4.184616754	74.2368		10.41026883	13.0953	0.479946915	2.513789264	0	1.000688106	0.913018719	0.143067213	0.718317123	7.067116611	0	2.508715889	0.058715757	0.059936673	0.100911358	5.666844869	10.65537911	2.530682015	2.521719927	3.255356272	0	9.403981226	0	0	0	0.504	0	0	0	0	0	0	1.138310465	0.02036533	1.287082081	1.748961134	0	0.370420404	2.289558856	0	4.184616754	74.2368	YES	$250/day (days 1-7)	$250/day (days 1-7)	$200/day (for days 1-100)	$50 copay	$200 copay	20% Coinsurance	20% Coinsurance	$50 copay	$500 copay	$50 copay	$50/$150 copay - Tier 2	$500 copay	10% coinsurance	$50 copay	$30 copay	$50 copay	$100 copay	$50 copay	$50 copay - Tier 1	$50-$100 copay	20% Coinsurance			20% coinsurance	$40 copay	Mulitple amts	50% Coinsurance	50% Coinsurance; $1000 every 3 yrs	Silver Sneakers		$50/$100 copay	$100 copay	$30 copay	$50 copay	$50 copay	$30 copay	20% coinsurance	20% coinsurance	50% Coinsurance	20% coinsurance	4000	3.8397	0.1407	1.9655	1.0526	0.4695	0.2142	0.0336	0.1648	2.7629	5.5785	0.6973	0.023	0.0141	0.0395	1.9939	4.1657	1.484	0.9859	2.6889	0.0755	2.3653			0	0	0	0	0			0.0941	0.534	0.0048	0.5363	0.6838	0.1556	0.1738	0.5749	0.0625	0.9816	34.5561		4.879977757	16.935	0.620672091	4.479303504	1.05259894	1.470146724	1.127183604	0.176626189	0.88312373	9.82998113	5.578492109	3.206033002	0.081670476	0.073995893	0.140362301	7.66073473	14.8210623	4.014723937	3.507577512	5.944227748	0.075513174	11.76931357	0	0	0	0.504	0	0	0	0	0	0.09407498	1.672332658	0.025142383	1.823366281	2.432711372	0.155646672	0.544197878	2.864418121	0.062451644	5.166193523	108.7929
H3342_004_0	2010	13	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Cardiac Rehab	Therapy (PT/OT/ST)	Urgent Care	Chiropractic	Podiatric	Physical Exam	Diabetes Education/Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	1653.593316	110.869549	706.7230877	1248.177147	117.8860837	7.281972005	1.643728394	221.4049052	269.1925045	6549.828956	286.5737304	8.522230488	0.923771497	39.00039145	4139.927803	4931.098105	779.2610995	1283.076834	1518.128265	0.736224144	63.67225702	0	0	0	302.4	143.52	162	14.7	4196.545893	0	35.2027117	245.9669377	4.726765101	661.1230773	783.5251612	299.7310037	3.316113812	968.4220034	41.25860525	23.51327685		$175/day (days 1-7)	$175/day (days 1-7)	$45/day (for days 1-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$90 copay - Tier 2	$200 copay	10% coinsurance	$30 copay	$15 coapy	$30 copay	$40 copay	$30 copay	$30 copay - Tier 1	0	20% coinsurance	0	0	0	$20 copay	$175/$80 frames/lens	$0 copay	$1000/ 3 yrs	Silver Sneakers	0	$0 copay	$50 copay	$30 copay	$30 copay	$30 copay	$0 copay	10% coinsurance	$30 copay	$0 copay	20% coinsurance	175	175	45	0	100	0.2	0.2	50	200	0	90	200	0.1	30	15	30	40	30	30	0	0.2	0	0	0	20	0	0	0	0	0	0	50	30	30	30	0	0.1	30	0	0.2	NO	85.09976777	97.38182294	38.87863064	0	86.39695697	0.172793914	0.172793914	43.19847849	172.7939139	0	77.75726127	172.7939139	0.086396957	25.91908709	12.95954355	25.91908709	34.55878279	25.91908709	25.91908709	0	0.172793914	0	0	0	20	0	0	0	0	0	0	43.19847849	25.91908709	25.91908709	25.91908709	0	0.086396957	25.91908709	0	0.172793914		11.7267	0.899723233	2.289702158	0	0.848749909	1.258280444	0.284026263	0.797029586	3.876235538	0	1.856932369	0.122715797	0.079811046	0.084237879	4.470964553	10.65079677	2.244192923	2.77134835	3.279041559	0	11.0021785	0	0	0	0.504	0	0	0	0	0	0	0.885449789	0.010209453	1.427975552	1.692354741	0	0.286502142	2.091717854	0	4.062951137	69.5038		10.86145641	11.7267	0.899723233	2.289702158	0	0.848749909	1.258280444	0.284026263	0.797029586	3.876235538	0	1.856932369	0.122715797	0.079811046	0.084237879	4.470964553	10.65079677	2.244192923	2.77134835	3.279041559	0	11.0021785	0	0	0	0.504	0	0	0	0	0	0	0.885449789	0.010209453	1.427975552	1.692354741	0	0.286502142	2.091717854	0	4.062951137	69.5038	YES	$250/day (days 1-7)	$250/day (days 1-7)	$250/day (for days 1-100)	$50 copay	$200 copay	20% Coinsurance	20% Coinsurance	$50 copay	$450 copay	$50 copay	$50/$150 copay - Tier 2	$450 copay	10% coinsurance	$50 copay	$25 copay	$50 copay	$100 copay	$50 copay	$50 copay - Tier 1	$50-$100 copay	20% Coinsurance			20% coinsurance	$40 copay	Mulitple amts	50% Coinsurance	50% Coinsurance; $1000 every 3 yrs	Silver Sneakers		$50/$100 copay	$100 copay	$30 copay	$50 copay	$50 copay	$25 copay	20% coinsurance	20% coinsurance	50% Coinsurance	20% coinsurance	3350	3.9296	0.3015	2.9838	1.054	0.3982	0.2952	0.0666	0.1833	2.0458	5.5308	0.496	0.0648	0.0187	0.0329	1.7479	4.1639	1.316	1.0834	2.8861	0.065	2.6661			0	0	0	0	0			0.0595	0.4154	0.0024	0.595	0.6616	0.1265	0.1344	0.5539	0.0631	0.953	34.8945		5.494071533	15.6563	1.20121779	5.273538988	1.053979135	1.246928878	1.553432647	0.350649707	0.980351315	5.922026517	5.530771872	2.352932665	0.187482467	0.098532156	0.117170383	6.218872506	14.81468851	3.560231982	3.854797294	6.165134712	0.064990081	13.66829094	0	0	0	0.504	0	0	0	0	0	0.059451375	1.300845986	0.012604263	2.022965365	2.353974907	0.126548633	0.420910555	2.645576529	0.063134365	5.015989058	104.3983
H3342_012_0	2010	12	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Cardiac Rehab	Therapy (PT/OT/ST)	Urgent Care	Chiropractic	Podiatric	Physical Exam	Diabetes Education/Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	1506.378199	67.0716836	677.0497847	1153.185564	130.2572354	7.051347693	1.321234744	189.2092124	280.1067508	6563.5981	282.7359999	7.154003458	1.825690373	71.2648806	3985.58832	4995.585903	839.7940988	1264.063529	1648.815973	1.03229056	61.30373309	0	0	0	302.4	143.52	0	0	4196.275007	0	30.81724567	225.3614957	7.288534788	714.2483936	808.3398593	273.4342019	3.531406271	1053.975386	43.89244442	23.01062686		$230/day (days 1-6)	$230/day (days 1-6)	$45/day (for days 1-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$300 copay	$0 copay	$75 copay - Tier 2	$300 copay	10% coinsurance	$25 copay	$15 coapy	$25 copay	$40 copay	$25 copay	$35 copay - Tier 1	0	20% coinsurance	0	0	0	$30 copay	$30 copay w/ $80 allowance 1 pair glasses / contacts every 2 years	0	0	Silver Sneakers	0	$0 copay	$50 copay	$25 copay	$25 copay	$25 copay	$0 copay	10% coinsurance	$25 copay	$0 copay	20% coinsurance	230	230	45	0	100	0.2	0.2	50	300	0	75	300	0.1	25	15	25	40	25	35	0	0.2	0	0	0	30	30	0	0	0	0	0	50	25	25	25	0	0.1	25	0	0.2	NO	116.0488451	114.7243561	38.74275442	0	86.09500983	0.17219002	0.17219002	43.04750491	258.2850295	0	64.57125737	258.2850295	0.08609501	21.52375246	12.91425147	21.52375246	34.43800393	21.52375246	30.13325344	0	0.17219002	0	0	0	30	30	0	0	0	0	0	43.04750491	21.52375246	21.52375246	21.52375246	0	0.08609501	21.52375246	0	0.17219002		14.5678	0.641229643	2.185897795	0	0.934541497	1.214171698	0.227503437	0.678748708	6.028948365	0	1.521384918	0.153981	0.157182831	0.127823971	4.289240819	8.960312863	2.410069373	2.267282541	4.140349133	0	10.55589101	0	0	0	0.756	0.3588	0	0	0	0	0	0.808437508	0.013073052	1.281108801	1.449875586	0	0.304036458	1.890458776	0	3.962200291	71.8863		11.42763978	14.5678	0.641229643	2.185897795	0	0.934541497	1.214171698	0.227503437	0.678748708	6.028948365	0	1.521384918	0.153981	0.157182831	0.127823971	4.289240819	8.960312863	2.410069373	2.267282541	4.140349133	0	10.55589101	0	0	0	0.756	0.3588	0	0	0	0	0	0.808437508	0.013073052	1.281108801	1.449875586	0	0.304036458	1.890458776	0	3.962200291	71.8863	YES	$275/day (days 1-6)	$275/day (days 1-6)	$250/day (for days 1-100)	$50 copay	$200 copay	20% Coinsurance	20% Coinsurance	$50 copay	$500 copay	$50 copay	$50/$150 copay - Tier 2	$500 copay	10% coinsurance	$50 copay	$30 copay	$50 copay	$100 copay	$50 copay	$50 copay - Tier 1	$50-$100 copay	20% Coinsurance			20% coinsurance	20% coinsurance	Mulitple amts	50% Coinsurance	50% Coinsurance; $1000 every 3 yrs	Silver Sneakers		$50/$100 copay	$100 copay	$25 copay	$50 copay	$50 copay	$30 copay	20% coinsurance	20% coinsurance	50% Coinsurance	20% coinsurance	3350	4.0857	0.1798	2.8486	0.9704	0.4384	0.2848	0.0534	0.1556	2.357	5.523	0.5008	0.0602	0.0369	0.06	2.0122	4.2036	1.4133	1.0637	2.9564	0.0904	2.5953			0	0.0568	0.0799	0	0			0.0519	0.3793	0.0031	0.6406	0.6802	0.1381	0.1426	0.6044	0.065	0.9294	35.6604		5.737347145	18.6535	0.821069948	5.034461451	0.970363645	1.372968372	1.498977405	0.28086844	0.834338246	8.38594464	5.523028712	2.02220272	0.214179333	0.194052877	0.187790772	6.301477253	13.16391643	3.82338166	3.330945955	7.096700691	0.090359346	13.15119646	0	0	0	0.812818032	0.43865164	0	0	0	0	0.051859832	1.187704487	0.01613957	1.921663202	2.130064133	0.138050952	0.446670845	2.494815709	0.064965048	4.891605298	107.5467
H3342_808_0	2010	6	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	256.0994	2.932168093	48.33045183	31.87750106	4.889273743	8.687020085	2.147843326	9.519098866	38.60894857	5.801039365	18.10980528	0	0.061433222	22.81985624	38.77093659	87.5838533	1.382739417	5.469352884	28.45240236	31.00191006	6.340385597	1.12766112	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.064016551	0.064016551	0.149501551	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.064016551	0.064016551	0.149501551	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.3946	0.187707289	7.225477493	0	1.139200782	2.02407568	0.500447495	2.217950036	8.995885016	1.351642172	4.21958463	0	0.014313941	5.317026504	9.033628226	20.40703782	0.322178284	1.274359222	6.62940975	7.223445043	1.477309844	0.262745041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.218	0	0	16.3946	0.187707289	7.225477493	0	1.139200782	2.02407568	0.500447495	2.217950036	8.995885016	1.351642172	4.21958463	0	0.014313941	5.317026504	9.033628226	20.40703782	0.322178284	1.274359222	6.62940975	7.223445043	1.477309844	0.262745041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.218	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				5.4156	0.062	2.566	0	0.6084	1.076	0.266	0.6895	2.9293	0.4496	1.3966	0	0.0043	1.7131	2.9639	7.3885	0.0974	0.3852	2.151	2.563	0.5478	0.0959	0	0	0	0	0	0	0	0											33.3692	0	0	21.8102	0.249711865	9.791489545	0	1.74761633	3.100076343	0.766485886	2.907493416	11.92514654	1.801227275	5.616181389	0	0.018642439	7.030170716	11.99757792	27.79552217	0.419537465	1.65957331	8.78041781	9.786413577	2.025112355	0.35861877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.5872
H3342_809_0	2010	5	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	256.0994	2.932168093	48.33045183	31.87750106	4.889273743	8.687020085	2.147843326	9.519098866	38.60894857	5.801039365	18.10980528	0	0.061433222	22.81985624	38.77093659	87.5838533	1.382739417	5.469352884	28.45240236	31.00191006	6.340385597	1.12766112	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.064016551	0.064016551	0.149501551	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.064016551	0.064016551	0.149501551	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.3946	0.187707289	7.225477493	0	1.139200782	2.02407568	0.500447495	2.217950036	8.995885016	1.351642172	4.21958463	0	0.014313941	5.317026504	9.033628226	20.40703782	0.322178284	1.274359222	6.62940975	7.223445043	1.477309844	0.262745041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.218	0	0	16.3946	0.187707289	7.225477493	0	1.139200782	2.02407568	0.500447495	2.217950036	8.995885016	1.351642172	4.21958463	0	0.014313941	5.317026504	9.033628226	20.40703782	0.322178284	1.274359222	6.62940975	7.223445043	1.477309844	0.262745041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.218	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				5.4156	0.062	2.566	0	0.6084	1.076	0.266	0.6895	2.9293	0.4496	1.3966	0	0.0043	1.7131	2.9639	7.3885	0.0974	0.3852	2.151	2.563	0.5478	0.0959	0	0	0	0	0	0	0	0											33.3692	0	0	21.8102	0.249711865	9.791489545	0	1.74761633	3.100076343	0.766485886	2.907493416	11.92514654	1.801227275	5.616181389	0	0.018642439	7.030170716	11.99757792	27.79552217	0.419537465	1.65957331	8.78041781	9.786413577	2.025112355	0.35861877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.5872
H3342_810_0	2010	5	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	256.0994	2.932168093	48.33045183	31.87750106	4.889273743	8.687020085	2.147843326	9.519098866	38.60894857	5.801039365	18.10980528	0	0.061433222	22.81985624	38.77093659	87.5838533	1.382739417	5.469352884	28.45240236	31.00191006	6.340385597	1.12766112	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.064016551	0.064016551	0.149501551	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.064016551	0.064016551	0.149501551	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.3946	0.187707289	7.225477493	0	1.139200782	2.02407568	0.500447495	2.217950036	8.995885016	1.351642172	4.21958463	0	0.014313941	5.317026504	9.033628226	20.40703782	0.322178284	1.274359222	6.62940975	7.223445043	1.477309844	0.262745041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.218	0	0	16.3946	0.187707289	7.225477493	0	1.139200782	2.02407568	0.500447495	2.217950036	8.995885016	1.351642172	4.21958463	0	0.014313941	5.317026504	9.033628226	20.40703782	0.322178284	1.274359222	6.62940975	7.223445043	1.477309844	0.262745041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.218	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				5.4156	0.062	2.566	0	0.6084	1.076	0.266	0.6895	2.9293	0.4496	1.3966	0	0.0043	1.7131	2.9639	7.3885	0.0974	0.3852	2.151	2.563	0.5478	0.0959	0	0	0	0	0	0	0	0											33.3692	0	0	21.8102	0.249711865	9.791489545	0	1.74761633	3.100076343	0.766485886	2.907493416	11.92514654	1.801227275	5.616181389	0	0.018642439	7.030170716	11.99757792	27.79552217	0.419537465	1.65957331	8.78041781	9.786413577	2.025112355	0.35861877	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.5872
H3344_001_0	2010	8	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	V	V	V	P	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	YES	148.9427418	4.437990868	64.04428715	957.1031632	106.9012581	8.834860676	1.296509863	181.9241909	366.5905387	6101.859523	573.7588808	0	0	2234.629631	4969.690326	3475.122493	3.458874563	599.4503097	813.0650556	1298.91866	9.35390689	450.8331018	0	0	405	405	36.56932635	0.765117385	10800	0											3400	1A IP Acute: $400 Per Admit	1B IP Psych: $400 Per Admit	2 SNF: $400 per Admit	6 Home Health: $20	10A Ambulance: $150	11A DME: 25%	"11B Prosthetics/Medical Supplies: 25%, 11C Diabetes Monitoring Supplies: 25%"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $25	8B OP Radiology: $25/$75	9A OP Hospital: $25	12 Renal Dialysis: $0	"3 CORF: $25, 5 Partial Hosp: $25, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: $25, 9A OP Hospital: $25"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $25"	"7B Chiropractic: $25, 7D Physician Specialist (excl. Radiology): $25, 7F Podiatry: $25"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $25	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 0% to 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $25, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation:	"16A Preventative Dental Services (Non Medicare Covered): , 16B Comprehensive Dental (Non Medicare Covered):"	17A Routine Eye Exams (Non Medicare Covered): $5	17B Eye Wear (Medicare Covered): Various	18A Routine Hearing Exams (Non Medicare Covered): $25	18B Hearing Aids (Non Medicare Covered):	14A Health Education/Wellness Program:	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											400	400	400	20	150	0.205058381	0.245295522	49.5	100	0	37.5	25	0	24	15	25	0.41	15	25	25	0.068465381	25	0	0	5	27.5	25	0	0	0											NO	400	400	400	20	150	0.205058381	0.245295522	49.5	100	0	37.5	25	0	24	15	25	0.41	15	25	25	0.068465381	25	0	0	5	27.5	25	0	0	0												4.9648	0.147933029	2.134809572	1.595171939	1.336265727	1.811662231	0.318028064	0.750437287	3.054921156	0	1.792996503	0	0	4.469259263	6.212112907	7.239838527	1.418138571	0.749312887	1.693885533	2.706080541	0.640418797	0.939235629	0	0	0.16875	0.928125	0.076186097	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1483	0	0	4.9648	0.147933029	2.134809572	1.595171939	1.336265727	1.811662231	0.318028064	0.750437287	3.054921156	0	1.792996503	0	0	4.469259263	6.212112907	7.239838527	1.418138571	0.749312887	1.693885533	2.706080541	0.640418797	0.939235629	0	0	0.16875	0.928125	0.076186097	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1483	NO	1A IP Acute: 30%	1B IP Psych: 45%	2 SNF: 30% for days 1-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 50%	"11B Prosthetics/Medical Supplies: 50%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: 30%	8A OP Diagnostic Procedures/Tests: 30%	8B OP Radiology: 30%	9A OP Hospital: 30%	12 Renal Dialysis: $0	"3 CORF: 30%, 5 Partial Hosp: 30%, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: 30%"	"7A PCP: $35, 14B Immunizations: 30%, 14C Physical Exams: $35, 14D Pap Smears and Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: 30%"	"7B Chiropractic: 30%, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: 30%"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: 30%, 7I Physical and Speech Therapy: 30%"	7D Physician Specialist (Radiology): 30%	"7G Other Health Care: 30%, 18A Hearing Exams (Medicare Covered): 30%"	15 Part B Drugs: 20%	"13A Blood: 30%, 16B Comprehensive Dental (Medicare Covered): 30%, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): 30%	18A Routine Hearing Exams (Non Medicare Covered): 30%	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												5.3153	0.2536	0.6543	0.2987	0.1485	0.4707	0.0691	0.0813	1.4672	0.2465	0.393	0	0	0.3492	1.8074	3.2893	0.1745	0.0721	0.8936	1.2472	0.2079	0.7138	0	0	0.0188	0.1031	0.0045	0	0	0											18.2794	0	0	10.28	0.401494131	2.789080771	1.893838824	1.484739696	2.282341401	0.38711048	0.83175842	4.522075046	0.246523554	2.186025585	0	0	4.818480545	8.019560052	10.52915884	1.592636058	0.821380536	2.587443052	3.953250213	0.848285152	1.653066673	0	0	0.1875	1.03125	0.080662163	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4277
H3344_003_0	2010	8	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	V	V	V	P	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	YES	234.9503844	12.09045919	76.90280613	870.8220839	124.1890728	12.05404714	1.896562452	238.7819266	474.6397239	7175.064839	743.682733	0	0	2928.693866	7746.881651	4302.611901	5.256253967	1075.272836	1322.717498	2232.694752	17.1126921	526.8135165	0	901.9537764	405	405	40.66789196	0	10800	0											3400	1A IP Acute: $200 Per Admit	1B IP Psych: $200 Per Admit	2 SNF: $25 for days 1-100	6 Home Health: $20	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $25"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $75	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $20/$75	9A OP Hospital: $20	12 Renal Dialysis: $0	"3 CORF: $20, 5 Partial Hosp: $20, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: $20, 9A OP Hospital: $25"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 777.501438466218, 14J Nutrition Therapy: $20"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 0% to 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation:	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $5	17B Eye Wear (Medicare Covered): Various	18A Routine Hearing Exams (Non Medicare Covered): $20	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program:	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											200	200	289.8897059	20	150	0.162800715	0.083108083	49.5	75	0	33.75	20	0	19	10	20	0.41	10	20	20	0.050465134	20	0	0	5	27.5	20	0	0	0											NO	200	200	289.8897059	20	150	0.162800715	0.083108083	49.5	75	0	33.75	20	0	19	10	20	0.41	10	20	20	0.050465134	20	0	0	5	27.5	20	0	0	0												3.9158	0.201507653	1.857777654	1.45137014	1.55236341	1.962407496	0.157619669	0.984975447	2.966498274	0	2.091607686	0	0	4.637098622	6.455734709	7.171019835	2.155064126	0.896060696	2.204529163	3.721157919	0.863594296	0.878022528	0	0	0.16875	0.928125	0.06777982	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2889	0	0	3.9158	0.201507653	1.857777654	1.45137014	1.55236341	1.962407496	0.157619669	0.984975447	2.966498274	0	2.091607686	0	0	4.637098622	6.455734709	7.171019835	2.155064126	0.896060696	2.204529163	3.721157919	0.863594296	0.878022528	0	0	0.16875	0.928125	0.06777982	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2889	NO	1A IP Acute: 30%	1B IP Psych: 30%	2 SNF: 30% for days 1-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 50%	"11B Prosthetics/Medical Supplies: 50%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: $50, 4B Urgent Care: $10"	9B ASC Services: 30%	8A OP Diagnostic Procedures/Tests: 30%	8B OP Radiology: 30%	9A OP Hospital: 30%	12 Renal Dialysis: $0	"3 CORF: 30%, 5 Partial Hosp: 30%, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: 30%"	"7A PCP: $25, 14B Immunizations: 30%, 14C Physical Exams: $25, 14D Pap Smears and Pelvic Exams: 30%, 14E Prostate Screening: 30%, 14F Colorectal Screening: 30%, 14G Bone Mass Measurement: 30%, 14H Mammography: 30%, 14I Diabetes Monitoring: 30%, 14J Nutrition Therapy: 30%"	"7B Chiropractic: 30%, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: 30%"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: 30%, 7I Physical and Speech Therapy: 30%"	7D Physician Specialist (Radiology): 30%	"7G Other Health Care: 30%, 18A Hearing Exams (Medicare Covered): 30%"	15 Part B Drugs: 20%	"13A Blood: 30%, 16B Comprehensive Dental (Medicare Covered): 30%, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): 30%	18A Routine Hearing Exams (Non Medicare Covered): 30%	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												7.5043	0.2823	0.7767	0.3148	0.1541	0.6362	0.1001	0.0942	1.8822	0.2935	0.4456	0	0	0.3759	1.896	3.46	0.2628	0.1371	1.3125	1.9932	0.3803	0.7271	0	0	0.0165	0.0909	0.0109	0	0	0											23.1472	0	0	11.4201	0.483768424	2.634448042	1.76618855	1.706439737	2.598586708	0.257696949	1.079216725	4.84865951	0.293474541	2.53719468	0	0	5.013001426	8.351777204	10.63101794	2.417878512	1.033179488	3.517060454	5.714380622	1.243872296	1.605150041	0	0	0.185271914	1.018995525	0.078718742	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4361
H3344_005_0	2010	12	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	V	V	V	P	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	YES	207.7461259	4.014421224	115.7259801	1774.618057	133.298811	10.05893426	1.265764895	232.4444282	429.2329065	7852.815157	732.3037431	0	0	1313.257393	7886.66977	3699.38873	1.652345491	750.9661937	1184.450146	1676.89864	15.56935606	604.384726	0	0	405	405	79.39455695	0	10800	0											3400	1A IP Acute: $450 Per Admit	1B IP Psych: $450 Per Admit	2 SNF: $450 Per Admit	6 Home Health: $15	10A Ambulance: $150	11A DME: 30%	"11B Prosthetics/Medical Supplies: 30%, 11C Diabetes Monitoring Supplies: $25"	"4A ER: $50, 4B Urgent Care: $30"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $30/$75	9A OP Hospital: $30	12 Renal Dialysis: $0	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: $30, 9A OP Hospital: $25"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $30"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 0% to 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $5	17B Eye Wear (Medicare Covered): Various	18A Routine Hearing Exams (Non Medicare Covered): $30	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Check	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											450	450	450	15	150	0.223647335	0.039546326	49.5	100	0	41.25	30	0	28.5	15	30	0.418580833	15	30	30	0.062566045	30	0	0	25	27.5	30	0	0	0											NO	450	450	450	15	150	0.223647335	0.039546326	49.5	100	0	41.25	30	0	28.5	15	30	0.418580833	15	30	30	0.062566045	30	0	0	25	27.5	30	0	0	0												7.7905	0.150540796	4.339724252	2.218272572	1.666235138	2.24965384	0.050056352	0.958833266	3.576940887	0	2.517294117	0	0	3.118986309	9.858337213	9.248471824	0.691640152	0.938707742	2.961125365	4.1922466	0.974113035	1.510961815	0	0	0.84375	0.928125	0.198486392	0	0	0	0	0	0	0	0	0	0	0	0	0	60.983	0	0	7.7905	0.150540796	4.339724252	2.218272572	1.666235138	2.24965384	0.050056352	0.958833266	3.576940887	0	2.517294117	0	0	3.118986309	9.858337213	9.248471824	0.691640152	0.938707742	2.961125365	4.1922466	0.974113035	1.510961815	0	0	0.84375	0.928125	0.198486392	0	0	0	0	0	0	0	0	0	0	0	0	0	60.983	NO	1A IP Acute: 30%	1B IP Psych: 45%	2 SNF: 30% for days Per Admit	6 Home Health: 30%	10A Ambulance: $150	11A DME: 50%	"11B Prosthetics/Medical Supplies: 50%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: N/A, 4B Urgent Care: N/A"	9B ASC Services: 30%	8A OP Diagnostic Procedures/Tests: 30%	8B OP Radiology: 30%	9A OP Hospital: 30%	12 Renal Dialysis: $0	"3 CORF: 30%, 5 Partial Hosp: 30%, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: 30%"	"7A PCP: 30%, 14B Immunizations: 30%, 14C Physical Exams: 30%, 14D Pap Smears and Pelvic Exams: 30%, 14E Prostate Screening: 30%, 14F Colorectal Screening: 30%, 14G Bone Mass Measurement: 30%, 14H Mammography: 30%, 14I Diabetes Monitoring: 30%, 14J Nutrition Therapy: 30%"	"7B Chiropractic: 30%, 7D Physician Specialist (excl. Radiology): 30%, 7F Podiatry: 30%"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: 30%, 7I Physical and Speech Therapy: 30%"	7D Physician Specialist (Radiology): 30%	"7G Other Health Care: 30%, 18A Hearing Exams (Medicare Covered): 30%"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): 30%, 17A Routine Eye Exams (Medicare Covered): 30%"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): 50%, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): 30%	18A Routine Hearing Exams (Non Medicare Covered): 30%	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"												7.808	0.1438	1.2292	0.4679	0.1851	0.5462	0.0687	0.1069	1.8215	0.323	0.488	0	0	0.6029	1.9597	2.8351	0.0849	0.0862	1.2858	1.3033	0.3508	0.649	0	0	0.0938	0.1031	0	0	0	0											22.5431	500	0	15.5985	0.294320355	5.568948022	2.686127995	1.851372375	2.795892279	0.118804974	1.065736455	5.398481349	0.323038674	3.005288149	0	0	3.721912079	11.81804436	12.08357676	0.776586467	1.024908598	4.246900655	5.495510273	1.324884014	2.159993261	0	0	0.9375	1.03125	0.198486392	0	0	0	0	0	0	0	0	0	0	0	0	0	83.5261
H3344_801_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	220.4929467	1.323770209	27.13461127	13.88336865	10.06544755	9.875227254	0.854389141	9.878598075	54.87760409	8.902393142	12.94648014	0.021351656	0.003824177	20.10811438	47.11325461	92.61451491	1.374985163	3.454527643	33.19701072	35.88949449	15.59443799	19.01471618	0	0	0	0	0	0	0	0												Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	0	0	0	0	0	0	0	0											0.090312304	0.090312304	0.178003348	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.090312304	0.090312304	0.178003348	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.9132	0.119552738	4.830051649	0	2.345249279	2.30092795	0.19907267	2.301713351	12.78648175	2.074257602	3.016529874	0.004974936	0.000891033	4.68519065	10.97738832	21.57918197	0.320371543	0.804904941	7.734903499	8.362252217	3.633504052	4.430428871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4211	0	0	19.9132	0.119552738	4.830051649	0	2.345249279	2.30092795	0.19907267	2.301713351	12.78648175	2.074257602	3.016529874	0.004974936	0.000891033	4.68519065	10.97738832	21.57918197	0.320371543	0.804904941	7.734903499	8.362252217	3.633504052	4.430428871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4211	NO	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	0	0	0	0	0	0	0	0												2.2126	0.0133	0.5367	0	0.2606	0.2557	0.0221	0.2557	1.4207	0.2305	0.3352	0.0006	0.0001	0.5206	1.2197	2.3977	0.0356	0.0894	0.8594	0.9291	0.4037	0.4923	0	0	0	0	0	0	0	0											12.4912	0	0	22.1258	0.132836375	5.366724055	0	2.605832532	2.556586611	0.221191855	2.557459279	14.20720195	2.304730669	3.35169986	0.005527707	0.000990037	5.205767389	12.19709814	23.97686886	0.355968381	0.894338823	8.594337221	9.291391352	4.037226725	4.922698745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.9123
H3344_803_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	227.4281851	4.13984356	39.61012742	16.28250775	12.27680934	10.71908303	1.912990919	11.48847973	52.6040813	9.465166246	14.92840097	0.063	0.0108	17.60386653	51.00722695	85.99609693	1.671730704	2.771880691	37.30287254	40.62223998	15.25446303	19.4104146	0	0	0	0	0	0	0	0												Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	0	0	0	0	0	0	0	0											0.090981706	0.090981706	0.171586748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.090981706	0.090981706	0.171586748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.6918	0.37665003	6.796572947	0	2.860496576	2.497546346	0.445726884	2.676815777	12.25675094	2.205383735	3.478317426	0.014679	0.0025164	4.101700902	11.88468388	20.03709058	0.389513254	0.645848201	8.691569302	9.464981914	3.554289887	4.522626603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5956	0	0	20.6918	0.37665003	6.796572947	0	2.860496576	2.497546346	0.445726884	2.676815777	12.25675094	2.205383735	3.478317426	0.014679	0.0025164	4.101700902	11.88468388	20.03709058	0.389513254	0.645848201	8.691569302	9.464981914	3.554289887	4.522626603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5956	NO	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	0	0	0	0	0	0	0	0												2.2991	0.0419	0.7552	0	0.3178	0.2775	0.0495	0.2974	1.3619	0.245	0.3865	0.0016	0.0003	0.4557	1.3205	2.2263	0.0433	0.0718	0.9657	1.0517	0.3949	0.5025	0	0	0	0	0	0	0	0											13.0662	0	0	22.9909	0.418500034	7.551747719	0	3.178329529	2.775051496	0.495252093	2.974239752	13.61861216	2.450426373	3.86479714	0.01631	0.002796	4.557445446	13.20520431	22.26343398	0.432792505	0.717609112	9.657299225	10.51664657	3.949210986	5.02514067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.6617
H3344_804_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	227.4281851	4.13984356	39.61012742	16.28250775	12.27680934	10.71908303	1.912990919	11.48847973	52.6040813	9.465166246	14.92840097	0.063	0.0108	17.60386653	51.00722695	85.99609693	1.671730704	2.771880691	37.30287254	40.62223998	15.25446303	19.4104146	0	0	0	0	0	0	0	0												Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	0	0	0	0	0	0	0	0											0.090981706	0.090981706	0.171586748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.090981706	0.090981706	0.171586748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.6918	0.37665003	6.796572947	0	2.860496576	2.497546346	0.445726884	2.676815777	12.25675094	2.205383735	3.478317426	0.014679	0.0025164	4.101700902	11.88468388	20.03709058	0.389513254	0.645848201	8.691569302	9.464981914	3.554289887	4.522626603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5956	0	0	20.6918	0.37665003	6.796572947	0	2.860496576	2.497546346	0.445726884	2.676815777	12.25675094	2.205383735	3.478317426	0.014679	0.0025164	4.101700902	11.88468388	20.03709058	0.389513254	0.645848201	8.691569302	9.464981914	3.554289887	4.522626603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.5956	NO	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	Traditional Medicare Cost Share	0	0	0	0	0	0	0	0												2.2991	0.0419	0.7552	0	0.3178	0.2775	0.0495	0.2974	1.3619	0.245	0.3865	0.0016	0.0003	0.4557	1.3205	2.2263	0.0433	0.0718	0.9657	1.0517	0.3949	0.5025	0	0	0	0	0	0	0	0											13.0662	0	0	22.9909	0.418500034	7.551747719	0	3.178329529	2.775051496	0.495252093	2.974239752	13.61861216	2.450426373	3.86479714	0.01631	0.002796	4.557445446	13.20520431	22.26343398	0.432792505	0.717609112	9.657299225	10.51664657	3.949210986	5.02514067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.6617
H3346_002_0	2010	12	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	NO			1093.701673		177.0074515	8.119915334	4.709427582	279.1235458			564.9654943	53.67151459		70.48403971	3954.969726	5227.766613	316.9625566	974.4271882		6.836826363	28.36801366				6.628301878		5.01218946			0.25												$0 Copay	$0 (190 day limit)	$0(day 1-15) $65 (days 16-100)	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	0.0% for OP Surgery and Cardiac Cath.;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$15 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 Copay	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture													29.81552011		35	0.2	0.2	46.50819953			15	15		15	10	15	15	15		31.86557297	0.062834775				15		15			0.5											YES			29.81552011		35	0.2	0.2	46.50819953			15	15		15	10	15	15	15		31.86557297	0.062834775				15		15			0.5											3000	0	0	2.717440352	0	0.516271733	1.623983067	0.941885516	1.081794464	0	0	0.706206868	0.067089393	0	0.08810505	3.295808105	6.534708266	0.396203196	1.218033985	0	0.018154949	1.782497768	0	0	0	0.008285377	0	0.006265237	0	0	0.125	0	0	0	0	0	0	0	0	0	0	21.1277	0	0	0	0	2.717440352	0	0.516271733	1.623983067	0.941885516	1.081794464	0	0	0.706206868	0.067089393	0	0.08810505	3.295808105	6.534708266	0.396203196	1.218033985	0	0.018154949	1.782497768	0	0	0	0.008285377	0	0.006265237	0	0	0.125	0	0	0	0	0	0	0	0	0	0	21.1277	NO	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20.0% for OP Surgery and Cardiac Cath.;20.0% for ASC	20.00%	"20.0% for MRI, CT, Other Imaging, and Diag Rad.;20.0% for Nuclear Med. and Radiation Therapy"	50.00%	$0 Copay	"$25 Copay for Card. Rehab and OP SA;20.0% for CORF, Chemotherapy; 50.0% for OP MH and Part. Hosp."	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$0 Copay for Preventive Services	50.00%	$25 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$25 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 Copay	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture												1.0392	0.1286	0.1604	0.0026	0.0105	0.0528	0.0362	0.019	0.3047	0.1626	0.0954	0.066		0.0104	0.172	0.3578	0.0155	0.0385		0.0004	0.0523				0.0052		0.0001														2.7304	0	0.984224655	1.0392	0.128643586	2.87787077	0.002574462	0.526815896	1.676741679	0.978104386	1.100832361	0.304686884	0.162568467	0.80159063	0.133120853	0	0.098520026	3.467828854	6.892538286	0.411702507	1.256548608	0	0.018511517	1.834824653	0	0	0	0.013444751	0	0.006376044	0	0	0.125	0	0	0	0	0	0	0	0	0	0	23.8581
H3346_802_0	2010	4	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	NO				71.34164395	217.4337983	8.273447992	4.16860808	242.4719336			322.7591298	44.65511996		44.6039979	3877.284844	5223.536748	172.1541942	912.3816184		6.949145477	19.31759739				4.645992034		0.667527591			0.25												$0 Copay	$0 (190 day limit)	$0 (days 1-100)	$0(day 1-20) $15(days 21+)	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	0.0% for OP Surgery and Cardiac Cath.;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$15 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 Copay	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture														3.233912635	35	0.2	0.2	45.29569892			15	15		15	10.0000328	15	15	15		29.72639183	0.086983681				15		15			0.5											YES				3.233912635	35	0.2	0.2	45.29569892			15	15		15	10.0000328	15	15	15		29.72639183	0.086983681				15		15			0.5											3000	0	0	0	0.019226054	0.634181912	1.654689598	0.833721616	0.915244642	0	0	0.403448912	0.0558189	0	0.055754997	3.231081302	6.529420935	0.215192743	1.140477023	0	0.017214418	1.680315722	0	0	0	0.00580749	0	0.000834409	0	0	0.125	0	0	0	0	0	0	0	0	0	0	17.5174	0	0	0	0	0	0.019226054	0.634181912	1.654689598	0.833721616	0.915244642	0	0	0.403448912	0.0558189	0	0.055754997	3.231081302	6.529420935	0.215192743	1.140477023	0	0.017214418	1.680315722	0	0	0	0.00580749	0	0.000834409	0	0	0.125	0	0	0	0	0	0	0	0	0	0	17.5174	NO	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20.0% for OP Surgery and Cardiac Cath.;20.0% for ASC	20.00%	"20.0% for MRI, CT, Other Imaging, and Diag Rad.;20.0% for Nuclear Med. and Radiation Therapy"	50.00%	$0 Copay	"$25 Copay for Card. Rehab and OP SA;20.0% for CORF, Chemotherapy; 50.0% for OP MH and Part. Hosp."	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$0 Copay for Preventive Services	50.00%	$25 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$25 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 Copay	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture												1.3634	0.0148	0.2897	0.0043	0.0179	0.0555	0.0279	0.0258	0.2913	0.1229	0.1538	0.0768		0.0177	0.2275	0.3069	0.0232	0.0535		0.0006	0.0656				0.0003																3.1393	0	1.503578738	1.3634	0.01478499	0.289719275	0.023513668	0.652043259	1.710147553	0.861664316	0.941021949	0.29131819	0.122884625	0.557287057	0.132573227	0	0.073411936	3.458584143	6.836314031	0.238395408	1.194011756	0	0.01779137	1.745945313	0	0	0	0.006080097	0	0.000834409	0	0	0.125	0	0	0	0	0	0	0	0	0	0	20.6568
H3347_001_0	2010	4	N/A																															D	D	D	P	T	Coin	Coin	V	V	V	Coin	V	Coin	V	P	P	P	P	Coin	V	Coin	P	T	P	V	P	P	P	P	P																																																			0	NO	5396.349209	239.1002196	4737.471056		1440.249585	21.20272328	4.41675259	316.6272313	160.4678069	873.7709065	18.66155727		2.086733993	617.3271011	20.88380218	14901.50881	506.7069896	4264.04356	43.74543698		15.36560427	901.0547765								230.2713977												1a: $100/day days 1-7	1b: $100/day days 1-7	"2: $0/day days 1-14, $75/day days 15-59, $0/day days 60-100"	6: $0	10a: $50	11a: 20%	11b: 20% 11c: $0	4a: $50 4b: $50	9b: $200	8a: $0	"8b: $80 Diag Rad, $0 x-rays, 20% Ther Rad"		12: 20%	5: $20/per day 9a: $200 9c: $20 9d: $0	"7a: $0 Primary Care, $30 Urgent Care 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0"	7b: $20 7d: $20 7f: $20	7e: $20 7h: $20	3: $25 7c: $25 7i: $25	"8b: $80 Diag Rad, $0 x-rays, 20% Ther Rad"	"7g: $20 16b: $0 MC Benefits, $400 Min $800 Max Comp (Dentures)"	15: 20%	"13a: $0 14j: $0 17a: $0 Routine, $20 Non-Routine 17b: $10 17B: $0,  up to $150 18a: $0"		16a: $0				"18b: $0, up to $750"	14a: $0	13b: $20											59.72	59.72	38.4		27.9763419	0.032252636	0.050156327	28.67771204	185.055538	4.654848896	0.090315533		0.175881303	51.88908966	3.333333333	7.999038528	10.09399855	7.753540108	0.114952608		0.2	17.92615794								8.385043755											NO	59.72	59.72	38.4		27.9763419	0.032252636	0.050156327	28.67771204	185.055538	4.654848896	0.090315533		0.175881303	51.88908966	3.333333333	7.999038528	10.09399855	7.753540108	0.114952608		0.2	17.92615794								8.385043755												26.8558	1.189922093	15.15990738	0	3.357742901	0.683843725	0.221528088	0.756678714	2.474621362	0.338939295	1.685428491	0	0.367017494	2.669378442	0.005801056	9.933145257	0.426224968	2.755119397	5.028652051	0	3.073120853	1.34603752	0	0	0	0	0	0	0	0.160902979	0	0	0	0	0	0	0	0	0	0	78.4898	0	0	26.8558	1.189922093	15.15990738	0	3.357742901	0.683843725	0.221528088	0.756678714	2.474621362	0.338939295	1.685428491	0	0.367017494	2.669378442	0.005801056	9.933145257	0.426224968	2.755119397	5.028652051	0	3.073120853	1.34603752	0	0	0	0	0	0	0	0.160902979	0	0	0	0	0	0	0	0	0	0	78.4898	NO																																																																																		0	0	0	26.8558	1.189922093	15.15990738	0	3.357742901	0.683843725	0.221528088	0.756678714	2.474621362	0.338939295	1.685428491	0	0.367017494	2.669378442	0.005801056	9.933145257	0.426224968	2.755119397	5.028652051	0	3.073120853	1.34603752	0	0	0	0	0	0	0	0.160902979	0	0	0	0	0	0	0	0	0	0	78.4898
H3347_002_0	2010	6	N/A																															Coin	Coin	Coin	P	T	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	P	P	P	P	Coin	V	Coin	P	T	P	V	P	P	P	P	P																																																			0	NO	611.9207089	49.03015728	73.73410485			18.64649151	9.462947367	14.49400975	24.50995965	8.038618122	12.28497672		6.31497769	1.953125224							13.89732287																					1a: FFS	1b: FFS	2: FFS	6: $0	10a: $0	11a: 20%	11b: 20% 11c: $0	4a: 20% 4b: $0	9b: 20%	8a: 20%	"8b: 20% Diag Rad, $0 x-rays, 20% Ther Rad"		12: 20%	5: 20% 9a: 20% 9c: $0 9d: $0	7a: $0 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0	7b: $0 7d: $0 7f: $0	7e: $0 7h: $0	3: $0 7c: $0 7i: $0		7g: $0 16b: $0	15: 20%	13a: $0 14j: $0 17a: $0 17b: $0 17B:  18a: $0							14a: $0	13b: $0											0.061567114	0.061567114	0.144638709			0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233							0.233																				NO	0.061567114	0.061567114	0.144638709			0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233							0.233																					37.6742	3.018645274	10.66480573	0	0	4.344632521	2.204866737	3.377104273	5.710820597	1.872998022	2.862399575	0	1.471389802	0.455078177	0	0	0	0	0	0	3.238076229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.895	0	0	37.6742	3.018645274	10.66480573	0	0	4.344632521	2.204866737	3.377104273	5.710820597	1.872998022	2.862399575	0	1.471389802	0.455078177	0	0	0	0	0	0	3.238076229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.895	NO																																																																																		0	0	0	37.6742	3.018645274	10.66480573	0	0	4.344632521	2.204866737	3.377104273	5.710820597	1.872998022	2.862399575	0	1.471389802	0.455078177	0	0	0	0	0	0	3.238076229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.895
H3347_003_0	2010	6	N/A																															Coin	Coin	Coin	P	T	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	P	P	P	P	Coin	V	Coin	P	T	P	V	P	P	P	P	P																																																			0	NO	943.999964	28.26789709	176.4270532			16.58427555	14.23851817	14.5911731	52.12270755	9.009797416	21.56800615		1.743394077	4.041396774							59.86196143																					1a: FFS	1b: FFS	2: FFS	6: $0	10a: $0	11a: 20%	11b: 20% 11c: $0	4a: 20% 4b: $0	9b: 20%	8a: 20%	"8b: 20% Diag Rad, $0 x-rays, 20% Ther Rad"		12: 20%	5: 20% 9a: 20% 9c: $0 9d: $0	7a: $0 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0	7b: $0 7d: $0 7f: $0	7e: $0 7h: $0	3: $0 7c: $0 7i: $0		7g: $0 16b: $0	15: 20%	13a: $0 14j: $0 17a: $0 17b: $0 17B:  18a: $0	10b: $0						14a: $0	13b: $0											0.061567114	0.061567114	0.144638709			0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233							0.233																				NO	0.061567114	0.061567114	0.144638709			0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233							0.233																					58.1194	1.740372838	25.51818118	0	0	3.864136203	3.317574734	3.399743333	12.14459086	2.099282798	5.025345433	0	0.40621082	0.941645448	0	0	0	0	0	0	13.94783701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.5243	0	0	58.1194	1.740372838	25.51818118	0	0	3.864136203	3.317574734	3.399743333	12.14459086	2.099282798	5.025345433	0	0.40621082	0.941645448	0	0	0	0	0	0	13.94783701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.5243	NO																																																																																		0	0	0	58.1194	1.740372838	25.51818118	0	0	3.864136203	3.317574734	3.399743333	12.14459086	2.099282798	5.025345433	0	0.40621082	0.941645448	0	0	0	0	0	0	13.94783701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.5243
H3347_004_0	2010	6	N/A																															D	D	D	P	T	Coin	Coin	V	V	V	Coin	V	Coin	V	P	P	P	P	Coin	V	Coin	P	T	P	V	P	P	P	P	P																																																			0	NO	1824.619697	193.6414521	1032.53114		254.8014191	6.519774779	3.401293927	152.0222129	132.8380356		4.935621643		0.355647689	97.67916267	2760.735073	5457.41705	913.5420157	1857.532531			12.9797199	687.3283418																				1a: $100/day days 1-7	1b: $100/day days 1-7	"2: $0/day days 1-14, $75/day days 15-59, $0/day days 60-100"	6: $0	10a: $50	11a: 20%	11b: 20% 11c: $0	4a: $50 4b: $50	9b: $200	8a: $0	"8b: $75 Diag Rad, $20 x-rays, 20% Ther Rad"		12: 20%	5: $30/per day 9a: $200 9c: $30 9d: $0	"7a: $20 Primary Care, $30 Urgent Care 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0"	7b: $30 7d: $30 7f: $30	7e: $30 7h: $30	3: $30 7c: $30 7i: $30		"7g: $30 16b: $0 MC Benefits, $400 Min $800 Max Comp (Dentures)"	15: 20%	13a: $0 14j: $0 17a: $30 17b: $10 17B: $0 18a: $30		16a: $0				"18b: $0,  up to $750"	14a: $0												59.72	59.72	38.4		50	0.2	0.2	50	200		0.210617718		0.2	30	20	30	30	12.59499613			0.2	30																			NO	59.72	59.72	38.4		50	0.2	0.2	50	200		0.210617718		0.2	30	20	30	30	12.59499613			0.2	30																				9.0805	0.96368896	3.304099648	0	1.06167258	1.303954956	0.680258785	0.633425887	2.21396726	0	1.039529367	0	0.071129538	0.244197907	4.601225121	13.64354262	2.283855039	1.949634588	0	0	2.59594398	1.718320855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.389	0	0	9.0805	0.96368896	3.304099648	0	1.06167258	1.303954956	0.680258785	0.633425887	2.21396726	0	1.039529367	0	0.071129538	0.244197907	4.601225121	13.64354262	2.283855039	1.949634588	0	0	2.59594398	1.718320855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.389	NO																																																																																		0	0	0	9.0805	0.96368896	3.304099648	0	1.06167258	1.303954956	0.680258785	0.633425887	2.21396726	0	1.039529367	0	0.071129538	0.244197907	4.601225121	13.64354262	2.283855039	1.949634588	0	0	2.59594398	1.718320855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.389
H3347_005_0	2010	4	N/A																															D	D	D	P	T	Coin	Coin	V	V	V	Coin	V	Coin	V	P	P	P	P	Coin	V	Coin	P	T	P	V	P	P	P	P	P																																																			0	NO	1499.082289	114.3333274	710.3089678		342.8273393	2.275558029	0.65213506	162.6478704	127.2323025	520.9267806	13.94782492		0.268952014	349.1873609	66.07332043	8952.463714	216.6492868	2291.394988	37.45041519		6.859466865	701.9897625								246.4922287												1a: $100/day days 1-7	1b: $100/day days 1-7	"2: $0/day days 1-14, $75/day days 15-59, $0/day days 60-100"	6: $0	10a: $50	11a: 20%	11b: 20% 11c: $0	4a: $50 4b: $50	9b: $200	8a: $0	"8b: $80 Diag Rad, $0 x-rays, 20% Ther Rad"		12: 20%	5: $20/per day 9a: $200 9c: $20 9d: $0	"7a: $0 Primary Care, $30 Urgent Care 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0"	7b: $20 7d: $20 7f: $20	7e: $20 7h: $20	3: $25 7c: $25 7i: $25	"8b: $80 Diag Rad, $0 x-rays, 20% Ther Rad"	"7g: $20 16b: $0 MC Benefits, $400 Min $800 Max Comp (Dentures)"	15: 20%	"13a: $0 14j: $0 17a: $0 Routine, $20 Non-Routine 17b: $10 17B: $0,  up to $150 18a: $0"		16a: $0				"18b: $0,  up to $750"	14a: $0	13b: $20											59.72	59.72	38.4		27.29077581	0.034718484	0.07270222	31.35813996	186.2521217	3.315692793	0.105946357		0.179074418	32.89934885	2.535657686	8.302819898	10.39149348	7.847594837	0.132047339		0.2	19.36565334								6.56653356											NO	59.72	59.72	38.4		27.29077581	0.034718484	0.07270222	31.35813996	186.2521217	3.315692793	0.105946357		0.179074418	32.89934885	2.535657686	8.302819898	10.39149348	7.847594837	0.132047339		0.2	19.36565334								6.56653356												7.4604	0.568998859	2.272988697	0	0.779668671	0.079003926	0.047411666	0.42502789	1.974773857	0.143936098	1.477721241	0	0.048162425	0.9573364	0.01396161	6.194224488	0.187609138	1.498494956	4.945227685	0	1.371893373	1.132874199	0	0	0	0	0	0	0	0.134883291	0	0	0	0	0	0	0	0	0	0	31.7146	0	0	7.4604	0.568998859	2.272988697	0	0.779668671	0.079003926	0.047411666	0.42502789	1.974773857	0.143936098	1.477721241	0	0.048162425	0.9573364	0.01396161	6.194224488	0.187609138	1.498494956	4.945227685	0	1.371893373	1.132874199	0	0	0	0	0	0	0	0.134883291	0	0	0	0	0	0	0	0	0	0	31.7146	NO																																																																																		0	0	0	7.4604	0.568998859	2.272988697	0	0.779668671	0.079003926	0.047411666	0.42502789	1.974773857	0.143936098	1.477721241	0	0.048162425	0.9573364	0.01396161	6.194224488	0.187609138	1.498494956	4.945227685	0	1.371893373	1.132874199	0	0	0	0	0	0	0	0.134883291	0	0	0	0	0	0	0	0	0	0	31.7146
H3347_007_0	2010	4	N/A																															Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	P	P	Coin	P																																																			0	NO	587.4090408	12.90388486	125.2619082		76.67274579	124.0083058	90.75802648	35.6984587	37.57102694	31.4191499	19.01583409		8.921816078	52.21290302	50.60327043	341.1987795	8.137059912	29.04244422	59.29930616	10.76242174	89.42680117	9.391085138																				1a: FFS	1b: FFS	2: FFS	6: $0	10a: 20%	11a: 20%	11b: 20% 11c: 20%	4a: 20% 4b: 20%	9b: 20%	8a: $0	8b: 20%		12: 20%	9a: 20% 9c: 20% 9d: 20%	"7a: 20% 14b: $0 14c: 20% 14d: $0 Pap Sm, 20% Br/Pel Exams 14e: 20% 14f: 20% 14g: 20% 14h: 20% 14i: 20%"	7b: 20% 7d: 20% 7f: 20%	7e: 45% 7h: 20%	3: 20% 7c: 20% 7i: 20%	8b: 20%	7g: 20% 16b: 20%	15: 20%	13a: 20% 14j: 20% 17a: 20% 17b: 20% 17B:  18a: 20%																			0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				36.1651	0.794454948	18.11772068	0	17.86474977	28.89393524	21.14662017	8.317740878	8.754049277	7.320661928	4.430689343	0	2.078783146	12.1656064	11.79056201	79.49931563	1.895934959	6.766889502	13.81673833	2.507644265	20.83644467	2.188122837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	305.3517	0	0	36.1651	0.794454948	18.11772068	0	17.86474977	28.89393524	21.14662017	8.317740878	8.754049277	7.320661928	4.430689343	0	2.078783146	12.1656064	11.79056201	79.49931563	1.895934959	6.766889502	13.81673833	2.507644265	20.83644467	2.188122837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	305.3517	NO																																																																																		0	0	0	36.1651	0.794454948	18.11772068	0	17.86474977	28.89393524	21.14662017	8.317740878	8.754049277	7.320661928	4.430689343	0	2.078783146	12.1656064	11.79056201	79.49931563	1.895934959	6.766889502	13.81673833	2.507644265	20.83644467	2.188122837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	305.3517
H3347_008_0	2010	4	N/A																															Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	P	P	Coin	P																																																			0	NO	604.6273352	49.03015624	73.72676181		23.88508674	18.64649083	11.02444643	14.49400927	24.50995911	27.67010763	14.63612154		6.31497769	51.24645246	56.0483083	193.2439425	12.48294198	29.94103566	46.85179262	11.4545982	13.89732267	14.65285232																				1a: FFS	1b: FFS	2: FFS	6: $0	10a: 20%	11a: 20%	11b: 20% 11c: 20%	4a: 20% 4b: 20%	9b: 20%	8a: $0	8b: 20%		12: 20%	9a: 20% 9c: 20% 9d: 20%	"7a: 20% 14b: $0 14c: 20% 14d: $0 Pap Sm, 20% Br/Pel Exams 14e: 20% 14f: 20% 14g: 20% 14h: 20% 14i: 20%"	7b: 20% 7d: 20% 7f: 20%	7e: 45% 7h: 20%	3: 20% 7c: 20% 7i: 20%	8b: 20%	7g: 20% 16b: 20%	15: 20%	13a: 20% 14j: 20% 17a: 20% 17b: 20% 17B:  18a: 20%																			0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				37.2252	3.01864521	10.66374364	0	5.565225211	4.344632362	2.568696017	3.377104159	5.710820472	6.447135079	3.410216319	0	1.471389802	11.94042342	13.05925583	45.0258386	2.908525481	6.976261309	10.91646768	2.668921381	3.238076183	3.414114591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.9507	0	0	37.2252	3.01864521	10.66374364	0	5.565225211	4.344632362	2.568696017	3.377104159	5.710820472	6.447135079	3.410216319	0	1.471389802	11.94042342	13.05925583	45.0258386	2.908525481	6.976261309	10.91646768	2.668921381	3.238076183	3.414114591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.9507	NO																																																																																		0	0	0	37.2252	3.01864521	10.66374364	0	5.565225211	4.344632362	2.568696017	3.377104159	5.710820472	6.447135079	3.410216319	0	1.471389802	11.94042342	13.05925583	45.0258386	2.908525481	6.976261309	10.91646768	2.668921381	3.238076183	3.414114591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.9507
H3347_009_0	2010	4	N/A																															D	D	D	P	T	Coin	Coin	V	V	V	Coin	V	Coin	V	P	P	P	P	Coin	V	Coin	P	T	P	V	P	P	P	P	P																																																			0	NO	1499.082289	114.3333274	710.3089678		342.9240939	2.275558029	0.65213506	163.0315054	127.2323025		9.649789646		0.268952014	62.30996409		4898.116814	216.6492868	2291.394988			6.859466865	701.9897625								246.4922287												1a: $100/day days 1-7	1b: $100/day days 1-7	"2: $0/day days 1-14, $75/day days 15-59, $0/day days 60-100"	6: $0	10a: $50	11a: 10%	11b: 10% 11c: $0	4a: $50 4b: $50	9b: $50	8a: $0	"8b: 20% Diag Rad, $0 x-rays, 20% Ther Rad"		12: 20%	5: $20/per day 9a: $50 9c: $20 9d: $0	7a: $0 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0	7b: $10 7d: $15 7f: $20	7e: $20 7h: $20	3: $25 7c: $20 7i: $20		"7g: $20 16b: $0 MC Benefits, $400 Min $800 Max Comp (Dentures)"	15: 20%	"13a: $0 14j: $0 17a: $0 Routine, $20 Non-Routine 17b: $10 17B: $0, up to $250 18a: $0"		16a: $0				"18b: $0, up to $750"	14a: $0	13b: $20											59.72	59.72	38.4		50	0.098	0.098	50	50		0.2		0.2	20		14.91232351	20	8.234603189			0.2	20								20											NO	59.72	59.72	38.4		50	0.098	0.098	50	50		0.2		0.2	20		14.91232351	20	8.234603189			0.2	20								20												7.4604	0.568998859	2.272988697	0	1.428850391	0.223004687	0.063909236	0.679297939	0.530134594	0	1.929957929	0	0.053790403	0.10384994	0	6.086858542	0.361082145	1.572394039	0	0	1.371893373	1.169982938	0	0	0	0	0	0	0	0.410820381	0	0	0	0	0	0	0	0	0	0	26.2882	0	0	7.4604	0.568998859	2.272988697	0	1.428850391	0.223004687	0.063909236	0.679297939	0.530134594	0	1.929957929	0	0.053790403	0.10384994	0	6.086858542	0.361082145	1.572394039	0	0	1.371893373	1.169982938	0	0	0	0	0	0	0	0.410820381	0	0	0	0	0	0	0	0	0	0	26.2882	NO																																																																																		0	0	0	7.4604	0.568998859	2.272988697	0	1.428850391	0.223004687	0.063909236	0.679297939	0.530134594	0	1.929957929	0	0.053790403	0.10384994	0	6.086858542	0.361082145	1.572394039	0	0	1.371893373	1.169982938	0	0	0	0	0	0	0	0.410820381	0	0	0	0	0	0	0	0	0	0	26.2882
H3347_010_0	2010	4	N/A																															D	D	D	P	T	Coin	Coin	V	V	V	Coin	V	Coin	V	P	P	P	P	Coin	V	Coin	P	T	P	V	P	P	P	P	P																																																			0	YES	1536.102241	117.1567977	727.8501022		351.3926306	2.389335931	0.684741813	166.9727331	130.3743139		10.13227913		0.282399615	0.19828793							7.202440208									252.5793731											1000	1a: $300 day1	1b: $300 day1	2: $300 day1	6: $0	10a: $50	11a: 10%	11b: 10% 11c: $0	4a: $50 4b: $50	9b: $50	8a: $0	"8b: $75 Diag Rad, $0 x-rays, 20% Ther Rad"		12: 20%	5: $20/per day 9a: $50 9c: $0 9d: $0	7a: $0 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0	7b: $0 7d: $0 7f: $0	7e: $0 7h: $0	3: $25 7c: $0 7i: $0		"7g: $0 16b: $0 MC Benefits, $400 Min $800 Max Comp (Dentures)"	15: 20%	13a: $0 14j: $0 17a: $0 17b: $0 17B: $0 18a: $0		16a: $0				"18b: $0, up to $3,000"	14a: $0	13b: $20											38.33235981	38.33235981	10.98901099		50	0.098	0.098	50	50		0.157247314		0.2	20							0.2									20											YES	34.79977898	34.79977898	9.976300847		45.39216885	0.088968651	0.088968651	45.39216885	45.39216885		0.142755933		0.181568675	18.15686754							0.181568675									18.15686754											1000	4.4547	0.339752556	0.605104299	0	1.329206135	0.212575994	0.060920555	0.631604541	0.493164406	0	1.446442956	0	0.051274924	0.000300024	0	0	0	0	0	0	1.307737528	0	0	0	0	0	0	0	0	0.382170852	0	0	0	0	0	0	0	0	0	0	11.3149	0	1.148595801	4.4547	0.339752556	0.605104299	0	1.329206135	0.212575994	0.060920555	0.631604541	0.493164406	0	1.446442956	0	0.051274924	0.000300024	0	0	0	0	0	0	1.307737528	0	0	0	0	0	0	0	0	0.382170852	0	0	0	0	0	0	0	0	0	0	11.3149	NO				"20%, $5,000 Max"	"20%, $5,000 Max"	"20%, $5,000 Max"	"20%, $5,000 Max"			"20%, $5,000 Max"			"20%, $5,000 Max"		"20%, $5,000 Max"	"20%, $5,000 Max"	"20%, $5,000 Max"	"20%, $5,000 Max"	"20%, $5,000 Max"	"20%, $5,000 Max"	"20%, $5,000 Max"	"20%, $5,000 Max"			"20%, $5,000 Max"			"20%, $5,000 Max"		"20%, $5,000 Max"															0.7367	0.1522	0.0579	0.0402			0.529			0.0028		1.3727	3.0693	0.0379	0.1226	0.9536	0.1915	0.1616	0.2646			0.0035			0.0109		0.0261											7.733	0	0	4.4547	0.339752556	0.605104299	0.736697161	1.48141396	0.270517391	0.101125851	0.631604541	0.493164406	0.529024578	1.446442956	0	0.054080904	0.000300024	1.372701115	3.069281677	0.037872896	0.122555152	0.953581197	0.191464196	1.469315693	0.264556475	0	0	0.003508064	0	0	0.010890596	0	0.40831559	0	0	0	0	0	0	0	0	0	0	19.0479
H3347_011_0	2010	3	N/A																															D	D	D	P	T	Coin	Coin	V	V	V	Coin	V	Coin	V	P	P	P	P	Coin	V	Coin	P	T	P	V	P	P	P	P	P																																																			0	NO	1499.082289	114.3333274	710.3089678		342.9240939	2.275558029	0.65213506	163.0315054	127.2323025		9.649789646		0.268952014	62.30996409	2438.953692	4898.116814	216.6492868	2291.394988			6.859466865	701.9897625								246.4922287												1a: $100/day days1-7	1b: $100/day days1-7	"2: $0/day days 1-14, $75/day days 15-59, $0/day days 60-100"	6: $0	10a: $50	11a: 20%	11b: 20% 11c: $0	4a: $50 4b: $50	9b: $200	8a: $0	"8b: $75 Diag Rad, $0 x-rays, 20% Ther Rad"		12: 20%	5: $30/per day 9a: $200 9c: $30 9d: $0	"7a: $20 Primary Care, $30 Urgent Care 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0"	7b: $30 7d: $30 7f: $30	7e: $30 7h: $30	3: $30 7c: $30 7i: $30		"7g: $30 16b: $0 MC Benefits, $400 Min $800 Max Comp (Dentures)"	15: 20%	13a: $0 14j: $0 17a: $30 17b: $10 17B: $0 18a: $30		16a: $0				"18b: $0, up to $750"	14a: $0	13b: $30											59.72	59.72	38.4		50	0.2	0.2	50	200		0.157869538		0.2	30	20	29.95272624	30	12.35190478			0.2	30								30											NO	59.72	59.72	38.4		50	0.2	0.2	50	200		0.157869538		0.2	30	20	29.95272624	30	12.35190478			0.2	30								30												7.4604	0.568998859	2.272988697	0	1.428850391	0.455111606	0.130427012	0.679297939	2.120538374	0	1.523407833	0	0.053790403	0.15577491	4.064922819	12.225996	0.541623217	2.358591059	0	0	1.371893373	1.754974406	0	0	0	0	0	0	0	0.616230572	0	0	0	0	0	0	0	0	0	0	39.7839	0	0	7.4604	0.568998859	2.272988697	0	1.428850391	0.455111606	0.130427012	0.679297939	2.120538374	0	1.523407833	0	0.053790403	0.15577491	4.064922819	12.225996	0.541623217	2.358591059	0	0	1.371893373	1.754974406	0	0	0	0	0	0	0	0.616230572	0	0	0	0	0	0	0	0	0	0	39.7839	NO																																																																																		0	0	0	7.4604	0.568998859	2.272988697	0	1.428850391	0.455111606	0.130427012	0.679297939	2.120538374	0	1.523407833	0	0.053790403	0.15577491	4.064922819	12.225996	0.541623217	2.358591059	0	0	1.371893373	1.754974406	0	0	0	0	0	0	0	0.616230572	0	0	0	0	0	0	0	0	0	0	39.7839
H3351_001_0	2010	4	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	NO	343.920652	9.218784871	2257.228046	0	262.5239709	6.240646867	14.56340017	742.9569817	537.6503399	0	1803.989957	0	0	1231.577266	6844.137981	9765.177171	303.628265	621.8767715	3204.081999	2240.11498	40.32435737	0	0	0	1142.522545	0	66.43184589	0	0	165.7967307	0	0	0	0	0	0	0	0	0	0		$100 Copay	$100 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$25-$50 Copay	$35 Copay	$0 Copay	$25 Copay	$35 Copay	$0 Copay	$25 Copay	$10 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$25 Copay	$0 Copay	$25 Copay	$0 Copay	$0 Copay	"$30% Coins, $1,500 Max"											93.49148467	93.92830295	24.79903802	0	99.12398372	0.198188388	0.056239856	13.78989939	22.98735086	0	11.71982628	0	0	7.668629199	6.372849296	12.64306247	17.66144291	24.58928073	5.774417806	1.015756533	0.1	0	0	0	23.11125264	0	15.60171244	0	0	12.14931693	0	0	0	0	0	0	0	0	0	0	NO	93.49148467	93.92830295	24.79903802	0	99.12398372	0.198188388	0.056239856	13.78989939	22.98735086	0	11.71982628	0	0	7.668629199	6.372849296	12.64306247	17.66144291	24.58928073	5.774417806	1.015756533	0.1	0	0	0	23.11125264	0	15.60171244	0	0	12.14931693	0	0	0	0	0	0	0	0	0	0		2.6795	0.072158735	4.664757012	0	2.168535151	1.236823744	0.819043533	0.853775169	1.02992975	0	1.761870741	0	0	0.787042449	3.634721659	10.28847875	0.446876106	1.274291876	1.541809012	0.189617619	4.032435737	0	0	0	2.200427265	0	0.08637088	0	0	0.167859752	0	0	0	0	0	0	0	0	0	0	39.9363			2.6795	0.072158735	4.664757012	0	2.168535151	1.236823744	0.819043533	0.853775169	1.02992975	0	1.761870741	0	0	0.787042449	3.634721659	10.28847875	0.446876106	1.274291876	1.541809012	0.189617619	4.032435737	0	0	0	2.200427265	0	0.08637088	0	0	0.167859752	0	0	0	0	0	0	0	0	0	0	39.9363	NO																																																																																		0			2.6795	0.072158735	4.664757012	0	2.168535151	1.236823744	0.819043533	0.853775169	1.02992975	0	1.761870741	0	0	0.787042449	3.634721659	10.28847875	0.446876106	1.274291876	1.541809012	0.189617619	4.032435737	0	0	0	2.200427265	0	0.08637088	0	0	0.167859752	0	0	0	0	0	0	0	0	0	0	39.9363
H3351_002_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	NO	348.5935569	10.28516769	2326.65575	0	284.7486074	6.25847559	16.4808845	763.4185168	541.28917	0	1914.865825	0	0	1379.527929	7030.891333	10119.94815	388.9689236	752.9406299	3231.537598	2343.684436	61.29633507	0	0	0	1059.710106	0	73.19102262	0	0	176.5052214	0	0	0	0	0	0	0	0	0	0		$250 Copay	$250 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$50 Copay	$0 Copay	$30 Copay	$50 Copay	$0 Copay	$30 Copay	$15 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	"$30% Coins, $1,500 Max"	0	0	0	0	0	0	0	0	0	0	228.2885974	195.2609678	24.28861378	0	99.11280092	0.198576437	0.054074289	14.57857311	33.92105851	0	12.88357905	0	0	9.565628879	8.841022061	14.9072518	22.05158552	28.46712409	6.84179991	1.370773849	0.1	0	0	0	28.0483405	0	20.52366539	0	0	9.102076271	0	0	0	0	0	0	0	0	0	0	NO	228.2885974	195.2609678	24.28861378	0	99.11280092	0.198576437	0.054074289	14.57857311	33.92105851	0	12.88357905	0	0	9.565628879	8.841022061	14.9072518	22.05158552	28.46712409	6.84179991	1.370773849	0.1	0	0	0	28.0483405	0	20.52366539	0	0	9.102076271	0	0	0	0	0	0	0	0	0	0		6.6317	0.16735765	4.709270243	0	2.35185267	1.242785785	0.891192105	0.927462722	1.530091801	0	2.055860436	0	0	1.099671017	5.180022116	12.57171794	0.71478179	1.786171195	1.842461137	0.267721778	6.129633507	0	0	0	2.476925824	0	0.125179005	0	0	0.133880332	0	0	0	0	0	0	0	0	0	0	52.8357			6.6317	0.16735765	4.709270243	0	2.35185267	1.242785785	0.891192105	0.927462722	1.530091801	0	2.055860436	0	0	1.099671017	5.180022116	12.57171794	0.71478179	1.786171195	1.842461137	0.267721778	6.129633507	0	0	0	2.476925824	0	0.125179005	0	0	0.133880332	0	0	0	0	0	0	0	0	0	0	52.8357	NO																																																																																		0			6.6317	0.16735765	4.709270243	0	2.35185267	1.242785785	0.891192105	0.927462722	1.530091801	0	2.055860436	0	0	1.099671017	5.180022116	12.57171794	0.71478179	1.786171195	1.842461137	0.267721778	6.129633507	0	0	0	2.476925824	0	0.125179005	0	0	0.133880332	0	0	0	0	0	0	0	0	0	0	52.8357
H3351_006_0	2010	7	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	NO	266.3257468	10.84876063	1193.896124	0	233.7352212	13.14796032	3.211796703	477.3492264	573.8106965	0	1037.655687	67.47273659	0	1019.021469	7891.661991	12151.20013	882.4719976	628.4643212	2841.51087	8701.02263	54.30650891	0	0	0	776.1008227	0	53.4438999	0	0	485.3029078	0	0	0	0	0	0	0	0	0	0		$250 Copay	$250 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$30-$50 Copay	$50 Copay	$0 Copay	$30 Copay	$50 Copay	$0 Copay	$30 Copay	$15 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	$30 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$30 Copay	$0 Copay	$30 Copay	$0 Copay	$0 Copay	"$30% Coins, $3,000 Max"											223.4529301	242.2464888	23.12558744	0	99.71323597	0.173518751	0.111445287	15.87598864	30.37619259	0	21.28588202	0.090471592	0	22.64107846	8.178052562	12.61387452	29.23021746	29.56868144	8.613247408	2.304500975	0.1	0	0	0	29.40877718	0	27.55149743	0	0	17.55223782	0	0	0	0	0	0	0	0	0	0	NO	223.4529301	242.2464888	23.12558744	0	99.71323597	0.173518751	0.111445287	15.87598864	30.37619259	0	21.28588202	0.090471592	0	22.64107846	8.178052562	12.61387452	29.23021746	29.56868144	8.613247408	2.304500975	0.1	0	0	0	29.40877718	0	27.55149743	0	0	17.55223782	0	0	0	0	0	0	0	0	0	0		4.9593	0.219006181	2.300795766	0	1.942207938	2.281417656	0.357939607	0.631532574	1.452515352	0	1.840618043	0.000508697	0	1.92264542	5.378202214	12.77280948	2.149570699	1.548571776	2.039553011	1.670959594	5.430650891	0	0	0	1.90201468	0	0.122704956	0	0	0.709846004	0	0	0	0	0	0	0	0	0	0	51.6333			4.9593	0.219006181	2.300795766	0	1.942207938	2.281417656	0.357939607	0.631532574	1.452515352	0	1.840618043	0.000508697	0	1.92264542	5.378202214	12.77280948	2.149570699	1.548571776	2.039553011	1.670959594	5.430650891	0	0	0	1.90201468	0	0.122704956	0	0	0.709846004	0	0	0	0	0	0	0	0	0	0	51.6333	NO																																																																																		0			4.9593	0.219006181	2.300795766	0	1.942207938	2.281417656	0.357939607	0.631532574	1.452515352	0	1.840618043	0.000508697	0	1.92264542	5.378202214	12.77280948	2.149570699	1.548571776	2.039553011	1.670959594	5.430650891	0	0	0	1.90201468	0	0.122704956	0	0	0.709846004	0	0	0	0	0	0	0	0	0	0	51.6333
H3351_007_0	2010	5	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	P	P	0	P	V	V	V	V	P	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	357.6136348	5.285617681	1891.628366	0	339.8404236	10.58707547	3.10380249	572.1092018	555.6483279	0	1142.923075	0	0	883.7866042	8404.625295	12895.03286	443.6722658	502.1832812	3045.771676	8930.578157	36.39503849	0	0	0	824.9585069	0	60.62259474	0	0	336.1335858	0	0	0	0	0	0	0	0	0	0		$100 Copay	$100 Copay	$25 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$25-$50 Copay	$35 Copay	$0 Copay	$25 Copay	$35 Copay	$0 Copay	$25 Copay	$10 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	$25 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$25 Copay	$0 Copay	$25 Copay	$0 Copay	$0 Copay	"$30% Coins, $3,000 Max"	0	0	0	0	0	0	0	0	0	0	93.14098391	92.30769231	22.21794045	0	100	0.185430759	0.088297395	14.23173327	18.02916663	0	18.23773578	0	0	21.41539193	5.582272868	10.48728528	23.7843533	24.90505288	6.937984153	1.66297221	0.1	0	0	0	24.36421484	0	19.38794791	0	0	15.40870566	0	0	0	0	0	0	0	0	0	0	NO	93.14098391	92.30769231	22.21794045	0	100	0.185430759	0.088297395	14.23173327	18.02916663	0	18.23773578	0	0	21.41539193	5.582272868	10.48728528	23.7843533	24.90505288	6.937984153	1.66297221	0.1	0	0	0	24.36421484	0	19.38794791	0	0	15.40870566	0	0	0	0	0	0	0	0	0	0		2.7757	0.040658598	3.502340532	0	2.83200353	1.963169439	0.274057673	0.678508797	0.834823024	0	1.737027422	0	0	1.57721971	3.909742645	11.26949069	0.879371493	1.042241764	1.760959635	1.237608608	3.639503849	0	0	0	1.674955525	0	0.097945642	0	0	0.431615291	0	0	0	0	0	0	0	0	0	0	42.159			2.7757	0.040658598	3.502340532	0	2.83200353	1.963169439	0.274057673	0.678508797	0.834823024	0	1.737027422	0	0	1.57721971	3.909742645	11.26949069	0.879371493	1.042241764	1.760959635	1.237608608	3.639503849	0	0	0	1.674955525	0	0.097945642	0	0	0.431615291	0	0	0	0	0	0	0	0	0	0	42.159	NO																																																																																		0			2.7757	0.040658598	3.502340532	0	2.83200353	1.963169439	0.274057673	0.678508797	0.834823024	0	1.737027422	0	0	1.57721971	3.909742645	11.26949069	0.879371493	1.042241764	1.760959635	1.237608608	3.639503849	0	0	0	1.674955525	0	0.097945642	0	0	0.431615291	0	0	0	0	0	0	0	0	0	0	42.159
H3351_010_0	2010	7	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	Coin	P	0	P	V	V	Coin	V	Coin	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	NO	219.898883	5.551621574	1616.182938	0	175.8575785	5.422670494	12.8783871	508.839981	405.5102201	0	15.73614018	0	0	887.8865866	5004.347884	6572.403808	1.707432361	434.3833061	31.92685518	1618.67668	38.47290318	0	0	0	810.4589869	0	51.22776929	0	0	0	0	0	0	0	0	0	0	0	0	0		$500 Copay	$500 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$40-$50 Copay	$125 Copay	$0 Copay	20% Coins	$125 Copay	$0 Copay	$40 Copay	$20 Copay	$40 Copay	45% -50% Coins	$40 Copay	20% Coins	$40 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$40 Copay	$0 Copay	$40 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0	436.275677	401.4803252	38.23258723	0	98.97710476	0.178394417	0.056071878	18.57982646	81.71106828	0	0.2	0	0	12.98998597	11.85158924	20.04815055	0.373952051	37.1016063	0.2	1.79531742	0.1	0	0	0	37.57485876	0	26.41274687	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	436.275677	401.4803252	38.23258723	0	98.97710476	0.178394417	0.056071878	18.57982646	81.71106828	0	0.2	0	0	12.98998597	11.85158924	20.04815055	0.373952051	37.1016063	0.2	1.79531742	0.1	0	0	0	37.57485876	0	26.41274687	0	0	0	0	0	0	0	0	0	0	0	0	0		7.9947	0.185738903	5.14923793	0	1.450489498	0.967374144	0.722115345	0.787846545	2.761222773	0	3.147228036	0	0	0.961136192	4.942456294	10.98037842	0.638497833	1.343026534	6.385371036	0.24216987	3.847290318	0	0	0	2.537740164	0	0.112755509	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1568			7.9947	0.185738903	5.14923793	0	1.450489498	0.967374144	0.722115345	0.787846545	2.761222773	0	3.147228036	0	0	0.961136192	4.942456294	10.98037842	0.638497833	1.343026534	6.385371036	0.24216987	3.847290318	0	0	0	2.537740164	0	0.112755509	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1568	NO																																																																																		0			7.9947	0.185738903	5.14923793	0	1.450489498	0.967374144	0.722115345	0.787846545	2.761222773	0	3.147228036	0	0	0.961136192	4.942456294	10.98037842	0.638497833	1.343026534	6.385371036	0.24216987	3.847290318	0	0	0	2.537740164	0	0.112755509	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1568
H3351_011_0	2010	7	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	Coin	P	0	P	V	V	Coin	V	Coin	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	164.182273	9.700292254	643.9213341	0	146.7073542	6.802276722	1.691664194	348.5387292	401.3077921	0	18.77338059	12.67550781	0	737.857608	5765.02576	7854.000548	3.572084288	321.6875461	23.86289993	6062.554375	20.97012637	0	0	0	569.0366827	0	34.56872546	0	0	0	0	0	0	0	0	0	0	0	0	0		$500 Copay	$500 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$40-$50 Copay	$125 Copay	$0 Copay	20% Coins	$125 Copay	$0 Copay	$40 Copay	$20 Copay	$40 Copay	45% -50% Coins	$40 Copay	20% Coins	$40 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$40 Copay	$0 Copay	$40 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0	458.4370435	459.3847447	42.45216566	0	99.5887593	0.175178069	0.070492598	17.43515342	78.39460923	0	0.2	0.153785259	0	26.93429912	11.15953309	16.17782001	0.442252512	39.66935047	0.2	3.103076014	0.1	0	0	0	39.1063586	0	36.81283556	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	458.4370435	459.3847447	42.45216566	0	99.5887593	0.175178069	0.070492598	17.43515342	78.39460923	0	0.2	0.153785259	0	26.93429912	11.15953309	16.17782001	0.442252512	39.66935047	0.2	3.103076014	0.1	0	0	0	39.1063586	0	36.81283556	0	0	0	0	0	0	0	0	0	0	0	0	0		6.2723	0.37134719	2.277987929	0	1.217533616	1.191609699	0.119249804	0.506402185	2.621697295	0	3.754676117	0.000162442	0	1.656139793	5.361249646	10.58838393	1.579763249	1.063428001	4.772579987	1.567713922	2.097012637	0	0	0	1.854412714	0	0.106047734	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9797			6.2723	0.37134719	2.277987929	0	1.217533616	1.191609699	0.119249804	0.506402185	2.621697295	0	3.754676117	0.000162442	0	1.656139793	5.361249646	10.58838393	1.579763249	1.063428001	4.772579987	1.567713922	2.097012637	0	0	0	1.854412714	0	0.106047734	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9797	NO																																																																																		0			6.2723	0.37134719	2.277987929	0	1.217533616	1.191609699	0.119249804	0.506402185	2.621697295	0	3.754676117	0.000162442	0	1.656139793	5.361249646	10.58838393	1.579763249	1.063428001	4.772579987	1.567713922	2.097012637	0	0	0	1.854412714	0	0.106047734	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9797
H3351_012_0	2010	5	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	Coin	P	0	P	V	V	Coin	V	Coin	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	NO	337.5417385	9.962576026	2203.945985	0	271.1954429	6.201840529	15.68089133	740.9147086	532.6563896	0	23.4167344	0	0	1309.913016	6655.33667	9650.464234	2.335193513	696.1026188	39.7249136	2263.930256	56.06253707	0	0	0	1044.126976	0	69.44802261	0	0	0	0	0	0	0	0	0	0	0	0	0		$350 Copay	$350 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$35-$50 Copay	$100 Copay	$0 Copay	10% Coins	$100 Copay	$0 Copay	$35 Copay	$20 Copay	$35 Copay	45% -50% Coins	$35 Copay	10% Coins	$35 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$35 Copay	$0 Copay	$35 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0	320.7142503	290.4127163	48.19037432	0	99.08281075	0.197875081	0.054862933	16.12208555	66.85520438	0	0.1	0	0	11.14034058	11.95574024	17.75346953	0.452121742	33.35504897	0.1	1.576794968	0.1	0	0	0	32.61782991	0	23.2801604	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	320.7142503	290.4127163	48.19037432	0	99.08281075	0.197875081	0.054862933	16.12208555	66.85520438	0	0.1	0	0	11.14034058	11.95574024	17.75346953	0.452121742	33.35504897	0.1	1.576794968	0.1	0	0	0	32.61782991	0	23.2801604	0	0	0	0	0	0	0	0	0	0	0	0	0		9.0212	0.241104897	8.850748502	0	2.239233895	1.227189699	0.860299694	0.995424193	2.967570983	0	2.34167344	0	0	1.216073094	6.630789705	14.27743523	1.05579176	1.934878078	3.97249136	0.297479486	5.606253707	0	0	0	2.838096342	0	0.134730092	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7085			9.0212	0.241104897	8.850748502	0	2.239233895	1.227189699	0.860299694	0.995424193	2.967570983	0	2.34167344	0	0	1.216073094	6.630789705	14.27743523	1.05579176	1.934878078	3.97249136	0.297479486	5.606253707	0	0	0	2.838096342	0	0.134730092	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7085	NO																																																																																		0			9.0212	0.241104897	8.850748502	0	2.239233895	1.227189699	0.860299694	0.995424193	2.967570983	0	2.34167344	0	0	1.216073094	6.630789705	14.27743523	1.05579176	1.934878078	3.97249136	0.297479486	5.606253707	0	0	0	2.838096342	0	0.134730092	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7085
H3351_013_0	2010	6	N/A																															A	A	D	0	T	Coin	Coin	V	P	0	Coin	P	0	P	V	V	Coin	V	Coin	V	Coin	0	0	0	V	0	V	0	0	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	0	0	0	0	0	0	0	0	NO	273.8161336	9.534961093	1252.713063	0	246.2086078	12.0672561	3.027698589	483.8004039	548.7529906	0	31.57951406	67.33127178	0	963.4941944	7571.903851	11704.50226	5.522142425	565.9959245	33.14752706	8387.64333	46.86493934	0	0	0	758.660189	0	52.00296146	0	0	0	0	0	0	0	0	0	0	0	0	0		$350 Copay	$350 Copay	$50 Copay	$0 Copay	$100 Copay	20% Coins	20% Coins	$35-$50 Copay	$100 Copay	$0 Copay	10% Coins	$100 Copay	$0 Copay	$35 Copay	$20 Copay	$35 Copay	45% -50% Coins	$35 Copay	10% Coins	$35 Copay	20% Coins	$0 Copay	$0 Copay	$0 Copay	$35 Copay	$0 Copay	$35 Copay	$0 Copay	$0 Copay	0	0	0	0	0	0	0	0	0	0	0	316.9616424	335.3072944	45.50671949	0	99.78534603	0.176293235	0.103713725	15.73551538	58.94296864	0	0.1	0.123028208	0	26.72203011	10.90637385	14.79551657	0.439443494	34.56800582	0.1	2.625167093	0.1	0	0	0	34.24966661	0	30.99008922	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	316.9616424	335.3072944	45.50671949	0	99.78534603	0.176293235	0.103713725	15.73551538	58.94296864	0	0.1	0.123028208	0	26.72203011	10.90637385	14.79551657	0.439443494	34.56800582	0.1	2.625167093	0.1	0	0	0	34.24966661	0	30.99008922	0	0	0	0	0	0	0	0	0	0	0	0	0		7.2324	0.266428501	4.750571832	0	2.04733426	2.12737562	0.314013899	0.634404058	2.695427526	0	3.157951406	0.000690304	0	2.145543406	6.881834511	14.43117977	2.426669564	1.630445868	3.314752706	1.834913771	4.686493934	0	0	0	2.165321545	0	0.134298035	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8781			7.2324	0.266428501	4.750571832	0	2.04733426	2.12737562	0.314013899	0.634404058	2.695427526	0	3.157951406	0.000690304	0	2.145543406	6.881834511	14.43117977	2.426669564	1.630445868	3.314752706	1.834913771	4.686493934	0	0	0	2.165321545	0	0.134298035	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8781	NO																																																																																		0			7.2324	0.266428501	4.750571832	0	2.04733426	2.12737562	0.314013899	0.634404058	2.695427526	0	3.157951406	0.000690304	0	2.145543406	6.881834511	14.43117977	2.426669564	1.630445868	3.314752706	1.834913771	4.686493934	0	0	0	2.165321545	0	0.134298035	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8781
H3351_801_0	2010	1	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	318.1912244	7.049660262	1881.011756	1543.950364	231.471846	6.394952725	16.31016571	632.5274887	626.5109524	17236.67798	2008.335577	0	76.52569758	1375.184808	6165.397267	11081.9477	284.3410261	1148.715723	3304.198311	2733.027322	2743.526136	48.34227461																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			983.8500925	600.3812408	46.32995398	0	139.2419422	0.233	0.233	82.85254279	208.0824219	3.331126149	32.83580831	0	47.3078797	22.38220555	20.84367861	33.73861902	18.99141238	12.92540044	30.48053406	16.48833045	69.00329251	170.8866525																			NO	983.8500925	600.3812408	46.32995398	0	139.2419422	0.233	0.233	82.85254279	208.0824219	3.331126149	32.83580831	0	47.3078797	22.38220555	20.84367861	33.73861902	18.99141238	12.92540044	30.48053406	16.48833045	69.00329251	170.8866525																				26.0877	0.352706981	7.262265674	0	2.685882451	1.490023985	3.800268611	4.367209235	10.86382636	4.784795729	5.495443502	0	0.301689041	2.56497242	10.70912993	31.15746762	0.45000314	1.237300893	8.392810763	3.755254801	15.77602804	0.68842079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.2232			26.0877	0.352706981	7.262265674	0	2.685882451	1.490023985	3.800268611	4.367209235	10.86382636	4.784795729	5.495443502	0	0.301689041	2.56497242	10.70912993	31.15746762	0.45000314	1.237300893	8.392810763	3.755254801	15.77602804	0.68842079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.2232	NO																																																																																		0			26.0877	0.352706981	7.262265674	0	2.685882451	1.490023985	3.800268611	4.367209235	10.86382636	4.784795729	5.495443502	0	0.301689041	2.56497242	10.70912993	31.15746762	0.45000314	1.237300893	8.392810763	3.755254801	15.77602804	0.68842079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.2232
H3351_802_0	2010	1	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	222.6470718	4.753466344	909.7462964	1479.938089	162.1036757	9.644232909	2.687507649	340.0795146	535.4450739	496.5622038	821.9688335	42.6514045	10.29862362	979.7014815	6223.834068	11987.20467	448.182526	790.6470855	2619.359318	8315.259217	1869.535701	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																			946.5231582	1281.018169	74.12639518	0	102.5359624	0.233	0.233	111.1713156	239.1746208	33.8088284	87.94363773	182.67647	92.68085034	21.12661492	15.86006413	23.68775878	20.49591514	17.42139281	33.25533798	16.31425443	61.09352511	0																			NO	946.5231582	1281.018169	74.12639518	0	102.5359624	0.233	0.233	111.1713156	239.1746208	33.8088284	87.94363773	182.67647	92.68085034	21.12661492	15.86006413	23.68775878	20.49591514	17.42139281	33.25533798	16.31425443	61.09352511	0																				17.5617	0.507439729	5.619684457	0	1.385121366	2.247106268	0.626189282	3.150590586	10.67207271	1.399015528	6.023910777	0.649284001	0.079540433	1.724814661	8.225867289	23.66250106	0.765492585	1.147847787	7.258973284	11.30477121	9.518043857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.53			17.5617	0.507439729	5.619684457	0	1.385121366	2.247106268	0.626189282	3.150590586	10.67207271	1.399015528	6.023910777	0.649284001	0.079540433	1.724814661	8.225867289	23.66250106	0.765492585	1.147847787	7.258973284	11.30477121	9.518043857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.53	NO																																																																																		0			17.5617	0.507439729	5.619684457	0	1.385121366	2.247106268	0.626189282	3.150590586	10.67207271	1.399015528	6.023910777	0.649284001	0.079540433	1.724814661	8.225867289	23.66250106	0.765492585	1.147847787	7.258973284	11.30477121	9.518043857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.53
H3351_803_0	2010	1	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	316.9058984	7.192321668	1592.962736	1497.536846	217.5821161	7.031771097	20.13140999	610.6078541	568.3569899	16814.32883	1705.766195	0	126.8331823	1270.269854	6677.915528	11004.59198	305.3037353	1037.540194	3202.595785	2704.230031	5481.220896	54.20773327																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			855.4533704	732.9619785	46.80684249	0	156.6347562	0.233	0.233	81.87889062	232.3778507	3.317695967	35.10083587	0	44.14609213	18.21777898	20.05644774	33.581687	18.19960665	12.64214054	37.04932774	17.44824573	37.08187583	112.0717996																			NO	855.4533704	732.9619785	46.80684249	0	156.6347562	0.233	0.233	81.87889062	232.3778507	3.317695967	35.10083587	0	44.14609213	18.21777898	20.05644774	33.581687	18.19960665	12.64214054	37.04932774	17.44824573	37.08187583	112.0717996																				22.5915	0.439308193	6.213462989	0	2.84007681	1.638402666	4.690618528	4.166324475	11.00613131	4.648735912	4.989484938	0	0.466599112	1.928457954	11.16127198	30.79606361	0.463033991	1.093060745	9.88783507	3.932005841	16.93782939	0.506263185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.3965			22.5915	0.439308193	6.213462989	0	2.84007681	1.638402666	4.690618528	4.166324475	11.00613131	4.648735912	4.989484938	0	0.466599112	1.928457954	11.16127198	30.79606361	0.463033991	1.093060745	9.88783507	3.932005841	16.93782939	0.506263185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.3965	NO																																																																																		0			22.5915	0.439308193	6.213462989	0	2.84007681	1.638402666	4.690618528	4.166324475	11.00613131	4.648735912	4.989484938	0	0.466599112	1.928457954	11.16127198	30.79606361	0.463033991	1.093060745	9.88783507	3.932005841	16.93782939	0.506263185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.3965
H3351_804_0	2010	1	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	239.7045702	4.793366915	1175.838021	1573.703482	169.9721454	11.08601674	3.856855244	357.6041998	526.7553591	500.4222806	908.1614368	50.72722322	5.32053261	1048.604915	6516.220241	11838.13713	350.637416	617.2216492	2581.733444	8496.44138	2066.284797	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																			889.2153104	985.1341654	70.22946056	0	100.9820681	0.233	0.233	109.271856	263.1005493	33.30199711	95.34993165	204.4400142	92.68085034	24.96390638	15.85313369	24.15546366	19.6909915	17.29621991	32.8193729	16.12375048	63.71833101	0																			NO	889.2153104	985.1341654	70.22946056	0	100.9820681	0.233	0.233	109.271856	263.1005493	33.30199711	95.34993165	204.4400142	92.68085034	24.96390638	15.85313369	24.15546366	19.6909915	17.29621991	32.8193729	16.12375048	63.71833101	0																				17.7624	0.393509126	6.881539158	0	1.430344897	2.583041901	0.898647272	3.256339553	11.54913536	1.388755112	7.216094244	0.864222853	0.041092624	2.181439578	8.608542551	23.82964093	0.575366531	0.889633448	7.060906053	11.4162084	10.97168489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.7986			17.7624	0.393509126	6.881539158	0	1.430344897	2.583041901	0.898647272	3.256339553	11.54913536	1.388755112	7.216094244	0.864222853	0.041092624	2.181439578	8.608542551	23.82964093	0.575366531	0.889633448	7.060906053	11.4162084	10.97168489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.7986	NO																																																																																		0			17.7624	0.393509126	6.881539158	0	1.430344897	2.583041901	0.898647272	3.256339553	11.54913536	1.388755112	7.216094244	0.864222853	0.041092624	2.181439578	8.608542551	23.82964093	0.575366531	0.889633448	7.060906053	11.4162084	10.97168489	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.7986
H3351_805_0	2010	1	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	313.5272363	7.275958013	1674.066434	1488.825912	217.471751	6.941565431	18.21781938	599.5930346	607.2648351	16895.64036	1859.578897	0	87.78603884	1337.801866	6286.103277	11055.40806	303.606277	1114.065068	3244.357266	2721.286829	3828.02704	59.29946929																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			951.5562115	692.5652961	46.5383813	0	145.9585364	0.233	0.233	83.8392668	215.7366764	3.368738943	34.40667188	0	45.3970357	20.60276368	19.99629758	33.71402601	18.76199141	12.85214646	33.83212324	17.13324031	53.03831018	152.3684907																			NO	951.5562115	692.5652961	46.5383813	0	145.9585364	0.233	0.233	83.8392668	215.7366764	3.368738943	34.40667188	0	45.3970357	20.60276368	19.99629758	33.71402601	18.76199141	12.85214646	33.83212324	17.13324031	53.03831018	152.3684907																				24.8616	0.419923001	6.492361836	0	2.645154874	1.617384745	4.244751915	4.189120033	10.91744143	4.743083471	5.331826745	0	0.332102162	2.296867975	10.47489931	31.0601929	0.474688197	1.193177285	9.146957905	3.885371766	16.91934046	0.752947553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.9992			24.8616	0.419923001	6.492361836	0	2.645154874	1.617384745	4.244751915	4.189120033	10.91744143	4.743083471	5.331826745	0	0.332102162	2.296867975	10.47489931	31.0601929	0.474688197	1.193177285	9.146957905	3.885371766	16.91934046	0.752947553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.9992	NO																																																																																		0			24.8616	0.419923001	6.492361836	0	2.645154874	1.617384745	4.244751915	4.189120033	10.91744143	4.743083471	5.331826745	0	0.332102162	2.296867975	10.47489931	31.0601929	0.474688197	1.193177285	9.146957905	3.885371766	16.91934046	0.752947553	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.9992
H3351_806_0	2010	1	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	S	O																			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0	NO	223.7960913	4.749585748	931.6487311	1485.856936	162.5415315	9.755591732	2.785792032	341.0872325	533.8527859	496.1298327	828.2452304	43.29279722	9.846475613	984.2182759	6239.793787	11955.54169	438.9403955	774.2250881	2611.997845	8318.230019	1883.8731	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																			941.1403231	1254.851064	73.69510204	0	102.3935905	0.233	0.233	110.9968312	241.2430731	33.76403707	88.65516955	184.9107847	92.68085034	21.48482229	15.85943001	23.72833535	20.43957776	17.41264955	33.21758253	16.29720541	61.34577152	0																			NO	941.1403231	1254.851064	73.69510204	0	102.3935905	0.233	0.233	110.9968312	241.2430731	33.76403707	88.65516955	184.9107847	92.68085034	21.48482229	15.85943001	23.72833535	20.43957776	17.41264955	33.21758253	16.29720541	61.34577152	0																				17.552	0.496668561	5.721495692	0	1.386934251	2.273052873	0.649089543	3.154966831	10.73235722	1.395945505	6.119018444	0.667108759	0.076048311	1.762146229	8.246631068	23.6404252	0.747646362	1.123442511	7.2303545	11.29699194	9.630637398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9029			17.552	0.496668561	5.721495692	0	1.386934251	2.273052873	0.649089543	3.154966831	10.73235722	1.395945505	6.119018444	0.667108759	0.076048311	1.762146229	8.246631068	23.6404252	0.747646362	1.123442511	7.2303545	11.29699194	9.630637398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9029	NO																																																																																		0			17.552	0.496668561	5.721495692	0	1.386934251	2.273052873	0.649089543	3.154966831	10.73235722	1.395945505	6.119018444	0.667108759	0.076048311	1.762146229	8.246631068	23.6404252	0.747646362	1.123442511	7.2303545	11.29699194	9.630637398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.9029
H3359_001_0	2010	9	N/A	i.6.	i.6.	i.6.	i.6.							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	Vision Exams							A	A	D	V	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	Coin	V	Coin	V	Coin			Coin	V	V	V			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	NO	325.7677701	38.52343079	575.321898	0.161797351	389.6674018	8.326785677	3.143812038	366.6842872	5.507245604	551.7033053	20.29868326		2.314003835	6.620301406	3640.426837	5242.679756	3.180870549	1270.52611	27.22280264	546.1727944	4.629568081			6.070669361	457.8201598	0.073875311	115				0	409.4857569	1.043532793	746.125327								1A IP Acute: $110 per day; days 1-8	1B IP Psych: $110 per day; days 1-8 (up to 190 days)	2 SNF: $50 days 1-30; $0 per day for days 31-100	6 Home Health - $0 per day	10A Ambulance - $75 per trip	11A DME - 10% coinsurance	11B Pros./Med Supp. - 10%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $0	9B ASC Services - $50;  9A Outpatient Hospital - 10%	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0; Diagnostic Radiology - $25; Therapeutic Radiology - 20% ($2000 OOP Max)		12 Renal Dialysis - 20%	3 CORF - $20; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - $0 - $15	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0; 14J - Nutrition Therapy	7D Physician Specialist - $15	7E Mental Health - 45%; 7H Psychiatric Services - 45%; 9C Outpatient Sub Abuse - 45%	7C Occupational Therapy - $20; 7I PT and ST Services - $20	8B Outpatient X-Rays - $0; Diagnostic Radiology - $25; Therapeutic Radiology - 20% ($2000 OOP Max)	7G Other Health Care - $15	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0-$150	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $10	18B Hearing Aids - $0 ($500 max every 3 years)		14C Routine Physical Exams - $0	7B Chiropractic Services - $10	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $10	17A Eye Exams (Medicare Covered) - $10							468.1540204	649.4974874	50	0	75	0.1	0.1	50	0.061715505	0	0.098163538		0.2	0.021801707	0	15	0.45	20	0.116374578	15	0.2			0.1	0	0	10				10	20	10	10							NO	468.1540204	649.4974874	50	0	75	0.1	0.1	50	0.061715505	0	0.051938132		0.2	0.021801707	0	15	0.45	20	0.088990103	15	0.2			0.1	0	0	10				10	20	10	10								12.7091	2.085072625	2.397174575	0	2.435421262	0.832678568	0.314381204	1.527851197	0.339882444	0	1.054275696	0	0.462800767	0.144333872	0	6.553349695	1.431391747	2.117543517	2.422560014	0.682715993	0.925913616	0	0	0.607066936	0	0	0.095833333	0	0	0	0	0.682476262	0.000869611	0.621771106	0	0	0	0	0	0	40.4445	0	0	12.7091	2.085072625	2.397174575	0	2.435421262	0.832678568	0.314381204	1.527851197	0.339882444	0	1.054275696	0	0.462800767	0.144333872	0	6.553349695	1.431391747	2.117543517	2.422560014	0.682715993	0.925913616	0	0	0.607066936	0	0	0.095833333	0	0	0	0	0.682476262	0.000869611	0.621771106	0	0	0	0	0	0	40.4445	NO																																																																																		0			12.7091	2.085072625	2.397174575	0	2.435421262	0.832678568	0.314381204	1.527851197	0.339882444	0	1.054275696	0	0.462800767	0.144333872	0	6.553349695	1.431391747	2.117543517	2.422560014	0.682715993	0.925913616	0	0	0.607066936	0	0	0.095833333	0	0	0	0	0.682476262	0.000869611	0.621771106	0	0	0	0	0	0	40.4445
H3359_019_0	2010	9	N/A	i.6.	i.6.	i.6.	i.6.							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	Vision Exams							A	A	D	V	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	Coin	V	Coin	V	Coin			Coin	V	V	V			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	NO	372.2239222	49.66991031	570.1466762	0.140612145	458.2907698	8.247859676	2.081106825	479.465289	6.713213476	624.2149635	20.06963636		2.423061451	9.742666651	3566.519466	5952.039533	4.698058619	1128.437708	23.38780759	521.9957174	4.944244897			11.275684	531.1394665	0	115				0	434.2254213	0.922832766	767.9943172								1A IP Acute: $100 per day; days 1-8	1B IP Psych: $100 per day; days 1-8 (up to 190 days)	2 SNF: $50 days 1-30; $0 per day for days 31-100	6 Home Health - $0 per day	10A Ambulance - $50 per trip	11A DME - 10% coinsurance	11B Pros./Med Supp. - 10%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $0	9B ASC Services - $50;  9A Outpatient Hospital - 10%	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0; Diagnostic Radiology - $25; Therapeutic Radiology - 20% ($2000 OOP Max)		12 Renal Dialysis - 20%	3 CORF - $20; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - $0 - $15	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0; 14J - Nutrition Therapy	7D Physician Specialist - $15	7E Mental Health - 45%; 7H Psychiatric Services - 45%; 9C Outpatient Sub Abuse - 45%	7C Occupational Therapy - $20; 7I PT and ST Services - $20	8B Outpatient X-Rays - $0; Diagnostic Radiology - $25; Therapeutic Radiology - 20% ($2000 OOP Max)	7G Other Health Care - $15	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0-$150	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $10	18B Hearing Aids - $0 ($500 max every 3 years)		14C Routine Physical Exams - $0	7B Chiropractic Services - $10	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $10	17A Eye Exams (Medicare Covered) - $10							425.594564	590.4522613	50	0	50	0.1	0.1	50	0.062700816	0	0.098163538		0.2	0.045686174	0	15	0.45	20	0.116374578	15	0.2			0.1	0	0	10				10	20	10	10							NO	425.594564	590.4522613	50	0	50	0.1	0.1	50	0.062700816	0	0.051938132		0.2	0.045686174	0	15	0.45	20	0.088990103	15	0.2			0.1	0	0	10				10	20	10	10								13.2014	2.443975905	2.375611151	0	1.909544874	0.824785968	0.208110682	1.997772038	0.420923966	0	1.042379427	0	0.48461229	0.445105163	0	7.440049416	2.114126379	1.880729513	2.081283409	0.652494647	0.988848979	0	0	1.1275684	0	0	0.095833333	0	0	0	0	0.723709035	0.000769027	0.639995264	0	0	0	0	0	0	43.0996	0	0	13.2014	2.443975905	2.375611151	0	1.909544874	0.824785968	0.208110682	1.997772038	0.420923966	0	1.042379427	0	0.48461229	0.445105163	0	7.440049416	2.114126379	1.880729513	2.081283409	0.652494647	0.988848979	0	0	1.1275684	0	0	0.095833333	0	0	0	0	0.723709035	0.000769027	0.639995264	0	0	0	0	0	0	43.0996	NO																																																																																		0			13.2014	2.443975905	2.375611151	0	1.909544874	0.824785968	0.208110682	1.997772038	0.420923966	0	1.042379427	0	0.48461229	0.445105163	0	7.440049416	2.114126379	1.880729513	2.081283409	0.652494647	0.988848979	0	0	1.1275684	0	0	0.095833333	0	0	0	0	0.723709035	0.000769027	0.639995264	0	0	0	0	0	0	43.0996
H3359_021_0	2010	10	N/A	i.6.	i.6.	i.6.	i.6.							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	Vision Exams							Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	V	V	Coin	V	Coin	V	Coin				V	V				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	NO	678.4806935	67.49135757	34.66820338	0	14.97493514	14.52785754	2.716187882	16.32035145	6.618790773	5.722957774	12.21670905		7.969131272	6.530506829	3599.537006	3023.878498	7.451530641	1352.170729	5.533402182	685.8686335	7.870120113				7.214848396	0					0	505.5142089	1.197158949	804.7971387								1A IP Acute: Medicare FFS Cost-Sharing	1B IP Psych: Medicare FFS Cost-sharing	2 SNF: Medicare FFS Cost-sharing	6 Home Health - $0 per day	10A Ambulance - 20%	11A DME - 10% coinsurance	11B Pros./Med Supp. - 10%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - 20%; 4B Urgent Care - 20%	9B ASC Services - 0-20%;  9A Outpatient Hospital - 0-20%	8A Outpatient C/D/T - 20%	8B Outpatient X-Rays - 20%; Diagnostic Radiology - 20%; Therapeutic Radiology - 20%		12 Renal Dialysis - 20%	3 CORF - $0; 5 Partial Hosp - 20%; 9D Cardiac Rehab Svcs - 0-20%	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0; 14J - Nutrition Therapy - $0	7D Physician Specialist - $0	7E Mental Health - 0-20%; 7H Psychiatric Services - 0-20%; 9C Outpatient Sub Abuse - 0-20%	7C Occupational Therapy - $0; 7I PT and ST Services - $0	8B Outpatient X-Rays - 20%; Diagnostic Radiology - 20%; Therapeutic Radiology - 20%	7G Other Health Care - $0	15 Medicare Part B Rx Drugs - 0%	13A Blood - $0	10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0	17A Eye Exams (Routine) - NC	17B Eye Wear - NC	18A Hearing Exams (Routine) - $0	18B Hearing Aids - $0		14C Routine Physical Exams - $0	7B Chiropractic Services - $0	7F Podiatry Services - $0	18A Hearing Exams (Medicare Covered) - $0	17A Eye Exams (Medicare Covered) - $0							0.061567114	0.061567114	0.144638709	0	0.2	0.1	0.1	0.2	0.2	0.2	0.2		0.2	0.2	0	0	0.2	0	0.2	0	0				0	0					0	0	0	0							NO	0.061567114	0.061567114	0.144638709	0	0.2	0.1	0.1	0.2	0.2	0.2	0.2		0.2	0.2	0	0	0.2	0	0.2	0	0				0	0					0	0	0	0								41.7721	4.155248093	5.014364176	0	2.994987029	1.452785754	0.271618788	3.264070289	1.323758155	1.144591555	2.443341811	0	1.593826254	1.306101366	0	0	1.490306128	0	1.106680436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3338	0	0	41.7721	4.155248093	5.014364176	0	2.994987029	1.452785754	0.271618788	3.264070289	1.323758155	1.144591555	2.443341811	0	1.593826254	1.306101366	0	0	1.490306128	0	1.106680436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3338	NO																																																																																		0			41.7721	4.155248093	5.014364176	0	2.994987029	1.452785754	0.271618788	3.264070289	1.323758155	1.144591555	2.443341811	0	1.593826254	1.306101366	0	0	1.490306128	0	1.106680436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3338
H3359_027_0	2010	6	N/A	i.6.	i.6.	i.6.	i.6.							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	Vision Exams							A	A	D	V	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	Coin	V	Coin	V	Coin			Coin	V	V	V			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	NO	232.1907471	33.82484906	238.4070932	0	309.1463793	3.714634486	1.085654284	337.6998204	5.25387247	474.20619	15.47737305		4.060572099	3.760275896	2030.256491	3909.953149	1.975840786	492.2900949	16.62719324	279.909715	1.471920295			7.848270342	318.7484419	0	115				0	226.6379551	0.481147794	434.6870105								1A IP Acute: $100 per day; days 1-8	1B IP Psych: $100 per day; days 1-8 (up to 190 days)	2 SNF: $50 days 1-30; $0 per day for days 31-100	6 Home Health - $0 per day	10A Ambulance - $75 per trip	11A DME - 10% coinsurance	11B Pros./Med Supp. - 10%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $0	9B ASC Services - $50;  9A Outpatient Hospital - 10%	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0; Diagnostic Radiology - $25; Therapeutic Radiology - 20% ($2000 OOP Max)		12 Renal Dialysis - 20%	3 CORF - $20; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - $0 - $15	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0; 14J - Nutrition Therapy	7D Physician Specialist - $15	7E Mental Health - 45%; 7H Psychiatric Services - 45%; 9C Outpatient Sub Abuse - 45%	7C Occupational Therapy - $20; 7I PT and ST Services - $20	8B Outpatient X-Rays - $0; Diagnostic Radiology - $25; Therapeutic Radiology - 20% ($2000 OOP Max)	7G Other Health Care - $15	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0-$150	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $10	18B Hearing Aids - $0 ($500 max every 3 years)		14C Routine Physical Exams - $0	7B Chiropractic Services - $10	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $10	17A Eye Exams (Medicare Covered) - $10							425.594564	590.4522613	50	0	75	0.1	0.1	50	0.055087992	0	0.098163538		0.2	0.099957483	0	15	0.45	20	0.116374578	15	0.2			0.1	0	0	10				10	20	10	10							NO	425.594564	590.4522613	50	0	75	0.1	0.1	50	0.055087992	0	0.051938132		0.2	0.099957483	0	15	0.45	20	0.088990103	15	0.2			0.1	0	0	10				10	20	10	10								8.2349	1.664329885	0.993362888	0	1.93216487	0.371463449	0.108565428	1.407082585	0.289425287	0	0.803865848	0	0.81211442	0.375867712	0	4.887441437	0.889128354	0.820483491	1.479655641	0.349887144	0.294384059	0	0	0.784827034	0	0	0.095833333	0	0	0	0	0.377729925	0.000400956	0.362239175	0	0	0	0	0	0	27.3352	0	0	8.2349	1.664329885	0.993362888	0	1.93216487	0.371463449	0.108565428	1.407082585	0.289425287	0	0.803865848	0	0.81211442	0.375867712	0	4.887441437	0.889128354	0.820483491	1.479655641	0.349887144	0.294384059	0	0	0.784827034	0	0	0.095833333	0	0	0	0	0.377729925	0.000400956	0.362239175	0	0	0	0	0	0	27.3352	NO																																																																																		0			8.2349	1.664329885	0.993362888	0	1.93216487	0.371463449	0.108565428	1.407082585	0.289425287	0	0.803865848	0	0.81211442	0.375867712	0	4.887441437	0.889128354	0.820483491	1.479655641	0.349887144	0.294384059	0	0	0.784827034	0	0	0.095833333	0	0	0	0	0.377729925	0.000400956	0.362239175	0	0	0	0	0	0	27.3352
H3359_031_0	2010	9	N/A	i.6.	i.6.	i.6.	i.6.							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	Vision Exams							A	A	D	V	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	Coin	V	Coin	V	Coin			Coin	V	V	V			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	NO	280.506153	25.98131064	348.8557361	0.015827566	311.4610791	6.314466997	3.002415521	370.5107308	6.987451768	487.309988	14.85336227		2.137605841	13.26394934	2010.444785	4976.667507	4.69827764	860.9461317	16.62004642	326.8131505	3.639462285			11.25	137.5	275	115				0	198.6251403	0.706402654	588.6620308								1A IP Acute: $150 per day; days 1-8	1B IP Psych: $150 per day; days 1-8 (up to 190 days)	2 SNF: $50 days 1-30; $0 per day for days 31-100	6 Home Health - $0 per day	10A Ambulance - $75 per trip	11A DME - 10% coinsurance	11B Pros./Med Supp. - 10%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $0	9B ASC Services - 20%;  9A Outpatient Hospital - 20%	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0; Diagnostic Radiology - $25; Therapeutic Radiology - 20% ($2000 OOP Max)		12 Renal Dialysis - 20%	3 CORF - $25; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - 20%	7A Primary Care - $10; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0; 14J - Nutrition Therapy - $0	7D Physician Specialist - $25	7E Mental Health - 45%; 7H Psychiatric Services - 45%; 9C Outpatient Sub Abuse - 45%	7C Occupational Therapy - $25; 7I PT and ST Services - $25	8B Outpatient X-Rays - $0; Diagnostic Radiology - $25; Therapeutic Radiology - 20% ($2000 OOP Max)	7G Other Health Care - $25	15 Medicare Part B Rx Drugs - 20% ($2000 OOP Max)	13A Blood - $0	10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0-$150	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $25	18B Hearing Aids - $0 ($500 max every 3 years)		14C Routine Physical Exams - $0	7B Chiropractic Services - $25	7F Podiatry Services - $25	18A Hearing Exams (Medicare Covered) - $25	17A Eye Exams (Medicare Covered) - $25							638.391846	885.678392	50	0	75	0.1	0.1	50	0.2	0	0.098163538		0.2	0.104293727	10	25	0.45	25	0.116374578	25	0.2			0.1	0	0	25				25	25	25	25							NO	638.391846	885.678392	50	0	75	0.1	0.1	50	0.2	0	0.051938132		0.2	0.104293727	10	25	0.45	25	0.088990103	25	0.2			0.1	0	0	25				25	25	25	25								14.9227	1.917590452	1.453565567	0	1.946631744	0.6314467	0.300241552	1.543794712	1.397490354	0	0.771455894	0	0.427521168	1.383346716	1.675370654	10.36805731	2.114224938	1.793637774	1.479019645	0.68086073	0.727892457	0	0	1.125	0	0	0.239583333	0	0	0	0	0.413802376	0.001471672	1.226379231	0	0	0	0	0	0	48.5411	0	0	14.9227	1.917590452	1.453565567	0	1.946631744	0.6314467	0.300241552	1.543794712	1.397490354	0	0.771455894	0	0.427521168	1.383346716	1.675370654	10.36805731	2.114224938	1.793637774	1.479019645	0.68086073	0.727892457	0	0	1.125	0	0	0.239583333	0	0	0	0	0.413802376	0.001471672	1.226379231	0	0	0	0	0	0	48.5411	NO																																																																																		0			14.9227	1.917590452	1.453565567	0	1.946631744	0.6314467	0.300241552	1.543794712	1.397490354	0	0.771455894	0	0.427521168	1.383346716	1.675370654	10.36805731	2.114224938	1.793637774	1.479019645	0.68086073	0.727892457	0	0	1.125	0	0	0.239583333	0	0	0	0	0.413802376	0.001471672	1.226379231	0	0	0	0	0	0	48.5411
H3359_032_0	2010	9	N/A	i.6.	i.6.	i.6.	i.6.	q.						Professional	Professional	Professional	Professional	Other Non-Covered						Chiropractic	Podiatry	Hearing Exams	Vision Exams	Acupuncture						A	A	D	V	T	Coin	Coin	V	V	V	Coin		Coin	Coin	V	V	Coin	V	Coin	V	Coin			Coin	V	V	V			Coin	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	NO	259.4914989	7.314170129	241.027232	0	236.5267042	5.387758183	2.356049771	263.1894455	72.50872838	524.1908738	13.31738946		2.767732437	8.806540299	4210.732221	6259.874436	5.409554534	2545.178493	21.56886007	493.0128115	5.349249243			11.25	137.5	275	115				0	229.6037984	2.030149808	768.7298448	1066.666667							1A IP Acute: $125 per day; days 3-10	1B IP Psych: $125 per day; days 3-10 (up to 190 days)	2 SNF: $0 days 1-14; $75 per day for days 15-100	6 Home Health - $0 per day	10A Ambulance - $75 per trip	11A DME - 10% coinsurance	11B Pros./Med Supp. - 10%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $0	9B ASC Services - $100;  9A Outpatient Hospital - $100	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0; Diagnostic Radiology - $25; Therapeutic Radiology - 20% ($2000 OOP Max)		12 Renal Dialysis - 20%	3 CORF - 10%; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - 10%	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0; 14J - Nutrition Therapy - $0	7D Physician Specialist - $10	7E Mental Health - 45%; 7H Psychiatric Services - 45%; 9C Outpatient Sub Abuse - 45%	7C Occupational Therapy - $20; 7I PT and ST Services - $20	8B Outpatient X-Rays - $0; Diagnostic Radiology - $25; Therapeutic Radiology - 20% ($2000 OOP Max)	7G Other Health Care - $10	15 Medicare Part B Rx Drugs - 20% ($2000 OOP Max)	13A Blood - $0	10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0-$150	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $10	18B Hearing Aids - $0 ($500 max every 3 years)		14C Routine Physical Exams - $0	7B Chiropractic Services - $10	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $10	17A Eye Exams (Medicare Covered) - $10	13B Accupuncture - $5						274.7115657	532.139866	75	0	75	0.1	0.1	50	100	0	0.098163538		0.2	0.066248969	0	10	0.45	20	0.116374578	10	0.2			0.1	0	0	10				10	20	10	10	5						NO	274.7115657	532.139866	75	0	75	0.1	0.1	50	100	0	0.051938132		0.2	0.066248969	0	10	0.45	20	0.088990103	10	0.2			0.1	0	0	10				10	20	10	10	5							5.9404	0.324346793	1.5064202	0	1.478291901	0.538775818	0.235604977	1.09662269	0.604239403	0	0.691680335	0	0.553546487	0.583424212	0	5.21656203	2.43429954	4.241964155	1.919415082	0.41084401	1.069849849	0	0	1.125	0	0	0.095833333	0	0	0	0	0.382672997	0.001691792	0.640608204	0.444444444	0	0	0	0	0	31.5366	0	0	5.9404	0.324346793	1.5064202	0	1.478291901	0.538775818	0.235604977	1.09662269	0.604239403	0	0.691680335	0	0.553546487	0.583424212	0	5.21656203	2.43429954	4.241964155	1.919415082	0.41084401	1.069849849	0	0	1.125	0	0	0.095833333	0	0	0	0	0.382672997	0.001691792	0.640608204	0.444444444	0	0	0	0	0	31.5366	NO																																																																																		0			5.9404	0.324346793	1.5064202	0	1.478291901	0.538775818	0.235604977	1.09662269	0.604239403	0	0.691680335	0	0.553546487	0.583424212	0	5.21656203	2.43429954	4.241964155	1.919415082	0.41084401	1.069849849	0	0	1.125	0	0	0.095833333	0	0	0	0	0.382672997	0.001691792	0.640608204	0.444444444	0	0	0	0	0	31.5366
H3359_033_0	2010	8	N/A	i.6.	i.6.	i.6.	i.6.							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	Vision Exams							A	A	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	V	V	V	V	V	V	Coin				V	V				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	NO	4194.582482	851.8427816	1543.260684	0	27.65164823	27.24934828	4.534550497	30.96907297	13.71320871	11.68211769	21.87875775		16.17590106	16.97603775	5928.983992	5012.59676	777.4263528	2237.52809	2407.995661	1137.277362	13.44761078				0	0					0	845.1011529	1.988366853	1418.534121								1A IP Acute: $100 per day; days 1-8	1B IP Psych: $100 per day; days 1-8 (up to 190 days)	2 SNF: $50 days 1-30; $0 per day for days 31-100	6 Home Health - $0 per day	10A Ambulance - 20% Coinsurance	11A DME - 10% coinsurance	11B Pros./Med Supp. - 10%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - 0% Coinsurance; 4B Urgent Care - 0% Coinsurance	9B ASC Services - 0% Coinsurance;  9A Outpatient Hospital - 0% Coinsurance	8A Outpatient C/D/T - 0% Coinsurance	8B Outpatient X-Rays - 0%; Diagnostic Radiology - 0%; Therapeutic Radiology - 0%		12 Renal Dialysis - 0%	3 CORF - 0%; 5 Partial Hosp - 0%; 9D Cardiac Rehab Svcs - 0%	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0; 14J - Nutrition Therapy - $0	7D Physician Specialist - $0	7E Mental Health - 0%; 7H Psychiatric Services - 0%; 9C Outpatient Sub Abuse - 0%	7C Occupational Therapy - $0; 7I PT and ST Services - $0	8B Outpatient X-Rays - 0%; Diagnostic Radiology - 0%; Therapeutic Radiology - 0%	7G Other Health Care - $0	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - $0	17A Eye Exams (Routine) - NA	17B Eye Wear - NA	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		14C Routine Physical Exams - $0	7B Chiropractic Services - $0	7F Podiatry Services - $0	18A Hearing Exams (Medicare Covered) - $0	17A Eye Exams (Medicare Covered) - $0							100	100	50	0	0.2	0.1	0.1	0	0	0	0		0	0	0	0	0	0	0	0	0.2				0	0					0	0	0	0							NO	100	100	50	0	0.2	0.1	0.1	0	0	0	0		0	0	0	0	0	0	0	0	0.2				0	0					0	0	0	0								34.9549	7.098689847	6.43025285	0	5.530329647	2.724934828	0.45345505	0	0	0	0	0	0	0	0	0	0	0	0	0	2.689522155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.882	0	0	34.9549	7.098689847	6.43025285	0	5.530329647	2.724934828	0.45345505	0	0	0	0	0	0	0	0	0	0	0	0	0	2.689522155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.882	NO																																																																																		0			34.9549	7.098689847	6.43025285	0	5.530329647	2.724934828	0.45345505	0	0	0	0	0	0	0	0	0	0	0	0	0	2.689522155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.882
H3359_804_0	2010	6	N/A																															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	NO	391.5946459	35.61221919	24.28467425	9.589070648	12.41601724	8.833950876	3.447800555	9.179863043	27.47259623	10.5550765	20.22401743		2.384217741	14.69164381	31.36522763	96.64801763	4.190688118	6.236133609	27.10747038	46.73815748	11.03142565																					1A IP Acute: Medicare FFS Cost-sharing	1B IP Psych: Medicare FFS Cost-sharing	2 SNF: Medicare FFS Cost-sharing	6 Home Health - $0 per day	10A Ambulance - Medicare FFS Cost-Sharing	11A DME - Medicare FFS Cost-Sharing	11B Pros./Med Supp. - Medicare FFS Cost-Sharing; 11C Diabetes Mon Supplies - Medicare FFS Cost-Sharing	4A Emergency Care - Medicare FFS Cost-Sharing; 4B Urgent Care - Medicare FFS Cost-Sharing	9B ASC Services - Medicare FFS Cost-Sharing;  9A Outpatient Hospital - Medicare FFS Cost-Sharing	8A Outpatient C/D/T - Medicare FFS Cost-Sharing	8B Outpatient X-Rays - Medicare FFS Cost-Sharing; Diagnostic Radiology - Medicare FFS Cost-Sharing; Therapeutic Radiology - Medicare FFS Cost-Sharing		12 ESRD - Medicare FFS Cost-Sharing	3 CORF - Medicare FFS Cost-Sharing; 5 Partial Hosp - Medicare FFS Cost-Sharing; 9D Cardiac Rehab Svcs - Medicare FFS Cost-Sharing	7A Primary Care - Medicare FFS Cost-Sharing	7D Physician Specialist - Medicare FFS Cost-Sharing	7E Mental Health - Medicare FFS Cost-Sharing; 7H Psychiatric Services - Medicare FFS Cost-Sharing; 9C Outpatient Sub Abuse - Medicare FFS Cost-Sharing	7C Occupational Therapy - Medicare FFS Cost-Sharing; 7I PT and ST Services - Medicare FFS Cost-Sharing	8B Outpatient X-Rays - Medicare FFS Cost-Sharing; Diagnostic Radiology - Medicare FFS Cost-Sharing; Therapeutic Radiology - Medicare FFS Cost-Sharing	"7G Other Health Care - Medicare FFS Cost-Sharing; 14B Immunizations, 14D Pap/Pelvic, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Meas., 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy - Medicare FFS Cost-Sharing;17A Eye Exams (Medicare Covered) - Medicare FFS Cost-Sharing; 18A Hearing Exams (Medicare Covered) - Medicare FFS Cost-Sharing; 7B Chiropractic Services - Medicare FFS Cost-Sharing; 7F Podiatry Services - Medicare FFS Cost-Sharing"	15 Medicare Part B Rx Drugs - Medicare FFS Cost-Sharing	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - NA	17A Eye Exams (Routine) - NA	17B Eye Wear - NA	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA													0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					24.1094	2.192541553	3.51250393	0	2.892932016	2.058310554	0.803337529	2.138908089	6.401114921	2.459332823	4.71219606	0	0.555522734	3.423153008	7.308098037	22.51898811	0.976430331	1.453019131	6.316040598	10.88999069	2.570322176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.2921	0	0	24.1094	2.192541553	3.51250393	0	2.892932016	2.058310554	0.803337529	2.138908089	6.401114921	2.459332823	4.71219606	0	0.555522734	3.423153008	7.308098037	22.51898811	0.976430331	1.453019131	6.316040598	10.88999069	2.570322176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.2921	NO																																																																																		0			24.1094	2.192541553	3.51250393	0	2.892932016	2.058310554	0.803337529	2.138908089	6.401114921	2.459332823	4.71219606	0	0.555522734	3.423153008	7.308098037	22.51898811	0.976430331	1.453019131	6.316040598	10.88999069	2.570322176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.2921
H3359_805_0	2010	6	N/A																															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	NO	391.5946459	35.61221919	24.28467425	9.589070648	12.41601724	8.833950876	3.447800555	9.179863043	27.47259623	10.5550765	20.22401743		2.384217741	14.69164381	31.36522763	96.64801763	4.190688118	6.236133609	27.10747038	46.73815748	11.03142565																					1A IP Acute: Medicare FFS Cost-sharing	1B IP Psych: Medicare FFS Cost-sharing	2 SNF: Medicare FFS Cost-sharing	6 Home Health - $0 per day	10A Ambulance - Medicare FFS Cost-Sharing	11A DME - Medicare FFS Cost-Sharing	11B Pros./Med Supp. - Medicare FFS Cost-Sharing; 11C Diabetes Mon Supplies - Medicare FFS Cost-Sharing	4A Emergency Care - Medicare FFS Cost-Sharing; 4B Urgent Care - Medicare FFS Cost-Sharing	9B ASC Services - Medicare FFS Cost-Sharing;  9A Outpatient Hospital - Medicare FFS Cost-Sharing	8A Outpatient C/D/T - Medicare FFS Cost-Sharing	8B Outpatient X-Rays - Medicare FFS Cost-Sharing; Diagnostic Radiology - Medicare FFS Cost-Sharing; Therapeutic Radiology - Medicare FFS Cost-Sharing		12 ESRD - Medicare FFS Cost-Sharing	3 CORF - Medicare FFS Cost-Sharing; 5 Partial Hosp - Medicare FFS Cost-Sharing; 9D Cardiac Rehab Svcs - Medicare FFS Cost-Sharing	7A Primary Care - Medicare FFS Cost-Sharing	7D Physician Specialist - Medicare FFS Cost-Sharing	7E Mental Health - Medicare FFS Cost-Sharing; 7H Psychiatric Services - Medicare FFS Cost-Sharing; 9C Outpatient Sub Abuse - Medicare FFS Cost-Sharing	7C Occupational Therapy - Medicare FFS Cost-Sharing; 7I PT and ST Services - Medicare FFS Cost-Sharing	8B Outpatient X-Rays - Medicare FFS Cost-Sharing; Diagnostic Radiology - Medicare FFS Cost-Sharing; Therapeutic Radiology - Medicare FFS Cost-Sharing	"7G Other Health Care - Medicare FFS Cost-Sharing; 14B Immunizations, 14D Pap/Pelvic, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Meas., 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy - Medicare FFS Cost-Sharing;17A Eye Exams (Medicare Covered) - Medicare FFS Cost-Sharing; 18A Hearing Exams (Medicare Covered) - Medicare FFS Cost-Sharing; 7B Chiropractic Services - Medicare FFS Cost-Sharing; 7F Podiatry Services - Medicare FFS Cost-Sharing"	15 Medicare Part B Rx Drugs - Medicare FFS Cost-Sharing	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - NA	17A Eye Exams (Routine) - NA	17B Eye Wear - NA	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA													0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					24.1094	2.192541553	3.51250393	0	2.892932016	2.058310554	0.803337529	2.138908089	6.401114921	2.459332823	4.71219606	0	0.555522734	3.423153008	7.308098037	22.51898811	0.976430331	1.453019131	6.316040598	10.88999069	2.570322176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.2921	0	0	24.1094	2.192541553	3.51250393	0	2.892932016	2.058310554	0.803337529	2.138908089	6.401114921	2.459332823	4.71219606	0	0.555522734	3.423153008	7.308098037	22.51898811	0.976430331	1.453019131	6.316040598	10.88999069	2.570322176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.2921	NO																																																																																		0			24.1094	2.192541553	3.51250393	0	2.892932016	2.058310554	0.803337529	2.138908089	6.401114921	2.459332823	4.71219606	0	0.555522734	3.423153008	7.308098037	22.51898811	0.976430331	1.453019131	6.316040598	10.88999069	2.570322176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.2921
H3361_039_0	2010	4	N/A																															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	V	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	NO	1569.985863	147.0431261	506.3570058	875.5190559	1111.046782	7.015994877	1.434041375	723.236341	120.2398246	2699.789125	401.515871	12.58450863	0.289299204	160.3678069	6821.564621	15376.46458	769.2341991	3479.117621	3088.276699	1893.003235	8.222183127	3.301082616	0	0	0	0	0	0	2040	7.347416882												"$200 days 1 - 5, $0 after day 5, unlimited coverage"	"$200 days 1 - 5, $0 after day 5, unlimited coverage"	"$0 days 1 - 20, $133.5 days 21 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $100.00 and $150.00	$0.00 copayment	Copay between $0.00 and $200.00	$200.00 copayment	20% coinsurance	Copay between $10.00 and $150.00	Copay between $0.00 and $5.00	Copay between $0.00 and $25.00	Copay between $10.00 and $20.00	$20.00 copayment	Copay between $0.00 and $70.00	Copay between $0.00 and $20.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	$0.00 copayment	$0.00 copayment											92.88992724	49.55194503	32.31	0	30.31379403	0.2	0.185143798	17.02224092	99.34181289	0	64.49366304	57.10183939	0.2	17.17118585	2.304497722	4.509283485	14.10533851	6.91206393	29.42492376	6.289577807	0.2	0	0	0	0	0	0	0	0	0											NO	92.88992724	49.55194503	32.31	0	30.31379403	0.2	0.185143798	17.02224092	99.34181289	0	64.49366304	57.10183939	0.2	17.17118585	2.304497722	4.509283485	14.10533851	6.91206393	29.42492376	6.289577807	0.2	0	0	0	0	0	0	0	0	0												12.153	0.607189408	1.363366238	0	2.806670276	1.403198975	0.265503867	1.02592527	0.995403513	0	2.157935774	0.059883216	0.057859841	0.229475451	1.310023344	5.778069817	0.904192398	2.003990285	7.572692203	0.992182595	1.644436625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.331	0	0	12.153	0.607189408	1.363366238	0	2.806670276	1.403198975	0.265503867	1.02592527	0.995403513	0	2.157935774	0.059883216	0.057859841	0.229475451	1.310023344	5.778069817	0.904192398	2.003990285	7.572692203	0.992182595	1.644436625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.331	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.153	0.607189408	1.363366238	0	2.806670276	1.403198975	0.265503867	1.02592527	0.995403513	0	2.157935774	0.059883216	0.057859841	0.229475451	1.310023344	5.778069817	0.904192398	2.003990285	7.572692203	0.992182595	1.644436625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.331
H3361_043_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	NO	377.0329382	38.02507207	696.9173409	2000.287303	1593.08258	9.26255851	4.867712316	1912.023509	174.620614	4161.461736	603.4843592	8.321333687	0.804748274	218.9442722	10690.88534	15908.99302	1480.188023	6200.487347	4712.477189	2353.304688	6.704241254	2.770402728	2040	560	361.2	216.72	0	0	2040	4727.378546												"$0 per admission, unlimited coverage"	"$0 per admission, unlimited coverage"	$0 days 1 - 100	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	$0.00 copayment	$0.00 copayment	Copay between $0.00 and $70.00	$0.00 copayment	20% coinsurance	Copay between $0.00 and $20.00	$0.00 copayment	Copay between $0.00 and $20.00	Copay between $10.00 and $20.00	$20.00 copayment	Copay between $0.00 and $70.00	Copay between $0.00 and $20.00	20% coinsurance	$0.00 copayment	$0.00 copayment	"$0.00 copayment, $750 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	$0.00 copayment	$0.00 copayment											0	0	0	0	35.94348818	0.2	0.064060746	17.64462433	0	0	36.92510229	0	0.2	1.765245002	0	4.721691273	12.2499266	5.629802729	28.53416116	5.891748123	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	35.94348818	0.2	0.064060746	17.64462433	0	0	36.92510229	0	0.2	1.765245002	0	4.721691273	12.2499266	5.629802729	28.53416116	5.891748123	0.2	0	0	0	0	0	0	0	0	0												0	0	0	0	4.771745406	1.852511702	0.311829283	2.811411377	0	0	1.856976808	0	0.160949655	0.032207524	0	6.259779459	1.51101622	2.908960049	11.20554863	1.155423206	1.340848251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1792	0	0	0	0	0	0	4.771745406	1.852511702	0.311829283	2.811411377	0	0	1.856976808	0	0.160949655	0.032207524	0	6.259779459	1.51101622	2.908960049	11.20554863	1.155423206	1.340848251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1792	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												2.9371	0	0.1655	0.2453	0.3871	0.1534	0.0806	0	0.2402	0.0579	0.1312	0	0	0.0877	0	1.3529	0	0.288	0.61	0.2678	0	0.0004	0	0	0	0	0	0	0	0											7.0051	0	0	2.9371	0	0.165521624	0.245291953	5.158870324	2.005891703	0.392389956	2.811411377	0.240192922	0.057868104	1.988205709	0	0.160949655	0.119951311	0	7.612672108	1.51101622	3.196911305	11.81554194	1.423265869	1.340848251	0.000383417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.1843
H3361_047_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	311.1479265	7.719464647	947.0497041	1662.035921	14.32708361	19.04230791	4.68997975	15.91437976	22.95059328	12284.21189	19.58080249	0.538611234	0.14826322	4.407406852	10535.18296	129.1960309	4.972133369	10.55526873	38.69869122	18.01804336	28.70795674	0.846853941	2320	0	0	0	0	0	2040	4310.51926												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	$0.00 copayment	$0.00 copayment											757.4048657	872.9663718	56.22412977	0	0.155555634	0.17	0.17	0.117447993	0.17	0	0.17	0.248625	0.17	0.17	0	0.114589054	0.3825	0.17	0.169356317	0.096831129	0.17	0.17	0	0	0	0	0	0	0	0											NO	757.4048657	872.9663718	56.22412977	0	0.155555634	0.17	0.17	0.117447993	0.17	0	0.17	0.248625	0.17	0.17	0	0.114589054	0.3825	0.17	0.169356317	0.096831129	0.17	0.17	0	0	0	0	0	0	0	0												19.6387	0.56156942	4.437253788	0	2.228658578	3.237192344	0.797296558	1.869111966	3.901600858	0	3.328736424	0.133912218	0.025204747	0.749259165	0	14.80445091	1.901841013	1.794395683	6.553867815	1.744707473	4.880352646	0.14396517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7321	0	0	19.6387	0.56156942	4.437253788	0	2.228658578	3.237192344	0.797296558	1.869111966	3.901600858	0	3.328736424	0.133912218	0.025204747	0.749259165	0	14.80445091	1.901841013	1.794395683	6.553867815	1.744707473	4.880352646	0.14396517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7321	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.6387	0.56156942	4.437253788	0	2.228658578	3.237192344	0.797296558	1.869111966	3.901600858	0	3.328736424	0.133912218	0.025204747	0.749259165	0	14.80445091	1.901841013	1.794395683	6.553867815	1.744707473	4.880352646	0.14396517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7321
H3361_059_0	2010	4	N/A																															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	V	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	NO	1783.55185	142.0936785	447.671732	682.6757776	716.4567506	9.49574613	2.900307777	910.474785	219.5503535	6750.210136	1105.90283	15.86730533	0.165324912	345.4824849	6637.83069	13629.77031	285.1533938	1740.045531	3364.526619	1624.621954	8.613423989	4.783548046	0	370	361.2	216.72	16.8	12.8	0	6.680265623												"$150 days 1 - 10, $0 after day 10, unlimited coverage"	"$150 days 1 - 10, $0 after day 10, unlimited coverage"	"$0 days 1 - 20, $133.5 days 21 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $35.00 and $100.00	$0.00 copayment	Copay between $0.00 and $85.00	$150.00 copayment	20% coinsurance	Copay between $25.00 and $35.00	Copay between $0.00 and $10.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	"$0.00 copayment, $500 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	Not Covered	Copay between $0.00 and $10.00											105.9586218	52.06281309	32.31	0	40.35100751	0.2	0.113464615	14.93053005	58.3795087	0	39.66984987	42.82637954	0.2	10.06614199	4.70788852	9.456259993	30.90954513	17.71011656	27.63902711	7.389925529	0.2	0	0	0	0	0	0	0	0	9.994496006											NO	105.9586218	52.06281309	32.31	0	40.35100751	0.2	0.113464615	14.93053005	58.3795087	0	39.66984987	42.82637954	0.2	10.06614199	4.70788852	9.456259993	30.90954513	17.71011656	27.63902711	7.389925529	0.2	0	0	0	0	0	0	0	0	9.994496006												15.7486	0.616483052	1.205356139	0	2.409145977	1.899149226	0.329082307	1.132822594	1.068103481	0	3.655916602	0.05662827	0.033064982	0.289806312	2.604180575	10.74055431	0.734496808	2.568034097	7.749353534	1.000486271	1.722684798	0	0	0	0	0	0	0	0	0.005563824	0	0	0	0	0	0	0	0	0	0	55.5695	0	0	15.7486	0.616483052	1.205356139	0	2.409145977	1.899149226	0.329082307	1.132822594	1.068103481	0	3.655916602	0.05662827	0.033064982	0.289806312	2.604180575	10.74055431	0.734496808	2.568034097	7.749353534	1.000486271	1.722684798	0	0	0	0	0	0	0	0	0.005563824	0	0	0	0	0	0	0	0	0	0	55.5695	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.7486	0.616483052	1.205356139	0	2.409145977	1.899149226	0.329082307	1.132822594	1.068103481	0	3.655916602	0.05662827	0.033064982	0.289806312	2.604180575	10.74055431	0.734496808	2.568034097	7.749353534	1.000486271	1.722684798	0	0	0	0	0	0	0	0	0.005563824	0	0	0	0	0	0	0	0	0	0	55.5695
H3361_065_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	394.9339186	52.52265802	676.9691264	920.1038842	30.3055025	15.24520754	3.687138935	32.10418769	18.59389138	12924.55724	33.8060055	0.761125693	0.229728148	8.216083182	7642.695792	85.96510766	16.20749061	6.627366589	25.89666724	8.888668283	11.99881716	0.065673279	2320	0	0	0	0	0	2040	4588.840627												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	$0.00 copayment	$0.00 copayment											688.5115159	564.5677571	56.77256886	0	0.166169968	0.170001658	0.17	0.11153398	0.17	0	0.170079607	0.248625	0.17	0.170076309	0	0.096885459	0.40070797	0.170001337	0.167230016	0.061497898	0.170130323	0.17	0	0	0	0	0	0	0	0											NO	688.5115159	564.5677571	56.77256886	0	0.166169968	0.170001658	0.17	0.11153398	0.17	0	0.170079607	0.248625	0.17	0.170076309	0	0.096885459	0.40070797	0.170001337	0.167230016	0.061497898	0.170130323	0.17	0	0	0	0	0	0	0	0												22.6597	2.471049937	3.202773029	0	5.035864366	2.591710557	0.626813619	3.580707836	3.160961534	0	5.749712119	0.189234876	0.039053785	1.397361105	0	8.328768878	6.494470661	1.126661184	4.330700074	0.546634417	2.041362637	0.011164457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5847	0	0	22.6597	2.471049937	3.202773029	0	5.035864366	2.591710557	0.626813619	3.580707836	3.160961534	0	5.749712119	0.189234876	0.039053785	1.397361105	0	8.328768878	6.494470661	1.126661184	4.330700074	0.546634417	2.041362637	0.011164457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5847	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.6597	2.471049937	3.202773029	0	5.035864366	2.591710557	0.626813619	3.580707836	3.160961534	0	5.749712119	0.189234876	0.039053785	1.397361105	0	8.328768878	6.494470661	1.126661184	4.330700074	0.546634417	2.041362637	0.011164457	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5847
H3361_098_0	2010	5	N/A																															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	V	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	NO	2376.298101	314.9459194	408.3324518	847.9650053	2591.842848	11.07787044	6.411477447	2148.316344	267.2653938	11109.51616	1967.207194	26.50299791	0.282721789	575.2132687	10048.19056	20084.44371	556.1942588	2495.50933	4922.48493	2098.66408	13.03306807	6.184955449	0	0	361.2	216.72	16.8	12.8	2040	3522.050073												"$100 days 1 - 10, $0 after day 10, unlimited coverage"	"$100 days 1 - 10, $0 after day 10, unlimited coverage"	"$0 days 1 - 7, $75 days 8 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $30.00 and $75.00	$0.00 copayment	Copay between $0.00 and $80.00	$100.00 copayment	20% coinsurance	Copay between $20.00 and $30.00	Copay between $0.00 and $10.00	Copay between $0.00 and $30.00	Copay between $20.00 and $30.00	$30.00 copayment	Copay between $0.00 and $80.00	Copay between $0.00 and $30.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Copay between $0.00 and $10.00											75.06624727	35.48867887	51.68	0	44.81754455	0.2	0.07273383	18.70654527	43.78528797	0	40.0430618	28.55091969	0.2	9.121878844	4.770618319	8.339465152	21.48280216	16.45985466	27.31933176	6.010255101	0.2	0	0	0	0	0	0	0	0	0.111050018											NO	75.06624727	35.48867887	51.68	0	44.81754455	0.2	0.07273383	18.70654527	43.78528797	0	40.0430618	28.55091969	0.2	9.121878844	4.770618319	8.339465152	21.48280216	16.45985466	27.31933176	6.010255101	0.2	0	0	0	0	0	0	0	0	0.111050018												14.865	0.931417883	1.758551759	0	9.680002693	2.215574087	0.46633131	3.348964746	0.975191019	0	6.564416603	0.06305708	0.056544358	0.437252146	3.994673495	13.9577932	0.995717602	3.42297674	11.20658324	1.051125541	2.606613613	0	0	0	0	0	0	0	0	0.032593644	0	0	0	0	0	0	0	0	0	0	78.6304	0	0	14.865	0.931417883	1.758551759	0	9.680002693	2.215574087	0.46633131	3.348964746	0.975191019	0	6.564416603	0.06305708	0.056544358	0.437252146	3.994673495	13.9577932	0.995717602	3.42297674	11.20658324	1.051125541	2.606613613	0	0	0	0	0	0	0	0	0.032593644	0	0	0	0	0	0	0	0	0	0	78.6304	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												2.0783	0	0.0863	0.1209	0.6756	0.1834	0.1061	0	0.3627	0.1875	0.4515	0	0	0.1441	0	1.5468	0	0.1347	0.5513	0.2312	0	0.0017	0	0	0	0	0	0	0	0											6.8621	0	0	16.9433	0.931417883	1.844897994	0.120893994	10.35561734	2.399014092	0.572420573	3.348964746	1.337889397	0.187457276	7.015931605	0.06305708	0.056544358	0.581397357	3.994673495	15.50458467	0.995717602	3.557674185	11.75784111	1.282315789	2.606613613	0.001659983	0	0	0	0	0	0	0	0.032593644	0	0	0	0	0	0	0	0	0	0	85.4924
H3361_099_0	2010	5	N/A																															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	V	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	NO	1959.501585	286.176372	429.1593513	351.1474625	476.5623628	9.596405094	4.143705039	990.0391521	249.9971766	7008.106469	1244.668978	3.547693757	0.053196934	399.9782302	7720.081853	11086.33955	159.3635752	785.3824877	3682.494679	1402.169562	13.8818792	3.653863842	0	0	361.2	216.72	16.8	12.8	2040	31.18432322												"$175 days 1 - 10, $0 after day 10, unlimited coverage"	"$175 days 1 - 10, $0 after day 10, unlimited coverage"	"$0 days 1 - 20, $133.5 days 21 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $35.00 and $125.00	$0.00 copayment	Copay between $0.00 and $85.00	$175.00 copayment	20% coinsurance	Copay between $25.00 and $35.00	Copay between $0.00 and $10.00	Copay between $0.00 and $35.00	Copay between $25.00 and $35.00	$35.00 copayment	Copay between $0.00 and $85.00	Copay between $0.00 and $35.00	20% coinsurance	$0.00 copayment	Not Covered	Not Covered	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Copay between $0.00 and $30.00											115.5377457	66.05556374	32.31	0	48.51737155	0.2	0.046482517	13.36107648	56.03055906	0	36.47580131	49.96410947	0.2	9.360361736	5.008888107	10.55425499	27.41389683	19.19755238	17.86900773	5.180539845	0.2	0	0	0	0	0	0	0	0	11.51274905											NO	115.5377457	66.05556374	32.31	0	48.51737155	0.2	0.046482517	13.36107648	56.03055906	0	36.47580131	49.96410947	0.2	9.360361736	5.008888107	10.55425499	27.41389683	19.19755238	17.86900773	5.180539845	0.2	0	0	0	0	0	0	0	0	11.51274905												18.8664	1.575295132	1.155511553	0	1.926796102	1.919281019	0.19260984	1.102332402	1.167290131	0	3.783358194	0.014771447	0.010639387	0.311995077	3.222418848	9.75067121	0.364064717	1.256451787	5.483543822	0.60533294	2.77637584	0	0	0	0	0	0	0	0	0.029918107	0	0	0	0	0	0	0	0	0	0	55.515	0	0	18.8664	1.575295132	1.155511553	0	1.926796102	1.919281019	0.19260984	1.102332402	1.167290131	0	3.783358194	0.014771447	0.010639387	0.311995077	3.222418848	9.75067121	0.364064717	1.256451787	5.483543822	0.60533294	2.77637584	0	0	0	0	0	0	0	0	0.029918107	0	0	0	0	0	0	0	0	0	0	55.515	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.478	0	0.0803	0.0406	0.1472	0.1589	0.0684	0	0.3185	0.1041	0.3893	0	0	0.0614	0	1.0665	0	0.053	0.4053	0.1823	0	0.0007	0	0	0	0	0	0	0	0											4.5545	0	0	20.3444	1.575295132	1.235838	0.040558705	2.073983059	2.078189232	0.261056396	1.102332402	1.485812761	0.104066156	4.172627655	0.014771447	0.010639387	0.373407178	3.222418848	10.81712188	0.364064717	1.309403189	5.8888474	0.787640321	2.77637584	0.000741069	0	0	0	0	0	0	0	0.029918107	0	0	0	0	0	0	0	0	0	0	60.0695
H3361_105_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	541.5729078	56.8142467	901.1476567	7493.571734	29.35298231	33.50253712	6.649066427	40.28825886	20.00560303	7312.36117	16.91015621	0.238437598	2.021286816	9.49446469	15585.87296	194.8715391	29.99112159	41.70661016	71.62776209	28.0011179	32.50644891	0.156022036	3620	338.5714286	1.204	216.72	0	0	0	5455.091534												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	Not Covered	$0.00 copayment											849.4660317	838.2434736	63.18510239	0	0.195461002	0.2	0.2	0.167605953	0.2	0	0.2	0.2925	0.200000002	0.2	0	0.130371403	0.45	0.2	0.195314436	0.143558284	0.2	0.2	0	0	0	0	0	0	0	0											NO	849.4660317	838.2434736	63.18510239	0	0.195461002	0.2	0.2	0.167605953	0.2	0	0.2	0.2925	0.200000002	0.2	0	0.130371403	0.45	0.2	0.195314436	0.143558284	0.2	0.2	0	0	0	0	0	0	0	0												38.3373	3.968680959	4.74492558	0	5.737363335	6.700507423	1.329813285	6.752552013	4.001120606	0	3.382031243	0.069742997	0.404257368	1.898892938	0	25.40567598	13.49600472	8.341322033	13.98993598	4.019792448	6.501289782	0.031204407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.1124	0	0	38.3373	3.968680959	4.74492558	0	5.737363335	6.700507423	1.329813285	6.752552013	4.001120606	0	3.382031243	0.069742997	0.404257368	1.898892938	0	25.40567598	13.49600472	8.341322033	13.98993598	4.019792448	6.501289782	0.031204407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.1124	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	38.3373	3.968680959	4.74492558	0	5.737363335	6.700507423	1.329813285	6.752552013	4.001120606	0	3.382031243	0.069742997	0.404257368	1.898892938	0	25.40567598	13.49600472	8.341322033	13.98993598	4.019792448	6.501289782	0.031204407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.1124
H3361_106_0	2010	5	N/A																															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	V	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	NO	1872.345107	293.2243084	456.191932	585.6087333	551.9524589	4.130018942	4.017651023	711.4333109	130.7007327	2738.7368	485.3319125	0.56098191	0.048941643	126.9422894	10242.73508	7949.842887	91.09303636	2683.318244	3811.518213	1834.068222	6.106511668	1.231080625	2780	560	361.2	216.72	16.8	12.8	2040	17.39026517												"$100 days 1 - 8, $0 after day 8, unlimited coverage"	"$100 days 1 - 8, $0 after day 8, unlimited coverage"	"$0 days 1 - 7, $75 days 8 - 100"	$0.00 copayment	Copay between $0.00 and $100.00	20% coinsurance	"$0.00 copayment, 20% coinsurance"	Copay between $0.00 and $50.00	Copay between $50.00 and $75.00	$0.00 copayment	Copay between $0.00 and $125.00	$100.00 copayment	20% coinsurance	Copay between $20.00 and $75.00	$0.00 copayment	Copay between $0.00 and $30.00	Copay between $20.00 and $30.00	$30.00 copayment	Copay between $0.00 and $80.00	Copay between $0.00 and $30.00	20% coinsurance	$0.00 copayment	$0.00 copayment	"$0.00 copayment, $750 benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	$0.00 copayment	"$0.00 copayment, $350 benefit limit"	$0.00 copayment	Copay between $0.00 and $15.00											59.60588263	33.71444301	48.24	0	46.6874874	0.2	0.059545099	14.0486042	32.24729338	0	40.32253018	28.55091969	0.2	8.359149503	0	9.701006951	24.73809253	9.501315167	26.99550279	8.079307958	0.2	0	0	0	0	0	0	0	0	2.326175131											NO	59.60588263	33.71444301	48.24	0	46.6874874	0.2	0.059545099	14.0486042	32.24729338	0	40.32253018	28.55091969	0.2	8.359149503	0	9.701006951	24.73809253	9.501315167	26.99550279	8.079307958	0.2	0	0	0	0	0	0	0	0	2.326175131												9.3002	0.823824519	1.833891567	0	2.147439456	0.826003788	0.239231428	0.832887083	0.351228739	0	1.630817558	0.001334712	0.009788329	0.088427465	0	6.426790092	0.187788997	2.124587695	8.574487545	1.234833498	1.221302334	0	0	0	0	0	0	0	0	0.003371067	0	0	0	0	0	0	0	0	0	0	37.8583	0	0	9.3002	0.823824519	1.833891567	0	2.147439456	0.826003788	0.239231428	0.832887083	0.351228739	0	1.630817558	0.001334712	0.009788329	0.088427465	0	6.426790092	0.187788997	2.124587695	8.574487545	1.234833498	1.221302334	0	0	0	0	0	0	0	0	0.003371067	0	0	0	0	0	0	0	0	0	0	37.8583	NO	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	20% conisurance	20% conisurance	Same as in-network	20% conisurance	20% conisurance	20% conisurance	Not covered OON	Not covered OON	20% conisurance	Not covered OON	20% conisurance	Not covered OON	20% conisurance	20% conisurance	20% conisurance	Not covered OON	20% conisurance	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												1.8944	0	0.0926	0.0775	0.1623	0.0684	0.0664	0	0.2173	0.0251	0.1612	0	0	0.0308	0	0.9135	0	0.1285	0.5076	0.2231	0	0.0003	0	0	0	0	0	0	0	0											4.5689	0	0	11.1946	0.823824519	1.926477133	0.077535246	2.309737733	0.894393349	0.305655198	0.832887083	0.568482672	0.025081734	1.792027005	0.001334712	0.009788329	0.119206209	0	7.340332679	0.187788997	2.253062672	9.082051451	1.457909315	1.221302334	0.000343913	0	0	0	0	0	0	0	0.003371067	0	0	0	0	0	0	0	0	0	0	42.4272
H3361_109_0	2010	5	N/A																															A	A	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	Coin	V	Coin	Coin	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	NO	312.802357	45.123333	440.6689396	1492.917174	17.24088535	6.223202474	6.613253673	11.37221135	14.79388911	3544.331651	9.507544628	0.002764605	0.428926961	2.535783786	11335.10537	80.14607855	6.680386898	13.10093431	39.44867942	17.22819558	6.157629722	0.020566226	3620	338.5714286	1.204	216.72	0	0	2040	7937.842516												Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	20% coinsurance	$0.00 copayment	20% coinsurance	Coin between 0% and 45%	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, 20% coinsurance"	45% coinsurance	20% coinsurance	"$0.00 copayment, 20% coinsurance"	"$0.00 copayment, 20% coinsurance"	20% coinsurance	20% coinsurance	$0.00 copayment	"$0.00 copayment, No benefit limit"	$0.00 copayment	"$0.00 copayment, $100 benefit limit"	Not Covered	Not Covered	$0.00 copayment	$0.00 copayment											630.5516519	353.1579249	45.71140371	0	0.167915742	0.17000546	0.17	0.09064298	0.17	0	0.170371763	0.248625	0.170000467	0.17032626	0	0.127475943	0.441108262	0.170000817	0.152357865	0.097981688	0.170339298	0.17	0	0	0	0	0	0	0	0											NO	630.5516519	353.1579249	45.71140371	0	0.167915742	0.17000546	0.17	0.09064298	0.17	0	0.170371763	0.248625	0.170000467	0.17032626	0	0.127475943	0.441108262	0.170000817	0.152357865	0.097981688	0.170339298	0.17	0	0	0	0	0	0	0	0												16.4365	1.327971887	1.678632983	0	2.89501606	1.057978402	1.124253124	1.030811131	2.51496115	0	1.619817144	0.00068735	0.072917784	0.431910569	0	10.21669697	2.946773856	2.227169531	6.010316585	1.688047692	1.048886327	0.003496258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3328	0	0	16.4365	1.327971887	1.678632983	0	2.89501606	1.057978402	1.124253124	1.030811131	2.51496115	0	1.619817144	0.00068735	0.072917784	0.431910569	0	10.21669697	2.946773856	2.227169531	6.010316585	1.688047692	1.048886327	0.003496258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3328	NO	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON	Not covered OON												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.4365	1.327971887	1.678632983	0	2.89501606	1.057978402	1.124253124	1.030811131	2.51496115	0	1.619817144	0.00068735	0.072917784	0.431910569	0	10.21669697	2.946773856	2.227169531	6.010316585	1.688047692	1.048886327	0.003496258	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3328
H3362_003_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	170.3729755	3.466547118	103.3410573	1425.057608	195.1109303	11.31181294	1.352526841	267.0102665	395.9391564	8164.395688	757.1966066	0	0	1015.350515	4842.218501	2607.498033	1.371440819	528.21823	820.4168978	1214.651304	14.84960064	495.0741035	0	0	450	450	17.95478048	0	12000	0											3400	1A IP Acute: $425 Per Admit	1B IP Psych: $425 Per Admit	2 SNF: $40 for days 1-100	6 Home Health: $20	10A Ambulance: $150	11A DME: 25%	"11B Prosthetics/Medical Supplies: 25%, 11C Diabetes Monitoring Supplies: 25%"	"4A ER: $50, 4B Urgent Care: $30"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $30/$75	9A OP Hospital: $30	12 Renal Dialysis: $0	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: $30, 9A OP Hospital: $30"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $30"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 0% - 20%	"13A Blood: $35, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $5	17B Eye Wear (Medicare Covered): Various	18A Routine Hearing Exams (Non Medicare Covered): $30	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											425	425	437.3102768	20	150	0.13544415	0.125	49.5	100	0	41.25	30	0	28	15	30	0.389142512	10	30	30	0.039575287	35	0	0	5	27.5	30	0	0	0											NO	425	425	437.3102768	20	150	0.13544415	0.125	49.5	100	0	41.25	30	0	28	15	30	0.389142512	10	30	30	0.039575287	35	0	0	5	27.5	30	0	0	0												6.034	0.122773544	3.766008866	2.375096013	2.438886629	1.532118892	0.169065855	1.101417349	3.29949297	0	2.602863335	0	0	2.369151202	6.052773127	6.518745082	0.533685925	0.440181858	2.051042245	3.036628261	0.58767721	1.443966135	0	0	0.1875	1.03125	0.044886951	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7393	0	0	6.034	0.122773544	3.766008866	2.375096013	2.438886629	1.532118892	0.169065855	1.101417349	3.29949297	0	2.602863335	0	0	2.369151202	6.052773127	6.518745082	0.533685925	0.440181858	2.051042245	3.036628261	0.58767721	1.443966135	0	0	0.1875	1.03125	0.044886951	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7393	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 1-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.034	0.122773544	3.766008866	2.375096013	2.438886629	1.532118892	0.169065855	1.101417349	3.29949297	0	2.602863335	0	0	2.369151202	6.052773127	6.518745082	0.533685925	0.440181858	2.051042245	3.036628261	0.58767721	1.443966135	0	0	0.1875	1.03125	0.044886951	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7393
H3362_004_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	180.6245811	3.942388796	80.01284468	997.2381865	155.0459924	10.24798633	1.280540318	230.9576081	459.2385417	7576.332516	644.0453515	0	0	1052.737433	6154.660078	3018.727936	1.80342647	763.5714685	1054.40815	1343.618645	20.37681475	560.793338	0	0	450	450	17.63096154	0	12000	0											3400	1A IP Acute: $400 Per Admit	1B IP Psych: $400 Per Admit	2 SNF: $25 for days 1-100	6 Home Health: $15	10A Ambulance: $150	11A DME: 25%	"11B Prosthetics/Medical Supplies: 25%, 11C Diabetes Monitoring Supplies: 25%"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: $75	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $25/$75	9A OP Hospital: $25	12 Renal Dialysis: $0	"3 CORF: $25, 5 Partial Hosp: $25, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: $25, 9A OP Hospital: $25"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $25"	"7B Chiropractic: $25, 7D Physician Specialist (excl. Radiology): $25, 7F Podiatry: $25"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $25	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 0% - 20%	"13A Blood: $25, 16B Comprehensive Dental (Medicare Covered): $25, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $5	17B Eye Wear (Medicare Covered): Various	18A Routine Hearing Exams (Non Medicare Covered): $25	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											400	400	296.7652495	15	150	0.127798761	0.125	49.5	75	0	37.5	25	0	23.5	10	25	0.422487741	10	25	25	0.024331823	25	0	0	5	27.5	25	0	0	0											NO	400	400	296.7652495	15	150	0.127798761	0.125	49.5	75	0	37.5	25	0	23.5	10	25	0.422487741	10	25	25	0.024331823	25	0	0	5	27.5	25	0	0	0												6.0208	0.13141296	1.978752651	1.246547733	1.938074905	1.309679956	0.16006754	0.952700133	2.870240886	0	2.012641723	0	0	2.061610807	5.128883398	6.289016533	0.761925576	0.636309557	2.196683646	2.79920551	0.495805055	1.168319454	0	0	0.1875	1.03125	0.03673117	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4142	0	0	6.0208	0.13141296	1.978752651	1.246547733	1.938074905	1.309679956	0.16006754	0.952700133	2.870240886	0	2.012641723	0	0	2.061610807	5.128883398	6.289016533	0.761925576	0.636309557	2.196683646	2.79920551	0.495805055	1.168319454	0	0	0.1875	1.03125	0.03673117	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4142	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 1-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.0208	0.13141296	1.978752651	1.246547733	1.938074905	1.309679956	0.16006754	0.952700133	2.870240886	0	2.012641723	0	0	2.061610807	5.128883398	6.289016533	0.761925576	0.636309557	2.196683646	2.79920551	0.495805055	1.168319454	0	0	0.1875	1.03125	0.03673117	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4142
H3362_016_0	2010	2	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	178.9745816	2.359571234	110.67814	1383.547944	208.6863395	10.49063184	1.214974273	263.3743975	449.76661	8826.576086	462.886346	0	0	852.4164017	4683.538467	2593.104872	0.932062346	518.8796672	642.8040701	1329.466701	12.53031326	576.9901957	0	0	450	450	17.5760146	0	12000	0											3400	1A IP Acute: $475 Per Admit	1B IP Psych: $475 Per Admit	2 SNF: $40 for days 1-100	6 Home Health: $20	10A Ambulance: $150	11A DME: 25%	"11B Prosthetics/Medical Supplies: 25%, 11C Diabetes Monitoring Supplies: 25%"	"4A ER: $50, 4B Urgent Care: $30"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $30/$75	9A OP Hospital: $30	12 Renal Dialysis: $0	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: $30, 9A OP Hospital: $30"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $30"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 0% - 20%	"13A Blood: $35, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $5	17B Eye Wear (Medicare Covered): Various	18A Routine Hearing Exams (Non Medicare Covered): $30	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											475	475	437.3102768	20	150	0.128134614	0.125	49.5	100	0	41.25	30	0	28	15	30	0.002129053	10	30	30	0.000195972	35	0	0	5	27.5	30	0	0	0											NO	475	475	437.3102768	20	150	0.128134614	0.125	49.5	100	0	41.25	30	0	28	15	30	0.002129053	10	30	30	0.000195972	35	0	0	5	27.5	30	0	0	0												7.0844	0.093399695	4.03339067	2.30591324	2.608579244	1.344213066	0.151871784	1.08641939	3.748055084	0	1.591171814	0	0	1.988971604	5.854423083	6.48276218	0.00198441	0.432399723	1.607010175	3.323666752	0.002455585	1.682888071	0	0	0.1875	1.03125	0.043940036	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6867	0	0	7.0844	0.093399695	4.03339067	2.30591324	2.608579244	1.344213066	0.151871784	1.08641939	3.748055084	0	1.591171814	0	0	1.988971604	5.854423083	6.48276218	0.00198441	0.432399723	1.607010175	3.323666752	0.002455585	1.682888071	0	0	0.1875	1.03125	0.043940036	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6867	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.0844	0.093399695	4.03339067	2.30591324	2.608579244	1.344213066	0.151871784	1.08641939	3.748055084	0	1.591171814	0	0	1.988971604	5.854423083	6.48276218	0.00198441	0.432399723	1.607010175	3.323666752	0.002455585	1.682888071	0	0	0.1875	1.03125	0.043940036	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6867
H3362_017_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	99.87914484	5.495425199	57.27423652	690.9146667	99.47942217	5.872723746	0.51003411	176.8724778	287.2426456	5338.840082	372.8448064	0	0	1222.968709	3062.200963	1433.593547	1.246431778	592.5387354	612.1213804	737.1933956	8.779069357	373.2875239	0	0	450	450	12.67140256	0	12000	0											3400	1A IP Acute: $600 Per Admit	1B IP Psych: $600 Per Admit	2 SNF: $50 for days 1-100	6 Home Health: $25	10A Ambulance: $180	11A DME: 30%	"11B Prosthetics/Medical Supplies: 30%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $150	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $35/$75	9A OP Hospital: $35	12 Renal Dialysis: $0	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: $35, 9A OP Hospital: $35"	"7A PCP: $25, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $35"	"7B Chiropractic: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $35	"7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 0% - 20%	"13A Blood: $35, 16B Comprehensive Dental (Medicare Covered): $35, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $5	17B Eye Wear (Medicare Covered): Various	18A Routine Hearing Exams (Non Medicare Covered): $35	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											600	600	692.3103831	25	180	0.170305287	0.15	49.5	150	0	45	35	0	33	25	35	0.422742798	20	35	35	0.033707179	35	0	0	5	27.5	35	0	0	0											NO	600	600	692.3103831	25	180	0.170305287	0.15	49.5	150	0	45	35	0	33	25	35	0.422742798	20	35	35	0.033707179	35	0	0	5	27.5	35	0	0	0												4.994	0.27477126	3.304295719	1.439405556	1.492191333	1.000155904	0.076505116	0.729598971	3.59053307	0	1.398168024	0	0	3.363163948	6.37958534	4.181314511	0.526920058	0.987564559	1.785354026	2.150147404	0.295917665	1.088755278	0	0	0.1875	1.03125	0.036958257	0	0	0	0	0	0	0	0	0	0	0	0	0	40.314	0	0	4.994	0.27477126	3.304295719	1.439405556	1.492191333	1.000155904	0.076505116	0.729598971	3.59053307	0	1.398168024	0	0	3.363163948	6.37958534	4.181314511	0.526920058	0.987564559	1.785354026	2.150147404	0.295917665	1.088755278	0	0	0.1875	1.03125	0.036958257	0	0	0	0	0	0	0	0	0	0	0	0	0	40.314	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 1-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.994	0.27477126	3.304295719	1.439405556	1.492191333	1.000155904	0.076505116	0.729598971	3.59053307	0	1.398168024	0	0	3.363163948	6.37958534	4.181314511	0.526920058	0.987564559	1.785354026	2.150147404	0.295917665	1.088755278	0	0	0.1875	1.03125	0.036958257	0	0	0	0	0	0	0	0	0	0	0	0	0	40.314
H3362_020_0	2010	5	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	V	V	P	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	341.5946635	8.057147648	10302.62668	164.9501141	775.6030929	24.23891911	6.613558268	211.7101688	114.7354234	39244.98252	171.8476127	7.330886689	0	144.3500114	6246.792197	7956.434442	301.6886524	0.729867762	8024.587248	5437.332356	6.98455315	384.8603246	1649.52514	0	450	450	33.56720646	0	2816.863281	0											3400	1A IP Acute: $150 Per Admit	1B IP Psych: $150 Per Admit	2 SNF: $0	6 Home Health: $0	10A Ambulance: $25	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $0"	9B ASC Services: $75	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $5, 5 Partial Hosp: $5, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $5, 9A OP Hospital: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $5"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0% - 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $5	17B Eye Wear (Medicare Covered): Check	18A Routine Hearing Exams (Non Medicare Covered): $5	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											150	150	0	0	25	0.026192487	0.2	49.5	75	0	0	0	0	20	0	0	0	0	0	0	0.077616496	0	0	0	5	27.5	5	0	0	0											NO	150	150	0	0	25	0.026192487	0.2	49.5	75	0	0	0	0	20	0	0	0	0	0	0	0.077616496	0	0	0	5	27.5	5	0	0	0												4.2699	0.100714346	0	0	1.615839777	0.634877581	1.322711654	0.873304446	0.717096396	0	0	0	0	0.240583352	0	0	0	0	0	0	0.542116545	0	0	0	0.1875	1.03125	0.013986336	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5499	0	0	4.2699	0.100714346	0	0	1.615839777	0.634877581	1.322711654	0.873304446	0.717096396	0	0	0	0	0.240583352	0	0	0	0	0	0	0.542116545	0	0	0	0.1875	1.03125	0.013986336	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5499	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.2699	0.100714346	0	0	1.615839777	0.634877581	1.322711654	0.873304446	0.717096396	0	0	0	0	0.240583352	0	0	0	0	0	0	0.542116545	0	0	0	0.1875	1.03125	0.013986336	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5499
H3362_801_0	2010	1	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	212.6131314	8.046897857	34.08300509	14.3387274	11.26908691	14.08342143	1.53178597	13.05473933	59.94815538	9.267600553	13.32707769	0	0	20.49057908	68.39674193	103.5679553	2.423862481	4.040384852	50.38281635	42.37594721	17.25630274	21.63478133	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0											0.091158431	0.091158431	0.169707101	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.091158431	0.091158431	0.169707101	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.3815	0.733542587	5.784127987	0	2.625697251	3.281437193	0.356906131	3.041754264	13.9679202	2.159350929	3.105209101	0	0	4.774304925	15.93644087	24.13133357	0.564759958	0.941409671	11.73919621	9.873595699	4.020718537	5.040904049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.4601	0	0	19.3815	0.733542587	5.784127987	0	2.625697251	3.281437193	0.356906131	3.041754264	13.9679202	2.159350929	3.105209101	0	0	4.774304925	15.93644087	24.13133357	0.564759958	0.941409671	11.73919621	9.873595699	4.020718537	5.040904049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.4601	NO	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.3815	0.733542587	5.784127987	0	2.625697251	3.281437193	0.356906131	3.041754264	13.9679202	2.159350929	3.105209101	0	0	4.774304925	15.93644087	24.13133357	0.564759958	0.941409671	11.73919621	9.873595699	4.020718537	5.040904049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.4601
H3362_807_0	2010	1	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	216.1677057	4.367817479	31.76978515	13.3395472	10.94222328	10.50878319	1.255943107	10.14359648	55.21925138	9.344321323	13.57977362	0	0	18.19661095	55.99722265	85.87509304	1.610177721	2.918170096	38.85286427	45.42070972	18.95641732	19.33092501	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0											0.091124123	0.091124123	0.17036867	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.091124123	0.091124123	0.17036867	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.6981	0.398013539	5.412576031	0	2.549538024	2.448546484	0.292634744	2.36345798	12.86608557	2.177226868	3.164087255	0	0	4.239810351	13.04735288	20.00889668	0.375171409	0.679933632	9.052717376	10.58302536	4.416845234	4.504105527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2781	0	0	19.6981	0.398013539	5.412576031	0	2.549538024	2.448546484	0.292634744	2.36345798	12.86608557	2.177226868	3.164087255	0	0	4.239810351	13.04735288	20.00889668	0.375171409	0.679933632	9.052717376	10.58302536	4.416845234	4.504105527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2781	NO	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0												2.1887	0.0442	0.6014	0	0.2833	0.2721	0.0325	0.2626	1.4296	0.2419	0.3516	0	0	0.4711	1.4497	2.2285	0.0417	0.0755	1.0059	1.1759	0.4908	0.5005	0	0	0	0	0	0	0	0											13.1473	0	0	21.8868	0.442237265	6.013973368	0	2.832820027	2.720607204	0.325149715	2.626064422	14.29565064	2.419140965	3.515652505	0	0	4.71090039	14.49705875	22.2374238	0.416857121	0.755481814	10.05857486	11.75891707	4.907605816	5.004561696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.4254
H3362_817_0	2010	1	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	231.8884537	4.685466025	34.08023564	14.30966277	11.73799401	11.27303209	1.347281287	10.88128726	59.23505905	10.02388499	14.56735962	0	0	19.5199554	60.06960811	92.12215804	1.727277534	3.130393362	41.67843011	48.72392064	20.33501851	19.59854673	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0											0.091124123	0.091124123	0.17036867	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.091124123	0.091124123	0.17036867	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.1306	0.426958984	5.806204408	0	2.734952605	2.626616477	0.31391654	2.535339931	13.80176876	2.335565204	3.39419479	0	0	4.548149608	13.99621869	21.46446282	0.402455665	0.729381653	9.711074216	11.35267351	4.738059313	4.566461387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6151	0	0	21.1306	0.426958984	5.806204408	0	2.734952605	2.626616477	0.31391654	2.535339931	13.80176876	2.335565204	3.39419479	0	0	4.548149608	13.99621869	21.46446282	0.402455665	0.729381653	9.711074216	11.35267351	4.738059313	4.566461387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6151	NO	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0												2.3478	0.0474	0.6451	0	0.3039	0.2918	0.0349	0.2817	1.5335	0.2595	0.3771	0	0	0.5053	1.5551	2.3906	0.0447	0.081	1.079	1.2614	0.5265	0.5074	0	0	0	0	0	0	0	0											14.074	0	0	23.4785	0.474398871	6.451338232	0	3.038836228	2.918462752	0.348796155	2.817044368	15.33529862	2.595072449	3.771327545	0	0	5.053499564	15.5513541	23.85505908	0.447172962	0.810424059	10.79008246	12.61408168	5.264510348	5.073845986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.6891
H3362_819_0	2010	1	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	231.8884537	4.685466025	34.08023564	14.30966277	11.73799401	11.27303209	1.347281287	10.88128726	59.23505905	10.02388499	14.56735962	0	0	19.5199554	60.06960811	92.12215804	1.727277534	3.130393362	41.67843011	48.72392064	20.33501851	19.59854673	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0											0.091124123	0.091124123	0.17036867	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.091124123	0.091124123	0.17036867	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.1306	0.426958984	5.806204408	0	2.734952605	2.626616477	0.31391654	2.535339931	13.80176876	2.335565204	3.39419479	0	0	4.548149608	13.99621869	21.46446282	0.402455665	0.729381653	9.711074216	11.35267351	4.738059313	4.566461387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6151	0	0	21.1306	0.426958984	5.806204408	0	2.734952605	2.626616477	0.31391654	2.535339931	13.80176876	2.335565204	3.39419479	0	0	4.548149608	13.99621869	21.46446282	0.402455665	0.729381653	9.711074216	11.35267351	4.738059313	4.566461387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6151	NO	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0												2.3478	0.0474	0.6451	0	0.3039	0.2918	0.0349	0.2817	1.5335	0.2595	0.3771	0	0	0.5053	1.5551	2.3906	0.0447	0.081	1.079	1.2614	0.5265	0.5074	0	0	0	0	0	0	0	0											14.074	0	0	23.4785	0.474398871	6.451338232	0	3.038836228	2.918462752	0.348796155	2.817044368	15.33529862	2.595072449	3.771327545	0	0	5.053499564	15.5513541	23.85505908	0.447172962	0.810424059	10.79008246	12.61408168	5.264510348	5.073845986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.6891
H3362_820_0	2010	1	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	254.5468257	4.740898074	40.40911085	15.88665751	14.22111545	12.04278112	1.430635639	12.91412563	60.81168238	10.80229418	16.20338399	0	0	19.73050918	64.21474955	97.22915997	1.915494567	2.929934465	42.27515834	48.84871772	18.00315743	21.36021505	0	0	0	0	0	0	0	0												Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	0	0	0	0	0	0	0	0											0.090981706	0.090981706	0.171586748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.090981706	0.090981706	0.171586748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.1591	0.431334996	6.933667915	0	3.313519899	2.805968001	0.333338104	3.008991272	14.16912199	2.516934544	3.77538847	0	0	4.59720864	14.96203664	22.65439427	0.446310234	0.68267473	9.850111894	11.38175123	4.194735681	4.976930107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.1935	0	0	23.1591	0.431334996	6.933667915	0	3.313519899	2.805968001	0.333338104	3.008991272	14.16912199	2.516934544	3.77538847	0	0	4.59720864	14.96203664	22.65439427	0.446310234	0.68267473	9.850111894	11.38175123	4.194735681	4.976930107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.1935	NO	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.1591	0.431334996	6.933667915	0	3.313519899	2.805968001	0.333338104	3.008991272	14.16912199	2.516934544	3.77538847	0	0	4.59720864	14.96203664	22.65439427	0.446310234	0.68267473	9.850111894	11.38175123	4.194735681	4.976930107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.1935
H3366_022_0	2010	6	N/A																															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																																																			0	NO	413.9376607	10.55072334	38.88005198		14.52511073	6.360718802	5.585912858	6.620439486	23.00995567	3.969305522	10.79415478	1.916937719	0.997014453	20.54352578	57.43542167	72.86394228	21.9111677	12.46554963	36.11369441	68.20348388	15.53557614	10.68727016																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				25.4849	0.649577585	5.62356052	0	3.384350801	1.482047481	1.301517696	1.5425624	5.361319671	0.924848187	2.515038063	0.446646489	0.232304367	4.786641507	13.38245325	16.97729855	5.105302075	2.904473064	8.414490797	15.89141174	3.619789241	2.490133947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.5207	0	0	25.4849	0.649577585	5.62356052	0	3.384350801	1.482047481	1.301517696	1.5425624	5.361319671	0.924848187	2.515038063	0.446646489	0.232304367	4.786641507	13.38245325	16.97729855	5.105302075	2.904473064	8.414490797	15.89141174	3.619789241	2.490133947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.5207	NO																																																																																		0	0	0	25.4849	0.649577585	5.62356052	0	3.384350801	1.482047481	1.301517696	1.5425624	5.361319671	0.924848187	2.515038063	0.446646489	0.232304367	4.786641507	13.38245325	16.97729855	5.105302075	2.904473064	8.414490797	15.89141174	3.619789241	2.490133947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.5207
H3370_001_0	2010	14	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	Urgent Care	Therapy (PT/OT/ST)	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	2386.894519	90.32517583	1684.684348	2356.626527	318.9642343	7.181938305	2.371543453	233.1531855	243.3510241	6783.270442	218.9404092	21.45159803	0.220419864	90.79113877	5914.185525	5464.392763	546.5136458	1017.003779	1959.411176	0	57.07958382	0	141.3850893	0	378	179.4	162	14.7	4196.545893	0	2.371588008	144.0367867	354.3304367	1165.533427	208.156904	5.901114707	1790.654798	40.9426885	26.83475125	0		$110/day (days 1-7)	$110/day (days 1-7)	$50/day (for days 1-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$100 copay	$0 copay	$45 copay Tier 2 - Radiology	$100 copay	10% coinsurance	$15 copay	$5 coapy	$15 copay	$40 copay	$15 copay	$15 copay Tier 1 - Radiology	0	20% coinsurance	0	$0 copay / 24 one-way trip(s) per year / $100 max per trip / plan-approved location	0	$20 copay	$80/$175 1 pair glasses/ contacts every 2yrs	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$15 copay	$30 copay	$15 copay	$15 copay	$0 copay	10% coinsurance	$15 copay	$0 copay (1/yr)	20% coinsurance	0	110	110	50	0	125	0.2	0.2	50	100	0	45	100	0.1	15	5	15	40	15	15	0	0.2	0	0	0	20	0	0	0	0	0	15	30	15	15	0	0.1	15	0	0.2	0	NO	66.12620033	49.51383298	45.85905086	0	114.6476272	0.183436203	0.183436203	45.85905086	91.71810173	0	41.27314578	91.71810173	0.091718102	13.75771526	4.585905086	13.75771526	36.68724069	13.75771526	13.75771526	0	0.183436203	0	0	0	20	0	0	0	0	0	13.75771526	27.51543052	13.75771526	13.75771526	0	0.091718102	13.75771526	0	0.183436203	0		13.153	0.372695473	6.438168767	0	3.047374384	1.317427496	0.435026927	0.891015316	1.859974499	0	0.753029952	0.163958321	0.020216492	0.104089886	2.26015779	6.264796641	1.670839805	1.165970701	2.24641842	0	10.47046215	0	0	0	0.63	0	0	0	0	0	0.002718969	0.330269516	0.406231438	1.336256418	0	0.541239039	2.052943237	0	4.92246489	0	62.8568		5.617424274	13.153	0.372695473	6.438168767	0	3.047374384	1.317427496	0.435026927	0.891015316	1.859974499	0	0.753029952	0.163958321	0.020216492	0.104089886	2.26015779	6.264796641	1.670839805	1.165970701	2.24641842	0	10.47046215	0	0	0	0.63	0	0	0	0	0	0.002718969	0.330269516	0.406231438	1.336256418	0	0.541239039	2.052943237	0	4.92246489	0	62.8568	YES																																									3400																																									0			13.153	0.372695473	6.438168767	0	3.047374384	1.317427496	0.435026927	0.891015316	1.859974499	0	0.753029952	0.163958321	0.020216492	0.104089886	2.26015779	6.264796641	1.670839805	1.165970701	2.24641842	0	10.47046215	0	0	0	0.63	0	0	0	0	0	0.002718969	0.330269516	0.406231438	1.336256418	0	0.541239039	2.052943237	0	4.92246489	0	62.8568
H3370_002_0	2010	13	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	Urgent Care	Therapy (PT/OT/ST)	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	2210.681701	63.15438537	1582.476405	2447.157892	294.1880822	6.133428442	0.908539081	245.9872911	317.08549	8293.309289	403.2740466	1.502774834	0	16.44212465	5395.138265	5388.286542	374.1036329	727.927081	1735.130403	0	43.43639651	0	141.3850893	0	378	179.4	162	14.7	4196.545893	0	20.33165952	413.7107597	327.32966	1070.87867	362.6845521	5.621291116	1855.355307	31.33521445	19.40740807	0		$190/day (days 1-7)	$190/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$300 copay	$0 copay	$75 copay Tier 2 - Radiology	$300 copay	10% coinsurance	$25 copay	$15 coapy	$25 copay	$40 copay	$25 copay	$25 copay Tier 1 - Radiology	0	20% coinsurance	0	$0 copay / 24 one-way trip(s) per year / $100 max per trip / plan-approved location	0	$20 copay	$80/$175 1 pair glasses/ contacts every 2yrs	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$25 copay	$50 copay	$25 copay	$25 copay	$0 copay	10% coinsurance	$25 copay	$0 copay (1/yr)	20% coinsurance	0	190	190	60	0	125	0.2	0.2	50	300	0	75	300	0.1	25	15	25	40	25	25	0	0.2	0	0	0	20	0	0	0	0	0	25	50	25	25	0	0.1	25	0	0.2	0	NO	119.870467	69.20903111	53.92602996	0	112.3458957	0.179753433	0.179753433	44.9383583	269.6301498	0	67.40753745	269.6301498	0	22.46917915	13.48150749	22.46917915	35.95068664	22.46917915	22.46917915	0	0.179753433	0	0	0	20	0	0	0	0	0	22.46917915	44.9383583	22.46917915	22.46917915	0	0.089876717	22.46917915	0	0.179753433	0		22.083	0.364237818	7.111389169	0	2.754235301	1.10250482	0.163313019	0.921188752	7.124650679	0	2.2653092	0.033766117	0	0.030786754	6.06121641	10.08919797	1.12077354	1.362993666	3.248912989	0	7.807841398	0	0	0	0.63	0	0	0	0	0	0.038069642	1.549290196	0.612902398	2.005147057	0	0.505223189	3.474025899	0	3.488548229	0	85.9485		9.608049059	22.083	0.364237818	7.111389169	0	2.754235301	1.10250482	0.163313019	0.921188752	7.124650679	0	2.2653092	0.033766117	0	0.030786754	6.06121641	10.08919797	1.12077354	1.362993666	3.248912989	0	7.807841398	0	0	0	0.63	0	0	0	0	0	0.038069642	1.549290196	0.612902398	2.005147057	0	0.505223189	3.474025899	0	3.488548229	0	85.9485	YES																																									4000																																									0			22.083	0.364237818	7.111389169	0	2.754235301	1.10250482	0.163313019	0.921188752	7.124650679	0	2.2653092	0.033766117	0	0.030786754	6.06121641	10.08919797	1.12077354	1.362993666	3.248912989	0	7.807841398	0	0	0	0.63	0	0	0	0	0	0.038069642	1.549290196	0.612902398	2.005147057	0	0.505223189	3.474025899	0	3.488548229	0	85.9485
H3370_003_0	2010	11	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	Urgent Care	Therapy (PT/OT/ST)	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	2279.372317	72.72056031	1409.109874	2141.191512	195.3601221	7.590282729	1.783002608	230.9284079	314.4470708	4249.504353	131.1684219	6.16881192	0	50.81152976	5331.863837	6040.855266	504.9327477	818.3767597	2138.718108	0	51.91933138	0	141.3850893	0	378	179.4	0	0	4196.545893	0	1.136360091	66.05011554	439.890091	1244.342031	300.9774307	5.840875104	1748.655385	53.51828338	35.52615973	0		$230/day (days 1-6)	$230/day (days 1-6)	$60/day (for days 1-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75 copay Tier 2 - Radiology	$200 copay	10% coinsurance	$25 copay	$15 coapy	$25 copay	$40 copay	$25 copay	$35 copay Tier 1 - Radiology	0	20% coinsurance	0	$0 copay / 24 one-way trip(s) per year / $100 max per trip / plan-approved location	0	$30 copay	$30 copay w/ $80 allowance 1 pair glasses / contacts every 2 years	0	0	Silver Sneakers	0	$25 copay	$50 copay	$25 copay	$25 copay	$0 copay	10% coinsurance	$25 copay	$0 copay (1/yr)	20% coinsurance	0	230	230	60	0	100	0.2	0.2	50	200	0	75	200	0.1	25	15	25	40	25	35	0	0.2	0	0	0	30	30	0	0	0	0	25	50	25	25	0	0.1	25	0	0.2	0	NO	128.4236528	85.69684839	53.62856023	0	89.38093372	0.178761867	0.178761867	44.69046686	178.7618674	0	67.03570029	178.7618674	0	22.34523343	13.40714006	22.34523343	35.75237349	22.34523343	31.2833268	0	0.178761867	0	0	0	30	30	0	0	0	0	22.34523343	44.69046686	22.34523343	22.34523343	0	0.089380934	22.34523343	0	0.178761867	0		24.3938	0.519326903	6.29737781	0	1.45512251	1.356853115	0.318732876	0.860024863	4.684262132	0	0.732747251	0.091895695	0	0.094616291	5.957087103	11.24869342	1.504378682	1.523901644	5.575518126	0	9.281196633	0	0	0	0.945	0.4485	0	0	0	0	0.002116019	0.245984208	0.819120564	2.317092762	0	0.522062871	3.256176063	0	6.350722656	0	90.8023		10.6204703	24.3938	0.519326903	6.29737781	0	1.45512251	1.356853115	0.318732876	0.860024863	4.684262132	0	0.732747251	0.091895695	0	0.094616291	5.957087103	11.24869342	1.504378682	1.523901644	5.575518126	0	9.281196633	0	0	0	0.945	0.4485	0	0	0	0	0.002116019	0.245984208	0.819120564	2.317092762	0	0.522062871	3.256176063	0	6.350722656	0	90.8023	YES																																									4000																																									0			24.3938	0.519326903	6.29737781	0	1.45512251	1.356853115	0.318732876	0.860024863	4.684262132	0	0.732747251	0.091895695	0	0.094616291	5.957087103	11.24869342	1.504378682	1.523901644	5.575518126	0	9.281196633	0	0	0	0.945	0.4485	0	0	0	0	0.002116019	0.245984208	0.819120564	2.317092762	0	0.522062871	3.256176063	0	6.350722656	0	90.8023
H3370_004_0	2010	13	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	Urgent Care	Therapy (PT/OT/ST)	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	2660.618112	41.22946712	1610.351687	2499.409604	154.0949912	8.228336887	3.594373128	264.4858121	318.8350931	4471.452862	315.1414521	1.62520205	0.298870797	14.03583589	6880.326706	5855.171616	375.547884	953.8492474	1826.238822	0	45.38284088	0	141.3850893	0	378	179.4	162	14.7	4196.545893	0	0.295491282	189.7324963	402.7176869	1316.86775	329.5795743	6.859058488	1581.249048	41.07338683	31.98128426	0		$180/day (days 1-7)	$180/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$150 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75 copay Tier 2 - Radiology	$200 copay	10% coinsurance	$25 copay	$15 coapy	$25 copay	$40 copay	$25 copay	$25 copay Tier 1 - Radiology	0	20% coinsurance	0	$0 copay / 24 one-way trip(s) per year / $100 max per trip / plan-approved location	0	$20 copay	$80/$175 1 pair glasses/ contacts every 2yrs	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$25 copay	$50 copay	$25 copay	$25 copay	$0 copay	10% coinsurance	$25 copay	$0 copay (1/yr)	20% coinsurance	0	180	180	60	0	150	0.2	0.2	50	200	0	75	200	0.1	25	15	25	40	25	25	0	0.2	0	0	0	20	0	0	0	0	0	25	50	25	25	0	0.1	25	0	0.2	0	NO	109.5068887	97.37916749	53.62910674	0	134.0727668	0.178763689	0.178763689	44.69092228	178.7636891	0	67.03638342	178.7636891	0.089381845	22.34546114	13.40727668	22.34546114	35.75273782	22.34546114	22.34546114	0	0.178763689	0	0	0	20	0	0	0	0	0	22.34546114	44.69092228	22.34546114	22.34546114	0	0.089381845	22.34546114	0	0.178763689	0		24.2797	0.334574265	7.196810207	0	1.721661819	1.470927857	0.6425434	0.985009573	4.749678122	0	1.760495268	0.024210593	0.026713623	0.026136435	7.687203652	10.90304249	1.11890542	1.776183441	3.400679053	0	8.112804059	0	0	0	0.63	0	0	0	0	0	0.000550241	0.706610021	0.749909369	2.452168094	0	0.6130753	2.944478264	0	5.717092357	0	90.0311		10.61854157	24.2797	0.334574265	7.196810207	0	1.721661819	1.470927857	0.6425434	0.985009573	4.749678122	0	1.760495268	0.024210593	0.026713623	0.026136435	7.687203652	10.90304249	1.11890542	1.776183441	3.400679053	0	8.112804059	0	0	0	0.63	0	0	0	0	0	0.000550241	0.706610021	0.749909369	2.452168094	0	0.6130753	2.944478264	0	5.717092357	0	90.0311	YES																																									4000																																									0			24.2797	0.334574265	7.196810207	0	1.721661819	1.470927857	0.6425434	0.985009573	4.749678122	0	1.760495268	0.024210593	0.026713623	0.026136435	7.687203652	10.90304249	1.11890542	1.776183441	3.400679053	0	8.112804059	0	0	0	0.63	0	0	0	0	0	0.000550241	0.706610021	0.749909369	2.452168094	0	0.6130753	2.944478264	0	5.717092357	0	90.0311
H3370_009_0	2010	7	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	Urgent Care	Therapy (PT/OT/ST)	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	2820.17049	32.18643175	1676.862971	2337.57729	184.1821612	5.691730031	1.661397828	293.9833126	288.5246967	4646.610414	331.4348209	1.82539175	0.006294552	21.19251416	6934.723893	5979.564061	261.602965	759.9101058	1815.513847	0	54.58820582	0	141.3850893	0	378	179.4	162	14.7	4196.545893	0	0.006223376	222.2475692	536.6607965	1460.48225	318.5423087	7.09186568	1701.139483	47.75945855	27.53247813	0		$200/day (days 1-7)	$200/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75 copay Tier 2 - Radiology	$200 copay	10% coinsurance	$25 copay	$15 coapy	$25 copay	$40 copay	$25 copay	$25 copay Tier 1 - Radiology	0	20% coinsurance	0	$0 copay / 24 one-way trip(s) per year / $100 max per trip / plan-approved location	0	$20 copay	$80/$175 1 pair glasses/ contacts every 2yrs	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$25 copay	$50 copay	$25 copay	$25 copay	$0 copay	10% coinsurance	$25 copay	$0 copay (1/yr)	20% coinsurance	0	200	200	60	0	125	0.2	0.2	50	200	0	75	200	0.1	25	15	25	40	25	25	0	0.2	0	0	0	20	0	0	0	0	0	25	50	25	25	0	0.1	25	0	0.2	0	NO	122.4906418	92.75337163	53.32285066	0	111.0892722	0.177742836	0.177742836	44.43570889	177.7428355	0	66.65356333	177.7428355	0.088871418	22.21785444	13.33071267	22.21785444	35.54856711	22.21785444	22.21785444	0	0.177742836	0	0	0	20	0	0	0	0	0	22.21785444	44.43570889	22.21785444	22.21785444	0	0.088871418	22.21785444	0	0.177742836	0		28.787	0.248783339	7.451259483	0	1.705055187	1.011664235	0.295301561	1.088613075	4.27359981	0	1.840942652	0.027037525	0.000559406	0.039237683	7.703734302	11.07109033	0.774967546	1.406964343	3.361401866	0	9.702662489	0	0	0	0.63	0	0	0	0	0	1.15E-05	0.822977357	0.993620955	2.704065171	0	0.630264158	3.149639118	0	4.893700732	0	94.6142		11.7668136	28.787	0.248783339	7.451259483	0	1.705055187	1.011664235	0.295301561	1.088613075	4.27359981	0	1.840942652	0.027037525	0.000559406	0.039237683	7.703734302	11.07109033	0.774967546	1.406964343	3.361401866	0	9.702662489	0	0	0	0.63	0	0	0	0	0	1.15E-05	0.822977357	0.993620955	2.704065171	0	0.630264158	3.149639118	0	4.893700732	0	94.6142	YES																																									4000																																									0			28.787	0.248783339	7.451259483	0	1.705055187	1.011664235	0.295301561	1.088613075	4.27359981	0	1.840942652	0.027037525	0.000559406	0.039237683	7.703734302	11.07109033	0.774967546	1.406964343	3.361401866	0	9.702662489	0	0	0	0.63	0	0	0	0	0	1.15E-05	0.822977357	0.993620955	2.704065171	0	0.630264158	3.149639118	0	4.893700732	0	94.6142
H3370_010_0	2010	6	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	Urgent Care	Therapy (PT/OT/ST)	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	V	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	1901.919967	59.27347812	1287.960955	2476.153871	193.529631	6.274693361	1.097580373	256.2721977	293.3207722	5241.08289	352.7612242	1.160965839	0.058712187	22.4583201	5392.321729	5323.971123	401.8674689	821.6417862	1590.6928	0	43.96652776	0	141.3850893	1572.93321	378	179.4	162	14.7	4196.545893	0	11.91720974	252.2296454	423.8236719	1107.51393	297.1414148	4.877177924	1607.233145	33.73679849	16.18868475	0		$275/day (days 1-5)	$275/day (days 1-5)	$60/day (for days 1-100)	$0 copay	$150 copay	20% coinsurance	20% coinsurance	$50 copay	$300 copay	$0 copay	$105 copay Tier 2 - Radiology	$300 copay	10% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$35 copay	$35 copay Tier 1 - Radiology	0	20% coinsurance	0	$0 copay / 24 one-way trip(s) per year / $100 max per trip / plan-approved location	$0 copay 1 exam/2cleanings/1 x-ray / yr	$20 copay	$80/$175 1 pair glasses/ contacts every 2yrs	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$35 copay	$50 copay	$35 copay	$35 copay	$0 copay	10% coinsurance	$35 copay	$0 copay (1/yr)	20% coinsurance	0	275	275	60	0	150	0.2	0.2	50	300	0	105	300	0.1	35	25	35	40	35	35	0	0.2	0	0	0	20	0	0	0	0	0	35	50	35	35	0	0.1	35	0	0.2	0	NO	152.4200403	93.95503818	53.23977937	0	133.0994484	0.177465931	0.177465931	44.36648281	266.1988968	0	93.1696139	266.1988968	0.088732966	31.05653797	22.1832414	31.05653797	35.49318625	31.05653797	31.05653797	0	0.177465931	0	0	0	20	0	0	0	0	0	31.05653797	44.36648281	31.05653797	31.05653797	0	0.088732966	31.05653797	0	0.177465931	0		24.1576	0.464086825	5.714229758	0	2.146557262	1.113544301	0.194783123	0.947491338	6.506805498	0	2.738885588	0.025753985	0.005209706	0.058123139	9.968264554	13.77867594	1.188629743	2.126445777	4.116784278	0	7.802560793	0	0	0	0.63	0	0	0	0	0	0.030842273	0.932545185	1.096874663	2.8662957	0	0.432766461	4.159591432	0	2.872940014	0	96.0762		12.1174445	24.1576	0.464086825	5.714229758	0	2.146557262	1.113544301	0.194783123	0.947491338	6.506805498	0	2.738885588	0.025753985	0.005209706	0.058123139	9.968264554	13.77867594	1.188629743	2.126445777	4.116784278	0	7.802560793	0	0	0	0.63	0	0	0	0	0	0.030842273	0.932545185	1.096874663	2.8662957	0	0.432766461	4.159591432	0	2.872940014	0	96.0762	YES																																									4000																																									0			24.1576	0.464086825	5.714229758	0	2.146557262	1.113544301	0.194783123	0.947491338	6.506805498	0	2.738885588	0.025753985	0.005209706	0.058123139	9.968264554	13.77867594	1.188629743	2.126445777	4.116784278	0	7.802560793	0	0	0	0.63	0	0	0	0	0	0.030842273	0.932545185	1.096874663	2.8662957	0	0.432766461	4.159591432	0	2.872940014	0	96.0762
H3370_014_0	2010	10	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	Urgent Care	Therapy (PT/OT/ST)	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	2108.930545	80.92198756	880.0588629	1924.098306	253.9227723	11.20044214	1.244979748	349.7059345	401.7001851	5711.809883	530.0236527	0.946981647	0.047890611	37.09408382	5438.852399	5343.238451	359.9817002	931.2213714	1640.405088	0	54.19722578	0	141.3850893	0	378	179.4	162	14.7	4196.545893	0	26.44366562	275.8579142	522.6784413	977.9378897	381.9286758	6.677444365	1490.513237	36.00204065	17.36731388	0		$75/day (days 1-7)	$75/day (days 1-7)	$25/day (for days 1-100)	$0 copay	$50 copay	20% coinsurance	20% coinsurance	$50 copay	$100 copay	$0 copay	$60 copay Tier 2 - Radiology	$100 copay	10% coinsurance	$20 copay	$10 coapy	$20 copay	$40 copay	$20 copay	$20 copay Tier 1 - Radiology	0	20% coinsurance	0	$0 copay / 24 one-way trip(s) per year / $100 max per trip / plan-approved location	0	$20 copay	$80/$175 1 pair glasses/ contacts every 2yrs	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$20 copay	$40 copay	$20 copay	$20 copay	$0 copay	10% coinsurance	$20 copay	$0 copay (1/yr)	20% coinsurance	0	75	75	25	0	50	0.2	0.2	50	100	0	60	100	0.1	20	10	20	40	20	20	0	0.2	0	0	0	20	0	0	0	0	0	20	40	20	20	0	0.1	20	0	0.2	0	NO	48.2394891	29.69615499	23.50832386	0	47.01664771	0.188066591	0.188066591	47.01664771	94.03329542	0	56.41997725	94.03329542	0.094033295	18.80665908	9.403329542	18.80665908	37.61331817	18.80665908	18.80665908	0	0.188066591	0	0	0	20	0	0	0	0	0	18.80665908	37.61331817	18.80665908	18.80665908	0	0.094033295	18.80665908	0	0.188066591	0		8.4778	0.20025599	1.724059063	0	0.994883128	2.106428969	0.234139097	1.370166727	3.147766014	0	2.491993536	0.00742065	0.004503312	0.058134649	4.261943453	8.374038663	1.128342185	1.459430239	2.570878272	0	10.19268748	0	0	0	0.63	0	0	0	0	0	0.041443084	0.864660958	0.819152938	1.532645375	0	0.627902099	2.335964526	0	3.266211514	0	58.9229		3.697792698	8.4778	0.20025599	1.724059063	0	0.994883128	2.106428969	0.234139097	1.370166727	3.147766014	0	2.491993536	0.00742065	0.004503312	0.058134649	4.261943453	8.374038663	1.128342185	1.459430239	2.570878272	0	10.19268748	0	0	0	0.63	0	0	0	0	0	0.041443084	0.864660958	0.819152938	1.532645375	0	0.627902099	2.335964526	0	3.266211514	0	58.9229	YES																																									4000																																									0			8.4778	0.20025599	1.724059063	0	0.994883128	2.106428969	0.234139097	1.370166727	3.147766014	0	2.491993536	0.00742065	0.004503312	0.058134649	4.261943453	8.374038663	1.128342185	1.459430239	2.570878272	0	10.19268748	0	0	0	0.63	0	0	0	0	0	0.041443084	0.864660958	0.819152938	1.532645375	0	0.627902099	2.335964526	0	3.266211514	0	58.9229
H3370_019_0	2010	6	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	Urgent Care	Therapy (PT/OT/ST)	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	V	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	2167.250359	62.6042548	1066.531031	2628.673843	227.8373541	7.502447264	1.488894479	231.1922927	310.2009233	5670.579557	290.2504264	31.52073939	0.061031654	75.77566972	5358.854435	5348.983599	365.0567275	828.5543984	1829.396759	0	46.43918986	0	141.3850893	1572.93321	378	179.4	162	14.7	4196.545893	0	5.284284219	164.7641035	352.0328915	1123.479469	266.5230792	5.190138547	1625.186715	41.54647995	16.44651452	0		$110/day (days 1-7)	$110/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$100 copay	$0 copay	$75 copay Tier 2 - Radiology	$100 copay	10% coinsurance	$25 copay	$15 coapy	$25 copay	$40 copay	$25 copay	$25 copay Tier 1 - Radiology	0	20% coinsurance	0	$0 copay / 24 one-way trip(s) per year / $100 max per trip / plan-approved location	$0 copay 1 exam/2cleanings/1 x-ray /yr	$20 copay	$80/$175 1 pair glasses/ contacts every 2yrs	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$25 copay	$50 copay	$25 copay	$25 copay	$0 copay	10% coinsurance	$25 copay	$0 copay (1/yr)	20% coinsurance	0	110	110	60	0	100	0.2	0.2	50	100	0	75	100	0.1	25	15	25	40	25	25	0	0.2	0	0	0	20	0	0	0	0	0	25	50	25	25	0	0.1	25	0	0.2	0	NO	70.00747616	57.68147593	55.66241372	0	92.77068953	0.185541379	0.185541379	46.38534476	92.77068953	0	69.57801715	92.77068953	0.09277069	23.19267238	13.91560343	23.19267238	37.10827581	23.19267238	23.19267238	0	0.185541379	0	0	0	20	0	0	0	0	0	23.19267238	46.38534476	23.19267238	23.19267238	0	0.09277069	23.19267238	0	0.185541379	0		12.6436	0.300925485	4.947140956	0	1.761385703	1.392014412	0.276251535	0.893661184	2.398129463	0	1.682920762	0.243683394	0.005661949	0.146453357	6.214307763	10.33810202	1.128885478	1.601365893	3.53571664	0	8.616391328	0	0	0	0.63	0	0	0	0	0	0.010213056	0.636886646	0.68038196	2.171374271	0	0.481492732	3.141035254	0	3.051508986	0	68.9295		5.321057961	12.6436	0.300925485	4.947140956	0	1.761385703	1.392014412	0.276251535	0.893661184	2.398129463	0	1.682920762	0.243683394	0.005661949	0.146453357	6.214307763	10.33810202	1.128885478	1.601365893	3.53571664	0	8.616391328	0	0	0	0.63	0	0	0	0	0	0.010213056	0.636886646	0.68038196	2.171374271	0	0.481492732	3.141035254	0	3.051508986	0	68.9295	YES																																									4000																																									0			12.6436	0.300925485	4.947140956	0	1.761385703	1.392014412	0.276251535	0.893661184	2.398129463	0	1.682920762	0.243683394	0.005661949	0.146453357	6.214307763	10.33810202	1.128885478	1.601365893	3.53571664	0	8.616391328	0	0	0	0.63	0	0	0	0	0	0.010213056	0.636886646	0.68038196	2.171374271	0	0.481492732	3.141035254	0	3.051508986	0	68.9295
H3370_021_0	2010	12	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	Urgent Care	Therapy (PT/OT/ST)	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	V	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	2386.740446	90.31934536	1684.575602	2356.474407	318.9436452	7.181474713	2.37139037	233.1384134	243.3353159	6782.832584	218.9262766	21.45021333	0.220405636	90.78527823	5913.803766	5464.040038	546.4783685	1016.938132	1959.284697	0	57.07589935	0	141.3850893	0	378	179.4	162	14.7	4196.275007	0	2.371434923	144.0274892	354.3075648	1165.458193	208.1434676	5.900733792	1790.539212	40.94004566	26.83301907	0		$150/day (days 1-7)	$150/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$150 copay	$0 copay	$75 copay Tier 2 - Radiology	$150 copay	10% coinsurance	$25 copay	$0 coapy	$25 copay	$40 copay	$25 copay	$25 copay Tier 1 - Radiology	0	20% coinsurance	0	$0 copay / 24 one-way trip(s) per year / $100 max per trip / plan-approved location	0	$20 copay	$80/$175 1 pair glasses/ contacts every 2yrs	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$25 copay	$50 copay	$25 copay	$25 copay	$0 copay	10% coinsurance	$25 copay	$0 copay (1/yr)	20% coinsurance	0	150	150	60	0	125	0.2	0.2	50	150	0	75	150	0.1	25	0	25	40	25	25	0	0.2	0	0	0	20	0	0	0	0	0	25	50	25	25	0	0.1	25	0	0.2	0	NO	89.59998466	67.09048235	54.68524164	0	113.9275867	0.182284139	0.182284139	45.5710347	136.7131041	0	68.35655205	136.7131041	0.091142069	22.78551735	0	22.78551735	36.45682776	22.78551735	22.78551735	0	0.182284139	0	0	0	20	0	0	0	0	0	22.78551735	45.5710347	22.78551735	22.78551735	0	0.091142069	22.78551735	0	0.182284139	0		17.821	0.504964037	7.676785322	0	3.028039984	1.309068933	0.432266851	0.885363227	2.772260531	0	1.247087118	0.244377104	0.020088226	0.172382461	0	10.37508159	1.660238979	1.93095512	3.720276288	0	10.40403116	0	0	0	0.63	0	0	0	0	0	0.004502864	0.546956809	0.672756764	2.212963989	0	0.537805089	3.399863523	0	4.891233773	0	77.1003		7.43042316	17.821	0.504964037	7.676785322	0	3.028039984	1.309068933	0.432266851	0.885363227	2.772260531	0	1.247087118	0.244377104	0.020088226	0.172382461	0	10.37508159	1.660238979	1.93095512	3.720276288	0	10.40403116	0	0	0	0.63	0	0	0	0	0	0.004502864	0.546956809	0.672756764	2.212963989	0	0.537805089	3.399863523	0	4.891233773	0	77.1003	YES																																									4000																																									0			17.821	0.504964037	7.676785322	0	3.028039984	1.309068933	0.432266851	0.885363227	2.772260531	0	1.247087118	0.244377104	0.020088226	0.172382461	0	10.37508159	1.660238979	1.93095512	3.720276288	0	10.40403116	0	0	0	0.63	0	0	0	0	0	0.004502864	0.546956809	0.672756764	2.212963989	0	0.537805089	3.399863523	0	4.891233773	0	77.1003
H3370_022_0	2010	13	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	Therapy (PT/OT/ST)	Ambulatory Surgery	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	V	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	2279.225184	72.71586622	1409.018916	2141.053299	195.3475117	7.589792779	1.782887516	230.9137795	245.9249156	4249.230049	131.159955	6.168413725	0	50.80824989	5331.519667	6040.46533	504.9001544	818.3239337	2138.580055	0	54.87570091	0	141.3850893	1572.93321	378	179.4	162	14.7	4196.275007	0	1.136286739	66.04585202	501.5390602	10.90427546	1244.261709	300.9580027	447.5372794	1366.221836	53.51482879	35.52386653		$150/day (days 1-7)	$150/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$75 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75 copay - Radiology	$200 copay	10% coinsurance	$25 copay	$15 coapy	$25 copay	$40 copay	$25 copay	$25 copay - Radiology	0	20% coinsurance	0	$0 copay / 24 one-way trip(s) per year / $100 max per trip / plan-approved location	$2.63 Liberty Dental	$20 copay	$80/$175 1 pair glasses/ contacts every 2yrs	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$25 copay	$50 copay	$200 copay	$25 copay	$25 copay	$0 copay	10% coinsurance	$25 copay	$0 copay (1/yr)	20% coinsurance	150	150	60	0	75	0.2	0.2	50	200	0	75	200	0.1	25	15	25	40	25	25	0	0.2	0	0	0	20	0	0	0	0	0	25	50	200	25	25	0	0.1	25	0	0.2	NO	88.07587805	60.29932023	52.01913507	0	65.02391883	0.173397117	0.173397117	43.34927922	173.3971169	0	65.02391883	173.3971169	0	21.67463961	13.00478377	21.67463961	34.67942338	21.67463961	21.67463961	0	0.173397117	0	0	0	20	0	0	0	0	0	21.67463961	43.34927922	173.3971169	21.67463961	21.67463961	0	0.086698558	21.67463961	0	0.173397117		16.7287	0.365393109	6.107995442	0	1.058521729	1.316048186	0.309147555	0.834162159	3.553555945	0	0.710711189	0.089132096	0	0.091770875	5.777938368	10.91040909	1.459137185	1.478073029	3.862745997	0	9.515288326	0	0	0	0.63	0	0	0	0	0	0.002052384	0.238586673	7.247118921	0.01969552	2.247410344	0	38.80083698	2.46769716	0	6.159736036	121.9819		18.61562942	16.7287	0.365393109	6.107995442	0	1.058521729	1.316048186	0.309147555	0.834162159	3.553555945	0	0.710711189	0.089132096	0	0.091770875	5.777938368	10.91040909	1.459137185	1.478073029	3.862745997	0	9.515288326	0	0	0	0.63	0	0	0	0	0	0.002052384	0.238586673	7.247118921	0.01969552	2.247410344	0	38.80083698	2.46769716	0	6.159736036	121.9819	YES																																									4000																																									0			16.7287	0.365393109	6.107995442	0	1.058521729	1.316048186	0.309147555	0.834162159	3.553555945	0	0.710711189	0.089132096	0	0.091770875	5.777938368	10.91040909	1.459137185	1.478073029	3.862745997	0	9.515288326	0	0	0	0.63	0	0	0	0	0	0.002052384	0.238586673	7.247118921	0.01969552	2.247410344	0	38.80083698	2.46769716	0	6.159736036	121.9819
H3370_801_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	305.1191116	3.653284311	37.50255182	18.569478	6.941546892	6.200339099	6.831381155	6.947919948	42.50556534	6.615905201	20.72853413	0	0.224979474	27.79295416	57.09636631	165.0601379	1.725621803	8.229258766	43.27605143	51.39946462	58.68972902	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.062876942	0.062876942	0.146863389	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.062876942	0.062876942	0.146863389	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.185	0.229707344	5.507751851	0	1.617380426	1.44467901	1.591711809	1.618865348	9.903796725	1.541505912	4.829748453	0	0.052420217	6.475758319	13.30345335	38.45901212	0.40206988	1.917417292	10.08331998	11.97607526	13.67470686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8143			19.185	0.229707344	5.507751851	0	1.617380426	1.44467901	1.591711809	1.618865348	9.903796725	1.541505912	4.829748453	0	0.052420217	6.475758319	13.30345335	38.45901212	0.40206988	1.917417292	10.08331998	11.97607526	13.67470686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8143	NO																																																																																		0			19.185	0.229707344	5.507751851	0	1.617380426	1.44467901	1.591711809	1.618865348	9.903796725	1.541505912	4.829748453	0	0.052420217	6.475758319	13.30345335	38.45901212	0.40206988	1.917417292	10.08331998	11.97607526	13.67470686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8143
H3370_803_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	305.1191116	3.653284311	37.50255182	18.569478	6.941546892	6.200339099	6.831381155	6.947919948	42.50556534	6.615905201	20.72853413	0	0.224979474	27.79295416	57.09636631	165.0601379	1.725621803	8.229258766	43.27605143	51.39946462	58.68972902	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.067764485	0.067764485	0.163365559	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.067764485	0.067764485	0.163365559	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				20.6762	0.247562931	6.126625328	0	1.617380426	1.44467901	1.591711809	1.618865348	9.903796725	1.541505912	4.829748453	0	0.052420217	6.475758319	13.30345335	38.45901212	0.40206988	1.917417292	10.08331998	11.97607526	13.67470686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.9423			20.6762	0.247562931	6.126625328	0	1.617380426	1.44467901	1.591711809	1.618865348	9.903796725	1.541505912	4.829748453	0	0.052420217	6.475758319	13.30345335	38.45901212	0.40206988	1.917417292	10.08331998	11.97607526	13.67470686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.9423	NO																																																																																		0			20.6762	0.247562931	6.126625328	0	1.617380426	1.44467901	1.591711809	1.618865348	9.903796725	1.541505912	4.829748453	0	0.052420217	6.475758319	13.30345335	38.45901212	0.40206988	1.917417292	10.08331998	11.97607526	13.67470686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.9423
H3370_805_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	305.1191116	3.653284311	37.50255182	18.569478	6.941546892	6.200339099	6.831381155	6.947919948	42.50556534	6.615905201	20.72853413	0	0.224979474	27.79295416	57.09636631	165.0601379	1.725621803	8.229258766	43.27605143	51.39946462	58.68972902	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.062876942	0.062876942	0.146863389	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.062876942	0.062876942	0.146863389	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.185	0.229707344	5.507751851	0	1.617380426	1.44467901	1.591711809	1.618865348	9.903796725	1.541505912	4.829748453	0	0.052420217	6.475758319	13.30345335	38.45901212	0.40206988	1.917417292	10.08331998	11.97607526	13.67470686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8143			19.185	0.229707344	5.507751851	0	1.617380426	1.44467901	1.591711809	1.618865348	9.903796725	1.541505912	4.829748453	0	0.052420217	6.475758319	13.30345335	38.45901212	0.40206988	1.917417292	10.08331998	11.97607526	13.67470686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8143	NO																																																																																		0			19.185	0.229707344	5.507751851	0	1.617380426	1.44467901	1.591711809	1.618865348	9.903796725	1.541505912	4.829748453	0	0.052420217	6.475758319	13.30345335	38.45901212	0.40206988	1.917417292	10.08331998	11.97607526	13.67470686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.8143
H3379_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2267.779233	201.5274274	1623.198101	1183.474849	255.6843595	4.209407251	6.436049705	194.593125	20.81631543	13057.66335	54.39243776	0	0.07497379	12.37685398	6923.099213	4751.16351	901.1746297	2151.765163	0	0	16.56363051	2204.402529	0	0	98.19526124	0	17.71122569	4.787996851	173.4145366	0											3200	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	73.00996713	0	150	0.2	0.124028689	49.95652466	0.2	3	0.16764962	0	0.2	0.151180429	10.83922009	34.99257966	38.5	35	0	0	0.2	34.8231406	0	0	35	0	0	0	0	0											NO	120.6129236	91.86135603	53.10667681	0	109.1084113	0.145477882	0.090217155	36.33784692	0.145477882	2.182168226	0.121946558	0	0.145477882	0.110679107	10.8340947	34.99257966	38.5	25.4586293	0	0	0.145477882	34.8231406	0	0	35	0	0	0	0	0												22.7936	1.54271523	7.183554745	0	2.324776188	0.61237565	0.580642093	0.589257932	3.028313474	2.374501506	6.632970559	0	0.010907028	1.369859145	6.250459377	13.8546223	2.891268604	4.565082634	0	0	2.40964188	6.397018268	0	0	0.286402845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.698	0	20.98531835	22.7936	1.54271523	7.183554745	0	2.324776188	0.61237565	0.580642093	0.589257932	3.028313474	2.374501506	6.632970559	0	0.010907028	1.369859145	6.250459377	13.8546223	2.891268604	4.565082634	0	0	2.40964188	6.397018268	0	0	0.286402845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.698	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.7936	1.54271523	7.183554745	0	2.324776188	0.61237565	0.580642093	0.589257932	3.028313474	2.374501506	6.632970559	0	0.010907028	1.369859145	6.250459377	13.8546223	2.891268604	4.565082634	0	0	2.40964188	6.397018268	0	0	0.286402845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.698
H3379_002_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	492.9925785	37.16293846	16540.32083	10.76495657	27.90007329	29.21569862	37.67325485	8.174044893	12.33313726	32.46902486	54.20728381	0	0.219677984	9.919695017	1.017598453	286.6401623	17.95301475	15.35313848	0	0	3.565277439	8.558678855	508.5713666	0	118.7630523	202.6889427	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.06109692	0.061838988	0	0	0.2	0.2	0.083989362	0.094381883	0.2	0	0.04970636	0	0.2	0.151222164	0.000841255	0.199964702	0.2	0	0	0	0.2	0.191151642	0	0	0	0	0	0	0	0											NO	0.06109692	0.061838988	0	0	0.2	0.2	0.083989362	0.094381883	0.2	0	0.04970636	0	0.2	0.151222164	0.000841255	0.199964702	0.2	0	0	0	0.2	0.191151642	0	0	0	0	0	0	0	0												30.1203	2.298118508	0	0	5.580014657	5.843139724	3.164152653	0.77148175	2.466627452	0	2.694446769	0	0.043935597	1.500077743	0.00085606	57.31791469	3.590602949	0	0	0	0.713055488	1.636005515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7408	0	0	30.1203	2.298118508	0	0	5.580014657	5.843139724	3.164152653	0.77148175	2.466627452	0	2.694446769	0	0.043935597	1.500077743	0.00085606	57.31791469	3.590602949	0	0	0	0.713055488	1.636005515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7408	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	30.1203	2.298118508	0	0	5.580014657	5.843139724	3.164152653	0.77148175	2.466627452	0	2.694446769	0	0.043935597	1.500077743	0.00085606	57.31791469	3.590602949	0	0	0	0.713055488	1.636005515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7408
H3379_005_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	Coin	V	V	Coin	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1768.303053	143.5358281	1135.65009	981.1528085	188.1482672	3.020209809	5.510755667	138.8154717	131.460738	13827.31941	53.45326502	0	0.039697788	8.258045677	8051.439923	4342.22721	7.140351656	2836.169436	0	0	19.75014738	2096.306018	0	0	117.0693142	260.5262106	17.47656015	4.7339348	160.1858656	0											3400	"$100 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$100 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$0 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$100 (9b)	"$0 (8a1, 8a2)"	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 9d); $60 (5); $100 (9a); 50% (9c)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"50% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											69.31217923	51.10808865	44.9785354	0	0	0.2	0.128026628	49.9673436	100	0	0.168054934	0	0.2	0.084893987	7.052698527	25	0.5	0	0	0	0.2	24.89085406	0	0	25	0	0	0	0	0											NO	63.69917186	46.96927667	41.33610411	0	0	0.183803691	0.117658834	45.92091091	91.9018455	0	0.154445586	0	0.183803691	0.078260926	7.052113936	25	0.5	0	0	0	0.183803691	24.89085406	0	0	25	0	0	0	0	0												9.3866	0.561814502	3.911945863	0	0	0.555125711	0.648389085	0.531211076	1.00679037	0	8.255620847	0	0.0072966	0.646282304	4.731639307	9.046306687	3.570175828	0	0	0	3.630149985	4.348237264	0	0	0.243894405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0815	0	2.566071373	9.3866	0.561814502	3.911945863	0	0	0.555125711	0.648389085	0.531211076	1.00679037	0	8.255620847	0	0.0072966	0.646282304	4.731639307	9.046306687	3.570175828	0	0	0	3.630149985	4.348237264	0	0	0.243894405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0815	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.3866	0.561814502	3.911945863	0	0	0.555125711	0.648389085	0.531211076	1.00679037	0	8.255620847	0	0.0072966	0.646282304	4.731639307	9.046306687	3.570175828	0	0	0	3.630149985	4.348237264	0	0	0.243894405	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0815
H3379_022_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	325.0058998	38.58358901	9421.839135	119.4274399	27.97381833	8.335143455	15.45581992	10.8646384	12.0299352	38.31812126	32.78688436	0	0.016173681	4.754495487	0.972008865	124.5913187	18.0574382	17.78434966	0	0	2.441639918	6.2250714	1604.496997	0	119.453836	203.86788	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.089947185	0.091039661	0	0	0.2	0.2	0.086760338	0.112398878	0.2	0	0.050563383	0	0.2	0.151985392	0.000708019	0.199745994	0.2	0	0	0	0.2	0.195400632	0	0	0	0	0	0	0	0											NO	0.089947185	0.091039661	0	0	0.2	0.2	0.086760338	0.112398878	0.2	0	0.050563383	0	0.2	0.151985392	0.000708019	0.199745994	0.2	0	0	0	0.2	0.195400632	0	0	0	0	0	0	0	0												29.2334	3.512636866	0	0	5.594763665	1.667028691	1.340952158	1.221173171	2.405987039	0	1.657815797	0	0.003234736	0.722613859	0.000688201	24.88661679	3.61148764	0	0	0	0.488327984	1.216382884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5631	0	0	29.2334	3.512636866	0	0	5.594763665	1.667028691	1.340952158	1.221173171	2.405987039	0	1.657815797	0	0.003234736	0.722613859	0.000688201	24.88661679	3.61148764	0	0	0	0.488327984	1.216382884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5631	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.2334	3.512636866	0	0	5.594763665	1.667028691	1.340952158	1.221173171	2.405987039	0	1.657815797	0	0.003234736	0.722613859	0.000688201	24.88661679	3.61148764	0	0	0	0.488327984	1.216382884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5631
H3379_036_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5941	0.782	0.6075	0	1.0914	0	1.5054	0	0.003	0.8791	1.2243	5.085	0.291	0.168	0	0	0.9507	0.2288	0	0	0	0	0	0	0	0											13.4103	NO	527.6012636	21.67036027	81.8491235	2126.514642	21.16029494	27.63882558	21.54708904	41.27446805	38.63959305	22.82553065	53.50157616	0	0.106567384	31.11560312	47.44196411	180.7845956	10.78146811	5.988410606	0	0	33.58777302	9.1599379	656.2632763	410.1645477	135.3804248	109.1143932	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4); $0 (16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.060828308	0.061567114	0.144638709	0	0.194368184	0.194368184	0.194368184	0.09071812	0.194368184	0	0.162082958	0	0.194368184	0.145482747	0.161736309	0.194194941	0.194368184	0	0	0	0.194368184	0.194524469	0	0	0	0	0	0	0	0											NO	0.060828308	0.061567114	0.144638709	0	0.194368184	0.194368184	0.194368184	0.09071812	0.194368184	0	0.162082958	0	0.194368184	0.145482747	0.161736309	0.194194941	0.194368184	0	0	0	0.194368184	0.194524469	0	0	0	0	0	0	0	0												32.0931	1.334181537	11.83855155	0	4.1128881	5.372108336	4.188068566	3.744342162	7.51030753	0	8.6716937	0	0.020713309	4.52678343	7.67308815	35.10745381	2.095574377	0	0	0	6.528394445	1.78183206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5991	146	0	32.0931	1.334181537	11.83855155	0	4.706960981	6.154092756	4.795615919	3.744342162	8.601693385	0	10.17706703	0	0.023734622	5.405889035	8.89739825	40.19245888	2.386583168	0.167985429	0	0	7.479089253	2.010656718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.0094	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	32.0931	1.334181537	11.83855155	0	4.706960981	6.154092756	4.795615919	3.744342162	8.601693385	0	10.17706703	0	0.023734622	5.405889035	8.89739825	40.19245888	2.386583168	0.167985429	0	0	7.479089253	2.010656718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.0094
H3379_037_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	NO	2749.617103	569.2856679	14690.36882	9.560950114	875.3828046	3088.85393	1956.55756	164.4482982	103.3178322	20572.37721	6142.020517	0	8.759555335	136.1282412	166.8060545	2356.536278	1872.087001	13.63596687	0	0	75.36394599	1377.807018	0	0	0	0	0	0	0	0												"$50 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$50 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$0 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	"$0 (4a, 4b); $0 n/c (4a1)"	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 7a1, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											35.84214157	28.06424514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	35.84214157	28.06424514	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												8.2127	1.331381045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.5441	0	0	8.2127	1.331381045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.5441	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.2127	1.331381045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.5441
H3384_013_0	2010	12	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	229.2435595	3.488200289	35.63990692		312.8694938	15.47342478	0.757456533	285.1139913	345.6742434		432.8376804	0.007858408		6.535052534	5007.558411	4774.699204	0.558914032	705.3712389	1050.750229	1225.948334	0.06760548	0									181.6046957											$350 Copay	$350 Copay	$350 Copay		$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$150 Copay		$75 Copay	50% Coinsurance		50% Coinsurance	$5 Copay	$30 Copay	50% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										350	350	350		100	0.2	0.2	50	150		75	0.5		0.5	5	30	0.5	30	30	30	0.2	30									30										NO	350	350	350		100	0.2	0.2	50	150		75	0.5		0.5	5	30	0.5	30	30	30	0.2	30									30											6.6863	0.101739175	1.039497285	0	2.607245782	3.094684956	0.151491307	1.187974964	4.320928042	0	2.705235503	0.003929204	0	3.267526267	2.086482671	11.93674801	0.279457016	1.763428097	2.626875573	3.064870836	0.013521096	0	0	0	0	0	0	0	0	0	0.454011739	0	0	0	0	0	0	0	0	0	47.3919	0		6.6863	0.101739175	1.039497285	0	2.607245782	3.094684956	0.151491307	1.187974964	4.320928042	0	2.705235503	0.003929204	0	3.267526267	2.086482671	11.93674801	0.279457016	1.763428097	2.626875573	3.064870836	0.013521096	0	0	0	0	0	0	0	0	0	0.454011739	0	0	0	0	0	0	0	0	0	47.3919	NO																																																																																		0	0		6.6863	0.101739175	1.039497285	0	2.607245782	3.094684956	0.151491307	1.187974964	4.320928042	0	2.705235503	0.003929204	0	3.267526267	2.086482671	11.93674801	0.279457016	1.763428097	2.626875573	3.064870836	0.013521096	0	0	0	0	0	0	0	0	0	0.454011739	0	0	0	0	0	0	0	0	0	47.3919
H3384_015_0	2010	6	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	233.0066869	2.573861962	40.6666262		326.3491569	12.61059629	0.435553277	275.0499518	335.4949656		354.5436305	0.202229181		4.807071796	4796.908552	4411.268359	0.205081431	478.798928	908.8425382	1156.741992	0.018386895	0									142.7936821											$400 Copay	$400 Copay	$400 Copay		$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$150 Copay		$75 Copay	50% Coinsurance		50% Coinsurance	$15 Copay	$30 Copay	50% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										400	400	400		100	0.2	0.2	50	150		75	0.5		0.5	15	30	0.5	30	30	30	0.2	30									30										NO	400	400	400		100	0.2	0.2	50	150		75	0.5		0.5	15	30	0.5	30	30	30	0.2	30									30											7.7669	0.085795399	1.355554207	0	2.719576308	2.522119258	0.087110655	1.146041466	4.19368707	0	2.215897691	0.10111459	0	2.403535898	5.996135689	11.0281709	0.102540715	1.19699732	2.272106345	2.891854981	0.003677379	0	0	0	0	0	0	0	0	0	0.356984205	0	0	0	0	0	0	0	0	0	48.4458	0		7.7669	0.085795399	1.355554207	0	2.719576308	2.522119258	0.087110655	1.146041466	4.19368707	0	2.215897691	0.10111459	0	2.403535898	5.996135689	11.0281709	0.102540715	1.19699732	2.272106345	2.891854981	0.003677379	0	0	0	0	0	0	0	0	0	0.356984205	0	0	0	0	0	0	0	0	0	48.4458	NO																																																																																		0	0		7.7669	0.085795399	1.355554207	0	2.719576308	2.522119258	0.087110655	1.146041466	4.19368707	0	2.215897691	0.10111459	0	2.403535898	5.996135689	11.0281709	0.102540715	1.19699732	2.272106345	2.891854981	0.003677379	0	0	0	0	0	0	0	0	0	0.356984205	0	0	0	0	0	0	0	0	0	48.4458
H3384_019_0	2010	10	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	173.284933	1.922051178	47.31476095		216.7202933	11.94483178	0.738661921	242.8132219	309.5829241		437.0267459	0.058191143		3.161420771	3839.934885	2996.494027	1.024640191	359.3822898	784.7027525	783.3660543	0.004572308	10.09990959									80.19588055											$550 Copay	$550 Copay	$550 Copay		$125 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$125 Copay		$35 Copay	50% Coinsurance		50% Coinsurance	$20 Copay	$35 Copay	50% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									$35 Copay										550	550	550		125	0.2	0.2	50	125		35	0.5		0.5	20	35	0.5	35	35	35	0.2	35									35										NO	550	550	550		125	0.2	0.2	50	125		35	0.5		0.5	20	35	0.5	35	35	35	0.2	35									35											7.9422	0.088094012	2.16859321	0	2.257503055	2.388966355	0.147732384	1.011721758	3.224822126	0	1.274661342	0.029095572	0	1.580710385	6.399891475	8.739774246	0.512320096	1.048198345	2.288716361	2.284817658	0.000914462	0.02945807	0	0	0	0	0	0	0	0	0.233904652	0	0	0	0	0	0	0	0	0	43.6521	0		7.9422	0.088094012	2.16859321	0	2.257503055	2.388966355	0.147732384	1.011721758	3.224822126	0	1.274661342	0.029095572	0	1.580710385	6.399891475	8.739774246	0.512320096	1.048198345	2.288716361	2.284817658	0.000914462	0.02945807	0	0	0	0	0	0	0	0	0.233904652	0	0	0	0	0	0	0	0	0	43.6521	NO																																																																																		0	0		7.9422	0.088094012	2.16859321	0	2.257503055	2.388966355	0.147732384	1.011721758	3.224822126	0	1.274661342	0.029095572	0	1.580710385	6.399891475	8.739774246	0.512320096	1.048198345	2.288716361	2.284817658	0.000914462	0.02945807	0	0	0	0	0	0	0	0	0.233904652	0	0	0	0	0	0	0	0	0	43.6521
H3384_022_0	2010	5	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	199.4997477	2.101173756	60.22407452		240.5483956	13.11016767	0.477592918	260.9182415	319.7070422		506.0004576	0.080298867		2.013616929	5629.486181	3493.774754	0.489181616	460.907237	838.3189741	1038.249396	0.007703455	17.27375941									80.61958265											$350 Copay	$350 Copay	$350 Copay		$50 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$125 Copay		$30 Copay	50% Coinsurance		50% Coinsurance	$5 Copay	$30 Copay	50% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										350	350	350		50	0.2	0.2	50	125		30	0.5		0.5	5	30	0.5	30	30	30	0.2	30									30										NO	350	350	350		50	0.2	0.2	50	125		30	0.5		0.5	5	30	0.5	30	30	30	0.2	30									30											5.8187	0.061284235	1.756535507	0	1.002284982	2.622033533	0.095518584	1.08715934	3.33028169	0	1.265001144	0.040149434	0	1.006808464	2.345619242	8.734436885	0.244590808	1.152268092	2.095797435	2.595623489	0.001540691	0.043184399	0	0	0	0	0	0	0	0	0.201548957	0	0	0	0	0	0	0	0	0	35.5004	0		5.8187	0.061284235	1.756535507	0	1.002284982	2.622033533	0.095518584	1.08715934	3.33028169	0	1.265001144	0.040149434	0	1.006808464	2.345619242	8.734436885	0.244590808	1.152268092	2.095797435	2.595623489	0.001540691	0.043184399	0	0	0	0	0	0	0	0	0.201548957	0	0	0	0	0	0	0	0	0	35.5004	NO																																																																																		0	0		5.8187	0.061284235	1.756535507	0	1.002284982	2.622033533	0.095518584	1.08715934	3.33028169	0	1.265001144	0.040149434	0	1.006808464	2.345619242	8.734436885	0.244590808	1.152268092	2.095797435	2.595623489	0.001540691	0.043184399	0	0	0	0	0	0	0	0	0.201548957	0	0	0	0	0	0	0	0	0	35.5004
H3384_041_0	2010	12	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	192.1820548	2.268817838	46.16284216		180.6718412	15.29887749	0.329007411	259.1056688	416.3367774		649.3280775	0.008989475		2.961478947	5513.363763	4477.840661	1.377722581	701.4447167	1087.839072	1237.073883	0.006063862	20.13938814									118.8307519											$400 Copay	$400 Copay	$400 Copay		$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$125 Copay		$25 Copay	50% Coinsurance		50% Coinsurance	$10 Copay	$25 Copay	50% Coinsurance	$25 Copay	$25 Copay	$25 Copay	20% Coinsurance	"$0 Copay for Blood, $25 Copay for other"									$25 Copay										400	400	400		100	0.2	0.2	50	125		25	0.5		0.5	10	25	0.5	25	25	25	0.2	25									25										NO	400	400	400		100	0.2	0.2	50	125		25	0.5		0.5	10	25	0.5	25	25	25	0.2	25									25											6.4061	0.075627261	1.538761405	0	1.505598677	3.059775498	0.065801482	1.079606954	4.336841431	0	1.352766828	0.004494738	0	1.480739474	4.594469803	9.32883471	0.688861291	1.46134316	2.266331399	2.577237257	0.001212772	0.041957059	0	0	0	0	0	0	0	0	0.247564066	0	0	0	0	0	0	0	0	0	42.1139	0		6.4061	0.075627261	1.538761405	0	1.505598677	3.059775498	0.065801482	1.079606954	4.336841431	0	1.352766828	0.004494738	0	1.480739474	4.594469803	9.32883471	0.688861291	1.46134316	2.266331399	2.577237257	0.001212772	0.041957059	0	0	0	0	0	0	0	0	0.247564066	0	0	0	0	0	0	0	0	0	42.1139	NO																																																																																		0	0		6.4061	0.075627261	1.538761405	0	1.505598677	3.059775498	0.065801482	1.079606954	4.336841431	0	1.352766828	0.004494738	0	1.480739474	4.594469803	9.32883471	0.688861291	1.46134316	2.266331399	2.577237257	0.001212772	0.041957059	0	0	0	0	0	0	0	0	0.247564066	0	0	0	0	0	0	0	0	0	42.1139
H3384_051_0	2010	5	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	227.0318368	2.169664079	69.46751419		217.1450515	14.64749738	0.393524305	269.3277861	392.1952155		574.1168305	0.031104552		2.308629863	5768.906619	4600.326577	1.209322738	685.4362983	1072.146771	1360.278345	0.004384751	119.2391647									91.95058568											$100 Copay	$100 Copay	$100 Copay		$50 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$75 Copay		$15 Copay	50% Coinsurance		50% Coinsurance	$5 Copay	$15 Copay	50% Coinsurance	$15 Copay	$15 Copay	$15 Copay	20% Coinsurance	"$0 Copay for Blood, $15 Copay for other"									$15 Copay										100	100	100		50	0.2	0.2	50	75		15	0.5		0.5	5	15	0.5	15	15	15	0.2	15									15										NO	100	100	100		50	0.2	0.2	50	75		15	0.5		0.5	5	15	0.5	15	15	15	0.2	15									15											1.8919	0.018080534	0.578895952	0	0.904771048	2.929499475	0.078704861	1.122199109	2.451220097	0	0.717646038	0.015552276	0	1.154314931	2.403711091	5.750408221	0.604661369	0.856795373	1.340183464	1.700347932	0.00087695	0.149048956	0	0	0	0	0	0	0	0	0.114938232	0	0	0	0	0	0	0	0	0	24.7838	0		1.8919	0.018080534	0.578895952	0	0.904771048	2.929499475	0.078704861	1.122199109	2.451220097	0	0.717646038	0.015552276	0	1.154314931	2.403711091	5.750408221	0.604661369	0.856795373	1.340183464	1.700347932	0.00087695	0.149048956	0	0	0	0	0	0	0	0	0.114938232	0	0	0	0	0	0	0	0	0	24.7838	NO																																																																																		0	0		1.8919	0.018080534	0.578895952	0	0.904771048	2.929499475	0.078704861	1.122199109	2.451220097	0	0.717646038	0.015552276	0	1.154314931	2.403711091	5.750408221	0.604661369	0.856795373	1.340183464	1.700347932	0.00087695	0.149048956	0	0	0	0	0	0	0	0	0.114938232	0	0	0	0	0	0	0	0	0	24.7838
H3384_052_0	2010	10	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	197.9253813	2.140094243	51.10712471		176.5090154	15.60437017	0.73393216	279.8739781	371.9105446		577.0058683	0.05385484		2.010240802	4882.215803	4161.622807	1.17432742	603.7136255	1029.668025	1207.922702	0.027256193	15.30934646									47.72687329											$450 Copay	$450 Copay	$450 Copay		$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$125 Copay		$25 Copay	50% Coinsurance		50% Coinsurance	$10 Copay	$25 Copay	50% Coinsurance	$25 Copay	$25 Copay	$25 Copay	20% Coinsurance	"$0 Copay for Blood, $25 Copay for other"									$25 Copay										450	450	450		100	0.2	0.2	50	125		25	0.5		0.5	10	25	0.5	25	25	25	0.2	25									25										NO	450	450	450		100	0.2	0.2	50	125		25	0.5		0.5	10	25	0.5	25	25	25	0.2	25									25											7.4222	0.080253534	1.916517177	0	1.470908462	3.120874033	0.146786432	1.166141575	3.874068173	0	1.202095559	0.02692742	0	1.005120401	4.068513169	8.670047515	0.58716371	1.25773672	2.14514172	2.516505629	0.005451239	0.031894472	0	0	0	0	0	0	0	0	0.099430986	0	0	0	0	0	0	0	0	0	40.8138	0		7.4222	0.080253534	1.916517177	0	1.470908462	3.120874033	0.146786432	1.166141575	3.874068173	0	1.202095559	0.02692742	0	1.005120401	4.068513169	8.670047515	0.58716371	1.25773672	2.14514172	2.516505629	0.005451239	0.031894472	0	0	0	0	0	0	0	0	0.099430986	0	0	0	0	0	0	0	0	0	40.8138	NO																																																																																		0	0		7.4222	0.080253534	1.916517177	0	1.470908462	3.120874033	0.146786432	1.166141575	3.874068173	0	1.202095559	0.02692742	0	1.005120401	4.068513169	8.670047515	0.58716371	1.25773672	2.14514172	2.516505629	0.005451239	0.031894472	0	0	0	0	0	0	0	0	0.099430986	0	0	0	0	0	0	0	0	0	40.8138
H3384_053_0	2010	11	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										D	D	D		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	345.4043573	1.861018673	50.37439105		260.0717075	11.47534015	0.386536613	233.4342856	362.9011397		353.5350216	0.069455633		4.912655405	4437.153986	4001.890151	0.503315609	572.1169188	907.5671126	994.7564357	0.026021923	0									301.1973844											"$300 per day for days 1-5, $0 after"	"$300 per day for days 1-5, $0 after"	$500 Copay		$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	$150 Copay		$75 Copay	50% Coinsurance		50% Coinsurance	$15 Copay	$30 Copay	50% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	"$0 Copay for Blood, $30 Copay for other"									$30 Copay										300	300	500		100	0.2	0.2	50	150		75	0.5		0.5	15	30	0.5	30	30	30	0.2	30									30										NO	300	300	500		100	0.2	0.2	50	150		75	0.5		0.5	15	30	0.5	30	30	30	0.2	30									30											8.6351	0.046525467	2.098932961	0	2.167264229	2.29506803	0.077307323	0.972642857	4.536264246	0	2.209593885	0.034727816	0	2.456327703	5.546442482	10.00472538	0.251657805	1.430292297	2.268917781	2.486891089	0.005204385	0	0	0	0	0	0	0	0	0	0.752993461	0	0	0	0	0	0	0	0	0	48.2769	0		8.6351	0.046525467	2.098932961	0	2.167264229	2.29506803	0.077307323	0.972642857	4.536264246	0	2.209593885	0.034727816	0	2.456327703	5.546442482	10.00472538	0.251657805	1.430292297	2.268917781	2.486891089	0.005204385	0	0	0	0	0	0	0	0	0	0.752993461	0	0	0	0	0	0	0	0	0	48.2769	NO																																																																																		0	0		8.6351	0.046525467	2.098932961	0	2.167264229	2.29506803	0.077307323	0.972642857	4.536264246	0	2.209593885	0.034727816	0	2.456327703	5.546442482	10.00472538	0.251657805	1.430292297	2.268917781	2.486891089	0.005204385	0	0	0	0	0	0	0	0	0	0.752993461	0	0	0	0	0	0	0	0	0	48.2769
H3384_805_0	2010	4	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A	V	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									COIN										0.1699	0.0027	0.0222	0	0.03	0.0751	0.0018	0.0244	0.2164	0.0039	0.0623	0.0143	0	0.0992	0.1916	0.4193	0.1057	0.0832	0.0954	0.1127	0.0001	0.0005									0.0384										1.7692	NO	162.0693134	2.576205077	21.21471024	0.601389264	157.0184415	10.95312568	0.257145879	256.1312662	46.46258428	0	924.4315207	1.248688482	0	8.581355317	4781.806888	5642.941205	9.026049384	1198.09077	1407.67382	1633.832605	0.02916165	8.114879918									3.293588097											$550 Copay	$550 Copay	$550 Copay	$20 Copay	$100 Copay	30% Coinsurance	30% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$35 Copay	50% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$35 Copay	50% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									50% Coinsurance										550	550	550	20	100	0.3	0.3	50	0.2	0	35	0.5	0	0.5	20	35	0.5	35	35	35	0.2	35									0.5										NO	550	550	550	20	100	0.3	0.3	50	0.2	0	35	0.5	0	0.5	20	35	0.5	35	35	35	0.2	35									0.5											7.4282	0.118076066	0.972340886	0.001002315	1.308487013	3.285937705	0.077143764	1.067213609	9.292516856	0	2.696258602	0.624344241	0	4.290677658	7.969678147	16.45857851	4.513024692	3.494431411	4.105715307	4.765345099	0.00583233	0.0236684	0	0	0	0	0	0	0	0	1.646794048	0	0	0	0	0	0	0	0	0	74.1452	250		7.5981	0.120776202	0.994576508	0.001026699	1.338470105	3.361079607	0.078907866	1.09161835	9.508888646	0.003902967	2.758512724	0.638623618	1.94E-07	4.389897692	8.161253445	16.87786108	4.618679549	3.577658385	4.201143029	4.878046072	0.005965705	0.024209668	0	0	0	0	0	0	0	0	1.685229755	0	0	0	0	0	0	0	0	0	75.9144	NO																																																																																		0			7.5981	0.120776202	0.994576508	0.001026699	1.338470105	3.361079607	0.078907866	1.09161835	9.508888646	0.003902967	2.758512724	0.638623618	1.94E-07	4.389897692	8.161253445	16.87786108	4.618679549	3.577658385	4.201143029	4.878046072	0.005965705	0.024209668	0	0	0	0	0	0	0	0	1.685229755	0	0	0	0	0	0	0	0	0	75.9144
H3384_806_0	2010	4	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A	V	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									COIN										0.1946	0.0031	0.0255	0	0.0304	0.0672	0.002	0.0228	0.1742	0.0023	0.0514	0.0164	0	0.1045	0.1772	0.3391	0.1195	0.0538	0.0755	0.0866	0.0002	0.0006									0.0245										1.5713	NO	170.5805305	2.714459921	22.35322071	0.633663472	146.1153397	9.002889238	0.270945892	219.7873438	34.76646822	0	704.9419712	1.315700706	0	8.309995747	4132.727541	4554.106719	9.388242518	737.5198721	1034.848092	1184.806132	0.030722024	8.550373764									1.960059525											$550 Copay	$550 Copay	$550 Copay	$20 Copay	$100 Copay	30% Coinsurance	30% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$35 Copay	50% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$35 Copay	50% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									50% Coinsurance										550	550	550	20	100	0.3	0.3	50	0.2	0	35	0.5	0	0.5	20	35	0.5	35	35	35	0.2	35									0.5										NO	550	550	550	20	100	0.3	0.3	50	0.2	0	35	0.5	0	0.5	20	35	0.5	35	35	35	0.2	35									0.5											7.8183	0.124412746	1.024522616	0.001056106	1.217627831	2.700866772	0.081283768	0.915780599	6.953293644	0	2.056080749	0.657850353	0	4.154997874	6.887879235	13.28281126	4.694121259	2.151099627	3.018306934	3.455684553	0.006144405	0.02493859	0	0	0	0	0	0	0	0	0.980029763	0	0	0	0	0	0	0	0	0	62.2071	250		8.0129	0.127509211	1.050022	0.001084069	1.247985319	2.76808753	0.083306806	0.938573085	7.127483728	0.00228067	2.107433186	0.674225667	2.23E-07	4.25948783	7.065127111	13.62195843	4.813625734	2.204852406	3.093796354	3.542249119	0.006297334	0.025559307	0	0	0	0	0	0	0	0	1.004482126	0	0	0	0	0	0	0	0	0	63.7783	NO																																																																																		0	0		8.0129	0.127509211	1.050022	0.001084069	1.247985319	2.76808753	0.083306806	0.938573085	7.127483728	0.00228067	2.107433186	0.674225667	2.23E-07	4.25948783	7.065127111	13.62195843	4.813625734	2.204852406	3.093796354	3.542249119	0.006297334	0.025559307	0	0	0	0	0	0	0	0	1.004482126	0	0	0	0	0	0	0	0	0	63.7783
H3384_807_0	2010	4	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A	V	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									COIN										0.1778	0.0027	0.0226	0	0.031	0.0785	0.0018	0.0262	0.2082	0.0024	0.057	0.015	0	0.1056	0.2096	0.3792	0.1488	0.0586	0.078	0.0953	0.0001	0.0006									0.0262										1.7253	NO	160.6842723	2.48062461	20.42761765	0.580329533	153.8658725	10.83995533	0.250108309	260.0768168	42.72544284	0	806.1636381	1.2460809	0	8.662213829	4956.159456	5214.013121	11.84351963	828.4388788	1102.321134	1342.509396	0.027926226	7.830709255									2.168404795											$550 Copay	$550 Copay	$550 Copay	$20 Copay	$100 Copay	30% Coinsurance	30% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$35 Copay	50% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$35 Copay	50% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									50% Coinsurance										550	550	550	20	100	0.3	0.3	50	0.2	0	35	0.5	0	0.5	20	35	0.5	35	35	35	0.2	35									0.5										NO	550	550	550	20	100	0.3	0.3	50	0.2	0	35	0.5	0	0.5	20	35	0.5	35	35	35	0.2	35									0.5											7.3647	0.113695295	0.936265809	0.000967216	1.282215604	3.251986599	0.075032493	1.083653403	8.545088569	0	2.351310611	0.62304045	0	4.331106914	8.260265759	15.20753827	5.921759817	2.416280063	3.215103308	3.915652405	0.005585245	0.022839569	0	0	0	0	0	0	0	0	1.084202397	0	0	0	0	0	0	0	0	0	70.0083	250		7.5425	0.116439321	0.958862865	0.00099205	1.313217371	3.330472847	0.076843392	1.109807229	8.753253819	0.002408025	2.408323527	0.638079602	2.05E-07	4.436701422	8.469862903	15.5867669	6.070548897	2.474918651	3.293122632	4.010926684	0.005720041	0.023390825	0	0	0	0	0	0	0	0	1.110451176	0	0	0	0	0	0	0	0	0	71.7336	NO																																																																																		0	0		7.5425	0.116439321	0.958862865	0.00099205	1.313217371	3.330472847	0.076843392	1.109807229	8.753253819	0.002408025	2.408323527	0.638079602	2.05E-07	4.436701422	8.469862903	15.5867669	6.070548897	2.474918651	3.293122632	4.010926684	0.005720041	0.023390825	0	0	0	0	0	0	0	0	1.110451176	0	0	0	0	0	0	0	0	0	71.7336
H3387_005_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5326	0.6012	0.4843	0	1.2833	0	1.7135	0	0.0259	0.9357	2.1829	3.6304	0.1734	0.1024	0	0	0.7795	0.2575	0	0	0	0	0	0	0	0											12.7025	NO	342.4854035	5.418790277	24.41436429	2113.25289	12.59896165	11.91501248	9.38071681	15.22906426	38.15092435	18.52351637	49.37259251	0	0.34322692	26.11448139	62.30284288	103.6244297	3.859761162	3.255345169	0	2.647821632	24.25101997	9.819650691	655.0412115	462.0379974	116.9716449	199.6316073	17.02360895	9.747637076	3899.054831	438.6436684												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14e, 14f, 14g, 14h, 14i, 14j); $0/20% (14b, 14d); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14c, 14c1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 18a); $0 n/c (13a1); $0 (17a, 17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4); $0 (16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d); $0 (13e)"											0.061567114	0.061567114	0.144638709	0	0.192731059	0.192731059	0.192731059	0.110143062	0.192731059	0.033939988	0.163354222	0	0.192731059	0.144488561	0.184506181	0.19243192	0.433644882	0.192731059	0	0.2	0.192731059	0.021714911	0	0	0	0	0	0	0	0											NO	0.061567114	0.061567114	0.144638709	0	0.192731059	0.192731059	0.192731059	0.110143062	0.192731059	0.033939988	0.163354222	0	0.192731059	0.144488561	0.184506181	0.19243192	0.433644882	0.192731059	0	0.2	0.192731059	0.021714911	0	0	0	0	0	0	0	0												21.0858	0.333619278	3.53126213	0	2.428211217	2.296392969	1.807955482	1.677375774	7.352868042	0.628687932	8.065221449	0	0.066150488	3.773243832	11.49525963	19.94064795	1.673765674	0.627406121	0	0.529564326	4.673924754	0.21323284	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2006	146	0	21.0858	0.333619278	3.53126213	0	2.960784976	2.897574804	2.29225104	1.677375774	8.636162824	0.628687932	9.778688657	0	0.092031236	4.70895563	13.67811362	23.57107967	1.847176195	0.72979806	0	0.529564326	5.453461384	0.470731223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9032	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	21.0858	0.333619278	3.53126213	0	2.960784976	2.897574804	2.29225104	1.677375774	8.636162824	0.628687932	9.778688657	0	0.092031236	4.70895563	13.67811362	23.57107967	1.847176195	0.72979806	0	0.529564326	5.453461384	0.470731223	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.9032
H3387_010_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5324	0.601	0.4841	0	1.2829	0	1.7129	0	0.0259	0.9354	2.1822	3.6293	0.1734	0.1024	0	0	0.7793	0.2574	0	0	0	0	0	0	0	0											12.6985	NO	341.2495689	5.399236951	24.32626677	2109.436682	12.55349917	11.87201799	9.34686715	15.17414369	38.01325941	18.45667556	49.19443497	0	0.34198841	26.02024911	62.08042647	103.2508626	3.845833484	3.243598484	0	2.638267153	24.16351186	9.784217169	655.0412115	462.0379974	116.9716449	199.6316073	17.02360895	9.747637076	3899.054831	438.6436684												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14e, 14f, 14g, 14h, 14i, 14j); $0/20% (14b, 14d); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14c, 14c1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 18a); $0 n/c (13a1); $0 (17a, 17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4); $0 (16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d); $0 (13e)"											0.061567114	0.061567114	0.144638709	0	0.192707063	0.192707063	0.192707063	0.110293395	0.192707063	0.033939988	0.163333884	0	0.192707063	0.144470572	0.184477002	0.192406879	0.433590892	0.192707063	0	0.2	0.192707063	0.021713555	0	0	0	0	0	0	0	0											NO	0.061567114	0.061567114	0.144638709	0	0.192707063	0.192707063	0.192707063	0.110293395	0.192707063	0.033939988	0.163333884	0	0.192707063	0.144470572	0.184477002	0.192406879	0.433590892	0.192707063	0	0.2	0.192707063	0.021713555	0	0	0	0	0	0	0	0												21.0098	0.332415436	3.518519817	0	2.419147959	2.287821721	1.801207319	1.673607827	7.325423586	0.626419356	8.035118146	0	0.065903582	3.759160263	11.45241097	19.86617628	1.667518372	0.625064338	0	0.527653431	4.656479409	0.212450138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8622	146	0	21.0098	0.332415436	3.518519817	0	2.951551682	2.888811614	2.285348254	1.673607827	8.608308646	0.626419356	9.748038288	0	0.091776068	4.694573313	13.63456803	23.49544102	1.840873527	0.727423586	0	0.527653431	5.435767153	0.469866308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5607	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	21.0098	0.332415436	3.518519817	0	2.951551682	2.888811614	2.285348254	1.673607827	8.608308646	0.626419356	9.748038288	0	0.091776068	4.694573313	13.63456803	23.49544102	1.840873527	0.727423586	0	0.527653431	5.435767153	0.469866308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.5607
H3388_001_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	P	P	P	P	P	P	P	P	P	P																																																			0	YES	348.6561229	10	1300.048057	1092.4897	711.7729856	11.75079937	2.261361877	481.65934	365.6749081					529.120511	3449.166375	10016.95618	540	1041.962702			1396.634767				807.2973676																2500	1A: $300/admit - $900 annual max	1B: $300/admit - $900 annual max	"2: $10 for days 1-20, $40 for days 21-100"	"6: $0 for days 1-20, $20 after 20 days"	10A: $75	11A: 20%	11B: 20%	4A: $50; 4B: $10-$30	9A: $150	"8A: $0-$20 for labs,& x-rays"	"8A: $0-$20 for labs,& x-rays; 8B: $0-$20"		12: $20	7I: $20; 9C: $20	7A: $10	"7B, 7D, 7F: $20; 18A: $20; 18B: $0 ($600 Limit)"	"7E, 7H: $20"	7C: $20; 7I: $20	"8A: $0-$20 for labs,& x-rays"		15: $15			16A: $0 ($250 Limit)	17A: $20	17B: $0 ($100 Limit)			14A: $0-$20												300	300	19.33	2	37.5	0.2	0.2	36.43777055	150					20	10	20	20	20			7.5				10																NO	248.8901348	248.8901348	16.03682102	1.659267566	31.11126685	0.165926757	0.165926757	30.23000542	124.4450674					16.59267566	8.296337828	16.59267566	16.59267566	16.59267566			6.222253371				8.296337828																	7.2314	0.207408446	1.737386501	0.15106106	1.845346608	1.949772026	0.375220442	1.213380371	3.792203216	0	0	0	0	0.731627085	2.384620789	13.85067541	0.746670404	1.440745763	0	0	0.724184616	0	0	0	0.558134307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9399	0	7.996343326	7.2314	0.207408446	1.737386501	0.15106106	1.845346608	1.949772026	0.375220442	1.213380371	3.792203216	0	0	0	0	0.731627085	2.384620789	13.85067541	0.746670404	1.440745763	0	0	0.724184616	0	0	0	0.558134307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9399	NO																																																																																		0	0	0	7.2314	0.207408446	1.737386501	0.15106106	1.845346608	1.949772026	0.375220442	1.213380371	3.792203216	0	0	0	0	0.731627085	2.384620789	13.85067541	0.746670404	1.440745763	0	0	0.724184616	0	0	0	0.558134307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9399
H3388_002_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	P	P	P	P	P	P	P	P	P	P																																																			0	YES	282.2939435	10	947.4279681	1032.932987	524.6128407	11.8798878	3.501088841	405.3852719	391.5740525				0.242085968	418.9297668	3199.450677	10795.85466	540.1247009	1312.601544			1395.777037				688.5486114																2500	1A: $300/admit - $900 annual max	1B: $300/admit - $900 annual max	"2: $10 for days 1-20, $40 for days 21-100"	"6: $0 for days 1-20, $20 after 20 days"	10A: $75	11A: 20%	11B: 20%	4A: $50; 4B: $10-$30	9A: $150	"8A: $0-$20 for labs,& x-rays"	"8A: $0-$20 for labs,& x-rays; 8B: $0-$20"		12: $20	7I: $20; 9C: $20	7A: $10	"7B, 7D, 7F: $20; 18A: $20; 18B: $0 ($600 Limit)"	"7E, 7H: $20"	7C: $20; 7I: $20	"8A: $0-$20 for labs,& x-rays"		15: $15			16A: $0 ($250 Limit)	17A: $20	17B: $0 ($100 Limit)			14A: $0-$20												300	300	19.33	2	37.5	0.2	0.2	36.22326581	150				20	20	10	20	20	20			7.5				10																NO	250.7513218	250.7513218	16.1567435	1.671675478	31.34391522	0.167167548	0.167167548	30.2767726	125.3756609				16.71675478	16.71675478	8.358377392	16.71675478	16.71675478	16.71675478			6.268783044				8.358377392																	5.8988	0.208959435	1.275612555	0.143894062	1.370285034	1.985931712	0.585268436	1.022813141	4.091154634	0	0	0	0.000337241	0.583595515	2.228518017	15.03930458	0.752427681	1.828536512	0	0	0.729151952	0	0	0	0.479595762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2242	0	7.507400371	5.8988	0.208959435	1.275612555	0.143894062	1.370285034	1.985931712	0.585268436	1.022813141	4.091154634	0	0	0	0.000337241	0.583595515	2.228518017	15.03930458	0.752427681	1.828536512	0	0	0.729151952	0	0	0	0.479595762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2242	NO																																																																																		0	0	0	5.8988	0.208959435	1.275612555	0.143894062	1.370285034	1.985931712	0.585268436	1.022813141	4.091154634	0	0	0	0.000337241	0.583595515	2.228518017	15.03930458	0.752427681	1.828536512	0	0	0.729151952	0	0	0	0.479595762	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2242
H3388_003_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	193.9832649	10	557.2218691	612.6873058	370.7059413	7.867734404	1.914697318	327.9139363	238.9948027				0.119770222	266.4569819	2196.326224	6882.753121	540.0616948	148.8714035			984.7057951				237.7299355																3350	1A: $600/admit - $1800 annual max	1B: $600/admit - $1800 annual max	"2: $30/day days 1-20, $65/day days 21-100"	"6: $0/day days 1-20, $25/day days 21+"	10A: $125	11A: 30%	11B: 30%	4A: $50; 4B: $20-$35	9A: $200	"8A: $0-$30 for labs,& x-rays"	"8A: $0-$30 for labs,& x-rays; 8B: $0-$30"		12: $30	7I: $30; 9C: $30	7A: $20	"7B, 7D, 7F: $30, 18A: $30"	"7E, 7H: $30"	7C: $30; 7I: $30	"8A: $0 - $30 for labs,& x-rays"		15: $15			16A: $0 ($100 Limit)	17A: $30	17B: n/c		18B: n/c	14A: $0												600	504	40.885	2.5	62.5	0.3	0.3	37.99011205	200				30	30	20	26.18242052	30	30			7.5				15																NO	539.1212898	467.4727739	36.73662322	2.246338707	56.15846769	0.269560645	0.269560645	34.13546368	179.7070966				26.95606449	26.95606449	17.97070966	23.52583387	26.95606449	26.95606449			6.739016122				13.47803224																	8.715	0.389560645	1.705870821	0.114691934	1.734856469	2.12083156	0.516127044	0.932791188	3.579088507	0	0	0	0.000269044	0.598552632	3.289128407	13.49354221	1.213161489	0.334415596	0	0	0.552995686	0	0	0	0.267010978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5579	0	4.453414762	8.715	0.389560645	1.705870821	0.114691934	1.734856469	2.12083156	0.516127044	0.932791188	3.579088507	0	0	0	0.000269044	0.598552632	3.289128407	13.49354221	1.213161489	0.334415596	0	0	0.552995686	0	0	0	0.267010978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5579	NO																																																																																		0	0	0	8.715	0.389560645	1.705870821	0.114691934	1.734856469	2.12083156	0.516127044	0.932791188	3.579088507	0	0	0	0.000269044	0.598552632	3.289128407	13.49354221	1.213161489	0.334415596	0	0	0.552995686	0	0	0	0.267010978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5579
H3388_004_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	196.9124104	10	339.9886431	529.7745816	338.5832206	7.87331213	1.152279652	401.4902993	316.7851351				0.063753271	253.2641648	2657.231513	7424.783946	540.0328399	572.9285034			1261.867495				254.7579623																3350	1A: $600/admit - $1800 annual max	1B: $600/admit - $1800 annual max	"2: $30/day days 1-20, $65/day days 21-100"	"6: $0/day days 1-20, $25/day days 21+"	10A: $125	11A: 30%	11B: 30%	4A: $50; 4B: $20-$35	9A: $200	"8A: $0-$30 for labs,& x-rays"	"8A: $0-$30 for labs,& x-rays; 8B: $0-$30"		12: $30	7I: $30; 9C: $30	7A: $20	"7B, 7D, 7F: $30; 18A: $30"	"7E, 7H: $30"	7C: $30; 7I: $30	"8A: $0 - $30 for labs,& x-rays"		15: $15			16A: $0 ($100 Limit)	17A: $30	17B: n/c		18B: n/c	14A: $0												600	504	40.885	2.5	62.5	0.3	0.3	37.37234949	200				30	30	20	26.33660886	30	30			7.5				15																NO	530.9731291	462.5838775	36.18139397	2.212388038	55.30970095	0.265486565	0.265486565	33.07285558	176.991043				26.54865646	26.54865646	17.6991043	23.30671936	26.54865646	26.54865646			6.637164114				13.27432823																	8.7129	0.385486565	1.025105254	0.097672246	1.560578056	2.090258589	0.305914766	1.106535891	4.67234429	0	0	0	0.000141047	0.560318609	3.919218142	14.42061298	1.194762195	1.267540167	0	0	0.697935138	0	0	0	0.281811734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2992	0	5.483320879	8.7129	0.385486565	1.025105254	0.097672246	1.560578056	2.090258589	0.305914766	1.106535891	4.67234429	0	0	0	0.000141047	0.560318609	3.919218142	14.42061298	1.194762195	1.267540167	0	0	0.697935138	0	0	0	0.281811734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2992	NO																																																																																		0	0	0	8.7129	0.385486565	1.025105254	0.097672246	1.560578056	2.090258589	0.305914766	1.106535891	4.67234429	0	0	0	0.000141047	0.560318609	3.919218142	14.42061298	1.194762195	1.267540167	0	0	0.697935138	0	0	0	0.281811734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2992
H3388_801_0	2010	2	N/A																															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																																																			0	NO	181.2056636	3.63	28.14879102		9.887116724	10.38103149	2.911147892	5.705232163	43.21779449	9.043654405	25.96062383		0.001873752	11.054857	42.60490924	106.8155693	6.16	4.873204318	21.70653747	77.48380522																						Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.091808604	0.091808604	0.197301464		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					NO	0.091808604	0.091808604	0.197301464		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																						16.6362	0.333265231	5.553797692	0	2.303698197	2.418780337	0.678297459	1.329319094	10.06974612	2.107171476	6.048825352	0	0.000436584	2.575781682	9.926943853	24.88802765	1.43528	1.135456606	5.057623232	18.05372662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5524	0	0	16.6362	0.333265231	5.553797692	0	2.303698197	2.418780337	0.678297459	1.329319094	10.06974612	2.107171476	6.048825352	0	0.000436584	2.575781682	9.926943853	24.88802765	1.43528	1.135456606	5.057623232	18.05372662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5524	NO																																																																																		0	0	0	16.6362	0.333265231	5.553797692	0	2.303698197	2.418780337	0.678297459	1.329319094	10.06974612	2.107171476	6.048825352	0	0.000436584	2.575781682	9.926943853	24.88802765	1.43528	1.135456606	5.057623232	18.05372662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.5524
H3388_803_0	2010	2	N/A																															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																																																			0	NO	196.5196983	3.63	21.18607253		7.700000215	9.382511349	1.955344037	5.595702369	46.20127141	9.825294986	30.96457876		0.002808603	11.03436873	48.69526617	116.7816839	6.16	6.199062334	25.13929483	85.6873365																						Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.092309714	0.092309714	0.198560428		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					NO	0.092309714	0.092309714	0.198560428		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																						18.1407	0.335084262	4.20671562	0	1.79410005	2.186125144	0.455595161	1.303798652	10.76489624	2.289293732	7.214746852	0	0.000654404	2.571007914	11.34599702	27.21013234	1.43528	1.444381524	5.857455696	19.9651494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.5211	0	0	18.1407	0.335084262	4.20671562	0	1.79410005	2.186125144	0.455595161	1.303798652	10.76489624	2.289293732	7.214746852	0	0.000654404	2.571007914	11.34599702	27.21013234	1.43528	1.444381524	5.857455696	19.9651494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.5211	NO																																																																																		0	0	0	18.1407	0.335084262	4.20671562	0	1.79410005	2.186125144	0.455595161	1.303798652	10.76489624	2.289293732	7.214746852	0	0.000654404	2.571007914	11.34599702	27.21013234	1.43528	1.444381524	5.857455696	19.9651494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.5211
H3388_804_0	2010	3	N/A																															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																																																			0	NO	202.624656	3.63	16.08116558		7.30593074	7.940882459	1.290155273	5.229846737	51.29668173	9.909171547	36.37536665		0.001345918	11.55234714	38.11621189	113.5457319	6.16	6.044216717	26.08745869	89.18913682																						Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.091808604	0.091808604	0.197301464		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					NO	0.091808604	0.091808604	0.197301464		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																						18.6027	0.333265231	3.172837519	0	1.702281863	1.850225613	0.300606179	1.21855429	11.95212684	2.30883697	8.475460429	0	0.000313599	2.691696883	8.881077369	26.45615554	1.43528	1.408302495	6.078377875	20.78106888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.6492	0	0	18.6027	0.333265231	3.172837519	0	1.702281863	1.850225613	0.300606179	1.21855429	11.95212684	2.30883697	8.475460429	0	0.000313599	2.691696883	8.881077369	26.45615554	1.43528	1.408302495	6.078377875	20.78106888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.6492	NO																																																																																		0	0	0	18.6027	0.333265231	3.172837519	0	1.702281863	1.850225613	0.300606179	1.21855429	11.95212684	2.30883697	8.475460429	0	0.000313599	2.691696883	8.881077369	26.45615554	1.43528	1.408302495	6.078377875	20.78106888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.6492
H3404_001_0	2010	12	N/A																															A	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	O	V	V	V	V	Coin	V	Coin	Coin	Coin	V	V	Coin	V	Coin	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	YES	180.1942012	0	604.8830608	459.4555694	19.97845878	8.782777586	0	1345.224239	902.2001206	13.83057559	32.74171612	0	0	1357.578449	4251.899081	4673.771515	60.79832646	315.5474837	0	1243.092049	0.150855155	554.5745605	0	0	64.40760356	0	0	0	0	0											3400	"(1a) $700 copay per admission, unlimited days"	(1b) $700 copay per admission	"(2) $0 copay for days 1-10, $100 after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 20% coinsurance	"(11b) 20% coinsurance, (11c) 20% coinsurance"	"(4a) $50 copay, includes worldwide coverage and waived copay if admitted to hospital, (4b) $30 copay"	"(9a  - surgery) $100 copay, (9b) $100 copay"	(8a) 20% coinsurance	(8b) 20% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $30 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $30 copay, (9d) 0% coinsurance"	"(7a) $20 copay, $40 copay for Urgent Care services, (14b) 0% coinsurance, (14c) 0% coinsurance"	(7d) $40 copay	"(7e) $40 copay, (7h) $40 copay"	"(7c) $40 copay, (7i) $40 copay"	0	"(7b) $40 copay, (7f) $40 copay, (7g) 0% coinsurance, (14d - j) 0% coinsurance"	(15) 20% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	0	(16b) $40 copay	(17a) $40 copay	(17b) 20% coinsurance	(18a) $40 copay	0	(14a) 0% coinsurance	0											700	0	67.83845487	0	100	0.2	0.2	49.05520774	100	0.2	0.2	0	0	0	19.23735119	40	40	40	0	12.58671124	0.2	0	0	0	40	0	0	0	0	0											NO	585.6648737	0	56.75800015	0	83.66641053	0.167332821	0.167332821	41.04273149	83.66641053	0.167332821	0.167332821	0	0	0	16.09520122	33.46656421	33.46656421	33.46656421	0	10.5308495	0.167332821	0	0	0	33.46656421	0	0	0	0	0												8.7945	0	2.860996071	0	0.139293828	1.46964695	0	4.600973102	6.290320473	2.314309231	5.478763724	0	0	0	5.702930941	13.03458954	0.169559258	0.880024177	0	1.090901273	0.025243019	0	0	0	0.1796251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0316	0	10.35298196	8.7945	0	2.860996071	0	0.139293828	1.46964695	0	4.600973102	6.290320473	2.314309231	5.478763724	0	0	0	5.702930941	13.03458954	0.169559258	0.880024177	0	1.090901273	0.025243019	0	0	0	0.1796251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0316	NO	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	$100 copay	20% coinsurance	20% coinsurance	"(4a) $50 copay, (4b) $30 copay"	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	0% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	100% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	0% coinsurance	0												3.3268	0	1.3064	0.176	1.1776	0.1704	0	0.9035	1.0061	0.4442	0.6311	0	0	0.0587	0.0242	1.4354	1.081	0.089	0	0.419	0.0215	0.0256	0	0	0	0	0	0	0	0											12.2965	0	2.400559804	12.1213	0	4.167374229	0.176003369	1.316860894	1.640078805	0	5.504517324	7.296371964	2.758485257	6.109869826	0	0	0.058661008	5.727174629	14.46997679	1.25058231	0.969039151	0	1.509894901	0.046783841	0.025578759	0	0	0.1796251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3281
H3404_002_0	2010	13	N/A																															A	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	O	V	V	V	V	Coin	V	Coin	Coin	Coin	V	V	Coin	V	Coin	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	NO	227.2911782	0	413.1601358	498.4094112	25.27168219	8.214765321	0	1365.007465	1326.739049	16.93636328	42.60598051	0	0	1844.399556	4849.159085	6155.422478	66.00859562	518.3709264	0	1547.88646	0.479253564	793.8028023	0	0	71.93576502	0	0	0	0	0												"(1a) $700 copay per admission, unlimited days"	(1b) $700 copay per admission	"(2) $0 copay for days 1-10, $100 after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 20% coinsurance	"(11b) 20% coinsurance, (11c) 20% coinsurance"	"(4a) $50 copay, includes worldwide coverage and waived copay if admitted to hospital, (4b) $20 copay"	"(9a  - surgery) $100 copay, (9b) $100 copay"	(8a) 20% coinsurance	(8b) 20% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $20 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $20 copay, (9d) 0% coinsurance"	"(7a) $20 copay, $40 copay for Urgent Care services, (14b) 0% coinsurance, (14c) 0% coinsurance"	(7d) $40 copay	"(7e) $40 copay, (7h) $40 copay"	"(7c) $40 copay, (7i) $40 copay"	0	"(7b) $40 copay, (7f) $40 copay, (7g) 0% coinsurance, (14d - j) 0% coinsurance"	(15) 20% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	0	(16b) $40 copay	(17a) $40 copay	(17b) 20% coinsurance	(18a) $40 copay	0	(14a) 0% coinsurance	0											700	0	70.24104663	0	100	0.2	0.2	49.45652174	100	0.2	0.2	0	0	0	19.3551317	40	40	40	0	12.26845638	0.2	0	0	0	40	0	0	0	0	0											NO	571.3942892	0	57.33618987	0	81.6277556	0.163255511	0.163255511	40.37024869	81.6277556	0.163255511	0.163255511	0	0	0	15.7991596	32.65110224	32.65110224	32.65110224	0	10.01446559	0.163255511	0	0	0	32.65110224	0	0	0	0	0												10.8227	0	1.974085666	0	0.171905891	1.341105712	0	4.592140901	9.024894233	2.764954645	6.955661129	0	0	0	6.384386525	16.74844405	0.17960445	1.41044851	0	1.291771307	0.078240786	0	0	0	0.195731835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.9361	0	14.39032515	10.8227	0	1.974085666	0	0.171905891	1.341105712	0	4.592140901	9.024894233	2.764954645	6.955661129	0	0	0	6.384386525	16.74844405	0.17960445	1.41044851	0	1.291771307	0.078240786	0	0	0	0.195731835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.9361	YES	"(1a) $700 copay per admission, unlimited days"	(1b) $700 copay per admission	"(2) $0 copay for days 1-10, $100 after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 20% coinsurance	"(11b) 20% coinsurance, (11c) 20% coinsurance"	"(4a) $50 copay, includes worldwide coverage and waived copay if admitted to hospital, (4b) $20 copay"	"(9a  - surgery) $100 copay, (9b) $100 copay"	(8a) 20% coinsurance	(8b) 20% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $20 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $20 copay, (9d) 0% coinsurance"	"(7a) $40 copay, $40 copay for Urgent Care services, (14b) 0% coinsurance, (14c) 0% coinsurance"	(7d) $40 copay	"(7e) $40 copay, (7h) $40 copay"	"(7c) $40 copay, (7i) $40 copay"	0	"(7b) $40 copay, (7f) $40 copay, (7g) 0% coinsurance, (14d - j) 0% coinsurance"	(15) 20% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	0	(16b) $40 copay	(17a) $40 copay	(17b) 20% coinsurance	(18a) $40 copay	0	(14a) 0% coinsurance	0											3400	1.1505	0	0.1492	0	1.4896	0.1594	0	0.9743	7.2242	0.5439	0.8212	0	0	0	0.0288	2.5124	1.2655	0.2773	0	0.658	0.0684	0	0	0	0	0	0	0	0	0											17.3228	0	3.898903575	11.9732	0	2.123333324	0	1.661465271	1.500515156	0	5.56641266	16.24908284	3.308874634	7.776903795	0	0	0	6.41320729	19.2608401	1.445096331	1.687753006	0	1.949794084	0.146674083	0	0	0	0.195731835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2589
H3404_801_0	2010	9	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	178.1594742	0	19.05357919	8.57289885	3.656733516	15.24661286	0	22.23220262	78.95218542	17.13213225	42.15098903	0	0	8.436976761	40.97921301	82.06444635	1.475433092	5.033195255	0	9.79164575	0.291990524	1.460291323																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			0.081816311	0.080571228	0.188668034	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																			NO	0.081816311	0.080571228	0.188668034	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																				14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838			14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838	NO																																																																																		0			14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838
H3404_803_0	2010	10	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	178.1594742	0	19.05357919	8.57289885	3.656733516	15.24661286	0	22.23220262	78.95218542	17.13213225	42.15098903	0	0	8.436976761	40.97921301	82.06444635	1.475433092	5.033195255	0	9.79164575	0.291990524	1.460291323																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			0.081816311	0.080571228	0.188668034	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																			NO	0.081816311	0.080571228	0.188668034	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																				14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838			14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838	NO																																																																																		0			14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838
H3404_807_0	2010	8	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	178.1594742	0	19.05357919	8.57289885	3.656733516	15.24661286	0	22.23220262	78.95218542	17.13213225	42.15098903	0	0	8.436976761	40.97921301	82.06444635	1.475433092	5.033195255	0	9.79164575	0.291990524	1.460291323																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			0.081816311	0.080571228	0.188668034	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																			NO	0.081816311	0.080571228	0.188668034	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																				14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838			14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838	NO																																																																																		0			14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838
H3404_808_0	2010	8	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	178.1594742	0	19.05357919	8.57289885	3.656733516	15.24661286	0	22.23220262	78.95218542	17.13213225	42.15098903	0	0	8.436976761	40.97921301	82.06444635	1.475433092	5.033195255	0	9.79164575	0.291990524	1.460291323																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			0.081816311	0.080571228	0.188668034	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																			NO	0.081816311	0.080571228	0.188668034	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																				14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838			14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838	NO																																																																																		0			14.5764	0	3.594801327	0	0.873860342	3.65760102	0	5.044966924	18.02674788	3.89598393	9.585472112	0	0	1.918636011	9.524286241	19.07321346	0.342916471	1.169802658	0	2.275749826	0.063062087	0.36035478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.9838
H3405_001_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	924.37734	43.966164	358.688508	355.998857	36.325705	7.134563	3.035884	305.029976	350.131216	798.277293	884.813201	81.799197	9.47765	609.156772	3627.99589	4470.503024	109.961707	1060.245253			19.114169	0							0.04	0.25	0.05	0.55	2.14	0.32	0.4	0.42					3900	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					137.58966	121.67922	58.254672	0	100	0.2	0.2	50	125	45.711659	69.200509	50	5.007511	54.554712	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	123.385454	109.117544	39.833147	0	87.0443	0.174089	0.174089	43.52215	108.805375	39.789393	60.235099	43.52215	4.358753	47.486768	13.056645	30.465505	30.465505	13.056645			0.174089	0							0	0	0	0	0	0	0	0						9.5046	0.399789986	1.190641006	0	0.263495464	1.242048938	0.52851401	1.106296697	3.174679855	2.646914078	4.441400897	0.296673077	0.003442561	2.410573859	3.947454533	11.34967769	0.279169911	1.153603823	0	0	3.327566567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2665	0	7.074602	9.5046	0.399789986	1.190641006	0	0.263495464	1.242048938	0.52851401	1.106296697	3.174679855	2.646914078	4.441400897	0.296673077	0.003442561	2.410573859	3.947454533	11.34967769	0.279169911	1.153603823	0	0	3.327566567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2665	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					6000	6.4931	0.0886	0.2602	1.2399	0.8663	1.3462	0.5729	0.1605	2.3145	0.2705	0.9814	0.2663	0.0005	0.4527	1.4234	2.5638	0.0303	0.2921			0.6806	0							0	0	0	0	0	0	0	0					20.3038	0	9.951979	15.9976	0.488350986	1.450843006	1.23986	1.129821464	2.588298938	1.10136701	1.266765697	5.489184855	2.917389078	5.422814897	0.562970077	0.003941561	2.863287859	5.370889533	13.91351569	0.309516911	1.445677823	0	0	4.008127567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5703
H3405_002_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin			V				O	O	O	O	O	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	YES	1091.572942	61.252308	409.977458	244.770779	40.174857	7.054992	3.113094	334.199431	397.035106	752.760084	977.438651	73.392933	13.20397	562.61482	3865.999066	4965.355812	77.692513	950.787087			22.794459	0			2.69				0.04	0.25	0.05	0.55	2.14	0.32	0.4	0.42					3900	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15				"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					137.58966	121.67922	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	5.007511	60.445636	15	35	35	15			0.2	0			0				0	0	0	0	0	0	0	0					NO	119.947226	106.076902	36.343867	0	85.3521	0.170704	0.170704	42.67605	106.690125	41.697669	59.819839	42.67605	4.274016	51.591619	12.802815	29.873235	29.873235	12.802815			0.170704	0			0				0	0	0	0	0	0	0	0						10.9109	0.541454589	1.241680517	0	0.285750701	1.204315354	0.531417598	1.188525969	3.529977091	2.615695068	4.872518561	0.26101004	0.004702832	2.418850786	4.124639236	12.36093675	0.193410558	1.014395932	0	0	3.891105329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1913	0	9.039846	10.9109	0.541454589	1.241680517	0	0.285750701	1.204315354	0.531417598	1.188525969	3.529977091	2.615695068	4.872518561	0.26101004	0.004702832	2.418850786	4.124639236	12.36093675	0.193410558	1.014395932	0	0	3.891105329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1913	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins			"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					6000	6.5946	0.1145	0.2646	1.0466	0.9533	1.3245	0.5845	0.1749	2.2924	0.2552	1.0433	0.1772	0.0007	0.4624	1.3826	2.4449	0.0206	0.265			0.8198	0			0				0	0	0	0	0	0	0	0					20.2218	0	10.269226	17.5056	0.655974589	1.506310517	1.046608	1.239047701	2.528844354	1.115880598	1.363454969	5.822363091	2.870918068	5.915850561	0.43818104	0.005394832	2.881220786	5.507212236	14.80585075	0.214038558	1.279437932	0	0	4.710929329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4131
H3405_005_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1108.485402	62.20133	416.329509	248.563174	40.797313	7.699835	3.397639	339.377403	403.186633	764.423093	992.582753	74.530058	13.408548	571.331783	3925.897539	5042.287343	78.896255	965.518258			24.877927	0							0.04	0.25	0.05	0.55	2.14	0.32	0.4	0.42					3900	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					137.58966	121.67922	58.254672	0	100	0.2	0.2	50	150	48.853712	92.020516	50	5.007511	63.922072	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	117.824905	104.2	35.17254	0	84.13	0.16826	0.16826	42.065	126.195	41.100628	77.41686	42.065	4.212819	53.777639	12.6195	29.4455	29.4455	12.6195			0.16826	0							0	0	0	0	0	0	0	0						10.8839	0.540114882	1.220280526	0	0.286023162	1.295574237	0.571686738	1.189659205	4.240011429	2.618189098	6.403553336	0.261258907	0.004707315	2.560406198	4.128571999	12.37272266	0.193594973	1.015363138	0	0	4.185959997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9716	0	10.513002	10.8839	0.540114882	1.220280526	0	0.286023162	1.295574237	0.571686738	1.189659205	4.240011429	2.618189098	6.403553336	0.261258907	0.004707315	2.560406198	4.128571999	12.37272266	0.193594973	1.015363138	0	0	4.185959997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9716	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					6000	6.7377	0.117	0.2588	1.1095	0.9403	1.4041	0.6196	0.1725	2.4301	0.2706	1.106	0.1878	0.0007	0.4902	1.4656	2.5918	0.0219	0.281			0.8691	0							0	0	0	0	0	0	0	0					21.0743	0	12.083261	17.6217	0.657119882	1.479092526	1.109492	1.226311162	2.699687237	1.191266738	1.362201205	6.670133429	2.888747098	7.509573336	0.449074907	0.005390315	3.050557198	5.594215999	14.96453766	0.215461973	1.296330138	0	0	5.055042997	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.0459
H3405_801_0	2010	4	N/A																															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	NO	250.516988	0.85454	43.496917	14.055403	1.648288	7.621463	3.725467	18.375511	52.322852	11.29587	26.930219	9.519991	0.836393	17.236467	31.98871	70.154466	0.337126	5.220688			22.801882	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																			0.080523472	0.080523472	0.180125848	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080523472	0.080523472	0.180125848	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.1725	0.068810528	7.834919064	0	0.384051104	1.775800879	0.868033811	4.281494063	12.19122452	2.63193771	6.274741027	2.218157903	0.194879569	4.016096811	7.45336943	16.34599058	0.078550358	1.216420304	0	0	5.312838506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3198	0	0	20.1725	0.068810528	7.834919064	0	0.384051104	1.775800879	0.868033811	4.281494063	12.19122452	2.63193771	6.274741027	2.218157903	0.194879569	4.016096811	7.45336943	16.34599058	0.078550358	1.216420304	0	0	5.312838506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3198	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7552	0.0128	1.4585	0	1.5362	1.1708	0.5724	1.1289	2.9377	0.6939	1.5044	0.5848	0.0514	1.0511	1.4044	3.0799	0.0148	0.2612			1.0011	0																			22.2193	0	0	23.9277	0.08161376	9.293398056	0	1.920220104	2.946625879	1.440398311	5.410379063	15.12888852	3.32581171	7.779105527	2.802987903	0.246256069	5.067159811	8.85777693	19.42590108	0.093345858	1.477613304	0	0	6.313923006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5391
H3405_802_0	2010	3	N/A																															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	NO	250.516988	0.85454	43.496917	14.055403	1.648288	7.621463	3.725467	18.375511	52.322852	11.29587	26.930219	9.519991	0.836393	17.236467	31.98871	70.154466	0.337126	5.220688			22.801882	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																			0.08052348	0.08052348	0.180126625	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.08052348	0.08052348	0.180126625	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.1725	0.068810534	7.834952846	0	0.384051104	1.775800879	0.868033811	4.281494063	12.19122452	2.63193771	6.274741027	2.218157903	0.194879569	4.016096811	7.45336943	16.34599058	0.078550358	1.216420304	0	0	5.312838506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3198	0	0	20.1725	0.068810534	7.834952846	0	0.384051104	1.775800879	0.868033811	4.281494063	12.19122452	2.63193771	6.274741027	2.218157903	0.194879569	4.016096811	7.45336943	16.34599058	0.078550358	1.216420304	0	0	5.312838506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3198	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7552	0.0128	1.4585	0	1.5362	1.1708	0.5724	1.1289	2.9377	0.6939	1.5044	0.5848	0.0514	1.0511	1.4044	3.0799	0.0148	0.2612			1.0011	0																			22.2193	0	0	23.9277	0.081613768	9.293438126	0	1.920220104	2.946625879	1.440398311	5.410379063	15.12888852	3.32581171	7.779105527	2.802987903	0.246256069	5.067159811	8.85777693	19.42590108	0.093345858	1.477613304	0	0	6.313923006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5391
H3405_803_0	2010	3	N/A																															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	NO	250.516988	0.85454	43.496917	14.055403	1.648288	7.621463	3.725467	18.375511	52.322852	11.29587	26.930219	9.519991	0.836393	17.236467	31.98871	70.154466	0.337126	5.220688			22.801882	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																			0.08052348	0.08052348	0.180126625	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.08052348	0.08052348	0.180126625	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.1725	0.068810534	7.834952846	0	0.384051104	1.775800879	0.868033811	4.281494063	12.19122452	2.63193771	6.274741027	2.218157903	0.194879569	4.016096811	7.45336943	16.34599058	0.078550358	1.216420304	0	0	5.312838506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3198	0	0	20.1725	0.068810534	7.834952846	0	0.384051104	1.775800879	0.868033811	4.281494063	12.19122452	2.63193771	6.274741027	2.218157903	0.194879569	4.016096811	7.45336943	16.34599058	0.078550358	1.216420304	0	0	5.312838506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3198	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7552	0.0128	1.4585	0	1.5362	1.1708	0.5724	1.1289	2.9377	0.6939	1.5044	0.5848	0.0514	1.0511	1.4044	3.0799	0.0148	0.2612			1.0011	0																			22.2193	0	0	23.9277	0.081613768	9.293438126	0	1.920220104	2.946625879	1.440398311	5.410379063	15.12888852	3.32581171	7.779105527	2.802987903	0.246256069	5.067159811	8.85777693	19.42590108	0.093345858	1.477613304	0	0	6.313923006	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.5391
H3435_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2191.184144	150.2160567	2870.034584	3663.483616	607.3871183	6.878273132	5.663658895	411.8151946	269.6820818	12185.37391	4814.240927	0	11.37513007	620.6473915	5343.547897	6406.653447	696.4370516	550.564897	0	0	693.4010885	1662.558978	1576.881712	367.9625691	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02009031	100	0	13.14050144	0	0	38.98086241	1.766688159	28.72213388	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.61071386	0	0	0.183540294	0.183540294	43.15040592	91.77014683	0	12.05905746	0	0	35.77279467	1.621292318	26.35834444	17.19823353	0	0	0	0	27.09347583	0	30	30	0	30	0	0	0												0	0	4.690285583	0	0	1.262440271	1.039509617	1.480832734	2.062397021	0	4.837933999	0	0	1.850190975	0.72195443	14.07239819	0.998123921	0	0	0	0	3.753708458	0	0.919906423	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0024	0	3.297475937	0	0	4.690285583	0	0	1.262440271	1.039509617	1.480832734	2.062397021	0	4.837933999	0	0	1.850190975	0.72195443	14.07239819	0.998123921	0	0	0	0	3.753708458	0	0.919906423	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0024	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.2385	0.104	0.524	0	0	0	0	0	0	0	0	0	0	0	0.6861	3.4665	0.1614	0	0	0	0.4091	0.3091	0	0	0.0202	0	0.0021	0	0	0											9.921	0	0	4.2385	0.104040127	5.21432318	0	0	1.262440271	1.039509617	1.480832734	2.062397021	0	4.837933999	0	0	1.850190975	1.408049112	17.53885235	1.159562558	0	0	0	0.409090512	4.06281553	0	0.919906423	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9235
H3435_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2191.184144	150.2160567	2870.034584	3663.483616	607.3871183	6.878273132	5.663658895	411.8151946	269.6820818	12185.37391	4814.240927	0	11.37513007	620.6473915	5343.547897	6406.653447	696.4370516	550.564897	0	0	693.4010885	1662.558978	1576.881712	367.9625691	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02009031	100	0	13.14050144	0	0	38.98086241	1.766688159	28.72213388	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.61071386	0	0	0.183540294	0.183540294	43.15040592	91.77014683	0	12.05905746	0	0	35.77279467	1.621292318	26.35834444	17.19823353	0	0	0	0	27.09347583	0	30	30	0	30	0	0	0												0	0	4.690285583	0	0	1.262440271	1.039509617	1.480832734	2.062397021	0	4.837933999	0	0	1.850190975	0.72195443	14.07239819	0.998123921	0	0	0	0	3.753708458	0	0.919906423	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0024	0	3.297475937	0	0	4.690285583	0	0	1.262440271	1.039509617	1.480832734	2.062397021	0	4.837933999	0	0	1.850190975	0.72195443	14.07239819	0.998123921	0	0	0	0	3.753708458	0	0.919906423	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0024	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.2385	0.104	0.524	0	0	0	0	0	0	0	0	0	0	0	0.6861	3.4665	0.1614	0	0	0	0.4091	0.3091	0	0	0.0202	0	0.0021	0	0	0											9.921	0	0	4.2385	0.104040127	5.21432318	0	0	1.262440271	1.039509617	1.480832734	2.062397021	0	4.837933999	0	0	1.850190975	1.408049112	17.53885235	1.159562558	0	0	0	0.409090512	4.06281553	0	0.919906423	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	47.9235
H3435_003_0	2010	4	N/A																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	3046.749765	409.1299454	1516.63991	2932.965901	399.6272468	2503.682745	23.67883738	750.7726596	568.7020912	24307.927	9026.876056	0	14.8590107	1310.359241	14476.25166	9532.362214	1500.051133	724.6448766	0	0	2948.86817	2201.537665	680.9385585	392.0452829	234.3087684	224.7210956	16.92098038	24.84013477	2096.32786	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0	0.107032341	49.07009523	100	0	13.88722048	0	0	38.74123707	0.371000878	29.73990751	19.99200451	0	0	0	0	29.81198132	0	30	0	0	30	0	0	0											NO	0	0	14.02254534	0	0	0	0.070234404	32.19969643	65.61979609	0	9.11276576	0	0	25.42192077	0.24345002	19.51526667	13.1187126	0	0	0	0	19.56256135	0	30	0	0	30	0	0	0												0	0	1.772262658	0	0	0	1.663069031	2.014554311	3.109842938	0	6.85498392	0	0	2.775987401	0.293686979	15.50221588	1.639894975	0	0	0	0	3.588976304	0	0.980113207	0	0	0.042302451	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2379	0	20.54617793	0	0	1.772262658	0	0	0	1.663069031	2.014554311	3.109842938	0	6.85498392	0	0	2.775987401	0.293686979	15.50221588	1.639894975	0	0	0	0	3.588976304	0	0.980113207	0	0	0.042302451	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2379	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.8542	0.3777	0.3184	0	0	0	0	0	0	0	0	0	0	0	2.1386	6.52	0.324	0	0	0	1.1812	0.4034	0	0	0.028	0	0.0021	0	0	0											18.1477	0	0	6.8542	0.377702021	2.090648078	0	0	0	1.663069031	2.014554311	3.109842938	0	6.85498392	0	0	2.775987401	2.432318375	22.02224765	1.963895237	0	0	0	1.18121238	3.99236797	0	0.980113207	0.027974239	0	0.044443701	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3856
H3449_005_0	2010	8	N/A																															A	A	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	O	V	V	V	V	Coin	V	Coin	Coin	Coin	V	V	Coin	V	Coin	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	YES	236.6695867	0	1130.073617	523.67624	236.0239693	7.931918121	0.000400723	1640.74232	2136.608359	16.51387552	34.92374357	0	0	0	5190.757488	5017.203621	117.0376081	266.8845836	0	1830.64943	0.189005958	0	0	0	100.9745053	0	0	0	0	0											3400	"(1a) $550 copay per admission, unlimited days"	(1b) $550 copay per admission	"(2) $0 copay for days 1-10, $100 after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 20% coinsurance	"(11b) 20% coinsurance, (11c) 20% coinsurance"	"(4a) $50 copay, includes worldwide coverage and waived copay if admitted to hospital, (4b) $35 copay"	"(9a  - surgery) $100 copay, (9b) $100 copay"	(8a) 20% coinsurance	(8b) 20% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $35 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) no cost sharing, (9c) $35 copay, (9d) 0% coinsurance"	"(7a) $15 copay, $35 copay for Urgent Care services, (14b) 0% coinsurance, (14c) 0% coinsurance"	(7d) $35 copay	"(7e) $35 copay, (7h) $35 copay"	"(7c) $35 copay, (7i) $35 copay"		"(7b) $35 copay, (7f) $35 copay, (7g) 0% coinsurance, (14d - j) 0% coinsurance"	(15) 20% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	(10b) 0	"(16a) 0, (16b) $35 copay"	(17a) $35 copay	(17b) 20% coinsurance	(18a) $35 copay	(18b) 0	(14a) 0% coinsurance	(13b) 0											550	0	69.69420214	0	100	0.2	0.2	49.70569436	100	0.2	0.2	0	0	0.2	14.42283412	35	35	35	0	9.488851075	0.2	0	0	0	35	0	0	0	0	0											NO	438.5086199	0	55.56637891	0	79.72883999	0.15945768	0.15945768	39.62977352	79.72883999	0.15945768	0.15945768	0	0	0.15945768	11.49915834	27.905094	27.905094	27.905094	0	7.565350891	0.15945768	0	0	0	27.905094	0	0	0	0	0												8.6485	0	5.232841567	0	1.568159774	1.264805261	6.39E-05	5.418520547	14.1957755	2.633264279	5.568859126	0	0	0	4.974111854	11.66712822	0.272162121	0.620619949	0	1.154125442	0.030138452	0	0	0	0.234808588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4839	0	16.14085189	8.6485	0	5.232841567	0	1.568159774	1.264805261	6.39E-05	5.418520547	14.1957755	2.633264279	5.568859126	0	0	0	4.974111854	11.66712822	0.272162121	0.620619949	0	1.154125442	0.030138452	0	0	0	0.234808588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4839	NO																																																																																		0			8.6485	0	5.232841567	0	1.568159774	1.264805261	6.39E-05	5.418520547	14.1957755	2.633264279	5.568859126	0	0	0	4.974111854	11.66712822	0.272162121	0.620619949	0	1.154125442	0.030138452	0	0	0	0.234808588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4839
H3449_012_0	2010	5	N/A																															A	A	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	O	V	V	V	V	Coin	V	Coin	Coin	Coin	V	V	Coin	V	Coin	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	YES	200.8535784	0	706.0270454	327.9654184	156.6466842	4.85188925	0	1242.024001	898.4956328	11830.09352	3807.471745	0	0	1266.979797	4064.179622	4693.34697	38.18240043	230.2174143	0	1650.827313	0.056050797	492.5988945	0	0	81.06057758	0	0	0	0	0											3400	"(1a) $350 copay per admission, unlimited days"	(1b) $350 copay per admission	"(2) $0 copay for days 1-10, $100 after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 10% coinsurance	"(11b) 10% coinsurance, (11c) 10% coinsurance"	"(4a) $50 copay, includes worldwide coverage and waived copay if admitted to hospital, (4b) $10 copay"	"(9a  - surgery) 0% coinsurance, (9b) 0% coinsurance"	(8a) 0% coinsurance	(8b) 0% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $10 copay for physician services, 10% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $10 copay, (9d) 0% coinsurance"	"(7a) $5 copay, $10 copay for Urgent Care services, (14b) 0% coinsurance, (14c) 0% coinsurance"	(7d) $10 copay	"(7e) $10 copay, (7h) $10 copay"	"(7c) $10 copay, (7i) $10 copay"		"(7b) $10 copay, (7f) $10 copay, (7g) 0% coinsurance, (14d - j) 0% coinsurance"	(15) 10% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	(10b) 0	"(16a) 0, (16b) $10 copay"	(17a) $10 copay	(17b) 10% coinsurance	(18a) $10 copay	(18b) 0	(14a) 0% coinsurance	(13b) 0											350	0	68.7518202	0	100	0.1	0.1	49.01146497	0	0	0	0	0	0	4.767546284	10	10	10	0	3.331632653	0.1	0	0	0	10	0	0	0	0	0											NO	339.6416856	0	66.71709742	0	97.04048159	0.097040482	0.097040482	47.56096164	0	0	0	0	0	0	4.626449873	9.704048159	9.704048159	9.704048159	0	3.233032371	0.097040482	0	0	0	9.704048159	0	0	0	0	0												5.6849	0	3.925339597	0	1.266755806	0.470829669	0	4.922654655	0	0	0	0	0	0	1.566893608	3.795372085	0.030876988	0.186170073	0	0.444764845	0.005439196	0	0	0	0.065551312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3655	0	0.68209796	5.6849	0	3.925339597	0	1.266755806	0.470829669	0	4.922654655	0	0	0	0	0	0	1.566893608	3.795372085	0.030876988	0.186170073	0	0.444764845	0.005439196	0	0	0	0.065551312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3655	NO																																																																																		0			5.6849	0	3.925339597	0	1.266755806	0.470829669	0	4.922654655	0	0	0	0	0	0	1.566893608	3.795372085	0.030876988	0.186170073	0	0.444764845	0.005439196	0	0	0	0.065551312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3655
H3449_013_0	2010	10	N/A																															A	A	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	O	V	V	V	V	Coin	V	Coin	Coin	Coin	V	V	Coin	V	Coin	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	YES	241.699827	0	1809.516445	766.88115	366.1745948	5.855793265	0	1693.145454	101.9713053	20.77566766	43.16859115	0	0	0	3836.863789	3795.594511	109.6583689	203.9881486	0	1442.066507	0.866000941	497.5703078	0	0	81.05781957	0	0	0	0	0											3400	"(1a) $975 copay per admission, unlimited days"	(1b) $975 copay per admission	"(2) $0 copay for days 1-10, $100 after day 10"	(6) 0% coinsurance	(10a) $100 copay	(11a) 20% coinsurance	"(11b) 20% coinsurance, (11c) 20% coinsurance"	"(4a) $50 copay, includes worldwide coverage and waived copay if admitted to hospital, (4b) $45 copay"	"(9a  - surgery) 30% coinsurance, (9b) 30% coinsurance"	(8a) 30% coinsurance	(8b) 30% coinsurance	(5) 0% coinsurance	(12) 0% coinsurance	"(3) $45 copay for physician services, 20% coinsurance for supplies, (9a - non-surgery) 0% coinsurance, (9c) $45 copay, (9d) 0% coinsurance"	"(7a) $25 copay, $45 copay for Urgent Care services, (14b) 0% coinsurance, (14c) 0% coinsurance"	(7d) $45 copay	"(7e) $45 copay, (7h) $45 copay"	"(7c) $45 copay, (7i) $45 copay"	0	"(7b) $45 copay, (7f) $45 copay, (7g) 0% coinsurance, (14d - j) 0% coinsurance"	(15) 20% coinsurance	"(13a) 0% coinsurance, 3 pint deductible waived"	0	(16b) $45 copay	(17a) $45 copay	(17b) 20% coinsurance	(18a) $45 copay	0	(14a) 0% coinsurance	0											975	0	75.51188857	0	100	0.2	0.2	49.54474097	0.2	0.2	0.2	0	0	0	24.11647203	45	45	45	0	8.352412101	0.2	0	0	0	45	0	0	0	0	0											NO	696.5492387	0	53.94640871	0	71.44094756	0.142881895	0.142881895	35.39523242	0.142881895	0.142881895	0.142881895	0	0	0	17.22903614	32.1484264	32.1484264	32.1484264	0	5.967042349	0.142881895	0	0	0	32.1484264	0	0	0	0	0												14.0297	0	8.13474281	0	2.179988335	0.836686839	0	4.994106405	14.56985335	2.968466767	6.168010113	0	0	0	5.508788741	10.16853256	0.293778667	0.546491499	0	0.71707266	0.123735856	0	0	0	0.217156779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4571	0	28.56549508	14.0297	0	8.13474281	0	2.179988335	0.836686839	0	4.994106405	14.56985335	2.968466767	6.168010113	0	0	0	5.508788741	10.16853256	0.293778667	0.546491499	0	0.71707266	0.123735856	0	0	0	0.217156779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4571	NO																																																																																		0			14.0297	0	8.13474281	0	2.179988335	0.836686839	0	4.994106405	14.56985335	2.968466767	6.168010113	0	0	0	5.508788741	10.16853256	0.293778667	0.546491499	0	0.71707266	0.123735856	0	0	0	0.217156779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.4571
H3449_801_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	197.7600786	0	21.1498004	9.516065078	4.059037057	16.92400234	0	24.67812705	87.63828287	19.01696127	46.78832233	0	0	9.365189223	45.48763081	91.09294601	1.637756093	5.586933245	0	10.86889508	0.324114501	1.620948468																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			0.081816311	0.080571228	0.187708627	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																			NO	0.081816311	0.080571228	0.187708627	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																				16.18	0	3.97	0	0.97	4.06	0	5.6	20.01	4.324609128	10.6400388	0	0	2.129718951	10.57212143	21.17159478	0.380643177	1.298501058	0	2.526121423	0.07	0.4	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3033			16.18	0	3.97	0	0.97	4.06	0	5.6	20.01	4.324609128	10.6400388	0	0	2.129718951	10.57212143	21.17159478	0.380643177	1.298501058	0	2.526121423	0.07	0.4	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3033	NO																																																																																		0			16.18	0	3.97	0	0.97	4.06	0	5.6	20.01	4.324609128	10.6400388	0	0	2.129718951	10.57212143	21.17159478	0.380643177	1.298501058	0	2.526121423	0.07	0.4	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3033
H3449_805_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	197.7600786	0	21.1498004	9.516065078	4.059037057	16.92400234	0	24.67812705	87.63828287	19.01696127	46.78832233	0	0	9.365189223	45.48763081	91.09294601	1.637756093	5.586933245	0	10.86889508	0.324114501	1.620948468																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			0.081816311	0.080571228	0.187708627	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																			NO	0.081816311	0.080571228	0.187708627	0	0.238972935	0.239895972	0.233	0.226921597	0.228324875	0.227408	0.227408	0.227408	0.227408	0.227408	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.2324175	0.215973059	0.246769103																				16.18	0	3.97	0	0.97	4.06	0	5.6	20.01	4.324609128	10.6400388	0	0	2.129718951	10.57212143	21.17159478	0.380643177	1.298501058	0	2.526121423	0.07	0.4	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3033			16.18	0	3.97	0	0.97	4.06	0	5.6	20.01	4.324609128	10.6400388	0	0	2.129718951	10.57212143	21.17159478	0.380643177	1.298501058	0	2.526121423	0.07	0.4	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3033	NO																																																																																		0			16.18	0	3.97	0	0.97	4.06	0	5.6	20.01	4.324609128	10.6400388	0	0	2.129718951	10.57212143	21.17159478	0.380643177	1.298501058	0	2.526121423	0.07	0.4	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3033
H3449_810_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	205.9424739	0	31.17666906	10.3403361	5.807500404	16.99972623	0	26.11102484	81.55125486	25.41530638	37.78254745	0	0	2.548305511	55.77672571	81.67696364	2.161099376	3.679766271	0	12.86209356	2.426713138	2.053539866																				FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare	FFS Medicare																			0.079342545	0.080571228	0.184753541	0	0.232458012	0.232944928	0.233	0.232851833	0.232982313	0.233036158	0.233036158	0.233036158	0.233036158	0.233036158	0.232993895	0.232993895	0.232993895	0.232993895	0.232993895	0.232993895	0.234885612	0.233742723																			NO	0.079342545	0.080571228	0.184753541	0	0.232458012	0.232944928	0.233	0.232851833	0.232982313	0.233036158	0.233036158	0.233036158	0.233036158	0.233036158	0.232993895	0.232993895	0.232993895	0.232993895	0.232993895	0.232993895	0.234885612	0.233742723																				16.34	0	5.76	0	1.35	3.96	0	6.08	19	5.922685349	8.804699691	0	0	0.593847325	12.9956366	19.03023392	0.503522962	0.857363078	0	2.996789283	0.57	0.48	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2448			16.34	0	5.76	0	1.35	3.96	0	6.08	19	5.922685349	8.804699691	0	0	0.593847325	12.9956366	19.03023392	0.503522962	0.857363078	0	2.996789283	0.57	0.48	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2448	NO																																																																																		0			16.34	0	5.76	0	1.35	3.96	0	6.08	19	5.922685349	8.804699691	0	0	0.593847325	12.9956366	19.03023392	0.503522962	0.857363078	0	2.996789283	0.57	0.48	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.2448
H3456_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1398.369419	141.7167065	874.7915706	900.495046	181.5808365	9.775907401	8.308711647	322.8578779	26.07815628	9716.003281	31.23788236	0	0.041288826	19.29974201	5728.890867	4243.299031	588.9964519	280.1186545	0	0	18.22714764	916.1421728	0	0	170.1241679	0	16.5033517	2.175222707	220.8643987	0											3950	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	74.36970205	0	150	0.2	0.12410433	49.48641216	0.2	3	0.176090334	0	0.2	0.149785135	13.25492116	39.61572398	38.5	40	0	0	0.2	38.08655391	0	0	34.93982574	0	0	0	0	0											YES	166.2602262	122.5937848	61.51440919	0	124.071512	0.165428683	0.102652079	40.93235986	0.165428683	2.481430239	0.14565196	0	0.165428683	0.124120216	13.17346502	39.61572398	38.5	33.08573653	0	0	0.165428683	38.08655391	0	0	34.93982574	0	0	0	0	0											7500	19.3744	1.447798951	4.484357219	0	1.877417411	1.617215483	0.852906524	1.101277904	4.314075038	2.009132029	4.5498588	0	0.006830356	2.395488147	6.289111954	14.00844693	1.88969695	0.772327667	0	0	3.015293022	2.907724854	0	0	0.495342398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4087	0	10.02670555	19.3744	1.447798951	4.484357219	0	1.877417411	1.617215483	0.852906524	1.101277904	4.314075038	2.009132029	4.5498588	0	0.006830356	2.395488147	6.289111954	14.00844693	1.88969695	0.772327667	0	0	3.015293022	2.907724854	0	0	0.495342398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.4087	NO	"$325 Days 1-24 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-24 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.1592	0.1189	0.604	0.099	0.1128	0.1458	0.1239	0.077	0.3889	0.1208	0.4015	0	0.0004	0.2145	0.6308	1.0908	0.1484	0.0624	0	0	0.3247	0.2309	0	0	0.0344	0	0.0043	0	0	0											6.0936	0	0.674575365	20.5336	1.566704541	5.088377027	0.099022498	1.990253827	1.763012149	0.976821615	1.178298985	4.703001414	2.129884748	4.951341483	0	0.007240874	2.610008522	6.919957408	15.09923467	2.038127205	0.834703078	0	0	3.339991378	3.138665939	0	0	0.529777966	0	0.004302344	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5024
H3456_010_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	439.6497963	38.85481019	8401.867236	73.93756006	20.71796595	9.398797756	14.81487318	16.89597458	9.3999913	35.01303221	35.05159536	0	0.012273637	6.897005756	1.127779297	152.8898585	18.36920138	35.46978	0	0	5.144545388	9.046911248	1996.007284	0	68.61442345	43.74127691	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080879738	0.081862083	0	0	0.2	0.2	0.056209808	0.067181746	0.2	0	0.062059061	0	0.2	0.151549305	0.007087228	0.199570012	0.2	0	0	0	0.2	0.197624343	0	0	0	0	0	0	0	0											NO	0.080879738	0.081862083	0	0	0.2	0.2	0.056209808	0.067181746	0.2	0	0.062059061	0	0.2	0.151549305	0.007087228	0.199570012	0.2	0	0	0	0.2	0.197624343	0	0	0	0	0	0	0	0												35.5588	3.180735684	0	0	4.143593191	1.879759551	0.832741174	1.135101077	1.87999826	0	2.175269095	0	0.002454727	1.045236429	0.007992829	30.51223084	3.673840275	0	0	0	1.028909078	1.787889895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8445	0	0	35.5588	3.180735684	0	0	4.143593191	1.879759551	0.832741174	1.135101077	1.87999826	0	2.175269095	0	0.002454727	1.045236429	0.007992829	30.51223084	3.673840275	0	0	0	1.028909078	1.787889895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8445	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	35.5588	3.180735684	0	0	4.143593191	1.879759551	0.832741174	1.135101077	1.87999826	0	2.175269095	0	0.002454727	1.045236429	0.007992829	30.51223084	3.673840275	0	0	0	1.028909078	1.787889895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8445
H3456_016_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5216	0.8185	0.5907	0	1.1595	0	1.4668	0	0.0035	0.9421	1.1883	4.7	0.3758	0.1423	0	0	0.9886	0.1989	0	0	0	0	0	0	0	0											13.0965	NO	378.4467242	20.99170295	58.21958884	1676.552111	14.30297686	22.44292427	16.19622694	34.04441229	31.79425406	14.88952532	40.22099319	0	0.095097031	25.83276612	35.62651139	128.9287126	10.30602796	3.901910998	0	0	27.10831015	5.95825053	448.7822188	161.1184964	278.3154389	197.9725708	0	0	73.3366949	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080261753	0.081236592	0.185941719	0	0.19270622	0.19270622	0.19270622	0.099440364	0.19270622	0	0.160875713	0	0.19270622	0.14418681	0.003052752	0.192626867	0.19270622	0	0	0	0.19270622	0.192724706	0	0	0	0	0	0	0	0											NO	0.080261753	0.081236592	0.185941719	0	0.19270622	0.19270622	0.19270622	0.099440364	0.19270622	0	0.160875713	0	0.19270622	0.14418681	0.003052752	0.192626867	0.19270622	0	0	0	0.19270622	0.192724706	0	0	0	0	0	0	0	0												30.3748	1.705294406	10.82545044	0	2.756272607	4.324891103	3.121113672	3.385388758	6.12695052	0	6.470580949	0	0.018325789	3.724744133	0.108758907	24.83513394	1.986035691	0	0	0	5.223939982	1.148302081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.136	146	0	30.3748	1.705294406	10.82545044	0	3.277886436	5.143359858	3.711772249	3.385388758	7.286451983	0	7.937396316	0	0.021793874	4.666836691	1.297019371	29.53508607	2.361885192	0.142298401	0	0	6.212550227	1.347231432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.2325	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	30.3748	1.705294406	10.82545044	0	3.277886436	5.143359858	3.711772249	3.385388758	7.286451983	0	7.937396316	0	0.021793874	4.666836691	1.297019371	29.53508607	2.361885192	0.142298401	0	0	6.212550227	1.347231432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.2325
H3456_020_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1262.424366	145.5533197	649.4130576	750.6404388	149.1652713	8.436997512	8.064347206	291.0580984	26.51254028	9487.448638	32.1209437	0	0.036245783	23.63917865	5601.459721	4167.008055	600.543931	328.3447842	0	0	21.89956359	982.5649619	0	0	185.2865555	0	16.77421794	0	94.61187063	0											3600	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	81.80667226	0	150	0.2	0.134273524	49.55011215	0.2	3	0.175554592	0	0.2	0.149787193	12.85394595	34.8760867	38.5	35	0	0	0.2	33.23279646	0	0	35	0	35	0	0	0											YES	164.6913807	121.4369794	67.02734942	0	122.9007627	0.163867684	0.110015456	40.5983105	0.163867684	2.458015254	0.143838621	0	0.163867684	0.122921073	12.78518674	34.8760867	38.5	28.67684463	0	0	0.163867684	33.23279646	0	0	35	0	35	0	0	0											6600	17.3259	1.472962958	3.627369661	0	1.527710467	1.382551239	0.887202838	0.984705588	4.344548561	1.943357789	4.620232258	0	0.005939513	2.905753198	5.967975713	12.11074452	1.926745112	0.784657697	0	0	3.588630757	2.721115116	0	0	0.54041912	0	0.048924802	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7174	0	10.03736732	17.3259	1.472962958	3.627369661	0	1.527710467	1.382551239	0.887202838	0.984705588	4.344548561	1.943357789	4.620232258	0	0.005939513	2.905753198	5.967975713	12.11074452	1.926745112	0.784657697	0	0	3.588630757	2.721115116	0	0	0.54041912	0	0.048924802	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7174	NO	"$325 Days 1-21 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-21 (1b); $0 n/c (1b1, 1b2)"	"$190 Days 1-35 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.0163	0.1186	0.7416	0.0813	0.09	0.1222	0.1168	0.0695	0.384	0.1145	0.4001	0	0.0003	0.2554	0.6111	0.9564	0.1513	0.0631	0	0	0.3788	0.2198	0	0	0.0393	0	0.0039	0	0	0											5.9346	0	0.81391165	18.3421	1.591558399	4.369018916	0.081294876	1.617724797	1.504743328	1.003997875	1.054220178	4.72852671	2.057862502	5.020341138	0	0.006289475	3.161164941	6.579120773	13.06715476	2.078085394	0.847769944	0	0	3.967475701	2.940952988	0	0	0.579754373	0	0.052811876	0	0	0	0	0	0	0	0	0	0	0	0	0	74.652
H3456_022_0	2010	3	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2055.581252	302.7872001	32.92123159	1102.911746	236.8004682	14.26141826	14.38511483	493.7524745	44.87240421	13921.56576	49.29335333	0	0.238016728	29.19320746	8740.404074	5708.515987	1087.531305	361.8043505	0	0	28.40998521	1235.298797	669.4372088	0	366.6987628	0	17.39774088	4.781694348	78.89795675	0											3950	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	0.190400185	0	150	0.2	0.107182926	49.49770932	0.2	3	0.174336241	0	0.2	0.150020724	13.21763885	39.61189354	38.5	40	0	0	0.2	39.61885282	0	0	40	0	0	0	0	0											NO	150.5629618	111.0192362	0.142619189	0	112.3574456	0.149809927	0.080285332	37.0762412	0.149809927	2.247148911	0.130586498	0	0.149809927	0.112652006	13.10808318	39.61189354	38.5	29.96198548	0	0	0.149809927	39.61885282	0	0	40	0	0	0	0	0												25.7912	2.801266974	4.695199358	0	2.21719131	2.136502034	1.154913715	1.525540487	6.722331617	2.606985946	6.437046376	0	0.035657269	3.28867339	9.547495304	18.84376063	3.489162936	0.903364725	0	0	4.256097823	4.078426769	0	0	1.222329209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7531	0	21.70214697	25.7912	2.801266974	4.695199358	0	2.21719131	2.136502034	1.154913715	1.525540487	6.722331617	2.606985946	6.437046376	0	0.035657269	3.28867339	9.547495304	18.84376063	3.489162936	0.903364725	0	0	4.256097823	4.078426769	0	0	1.222329209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7531	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.7912	2.801266974	4.695199358	0	2.21719131	2.136502034	1.154913715	1.525540487	6.722331617	2.606985946	6.437046376	0	0.035657269	3.28867339	9.547495304	18.84376063	3.489162936	0.903364725	0	0	4.256097823	4.078426769	0	0	1.222329209	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7531
H3456_023_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1355.394682	201.3487543	1077.389285	628.8090293	227.6475823	9.178465855	6.798084214	308.8148541	28.26845135	10032.63246	28.72685637	0	0.015465906	17.48096856	5986.582923	4394.760424	610.2128844	441.7800811	0	0	25.48629762	1185.009857	0	0	229.7835754	0	16.47648002	3.599587514	241.0802929	0											3950	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	69.22791329	0	150	0.2	0.110451498	48.92872359	0.2	3	0.175475221	0	0.2	0.15040853	13.19678474	39.59992215	38.5	40	0	0	0.2	38.4857193	0	0	40	0	0	0	0	0											YES	163.8144482	120.7903638	56.41906608	0	122.2463528	0.162995137	0.090015285	39.87572005	0.162995137	2.444927056	0.143008038	0	0.162995137	0.12283234	13.06716589	39.59992215	38.5	32.59902742	0	0	0.162995137	38.4857193	0	0	40	0	0	0	0	0											7500	18.5028	2.026749106	5.065441439	0	2.319090556	1.4960453	0.611931489	1.026184556	4.607620103	2.044087878	4.108171381	0	0.002520867	2.14722827	6.518972679	14.50268089	1.957766338	1.200133415	0	0	4.154142574	3.800496394	0	0	0.765945251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.858	0	11.2545898	18.5028	2.026749106	5.065441439	0	2.319090556	1.4960453	0.611931489	1.026184556	4.607620103	2.044087878	4.108171381	0	0.002520867	2.14722827	6.518972679	14.50268089	1.957766338	1.200133415	0	0	4.154142574	3.800496394	0	0	0.765945251	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.858	NO	"$325 Days 1-24 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-24 (1b); $0 n/c (1b1, 1b2)"	"$160 Days 1-47 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.0924	0.1642	1.0373	0.0746	0.1375	0.1331	0.0986	0.0725	0.4099	0.1212	0.357	0	0.0001	0.1896	0.6372	1.1293	0.1538	0.0956	0	0	0.4414	0.3007	0	0	0.0599	0	0.0043	0	0	0											6.7102	0	0.903831613	19.5951	2.19099296	6.102756975	0.074575864	2.456621768	1.629127376	0.710499504	1.098681749	5.017495157	2.165310347	4.465124257	0	0.002670365	2.336821897	7.156161656	15.63198591	2.111543248	1.295772734	0	0	4.595537245	4.101219284	0	0	0.825848724	0	0.004295339	0	0	0	0	0	0	0	0	0	0	0	0	0	83.5682
H3456_024_0	2010	3	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2098.757433	303.8569876	39.45346332	1116.429206	254.7193786	13.42823484	15.09896441	499.5961768	42.08968978	12675.30975	47.22042256	0	0.121941852	31.27771376	7515.755147	5420.331713	1100.760046	368.7832339	0	0	29.58135383	1228.347351	669.4372088	0	223.50708	0	17.39774088	4.781694348	78.89795675	0											3950	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	0.163360695	0	150	0.2	0.106700404	49.39568921	0.2	3	0.174436686	0	0.2	0.150219857	13.20399936	39.62712364	38.5	40	0	0	0.2	39.80243735	0	0	40	0	0	0	0	0											NO	150.2946075	110.8213622	0.122147173	0	112.1571864	0.149542915	0.079781448	36.93387683	0.149542915	2.243143728	0.130428853	0	0.149542915	0.112586144	13.0480753	39.62712364	38.5	29.90858305	0	0	0.149542915	39.80243735	0	0	40	0	0	0	0	0												26.286	2.806153775	4.819129014	0	2.380717402	2.008097384	1.204617239	1.537668638	6.294214911	2.369378465	6.158905535	0	0.01823554	3.521437183	8.172178261	17.89934624	3.531605146	0.919148665	0	0	4.423681888	4.074268208	0	0	0.7450236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.1698	0	21.932921	26.286	2.806153775	4.819129014	0	2.380717402	2.008097384	1.204617239	1.537668638	6.294214911	2.369378465	6.158905535	0	0.01823554	3.521437183	8.172178261	17.89934624	3.531605146	0.919148665	0	0	4.423681888	4.074268208	0	0	0.7450236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.1698	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.286	2.806153775	4.819129014	0	2.380717402	2.008097384	1.204617239	1.537668638	6.294214911	2.369378465	6.158905535	0	0.01823554	3.521437183	8.172178261	17.89934624	3.531605146	0.919148665	0	0	4.423681888	4.074268208	0	0	0.7450236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.1698
H3456_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	216.4117827	12.97764438	18.88217949	825.2778755	4.768632077	8.012231347	7.151345636	10.82909785	34.44923179	15.70070332	34.96017777	0	0.023601677	25.48288307	31.99975347	109.8056267	4.918556531	5.308980465	0	0	26.03385054	7.31200439	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081689831	0.081689831	0.190899569	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081689831	0.081689831	0.190899569	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.6786	1.060141576	3.60459993	0	1.111091274	1.866849904	1.666263533	2.523179799	8.026671007	3.658263875	8.14572142	0	0.005499191	5.937511756	7.455942558	25.58471103	1.146023672	1.236992448	0	0	6.065887177	1.703697023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4777	0	0	17.6786	1.060141576	3.60459993	0	1.111091274	1.866849904	1.666263533	2.523179799	8.026671007	3.658263875	8.14572142	0	0.005499191	5.937511756	7.455942558	25.58471103	1.146023672	1.236992448	0	0	6.065887177	1.703697023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4777	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.6786	1.060141576	3.60459993	0	1.111091274	1.866849904	1.666263533	2.523179799	8.026671007	3.658263875	8.14572142	0	0.005499191	5.937511756	7.455942558	25.58471103	1.146023672	1.236992448	0	0	6.065887177	1.703697023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4777
H3456_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	218.4547239	13.10015418	19.06042849	833.0685521	4.813648272	8.087867329	7.218854801	10.93132523	34.77443476	15.84891898	35.29020411	0	0.023824478	25.72344313	32.30183321	110.842199	4.964988023	5.359097584	0	0	26.27961178	7.381030185	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081689831	0.081689831	0.190899569	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081689831	0.081689831	0.190899569	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.8455	1.070149381	3.638627585	0	1.121580047	1.884473088	1.681993169	2.546998779	8.1024433	3.692798122	8.222617557	0	0.005551103	5.99356225	7.526327138	25.82623236	1.156842209	1.248669737	0	0	6.123149544	1.719780033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4073	0	0	17.8455	1.070149381	3.638627585	0	1.121580047	1.884473088	1.681993169	2.546998779	8.1024433	3.692798122	8.222617557	0	0.005551103	5.99356225	7.526327138	25.82623236	1.156842209	1.248669737	0	0	6.123149544	1.719780033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4073	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.8455	1.070149381	3.638627585	0	1.121580047	1.884473088	1.681993169	2.546998779	8.1024433	3.692798122	8.222617557	0	0.005551103	5.99356225	7.526327138	25.82623236	1.156842209	1.248669737	0	0	6.123149544	1.719780033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4073
H3456_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	218.4284518	13.09857871	19.05813622	833.0184569	4.813069367	8.086894657	7.217986639	10.9300106	34.77025268	15.84701294	35.28596	0	0.023821613	25.72034955	32.29794849	110.8288687	4.964390918	5.358453082	0	0	26.27645131	7.380142519	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081699348	0.081699348	0.190943224	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081699348	0.081699348	0.190943224	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.8455	1.07014534	3.639021983	0	1.121445163	1.884246455	1.681790887	2.546692469	8.101468875	3.692354015	8.221628679	0	0.005550436	5.992841446	7.525421998	25.82312641	1.156703084	1.248519568	0	0	6.122413155	1.719573207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3984	0	0	17.8455	1.07014534	3.639021983	0	1.121445163	1.884246455	1.681790887	2.546692469	8.101468875	3.692354015	8.221628679	0	0.005550436	5.992841446	7.525421998	25.82312641	1.156703084	1.248519568	0	0	6.122413155	1.719573207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3984	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.8455	1.07014534	3.639021983	0	1.121445163	1.884246455	1.681790887	2.546692469	8.101468875	3.692354015	8.221628679	0	0.005550436	5.992841446	7.525421998	25.82312641	1.156703084	1.248519568	0	0	6.122413155	1.719573207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3984
H3456_805_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	218.3811014	13.09573923	19.05400485	832.9281621	4.812026002	8.085141599	7.216421941	10.92764121	34.76271527	15.84357766	35.27831079	0	0.023816449	25.71477396	32.29094702	110.8048435	4.963314749	5.35729149	0	0	26.27075516	7.378542669	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081720117	0.081720117	0.190991952	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081720117	0.081720117	0.190991952	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.8461	1.070185344	3.639161574	0	1.121202058	1.883837993	1.681426312	2.546140403	8.099712658	3.691553595	8.219846415	0	0.005549233	5.991542332	7.523790655	25.81752854	1.156452337	1.248248917	0	0	6.121085953	1.719200442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3826	0	0	17.8461	1.070185344	3.639161574	0	1.121202058	1.883837993	1.681426312	2.546140403	8.099712658	3.691553595	8.219846415	0	0.005549233	5.991542332	7.523790655	25.81752854	1.156452337	1.248248917	0	0	6.121085953	1.719200442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3826	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.8461	1.070185344	3.639161574	0	1.121202058	1.883837993	1.681426312	2.546140403	8.099712658	3.691553595	8.219846415	0	0.005549233	5.991542332	7.523790655	25.81752854	1.156452337	1.248248917	0	0	6.121085953	1.719200442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3826
H3456_806_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	218.4416639	13.099371	19.05928899	833.0436499	4.813360495	8.087383809	7.218423233	10.93067172	34.77235583	15.84797148	35.28809434	0	0.023823054	25.7219053	32.29990209	110.8355724	4.964691199	5.358777199	0	0	26.27804069	7.380588921	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081696371	0.081696371	0.190936232	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081696371	0.081696371	0.190936232	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.8459	1.070171076	3.639108829	0	1.121512995	1.884360427	1.681892613	2.546846511	8.101958908	3.692577354	8.222125981	0	0.005550772	5.993203935	7.525877188	25.82468838	1.156773049	1.248595087	0	0	6.122783481	1.719677219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4036	0	0	17.8459	1.070171076	3.639108829	0	1.121512995	1.884360427	1.681892613	2.546846511	8.101958908	3.692577354	8.222125981	0	0.005550772	5.993203935	7.525877188	25.82468838	1.156773049	1.248595087	0	0	6.122783481	1.719677219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4036	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.8459	1.070171076	3.639108829	0	1.121512995	1.884360427	1.681892613	2.546846511	8.101958908	3.692577354	8.222125981	0	0.005550772	5.993203935	7.525877188	25.82468838	1.156773049	1.248595087	0	0	6.122783481	1.719677219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.4036
H3518_001_0	2010	7	N/A	g.1.	h.6.	h.7.	h.8.	h.9.	f.1.	i.7.	i.8.	i.9.		OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Emergency	Professional	Professional	Professional		ASC	AIXIDTF	IDTF	OP MH	OP Rehab	Urgent Care ER	AIXPhy	All Shots	E Medicine		D	D	D		T	Coin		V	V		V			V	V	V	V	V			Coin									O	V	V	V		V	V	V	O	O																																										0	NO	1457.108699	3.840675227	486.3555124		134.6653914	0.200185531		130.0005177	110.4256658		4.785238412			526.7845876	3384.367779	5607.16833	196.665956	384.8052288			57.10345787									226.5707564	223.19624	143.7285316	245.6117043		811.1524877	35.41194908	2.14033825	54.03477382	0			$200 for days 1-7 #1A INPATIENT HOSPITAL-ACUTE	$200 for days 1-7 #1B INPATIENT PSYCHIATRIC HOSP	$100 for days 7-25 #2 SNF	$0/visit #6 HOME HEALTH	$100/transport #10A AMBULANCE	20% coinsurance/electric wheelchair #11A DME	"$0/other #11B PROS./MED. SUPP., #11C DIABETES MON SUPPLIES"	$50/visit #4A EMERGENCY CARE	$150/visit #9A OUTPATIENT HOSPITAL	$0/visit #8A OUTPATIENT DIAG PROCS/TESTS/LAB SERVICES	$50/ visit #8B OUTPATIENT DIAG/THERAPEUTIC RAD SERVICES		$0/other #12 END-STAGE RENAL DISEASE	$150/visit #8A OUTPATIENT DIAG PROCS/TESTS/LAB SERVICES	"$20/visit #7A PRIMARY CARE, #14B IMMUNIZATIONS"	"$60/visit #7B CHIROPRACTIC SERVICES, #7D PHYSICIAN SPECIALIST,  #7F PODIATRY SERVICES, #16B COMP DENTAL, #17A EYE EXAMS, #18A HEARING EXAMS"	"$40/visit #7E MENTAL HEALTH, #7F PODIATRY SERVICES, #7H PSYCHIATRIC SERVICES"	"$60/visit #7C OCCUPATIONAL THERAPY, #7I PT AND SP SERVICES"			20% coinsurance #15 MEDICARE PART B RX DRUGS									"$0/visit #1A INPATIENT HOSPITAL-ACUTE (Excess Days), $50/visit #4A EMERGENCY CARE (Worldwide Coverage), $20/visit #14 PHYSICAL EXAMS (Routine), $60/visit #7F PODIATRY SERVICES (Routine), $25/visit Urgent Care ER (Worldwide Coverage)"	$100/visit #9B ASC SERVICES	$100/visit #8B OUTPATIENT DIAG/THERAPEUTIC RAD SERVICES	$75/visit #8A OUTPATIENT DIAG PROCS/TESTS/LAB SERVICES		"$60/visit #3 CORF, #9C OUTPATIENT SUB ABUSE, #9D CARDIAC REHAB SERVICES"	$25/visit #7A PRIMARY CARE	$100/visit #8B OUTPATIENT DIAG/THERAPEUTIC RAD SERVICES	$6/shot #7G OTHER HEALTH CARE	$5/use #7G OTHER HEALTH CARE		171.9323499	189.9702538	51.52574897		100	0.2		50	150		50			150	20	60	40	60			0.2									19.40377152	100	100	75		60	25	100	6	5		NO	171.9323499	189.9702538	51.52574897		100	0.2		50	150		50			150	20	60	40	60			0.2									19.40377152	100	100	75		60	25	100	6	5			20.877	0.060801171	2.088319337	0	1.122211595	0.040037106	0	0.541668824	1.380320823	0	0.019938493	0	0	6.584807345	5.640612965	28.03584165	0.655553187	1.924026144	0	0	11.42069157	0	0	0	0	0	0	0	0	0.366360599	1.859968667	1.197737763	1.535073152	0	4.055762439	0.073774894	0.017836152	0.027017387	0	0	89.5254		0	20.877	0.060801171	2.088319337	0	1.122211595	0.040037106	0	0.541668824	1.380320823	0	0.019938493	0	0	6.584807345	5.640612965	28.03584165	0.655553187	1.924026144	0	0	11.42069157	0	0	0	0	0	0	0	0	0.366360599	1.859968667	1.197737763	1.535073152	0	4.055762439	0.073774894	0.017836152	0.027017387	0	0	89.5254	NO																																																																																		0			20.877	0.060801171	2.088319337	0	1.122211595	0.040037106	0	0.541668824	1.380320823	0	0.019938493	0	0	6.584807345	5.640612965	28.03584165	0.655553187	1.924026144	0	0	11.42069157	0	0	0	0	0	0	0	0	0.366360599	1.859968667	1.197737763	1.535073152	0	4.055762439	0.073774894	0.017836152	0.027017387	0	0	89.5254
H3518_801_0	2010	3	N/A																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																			0		0		0	0		0	0					0						0	0	0																			0	NO	251.1662845		60.12011716		8.013025973	40.87326546		4.354437322	13.69982851					60.40826668						259.2005584	27.5102985	0																				8.5% coinsurance		14.9% coinsurance		23.3% coinsurance	23.3% coinsurance		23.3% coinsurance	23.3% coinsurance					23.3% coinsurance						23.3% coinsurance	23.3% coinsurance	23.3% coinsurance																																																											NO	0.084896931		0.148961524		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																				21.3232	0	8.955584273	0	1.867035052	9.523470851	0	1.014583896	3.192060042	0	0	0	0	14.07512614	0	0	0	0	0	60.3937301	6.409899551	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.7547		0	21.3232	0	8.955584273	0	1.867035052	9.523470851	0	1.014583896	3.192060042	0	0	0	0	14.07512614	0	0	0	0	0	60.3937301	6.409899551	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.7547	NO																																																																																		0			21.3232	0	8.955584273	0	1.867035052	9.523470851	0	1.014583896	3.192060042	0	0	0	0	14.07512614	0	0	0	0	0	60.3937301	6.409899551	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.7547
H3518_802_0	2010	3	N/A																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																			0		0		0	0		0	0					0						0	0	0																			0	NO	126.8158788		23.26102575		3.808613232	20.31431179		2.355544914	6.717218189					29.17300445						137.7520786	14.70033269	0																				8.5% coinsurance		14.9% coinsurance		23.3% coinsurance	23.3% coinsurance		23.3% coinsurance	23.3% coinsurance					23.3% coinsurance						23.3% coinsurance	23.3% coinsurance	23.3% coinsurance																																																											NO	0.084896931		0.148961524		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																				10.7663	0	3.464997844	0	0.887406883	4.733234647	0	0.548841965	1.565111838	0	0	0	0	6.797310038	0	0	0	0	0	32.09623431	3.425177517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2846		0	10.7663	0	3.464997844	0	0.887406883	4.733234647	0	0.548841965	1.565111838	0	0	0	0	6.797310038	0	0	0	0	0	32.09623431	3.425177517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2846	NO																																																																																		0			10.7663	0	3.464997844	0	0.887406883	4.733234647	0	0.548841965	1.565111838	0	0	0	0	6.797310038	0	0	0	0	0	32.09623431	3.425177517	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2846
H3528_001_0	2010	6	N/A																															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	V	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	YES	1009.215467	20.20724981	1008.495226	32.66427993	159.7980427	10.88234005	1.261378437	329.295207	579.3372818	2864.713333	1523.824762	0	0	147.5282529	3116.811997	6752.929857	691.9680012	531.4848746	1186.011939	4081.740903	9.860275638	0	0	0	612.2783811	0	27	0	0	0											3400	$250 Days 1-10	$250 Days 1-10	$100 Days 11-100	0	$100 copay	0.2	0.2	50	"$175, Colorectal exempt"	0	"$30 X-ray, $175 advanced rad"	0	0	0	$25 copay	$40 copay	$40 copay	$40 copay	$30 copay	0	10% coinsurance	0	0	0	$40 copay	0	$40 copay	0	0	0											185.06	185.06	54.08	0	100	0.2	0.2	50	157.5	0	55.81	0	0	0	25	40	40	40	30	0	0.1	0	0	0	40	0	40	0	0	0											NO	179.6799478	179.6799478	52.50778979	0	97.09280656	0.194185613	0.194185613	48.54640328	152.9211703	0	54.18749534	0	0	0	24.27320164	38.83712262	38.83712262	38.83712262	29.12784197	0	0.097092807	0	0	0	38.83712262	0	38.83712262	0	0	0												15.1113	0.302569799	4.412821277	0	1.292936704	2.113193875	0.244941545	1.332174826	7.382744596	0	6.881020601	0	0	0	6.30458384	21.85536375	2.239503843	1.720111937	2.878830694	0	0.957361835	0	0	0	1.981594214	0	0.087383526	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0985	0	2.34	15.1113	0.302569799	4.412821277	0	1.292936704	2.113193875	0.244941545	1.332174826	7.382744596	0	6.881020601	0	0	0	6.30458384	21.85536375	2.239503843	1.720111937	2.878830694	0	0.957361835	0	0	0	1.981594214	0	0.087383526	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0985	NO																																																																																		0			15.1113	0.302569799	4.412821277	0	1.292936704	2.113193875	0.244941545	1.332174826	7.382744596	0	6.881020601	0	0	0	6.30458384	21.85536375	2.239503843	1.720111937	2.878830694	0	0.957361835	0	0	0	1.981594214	0	0.087383526	0	0	0	0	0	0	0	0	0	0	0	0	0	77.0985
H3528_002_0	2010	6	N/A																															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	V	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	YES	1296.392136	22.08919285	931.6183068	53.23067034	221.5112828	10.87184709	0.335197095	358.4219125	785.3052689	3714.562152	1872.62302	0	0	183.0176706	3561.006339	8822.364172	756.4124149	1146.40729	1559.520929	4986.225155	14.49438556	0	0	430.9236548	798.8305968	0	27	0	0	0											2500	$100 Days 1-7	$100 Days 1-7	$100 Days 11-100	0	$100 copay	0.2	0.2	50	"$100, Colorectal exempt"	0	"$30 X-ray, $100 advanced rad"	0	0	0	$10 copay	$25 copay	$25 copay	$25 copay	$30 copay	0	10% coinsurance	0	0	0	$25 copay	0	$25 copay	0	0	0											63.31	63.31	54.08	0	100	0.2	0.2	50	90	0	42.46	0	0	0	10	25	25	25	30	0	0.1	0	0	0	25	0	25	0	0	0											NO	59.49886743	59.49886743	50.82449456	0	93.98020445	0.187960409	0.187960409	46.99010222	84.582184	0	39.90399481	0	0	0	9.398020445	23.49505111	23.49505111	23.49505111	28.19406133	0	0.093980204	0	0	0	23.49505111	0	23.49505111	0	0	0												6.4278	0.109523496	3.945752464	0	1.734806304	2.043476824	0.063003783	1.403523526	5.535236229	0	6.227094939	0	0	0	2.788867531	17.27349143	1.480995696	2.244574822	3.664102393	0	1.362185318	0	0	0	1.564047142	0	0.052863865	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9214	0	3.71	6.4278	0.109523496	3.945752464	0	1.734806304	2.043476824	0.063003783	1.403523526	5.535236229	0	6.227094939	0	0	0	2.788867531	17.27349143	1.480995696	2.244574822	3.664102393	0	1.362185318	0	0	0	1.564047142	0	0.052863865	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9214	NO																																																																																		0			6.4278	0.109523496	3.945752464	0	1.734806304	2.043476824	0.063003783	1.403523526	5.535236229	0	6.227094939	0	0	0	2.788867531	17.27349143	1.480995696	2.244574822	3.664102393	0	1.362185318	0	0	0	1.564047142	0	0.052863865	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9214
H3528_003_0	2010	4	N/A																															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	V	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	YES	1100.880569	18.3632079	901.8278869	28.73900981	172.690978	11.29821943	0.438849449	285.0349324	555.3562671	2691.494129	1486.360515	0	0	155.4325859	2671.259676	6560.812163	628.821457	731.6204975	1094.455076	3857.749323	12.76410571	0	0	0	576.7660019	0	27	0	0	0											4500	$200 Days 1-7	$200 Days 1-7	$75 Days 11-100	0	$100 copay	0.2	0.2	50	"$125, Colorectal exempt"	0	"$30 X-ray, $175 advanced rad"	0	0	0	$20 copay	$30 copay	$30 copay	$30 copay	$30 copay	0	10% coinsurance	0	0	0	$30 copay	0	$30 copay	0	0	0											126.61	126.61	40.56	0	100	0.2	0.2	50	112.5	0	55.81	0	0	0	20	30	30	30	30	0	0.1	0	0	0	30	0	30	0	0	0											NO	123.7385599	123.7385599	39.64012312	0	97.73205897	0.195464118	0.195464118	48.86602948	109.9485663	0	54.54426211	0	0	0	19.54641179	29.31961769	29.31961769	29.31961769	29.31961769	0	0.097732059	0	0	0	29.31961769	0	29.31961769	0	0	0												11.3518	0.189353075	2.979047372	0	1.406453737	2.208396495	0.08577932	1.160710451	5.088385447	0	6.75603646	0	0	0	4.35112847	16.03004203	1.536400393	1.78756944	2.674083701	0	1.247462332	0	0	0	1.409213223	0	0.06596914	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3278		1.4	11.3518	0.189353075	2.979047372	0	1.406453737	2.208396495	0.08577932	1.160710451	5.088385447	0	6.75603646	0	0	0	4.35112847	16.03004203	1.536400393	1.78756944	2.674083701	0	1.247462332	0	0	0	1.409213223	0	0.06596914	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3278	NO																																																																																		0			11.3518	0.189353075	2.979047372	0	1.406453737	2.208396495	0.08577932	1.160710451	5.088385447	0	6.75603646	0	0	0	4.35112847	16.03004203	1.536400393	1.78756944	2.674083701	0	1.247462332	0	0	0	1.409213223	0	0.06596914	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3278
H3528_005_0	2010	6	N/A																															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	V	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	YES	1086.347674	19.4747276	866.9823387	47.25330754	179.0175179	14.21183313	0.473293664	314.3878553	619.5456313	2937.614872	1574.207657	0	0	164.7713935	3016.028646	7129.128745	666.8838391	754.1145422	1218.047272	4151.61311	10.52484782	0	0	0	619.5171132	0	27	0	0	0											3400	$200 Days 1-7	$200 Days 1-7	$100 Days 11-100	0	$100 copay	0.2	0.2	50	"$150, Colorectal exempt"	0	"$30 X-ray, $175 advanced rad"	0	0	0	$20 copay	$35 copay	$35 copay	$35 copay	$30 copay	0	10% coinsurance	0	0	0	$35 copay	0	$35 copay	0	0	0											126.61	126.61	54.08	0	100	0.2	0.2	50	135	0	55.81	0	0	0	20	35	35	35	30	0	0.1	0	0	0	35	0	35	0	0	0											NO	122.4692956	122.4692956	52.31134591	0	96.72955975	0.193459119	0.193459119	48.36477987	130.5849057	0	53.9847673	0	0	0	19.34591195	33.85534591	33.85534591	33.85534591	29.01886792	0	0.09672956	0	0	0	33.85534591	0	33.85534591	0	0	0												11.087	0.198754681	3.779417752	0	1.443023808	2.749408724	0.091562976	1.267108285	6.741942318	0	7.081936171	0	0	0	4.862318718	20.11325998	1.881465255	2.12756739	2.94552941	0	1.018063896	0	0	0	1.747830514	0	0.076174528	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2124		2.34	11.087	0.198754681	3.779417752	0	1.443023808	2.749408724	0.091562976	1.267108285	6.741942318	0	7.081936171	0	0	0	4.862318718	20.11325998	1.881465255	2.12756739	2.94552941	0	1.018063896	0	0	0	1.747830514	0	0.076174528	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2124	NO																																																																																		0			11.087	0.198754681	3.779417752	0	1.443023808	2.749408724	0.091562976	1.267108285	6.741942318	0	7.081936171	0	0	0	4.862318718	20.11325998	1.881465255	2.12756739	2.94552941	0	1.018063896	0	0	0	1.747830514	0	0.076174528	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2124
H3528_006_0	2010	6	N/A																															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	V	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	YES	1301.442401	22.14231141	1073.163508	49.14776236	217.6543762	19.15437056	0.853710176	368.6082177	762.6679552	3623.769835	1874.197259	0	0	200.9792425	3587.786652	8716.035868	798.138298	906.1618685	1436.255591	5203.08052	15.16237368	0	0	325.4798962	780.6595467	0	27	0	0	0											2500	$100 Days 1-7	$100 Days 1-7	$100 Days 11-100	0	$100 copay	0.2	0.2	50	"$100, Colorectal exempt"	0	"$30 X-ray, $100 advanced rad"	0	0	0	$10 copay	$25 copay	$25 copay	$25 copay	$30 copay	0	10% coinsurance	0	0	0	$25 copay	0	$25 copay	0	0	0											63.31	63.31	54.08	0	100	0.2	0.2	50	90	0	42.46	0	0	0	10	25	25	25	30	0	0.1	0	0	0	25	0	25	0	0	0											NO	59.58233614	59.58233614	50.89579432	0	94.11204571	0.188224091	0.188224091	47.05602285	84.70084114	0	39.95997461	0	0	0	9.411204571	23.52801143	23.52801143	23.52801143	28.23361371	0	0.094112046	0	0	0	23.52801143	0	23.52801143	0	0	0												6.4619	0.109940887	4.551625763	0	1.70699155	3.605313996	0.160688822	1.445436393	5.383218109	0	6.241072907	0	0	0	2.813782845	17.08924929	1.564883916	1.776682233	3.379223796	0	1.426962005	0	0	0	1.530613895	0	0.052938026	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3005		3.71	6.4619	0.109940887	4.551625763	0	1.70699155	3.605313996	0.160688822	1.445436393	5.383218109	0	6.241072907	0	0	0	2.813782845	17.08924929	1.564883916	1.776682233	3.379223796	0	1.426962005	0	0	0	1.530613895	0	0.052938026	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3005	NO	$200 Days 1-7	0	0	0	100	0.2	0.2	50	0.2	0	0.2	0	0	0.2	40	40	0	40	0.2	0	0.1	0	0	0	40	0	40	0	0	0												0.7227	0	0	0	0.0955	0.2016	0.009	0.0808	0.8537	0	0.35	0	0	0.1063	0.6294	1.5291	0	0.159	0.3345	0	0.0798	0	0	0	0.137	0	0.0047	0	0	0											5.2932			7.1846	0.109940887	4.551625763	0	1.802453995	3.806938949	0.169675245	1.526271528	6.236928285	0	6.591037123	0	0	0.106318243	3.4432191	18.61837839	1.564883916	1.935657999	3.713746553	0	1.506763972	0	0	0	1.66757171	0	0.057674868	0	0	0	0	0	0	0	0	0	0	0	0	0	64.5937
H3528_007_0	2010	4	N/A																															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	V	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	YES	1301.442401	22.14231141	1073.163508	49.14776236	217.6543762	19.15437056	0.853710176	368.6082177	762.6679552	3623.769835	1874.197259	0	0	200.9792425	3587.786652	8716.035868	798.138298	906.1618685	1436.255591	5203.08052	15.16237368	0	0	325.4798962	780.6595467	0	27	0	0	0											2500	$100 Days 1-7	$100 Days 1-7	$100 Days 11-100	0	$100 copay	0.2	0.2	50	"$100, Colorectal exempt"	0	"$30 X-ray, $100 advanced rad"	0	0	0	$10 copay	$25 copay	$25 copay	$25 copay	$30 copay	0	10% coinsurance	0	0	0	$25 copay	0	$25 copay	0	0	0											63.31	63.31	54.08	0	100	0.2	0.2	50	90	0	42.46	0	0	0	10	25	25	25	30	0	0.1	0	0	0	25	0	25	0	0	0											NO	59.58233614	59.58233614	50.89579432	0	94.11204571	0.188224091	0.188224091	47.05602285	84.70084114	0	39.95997461	0	0	0	9.411204571	23.52801143	23.52801143	23.52801143	28.23361371	0	0.094112046	0	0	0	23.52801143	0	23.52801143	0	0	0												6.4619	0.109940887	4.551625763	0	1.70699155	3.605313996	0.160688822	1.445436393	5.383218109	0	6.241072907	0	0	0	2.813782845	17.08924929	1.564883916	1.776682233	3.379223796	0	1.426962005	0	0	0	1.530613895	0	0.052938026	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3005		3.71	6.4619	0.109940887	4.551625763	0	1.70699155	3.605313996	0.160688822	1.445436393	5.383218109	0	6.241072907	0	0	0	2.813782845	17.08924929	1.564883916	1.776682233	3.379223796	0	1.426962005	0	0	0	1.530613895	0	0.052938026	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3005	NO	$200 Days 1-7	0	0	0	100	0.2	0.2	50	0.2	0	0.2	0	0	0.2	40	40	0	40	0.2	0	0.1	0	0	0	40	0	40	0	0	0												0.7227	0	0	0	0.0955	0.2016	0.009	0.0808	0.8537	0	0.35	0	0	0.1063	0.6294	1.5291	0	0.159	0.3345	0	0.0798	0	0	0	0.137	0	0.0047	0	0	0											5.2932			7.1846	0.109940887	4.551625763	0	1.802453995	3.806938949	0.169675245	1.526271528	6.236928285	0	6.591037123	0	0	0.106318243	3.4432191	18.61837839	1.564883916	1.935657999	3.713746553	0	1.506763972	0	0	0	1.66757171	0	0.057674868	0	0	0	0	0	0	0	0	0	0	0	0	0	64.5937
H3528_801_0	2010	3	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	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	NO	1583.378837	26.93908486	1305.647015	59.79482974	10.6498471	23.30385498	1.03865267	17.14508351	98.67200367	28.10213774	40.44893849	0	0	12.28828511	34.61200307	114.529743	7.153537404	15.44812985	38.66421137	58.42786992	18.44705658	0	0	0	8.543283935	0	0	0	0	0												2010 Mcare defined cost share	2010 Mcare defined cost share	$128/day (Days 21 - 100)	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	50% Days 1 - 999	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	0											148	148	45.34	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.5	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0	0.233	0											NO	148	148	45.34	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.5	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0	0.233	0												19.5283	0.332248713	4.933169639	0	2.481414374	5.42979821	0.242006072	3.994804459	22.99057685	0	9.424602669	0	0	2.863170431	8.064596714	26.68543012	3.576768702	3.599414256	9.008761249	13.61369369	4.298164183	0	0	0	1.990585157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.0575		0	19.5283	0.332248713	4.933169639	0	2.481414374	5.42979821	0.242006072	3.994804459	22.99057685	0	9.424602669	0	0	2.863170431	8.064596714	26.68543012	3.576768702	3.599414256	9.008761249	13.61369369	4.298164183	0	0	0	1.990585157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.0575	NO																																																																																		0			19.5283	0.332248713	4.933169639	0	2.481414374	5.42979821	0.242006072	3.994804459	22.99057685	0	9.424602669	0	0	2.863170431	8.064596714	26.68543012	3.576768702	3.599414256	9.008761249	13.61369369	4.298164183	0	0	0	1.990585157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.0575
H3528_805_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	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	NO	1583.378837	26.93908486	1305.647015	59.79482974	10.6498471	23.30385498	1.03865267	17.14508351	98.67200367	28.10213774	40.44893849	0	0	12.28828511	34.61200307	114.529743	7.153537404	15.44812985	38.66421137	58.42786992	18.44705658	0	0	0	8.543283935	0	0	0	0	0												2010 Mcare defined cost share	2010 Mcare defined cost share	$128/day (Days 21 - 100)	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	50% Days 1 - 999	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	0											148	148	45.34	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.5	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0	0.233	0											NO	148	148	45.34	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.5	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0	0.233	0												19.5283	0.332248713	4.933169639	0	2.481414374	5.42979821	0.242006072	3.994804459	22.99057685	0	9.424602669	0	0	2.863170431	8.064596714	26.68543012	3.576768702	3.599414256	9.008761249	13.61369369	4.298164183	0	0	0	1.990585157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.0575		0	19.5283	0.332248713	4.933169639	0	2.481414374	5.42979821	0.242006072	3.994804459	22.99057685	0	9.424602669	0	0	2.863170431	8.064596714	26.68543012	3.576768702	3.599414256	9.008761249	13.61369369	4.298164183	0	0	0	1.990585157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.0575	NO																																																																																		0			19.5283	0.332248713	4.933169639	0	2.481414374	5.42979821	0.242006072	3.994804459	22.99057685	0	9.424602669	0	0	2.863170431	8.064596714	26.68543012	3.576768702	3.599414256	9.008761249	13.61369369	4.298164183	0	0	0	1.990585157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.0575
H3528_806_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	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	NO	1504.209895	25.59213062	1240.364664	56.80508826	10.11735474	22.13866223	0.986720037	16.28782934	93.73840348	26.69703085	38.42649157	0	0	11.67387086	32.88140291	108.8032559	6.795860534	14.67572336	36.7310008	55.50647643	17.52470375	0	0	0	8.116119738	0	0	0	0	0												2010 Mcare defined cost share	2010 Mcare defined cost share	$128/day (Days 21 - 100)	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	50% Days 1 - 999	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	0											148	148	45.34	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.5	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0	0.233	0											NO	148	148	45.34	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.5	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0	0.233	0												18.5519	0.315636278	4.686511157	0	2.357343655	5.1583083	0.229905769	3.795064236	21.84104801	0	8.953372535	0	0	2.72001191	7.661366878	25.35115862	3.397930267	3.419443543	8.558323187	12.93300901	4.083255974	0	0	0	1.891055899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.9047		0	18.5519	0.315636278	4.686511157	0	2.357343655	5.1583083	0.229905769	3.795064236	21.84104801	0	8.953372535	0	0	2.72001191	7.661366878	25.35115862	3.397930267	3.419443543	8.558323187	12.93300901	4.083255974	0	0	0	1.891055899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.9047	NO	20% Coinsurance	0	0	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	0	0	0												3.105	0	0	0	0.1241	0.2715	0.0121	0.1997	1.1495	0.3274	0.4712	0	0	0.1432	0.4032	1.3343	0	0.18	0.4504	0.6807	0.2149	0	0	0	0.0995	0	0	0	0	0											9.1667		0	21.6569	0.315636278	4.686511157	0	2.481414374	5.42979821	0.242006072	3.994804459	22.99057685	0.327389905	9.424602669	0	0	2.863170431	8.064596714	26.68543012	3.397930267	3.599414256	9.008761249	13.61369369	4.298164183	0	0	0	1.990585157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.0714
H3528_807_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	Coin	Coin	V	Coin	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	NO	1504.209895	25.59213062	1240.364664	56.80508826	10.11735474	22.13866223	0.986720037	16.28782934	93.73840348	26.69703085	38.42649157	0	0	11.67387086	32.88140291	108.8032559	6.795860534	14.67572336	36.7310008	55.50647643	17.52470375	0	0	0	8.116119738	0	0	0	0	0												2010 Mcare defined cost share	2010 Mcare defined cost share	$128/day (Days 21 - 100)	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	50% Days 1 - 999	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	0											148	148	45.34	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.5	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0	0.233	0											NO	148	148	45.34	0	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.5	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0	0.233	0												18.5519	0.315636278	4.686511157	0	2.357343655	5.1583083	0.229905769	3.795064236	21.84104801	0	8.953372535	0	0	2.72001191	7.661366878	25.35115862	3.397930267	3.419443543	8.558323187	12.93300901	4.083255974	0	0	0	1.891055899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.9047			18.5519	0.315636278	4.686511157	0	2.357343655	5.1583083	0.229905769	3.795064236	21.84104801	0	8.953372535	0	0	2.72001191	7.661366878	25.35115862	3.397930267	3.419443543	8.558323187	12.93300901	4.083255974	0	0	0	1.891055899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.9047	NO	20% Coinsurance	0	0	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	20% Coins. After Part B ded.	0	20% Coins. After Part B ded.	0	0	0												3.105	0	0	0	0.1241	0.2715	0.0121	0.1997	1.1495	0.3274	0.4712	0	0	0.1432	0.4032	1.3343	0	0.18	0.4504	0.6807	0.2149	0	0	0	0.0995	0	0	0	0	0											9.1667			21.6569	0.315636278	4.686511157	0	2.481414374	5.42979821	0.242006072	3.994804459	22.99057685	0.327389905	9.424602669	0	0	2.863170431	8.064596714	26.68543012	3.397930267	3.599414256	9.008761249	13.61369369	4.298164183	0	0	0	1.990585157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.0714
H3533_001_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1179.143519	42.11525209	470.3642518	938.1882646	153.2511368	10.59859885	4.403212693	398.1547013	193.4758263	2.83686055	9.21866525	0.319927848	0.146807626	7.766614982	4590.228394	3253.059835	98.1949227	70.01862451	19.63840158	90.43606715	7.271620533	0	0	0	401	5.124751181	0	0	0	0											3200	1a (IP Acute): $395 Copay per day (days -); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $850 Copay per day (days -);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): $15 Copay per visit;	10a (Ambulance): $100 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 0% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $10 Copay per visit; 7i (PT/ST): $10 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 0% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											71.20156718	92.79711139	21.05796869	15	100	0.2	0.091238792	48.77883199	200	0	0.175668124	0.2	0.2	0.198479611	0	10	40	10	0.2	0.021817581	0.2	0	0	0	5	0	0	0	0	0											NO	65.53736314	85.41494561	19.38277198	13.80672485	92.04483235	0.184089665	0.083980593	44.89839413	184.0896647	0	0.16169343	0.184089665	0.184089665	0.182690225	0	9.204483235	36.81793294	9.204483235	0.184089665	0.020081956	0.184089665	0	0	0	5	0	0	0	0	0												6.4398	0.299772664	0.75974692	1.079442269	1.175497933	1.951092508	0.369784414	1.489708892	2.968074999	0	1.490597606	0.05889541	0.027025767	1.418884637	0	2.495227893	0.30127784	0.053707105	3.615226763	1.816133146	1.338630186	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3156	0	2.519215475	6.4398	0.299772664	0.75974692	1.079442269	1.175497933	1.951092508	0.369784414	1.489708892	2.968074999	0	1.490597606	0.05889541	0.027025767	1.418884637	0	2.495227893	0.30127784	0.053707105	3.615226763	1.816133146	1.338630186	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3156	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.4398	0.299772664	0.75974692	1.079442269	1.175497933	1.951092508	0.369784414	1.489708892	2.968074999	0	1.490597606	0.05889541	0.027025767	1.418884637	0	2.495227893	0.30127784	0.053707105	3.615226763	1.816133146	1.338630186	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3156
H3533_002_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	403.6674529	9.928408211	38.15009558	2832.953429	15.08128724	17.27268152	6.527095736	28.72292201	25.54309822	5.916544088	12.12261199	0.693847493	0	12.11105985	4850.628723	3451.903271	359.9896142	1.441369705	21.15999566	103.2065121	16.65898241	0	0	0	412	0.041932871	0	0	0	0												1a (IP Acute): 8.64% Coin MC CS; 1a1 (Add'l Days): 8.64% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.64% Coin MC CS;	2a (SNF): 17.39% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance; Special Duty Nursing benefit as medically necessary;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): 0% Coinsurance; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (4 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): Unlimited	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS) ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 0 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 0 copay; 18a1 (Routine Hearing Exam): 0 copay (1 exam per year);	18b (Hearing Aids): No limit;		13c (OTC Rx): $23.0 OTC per month (cumulative benefit)											0.0864	0.0864	0.1739	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.152103659	0.2	0	0	0	0	0.2	0	0	0	0											NO	0.0864	0.0864	0.1739	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.152103659	0.2	0	0	0	0	0.2	0	0	0	0												34.8769	0.857814469	6.634301621	0	3.016257448	3.454536304	1.305419147	5.744584403	5.108619643	0	2.424522399	0.138769499	0	2.422211969	0	2.876586059	0.299991345	0.288273941	4.231999132	15.69808816	3.331796481	0	0	0	0	0.008386574	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.719	0	0	34.8769	0.857814469	6.634301621	0	3.016257448	3.454536304	1.305419147	5.744584403	5.108619643	0	2.424522399	0.138769499	0	2.422211969	0	2.876586059	0.299991345	0.288273941	4.231999132	15.69808816	3.331796481	0	0	0	0	0.008386574	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.719	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	34.8769	0.857814469	6.634301621	0	3.016257448	3.454536304	1.305419147	5.744584403	5.108619643	0	2.424522399	0.138769499	0	2.422211969	0	2.876586059	0.299991345	0.288273941	4.231999132	15.69808816	3.331796481	0	0	0	0	0.008386574	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.719
H3533_003_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	269.9551813	6.162326119	24.53976989	1721.00226	9.819982052	12.10454735	4.693561964	19.00694697	20.87180169	3.908230974	9.029395832	0.454500999	0.044035782	8.587875675	3947.522784	2805.157279	220.2298071	1.20378166	16.82480747	80.45745831	10.78948012	0	0	0	358	0.039203359	0	0	0	0												1a (IP Acute): 8.64% Coin MC CS; 1a1 (Add'l Days): 8.64% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.64% Coin MC CS;	2a (SNF): 17.39% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 700 allowance (every 3 years);		13c (OTC Rx): $12.5 OTC  per month (cumulative benefit)											0.0864	0.0864	0.1739	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155770086	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0864	0.0864	0.1739	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155770086	0.2	0	0	0	5	0.2	0	0	0	0												23.3241	0.532424977	4.267465984	0	1.96399641	2.42090947	0.938712393	3.801389393	4.174360339	0	1.805879166	0.0909002	0.008807156	1.717575135	0	2.337631066	0.183524839	0.240756332	3.364961493	12.53286518	2.157896024	0	0	0	0.149166667	0.007840672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0212	0	0	23.3241	0.532424977	4.267465984	0	1.96399641	2.42090947	0.938712393	3.801389393	4.174360339	0	1.805879166	0.0909002	0.008807156	1.717575135	0	2.337631066	0.183524839	0.240756332	3.364961493	12.53286518	2.157896024	0	0	0	0.149166667	0.007840672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0212	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.3241	0.532424977	4.267465984	0	1.96399641	2.42090947	0.938712393	3.801389393	4.174360339	0	1.805879166	0.0909002	0.008807156	1.717575135	0	2.337631066	0.183524839	0.240756332	3.364961493	12.53286518	2.157896024	0	0	0	0.149166667	0.007840672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0212
H3533_801_0	2010	3	N/A																															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	NO	232.9972708	4.32505402	21.0834091	24.21150117	8.071249623	12.82802441	5.148678825	17.30552942	28.74664214	3.274119117	10.22658193	0.3607178	0.14836198	8.584042377	28.46987518	34.44916166	0.899077172	1.837800599	22.13935278	102.1359003	7.996045637	0	0	0	0	0	0	0	0	0												FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312
H3597_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1328.970459	62.21194341	743.1517582	578.7602193	184.4489532	6.836978498	0	284.0531996	411.0279132	3060.902577	2539.621659	97.68598834	0.215559354	274.3177644	3858.004443	5432.721743	202.1097775	750.3480154	0	0	278	0	0	0	897.7655628	0	46.81713623	0	108.4290439	0												$125/day 1-5	$125/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$25 per visit	$25 X-ray; $175 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$5 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$110 Every 2 Years	$0 per visit	$750 Every 3 Yrs	Coaching Only	0											76.60484259	76.60484259	47.56208437	0	100	0.2	0.2	47.5	150	3.75	24.6875	25	25	25	5	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											NO	76.60484259	76.60484259	47.56208437	0	100	0.2	0.2	47.5	150	3.75	24.6875	25	25	25	5	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0												8.4838	0.397144678	2.945487218	0	1.53707461	1.3673957	0	1.124377248	5.137848915	0.956532055	5.224742475	0.203512476	0.000449082	0.571495342	1.607501851	11.3181703	0.421062036	1.563225032	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9023	0	0	8.4838	0.397144678	2.945487218	0	1.53707461	1.3673957	0	1.124377248	5.137848915	0.956532055	5.224742475	0.203512476	0.000449082	0.571495342	1.607501851	11.3181703	0.421062036	1.563225032	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9023	NO																																																																																		0			8.4838	0.397144678	2.945487218	0	1.53707461	1.3673957	0	1.124377248	5.137848915	0.956532055	5.224742475	0.203512476	0.000449082	0.571495342	1.607501851	11.3181703	0.421062036	1.563225032	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9023
H3597_002_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1497.59639	70.79245253	1002.168075	685.8314098	225.0186677	8.853710312	0	258.8006523	410.9766697	3305.88086	2818.458048	53.78656631	0.243305919	208.806994	4257.937389	5805.782955	218.1716742	661.0570578	0	0	278	0	0	0	936.9753803	0	60.17572316	0	138.6082164	0												$75/day 1-5	$75/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$20 per visit	$20 X-ray; $175 Complex Radiology	$20 per visit	$20 per visit	$20 per visit	$0 PCP visit; $20 if no PCP selected	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$45 per script	0	Not Covered	0	$0 per visit	$120 Every 2 Years	$0 per visit	$750 Every 3 Yrs	Coaching Only	0											45.96290555	45.96290555	47.56208437	0	100	0.2	0.2	47.5	100	3	22.59375	20	20	20	0	20	20	20	20	20	$45 	0	0	0	0	0	0	0	0	0											NO	45.96290555	45.96290555	47.56208437	0	100	0.2	0.2	47.5	100	3	22.59375	20	20	20	0	20	20	20	20	20	$45 	0	0	0	0	0	0	0	0	0												5.7362	0.271152234	3.972100213	0	1.875155564	1.770742062	0	1.024419249	3.424805581	0.826470215	5.306628044	0.089644277	0.00040551	0.348011657	0	9.676304925	0.363619457	1.101761763	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8299	0	0	5.7362	0.271152234	3.972100213	0	1.875155564	1.770742062	0	1.024419249	3.424805581	0.826470215	5.306628044	0.089644277	0.00040551	0.348011657	0	9.676304925	0.363619457	1.101761763	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8299	NO																							0	0		0		0	0																																								0	0	0											0			5.7362	0.271152234	3.972100213	0	1.875155564	1.770742062	0	1.024419249	3.424805581	0.826470215	5.306628044	0.089644277	0.00040551	0.348011657	0	9.676304925	0.363619457	1.101761763	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8299
H3597_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	273.0379189	4.195844901	36.56609395	5.667204348	7.250080716	9.153680961	0	9.148793675	31.28292627	10.82486058	47.56907263	0.634894364	0.012078442	20.8552842	16.56635704	104.4202808	2.010095861	5.184621981	0	-8.20E-09	54.35205822	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.079735132	0.079735132	0.13928932	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079735132	0.079735132	0.13928932	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.7707	0.334556249	5.093266368	0	1.689268807	2.132807664	0	2.131668926	7.28892182	2.522192514	11.08359392	0.147930387	0.002814277	4.859281218	3.859961191	24.32992543	0.468352336	1.208016921	0	-1.91E-09	12.66402957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5873			21.7707	0.334556249	5.093266368	0	1.689268807	2.132807664	0	2.131668926	7.28892182	2.522192514	11.08359392	0.147930387	0.002814277	4.859281218	3.859961191	24.32992543	0.468352336	1.208016921	0	-1.91E-09	12.66402957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5873	NO																																																																																		0			21.7707	0.334556249	5.093266368	0	1.689268807	2.132807664	0	2.131668926	7.28892182	2.522192514	11.08359392	0.147930387	0.002814277	4.859281218	3.859961191	24.32992543	0.468352336	1.208016921	0	-1.91E-09	12.66402957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5873
H3597_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	272.4637646	4.187021722	36.48920141	5.655287139	7.234834976	9.13443226	0	9.129555251	31.21714336	10.80209766	47.46904261	0.633559284	0.012053043	20.81142893	16.53152069	104.200702	2.005868956	5.173719564	0	-8.18E-09	54.23776469	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.079868687	0.079868687	0.13949005	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079868687	0.079868687	0.13949005	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.7613	0.334411926	5.089880542	0	1.685716549	2.128322716	0	2.127186373	7.273594403	2.516888754	11.06028693	0.147619313	0.002808359	4.84906294	3.85184432	24.27876356	0.467367467	1.205476658	0	-1.91E-09	12.63739917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.418			21.7613	0.334411926	5.089880542	0	1.685716549	2.128322716	0	2.127186373	7.273594403	2.516888754	11.06028693	0.147619313	0.002808359	4.84906294	3.85184432	24.27876356	0.467367467	1.205476658	0	-1.91E-09	12.63739917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.418	NO																																																																																		0			21.7613	0.334411926	5.089880542	0	1.685716549	2.128322716	0	2.127186373	7.273594403	2.516888754	11.06028693	0.147619313	0.002808359	4.84906294	3.85184432	24.27876356	0.467367467	1.205476658	0	-1.91E-09	12.63739917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.418
H3619_001_0	2010	9	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	O	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	YES	1062.580981	36.72038	593.541255	417.254394	38.664407	7.723551	4.07012	320.949541	401.351937	1276.749501	1005.486965	122.339297	0.078088	581.037736	3607.378823	3923.055075	53.453801	623.037964			19.753279	0		1.52					0.04	0.25	7.084726	0.05	0.55	2.34	0.32	0.4	0.49				4700	$195/Day(Days 1-8):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	121.67922	50.7565	0	150	0.2	0.2	50	131.006318	90.365488	104.966072	150	0.2	120.381433	15	35	35	55.413402			0.2	0		0					0	0	0	0	0	0	0	0	0				NO	126.597869	106.58978	29.726712	0	125.664	0.167552	0.167552	41.888	109.751853	75.704591	87.936376	125.664	0.167552	100.850749	12.5664	29.3216	29.3216	46.423131			0.167552	0		0					0	0	0	0	0	0	0	0	0					11.21	0.326168102	1.470335829	0	0.40489367	1.294096417	0.681956746	1.120327864	3.670759899	8.054649899	7.368239985	1.281137118	0.013083801	4.883174239	3.777647103	9.585854307	0.130612581	2.410281085	0	0	3.309701403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.993	0	11.966315	11.21	0.326168102	1.470335829	0	0.40489367	1.294096417	0.681956746	1.120327864	3.670759899	8.054649899	7.368239985	1.281137118	0.013083801	4.883174239	3.777647103	9.585854307	0.130612581	2.410281085	0	0	3.309701403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.993	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.9412	0.0836	0.3073	1.7512	1.7696	1.3984	0.7369	0.216	3.0732	0.3958	1.2798	0.1898	0.0027	0.8242	1.602	2.7558	0.0214	0.2455			0.8848	0		0					0	0	0	0	0	0	0	0	0				24.4792	500	12.177212	18.1513	0.409811102	1.777626829	1.751246	2.17447267	2.692513417	1.418887746	1.336343864	6.743992899	8.450418899	8.648055985	1.470920118	0.015738801	5.707396239	5.379696103	12.34161531	0.152007581	2.655731085	0	0	4.194455403	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4722
H3619_004_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	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	YES	1695.596994	93.747465	877.415859	524.414264	63.253235	10.266401	7.321442	387.748331	395.228715	2330.609024	949.98866	95.033152	0.017062	912.728562	3330.601315	3784.246706	102.956907	592.709478			14.024861	0							0.04	0.25	3.612628	0.05	0.55	2.34	0.32	0.4	0.88				4900	$195/Day(Days 1-8):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	121.67922	50.7565	0	150	0.2	0.2	50	137.655804	115.016122	109.399547	150	0.2	122.733412	15	35	35	62.263657			0.2	0							0	0	0	0	0	0	0	0	0				NO	114.111939	96.077182	21.413254	0	116.9715	0.155962	0.155962	38.9905	107.345373	89.690722	85.310861	116.9715	0.155962	95.708742	11.69715	27.29335	27.29335	48.553822			0.155962	0							0	0	0	0	0	0	0	0	0					16.124	0.750582688	1.565694054	0	0.616568815	1.601168433	1.141866737	1.259875108	3.535497819	17.41950051	6.753695877	0.926347528	0.002661024	7.279675205	3.246545264	8.607064153	0.234169908	2.398192541	0	0	2.187345371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6504	0	22.79622	16.124	0.750582688	1.565694054	0	0.616568815	1.601168433	1.141866737	1.259875108	3.535497819	17.41950051	6.753695877	0.926347528	0.002661024	7.279675205	3.246545264	8.607064153	0.234169908	2.398192541	0	0	2.187345371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6504	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	7.4546	0.137	0.2889	1.8291	2.6563	1.7056	1.2163	0.2395	2.9446	0.8335	1.2047	0.2973	0.0005	1.2793	1.3885	2.509	0.0387	0.22			0.523	0							0	0	0	0	0	0	0	0	0				26.7668	500	18.76508	23.5786	0.887630688	1.854629054	1.82909	3.272903815	3.306777433	2.358214737	1.499340108	6.480125819	18.25303951	7.958368877	1.223666528	0.003193024	8.559005205	4.635092264	11.11609015	0.272862908	2.618240541	0	0	2.710327371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4172
H3619_012_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	O	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	YES	1211.789582	55.199217	659.134064	514.220758	43.263091	9.235222	4.327062	338.76471	420.63528	1441.557877	1045.996516	96.363477	0.043318	592.328149	3676.634583	4228.211296	79.691976	690.756148			18.326014	0		1.52					0.04	0.25	9.505018	0.05	0.55	2.34	0.32	0.4	0.42				4900	$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	143.64207	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	115.154619	15	35	35	54.138383			0.2	0		0					0	0	0	0	0	0	0	0	0				NO	125.805178	125.04114	28.639304	0	125.406	0.167208	0.167208	41.802	110.225252	65.101496	85.652473	125.406	0.167208	96.273867	12.5406	29.2614	29.2614	45.261854			0.167208	0		0					0	0	0	0	0	0	0	0	0					12.7041	0.575181085	1.57309507	0	0.452120932	1.544203	0.723519383	1.180086867	3.863719145	7.820631197	7.466015695	1.007046516	0.007243116	4.752143453	3.842266971	10.31028183	0.194324899	2.60540866	0	0	3.064256149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6857	0	12.767194	12.7041	0.575181085	1.57309507	0	0.452120932	1.544203	0.723519383	1.180086867	3.863719145	7.820631197	7.466015695	1.007046516	0.007243116	4.752143453	3.842266971	10.31028183	0.194324899	2.60540866	0	0	3.064256149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6857	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	7.0776	0.0962	0.31	1.761	1.9204	1.6217	0.7598	0.2211	3.1271	0.4148	1.3311	0.2228	0.0014	0.9056	1.5908	2.7314	0.0271	0.2635			0.7894	0		0					0	0	0	0	0	0	0	0	0				25.1728	500	14.095048	19.7817	0.671342085	1.88304807	1.761002	2.372504932	3.165934	1.483363383	1.401222867	6.990804145	8.235394197	8.797127695	1.229840516	0.008671116	5.657750453	5.433078971	13.04167783	0.221435899	2.86891066	0	0	3.853629149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8585
H3619_013_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	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	YES	1256.039562	57.214884	683.203151	532.998158	44.842896	9.775429	4.58017	351.135118	435.995292	1494.198126	1084.19236	99.882307	0.045851	613.957735	3810.891395	4382.609608	82.602026	715.979955			19.397982	0							0.04	0.25	9.852105	0.05	0.55	2.34	0.32	0.4	0.42				4900	$195/Day(Days 1-8):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	121.67922	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	115.154619	15	35	35	54.138383			0.2	0							0	0	0	0	0	0	0	0	0				NO	124.498719	104.822389	27.690412	0	124.32915	0.165772	0.165772	41.44305	109.278757	64.542475	84.916983	124.32915	0.165772	95.447172	12.432915	29.010135	29.010135	44.873194			0.165772	0							0	0	0	0	0	0	0	0	0					13.0313	0.499783402	1.576514728	0	0.464606595	1.620492416	0.759263941	1.212675854	3.970418631	8.036603766	7.67219535	1.034856861	0.007600812	4.883377461	3.948374066	10.59500803	0.199691327	2.677358952	0	0	3.215642272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4057	0	13.874519	13.0313	0.499783402	1.576514728	0	0.464606595	1.620492416	0.759263941	1.212675854	3.970418631	8.036603766	7.67219535	1.034856861	0.007600812	4.883377461	3.948374066	10.59500803	0.199691327	2.677358952	0	0	3.215642272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4057	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	7.1403	0.097	0.3017	1.8156	1.9389	1.6721	0.7834	0.2233	3.2241	0.4276	1.3724	0.2297	0.0015	0.9337	1.6402	2.8161	0.028	0.2717			0.8139	0							0	0	0	0	0	0	0	0	0				25.7311	500	15.536448	20.1716	0.596796402	1.878167728	1.815643	2.403465595	3.292542416	1.542684941	1.435939854	7.194532631	8.464235766	9.04461035	1.264563861	0.009072812	5.817084461	5.588547066	13.41115403	0.227643327	2.949036952	0	0	4.029508272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1368
H3619_014_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	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	YES	1251.697962	57.017116	680.841605	531.155808	44.687893	9.00751	4.22037	349.921392	434.488241	1489.033313	1080.444763	99.537056	0.042249	611.835543	3797.718749	4367.460772	82.316506	713.505113			17.874153	0		3.44	2.69				0.04	0.25	9.818051	0.05	0.55	2.34	0.32	0.4	0.42				3900	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	115.154619	10	35	35	54.138383			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	100.963557	89.288446	25.520064	0	121.9152	0.162554	0.162554	40.6384	107.157023	63.289331	83.268252	121.9152	0.162554	93.593989	8.12768	28.44688	28.44688	44.001945			0.162554	0		0	0				0	0	0	0	0	0	0	0	0					10.5313	0.424247474	1.447926778	0	0.454011118	1.464206781	0.686038025	1.185020458	3.879872203	7.853326851	7.4972289	1.011256674	0.006867744	4.772010757	2.572220227	10.35338604	0.195137314	2.616301062	0	0	2.905515067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8559	0	14.806164	10.5313	0.424247474	1.447926778	0	0.454011118	1.464206781	0.686038025	1.185020458	3.879872203	7.853326851	7.4972289	1.011256674	0.006867744	4.772010757	2.572220227	10.35338604	0.195137314	2.616301062	0	0	2.905515067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8559	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	7.0373	0.0956	0.3129	1.7326	2.001	1.5956	0.7476	0.2304	3.0767	0.4081	1.3096	0.2192	0.0014	0.891	1.5652	2.6873	0.0267	0.2593			0.7766	0		0	0				0	0	0	0	0	0	0	0	0				24.9741	500	13.556802	17.5687	0.519860474	1.760811778	1.732605	2.454990118	3.059785781	1.433629025	1.415437458	6.956530203	8.261400851	8.8068759	1.230458674	0.008272744	5.663014757	4.137379227	13.04073604	0.221811314	2.875554062	0	0	3.682159067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.83
H3619_015_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	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	YES	1156.206092	52.667288	628.90029	490.634003	41.278659	8.019682	3.757534	323.225936	401.341191	1375.435161	998.017777	91.943387	0.037616	565.158691	3507.991294	4034.267775	76.036591	659.071903			15.913946	0		3.44	2.69				0.04	0.25	9.069033	0.05	0.55	2.34	0.32	0.4	0.42				3900	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	115.154619	10	35	35	54.138383			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	103.868622	91.857578	27.386126	0	124.308	0.165744	0.165744	41.436	109.260168	64.531496	84.902538	124.308	0.165744	95.430936	8.2872	29.0052	29.0052	44.865561			0.165744	0		0	0				0	0	0	0	0	0	0	0	0					10.0078	0.40315746	1.435261882	0	0.427605629	1.329214173	0.622788715	1.116099157	3.654217163	7.396574049	7.061186853	0.952441546	0.006234626	4.494468573	2.422618788	9.751228639	0.183788044	2.464135889	0	0	2.637641066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3665	0	12.391726	10.0078	0.40315746	1.435261882	0	0.427605629	1.329214173	0.622788715	1.116099157	3.654217163	7.396574049	7.061186853	0.952441546	0.006234626	4.494468573	2.422618788	9.751228639	0.183788044	2.464135889	0	0	2.637641066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3665	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.8262	0.0927	0.3275	1.235	1.4797	1.1373	0.5329	0.1704	2.193	0.2909	0.9335	0.1562	0.001	0.6351	1.1156	1.9155	0.019	0.1848			0.5536	0		0	0				0	0	0	0	0	0	0	0	0				19.7997	0	10.438177	16.834	0.49590146	1.762789882	1.234951	1.907313629	2.466497173	1.155650715	1.286490157	5.847171163	7.687437049	7.994664853	1.108682546	0.007236626	5.129550573	3.538219788	11.66669464	0.202800044	2.648923889	0	0	3.191210066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.1661
H3619_016_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	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	YES	1254.708468	57.15425	682.479123	532.433311	44.795373	10.170697	4.765369	350.763001	435.533245	1492.614643	1083.043381	99.776456	0.047705	613.307092	3806.852784	4377.965115	82.514489	715.221191			20.182336	0		3.44	2.69				0.04	0.25	9.841664	0.05	0.55	2.34	0.32	0.4	0.42				3400	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	96.062843	84.954435	22.654656	0	118.1589	0.157545	0.157545	39.3863	103.855433	61.339339	80.702694	118.1589	0.157545	89.813055	7.87726	23.63178	23.63178	39.867259			0.157545	0		0	0				0	0	0	0	0	0	0	0	0					10.0442	0.404625585	1.288444147	0	0.441081	1.602342459	0.750760059	1.151271399	3.769374479	7.629666299	7.28370988	0.982456357	0.007515684	4.590248632	2.498964097	8.62159237	0.162497021	2.376159039	0	0	3.179626125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7846	0	16.719413	10.0442	0.404625585	1.288444147	0	0.441081	1.602342459	0.750760059	1.151271399	3.769374479	7.629666299	7.28370988	0.982456357	0.007515684	4.590248632	2.498964097	8.62159237	0.162497021	2.376159039	0	0	3.179626125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7846	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	7.1765	0.0975	0.2967	1.4487	1.4853	1.3341	0.6251	0.171	2.5725	0.3412	1.095	0.1833	0.0012	0.745	1.3087	2.247	0.0223	0.2168			0.6494	0		0	0				0	0	0	0	0	0	0	0	0				22.0171	0	15.909846	17.2207	0.502129585	1.585133147	1.448674	1.92637	2.936446459	1.375840059	1.322305399	6.341845479	7.970867299	8.37873888	1.165736357	0.008690684	5.335238632	3.807633097	10.86855237	0.184800021	2.592927039	0	0	3.828997125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8017
H3619_017_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	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	YES	1245.183731	56.720381	677.298291	528.391506	44.455323	9.115705	4.271064	348.10029	432.227027	1481.283913	1074.821789	99.019034	0.042757	608.651359	3777.954222	4344.731127	81.888105	709.791807			18.08885	0							0.04	0.25	9.766954	0.05	0.55	1.17	0.32	0.4	0.42				4000	$195/Day(Days 1-8):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	121.67922	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0							0	0	0	0	0	0	0	0	0				NO	118.202282	99.521069	23.277946	0	122.54535	0.163394	0.163394	40.84845	107.710891	63.616458	83.698645	122.54535	0.163394	93.147213	8.16969	24.50907	24.50907	41.347264			0.163394	0							0	0	0	0	0	0	0	0	0					12.2653	0.470406079	1.313842754	0	0.45398276	1.489451503	0.697866231	1.184946441	3.879629849	7.85283632	7.496760613	1.011193515	0.006986237	4.724514815	2.572059569	8.87377661	0.167250108	2.445662436	0	0	2.955609557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8621	0	14.65019	12.2653	0.470406079	1.313842754	0	0.45398276	1.489451503	0.697866231	1.184946441	3.879629849	7.85283632	7.496760613	1.011193515	0.006986237	4.724514815	2.572059569	8.87377661	0.167250108	2.445662436	0	0	2.955609557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8621	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	7.055	0.0959	0.3114	1.7451	1.9811	1.6071	0.753	0.2281	3.0989	0.411	1.3191	0.2208	0.0014	0.8974	1.5765	2.7068	0.0269	0.2611			0.7823	0							0	0	0	0	0	0	0	0	0				25.0789	500	13.824754	19.3203	0.566260079	1.625231754	1.745122	2.43513176	3.096558503	1.450858231	1.413079441	6.978515849	8.26385932	8.815868613	1.231978515	0.008401237	5.621955815	4.148526569	11.58054161	0.194117108	2.706788436	0	0	3.737864557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.941
H3619_801_0	2010	5	N/A																															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	NO	270.728515	0.654007	51.041169	17.107165	1.957866	8.090004	5.380995	20.694653	54.110196	10.054599	28.363644	10.345415	0.640117	18.009634	33.228198	73.488289	0.31321	5.443278			24.893323	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																			0.079819292	0.079819292	0.172806761	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079819292	0.079819292	0.172806761	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.6094	0.052202376	8.82025909	0	0.456182778	1.884970932	1.253771835	4.821854149	12.60767567	2.342721567	6.608729052	2.410481695	0.149147261	4.196244722	7.742170134	17.12277134	0.07297793	1.268283774	0	0	5.800144259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2199	0	0	21.6094	0.052202376	8.82025909	0	0.456182778	1.884970932	1.253771835	4.821854149	12.60767567	2.342721567	6.608729052	2.410481695	0.149147261	4.196244722	7.742170134	17.12277134	0.07297793	1.268283774	0	0	5.800144259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2199	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.0217	0.0097	1.6415	0	1.8247	1.2428	0.8267	1.1509	2.852	0.5921	1.4847	0.5799	0.0394	1.0129	1.4429	3.1902	0.0136	0.2617			1.0794	0																			23.2668	0	0	25.6311	0.06190042	10.46175051	0	2.280922278	3.127792932	2.080455835	5.972757649	15.45971217	2.934774567	8.093405052	2.990418695	0.188524261	5.209095722	9.185022634	20.31300734	0.08660843	1.529942774	0	0	6.879516759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4867
H3619_804_0	2010	4	N/A																															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	NO	270.728515	0.654007	51.041169	17.107165	1.957866	8.090004	5.380995	20.694653	54.110196	10.054599	28.363644	10.345415	0.640117	18.009634	33.228198	73.488289	0.31321	5.443278			24.893323	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																			0.079819292	0.079819292	0.172806761	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079819292	0.079819292	0.172806761	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.6094	0.052202376	8.82025909	0	0.456182778	1.884970932	1.253771835	4.821854149	12.60767567	2.342721567	6.608729052	2.410481695	0.149147261	4.196244722	7.742170134	17.12277134	0.07297793	1.268283774	0	0	5.800144259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2199	0	0	21.6094	0.052202376	8.82025909	0	0.456182778	1.884970932	1.253771835	4.821854149	12.60767567	2.342721567	6.608729052	2.410481695	0.149147261	4.196244722	7.742170134	17.12277134	0.07297793	1.268283774	0	0	5.800144259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2199	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.0217	0.0097	1.6415	0	1.8247	1.2428	0.8267	1.1509	2.852	0.5921	1.4847	0.5799	0.0394	1.0129	1.4429	3.1902	0.0136	0.2617			1.0794	0																			23.2668	0	0	25.6311	0.06190042	10.46175051	0	2.280922278	3.127792932	2.080455835	5.972757649	15.45971217	2.934774567	8.093405052	2.990418695	0.188524261	5.209095722	9.185022634	20.31300734	0.08660843	1.529942774	0	0	6.879516759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4867
H3619_806_0	2010	4	N/A																															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	NO	270.728515	0.654007	51.041169	17.107165	1.957866	8.090004	5.380995	20.694653	54.110196	10.054599	28.363644	10.345415	0.640117	18.009634	33.228198	73.488289	0.31321	5.443278			24.893323	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																			0.079819292	0.079819292	0.172806761	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079819292	0.079819292	0.172806761	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.6094	0.052202376	8.82025909	0	0.456182778	1.884970932	1.253771835	4.821854149	12.60767567	2.342721567	6.608729052	2.410481695	0.149147261	4.196244722	7.742170134	17.12277134	0.07297793	1.268283774	0	0	5.800144259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2199	0	0	21.6094	0.052202376	8.82025909	0	0.456182778	1.884970932	1.253771835	4.821854149	12.60767567	2.342721567	6.608729052	2.410481695	0.149147261	4.196244722	7.742170134	17.12277134	0.07297793	1.268283774	0	0	5.800144259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2199	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.0217	0.0097	1.6415	0	1.8247	1.2428	0.8267	1.1509	2.852	0.5921	1.4847	0.5799	0.0394	1.0129	1.4429	3.1902	0.0136	0.2617			1.0794	0																			23.2668	0	0	25.6311	0.06190042	10.46175051	0	2.280922278	3.127792932	2.080455835	5.972757649	15.45971217	2.934774567	8.093405052	2.990418695	0.188524261	5.209095722	9.185022634	20.31300734	0.08660843	1.529942774	0	0	6.879516759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.4867
H3620_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	V	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	971.9176339	26.61293581	1134.009202	0	99.40258901	9.475503878	3.051030684	317.8263134	36.72940991	2747.434834	935.5021212	0	0	373.1856239	3185.275937	3288.739944	232.9811305	295.5109672	484.5202272	1099.633463	8.588495777	0	0	0	112.9402369	0	2.867611819	0	0	0											3400	$150/Days 1-10 for IP Medical; $150/Days 1-10 for IP Surgical;	$150/Days 1-10 for IP Psych; $150/Days 1-10 for IP Substance Abuse;	$75/Days 11-100	No Cost-Sharing	$125/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care; $40/Visit for Urgent Care - Worldwide;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	$30/Case for OP Fac - Pathology	$30/Case for OP Fac - Radiology; $30/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	$30/Procedure for Prof Radiology (Office);	$35/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; $30/Procedure for Prof Path (Office); $30/Procedure for Prof Path (Labs)	15% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	No Cost-Sharing	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	150	75	0	125	0.2	0.2	48.03082113	0.178	30	30	0	0	10	15	30	30	10	30	31.67537001	0.006416293	0	0	0	30	0	30	0	0	0											NO	139.8202314	139.8202313	69.91011568	0	116.5168595	0.186426975	0.186426975	44.77120348	0.165920008	27.96404627	27.96404627	0	0	9.321348758	13.98202314	27.96404627	27.96404627	9.321348761	27.96404627	29.52571709	0.00598085	0	0	0	27.96404628	0	27.96404619	0	0	0												11.3245	0.31008557	6.606559541	0	0.965173125	1.766489526	0.568794421	1.185788879	6.094143981	6.40244957	2.180035384	0	0	0.289882779	3.711383487	7.663872996	0.542924593	0.229546732	1.129095504	2.705622211	0.051366506	0	0	0	0.263188834	0	0.006682502	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9976	0	3.93135325	11.3245	0.31008557	6.606559541	0	0.965173125	1.766489526	0.568794421	1.185788879	6.094143981	6.40244957	2.180035384	0	0	0.289882779	3.711383487	7.663872996	0.542924593	0.229546732	1.129095504	2.705622211	0.051366506	0	0	0	0.263188834	0	0.006682502	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9976	NO	$250/Days 1-10 for IP Medical; $250/Days 1-10 for IP Surgical;	$250/Days 1-10 for IP Psych; $250/Days 1-10 for IP Substance Abuse;	$100/Day for SNF	$50/Visit for Home Health	$125/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $40/Visit for Urgent Care;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	$40/Case for OP Fac - Pathology	$40/Case for OP Fac - Radiology; $80/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Visit for Prof - CORF; $15/Visit for Prof - CORF;	$30/Visit for PCP - Office Visits; $40/Visit for PCP - Consults; $10/Unit for PCP - Routine Physicals; $10/Visit for PCP - Immunizations;	$40/Visit for Speclst - Office Visits; $40/Visit for Speclst - Consults; $10/Visit for Speclst - Immunizations;	$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $15/Visit for Occ Therapy (Specialist);	$40/Visit for Prof Radiology (Office);	$45/Visit for Chiropractor; $40/Visit for Vision Exams; $40/Visit for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical; $40/Procedure for Prof Path (Office); $40/Visit for Prof Path (Labs)	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$40/Unit for Vision (Refractions)	No Cost-Sharing	$40/Unit for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												2.6904	0.0334	1.5655	0.3372	1.6161	0.4326	0.0709	0.1198	0.7445	0.5449	0.2722	0	0	0.0701	0.6621	1.0672	0.0848	0.3496	0.4463	3.1751	0.0053	0	0	0	0.0299	0	0.0021	0	0	0											14.3196	0	0	14.0148	0.343466975	8.172076579	0.337191127	2.581244907	2.199053738	0.639678038	1.30561085	6.83862961	6.947302291	2.452228245	0	0	0.359967051	4.373501083	8.731058671	0.627676807	0.579113855	1.575354285	5.880716604	0.056674374	0	0	0	0.293047497	0	0.00878046	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3172
H3620_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	220.5089422	2.218196104	55.07705007	0	5.34450145	11.17228165	4.86092944	14.34725327	38.34223063	14.49191484	30.16120747	0	0.297739649	21.95385887	38.59663362	113.3113371	0.99051199	5.163548958	25.47891963	33.49795306	7.889050694	0.852515042	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081607468	0.081607468	0.174455558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999646	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081607468	0.081607468	0.174455558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999646	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.9952	0.181021368	9.608497495	0	1.245268838	2.603141624	1.13259656	3.342910011	8.933739737	3.376616157	7.02756134	0	0.069373338	5.115249118	8.993015633	26.4015014	0.230789294	1.203106907	5.936588274	7.805023063	1.838148812	0.198636005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.238	0	0	17.9952	0.181021368	9.608497495	0	1.245268838	2.603141624	1.13259656	3.342910011	8.933739737	3.376616157	7.02756134	0	0.069373338	5.115249118	8.993015633	26.4015014	0.230789294	1.203106907	5.936588274	7.805023063	1.838148812	0.198636005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.238	NO	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												2.1154	0.0201	0.8511	0	0.4969	0.8673	0.1256	0.3376	0.8167	0.3062	1.236	0	0.0052	0.4923	0.7954	2.324	0.0226	0.0727	3.7565	1.0775	0.1677	0.0174	0	0	0	0	0	0	0	0											15.904	0	0	20.1105	0.201134853	10.4596148	0	1.742216009	3.470400717	1.258171931	3.680505486	9.750475951	3.682784134	8.263521165	0	0.074550673	5.607503851	9.788401471	28.72545924	0.253404077	1.275804779	9.693046635	8.882537037	2.005836851	0.216033178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.1419
H3620_802_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	220.5089422	2.218196104	55.07705007	0	5.34450145	11.17228165	4.86092944	14.34725327	38.34223063	14.49191484	30.16120747	0	0.297739649	21.95385887	38.59663362	113.3113371	0.99051199	5.163548958	25.47891963	33.49795306	7.889050694	0.852515042	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081607468	0.081607468	0.174455558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999646	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081607468	0.081607468	0.174455558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999646	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.9952	0.181021368	9.608497495	0	1.245268838	2.603141624	1.13259656	3.342910011	8.933739737	3.376616157	7.02756134	0	0.069373338	5.115249118	8.993015633	26.4015014	0.230789294	1.203106907	5.936588274	7.805023063	1.838148812	0.198636005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.238	0	0	17.9952	0.181021368	9.608497495	0	1.245268838	2.603141624	1.13259656	3.342910011	8.933739737	3.376616157	7.02756134	0	0.069373338	5.115249118	8.993015633	26.4015014	0.230789294	1.203106907	5.936588274	7.805023063	1.838148812	0.198636005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.238	NO	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												2.1154	0.0201	0.8511	0	0.4969	0.8673	0.1256	0.3376	0.8167	0.3062	1.236	0	0.0052	0.4923	0.7954	2.324	0.0226	0.0727	3.7565	1.0775	0.1677	0.0174	0	0	0	0	0	0	0	0											15.904	0	0	20.1105	0.201134853	10.4596148	0	1.742216009	3.470400717	1.258171931	3.680505486	9.750475951	3.682784134	8.263521165	0	0.074550673	5.607503851	9.788401471	28.72545924	0.253404077	1.275804779	9.693046635	8.882537037	2.005836851	0.216033178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.1419
H3620_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	220.5089422	2.218196104	55.07705007	0	5.34450145	11.17228165	4.86092944	14.34725327	38.34223063	14.49191484	30.16120747	0	0.297739649	21.95385887	38.59663362	113.3113371	0.99051199	5.163548958	25.47891963	33.49795306	7.889050694	0.852515042	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081607468	0.081607468	0.174455558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999646	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081607468	0.081607468	0.174455558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999646	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.9952	0.181021368	9.608497495	0	1.245268838	2.603141624	1.13259656	3.342910011	8.933739737	3.376616157	7.02756134	0	0.069373338	5.115249118	8.993015633	26.4015014	0.230789294	1.203106907	5.936588274	7.805023063	1.838148812	0.198636005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.238	0	0	17.9952	0.181021368	9.608497495	0	1.245268838	2.603141624	1.13259656	3.342910011	8.933739737	3.376616157	7.02756134	0	0.069373338	5.115249118	8.993015633	26.4015014	0.230789294	1.203106907	5.936588274	7.805023063	1.838148812	0.198636005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.238	NO	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												2.1154	0.0201	0.8511	0	0.4969	0.8673	0.1256	0.3376	0.8167	0.3062	1.236	0	0.0052	0.4923	0.7954	2.324	0.0226	0.0727	3.7565	1.0775	0.1677	0.0174	0	0	0	0	0	0	0	0											15.904	0	0	20.1105	0.201134853	10.4596148	0	1.742216009	3.470400717	1.258171931	3.680505486	9.750475951	3.682784134	8.263521165	0	0.074550673	5.607503851	9.788401471	28.72545924	0.253404077	1.275804779	9.693046635	8.882537037	2.005836851	0.216033178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.1419
H3620_805_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	220.5089422	2.218196104	55.07705007	0	5.34450145	11.17228165	4.86092944	14.34725327	38.34223063	14.49191484	30.16120747	0	0.297739649	21.95385887	38.59663362	113.3113371	0.99051199	5.163548958	25.47891963	33.49795306	7.889050694	0.852515042	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081607468	0.081607468	0.174455558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999646	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081607468	0.081607468	0.174455558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999646	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.9952	0.181021368	9.608497495	0	1.245268838	2.603141624	1.13259656	3.342910011	8.933739737	3.376616157	7.02756134	0	0.069373338	5.115249118	8.993015633	26.4015014	0.230789294	1.203106907	5.936588274	7.805023063	1.838148812	0.198636005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.238	0	0	17.9952	0.181021368	9.608497495	0	1.245268838	2.603141624	1.13259656	3.342910011	8.933739737	3.376616157	7.02756134	0	0.069373338	5.115249118	8.993015633	26.4015014	0.230789294	1.203106907	5.936588274	7.805023063	1.838148812	0.198636005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.238	NO	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												2.1154	0.0201	0.8511	0	0.4969	0.8673	0.1256	0.3376	0.8167	0.3062	1.236	0	0.0052	0.4923	0.7954	2.324	0.0226	0.0727	3.7565	1.0775	0.1677	0.0174	0	0	0	0	0	0	0	0											15.904	0	0	20.1105	0.201134853	10.4596148	0	1.742216009	3.470400717	1.258171931	3.680505486	9.750475951	3.682784134	8.263521165	0	0.074550673	5.607503851	9.788401471	28.72545924	0.253404077	1.275804779	9.693046635	8.882537037	2.005836851	0.216033178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.1419
H3620_806_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	220.5089422	2.218196104	55.07705007	0	5.34450145	11.17228165	4.86092944	14.34725327	38.34223063	14.49191484	30.16120747	0	0.297739649	21.95385887	38.59663362	113.3113371	0.99051199	5.163548958	25.47891963	33.49795306	7.889050694	0.852515042	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081607468	0.081607468	0.174455558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999646	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081607468	0.081607468	0.174455558	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999646	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.9952	0.181021368	9.608497495	0	1.245268838	2.603141624	1.13259656	3.342910011	8.933739737	3.376616157	7.02756134	0	0.069373338	5.115249118	8.993015633	26.4015014	0.230789294	1.203106907	5.936588274	7.805023063	1.838148812	0.198636005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.238	0	0	17.9952	0.181021368	9.608497495	0	1.245268838	2.603141624	1.13259656	3.342910011	8.933739737	3.376616157	7.02756134	0	0.069373338	5.115249118	8.993015633	26.4015014	0.230789294	1.203106907	5.936588274	7.805023063	1.838148812	0.198636005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.238	NO	8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												2.1154	0.0201	0.8511	0	0.4969	0.8673	0.1256	0.3376	0.8167	0.3062	1.236	0	0.0052	0.4923	0.7954	2.324	0.0226	0.0727	3.7565	1.0775	0.1677	0.0174	0	0	0	0	0	0	0	0											15.904	0	0	20.1105	0.201134853	10.4596148	0	1.742216009	3.470400717	1.258171931	3.680505486	9.750475951	3.682784134	8.263521165	0	0.074550673	5.607503851	9.788401471	28.72545924	0.253404077	1.275804779	9.693046635	8.882537037	2.005836851	0.216033178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.1419
H3623_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1689.56256	38.84232905	1221.410468	814.6477184	260.0375984	14.75479306	0	382.9874023	405.0861573	3074.720463	2646.287903	49.07981406	0.140972796	527.5194605	3948.945664	5347.518368	203.0977178	574.7366562	0	0	278	0	0	0	651.313617	0	41.47813903	0	104.5871779	0											5000	$200/day 1-5	$200/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$30 per visit	$50 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$15 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$50 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Yrs	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											122.5677481	122.5677481	47.56208437	0	100	0.2	0.2	47.5	200	4.5	36.875	30	25	30	15	30	30	30	50	30	$45 	0	0	0	0	0	0	0	0	0											NO	93.82667596	93.82667596	36.40918876	0	100	0.153101737	0.153101737	47.5	153.1017374	4.5	36.875	30	25	30	15	30	30	30	50	30	$45 	0	0	0	0	0	0	0	0	0												13.2105	0.303703885	3.705880357	0	2.166979986	2.258984453	0	1.515991801	5.168282874	1.153020174	8.131822201	0.122699535	0.000293693	1.318798651	4.93618208	13.36879592	0.507744294	1.436841641	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.349	0	7.55	13.2105	0.303703885	3.705880357	0	2.166979986	2.258984453	0	1.515991801	5.168282874	1.153020174	8.131822201	0.122699535	0.000293693	1.318798651	4.93618208	13.36879592	0.507744294	1.436841641	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.349	NO																																																																																		0			13.2105	0.303703885	3.705880357	0	2.166979986	2.258984453	0	1.515991801	5.168282874	1.153020174	8.131822201	0.122699535	0.000293693	1.318798651	4.93618208	13.36879592	0.507744294	1.436841641	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.349
H3623_003_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1705.456321	126.9012673	1277.270274	1736.287345	244.9422752	17.83222941	0	336.2295155	437.169163	4257.554295	3326.506856	25.67062226	0.14114353	578.4009856	4825.221486	6576.929186	326.37467	921.9903101	0	0	278	0	0	0	807.3207919	0	39.69774762	0	146.3545833	0											2500	$100/day 1-5	$100/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$25 per visit	$50 X-ray; $175 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$0 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$50 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											61.28387407	61.28387407	47.56208437	0	100	0.2	0.2	47.5	150	3.75	36.875	25	25	25	0	25	25	25	50	25	$45 	0	0	0	0	0	0	0	0	0											NO	37.42505548	37.42505548	29.04538385	0	100	0.122136716	0.122136716	47.5	91.60253668	3.75	36.875	25	25	25	0	25	25	25	50	25	$45 	0	0	0	0	0	0	0	0	0												5.3189	0.395773914	3.091567116	0	2.041185626	2.177969932	0	1.330908499	3.337150357	1.330485717	10.22207836	0.053480463	0.000294049	1.205002053	0	13.7019358	0.679947229	1.920813146	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.85	0	9.13	5.3189	0.395773914	3.091567116	0	2.041185626	2.177969932	0	1.330908499	3.337150357	1.330485717	10.22207836	0.053480463	0.000294049	1.205002053	0	13.7019358	0.679947229	1.920813146	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.85	NO																																																																																		0			5.3189	0.395773914	3.091567116	0	2.041185626	2.177969932	0	1.330908499	3.337150357	1.330485717	10.22207836	0.053480463	0.000294049	1.205002053	0	13.7019358	0.679947229	1.920813146	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.85
H3623_004_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1673.62045	75.9030886	1229.423459	672.5287522	223.984528	11.02274878	0	290.3871096	409.7650068	2670.405827	2860.420226	38.6004837	0.249583555	293.671699	4244.941803	6086.683855	227.9356948	545.5996149	0	0	278	0	0	0	855.1885899	0	55.27334796	0	55.08040483	0											5000	$200/day 1-8	$200/day 1-8	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$250 per procedure	$40 per visit	$50 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$20 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$50 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Yrs	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											152.3663772	152.3663772	47.56208437	0	150	0.2	0.2	47.5	250	6	36.875	40	25	40	20	40	40	40	50	40	$45 	0	0	0	0	0	0	0	0	0											NO	103.1057468	103.1057468	32.18508123	0	150	0.135339238	0.135339238	47.5	169.1740472	6	36.875	40	25	40	20	40	40	40	50	40	$45 	0	0	0	0	0	0	0	0	0												14.38	0.652170386	3.29742449	0	2.7998066	1.491810418	0	1.149448975	5.776800385	1.335202913	8.789832985	0.128668279	0.000519966	0.978905663	7.074903005	20.28894618	0.759785649	1.818665383	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7654	0	12.23	14.38	0.652170386	3.29742449	0	2.7998066	1.491810418	0	1.149448975	5.776800385	1.335202913	8.789832985	0.128668279	0.000519966	0.978905663	7.074903005	20.28894618	0.759785649	1.818665383	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7654	NO																																																																																		0			14.38	0.652170386	3.29742449	0	2.7998066	1.491810418	0	1.149448975	5.776800385	1.335202913	8.789832985	0.128668279	0.000519966	0.978905663	7.074903005	20.28894618	0.759785649	1.818665383	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7654
H3623_006_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1745.558697	73.32390504	1120.693002	774.0793083	226.5951918	11.73566137	0	288.000696	390.2103964	2823.436659	2922.683022	63.21522996	0.253634953	387.396896	4281.039485	6330.477189	217.402999	643.9880633	0	0	278	0	0	0	858.0990091	0	50.34819643	0	40.11736171	0											2500	$150/day 1-5	$150/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$25 per visit	$50 X-ray; $125 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$5 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$50 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											91.92581111	91.92581111	47.56208437	0	100	0.2	0.2	47.5	150	3.75	32.125	25	25	25	5	25	25	25	50	25	$45 	0	0	0	0	0	0	0	0	0											NO	55.29934732	55.29934732	28.61168361	0	100	0.120312993	0.120312993	47.5	90.23474472	3.75	32.125	25	25	25	5	25	25	25	50	25	$45 	0	0	0	0	0	0	0	0	0												8.044	0.337897008	2.672076134	0	1.888293265	1.411952544	0	1.140002755	2.934211292	0.882323956	7.824266005	0.131698396	0.000528406	0.807076867	1.783766452	13.18849414	0.452922915	1.341641799	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8837	0	10.2	8.044	0.337897008	2.672076134	0	1.888293265	1.411952544	0	1.140002755	2.934211292	0.882323956	7.824266005	0.131698396	0.000528406	0.807076867	1.783766452	13.18849414	0.452922915	1.341641799	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8837	NO																																																																																		0			8.044	0.337897008	2.672076134	0	1.888293265	1.411952544	0	1.140002755	2.934211292	0.882323956	7.824266005	0.131698396	0.000528406	0.807076867	1.783766452	13.18849414	0.452922915	1.341641799	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8837
H3623_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	352.0075447	5.409391734	47.14195377	7.306306376	9.346991516	11.80116217	0	11.79486136	40.33075739	13.95569014	61.32727837	0.81852223	0.01557184	26.88717162	21.35777584	134.6213259	2.591467556	6.68414871	0	-1.06E-08	70.07207878	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.079364595	0.079364595	0.168223369	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079364595	0.079364595	0.168223369	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												27.9369	0.429314186	7.930378302	0	2.177849023	2.749670786	0	2.748202696	9.397066471	3.251675803	14.28925586	0.19071568	0.003628239	6.264710987	4.97636177	31.36676894	0.603811941	1.557406649	0	-2.46E-09	16.32679435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2005			27.9369	0.429314186	7.930378302	0	2.177849023	2.749670786	0	2.748202696	9.397066471	3.251675803	14.28925586	0.19071568	0.003628239	6.264710987	4.97636177	31.36676894	0.603811941	1.557406649	0	-2.46E-09	16.32679435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2005	NO																																																																																		0			27.9369	0.429314186	7.930378302	0	2.177849023	2.749670786	0	2.748202696	9.397066471	3.251675803	14.28925586	0.19071568	0.003628239	6.264710987	4.97636177	31.36676894	0.603811941	1.557406649	0	-2.46E-09	16.32679435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2005
H3623_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	350.343968	4.528710947	51.26375818	7.080609684	8.506191133	11.56180866	0	11.98596591	38.46320739	16.57354152	57.82369826	0.685261997	0.013036653	25.64213744	25.68904449	132.6956833	2.529504955	6.379942784	0	-8.85E-09	66.11191792	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.079379573	0.079379573	0.168174818	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079379573	0.079379573	0.168174818	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												27.8102	0.359487141	8.621273196	0	1.981942534	2.693901417	0	2.792730058	8.961927323	3.861635173	13.47292169	0.159666045	0.00303754	5.974618024	5.985547367	30.9180942	0.589374654	1.486526669	0	-2.06E-09	15.40407688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.0769			27.8102	0.359487141	8.621273196	0	1.981942534	2.693901417	0	2.792730058	8.961927323	3.861635173	13.47292169	0.159666045	0.00303754	5.974618024	5.985547367	30.9180942	0.589374654	1.486526669	0	-2.06E-09	15.40407688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.0769	NO																																																																																		0			27.8102	0.359487141	8.621273196	0	1.981942534	2.693901417	0	2.792730058	8.961927323	3.861635173	13.47292169	0.159666045	0.00303754	5.974618024	5.985547367	30.9180942	0.589374654	1.486526669	0	-2.06E-09	15.40407688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.0769
H3653_004_0	2010	6	N/A																															A	A	D		T	Coin	Coin	V	V				Coin		V	V	V	V		V					V		V																																																						0	YES	394.9707098	29.80147725	1137.222349		281.6818931	0	14.3963284	492.2732196	495.7845497				0		4799.781673	5947.614129	171.0728443	2177.767547		5066.478433					242.0307648		30.60794428														3400	$350 per admit	$350 per admit	$90 per day after 15 days		$50 per trip	20% Coinsurance	20% Coinsurance	$50 per visit if ER/$25 if UC	$125 per visit				5% Coinsurance		$15 per visit	$25 per visit	$25 per visit	$25 per visit		$25 per visit					$25 per visit		$25 per visit														350	350	90		50	0.2	0.2	50	125				0.05		15	25	25	25		25					25		25														NO	320.2103418	320.2103418	82.33980217		45.74433454	0.182977338	0.182977338	45.74433454	114.3608363				0.045744335		13.72330036	22.87216727	22.87216727	22.87216727		22.87216727					22.87216727		22.87216727															10.5395	0.795228435	7.803221939	0	1.073779229	0	2.634201849	1.876559237	4.724861313	0	0	0	0	0	5.489070464	11.33623544	0.326067226	4.1508553	0	9.656778516	0	0	0	0	0.461314011	0	0.058339168	0	0	0	0	0	0	0	0	0	0	0	0	0	60.926		5.668037884	10.5395	0.795228435	7.803221939	0	1.073779229	0	2.634201849	1.876559237	4.724861313	0	0	0	0	0	5.489070464	11.33623544	0.326067226	4.1508553	0	9.656778516	0	0	0	0	0.461314011	0	0.058339168	0	0	0	0	0	0	0	0	0	0	0	0	0	60.926	NO																																																																																		0			10.5395	0.795228435	7.803221939	0	1.073779229	0	2.634201849	1.876559237	4.724861313	0	0	0	0	0	5.489070464	11.33623544	0.326067226	4.1508553	0	9.656778516	0	0	0	0	0.461314011	0	0.058339168	0	0	0	0	0	0	0	0	0	0	0	0	0	60.926
H3653_015_0	2010	5	N/A																															A	A	D		T	Coin	Coin	V	V	V	V		Coin		V	V	V	V		V					V		V														9.9068	0.1919	1.9023	0.0099	0.2938	0	0.4627	0.9732	1.361	0.7631	1.1312	0.302	0	1.5776	1.4595	4.6799	0.0636	0.4517	0	1.6637	0.057	0.7861			0.0726	0	0.013														28.1226	YES	417.7102486	31.51722941	1354.416693		297.8990863	0	15.22516421	520.6147287	524.3282157	6929.124517	1768.104169		0		5076.118168	6290.034463	180.9219736	2303.147552		5358.169387					255.9651347		32.37012694														3400	$750 per Admission	$750 per Admission	$95 per day after 10 days		$175 per trip	20% Coinsurance	20% Coinsurance	$50 per visit if ER/$25 if UC	$175 per visit	$5 per visit	$15 or $100 per visit routine or advanced respectively.		5% Coinsurance		$20 per visit	$40 per visit	$40 per visit	$40 per visit		$40 per visit					$40 per visit		$40 per visit														750	750	95		175	0.2	0.2	50	175	5	15		0.05		20	40	40	40		40					40		40														NO	624.8113944	624.8113944	79.14277663		145.7893254	0.166616372	0.166616372	41.65409296	145.7893254	4.165409296	12.49622789		0.041654093		16.66163718	33.32327437	33.32327437	33.32327437		33.32327437					33.32327437		33.32327437															21.7492	1.641027005	8.932691482	0	3.619208902	0	2.536761621	1.807144526	6.370121403	2.405219973	1.841219386	0	0	0	7.048036601	17.46704535	0.50240938	6.395701481	0	14.87931238	0	0	0	0	0.710799701	0	0.089889885	0	0	0	0	0	0	0	0	0	0	0	0	0	97.9958	350	16.22869909	31.656	1.832900185	10.8349966	0.009919392	3.912966676	0	2.999481366	2.780302896	7.73110363	3.168314214	2.972438201	0.302016367	0	1.577573064	8.507545276	22.14697469	0.566050061	6.847419644	0	16.5430037	0.056955693	0.786143593	0	0	0.783399595	0	0.102889103	0	0	0	0	0	0	0	0	0	0	0	0	0	126.1184	NO																																																																																		0			31.656	1.832900185	10.8349966	0.009919392	3.912966676	0	2.999481366	2.780302896	7.73110363	3.168314214	2.972438201	0.302016367	0	1.577573064	8.507545276	22.14697469	0.566050061	6.847419644	0	16.5430037	0.056955693	0.786143593	0	0	0.783399595	0	0.102889103	0	0	0	0	0	0	0	0	0	0	0	0	0	126.1184
H3653_018_0	2010	5	N/A																															A	A	D		T	Coin	Coin	V	V				Coin		V	V	V	V		V					V		V																																																						0	YES	394.9425912	29.79935563	1137.141389		281.6618397	0	14.3953035	492.2381738	495.749254				0		4799.439968	5947.190709	171.0606654	2177.612508		5066.117742					242.0135342		30.60576525														3400	$350 per admit	$350 per admit	$75 per day after 15 days		$50 per trip	20% Coinsurance	20% Coinsurance	$50 per visit if ER/$25 if UC	$100 per visit				5% Coinsurance		$15 per visit	$25 per visit	$25 per visit	$25 per visit		$25 per visit					$25 per visit		$25 per visit														350	350	75		50	0.2	0.2	50	100				0.05		15	25	25	25		25					25		25														NO	325.2602746	325.2602746	69.69863027		46.46575351	0.185863014	0.185863014	46.46575351	92.93150703				0.046465754		13.93972605	23.23287676	23.23287676	23.23287676		23.23287676					23.23287676		23.23287676															10.7049	0.807712216	6.604766434	0	1.090635801	0	2.675554496	1.906018138	3.839227107	0	0	0	0	0	5.575239864	11.51419573	0.331185946	4.216016918	0	9.808374095	0	0	0	0	0.468555885	0	0.059254998	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6017		4.533381281	10.7049	0.807712216	6.604766434	0	1.090635801	0	2.675554496	1.906018138	3.839227107	0	0	0	0	0	5.575239864	11.51419573	0.331185946	4.216016918	0	9.808374095	0	0	0	0	0.468555885	0	0.059254998	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6017	NO																																																																																		0			10.7049	0.807712216	6.604766434	0	1.090635801	0	2.675554496	1.906018138	3.839227107	0	0	0	0	0	5.575239864	11.51419573	0.331185946	4.216016918	0	9.808374095	0	0	0	0	0.468555885	0	0.059254998	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6017
H3653_803_0	2010	3	N/A																															A	A	D		T	Coin	Coin	V	V	V	V		Coin		V	V	V	V		V					V		V																																																						0	NO	343.6453249	25.92885517	1114.262736		245.0780862	0	12.52556411	428.3036344	431.3586766	5700.509513	1454.598574		0		4176.062912	5174.737618	148.8423868	1894.772492		4408.103143					210.5795158		26.63052397															$750 per Admission	$750 per Admission	$95 per day after 10 days		$175 per trip	20% Coinsurance	20% Coinsurance	$50 per visit if ER	$175 per visit	$5 per visit	$15 or $100 per visit routine or advanced respectively.		5% Coinsurance		$20 per visit	$40 per visit	$40 per visit	$40 per visit		$40 per visit					$40 per visit		$40 per visit														750	750	95		175	0.2	0.2	50	175	5	15		0.05		20	40	40	40		40					40		40														NO	750	750	95		175	0.2	0.2	50	175	5	15		0.05		20	40	40	40		40					40		40															21.4778	1.620553448	8.821246661	0	3.574055424	0	2.505112823	1.784598477	6.290647367	2.375212297	1.818248217	0	0	0	6.960104853	17.24912539	0.496141289	6.315908307	0	14.69367714	0	0	0	0	0.701931719	0	0.088768413	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7732			21.4778	1.620553448	8.821246661	0	3.574055424	0	2.505112823	1.784598477	6.290647367	2.375212297	1.818248217	0	0	0	6.960104853	17.24912539	0.496141289	6.315908307	0	14.69367714	0	0	0	0	0.701931719	0	0.088768413	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7732	NO																																																																																		0			21.4778	1.620553448	8.821246661	0	3.574055424	0	2.505112823	1.784598477	6.290647367	2.375212297	1.818248217	0	0	0	6.960104853	17.24912539	0.496141289	6.315908307	0	14.69367714	0	0	0	0	0.701931719	0	0.088768413	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7732
H3653_806_0	2010	4	N/A																															A	A	D		T	Coin	Coin	V	V	V	V		Coin		V	V	V	V		V					V		V																																																						0	NO	352.9311822	26.62949514	1144.371933		251.7004959	0	12.86402529	439.8770973	443.0146917	5854.54658	1493.9042		0		4288.906944	5314.56747	152.8643509	1945.972336		4527.217281					216.2697178		27.35012417															$750 per Admission	$750 per Admission	$95 per day after 10 days		$175 per trip	20% Coinsurance	20% Coinsurance	$50 per visit if ER	$175 per visit	$5 per visit	$15 or $100 per visit routine or advanced respectively.		5% Coinsurance		$20 per visit	$40 per visit	$40 per visit	$40 per visit		$40 per visit					$40 per visit		$40 per visit														750	750	95		175	0.2	0.2	50	175	5	15		0.05		20	40	40	40		40					40		40														NO	750	750	95		175	0.2	0.2	50	175	5	15		0.05		20	40	40	40		40					40		40															22.0582	1.664343446	9.059611136	0	3.670632232	0	2.572805058	1.832821239	6.460630921	2.439394408	1.86738025	0	0	0	7.14817824	17.7152249	0.509547836	6.486574453	0	15.09072427	0	0	0	0	0.720899059	0	0.091167081	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3881			22.0582	1.664343446	9.059611136	0	3.670632232	0	2.572805058	1.832821239	6.460630921	2.439394408	1.86738025	0	0	0	7.14817824	17.7152249	0.509547836	6.486574453	0	15.09072427	0	0	0	0	0.720899059	0	0.091167081	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3881	NO																																																																																		0			22.0582	1.664343446	9.059611136	0	3.670632232	0	2.572805058	1.832821239	6.460630921	2.439394408	1.86738025	0	0	0	7.14817824	17.7152249	0.509547836	6.486574453	0	15.09072427	0	0	0	0	0.720899059	0	0.091167081	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3881
H3653_809_0	2010	4	N/A																															A	A	D		T	Coin	Coin	V	V	V	V		Coin		V	V	V	V		V					V		V																																																						0	NO	345.3345233	26.0563092	1119.739926		246.2827746	0	12.58713388	430.4089732	433.4790325	5728.530531	1461.748694		0		4196.590468	5200.174189	149.5740258	1904.0863		4429.7713					211.6146254		26.76142708															$750 per Admission	$750 per Admission	$95 per day after 10 days		$175 per trip	20% Coinsurance	20% Coinsurance	$50 per visit if ER	$175 per visit	$5 per visit	$15 or $100 per visit routine or advanced respectively.		5% Coinsurance		$20 per visit	$40 per visit	$40 per visit	$40 per visit		$40 per visit					$40 per visit		$40 per visit														750	750	95		175	0.2	0.2	50	175	5	15		0.05		20	40	40	40		40					40		40														NO	750	750	95		175	0.2	0.2	50	175	5	15		0.05		20	40	40	40		40					40		40															21.5834	1.628519325	8.864607751	0	3.591623796	0	2.517426777	1.793370722	6.321569224	2.386887721	1.827185868	0	0	0	6.994317447	17.33391396	0.498580086	6.346954335	0	14.76590433	0	0	0	0	0.705382085	0	0.089204757	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2489			21.5834	1.628519325	8.864607751	0	3.591623796	0	2.517426777	1.793370722	6.321569224	2.386887721	1.827185868	0	0	0	6.994317447	17.33391396	0.498580086	6.346954335	0	14.76590433	0	0	0	0	0.705382085	0	0.089204757	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2489	NO																																																																																		0			21.5834	1.628519325	8.864607751	0	3.591623796	0	2.517426777	1.793370722	6.321569224	2.386887721	1.827185868	0	0	0	6.994317447	17.33391396	0.498580086	6.346954335	0	14.76590433	0	0	0	0	0.705382085	0	0.089204757	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2489
H3655_013_0	2010	10	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Partial Hospitalization	Ambulatory Surgical Center	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	2294.478871	64.96823199	1144.526184	922.3391583	411.6719406	14.08465587	1.545180242	363.1078595	262.4629424	5839.546631	918.8436515	89.68010157	0.078305438	198.2604925	4493.815983	4464.910585	28.2927593	1981.260622	3046.648981	0	47.48142322	0	0	0	302.4	239.2	162	0	0	0	0	0.537739509	170.9515098	138.6789556	619.2996984	89.1119023	0.761954439	827.2439543	34.25352072	14.84549183		$225/day (days1-8) w/$1800 yrly max	$225/day (days1-8) w/$1800 yrly max	$128/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$40 copay	$25 coapy	$40 copay	$40 copay	$50/$40 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$40 copay	$40 copay	$40 copay		Silver Sneakers		$40 copay	$40 copay	$200 copay	$40 copay	$40 copay	$0 copay	20% coinsurance	$40 copay	$40 copay	20% coinsurance	225	225	128	0	125	0.2	0.2	50	200	0	91.92595262	200	0.2	40	25	40	40	47.65333333	79.09709364	0	0.2	0	0	0	40	40	40	0	0	0	40	40	200	40	40	0	0.2	40	40	0.2	NO	110.6855484	92.72203329	109.1609386	0	106.6024791	0.170563967	0.170563967	42.64099163	170.5639665	0	78.39627552	170.5639665	0.170563967	34.1127933	21.32049581	34.1127933	34.1127933	39.64134297	67.45557015	0	0.170563967	0	0	0	40	40	40	0	0	0	0	34.1127933	170.5639665	34.1127933	34.1127933	0	0.170563967	34.1127933	34.1127933	0.170563967		21.1638	0.501998881	10.4114627	0	3.657104119	2.402334773	0.263552071	1.290273267	3.730560043	0	6.002826672	1.27468282	0.013356086	0.5636016	7.984198738	12.69254766	0.080428754	6.544985985	17.12612034	0	8.098619879	0	0	0	1.008	0.797333333	0.54	0	0	0	0	0.00152865	2.429847299	0.394227212	1.76050355	0	0.129961971	2.351633502	0.097373606	2.532105972	115.845		19.93043712	21.1638	0.501998881	10.4114627	0	3.657104119	2.402334773	0.263552071	1.290273267	3.730560043	0	6.002826672	1.27468282	0.013356086	0.5636016	7.984198738	12.69254766	0.080428754	6.544985985	17.12612034	0	8.098619879	0	0	0	1.008	0.797333333	0.54	0	0	0	0	0.00152865	2.429847299	0.394227212	1.76050355	0	0.129961971	2.351633502	0.097373606	2.532105972	115.845	YES																																									3400																																									0			21.1638	0.501998881	10.4114627	0	3.657104119	2.402334773	0.263552071	1.290273267	3.730560043	0	6.002826672	1.27468282	0.013356086	0.5636016	7.984198738	12.69254766	0.080428754	6.544985985	17.12612034	0	8.098619879	0	0	0	1.008	0.797333333	0.54	0	0	0	0	0.00152865	2.429847299	0.394227212	1.76050355	0	0.129961971	2.351633502	0.097373606	2.532105972	115.845
H3655_030_0	2010	9	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Partial Hospitalization	Ambulatory Surgical Center	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	2294.330763	64.96403831	1144.452305	922.2796215	411.6453673	14.03298068	1.53951113	363.0846933	262.4460005	5839.16969	918.7843404	89.67431275	0.078018143	198.2476948	4493.525909	4464.622376	28.29093301	1981.132732	3046.452321	0	46.41008033	0	0	1572.93321	378	299	162	0	0	0	0	0.537704798	170.9404749	138.6700039	619.2597228	89.10615016	0.759158904	827.190556	34.25130966	14.7910252		$190/day (days 1-7)w/$1330 yrly max	$190/day (days 1-7)w/$1330 yrly max	$128/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$175 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$175 copay	20% coinsurance	$20 copay	$15 coapy	$20 copay	$40 copay	$40/$20 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance			"$0 deduct, 1 exam/2cleanings"	$20 copay 1/yr $100 limit	$20 copay 1/yr $125 limit	$20 copay 1/yr $100 limit		Silver Sneakers		$20 copay	$40 copay	$175 copay	$20 copay	$20 copay	$0 copay	20% coinsurance	$20 copay	$20 copay	20% coinsurance	190	190	128	0	125	0.2	0.2	50	175	0	91.92001883	175	0.2	20	15	20	40	35.3079476	79.09198794	0	0.2	0	0	0	20	20	20	0	0	0	20	40	175	20	20	0	0.2	20	20	0.2	NO	87.74490534	71.1977536	110.0639087	0	107.4842859	0.171974857	0.171974857	42.99371435	150.4780002	0	79.03966066	150.4780002	0.171974857	17.19748574	12.89811431	17.19748574	34.39497148	30.36039627	68.00916674	0	0.171974857	0	0	0	20	20	20	0	0	0	0	34.39497148	150.4780002	17.19748574	17.19748574	0	0.171974857	17.19748574	17.19748574	0.171974857		16.7763	0.385441133	10.49690784	0	3.687117362	2.413319851	0.264757207	1.300863299	3.29102911	0	6.051700207	1.124500938	0.013417159	0.284113492	4.829834234	6.398356638	0.08108882	5.012331233	17.26555699	0	7.981366948	0	0	0	0.63	0.498333333	0.27	0	0	0	0	0.001541195	2.143565068	0.198731285	0.887475854	0	0.130556244	1.185466483	0.049086367	2.54368445	96.1965		15.6418489	16.7763	0.385441133	10.49690784	0	3.687117362	2.413319851	0.264757207	1.300863299	3.29102911	0	6.051700207	1.124500938	0.013417159	0.284113492	4.829834234	6.398356638	0.08108882	5.012331233	17.26555699	0	7.981366948	0	0	0	0.63	0.498333333	0.27	0	0	0	0	0.001541195	2.143565068	0.198731285	0.887475854	0	0.130556244	1.185466483	0.049086367	2.54368445	96.1965	YES																																									3000																								0	0	0	0	0													0			16.7763	0.385441133	10.49690784	0	3.687117362	2.413319851	0.264757207	1.300863299	3.29102911	0	6.051700207	1.124500938	0.013417159	0.284113492	4.829834234	6.398356638	0.08108882	5.012331233	17.26555699	0	7.981366948	0	0	0	0.63	0.498333333	0.27	0	0	0	0	0.001541195	2.143565068	0.198731285	0.887475854	0	0.130556244	1.185466483	0.049086367	2.54368445	96.1965
H3655_031_0	2010	9	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Partial Hospitalization	Ambulatory Surgical Center	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	2306.926925	43.33670898	1229.728215	972.6538096	406.8777665	14.13973055	1.454008926	373.8687146	215.4781294	6703.734822	731.3656047	76.02616035	0.014063304	102.4990146	5057.76396	4071.839319	9.575488262	2389.747005	3368.37407	0	49.14550444	0	0	0	302.4	239.2	129.6	0	0	0	0	0	213.0175997	193.4434074	884.7572466	72.47645088	0.802725165	847.4169642	43.8229703	13.10626492		$260/day (days 1-8)w/$2080 yrly max	$260/day (days 1-8)w/$2080 yrly max	$128/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$0 copay	$100/$175 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$45 copay	$0 coapy	$45 copay	$40 copay	$50/$45 OP/PR copay	$100/$175 copay for Lower/Higher Tier		20% coinsurance				$45 copay 1/yr $50 limit	$45 copay 1/yr $75 limit	$45 copay 1/yr $50 limit		Silver Sneakers		$45 copay	$40 copay	$250 copay	$45 copay	$45 copay	$0 copay	20% coinsurance	$45 copay	$45 copay	20% coinsurance	260	260	128	0	125	0.2	0.2	50	250	0	128.3318134	250	0.2	45	0	45	40	48.00190129	106.2328205	0	0.2	0	0	0	45	45	45	0	0	0	45	40	250	45	45	0	0.2	45	45	0.2	NO	126.9881233	115.7950889	108.1402475	0	105.6057104	0.168969137	0.168969137	42.24228417	211.2114208	0	108.4205786	211.2114208	0.168969137	38.01805575	0	38.01805575	33.79382733	40.5541991	89.75033984	0	0.168969137	0	0	0	45	45	45	0	0	0	0	0	211.2114208	38.01805575	38.01805575	0	0.168969137	38.01805575	38.01805575	0.168969137		24.4127	0.418181506	11.08192612	0	3.580717965	2.389178064	0.245682633	1.31608904	3.792620156	0	6.607923503	1.338132779	0.002376264	0.324734438	0	12.90028452	0.026966033	8.076189654	25.19272646	0	8.304073457	0	0	0	1.134	0.897	0.486	0	0	0	0	0	3.749312492	0.612861854	2.803062527	0	0.135635778	2.684762116	0.138838677	2.214554268	124.8665		22.85705589	24.4127	0.418181506	11.08192612	0	3.580717965	2.389178064	0.245682633	1.31608904	3.792620156	0	6.607923503	1.338132779	0.002376264	0.324734438	0	12.90028452	0.026966033	8.076189654	25.19272646	0	8.304073457	0	0	0	1.134	0.897	0.486	0	0	0	0	0	3.749312492	0.612861854	2.803062527	0	0.135635778	2.684762116	0.138838677	2.214554268	124.8665	YES																																									3400																								0	0	0	0	0													0			24.4127	0.418181506	11.08192612	0	3.580717965	2.389178064	0.245682633	1.31608904	3.792620156	0	6.607923503	1.338132779	0.002376264	0.324734438	0	12.90028452	0.026966033	8.076189654	25.19272646	0	8.304073457	0	0	0	1.134	0.897	0.486	0	0	0	0	0	3.749312492	0.612861854	2.803062527	0	0.135635778	2.684762116	0.138838677	2.214554268	124.8665
H3655_801_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	299.6427035	3.587713605	53.39333762	9.934930872	11.58437994	14.60936349	1.470360748	16.41826811	51.15605177	8.643965705	27.08272454	0	0.293945394	36.31269423	42.82615912	123.8063328	1.29433375	6.172503928	32.45998273	38.55309528	65.55542066	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.080862897	0.080862897	0.171981517	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080862897	0.080862897	0.171981517	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				24.23	0.290112915	9.182667209	0	2.699160527	3.403981693	0.342594054	3.825456469	11.91936006	2.014044009	6.310274819	0	0.068489277	8.460857755	9.978495074	28.84687554	0.301579764	1.438193415	7.563175977	8.9828712	15.27441301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.1326			24.23	0.290112915	9.182667209	0	2.699160527	3.403981693	0.342594054	3.825456469	11.91936006	2.014044009	6.310274819	0	0.068489277	8.460857755	9.978495074	28.84687554	0.301579764	1.438193415	7.563175977	8.9828712	15.27441301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.1326	NO																																																																																		0			24.23	0.290112915	9.182667209	0	2.699160527	3.403981693	0.342594054	3.825456469	11.91936006	2.014044009	6.310274819	0	0.068489277	8.460857755	9.978495074	28.84687554	0.301579764	1.438193415	7.563175977	8.9828712	15.27441301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.1326
H3655_803_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	270.0197577	3.233029027	48.11482448	8.952754715	10.43913778	14.40869207	0.081376234	14.79514343	46.09871871	7.789415519	24.40530216	0	0.264885689	32.72278878	38.5923267	111.5667279	1.166374757	5.562284665	29.25095979	34.74170178	59.07455311	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.080134373	0.080134373	0.167282051	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080134373	0.080134373	0.167282051	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				21.6379	0.259076753	8.048746536	0	2.432319102	3.357225253	0.018960663	3.447268419	10.74100146	1.814933816	5.686435403	0	0.061718366	7.624409785	8.992012121	25.99504761	0.271765318	1.296012327	6.815473631	8.094816514	13.76437087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.3595			21.6379	0.259076753	8.048746536	0	2.432319102	3.357225253	0.018960663	3.447268419	10.74100146	1.814933816	5.686435403	0	0.061718366	7.624409785	8.992012121	25.99504761	0.271765318	1.296012327	6.815473631	8.094816514	13.76437087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.3595	NO																																																																																		0			21.6379	0.259076753	8.048746536	0	2.432319102	3.357225253	0.018960663	3.447268419	10.74100146	1.814933816	5.686435403	0	0.061718366	7.624409785	8.992012121	25.99504761	0.271765318	1.296012327	6.815473631	8.094816514	13.76437087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.3595
H3655_804_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	299.6427035	3.587713605	53.39333762	9.934930872	11.58437994	14.60936349	1.470360748	16.41826811	51.15605177	8.643965705	27.08272454	0	0.293945394	36.31269423	42.82615912	123.8063328	1.29433375	6.172503928	32.45998273	38.55309528	65.55542066	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.080862897	0.080862897	0.171981517	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080862897	0.080862897	0.171981517	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				24.23	0.290112915	9.182667209	0	2.699160527	3.403981693	0.342594054	3.825456469	11.91936006	2.014044009	6.310274819	0	0.068489277	8.460857755	9.978495074	28.84687554	0.301579764	1.438193415	7.563175977	8.9828712	15.27441301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.1326			24.23	0.290112915	9.182667209	0	2.699160527	3.403981693	0.342594054	3.825456469	11.91936006	2.014044009	6.310274819	0	0.068489277	8.460857755	9.978495074	28.84687554	0.301579764	1.438193415	7.563175977	8.9828712	15.27441301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.1326	NO																																																																																		0			24.23	0.290112915	9.182667209	0	2.699160527	3.403981693	0.342594054	3.825456469	11.91936006	2.014044009	6.310274819	0	0.068489277	8.460857755	9.978495074	28.84687554	0.301579764	1.438193415	7.563175977	8.9828712	15.27441301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.1326
H3659_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1749.01902	142.8508775	1547.060681	2203.7466	391.6165004	10.06798542	7.440597275	334.6767163	33.18033117	9818.319538	38.66118201	0	0.109040692	15.30299571	5687.088245	5006.722082	640.8310015	358.0723241	0	0	31.07639705	853.7166644	0	0	396.6063765	0	17.32073196	3.462664666	106.6794894	0												"$275 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$115 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$25 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											190.6084929	140.5472438	83.9614622	0	150	0.2	0.112351577	49.59675054	0.2	3	0.177083491	0	0.2	0.151139704	16.80833968	39.91484278	38.5	40	0	0	0.2	39.52806879	0	0	40	0	0	0	0	0											NO	148.687889	109.6366309	65.49578346	0	117.0104386	0.156013918	0.087642048	38.6889169	0.156013918	2.340208772	0.138137447	0	0.156013918	0.118283108	16.72512855	39.91484278	38.5	31.20278363	0	0	0.156013918	39.52806879	0	0	40	0	0	0	0	0												21.6715	1.305140745	8.443829279	0	3.818601541	1.570745853	0.652109186	1.079023305	5.176593471	1.914743126	5.340556967	0	0.017011866	1.810085895	7.926440164	16.65354373	2.055999463	0.931071104	0	0	4.848350466	2.812147586	0	0	1.322021255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3495	0	16.54759329	21.6715	1.305140745	8.443829279	0	3.818601541	1.570745853	0.652109186	1.079023305	5.176593471	1.914743126	5.340556967	0	0.017011866	1.810085895	7.926440164	16.65354373	2.055999463	0.931071104	0	0	4.848350466	2.812147586	0	0	1.322021255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3495	YES	"$325 Days 1-13 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-13 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-24 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$32 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$32 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											4200	1.1717	0.0822	0.3897	0.1439	0.1385	0.0855	0.0632	0.0498	0.2816	0.0694	0.2843	0	0.0006	0.0976	0.4568	0.7784	0.0968	0.0436	0	0	0.303	0.1319	0	0	0.062	0	0.0027	0	0	0											4.7333	0	0.898080468	22.8432	1.387361232	8.833480166	0.143941311	3.957100042	1.656200938	0.715263517	1.128833782	5.458221613	1.984189768	5.624871661	0	0.017628876	1.907645716	8.383275192	17.43193464	2.152791646	0.974715062	0	0	5.15137237	2.944087271	0	0	1.383991001	0	0.002706364	0	0	0	0	0	0	0	0	0	0	0	0	0	94.0828
H3659_003_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1878.976922	113.51112	978.953137	1175.597079	356.4947969	6.995863222	7.811614004	358.1689675	320.4489652	8815.235041	37.33198469	0	0.272728501	749.0627526	6023.634158	5058.910761	606.4929073	577.7229629	0	0	15.80506179	1060.644473	0	0	293.5430234	0	18.17205577	1.902966232	498.0613877	0											2940	"$175 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-33 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $150 (9a); $40/$30 (9c)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											159.8021949	122.8528282	73.67455787	0	150	0.2	0.124558403	49.73159403	150	3	0.176284998	0	0.2	58.79605234	7.206543438	25	38.5	25	0	0	0.2	24.47735365	0	0	25	0	0	0	0	0											NO	129.1196426	91.74501607	67.21091867	0	112.0181978	0.149357597	0.093018719	37.1389569	112.0181978	2.240363956	0.131647519	0	0.149357597	44.00133793	7.154730439	25	38.5	18.66969963	0	0	0.149357597	24.47735365	0	0	25	0	0	0	0	0												20.2177	0.867839961	5.483028306	0	3.327825389	1.04488532	0.726626329	1.108501821	2.991342963	1.645777904	4.914663148	0	0.040734074	2.746646942	3.591456555	10.53939742	1.945831411	0.898826182	0	0	2.36060605	2.163480823	0	0	0.611547965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2268	0	16.42065718	20.2177	0.867839961	5.483028306	0	3.327825389	1.04488532	0.726626329	1.108501821	2.991342963	1.645777904	4.914663148	0	0.040734074	2.746646942	3.591456555	10.53939742	1.945831411	0.898826182	0	0	2.36060605	2.163480823	0	0	0.611547965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2268	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.2177	0.867839961	5.483028306	0	3.327825389	1.04488532	0.726626329	1.108501821	2.991342963	1.645777904	4.914663148	0	0.040734074	2.746646942	3.591456555	10.53939742	1.945831411	0.898826182	0	0	2.36060605	2.163480823	0	0	0.611547965	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2268
H3659_031_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1679.225042	133.7135292	1158.474932	1622.713649	335.9450612	8.725976427	7.863277049	328.8087601	28.72170131	8689.387564	38.35629138	0	0.413670214	18.9924335	5611.755048	4501.56923	617.5847619	280.5729174	0	0	24.74793547	792.5846226	0	0	372.3013921	0	17.71998539	4.727367507	490.9189715	0											3400	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$15 (8a1); $15 (8a2)	"$25 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	74.36970205	0	150	0.2	0.119833387	49.6295568	0.2	4.5	0.192530699	0	0.2	0.150282962	13.58895872	35	38.5	35	0	0	0.2	34.43939656	0	0	35	0	0	0	0	0											NO	128.8058805	98.10128544	57.77033163	0	116.5198933	0.155359858	0.093086489	38.5522044	0.155359858	3.495596798	0.14955771	0	0.155359858	0.117007265	13.51442102	35	38.5	27.18797509	0	0	0.155359858	34.43939656	0	0	35	0	0	0	0	0												18.0245	1.093122424	5.577123417	0	3.262023556	1.355666456	0.731964856	1.056358544	4.462199428	2.531216278	5.736479094	0	0.064267746	2.222252706	6.319968365	13.12957692	1.981417778	0.635684124	0	0	3.844835733	2.27467801	0	0	1.08587906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3892	0	14.56674591	18.0245	1.093122424	5.577123417	0	3.262023556	1.355666456	0.731964856	1.056358544	4.462199428	2.531216278	5.736479094	0	0.064267746	2.222252706	6.319968365	13.12957692	1.981417778	0.635684124	0	0	3.844835733	2.27467801	0	0	1.08587906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3892	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.0245	1.093122424	5.577123417	0	3.262023556	1.355666456	0.731964856	1.056358544	4.462199428	2.531216278	5.736479094	0	0.064267746	2.222252706	6.319968365	13.12957692	1.981417778	0.635684124	0	0	3.844835733	2.27467801	0	0	1.08587906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.3892
H3659_054_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1734.137623	130.3715865	966.5880587	1374.349983	317.902164	7.684741539	7.021201316	317.9924587	27.91420787	8893.267788	43.24887918	0	0.363184177	18.80007218	5527.10357	4593.744548	620.5518621	298.855217	0	0	35.90054828	835.8434273	0	0	376.2471823	0	18.04091673	0	106.8732907	0											2940	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-30 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$15 (8a1); $15 (8a2)	"$25 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	78.51794483	0	150	0.2	0.129000445	49.58047304	0.2	4.5	0.189003879	0	0.2	0.150480816	10.16133121	34.99772375	38.5	35	0	0	0.2	34.44887019	0	0	35	0	35	0	0	0											NO	132.9494698	101.2571308	72.16095091	0	108.2414264	0.144321902	0.093087948	35.77774081	0.144321902	3.247242791	0.136386996	0	0.144321902	0.108931939	10.05794857	34.99772375	38.5	25.25633282	0	0	0.144321902	34.44887019	0	0	35	0	35	0	0	0												19.2127	1.100087732	5.812492788	0	2.867515306	1.109076514	0.653589224	0.948087647	4.028631567	2.406549976	5.898584731	0	0.052415431	2.047928322	4.632610289	13.39755022	1.990937224	0.628998902	0	0	5.181235403	2.399488477	0	0	1.097387615	0	0.05261934	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5185	0	20.07970805	19.2127	1.100087732	5.812492788	0	2.867515306	1.109076514	0.653589224	0.948087647	4.028631567	2.406549976	5.898584731	0	0.052415431	2.047928322	4.632610289	13.39755022	1.990937224	0.628998902	0	0	5.181235403	2.399488477	0	0	1.097387615	0	0.05261934	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5185	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.2127	1.100087732	5.812492788	0	2.867515306	1.109076514	0.653589224	0.948087647	4.028631567	2.406549976	5.898584731	0	0.052415431	2.047928322	4.632610289	13.39755022	1.990937224	0.628998902	0	0	5.181235403	2.399488477	0	0	1.097387615	0	0.05261934	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5185
H3659_056_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.7451	0.7084	0.6132	0	1.5468	0	1.6811	0	0.0508	0.9277	1.1006	5.2941	0.3798	0.1656	0	0	1.0136	0.1309	0	0	0	0	0	0	0	0											14.3575	NO	461.1302703	22.79917033	86.59160531	3558.360193	22.01801574	20.93344576	18.12125454	34.68476884	45.71137267	17.577498	49.6785737	0	1.50016068	27.41424324	35.33053212	156.4566662	11.22265147	4.89366772	0	0	29.95248505	4.458735914	494.2417653	175.9226447	272.8707577	195.5539481	0	0	80.07513483	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078268115	0.07921874	0.170817183	0	0.193232216	0.193232216	0.193232216	0.106663666	0.193232216	0	0.161362507	0	0.193232216	0.145310541	0.163361943	0.193222392	0.193232216	0	0	0	0.193232216	0.193010818	0	0	0	0	0	0	0	0											NO	0.075619606	0.076538063	0.165036914	0	0.193232216	0.193232216	0.193232216	0.103054283	0.193232216	0	0.161362507	0	0.193232216	0.145310541	0.163361943	0.193222392	0.193232216	0	0	0	0.193232216	0.192582462	0	0	0	0	0	0	0	0												34.8705	1.745004338	14.2908113	0	4.254589968	4.045016107	3.501610167	3.574413966	8.832909825	0	8.016259183	0	0.289879372	3.983578508	5.771664391	30.23093134	2.16857781	0	0	0	5.787785052	0.85867434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2222	146	0	34.8705	1.745004338	14.2908113	0	4.999655872	4.753381332	4.114813875	3.574413966	10.37973337	0	9.697328533	0	0.340643191	4.91124693	6.872293763	35.52498703	2.548340231	0.165596437	0	0	6.801344839	0.98961208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.5797	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	34.8705	1.745004338	14.2908113	0	4.999655872	4.753381332	4.114813875	3.574413966	10.37973337	0	9.697328533	0	0.340643191	4.91124693	6.872293763	35.52498703	2.548340231	0.165596437	0	0	6.801344839	0.98961208	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.5797
H3659_058_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	322.9082035	35.79985902	11242.08918	210.4918491	26.43000833	13.36529652	19.70377206	18.56930764	6.032232397	39.72523652	26.0104952	0	0.016951761	8.971674948	0.902577011	108.6701458	16.65257154	26.92856416	0	0	1.211023366	9.140142435	1655.106931	0	109.0184716	193.1751715	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07885147	0.079809181	0	0	0.2	0.2	0.104130082	0.048296714	0.2	0	0.066273699	0	0.2	0.151212256	0.016163125	0.199079764	0.2	0	0	0	0.2	0.185950533	0	0	0	0	0	0	0	0											NO	0.07885147	0.079809181	0	0	0.2	0.2	0.104130082	0.048296714	0.2	0	0.066273699	0	0.2	0.151212256	0.016163125	0.199079764	0.2	0	0	0	0.2	0.185950533	0	0	0	0	0	0	0	0												25.4618	2.857157414	0	0	5.286001666	2.673059303	2.05175541	0.896836546	1.206446479	0	1.723811732	0	0.003390352	1.356627207	0.014588465	21.63402696	3.330514307	0	0	0	0.242204673	1.699614356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4378	0	0	25.4618	2.857157414	0	0	5.286001666	2.673059303	2.05175541	0.896836546	1.206446479	0	1.723811732	0	0.003390352	1.356627207	0.014588465	21.63402696	3.330514307	0	0	0	0.242204673	1.699614356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4378	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.8545	0.8708	0.5658	0.0585	0.98	0.4956	0.7306	0.1108	0.2237	0.4419	0.7609	0	0.0004	0.2515	0.0231	3.0285	0.4641	0	0	0	0.0337	0.2368	0	0	0.019	0	0	0	0	0											17.1503	0	0	33.3163	3.727964795	0.565776784	0.058549809	6.265990739	3.168626478	2.782344711	1.007681512	1.430113523	0.441887462	2.484735309	0	0.003809385	1.608136745	0.037709432	24.66253922	3.794602366	0	0	0	0.275954505	1.936445865	0	0	0.018988873	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.5882
H3659_059_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2998.531206	233.969464	60.27284988	2404.736794	469.6481475	15.25635269	18.29297369	628.0651703	47.33658402	12556.99295	59.40564255	0	0.056044472	27.98242358	8665.706462	6303.347119	1033.149802	417.6581048	0	0	34.19600323	987.5711719	667.5562403	0	311.9673927	0	17.34885713	4.76825886	78.67627118	0											3750	"$275 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$25 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											190.6084929	140.5472438	0.170489951	0	150	0.2	0.098317658	49.75742924	0.2	3	0.17578379	0	0.2	0.151149369	17.12095686	39.66746111	38.5	40	0	0	0.2	39.56896531	0	0	40	0	0	0	0	0											NO	128.832799	94.99626451	0.115234622	0	101.3854082	0.135180544	0.066453173	33.63118182	0.135180544	2.027708163	0.118812742	0	0.135180544	0.102535733	17.03329136	39.66746111	38.5	27.03610884	0	0	0.135180544	39.56896531	0	0	40	0	0	0	0	0												32.1924	1.852185424	6.945519047	0	3.967955761	2.06236206	1.215626142	1.760214494	6.39898519	2.121826426	7.058147269	0	0.007576122	2.869198307	12.30045858	20.83648139	3.314688947	0.940987498	0	0	4.622634327	3.256430786	0	0	1.039891309	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7636	0	35.53855983	32.1924	1.852185424	6.945519047	0	3.967955761	2.06236206	1.215626142	1.760214494	6.39898519	2.121826426	7.058147269	0	0.007576122	2.869198307	12.30045858	20.83648139	3.314688947	0.940987498	0	0	4.622634327	3.256430786	0	0	1.039891309	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7636	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	32.1924	1.852185424	6.945519047	0	3.967955761	2.06236206	1.215626142	1.760214494	6.39898519	2.121826426	7.058147269	0	0.007576122	2.869198307	12.30045858	20.83648139	3.314688947	0.940987498	0	0	4.622634327	3.256430786	0	0	1.039891309	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7636
H3659_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	228.213869	6.344997428	36.08481325	1303.192911	7.550556606	7.876169648	9.48799222	12.46956748	37.43214654	16.40510579	51.14780914	0	0.09029809	20.99120378	30.14203497	128.3723315	3.132467185	7.98806078	0	0	32.73595001	6.846119956	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080360651	0.080360651	0.171216136	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080360651	0.080360651	0.171216136	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.3394	0.509888124	6.178302286	0	1.759279689	1.835147528	2.210702187	2.905409224	8.721690144	3.82238965	11.91743953	0	0.021039455	4.89095048	7.023094148	29.91075324	0.729864854	1.861218162	0	0	7.627476353	1.59514595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8592	0	0	18.3394	0.509888124	6.178302286	0	1.759279689	1.835147528	2.210702187	2.905409224	8.721690144	3.82238965	11.91743953	0	0.021039455	4.89095048	7.023094148	29.91075324	0.729864854	1.861218162	0	0	7.627476353	1.59514595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8592	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.3394	0.509888124	6.178302286	0	1.759279689	1.835147528	2.210702187	2.905409224	8.721690144	3.82238965	11.91743953	0	0.021039455	4.89095048	7.023094148	29.91075324	0.729864854	1.861218162	0	0	7.627476353	1.59514595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.8592
H3659_802_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	226.4792826	6.945470371	35.8105432	1293.287725	7.493167047	7.816305201	9.415876784	12.37478997	37.14763581	16.28041541	50.75904969	0	0.089611761	20.83188401	29.91293423	127.3966112	3.432703656	7.927345881	0	0	32.48713369	6.794084613	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080360651	0.080360651	0.171216136	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080360651	0.080360651	0.171216136	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.2	0.55814252	6.131342828	0	1.745907922	1.821199112	2.193899291	2.883326063	8.655399144	3.793336791	11.82685858	0	0.02087954	4.853828975	6.969713676	29.6834104	0.799819952	1.84707159	0	0	7.56950215	1.583021715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1367	0	0	18.2	0.55814252	6.131342828	0	1.745907922	1.821199112	2.193899291	2.883326063	8.655399144	3.793336791	11.82685858	0	0.02087954	4.853828975	6.969713676	29.6834104	0.799819952	1.84707159	0	0	7.56950215	1.583021715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1367	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.2	0.55814252	6.131342828	0	1.745907922	1.821199112	2.193899291	2.883326063	8.655399144	3.793336791	11.82685858	0	0.02087954	4.853828975	6.969713676	29.6834104	0.799819952	1.84707159	0	0	7.56950215	1.583021715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1367
H3659_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	226.4792826	6.945470371	35.8105432	1293.287725	7.493167047	7.816305201	9.415876784	12.37478997	37.14763581	16.28041541	50.75904969	0	0.089611761	20.83188401	29.91293423	127.3966112	3.432703656	7.927345882	0	0	32.48713369	6.794084613	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080360651	0.080360651	0.171216136	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080360651	0.080360651	0.171216136	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.2	0.55814252	6.131342828	0	1.745907922	1.821199112	2.193899291	2.883326063	8.655399144	3.793336791	11.82685858	0	0.02087954	4.853828975	6.969713677	29.6834104	0.799819952	1.84707159	0	0	7.56950215	1.583021715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1367	0	0	18.2	0.55814252	6.131342828	0	1.745907922	1.821199112	2.193899291	2.883326063	8.655399144	3.793336791	11.82685858	0	0.02087954	4.853828975	6.969713677	29.6834104	0.799819952	1.84707159	0	0	7.56950215	1.583021715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1367	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.2	0.55814252	6.131342828	0	1.745907922	1.821199112	2.193899291	2.883326063	8.655399144	3.793336791	11.82685858	0	0.02087954	4.853828975	6.969713677	29.6834104	0.799819952	1.84707159	0	0	7.56950215	1.583021715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1367
H3659_806_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	226.4792823	6.945470371	35.81054316	1293.287724	7.493167038	7.816305191	9.415876772	12.37478996	37.14763576	16.28041539	50.75904963	0	0.089611761	20.83188399	29.91293419	127.396611	3.432703656	7.927345871	0	0	32.48713365	6.794084604	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080360651	0.080360651	0.171216135	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080360651	0.080360651	0.171216135	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.2	0.558142517	6.131342806	0	1.74590792	1.821199109	2.193899288	2.88332606	8.655399133	3.793336786	11.82685856	0	0.02087954	4.853828969	6.969713667	29.68341037	0.799819952	1.847071588	0	0	7.56950214	1.583021713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1367	0	0	18.2	0.558142517	6.131342806	0	1.74590792	1.821199109	2.193899288	2.88332606	8.655399133	3.793336786	11.82685856	0	0.02087954	4.853828969	6.969713667	29.68341037	0.799819952	1.847071588	0	0	7.56950214	1.583021713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1367	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.2	0.558142517	6.131342806	0	1.74590792	1.821199109	2.193899288	2.88332606	8.655399133	3.793336786	11.82685856	0	0.02087954	4.853828969	6.969713667	29.68341037	0.799819952	1.847071588	0	0	7.56950214	1.583021713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1367
H3660_028_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	T	P	V	P	V	P	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	YES	1598.264786	61.93716096	325.791568	0	289.5418606	19.90090533	0.487993876	274.3330704	146.3434927	4049.90601	1162.597001	0	0.338663993	169.9477344	0	2499.750637	180.8066875	280.7549954	0	0	6.588	0	0	0	446.8886307	0	0	0	0	0											2500	1A IP Acute: 100.00/0.00 Per Day for days 1-15/16-90	1B IP Psych: 100.00/0.00 Per Day for days 1-15/16-90	2 SNF: 0.00/75.00 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min 0.00/ max 100.00	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: min 0.00/ max 150.00	8A OP Diagnostic Procedures/Tests: min 0.00/ max 100.00	8B OP Radiology: min 0.00/ max 100.00	9A OP Hospital: min 0.00/ max 150.00	12 Renal Dialysis: 20%	"3 CORF: $25, 5 Partial Hosp: $25, 9C OP Substance Abuse: $25, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $25, 7D Physician Specialist (excl. Radiology): $25, 7F Podiatry: $25"	"7E Mental Health: $25, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $25	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											100	100	75	0	100	0.2	0.2	48.93663335	150	5	100.0044219	0	0.2	25	0	25	25	25	0	0	0.2	0	0	0	25	0	0	0	0	0											NO	90.72923184	100	75	0	100	0.2	0.2	48.93663335	150	5	100.0044219	0	0.2	25	0	25	25	25	0	0	0.2	0	0	0	25	0	0	0	0	0												12.0841	0.516143008	2.0361973	0	2.412848838	3.980181066	0.097598775	1.11874474	1.829293659	1.687460838	9.688736749	0	0.067732799	0.35405778	0	5.207813828	0.376680599	0.58490624	0	0	1.3176	0	0	0	0.931017981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2911	0	1.234761857	12.0841	0.516143008	2.0361973	0	2.412848838	3.980181066	0.097598775	1.11874474	1.829293659	1.687460838	9.688736749	0	0.067732799	0.35405778	0	5.207813828	0.376680599	0.58490624	0	0	1.3176	0	0	0	0.931017981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2911	NO	1A IP Acute: 20%	1B IP Psych: 20%	2 SNF: $75 for days 1-10/11-100	6 Home Health: 20%	10A Ambulance: min 0.00/ max 200.00	11A DME: 30%	"11B Prosthetics/Medical Supplies: 30%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $15, 14C Physical Exams: $15, 14D Pap Smears and Pelvic Exams: $15, 14E Prostate Screening: $15, 14F Colorectal Screening: $15, 14G Bone Mass Measurement: $15, 14H Mammography: $15, 14I Diabetes Monitoring: $15, 14J Nutrition Therapy: $15"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $40	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $40	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"												6.0463	0.079	0.6442	0.0635	0.5362	0.6634	0.0163	0.1249	0.6927	0.3799	0.6823	0	0.0075	0.0629	0.6459	1.531	0.0789	0.104	0	0	0.1464	0	0	0	0.2318	0	0	0	0	0											12.737	0	0	18.1304	0.595117521	2.680422414	0.063460964	2.949037469	4.643544577	0.113865238	1.243622668	2.521963252	2.067382837	10.37099752	0	0.075258665	0.417001385	0.645943983	6.738846761	0.455608261	0.688889572	0	0	1.464	0	0	0	1.162772981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0281
H3660_029_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	T	P	V	P	V	P	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	YES	1117.070309	38.55787096	181.1508495	0	173.0885042	12.51434986	0.617481723	253.7276156	204.8451528	3058.889589	940.2213189	0	0.146113718	127.3556045	0	2165.560749	188.3546614	250.1299557	0	0	9.074422335	0	0	0	378.6281118	0	0.654206678	0	0	0											3400	1A IP Acute: 195.00/0.00 Per Day for days 1-15/16-90	1B IP Psych: 195.00/0.00 Per Day for days 1-12/13-90	2 SNF: 0.00/100.00 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min 0.00/ max 150.00	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: min 0.00/ max 250.00	8A OP Diagnostic Procedures/Tests: min 0.00/ max 100.00	8B OP Radiology: min 0.00/ max 150.00	9A OP Hospital: min 0.00/ max 250.00	12 Renal Dialysis: 20%	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $30	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											195	195	100	0	150	0.2	0.2	48.70789104	250	7	112.5106533	0	0.2	30	0	30	30	30	0	0	0.2	0	0	0	30	0	30	0	0	0											NO	181.0735608	195	100	0	150	0.2	0.2	48.70789104	250	7	112.5106533	0	0.2	30	0	30	30	30	0	0	0.2	0	0	0	30	0	30	0	0	0												16.856	0.626565403	1.509590413	0	2.163606303	2.502869973	0.123496345	1.029878088	4.26760735	1.784352261	8.815409573	0	0.029222744	0.318389011	0	5.413901872	0.470886653	0.625324889	0	0	1.814884467	0	0	0	0.94657028	0	0.001635517	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3002	0	1.296400978	16.856	0.626565403	1.509590413	0	2.163606303	2.502869973	0.123496345	1.029878088	4.26760735	1.784352261	8.815409573	0	0.029222744	0.318389011	0	5.413901872	0.470886653	0.625324889	0	0	1.814884467	0	0	0	0.94657028	0	0.001635517	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3002	NO	1A IP Acute: 25%	1B IP Psych: 25%	2 SNF: $100 for days 1-10/11-100	6 Home Health: 20%	10A Ambulance: $200	11A DME: 30%	"11B Prosthetics/Medical Supplies: 30%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $20	8A OP Diagnostic Procedures/Tests: $20	8B OP Radiology: $20	9A OP Hospital: $20	12 Renal Dialysis: 20%	"3 CORF: $45, 5 Partial Hosp: $45, 9C OP Substance Abuse: $45, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $15, 14C Physical Exams: $15, 14D Pap Smears and Pelvic Exams: $15, 14E Prostate Screening: $15, 14F Colorectal Screening: $15, 14G Bone Mass Measurement: $15, 14H Mammography: $15, 14I Diabetes Monitoring: $15, 14J Nutrition Therapy: $15"	"7B Chiropractic: $45, 7D Physician Specialist (excl. Radiology): $45, 7F Podiatry: $45"	"7E Mental Health: $45, 7H Psychiatric: $45"	"7C Occupational Therapy: $45, 7I Physical and Speech Therapy: $45"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $45, 18A Hearing Exams (Medicare Covered): $45"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $45, 17A Routine Eye Exams (Medicare Covered): $45"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $45	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $45	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"												5.8054	0.0582	0.4577	0.0675	0.3205	0.4171	0.0206	0.1144	0.6801	0.329	0.5911	0	0.0032	0.0531	0.5307	1.2417	0.0789	0.1042	0	0	0.2017	0	0	0	0.1829	0	0.0003	0	0	0											11.2586	0	0	22.6614	0.684802148	1.967314616	0.067545823	2.48414057	2.920014968	0.144079069	1.144308986	4.947713076	2.11339271	9.406489253	0	0.032469715	0.371453846	0.530734669	6.655606285	0.549762636	0.729545704	0	0	2.016538297	0	0	0	1.12952011	0	0.001908103	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5588
H3660_032_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	T	P	V	P	V	P	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	YES	2130.757291	7.207635657	355.0627011	0	41.04383801	35.52279033	0.163626204	342.8509735	26.07736434	4774.924707	1387.638063	0	0.046036477	7.322724841	0	369.7417194	96.08114627	89.27032398	0	0	19.359	0	0	0	29.32926431	0	0	0	0	0											2000	1A IP Acute: 100.00/0.00 Per Day for days 1-15/16-90	1B IP Psych: 100.00/0.00 Per Day for days 1-15/16-90	2 SNF: $0 for days	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	"11B Prosthetics/Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 10%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: min 0.00/ max 100.00	8B OP Radiology: min 0.00/ max 100.00	9A OP Hospital: $0	12 Renal Dialysis: 20%	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											100	100	0	0	0	0.1	0.1	48.71126671	0	5	99.96920725	0	0.2	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	81.92112108	100	0	0	0	0.1	0.1	48.71126671	0	5	99.96920725	0	0.2	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0												14.5462	0.06006363	0	0	0	3.552279033	0.01636262	1.391725434	0	1.989551961	11.56008976	0	0.009207295	0	0	0	0	0	0	0	3.8718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9972	0	3.531940977	14.5462	0.06006363	0	0	0	3.552279033	0.01636262	1.391725434	0	1.989551961	11.56008976	0	0.009207295	0	0	0	0	0	0	0	3.8718	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9972	NO	1A IP Acute: 15%	1B IP Psych: 15%	2 SNF: $50 for days	6 Home Health: 20%	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $150	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $150	12 Renal Dialysis: 20%	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $15, 14C Physical Exams: $15, 14D Pap Smears and Pelvic Exams: $15, 14E Prostate Screening: $15, 14F Colorectal Screening: $15, 14G Bone Mass Measurement: $15, 14H Mammography: $15, 14I Diabetes Monitoring: $15, 14J Nutrition Therapy: $15"	"7B Chiropractic: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $35, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $35	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $35	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"												5.9056	0.0124	0.4613	0.1796	0.3374	0.7894	0.0036	0.1556	0.7896	0.4962	1.0345	0	0.001	0.1087	0.6796	1.9454	0.1224	0.0289	0	0	0.4302	0	0	0	0.2031	0	0	0	0	0											13.6848	0	0	20.4518	0.072504741	0.461311661	0.179559706	0.337448775	4.341674373	0.019998758	1.547349111	0.78960748	2.485793187	12.5946108	0	0.010230328	0.108732833	0.679552988	1.945409114	0.122405123	0.028930198	0	0	4.302	0	0	0	0.203099395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.682
H3660_043_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	T	P	V	P	V	P	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	YES	1117.070309	43.24436812	181.1508495	0	173.0885042	12.51434986	0.617481723	253.7276156	204.8451528	0	940.2213189	0	0.146113718	127.3556045	0	2165.560749	188.3546614	250.1299557	0	0	9.074422335	0	0	0	378.6281118	0	0.654206678	0	0	0											3000	1A IP Acute: 150.00/0.00 Per Day for days 1-15/16-90	1B IP Psych: 150.00/0.00 Per Day for days 1-15/16-90	2 SNF: 0.00/100.00 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min 0.00/ max 150.00	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: min 0.00/ max 250.00	8A OP Diagnostic Procedures/Tests: min 0.00/ max 100.00	8B OP Radiology: min 0.00/ max 150.00	9A OP Hospital: min 0.00/ max 250.00	12 Renal Dialysis: 20%	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $30	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											150	150	100	0	150	0.2	0.2	48.70789104	250	0	112.5106533	0	0.2	30	0	30	30	30	0	0	0.2	0	0	0	30	0	30	0	0	0											NO	130.1115513	150	100	0	150	0.2	0.2	48.70789104	250	0	112.5106533	0	0.2	30	0	30	30	30	0	0	0.2	0	0	0	30	0	30	0	0	0												12.112	0.540554601	1.509590413	0	2.163606303	2.502869973	0.123496345	1.029878088	4.26760735	0	8.815409573	0	0.029222744	0.318389011	0	5.413901872	0.470886653	0.625324889	0	0	1.814884467	0	0	0	0.94657028	0	0.001635517	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6858	0	1.851399633	12.112	0.540554601	1.509590413	0	2.163606303	2.502869973	0.123496345	1.029878088	4.26760735	0	8.815409573	0	0.029222744	0.318389011	0	5.413901872	0.470886653	0.625324889	0	0	1.814884467	0	0	0	0.94657028	0	0.001635517	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6858	NO	1A IP Acute: 25%	1B IP Psych: 25%	2 SNF: $100 for days 1-10/11-100	6 Home Health: 20%	10A Ambulance: $200	11A DME: 30%	"11B Prosthetics/Medical Supplies: 30%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: $45, 5 Partial Hosp: $45, 9C OP Substance Abuse: $45, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $15, 14C Physical Exams: $15, 14D Pap Smears and Pelvic Exams: $15, 14E Prostate Screening: $15, 14F Colorectal Screening: $15, 14G Bone Mass Measurement: $15, 14H Mammography: $15, 14I Diabetes Monitoring: $15, 14J Nutrition Therapy: $15"	"7B Chiropractic: $45, 7D Physician Specialist (excl. Radiology): $45, 7F Podiatry: $45"	"7E Mental Health: $45, 7H Psychiatric: $45"	"7C Occupational Therapy: $45, 7I Physical and Speech Therapy: $45"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $45, 18A Hearing Exams (Medicare Covered): $45"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $45, 17A Routine Eye Exams (Medicare Covered): $45"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $45	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $45	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"												5.8054	0.0582	0.4577	0.0675	0.3205	0.4171	0.0206	0.1144	0.6801	0.329	0.5911	0	0.0032	0.0531	0.5307	1.2417	0.0789	0.1042	0	0	0.2017	0	0	0	0.1829	0	0.0003	0	0	0											11.2586	0	0	17.9174	0.598791346	1.967314616	0.067545823	2.48414057	2.920014968	0.144079069	1.144308986	4.947713076	0.329040449	9.406489253	0	0.032469715	0.371453846	0.530734669	6.655606285	0.549762636	0.729545704	0	0	2.016538297	0	0	0	1.12952011	0	0.001908103	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9444
H3660_801_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	T	P	V	P	V	P	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	NO	1241.353756	3.054297467	263.0656592	0	183.9040981	21.85723492	0.386069483	221.6164287	76.25784783	0	1299.438182	0	0.112835313	178.8671708	4370.842874	4215.509096	128.9825122	619.6014767	122.7414229	0	14.21087259	0	0	0	705.9365454	0	45.07453384	0	0	0												1A IP Acute: 250.00/0.00 Per Day for days 1-10/11-90	1B IP Psych: 250.00/0.00 Per Day for days 1-10/11-90	2 SNF: 0.00/100.00 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min 0.00/ max 100.00	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: min 0.00/ max 250.00	8A OP Diagnostic Procedures/Tests: min 0.00/ max 50.00	8B OP Radiology: min 0.00/ max 100.00	9A OP Hospital: min 0.00/ max 250.00	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $0"	"7A PCP: $20, 14B Immunizations: 20/40, 14C Physical Exams: 20/40, 14D Pap Smears and Pelvic Exams: 20/40, 14E Prostate Screening: 20/40, 14F Colorectal Screening: 20/40, 14G Bone Mass Measurement: 20/40, 14H Mammography: 20/40, 14I Diabetes Monitoring: 20/40, 14J Nutrition Therapy: 20/40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $40	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $40	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											250	250	100	0	100	0.2	0.2	48.16949128	250	0	83.39740509	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	40	0	0	0											NO	250	250	100	0	100	0.2	0.2	48.16949128	250	0	83.39740509	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	40	0	0	0												25.8615	0.063631197	2.192213826	0	1.532534151	4.371446983	0.077213897	0.889595886	1.588705163	0	9.030814369	0	0.022567063	0.596223903	7.284738123	14.05169699	0.429941707	2.065338256	0.204569038	0	2.842174517	0	0	0	2.353121818	0	0.150248446	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6083	0	0	25.8615	0.063631197	2.192213826	0	1.532534151	4.371446983	0.077213897	0.889595886	1.588705163	0	9.030814369	0	0.022567063	0.596223903	7.284738123	14.05169699	0.429941707	2.065338256	0.204569038	0	2.842174517	0	0	0	2.353121818	0	0.150248446	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6083	NO	1A IP Acute: Not Covered	1B IP Psych: Not Covered	2 SNF: Not Covered for days 1-10/11-100	6 Home Health: Not Covered	10A Ambulance: Not Covered	11A DME: Not Covered	"11B Prosthetics/Medical Supplies: Not Covered, 11C Diabetes Monitoring Supplies: Not Covered"	"4A ER: Not Covered, 4B Urgent Care: Not Covered"	9B ASC Services: Not Covered	8A OP Diagnostic Procedures/Tests: Not Covered	8B OP Radiology: Not Covered	9A OP Hospital: Not Covered	12 Renal Dialysis: Not Covered	"3 CORF: Not Covered, 5 Partial Hosp: Not Covered, 9C OP Substance Abuse: Not Covered, 9D Cardiac Rehab: Not Covered"	"7A PCP: Not Covered, 14B Immunizations: Not Covered, 14C Physical Exams: Not Covered, 14D Pap Smears and Pelvic Exams: Not Covered, 14E Prostate Screening: Not Covered, 14F Colorectal Screening: Not Covered, 14G Bone Mass Measurement: Not Covered, 14H Mammography: Not Covered, 14I Diabetes Monitoring: Not Covered, 14J Nutrition Therapy: Not Covered"	"7B Chiropractic: Not Covered, 7D Physician Specialist (excl. Radiology): Not Covered, 7F Podiatry: Not Covered"	"7E Mental Health: Not Covered, 7H Psychiatric: Not Covered"	"7C Occupational Therapy: Not Covered, 7I Physical and Speech Therapy: Not Covered"	7D Physician Specialist (Radiology): Not Covered	"7G Other Health Care: Not Covered, 18A Hearing Exams (Medicare Covered): Not Covered"	15 Part B Drugs: Not Covered	"13A Blood: Not Covered, 16B Comprehensive Dental (Medicare Covered): Not Covered, 17A Routine Eye Exams (Medicare Covered): Not Covered"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot 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	0	0	25.8615	0.063631197	2.192213826	0	1.532534151	4.371446983	0.077213897	0.889595886	1.588705163	0	9.030814369	0	0.022567063	0.596223903	7.284738123	14.05169699	0.429941707	2.065338256	0.204569038	0	2.842174517	0	0	0	2.353121818	0	0.150248446	0	0	0	0	0	0	0	0	0	0	0	0	0	75.6083
H3660_802_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	T	P	V	P	V	P	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	NO	1308.3073	3.219033778	277.2543447	0	193.8231328	23.03612476	0.406892492	233.5695123	80.3708842	0	1369.524562	0	0.118921188	188.5145343	4606.588259	4442.876412	135.9393013	653.0202458	129.3615932	0	14.97734892	0	0	0	744.0118749	0	47.50566981	0	0	0												1A IP Acute: 250.00/0.00 Per Day for days 1-10/11-90	1B IP Psych: 250.00/0.00 Per Day for days 1-10/11-90	2 SNF: 0.00/100.00 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min 0.00/ max 100.00	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: min 0.00/ max 250.00	8A OP Diagnostic Procedures/Tests: min 0.00/ max 50.00	8B OP Radiology: min 0.00/ max 100.00	9A OP Hospital: min 0.00/ max 250.00	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $0"	"7A PCP: $20, 14B Immunizations: 20/40, 14C Physical Exams: 20/40, 14D Pap Smears and Pelvic Exams: 20/40, 14E Prostate Screening: 20/40, 14F Colorectal Screening: 20/40, 14G Bone Mass Measurement: 20/40, 14H Mammography: 20/40, 14I Diabetes Monitoring: 20/40, 14J Nutrition Therapy: 20/40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: $0	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $40	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): $40	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											250	250	100	0	100	0.2	0.2	48.16949128	250	0	83.39740509	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	40	0	0	0											NO	250	250	100	0	100	0.2	0.2	48.16949128	250	0	83.39740509	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	40	0	0	0												27.2564	0.067063204	2.310452873	0	1.615192774	4.607224951	0.081378498	0.937577049	1.674393421	0	9.517899554	0	0.023784238	0.628381781	7.677647098	14.80958804	0.453131004	2.176734153	0.215602655	0	2.995469785	0	0	0	2.480039583	0	0.158352233	0	0	0	0	0	0	0	0	0	0	0	0	0	79.6863	0	0	27.2564	0.067063204	2.310452873	0	1.615192774	4.607224951	0.081378498	0.937577049	1.674393421	0	9.517899554	0	0.023784238	0.628381781	7.677647098	14.80958804	0.453131004	2.176734153	0.215602655	0	2.995469785	0	0	0	2.480039583	0	0.158352233	0	0	0	0	0	0	0	0	0	0	0	0	0	79.6863	NO	1A IP Acute: Not Covered	1B IP Psych: Not Covered	2 SNF: Not Covered for days 1-10/11-100	6 Home Health: Not Covered	10A Ambulance: Not Covered	11A DME: Not Covered	"11B Prosthetics/Medical Supplies: Not Covered, 11C Diabetes Monitoring Supplies: Not Covered"	"4A ER: Not Covered, 4B Urgent Care: Not Covered"	9B ASC Services: Not Covered	8A OP Diagnostic Procedures/Tests: Not Covered	8B OP Radiology: Not Covered	9A OP Hospital: Not Covered	12 Renal Dialysis: Not Covered	"3 CORF: Not Covered, 5 Partial Hosp: Not Covered, 9C OP Substance Abuse: Not Covered, 9D Cardiac Rehab: Not Covered"	"7A PCP: Not Covered, 14B Immunizations: Not Covered, 14C Physical Exams: Not Covered, 14D Pap Smears and Pelvic Exams: Not Covered, 14E Prostate Screening: Not Covered, 14F Colorectal Screening: Not Covered, 14G Bone Mass Measurement: Not Covered, 14H Mammography: Not Covered, 14I Diabetes Monitoring: Not Covered, 14J Nutrition Therapy: Not Covered"	"7B Chiropractic: Not Covered, 7D Physician Specialist (excl. Radiology): Not Covered, 7F Podiatry: Not Covered"	"7E Mental Health: Not Covered, 7H Psychiatric: Not Covered"	"7C Occupational Therapy: Not Covered, 7I Physical and Speech Therapy: Not Covered"	7D Physician Specialist (Radiology): Not Covered	"7G Other Health Care: Not Covered, 18A Hearing Exams (Medicare Covered): Not Covered"	15 Part B Drugs: Not Covered	"13A Blood: Not Covered, 16B Comprehensive Dental (Medicare Covered): Not Covered, 17A Routine Eye Exams (Medicare Covered): Not Covered"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot 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	0	0	27.2564	0.067063204	2.310452873	0	1.615192774	4.607224951	0.081378498	0.937577049	1.674393421	0	9.517899554	0	0.023784238	0.628381781	7.677647098	14.80958804	0.453131004	2.176734153	0.215602655	0	2.995469785	0	0	0	2.480039583	0	0.158352233	0	0	0	0	0	0	0	0	0	0	0	0	0	79.6863
H3660_805_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	T	P	V	P	V	P	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	NO	1214.284024	81.92759678	303.32182	0	233.2647815	22.83000545	0.145442368	224.5220499	123.9125738	0	1160.936984	0	1.078023041	184.6945202	3849.21396	4261.568123	148.3784853	785.8883725	60.38659283	0	7.454135428	0	0	0	755.695076	0	63.83725528	0	0	0												1A IP Acute: 250.00/0.00 Per Day for days 1-10/11-90	1B IP Psych: 250.00/0.00 Per Day for days 1-10/11-90	2 SNF: 0.00/100.00 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min 0.00/ max 100.00	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: min 0.00/ max 250.00	8A OP Diagnostic Procedures/Tests: min 0.00/ max 50.00	8B OP Radiology: min 0.00/ max 100.00	9A OP Hospital: min 0.00/ max 250.00	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $0"	"7A PCP: $20, 14B Immunizations: 20/40, 14C Physical Exams: 20/40, 14D Pap Smears and Pelvic Exams: 20/40, 14E Prostate Screening: 20/40, 14F Colorectal Screening: 20/40, 14G Bone Mass Measurement: 20/40, 14H Mammography: 20/40, 14I Diabetes Monitoring: 20/40, 14J Nutrition Therapy: 20/40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $40	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): 20/40 (PCP/Specialist)	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											250	250	100	0	100	0.2	0.2	48.50152985	250	0	81.77356021	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	35.13513514	0	0	0											NO	250	250	100	0	100	0.2	0.2	48.50152985	250	0	81.77356021	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	35.13513514	0	0	0												25.2976	1.706824933	2.527681833	0	1.943873179	4.56600109	0.029088474	0.907471909	2.581511954	0	7.911162529	0	0.215604608	0.615648401	6.415356601	14.20522708	0.494594951	2.619627908	0.100644321	0	1.490827086	0	0	0	2.518983587	0	0.186910883	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3346	0	0	25.2976	1.706824933	2.527681833	0	1.943873179	4.56600109	0.029088474	0.907471909	2.581511954	0	7.911162529	0	0.215604608	0.615648401	6.415356601	14.20522708	0.494594951	2.619627908	0.100644321	0	1.490827086	0	0	0	2.518983587	0	0.186910883	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3346	NO	1A IP Acute: 20%	1B IP Psych: 20%	2 SNF: $100 for days 1-10/11-100	6 Home Health: 20%	10A Ambulance: $200	11A DME: 30%	"11B Prosthetics/Medical Supplies: 30%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: $55, 5 Partial Hosp: $55, 9C OP Substance Abuse: $55, 9D Cardiac Rehab: 20%"	"7A PCP: $35, 14B Immunizations: $35, 14C Physical Exams: $35, 14D Pap Smears and Pelvic Exams: $35, 14E Prostate Screening: $35, 14F Colorectal Screening: $35, 14G Bone Mass Measurement: $35, 14H Mammography: $35, 14I Diabetes Monitoring: $35, 14J Nutrition Therapy: $35"	"7B Chiropractic: $55, 7D Physician Specialist (excl. Radiology): $55, 7F Podiatry: $55"	"7E Mental Health: $55, 7H Psychiatric: $55"	"7C Occupational Therapy: $55, 7I Physical and Speech Therapy: $55"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $55, 18A Hearing Exams (Medicare Covered): $55"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $55, 17A Routine Eye Exams (Medicare Covered): $55"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"												4.6135	0.0937	0.7715	0.0693	0.4283	0.7546	0.0048	0.1	0.7331	0.4053	0.7614	0	0.0238	0.1798	1.2885	2.148	0.0755	0.1984	0	0	0.1643	0	0	0	0.3816	0	0.0244	0	0	0											13.2197	0	0	29.9111	1.800556201	3.299135055	0.069293356	2.372211887	5.320600862	0.033895778	1.007454086	3.314660855	0.405286535	8.672590043	0	0.239359193	0.795447811	7.703857731	16.35320947	0.570076975	2.81805534	0.100644321	0	1.655081358	0	0	0	2.900591556	0	0.211305913	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5544
H3660_806_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	P	P	Coin	P	P	P	P	P	P	P	Coin	P	T	P	V	P	V	P	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	NO	1013.79747	68.40079315	253.2413238	0	194.751179	19.06061622	0.121428844	187.4519319	103.4537648	0	969.2583891	0	0.900034102	154.2001983	3213.682547	3557.954231	123.8801878	656.1328552	50.41635551	0	6.223406954	0	0	0	630.9246775	0	53.29729011	0	0	0												1A IP Acute: 250.00/0.00 Per Day for days 1-10/11-90	1B IP Psych: 250.00/0.00 Per Day for days 1-10/11-90	2 SNF: 0.00/100.00 for days 1-10/11-100	6 Home Health: $0	10A Ambulance: min 0.00/ max 100.00	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: min 0.00/ max 250.00	8A OP Diagnostic Procedures/Tests: min 0.00/ max 50.00	8B OP Radiology: min 0.00/ max 100.00	9A OP Hospital: min 0.00/ max 250.00	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $0"	"7A PCP: $20, 14B Immunizations: 20/40, 14C Physical Exams: 20/40, 14D Pap Smears and Pelvic Exams: 20/40, 14E Prostate Screening: 20/40, 14F Colorectal Screening: 20/40, 14G Bone Mass Measurement: 20/40, 14H Mammography: 20/40, 14I Diabetes Monitoring: 20/40, 14J Nutrition Therapy: 20/40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $40	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): 20/40 (PCP/Specialist)	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											250	250	100	0	100	0.2	0.2	48.50152985	250	0	81.77356021	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	35.13513514	0	0	0											NO	250	250	100	0	100	0.2	0.2	48.50152985	250	0	81.77356021	0	0.2	40	20	40	40	40	20	0	0.2	0	0	0	40	0	35.13513514	0	0	0												21.1208	1.425016524	2.110344365	0	1.622926492	3.812123244	0.024285769	0.757642122	2.155286767	0	6.60497577	0	0.18000682	0.514000661	5.356137578	11.85984744	0.412933959	2.187109517	0.084027259	0	1.244681391	0	0	0	2.103082258	0	0.156050624	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7313	0	0	21.1208	1.425016524	2.110344365	0	1.622926492	3.812123244	0.024285769	0.757642122	2.155286767	0	6.60497577	0	0.18000682	0.514000661	5.356137578	11.85984744	0.412933959	2.187109517	0.084027259	0	1.244681391	0	0	0	2.103082258	0	0.156050624	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7313	NO	1A IP Acute: 20%	1B IP Psych: 20%	2 SNF: $100 for days 1-10/11-100	6 Home Health: 20%	10A Ambulance: $200	11A DME: 30%	"11B Prosthetics/Medical Supplies: 30%, 11C Diabetes Monitoring Supplies: 30%"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: $55, 5 Partial Hosp: $55, 9C OP Substance Abuse: $55, 9D Cardiac Rehab: 20%"	"7A PCP: $35, 14B Immunizations: $35, 14C Physical Exams: $35, 14D Pap Smears and Pelvic Exams: $35, 14E Prostate Screening: $35, 14F Colorectal Screening: $35, 14G Bone Mass Measurement: $35, 14H Mammography: $35, 14I Diabetes Monitoring: $35, 14J Nutrition Therapy: $35"	"7B Chiropractic: $55, 7D Physician Specialist (excl. Radiology): $55, 7F Podiatry: $55"	"7E Mental Health: $55, 7H Psychiatric: $55"	"7C Occupational Therapy: $55, 7I Physical and Speech Therapy: $55"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $55, 18A Hearing Exams (Medicare Covered): $55"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $55, 17A Routine Eye Exams (Medicare Covered): $55"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"												4.6213	0.0939	0.7728	0.0694	0.4291	0.7559	0.0048	0.1002	0.7344	0.406	0.7627	0	0.0001	0.1801	1.2907	2.1516	0.0756	0.1988	0	0	0.1645	0	0	0	0.3823	0	0.0244	0	0	0											13.2184	0	0	25.7421	1.518906485	2.883103703	0.069410673	2.051990403	4.568000599	0.029101212	0.857793576	2.889676933	0.40597271	7.367692427	0	0.180084472	0.694104483	6.646820218	14.01146649	0.48854378	2.385872899	0.084027259	0	1.409213755	0	0	0	2.485336313	0	0.180486956	0	0	0	0	0	0	0	0	0	0	0	0	0	76.9497
H3664_012_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	V	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	1806.847106	41.05216785	1749.059568	0	350.7183391	17.5201042	4.905785795	472.8207289	45.60223062	3604.376705	1268.763505	0	0	623.238394	5163.970749	4660.298159	249.9073194	1091.842666	1419.969008	1609.70526	9.121712133	0	0	0	144.1950535	0	9.95903322	0	0	0											3400	$150/Days 1-10 for IP Medical; $150/Days 1-10 for IP Surgical;	$150/Days 1-10 for IP Psych; $150/Days 1-10 for IP Substance Abuse;	$75/Days 11-100	No Cost-Sharing	$125/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care; $40/Visit for Urgent Care - Worldwide;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	$30/Case for OP Fac - Pathology	$30/Case for OP Fac - Radiology; $30/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	$30/Procedure for Prof Radiology (Office);	$35/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; $30/Procedure for Prof Path (Office); $30/Procedure for Prof Path (Labs)	15% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	No Cost-Sharing	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	150	75	0	125	0.2	0.2	48.78660386	0.1788	30	30	0	0	10	15	30	30	10	30	31.46285489	0.017588797	0	0	0	30	0	30	0	0	0											NO	135.9415724	135.9415724	67.97078621	0	113.2846437	0.18125543	0.18125543	44.21418428	0.162042354	27.18831449	27.18831449	0	0	9.062771495	13.59415724	27.18831449	27.18831449	9.062771497	27.18831449	28.51406645	0.015940325	0	0	0	27.18831449	0	27.18831443	0	0	0												20.4688	0.465058021	9.9070795	0	3.31091684	3.175614019	0.889200313	1.742115237	7.389492812	8.166410615	2.874628432	0	0	0.470688929	5.849985863	10.55880433	0.566213233	0.824593383	3.217213662	3.824936896	0.145403051	0	0	0	0.326701705	0	0.022564111	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1964	0	8.707191684	20.4688	0.465058021	9.9070795	0	3.31091684	3.175614019	0.889200313	1.742115237	7.389492812	8.166410615	2.874628432	0	0	0.470688929	5.849985863	10.55880433	0.566213233	0.824593383	3.217213662	3.824936896	0.145403051	0	0	0	0.326701705	0	0.022564111	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1964	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.4688	0.465058021	9.9070795	0	3.31091684	3.175614019	0.889200313	1.742115237	7.389492812	8.166410615	2.874628432	0	0	0.470688929	5.849985863	10.55880433	0.566213233	0.824593383	3.217213662	3.824936896	0.145403051	0	0	0	0.326701705	0	0.022564111	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1964
H3664_014_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	V	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	1219.450893	21.0054655	957.2496453	0	154.4168949	10.04648396	2.603551523	333.8342687	37.27023108	2475.353813	817.6940612	0	0	301.4003678	3574.986411	3593.997733	90.92587699	762.4141136	644.5156006	1056.996189	7.242599253	0	0	0	107.1606538	0	5.384406934	0	0	0											3400	$200/Days 1-10 for IP Medical; $200/Days 1-10 for IP Surgical;	$200/Days 1-10 for IP Psych; $200/Days 1-10 for IP Substance Abuse;	$75/Days 5-100	No Cost-Sharing	$125/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care; $40/Visit for Urgent Care - Worldwide;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	$35/Case for OP Fac - Pathology	$35/Case for OP Fac - Radiology; $35/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Visit for Prof - CORF; $15/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $15/Visit for Occ Therapy (Specialist);	$35/Procedure for Prof Radiology (Office);	$40/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; $35/Procedure for Prof Path (Office); $35/Procedure for Prof Path (Labs)	15% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	$35/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											200	200	75	0	125	0.2	0.2	48.47271526	0.1968	35	35	0	0	15	25	35	35	15	35	36.19079653	0.009445654	0	0	0	35	0	35	0	0	0											NO	184.8901791	184.8901791	69.33381717	0	115.556362	0.184890179	0.184890179	44.81064504	0.181931936	32.35578135	32.35578135	0	0	13.86676343	23.11127239	32.35578135	32.35578134	13.86676343	32.35578135	33.45661427	0.008732043	0	0	0	32.35578135	0	32.35578143	0	0	0												18.7887	0.323642023	5.530814325	0	1.486987884	1.857496218	0.481371108	1.246610743	6.780645306	6.674333895	2.204760855	0	0	0.3482873	6.885207062	9.6905504	0.245164816	0.881018013	1.737817154	2.946959481	0.063242688	0	0	0	0.28893889	0	0.014518058	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4771	0	5.59616702	18.7887	0.323642023	5.530814325	0	1.486987884	1.857496218	0.481371108	1.246610743	6.780645306	6.674333895	2.204760855	0	0	0.3482873	6.885207062	9.6905504	0.245164816	0.881018013	1.737817154	2.946959481	0.063242688	0	0	0	0.28893889	0	0.014518058	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4771	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.7887	0.323642023	5.530814325	0	1.486987884	1.857496218	0.481371108	1.246610743	6.780645306	6.674333895	2.204760855	0	0	0.3482873	6.885207062	9.6905504	0.245164816	0.881018013	1.737817154	2.946959481	0.063242688	0	0	0	0.28893889	0	0.014518058	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4771
H3664_017_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	V	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	1148.760327	31.79938358	1004.529027	0	209.6935451	10.2784168	0.238187965	421.4202914	32.94141318	2967.955888	1087.394684	0	0	213.1708348	4251.656585	3511.629523	131.0495674	253.1650526	1116.086103	1170.640125	7.839628952	0	0	0	65.62436836	0	0.95552904	0	0	0											3400	$150/Days 1-10 for IP Medical; $150/Days 1-10 for IP Surgical;	$150/Days 1-10 for IP Psych; $150/Days 1-10 for IP Substance Abuse;	$75/Days 11-100	No Cost-Sharing	$125/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care; $40/Visit for Urgent Care - Worldwide;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	$30/Case for OP Fac - Pathology	$30/Case for OP Fac - Radiology; $30/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	$30/Procedure for Prof Radiology (Office);	$35/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; $30/Procedure for Prof Path (Office); $30/Procedure for Prof Path (Labs)	15% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	No Cost-Sharing	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	150	75	0	125	0.2	0.2	47.9554666	0.178	30	30	0	0	10	15	30	30	10	30	30.62759635	0.008081631	0	0	0	30	0	30	0	0	0											NO	140.2575949	140.2575949	70.12879746	0	116.8813291	0.187010127	0.187010127	44.84078939	0.166439013	28.05151898	28.05151898	0	0	9.350506335	14.02575949	28.05151898	28.05151898	9.350506336	28.05151898	28.63835335	0.007556734	0	0	0	28.05151898	0	28.05151919	0	0	0												13.4269	0.371675422	5.87053439	0	2.042438355	1.922168027	0.044543562	1.574734877	5.482736286	6.937972579	2.541922719	0	0	0.166104603	4.969392726	8.208878519	0.306344952	0.197268452	2.608992542	2.79376713	0.059241989	0	0	0	0.153405268	0	0.00223367	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6812	0	4.145505388	13.4269	0.371675422	5.87053439	0	2.042438355	1.922168027	0.044543562	1.574734877	5.482736286	6.937972579	2.541922719	0	0	0.166104603	4.969392726	8.208878519	0.306344952	0.197268452	2.608992542	2.79376713	0.059241989	0	0	0	0.153405268	0	0.00223367	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6812	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.4269	0.371675422	5.87053439	0	2.042438355	1.922168027	0.044543562	1.574734877	5.482736286	6.937972579	2.541922719	0	0	0.166104603	4.969392726	8.208878519	0.306344952	0.197268452	2.608992542	2.79376713	0.059241989	0	0	0	0.153405268	0	0.00223367	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6812
H3664_801_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	211.6430534	2.138161626	54.36834097	0	6.30588374	12.79521343	0.576633737	14.01728082	40.94677974	17.01635016	41.64431928	0	0.109012067	19.60701523	40.1045247	149.4089766	1.255730437	3.782603966	26.07716382	30.16453493	6.28724067	1.433561946	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081716879	0.081716879	0.174679844	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999731	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081716879	0.081716879	0.174679844	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999731	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537	0	0	17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537
H3664_802_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	273.7061537	3.525077406	77.25914911	0	8.073103955	12.91463986	5.98681864	15.27041616	43.62728518	14.35499056	32.75801617	0	0.238870002	26.16817358	46.22201967	132.7312584	1.362245014	4.863793035	28.82758653	39.91370316	11.24899076	1.260092549	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.08186185	0.08186185	0.174971626	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999698	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08186185	0.08186185	0.174971626	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999698	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.4061	0.28856936	13.51815891	0	1.881033222	3.009111087	1.394928743	3.558006965	10.16515745	3.3447128	7.632617767	0	0.05565671	6.097184443	10.76973058	30.92634306	0.317403088	1.133263777	6.716827662	9.299892837	2.621014847	0.293601564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.4293	0	0	22.4061	0.28856936	13.51815891	0	1.881033222	3.009111087	1.394928743	3.558006965	10.16515745	3.3447128	7.632617767	0	0.05565671	6.097184443	10.76973058	30.92634306	0.317403088	1.133263777	6.716827662	9.299892837	2.621014847	0.293601564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.4293	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.4061	0.28856936	13.51815891	0	1.881033222	3.009111087	1.394928743	3.558006965	10.16515745	3.3447128	7.632617767	0	0.05565671	6.097184443	10.76973058	30.92634306	0.317403088	1.133263777	6.716827662	9.299892837	2.621014847	0.293601564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.4293
H3664_803_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	211.6430534	2.138161626	54.36834097	0	6.30588374	12.79521343	0.576633737	14.01728082	40.94677974	17.01635016	41.64431928	0	0.109012067	19.60701523	40.1045247	149.4089766	1.255730437	3.782603966	26.07716382	30.16453493	6.28724067	1.433561946	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081716879	0.081716879	0.174679844	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999731	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081716879	0.081716879	0.174679844	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999731	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537	0	0	17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537
H3664_805_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	211.6430534	2.138161626	54.36834097	0	6.30588374	12.79521343	0.576633737	14.01728082	40.94677974	17.01635016	41.64431928	0	0.109012067	19.60701523	40.1045247	149.4089766	1.255730437	3.782603966	26.07716382	30.16453493	6.28724067	1.433561946	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081716879	0.081716879	0.174679844	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999731	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081716879	0.081716879	0.174679844	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999731	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537	0	0	17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537
H3664_806_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	211.6430534	2.138161626	54.36834097	0	6.30588374	12.79521343	0.576633737	14.01728082	40.94677974	17.01635016	41.64431928	0	0.109012067	19.60701523	40.1045247	149.4089766	1.255730437	3.782603966	26.07716382	30.16453493	6.28724067	1.433561946	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081716879	0.081716879	0.174679844	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999731	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081716879	0.081716879	0.174679844	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999731	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537	0	0	17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.2948	0.174723896	9.497053328	0	1.469270911	2.98128473	0.134355661	3.26602643	9.540599678	3.964809588	9.703126393	0	0.025399812	4.568434549	9.344354254	34.8122514	0.292585192	0.881346724	6.075979169	7.028336639	1.464927076	0.334019934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8537
H3668_005_0	2010	4	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	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	0	0	0	0	0											0	YES	0	0	61.18293815	0	222.8626547	13.99126872	0	365.5781244	342.6038094	0	1273.745584	139.1818184	13.54489189	1229.88873	4700.239155	2565.998719	12.91581595	361.371513	609.4859776	2309.379352	31.70845858	250.4943793	0	0	168.4772594	0	69.97108763	0	0	0											3350	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $200 per Admit	6 Home Health: $0	10A Ambulance: $50	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: 25"	9B ASC Services: $100	"8A OP Diagnostic Procedures/Tests: $0, 9A OP Hospital: $15"	"8B OP Radiology: $15/$35, 9A OP Hospital: $15"	9A OP Hospital: $15	"12 Renal Dialysis: $15, 9A OP Hospital: $15"	"3 CORF: $15, 5 Partial Hosp: $15, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $15, 9A OP Hospital: $15"	"7A PCP: $10, 14B Immunizations: $10, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $10, 14E Prostate Screening: $10, 14F Colorectal Screening: $10, 14G Bone Mass Measurement: $10, 14H Mammography: $10, 14I Diabetes Monitoring: $10, 14J Nutrition Therapy: $10"	"7B Chiropractic: $25, 7D Physician Specialist (excl. Radiology): $25, 7F Podiatry: $25"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $15	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 15%	"13A Blood: $25, 16B Comprehensive Dental (Medicare Covered): $25, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $25"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $25	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											0	0	200	0	50	0.198912837	0.198912837	42.74905881	100	0	17.47251436	15	15	15	10	25	20.1771515	25	15	25	0.15	25	0	0	25	0	25	0	0	0											NO	0	0	200	0	50	0.198912837	0.198912837	42.74905881	100	0	17.47251436	15	15	15	10	25	20.1771515	25	15	25	0.15	25	0	0	25	0	25	0	0	0												0	0	1.019715636	0	0.928594394	2.783042956	0	1.302343395	2.855031745	0	1.854628167	0.173977273	0.016931115	1.537360913	3.916865962	5.345830665	0.021717031	0.752857319	0.761857472	4.811206983	4.756268787	0.52186329	0	0	0.350994291	0	0.145773099	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8569	0	0	0	0	1.019715636	0	0.928594394	2.783042956	0	1.302343395	2.855031745	0	1.854628167	0.173977273	0.016931115	1.537360913	3.916865962	5.345830665	0.021717031	0.752857319	0.761857472	4.811206983	4.756268787	0.52186329	0	0	0.350994291	0	0.145773099	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8569	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	1.019715636	0	0.928594394	2.783042956	0	1.302343395	2.855031745	0	1.854628167	0.173977273	0.016931115	1.537360913	3.916865962	5.345830665	0.021717031	0.752857319	0.761857472	4.811206983	4.756268787	0.52186329	0	0	0.350994291	0	0.145773099	0	0	0	0	0	0	0	0	0	0	0	0	0	33.8569
H3668_011_0	2010	4	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	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	0	0	0	0	0											0	YES	130.1454466	2.379500693	34.61614226	0	149.8363109	7.827853132	0	265.0782839	208.6395097	0	932.4062866	62.76774242	3.37375845	565.3746357	2664.46046	1267.396051	12.14093635	231.1869272	320.0810439	1246.038441	16.41904123	84.50647836	0	0	100.7983387	0	41.86303489	0	0	0											3350	1A IP Acute: $110 per day for days 1-16	1B IP Psych: $110 per day for days 1-16	2 SNF: $500 per Admit	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $250	"8A OP Diagnostic Procedures/Tests: $0, 9A OP Hospital: $35"	"8B OP Radiology: $35/$50, 9A OP Hospital: $35"	9A OP Hospital: $35	"12 Renal Dialysis: $35, 9A OP Hospital: $35"	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35, 9D Cardiac Rehab: $35, 9A OP Hospital: $35"	"7A PCP: $15, 14B Immunizations: $15, 14C Physical Exams: $15, 14D Pap Smears and Pelvic Exams: $15, 14E Prostate Screening: $15, 14F Colorectal Screening: $15, 14G Bone Mass Measurement: $15, 14H Mammography: $15, 14I Diabetes Monitoring: $15, 14J Nutrition Therapy: $15"	"7B Chiropractic: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): $35	"7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $35, 16B Comprehensive Dental (Medicare Covered): $35, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $35"	17A Routine Eye Exams (Non Medicare Covered): $35	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $35	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											679.25	679.25	500	0	150	0.2	0.2	47.5	250	0	36.85438577	35	35	35	15	35	35	35	35	35	0.2	35	0	0	35	0	34.17335	0	0	0											NO	642.5122234	642.5122234	472.9571022	0	141.8871307	0.189182841	0.189182841	44.93092471	236.4785511	0	34.861087	33.10699716	33.10699716	33.10699716	14.18871307	33.10699716	33.10699716	33.10699716	33.10699716	33.10699716	0.189182841	33.10699716	0	0	33.10699716	0	32.32505718	0	0	0												6.9683	0.127404857	1.364329194	0	1.771653686	1.480895494	0	0.992517701	4.111564079	0	2.708724723	0.173170956	0.009307918	1.559821371	3.150438745	3.496639789	0.033495829	0.637825412	0.883076851	3.437715926	3.106200865	0.233146312	0	0	0.278094193	0	0.11276875	0	0	0	0	0	0	0	0	0	0	0	0	0	36.6371	0	2.09484991	6.9683	0.127404857	1.364329194	0	1.771653686	1.480895494	0	0.992517701	4.111564079	0	2.708724723	0.173170956	0.009307918	1.559821371	3.150438745	3.496639789	0.033495829	0.637825412	0.883076851	3.437715926	3.106200865	0.233146312	0	0	0.278094193	0	0.11276875	0	0	0	0	0	0	0	0	0	0	0	0	0	36.6371	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.9683	0.127404857	1.364329194	0	1.771653686	1.480895494	0	0.992517701	4.111564079	0	2.708724723	0.173170956	0.009307918	1.559821371	3.150438745	3.496639789	0.033495829	0.637825412	0.883076851	3.437715926	3.106200865	0.233146312	0	0	0.278094193	0	0.11276875	0	0	0	0	0	0	0	0	0	0	0	0	0	36.6371
H3668_013_0	2010	3	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	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	0	0	0	0	0											0	YES	196.7304282	0	24.96915167	0	181.6071221	16.22583854	0	398.6531642	329.8613646	0	1149.416326	107.367473	45.36451455	1207.99383	4137.955508	2724.314411	3.175609569	399.4796227	602.1745136	2408.49705	14.9145206	275.5310629	0	0	186.2438782	0	77.3498261	0	0	0											3350	1A IP Acute: $200	1B IP Psych: $200	2 SNF: $300 per Admit	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	"8A OP Diagnostic Procedures/Tests: $0, 9A OP Hospital: $0"	"8B OP Radiology: $0, 9A OP Hospital: $0"	9A OP Hospital: $0	"12 Renal Dialysis: $0, 9A OP Hospital: $0"	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0, 9A OP Hospital: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											200	200	300	0	0	0	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											NO	200	200	300	0	0	0	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												3.2788	0	0.624228792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.98290412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.886	0	0	3.2788	0	0.624228792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.98290412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.886	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.2788	0	0.624228792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.98290412	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.886
H3668_801_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	214.4893591	0.798241821	24.51455317	23.3431987	7.100649174	14.47531895	0	13.38368683	55.22735697	6.731365347	45.32691895	54.52305929	0.333211048	23.63512616	47.59680927	47.43989689	0.427678623	1.909984967	23.36780141	116.1896849	32.67693844	2.626645526	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing											0.077367273	0.077367273	0.157554835	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077367273	0.077367273	0.157554835	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.5945	0.061757793	3.862386378	0	1.654451258	3.372749315	0	3.118399032	12.86797417	1.568408126	10.56117211	12.70387281	0.077638174	5.506984394	11.09005656	11.05349597	0.099649119	0.445026497	5.444697729	27.07219659	7.613726656	0.612008408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3811	0	0	16.5945	0.061757793	3.862386378	0	1.654451258	3.372749315	0	3.118399032	12.86797417	1.568408126	10.56117211	12.70387281	0.077638174	5.506984394	11.09005656	11.05349597	0.099649119	0.445026497	5.444697729	27.07219659	7.613726656	0.612008408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3811	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.5945	0.061757793	3.862386378	0	1.654451258	3.372749315	0	3.118399032	12.86797417	1.568408126	10.56117211	12.70387281	0.077638174	5.506984394	11.09005656	11.05349597	0.099649119	0.445026497	5.444697729	27.07219659	7.613726656	0.612008408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3811
H3668_802_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	206.4399227	0.508972672	25.50827378	24.14009455	7.30788595	15.31060711	0	13.15190327	56.05970004	7.625230649	46.86203405	51.38177229	0.212359305	20.68746385	50.19610627	47.5683629	0.596924224	1.915157157	23.18457847	121.2935793	48.73910006	2.548102928	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing											0.077149855	0.077149855	0.156416727	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077149855	0.077149855	0.156416727	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												15.9268	0.039267168	3.989920706	0	1.702737426	3.567371456	0	3.064393462	13.06191011	1.776678741	10.91885393	11.97195294	0.049479718	4.820179077	11.69569276	11.08342856	0.139083344	0.446231618	5.402006784	28.26140399	11.35621031	0.593707982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.8673	0	0	15.9268	0.039267168	3.989920706	0	1.702737426	3.567371456	0	3.064393462	13.06191011	1.776678741	10.91885393	11.97195294	0.049479718	4.820179077	11.69569276	11.08342856	0.139083344	0.446231618	5.402006784	28.26140399	11.35621031	0.593707982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.8673	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.9268	0.039267168	3.989920706	0	1.702737426	3.567371456	0	3.064393462	13.06191011	1.776678741	10.91885393	11.97195294	0.049479718	4.820179077	11.69569276	11.08342856	0.139083344	0.446231618	5.402006784	28.26140399	11.35621031	0.593707982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.8673
H3672_013_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	YES	1708.7	51	1876.5	460.3	391.7	13.02010608	0	414.7	465.1	7912.9	750.6	218.6	1260	5369.5	4170.1	3445	173.6	362.3	766.3	0	16.53418316	0	0	0	221.7	160.6	0	0	0	0											3400	$100 / days 1-10	$100 / days 1-10	$75 / days 21-100	$0.00 	125	20%	20%	$50.00 	$150.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$30 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											71.35833272	71.35833272	18.92780667	$0.00 	125	20%	20%	$50.00 	$150.00 	$0.00 	5	$0.00 	$0.00 	3	15	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	61.01137448	61.01137448	16.1832747	0	106.875	0.171	0.171	42.75	128.25	0	4.275	0	0	2.565	12.825	25.65	25.65	25.65	0	0	0.1539	0	0	0	25.65	12.825	0	0	0	0												8.6875	0.259298342	2.530659581	0	3.488578125	2.22643814	0	1.47736875	4.97075625	0	0.26740125	0	0	1.147730625	4.456794375	7.3636875	0.37107	0.77441625	0	0	2.544610788	0	0	0	0.47388375	0.17164125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2118		6.98914352	8.6875	0.259298342	2.530659581	0	3.488578125	2.22643814	0	1.47736875	4.97075625	0	0.26740125	0	0	1.147730625	4.456794375	7.3636875	0.37107	0.77441625	0	0	2.544610788	0	0	0	0.47388375	0.17164125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2118	NO																																																																																		0		0	8.6875	0.259298342	2.530659581	0	3.488578125	2.22643814	0	1.47736875	4.97075625	0	0.26740125	0	0	1.147730625	4.456794375	7.3636875	0.37107	0.77441625	0	0	2.544610788	0	0	0	0.47388375	0.17164125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2118
H3672_014_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	YES	1575.1	22.7	1430.4	494.4	347.1	10.41136495	0	404.6	417.6	6570.8	695.7	196.6	1436.4	4578.6	3590.5	3283.3	109.5	234.3	626.1	0	7.434256618	0	0	0	184.8	131.4	0	0	0	0											3400	$150 / days 1-10	$150 / days 1-10	$75 / days 21-100	$0.00 	$125.00 	20%	20%	$50.00 	$200.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$35 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											107.0374991	107.0374991	18.92780667	$0.00 	$125.00 	20%	20%	$50.00 	$200.00 	$0.00 	5	$0.00 	$0.00 	3.5	15	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	87.55667425	87.55667425	15.48294586	0	102.25	0.1636	0.1636	40.9	163.6	0	4.09	0	0	2.863	12.27	28.63	28.63	28.63	0	0	0.14724	0	0	0	28.63	12.27	0	0	0	0												11.4925	0.165628042	1.845567146	0	2.95758125	1.703299307	0	1.379011667	5.69328	0	0.23711775	0	0	1.09237765	3.67128625	7.833406583	0.26124875	0.55900075	0	0	1.094619945	0	0	0	0.440902	0.1343565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5612		9.024625017	11.4925	0.165628042	1.845567146	0	2.95758125	1.703299307	0	1.379011667	5.69328	0	0.23711775	0	0	1.09237765	3.67128625	7.833406583	0.26124875	0.55900075	0	0	1.094619945	0	0	0	0.440902	0.1343565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5612	NO																																																																																		0		0	11.4925	0.165628042	1.845567146	0	2.95758125	1.703299307	0	1.379011667	5.69328	0	0.23711775	0	0	1.09237765	3.67128625	7.833406583	0.26124875	0.55900075	0	0	1.094619945	0	0	0	0.440902	0.1343565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5612
H3672_804_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	YES	1705.2	50.9	1876.5	460.3	391.7	13.02009741	0	414.7	463.2	7936.1	752.8	219.3	1263.7	5385.2	4221.6	3487.6	175.7	366.8	775.8	0	16.53417215	0	0	0	220.3	159.6	0	0	0	0											3400	$150 / days 1-10	$150 / days 1-10	$75 / days 21-100	$0.00 	125	20%	20%	$50.00 	$200.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$35 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											107.0374991	107.0374991	18.92780667	$0.00 	125	20%	20%	$50.00 	$200.00 	$0.00 	5	$0.00 	$0.00 	3.5	15	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	87.55667425	87.55667425	15.48294586	0	102.25	0.1636	0.1636	40.9	163.6	0	4.09	0	0	2.863	12.27	28.63	28.63	28.63	0	0	0.14724	0	0	0	28.63	12.27	0	0	0	0												12.4418	0.371386227	2.421145658	0	3.337610417	2.130087937	0	1.413435833	6.31496	0	0.256579333	0	0	1.284818967	4.316586	8.320832333	0.419190917	0.875123667	0	0	2.434491507	0	0	0	0.525599083	0.163191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.0268		10.46318496	12.4418	0.371386227	2.421145658	0	3.337610417	2.130087937	0	1.413435833	6.31496	0	0.256579333	0	0	1.284818967	4.316586	8.320832333	0.419190917	0.875123667	0	0	2.434491507	0	0	0	0.525599083	0.163191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.0268	NO																																																																																		0		0	12.4418	0.371386227	2.421145658	0	3.337610417	2.130087937	0	1.413435833	6.31496	0	0.256579333	0	0	1.284818967	4.316586	8.320832333	0.419190917	0.875123667	0	0	2.434491507	0	0	0	0.525599083	0.163191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.0268
H3672_805_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	YES	1547.2	26.2	1463.7	435.8	322	13.61580053	0	360.2	500.4	7880.1	707.4	213.1	1497.4	5410.4	4089.3	3427.5	115.7	385.7	748.6	0	21.81841998	0	0	0	222.3	155.1	0	0	0	0											3400	$100 / days 1-10	$100 / days 1-10	$50 / days 21-100	$0.00 	100	20%	20%	$50.00 	$150.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$30 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											71.35833272	71.35833272	12.61853778	$0.00 	100	20%	20%	$50.00 	$150.00 	$0.00 	5	$0.00 	$0.00 	3	15	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	61.86767447	61.86767447	10.94027225	0	86.7	0.1734	0.1734	43.35	130.05	0	4.335	0	0	2.601	13.005	26.01	26.01	26.01	0	0	0.15606	0	0	0	26.01	13.005	0	0	0	0												7.9768	0.135077756	1.334439708	0	2.32645	2.360979813	0	1.3012225	5.423085	0	0.25554825	0	0	1.1727042	4.431778875	7.42910625	0.25077975	0.83600475	0	0	3.404982622	0	0	0	0.48183525	0.168089625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2889		6.027015397	7.9768	0.135077756	1.334439708	0	2.32645	2.360979813	0	1.3012225	5.423085	0	0.25554825	0	0	1.1727042	4.431778875	7.42910625	0.25077975	0.83600475	0	0	3.404982622	0	0	0	0.48183525	0.168089625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2889	NO																																																																																		0		0	7.9768	0.135077756	1.334439708	0	2.32645	2.360979813	0	1.3012225	5.423085	0	0.25554825	0	0	1.1727042	4.431778875	7.42910625	0.25077975	0.83600475	0	0	3.404982622	0	0	0	0.48183525	0.168089625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2889
H3706_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	709.1491712	13.89060414	276.3096684	0	167.8982246	6.183637484	4.207734434	207.8234476	332.9197392	4.614110103	14.71852245	0	0.287151762	405.5964161	0	3369.769822	153.8617536	440.6680646	29.2757048	7038.429419	4.266606851	0	0	0	0	0	0	0	0	0											3000	$175/Days 1-5 for IP Medical; $175/Days 1-5 for IP Surgical;	$175/Days 1-5 for IP Psych; $175/Days 1-5 for IP Substance Abuse;	$105/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$250/Case for OP Fac - Surgery; $250/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	No Cost-Sharing	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											175	175	105	0	100	0.2	0.191626564	47.79933782	250	0.2	0.2	0	0.2	25	0	25	25	25	0.2	5.650200016	0.2	0	0	0	0	0	0	0	0	0											NO	169.9141943	169.9141943	101.8369177	0	96.98754063	0.193975081	0.185853892	46.35940219	242.4688516	0.193975081	0.193975081	0	0.193975081	24.24688516	0	24.24688516	24.24688516	24.24688516	0.193975081	5.479990035	0.193975081	0	0	0	0	0	0	0	0	0												10.0412	0.196684234	2.344877079	0	1.35700299	1.199471583	0.782023819	0.802880899	6.726888903	0.895022382	2.855026587	0	0.055700286	0.819537477	0	6.80886849	0.310889023	0.89040233	5.678757217	3.214210257	0.827615411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8071	0	1.458406942	10.0412	0.196684234	2.344877079	0	1.35700299	1.199471583	0.782023819	0.802880899	6.726888903	0.895022382	2.855026587	0	0.055700286	0.819537477	0	6.80886849	0.310889023	0.89040233	5.678757217	3.214210257	0.827615411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8071	NO																																																																																		0			10.0412	0.196684234	2.344877079	0	1.35700299	1.199471583	0.782023819	0.802880899	6.726888903	0.895022382	2.855026587	0	0.055700286	0.819537477	0	6.80886849	0.310889023	0.89040233	5.678757217	3.214210257	0.827615411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.8071
H3706_006_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	P	V	V	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	YES	786.0675697	12.73918555	190.3488347	0	241.2388157	8.123385669	4.375245804	349.8250255	253.5035137	7.012290619	23.31822431	0	0.229486511	337.3956844	3611.946741	3173.24459	146.6892543	256.1500644	23.92510805	8960.864403	7.074388619	0	0	871.9999999	382.0607421	0	0	0	0	0											3000	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$105/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	$15/Procedure for Dental - Preventive;	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											250	250	105	0	100	0.2	0.191120618	48.76895766	200	0.1	0.2	0	0.200000001	25	15	25	25	25	0.2	3.754815638	0.2	0	0	15	25	0	0	0	0	0											NO	240.5414443	240.5414443	101.0274066	0	96.21657771	0.192433155	0.183889718	46.92382204	192.4331554	0.096216578	0.192433155	0	0.186377416	24.05414443	14.43248666	24.05414443	24.05414444	24.05414442	0.180358071	3.612755106	0.192433155	0	0	14.43248666	24.05414443	0	0	0	0	0												15.7568	0.255358508	1.602537427	0	1.934264438	1.563208737	0.804562715	1.36792727	4.065206754	0.674698605	4.487199482	0	0.042771103	0.67631371	4.344114429	6.360806973	0.294040376	0.513455887	4.315086339	2.697784052	1.361346925	0	0	1.048760697	0.765845356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9321	0	2.129536307	15.7568	0.255358508	1.602537427	0	1.934264438	1.563208737	0.804562715	1.36792727	4.065206754	0.674698605	4.487199482	0	0.042771103	0.67631371	4.344114429	6.360806973	0.294040376	0.513455887	4.315086339	2.697784052	1.361346925	0	0	1.048760697	0.765845356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9321	NO																																																																																		0			15.7568	0.255358508	1.602537427	0	1.934264438	1.563208737	0.804562715	1.36792727	4.065206754	0.674698605	4.487199482	0	0.042771103	0.67631371	4.344114429	6.360806973	0.294040376	0.513455887	4.315086339	2.697784052	1.361346925	0	0	1.048760697	0.765845356	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9321
H3706_009_0	2010	1	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	575.3151384	11.34719378	199.236863	0	120.9752237	4.460972892	3.035612499	149.7863021	240.1424764	3.326075095	10.60702561	0	0.208655089	292.4268797	0	2429.947456	110.9560372	317.7861038	21.51024217	5075.487528	3.073671056	0	0	0	0	0	0	0	0	0											3000	$195/Days 1-5 for IP Medical; $195/Days 1-5 for IP Surgical;	$195/Days 1-5 for IP Psych; $195/Days 1-5 for IP Substance Abuse;	$105/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 0-20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $250/deductible for ER - Worldwide; $25/Visit for Urgent Care;	$250/Case for OP Fac - Surgery; $250/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	No Cost-Sharing	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											195	195	105	0	100	0.2	0.19162715	47.79822556	250	0.2	0.2	0	0.2	25	0	25	25	25	0.2	5.650490051	0.2	0	0	0	0	0	0	0	0	0											NO	191.3164114	191.3164115	103.0165292	0	98.11098022	0.19622196	0.188007275	46.89530761	245.2774505	0.19622196	0.19622196	0	0.19622196	24.52774506	0	24.52774505	24.52774506	24.52774506	0.19622196	5.543751176	0.19622196	0	0	0	0	0	0	0	0	0												9.1723	0.1809087	1.710390843	0	0.989083149	0.875340846	0.570717234	0.585356226	4.908461198	0.652648976	2.081331359	0	0.040942711	0.597714329	0	4.966760974	0.226791783	0.649548045	4.220781888	2.344769996	0.60312176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3769	0	0.681144327	9.1723	0.1809087	1.710390843	0	0.989083149	0.875340846	0.570717234	0.585356226	4.908461198	0.652648976	2.081331359	0	0.040942711	0.597714329	0	4.966760974	0.226791783	0.649548045	4.220781888	2.344769996	0.60312176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3769	NO																																																																																		0			9.1723	0.1809087	1.710390843	0	0.989083149	0.875340846	0.570717234	0.585356226	4.908461198	0.652648976	2.081331359	0	0.040942711	0.597714329	0	4.966760974	0.226791783	0.649548045	4.220781888	2.344769996	0.60312176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3769
H3706_010_0	2010	1	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	P	V	V	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	YES	549.4977781	10.78475871	198.1744953	0	126.6144629	6.386038217	4.336762075	145.1328212	215.2811199	3.344960371	11.00131054	0	0.271088595	309.5111857	2742.138342	2397.112308	110.7551038	317.9432632	18.46415322	5588.159193	5.173778294	0	0	871.9999999	381.9793236	0	0	0	0	0											3000	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$105/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 0-20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $500/Deductible for ER - Worldwide; $25/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	$15/Procedure for Dental - Preventive;	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											250	250	105	0	100	0.2	0.191585576	47.75837066	200	0.1	0.2	0	0.2	25	15	25	25	25	0.2	4.89192185	0.2	0	0	15	25	0	0	0	0	0											NO	243.9696754	243.9696753	102.4672637	0	97.58787016	0.19517574	0.186964283	46.60637674	195.1757403	0.09758787	0.19517574	0	0.190721344	24.39696755	14.63818053	24.39696754	24.39696754	24.39696754	0.181568463	4.773922342	0.19517574	0	0	14.63818053	24.39696754	0	0	0	0	0												11.1717	0.21926284	1.692199855	0	1.029669647	1.246399737	0.810819611	0.563676245	3.501470997	0.326427558	2.147188929	0	0.051702381	0.629261196	3.344993006	4.873522597	0.225174056	0.646404289	3.352507914	2.223119835	1.009796009	0	0	1.063707785	0.776594763	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9056	0	0.987485633	11.1717	0.21926284	1.692199855	0	1.029669647	1.246399737	0.810819611	0.563676245	3.501470997	0.326427558	2.147188929	0	0.051702381	0.629261196	3.344993006	4.873522597	0.225174056	0.646404289	3.352507914	2.223119835	1.009796009	0	0	1.063707785	0.776594763	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9056	NO																																																																																		0			11.1717	0.21926284	1.692199855	0	1.029669647	1.246399737	0.810819611	0.563676245	3.501470997	0.326427558	2.147188929	0	0.051702381	0.629261196	3.344993006	4.873522597	0.225174056	0.646404289	3.352507914	2.223119835	1.009796009	0	0	1.063707785	0.776594763	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9056
H3706_017_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	0	V	Coin	Coin	Coin	V	T	P	V	P	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	YES	245.5684594	3.453212888	0	0	168.800989	6.365679832	4.249930594	208.2873762	335.5971548	4.614110103	14.71852245	0	0.291645829	407.8434569	0	3449.389247	158.0064442	453.6378248	30.35269646	13.80120914	4.266606851	0	0	1090	401.3094078	312.283125	0	0	0	0											2500	$150/Admit for IP Medical; $150/Admit for IP Surgical;	$150/Admit for IP Psych; $150/Admit for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Diabetes Monitoring Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $150/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$15/Case for OP Fac - Cardiovascular; $15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Visit for Prof - CORF; $15/Visit for Prof - CORF;	No Cost-Sharing	$15/Visit for Speclst - Office Visits; $15/Consult for Speclst - Consults;	$15/Service for OP Psych - Non-Physician; $15/Service for OP Psych - Psychiatrist; $15/Service for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $15/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$20/Visit for Chiropractor; $10/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	$15/Procedure for Dental - Preventive;	$10/Exam for Vision (Refractions)	$20/Service for Vision Hardware	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	150	0	0	50	0.1	0.1	46.84797803	174.9456744	0.2	0.2	0	0.2	15	0	15	15	15	0.2	0.179830253	0.2	0	0	15	10	20	0	0	0	0											NO	146.9102113	146.9102113	0	0	48.97007043	0.097940141	0.097940141	45.88297568	171.3420399	0.195880282	0.195880282	0	0.195880282	14.69102113	0	14.69102113	14.69102114	14.69102113	0.195880282	0.176126003	0.195880282	0	0	14.69102113	9.794014085	19.58802817	0	0	0	0												3.0064	0.04227602	0	0	0.688849693	0.623455579	0.416238801	0.796403718	4.791825092	0.903813187	2.883068323	0	0.057127667	0.49930307	0	4.22292086	0.193439668	0.555366906	5.945494734	2.4307518	0.835744152	0	0	1.334434419	0.327535833	0.509750888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.0642	0	0.653336083	3.0064	0.04227602	0	0	0.688849693	0.623455579	0.416238801	0.796403718	4.791825092	0.903813187	2.883068323	0	0.057127667	0.49930307	0	4.22292086	0.193439668	0.555366906	5.945494734	2.4307518	0.835744152	0	0	1.334434419	0.327535833	0.509750888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.0642	NO																																																																																		0			3.0064	0.04227602	0	0	0.688849693	0.623455579	0.416238801	0.796403718	4.791825092	0.903813187	2.883068323	0	0.057127667	0.49930307	0	4.22292086	0.193439668	0.555366906	5.945494734	2.4307518	0.835744152	0	0	1.334434419	0.327535833	0.509750888	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.0642
H3706_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	198.255486	3.749117416	38.2660869	0	6.567644133	6.229911298	4.107418496	9.623741658	24.66400592	4.335156601	13.79097367	0	0.275481384	17.39605324	42.13495607	115.0808723	2.331046112	3.260475991	31.71758304	38.80664376	3.862285523	0.430671806	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing											0.081424601	0.081424601	0.189764946	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081424601	0.081424601	0.189764946	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.1429	0.305270391	7.261561928	0	1.530261083	1.451569333	0.95702851	2.242331806	5.746713378	1.010091488	3.213296866	0	0.064187162	4.053280404	9.817444765	26.81384325	0.543133744	0.759690906	7.390196847	9.041947996	0.899912527	0.100346531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.345	0	0	16.1429	0.305270391	7.261561928	0	1.530261083	1.451569333	0.95702851	2.242331806	5.746713378	1.010091488	3.213296866	0	0.064187162	4.053280404	9.817444765	26.81384325	0.543133744	0.759690906	7.390196847	9.041947996	0.899912527	0.100346531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.345	NO																																																																																		0			16.1429	0.305270391	7.261561928	0	1.530261083	1.451569333	0.95702851	2.242331806	5.746713378	1.010091488	3.213296866	0	0.064187162	4.053280404	9.817444765	26.81384325	0.543133744	0.759690906	7.390196847	9.041947996	0.899912527	0.100346531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.345
H3706_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	198.255486	3.749117416	38.2660869	0	6.567644133	6.229911298	4.107418496	9.623741658	24.66400592	4.335156601	13.79097367	0	0.275481384	17.39605324	42.13495607	115.0808723	2.331046112	3.260475991	31.71758304	38.80664376	3.862285523	0.430671806	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing											0.081424601	0.081424601	0.189764946	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081424601	0.081424601	0.189764946	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.1429	0.305270391	7.261561928	0	1.530261083	1.451569333	0.95702851	2.242331806	5.746713378	1.010091488	3.213296866	0	0.064187162	4.053280404	9.817444765	26.81384325	0.543133744	0.759690906	7.390196847	9.041947996	0.899912527	0.100346531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.345	0	0	16.1429	0.305270391	7.261561928	0	1.530261083	1.451569333	0.95702851	2.242331806	5.746713378	1.010091488	3.213296866	0	0.064187162	4.053280404	9.817444765	26.81384325	0.543133744	0.759690906	7.390196847	9.041947996	0.899912527	0.100346531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.345	NO																																																																																		0			16.1429	0.305270391	7.261561928	0	1.530261083	1.451569333	0.95702851	2.242331806	5.746713378	1.010091488	3.213296866	0	0.064187162	4.053280404	9.817444765	26.81384325	0.543133744	0.759690906	7.390196847	9.041947996	0.899912527	0.100346531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.345
H3706_807_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	198.255486	3.749117416	38.2660869	0	6.567644133	6.229911298	4.107418496	9.623741658	24.66400592	4.335156601	13.79097367	0	0.275481384	17.39605324	42.13495607	115.0808723	2.331046112	3.260475991	31.71758304	38.80664376	3.862285523	0.430671806	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing											0.081424601	0.081424601	0.189764946	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081424601	0.081424601	0.189764946	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.1429	0.305270391	7.261561928	0	1.530261083	1.451569333	0.95702851	2.242331806	5.746713378	1.010091488	3.213296866	0	0.064187162	4.053280404	9.817444765	26.81384325	0.543133744	0.759690906	7.390196847	9.041947996	0.899912527	0.100346531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.345	0	0	16.1429	0.305270391	7.261561928	0	1.530261083	1.451569333	0.95702851	2.242331806	5.746713378	1.010091488	3.213296866	0	0.064187162	4.053280404	9.817444765	26.81384325	0.543133744	0.759690906	7.390196847	9.041947996	0.899912527	0.100346531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.345	NO																																																																																		0			16.1429	0.305270391	7.261561928	0	1.530261083	1.451569333	0.95702851	2.242331806	5.746713378	1.010091488	3.213296866	0	0.064187162	4.053280404	9.817444765	26.81384325	0.543133744	0.759690906	7.390196847	9.041947996	0.899912527	0.100346531	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.345
H3708_001_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																										0	NO	726.2970248	25.00791169	390.6339442		38.24383319	61.52361523	16.17156236	25.21789507	47.87535727	41.67945628	76.96747896	4.03045987	0.397235533	10.81748889	28.51110268	214.1203878	18.74530094	39.93220617		12.30168994	26.45422526	11.4695112																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																		0.082825237	0.082825237	0.182406853		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.082825237	0.082825237	0.182406853		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				60.1557	2.071286212	71.25430852	0	8.910813134	14.33500235	3.76797403	5.87576955	11.15495824	9.711313312	17.9334226	0.93909715	0.092555879	2.520474912	6.643086925	49.89005036	4.367655119	9.304204037	0	2.866293756	6.163834485	2.672396109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	290.6302	0	0	60.1557	2.071286212	71.25430852	0	8.910813134	14.33500235	3.76797403	5.87576955	11.15495824	9.711313312	17.9334226	0.93909715	0.092555879	2.520474912	6.643086925	49.89005036	4.367655119	9.304204037	0	2.866293756	6.163834485	2.672396109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	290.6302	NO																																																																																		0	0	0	60.1557	2.071286212	71.25430852	0	8.910813134	14.33500235	3.76797403	5.87576955	11.15495824	9.711313312	17.9334226	0.93909715	0.092555879	2.520474912	6.643086925	49.89005036	4.367655119	9.304204037	0	2.866293756	6.163834485	2.672396109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	290.6302
H3709_001_0	2010	6	N/A	q.1	q.2									Other Non-Covered	Other Non-Covered									Foreign Emergency (Non-coveredd)	Professional (non-covered)									D	D	D	0	T	Coin	Coin	P	P	0	V	0	P	Coin	V	V	V	Coin	0	Coin	Coin	V	0	0	0	0	0	0	0	0	V	V																																																	0	YES	1472.420596	105.874264	926.4497692	3241.463341	208.6178257	5.76462762	0.938902989	201.0790085	270.5716817	560.9828688	463.9615218	12.07779759	51.68549302	10.38101368	4343.318849	4110.648079	326.352819	15.3678588	26.72331169	2.680294123	9.552971057	0.997087126	0	0	0	0	0	0	0	0	0	0									2500	$100 / day up to 5 days.	$200 / day up to 5 days.	$100/day for days 21 to 100.	0	$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	0	"$100 copay for CT, MRI, PET, and nuclear medicine studies. $0 copay for all other lab plus 0% for Hospital Based physician costs"	0	$35 copay	20% coinsurance and 0% for medical/surgical supplies	$20 copay for Office Visits and 20% coinsurance for other services	$20 copay for Office Visits and 20% coinsurance for other services	$40 copay	20% coinsurance	0	$20 copay for Office Visits and 20% coinsurance for other services	20% coinsurance	$20 copay for Vision Exams and 0% Coinsurance for OP Blood	0	0	0	0	0	0	0	0	None	None									61.82069251	93.74957471	42.71645621	0	100	0.2	0.2	46	150	0	50	50	35	0.2	20	20	40	0.2	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0									YES	54.28710022	82.32506546	37.51094407	0	87.81380152	0.175627603	0.175627603	40.3943487	131.7207023	0	43.90690076	43.90690076	30.73483053	0.175627603	17.5627603	17.5627603	35.12552061	0.175627603	0	0.175627603	0.175627603	0	0	0	0	0	0	0	0	0	0	0									2500	6.6611	0.726342143	2.896000457	0	1.526627029	1.012427731	0.164897282	0.676871299	2.969990994	0	1.697592708	0.044191555	0.132378739	1.82319255	6.356722322	6.016193908	0.955276056	2.699020205	0	0.470733632	1.677765409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5073	0	5.343785756	6.6611	0.726342143	2.896000457	0	1.526627029	1.012427731	0.164897282	0.676871299	2.969990994	0	1.697592708	0.044191555	0.132378739	1.82319255	6.356722322	6.016193908	0.955276056	2.699020205	0	0.470733632	1.677765409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5073	NO	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$100 copay	30% coinsurance	30% coinsurance	$50 copay for ER and $20 copay for Urgent Care	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	0	0	0	0	0	0	0	0	$50 copay for worldwide emergency care	None										4.2033	0.127	0.7881	0.4525	0.1155	0.1126	0.0183	0.1157	0.4027	0.2227	0.3224	0.0263	0.0097	0.2028	0.9744	1.8497	0.0455	0.3002	0.522	0.0524	0.1866	0.0195	0	0	0	0	0	0	0	0	0.0276	0									11.0978	500	0.286016078	10.8645	0.853339241	3.684118659	0.452541308	1.642149216	1.125041793	0.183239087	0.792589275	3.372698206	0.222673693	2.01995465	0.070490401	0.142126449	2.025989364	7.331104043	7.86588981	1.000825009	2.999236821	0.522049447	0.523094136	1.864386113	0.019478453	0	0	0	0	0	0	0	0	0.02764382	0	0	0	0	0	0	0	0	0	49.6051
H3709_003_0	2010	4	N/A	q.1	q.2									Other Non-Covered	Other Non-Covered									Foreign Emergency (Non-coveredd)	Professional (non-covered)									D	D	D	0	T	Coin	Coin	P	P	0	V	0	P	Coin	V	V	V	Coin	0	Coin	Coin	V	0	0	0	0	0	0	0	0	V	V																																																	0	YES	1259.796061	90.58551684	792.6660172	2773.380621	178.4924197	4.975497489	0.810374889	172.0422435	231.4998443	479.974275	396.9632718	10.33370619	44.22186206	8.959938252	3716.122954	3517.050949	279.2259201	13.26412527	23.06511001	2.313383892	8.245247853	0.860594096	0	0	0	0	0	0	0	0	0	0									2500	$100 / day up to 5 days.	$200 / day up to 5 days.	$100/day for days 21 to 100.	0	$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	0	"$100 copay for CT, MRI, PET, and nuclear medicine studies. $0 copay for all other lab plus 0% for Hospital Based physician costs"	0	$35 copay	20% coinsurance and 0% for medical/surgical supplies	$20 copay for Office Visits and 20% coinsurance for other services	$20 copay for Office Visits and 20% coinsurance for other services	$40 copay	20% coinsurance	0	$20 copay for Office Visits and 20% coinsurance for other services	20% coinsurance	$20 copay for Vision Exams and 0% Coinsurance for OP Blood	0	0	0	0	0	0	0	0	None	None									61.82069251	93.74957471	42.71645621	0	100	0.2	0.2	46	150	0	50	50	35	0.2	20	20	40	0.2	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0									YES	58.37048814	88.5174238	40.33245665	0	94.41901371	0.188838027	0.188838027	43.43274631	141.6285206	0	47.20950686	47.20950686	33.0466548	0.188838027	18.88380274	18.88380274	37.76760548	0.188838027	0	0.188838027	0.188838027	0	0	0	0	0	0	0	0	0	0	0									2500	6.1279	0.668199715	2.664180648	0	1.404423185	0.939563131	0.153029595	0.622688926	2.732248371	0	1.561703359	0.040654098	0.121782051	1.691977065	5.847877736	5.53460803	0.878807866	2.504771251	0	0.436854851	1.55701634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4883	0	2.097667437	6.1279	0.668199715	2.664180648	0	1.404423185	0.939563131	0.153029595	0.622688926	2.732248371	0	1.561703359	0.040654098	0.121782051	1.691977065	5.847877736	5.53460803	0.878807866	2.504771251	0	0.436854851	1.55701634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.4883	NO	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$100 copay	30% coinsurance	30% coinsurance	$50 copay for ER and $20 copay for Urgent Care	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	0	0	0	0	0	0	0	0	$50 copay for worldwide emergency care	None										3.8119	0.1152	0.714	0.4107	0.1046	0.1022	0.0166	0.1091	0.3655	0.2021	0.2926	0.0239	0.0088	0.1841	0.8843	1.6787	0.0413	0.2725	0.4738	0.0475	0.1694	0.0177	0	0	0	0	0	0	0	0	0.0255	0									10.072	500	0.19583804	9.9398	0.783370776	3.378209759	0.410722277	1.509038209	1.041768021	0.169676027	0.731790847	3.097732449	0.202091463	1.85426866	0.064522082	0.130628758	1.876028913	6.732195161	7.213332375	0.920146627	2.777238169	0.473795242	0.484375555	1.726387273	0.017678016	0	0	0	0	0	0	0	0	0.025466166	0	0	0	0	0	0	0	0	0	45.5603
H3709_801_0	2010	5	N/A	q.1	q.2									Other Non-Covered	Other Non-Covered									Foreign Emergency (Non-coveredd)	Professional (non-covered)									D	D	D	0	T	Coin	Coin	P	P	0	V	0	P	Coin	V	V	V	Coin	0	Coin	Coin	V	0	0	0	0	0	0	0	0	V	V																																																	0	YES	1404.279826	100.9746083	883.57547	3091.454702	198.9633972	5.713807867	0.930625817	191.7734618	258.0501488	535.0216692	442.490282	11.51886053	49.2935886	10.28949684	4142.318473	3920.415255	311.2498432	15.23237897	26.48772456	2.65666521	9.46875406	0.988297015	0	0	0	0	0	0	0	0	0	0									2500	$100 / day up to 5 days.	$200 / day up to 5 days.	$100/day for days 21 to 100.	0	$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	0	"$100 copay for CT, MRI, PET, and nuclear medicine studies. $0 copay for all other lab plus 0% for Hospital Based physician costs"	0	$35 copay	20% coinsurance and 0% for medical/surgical supplies	$20 copay for Office Visits and 20% coinsurance for other services	$20 copay for Office Visits and 20% coinsurance for other services	$40 copay	20% coinsurance	0	$20 copay for Office Visits and 20% coinsurance for other services	20% coinsurance	$20 copay for Vision Exams and 0% Coinsurance for OP Blood	0	0	0	0	0	0	0	0	None	None									61.82069251	93.74957471	42.71645621	0	100	0.2	0.2	46	150	0	50	50	35	0.2	20	20	40	0.2	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0									YES	55.26827188	83.81298839	38.18890762	0	89.40092651	0.178801853	0.178801853	41.12442619	134.1013898	0	44.70046325	44.70046325	31.29032428	0.178801853	17.8801853	17.8801853	35.7603706	0.178801853	0	0.178801853	0.178801853	0	0	0	0	0	0	0	0	0	0	0									2500	6.4677	0.70524864	2.8118985	0	1.482292671	1.021639434	0.166397621	0.657214465	2.883740299	0	1.648293383	0.0429082	0.128534364	1.839781101	6.172118489	5.841479268	0.927534145	2.723577586	0	0.475016662	1.693030772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6884	0	4.468207975	6.4677	0.70524864	2.8118985	0	1.482292671	1.021639434	0.166397621	0.657214465	2.883740299	0	1.648293383	0.0429082	0.128534364	1.839781101	6.172118489	5.841479268	0.927534145	2.723577586	0	0.475016662	1.693030772	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6884	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$100 copay	30% coinsurance	30% coinsurance	$50 copay for ER and $20 copay for Urgent Care	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	0	0	0	0	0	0	0	0	$50 copay for worldwide emergency care	None									0	4.1619	0.1257	0.7771	0.4496	0.1128	0.1119	0.0182	0.1144	0.4	0.2212	0.3202	0.0261	0.0097	0.2015	0.9679	1.8375	0.0452	0.2982	0.5186	0.052	0.1854	0.0193	0	0	0	0	0	0	0	0	0.5153	0									11.4899	500	0.302910456	10.6295	0.830992554	3.588960559	0.449566075	1.595107278	1.133509879	0.184618311	0.771603707	3.283788342	0.221203327	1.968526694	0.069033389	0.138217708	2.0412388	7.140066142	7.678961199	0.972782328	3.021811802	0.518602234	0.527031418	1.878419177	0.019349833	0	0	0	0	0	0	0	0	0.515335541	0	0	0	0	0	0	0	0	0	49.1783
H3709_802_0	2010	4	N/A	q.1	q.2									Other Non-Covered	Other Non-Covered									Foreign Emergency (Non-coveredd)	Professional (non-covered)									D	D	D	0	T	Coin	Coin	P	P	0	V	0	P	Coin	V	V	V	Coin	0	Coin	Coin	V	0	0	0	0	0	0	0	0	V	V																																																	0	YES	1430.35296	102.8493946	899.9807347	3148.853458	202.6575323	5.819895614	0.947904661	195.3341021	262.8413423	544.9553674	450.7059585	11.73273016	50.20881814	10.48054098	4219.22852	3993.205245	317.0287905	15.51519715	26.97951971	2.705991269	9.644559548	1.006646635	0	0	0	0	0	0	0	0	0	0									2500	$100 / day up to 5 days.	$200 / day up to 5 days.	$100/day for days 21 to 100.	0	$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	0	"$100 copay for CT, MRI, PET, and nuclear medicine studies. $0 copay for all other lab plus 0% for Hospital Based physician costs"	0	$35 copay	20% coinsurance and 0% for medical/surgical supplies	$20 copay for Office Visits and 20% coinsurance for other services	$20 copay for Office Visits and 20% coinsurance for other services	$40 copay	20% coinsurance	0	$20 copay for Office Visits and 20% coinsurance for other services	20% coinsurance	$20 copay for Vision Exams and 0% Coinsurance for OP Blood	0	0	0	0	0	0	0	0	None	None									61.82069251	93.74957471	42.71645621	0	100	0.2	0.2	46	150	0	50	50	35	0.2	20	20	40	0.2	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0									YES	54.80295486	83.10734647	37.86738593	0	88.64823838	0.177296477	0.177296477	40.77818965	132.9723576	0	44.32411919	44.32411919	31.02688343	0.177296477	17.72964768	17.72964768	35.45929535	0.177296477	0	0.177296477	0.177296477	0	0	0	0	0	0	0	0	0	0	0									2500	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	0	4.874367854	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$100 copay	30% coinsurance	30% coinsurance	$50 copay for ER and $20 copay for Urgent Care	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	0	0	0	0	0	0	0	0	$50 copay for worldwide emergency care	None									0	4.2126	0.1273	0.7865	0.455	0.1141	0.1132	0.0184	0.1152	0.4049	0.2239	0.3241	0.0264	0.0098	0.2039	0.9797	1.8599	0.0458	0.3019	0.5249	0.0526	0.1876	0.0196	0	0	0	0	0	0	0	0	0.5177	0									11.6253	500	0.318855671	10.7448	0.839570602	3.626520471	0.455042163	1.611251141	1.145080107	0.18650279	0.778980876	3.317473706	0.223897768	1.988896071	0.069780326	0.139619891	2.062074612	7.213524319	7.759707495	0.982600803	3.052656748	0.52491924	0.532411056	1.897593018	0.01958553	0	0	0	0	0	0	0	0	0.51765377	0	0	0	0	0	0	0	0	0	49.6902
H3709_803_0	2010	5	N/A	q.1	q.2									Other Non-Covered	Other Non-Covered									Foreign Emergency (Non-coveredd)	Professional (non-covered)									D	D	D	0	T	Coin	Coin	P	P	0	V	0	P	Coin	V	V	V	Coin	0	Coin	Coin	V	0	0	0	0	0	0	0	0	V	V																																																	0	YES	1430.35296	102.8493946	899.9807347	3148.853458	202.6575323	5.819895614	0.947904661	195.3341021	262.8413423	544.9553674	450.7059585	11.73273016	50.20881814	10.48054098	4219.22852	3993.205245	317.0287905	15.51519715	26.97951971	2.705991269	9.644559548	1.006646635	0	0	0	0	0	0	0	0	0	0									2500	$100 / day up to 5 days.	$200 / day up to 5 days.	$100/day for days 21 to 100.	0	$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	0	"$100 copay for CT, MRI, PET, and nuclear medicine studies. $0 copay for all other lab plus 0% for Hospital Based physician costs"	0	$35 copay	20% coinsurance and 0% for medical/surgical supplies	$20 copay for Office Visits and 20% coinsurance for other services	$20 copay for Office Visits and 20% coinsurance for other services	$40 copay	20% coinsurance	0	$20 copay for Office Visits and 20% coinsurance for other services	20% coinsurance	$20 copay for Vision Exams and 0% Coinsurance for OP Blood	0	0	0	0	0	0	0	0	None	None									61.82069251	93.74957471	42.71645621	0	100	0.2	0.2	46	150	0	50	50	35	0.2	20	20	40	0.2	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0									YES	54.80295486	83.10734647	37.86738593	0	88.64823838	0.177296477	0.177296477	40.77818965	132.9723576	0	44.32411919	44.32411919	31.02688343	0.177296477	17.72964768	17.72964768	35.45929535	0.177296477	0	0.177296477	0.177296477	0	0	0	0	0	0	0	0	0	0	0									2500	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	0	4.874367854	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$100 copay	30% coinsurance	30% coinsurance	$50 copay for ER and $20 copay for Urgent Care	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	0	0	0	0	0	0	0	0	$50 copay for worldwide emergency care	None									0	4.2126	0.1273	0.7865	0.455	0.1141	0.1132	0.0184	0.1152	0.4049	0.2239	0.3241	0.0264	0.0098	0.2039	0.9797	1.8599	0.0458	0.3019	0.5249	0.0526	0.1876	0.0196	0	0	0	0	0	0	0	0	0.5177	0									11.6253	500	0.318855671	10.7448	0.839570602	3.626520471	0.455042163	1.611251141	1.145080107	0.18650279	0.778980876	3.317473706	0.223897768	1.988896071	0.069780326	0.139619891	2.062074612	7.213524319	7.759707495	0.982600803	3.052656748	0.52491924	0.532411056	1.897593018	0.01958553	0	0	0	0	0	0	0	0	0.51765377	0	0	0	0	0	0	0	0	0	49.6902
H3709_804_0	2010	4	N/A	q.1	q.2									Other Non-Covered	Other Non-Covered									Foreign Emergency (Non-coveredd)	Professional (non-covered)									D	D	D	0	T	Coin	Coin	P	P	0	V	0	P	Coin	V	V	V	Coin	0	Coin	Coin	V	0	0	0	0	0	0	0	0	V	V																																																	0	YES	1430.35296	102.8493946	899.9807347	3148.853458	202.6575323	5.819895614	0.947904661	195.3341021	262.8413423	544.9553674	450.7059585	11.73273016	50.20881814	10.48054098	4219.22852	3993.205245	317.0287905	15.51519715	26.97951971	2.705991269	9.644559548	1.006646635	0	0	0	0	0	0	0	0	0	0									2500	$100 / day up to 5 days.	$200 / day up to 5 days.	$100/day for days 21 to 100.	0	$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	0	"$100 copay for CT, MRI, PET, and nuclear medicine studies. $0 copay for all other lab plus 0% for Hospital Based physician costs"	0	$35 copay	20% coinsurance and 0% for medical/surgical supplies	$20 copay for Office Visits and 20% coinsurance for other services	$20 copay for Office Visits and 20% coinsurance for other services	$40 copay	20% coinsurance	0	$20 copay for Office Visits and 20% coinsurance for other services	20% coinsurance	$20 copay for Vision Exams and 0% Coinsurance for OP Blood	0	0	0	0	0	0	0	0	None	None									61.82069251	93.74957471	42.71645621	0	100	0.2	0.2	46	150	0	50	50	35	0.2	20	20	40	0.2	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0									YES	54.80295486	83.10734647	37.86738593	0	88.64823838	0.177296477	0.177296477	40.77818965	132.9723576	0	44.32411919	44.32411919	31.02688343	0.177296477	17.72964768	17.72964768	35.45929535	0.177296477	0	0.177296477	0.177296477	0	0	0	0	0	0	0	0	0	0	0									2500	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	0	4.874367854	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$100 copay	30% coinsurance	30% coinsurance	$50 copay for ER and $20 copay for Urgent Care	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	0	0	0	0	0	0	0	0	$50 copay for worldwide emergency care	None									0	4.2126	0.1273	0.7865	0.455	0.1141	0.1132	0.0184	0.1152	0.4049	0.2239	0.3241	0.0264	0.0098	0.2039	0.9797	1.8599	0.0458	0.3019	0.5249	0.0526	0.1876	0.0196	0	0	0	0	0	0	0	0	0.5177	0									11.6253	500	0.318855671	10.7448	0.839570602	3.626520471	0.455042163	1.611251141	1.145080107	0.18650279	0.778980876	3.317473706	0.223897768	1.988896071	0.069780326	0.139619891	2.062074612	7.213524319	7.759707495	0.982600803	3.052656748	0.52491924	0.532411056	1.897593018	0.01958553	0	0	0	0	0	0	0	0	0.51765377	0	0	0	0	0	0	0	0	0	49.6902
H3709_805_0	2010	5	N/A	q.1	q.2									Other Non-Covered	Other Non-Covered									Foreign Emergency (Non-coveredd)	Professional (non-covered)									D	D	D	0	T	Coin	Coin	P	P	0	V	0	P	Coin	V	V	V	Coin	0	Coin	Coin	V	0	0	0	0	0	0	0	0	V	V																																																	0	YES	1430.35296	102.8493946	899.9807347	3148.853458	202.6575323	5.819895614	0.947904661	195.3341021	262.8413423	544.9553674	450.7059585	11.73273016	50.20881814	10.48054098	4219.22852	3993.205245	317.0287905	15.51519715	26.97951971	2.705991269	9.644559548	1.006646635	0	0	0	0	0	0	0	0	0	0									2500	$100 / day up to 5 days.	$200 / day up to 5 days.	$100/day for days 21 to 100.	0	$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	0	"$100 copay for CT, MRI, PET, and nuclear medicine studies. $0 copay for all other lab plus 0% for Hospital Based physician costs"	0	$35 copay	20% coinsurance and 0% for medical/surgical supplies	$20 copay for Office Visits and 20% coinsurance for other services	$20 copay for Office Visits and 20% coinsurance for other services	$40 copay	20% coinsurance	0	$20 copay for Office Visits and 20% coinsurance for other services	20% coinsurance	$20 copay for Vision Exams and 0% Coinsurance for OP Blood	0	0	0	0	0	0	0	0	None	None									61.82069251	93.74957471	42.71645621	0	100	0.2	0.2	46	150	0	50	50	35	0.2	20	20	40	0.2	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0									YES	54.80295486	83.10734647	37.86738593	0	88.64823838	0.177296477	0.177296477	40.77818965	132.9723576	0	44.32411919	44.32411919	31.02688343	0.177296477	17.72964768	17.72964768	35.45929535	0.177296477	0	0.177296477	0.177296477	0	0	0	0	0	0	0	0	0	0	0									2500	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	0	4.874367854	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$100 copay	30% coinsurance	30% coinsurance	$50 copay for ER and $20 copay for Urgent Care	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	0	0	0	0	0	0	0	0	$50 copay for worldwide emergency care	None									0	4.2126	0.1273	0.7865	0.455	0.1141	0.1132	0.0184	0.1152	0.4049	0.2239	0.3241	0.0264	0.0098	0.2039	0.9797	1.8599	0.0458	0.3019	0.5249	0.0526	0.1876	0.0196	0	0	0	0	0	0	0	0	0.5177	0									11.6253	500	0.318855671	10.7448	0.839570602	3.626520471	0.455042163	1.611251141	1.145080107	0.18650279	0.778980876	3.317473706	0.223897768	1.988896071	0.069780326	0.139619891	2.062074612	7.213524319	7.759707495	0.982600803	3.052656748	0.52491924	0.532411056	1.897593018	0.01958553	0	0	0	0	0	0	0	0	0.51765377	0	0	0	0	0	0	0	0	0	49.6902
H3709_806_0	2010	5	N/A	q.1	q.2									Other Non-Covered	Other Non-Covered									Foreign Emergency (Non-coveredd)	Professional (non-covered)									D	D	D	0	T	Coin	Coin	P	P	0	V	0	P	Coin	V	V	V	Coin	0	Coin	Coin	V	0	0	0	0	0	0	0	0	V	V																																																	0	YES	1430.35296	102.8493946	899.9807347	3148.853458	202.6575323	5.819895614	0.947904661	195.3341021	262.8413423	544.9553674	450.7059585	11.73273016	50.20881814	10.48054098	4219.22852	3993.205245	317.0287905	15.51519715	26.97951971	2.705991269	9.644559548	1.006646635	0	0	0	0	0	0	0	0	0	0									2500	$100 / day up to 5 days.	$200 / day up to 5 days.	$100/day for days 21 to 100.	0	$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	0	"$100 copay for CT, MRI, PET, and nuclear medicine studies. $0 copay for all other lab plus 0% for Hospital Based physician costs"	0	$35 copay	20% coinsurance and 0% for medical/surgical supplies	$20 copay for Office Visits and 20% coinsurance for other services	$20 copay for Office Visits and 20% coinsurance for other services	$40 copay	20% coinsurance	0	$20 copay for Office Visits and 20% coinsurance for other services	20% coinsurance	$20 copay for Vision Exams and 0% Coinsurance for OP Blood	0	0	0	0	0	0	0	0	None	None									61.82069251	93.74957471	42.71645621	0	100	0.2	0.2	46	150	0	50	50	35	0.2	20	20	40	0.2	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0									YES	54.80295486	83.10734647	37.86738593	0	88.64823838	0.177296477	0.177296477	40.77818965	132.9723576	0	44.32411919	44.32411919	31.02688343	0.177296477	17.72964768	17.72964768	35.45929535	0.177296477	0	0.177296477	0.177296477	0	0	0	0	0	0	0	0	0	0	0									2500	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	0	4.874367854	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$100 copay	30% coinsurance	30% coinsurance	$50 copay for ER and $20 copay for Urgent Care	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	0	0	0	0	0	0	0	0	$50 copay for worldwide emergency care	None									0	4.2126	0.1273	0.7865	0.455	0.1141	0.1132	0.0184	0.1152	0.4049	0.2239	0.3241	0.0264	0.0098	0.2039	0.9797	1.8599	0.0458	0.3019	0.5249	0.0526	0.1876	0.0196	0	0	0	0	0	0	0	0	0.5177	0									11.6253	500	0.318855671	10.7448	0.839570602	3.626520471	0.455042163	1.611251141	1.145080107	0.18650279	0.778980876	3.317473706	0.223897768	1.988896071	0.069780326	0.139619891	2.062074612	7.213524319	7.759707495	0.982600803	3.052656748	0.52491924	0.532411056	1.897593018	0.01958553	0	0	0	0	0	0	0	0	0.51765377	0	0	0	0	0	0	0	0	0	49.6902
H3709_807_0	2010	4	N/A	q.1	q.2									Other Non-Covered	Other Non-Covered									Foreign Emergency (Non-coveredd)	Professional (non-covered)									D	D	D	0	T	Coin	Coin	P	P	0	V	0	P	Coin	V	V	V	Coin	0	Coin	Coin	V	0	0	0	0	0	0	0	0	V	V																																																	0	YES	1430.35296	102.8493946	899.9807347	3148.853458	202.6575323	5.819895614	0.947904661	195.3341021	262.8413423	544.9553674	450.7059585	11.73273016	50.20881814	10.48054098	4219.22852	3993.205245	317.0287905	15.51519715	26.97951971	2.705991269	9.644559548	1.006646635	0	0	0	0	0	0	0	0	0	0									2500	$100 / day up to 5 days.	$200 / day up to 5 days.	$100/day for days 21 to 100.	0	$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	0	"$100 copay for CT, MRI, PET, and nuclear medicine studies. $0 copay for all other lab plus 0% for Hospital Based physician costs"	0	$35 copay	20% coinsurance and 0% for medical/surgical supplies	$20 copay for Office Visits and 20% coinsurance for other services	$20 copay for Office Visits and 20% coinsurance for other services	$40 copay	20% coinsurance	0	$20 copay for Office Visits and 20% coinsurance for other services	20% coinsurance	$20 copay for Vision Exams and 0% Coinsurance for OP Blood	0	0	0	0	0	0	0	0	None	None									61.82069251	93.74957471	42.71645621	0	100	0.2	0.2	46	150	0	50	50	35	0.2	20	20	40	0.2	0	0.2	0.2	0	0	0	0	0	0	0	0	0	0	0									YES	54.80295486	83.10734647	37.86738593	0	88.64823838	0.177296477	0.177296477	40.77818965	132.9723576	0	44.32411919	44.32411919	31.02688343	0.177296477	17.72964768	17.72964768	35.45929535	0.177296477	0	0.177296477	0.177296477	0	0	0	0	0	0	0	0	0	0	0									2500	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	0	4.874367854	6.5323	0.712295023	2.839993151	0	1.49710277	1.031846987	0.168060157	0.663780922	2.912552746	0	1.664762052	0.043336911	0.129818596	1.85816299	6.23378626	5.899843508	0.93680146	2.750789792	0	0.479762718	1.709946428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0649	YES	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$100 copay	30% coinsurance	30% coinsurance	$50 copay for ER and $20 copay for Urgent Care	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	0	0	0	0	0	0	0	0	$50 copay for worldwide emergency care	None									0	4.2126	0.1273	0.7865	0.455	0.1141	0.1132	0.0184	0.1152	0.4049	0.2239	0.3241	0.0264	0.0098	0.2039	0.9797	1.8599	0.0458	0.3019	0.5249	0.0526	0.1876	0.0196	0	0	0	0	0	0	0	0	0.5177	0									11.6253	500	0.318855671	10.7448	0.839570602	3.626520471	0.455042163	1.611251141	1.145080107	0.18650279	0.778980876	3.317473706	0.223897768	1.988896071	0.069780326	0.139619891	2.062074612	7.213524319	7.759707495	0.982600803	3.052656748	0.52491924	0.532411056	1.897593018	0.01958553	0	0	0	0	0	0	0	0	0.51765377	0	0	0	0	0	0	0	0	0	49.6902
H3749_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1504.618013	71.19687537	604.4849136	452.2156226	218.0977307	13.65397413	9.95976366	370.4917023	312.781995	11762.87478	44.16405869	0	0.227063392	1089.528693	6349.889456	4968.903273	298.4902594	919.8434512	0	0	22.96451535	872.4091133	0	0	198.0892343	118.5552724	16.97562951	4.665678853	949.2117761	0												"$225 Days 1-3 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-3 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$95 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $200 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$200 (14f, 14f1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											106.0701193	68.89151132	45.05417382	0	150	0.2	0.107864876	49.99965483	200	3	0.162815946	0	0.2	77.06007107	7.857317069	34.98860802	38.5	30	0	0	0.2	34.14933051	0	0	35	30	0	0	0	0											NO	106.0701193	68.89151132	45.05417382	0	150	0.2	0.107864876	49.99965483	200	3	0.162815946	0	0.2	77.06007107	7.857317069	34.98860802	38.5	30	0	0	0.2	34.14933051	0	0	35	30	0	0	0	0												13.2996	0.408738362	2.269547364	0	2.726221633	2.730794826	1.074308669	1.543704769	5.213033249	2.940718695	7.190612987	0	0.045412678	6.996596541	4.157757901	14.48791741	0.957656249	2.299608628	0	0	4.59290307	2.482682262	0	0	0.577760267	0.296388181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2919	0	0	13.2996	0.408738362	2.269547364	0	2.726221633	2.730794826	1.074308669	1.543704769	5.213033249	2.940718695	7.190612987	0	0.045412678	6.996596541	4.157757901	14.48791741	0.957656249	2.299608628	0	0	4.59290307	2.482682262	0	0	0.577760267	0.296388181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2919	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.2996	0.408738362	2.269547364	0	2.726221633	2.730794826	1.074308669	1.543704769	5.213033249	2.940718695	7.190612987	0	0.045412678	6.996596541	4.157757901	14.48791741	0.957656249	2.299608628	0	0	4.59290307	2.482682262	0	0	0.577760267	0.296388181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2919
H3749_004_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1924.600487	75.83694466	897.2674616	1003.990566	363.8382478	17.01038976	11.28896195	323.9047256	271.4645248	11382.02749	44.50826954	0	0.104544751	1231.818407	5593.621455	5141.27543	317.7389469	871.1032317	0	0	25.66024698	827.629999	0	0	180.8633479	124.2842302	16.92886188	4.652824969	24.32503066	0												"$150 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$140 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $140 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$140 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											123.5154042	100.9460757	52.47946026	0	150	0.2	0.103277982	49.99986451	140	3	0.166394718	0	0.2	54.44465742	10.47711835	30	38.5	25	0	0	0.2	29.51123773	0	0	30	30	0	0	0	0											NO	123.5154042	100.9460757	52.47946026	0	150	0.2	0.103277982	49.99986451	140	3	0.166394718	0	0.2	54.44465742	10.47711835	30	38.5	25	0	0	0.2	29.51123773	0	0	30	30	0	0	0	0												19.8098	0.637953496	3.924009341	0	4.547978098	3.402077953	1.16590121	1.349599366	3.167086123	2.845506874	7.405940974	0	0.02090895	5.5888276	4.883752832	12.85318858	1.019412454	1.814798399	0	0	5.132049396	2.035365471	0	0	0.45215837	0.310710575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.367	0	0	19.8098	0.637953496	3.924009341	0	4.547978098	3.402077953	1.16590121	1.349599366	3.167086123	2.845506874	7.405940974	0	0.02090895	5.5888276	4.883752832	12.85318858	1.019412454	1.814798399	0	0	5.132049396	2.035365471	0	0	0.45215837	0.310710575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.367	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.8098	0.637953496	3.924009341	0	4.547978098	3.402077953	1.16590121	1.349599366	3.167086123	2.845506874	7.405940974	0	0.02090895	5.5888276	4.883752832	12.85318858	1.019412454	1.814798399	0	0	5.132049396	2.035365471	0	0	0.45215837	0.310710575	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.367
H3749_011_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.6282	0.9824	0.5911	0	1.2465	0	1.5526	0	0.004	0.7759	1.1215	5.0857	0.2957	0.1914	0	0	0.9034	0.1909	0	0	0	0	0	0	0	0											13.5695	NO	463.8588587	18.25218004	94.9862841	1432.769248	19.09948175	29.85988363	17.67338834	35.16255924	37.74982719	16.95964987	46.96029644	0	0.120261243	22.8869718	36.6050614	153.7744984	8.635315821	5.88163173	0	0	26.84251907	6.1071863	871.914905	181.3914415	162.2820289	199.8028499	0	0	52.72880079	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0/20% (14f)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080081462	0.081053989	0.1898187	0	0.193355585	0.193355585	0.193355585	0.122476361	0.193355585	0	0.160830925	0	0.193355585	0.144749762	0.164810757	0.193139302	0.193355585	0	0	0	0.193355585	0.193357162	0	0	0	0	0	0	0	0											NO	0.080081462	0.081053989	0.1898187	0	0.193355585	0.193355585	0.193355585	0.122476361	0.193355585	0	0.160830925	0	0.193355585	0.144749762	0.164810757	0.193139302	0.193355585	0	0	0	0.193355585	0.193357162	0	0	0	0	0	0	0	0												37.1465	1.479412007	18.03017297	0	3.692991476	5.773575281	3.417248349	4.306582309	7.299139937	0	7.552667898	0	0.023253183	3.312883726	6.032907884	29.69989923	1.669686546	0	0	0	5.19015099	1.180868211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.8079	146	0	37.1465	1.479412007	18.03017297	0	4.321209267	6.755992955	4.00833194	4.306582309	8.545602693	0	9.105316625	0	0.02720499	4.088818648	7.154438139	34.78562283	1.965409246	0.191428107	0	0	6.093599006	1.371785816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.3774	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	37.1465	1.479412007	18.03017297	0	4.321209267	6.755992955	4.00833194	4.306582309	8.545602693	0	9.105316625	0	0.02720499	4.088818648	7.154438139	34.78562283	1.965409246	0.191428107	0	0	6.093599006	1.371785816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.3774
H3749_014_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2237.915539	291.8933642	34.9182824	1192.03617	299.1602352	21.76845282	18.86341025	589.635237	362.0771673	15604.0811	62.26186823	0	0.219831171	996.5026843	9406.44028	6491.406947	1044.28883	478.2115348	0	0	37.28105231	1317.774184	637.3523789	0	146.0096532	163.6283485	17.24123506	4.738679397	57.33442301	0												"$225 Days 1-3 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-3 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $200 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$200 (14f, 14f1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											106.0701193	68.89151132	0.189786817	0	150	0.2	0.105556376	49.62354619	200	3	0.168363555	0	0.2	76.78001749	8.566300491	34.90527175	38.5	30	0	0	0.2	34.62508444	0	0	35	30	0	0	0	0											NO	106.0701193	68.89151132	0.189786817	0	150	0.2	0.105556376	49.62354619	200	3	0.168363555	0	0.2	76.78001749	8.566300491	34.90527175	38.5	30	0	0	0.2	34.62508444	0	0	35	30	0	0	0	0												19.7813	1.675747917	6.627029682	0	3.73950294	4.353690564	1.991153219	2.438315952	6.034619454	3.901020274	10.48262945	0	0.043966234	6.375957794	6.714866166	18.88202696	3.350426663	1.195528837	0	0	7.456210462	3.802336867	0	0	0.425861489	0.409070871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.6813	0	0	19.7813	1.675747917	6.627029682	0	3.73950294	4.353690564	1.991153219	2.438315952	6.034619454	3.901020274	10.48262945	0	0.043966234	6.375957794	6.714866166	18.88202696	3.350426663	1.195528837	0	0	7.456210462	3.802336867	0	0	0.425861489	0.409070871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.6813	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.7813	1.675747917	6.627029682	0	3.73950294	4.353690564	1.991153219	2.438315952	6.034619454	3.901020274	10.48262945	0	0.043966234	6.375957794	6.714866166	18.88202696	3.350426663	1.195528837	0	0	7.456210462	3.802336867	0	0	0.425861489	0.409070871	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.6813
H3749_016_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2326.56007	317.8980585	35.37205485	1507.900966	311.4945229	21.44210102	18.93492034	538.8150183	375.7160369	15831.97139	56.01087509	0	0.250844102	1023.994659	9581.920386	6576.699428	1139.037648	434.4856057	0	0	38.17310511	1367.800169	642.6937844	0	136.1036053	168.7116729	17.38572723	4.778392449	66.11412274	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$240 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $240 (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$240 (14f, 14f1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	0.193290126	0	150	0.2	0.100712433	49.53811194	240	3	0.172131112	0	0.2	94.0110203	15.18280022	34.89140457	38.5	30	0	0	0.2	34.72338905	0	0	35	30	0	0	0	0											NO	184.2401855	140.3212257	0.193290126	0	150	0.2	0.100712433	49.53811194	240	3	0.172131112	0	0.2	94.0110203	15.18280022	34.89140457	38.5	30	0	0	0.2	34.72338905	0	0	35	30	0	0	0	0												35.7205	3.717320435	6.837068931	0	3.893681537	4.288420204	1.906981889	2.224323224	7.514320738	3.957992848	9.641214199	0	0.05016882	8.022231889	12.12336525	19.12252337	3.654412453	1.086214014	0	0	7.634621022	3.957888118	0	0	0.396968849	0.421779182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.172	0	0	35.7205	3.717320435	6.837068931	0	3.893681537	4.288420204	1.906981889	2.224323224	7.514320738	3.957992848	9.641214199	0	0.05016882	8.022231889	12.12336525	19.12252337	3.654412453	1.086214014	0	0	7.634621022	3.957888118	0	0	0.396968849	0.421779182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.172	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	35.7205	3.717320435	6.837068931	0	3.893681537	4.288420204	1.906981889	2.224323224	7.514320738	3.957992848	9.641214199	0	0.05016882	8.022231889	12.12336525	19.12252337	3.654412453	1.086214014	0	0	7.634621022	3.957888118	0	0	0.396968849	0.421779182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.172
H3749_017_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1478.509596	69.96145371	593.9957769	444.3686915	214.3132575	13.09111927	9.54919445	364.031306	307.3545425	11558.76315	42.34349313	0	0.217703206	1070.622984	6202.30428	4883.664154	293.3107998	903.8821534	0	0	22.01785404	857.2709051	0	0	116.6419713	147.1910591	16.97562951	4.665678853	76.98370108	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$240 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $240 (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$240 (14f, 14f1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	52.47946026	0	150	0.2	0.107864876	49.9996548	240	3	0.163499212	0	0.2	92.11503918	13.76863466	34.98840918	38.5	30	0	0	0.2	34.14933051	0	0	35	30	0	0	0	0											NO	184.2401855	140.3212257	52.47946026	0	150	0.2	0.107864876	49.9996548	240	3	0.163499212	0	0.2	92.11503918	13.76863466	34.98840918	38.5	30	0	0	0.2	34.14933051	0	0	35	30	0	0	0	0												22.7001	0.818089745	2.597714814	0	2.678915719	2.618223854	1.030022673	1.516786637	6.14709085	2.889690787	6.923127769	0	0.043540641	8.21837318	7.116438472	14.23930331	0.941038816	2.259705384	0	0	4.403570808	2.439602289	0	0	0.34020575	0.367977648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2895	0	0	22.7001	0.818089745	2.597714814	0	2.678915719	2.618223854	1.030022673	1.516786637	6.14709085	2.889690787	6.923127769	0	0.043540641	8.21837318	7.116438472	14.23930331	0.941038816	2.259705384	0	0	4.403570808	2.439602289	0	0	0.34020575	0.367977648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2895	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.7001	0.818089745	2.597714814	0	2.678915719	2.618223854	1.030022673	1.516786637	6.14709085	2.889690787	6.923127769	0	0.043540641	8.21837318	7.116438472	14.23930331	0.941038816	2.259705384	0	0	4.403570808	2.439602289	0	0	0.34020575	0.367977648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2895
H3749_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	294.735974	5.753406026	27.91244027	648.6824635	8.792531779	16.90570504	10.02292254	11.61765786	52.49718416	20.7401835	59.61091612	0	0.125962568	20.98781467	25.17604423	127.7196345	2.366442441	8.239260235	0	0	34.78125983	7.623498136	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.084549686	0.084549686	0.192359181	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.084549686	0.084549686	0.192359181	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												24.9198	0.486448675	5.369214151	0	2.048659905	3.939029274	2.335340953	2.706914282	12.23184391	4.832462757	13.88934346	0	0.029349278	4.890160817	5.866018305	29.75867484	0.551381089	1.919747635	0	0	8.10403354	1.776275066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6547	0	0	24.9198	0.486448675	5.369214151	0	2.048659905	3.939029274	2.335340953	2.706914282	12.23184391	4.832462757	13.88934346	0	0.029349278	4.890160817	5.866018305	29.75867484	0.551381089	1.919747635	0	0	8.10403354	1.776275066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6547	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.9198	0.486448675	5.369214151	0	2.048659905	3.939029274	2.335340953	2.706914282	12.23184391	4.832462757	13.88934346	0	0.029349278	4.890160817	5.866018305	29.75867484	0.551381089	1.919747635	0	0	8.10403354	1.776275066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6547
H3749_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	231.7182359	6.811908953	22.64496984	448.4900261	6.314699901	14.32933135	12.39280607	11.23882785	47.79168475	19.92778591	50.9626215	0	0.099956538	20.50165363	25.97762699	121.6595102	2.396332188	6.638144039	0	0	32.58291299	7.840102876	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081885821	0.081885821	0.190416386	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081885821	0.081885821	0.190416386	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.9744	0.55779876	4.311973311	0	1.471325077	3.338734204	2.887523813	2.61864689	11.13546255	4.643174116	11.87429081	0	0.023289873	4.776885295	6.052787088	28.34666588	0.5583454	1.546687561	0	0	7.591818728	1.82674397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.5366	0	0	18.9744	0.55779876	4.311973311	0	1.471325077	3.338734204	2.887523813	2.61864689	11.13546255	4.643174116	11.87429081	0	0.023289873	4.776885295	6.052787088	28.34666588	0.5583454	1.546687561	0	0	7.591818728	1.82674397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.5366	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.9744	0.55779876	4.311973311	0	1.471325077	3.338734204	2.887523813	2.61864689	11.13546255	4.643174116	11.87429081	0	0.023289873	4.776885295	6.052787088	28.34666588	0.5583454	1.546687561	0	0	7.591818728	1.82674397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.5366
H3749_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	225.199229	6.620267235	22.00789131	441.8194767	6.137046332	13.92619946	12.0441551	10.92264214	46.44714526	19.36715082	49.52887298	0	0.097144427	19.92487373	25.2467897	118.2368224	2.328915371	6.451390907	0	0	31.66624698	7.619534634	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085444218	0.085444218	0.1932901	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085444218	0.085444218	0.1932901	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.242	0.565663559	4.253907503	0	1.429931795	3.244804475	2.806288138	2.544975619	10.82218485	4.512546142	11.5402274	0	0.022634652	4.64249558	5.882502	27.54917963	0.542637281	1.503174081	0	0	7.378235546	1.77535157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2587	0	0	19.242	0.565663559	4.253907503	0	1.429931795	3.244804475	2.806288138	2.544975619	10.82218485	4.512546142	11.5402274	0	0.022634652	4.64249558	5.882502	27.54917963	0.542637281	1.503174081	0	0	7.378235546	1.77535157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2587	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.242	0.565663559	4.253907503	0	1.429931795	3.244804475	2.806288138	2.544975619	10.82218485	4.512546142	11.5402274	0	0.022634652	4.64249558	5.882502	27.54917963	0.542637281	1.503174081	0	0	7.378235546	1.77535157	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2587
H3755_001_0	2010	7	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	P	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	NO	868.6833764	17.50885686	129.4082541	0	109.6690404	19.24082959	0	323.3481461	411.0308346	0	347.4691282	0	0	394.8135714	4130.143222	3030.267994	95.41031358	58.66694371	140.2780688	491.419527	0	0	0	0	234.8821819	108.1227703	0.413263824	0	0	0												$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$50/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	"Wheelchairs - $50 copay, Power wheelchairs & Scooters - 20% Coins"	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC; $200 for Colonoscopy / EGD / Bronchoscope / Flexible Sigmoidoscopy / Nuclear Medicine	No Cost-Sharing	$200/Case for OP Fac - Radiology; $200/Case for OP Fac - CT/MRI/PET; $200 for Bone Mass Measurement CT and MRI Scans; $50 for Dexascan and Ultrascan Screenings	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Procedure for PCP - Asst Surgeon (OP); $25/Visit for Immunizations;	$40/Visit for Speclst - Office Visits; $40/Procedure for Speclst - Asst Surgeon (OP); $40/Consult for Speclst - Consults; $25/Visit for Flexible Sigmoidoscopy / Barium Enema	$25 group/$35 individual/Visit for OP Psych - Non-Physician; $25 group/$35 individual/Visit for OP Psych - Psychiatrist; $25 group/$35 individual/Visit for OP Substance Abuse;	$25/Visit for PT/ST; $25/Visit for Occ Therapy	$200/Procedure for Prof Radiology (Office);	$40/Visit for Chiropractor; $40/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$40/Exam for Vision (Refractions)	$40/Service for Vision Hardware	$25/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											250	250	50	0	100	76	0	42.47723065	200	0	187.05	0	0	25	25	39.75	34	25	200	39.8566291	0	0	0	0	40	40	25	0	0	0											NO	250	250	50	0	100	76	0	42.47723065	200	0	187.05	0	0	25	25	39.75	34	25	200	39.8566291	0	0	0	0	40	40	25	0	0	0												18.0976	0.364767851	0.539201059	0	0.91390867	0.121858587	0	1.144577815	6.85051391	0	5.416175036	0	0	0.822528274	8.604465046	10.03776273	0.270329222	0.122222799	2.337967813	1.632193819	0	0	0	0	0.782940606	0.360409234	0.000860966	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4203	0	0	18.0976	0.364767851	0.539201059	0	0.91390867	0.121858587	0	1.144577815	6.85051391	0	5.416175036	0	0	0.822528274	8.604465046	10.03776273	0.270329222	0.122222799	2.337967813	1.632193819	0	0	0	0	0.782940606	0.360409234	0.000860966	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4203	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.0976	0.364767851	0.539201059	0	0.91390867	0.121858587	0	1.144577815	6.85051391	0	5.416175036	0	0	0.822528274	8.604465046	10.03776273	0.270329222	0.122222799	2.337967813	1.632193819	0	0	0	0	0.782940606	0.360409234	0.000860966	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4203
H3755_002_0	2010	4	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	P	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	NO	671.0575625	6.740585936	0	0	72.99452107	14.20790318	0	265.4538758	385.0841347	0	382.8779039	0	0	376.2401566	3374.01073	2989.127628	49.21886456	61.09928016	111.0233835	566.5179182	0	0	0	0	229.6580754	154.5929854	23.03188744	0	0	0												$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical;	$150/Days 1-5 for IP Psych; $150/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	"Wheelchairs - $50 copay, Power wheelchairs & Scooters - 20% Coins"	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care; $15/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC; $100 for Colonoscopy / EGD / Bronchoscope / Flexible Sigmoidoscopy / Nuclear Medicine	No Cost-Sharing	$100/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; $100 for Bone Mass Measurement CT and MRI Scans; $50 for Dexascan and Ultrascan Screenings	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Procedure for PCP - Asst Surgeon (OP); $15/Visit for Immunizations;	$30/Visit for Speclst - Office Visits; $30/Procedure for Speclst - Asst Surgeon (OP); $30/Consult for Speclst - Consults; $25/Visit for Flexible Sigmoidoscopy / Barium Enema	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$20/Visit for PT/ST; $20/Visit for Occ Therapy	$100/Procedure for Prof Radiology (Office);	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	$30/Service for Vision Hardware	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	150	0	0	50	76	0	39.57111062	100	0	96.45481061	0	0	20	15	29.92431601	30	20	100	29.59720218	0	0	0	0	30	30	15	0	0	0											NO	150	150	0	0	50	76	0	39.57111062	100	0	96.45481061	0	0	20	15	29.92431601	30	20	100	29.59720218	0	0	0	0	30	30	15	0	0	0												8.3882	0.084257324	0	0	0.304143838	0.089983387	0	0.875358724	3.209034456	0	3.077534642	0	0	0.627066928	4.217513413	7.453966644	0.123047161	0.101832134	0.925194863	1.39727878	0	0	0	0	0.574145188	0.386482464	0.028789859	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8638	0	0	8.3882	0.084257324	0	0	0.304143838	0.089983387	0	0.875358724	3.209034456	0	3.077534642	0	0	0.627066928	4.217513413	7.453966644	0.123047161	0.101832134	0.925194863	1.39727878	0	0	0	0	0.574145188	0.386482464	0.028789859	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8638	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.3882	0.084257324	0	0	0.304143838	0.089983387	0	0.875358724	3.209034456	0	3.077534642	0	0	0.627066928	4.217513413	7.453966644	0.123047161	0.101832134	0.925194863	1.39727878	0	0	0	0	0.574145188	0.386482464	0.028789859	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8638
H3755_004_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	P	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	NO	932.3411136	16.28372834	0	0	107.1887623	23.45563985	0	366.8513889	506.2797131	0	546.1143638	0	0	572.7828978	4805.719946	4038.994453	143.5211965	138.8503714	152.2491538	662.4113871	0	0	0	0	246.3368484	162.7908433	0.4547384	0	0	0												$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical;	$150/Days 1-5 for IP Psych; $150/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	"Wheelchairs - $50 copay, Power wheelchairs & Scooters - 20% Coins"	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care; $15/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC; $100 for Colonoscopy / EGD / Bronchoscope / Flexible Sigmoidoscopy / Nuclear Medicine	No Cost-Sharing	$100/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; $100 for Bone Mass Measurement CT and MRI Scans; $50 for Dexascan and Ultrascan Screenings	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Procedure for PCP - Asst Surgeon (OP); $15/Visit for Immunizations;	$30/Visit for Speclst - Office Visits; $30/Procedure for Speclst - Asst Surgeon (OP); $30/Consult for Speclst - Consults; $25/Visit for Flexible Sigmoidoscopy / Barium Enema	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$20/Visit for PT/ST; $20/Visit for Occ Therapy	$100/Procedure for Prof Radiology (Office);	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	$30/Service for Vision Hardware	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	150	0	0	50	76	0	38.28242585	100	0	97.16473946	0	0	20	15	29.93610718	30	20	100	29.90161828	0	0	0	0	30	30	15	0	0	0											NO	150	150	0	0	50	76	0	38.28242585	100	0	97.16473946	0	0	20	15	29.93610718	30	20	100	29.90161828	0	0	0	0	30	30	15	0	0	0												11.6543	0.203546604	0	0	0.446619843	0.148552386	0	1.170330091	4.218997609	0	4.421921656	0	0	0.954638163	6.007149932	10.0759809	0.358802991	0.231417286	1.268742949	1.650597704	0	0	0	0	0.615842121	0.406977108	0.000568423	0	0	0	0	0	0	0	0	0	0	0	0	0	43.8349	0	0	11.6543	0.203546604	0	0	0.446619843	0.148552386	0	1.170330091	4.218997609	0	4.421921656	0	0	0.954638163	6.007149932	10.0759809	0.358802991	0.231417286	1.268742949	1.650597704	0	0	0	0	0.615842121	0.406977108	0.000568423	0	0	0	0	0	0	0	0	0	0	0	0	0	43.8349	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.6543	0.203546604	0	0	0.446619843	0.148552386	0	1.170330091	4.218997609	0	4.421921656	0	0	0.954638163	6.007149932	10.0759809	0.358802991	0.231417286	1.268742949	1.650597704	0	0	0	0	0.615842121	0.406977108	0.000568423	0	0	0	0	0	0	0	0	0	0	0	0	0	43.8349
H3755_801_0	2010	4	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	P	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	NO	861.1490615	16.43753897	0	0	80.51585827	24.19411971	0	282.5586012	446.9689065	0	568.0360104	0	0	504.4349236	4411.224856	3827.235467	117.5789012	126.0253742	155.0786192	619.2776607	0	0	0	0	253.2287904	141.5783212	32.95780552	0	0	0												$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical;	$150/Days 1-5 for IP Psych; $150/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	"Wheelchairs - $50 copay, Power wheelchairs & Scooters - 20% Coins"	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care; $15/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC; $100 for Colonoscopy / EGD / Bronchoscope / Flexible Sigmoidoscopy / Nuclear Medicine	No Cost-Sharing	$100/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET; $100 for Bone Mass Measurement CT and MRI Scans; $50 for Dexascan and Ultrascan Screenings	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Procedure for PCP - Asst Surgeon (OP); $15/Visit for Immunizations;	$30/Visit for Speclst - Office Visits; $30/Procedure for Speclst - Asst Surgeon (OP); $30/Consult for Speclst - Consults; $25/Visit for Flexible Sigmoidoscopy / Barium Enema	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$20/Visit for PT/ST; $20/Visit for Occ Therapy	$100/Procedure for Prof Radiology (Office);	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	$30/Service for Vision Hardware	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	150	0	0	50	76	0	36.94914413	100	0	97.52029858	0	0	20	15	29.9386607	30	20	100	29.44035258	0	0	0	0	30	30	15	0	0	0											NO	150	150	0	0	50	76	0	36.94914413	100	0	97.52029858	0	0	20	15	29.9386607	30	20	100	29.44035258	0	0	0	0	30	30	15	0	0	0												10.7644	0.205469237	0	0	0.335482743	0.153229425	0	0.870024874	3.724740887	0	4.616253445	0	0	0.840724873	5.51403107	9.548525338	0.293947253	0.21004229	1.292321827	1.519312723	0	0	0	0	0.633071976	0.353945803	0.041197257	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9167	0	0	10.7644	0.205469237	0	0	0.335482743	0.153229425	0	0.870024874	3.724740887	0	4.616253445	0	0	0.840724873	5.51403107	9.548525338	0.293947253	0.21004229	1.292321827	1.519312723	0	0	0	0	0.633071976	0.353945803	0.041197257	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9167	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.7644	0.205469237	0	0	0.335482743	0.153229425	0	0.870024874	3.724740887	0	4.616253445	0	0	0.840724873	5.51403107	9.548525338	0.293947253	0.21004229	1.292321827	1.519312723	0	0	0	0	0.633071976	0.353945803	0.041197257	0	0	0	0	0	0	0	0	0	0	0	0	0	40.9167
H3805_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1293.133324	88.58293209	1199.863844	345.8034761	383.1087843	12.41880444	8.487752783	387.8603926	191.8651906	14199.06188	51.70848803	0	0.176680514	890.8994786	6319.747517	4521.33572	377.9955593	584.5064023	0	0	26.40500725	986.3022076	0	0	266.442683	144.5315119	17.35085152	4.76880701	0	0												"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$95 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $200 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$200 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	45.05417382	0	150	0.2	0.096587735	49.99818515	200	3	0.153753047	0	0.2	76.42819476	10.81369632	30	38.5	25	0	0	0.2	29.34461825	0	0	30	30	0	0	0	0											NO	165.816167	126.2891031	45.05417382	0	150	0.2	0.096587735	49.99818515	200	3	0.153753047	0	0.2	76.42819476	10.81369632	30	38.5	25	0	0	0.2	29.34461825	0	0	30	30	0	0	0	0												17.8685	0.93225492	4.504906181	0	4.788859803	2.483760888	0.819812818	1.61602631	3.197753177	3.54976547	7.950337614	0	0.035336103	5.674153238	5.694985872	11.3033393	1.212735753	1.217721671	0	0	5.281001449	2.41188848	0	0	0.666106708	0.36132878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.5706	0	0	17.8685	0.93225492	4.504906181	0	4.788859803	2.483760888	0.819812818	1.61602631	3.197753177	3.54976547	7.950337614	0	0.035336103	5.674153238	5.694985872	11.3033393	1.212735753	1.217721671	0	0	5.281001449	2.41188848	0	0	0.666106708	0.36132878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.5706	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.8685	0.93225492	4.504906181	0	4.788859803	2.483760888	0.819812818	1.61602631	3.197753177	3.54976547	7.950337614	0	0.035336103	5.674153238	5.694985872	11.3033393	1.212735753	1.217721671	0	0	5.281001449	2.41188848	0	0	0.666106708	0.36132878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.5706
H3805_007_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1006.347234	83.75009722	888.1365683	260.0669457	236.4915026	11.92724396	8.411838601	315.1547439	110.360192	12009.45493	44.86868125	0	0.016349871	1129.256554	6169.558431	4230.187762	376.2800757	539.6946554	0	0	15.43719668	733.2021949	0	0	325.7912477	127.5968315	17.31114594	4.757894103	0	0												"$175 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$95 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $150 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$150 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											128.9681299	98.22485799	45.05417382	0	150	0.2	0.084718851	49.99477385	150	3	0.154323924	0	0.2	57.77906455	10.5499253	30	38.5	25	0	0	0.2	28.34524687	0	0	30	30	0	0	0	0											NO	128.9681299	98.22485799	45.05417382	0	150	0.2	0.084718851	49.99477385	150	3	0.154323924	0	0.2	57.77906455	10.5499253	30	38.5	25	0	0	0.2	28.34524687	0	0	30	30	0	0	0	0												10.8156	0.685528451	3.33452161	0	2.956143783	2.385448792	0.712641297	1.313007512	1.3795024	3.002363734	6.924310957	0	0.003269974	5.437282277	5.424031714	10.57546941	1.207231909	1.124363865	0	0	3.087439336	1.731899768	0	0	0.814478119	0.318992079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2335	0	0	10.8156	0.685528451	3.33452161	0	2.956143783	2.385448792	0.712641297	1.313007512	1.3795024	3.002363734	6.924310957	0	0.003269974	5.437282277	5.424031714	10.57546941	1.207231909	1.124363865	0	0	3.087439336	1.731899768	0	0	0.814478119	0.318992079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2335	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.8156	0.685528451	3.33452161	0	2.956143783	2.385448792	0.712641297	1.313007512	1.3795024	3.002363734	6.924310957	0	0.003269974	5.437282277	5.424031714	10.57546941	1.207231909	1.124363865	0	0	3.087439336	1.731899768	0	0	0.814478119	0.318992079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2335
H3805_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	270.3702684	5.99608967	28.87469542	315.8816686	12.40876452	13.73166278	10.87204197	29.04260315	47.54421888	30.61211683	63.43121055	0	0.155022618	19.54438454	36.03396545	155.2365754	2.96621671	7.546236201	0	0	26.09557238	10.94989561	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083891989	0.083891989	0.130387307	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083891989	0.083891989	0.130387307	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.6819	0.503023888	3.764893783	0	2.891242133	3.199477427	2.53318578	6.766926533	11.077803	7.132623222	14.77947206	0	0.03612027	4.553841597	8.395913949	36.17012206	0.691128493	1.758273035	0	0	6.080268364	2.551325677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.5675	0	0	22.6819	0.503023888	3.764893783	0	2.891242133	3.199477427	2.53318578	6.766926533	11.077803	7.132623222	14.77947206	0	0.03612027	4.553841597	8.395913949	36.17012206	0.691128493	1.758273035	0	0	6.080268364	2.551325677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.5675	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.6819	0.503023888	3.764893783	0	2.891242133	3.199477427	2.53318578	6.766926533	11.077803	7.132623222	14.77947206	0	0.03612027	4.553841597	8.395913949	36.17012206	0.691128493	1.758273035	0	0	6.080268364	2.551325677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.5675
H3805_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	263.0479903	6.257011109	30.46474851	319.4218991	13.14261779	13.9871982	10.03893004	28.91566695	47.32365031	30.96024596	52.10140004	0	0.135364214	18.66989624	36.27945	153.1589134	2.995150633	7.050953707	0	0	31.86969529	10.87155068	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083366668	0.083366668	0.128632289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083366668	0.083366668	0.128632289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.9294	0.521626166	3.918750346	0	3.062229945	3.25901718	2.3390707	6.7373504	11.02641052	7.213737309	12.13962621	0	0.031539862	4.350085823	8.453111849	35.68602681	0.697870097	1.642872214	0	0	7.425639004	2.533071309	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.9675	0	0	21.9294	0.521626166	3.918750346	0	3.062229945	3.25901718	2.3390707	6.7373504	11.02641052	7.213737309	12.13962621	0	0.031539862	4.350085823	8.453111849	35.68602681	0.697870097	1.642872214	0	0	7.425639004	2.533071309	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.9675	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.9294	0.521626166	3.918750346	0	3.062229945	3.25901718	2.3390707	6.7373504	11.02641052	7.213737309	12.13962621	0	0.031539862	4.350085823	8.453111849	35.68602681	0.697870097	1.642872214	0	0	7.425639004	2.533071309	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.9675
H3805_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	254.0903143	6.043938666	29.42732053	313.6259724	12.69506709	13.51088668	9.697070436	27.93099045	45.71211957	29.90594461	50.32717071	0	0.130754604	18.03412297	35.04401172	147.9433331	2.893155598	6.810844827	0	0	30.78442411	10.50133752	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083969563	0.083969563	0.130635443	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083969563	0.083969563	0.130635443	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.3359	0.507506887	3.844251066	0	2.957950633	3.148036595	2.259417412	6.507920775	10.65092386	6.968085094	11.72623078	0	0.030465823	4.201950652	8.16525473	34.47079661	0.674105254	1.586926845	0	0	7.172770818	2.446811642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6553	0	0	21.3359	0.507506887	3.844251066	0	2.957950633	3.148036595	2.259417412	6.507920775	10.65092386	6.968085094	11.72623078	0	0.030465823	4.201950652	8.16525473	34.47079661	0.674105254	1.586926845	0	0	7.172770818	2.446811642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6553	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.3359	0.507506887	3.844251066	0	2.957950633	3.148036595	2.259417412	6.507920775	10.65092386	6.968085094	11.72623078	0	0.030465823	4.201950652	8.16525473	34.47079661	0.674105254	1.586926845	0	0	7.172770818	2.446811642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6553
H3810_001_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	605.5332182	10.8380039	483.6038274	0	157.8865333	0	0	344.1153469	286.8578211	0	0	0	0	268.7914635	2842.582677	2795.419263	77.74459506	412.976566	0	1359.227246	0	0	0	0	236.197631	0	0	0	0	402.9791393											2000	$200/Days 1-10 for IP Medical; $200/Days 1-10 for IP Surgical;	$200/Days 1-10 for IP Psych; $200/Days 1-10 for IP Substance Abuse;	$150/Days 1-10 for SNF	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults; $20/Exam for PCP - Routine Physicals;	$20/Visit for Speclst - Office Visits; $20/Consult for Speclst - Consults;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Visit for Acupuncture; $20/Service for Care Coordination Counseling;											200	200	150	0	100	0	0	49.393148	83.27731669	0	0	0	0	20	20	20	20	20	0	20	0	0	0	0	20	0	0	0	0	20											NO	193.2127094	193.2127093	144.909532	0	96.60635469	0	0	47.71691975	80.45117994	0	0	0	0	19.32127094	19.32127094	19.32127094	19.32127094	19.32127094	0	19.32127094	0	0	0	0	19.32127094	0	0	0	0	19.32127094												9.7497	0.174503341	5.83990036	0	1.271070203	0	0	1.368343699	1.923170849	0	0	0	0	0.432782724	4.576859172	4.500921081	0.125177032	0.66493601	0	2.188499825	0	0	0	0	0.380303202	0	0	0	0	0.648839094	0	0	0	0	0	0	0	0	0	0	33.845	0	1.188928376	9.7497	0.174503341	5.83990036	0	1.271070203	0	0	1.368343699	1.923170849	0	0	0	0	0.432782724	4.576859172	4.500921081	0.125177032	0.66493601	0	2.188499825	0	0	0	0	0.380303202	0	0	0	0	0.648839094	0	0	0	0	0	0	0	0	0	0	33.845	YES	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											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	0	0	9.7497	0.174503341	5.83990036	0	1.271070203	0	0	1.368343699	1.923170849	0	0	0	0	0.432782724	4.576859172	4.500921081	0.125177032	0.66493601	0	2.188499825	0	0	0	0	0.380303202	0	0	0	0	0.648839094	0	0	0	0	0	0	0	0	0	0	33.845
H3810_002_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	322.1495327	8.141484968	78.73971983	0	27.03550862	35.51796148	24.0977351	39.9495521	42.23623585	13.70803545	24.17287583	0	0.268880107	46.36093393	50.36134352	136.8868728	4.214985409	6.532278951	25.43906325	56.95021229	27.1683516	3.029460921	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	23% Coinsurance for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; $50/Case for ER - Worldwide; 23% Coinsurance for Urgent Care; 23% Coinsurance for Urgent Care - Worldwide;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	20 to 23% Coinsurance	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.082225702	0.082225702	0.124309392	0	0.23	0.2	0.2	0.229394919	0.23	0.23	0.23	0	0.2	0.222802575	0.23	0.23	0.23	0.23	0.23	0.23	0.2	0.23	0	0	0	0	0	0	0	0											NO	0.082225702	0.082225702	0.124309392	0	0.23	0.2	0.2	0.229394919	0.23	0.23	0.23	0	0.2	0.222802575	0.23	0.23	0.23	0.23	0.23	0.23	0.2	0.23	0	0	0	0	0	0	0	0												26.489	0.669439316	9.788086719	0	6.218166983	7.103592295	4.81954702	9.164224258	9.714334246	3.152848154	5.559761442	0	0.053776021	10.32933547	11.58310901	31.48398074	0.969446644	1.502424159	5.850984547	13.09854883	5.43367032	0.696776012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	163.681	0	0	26.489	0.669439316	9.788086719	0	6.218166983	7.103592295	4.81954702	9.164224258	9.714334246	3.152848154	5.559761442	0	0.053776021	10.32933547	11.58310901	31.48398074	0.969446644	1.502424159	5.850984547	13.09854883	5.43367032	0.696776012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	163.681	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.489	0.669439316	9.788086719	0	6.218166983	7.103592295	4.81954702	9.164224258	9.714334246	3.152848154	5.559761442	0	0.053776021	10.32933547	11.58310901	31.48398074	0.969446644	1.502424159	5.850984547	13.09854883	5.43367032	0.696776012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	163.681
H3810_003_0	2010	8	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	763.4406008	14.45265923	498.7992157	0	195.8643522	0	0	551.0544893	236.4673015	0	0	0	0	210.69922	3333.423636	3335.506201	155.6898628	600.7273813	0	1831.749121	0	0	0	0	217.7239163	0	0	0	0	151.9352945											2000	$200/Days 1-10 for IP Medical; $200/Days 1-10 for IP Surgical;	$200/Days 1-10 for IP Psych; $200/Days 1-10 for IP Substance Abuse;	$130/Days 1-10 for SNF	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults; $20/Exam for PCP - Routine Physicals;	$20/Visit for Speclst - Office Visits; $20/Consult for Speclst - Consults;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Visit for Acupuncture; $20/Service for Care Coordination Counseling;											200	200	130	0	100	0	0	49.8570664	92.34960319	0	0	0	0	20	20	20	20	20	0	20	0	0	0	0	20	0	0	0	0	20											NO	191.8029342	191.8029341	124.6719072	0	95.90146708	0	0	47.81365812	88.5646243	0	0	0	0	19.18029341	19.18029342	19.18029341	19.18029342	19.18029342	0	19.18029342	0	0	0	0	19.18029342	0	0	0	0	19.18029342												12.2025	0.231005204	5.182187461	0	1.565306561	0	0	2.195660913	1.74521981	0	0	0	0	0.336772738	5.328003618	5.331332302	0.248848104	0.960177286	0	2.927790467	0	0	0	0	0.348000717	0	0	0	0	0.242846961	0	0	0	0	0	0	0	0	0	0	38.8457	0	1.66014389	12.2025	0.231005204	5.182187461	0	1.565306561	0	0	2.195660913	1.74521981	0	0	0	0	0.336772738	5.328003618	5.331332302	0.248848104	0.960177286	0	2.927790467	0	0	0	0	0.348000717	0	0	0	0	0.242846961	0	0	0	0	0	0	0	0	0	0	38.8457	YES	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											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	0	0	12.2025	0.231005204	5.182187461	0	1.565306561	0	0	2.195660913	1.74521981	0	0	0	0	0.336772738	5.328003618	5.331332302	0.248848104	0.960177286	0	2.927790467	0	0	0	0	0.348000717	0	0	0	0	0.242846961	0	0	0	0	0	0	0	0	0	0	38.8457
H3810_004_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	491.3730377	8.197246476	0	0	169.7547381	0	0	294.3314463	313.0459564	0	0	0	0	376.8486433	3071.998155	3098.097001	132.6744497	411.6641515	0	1413.324128	0	0	0	0	285.7946174	0	0	0	0	670.6282019											500	$150/Days 1-3 for IP Medical; $150/Days 1-3 for IP Surgical;	$150/Days 1-3 for IP Psych; $150/Days 1-3 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$5/Case for OP Fac - Cardiovascular; $5/Case for OP Fac - Occ Therapy; $5/Case for OP Fac - Physical/Speech Therapy; $5/Case for OP Fac - CORF; $5/Visit for Prof - CORF; $5/Visit for Prof - CORF;	$5/Visit for PCP - Office Visits; $5/Consult for PCP - Consults; $5/Exam for PCP - Routine Physicals;	$5/Visit for Speclst - Office Visits; $5/Consult for Speclst - Consults;	$5/Visit for OP Psych - Non-Physician; $5/Visit for OP Psych - Psychiatrist; $5/Visit for OP Substance Abuse;	$5/Visit for PT/ST (PCP); $5/Visit for Occ Therapy (PCP); $5/Visit for PT/ST (Specialist); $5/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$5/Visit for Chiropractor; $5/Exam for Vision Exams; $5/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$5/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$5/Visit for Acupuncture; $5/Service for Care Coordination Counseling;											150	150	0	0	100	0	0	48.8660032	76.01618237	0	0	0	0	5	5	5	5	5	0	5	0	0	0	0	5	0	0	0	0	5											YES	140.4719942	140.4719941	0	0	93.64799612	0	0	45.76203278	71.18763151	0	0	0	0	4.682399807	4.682399806	4.682399806	4.682399804	4.68239981	0	4.682399805	0	0	0	0	4.682399806	0	0	0	0	4.682399805											1000	5.752	0.095956963	0	0	1.324765921	0	0	1.122433774	1.857083349	0	0	0	0	0.147046335	1.19869363	1.2088774	0.051769568	0.160631345	0	0.551479052	0	0	0	0	0.111517055	0	0	0	0	0.261679113	0	0	0	0	0	0	0	0	0	0	13.8439	0	0.93901421	5.752	0.095956963	0	0	1.324765921	0	0	1.122433774	1.857083349	0	0	0	0	0.147046335	1.19869363	1.2088774	0.051769568	0.160631345	0	0.551479052	0	0	0	0	0.111517055	0	0	0	0	0.261679113	0	0	0	0	0	0	0	0	0	0	13.8439	YES	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Visit for Urgent Care;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Prof	20% Coinsurance for Prof - CORF; 20% Coinsurance for Prof - CORF;	20% Coinsurance for PCP - Office Visits; 20% Coinsurance for PCP - Consults; 20% Coinsurance for PCP - Primary Surgeon (IP); 20% Coinsurance for PCP - Asst Surgeon (IP); 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - IP Visits; 20% Coinsurance for PCP - Tx Injections; 20% Coinsurance for PCP - Allergy Testing; 20% Coinsurance for PCP - Allergy Tx; 20% Coinsurance for PCP - ER Visits; 20% Coinsurance for PCP - Cardio; 20% Coinsurance for PCP - Immunizations;	20% Coinsurance for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (IP); 20% Coinsurance for Speclst - Asst Surgeon (IP); 20% Coinsurance for Speclst - Anesthesia (IP); 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); 20% Coinsurance for Speclst - IP Visits; 20% Coinsurance for Speclst - Tx Injections; 20% Coinsurance for Speclst - Allergy Testing; 20% Coinsurance for Speclst - Allergy Tx; 20% Coinsurance for Speclst - ER Visits; 20% Coinsurance for Speclst - Consults; 20% Coinsurance for Speclst - Cardio; 20% Coinsurance for Speclst - Immunizations;	20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse;	20% Coinsurance for PT/ST (PCP); 20% Coinsurance for Occ Therapy (PCP); 20% Coinsurance for PT/ST (Specialist); 20% Coinsurance for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	20% Coinsurance for Chiropractor; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											1500	0	0	0	0	0	0	0	0.004	0	0	0	0	0.0023	0.0112	0.7489	2.3323	0.0305	0.098	0.5716	0.9047	0	0	0	0	0	0	0	0	0	0											4.7034	0	0	5.752	0.095956963	0	0	1.324765921	0	0	1.126454759	1.857083349	0	0	0	0.002283997	0.158217857	1.947619626	3.54120964	0.082240435	0.258583518	0.571578411	1.45618608	0	0	0	0	0.111517055	0	0	0	0	0.261679113	0	0	0	0	0	0	0	0	0	0	18.5474
H3810_005_0	2010	7	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	501.9234868	7.503950161	0	0	188.4612163	0	0	320.019407	335.4450844	0	0	0	0	404.5899729	3454.653262	3381.933688	436.6189432	704.5642946	0	1208.782993	0	0	0	0	276.0271993	0	0	0	0	617.7776715											500	$150/Days 1-3 for IP Medical; $150/Days 1-3 for IP Surgical;	$150/Days 1-3 for IP Psych; $150/Days 1-3 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$5/Case for OP Fac - Cardiovascular; $5/Case for OP Fac - Occ Therapy; $5/Case for OP Fac - Physical/Speech Therapy; $5/Case for OP Fac - CORF; $5/Visit for Prof - CORF; $5/Visit for Prof - CORF;	$5/Visit for PCP - Office Visits; $5/Consult for PCP - Consults; $5/Exam for PCP - Routine Physicals;	$5/Visit for Speclst - Office Visits; $5/Consult for Speclst - Consults;	$5/Visit for OP Psych - Non-Physician; $5/Visit for OP Psych - Psychiatrist; $5/Visit for OP Substance Abuse;	$5/Visit for PT/ST (PCP); $5/Visit for Occ Therapy (PCP); $5/Visit for PT/ST (Specialist); $5/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$5/Visit for Chiropractor; $5/Exam for Vision Exams; $5/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$5/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$5/Visit for Acupuncture; $5/Service for Care Coordination Counseling;											150	150	0	0	100	0	0	49.02077277	78.78516435	0	0	0	0	5	5	5	5	5	0	5	0	0	0	0	5	0	0	0	0	5											YES	139.9589577	139.9589578	0	0	93.30597182	0	0	45.73930842	73.51126324	0	0	0	0	4.665298593	4.665298591	4.665298591	4.665298591	4.665298591	0	4.66529859	0	0	0	0	4.665298593	0	0	0	0	4.665298591											1000	5.8541	0.08752042	0	0	1.465379745	0	0	1.219788863	2.054915992	0	0	0	0	0.157294419	1.343082416	1.314810872	0.169746478	0.273916901	0	0.469944466	0	0	0	0	0.107312442	0	0	0	0	0.240176442	0	0	0	0	0	0	0	0	0	0	14.7579	0	1.058775873	5.8541	0.08752042	0	0	1.465379745	0	0	1.219788863	2.054915992	0	0	0	0	0.157294419	1.343082416	1.314810872	0.169746478	0.273916901	0	0.469944466	0	0	0	0	0.107312442	0	0	0	0	0.240176442	0	0	0	0	0	0	0	0	0	0	14.7579	YES	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Visit for Urgent Care;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Prof	20% Coinsurance for Prof - CORF; 20% Coinsurance for Prof - CORF;	20% Coinsurance for PCP - Office Visits; 20% Coinsurance for PCP - Consults; 20% Coinsurance for PCP - Primary Surgeon (IP); 20% Coinsurance for PCP - Asst Surgeon (IP); 20% Coinsurance for PCP - Primary Surgeon (OP); 20% Coinsurance for PCP - Asst Surgeon (OP); 20% Coinsurance for PCP - IP Visits; 20% Coinsurance for PCP - Tx Injections; 20% Coinsurance for PCP - Allergy Testing; 20% Coinsurance for PCP - Allergy Tx; 20% Coinsurance for PCP - ER Visits; 20% Coinsurance for PCP - Cardio; 20% Coinsurance for PCP - Immunizations;	20% Coinsurance for Speclst - Office Visits; 20% Coinsurance for Speclst - Primary Surgeon (IP); 20% Coinsurance for Speclst - Asst Surgeon (IP); 20% Coinsurance for Speclst - Anesthesia (IP); 20% Coinsurance for Speclst - Primary Surgeon (OP); 20% Coinsurance for Speclst - Asst Surgeon (OP); 20% Coinsurance for Speclst - Anesthesia (OP); 20% Coinsurance for Speclst - IP Visits; 20% Coinsurance for Speclst - Tx Injections; 20% Coinsurance for Speclst - Allergy Testing; 20% Coinsurance for Speclst - Allergy Tx; 20% Coinsurance for Speclst - ER Visits; 20% Coinsurance for Speclst - Consults; 20% Coinsurance for Speclst - Cardio; 20% Coinsurance for Speclst - Immunizations;	20% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 20% Coinsurance for OP Substance Abuse;	20% Coinsurance for PT/ST (PCP); 20% Coinsurance for Occ Therapy (PCP); 20% Coinsurance for PT/ST (Specialist); 20% Coinsurance for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	20% Coinsurance for Chiropractor; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 20% Coinsurance for Misc. Medical (PCP); 20% Coinsurance for Misc. Medical; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											1500	0	0	0	0	0	0	0	0.0036	0	0	0	0	0.0019	0.0094	0.6409	2.0034	0.0257	0.0827	0.475	0.7661	0	0	0	0	0	0	0	0	0	0											4.0088	0	0	5.8541	0.08752042	0	0	1.465379745	0	0	1.223361347	2.054915992	0	0	0	0.001927459	0.166722034	1.983993864	3.318247625	0.195460752	0.356578448	0.475011891	1.236091122	0	0	0	0	0.107312442	0	0	0	0	0.240176442	0	0	0	0	0	0	0	0	0	0	18.7668
H3810_006_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	O	V	T	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	YES	620.5812436	14.77414622	371.9479816	0	141.3567557	10.14998694	6.199528311	231.7406501	290.7067789	0	0	0	0.325584615	359.9832406	2649.000443	3526.893657	113.8322784	473.5928097	0	954.3123083	0	0	0	0	258.0472681	0	0	0	0	624.2394308											3400	$300/Days 1-10 for IP Medical; $300/Days 1-10 for IP Surgical;	$250/Days 1-10 for IP Psych; $300/Days 1-10 for IP Substance Abuse;	$150/Days 1-10 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults; $30/Exam for PCP - Routine Physicals;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults; $15/Visit for Speclst - Cardio;	$20/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Visit for Acupuncture; $20/Service for Care Coordination Counseling;											300	254.2680666	150	0	100	0.2	0.2	48.65834137	200	0	0	0	0.2	20	20.08995555	25.9470655	23.96747225	20	0	30	0	0	0	0	30	0	0	0	0	29.04490212											NO	292.3630265	247.7952717	146.1815132	0	97.45434216	0.194908684	0.194908684	47.41966648	194.9086843	0	0	0	0.194908684	19.49086843	19.57853402	25.286542	23.35734242	19.49086843	0	29.23630265	0	0	0	0	29.23630265	0	0	0	0	28.30551829												15.1196	0.305080298	4.530993234	0	1.147985803	1.9783206	1.208341907	0.915755361	4.721772984	0	0	0	0.063459269	0.584698832	4.321962108	7.431912047	0.221568292	0.769227929	0	2.325046956	0	0	0	0	0.628695669	0	0	0	0	1.472451719	0	0	0	0	0	0	0	0	0	0	47.7469	0	1.247221608	15.1196	0.305080298	4.530993234	0	1.147985803	1.9783206	1.208341907	0.915755361	4.721772984	0	0	0	0.063459269	0.584698832	4.321962108	7.431912047	0.221568292	0.769227929	0	2.325046956	0	0	0	0	0.628695669	0	0	0	0	1.472451719	0	0	0	0	0	0	0	0	0	0	47.7469	YES	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											3400	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.1196	0.305080298	4.530993234	0	1.147985803	1.9783206	1.208341907	0.915755361	4.721772984	0	0	0	0.063459269	0.584698832	4.321962108	7.431912047	0.221568292	0.769227929	0	2.325046956	0	0	0	0	0.628695669	0	0	0	0	1.472451719	0	0	0	0	0	0	0	0	0	0	47.7469
H3810_007_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	O	V	T	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	YES	668.4201853	13.2102246	351.2349635	0	149.8999537	9.34043021	5.704163946	271.4593046	274.3938617	0	0	0	0.302379732	340.997311	2664.511497	3704.792955	208.5897461	425.7089616	0	1024.824822	0	0	0	0	245.0191691	0	0	0	0	562.1062873											3400	$300/Days 1-10 for IP Medical; $300/Days 1-10 for IP Surgical;	$250/Days 1-10 for IP Psych; $300/Days 1-10 for IP Substance Abuse;	$150/Days 1-10 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults; $30/Exam for PCP - Routine Physicals;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults; $15/Visit for Speclst - Cardio;	$20/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Visit for Acupuncture; $20/Service for Care Coordination Counseling;											300	254.3309876	150	0	100	0.2	0.2	48.96277655	200	0	0	0	0.2	20	20.08065516	26.51494733	23.98212618	20	0	30	0	0	0	0	30	0	0	0	0	29.03145189											NO	292.0419074	247.5843558	146.0209537	0	97.34730246	0.194694605	0.194694605	47.66394218	194.6946049	0	0	0	0.194694605	19.46946049	19.54797612	25.81158598	23.34595291	19.46946049	0	29.20419074	0	0	0	0	29.20419074	0	0	0	0	28.26133528												16.2672	0.272553746	4.273972028	0	1.216029678	1.81853137	1.110569946	1.07823505	4.451917042	0	0	0	0.058871702	0.553252806	4.340483925	7.968881823	0.405810533	0.690693651	0	2.494098297	0	0	0	0	0.596298879	0	0	0	0	1.323822854	0	0	0	0	0	0	0	0	0	0	48.9212	0	1.333095761	16.2672	0.272553746	4.273972028	0	1.216029678	1.81853137	1.110569946	1.07823505	4.451917042	0	0	0	0.058871702	0.553252806	4.340483925	7.968881823	0.405810533	0.690693651	0	2.494098297	0	0	0	0	0.596298879	0	0	0	0	1.323822854	0	0	0	0	0	0	0	0	0	0	48.9212	YES	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											3400	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.2672	0.272553746	4.273972028	0	1.216029678	1.81853137	1.110569946	1.07823505	4.451917042	0	0	0	0.058871702	0.553252806	4.340483925	7.968881823	0.405810533	0.690693651	0	2.494098297	0	0	0	0	0.596298879	0	0	0	0	1.323822854	0	0	0	0	0	0	0	0	0	0	48.9212
H3810_008_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	778.5875142	76.77998434	384.8216701	0	142.821532	0	0	248.919406	263.0728969	0	0	0	0	322.9747961	2471.064868	3439.994712	125.036622	395.1405654	0	1100.075321	0	0	0	0	257.110272	0	0	0	0	634.4387491											2000	$200/Days 1-10 for IP Medical; $200/Days 1-10 for IP Surgical;	$200/Days 1-10 for IP Psych; $200/Days 1-10 for IP Substance Abuse;	$150/Days 1-10 for SNF	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults; $20/Exam for PCP - Routine Physicals;	$20/Visit for Speclst - Office Visits; $20/Consult for Speclst - Consults;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Visit for Acupuncture; $20/Service for Care Coordination Counseling;											200	200	150	0	100	0	0	48.79153341	79.45094639	0	0	0	0	20	20	20	20	20	0	20	0	0	0	0	20	0	0	0	0	20											NO	192.5654585	192.5654585	144.4240939	0	96.28272924	0	0	46.97782	76.49753959	0	0	0	0	19.25654585	19.25654585	19.25654585	19.25654585	19.25654585	0	19.25654585	0	0	0	0	19.25654585	0	0	0	0	19.25654585												12.4941	1.232097741	4.631460084	0	1.145937241	0	0	0.974474254	1.677035779	0	0	0	0	0.518281581	3.965347827	5.520201325	0.200647787	0.634086868	0	1.765304239	0	0	0	0	0.412587978	0	0	0	0	1.018091572	0	0	0	0	0	0	0	0	0	0	36.1896	0	1.397204897	12.4941	1.232097741	4.631460084	0	1.145937241	0	0	0.974474254	1.677035779	0	0	0	0	0.518281581	3.965347827	5.520201325	0.200647787	0.634086868	0	1.765304239	0	0	0	0	0.412587978	0	0	0	0	1.018091572	0	0	0	0	0	0	0	0	0	0	36.1896	YES	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											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	0	0	12.4941	1.232097741	4.631460084	0	1.145937241	0	0	0.974474254	1.677035779	0	0	0	0	0.518281581	3.965347827	5.520201325	0.200647787	0.634086868	0	1.765304239	0	0	0	0	0.412587978	0	0	0	0	1.018091572	0	0	0	0	0	0	0	0	0	0	36.1896
H3810_010_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	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	YES	874.4965654	10.38237332	478.791399	0	181.1000541	0	0	316.1011966	312.6132685	0	0	0	0	359.14914	2522.012211	4562.217257	158.0294334	451.7292622	0	1521.757215	0	0	0	0	306.6586755	0	0	0	0	644.1776587											2000	$200/Days 1-10 for IP Medical; $200/Days 1-10 for IP Surgical;	$200/Days 1-10 for IP Psych; $200/Days 1-10 for IP Substance Abuse;	$150/Days 1-10 for SNF	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$20/Visit for PCP - Office Visits; $20/Consult for PCP - Consults; $20/Exam for PCP - Routine Physicals;	$20/Visit for Speclst - Office Visits; $20/Consult for Speclst - Consults;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Visit for Acupuncture; $20/Service for Care Coordination Counseling;											200	200	150	0	100	0	0	49.03376398	82.44194183	0	0	0	0	20	20	20	20	20	0	20	0	0	0	0	20	0	0	0	0	20											NO	191.1854065	191.1854066	143.3890549	0	95.59270327	0	0	46.87270051	78.80848083	0	0	0	0	19.11854065	19.11854066	19.11854065	19.11854066	19.11854065	0	19.11854066	0	0	0	0	19.11854065	0	0	0	0	19.11854065												13.9326	0.165413189	5.721120516	0	1.442653645	0	0	1.234709726	2.053048065	0	0	0	0	0.572200619	4.018099416	7.268578009	0.251774346	0.719700355	0	2.424481433	0	0	0	0	0.488572196	0	0	0	0	1.026311396	0	0	0	0	0	0	0	0	0	0	41.3192	0	1.905021677	13.9326	0.165413189	5.721120516	0	1.442653645	0	0	1.234709726	2.053048065	0	0	0	0	0.572200619	4.018099416	7.268578009	0.251774346	0.719700355	0	2.424481433	0	0	0	0	0.488572196	0	0	0	0	1.026311396	0	0	0	0	0	0	0	0	0	0	41.3192	YES	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											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	0	0	13.9326	0.165413189	5.721120516	0	1.442653645	0	0	1.234709726	2.053048065	0	0	0	0	0.572200619	4.018099416	7.268578009	0.251774346	0.719700355	0	2.424481433	0	0	0	0	0.488572196	0	0	0	0	1.026311396	0	0	0	0	0	0	0	0	0	0	41.3192
H3810_017_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	324.5903048	8.163718578	78.13215399	0	26.96713832	35.44232302	24.02236348	40.80291646	43.02592383	13.84514163	24.97109565	0	0.290472667	47.55507868	48.68801639	133.0423968	4.147945459	6.321246636	24.1639365	54.70847629	27.51643995	3.068275202	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	23% Coinsurance for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; $50/Case for ER - Worldwide; 23% Coinsurance for Urgent Care; 23% Coinsurance for Urgent Care - Worldwide;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	20 to 23% Coinsurance	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.082225702	0.082225702	0.124309392	0	0.23	0.2	0.2	0.229375779	0.23	0.23	0.23	0	0.2	0.222799143	0.23	0.23	0.23	0.23	0.23	0.23	0.2	0.23	0	0	0	0	0	0	0	0											NO	0.082225702	0.082225702	0.124309392	0	0.23	0.2	0.2	0.229375779	0.23	0.23	0.23	0	0.2	0.222799143	0.23	0.23	0.23	0.23	0.23	0.23	0.2	0.23	0	0	0	0	0	0	0	0												26.6897	0.67126749	9.712560579	0	6.202441813	7.088464605	4.804472696	9.359200748	9.895962481	3.184382574	5.743351999	0	0.058094533	10.59523078	11.19824377	30.59975126	0.954027456	1.453886726	5.557705396	12.58294955	5.50328799	0.705703296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.5607	0	0	26.6897	0.67126749	9.712560579	0	6.202441813	7.088464605	4.804472696	9.359200748	9.895962481	3.184382574	5.743351999	0	0.058094533	10.59523078	11.19824377	30.59975126	0.954027456	1.453886726	5.557705396	12.58294955	5.50328799	0.705703296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.5607	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.6897	0.67126749	9.712560579	0	6.202441813	7.088464605	4.804472696	9.359200748	9.895962481	3.184382574	5.743351999	0	0.058094533	10.59523078	11.19824377	30.59975126	0.954027456	1.453886726	5.557705396	12.58294955	5.50328799	0.705703296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.5607
H3811_001_0	2010	4	N/A																															D	D	D	V	T	COIN	COIN	V	V	V	V			V			V		P	V	COIN	V			V	P	V			P																																																			0	NO	1178.349043	18.81254669	157.9152544	1031.25231	264.7893383	8.28784055	0	330.8407476	732.9004722	8963.389627	2079.653015	0	0	4078.404355	0	0	196.5228501	0	2369.856102	18312.14859	29.21439938	23.92479114	0	0	297.1981664	256.2311887	44.05130506	0	0	116.1216904												"$100 days 1-5, $0 days 6-90"	"$50 days 1-5, $0 days 6-90"	$40 day copay		$50 copay	20% coinsurance	20% coinsurance	$50 copay	$30 copay					"$15 copay for therapy and rehab, $0 other"			"$15, $20, $30, $40 Copays"			$10 PCP; $15 SCP; $0 other	20% coinsurance	$10 copay			$15 copay	$0 copay	$10 copay			$15 copay											59.74732647	12.75511045	40	0	50	0.20000814	0	50	30	0	0	0	0	15.000284	0	0	21.02357185	0	0	5.075846935	0.2	10	0	0	15	0	10	0	0	15											NO	59.74732647	12.75511045	40	0	50	0.20000814	0	50	30	0	0	0	0	15.000284	0	0	21.02357185	0	0	5.075846935	0.2	10	0	0	15	0	10	0	0	15												5.8669	0.019996343	0.526384181	0	1.10328891	1.657635572	0	1.378503115	1.83225118	0	0	0	0	5.098101968	0	0	0.344301022	0	0	7.745805273	5.842879877	0.019937326	0	0	0.371497708	0	0.036709421	0	0	0.145152113	0	0	0	0	0	0	0	0	0	0	31.9894			5.8669	0.019996343	0.526384181	0	1.10328891	1.657635572	0	1.378503115	1.83225118	0	0	0	0	5.098101968	0	0	0.344301022	0	0	7.745805273	5.842879877	0.019937326	0	0	0.371497708	0	0.036709421	0	0	0.145152113	0	0	0	0	0	0	0	0	0	0	31.9894	NO																																																																																		0			5.8669	0.019996343	0.526384181	0	1.10328891	1.657635572	0	1.378503115	1.83225118	0	0	0	0	5.098101968	0	0	0.344301022	0	0	7.745805273	5.842879877	0.019937326	0	0	0.371497708	0	0.036709421	0	0	0.145152113	0	0	0	0	0	0	0	0	0	0	31.9894
H3811_002_0	2010	4	N/A																															D	D	D	V	T	COIN	COIN	V	V	P	P		COIN	V			V		P	V	COIN	V			V	P	V			P																																																			0	NO	1619.265189	25.20306088	234.8362186	1425.665317	412.9094839	10.6810316	0	420.8521565	774.9129863	11162.65669	2666.395966	0	0	4554.395448	0	0	420.8971568	0	2926.269371	20477.80976	29.02289757	17.41137002	0	0	328.6202762	283.3219498	32.04778794	0	0	130.6064325												"$150 days 1-5, $0 days 6-90"	$500 per admission	$40 per day		$100 copay	20% coinsurance	20% coinsurance	$50 copay	$50 copay					"$20 copay for therapy and rehab, $0 other"			"$15, $20, $30, $40 Copays"			"$15 PCP, $20 SCP, $0 all other"	20% coinsurance	$10 copay			$20 copay	$20 copay	$10 copay			$20 copay											80.9479907	14.26245258	40	0	100	0.2	0	50	50	0	0	0	0	20.00051265	0	0	22.12320999	0	0	6.268133164	0.2	10	0	0	20	20	10	0	0	20											NO	80.9479907	14.26245258	40	0	100	0.2	0	50	50	0	0	0	0	20.00051265	0	0	22.12320999	0	0	6.268133164	0.2	7.922009777	0	0	20	20	10	0	0	20												10.923	0.029954788	0.782787395	0	3.440912366	2.136206321	0	1.753550652	3.228804109	0	0	0	0	7.590853648	0	0	0.775966349	0	0	10.69646987	5.804579514	0.01149442	0	0	0.54770046	0.47220325	0.02670649	0	0	0.217677388	0	0	0	0	0	0	0	0	0	0	48.4389			10.923	0.029954788	0.782787395	0	3.440912366	2.136206321	0	1.753550652	3.228804109	0	0	0	0	7.590853648	0	0	0.775966349	0	0	10.69646987	5.804579514	0.01149442	0	0	0.54770046	0.47220325	0.02670649	0	0	0.217677388	0	0	0	0	0	0	0	0	0	0	48.4389	NO																																																																																		0			10.923	0.029954788	0.782787395	0	3.440912366	2.136206321	0	1.753550652	3.228804109	0	0	0	0	7.590853648	0	0	0.775966349	0	0	10.69646987	5.804579514	0.01149442	0	0	0.54770046	0.47220325	0.02670649	0	0	0.217677388	0	0	0	0	0	0	0	0	0	0	48.4389
H3811_003_0	2010	5	N/A																															D	D	D	V	T	COIN	COIN	V	P	P	P			V			V		P	V	COIN	V			V	P	V	P		V																																																			0	NO	3278.983172	68.5161007	764.737175	3247.185861	844.5751419	26.92098412	0	922.8017532	846.6376272	14152.54083	2439.155302	0	0	5106.783997	0	0	2523.529567	0	3342.043167	21192.90164	31.30320837	79.54354753	0	0	599.3820731	516.8252189	0	0	0	28.85668102												"$100 days 1-5, $0 days 6-90"	$500 per admission	$40 per day		$50 copay	20% coinsurance	20% coinsurance	$50 copay	$35 copay					"$15 copay for therapy and rehab, $0 other"			"$15, $20, $30, $40 Copays"			"$15 PCP, $20 SCP, $0 all other"	20% coinsurance	"Copays ($25, $22.50, $0)"			$15 copay	$15 copay				"$0, $25 copays"											48.09664944	12.35969143	40	0	50	0.2	0	50	35	0	0	0	0	9.334336875	0	0	24.06969109	0	0	5.134163731	0.2	9.539865072	0	0	15	15	0	0	0	14.06738779											NO	48.09664944	12.35969143	40	0	50	0.2	0	50	35	0	0	0	0	9.334336875	0	0	24.06969109	0	0	5.134163731	0.2	9.539865072	0	0	15	15	0	0	0	14.06738779												13.1423	0.070569822	2.549123917	0	3.519063091	5.384196825	0	3.845007305	2.469359746	0	0	0	0	3.972370182	0	0	5.061714761	0	0	9.067318911	6.260641674	0.063236226	0	0	0.749227591	0.646031524	0	0	0	0.033828177	0	0	0	0	0	0	0	0	0	0	56.834			13.1423	0.070569822	2.549123917	0	3.519063091	5.384196825	0	3.845007305	2.469359746	0	0	0	0	3.972370182	0	0	5.061714761	0	0	9.067318911	6.260641674	0.063236226	0	0	0.749227591	0.646031524	0	0	0	0.033828177	0	0	0	0	0	0	0	0	0	0	56.834	NO																																																																																		0			13.1423	0.070569822	2.549123917	0	3.519063091	5.384196825	0	3.845007305	2.469359746	0	0	0	0	3.972370182	0	0	5.061714761	0	0	9.067318911	6.260641674	0.063236226	0	0	0.749227591	0.646031524	0	0	0	0.033828177	0	0	0	0	0	0	0	0	0	0	56.834
H3811_009_0	2010	4	N/A																															D	D	D	V	T	COIN	COIN	V	V	P	P		COIN	V			V		P	V	COIN	V			V	P	V			P																																																			0	NO	1426.218527	22.37197215	226.7246322	1441.314654	267.5619763	13.54406597	0	401.636758	785.6576572	10306.76491	2665.086466	0	0	4738.604482	0	0	207.8092182	0	2864.940018	21273.0405	26.80003752	34.40264416	0	0	335.9324336	289.6261703	63.32907253	0	0	173.2661939												"$150 days 1-5, $0 days 6-90"	$500 per admission	$40 per day		$100 copay	20% coinsurance	20% coinsurance	$50 copay	$50 copay					"$20 copay for therapy and rehab, $0 other"			"$15, $20, $30, $40 Copays"			"$15 PCP, $20 SCP, $0 Other"	20% coinsurance	$10 copay			$20 copay	$20 copay	$10 copay			$20 copay											80.9479907	11.35102164	40	0	100	0.20000814	0	50	50	0	0	0	0	20.00060549	0	0	17.95556561	0	0	6.047133517	0.2	10	0	0	20	20	10	0	0	20											NO	80.9479907	11.35102164	40	0	100	0.20000814	0	50	50	0	0	0	0	20.00060549	0	0	17.95556561	0	0	6.047133517	0.2	5.46628867	0	0	20	20	10	0	0	20												9.6208	0.021162062	0.755748774	0	2.229683136	2.70892344	0	1.673486491	3.273573572	0	0	0	0	7.897913236	0	0	0.310944338	0	0	10.72007635	5.360007504	0.015671232	0	0	0.559887389	0.482710284	0.052774227	0	0	0.28877699	0	0	0	0	0	0	0	0	0	0	45.9721			9.6208	0.021162062	0.755748774	0	2.229683136	2.70892344	0	1.673486491	3.273573572	0	0	0	0	7.897913236	0	0	0.310944338	0	0	10.72007635	5.360007504	0.015671232	0	0	0.559887389	0.482710284	0.052774227	0	0	0.28877699	0	0	0	0	0	0	0	0	0	0	45.9721	NO																																																																																		0			9.6208	0.021162062	0.755748774	0	2.229683136	2.70892344	0	1.673486491	3.273573572	0	0	0	0	7.897913236	0	0	0.310944338	0	0	10.72007635	5.360007504	0.015671232	0	0	0.559887389	0.482710284	0.052774227	0	0	0.28877699	0	0	0	0	0	0	0	0	0	0	45.9721
H3812_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	998.5104122	116.43064	625.849113	236.9781985	140.6561579	5.750945599	6.259037415	422.8498513	24.96538858	5918.582256	21.02903198	0	0.028066939	10.54023467	4204.986919	2528.806375	421.5951967	289.6940375	0	0	10.47257411	629.6939562	0	0	129.5762086	0	13.27655011	4.462366734	93.24661564	0											3300	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$85 Days 1-20 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	55.32652002	0	150	0.2	0.108701972	49.78794444	0.2	3	0.174252136	0	0.2	0.150674224	10.04500766	25	38.5	25	0	0	0.2	23.69013423	0	0	25	0	0	0	0	0											YES	156.2408374	118.9963294	46.91843852	0	127.2042011	0.169605601	0.092182317	42.2215713	0.169605601	2.544084022	0.147770692	0	0.169605601	0.128018878	9.993779303	25	38.5	21.20070018	0	0	0.169605601	23.69013423	0	0	25	0	0	0	0	0											3900	13.0007	1.154568232	2.446988594	0	1.491004516	0.975392587	0.576972569	1.487782095	4.234269746	1.254780879	3.107474602	0	0.00476031	1.349349018	3.501975937	5.268346614	1.352617923	0.511809703	0	0	1.77620723	1.243127862	0	0	0.269950435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0081	0	5.995412185	13.0007	1.154568232	2.446988594	0	1.491004516	0.975392587	0.576972569	1.487782095	4.234269746	1.254780879	3.107474602	0	0.00476031	1.349349018	3.501975937	5.268346614	1.352617923	0.511809703	0	0	1.77620723	1.243127862	0	0	0.269950435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0081	NO	"$375 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-22 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.9897	0.2348	0.3279	0.1113	0.3681	0.3612	0.3931	0.4927	1.5678	0.3097	1.1254	0	0.0012	0.4995	1.9115	2.4205	0.4437	0.2081	0	0	0.677	0.5879	0	0	0.1254	0	0.0128	0.0029	0	0											14.1721	0	2.909609347	14.9903	1.389388275	2.774860751	0.111296355	1.859059361	1.336556451	0.970044994	1.980440045	5.802115597	1.564523859	4.232862556	0	0.005935394	1.848884517	5.413438528	7.688839008	1.796312868	0.719882265	0	0	2.453180016	1.831056119	0	0	0.395346766	0	0.012848274	0.002935768	0	0	0	0	0	0	0	0	0	0	0	0	59.1801
H3812_005_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	273.7570006	36.23822616	11165.6368	67.63283482	21.336004	31.06664939	12.08109218	16.43759345	8.463832531	34.42000488	21.97978668	0	0.013704265	7.748846803	1.775995563	96.08854459	16.78386788	30.99139564	0	0	0.979497099	8.261969239	1533.895559	0	164.6923628	227.5232422	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083326428	0.084338489	0	0	0.2	0.2	0.090661937	0.097716691	0.2	0	0.064462435	0	0.2	0.151326007	0.001767074	0.198628539	0.2	0	0	0	0.2	0.190549522	0	0	0	0	0	0	0	0											NO	0.083326428	0.084338489	0	0	0.2	0.2	0.090661937	0.097716691	0.2	0	0.064462435	0	0.2	0.151326007	0.001767074	0.198628539	0.2	0	0	0	0.2	0.190549522	0	0	0	0	0	0	0	0												22.8112	3.056277253	0	0	4.2672008	6.213329879	1.095295222	1.606227239	1.692766506	0	1.416870565	0	0.002740853	1.172602044	0.003138315	19.08592719	3.356773576	0	0	0	0.19589942	1.574314289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5506	0	0	22.8112	3.056277253	0	0	4.2672008	6.213329879	1.095295222	1.606227239	1.692766506	0	1.416870565	0	0.002740853	1.172602044	0.003138315	19.08592719	3.356773576	0	0	0	0.19589942	1.574314289	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5506	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.659	0.8815	0.5349	0.0402	0.7911	1.1519	0.448	0.1985	0.3138	0.3829	0.6421	0	0.0003	0.2174	0.0491	2.6779	0.4677	0	0	0	0.0273	0.2194	0	0	0.0356	0	0	0	0	0											15.7386	0	0	29.4701	3.937747619	0.534899761	0.040196103	5.058311061	7.365239351	1.543245831	1.804749706	2.006594004	0.382874212	2.059009529	0	0.00307961	1.389994558	0.052195967	21.76380466	3.824520714	0	0	0	0.22319688	1.793685952	0	0	0.035632274	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2891
H3812_007_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1878.199208	223.0668099	37.41050991	591.2358233	264.3554228	16.26442528	15.82598371	623.6940833	45.54124106	12109.85903	53.94774118	0	0.110245846	22.91755796	8015.434742	5931.661452	826.6917582	420.9314593	0	0	27.71177792	969.3946594	672.1728274	0	259.9311771	0	15.19788714	4.561172758	79.22036895	0											3300	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	0.129318133	0	150	0.2	0.092399226	49.65857592	0.2	3	0.172759289	0	0.2	0.14995364	10.05328492	25	38.5	25	0	0	0.2	24.79241127	0	0	25	0	0	0	0	0											NO	130.9326672	99.7210912	0.091901601	0	106.5994372	0.142132583	0.065664703	35.29050829	0.142132583	2.131988743	0.12277362	0	0.142132583	0.106937079	9.947326924	25	38.5	17.76657286	0	0	0.142132583	24.79241127	0	0	25	0	0	0	0	0												20.4931	1.853705474	3.438085757	0	2.34834494	2.311704773	1.039208527	1.834206768	6.472894218	2.151506927	6.623359464	0	0.015669527	2.450736714	6.644345819	12.35762803	2.652302724	0.62320912	0	0	3.938746571	2.00280259	0	0	0.541523286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.7931	0	22.69340175	20.4931	1.853705474	3.438085757	0	2.34834494	2.311704773	1.039208527	1.834206768	6.472894218	2.151506927	6.623359464	0	0.015669527	2.450736714	6.644345819	12.35762803	2.652302724	0.62320912	0	0	3.938746571	2.00280259	0	0	0.541523286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.7931	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.8563	0.1527	1.6033	0.1524	0.3672	0.5421	0.5275	0.2868	1.518	0.3364	1.5273	0	0.0024	0.5794	1.7167	5.477	0.4478	0.2623	0	0	1.2423	0.2855	0	0	0.0627	0	0.003	0.003	0	0											21.9521	0	0	25.3495	2.006429742	5.041393324	0.15244651	2.715505249	2.853852283	1.566741317	2.120982323	7.990935587	2.4878919	8.1506472	0	0.018119434	3.030133088	8.361010441	17.83464065	3.100094093	0.88548058	0	0	5.180998685	2.288293556	0	0	0.604197429	0	0.002972527	0.003000772	0	0	0	0	0	0	0	0	0	0	0	0	101.7452
H3812_801_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	194.6444267	5.29692753	22.81166338	177.7881299	5.923124783	6.16515654	6.67036959	16.50215501	27.22336512	12.33345117	23.00786106	0	0.02595534	11.07570424	22.91005973	69.99010807	2.18937651	4.368064655	0	0	11.42484992	4.606133503	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083510683	0.083510683	0.1291268	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083510683	0.083510683	0.1291268	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.2549	0.442350034	2.945597104	0	1.380088074	1.436481474	1.554196114	3.845002118	6.343044073	2.873694122	5.360831627	0	0.006047594	2.580639088	5.338043918	16.30769518	0.510124727	1.017759065	0	0	2.661990031	1.073229106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9317	0	0	16.2549	0.442350034	2.945597104	0	1.380088074	1.436481474	1.554196114	3.845002118	6.343044073	2.873694122	5.360831627	0	0.006047594	2.580639088	5.338043918	16.30769518	0.510124727	1.017759065	0	0	2.661990031	1.073229106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9317	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.4135	0.0385	0.2913	0	0.3893	0.4052	0.4384	1.0845	1.7891	0.8105	1.512	0	0.0017	0.7279	1.5498	4.7345	0.1481	0.2955	0	0	0.7728	0.3116	0	0	0	0	0	0	0	0											16.714	0	0	17.6684	0.480815254	3.236919895	0	1.769343685	1.841642915	1.992559121	4.929489895	8.132107785	3.684223233	6.87286106	0	0.007753326	3.308511651	6.887798604	21.04218733	0.658225454	1.313237503	0	0	3.434825847	1.38481175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6457
H3812_803_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	194.6444267	5.29692753	22.81166338	177.7881299	5.923124783	6.16515654	6.67036959	16.50215501	27.22336512	12.33345117	23.00786106	0	0.02595534	11.07570424	22.91005973	69.99010807	2.18937651	4.368064655	0	0	11.42484992	4.606133503	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083510683	0.083510683	0.1291268	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083510683	0.083510683	0.1291268	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.2549	0.442350034	2.945597104	0	1.380088074	1.436481474	1.554196114	3.845002118	6.343044073	2.873694122	5.360831627	0	0.006047594	2.580639088	5.338043918	16.30769518	0.510124727	1.017759065	0	0	2.661990031	1.073229106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9317	0	0	16.2549	0.442350034	2.945597104	0	1.380088074	1.436481474	1.554196114	3.845002118	6.343044073	2.873694122	5.360831627	0	0.006047594	2.580639088	5.338043918	16.30769518	0.510124727	1.017759065	0	0	2.661990031	1.073229106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9317	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.4135	0.0385	0.2913	0	0.3893	0.4052	0.4384	1.0845	1.7891	0.8105	1.512	0	0.0017	0.7279	1.5498	4.7345	0.1481	0.2955	0	0	0.7728	0.3116	0	0	0	0	0	0	0	0											16.714	0	0	17.6684	0.480815254	3.236919895	0	1.769343685	1.841642915	1.992559121	4.929489895	8.132107785	3.684223233	6.87286106	0	0.007753326	3.308511651	6.887798604	21.04218733	0.658225454	1.313237503	0	0	3.434825847	1.38481175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6457
H3812_804_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	194.6444267	5.29692753	22.81166338	177.7881299	5.923124783	6.16515654	6.67036959	16.50215501	27.22336512	12.33345117	23.00786106	0	0.02595534	11.07570424	22.91005973	69.99010807	2.18937651	4.368064655	0	0	11.42484992	4.606133503	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083510683	0.083510683	0.1291268	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083510683	0.083510683	0.1291268	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.2549	0.442350034	2.945597104	0	1.380088074	1.436481474	1.554196114	3.845002118	6.343044073	2.873694122	5.360831627	0	0.006047594	2.580639088	5.338043918	16.30769518	0.510124727	1.017759065	0	0	2.661990031	1.073229106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9317	0	0	16.2549	0.442350034	2.945597104	0	1.380088074	1.436481474	1.554196114	3.845002118	6.343044073	2.873694122	5.360831627	0	0.006047594	2.580639088	5.338043918	16.30769518	0.510124727	1.017759065	0	0	2.661990031	1.073229106	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9317	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.4135	0.0385	0.2913	0	0.3893	0.4052	0.4384	1.0845	1.7891	0.8105	1.512	0	0.0017	0.7279	1.5498	4.7345	0.1481	0.2955	0	0	0.7728	0.3116	0	0	0	0	0	0	0	0											16.714	0	0	17.6684	0.480815254	3.236919895	0	1.769343685	1.841642915	1.992559121	4.929489895	8.132107785	3.684223233	6.87286106	0	0.007753326	3.308511651	6.887798604	21.04218733	0.658225454	1.313237503	0	0	3.434825847	1.38481175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6457
H3813_001_0	2010	9	N/A																															A	A	D	V	T	Coin	Coin	V	Coin	P	P	V	Coin	P	V	V	V	V	P	P	Coin	V	T	P	V	P	V	P	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	NO	440.5954918		184.6764343	1542.766978	73.35869586	34.07228821		175.3709409	32.7444267	17617.94955					12691.39014						1.734132251	0	0	0	167.3656617					0.402277515												$400 copay per admit	$400 copay per admit	"$0 for 1st 20 days, $50 21-100th"	$0 copay	$50 copay	10% coinsurance	Supplies 10% coins	$50 ER copay/$20 Urgent	$400 or 10% copay	$0 copay	X-Ray $10 copay	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	10% coinsurance	"10% coinsurance, $20 Physical Therapy and O/P Psych copays"	"$20 Office and Hospital Outpatient, $20 Inpatient Hospital, $10 diabetes monitoring, $20 Urgent Care and $0 and 10% Immunizations"	"$30 O/P Surgery, PCP, specialist, Chiro and Podiatrist visits, $30 inpatient visits"	$20 copay for Group Visits	$20 copay per visit	$20 copay per visit	$20 copay per visit	20% coinsurance	$20 copay per visit	N/A	$0 copay	"$30 copay, one exam per two years"	N/A	N/A	N/A	N/A	$0 copay											400	400	14.62165803	0	50	0.1	0.1	46.78305709	0.1	1.505866133	10	50	0.1	20	15.08	30	20	20	20	20	0.2	20	0	0	30	0	0	0	0	0											NO	284.8013522	284.8013522	10.41066994	0	35.60016903	0.071200338	0.071200338	33.3096948	0.071200338	1.072181777	7.120033806	35.60016903	0.071200338	14.24006761	10.73701098	21.36010142	14.24006761	14.24006761	14.24006761	14.24006761	0.142400676	14.24006761	0	0	21.36010142	0	0	0	0	0												10.4568	0	0.160217117	0	0.217631831	2.425958439	0	0.486796043	2.33141425	1.574137038	0	0	0	0	11.35563294	0	0	0	0	0	0.246941605	0	0	0	0.297912292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5535	0	11.95402395	10.4568	0	0.160217117	0	0.217631831	2.425958439	0	0.486796043	2.33141425	1.574137038	0	0	0	0	11.35563294	0	0	0	0	0	0.246941605	0	0	0	0.297912292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5535	YES	$400 copay per admit	$400 copay per admit	"$0 for 1st 20 days, $50 21-100th"	$0 copay	$50 copay	10% coinsurance	"Supplies 10% coins, Equipment $10 copay"	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	$400 or 10% copay	$0 copay	"O/P Diag 10% to $100, O/P Radiation Therapy $30 O/P X-Ray $10"	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	10% coinsurance	"10% coinsurance, $20 Physical Therapy and O/P Psych copays"	"$20 Office and Hospital Outpatient, $20 Inpatient Hospital, $10 diabetes monitoring, $20 Urgent Care and $0 and 10% Immunizations"	"$30 O/P Surgery, PCP, specialist, Chiro and Podiatrist visits, $30 inpatient visits"	$25 copay per visit	$20 copay per visit	$20 copay per visit	$20 copay per visit	20% coinsurance	$20 copay per visit	N/A	N/A	"$30 copay, one exam per two years"	N/A	N/A	N/A	N/A	N/A											2500	2.6142	0	0.0401	0	0.0544	0.6065	0	0.1217	0.5829	0.3935	0	0	0	0	2.8389	0	0	0	0	0	0.0617	0	0	0	0.0745	0	0	0	0	0											7.3884	0	2.988505988	13.0711	0	0.200271396	0	0.272039789	3.032448048	0	0.608495054	2.914267813	1.967671297	0	0	0	0	14.19454118	0	0	0	0	0	0.308677006	0	0	0	0.372390365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9419
H3813_002_0	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	Coin	P	P	V	Coin	P	V	V	V	V	P	P	Coin	V	T	P	V	P	V	P	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	NO	545.2200633		234.1816458	813.8832875	1964.284107	65.98151714		218.3187452	39.210315	23067.14247					24900.77714						5.850804627	0	0	0	165.6976785					0.398847329												$400 copay per admit	$400 copay per admit	"$0 for 1st 20 days, $50 21-100th"	$0 copay	$50 copay	10% coinsurance	Supplies 10% coins	$50 ER copay/$20 Urgent	$400 or 10% copay	$0 copay	X-Ray $10 copay	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	10% coinsurance	"10% coinsurance, $20 Physical Therapy and O/P Psych copays"	"$20 Office and Hospital Outpatient, $20 Inpatient Hospital, $10 diabetes monitoring, $20 Urgent Care and $0 and 10% Immunizations"	"$30 O/P Surgery, PCP, specialist, Chiro and Podiatrist visits, $30 inpatient visits"	$20 copay for Group Visits	$20 copay per visit	$20 copay per visit	$20 copay per visit	20% coinsurance	$20 copay per visit	N/A	$0 copay	"$30 copay, one exam per two years"	N/A	N/A	N/A	N/A	$0 copay											400	400	13.35261491	0	50	0.1	0.1	47.08657899	0.1	1.364660124	10	50	0.1	20	14.53167895	30	20	20	20	20	0.2	20	0	0	30	0	0	0	0	0											NO	293.391763	293.391763	9.793868072	0	36.67397037	0.073347941	0.073347941	34.53703605	0.073347941	1.000950099	7.334794075	36.67397037	0.073347941	14.66958815	10.65868727	22.00438222	14.66958815	14.66958815	14.66958815	14.66958815	0.146695881	14.66958815	0	0	22.00438222	0	0	0	0	0												13.3303	0	0.191128679	0	6.003174762	4.83960841	0	0.628340198	2.875995862	1.924088212	0	0	0	0	22.11746635	0	0	0	0	0	0.858288942	0	0	0	0.303839588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0722	0	19.28456432	13.3303	0	0.191128679	0	6.003174762	4.83960841	0	0.628340198	2.875995862	1.924088212	0	0	0	0	22.11746635	0	0	0	0	0	0.858288942	0	0	0	0.303839588	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0722	YES	$400 copay per admit	$400 copay per admit	"$0 for 1st 20 days, $50 21-100th"	$0 copay	$50 copay	10% coinsurance	"Supplies 10% coins, Equipment $10 copay"	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	$400 or 10% copay	$0 copay	"O/P Diag 10% to $100, O/P Radiation Therapy $30 O/P X-Ray $10"	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	10% coinsurance	"10% coinsurance, $20 Physical Therapy and O/P Psych copays"	"$20 Office and Hospital Outpatient, $20 Inpatient Hospital, $10 diabetes monitoring, $20 Urgent Care and $0 and 10% Immunizations"	"$30 O/P Surgery, PCP, specialist, Chiro and Podiatrist visits, $30 inpatient visits"	$25 copay per visit	$20 copay per visit	$20 copay per visit	$20 copay per visit	20% coinsurance	$20 copay per visit	N/A	N/A	"$30 copay, one exam per two years"	N/A	N/A	N/A	N/A	N/A											2500	3.3326	0	0.0478	0	1.5008	1.2099	0	0.1571	0.719	0.481	0	0	0	0	5.5294	0	0	0	0	0	0.2146	0	0	0	0.076	0	0	0	0	0											13.268	0	4.821141079	16.6628	0	0.238910848	0	7.503968452	6.049510512	0	0.785425247	3.594994827	2.405110265	0	0	0	0	27.64683294	0	0	0	0	0	1.072861178	0	0	0	0.379799485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3402
H3813_003_0	2010	9	N/A																															A	A	D	V	T	Coin	Coin	V	Coin	P	P	V	Coin	P	V	V	V	V	P	P	Coin	V	T	P	V	P	V	P	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	NO	524.3713578		329.2074863	813.9858887	543.926566	45.03036467		204.0088243	33.28208179	22116.1778					24445.54154						2.615440214	0	0	0	149.9422513					0.357073998												$400 copay per admit	$400 copay per admit	"$0 for 1st 20 days, $50 21-100th"	$0 copay	$50 copay	10% coinsurance	Supplies 10% coins	$50 ER copay/$20 Urgent	$400 or 10% copay	$0 copay	X-Ray $10 copay	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	10% coinsurance	"10% coinsurance, $20 Physical Therapy and O/P Psych copays"	"$20 Office and Hospital Outpatient, $20 Inpatient Hospital, $10 diabetes monitoring, $20 Urgent Care and $0 and 10% Immunizations"	"$30 O/P Surgery, PCP, specialist, Chiro and Podiatrist visits, $30 inpatient visits"	$20 copay for Group Visits	$20 copay per visit	$20 copay per visit	$20 copay per visit	20% coinsurance	$20 copay per visit	N/A	$0 copay	"$30 copay, one exam per two years"	N/A	N/A	N/A	N/A	$0 copay											400	400	12.38500206	0	50	0.1	0.1	46.92577136	0.1	1.490482667	10	50	0.1	20	15.43626531	30	20	20	20	20	0.2	20	0	0	30	0	0	0	0	0											NO	293.391763	293.391763	9.084143975	0	36.67397037	0.073347941	0.073347941	34.41908697	0.073347941	1.093238343	7.334794075	36.67397037	0.073347941	14.66958815	11.32218273	22.00438222	14.66958815	14.66958815	14.66958815	14.66958815	0.146695881	14.66958815	0	0	22.00438222	0	0	0	0	0												12.8205	0	0.249214017	0	1.662328897	3.30288452	0	0.585149789	2.441172163	2.014854464	0	0	0	0	23.0647407	0	0	0	0	0	0.383674308	0	0	0	0.274948884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7995	0	17.00528605	12.8205	0	0.249214017	0	1.662328897	3.30288452	0	0.585149789	2.441172163	2.014854464	0	0	0	0	23.0647407	0	0	0	0	0	0.383674308	0	0	0	0.274948884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7995	YES	$400 copay per admit	$400 copay per admit	"$0 for 1st 20 days, $50 21-100th"	$0 copay	$50 copay	10% coinsurance	"Supplies 10% coins, Equipment $10 copay"	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	$400 or 10% copay	$0 copay	"O/P Diag 10% to $100, O/P Radiation Therapy $30 O/P X-Ray $10"	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	10% coinsurance	"10% coinsurance, $20 Physical Therapy and O/P Psych copays"	"$20 Office and Hospital Outpatient, $20 Inpatient Hospital, $10 diabetes monitoring, $20 Urgent Care and $0 and 10% Immunizations"	"$30 O/P Surgery, PCP, specialist, Chiro and Podiatrist visits, $30 inpatient visits"	$25 copay per visit	$20 copay per visit	$20 copay per visit	$20 copay per visit	20% coinsurance	$20 copay per visit	N/A	N/A	"$30 copay, one exam per two years"	N/A	N/A	N/A	N/A	N/A											2500	3.2051	0	0.0623	0	0.4156	0.8257	0	0.1463	0.6103	0.5037	0	0	0	0	5.7662	0	0	0	0	0	0.0959	0	0	0	0.0687	0	0	0	0	0											11.6999	0	4.251321514	16.0256	0	0.311517521	0	2.077911121	4.128605649	0	0.731437236	3.051465204	2.51856808	0	0	0	0	28.83092587	0	0	0	0	0	0.479592885	0	0	0	0.343686105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4994
H3813_801_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	Coin	P	P	V	Coin	P	V	V	V	V	P	P	Coin	V	T	P	V	P	V	P	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	YES	393.9523939		116.0088923	676.4088272	48.31491623	31.05118787		144.148349	30.13975721	17431.8625					11899.80459						1.859900374	0	0	0	219.275389					0.530933145											2500	$400 copay per admit	$400 copay per admit	"$0 for 1st 20 days, $50 21-100th"	$0 copay	$50 copay	10% coinsurance	Supplies 10% coins	$50 ER copay/$20 Urgent	$400 or 10% copay	$0 copay	X-Ray $10 copay	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	10% coinsurance	"10% coinsurance, $20 Physical Therapy and O/P Psych copays"	"$20 Office and Hospital Outpatient, $20 Inpatient Hospital, $10 diabetes monitoring, $20 Urgent Care and $0 and 10% Immunizations"	"$30 O/P Surgery, PCP, specialist, Chiro and Podiatrist visits, $30 inpatient visits"	$20 copay for Group Visits	$20 copay per visit	$20 copay per visit	$20 copay per visit	20% coinsurance	$20 copay per visit	N/A	$0 copay	"$30 copay, one exam per two years"	N/A	N/A	N/A	N/A	$0 copay											400	400	12.29508197	0	50	0.1	0.1	48.15384615	0.1	1.490844758	10	50	0.1	20	15.43626531	30	20	20	20	20	0.2	20	0	0	30	0	0	0	0	0											YES	293.391763	293.391763	9.018189436	0	36.67397037	0.073347941	0.073347941	35.31985454	0.073347941	1.09350393	7.334794075	36.67397037	0.073347941	14.66958815	11.32218273	22.00438222	14.66958815	14.66958815	14.66958815	14.66958815	0.146695881	14.66958815	0	0	22.00438222	0	0	0	0	0											2500	9.6319	0	0.087182514	0	0.147658317	2.277540688	0	0.424274893	2.210689126	1.588484178	0	0	0	0	11.22764684	0	0	0	0	0	0.272839725	0	0	0	0.402084956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.2703	0	11.4349756	9.6319	0	0.087182514	0	0.147658317	2.277540688	0	0.424274893	2.210689126	1.588484178	0	0	0	0	11.22764684	0	0	0	0	0	0.272839725	0	0	0	0.402084956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.2703	YES	$400 copay per admit	$400 copay per admit	"$0 for 1st 20 days, $50 21-100th"	$0 copay	$50 copay	10% coinsurance	"Supplies 10% coins, Equipment $10 copay"	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	$400 or 10% copay	$0 copay	"O/P Diag 10% to $100, O/P Radiation Therapy $30 O/P X-Ray $10"	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	10% coinsurance	"10% coinsurance, $20 Physical Therapy and O/P Psych copays"	"$20 Office and Hospital Outpatient, $20 Inpatient Hospital, $10 diabetes monitoring, $20 Urgent Care and $0 and 10% Immunizations"	"$30 O/P Surgery, PCP, specialist, Chiro and Podiatrist visits, $30 inpatient visits"	$25 copay per visit	$20 copay per visit	$20 copay per visit	$20 copay per visit	20% coinsurance	$20 copay per visit	N/A	N/A	"$30 copay, one exam per two years"	N/A	N/A	N/A	N/A	N/A											2500	2.408	0	0.0218	0	0.0369	0.5694	0	0.1061	0.5527	0.3971	0	0	0	0	2.8069	0	0	0	0	0	0.0682	0	0	0	0.1005	0	0	0	0	0											7.0676	0	2.858743899	12.0398	0	0.108978142	0	0.184572896	2.84692586	0	0.530343616	2.763361407	1.985605223	0	0	0	0	14.03455855	0	0	0	0	0	0.341049656	0	0	0	0.502606195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3378
H3813_802_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	Coin	P	P	V	Coin	P	V	V	V	V	P	P	Coin	V	T	P	V	P	V	P	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	YES	393.9523939		116.0088923	676.4088272	48.31491623	31.05118787		144.148349	30.13975721	17431.8625					11899.80459						1.859900374	0	0	0	219.275389					0.530933145											2500	$400 copay per admit	$400 copay per admit	"$0 for 1st 20 days, $50 21-100th"	$0 copay	$50 copay	10% coinsurance	Supplies 10% coins	$50 ER copay/$20 Urgent	$400 or 10% copay	$0 copay	X-Ray $10 copay	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	10% coinsurance	"10% coinsurance, $20 Physical Therapy and O/P Psych copays"	"$20 Office and Hospital Outpatient, $20 Inpatient Hospital, $10 diabetes monitoring, $20 Urgent Care and $0 and 10% Immunizations"	"$30 O/P Surgery, PCP, specialist, Chiro and Podiatrist visits, $30 inpatient visits"	$20 copay for Group Visits	$20 copay per visit	$20 copay per visit	$20 copay per visit	20% coinsurance	$20 copay per visit	N/A	$0 copay	"$30 copay, one exam per two years"	N/A	N/A	N/A	N/A	$0 copay											400	400	12.29508197	0	50	0.1	0.1	48.15384615	0.1	1.490844758	10	50	0.1	20	15.43626531	30	20	20	20	20	0.2	20	0	0	30	0	0	0	0	0											YES	293.391763	293.391763	9.018189436	0	36.67397037	0.073347941	0.073347941	35.31985454	0.073347941	1.09350393	7.334794075	36.67397037	0.073347941	14.66958815	11.32218273	22.00438222	14.66958815	14.66958815	14.66958815	14.66958815	0.146695881	14.66958815	0	0	22.00438222	0	0	0	0	0											2500	9.6319	0	0.087182514	0	0.147658317	2.277540688	0	0.424274893	2.210689126	1.588484178	0	0	0	0	11.22764684	0	0	0	0	0	0.272839725	0	0	0	0.402084956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.2703	0	11.4349756	9.6319	0	0.087182514	0	0.147658317	2.277540688	0	0.424274893	2.210689126	1.588484178	0	0	0	0	11.22764684	0	0	0	0	0	0.272839725	0	0	0	0.402084956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.2703	YES	$400 copay per admit	$400 copay per admit	"$0 for 1st 20 days, $50 21-100th"	$0 copay	$50 copay	10% coinsurance	"Supplies 10% coins, Equipment $10 copay"	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	$400 or 10% copay	$0 copay	"O/P Diag 10% to $100, O/P Radiation Therapy $30 O/P X-Ray $10"	"$50 ER copay, $20 Primary Care and $30 Specialist copay"	10% coinsurance	"10% coinsurance, $20 Physical Therapy and O/P Psych copays"	"$20 Office and Hospital Outpatient, $20 Inpatient Hospital, $10 diabetes monitoring, $20 Urgent Care and $0 and 10% Immunizations"	"$30 O/P Surgery, PCP, specialist, Chiro and Podiatrist visits, $30 inpatient visits"	$25 copay per visit	$20 copay per visit	$20 copay per visit	$20 copay per visit	20% coinsurance	$20 copay per visit	N/A	N/A	"$30 copay, one exam per two years"	N/A	N/A	N/A	N/A	N/A											2500	2.408	0	0.0218	0	0.0369	0.5694	0	0.1061	0.5527	0.3971	0	0	0	0	2.8069	0	0	0	0	0	0.0682	0	0	0	0.1005	0	0	0	0	0											7.0676	0	2.858743899	12.0398	0	0.108978142	0	0.184572896	2.84692586	0	0.530343616	2.763361407	1.985605223	0	0	0	0	14.03455855	0	0	0	0	0	0.341049656	0	0	0	0.502606195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3378
H3814_005_0	2010	4	N/A																															D	D	D		T	Coin	Coin	V	V		Coin			V	V	V	V	V	Coin	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	YES	967.4092557	39.60313983	688.0085152		126.8511558	12.82729626	9.660014862	231.3166602	130.0425757		20.79607646			8.72054942	4640.379501	4431.814125	96.3909692	856.8216665	42.62749058	105.92587	50.05996747				69.87201951	0				0											1750	$150/day (Days 1-8)	$150/day (Days 1-8)	$10/day (Days 1-100)		$100 Ambulance Waived	10% DME	10% Prosthetics/$0 Supplies	$50 ER Waived	$150 Copay OP Surg/ASC		$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$20 Copay OP MH/SA Visits/$20 Copay Partial Hospitalization/$20 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	$15 PCP / $20 Specialist	$15 PCP / $20 Specialist/$20 Copay Chiro/$20 Copay Podiatry	$20 Copay OP MH/SA Visits	$20 PT/ST/OT	$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/$0 Diagnostic 10% MRI/CT/PET/$0 Pap & Pelvic Exams/$0 Prostate Exams/$20 Copay Dental/$20 Copay Hearing/$20 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/10% Part B Rx				$20 Copay Mand Suppl Vision Exams	$200 Vision Hardware Coverage				No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											150	150	10		100	0.1	0.024674293	50	150		0.061370985			21.2	15	20	20	20	0.028711939	0.012474151	0.095158812				20	0				0											NO	137.870676	137.870676	9.191378399		91.91378399	0.091913784	0.022679076	45.956892	137.870676		0.056408395			19.48572221	13.7870676	18.3827568	18.3827568	18.3827568	0.02639023	0.011465464	0.087464065				20	0				0												11.1148	0.455009305	0.526978884	0	0.971614144	1.179005338	0.219080212	0.885882897	1.494088152	0	1.173073285	0	0	0.014160517	5.331435488	6.789080103	0.147660979	1.312562026	1.124949278	1.214489297	4.37844823	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4488	0	3.372326052	11.1148	0.455009305	0.526978884	0	0.971614144	1.179005338	0.219080212	0.885882897	1.494088152	0	1.173073285	0	0	0.014160517	5.331435488	6.789080103	0.147660979	1.312562026	1.124949278	1.214489297	4.37844823	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4488	NO																																																																																		0	0		11.1148	0.455009305	0.526978884	0	0.971614144	1.179005338	0.219080212	0.885882897	1.494088152	0	1.173073285	0	0	0.014160517	5.331435488	6.789080103	0.147660979	1.312562026	1.124949278	1.214489297	4.37844823	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4488
H3814_006_0	2010	6	N/A																															D	D	D		T	Coin	Coin	V	V		Coin			V	V	V	V	V	Coin	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	YES	967.4725115	73.35066872	849.1466354		137.4598084	16.91784761	14.6690309	291.6223612	144.0645797		24.14994916			9.451329163	5236.902093	4845.052716	159.6444019	1185.846921	41.8253946	115.0920867	58.97397856				69.87201951	0				0											1750	$150/day (Days 1-8)	$150/day (Days 1-8)	$10/day (Days 1-100)		$100 Ambulance Waived	10% DME	10% Prosthetics/$0 Supplies	$50 ER Waived	$150 Copay OP Surg/ASC		$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$20 Copay OP MH/SA Visits/$20 Copay Partial Hospitalization/$20 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	$15 PCP / $20 Specialist	$15 PCP / $20 Specialist/$20 Copay Chiro/$20 Copay Podiatry	$20 Copay OP MH/SA Visits	$20 PT/ST/OT	$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/$0 Diagnostic 10% MRI/CT/PET/$0 Pap & Pelvic Exams/$0 Prostate Exams/$20 Copay Dental/$20 Copay Hearing/$20 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/10% Part B Rx				$20 Copay Mand Suppl Vision Exams	$200 Vision Hardware Coverage				No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											150	150	10		100	0.1	0.024674293	50	150		0.061370985			21.2	15	20	20	20	0.028711939	0.012243538	0.095158812				20	0				0											NO	137.870676	137.870676	9.191378399		91.91378399	0.091913784	0.022679076	45.956892	137.870676		0.056408395			19.48572221	13.7870676	18.3827568	18.3827568	18.3827568	0.02639023	0.011253499	0.087464065				20	0				0												11.1155	0.84274219	0.650402337	0	1.052870928	1.55498339	0.332680068	1.116838113	1.655190082	0	1.36225986	0	0	0.015347165	6.016793597	7.422118813	0.244558685	1.816594628	1.103781781	1.295188721	5.158103872	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8724	0	3.761502646	11.1155	0.84274219	0.650402337	0	1.052870928	1.55498339	0.332680068	1.116838113	1.655190082	0	1.36225986	0	0	0.015347165	6.016793597	7.422118813	0.244558685	1.816594628	1.103781781	1.295188721	5.158103872	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8724	NO																																																																																		0	0		11.1155	0.84274219	0.650402337	0	1.052870928	1.55498339	0.332680068	1.116838113	1.655190082	0	1.36225986	0	0	0.015347165	6.016793597	7.422118813	0.244558685	1.816594628	1.103781781	1.295188721	5.158103872	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8724
H3814_007_0	2010	10	N/A																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	Coin	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	NO	334.6944753	18.06401109	48.58270956		34.73674485	36.10093732	22.43369755	26.88776802	18.5912452	33.02873356	24.45519158			30.81413305	28.60574189	32.56566554	3.560526061	4.095678051	25.051471	121.1234331	27.89209237			800		0				0												IP Medicare FFS (Ded 1-60 & per diem to 90)	IP Medicare FFS (Ded 1-60 & per diem to 90)	SNF Medicare FFS - perdiem 21+		Medicare	Medicare DME	Medicare Prosthetics/Medicare Supplies	Medicare	Medicare OP Surg/ASC	Medicare Diagnostic	Medicare Diagnostic/Medicare Bone Mass/Medicare Colorectal Screening/Medicare Mammograms			Medicare MH/SA/Medicare Partial Hospitalization/Medicare Cardiac Rehab/Medicare Other OP Facility/Medicare Urgent Care	Medicare	Medicare/Medicare Chiro/Medicare Podiatry	Medicare MH/SA	Medicare	Medicare Diagnostic/Medicare Bone Mass/Medicare Colorectal Screening/Medicare Mammograms	Medicare Hospice/Medicare Urgent Care/Medicare Diagnostic/Medicare Pap & Pelvic Exams/Medicare Prostate Exams/Medicare Dental/Medicare Hearing/Medicare Vision/Medicare Physical Exams	Medicare Immunizations/Part B Rx $0 MedImpact/Medicare Other In-Network			$20 Copay Mand Suppl Dental ($275 Max benefit)		$250 Vision Hardware Coverage				No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/Comprehensive Medical exam/No Coverage Accupuncture/No Fitness//											0.082225702	0.082225702	0.124309392		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.22125098	0.233	0.233	0.233	0.233	0.233	0.233	0.148746388			20		0				0											NO	0.082225702	0.082225702	0.124309392		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.22125098	0.233	0.233	0.233	0.233	0.233	0.233	0.148746388			20		0				0												27.5205	1.485325991	6.0392871	0	8.09366155	8.411518396	5.227051528	6.264849948	4.331760132	7.69569492	5.698059638	0	0	6.817657139	6.66513786	7.58780007	0.829602572	0.954292986	5.836992742	28.2217599	4.148847997	0	0	1.333333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1631	0	0	27.5205	1.485325991	6.0392871	0	8.09366155	8.411518396	5.227051528	6.264849948	4.331760132	7.69569492	5.698059638	0	0	6.817657139	6.66513786	7.58780007	0.829602572	0.954292986	5.836992742	28.2217599	4.148847997	0	0	1.333333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1631	NO																																																																																		0	0		27.5205	1.485325991	6.0392871	0	8.09366155	8.411518396	5.227051528	6.264849948	4.331760132	7.69569492	5.698059638	0	0	6.817657139	6.66513786	7.58780007	0.829602572	0.954292986	5.836992742	28.2217599	4.148847997	0	0	1.333333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.1631
H3814_011_0	2010	4	N/A																															D	D	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	Coin	Coin									V											0	0	0		0	0	0	0	0	0	0			0	0	0	0	0	0	0	0									0											0	YES	677.6791369	44.17964465	516.417401		87.05103154	10.02699339	8.517144679	177.6205866	92.42581246	23.13429635	15.20926874			6.101039083	3314.633434	3084.228789	93.45180848	709.9488352	26.8670496	72.85527675	36.87831895									0											3400	$215/ day (Days 1-10)	$215/ day (Days 1-10)	$25/day (Days 1-100)		$200 Ambulance Waived	25% DME	25% Prosthetics/20% Supplies	$50 ER Waived	$200 Copay OP Surg/ASC	20% Diagnostic	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$30 Copay OP MH/SA Visits/$30 Copay Partial Hospitalization/$30 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	OON $25 PCP / $30 Specialist	OON $25 PCP / $30 Specialist/$30 Copay Chiro/$30 Copay Podiatry	$30 Copay OP MH/SA Visits	$30 PT/ST/OT	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/20% Diagnostic/$0 Pap & Pelvic Exams/$0 Prostate Exams/$30 Copay Dental/$30 Copay Hearing/$30 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/20% Part B Rx									No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											215	215	25		200	0.25	0.212337146	50	200	0.2	0.2			30.8	25	30	30	30	0.163211391	0.107406383	0.190317623									0											NO	193.1551029	193.1551029	22.45989568		179.6791655	0.224598957	0.190762806	44.91979136	179.6791655	0.179679165	0.179679165			27.67059148	22.45989568	26.95187482	26.95187482	26.95187482	0.146628432	0.096493447	0.170980559									0												10.9081	0.711126984	0.966556746	0	1.303438058	2.252052256	1.62475442	0.664889974	1.383916071	4.156751062	2.732788714	0	0	0.01406828	6.203860096	6.927145686	0.209891787	1.594537678	3.939473367	7.030056752	6.305475579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9289	0	6.664568264	10.9081	0.711126984	0.966556746	0	1.303438058	2.252052256	1.62475442	0.664889974	1.383916071	4.156751062	2.732788714	0	0	0.01406828	6.203860096	6.927145686	0.209891787	1.594537678	3.939473367	7.030056752	6.305475579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9289	NO																																																																																		0	0		10.9081	0.711126984	0.966556746	0	1.303438058	2.252052256	1.62475442	0.664889974	1.383916071	4.156751062	2.732788714	0	0	0.01406828	6.203860096	6.927145686	0.209891787	1.594537678	3.939473367	7.030056752	6.305475579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9289
H3814_012_0	2010	6	N/A																															D	D	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	Coin	Coin									V											0	0	0		0	0	0	0	0	0	0			0	0	0	0	0	0	0	0									0											0	YES	661.022991	37.10899704	445.1967917		80.79554001	9.93726921	7.897052935	161.2398368	105.7643074	25.72111669	16.30870134			6.529867642	3458.997468	3223.749605	90.76545917	699.3941531	27.34723424	76.6874751	38.30070677									0											3400	$215/ day (Days 1-10)	$215/ day (Days 1-10)	$25/day (Days 1-100)		$200 Ambulance Waived	25% DME	25% Prosthetics/20% Supplies	$50 ER Waived	$200 Copay OP Surg/ASC	20% Diagnostic	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$30 Copay OP MH/SA Visits/$30 Copay Partial Hospitalization/$30 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	OON $25 PCP / $30 Specialist	OON $25 PCP / $30 Specialist/$30 Copay Chiro/$30 Copay Podiatry	$30 Copay OP MH/SA Visits	$30 PT/ST/OT	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/20% Diagnostic/$0 Pap & Pelvic Exams/$0 Prostate Exams/$30 Copay Dental/$30 Copay Hearing/$30 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/20% Part B Rx									No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											215	215	25		200	0.25	0.212337146	50	200	0.2	0.2			30.8	25	30	30	30	0.163211391	0.107497094	0.190317623									0											NO	193.1551029	193.1551029	22.45989568		179.6791655	0.224598957	0.190762806	44.91979136	179.6791655	0.179679165	0.179679165			27.67059148	22.45989568	26.95187482	26.95187482	26.95187482	0.146628432	0.096574941	0.170980559									0												10.64	0.597316012	0.833256125	0	1.209772933	2.231900298	1.506463979	0.603571653	1.583636873	4.621548782	2.930333847	0	0	0.015057108	6.47406019	7.240507984	0.203858274	1.570831972	4.009882088	7.406088392	6.548676241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2268	0	6.811351872	10.64	0.597316012	0.833256125	0	1.209772933	2.231900298	1.506463979	0.603571653	1.583636873	4.621548782	2.930333847	0	0	0.015057108	6.47406019	7.240507984	0.203858274	1.570831972	4.009882088	7.406088392	6.548676241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2268	NO																																																																																		0	0		10.64	0.597316012	0.833256125	0	1.209772933	2.231900298	1.506463979	0.603571653	1.583636873	4.621548782	2.930333847	0	0	0.015057108	6.47406019	7.240507984	0.203858274	1.570831972	4.009882088	7.406088392	6.548676241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2268
H3814_015_0	2010	7	N/A																															D	D	D		T	Coin	Coin	V	V		Coin			V	V	V	V	V	Coin	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	YES	884.2967127	57.64957545	760.0005726		128.1111629	15.06077224	12.53450178	261.4004626	137.409085		22.38315929			8.978770249	4927.599571	4585.075472	138.9273054	1055.423969	39.94108692	108.3080943	54.27304244				68.12521902	0				0											2000	$150/day (Days 1-7)	$150/day (Days 1-7)	$50/day (Days 1-100)		$50 Ambulance Waived	10% DME	10% Prosthetics/$0 Supplies	$50 ER Waived	$100 Copay OP Surg/ASC		$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$20 Copay OP MH/SA Visits/$20 Copay Partial Hospitalization/$20 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	$15 PCP / $20 Specialist	$15 PCP / $20 Specialist/$20 Copay Chiro/$20 Copay Podiatry	$20 Copay OP MH/SA Visits	$20 PT/ST/OT	$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/$0 Diagnostic 10% MRI/CT/PET/$0 Pap & Pelvic Exams/$0 Prostate Exams/$20 Copay Dental/$20 Copay Hearing/$20 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/10% Part B Rx				$20 Copay Mand Suppl Vision Exams	$200 Vision Hardware Coverage				No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											150	150	50		50	0.1	0.024674293	50	100		0.061370985			21.2	15	20	20	20	0.028711939	0.012445663	0.095158812				20	0				0											YES	133.9951002	133.9951002	44.66503338		44.66503338	0.089330067	0.022041562	44.66503338	89.33006677		0.054822742			18.93797415	13.39951002	17.86601335	17.86601335	17.86601335	0.025648395	0.011117719	0.08500543				20	0				0											3500	9.8743	0.643730053	2.828787579	0	0.476840781	1.34537979	0.27628	0.972955032	1.022896895	0	1.227106163	0	0	0.014169977	5.502284983	6.826418301	0.206839758	1.571351561	1.024424759	1.204138928	4.613503311	0	0	0	0.113542032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7449	0	4.733728934	9.8743	0.643730053	2.828787579	0	0.476840781	1.34537979	0.27628	0.972955032	1.022896895	0	1.227106163	0	0	0.014169977	5.502284983	6.826418301	0.206839758	1.571351561	1.024424759	1.204138928	4.613503311	0	0	0	0.113542032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7449	NO	OON $300/day (Days 1-7)	OON $300/day (Days 1-7)	$50/day (Days 1-100)	$0 Copay HHC	OON $50 Ambulance	OON 35% DME	OON 35% Prosthetics/OON $0 Supplies	OON $50 ER Waived	OON $200 Copay OP Surg/ASC	$0 Diagnostic 15% MRI/CT/PET	$0 Diagnostic 15% MRI/CT/PET/OON $0 Bone Mass/OON $0 Colorectal Screening/OON $0 Mammograms			OON $30 Copay OP MH/SA Visits/OON $30 Copay Partial Hospitalization/$50 Copay Urgent Care	OON $25 PCP / $30 Specialist	OON $25 PCP / $30 Specialist/OON $30 Copay Chiro/OON $30 Copay Podiatry	OON $30 Copay OP MH/SA Visits	OON $30 PT/ST/OT	$0 Diagnostic 15% MRI/CT/PET/OON $0 Bone Mass/OON $0 Colorectal Screening/OON $0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/$0 Diagnostic 15% MRI/CT/PET/OON $0 Pap & Pelvic Exams/OON $0 Prostate Exams/OON $30 Copay Dental/OON $30 Copay Hearing/OON $30 Copay Vision/$0 Copay Physical Exams	OON $0 Immunizations/OON 10% Part B Rx		No Transportation	No Coverage Mand Suppl Dental	OON $30 Copay Mand Suppl Vision Exams	$200 Vision Hardware Coverage	$30 Copay Mand Suppl Hearing Exams	$300 Hearing Aids Coverage	No Health & Wellness Ed	$30 Copay Mand Suppl Chiro/$30 Copay Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//												0.4504	0.0294	0.0774	0	0.0237	0.1289	0.0265	0.0266	0.056	0	0.0504	0	0	0.2847	0.251	0.2802	0.0085	0.0645	0.0382	0.0494	0.1259	0	0	0	0.0044	0	0	0	0	0.001											1.9768	0	0.096653593	10.3246	0.673090256	2.906199323	0	0.500506278	1.474240185	0.302742082	0.999580625	1.078881468	0	1.277477087	0	0	0.298830684	5.753241424	7.106632845	0.215330229	1.635853257	1.062653074	1.25356708	4.73935916	0	0	0	0.117909033	0	0	0	0	0.001030714	0	0	0	0	0	0	0	0	0	0	41.7218
H3814_018_0	2010	5	N/A																															D	D	D		T	Coin	Coin	V	V		Coin			V	V	V	V	V	Coin	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	YES	853.9730969	55.672701	700.3430088		118.0548549	13.87855079	11.55058431	240.8813797	125.9834107		20.62615436			8.273966097	4540.799091	4225.162017	128.0219655	972.5766333	36.80584199	99.80626246	50.01278579				69.87201951	0				0											1750	$150/day (Days 1-8)	$150/day (Days 1-8)	$10/day (Days 1-100)		$100 Ambulance Waived	10% DME	10% Prosthetics/$0 Supplies	$50 ER Waived	$150 Copay OP Surg/ASC		$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$20 Copay OP MH/SA Visits/$20 Copay Partial Hospitalization/$20 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	$15 PCP / $20 Specialist	$15 PCP / $20 Specialist/$20 Copay Chiro/$20 Copay Podiatry	$20 Copay OP MH/SA Visits	$20 PT/ST/OT	$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/$0 Diagnostic 10% MRI/CT/PET/$0 Pap & Pelvic Exams/$0 Prostate Exams/$20 Copay Dental/$20 Copay Hearing/$20 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/10% Part B Rx				$20 Copay Mand Suppl Vision Exams	$200 Vision Hardware Coverage				No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											150	150	10		100	0.1	0.024674293	50	150		0.061370985			21.2	15	20	20	20	0.028711939	0.012445663	0.095158812				20	0				0											NO	137.870676	137.870676	9.191378399		91.91378399	0.091913784	0.022679076	45.956892	137.870676		0.056408395			19.48572221	13.7870676	18.3827568	18.3827568	18.3827568	0.02639023	0.011439279	0.087464065				20	0				0												9.8115	0.639636077	0.536426467	0	0.904239036	1.275630119	0.261956581	0.922513296	1.4474515	0	1.163488253	0	0	0.01343535	5.217025335	6.472510482	0.196116388	1.489886643	0.971314633	1.141711728	4.374321528	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9556	0	3.240964714	9.8115	0.639636077	0.536426467	0	0.904239036	1.275630119	0.261956581	0.922513296	1.4474515	0	1.163488253	0	0	0.01343535	5.217025335	6.472510482	0.196116388	1.489886643	0.971314633	1.141711728	4.374321528	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9556	NO																																																																																		0	0		9.8115	0.639636077	0.536426467	0	0.904239036	1.275630119	0.261956581	0.922513296	1.4474515	0	1.163488253	0	0	0.01343535	5.217025335	6.472510482	0.196116388	1.489886643	0.971314633	1.141711728	4.374321528	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9556
H3814_019_0	2010	6	N/A																															D	D	D		T	Coin	Coin	V	V		Coin			V	V	V	V	V	Coin	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	YES	983.020526	64.08563457	806.1747558		135.8946154	15.97579636	13.29604118	277.2819676	145.0212883		23.7430584			9.524279552	5226.978142	4863.643835	147.3678975	1119.546736	42.36772596	114.8884022	57.57042601				69.87201951	0				0											1750	$150/day (Days 1-8)	$150/day (Days 1-8)	$10/day (Days 1-100)		$100 Ambulance Waived	10% DME	10% Prosthetics/$0 Supplies	$50 ER Waived	$150 Copay OP Surg/ASC		$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$20 Copay OP MH/SA Visits/$20 Copay Partial Hospitalization/$20 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	$15 PCP / $20 Specialist	$15 PCP / $20 Specialist/$20 Copay Chiro/$20 Copay Podiatry	$20 Copay OP MH/SA Visits	$20 PT/ST/OT	$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/$0 Diagnostic 10% MRI/CT/PET/$0 Pap & Pelvic Exams/$0 Prostate Exams/$20 Copay Dental/$20 Copay Hearing/$20 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/10% Part B Rx				$20 Copay Mand Suppl Vision Exams	$200 Vision Hardware Coverage				No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											150	150	10		100	0.1	0.024674293	50	150		0.061370985			21.2	15	20	20	20	0.028711939	0.012445663	0.095158812				20	0				0											NO	137.870676	137.870676	9.191378399		91.91378399	0.091913784	0.022679076	45.956892	137.870676		0.056408395			19.48572221	13.7870676	18.3827568	18.3827568	18.3827568	0.02639023	0.011439279	0.087464065				20	0				0												11.2941	0.736294147	0.617488103	0	1.04088236	1.468395896	0.30154193	1.06191812	1.66618192	0	1.339307806	0	0	0.015465622	6.005391748	7.45059848	0.225752352	1.715029615	1.118094031	1.314240539	5.035343461	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5225	0	3.730720382	11.2941	0.736294147	0.617488103	0	1.04088236	1.468395896	0.30154193	1.06191812	1.66618192	0	1.339307806	0	0	0.015465622	6.005391748	7.45059848	0.225752352	1.715029615	1.118094031	1.314240539	5.035343461	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5225	NO																																																																																		0	0		11.2941	0.736294147	0.617488103	0	1.04088236	1.468395896	0.30154193	1.06191812	1.66618192	0	1.339307806	0	0	0.015465622	6.005391748	7.45059848	0.225752352	1.715029615	1.118094031	1.314240539	5.035343461	0	0	0	0.116453366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5225
H3814_021_0	2010	7	N/A																															D	D	D		T	Coin	Coin	V	V		Coin			V	V	V	V	V	Coin	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	YES	914.5720008	59.62329929	786.0203869		132.49725	15.57640145	12.96364015	270.3499184	142.113501		23.14948194			9.286172563	5096.303688	4742.052739	143.6837001	1091.558068	41.30853282	112.0161921	56.13116536				68.12521902	0				0											2000	$150/day (Days 1-7)	$150/day (Days 1-7)	$50/day (Days 1-100)		$50 Ambulance Waived	10% DME	10% Prosthetics/$0 Supplies	$50 ER Waived	$100 Copay OP Surg/ASC		$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$20 Copay OP MH/SA Visits/$20 Copay Partial Hospitalization/$20 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	$15 PCP / $20 Specialist	$15 PCP / $20 Specialist/$20 Copay Chiro/$20 Copay Podiatry	$20 Copay OP MH/SA Visits	$20 PT/ST/OT	$0 Diagnostic 10% MRI/CT/PET/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/$0 Diagnostic 10% MRI/CT/PET/$0 Pap & Pelvic Exams/$0 Prostate Exams/$20 Copay Dental/$20 Copay Hearing/$20 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/10% Part B Rx				$20 Copay Mand Suppl Vision Exams	$200 Vision Hardware Coverage				No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											150	150	50		50	0.1	0.024674293	50	100		0.061370985			21.2	15	20	20	20	0.028711939	0.012445663	0.095158812				20	0				0											YES	133.9951002	133.9951002	44.66503338		44.66503338	0.089330067	0.022041562	44.66503338	89.33006677		0.054822742			18.93797415	13.39951002	17.86601335	17.86601335	17.86601335	0.025648395	0.011117719	0.08500543				20	0				0											3500	10.2123	0.665769163	2.925635568	0	0.493166175	1.391440982	0.28573888	1.006265678	1.057917378	0	1.269118072	0	0	0.014655108	5.690664359	7.060131463	0.213921242	1.625149252	1.059497551	1.245364517	4.771453849	0	0	0	0.113542032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1018	0	4.895795585	10.2123	0.665769163	2.925635568	0	0.493166175	1.391440982	0.28573888	1.006265678	1.057917378	0	1.269118072	0	0	0.014655108	5.690664359	7.060131463	0.213921242	1.625149252	1.059497551	1.245364517	4.771453849	0	0	0	0.113542032	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1018	NO	OON $300/day (Days 1-7)	OON $300/day (Days 1-7)	$50/day (Days 1-100)	$0 Copay HHC	OON $50 Ambulance	OON 35% DME	OON 35% Prosthetics/OON $0 Supplies	OON $50 ER Waived	OON $200 Copay OP Surg/ASC	$0 Diagnostic 15% MRI/CT/PET	$0 Diagnostic 15% MRI/CT/PET/OON $0 Bone Mass/OON $0 Colorectal Screening/OON $0 Mammograms			OON $30 Copay OP MH/SA Visits/OON $30 Copay Partial Hospitalization/$50 Copay Urgent Care	OON $25 PCP / $30 Specialist	OON $25 PCP / $30 Specialist/OON $30 Copay Chiro/OON $30 Copay Podiatry	OON $30 Copay OP MH/SA Visits	OON $30 PT/ST/OT	$0 Diagnostic 15% MRI/CT/PET/OON $0 Bone Mass/OON $0 Colorectal Screening/OON $0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/$0 Diagnostic 15% MRI/CT/PET/OON $0 Pap & Pelvic Exams/OON $0 Prostate Exams/OON $30 Copay Dental/OON $30 Copay Hearing/OON $30 Copay Vision/$0 Copay Physical Exams	OON $0 Immunizations/OON 10% Part B Rx		No Transportation	No Coverage Mand Suppl Dental	OON $30 Copay Mand Suppl Vision Exams	$200 Vision Hardware Coverage	$30 Copay Mand Suppl Hearing Exams	$300 Hearing Aids Coverage	No Health & Wellness Ed	$30 Copay Mand Suppl Chiro/$30 Copay Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//												0.4658	0.0304	0.0801	0	0.0245	0.1333	0.0274	0.0275	0.0579	0	0.0521	0	0	0.2944	0.2595	0.2898	0.0088	0.0667	0.0431	0.0511	0.1305	0	0	0	0.0044	0	0	0	0	0.001											2.0482	0	0.100143739	10.6781	0.696134559	3.005697625	0	0.517641897	1.524713116	0.313106933	1.033802839	1.115818671	0	1.321213523	0	0	0.309061622	5.950212688	7.349939592	0.222702398	1.691859265	1.102557782	1.29648492	4.901983418	0	0	0	0.117909033	0	0	0	0	0.001030714	0	0	0	0	0	0	0	0	0	0	43.15
H3814_023_0	2010	5	N/A																															D	D	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	Coin	Coin									V											0	0	0		0	0	0	0	0	0	0			0	0	0	0	0	0	0	0									0											0	YES	608.4555201	39.66677916	463.6663595		78.15893656	9.002755356	7.647134777	159.4769863	82.98469398	20.7711726	13.65567127			5.477829708	2976.050022	2769.180767	83.90588648	637.428931	24.1226323	65.41325074	33.1112698									0											3400	$215/ day (Days 1-10)	$215/ day (Days 1-10)	$25/day (Days 1-100)		$200 Ambulance Waived	25% DME	25% Prosthetics/20% Supplies	$50 ER Waived	$200 Copay OP Surg/ASC	20% Diagnostic	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$30 Copay OP MH/SA Visits/$30 Copay Partial Hospitalization/$30 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	OON $25 PCP / $30 Specialist	OON $25 PCP / $30 Specialist/$30 Copay Chiro/$30 Copay Podiatry	$30 Copay OP MH/SA Visits	$30 PT/ST/OT	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/20% Diagnostic/$0 Pap & Pelvic Exams/$0 Prostate Exams/$30 Copay Dental/$30 Copay Hearing/$30 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/20% Part B Rx									No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											215	215	25		200	0.25	0.212337146	50	200	0.2	0.2			30.8	25	30	30	30	0.163211391	0.107406383	0.190317623									0											NO	193.1551029	193.1551029	22.45989568		179.6791655	0.224598957	0.190762806	44.91979136	179.6791655	0.179679165	0.179679165			27.67059148	22.45989568	26.95187482	26.95187482	26.95187482	0.146628432	0.096493447	0.170980559									0												9.7939	0.638486734	0.867824839	0	1.170294374	2.022009461	1.45878889	0.596972746	1.242551713	3.732146958	2.453639618	0	0	0.012631232	5.570147752	6.219551115	0.188451746	1.431658729	3.537063761	6.311950014	5.66138341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9094	0	5.98379547	9.7939	0.638486734	0.867824839	0	1.170294374	2.022009461	1.45878889	0.596972746	1.242551713	3.732146958	2.453639618	0	0	0.012631232	5.570147752	6.219551115	0.188451746	1.431658729	3.537063761	6.311950014	5.66138341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9094	NO																																																																																		0	0		9.7939	0.638486734	0.867824839	0	1.170294374	2.022009461	1.45878889	0.596972746	1.242551713	3.732146958	2.453639618	0	0	0.012631232	5.570147752	6.219551115	0.188451746	1.431658729	3.537063761	6.311950014	5.66138341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9094
H3814_024_0	2010	6	N/A																															D	D	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	Coin	Coin									V											0	0	0		0	0	0	0	0	0	0			0	0	0	0	0	0	0	0									0											0	YES	757.464476	49.38105596	577.2168785		97.29982878	11.20750349	9.519895449	198.5324282	103.3073999	25.85797129	16.99990474			6.819333989	3704.875863	3447.34494	104.4541897	793.5333894	30.03019355	81.43276223	41.22012177									0											3400	$215/ day (Days 1-10)	$215/ day (Days 1-10)	$25/day (Days 1-100)		$200 Ambulance Waived	25% DME	25% Prosthetics/20% Supplies	$50 ER Waived	$200 Copay OP Surg/ASC	20% Diagnostic	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$30 Copay OP MH/SA Visits/$30 Copay Partial Hospitalization/$30 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	OON $25 PCP / $30 Specialist	OON $25 PCP / $30 Specialist/$30 Copay Chiro/$30 Copay Podiatry	$30 Copay OP MH/SA Visits	$30 PT/ST/OT	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/20% Diagnostic/$0 Pap & Pelvic Exams/$0 Prostate Exams/$30 Copay Dental/$30 Copay Hearing/$30 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/20% Part B Rx									No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											215	215	25		200	0.25	0.212337146	50	200	0.2	0.2			30.8	25	30	30	30	0.163211391	0.107406383	0.190317623									0											NO	193.1551029	193.1551029	22.45989568		179.6791655	0.224598957	0.190762806	44.91979136	179.6791655	0.179679165	0.179679165			27.67059148	22.45989568	26.95187482	26.95187482	26.95187482	0.146628432	0.096493447	0.170980559									0												12.1923	0.794850245	1.080352573	0	1.456896003	2.517193593	1.816041971	0.743169604	1.54684895	4.646138702	3.054528697	0	0	0.015724584	6.934260449	7.742700773	0.23460302	1.782267715	4.403280206	7.857727889	7.047839449	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8668	0	7.449209269	12.1923	0.794850245	1.080352573	0	1.456896003	2.517193593	1.816041971	0.743169604	1.54684895	4.646138702	3.054528697	0	0	0.015724584	6.934260449	7.742700773	0.23460302	1.782267715	4.403280206	7.857727889	7.047839449	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8668	NO																																																																																		0	0		12.1923	0.794850245	1.080352573	0	1.456896003	2.517193593	1.816041971	0.743169604	1.54684895	4.646138702	3.054528697	0	0	0.015724584	6.934260449	7.742700773	0.23460302	1.782267715	4.403280206	7.857727889	7.047839449	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.8668
H3814_025_0	2010	13	N/A																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin	Coin	Coin	Coin	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	NO	337.1380257	18.19589352	48.93740409		34.99035222	36.36450444	22.59748235	27.08407128	18.72697689	33.26987102	24.63373499			31.03910206	28.8145878	32.80342221	3.586520887	4.125579936	25.23436775	122.0077357	28.09572804				0	0				0												IP Medicare FFS (Ded 1-60 & per diem to 90)	IP Medicare FFS (Ded 1-60 & per diem to 90)	SNF Medicare FFS - perdiem 21+		Medicare	Medicare DME	Medicare Prosthetics/Medicare Supplies	Medicare	Medicare OP Surg/ASC	Medicare Diagnostic	Medicare Diagnostic/Medicare Bone Mass/Medicare Colorectal Screening/Medicare Mammograms			Medicare MH/SA/Medicare Partial Hospitalization/Medicare Cardiac Rehab/Medicare Other OP Facility/Medicare Urgent Care	Medicare	Medicare/Medicare Chiro/Medicare Podiatry	Medicare MH/SA	Medicare	Medicare Diagnostic/Medicare Bone Mass/Medicare Colorectal Screening/Medicare Mammograms	Medicare Hospice/Medicare Urgent Care/Medicare Diagnostic/Medicare Pap & Pelvic Exams/Medicare Prostate Exams/Medicare Dental/Medicare Hearing/Medicare Vision/Medicare Physical Exams	Medicare Immunizations/Part B Rx $0 MedImpact/Medicare Other In-Network				$0 Copay Mand Suppl Vision Exams	$280 Vision Hardware Coverage				No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/No Coverage for Suppl Phys Exams/No Coverage Accupuncture/No Fitness//											0.084434717	0.084434717	0.132068164		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.22125098	0.233	0.233	0.233	0.233	0.233	0.233	0.148746388				0	0				0											NO	0.084434717	0.084434717	0.132068164		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.22125098	0.233	0.233	0.233	0.233	0.233	0.233	0.148746388				0	0				0												28.4662	1.536365115	6.463073119	0	8.152752067	8.472929534	5.265213388	6.310588607	4.363385614	7.751879947	5.739660252	0	0	6.867431754	6.713798956	7.643197374	0.835659367	0.961260125	5.879607685	28.42780242	4.179138067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.0299	0	0	28.4662	1.536365115	6.463073119	0	8.152752067	8.472929534	5.265213388	6.310588607	4.363385614	7.751879947	5.739660252	0	0	6.867431754	6.713798956	7.643197374	0.835659367	0.961260125	5.879607685	28.42780242	4.179138067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.0299	NO																																																																																		0	0		28.4662	1.536365115	6.463073119	0	8.152752067	8.472929534	5.265213388	6.310588607	4.363385614	7.751879947	5.739660252	0	0	6.867431754	6.713798956	7.643197374	0.835659367	0.961260125	5.879607685	28.42780242	4.179138067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.0299
H3814_026_0	2010	7	N/A																															D	D	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	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	YES	987.7657414	64.39498736	752.7152441		126.8830956	14.61505899	12.41434666	258.8946905	134.7172226	33.71988917	22.16859542			8.892700195	4831.314958	4495.483734	136.2126851	1034.801131	39.16064362	106.1917691	53.7527837				68.12521902	0				0											3400	$215/ day (Days 1-10)	$215/ day (Days 1-10)	$25/day (Days 1-100)		$200 Ambulance Waived	25% DME	25% Prosthetics/20% Supplies	$50 ER Waived	$200 Copay OP Surg/ASC	20% Diagnostic	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$30 Copay OP MH/SA Visits/$30 Copay Partial Hospitalization/$30 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	OON $25 PCP / $30 Specialist	OON $25 PCP / $30 Specialist/$30 Copay Chiro/$30 Copay Podiatry	$30 Copay OP MH/SA Visits	$30 PT/ST/OT	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/20% Diagnostic/$0 Pap & Pelvic Exams/$0 Prostate Exams/$30 Copay Dental/$30 Copay Hearing/$30 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/20% Part B Rx				$30 Copay Mand Suppl Vision Exams	$100 Vision Hardware Coverage				No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											215	215	25		200	0.25	0.212337146	50	200	0.2	0.2			30.8	25	30	30	30	0.163211391	0.107406383	0.190317623				30	0				0											YES	193.1551029	193.1551029	22.45989568		179.6791655	0.224598957	0.190762806	44.91979136	179.6791655	0.179679165	0.179679165			27.67059148	22.45989568	26.95187482	26.95187482	26.95187482	0.146628432	0.096493447	0.170980559				30	0				0											5000	15.8993	1.036518367	1.408825488	0	1.89985406	3.282527003	2.368195606	0.969124624	2.017156511	6.058761545	3.983234724	0	0	0.020505523	9.042569164	10.09680957	0.30593227	2.324152546	5.742063787	10.2468098	9.190680988	0	0	0	0.170313048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0634	0	9.714084223	15.8993	1.036518367	1.408825488	0	1.89985406	3.282527003	2.368195606	0.969124624	2.017156511	6.058761545	3.983234724	0	0	0.020505523	9.042569164	10.09680957	0.30593227	2.324152546	5.742063787	10.2468098	9.190680988	0	0	0	0.170313048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0634	NO	OON $300/day (Days 1-7)	OON $300/day (Days 1-7)	$50/day (Days 1-100)	$0 Copay HHC	$200 Ambulance Waived	OON 35% DME	OON 35% Prosthetics/20% Supplies	$100 ER Waived	OON $400 Copay OP Surg/ASC	20% Diagnostic	20% Diagnostic/20% Bone Mass/20% Colorectal Screening/20% Mammograms			OON $40 Copay OP MH/SA Visits/OON $40 Copay Partial Hospitalization/OON $35 Copay Urgent Care	OON $30 PCP / $40 Specialist	OON $30 PCP / $40 Specialist/OON $40 Copay Chiro/OON $40 Copay Podiatry	OON $40 Copay OP MH/SA Visits	OON $40 PT/ST/OT	20% Diagnostic/20% Bone Mass/20% Colorectal Screening/20% Mammograms	Medicare Hospice/OON $35 Copay Urgent Care/20% Diagnostic/20% Pap & Pelvic Exams/20% Prostate Exams/OON $40 Copay Dental/OON $40 Copay Hearing/OON $40 Copay Vision/$0 Copay Physical Exams	20% Immunizations/OON 20% Part B Rx		No Transportation	No Coverage Mand Suppl Dental	OON $40 Copay Mand Suppl Vision Exams	$200 Vision Hardware Coverage	No Coverage Mand Suppl Hearing Exams	No Coverage Hearing Aids	No Health & Wellness Ed	$40 Copay Mand Suppl Chiro/$40 Copay Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//												0.4363	0.0284	0.0744	0	0.0502	0.1213	0.0698	0.0512	0.1065	0.1576	0.1036	0	0	0.5467	0.2779	0.3447	0.0108	0.0818	0.1638	0.272	0.2539	0	0	0	0.0058	0	0	0	0	0.0013											3.1579	0	0.256065664	16.3356	1.064959183	1.483212053	0	1.950010598	3.403850144	2.43798159	1.020294802	2.123663203	6.216314806	4.086815566	0	0	0.567182638	9.320445859	10.44155772	0.316701169	2.405963352	5.90587133	10.51880079	9.444621514	0	0	0	0.176135716	0	0	0	0	0.001334058	0	0	0	0	0	0	0	0	0	0	89.2213
H3814_027_0	2010	7	N/A																															D	D	D		T	Coin	Coin	V	V	Coin	Coin			V	V	V	V	V	Coin	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	YES	1031.471086	67.24425109	786.0203869		132.49725	15.26172668	12.96364015	270.3499184	140.6780111	35.21188197	23.14948194			9.286172563	5045.084556	4694.393917	142.2396428	1080.587635	40.89337168	110.8904013	56.13116536				68.12521902	0				0											3400	$215/ day (Days 1-10)	$215/ day (Days 1-10)	$25/day (Days 1-100)		$200 Ambulance Waived	25% DME	25% Prosthetics/20% Supplies	$50 ER Waived	$200 Copay OP Surg/ASC	20% Diagnostic	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$30 Copay OP MH/SA Visits/$30 Copay Partial Hospitalization/$30 Copay Cardiac Rehab/$0 Copay Other OP Facility/$50 Copay Urgent Care	OON $25 PCP / $30 Specialist	OON $25 PCP / $30 Specialist/$30 Copay Chiro/$30 Copay Podiatry	$30 Copay OP MH/SA Visits	$30 PT/ST/OT	20% Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	Medicare Hospice/$50 Copay Urgent Care/20% Diagnostic/$0 Pap & Pelvic Exams/$0 Prostate Exams/$30 Copay Dental/$30 Copay Hearing/$30 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/20% Part B Rx				$30 Copay Mand Suppl Vision Exams	$100 Vision Hardware Coverage				No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											215	215	25		200	0.25	0.212337146	50	200	0.2	0.2			30.8	25	30	30	30	0.163211391	0.107406383	0.190317623				30	0				0											YES	193.1551029	193.1551029	22.45989568		179.6791655	0.224598957	0.190762806	44.91979136	179.6791655	0.179679165	0.179679165			27.67059148	22.45989568	26.95187482	26.95187482	26.95187482	0.146628432	0.096493447	0.170980559				30	0				0											5000	16.6028	1.082380853	1.471161324	0	1.983916275	3.427767891	2.472980375	1.012005161	2.106408969	6.326841566	4.159479596	0	0	0.021412824	9.442672735	10.54355977	0.319468754	2.426988556	5.996130986	10.70019701	9.597338014	0	0	0	0.170313048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.8638	0	10.1439001	16.6028	1.082380853	1.471161324	0	1.983916275	3.427767891	2.472980375	1.012005161	2.106408969	6.326841566	4.159479596	0	0	0.021412824	9.442672735	10.54355977	0.319468754	2.426988556	5.996130986	10.70019701	9.597338014	0	0	0	0.170313048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.8638	NO	OON $300/day (Days 1-7)	OON $300/day (Days 1-7)	$50/day (Days 1-100)	$0 Copay HHC	$200 Ambulance Waived	OON 35% DME	OON 35% Prosthetics/20% Supplies	$100 ER Waived	OON $400 Copay OP Surg/ASC	20% Diagnostic	20% Diagnostic/20% Bone Mass/20% Colorectal Screening/20% Mammograms			OON $40 Copay OP MH/SA Visits/OON $40 Copay Partial Hospitalization/OON $35 Copay Urgent Care	OON $30 PCP / $40 Specialist	OON $30 PCP / $40 Specialist/OON $40 Copay Chiro/OON $40 Copay Podiatry	OON $40 Copay OP MH/SA Visits	OON $40 PT/ST/OT	20% Diagnostic/20% Bone Mass/20% Colorectal Screening/20% Mammograms	Medicare Hospice/OON $35 Copay Urgent Care/20% Diagnostic/20% Pap & Pelvic Exams/20% Prostate Exams/OON $40 Copay Dental/OON $40 Copay Hearing/OON $40 Copay Vision/$0 Copay Physical Exams	20% Immunizations/OON 20% Part B Rx		No Transportation	No Coverage Mand Suppl Dental	OON $40 Copay Mand Suppl Vision Exams	$200 Vision Hardware Coverage	No Coverage Mand Suppl Hearing Exams	No Coverage Hearing Aids	No Health & Wellness Ed	$40 Copay Mand Suppl Chiro/$40 Copay Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//												0.4556	0.0297	0.0777	0	0.0524	0.1267	0.0729	0.0534	0.1112	0.1645	0.1082	0	0	0.5709	0.2902	0.36	0.0112	0.0854	0.1863	0.2949	0.2659	0	0	0	0.0058	0	0	0	0	0.0013											3.3242	0	0.269549294	17.0584	1.11208008	1.548839246	0	2.036292072	3.554459177	2.545854156	1.065439449	2.217628228	6.491366034	4.267643544	0	0	0.592278581	9.732844548	10.90356187	0.330714141	2.512419218	6.182429035	10.9951342	9.863236225	0	0	0	0.176135716	0	0	0	0	0.001334058	0	0	0	0	0	0	0	0	0	0	93.1881
H3815_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	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	NO	0	7.055838617	57.08992959	0	185.1547965	3.268730772	0.496595637	234.1981323	120.7719151	0	0	0	1.096329015	0	66.30245691	0	636.195482	0	0	0	8.867393421	0	0	173.2004994	0	0	0	0	0	6.228891059												$0 copay	1B - $200 per admit	2 - $75 copay days 15-100	$0 copay	10A - $55 copay	11A - 20% coinsurance on items >$150	11B - 20% coinsurance on items >$150	4A - $50 copay	"9A - $50 copay, 9B -$25 outpatient"	$0 copay	$0 copay	$0 copay	12 - $25 copay	$0 copay	4B- $25 copay	$0 copay	7E & 7H & 9C- $30 copay	$0 copay	$0 copay	$0 copay	15 - 20% coinsurance	$0 copay	$0 copay	16A - $20 copay	$0 copay	17B - $150 max	$0 copay	18B - $500 max	$0 copay	4A - $50 worldwide emerg.											0	200	75	0	55	0.2	0.2	50	37.5	0	0	0	25	0	25	0	30	0	0	0	0.2	0	0	20	0	0	0	0	0	50											NO	0	200	75	0	55	0.2	0.2	50	37.5	0	0	0	25	0	25	0	30	0	0	0	0.2	0	0	20	0	0	0	0	0	50												0	0.11759731	0.35681206	0	0.848626151	0.653746154	0.099319127	0.975825551	0.377412235	0	0	0	0.002284019	0	0.138130119	0	1.590488705	0	0	0	1.773478684	0	0	0.288667499	0	0	0	0	0	0.025953713	0	0	0	0	0	0	0	0	0	0	7.2483			0	0.11759731	0.35681206	0	0.848626151	0.653746154	0.099319127	0.975825551	0.377412235	0	0	0	0.002284019	0	0.138130119	0	1.590488705	0	0	0	1.773478684	0	0	0.288667499	0	0	0	0	0	0.025953713	0	0	0	0	0	0	0	0	0	0	7.2483	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.11759731	0.35681206	0	0.848626151	0.653746154	0.099319127	0.975825551	0.377412235	0	0	0	0.002284019	0	0.138130119	0	1.590488705	0	0	0	1.773478684	0	0	0.288667499	0	0	0	0	0	0.025953713	0	0	0	0	0	0	0	0	0	0	7.2483
H3815_005_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	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	NO	0	6.878043832	42.76315342	0	199.8661713	11.08	1.71	306.2704708	185.9493455	0	0	0	1.098089593	0	108.8730543	0	399.5340965	0	0	0	8.64	0	0	1185.440885	0	0	0	0	0	4												$0 copay	1B - $200 per admit	2 - $100 copay days 15-100	$0 copay	10A - $55 copay	11A - 20% coinsurance on items >$150	11B - 20% coinsurance on items >$150	4A - $50 copay	"9A - $75 copay, 9B -$25 outpatient"	$0 copay	$0 copay	$0 copay	12 - $25 copay	5 - $30 copay	4B- $25 copay	$0 copay	7E & 7H & 9C- $30 copay	$0 copay	$0 copay	$0 copay	15 - 20% coinsurance	$0 copay	$0 copay	16A - $20 copay	$0 copay	17B - $100 max	$0 copay	18B - $500 max	$0 copay	4A - $50 worldwide emerg.											0	200	100	0	55	0.04	0.2	50	50	0	0	0	25	0	9.54	0	30	0	0	0	0.2	0	0	20	0	0	0	0	0	50											NO	0	200	100	0	55	0.04	0.2	50	50	0	0	0	25	0	9.54	0	30	0	0	0	0.2	0	0	20	0	0	0	0	0	50												0	0.114634064	0.356359612	0	0.916053285	0.4432	0.342	1.276126961	0.774788939	0	0	0	0.002287687	0	0.086554078	0	0.998835241	0	0	0	1.728	0	0	1.975734808	0	0	0	0	0	0.016666667	0	0	0	0	0	0	0	0	0	0	9.0312			0	0.114634064	0.356359612	0	0.916053285	0.4432	0.342	1.276126961	0.774788939	0	0	0	0.002287687	0	0.086554078	0	0.998835241	0	0	0	1.728	0	0	1.975734808	0	0	0	0	0	0.016666667	0	0	0	0	0	0	0	0	0	0	9.0312	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.114634064	0.356359612	0	0.916053285	0.4432	0.342	1.276126961	0.774788939	0	0	0	0.002287687	0	0.086554078	0	0.998835241	0	0	0	1.728	0	0	1.975734808	0	0	0	0	0	0.016666667	0	0	0	0	0	0	0	0	0	0	9.0312
H3817_001_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	528.3860333	4.164592435	0	0	0	0	0	320.4600484	207.9768378	0	0	0	0	599.7495258	4363.609844	3381.161355	67.11175488	799.6491208	0	714.0574668	0	0	0	0	241.7462046	0	0	0	0	0											2000	$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical;	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals; $10/Procedure for PCP - Cardio;	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											125	125	0	0	0	0	0	50	100	0	0	0	0	10	10	10	10	10	0	10	0	0	0	0	10	0	0	0	0	0											YES	123.4811757	123.4811757	0	0	0	0	0	49.39247029	98.78494058	0	0	0	0	9.87849406	9.878494058	9.878494058	9.878494067	9.87849406	0	9.878494058	0	0	0	0	9.878494059	0	0	0	0	0											3500	5.4371	0.042854064	0	0	0	0	0	1.319026118	1.71208163	0	0	0	0	0.493718511	3.592157827	2.78339853	0.055246923	0.658277424	0	0.587817704	0	0	0	0	0.199007371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.8807	0	0.207633776	5.4371	0.042854064	0	0	0	0	0	1.319026118	1.71208163	0	0	0	0	0.493718511	3.592157827	2.78339853	0.055246923	0.658277424	0	0.587817704	0	0	0	0	0.199007371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.8807	NO	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical;	$225/Days 1-5 for IP Psych; $225/Days 1-5 for IP Substance Abuse;	$25/Days Custom for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.4592	0.0038	0.0805	0.0096	1.5237	0.1013	0.0043	0.1357	0.3546	0.1237	0.216	0	0	0.123	0.1373	0.2678	0.0367	0.0367	0.3218	0.4755	0	0	0	0	0.01	0	0	0	0	0											4.4212	0	0.094776371	5.8963	0.046635439	0.080486529	0.009561716	1.523689825	0.101287043	0.004323681	1.454715226	2.066682974	0.123742155	0.215971222	0	0	0.616712471	3.729455701	3.051206718	0.091930245	0.695001456	0.321841352	1.063333328	0	0	0	0	0.209021579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3019
H3817_002_0	2010	7	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	O											1.1176	0.0135	0.2751	0.0871	0	0.1027	0.0079	0.1364	0.3139	0.0344	0.1025	0	0.0001	0.1053	0.3903	0.481	0.0092	0.0364	0.1343	0.1499	0.0344	0.0046	0	0	0.0136	0.0068	0	0	0	0											3.5572	YES	625.7076811	10.76161753	1471.842168	17.08995086	0.084991956	20.14136858	1.41662384	381.6606419	452.5503335	6.743578755	0	0	0.019846702	752.6705398	4483.967035	3559.812153	192.9838778	953.7479128	0	634.5434855	6.741293476	0	0	0	224.9702211	0	0	0	0	0											2500	$175/Days 1-5 for IP Medical; $175/Days 1-5 for IP Surgical;	$175/Days 1-5 for IP Psych; $175/Days 1-5 for IP Substance Abuse;	$10/Day for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $35/Visit for Urgent Care; $35/Visit for Urgent Care - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams;	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											175	175	10	0.1	100	0.06578246	0.1	50	200	0.1	0	0	0.099999999	25	25	25	25	25	0	25	0.001145428	0	0	0	25	0	0	0	0	0											YES	167.5964776	167.5964776	9.576941577	0.095769416	95.76941611	0.062999477	0.095769416	47.88470788	191.5388315	0.095769416	0	0	0.095769417	23.94235394	23.94235394	23.94235394	23.94235393	23.94235394	0	23.94235394	0.00109697	0	0	0	23.94235394	0	0	0	0	0											4000	8.7389	0.150300766	1.174645537	1.63669461	0.000678303	1.26889569	0.135669238	1.522975696	7.223413508	0.645828598	0	0	0.001900707	1.501725372	8.946393819	7.102523544	0.385040692	1.902914175	0	1.266038727	0.007394997	0	0	0	0.448859722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0608	50	1.946370433	9.8564	0.163850586	1.449719852	1.723827045	0.000703473	1.371585657	0.143578987	1.65940365	7.537323	0.680210466	0.102524182	0	0.002001895	1.607046029	9.336695023	7.583478442	0.394285298	1.939322538	0.134313361	1.415986406	0.041765214	0.004636058	0	0	0.462472801	0.006760402	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6179	NO	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$30/Days Custom for SNF	20% Coinsurance for Home Health	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$300/Case for OP Fac - Surgery; $300/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	$35/Case for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; $35/Procedure for PCP - Cardio;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults; $35/Procedure for Speclst - Cardio;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.9569	0.0282	0.1795	0.0143	2.2138	0.2851	0.0083	0.2223	0.6723	0.3226	0.4709	0	0.0067	0.2939	0.3483	0.487	0.2164	0.0696	0.6	0.6684	0.0232	0.0003	0	0.0627	0.0227	0.0047	0	0	0	0											8.178	50	0.264653889	10.8134	0.192057778	1.629182514	1.738150792	2.214488043	1.65668753	0.151908159	1.881722836	8.209628029	1.002772483	0.573404651	0	0.008737173	1.900948732	9.685007	8.070464331	0.610658414	2.008928341	0.734272608	2.084382366	0.064947925	0.004888244	0	0.062685162	0.485212121	0.011423878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7959
H3817_003_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	600.7402182	9.120517699	0	0	0.059038428	0	0	361.334303	253.6060379	0	0	0	0	760.5667597	5462.586058	4021.892387	230.6575765	1089.937403	0	701.3831827	0	0	0	0	238.2476657	0	0	0	0	0											2000	$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical;	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals; $10/Procedure for PCP - Cardio;	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											125	125	0	0	100	0	0	50	100	0	0	0	0	10	10	10	10	10	0	10	0	0	0	0	10	0	0	0	0	0											YES	122.8139739	122.813974	0	0	98.25117295	0	0	49.12558958	98.25117915	0	0	0	0	9.825117916	9.825117915	9.825117915	9.825117911	9.825117915	0	9.825117916	0	0	0	0	9.825117917	0	0	0	0	0											3500	6.1483	0.093343919	0	0	0.000483383	0	0	1.479230056	2.076424356	0	0	0	0	0.622721508	4.472546012	3.292963912	0.188853157	0.892396959	0	0.574264373	0	0	0	0	0.195067617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.0366	0	0.356640715	6.1483	0.093343919	0	0	0.000483383	0	0	1.479230056	2.076424356	0	0	0	0	0.622721508	4.472546012	3.292963912	0.188853157	0.892396959	0	0.574264373	0	0	0	0	0.195067617	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.0366	NO	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical;	$225/Days 1-5 for IP Psych; $225/Days 1-5 for IP Substance Abuse;	$25/Days Custom for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.7298	0.0278	0.1185	0.0145	1.81	0.1577	0.0009	0.2296	0.4721	0.1876	0.2551	0	0	0.1968	0.2691	0.3807	0.1796	0.0512	0.3615	0.6053	0	0	0	0	0.0172	0	0	0	0	0											6.0651	0	0.177796109	6.8781	0.121129812	0.118463545	0.014541079	1.810523488	0.157721192	0.000925273	1.708781865	2.54855408	0.187607356	0.255087781	0	0	0.819482102	4.74166093	3.673701253	0.368406088	0.943612676	0.361549348	1.179605676	0	0	0	0	0.212266868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1017
H3818_001_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	P	T	V	V	P	V	O	O	O																																																			0	YES	993.0448328	29.22196179		2278.574039	141.4029552	4.611847586	6.321945076	266.1633685					12.25643315	187.0402567	4210.690138	5064.957267	180.1912025	452.3071185			26.03844602	15.34208587			69.49088772		283.3066125														1500	"#1A  $160/day days 1-5, $0/day days 6-90"	"#1B  $160/day days 1-5, $0/day days 6-90"	#2 $0	#6 $20	#10A $50	#11A 20%	"#11B 20%, #11C 20%"	"#4A $50, #4B $20"	"#9A $0, #9B $0"	#8A $0	"#8A $0, #8B $0"	#9A $0	#12 20%	"#3 $0, #5 $0, #9C $0, #9D $0"	"#7A $15, #14B $0, #14C $0, #14D $0, #14E $0, #14F $0, #14G $0, #14H $0, #14I $0, #17A $20, #18A $20"	"#7B $25, #7D $25, #7F $20 or $25, #7G $25, #14J $0, #17A $20"	"#7E $25, #7H $25"	"#7C $25, #7I $25"	$0 (incl in h2)		#15 20%	"#13A $0, #16B $0"	#10B $0 n/c	"#16A $12/$35/$8/$40, #16B $45/$870/$200/$830/$50/$250"	#17A $25	#17B $0	#18A $20	#18B $0	#14A $0	"#13B n/c, #13C n/c, #13D n/c"											127.489793	127.489793		20	50	0.2	0.2	43.99371791					50.98220331	25	15.35476657	24.84998539	25	25			0.2	34.50603487			25		20														NO	93.91999724	93.91999724		14.73372809	36.83432022	0.147337281	0.147337281	32.42341077					37.55789605	18.41716011	11.31164777	18.49733729	18.41716011	18.41716011			0.147337281	25.42012676			25		20															7.7722	0.228710548	0	2.797657527	0.434040144	0.679497083	0.931458197	0.719160352	0	0	0	0	0.038360487	0.28706253	3.969153644	7.807351911	0.276550852	0.694184385	0	0	3.836433836	0.032499814	0	0	0.144772683	0	0.472177688	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1213	0	10.79348943	7.7722	0.228710548	0	2.797657527	0.434040144	0.679497083	0.931458197	0.719160352	0	0	0	0	0.038360487	0.28706253	3.969153644	7.807351911	0.276550852	0.694184385	0	0	3.836433836	0.032499814	0	0	0.144772683	0	0.472177688	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1213	NO																																																																																		0	0	0	7.7722	0.228710548	0	2.797657527	0.434040144	0.679497083	0.931458197	0.719160352	0	0	0	0	0.038360487	0.28706253	3.969153644	7.807351911	0.276550852	0.694184385	0	0	3.836433836	0.032499814	0	0	0.144772683	0	0.472177688	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1213
H3818_002_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	O	O																																																			0	NO	327.9824353	20.34987907	78.93739657		29.34581313	6.771477299	7.971704596	44.91893187	53.17369625	29.93648356	51.14193442	7.271343192	0.054232126	63.8147804	112.1423812	50.5131365	11.59202104		21.91813252	40.08902669	38.45771554	7.595084059																				FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin		20% Coinsurance	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin; 0% on Diab Mon Supplies	$50; 20% Coins on Urgent Care	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	0% Cost Sharing	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin	FFS Medicare Ded & Coin																			0.083412966	0.083412966	0.128792408		0.2	0.233	0.233	0.086615903	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233																			NO	0.083412966	0.083412966	0.128792408		0.2	0.233	0.233	0.086615903	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233																				27.358	1.697443778	10.1665374	0	5.869162627	1.577754211	1.857407171	3.89069384	12.38947123	6.97520067	11.91607072	1.694222964	0.012636085	14.86884383	26.12917481	11.7695608	2.700940901	0	5.106924876	9.340743219	8.960647721	1.769654586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.0511	0	0	27.358	1.697443778	10.1665374	0	5.869162627	1.577754211	1.857407171	3.89069384	12.38947123	6.97520067	11.91607072	1.694222964	0.012636085	14.86884383	26.12917481	11.7695608	2.700940901	0	5.106924876	9.340743219	8.960647721	1.769654586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.0511	NO																																																																																		0	0	0	27.358	1.697443778	10.1665374	0	5.869162627	1.577754211	1.857407171	3.89069384	12.38947123	6.97520067	11.91607072	1.694222964	0.012636085	14.86884383	26.12917481	11.7695608	2.700940901	0	5.106924876	9.340743219	8.960647721	1.769654586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.0511
H3818_003_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	P	P	Coin	P	T	V	V	P	V	O	O	O																																																			0	YES	1123.457906	208.3976818	572.9270621	1863.45842	151.4346204	6.478503138	9.820342065	356.2753288	37.8109156	10.32038917	23.68902481	3.81432276	0.085876641	28.67930408	3629.469961	4428.377994	3.650178784	4.051423219			22.21860087	185.8994812																			3400	"#1A $225/day days 1-5, $0/day days 6-90"	"#1B $225/day days 1-5, $0/day days 6-90"	"#2 $0/day days 1-20, $25/day days 21-100"	#6 $20	#10A $50	#11A 20%	"#11B 20%, #11C 20%"	"#4A $50, #4B $30"	"#9A 20%, #9B 20%"	#8A 20%	"#8A 20%, #8B 20%"	#9A 20%	#12 20%	"#3 $0, #5 20%, #9C 20%, #9D 20%"	"#7A $20, #14B $0, #14C $0, #14D $0, #14E $0, #14F $0, #14G $0, #14H $0, #14I 20%, #17A $30, #18A $30"	"#7B $30, #7D $30, #7F $30 or $20, #7G $30, #14J 20%, #17A $20"	"#7E $30, #7H $30"	"#7C 20%, #7I 20%"	$0 (incl in h2)		#15 20%	"#13A $0, #16B $0"	#10B $0 n/c	"#16A n/c, #16B n/c"	#17A n/c	#17B n/c	#18A n/c	#18B n/c	#14A $0	"#13B n/c, #13C n/c, #13D n/c"											134.718626	134.718626	11.2188787	20	50	0.2	0.2	45.99572707	0.2	0.2	0.2	0.2	0.2	0.2	19.98714132	29.65511407	0.349561623	0.2			0.2	35.55914822																			NO	109.2394747	109.2394747	9.098059223	16.21742708	40.5435677	0.162174271	0.162174271	37.30459222	0.162174271	0.162174271	0.162174271	0.162174271	0.162174271	0.162174271	16.20700035	24.16794554	0.283449506	0.162174271			0.162174271	28.83389467																				10.2272	1.897104441	0.434377028	2.518375087	0.511641649	1.050646522	1.592606814	1.107558822	6.131957666	1.673701588	3.841750324	0.618585012	0.013926982	4.651045226	4.901901743	8.918733183	1.034641375	0.657036606	0	0	3.603285394	0.446683838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8327	0	12.96686488	10.2272	1.897104441	0.434377028	2.518375087	0.511641649	1.050646522	1.592606814	1.107558822	6.131957666	1.673701588	3.841750324	0.618585012	0.013926982	4.651045226	4.901901743	8.918733183	1.034641375	0.657036606	0	0	3.603285394	0.446683838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8327	NO																																																																																		0	0	0	10.2272	1.897104441	0.434377028	2.518375087	0.511641649	1.050646522	1.592606814	1.107558822	6.131957666	1.673701588	3.841750324	0.618585012	0.013926982	4.651045226	4.901901743	8.918733183	1.034641375	0.657036606	0	0	3.603285394	0.446683838	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8327
H3818_004_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	P	P	Coin	P	T	V	V	P	V	O	O	O																																																			0	YES	722.6259549	40.74527682	510.9394644	1354.962409	102.147665	6.143381135	9.24993906	239.6962179	32.55562419	5.85861447	17.25669336	2.394141255	0.034984095	22.56647634	2903.829116	3753.230563	1.412323598	3.492078841			21.45027787	83.01611604																			3400	"#1A $250/day days 1-5, $0/day days 6-90"	"#1B $250/day days 1-5, $0/day days 6-90"	"#2 $0/day days 1-20, $25/day days 21-100"	#6 $20	#10A $50	#11A 20%	"#11B 20%, #11C  20%"	"#4A $50, #4B $30"	"#9A 20%, #9B 20%"	#8A 20%	"#8A 20%, #8B 20%"	#9A 20%	#12 20%	"#3 $0, #5 20%, #9C 20%, #9D 20%"	"#7A $20, #14B $0, #14C $0, #14D $0, #14E $0, #14F $0, #14G $0, #14H $0, #14I $0, #17A $30, #18A $30"	"#7B $30, #7D $30, #7F $30 or $20, #7G $30, #14J $0, #17A $20"	"#7E $30, #7H $30"	"#7C 20%, #7I 20%"	$0 (incl in h2)		#15 20%	"#13A 20%, #16B $0"	#10B $0 n/c	"#16A n/c, #16B n/c"	#17A n/c	#17B n/c	#18A n/c	#18B n/c	#14A $0	"#13B n/c, #13C n/c, #13D n/c"											215.7370607	215.7370607	11.48476101	20	50	0.2	0.2	45.99213696	0.2	0.2	0.2	0.2	0.2	0.2	19.99505105	29.57752665	0.286272247	0.2			0.2	36.70355209																			NO	184.2970338	184.2970338	9.811862669	17.08533835	42.71334586	0.170853383	0.170853383	39.2995691	0.170853383	0.170853383	0.170853383	0.170853383	0.170853383	0.170853383	17.08111062	25.38155194	0.24455291	0.170853383			0.170853383	31.3546303																				11.0982	0.625769471	0.417772321	1.929165933	0.363589046	1.049617453	1.580383385	0.784996506	5.562238543	1.000964105	2.948364448	0.409047134	0.005977151	3.855558835	4.133385531	7.93856804	0.345387845	0.596633485	0	0	3.66485255	0.216911636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5273	0	8.236310324	11.0982	0.625769471	0.417772321	1.929165933	0.363589046	1.049617453	1.580383385	0.784996506	5.562238543	1.000964105	2.948364448	0.409047134	0.005977151	3.855558835	4.133385531	7.93856804	0.345387845	0.596633485	0	0	3.66485255	0.216911636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5273	NO																																																																																		0	0	0	11.0982	0.625769471	0.417772321	1.929165933	0.363589046	1.049617453	1.580383385	0.784996506	5.562238543	1.000964105	2.948364448	0.409047134	0.005977151	3.855558835	4.133385531	7.93856804	0.345387845	0.596633485	0	0	3.66485255	0.216911636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5273
H3818_014_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	P	T	V	V	P	V	O	O	O																																																			0	YES	1007.913529	42.90633757		1904.18465	139.0768969	8.809749167	13.51128229	306.7908034					3.163454959	167.9571396	3934.204289	4961.199871	186.0536152	591.7539853			25.3055214																				1500	"#1A  $160/day days 1-5, $0/day days 6-90"	"#1B  $160/day days 1-5, $0/day days 6-90"	#2 $0	#6 $20	#10A $50	#11A 20%	"#11B 20%, #11C 20%"	"#4A $50, #4B $20"	"#9A $0, #9B $0"	#8A $0	"#8A $0, #8B $0"	#9A $0	#12 20%	"#3 $0, #5 $0, #9C $0, #9D $0"	"#7A $15, #14B $0, #14C $0, #14D $0, #14E $0, #14F $0, #14G $0, #14H $0, #14I 20%, #17A $30, #18A $30"	"#7B $30, #7D $25, #7F $20 or $25, #7G $25, #14J 20%, #17A $30"	"#7E $25, #7H $25"	"#7C $25, #7I $25"	$0 (incl in h2)		#15 20%	"#13A $0, #16B $0"	#10B $0 n/c	"#16A n/c, #16B n/c"	#17A n/c	#17B n/c	#18A n/c	#18B n/c	#14A $0	"#13B n/c, #13C n/c, #13D n/c"											125.4344391	125.4344391		20	50	0.2	0.2	43.9883487					39.89336018	25	14.88108211	23.94344203	25	25			0.2																				NO	91.75289884	91.75289884		14.62961838	36.57404596	0.146296184	0.146296184	32.18880451					29.18123178	18.28702298	10.88522762	17.71584742	18.28702298	18.28702298			0.146296184																					7.7066	0.328065071	0	2.321457897	0.423883735	1.288832684	1.976649038	0.822935766	0	0	0	0	0.007692793	0.255953006	3.568725767	7.324321662	0.283530561	0.901784894	0	0	3.702101212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9125	0	11.23325225	7.7066	0.328065071	0	2.321457897	0.423883735	1.288832684	1.976649038	0.822935766	0	0	0	0	0.007692793	0.255953006	3.568725767	7.324321662	0.283530561	0.901784894	0	0	3.702101212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9125	NO																																																																																		0	0	0	7.7066	0.328065071	0	2.321457897	0.423883735	1.288832684	1.976649038	0.822935766	0	0	0	0	0.007692793	0.255953006	3.568725767	7.324321662	0.283530561	0.901784894	0	0	3.702101212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9125
H3818_015_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	P	T	V	V	P	V	O	O	O																																																			0	YES	2758.46059	85.1349318		4728.447228	277.8115947	16.35980906	28.07891526	353.0154935						212.143077	5446.823045	8255.218488	318.5213265	749.4422251			34.11518824			1148.29499	153.9163096		266.1970705														1500	"#1A  $100/day days 1-5, $0/day days 6-90"	"#1B  $100/day days 1-5, $0/day days 6-90"	#2 $0	#6 $20	#10A $50	#11A 20%	"#11B 20%, #11C 0%"	"#4A $50, #4B $20"	"#9A $0, #9B $0"	#8A $0	"#8A $0, #8B $0"	#9A $0	#12 $0	"#3 $0, #5 $0, #9C $0, #9D $0"	"#7A $15, #14B $0, #14C $0, #14D $0, #14E $0, #14F $0, #14G $0, #14H $0, #14I $0, #17A $0, #18A $20"	"#7B $25, #7D $25, #7F $10 or $20, #7G $25, #14J $0, #17A $0"	"#7E $25, #7H $25"	"#7C $25, #7I $25"	$0 (incl in h2)		#15 20%	"#13A $0, #16B $0"	#10B $0 n/c	"#16A $12/$35/$8/$40, #16B $45/$870/$200/$830/$50/$250"	#17A $25	#17B $0	#18A $20	#18B $0	#14A $0	"#13B n/c, #13C n/c, #13D n/c"											59.57741991	59.57741991		20	50	0.2	0.2	43.98720379						25	14.7760236	22.88926595	25	25			0.2			12	25		20														NO	36.49437356	36.49437356		12.25107553	30.62768882	0.122510755	0.122510755	26.9638083						15.31384441	9.05110906	14.09108767	15.31384441	15.31384441			0.122510755			12	25		20															8.389	0.258912167	0	4.827380344	0.70906059	2.004252564	3.439969116	0.793220174	0	0	0	0	0	0.270727173	4.108315784	9.693750622	0.40648217	0.956403469	0	0	4.179477478	0	0	1.14829499	0.320658978	0	0.443661784	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9496	0	25.24403294	8.389	0.258912167	0	4.827380344	0.70906059	2.004252564	3.439969116	0.793220174	0	0	0	0	0	0.270727173	4.108315784	9.693750622	0.40648217	0.956403469	0	0	4.179477478	0	0	1.14829499	0.320658978	0	0.443661784	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9496	NO																																																																																		0	0	0	8.389	0.258912167	0	4.827380344	0.70906059	2.004252564	3.439969116	0.793220174	0	0	0	0	0	0.270727173	4.108315784	9.693750622	0.40648217	0.956403469	0	0	4.179477478	0	0	1.14829499	0.320658978	0	0.443661784	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9496
H3864_001_0	2010	3	N/A																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V	Coin	Coin				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	YES	520.6188809	1.008950211	82.54462179		118.8910018	8.932235815	4.498070673	191.3016875	154.8440363		91.92858212			1.845383535	3933.988615	3877.783991	60.63399152	1653.227501	820.229998	133.8566878	37.22906874				8.877379768	0	8.606671027	21.84339501		0											3400	$125/day (Days 1-4)	$125/day (Days 1-4)	$25/day (Days 21-100)		$50 Ambulance	20% DME ($500 Max CS)	20% Prosthetics/$0 Supplies	$50 ER Waived	$125 Copay OP Surg/ASC		"$0 Diag/Lab ($50CT, $75MRI, $200PET)/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms"			$25 Copay OP MH/SA Visits/$125 Copay Partial Hospitalization/$25 Copay Urgent Care	$10 PCP / $25 Specialist	$10 PCP / $25 Specialist/$25 Copay Chiro/$25 Copay Podiatry	$25 Copay OP MH/SA Visits	$25 PT/ST/OT	"$0 Diag/Lab ($50CT, $75MRI, $200PET)/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms"	"Medicare Hospice/$25 Copay Urgent Care/$0 Diag/Lab ($50CT, $75MRI, $200PET)/$0 Pap & Pelvic Exams/$0 Prostate Exams/$25 Copay Dental/$25 Copay Hearing/$25 Copay Vision/$0 Copay Physical Exams"	$0 Immunizations/10% Part B Rx				$25 Copay Mand Suppl Vision Exams	$100 Vision Hardware Coverage	$25 Copay Mand Suppl Hearing Exams	$250 Hearing Aids Coverage		No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											125	125	25		50	0.2	0.135603303	50	125		58.51808635			25	10	25	25	25	58.51808635	0.019427359	0.093240839				25	0	25	0		0											NO	120.2832692	120.2832692	24.05665384		48.11330769	0.192453231	0.130486469	48.11330769	120.2832692		56.30997387			24.05665384	9.622661537	24.05665384	24.05665384	24.05665384	56.30997387	0.01869429	0.089722503				25	0	24.05665384	0		0												5.2185	0.010113319	0.165478949	0	0.476686612	1.71903764	0.586937359	0.767013079	1.552095575	0	0.431374671	0	0	0.003699479	3.154620078	7.773875596	0.121554245	3.314260143	3.84892748	2.502355748	3.340285249	0	0	0	0.018494541	0	0.017253975	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0225	0	1.372632039	5.2185	0.010113319	0.165478949	0	0.476686612	1.71903764	0.586937359	0.767013079	1.552095575	0	0.431374671	0	0	0.003699479	3.154620078	7.773875596	0.121554245	3.314260143	3.84892748	2.502355748	3.340285249	0	0	0	0.018494541	0	0.017253975	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0225	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambulance	$0 DME	$0 Prosthetics/OON $0 Supplies	$0 ER	$0 Copay OP Surg/ASC	OON 10% Rad/$0 Lab	OON 10% Rad/$0 Lab/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			10% Coin OP MH/SA/$0 Copay Partial Hospitalization/$0 Copay Urgent Care	OON 10% PCP / 10% Specialist	OON 10% PCP / 10% Specialist/$0 Copay Chiro/$0 Copay Podiatry	10% Coin OP MH/SA	$0 PT/ST/OT	OON 10% Rad/$0 Lab/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	$0 Copay Hospice/$0 Copay Urgent Care/OON 10% Rad/$0 Lab/$0 Pap & Pelvic Exams/$0 Prostate Exams/$0 Copay Dental/$0 Copay Hearing/$0 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/$0 Part B Rx		No Transportation	No Coverage Mand Suppl Dental	No Coverage Mand Suppl Vision Exams	No Coverage Vision Hardware Coverage	No Coverage Mand Suppl Hearing Exams	No Coverage Hearing Aids Coverage	No Health & Wellness Ed	No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//												0	0	0	0	0	0	0	0	0	0	0.0944	0	0	0	0.1511	0.1336	0.003	0	0.1345	0	0	0	0	0	0	0	0	0	0	0											0.5167	0	0	5.2185	0.010113319	0.165478949	0	0.476686612	1.71903764	0.586937359	0.767013079	1.552095575	0	0.525796969	0	0	0.003699863	3.305762494	7.907462853	0.124556269	3.314260143	3.983446315	2.502355748	3.340285249	0	0	0	0.018494541	0	0.017253975	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5392
H3864_002_0	2010	3	N/A																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V	Coin	Coin				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	YES	453.6371896	3.226133238	51.64292035		93.21566398	7.12072831	3.88477951	175.7641178	137.3440473		108.2198211			1.735819961	3427.903675	3345.361108	113.8786382	1562.984808	746.8248426	104.2842279	36.16283133				8.877379768	0	8.606671027	21.84339501		0											3400	$200/day (Days 1-4)	$200/day (Days 1-4)	$50/day (Days 21-100)		$50 Ambulance	20% DME ($500 Max CS)	20% Prosthetics/$0 Supplies	$50 ER Waived	$200 Copay OP Surg/ASC		"$0 Diag/Lab ($100CT, $150MRI, $300PET)/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms"			$25 Copay OP MH/SA Visits/$200 Copay Partial Hospitalization/$25 Copay Urgent Care	$15 PCP / $25 Specialist	$15 PCP / $25 Specialist/$25 Copay Chiro/$25 Copay Podiatry	$25 Copay OP MH/SA Visits	$25 PT/ST/OT	"$0 Diag/Lab ($100CT, $150MRI, $300PET)/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms"	"Medicare Hospice/$25 Copay Urgent Care/$0 Diag/Lab ($100CT, $150MRI, $300PET)/$0 Pap & Pelvic Exams/$0 Prostate Exams/$25 Copay Dental/$25 Copay Hearing/$25 Copay Vision/$0 Copay Physical Exams"	$0 Immunizations/10% Part B Rx				$25 Copay Mand Suppl Vision Exams	$100 Vision Hardware Coverage	$25 Copay Mand Suppl Hearing Exams	$250 Hearing Aids Coverage		No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											200	200	50		50	0.2	0.135603303	50	200		115.9193199			25	15	25	25	25	115.9193199	0.019815821	0.093240839				25	0	25	0		0											NO	190.1890248	190.1890248	47.54725619		47.54725619	0.190189025	0.1289513	47.54725619	190.1890248		110.232912			23.77362809	14.26417686	23.77362809	23.77362809	23.77362809	110.232912	0.018843758	0.088666921				25	0	23.77362809	0		0												7.1897	0.051131261	0.204623264	0	0.369345755	1.354284373	0.500947368	0.696425128	2.176777535	0	0.994115501	0	0	0.003438895	4.074685356	6.627614236	0.225609033	3.096484962	6.860389762	1.965106771	3.206446914	0	0	0	0.018494541	0	0.017050983	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6327	0	2.043514606	7.1897	0.051131261	0.204623264	0	0.369345755	1.354284373	0.500947368	0.696425128	2.176777535	0	0.994115501	0	0	0.003438895	4.074685356	6.627614236	0.225609033	3.096484962	6.860389762	1.965106771	3.206446914	0	0	0	0.018494541	0	0.017050983	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6327	NO																																																																																		0	0		7.1897	0.051131261	0.204623264	0	0.369345755	1.354284373	0.500947368	0.696425128	2.176777535	0	0.994115501	0	0	0.003438895	4.074685356	6.627614236	0.225609033	3.096484962	6.860389762	1.965106771	3.206446914	0	0	0	0.018494541	0	0.017050983	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6327
H3864_006_0	2010	5	N/A																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V	Coin	Coin				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	YES	599.5761833	12.3981841	103.6345289		134.6090295	9.219637957	3.912620031	271.3154606	166.9457155		156.6951396			2.496516917	4176.094526	3750.76558	292.8866585	1845.86708	958.1166557	117.8366896	30.4331336				8.877379768	0	8.606671027	21.84339501		0											3400	$200/day (Days 1-4)	$200/day (Days 1-4)	$50/day (Days 21-100)		$50 Ambulance	20% DME ($500 Max CS)	20% Prosthetics/$0 Supplies	$50 ER Waived	$200 Copay OP Surg/ASC		"$0 Diag/Lab ($100CT, $150MRI, $300PET)/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms"			$25 Copay OP MH/SA Visits/$200 Copay Partial Hospitalization/$25 Copay Urgent Care	$15 PCP / $25 Specialist	$15 PCP / $25 Specialist/$25 Copay Chiro/$25 Copay Podiatry	$25 Copay OP MH/SA Visits	$25 PT/ST/OT	"$0 Diag/Lab ($100CT, $150MRI, $300PET)/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms"	"Medicare Hospice/$25 Copay Urgent Care/$0 Diag/Lab ($100CT, $150MRI, $300PET)/$0 Pap & Pelvic Exams/$0 Prostate Exams/$25 Copay Dental/$25 Copay Hearing/$25 Copay Vision/$0 Copay Physical Exams"	$0 Immunizations/10% Part B Rx				$25 Copay Mand Suppl Vision Exams	$100 Vision Hardware Coverage	$25 Copay Mand Suppl Hearing Exams	$250 Hearing Aids Coverage		No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											200	200	50		50	0.2	0.135603303	50	200		115.9193199			25	15	25	25	25	115.9193199	0.019574748	0.093240839				25	0	25	0		0											NO	190.1890248	190.1890248	47.54725619		47.54725619	0.190189025	0.1289513	47.54725619	190.1890248		110.232912			23.77362809	14.26417686	23.77362809	23.77362809	23.77362809	110.232912	0.018614511	0.088666921				25	0	23.77362809	0		0												9.5027	0.196499879	0.410628125	0	0.533357501	1.753473952	0.504537439	1.075025476	2.645936902	0	1.439413461	0	0	0.004945939	4.964045908	7.430775498	0.580248208	3.656913123	8.801332416	2.193472408	2.698412257	0	0	0	0.018494541	0	0.017050983	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4273	0	2.497187072	9.5027	0.196499879	0.410628125	0	0.533357501	1.753473952	0.504537439	1.075025476	2.645936902	0	1.439413461	0	0	0.004945939	4.964045908	7.430775498	0.580248208	3.656913123	8.801332416	2.193472408	2.698412257	0	0	0	0.018494541	0	0.017050983	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4273	NO																																																																																		0	0		9.5027	0.196499879	0.410628125	0	0.533357501	1.753473952	0.504537439	1.075025476	2.645936902	0	1.439413461	0	0	0.004945939	4.964045908	7.430775498	0.580248208	3.656913123	8.801332416	2.193472408	2.698412257	0	0	0	0.018494541	0	0.017050983	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4273
H3864_007_0	2010	5	N/A																															D	D	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V	Coin	Coin				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	YES	586.2106652	13.05914848	60.89191644		142.4739192	11.48834473	5.478712383	227.7222604	163.5854615		111.2019979			2.340392521	4583.415338	4538.945175	259.5235621	2370.291113	979.4752305	140.620429	42.1773349				8.877379768	0	8.606671027	21.84339501		0											3400	$125/day (Days 1-4)	$125/day (Days 1-4)	$25/day (Days 21-100)		$50 Ambulance	20% DME ($500 Max CS)	20% Prosthetics/$0 Supplies	$50 ER Waived	$125 Copay OP Surg/ASC		"$0 Diag/Lab ($50CT, $75MRI, $200PET)/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms"			$25 Copay OP MH/SA Visits/$125 Copay Partial Hospitalization/$25 Copay Urgent Care	$10 PCP / $25 Specialist	$10 PCP / $25 Specialist/$25 Copay Chiro/$25 Copay Podiatry	$25 Copay OP MH/SA Visits	$25 PT/ST/OT	"$0 Diag/Lab ($50CT, $75MRI, $200PET)/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms"	"Medicare Hospice/$25 Copay Urgent Care/$0 Diag/Lab ($50CT, $75MRI, $200PET)/$0 Pap & Pelvic Exams/$0 Prostate Exams/$25 Copay Dental/$25 Copay Hearing/$25 Copay Vision/$0 Copay Physical Exams"	$0 Immunizations/10% Part B Rx				$25 Copay Mand Suppl Vision Exams	$100 Vision Hardware Coverage	$25 Copay Mand Suppl Hearing Exams	$250 Hearing Aids Coverage		No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											125	125	25		50	0.2	0.135603303	50	125		58.51808635			25	10	25	25	25	58.51808635	0.020346234	0.093240839				25	0	25	0		0											NO	120.2832692	120.2832692	24.05665384		48.11330769	0.192453231	0.130486469	48.11330769	120.2832692		56.30997387			24.05665384	9.622661537	24.05665384	24.05665384	24.05665384	56.30997387	0.019578492	0.089722503				25	0	24.05665384	0		0												5.8759	0.130899756	0.122071313	0	0.571240959	2.210969059	0.714897834	0.913039265	1.639716175	0	0.521815133	0	0	0.004691834	3.675387874	9.099319408	0.520272375	4.751772735	4.596185387	2.753135932	3.784256077	0	0	0	0.018494541	0	0.017253975	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9214	0	1.643159159	5.8759	0.130899756	0.122071313	0	0.571240959	2.210969059	0.714897834	0.913039265	1.639716175	0	0.521815133	0	0	0.004691834	3.675387874	9.099319408	0.520272375	4.751772735	4.596185387	2.753135932	3.784256077	0	0	0	0.018494541	0	0.017253975	0	0	0	0	0	0	0	0	0	0	0	0	0	41.9214	NO	$0 Copay	$0 Copay	$0 Copay	$0 Copay HHC	$0 Ambulance	$0 DME	$0 Prosthetics/OON $0 Supplies	$0 ER	$0 Copay OP Surg/ASC	OON 10% Rad/$0 Lab	OON 10% Rad/$0 Lab/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			10% Coin OP MH/SA/$0 Copay Partial Hospitalization/$0 Copay Urgent Care	OON 10% PCP / 10% Specialist	OON 10% PCP / 10% Specialist/$0 Copay Chiro/$0 Copay Podiatry	10% Coin OP MH/SA	$0 PT/ST/OT	OON 10% Rad/$0 Lab/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	$0 Copay Hospice/$0 Copay Urgent Care/OON 10% Rad/$0 Lab/$0 Pap & Pelvic Exams/$0 Prostate Exams/$0 Copay Dental/$0 Copay Hearing/$0 Copay Vision/$0 Copay Physical Exams	$0 Immunizations/$0 Part B Rx		No Transportation	No Coverage Mand Suppl Dental	No Coverage Mand Suppl Vision Exams	No Coverage Vision Hardware Coverage	No Coverage Mand Suppl Hearing Exams	No Coverage Hearing Aids Coverage	No Health & Wellness Ed	No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//												0	0	0	0	0	0	0	0	0	0	0.1185	0	0	0	0.1745	0.1563	0.0117	0	0.1504	0	0	0	0	0	0	0	0	0	0	0											0.6114	0	0	5.8759	0.130899756	0.122071313	0	0.571240959	2.210969059	0.714897834	0.913039265	1.639716175	0	0.64029894	0	0	0.004692908	3.84986131	9.255613342	0.531988186	4.751772735	4.746592892	2.753135932	3.784256077	0	0	0	0.018494541	0	0.017253975	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5327
H3864_801_0	2010	3	N/A																															D	D			T			V	V		V			V	V	V	V	V	V	V	Coin				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	YES	352.9925959	3.276664202			74.66308949			156.6231178	156.9432107		0			2.341900898	3931.093664	4043.184416	184.8373434	2253.550279	0	1183.863563	26.01924976				8.877379768	0	8.606671027	21.84339501		67.72393924											3400	$125/day (Days 1-4)	$125/day (Days 1-4)			$50 Ambulance			$50 ER Waived	$125 Copay OP Surg/ASC		$0 Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms			$15 Copay OP MH/SA Visits/$125 Copay Partial Hospitalization/$15 Copay Urgent Care	$10 PCP / $15 Specialist	$10 PCP / $15 Specialist/$15 Copay Chiro/$15 Copay Podiatry	$15 Copay OP MH/SA Visits	$15 PT/ST/OT	$0 Diagnostic/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms	$0 Copay Hospice/$15 Copay Urgent Care/$0 Diagnostic/$0 Pap & Pelvic Exams/$0 Prostate Exams/$15 Copay Dental/$15 Copay Hearing/$15 Copay Vision/$15 Copay Physical Exams	$0 Immunizations/10% Part B Rx				$15 Copay Mand Suppl Vision Exams	$100 Vision Hardware Coverage	$15 Copay Mand Suppl Hearing Exams	$250 Hearing Aids Coverage		No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$15 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											125	125			50			50	125		0			15	10	15	15	15	0	15	0.093240839				15	0	15	0		15											NO	123.7072967	123.7072967			49.48291869			49.48291869	123.7072967		0			14.84487561	9.896583737	14.84487561	14.84487561	14.84487561	0	14.84487561	0.092276577				15	0	14.84487561	0		14.84487561												3.639	0.033778939	0	0	0.307878965	0	0	0.645847417	1.617918361	0	0	0	0	0.002897102	3.242033135	5.001714142	0.228657281	2.78780613	0	1.464525611	2.400967305	0	0	0	0.011096725	0	0.01064708	0	0	0.083779454	0	0	0	0	0	0	0	0	0	0	21.4785	0	0.224328065	3.639	0.033778939	0	0	0.307878965	0	0	0.645847417	1.617918361	0	0	0	0	0.002897102	3.242033135	5.001714142	0.228657281	2.78780613	0	1.464525611	2.400967305	0	0	0	0.011096725	0	0.01064708	0	0	0.083779454	0	0	0	0	0	0	0	0	0	0	21.4785	NO																																																																																		0	0		3.639	0.033778939	0	0	0.307878965	0	0	0.645847417	1.617918361	0	0	0	0	0.002897102	3.242033135	5.001714142	0.228657281	2.78780613	0	1.464525611	2.400967305	0	0	0	0.011096725	0	0.01064708	0	0	0.083779454	0	0	0	0	0	0	0	0	0	0	21.4785
H3887_001_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	460.8193397	36.83784844	12394.45224	89.42693316	34.4200337	16.17265452	17.03509974	21.63868925	6.84319303	48.09494601	29.84489103	0	0.019064827	10.39059093	1.400810063	153.4641323	17.27276685	29.17479907	0	0	1.706920951	10.39692071	1240.047079	0	168.2807252	284.5812469	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071044568	0.071907457	0	0	0.2	0.2	0.017130393	0.045811326	0.2	0	0.065699279	0	0.2	0.151140877	0.018470167	0.199115791	0.2	0	0	0	0.2	0.19078721	0	0	0	0	0	0	0	0											NO	0.071044568	0.071907457	0	0	0.2	0.2	0.017130393	0.045811326	0.2	0	0.065699279	0	0.2	0.151140877	0.018470167	0.199115791	0.2	0	0	0	0.2	0.19078721	0	0	0	0	0	0	0	0												32.7387	2.648916013	0	0	6.884006741	3.234530904	0.291817948	0.99129704	1.368638606	0	1.960787833	0	0.003812965	1.570443022	0.025873196	30.55713206	3.454553371	0	0	0	0.34138419	1.983599494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0555	0	0	32.7387	2.648916013	0	0	6.884006741	3.234530904	0.291817948	0.99129704	1.368638606	0	1.960787833	0	0.003812965	1.570443022	0.025873196	30.55713206	3.454553371	0	0	0	0.34138419	1.983599494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0555	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												11.2091	0.8961	0.6729	0.0588	1.2762	0.5997	0.6316	0.1225	0.2537	0.535	0.8727	0	0.0005	0.2911	0.0354	4.2769	0.4814	0	0	0	0.0476	0.2764	0	0	0.028	0	0	0	0	0											22.5657	0	0	43.9478	3.544971786	0.672919748	0.058812118	8.160255181	3.834191127	0.923456478	1.113816899	1.622374977	0.534988725	2.83351076	0	0.004284231	1.86159257	0.061306883	34.83400132	3.935925562	0	0	0	0.388954118	2.260002702	0	0	0.028043729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6212
H3887_002_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	420.4605362	23.18250809	1957.105167	1286.550799	14.99722687	20.04781372	16.27687009	29.70250225	31.6615434	15.45956944	39.8282748	0	0.067201107	23.61107607	29.81998389	114.7679066	9.930753772	5.389337144	0	0	18.54123085	4.489042478	734.8306209	204.4126409	119.5719235	199.4652587	0	0	93.04299515	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071044568	0.071907457	43.47002967	0	0.2	0.2	0.2	0.097403761	0.2	0	0.166948331	0	0.2	0.148465324	0.168862293	0.199741588	0.2	0	0	0	0.2	0.199510342	0	0	0	0	0	0	0	0											NO	0.071044568	0.071907457	43.47002967	0	0.2	0.2	0.2	0.097403761	0.2	0	0.166948331	0	0.2	0.148465324	0.168862293	0.199741588	0.2	0	0	0	0.2	0.199510342	0	0	0	0	0	0	0	0												29.8714	1.66699521	7.089618306	0	2.999445374	4.009562744	3.255374018	2.893135421	6.33230868	0	6.649264009	0	0.013440221	3.505426068	5.035470843	22.92392386	1.986150754	0	0	0	3.70824617	0.895610401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8354	0	0	29.8714	1.66699521	7.089618306	0	2.999445374	4.009562744	3.255374018	2.893135421	6.33230868	0	6.649264009	0	0.013440221	3.505426068	5.035470843	22.92392386	1.986150754	0	0	0	3.70824617	0.895610401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8354	NO	"25% (1a, 1a1); $0 n/c (1a2, 1a3)"	"25% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												17.8265	0.9829	5.9662	0.6417	0.8891	1.1885	0.9649	0.5712	1.8769	0.2749	1.9709	0	0.0027	1.039	2.6941	10.5767	0.9152	0	0	0	1.7087	0.4127	0	0	0.0654	0	0	0	0	0											50.5681	0	0	47.698	2.649879324	13.05580831	0.641656769	3.888502536	5.198025953	4.220290269	3.464322137	8.209250474	0.274939648	8.62015364	0	0.016096074	4.544459543	7.729573616	33.50057408	2.901337867	0	0	0	5.416947837	1.308293624	0	0	0.065437732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.4035
H3887_003_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1385.087589	120.7842024	717.8075922	298.0624719	184.9396952	5.456971669	6.455861383	217.1193338	26.56055898	7305.842949	29.06744043	0	0.316350963	16.88623918	4466.553856	3675.658301	419.4854879	423.215677	0	0	13.19704838	693.8237066	0	0	129.9662933	0	13.09778199	4.700856933	88.07212008	0											3800	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-24 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$13 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$13 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	64.42748214	0	150	0.2	0.102134898	49.74085832	0.2	3	0.172082114	0	0.2	0.151141942	8.555380593	39.40444849	38.5	40	0	0	0.2	37.38700729	0	0	40	0	0	0	0	0											NO	150.3129905	114.4815557	52.56338341	0	122.3780171	0.16317069	0.083327109	40.58125074	0.16317069	2.447560343	0.140393786	0	0.16317069	0.123482821	8.507475174	39.40444849	38.5	32.6341379	0	0	0.16317069	37.38700729	0	0	40	0	0	0	0	0												17.3497	1.15229695	3.144199641	0	1.886046099	0.89041783	0.537948263	0.734247844	4.333904722	1.490124289	4.080888018	0	0.051619205	2.085160446	3.166591337	12.06977401	1.345849274	1.150939897	0	0	2.153371484	2.161665998	0	0	0.433220978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.218	0	9.277599336	17.3497	1.15229695	3.144199641	0	1.886046099	0.89041783	0.537948263	0.734247844	4.333904722	1.490124289	4.080888018	0	0.051619205	2.085160446	3.166591337	12.06977401	1.345849274	1.150939897	0	0	2.153371484	2.161665998	0	0	0.433220978	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.218	NO	"$325 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$140 Days 1-22 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$50 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $50 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$50 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$50 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.816	0.4234	2.2871	0.4388	0.7913	0.5603	0.6629	0.308	2.7274	0.6252	2.5165	0	0.0217	1.3025	2.2705	4.8188	0.4935	0.5722	0	0	1.2847	0.9042	0	0	0.1757	0	0.0177	0	0	0											28.0185	0	0	22.1658	1.575689743	5.431288136	0.438847519	2.677314929	1.450764585	1.200865573	1.042293036	7.061264134	2.115288703	6.597430681	0	0.073275445	3.387645229	5.437130562	16.88855324	1.839300332	1.723168599	0	0	3.438117254	3.065829283	0	0	0.60894803	0	0.017709473	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2365
H3887_005_0	2010	6	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2501.503823	200.5140845	49.13453617	570.4899515	259.170777	12.82806523	13.9982056	360.0679406	32.36383741	10187.83195	46.99132059	0	0.3523089	24.70842976	7187.463437	6053.996944	906.7491979	532.4698584	0	0	20.46590451	939.1571816	666.1693504	0	164.3328284	0	14.02337917	4.758352503	78.5128163	0											3800	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$13 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$13 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	0.162897447	0	150	0.2	0.089119617	49.66306295	0.2	3	0.173491867	0	0.2	0.150121151	9.368773348	39.60799654	38.5	40	0	0	0.2	39.75374443	0	0	40	0	0	0	0	0											NO	127.3171888	96.96746632	0.11256852	0	103.6558787	0.138207838	0.061585148	34.31912286	0.138207838	2.073117574	0.11988968	0	0.138207838	0.104081684	9.261072575	39.60799654	38.5	27.64156765	0	0	0.138207838	39.75374443	0	0	40	0	0	0	0	0												26.5404	1.620278562	5.531002032	0	2.238714552	1.772939164	0.862081569	1.029767991	4.472936006	1.760047788	5.633774376	0	0.048691851	2.571694982	5.546968376	19.98222417	2.909153677	1.226525134	0	0	2.82854842	3.111251215	0	0	0.547776095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2347	0	26.04525883	26.5404	1.620278562	5.531002032	0	2.238714552	1.772939164	0.862081569	1.029767991	4.472936006	1.760047788	5.633774376	0	0.048691851	2.571694982	5.546968376	19.98222417	2.909153677	1.226525134	0	0	2.82854842	3.111251215	0	0	0.547776095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2347	NO	"25% (1a, 1a1); $0 n/c (1a2, 1a3)"	"25% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												19.9771	0.4666	4.403	0.5088	1.1089	1.3172	1.4374	0.5101	3.3233	0.8718	4.1101	0	0.0241	1.9227	2.6756	9.8784	0.771	0.4073	0	0	1.4402	0.4042	0	0	0.0648	0	0.0043	0	0	0											55.6268	0	0	46.5175	2.086857329	9.933966961	0.508837598	3.347582809	3.090183446	2.299481205	1.539827229	7.796202532	2.631825355	9.74389485	0	0.072809642	4.494369125	8.222526678	29.86060004	3.680170356	1.633785352	0	0	4.268741701	3.515436085	0	0	0.612606349	0	0.00430566	0	0	0	0	0	0	0	0	0	0	0	0	0	145.8615
H3887_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	278.6607191	5.044313292	23.84452505	316.8425206	6.2848607	5.843781126	6.913475676	9.825462455	28.44326536	13.51158816	31.12784344	0	0.338775038	18.06653461	23.21389522	85.89567707	2.136882247	5.170115188	0	0	14.13250186	4.126487965	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.0378	0.362723743	3.884212264	0	1.464372543	1.361601002	1.610839833	2.289332752	6.627280829	3.148200042	7.252787523	0	0.078934584	4.209502564	5.408837585	20.01369276	0.497893563	1.204636839	0	0	3.292872933	0.961471696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.707	0	0	20.0378	0.362723743	3.884212264	0	1.464372543	1.361601002	1.610839833	2.289332752	6.627280829	3.148200042	7.252787523	0	0.078934584	4.209502564	5.408837585	20.01369276	0.497893563	1.204636839	0	0	3.292872933	0.961471696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.707	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.6038	0.0471	1.5483	0	0.5012	0.4661	0.5514	0.7836	2.2684	1.0776	2.4825	0	0.027	1.4408	1.7552	6.4945	0.1616	0.3909	0	0	1.0685	0.312	0	0	0	0	0	0	0	0											23.9804	0	0	22.6416	0.409857336	5.432464705	0	1.965600729	1.827652352	2.162201118	3.072929869	8.895678966	4.225771868	9.735285265	0	0.105952462	5.650339011	7.164023292	26.50820233	0.659461673	1.595545482	0	0	4.361421104	1.273472445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.6874
H3887_802_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	278.6607191	5.044313292	23.84452505	316.8425206	6.2848607	5.843781126	6.913475676	9.825462455	28.44326536	13.51158816	31.12784344	0	0.338775038	18.06653461	23.21389522	85.89567707	2.136882247	5.170115188	0	0	14.13250186	4.126487965	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.0378	0.362723743	3.884212264	0	1.464372543	1.361601002	1.610839833	2.289332752	6.627280829	3.148200042	7.252787523	0	0.078934584	4.209502564	5.408837585	20.01369276	0.497893563	1.204636839	0	0	3.292872933	0.961471696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.707	0	0	20.0378	0.362723743	3.884212264	0	1.464372543	1.361601002	1.610839833	2.289332752	6.627280829	3.148200042	7.252787523	0	0.078934584	4.209502564	5.408837585	20.01369276	0.497893563	1.204636839	0	0	3.292872933	0.961471696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.707	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.6038	0.0471	1.5483	0	0.5012	0.4661	0.5514	0.7836	2.2684	1.0776	2.4825	0	0.027	1.4408	1.7552	6.4945	0.1616	0.3909	0	0	1.0685	0.312	0	0	0	0	0	0	0	0											23.9804	0	0	22.6416	0.409857336	5.432464705	0	1.965600729	1.827652352	2.162201118	3.072929869	8.895678966	4.225771868	9.735285265	0	0.105952462	5.650339011	7.164023292	26.50820233	0.659461673	1.595545482	0	0	4.361421104	1.273472445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.6874
H3887_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	278.6607191	5.044313292	23.84452505	316.8425206	6.2848607	5.843781126	6.913475676	9.825462455	28.44326536	13.51158816	31.12784344	0	0.338775038	18.06653461	23.21389522	85.89567707	2.136882247	5.170115188	0	0	14.13250186	4.126487965	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071907457	0.071907457	0.162897447	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.0378	0.362723743	3.884212264	0	1.464372543	1.361601002	1.610839833	2.289332752	6.627280829	3.148200042	7.252787523	0	0.078934584	4.209502564	5.408837585	20.01369276	0.497893563	1.204636839	0	0	3.292872933	0.961471696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.707	0	0	20.0378	0.362723743	3.884212264	0	1.464372543	1.361601002	1.610839833	2.289332752	6.627280829	3.148200042	7.252787523	0	0.078934584	4.209502564	5.408837585	20.01369276	0.497893563	1.204636839	0	0	3.292872933	0.961471696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.707	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.6038	0.0471	1.5483	0	0.5012	0.4661	0.5514	0.7836	2.2684	1.0776	2.4825	0	0.027	1.4408	1.7552	6.4945	0.1616	0.3909	0	0	1.0685	0.312	0	0	0	0	0	0	0	0											23.9804	0	0	22.6416	0.409857336	5.432464705	0	1.965600729	1.827652352	2.162201118	3.072929869	8.895678966	4.225771868	9.735285265	0	0.105952462	5.650339011	7.164023292	26.50820233	0.659461673	1.595545482	0	0	4.361421104	1.273472445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.6874
H3907_002_0	2010	3	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T																		0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0																		0	YES	380.8481664	4.729945029	1434.837584		321.1337338	17.68064982	0	1382.588971	972.5120181		7245.173942	1727.717529		3865.963042	26938.7342	6287.906756	27.78348034	726.9710003			1145.636458	490.4314423	0																		3400	1a: $250 per admit; $750 max	1b: $250 per admit; $750 max	"2: $25/day days 1-10, $60/day days 11-60, $0/day days 61-100 - $3250 annual max"	6: $0	10a: $100 per trip	11a: 20% coinsurance	"11b: 20% coinsurance & $0 supplies; Diabetic supplies refer to row ""k"""	4a: $50; 4b: $50	9A: $150 - $300 combined max; 9B: $150 - $300 combined max	8a: $0	"8B: $20 x-rays, $60 advanced imaging, $0 ther rad"	$250 observation stay copay - no PBP code - $750 annual max; 5: $0	12: $0	3: $0; 5: $0; 7C: $30; 7I: $30; 9C: $30; 9D: $0	7A: $15; 14B: $0; 14C: $15; 14D: $0; 14E: $0; 14F: $0-$150; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7a: $30; 7b: $30; 7d: $30; 7f: $30; 7g: $30, 14a: $30; 16b: $30 (Medicare-covered); 17a: $30 (Medicare-covered); 18a: $30 (Medicare-covered)"	7e: $30; 7h: $30; 9c: $30	7c: $30; 7i: $30			"15: $5 per drug, per visit and in pharmacy $32 copay (31-day supply)"	11c: $20/$60 copay supplies; 13a: $0	10b: not covered	16a: not covered; 16b: routine not covered	17A: $150 limit/2 yrs for glasses and exam	17B: $150 limit/2 yrs for glasses and exam	18a: routine not covered	18b: routine not covered	14a: $0	13b: not covered											185.0850966	208.3333333	40.98645909		87.72558427	0.177790065	0	10.71085862	33.22258603		6.158021863	2.898411215		0.982803276	1.840522061	17.67179296	0.194805195	28.27157091			5	24.95705955	0																		NO	181.1015602	203.8494315	40.10431864		85.8374903	0.173963537	0	10.48033171	32.50754532		6.025484428	2.836029496		0.961650668	1.800909004	17.29144775	0.190612455	27.66308956			4.892386356	24.41991552	0																			5.7477	0.080349717	4.795265305	0	2.29710948	3.075788384	0	1.207499253	2.634498209	0	3.637973564	0.40832149	0	0.309808828	4.042850747	9.060584261	0.000441323	1.675855324	0	0	0.467074681	0.998024533	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4391	0	0.889504966	5.7477	0.080349717	4.795265305	0	2.29710948	3.075788384	0	1.207499253	2.634498209	0	3.637973564	0.40832149	0	0.309808828	4.042850747	9.060584261	0.000441323	1.675855324	0	0	0.467074681	0.998024533	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4391	NO																																																																																		0	0	0	5.7477	0.080349717	4.795265305	0	2.29710948	3.075788384	0	1.207499253	2.634498209	0	3.637973564	0.40832149	0	0.309808828	4.042850747	9.060584261	0.000441323	1.675855324	0	0	0.467074681	0.998024533	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4391
H3907_006_0	2010	6	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T	V			V														0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0	0			0														0	YES	419.2583994	9.76519234	1533.135197		379.8766528	25.27965915	0	1640.186707	1202.816235		9431.263312	2237.51523		5218.655136	35374.48599	8290.399988	62.80677926	1249.114888			1812.60879	972.4671278	0	0			1.226174134														3200	"1a:  $200 per Admit, max 2"	"1b:  $200 per Admit, max 2"	"2:  $25 per day, day 1-10; $60 per day, day 11 - 60"		10a:  $100 per Trip	11a:  20% Coinsurance	"11b:  20% Coinsurance, supplies paid 100%"	"4a,b:  $50 Copay"	"9a,b:  $100 Copay, max 2x"		8b:  $20/$50 Copay depending on type of Service	"9a:  $200 Observation copay- no PBP code, 2x Max"		"7c,i:  $30 Copay"	"7a, 14c:  $5 Copay"	"7a,b,d,f,g 14a, 16b, 17a, 18a:  $30 Copay"	"7e,h 9c:  $30 Copay"	"7c,i:  $30 Copay"			"15: $5 per drug, per visit and in Pharmacy $32/$96 Copay per 31/90 day supply"	11c:  $15/$45 Copay per 31/90 day supply	10a:  $100 per Trip	0			18a $30														156.7128104	181.1320755	41.40408508		84.84954545	0.167706351	0	10.77676596	23.13922806		5.519877676	11.24759498		2.534996182	8.05E-05	17.66087225	0	28.80577396			5	16.15240416	0	0			25.38461538														NO	153.8853822	177.8640725	40.65706844		83.31868148	0.164680576	0	10.58233048	22.7217478		5.420287491	11.04466475		2.489259528	7.90E-05	17.34223303	0	28.28605731			4.909789501	15.86098087	0	0			24.92662362															5.3765	0.14473974	5.194398554	0	2.637568486	4.163068826	0	1.446416481	2.277507261	0	4.260013213	2.059383798	0	1.082548918	0.000232906	11.98117071	0	2.944377942	0	0	0.741627301	1.285356876	0	0	0	0	0.002547032	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5974	0	0.837788973	5.3765	0.14473974	5.194398554	0	2.637568486	4.163068826	0	1.446416481	2.277507261	0	4.260013213	2.059383798	0	1.082548918	0.000232906	11.98117071	0	2.944377942	0	0	0.741627301	1.285356876	0	0	0	0	0.002547032	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5974	NO																																																																																		0	0	0	5.3765	0.14473974	5.194398554	0	2.637568486	4.163068826	0	1.446416481	2.277507261	0	4.260013213	2.059383798	0	1.082548918	0.000232906	11.98117071	0	2.944377942	0	0	0.741627301	1.285356876	0	0	0	0	0.002547032	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5974
H3907_020_0	2010	5	N/A																															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	NO	351.9693743	53.23047231		38.18582948	26.59021444	47.13605135	0	47.65181294	30.78986578	24.48629425	57.18580628	18.71317077	0.92240728	60.45244497	89.20429912	78.06247729	1.89334263	11.53570266	0	1.233236422	44.70506298	21.66346446																				Medicare Cost Sharing	Medicare Cost Sharing		Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing																			0.087374681	0.087374681		0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.087374681	0.087374681		0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				30.7532	4.65099554	0	0	6.195519965	10.98269996	0	11.10287241	7.174038727	5.70530656	13.32429286	4.360168788	0.214920896	14.08541968	20.78460169	18.18855721	0.441148833	2.68781872	0	0.287344086	10.41627968	5.047587219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.4028	0	0	30.7532	4.65099554	0	0	6.195519965	10.98269996	0	11.10287241	7.174038727	5.70530656	13.32429286	4.360168788	0.214920896	14.08541968	20.78460169	18.18855721	0.441148833	2.68781872	0	0.287344086	10.41627968	5.047587219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.4028	NO																																																																																		0	0	0	30.7532	4.65099554	0	0	6.195519965	10.98269996	0	11.10287241	7.174038727	5.70530656	13.32429286	4.360168788	0.214920896	14.08541968	20.78460169	18.18855721	0.441148833	2.68781872	0	0.287344086	10.41627968	5.047587219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.4028
H3907_029_0	2010	5	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T	V																	0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0	0																	0	YES	389.6799359	15.33080297	1324.594593		319.3070578	20.98637655	0	1549.578369	1044.008861		7721.010708	1909.10505		4526.57906	31518.2287	6703.406609	73.77000227	903.3422603			1266.27809	793.8590937	0	0																	3400	"1a:  $275 per Admit, max 3"	"1b:  $275 per Admit, max 3"	"2:  $25 per day, day 1-10; $60 per day, day 11 - 60"		10a:  $100 per Trip	11a:  20% Coinsurance	"11b:  20% Coinsurance, supplies paid 100%"	"4a,b:  $50 Copay"	"9a,b:  $175 Copay, max 2x"		8b:  $20/$60 Copay depending on type of Service	"9a:  $275 Observation copay- no PBP code, 3x Max"		"7c,i:  $40 Copay"	"7a, 14c:  $15 Copay"	"7a,b,d,f,g 14a, 16b, 17a, 18a:  $40 Copay"	"7e,h 9c:  $40 Copay"	"7c,i:  $40 Copay"			"15:  $5 per drug, per visit and in pharmacy $32/$96 Copay per 31/90 day supply"	11c:  $20/$60 Copay per 31/90 day supply	10a:  $100 per Trip																		202.6708496	202.6939655	40.45262742		84.52053069	0.173616109	0	11.92679271	41.96719325		6.630999075	3.225383667		3.210704352	1.843604467	23.41394083	0.036900369	37.25086334			5	20.75242958	0	0																	NO	199.5928591	199.6156239	39.83826772		83.23690558	0.170979377	0	11.74565884	41.32983162		6.530293165	3.176399314		3.161942937	1.815605388	23.05835004	0.036339958	36.68512928			4.924064301	20.43725954	0	0																		6.4814	0.255022317	4.397462834	0	2.214844285	3.588237594	0	1.516734906	3.595725868	0	4.201705288	0.505339998	0	1.192732057	4.768722155	12.88079134	0.0002234	2.7616023	0	0	0.519602895	1.352025361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2322	0	0.774648391	6.4814	0.255022317	4.397462834	0	2.214844285	3.588237594	0	1.516734906	3.595725868	0	4.201705288	0.505339998	0	1.192732057	4.768722155	12.88079134	0.0002234	2.7616023	0	0	0.519602895	1.352025361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2322	NO																																																																																		0	0	0	6.4814	0.255022317	4.397462834	0	2.214844285	3.588237594	0	1.516734906	3.595725868	0	4.201705288	0.505339998	0	1.192732057	4.768722155	12.88079134	0.0002234	2.7616023	0	0	0.519602895	1.352025361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2322
H3907_030_0	2010	6	N/A																																																																																																															0	NO																																																																																																																										NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H3907_031_0	2010	6	N/A																																																																																																															0	NO																																																																																																																										NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H3907_801_0	2010	5	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			coin	P	T	V			V														0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0	0			0														0	YES	348.6831721	7.307404607	1397.2412		295.3414866	22.01736725	0	1384.84837	1140.602083		9864.517948	1868.062977		4405.080036	35145.65965	9043.513535	42.44832012	1508.150633			46.24197055	838.8345433	60.30356589	346.0521443			1.563059242														3200	"1a:  $150 per Admit,"	1b:  $150 per Admit	"2:  $60 per day, day 11 - 50"		10a:  $75 per Trip	11a:  20% Coinsurance	"11b:  20% Coinsurance, supplies paid 100%"	"4a,b:  $50 Copay"	"9a,b:  $100 Copay,"		8b:  $10/$50 Copay depending on type of Service	"9a:  $150 Observation copay- no PBP code,"		"7c,i:  $25 Copay"	"7a, 14c:  $10"	"7a,b,d,f,g 14a, 16b, 17a, 18a:  $25 Copay"	"7e,h 9c:  $25 Copay"	"7c,i:  $25 Copay"			15:  20% Coinsurance	11c:  $20/$60 Copay per 31/90 day supply	10a:  $75 per Trip	"16a: $25 copay, 16b: 20%"			18a $25														129.0685017	135.7835821	38.34937843		69	0.177851557	0	10.76706049	23		4.000976743	9		1.347286308	1.101270335	15.04905503	24.5	24			0.2	59.22839016	39.75	17.70447377			21.42857143														NO	126.7398349	133.3337611	37.65747512		67.75509511	0.174642741	0	10.57280011	22.5850317		3.928790721	8.837621101		1.322978434	1.081401106	14.77753848	24.05796855	23.5669896			0.19639158	58.15978563	39.03282653	17.38504788			21.041955															3.6827	0.081193645	4.384714644	0	1.667574209	3.84517337	0	1.22014375	2.146711184	0	3.229635548	1.375769398	0	0.485652157	3.167212935	11.1367391	0.085101696	2.961880857	0	0	9.081533659	4.065536435	0.196151552	0.501344425	0	0	0.002740819	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3175	0	5.140595877	3.6827	0.081193645	4.384714644	0	1.667574209	3.84517337	0	1.22014375	2.146711184	0	3.229635548	1.375769398	0	0.485652157	3.167212935	11.1367391	0.085101696	2.961880857	0	0	9.081533659	4.065536435	0.196151552	0.501344425	0	0	0.002740819	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3175	NO																																																																																		0	0	0	3.6827	0.081193645	4.384714644	0	1.667574209	3.84517337	0	1.22014375	2.146711184	0	3.229635548	1.375769398	0	0.485652157	3.167212935	11.1367391	0.085101696	2.961880857	0	0	9.081533659	4.065536435	0.196151552	0.501344425	0	0	0.002740819	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3175
H3907_802_0	2010	5	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			coin	P	T	V			V														0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0	0			0														0	YES	348.6831721	7.307404607	1397.2412		295.3414866	22.01736725	0	1384.84837	1140.602083		9864.517948	1868.062977		4405.080036	35145.65965	9043.513535	42.44832012	1508.150633			46.24197055	838.8345433	60.30356589	346.0521443			1.563059242														3200	"1a:  $150 per Admit,"	1b:  $150 per Admit	"2:  $60 per day, day 11 - 50"		10a:  $75 per Trip	11a:  20% Coinsurance	"11b:  20% Coinsurance, supplies paid 100%"	"4a,b:  $50 Copay"	"9a,b:  $100 Copay,"		8b:  $10/$50 Copay depending on type of Service	"9a:  $150 Observation copay- no PBP code,"		"7c,i:  $25 Copay"	"7a, 14c:  $10"	"7a,b,d,f,g 14a, 16b, 17a, 18a:  $25 Copay"	"7e,h 9c:  $25 Copay"	"7c,i:  $25 Copay"			15:  20% Coinsurance	11c:  $20/$60 Copay per 31/90 day supply	10a:  $75 per Trip	"16a: $25 copay, 16b: 20%"			18a $25														129.0685017	135.7835821	38.34937843		69	0.177851557	0	10.76706049	23		4.000976743	9		1.347286308	1.101270335	15.04905503	24.5	24			0.2	59.22839016	39.75	17.70447377			21.42857143														NO	126.7398349	133.3337611	37.65747512		67.75509511	0.174642741	0	10.57280011	22.5850317		3.928790721	8.837621101		1.322978434	1.081401106	14.77753848	24.05796855	23.5669896			0.19639158	58.15978563	39.03282653	17.38504788			21.041955															3.6827	0.081193645	4.384714644	0	1.667574209	3.84517337	0	1.22014375	2.146711184	0	3.229635548	1.375769398	0	0.485652157	3.167212935	11.1367391	0.085101696	2.961880857	0	0	9.081533659	4.065536435	0.196151552	0.501344425	0	0	0.002740819	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3175	0	0.979633954	3.6827	0.081193645	4.384714644	0	1.667574209	3.84517337	0	1.22014375	2.146711184	0	3.229635548	1.375769398	0	0.485652157	3.167212935	11.1367391	0.085101696	2.961880857	0	0	9.081533659	4.065536435	0.196151552	0.501344425	0	0	0.002740819	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3175	NO																																																																																		0	0	0	3.6827	0.081193645	4.384714644	0	1.667574209	3.84517337	0	1.22014375	2.146711184	0	3.229635548	1.375769398	0	0.485652157	3.167212935	11.1367391	0.085101696	2.961880857	0	0	9.081533659	4.065536435	0.196151552	0.501344425	0	0	0.002740819	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3175
H3907_803_0	2010	5	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			coin	P	T	V			V														0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0	0			0														0	YES	348.6831721	7.307404607	1397.2412		295.3414866	22.01736725	0	1384.84837	1140.602083		9864.517948	1868.062977		4405.080036	35145.65965	9043.513535	42.44832012	1508.150633			46.24197055	838.8345433	60.30356589	346.0521443			1.563059242														3200	"1a:  $150 per Admit,"	1b:  $150 per Admit	"2:  $60 per day, day 11 - 50"		10a:  $75 per Trip	11a:  20% Coinsurance	"11b:  20% Coinsurance, supplies paid 100%"	"4a,b:  $50 Copay"	"9a,b:  $100 Copay,"		8b:  $10/$50 Copay depending on type of Service	"9a:  $150 Observation copay- no PBP code,"		"7c,i:  $25 Copay"	"7a, 14c:  $10"	"7a,b,d,f,g 14a, 16b, 17a, 18a:  $25 Copay"	"7e,h 9c:  $25 Copay"	"7c,i:  $25 Copay"			15:  20% Coinsurance	11c:  $20/$60 Copay per 31/90 day supply	10a:  $75 per Trip	"16a: $25 copay, 16b: 20%"			18a $25														129.0685017	135.7835821	38.34937843		69	0.177851557	0	10.76706049	23		4.000976743	9		1.347286308	1.101270335	15.04905503	24.5	24			0.2	59.22839016	39.75	17.70447377			21.42857143														NO	126.7398349	133.3337611	37.65747512		67.75509511	0.174642741	0	10.57280011	22.5850317		3.928790721	8.837621101		1.322978434	1.081401106	14.77753848	24.05796855	23.5669896			0.19639158	58.15978563	39.03282653	17.38504788			21.041955															3.6827	0.081193645	4.384714644	0	1.667574209	3.84517337	0	1.22014375	2.146711184	0	3.229635548	1.375769398	0	0.485652157	3.167212935	11.1367391	0.085101696	2.961880857	0	0	9.081533659	4.065536435	0.196151552	0.501344425	0	0	0.002740819	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3175	0	5.140595877	3.6827	0.081193645	4.384714644	0	1.667574209	3.84517337	0	1.22014375	2.146711184	0	3.229635548	1.375769398	0	0.485652157	3.167212935	11.1367391	0.085101696	2.961880857	0	0	9.081533659	4.065536435	0.196151552	0.501344425	0	0	0.002740819	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3175	NO																																																																																		0	0	0	3.6827	0.081193645	4.384714644	0	1.667574209	3.84517337	0	1.22014375	2.146711184	0	3.229635548	1.375769398	0	0.485652157	3.167212935	11.1367391	0.085101696	2.961880857	0	0	9.081533659	4.065536435	0.196151552	0.501344425	0	0	0.002740819	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3175
H3909_001_0	2010	7	N/A																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V	V	S																				0	0	0		0	0	0	0	0		0			0	0	0	0	0	0	0	0																				0	NO	419.6058262	6.100584478	1272.298374		278.9020656	9.523220828	11.70647289	257.6412709	385.6543612		755.7249418			370.7204449	3813.484665	6133.269242	225.5984983	888.5729641	152.4766748	87.10408682	0.810182406																					$850/stay (PBP 1A)	$850/stay (PBP 1A)	$25 per day 100 day max (PBP category 2)		$100 per trip (PBP category 10A)	20% coinsurance (PBP category 11A)	20% coinsurance (PBP categories 11B and 11C)	"$50 per visit (PBP category 4A), $20-40 per Visit (PBP category 4B)"	$125/$250 per visit (PBP categories 9A and 9B)		$40 per visit (PBP category 8A)			"$40 per visit (PBP categories 3, 5, 9C, and 9D)"	$20 per visit (PBP category 7A)	"$40 per visit (PBP categories 4B, 7B, 7D, and 7F)"	"$40 per visit (PBP categories 7E, 7H and 9C)"	$40 per visit (PBP categories 7C and 7I)	$40 per visit (per note in PBP category 8B)	"$40 per visit (PBP category 17A - Medicare covered vision exams, PBP category 18A - Medicare Covered Hearing Exams) and 7D"	$50 per script for certain injectible drugs (PBP category 15)																				850	850	25		100	0.2	0.2	50	196.4935776		40			40	20	40	40	40	40	40	50																				NO	850	850	25		100	0.2	0.2	50	196.4935776		40			40	20	40	40	40	40	40	50																					29.7221	0.432124734	2.650621613	0	2.32418388	1.904644166	2.341294578	1.073505295	6.314883762	0	2.519083139	0	0	1.235734816	6.355807774	20.44423081	0.751994994	2.96190988	0.508255583	0.290346956	0.00337576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8341			29.7221	0.432124734	2.650621613	0	2.32418388	1.904644166	2.341294578	1.073505295	6.314883762	0	2.519083139	0	0	1.235734816	6.355807774	20.44423081	0.751994994	2.96190988	0.508255583	0.290346956	0.00337576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8341	NO	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	paid at in-network levels	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter																					0.208	0	0.092	0.0202	0.7551	0.0638	0.0337		0.2592	0.0091	0.0274	0	0.0569	0.0329	0.3651	0.4338	0.5307	0.2418	0.2733	0.8424	0																				4.2453	500		29.93	0.432124734	2.74257282	0.020159307	3.079241085	1.968479828	2.374982668	1.073505295	6.574046413	0.00908333	2.546505623	0	0.05691678	1.268636605	6.720931926	20.87805152	1.282728275	3.203750536	0.781573163	1.132702187	0.00337576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0794
H3909_007_0	2010	6	N/A																															A	A	D		T	Coin	Coin	V	V		V			V	V	V	V	V	V	V	S																				0	0	0		0	0	0	0	0		0			0	0	0	0	0	0	0	0																				0	NO	517.7751371	11.09518151	2666.368263		297.2895463	12.09928386	10.46979677	312.334093	458.0514669		843.4824787			319.4549698	4747.807954	7270.35601	143.37211	825.2884595	166.2682419	215.9096457	1																					$850/stay (PBP 1A)	$850/stay (PBP 1B)	$25 per day 100 day max (PBP category 2)		$100 per trip (PBP category 10A)	20% coinsurance (PBP category 11A)	20% coinsurance (PBP categories 11B)	$50 per visit (PBP category 4A)	$125/$250 per visit (PBP categories 9B and 9A respectively)		$40 per visit (PBP category 8B)			"$40 per visit (PBP categories 3, 5, 9C, and 9D)"	"$20 per visit (PBP category 4B, 7A)"	"$40 per visit (PBP categories 4B, 7B, 7D, and 7F)"	"$40 per visit (PBP categories 7E, 7H and 9C)"	$40 per visit (PBP categories 7C and 7I)	$40 per visit (per note in PBP category 8B)	"$40 per visit (PBP category 17A - Medicare covered vision exams, PBP category 18A - Medicare Covered Hearing Exams) and 7D"	$50 per script for certain injectible drugs (PBP category 15)																				850	850	25		100	0.2	0.2	50	196.4935776		40			40	20	40	40	40	40	40	50																				NO	850	850	25		100	0.2	0.2	50	196.4935776		40			40	20	40	40	40	40	40	50																					36.6757	0.78590869	5.554933881	0	2.477412886	2.419856771	2.093959354	1.301392054	7.500347621	0	2.811608262	0	0	1.064849899	7.913013257	24.23452003	0.477907033	2.750961532	0.554227473	0.719698819	0.004166667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3405			36.6757	0.78590869	5.554933881	0	2.477412886	2.419856771	2.093959354	1.301392054	7.500347621	0	2.811608262	0	0	1.064849899	7.913013257	24.23452003	0.477907033	2.750961532	0.554227473	0.719698819	0.004166667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.3405	NO	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter	$500 plan level oon deductible; 30% coinsurance thereafter																				0	0	0	0	0.4665	0.1245	0.237	0	0	0	0.0202	0	0	0.2016	0.3058	0.763	0.3477	0.2494	0.6127	0.7604	0	0																			4.0889	500		36.6757	0.78590869	5.554933881	0	2.943881002	2.544370309	2.330968352	1.301392054	7.500347621	0	2.831807101	0	0	1.266453999	8.218853058	24.99748529	0.825625073	3.000404921	1.166918156	1.480104239	0.004166667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.4294
H3909_801_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	NO	287.008952	7.326263866	22.96475384	9.298480673	6.61007181	5.025986094	11.10833634	7.014437257	64.64554489	12.54776833	32.4006874	0	0.293658964	112.2654713	19.90048994	41.68942445	0	11.28158296	23.74395542	220.7531254	19.05877014	1.081681642																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				21.2227	0.541735664	3.434912376	0	1.540146732	1.17105476	2.588242367	1.634363881	15.06241196	2.92363002	7.549360164	0	0.068422539	26.15785482	4.636814156	9.713635897	0	2.628608829	5.532341613	51.43547822	4.440693442	0.252031823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.5344			21.2227	0.541735664	3.434912376	0	1.540146732	1.17105476	2.588242367	1.634363881	15.06241196	2.92363002	7.549360164	0	0.068422539	26.15785482	4.636814156	9.713635897	0	2.628608829	5.532341613	51.43547822	4.440693442	0.252031823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.5344	NO																																																																																		0			21.2227	0.541735664	3.434912376	0	1.540146732	1.17105476	2.588242367	1.634363881	15.06241196	2.92363002	7.549360164	0	0.068422539	26.15785482	4.636814156	9.713635897	0	2.628608829	5.532341613	51.43547822	4.440693442	0.252031823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	162.5344
H3909_802_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	NO	337.3029872	4.763697987	22.8538349	11.31665566	7.445704449	8.587479915	9.515927861	7.326615099	64.10047714	13.2523749	36.40879892	0	0.342777899	132.5662874	21.47577826	46.62470307	0	10.73265404	28.92805657	287.3337553	7.988242098	1.815928426																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				24.9416	0.35224845	3.418321871	0	1.734849137	2.00088282	2.217211192	1.707101318	14.93541117	3.087803353	8.483250149	0	0.07986725	30.88794497	5.003856334	10.86355582	0	2.50070839	6.74023718	66.94876499	1.861260409	0.423111323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.188			24.9416	0.35224845	3.418321871	0	1.734849137	2.00088282	2.217211192	1.707101318	14.93541117	3.087803353	8.483250149	0	0.07986725	30.88794497	5.003856334	10.86355582	0	2.50070839	6.74023718	66.94876499	1.861260409	0.423111323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.188	NO																																																																																		0			24.9416	0.35224845	3.418321871	0	1.734849137	2.00088282	2.217211192	1.707101318	14.93541117	3.087803353	8.483250149	0	0.07986725	30.88794497	5.003856334	10.86355582	0	2.50070839	6.74023718	66.94876499	1.861260409	0.423111323	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	188.188
H3912_001_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	350.3788685	36.74816391	9198.663718	44.21538152	25.11469003	11.01936135	15.91222059	15.84749824	13.71786373	35.88566807	35.31162331	0	0.116010508	6.745513165	1.125572069	168.988056	16.85975131	49.48559291	0	0	1.272614228	8.641813265	1117.333205	0	110.4350522	142.1990681	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076905221	0.077839293	0	0	0.2	0.2	0.107786401	0.04835424	0.2	0	0.086394358	0	0.2	0.151508444	0.001434008	0.199664593	0.2	0	0	0	0.2	0.194637515	0	0	0	0	0	0	0	0											NO	0.076905221	0.077839293	0	0	0.2	0.2	0.107786401	0.04835424	0.2	0	0.086394358	0	0.2	0.151508444	0.001434008	0.199664593	0.2	0	0	0	0.2	0.194637515	0	0	0	0	0	0	0	0												26.946	2.860451095	0	0	5.022938006	2.20387227	1.715120983	0.76629373	2.743572746	0	3.050725039	0	0.023202102	1.022002203	0.001614079	33.74093138	3.371950261	0	0	0	0.254522846	1.682021056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4052	0	0	26.946	2.860451095	0	0	5.022938006	2.20387227	1.715120983	0.76629373	2.743572746	0	3.050725039	0	0.023202102	1.022002203	0.001614079	33.74093138	3.371950261	0	0	0	0.254522846	1.682021056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4052	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.5323	0.5802	0	0.0108	0.3965	0.174	0.2512	0.0403	0.2166	0.17	0.4465	0	0.0012	0.0807	0.0292	4.4084	0.4398	0	0	0	0.0332	0.2194	0	0	0.018	0	0	0	0	0											13.0484	0	0	32.4783	3.440685262	0	0.010794846	5.419485743	2.377862186	1.966366572	0.806624979	2.960170594	0.169984743	3.497223906	0	0.024423265	1.102686587	0.030766297	38.14931545	3.811769861	0	0	0	0.287721478	1.901415107	0	0	0.018005715	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4536
H3912_005_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	337.0079224	15.46310924	1655.241481	1062.914647	12.77665952	21.25167753	13.0296396	24.19041384	23.41033899	12.21899577	29.67632439	0	0.053538697	16.37807042	26.21055701	93.36153509	6.519459254	2.725117303	0	0	15.47341751	3.617608439	468.9839195	347.2880256	105.2630833	137.7704911	0	0	61.08197118	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078872564	0.079830531	43.47002967	0	0.2	0.2	0.2	0.102630603	0.2	0	0.166726277	0	0.2	0.149901278	0.170735495	0.199847361	0.2	0	0	0	0.2	0.19955736	0	0	0	0	0	0	0	0											NO	0.078872564	0.079830531	43.47002967	0	0.2	0.2	0.2	0.102630603	0.2	0	0.166726277	0	0.2	0.149901278	0.170735495	0.199847361	0.2	0	0	0	0.2	0.19955736	0	0	0	0	0	0	0	0												26.5807	1.234428216	5.996116357	0	2.555331904	4.250335505	2.605927921	2.482676754	4.682067798	0	4.947823091	0	0.010707739	2.455093692	4.475072435	18.65805645	1.303891851	0	0	0	3.094683501	0.721920391	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0548	0	0	26.5807	1.234428216	5.996116357	0	2.555331904	4.250335505	2.605927921	2.482676754	4.682067798	0	4.947823091	0	0.010707739	2.455093692	4.475072435	18.65805645	1.303891851	0	0	0	3.094683501	0.721920391	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0548	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												17.146	0.7867	5.1288	0.4898	0.7574	1.2598	0.7724	0.4903	1.3878	0.2173	1.4666	0	0.0021	0.7277	2.3849	8.6039	0.6008	0	0	0	1.426	0.3326	0	0.0762	0.0558	0.0249	0	0	0	0											44.1378	0	0	43.7267	2.021147808	11.12489282	0.489772732	3.312750642	5.510165491	3.378343681	2.972930301	6.069866337	0.217307889	6.414393408	0	0.01282364	3.182801104	6.859992245	27.26196263	1.904704762	0	0	0	4.520665115	1.054569982	0	0.076159655	0.055792069	0.02489453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.1926
H3912_008_0	2010	5	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2205.782904	186.0188427	49.42577149	919.7933865	324.6076342	15.86683722	15.33673584	469.1352958	38.47157477	12096.24668	46.75706187	0	0.158517335	26.71475631	7601.386599	5654.637994	744.8547408	338.9895659	0	0	19.47473303	1084.554228	668.7796991	0	131.0051655	0	14.59974862	4.538147958	78.82046454	0											3350	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	0.172661179	0	150	0.2	0.103142441	49.62177511	0.2	3	0.176382924	0	0.2	0.149489004	10.28151283	25	38.5	25	0	0	0.2	24.78559098	0	0	25	0	0	0	0	0											NO	126.8679001	96.6252785	0.118894589	0	103.2900882	0.137720118	0.071023946	34.16958351	0.137720118	2.065801763	0.121457385	0	0.137720118	0.10324096	10.1767961	25	38.5	17.2150147	0	0	0.137720118	24.78559098	0	0	25	0	0	0	0	0												23.3203	1.49784354	5.876456809	0	2.794062597	2.185182687	1.089275494	1.335846472	5.2983098	2.082370643	5.678990478	0	0.021831026	2.75805709	6.446480128	11.78049582	2.389742293	0.486309196	0	0	2.682062522	2.24010979	0	0	0.272927428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2366	0	25.87948587	23.3203	1.49784354	5.876456809	0	2.794062597	2.185182687	1.089275494	1.335846472	5.2983098	2.082370643	5.678990478	0	0.021831026	2.75805709	6.446480128	11.78049582	2.389742293	0.486309196	0	0	2.682062522	2.24010979	0	0	0.272927428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2366	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												11.6699	0.3329	2.5146	0.2693	0.5015	0.5883	0.5687	0.2398	1.4265	0.3738	1.4986	0	0.0039	0.7496	1.9328	6.7046	0.5143	0.2396	0	0	1.1128	0.3533	0	0	0.0424	0	0.0036	0.003	0	0											31.6438	0	0	34.9902	1.830740578	8.391101324	0.269318199	3.295563155	2.773503617	1.65794098	1.575614813	6.72478392	2.456131074	7.177553125	0	0.025749432	3.507679195	8.379240798	18.48506825	2.904046757	0.725892773	0	0	3.794904409	2.593448532	0	0	0.315279592	0	0.003640027	0.002985624	0	0	0	0	0	0	0	0	0	0	0	0	111.8804
H3916_001_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	249.8103997	0	391.330855	0	247.2571807	13.50218344	0	280.481172	603.0682367	0	1950.166599	0	0	680.4204944	3731.880355	6394.461267	0	0	0	3749.876917	79.19312233	0	0	12.29411765	420	0	174.4298937	0	0	0												"$100/admit $300max; PBP 1a, 1b"		$50 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$50; PBP 9a, 9b"	$0; PBP 8a	$0-$50; PBP 8b			"$0-$25; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$10; PBP 7a, 14c-j"	"$0-$25; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$25; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0-$25; 0%-40%; PBP 16a, 16b"	"$0-$25; PBP 17a, 17b"		"$0-$25; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											100	0	50	0	100	0.15	0	50	50	0	14	0	0	25	10	25	0	0	0	25	0.042	0	0	0.32	25	0	25	0	0	0											NO	96.25125154	0	48.12562577	0	100	0.122574743	0	48.12562577	48.12562577	0	13.47517522	0	0	24.06281289	9.625125154	24.06281289	0	0	0	24.06281289	0.040425526	0	0	0.32	25	0	25	0	0	0												2.0037	0	1.56942019	0	2.060476506	1.65502666	0	1.124860993	2.418586356	0	2.189903052	0	0	1.364402587	2.993317957	12.82239375	0	0	0	7.519382217	3.201423598	0	0	3.934117647	0.875	0	0.363395612	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0954	0	1.819437333	2.0037	0	1.56942019	0	2.060476506	1.65502666	0	1.124860993	2.418586356	0	2.189903052	0	0	1.364402587	2.993317957	12.82239375	0	0	0	7.519382217	3.201423598	0	0	3.934117647	0.875	0	0.363395612	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0954	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	1.3618	0	0.0541	0.0109	0.6886	0.0285	0	0.001	0.2225	0.0993	0.1178	0	0	0.0714	0.0973	0.2274	0	0	0	0.5995	0.0665	0	0	0	0	0	0.028	0	0	0											3.6748	500	1.445138583	3.3655	0	1.623543823	0.010902176	2.749028495	1.683530085	0	1.125905977	2.641067797	0.099346594	2.307710571	0	0	1.435808348	3.090646002	13.04981273	0	0	0	8.11892077	3.267935276	0	0	3.934117647	0.875	0	0.39140834	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7702
H3916_002_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	238.9629453	0	270.460481	0	179.1988677	11.7150202	0	322.1940527	577.5995266	0	1839.497172	0	0	799.7156444	4171.049521	5614.241195	0	0	0	2599.068009	75.85304423	0	0	12.29411765	420	0	174.4298937	0	0	0												"$100/admit $300max; PBP 1a, 1b"		$50 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$50; PBP 9a, 9b"	$0; PBP 8a	$0-$50; PBP 8b			"$0-$25; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$10; PBP 7a, 14c-j"	"$0-$25; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$25; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0-$25; 0%-40%; PBP 16a, 16b"	"$0-$25; PBP 17a, 17b"		"$0-$25; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											100	0	50	0	100	0.15	0	50	50	0	14	0	0	25	10	25	0	0	0	25	0.042	0	0	0.32	25	0	25	0	0	0											NO	97.04079741	0	48.52039871	0	100	0.122574743	0	48.52039871	48.52039871	0	13.58571164	0	0	24.26019935	9.704079741	24.26019935	0	0	0	24.26019935	0.040757135	0	0	0.32	25	0	25	0	0	0												1.9324	0	1.093570864	0	1.493323898	1.435965586	0	1.302748658	2.33544661	0	2.082573178	0	0	1.616771746	3.37301643	11.35021755	0	0	0	5.254492335	3.091552757	0	0	3.934117647	0.875	0	0.363395612	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5346	0	1.340801805	1.9324	0	1.093570864	0	1.493323898	1.435965586	0	1.302748658	2.33544661	0	2.082573178	0	0	1.616771746	3.37301643	11.35021755	0	0	0	5.254492335	3.091552757	0	0	3.934117647	0.875	0	0.363395612	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5346	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	2.381	0	0.0661	0.0257	1.0314	0.0831	0	0.0047	0.2283	0.142	0.1861	0	0	0.0841	0.0564	0.1697	0	0	0	0.4967	0.1791	0	0	0	0	0	0.028	0	0	0											5.1625	500	1.775869854	4.3134	0	1.159695885	0.025670511	2.524693548	1.519035652	0	1.307449552	2.563791755	0.142017906	2.268706259	0	0	1.700856218	3.429436225	11.51996633	0	0	0	5.751217813	3.2706404	0	0	3.934117647	0.875	0	0.39140834	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6971
H3916_005_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	0	0	235.5312048	0	63.65476146	10.66944142	0	263.2437294	0	0	0	0	0	833.0629405	4757.226591	5546.311263	0	0	0	1453.376421	68.83070952	0	0	12.29411765	420	0	290.7164895	0	0	0												"$0; PBP 1a, 1b"		$25 days 16-55; PBP 2	$0; PBP 6	$50; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b			"$0-$25; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$10; PBP 7a, 14c-j"	"$0-$25; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$25; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0-$25; 0%-40%; PBP 16a, 16b"	"$0-$25; PBP 17a, 17b"		"$0-$25; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											0	0	25	0	50	0.15	0	50	0	0	0	0	0	25	10	25	0	0	0	25	0.042	0	0	0.32	25	0	25	0	0	0											NO	0	0	24.60484049	0	50	0.122574743	0	49.20968098	0	0	0	0	0	24.60484049	9.841936196	24.60484049	0	0	0	24.60484049	0.041336132	0	0	0.32	25	0	25	0	0	0												0	0	0.482933977	0	0.265228173	1.307804036	0	1.079511662	0	0	0	0	0	1.708115064	3.901693381	11.37217533	0	0	0	2.980007918	2.845195296	0	0	3.934117647	0.875	0	0.605659353	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3574	0	0.683994194	0	0	0.482933977	0	0.265228173	1.307804036	0	1.079511662	0	0	0	0	0	1.708115064	3.901693381	11.37217533	0	0	0	2.980007918	2.845195296	0	0	3.934117647	0.875	0	0.605659353	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3574	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	3.6673	0	0.5253	0.053	1.1481	0.0953	0	0.0008	0.6352	0.3096	0.3975	0	0	0.2004	0.2052	0.5885	0	0	0	1.6259	0.2259	0	0	0	0	0	0.0467	0	0	0											9.7249	500	3.892457289	3.6673	0	1.008273317	0.0530068	1.413366217	1.403140726	0	1.080360131	0.635193761	0.309647484	0.397495296	0	0	1.908503286	4.106927703	11.96071025	0	0	0	4.605916441	3.0710543	0	0	3.934117647	0.875	0	0.652347233	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0824
H3916_012_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	241.920075	0	396.8383793	0	79.23161687	6.893637407	0	291.6190588	450.7336496	4454.362873	1698.134517	0	0	704.1678532	3914.893891	4608.349619	0	0	0	1301.795571	41.51537499	0	0	0	424.7270208	0	176.376282	0	0	0												"$250/admit $500max; PBP 1a, 1b"		$35 days 16-55; PBP 2	$0; PBP 6	$75; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$50; PBP 9a, 9b"	$15-$50; PBP 8a	$0-$50; PBP 8b			"$0-$25; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$25; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$25; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$25; PBP 17a, 17b"		"$0-$25; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											250	0	35	0	75	0.15	0	50	50	12	19	0	0	25	15	25	0	0	0	25	0.042	0	0	0	25	0	25	0	0	0											NO	240.7405448	0	33.70367628	0	75	0.135369596	0	48.14810897	48.14810897	11.55554615	18.29628141	0	0	24.07405448	14.44443269	24.07405448	0	0	0	24.07405448	0.040444412	0	0	0	25	0	25	0	0	0												4.8533	0	1.114576022	0	0.495197605	0.93318891	0	1.170075518	1.80849774	4.28938298	2.589128916	0	0	1.412681272	4.712368441	9.245138317	0	0	0	2.611624792	1.679064911	0	0	0	0.88484796	0	0.367450588	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1666	0	1.465727834	4.8533	0	1.114576022	0	0.495197605	0.93318891	0	1.170075518	1.80849774	4.28938298	2.589128916	0	0	1.412681272	4.712368441	9.245138317	0	0	0	2.611624792	1.679064911	0	0	0	0.88484796	0	0.367450588	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1666	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	4.4894	0	0.9767	0.0504	1.8419	0.0612	0	0.0008	0.6963	0.3084	0.3787	0	0	0.2052	0.2036	0.5788	0	0	0	1.724	0.1671	0	0	0	0	0	0.0425	0	0	0											11.725	500	6.553606387	9.3427	0	2.091287837	0.05040481	2.337131561	0.994349841	0	1.170888515	2.504763746	4.5977333	2.967849181	0	0	1.617879946	4.915981538	9.823970394	0	0	0	4.335654261	1.846155515	0	0	0	0.88484796	0	0.409938553	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8916
H3916_015_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	181.4919435	0	226.3236945	0	58.91176716	7.073540961	0	220.5135478	502.3970675	0	1713.522285	0	0	518.2685774	4015.54171	4275.514877	0	0	0	1155.274213	40.36147099	0	0	0	420	0	174.4298937	0	0	0												"$100/admit $200max; PBP 1a, 1b"		$25 days 16-55; PBP 2	$0; PBP 6	$75; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$50; PBP 9a, 9b"	$0; PBP 8a	$0-$50; PBP 8b			"$0-$25; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$25; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$25; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$25; PBP 17a, 17b"		"$0-$25; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											100	0	25	0	75	0.15	0	50	50	0	14	0	0	25	15	25	0	0	0	25	0.042	0	0	0	25	0	25	0	0	0											NO	98.20734205	0	24.55183551	0	75	0.122574743	0	49.10367103	49.10367103	0	13.74902789	0	0	24.55183551	14.73110131	24.55183551	0	0	0	24.55183551	0.041247084	0	0	0	25	0	25	0	0	0												1.4853	0	0.463055177	0	0.368198545	0.867037463	0	0.902335392	2.055795027	0	1.963272141	0	0	1.060370405	4.929445978	8.747644833	0	0	0	2.363675205	1.664792971	0	0	0	0.875	0	0.363395612	0	0	0	0	0	0	0	0	0	0	0	0	0	28.1093	0	0.661942954	1.4853	0	0.463055177	0	0.368198545	0.867037463	0	0.902335392	2.055795027	0	1.963272141	0	0	1.060370405	4.929445978	8.747644833	0	0	0	2.363675205	1.664792971	0	0	0	0.875	0	0.363395612	0	0	0	0	0	0	0	0	0	0	0	0	0	28.1093	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	3.3825	0	0.5227	0.0385	1.0101	0.0632	0	0.0008	0.6313	0.3029	0.3622	0	0	0.1716	0.1958	0.5248	0	0	0	1.4807	0.1517	0	0	0	0	0	0.028	0	0	0											8.8667	500	2.56165719	4.8678	0	0.985786334	0.038459667	1.37826973	0.930243019	0	0.903127018	2.687089947	0.302907287	2.325436014	0	0	1.232009634	5.12524129	9.272397845	0	0	0	3.844394697	1.816529451	0	0	0	0.875	0	0.39140834	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9761
H3916_018_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	195.5956744	0	190.9687705	0	51.83676432	6.578504637	0	270.6806551	422.2397325	3849.009856	1615.403269	0	0	565.6667247	3668.126331	3793.642366	0	0	0	1132.667411	45.91197308	0	0	0	408.7406857	0	171.9798302	0	0	0												"$250/admit $750max; PBP 1a, 1b"		$50 days 16-55; PBP 2	$0; PBP 6	$75; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$100; PBP 9a, 9b"	$15-$50; PBP 8a	$0-$50; PBP 8b			"$0-$35; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$35; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$35; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$35; PBP 17a, 17b"		"$0-$35; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											250	0	50	0	75	0.15	0	50	100	12	19	0	0	35	15	35	0	0	0	35	0.042	0	0	0	35	0	35	0	0	0											NO	239.983184	0	47.9966368	0	75	0.122574743	0	47.9966368	95.9932736	11.51919283	18.23872198	0	0	33.59764576	14.39899104	33.59764576	0	0	0	33.59764576	0.040317175	0	0	0	35	0	35	0	0	0												3.9116	0	0.76382156	0	0.323979777	0.806358513	0	1.082646757	3.377681181	3.694790562	2.455240926	0	0	1.583755853	4.401443182	10.62145436	0	0	0	3.171246537	1.851041049	0	0	0	1.192160333	0	0.501607838	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7389	0	1.721226693	3.9116	0	0.76382156	0	0.323979777	0.806358513	0	1.082646757	3.377681181	3.694790562	2.455240926	0	0	1.583755853	4.401443182	10.62145436	0	0	0	3.171246537	1.851041049	0	0	0	1.192160333	0	0.501607838	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7389	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	3.781	0	0.647	0.041	1.4956	0.0584	0	0.0008	0.6307	0.3123	0.3932	0	0	0.2129	0.2163	0.5426	0	0	0	1.6183	0.2067	0	0	0	0	0	0.0414	0	0	0											10.1981	500	4.549603568	7.6926	0	1.410851508	0.041003296	1.819567634	0.864713084	0	1.083477072	4.008356332	4.007101262	2.848423523	0	0	1.796641558	4.617714092	11.16400539	0	0	0	4.789586842	2.057705215	0	0	0	1.192160333	0	0.543036725	0	0	0	0	0	0	0	0	0	0	0	0	0	49.937
H3916_019_0	2010	5	N/A																															A	A	D	V	T	Ded	Ded	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	P	V	P													6.3898	0	7.2393	3.4824	1.6058	0	0	0	6.1161	4.9324	8.4553	0	0	3.4301	0	0	0	0	0	19.1158	11.3196	0	0	0	0	0	0	0	0	0											72.0866	NO	0	0	0	0	0	595.2914126	0	256.7939347	0	0	0	0	0	0	2913.533271	3587.603179	0	0	0	0	0	0	0	12.29411765	387.1927204	0	173.7943805	0	0	0												"$0; PBP 1a, 1b"		$0; PBP 2	$0; PBP 6	$0; PBP 10a	"$500 ded; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b			"$0; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$15; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$15; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	$0; PBP 15			"0%-40%; PBP 16a, 16b"	"$0-$15; PBP 17a, 17b"		"$0-$15; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											0	0	0	0	0	71.26141	0	50	0	0	0	0	0	0	15	15	0	0	0	0	0	0	0	0.32	15	0	15	0	0	0											NO	0	0	0	0	0	71.26141	0	50	0	0	0	0	0	0	15	15	0	0	0	0	0	0	0	0.32	15	0	15	0	0	0												0	0	0	0	0	3.535108785	0	1.069974728	0	0	0	0	0	0	3.641916589	4.484503974	0	0	0	0	0	0	0	3.934117647	0.483990901	0	0.217242976	0	0	0	0	0	0	0	0	0	0	0	0	0	17.3669	1200	0	6.3898	0	7.239344045	3.482436633	1.605802118	3.535108785	0	1.069974728	6.116053793	4.932426454	8.455278852	0	0	3.430052095	3.641916589	4.484503974	0	0	0	19.11579763	11.31961462	0	0	3.934117647	0.483990901	0	0.217242976	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4534	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	1.1652	0	0.1061	0.0178	1.2451	0.0236	0	0.001	0.3184	0.1539	0.1769	0	0	0.1083	0.1626	0.3547	0	0	0	0.9436	0.0895	0	0	0	0	0	0.0419	0	0	0											4.9086	1200	1.218685244	7.5549	0	7.345466211	3.500208618	2.850930307	3.558714922	0	1.070951928	6.434468921	5.086349367	8.632205149	0	0	3.538302365	3.804508591	4.839222056	0	0	0	20.05942024	11.409154	0	0	3.934117647	0.483990901	0	0.259108842	0	0	0	0	0	0	0	0	0	0	0	0	0	94.362
H3916_020_0	2010	5	N/A																															A	A	D	V	T	Ded	Ded	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	P	V	P													5.3673	0	7.3824	2.4421	1.5827	0	0	0	5.5575	3.5785	7.6845	0	0	4.0655	0	0	0	0	0	13.1643	9.1676	0	0	0	0	0	0	0	0	0											59.9924	NO	0	0	0	0	0	543.6114315	0	264.2332684	0	0	0	0	0	0	2798.518874	2932.227697	0	0	0	0	0	0	0	12.29411765	343.9799748	0	157.9987895	0	0	0												"$0; PBP 1a, 1b"		$0; PBP 2	$0; PBP 6	$0; PBP 10a	"$500 ded; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b			"$0; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$15; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$15; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	$0; PBP 15			"0%-40%; PBP 16a, 16b"	"$0-$15; PBP 17a, 17b"		"$0-$15; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											0	0	0	0	0	57.07216882	0	50	0	0	0	0	0	0	15	15	0	0	0	0	0	0	0	0.32	15	0	15	0	0	0											NO	0	0	0	0	0	57.07216882	0	50	0	0	0	0	0	0	15	15	0	0	0	0	0	0	0	0.32	15	0	15	0	0	0												0	0	0	0	0	2.585423616	0	1.100971952	0	0	0	0	0	0	3.498148592	3.665284621	0	0	0	0	0	0	0	3.934117647	0.429974969	0	0.197498487	0	0	0	0	0	0	0	0	0	0	0	0	0	15.4114	1000	0	5.3673	0	7.382386511	2.442085073	1.582719382	2.585423616	0	1.100971952	5.557470736	3.578458864	7.684536078	0	0	4.065491585	3.498148592	3.665284621	0	0	0	13.16431516	9.16762045	0	0	3.934117647	0.429974969	0	0.197498487	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4038	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	1.919	0	0.171	0.0357	1.9809	0.0577	0	0.0041	0.305	0.1871	0.2527	0	0	0.0799	0.0811	0.2388	0	0	0	0.7163	0.2063	0	0	0	0	0	0.0381	0	0	0											6.2736	1000	1.378918442	7.2863	0	7.553352363	2.477795344	3.563593478	2.643081645	0	1.105040221	5.862499441	3.765512113	7.937282654	0	0	4.145364062	3.579266043	3.904096982	0	0	0	13.88062024	9.373888713	0	0	3.934117647	0.429974969	0	0.235558957	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6774
H3916_022_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	193.9810591	0	241.0975129	0	150.9441453	7.741801325	0	225.7622835	376.8255604	3767.840391	1411.571976	0	0	539.9332345	2924.322893	4044.984162	0	0	0	1887.99641	38.73711067	0	0	0	362.3632777	0	152.3200837	0	0	0												"$200/admit $600max; PBP 1a, 1b"		$60 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$100; PBP 9a, 9b"	$20-$50; PBP 8a	$0-$50; PBP 8b			"$0-$30; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$20; PBP 7a, 14c-j"	"$0-$30; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$30; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$30; PBP 17a, 17b"		"$0-$30; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											200	0	60	0	100	0.15	0	50	100	15	23	0	0	30	20	30	0	0	0	30	0.042	0	0	0	30	0	30	0	0	0											NO	192.5133791	0	57.75401374	0	100	0.122574743	0	48.12834478	96.25668956	14.43850343	22.1390386	0	0	28.87700687	19.25133791	28.87700687	0	0	0	28.87700687	0.04042781	0	0	0	30	0	30	0	0	0												3.112	0	1.160362423	0	1.257867878	0.948949305	0	0.905463752	3.022665082	4.533498035	2.604237205	0	0	1.299304643	4.691427348	9.73391962	0	0	0	4.543307107	1.566056535	0	0	0	0.905908194	0	0.380800209	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6658	0	1.657905874	3.112	0	1.160362423	0	1.257867878	0.948949305	0	0.905463752	3.022665082	4.533498035	2.604237205	0	0	1.299304643	4.691427348	9.73391962	0	0	0	4.543307107	1.566056535	0	0	0	0.905908194	0	0.380800209	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6658	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	1.5139	0	0.0494	0.0111	0.677	0.0163	0	0.0008	0.2025	0.0903	0.1094	0	0	0.0635	0.1042	0.1972	0	0	0	0.5519	0.047	0	0	0	0	0	0.0367	0	0	0											3.6712	500	1.491301398	4.6259	0	1.209784864	0.011111908	1.934849212	0.965257014	0	0.906296139	3.225176676	4.623801946	2.713606376	0	0	1.362800121	4.795584877	9.931110645	0	0	0	5.095216603	1.613092867	0	0	0	0.905908194	0	0.417493021	0	0	0	0	0	0	0	0	0	0	0	0	0	44.337
H3916_024_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	193.9508091	0	454.2287622	0	141.8133712	12.26040909	0	337.492216	437.1090474	3603.951541	1417.160664	0	0	747.2596569	3237.338434	3714.647541	0	0	0	1570.911815	41.05259028	0	0	0	347.8751325	0	146.1167265	0	0	0												"$200/admit $600max; PBP 1a, 1b"		$60 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$100; PBP 9a, 9b"	$20-$50; PBP 8a	$0-$50; PBP 8b			"$0-$30; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$20; PBP 7a, 14c-j"	"$0-$30; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$30; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$30; PBP 17a, 17b"		"$0-$30; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											200	0	60	0	100	0.15	0	50	100	15	23	0	0	30	20	30	0	0	0	30	0.042	0	0	0	30	0	30	0	0	0											NO	192.0043629	0	57.60130887	0	100	0.122574743	0	48.00109072	96.00218144	14.40032722	22.08050173	0	0	28.80065443	19.20043629	28.80065443	0	0	0	28.80065443	0.040320916	0	0	0	30	0	30	0	0	0												3.1033	0	2.180347602	0	1.181778093	1.502816489	0	1.34999954	3.49695184	4.324840122	2.607634875	0	0	1.793463929	5.179859195	8.915356681	0	0	0	3.770274026	1.655278053	0	0	0	0.869687831	0	0.365291816	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2969	0	1.93439022	3.1033	0	2.180347602	0	1.181778093	1.502816489	0	1.34999954	3.49695184	4.324840122	2.607634875	0	0	1.793463929	5.179859195	8.915356681	0	0	0	3.770274026	1.655278053	0	0	0	0.869687831	0	0.365291816	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2969	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	2.4419	0	0.1235	0.0291	1.2214	0.0863	0	0.0047	0.2124	0.1437	0.1773	0	0	0.0661	0.0562	0.1694	0	0	0	0.529	0.1324	0	0	0	0	0	0.0352	0	0	0											5.4287	500	2.084401777	5.5452	0	2.303854135	0.029076844	2.403191436	1.589130091	0	1.354678162	3.709393895	4.468550997	2.784937958	0	0	1.859571166	5.23610354	9.084722937	0	0	0	4.299271044	1.787727506	0	0	0	0.869687831	0	0.400489904	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7256
H3916_025_0	2010	6	N/A																															A	A	D	V	T	Ded	Ded	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	P	V	P													4.9536	0	6.5318	1.4099	0.4924	0	0	0	7.3391	5.115	9.0365	0	0	5.2216	0	0	0	0	0	16.9693	6.6366	0	0	0	0	0	0	0	0	0											63.7059	NO	0	0	0	0	0	359.183136	0	282.3026474	0	0	0	0	0	0	3423.573796	3944.635391	0	0	0	0	0	0	0	12.29411765	400.631818	0	179.965769	0	0	0												"$0; PBP 1a, 1b"		$0; PBP 2	$0; PBP 6	$0; PBP 10a	"$500 ded; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b			"$0; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$15; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$15; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	$0; PBP 15			"0%-40%; PBP 16a, 16b"	"$0-$15; PBP 17a, 17b"		"$0-$15; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											0	0	0	0	0	54.13577113	0	50	0	0	0	0	0	0	15	15	0	0	0	0	0	0	0	0.32	15	0	15	0	0	0											NO	0	0	0	0	0	54.13577113	0	50	0	0	0	0	0	0	15	15	0	0	0	0	0	0	0	0.32	15	0	15	0	0	0												0	0	0	0	0	1.620388003	0	1.176261031	0	0	0	0	0	0	4.279467245	4.930794239	0	0	0	0	0	0	0	3.934117647	0.500789772	0	0.224957211	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6668	1100	0	4.9536	0	6.531842842	1.409875213	0.492400735	1.620388003	0	1.176261031	7.33910446	5.114990408	9.03654395	0	0	5.221556179	4.279467245	4.930794239	0	0	0	16.96933111	6.636592074	0	0	3.934117647	0.500789772	0	0.224957211	0	0	0	0	0	0	0	0	0	0	0	0	0	80.3726	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	3.419	0	1.2965	0.0573	1.8032	0.0454	0	0.0009	1.0132	0.5388	0.654	0	0	0.2958	0.362	0.994	0	0	0	2.6676	0.1988	0	0	0	0	0	0.0434	0	0	0											13.3899	1100	3.871987931	8.3727	0	7.828371085	1.467166486	2.295628188	1.66577741	0	1.177169119	8.352343083	5.65380894	9.690584423	0	0	5.517323326	4.641433451	5.9247457	0	0	0	19.63689771	6.835420673	0	0	3.934117647	0.500789772	0	0.268309862	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7625
H3916_026_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	0	0	682.2567671	0	342.6051432	17.69787503	0	0	0	0	0	0	0	355.1745426	0	6402.107661	0	0	0	5942.145592	79.85699007	0	0	12.29411765	397.1708891	0	297.4890469	0	0	0												"$0; PBP 1a, 1b"		$25 days 16-55; PBP 2	$0; PBP 6	$25; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$0; PBP 4a, 4b"	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b			"$0-$10; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0; PBP 7a, 14c-j"	"$0-$10; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$10; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0-$10; 0%-40%; PBP 16a, 16b"	"$0-$10; PBP 17a, 17b"		"$0-$10; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											0	0	25	0	25	0.15	0	0	0	0	0	0	0	10	0	10	0	0	0	10	0.042	0	0	0.32	10	0	10	0	0	0											NO	0	0	24.88945833	0	25	0.122574743	0	0	0	0	0	0	0	9.95578333	0	9.95578333	0	0	0	9.95578333	0.04181429	0	0	0.32	10	0	10	0	0	0												0	0	1.415083448	0	0.713760715	2.169312478	0	0	0	0	0	0	0	0.294670066	0	5.311499727	0	0	0	4.929892836	3.33916334	0	0	3.934117647	0.330975741	0	0.247907539	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6864	0	0.553277704	0	0	1.415083448	0	0.713760715	2.169312478	0	0	0	0	0	0	0	0.294670066	0	5.311499727	0	0	0	4.929892836	3.33916334	0	0	3.934117647	0.330975741	0	0.247907539	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6864	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	1.524	0	0.0771	0.0134	0.9957	0.0373	0	0	0.2015	0.0921	0.1288	0	0	0.1039	0.0936	0.2502	0	0	0	0.6249	0.0604	0	0	0	0	0	0.0478	0	0	0											4.2507	500	1.945417703	1.524	0	1.492231125	0.01342909	1.709428109	2.206624205	0	0	0.201512089	0.092120096	0.128761847	0	0	0.398595911	0.093622171	5.561680212	0	0	0	5.554769403	3.399545597	0	0	3.934117647	0.330975741	0	0.295682817	0	0	0	0	0	0	0	0	0	0	0	0	0	26.9371
H3916_027_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	0	0	588.1220227	0	236.8276222	17.90454643	0	0	0	0	0	0	0	1187.203696	0	5936.373148	0	0	0	4256.965543	77.2183335	0	0	12.29411765	414.3253285	0	313.9819497	0	0	0												"$0; PBP 1a, 1b"		$25 days 16-55; PBP 2	$0; PBP 6	$25; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$0; PBP 4a, 4b"	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b			"$0-$10; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0; PBP 7a, 14c-j"	"$0-$10; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$10; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0-$10; 0%-40%; PBP 16a, 16b"	"$0-$10; PBP 17a, 17b"		"$0-$10; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											0	0	25	0	25	0.15	0	0	0	0	0	0	0	10	0	10	0	0	0	10	0.042	0	0	0.32	10	0	10	0	0	0											NO	0	0	24.9149377	0	25	0.122574743	0	0	0	0	0	0	0	9.965975081	0	9.965975081	0	0	0	9.965975081	0.041857095	0	0	0.32	10	0	10	0	0	0												0	0	1.221085297	0	0.49339088	2.194645171	0	0	0	0	0	0	0	0.985970204	0	4.930145572	0	0	0	3.535401044	3.232135147	0	0	3.934117647	0.345271107	0	0.261651625	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1338	0	0.538509073	0	0	1.221085297	0	0.49339088	2.194645171	0	0	0	0	0	0	0	0.985970204	0	4.930145572	0	0	0	3.535401044	3.232135147	0	0	3.934117647	0.345271107	0	0.261651625	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1338	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	2.6853	0	0.1079	0.0352	1.3027	0.1263	0	0	0.2461	0.1387	0.1749	0	0	0.0778	0.0596	0.2084	0	0	0	0.5535	0.1616	0	0	0	0	0	0.0504	0	0	0											5.9283	500	2.529356671	2.6853	0	1.32897475	0.03515181	1.79609717	2.320958917	0	0	0.246053796	0.138715326	0.174910882	0	0	1.063762182	0.059608512	5.138530621	0	0	0	4.088877453	3.393751434	0	0	3.934117647	0.345271107	0	0.312075078	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0621
H3916_801_0	2010	3	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	278.5783251	0	57.96801463	0	6.919329482	20.75051812	0	13.69271896	42.11535931	28.08382497	45.7285517	0	0	26.33262972	27.84396774	56.532062	0	0	0	110.5990116	80.75313789	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.078896403	0	0.171125094	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.078896403	0	0.171125094	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												21.9788	0	9.919781944	0	1.612203769	4.834870722	0	3.190403518	9.81287872	6.543531219	10.65475255	0	0	6.135502725	6.487644483	13.17197045	0	0	0	25.76956971	18.81548113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.9274		0	21.9788	0	9.919781944	0	1.612203769	4.834870722	0	3.190403518	9.81287872	6.543531219	10.65475255	0	0	6.135502725	6.487644483	13.17197045	0	0	0	25.76956971	18.81548113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.9274	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e												0.6728	0	0.285	0	0.9073	0.0118	0	0.0034	0.3251	0.1922	0.2604	0	0	0.2576	0.1821	0.4162	0	0	0	0.9643	0.2954	0	0	0	0	0	0	0	0	0											4.7735		0	22.6516	0	10.20476407	0	2.519496926	4.846621289	0	3.193765351	10.13801308	6.735736318	10.91515964	0	0	6.393123215	6.669728578	13.58818952	0	0	0	26.7338238	19.11092739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.7009
H3916_802_0	2010	3	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	276.3394624	0	46.82737734	0	8.082503289	25.92541194	0	13.35806051	40.22336519	29.45440517	51.94810241	0	0	23.01604788	26.91617953	58.01882646	0	0	0	115.3031224	69.80411791	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.086077661	0	0.174360963	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.086077661	0	0.174360963	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												23.7867	0	8.164866605	0	1.883223266	6.040620981	0	3.112428099	9.372044089	6.862876405	12.10390786	0	0	5.362739157	6.27146983	13.51838656	0	0	0	26.86562752	16.26435947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.6092		0	23.7867	0	8.164866605	0	1.883223266	6.040620981	0	3.112428099	9.372044089	6.862876405	12.10390786	0	0	5.362739157	6.27146983	13.51838656	0	0	0	26.86562752	16.26435947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.6092	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e												0.7281	0	0.2346	0	1.0598	0.0147	0	0.0033	0.3105	0.2016	0.2958	0	0	0.2252	0.176	0.4272	0	0	0	1.0053	0.2554	0	0	0	0	0	0	0	0	0											4.9374		0	24.5147	0	8.399432347	0	2.94303693	6.055301978	0	3.115707766	9.682572087	7.064461725	12.39973299	0	0	5.587912472	6.447486705	13.94555199	0	0	0	27.87089426	16.51974727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.5466
H3916_804_0	2010	3	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	285.5046108	0	55.17592993	0	8.679030336	26.72940347	0	13.16176685	39.61124366	28.29501461	51.57176917	0	0	23.52399837	26.77130946	56.61112472	0	0	0	115.4047376	69.77064852	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.085629366	0	0.174689502	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.085629366	0	0.174689502	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												24.4476	0	9.63865573	0	2.022214068	6.227951008	0	3.066691675	9.229419772	6.592738405	12.01622222	0	0	5.481091621	6.237715104	13.19039206	0	0	0	26.88930387	16.25656111	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.2965		0	24.4476	0	9.63865573	0	2.022214068	6.227951008	0	3.066691675	9.229419772	6.592738405	12.01622222	0	0	5.481091621	6.237715104	13.19039206	0	0	0	26.88930387	16.25656111	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.2965	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e												0.7483	0	0.2769	0	1.138	0.0151	0	0.0032	0.3058	0.1937	0.2937	0	0	0.2301	0.1751	0.4168	0	0	0	1.0062	0.2553	0	0	0	0	0	0	0	0	0											5.0582		0	25.1959	0	9.915561471	0	3.160247003	6.243087288	0	3.069923149	9.535222137	6.786388881	12.30990427	0	0	5.711234377	6.412784609	13.60719324	0	0	0	27.89545654	16.51182645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.3547
H3920_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	2020.672163	356.4284242	913.3413765	557.9985571	612.5282235	12.96059778	5.03518397	559.0934394	338.3224319	8245.402727	33.90922533	0	3.209819843	1215.799533	8668.85319	12284.38172	781.1677626	777.9451362	0	0	23.82013927	4.79129343	653.3248201	1460.503695	116.6651464	179.164332	16.97900233	3.2666241	4269.94436	0												"$150 Days 1-10/$0 Days 11-90/$0 Days 91-150 (1a); $0 n/c (1a1, 1a2, 1a3)"	"$150 Days 1-10/$0 Days 11-90 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-5/$50 Days 6-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); 10% (11c)"	"$50 (4a, 4a1); $30 (4b)"	$125 (9b)	$0 (8a1); $10 (8a2)	"$15 (8b1); 10% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9c, 9d); $30 (5); $125 (9a)"	"$10 (7a); $30 (7a1); $0 (14b, 14b1, 14c, 14c1, 14d, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14d1, 14d2, 14e1, 14h1)"	"$30 (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"10% (13a); $0 n/c (13a1); $10 (16b); $0 (17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5); $10 (16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a1, 14a6); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											124.7960179	100.9460757	37.42398233	0	150	0.2	0.181359428	49.64342011	125	1.130305662	0.076687854	0	0.2	49.48216059	7.391363853	29.86173441	30	30	0	0	0.2	0.003144887	0	3.003743952	0	0	0	0	0	0											NO	124.7960179	100.9460757	37.42398233	0	150	0.2	0.181359428	49.64342011	125	1.130305662	0.076687854	0	0.2	49.48216059	7.391363853	29.86173441	30	30	0	0	0.2	0.003144887	0	3.003743952	0	0	0	0	0	0												21.0143	2.998337558	2.848405961	0	7.656602794	2.592119556	0.913178086	2.312942541	3.524191999	0.776652116	2.600425727	0	0.641963969	5.013365643	5.33955401	30.56941203	1.952919406	1.944862841	0	0	4.764027855	0.015068075	0	0.365581595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8439	0	0	21.0143	2.998337558	2.848405961	0	7.656602794	2.592119556	0.913178086	2.312942541	3.524191999	0.776652116	2.600425727	0	0.641963969	5.013365643	5.33955401	30.56941203	1.952919406	1.944862841	0	0	4.764027855	0.015068075	0	0.365581595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8439	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.0143	2.998337558	2.848405961	0	7.656602794	2.592119556	0.913178086	2.312942541	3.524191999	0.776652116	2.600425727	0	0.641963969	5.013365643	5.33955401	30.56941203	1.952919406	1.944862841	0	0	4.764027855	0.015068075	0	0.365581595	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8439
H3920_003_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.8614	0.877	0.2147	0	1.448	0	1.2659	0	0.0272	1.1375	1.67	3.9881	0.4008	0.1145	0	0	0.8563	0.1396	0	0	0	0	0	0	0	0											13.0009	NO	286.9568681	12.21172335	45.34933546	198.1656722	20.7002827	21.07617685	5.159336427	36.94435802	34.79939876	31.67424303	30.42233315	0	0.652907302	27.33618939	42.85355713	96.0031404	9.632526389	2.750745159	0	0	20.57942918	3.473358002	649.9539151	1717.348116	116.0631991	178.2399129	16.8913972	3.249769575	3868.773304	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14c, 14e, 14f, 14g, 14h, 14i); $0/20% (14b, 14d); $0 (14b1, 14j); $0 n/c (14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1, 16b); $0 (17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b1, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083354605	0.083354605	0.17680938	0	0.191677888	0.191677888	0.191677888	0.108210786	0.191677888	0.134050367	0.160072021	0	0.191677888	0.144194249	0.182938521	0.19135926	0.431275248	0.191677888	0	0	0.191677888	0.006864389	0	0	0	0	0	0	0	0											NO	0.083354605	0.083354605	0.17680938	0	0.191677888	0.191677888	0.191677888	0.108210786	0.191677888	0.134050367	0.160072021	0	0.191677888	0.144194249	0.182938521	0.19135926	0.431275248	0.191677888	0	0	0.191677888	0.006864389	0	0	0	0	0	0	0	0												23.9192	1.017903382	8.018187904	0	3.967786468	4.039837065	0.98893071	3.997778024	6.670275256	4.245943899	4.869764361	0	0.125147893	3.941721313	7.83956635	18.37108991	4.154270206	0.527257022	0	0	3.944621521	0.023842481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6631	146	0	23.9192	1.017903382	8.018187904	0	4.82913683	4.916828593	1.203613589	3.997778024	8.118297736	4.245943899	6.135654689	0	0.152315731	5.07919547	9.509572464	22.35919387	4.555085026	0.64171707	0	0	4.800943099	0.163410359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.664	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	23.9192	1.017903382	8.018187904	0	4.82913683	4.916828593	1.203613589	3.997778024	8.118297736	4.245943899	6.135654689	0	0.152315731	5.07919547	9.509572464	22.35919387	4.555085026	0.64171707	0	0	4.800943099	0.163410359	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.664
H3920_007_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	1757.739303	76.69451186	655.1397934	1935.454093	247.3649394	10.35028491	6.709387099	284.0841691	357.042429	12098.99365	44.39775459	0	0.44898817	1834.660845	8912.831544	12830.76676	356.0102454	486.2725433	0	0	24.79827418	8.683448613	678.0751414	1515.832889	121.0848467	185.9517288	17.62222872	3.390375707	4431.705389	0												"$150 Days 1-10/$0 Days 11-90/$0 Days 91-150 (1a); $0 n/c (1a1, 1a2, 1a3)"	"$150 Days 1-10/$0 Days 11-90 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-5/$50 Days 6-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); 10% (11c)"	"$50 (4a, 4a1); $30 (4b)"	$125 (9b)	$0 (8a1); $10 (8a2)	"$15 (8b1); 10% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 5, 9c, 9d); $125 (9a)"	"$5 (7a); $25 (7a1); $0 (14b, 14b1, 14c, 14c1, 14d, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14d1, 14d2, 14e1, 14h1)"	"$25 (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"$25 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"10% (13a); $0 n/c (13a1); $35 (16b); $0 (17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5); $10 (16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a1, 14a6); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											123.8891768	100.9460757	37.42398233	0	150	0.2	0.17822507	47.47821675	125	2.781291092	0.083786344	0	0.2	48.89942658	3.853252546	24.88550613	25	25	0	0	0.2	0.132003806	0	3.003743952	0	0	0	0	0	0											NO	123.8891768	100.9460757	37.42398233	0	150	0.2	0.17822507	47.47821675	125	2.781291092	0.083786344	0	0.2	48.89942658	3.853252546	24.88550613	25	25	0	0	0.2	0.132003806	0	3.003743952	0	0	0	0	0	0												18.1471	0.6451675	2.043161671	0	3.092061742	2.070056982	1.195780985	1.123984146	3.719191969	2.804235271	3.71992556	0	0.089797634	7.476155275	2.861949236	26.60834375	0.741688011	1.013067799	0	0	4.959654836	1.146248263	0	0.379431156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.837	0	0	18.1471	0.6451675	2.043161671	0	3.092061742	2.070056982	1.195780985	1.123984146	3.719191969	2.804235271	3.71992556	0	0.089797634	7.476155275	2.861949236	26.60834375	0.741688011	1.013067799	0	0	4.959654836	1.146248263	0	0.379431156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.837	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.1471	0.6451675	2.043161671	0	3.092061742	2.070056982	1.195780985	1.123984146	3.719191969	2.804235271	3.71992556	0	0.089797634	7.476155275	2.861949236	26.60834375	0.741688011	1.013067799	0	0	4.959654836	1.146248263	0	0.379431156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.837
H3920_009_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.8613	0.877	0.2147	0	1.448	0	1.2658	0	0.0272	1.1374	1.6699	3.9879	0.4008	0.1145	0	0	0.8563	0.1396	0	0	0	0	0	0	0	0											13.0003	NO	286.8254631	12.20613129	45.32856883	198.1202944	20.69080351	21.06652553	5.156973834	36.92744024	34.78346321	31.65973858	30.40840198	0	0.652608319	27.32367145	42.83393338	95.95917808	9.628115406	2.749485521	0	0	20.57000533	3.471767461	649.9539151	1717.348116	116.0631991	178.2399129	16.8913972	3.249769575	3868.773304	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14c, 14e, 14f, 14g, 14h, 14i); $0/20% (14b, 14d); $0 (14b1, 14j); $0 n/c (14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1, 16b); $0 (17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b1, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083350287	0.083350287	0.176839745	0	0.191674445	0.191674445	0.191674445	0.108235565	0.191674445	0.134050367	0.160069146	0	0.191674445	0.14419166	0.182935454	0.191355677	0.431267502	0.191674445	0	0	0.191674445	0.006864389	0	0	0	0	0	0	0	0											NO	0.083350287	0.083350287	0.176839745	0	0.191674445	0.191674445	0.191674445	0.108235565	0.191674445	0.134050367	0.160069146	0	0.191674445	0.14419166	0.182935454	0.191355677	0.431267502	0.191674445	0	0	0.191674445	0.006864389	0	0	0	0	0	0	0	0												23.907	1.017384551	8.015892566	0	3.965898289	4.037914599	0.9884601	3.996862351	6.667101024	4.243999571	4.867446951	0	0.125088338	3.939845538	7.835845045	18.36233352	4.152293283	0.527006113	0	0	3.942744365	0.023831563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6169	146	0	23.907	1.017384551	8.015892566	0	4.827210352	4.914867132	1.203133434	3.996862351	8.115059119	4.243999571	6.133280993	0	0.152254968	5.077269118	9.505776905	22.35025711	4.553090282	0.641461071	0	0	4.799027869	0.163393235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.6172	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	23.907	1.017384551	8.015892566	0	4.827210352	4.914867132	1.203133434	3.996862351	8.115059119	4.243999571	6.133280993	0	0.152254968	5.077269118	9.505776905	22.35025711	4.553090282	0.641461071	0	0	4.799027869	0.163393235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.6172
H3921_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1332.347043	181.6888609	740.7555674	687.6501254	158.1667268	8.499310486	6.841314651	375.6008159	21.28659627	7283.427188	23.72305465	0	0.024334203	12.88346769	4886.500631	3793.015145	411.589918	266.1016378	0	0	14.23435562	781.6987006	0	0	135.2013793	0	13.04727583	4.516545118	83.57863454	0											3250	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$80 Days 1-29 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	62.46806925	0	150	0.2	0.118807126	49.70415732	0.2	3	0.177180675	0	0.2	0.149208261	10.18288421	25	38.5	25	0	0	0.2	24.07260379	0	0	25	0	0	0	0	0											YES	145.4255194	110.7591542	49.3076545	0	118.3988598	0.157865146	0.093777521	39.23277038	0.157865146	2.367977197	0.139853266	0	0.157865146	0.11803916	10.10058926	25	38.5	19.73314331	0	0	0.157865146	24.07260379	0	0	25	0	0	0	0	0											3850	16.1464	1.67697538	3.043743299	0	1.560563343	1.341744895	0.641561531	1.22798838	3.360411638	1.437249125	3.31774668	0	0.003841523	1.520753704	4.113044649	7.902114886	1.320517653	0.437585146	0	0	2.247108634	1.568126925	0	0	0.28166954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1492	0	10.1618519	16.1464	1.67697538	3.043743299	0	1.560563343	1.341744895	0.641561531	1.22798838	3.360411638	1.437249125	3.31774668	0	0.003841523	1.520753704	4.113044649	7.902114886	1.320517653	0.437585146	0	0	2.247108634	1.568126925	0	0	0.28166954	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1492	NO	"$295 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"25% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25%/25%/$10 (8a1); $10 (8a2)	"$21 (8b1); 25% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$20 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $30 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.944	0.4063	2.584	0.3743	0.4738	0.611	0.4918	0.5287	1.2753	0.4363	1.2706	0	0.0012	0.577	1.9476	3.0711	0.4842	0.1511	0	0	0.9702	0.6191	0	0	0.1097	0	0	0.003	0	0											19.3303	0	5.456658772	19.0904	2.083318597	5.627746981	0.374299868	2.034345194	1.95276884	1.133390495	1.756689255	4.635673913	1.873593188	4.588351736	0	0.005007796	2.097727807	6.060675195	10.97320047	1.804680959	0.588723978	0	0	3.217278032	2.187258837	0	0	0.391352778	0	0	0.002971411	0	0	0	0	0	0	0	0	0	0	0	0	72.4795
H3921_008_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1376.093414	87.35521126	765.0775844	710.2284749	163.3599835	9.084256578	7.312152877	387.9156206	23.52515315	7522.571715	26.21783618	0	0.026893255	14.22784552	5057.381386	3925.808705	377.1594213	274.8388364	0	0	15.56302121	807.3650472	0	0	89.73662012	0	13.05992688	4.516545118	78.44525732	0											3250	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$80 Days 1-29 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	62.46806925	0	150	0.2	0.118807126	49.70414383	0.2	3	0.175056166	0	0.2	0.148798628	10.16186949	25	38.5	25	0	0	0.2	24.07260379	0	0	25	0	0	0	0	0											YES	144.3143417	109.9128578	48.93090108	0	117.4941894	0.156658919	0.093060979	38.93298727	0.156658919	2.349883788	0.137120549	0	0.156658919	0.116734461	10.07739331	25	38.5	19.5823649	0	0	0.156658919	24.07260379	0	0	25	0	0	0	0	0											3850	16.5492	0.800121743	3.1196613	0	1.599487404	1.423129818	0.680476109	1.258559493	3.685425068	1.473097443	3.595004088	0	0.004213068	1.66087988	4.247101778	8.178768136	1.210053143	0.448499532	0	0	2.438086082	1.619614908	0	0	0.186951292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1783	0	10.74891464	16.5492	0.800121743	3.1196613	0	1.599487404	1.423129818	0.680476109	1.258559493	3.685425068	1.473097443	3.595004088	0	0.004213068	1.66087988	4.247101778	8.178768136	1.210053143	0.448499532	0	0	2.438086082	1.619614908	0	0	0.186951292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1783	NO	"$295 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"25% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25%/25%/$10 (8a1); $10 (8a2)	"$21 (8b1); 25% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$20 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $30 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.9942	0.1924	2.6281	0.3939	0.4819	0.6431	0.5176	0.5459	1.3878	0.4438	1.3655	0	0.0013	0.6253	2.025	3.1848	0.4437	0.1537	0	0	1.0445	0.6398	0	0	0.0728	0	0.0106	0.003	0	0											19.7987	0	5.883699777	19.5434	0.992503477	5.747713492	0.393945075	2.08134563	2.066223482	1.198118819	1.804454397	5.073254369	1.916879696	4.960513915	0	0.005482288	2.286172249	6.272095016	11.36361295	1.653715012	0.602214769	0	0	3.48259938	2.259447572	0	0	0.259750868	0	0.010594974	0.002971411	0	0	0	0	0	0	0	0	0	0	0	0	73.977
H3921_801_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	206.4400235	5.121272781	21.55191483	873.659027	5.357841428	9.164372074	7.788957266	11.70802275	20.52160473	11.27918452	24.58193238	0	0.032491291	15.16563308	23.35580438	77.86707393	2.154877404	2.709364421	0	0	15.1728552	4.614663952	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085434117	0.085434117	0.173071189	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085434117	0.085434117	0.173071189	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.637	0.437531416	3.730015519	0	1.248377053	2.135298693	1.814827043	2.727969302	4.781533902	2.628049992	5.727590246	0	0.007570471	3.533592508	5.441902421	18.14302823	0.502086435	0.63128191	0	0	3.535275262	1.075216701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7382	0	0	17.637	0.437531416	3.730015519	0	1.248377053	2.135298693	1.814827043	2.727969302	4.781533902	2.628049992	5.727590246	0	0.007570471	3.533592508	5.441902421	18.14302823	0.502086435	0.63128191	0	0	3.535275262	1.075216701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7382	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.2918	0.0569	1.4868	0	0.4273	0.7309	0.6212	0.9337	1.6366	0.8995	1.9605	0	0.0026	1.2095	1.7659	5.8875	0.1629	0.2049	0	0	1.1472	0.3489	0	0	0	0	0	0	0	0											21.7745	0	0	19.9288	0.494385781	5.216804922	0	1.675673896	2.866172743	2.436009454	3.661703761	6.418166311	3.527583882	7.688040598	0	0.010161706	4.743077192	7.207817777	24.03050096	0.665015146	0.83613498	0	0	4.68248379	1.42412808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5127
H3921_803_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	206.4534408	5.121272781	21.55331557	873.6874176	5.358189654	9.1649677	7.789463499	11.7087837	20.5229385	11.27991759	24.58353005	0	0.032493403	15.1666178	23.35732236	77.8721348	2.14006725	2.709540513	0	0	15.17384134	4.614963875	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085430943	0.085430943	0.173073664	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085430943	0.085430943	0.173073664	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.6375	0.437515164	3.730311293	0	1.248458189	2.135437474	1.814944995	2.728146603	4.781844671	2.628220799	5.727962503	0	0.007570963	3.533821948	5.442256111	18.14420741	0.498635669	0.631322939	0	0	3.535505032	1.075286583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.739	0	0	17.6375	0.437515164	3.730311293	0	1.248458189	2.135437474	1.814944995	2.728146603	4.781844671	2.628220799	5.727962503	0	0.007570963	3.533821948	5.442256111	18.14420741	0.498635669	0.631322939	0	0	3.535505032	1.075286583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.739	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.2919	0.0569	1.4869	0	0.4273	0.7309	0.6212	0.9338	1.6367	0.8996	1.9606	0	0.0026	1.2096	1.766	5.8879	0.1618	0.2049	0	0	1.1473	0.3489	0	0	0	0	0	0	0	0											21.7747	0	0	19.9294	0.494367417	5.217218592	0	1.675782805	2.866359026	2.436167779	3.661941748	6.418583451	3.527813153	7.688540272	0	0.010162366	4.743385165	7.208286239	24.03206279	0.660444595	0.836189324	0	0	4.682788122	1.42422064	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.5137
H3921_804_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	234.9247542	5.095232411	24.52566226	931.9860443	6.097119925	10.42887818	8.863682731	13.32350346	23.35318929	12.83549384	27.97376364	0	0.036974461	17.2561807	26.57845369	88.61122419	2.14006725	3.083204312	0	0	17.26641578	5.25139833	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079626483	0.079626483	0.171710886	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079626483	0.079626483	0.171710886	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.7062	0.405715436	4.2113232	0	1.420628943	2.429928616	2.065238076	3.104376307	5.441293106	2.990670065	6.517886928	0	0.008615049	4.020690102	6.19277971	20.64641524	0.498635669	0.718386605	0	0	4.023074876	1.223575811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6255	0	0	18.7062	0.405715436	4.2113232	0	1.420628943	2.429928616	2.065238076	3.104376307	5.441293106	2.990670065	6.517886928	0	0.008615049	4.020690102	6.19277971	20.64641524	0.498635669	0.718386605	0	0	4.023074876	1.223575811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6255	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.4308	0.0527	1.6786	0	0.4863	0.8317	0.7069	1.0626	1.8625	1.0237	2.231	0	0.0029	1.3762	2.0096	6.6998	0.1618	0.2331	0	0	1.3055	0.3971	0	0	0	0	0	0	0	0											24.5527	0	0	21.137	0.458435521	5.889962517	0	1.906884487	3.261649149	2.772131646	4.166948063	7.303749135	4.014322235	8.748841514	0	0.011563825	5.396899466	8.202357231	27.34624535	0.660444595	0.951505437	0	0	5.328575995	1.620630213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.1781
H3923_013_0	2010	9	N/A																															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	P	V	P	O	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	NO	194.4453914	25.54943973	444.0208396	373.1095982	751.4269339	12.22713947	0	214.2679962	408.7430862	2386.421957	859.4097095	0	4.663129508	988.7992971	4195.042974	5124.108478	208.384085	725.294842	2493.132964	16818.65308	5.527942928	372.2081436	0	332.5	590.3081602	12.24760867	12.37199805	11.91845474	0	0												"1a - $250 copay/admit, $500 max"	"1b - $250 copay/admit, $500 max"	2 - $0 copay Days 1-10/ $50 copay Days 11-100	6 - $0 copay	10a - $75 copay/trip	"11a - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	"11b,11c - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $30 Urgent Care copay	"9a,9b - $100 copay"	8a - $0 copay	8b - $100 copay (High Tech Imaging Only)	5 - $0 copay	12 - $0 copay	3 - $30 CORF copay; 9c - $30 SA Ind/Grp Session copay; 9d - $30 Cardiac Rehab copay	7a - $20 OV copay	7d - $30 Specialist OV copay (excluding MH and Radiology); 18a - $30 Hearing Exam copay	"7e,7h - $30 MH/Psych Ind/Grp Session copay"	"7c,7i -  $30 OT/PT/ST copay"	7d - $30 OV copay (Radiology only); 14h - $0 Mammography Screening copay	"7b,7f,7g - $30 Chiro/Pod/Other OV copay; 14b - $0 Immunization copay; 14c - $20 Physical Exam copay; 14d - $0 Pap Smear copay, $0 Pelvic Exam copay; 14e - $0 Prostate Screening copay; 14f - $0 Colorectal Screening copay; 14g - $0 Bone Mass Meas copay; 14i - $0 Diabetes Monitoring copay; 14j - $0 Nutrition Therapy copay"	15 - $0 Copay	13a - $0 copay; 17a - $30 Eye Exam copay	0	"16a,16b - $10 Preventive OV copay"	17a - $20 Routine Eye Exam copay	17b - $40 allowance every 2 years	18a - $15 Routine Hearing Exam/Fitting copay	18b - $400 allowance every 3 years	0	0											250	250	50	0	75	0.320954372	0	49.6	100	0	21.62583519	0	0	8.597350078	20	24.91224782	30	30	0	1.615688152	0	27.27602061	0	10	20	0	15	0	0	0											NO	199.8468552	199.8468552	39.96937104	0	59.95405656	0.257	0	39.64961607	79.93874208	0	17.28742062	0	0	6.872613505	15.98774842	19.91453753	23.98162263	23.98162263	0	1.291560784	0	21.80410776	0	7.993874208	20	0	11.99081131	0	0	0												3.2383	0.425497932	1.478936141	0	3.754257742	3.142374843	0	0.707970316	2.722867346	0	1.238081427	0	0	0.56630295	5.589107638	8.503687548	0.416449041	1.449478933	0	1.81019273	0	0.676305539	0	0.221496931	0.983846934	0	0.012362525	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9375	0	14.07	3.2383	0.425497932	1.478936141	0	3.754257742	3.142374843	0	0.707970316	2.722867346	0	1.238081427	0	0	0.56630295	5.589107638	8.503687548	0.416449041	1.449478933	0	1.81019273	0	0.676305539	0	0.221496931	0.983846934	0	0.012362525	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9375	YES	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $30 Urgent Care copay	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max"	0	"$350 deductible, 25% coinsurance, no separate OOP Max, $100 Preventive Dental OON allowance"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max, $40 Glasses/Contacts OON allowance"	"$350 deductible, 25% coinsurance, no separate OOP Max"	"$350 deductible, 25% coinsurance, no separate OOP Max, $400 Hearing Aid OON allowance"	"$250 deductible, 20% coinsurance, no separate OOP Max"	0											3350	2.9333	0.035	0.1864	0.0436	0.0859	0.1832	0	0.084	0.5332	0.1917	0.3329	0	0.0024	0.3896	0.0498	0.5998	0.0277	0.0866	0.3142	1.5889	0.0828	0.0439	0	0.0222	0.0772	0.0006	0.0021	0.006	0	0											7.903	350	0	6.1716	0.460492256	1.66536761	0.043588611	3.840136454	3.325613828	0	0.791924673	3.25610281	0.19174854	1.570999922	0	0.002382084	0.955879208	5.638922058	9.103481778	0.444163304	1.536068718	0.314175819	3.399078722	0.082843142	0.720160029	0	0.243730824	1.061031721	0.000611819	0.014487945	0.005953765	0	0	0	0	0	0	0	0	0	0	0	0	44.8405
H3923_017_0	2010	8	N/A																															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	P	V	P	O	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	NO	218.8997853	35.25471156	493.6354742	541.4368738	190.7214037	15.74501822	0	221.0060025	607.4829895	2991.147348	1091.350254	0	5.882101751	1386.193301	4247.21011	6847.405391	208.6202031	1210.505812	3078.435605	19572.95195	7.673051174	347.7788216	0	332.5	573.5607997	20.83807929	15.01999894	12.46907018	0	0												1a - $0 copay/admit	1b - $0 copay/admit	2 - $0 copay Days 1-10/ $25 copay Days 11-100	6 - $0 copay	10a - $50 copay/trip	"11a - 0% coinsurance for diabetic supplies, 15% coinsurance for all other"	"11b,11c - 0% coinsurance for diabetic supplies, 15% coinsurance for all other"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $20 Urgent Care copay	"9a,9b - $50 copay"	8a - $0 copay	8b - $50 copay (High Tech Imaging Only)	5 - $0 copay	12 - $0 copay	3 - $20 CORF copay; 9c - $30 SA Ind/Grp Session copay; 9d - $20 Cardiac Rehab copay	7a - $15 OV copay	7d - $20 Specialist OV copay (excluding MH and Radiology); 18a - $20 Hearing Exam copay	"7e,7h - $30 MH/Psych Ind/Grp Session copay"	"7c,7i -  $20 OT/PT/ST copay"	7d - $20 OV copay (Radiology only); 14h - $0 Mammography Screening copay	"7b,7f,7g - $20 Chiro/Pod/Other OV copay; 14b - $0 Immunization copay; 14c - $15 Physical Exam copay; 14d - $0 Pap Smear copay, $0 Pelvic Exam copay; 14e - $0 Prostate Screening copay; 14f - $0 Colorectal Screening copay; 14g - $0 Bone Mass Meas copay; 14i - $0 Diabetes Monitoring copay; 14j - $0 Nutrition Therapy copay"	15 - $0 Copay	13a - $0 copay; 17a - $20 Eye Exam copay	0	"16a,16b - $10 Preventive OV copay"	17a - $20 Routine Eye Exam copay	17b - $40 allowance every 2 years	18a - $15 Routine Hearing Exam/Fittinig copay	18b - $400 allowance every 3 years	0	0											0	0	25	0	50	0.196187066	0	49.4	50	0	10.81291759	0	0	7.71404034	15	17.45251278	30	20	0	1.322311931	0	17.75765924	0	10	20	0	15	0	0	0											NO	0	0	22.40632338	0	44.81264676	0.176	0	44.274895	44.81264676	0	9.691109132	0	0	6.913731296	13.44379403	15.6418658	26.88758805	17.9250587	0	1.185125949	0	15.91535421	0	8.962529352	17.9250587	0	13.44379403	0	0	0												0	0	0.921713005	0	0.712227574	2.771123208	0	0.81541813	2.268576718	0	0.881366201	0	0	0.798647334	4.758218159	8.925516353	0.467441173	1.808198979	0	1.933034438	0	0.461251928	0	0.248336751	0.85675925	0	0.016827148	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6447	0	3.49	0	0	0.921713005	0	0.712227574	2.771123208	0	0.81541813	2.268576718	0	0.881366201	0	0	0.798647334	4.758218159	8.925516353	0.467441173	1.808198979	0	1.933034438	0	0.461251928	0	0.248336751	0.85675925	0	0.016827148	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6447	YES	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $20 Urgent Care copay	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max"	0	"$250 deductible, 20% coinsurance, no separate OOP Max, $100 Preventive Dental OON allowance"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max, $40 Glasses/Contacts OON allowance"	"$250 deductible, 20% coinsurance, no separate OOP Max"	"$250 deductible, 20% coinsurance, no separate OOP Max, $400 Hearing Aid OON allowance"	"$250 deductible, 20% coinsurance, no separate OOP Max"	0											2500	2.5702	0.0335	0.2148	0.0467	0.0713	0.1841	0	0.0745	0.5582	0.1829	0.3638	0	0.0025	0.4118	0.0338	0.5881	0.0219	0.1088	0.3137	1.5681	0.0897	0.0418	0	0.0174	0.0616	0.0008	0.0015	0.0049	0	0											7.5665	250	0	2.5702	0.033452437	1.136504206	0.046745634	0.783499953	2.955262786	0	0.889916229	2.826783363	0.182942548	1.245198134	0	0.002504445	1.210431311	4.79197035	9.51363064	0.48931997	1.916968697	0.313716593	3.50117202	0.089737108	0.503100244	0	0.265687829	0.918408822	0.000812345	0.018312541	0.004860901	0	0	0	0	0	0	0	0	0	0	0	0	36.2111
H3923_021_0	2010	8	N/A																															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	P	V	P	O	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	NO	34.97011305	25.07555257	422.19121	345.86219	200.0700438	11.32155745	0	197.0080152	322.4658274	2208.086627	818.0392481	0	4.219758178	1020.15197	4042.215594	4853.657032	197.4828592	679.1564541	2332.677097	15478.3555	5.295497771	324.6306794	0	0	131.9150203	12.79691119	9.610447492	10.60389507	0	0												"1a - $500 copay/admit, $1,000 max"	"1b - $500 copay/admit, $1,000 max"	2 - $0 copay Days 1-10/ $100 copay Days 11-100	6 - $0 copay	10a - $100 copay/trip	"11a - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	"11b,11c - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $40 Urgent Care copay	"9a,9b - $250 copay"	8a - $0 copay	8b - $150 copay (High Tech Imaging Only)	5 - $0 copay	12 - $0 copay	3 - $50 CORF copay; 9c - $50 SA Ind/Grp Session copay; 9d - $50 Cardiac Rehab copay	7a - $20 OV copay	7d - $50 Specialist OV copay (excluding MH and Radiology); 18a - $50 Hearing Exam copay	"7e,7h - $50 MH/Psych Ind/Grp Session copay"	"7c,7i -  $50 OT/PT/ST copay"	7d - $50 OV copay (Radiology only); 14h - $0 Mammography Screening copay	"7b,7f,7g - $50 Chiro/Pod/Other OV copay; 14b - $0 Immunization copay; 14c - $20 Physical Exam copay; 14d - $0 Pap Smear copay, $10 Pelvic Exam copay; 14e - $10 Prostate Screening copay; 14f - $10 Colorectal Screening copay; 14g - $10 Bone Mass Meas copay; 14i - $0 Diabetes Monitoring copay; 14j - $0 Nutrition Therapy copay"	15 - $0 Copay	13a - $0 copay; 17a - $50 Eye Exam copay	0	0	0	0	0	0	0	0											500	500	100	0	100	0.22250468	0	49.8	250	0	32.43875278	0	0	19.62624114	20	34.73068034	50	50	0	2.70325845	0	45.31078977	0	0	0	0	0	0	0	0											NO	417.7474941	417.7474941	83.54949881	0	83.54949881	0.186	0	41.60765041	208.873747	0	27.10241537	0	0	16.39762611	16.70989976	29.01730936	41.77474941	41.77474941	0	2.258558887	0	37.85693776	0	0	0	0	0	0	0	0												1.2174	0.872937437	2.939488667	0	1.392979324	2.105809686	0	0.683086719	5.612887139	0	1.847569958	0	0	1.394005881	5.628751449	11.7366723	0.68748308	2.364299223	0	2.913231448	0	1.024126952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4207	0	9.98	1.2174	0.872937437	2.939488667	0	1.392979324	2.105809686	0	0.683086719	5.612887139	0	1.847569958	0	0	1.394005881	5.628751449	11.7366723	0.68748308	2.364299223	0	2.913231448	0	1.024126952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4207	YES	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $40 Urgent Care copay	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	"$1000 deductible, 30% coinsurance, no separate OOP Max"	0	0	0	0	0	0	0	0											3350	3.5049	0.0502	0.3069	0.053	0.1013	0.231	0	0.1262	0.7325	0.2383	0.4292	0	0.0029	0.5624	0.0654	0.7649	0.0364	0.114	0.4202	1.983	0.1081	0.0608	0	0	0	0	0	0	0	0											9.8914	1000	0	4.7223	0.923182934	3.246404038	0.052994877	1.494256357	2.336832926	0	0.809305086	6.345403104	0.238285117	2.276727742	0	0.002878413	1.956365116	5.694108827	12.50160492	0.723858818	2.478287685	0.420153469	4.896268229	0.108057841	1.084892779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3121
H3923_801_0	2010	6	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	233.5432572	3.227942923	31.68564948	4.329926049	7.745947095	16.19052369	0	15.75327473	38.42979615	13.89308076	23.90042595	0	0.21431702	33.62870875	0	49.16575797	1.651923907	8.195149045	26.34263725	143.2568994	5.438740246	4.829213346	0	0	0	0	0	0	0	0												Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing																			0.076791749	0.076791749	0.177742972	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076791749	0.076791749	0.177742972	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.9342	0.247879383	5.631901509	0	1.804805673	3.77239202	0	3.670513012	8.954142503	3.237087818	5.568799247	0	0.049935866	7.835489139	0	11.45562161	0.38489827	1.909469727	6.13783448	33.37885757	1.267226477	1.12520671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3663	0	0	17.9342	0.247879383	5.631901509	0	1.804805673	3.77239202	0	3.670513012	8.954142503	3.237087818	5.568799247	0	0.049935866	7.835489139	0	11.45562161	0.38489827	1.909469727	6.13783448	33.37885757	1.267226477	1.12520671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3663	NO	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	NA	NA	NA	NA	NA	NA	NA	NA												0.9439	0.013	0.2964	0	0.095	0.1985	0	0.1932	0.4713	0.1704	0.2931	0	0.0026	0.4124	0	0.6029	0.0203	0.1005	0.323	1.7568	0.0667	0.0592	0	0	0	0	0	0	0	0											6.0193	0	0	18.8781	0.260925666	5.928317378	0	1.899795445	3.970938968	0	3.863697907	9.425413161	3.407460861	5.861893945	0	0.052564069	8.247883304	0	12.05854906	0.405156074	2.009968134	6.4608784	35.13563955	1.333922608	1.184428115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.3855
H3923_802_0	2010	6	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	233.5972358	3.363783714	31.68564948	4.329926049	7.745947095	16.19052369	0	15.75327473	38.42979615	13.89308076	23.90042595	0	0.21431702	33.62870875	0	49.16575797	1.752036337	8.195149045	26.34263725	143.2568994	5.438740246	4.829213346	0	0	0	0	0	0	0	0												Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing																			0.078335319	0.078335319	0.176709857	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078335319	0.078335319	0.176709857	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.2989	0.26350307	5.599166597	0	1.804805673	3.77239202	0	3.670513012	8.954142503	3.237087818	5.568799247	0	0.049935866	7.835489139	0	11.45562161	0.408224466	1.909469727	6.13783448	33.37885757	1.267226477	1.12520671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7372	0	0	18.2989	0.26350307	5.599166597	0	1.804805673	3.77239202	0	3.670513012	8.954142503	3.237087818	5.568799247	0	0.049935866	7.835489139	0	11.45562161	0.408224466	1.909469727	6.13783448	33.37885757	1.267226477	1.12520671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7372	NO	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	NA	NA	NA	NA	NA	NA	NA	NA												0.9631	0.0139	0.2947	0	0.095	0.1985	0	0.1932	0.4713	0.1704	0.2931	0	0.0026	0.4124	0	0.6029	0.0215	0.1005	0.323	1.7568	0.0667	0.0592	0	0	0	0	0	0	0	0											6.0388	0	0	19.262	0.277371652	5.893859576	0	1.899795445	3.970938968	0	3.863697907	9.425413161	3.407460861	5.861893945	0	0.052564069	8.247883304	0	12.05854906	0.429709965	2.009968134	6.4608784	35.13563955	1.333922608	1.184428115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.776
H3923_803_0	2010	6	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	233.5972358	3.363783714	31.68564948	4.329926049	7.745947095	16.19052369	0	15.75327473	38.42979615	13.89308076	23.90042595	0	0.21431702	33.62870875	0	49.16575797	1.752036337	8.195149045	26.34263725	143.2568994	5.438740246	4.829213346	0	0	0	0	0	0	0	0												Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing																			0.078335319	0.078335319	0.176709857	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078335319	0.078335319	0.176709857	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.2989	0.26350307	5.599166597	0	1.804805673	3.77239202	0	3.670513012	8.954142503	3.237087818	5.568799247	0	0.049935866	7.835489139	0	11.45562161	0.408224466	1.909469727	6.13783448	33.37885757	1.267226477	1.12520671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7372	0	0	18.2989	0.26350307	5.599166597	0	1.804805673	3.77239202	0	3.670513012	8.954142503	3.237087818	5.568799247	0	0.049935866	7.835489139	0	11.45562161	0.408224466	1.909469727	6.13783448	33.37885757	1.267226477	1.12520671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.7372	NO	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	NA	NA	NA	NA	NA	NA	NA	NA												0.9631	0.0139	0.2947	0	0.095	0.1985	0	0.1932	0.4713	0.1704	0.2931	0	0.0026	0.4124	0	0.6029	0.0215	0.1005	0.323	1.7568	0.0667	0.0592	0	0	0	0	0	0	0	0											6.0388	0	0	19.262	0.277371652	5.893859576	0	1.899795445	3.970938968	0	3.863697907	9.425413161	3.407460861	5.861893945	0	0.052564069	8.247883304	0	12.05854906	0.429709965	2.009968134	6.4608784	35.13563955	1.333922608	1.184428115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.776
H3924_001_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	V	O	O	O											8.2276	0	1.1451	0	0.4193	0.2674	0.3149	0	1.5246	1.2877	0.9011	0	0.0017	0.3769	0	0.8941	0	0	0.7169	0.1155	0.3331	0.0329	0	0	0	0	0	0	0	0											16.5589	YES	334.8297798	4.777267337	1039.169775	0	123.3563013	7.573641296	8.919625657	238.1532691	240.4741901	4815.854176	813.2239899	28.43672756	0	2485.136945	4026.907457	3330.542224	134.4170695	492.2212427	568.0377368	102.8735903	9.434652243	0	0	478.094107	895.5734516	0	0.517809761	0	0	0											2900	$275 Copay per Admit (PBP 1a)	$275 Copay per Admit (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$100 Copay (PBP 9a, 9b)"	$10 Copay (PBP 8a)	"$20 General, $100 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $20 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$20 Copay (PBP 7c, 7i)"	"$20 Office General, $100 Office CT/MRI/PT (PBP 7d)"	Lab $10 Copay (PBP 7g)	"20% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												275	275	60	0	100	0.2	0.2	50	100	10	39.76	25	0	5.22	10	20	20	20	29.36936937	10	0.2	0	0	20	20	0	20	0	0	0											YES	268.2642483	268.2642483	58.53038145	0	97.55063576	0.195101272	0.195101272	48.77531788	97.55063576	9.755063576	38.78613278	24.38765894	0	5.092143187	9.755063576	19.51012715	19.51012715	19.51012715	28.65000654	9.755063576	0.161	0	0	19.51012715	19.51012715	0	19.51012715	0	0	0											3500	7.4852	0.106797503	5.068583612	0	1.002790468	1.477627047	1.740230307	0.968000117	1.954867511	3.914913639	2.628484471	0.057792101	0	1.054556097	3.273561521	5.414941855	0.218541176	0.800274919	1.356190406	0.083628201	1.518979011	0	0	0.777306401	1.456062659	0	0.000841878	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3602	250	1.39341937	15.7128	0.106797503	6.21365983	0	1.422088426	1.745048181	2.055129774	0.968000117	3.479503298	5.20261051	3.52956057	0.057792101	0.001675013	1.431486385	3.273561521	6.309086487	0.218541176	0.800274919	2.073063367	0.199159963	1.852061035	0.032913742	0	0.777306401	1.456062659	0	0.000841878	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9191	NO	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	N/A	20% Coinsurance	$30 Copay	$200 Max per 2 Years	$30 Copay	$800 Max per 3 Years	20% Coinsurance	20% Coinsurance												1.9123	0	0.2662	0.0758	0.0975	0.0622	0.0732	0.0422	0.3544	0.2993	0.2094	0	0.0004	0.1542	0.3898	1.3368	0	0.0161	0.1666	0.0269	0.0774	0.0077	0	0.0431	0.1206	0	0.0036	0	0	0											5.7354	250	2.891354201	17.6252	0.106797503	6.479810458	0.07575805	1.519546056	1.807205007	2.128322012	1.010164761	3.833875143	5.501910527	3.73899813	0.057792101	0.002064338	1.585693619	3.663350568	7.645882314	0.218541176	0.81639621	2.239686502	0.226013067	1.929479454	0.040563899	0	0.820365166	1.576649357	0	0.004452802	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6545
H3924_002_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	V	O	O	O											8.2276	0	1.1451	0	0.4193	0.2674	0.3149	0	1.5246	1.2877	0.9011	0	0.0017	0.3769	0	0.8941	0	0	0.7169	0.1155	0.3331	0.0329	0	0	0	0	0	0	0	0											16.5589	YES	334.8297798	4.777267337	1039.169775	0	123.3563013	7.573641296	8.919625657	238.1532691	240.4741901	4815.854176	813.2239899	28.43672756	0	2485.136945	4026.907457	3330.542224	134.4170695	492.2212427	568.0377368	102.8735903	9.434652243	0	0	478.094107	895.5734516	0	0.517809761	0	0	0											2900	$275 Copay per Admit (PBP 1a)	$275 Copay per Admit (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$100 Copay (PBP 9a, 9b)"	$10 Copay (PBP 8a)	"$20 General, $100 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $20 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$20 Copay (PBP 7c, 7i)"	"$20 Office General, $100 Office CT/MRI/PT (PBP 7d)"	Lab $10 Copay (PBP 7g)	"20% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												275	275	60	0	100	0.2	0.2	50	100	10	39.76	25	0	5.22	10	20	20	20	29.36936937	10	0.2	0	0	20	20	0	20	0	0	0											YES	268.2642483	268.2642483	58.53038145	0	97.55063576	0.195101272	0.195101272	48.77531788	97.55063576	9.755063576	38.78613278	24.38765894	0	5.092143187	9.755063576	19.51012715	19.51012715	19.51012715	28.65000654	9.755063576	0.161	0	0	19.51012715	19.51012715	0	19.51012715	0	0	0											3500	7.4852	0.106797503	5.068583612	0	1.002790468	1.477627047	1.740230307	0.968000117	1.954867511	3.914913639	2.628484471	0.057792101	0	1.054556097	3.273561521	5.414941855	0.218541176	0.800274919	1.356190406	0.083628201	1.518979011	0	0	0.777306401	1.456062659	0	0.000841878	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3602	250	1.39341937	15.7128	0.106797503	6.21365983	0	1.422088426	1.745048181	2.055129774	0.968000117	3.479503298	5.20261051	3.52956057	0.057792101	0.001675013	1.431486385	3.273561521	6.309086487	0.218541176	0.800274919	2.073063367	0.199159963	1.852061035	0.032913742	0	0.777306401	1.456062659	0	0.000841878	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9191	NO	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	N/A	20% Coinsurance	$30 Copay	$200 Max per 2 Years	$30 Copay	$800 Max per 3 Years	20% Coinsurance	20% Coinsurance												1.9123	0	0.2662	0.0758	0.0975	0.0622	0.0732	0.0422	0.3544	0.2993	0.2094	0	0.0004	0.1542	0.3898	1.3368	0	0.0161	0.1666	0.0269	0.0774	0.0077	0	0.0431	0.1206	0	0.0036	0	0	0											5.7354	250	2.891354201	17.6252	0.106797503	6.479810458	0.07575805	1.519546056	1.807205007	2.128322012	1.010164761	3.833875143	5.501910527	3.73899813	0.057792101	0.002064338	1.585693619	3.663350568	7.645882314	0.218541176	0.81639621	2.239686502	0.226013067	1.929479454	0.040563899	0	0.820365166	1.576649357	0	0.004452802	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6545
H3924_003_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	V	O	O	O											8.2276	0	1.1451	0	0.4193	0.2674	0.3149	0	1.5246	1.2877	0.9011	0	0.0017	0.3769	0	0.8941	0	0	0.7169	0.1155	0.3331	0.0329	0	0	0	0	0	0	0	0											16.5589	YES	334.8297798	4.777267337	1039.169775	0	123.3563013	7.573641296	8.919625657	238.1532691	240.4741901	4815.854176	813.2239899	28.43672756	0	2485.136945	4026.907457	3330.542224	134.4170695	492.2212427	568.0377368	102.8735903	9.434652243	0	0	478.094107	895.5734516	0	0.517809761	0	0	0											2900	$275 Copay per Admit (PBP 1a)	$275 Copay per Admit (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$100 Copay (PBP 9a, 9b)"	$10 Copay (PBP 8a)	"$20 General, $100 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $20 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$20 Copay (PBP 7c, 7i)"	"$20 Office General, $100 Office CT/MRI/PT (PBP 7d)"	Lab $10 Copay (PBP 7g)	"20% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												275	275	60	0	100	0.2	0.2	50	100	10	39.76	25	0	5.22	10	20	20	20	29.36936937	10	0.2	0	0	20	20	0	20	0	0	0											YES	268.2642483	268.2642483	58.53038145	0	97.55063576	0.195101272	0.195101272	48.77531788	97.55063576	9.755063576	38.78613278	24.38765894	0	5.092143187	9.755063576	19.51012715	19.51012715	19.51012715	28.65000654	9.755063576	0.161	0	0	19.51012715	19.51012715	0	19.51012715	0	0	0											3500	7.4852	0.106797503	5.068583612	0	1.002790468	1.477627047	1.740230307	0.968000117	1.954867511	3.914913639	2.628484471	0.057792101	0	1.054556097	3.273561521	5.414941855	0.218541176	0.800274919	1.356190406	0.083628201	1.518979011	0	0	0.777306401	1.456062659	0	0.000841878	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3602	250	1.39341937	15.7128	0.106797503	6.21365983	0	1.422088426	1.745048181	2.055129774	0.968000117	3.479503298	5.20261051	3.52956057	0.057792101	0.001675013	1.431486385	3.273561521	6.309086487	0.218541176	0.800274919	2.073063367	0.199159963	1.852061035	0.032913742	0	0.777306401	1.456062659	0	0.000841878	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9191	NO	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	N/A	20% Coinsurance	$30 Copay	$200 Max per 2 Years	$30 Copay	$800 Max per 3 Years	20% Coinsurance	20% Coinsurance												1.9123	0	0.2662	0.0758	0.0975	0.0622	0.0732	0.0422	0.3544	0.2993	0.2094	0	0.0004	0.1542	0.3898	1.3368	0	0.0161	0.1666	0.0269	0.0774	0.0077	0	0.0431	0.1206	0	0.0036	0	0	0											5.7354	250	2.891354201	17.6252	0.106797503	6.479810458	0.07575805	1.519546056	1.807205007	2.128322012	1.010164761	3.833875143	5.501910527	3.73899813	0.057792101	0.002064338	1.585693619	3.663350568	7.645882314	0.218541176	0.81639621	2.239686502	0.226013067	1.929479454	0.040563899	0	0.820365166	1.576649357	0	0.004452802	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6545
H3924_017_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	V	O	O	O											7.3049	0	1.3564	0	0.3637	0.2846	0.2697	0	1.3072	1.2413	0.8546	0	0.0011	0.3516	0	0.8734	0	0	1.0095	0.0953	0.2549	0.0358	0	0	0	0	0	0	0	0											15.604	YES	297.279129	4.777267337	1230.983962	0	106.9939518	8.059188449	7.640632535	233.2659183	206.1730909	4642.320511	771.2781061	24.07117008	0	2318.109103	2924.256952	3253.314465	134.4170695	398.1831338	799.9249392	84.89886067	7.218718962	0	0	477.1170265	612.4675003	0	0.454617426	0	0	0											2900	$275 Copay per Admit (PBP 1a)	$275 Copay per Admit (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$100 Copay (PBP 9a, 9b)"	$10 Copay (PBP 8a)	"$20 General, $100 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $20 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$20 Copay (PBP 7c, 7i)"	"$20 Office General, $100 Office CT/MRI/PT (PBP 7d)"	Lab $10 Copay (PBP 7g)	"20% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												275	275	60	0	100	0.2	0.2	50	100	10	39.76	25	0	5.22	10	20	20	20	29.36936937	10	0.2	0	0	20	20	0	20	0	0	0											YES	268.2642483	268.2642483	58.53038145	0	97.55063576	0.195101272	0.195101272	48.77531788	97.55063576	9.755063576	38.78613278	24.38765894	0	5.092143187	9.755063576	19.51012715	19.51012715	19.51012715	28.65000654	9.755063576	0.161	0	0	19.51012715	19.51012715	0	19.51012715	0	0	0											3500	6.6458	0.106797503	6.004163404	0	0.869777335	1.572357914	1.490697123	0.948134943	1.676026341	3.77384431	2.492907919	0.048919957	0	0.983678623	2.377192706	5.289381574	0.218541176	0.647383631	1.909821228	0.069016149	1.162213753	0	0	0.775717821	0.995776567	0	0.000739137	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0589	250	1.258172339	13.9507	0.106797503	7.360602451	0	1.233458355	1.856923453	1.760442873	0.948134943	2.983188963	5.015140533	3.347506745	0.048919957	0.001073987	1.335275155	2.377192706	6.162793009	0.218541176	0.647383631	2.91933965	0.164361465	1.417064219	0.035803089	0	0.775717821	0.995776567	0	0.000739137	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6629	NO	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	N/A	20% Coinsurance	$30 Copay	$200 Max per 2 Years	$30 Copay	$800 Max per 3 Years	20% Coinsurance	20% Coinsurance												1.6979	0	0.3153	0.0881	0.0845	0.0661	0.0627	0.0413	0.3038	0.2885	0.1986	0	0.0002	0.1438	0.2831	1.3058	0	0.013	0.2346	0.0222	0.0592	0.0083	0	0.043	0.0825	0	0.0032	0	0	0											5.3459	250	2.687893032	15.6486	0.106797503	7.675880245	0.088097971	1.317988913	1.92306516	1.82314001	0.989434289	3.287013413	5.303655624	3.54614157	0.048919957	0.001323614	1.47911801	2.660249454	7.468591557	0.218541176	0.660424973	3.153982513	0.186522623	1.476299238	0.044124818	0	0.818688586	1.078243765	0	0.003909392	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0087
H3924_018_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	V	O	O	O											7.3049	0	1.3564	0	0.3637	0.2846	0.2697	0	1.3072	1.2413	0.8546	0	0.0011	0.3516	0	0.8734	0	0	1.0095	0.0953	0.2549	0.0358	0	0	0	0	0	0	0	0											15.604	YES	297.279129	4.777267337	1230.983962	0	106.9939518	8.059188449	7.640632535	233.2659183	206.1730909	4642.320511	771.2781061	24.07117008	0	2318.109103	2924.256952	3253.314465	134.4170695	398.1831338	799.9249392	84.89886067	7.218718962	0	0	477.1170265	612.4675003	0	0.454617426	0	0	0											2900	$275 Copay per Admit (PBP 1a)	$275 Copay per Admit (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$100 Copay (PBP 9a, 9b)"	$10 Copay (PBP 8a)	"$20 General, $100 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $20 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$20 Copay (PBP 7c, 7i)"	"$20 Office General, $100 Office CT/MRI/PT (PBP 7d)"	Lab $10 Copay (PBP 7g)	"20% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												275	275	60	0	100	0.2	0.2	50	100	10	39.76	25	0	5.22	10	20	20	20	29.36936937	10	0.2	0	0	20	20	0	20	0	0	0											YES	268.2642483	268.2642483	58.53038145	0	97.55063576	0.195101272	0.195101272	48.77531788	97.55063576	9.755063576	38.78613278	24.38765894	0	5.092143187	9.755063576	19.51012715	19.51012715	19.51012715	28.65000654	9.755063576	0.161	0	0	19.51012715	19.51012715	0	19.51012715	0	0	0											3500	6.6458	0.106797503	6.004163404	0	0.869777335	1.572357914	1.490697123	0.948134943	1.676026341	3.77384431	2.492907919	0.048919957	0	0.983678623	2.377192706	5.289381574	0.218541176	0.647383631	1.909821228	0.069016149	1.162213753	0	0	0.775717821	0.995776567	0	0.000739137	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0589	250	1.258172339	13.9507	0.106797503	7.360602451	0	1.233458355	1.856923453	1.760442873	0.948134943	2.983188963	5.015140533	3.347506745	0.048919957	0.001073987	1.335275155	2.377192706	6.162793009	0.218541176	0.647383631	2.91933965	0.164361465	1.417064219	0.035803089	0	0.775717821	0.995776567	0	0.000739137	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6629	NO	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	N/A	20% Coinsurance	$30 Copay	$200 Max per 2 Years	$30 Copay	$800 Max per 3 Years	20% Coinsurance	20% Coinsurance												1.6979	0	0.3153	0.0881	0.0845	0.0661	0.0627	0.0413	0.3038	0.2885	0.1986	0	0.0002	0.1438	0.2831	1.3058	0	0.013	0.2346	0.0222	0.0592	0.0083	0	0.043	0.0825	0	0.0032	0	0	0											5.3459	250	2.687893032	15.6486	0.106797503	7.675880245	0.088097971	1.317988913	1.92306516	1.82314001	0.989434289	3.287013413	5.303655624	3.54614157	0.048919957	0.001323614	1.47911801	2.660249454	7.468591557	0.218541176	0.660424973	3.153982513	0.186522623	1.476299238	0.044124818	0	0.818688586	1.078243765	0	0.003909392	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0087
H3924_019_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	V	O	O	O											7.3049	0	1.3564	0	0.3637	0.2846	0.2697	0	1.3072	1.2413	0.8546	0	0.0011	0.3516	0	0.8734	0	0	1.0095	0.0953	0.2549	0.0358	0	0	0	0	0	0	0	0											15.604	YES	297.279129	4.777267337	1230.983962	0	106.9939518	8.059188449	7.640632535	233.2659183	206.1730909	4642.320511	771.2781061	24.07117008	0	2318.109103	2924.256952	3253.314465	134.4170695	398.1831338	799.9249392	84.89886067	7.218718962	0	0	477.1170265	612.4675003	0	0.454617426	0	0	0											2900	$275 Copay per Admit (PBP 1a)	$275 Copay per Admit (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$100 Copay (PBP 9a, 9b)"	$10 Copay (PBP 8a)	"$20 General, $100 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $20 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$20 Copay (PBP 7c, 7i)"	"$20 Office General, $100 Office CT/MRI/PT (PBP 7d)"	Lab $10 Copay (PBP 7g)	"20% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												275	275	60	0	100	0.2	0.2	50	100	10	39.76	25	0	5.22	10	20	20	20	29.36936937	10	0.2	0	0	20	20	0	20	0	0	0											YES	268.2642483	268.2642483	58.53038145	0	97.55063576	0.195101272	0.195101272	48.77531788	97.55063576	9.755063576	38.78613278	24.38765894	0	5.092143187	9.755063576	19.51012715	19.51012715	19.51012715	28.65000654	9.755063576	0.161	0	0	19.51012715	19.51012715	0	19.51012715	0	0	0											3500	6.6458	0.106797503	6.004163404	0	0.869777335	1.572357914	1.490697123	0.948134943	1.676026341	3.77384431	2.492907919	0.048919957	0	0.983678623	2.377192706	5.289381574	0.218541176	0.647383631	1.909821228	0.069016149	1.162213753	0	0	0.775717821	0.995776567	0	0.000739137	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0589	250	1.258172339	13.9507	0.106797503	7.360602451	0	1.233458355	1.856923453	1.760442873	0.948134943	2.983188963	5.015140533	3.347506745	0.048919957	0.001073987	1.335275155	2.377192706	6.162793009	0.218541176	0.647383631	2.91933965	0.164361465	1.417064219	0.035803089	0	0.775717821	0.995776567	0	0.000739137	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6629	NO	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	N/A	20% Coinsurance	$30 Copay	$200 Max per 2 Years	$30 Copay	$800 Max per 3 Years	20% Coinsurance	20% Coinsurance												1.6979	0	0.3153	0.0881	0.0845	0.0661	0.0627	0.0413	0.3038	0.2885	0.1986	0	0.0002	0.1438	0.2831	1.3058	0	0.013	0.2346	0.0222	0.0592	0.0083	0	0.043	0.0825	0	0.0032	0	0	0											5.3459	250	2.687893032	15.6486	0.106797503	7.675880245	0.088097971	1.317988913	1.92306516	1.82314001	0.989434289	3.287013413	5.303655624	3.54614157	0.048919957	0.001323614	1.47911801	2.660249454	7.468591557	0.218541176	0.660424973	3.153982513	0.186522623	1.476299238	0.044124818	0	0.818688586	1.078243765	0	0.003909392	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0087
H3924_021_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	V	O	O	O											7.2029	0	1.1045	0	0.406	0.2833	0.299	0	1.4647	1.285	0.8971	0	0.0014	0.3718	0	0.8622	0	0	0.8492	0.1251	0.2841	0.0333	0	0	0	0	0	0	0	0											15.4696	YES	293.1274787	4.777267337	1002.305334	0	119.4504804	8.022950648	8.469121494	241.1416491	231.0172186	4805.940499	809.6505862	27.00946028	0	2451.372075	3422.375056	3211.502685	134.4170695	433.7652999	672.8988839	111.3664745	8.047894192	0	0	477.4022205	734.1963908	0	0.471817449	0	0	0											2900	$275 Copay per Admit (PBP 1a)	$275 Copay per Admit (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$100 Copay (PBP 9a, 9b)"	$10 Copay (PBP 8a)	"$20 General, $100 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $20 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$20 Copay (PBP 7c, 7i)"	"$20 Office General, $100 Office CT/MRI/PT (PBP 7d)"	Lab $10 Copay (PBP 7g)	"20% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												275	275	60	0	100	0.2	0.2	50	100	10	39.76	25	0	5.22	10	20	20	20	29.36936937	10	0.2	0	0	20	20	0	20	0	0	0											YES	268.2642483	268.2642483	58.53038145	0	97.55063576	0.195101272	0.195101272	48.77531788	97.55063576	9.755063576	38.78613278	24.38765894	0	5.092143187	9.755063576	19.51012715	19.51012715	19.51012715	28.65000654	9.755063576	0.161	0	0	19.51012715	19.51012715	0	19.51012715	0	0	0											3500	6.553	0.106797503	4.888776125	0	0.971039192	1.565287873	1.652336372	0.980146716	1.877989712	3.906854593	2.616934595	0.054891459	0	1.040228134	2.782123855	5.221402145	0.218541176	0.70523468	1.606546452	0.090532253	1.295710965	0	0	0.776181502	1.193688745	0	0.000767102	0	0	0	0	0	0	0	0	0	0	0	0	0	40.105	250	1.288316009	13.7558	0.106797503	5.993230882	0	1.377060952	1.848573875	1.95133119	0.980146716	3.342667143	5.191900676	3.514051257	0.054891459	0.001406328	1.412037174	2.782123855	6.083588447	0.218541176	0.70523468	2.455755904	0.215601914	1.579834727	0.033298254	0	0.776181502	1.193688745	0	0.000767102	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5746	NO	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	N/A	20% Coinsurance	$30 Copay	$200 Max per 2 Years	$30 Copay	$800 Max per 3 Years	20% Coinsurance	20% Coinsurance												1.6742	0	0.2567	0.0489	0.0944	0.0658	0.0695	0.0427	0.3404	0.2987	0.2085	0	0.0003	0.1521	0.3313	1.289	0	0.0142	0.1974	0.0291	0.066	0.0077	0	0.043	0.0989	0	0.0033	0	0	0											5.3321	250	2.683865556	15.43	0.106797503	6.249939843	0.048864404	1.471432788	1.914418179	2.020826702	1.022840447	3.683102838	5.490584568	3.722568524	0.054891459	0.001733202	1.564149238	3.113396506	7.3726048	0.218541176	0.719441414	2.653138074	0.244671916	1.645873752	0.041037784	0	0.819177953	1.29254643	0	0.0040573	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9067
H3924_022_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	V	O	O	O											7.2029	0	1.1045	0	0.406	0.2833	0.299	0	1.4647	1.285	0.8971	0	0.0014	0.3718	0	0.8622	0	0	0.8492	0.1251	0.2841	0.0333	0	0	0	0	0	0	0	0											15.4696	YES	293.1274787	4.777267337	1002.305334	0	119.4504804	8.022950648	8.469121494	241.1416491	231.0172186	4805.940499	809.6505862	27.00946028	0	2451.372075	3422.375056	3211.502685	134.4170695	433.7652999	672.8988839	111.3664745	8.047894192	0	0	477.4022205	734.1963908	0	0.471817449	0	0	0											2900	$275 Copay per Admit (PBP 1a)	$275 Copay per Admit (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$100 Copay (PBP 9a, 9b)"	$10 Copay (PBP 8a)	"$20 General, $100 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $20 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$20 Copay (PBP 7c, 7i)"	"$20 Office General, $100 Office CT/MRI/PT (PBP 7d)"	Lab $10 Copay (PBP 7g)	"20% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												275	275	60	0	100	0.2	0.2	50	100	10	39.76	25	0	5.22	10	20	20	20	29.36936937	10	0.2	0	0	20	20	0	20	0	0	0											YES	268.2642483	268.2642483	58.53038145	0	97.55063576	0.195101272	0.195101272	48.77531788	97.55063576	9.755063576	38.78613278	24.38765894	0	5.092143187	9.755063576	19.51012715	19.51012715	19.51012715	28.65000654	9.755063576	0.161	0	0	19.51012715	19.51012715	0	19.51012715	0	0	0											3500	6.553	0.106797503	4.888776125	0	0.971039192	1.565287873	1.652336372	0.980146716	1.877989712	3.906854593	2.616934595	0.054891459	0	1.040228134	2.782123855	5.221402145	0.218541176	0.70523468	1.606546452	0.090532253	1.295710965	0	0	0.776181502	1.193688745	0	0.000767102	0	0	0	0	0	0	0	0	0	0	0	0	0	40.105	250	1.288316009	13.7558	0.106797503	5.993230882	0	1.377060952	1.848573875	1.95133119	0.980146716	3.342667143	5.191900676	3.514051257	0.054891459	0.001406328	1.412037174	2.782123855	6.083588447	0.218541176	0.70523468	2.455755904	0.215601914	1.579834727	0.033298254	0	0.776181502	1.193688745	0	0.000767102	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5746	NO	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	N/A	20% Coinsurance	$30 Copay	$200 Max per 2 Years	$30 Copay	$800 Max per 3 Years	20% Coinsurance	20% Coinsurance												1.6742	0	0.2567	0.0489	0.0944	0.0658	0.0695	0.0427	0.3404	0.2987	0.2085	0	0.0003	0.1521	0.3313	1.289	0	0.0142	0.1974	0.0291	0.066	0.0077	0	0.043	0.0989	0	0.0033	0	0	0											5.3321	250	2.683865556	15.43	0.106797503	6.249939843	0.048864404	1.471432788	1.914418179	2.020826702	1.022840447	3.683102838	5.490584568	3.722568524	0.054891459	0.001733202	1.564149238	3.113396506	7.3726048	0.218541176	0.719441414	2.653138074	0.244671916	1.645873752	0.041037784	0	0.819177953	1.29254643	0	0.0040573	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9067
H3924_023_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	V	O	O	O											7.2029	0	1.1045	0	0.406	0.2833	0.299	0	1.4647	1.285	0.8971	0	0.0014	0.3718	0	0.8622	0	0	0.8492	0.1251	0.2841	0.0333	0	0	0	0	0	0	0	0											15.4696	YES	293.1274787	4.777267337	1002.305334	0	119.4504804	8.022950648	8.469121494	241.1416491	231.0172186	4805.940499	809.6505862	27.00946028	0	2451.372075	3422.375056	3211.502685	134.4170695	433.7652999	672.8988839	111.3664745	8.047894192	0	0	477.4022205	734.1963908	0	0.471817449	0	0	0											2900	$275 Copay per Admit (PBP 1a)	$275 Copay per Admit (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$100 Copay (PBP 9a, 9b)"	$10 Copay (PBP 8a)	"$20 General, $100 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $20 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$20 Copay (PBP 7c, 7i)"	"$20 Office General, $100 Office CT/MRI/PT (PBP 7d)"	Lab $10 Copay (PBP 7g)	"20% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												275	275	60	0	100	0.2	0.2	50	100	10	39.76	25	0	5.22	10	20	20	20	29.36936937	10	0.2	0	0	20	20	0	20	0	0	0											YES	268.2642483	268.2642483	58.53038145	0	97.55063576	0.195101272	0.195101272	48.77531788	97.55063576	9.755063576	38.78613278	24.38765894	0	5.092143187	9.755063576	19.51012715	19.51012715	19.51012715	28.65000654	9.755063576	0.161	0	0	19.51012715	19.51012715	0	19.51012715	0	0	0											3500	6.553	0.106797503	4.888776125	0	0.971039192	1.565287873	1.652336372	0.980146716	1.877989712	3.906854593	2.616934595	0.054891459	0	1.040228134	2.782123855	5.221402145	0.218541176	0.70523468	1.606546452	0.090532253	1.295710965	0	0	0.776181502	1.193688745	0	0.000767102	0	0	0	0	0	0	0	0	0	0	0	0	0	40.105	250	1.288316009	13.7558	0.106797503	5.993230882	0	1.377060952	1.848573875	1.95133119	0.980146716	3.342667143	5.191900676	3.514051257	0.054891459	0.001406328	1.412037174	2.782123855	6.083588447	0.218541176	0.70523468	2.455755904	0.215601914	1.579834727	0.033298254	0	0.776181502	1.193688745	0	0.000767102	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5746	NO	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$50 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Copay	$30 Copay	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	N/A	20% Coinsurance	$30 Copay	$200 Max per 2 Years	$30 Copay	$800 Max per 3 Years	20% Coinsurance	20% Coinsurance												1.6742	0	0.2567	0.0489	0.0944	0.0658	0.0695	0.0427	0.3404	0.2987	0.2085	0	0.0003	0.1521	0.3313	1.289	0	0.0142	0.1974	0.0291	0.066	0.0077	0	0.043	0.0989	0	0.0033	0	0	0											5.3321	250	2.683865556	15.43	0.106797503	6.249939843	0.048864404	1.471432788	1.914418179	2.020826702	1.022840447	3.683102838	5.490584568	3.722568524	0.054891459	0.001733202	1.564149238	3.113396506	7.3726048	0.218541176	0.719441414	2.653138074	0.244671916	1.645873752	0.041037784	0	0.819177953	1.29254643	0	0.0040573	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9067
H3924_801_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	O	V	O	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	NO	254.2703732	1.339512316	31.81580829	0	9.884398947	7.817100182	10.2032674	11.57155514	59.27995993	41.73561237	29.98989622	5.680177536	0.027319834	25.23182642	43.62792054	172.6022808	0.937944963	3.893865504	29.84913294	5.05425162	16.12293068	1.08166354	0	0	0	0	0	0	0	0												Medicare FFS Benefits (PBP 1a)	Medicare FFS Benefits (PBP 1b)	Medicare FFS Benefits (PBP 2)	Medicare FFS Benefits (PBP 6)	Medicare FFS Benefits (PBP 10a)	Medicare FFS Benefits (PBP 11a)	"Medicare FFS Benefits (PBP 11b, 11c)"	"Medicare FFS Benefits (PBP 4a, 4b)"	"Medicare FFS Benefits (PBP 9a, 9b)"	Medicare FFS Benefits (PBP 8a)	Medicare FFS Benefits (PBP 8b)	Medicare FFS Benefits (PBP 5)	Medicare FFS Benefits (PBP 12)	"Medicare FFS Benefits (PBP 3, 9a, 9c, 9d)"	"Medicare FFS Benefits (PBP 7a, 14b-i)"	"Medicare FFS Benefits (PBP 7b, 7d, 7f, 7g, 14d-i)"	"Medicare FFS Benefits (PBP 7e, 7h)"	"Medicare FFS Benefits (PBP 7c, 7i)"	Medicare FFS Benefits (PBP 7d)	Medicare FFS Benefits (PBP 7g)	Medicare FFS Benefits (PBP 15)	Medicare FFS Benefits (PBP 13a)	N/A (PBP 10b)	"N/A (PBP 16a, 16b)"	N/A (PBP 17a)	N/A (PBP 17b)	N/A (PBP 18a)	N/A (PBP 18b)	N/A (PBP 14a)												0.079728646	0.079728646	0.171713097	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079728646	0.079728646	0.171713097	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.2726	0.106797503	5.463190975	0	2.303064955	1.821384342	2.377361304	2.696172349	13.81223066	9.724397681	6.987645819	1.323481366	0.006365521	5.879015557	10.16530549	40.21633143	0.218541176	0.907270662	6.954847975	1.177640628	3.756642849	0.252027605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4223	146	0	20.2726	0.106797503	5.463190975	0	2.303064955	1.821384342	2.377361304	2.696172349	13.81223066	9.724397681	6.987645819	1.323481366	0.006365521	5.879015557	10.16530549	40.21633143	0.218541176	0.907270662	6.954847975	1.177640628	3.756642849	0.252027605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4223	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	20.2726	0.106797503	5.463190975	0	2.303064955	1.821384342	2.377361304	2.696172349	13.81223066	9.724397681	6.987645819	1.323481366	0.006365521	5.879015557	10.16530549	40.21633143	0.218541176	0.907270662	6.954847975	1.177640628	3.756642849	0.252027605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4223
H3924_802_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	O	V	O	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	NO	254.2703732	1.339512316	31.81580829	0	9.884398947	7.817100182	10.2032674	11.57155514	59.27995993	41.73561237	29.98989622	5.680177536	0.027319834	25.23182642	43.62792054	172.6022808	0.937944963	3.893865504	29.84913294	5.05425162	16.12293068	1.08166354	0	0	0	0	0	0	0	0												Medicare FFS Benefits (PBP 1a)	Medicare FFS Benefits (PBP 1b)	Medicare FFS Benefits (PBP 2)	Medicare FFS Benefits (PBP 6)	Medicare FFS Benefits (PBP 10a)	Medicare FFS Benefits (PBP 11a)	"Medicare FFS Benefits (PBP 11b, 11c)"	"Medicare FFS Benefits (PBP 4a, 4b)"	"Medicare FFS Benefits (PBP 9a, 9b)"	Medicare FFS Benefits (PBP 8a)	Medicare FFS Benefits (PBP 8b)	Medicare FFS Benefits (PBP 5)	Medicare FFS Benefits (PBP 12)	"Medicare FFS Benefits (PBP 3, 9a, 9c, 9d)"	"Medicare FFS Benefits (PBP 7a, 14b-i)"	"Medicare FFS Benefits (PBP 7b, 7d, 7f, 7g, 14d-i)"	"Medicare FFS Benefits (PBP 7e, 7h)"	"Medicare FFS Benefits (PBP 7c, 7i)"	Medicare FFS Benefits (PBP 7d)	Medicare FFS Benefits (PBP 7g)	Medicare FFS Benefits (PBP 15)	Medicare FFS Benefits (PBP 13a)	N/A (PBP 10b)	"N/A (PBP 16a, 16b)"	N/A (PBP 17a)	N/A (PBP 17b)	N/A (PBP 18a)	N/A (PBP 18b)	N/A (PBP 14a)												0.079728646	0.079728646	0.171713097	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079728646	0.079728646	0.171713097	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.2726	0.106797503	5.463190975	0	2.303064955	1.821384342	2.377361304	2.696172349	13.81223066	9.724397681	6.987645819	1.323481366	0.006365521	5.879015557	10.16530549	40.21633143	0.218541176	0.907270662	6.954847975	1.177640628	3.756642849	0.252027605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4223	146	0	20.2726	0.106797503	5.463190975	0	2.303064955	1.821384342	2.377361304	2.696172349	13.81223066	9.724397681	6.987645819	1.323481366	0.006365521	5.879015557	10.16530549	40.21633143	0.218541176	0.907270662	6.954847975	1.177640628	3.756642849	0.252027605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4223	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	20.2726	0.106797503	5.463190975	0	2.303064955	1.821384342	2.377361304	2.696172349	13.81223066	9.724397681	6.987645819	1.323481366	0.006365521	5.879015557	10.16530549	40.21633143	0.218541176	0.907270662	6.954847975	1.177640628	3.756642849	0.252027605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.4223
H3931_004_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	O																																																			0	NO	1789.988407	71.94613811	1068.338883	1066.853866	245.8154765	12.44739337	0	226.4290259	404.9202174	1826.155073	2429.226191	24.3321489	0	875.7642782	4902.885266	6540.037698	276.0188131	562.1788925	0	0	267	0	0	0	1049.584318	0	68.80261283	0	0	0												$225/day 1-7	$225/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$40 X-ray; $150 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$20 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 eyewear reimbursement/2years	$0 per visit	Not Covered	Not Covered	0											162.6423925	162.6423925	47.8866492	0	150	0.2	0.2	48.5	250	0	42	40	25	40	20	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0											NO	162.6423925	162.6423925	47.8866492	0	150	0.2	0.2	48.5	250	0	42	40	25	40	20	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0												24.2607	0.975124336	4.26326411	0	3.072693457	2.489478673	0	0.915150646	8.435837863	0	8.502291669	0.081107163	0	2.919214261	8.171475444	21.80012566	0.92006271	1.873929642	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6817			24.2607	0.975124336	4.26326411	0	3.072693457	2.489478673	0	0.915150646	8.435837863	0	8.502291669	0.081107163	0	2.919214261	8.171475444	21.80012566	0.92006271	1.873929642	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6817	NO																																																																																		0			24.2607	0.975124336	4.26326411	0	3.072693457	2.489478673	0	0.915150646	8.435837863	0	8.502291669	0.081107163	0	2.919214261	8.171475444	21.80012566	0.92006271	1.873929642	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6817
H3931_054_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	V																																																			0	NO	2301.936889	108.8624842	1202.491168	1280.813724	247.1592373	13.09612637	0	298.7068774	393.8109247	1634.900441	2318.976912	29.43618857	0.030275851	559.4200956	6059.783386	6546.111308	181.9840968	409.8816281	0	0	267.9561607	0	0	0	995.1509577	0	53.80445576	0	43.22366059	0												$250/day 1-7	$250/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$45 X-ray; $175 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	$25 PCP visit; $45 if no PCP selected	$45 per visit	$40 per visit	$45 per visit	$40 per visit	$45 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	48.5	45	25	45	25	45	40	45	40	45	$45 	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	48.5	45	25	45	25	45	40	45	40	45	$45 	0	0	0	0	0	0	0	0	0												34.666	1.63941249	4.79860606	0	3.089490467	2.619225273	0	1.20727363	8.204394265	0	9.372531687	0.110385707	6.31E-05	2.097825359	12.62454872	24.54791741	0.606613656	1.537056105	0	0	1.004835603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1262			34.666	1.63941249	4.79860606	0	3.089490467	2.619225273	0	1.20727363	8.204394265	0	9.372531687	0.110385707	6.31E-05	2.097825359	12.62454872	24.54791741	0.606613656	1.537056105	0	0	1.004835603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1262	NO																																																																																		0			34.666	1.63941249	4.79860606	0	3.089490467	2.619225273	0	1.20727363	8.204394265	0	9.372531687	0.110385707	6.31E-05	2.097825359	12.62454872	24.54791741	0.606613656	1.537056105	0	0	1.004835603	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1262
H3931_055_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	V																																																			0	NO	1556.371877	40.47066519	1075.220636	753.7046745	251.5843141	10.29146894	0	198.855861	408.1041892	1628.987862	2271.460452	7.994205469	0	613.8806567	4799.878194	5553.987105	124.5342355	401.2769811	0	0	267	0	0	0	990.089103	0	65.51674848	0	39.31004909	0												$250/day 1-7	$250/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$45 X-ray; $175 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	$25 PCP visit; $45 if no PCP selected	$45 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	Not Covered	Not Covered	0											180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	48.5	45	25	45	25	45	40	45	45	45	$45 	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	48.5	45	25	45	25	45	40	45	45	45	$45 	0	0	0	0	0	0	0	0	0												23.4382	0.609467205	4.290726116	0	3.144803927	2.058293787	0	0.803709105	8.502170608	0	9.180485994	0.029978271	0	2.302052463	9.999746238	20.82745165	0.415114118	1.504788679	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1082			23.4382	0.609467205	4.290726116	0	3.144803927	2.058293787	0	0.803709105	8.502170608	0	9.180485994	0.029978271	0	2.302052463	9.999746238	20.82745165	0.415114118	1.504788679	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1082	NO																																																																																		0			23.4382	0.609467205	4.290726116	0	3.144803927	2.058293787	0	0.803709105	8.502170608	0	9.180485994	0.029978271	0	2.302052463	9.999746238	20.82745165	0.415114118	1.504788679	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1082
H3931_058_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	V																																																			0	NO	2229.835292	131.1483259	1285.755597	1174.082399	246.8129667	18.21765035	0	261.0416439	413.6924385	1776.36222	2592.835849	66.20166689	0	790.4453379	6494.767421	7262.059782	282.6057634	623.8173149	0	0	267	0	0	0	1072.145038	0	70.14339291	0	24.58296481	0												$175/day 1-10	$175/day 1-10	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$0 per visit	$35 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 eyewear reimbursement/2years	$0 per visit	Not Covered	Not Covered	0											143.4382958	143.4382958	47.8866492	0	100	0.2	0.2	48.5	200	0	40.5	35	25	35	15	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	143.4382958	143.4382958	47.8866492	0	100	0.2	0.2	48.5	200	0	40.5	35	25	35	15	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												26.6536	1.56764103	5.130877269	0	2.056774722	3.64353007	0	1.055043311	6.894873975	0	8.750820992	0.193088195	0	2.305465569	8.118459277	21.1810077	0.82426681	1.819467169	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1962			26.6536	1.56764103	5.130877269	0	2.056774722	3.64353007	0	1.055043311	6.894873975	0	8.750820992	0.193088195	0	2.305465569	8.118459277	21.1810077	0.82426681	1.819467169	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1962	NO																																																																																		0			26.6536	1.56764103	5.130877269	0	2.056774722	3.64353007	0	1.055043311	6.894873975	0	8.750820992	0.193088195	0	2.305465569	8.118459277	21.1810077	0.82426681	1.819467169	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1962
H3931_064_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	V																																																			0	NO	1017.642895	95.85479491	653.7669264	586.8817786	148.1235923	6.785459296	0	168.2112056	407.8481929	1373.686615	2103.174257	43.27425207	0	488.255777	4390.453808	4397.548609	194.2932524	299.7123495	0	0	267	0	0	0	913.3881485	0	56.61395951	0	18.30192657	0												$250/day 1-7	$250/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$45 X-ray; $175 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	$25 PCP visit; $45 if no PCP selected	$45 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	48.5	45	25	45	25	45	40	45	45	45	$45 	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	48.5	45	25	45	25	45	40	45	45	45	$45 	0	0	0	0	0	0	0	0	0												15.3252	1.443523443	2.608892289	0	1.851544904	1.357091859	0	0.679853623	8.496837352	0	8.50032929	0.162278445	0	1.830959164	9.146778767	16.49080728	0.647644175	1.12392131	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6669			15.3252	1.443523443	2.608892289	0	1.851544904	1.357091859	0	0.679853623	8.496837352	0	8.50032929	0.162278445	0	1.830959164	9.146778767	16.49080728	0.647644175	1.12392131	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6669	NO																																																																																		0			15.3252	1.443523443	2.608892289	0	1.851544904	1.357091859	0	0.679853623	8.496837352	0	8.50032929	0.162278445	0	1.830959164	9.146778767	16.49080728	0.647644175	1.12392131	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6669
H3931_065_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	V																																																			0	NO	2130.686368	131.5126526	1398.387639	1074.671433	294.4876402	15.77516741	0	287.1510745	404.5329193	1479.888104	2257.237866	67.29819876	0	492.6060977	6430.05825	5875.438122	240.7066928	461.5155721	0	0	267	0	0	0	929.3226432	0	53.43984205	0	14.21272395	0												$250/day 1-7	$250/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$45 X-ray; $160 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	$25 PCP visit; $45 if no PCP selected	$45 per visit	$40 per visit	$45 per visit	$45 per visit	$45 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	45.5	45	25	45	25	45	40	45	45	45	$45 	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.8866492	0	150	0.2	0.2	48.5	250	0	45.5	45	25	45	25	45	40	45	45	45	$45 	0	0	0	0	0	0	0	0	0												32.087	1.980512265	5.580341528	0	3.681095503	3.155033481	0	1.160568926	8.427769152	0	8.558693576	0.252368245	0	1.847272866	13.39595469	22.03289296	0.802355643	1.730683395	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.6938			32.087	1.980512265	5.580341528	0	3.681095503	3.155033481	0	1.160568926	8.427769152	0	8.558693576	0.252368245	0	1.847272866	13.39595469	22.03289296	0.802355643	1.730683395	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.6938	NO																																																																																		0			32.087	1.980512265	5.580341528	0	3.681095503	3.155033481	0	1.160568926	8.427769152	0	8.558693576	0.252368245	0	1.847272866	13.39595469	22.03289296	0.802355643	1.730683395	0	0	1.00125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.6938
H3931_070_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	V																																																			0	NO	1491.100767	53.30130784	1061.477715	738.1230556	206.8924799	9.289575371	0	242.8198978	400.0702645	2466.900613	2723.198957	37.70795555	0.243812633	194.4448024	4748.918052	5481.765083	250.2234094	546.3888077	0	0	274.7	0	0	0	863.4859019	0	50.87633619	0														$150/day 1-7	$150/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$125 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$150 per procedure	$0 per visit	$35 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$40 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 eyewear reimbursement/2 years	$0 per visit	Not Covered													108.4282617	108.4282617	47.8866492	0	125	0.2	0.2	48.5	150	0	40.5	35	25	35	15	35	35	35	40	35	$45 	0	0	0	0	0	0	0													NO	108.4282617	108.4282617	47.8866492	0	125	0.2	0.2	48.5	150	0	40.5	35	25	35	15	35	35	35	40	35	$45 	0	0	0	0	0	0	0														13.4731	0.481614013	4.235884249	0	2.155129999	1.857915074	0	0.981397087	5.000878306	0	9.190796481	0.109981537	0.000507943	0.567130674	5.936147565	15.98848149	0.729818277	1.593634022	0	0	1.030125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3326			13.4731	0.481614013	4.235884249	0	2.155129999	1.857915074	0	0.981397087	5.000878306	0	9.190796481	0.109981537	0.000507943	0.567130674	5.936147565	15.98848149	0.729818277	1.593634022	0	0	1.030125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3326	NO																																																																																		0			13.4731	0.481614013	4.235884249	0	2.155129999	1.857915074	0	0.981397087	5.000878306	0	9.190796481	0.109981537	0.000507943	0.567130674	5.936147565	15.98848149	0.729818277	1.593634022	0	0	1.030125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.3326
H3931_077_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V																																																					0	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.49842863	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0														$125/day 1-7	$125/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$135 per procedure	$0 per visit	$30 X-ray; $150 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$10 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 eyewear reimbursement/2 years	$0 per visit	Not Covered													90.35688474	90.35688474	47.8866492	0	100	0.2	0.2	48.5	135	0	39	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											NO	90.35688474	90.35688474	47.8866492	0	100	0.2	0.2	48.5	135	0	39	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0												12.8984	0.573350015	4.659178734	0	1.956222648	2.099685727	0	0.978035432	4.516847436	0	9.410450062	0.13467127	0.000725633	0	3.851098073	14.66959615	0.541802791	1.386687469	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7192			12.8984	0.573350015	4.659178734	0	1.956222648	2.099685727	0	0.978035432	4.516847436	0	9.410450062	0.13467127	0.000725633	0	3.851098073	14.66959615	0.541802791	1.386687469	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7192	NO																																																																																		0			12.8984	0.573350015	4.659178734	0	1.956222648	2.099685727	0	0.978035432	4.516847436	0	9.410450062	0.13467127	0.000725633	0	3.851098073	14.66959615	0.541802791	1.386687469	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7192
H3931_801_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	411.4864742	0.869657502	59.51200224	12.14529364	9.883496672	14.59284367	0	12.23274087	52.98646324	13.37749717	75.38791679	0.559862987	0.001721293	35.32430871	49.9118655	135.7603043	1.791566217	10.09349921	0	-1.17E-09	75.28579429	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.074594537	0.074594537	0.152249298	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074594537	0.074594537	0.152249298	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												30.6946	0.064871699	9.060660542	0	2.302854725	3.400132575	0	2.850228624	12.34584593	3.116956841	17.56538461	0.130448076	0.000401061	8.23056393	11.62946466	31.63215091	0.417434929	2.351785315	0	-2.72E-10	17.54159007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.3354			30.6946	0.064871699	9.060660542	0	2.302854725	3.400132575	0	2.850228624	12.34584593	3.116956841	17.56538461	0.130448076	0.000401061	8.23056393	11.62946466	31.63215091	0.417434929	2.351785315	0	-2.72E-10	17.54159007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.3354	NO																																																																																		0			30.6946	0.064871699	9.060660542	0	2.302854725	3.400132575	0	2.850228624	12.34584593	3.116956841	17.56538461	0.130448076	0.000401061	8.23056393	11.62946466	31.63215091	0.417434929	2.351785315	0	-2.72E-10	17.54159007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.3354
H3931_804_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	333.4857517	3.192037943	46.0949977	10.26758854	8.271590027	12.91357285	0	10.36599617	50.69738372	14.60436898	82.24964384	0.478293809	0	33.79825584	49.81778311	126.3095007	1.915626456	8.595108207	0	0	85.87665813	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.075253575	0.075253575	0.153494751	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075253575	0.075253575	0.153494751	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.096	0.240212268	7.075340187	0	1.927280476	3.008862475	0	2.415277108	11.81249041	3.402817972	19.16416702	0.111442457	0	7.874993612	11.60754347	29.43011366	0.446340964	2.002660212	0	0	20.00926135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.6248			25.096	0.240212268	7.075340187	0	1.927280476	3.008862475	0	2.415277108	11.81249041	3.402817972	19.16416702	0.111442457	0	7.874993612	11.60754347	29.43011366	0.446340964	2.002660212	0	0	20.00926135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.6248	NO																																																																																		0			25.096	0.240212268	7.075340187	0	1.927280476	3.008862475	0	2.415277108	11.81249041	3.402817972	19.16416702	0.111442457	0	7.874993612	11.60754347	29.43011366	0.446340964	2.002660212	0	0	20.00926135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.6248
H3949_002_0	2010	3	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	2022.726457	12.7244306	881.984662	22.54791811	198.8420491	14.38314434	4.153697991	342.3826109	529.3099322	0.737610199	1443.993563	0	1.858402831	1431.031943	329.8516776	4723.452954	519.5782553	286.6415772	19.27342339	86.08937659	23.68536716	0	0	0	0	0	0	0	0	0												1a:  Acute - $150/$0/day for 1-7/8-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $150/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $35/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $35/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $35/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											150	0.075199698	85	0	100	0.2	0.2	40.04725175	237.6406966	0	55.95127775	0	0.2	53.35181985	35	34.76528052	35	35	0	34.96014128	0.2	0	0	0	0	0	0	0	0	0											NO	150	0.075199698	85	0	100	0.2	0.2	40.04725175	237.6406966	0	55.95127775	0	0.2	53.35181985	35	34.76528052	35	35	0	34.96014128	0.2	0	0	0	0	0	0	0	0	0												25.2841	0.956873336	6.247391356	0	1.657017076	2.876628868	0.830739598	1.142623551	10.48213175	0	6.732773742	0	0.371680566	6.362346536	0.962067393	13.68434724	1.515436578	0.836037933	0	0.250808064	4.737073433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9301		0	25.2841	0.956873336	6.247391356	0	1.657017076	2.876628868	0.830739598	1.142623551	10.48213175	0	6.732773742	0	0.371680566	6.362346536	0.962067393	13.68434724	1.515436578	0.836037933	0	0.250808064	4.737073433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9301	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	25.2841	0.956873336	6.247391356	0	1.657017076	2.876628868	0.830739598	1.142623551	10.48213175	0	6.732773742	0	0.371680566	6.362346536	0.962067393	13.68434724	1.515436578	0.836037933	0	0.250808064	4.737073433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9301
H3949_009_0	2010	1	N/A																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	381.7285225	12.791805	39.2280387	17.85600133	14.25650238	13.15567531	3.83452698	272.7112234	19.72445633	0.601579738	27.82030267	0	2.45493991	8.309915549	69.7787388	78.47430982	7.639796024	1.66305411	15.08978497	12.02804972	13.03897436	0.047339568	0	0	0	0	0	0	0	0												1a:  Acute - MC Cost Shares for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - MC Cost Shares for 1-100/2:  Non-Medicare Covered Stay - MC Cost Shares for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - 20.0%/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - 20.0%/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/14e:  Prostate Cancer Screening - 20.0%/14h:  Mammography - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/ Visits/17a:  Vision Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/7f:  Routine Footcare - $0/visit/14e:  Prostate Cancer Screening - 20.0%/14h:  Mammography - 20.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 45.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 45.0%/7h:  Psychiatric Services - Individual - 45.0%/7h:  Psychiatric Services - Group - 45.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Home Safety - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit//14a:  Home Safety - $0/service											0.074574895	0.074574895	0.150599391	0	0.2	0.2	0.2	90.43004686	0.2	0	0.2	0	0.2	0.2	0.071079884	0.19915896	0.45	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.074574895	0.074574895	0.150599391	0	0.2	0.2	0.2	90.43004686	0.2	0	0.2	0	0.2	0.2	0.071079884	0.19915896	0.45	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0												28.4674	0.953947519	5.907718746	0	2.851300476	2.631135062	0.766905396	2.055107393	3.944891266	0	5.564060534	0	0.490987982	1.66198311	4.959864688	15.62886196	3.437908211	0.332610822	3.017956994	2.405609945	2.607794872	0.009467914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6955		0	28.4674	0.953947519	5.907718746	0	2.851300476	2.631135062	0.766905396	2.055107393	3.944891266	0	5.564060534	0	0.490987982	1.66198311	4.959864688	15.62886196	3.437908211	0.332610822	3.017956994	2.405609945	2.607794872	0.009467914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6955	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	28.4674	0.953947519	5.907718746	0	2.851300476	2.631135062	0.766905396	2.055107393	3.944891266	0	5.564060534	0	0.490987982	1.66198311	4.959864688	15.62886196	3.437908211	0.332610822	3.017956994	2.405609945	2.607794872	0.009467914	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6955
H3949_013_0	2010	2	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1391.489275	11.84389596	680.8599024	24.11632407	151.9693095	12.79795326	3.871620813	260.4081898	452.974015	2.766274826	1220.525401	0	0.794303544	1245.59108	386.917184	5337.268556	524.0030779	460.63664	28.01532242	96.5693931	20.76872475	0	0	0	0	0	0	0	0	0												1a:  Acute - $150/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $50/visit/8b:  Outpatient Therapeutic Radiological Services - $50/visit/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $25/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/ Visits/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $25/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $25/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit												150	0.074545341	85	0	100	0.2	0.2	33.14111883	191.7231306	0	20.82616461	0	0.2	41.47555272	25	25	25	25	0	24.97665644	0.2	0	0	0	0	0	0	0	0	0											NO	150	0.074545341	85	0	100	0.2	0.2	33.14111883	191.7231306	0	20.82616461	0	0.2	41.47555272	25	25	25	25	0	24.97665644	0.2	0	0	0	0	0	0	0	0	0												17.3936	0.882907258	4.822757642	0	1.266410913	2.559590651	0.774324163	0.719184897	7.237133022	0	2.118238576	0	0.158860709	4.305131544	0.806077467	11.11930949	1.091673079	0.959659667	0	0.20099838	4.15374495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5696		0	17.3936	0.882907258	4.822757642	0	1.266410913	2.559590651	0.774324163	0.719184897	7.237133022	0	2.118238576	0	0.158860709	4.305131544	0.806077467	11.11930949	1.091673079	0.959659667	0	0.20099838	4.15374495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5696	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	17.3936	0.882907258	4.822757642	0	1.266410913	2.559590651	0.774324163	0.719184897	7.237133022	0	2.118238576	0	0.158860709	4.305131544	0.806077467	11.11930949	1.091673079	0.959659667	0	0.20099838	4.15374495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5696
H3949_016_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	550.0350707	11.7354203	282.9688048	2.504598318	46.69495966	9.640661714	9.01310519	360.9218993	14.22355837	11.39961344	10.54638067	0	7.746497915	75.04481873	0	0	7.356482164	1.09424996	17.06787064	5.085209574	2.475075157	0.709571871	0	0	0	0	0	0	0	0												1a:  Acute - MC Cost Shares for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/ Visits/17a:  Vision Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/7f:  Routine Footcare - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 45.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 45.0%/7h:  Psychiatric Services - Individual - 45.0%/7h:  Psychiatric Services - Group - 45.0%	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit		9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/ /18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											0.077840032	0.077840032	0	0	0.2	0.2	0.2	50	0.2	0	0.2	0	0.2	0.022327384	0	0	0.45	0	0	18.15256415	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.077840032	0.077840032	0	0	0.2	0.2	0.2	50	0.2	0	0.2	0	0.2	0.022327384	0	0	0.45	0	0	18.15256415	0.2	0.2	0	0	0	0	0	0	0	0												42.8147	0.913485494	0	0	9.338991931	1.928132343	1.802621038	1.503841247	2.844711674	0	2.109276133	0	1.549299583	1.675554493	0	0	3.310416974	0	0	0.007692466	0.495015031	0.141914374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4357		0	42.8147	0.913485494	0	0	9.338991931	1.928132343	1.802621038	1.503841247	2.844711674	0	2.109276133	0	1.549299583	1.675554493	0	0	3.310416974	0	0	0.007692466	0.495015031	0.141914374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4357	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	42.8147	0.913485494	0	0	9.338991931	1.928132343	1.802621038	1.503841247	2.844711674	0	2.109276133	0	1.549299583	1.675554493	0	0	3.310416974	0	0	0.007692466	0.495015031	0.141914374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4357
H3949_022_0	2010	3	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	974.9348412	11.4464137	935.7759131	20.48312609	137.6249939	11.44340856	2.954915514	201.8261209	412.9158112	11.44497195	867.1036672	0	0.056857992	1339.585568	361.5520715	4300.36796	573.9134182	633.7074744	28.0841197	80.59353971	7.029010754	0	0	0	0	0	0	0	0	0												1a:  Acute - $150/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $160/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $150/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $160/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $35/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $35/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $35/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit												150	0.078066914	85	0	100	0.2	0.2	40.05485941	155.0620395	0	55.75768906	0	0.2	44.28748686	35	34.15100798	35	35	0	34.38713606	0.2	0	0	0	0	0	0	0	0	0											NO	150	0.078066914	85	0	100	0.2	0.2	40.05485941	155.0620395	0	55.75768906	0	0.2	44.28748686	35	34.15100798	35	35	0	34.38713606	0.2	0	0	0	0	0	0	0	0	0												12.1867	0.8935862	6.628412718	0	1.146874949	2.288681713	0.590983103	0.673676408	5.335630653	0	4.028974722	0	0.011371598	4.943906519	1.054526875	12.23849171	1.673914136	1.848313467	0	0.230948418	1.405802151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1808		0	12.1867	0.8935862	6.628412718	0	1.146874949	2.288681713	0.590983103	0.673676408	5.335630653	0	4.028974722	0	0.011371598	4.943906519	1.054526875	12.23849171	1.673914136	1.848313467	0	0.230948418	1.405802151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1808	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	12.1867	0.8935862	6.628412718	0	1.146874949	2.288681713	0.590983103	0.673676408	5.335630653	0	4.028974722	0	0.011371598	4.943906519	1.054526875	12.23849171	1.673914136	1.848313467	0	0.230948418	1.405802151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1808
H3949_023_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	341.529828	11.6071023	71.48973071	44.88454114	14.44294538	25.52188473	8.23858265	345.4819885	26.07564579	14.80247556	21.45691798	0	0.244173212	31.01574314	82.71992237	98.77077037	7.640846118	5.416899903	19.32809223	32.83127425	7.518216132	0.856435399	0	0	0	0	0	0	0	0												1a:  Acute - MC Cost Shares for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - MC Cost Shares for 1-100/2:  Non-Medicare Covered Stay - MC Cost Shares for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - 20.0%/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - 20.0%/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/14e:  Prostate Cancer Screening - 20.0%/14h:  Mammography - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/ Visits/17a:  Vision Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/7f:  Routine Footcare - $0/visit/14e:  Prostate Cancer Screening - 20.0%/14h:  Mammography - 20.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 45.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 45.0%/7h:  Psychiatric Services - Individual - 45.0%/7h:  Psychiatric Services - Group - 45.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											0.081119959	0.081119959	0.176859882	0	0.2	0.2	0.2	69.55847414	0.2	0	0.2	0	0.2	0.2	0.051876771	0.199331786	0.45	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.081119959	0.081119959	0.176859882	0	0.2	0.2	0.2	69.55847414	0.2	0	0.2	0	0.2	0.2	0.051876771	0.199331786	0.45	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0												27.7049	0.941567661	12.64366531	0	2.888589077	5.104376945	1.64771653	2.002599997	5.215129159	0	4.291383596	0	0.048834642	6.203148628	4.291242436	19.68815407	3.438380753	1.083379981	3.865618445	6.566254851	1.503643226	0.17128708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2999		0	27.7049	0.941567661	12.64366531	0	2.888589077	5.104376945	1.64771653	2.002599997	5.215129159	0	4.291383596	0	0.048834642	6.203148628	4.291242436	19.68815407	3.438380753	1.083379981	3.865618445	6.566254851	1.503643226	0.17128708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2999	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	27.7049	0.941567661	12.64366531	0	2.888589077	5.104376945	1.64771653	2.002599997	5.215129159	0	4.291383596	0	0.048834642	6.203148628	4.291242436	19.68815407	3.438380753	1.083379981	3.865618445	6.566254851	1.503643226	0.17128708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.2999
H3949_024_0	2010	2	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	2028.051716	11.78280435	1152.140004	45.17486691	965.2365638	22.05534651	10.75975409	2082.674018	744.1069434	5.651401279	1772.313423	0	1.405145496	1869.060146	332.9878414	5282.966513	528.9526189	612.238516	25.59421375	82.77440613	18.08593617	0	0	0	0	0	0	0	0	0												1a:  Acute - $150/$0/day for 1-7/8-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $150/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $35/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $35/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $35/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											150	0.077792604	85	0	100	0.2	0.043124301	40.04622299	191.7371488	0	62.98319898	0	0.2	47.02769685	35	34.90244849	35	35	0	34.80997816	0.2	0	0	0	0	0	0	0	0	0											NO	150	0.077792604	85	0	100	0.2	0.043124301	40.04622299	191.7371488	0	62.98319898	0	0.2	47.02769685	35	34.90244849	35	35	0	34.80997816	0.2	0	0	0	0	0	0	0	0	0												25.3506	0.916615035	8.160991693	0	8.043638032	4.411069302	0.464006875	6.950269011	11.88941198	0	9.302164084	0	0.281029099	7.324799496	0.971214538	15.36570555	1.542778472	1.785695672	0	0.240114606	3.617187235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6173		0	25.3506	0.916615035	8.160991693	0	8.043638032	4.411069302	0.464006875	6.950269011	11.88941198	0	9.302164084	0	0.281029099	7.324799496	0.971214538	15.36570555	1.542778472	1.785695672	0	0.240114606	3.617187235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6173	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	25.3506	0.916615035	8.160991693	0	8.043638032	4.411069302	0.464006875	6.950269011	11.88941198	0	9.302164084	0	0.281029099	7.324799496	0.971214538	15.36570555	1.542778472	1.785695672	0	0.240114606	3.617187235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6173
H3949_025_0	2010	3	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1278.955568	11.4464137	1244.065873	28.33219274	207.220649	19.44704809	11.07275532	222.5540373	413.2633518	15.55674824	787.5417328	0	0.05387419	1701.821246	361.5920982	4562.218816	573.9134182	435.2645198	28.83218094	56.07051022	8.712806384	0	0	0	0	0	0	0	0	0												1a:  Acute - $150/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $160/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $150/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $160/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $35/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $35/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $35/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit												150	0.078066914	85	0	100	0.2	0.033294415	40.05485941	155.0620395	0	55.75481282	0	0.2	44.86739464	35	34.20850373	35	35	0	34.23772752	0.2	0	0	0	0	0	0	0	0	0											NO	150	0.078066914	85	0	100	0.2	0.033294415	40.05485941	155.0620395	0	55.75481282	0	0.2	44.86739464	35	34.20850373	35	35	0	34.23772752	0.2	0	0	0	0	0	0	0	0	0												15.9869	0.8935862	8.812133265	0	1.726838742	3.889409618	0.368660911	0.742864223	5.340121517	0	3.659103491	0	0.010774838	6.363023787	1.05464362	13.00555662	1.673914136	1.269521516	0	0.159977238	1.742561277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6996		0	15.9869	0.8935862	8.812133265	0	1.726838742	3.889409618	0.368660911	0.742864223	5.340121517	0	3.659103491	0	0.010774838	6.363023787	1.05464362	13.00555662	1.673914136	1.269521516	0	0.159977238	1.742561277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6996	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	15.9869	0.8935862	8.812133265	0	1.726838742	3.889409618	0.368660911	0.742864223	5.340121517	0	3.659103491	0	0.010774838	6.363023787	1.05464362	13.00555662	1.673914136	1.269521516	0	0.159977238	1.742561277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6996
H3952_008_0	2010	4	N/A																															A	A	D	0	T	Coin	Coin	V	V	0	V	0	0	V	V	V	V	V	V	V	S	0	0	V	V	0	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	NO	1591.81866	55.01107412	1601.701939	0	319.151037	10.3475848	9.559291666	312.8229171	374.4605857	0	861.6394591	0	0	424.8964149	5355.971176	4984.583358	266.4955652	127.5619988	37.36583347	88.57900208	0	0	0	808	184.510925	0	32.96420924															$175 per day; 8 days max	$175 per day; 8 days max	$0 Days 1-10; $40 Days 11-20; $90 Days 21-100 (PBP 2)	$0 Copay per visit	$100 copay per trip	20% coinsurance	20% coinsurance	$50 copay per visit	$150/$300 copay per visit	$0 Copay per visit	$35 copay per visit	$0 Copay per visit	$0 Copay per visit	$35 copay per visit	$10 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$25 per script for certain injectible drugs	$0 copay	0	$15 per visit	$35 copay per visit	$0 copay	$35 copay per visit														175	175	39.29738885	0	100	0.2	0.2	50	236	0	35	0	0	35	10	35	35	35	35	35	25	0	0	15	35	0	35														NO	175	175	39.29738885	0	100	0.2	0.2	50	236	0	35	0	0	35	10	35	35	35	35	35	25	0	0	15	35	0	35															23.214	0.802244831	5.245225326	0	2.659591975	2.06951696	1.911858333	1.303428821	7.364391518	0	2.513115089	0	0	1.23928121	4.463309313	14.53836813	0.777278732	0.37205583	0.108983681	0.258355423	0	0	0	1.01	0.538156865	0	0.09614561	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4853			23.214	0.802244831	5.245225326	0	2.659591975	2.06951696	1.911858333	1.303428821	7.364391518	0	2.513115089	0	0	1.23928121	4.463309313	14.53836813	0.777278732	0.37205583	0.108983681	0.258355423	0	0	0	1.01	0.538156865	0	0.09614561	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4853	NO																																																																																		0			23.214	0.802244831	5.245225326	0	2.659591975	2.06951696	1.911858333	1.303428821	7.364391518	0	2.513115089	0	0	1.23928121	4.463309313	14.53836813	0.777278732	0.37205583	0.108983681	0.258355423	0	0	0	1.01	0.538156865	0	0.09614561	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4853
H3952_020_0	2010	7	N/A																															A	A	D	0	T	Coin	Coin	V	V	0	V	0	0	V	V	V	V	V	V	V	S	0	0	V	V	0	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	NO	1343.646922	58.4898946	1601.701939	0	267.0169683	9.106647345	10.16443601	288.4403489	390.281989	0	900.5913405	0	0	474.6392719	5181.506148	4960.801034	358.5810716	168.613706	33.69582263	90.07847177	1.340704724	0	0	808	0.569188208	0	25.7569434															$175 per day; 8 days max	$175 per day; 8 days max	$0 Days 1-10; $40 Days 11-20; $90 Days 21-100 (PBP 2)	$0 Copay per visit	$100 copay per trip	20% coinsurance	20% coinsurance	$50 copay per visit	$150/$300 copay per visit	$0 Copay per visit	$35 copay per visit	$0 Copay per visit	$0 Copay per visit	$35 copay per visit	$10 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$25 per script for certain injectible drugs	$0 copay	0	$15 per visit	$35 copay per visit	$0 copay	$35 copay per visit														175	175	39.29738885	0	100	0.2	0.2	50	236	0	35	0	0	35	10	35	35	35	35	35	25	0	0	15	35	0	35														NO	175	175	39.29738885	0	100	0.2	0.2	50	236	0	35	0	0	35	10	35	35	35	35	35	25	0	0	15	35	0	35															19.5949	0.85297763	5.245225326	0	2.225141403	1.821329469	2.032887202	1.201834787	7.675545784	0	2.626724743	0	0	1.384364543	4.31792179	14.46900302	1.045861459	0.491789976	0.098279483	0.262728876	0.002793135	0	0	1.01	0.001660132	0	0.075124418	0	0	0	0	0	0	0	0	0	0	0	0	0	66.436			19.5949	0.85297763	5.245225326	0	2.225141403	1.821329469	2.032887202	1.201834787	7.675545784	0	2.626724743	0	0	1.384364543	4.31792179	14.46900302	1.045861459	0.491789976	0.098279483	0.262728876	0.002793135	0	0	1.01	0.001660132	0	0.075124418	0	0	0	0	0	0	0	0	0	0	0	0	0	66.436	NO																																																																																		0			19.5949	0.85297763	5.245225326	0	2.225141403	1.821329469	2.032887202	1.201834787	7.675545784	0	2.626724743	0	0	1.384364543	4.31792179	14.46900302	1.045861459	0.491789976	0.098279483	0.262728876	0.002793135	0	0	1.01	0.001660132	0	0.075124418	0	0	0	0	0	0	0	0	0	0	0	0	0	66.436
H3952_042_0	2010	7	N/A																															A	A	D	0	T	Coin	Coin	V	V	0	V	0	0	V	V	V	V	V	V	V	S	0	0	V	V	0	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	NO	1131.471173	93.07754831	1588.522451	0	239.3779767	6.563385062	7.01384035	298.0343999	335.0446284	0	1650.407754	0	0	412.6020417	4800.170609	7803.914536	324.3678702	413.6008332	27.09716511	69.80960456	0	0	0	808	209.5029397	0	9.246825723															$215 per day; 8 days max (PBP 1A)	$215 per day; 8 days max (PBP 1B)	$0 Days 1-10; $35 Days 11-20; $80 Days 21-100 (PBP 2)	$0 Copay per visit	$100 copay per trip (PBP 10A)	20% coinsurance (PBP 11A)	20% coinsurance (PBP 11B)	$50 copay per visit (PBP 4A)	$150/$300 copay per visit (PBP 9B and A respectively)	$0 Copay per visit	$45 copay per visit (PBP 8B)	$0 Copay per visit	$0 Copay per visit	"$45 copay per visit (PBP 3, 5, 9C, 9D)"	"$20 copay per visit (PBP 4B, 7A)"	"$45 copay per visit ( PBP 4B, 7B, 7E, 7F)"	"$40 copay per visit (PBP 7E, 7H)"	"$45 copay per visit (PBP 7C, 7I)"	$45 copay per visit (office visit referenced in PBP 8B)	$45 copay per visit (PBP 7F)	$25 per script for certain injectible drugs (PBP 15)	$0 copay	0	$15 per visit (PBP 16A)	$45 copay per visit (PBP 17A)	$0 copay	$45 copay per visit (PBP 18A)														215	215	34.78730479	0	100	0.2	0.2	50	235.7922931	0	45	0	0	45	20	45	40	45	45	45	25	0	0	15	45	0	45														NO	215	215	34.78730479	0	100	0.2	0.2	50	235.7922931	0	45	0	0	45	20	45	40	45	45	45	25	0	0	15	45	0	45															20.2722	1.667639407	4.605034556	0	1.994816472	1.312677012	1.40276807	1.241809999	6.583411769	0	6.189029079	0	0	1.547257656	8.000284348	29.26467951	1.081226234	1.551003125	0.101614369	0.261786017	0	0	0	1.01	0.785636024	0	0.034675596	0	0	0	0	0	0	0	0	0	0	0	0	0	88.9075			20.2722	1.667639407	4.605034556	0	1.994816472	1.312677012	1.40276807	1.241809999	6.583411769	0	6.189029079	0	0	1.547257656	8.000284348	29.26467951	1.081226234	1.551003125	0.101614369	0.261786017	0	0	0	1.01	0.785636024	0	0.034675596	0	0	0	0	0	0	0	0	0	0	0	0	0	88.9075	NO																																																																																		0			20.2722	1.667639407	4.605034556	0	1.994816472	1.312677012	1.40276807	1.241809999	6.583411769	0	6.189029079	0	0	1.547257656	8.000284348	29.26467951	1.081226234	1.551003125	0.101614369	0.261786017	0	0	0	1.01	0.785636024	0	0.034675596	0	0	0	0	0	0	0	0	0	0	0	0	0	88.9075
H3952_043_0	2010	9	N/A																															A	A	D	0	T	Coin	Coin	V	V	0	V	0	0	V	V	V	V	V	V	V	S	0	0	V	V	0	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	NO	1191.184554	148.8377117	1588.522451	0	250.0926984	7.537281879	9.022283989	297.1743861	359.960111	0	1396.662684	0	0	446.373028	4729.796259	5993.529378	441.3713254	637.2429122	21.98778085	71.53745831	2.310956671	0	0	808	33.4063789	0	22.60829058															$215 per day; 8 days max (PBP 1A)	$215 per day; 8 days max (PBP 1B)	$0 Days 1-10; $35 Days 11-20; $80 Days 21-100 (PBP 2)	0	$100 copay per trip (PBP 10A)	20% coinsurance (PBP 11A)	20% coinsurance (PBP 11B)	$50 copay per visit (PBP 4A)	$150/$300 copay per visit (PBP 9B and A respectively)	0	$45 copay per visit (PBP 8B)	0	0	"$45 copay per visit (PBP 3, 5, 9C, 9D)"	"$20 copay per visit (PBP 4B, 7A)"	"$45 copay per visit ( PBP 4B, 7B, 7E, 7F)"	"$40 copay per visit (PBP 7E, 7H)"	"$45 copay per visit (PBP 7C, 7I)"	$45 copay per visit (office visit referenced in PBP 8B)	$45 copay per visit (PBP 7F)	$25 per script for certain injectible drugs (PBP 15)	0	0	$15 per visit (PBP 16A)	$45 copay per visit (PBP 17A)	0	$45 copay per visit (PBP 18A)														215	215	34.78730479	0	100	0.2	0.2	50	235.7922931	0	45	0	0	45	20	45	40	45	45	45	25	0	0	15	45	0	45														NO	215	215	34.78730479	0	100	0.2	0.2	50	235.7922931	0	45	0	0	45	20	45	40	45	45	45	25	0	0	15	45	0	45															21.3421	2.666675667	4.605034556	0	2.08410582	1.507456376	1.804456798	1.238226609	7.072985001	0	5.237485066	0	0	1.673898855	7.882993765	22.47573517	1.471237751	2.389660921	0.082454178	0.268265469	0.004814493	0	0	1.01	0.125273921	0	0.08478109	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0276			21.3421	2.666675667	4.605034556	0	2.08410582	1.507456376	1.804456798	1.238226609	7.072985001	0	5.237485066	0	0	1.673898855	7.882993765	22.47573517	1.471237751	2.389660921	0.082454178	0.268265469	0.004814493	0	0	1.01	0.125273921	0	0.08478109	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0276	NO																																																																																		0			21.3421	2.666675667	4.605034556	0	2.08410582	1.507456376	1.804456798	1.238226609	7.072985001	0	5.237485066	0	0	1.673898855	7.882993765	22.47573517	1.471237751	2.389660921	0.082454178	0.268265469	0.004814493	0	0	1.01	0.125273921	0	0.08478109	0	0	0	0	0	0	0	0	0	0	0	0	0	85.0276
H3952_044_0	2010	4	N/A																															A	A	D	0	T	Coin	Coin	V	V	0	V	0	0	V	V	V	V	V	V	V	S	0	0	V	V	0	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	NO	1468.560307	55.5295993	1601.701939	0	331.748639	8.39609814	6.684972249	276.4937668	401.3301676	0	806.6098744	0	0	505.4416731	4989.140561	5238.900921	266.8452034	152.9108686	51.33624188	98.84243366	0	0	0	808	184.510925	0	36.30170069															$175 per day; 8 days max	$175 per day; 8 days max	$0 Days 1-10; $40 Days 11-20; $90 Days 21-100 (PBP 2)	$0 Copay per visit	$100 copay per trip	20% coinsurance	20% coinsurance	$50 copay per visit	$150/$300 copay per visit	$0 Copay per visit	$35 copay per visit	$0 Copay per visit	$0 Copay per visit	$35 copay per visit	$10 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$25 per script for certain injectible drugs	$0 copay	0	$15 per visit	$35 copay per visit	$0 copay	$35 copay per visit														175	175	39.29738885	0	100	0.2	0.2	50	236	0	35	0	0	35	10	35	35	35	35	35	25	0	0	15	35	0	35														NO	175	175	39.29738885	0	100	0.2	0.2	50	236	0	35	0	0	35	10	35	35	35	35	35	25	0	0	15	35	0	35															21.4165	0.809806656	5.245225326	0	2.764571992	1.679219628	1.33699445	1.152057362	7.892826629	0	2.352612134	0	0	1.47420488	4.157617134	15.28012769	0.77829851	0.445990034	0.149730705	0.288290432	0	0	0	1.01	0.538156865	0	0.10587996	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8781			21.4165	0.809806656	5.245225326	0	2.764571992	1.679219628	1.33699445	1.152057362	7.892826629	0	2.352612134	0	0	1.47420488	4.157617134	15.28012769	0.77829851	0.445990034	0.149730705	0.288290432	0	0	0	1.01	0.538156865	0	0.10587996	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8781	NO																																																																																		0			21.4165	0.809806656	5.245225326	0	2.764571992	1.679219628	1.33699445	1.152057362	7.892826629	0	2.352612134	0	0	1.47420488	4.157617134	15.28012769	0.77829851	0.445990034	0.149730705	0.288290432	0	0	0	1.01	0.538156865	0	0.10587996	0	0	0	0	0	0	0	0	0	0	0	0	0	68.8781
H3952_045_0	2010	5	N/A																															A	A	D	0	T	Coin	Coin	V	V	0	V	0	0	V	V	V	V	V	V	V	S	0	0	V	V	0	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	NO	1316.467344	58.61929647	1601.701939	0	293.9921511	8.466936385	7.704668242	262.7495404	412.5168077	0	877.7437562	0	0	609.3634445	5029.293095	5262.847941	358.5328298	216.6718251	57.36089922	104.2181155	1.340704724	0	0	808	0.569188208	0	32.13494348															$175 per day; 8 days max	$175 per day; 8 days max	$0 Days 1-10; $40 Days 11-20; $90 Days 21-100 (PBP 2)	$0 Copay per visit	$100 copay per trip	20% coinsurance	20% coinsurance	$50 copay per visit	$150/$300 copay per visit	$0 Copay per visit	$35 copay per visit	$0 Copay per visit	$0 Copay per visit	$35 copay per visit	$10 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$35 copay per visit	$25 per script for certain injectible drugs	$0 copay	0	$15 per visit	$35 copay per visit	$0 copay	$35 copay per visit														175	175	39.29738885	0	100	0.2	0.2	50	236	0	35	0	0	35	10	35	35	35	35	35	25	0	0	15	35	0	35														NO	175	175	39.29738885	0	100	0.2	0.2	50	236	0	35	0	0	35	10	35	35	35	35	35	25	0	0	15	35	0	35															19.1985	0.85486474	5.245225326	0	2.449934592	1.693387277	1.540933648	1.094789752	8.112830552	0	2.560085955	0	0	1.777310046	4.191077579	15.34997316	1.045720754	0.63195949	0.167302623	0.303969504	0.002793135	0	0	1.01	0.001660132	0	0.093726918	0	0	0	0	0	0	0	0	0	0	0	0	0	67.326			19.1985	0.85486474	5.245225326	0	2.449934592	1.693387277	1.540933648	1.094789752	8.112830552	0	2.560085955	0	0	1.777310046	4.191077579	15.34997316	1.045720754	0.63195949	0.167302623	0.303969504	0.002793135	0	0	1.01	0.001660132	0	0.093726918	0	0	0	0	0	0	0	0	0	0	0	0	0	67.326	NO																																																																																		0			19.1985	0.85486474	5.245225326	0	2.449934592	1.693387277	1.540933648	1.094789752	8.112830552	0	2.560085955	0	0	1.777310046	4.191077579	15.34997316	1.045720754	0.63195949	0.167302623	0.303969504	0.002793135	0	0	1.01	0.001660132	0	0.093726918	0	0	0	0	0	0	0	0	0	0	0	0	0	67.326
H3952_046_0	2010	7	N/A																															A	A	D	0	T	Coin	Coin	V	V	0	V	0	0	V	V	V	V	V	V	V	S	0	0	V	V	0	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	NO	1110.369753	98.80663383	1588.522451	0	251.1107263	4.762159306	4.917169501	249.0088609	339.8801173	0	1571.632842	0	0	386.616066	4819.35255	7953.892718	338.6154193	376.3533423	43.38570012	87.44026623	0	0	0	808	210.1601547	0	27.95768488															$215 per day; 8 days max	$215 per day; 8 days max	$0 Days 1-10; $35 Days 11-20; $80 Days 21-100 (PBP 2)	$0 Copay per visit	$100 copay per trip	20% coinsurance	20% coinsurance	$50 copay per visit	$150/$300 copay per visit	$0 Copay per visit	$45 copay per visit	$0 Copay per visit	$0 Copay per visit	$45 copay per visit	$20 copay per visit	$45 copay per visit	$40 copay per visit	$45 copay per visit	$45 copay per visit	$45 copay per visit	$25 per script for certain injectible drugs	$0 copay	0	$15 per visit	$45 copay per visit	$0 copay	$45 copay per visit														215	215	34.78730479	0	100	0.2	0.2	50	235.7922931	0	45	0	0	45	20	45	40	45	45	45	25	0	0	15	45	0	45														NO	215	215	34.78730479	0	100	0.2	0.2	50	235.7922931	0	45	0	0	45	20	45	40	45	45	45	25	0	0	15	45	0	45															19.8941	1.770285523	4.605034556	0	2.092589386	0.952431861	0.9834339	1.037536921	6.67842602	0	5.893623156	0	0	1.449810248	8.032254249	29.82709769	1.128718064	1.411325033	0.162696375	0.327900998	0	0	0	1.01	0.78810058	0	0.104841318	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1502			19.8941	1.770285523	4.605034556	0	2.092589386	0.952431861	0.9834339	1.037536921	6.67842602	0	5.893623156	0	0	1.449810248	8.032254249	29.82709769	1.128718064	1.411325033	0.162696375	0.327900998	0	0	0	1.01	0.78810058	0	0.104841318	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1502	NO																																																																																		0			19.8941	1.770285523	4.605034556	0	2.092589386	0.952431861	0.9834339	1.037536921	6.67842602	0	5.893623156	0	0	1.449810248	8.032254249	29.82709769	1.128718064	1.411325033	0.162696375	0.327900998	0	0	0	1.01	0.78810058	0	0.104841318	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1502
H3952_047_0	2010	7	N/A																															A	A	D	0	T	Coin	Coin	V	V	0	V	0	0	V	V	V	V	V	V	V	S	0	0	V	V	0	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	NO	1080.395611	59.13569784	1588.522451	0	240.8851171	7.445837824	5.716656914	290.367477	370.6968565	0	948.7343757	0	0	667.5139375	9385.56253	5017.850028	187.3900868	178.7445119	60.78658871	106.8823681	2.186462373	0	0	808	29.06606211	0	24.18468484															$215 per day; 8 days max (PBP 1A)	$215 per day; 8 days max (PBP 1B)	$0 Days 1-10; $35 Days 11-20; $80 Days 21-100 (PBP 2)	0	$100 copay per trip (PBP 10A)	20% coinsurance (PBP 11A)	20% coinsurance (PBP 11B)	$50 copay per visit (PBP 4A)	$150/$300 copay per visit (PBP 9B and A respectively)	0	$45 copay per visit (PBP 8B)	0	0	"$45 copay per visit (PBP 3, 5, 9C, 9D)"	"$20 copay per visit (PBP 4B, 7A)"	"$45 copay per visit ( PBP 4B, 7B, 7E, 7F)"	"$40 copay per visit (PBP 7E, 7H)"	"$45 copay per visit (PBP 7C, 7I)"	$45 copay per visit (office visit referenced in PBP 8B)	$45 copay per visit (PBP 7F)	$25 per script for certain injectible drugs (PBP 15)	0	0	$15 per visit (PBP 16A)	$45 copay per visit (PBP 17A)	0	$45 copay per visit (PBP 18A)														215	215	34.78730479	0	100	0.2	0.2	50	235.7922931	0	45	0	0	45	20	45	40	45	45	45	25	0	0	15	45	0	45														NO	215	215	34.78730479	0	100	0.2	0.2	50	235.7922931	0	45	0	0	45	20	45	40	45	45	45	25	0	0	15	45	0	45															19.3571	1.059514586	4.605034556	0	2.007375976	1.489167565	1.143331383	1.209864488	7.283955154	0	3.557753909	0	0	2.503177266	15.64260422	18.81693761	0.624633623	0.67029192	0.227949708	0.40080888	0.00455513	0	0	1.01	0.108997733	0	0.090692568	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8137			19.3571	1.059514586	4.605034556	0	2.007375976	1.489167565	1.143331383	1.209864488	7.283955154	0	3.557753909	0	0	2.503177266	15.64260422	18.81693761	0.624633623	0.67029192	0.227949708	0.40080888	0.00455513	0	0	1.01	0.108997733	0	0.090692568	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8137	NO																																																																																		0			19.3571	1.059514586	4.605034556	0	2.007375976	1.489167565	1.143331383	1.209864488	7.283955154	0	3.557753909	0	0	2.503177266	15.64260422	18.81693761	0.624633623	0.67029192	0.227949708	0.40080888	0.00455513	0	0	1.01	0.108997733	0	0.090692568	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8137
H3952_802_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	NO	366.4956234	4.817700163	39.24466603	16.3965188	9.690110165	9.452947353	12.22165346	8.356377231	55.01383125	7.116902516	25.85018631	0	0.606796802	80.22488466	40.07146286	39.36467483	4.240303634	1.856481592	15.78991703	223.545156	3.105891825	2.575008867																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				27.1003	0.356241605	5.869951401	0	2.257795668	2.202536733	2.847645255	1.947035895	12.81822268	1.658238286	6.02309341	0	0.141383655	18.69239813	9.336650846	9.171969236	0.987990747	0.432560211	3.679050668	52.08602135	0.723672795	0.599977066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	158.9327			27.1003	0.356241605	5.869951401	0	2.257795668	2.202536733	2.847645255	1.947035895	12.81822268	1.658238286	6.02309341	0	0.141383655	18.69239813	9.336650846	9.171969236	0.987990747	0.432560211	3.679050668	52.08602135	0.723672795	0.599977066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	158.9327	NO																																																																																		0			27.1003	0.356241605	5.869951401	0	2.257795668	2.202536733	2.847645255	1.947035895	12.81822268	1.658238286	6.02309341	0	0.141383655	18.69239813	9.336650846	9.171969236	0.987990747	0.432560211	3.679050668	52.08602135	0.723672795	0.599977066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	158.9327
H3952_804_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin																																																											0	NO	400.1418541	5.87510849	47.98598422	16.68748748	10.54005747	10.44832526	10.40848472	8.483153252	57.71494661	6.979997757	24.7953856	0	1.220055994	100.0660596	39.04988158	41.35243249	4.426463865	2.079453811	17.13864848	259.8582762	5.879355854	1.773601079																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				29.5882	0.434430953	7.177418585	0	2.455833391	2.434459786	2.42517694	1.976574708	13.44758256	1.626339477	5.777324844	0	0.284273047	23.3153919	9.098622408	9.635116771	1.03136608	0.484512738	3.993305095	60.54697835	1.369889914	0.413249051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	177.5161			29.5882	0.434430953	7.177418585	0	2.455833391	2.434459786	2.42517694	1.976574708	13.44758256	1.626339477	5.777324844	0	0.284273047	23.3153919	9.098622408	9.635116771	1.03136608	0.484512738	3.993305095	60.54697835	1.369889914	0.413249051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	177.5161	NO																																																																																		0			29.5882	0.434430953	7.177418585	0	2.455833391	2.434459786	2.42517694	1.976574708	13.44758256	1.626339477	5.777324844	0	0.284273047	23.3153919	9.098622408	9.635116771	1.03136608	0.484512738	3.993305095	60.54697835	1.369889914	0.413249051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	177.5161
H3954_003_0	2010	2	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1023.20163	27.29648629	945.5746295	0	113.7393186	8.728954731	15.57492579	274.1178685	348.4030669	5128.531628	983.6673768	31.85081875	0	2517.390078	3819.785748	3269.323441	139.6429243	551.9318422	490.3007503	102.1237334	5.204854313	0	0	482.7688877	956.0805494	0	0.412675525	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.0033	0.106797503	4.439472886	0	0.445005084	1.639297698	2.924971064	1.07248616	1.363126999	2.006537999	2.295304212	0.062308164	0	0.514132869	2.988982348	5.116491185	0.218541176	0.431886667	0.845089661	0.039955911	0.468436888	0	0	0.755533309	1.49626606	0	0.000645837	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2345	None	2.180624325	4.0033	0.106797503	4.439472886	0	0.445005084	1.639297698	2.924971064	1.07248616	1.363126999	2.006537999	2.295304212	0.062308164	0	0.514132869	2.988982348	5.116491185	0.218541176	0.431886667	0.845089661	0.039955911	0.468436888	0	0	0.755533309	1.49626606	0	0.000645837	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2345	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.0033	0.106797503	4.439472886	0	0.445005084	1.639297698	2.924971064	1.07248616	1.363126999	2.006537999	2.295304212	0.062308164	0	0.514132869	2.988982348	5.116491185	0.218541176	0.431886667	0.845089661	0.039955911	0.468436888	0	0	0.755533309	1.49626606	0	0.000645837	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2345
H3954_004_0	2010	2	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1052.700733	27.29648629	1212.41525	0	139.6748394	10.06994603	9.027183978	285.7750143	283.346048	5438.978102	1037.457699	26.77718752	0	3122.046604	4182.506423	3449.834123	139.6429243	422.2889383	904.0907246	130.5706326	8.215247574	0	0	496.5544256	801.5780153	0	0.529934266	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.1187	0.106797503	5.692289598	0	0.546477809	1.891135864	1.695305151	1.118094744	1.108591413	2.128000182	2.420819356	0.052382873	0	0.637623383	3.272811276	5.398990403	0.218541176	0.330441094	1.558304212	0.05108576	0.739372282	0	0	0.777107676	1.254469594	0	0.000829347	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1182	None	2.315492403	4.1187	0.106797503	5.692289598	0	0.546477809	1.891135864	1.695305151	1.118094744	1.108591413	2.128000182	2.420819356	0.052382873	0	0.637623383	3.272811276	5.398990403	0.218541176	0.330441094	1.558304212	0.05108576	0.739372282	0	0	0.777107676	1.254469594	0	0.000829347	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1182	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.1187	0.106797503	5.692289598	0	0.546477809	1.891135864	1.695305151	1.118094744	1.108591413	2.128000182	2.420819356	0.052382873	0	0.637623383	3.272811276	5.398990403	0.218541176	0.330441094	1.558304212	0.05108576	0.739372282	0	0	0.777107676	1.254469594	0	0.000829347	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1182
H3954_005_0	2010	2	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1097.859194	27.29648629	1427.85744	0	101.3593223	8.449372206	10.61662289	220.1294216	241.4770955	6193.201089	762.486064	20.98600765	0	2765.000996	3886.172367	3737.737806	139.6429243	402.3691241	1079.246115	80.04481509	7.715496545	0	0	505.1458954	679.9704274	0	0.5074545	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.2954	0.106797503	6.703790682	0	0.396568348	1.5867921	1.993801779	0.861256362	0.944779136	2.423089926	1.779196419	0.041053877	0	0.564703066	3.040929878	5.849559667	0.218541176	0.31485384	1.860204646	0.031317534	0.694394689	0	0	0.790553326	1.064153719	0	0.000794166	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5625	None	2.342282533	4.2954	0.106797503	6.703790682	0	0.396568348	1.5867921	1.993801779	0.861256362	0.944779136	2.423089926	1.779196419	0.041053877	0	0.564703066	3.040929878	5.849559667	0.218541176	0.31485384	1.860204646	0.031317534	0.694394689	0	0	0.790553326	1.064153719	0	0.000794166	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5625	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.2954	0.106797503	6.703790682	0	0.396568348	1.5867921	1.993801779	0.861256362	0.944779136	2.423089926	1.779196419	0.041053877	0	0.564703066	3.040929878	5.849559667	0.218541176	0.31485384	1.860204646	0.031317534	0.694394689	0	0	0.790553326	1.064153719	0	0.000794166	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5625
H3954_007_0	2010	2	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1011.554096	27.29648629	917.6202697	0	145.6513825	9.084085788	11.08454015	298.5669426	268.5086256	3951.2521	918.8205627	29.66887031	0	2318.181324	3312.338374	3419.703531	139.6429243	352.4847325	675.5432348	215.6875063	4.182851934	0	0	500.8722499	592.5038862	0	0.37251539	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												3.9577	0.106797503	4.308227166	0	0.569861034	1.705991311	2.08167664	1.168143163	1.050539998	1.545927384	2.143989683	0.058039728	0	0.473447967	2.591904777	5.351836026	0.218541176	0.275819303	1.164376361	0.084387737	0.376456674	0	0	0.783865071	0.927268582	0	0.000582987	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9454	None	2.027669487	3.9577	0.106797503	4.308227166	0	0.569861034	1.705991311	2.08167664	1.168143163	1.050539998	1.545927384	2.143989683	0.058039728	0	0.473447967	2.591904777	5.351836026	0.218541176	0.275819303	1.164376361	0.084387737	0.376456674	0	0	0.783865071	0.927268582	0	0.000582987	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9454	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	3.9577	0.106797503	4.308227166	0	0.569861034	1.705991311	2.08167664	1.168143163	1.050539998	1.545927384	2.143989683	0.058039728	0	0.473447967	2.591904777	5.351836026	0.218541176	0.275819303	1.164376361	0.084387737	0.376456674	0	0	0.783865071	0.927268582	0	0.000582987	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9454
H3954_009_0	2010	2	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	101.5136072	25.63140062	6.978361111	0	82.26417921	5.811951761	8.631030397	170.5263438	38.06540824	23.49891427	426.5831637	0.655356299	0.014634076	1281.221131	3349.378729	5749.940222	131.1247059	401.1498476	745.2515266	0.708136086	4.47621263	0.588766554	0	461.2257846	863.856687	0	15.64040542	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												10.172	0.106797503	0.69925382	0	0.342767413	0.776501227	1.153142003	0.710526433	3.814274113	2.354665418	1.703679947	0.098303445	0.002195111	2.11347355	2.79114894	9.583233703	0.218541176	0.33429154	1.19827577	0.070957472	0.568479004	0.058996268	0	0.768709641	1.439761145	0	0.026067342	0	0	0	0	0	0	0	0	0	0	0	0	0	41.106	None	9.594754009	10.172	0.106797503	0.69925382	0	0.342767413	0.776501227	1.153142003	0.710526433	3.814274113	2.354665418	1.703679947	0.098303445	0.002195111	2.11347355	2.79114894	9.583233703	0.218541176	0.33429154	1.19827577	0.070957472	0.568479004	0.058996268	0	0.768709641	1.439761145	0	0.026067342	0	0	0	0	0	0	0	0	0	0	0	0	0	41.106	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	10.172	0.106797503	0.69925382	0	0.342767413	0.776501227	1.153142003	0.710526433	3.814274113	2.354665418	1.703679947	0.098303445	0.002195111	2.11347355	2.79114894	9.583233703	0.218541176	0.33429154	1.19827577	0.070957472	0.568479004	0.058996268	0	0.768709641	1.439761145	0	0.026067342	0	0	0	0	0	0	0	0	0	0	0	0	0	41.106
H3954_010_0	2010	2	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	178.9135478	25.63140062	16.56710493	0	139.7018496	11.00837446	9.789265871	303.1111214	56.51886021	42.48611487	764.597255	0.894030151	0.022081464	1720.837591	5056.387059	9479.55502	131.1247059	485.3942724	1753.117513	1.587861129	7.123823616	1.142929388	0	472.182452	1076.959266	0	20.09548393	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												17.9277	0.106797503	1.660076231	0	0.58209104	1.470765179	1.307887139	1.262963006	5.663368275	4.257242878	3.053634372	0.134104523	0.00331222	2.838654972	4.213655882	15.79925837	0.218541176	0.404495227	2.818804339	0.159108699	0.904725599	0.114525134	0	0.786970753	1.794932111	0	0.033492473	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5171	None	16.34516274	17.9277	0.106797503	1.660076231	0	0.58209104	1.470765179	1.307887139	1.262963006	5.663368275	4.257242878	3.053634372	0.134104523	0.00331222	2.838654972	4.213655882	15.79925837	0.218541176	0.404495227	2.818804339	0.159108699	0.904725599	0.114525134	0	0.786970753	1.794932111	0	0.033492473	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5171	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	17.9277	0.106797503	1.660076231	0	0.58209104	1.470765179	1.307887139	1.262963006	5.663368275	4.257242878	3.053634372	0.134104523	0.00331222	2.838654972	4.213655882	15.79925837	0.218541176	0.404495227	2.818804339	0.159108699	0.904725599	0.114525134	0	0.786970753	1.794932111	0	0.033492473	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5171
H3954_011_0	2010	2	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	134.7112559	25.63140062	11.3534369	0	88.17804588	5.614180029	4.682922533	181.6309106	32.15610892	25.08085615	385.4373723	0.425129886	0.002333965	1111.756832	3703.097065	6603.962594	131.1247059	278.662796	1434.84	0.892666095	3.511597198	0.731148216	0	467.5059993	661.407127	0	13.83605342	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												13.4985	0.106797503	1.137650231	0	0.367408525	0.750078091	0.625658168	0.756795461	3.222143661	2.513180989	1.539352647	0.063769483	0.000350095	1.833929055	3.085914221	11.00660432	0.218541176	0.232218997	2.307051974	0.089447962	0.445972844	0.07326336	0	0.779176665	1.102345212	0	0.023060089	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7792	None	10.96909236	13.4985	0.106797503	1.137650231	0	0.367408525	0.750078091	0.625658168	0.756795461	3.222143661	2.513180989	1.539352647	0.063769483	0.000350095	1.833929055	3.085914221	11.00660432	0.218541176	0.232218997	2.307051974	0.089447962	0.445972844	0.07326336	0	0.779176665	1.102345212	0	0.023060089	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7792	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	13.4985	0.106797503	1.137650231	0	0.367408525	0.750078091	0.625658168	0.756795461	3.222143661	2.513180989	1.539352647	0.063769483	0.000350095	1.833929055	3.085914221	11.00660432	0.218541176	0.232218997	2.307051974	0.089447962	0.445972844	0.07326336	0	0.779176665	1.102345212	0	0.023060089	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7792
H3954_013_0	2010	2	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	141.4963203	25.63140062	9.71560425	0	92.26786872	6.775651169	4.448101948	208.1033311	29.2696267	21.61045872	432.6892654	0.515370763	0.017325283	877.2888278	3509.767714	6520.272145	131.1247059	389.8551598	1286.71554	2.931498774	4.068866135	0.803556093	0	466.9262379	595.5470694	0	10.5802316	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												14.1784	0.106797503	0.973534227	0	0.384449453	0.905255525	0.594285149	0.867097213	2.932909027	2.165436208	1.728066383	0.077305614	0.002598792	1.447155911	2.924806428	10.86712024	0.218541176	0.3248793	2.06888547	0.293745435	0.516745999	0.080518858	0	0.778210396	0.992578449	0	0.017633719	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4469	None	11.08833171	14.1784	0.106797503	0.973534227	0	0.384449453	0.905255525	0.594285149	0.867097213	2.932909027	2.165436208	1.728066383	0.077305614	0.002598792	1.447155911	2.924806428	10.86712024	0.218541176	0.3248793	2.06888547	0.293745435	0.516745999	0.080518858	0	0.778210396	0.992578449	0	0.017633719	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4469	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	14.1784	0.106797503	0.973534227	0	0.384449453	0.905255525	0.594285149	0.867097213	2.932909027	2.165436208	1.728066383	0.077305614	0.002598792	1.447155911	2.924806428	10.86712024	0.218541176	0.3248793	2.06888547	0.293745435	0.516745999	0.080518858	0	0.778210396	0.992578449	0	0.017633719	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4469
H3954_015_0	2010	2	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	156.9147279	25.63140062	6.700318294	0	146.2530653	8.155485731	5.631855931	262.2804566	45.04721045	22.01981527	745.3788373	0.888151224	0	1258.33408	4387.718719	8128.31284	131.1247059	356.5373761	1131.514577	1.425638078	4.250410445	0.654323467	0	471.5328319	946.0288722	0	12.16200608	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												15.7234	0.106797503	0.671393052	0	0.609387772	1.089607233	0.752439666	1.092835236	4.513872743	2.206455027	2.976880211	0.133222684	0	2.075719585	3.656432266	13.54718807	0.218541176	0.29711448	1.81934079	0.142853437	0.539802126	0.065565278	0	0.785888053	1.576714787	0	0.02027001	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6217	None	12.6039951	15.7234	0.106797503	0.671393052	0	0.609387772	1.089607233	0.752439666	1.092835236	4.513872743	2.206455027	2.976880211	0.133222684	0	2.075719585	3.656432266	13.54718807	0.218541176	0.29711448	1.81934079	0.142853437	0.539802126	0.065565278	0	0.785888053	1.576714787	0	0.02027001	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6217	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	15.7234	0.106797503	0.671393052	0	0.609387772	1.089607233	0.752439666	1.092835236	4.513872743	2.206455027	2.976880211	0.133222684	0	2.075719585	3.656432266	13.54718807	0.218541176	0.29711448	1.81934079	0.142853437	0.539802126	0.065565278	0	0.785888053	1.576714787	0	0.02027001	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6217
H3954_018_0	2010	2	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	223.4509504	25.63140062	12.44654589	0	134.5751123	9.765946635	5.46022028	284.2387744	57.13739559	34.9105282	808.8204504	0.501995472	0.034661391	1085.073986	4443.078113	9005.459086	131.1247059	460.6540216	1966.444562	2.57293258	4.841807124	1.705090485	0	464.8334683	1129.012029	0	23.92880317	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												22.3905	0.106797503	1.247183204	0	0.560729635	1.304771591	0.72950842	1.184328227	5.725347474	3.498145171	3.230252152	0.075299321	0.005199209	1.789913633	3.702565095	15.00909848	0.218541176	0.383878351	3.161808849	0.25781597	0.614909505	0.170855451	0	0.774722447	1.881686715	0	0.039881339	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0637	None	17.66599327	22.3905	0.106797503	1.247183204	0	0.560729635	1.304771591	0.72950842	1.184328227	5.725347474	3.498145171	3.230252152	0.075299321	0.005199209	1.789913633	3.702565095	15.00909848	0.218541176	0.383878351	3.161808849	0.25781597	0.614909505	0.170855451	0	0.774722447	1.881686715	0	0.039881339	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0637	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	22.3905	0.106797503	1.247183204	0	0.560729635	1.304771591	0.72950842	1.184328227	5.725347474	3.498145171	3.230252152	0.075299321	0.005199209	1.789913633	3.702565095	15.00909848	0.218541176	0.383878351	3.161808849	0.25781597	0.614909505	0.170855451	0	0.774722447	1.881686715	0	0.039881339	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0637
H3954_019_0	2010	2	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	178.2907387	25.63140062	13.5170301	0	128.062679	7.998645201	8.307458694	326.6167104	56.72442673	54.10702875	921.2080692	1.129440883	0.029865478	1534.469591	5286.320359	8409.935597	131.1247059	513.7140675	1097.416684	0.484529231	4.532839335	0.825962196	0	464.3585548	1101.073141	0	17.02340473	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												17.8653	0.106797503	1.354449102	0	0.533594496	1.068652678	1.109911461	1.36090296	5.68396669	5.421695146	3.679103744	0.169416132	0.004479822	2.531226511	4.405266966	14.01655933	0.218541176	0.428095056	1.764515435	0.048551359	0.575670596	0.08276402	0	0.773930925	1.835121902	0	0.028372341	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0669	None	16.32264794	17.8653	0.106797503	1.354449102	0	0.533594496	1.068652678	1.109911461	1.36090296	5.68396669	5.421695146	3.679103744	0.169416132	0.004479822	2.531226511	4.405266966	14.01655933	0.218541176	0.428095056	1.764515435	0.048551359	0.575670596	0.08276402	0	0.773930925	1.835121902	0	0.028372341	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0669	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	17.8653	0.106797503	1.354449102	0	0.533594496	1.068652678	1.109911461	1.36090296	5.68396669	5.421695146	3.679103744	0.169416132	0.004479822	2.531226511	4.405266966	14.01655933	0.218541176	0.428095056	1.764515435	0.048551359	0.575670596	0.08276402	0	0.773930925	1.835121902	0	0.028372341	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0669
H3954_020_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1195.594545	27.29648629	2293.425688	0	237.060591	12.84644842	15.3397569	409.0247361	281.7200447	5426.016677	894.8542319	35.31849216	0	4200.54891	4488.455909	3244.060738	139.6429243	389.9430711	551.2820102	118.5923106	12.12314686	0	0	464.4416825	930.8258838	0	0.485299678	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.6778	0.106797503	10.7676336	0	0.927499562	2.412563014	2.880806346	1.60030928	1.102229675	2.122929025	2.088066288	0.0690918	0	0.857888605	3.512216749	5.076955055	0.218541176	0.305130453	0.950197867	0.046399242	1.091083217	0	0	0.726851233	1.456742508	0	0.000759494	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9985	None	2.843648615	4.6778	0.106797503	10.7676336	0	0.927499562	2.412563014	2.880806346	1.60030928	1.102229675	2.122929025	2.088066288	0.0690918	0	0.857888605	3.512216749	5.076955055	0.218541176	0.305130453	0.950197867	0.046399242	1.091083217	0	0	0.726851233	1.456742508	0	0.000759494	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9985	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.6778	0.106797503	10.7676336	0	0.927499562	2.412563014	2.880806346	1.60030928	1.102229675	2.122929025	2.088066288	0.0690918	0	0.857888605	3.512216749	5.076955055	0.218541176	0.305130453	0.950197867	0.046399242	1.091083217	0	0	0.726851233	1.456742508	0	0.000759494	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9985
H3954_021_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1098.989104	27.29648629	1174.999733	0	156.1254732	10.1163741	12.5663309	291.0002614	351.9571931	8270.748398	1171.964342	41.28799925	0	3929.012516	4088.808471	3507.512634	139.6429243	678.6825289	561.6508796	85.91566338	13.26332964	0	0	508.3746827	961.7515388	0	0.540534147	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.2998	0.106797503	5.516623747	0	0.610840914	1.899855056	2.359956944	1.138538523	1.377032518	3.235930311	2.734679175	0.080769649	0	0.802432049	3.199492629	5.489257271	0.218541176	0.531069079	0.968069805	0.033614503	1.193699668	0	0	0.795606379	1.505141158	0	0.000845936	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0986	None	2.530075512	4.2998	0.106797503	5.516623747	0	0.610840914	1.899855056	2.359956944	1.138538523	1.377032518	3.235930311	2.734679175	0.080769649	0	0.802432049	3.199492629	5.489257271	0.218541176	0.531069079	0.968069805	0.033614503	1.193699668	0	0	0.795606379	1.505141158	0	0.000845936	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0986	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.2998	0.106797503	5.516623747	0	0.610840914	1.899855056	2.359956944	1.138538523	1.377032518	3.235930311	2.734679175	0.080769649	0	0.802432049	3.199492629	5.489257271	0.218541176	0.531069079	0.968069805	0.033614503	1.193699668	0	0	0.795606379	1.505141158	0	0.000845936	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0986
H3954_023_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1459.858976	27.29648629	2271.080477	0	214.2451389	14.79316996	11.85646041	423.0516988	377.108923	7207.936864	1270.881498	41.93439973	0	3957.123595	5629.538432	4489.774767	139.6429243	558.4382018	905.0889395	144.0109465	10.90953019	0	0	499.0222208	1112.16047	0	0.67207809	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												5.7117	0.106797503	10.66272284	0	0.838234106	2.778157319	2.226643265	1.655189772	1.475438661	2.820105298	2.965493951	0.082034169	0	0.808173245	4.405113823	7.02649751	0.218541176	0.436977893	1.56002475	0.056344283	0.981857717	0	0	0.780969776	1.740531136	0	0.001051802	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3386	None	3.250481001	5.7117	0.106797503	10.66272284	0	0.838234106	2.778157319	2.226643265	1.655189772	1.475438661	2.820105298	2.965493951	0.082034169	0	0.808173245	4.405113823	7.02649751	0.218541176	0.436977893	1.56002475	0.056344283	0.981857717	0	0	0.780969776	1.740531136	0	0.001051802	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3386	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	5.7117	0.106797503	10.66272284	0	0.838234106	2.778157319	2.226643265	1.655189772	1.475438661	2.820105298	2.965493951	0.082034169	0	0.808173245	4.405113823	7.02649751	0.218541176	0.436977893	1.56002475	0.056344283	0.981857717	0	0	0.780969776	1.740531136	0	0.001051802	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3386
H3954_024_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1204.662776	27.29648629	1201.093815	0	176.968551	10.78840309	12.59388923	284.8807813	302.7995858	5899.436213	1170.883725	38.39227218	0	3021.656524	4386.062403	3872.163119	139.6429243	436.2740459	854.8620678	118.3709779	8.568740982	0	0	495.8049113	796.6237552	0	0.739050494	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.7132	0.106797503	5.639135464	0	0.692389456	2.0260621	2.365132398	1.114596057	1.184703379	2.308154419	2.732157646	0.075104882	0	0.617120466	3.43209383	6.059935281	0.218541176	0.341384441	1.473452967	0.046312645	0.771186688	0	0	0.775934686	1.246716177	0	0.001156614	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9413	None	2.500360047	4.7132	0.106797503	5.639135464	0	0.692389456	2.0260621	2.365132398	1.114596057	1.184703379	2.308154419	2.732157646	0.075104882	0	0.617120466	3.43209383	6.059935281	0.218541176	0.341384441	1.473452967	0.046312645	0.771186688	0	0	0.775934686	1.246716177	0	0.001156614	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9413	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.7132	0.106797503	5.639135464	0	0.692389456	2.0260621	2.365132398	1.114596057	1.184703379	2.308154419	2.732157646	0.075104882	0	0.617120466	3.43209383	6.059935281	0.218541176	0.341384441	1.473452967	0.046312645	0.771186688	0	0	0.775934686	1.246716177	0	0.001156614	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9413
H3954_026_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1431.687398	27.29648629	2965.780917	0	180.8276256	13.65095895	6.239253232	335.3614992	232.2575368	5437.502199	823.3978676	31.51981318	0	2987.255969	5012.067207	4198.117624	139.6429243	415.4462715	983.222372	150.2525968	8.665063762	0	0	503.5952734	706.5644483	0	0.697929114	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												5.6015	0.106797503	13.92434141	0	0.707488085	2.563650091	1.171731757	1.312101866	0.908707613	2.127422735	1.921328935	0.061660635	0	0.610094755	3.921942589	6.570054081	0.218541176	0.325086707	1.694696696	0.058786328	0.779855739	0	0	0.788126603	1.105773362	0	0.001092259	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4808	None	3.055505834	5.6015	0.106797503	13.92434141	0	0.707488085	2.563650091	1.171731757	1.312101866	0.908707613	2.127422735	1.921328935	0.061660635	0	0.610094755	3.921942589	6.570054081	0.218541176	0.325086707	1.694696696	0.058786328	0.779855739	0	0	0.788126603	1.105773362	0	0.001092259	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4808	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	5.6015	0.106797503	13.92434141	0	0.707488085	2.563650091	1.171731757	1.312101866	0.908707613	2.127422735	1.921328935	0.061660635	0	0.610094755	3.921942589	6.570054081	0.218541176	0.325086707	1.694696696	0.058786328	0.779855739	0	0	0.788126603	1.105773362	0	0.001092259	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4808
H3954_027_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	978.602506	27.29648629	1173.217134	0	107.3766624	8.818961141	10.41383319	244.4091988	276.5971501	7611.002593	1036.9292	32.29344937	0	3318.117226	3984.686776	3782.925562	139.6429243	457.0034603	1083.666854	81.80742459	8.565755702	0	0	502.4061744	787.1626871	0	0.613018307	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												3.8288	0.106797503	5.508254446	0	0.420111191	1.656200902	1.955717873	0.95625099	1.08218635	2.977804764	2.419586149	0.06317406	0	0.677667376	3.118017402	5.920278505	0.218541176	0.357605208	1.867824298	0.032007155	0.770918013	0	0	0.786265663	1.231909605	0	0.000959374	0	0	0	0	0	0	0	0	0	0	0	0	0	35.9569	None	2.371432296	3.8288	0.106797503	5.508254446	0	0.420111191	1.656200902	1.955717873	0.95625099	1.08218635	2.977804764	2.419586149	0.06317406	0	0.677667376	3.118017402	5.920278505	0.218541176	0.357605208	1.867824298	0.032007155	0.770918013	0	0	0.786265663	1.231909605	0	0.000959374	0	0	0	0	0	0	0	0	0	0	0	0	0	35.9569	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	3.8288	0.106797503	5.508254446	0	0.420111191	1.656200902	1.955717873	0.95625099	1.08218635	2.977804764	2.419586149	0.06317406	0	0.677667376	3.118017402	5.920278505	0.218541176	0.357605208	1.867824298	0.032007155	0.770918013	0	0	0.786265663	1.231909605	0	0.000959374	0	0	0	0	0	0	0	0	0	0	0	0	0	35.9569
H3954_032_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1306.735425	27.29648629	1807.146517	0	223.4889456	14.23466197	9.787661532	429.1623479	294.8360783	4116.004521	1188.197046	35.71520176	0	2288.378408	4592.887606	4030.233247	139.6429243	616.5235079	804.4886281	250.5468455	9.985251935	0	0	502.6610399	647.4345765	0	0.420626586	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												5.1126	0.106797503	8.484552896	0	0.874400499	2.673269519	1.838122836	1.679097686	1.153546156	1.610386769	2.772556809	0.069867863	0	0.467361243	3.593934552	6.307315032	0.218541176	0.482429645	1.386628558	0.098026453	0.898672674	0	0	0.786664527	1.013235112	0	0.000658281	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6287	None	2.745784067	5.1126	0.106797503	8.484552896	0	0.874400499	2.673269519	1.838122836	1.679097686	1.153546156	1.610386769	2.772556809	0.069867863	0	0.467361243	3.593934552	6.307315032	0.218541176	0.482429645	1.386628558	0.098026453	0.898672674	0	0	0.786664527	1.013235112	0	0.000658281	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6287	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	5.1126	0.106797503	8.484552896	0	0.874400499	2.673269519	1.838122836	1.679097686	1.153546156	1.610386769	2.772556809	0.069867863	0	0.467361243	3.593934552	6.307315032	0.218541176	0.482429645	1.386628558	0.098026453	0.898672674	0	0	0.786664527	1.013235112	0	0.000658281	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6287
H3954_033_0	2010	5	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1061.072516	27.29648629	1050.623419	0	145.6647068	10.18777998	9.323981974	336.1419437	285.8908353	4804.998036	1167.556372	32.92326337	0	2669.36132	3952.552201	3684.546707	139.6429243	730.1996013	805.7207178	201.1441311	11.1515695	0	0	485.8592493	709.5363626	0	0.350230723	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.1514	0.106797503	4.932676953	0	0.569913165	1.91326508	1.751043815	1.315155355	1.118547893	1.879955481	2.724393551	0.064406134	0	0.545170336	3.092872097	5.766315596	0.218541176	0.571381188	1.388752206	0.078697641	1.003641255	0	0	0.760369725	1.110424407	0	0.000548111	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0643	None	2.324189914	4.1514	0.106797503	4.932676953	0	0.569913165	1.91326508	1.751043815	1.315155355	1.118547893	1.879955481	2.724393551	0.064406134	0	0.545170336	3.092872097	5.766315596	0.218541176	0.571381188	1.388752206	0.078697641	1.003641255	0	0	0.760369725	1.110424407	0	0.000548111	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0643	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.1514	0.106797503	4.932676953	0	0.569913165	1.91326508	1.751043815	1.315155355	1.118547893	1.879955481	2.724393551	0.064406134	0	0.545170336	3.092872097	5.766315596	0.218541176	0.571381188	1.388752206	0.078697641	1.003641255	0	0	0.760369725	1.110424407	0	0.000548111	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0643
H3954_038_0	2010	3	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	149.1397742	25.63140062	10.92193854	0	142.4841859	9.514674643	8.90785916	283.6741902	48.96346669	39.19416303	619.8330347	0.819841413	0.023873355	1678.273258	4405.827136	8165.646408	131.1247059	396.3099648	1016.157935	1.83549786	6.513033283	0.95707003	0	424.9404741	1044.724566	0	19.10344942	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												14.9443	0.106797503	1.094412733	0	0.593684108	1.271200594	1.190127491	1.181975792	4.906293986	3.927378908	2.475477707	0.122976212	0.003581003	2.768441805	3.671522613	13.60941068	0.218541176	0.330258304	1.633861036	0.183922682	0.827155227	0.095901439	0	0.708234123	1.74120761	0	0.031839082	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6385	None	13.8725789	14.9443	0.106797503	1.094412733	0	0.593684108	1.271200594	1.190127491	1.181975792	4.906293986	3.927378908	2.475477707	0.122976212	0.003581003	2.768441805	3.671522613	13.60941068	0.218541176	0.330258304	1.633861036	0.183922682	0.827155227	0.095901439	0	0.708234123	1.74120761	0	0.031839082	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6385	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	14.9443	0.106797503	1.094412733	0	0.593684108	1.271200594	1.190127491	1.181975792	4.906293986	3.927378908	2.475477707	0.122976212	0.003581003	2.768441805	3.671522613	13.60941068	0.218541176	0.330258304	1.633861036	0.183922682	0.827155227	0.095901439	0	0.708234123	1.74120761	0	0.031839082	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6385
H3954_039_0	2010	4	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	126.1908579	25.63140062	11.18585494	0	125.2860146	9.468392283	7.736391943	230.0234584	42.39175515	35.36686316	640.4524356	0.837018182	0.016573839	1298.265554	3945.275485	6548.9735	131.1247059	393.4830541	1308.227787	1.073797108	6.640022335	0.760222432	0	465.0059615	879.8762497	0	20.47632224	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												12.6447	0.106797503	1.120857989	0	0.522025061	1.265017076	1.033614538	0.958431077	4.247787736	3.543871375	2.557827089	0.125552727	0.002486076	2.141589647	3.287729571	10.91495583	0.218541176	0.327902545	2.103474602	0.107597861	0.843282837	0.076176688	0	0.775009936	1.466460416	0	0.034127204	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4258	None	12.09943424	12.6447	0.106797503	1.120857989	0	0.522025061	1.265017076	1.033614538	0.958431077	4.247787736	3.543871375	2.557827089	0.125552727	0.002486076	2.141589647	3.287729571	10.91495583	0.218541176	0.327902545	2.103474602	0.107597861	0.843282837	0.076176688	0	0.775009936	1.466460416	0	0.034127204	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4258	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	12.6447	0.106797503	1.120857989	0	0.522025061	1.265017076	1.033614538	0.958431077	4.247787736	3.543871375	2.557827089	0.125552727	0.002486076	2.141589647	3.287729571	10.91495583	0.218541176	0.327902545	2.103474602	0.107597861	0.843282837	0.076176688	0	0.775009936	1.466460416	0	0.034127204	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4258
H3954_041_0	2010	3	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	145.5599673	25.63140062	13.47861736	0	113.6582272	8.956161487	7.964322643	246.6042704	45.98245098	34.56573058	622.0588255	0.727362467	0.017964974	1400.034076	3849.079085	7712.348984	131.1247059	394.9056697	1426.296281	1.29184747	5.795779834	0.929861189	0	415.7735679	876.1894083	0	16.34922576	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												14.5856	0.106797503	1.350600024	0	0.473575947	1.196580885	1.064067039	1.027517793	4.607586798	3.46359536	2.484367029	0.10910437	0.002694746	2.30946471	3.207565904	12.85391497	0.218541176	0.329088058	2.29331469	0.129447196	0.736064039	0.093175028	0	0.692955947	1.460315681	0	0.02724871	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8232	None	13.29805027	14.5856	0.106797503	1.350600024	0	0.473575947	1.196580885	1.064067039	1.027517793	4.607586798	3.46359536	2.484367029	0.10910437	0.002694746	2.30946471	3.207565904	12.85391497	0.218541176	0.329088058	2.29331469	0.129447196	0.736064039	0.093175028	0	0.692955947	1.460315681	0	0.02724871	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8232	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	14.5856	0.106797503	1.350600024	0	0.473575947	1.196580885	1.064067039	1.027517793	4.607586798	3.46359536	2.484367029	0.10910437	0.002694746	2.30946471	3.207565904	12.85391497	0.218541176	0.329088058	2.29331469	0.129447196	0.736064039	0.093175028	0	0.692955947	1.460315681	0	0.02724871	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8232
H3954_042_0	2010	4	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	144.0291806	25.63140062	13.33686899	0	112.4629363	8.861973689	7.880565554	244.0108476	45.49887486	34.20221882	615.5169212	0.719713133	0.017776045	1385.310566	4330.650636	7631.241785	131.1247059	390.7526298	1411.296584	1.278261709	5.734828305	0.92008227	0	471.7770209	866.9749305	0	16.17728853	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												14.4322	0.106797503	1.336396389	0	0.468595568	1.183996999	1.05287674	1.016711865	4.559130943	3.427170333	2.458240093	0.10795697	0.002666407	2.285177141	3.60887553	12.71873631	0.218541176	0.325627192	2.269196962	0.12808586	0.728323195	0.092195149	0	0.786295035	1.444958217	0	0.026962148	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7857	None	13.15820084	14.4322	0.106797503	1.336396389	0	0.468595568	1.183996999	1.05287674	1.016711865	4.559130943	3.427170333	2.458240093	0.10795697	0.002666407	2.285177141	3.60887553	12.71873631	0.218541176	0.325627192	2.269196962	0.12808586	0.728323195	0.092195149	0	0.786295035	1.444958217	0	0.026962148	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7857	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	14.4322	0.106797503	1.336396389	0	0.468595568	1.183996999	1.05287674	1.016711865	4.559130943	3.427170333	2.458240093	0.10795697	0.002666407	2.285177141	3.60887553	12.71873631	0.218541176	0.325627192	2.269196962	0.12808586	0.728323195	0.092195149	0	0.786295035	1.444958217	0	0.026962148	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7857
H3954_044_0	2010	3	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	167.0938196	25.63140062	16.92963856	0	98.74443578	10.70472467	5.991002223	231.900924	40.8809629	35.58330317	660.0104643	0.547937539	0.003405973	1346.819691	4855.215717	8838.332906	131.1247059	284.2698504	2306.789241	1.036897029	5.781003178	1.022791855	0	469.0845751	855.8356944	0	19.51285223	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												16.7433	0.106797503	1.696403247	0	0.411435149	1.430196289	0.800423123	0.96625385	4.096401581	3.565559347	2.635937582	0.082190631	0.000510896	2.221683458	4.046013098	14.73055484	0.218541176	0.236891542	3.709042591	0.103900357	0.734187404	0.102486974	0	0.781807625	1.426392824	0	0.03252142	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8795	None	14.31552111	16.7433	0.106797503	1.696403247	0	0.411435149	1.430196289	0.800423123	0.96625385	4.096401581	3.565559347	2.635937582	0.082190631	0.000510896	2.221683458	4.046013098	14.73055484	0.218541176	0.236891542	3.709042591	0.103900357	0.734187404	0.102486974	0	0.781807625	1.426392824	0	0.03252142	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8795	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	16.7433	0.106797503	1.696403247	0	0.411435149	1.430196289	0.800423123	0.96625385	4.096401581	3.565559347	2.635937582	0.082190631	0.000510896	2.221683458	4.046013098	14.73055484	0.218541176	0.236891542	3.709042591	0.103900357	0.734187404	0.102486974	0	0.781807625	1.426392824	0	0.03252142	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8795
H3954_045_0	2010	4	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	146.2051993	25.63140062	14.81246369	0	81.68092615	8.112739588	6.286288923	191.2101029	36.39144542	37.48895167	500.8180215	0.400894869	0.002492308	1486.50387	3955.385163	7559.492571	131.1247059	437.1579657	1872.425585	0.815082165	4.448093841	0.86881178	0	467.3964894	734.8869444	0	17.43910899	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												14.6502	0.106797503	1.484255638	0	0.340337192	1.083896168	0.839874669	0.796708762	3.646537752	3.756511344	2.000157749	0.06013423	0.000373846	2.452103337	3.296154302	12.59915428	0.218541176	0.364298305	3.010637522	0.081673807	0.564907918	0.087057684	0	0.778994149	1.224811574	0	0.029065182	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4732	None	12.83937523	14.6502	0.106797503	1.484255638	0	0.340337192	1.083896168	0.839874669	0.796708762	3.646537752	3.756511344	2.000157749	0.06013423	0.000373846	2.452103337	3.296154302	12.59915428	0.218541176	0.364298305	3.010637522	0.081673807	0.564907918	0.087057684	0	0.778994149	1.224811574	0	0.029065182	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4732	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	14.6502	0.106797503	1.484255638	0	0.340337192	1.083896168	0.839874669	0.796708762	3.646537752	3.756511344	2.000157749	0.06013423	0.000373846	2.452103337	3.296154302	12.59915428	0.218541176	0.364298305	3.010637522	0.081673807	0.564907918	0.087057684	0	0.778994149	1.224811574	0	0.029065182	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4732
H3954_050_0	2010	3	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	146.345523	25.63140062	12.54853374	0	100.7163474	7.799859533	6.050676848	230.688262	35.69718733	19.80743976	527.729946	0.562824419	0.023850972	909.839391	4879.777349	9705.387482	131.1247059	558.5219471	1790.480216	2.967078797	6.695100164	1.251552263	0	455.9561555	866.1482759	0	14.46284681	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												14.6643	0.106797503	1.257402708	0	0.419651447	1.042094075	0.808395904	0.961201092	3.576970899	1.984768014	2.107638095	0.084423663	0.003577646	1.500850588	4.066481124	16.1756458	0.218541176	0.465434956	2.87887912	0.297310665	0.850277721	0.125409489	0	0.759926926	1.44358046	0	0.024104745	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8236	None	11.96005651	14.6643	0.106797503	1.257402708	0	0.419651447	1.042094075	0.808395904	0.961201092	3.576970899	1.984768014	2.107638095	0.084423663	0.003577646	1.500850588	4.066481124	16.1756458	0.218541176	0.465434956	2.87887912	0.297310665	0.850277721	0.125409489	0	0.759926926	1.44358046	0	0.024104745	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8236	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	14.6643	0.106797503	1.257402708	0	0.419651447	1.042094075	0.808395904	0.961201092	3.576970899	1.984768014	2.107638095	0.084423663	0.003577646	1.500850588	4.066481124	16.1756458	0.218541176	0.465434956	2.87887912	0.297310665	0.850277721	0.125409489	0	0.759926926	1.44358046	0	0.024104745	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8236
H3954_051_0	2010	4	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	131.5483517	25.63140062	8.772465609	0	93.25770282	7.660322509	5.254504407	267.1485154	40.90290959	20.36682252	552.1593394	0.624442966	0.019506747	1028.985193	4002.239324	7304.868453	131.1247059	480.1557523	1721.442386	2.322530209	4.48667401	0.862126796	0	464.8301814	693.822368	0	11.93246556	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												13.1816	0.106797503	0.879028757	0	0.388573762	1.023451342	0.702023913	1.113118814	4.098600709	2.040819933	2.205203755	0.093666445	0.002926012	1.697390822	3.335199437	12.17478076	0.218541176	0.400129794	2.767874505	0.232724861	0.569807599	0.086387827	0	0.774716969	1.156370613	0	0.019887443	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2696	None	11.15784225	13.1816	0.106797503	0.879028757	0	0.388573762	1.023451342	0.702023913	1.113118814	4.098600709	2.040819933	2.205203755	0.093666445	0.002926012	1.697390822	3.335199437	12.17478076	0.218541176	0.400129794	2.767874505	0.232724861	0.569807599	0.086387827	0	0.774716969	1.156370613	0	0.019887443	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2696	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	13.1816	0.106797503	0.879028757	0	0.388573762	1.023451342	0.702023913	1.113118814	4.098600709	2.040819933	2.205203755	0.093666445	0.002926012	1.697390822	3.335199437	12.17478076	0.218541176	0.400129794	2.767874505	0.232724861	0.569807599	0.086387827	0	0.774716969	1.156370613	0	0.019887443	0	0	0	0	0	0	0	0	0	0	0	0	0	49.2696
H3954_056_0	2010	3	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	170.133364	25.63140062	12.4091651	0	195.0143943	11.39672079	5.921254745	425.0292063	48.83971164	26.78770025	829.0447293	1.315975104	0	1566.302903	5521.536036	9164.365986	131.1247059	410.1303171	1229.184489	1.196182038	6.222090987	0.723916024	0	448.1141314	1132.679744	0	14.91289024	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												17.0479	0.106797503	1.24343753	0	0.812559976	1.522649884	0.791104566	1.770955026	4.893893338	2.684212159	3.311023503	0.197396266	0	2.583738027	4.60128003	15.27394331	0.218541176	0.341775264	1.976382385	0.119861218	0.790205555	0.072538672	0	0.746856886	1.887799573	0	0.024854817	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0197	None	14.24461135	17.0479	0.106797503	1.24343753	0	0.812559976	1.522649884	0.791104566	1.770955026	4.893893338	2.684212159	3.311023503	0.197396266	0	2.583738027	4.60128003	15.27394331	0.218541176	0.341775264	1.976382385	0.119861218	0.790205555	0.072538672	0	0.746856886	1.887799573	0	0.024854817	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0197	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	17.0479	0.106797503	1.24343753	0	0.812559976	1.522649884	0.791104566	1.770955026	4.893893338	2.684212159	3.311023503	0.197396266	0	2.583738027	4.60128003	15.27394331	0.218541176	0.341775264	1.976382385	0.119861218	0.790205555	0.072538672	0	0.746856886	1.887799573	0	0.024854817	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0197
H3954_057_0	2010	4	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	171.9446064	25.63140062	10.31944961	0	177.4630359	10.85985863	5.312870712	310.3516725	50.07525753	29.0182304	875.3261413	0.974674477	0	1295.590067	5012.784548	9474.195869	131.1247059	472.2707599	1236.093202	0.999335897	6.363951219	0.84897949	0	462.3263946	1068.811023	0	14.58048558	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												17.2294	0.106797503	1.034041439	0	0.739429316	1.450922839	0.709821897	1.293131969	5.017698938	2.907718323	3.49586135	0.146201172	0	2.137176224	4.177320457	15.79032645	0.218541176	0.393558967	1.987490774	0.100136613	0.808221805	0.085070426	0	0.770543991	1.781351705	0	0.024300809	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4051	None	14.32699262	17.2294	0.106797503	1.034041439	0	0.739429316	1.450922839	0.709821897	1.293131969	5.017698938	2.907718323	3.49586135	0.146201172	0	2.137176224	4.177320457	15.79032645	0.218541176	0.393558967	1.987490774	0.100136613	0.808221805	0.085070426	0	0.770543991	1.781351705	0	0.024300809	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4051	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	17.2294	0.106797503	1.034041439	0	0.739429316	1.450922839	0.709821897	1.293131969	5.017698938	2.907718323	3.49586135	0.146201172	0	2.137176224	4.177320457	15.79032645	0.218541176	0.393558967	1.987490774	0.100136613	0.808221805	0.085070426	0	0.770543991	1.781351705	0	0.024300809	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4051
H3954_059_0	2010	3	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	263.7829448	25.63140062	14.52785325	0	173.701532	10.35553138	5.166221605	345.542514	67.93667248	41.86130567	881.9832104	0.664821466	0.01177963	1402.616199	5396.982836	10663.11716	131.1247059	438.9689398	2221.022409	3.151188122	5.937485783	1.340061661	0	466.9610674	1271.525023	0	28.09680944	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												26.4319	0.106797503	1.455736773	0	0.723756383	1.383542595	0.690228959	1.439760475	6.807469121	4.194635023	3.522448229	0.09972322	0.001766945	2.313724123	4.497485697	17.77186194	0.218541176	0.36580745	3.571139733	0.315759001	0.754060694	0.13427841	0	0.778268446	2.119208371	0	0.046828016	0	0	0	0	0	0	0	0	0	0	0	0	0	79.7447	None	20.71738271	26.4319	0.106797503	1.455736773	0	0.723756383	1.383542595	0.690228959	1.439760475	6.807469121	4.194635023	3.522448229	0.09972322	0.001766945	2.313724123	4.497485697	17.77186194	0.218541176	0.36580745	3.571139733	0.315759001	0.754060694	0.13427841	0	0.778268446	2.119208371	0	0.046828016	0	0	0	0	0	0	0	0	0	0	0	0	0	79.7447	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	26.4319	0.106797503	1.455736773	0	0.723756383	1.383542595	0.690228959	1.439760475	6.807469121	4.194635023	3.522448229	0.09972322	0.001766945	2.313724123	4.497485697	17.77186194	0.218541176	0.36580745	3.571139733	0.315759001	0.754060694	0.13427841	0	0.778268446	2.119208371	0	0.046828016	0	0	0	0	0	0	0	0	0	0	0	0	0	79.7447
H3954_060_0	2010	4	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	216.4148667	25.63140062	10.79035856	0	134.4265979	8.574460022	4.659083785	247.3721207	63.43688158	51.89790807	794.7347971	0.793062732	0.004822953	1141.497541	4697.80924	9741.978162	131.1247059	377.8036434	2037.112785	2.606990341	7.505687532	0.962543964	0	462.9488094	1152.410874	0	21.98082807	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												21.6855	0.106797503	1.081228003	0	0.560110824	1.145583962	0.622473211	1.03071717	6.356575863	5.200334278	3.17399713	0.11895941	0.000723443	1.88298866	3.914841033	16.23663027	0.218541176	0.314836369	3.275434943	0.261228665	0.953222317	0.096449945	0	0.771581349	1.92068479	0	0.036634713	0	0	0	0	0	0	0	0	0	0	0	0	0	70.966	None	18.28644496	21.6855	0.106797503	1.081228003	0	0.560110824	1.145583962	0.622473211	1.03071717	6.356575863	5.200334278	3.17399713	0.11895941	0.000723443	1.88298866	3.914841033	16.23663027	0.218541176	0.314836369	3.275434943	0.261228665	0.953222317	0.096449945	0	0.771581349	1.92068479	0	0.036634713	0	0	0	0	0	0	0	0	0	0	0	0	0	70.966	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	21.6855	0.106797503	1.081228003	0	0.560110824	1.145583962	0.622473211	1.03071717	6.356575863	5.200334278	3.17399713	0.11895941	0.000723443	1.88298866	3.914841033	16.23663027	0.218541176	0.314836369	3.275434943	0.261228665	0.953222317	0.096449945	0	0.771581349	1.92068479	0	0.036634713	0	0	0	0	0	0	0	0	0	0	0	0	0	70.966
H3954_062_0	2010	3	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	212.2171563	25.63140062	16.7697741	0	174.4470869	9.964968979	8.251829531	408.2774122	62.40418871	51.21608474	1039.211134	1.367566061	0.025815797	1673.736567	6457.179535	9794.941514	131.1247059	576.4378752	1302.12219	0.61772492	6.31990842	1.046056603	0	465.5021565	1281.534104	0	20.63626423	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												21.2648	0.106797503	1.680384322	0	0.726862862	1.331361814	1.10247917	1.701155884	6.253096776	5.132013427	4.150382201	0.205134909	0.00387237	2.760958182	5.380982946	16.32490252	0.218541176	0.480364896	2.09365753	0.061897988	0.802628369	0.104818175	0	0.775836928	2.135890174	0	0.034393774	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8332	None	18.4984845	21.2648	0.106797503	1.680384322	0	0.726862862	1.331361814	1.10247917	1.701155884	6.253096776	5.132013427	4.150382201	0.205134909	0.00387237	2.760958182	5.380982946	16.32490252	0.218541176	0.480364896	2.09365753	0.061897988	0.802628369	0.104818175	0	0.775836928	2.135890174	0	0.034393774	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8332	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	21.2648	0.106797503	1.680384322	0	0.726862862	1.331361814	1.10247917	1.701155884	6.253096776	5.132013427	4.150382201	0.205134909	0.00387237	2.760958182	5.380982946	16.32490252	0.218541176	0.480364896	2.09365753	0.061897988	0.802628369	0.104818175	0	0.775836928	2.135890174	0	0.034393774	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8332
H3954_063_0	2010	4	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	144.1181983	25.63140062	9.796378086	0	99.77271839	8.635152997	9.55201147	333.0656494	52.40866962	45.71816416	785.3664503	1.084610658	0.007015077	1580.026279	5050.225335	7540.747735	131.1247059	440.4706557	941.0721884	0.554906176	7.827100504	0.990663642	0	471.2471797	1136.673486	0	24.26168787	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												14.4411	0.106797503	0.98162802	0	0.41571966	1.153692799	1.276188952	1.387773539	5.251514198	4.581104423	3.136582	0.162691599	0.001052261	2.606375799	4.208521113	12.56791289	0.218541176	0.36705888	1.513132091	0.055603351	0.994041764	0.099267625	0	0.785411966	1.89445581	0	0.040436146	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2466	None	14.01540525	14.4411	0.106797503	0.98162802	0	0.41571966	1.153692799	1.276188952	1.387773539	5.251514198	4.581104423	3.136582	0.162691599	0.001052261	2.606375799	4.208521113	12.56791289	0.218541176	0.36705888	1.513132091	0.055603351	0.994041764	0.099267625	0	0.785411966	1.89445581	0	0.040436146	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2466	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	14.4411	0.106797503	0.98162802	0	0.41571966	1.153692799	1.276188952	1.387773539	5.251514198	4.581104423	3.136582	0.162691599	0.001052261	2.606375799	4.208521113	12.56791289	0.218541176	0.36705888	1.513132091	0.055603351	0.994041764	0.099267625	0	0.785411966	1.89445581	0	0.040436146	0	0	0	0	0	0	0	0	0	0	0	0	0	58.2466
H3954_089_0	2010	2	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	154.1755154	25.63140062	17.97360158	0	73.32122006	17.5059437	0.820003486	185.6655186	41.31829759	9.423151254	501.6102589	0	3.232505768	1043.909791	2920.794056	2726.630638	131.1247059	876.0466371	1674.380153	28.16720332	17.22345013	21.31874077	0	470.1030928	249.9986164	0	30.05275566	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												15.4489	0.106797503	1.801011638	0	0.305505084	2.338867789	0.109555918	0.773606327	4.140223899	0.944229513	2.003321772	0	0.484875865	1.722010103	2.433995047	4.544384396	0.218541176	0.730038864	2.692204035	2.822442722	2.187378167	2.136205148	0	0.783505155	0.416664361	0	0.050087926	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1943	None	15.17639513	15.4489	0.106797503	1.801011638	0	0.305505084	2.338867789	0.109555918	0.773606327	4.140223899	0.944229513	2.003321772	0	0.484875865	1.722010103	2.433995047	4.544384396	0.218541176	0.730038864	2.692204035	2.822442722	2.187378167	2.136205148	0	0.783505155	0.416664361	0	0.050087926	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1943	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	15.4489	0.106797503	1.801011638	0	0.305505084	2.338867789	0.109555918	0.773606327	4.140223899	0.944229513	2.003321772	0	0.484875865	1.722010103	2.433995047	4.544384396	0.218541176	0.730038864	2.692204035	2.822442722	2.187378167	2.136205148	0	0.783505155	0.416664361	0	0.050087926	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1943
H3954_090_0	2010	3	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	154.1755154	25.63140062	17.97360158	0	73.32122006	17.5059437	0.820003486	185.6655186	41.31829759	9.423151254	501.6102589	0	3.232505768	1043.909791	2920.794056	2726.630638	131.1247059	876.0466371	1674.380153	28.16720332	17.22345013	21.31874077	0	470.1030928	249.9986164	0	30.05275566	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												15.4489	0.106797503	1.801011638	0	0.305505084	2.338867789	0.109555918	0.773606327	4.140223899	0.944229513	2.003321772	0	0.484875865	1.722010103	2.433995047	4.544384396	0.218541176	0.730038864	2.692204035	2.822442722	2.187378167	2.136205148	0	0.783505155	0.416664361	0	0.050087926	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1943	None	15.17639513	15.4489	0.106797503	1.801011638	0	0.305505084	2.338867789	0.109555918	0.773606327	4.140223899	0.944229513	2.003321772	0	0.484875865	1.722010103	2.433995047	4.544384396	0.218541176	0.730038864	2.692204035	2.822442722	2.187378167	2.136205148	0	0.783505155	0.416664361	0	0.050087926	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1943	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	15.4489	0.106797503	1.801011638	0	0.305505084	2.338867789	0.109555918	0.773606327	4.140223899	0.944229513	2.003321772	0	0.484875865	1.722010103	2.433995047	4.544384396	0.218541176	0.730038864	2.692204035	2.822442722	2.187378167	2.136205148	0	0.783505155	0.416664361	0	0.050087926	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1943
H3954_091_0	2010	4	N/A																															Coin	D	Coin	V	P	Coin	Coin	V	Coin	Coin	V	Coin	Coin	V	P	P	P	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	123.8554663	25.63140062	14.43892567	0	58.90192019	14.06323706	0.658742174	149.1526675	33.19267008	7.570000918	402.9639361	0	2.596803444	838.6152214	2346.39274	2190.413363	131.1247059	703.7639181	1345.097723	22.62786081	13.83629847	17.12621212	0	470.1030928	200.8340633	0	24.14260175	0	0	0											2000	15% Coinsurance (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	15% Coinsurance (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"15% Coinsurance (PBP 9a, 9b)"	15% Coinsurance (PBP 8a)	"$15 General, 15% CT/MRI/PT (PBP 8b)"	15% Coinsurance (PBP 5)	15% Coinsurance (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services 15% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, 15% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 15% Coinsurance (PBP 7g)"	"15% Coinsurance, $1000 OOP Max (PBP 15)"	15% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0.15	50	0.15	0	50	0.2	0.2	50	0.15	0.15	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.15	0.15	0.15	0	20	20	0	20	0	0	0											NO	0.100203158	50	0.100203158	0	50	0.133604211	0.133604211	50	0.100203158	0.100203158	47.925378	0.15	0.15	19.79493	10	20	20	10	19.294572	0.100203158	0.127	0.100203158	0	20	20	0	20	0	0	0												12.4107	0.106797503	1.446825949	0	0.245424667	1.878907685	0.088010728	0.621469448	3.326010362	0.758537997	1.609349913	0	0.389520517	1.3833608	1.955327283	3.650688939	0.218541176	0.586469932	2.162757072	2.26738311	1.757209906	1.716100537	0	0.783505155	0.334723439	0	0.04023767	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7379	None	12.19181588	12.4107	0.106797503	1.446825949	0	0.245424667	1.878907685	0.088010728	0.621469448	3.326010362	0.758537997	1.609349913	0	0.389520517	1.3833608	1.955327283	3.650688939	0.218541176	0.586469932	2.162757072	2.26738311	1.757209906	1.716100537	0	0.783505155	0.334723439	0	0.04023767	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7379	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	12.4107	0.106797503	1.446825949	0	0.245424667	1.878907685	0.088010728	0.621469448	3.326010362	0.758537997	1.609349913	0	0.389520517	1.3833608	1.955327283	3.650688939	0.218541176	0.586469932	2.162757072	2.26738311	1.757209906	1.716100537	0	0.783505155	0.334723439	0	0.04023767	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7379
H3954_097_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	O	V	O	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	NO	330.870408	16.69158316	90.66009285	0	23.88136716	33.13703739	8.614274094	662.9054239	50.91788666	34.3566736	31.6019676	5.852794362	11.59583529	28.01522072	0	87.09723714	5.509382015	3.937828384	22.84226375	39.59811694	17.90222181	9.641764196	0	0	0	0	0	0	0	0												Medicare FFS Benefits (PBP 1a)	Medicare FFS Benefits (PBP 1b)	Medicare FFS Benefits (PBP 2)	Medicare FFS Benefits (PBP 6)	Medicare FFS Benefits (PBP 10a)	Medicare FFS Benefits (PBP 11a)	"Medicare FFS Benefits (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"Medicare FFS Benefits (PBP 9a, 9b)"	Medicare FFS Benefits (PBP 8a)	Medicare FFS Benefits (PBP 8b)	Medicare FFS Benefits (PBP 5)	Medicare FFS Benefits (PBP 12)	"Medicare FFS Benefits (PBP 3, 9a, 9c, 9d)"	"CIF (PBP 7a, 14b-i)"	"Medicare FFS Benefits (PBP 7b, 7d, 7f, 7g, 14d-i)"	"Medicare FFS Benefits (PBP 7e, 7h)"	"Medicare FFS Benefits (PBP 7c, 7i)"	Medicare FFS Benefits (PBP 7d)	Medicare FFS Benefits (PBP 7g)	Medicare FFS Benefits (PBP 15)	Medicare FFS Benefits (PBP 13a)	N/A (PBP 10b)	"$0 Copay, one per six months (PBP 16a, 16b)"	CIF (PBP 17a)	$200 Max per 2 Years (PBP 17b)	CIF (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)	$40 per Quarter (PBP 13c)											0.080742218	0.080742218	0.183617242	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080742218	0.080742218	0.183617242	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												26.7152	1.347715438	16.64675625	0	5.564358549	7.720929712	2.007125864	2.762105933	11.86386759	8.005104948	7.36325845	1.363701086	2.701829622	6.527546427	0	20.29365625	1.28368601	0.917514014	5.322247454	9.226361247	4.171217682	2.246531058	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.0507	146	0	26.7152	1.347715438	16.64675625	0	5.564358549	7.720929712	2.007125864	2.762105933	11.86386759	8.005104948	7.36325845	1.363701086	2.701829622	6.527546427	0	20.29365625	1.28368601	0.917514014	5.322247454	9.226361247	4.171217682	2.246531058	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.0507	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	26.7152	1.347715438	16.64675625	0	5.564358549	7.720929712	2.007125864	2.762105933	11.86386759	8.005104948	7.36325845	1.363701086	2.701829622	6.527546427	0	20.29365625	1.28368601	0.917514014	5.322247454	9.226361247	4.171217682	2.246531058	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.0507
H3954_098_0	2010	3	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	O	O	O	O	V	O	V	O	O	O											19.309	0	6.6528	0	2.7492	0.7312	0.6833	0	8.3237	9.9771	5.3171	0.5301	0.006	2.2018	0	4.5423	0	0	4.4095	0.6928	0.6822	0.1428	0	0	0	0	0	0	0	0											66.9508	NO	0	25.63140062	0	0	0	0	0	188.6489134	0	0	0	0	0	13134.56968	5136.39949	9149.370555	131.1247059	373.9237133	0	0	0	0	0	465.0001824	958.1778265	0	18.98488546	0	0	0												Deductible with $500 Initial Coverage (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	Deductible with $500 Initial Coverage (PBP 2)	CIF (PBP 6)	Deductible with $500 Initial Coverage (PBP 10a)	Deductible with $500 Initial Coverage (PBP 11a)	"Deductible with $500 Initial Coverage (PBP 11b, 11c)"	"ER $50 Copay, Urgent Care $20 Copay (PBP 4a, 4b)"	"Deductible with $500 Initial Coverage (PBP 9a, 9b)"	Deductible with $500 Initial Coverage (PBP 8a)	Deductible with $500 Initial Coverage (PBP 8b)	Deductible with $500 Initial Coverage (PBP 5)	Deductible with $500 Initial Coverage (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services Deductible with $500 Initial Coverage (PBP 3, 9a, 9c, 9d)"	"PCP Visit $10 Copay, Immunizations & Screenings CIF (PBP 7a, 14b-i)"	"Specialist Visit $20 Copay, Other Prof Services CIF or Deductible with $500 Initial Coverage (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	Deductible with $500 Initial Coverage (PBP 7d)	Deductible with $500 Initial Coverage (PBP 7g)	Deductible with $500 Initial Coverage (PBP 15)	Deductible with $500 Initial Coverage (PBP 13a)	N/A (PBP 10b)	"Office Visit $20 Copay, X-Rays $20-$30 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0	50	0	0	0	0	0	50	0	0	0	0	0	2.61	10	20	20	10	0	0	0	0	0	20	20	0	20	0	0	0											NO	0	50	0	0	0	0	0	50	0	0	0	0	0	2.61	10	20	20	10	0	0	0	0	0	20	20	0	20	0	0	0												0	0.106797503	0	0	0	0	0	0.786037139	0	0	0	0	0	2.856768906	4.280332908	15.24895092	0.218541176	0.311603094	0	0	0	0	0	0.775000304	1.596963044	0	0.031641476	0	0	0	0	0	0	0	0	0	0	0	0	0	26.2126	2200	0	19.309	0.106797503	6.652754982	0	2.749212058	0.731173268	0.683290576	0.786037139	8.323680201	9.977084356	5.317054406	0.530065394	0.005997368	5.058605556	4.280332908	19.79123405	0.218541176	0.311603094	4.409520821	0.692788027	0.682231383	0.14283146	0	0.775000304	1.596963044	0	0.031641476	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1635	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	19.309	0.106797503	6.652754982	0	2.749212058	0.731173268	0.683290576	0.786037139	8.323680201	9.977084356	5.317054406	0.530065394	0.005997368	5.058605556	4.280332908	19.79123405	0.218541176	0.311603094	4.409520821	0.692788027	0.682231383	0.14283146	0	0.775000304	1.596963044	0	0.031641476	0	0	0	0	0	0	0	0	0	0	0	0	0	93.1635
H3954_099_0	2010	4	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	O	O	O	O	V	O	V	O	O	O											24.7712	0	9.8602	0	3.7845	1.3403	1.0874	0	12.1086	10.146	7.6577	0.7952	0.009	3.0309	0	5.9546	0	0	5.7764	0.8172	1.0349	0.2405	0	0	0	0	0	0	0	0											88.4145	NO	0	25.63140062	0	0	0	0	0	305.2877698	0	0	0	0	0	18249.67852	6711.627105	12106.52311	131.1247059	599.0801131	0	0	0	0	0	467.635085	1317.41312	0	24.33987705	0	0	0												Deductible with $500 Initial Coverage (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	Deductible with $500 Initial Coverage (PBP 2)	CIF (PBP 6)	Deductible with $500 Initial Coverage (PBP 10a)	Deductible with $500 Initial Coverage (PBP 11a)	"Deductible with $500 Initial Coverage (PBP 11b, 11c)"	"ER $50 Copay, Urgent Care $20 Copay (PBP 4a, 4b)"	"Deductible with $500 Initial Coverage (PBP 9a, 9b)"	Deductible with $500 Initial Coverage (PBP 8a)	Deductible with $500 Initial Coverage (PBP 8b)	Deductible with $500 Initial Coverage (PBP 5)	Deductible with $500 Initial Coverage (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services Deductible with $500 Initial Coverage (PBP 3, 9a, 9c, 9d)"	"PCP Visit $10 Copay, Immunizations & Screenings CIF (PBP 7a, 14b-i)"	"Specialist Visit $20 Copay, Other Prof Services CIF or Deductible with $500 Initial Coverage (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	Deductible with $500 Initial Coverage (PBP 7d)	Deductible with $500 Initial Coverage (PBP 7g)	Deductible with $500 Initial Coverage (PBP 15)	Deductible with $500 Initial Coverage (PBP 13a)	N/A (PBP 10b)	"Office Visit $20 Copay, X-Rays $20-$30 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0	50	0	0	0	0	0	50	0	0	0	0	0	2.61	10	20	20	10	0	0	0	0	0	20	20	0	20	0	0	0											NO	0	50	0	0	0	0	0	50	0	0	0	0	0	2.61	10	20	20	10	0	0	0	0	0	20	20	0	20	0	0	0												0	0.106797503	0	0	0	0	0	1.272032374	0	0	0	0	0	3.969305077	5.593022587	20.17753852	0.218541176	0.499233428	0	0	0	0	0	0.779391808	2.195688534	0	0.040566462	0	0	0	0	0	0	0	0	0	0	0	0	0	34.8521	2200	0	24.7712	0.106797503	9.860237268	0	3.784544299	1.340296262	1.087360929	1.272032374	12.10862488	10.14598151	7.657674829	0.795153442	0.009024693	7.000220053	5.593022587	26.13212638	0.218541176	0.499233428	5.776368208	0.817221571	1.034856583	0.240494682	0	0.779391808	2.195688534	0	0.040566462	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2667	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	24.7712	0.106797503	9.860237268	0	3.784544299	1.340296262	1.087360929	1.272032374	12.10862488	10.14598151	7.657674829	0.795153442	0.009024693	7.000220053	5.593022587	26.13212638	0.218541176	0.499233428	5.776368208	0.817221571	1.034856583	0.240494682	0	0.779391808	2.195688534	0	0.040566462	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2667
H3954_100_0	2010	5	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	O	O	O	O	V	O	V	O	O	O											21.4395	0	6.0395	0	2.3257	0.8462	1.3414	0	12.2599	10.3733	7.8033	0.6924	0.0048	2.4596	0	5.68	0	0	5.5496	0.773	1.218	0.279	0	0	0	0	0	0	0	0											79.0852	NO	0	25.63140062	0	0	0	0	0	255.3220389	0	0	0	0	0	15054.3319	6010.154442	11739.04683	131.1247059	443.9908779	0	0	0	0	0	473.0827934	1085.878667	0	22.28605952	0	0	0												Deductible with $500 Initial Coverage (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	Deductible with $500 Initial Coverage (PBP 2)	CIF (PBP 6)	Deductible with $500 Initial Coverage (PBP 10a)	Deductible with $500 Initial Coverage (PBP 11a)	"Deductible with $500 Initial Coverage (PBP 11b, 11c)"	"ER $50 Copay, Urgent Care $20 Copay (PBP 4a, 4b)"	"Deductible with $500 Initial Coverage (PBP 9a, 9b)"	Deductible with $500 Initial Coverage (PBP 8a)	Deductible with $500 Initial Coverage (PBP 8b)	Deductible with $500 Initial Coverage (PBP 5)	Deductible with $500 Initial Coverage (PBP 12)	"CORF $10 Copay, OP Facility SA $25/$10 Copay (Indiv/Grp Visit), Other Services Deductible with $500 Initial Coverage (PBP 3, 9a, 9c, 9d)"	"PCP Visit $10 Copay, Immunizations & Screenings CIF (PBP 7a, 14b-i)"	"Specialist Visit $20 Copay, Other Prof Services CIF or Deductible with $500 Initial Coverage (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	Deductible with $500 Initial Coverage (PBP 7d)	Deductible with $500 Initial Coverage (PBP 7g)	Deductible with $500 Initial Coverage (PBP 15)	Deductible with $500 Initial Coverage (PBP 13a)	N/A (PBP 10b)	"Office Visit $20 Copay, X-Rays $20-$30 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												0	50	0	0	0	0	0	50	0	0	0	0	0	2.61	10	20	20	10	0	0	0	0	0	20	20	0	20	0	0	0											NO	0	50	0	0	0	0	0	50	0	0	0	0	0	2.61	10	20	20	10	0	0	0	0	0	20	20	0	20	0	0	0												0	0.106797503	0	0	0	0	0	1.063841829	0	0	0	0	0	3.274317188	5.008462035	19.56507805	0.218541176	0.369992398	0	0	0	0	0	0.788471322	1.809797778	0	0.037143433	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2424	2200	0	21.4395	0.106797503	6.039546912	0	2.325670748	0.846207214	1.341383583	1.063841829	12.25989636	10.37334333	7.803314328	0.69242678	0.004757883	5.733918563	5.008462035	25.24509737	0.218541176	0.369992398	5.549565937	0.772954425	1.217976054	0.278987671	0	0.788471322	1.809797778	0	0.037143433	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3276	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	21.4395	0.106797503	6.039546912	0	2.325670748	0.846207214	1.341383583	1.063841829	12.25989636	10.37334333	7.803314328	0.69242678	0.004757883	5.733918563	5.008462035	25.24509737	0.218541176	0.369992398	5.549565937	0.772954425	1.217976054	0.278987671	0	0.788471322	1.809797778	0	0.037143433	0	0	0	0	0	0	0	0	0	0	0	0	0	111.3276
H3954_106_0	2010	6	N/A																															D	D	D	V	P	Coin	O	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	NO	1351.084184	85.42831072	0	0	1213.093419	34.15017517	0	560.9931031	0	0	0	0	0	0	0	1868.135477	1154.873143	0	0	6679.876216	9.128542391	0	0	0	351.7654765	0	75.37831639	0	0	0												$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	CIF (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	"10% Coinsurance (PBP 11a, 11c)"	CIF (PBP 11b)	"ER $50 Copay, Urgent Care $10 Copay (PBP 4a, 4b)"	"CIF (PBP 9a, 9b)"	"Office Lab $10 Copay, Other Lab CIF (PBP 8a)"	CIF (PBP 8b)	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF CIF, OP Facility SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"CIF (PBP 7a, 14b-i)"	"$10 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"CIF (PBP 7c, 7i)"	CIF (PBP 7d)	Lab $10 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	CIF (PBP 10b)	"$0 Copay, one per six months, $250 Max per 5 Years Denture Coverage (PBP 16a, 16b)"	$10 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$10 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	0	0	50	0.1	0	50	0	0	0	0	0	0	0	10	20	0	0	4.92	0.09	0	0	0	10	0	10	0	0	0											NO	50	50	0	0	50	0.1	0	50	0	0	0	0	0	0	0	10	20	0	0	4.92	0.09	0	0	0	10	0	10	0	0	0												5.6295	0.355951295	0	0	5.054555914	3.415017517	0	2.337471263	0	0	0	0	0	0	0	1.556779564	1.924788571	0	0	2.738749249	0.821568815	0	0	0	0.293137897	0	0.062815264	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1904	None	0	5.6295	0.355951295	0	0	5.054555914	3.415017517	0	2.337471263	0	0	0	0	0	0	0	1.556779564	1.924788571	0	0	2.738749249	0.821568815	0	0	0	0.293137897	0	0.062815264	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1904	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	5.6295	0.355951295	0	0	5.054555914	3.415017517	0	2.337471263	0	0	0	0	0	0	0	1.556779564	1.924788571	0	0	2.738749249	0.821568815	0	0	0	0.293137897	0	0.062815264	0	0	0	0	0	0	0	0	0	0	0	0	0	24.1904
H3954_110_0	2010	2	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	922.0626273	27.29648629	1590.991729	0	80.45237492	16.17546757	0.902864248	187.4757639	216.6535377	1379.464607	683.969279	0	0	1890.917259	2335.407782	1022.226791	139.6429243	925.4732795	720.7482901	2195.706313	22.02617185	0	0	500.6422713	188.5333444	0	0.780066134	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												3.6076	0.106797503	7.469706168	0	0.314769917	3.03775281	0.169557906	0.733498926	0.847656966	0.539715527	1.595984175	0	0	0.386186759	1.827456589	1.599784928	0.218541176	0.724182841	1.242292467	0.859070095	1.982355466	0	0	0.783505155	0.295054684	0	0.001220803	0	0	0	0	0	0	0	0	0	0	0	0	0	28.3427	None	1.932699025	3.6076	0.106797503	7.469706168	0	0.314769917	3.03775281	0.169557906	0.733498926	0.847656966	0.539715527	1.595984175	0	0	0.386186759	1.827456589	1.599784928	0.218541176	0.724182841	1.242292467	0.859070095	1.982355466	0	0	0.783505155	0.295054684	0	0.001220803	0	0	0	0	0	0	0	0	0	0	0	0	0	28.3427	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	3.6076	0.106797503	7.469706168	0	0.314769917	3.03775281	0.169557906	0.733498926	0.847656966	0.539715527	1.595984175	0	0	0.386186759	1.827456589	1.599784928	0.218541176	0.724182841	1.242292467	0.859070095	1.982355466	0	0	0.783505155	0.295054684	0	0.001220803	0	0	0	0	0	0	0	0	0	0	0	0	0	28.3427
H3954_111_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	987.5701256	27.29648629	1704.022975	0	86.16807541	17.32464593	0.967007806	200.7948898	232.0455846	1477.46801	732.5615493	0	0	2025.256571	2501.32571	1094.850404	139.6429243	991.223086	771.9535076	2351.699218	23.59101069	0	0	500.6422713	201.9276057	0	0.83548556	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												3.8639	0.106797503	8.00038787	0	0.337132595	3.253568505	0.181604066	0.785610006	0.90787835	0.578059359	1.709370107	0	0	0.413623213	1.957287368	1.713440883	0.218541176	0.775632065	1.330550541	0.920102319	2.123190962	0	0	0.783505155	0.316016703	0	0.001307535	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2775	None	2.064889116	3.8639	0.106797503	8.00038787	0	0.337132595	3.253568505	0.181604066	0.785610006	0.90787835	0.578059359	1.709370107	0	0	0.413623213	1.957287368	1.713440883	0.218541176	0.775632065	1.330550541	0.920102319	2.123190962	0	0	0.783505155	0.316016703	0	0.001307535	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2775	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	3.8639	0.106797503	8.00038787	0	0.337132595	3.253568505	0.181604066	0.785610006	0.90787835	0.578059359	1.709370107	0	0	0.413623213	1.957287368	1.713440883	0.218541176	0.775632065	1.330550541	0.920102319	2.123190962	0	0	0.783505155	0.316016703	0	0.001307535	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2775
H3954_112_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1008.171588	27.29648629	1739.570188	0	87.96560686	17.68605119	0.987180323	204.9836236	236.8862316	1508.289114	747.8433391	0	0	2067.50496	2553.505263	1117.689815	139.6429243	1011.900752	788.0570436	2400.757448	24.08313708	0	0	500.6422713	206.1399688	0	0.852914422	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												3.9445	0.106797503	8.167282032	0	0.344165437	3.321440413	0.185392465	0.801998427	0.926817381	0.590118116	1.745028865	0	0	0.422251707	1.998117868	1.74918456	0.218541176	0.791812338	1.358306835	0.939296352	2.167482337	0	0	0.783505155	0.322609051	0	0.001334811	0	0	0	0	0	0	0	0	0	0	0	0	0	30.886	None	2.106461596	3.9445	0.106797503	8.167282032	0	0.344165437	3.321440413	0.185392465	0.801998427	0.926817381	0.590118116	1.745028865	0	0	0.422251707	1.998117868	1.74918456	0.218541176	0.791812338	1.358306835	0.939296352	2.167482337	0	0	0.783505155	0.322609051	0	0.001334811	0	0	0	0	0	0	0	0	0	0	0	0	0	30.886	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	3.9445	0.106797503	8.167282032	0	0.344165437	3.321440413	0.185392465	0.801998427	0.926817381	0.590118116	1.745028865	0	0	0.422251707	1.998117868	1.74918456	0.218541176	0.791812338	1.358306835	0.939296352	2.167482337	0	0	0.783505155	0.322609051	0	0.001334811	0	0	0	0	0	0	0	0	0	0	0	0	0	30.886
H3954_113_0	2010	2	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1040.892085	27.29648629	1176.561336	0	103.58009	6.227047694	7.427099768	269.7599698	230.0919908	5598.41513	919.5737501	37.08228031	0	2241.790107	5827.88903	4310.626401	139.6429243	741.6537545	650.3628622	59.74749716	10.41954707	0	0	501.4543839	1152.3421	0	0.738661333	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.0725	0.106797503	5.523955474	0	0.405257102	1.169439557	1.394809336	1.055435882	0.900234914	2.19037992	2.145747182	0.072542211	0	0.457846398	4.560323166	6.746130318	0.218541176	0.580344063	1.120975097	0.023376208	0.937759237	0	0	0.784776111	1.803415386	0	0.001156005	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2717	None	2.399586707	4.0725	0.106797503	5.523955474	0	0.405257102	1.169439557	1.394809336	1.055435882	0.900234914	2.19037992	2.145747182	0.072542211	0	0.457846398	4.560323166	6.746130318	0.218541176	0.580344063	1.120975097	0.023376208	0.937759237	0	0	0.784776111	1.803415386	0	0.001156005	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2717	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.0725	0.106797503	5.523955474	0	0.405257102	1.169439557	1.394809336	1.055435882	0.900234914	2.19037992	2.145747182	0.072542211	0	0.457846398	4.560323166	6.746130318	0.218541176	0.580344063	1.120975097	0.023376208	0.937759237	0	0	0.784776111	1.803415386	0	0.001156005	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2717
H3954_114_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1267.438492	27.29648629	1432.635667	0	126.123923	7.582342164	9.043581242	328.4722542	280.1706827	6816.88999	1119.71566	45.15310486	0	2729.707638	7117.231712	5248.818689	139.6429243	903.0720189	791.9119932	72.7513244	12.68732391	0	0	501.6311373	1403.145201	0	0.899428308	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.9589	0.106797503	6.726224458	0	0.493459849	1.423963858	1.698384557	1.285147695	1.096167796	2.667108208	2.612761316	0.088330761	0	0.557495015	5.569233815	8.214401248	0.218541176	0.706653855	1.364951283	0.028463956	1.141859152	0	0	0.78505273	2.19592224	0	0.001407605	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9412	None	2.907233882	4.9589	0.106797503	6.726224458	0	0.493459849	1.423963858	1.698384557	1.285147695	1.096167796	2.667108208	2.612761316	0.088330761	0	0.557495015	5.569233815	8.214401248	0.218541176	0.706653855	1.364951283	0.028463956	1.141859152	0	0	0.78505273	2.19592224	0	0.001407605	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9412	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.9589	0.106797503	6.726224458	0	0.493459849	1.423963858	1.698384557	1.285147695	1.096167796	2.667108208	2.612761316	0.088330761	0	0.557495015	5.569233815	8.214401248	0.218541176	0.706653855	1.364951283	0.028463956	1.141859152	0	0	0.78505273	2.19592224	0	0.001407605	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9412
H3954_115_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	853.488656	27.29648629	759.611744	0	104.5324255	7.289462226	7.011716835	300.475609	270.4997781	5313.698924	1032.374918	41.24613421	0	2615.874229	3810.258245	3187.222595	139.6429243	691.7606665	416.4585454	37.02228609	5.904031546	0	0	496.3286866	726.6463966	0	0.431344083	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												3.3393	0.106797503	3.566377138	0	0.408983115	1.368961006	1.316800422	1.17561082	1.058330382	2.078984704	2.40895912	0.08068775	0	0.534246533	2.981527077	4.988003361	0.218541176	0.541302722	0.717814139	0.014484969	0.531362839	0	0	0.776754394	1.137201611	0	0.000675053	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3517	None	1.931286704	3.3393	0.106797503	3.566377138	0	0.408983115	1.368961006	1.316800422	1.17561082	1.058330382	2.078984704	2.40895912	0.08068775	0	0.534246533	2.981527077	4.988003361	0.218541176	0.541302722	0.717814139	0.014484969	0.531362839	0	0	0.776754394	1.137201611	0	0.000675053	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3517	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	3.3393	0.106797503	3.566377138	0	0.408983115	1.368961006	1.316800422	1.17561082	1.058330382	2.078984704	2.40895912	0.08068775	0	0.534246533	2.981527077	4.988003361	0.218541176	0.541302722	0.717814139	0.014484969	0.531362839	0	0	0.776754394	1.137201611	0	0.000675053	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3517
H3954_122_0	2010	2	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1184.370272	27.29648629	566.1992707	0	169.4211383	8.578962314	5.517231583	295.6970473	224.2825133	3412.713267	990.9216402	35.78338417	0	2188.152945	3720.562692	3142.860889	139.6429243	414.3575234	484.4130763	85.48101295	6.782066848	0	0	501.4664429	737.5007254	0	0.343104179	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.6338	0.106797503	2.658305576	0	0.662860203	1.611129122	1.036136091	1.156914698	0.877505333	1.335224066	2.312231419	0.070001245	0	0.446891946	2.911340307	4.918577291	0.218541176	0.324234762	0.834941579	0.033444446	0.610386016	0	0	0.784794983	1.154188635	0	0.000536958	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6988	None	1.8925227	4.6338	0.106797503	2.658305576	0	0.662860203	1.611129122	1.036136091	1.156914698	0.877505333	1.335224066	2.312231419	0.070001245	0	0.446891946	2.911340307	4.918577291	0.218541176	0.324234762	0.834941579	0.033444446	0.610386016	0	0	0.784794983	1.154188635	0	0.000536958	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6988	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.6338	0.106797503	2.658305576	0	0.662860203	1.611129122	1.036136091	1.156914698	0.877505333	1.335224066	2.312231419	0.070001245	0	0.446891946	2.911340307	4.918577291	0.218541176	0.324234762	0.834941579	0.033444446	0.610386016	0	0	0.784794983	1.154188635	0	0.000536958	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6988
H3954_123_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1184.370272	27.29648629	566.1992707	0	169.4211383	8.578962314	5.517231583	295.6970473	224.2825133	3412.713267	990.9216402	35.78338417	0	2188.152945	3720.562692	3142.860889	139.6429243	414.3575234	484.4130763	85.48101295	6.782066848	0	0	501.4664429	737.5007254	0	0.343104179	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.6338	0.106797503	2.658305576	0	0.662860203	1.611129122	1.036136091	1.156914698	0.877505333	1.335224066	2.312231419	0.070001245	0	0.446891946	2.911340307	4.918577291	0.218541176	0.324234762	0.834941579	0.033444446	0.610386016	0	0	0.784794983	1.154188635	0	0.000536958	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6988	None	1.8925227	4.6338	0.106797503	2.658305576	0	0.662860203	1.611129122	1.036136091	1.156914698	0.877505333	1.335224066	2.312231419	0.070001245	0	0.446891946	2.911340307	4.918577291	0.218541176	0.324234762	0.834941579	0.033444446	0.610386016	0	0	0.784794983	1.154188635	0	0.000536958	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6988	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.6338	0.106797503	2.658305576	0	0.662860203	1.611129122	1.036136091	1.156914698	0.877505333	1.335224066	2.312231419	0.070001245	0	0.446891946	2.911340307	4.918577291	0.218541176	0.324234762	0.834941579	0.033444446	0.610386016	0	0	0.784794983	1.154188635	0	0.000536958	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6988
H3954_124_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1184.370272	27.29648629	566.1992707	0	169.4211383	8.578962314	5.517231583	295.6970473	224.2825133	3412.713267	990.9216402	35.78338417	0	2188.152945	3720.562692	3142.860889	139.6429243	414.3575234	484.4130763	85.48101295	6.782066848	0	0	501.4664429	737.5007254	0	0.343104179	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.6338	0.106797503	2.658305576	0	0.662860203	1.611129122	1.036136091	1.156914698	0.877505333	1.335224066	2.312231419	0.070001245	0	0.446891946	2.911340307	4.918577291	0.218541176	0.324234762	0.834941579	0.033444446	0.610386016	0	0	0.784794983	1.154188635	0	0.000536958	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6988	None	1.8925227	4.6338	0.106797503	2.658305576	0	0.662860203	1.611129122	1.036136091	1.156914698	0.877505333	1.335224066	2.312231419	0.070001245	0	0.446891946	2.911340307	4.918577291	0.218541176	0.324234762	0.834941579	0.033444446	0.610386016	0	0	0.784794983	1.154188635	0	0.000536958	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6988	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.6338	0.106797503	2.658305576	0	0.662860203	1.611129122	1.036136091	1.156914698	0.877505333	1.335224066	2.312231419	0.070001245	0	0.446891946	2.911340307	4.918577291	0.218541176	0.324234762	0.834941579	0.033444446	0.610386016	0	0	0.784794983	1.154188635	0	0.000536958	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6988
H3954_125_0	2010	2	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1205.4708	27.29648629	874.2162732	0	153.6909431	8.439607183	5.404049936	277.6688425	320.6344945	6400.322295	1092.008302	25.21617514	0	2099.304609	3351.677732	3221.338078	139.6429243	389.4513305	782.304011	187.2254419	7.171041126	0	0	500.6422713	781.4701558	0	0.549482738	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.7164	0.106797503	4.104445403	0	0.601315815	1.584958229	1.014880578	1.086379346	1.25448246	2.504126098	2.548108552	0.049329143	0	0.428746229	2.622687825	5.041394093	0.218541176	0.304745666	1.348390822	0.073251954	0.645393701	0	0	0.783505155	1.223000794	0	0.00085994	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2617	None	2.125594787	4.7164	0.106797503	4.104445403	0	0.601315815	1.584958229	1.014880578	1.086379346	1.25448246	2.504126098	2.548108552	0.049329143	0	0.428746229	2.622687825	5.041394093	0.218541176	0.304745666	1.348390822	0.073251954	0.645393701	0	0	0.783505155	1.223000794	0	0.00085994	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2617	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.7164	0.106797503	4.104445403	0	0.601315815	1.584958229	1.014880578	1.086379346	1.25448246	2.504126098	2.548108552	0.049329143	0	0.428746229	2.622687825	5.041394093	0.218541176	0.304745666	1.348390822	0.073251954	0.645393701	0	0	0.783505155	1.223000794	0	0.00085994	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2617
H3954_126_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1205.4708	27.29648629	874.2162732	0	153.6909431	8.439607183	5.404049936	277.6688425	320.6344945	6400.322295	1092.008302	25.21617514	0	2099.304609	3351.677732	3221.338078	139.6429243	389.4513305	782.304011	187.2254419	7.171041126	0	0	500.6422713	781.4701558	0	0.549482738	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.7164	0.106797503	4.104445403	0	0.601315815	1.584958229	1.014880578	1.086379346	1.25448246	2.504126098	2.548108552	0.049329143	0	0.428746229	2.622687825	5.041394093	0.218541176	0.304745666	1.348390822	0.073251954	0.645393701	0	0	0.783505155	1.223000794	0	0.00085994	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2617	None	2.125594787	4.7164	0.106797503	4.104445403	0	0.601315815	1.584958229	1.014880578	1.086379346	1.25448246	2.504126098	2.548108552	0.049329143	0	0.428746229	2.622687825	5.041394093	0.218541176	0.304745666	1.348390822	0.073251954	0.645393701	0	0	0.783505155	1.223000794	0	0.00085994	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2617	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.7164	0.106797503	4.104445403	0	0.601315815	1.584958229	1.014880578	1.086379346	1.25448246	2.504126098	2.548108552	0.049329143	0	0.428746229	2.622687825	5.041394093	0.218541176	0.304745666	1.348390822	0.073251954	0.645393701	0	0	0.783505155	1.223000794	0	0.00085994	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2617
H3954_127_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	O	O	V	O	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	YES	1205.4708	27.29648629	874.2162732	0	153.6909431	8.439607183	5.404049936	277.6688425	320.6344945	6400.322295	1092.008302	25.21617514	0	2099.304609	3351.677732	3221.338078	139.6429243	389.4513305	782.304011	187.2254419	7.171041126	0	0	500.6422713	781.4701558	0	0.549482738	0	0	0											2000	$50 Copay Days 1-5 (PBP 1a)	$50 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$50 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"$50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"	$25 Copay (PBP 5)	CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 3, 9a, 9c, 9d)"	"$10 Copay (PBP 7a, 14b-i)"	"$20 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	Lab $5 Copay (PBP 7g)	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												50	50	60	0	50	0.2	0.2	50	50	5	29.82	25	0	2.61	10	20	20	10	22.02702703	5	0.1	0	0	20	20	0	20	0	0	0											NO	46.95	46.95	56.34	0	46.95	0.1878	0.1878	46.95	46.95	4.695	28.00098	23.475	0	2.45079	9.39	18.78	18.78	9.39	20.68337838	4.695	0.09	0	0	18.78	18.78	0	18.78	0	0	0												4.7164	0.106797503	4.104445403	0	0.601315815	1.584958229	1.014880578	1.086379346	1.25448246	2.504126098	2.548108552	0.049329143	0	0.428746229	2.622687825	5.041394093	0.218541176	0.304745666	1.348390822	0.073251954	0.645393701	0	0	0.783505155	1.223000794	0	0.00085994	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2617	None	2.125594787	4.7164	0.106797503	4.104445403	0	0.601315815	1.584958229	1.014880578	1.086379346	1.25448246	2.504126098	2.548108552	0.049329143	0	0.428746229	2.622687825	5.041394093	0.218541176	0.304745666	1.348390822	0.073251954	0.645393701	0	0	0.783505155	1.223000794	0	0.00085994	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2617	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	4.7164	0.106797503	4.104445403	0	0.601315815	1.584958229	1.014880578	1.086379346	1.25448246	2.504126098	2.548108552	0.049329143	0	0.428746229	2.622687825	5.041394093	0.218541176	0.304745666	1.348390822	0.073251954	0.645393701	0	0	0.783505155	1.223000794	0	0.00085994	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2617
H3954_134_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	T	V	V	O	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	YES	1906.343198	43.31728718	2214.612696	0	373.4654955	44.78796768	2.109973833	362.2428155	386.8682119	4015.587457	978.0617288	0	0	380.0955552	5857.022153	5288.82799	124.7257082	532.2391801	1085.075295	2688.384004	31.09832506	0	0	0	356.1118765	0	76.30968781	0	0	0											2000	$100 Copay Days 1-5 (PBP 1a)	$100 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"Prosthetics 20% Coinsurance, Diabetes Monitoring Supplies CIF (PBP 11b, 11c)"	"ER $50 Copay, Urgent Care $30 Copay (PBP 4a, 4b)"	"OP Surgery $100 Copay, ASC $50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"		CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit), All Other CIF (PBP 3, 5, 9a, 9c, 9d, 13a, 13b)"	"PCP Visit $5 Copay, Immunizations & Screenings CIF (PBP 4b, 7a, 14b-i)"	"Specialist Visit $30 Copay, Other Prof Services CIF (PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	"Lab $5 Copay (PBP 7d, 7g)"	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 7g)	N/A (PBP 10b)	"Office Visit $20 Copay, X-Rays $20-$30 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												100	100	60	0	100	0.156	0.2	49.08343285	78.5	5	29.88470616	0	0	10	5	27.44783569	20	10	23.40418189	5	0.1	0	0	0	20	0	20	0	0	0											NO	89.2991074	89.2991074	53.57946444	0	89.2991074	0.139306608	0.178598215	43.83106741	70.09979931	4.46495537	26.68677585	0	0	8.92991074	4.46495537	24.51067227	17.85982148	8.92991074	20.89972552	4.46495537	0.09	0	0	0	17.85982148	0	17.85982148	0	0	0												14.1862	0.32234959	9.888146851	0	2.77917795	6.239259835	0.37683756	1.323124105	2.259948667	1.494118232	2.175109511	0	0	0.282851615	2.179278543	10.80272746	0.185631574	0.396070698	1.889814652	1.000292883	2.798849256	0	0	0	0.530007878	0	0.113573117	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2234	0	7.312115159	14.1862	0.32234959	9.888146851	0	2.77917795	6.239259835	0.37683756	1.323124105	2.259948667	1.494118232	2.175109511	0	0	0.282851615	2.179278543	10.80272746	0.185631574	0.396070698	1.889814652	1.000292883	2.798849256	0	0	0	0.530007878	0	0.113573117	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2234	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	14.1862	0.32234959	9.888146851	0	2.77917795	6.239259835	0.37683756	1.323124105	2.259948667	1.494118232	2.175109511	0	0	0.282851615	2.179278543	10.80272746	0.185631574	0.396070698	1.889814652	1.000292883	2.798849256	0	0	0	0.530007878	0	0.113573117	0	0	0	0	0	0	0	0	0	0	0	0	0	61.2234
H3954_135_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	T	V	V	O	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	YES	2115.043759	48.05952991	2370.030373	0	307.7586442	40.27137426	1.897195839	343.3816302	521.2315268	4297.486628	929.7305028	0	0	420.4919935	6049.355794	5468.026738	130.5361724	557.0340419	1119.900617	3165.144102	32.46260008	0	0	0	367.8059237	0	78.81555509	0	0	0											2000	$100 Copay Days 1-5 (PBP 1a)	$100 Copay Days 1-5 (PBP 1b)	$60 Copay Days 7-100 (PBP 2)	CIF (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"Prosthetics 20% Coinsurance, Diabetes Monitoring Supplies CIF (PBP 11b, 11c)"	"ER $50 Copay, Urgent Care $30 Copay (PBP 4a, 4b)"	"OP Surgery $100 Copay, ASC $50 Copay (PBP 9a, 9b)"	$5 Copay (PBP 8a)	"$15 General, $75 CT/MRI/PT (PBP 8b)"		CIF (PBP 12)	"CORF $10 Copay, OP Facility MH/SA $25/$10 Copay (Indiv/Grp Visit), All Other CIF (PBP 3, 5, 9a, 9c, 9d, 13a, 13b)"	"PCP Visit $5 Copay, Immunizations & Screenings CIF (PBP 4b, 7a, 14b-i)"	"Specialist Visit $30 Copay, Other Prof Services CIF (PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a)"	"OP MH/SA $25/$10 Copay (Indiv/Grp Visit) (PBP 7e, 7h)"	"$10 Copay (PBP 7c, 7i)"	"$15 Office General, $75 Office CT/MRI/PT (PBP 7d)"	"Lab $5 Copay (PBP 7d, 7g)"	"10% Coinsurance, $1000 OOP Max (PBP 15)"	CIF (PBP 7g)	N/A (PBP 10b)	"Office Visit $20 Copay, X-Rays $20-$30 Copay (PBP 16a, 16b)"	$20 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$20 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												100	100	60	0	100	0.156	0.2	49.00133628	78.5	5	29.88470616	0	0	10	5	27.45041376	20	10	23.40418189	5	0.1	0	0	0	20	0	20	0	0	0											NO	88.88826293	88.88826293	53.33295776	0	88.88826293	0.13866569	0.177776526	43.55643664	69.7772864	4.444413147	26.56399619	0	0	8.888826293	4.444413147	24.40019596	17.77765259	8.888826293	20.80357074	4.444413147	0.09	0	0	0	17.77765259	0	17.77765259	0	0	0												15.6669	0.355994011	10.53339415	0	2.279677607	5.584257906	0.337276885	1.246373351	3.030843461	1.591650506	2.058113128	0	0	0.311473357	2.240486368	11.11841033	0.19338556	0.412614903	1.941494309	1.172267338	2.921634007	0	0	0	0.544893828	0	0.116762963	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6579	0	7.917138475	15.6669	0.355994011	10.53339415	0	2.279677607	5.584257906	0.337276885	1.246373351	3.030843461	1.591650506	2.058113128	0	0	0.311473357	2.240486368	11.11841033	0.19338556	0.412614903	1.941494309	1.172267338	2.921634007	0	0	0	0.544893828	0	0.116762963	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6579	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	15.6669	0.355994011	10.53339415	0	2.279677607	5.584257906	0.337276885	1.246373351	3.030843461	1.591650506	2.058113128	0	0	0.311473357	2.240486368	11.11841033	0.19338556	0.412614903	1.941494309	1.172267338	2.921634007	0	0	0	0.544893828	0	0.116762963	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6579
H3954_801_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	O	V	O	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	NO	245.7522827	1.299400474	40.45460357	0	11.65400727	11.06445922	14.62737039	15.21849456	85.17383113	49.24255728	39.17169247	7.297887491	0.021273008	30.60942523	34.01010115	132.6592327	0.937944963	3.029782126	20.39185596	3.765881588	8.910180834	0.746869758	0	0	0	0	0	0	0	0												Medicare FFS Benefits (PBP 1a)	Medicare FFS Benefits (PBP 1b)	Medicare FFS Benefits (PBP 2)	Medicare FFS Benefits (PBP 6)	Medicare FFS Benefits (PBP 10a)	Medicare FFS Benefits (PBP 11a)	"Medicare FFS Benefits (PBP 11b, 11c)"	"Medicare FFS Benefits (PBP 4a, 4b)"	"Medicare FFS Benefits (PBP 9a, 9b)"	Medicare FFS Benefits (PBP 8a)	Medicare FFS Benefits (PBP 8b)	Medicare FFS Benefits (PBP 5)	Medicare FFS Benefits (PBP 12)	"Medicare FFS Benefits (PBP 3, 9a, 9c, 9d)"	"Medicare FFS Benefits (PBP 7a, 14b-i)"	"Medicare FFS Benefits (PBP 7b, 7d, 7f, 7g, 14d-i)"	"Medicare FFS Benefits (PBP 7e, 7h)"	"Medicare FFS Benefits (PBP 7c, 7i)"	Medicare FFS Benefits (PBP 7d)	Medicare FFS Benefits (PBP 7g)	Medicare FFS Benefits (PBP 15)	Medicare FFS Benefits (PBP 13a)	N/A (PBP 10b)	"N/A (PBP 16a, 16b)"	N/A (PBP 17a)	N/A (PBP 17b)	N/A (PBP 18a)	N/A (PBP 18b)	N/A (PBP 14a)												0.082189829	0.082189829	0.18262243	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082189829	0.082189829	0.18262243	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.1983	0.106797503	7.387917988	0	2.715383694	2.578018997	3.408177301	3.545909233	19.84550265	11.47351585	9.127004345	1.700407785	0.004956611	7.131996079	7.924353568	30.90960123	0.218541176	0.705939235	4.751302438	0.87745041	2.076072134	0.174020654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.8612	146	0	20.1983	0.106797503	7.387917988	0	2.715383694	2.578018997	3.408177301	3.545909233	19.84550265	11.47351585	9.127004345	1.700407785	0.004956611	7.131996079	7.924353568	30.90960123	0.218541176	0.705939235	4.751302438	0.87745041	2.076072134	0.174020654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.8612	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	20.1983	0.106797503	7.387917988	0	2.715383694	2.578018997	3.408177301	3.545909233	19.84550265	11.47351585	9.127004345	1.700407785	0.004956611	7.131996079	7.924353568	30.90960123	0.218541176	0.705939235	4.751302438	0.87745041	2.076072134	0.174020654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.8612
H3954_802_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	O	V	O	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	NO	237.0706964	1.312458255	28.38809344	0	12.11715382	8.76046025	11.36524326	13.4016946	66.95776658	51.69612703	35.50923035	6.643026404	0.037120207	30.28726473	35.13145228	134.2191443	0.937944963	3.290563194	24.5621429	4.007244857	14.1811537	0.872706409	0	0	0	0	0	0	0	0												Medicare FFS Benefits (PBP 1a)	Medicare FFS Benefits (PBP 1b)	Medicare FFS Benefits (PBP 2)	Medicare FFS Benefits (PBP 6)	Medicare FFS Benefits (PBP 10a)	Medicare FFS Benefits (PBP 11a)	"Medicare FFS Benefits (PBP 11b, 11c)"	"Medicare FFS Benefits (PBP 4a, 4b)"	"Medicare FFS Benefits (PBP 9a, 9b)"	Medicare FFS Benefits (PBP 8a)	Medicare FFS Benefits (PBP 8b)	Medicare FFS Benefits (PBP 5)	Medicare FFS Benefits (PBP 12)	"Medicare FFS Benefits (PBP 3, 9a, 9c, 9d)"	"Medicare FFS Benefits (PBP 7a, 14b-i)"	"Medicare FFS Benefits (PBP 7b, 7d, 7f, 7g, 14d-i)"	"Medicare FFS Benefits (PBP 7e, 7h)"	"Medicare FFS Benefits (PBP 7c, 7i)"	Medicare FFS Benefits (PBP 7d)	Medicare FFS Benefits (PBP 7g)	Medicare FFS Benefits (PBP 15)	Medicare FFS Benefits (PBP 13a)	N/A (PBP 10b)	"N/A (PBP 16a, 16b)"	N/A (PBP 17a)	N/A (PBP 17b)	N/A (PBP 18a)	N/A (PBP 18b)	N/A (PBP 14a)												0.081372114	0.081372114	0.183642912	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081372114	0.081372114	0.183642912	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.2909	0.106797503	5.213272136	0	2.823296841	2.041187238	2.648101681	3.122594842	15.60115961	12.0451976	8.273650672	1.547825152	0.008649008	7.056932683	8.185628381	31.27306062	0.218541176	0.766701224	5.722979295	0.933688052	3.304208813	0.203340593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.3878	146	0	19.2909	0.106797503	5.213272136	0	2.823296841	2.041187238	2.648101681	3.122594842	15.60115961	12.0451976	8.273650672	1.547825152	0.008649008	7.056932683	8.185628381	31.27306062	0.218541176	0.766701224	5.722979295	0.933688052	3.304208813	0.203340593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.3878	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	19.2909	0.106797503	5.213272136	0	2.823296841	2.041187238	2.648101681	3.122594842	15.60115961	12.0451976	8.273650672	1.547825152	0.008649008	7.056932683	8.185628381	31.27306062	0.218541176	0.766701224	5.722979295	0.933688052	3.304208813	0.203340593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.3878
H3957_003_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	366.6859655	0	945.7883457	0	607.4213996	16.17943961	0	354.3799784	532.4298131	0	1933.181456	0	0	760.860725	4366.393923	4352.882231	0	0	0	2238.297142	58.60147365	0	0	0	420	0	200.5611707	0	0	0											3400	"$200/admit $400max; PBP 1a, 1b"		$60 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$125; PBP 9a, 9b"	$0; PBP 8a	$0-$50; PBP 8b			"$0-$30; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$30; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$30; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$30; PBP 17a, 17b"		"$0-$30; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											200	0	60	0	100	0.15	0	50	125	0	23	0	0	30	15	30	0	0	0	30	0.042	0	0	0	30	0	30	0	0	0											NO	189.4252954	0	56.82758862	0	100	0.135369596	0	47.35632385	118.3908096	0	21.78390897	0	0	28.41379431	14.20689716	28.41379431	0	0	0	28.41379431	0.039779312	0	0	0	30	0	30	0	0	0												5.7883	0	4.478905919	0	5.061844997	2.190204201	0	1.398511085	5.25289972	0	3.509354071	0	0	1.801578345	5.169409117	10.30682503	0	0	0	5.299876215	2.331126306	0	0	0	1.05	0	0.501402927	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1402	0	2.767646765	5.7883	0	4.478905919	0	5.061844997	2.190204201	0	1.398511085	5.25289972	0	3.509354071	0	0	1.801578345	5.169409117	10.30682503	0	0	0	5.299876215	2.331126306	0	0	0	1.05	0	0.501402927	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1402	NO																																																																																		0			5.7883	0	4.478905919	0	5.061844997	2.190204201	0	1.398511085	5.25289972	0	3.509354071	0	0	1.801578345	5.169409117	10.30682503	0	0	0	5.299876215	2.331126306	0	0	0	1.05	0	0.501402927	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1402
H3957_006_0	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	314.5917049	0	943.7778242	0	486.403099	14.41360636	0	404.5110905	579.2915758	0	1822.608543	0	0	1103.670853	4544.732803	4448.177307	0	0	0	1962.949159	52.28220346	0	0	0	420	0	200.5611707	0	0	0											3400	"$200/admit $400max; PBP 1a, 1b"		$60 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$125; PBP 9a, 9b"	$0; PBP 8a	$0-$50; PBP 8b			"$0-$30; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$30; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$30; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$30; PBP 17a, 17b"		"$0-$30; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											200	0	60	0	100	0.15	0	50	125	0	23	0	0	30	15	30	0	0	0	30	0.042	0	0	0	30	0	30	0	0	0											NO	189.4369517	0	56.83108552	0	100	0.135369596	0	47.35923793	118.3980948	0	21.78524945	0	0	28.41554276	14.20777138	28.41554276	0	0	0	28.41554276	0.03978176	0	0	0	30	0	30	0	0	0												4.9663	0	4.469659853	0	4.053359158	1.951164068	0	1.596444749	5.71558491	0	3.308831814	0	0	2.613450527	5.380877054	10.53311437	0	0	0	4.648188813	2.079878063	0	0	0	1.05	0	0.501402927	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8682	0	2.737501479	4.9663	0	4.469659853	0	4.053359158	1.951164068	0	1.596444749	5.71558491	0	3.308831814	0	0	2.613450527	5.380877054	10.53311437	0	0	0	4.648188813	2.079878063	0	0	0	1.05	0	0.501402927	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8682	NO																																																																																		0			4.9663	0	4.469659853	0	4.053359158	1.951164068	0	1.596444749	5.71558491	0	3.308831814	0	0	2.613450527	5.380877054	10.53311437	0	0	0	4.648188813	2.079878063	0	0	0	1.05	0	0.501402927	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8682
H3957_020_0	2010	9	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	371.1665063	0	882.3681232	0	607.1092597	18.33327626	0	350.4653625	575.6517241	0	2102.693296	0	0	805.0989155	4844.103333	5508.336381	0	0	0	2981.180591	76.39931332	0	0	11.29310345	420	0	334.4413665	0	0	0											3400	"$100/admit $200max; PBP 1a, 1b"		$40 days 16-55; PBP 2	$0; PBP 6	$75; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$50; PBP 9a, 9b"	$0; PBP 8a	$0-$30; PBP 8b			"$0-$25; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$5; PBP 7a, 14c-j"	"$0-$25; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$25; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$25; 0%-50%; PBP 16a, 16b"	"$0-$25; PBP 17a, 17b"		"$0-$25; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											100	0	40	0	75	0.15	0	50	50	0	12	0	0	25	5	25	0	0	0	25	0.042	0	0	0.42	25	0	25	0	0	0											NO	96.82992306	0	38.73196923	0	75	0.122574743	0	48.41496153	48.41496153	0	11.61959077	0	0	24.20748077	4.841496153	24.20748077	0	0	0	24.20748077	0.040668568	0	0	0.42	25	0	25	0	0	0												2.995	0	2.847987916	0	3.794432873	2.24719662	0	1.413980587	2.322513006	0	2.036036301	0	0	1.624118043	1.954392304	11.11191225	0	0	0	6.013905986	3.107050645	0	0	4.743103448	0.875	0	0.696752847	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7834	0	1.662622196	2.995	0	2.847987916	0	3.794432873	2.24719662	0	1.413980587	2.322513006	0	2.036036301	0	0	1.624118043	1.954392304	11.11191225	0	0	0	6.013905986	3.107050645	0	0	4.743103448	0.875	0	0.696752847	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7834	NO																																																																																		0			2.995	0	2.847987916	0	3.794432873	2.24719662	0	1.413980587	2.322513006	0	2.036036301	0	0	1.624118043	1.954392304	11.11191225	0	0	0	6.013905986	3.107050645	0	0	4.743103448	0.875	0	0.696752847	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7834
H3957_021_0	2010	9	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	297.6453338	0	780.7993098	0	425.793224	14.59890405	0	382.9958509	614.576425	0	1888.403429	0	0	951.3864396	4971.348187	5263.007396	0	0	0	2639.884815	69.84055277	0	0	11.29310345	420	0	334.4413665	0	0	0											3400	"$100/admit $200max; PBP 1a, 1b"		$40 days 16-55; PBP 2	$0; PBP 6	$75; PBP 10a	"15% $500max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$50; PBP 9a, 9b"	$0; PBP 8a	$0-$30; PBP 8b			"$0-$25; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$5; PBP 7a, 14c-j"	"$0-$25; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$25; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$25; 0%-50%; PBP 16a, 16b"	"$0-$25; PBP 17a, 17b"		"$0-$25; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											100	0	40	0	75	0.15	0	50	50	0	12	0	0	25	5	25	0	0	0	25	0.042	0	0	0.42	25	0	25	0	0	0											NO	97.13943547	0	38.85577419	0	75	0.122574743	0	48.56971773	48.56971773	0	11.65673226	0	0	24.28485887	4.856971773	24.28485887	0	0	0	24.28485887	0.040798563	0	0	0.42	25	0	25	0	0	0												2.4094	0	2.528213472	0	2.66120765	1.789456907	0	1.550166697	2.487483624	0	1.83438443	0	0	1.925357118	2.012141485	10.65094932	0	0	0	5.342435846	2.849394185	0	0	4.743103448	0.875	0	0.696752847	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3555	0	1.389536424	2.4094	0	2.528213472	0	2.66120765	1.789456907	0	1.550166697	2.487483624	0	1.83438443	0	0	1.925357118	2.012141485	10.65094932	0	0	0	5.342435846	2.849394185	0	0	4.743103448	0.875	0	0.696752847	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3555	NO																																																																																		0			2.4094	0	2.528213472	0	2.66120765	1.789456907	0	1.550166697	2.487483624	0	1.83438443	0	0	1.925357118	2.012141485	10.65094932	0	0	0	5.342435846	2.849394185	0	0	4.743103448	0.875	0	0.696752847	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3555
H3957_024_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	354.4055161	0	438.4249713	0	338.704688	8.859514135	0	278.6144621	413.6213351	4182.283237	1461.779156	0	0	623.6406947	3133.306483	3788.667359	0	0	0	1710.127936	43.31319365	0	0	0	420	0	205.225384	0	0	0											3400	"$200/admit $600max; PBP 1a, 1b"		$60 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$150; PBP 9a, 9b"	$20-$75; PBP 8a	$0-$75; PBP 8b			"$0-$30; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$10; PBP 7a, 14c-j"	"$0-$30; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$30; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$30; PBP 17a, 17b"		"$0-$30; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											200	0	60	0	100	0.15	0	50	150	15	34	0	0	30	10	30	0	0	0	30	0.042	0	0	0	30	0	30	0	0	0											NO	191.1916424	0	57.35749271	0	100	0.135369596	0	47.79791059	143.3937318	14.33937318	32.5025792	0	0	28.67874635	9.559582118	28.67874635	0	0	0	28.67874635	0.040150245	0	0	0	30	0	30	0	0	0												5.6466	0	2.095579758	0	2.822539067	1.199308848	0	1.109765762	4.942558898	4.997610005	3.959299398	0	0	1.490436108	2.496091719	9.054519183	0	0	0	4.087027109	1.739035332	0	0	0	1.05	0	0.51306346	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2034	0	2.047018844	5.6466	0	2.095579758	0	2.822539067	1.199308848	0	1.109765762	4.942558898	4.997610005	3.959299398	0	0	1.490436108	2.496091719	9.054519183	0	0	0	4.087027109	1.739035332	0	0	0	1.05	0	0.51306346	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2034	NO																																																																																		0			5.6466	0	2.095579758	0	2.822539067	1.199308848	0	1.109765762	4.942558898	4.997610005	3.959299398	0	0	1.490436108	2.496091719	9.054519183	0	0	0	4.087027109	1.739035332	0	0	0	1.05	0	0.51306346	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2034
H3957_025_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	318.2252173	0	803.9034198	0	367.0303566	10.5402452	0	317.721225	515.2946583	4229.110132	1548.826074	0	0	850.9512632	3659.204819	4142.847657	0	0	0	2155.034245	43.20320231	0	0	0	402.6814847	0	193.0869566	0	0	0											3400	"$200/admit $600max; PBP 1a, 1b"		$60 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$150; PBP 9a, 9b"	$20-$75; PBP 8a	$0-$75; PBP 8b			"$0-$30; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$10; PBP 7a, 14c-j"	"$0-$30; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$30; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$30; PBP 17a, 17b"		"$0-$30; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											200	0	60	0	100	0.15	0	50	150	15	34	0	0	30	10	30	0	0	0	30	0.042	0	0	0	30	0	30	0	0	0											NO	188.7870234	0	56.63610703	0	100	0.135369596	0	47.19675586	141.5902676	14.15902676	32.09379398	0	0	28.31805351	9.439351171	28.31805351	0	0	0	28.31805351	0.039645275	0	0	0	30	0	30	0	0	0												5.0064	0	3.794163344	0	3.058586305	1.426828734	0	1.24961759	6.080059046	4.990006959	4.142308743	0	0	2.008106951	2.878376608	9.776448471	0	0	0	5.085531256	1.712802833	0	0	0	1.006703712	0	0.482717391	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6987	0	2.929362303	5.0064	0	3.794163344	0	3.058586305	1.426828734	0	1.24961759	6.080059046	4.990006959	4.142308743	0	0	2.008106951	2.878376608	9.776448471	0	0	0	5.085531256	1.712802833	0	0	0	1.006703712	0	0.482717391	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6987	NO																																																																																		0			5.0064	0	3.794163344	0	3.058586305	1.426828734	0	1.24961759	6.080059046	4.990006959	4.142308743	0	0	2.008106951	2.878376608	9.776448471	0	0	0	5.085531256	1.712802833	0	0	0	1.006703712	0	0.482717391	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6987
H3957_030_0	2010	7	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	521.5443994	0	214.4045948	0	53.61610152	58.28265485	0	35.12330313	44.35442198	39.74294721	60.06453812	0	0	55.05988983	16.37874193	40.19468907	0	0	0	176.1631394	56.85037464	0	0	0	0	0	0	0	0	0												"Medicare FFS cost sharing; PBP 1a, 1b"		Medicare FFS cost sharing; PBP 2	Medicare FFS cost sharing; PBP 6	Medicare FFS cost sharing; PBP 10a	"Medicare FFS cost sharing; PBP 11a, 11b, 11c"		"Medicare FFS cost sharing; PBP 4a, 4b"	"Medicare FFS cost sharing; PBP 9a, 9b"	Medicare FFS cost sharing; PBP 8a	Medicare FFS cost sharing; PBP 8b			"Medicare FFS cost sharing; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"Medicare FFS cost sharing, $0; PBP 7a, 14c-j"	"Medicare FFS cost sharing, $0; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"Medicare FFS cost sharing; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	Medicare FFS cost sharing; PBP 15			"$0; PBP 16a, 16b"	"$0; PBP 17a, 17b"		"$0; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											0.086705035	0	0.174785484	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.086705035	0	0.174785484	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												45.2205	0	37.47481095	0	12.49255165	13.57985858	0	8.183729629	10.33458032	9.2601067	13.99503738	0	0	12.82895433	3.816246871	9.365362552	0	0	0	41.04601149	13.24613729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	230.8439			45.2205	0	37.47481095	0	12.49255165	13.57985858	0	8.183729629	10.33458032	9.2601067	13.99503738	0	0	12.82895433	3.816246871	9.365362552	0	0	0	41.04601149	13.24613729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	230.8439	NO																																																																																		0			45.2205	0	37.47481095	0	12.49255165	13.57985858	0	8.183729629	10.33458032	9.2601067	13.99503738	0	0	12.82895433	3.816246871	9.365362552	0	0	0	41.04601149	13.24613729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	230.8439
H3957_031_0	2010	9	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	269.9411854	0	274.1644879	0	235.9464017	10.31926202	0	312.2419603	412.633573	3988.76448	1545.507506	0	0	513.9555079	3786.255487	3880.8746	0	0	0	2432.826212	27.24406735	0	0	0	417.7593517	0	201.644829	0	0	0											3400	"$300/admit $900max; PBP 1a, 1b"		$75 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$150; PBP 9a, 9b"	$20-$75; PBP 8a	$0-$75; PBP 8b			"$0-$40; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$10; PBP 7a, 14c-j"	"$0-$40; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$40; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$40; PBP 17a, 17b"		"$0-$40; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											300	0	75	0	100	0.15	0	50	150	15	25	0	0	40	10	40	0	0	0	40	0.042	0	0	0	40	0	40	0	0	0											NO	282.7964519	0	70.69911298	0	100	0.135369596	0	47.13274198	141.398226	14.1398226	23.56637099	0	0	37.70619359	9.426548397	37.70619359	0	0	0	37.70619359	0.039591503	0	0	0	40	0	40	0	0	0												6.3615	0	1.615265509	0	1.966220014	1.39691433	0	1.226401646	4.862137933	4.700035176	3.035166938	0	0	1.614942156	2.974276716	12.19441741	0	0	0	7.644384675	1.078633582	0	0	0	1.392531172	0	0.67214943	0	0	0	0	0	0	0	0	0	0	0	0	0	52.735	0	3.028845661	6.3615	0	1.615265509	0	1.966220014	1.39691433	0	1.226401646	4.862137933	4.700035176	3.035166938	0	0	1.614942156	2.974276716	12.19441741	0	0	0	7.644384675	1.078633582	0	0	0	1.392531172	0	0.67214943	0	0	0	0	0	0	0	0	0	0	0	0	0	52.735	NO																																																																																		0			6.3615	0	1.615265509	0	1.966220014	1.39691433	0	1.226401646	4.862137933	4.700035176	3.035166938	0	0	1.614942156	2.974276716	12.19441741	0	0	0	7.644384675	1.078633582	0	0	0	1.392531172	0	0.67214943	0	0	0	0	0	0	0	0	0	0	0	0	0	52.735
H3957_032_0	2010	9	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	221.8384452	0	441.0106771	0	266.5356558	9.667340276	0	296.8104049	427.679899	4146.271935	1381.622473	0	0	1014.76016	3523.061716	3598.807484	0	0	0	1322.450032	37.60701996	0	0	0	340.927387	0	160.3436747	0	0	0											3400	"$300/admit $900max; PBP 1a, 1b"		$75 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$150; PBP 9a, 9b"	$20-$75; PBP 8a	$0-$75; PBP 8b			"$0-$40; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$10; PBP 7a, 14c-j"	"$0-$40; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$40; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	10% $300qtr max; PBP 15			"$0; PBP 16a, 16b"	"$0-$40; PBP 17a, 17b"		"$0-$40; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											300	0	75	0	100	0.15	0	50	150	15	25	0	0	40	10	40	0	0	0	40	0.042	0	0	0	40	0	40	0	0	0											NO	284.5188006	0	71.12970015	0	100	0.135369596	0	47.4198001	142.2594003	14.22594003	23.70990005	0	0	37.93584008	9.48396002	37.93584008	0	0	0	37.93584008	0.039832632	0	0	0	40	0	40	0	0	0												5.2598	0	2.614079768	0	2.221130465	1.308663947	0	1.172890839	5.070123829	4.915384658	2.729844228	0	0	3.207981595	2.784381372	11.3769821	0	0	0	4.180687745	1.49798659	0	0	0	1.136424623	0	0.534478916	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0108	0	2.579638888	5.2598	0	2.614079768	0	2.221130465	1.308663947	0	1.172890839	5.070123829	4.915384658	2.729844228	0	0	3.207981595	2.784381372	11.3769821	0	0	0	4.180687745	1.49798659	0	0	0	1.136424623	0	0.534478916	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0108	NO																																																																																		0			5.2598	0	2.614079768	0	2.221130465	1.308663947	0	1.172890839	5.070123829	4.915384658	2.729844228	0	0	3.207981595	2.784381372	11.3769821	0	0	0	4.180687745	1.49798659	0	0	0	1.136424623	0	0.534478916	0	0	0	0	0	0	0	0	0	0	0	0	0	50.0108
H3957_805_0	2010	3	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	261.6400571	0	37.73354755	0	9.199984685	21.01713714	0	12.47446419	46.28219528	30.06920698	58.25524603	0	0	24.64658881	27.63285504	57.6684881	0	0	0	119.0020327	75.83954544	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.085647085	0	0.176491508	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.085647085	0	0.176491508	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												22.4087	0	6.659650726	0	2.143596432	4.896992953	0	2.906550155	10.7837515	7.006125226	13.57347233	0	0	5.742655192	6.438455224	13.43675773	0	0	0	27.72747362	17.67061409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.3948		0	22.4087	0	6.659650726	0	2.143596432	4.896992953	0	2.906550155	10.7837515	7.006125226	13.57347233	0	0	5.742655192	6.438455224	13.43675773	0	0	0	27.72747362	17.67061409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.3948	NO																																																																																		0			22.4087	0	6.659650726	0	2.143596432	4.896992953	0	2.906550155	10.7837515	7.006125226	13.57347233	0	0	5.742655192	6.438455224	13.43675773	0	0	0	27.72747362	17.67061409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.3948
H3957_806_0	2010	3	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	314.0158667	0	65.80207916	0	15.0654012	29.08069386	0	13.5975276	41.29086785	29.36178022	54.04282221	0	0	25.5595494	28.35636681	59.70233445	0	0	0	124.2189708	72.41736475	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.086900904	0	0.174388772	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.086900904	0	0.174388772	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												27.2883	0	11.47514377	0	3.510238481	6.77580167	0	3.168223932	9.620772208	6.841294791	12.59197758	0	0	5.955375011	6.607033468	13.91064393	0	0	0	28.94302021	16.87324599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.561		0	27.2883	0	11.47514377	0	3.510238481	6.77580167	0	3.168223932	9.620772208	6.841294791	12.59197758	0	0	5.955375011	6.607033468	13.91064393	0	0	0	28.94302021	16.87324599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.561	NO																																																																																		0			27.2883	0	11.47514377	0	3.510238481	6.77580167	0	3.168223932	9.620772208	6.841294791	12.59197758	0	0	5.955375011	6.607033468	13.91064393	0	0	0	28.94302021	16.87324599	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.561
H3957_808_0	2010	3	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	303.7561312	0	58.59808982	0	13.91100555	27.67538486	0	13.60922669	42.24472973	30.06841874	54.54643567	0	0	25.29889822	28.41378065	60.28684302	0	0	0	123.5779901	73.17763282	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.086898566	0	0.174374885	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.086898566	0	0.174374885	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												26.396	0	10.21803519	0	3.241264292	6.448364673	0	3.170949819	9.843022027	7.005941567	12.70931951	0	0	5.894643285	6.620410891	14.04683442	0	0	0	28.79367169	17.05038845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.4388		0	26.396	0	10.21803519	0	3.241264292	6.448364673	0	3.170949819	9.843022027	7.005941567	12.70931951	0	0	5.894643285	6.620410891	14.04683442	0	0	0	28.79367169	17.05038845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.4388	NO																																																																																		0			26.396	0	10.21803519	0	3.241264292	6.448364673	0	3.170949819	9.843022027	7.005941567	12.70931951	0	0	5.894643285	6.620410891	14.04683442	0	0	0	28.79367169	17.05038845	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.4388
H3959_001_0	2010	7	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	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	NO	2404.618672	124.066568	1701.252688	0	345.723564	13.21169956	8.704113957	150.3080967	857.439006	2668.474877	37.02858973	0	0	434.2978624	8070.899275	32146.92291	182.5880741	2452.773441	59.27437596	2153.966581	58.53575171	0	0	0	360.1694358	0	0	0	0	751.1411301												1a $170 days 1-8	1b $170 days 1-8	2 $75 days 6-100	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $175, 9b $175"	8a $10	8b $90 15B Outpatient Chemotherapy Drugs 15%	5 $0	12 $0	4b $50	7a $12	"16b $25, 17a $25, 18a $25, 7b $35, 7d $35, 7f $35"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	8b $90 15B Physician Chemotherapy Drugs 15%	7g $35	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%		10b $0	16a $25 deductible	17a $25	17b 1 pair of glasses after cataract surgery - Medicare Covered Only	18a $25	"18b $750 Allowance every 3 yrs ($500 for 1st aid, $250 for 2nd aid)"	14a $0	"14c $12, 7f $35"											136.5650248	107.3340617	57.38287228	0	47.12282893	0.198861035	0.2	45.79184192	173.8794608	3.553898377	0.143285286	0	0	2.433248202	6.657185938	7.281103249	25.41761492	5.220204702	0.299751898	0.864745766	0.207966834	0	0	0	12.65790849	0	0	0	0	3.443654913											NO	136.5650248	107.3340617	57.38287228	0	47.12282893	0.198861035	0.2	45.79184192	173.8794608	3.553898377	0.143285286	0	0	2.433248202	6.657185938	7.281103249	25.41761492	5.220204702	0.299751898	0.864745766	0.207966834	0	0	0	12.65790849	0	0	0	0	3.443654913												27.3656	1.109714055	8.135230477	0	1.357622697	2.627292251	1.740822791	0.573573717	12.42425267	0.790290711	5.305652084	0	0	0.088062874	4.47745643	19.50542207	0.386746113	1.066998288	17.76760671	0.155219457	12.17349494	0	0	0	0.37991598	0	0	0	0	0.215555904	0	0	0	0	0	0	0	0	0	0	117.6465	0	0	27.3656	1.109714055	8.135230477	0	1.357622697	2.627292251	1.740822791	0.573573717	12.42425267	0.790290711	5.305652084	0	0	0.088062874	4.47745643	19.50542207	0.386746113	1.066998288	17.76760671	0.155219457	12.17349494	0	0	0	0.37991598	0	0	0	0	0.215555904	0	0	0	0	0	0	0	0	0	0	117.6465	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.3656	1.109714055	8.135230477	0	1.357622697	2.627292251	1.740822791	0.573573717	12.42425267	0.790290711	5.305652084	0	0	0.088062874	4.47745643	19.50542207	0.386746113	1.066998288	17.76760671	0.155219457	12.17349494	0	0	0	0.37991598	0	0	0	0	0.215555904	0	0	0	0	0	0	0	0	0	0	117.6465
H3959_002_0	2010	8	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	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	NO	2166.735442	59.96384021	1200.444761	0	301.5745969	13.45037111	7.388226351	171.3310567	843.2946955	3009.483092	27.10411435	0	0	460.0506346	7098.034981	29392.78123	134.027314	1952.484033	56.06226414	1764.020253	48.62436262	0	0	0	312.3691384	0	211.7188946	0	0	456.6622624												1a $170 days 1-8	1b $170 days 1-8	2 $75 days 6-100	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $150, 9b $150"	8a $10	8b $90 15B Outpatient Chemotherapy Drugs 15%	5 $0	12 $0	4b $50	7a $10	"16b $30, 17a $25, 18a $30, 7b $35, 7d $35, 7f $35"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	8b $90 15B Physician Chemotherapy Drugs 15%	7g $35	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%		10b $0	16a $25 deductible	17a $25	17b 1 pair of glasses after cataract surgery - Medicare Covered Only	18a $30	"18b $750 Allowance every 3 yrs ($500 for 1st aid, $250 for 2nd aid)"	14a $0	"14c $10, 7f $35"											135.6949124	107.5103891	57.34735291	0	48.2994405	0.198923971	0.2	45.79184192	149.3365521	3.553898377	0.208301827	0	0	0.201444114	6.326709945	7.065942835	25.92769377	5.870982075	0.286229571	0.646882659	0.209045944	0	0	0	10.32403984	0	29.88684017	0	0	2.650190547											NO	135.6949124	107.5103891	57.34735291	0	48.2994405	0.198923971	0.2	45.79184192	149.3365521	3.553898377	0.208301827	0	0	0.201444114	6.326709945	7.065942835	25.92769377	5.870982075	0.286229571	0.646882659	0.209045944	0	0	0	10.32403984	0	29.88684017	0	0	2.650190547												24.5012	0.537227983	5.736860782	0	1.213823691	2.675601233	1.47764527	0.653797055	10.49456018	0.89128309	5.645836534	0	0	0.007722874	3.742267376	17.30730933	0.28958493	0.955249897	16.04667779	0.095092843	10.16472578	0	0	0	0.268742619	0	0.52730073	0	0	0.100853501	0	0	0	0	0	0	0	0	0	0	103.3334	0	0	24.5012	0.537227983	5.736860782	0	1.213823691	2.675601233	1.47764527	0.653797055	10.49456018	0.89128309	5.645836534	0	0	0.007722874	3.742267376	17.30730933	0.28958493	0.955249897	16.04667779	0.095092843	10.16472578	0	0	0	0.268742619	0	0.52730073	0	0	0.100853501	0	0	0	0	0	0	0	0	0	0	103.3334	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.5012	0.537227983	5.736860782	0	1.213823691	2.675601233	1.47764527	0.653797055	10.49456018	0.89128309	5.645836534	0	0	0.007722874	3.742267376	17.30730933	0.28958493	0.955249897	16.04667779	0.095092843	10.16472578	0	0	0	0.268742619	0	0.52730073	0	0	0.100853501	0	0	0	0	0	0	0	0	0	0	103.3334
H3959_010_0	2010	10	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	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	NO	1587.614412	68.08714228	1242.547866	0	243.8865027	8.935893226	7.201587833	130.6317975	653.3721408	2201.608986	30.01013572	0	0	322.0040405	5721.704667	24632.84917	253.9174749	1424.610939	35.73901001	1597.437202	42.09287625	0	0	0	146.8107635	0	0	0	0	562.9391328												1a $185 days 1-7	1b $185 days 1-7	2 $85 days 11-100	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $175, 9b $175"	8a $10	8b $105 ($25 x-ray) 15B Outpatient Chemotherapy Drugs 15%	5 $0	12 $0	4b $50 3 $0 9d $15	7a $15	"16b $25, 17a $25, 18a $25, 7b $40, 7d $40, 7f $40"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	8b $105 ($25 x-ray) 15B Physician Chemotherapy Drugs 15%	7g $40	"11c 20%, 15A 20% coinsurance, 15B Physician Chemotherapy Drugs 15%"		10b $0		17a $25	17b 1 pair of glasses after cataract surgery.	18a $25		14a $0	"14c $15, 7f $40"											139.1965645	108.2579676	49.00660291	0	47.22594174	0.198463032	0.2	50	173.9771372	5.152060606	0.153968377	0	0	4.659818471	8.190254696	7.091933102	28.72538643	20.05999106	0.386319393	1.555344127	0.210102878	0	0	0	24.79914243	0	0	0	0	5.083901406											NO	139.1965645	108.2579676	49.00660291	0	47.22594174	0.198463032	0.2	50	173.9771372	5.152060606	0.153968377	0	0	4.659818471	8.190254696	7.091933102	28.72538643	20.05999106	0.386319393	1.555344127	0.210102878	0	0	0	24.79914243	0	0	0	0	5.083901406												18.4159	0.61424797	5.074420823	0	0.959814147	1.773444462	1.440317567	0.544299156	9.472651214	0.945235244	4.620611898	0	0	0.125040031	3.905184877	14.55787653	0.607823132	2.381473558	13.80667266	0.207047048	8.843834439	0	0	0	0.30339842	0	0	0	0	0.238493921	0	0	0	0	0	0	0	0	0	0	88.8378	0	0	18.4159	0.61424797	5.074420823	0	0.959814147	1.773444462	1.440317567	0.544299156	9.472651214	0.945235244	4.620611898	0	0	0.125040031	3.905184877	14.55787653	0.607823132	2.381473558	13.80667266	0.207047048	8.843834439	0	0	0	0.30339842	0	0	0	0	0.238493921	0	0	0	0	0	0	0	0	0	0	88.8378	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.4159	0.61424797	5.074420823	0	0.959814147	1.773444462	1.440317567	0.544299156	9.472651214	0.945235244	4.620611898	0	0	0.125040031	3.905184877	14.55787653	0.607823132	2.381473558	13.80667266	0.207047048	8.843834439	0	0	0	0.30339842	0	0	0	0	0.238493921	0	0	0	0	0	0	0	0	0	0	88.8378
H3959_011_0	2010	8	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	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	NO	1829.285589	30.24428559	947.7515453	0	259.2803738	8.525965164	5.107939665	123.0298675	720.9580692	2909.772581	20.0041943	0	0	403.8939133	5580.326773	24930.70252	148.2320103	959.4732824	42.13298122	1390.281771	23.80262106	0	0	0	116.3469905	0	0	0	0	478.7731342												1a $150 days 1-7	1b $150 days 1-7	2 $70 days 6-100	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $150, 9b $150"	8a $10	8b $105 15B Outpatient Chemotherapy Drugs 15%	5 $0	12 $0	4b $50	7a $20	"16b $30, 17a $25, 18a $30, 7b $40, 7d $40, 7f $40"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	8b $105 15B Physician Chemotherapy Drugs 15%	7g $40	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%		10b $0		17a $25	17b 1 pair of glasses after cataract surgery	18a $30		14a $0	"14c $20, 7f $40"											116.3917097	87.83528523	53.56306922	0	47.87925979	0.198460543	0.2	50	149.2553191	5.152060606	0.24924965	0	0	0.396731756	12.29887233	6.354583166	29.45206287	18.72802635	0.335140697	1.63514491	0.21940176	0	0	0	24.84848485	0	0	0	0	5.226789495											NO	116.3917097	87.83528523	53.56306922	0	47.87925979	0.198460543	0.2	50	149.2553191	5.152060606	0.24924965	0	0	0.396731756	12.29887233	6.354583166	29.45206287	18.72802635	0.335140697	1.63514491	0.21940176	0	0	0	24.84848485	0	0	0	0	5.226789495												17.7428	0.221376288	4.230373468	0	1.034512698	1.692067676	1.021587933	0.512624448	8.96723556	1.249277057	4.986038435	0	0	0.013353128	5.719310547	13.20201855	0.363811541	1.497420076	14.12047671	0.18944268	5.222336964	0	0	0	0.240920536	0	0	0	0	0.208537199	0	0	0	0	0	0	0	0	0	0	82.4355	0	0	17.7428	0.221376288	4.230373468	0	1.034512698	1.692067676	1.021587933	0.512624448	8.96723556	1.249277057	4.986038435	0	0	0.013353128	5.719310547	13.20201855	0.363811541	1.497420076	14.12047671	0.18944268	5.222336964	0	0	0	0.240920536	0	0	0	0	0.208537199	0	0	0	0	0	0	0	0	0	0	82.4355	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.7428	0.221376288	4.230373468	0	1.034512698	1.692067676	1.021587933	0.512624448	8.96723556	1.249277057	4.986038435	0	0	0.013353128	5.719310547	13.20201855	0.363811541	1.497420076	14.12047671	0.18944268	5.222336964	0	0	0	0.240920536	0	0	0	0	0.208537199	0	0	0	0	0	0	0	0	0	0	82.4355
H3959_803_0	2010	6	N/A																															COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	324.7538244	6.734211823	54.33480967	0	13.55945645	14.92413153	7.302849301	4.101741963	57.13099005	10.29249874	37.99114664	4.0035838	0.246588402	8.294139301	44.92901374	143.0453403	1.92352966	16.75939195	63.343876	8.958862476	50.25737207	0	0	0	0	0	0	0	0	0												FFS 8.3%	FFS 8.3%	FFS 17.6%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%											0.083284741	0.083284741	0.176249173	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23299646	0.232671895	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.083284741	0.083284741	0.176249173	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23299646	0.232671895	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												27.047	0.560857087	9.576465246	0	3.159353352	3.477322648	1.701563887	0.955705877	13.31152068	2.398152207	8.851937166	0.932835025	0.057455098	1.932534457	10.4684602	33.32905797	0.447551291	3.904938325	14.75912311	2.087414957	11.70996769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6693	0	0	27.047	0.560857087	9.576465246	0	3.159353352	3.477322648	1.701563887	0.955705877	13.31152068	2.398152207	8.851937166	0.932835025	0.057455098	1.932534457	10.4684602	33.32905797	0.447551291	3.904938325	14.75912311	2.087414957	11.70996769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6693	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.047	0.560857087	9.576465246	0	3.159353352	3.477322648	1.701563887	0.955705877	13.31152068	2.398152207	8.851937166	0.932835025	0.057455098	1.932534457	10.4684602	33.32905797	0.447551291	3.904938325	14.75912311	2.087414957	11.70996769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.6693
H3959_804_0	2010	6	N/A																															COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	324.5571836	6.819220117	53.14763822	0	13.51581083	14.91310611	7.232209018	4.171535332	57.93380523	10.04916368	39.12151332	4.23653099	0.269283077	8.599520955	45.15959928	144.5167872	1.990491098	16.76532326	64.24777048	9.060245137	49.27528451	0	0	0	0	0	0	0	0	0												FFS 8.7%	FFS 8.7%	FFS 17.3%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%											0.087498772	0.087498772	0.17288646	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.232996151	0.232653079	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.087498772	0.087498772	0.17288646	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.232996151	0.232653079	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												28.3984	0.596673384	9.188507003	0	3.149183923	3.474753724	1.685104701	0.971967732	13.49857662	2.341455138	9.115312605	0.987111721	0.062742957	2.003688382	10.52218663	33.67185518	0.463093883	3.90632032	14.96973052	2.111037117	11.48114129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.5988	0	0	28.3984	0.596673384	9.188507003	0	3.149183923	3.474753724	1.685104701	0.971967732	13.49857662	2.341455138	9.115312605	0.987111721	0.062742957	2.003688382	10.52218663	33.67185518	0.463093883	3.90632032	14.96973052	2.111037117	11.48114129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.5988	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.3984	0.596673384	9.188507003	0	3.149183923	3.474753724	1.685104701	0.971967732	13.49857662	2.341455138	9.115312605	0.987111721	0.062742957	2.003688382	10.52218663	33.67185518	0.463093883	3.90632032	14.96973052	2.111037117	11.48114129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.5988
H3959_806_0	2010	6	N/A																															COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	324.7496318	6.734124885	54.33410821	0	13.5592814	14.92393887	7.302755022	4.10168901	57.1302525	10.29236587	37.99065617	4.003532114	0.246585218	8.294032224	44.92843371	143.0434936	1.923504828	16.75917559	63.34305824	8.958746818	52.44282628	0	0	0	0	0	0	0	0	0												FFS 8.8%	FFS 8.8%	FFS 17.3%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%											0.087874157	0.087874157	0.172567074	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23299646	0.232671895	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.087874157	0.087874157	0.172567074	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23299646	0.232671895	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												28.5371	0.591755548	9.376278075	0	3.159312565	3.477277756	1.70154192	0.955693539	13.31134883	2.398121247	8.851822889	0.932822983	0.057454356	1.932509508	10.46832505	33.3286277	0.447545513	3.904887913	14.75893257	2.087388009	12.21917852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.4979	0	0	28.5371	0.591755548	9.376278075	0	3.159312565	3.477277756	1.70154192	0.955693539	13.31134883	2.398121247	8.851822889	0.932822983	0.057454356	1.932509508	10.46832505	33.3286277	0.447545513	3.904887913	14.75893257	2.087388009	12.21917852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.4979	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.5371	0.591755548	9.376278075	0	3.159312565	3.477277756	1.70154192	0.955693539	13.31134883	2.398121247	8.851822889	0.932822983	0.057454356	1.932509508	10.46832505	33.3286277	0.447545513	3.904887913	14.75893257	2.087388009	12.21917852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.4979
H3962_001_0	2010	6	N/A																															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	P	V	P	O	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	YES	423.274853	33.12805382	1211.603783	1055.389458	408.6896581	21.57538548	0	298.1292269	628.998544	2288.507122	1029.516641	0	3.970482269	1612.606148	4470.747484	3709.577696	212.7691995	1072.432538	3753.034925	18858.8238	7.463224075	341.6980599	0	350	578.945423	24.07250865	0.163339719	16.54585321	0	0											1500	1a - $0 copay/admit	1b - $0 copay/admit	2 - $0 copay Days 1-10/ $25 copay Days 11-100	6 - $0 copay	10a - $50 copay/trip	"11a - 0% coinsurance for diabetic supplies, 10% coinsurance for all other"	"11b,11c - 0% coinsurance for diabetic supplies, 10% coinsurance for all other"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $15 Urgent Care copay	"9a,9b - $35 copay"	8a - $0 copay	8b - $50 copay (High Tech Imaging Only)	5 - $0 copay	12 - $0 copay	"3 - $15 CORF copay; 9c - $0 SA Ind/Grp copay initial visit, $25 SA Ind/Grp Session copay thereafter; 9d - $10 Cardiac Rehab copay"	7a - $10 OV copay	7d - $15 Specialist OV copay (excluding MH and Radiology); 18a - $15 Hearing Exam copay	"7e,7h - $15 MH/Psych Ind/Grp Session copay"	"7c,7i -  $15 OT/PT/ST copay"	7d - $15 OV copay (Radiology only); 14h - $0 Mammography Screening copay	"7b,7f,7g - $15 Chiro/Pod/Other OV copay; 14b - $0 Immunization copay; 14c - $10 Physical Exam copay; 14d - $0 Pap Smear copay, $0 Pelvic Exam copay; 14e - $0 Prostate Screening copay; 14f - $0 Colorectal Screening copay; 14g - $0 Bone Mass Meas copay; 14i - $0 Diabetes Monitoring copay; 14j - $0 Nutrition Therapy copay"	15 - $0 Copay	13a - $0 copay; 17a - $15 Eye Exam copay	0	"16a,16b - $10 Preventive OV copay"	17a - $20 Routine Eye Exam copay	17b - $40 allowance every 2 years	18a - $15 Routine Hearing Exam/Fitting copay	18b - $400 allowance every 3 years	0	0											0	0	25	0	50	0.082650647	0	49.3	35	0	9.93485342	0	0	7.844679308	10	12.48736407	15	15	0	0.414582334	0	12.34266392	0	10	16.37271508	0	15	0	0	0											NO	0	0	21.94659053	0	43.89318105	0.073	0	43.27867652	30.72522674	0	8.721446399	0	0	6.886558583	8.778636211	10.96220264	14.00192476	13.16795432	0	0.363946749	0	10.83517564	0	8.778636211	14.37301095	0	13.16795432	0	0	0												0	0	2.215881008	0	1.494890763	1.57500314	0	1.075219864	1.61051024	0	0.748239516	0	0	0.925442226	3.270588813	3.388761867	0.24826486	1.176811889	0	0.571967301	0	0.308529875	0	0.256043556	0.693432409	0	0.000179237	0	0	0	0	0	0	0	0	0	0	0	0	0	19.5598	0	2.72	0	0	2.215881008	0	1.494890763	1.57500314	0	1.075219864	1.61051024	0	0.748239516	0	0	0.925442226	3.270588813	3.388761867	0.24826486	1.176811889	0	0.571967301	0	0.308529875	0	0.256043556	0.693432409	0	0.000179237	0	0	0	0	0	0	0	0	0	0	0	0	0	19.5598	NO	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	2.215881008	0	1.494890763	1.57500314	0	1.075219864	1.61051024	0	0.748239516	0	0	0.925442226	3.270588813	3.388761867	0.24826486	1.176811889	0	0.571967301	0	0.308529875	0	0.256043556	0.693432409	0	0.000179237	0	0	0	0	0	0	0	0	0	0	0	0	0	19.5598
H3962_004_0	2010	6	N/A																															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	P	V	P	O	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	YES	156.9001676	25.23198048	560.2630136	541.88257	208.5075709	12.90219771	0	243.4530551	404.6998984	1762.513044	899.6069675	0	2.750346473	1141.595988	4128.936288	2627.108318	196.2358825	890.9645309	2753.300132	13867.95567	5.802630046	302.8273479	0	350	568.3741279	20.96346032	4.149777843	11.46204548	0	0											2500	1a - $0 copay/admit	"1b - $150 copay/admit, $450 max"	2 - $0 copay Days 1-10/ $25 copay Days 11-100	6 - $0 copay	10a - $75 copay/trip	"11a - 0% coinsurance for diabetic supplies, 10% coinsurance for all other"	"11b,11c - 0% coinsurance for diabetic supplies, 10% coinsurance for all other"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $25 Urgent Care copay	"9a,9b - $100 copay"	8a - $0 copay	8b - $100 copay (High Tech Imaging Only)	5 - $0 copay	12 - $0 copay	"3 - $25 CORF copay; 9c - $0 SA Ind/Grp copay initial visit, $25 SA Ind/Grp Session copay thereafter; 9d - $25 Cardiac Rehab copay"	7a - $15 OV copay	7d - $25 Specialist OV copay (excluding MH and Radiology); 18a - $25 Hearing Exam copay	"7e,7h - $15 MH/Psych Ind/Grp Session copay"	"7c,7i -  $25 OT/PT/ST copay"	7d - $25 OV copay (Radiology only); 14h - $0 Mammography Screening copay	"7b,7f,7g - $25 Chiro/Pod/Other OV copay; 14b - $0 Immunization copay; 14c - $15 Physical Exam copay; 14d - $0 Pap Smear copay, $0 Pelvic Exam copay; 14e - $0 Prostate Screening copay; 14f - $0 Colorectal Screening copay; 14g - $0 Bone Mass Meas copay; 14i - $0 Diabetes Monitoring copay; 14j - $0 Nutrition Therapy copay"	15 - $0 Copay	13a - $0 copay; 17a - $25 Eye Exam copay	0	"16a,16b - $10 Preventive OV copay"	17a - $20 Routine Eye Exam copay	17b - $40 allowance every 2 years	18a - $15 Routine Hearing Exam/Fitting copay	18b - $400 allowance every 3 years	0	0											0	150	25	0	75	0.083230054	0	49.5	100	0	19.86970684	0	0	12.1112226	15	20.11389389	15	25	0	0.734735316	0	21.66782034	0	10	20	0	15	0	0	0											NO	0	140.8249673	23.47082789	0	70.41248366	0.078	0	46.47223922	93.88331155	0	18.65433878	0	0	11.37041685	14.08249673	18.88358966	14.97438819	23.47082789	0	0.689793846	0	20.34246728	0	9.388331155	20	0	14.08249673	0	0	0												0	0.296107736	1.09581973	0	1.223461328	1.006371422	0	0.942817385	3.166213887	0	1.398464428	0	0	1.081701855	4.845477648	4.134102956	0.244876024	1.742639597	0	0.797169206	0	0.513354618	0	0.273826325	0.947290213	0	0.004869936	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7146	0	1.56	0	0.296107736	1.09581973	0	1.223461328	1.006371422	0	0.942817385	3.166213887	0	1.398464428	0	0	1.081701855	4.845477648	4.134102956	0.244876024	1.742639597	0	0.797169206	0	0.513354618	0	0.273826325	0.947290213	0	0.004869936	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7146	NO	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.296107736	1.09581973	0	1.223461328	1.006371422	0	0.942817385	3.166213887	0	1.398464428	0	0	1.081701855	4.845477648	4.134102956	0.244876024	1.742639597	0	0.797169206	0	0.513354618	0	0.273826325	0.947290213	0	0.004869936	0	0	0	0	0	0	0	0	0	0	0	0	0	23.7146
H3962_007_0	2010	6	N/A																															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	P	V	P	O	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	YES	48.74363578	22.80357497	711.7141031	668.4089082	277.5733753	13.61287238	0	219.2764826	410.4980049	1502.020584	766.7039183	0	2.365652351	939.0228507	3683.114394	2388.361951	175.1483306	605.1687619	2565.519372	13414.69335	4.98506922	260.8109568	0	0	72.26614992	23.33899902	1.53041348	12.60662581	0	0											3350	"1a - $500 copay/admit, $1,000 max"	"1b - $500 copay/admit, $1,000 max"	2 - $0 copay Days 1-10/ $50 copay Days 11-100	6 - $0 copay	10a - $75 copay/trip	"11a - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	"11b,11c - 0% coinsurance for diabetic supplies, 20% coinsurance for all other"	4a - $50 ER copay (WIA) World Wide Coverage; 4b - $40 Urgent Care copay	"9a,9b - $150 copay"	8a - $0 copay	8b - $150 copay (High Tech Imaging Only)	5 - $0 copay	12 - $0 copay	3 - $40 CORF copay; 9c - $40 SA Ind/Grp Session copay; 9d - $40 Cardiac Rehab copay	7a - $20 OV copay	7d - $40 Specialist OV copay (excluding MH and Radiology); 18a - $40 Hearing Exam copay	"7e,7h - $40 MH/Psych Ind/Grp Session copay"	"7c,7i -  $40 OT/PT/ST copay"	7d - $40 OV copay (Radiology only); 14h - $0 Mammography Screening copay	"7b,7f,7g - $40 Chiro/Pod/Other OV copay; 14b - $0 Immunization copay; 14c - $20 Physical Exam copay; 14d - $0 Pap Smear copay, $10 Pelvic Exam copay; 14e - $10 Prostate Screening copay; 14f - $10 Colorectal Screening copay; 14g - $10 Bone Mass Meas copay; 14i - $0 Diabetes Monitoring copay; 14j - $0 Nutrition Therapy copay"	15 - $0 Copay	13a - $0 copay; 17a - $40 Eye Exam copay	0	0	0	0	18a - $15 Routine Hearing Exam/Fitting copay	18b - $400 allowance every 3 years	0	0											500	500	50	0	75	0.164992903	0	49.8	150	0	29.80456026	0	0	20.62118225	20	30.12494017	40	40	0	0.975757654	0	33.65060938	0	0	0	0	15	0	0	0											NO	448.1347468	448.1347468	44.81347468	0	67.22021202	0.148	0	44.63422078	134.440424	0	26.71291813	0	0	18.48213657	17.92538987	27.00006487	35.85077974	35.85077974	0	0.874541818	0	30.16001462	0	0	0	0	13.4440424	0	0	0												1.8203	0.851589524	2.657865162	0	1.554878428	2.014705112	0	0.815602911	4.598960487	0	1.706741583	0	0	1.446262381	5.501771787	5.3738273	0.523267018	1.807980999	0	0.977642526	0	0.655505189	0	0	0	0	0.001714579	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3086	0	4.67	1.8203	0.851589524	2.657865162	0	1.554878428	2.014705112	0	0.815602911	4.598960487	0	1.706741583	0	0	1.446262381	5.501771787	5.3738273	0.523267018	1.807980999	0	0.977642526	0	0.655505189	0	0	0	0	0.001714579	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3086	NO	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.8203	0.851589524	2.657865162	0	1.554878428	2.014705112	0	0.815602911	4.598960487	0	1.706741583	0	0	1.446262381	5.501771787	5.3738273	0.523267018	1.807980999	0	0.977642526	0	0.655505189	0	0	0	0	0.001714579	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3086
H3962_801_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	222.1641159	3.36047166	23.63467344	5.364448014	6.86708501	19.04711387	0	15.41474811	48.52718675	11.4966072	34.53201384	0	0.219248759	37.52123692	21.95714304	34.49914437	2.301532597	12.00431565	28.98456799	136.5091164	5.654566619	6.328498218	0	0	0	0	0	0	0	0												Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing																			0.075507133	0.075507133	0.173762621	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075507133	0.075507133	0.173762621	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.775	0.253739581	4.106822793	0	1.600030807	4.437977531	0	3.591636309	11.30683451	2.678709478	8.045959224	0	0.051084961	8.742448202	5.116014328	8.038300639	0.536257095	2.797005547	6.753404343	31.80662412	1.317514022	1.474540085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.4299	0	0	16.775	0.253739581	4.106822793	0	1.600030807	4.437977531	0	3.591636309	11.30683451	2.678709478	8.045959224	0	0.051084961	8.742448202	5.116014328	8.038300639	0.536257095	2.797005547	6.753404343	31.80662412	1.317514022	1.474540085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.4299	NO	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.775	0.253739581	4.106822793	0	1.600030807	4.437977531	0	3.591636309	11.30683451	2.678709478	8.045959224	0	0.051084961	8.742448202	5.116014328	8.038300639	0.536257095	2.797005547	6.753404343	31.80662412	1.317514022	1.474540085	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.4299
H3962_802_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	233.6821158	3.349855251	23.17835373	4.954208108	8.085711023	17.14051212	0	20.13611543	53.11400067	9.198186168	38.82032662	0	0.218829469	44.74132698	22.36565866	35.16962397	2.29313729	11.72792089	30.83203718	134.2390999	1.533518783	5.863726871	0	0	0	0	0	0	0	0												Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing																			0.074643051	0.074643051	0.171589202	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074643051	0.074643051	0.171589202	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.4427	0.250043415	3.977155217	0	1.883970668	3.993739324	0	4.691714894	12.37556216	2.143177377	9.045136103	0	0.050987266	10.42472919	5.211198467	8.194522384	0.534300989	2.732605568	7.183864663	31.27771028	0.357309876	1.366248361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.1367	0	0	17.4427	0.250043415	3.977155217	0	1.883970668	3.993739324	0	4.691714894	12.37556216	2.143177377	9.045136103	0	0.050987266	10.42472919	5.211198467	8.194522384	0.534300989	2.732605568	7.183864663	31.27771028	0.357309876	1.366248361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.1367	NO	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.4427	0.250043415	3.977155217	0	1.883970668	3.993739324	0	4.691714894	12.37556216	2.143177377	9.045136103	0	0.050987266	10.42472919	5.211198467	8.194522384	0.534300989	2.732605568	7.183864663	31.27771028	0.357309876	1.366248361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.1367
H3962_803_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	225.5577616	3.348986317	23.57717065	5.274942088	7.187243634	18.61712526	0	16.62851171	49.78622738	10.9509618	35.68332141	0	0.219666136	39.41057264	22.06516033	34.7484227	2.29250892	11.96398405	29.51415091	136.0627108	4.640621052	6.227692087	0	0	0	0	0	0	0	0												Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing	Consistent with Medicare Cost Sharing																			0.078335319	0.078335319	0.176709857	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078335319	0.078335319	0.176709857	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.6691	0.262343911	4.166318461	0	1.674627767	4.337790186	0	3.874443228	11.60019098	2.5515741	8.314213888	0	0.05118221	9.182663424	5.141182356	8.096382489	0.534154578	2.787608284	6.876797162	31.70261161	1.081264705	1.451052256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3555	0	0	17.6691	0.262343911	4.166318461	0	1.674627767	4.337790186	0	3.874443228	11.60019098	2.5515741	8.314213888	0	0.05118221	9.182663424	5.141182356	8.096382489	0.534154578	2.787608284	6.876797162	31.70261161	1.081264705	1.451052256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3555	NO	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.6691	0.262343911	4.166318461	0	1.674627767	4.337790186	0	3.874443228	11.60019098	2.5515741	8.314213888	0	0.05118221	9.182663424	5.141182356	8.096382489	0.534154578	2.787608284	6.876797162	31.70261161	1.081264705	1.451052256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3555
H3964_001_0	2010	1	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	P	O	coin	V	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1861.521526	137.2226928	830.8290675	20.6828846	193.1742951	8.221066252	3.310024302	303.3738991	338.2907405	0.892066373	1128.493122	0	0.589845479	994.5487101	0.650023499	4592.812688	540.5237527	232.2388115	18.83230171	80.80531972	22.19863959	0	0	0	0	0	0	0	0	0												1a:  Acute - $200/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-7/8-190/1b:  Additional Days - $0/day for 191-999	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services - $250/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $150/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit/9a:  Outpatient Hospital Services - $250/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $40/visit/14e:  Prostate Cancer Screening - $0/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/ Visits/7f:  Podiatry Services - $40/visit/None Visits/17a:  Vision Exams - $40/visit/14h:  Mammography - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit/ /18a:  Hearing Exams - $40/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service	10b:  Transportation - $0/trip	16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14g:   Additional Prostate Screening - $0/visit/14g:   Additional Mammography Screening - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											200	150	85	0	100	0.2	0.2	43.42237969	237.584696	0	55.65234717	0	0.2	57.498213	40	39.78713324	20	10	0	39.60922941	0.2	0	0	0	0	0	0	0	0	0											NO	200	150	85	0	100	0.2	0.2	43.42237969	237.584696	0	55.65234717	0	0.2	57.498213	40	39.78713324	20	10	0	39.60922941	0.2	0	0	0	0	0	0	0	0	0												31.0254	1.71528366	5.885039228	0	1.609785793	1.64421325	0.66200486	1.097768053	6.697725228	0	5.233607582	0	0.117969096	4.765397797	0.002166745	15.2279042	0.900872921	0.193532343	0	0.266719704	4.439727918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4851	0	0	31.0254	1.71528366	5.885039228	0	1.609785793	1.64421325	0.66200486	1.097768053	6.697725228	0	5.233607582	0	0.117969096	4.765397797	0.002166745	15.2279042	0.900872921	0.193532343	0	0.266719704	4.439727918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4851	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	31.0254	1.71528366	5.885039228	0	1.609785793	1.64421325	0.66200486	1.097768053	6.697725228	0	5.233607582	0	0.117969096	4.765397797	0.002166745	15.2279042	0.900872921	0.193532343	0	0.266719704	4.439727918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.4851
H3964_002_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	P	V	V	V	V	O	O											11.0595	0.0205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											11.08	NO	395.1829281	10.83604539	26.95093298	18.69378748	14.89034461	9.855946781	6.414735415	329.4478856	17.49782444	0.716005149	16.94911174	0	0.828052262	14.81898963	68.8943018	85.15403572	8.414989345	1.251011288	14.24516017	14.35206186	149.1169566	0.197028903	0	0	0	0	0	0	0	0												1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Additional Days - $0/day for 191-999	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - 20.0%/14e:  Prostate Cancer Screening - 20.0%/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/14h:  Mammography - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/14h:  Mammography - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14e:  Prostate Cancer Screening - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/7f:  Routine Footcare - $15/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 45.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 45.0%/7h:  Psychiatric Services - Individual - 45.0%/7h:  Psychiatric Services - Group - 45.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service		18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Home Safety - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/14a:  Home Safety - $0/service/											0	0	0	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0	0.2	0.2	0.065936177	0.199996959	0.45	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0	0.2	0.2	0.065936177	0.199996959	0.45	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0												0	0	0	0	2.978068921	1.971189356	1.282947083	1.372699524	3.499564888	0.14320103	3.389822349	0	0.165610452	2.963797925	4.542626869	17.03054816	3.786745205	0.250202258	2.849032033	2.870412372	29.82339132	0.039405781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9593	650	0	11.0595	0.020543033	0	0	2.978068921	1.971189356	1.282947083	1.372699524	3.499564888	0.14320103	3.389822349	0	0.165610452	2.963797925	4.542626869	17.03054816	3.786745205	0.250202258	2.849032033	2.870412372	29.82339132	0.039405781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0393	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	11.0595	0.020543033	0	0	2.978068921	1.971189356	1.282947083	1.372699524	3.499564888	0.14320103	3.389822349	0	0.165610452	2.963797925	4.542626869	17.03054816	3.786745205	0.250202258	2.849032033	2.870412372	29.82339132	0.039405781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0393
H3964_003_0	2010	2	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	P	O	coin	V	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1760.623609	135.2984929	645.5813181	20.73060043	199.7844766	11.01401062	4.285562388	292.1886394	397.586027	0.674133856	1375.852053	0	0.787912094	1301.454397	0.792418	5413.613624	539.7117615	417.6627066	22.57081912	95.98808411	32.53441069	0	0	0	0	0	0	0	0	0												1a:  Acute - $200/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-7/8-190/1b:  Additional Days - $0/day for 191-999	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services - $250/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $150/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - $0/day/5:  Partial Hospitalization - $0/day/7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit/9a:  Outpatient Hospital Services - $250/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $40/visit/14e:  Prostate Cancer Screening - $0/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/ Visits/7f:  Podiatry Services - $40/visit/None Visits/17a:  Vision Exams - $40/visit/14h:  Mammography - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit/ /18a:  Hearing Exams - $40/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service	10b:  Transportation - $0/trip	16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14g:   Additional Prostate Screening - $0/visit/14g:   Additional Mammography Screening - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											200	150	85	0	100	0.2	0.2	43.42228481	237.584696	0	54.06528808	0	0.2	53.69099628	40	39.48796418	20	10	0	39.53050644	0.2	0	0	0	0	0	0	0	0	0											NO	200	150	85	0	100	0.2	0.2	43.42228481	237.584696	0	54.06528808	0	0.2	53.69099628	40	39.48796418	20	10	0	39.53050644	0.2	0	0	0	0	0	0	0	0	0												29.3437	1.691231161	4.57286767	0	1.664870639	2.202802125	0.857112478	1.057291526	7.871696278	0	6.198819801	0	0.157582419	5.823031934	0.002641393	17.81438174	0.899519603	0.348052255	0	0.316204798	6.506882139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3287	0	0	29.3437	1.691231161	4.57286767	0	1.664870639	2.202802125	0.857112478	1.057291526	7.871696278	0	6.198819801	0	0.157582419	5.823031934	0.002641393	17.81438174	0.899519603	0.348052255	0	0.316204798	6.506882139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3287	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	29.3437	1.691231161	4.57286767	0	1.664870639	2.202802125	0.857112478	1.057291526	7.871696278	0	6.198819801	0	0.157582419	5.823031934	0.002641393	17.81438174	0.899519603	0.348052255	0	0.316204798	6.506882139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.3287
H4003_001_0	2010	5	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	Coin	Coin	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	V	O	O	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	0	0	0	0						0	YES	222.6627132	0	0	0	3.923181652	35.12968303	4.029461435	380.4538649	52.87577825	60.36733152	22.41769683	0	0.015093229	16.63614478	4794.914176	3901.103432	842.571696	124.89347	891.2045082	1116.91529	0	0	0	5.935589459	0	0	0	0	0	0	100	0	0	0	0						3250	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	$0 copay	0%-20% coins	0%-20% coins	0%-20% coins	$50 copay ER; $25-$50 copay Urgent Care	$25-$50 copay	$5-$10 copay	$0-$50 copay	$25-$50 copay	0%-20% coins	$25-$50 copay	$0-$10 copay	$15-$20 copay; 20% coin	$10-$15 copay	$4-$10 copay	$0-$50 copay	$0-$20 copay	$0 copay	$0 copay	$0 copay	$5-$10 copay Preventive; 0%-50% coins Comprehensive	$0 copay	$250 per year	$0 copay	$200 per 3 years	$0 copay	$0-$20 copay	$15 copay	$0 copay	Not covered	20% coin							85.25	0	0	0	0.02	0.1	0.1	49.92359778	27.5	5.5	23.59969755	0	0.02	14.31543761	1	16.74359094	10.5	4.6	6.776041307	5.5	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0						NO	85.25	0	0	0	0.02	0.1	0.1	49.92359778	27.5	5.5	23.59969755	0	0.02	14.31543761	1	16.74359094	10.5	4.6	6.776041307	5.5	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0							1.5818	0	0	0	0.078463633	3.512968303	0.402946143	1.582802144	0.121173658	0.02766836	0.044087572	0	0.000301865	0.019846141	0.399576181	5.443206674	0.737250234	0.04787583	0.503236547	0.511919508	0	0	0	1.840032732	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	16.9802		0	1.5818	0	0	0	0.078463633	3.512968303	0.402946143	1.582802144	0.121173658	0.02766836	0.044087572	0	0.000301865	0.019846141	0.399576181	5.443206674	0.737250234	0.04787583	0.503236547	0.511919508	0	0	0	1.840032732	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	16.9802	NO																																																																																		0			1.5818	0	0	0	0.078463633	3.512968303	0.402946143	1.582802144	0.121173658	0.02766836	0.044087572	0	0.000301865	0.019846141	0.399576181	5.443206674	0.737250234	0.04787583	0.503236547	0.511919508	0	0	0	1.840032732	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	16.9802
H4003_009_0	2010	6	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	O	O	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	V	O	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	0	0	0						0	YES	341.4759602	0	0	0	5.207063478	6515.959645	744.268353	506.8839821	80.99166374	95.64573919	29.5689	0	0.457080561	15.40748808	5065.612738	5060.096183	842.571696	182.8893817	1323.35577	1808.365571	0	0	0	5.935589459	0	0	0	0	0	0	0	0	0	0	0						3250	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	$0 copay	0%-20% coins	"0%-10% coins DME, $0-$10 copay Diabetic Supplies"	"20% coins Prosth, $0-$0 copay Diabetes Self-Monitoring"	$50 copay ER; $25-$50 copay Urgent Care	$25-$50 copay	$5-$10 copay	$0-$50 copay	$25-$50 copay	0%-20% coins	$25-$50 copay	$0-$10 copay	$10-$15 copay	$10-$15 copay	$4-$10 copay	$0-$50 copay	$0-$15 copay	$0 copay	$0 copay	Not covered	"$5-$10 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$200 per year	$0 copay	$200 per 3 years	$0 copay	$0-$15 copay	Not covered	$0 copay	$0 copay	Not covered							85.25	0	0	0	0.02	6.148248024	5.887627366	49.95891149	27.5	5.5	25.04457714	0	0.02	20.32064488	1	4.395496188	10.5	4.6	6.798226846	5.5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	85.25	0	0	0	0.02	6.148248024	5.887627366	49.95891149	27.5	5.5	25.04457714	0	0.02	20.32064488	1	4.395496188	10.5	4.6	6.798226846	5.5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							2.4259	0	0	0	0.10414127	3.338478001	0.36516456	2.110281	0.185605896	0.04383763	0.061711716	0	0.009141611	0.026090841	0.422134395	1.853469457	0.737250234	0.070107596	0.74970606	0.82883422	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.1719		0	2.4259	0	0	0	0.10414127	3.338478001	0.36516456	2.110281	0.185605896	0.04383763	0.061711716	0	0.009141611	0.026090841	0.422134395	1.853469457	0.737250234	0.070107596	0.74970606	0.82883422	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.1719	NO																																																																																		0			2.4259	0	0	0	0.10414127	3.338478001	0.36516456	2.110281	0.185605896	0.04383763	0.061711716	0	0.009141611	0.026090841	0.422134395	1.853469457	0.737250234	0.070107596	0.74970606	0.82883422	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.1719
H4003_015_0	2010	5	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	Coin	Coin	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	V	O	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	0	0	0						0	YES	205.1140066	0	0	0	3.201120471	36.58076067	4.038946464	385.0104582	68.00315753	76.20119285	20.99168775	0	0.031064387	24.75915256	10171.39628	3976.54856	788.8177949	174.2300662	1131.366994	1449.843894	0	0	0	5.935589459	0	0	0	0	0	0	60	0	0	0	0						3250	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	$0 copay	0%-20% coins	0%-20% coins	0%-20% coins	$50 copay ER; $25-$50 copay Urgent Care	$25-$50 copay	$5-$10 copay	$0-$50 copay	$25-$50 copay	0%-20% coins	$0-$25 copay	$0-$5 copay	$3-$12 copay	$10-$15 copay	$4-$10 copay	$0-$50 copay	$0-$12 copay	$0 copay	$0 copay	Not covered	"$5-$10 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$200 per year	$0 copay	$200 per 3 years	$0 copay	$0-$15 copay	$15 copay	$0 copay	Not covered	Not covered							85.25	0	0	0	0.02	0.1	0.1	49.95904526	27.5	5.5	25.45070925	0	0.02	11.55331657	0.5	4.229336948	10.5	4.6	6.915544629	5.5	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0						NO	85.25	0	0	0	0.02	0.1	0.1	49.95904526	27.5	5.5	25.45070925	0	0.02	11.55331657	0.5	4.229336948	10.5	4.6	6.915544629	5.5	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0							1.4572	0	0	0	0.064022409	3.658076067	0.403894646	1.602896242	0.155840569	0.034925547	0.044521112	0	0.000621288	0.023837527	0.423808178	1.401513646	0.690215571	0.066788192	0.652001578	0.664511785	0	0	0	1.840032732	0	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	13.2597		0	1.4572	0	0	0	0.064022409	3.658076067	0.403894646	1.602896242	0.155840569	0.034925547	0.044521112	0	0.000621288	0.023837527	0.423808178	1.401513646	0.690215571	0.066788192	0.652001578	0.664511785	0	0	0	1.840032732	0	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	13.2597	NO																																																																																		0			1.4572	0	0	0	0.064022409	3.658076067	0.403894646	1.602896242	0.155840569	0.034925547	0.044521112	0	0.000621288	0.023837527	0.423808178	1.401513646	0.690215571	0.066788192	0.652001578	0.664511785	0	0	0	1.840032732	0	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	13.2597
H4003_017_0	2010	4	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	Coin	Coin	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	V	O	O	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	0	0	0	0						0	YES	371.8520793	0	0	0	5.920917468	38.50434071	4.053398913	815.0280572	96.54606662	255.8870296	37.99799064	0	0.33762619	5.019534059	0	4732.965452	818.5745687	210.0664658	324.4393407	4699.6042	0	0	0	5.935589459	0	0	0	0	0	0	0	0	0	0	0						3250	"$0-$150 copay, Days 1-4"	"$0-$150 copay, Days 1-4"	"$0-$150 copay, Days 1-4"	$0 copay	0%-20% coins	0%-20% coins	0%-20% coins	$0-$50 copay	$0-$25 copay	$0-$5 copay	$0-$50 copay	$0-$25 copay	0%-20% coins	$0-$25 copay	$0 copay	$0-$12 copay	$0-$12 copay	$0-$25 copay	$0-$50 copay	$0-$25 copay	$0 copay	$0 copay	Not Covered	"$5-$10 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$200 per year	$0 copay	$200 per 3 years	$0 copay	$0 copay	Not Covered	$0 copay	Not covered	Not Covered							46.5	0	0	0	0.02	0.1	0.1	5	2.5	0.5	3.305372741	0	0.02	2.5	0	1.2	1.2	2.5	3.082830947	0.5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	46.5	0	0	0	0.02	0.1	0.1	5	2.5	0.5	3.305372741	0	0.02	2.5	0	1.2	1.2	2.5	3.082830947	0.5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							1.4409	0	0	0	0.118418349	3.850434071	0.405339891	0.339595024	0.020113764	0.01066196	0.01046646	0	0.006752524	0.001045736	0	0.473296545	0.081857457	0.043763847	0.083349303	0.195816842	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.9219		0	1.4409	0	0	0	0.118418349	3.850434071	0.405339891	0.339595024	0.020113764	0.01066196	0.01046646	0	0.006752524	0.001045736	0	0.473296545	0.081857457	0.043763847	0.083349303	0.195816842	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.9219	NO																																																																																		0			1.4409	0	0	0	0.118418349	3.850434071	0.405339891	0.339595024	0.020113764	0.01066196	0.01046646	0	0.006752524	0.001045736	0	0.473296545	0.081857457	0.043763847	0.083349303	0.195816842	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.9219
H4003_018_0	2010	3	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	Coin	Coin	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	V	O	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	0	0	0						0	YES	257.1636278	0	0	0	5.388974151	36.86930028	4.563273	420.3542612	71.40844204	95.99894096	20.44134317	0	0.011110481	27.84945802	0	4005.074842	955.9383936	156.3638867	285.972752	1451.46481	0	0	0	5.935589459	0	0	0	0	0	0	0	0	0	0	0						3250	"$25 per day, Days 1-4"	"$25 per day, Days 1-4"	"$25 per day, Days 1-4"	$0 copay	0% coin	0%-20% coins	0%-20% coins	$50 copay ER; $25-$50 copay Urgent Care	$25 copay	$5 copay	$0-$30 copay	$25 copay	0% coin	$0-$25 copay	$0 copay	$15 copay	$10-$15 copay	$4 copay	$0-$30 copay	$0-$15 copay	$0 copay	$0 copay	Not covered	"$5-$10 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$200 per 2 years	$10 copay	$200 per 3 years	$0 copay	$0-$5 copay	Not covered	$0 copay	Not covered	Not covered							77.5	0	0	0	0	0.1	0.1	49.94336887	25	5	23.91650705	0	0	10.45758294	0	14.83573129	10	4	23.72504825	5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	77.5	0	0	0	0	0.1	0.1	49.94336887	25	5	23.91650705	0	0	10.45758294	0	14.83573129	10	4	23.72504825	5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							1.6608	0	0	0	0	3.686930028	0.4563273	1.749492327	0.148767588	0.039999559	0.040740461	0	0	0.024269835	0	4.951517846	0.796615328	0.052121296	0.565393112	0.604777004	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6178		0	1.6608	0	0	0	0	3.686930028	0.4563273	1.749492327	0.148767588	0.039999559	0.040740461	0	0	0.024269835	0	4.951517846	0.796615328	0.052121296	0.565393112	0.604777004	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6178	NO																																																																																		0			1.6608	0	0	0	0	3.686930028	0.4563273	1.749492327	0.148767588	0.039999559	0.040740461	0	0	0.024269835	0	4.951517846	0.796615328	0.052121296	0.565393112	0.604777004	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6178
H4003_019_0	2010	5	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	O	O	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	V	O	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	0	0	0						0	YES	205.2572679	0	0	0	3.201120471	0	734.9718485	389.9196768	68.17389131	76.20119285	21.38485968	0	0.031064387	24.75749001	10171.39628	5468.404544	831.0692678	174.2300662	1131.366994	1449.843894	0	0	0	5.935589459	0	0	0	0	0	0	80	0	0	0	0						3250	"$0-$50 per day, Days 1-4"	"$0-$50 per day, Days 1-4"	"$0-$50 per day, Days 1-4"	$0 copay	0%-20% coins	"0%-10% coins DME, $0-$10 copay Diabetic Supplies"	"20% coins Prosth, $0-$0 copay Diabetes Self-Monitoring"	$50 copay ER; $25-$50 copay Urgent Care	$0-$25 copay	$5-$10 copay	$0-$50 copay	$25-$50 copay	0%-20% coins	$0-$50 copay	$0-$5 copay	$10-$15 copay	$0-$15 copay	$4-$10 copay	$0-$50 copay	$0-$15 copay	$0 copay	$0 copay	Not covered	"$5-$10 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$200 per year	$0 copay	$200 per 3 years	$0 copay	$0-$15 copay	$15 copay	$0 copay	Not covered	Not covered							15.5	0	0	0	0.02	0	13.05222553	49.9595609	2.5	5.5	25.57112142	0	0.02	11.5522457	0.5	1.89173545	10.5	4.6	6.915544629	5.5	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0						NO	15.5	0	0	0	0.02	0	13.05222553	49.9595609	2.5	5.5	25.57112142	0	0.02	11.5522457	0.5	1.89173545	10.5	4.6	6.915544629	5.5	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0							0.2651	0	0	0	0.064022409	0	0.799418193	1.62335132	0.014202894	0.034925547	0.04556957	0	0.000621288	0.023833717	0.423808178	0.862064561	0.727185609	0.066788192	0.652001578	0.664511785	0	0	0	1.840032732	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	8.2075		0	0.2651	0	0	0	0.064022409	0	0.799418193	1.62335132	0.014202894	0.034925547	0.04556957	0	0.000621288	0.023833717	0.423808178	0.862064561	0.727185609	0.066788192	0.652001578	0.664511785	0	0	0	1.840032732	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	8.2075	NO																																																																																		0			0.2651	0	0	0	0.064022409	0	0.799418193	1.62335132	0.014202894	0.034925547	0.04556957	0	0.000621288	0.023833717	0.423808178	0.862064561	0.727185609	0.066788192	0.652001578	0.664511785	0	0	0	1.840032732	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	8.2075
H4003_020_0	2010	3	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	O	O	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	V	O	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	0	0	0						0	YES	0	0	0	0	3.432714637	0	0	387.384262	63.18145782	0	20.72403377	0	0.025982975	17.56264633	0	0	835.2132871	0	256.7948534	0	0	0	0	5.935589459	0	0	0	0	0	0	0	0	0	0	0						3250	$0 copay	$0 copay	$0 copay	$0 copay	0% coin	$0 copay	$0 copay	$50 copay ER; $25-$50 copay Urgent Care	$25 copay	$0 copay	$0-$30 copay	$0-$25 copay	0% coin	$0-$25 copay	$0 copay	$0 copay	$10-$15 copay	$0 copay	$0-$30 copay	$0 copay	$0 copay	$0 copay	Not covered	"$5 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$200 per 2 years	$0 copay	$200 per 3 years	$0 copay	$0 copay	Not covered	$0 copay	Not covered	Not covered							0	0	0	0	0	0	0	49.94244387	25	0	24.29471894	0	0	12.24810587	0	0	10	0	23.48685987	0	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	0	0	0	0	0	0	0	49.94244387	25	0	24.29471894	0	0	12.24810587	0	0	10	0	23.48685987	0	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							0	0	0	0	0	0	0	1.612243063	0.131628037	0	0.041957048	0	0	0.017925763	0	0	0.696011073	0	0.502608728	0	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8424		0	0	0	0	0	0	0	0	1.612243063	0.131628037	0	0.041957048	0	0	0.017925763	0	0	0.696011073	0	0.502608728	0	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8424	NO																																																																																		0			0	0	0	0	0	0	0	1.612243063	0.131628037	0	0.041957048	0	0	0.017925763	0	0	0.696011073	0	0.502608728	0	0	0	0	1.840032732	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8424
H4003_801_0	2010	4	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						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	0	0	0						0	NO	143.4415069	0	0	13.11809759	3.18128366	36.77291067	4.128071535	8.736449458	12.67637413	1.638676829	7.717015408	0.599416779	0.031391815	9.978103604	73.24042677	69.63662642	5.620220118	8.365732944	31.34561854	124.7633559	1.006270743	0	0	0	0	0	0	0	0	0	0	0	0	0	0							FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins																			0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0						NO	0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0							21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586		0	21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586	NO																																																																																		0			21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586
H4003_803_0	2010	4	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						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	0	0	0						0	NO	142.4707787	0	0	13.09565633	3.177271615	36.78493105	4.128177626	8.710072933	12.55029912	1.632294558	7.715308507	0.601013266	0.031475424	9.990426654	73.15316999	69.24846978	5.620220118	8.23737123	31.23578468	124.0866985	1.007413395	0	0	0	0	0	0	0	0	0	0	0	0	0	0							FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins																			0.153299756	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0						NO	0.153299756	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0							21.8407	0	0	0	0.740304286	8.570888935	0.961865387	2.029446993	2.924219695	0.380324632	1.797666882	0.140036091	0.007333774	2.32776941	17.04468861	16.13489346	1.309511288	1.919307497	7.277937832	28.91220074	0.234727321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.5539		0	21.8407	0	0	0	0.740304286	8.570888935	0.961865387	2.029446993	2.924219695	0.380324632	1.797666882	0.140036091	0.007333774	2.32776941	17.04468861	16.13489346	1.309511288	1.919307497	7.277937832	28.91220074	0.234727321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.5539	NO																																																																																		0			21.8407	0	0	0	0.740304286	8.570888935	0.961865387	2.029446993	2.924219695	0.380324632	1.797666882	0.140036091	0.007333774	2.32776941	17.04468861	16.13489346	1.309511288	1.919307497	7.277937832	28.91220074	0.234727321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.5539
H4003_804_0	2010	4	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						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	0	0	0						0	NO	143.4415069	0	0	13.11809759	3.18128366	36.77291067	4.128071535	8.736449458	12.67637413	1.638676829	7.717015408	0.599416779	0.031391815	9.978103604	73.24042677	69.63662642	5.620220118	8.365732944	31.34561854	124.7633559	1.006270743	0	0	0	0	0	0	0	0	0	0	0	0	0	0							FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins																			0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0						NO	0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0							21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586		0	21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586	NO																																																																																		0			21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586
H4003_805_0	2010	4	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						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	0	0	0						0	NO	143.4415069	0	0	13.11809759	3.18128366	36.77291067	4.128071535	8.736449458	12.67637413	1.638676829	7.717015408	0.599416779	0.031391815	9.978103604	73.24042677	69.63662642	5.620220118	8.365732944	31.34561854	124.7633559	1.006270743	0	0	0	0	0	0	0	0	0	0	0	0	0	0							FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins																			0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0						NO	0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0							21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586		0	21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586	NO																																																																																		0			21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586
H4003_806_0	2010	4	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						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	0	0	0						0	NO	143.4415069	0	0	13.11809759	3.18128366	36.77291067	4.128071535	8.736449458	12.67637413	1.638676829	7.717015408	0.599416779	0.031391815	9.978103604	73.24042677	69.63662642	5.620220118	8.365732944	31.34561854	124.7633559	1.006270743	0	0	0	0	0	0	0	0	0	0	0	0	0	0							FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins																			0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0						NO	0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0							21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586		0	21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586	NO																																																																																		0			21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586
H4003_807_0	2010	4	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						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	0	0	0						0	NO	143.4415069	0	0	13.11809759	3.18128366	36.77291067	4.128071535	8.736449458	12.67637413	1.638676829	7.717015408	0.599416779	0.031391815	9.978103604	73.24042677	69.63662642	5.620220118	8.365732944	31.34561854	124.7633559	1.006270743	0	0	0	0	0	0	0	0	0	0	0	0	0	0							FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins																			0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0						NO	0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0							21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586		0	21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586	NO																																																																																		0			21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586
H4003_808_0	2010	4	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						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	0	0	0						0	NO	143.4415069	0	0	13.11809759	3.18128366	36.77291067	4.128071535	8.736449458	12.67637413	1.638676829	7.717015408	0.599416779	0.031391815	9.978103604	73.24042677	69.63662642	5.620220118	8.365732944	31.34561854	124.7633559	1.006270743	0	0	0	0	0	0	0	0	0	0	0	0	0	0							FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins																			0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0						NO	0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0							21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586		0	21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586	NO																																																																																		0			21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586
H4003_809_0	2010	4	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						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	0	0	0						0	NO	143.4415069	0	0	13.11809759	3.18128366	36.77291067	4.128071535	8.736449458	12.67637413	1.638676829	7.717015408	0.599416779	0.031391815	9.978103604	73.24042677	69.63662642	5.620220118	8.365732944	31.34561854	124.7633559	1.006270743	0	0	0	0	0	0	0	0	0	0	0	0	0	0							FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins	FFS Medicare Ded & Coins																			0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0						NO	0.153299716	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0							21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586		0	21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586	NO																																																																																		0			21.9895	0	0	0	0.741239093	8.568088186	0.961840668	2.035592724	2.953595172	0.381811701	1.79806459	0.13966411	0.007314293	2.32489814	17.06501944	16.22533396	1.309511288	1.949215776	7.303529119	29.06986193	0.234461083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.0586
H4004_015_0	2010	5	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	Coin	Coin	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	V	O	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	0	0	0						0	YES	243.1113473	0	0	0	4.821366901	9.444763779	6.149068847	430.7353253	70.8855977	52.74654901	50.33410205	0	0.100540881	26.04702727	4860.380014	3865.680978	941.0457669	123.7314872	789.6247189	1348.687738	0	0	0	7.016781527	0	0	0	0	0	0	100	0	0	0	0						3250	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	$0 copay	0%-20% coins	0%-20% coins	0%-20% coins	$50 copay ER; $25-$50 copay Urgent Care	$25-$50 copay	$5-$10 copay	$0-$50 copay	$25-$50 copay	0%-20% coins	$25-$50 copay	$0-$10 copay	$15-$20 copay; 20% coin	$10-$15 copay	$4-$10 copay	$0-$50 copay	$0-$20 copay	$0 copay	$0 copay	$0 copay	$5-$10 copay Preventive; 0%-50% coins Comprehensive	$0 copay	$250 per year	$0 copay	$200 per 3 years	$0 copay	$0-$20 copay	$15 copay	$0 copay	Not covered	20% coin							85.25	0	0	0	0.02	0.095970618	0.1	49.72441818	27.5	5.5	25.49596725	0	0.02	14.71893467	1	16.66753229	10.5	4.6	6.606323089	5.5	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0						NO	85.25	0	0	0	0.02	0.095970618	0.1	49.72441818	27.5	5.5	25.49596725	0	0.02	14.71893467	1	16.66753229	10.5	4.6	6.606323089	5.5	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0							1.7271	0	0	0	0.096427338	0.906419815	0.614906885	1.78483862	0.162446161	0.024175502	0.106943051	0	0.002010818	0.031948708	0.405031668	5.36928021	0.823415046	0.047430403	0.434709668	0.618148547	0	0	0	2.175202273	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	15.4554		0	1.7271	0	0	0	0.096427338	0.906419815	0.614906885	1.78483862	0.162446161	0.024175502	0.106943051	0	0.002010818	0.031948708	0.405031668	5.36928021	0.823415046	0.047430403	0.434709668	0.618148547	0	0	0	2.175202273	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	15.4554	NO																																																																																		0			1.7271	0	0	0	0.096427338	0.906419815	0.614906885	1.78483862	0.162446161	0.024175502	0.106943051	0	0.002010818	0.031948708	0.405031668	5.36928021	0.823415046	0.047430403	0.434709668	0.618148547	0	0	0	2.175202273	0	0	0	0	0	0	0.125	0	0	0	0	0	0	0	0	0	15.4554
H4004_025_0	2010	3	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	Coin	Coin	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	V	O	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	0	0	0						0	YES	275.70788	0	0	0	4.172801148	7.315166901	5.857477007	394.7192795	56.6390623	57.80217203	48.55160582	0	0.05661261	32.01843811	0	2860.040142	938.9860313	110.9634596	181.1581773	1298.392526	0	0	0	7.016781527	0	0	0	0	0	0	0	0	0	0	0						3250	"$25 per day, Days 1-4"	"$25 per day, Days 1-4"	"$25 per day, Days 1-4"	$0 copay	0% coin	0%-20% coins	0%-20% coins	$50 copay ER; $25-$50 copay Urgent Care	$25 copay	$5 copay	$0-$30 copay	$25 copay	0% coin	$0-$25 copay	$0 copay	$15 copay	$10-$15 copay	$4 copay	$0-$30 copay	$0-$15 copay	$0 copay	$0 copay	Not covered	"$5-$10 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$200 per 2 years	$10 copay	$200 per 3 years	$0 copay	$0-$5 copay	Not covered	$0 copay	Not covered	Not covered							77.5	0	0	0	0	0.094817085	0.1	49.72998215	25	5	24.75143274	0	0	7.826305506	0	14.73496344	10	4	23.71744093	5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	77.5	0	0	0	0	0.094817085	0.1	49.72998215	25	5	24.75143274	0	0	7.826305506	0	14.73496344	10	4	23.71744093	5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							1.7806	0	0	0	0	0.693602804	0.585747701	1.635781894	0.117998046	0.024084238	0.100143484	0	0	0.020882173	0	3.511882244	0.782488359	0.03698782	0.358050697	0.540996886	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3645		0	1.7806	0	0	0	0	0.693602804	0.585747701	1.635781894	0.117998046	0.024084238	0.100143484	0	0	0.020882173	0	3.511882244	0.782488359	0.03698782	0.358050697	0.540996886	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3645	NO																																																																																		0			1.7806	0	0	0	0	0.693602804	0.585747701	1.635781894	0.117998046	0.024084238	0.100143484	0	0	0.020882173	0	3.511882244	0.782488359	0.03698782	0.358050697	0.540996886	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.3645
H4004_035_0	2010	5	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	Coin	Coin	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	V	V	V	O	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	0	0	0						0	YES	762.0441269	0	0	0	23.76463836	103.4189685	7.237131572	502.3502456	18.40343294	35.1342206	14.73595129	0	0	1.305790372	4160.959394	783.8662026	922.0327814	149.7536312	499.1043239	1267.290006	0	0	0	7.016781527	0	0	0	0	0	0	0	0	0	0	0						3250	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	$0 copay	0%-20% coins	0%-20% coins	0%-20% coins	$50 copay	$25-$50 copay	$5-$10 copay	$0-$50 copay	$25-$50 copay	0%-20% coins	$25-$50 copay	$0-$10 copay	$5-$12 copay	$10-$15 copay	$4-$10 copay	$0-$50 copay	$0-$10 copay	$0 copay	$0 copay	Not covered	"$5 copay Preventive, 50% Coins Comprehensive"	$0 copay	$100 per year	$0 copay	$200 per 3 years	$0 copay	$0-$15 copay	Not covered	$0 copay	$0 copay	Not covered							85.25	0	0	0	0.02	0.099632016	0.1	50	27.5	5.5	28.450096	0	0	27.5	1	5.698497167	10.5	4.6	2.555251529	5.5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	85.25	0	0	0	0.02	0.099632016	0.1	50	27.5	5.5	28.450096	0	0	27.5	1	5.698497167	10.5	4.6	2.555251529	5.5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							5.4137	0	0	0	0.475292767	10.30384029	0.723713157	2.093126023	0.042174534	0.016103184	0.034936602	0	0	0.002992436	0.346746616	0.372238278	0.806778684	0.057405559	0.106278091	0.580841253	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5514		0	5.4137	0	0	0	0.475292767	10.30384029	0.723713157	2.093126023	0.042174534	0.016103184	0.034936602	0	0	0.002992436	0.346746616	0.372238278	0.806778684	0.057405559	0.106278091	0.580841253	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5514	NO																																																																																		0			5.4137	0	0	0	0.475292767	10.30384029	0.723713157	2.093126023	0.042174534	0.016103184	0.034936602	0	0	0.002992436	0.346746616	0.372238278	0.806778684	0.057405559	0.106278091	0.580841253	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5514
H4004_048_0	2010	4	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	Coin	Coin	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	V	O	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	0	0	0						0	YES	390.0924223	0	0	0	7.947421819	18.56826305	8.984020857	819.1871249	93.76504124	203.0258982	86.38774241	0.614945392	0.506438405	9.120358928	0	3786.954492	914.2740229	184.7403725	254.3477847	4453.400623	0	0	0	7.016781527	0	0	0	0	0	0	0	0	0	0	0						3250	"$0-$150 copay, Days 1-4"	"$0-$150 copay, Days 1-4"	"$0-$150 copay, Days 1-4"	$0 copay	0%-20% coins	0%-20% coins	0%-20% coins	$0-$50 copay	$0-$25 copay	$0-$5 copay	$0-$50 copay	$0-$25 copay	0%-20% coins	$0-$25 copay	$0 copay	$0-$12 copay	$0-$12 copay	$0-$25 copay	$0-$50 copay	$0-$25 copay	$0 copay	$0 copay	Not Covered	"$5-$10 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$200 per year	$0 copay	$200 per 3 years	$0 copay	$0 copay	Not Covered	$0 copay	Not covered	Not Covered							46.5	0	0	0	0.02	0.097945065	0.1	5	2.5	0.5	3.120195338	2.5	0.02	2.5	0	1.2	1.2	2.5	3.119874015	0.5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	46.5	0	0	0	0.02	0.097945065	0.1	5	2.5	0.5	3.120195338	2.5	0.02	2.5	0	1.2	1.2	2.5	3.119874015	0.5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							1.5116	0	0	0	0.158948436	1.818669725	0.898402086	0.341327969	0.019534384	0.008459412	0.022462219	0.000128114	0.010128768	0.001900075	0	0.378695449	0.091427402	0.038487578	0.066127754	0.185558359	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7271		0	1.5116	0	0	0	0.158948436	1.818669725	0.898402086	0.341327969	0.019534384	0.008459412	0.022462219	0.000128114	0.010128768	0.001900075	0	0.378695449	0.091427402	0.038487578	0.066127754	0.185558359	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7271	NO																																																																																		0			1.5116	0	0	0	0.158948436	1.818669725	0.898402086	0.341327969	0.019534384	0.008459412	0.022462219	0.000128114	0.010128768	0.001900075	0	0.378695449	0.091427402	0.038487578	0.066127754	0.185558359	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7271
H4004_049_0	2010	5	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	Coin	Coin	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	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	0	0	0						0	YES	274.6626467	0	0	0	4.217444978	11.39692416	6.911644131	445.6702953	92.76229151	73.63138218	72.59874912	0	0.38308009	34.47853996	11153.43113	3433.106365	813.7688486	170.952261	1027.787891	1630.499933	0	0	0	7.016781527	0	0	0	0	0	0	60	0	0	0	0						3250	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	"$25-$50 per day, Days 1-4"	$0 copay	0%-20% coins	0%-20% coins	0%-20% coins	$50 copay ER; $25-$50 copay Urgent Care	$25-$50 copay	$5-$10 copay	$0-$50 copay	$25-$50 copay	0%-20% coins	$0-$25 copay	$0-$5 copay	$3-$12 copay	$10-$15 copay	$4-$10 copay	$0-$50 copay	$0-$12 copay	$0 copay	$0 copay	Not covered	"$5-$10 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$200 per year	$0 copay	$200 per 3 years	$0 copay	$0-$15 copay	$15 copay	$0 copay	Not covered	Not covered							85.25	0	0	0	0.02	0.096660804	0.1	49.81223294	27.5	5.5	25.77218907	0	0.02	10.67011402	0.5	4.107921246	10.5	4.6	6.467056322	5.5	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0						NO	85.25	0	0	0	0.02	0.096660804	0.1	49.81223294	27.5	5.5	25.77218907	0	0.02	10.67011402	0.5	4.107921246	10.5	4.6	6.467056322	5.5	0	0	0	0.31	0	0	0	0	0	0	15	0	0	0	0							1.9512	0	0	0	0.0843489	1.101635854	0.691164413	1.849986047	0.212580251	0.033747717	0.155919057	0	0.007661602	0.030657496	0.464726297	1.175244215	0.712047742	0.0655317	0.553896848	0.747312469	0	0	0	2.175202273	0	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	12.0879		0	1.9512	0	0	0	0.0843489	1.101635854	0.691164413	1.849986047	0.212580251	0.033747717	0.155919057	0	0.007661602	0.030657496	0.464726297	1.175244215	0.712047742	0.0655317	0.553896848	0.747312469	0	0	0	2.175202273	0	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	12.0879	NO																																																																																		0			1.9512	0	0	0	0.0843489	1.101635854	0.691164413	1.849986047	0.212580251	0.033747717	0.155919057	0	0.007661602	0.030657496	0.464726297	1.175244215	0.712047742	0.0655317	0.553896848	0.747312469	0	0	0	2.175202273	0	0	0	0	0	0	0.075	0	0	0	0	0	0	0	0	0	12.0879
H4004_050_0	2010	5	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	O	O	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	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	0	0	0						0	YES	274.8544841	0	0	0	4.217444978	0	1233.04793	443.7795903	92.99518741	73.63138218	73.80315108	0	0.38308009	34.45583639	11153.43113	208.5916728	935.7869739	170.952261	1027.787891	1630.499933	0	0	0	7.016781527	0	0	0	0	0	0	0	0	0	0	0						3250	"$0-$50 per day, Days 1-4"	"$0-$50 per day, Days 1-4"	"$0-$50 per day, Days 1-4"	$0 copay	0%-20% coins	"0%-10% coins DME, $0-$10 copay Diabetic Supplies"	"20% coins Prosth, $0-$0 copay Diabetes Self-Monitoring"	$50 copay ER; $25-$50 copay Urgent Care	$0-$25 copay	$5-$10 copay	$0-$50 copay	$25-$50 copay	0%-20% coins	$0-$50 copay	$0-$5 copay	$10-$15 copay	$0-$15 copay	$4-$10 copay	$0-$50 copay	$0-$15 copay	$0 copay	$0 copay	$0 copay	"$5-$10 copay Preventive, 0%-50% coins Comprehensive"	$0 copay	$200 per year	$0 copay	$200 per 3 years	$0 copay	$0-$15 copay	$15 copay	$0 copay	Not covered	Not covered							15.5	0	0	0	0.02	0	13.31338795	49.81143297	2.5	5.5	25.87382142	0	0.02	10.6590245	0.5	6.450920238	10.5	4.6	6.467056322	5.5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	15.5	0	0	0	0.02	0	13.31338795	49.81143297	2.5	5.5	25.87382142	0	0.02	10.6590245	0.5	6.450920238	10.5	4.6	6.467056322	5.5	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							0.355	0	0	0	0.0843489	0	1.368003789	1.842108109	0.019373997	0.033747717	0.159130796	0	0.007661602	0.030605467	0.464726297	0.11213402	0.818813602	0.0655317	0.553896848	0.747312469	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8376		0	0.355	0	0	0	0.0843489	0	1.368003789	1.842108109	0.019373997	0.033747717	0.159130796	0	0.007661602	0.030605467	0.464726297	0.11213402	0.818813602	0.0655317	0.553896848	0.747312469	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8376	NO																																																																																		0			0.355	0	0	0	0.0843489	0	1.368003789	1.842108109	0.019373997	0.033747717	0.159130796	0	0.007661602	0.030605467	0.464726297	0.11213402	0.818813602	0.0655317	0.553896848	0.747312469	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8376
H4004_051_0	2010	3	N/A	q.	q.	q.	q.	q.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered						Acupuncture	Health Education	Respite Care/Diapers	USA Benefit	0						A	A	A	V	Coin	Coin	Coin	V	P	P	P	P	Coin	V	V	V	V	V	P	V	O	O	T	Coin	V	V	V	V	O	O	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	0	0	0						0	YES	260.7512224	0	0	0	4.468048435	10.30730041	6.527976709	438.3634762	83.73775406	0	63.72677928	0	0.266522377	23.59348585	0	2854.093196	939.4196609	0	213.4010543	0	0	0	0	7.016781527	0	0	0	0	0	0	0	0	0	0	0						3250	"Annual Ded $450, $25 per day, Days 1-4"	"Annual Ded $450, $25 per day, Days 1-4"	"$0-$50 per day, Days 1-4"	$0 copay	0% coins	20% coins	20% coins	$50 copay ER; $25-$50 copay Urgent Care	$25 copay	$5 copay	$0-$30 copay	$0-$25 copay	0% coins	$0-$25 copay	$0 copay	$15 copay	$10 copay	$4 copay	$0-$30 copay	$0-$15 copay	$0 copay	$0 copay	Not covered	"$10 copay Preventive, 0%-50% coins Comprehensive"	$10 copay	$200 per 2 years	$0 copay	$200 per 3 years	$0 copay	$0-$10 copay	Not covered	$0 copay	Not covered	Not covered							415	0	0	0	0	0.192812563	0.2	49.75062198	25	0	24.17498346	0	0	12.12682654	0	14.99893137	10	0	23.37502634	0	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0						NO	415	0	0	0	0	0.192812563	0.2	49.75062198	25	0	24.17498346	0	0	12.12682654	0	14.99893137	10	0	23.37502634	0	0	0	0	0.31	0	0	0	0	0	0	0	0	0	0	0							9.0176	0	0	0	0	1.987377006	1.305595342	1.817404633	0.174453654	0	0.12838282	0	0	0.023842843	0	3.567362332	0.782849717	0	0.415687939	0	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3958		0	9.0176	0	0	0	0	1.987377006	1.305595342	1.817404633	0.174453654	0	0.12838282	0	0	0.023842843	0	3.567362332	0.782849717	0	0.415687939	0	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3958	NO																																																																																		0			9.0176	0	0	0	0	1.987377006	1.305595342	1.817404633	0.174453654	0	0.12838282	0	0	0.023842843	0	3.567362332	0.782849717	0	0.415687939	0	0	0	0	2.175202273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.3958
H4005_001_0	2010	4	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	NO	151.1837551	4.616948796	0	0	0	0	0	288.6890167	194.6698778	0	0	0	0	0	0	4270.873239	453.1621981	0	1518.006497	0	0	0	0	0	0	0	0	0	0	0												$25/Admit for IP Medical; $25/Admit for IP Surgical;	$25/Admit for IP Psych; $25/Admit for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for ER - Facility; $25/Visit for Urgent Care;	$25/Case for OP Fac - Surgery; $25/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$8/Visit for Speclst - Office Visits;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	No Cost-Sharing	$3/Procedure for Prof Radiology (OP); $3/Procedure for Prof Radiology (Office);	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											25	25	0	0	0	0	0	25	25	0	0	0	0	0	0	7.8	10	0	2.6	0	0	0	0	0	0	0	0	0	0	0											NO	25	25	0	0	0	0	0	25	25	0	0	0	0	0	0	7.8	10	0	2.6	0	0	0	0	0	0	0	0	0	0	0												0.315	0.009618643	0	0	0	0	0	0.601435451	0.405562245	0	0	0	0	0	0	2.776067606	0.377635165	0	0.328901408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8142	0	0	0.315	0.009618643	0	0	0	0	0	0.601435451	0.405562245	0	0	0	0	0	0	2.776067606	0.377635165	0	0.328901408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.8142	NO	$250/Admit for IP Medical; $250/Admit for IP Surgical;	$250/Admit for IP Psych; $250/Admit for IP Substance Abuse;	20% Coinsurance for SNF	20% Coinsurance for Home Health	20% Coinsurance for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	No Cost-Sharing	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	25% Coinsurance for OP Fac - Cardiovascular; 25% Coinsurance for OP Fac - Occ Therapy; 25% Coinsurance for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for Prof - CORF; 25% Coinsurance for Prof - CORF;	20% Coinsurance for PCP - Office Visits; 20% Coinsurance for PCP - Routine Physicals; 20% Coinsurance for PCP - Immunizations;	20% Coinsurance for Speclst - Office Visits; 20% Coinsurance for Speclst - Immunizations;	25% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 25% Coinsurance for OP Substance Abuse;	25% Coinsurance for PT/ST (PCP); 25% Coinsurance for Occ Therapy (PCP); 25% Coinsurance for PT/ST (Specialist); 25% Coinsurance for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	25% Coinsurance for Chiropractor; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	20% Coinsurance for Blood Products	No Cost-Sharing	20% Coinsurance for Dental	20% Coinsurance for Vision (Refractions)	20% Coinsurance for Vision Hardware	20% Coinsurance for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.3394	0.0104	0.034	0.1777	0.0272	0.1873	0.0913	0	0.231	0.0314	0.0468	0	0	0.0547	0.4132	0.5636	0.0832	0.1413	0.4938	0.569	0.2025	0.0199	0	0.2094	0.0309	0.0591	0	0	0	0											4.017	0	0	0.6544	0.02002088	0.033973698	0.177715894	0.027201256	0.187320022	0.091251037	0.601435451	0.636531394	0.031388418	0.046839843	0	0	0.054664457	0.413193022	3.339697006	0.460834287	0.141270744	0.82270281	0.568987915	0.202475542	0.019868821	0	0.209385254	0.030904455	0.059112977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8312
H4005_003_0	2010	4	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	NO	210.0323092	3.990383664	0	0	0	0	0	347.8797768	247.3187868	0	0	0	0	0	0	6574.28689	545.6278417	0	2171.46342	0	0	0	0	0	0	0	0	0	0	0												$25/Admit for IP Medical; $25/Admit for IP Surgical;	$25/Admit for IP Psych; $25/Admit for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for ER - Facility; $25/Visit for Urgent Care;	$25/Case for OP Fac - Surgery; $25/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$8/Visit for Speclst - Office Visits;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	No Cost-Sharing	$3/Procedure for Prof Radiology (OP); $3/Procedure for Prof Radiology (Office);	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											25	25	0	0	0	0	0	25	25	0	0	0	0	0	0	7.8	10	0	2.6	0	0	0	0	0	0	0	0	0	0	0											NO	25	25	0	0	0	0	0	25	25	0	0	0	0	0	0	7.8	10	0	2.6	0	0	0	0	0	0	0	0	0	0	0												0.4376	0.008313299	0	0	0	0	0	0.724749535	0.515247473	0	0	0	0	0	0	4.273286479	0.454689868	0	0.470483741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8843	0	0	0.4376	0.008313299	0	0	0	0	0	0.724749535	0.515247473	0	0	0	0	0	0	4.273286479	0.454689868	0	0.470483741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.8843	NO	$250/Admit for IP Medical; $250/Admit for IP Surgical;	$250/Admit for IP Psych; $250/Admit for IP Substance Abuse;	20% Coinsurance for SNF	20% Coinsurance for Home Health	20% Coinsurance for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	No Cost-Sharing	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	25% Coinsurance for OP Fac - Cardiovascular; 25% Coinsurance for OP Fac - Occ Therapy; 25% Coinsurance for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for Prof - CORF; 25% Coinsurance for Prof - CORF;	20% Coinsurance for PCP - Office Visits; 20% Coinsurance for PCP - Routine Physicals; 20% Coinsurance for PCP - Immunizations;	20% Coinsurance for Speclst - Office Visits; 20% Coinsurance for Speclst - Immunizations;	25% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 25% Coinsurance for OP Substance Abuse;	25% Coinsurance for PT/ST (PCP); 25% Coinsurance for Occ Therapy (PCP); 25% Coinsurance for PT/ST (Specialist); 25% Coinsurance for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	25% Coinsurance for Chiropractor; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	20% Coinsurance for Blood Products	No Cost-Sharing	20% Coinsurance on Dental	20% Coinsurance for Vision (Refractions)	20% Coinsurance for Vision Hardware	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.4698	0.0089	0.0682	0.2077	0.0384	0.2783	0.1186	0	0.2995	0.0408	0.0785	0	0	0.0934	0.5572	0.8471	0.0982	0.2236	0.7208	0.7628	0.4238	0.0171	0	0.2116	0.0414	0.0668	0	0	0	0											5.6726	0	0	0.9074	0.017239639	0.068222513	0.207688218	0.038415429	0.278307127	0.118590385	0.724749535	0.814784336	0.040758584	0.078530269	0	0	0.093353224	0.557161376	5.120354502	0.552854281	0.223609535	1.191315966	0.762788667	0.423843189	0.017121777	0	0.211611143	0.041431818	0.066815843	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.5569
H4005_004_0	2010	4	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	NO	165.2467319	5.236263408	0	0	0	0	0	330.9422921	227.1784606	0	0	0	0	0	0	5238.750783	690.9136265	0	1874.602931	0	0	0	0	0	0	0	0	0	0	0												$25/Admit for IP Medical; $25/Admit for IP Surgical;	$25/Admit for IP Psych; $25/Admit for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for ER - Facility; $25/Visit for Urgent Care;	$25/Case for OP Fac - Surgery; $25/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$8/Visit for Speclst - Office Visits;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	No Cost-Sharing	$3/Procedure for Prof Radiology (OP); $3/Procedure for Prof Radiology (Office);	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											25	25	0	0	0	0	0	25	25	0	0	0	0	0	0	7.8	10	0	2.6	0	0	0	0	0	0	0	0	0	0	0											NO	25	25	0	0	0	0	0	25	25	0	0	0	0	0	0	7.8	10	0	2.6	0	0	0	0	0	0	0	0	0	0	0												0.3443	0.010908882	0	0	0	0	0	0.689463109	0.47328846	0	0	0	0	0	0	3.405188009	0.575761355	0	0.406163968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.905	0	0	0.3443	0.010908882	0	0	0	0	0	0.689463109	0.47328846	0	0	0	0	0	0	3.405188009	0.575761355	0	0.406163968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.905	NO	$250/Admit for IP Medical; $250/Admit for IP Surgical;	$250/Admit for IP Psych; $250/Admit for IP Substance Abuse;	20% Coinsurance for SNF	20% Coinsurance for Home Health	20% Coinsurance for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	No Cost-Sharing	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	25% Coinsurance for OP Fac - Cardiovascular; 25% Coinsurance for OP Fac - Occ Therapy; 25% Coinsurance for OP Fac - Physical/Speech Therapy; 25% Coinsurance for OP Fac - CORF; 25% Coinsurance for Prof - CORF; 25% Coinsurance for Prof - CORF;	20% Coinsurance for PCP - Office Visits; 20% Coinsurance for PCP - Routine Physicals; 20% Coinsurance for PCP - Immunizations;	20% Coinsurance for Speclst - Office Visits; 20% Coinsurance for Speclst - Immunizations;	25% Coinsurance for OP Psych - Non-Physician; 20% Coinsurance for OP Psych - Psychiatrist; 25% Coinsurance for OP Substance Abuse;	25% Coinsurance for PT/ST (PCP); 25% Coinsurance for Occ Therapy (PCP); 25% Coinsurance for PT/ST (Specialist); 25% Coinsurance for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	25% Coinsurance for Chiropractor; 20% Coinsurance for Vision Exams; 20% Coinsurance for Hearing/Speech Exams; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	20% Coinsurance for Part B Rx	20% Coinsurance for Blood Products	No Cost-Sharing	20% Coinsurance for Dental	20% Coinsurance for Vision (Refractions)	20% Coinsurance for Vision Hardware	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.3602	0.0114	0.0443	0.1485	0.0276	0.1998	0.1421	0	0.2663	0.0365	0.0509	0	0	0.0584	0.5279	0.6703	0.1231	0.1956	0.6029	0.6465	0.2901	0.0142	0	0.2328	0.0352	0.0717	0	0	0	0											4.7562	0	0	0.7045	0.022322355	0.044343001	0.148472963	0.027569052	0.199768613	0.142133324	0.689463109	0.739541926	0.036464239	0.050884166	0	0	0.058399687	0.527936694	4.075517409	0.698812649	0.195601496	1.009030532	0.646481353	0.290076048	0.01416435	0	0.23282412	0.035202864	0.071746275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.6612
H4005_801_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	88.09989512	2.325802961	2.931920516	0	2.074832605	12.54881995	4.977842236	6.245516992	13.68102027	1.815205003	3.953982919	0	1.651438557	9.315368361	38.76075148	98.55203503	3.784927949	9.028966079	31.37762534	53.86071208	17.44676	1.007883705	0	0	0	0	0	0	0	0												15% Coinsurance for IP Medical; 15% Coinsurance for IP Surgical;	15% Coinsurance for IP Psych; 15% Coinsurance for IP Substance Abuse;	16% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.153696254	0.153585254	0.157181775	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.153696254	0.153585254	0.157181775	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												13.5406	0.357209038	0.46084447	0	0.483435997	2.923875049	1.159837241	1.455205459	3.187677723	0.422942766	0.92127802	0	0.384785184	2.170480828	9.031255096	22.96262416	0.881888212	2.103749096	7.310986704	12.54954592	4.065095081	0.234836903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6082	0	0	13.5406	0.357209038	0.46084447	0	0.483435997	2.923875049	1.159837241	1.455205459	3.187677723	0.422942766	0.92127802	0	0.384785184	2.170480828	9.031255096	22.96262416	0.881888212	2.103749096	7.310986704	12.54954592	4.065095081	0.234836903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6082	NO	15% Coinsurance for IP Medical; 15% Coinsurance for IP Surgical;	15% Coinsurance for IP Psych; 15% Coinsurance for IP Substance Abuse;	16% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												1.2977	0.0343	0.044	0	0.0461	0.31	0.116	0.1389	0.3042	0.0404	0.0879	0	0.0367	0.2071	0.856	2.1849	0.0842	0.2008	0.6977	1.1976	0.3879	0.0224	0	0	0	0	0	0	0	0											8.2946	0	0	14.8383	0.391467635	0.504821368	0	0.529568732	3.23389277	1.27583594	1.594071014	3.491867509	0.463302827	1.009192605	0	0.421503991	2.377602801	9.887224783	25.14749991	0.966043955	2.304503076	8.008650544	13.74710854	4.453013971	0.25724663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9027
H4005_802_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	88.09989512	2.325802961	2.931920516	0	2.074832605	12.54881995	4.977842236	6.245516992	13.68102027	1.815205003	3.953982919	0	1.651438557	9.315368361	38.76075148	98.55203503	3.784927949	9.028966079	31.37762534	53.86071208	17.44676	1.007883705	0	0	0	0	0	0	0	0												15% Coinsurance for IP Medical; 15% Coinsurance for IP Surgical;	15% Coinsurance for IP Psych; 15% Coinsurance for IP Substance Abuse;	16% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.153696254	0.153585254	0.157181775	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.153696254	0.153585254	0.157181775	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												13.5406	0.357209038	0.46084447	0	0.483435997	2.923875049	1.159837241	1.455205459	3.187677723	0.422942766	0.92127802	0	0.384785184	2.170480828	9.031255096	22.96262416	0.881888212	2.103749096	7.310986704	12.54954592	4.065095081	0.234836903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6082	0	0	13.5406	0.357209038	0.46084447	0	0.483435997	2.923875049	1.159837241	1.455205459	3.187677723	0.422942766	0.92127802	0	0.384785184	2.170480828	9.031255096	22.96262416	0.881888212	2.103749096	7.310986704	12.54954592	4.065095081	0.234836903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6082	NO	15% Coinsurance for IP Medical; 15% Coinsurance for IP Surgical;	15% Coinsurance for IP Psych; 15% Coinsurance for IP Substance Abuse;	16% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												1.2977	0.0343	0.044	0	0.0461	0.31	0.116	0.1389	0.3042	0.0404	0.0879	0	0.0367	0.2071	0.856	2.1849	0.0842	0.2008	0.6977	1.1976	0.3879	0.0224	0	0	0	0	0	0	0	0											8.2946	0	0	14.8383	0.391467635	0.504821368	0	0.529568732	3.23389277	1.27583594	1.594071014	3.491867509	0.463302827	1.009192605	0	0.421503991	2.377602801	9.887224783	25.14749991	0.966043955	2.304503076	8.008650544	13.74710854	4.453013971	0.25724663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9027
H4005_804_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	88.09989512	2.325802961	2.931920516	0	2.074832605	12.54881995	4.977842236	6.245516992	13.68102027	1.815205003	3.953982919	0	1.651438557	9.315368361	38.76075148	98.55203503	3.784927949	9.028966079	31.37762534	53.86071208	17.44676	1.007883705	0	0	0	0	0	0	0	0												15% Coinsurance for IP Medical; 15% Coinsurance for IP Surgical;	15% Coinsurance for IP Psych; 15% Coinsurance for IP Substance Abuse;	16% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.153696254	0.153585254	0.157181775	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.153696254	0.153585254	0.157181775	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												13.5406	0.357209038	0.46084447	0	0.483435997	2.923875049	1.159837241	1.455205459	3.187677723	0.422942766	0.92127802	0	0.384785184	2.170480828	9.031255096	22.96262416	0.881888212	2.103749096	7.310986704	12.54954592	4.065095081	0.234836903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6082	0	0	13.5406	0.357209038	0.46084447	0	0.483435997	2.923875049	1.159837241	1.455205459	3.187677723	0.422942766	0.92127802	0	0.384785184	2.170480828	9.031255096	22.96262416	0.881888212	2.103749096	7.310986704	12.54954592	4.065095081	0.234836903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6082	NO	15% Coinsurance for IP Medical; 15% Coinsurance for IP Surgical;	15% Coinsurance for IP Psych; 15% Coinsurance for IP Substance Abuse;	16% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												1.2977	0.0343	0.044	0	0.0461	0.31	0.116	0.1389	0.3042	0.0404	0.0879	0	0.0367	0.2071	0.856	2.1849	0.0842	0.2008	0.6977	1.1976	0.3879	0.0224	0	0	0	0	0	0	0	0											8.2946	0	0	14.8383	0.391467635	0.504821368	0	0.529568732	3.23389277	1.27583594	1.594071014	3.491867509	0.463302827	1.009192605	0	0.421503991	2.377602801	9.887224783	25.14749991	0.966043955	2.304503076	8.008650544	13.74710854	4.453013971	0.25724663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9027
H4005_807_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	88.09989512	2.325802961	2.931920516	0	2.074832605	12.54881995	4.977842236	6.245516992	13.68102027	1.815205003	3.953982919	0	1.651438557	9.315368361	38.76075148	98.55203503	3.784927949	9.028966079	31.37762534	53.86071208	17.44676	1.007883705	0	0	0	0	0	0	0	0												15% Coinsurance for IP Medical; 15% Coinsurance for IP Surgical;	15% Coinsurance for IP Psych; 15% Coinsurance for IP Substance Abuse;	16% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.153696254	0.153585254	0.157181775	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.153696254	0.153585254	0.157181775	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												13.5406	0.357209038	0.46084447	0	0.483435997	2.923875049	1.159837241	1.455205459	3.187677723	0.422942766	0.92127802	0	0.384785184	2.170480828	9.031255096	22.96262416	0.881888212	2.103749096	7.310986704	12.54954592	4.065095081	0.234836903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6082	0	0	13.5406	0.357209038	0.46084447	0	0.483435997	2.923875049	1.159837241	1.455205459	3.187677723	0.422942766	0.92127802	0	0.384785184	2.170480828	9.031255096	22.96262416	0.881888212	2.103749096	7.310986704	12.54954592	4.065095081	0.234836903	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.6082	NO	15% Coinsurance for IP Medical; 15% Coinsurance for IP Surgical;	15% Coinsurance for IP Psych; 15% Coinsurance for IP Substance Abuse;	16% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												1.2977	0.0343	0.044	0	0.0461	0.31	0.116	0.1389	0.3042	0.0404	0.0879	0	0.0367	0.2071	0.856	2.1849	0.0842	0.2008	0.6977	1.1976	0.3879	0.0224	0	0	0	0	0	0	0	0											8.2946	0	0	14.8383	0.391467635	0.504821368	0	0.529568732	3.23389277	1.27583594	1.594071014	3.491867509	0.463302827	1.009192605	0	0.421503991	2.377602801	9.887224783	25.14749991	0.966043955	2.304503076	8.008650544	13.74710854	4.453013971	0.25724663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.9027
H4006_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O		V	P	P	P	P	O	O																																																			0	YES						6.026117765	8.628327773	343.9118304			333.7340865			0.034268498		36.84585467	717.7385852							1092.00458																	3400	1a (IP Acute) - $0	1b (IP Psych) - $0	2 (SNF) - $0; 2a2 (Waiver 3 Day) - $0	6a (Home Health) - $0	10a (Ambulance) - $0	11a (Medical Equip) - 10%	"11b (Med Prosthetics) - 20%, 11c (Diab Supp) - 10%"	"4a (ER) $35 (WW coverage), 4b (UC) - $35 (WW coverage); $0 if hosp. in 24 hrs"	"9a (OP Surgery) - $0, 9b (ASC) - $0"	8a (OP Diag Proc/Test/Lab) - $0	"8b (OP Radiology) - 0%, $20"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA) - $10, 9d (Cardiac Rehab) - $0, 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	"7a (PCP) - $0, 14c (Routine Physical) - $0"	"7b (Chiro) - $0, 7d (Spec) - $0, 7f (Pod) - $0; 17a (MCR Eye Exam) - $0; 18a (MCR Hearing Exam) - $0, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $0; 14i (Diab Mon.) - $0; 13b: $15 14A: Alivia - $15"	"7e (MH), 7h (Psychiatric) - $10"	"7c (OT), 7i (PT/ST) - $0"	8b (Prof Radiology) - 0%	"7g (Prof. Other)  - $0; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - 0%	13a (Blood) - $0		16a (Preventive); 16b (Comp. Dental) - $5; 5%	17a1 (Rountine Eye Exam) - $0	17b1 (Non MCR Covered) - $220 limit	18a1 (Hearing Exam Non-covered) - $0	18b (Hearing Aids) - $300 limit	14a (Health Ed & Wellness) - $0	13C OTC - $60/Qtr																0.09671885	0.103004244	35			8.342467967			9.926650367		14.63414634	9.926650367							4.322475446																	NO						0.096603297	0.102881182	34.95818457			8.332500998			9.914790733		14.61666254	9.914790733							4.322475446																		0	0	0	0	0	0.582142844	0.887692561	1.00187777	0	0	0.231736634	0	0	2.83E-05	0	0.044880285	0.593018989	0	0	0	0	0	0	0.393346915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.7347	0	0.003996808	0	0	0	0	0	0.582142844	0.887692561	1.00187777	0	0	0.231736634	0	0	2.83E-05	0	0.044880285	0.593018989	0	0	0	0	0	0	0.393346915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.7347	NO																																																																																		0	0	0	0	0	0	0	0	0.582142844	0.887692561	1.00187777	0	0	0.231736634	0	0	2.83E-05	0	0.044880285	0.593018989	0	0	0	0	0	0	0.393346915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.7347
H4006_007_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O		V	P	P	P	P	O	O																																																			0	YES						9.615722256	11.39149204	442.8497134			361.7626522			0.225116772		42.26311814	754.9034338							1103.568582																	3400	1a (IP Acute) - $0	1b (IP Psych) - $0	2 (SNF) - $0; 2a2 (Waiver 3 Day) - $0	6a (Home Health) - $0	10a (Ambulance) - $0	11a (Medical Equip) - 10%	"11b (Med Prosthetics) - 20%, 11c (Diab Supp) - 10%"	"4a (ER) $35 (WW coverage), 4b (UC) - $35 (WW coverage); $0 if hosp. in 24 hrs"	"9a (OP Surgery) - $0, 9b (ASC) - $0"	8a (OP Diag Proc/Test/Lab) - $0	"8b (OP Radiology) - 0%, $20"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA) - $10, 9d (Cardiac Rehab) - $0, 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	"7a (PCP) - $0, 14c (Routine Physical) - $0"	"7b (Chiro) - $0, 7d (Spec) - $0, 7f (Pod) - $0; 17a (MCR Eye Exam) - $0; 18a (MCR Hearing Exam) - $0, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $0; 14i (Diab Mon.) - $0; 13b: $15 14A: Alivia - $15"	"7e (MH), 7h (Psychiatric) - $10"	"7c (OT), 7i (PT/ST) - $0"	8b (Prof Radiology) - 0%	"7g (Prof. Other)  - $0; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - 0%	13a (Blood) - $0		16a (Preventive); 16b (Comp. Dental) - $5; 5%	17a1 (Rountine Eye Exam) - $0	17b1 (Non MCR Covered) - $220 limit	18a1 (Hearing Exam Non-covered) - $0	18b (Hearing Aids) - $300 limit	14a (Health Ed & Wellness) - $0	13C OTC - $55/Qtr																0.095566644	0.102853012	35			7.868375856			7.692307692		12.47171946	9.247625079							4.520973947																	NO						0.095427723	0.102703498	34.94912186			7.856937904			7.681125684		12.4535898	9.234182167							4.520973947																		0	0	0	0	0	0.91760648	1.169946085	1.289767383	0	0	0.236862225	0	0	0.000144096	0	0.043860628	0.580909652	0	0	0	0	0	0	0.415767067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6549	0	0.00617118	0	0	0	0	0	0.91760648	1.169946085	1.289767383	0	0	0.236862225	0	0	0.000144096	0	0.043860628	0.580909652	0	0	0	0	0	0	0.415767067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6549	NO																																																																																		0	0	0	0	0	0	0	0	0.91760648	1.169946085	1.289767383	0	0	0.236862225	0	0	0.000144096	0	0.043860628	0.580909652	0	0	0	0	0	0	0.415767067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.6549
H4006_008_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O		V	P	P	P	P	O	O																																																			0	NO						12.68978489	14.98523484	399.0754035			395.2632202					43.25015211	667.9272259							106.2799869																		1a (IP Acute) - $0	1b (IP Psych) - $0	2 (SNF) - $0; 2a2 (Waiver 3 Day) - $0	6a (Home Health) - $0	10a (Ambulance) - $0	11a (Medical Equip) - 10%	"11b (Prosthetics) - 20%, 11c (Diab Supp) - 10%"	"4a (ER) $35 (WW coverage), 4b (UC) - $35 (WW coverage); $0 if hosp. in 24 hrs"	"9a (OP Surgery) - $0, 9b (ASC) - $0"	8a (OP Diag Proc/Test/Lab) - $0	"8b (OP Radiology) - 0%, $20"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA) - $10, 9d (Cardiac Rehab) - $0, 3 (CORF)- $0; 5 (Partial Hospitalization), 9a (OP Other excluding Surgery) - $0"	"7a (PCP) - $0, 14c (Routine Physical) - $0"	"7b (Chiro) - $0, 7d (Spec) - $0, 7f (Pod) - $0; 17a (MCR Eye Exam) - $0; 18a (MCR Hearing Exam) - $0, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $0; 14i (Diab Mon.) - $0; 13b: $15 14A: Alivia - $15"	"7e (MH), 7h (Psychiatric) - $10"	"7c (OT), 7i (PT/ST) - $0"	8b (Prof Radiology) - 0%	"7g (Prof. Other)  - $0; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - 0%	13a (Blood) - $0		16a (Preventive); 16b (Comp. Dental) - $0; 25% Prosthodontics	17a1 (Rountine Eye Exam) - $0	17b1 (Non MCR Covered) - $325 limit	18a1 (Hearing Exam Non-covered) - $0	18b (Hearing Aids) - $550 limit	14a (Health Ed & Wellness) - $0	13C OTC - $75/Qtr																0.1	0.127747454	35			7.785989848					13.00492611	8.832685805							98.66528921																	NO						0.09977422	0.127459026	34.92097715			7.768410674					12.97556364	8.812743406							98.66528921																		0	0	0	0	0	1.266113395	1.910003438	1.161341921	0	0	0.255880585	0	0	0	0	0.046766258	0.490522605	0	0	0	0	0	0	0.873845471	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.0045	0	0.011610123	0	0	0	0	0	1.266113395	1.910003438	1.161341921	0	0	0.255880585	0	0	0	0	0.046766258	0.490522605	0	0	0	0	0	0	0.873845471	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.0045	YES			2 (SNF) - 20%	6a (Home Health) - 20%	10a (Ambulance) - 20%	11a (Medical Equip) - 20%	"11b (Med Supp), 11c (Diab Supp) - 20%"		"9a (OP Surgery) , 9b (ASC) - 20%"	8a (OP Diag Proc/Test/Lab) - 20%	8b (OP Radiology) - 20%	9a (OP Observation) - 20%		"7i, 7c (OP PT/ST/OT), 9c (OP SA) - $10, 9d (Cardiac Rehab), 3 (CORF),  5 (Partial Hospitalization), 9a (OP Other excluding Surgery) - 20%"	"7a (PCP), 14c (Routine Physical) - 20%"	"7b (Chiro) , 7d (Spec), 7f (Pod), 17a (MCR Eye Exam), 18a (MCR Hearing Exam), 16b (Comp Dental), 14j (Nutrition Therap); 14i (Diab Mon.) - 20%"	"7e (MH), 7h (Psychiatric) - 20%"	"7c (OT), 7i (PT/ST) - 20%"	8b (Prof Radiology) - 20%	"7g (Prof. Other), 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - 20%"		13a (Blood) - 20%		16a (Preventive); 16b (Comp. Dental) - 20%; 25% Prosthodontics	17a1 (Rountine Eye Exam) - 20%	17b1 (Non MCR Covered) - $300 limit	18a1 (Hearing Exam Non-covered) - 20%	18b (Hearing Aids) - $500 limit													3400				0.0021	0.1536	0.0372	0.0004		0.0059	0.0001	0.0005			0.0007	0.0962	0.6069		0.0248	0.0225	0.13					0.0005																1.0816	0	0.002447547	0	0	0	0.00213272	0.153561322	1.303349542	1.91045309	1.161341921	0.00590434	0.000117318	0.256340296	0	0	0.000735537	0.096230098	0.653673926	0.490522605	0.024825796	0.022541479	0.130004534	0	0	0	0.873845471	0.000488769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.0861
H4006_013_0	2010	8	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	T	P	P	P	P	P	O	O																																																			0	YES	241.1196579	0.134544248	5.158490113	108.0655005		9.766427613	9.238742183	447.3872001	87.78013564	188.3434075	284.9495897			12.31810855	7580.544541	2620.223498	754.6387494	1787.305043	2652.310771	8834.164665				486.7083137	224.9305725																3400	"1a (IP Acute) - $3, 1a (additional days)"	1b (IP Psych) - $3	2 (SNF) - $3; 2a2 (Waiver 3 Day) - $0	6a (Home Health) - $1	10a (Ambulance) - $0	11a (Medical Equip) - 10%	"11b (Med Supp), 11c (Diab Supp) - 10%"	"4a (ER) $1 (WW coverage), 4b (UC) - $1 (WW coverage)"	9a (OP Surgery) - $1 9b (ASC) - $1	8a (OP Diag Proc/Test/Lab) - $0.5	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - $1, 8b (OP x-rays) - $.5"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA) - $1, 9d (Cardiac Rehab) - $1, 3 (CORF)- $1; 5 (Partial Hospitalization) - $1, 9a (OP Other excluding Surgery) - $0"	"7a (PCP) - $1, 14c (Routine Physical) - $1"	"7b (Chiro) - $1, 7d (Spec) - $1, 7f (Pod) - $1; 17a (MCR Eye Exam) - $1; 18a (MCR Hearing Exam) - $1, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $0; 14i (Diab Mon.) - $0; 13b/14a Alivia - $15"	"7e (MH), 7h (Psychiatric) - $1"	"7c (OT), 7i (PT/ST) - $1"	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - $1, 8b (OP x-rays) - $.5"	"7g (Prof. Other)  - $1; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0; Labs - $0.5"	15 (Part B Rx) - 0%	13a (Blood) - $0	1 Round trip per year	16a (Preventive) - $1; 16b (Comp. Dental) - $0	17a1 (Rountine Eye Exam) - $1	17b1 (Non MCR Covered) - $250/2yr limit	18a1 (Hearing Exam Non-covered) - $1	18b (Hearing Aids) - $300/2yr limit	14a (Health Ed & Wellness) - $0	13C OTC - $25/Qtr											3	3	3	1		0.1	0.1	1	1	0.5	1			1	1	1.085955294	1	1	0.25	0.1				1	1																NO	2.996475711	2.996475711	2.996475711	0.998825237		0.099882524	0.099882524	0.998825237	0.998825237	0.499412619	0.998825237			0.998825237	0.998825237	1.084679554	0.998825237	0.998825237	0.249706309	0.099882524				1	0.998825237																	0.0602	3.36E-05	0.001288108	0.008994879	0	0.975495438	0.922788885	0.037238469	0.007306418	0.007838423	0.023717903	0	0	0.001025303	0.630969933	0.236841905	0.062812686	0.148767115	0.055191561	0.073531555	0	0	0	0.040559026	0.018722194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3133	0	0.003849255	0.0602	3.36E-05	0.001288108	0.008994879	0	0.975495438	0.922788885	0.037238469	0.007306418	0.007838423	0.023717903	0	0	0.001025303	0.630969933	0.236841905	0.062812686	0.148767115	0.055191561	0.073531555	0	0	0	0.040559026	0.018722194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3133	NO																																																																																		0	0	0	0.0602	3.36E-05	0.001288108	0.008994879	0	0.975495438	0.922788885	0.037238469	0.007306418	0.007838423	0.023717903	0	0	0.001025303	0.630969933	0.236841905	0.062812686	0.148767115	0.055191561	0.073531555	0	0	0	0.040559026	0.018722194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.3133
H4006_015_0	2010	8	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	T	P	P	P	P	P	O	O																																																			0	YES	340.3001452	0.295846396	114.5534014	147.9371901		14.6532931	15.83823786	692.9710493	117.8727182	257.3196379	410.935647			16.63104873	11978.17384	4332.192553	1239.570996	3058.572927	4687.232714	13017.41872				597.2877124	314.1903142																3400	"1a (IP Acute) - $3, 1a (additional days)"	1b (IP Psych) - $3	2 (SNF) - $3; 2a2 (Waiver 3 Day) - $0	6a (Home Health) - $1	10a (Ambulance) - $0	11a (Medical Equip) - 10%	"11b (Med Supp), 11c (Diab Supp) - 10%"	"4a (ER) $1 (WW coverage), 4b (UC) - $1 (WW coverage)"	9a (OP Surgery) - $1 9b (ASC) - $1	8a (OP Diag Proc/Test/Lab) - $0.5	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - $1, 8b (OP x-rays) - $.5"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA) - $1, 9d (Cardiac Rehab) - $1, 3 (CORF)- $1; 5 (Partial Hospitalization) - $1, 9a (OP Other excluding Surgery) - $0"	"7a (PCP) - $1, 14c (Routine Physical) - $1"	"7b (Chiro) - $1, 7d (Spec) - $1, 7f (Pod) - $1; 17a (MCR Eye Exam) - $1; 18a (MCR Hearing Exam) - $1, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $0; 14i (Diab Mon.) - $0; 13b/14a Alivia - $15"	"7e (MH), 7h (Psychiatric) - $1"	"7c (OT), 7i (PT/ST) - $1"	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - $1, 8b (OP x-rays) - $.5"	"7g (Prof. Other)  - $1; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0; Labs - $0.5"	15 (Part B Rx) - 0%	13a (Blood) - $0	1 Round trip per year	16a (Preventive) - $1; 16b (Comp. Dental) - $0	17a1 (Rountine Eye Exam) - $1	17b1 (Non MCR Covered) - $250/2yr limit	18a1 (Hearing Exam Non-covered) - $1	18b (Hearing Aids) - $300/2yr limit	14a (Health Ed & Wellness) - $0	13C OTC - $25/Qtr											3	3	3	1		0.1	0.1	1	1	0.5	1			1	1	1.002200095	1	1	0.25	0.1				1	1																NO	2.994588691	2.994588691	2.994588691	0.99819623		0.099819623	0.099819623	0.99819623	0.99819623	0.499098115	0.99819623			0.99819623	0.99819623	1.000392357	0.99819623	0.99819623	0.249549058	0.099819623				1	0.99819623																	0.0849	7.38E-05	0.028586693	0.012305862	0	1.462686194	1.580966932	0.057643424	0.009805009	0.010702312	0.034182868	0	0	0.001383421	0.996380664	0.361157693	0.103111258	0.25442133	0.097474542	0.108282819	0	0	0	0.049773976	0.026135299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.28	0	0.009451163	0.0849	7.38E-05	0.028586693	0.012305862	0	1.462686194	1.580966932	0.057643424	0.009805009	0.010702312	0.034182868	0	0	0.001383421	0.996380664	0.361157693	0.103111258	0.25442133	0.097474542	0.108282819	0	0	0	0.049773976	0.026135299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.28	NO																																																																																		0	0	0	0.0849	7.38E-05	0.028586693	0.012305862	0	1.462686194	1.580966932	0.057643424	0.009805009	0.010702312	0.034182868	0	0	0.001383421	0.996380664	0.361157693	0.103111258	0.25442133	0.097474542	0.108282819	0	0	0	0.049773976	0.026135299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.28
H4006_020_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O		V	P	P	P	P	O	O																																																			0	YES						7.531186576	10.17286779	369.8412849			275.3796733			0.095939675		31.09521718	669.4253673							1012.675101																	3400	1a (IP Acute) - $0	1b (IP Psych) - $0	2 (SNF) - $0; 2a2 (Waiver 3 Day) - $0	6a (Home Health) - $0	10a (Ambulance) - $0	11a (Medical Equip) - 10%	"11b (Med Prosthetics) - 20%, 11c (Diab Supp) - 10%"	"4a (ER) $35 (WW coverage), 4b (UC) - $35 (WW coverage); $0 if hosp. in 24 hrs"	"9a (OP Surgery) - $0, 9b (ASC) - $0"	8a (OP Diag Proc/Test/Lab) - $0	"8b (OP Radiology) - 0%, $20"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA) - $10, 9d (Cardiac Rehab) - $0, 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	"7a (PCP) - $0, 14c (Routine Physical) - $0"	"7b (Chiro) - $0, 7d (Spec) - $0, 7f (Pod) - $0; 17a (MCR Eye Exam) - $0; 18a (MCR Hearing Exam) - $0, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $0; 14i (Diab Mon.) - $0;13b/14a: Alivia - $15"	"7e (MH), 7h (Psychiatric) - $10"	"7c (OT), 7i (PT/ST) - $0"	8b (Prof Radiology) - 0%	"7g (Prof. Other)  - $0; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - 0%	13a (Blood) - $0		16a (Preventive); 16b (Comp. Dental) - $5; 5%	17a1 (Rountine Eye Exam) - $0	17b1 (Non MCR Covered) - $220 limit	18a1 (Hearing Exam Non-covered) - $0	18b (Hearing Aids) - $300 limit	14a (Health Ed & Wellness) - $0	13C OTC - $50/Qtr																0.097247073	0.126838487	35			8.019794278			10		15	10							4.428504982																	NO						0.097115795	0.126667263	34.95275208			8.008968033			9.986500595		14.97975089	9.986500595							4.428504982																		0	0	0	0	0	0.731397172	1.288569318	1.077247562	0	0	0.18379225	0	0	7.98E-05	0	0.038816551	0.557101402	0	0	0	0	0	0	0.373719727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.2507	0	0.0052408	0	0	0	0	0	0.731397172	1.288569318	1.077247562	0	0	0.18379225	0	0	7.98E-05	0	0.038816551	0.557101402	0	0	0	0	0	0	0.373719727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.2507	NO																																																																																		0	0	0	0	0	0	0	0	0.731397172	1.288569318	1.077247562	0	0	0.18379225	0	0	7.98E-05	0	0.038816551	0.557101402	0	0	0	0	0	0	0.373719727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.2507
H4006_022_0	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	P	P	P	P	Coin	Coin	S	O		P	P	P	P	P	O	O																																																			0	YES	227.794495	0.102588968				9.440858701	11.57967543	426.4161472		1.562907564	6.484008297			21.70333645	6282.779846	6486.220394	709.1810955	4627.73068	24.79828652	19.07195335				1138.091294	317.0902126																3400	1a (IP Acute) - $50 per admit	1b (IP Psych) - $50 per admit	2 (SNF) - $0; 2a2 (Waiver 3 Day) - $0	6a (Home Health) - $0	10a (Ambulance) - $0	11a (Medical Equip) - 10%	"11b (Med Prosthetics) - 20%, 11c (Diab Supp) - 10%"	"4a (ER) $35 (WW coverage), 4b (UC) - $35 (WW coverage); $0 if hosp. in 24 hrs"	"9a (OP Surgery) - $0, 9b (ASC) - $0"	8a (OP Diag Proc/Test/Lab) - 10%	8b (Radiology) - 10%	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA) - $15, 9d (Cardiac Rehab) - $0, 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	"7a (PCP) - $10, 14c (Routine Physical) - $0"	"7b (Chiro) - $15, 7d (Spec) - $15, 7f (Pod) - $15; 17a (MCR Eye Exam) - $15; 18a (MCR Hearing Exam) - $15, 16b (Comp Dental) - $15, 14j (Nutrition Therap) - $0; 14i (Diab Mon.) - $0; 14a/13b: $15"	"7e (MH), 7h (Psychiatric) - $15"	"7c (OT), 7i (PT/ST) - $15"	8b (Prof Radiology) - 10%	"7g (Prof. Other)  - $0; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0, Labs/Pathology - 10%"	15 (Part B Rx) - 0%	13a (Blood) - $0		16a (Preventive) - $15; 16b (Comp. Dental) - 15%	17a1 (Rountine Eye Exam) - $15	17b1 (Non MCR Covered) - $220 limit	18a1 (Hearing Exam Non-covered) - $15	18b (Hearing Aids) - $300 limit	14a (Health Ed & Wellness) - $0	13C OTC - $50/Qtr											50	50				0.095584305	0.103693379	35		0.1	0.1			15	10	14.98871303	15	14.98745475	0.1	0.1				13.20797427	15																NO	47.51127978	47.51127978				0.090826653	0.098532103	33.25789585		0.09502256	0.09502256			14.25338393	9.502255956	14.24265877	14.25338393	14.2524048	0.09502256	0.09502256				13.20797427	14.25338393																	0.9019	0.000406178	0	0	0	0.8574816	1.140969775	1.181808651	0	0.148511477	0.616127065	0	0	0.025778832	4.975048518	7.698418646	0.842352536	5.49635758	2.356396658	1.812265823	0	0	0	1.252656711	0.376634045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6831	0	1.484794268	0.9019	0.000406178	0	0	0	0.8574816	1.140969775	1.181808651	0	0.148511477	0.616127065	0	0	0.025778832	4.975048518	7.698418646	0.842352536	5.49635758	2.356396658	1.812265823	0	0	0	1.252656711	0.376634045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6831	NO																																																																																		0	0	0	0.9019	0.000406178	0	0	0	0.8574816	1.140969775	1.181808651	0	0.148511477	0.616127065	0	0	0.025778832	4.975048518	7.698418646	0.842352536	5.49635758	2.356396658	1.812265823	0	0	0	1.252656711	0.376634045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.6831
H4006_803_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	115.5974275		2.681042314		1.740440375	11.1772237	13.79291205	7.973223088	18.99863337	1.84153998	7.012335014	0.387509722	0.039953786	3.613973785	84.56347048	122.6893034	4.011948246	9.984075264	28.21472154	29.49498525	18.33252742	0.203006601																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.152528766		0.157065437		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.152528766		0.157065437		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818	0	0	17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818	NO																																																																																		0	0	0	17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818
H4006_807_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	94.73673831		3.725250785		1.803510183	8.57572336	11.5151864	6.705941066	16.52735697	2.350711892	7.201907733	0.640878879	0.00697462	5.91841313	67.15566381	119.8267654	3.84914891	9.219031695	33.00202527	31.02769404	20.70072214	0.210982589																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.152491081		0.157109599		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.152491081		0.157109599		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				14.4465	0	0.585272657	0	0.420217873	1.998143543	2.683038431	1.562484268	3.850874175	0.547715871	1.678044502	0.149324779	0.001625086	1.378990259	15.64726967	27.91963634	0.896851696	2.148034385	7.689471888	7.229452712	4.823268258	0.049158943	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7054	0	0	14.4465	0	0.585272657	0	0.420217873	1.998143543	2.683038431	1.562484268	3.850874175	0.547715871	1.678044502	0.149324779	0.001625086	1.378990259	15.64726967	27.91963634	0.896851696	2.148034385	7.689471888	7.229452712	4.823268258	0.049158943	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7054	NO																																																																																		0	0	0	14.4465	0	0.585272657	0	0.420217873	1.998143543	2.683038431	1.562484268	3.850874175	0.547715871	1.678044502	0.149324779	0.001625086	1.378990259	15.64726967	27.91963634	0.896851696	2.148034385	7.689471888	7.229452712	4.823268258	0.049158943	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7054
H4006_809_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	115.5974275		2.681042314		1.740440375	11.1772237	13.79291205	7.973223088	18.99863337	1.84153998	7.012335014	0.387509722	0.039953786	3.613973785	84.56347048	122.6893034	4.011948246	9.984075264	28.21472154	29.49498525	18.33252742	0.203006601																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.152528766		0.157065437		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.152528766		0.157065437		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818	0	0	17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818	NO																																																																																		0	0	0	17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818
H4006_811_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	115.5974275		2.681042314		1.740440375	11.1772237	13.79291205	7.973223088	18.99863337	1.84153998	7.012335014	0.387509722	0.039953786	3.613973785	84.56347048	122.6893034	4.011948246	9.984075264	28.21472154	29.49498525	18.33252742	0.203006601																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.152528766		0.157065437		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.152528766		0.157065437		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818	0	0	17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818	NO																																																																																		0	0	0	17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818
H4006_813_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	115.5974275		2.681042314		1.740440375	11.1772237	13.79291205	7.973223088	18.99863337	1.84153998	7.012335014	0.387509722	0.039953786	3.613973785	84.56347048	122.6893034	4.011948246	9.984075264	28.21472154	29.49498525	18.33252742	0.203006601																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.152528766		0.157065437		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.152528766		0.157065437		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818	0	0	17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818	NO																																																																																		0	0	0	17.6319	0	0.421099083	0	0.405522607	2.604293123	3.213748508	1.85776098	4.426681574	0.429078815	1.633874058	0.090289765	0.009309232	0.842055892	19.70328862	28.58660769	0.934783941	2.326289536	6.574030119	6.872331564	4.271478889	0.047300538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.8818
H4007_002_0	2010	4	N/A	r.	s.	t.								Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)																		D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			S	Coin	T	Coin	V		V		O	O	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	NO	1752.5519	59.09969186	0	125.2959789	180.4915057	9972.857164	37652.60337	1115.74883	154.1964376	1845.750676	2232.094555	3.908916294	32.75063751	524.8414373	6031.602834	5742.357172	88.93694527	850.7793745			1144.713256	0	2.32	8.57	1.5		0.09		0.04	0.85	0.05	0.55	1.42									$90/Day(Days 1-1):1a	$90/Day(Days 1-1):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$0/Trip:10a	0% Coins:11a	0% Coins:11b	$50/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		TRN045: Transportation 10b	"DEN841: Dental 16a, 16b"	"VIS734: Vision 7a, 7b"		"HER756: Hearing 18a, 18b"		$0: Nurse hotline 14a	NMW001: Nutritional benefit 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a								90	90	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								NO	90	90	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									13.1441	0.443247689	0	0	0	0	0	4.64895346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2363	0	0	13.1441	0.443247689	0	0	0	0	0	4.64895346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2363	NO																																																																																		0	0	0	13.1441	0.443247689	0	0	0	0	0	4.64895346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2363
H4007_005_0	2010	3	N/A	r.	s.	t.								Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)																		D	D	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	O	T	Coin	V		V		O	O	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	NO	1752.5519	59.09969186	0	125.2959789	180.4915057	9972.857164	37652.60337	1115.74883	154.1964376	1845.750676	2232.094555	3.908916294	32.75063751	524.8414373	6031.602834	5742.357172	88.93694527	850.7793745			1144.713256	0	2.32	8.57	1.5		0.09		0.04	0.85	0.05	0.55	1.42									$90/Day(Days 1-5):1a	$90/Day(Days 1-5):1b	$0/Admit(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	$0/Service:11b	$50/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		TRN045: Transportation 10b	"DEN841: Dental 16a, 16b"	"VIS734: Vision 7a, 7b"		"HER756: Hearing 18a, 18b"		$0: Nurse hotline 14a	NMW001: Nutritional benefit 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a								90	90	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								NO	90	90	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									13.1441	0.443247689	0	0	0	0	0	4.64895346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2363	0	0	13.1441	0.443247689	0	0	0	0	0	4.64895346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2363	NO																																																																																		0	0	0	13.1441	0.443247689	0	0	0	0	0	4.64895346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2363
H4007_010_0	2010	4	N/A	r.	s.	t.								Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)																		D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	O							O		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	YES	1079.977675	0	0	71.530142	78.074583	1464.371159	17764.21797	517.166689	145.782331	2875.184954	1789.256881	0	0.768687	173.743968	6236.561907	4441.606389	0.974468	1012.088217			894.696334	0							0.04		0.05		1.42								5000	$95/Day(Days 1-10):1a	$95/Day(Days 1-10):1b	"$0/Day(Days 1-100) $25(Days 101-100):2. $0 SNF 1,2. $25 SNF 2"	$0/Visit:6	$15/Trip:10a	$0/Service:11a	$0/Service:11b	$35/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0-$25/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,9a. $25 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$0/Visit:9a	"$0-$15/Proc:12. $0 Dialysis -- Dialysis Center,12. $15 Dialysis -- OP Hosp"	"$0-$15/Visit:9d. $0 Cardiac Rehab,8b. $0 Nuclear Medicine,9a. $0 OP Other,5. $15 Partial Hospitalization,7h. $0 Psych -- OP,8b. $0 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	"$0-$15/Visit:7i. $0 Therapy (AT,PT,ST,OT) -- OP,7i. $15 Therapy (AT,PT,ST,OT) - Specialist"			$0/Script:15								$0: Nurse hotline 14a		$0: Additional Smoking Cessation 14a		$0: Membership in health club/fitness class 14a								75.561575	0	0	0	15	0	0	35	0	0	1.718955	0	0	0	0	15	15	13.649175			0	0							0		0	0	0								NO	74.306875	0	0	0	14.5707	0	0	33.9983	0	0	1.669759	0	0	0	0	14.5707	14.5707	13.258536			0	0							0		0	0	0									6.6875	0	0	0	0.094800111	0	0	1.465232354	0	0	0.248968982	0	0	0	0	5.393109518	0.001183223	1.118234005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.009	0	0.358099	6.6875	0	0	0	0.094800111	0	0	1.465232354	0	0	0.248968982	0	0	0	0	5.393109518	0.001183223	1.118234005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.009	NO																																																																																		0	0	0	6.6875	0	0	0	0.094800111	0	0	1.465232354	0	0	0.248968982	0	0	0	0	5.393109518	0.001183223	1.118234005	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.009
H4007_012_0	2010	3	N/A	r.	s.	t.	u.	v.						Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																D	D	D	V	T	O	O	V	V	V	V	Coin	P	V	V	V	V	V			S	O	T	Coin	V		V		O	O	O	O	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	YES	1593.050046	54.794678	732.05149	1080.4358	215.508232	1610.501698	6080.462265	354.961535	286.33623	1123.883663	1359.129723	2.380152	19.941971	319.577679	4604.435471	4383.629655	67.893135	649.472261			2210.78304	0	2.32	8.57	1.5		0.09		0.04	0.09	0.05	0.55	1.42	0.85	3.21						3400	$0/Day(Days 1-1):1a	$0/Day(Days 1-1):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	$0/Service:11b	$10/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	20% Coins:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15		TRN045: $0 Other - Transportation 10b	"DEN841: Dental 16a, 16b"	"VIS734: Vision 7a, 7b"		"HER756: Hearing 18a, 18b"		$0: Nurse hotline 14a	Assist America: Emergency Care 4a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	NMW001: Nutritional benefit 14a	OTC001 (PR): $0 OTC items 13c						0	0	0	0	0	0	0	10	0	0	0	0.2	0	0	0	0	0	0			0	0	0	0	0		0		0	0	0	0	0	0	0						NO	0	0	0	0	0	0	0	9.98803	0	0	0	0.199761	0	0	0	0	0	0			0	0	0	0	0		0		0	0	0	0	0	0	0							0	0	0	0	0	0	0	0.295447205	0	0	0	0.475461544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7709	0	0.000923	0	0	0	0	0	0	0	0.295447205	0	0	0	0.475461544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7709	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0.295447205	0	0	0	0.475461544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7709
H4007_801_0	2010	3	N/A																															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	NO	131.437992	0.808844	12.6599	6.124027	2.982977	2.903115	1.227062	12.017085	33.975062	4.885372	16.01746	2.479701	0.528712	8.75119	40.569566	50.327276	0.17606	3.422763			12.937684	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																			0.153186312	0.153186312	0.154644817	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.153186312	0.153186312	0.154644817	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.1345	0.12390383	1.957787915	0	0.695033641	0.676425795	0.285905446	2.799980805	7.916189446	1.138291676	3.73206818	0.577770333	0.123189896	2.03902727	9.452708878	11.72625531	0.04102198	0.797503779	0	0	3.014480372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.232	0	0	20.1345	0.12390383	1.957787915	0	0.695033641	0.676425795	0.285905446	2.799980805	7.916189446	1.138291676	3.73206818	0.577770333	0.123189896	2.03902727	9.452708878	11.72625531	0.04102198	0.797503779	0	0	3.014480372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.232	NO																																																																																		0	0	0	20.1345	0.12390383	1.957787915	0	0.695033641	0.676425795	0.285905446	2.799980805	7.916189446	1.138291676	3.73206818	0.577770333	0.123189896	2.03902727	9.452708878	11.72625531	0.04102198	0.797503779	0	0	3.014480372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.232
H4007_802_0	2010	2	N/A																															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	NO	131.437992	0.808844	12.6599	6.124027	2.982977	2.903115	1.227062	12.017085	33.975062	4.885372	16.01746	2.479701	0.528712	8.75119	40.569566	50.327276	0.17606	3.422763			12.937684	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																			0.153186455	0.153186455	0.154645723	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.153186455	0.153186455	0.154645723	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.1345	0.123903945	1.957799391	0	0.695033641	0.676425795	0.285905446	2.799980805	7.916189446	1.138291676	3.73206818	0.577770333	0.123189896	2.03902727	9.452708878	11.72625531	0.04102198	0.797503779	0	0	3.014480372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2321	0	0	20.1345	0.123903945	1.957799391	0	0.695033641	0.676425795	0.285905446	2.799980805	7.916189446	1.138291676	3.73206818	0.577770333	0.123189896	2.03902727	9.452708878	11.72625531	0.04102198	0.797503779	0	0	3.014480372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2321	NO																																																																																		0	0	0	20.1345	0.123903945	1.957799391	0	0.695033641	0.676425795	0.285905446	2.799980805	7.916189446	1.138291676	3.73206818	0.577770333	0.123189896	2.03902727	9.452708878	11.72625531	0.04102198	0.797503779	0	0	3.014480372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2321
H4007_803_0	2010	2	N/A																															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	NO	131.437992	0.808844	12.6599	6.124027	2.982977	2.903115	1.227062	12.017085	33.975062	4.885372	16.01746	2.479701	0.528712	8.75119	40.569566	50.327276	0.17606	3.422763			12.937684	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																			0.153186455	0.153186455	0.154645723	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.153186455	0.153186455	0.154645723	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.1345	0.123903945	1.957799391	0	0.695033641	0.676425795	0.285905446	2.799980805	7.916189446	1.138291676	3.73206818	0.577770333	0.123189896	2.03902727	9.452708878	11.72625531	0.04102198	0.797503779	0	0	3.014480372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2321	0	0	20.1345	0.123903945	1.957799391	0	0.695033641	0.676425795	0.285905446	2.799980805	7.916189446	1.138291676	3.73206818	0.577770333	0.123189896	2.03902727	9.452708878	11.72625531	0.04102198	0.797503779	0	0	3.014480372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2321	NO																																																																																		0	0	0	20.1345	0.123903945	1.957799391	0	0.695033641	0.676425795	0.285905446	2.799980805	7.916189446	1.138291676	3.73206818	0.577770333	0.123189896	2.03902727	9.452708878	11.72625531	0.04102198	0.797503779	0	0	3.014480372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2321
H4008_001_0	2010	5	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Part B Rx																	A	A	A	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			Coin	O					V		O	O	O	O	O	S							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0					0		0	0	0	0	0	0							0	YES	258.837604	8.496431	35.014416	447.726005	162.022341	10894.67765	13458.80413	511.444976	325.692426	2740.438626	1369.380951	81.127488	21.867891	780.68588	5032.703711	4979.677786	71.584206	1128.447942			3.585313	0					0.47		0.04	0.09	0.05	0.55	1.42	1040.575729							3400	$175/Admit:1a	$175/Admit:1b	$0/Admit(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$15/Trip:10a	$0/Service:11a	$0/Service:11b	$35/Visit:4a	"$0-$10/Visit:9b. $0 Surgery ASC -- Physician,9b. $0 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $10 Surgery OP -- Facility"	"$0-$10/Visit:8a. $0 Lab -- FSL,8a. $10 Lab -- OP"	"$0-$15/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $0 Advanced Imaging -- FSR,8b. $10 Advanced Imaging -- Office,9a. $15 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $10 Radiology OP -- Facility"	$10/Visit:9a	$0/Proc:12	"$10/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$10/Visit:7b, 7d, 7f"	$10/Visit:7e	$10/Visit:7i			20% Coins:15						"HER809: Hearing 18a, 18b"		$0: Nurse hotline 14a	Assist America: Emergency Care 4a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0/Script:15							175	175	0	0	15	0	0	35	6.61625	4.143964	6.076391	10	0	10	0	10	10	10			0.2	0					0		0	0	0	0	0	0							NO	171.799075	171.799075	0	0	14.502945	0	0	33.840205	6.397007	4.006645	5.875038	9.66863	0	9.66863	0	9.66863	9.66863	9.66863			0.193373	0					0		0	0	0	0	0	0								3.7057	0.121639916	0	0	0.195816758	0	0	1.44228357	0.173621394	0.91499706	0.670430427	0.065365972	0	0.629013577	0	4.012221836	0.057676767	0.909212135	0	0	0.693302731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5913	0	0.405947	3.7057	0.121639916	0	0	0.195816758	0	0	1.44228357	0.173621394	0.91499706	0.670430427	0.065365972	0	0.629013577	0	4.012221836	0.057676767	0.909212135	0	0	0.693302731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5913	NO																																																																																		0	0	0	3.7057	0.121639916	0	0	0.195816758	0	0	1.44228357	0.173621394	0.91499706	0.670430427	0.065365972	0	0.629013577	0	4.012221836	0.057676767	0.909212135	0	0	0.693302731	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5913
H4008_801_0	2010	3	N/A																															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	NO	300.999364	2.311476	53.386621	21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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																			0.079182523	0.079182523	0.160171602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079182523	0.079182523	0.160171602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415	0	0	23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415	NO																																																																																		0	0	0	23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415
H4008_802_0	2010	3	N/A																															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	NO	300.999364	2.311476	53.386621	21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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																			0.079182523	0.079182523	0.160171602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079182523	0.079182523	0.160171602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415	0	0	23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415	NO																																																																																		0	0	0	23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415
H4008_803_0	2010	3	N/A																															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	NO	300.999364	2.311476	53.386621	21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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																			0.079182523	0.079182523	0.160171602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079182523	0.079182523	0.160171602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415	0	0	23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415	NO																																																																																		0	0	0	23.8339	0.183028501	8.551020592	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6415
H4008_805_0	2010	4	N/A																																		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	NO				21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	NO																																																																																		0	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735
H4008_806_0	2010	4	N/A																																		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	NO				21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	NO																																																																																		0	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735
H4008_807_0	2010	4	N/A																																		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	NO				21.311769	8.316958	13.143028	5.005396	22.101673	79.784211	17.135288	36.502835	5.416219	2.056657	24.382219	39.931235	80.620881	0.500348	9.79434			41.890379	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735	NO																																																																																		0	0	0	0	0	0	0	1.937851214	3.062325524	1.166257268	5.149689809	18.58972116	3.992522104	8.505160555	1.261979027	0.479201081	5.681057027	9.303977755	18.78466527	0.116581084	2.28208122	0	0	9.760458307	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0735
H4009_002_0	2010	14	N/A																															Coin	Coin	Coin	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	Coin	V	Coin	V	S	O	T	V	V	Coin	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	0	0	0	0	0											0	YES	95.59328537	0.940674494	6.320355181	409.4990446	100.7782705	7.222511163	8.129934291	267.0662399	90.34982159	2.190295923	10.45089076	0	32.41296918	189.9618365	12107.86024	14540.56491	1.02888173	860.4654064	23.68045174	18265.66388	66.72284437	12.50771438	500	1078.271894	416.6473826	3.610135495	32.07085917	3.78543117	30041.30864	6605.117223											3400	"$0 copay, days 1-1"	"$0 copay, days 1-1"	"$0 copay, days 1-1"	$0 copay	$0 copay	10% coinsurance	10% coinsurance	"$25 copay, waived if admitted"	$0 copay	$0 copay to 10% coinsurance	10% coinsurance	$0 copay	$0 copay	Varies	$0 copay	$0 copay	"20% coinsurance Group, 20% coinsurance Individual"	$10 copay	10% coinsurance	Varies	$0 copay	Varies	$0 copay	$0 copay	$0 copay	$0 copay; and $150 credit covered every 1years	$0 copay	$100 credit	Varies	Varies											0	0	0	0	0	0.1	0.1	22.5	0	0	0.1	0	0	6.28468372	0.019672414	0.023147358	0.2	10	0.078022624	0.343713209	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.099981837	0.099989243	22.5	0	0	0.099987448	0	0	6.27915925	0.019554271	0.023029215	0.2	10	0.078015238	0.343655754	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0.722119937	0.812905976	0.5007492	0	0	1.044957896	0	0	0.099400052	0.019730032	0.027904816	0.205776346	0.717054505	1.847436079	0.523091708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5211		0.001749064	0	0	0	0	0	0.722119937	0.812905976	0.5007492	0	0	1.044957896	0	0	0.099400052	0.019730032	0.027904816	0.205776346	0.717054505	1.847436079	0.523091708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5211	NO																																																																																		0			0	0	0	0	0	0.722119937	0.812905976	0.5007492	0	0	1.044957896	0	0	0.099400052	0.019730032	0.027904816	0.205776346	0.717054505	1.847436079	0.523091708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.5211
H4009_007_0	2010	12	N/A																															D	D	Coin	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	Coin	V	Coin	V	S	O	T	V	V	Coin	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	0	0	0	0	0											0	YES	1846.804529	146.4194199	10.91688567	141.0084469	177.7165978	17.54172126	21.1547376	556.1999848	104.0328986	2.461045401	11.68576102	0	245.4745437	148.8978137	16300.60911	15995.75354	3.470909155	1232.490508	18.63064068	18053.66658	58.67005658	8.071013075	2000	1078.271894	699.9946558	4.53425204	2.614255871	0.456441284	30000	7482.496479											3400	"$3 copay, days 1-100"	"$3 copay, days 1-100"	"$0 copay, days 1-1"	$0 copay	$0 copay	10% coinsurance	10% coinsurance	"$25 copay, waived if admitted"	$1.001 copay to $0 copay	$0 copay to $10 copay	10% coinsurance to $20 copay	$0 copay	$0 copay	Varies	$1 copay	$1 copay	"20% coinsurance Group, 20% coinsurance Individual"	$10 copay	10% coinsurance	Varies	$0 copay	Varies	$0 copay	$0 copay	$0 copay	$0 copay; and $150 credit covered every 1years	$0 copay	$200 credit	Varies	Varies											2.605309091	2.822145594	0	0	0	0.1	0.1	22.5	0.333638312	0	0.113691704	0	0	3.162472354	0.696332344	0.73830859	0.2	10	0.066592159	0.153261763	0	0	0	0	0	0	0	0	0	0											NO	2.576115462	2.822145594	0	0	0	0.099903952	0.099946904	22.5	0.139295007	0	0.113547525	0	0	3.071948987	0.695080308	0.737056554	0.2	10	0.06647158	0.15251517	0	0	0	0	0	0	0	0	0	0												0.3965	0.034434743	0	0	0	1.752487285	2.114350533	1.042874972	0.001207605	0	1.326889239	0	0	0.038117207	0.944186034	0.982481249	0.694181831	1.027075423	1.23840813	0.229454836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.8226		0.022464553	0.3965	0.034434743	0	0	0	1.752487285	2.114350533	1.042874972	0.001207605	0	1.326889239	0	0	0.038117207	0.944186034	0.982481249	0.694181831	1.027075423	1.23840813	0.229454836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.8226	NO																																																																																		0			0.3965	0.034434743	0	0	0	1.752487285	2.114350533	1.042874972	0.001207605	0	1.326889239	0	0	0.038117207	0.944186034	0.982481249	0.694181831	1.027075423	1.23840813	0.229454836	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.8226
H4009_008_0	2010	12	N/A																															Coin	Coin	Coin	V	T	P	P	V	V	Coin	Coin	V	V	V	V	V	Coin	V	Coin	V	S	O	T	V	V	Coin	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	0	0	0	0	0											0	YES	89.35880378	0.880443457	5.995447607	1513.82337	212.4075974	5618.25175	6053.754346	144.4695796	146.9324056	2.037261163	9.712241043	0	50.89712092	298.8744053	7217.613036	8626.301129	1.02517041	537.7514281	21.85472536	10840.88331	92.93582888	45.82620451	500	1078.271894	379.7730556	8.103924231	135.4102556	15.82276953	30203.84582	7521.636668											3400	"$0 copay, days 1-7"	"$0 copay, days 1-7"	"$0 copay, days 1-7"	$0 copay	$0 copay	$0 copay	$0 copay	"$25 copay, waived if admitted"	$0 copay	$0 copay to 10% coinsurance	10% coinsurance	$0 copay	$0 copay	Varies	$0 copay	$0 copay	"$0 copay Group, $0 copay Individual"	$0 copay	10% coinsurance	Varies	$0 copay	Varies	$0 copay	$0 copay	$0 copay	$0 copay; and $350 credit covered every 1years	$0 copay	$500 credit	Varies	Varies											0	0	0	0	0	0	0	22.5	0	0	0.1	0	0	0	0.019667161	0.023252428	0	0	0.078027789	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	22.5	0	0	0.1	0	0	0	0.019667161	0.023252428	0	0	0.078027789	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0.270880462	0	0	0.971224104	0	0	0	0.011829163	0.016715204	0	0	1.705275902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.9759		0	0	0	0	0	0	0	0	0.270880462	0	0	0.971224104	0	0	0	0.011829163	0.016715204	0	0	1.705275902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.9759	NO																																																																																		0			0	0	0	0	0	0	0	0.270880462	0	0	0.971224104	0	0	0	0.011829163	0.016715204	0	0	1.705275902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.9759
H4009_013_0	2010	11	N/A																															Coin	Coin	Coin	V	T	P	P	V	V	Coin	Coin	V	V	V	V	V	Coin	V	Coin	V	S	O	T	V	V	Coin	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	0	0	0	0	0											0	YES	97.64245707	0.962384599	6.414396263	1450.034389	231.4067131	7978.972444	8597.467906	229.3897118	153.9087605	2.200423732	10.37785314	0	56.01343696	328.5133842	9249.682104	11042.9353	1.018533547	628.5672881	23.0257089	13802.89797	99.12916144	39.6549254	500	1078.271894	453.1611889	2.385198959	125.5990332	14.74963836	30175.69769	1341.309931											3400	"$0 copay, days 1-1"	"$0 copay, days 1-1"	"$0 copay, days 1-1"	$0 copay	$0 copay	$0 copay	$0 copay	"$25 copay, waived if admitted"	$0 copay	$0 copay to 20% coinsurance	20% coinsurance	$0 copay	$0 copay	Varies	$0 copay	$0 copay	"10% coinsurance Group, 10% coinsurance Individual"	$10 copay	20% coinsurance	Varies	$0 copay	Varies	$0 copay	$0 copay	$0 copay	$0 copay; and $100 credit covered every 1years	$0 copay	$200 credit	Varies	Varies											0	0	0	0	0	0	0	22.5	0	0	0.2	0	0	6.287617195	0.019668536	0.02327941	0.1	10	0.155535298	0.326311406	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	22.5	0	0	0.19995579	0	0	6.276444317	0.019125909	0.022736783	0.1	10	0.155508731	0.326045488	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0.43010571	0	0	2.075111823	0	0	0.171824664	0.014742382	0.020923402	0.101853355	0.523806073	3.580698762	0.37503105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.2941		0.0061174	0	0	0	0	0	0	0	0.43010571	0	0	2.075111823	0	0	0.171824664	0.014742382	0.020923402	0.101853355	0.523806073	3.580698762	0.37503105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.2941	NO																																																																																		0			0	0	0	0	0	0	0	0.43010571	0	0	2.075111823	0	0	0.171824664	0.014742382	0.020923402	0.101853355	0.523806073	3.580698762	0.37503105	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.2941
H4009_014_0	2010	12	N/A																															D	D	Coin	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	Coin	V	Coin	V	S	O	T	V	V	Coin	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	0	0	0	0	0											0	YES	1234.659776	30.42482866	6.638128511	2207.098894	287.49054	8.011239054	9.017036337	155.6733673	185.7382917	2.281385951	10.88574951	0	64.38015136	377.3015775	7567.410218	8998.772118	1.053941006	519.5764134	23.62924065	11239.09625	117.4229927	57.83520535	500	1078.271894	437.1270469	2.479317454	187.340163	21.81775025	30250	1649.925249											3400	"$50 copay, days 1-1"	"$50 copay, days 1-1"	"$0 copay, days 1-7"	$0 copay	$0 copay	10% coinsurance	10% coinsurance	"$25 copay, waived if admitted"	$0 copay	$0 copay to 10% coinsurance	10% coinsurance	$0 copay	$0 copay	Varies	$0 copay	$0 copay	"10% coinsurance Group, 10% coinsurance Individual"	$10 copay	10% coinsurance	Varies	$0 copay	Varies	$0 copay	$0 copay	$0 copay	$0 copay; and $100 credit covered every 1years	$0 copay	$100 credit	Varies	Varies											9.090909091	6.385696041	0	0	0	0.1	0.1	22.5	0	0	0.1	0	0	6.284581478	0.019652824	0.023353213	0.1	10	0.078033608	0.334654321	0	0	0	0	0	0	0	0	0	0											NO	9.08190149	6.385696041	0	0	0	0.099956618	0.099974305	22.5	0	0	0.099968074	0	0	6.27721249	0.019149329	0.022849718	0.1	10	0.078013997	0.334406941	0	0	0	0	0	0	0	0	0	0												0.9344	0.016190309	0	0	0	0.800776364	0.90147194	0.291887564	0	0	1.08822741	0	0	0.197366848	0.012075902	0.017134951	0.105394101	0.432980345	1.843411516	0.31320265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9545		0	0.9344	0.016190309	0	0	0	0.800776364	0.90147194	0.291887564	0	0	1.08822741	0	0	0.197366848	0.012075902	0.017134951	0.105394101	0.432980345	1.843411516	0.31320265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9545	NO																																																																																		0			0.9344	0.016190309	0	0	0	0.800776364	0.90147194	0.291887564	0	0	1.08822741	0	0	0.197366848	0.012075902	0.017134951	0.105394101	0.432980345	1.843411516	0.31320265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.9545
H4009_801_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	Coin	V	Coin	O	T	V	Coin	V	Coin	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	0	0	0	0	0											0	YES	94.37551418	0.933950692	6.287868801	1990.062195	6.683710104	6.942421315	7.839293184	3.949924013	10.97033365	2.080057159	10.06333199	0	0.41172189	359.9276706	39.99120048	72.90993195	1.017507371	3.583185999	22.19567784	10128.65951	2.423893245	54.96989892	0	0	2.364882092	0	0.621167904	0	30000	2110.403207											3400	20% copay	20% copay	"20% copay, days 21-100"	$0 copay	20% coinsurance	20% coinsurance	20% coinsurance	"20% coinsurance, waived if admitted"	20% coinsurance	$0 copay to 20% coinsurance	20% coinsurance	$0 copay	20% coinsurance	Varies	20% coinsurance	20% coinsurance	"20% coinsurance Group, 20% coinsurance Individual"	20% coinsurance	20% coinsurance	Varies	20% coinsurance	Varies	Not Covered	Not Covered	20% coinsurance	Not Covered	20% coinsurance	Not Covered	Varies	Varies											0.163674393	0.197957099	0.063605732	0	0.2	0.2	0.2	0.178297628	0.2	0	0.2	0	0.2	45.38986207	0.198596403	0.19287001	0.2	0.2	0.2	2.176861155	0.2	52.12414317	0	0	0.2	0	0.2	0	0	0.853112019											NO	0.148439317	0.197957099	0	0	0.2	0.122335194	0.154147073	0.178297628	0.15085092	0	0.146421145	0	0.2	33.38349261	0.186293715	0.184827699	0.2	0.2	0.167610403	1.750994887	0.2	52.12414317	0	0	0.2	0	0.2	0	0	0.853112019												14.009	0.184882169	0	0	1.336742021	0.84930246	1.208404101	0.704262084	1.654884926	0	1.473484594	0	0.082344378	1.001303561	7.450109296	13.47577496	0.203501474	0.7166372	3.720226497	1.477935918	0.484778649	0.238771573	0	0	0.472976418	0	0.124233581	0	0	0.150034195	0	0	0	0	0	0	0	0	0	0	51.0196		7.18909071	14.009	0.184882169	0	0	1.336742021	0.84930246	1.208404101	0.704262084	1.654884926	0	1.473484594	0	0.082344378	1.001303561	7.450109296	13.47577496	0.203501474	0.7166372	3.720226497	1.477935918	0.484778649	0.238771573	0	0	0.472976418	0	0.124233581	0	0	0.150034195	0	0	0	0	0	0	0	0	0	0	51.0196	NO																																																																																		0			14.009	0.184882169	0	0	1.336742021	0.84930246	1.208404101	0.704262084	1.654884926	0	1.473484594	0	0.082344378	1.001303561	7.450109296	13.47577496	0.203501474	0.7166372	3.720226497	1.477935918	0.484778649	0.238771573	0	0	0.472976418	0	0.124233581	0	0	0.150034195	0	0	0	0	0	0	0	0	0	0	51.0196
H4011_001_0	2010	4	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	O	O	O	O	V	O	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	NO	0	0	0	0	0	0	0	369.9943898	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												"$0; PBP 1a, 1b"		$0; PBP 2	$0; PBP 6	$0; PBP 10a	$0; PBP 11a	"$0; PBP 11b, 11c"	$25; PBP 4a	"$0; PBP 9a, 9b"	$0; PBP 8a	"$0; PBP 7d, 8b"				"$0; PBP 4b, 7a, 14b-j"	"$0; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$0; PBP 7e, 7h"	"$0; PBP 7c, 7i"		"$0; PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	$0; PBP 15		$0; PBP 10b	"$0; PBP 16a, 16b"	$0; PBP 17a	$0; PBP 17b	$0; PBP 18a	$0; PBP 18b	$0; PBP 14a	$0; PBP 13b-e											0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0.770821645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7708	0	0	0	0	0	0	0	0	0	0.770821645	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7708	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.2353	0	0	0.01	0.091	0.7203	0.2134	0.085	0.0185	0.1858	0.1565	0	0	0	0.4809	0.2808	0	0.0419	0	0.4377	0.0022	0	0	0.0087	0	0	0.0034	0.0028	0	0											2.9742	0	0	0.2353	0	0	0.009972492	0.091024023	0.720325873	0.213400878	0.855782164	0.018539598	0.185827095	0.15647514	0	0	0	0.480905674	0.280801425	0	0.041936221	0	0.437740282	0.002204576	0	0	0.008673261	0	0	0.003353975	0.002768923	0	0	0	0	0	0	0	0	0	0	0	0	3.745
H4011_003_0	2010	6	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	O	O	O	O	V	O	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	NO	0	0	0	0	0	0	0	318.8905612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												"$0; PBP 1a, 1b"		$0; PBP 2	$0; PBP 6	$0; PBP 10a	$0; PBP 11a	"$0; PBP 11b, 11c"	$25; PBP 4a	"$0; PBP 9a, 9b"	$0; PBP 8a	"$0; PBP 7d, 8b"				"$0; PBP 4b, 7a, 14b-j"	"$0; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$0; PBP 7e, 7h"	"$0; PBP 7c, 7i"		"$0; PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	$0; PBP 15		$0; PBP 10b	"$0; PBP 16a, 16b"	$0; PBP 17a	$0; PBP 17b	$0; PBP 18a	$0; PBP 18b	$0; PBP 14a	$0; PBP 13b-e											0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0.664355336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.6644	0	0	0	0	0	0	0	0	0	0.664355336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.6644	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.2916	0	0	0.0097	0.1005	0.6654	0.1729	0.0472	0.018	0.2047	0.1363	0	0	0	0.5166	0.2743	0	0.0407	0	0.4354	0.0021	0	0	0.0293	0	0	0.0033	0.0037	0	0											2.9517	0	0	0.2916	0	0	0.009686088	0.100483548	0.66543734	0.172946675	0.711524952	0.018007151	0.204680028	0.136269921	0	0	0	0.516564208	0.274330556	0	0.040731837	0	0.435354105	0.002141262	0	0	0.029308205	0	0	0.00325765	0.003723357	0	0	0	0	0	0	0	0	0	0	0	0	3.616
H4011_004_0	2010	6	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	O	O	O	O	V	O	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	NO	0	0	0	0	0	0	0	461.628127	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												"$0; PBP 1a, 1b"		$0; PBP 2	$0; PBP 6	$0; PBP 10a	$0; PBP 11a	"$0; PBP 11b, 11c"	$25; PBP 4a	"$0; PBP 9a, 9b"	$0; PBP 8a	"$0; PBP 7d, 8b"				"$0; PBP 4b, 7a, 14b-j"	"$0; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$0; PBP 7e, 7h"	"$0; PBP 7c, 7i"		"$0; PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	$0; PBP 15		$0; PBP 10b	"$0; PBP 16a, 16b"	$0; PBP 17a	$0; PBP 17b	$0; PBP 18a	$0; PBP 18b	$0; PBP 14a	$0; PBP 13b-e											0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0.961725265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.9617	0	0	0	0	0	0	0	0	0	0.961725265	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.9617	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.1778	0	0	0.0049	0.0707	0.6429	0.248	0.0738	0.0354	0.2501	0.1455	0	0	0	0.8979	0.3693	0	0.0921	0	0.6337	0.0046	0	0	0.0298	0	0	0.0016	0.0052	0	0											3.6833	0	0	0.1778	0	0	0.004854624	0.070731286	0.6428643	0.248029855	1.035515918	0.035443183	0.250120272	0.145453495	0	0	0	0.897884031	0.369296568	0	0.092071472	0	0.633746188	0.00460789	0	0	0.029782107	0	0	0.00163272	0.00517939	0	0	0	0	0	0	0	0	0	0	0	0	4.6451
H4011_801_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_802_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_803_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_805_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_806_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_807_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_809_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_810_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_811_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	58.97442155	0	0.175831201	5.411532549	0.542632888	11.08680107	0.641098793	3.733783892	9.019353435	22.56268408	20.62255694	0	0	0	74.16936116	21.21428794	1.061112633	8.272169087	0.001104351	102.1813545	6.190348963	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152347319	0	0.149261198	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152347319	0	0.149261198	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												8.9846	0	0.026244776	0	0.126433463	2.583224648	0.149376019	0.869971647	2.10150935	5.257105391	4.805055766	0	0	0	17.28146115	4.94292909	0.247239244	1.927415397	0.000257314	23.80825561	1.442351308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5534	0	0	8.9846	0	0.026244776	0	0.126433463	2.583224648	0.149376019	0.869971647	2.10150935	5.257105391	4.805055766	0	0	0	17.28146115	4.94292909	0.247239244	1.927415397	0.000257314	23.80825561	1.442351308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5534	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5606	0	0	0	0.1073	1.0628	0.8177	0.0528	0.0186	0.3199	0.1382	0	0	0	0.7598	0.4557	0	0.068	0	0.6278	0.0022	0	0	0	0	0	0	0	0	0											4.9914	0	0	9.5452	0	0.026244776	0	0.233696202	3.646065681	0.967063357	0.922761239	2.120122226	5.576994205	4.94326796	0	0	0	18.04123123	5.398599694	0.247239244	1.99545378	0.000257314	24.43609542	1.444564598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5449
H4011_813_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_814_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_815_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_817_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_818_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4011_819_0	2010	5	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	59.19131323	0	0.274473864	4.556560468	0.793754162	11.0917095	1.208217674	3.929714082	7.583228737	22.21781286	24.69462983	0	0	0	74.62605287	21.89898693	1.07745446	7.22223458	0.002496381	107.6270226	5.913622179	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.152861016	0	0.152565278	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	0	0	9.048	0	0.041875181	0	0.18494472	2.584368314	0.281514718	0.915623381	1.766892296	5.176750396	5.75384875	0	0	0	17.38787032	5.102463955	0.251046889	1.682780657	0.000581657	25.07709627	1.377873968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6336	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e												0.5758	0	0	0	0.1174	1.0695	0.3029	0.0596	0.0309	0.3299	0.1856	0	0	0	0.7744	0.3835	0	0.0697	0	0.6896	0.004	0	0	0	0	0	0	0	0	0											4.5929	0	0	9.6239	0	0.041875181	0	0.302365548	3.65384389	0.584392822	0.975266993	1.797787159	5.506636748	5.939459301	0	0	0	18.16222752	5.48600946	0.251046889	1.752496364	0.000581657	25.76669005	1.381886601	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2264
H4012_003_0	2010	4	N/A																															D	D	D	V	T	O	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	0	0	0	0	0	0	0.404685921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	0%-20% Coinsurance for Diabetes Monitoring Supplies;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0.040468592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0405	0	0	0	0	0	0	0	0	0.040468592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0405	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0.040468592	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0405
H4012_004_0	2010	4	N/A																															D	D	D	V	T	O	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	0	0	0	0	0	0	0.342189872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Diabetes Monitoring Supplies;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342	0	0	0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342
H4012_005_0	2010	4	N/A																															D	D	D	V	T	O	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	0	0	0	0	0	0	0.342189872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Diabetes Monitoring Supplies;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342	0	0	0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342
H4012_007_0	2010	3	N/A																															D	D	D	V	T	O	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	0	0	0	0	0	0	0.342189872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Diabetes Monitoring Supplies;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342	0	0	0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342
H4012_008_0	2010	3	N/A																															D	D	D	V	T	O	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	0	0	0	0	0	0	0.342189872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Diabetes Monitoring Supplies;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342	0	0	0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0.034218987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0342
H4036_001_0	2010	12	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13	I.14	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies\Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Partial Hosp	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	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	0	0	0	0	0	0	0	0	0	0	NO	1331.038175	75.92998985	284.5777694	392.846907	68.24596247	9.076129628	0.776337847	257.3577211	317.7066944	3579.970373	702.897858	69.10950855	0.000307008	149.2550441	2814.104107	2859.606493	64.11569632	1110.988582	1896.342435	0	32.35766472	0	0	0	302.4	239.2	129.6	0	0	0	0.022908875	72.96388551	186.9439727	295.2036182	91.91337744	0.864678093	526.853849	25.00765389	3.969080843	9.116477304		$270/day (days 1-9) w/$2430 yrly max	$270/day (days 1-9) w/$2430 yrly max	$128/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$35 copay	$20 coapy	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay/ $50 limit	$35 copay/ $75 limit	$35 copay/ $50 limit		Silver Sneakers		$35 copay	$0 copay	$35 copay	$35 copay	$0 copay	20% coinsurance	$35 copay	$35 copay	$40 copay	20% coinsurance	270	270	128	0	125	0.2	0.2	50	200	0	93.26879787	200	0.2	35	20	35	40	46.39830669	79.37154217	0	0.2	0	0	0	35	35	35	0	0	0	35	0	35	35	0	0.2	35	35	40	0.2	NO	155.7883769	132.3101806	110.9810696	0	108.3799508	0.173407921	0.173407921	43.35198032	173.4079213	0	80.86774179	173.4079213	0.173407921	30.34638622	17.34079213	30.34638622	34.68158425	40.22916957	68.81827068	0	0.173407921	0	0	0	35	35	35	0	0	0	30.34638622	0	30.34638622	30.34638622	0	0.173407921	30.34638622	30.34638622	34.68158425	0.173407921		17.28	0.837192556	2.631895436	0	0.616374505	1.573872772	0.134623132	0.929747238	4.591071454	0	4.73681354	0.998678018	5.32E-05	0.377445934	4.066566195	7.231560257	0.185302827	3.724512337	10.87525058	0	5.611075377	0	0	0	0.882	0.697666667	0.378	0	0	0	5.79E-05	0	0.472756167	0.746530251	0	0.149942031	1.332342532	0.063240994	0.011471168	1.580869379	72.7169		11.10887876	17.28	0.837192556	2.631895436	0	0.616374505	1.573872772	0.134623132	0.929747238	4.591071454	0	4.73681354	0.998678018	5.32E-05	0.377445934	4.066566195	7.231560257	0.185302827	3.724512337	10.87525058	0	5.611075377	0	0	0	0.882	0.697666667	0.378	0	0	0	5.79E-05	0	0.472756167	0.746530251	0	0.149942031	1.332342532	0.063240994	0.011471168	1.580869379	72.7169	YES	$350/day (Days 1-9)	$350/day (Days 1-9)	30% Coinsurance	$0 copay	$125 copay	30% Coinsurance	30% Coinsurance	$50 copay	$275 copay	$0 copay	30% Coinsurance	$275 copay	20% Coinsurance	$40 copay	$25 copay	$40 copay	$50 copay	$80/$40 OP/PR copay	30% Coinsurance		20% Coinsurance				$40 copay / $50 limit	$40 copay / $75 limit	$40 copay / $50 limit		Silver Sneakers		$40 copay	$0 copay	$40 copay	$40 copay	$0 copay	20% Coinsurance	$40 copay	$40 copay	$50 copay	20% coinsurance	3400	5.2426	0.5566	3.0052		1.2182	0.9598	0.0312	0.2644	1.3975		1.7662	0.4112	0.001	0.1459	1.5642	2.4605	0.1157	1.2866	4.9678		2.0407			0	0.252	0.1993	0.108	0			0.0013		1.8453	0.2696		0.2886	0.3007	0.0485		0.3531	31.1015		4.700875065	22.5226	1.393766797	5.637085125	0	1.834606077	2.533642674	0.16586751	1.194187219	5.988552419	0	6.503011135	1.409851275	0.001064754	0.523320608	5.63073334	9.692107461	0.300979834	5.011086233	15.843065	0	7.651732962	0	0	0	1.134	0.897	0.486	0	0	0	0.001315917	0	2.318029738	1.016117755	0	0.438570689	1.633005643	0.111706969	0.011471168	1.933980032	103.8185
H4036_003_0	2010	11	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	1252.253666	78.19032939	395.1109896	534.6880514	91.59899979	11.65029692	1.0795585	285.2724691	371.3919962	4242.550056	808.782555	84.36817514	0.000426919	120.1670091	3184.340907	3353.143725	45.72947161	1400.493288	2091.922437	0	43.40607043	0	0	1101.053247	302.4	239.2	129.6	0	0	0	0.031856582	0.005445028	228.3725293	368.2910849	103.691234	0.98783668	596.8044315	25.44237301	12.64812655	0		$200/day (days 1-7) w/$1400 yrly max	$200/day (days 1-7) w/$1400 yrly max	$115/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$150 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$150 copay	20% coinsurance	$20 copay	$5 copay	$20 copay	$40 copay	$40/$20 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance			$0 deduct 1 exam/2cleanings/yr	$20 copay; $100 limit	$20 copay; $125 limit	$20 copay; $100 limit		Silver Sneakers		$20 copay	$0 copay	$20 copay	$20 copay	$0 copay	20% coinsurance	$20 copay	$20 copay	20% coinsurance		200	200	115	0	100	0.2	0.2	50	150	0	93.03477439	150	0.2	20	5	20	40	33.48777314	80.33904962	0	0.2	0	0	0	20	20	20	0	0	0	20	0	20	20	0	0.2	20	20	0.2	0	NO	103.605167	86.88886067	102.9466192	0	89.5187993	0.179037599	0.179037599	44.75939965	134.278199	0	83.28361296	134.278199	0.179037599	17.90375986	4.475939965	17.90375986	35.80751972	29.97785243	71.91855259	0	0.179037599	0	0	0	20	20	20	0	0	0	17.90375986	0	17.90375986	17.90375986	0	0.179037599	17.90375986	17.90375986	0.179037599	0		10.8117	0.56615572	3.389611716	0	0.683319373	2.085841183	0.193281561	1.064052038	4.155820696	0	5.61319444	0.944067217	7.64E-05	0.179286773	1.187743227	5.002823336	0.136454913	3.498648426	12.53733615	0	7.771318615	0	0	0	0.504	0.398666667	0.216	0	0	0	4.75E-05	0	0.340727244	0.549482929	0	0.176859907	0.890420269	0.037959511	2.264490205	0	65.1993		7.618217117	10.8117	0.56615572	3.389611716	0	0.683319373	2.085841183	0.193281561	1.064052038	4.155820696	0	5.61319444	0.944067217	7.64E-05	0.179286773	1.187743227	5.002823336	0.136454913	3.498648426	12.53733615	0	7.771318615	0	0	0	0.504	0.398666667	0.216	0	0	0	4.75E-05	0	0.340727244	0.549482929	0	0.176859907	0.890420269	0.037959511	2.264490205	0	65.1993	YES	$250/day (days 1-7)	$250/day (days 1-7)	25% Coinsurance	$0 copay	$100 copay	25% Coinsurance	25% Coinsurance	$50 copay	$225 copay	$0 copay	25% Coinsurance	$225 copay	20% Coinsurance	$30 copay	$15 copay	$30 copay	$50 copay	$60/$30 OP/PR copay	25% Coinsurance		20% Coinsurance			20% Coinsurance	$30 copay; $100 limit	$30 copay; $125 limit	$30 copay; $100 limit		Silver Sneakers		$30 copay	$0 copay	$30 copay	$30 copay	$0 copay	25% coinsurance	$30 copay	$30 copay	20% coinsurance		3850	4.9098	0.3067	0.9734		0.9312	0.6864	0.0374	0.2427	1.2013		1.1162	0.2629	0.0015	0.0808	0.7873	1.1621	0.0406	0.8944	3.3189		1.1128			0.4904	0.189	0.1495	0.081	0			0.0014		0.6053	0.2048		0.3446	0.165	0.0217	0.4082		20.7272		2.326012744	15.7214	0.872832121	4.363010878	0	1.614485404	2.77228878	0.230663461	1.306748948	5.357170403	0	6.729406856	1.206941836	0.001528692	0.260054047	1.975046671	6.164883578	0.177071093	4.393073609	15.85626281	0	8.88416568	0	0	0.490445344	0.693	0.548166667	0.297	0	0	0	0.001402117	0	0.945990818	0.754299302	0	0.521483202	1.055435696	0.059621088	2.67264564	0	85.9266
H4036_801_0	2010	9	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	203.9641538	2.335254139	53.96357882	14.63369598	5.29042869	9.352757974	2.312445303	7.864849287	31.63309385	5.336578174	16.75519032	0	0.038262869	27.15529965	24.47422195	72.58164193	0.879105284	3.439454473	16.41456747	23.51914593	8.016064284	1.403223977	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.080473007	0.080473007	0.151460256	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080473007	0.080473007	0.151460256	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.4136	0.187924924	8.17333747	0	1.232669885	2.179192608	0.538799756	1.832509884	7.370510867	1.243422715	3.903959345	0	0.008915249	6.327184819	5.702493714	16.91152257	0.204831531	0.801392892	3.824594221	5.479961001	1.867742978	0.326951187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5315	0	0	16.4136	0.187924924	8.17333747	0	1.232669885	2.179192608	0.538799756	1.832509884	7.370510867	1.243422715	3.903959345	0	0.008915249	6.327184819	5.702493714	16.91152257	0.204831531	0.801392892	3.824594221	5.479961001	1.867742978	0.326951187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5315	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.5083	0.086	2.8672	0	0.6713	1.1867	0.2934	0.7615	3.2307	0.4959	1.5403	0	0.0048	1.8904	3.2747	8.1541	0.1076	0.4255	2.3749	2.8301	0.6049	0.1057	0	0	0	0	0	0	0	0											38.4141	0	0	23.9219	0.273889793	11.04049125	0	1.903984773	3.365922399	0.832215638	2.594047238	10.60121698	1.739273743	5.44427715	0	0.013689184	8.217633088	8.977240265	25.06558938	0.31248034	1.226852353	6.199503002	8.310039384	2.472665494	0.432691095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.9456
H4036_802_0	2010	7	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	203.9641538	2.335254139	53.96357882	14.63369598	5.29042869	9.352757974	2.312445303	7.864849287	31.63309385	5.336578174	16.75519032	0	0.038262869	27.15529965	24.47422195	72.58164193	0.879105284	3.439454473	16.41456747	23.51914593	8.016064284	1.403223977	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.080473007	0.080473007	0.151460256	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080473007	0.080473007	0.151460256	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.4136	0.187924924	8.17333747	0	1.232669885	2.179192608	0.538799756	1.832509884	7.370510867	1.243422715	3.903959345	0	0.008915249	6.327184819	5.702493714	16.91152257	0.204831531	0.801392892	3.824594221	5.479961001	1.867742978	0.326951187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5315	0	0	16.4136	0.187924924	8.17333747	0	1.232669885	2.179192608	0.538799756	1.832509884	7.370510867	1.243422715	3.903959345	0	0.008915249	6.327184819	5.702493714	16.91152257	0.204831531	0.801392892	3.824594221	5.479961001	1.867742978	0.326951187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5315	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.5083	0.086	2.8672	0	0.6713	1.1867	0.2934	0.7615	3.2307	0.4959	1.5403	0	0.0048	1.8904	3.2747	8.1541	0.1076	0.4255	2.3749	2.8301	0.6049	0.1057	0	0	0	0	0	0	0	0											38.4141	0	0	23.9219	0.273889793	11.04049125	0	1.903984773	3.365922399	0.832215638	2.594047238	10.60121698	1.739273743	5.44427715	0	0.013689184	8.217633088	8.977240265	25.06558938	0.31248034	1.226852353	6.199503002	8.310039384	2.472665494	0.432691095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.9456
H4036_803_0	2010	7	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	203.9641538	2.335254139	53.96357882	14.63369598	5.29042869	9.352757974	2.312445303	7.864849287	31.63309385	5.336578174	16.75519032	0	0.038262869	27.15529965	24.47422195	72.58164193	0.879105284	3.439454473	16.41456747	23.51914593	8.016064284	1.403223977	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.080473007	0.080473007	0.151460256	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080473007	0.080473007	0.151460256	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												16.4136	0.187924924	8.17333747	0	1.232669885	2.179192608	0.538799756	1.832509884	7.370510867	1.243422715	3.903959345	0	0.008915249	6.327184819	5.702493714	16.91152257	0.204831531	0.801392892	3.824594221	5.479961001	1.867742978	0.326951187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5315	0	0	16.4136	0.187924924	8.17333747	0	1.232669885	2.179192608	0.538799756	1.832509884	7.370510867	1.243422715	3.903959345	0	0.008915249	6.327184819	5.702493714	16.91152257	0.204831531	0.801392892	3.824594221	5.479961001	1.867742978	0.326951187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5315	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.5083	0.086	2.8672	0	0.6713	1.1867	0.2934	0.7615	3.2307	0.4959	1.5403	0	0.0048	1.8904	3.2747	8.1541	0.1076	0.4255	2.3749	2.8301	0.6049	0.1057	0	0	0	0	0	0	0	0											38.4141	0	0	23.9219	0.273889793	11.04049125	0	1.903984773	3.365922399	0.832215638	2.594047238	10.60121698	1.739273743	5.44427715	0	0.013689184	8.217633088	8.977240265	25.06558938	0.31248034	1.226852353	6.199503002	8.310039384	2.472665494	0.432691095	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.9456
H4102_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1582.963621	114.9410975	1884.410413	1713.621212	339.4884636	4.910782926	4.679079216	292.0850151	27.65828311	8464.747164	37.67914624	0	0.085661859	22.52252061	4547.557219	4590.046279	485.9497189	480.4823379	0	0	9.99578198	1158.77641	0	0	89.81076754	0	13.62303836	4.75818636	114.9289139	0											3950	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$105 Days 1-27 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	79.45834165	0	150	0.2	0.112920511	48.56048743	0.2	3	0.170332539	0	0.2	0.149275931	13.45193767	39.41079754	38.5	40	0	0	0.2	39.48623488	0	0	40	0	0	0	0	0											YES	153.2809729	113.0233913	60.59268446	0	114.3857584	0.152514345	0.086109989	37.03085455	0.152514345	2.287715168	0.129890778	0	0.152514345	0.114029607	12.99858428	39.41079754	38.5	30.5028689	0	0	0.152514345	39.48623488	0	0	40	0	0	0	0	0											3950	20.2199	1.082586053	9.515123793	0	3.236053781	0.748964839	0.40291546	0.901346476	4.218284919	1.613744206	4.894173618	0	0.013064662	2.568234174	4.925983815	15.07478205	1.559088681	1.221340814	0	0	1.524500136	3.812976459	0	0	0.299369225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8324	0	16.40619583	20.2199	1.082586053	9.515123793	0	3.236053781	0.748964839	0.40291546	0.901346476	4.218284919	1.613744206	4.894173618	0	0.013064662	2.568234174	4.925983815	15.07478205	1.559088681	1.221340814	0	0	1.524500136	3.812976459	0	0	0.299369225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8324	NO	"$325 Days 1-13 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-13 (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$50 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$30 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$50 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$50 (7c, 7i)"	Included in h.2.	$30 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $50 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$50 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$50 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.5288	0.2593	0	0.9188	0.9312	0.3233	0.308	0.3874	1.8208	0.4644	2.079	0	0.0038	1.1057	2.6397	6.0723	0.5716	0.4165	0	0	0.6239	1.548	0	0	0.1214	0	0.0174	0	0	0											24.1414	0	7.291685518	23.7487	1.341929728	9.515123793	0.918768639	4.167295829	1.072260247	0.710956936	1.288701818	6.039134271	2.078132799	6.973142765	0	0.016824292	3.673942294	7.565672608	21.14712464	2.130723243	1.637854192	0	0	2.148379756	5.360948173	0	0	0.420802106	0	0.017371602	0	0	0	0	0	0	0	0	0	0	0	0	0	101.9737
H4102_025_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1597.338651	129.1667792	1823.712611	2356.093019	403.9909234	7.089426505	6.017114786	372.1922942	36.76953801	10602.39882	47.82193077	0	0.075921644	26.53379484	5482.887524	5880.396527	630.4421622	587.6889371	0	0	11.71567591	1475.170472	0	0	118.8596709	0	18.01088504	0	114.719522	0											3450	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$115 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	83.9614622	0	150	0.2	0.128092853	48.55340737	0.2	3	0.171237865	0	0.2	0.149987559	13.34659658	34.51788946	38.5	35	0	0	0.2	34.63353396	0	0	35	0	35	0	0	0											NO	149.8571308	110.4987841	62.59647179	0	111.83072	0.149107627	0.095498106	36.19841669	0.149107627	2.236614399	0.127664358	0	0.149107627	0.112034158	12.96214546	34.51788946	38.5	26.09383466	0	0	0.149107627	34.63353396	0	0	35	0	35	0	0	0												19.9477	1.189397671	9.513164586	0	3.764882986	1.05708756	0.574623066	1.122730979	5.482618545	1.976123155	6.10515609	0	0.011320496	2.972691365	5.922498801	16.91490644	2.022668604	1.277921496	0	0	1.746896629	4.257530553	0	0	0.34667404	0	0.052531748	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2591	0	19.53498373	19.9477	1.189397671	9.513164586	0	3.764882986	1.05708756	0.574623066	1.122730979	5.482618545	1.976123155	6.10515609	0	0.011320496	2.972691365	5.922498801	16.91490644	2.022668604	1.277921496	0	0	1.746896629	4.257530553	0	0	0.34667404	0	0.052531748	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2591	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.9477	1.189397671	9.513164586	0	3.764882986	1.05708756	0.574623066	1.122730979	5.482618545	1.976123155	6.10515609	0	0.011320496	2.972691365	5.922498801	16.91490644	2.022668604	1.277921496	0	0	1.746896629	4.257530553	0	0	0.34667404	0	0.052531748	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2591
H4102_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	260.0489509	6.820932845	39.81272148	1779.659588	9.826183185	4.429436047	7.848026099	20.46770465	42.51294018	25.52626265	56.45340439	0	0.221580835	37.89789336	24.78131878	118.3625771	3.370460951	13.75607084	0	0	15.11309244	9.565114745	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080857452	0.080857452	0.154947614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080857452	0.080857452	0.154947614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.0269	0.551523251	6.168886181	0	2.289500682	1.032058599	1.828590081	4.768975183	9.905515062	5.947619198	13.15364322	0	0.051628335	8.830209153	5.774047276	27.57848046	0.785317402	3.205164505	0	0	3.521350539	2.228671735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6481	0	0	21.0269	0.551523251	6.168886181	0	2.289500682	1.032058599	1.828590081	4.768975183	9.905515062	5.947619198	13.15364322	0	0.051628335	8.830209153	5.774047276	27.57848046	0.785317402	3.205164505	0	0	3.521350539	2.228671735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6481	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.0269	0.551523251	6.168886181	0	2.289500682	1.032058599	1.828590081	4.768975183	9.905515062	5.947619198	13.15364322	0	0.051628335	8.830209153	5.774047276	27.57848046	0.785317402	3.205164505	0	0	3.521350539	2.228671735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6481
H4102_802_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	261.5831808	6.820932845	40.04760752	1790.159176	9.884155439	4.455568716	7.894327675	20.58845947	42.7637569	25.67686182	56.78646668	0	0.222888112	38.11130396	24.92752295	119.0608895	3.370460951	13.83722854	0	0	15.20225626	9.621546755	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080857452	0.080857452	0.154947614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080857452	0.080857452	0.154947614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.1509	0.551523251	6.205281212	0	2.303008217	1.038147511	1.839378348	4.797111056	9.963955357	5.982708804	13.23124674	0	0.05193293	8.879933822	5.808112846	27.74118725	0.785317402	3.224074249	0	0	3.542125709	2.241820394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.3378	0	0	21.1509	0.551523251	6.205281212	0	2.303008217	1.038147511	1.839378348	4.797111056	9.963955357	5.982708804	13.23124674	0	0.05193293	8.879933822	5.808112846	27.74118725	0.785317402	3.224074249	0	0	3.542125709	2.241820394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.3378	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.1509	0.551523251	6.205281212	0	2.303008217	1.038147511	1.839378348	4.797111056	9.963955357	5.982708804	13.23124674	0	0.05193293	8.879933822	5.808112846	27.74118725	0.785317402	3.224074249	0	0	3.542125709	2.241820394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.3378
H4102_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	261.4161589	6.820932845	40.02203697	1789.587573	9.877844368	4.452723818	7.889287116	20.57531366	42.73645207	25.66046704	56.7502083	0	0.222745797	38.08698251	24.91160663	118.9848686	3.370460951	13.82839341	0	0	15.19254956	9.615403359	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080857452	0.080857452	0.154947614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080857452	0.080857452	0.154947614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.1374	0.551523251	6.201319116	0	2.301537738	1.03748465	1.838203898	4.794048082	9.957593333	5.978888821	13.22279853	0	0.051899771	8.874266926	5.804404344	27.72347439	0.785317402	3.222015665	0	0	3.539864048	2.240388983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.2625	0	0	21.1374	0.551523251	6.201319116	0	2.301537738	1.03748465	1.838203898	4.794048082	9.957593333	5.978888821	13.22279853	0	0.051899771	8.874266926	5.804404344	27.72347439	0.785317402	3.222015665	0	0	3.539864048	2.240388983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.2625	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.1374	0.551523251	6.201319116	0	2.301537738	1.03748465	1.838203898	4.794048082	9.957593333	5.978888821	13.22279853	0	0.051899771	8.874266926	5.804404344	27.72347439	0.785317402	3.222015665	0	0	3.539864048	2.240388983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.2625
H4102_805_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	261.4161589	6.820932845	40.02203697	1789.587573	9.877844368	4.452723818	7.889287116	20.57531366	42.73645207	25.66046704	56.7502083	0	0.222745797	38.08698251	24.91160663	118.9848686	3.370460951	13.82839341	0	0	15.19254956	9.615403359	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080857452	0.080857452	0.154947614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080857452	0.080857452	0.154947614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.1374	0.551523251	6.201319116	0	2.301537738	1.03748465	1.838203898	4.794048082	9.957593333	5.978888821	13.22279853	0	0.051899771	8.874266926	5.804404344	27.72347439	0.785317402	3.222015665	0	0	3.539864048	2.240388983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.2625	0	0	21.1374	0.551523251	6.201319116	0	2.301537738	1.03748465	1.838203898	4.794048082	9.957593333	5.978888821	13.22279853	0	0.051899771	8.874266926	5.804404344	27.72347439	0.785317402	3.222015665	0	0	3.539864048	2.240388983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.2625	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.1374	0.551523251	6.201319116	0	2.301537738	1.03748465	1.838203898	4.794048082	9.957593333	5.978888821	13.22279853	0	0.051899771	8.874266926	5.804404344	27.72347439	0.785317402	3.222015665	0	0	3.539864048	2.240388983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.2625
H4106_002_0	2010	3	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2477.009877	250.6675885	55.78660002	1910.805347	413.5937648	14.35406322	15.34064084	597.8338236	52.6094693	15713.92343	55.93848464	0	0.155712455	38.71899121	8718.901959	7203.068331	1035.381582	509.2070897	0	0	27.34477936	1605.794457	670.86966	0	243.2594745	0	17.43496829	4.791926143	79.06678136	0											3950	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	0.154947614	0	150	0.2	0.098031206	49.22682449	0.2	3	0.17382383	0	0.2	0.149927669	13.13708913	39.66518788	38.5	40	0	0	0.2	39.60771389	0	0	40	0	0	0	0	0											NO	142.0322596	104.7290302	0.109487449	0	105.9914183	0.141321891	0.069269777	34.78413966	0.141321891	2.119828367	0.122825562	0	0.141321891	0.106184283	12.89778124	39.66518788	38.5	28.26437822	0	0	0.141321891	39.60771389	0	0	40	0	0	0	0	0												29.3179	2.187681121	6.107932514	0	3.653115813	2.028543359	1.06264277	1.732927934	7.434869693	2.77590172	6.870675815	0	0.022005579	4.111348325	9.371207509	23.80925489	3.321849242	1.199368481	0	0	3.864415932	5.300153953	0	0	0.810864915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9827	0	30.2089146	29.3179	2.187681121	6.107932514	0	3.653115813	2.028543359	1.06264277	1.732927934	7.434869693	2.77590172	6.870675815	0	0.022005579	4.111348325	9.371207509	23.80925489	3.321849242	1.199368481	0	0	3.864415932	5.300153953	0	0	0.810864915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9827	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.3179	2.187681121	6.107932514	0	3.653115813	2.028543359	1.06264277	1.732927934	7.434869693	2.77590172	6.870675815	0	0.022005579	4.111348325	9.371207509	23.80925489	3.321849242	1.199368481	0	0	3.864415932	5.300153953	0	0	0.810864915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9827
H4125_001_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	YES	1523.790271	109.5237387	546.8476851	1941.766729	145.1015369	15.32552667	3.871154743	410.9962614	347.5546017	5.814747148	10.31848169	0.053739573	0.003721685	9.113245193	4191.678426	2511.525493	68.39726959	61.40570064	22.43774045	83.18033361	6.857427181	0.077253923	0	0	295	11.70744072	0	0	0	0											4950	1a (IP Acute): $150 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $275 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): $5.0 OTC per month											105.0843571	83.13245533	52.30090032	0	150	0.2	0.1	49.83055502	275	0	0.189548186	0.2	0.2	0.199632595	0	30	40	30	0.2	0.026341576	0.2	30	0	0	25	0	0	0	0	0											NO	97.24315493	76.92926381	48.39830295	0	138.8072748	0.185076366	0.092538183	46.1122903	254.4800038	0	0.175404448	0.185076366	0.185076366	0.184736376	0	27.76145496	37.01527328	27.76145496	0.185076366	0.024376016	0.185076366	27.76145496	0	0	25	0	0	0	0	0												12.3482	0.702131716	2.205541661	0	1.678429075	2.83639279	0.358229627	1.579331576	7.370474696	0	1.809907583	0.009945925	0.000688796	1.683547894	0	5.810300155	0.210978635	0.142059299	4.152695473	2.027605138	1.269147705	0.000178723	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8104	0	3.724876877	12.3482	0.702131716	2.205541661	0	1.678429075	2.83639279	0.358229627	1.579331576	7.370474696	0	1.809907583	0.009945925	0.000688796	1.683547894	0	5.810300155	0.210978635	0.142059299	4.152695473	2.027605138	1.269147705	0.000178723	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8104	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.3482	0.702131716	2.205541661	0	1.678429075	2.83639279	0.358229627	1.579331576	7.370474696	0	1.809907583	0.009945925	0.000688796	1.683547894	0	5.810300155	0.210978635	0.142059299	4.152695473	2.027605138	1.269147705	0.000178723	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8104
H4125_002_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	YES	1583.62367	95.96526111	595.8240086	1539.225872	156.2219963	18.89851439	5.869790984	477.4866246	301.2081381	5.439435093	13.38824868	0.086709156	0.008064159	10.80103557	4956.863887	3063.479091	126.1669251	85.84926628	17.88361978	106.8707217	9.227474018	0.155745897	0	0	295	11.34716742	0	0	0	0											3950	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $275 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $25 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $25 Copay per visit; 7i (PT/ST): $25 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 25 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $25 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $25 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 25 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): $5.0 OTC per month											97.12420184	72.60119004	53.89086557	0	125	0.2	0.091990075	49.79629334	275	0	0.190968037	0.2	0.2	0.199024705	0	25	40	25	0.2	0.022644156	0.2	25	0	0	25	0	0	0	0	0											NO	89.22481506	66.69632936	49.50776864	0	114.8333955	0.183733433	0.084508262	45.74621958	252.6334701	0	0.175436065	0.183733433	0.183733433	0.182837461	0	22.9666791	36.74668656	22.9666791	0.183733433	0.020802442	0.183733433	22.9666791	0	0	25	0	0	0	0	0												11.7749	0.533377555	2.458159764	0	1.494958524	3.472288924	0.496045832	1.820267331	6.341271429	0	2.348781661	0.015931371	0.001481656	1.974833923	0	5.863161767	0.386351371	0.164306046	3.285818853	2.223172042	1.695395477	0.000298081	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9654	0	4.103377156	11.7749	0.533377555	2.458159764	0	1.494958524	3.472288924	0.496045832	1.820267331	6.341271429	0	2.348781661	0.015931371	0.001481656	1.974833923	0	5.863161767	0.386351371	0.164306046	3.285818853	2.223172042	1.695395477	0.000298081	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9654	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.7749	0.533377555	2.458159764	0	1.494958524	3.472288924	0.496045832	1.820267331	6.341271429	0	2.348781661	0.015931371	0.001481656	1.974833923	0	5.863161767	0.386351371	0.164306046	3.285818853	2.223172042	1.695395477	0.000298081	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.9654
H4125_003_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	YES	1162.950214	75.52050293	468.8876815	1231.869896	114.1131819	14.09644201	4.220719193	368.645014	292.6080164	4.177726442	8.707787977	0.061976457	0.005763959	10.87718217	4270.43867	2463.385653	99.23983639	64.76019189	14.77384863	75.76696008	7.251291528	0.122565274	0	0	346	8.92972916	0	0	0	0											3950	1a (IP Acute): $185 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0 copay;	7d (SPC w/Copay): $18 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $25 Copay per visit; 7i (PT/ST): $25 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 25 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $25 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $25 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 25 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 25 copay;"	17a1 (Routine Eye Exam): 10 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											119.0930988	72.60119004	20.95755883	0	125	0.2	0.1	49.79236101	200	0	0.190024448	0.2	0.2	0.199381023	0	18	40	25	0.2	0.024150823	0.2	25	0	0	10	0	0	0	0	0											NO	108.9906574	66.44256897	19.17976892	0	114.3964874	0.18303438	0.09151719	45.56856959	183.0343798	0	0.173905035	0.18303438	0.18303438	0.182467909	0	16.47309418	36.60687597	22.87929748	0.18303438	0.022102154	0.18303438	22.87929748	0	0	10	0	0	0	0	0												10.5626	0.418148019	0.749429782	0	1.087845598	2.580133521	0.38626836	1.399885498	4.463110568	0	1.514328171	0.011343822	0.001055003	1.98473669	0	3.381631989	0.302738365	0.123472308	2.704122223	1.674613038	1.327235648	0.000233684	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9612	0	3.213679494	10.5626	0.418148019	0.749429782	0	1.087845598	2.580133521	0.38626836	1.399885498	4.463110568	0	1.514328171	0.011343822	0.001055003	1.98473669	0	3.381631989	0.302738365	0.123472308	2.704122223	1.674613038	1.327235648	0.000233684	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9612	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.5626	0.418148019	0.749429782	0	1.087845598	2.580133521	0.38626836	1.399885498	4.463110568	0	1.514328171	0.011343822	0.001055003	1.98473669	0	3.381631989	0.302738365	0.123472308	2.704122223	1.674613038	1.327235648	0.000233684	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9612
H4125_005_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	491.4351464	10.85068494	41.6939613	4050.025448	18.00259745	23.61638903	9.015388583	36.46887812	30.41821401	7.400625162	15.08439533	0.758300866	0	15.07218188	6291.606921	4354.813423	3.48644726	1.575262441	40.42676454	135.1074459	18.81992375	0	0	0	401	0.045828129	0	0	0	0												1a (IP Acute): 8.29% Coin MC CS; 1a1 (Add'l Days): 8.29% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.29% Coin MC CS;	2a (SNF): 18.23% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): 20.00% Coin MC CS; 7e (MH Non-Phys): 20.00% Coin MC CS per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): 20.00% Coin MC CS; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 20.00% Coin MC CS per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $19.5 OTC per month (cumulative benefit)											0.0829	0.0829	0.1823	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	0.2	0.2	0.2	0.15384795	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0829	0.0829	0.1823	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	0.2	0.2	0.2	0.15384795	0.2	0	0	0	5	0.2	0	0	0	0												40.74	0.899521782	7.600809145	0	3.600519489	4.723277806	1.803077717	7.293775624	6.083642802	0	3.016879066	0.151660173	0	3.014436377	0	3.629011186	0.697289452	0.315052488	8.085352908	20.78600352	3.763984751	0	0	0	0.167083333	0.009165626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3805	0	0	40.74	0.899521782	7.600809145	0	3.600519489	4.723277806	1.803077717	7.293775624	6.083642802	0	3.016879066	0.151660173	0	3.014436377	0	3.629011186	0.697289452	0.315052488	8.085352908	20.78600352	3.763984751	0	0	0	0.167083333	0.009165626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3805	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	40.74	0.899521782	7.600809145	0	3.600519489	4.723277806	1.803077717	7.293775624	6.083642802	0	3.016879066	0.151660173	0	3.014436377	0	3.629011186	0.697289452	0.315052488	8.085352908	20.78600352	3.763984751	0	0	0	0.167083333	0.009165626	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3805
H4125_006_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	YES	1557.690129	107.8027791	669.3201605	1185.069555	153.7689102	15.9386699	4.890324192	430.5644518	299.3253931	4.894093777	11.05455768	0.090987225	0.00846203	10.63917647	4666.290052	3013.658105	100.8390591	88.33682819	17.19470253	97.398042	9.424210594	0.174957483	0	0	265	12.74686453	0	0	0	0											4450	1a (IP Acute): $175 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $250 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 30 copay;"	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  70 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): $5.0 OTC per month											108.5580528	72.60119004	53.89086557	0	125	0.2	0.1	49.74622772	250	0	0.190327807	0.2	0.2	0.19915832	0	30	40	30	0.2	0.02561827	0.2	30	0	0	25	0	0	0	0	0											NO	99.74867468	66.70967558	49.51767535	0	114.8563742	0.183770199	0.091885099	45.70937075	229.7127483	0	0.174882894	0.183770199	0.183770199	0.18299682	0	27.5655298	36.75403973	27.5655298	0.183770199	0.023539373	0.183770199	27.5655298	0	0	25	0	0	0	0	0												12.9481	0.599290702	2.761931535	0	1.471778291	2.929052534	0.449347924	1.64006918	5.72990489	0	1.933253043	0.01672074	0.001555069	1.946935467	0	6.922756858	0.308853565	0.202920956	3.159873899	2.292688856	1.731889053	0.0004019	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5994	0	4.154728606	12.9481	0.599290702	2.761931535	0	1.471778291	2.929052534	0.449347924	1.64006918	5.72990489	0	1.933253043	0.01672074	0.001555069	1.946935467	0	6.922756858	0.308853565	0.202920956	3.159873899	2.292688856	1.731889053	0.0004019	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5994	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.9481	0.599290702	2.761931535	0	1.471778291	2.929052534	0.449347924	1.64006918	5.72990489	0	1.933253043	0.01672074	0.001555069	1.946935467	0	6.922756858	0.308853565	0.202920956	3.159873899	2.292688856	1.731889053	0.0004019	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5994
H4141_001_0	2010	5	N/A	r.	s.	t.	u.	v.	w.			z.		DME/Prosthetics/Supplies	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Part B Rx			Other Non-Covered		Prosthetics/Supplies	Renal Dialysis									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	O	P	O	O	O	S			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	YES	1589.083778	49.055267	736.287346	1260.737067	212.098234	10.600512	1.563854	353.129005	298.055084	1247.915038	1360.527206	61.006715	0.044993	337.388879	4687.640377	4447.760548	72.831247	672.067562			13.754002	0			1.5				0.04	0.25	6942.456739	19.988699	0.05	0.55	2.18	473.759405			0.42		3400	$150/Day(Days 1-7):1a	$150/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	$0/Visit:8a	"$0-$150/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$150/Visit:9d. $10 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $0 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$10/Visit:7i			20% Coins:15				"VIS734: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$50/Script:15			$0: Nutritional benefit 14a		105.8382	93.5994	58.254672	0	100	0.2	0.2	50	175	0	54.043328	50	0.2	33.115649	10	35	35	10			0.2	0			0				0	0	0	0	0	0	0	50			0		NO	92.971133	82.22024	30.319227	0	86.6913	0.173383	0.173383	43.34565	151.709775	0	46.850864	43.34565	0.173383	28.708387	8.66913	30.341955	30.341955	8.66913			0.173383	0			0				0	0	0	0	0	0	0	43.34565			0			12.3116	0.336111319	1.860305265	0	1.532255969	1.837948572	0.271145698	1.275550521	3.768155811	0	5.311822925	0.220364643	0.007801021	0.807157542	3.386480318	11.24614587	0.184153535	0.485520089	0	0	2.384710129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.711284113	0	0	0	0	48.9385	0	8.750173	12.3116	0.336111319	1.860305265	0	1.532255969	1.837948572	0.271145698	1.275550521	3.768155811	0	5.311822925	0.220364643	0.007801021	0.807157542	3.386480318	11.24614587	0.184153535	0.485520089	0	0	2.384710129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.711284113	0	0	0	0	48.9385	NO																																																																																		0	0	0	12.3116	0.336111319	1.860305265	0	1.532255969	1.837948572	0.271145698	1.275550521	3.768155811	0	5.311822925	0.220364643	0.007801021	0.807157542	3.386480318	11.24614587	0.184153535	0.485520089	0	0	2.384710129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.711284113	0	0	0	0	48.9385
H4141_801_0	2010	2	N/A																															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	NO	246.23339	1.515272	23.716811	11.472634	5.588251	5.438641	2.298755	22.512576	63.648223	9.152161	30.0068	4.645424	0.99048	16.39431	76.002239	94.282146	0.329827	6.41214			24.237206	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																			0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.5975	0.120598909	4.026819008	0	1.302062483	1.267203353	0.535609915	5.245430208	14.83003596	2.132453513	6.9915844	1.082383792	0.23078184	3.81987423	17.70852169	21.96774002	0.076849691	1.49402862	0	0	5.647268998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0767	0	0	19.5975	0.120598909	4.026819008	0	1.302062483	1.267203353	0.535609915	5.245430208	14.83003596	2.132453513	6.9915844	1.082383792	0.23078184	3.81987423	17.70852169	21.96774002	0.076849691	1.49402862	0	0	5.647268998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0767	NO																																																																																		0	0	0	19.5975	0.120598909	4.026819008	0	1.302062483	1.267203353	0.535609915	5.245430208	14.83003596	2.132453513	6.9915844	1.082383792	0.23078184	3.81987423	17.70852169	21.96774002	0.076849691	1.49402862	0	0	5.647268998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0767
H4141_802_0	2010	2	N/A																															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	NO	246.23339	1.515272	23.716811	11.472634	5.588251	5.438641	2.298755	22.512576	63.648223	9.152161	30.0068	4.645424	0.99048	16.39431	76.002239	94.282146	0.329827	6.41214			24.237206	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																			0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.5975	0.120598909	4.026819008	0	1.302062483	1.267203353	0.535609915	5.245430208	14.83003596	2.132453513	6.9915844	1.082383792	0.23078184	3.81987423	17.70852169	21.96774002	0.076849691	1.49402862	0	0	5.647268998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0767	0	0	19.5975	0.120598909	4.026819008	0	1.302062483	1.267203353	0.535609915	5.245430208	14.83003596	2.132453513	6.9915844	1.082383792	0.23078184	3.81987423	17.70852169	21.96774002	0.076849691	1.49402862	0	0	5.647268998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0767	NO																																																																																		0	0	0	19.5975	0.120598909	4.026819008	0	1.302062483	1.267203353	0.535609915	5.245430208	14.83003596	2.132453513	6.9915844	1.082383792	0.23078184	3.81987423	17.70852169	21.96774002	0.076849691	1.49402862	0	0	5.647268998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0767
H4141_803_0	2010	2	N/A																															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	NO	246.23339	1.515272	23.716811	11.472634	5.588251	5.438641	2.298755	22.512576	63.648223	9.152161	30.0068	4.645424	0.99048	16.39431	76.002239	94.282146	0.329827	6.41214			24.237206	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																			0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079588951	0.079588951	0.169787541	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.5975	0.120598909	4.026819008	0	1.302062483	1.267203353	0.535609915	5.245430208	14.83003596	2.132453513	6.9915844	1.082383792	0.23078184	3.81987423	17.70852169	21.96774002	0.076849691	1.49402862	0	0	5.647268998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0767	0	0	19.5975	0.120598909	4.026819008	0	1.302062483	1.267203353	0.535609915	5.245430208	14.83003596	2.132453513	6.9915844	1.082383792	0.23078184	3.81987423	17.70852169	21.96774002	0.076849691	1.49402862	0	0	5.647268998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0767	NO																																																																																		0	0	0	19.5975	0.120598909	4.026819008	0	1.302062483	1.267203353	0.535609915	5.245430208	14.83003596	2.132453513	6.9915844	1.082383792	0.23078184	3.81987423	17.70852169	21.96774002	0.076849691	1.49402862	0	0	5.647268998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.0767
H4152_004_0	2010	8	N/A	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Routine Exams	Partial Hospitalization								D	D	D		T	Coin		V	V		O		V	V	V	V	V	V							V		V		O		V	V	V																																																0	YES	1631.773229	107.7418015	1929.38856	0	416.6659033	4.046695579	0	230.5342949	255.5556299	0	282.8428573	0	56.80005616	23.14076362	3035.372229	4205.604803	195.0399121	1098.804747	0	0	0	0	0	0	361.587218	0	0	0	850.146858	0	108.9961368	406.1328042	36.96511591								3400	$340 per day  (PBP# 1a)	$165 per day  (PBP# 1b)	$80 per day  (PBP# 2)	No Copay	$150 Copay per day (PBP# 10a)	"20% Coinsurance for non-capitated services (PBP# 11a, 11b, 11c)"	Grouped in Line e.1.	$50 Copay per visit (PBP# 4a)	"$175 Copay per visit (PBP# 9a, 9b)"	No Copay	$150 Copay per day for specified services (PBP# 8b)	No Copay	$25 Copay per visit (PBP# 12)	"$30 Copay per visit at a wound care clinic (PBP# 9a, 9b)"	"$10 Copay per visit; Includes PCP, Nutrition Therapy, Nutrition Training and Smoking Cessation (PBP# 7a, 7g, 14a, 14i, 14j)"	"$30 Copay per visit (PBP# 7b, 7d, 7f, 7g, 14i, 17a, 18a)"	"$30 Copay per visit (PBP# 7e, 7h, 9c)"	"$15 Copay per visit (PBP# 7c, 7i)"	No Copay	No Copay	No Copay	No Copay	No Copay	Not Covered	$30 Copay per visit (PBP# 17a)	Not Covered	$30 Copay per visit (PBP# 18a)	Not Covered	$15 Monthly (PBP# 14a)	Not Covered	$35 Copay per visit (PBP# 4b)	$10 Copay per visit; Weighted average of PCP and Specialist. (PBP# 14c)	$40 Copay per visit (PBP# 5)								340	165	80	0	150	0.2	0	50	175	0	150	0	25	30	10	30	30	15	0	0	0	0	0	0	30	0	30	0	15	0	35	10	40								NO	180.0594204	87.08304335	37.54194994	0	131.3244104	0.175099214	0	43.77480348	153.2118122	0	131.3244104	0	21.88740174	26.26488209	8.754960696	26.26488209	26.26488209	13.13244104	0	0	0	0	0	0	30	0	30	0	15	0	30.64236244	8.754960696	35.01984278									24.4847	0.781873664	6.03608406	0	4.559867008	0.708573215	0	0.840966121	3.262845098	0	3.095347623	0	0.103600471	0.050649119	2.214547046	9.204976187	0.426891691	1.202499046	0	0	0	0	0	0	0.903968045	0	0	0	1.062683573	0	0.278324927	0.296306395	0.107876046	0	0	0	0	0	0	0	59.6226	0	32.92190879	24.4847	0.781873664	6.03608406	0	4.559867008	0.708573215	0	0.840966121	3.262845098	0	3.095347623	0	0.103600471	0.050649119	2.214547046	9.204976187	0.426891691	1.202499046	0	0	0	0	0	0	0.903968045	0	0	0	1.062683573	0	0.278324927	0.296306395	0.107876046	0	0	0	0	0	0	0	59.6226	NO																																																																																		0			24.4847	0.781873664	6.03608406	0	4.559867008	0.708573215	0	0.840966121	3.262845098	0	3.095347623	0	0.103600471	0.050649119	2.214547046	9.204976187	0.426891691	1.202499046	0	0	0	0	0	0	0.903968045	0	0	0	1.062683573	0	0.278324927	0.296306395	0.107876046	0	0	0	0	0	0	0	59.6226
H4152_005_0	2010	8	N/A	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Routine Exams	Partial Hospitalization								D	D	D		T	Coin		V	V		O		V	V	V	V	V	V							V		V		O		V	V	V																																																0	YES	1680.760173	81.5356728	2177.28987	0	418.7789575	4.5517529	0	251.5079297	295.5110385	0	324.0517427	0	76.89320589	51.755585	3683.310481	5029.947984	363.5654886	1364.893877	0	0	0	0	0	0	430.5903554	0	0	0	850.146858	0	130.1346894	455.4541272	47.10506132								2400	$240 per day  (PBP# 1a)	$165 per day  (PBP# 1b)	$80 per day  (PBP# 2)	No Copay	$150 Copay per day (PBP# 10a)	"20% Coinsurance for non-capitated services (PBP# 11a, 11b, 11c)"	Grouped in Line e.1.	$50 Copay per visit (PBP# 4a)	"$150 Copay per visit (PBP# 9a, 9b)"	No Copay	$150 Copay per day for specified services (PBP# 8b)	No Copay	$25 Copay per visit (PBP# 12)	"$30 Copay per visit at a wound care clinic (PBP# 9a, 9b)"	"$10 Copay per visit; Includes PCP, Nutrition Therapy, Nutrition Training and Smoking Cessation (PBP# 7a, 7g, 14a, 14i, 14j)"	"$30 Copay per visit (PBP# 7b, 7d, 7f, 7g, 14i, 17a, 18a)"	"$30 Copay per visit (PBP# 7e, 7h, 9c)"	"$15 Copay per visit (PBP# 7c, 7i)"	No Copay	No Copay	No Copay	No Copay	Not Covered	Not Covered	$30 Copay per visit (PBP# 17a)	No Copay	$30 Copay per visit (PBP# 18a)	Not Covered	$15 Monthly (PBP# 14a)	Not Covered	$35 Copay per visit (PBP# 4b)	$10 Copay per visit; Weighted average of PCP and Specialist. (PBP# 14c)	$40 Copay per visit (PBP# 5)								240	165	80	0	150	0.2	0	50	150	0	150	0	25	30	10	30	30	15	0	0	0	0	0	0	30	0	30	0	15	0	35	10	40								NO	119.9436042	70.11136909	31.33748366	0	129.2752347	0.17236698	0	43.0917449	129.2752347	0	129.2752347	0	21.54587245	25.85504694	8.61834898	25.85504694	25.85504694	12.92752347	0	0	0	0	0	0	30	0	30	0	15	0	30.16422143	8.61834898	34.47339592									16.7997	0.476381471	5.685898811	0	4.511479001	0.784571899	0	0.903159629	3.183521571	0	3.490988758	0	0.138060934	0.111511923	2.645337927	10.83746177	0.783333564	1.470391469	0	0	0	0	0	0	1.076475888	0	0	0	1.062683573	0	0.327117632	0.327105218	0.135322619	0	0	0	0	0	0	0	54.7505	0	30.91707271	16.7997	0.476381471	5.685898811	0	4.511479001	0.784571899	0	0.903159629	3.183521571	0	3.490988758	0	0.138060934	0.111511923	2.645337927	10.83746177	0.783333564	1.470391469	0	0	0	0	0	0	1.076475888	0	0	0	1.062683573	0	0.327117632	0.327105218	0.135322619	0	0	0	0	0	0	0	54.7505	NO																																																																																		0			16.7997	0.476381471	5.685898811	0	4.511479001	0.784571899	0	0.903159629	3.183521571	0	3.490988758	0	0.138060934	0.111511923	2.645337927	10.83746177	0.783333564	1.470391469	0	0	0	0	0	0	1.076475888	0	0	0	1.062683573	0	0.327117632	0.327105218	0.135322619	0	0	0	0	0	0	0	54.7505
H4152_007_0	2010	8	N/A	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Routine Exams	Partial Hospitalization								D	D	D		T	Coin		V	V		O		V	V	V	V	V	V							V		V		O		V	V	V																																																0	YES	2305.42586	113.209871	2700.447792	0	526.3744938	7.228494586	0	297.6120129	349.2543803	0	384.9932076	0	98.56466773	50.64072234	3987.731858	5833.222796	587.8848702	1735.763862	0	0	0	0	0	0	466.733532	0	0	0	850.146858	0	141.4575617	435.4785947	68.35410805								1400	$140 per day  (PBP# 1a)	$165 per day  (PBP# 1b)	$80 per day  (PBP# 2)	No Copay	$150 Copay per day (PBP# 10a)	"20% Coinsurance for non-capitated services (PBP# 11a, 11b, 11c)"	Grouped in Line e.1.	$50 Copay per visit (PBP# 4a)	"$95 Copay per visit (PBP# 9a, 9b)"	No Copay	$150 Copay per day for specified services (PBP# 8b)	No Copay	$25 Copay per visit (PBP# 12)	"$30 Copay per visit at a wound care clinic (PBP# 9a, 9b)"	"$10 Copay per visit; Includes PCP, Nutrition Therapy, Nutrition Training and Smoking Cessation (PBP# 7a, 7g, 14a, 14i, 14j)"	"$30 Copay per visit (PBP# 7b, 7d, 7f, 7g, 14i, 17a, 18a)"	"$30 Copay per visit (PBP# 7e, 7h, 9c)"	"$15 Copay per visit (PBP# 7c, 7i)"	No Copay	No Copay	No Copay	No Copay	Not Covered	Not Covered	$30 Copay per visit (PBP# 17a)	No Copay	$30 Copay per visit (PBP# 18a)	No Copay	$15 Monthly (PBP# 14a)	Not Covered	$35 Copay per visit (PBP# 4b)	$10 Copay per visit; Weighted average of PCP and Specialist. (PBP# 14c)	$40 Copay per visit (PBP# 5)								140	165	80	0	150	0.2	0	50	95	0	150	0	25	30	10	30	30	15	0	0	0	0	0	0	30	0	30	0	15	0	35	10	40								YES	54.4412323	44.37215561	20.4668186	0	115.5606047	0.154080806	0	38.52020158	73.18838299	0	115.5606047	0	19.26010079	23.11212095	7.704040315	23.11212095	23.11212095	11.55606047	0	0	0	0	0	0	30	0	30	0	15	0	26.9641411	7.704040315	30.81616126								3000	10.4592	0.418613834	4.605797925	0	5.069012901	1.113772274	0	0.955339561	2.130113612	0	3.707503991	0	0.15819712	0.097534542	2.56013725	11.2348459	1.132272185	1.671549346	0	0	0	0	0	0	1.16683383	0	0	0	1.062683573	0	0.317856804	0.279578721	0.175534268	0	0	0	0	0	0	0	48.3164	0	39.76114632	10.4592	0.418613834	4.605797925	0	5.069012901	1.113772274	0	0.955339561	2.130113612	0	3.707503991	0	0.15819712	0.097534542	2.56013725	11.2348459	1.132272185	1.671549346	0	0	0	0	0	0	1.16683383	0	0	0	1.062683573	0	0.317856804	0.279578721	0.175534268	0	0	0	0	0	0	0	48.3164	NO	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	Not Applicable	Not Applicable	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable									0.0248	0	0.0019	0.0468	0	0.0881	0.0075	0	0.0596	0.0077	0.0403	0	0	0	0.0129	0.2492	0.0103	0.0157	0	0	0	0	0	0	0.0025	0	0.0017	0	0	0	0	0.0002	0								0.5691	3000	6.91E-05	10.484	0.418613834	4.607690807	0.046790218	5.069012901	1.201902855	0.00745931	0.955339561	2.189690407	0.007691774	3.747776053	0	0.15819712	0.097534542	2.573054777	11.48405941	1.142539836	1.687234818	0	0	0	0	0	0	1.169323421	0	0.001720025	0	1.062683573	0	0.317856804	0.279794972	0.175534268	0	0	0	0	0	0	0	48.8855
H4152_013_0	2010	8	N/A	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Routine Exams	Partial Hospitalization								D	D	D		T	Coin		V	V		O		V	V	V	V	V	V							V		V		O		V	V	V																																																0	YES	1535.992703	111.8371	1823.990975	0	386.996466	4.014275792	0	250.8247048	284.9320511	0	327.9007216	0	58.50478586	29.46492514	3522.015672	4642.643202	449.5955535	1226.899744	0	0	0	0	0	0	397.6806937	0	0	0	850.146858	0	122.3445801	440.0681242	60.63173281								3400	$340 per day  (PBP# 1a)	$165 per day  (PBP# 1b)	$80 per day  (PBP# 2)	No Copay	$150 Copay per day (PBP# 10a)	"20% Coinsurance for non-capitated services (PBP# 11a, 11b, 11c)"	Grouped in Line e.1.	$50 Copay per visit (PBP# 4a)	"$175 Copay per visit (PBP# 9a, 9b)"	No Copay	$150 Copay per day for specified services (PBP# 8b)	No Copay	$25 Copay per visit (PBP# 12)	"$30 Copay per visit at a wound care clinic (PBP# 9a, 9b)"	"$10 Copay per visit; Includes PCP, Nutrition Therapy, Nutrition Training and Smoking Cessation (PBP# 7a, 7g, 14a, 14i, 14j)"	"$30 Copay per visit (PBP# 7b, 7d, 7f, 7g, 14i, 17a, 18a)"	"$30 Copay per visit (PBP# 7e, 7h, 9c)"	"$15 Copay per visit (PBP# 7c, 7i)"	No Copay	No Copay	No Copay	No Copay	Not Covered	Not Covered	$30 Copay per visit (PBP# 17a)	Not Covered	$30 Copay per visit (PBP# 18a)	Not Covered	$15 Monthly (PBP# 14a)	Not Covered	$35 Copay per visit (PBP# 4b)	$10 Copay per visit; Weighted average of PCP and Specialist. (PBP# 14c)	$40 Copay per visit (PBP# 5)								340	165	80	0	150	0.2	0	50	175	0	150	0	25	30	10	30	30	15	0	0	0	0	0	0	30	0	30	0	15	0	35	10	40								NO	183.1411182	83.68485357	39.20986222	0	132.7413707	0.176988494	0	44.24712358	154.8649325	0	132.7413707	0	22.12356179	26.54827415	8.849424717	26.54827415	26.54827415	13.27413707	0	0	0	0	0	0	30	0	30	0	15	0	30.97298651	8.849424717	35.39769887									23.442	0.779922612	5.959869567	0	4.280870115	0.710480628	0	0.924855976	3.677165239	0	3.627165938	0	0.107861187	0.065186909	2.597317711	10.27118037	0.994665501	1.357169615	0	0	0	0	0	0	0.994201734	0	0	0	1.062683573	0	0.315781419	0.324529145	0.178851985	0	0	0	0	0	0	0	61.6717	0	30.77018219	23.442	0.779922612	5.959869567	0	4.280870115	0.710480628	0	0.924855976	3.677165239	0	3.627165938	0	0.107861187	0.065186909	2.597317711	10.27118037	0.994665501	1.357169615	0	0	0	0	0	0	0.994201734	0	0	0	1.062683573	0	0.315781419	0.324529145	0.178851985	0	0	0	0	0	0	0	61.6717	NO																																																																																		0			23.442	0.779922612	5.959869567	0	4.280870115	0.710480628	0	0.924855976	3.677165239	0	3.627165938	0	0.107861187	0.065186909	2.597317711	10.27118037	0.994665501	1.357169615	0	0	0	0	0	0	0.994201734	0	0	0	1.062683573	0	0.315781419	0.324529145	0.178851985	0	0	0	0	0	0	0	61.6717
H4152_815_0	2010	7	N/A	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Routine Exams	Partial Hospitalization								D	D	D		T			V	V		O		V	V	V	V	V	V				V		Coin	V		V		O		V	V	V																																																0	NO	174.5179022	4.070388389	253.2602686	0	271.0184498	0	0	197.287726	0	0	0	0	0	0	3088.267461	4987.398729	366.8778178	0	0	0	0	0	0	7.892182783	377.6316304	0	0	0	848.647939	0	105.8363475	444.9435792	60.08780199									$100 copay per stay per benefit period (PBP# 1a)	$100 copay per stay per benefit period (PBP# 1b)	$0 for days 1-29 and $50 for days 30-100 (PBP# 2)	No Copay	$50 Copay per day (PBP# 10a)	No Copay	No Copay	$50 Copay per visit (PBP# 4a)	No Copay	No Copay	No Copay	No Copay	No Copay	No Copay	"$10 Copay per visit; Includes PCP, Nutrition Therapy, Nutrition Training and Smoking Cessation (PBP# 7a, 7g, 14a, 14i, 14j)"	"$20 Copay per visit (PBP# 7b, 7d, 7f, 7g, 14i, 17a, 18a)"	"$20 Copay per visit (PBP# 7e, 7h, 9c)"	No Copay	No Copay	No Copay	No Copay	No Copay	Not Covered	20% Coinsurance on Comprehensive Dental (PBP# 16B)	$30 Copay per visit (PBP# 17a)	No Copay	$20 Copay per visit (PBP# 18a)	No Copay	$15 Monthly (PBP# 14a)	Not Covered	$25 Copay per visit (PBP# 4b)	$10 Copay per visit; Weighted average of PCP and Specialist. (PBP# 14c)	$20 Copay per visit (PBP# 5)								100	100	50	0	50	0	0	50	0	0	0	0	0	0	10	20	20	0	0	0	0	0	0	0.2	30	0	20	0	15	0	25	10	20								YES	100	100	50	0	50	0	0	50	0	0	0	0	0	0	10	20	20	0	0	0	0	0	0	0.2	30	0	20	0	15	0	25	10	20								3000	1.4543	0.033919903	1.055251119	0	1.129243541	0	0	0.822032192	0	0	0	0	0	0	2.573556218	8.312331215	0.61146303	0	0	0	0	0	0	1.578436557	0.944079076	0	0	0	1.060809924	0	0.220492391	0.370786316	0.100146337	0	0	0	0	0	0	0	20.2669	0	0	1.4543	0.033919903	1.055251119	0	1.129243541	0	0	0.822032192	0	0	0	0	0	0	2.573556218	8.312331215	0.61146303	0	0	0	0	0	0	1.578436557	0.944079076	0	0	0	1.060809924	0	0.220492391	0.370786316	0.100146337	0	0	0	0	0	0	0	20.2669	NO	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	Not Applicable	Not Applicable	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable									0.1506	0	0.0115	0.2841	0.0029	0.5352	0.0453	0.0031	0.3618	0.0467	0.2445	0	0	0	0.0784	1.5133	0.0623	0.0952	0	0	0	0	0	0	0.0151	0.0008	0.0104	0.0008	0	0	0	0.0013	0.1114								3.5748	3000	0.00041945	1.6049	0.033919903	1.066745342	0.284126153	1.132151839	0.535158928	0.045295475	0.825170766	0.361770603	0.046707072	0.244545687	0	0	0	2.651995847	9.825640629	0.673811708	0.095247533	0	0	0	0	0	1.578436557	0.959196718	0.000776855	0.010444575	0.000790969	1.060809924	0	0.220492391	0.372099465	0.211510014	0	0	0	0	0	0	0	23.8417
H4152_817_0	2010	7	N/A	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Routine Exams	Partial Hospitalization								D	D	D		T			V	V		O		V	V	V	V	V	V							V		V		O		V	V	V																																																0	NO	221.6953728	5.170737557	321.7241839	0	326.8131891	0	0	239.5123652	0	0	0	0	0	0	3718.686958	6005.494939	441.7699482	0	0	0	0	0	0	0	455.3748925	0	0	0	885.2998704	0	128.4880434	535.7715632	72.47583559									$100 copay per stay per benefit period (PBP# 1a)	$100 copay per stay per benefit period (PBP# 1b)	$0 for days 1-29 and $50 for days 30-100 (PBP# 2)	No Copay	$50 Copay per day (PBP# 10a)	No Copay	No Copay	$50 Copay per visit (PBP# 4a)	No Copay	No Copay	No Copay	No Copay	No Copay	No Copay	"$10 Copay per visit; Includes PCP, Nutrition Therapy, Nutrition Training and Smoking Cessation (PBP# 7a, 7g, 14a, 14i, 14j)"	"$20 Copay per visit (PBP# 7b, 7d, 7f, 7g, 14i, 17a, 18a)"	"$20 Copay per visit (PBP# 7e, 7h, 9c)"	No Copay	No Copay	No Copay	No Copay	No Copay	Not Covered	No Copay	$20 Copay per visit (PBP# 17a)	No Copay	$20 Copay per visit (PBP# 18a)	Not Covered	$15 Monthly (PBP# 14a)	Not Covered	$25 Copay per visit (PBP# 4b)	$10 Copay per visit; Weighted average of PCP and Specialist. (PBP# 14c)	$20 Copay per visit (PBP# 5)								100	100	50	0	50	0	0	50	0	0	0	0	0	0	10	20	20	0	0	0	0	0	0	0	20	0	20	0	15	0	25	10	20								NO	100	100	50	0	50	0	0	50	0	0	0	0	0	0	10	20	20	0	0	0	0	0	0	0	20	0	20	0	15	0	25	10	20									1.8475	0.04308948	1.340517433	0	1.361721621	0	0	0.997968188	0	0	0	0	0	0	3.098905798	10.00915823	0.736283247	0	0	0	0	0	0	0	0.758958154	0	0	0	1.106624838	0	0.267683424	0.446476303	0.120793059	0	0	0	0	0	0	0	22.1356	0	0	1.8475	0.04308948	1.340517433	0	1.361721621	0	0	0.997968188	0	0	0	0	0	0	3.098905798	10.00915823	0.736283247	0	0	0	0	0	0	0	0.758958154	0	0	0	1.106624838	0	0.267683424	0.446476303	0.120793059	0	0	0	0	0	0	0	22.1356	NO																																																																																		0	3000	0.001978818	1.8475	0.04308948	1.340517433	0	1.361721621	0	0	0.997968188	0	0	0	0	0	0	3.098905798	10.00915823	0.736283247	0	0	0	0	0	0	0	0.758958154	0	0	0	1.106624838	0	0.267683424	0.446476303	0.120793059	0	0	0	0	0	0	0	22.1356
H4152_821_0	2010	7	N/A	f.2.	i.7.	h.6.								OP Facility - Emergency	Professional	OP Facility - Other								Urgent Care	Routine Exams	Partial Hospitalization								D	D	D		T			V	V		O		V	V	V	V	V	V						Coin	V		V		O		V	V	V																																																0	NO	174.5179022	4.070388389	253.2602686	0	271.0184498	0	0	197.287726	0	0	0	0	0	0	3088.267461	4987.398729	366.8778178	0	0	0	0	0	0	7.892182783	377.6316304	0	0	0	848.647939	0	105.8363475	444.9435792	60.08780199									$100 copay per stay per benefit period (PBP# 1a)	$100 copay per stay per benefit period (PBP# 1b)	$0 for days 1-29 and $50 for days 30-100 (PBP# 2)	No Copay	$50 Copay per day (PBP# 10a)	No Copay	No Copay	$50 Copay per visit (PBP# 4a)	No Copay	No Copay	No Copay	No Copay	No Copay	No Copay	"$10 Copay per visit; Includes PCP, Nutrition Therapy, Nutrition Training and Smoking Cessation (PBP# 7a, 7g, 14a, 14i, 14j)"	"$10 Copay per visit (PBP# 7b, 7d, 7f, 7g, 14i, 17a, 18a)"	"$10 Copay per visit (PBP# 7e, 7h, 9c)"	No Copay	No Copay	No Copay	No Copay	No Copay	Not Covered	20% Coinsurance on Comprehensive Dental (PBP# 16B)	$10 Copay per visit (PBP# 17a)	No Copay	$10 Copay per visit (PBP# 18a)	No Copay	$15 Monthly (PBP# 14a)	Not Covered	$25 Copay per visit (PBP# 4b)	$10 Copay per visit; Weighted average of PCP and Specialist. (PBP# 14c)	$20 Copay per visit (PBP# 5)								100	100	50	0	50	0	0	50	0	0	0	0	0	0	10	10	10	0	0	0	0	0	0	0.2	10	0	10	0	15	0	25	10	20								YES	100	100	50	0	50	0	0	50	0	0	0	0	0	0	10	10	10	0	0	0	0	0	0	0.2	10	0	10	0	15	0	25	10	20								3000	1.4543	0.033919903	1.055251119	0	1.129243541	0	0	0.822032192	0	0	0	0	0	0	2.573556218	4.156165607	0.305731515	0	0	0	0	0	0	1.578436557	0.314693025	0	0	0	1.060809924	0	0.220492391	0.370786316	0.100146337	0	0	0	0	0	0	0	15.1756	0	0	1.4543	0.033919903	1.055251119	0	1.129243541	0	0	0.822032192	0	0	0	0	0	0	2.573556218	4.156165607	0.305731515	0	0	0	0	0	0	1.578436557	0.314693025	0	0	0	1.060809924	0	0.220492391	0.370786316	0.100146337	0	0	0	0	0	0	0	15.1756	NO	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable	Not Applicable	Not Applicable	Not Applicable	20% Coinsurance on OON Benefits Subject to a $3000 OOP OON Max (PBP Sec. C)	Not Applicable									0.1506	0	0.0115	0.2841	0.0029	0.5352	0.0453	0.0031	0.3618	0.0467	0.2445	0	0	0	0.0784	1.5133	0.0623	0.0952	0	0	0	0	0	0	0.0151	0.0008	0.0104	0.0008	0	0	0	0.0013	0.1114								3.5748	3000	0.00041945	1.6049	0.033919903	1.066745342	0.284126153	1.132151839	0.535158928	0.045295475	0.825170766	0.361770603	0.046707072	0.244545687	0	0	0	2.651995847	5.669475022	0.368080194	0.095247533	0	0	0	0	0	1.578436557	0.329810668	0.000776855	0.010444575	0.000790969	1.060809924	0	0.220492391	0.372099465	0.211510014	0	0	0	0	0	0	0	18.7504
H4155_001_0	2010	5	N/A																															D	D	D	V	T	Coin		V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	P																																																			0	YES			1498.217096		171.8548408	75.86497313		53.57502157													40.59444117			825																	3400			"$0/day for (1-5), then $25 for (6-100)"		$25 (waived if admitted)	20% high cost DME		$50 @ ER; $0 @ UCC													20% for Chemo (0% other)			$15 Office Visit Copay																			15.53085758		20	0.008408694		28													0.0746			15																	NO			15.50223695		19.96314352	0.008393198		27.94840093													0.074462525			15																		0	0	1.935476368	0	0.285896904	0.636749767	0	0.124778015	0	0	0	0	0	0	0	0	0	0	0	0	3.022764604	0	0	1.03125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.0369	0	0.010493462	0	0	1.935476368	0	0.285896904	0.636749767	0	0.124778015	0	0	0	0	0	0	0	0	0	0	0	0	3.022764604	0	0	1.03125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.0369	NO																																																																																		0			0	0	1.935476368	0	0.285896904	0.636749767	0	0.124778015	0	0	0	0	0	0	0	0	0	0	0	0	3.022764604	0	0	1.03125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.0369
H4155_003_0	2010	3	N/A																															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	V	V	V	V	P																																																			0	YES			809.143458		195.5792006			75.24343791													59.78694418			825																	3400			"$0/day for (1-5), then $10 for (6-100)"		$25 (waived if admitted)			$50 @ ER; $0 @ UCC													20% Chemo (0% else)			$15 Office Vist																			6.212343034	0	20			28													0.0746			15																	NO			6.208588134	0	19.98791149			27.98307608													0.07455491			15																		0	0	0.418636539	0	0.325768313	0	0	0.175461904	0	0	0	0	0	0	0	0	0	0	0	0	4.457410233	0	0	1.03125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4085	0	0.003034905	0	0	0.418636539	0	0.325768313	0	0	0.175461904	0	0	0	0	0	0	0	0	0	0	0	0	4.457410233	0	0	1.03125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4085	NO																																																																																		0			0	0	0.418636539	0	0.325768313	0	0	0.175461904	0	0	0	0	0	0	0	0	0	0	0	0	4.457410233	0	0	1.03125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4085
H4155_004_0	2010	5	N/A																															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	V	V	V	V	P																																																			0	YES			1902.000541		329.7622792			133.9541288													41.06183364			825																	3400			"$0/day for (1-5), then $10 for (6-100)"		$25 (waived if admitted)			$50 @ ER; $0 @ UCC													20% Chemo (else 0%)			$15 Office Visit																			6.212343034		20			28													0.0746			15																	NO			6.212343034		20			28													0.0746			15																		0	0	0.984656651	0	0.549603799	0	0	0.312559634	0	0	0	0	0	0	0	0	0	0	0	0	3.06321279	0	0	1.03125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9413	0	0	0	0	0.984656651	0	0.549603799	0	0	0.312559634	0	0	0	0	0	0	0	0	0	0	0	0	3.06321279	0	0	1.03125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9413	NO																																																																																		0			0	0	0.984656651	0	0.549603799	0	0	0.312559634	0	0	0	0	0	0	0	0	0	0	0	0	3.06321279	0	0	1.03125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9413
H4205_002_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	657.1155347	31.8265901	139.1704578	16.52420172	179.9807849	16.57959777	5.600438015	394.4692663	320.5607129	2269.676501	943.9491276	0	0	1330.412252	3392.940973	4735.487597	389.7688816	490.8570321	29.14070581	19.31831185	8.668876831	5.202333207	0	0	420	315	0	0	1072.983746	0											3400	1a:  Acute - $225/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $225/$0/day for 1-5/6-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 25.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $30/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $30/visit/:  Routine Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $30/service			17a:  Routine Eye Exams - $25/visit	17b:  Wear - $10/service			/14a:  Nursing Hotline - $0/service/:  Routine Exams - $20/visit/14c:  Routine Exams - $20/visit												225	225	128	0.1	150	0.25	0.041850775	53.04254985	160.5644982	22.5	38.45208352	0	0	29.1120836	20.00071331	29.35552844	30	30	0	0.002024736	0.2	30	0	0	25	10	0	0	1.360388665	0											NO	188.7462462	188.7462462	107.3756423	0.083887221	125.8308308	0.209718051	0.035107452	44.49592076	134.6930947	18.87462462	32.2563841	0	0	24.42131776	16.77804248	24.62553687	25.16616616	25.16616616	0	0.001698494	0.167774441	25.16616616	0	0	25	10	0	0	1.141192239	0												10.3357	0.500595784	1.245293108	1.386169354	1.887260974	3.477040936	0.196617108	1.462689435	3.598109537	3.569940996	2.537365469	0	0	2.70753503	4.743908982	9.717827036	0.817415703	1.029415802	0	0.032812044	1.454415965	0.010910232	0	0	0.875	0.2625	0	0	0.10204006	0	0	0	0	0	0	0	0	0	0	0	51.9505	0	9.76	10.3357	0.500595784	1.245293108	1.386169354	1.887260974	3.477040936	0.196617108	1.462689435	3.598109537	3.569940996	2.537365469	0	0	2.70753503	4.743908982	9.717827036	0.817415703	1.029415802	0	0.032812044	1.454415965	0.010910232	0	0	0.875	0.2625	0	0	0.10204006	0	0	0	0	0	0	0	0	0	0	0	51.9505	NO																																																																																		0			10.3357	0.500595784	1.245293108	1.386169354	1.887260974	3.477040936	0.196617108	1.462689435	3.598109537	3.569940996	2.537365469	0	0	2.70753503	4.743908982	9.717827036	0.817415703	1.029415802	0	0.032812044	1.454415965	0.010910232	0	0	0.875	0.2625	0	0	0.10204006	0	0	0	0	0	0	0	0	0	0	0	51.9505
H4205_004_0	2010	5	N/A																															Ded	Ded	D	coin	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	232.2024603	5.619137199	85.5156872	12.20522363	137.0502354	15.8916382	5.154075928	361.2580561	394.6770439	2485.253063	1252.065981	0	0	2098.222935	3301.7005	4954.832219	398.9661986	545.3501238	27.24087735	24.80029741	7.6984138	21.16077678	0	0	420	315	0	0	1080.111859	0											3400	1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 25.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $35/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $35/service			17a:  Routine Eye Exams - $25/visit	17b:  Wear - $10/service			/14a:  Nursing Hotline - $0/service/:  Routine Exams - $25/visit/14c:  Routine Exams - $25/visit												950	950	128	0.1	150	0.25	0.028499739	53.0558919	163.0287262	25	38.53301743	0	0	28.75882576	25	33.33151542	35	35	0	0.002573583	0.2	35	0	0	25	10	0	0	1.854249121	0											NO	815.9057125	815.9057125	109.9325592	0.085862738	128.7844674	0.214417071	0.024485571	45.53123793	139.7973857	21.4409691	33.04327737	0	0	24.65990694	21.43926959	28.58462154	30.03243847	30.02406399	0	0.002204623	0.171670468	29.95483222	0	0	25	10	0	0	1.589581785	0												15.7879	0.382057178	0.783413195	1.047973916	1.470828465	3.407438514	0.126200492	1.370710542	4.597901577	4.440519511	3.447696958	0	0	4.31183186	5.89883726	11.80266698	0.998493984	1.364468918	0	0.054675309	1.321590302	0.052822293	0	0	0.875	0.2625	0	0	0.143077178	0	0	0	0	0	0	0	0	0	0	0	63.9486	0	7.737917532	15.7879	0.382057178	0.783413195	1.047973916	1.470828465	3.407438514	0.126200492	1.370710542	4.597901577	4.440519511	3.447696958	0	0	4.31183186	5.89883726	11.80266698	0.998493984	1.364468918	0	0.054675309	1.321590302	0.052822293	0	0	0.875	0.2625	0	0	0.143077178	0	0	0	0	0	0	0	0	0	0	0	63.9486	NO																																																																																		0			15.7879	0.382057178	0.783413195	1.047973916	1.470828465	3.407438514	0.126200492	1.370710542	4.597901577	4.440519511	3.447696958	0	0	4.31183186	5.89883726	11.80266698	0.998493984	1.364468918	0	0.054675309	1.321590302	0.052822293	0	0	0.875	0.2625	0	0	0.143077178	0	0	0	0	0	0	0	0	0	0	0	63.9486
H4205_005_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	636.435459	31.7930347	135.73632	15.71329471	164.6054259	16.32476541	5.462079754	373.5893791	327.8421907	2376.745631	957.5899622	0	0	1383.444343	3450.377394	4788.309933	368.381012	473.9779881	30.72797342	20.47201173	7.906753494	8.51860127	0	0	420	315	0	0	1076.566277	0											3400	1a:  Acute - $225/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $225/$0/day for 1-5/6-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 25.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $30/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $30/visit/:  Routine Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $30/service			17a:  Routine Eye Exams - $25/visit	17b:  Wear - $10/service			/14a:  Nursing Hotline - $0/service/:  Routine Exams - $20/visit/14c:  Routine Exams - $20/visit												225	225	128	0.1	150	0.25	0.038772807	53.17298293	161.276617	22.5	38.45072031	0	0	29.00938485	20.00073662	29.33172671	30	30	0	0.002212212	0.2	30	0	0	25	10	0	0	1.422416408	0											NO	189.0619639	189.0619639	107.5552506	0.08402754	126.0413093	0.210068849	0.032579835	44.67994924	135.5167731	18.90619639	32.3091942	0	0	24.37587231	16.80612687	24.64672825	25.20826185	25.20826185	0	0.001858868	0.168055079	25.20826185	0	0	25	10	0	0	1.19522151	0												10.0271	0.500904465	1.216596159	1.320349492	1.728923616	3.429324677	0.177953659	1.390996208	3.702342981	3.74460164	2.578246671	0	0	2.810221888	4.832290019	9.83468114	0.773853751	0.995680103	0	0.038054761	1.328770083	0.017894928	0	0	0.875	0.2625	0	0	0.107227931	0	0	0	0	0	0	0	0	0	0	0	51.6936	0	9.61	10.0271	0.500904465	1.216596159	1.320349492	1.728923616	3.429324677	0.177953659	1.390996208	3.702342981	3.74460164	2.578246671	0	0	2.810221888	4.832290019	9.83468114	0.773853751	0.995680103	0	0.038054761	1.328770083	0.017894928	0	0	0.875	0.2625	0	0	0.107227931	0	0	0	0	0	0	0	0	0	0	0	51.6936	NO																																																																																		0			10.0271	0.500904465	1.216596159	1.320349492	1.728923616	3.429324677	0.177953659	1.390996208	3.702342981	3.74460164	2.578246671	0	0	2.810221888	4.832290019	9.83468114	0.773853751	0.995680103	0	0.038054761	1.328770083	0.017894928	0	0	0.875	0.2625	0	0	0.107227931	0	0	0	0	0	0	0	0	0	0	0	51.6936
H4205_006_0	2010	6	N/A																															Ded	Ded	D	coin	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	230.7204401	5.139989269	107.3015962	14.65951025	163.0260969	15.2014368	5.086226851	392.6699947	361.6015232	2351.291785	1149.822054	0	0	1752.820899	3089.427534	4606.277513	414.4415379	533.2418336	26.47519082	20.79749956	8.755674307	10.162705	0	0	420	315	0	0	1068.539798	0											3400	1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 25.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $35/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $35/service			17a:  Routine Eye Exams - $25/visit	17b:  Wear - $10/service			/14a:  Nursing Hotline - $0/service/:  Routine Exams - $25/visit/14c:  Routine Exams - $25/visit												950	950	128	0.1	150	0.25	0.038772807	52.83437482	161.276617	25	38.53301743	0	0	31.0697988	25	33.4452893	35	35	0	0.002095986	0.2	35	0	0	25	10	0	0	1.603585533	0											NO	823.1987049	823.1987049	110.9151939	0.086652495	129.9787429	0.216631238	0.033597604	45.78230413	139.7502129	21.66312381	33.3898211	0	0	26.92275593	21.66312381	28.98117773	30.32837334	30.32837334	0	0.001816224	0.173304991	30.32837334	0	0	25	10	0	0	1.389546878	0												15.8274	0.352602709	0.991781446	1.270283142	1.765827261	3.293106075	0.170885038	1.498111427	4.211157488	4.244693755	3.199362723	0	0	3.932564104	5.577220931	11.12461227	1.047444807	1.347696451	0	0.037772914	1.517402053	0.025684859	0	0	0.875	0.2625	0	0	0.123732178	0	0	0	0	0	0	0	0	0	0	0	62.6968	0	6.99	15.8274	0.352602709	0.991781446	1.270283142	1.765827261	3.293106075	0.170885038	1.498111427	4.211157488	4.244693755	3.199362723	0	0	3.932564104	5.577220931	11.12461227	1.047444807	1.347696451	0	0.037772914	1.517402053	0.025684859	0	0	0.875	0.2625	0	0	0.123732178	0	0	0	0	0	0	0	0	0	0	0	62.6968	NO																																																																																		0			15.8274	0.352602709	0.991781446	1.270283142	1.765827261	3.293106075	0.170885038	1.498111427	4.211157488	4.244693755	3.199362723	0	0	3.932564104	5.577220931	11.12461227	1.047444807	1.347696451	0	0.037772914	1.517402053	0.025684859	0	0	0.875	0.2625	0	0	0.123732178	0	0	0	0	0	0	0	0	0	0	0	62.6968
H4205_007_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	611.7930124	28.61583798	133.9030934	15.74960062	167.9649009	16.4181903	5.493338653	377.9883478	321.1909372	2372.855066	941.3639479	0	0	1413.572702	3650.633321	4855.617168	378.8157194	487.4038202	30.77376516	20.57397803	8.047027628	8.672510654	0	873	420	315	0	0	1081.074664	0											3400	1a:  Acute - $150/$0/day for 1-4/5-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-4/5-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 25.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $20/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $20/service		16a:  Preventive Dental - Oral Exams - $10/service/16a:  Preventive Dental - Prophylaxis - $10/service/16a:  Preventive Dental - X-Rays - $10/service	17a:  Routine Eye Exams - $25/visit	17b:  Wear - $10/service			/14a:  Nursing Hotline - $0/service/:  Routine Exams - $10/visit/14c:  Routine Exams - $10/visit												150	150	128	0.1	150	0.25	0.038772807	52.4274692	161.276617	17.5	38.44848332	0	0	23.40153667	10.0020734	20.63711732	20	20	0	0.001896742	0.2	20	0	10	25	10	0	0	0.74994509	0											NO	133.5043624	133.5043624	113.9237226	0.089002908	133.5043624	0.222507271	0.034508926	46.66197232	143.5408795	15.57550895	34.22026834	0	0	20.82804821	8.902136215	18.36763459	17.80058165	17.80058165	0	0.001688155	0.178005817	17.80058165	0	10	25	10	0	0	0.66747294	0												6.8064	0.3183616	1.271228239	1.401760259	1.868670584	3.653166713	0.189569214	1.469806819	3.842002468	3.079868775	2.684477242	0	0	2.4534967	2.708202925	7.43218349	0.561928345	0.723005958	0	0.034732068	1.432417724	0.012864645	0	0.7275	0.875	0.2625	0	0	0.06013234	0	0	0	0	0	0	0	0	0	0	0	43.8693	0	5.19	6.8064	0.3183616	1.271228239	1.401760259	1.868670584	3.653166713	0.189569214	1.469806819	3.842002468	3.079868775	2.684477242	0	0	2.4534967	2.708202925	7.43218349	0.561928345	0.723005958	0	0.034732068	1.432417724	0.012864645	0	0.7275	0.875	0.2625	0	0	0.06013234	0	0	0	0	0	0	0	0	0	0	0	43.8693	NO																																																																																		0			6.8064	0.3183616	1.271228239	1.401760259	1.868670584	3.653166713	0.189569214	1.469806819	3.842002468	3.079868775	2.684477242	0	0	2.4534967	2.708202925	7.43218349	0.561928345	0.723005958	0	0.034732068	1.432417724	0.012864645	0	0.7275	0.875	0.2625	0	0	0.06013234	0	0	0	0	0	0	0	0	0	0	0	43.8693
H4205_008_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	625.6826075	32.92058998	103.9972247	14.59274645	162.865756	15.15531139	5.070793815	385.9121697	351.1948277	2086.80111	1056.664232	0	0	1715.494167	3215.263338	4526.441902	403.9839546	519.7865683	26.26261335	20.29869854	8.659102808	10.15070039	0	873	420	315	0	0	1071.377143	0											3400	1a:  Acute - $225/$0/day for 1-6/7-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $225/$0/day for 1-6/7-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 25.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit/4a:  Worldwide Coverage - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $25/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $25/visit/:  Routine Exams - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $25/service		16a:  Preventive Dental - Oral Exams - $10/service/16a:  Preventive Dental - Prophylaxis - $10/service/16a:  Preventive Dental - X-Rays - $10/service	17a:  Routine Eye Exams - $25/visit	17b:  Wear - $10/service			/14a:  Nursing Hotline - $0/service/:  Routine Exams - $15/visit/14c:  Routine Exams - $15/visit												225	225	128	0.1	150	0.25	0.038772807	52.05721541	161.276617	20	38.45685786	0	0	25.18965818	15.00142629	24.98999622	25	25	0	0.0019828	0.2	25	0	10	25	10	0	0	0.99932797	0											NO	193.4473597	193.4473597	110.0500535	0.085976604	128.9649065	0.214941511	0.033335543	44.75702611	138.6601589	17.19532086	33.06390052	0	0	21.65721274	12.89771692	21.48555017	21.49415108	21.49415108	0	0.001704744	0.171953209	21.49415108	0	10	25	10	0	0	0.859188255	0												10.0864	0.530700101	0.953741679	1.254634787	1.750330583	3.257505526	0.169037663	1.439356755	4.058060884	2.99026789	2.911453422	0	0	3.096068511	3.455796363	8.104424549	0.72360768	0.931030919	0	0.034604092	1.488960512	0.018181724	0	0.7275	0.875	0.2625	0	0	0.076709555	0	0	0	0	0	0	0	0	0	0	0	49.1959	0	7.72	10.0864	0.530700101	0.953741679	1.254634787	1.750330583	3.257505526	0.169037663	1.439356755	4.058060884	2.99026789	2.911453422	0	0	3.096068511	3.455796363	8.104424549	0.72360768	0.931030919	0	0.034604092	1.488960512	0.018181724	0	0.7275	0.875	0.2625	0	0	0.076709555	0	0	0	0	0	0	0	0	0	0	0	49.1959	NO																																																																																		0			10.0864	0.530700101	0.953741679	1.254634787	1.750330583	3.257505526	0.169037663	1.439356755	4.058060884	2.99026789	2.911453422	0	0	3.096068511	3.455796363	8.104424549	0.72360768	0.931030919	0	0.034604092	1.488960512	0.018181724	0	0.7275	0.875	0.2625	0	0	0.076709555	0	0	0	0	0	0	0	0	0	0	0	49.1959
H4205_801_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	332.3039739	3.804659867	65.86897235	47.40289389	10.67121989	18.89116994	4.670793077	11.41199656	48.40407023	7.448609998	23.21515888	0	0.070093098	28.43156662	48.30108041	121.2940198	1.581837314	6.249664679	34.81003187	41.73307056	9.095449154	1.591282181	0	0	0	0	0	0	0	0												Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare											0.076576493	0.076576493	0.164878276	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076576493	0.076576493	0.164878276	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624	0	0	25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624	NO																																																																																		0			25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624
H4205_802_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	332.3039739	3.804659867	65.86897235	47.40289389	10.67121989	18.89116994	4.670793077	11.41199656	48.40407023	7.448609998	23.21515888	0	0.070093098	28.43156662	48.30108041	121.2940198	1.581837314	6.249664679	34.81003187	41.73307056	9.095449154	1.591282181	0	0	0	0	0	0	0	0												Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare											0.076576493	0.076576493	0.164878276	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076576493	0.076576493	0.164878276	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624	0	0	25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624	NO																																																																																		0			25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624
H4205_803_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	332.3039739	3.804659867	65.86897235	47.40289389	10.67121989	18.89116994	4.670793077	11.41199656	48.40407023	7.448609998	23.21515888	0	0.070093098	28.43156662	48.30108041	121.2940198	1.581837314	6.249664679	34.81003187	41.73307056	9.095449154	1.591282181	0	0	0	0	0	0	0	0												Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare											0.076576493	0.076576493	0.164878276	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076576493	0.076576493	0.164878276	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624	0	0	25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624	NO																																																																																		0			25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624
H4205_804_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	332.3039739	3.804659867	65.86897235	47.40289389	10.67121989	18.89116994	4.670793077	11.41199656	48.40407023	7.448609998	23.21515888	0	0.070093098	28.43156662	48.30108041	121.2940198	1.581837314	6.249664679	34.81003187	41.73307056	9.095449154	1.591282181	0	0	0	0	0	0	0	0												Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare											0.076576493	0.076576493	0.164878276	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076576493	0.076576493	0.164878276	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624	0	0	25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624	NO																																																																																		0			25.4467	0.291347509	10.86036258	0	2.486394234	4.401642595	1.088294787	2.658995199	11.27814836	1.735526129	5.409132019	0	0.016331692	6.624555022	11.25415174	28.26150661	0.368568094	1.45617187	8.110737425	9.723805441	2.119239653	0.370768748	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9624
H4209_001_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	615.4621015	18.80543339	96.37460002	13.84597653	179.3187263	12.97123498	4.844402323	287.3122018	282.7402283	1701.593106	934.8636048	0	0.060255682	1138.659107	3015.947117	4007.288669	223.0489396	350.6910591	21.71170371	16.33817187	4.430764621	2.147805245	0	0	420	315	0	0	1072.780531	0												1a:  Acute - $275/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-5/6-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 25.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $40/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $150/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $40/visit/:  Routine Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $40/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $30/service			17a:  Routine Eye Exams - $25/visit	17b:  Wear - $10/service			/14a:  Nursing Hotline - $0/service/:  Routine Exams - $25/visit/14c:  Routine Exams - $25/visit												275	275	128	0.1	150	0.25	0.093869616	53.06243553	157.8817389	27.5	52.0525121	0	0.2	38.00846567	25	37.39771547	40	40	0	0.001658728	0.2	30	0	0	25	10	0	0	1.696072234	0											NO	229.0879778	228.7791356	106.3778358	0.083314265	124.8927289	0.208146057	0.078156647	44.19295527	131.4828479	22.89643368	43.38105795	0	0.165434698	31.66423812	20.82144588	31.14274869	33.25252747	33.28508473	0	0.001378533	0.166229721	24.81520467	0	0	25	10	0	0	1.41295201	0												11.7496	0.358524233	0.854343448	1.153567353	1.866300423	2.699911413	0.378622241	1.05809794	3.097957537	3.246701143	3.379614351	0	0.00996838	3.004564424	5.23303164	10.39983199	0.618078416	0.972731801	0	0.022522702	0.736524768	0.004441519	0	0	0.875	0.2625	0	0	0.126315617	0	0	0	0	0	0	0	0	0	0	0	52.1087	0	10.23392918	11.7496	0.358524233	0.854343448	1.153567353	1.866300423	2.699911413	0.378622241	1.05809794	3.097957537	3.246701143	3.379614351	0	0.00996838	3.004564424	5.23303164	10.39983199	0.618078416	0.972731801	0	0.022522702	0.736524768	0.004441519	0	0	0.875	0.2625	0	0	0.126315617	0	0	0	0	0	0	0	0	0	0	0	52.1087	YES	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	"$35 OV Copay, 30% Coinsurance Other"	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	Allowance Only	Allowance Only	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance											3400	1.2561	0.0192	0.0699	0.1074	0.0375	0.0733	0.0256	0.0638	0.1845	0.0896	0.098	0	0.0004	0.0817	0.2092	0.5419	0.0112	0.0334	0.1602	0.1202	0.0356	0.0007	0	0	0	0	0	0	0.0036	0											3.2232	2000	1.118642139	13.0057	0.377683711	0.924272883	1.260969662	1.90384545	2.773239439	0.404193544	1.12186268	3.282484117	3.336268641	3.477600561	0	0.010409592	3.086270693	5.44226782	10.94175228	0.629307802	1.006179829	0.160231346	0.142719879	0.772105014	0.005169953	0	0	0.875	0.2625	0	0	0.129935581	0	0	0	0	0	0	0	0	0	0	0	55.332
H4209_003_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	614.7834562	23.34766924	116.0399633	13.84486498	224.6629374	14.36927908	5.828088171	355.3267312	328.0105328	1960.940715	1017.035192	0	0.150915237	1643.678366	3103.909423	4371.629396	352.6362602	481.928114	25.32156505	20.01403595	7.408312356	6.219823218	0	0	420	315	0	0	1071.72253	0												1a:  Acute - $275/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $275/$0/day for 1-5/6-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 25.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $40/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $150/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - $40/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $40/visit/:  Routine Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $40/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $40/visit/9c:  Outpatient Substance Abuse Svcs - Group - $40/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $30/service			17a:  Routine Eye Exams - $25/visit	17b:  Wear - $10/service			/14a:  Nursing Hotline - $0/service/:  Routine Exams - $25/visit/14c:  Routine Exams - $25/visit												275	275	128	0.1	150	0.25	0.086021916	52.43406044	160.7342305	27.5	52.07237026	0	0.2	39.15264387	25	37.27093974	40	40	0	0.001949282	0.2	30	0	0	25	10	0	0	1.673066666	0											NO	218.6007319	218.6007319	101.7487043	0.079491175	119.2367628	0.198727939	0.068379832	41.68045086	127.7695288	21.86007345	41.3929397	0	0.15898235	31.12289713	19.87279405	29.62710833	31.79647009	31.79647009	0	0.001549507	0.15898235	23.84735257	0	0	25	10	0	0	1.329940355	0												11.1993	0.425318132	0.983909659	1.100544588	2.232340116	2.855577213	0.39852369	1.23418153	3.492479268	3.57219234	3.508173032	0	0.023992859	4.263002724	5.140279392	10.79322814	0.934382358	1.276967739	0	0.031011894	1.177790911	0.012360526	0	0	0.875	0.2625	0	0	0.118777253	0	0	0	0	0	0	0	0	0	0	0	55.9119	0	14.13185861	11.1993	0.425318132	0.983909659	1.100544588	2.232340116	2.855577213	0.39852369	1.23418153	3.492479268	3.57219234	3.508173032	0	0.023992859	4.263002724	5.140279392	10.79322814	0.934382358	1.276967739	0	0.031011894	1.177790911	0.012360526	0	0	0.875	0.2625	0	0	0.118777253	0	0	0	0	0	0	0	0	0	0	0	55.9119	YES	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	"$35 OV Copay, 30% Coinsurance Other"	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	Allowance Only	Allowance Only	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance											3400	3.0939	0.0544	0.2469	0.2521	0.1022	0.1957	0.0742	0.1642	0.5142	0.2367	0.2268	0	0.0025	0.2127	0.5484	1.4975	0.0406	0.0957	0.4246	0.327	0.125	0.0042	0	0	0	0	0	0	0.0087	0											8.4485	2000	3.547109647	14.2932	0.479733748	1.230799182	1.352692623	2.334546107	3.05132118	0.472708743	1.398410239	4.006711758	3.808916036	3.735001373	0	0.026538139	4.475710882	5.688689051	12.29076012	0.974958093	1.3726663	0.424632976	0.357980412	1.302824121	0.016555774	0	0	0.875	0.2625	0	0	0.127491906	0	0	0	0	0	0	0	0	0	0	0	64.3603
H4209_004_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	801.1203494	20.29134781	229.4109569	14.19111373	357.4086345	15.941261	9.134024958	299.1811291	329.9323472	2325.723939	929.517721	0	0.534525994	1078.345375	4232.123054	5524.490694	403.1215999	587.9313889	27.83408956	23.49714248	7.152166672	2.054900034	0	873	420	315	0	0	1101.154698	0												1a:  Acute - $225/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $225/$0/day for 1-5/6-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 25.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $20/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $20/service		16a:  Preventive Dental - Oral Exams - $10/service/16a:  Preventive Dental - Prophylaxis - $10/service/16a:  Preventive Dental - X-Rays - $10/service	17a:  Routine Eye Exams - $25/visit	17b:  Wear - $10/service			/14a:  Nursing Hotline - $0/service/:  Routine Exams - $10/visit/14c:  Routine Exams - $10/visit												225	225	128	0.1	150	0.25	0.139911808	52.67181495	161.2913626	17.5	38.45498175	0	0.2	20	10.00221424	20.68108621	20	20	0	0.001676653	0.2	20	0	10	25	10	0	0	0.918623858	0											NO	188.8236797	189.6326445	107.2114261	0.084087351	125.5660785	0.210057056	0.116908958	44.31104241	135.495113	14.69045545	32.31635432	0	0.166870367	16.82143629	8.396460396	17.36147759	16.7871827	16.77837396	0	0.001407843	0.167992754	17.07434759	0	10	25	10	0	0	0.770912178	0												12.6059	0.320658495	2.049622988	1.193293166	3.739866721	3.348574348	1.067849337	1.104752308	3.725351723	2.847161994	2.503218668	0	0.089196549	1.511609836	2.961237801	7.992776784	0.563939662	0.822044392	0	0.033080292	1.201512173	0.00292384	0	0.7275	0.875	0.2625	0	0	0.07074113	0	0	0	0	0	0	0	0	0	0	0	51.6203	0	9.523467967	12.6059	0.320658495	2.049622988	1.193293166	3.739866721	3.348574348	1.067849337	1.104752308	3.725351723	2.847161994	2.503218668	0	0.089196549	1.511609836	2.961237801	7.992776784	0.563939662	0.822044392	0	0.033080292	1.201512173	0.00292384	0	0.7275	0.875	0.2625	0	0	0.07074113	0	0	0	0	0	0	0	0	0	0	0	51.6203	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 20.0%	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	"$35 OV Copay, 20% Coinsurance Other"	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	Preventive Dental: 50%	Allowance Only	Allowance Only	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance											3400	1.0181	0.0123	0.1032	0.0679	0.0594	0.0705	0.0354	0.0379	0.1792	0.0772	0.0604	0	0.0025	0.0568	0.2105	0.4507	0.0118	0.0323	0.1249	0.1066	0.0365	0.0005	0	0	0	0	0	0	0.0027	0											2.7571	1000	0.967428424	13.624	0.332959102	2.15283048	1.261146495	3.799312171	3.419036769	1.103219306	1.142646021	3.904519355	2.924375896	2.563645687	0	0.091718698	1.568437955	3.171692384	8.443445929	0.575711638	0.854366668	0.124865445	0.139659814	1.237982731	0.003383468	0	0.7275	0.875	0.2625	0	0	0.07347327	0	0	0	0	0	0	0	0	0	0	0	54.3774
H4209_006_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	V	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	763.473577	28.99446951	139.1197557	17.11137493	274.1749814	17.6879666	7.174126419	433.1439788	409.0094978	2407.311672	1275.230215	0	0.188466834	1982.980433	4117.989673	5646.105511	470.8520617	643.4931265	30.62030533	24.81263061	9.316322932	8.048566075	0	873	420	315	0	0	1095.254816	0												1a:  Acute - $225/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $225/$0/day for 1-5/6-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$128/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$128/day for 1-20/21-100	6:  Home Health Services - 10.0%	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 25.0%	11b:  Prosthetics Devices - 25.0%/11b:  Medical Supplies - 25.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - 35.5%	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $20/visit/8a:  Outpatient Lab Services - $15/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $25/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $20/service		16a:  Preventive Dental - Oral Exams - $10/service/16a:  Preventive Dental - Prophylaxis - $10/service/16a:  Preventive Dental - X-Rays - $10/service	17a:  Routine Eye Exams - $25/visit	17b:  Wear - $10/service			/14a:  Nursing Hotline - $0/service/:  Routine Exams - $10/visit/14c:  Routine Exams - $10/visit												225	225	128	0.1	150	0.25	0.086021916	52.16225381	161.0372434	17.5	38.45240156	0	0.2	20	10.00213442	20.63031083	20	20	0	0.00163692	0.2	20	0	10	25	10	0	0	0.869704609	0											NO	185.2675991	185.2676229	105.3966921	0.082341155	123.5117394	0.205852911	0.070831448	42.9510057	132.5999318	14.40970347	31.66215384	0	0.164682331	16.46823285	8.235873775	16.98723782	16.46823315	16.46823315	0	0.001347859	0.164682331	16.46823315	0	10	25	10	0	0	0.716124913	0												11.7872	0.447644704	1.221896839	1.408970371	2.821985739	3.64111942	0.508153765	1.550330792	4.519552626	2.890720612	3.364711271	0	0.031037158	2.721348626	2.826270262	7.992644755	0.646175128	0.88309957	0	0.033443931	1.534233781	0.011045472	0	0.7275	0.875	0.2625	0	0	0.065361605	0	0	0	0	0	0	0	0	0	0	0	52.772	0	10.9174846	11.7872	0.447644704	1.221896839	1.408970371	2.821985739	3.64111942	0.508153765	1.550330792	4.519552626	2.890720612	3.364711271	0	0.031037158	2.721348626	2.826270262	7.992644755	0.646175128	0.88309957	0	0.033443931	1.534233781	0.011045472	0	0.7275	0.875	0.2625	0	0	0.065361605	0	0	0	0	0	0	0	0	0	0	0	52.772	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 20.0%	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	"$35 OV Copay, 20% Coinsurance Other"	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	Preventive Dental: 50%	Allowance Only	Allowance Only	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance											3400	2.4306	0.0428	0.194	0.198	0.1037	0.1922	0.0636	0.1284	0.4038	0.1859	0.1781	0	0.002	0.1673	0.5186	1.1775	0.0318	0.0752	0.333	0.2565	0.0984	0.0033	0	0	0	0	0	0	0.0068	0											6.7916	1000	2.594550599	14.2179	0.490395467	1.415861665	1.607005357	2.92567998	3.833309409	0.571796124	1.678732331	4.923367314	3.076636447	3.542855878	0	0.033036025	2.888606981	3.344888083	9.170169287	0.677957176	0.958344427	0.333030423	0.28991457	1.632614861	0.014343315	0	0.7275	0.875	0.2625	0	0	0.072165144	0	0	0	0	0	0	0	0	0	0	0	59.5636
H4209_809_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	322.4424579	3.691752057	63.88841355	45.96468928	10.35883331	18.33860573	4.534173	11.08329353	46.97849543	7.230375551	22.53558135	0	0.067968492	27.60626453	46.83779192	117.6606224	1.533876096	6.06019896	33.761384	40.47899105	8.826207721	1.544228217	0	0	0	0	0	0	0	0												Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare											0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.6796	0.282565487	10.53076311	0	2.413608162	4.272895134	1.056462309	2.582407394	10.94598944	1.684677503	5.250790455	0	0.015836659	6.432259635	10.91320552	27.41492501	0.35739313	1.412026358	7.866402473	9.431604914	2.056506399	0.359805175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9598	0	0	24.6796	0.282565487	10.53076311	0	2.413608162	4.272895134	1.056462309	2.582407394	10.94598944	1.684677503	5.250790455	0	0.015836659	6.432259635	10.91320552	27.41492501	0.35739313	1.412026358	7.866402473	9.431604914	2.056506399	0.359805175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9598	NO	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare												0.7379	0.0084	0.3224	0	0.0694	0.1226	0.0303	0.0787	0.3338	0.0512	0.1592	0	0.0005	0.1953	0.3384	0.8426	0.0111	0.044	0.2454	0.2924	0.0625	0.0109	0	0	0	0	0	0	0	0											3.9571	0	0	25.4176	0.291014111	10.85318063	0	2.482975087	4.395520538	1.086781124	2.661096045	11.27981997	1.735914047	5.409952291	0	0.016329952	6.627599272	11.25157896	28.25748186	0.368516172	1.455988488	8.111799588	9.724033839	2.119012347	0.370731334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9169
H4209_810_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	322.4424579	3.691752057	63.88841355	45.96468928	10.35883331	18.33860573	4.534173	11.08329353	46.97849543	7.230375551	22.53558135	0	0.067968492	27.60626453	46.83779192	117.6606224	1.533876096	6.06019896	33.761384	40.47899105	8.826207721	1.544228217	0	0	0	0	0	0	0	0												Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare											0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.6796	0.282565487	10.53076311	0	2.413608162	4.272895134	1.056462309	2.582407394	10.94598944	1.684677503	5.250790455	0	0.015836659	6.432259635	10.91320552	27.41492501	0.35739313	1.412026358	7.866402473	9.431604914	2.056506399	0.359805175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9598	0	0	24.6796	0.282565487	10.53076311	0	2.413608162	4.272895134	1.056462309	2.582407394	10.94598944	1.684677503	5.250790455	0	0.015836659	6.432259635	10.91320552	27.41492501	0.35739313	1.412026358	7.866402473	9.431604914	2.056506399	0.359805175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9598	NO	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare												0.7379	0.0084	0.3224	0	0.0694	0.1226	0.0303	0.0787	0.3338	0.0512	0.1592	0	0.0005	0.1953	0.3384	0.8426	0.0111	0.044	0.2454	0.2924	0.0625	0.0109	0	0	0	0	0	0	0	0											3.9571	0	0	25.4176	0.291014111	10.85318063	0	2.482975087	4.395520538	1.086781124	2.661096045	11.27981997	1.735914047	5.409952291	0	0.016329952	6.627599272	11.25157896	28.25748186	0.368516172	1.455988488	8.111799588	9.724033839	2.119012347	0.370731334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9169
H4209_811_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	322.4424579	3.691752057	63.88841355	45.96468928	10.35883331	18.33860573	4.534173	11.08329353	46.97849543	7.230375551	22.53558135	0	0.067968492	27.60626453	46.83779192	117.6606224	1.533876096	6.06019896	33.761384	40.47899105	8.826207721	1.544228217	0	0	0	0	0	0	0	0												Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare											0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.6796	0.282565487	10.53076311	0	2.413608162	4.272895134	1.056462309	2.582407394	10.94598944	1.684677503	5.250790455	0	0.015836659	6.432259635	10.91320552	27.41492501	0.35739313	1.412026358	7.866402473	9.431604914	2.056506399	0.359805175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9598	0	0	24.6796	0.282565487	10.53076311	0	2.413608162	4.272895134	1.056462309	2.582407394	10.94598944	1.684677503	5.250790455	0	0.015836659	6.432259635	10.91320552	27.41492501	0.35739313	1.412026358	7.866402473	9.431604914	2.056506399	0.359805175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9598	NO	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare												0.7379	0.0084	0.3224	0	0.0694	0.1226	0.0303	0.0787	0.3338	0.0512	0.1592	0	0.0005	0.1953	0.3384	0.8426	0.0111	0.044	0.2454	0.2924	0.0625	0.0109	0	0	0	0	0	0	0	0											3.9571	0	0	25.4176	0.291014111	10.85318063	0	2.482975087	4.395520538	1.086781124	2.661096045	11.27981997	1.735914047	5.409952291	0	0.016329952	6.627599272	11.25157896	28.25748186	0.368516172	1.455988488	8.111799588	9.724033839	2.119012347	0.370731334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9169
H4209_812_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	322.4424579	3.691752057	63.88841355	45.96468928	10.35883331	18.33860573	4.534173	11.08329353	46.97849543	7.230375551	22.53558135	0	0.067968492	27.60626453	46.83779192	117.6606224	1.533876096	6.06019896	33.761384	40.47899105	8.826207721	1.544228217	0	0	0	0	0	0	0	0												Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare											0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.6796	0.282565487	10.53076311	0	2.413608162	4.272895134	1.056462309	2.582407394	10.94598944	1.684677503	5.250790455	0	0.015836659	6.432259635	10.91320552	27.41492501	0.35739313	1.412026358	7.866402473	9.431604914	2.056506399	0.359805175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9598	0	0	24.6796	0.282565487	10.53076311	0	2.413608162	4.272895134	1.056462309	2.582407394	10.94598944	1.684677503	5.250790455	0	0.015836659	6.432259635	10.91320552	27.41492501	0.35739313	1.412026358	7.866402473	9.431604914	2.056506399	0.359805175	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9598	NO	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare	Similar to FFS Medicare												0.7379	0.0084	0.3224	0	0.0694	0.1226	0.0303	0.0787	0.3338	0.0512	0.1592	0	0.0005	0.1953	0.3384	0.8426	0.0111	0.044	0.2454	0.2924	0.0625	0.0109	0	0	0	0	0	0	0	0											3.9571	0	0	25.4176	0.291014111	10.85318063	0	2.482975087	4.395520538	1.086781124	2.661096045	11.27981997	1.735914047	5.409952291	0	0.016329952	6.627599272	11.25157896	28.25748186	0.368516172	1.455988488	8.111799588	9.724033839	2.119012347	0.370731334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.9169
H4213_001_0	2010	4	N/A	i.5.	h.2.									Professional	OP Facility - Other									Radiology	Radiology									D	D	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin	P									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	YES	891.9852342	27.12941306	368.7621408	0	318.8022675	23.19298096	1.223037462	306.2482893	421.1525343	0	187.6239089	0	0	1672.440427	3843.658966	3870.666121	110.9495077	477.9317425	149.9174851	0	12.57917273	0	0	0	0	0	0	0	0	0	6.099287646	4.662951326									3400	"$175 copay per day for days 1-5, $0 after day 5, unlimited coverage"	"$175 copay per day for days 1-5, $0 after day 5, 190 day per lifetime limit"	"$0 copay for days 1-20, $133 copay per day for days 21-100*"	No cost sharing	"$150 copay ground, $300 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $10 to $25 copay"	"(9a) $150 copay, (9b) $150 copay"	No cost sharing	"$0 to $150 copay for diag rad, 20% therapeutic rad"	$150 copay	20% coinsurance	"(3) $150 copay, (9c) $25 copay, (9d) $25 copay"	"(7a) $10 to $25 copay, $10 copay for PCP, $25 copay for Spec; (14b-14j) $0 copay"	"(7b) $20 copay, (7c) $25 copay, (7f) $20 copay, (7g) $25 copay"	"(7e) $25 copay, (7h) $25 copay"	"(7c) $25 copay, (7i) $25 copay"	"$0 to $150 copay for diag rad, 20% for therapeutic rad"	No cost sharing	20% coinsurance	n/a	Not covered	"(16a) not covered, (16b) $25 copay Medicare covered only"	(17a) $25 copay Medicare covered only  (17b) $25 copay Medicare covered only	(17a) $25 copay Medicare covered only  (17b) $25 copay Medicare covered only	(18a) $25 copay Medicare covered only	Not covered	$0 copay for plan covered services	n/a	20% coinsurance for Therapeutic radiology	20% coinsurance for Therapeutic radiology									175	175	133	0	150	0.2	0.2	48.16030478	150	0	150	0	0	105.2744501	10	24.41674074	25	25	150	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2									YES	140.9769084	140.9769084	107.1424504	0	120.8373501	0.161116467	0.161116467	38.79709073	120.8373501	0	120.8373501	0	0	84.80723721	8.055823338	19.66969499	20.13955835	20.13955835	120.8373501	0	0.161116467	0	0	0	0	0	0	0	0	0	0.161116467	0.161116467									3400	10.4791	0.318718398	3.292506615	0	3.210268433	3.736771146	0.197051475	0.990128555	4.240913018	0	1.88933133	0	0	11.81958767	2.5803198	6.344568501	0.186206174	0.802111185	1.509635969	0	2.026711864	0	0	0	0	0	0	0	0	0	0.982695675	0.751278242	0	0	0	0	0	0	0	0	55.3579	0	13.35997081	10.4791	0.318718398	3.292506615	0	3.210268433	3.736771146	0.197051475	0.990128555	4.240913018	0	1.88933133	0	0	11.81958767	2.5803198	6.344568501	0.186206174	0.802111185	1.509635969	0	2.026711864	0	0	0	0	0	0	0	0	0	0.982695675	0.751278242	0	0	0	0	0	0	0	0	55.3579	NO	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$150 copay ground, $300 copay air"	30% coinsurance	30% coinsurance	$50 copay	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, no cost sharing for immunization"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance										2.3336	0.0294	0.3035	0.2353	0.1243	0.2339	0.0123	0.073	0.3851	0.0377	0.1171	0	0	0.2936	0.185	0.2735	0.0117	0.0462	0.1925	0.8097	0.1269	0.1872	0	0	0	0	0	0	0	0	0.0853	0.0584									6.1553	500	5.019310403	12.8127	0.348111799	3.596005488	0.235297463	3.334612561	3.97071953	0.209388295	1.063168126	4.626017956	0.037685875	2.006392795	0	0	12.1131961	2.765284345	6.61802455	0.197925439	0.848320409	1.702163041	0.809715226	2.153598405	0.187171423	0	0	0	0	0	0	0	0	1.067995781	0.809644664	0	0	0	0	0	0	0	0	61.5132
H4213_002_0	2010	5	N/A	i.5.	h.2.									Professional	OP Facility - Other									Radiology	Radiology									D	D	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin	P									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	YES	1020.657689	31.04293992	323.5016595	0	290.83925	22.37143471	1.179714793	276.7943536	500.2663368	0	187.7156632	0	0	1633.832303	3834.590053	3884.271952	113.6321854	489.4877814	155.0025935	0	14.05335589	0	0	0	0	0	0	0	0	0	6.291644237	4.812059616									5100	"$220 copay per day for days 1-5, $0 after day 5, unlimited coverage"	"$220 copay per day for days 1-5, $0 after day 5, 190 day per lifetime limit"	"$0 copay for days 1-20, $133 copay per day for days 21-100*"	No cost sharing	"$150 copay ground, $300 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $20 to $40 copay"	"(9a) $250 copay, (9b) $250 copay"	No cost sharing	"$0 to $250 copay for diag rad, 20% therapeutic rad"	$250 copay	20% coinsurance	"(3) $250 copay, (9c) $40 copay, (9d) $40 copay"	"(7a) $20 to $40 copay, $20 copay for PCP, $40 copay for Spec; (14b-14j) $0 copay"	"(7b) $25 copay, (7c) $40 copay, (7f) $25 copay, (7g) $40 copay"	"(7e) $40 copay, (7h) $40 copay"	"(7c) $40 copay, (7i) $40 copay"	"$0 to $250 copay for diag rad, 20% for therapeutic rad"	No cost sharing	20% coinsurance	n/a	Not covered	"(16a) not covered, (16b) $40 copay Medicare covered only"	(17a) $40 copay Medicare covered only  (17b) $40 copay Medicare covered only	(17a) $40 copay Medicare covered only  (17b) $40 copay Medicare covered only	(18a) $40 copay Medicare covered only	Not covered	$0 copay for plan covered services	n/a	20% coinsurance for Therapeutic radiology	20% coinsurance for Therapeutic radiology									220	220	133	0	150	0.2	0.2	48.64012609	250	0	250	0	0	128.4571658	20	38.12757923	40	40	250	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2									YES	182.9838919	182.9838919	110.6220801	0	124.7617444	0.166348993	0.166348993	40.45617987	207.9362407	0	207.9362407	0	0	106.8436006	16.63489926	31.71242198	33.26979852	33.26979852	207.9362407	0	0.166348993	0	0	0	0	0	0	0	0	0	0.166348993	0.166348993									5100	15.5637	0.473363163	2.982202207	0	3.023801015	3.721465626	0.196244367	0.93317018	8.668625119	0	3.252740779	0	0	14.54704383	5.31566827	10.2649726	0.315043326	1.357096655	2.685888051	0	2.337761595	0	0	0	0	0	0	0	0	0	1.046608681	0.800481269	0	0	0	0	0	0	0	0	77.4858	0	15.67473547	15.5637	0.473363163	2.982202207	0	3.023801015	3.721465626	0.196244367	0.93317018	8.668625119	0	3.252740779	0	0	14.54704383	5.31566827	10.2649726	0.315043326	1.357096655	2.685888051	0	2.337761595	0	0	0	0	0	0	0	0	0	1.046608681	0.800481269	0	0	0	0	0	0	0	0	77.4858	NO	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$150 copay ground, $300 copay air"	30% coinsurance	30% coinsurance	$50 copay	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, no cost sharing for immunization"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance										2.9915	0.0377	0.3024	0.2859	0.132	0.2548	0.0134	0.0693	0.5304	0.0392	0.1402	0	0	0.3303	0.2251	0.3343	0.0147	0.0583	0.2449	1.0044	0.16	0.2361	0	0	0	0	0	0	0	0	0.1008	0.0654									7.5712	500	4.449907669	18.5551	0.511042547	3.284626468	0.285903493	3.155811299	3.976226442	0.209678691	1.002436024	9.199071325	0.039242767	3.392944431	0	0	14.87736624	5.540765888	10.59928834	0.329757438	1.415378322	2.930789156	1.004413809	2.497798018	0.236071099	0	0	0	0	0	0	0	0	1.147413504	0.865899524	0	0	0	0	0	0	0	0	85.0571
H4213_003_0	2010	5	N/A	i.5.	h.2.									Professional	OP Facility - Other									Radiology	Radiology									D	D	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin	P									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	YES	1047.146015	31.84857291	376.8567051	0	342.6522555	23.22551641	1.224753157	315.4603826	479.2582691	0	208.4719645	0	0	1972.989238	3840.105216	3889.542663	113.7215834	489.8728767	149.0950118	0	14.19806441	0	0	0	0	0	0	0	0	0	5.598216936	6.047548235									5100	"$220 copay per day for days 1-5, $0 after day 5, unlimited coverage"	"$220 copay per day for days 1-5, $0 after day 5, 190 day per lifetime limit"	"$0 copay for days 1-20, $133 copay per day for days 21-100*"	No cost sharing	"$150 copay ground, $300 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $20 to $40 copay"	"(9a) $250 copay, (9b) $250 copay"	No cost sharing	"$0 to $250 copay for diag rad, 20% therapeutic rad"	$250 copay	20% coinsurance	"(3) $250 copay, (9c) $40 copay, (9d) $40 copay"	"(7a) $20 to $40 copay, $20 copay for PCP, $40 copay for Spec; (14b-14j) $0 copay"	"(7b) $25 copay, (7c) $40 copay, (7f) $25 copay, (7g) $40 copay"	"(7e) $40 copay, (7h) $40 copay"	"(7c) $40 copay, (7i) $40 copay"	"$0 to $250 copay for diag rad, 20% for therapeutic rad"	No cost sharing	20% coinsurance	n/a	Not covered	"(16a) not covered, (16b) $40 copay Medicare covered only"	(17a) $40 copay Medicare covered only  (17b) $40 copay Medicare covered only	(17a) $40 copay Medicare covered only  (17b) $40 copay Medicare covered only	(18a) $40 copay Medicare covered only	Not covered	$0 copay for plan covered services	n/a	20% coinsurance for Therapeutic radiology	20% coinsurance for Therapeutic radiology									220	220	133	0	150	0.2	0.2	48.80586733	250	0	250	0	0	131.6211421	20	38.12864545	40	40	250	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2									YES	179.3145905	179.3145905	108.4038206	0	122.2599481	0.163013264	0.163013264	39.7800187	203.7665801	0	203.7665801	0	0	107.27996	16.30132641	31.07737475	32.60265281	32.60265281	203.7665801	0	0.163013264	0	0	0	0	0	0	0	0	0	0.163013264	0.163013264									5100	15.6474	0.475909484	3.404392222	0	3.491053913	3.78606724	0.19965101	1.04575166	8.138068206	0	3.539968271	0	0	17.63851721	5.21656738	10.07306458	0.308968775	1.33092961	2.531715055	0	2.314472824	0	0	0	0	0	0	0	0	0	0.912583616	0.985830577	0	0	0	0	0	0	0	0	81.0409	0	18.38769422	15.6474	0.475909484	3.404392222	0	3.491053913	3.78606724	0.19965101	1.04575166	8.138068206	0	3.539968271	0	0	17.63851721	5.21656738	10.07306458	0.308968775	1.33092961	2.531715055	0	2.314472824	0	0	0	0	0	0	0	0	0	0.912583616	0.985830577	0	0	0	0	0	0	0	0	81.0409	NO	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$150 copay ground, $300 copay air"	30% coinsurance	30% coinsurance	$50 copay	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, no cost sharing for immunization"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance										3.0784	0.0388	0.3435	0.3054	0.1478	0.2582	0.0136	0.0778	0.5113	0.0538	0.1632	0	0	0.3937	0.2216	0.3293	0.0145	0.0575	0.2131	0.9675	0.1579	0.2329	0	0	0	0	0	0	0	0	0.0873	0.0788									7.7459	500	4.783040523	18.7258	0.514683749	3.74793455	0.30540251	3.638845253	4.04429246	0.213268023	1.123564801	8.649330297	0.053789065	3.703208957	0	0	18.03224246	5.43819234	10.40237907	0.323482458	1.388417391	2.744769397	0.967503188	2.472329306	0.232855449	0	0	0	0	0	0	0	0	0.999851088	1.064627683	0	0	0	0	0	0	0	0	88.7867
H4213_004_0	2010	6	N/A	i.5.	h.2.									Professional	OP Facility - Other									Radiology	Radiology									D	D	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	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									0	YES	891.9852342	27.12941306	368.7621408	0	318.8022675	23.19298096	1.223037462	305.4592088	409.6433051	0	181.0580669	0	0	1665.708121	3651.476017	3712.333584	105.9063483	456.2075724	144.671168	0	12.57917273	0	0	0	0	0	0	0	0	0	5.802142863	4.662951326									4750	"$220 copay per day for days 1-5, $0 after day 5, unlimited coverage"	"$220 copay per day for days 1-5, $0 after day 5, 190 day per lifetime limit"	"$0 copay for days 1-20, $133 copay per day for days 21-100*"	No cost sharing	"$150 copay ground, $300 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $18 to $35 copay"	"(9a) $250 copay, (9b) $250 copay"	No cost sharing	"$0 to $250 copay for diag rad, 20% therapeutic rad"	$250 copay	20% coinsurance	"(3) $250 copay, (9c) $35 copay, (9d) $35 copay"	"(7a) $18 to $35 copay, $18 copay for PCP, $35 copay for Spec; (14b-14j) $0 copay"	"(7b) $25 copay, (7c) $35 copay, (7f) $25 copay, (7g) $35 copay"	"(7e) $35 copay, (7h) $35 copay"	"(7c) $35 copay, (7i) $35 copay"	"$0 to $250 copay for diag rad, 20% for therapeutic rad"	No cost sharing	20% coinsurance	n/a	Not covered	"(16a) not covered, (16b) $35 copay Medicare covered only"	(17a) $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(17a) $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(18a) $35 copay Medicare covered only	Not covered	$0 copay for plan covered services	n/a	20% coinsurance for Therapeutic radiology	20% coinsurance for Therapeutic radiology									220	220	133	0	150	0.2	0.2	48.69803697	250	0	250	0	0	128.630155	18	33.81168925	35	35	250	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									YES	183.1670456	183.1670456	110.7328049	0	124.886622	0.166515496	0.166515496	40.54488891	208.14437	0	208.14437	0	0	107.0945703	14.98639464	28.15085104	29.1402118	29.1402118	208.14437	0	0.166515496	0.166515496	0	0	0	0	0	0	0	0	0.166515496	0.166515496									4750	13.6152	0.414101203	3.402838848	0	3.317844857	3.861990729	0.20365469	1.032067474	7.105412306	0	3.140518106	0	0	14.86569129	4.560205052	8.708779143	0.257177785	1.107832107	2.509374094	0	2.094627186	0	0	0	0	0	0	0	0	0	0.966146697	0.776453653	0	0	0	0	0	0	0	0	71.9399	0	14.46635392	13.6152	0.414101203	3.402838848	0	3.317844857	3.861990729	0.20365469	1.032067474	7.105412306	0	3.140518106	0	0	14.86569129	4.560205052	8.708779143	0.257177785	1.107832107	2.509374094	0	2.094627186	0	0	0	0	0	0	0	0	0	0.966146697	0.776453653	0	0	0	0	0	0	0	0	71.9399	NO	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$150 copay ground, $300 copay air"	30% coinsurance	30% coinsurance	$50 copay	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, no cost sharing for immunization"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance										2.6832	0.0338	0.3469	0.2685	0.1446	0.269	0.0142	0.0805	0.4428	0.0433	0.1365	0	0	0.3376	0.2122	0.3144	0.0135	0.0531	0.2249	0.9295	0.1459	0.2152	0	0	0	0	0	0	0	0	0.0946	0.0652									7.0695	500	4.096773739	16.2984	0.447898233	3.749776529	0.268494567	3.462418481	4.130988542	0.217839774	1.112576151	7.548212484	0.043331857	3.277036193	0	0	15.20328724	4.772387157	9.023203538	0.270652794	1.160964256	2.734250397	0.929544003	2.240523479	0.215212871	0	0	0	0	0	0	0	0	1.060720787	0.841645521	0	0	0	0	0	0	0	0	79.0094
H4213_005_0	2010	5	N/A	i.5.	h.2.									Professional	OP Facility - Other									Radiology	Radiology									D	D	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin	P									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	YES	1020.657689	31.04293992	323.5016595	0	290.83925	22.37143471	1.179714793	277.188578	500.2663368	0	187.7156632	0	0	1636.090593	3962.409722	3965.905869	116.4037021	501.4265078	155.0025935	0	14.05335589	0	0	0	0	0	0	0	0	0	6.485564779	4.812059616									5100	"$220 copay per day for days 1-5, $0 after day 5, unlimited coverage"	"$220 copay per day for days 1-5, $0 after day 5, 190 day per lifetime limit"	"$0 copay for days 1-20, $133 copay per day for days 21-100*"	No cost sharing	"$150 copay ground, $300 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $15 to $35 copay"	"(9a) $250 copay, (9b) $250 copay"	No cost sharing	"$0 to $250 copay for diag rad, 20% therapeutic rad"	$250 copay	20% coinsurance	"(3) $250 copay, (9c) $35 copay, (9d) $35 copay"	"(7a) $15 to $35 copay, $15 copay for PCP, $35 copay for Spec; (14b-14j) $0 copay"	"(7b) $25 copay, (7c) $35 copay, (7f) $25 copay, (7g) $35 copay"	"(7e) $35 copay, (7h) $35 copay"	"(7c) $35 copay, (7i) $35 copay"	"$0 to $250 copay for diag rad, 20% for therapeutic rad"	No cost sharing	20% coinsurance	n/a	Not covered	"(16a) not covered, (16b) $35 copay Medicare covered only"	(17a) $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(17a) $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(18a) $35 copay Medicare covered only	Not covered	$0 copay for plan covered services	n/a	20% coinsurance for Therapeutic radiology	20% coinsurance for Therapeutic radiology									220	220	133	0	150	0.2	0.2	48.29503738	250	0	250	0	0	127.2020751	15	33.777414	35	35	250	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2									YES	184.4122953	184.4122953	111.4856149	0	125.7356559	0.167647541	0.167647541	40.48272134	209.5594265	0	209.5594265	0	0	106.6255756	12.57356559	28.31350202	29.33831971	29.33831971	209.5594265	0	0.167647541	0	0	0	0	0	0	0	0	0	0.167647541	0.167647541									5100	15.6852	0.477058317	3.005481785	0	3.047405321	3.750516021	0.197776284	0.93511233	8.736293884	0	3.278132227	0	0	14.53742511	4.151801543	9.35739032	0.284590752	1.2259176	2.70685455	0	2.35601056	0	0	0	0	0	0	0	0	0	1.087288988	0.806729963	0	0	0	0	0	0	0	0	75.6269	0	14.59441263	15.6852	0.477058317	3.005481785	0	3.047405321	3.750516021	0.197776284	0.93511233	8.736293884	0	3.278132227	0	0	14.53742511	4.151801543	9.35739032	0.284590752	1.2259176	2.70685455	0	2.35601056	0	0	0	0	0	0	0	0	0	1.087288988	0.806729963	0	0	0	0	0	0	0	0	75.6269	NO	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$150 copay ground, $300 copay air"	30% coinsurance	30% coinsurance	$50 copay	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, no cost sharing for immunization"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance										2.9915	0.0377	0.3024	0.2859	0.132	0.2548	0.0134	0.0693	0.5304	0.0392	0.1402	0	0	0.3303	0.2251	0.3343	0.0147	0.0583	0.2449	1.0044	0.16	0.2361	0	0	0	0	0	0	0	0	0.1008	0.0654									7.5712	500	4.449907669	18.6766	0.514737701	3.307906047	0.285903493	3.179415605	4.005276837	0.211210608	1.004378174	9.26674009	0.039242767	3.41833588	0	0	14.86774752	4.376899162	9.691706055	0.299304864	1.284199266	2.951755656	1.004413809	2.516046984	0.236071099	0	0	0	0	0	0	0	0	1.188093812	0.872148217	0	0	0	0	0	0	0	0	83.1982
H4213_006_0	2010	5	N/A	i.5.	h.2.									Professional	OP Facility - Other									Radiology	Radiology									D	D	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin	P									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	YES	1047.146015	31.84857291	376.8567051	0	342.6522555	23.22551641	1.224753157	315.8549171	479.2582691	0	208.4719645	0	0	1976.630309	3968.108723	3971.293991	116.4952805	501.8209957	149.0950118	0	14.19806441	0	0	0	0	0	0	0	0	0	5.770764718	6.047548235									5100	"$220 copay per day for days 1-5, $0 after day 5, unlimited coverage"	"$220 copay per day for days 1-5, $0 after day 5, 190 day per lifetime limit"	"$0 copay for days 1-20, $133 copay per day for days 21-100*"	No cost sharing	"$150 copay ground, $300 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $15 to $35 copay"	"(9a) $250 copay, (9b) $250 copay"	No cost sharing	"$0 to $250 copay for diag rad, 20% therapeutic rad"	$250 copay	20% coinsurance	"(3) $250 copay, (9c) $35 copay, (9d) $35 copay"	"(7a) $15 to $35 copay, $15 copay for PCP, $35 copay for Spec; (14b-14j) $0 copay"	"(7b) $25 copay, (7c) $35 copay, (7f) $25 copay, (7g) $35 copay"	"(7e) $35 copay, (7h) $35 copay"	"(7c) $35 copay, (7i) $35 copay"	"$0 to $250 copay for diag rad, 20% for therapeutic rad"	No cost sharing	20% coinsurance	n/a	Not covered	"(16a) not covered, (16b) $35 copay Medicare covered only"	(17a) $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(17a) $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(18a) $35 copay Medicare covered only	Not covered	$0 copay for plan covered services	n/a	20% coinsurance for Therapeutic radiology	20% coinsurance for Therapeutic radiology									220	220	133	0	150	0.2	0.2	48.50257842	250	0	250	0	0	130.4412843	15	33.77811223	35	35	250	0	0.2	0	0	0	0	0	0	0	0	0	0.2	0.2									YES	181.1201988	181.1201988	109.4953929	0	123.4910446	0.164654726	0.164654726	39.93089384	205.8184077	0	205.8184077	0	0	107.3888698	12.34910446	27.8086291	28.81457708	28.81457708	205.8184077	0	0.164654726	0	0	0	0	0	0	0	0	0	0.164654726	0.164654726									5100	15.8049	0.480701655	3.43867275	0	3.526207082	3.824191045	0.201661396	1.051030764	8.220014486	0	3.575613983	0	0	17.68900791	4.083549095	9.203020137	0.279730187	1.20497998	2.557208161	0	2.337778409	0	0	0	0	0	0	0	0	0	0.950183685	0.995757399	0	0	0	0	0	0	0	0	79.4242	0	17.04944586	15.8049	0.480701655	3.43867275	0	3.526207082	3.824191045	0.201661396	1.051030764	8.220014486	0	3.575613983	0	0	17.68900791	4.083549095	9.203020137	0.279730187	1.20497998	2.557208161	0	2.337778409	0	0	0	0	0	0	0	0	0	0.950183685	0.995757399	0	0	0	0	0	0	0	0	79.4242	NO	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$150 copay ground, $300 copay air"	30% coinsurance	30% coinsurance	$50 copay	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, no cost sharing for immunization"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance										3.0784	0.0388	0.3435	0.3054	0.1478	0.2582	0.0136	0.0778	0.5113	0.0538	0.1632	0	0	0.3937	0.2216	0.3293	0.0145	0.0575	0.2131	0.9675	0.1579	0.2329	0	0	0	0	0	0	0	0	0.0873	0.0788									7.7459	500	4.783040523	18.8833	0.51947592	3.782215079	0.30540251	3.673998421	4.082416266	0.215278408	1.128843905	8.731276578	0.053789065	3.738854669	0	0	18.08273316	4.305174055	9.532334631	0.29424387	1.262467761	2.770262503	0.967503188	2.495634891	0.232855449	0	0	0	0	0	0	0	0	1.037451157	1.074554504	0	0	0	0	0	0	0	0	87.1701
H4213_007_0	2010	6	N/A	i.5.	h.2.									Professional	OP Facility - Other									Radiology	Radiology									D	D	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	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									0	YES	890.4888543	27.0839012	368.1435114	0	318.26745	23.1540728	1.220985714	305.0900039	415.3393839	0	181.6549616	0	0	1662.913756	3717.298065	3706.105834	105.7286815	455.4422461	144.9046078	0	12.55807011	0	0	0	0	0	0	0	0	0	5.874377339	4.655128834									4000	"$175 copay per day for days 1-5, $0 after day 5, unlimited coverage"	"$175 copay per day for days 1-5, $0 after day 5, 190 day per lifetime limit"	"$0 copay for days 1-20, $133 copay per day for days 21-100*"	No cost sharing	"$150 copay ground, $300 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $15 to $35 copay"	"(9a) $200 copay, (9b) $200 copay"	No cost sharing	"$0 to $200 copay for diag rad, 20% therapeutic rad"	$200 copay	20% coinsurance	"(3) $200 copay, (9c) $35 copay, (9d) $35 copay"	"(7a) $15 to $35 copay, $15 copay for PCP, $35 copay for Spec; (14b-14j) $0 copay"	"(7b) $25 copay, (7c) $35 copay, (7f) $25 copay, (7g) $35 copay"	"(7e) $35 copay, (7h) $35 copay"	"(7c) $35 copay, (7i) $35 copay"	"$0 to $200 copay for diag rad, 20% for therapeutic rad"	No cost sharing	20% coinsurance	n/a	Not covered	"(16a) not covered, (16b) $35 copay Medicare covered only"	(17a) $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(17a) $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(18a) $35 copay Medicare covered only	Not covered	$0 copay for plan covered services	n/a	20% coinsurance for Therapeutic radiology	20% coinsurance for Therapeutic radiology									175	175	133	0	150	0.2	0.2	48.59301899	200	0	200	0	0	118.0693765	15	33.81168925	35	35	200	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									YES	142.8558713	142.8558713	108.5704622	0	122.4478897	0.163263853	0.163263853	39.66741752	163.2638529	0	163.2638529	0	0	96.38230658	12.24478897	27.6011333	28.57117426	28.57117426	163.2638529	0	0.163263853	0.163263853	0	0	0	0	0	0	0	0	0.163263853	0.163263853									4000	10.601	0.322424525	3.330792599	0	3.247598134	3.780223135	0.199342832	1.008511047	5.650825673	0	2.471474078	0	0	13.35628862	3.793127528	8.524393429	0.251732715	1.084376648	1.971473715	0	2.050278911	0	0	0	0	0	0	0	0	0	0.959073478	0.760014269	0	0	0	0	0	0	0	0	63.3629	0	14.25734671	10.601	0.322424525	3.330792599	0	3.247598134	3.780223135	0.199342832	1.008511047	5.650825673	0	2.471474078	0	0	13.35628862	3.793127528	8.524393429	0.251732715	1.084376648	1.971473715	0	2.050278911	0	0	0	0	0	0	0	0	0	0.959073478	0.760014269	0	0	0	0	0	0	0	0	63.3629	NO	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$150 copay ground, $300 copay air"	30% coinsurance	30% coinsurance	$50 copay	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, no cost sharing for immunization"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance										2.5	0.0315	0.3252	0.2521	0.134	0.2506	0.0132	0.0766	0.4126	0.0404	0.1265	0	0	0.3145	0.1979	0.2929	0.0126	0.0495	0.2079	0.8667	0.1359	0.2005	0	0	0	0	0	0	0	0	0.0897	0.0616									6.5925	500	4.566508654	13.1009	0.353913282	3.655979209	0.252123971	3.381568657	4.030848907	0.212559102	1.085103086	6.063383437	0.040372373	2.597924328	0	0	13.6708274	3.991042648	8.817343233	0.264287407	1.133879972	2.179394642	0.866732084	2.186210764	0.20051424	0	0	0	0	0	0	0	0	1.048785087	0.821649105	0	0	0	0	0	0	0	0	69.9554
H4213_008_0	2010	6	N/A	i.5.	h.2.									Professional	OP Facility - Other									Radiology	Radiology									D	D	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	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									0	YES	1022.463116	31.09785134	324.073897	0	291.3537115	22.41100723	1.181801574	277.678893	508.9735909	0	188.9533489	0	0	1638.984651	3969.418773	3972.921104	116.609607	502.3134741	156.3005784	0	14.07821467	0	0	0	0	0	0	0	0	0	6.497037004	4.820571601									4000	"$175 copay per day for days 1-5, $0 after day 5, unlimited coverage"	"$175 copay per day for days 1-5, $0 after day 5, 190 day per lifetime limit"	"$0 copay for days 1-20, $133 copay per day for days 21-100*"	No cost sharing	"$150 copay ground, $300 copay air"	20% coinsurance	"(11a) 20% coinsurance, (11b) 20% coinsurance"	"(4a) $50 copay, (4b) $15 to $35 copay"	"(9a) $200 copay, (9b) $200 copay"	No cost sharing	"$0 to $200 copay for diag rad, 20% therapeutic rad"	$200 copay	20% coinsurance	"(3) $200 copay, (9c) $35 copay, (9d) $35 copay"	"(7a) $15 to $35 copay, $15 copay for PCP, $35 copay for Spec; (14b-14j) $0 copay"	"(7b) $25 copay, (7c) $35 copay, (7f) $25 copay, (7g) $35 copay"	"(7e) $35 copay, (7h) $35 copay"	"(7c) $35 copay, (7i) $35 copay"	"$0 to $200 copay for diag rad, 20% for therapeutic rad"	No cost sharing	20% coinsurance	n/a	Not covered	"(16a) not covered, (16b) $35 copay Medicare covered only"	(17a) $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(17a) $35 copay Medicare covered only  (17b) $35 copay Medicare covered only	(18a) $35 copay Medicare covered only	Not covered	$0 copay for plan covered services	n/a	20% coinsurance for Therapeutic radiology	20% coinsurance for Therapeutic radiology									175	175	133	0	150	0.2	0.2	48.29503738	200	0	200	0	0	116.4837423	15	33.777414	35	35	200	0	0.2	0.2	0	0	0	0	0	0	0	0	0.2	0.2									YES	140.5526414	140.5526414	106.8200075	0	120.4736927	0.16063159	0.16063159	38.78854327	160.6315902	0	160.6315902	0	0	93.55484381	12.04736927	27.12859862	28.11052829	28.11052829	160.6315902	0	0.16063159	0.16063159	0	0	0	0	0	0	0	0	0.16063159	0.16063159									4000	11.9758	0.364240429	2.884798009	0	2.925038124	3.599915729	0.189834666	0.897563313	6.813103107	0	2.529323076	0	0	12.77791275	3.98508781	8.981648499	0.273163138	1.176691427	2.092234205	0	2.26140601	0	0	0	0	0	0	0	0	0	1.043629385	0.774336082	0	0	0	0	0	0	0	0	65.5458	0	16.06428689	11.9758	0.364240429	2.884798009	0	2.925038124	3.599915729	0.189834666	0.897563313	6.813103107	0	2.529323076	0	0	12.77791275	3.98508781	8.981648499	0.273163138	1.176691427	2.092234205	0	2.26140601	0	0	0	0	0	0	0	0	0	1.043629385	0.774336082	0	0	0	0	0	0	0	0	65.5458	NO	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"$150 copay ground, $300 copay air"	30% coinsurance	30% coinsurance	$50 copay	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, no cost sharing for immunization"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance										2.7062	0.0341	0.2737	0.259	0.1187	0.2305	0.0122	0.0645	0.4799	0.0355	0.1255	0	0	0.2988	0.2039	0.3024	0.0133	0.0527	0.2193	0.9095	0.1448	0.2136	0	0	0	0	0	0	0	0	0.0935	0.0603									6.8517	500	5.187305688	14.6821	0.398327059	3.158449262	0.258952846	3.04372634	3.830384937	0.201988019	0.962040765	7.292970927	0.035500944	2.654843961	0	0	13.07673871	4.189035406	9.284087015	0.28647425	1.229415899	2.31151544	0.909480117	2.406182858	0.213561569	0	0	0	0	0	0	0	0	1.137090797	0.834672282	0	0	0	0	0	0	0	0	72.3975
H4270_001_0	2010	5	N/A																															A	A	D		T	Coin	Coin	V	V	V	V			V		V	V	V		V	Coin																																																												0	YES	235.1835811	0.73595728	286.6376014		83.35510711	6.989650041	0.687125266	178.488713	549.5938585	1207.505759	535.6498811			1382.000976		1295.071513	27.26859643	228.6734153		139.802929	14.24527411																				3400	#1A $300	#1B $300	#2 $125/day days 21-100		#10A $100	#11A 20%	#11B 20%/10%	#4A $50	"#9A $200, #9B $200"	#8A $25	#8B $25			"#4B $25, #7A $25, #9A $25, #9C $25, #9D $25"		#7D $30	"#7E $30, #7H $30"	#7I $30		#7F $30	"#15 20%, 11c 0%"																				300	300	125		100	0.2	0.19	50	200	25	25			25		30	30	30		30	0.2																				NO	294	294	122.5		98	0.196	0.1862	49	196	24.5	24.5			24.5		29.4	29.4	29.4		29.4	0.196																					5.762	0.018030953	2.926092181	0	0.680733375	1.369971408	0.127942725	0.728828911	8.976699688	2.465324258	1.093618507	0	0	2.821585327	0	3.172925206	0.066808061	0.560249867	0	0.342517176	2.792073726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9054		0.691946921	5.762	0.018030953	2.926092181	0	0.680733375	1.369971408	0.127942725	0.728828911	8.976699688	2.465324258	1.093618507	0	0	2.821585327	0	3.172925206	0.066808061	0.560249867	0	0.342517176	2.792073726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9054	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.2131	0.0237							0.314						1.6182																					2.169		0	5.762	0.018030953	2.926092181	0	0.680733375	1.583086693	0.151622201	0.728828911	8.976699688	2.465324258	1.093618507	0	0	3.135632143	0	3.172925206	0.066808061	0.560249867	0	1.960701149	2.792073726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0744
H4270_002_0	2010	8	N/A																															A	A	D		T	Coin	Coin	V	V					V		V	V	V		V	Coin																																																												0	YES	229.0994899	5.680669196	513.9568768		58.37481361	6.478888902	1.40857923	332.8812908	995.928991					22.83891676		2087.700808	166.4653479	5.502587197		179.2096421	35.60724518																				3400	#1A $150	#1B $150	#2 $75/day days 21-100		#10A $100	#11A 20%	#11B 10%/10%	#4A $50	"#9A $100, #9B $100"					"#4B $20, #7A $20"		#7D $15	"#7E $15, #7H $15"	#7I $15		#7F $15	"#15 20%, 11c 0%"																				150	150	75		100	0.2	0.1	50	100					20		15	15	15		15	0.2																				NO	148.5	148.5	74.25		99	0.198	0.099	49.5	99					19.8		14.85	14.85	14.85		14.85	0.198																					2.8351	0.070298281	3.180108175	0	0.481592212	1.282820003	0.139449344	1.373135325	8.216414176	0	0	0	0	0.037684213	0	2.58352975	0.206000868	0.006809452	0	0.221771932	7.050234546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.685		0.279646005	2.8351	0.070298281	3.180108175	0	0.481592212	1.282820003	0.139449344	1.373135325	8.216414176	0	0	0	0	0.037684213	0	2.58352975	0.206000868	0.006809452	0	0.221771932	7.050234546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.685	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.2031	0.0226							0.2993						1.5421																					2.067		0	2.8351	0.070298281	3.180108175	0	0.481592212	1.485909703	0.162014866	1.373135325	8.216414176	0	0	0	0	0.336957321	0	2.58352975	0.206000868	0.006809452	0	1.763831659	7.050234546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.7519
H4270_003_0	2010	7	N/A																															A	A	D		T	Coin	Coin	V	V	V	V			V		V	V	V		V	Coin																																																												0	YES	246.4354522	7.930318506	764.6441909		92.94829526	8.902769443	2.283368584	219.9286949	680.8144748	1649.851252	525.4259147			1538.267597		1424.397472	97.36246216	302.0770616		159.5402773	24.82579462																				3400	#1A $300	#1B $300	#2 $125/day days 21-100		#10A $100	#11A 20%	#11B 20%/10%	#4A $50	"#9A $200, #9B $200"	#8A $25	#8B $25			"#4B $25, #7A $25, #9A $25, #9C $25, #9D $25"		#7D $30	"#7E $30, #7H $30"	#7I $30		#7F $30	"#15 20%, 11c 0%"																				300	300	125		100	0.2	0.19	50	200	25	25			25		30	30	30		30	0.2																				NO	294	294	122.5		98	0.196	0.1862	49	196	24.5	24.5			24.5		29.4	29.4	29.4		29.4	0.196																					6.0377	0.194292803	7.805742782	0	0.759077745	1.744942811	0.42516323	0.898042171	11.11996976	3.368446305	1.072744576	0	0	3.140629678	0	3.489773807	0.238538032	0.740088801	0	0.390873679	4.865855745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2919		0.944731643	6.0377	0.194292803	7.805742782	0	0.759077745	1.744942811	0.42516323	0.898042171	11.11996976	3.368446305	1.072744576	0	0	3.140629678	0	3.489773807	0.238538032	0.740088801	0	0.390873679	4.865855745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2919	NO						Section C POS	Section C POS		Section C POS					Section C POS						Section C POS																											0.1979	0.022							0.2917						1.5029																					2.0145		0	6.0377	0.194292803	7.805742782	0	0.759077745	1.942876497	0.447155862	0.898042171	11.11996976	3.368446305	1.072744576	0	0	3.432304879	0	3.489773807	0.238538032	0.740088801	0	1.893783794	4.865855745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3064
H4270_801_0	2010	6	N/A																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	Coin																																																												0	YES	323.3294607	4.157244596	830.9469234		159.7074209	10.93727699	1.857515798	233.2121149	817.7748594	1536.020255	496.128414			2108.550163	2858.7542	2185.731486	271.4268606	920.6586957		212.6349738	39.63016497																				3400	#1A $300	#1B $300	#2 $125/day days 21-100		#10A $100	#11A 20%	#11B 20%/10%	#4A $50	"#9A $200, #9B $200"	#8A $25	#8B $25			"#9A $25, #9C $25, #9D $25"	#7A $25	#7D $30	"#7E $30, #7H $30"	#7I $30		"#4B $25, #7A $25, #7F $30"	"#15 20%, 11c 0%"																				300	300	125		100	0.2	0.19	50	200	25	25			25	30	30	30	30		30	0.2																				NO	294	294	122.5		98	0.196	0.1862	49	196	24.5	24.5			24.5	29.4	29.4	29.4	29.4		29.4	0.196																					7.9216	0.101852493	8.482583176	0	1.304277271	2.143706289	0.345869442	0.952282803	13.35698937	3.136041355	1.012928845	0	0	4.304956583	7.003947791	5.355042141	0.664995808	2.255613805	0	0.520955686	7.767512335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6311		1.359818918	7.9216	0.101852493	8.482583176	0	1.304277271	2.143706289	0.345869442	0.952282803	13.35698937	3.136041355	1.012928845	0	0	4.304956583	7.003947791	5.355042141	0.664995808	2.255613805	0	0.520955686	7.767512335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6311	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0599	0.0067							0.3585						0.5247																					0.9497		0	7.9216	0.101852493	8.482583176	0	1.304277271	2.203557846	0.352519614	0.952282803	13.35698937	3.136041355	1.012928845	0	0	4.663479303	7.003947791	5.355042141	0.664995808	2.255613805	0	1.04563484	7.767512335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5808
H4270_802_0	2010	6	N/A																															A	A	D		T	Coin	Coin	V	V	V	V			V	V	V	V	V		V	Coin																																																												0	YES	323.3294607	4.157244596	830.9469234		159.7074209	10.93727699	1.857515798	233.2121149	817.7748594	1536.020255	496.128414			2108.550163	2858.7542	2185.731486	271.4268606	920.6586957		212.6349738	39.63016497																				3400	#1A $300	#1B $300	#2 $125/day days 21-100		#10A $100	#11A 20%	#11B 20%/10%	#4A $50	"#9A $200, #9B $200"	#8A $25	#8B $25			"#9A $25, #9C $25, #9D $25"	#7A $25	#7D $30	"#7E $30, #7H $30"	#7I $30		"#4B $25, #7A $25, #7F $30"	"#15 20%, 11c 0%"																				300	300	125		100	0.2	0.19	50	200	25	25			25	30	30	30	30		30	0.2																				NO	294	294	122.5		98	0.196	0.1862	49	196	24.5	24.5			24.5	29.4	29.4	29.4	29.4		29.4	0.196																					7.9216	0.101852493	8.482583176	0	1.304277271	2.143706289	0.345869442	0.952282803	13.35698937	3.136041355	1.012928845	0	0	4.304956583	7.003947791	5.355042141	0.664995808	2.255613805	0	0.520955686	7.767512335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6311		1.359818918	7.9216	0.101852493	8.482583176	0	1.304277271	2.143706289	0.345869442	0.952282803	13.35698937	3.136041355	1.012928845	0	0	4.304956583	7.003947791	5.355042141	0.664995808	2.255613805	0	0.520955686	7.767512335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6311	NO						Section C POS	Section C POS							Section C POS						Section C POS																											0.0599	0.0067							0.3585						0.5247																					0.9497		0	7.9216	0.101852493	8.482583176	0	1.304277271	2.203557846	0.352519614	0.952282803	13.35698937	3.136041355	1.012928845	0	0	4.663479303	7.003947791	5.355042141	0.664995808	2.255613805	0	1.04563484	7.767512335	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5808
H4346_001_0	2010	8	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	973.7233517	38.42698715	707.5223241	0	259.849858	1627.695592	4653.331858	305.4356683	227.5169192	0	445.0736701	11.14727488	0	26.12621819	0	4026.065763	637.2716875	32.91623777	0	0	18.29725294	0	0	0	330.7271777	493.1	0	0	0	161.5188334												1a:$50 Days 1-5; Unlimited Add'l Days	1b:$50 Days 1-5; 60 Add'l Days	"2:$0 Days 1-20, $75 Days 21-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$100 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; Therapeutic Shoes: $50; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$25; 9b:$25	8a:$0	8b: X-Rays $0; Diagnostic $30; Therapeutic $0	9a:$25	12:$0	5:$30; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 4 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$15; 7h:$15	3:$15; 7c:$15; 7i:PT $0;SP $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0		7g:Consult with Nutritionist $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $20 per month											41.16720863	27.17391304	8.721797833	0	28.3943387	1.091158499	0.14329044	50	25	0	30	25	0	30	0	14.3770639	12.26910637	14.80947963	0	0	0.175152855	0	0	0	20	19.01237072	0	0	0	20											NO	41.16720863	27.17391304	8.721797833	0	28.3943387	1.091158499	0.14329044	50	25	0	30	25	0	30	0	14.3770639	12.26910637	14.80947963	0	0	0.175152855	0	0	0	20	19.01237072	0	0	0	20												3.3405	0.087017634	0.514238889	0	0.614855407	0.148006156	0.055564831	1.272648618	0.473993582	0	1.112684175	0.023223489	0	0.065315545	0	4.823583727	0.651562843	0.040622696	0	0	3.20481609	0	0	0	0.551211963	0.78125	0	0	0	0.269198056	0	0	0	0	0	0	0	0	0	0	18.0302	0	0	3.3405	0.087017634	0.514238889	0	0.614855407	0.148006156	0.055564831	1.272648618	0.473993582	0	1.112684175	0.023223489	0	0.065315545	0	4.823583727	0.651562843	0.040622696	0	0	3.20481609	0	0	0	0.551211963	0.78125	0	0	0	0.269198056	0	0	0	0	0	0	0	0	0	0	18.0302	NO																																																																																		0	0	0	3.3405	0.087017634	0.514238889	0	0.614855407	0.148006156	0.055564831	1.272648618	0.473993582	0	1.112684175	0.023223489	0	0.065315545	0	4.823583727	0.651562843	0.040622696	0	0	3.20481609	0	0	0	0.551211963	0.78125	0	0	0	0.269198056	0	0	0	0	0	0	0	0	0	0	18.0302
H4346_003_0	2010	9	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	2871.287129	0	0	0	873.5390341	4352.55424	2638.26311	77.94873701	32.87209218	0	0	2.422558395	0	0	0	120.1777846	0	0	0	0	7.45294487	0	0	0	314.0684358	493.1	0	0	0	0												1a:$50 Days 1-5; Unlimited Add'l Days	1b:$50 Days 1-5; 60 Add'l Days	2:$0; 3 Day Waiver; 50 Add'l SNF Days	6:$0	10a:$50 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$25; 9b:$25	8a:$0	8b: X-Rays $0; Diagnostic $0; Therapeutic $0	9a:$25	12:$0	5:$0; 9c:$0; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$0; 7d:$0; 7f:$0; 16b:$0; 17a:$0; 6 Routine Footcare Visits	7e:$0; 7h:$0	3:$0; 7c:$0; 7i:$0	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0		14a:Newsletters 14a:Additional Smoking Cessation $0 14c:Comprehensive Health Assessment $0	13c:OTC $40 per month Allowance											41.16720863	0	0	0	14.19716935	1.091158499	0.537554623	50	25	0	0	25	0	0	0	0	0	0	0	0	0.176268682	0	0	0	20	19.01237072	0	0	0	0											NO	41.16720863	0	0	0	14.19716935	1.091158499	0.537554623	50	25	0	0	25	0	0	0	0	0	0	0	0	0.176268682	0	0	0	20	19.01237072	0	0	0	0												9.8502	0	0	0	1.0334818	0.395777212	0.118184211	0.324786404	0.068483525	0	0	0.005046997	0	0	0	0	0	0	0	0	1.313720768	0	0	0	0.523447393	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4144	0	0	9.8502	0	0	0	1.0334818	0.395777212	0.118184211	0.324786404	0.068483525	0	0	0.005046997	0	0	0	0	0	0	0	0	1.313720768	0	0	0	0.523447393	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4144	NO																																																																																		0	0	0	9.8502	0	0	0	1.0334818	0.395777212	0.118184211	0.324786404	0.068483525	0	0	0.005046997	0	0	0	0	0	0	0	0	1.313720768	0	0	0	0.523447393	0.78125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4144
H4346_005_0	2010	7	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	2358.120854	41.56401461	1612.771362	0	543.0842024	10194.45397	5550.38458	460.2322886	278.3558927	0	631.4336156	14.16865776	0	20.5544394	0	4865.273164	776.1807318	25.06342196	0	0	27.35001536	0	0	0	330.0555224	493.1	0	0	0	146.0392625												1a:$50 Days 1-5; Unlimited Add'l Days	1b:$50 Days 1-5; 60 Add'l Days	"2:$0 Days 1-20, $50 Days 21-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$100 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$25; 9b:$25	8a:$0	8b: X-Rays $0; Diagnostic $30; Therapeutic $0	9a:$25	12:$0	5:$30; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 9 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$15; 7h:$15	3:$15; 7c:$15; 7i:PT $0;SP $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 7g:Health Alert Call $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $20 per month											41.16720863	27.17391304	5.814531888	0	28.3943387	1.091158499	0.156200136	50	25	0	30	25	0	30	0	14.55505618	12.28103832	14.61534326	0	0	0.175242634	0	0	0	20	19.01237072	0	0	0	20											NO	41.16720863	27.17391304	5.814531888	0	28.3943387	1.091158499	0.156200136	50	25	0	30	25	0	30	0	14.55505618	12.28103832	14.61534326	0	0	0.175242634	0	0	0	20	19.01237072	0	0	0	20												8.0898	0.09412141	0.781459209	0	1.285043066	0.926980424	0.072247569	1.917634536	0.57990811	0	1.578584039	0.029518037	0	0.051386098	0	5.901193684	0.794358776	0.030525876	0	0	4.792888732	0	0	0	0.550092537	0.78125	0	0	0	0.243398771	0	0	0	0	0	0	0	0	0	0	28.5004	0	0	8.0898	0.09412141	0.781459209	0	1.285043066	0.926980424	0.072247569	1.917634536	0.57990811	0	1.578584039	0.029518037	0	0.051386098	0	5.901193684	0.794358776	0.030525876	0	0	4.792888732	0	0	0	0.550092537	0.78125	0	0	0	0.243398771	0	0	0	0	0	0	0	0	0	0	28.5004	NO																																																																																		0	0	0	8.0898	0.09412141	0.781459209	0	1.285043066	0.926980424	0.072247569	1.917634536	0.57990811	0	1.578584039	0.029518037	0	0.051386098	0	5.901193684	0.794358776	0.030525876	0	0	4.792888732	0	0	0	0.550092537	0.78125	0	0	0	0.243398771	0	0	0	0	0	0	0	0	0	0	28.5004
H4346_006_0	2010	8	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	NO	1460.305013	32.23765961	1195.994572	0	443.2018875	4190.696074	4087.098144	438.3499434	267.0524143	0	522.069908	13.61416438	0	29.72307502	0	4802.430337	871.5531756	21.5679395	0	0	17.67668077	0	0	0	333.9849633	493.1	0	0	0	119.4786852												1a:$50 Days 1-5; Unlimited Add'l Days	1b:$50 Days 1-5; 60 Add'l Days	"2:$0 Days 1-20, $50 Days 21-100; 3 Day Waiver"	6:$0; Respite Care up to 80 hours	10a:$100 (waived if admitted)	11a:$0-$499 $0;$500-$1000 $100;>$1001 $250	11b:$0-$499 $0;$500-$1000 $100;>$1001 $250; 11c:$0	4a:$50 (waived if admitted) ;4b:$0; Worldwide Coverage	9a:$25; 9b:$25	8a:$0	8b: X-Rays $0; Diagnostic $30; Therapeutic $0	9a:$25	12:$0	5:$30; 9c:$30; 9d:$0; First 3 Pints of Blood	"7a:$0; 14b,14c,14d,14e,14f,14i,14j:$0; 1 Routine Physical"	7b:$15; 7d:$15; 7f:$0; 16b:$0-$15; 17a:$0-$15; 12 Routine Footcare Visits	7e:Visits 1-10:$0; Visits 11+:$15; 7h:$15	3:$15; 7c:$15; 7i:PT $0;SP $15	14g:$0; 14h:$0	7g:$0; 18a:$0	15:20% for drugs above $50 capped at $550 copay	17b:$0			17a: 1 Routine Eye Exam Per Year $20 copay	17b:$80 Allowance Every 2 Years	18a:$0	18b:$250 Allowance	7g:Consult with Nutritionist $0 7g:Consult with Exercise Coach $0 14a:Newsletters 14a:Additional Smoking Cessation $0 14a:Support Groups $0 14a:Helpline $0 14c:Healthy Start $0	13c:OTC $20 per month Allowance 13e:Exercise/Strength Training 12 Weeks $0 then $20 per month 13e:Electronic Health Monitoring $0											41.16720863	27.17391304	5.814531888	0	28.3943387	1.091158499	0.202536468	50	25	0	30	25	0	30	0	14.27771417	12.20571995	14.22933575	0	0	0.174726227	0	0	0	20	19.01237072	0	0	0	20											NO	41.16720863	27.17391304	5.814531888	0	28.3943387	1.091158499	0.202536468	50	25	0	30	25	0	30	0	14.27771417	12.20571995	14.22933575	0	0	0.174726227	0	0	0	20	19.01237072	0	0	0	20												5.0097	0.073001947	0.579512381	0	1.048702042	0.38105947	0.068982202	1.826458097	0.556359196	0	1.30517477	0.028362842	0	0.074307688	0	5.713977308	0.886494499	0.025574788	0	0	3.088579738	0	0	0	0.556641606	0.78125	0	0	0	0.199131142	0	0	0	0	0	0	0	0	0	0	22.2033	0	0	5.0097	0.073001947	0.579512381	0	1.048702042	0.38105947	0.068982202	1.826458097	0.556359196	0	1.30517477	0.028362842	0	0.074307688	0	5.713977308	0.886494499	0.025574788	0	0	3.088579738	0	0	0	0.556641606	0.78125	0	0	0	0.199131142	0	0	0	0	0	0	0	0	0	0	22.2033	NO																																																																																		0	0	0	5.0097	0.073001947	0.579512381	0	1.048702042	0.38105947	0.068982202	1.826458097	0.556359196	0	1.30517477	0.028362842	0	0.074307688	0	5.713977308	0.886494499	0.025574788	0	0	3.088579738	0	0	0	0.556641606	0.78125	0	0	0	0.199131142	0	0	0	0	0	0	0	0	0	0	22.2033
H4382_001_0	2010	9	N/A																															A	A	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	O	V																																																			0	NO						2.777086741	4.693967634	198.881264	122.2218414		199.2383442				2313.049016	4115.99044	19.75335241	189.2240049		291.32917		450.4803999			400																	PBP: 1A IP Acute: $0 per admit	1B IP Psych: $0 per admit	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	"11B Prosthetic Medical Supplies:10%, 11C Diabetes Monitoring Supplies:10%"	"4A ER/World Wide Coverage: $25, 4B Urgent Care: $0"	9B ASC Services: $50	8A OP C/D/T: $0	8B OP X-Ray: $0.  $25 for MRI/CAT/PET scans	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $5, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0"	"7B Chiropractic: $10, 7D Physician Specialist (excl. Radiology): $10, 7F Podiatry: $10"	"7E Mental Health: $10, 7H Psychiatric: $10"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $10, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Medicare Covered Comprehensive Dental Services: $0, 17A Medicare Covered Eye Exams: $0, 18A Hearing Screening: $10"	10B Transportation: Not Covered	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: $0"	17A Routine Eye Exams: $15	17B Eye Wear: Medicare Covered: $0	18A Routine Hearing Exams: $0	18B Hearing Aids: $0	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered																0.1	0.1	25	49.54912614		10				5	10	10	10		6.609788095		9.976921302			15																YES						0.1	0.1	25	49.54912614		10				5	10	10	10		6.609788095		9.976921302			15																2000	0	0	0	0	0	0.277708674	0.469396763	0.414335967	0.504665453	0	0.166031954	0	0	0	0.963770423	3.429992033	0.016461127	0.157686671	0	0.160468673	0	0.374533958	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.4351	0	0	0	0	0	0	0	0.277708674	0.469396763	0.414335967	0.504665453	0	0.166031954	0	0	0	0.963770423	3.429992033	0.016461127	0.157686671	0	0.160468673	0	0.374533958	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.4351	NO	PBP: 1A IP Acute: 20% Coinsurance	1B IP Psych: 20% Coinsurance	2 SNF: 20% Coinsurance	6 Home Health: 20% Coinsurance	10A Ambulance: 20% Coinsurance	11A DME:  20% Coinsurance	"11B Prosthetic Medical Supplies: 20% Coinsurance, 11C Diabetes Monitoring Supplies: 20% Coinsurance"	"4A ER/World Wide Coverage: 20% Coinsurance, 4B Urgent Care: 20% Coinsurance"	9B ASC Services: 20% Coinsurance	8A OP C/D/T: 20% Coinsurance	8B OP X-Ray: 20% Coinsurance	9A OP Hospital: 20% Coinsurance	12 Renal Dialysis: 20% Coinsurance	"3 CORF: 20% Coinsurance, 5 Partial Hosp: 20% Coinsurance, 9C OP Substance Abuse: 20% Coinsurance, 9D Cardiac Rehab: 20% Coinsurance"	"7A PCP: 20% Coinsurance, 14B Immunizations: 20% Coinsurance, 14C Routine Physical Exams: 20% Coinsurance, 14D Pap Smears: 20% Coinsurance, 14D Pelvic Exams: 20% Coinsurance, 14E Prostate Screening: 20% Coinsurance, 14F Colorectal Screening: 20% Coinsurance, 14G Bone Mass Measurement: 20% Coinsurance, 14H Mammography: 20% Coinsurance, 14I Diabetes Monitoring: 20% Coinsurance"	"7B Chiropractic: 20% Coinsurance, 7D Physician Specialist (excl. Radiology): 20% Coinsurance, 7F Podiatry: 20% Coinsurance"	"7E Mental Health: 20% Coinsurance, 7H Psychiatric: 20% Coinsurance"	"7C Occupational Therapy: 20% Coinsurance, 7I Physical and Speech Therapy: 20% Coinsurance"	7D Physician Specialist (Radiology): 20% Coinsurance	"7G Other Health Care: 20% Coinsurance, 18A Medicare Covered Hearing Exams: 20% Coinsurance"	15 Part B Drugs: 20% Coinsurance	"13A Blood: 20% Coinsurance, 16B Medicare Covered Comprehensive Dental Services: 20% Coinsurance, 17A Medicare Covered Eye Exams: 20% Coinsurance"	10B Transportation: Not Covered	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: Not Covered"	17A Routine Eye Exams: Not Covered	"17B Eye Wear: Medicare Covered: Not Covered, Routine: Not Covered"	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: Not Covered	13B Acupuncture: Not Covered												2.0703		0.0975	0.2569	0.0669	0.0424	0.0745	0.1825	0.3608	0.0254	0.151	0.0122	0.0006	0.1918	0.268	0.5322	0.0047	0.0427	0.3083	0.4829	0.4924	0.0802																			5.7444	100	3.239413316	2.0703	0	0.097527813	0.25691901	0.066934675	0.320153617	0.543888897	0.596791974	0.865514688	0.025411788	0.316989935	0.012222885	0.000639557	0.191822559	1.231727597	3.962175108	0.021154233	0.200430943	0.308318194	0.643338919	0.492423802	0.454744389	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.1794
H4382_002_0	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	V	P	V	P	P	P	P	V	Coin	V	T	V	V	V	V	V	O	V																																																			0	NO						2.777086741	4.693967634	198.881264	122.2218414		368.339796				2313.049016	4115.99044	19.75335241	189.2240049		291.32917		450.4803999			400																	PBP: 1A IP Acute: $0 per admit	1B IP Psych: $0 per admit	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	"11B Prosthetic Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 0%"	"4A ER/World Wide Coverage to $5k: $25, 4B Urgent Care: $0"	9B ASC Services: $50	8A OP C/D/T: $0	8B OP X-Ray: $0.  $25 PET/CAT/MRI	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $5, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0"	"7B Chiropractic: $10, 7D Physician Specialist (excl. Radiology): $10, 7F Podiatry: $10"	"7E Mental Health: $10, 7H Psychiatric: $10"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $10, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Medicare Covered Comprehensive Dental Services: $0, 17A Medicare Covered Eye Exams: $0"	10B Transportation: Not Covered	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: $0"	17A Routine Eye Exams: $15	17B Eye Wear: Medicare Covered: $0	18A Routine Hearing Exams: $0	18B Hearing Aids: $0	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered																0.1	0.1	25	49.54912614		10				5	10	10	10		6.609788095		9.976921302			15																YES						0.1	0.1	25	49.54912614		10				5	10	10	10		6.609788095		9.976921302			15																2000	0	0	0	0	0	0.277708674	0.469396763	0.414335967	0.504665453	0	0.30694983	0	0	0	0.963770423	3.429992033	0.016461127	0.157686671	0	0.160468673	0	0.374533958	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.576	0	0	0	0	0	0	0	0.277708674	0.469396763	0.414335967	0.504665453	0	0.30694983	0	0	0	0.963770423	3.429992033	0.016461127	0.157686671	0	0.160468673	0	0.374533958	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.576	NO	PBP: 1A IP Acute: 20% Coinsurance	1B IP Psych: 20% Coinsurance	2 SNF: 20% Coinsurance	6 Home Health: 20% Coinsurance	10A Ambulance: 20% Coinsurance	11A DME:  20% Coinsurance	"11B Prosthetic Medical Supplies: 20% Coinsurance, 11C Diabetes Monitoring Supplies: 20% Coinsurance"	"4A ER/World Wide Coverage: 20% Coinsurance, 4B Urgent Care: 20% Coinsurance"	9B ASC Services: 20% Coinsurance	8A OP C/D/T: 20% Coinsurance	8B OP X-Ray: 20% Coinsurance	9A OP Hospital: 20% Coinsurance	12 Renal Dialysis: 20% Coinsurance	"3 CORF: 20% Coinsurance, 5 Partial Hosp: 20% Coinsurance, 9C OP Substance Abuse: 20% Coinsurance, 9D Cardiac Rehab: 20% Coinsurance"	"7A PCP: 20% Coinsurance, 14B Immunizations: 20% Coinsurance, 14C Routine Physical Exams: 20% Coinsurance, 14D Pap Smears: 20% Coinsurance, 14D Pelvic Exams: 20% Coinsurance, 14E Prostate Screening: 20% Coinsurance, 14F Colorectal Screening: 20% Coinsurance, 14G Bone Mass Measurement: 20% Coinsurance, 14H Mammography: 20% Coinsurance, 14I Diabetes Monitoring: 20% Coinsurance"	"7B Chiropractic: 20% Coinsurance, 7D Physician Specialist (excl. Radiology): 20% Coinsurance, 7F Podiatry: 20% Coinsurance"	"7E Mental Health: 20% Coinsurance, 7H Psychiatric: 20% Coinsurance"	"7C Occupational Therapy: 20% Coinsurance, 7I Physical and Speech Therapy: 20% Coinsurance"	7D Physician Specialist (Radiology): 20% Coinsurance	"7G Other Health Care: 20% Coinsurance, 18A Medicare Covered Hearing Exams: 20% Coinsurance"	15 Part B Drugs: 20% Coinsurance	"13A Blood: 20% Coinsurance, 16B Medicare Covered Comprehensive Dental Services: 20% Coinsurance, 17A Medicare Covered Eye Exams: 20% Coinsurance"	10B Transportation: Not Covered	"16A Preventive Dental Services: Not Covered, 16B Non Medicare Covered Comprehensive Dental: Not Covered"	17A Routine Eye Exams: Not Covered	"17B Eye Wear: Medicare Covered: Not Covered, Routine: Not Covered"	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: Not Covered	13B Acupuncture: Not Covered												2.0703		0.0975	0.2569	0.0669	0.0424	0.0745	0.1825	0.3608	0.0254	0.151	0.0122	0.0006	0.1918	0.268	0.5322	0.0047	0.0427	0.3083	0.4829	0.4924	0.0802																			5.7444	100	3.239413316	2.0703	0	0.097527813	0.25691901	0.066934675	0.320153617	0.543888897	0.596791974	0.865514688	0.025411788	0.457907811	0.012222885	0.000639557	0.191822559	1.231727597	3.962175108	0.021154233	0.200430943	0.308318194	0.643338919	0.492423802	0.454744389	0	0	0.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.3203
H4382_801_0	2010	5	N/A																															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																																																			0	NO	119.8244865	2.395018336	3.945278778		4.952359454	28.42406192	19.31641987	8.027353862	21.17999118	1.90170603	5.323548367	0.927467697	0.618463107	8.317100982	48.78559718	59.75861384	3.698190421	5.923866596	27.2786478	53.46250403	21.45981281	5.295824506																				Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share											0.090257079	0.090257079	0.118707739		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.090257079	0.090257079	0.118707739		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				10.815	0.216167359	0.468335122	0	1.153899753	6.622806428	4.500725831	1.87037345	4.934937944	0.443097505	1.240386769	0.216099973	0.144101904	1.937884529	11.36704414	13.92375702	0.861678368	1.380260917	6.355924938	12.45676344	5.000136384	1.23392711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1433	0	0	10.815	0.216167359	0.468335122	0	1.153899753	6.622806428	4.500725831	1.87037345	4.934937944	0.443097505	1.240386769	0.216099973	0.144101904	1.937884529	11.36704414	13.92375702	0.861678368	1.380260917	6.355924938	12.45676344	5.000136384	1.23392711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1433	NO	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share												1.3315	0.0266	0.0577		0.1283	0.7359	0.5001	0.2188	0.5772	0.0518	0.1451	0.0253	0.0169	0.2267	1.2631	1.6272	0.1006	0.1613	0.743	1.4526	0.5556	0.1443																			10.0894	0	0	12.1465	0.242780761	0.525994109	0	1.282224445	7.358673808	5.000806478	2.089130578	5.512123669	0.494921775	1.385461245	0.241374824	0.160954863	2.16453769	12.63015609	15.55097446	0.962288868	1.541577623	7.098935683	13.90936558	5.555707094	1.378218109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2327
H4382_802_0	2010	5	N/A																															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																																																			0	NO	119.8244865	2.395018336	3.945278778		4.952359454	28.42406192	19.31641987	8.027353862	21.17999118	1.90170603	5.323548367	0.927467697	0.618463107	8.317100982	48.78559718	59.75861384	3.698190421	5.923866596	27.2786478	53.46250403	21.45981281	5.295824506																				Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share											0.090257079	0.090257079	0.118707739		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.090257079	0.090257079	0.118707739		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				10.815	0.216167359	0.468335122	0	1.153899753	6.622806428	4.500725831	1.87037345	4.934937944	0.443097505	1.240386769	0.216099973	0.144101904	1.937884529	11.36704414	13.92375702	0.861678368	1.380260917	6.355924938	12.45676344	5.000136384	1.23392711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1433	0	0	10.815	0.216167359	0.468335122	0	1.153899753	6.622806428	4.500725831	1.87037345	4.934937944	0.443097505	1.240386769	0.216099973	0.144101904	1.937884529	11.36704414	13.92375702	0.861678368	1.380260917	6.355924938	12.45676344	5.000136384	1.23392711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1433	NO	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share												1.3315	0.0266	0.0577		0.1283	0.7359	0.5001	0.2188	0.5772	0.0518	0.1451	0.0253	0.0169	0.2267	1.2631	1.6272	0.1006	0.1613	0.743	1.4526	0.5556	0.1443																			10.0894	0	0	12.1465	0.242780761	0.525994109	0	1.282224445	7.358673808	5.000806478	2.089130578	5.512123669	0.494921775	1.385461245	0.241374824	0.160954863	2.16453769	12.63015609	15.55097446	0.962288868	1.541577623	7.098935683	13.90936558	5.555707094	1.378218109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2327
H4382_803_0	2010	5	N/A																															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																																																			0	NO	119.8244865	2.395018336	3.945278778		4.952359454	28.42406192	19.31641987	8.027353862	21.17999118	1.90170603	5.323548367	0.927467697	0.618463107	8.317100982	48.78559718	59.75861384	3.698190421	5.923866596	27.2786478	53.46250403	21.45981281	5.295824506																				Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share											0.090257079	0.090257079	0.118707739		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.090257079	0.090257079	0.118707739		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				10.815	0.216167359	0.468335122	0	1.153899753	6.622806428	4.500725831	1.87037345	4.934937944	0.443097505	1.240386769	0.216099973	0.144101904	1.937884529	11.36704414	13.92375702	0.861678368	1.380260917	6.355924938	12.45676344	5.000136384	1.23392711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1433	0	0	10.815	0.216167359	0.468335122	0	1.153899753	6.622806428	4.500725831	1.87037345	4.934937944	0.443097505	1.240386769	0.216099973	0.144101904	1.937884529	11.36704414	13.92375702	0.861678368	1.380260917	6.355924938	12.45676344	5.000136384	1.23392711	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.1433	NO	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share												1.3315	0.0266	0.0577		0.1283	0.7359	0.5001	0.2188	0.5772	0.0518	0.1451	0.0253	0.0169	0.2267	1.2631	1.6272	0.1006	0.1613	0.743	1.4526	0.5556	0.1443																			10.0894	0	0	12.1465	0.242780761	0.525994109	0	1.282224445	7.358673808	5.000806478	2.089130578	5.512123669	0.494921775	1.385461245	0.241374824	0.160954863	2.16453769	12.63015609	15.55097446	0.962288868	1.541577623	7.098935683	13.90936558	5.555707094	1.378218109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.2327
H4406_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1318.833733	111.5801598	1102.734535	666.0165842	204.1739692	8.240712588	7.63338913	277.8035683	22.90024569	7315.490014	25.54716191	0	0.016298134	11.27483778	4776.421807	3786.816948	484.6074622	259.7151269	0	0	22.34346623	747.2574113	692.4543639	0	193.8835954	178.0364274	13.66244276	3.940498952	91.3642198	0											3750	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-21 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	73.538265	0	150	0.2	0.124124567	49.60431018	0.2	3	0.175872191	0	0.2	0.149718227	10.63212133	30	38.5	30	0	0	0.2	28.2504375	0	0	30	15	0	0	0	0											YES	148.6531796	113.2174086	59.33394434	0	121.0266744	0.161368899	0.100149224	40.02296463	0.161368899	2.420533487	0.141901509	0	0.161368899	0.121060131	10.53778624	30	38.5	24.20533487	0	0	0.161368899	28.2504375	0	0	30	15	0	0	0	0											5000	16.3374	1.052734712	5.452465795	0	2.05920804	1.329794719	0.764477997	0.926543532	3.695387436	1.475615713	3.625180835	0	0.002630012	1.364933334	4.194409334	9.467042369	1.554782274	0.523874302	0	0	3.605540548	1.759195732	0	0	0.484708988	0.222545534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8985	0	10.14020365	16.3374	1.052734712	5.452465795	0	2.05920804	1.329794719	0.764477997	0.926543532	3.695387436	1.475615713	3.625180835	0	0.002630012	1.364933334	4.194409334	9.467042369	1.554782274	0.523874302	0	0	3.605540548	1.759195732	0	0	0.484708988	0.222545534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8985	NO	"$300 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$300 Days 1-17 (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.4199	0.2072	0	0.4242	0.7271	0.7044	0.6524	0.4321	1.9573	0.5211	1.8781	0	0.0009	0.7213	1.7986	3.2825	0.4121	0.1716	0	0	1.181	0.6238	0	0	0.1705	0	0.012	0	0	0											18.2982	0	3.889751606	18.7573	1.259957434	5.452465795	0.424242641	2.786341853	2.034147085	1.416921052	1.35866724	5.652723294	1.996675294	5.503264715	0	0.003558704	2.086268736	5.99296615	12.74954891	1.966848187	0.695469987	0	0	4.786539883	2.38298454	0	0	0.655254744	0.222545534	0.012017889	0	0	0	0	0	0	0	0	0	0	0	0	0	78.1967
H4406_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	255.357603	5.959038856	29.743416	974.4558851	9.955589263	12.10792624	11.21559714	17.00917648	33.64690646	16.67573779	37.53597141	0	0.023946546	16.54407401	31.6933159	116.5207104	2.945716128	4.452153338	0	0	29.38383892	5.905625421	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078522821	0.078522821	0.193758072	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078522821	0.078522821	0.193758072	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.0514	0.467920539	5.763026931	0	2.319652298	2.821146814	2.613234134	3.963138121	7.839729205	3.885446906	8.745881337	0	0.005579545	3.854769245	7.384542604	27.14932551	0.686351858	1.037351728	0	0	6.846434468	1.376010723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8109	0	0	20.0514	0.467920539	5.763026931	0	2.319652298	2.821146814	2.613234134	3.963138121	7.839729205	3.885446906	8.745881337	0	0.005579545	3.854769245	7.384542604	27.14932551	0.686351858	1.037351728	0	0	6.846434468	1.376010723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8109	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.0514	0.467920539	5.763026931	0	2.319652298	2.821146814	2.613234134	3.963138121	7.839729205	3.885446906	8.745881337	0	0.005579545	3.854769245	7.384542604	27.14932551	0.686351858	1.037351728	0	0	6.846434468	1.376010723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8109
H4406_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	255.357603	5.959038856	29.743416	974.4558851	9.955589263	12.10792624	11.21559714	17.00917648	33.64690646	16.67573779	37.53597141	0	0.023946546	16.54407401	31.6933159	116.5207104	2.945716128	4.452153338	0	0	29.38383892	5.905625421	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078522821	0.078522821	0.193758072	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078522821	0.078522821	0.193758072	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.0514	0.467920539	5.763026931	0	2.319652298	2.821146814	2.613234134	3.963138121	7.839729205	3.885446906	8.745881337	0	0.005579545	3.854769245	7.384542604	27.14932551	0.686351858	1.037351728	0	0	6.846434468	1.376010723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8109	0	0	20.0514	0.467920539	5.763026931	0	2.319652298	2.821146814	2.613234134	3.963138121	7.839729205	3.885446906	8.745881337	0	0.005579545	3.854769245	7.384542604	27.14932551	0.686351858	1.037351728	0	0	6.846434468	1.376010723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8109	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.0514	0.467920539	5.763026931	0	2.319652298	2.821146814	2.613234134	3.963138121	7.839729205	3.885446906	8.745881337	0	0.005579545	3.854769245	7.384542604	27.14932551	0.686351858	1.037351728	0	0	6.846434468	1.376010723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8109
H4406_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	255.357603	5.959038856	29.743416	974.4558851	9.955589263	12.10792624	11.21559714	17.00917648	33.64690646	16.67573779	37.53597141	0	0.023946546	16.54407401	31.6933159	116.5207104	2.945716128	4.452153338	0	0	29.38383892	5.905625421	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.078522821	0.078522821	0.193758072	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078522821	0.078522821	0.193758072	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.0514	0.467920539	5.763026931	0	2.319652298	2.821146814	2.613234134	3.963138121	7.839729205	3.885446906	8.745881337	0	0.005579545	3.854769245	7.384542604	27.14932551	0.686351858	1.037351728	0	0	6.846434468	1.376010723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8109	0	0	20.0514	0.467920539	5.763026931	0	2.319652298	2.821146814	2.613234134	3.963138121	7.839729205	3.885446906	8.745881337	0	0.005579545	3.854769245	7.384542604	27.14932551	0.686351858	1.037351728	0	0	6.846434468	1.376010723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8109	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.0514	0.467920539	5.763026931	0	2.319652298	2.821146814	2.613234134	3.963138121	7.839729205	3.885446906	8.745881337	0	0.005579545	3.854769245	7.384542604	27.14932551	0.686351858	1.037351728	0	0	6.846434468	1.376010723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8109
H4407_001_0	2010	5	N/A																															D	D	D	P	T	COIN	COIN	V	V	P	P	V	COIN	P	V	V	COIN	P	P	P	COIN																																																												0	NO	969.3487028	70.27026223	176.4221202	895.2955869	205.3198329	7.417796613	2.217863934	326.7704437	179.7094933	179.1808741	458.8760057	3.512316203	2.809852962	327.6433911	3742.700414	2679.939862	0.117263435	97.39002093	150.5077551	1009.966362	19.22415535																					$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $50 (6-20 Days)	No Cost Sharing	$125CP/Trip; 20% on Air Ambulance	20% Coins.	20% Coins.	$50 CP / Visit	$135 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$135 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.																				225	225	50	0	133.6163748	0.2	0.2	50	135	0	100	175	0.2	135	15	30	0.2	15	30	0	0.2																				NO	213.3	213.3	47.4	0	126.6683233	0.1896	0.1896	50	127.98	0	94.8	165.9	0.1896	127.98	15	30	0.2	15	30	0	0.1896																					17.2302	1.249053911	0.696867375	0	2.167293247	1.406414238	0.420507002	1.361543516	1.916601746	0	3.625120445	0.048557772	0.532748122	3.494316766	4.678375517	6.699849655	0.023452687	0.121737526	0.376269388	0	3.644899854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6938		2.1	17.2302	1.249053911	0.696867375	0	2.167293247	1.406414238	0.420507002	1.361543516	1.916601746	0	3.625120445	0.048557772	0.532748122	3.494316766	4.678375517	6.699849655	0.023452687	0.121737526	0.376269388	0	3.644899854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6938	NO																																																																																		0			17.2302	1.249053911	0.696867375	0	2.167293247	1.406414238	0.420507002	1.361543516	1.916601746	0	3.625120445	0.048557772	0.532748122	3.494316766	4.678375517	6.699849655	0.023452687	0.121737526	0.376269388	0	3.644899854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6938
H4407_002_0	2010	8	N/A																															D	D	D		T	COIN		P	P		P		COIN		V	V	COIN	V			COIN																																																												0	NO	1212.65	56.73354982	242.1		190.9339086	14.20747997		376.6636646	428.3970859		3525.773731		0.410727893		4646.167828	7567.648545	1.546242096	114.3139649			40.80829709																					$185 per days 1-6	$185 per days 1-10	$0 for days 1-5; $95 for days 6-35		$150 per trip	20% coinsurance		$50 per visit	$250 per visit		"$25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"		20% Coinsurance		$5 per visit	$35 per visit	20% coinsurance	$35 per visit			20% per Script																				185	185	95		150	0.2		50	250		46.66983964		0.2		5	35	0.2	35			0.2																				NO	175.4075246	175.4075246	90.07413425		142.2223172	0.189629756		50	237.0371954		44.24995159		0.189629756		5	35	0.2	35			0.189629756																					17.7257	0.829290961	1.817245658	0	2.26292191	2.694160965	0	1.569431936	8.462170313	0	13.00127641	0	0.07788623	0	1.935903262	22.07230826	0.309248419	0.333415731	0	0	7.738467432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8294		2.986395647	17.7257	0.829290961	1.817245658	0	2.26292191	2.694160965	0	1.569431936	8.462170313	0	13.00127641	0	0.07788623	0	1.935903262	22.07230826	0.309248419	0.333415731	0	0	7.738467432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8294	NO																																																																																		0			17.7257	0.829290961	1.817245658	0	2.26292191	2.694160965	0	1.569431936	8.462170313	0	13.00127641	0	0.07788623	0	1.935903262	22.07230826	0.309248419	0.333415731	0	0	7.738467432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.8294
H4407_003_0	2010	5	N/A																															D	D			COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN			COIN		COIN	COIN	COIN																				29.68				0.6715	0.6706	0.1137	1.2528	1.5887	0.0546	0.5738	0.0464	0.0014	0.5374			0.02																								35.2109	NO	3209.427589	109	0	0	20.34885788	20.320878	3.445257148	748.2020266	51.80027803	1.654801026	17.38771461	1.404659968	0.041119992	16.28612453	0	0	1.891495461	0	11.87963527	4.661219173	27.19638466																					Standard Medicare Benefits	$225 Days 1-7	No Cost Sharing	No Cost Sharing	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	$50 CP / Visit	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	No Cost Sharing	No Cost Sharing	20% Coins.	No Cost Sharing	20% Coins.	20% Coins.	20% Coins.																				7.476718814	225	0	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0.2	0	0.2	0.2	0.2																				NO	7.476718814	225	0	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0.2	0	0.2	0.2	0.2																					1.9997	2.04375	0	0	4.069771575	4.064175601	0.68905143	3.117508444	10.36005561	0.330960205	3.477542923	0.280931994	0.008223998	3.257224905	0	0	0.378299092	0	2.375927054	0.932243835	5.439276933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8246	35.21088794	0	31.6797	2.04375	0	0	4.741283885	4.734764575	0.802744915	4.370331225	11.94877013	0.385568639	4.051337505	0.327285773	0.009580958	3.794667014	0	0	0.398299092	0	2.375927054	0.932243835	5.439276933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0355	NO																																																																																		0			31.6797	2.04375	0	0	4.741283885	4.734764575	0.802744915	4.370331225	11.94877013	0.385568639	4.051337505	0.327285773	0.009580958	3.794667014	0	0	0.398299092	0	2.375927054	0.932243835	5.439276933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0355
H4407_004_0	2010	7	N/A																															D	D	D		COIN	COIN		COIN	COIN		COIN		COIN		V	V	COIN	V			COIN																																																												0	NO	1712.433386	104.1131976	824.7231028		16.37453389	21.71364947		45.34597818	49.65481111		27.71471913		2.141743134		7467.044287	13287.17257	3.635407126	488.2313262			44.75915142																					$140 per day for 1st 6 days	$140 per day for 1st 10 days	$0 Days 1-5; $95 days 6-35		20% Coinsurance	20% Coinsurance		20% Coinsurance	20% Coinsurance		20% Coinsurance		20% Coinsurance		$0/visit	$0/visit	20% Coinsurance	$0/visit			20% Coinsurance																				140	140	95		0.2	0.2		0.2	0.2		0.2		0.2		0	0	0.2	0			0.2																				NO	140	140	95		0.2	0.2		0.2	0.2		0.2		0.2		0	0	0.2	0			0.2																					19.9784	1.214653972	6.529057897	0	3.274906779	4.342729895	0	9.069195636	9.930962222	0	5.542943827	0	0.428348627	0	0	0	0.727081425	0	0	0	8.951830285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9901		0	19.9784	1.214653972	6.529057897	0	3.274906779	4.342729895	0	9.069195636	9.930962222	0	5.542943827	0	0.428348627	0	0	0	0.727081425	0	0	0	8.951830285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9901	NO																																																																																		0			19.9784	1.214653972	6.529057897	0	3.274906779	4.342729895	0	9.069195636	9.930962222	0	5.542943827	0	0.428348627	0	0	0	0.727081425	0	0	0	8.951830285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.9901
H4407_005_0	2010	4	N/A																															D	D	D	P	T	COIN	COIN	V	V	P	P	V	COIN	P	V	V	COIN	P	P	P	COIN																																																												0	NO	836.9608299	48.5476353	254.634932	1077.085753	215.8421232	6.894611529	2.138638116	315.5652977	231.6008101	202.5125089	206.1210927	4.197229142	15.98421168	276.8575928	3078.129426	3522.407141	0.18324197	153.0716978	37.37819665	1145.512775	17.93638369																					$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $50 (6-20 Days)	No Cost Sharing	$125 CP/Trip; 20% Coin Air Ambulance	20% Coins.	20% Coins.	$50 CP / Visit	$175 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.																				225	225	50	0	131.5445461	0.2	0.2	50	175	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2																				NO	213.3	213.3	47.4	0	124.7042297	0.1896	0.1896	50	165.9	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896																					14.877	0.862934218	1.005807981	0	2.243035476	1.307218346	0.405485787	1.314855407	3.201881199	0	1.628356632	0.058026693	3.030606535	3.82755622	3.847661782	8.806017853	0.036648394	0.191339622	0.093445492	0	3.400738348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1386		1.95	14.877	0.862934218	1.005807981	0	2.243035476	1.307218346	0.405485787	1.314855407	3.201881199	0	1.628356632	0.058026693	3.030606535	3.82755622	3.847661782	8.806017853	0.036648394	0.191339622	0.093445492	0	3.400738348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1386	NO																																																																																		0			14.877	0.862934218	1.005807981	0	2.243035476	1.307218346	0.405485787	1.314855407	3.201881199	0	1.628356632	0.058026693	3.030606535	3.82755622	3.847661782	8.806017853	0.036648394	0.191339622	0.093445492	0	3.400738348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1386
H4407_009_0	2010	6	N/A																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN			COIN																																																									0	NO	1060.013567	61.24124639	206.5254556	984.6119472	239.3838831	9.149429453	3.327344556	373.5537331	192.3969668	193.5814062	602.4010198	5.699158182	4.559326545	270.2815876	3748.047979	2854.097112	0.198162245	164.5783717	57.35182395	1024.038917	31.47040987			12.86395																		$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $50 (6-20 Days)	No Cost Sharing	$125CP/Trip; 20% on Air Ambulance	20% Coins.	20% Coins.	$50 CP / Visit	$175 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.			Various cost sharing																	225	225	50	0	132.6076305	0.2	0.2	50	175	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2			0.242																	NO	213.3	213.3	47.4	0	125.7120337	0.1896	0.1896	50	165.9	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896			0.242																		18.8417	1.088563154	0.815775549	0	2.507786232	1.734731824	0.630864528	1.556473888	2.659888066	0	4.758968056	0.078790862	0.864448313	3.736642949	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	5.966789711	0	0	3.1130759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5636		2.42	18.8417	1.088563154	0.815775549	0	2.507786232	1.734731824	0.630864528	1.556473888	2.659888066	0	4.758968056	0.078790862	0.864448313	3.736642949	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	5.966789711	0	0	3.1130759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5636	NO																																																																																		0			18.8417	1.088563154	0.815775549	0	2.507786232	1.734731824	0.630864528	1.556473888	2.659888066	0	4.758968056	0.078790862	0.864448313	3.736642949	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	5.966789711	0	0	3.1130759	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5636
H4407_011_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	P	P	O	V	O	COIN	O	V	V	COIN	V			Coin	Coin	T	V	V																																																								0	NO	1015.27	53.51866918	433.89		238.1972026	11.31426474		348.1352876	412.3740188		3066.730097		0.481115668		3770.505077	5749.314342	1.249984981	83.11966284			42.25593092																					$185 days/days 1-6	$185 days/days 1-10	"$0/day, days 1-5; $95/day, days 6-35"		$150 per trip	20% coinsurance		$50 per visit	$100 per visit		"$25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"		20% Coinsurance		$0 per visit	$15 per visit	20% Coinsurance	$15 per visit			20% per script																				185	185	95		150	0.2		50	100		46.90962147		0.2		0	15	0.2	15			0.2																				NO	175.4075246	175.4075246	90.07413425		142.2223172	0.189629756		50	94.81487815		44.47730044		0.189629756		0	15	0.2	15			0.189629756																					14.8405	0.782298107	3.256855509	0	2.823079843	2.145521265	0	1.450563698	3.258266029	0	11.36665633	0	0.091233847	0	0	7.186642928	0.249996996	0.103899579	0	0	8.012981884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5685		2.547168341	14.8405	0.782298107	3.256855509	0	2.823079843	2.145521265	0	1.450563698	3.258266029	0	11.36665633	0	0.091233847	0	0	7.186642928	0.249996996	0.103899579	0	0	8.012981884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5685	NO																																																																																		0			14.8405	0.782298107	3.256855509	0	2.823079843	2.145521265	0	1.450563698	3.258266029	0	11.36665633	0	0.091233847	0	0	7.186642928	0.249996996	0.103899579	0	0	8.012981884	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.5685
H4407_013_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	O	V	O	Coin	O	V	V	COIN	V			Coin	Coin	T	V	V	V			O	V																																																			0	NO	1899.354076	88.55093331	437.5686944		318.3442545	18.56301737		483.0697531	51.11276108		4358.238959		0.377866687		7147.853853	9058.640346	1.071486712	322.902112			59.76524451																					$185/day for days 1-6	$185/day for days 1-10	$0 day/1-5; $95/day; days 6-35		$150 per Trip	20% coinsurance		$50 per visit	$175 per visit		"$25 Xray/$100 for MRI, MRA, CT, PET and Nuc Scan"		20% Coinsurance		$5 per visit	$35 per visit	20% coinsurance	$35 per visit			20% per script																				185	185	95		150	0.2		50	175		46.25910772		0.2		5	35	0.2	35			0.2																				NO	175.4075246	175.4075246	90.07413425		142.2223172	0.189629756		50	165.9260368		43.86051662		0.189629756		5	35	0.2	35			0.189629756																					27.7634	1.294375001	3.284468443	0	3.772971463	3.52010046	0	2.012790638	0.706744823	0	15.92955103	0	0.071654768	0	2.978272439	26.42103434	0.214297342	0.941797827	0	0	11.33326875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2447		3.701013707	27.7634	1.294375001	3.284468443	0	3.772971463	3.52010046	0	2.012790638	0.706744823	0	15.92955103	0	0.071654768	0	2.978272439	26.42103434	0.214297342	0.941797827	0	0	11.33326875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2447	NO																																																																																		0			27.7634	1.294375001	3.284468443	0	3.772971463	3.52010046	0	2.012790638	0.706744823	0	15.92955103	0	0.071654768	0	2.978272439	26.42103434	0.214297342	0.941797827	0	0	11.33326875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2447
H4407_020_0	2010	6	N/A																															A	D	D		T	COIN		P	P		P		COIN		V	V	COIN	V			COIN																																																												0	NO	288.0504178	10.40021234	242.1		190.9339086	14.20747997		376.6636646	428.3970859		3525.773731		0.42		4646.167828	7567.648545	1.546242096	114.3139649			40.80829709																					$300 per admit	$185 / day days 1-10	$0 days 1-5; $50 days 6-35		$50 per trip	20% Coinsurance		$50 per visit	$50 per visit		"$25/Xray; $100/MRI,MRA,CT,PET, NUC Scan"		20% Coinsurance		$0 per visit	$15 per visit	20% Coinsurance	$15 per visit			20% per script																				300	185	50		50	0.2		50	50		46.14835788		0.2		0	15	0.2	15			0.2																				NO	284.4446345	175.4075246	47.40743908		47.40743908	0.189629756		50	47.40743908		43.75550929		0.189629756		0	15	0.2	15			0.189629756																					6.8279	0.152022959	0.956445083	0	0.754307303	2.694160965	0	1.569431936	1.692434063	0	12.8560021	0	0.079644498	0	0	9.459560681	0.309248419	0.142892456	0	0	7.738467432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2325		1.845753212	6.8279	0.152022959	0.956445083	0	0.754307303	2.694160965	0	1.569431936	1.692434063	0	12.8560021	0	0.079644498	0	0	9.459560681	0.309248419	0.142892456	0	0	7.738467432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2325	NO																																																																																		0			6.8279	0.152022959	0.956445083	0	0.754307303	2.694160965	0	1.569431936	1.692434063	0	12.8560021	0	0.079644498	0	0	9.459560681	0.309248419	0.142892456	0	0	7.738467432	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2325
H4407_021_0	2010	7	N/A																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	NO	1133.337288	77.09083154	347.7632521	1493.048731	260.9307196	10.24262207	4.326329614	424.9714513	270.6803178	198.2099165	342.17298	10.27677162	5.237303463	447.5820489	4343.119916	3398.525315	0.175560486	117.722985	26.94816256	956.3779506	36.76810597																					$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $70 (6-20 Days)	No Cost Sharing	$125 CP/Trip; 20% Air Ambulance	20% Coins.	20% Coins.	$50 CP / Visit	$200 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.																				225	225	70	0	134.0777214	0.2	0.2	50	200	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2																				NO	213.3	213.3	66.36	0	127.1056799	0.1896	0.1896	50	189.6	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896																					20.1451	1.370289531	1.923130784	0	2.76381471	1.942001145	0.820272095	1.77071438	4.27674902	0	2.703166542	0.142076368	0.992992736	6.187821826	5.428899895	8.496313287	0.035112097	0.147153731	0.067370406	0	6.971232892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1842		2.68	20.1451	1.370289531	1.923130784	0	2.76381471	1.942001145	0.820272095	1.77071438	4.27674902	0	2.703166542	0.142076368	0.992992736	6.187821826	5.428899895	8.496313287	0.035112097	0.147153731	0.067370406	0	6.971232892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1842	NO																																																																																		0			20.1451	1.370289531	1.923130784	0	2.76381471	1.942001145	0.820272095	1.77071438	4.27674902	0	2.703166542	0.142076368	0.992992736	6.187821826	5.428899895	8.496313287	0.035112097	0.147153731	0.067370406	0	6.971232892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1842
H4407_802_0	2010	1	N/A																															D	D	D		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																				31.8619	2.3982	9.6529		0.4485	0.5871		0.7924	1.9457	0.5637	0.2693	0.0716	0.0197	0.5779	3.0561	5.5755	0.1978	0.047	1.2543		0.8555																				60.1752	NO	2562.737839	192.894246	1164.347561		13.59083929	17.79106501		25.83481288	59.00300534	17.08317248	8.160751185	2.168428172	0.598455087	17.5106404	99.64525626	181.78976	6.449590956	1.533856875	40.89668993		25.92563718																					Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits																				11.22957087	11.22957087	7.488102094		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																				NO	11.22957087	11.22957087	7.488102094		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																					2.3982	0.180509967	0.726562784	0	2.718167858	3.558213001	0	5.166962577	11.80060107	3.416634496	1.632150237	0.433685634	0.119691017	3.50212808	19.92905125	36.357952	1.289918191	0.306771375	8.179337986	0	5.185127436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9017	60.17516107	1.85	34.2601	2.578713816	10.37946834	0	3.166665554	4.145318146	0	5.959316288	13.74632547	3.980379188	1.901455026	0.505243764	0.139440035	4.079979213	22.98517126	41.93344394	1.487727146	0.353814765	9.433639466	0	6.040673463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0768	NO																																																																																		0			34.2601	2.578713816	10.37946834	0	3.166665554	4.145318146	0	5.959316288	13.74632547	3.980379188	1.901455026	0.505243764	0.139440035	4.079979213	22.98517126	41.93344394	1.487727146	0.353814765	9.433639466	0	6.040673463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0768
H4407_807_0	2010	1	N/A																															D	D	D		COIN	COIN		COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN		COIN																				31.8619	2.3982	9.6529		0.4485	0.5871		0.7924	1.9457	0.5637	0.2693	0.0716	0.0197	0.5779	3.0561	5.5755	0.1978	0.047	1.2543		0.8555																				60.1752	NO	2562.737839	192.894246	1164.347561		13.59083929	17.79106501		25.83481288	59.00300534	17.08317248	8.160751185	2.168428172	0.598455087	17.5106404	99.64525626	181.78976	6.449590956	1.533856875	40.89668993		25.92563718																					Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits		Standard Medicare benefits																				11.22957087	11.22957087	7.488102094		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																				NO	11.22957087	11.22957087	7.488102094		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																					2.3982	0.180509967	0.726562784	0	2.718167858	3.558213001	0	5.166962577	11.80060107	3.416634496	1.632150237	0.433685634	0.119691017	3.50212808	19.92905125	36.357952	1.289918191	0.306771375	8.179337986	0	5.185127436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9017	60.17516107	1.85	34.2601	2.578713816	10.37946834	0	3.166665554	4.145318146	0	5.959316288	13.74632547	3.980379188	1.901455026	0.505243764	0.139440035	4.079979213	22.98517126	41.93344394	1.487727146	0.353814765	9.433639466	0	6.040673463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0768	NO																																																																																		0			34.2601	2.578713816	10.37946834	0	3.166665554	4.145318146	0	5.959316288	13.74632547	3.980379188	1.901455026	0.505243764	0.139440035	4.079979213	22.98517126	41.93344394	1.487727146	0.353814765	9.433639466	0	6.040673463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0768
H4408_001_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1332.194822	39.342736	289.397524	391.618633	36.958631	7.758585	3.353152	305.836383	370.459262	762.652206	898.798585	55.63888	0.30662	532.06493	3645.395703	4280.283904	83.122173	873.265067			25.301334	0							0.04	0.25	0.05	0.55	2.01	0.32	0.4	0.42					4900	$195/Day(Days 1-8):1a	$195/Day(Days 1-8):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$225/Visit:9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $225 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $90 OP Other,5. $35 Partial Hospitalization,7h. $90 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					144.519765	130.271895	58.254672	0	100	0.2	0.2	50	225	24.029235	92.329519	50	0.2	67.3773	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	131.041852	118.122738	42.957286	0	88.1312	0.176262	0.176262	44.0656	198.2952	21.177253	81.371113	44.0656	0.176262	59.380423	13.21968	30.84592	30.84592	13.21968			0.176262	0							0	0	0	0	0	0	0	0						14.5478	0.387272641	1.035977684	0	0.271434042	1.367543709	0.591033278	1.123071977	6.121691121	1.34590656	6.094686769	0.204313386	0.054045454	2.632853384	4.015913722	11.00244124	0.213664992	0.962023728	0	0	4.459663734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.4313	0	7.353882	14.5478	0.387272641	1.035977684	0	0.271434042	1.367543709	0.591033278	1.123071977	6.121691121	1.34590656	6.094686769	0.204313386	0.054045454	2.632853384	4.015913722	11.00244124	0.213664992	0.962023728	0	0	4.459663734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.4313	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					7000	8.4559	0.0852	0.2583	2.0175	1.3542	1.687	0.7291	0.2472	3.8028	0.3837	1.6569	0.3077	0.0125	0.8548	2.3306	3.8174	0.0357	0.4172			1.4027	0							0	0	0	0	0	0	0	0					29.8565	1000	12.513545	23.0037	0.472510641	1.294310684	2.017497	1.625680042	3.054548709	1.320133278	1.370274977	9.924463121	1.72965656	7.751540769	0.512060386	0.066564454	3.487673384	6.346487722	14.81979924	0.249332992	1.379250728	0	0	5.862353734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2878
H4408_002_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1092.049166	36.426426	363.469048	400.874559	39.883252	8.52876	3.467741	339.689754	407.110889	862.5324	1055.935386	96.718543	0.125575	523.168361	3759.197047	3977.227401	66.400525	712.746216			24.403137	0							0.04	0.25	0.05	0.55	2.01	0.32	0.4	0.42					4900	$195/Day(Days 1-5):1a	$195/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $200 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $90 OP Other,5. $35 Partial Hospitalization,7h. $90 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					118.300845	98.80884	58.254672	0	100	0.2	0.2	50	200	31.725496	86.920556	50	0.2	70.442384	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	108.973178	91.018059	43.205451	0	88.9826	0.177965	0.177965	44.4913	177.9652	28.230171	77.34417	44.4913	0.177965	62.681464	13.34739	31.14391	31.14391	13.34739			0.177965	0							0	0	0	0	0	0	0	0						9.917	0.276288549	1.308653679	0	0.295742955	1.517820773	0.617136527	1.259436563	6.037630899	2.029119762	6.8058705	0.358594476	0.022347955	2.732746565	4.181289089	10.32220102	0.172330998	0.792775143	0	0	4.342904276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9899	0	6.46517	9.917	0.276288549	1.308653679	0	0.295742955	1.517820773	0.617136527	1.259436563	6.037630899	2.029119762	6.8058705	0.358594476	0.022347955	2.732746565	4.181289089	10.32220102	0.172330998	0.792775143	0	0	4.342904276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9899	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					7000	8.1501	0.0778	0.3056	1.6632	1.5221	1.6095	0.6544	0.286	3.9354	0.3989	1.7997	0.3085	0.0053	0.8346	2.377	3.3569	0.0275	0.3432			1.3792	0							0	0	0	0	0	0	0	0					29.0349	1000	10.739428	18.0671	0.354051549	1.614212679	1.663158	1.817799955	3.127343773	1.271558527	1.545396563	9.973078899	2.428049762	8.6055305	0.667135476	0.027687955	3.567388565	6.558305089	13.67905602	0.199826998	1.135962143	0	0	5.722101276	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.0248
H4408_006_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1109.63085	62.265605	416.759722	248.820026	40.83947	7.83039	3.455247	339.728098	403.603264	765.213007	993.608433	74.607073	0.460875	571.922167	3929.954348	5047.497769	78.977782	966.515972			25.299746	0							0.04	0.25	0.05	0.55	2.01	0.32	0.4	0.42					4900	$225/Day(Days 1-5):1a	$225/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					136.500975	114.0102	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	0.2	60.445636	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	124.679991	104.136917	42.202189	0	88.5211	0.177042	0.177042	44.26055	110.651375	43.245843	62.040863	44.26055	0.177042	53.507142	13.278165	30.982385	30.982385	13.278165			0.177042	0							0	0	0	0	0	0	0	0						11.5291	0.540345678	1.465681046	0	0.301262901	1.386307906	0.611723839	1.253046039	3.721604676	2.75769013	5.137027056	0.275179174	0.081594232	2.55016005	4.348548523	13.03195993	0.203910004	1.069463213	0	0	4.479117631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7437	0	7.0455	11.5291	0.540345678	1.465681046	0	0.301262901	1.386307906	0.611723839	1.253046039	3.721604676	2.75769013	5.137027056	0.275179174	0.081594232	2.55016005	4.348548523	13.03195993	0.203910004	1.069463213	0	0	4.479117631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7437	YES	20% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					7500	6.1532	0.1603	0.3996	1.2786	1.0666	1.6181	0.714	0.1957	2.8004	0.3118	1.2746	0.2164	0.0134	0.5648	1.689	2.9867	0.0252	0.3238			1.0015	0							0	0	0	0	0	0	0	0					22.7937	0	6.912509	17.6823	0.700627678	1.865252046	1.278552	1.367862901	3.004372906	1.325713839	1.448766039	6.522018676	3.06947513	6.411578056	0.491614174	0.095006232	3.11499805	6.037521523	16.01870393	0.229109004	1.393242213	0	0	5.480627631	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5373
H4408_007_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1155.54944	64.842272	434.006014	259.116661	42.529484	7.728321	3.410208	353.786678	420.305118	796.878944	1034.725799	77.694453	0.454868	595.589369	4092.583172	5256.372619	82.246029	1006.512201			24.969963	0							0.04	0.25	0.05	0.55	2.01	0.32	0.4	0.42					4900	$225/Day(Days 1-5):1a	$225/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					136.500975	114.0102	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	0.2	60.445636	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	123.907395	103.491619	41.162169	0	88.0472	0.176094	0.176094	44.0236	110.059	43.014326	61.708726	44.0236	0.176094	53.22069	13.20708	30.81652	30.81652	13.20708			0.176094	0							0	0	0	0	0	0	0	0						11.9318	0.559219309	1.488719075	0	0.312050165	1.360910958	0.600517168	1.2979136	3.854863415	2.856434223	5.320967568	0.28503246	0.080099526	2.641473098	4.504256113	13.49859266	0.211211366	1.107757263	0	0	4.397060665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3088	0	7.634106	11.9318	0.559219309	1.488719075	0	0.312050165	1.360910958	0.600517168	1.2979136	3.854863415	2.856434223	5.320967568	0.28503246	0.080099526	2.641473098	4.504256113	13.49859266	0.211211366	1.107757263	0	0	4.397060665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3088	YES	20% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					7500	6.1087	0.1591	0.3997	1.266	1.1144	1.6022	0.707	0.2045	2.7729	0.3087	1.262	0.2143	0.0133	0.5593	1.6724	2.9574	0.025	0.3206			0.9917	0							0	0	0	0	0	0	0	0					22.659	0	6.747575	18.0404	0.718340309	1.888399075	1.265998	1.426408165	2.963087958	1.307496168	1.5023966	6.627779415	3.165157223	6.583003568	0.49934246	0.093379526	3.200765098	6.176645113	16.45600966	0.236163366	1.428357263	0	0	5.388736665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9679
H4408_801_0	2010	5	N/A																								0.942359396							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	NO	256.878825	0.876241	44.601515	14.412337	1.690146	7.815009	3.820073	18.842153	53.651581	11.582727	27.614109	9.761749	0.857633	17.674185	32.801058	71.936027	0.345687	5.353266			23.380932	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																			0.087742414	0.087742414	0.203988394	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.087742414	0.087742414	0.203988394	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.5392	0.0768835	9.098191398	0	0.393804018	1.820897097	0.890077009	4.390221649	12.50081837	2.698775391	6.434087397	2.274487517	0.199828489	4.118085105	7.642646514	16.76109429	0.080545071	1.247310978	0	0	5.447757156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6147	0	0	22.5392	0.0768835	9.098191398	0	0.393804018	1.820897097	0.890077009	4.390221649	12.50081837	2.698775391	6.434087397	2.274487517	0.199828489	4.118085105	7.642646514	16.76109429	0.080545071	1.247310978	0	0	5.447757156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6147	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.9539	0.0135	1.596	0	1.4844	1.1314	0.553	1.0908	2.8386	0.6706	1.4537	0.5651	0.0496	1.0156	1.3571	2.976	0.0143	0.2524			0.9673	0																			21.9832	0	0	26.493	0.090361137	10.69418412	0	1.87820524	2.952339963	1.443063397	5.481044114	15.33941596	3.369341375	7.887748856	2.839550241	0.24945125	5.133704934	8.999697287	19.73714254	0.094817104	1.499706393	0	0	6.415071642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.5979
H4408_803_0	2010	3	N/A																								0.942359396							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	NO	256.878825	0.876241	44.601515	14.412337	1.690146	7.815009	3.820073	18.842153	53.651581	11.582727	27.614109	9.761749	0.857633	17.674185	32.801058	71.936027	0.345687	5.353266			23.380932	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																			0.087742414	0.087742414	0.203988394	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.087742414	0.087742414	0.203988394	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.5392	0.0768835	9.098191398	0	0.393804018	1.820897097	0.890077009	4.390221649	12.50081837	2.698775391	6.434087397	2.274487517	0.199828489	4.118085105	7.642646514	16.76109429	0.080545071	1.247310978	0	0	5.447757156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6147	0	0	22.5392	0.0768835	9.098191398	0	0.393804018	1.820897097	0.890077009	4.390221649	12.50081837	2.698775391	6.434087397	2.274487517	0.199828489	4.118085105	7.642646514	16.76109429	0.080545071	1.247310978	0	0	5.447757156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6147	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.9539	0.0135	1.596	0	1.4844	1.1314	0.553	1.0908	2.8386	0.6706	1.4537	0.5651	0.0496	1.0156	1.3571	2.976	0.0143	0.2524			0.9673	0																			21.9832	0	0	26.493	0.090361137	10.69418412	0	1.87820524	2.952339963	1.443063397	5.481044114	15.33941596	3.369341375	7.887748856	2.839550241	0.24945125	5.133704934	8.999697287	19.73714254	0.094817104	1.499706393	0	0	6.415071642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.5979
H4408_804_0	2010	3	N/A																								0.942359396							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	NO	256.878825	0.876241	44.601515	14.412337	1.690146	7.815009	3.820073	18.842153	53.651581	11.582727	27.614109	9.761749	0.857633	17.674185	32.801058	71.936027	0.345687	5.353266			23.380932	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																			0.087742414	0.087742414	0.203988394	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.087742414	0.087742414	0.203988394	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.5392	0.0768835	9.098191398	0	0.393804018	1.820897097	0.890077009	4.390221649	12.50081837	2.698775391	6.434087397	2.274487517	0.199828489	4.118085105	7.642646514	16.76109429	0.080545071	1.247310978	0	0	5.447757156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6147	0	0	22.5392	0.0768835	9.098191398	0	0.393804018	1.820897097	0.890077009	4.390221649	12.50081837	2.698775391	6.434087397	2.274487517	0.199828489	4.118085105	7.642646514	16.76109429	0.080545071	1.247310978	0	0	5.447757156	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6147	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.9539	0.0135	1.596	0	1.4844	1.1314	0.553	1.0908	2.8386	0.6706	1.4537	0.5651	0.0496	1.0156	1.3571	2.976	0.0143	0.2524			0.9673	0																			21.9832	0	0	26.493	0.090361137	10.69418412	0	1.87820524	2.952339963	1.443063397	5.481044114	15.33941596	3.369341375	7.887748856	2.839550241	0.24945125	5.133704934	8.999697287	19.73714254	0.094817104	1.499706393	0	0	6.415071642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.5979
H4449_011_0	2010	10	N/A	h.1.	h.1.	h.2.	h.2.	i.1.						OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Chemotherapy	Genetic Testing	Complex diag xray	PET Scans	Urgently Needed Svc						D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin			V		V				Coin	Coin	Coin	Coin	V																																														0	YES	1146.396103	50.7497707	1847.286554	16400.22384	158.4108872	11.80003364	3.551575652	431.4975351	33.26149416	6144.77881	2480.231803	0	0	686.5153787	121.8317902	9999.567246	90.46083238	740.8807884	67.31385761	129.5440446	2.253694822	0			117.5931496		0.069336				0.2	0.5	8.115203308	3.617003505	0.526668277						4250	"$225/Day,days 1-7"	"$225/Day,days 1-7"	"$50/day, days 1-16"	0	$150/trip	0.2	0.2	$50/visit	0.2	$10/visit	$15/visit	150	0.2	$25/visit	$10/visit	$25/visit	$25/visit	$25/visit	$25/visit	$25/visit	0.2	0.2			$25/visit		$25/visit				0.2	0.2	0.2	0.2	$25/visit						112.4609717	112.4609717	30.6	0	150	0.2	0.2	50	0.2	10	15	150	0.2	25	10	25	25	25	25	25	0.2	0.2			25		25				0.2	0.2	0.2	0.2	25						NO	92.62148077	92.62148077	25.20178572	0	123.5381653	0.164717554	0.164717554	41.17938843	0.164717554	8.235877686	12.35381653	123.5381653	0.164717554	20.58969422	10	25	25	25	25	25	0.164717554	0.164717554			25		25				0.164717554	0.164717554	0.164717554	0.164717554	25							8.8484	0.391709909	3.879576657	0	1.630815864	1.943672675	0.585006853	1.480733717	5.478751951	4.217303891	2.55336072	0	0	1.177928477	0.101526492	20.83243176	0.188460067	1.543501642	0.140237203	0.269883426	0.371223098	0	0	0	0.244985728	0	0.00014445	0	0	0	0.032943511	0.082358777	1.336716437	0.595783969	0.001097226	0	0	0	0	0	57.9286		7.390899009	8.8484	0.391709909	3.879576657	0	1.630815864	1.943672675	0.585006853	1.480733717	5.478751951	4.217303891	2.55336072	0	0	1.177928477	0.101526492	20.83243176	0.188460067	1.543501642	0.140237203	0.269883426	0.371223098	0	0	0	0.244985728	0	0.00014445	0	0	0	0.032943511	0.082358777	1.336716437	0.595783969	0.001097226	0	0	0	0	0	57.9286	NO																																																																																		0			8.8484	0.391709909	3.879576657	0	1.630815864	1.943672675	0.585006853	1.480733717	5.478751951	4.217303891	2.55336072	0	0	1.177928477	0.101526492	20.83243176	0.188460067	1.543501642	0.140237203	0.269883426	0.371223098	0	0	0	0.244985728	0	0.00014445	0	0	0	0.032943511	0.082358777	1.336716437	0.595783969	0.001097226	0	0	0	0	0	57.9286
H4449_013_0	2010	11	N/A	h.1.	h.1.	h.2.	h.2.	i.1.						OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Chemotherapy	Genetic Testing	Complex diag xray	PET Scans	Urgently Needed Svc						D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin			V		V				Coin	Coin	Coin	Coin	V																																														0	YES	437.3461291	88.0890532	2466.005035	12976.74007	186.7313138	11.30117821	3.642505491	312.8315304	33.67050112	4775.310619	1252.992675	0	0	26.03138379	122.6099531	8248.057876	178.1839509	473.7769851	114.4518304	261.1205447	2.543831463	0			225.1796907		16.05622968				0.153988051	0	11.71728074	6.800827624	0						4600	"$250/Day,days 1-7"	"$250/Day,days 1-7"	"$100/day, days 21 - 100"	0	$150/trip	0.2	0.2	$50/visit	0.2	$10/visit	$15/visit	0.2	0.2	0.2	$10/visit	$25/visit	$25/visit	$25/visit	$25/visit	$25/visit	0.2	0.2			$25/visit		$25/visit				0.2	0.5	0.2	0.2	$25/visit						196.4207292	196.4207292	17.97649248	0	150	0.2	0.2	50	0.2	10	15	0.2	0.2	0.2	10	25	25	25	25	25	0.2	0.2			25		25				0.2	0.5	0.2	0.2	25						NO	142.2872242	142.2872242	13.02217554	0	108.6600366	0.144880049	0.144880049	36.2200122	0.144880049	7.24400244	10.86600366	0.144880049	0.144880049	0.144880049	7.24400244	18.1100061	18.1100061	18.1100061	18.1100061	18.1100061	0.144880049	0.144880049			25		25				0.144880049	0.362200122	0.144880049	0.144880049	18.1100061							5.1857	1.044495572	2.676062537	0	1.690852616	1.63731525	0.527726373	0.944230154	4.878183846	2.882696814	1.13458525	0	0	3.771428154	0.074015567	12.4476982	0.26890937	0.715008674	0.172726945	0.394074555	0.368550427	0	0	0	0.469124356	0	0.033450479	0	0	0	0.022309796	0	1.697600206	0.985304238	0	0	0	0	0	0	44.0221		19.01869582	5.1857	1.044495572	2.676062537	0	1.690852616	1.63731525	0.527726373	0.944230154	4.878183846	2.882696814	1.13458525	0	0	3.771428154	0.074015567	12.4476982	0.26890937	0.715008674	0.172726945	0.394074555	0.368550427	0	0	0	0.469124356	0	0.033450479	0	0	0	0.022309796	0	1.697600206	0.985304238	0	0	0	0	0	0	44.0221	NO																																																																																		0			5.1857	1.044495572	2.676062537	0	1.690852616	1.63731525	0.527726373	0.944230154	4.878183846	2.882696814	1.13458525	0	0	3.771428154	0.074015567	12.4476982	0.26890937	0.715008674	0.172726945	0.394074555	0.368550427	0	0	0	0.469124356	0	0.033450479	0	0	0	0.022309796	0	1.697600206	0.985304238	0	0	0	0	0	0	44.0221
H4449_014_0	2010	11	N/A	h.1.	h.1.	h.2.	h.2.	i.1.						OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Chemotherapy	Genetic Testing	Complex diag xray	PET Scans	Urgently Needed Svc						D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin			V		V				Coin	Coin	Coin	Coin	V																																														0	YES	444.5534876	89.54356939	1012.225968	2557.612388	367.075933	11.00923213	3.548407764	304.7500778	32.80068291	4651.948863	1220.623812	0	0	25.35890875	89.12884744	8034.983799	32.58387789	461.5377895	127.9239258	254.3749544	2.478116049	0			259.9627		18.5364				0.150010041	0	11.41458539	6.625140196	0						4500	"$250/Day,days 1-7"	"$250/Day,days 1-7"	"$135/day, dyas 17 - 100"	0	$150/trip	0.2	0.2	$50/visit	0.2	$10/visit	$15/visit	0.2	0.2	0.2	$10/visit	$35/visit	$35/visit	$35/visit	$35/visit	$35/visit	0.2	0.2			$35/visit		$35/visit				0.2	0.2	0.2	0.2	$25/visit						124.9566353	124.9566353	46.258	0	150	0.2	0.2	50	0.2	10	15	0.2	0.2	0.2	10	35	35	35	35	35	0.2	0.2			35		35				0.2	0.2	0.2	0.2	35						NO	82.08022971	82.08022971	30.38547939	0	98.53045763	0.131373944	0.131373944	32.84348588	0.131373944	6.568697176	9.853045763	0.131373944	0.131373944	0.131373944	6.568697176	22.99044011	22.99044011	22.99044011	22.99044011	22.99044011	0.131373944	0.131373944			35		35				0.131373944	0.131373944	0.131373944	0.131373944	22.99044011							3.0408	0.612479729	2.563080941	0	3.014013305	1.44632624	0.466168321	0.834087906	4.309155064	2.546436946	1.002238523	0	0	3.331499846	0.048788367	15.39398449	0.062426474	0.884246409	0.245085613	0.487349346	0.325559878	0	0	0	0.758224542	0	0.0540645	0	0	0	0.019707411	0	1.499579096	0.870370794	0	0	0	0	0	0	43.8156		29.83231864	3.0408	0.612479729	2.563080941	0	3.014013305	1.44632624	0.466168321	0.834087906	4.309155064	2.546436946	1.002238523	0	0	3.331499846	0.048788367	15.39398449	0.062426474	0.884246409	0.245085613	0.487349346	0.325559878	0	0	0	0.758224542	0	0.0540645	0	0	0	0.019707411	0	1.499579096	0.870370794	0	0	0	0	0	0	43.8156	NO																																																																																		0			3.0408	0.612479729	2.563080941	0	3.014013305	1.44632624	0.466168321	0.834087906	4.309155064	2.546436946	1.002238523	0	0	3.331499846	0.048788367	15.39398449	0.062426474	0.884246409	0.245085613	0.487349346	0.325559878	0	0	0	0.758224542	0	0.0540645	0	0	0	0.019707411	0	1.499579096	0.870370794	0	0	0	0	0	0	43.8156
H4449_015_0	2010	9	N/A	h.1.	h.1.	h.2.	h.2.	i.1.						OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional						Chemotherapy	Genetic Testing	Complex diag xray	PET Scans	Urgently Needed Svc						D	D	D	V	T	Coin	Coin	V	Coin	V	V	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin			V		V				Coin	Coin	Coin	Coin	V																																														0	YES	444.5534876	89.54356939	1012.225968	2557.612388	367.075933	11.00923213	3.548407764	304.7500778	32.80068291	4651.948863	1220.623812	0	0	25.35890875	89.12884744	8034.983799	32.58387789	461.5377895	127.9239258	254.3749544	2.478116049	0			259.9627		18.5364				0.150010041	0	11.41458539	6.625140196	0						4500	"$250/Day,days 1-7"	"$250/Day,days 1-7"	"$135/day, days 17 - 100"	0	$150/trip	0.2	0.2	$50/visit	0.2	$10/visit	$15/visit	0.2	0.2	0.2	$10/visit	$35/visit	$35/visit	$35/visit	$35/visit	$35/visit	0.2	0.2			$35/visit		$35/visit				0.2	0.2	0.2	0.2	$25/visit						124.9566353	124.9566353	46.258	0	150	0.2	0.2	50	0.2	10	15	0.2	0.2	0.2	10	35	35	35	35	35	0.2	0.2			35		35				0.2	0.2	0.2	0.2	35						NO	82.08022971	82.08022971	30.38547939	0	98.53045763	0.131373944	0.131373944	32.84348588	0.131373944	6.568697176	9.853045763	0.131373944	0.131373944	0.131373944	6.568697176	22.99044011	22.99044011	22.99044011	22.99044011	22.99044011	0.131373944	0.131373944			35		35				0.131373944	0.131373944	0.131373944	0.131373944	22.99044011							3.0408	0.612479729	2.563080941	0	3.014013305	1.44632624	0.466168321	0.834087906	4.309155064	2.546436946	1.002238523	0	0	3.331499846	0.048788367	15.39398449	0.062426474	0.884246409	0.245085613	0.487349346	0.325559878	0	0	0	0.758224542	0	0.0540645	0	0	0	0.019707411	0	1.499579096	0.870370794	0	0	0	0	0	0	43.8156		29.83231864	3.0408	0.612479729	2.563080941	0	3.014013305	1.44632624	0.466168321	0.834087906	4.309155064	2.546436946	1.002238523	0	0	3.331499846	0.048788367	15.39398449	0.062426474	0.884246409	0.245085613	0.487349346	0.325559878	0	0	0	0.758224542	0	0.0540645	0	0	0	0.019707411	0	1.499579096	0.870370794	0	0	0	0	0	0	43.8156	NO																																																																																		0			3.0408	0.612479729	2.563080941	0	3.014013305	1.44632624	0.466168321	0.834087906	4.309155064	2.546436946	1.002238523	0	0	3.331499846	0.048788367	15.39398449	0.062426474	0.884246409	0.245085613	0.487349346	0.325559878	0	0	0	0.758224542	0	0.0540645	0	0	0	0.019707411	0	1.499579096	0.870370794	0	0	0	0	0	0	43.8156
H4454_002_0	2010	6	N/A																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	NO	1045.690675	62.69657848	337.0222941	1568.794961	249.7853712	8.767782985	3.155248148	339.1564737	284.0187913	297.1678873	255.5753776	7.120162586	0.647781706	351.4322732	3584.434118	4137.889757	0.153358193	122.8180883	28.17970396	958.6983199	37.99769095																					$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $70 (6-20 Days)	No Cost Sharing	$125 CP/Trip; 20% Coins on Air	20% Coins.	20% Coins.	$50 CP / Visit	$200 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.																				225	225	70	0	127.6255544	0.2	0.2	50	200	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2																				NO	213.3	213.3	66.36	0	120.9890256	0.1896	0.1896	50	189.6	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896																					18.5872	1.114431682	1.863733286	0	2.518440722	1.662371654	0.598235049	1.413151974	4.487496903	0	2.019045483	0.098436248	0.122819411	4.858551177	4.480542648	10.34472439	0.030671639	0.15352261	0.07044926	0	7.204362204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6281		2.39	18.5872	1.114431682	1.863733286	0	2.518440722	1.662371654	0.598235049	1.413151974	4.487496903	0	2.019045483	0.098436248	0.122819411	4.858551177	4.480542648	10.34472439	0.030671639	0.15352261	0.07044926	0	7.204362204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6281	NO																																																																																		0			18.5872	1.114431682	1.863733286	0	2.518440722	1.662371654	0.598235049	1.413151974	4.487496903	0	2.019045483	0.098436248	0.122819411	4.858551177	4.480542648	10.34472439	0.030671639	0.15352261	0.07044926	0	7.204362204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6281
H4454_007_0	2010	5	N/A																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	V	V	V	V	COIN	V	P		COIN			COIN																																																									0	NO	937	49.62791774	284.7726017	1516.803387	226.8000038	7.558931902	2.97160517	397.3330735	85.343162	342.3368645	268.7518786	3.31161472	0.301285737	772.3042896	3960.306456	3760.326316	0.983691434	114.2256539	46.90028473	973.6388393	37.06978336			12.31																		$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $50 (6-20 Days)	No Cost Sharing	$125 CP/Trip; 20% coin Air	20% Coins.	20% Coins.	$50 CP / Visit	$175 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.			Various Cost Sharing																	225	225	50	0	126.0244227	0.2	0.2	50	175	0	100	175	0.2	175	15	30	0.2	15	30		0.2			0.24																	NO	213.3	213.3	47.4	0	119.4711528	0.1896	0.1896	50	165.9	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30		0.1896			0.24																		16.6552	0.882136238	1.124851777	0	2.258004825	1.433173489	0.56341634	1.655554473	1.179869215	0	2.123139841	0.045783073	4.76E-06	10.6771068	4.95038307	9.400815791	0.196738287	0.142782067	0.117250712	0	7.028430925	0	0	2.9544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.389		2.541543904	16.6552	0.882136238	1.124851777	0	2.258004825	1.433173489	0.56341634	1.655554473	1.179869215	0	2.123139841	0.045783073	4.76E-06	10.6771068	4.95038307	9.400815791	0.196738287	0.142782067	0.117250712	0	7.028430925	0	0	2.9544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.389	NO																																																																																		0			16.6552	0.882136238	1.124851777	0	2.258004825	1.433173489	0.56341634	1.655554473	1.179869215	0	2.123139841	0.045783073	4.76E-06	10.6771068	4.95038307	9.400815791	0.196738287	0.142782067	0.117250712	0	7.028430925	0	0	2.9544	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.389
H4454_012_0	2010	4	N/A																															D	D	D	P	T	COIN	COIN	V	V	P	P	V	COIN	P	V	V	COIN	P	P	P	COIN																																																												0	NO	836.9608299	48.5476353	254.634932	1077.085753	215.8421232	6.894611529	2.138638116	315.5652977	231.6008101	202.5125089	206.1210927	4.197229142	15.98421168	276.8575928	3078.129426	3522.407141	0.18324197	153.0716978	37.37819665	1145.512775	17.93638369																					$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $50 (6-20 Days)	No Cost Sharing	$125 CP/Trip; 20% Coin Air Ambulance	20% Coins.	20% Coins.	$50 CP / Visit	$175 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.																				225	225	50	0	131.5445461	0.2	0.2	50	175	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2																				NO	213.3	213.3	47.4	0	124.7042297	0.1896	0.1896	50	165.9	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896																					14.877	0.862934218	1.005807981	0	2.243035476	1.307218346	0.405485787	1.314855407	3.201881199	0	1.628356632	0.058026693	3.030606535	3.82755622	3.847661782	8.806017853	0.036648394	0.191339622	0.093445492	0	3.400738348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1386		1.95	14.877	0.862934218	1.005807981	0	2.243035476	1.307218346	0.405485787	1.314855407	3.201881199	0	1.628356632	0.058026693	3.030606535	3.82755622	3.847661782	8.806017853	0.036648394	0.191339622	0.093445492	0	3.400738348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1386	NO																																																																																		0			14.877	0.862934218	1.005807981	0	2.243035476	1.307218346	0.405485787	1.314855407	3.201881199	0	1.628356632	0.058026693	3.030606535	3.82755622	3.847661782	8.806017853	0.036648394	0.191339622	0.093445492	0	3.400738348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1386
H4454_019_0	2010	5	N/A																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN			COIN																																																									0	NO	1060.013567	61.24124639	206.5254556	984.6119472	239.3838831	8.74067955	3.203853805	373.5537331	192.3969668	193.5814062	602.4010198	5.699158182	4.559326545	270.2815876	3748.047979	2854.097112	0.198162245	164.5783717	57.35182395	1024.038917	30.11522475			12.31																		$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $75 (6-20 Days)	No Cost Sharing	$125CP/Trip; 20% Coins on Air	20% Coins.	20% Coins.	$50 CP / Visit	$210 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.			Various cost sharing																	225	225	75	0	132.6076305	0.2	0.2	50	210	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2			0.242																	NO	213.3	213.3	71.1	0	125.7120337	0.1896	0.1896	50	199.08	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896			0.242																		18.8417	1.088563154	1.223663324	0	2.507786232	1.657232843	0.607450681	1.556473888	3.191865679	0	4.758968056	0.078790862	0.864448313	3.736642949	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	5.709846613	0	0	2.97902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0115		2.42	18.8417	1.088563154	1.223663324	0	2.507786232	1.657232843	0.607450681	1.556473888	3.191865679	0	4.758968056	0.078790862	0.864448313	3.736642949	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	5.709846613	0	0	2.97902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0115	NO																																																																																		0			18.8417	1.088563154	1.223663324	0	2.507786232	1.657232843	0.607450681	1.556473888	3.191865679	0	4.758968056	0.078790862	0.864448313	3.736642949	4.685059974	7.135242779	0.039632449	0.205722965	0.14337956	0	5.709846613	0	0	2.97902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0115
H4454_020_0	2010	7	N/A																															D	D			COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN			COIN		COIN	COIN	COIN																				29.81				0.7573	0.7966	0.1854		1.7338	0.0657	0.6878	0.0796	0.0012	0.6844																											34.8018	NO	3649.852295	141.464407	0	0	22.94709332	24.13975097	5.618193365	968.6305062	52.57760716	1.990900876	20.84328889	2.411977083	0.034975591	20.73963617	0	0	1.790177743	0	11.21838082	6.831878099	34.0560657																					Standard Medicare Beneftis	$225 Days 1-7	No Cost Sharing	No Cost Sharing	Standard Medicare Beneftis	Standard Medicare Beneftis	Standard Medicare Beneftis	$50 CP / Visit	Standard Medicare Beneftis	Standard Medicare Beneftis	Standard Medicare Beneftis	Standard Medicare Beneftis	Standard Medicare Beneftis	Standard Medicare Beneftis	No Cost Sharing	No Cost Sharing	20% Coins.	No Cost Sharing	20% Coins.	20% Coins.	20% Coins.																				6.707549072	225	0	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0.2	0	0.2	0.2	0.2																				NO	6.707549072	225	0	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0.2	0	0.2	0.2	0.2																					2.0401	2.652457631	0	0	4.589418664	4.827950195	1.123638673	4.035960442	10.51552143	0.398180175	4.168657778	0.482395417	0.006995118	4.147927234	0	0	0.358035549	0	2.243676164	1.36637562	6.81121314	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7685	34.80178791	0	31.8501	2.652457631	0	0	5.346672743	5.624561977	1.309039054	4.035960442	12.24935741	0.463879904	4.856486311	0.56199066	0.008149313	4.832335228	0	0	0.358035549	0	2.243676164	1.36637562	6.81121314	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5703	NO																																																																																		0			31.8501	2.652457631	0	0	5.346672743	5.624561977	1.309039054	4.035960442	12.24935741	0.463879904	4.856486311	0.56199066	0.008149313	4.832335228	0	0	0.358035549	0	2.243676164	1.36637562	6.81121314	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5703
H4454_021_0	2010	7	N/A																															D	D	D	P	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	COIN	V	P		COIN																																																												0	NO	1133.337288	77.09083154	347.7632521	1493.048731	260.9307196	10.08727799	4.260714609	424.9714513	270.6803178	196.7628544	339.6748934	10.20174446	5.199067721	444.3144071	4343.119916	3398.525315	0.175560486	117.722985	26.94816256	956.3779506	36.21046481																					$225/day 1-5	$225/day 1-7	$0 (0-5 Days); $70 (6-20 Days)	No Cost Sharing	$125 CP/Trip; 20% Air Ambulance	20% Coins.	20% Coins.	$50 CP / Visit	$200 CP / Surg	No Cost Sharing	"$100 CP / (MRI, CT, Test)"	$175 /Admit	20% Coins.	$175 CP / Surg	$15 CP / Visit	$30 CP / Visit	20% Coins.	$15 CP / Visit	$30 CP / Visit	No Cost Sharing	20% Coins.																				225	225	70	0	134.0777214	0.2	0.2	50	200	0	100	175	0.2	175	15	30	0.2	15	30	0	0.2																				NO	213.3	213.3	66.36	0	127.1056799	0.1896	0.1896	50	189.6	0	94.8	165.9	0.1896	165.9	15	30	0.2	15	30	0	0.1896																					20.1451	1.370289531	1.923130784	0	2.76381471	1.912547907	0.80783149	1.77071438	4.27674902	0	2.683431658	0.141039117	0.98574324	6.142646679	5.428899895	8.496313287	0.035112097	0.147153731	0.067370406	0	6.865504128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9634		2.68	20.1451	1.370289531	1.923130784	0	2.76381471	1.912547907	0.80783149	1.77071438	4.27674902	0	2.683431658	0.141039117	0.98574324	6.142646679	5.428899895	8.496313287	0.035112097	0.147153731	0.067370406	0	6.865504128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9634	NO																																																																																		0			20.1451	1.370289531	1.923130784	0	2.76381471	1.912547907	0.80783149	1.77071438	4.27674902	0	2.683431658	0.141039117	0.98574324	6.142646679	5.428899895	8.496313287	0.035112097	0.147153731	0.067370406	0	6.865504128	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9634
H4454_028_0	2010	8	N/A																															D	D			COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN			COIN		COIN	COIN	COIN																				33.36				0.7881	0.9797	0.2513		1.7265	0.0948	0.9911	0.167	0.0021	0.9876																											39.3483	NO	2855.198123	95.08019447	0	0	23.88321239	29.68863654	7.615792347	1306.573908	52.3555265	2.872078335	30.03469012	5.059406578	0.0644335	29.92701182	0	0	0.812790188	0	17.20710842	3.279568599	52.8051707																					Standard Medicare Beneftis	$225 Days 1-7	No Cost Sharing	No Cost Sharing	Standard Medicare Beneftis	Standard Medicare Beneftis	Standard Medicare Beneftis	$50 CP / Visit	Standard Medicare Beneftis	Standard Medicare Beneftis	Standard Medicare Beneftis	Standard Medicare Beneftis	Standard Medicare Beneftis	Standard Medicare Beneftis	No Cost Sharing	No Cost Sharing	20% Coins.	No Cost Sharing	20% Coins.	20% Coins.	20% Coins.																				9.58	225	0	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0.2	0	0.2	0.2	0.2																				NO	9.58	225	0	0	0.2	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	0	0	0.2	0	0.2	0.2	0.2																					2.2794	1.782753646	0	0	4.776642478	5.937727308	1.523158469	5.444057951	10.4711053	0.574415667	6.006938023	1.011881316	0.0128867	5.985402364	0	0	0.162558038	0	3.441421684	0.65591372	10.56103414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6273	39.34830612	0	35.6394	1.782753646	0	0	5.564788487	6.917452314	1.774479617	5.444057951	12.19761779	0.669194252	6.998082797	1.178841733	0.015013005	6.972993754	0	0	0.162558038	0	3.441421684	0.65591372	10.56103414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9756	NO																																																																																		0			35.6394	1.782753646	0	0	5.564788487	6.917452314	1.774479617	5.444057951	12.19761779	0.669194252	6.998082797	1.178841733	0.015013005	6.972993754	0	0	0.162558038	0	3.441421684	0.65591372	10.56103414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.9756
H4454_803_0	2010	1	N/A																															D	D	D	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																				15.6859	0.6095	0	0	0.2248	0.2959	0.0779	0.566	1.444	0.0226	0.6991	0.0476	0	0.6374	1.4321	4.5689	0	0.0601	0.1423	0.2926	1.2393																				28.0459	NO	1364.396853	53.73496979	443.9057688	1387.305892	6.812384014	8.96669564	2.3596526	17.15168924	43.78753769	0.683771404	21.18543443	1.441912674	0	19.31606106	46.69416225	148.9686753	0	1.958423689	4.639530843	9.539398794	37.55345981																					Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits																				9.151629691	9.151629691	115.3299373	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																				NO	9.151629691	9.151629691	115.3299373	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																					1.0405	0.040980212	4.26630204	0	1.362476803	1.793339128	0.47193052	3.430337848	8.757507537	0.136754281	4.237086886	0.288382535	0	3.863212211	9.338832451	29.79373505	0	0.391684738	0.927906169	1.907879759	7.510691962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.5596			16.7265	0.650479557	4.26630204	0	1.587285475	2.089240084	0.549799056	3.996380157	10.20147603	0.159318737	4.936206222	0.335965653	0	4.500642226	10.77094241	34.36260432	0	0.451749592	1.07020058	2.20045312	8.749956136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.6055	NO																																																																																		0			16.7265	0.650479557	4.26630204	0	1.587285475	2.089240084	0.549799056	3.996380157	10.20147603	0.159318737	4.936206222	0.335965653	0	4.500642226	10.77094241	34.36260432	0	0.451749592	1.07020058	2.20045312	8.749956136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.6055
H4454_805_0	2010	1	N/A																															D	D	D	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN																				14.5771	0.5894	0.01	0	0.1943	0.2138	0.0818	0.4763	1.5865	0.0446	0.5774	0.027	0	0.4331	1.4837	4.7733	0.0045	0.0388	0.1052	0.2565	1.4301																				26.9034	NO	1241.060696	50.91261489	383.8130955	1326.706925	5.889339402	6.47844311	2.477652394	14.55129845	48.10929026	1.352153272	17.49565438	0.817435182	0	13.12564753	48.37519428	155.635766	0.146295661	1.265471364	3.431413153	8.363967145	43.33541415																					Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits	Standard Medicare Benefits																				9.340233169	9.340233169	129.344729	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																				NO	9.340233169	9.340233169	129.344729	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																					0.966	0.039627975	4.137016737	0	1.17786788	1.295688622	0.495530479	2.91025969	9.621858052	0.270430654	3.499130875	0.163487036	0	2.625129506	9.675038857	31.1271532	0.029259132	0.253094273	0.686282631	1.672793429	8.667082829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3127			15.5431	0.629015469	4.147016737	0	1.372216081	1.509477245	0.577293008	3.386548014	11.20834368	0.315051712	4.07648747	0.190462397	0	3.058275874	11.15870607	35.90050215	0.03374602	0.291906279	0.791524072	1.929316301	10.0971515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2161	NO																																																																																		0			15.5431	0.629015469	4.147016737	0	1.372216081	1.509477245	0.577293008	3.386548014	11.20834368	0.315051712	4.07648747	0.190462397	0	3.058275874	11.15870607	35.90050215	0.03374602	0.291906279	0.791524072	1.929316301	10.0971515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.2161
H4456_010_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1204.0292	71.56091844	574.6823131	188.5618169	225.5469111	13.64460861	7.332166785	282.7104513	50.54204376	14545.22451	55.07123639	0	0.031592609	30.25117002	6301.882239	4418.677213	364.496872	599.2467474	0	0	45.84694908	1075.236006	0	0	116.2801558	0	17.12664432	4.651206231	54.2281224	0											2940	"$175 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$95 Days 1-31 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											161.2860714	122.8528282	76.11788894	0	150	0.2	0.097968805	50	0.2	3	0.109771836	0	0.2	0.158207799	6.337339303	25	38.5	25	0	0	0.2	23.32692387	0	0	25	0	0	0	0	0											NO	120.3864847	91.69930173	70.90950847	0	111.9623818	0.149283176	0.073125471	37.32079393	0.149283176	2.239247636	0.081935442	0	0.149283176	0.118212243	6.337339303	25	38.5	18.66039697	0	0	0.149283176	23.32692387	0	0	25	0	0	0	0	0												12.0791	0.546840521	3.395870029	0	2.104397448	2.036910505	0.536168153	0.879248208	7.5450768	2.714196634	4.512286078	0	0.004716245	3.576058646	3.328097166	9.205577528	1.169427464	0.931848516	0	0	6.844178157	2.090162372	0	0	0.242250325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7424	0	16.2027232	12.0791	0.546840521	3.395870029	0	2.104397448	2.036910505	0.536168153	0.879248208	7.5450768	2.714196634	4.512286078	0	0.004716245	3.576058646	3.328097166	9.205577528	1.169427464	0.931848516	0	0	6.844178157	2.090162372	0	0	0.242250325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7424	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.0791	0.546840521	3.395870029	0	2.104397448	2.036910505	0.536168153	0.879248208	7.5450768	2.714196634	4.512286078	0	0.004716245	3.576058646	3.328097166	9.205577528	1.169427464	0.931848516	0	0	6.844178157	2.090162372	0	0	0.242250325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7424
H4456_013_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1086.244692	70.80486415	327.605091	145.9814156	230.6900463	16.73690416	6.603019392	370.2794097	48.5805108	13901.48701	46.91289359	0	0.009802663	32.80466421	6082.926204	4192.555723	365.9909887	454.4627599	0	0	19.63631361	817.8848307	0	0	27.48116698	0	17.54596691	4.676908279	17.90059389	0											3400	"$175 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$95 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$23 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $23 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$23 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$23 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $23 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$23 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$23/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											163.4428359	122.8528282	73.07390847	0	150	0.2	0.085441062	50	0.2	3	0.12533714	0	0.2	0.151443276	6.552096411	23	38.5	23	0	0	0.2	21.28208544	0	0	23	0	0	0	0	0											NO	133.1194106	100.0600362	59.51656168	0	122.1706138	0.162894152	0.069589247	40.72353794	0.162894152	2.443412276	0.102083436	0	0.162894152	0.123432777	6.552096411	23	38.5	18.73282745	0	0	0.162894152	21.28208544	0	0	23	0	0	0	0	0												12.05	0.590394773	1.624827384	0	2.348628714	2.726343806	0.459499146	1.256590632	7.913481098	2.830588669	4.789029364	0	0.001596796	4.049170795	3.321326579	8.035731803	1.174221089	0.709447705	0	0	3.19864065	1.45052457	0	0	0.052672237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5827	0	10.14420977	12.05	0.590394773	1.624827384	0	2.348628714	2.726343806	0.459499146	1.256590632	7.913481098	2.830588669	4.789029364	0	0.001596796	4.049170795	3.321326579	8.035731803	1.174221089	0.709447705	0	0	3.19864065	1.45052457	0	0	0.052672237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5827	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.05	0.590394773	1.624827384	0	2.348628714	2.726343806	0.459499146	1.256590632	7.913481098	2.830588669	4.789029364	0	0.001596796	4.049170795	3.321326579	8.035731803	1.174221089	0.709447705	0	0	3.19864065	1.45052457	0	0	0.052672237	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.5827
H4456_015_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1302.304956	66.85107006	649.2582014	138.5853923	210.0560022	11.73146762	8.550057004	312.5865621	605.7973588	16131.99899	45.99296228	0	0.544571402	2512.9295	6874.06192	4851.180014	272.2986095	784.3882006	0	0	23.93390988	1123.765723	0	0	38.44726214	49.73173763	17.39646065	4.781342485	24.29939519	0											2400	"$50 Days 1-48 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$50 Days 1-48 (1b); $0 n/c (1b1, 1b2)"	"$15 Days 1-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$25 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$20 (3, 9d); $60 (5); $25 (9a); $40/$30 (9c)"	"$20 (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$20/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											49.38288457	48.82590607	14.96790291	0	150	0.2	0.086927523	50	25	3	0.110301354	0	0.2	10.84593692	12.45480588	20	38.5	20	0	0	0.2	18.57892139	0	0	20	15	0	0	0	0											NO	42.26449106	41.78779933	12.81032496	0	128.3779535	0.171170605	0.074397184	42.79265117	21.39632558	2.56755907	0.094401748	0	0.171170605	9.288601046	12.45480588	20	38.5	17.11706047	0	0	0.171170605	18.57892139	0	0	20	15	0	0	0	0												4.5868	0.232796592	0.693100712	0	2.247213307	2.008082406	0.636100162	1.114700643	1.080153127	3.451655026	4.341816015	0	0.093214616	1.945133299	7.134592235	8.085300024	0.873624705	1.118868355	0	0	4.096781826	1.739862919	0	0	0.06407877	0.062164672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.606	0	4.6548546	4.5868	0.232796592	0.693100712	0	2.247213307	2.008082406	0.636100162	1.114700643	1.080153127	3.451655026	4.341816015	0	0.093214616	1.945133299	7.134592235	8.085300024	0.873624705	1.118868355	0	0	4.096781826	1.739862919	0	0	0.06407877	0.062164672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.606	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.5868	0.232796592	0.693100712	0	2.247213307	2.008082406	0.636100162	1.114700643	1.080153127	3.451655026	4.341816015	0	0.093214616	1.945133299	7.134592235	8.085300024	0.873624705	1.118868355	0	0	4.096781826	1.739862919	0	0	0.06407877	0.062164672	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.606
H4456_019_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	273.8198731	6.342670478	645.0943401	262.6972233	279.805206	16.97082882	7.996751071	318.1773605	550.3213797	16481.95499	61.77233433	0	0.045866209	2318.838622	7250.047328	5018.626651	294.1867425	655.6945693	0	0	33.5715349	1314.544214	0	0	0.56801567	6.645783344	17.3352505	4.764519136	0	0											2800	"$150 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 (1b); $0 n/c (1b1, 1b2)"	"$15 Days 1-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$140 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $140 (9a); $40/$30 (9c)"	"$20 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											150	150	14.96790291	0	150	0.2	0.094647752	50	140	0	0.08175464	0	0.2	54.74369913	12.5978248	24.99997018	38.5	25	0	0	0.2	23.42512207	0	0	25	15	0	0	0	0											NO	124.2653114	124.2653114	12.39994078	0	124.2653114	0.165687082	0.078409549	41.42177047	115.9809573	0	0.067728439	0	0.165687082	45.35991959	12.5978248	24.99997018	38.5	20.71088524	0	0	0.165687082	23.42512207	0	0	25	15	0	0	0	0												2.8355	0.06568116	0.666594301	0	2.897506755	2.811847104	0.627021643	1.098289133	5.318900038	0	4.183743748	0	0.007599438	8.765194451	7.611235502	10.45545972	0.943849132	1.131667914	0	0	5.562369652	2.566113224	0	0	0.001183366	0.008307229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5581	0	7.447662545	2.8355	0.06568116	0.666594301	0	2.897506755	2.811847104	0.627021643	1.098289133	5.318900038	0	4.183743748	0	0.007599438	8.765194451	7.611235502	10.45545972	0.943849132	1.131667914	0	0	5.562369652	2.566113224	0	0	0.001183366	0.008307229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5581	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.8355	0.06568116	0.666594301	0	2.897506755	2.811847104	0.627021643	1.098289133	5.318900038	0	4.183743748	0	0.007599438	8.765194451	7.611235502	10.45545972	0.943849132	1.131667914	0	0	5.562369652	2.566113224	0	0	0.001183366	0.008307229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5581
H4456_020_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	250.6552824	9.625026557	554.9918193	180.8826222	259.8547101	13.83889034	6.840954298	332.3484879	516.7245512	14901.7487	55.74334401	0	0.02992656	2029.775057	6689.074316	4743.957089	298.3657194	565.6207134	0	0	30.90851898	1164.00475	0	0	43.7183429	5.100140026	17.56004549	0	0	0											2800	"$150 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 (1b); $0 n/c (1b1, 1b2)"	"$15 Days 1-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$140 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $140 (9a); $40/$30 (9c)"	"$20 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$25 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											150	150	14.96790291	0	150	0.2	0.106235693	50	140	0	0.082350703	0	0.2	54.74106682	12.84728433	24.99999881	38.5	25	0	0	0.2	23.56592398	0	0	25	15	25	0	0	0											NO	127.2395179	127.2395179	12.696725	0	127.2395179	0.169652691	0.090115856	42.41317264	118.7568834	0	0.069855092	0	0.169652691	46.44370697	12.84728433	24.99999881	38.5	21.20658632	0	0	0.169652691	23.56592398	0	0	25	15	25	0	0	0												2.6578	0.102056978	0.587214876	0	2.75531567	2.347804981	0.616478452	1.174662816	5.113716439	0	3.893956417	0	0.005077121	7.855856498	7.161369971	9.883243463	0.957256683	0.999573707	0	0	5.243713405	2.285903954	0	0	0.091079881	0.006375175	0.036583428	0	0	0	0	0	0	0	0	0	0	0	0	0	53.775	0	5.96442114	2.6578	0.102056978	0.587214876	0	2.75531567	2.347804981	0.616478452	1.174662816	5.113716439	0	3.893956417	0	0.005077121	7.855856498	7.161369971	9.883243463	0.957256683	0.999573707	0	0	5.243713405	2.285903954	0	0	0.091079881	0.006375175	0.036583428	0	0	0	0	0	0	0	0	0	0	0	0	0	53.775	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.6578	0.102056978	0.587214876	0	2.75531567	2.347804981	0.616478452	1.174662816	5.113716439	0	3.893956417	0	0.005077121	7.855856498	7.161369971	9.883243463	0.957256683	0.999573707	0	0	5.243713405	2.285903954	0	0	0.091079881	0.006375175	0.036583428	0	0	0	0	0	0	0	0	0	0	0	0	0	53.775
H4456_021_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1703.57012	69.12236353	675.7447566	257.5445954	331.7898834	25.60885847	11.30833012	429.4960691	572.9757779	18872.21906	68.20162053	0	0.021685125	2931.585329	7887.128868	5740.945434	373.5626425	753.635436	0	0	40.08004282	1374.52271	0	0	119.7712123	54.4581096	17.43104736	4.790848491	25.69716374	0											2250	"$150 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-13 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-23 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$20 (3, 9d); $60 (5); $125 (9a); $40/$30 (9c)"	"$15 (7a); $20 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$20/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											135.0343613	112.6710137	69.30283311	0	150	0.2	0.090073498	50	125	3	0.119644535	0	0.2	48.57722907	10.09747695	20	38.5	20	0	0	0.2	18.88112973	0	0	20	15	0	0	0	0											NO	85.6765752	71.48748279	63.4479805	0	95.17197075	0.126895961	0.057149815	31.72399025	79.30997562	1.903439415	0.075912041	0	0.126895961	30.84406531	10.09747695	20	38.5	12.6895961	0	0	0.126895961	18.88112973	0	0	20	15	0	0	0	0												12.163	0.411781981	3.572886678	0	2.631424756	3.249660705	0.64626898	1.135444092	3.786891248	2.993510468	5.177324239	0	0.002751755	7.535167446	6.636675165	9.56824239	1.198513478	0.796944107	0	0	5.085995551	2.162711802	0	0	0.199618687	0.068072637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0229	0	28.32875799	12.163	0.411781981	3.572886678	0	2.631424756	3.249660705	0.64626898	1.135444092	3.786891248	2.993510468	5.177324239	0	0.002751755	7.535167446	6.636675165	9.56824239	1.198513478	0.796944107	0	0	5.085995551	2.162711802	0	0	0.199618687	0.068072637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0229	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.163	0.411781981	3.572886678	0	2.631424756	3.249660705	0.64626898	1.135444092	3.786891248	2.993510468	5.177324239	0	0.002751755	7.535167446	6.636675165	9.56824239	1.198513478	0.796944107	0	0	5.085995551	2.162711802	0	0	0.199618687	0.068072637	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0229
H4456_025_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1203.643422	74.56653283	442.5396536	165.5067303	224.8454764	13.11958858	6.210456429	285.018591	45.16826714	13986.74603	45.64136324	0	0.027016652	22.57812796	6206.699973	4163.678263	348.7231906	569.7137638	0	0	24.82642802	984.5801329	0	0	72.93556815	0	16.68637099	4.651206231	47.69488371	0											2400	"$190 Days 1-9 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$190 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$80 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											153.2779044	121.6705336	58.4079737	0	150	0.2	0.088740197	50	0.2	3	0.117124131	0	0.2	0.155173428	6.234801401	24.99986328	38.5	25	0	0	0.2	23.31830601	0	0	25	0	0	0	0	0											NO	113.820185	90.34937363	43.37224208	0	111.3860985	0.148514798	0.065896162	37.1286995	0.148514798	2.22772197	0.086973333	0	0.148514798	0.115399847	6.234801401	24.99986328	38.5	18.56434975	0	0	0.148514798	23.31830601	0	0	25	0	0	0	0	0												11.4166	0.561419961	1.599494749	0	2.087055031	1.948453048	0.409245246	0.881864135	6.70815607	2.596548452	3.969581492	0	0.004012373	2.605512514	3.224795141	8.674282276	1.118820236	0.881363797	0	0	3.687091942	1.913228403	0	0	0.1519491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4395	0	13.63832991	11.4166	0.561419961	1.599494749	0	2.087055031	1.948453048	0.409245246	0.881864135	6.70815607	2.596548452	3.969581492	0	0.004012373	2.605512514	3.224795141	8.674282276	1.118820236	0.881363797	0	0	3.687091942	1.913228403	0	0	0.1519491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4395	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.4166	0.561419961	1.599494749	0	2.087055031	1.948453048	0.409245246	0.881864135	6.70815607	2.596548452	3.969581492	0	0.004012373	2.605512514	3.224795141	8.674282276	1.118820236	0.881363797	0	0	3.687091942	1.913228403	0	0	0.1519491	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4395
H4456_026_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1344.651425	72.74701742	676.4020088	208.8649071	256.1149221	15.77128029	7.939932938	304.9130715	55.18195052	14647.66507	54.66166866	0	0.036724944	30.0688878	6401.960248	4469.815429	334.2274933	625.3762576	0	0	32.63588797	1109.432544	0	0	111.0765716	0	16.04125317	4.676908279	60.9014636	0											3600	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$95 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											186.0244495	140.3212257	73.07390847	0	150	0.2	0.092206746	50	0.2	3	0.115911104	0	0.2	0.15349506	9.612600219	29.99918259	38.5	30	0	0	0.2	28.07678564	0	0	30	0	0	0	0	0											YES	142.8187841	107.7304994	56.1019091	0	115.161301	0.153548401	0.070790992	38.38710032	0.153548401	2.303226019	0.088989823	0	0.153548401	0.117956002	9.612600219	29.99918259	38.5	23.03226019	0	0	0.153548401	28.07678564	0	0	30	0	0	0	0	0											4400	16.0035	0.653089376	3.162287001	0	2.457877302	2.421654875	0.562075729	0.975394055	8.473100282	2.811406942	4.864332231	0	0.005639056	3.546805789	5.128290373	11.1742341	1.072313208	1.200319057	0	0	5.011188422	2.595774976	0	0	0.277691429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3969	0	15.77168605	16.0035	0.653089376	3.162287001	0	2.457877302	2.421654875	0.562075729	0.975394055	8.473100282	2.811406942	4.864332231	0	0.005639056	3.546805789	5.128290373	11.1742341	1.072313208	1.200319057	0	0	5.011188422	2.595774976	0	0	0.277691429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3969	NO	"$325 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-36 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$20 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.2248	0.0568	0.2664	0.0181	0.121	0.1789	0.0901	0.0669	0.6259	0.1385	0.3447	0	0.0003	0.2595	0.4338	0.6859	0.0638	0.069	0	0	0.3702	0.1615	0	0	0.0171	0	0.0025	0	0	0											5.1954	0	1.499155853	17.2282	0.709884211	3.428689999	0.018134307	2.578923276	2.600548003	0.652138134	1.042260957	9.09902738	2.949863605	5.209008441	0	0.00591677	3.806260403	5.562065446	11.86011932	1.136080295	1.269284835	0	0	5.381376255	2.757313697	0	0	0.294742657	0	0.002462473	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5923
H4456_027_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1346.61757	65.52865749	736.5680303	92.15499503	249.972676	13.65481298	7.695522982	281.4377565	524.8799955	15087.8424	43.11664312	0	0.041208612	2262.308847	6336.121043	4522.184335	269.0710659	704.7957823	0	0	20.63187027	1043.90041	0	0	1.027267881	1.964437254	16.46170502	4.762556753	0	0											2800	"$75 Days 1-38 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$75 Days 1-38 (1b); $0 n/c (1b1, 1b2)"	"$40 Days 1-70 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$50 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $50 (9a); $40/$30 (9c)"	"$20 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											73.42466491	71.80074406	38.90028877	0	150	0.2	0.100918028	50	50	0	0.075981485	0	0.2	20.14714763	12.88078768	25	38.5	25	0	0	0.2	23.26818369	0	0	25	15	0	0	0	0											YES	63.62028007	62.21320113	34.65880581	0	129.9705218	0.173294029	0.087442459	43.32350726	43.32350726	0	0.065835688	0	0.173294029	17.46336249	12.88078768	25	38.5	21.66175363	0	0	0.173294029	23.26818369	0	0	25	15	0	0	0	0											3600	7.1393	0.339728962	2.127380694	0	2.707423261	2.366297557	0.67291545	1.016072557	1.894970192	0	2.838613878	0	0.007141206	3.292293288	6.801185821	9.421217364	0.86326967	1.272259383	0	0	3.575379926	2.024138875	0	0	0.002140141	0.002455547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3642	0	4.506222123	7.1393	0.339728962	2.127380694	0	2.707423261	2.366297557	0.67291545	1.016072557	1.894970192	0	2.838613878	0	0.007141206	3.292293288	6.801185821	9.421217364	0.86326967	1.272259383	0	0	3.575379926	2.024138875	0	0	0.002140141	0.002455547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3642	NO	"$150 Days 1-24 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-24 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 1-48 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	$140 (9b)	30%/30%/$0 (8a1); $0 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); $140 (9a); $45/$35 (9c)"	"$30 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$30 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.6702	0.0307	0.1922	0.0084	0.1304	0.171	0.0964	0.0617	0.2556	0	0.3219	0	0.0003	0.4358	0.6169	0.6939	0.0513	0.0858	0	0	0.2584	0.151	0	0	0.0002	0	0.0025	0	0	0											4.2347	0	0.707931204	7.8095	0.37041189	2.319559292	0.008413011	2.837864432	2.537306629	0.769292035	1.077791364	2.150604388	0	3.160476146	0	0.007485263	3.72805424	7.418132603	10.11516582	0.914605597	1.358074191	0	0	3.833767719	2.175163699	0	0	0.002293451	0.002455547	0.002527016	0	0	0	0	0	0	0	0	0	0	0	0	0	52.599
H4456_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	190.6259588	5.542546631	13.9165855	230.8762025	6.052121675	18.1017687	10.91557045	11.45888031	55.29877398	28.25254085	62.71756826	0	0.027813399	28.40898182	32.15376944	131.0833381	2.879534037	10.05618289	0	0	35.46851282	10.82412777	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.086048855	0.086048855	0.205937025	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.086048855	0.086048855	0.205937025	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.4031	0.476929793	2.865940209	0	1.41014435	4.217712107	2.543327916	2.669919113	12.88461434	6.582842017	14.6131934	0	0.006480522	6.619292763	7.491828281	30.54241778	0.670931431	2.343090614	0	0	8.264163488	2.52202177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.128	0	0	16.4031	0.476929793	2.865940209	0	1.41014435	4.217712107	2.543327916	2.669919113	12.88461434	6.582842017	14.6131934	0	0.006480522	6.619292763	7.491828281	30.54241778	0.670931431	2.343090614	0	0	8.264163488	2.52202177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.128	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.4031	0.476929793	2.865940209	0	1.41014435	4.217712107	2.543327916	2.669919113	12.88461434	6.582842017	14.6131934	0	0.006480522	6.619292763	7.491828281	30.54241778	0.670931431	2.343090614	0	0	8.264163488	2.52202177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.128
H4456_805_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	189.8433563	5.519792066	13.85945186	229.9285799	6.027275083	18.02745306	10.87075729	11.41183663	55.07174845	28.13655187	62.46008536	0	0.027699213	28.29235059	32.02176423	130.545184	2.867712297	10.01489789	0	0	35.32289915	10.77969001	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.086049	0.086049	0.205930867	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.086049	0.086049	0.205930867	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.3358	0.474972589	2.85408894	0	1.404355094	4.200396563	2.532886448	2.658957934	12.83171739	6.555816587	14.55319989	0	0.006453917	6.592117686	7.461071066	30.41702786	0.668176965	2.333471207	0	0	8.230235501	2.511667773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6224	0	0	16.3358	0.474972589	2.85408894	0	1.404355094	4.200396563	2.532886448	2.658957934	12.83171739	6.555816587	14.55319989	0	0.006453917	6.592117686	7.461071066	30.41702786	0.668176965	2.333471207	0	0	8.230235501	2.511667773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6224	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.3358	0.474972589	2.85408894	0	1.404355094	4.200396563	2.532886448	2.658957934	12.83171739	6.555816587	14.55319989	0	0.006453917	6.592117686	7.461071066	30.41702786	0.668176965	2.333471207	0	0	8.230235501	2.511667773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.6224
H4456_810_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	190.8162072	0	13.93047453	230.5169608	6.058161811	18.11983462	10.92646441	11.4703165	55.35396324	28.28073744	62.78016162	0	0.027841157	28.40936718	32.18585954	131.2141618	0	10.06621916	0	0	35.50391109	10.83493046	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.087693754	0	0.166843195	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.087693754	0	0.166843195	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.7334	0	2.324204882	0	1.411551702	4.221921466	2.545866207	2.672583745	12.89747343	6.589411823	14.62777766	0	0.00648699	6.619382552	7.499305272	30.57289971	0	2.345429064	0	0	8.272411285	2.524538797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8646	0	0	16.7334	0	2.324204882	0	1.411551702	4.221921466	2.545866207	2.672583745	12.89747343	6.589411823	14.62777766	0	0.00648699	6.619382552	7.499305272	30.57289971	0	2.345429064	0	0	8.272411285	2.524538797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8646	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.7334	0	2.324204882	0	1.411551702	4.221921466	2.545866207	2.672583745	12.89747343	6.589411823	14.62777766	0	0.00648699	6.619382552	7.499305272	30.57289971	0	2.345429064	0	0	8.272411285	2.524538797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8646
H4461_001_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin	T		V				O	O	O	O	O	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	YES	272.967228	5.878108	833.817418	2563.4225	245.967746	0.703981	11.372594	319.436682	568.544497	806.525242	870.429459	4.393679	0.984994	1167.720426	7449.994029	8464.237514	174.498647	479.182063			27.765883	6.568443	0.58		1.5				0.04	0.25	0.05	0.55	2.01	0.32	0.4	0.42					3200	$0/Admit:1a	$100/Admit:1b	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$0/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0-$75/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $75 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$0/Visit:9a	20% Coins:12	"$0-$75/Visit:9d. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $15 OP Other,5. $15 Partial Hospitalization,7h. $15 Psych -- OP,8b. $0 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	$10/Visit:7i			20% Coins:15		Transportation		"VIS734: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					0	100	69.3508	0	0	0.2	0.2	50	0	0	34.420155	0	0.2	15.392669	10	15	15	10			0.2	0	0		0				0	0	0	0	0	0	0	0					NO	0	92.7989	37.165371	0	0	0.181826	0.181826	45.4565	0	0	31.292396	0	0.181826	13.993937	9.0913	13.63695	13.63695	9.0913			0.181826	0	0		0				0	0	0	0	0	0	0	0						0	0.04545683	2.582427807	0	0	0.128002049	2.067833277	1.210039461	0	0	2.26981861	0	0.179097519	1.361750506	5.64417756	9.618865314	0.198302444	0.363032324	0	0	5.048559442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7174	0	5.047544	0	0.04545683	2.582427807	0	0	0.128002049	2.067833277	1.210039461	0	0	2.26981861	0	0.179097519	1.361750506	5.64417756	9.618865314	0.198302444	0.363032324	0	0	5.048559442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7174	NO																																																																																		0	0	0	0	0.04545683	2.582427807	0	0	0.128002049	2.067833277	1.210039461	0	0	2.26981861	0	0.179097519	1.361750506	5.64417756	9.618865314	0.198302444	0.363032324	0	0	5.048559442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7174
H4461_004_0	2010	2	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin	T		V				O	O	O	O	O	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	YES	169.932591	0.565733	869.806568	2180.114618	212.834201	0.412912	8.375057	270.988058	486.074879	658.590516	661.654766	2.477804	1.735463	912.228621	6167.477109	7059.529016	120.913797	373.691499			17.67933	5.503726	0.58		1.5				0.04	0.25	0.05	0.55	2.01	0.32	0.4	0.42					3200	$0/Admit:1a	$100/Admit:1b	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$0/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0-$75/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $75 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$0/Visit:9a	20% Coins:12	"$0-$75/Visit:9d. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $15 OP Other,5. $15 Partial Hospitalization,7h. $15 Psych -- OP,8b. $0 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	$10/Visit:7i			20% Coins:15		Transportation		"VIS734: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					0	100	69.3508	0	0	0.2	0.2	50	0	0	38.039602	0	0.2	14.678851	10	15	15	10			0.2	0	0		0				0	0	0	0	0	0	0	0					NO	0	93.6676	37.724061	0	0	0.18488	0.18488	46.22005	0	0	35.163846	0	0.18488	13.569145	9.24401	13.866015	13.866015	9.24401			0.18488	0	0		0				0	0	0	0	0	0	0	0						0	0.004415904	2.734386336	0	0	0.076339171	1.548380538	1.043756799	0	0	1.938860525	0	0.320852399	1.031513536	4.751018339	8.157294602	0.139716044	0.287867329	0	0	3.26855453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.303	0	4.138059	0	0.004415904	2.734386336	0	0	0.076339171	1.548380538	1.043756799	0	0	1.938860525	0	0.320852399	1.031513536	4.751018339	8.157294602	0.139716044	0.287867329	0	0	3.26855453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.303	NO																																																																																		0	0	0	0	0.004415904	2.734386336	0	0	0.076339171	1.548380538	1.043756799	0	0	1.938860525	0	0.320852399	1.031513536	4.751018339	8.157294602	0.139716044	0.287867329	0	0	3.26855453	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.303
H4461_011_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Lab	Radiology	Renal Dialysis	Other					Therapy (PT/OT/ST)		Coin	Coin	D	V	T	O	O	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			S	O	T								V	V	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	YES	333.817672	10.948565	1313.896314	4677.350577	656.426789	809.397688	1325.602341	837.887175	54.146671	5.949861	7.099556	0.562895	0.010739	33.501426	7261.660258	9971.2324	916.752464	1.394666			1747.396668	820.912395	0.58								108.314736	560.807607	15.427836	0	0				346.61585		3400	10% Coins:1a	8% Coins:1b	$0/Day(Days 1-20) $0(Days 20-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	$0/Service:11b	$0/Visit:4a	"10% Coins:9a, 9b"	10% Coins:8a	"10% Coins:14h, 8a, 8b, 9a"	10% Coins:9a	10% Coins:12	"10% Coins:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	10% Coins:7i			$0/Script:15		Transportation								$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"				$0/Visit:7i		0.1	0.08	0	0	0	0	0	0	0.1	0.1	0.1	0.1	0.1	0.1	0	0	0	0.1			0	0	0								0	0	0	0	0				0		NO	0.086912	0.06953	0	0	0	0	0	0	0.089843	0.089843	0.089843	0.089843	0.089843	0.089843	0	0	0	0.089843			0	0	0								0	0	0	0	0				0			29.0128	0.761253724	0	0	0	0	0	0	4.864699363	0.534553362	0.63784541	0.050572175	0.000964824	3.009868616	0	0	0	0.125300977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9978	0	5.526409	29.0128	0.761253724	0	0	0	0	0	0	4.864699363	0.534553362	0.63784541	0.050572175	0.000964824	3.009868616	0	0	0	0.125300977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9978	NO																																																																																		0	0	0	29.0128	0.761253724	0	0	0	0	0	0	4.864699363	0.534553362	0.63784541	0.050572175	0.000964824	3.009868616	0	0	0	0.125300977	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.9978
H4461_012_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin	T		V				O	O	O	O	O	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	YES	324.447074	8.36449	1022.603029	1748.444923	276.194056	6.688199	7.877046	395.530058	393.63767	819.759394	1147.723398	42.507638	2.077293	660.095593	5864.117878	7417.453309	141.118804	803.97786			28.120671	3.826149	0.58		1.5				0.04	0.25	0.05	0.55	2.01	0.32	0.4	0.42					3200	$0/Admit:1a	$100/Admit:1b	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$0/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0-$75/Visit:14h. $0 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $75 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $0 Radiology OP -- Facility"	$0/Visit:9a	20% Coins:12	"$0-$75/Visit:9d. $10 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $15 OP Other,5. $15 Partial Hospitalization,7h. $15 Psych -- OP,8b. $0 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	$10/Visit:7i			20% Coins:15		Transportation		"VIS734: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					0	100	69.3508	0	0	0.2	0.2	50	0	0	26.528479	0	0.2	14.613513	10	15	15	10			0.2	0	0		0				0	0	0	0	0	0	0	0					NO	0	92.4215	33.232418	0	0	0.182109	0.182109	45.52725	0	0	24.155374	0	0.182109	13.306261	9.10545	13.658175	13.658175	9.10545			0.182109	0	0		0				0	0	0	0	0	0	0	0						0	0.064421559	2.831964276	0	0	1.217981232	1.43448097	1.500616319	0	0	2.310307327	0	0.378293751	0.731950354	4.449619344	8.442406279	0.160618777	0.61004835	0	0	5.121027275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2537	0	5.672619	0	0.064421559	2.831964276	0	0	1.217981232	1.43448097	1.500616319	0	0	2.310307327	0	0.378293751	0.731950354	4.449619344	8.442406279	0.160618777	0.61004835	0	0	5.121027275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2537	NO																																																																																		0	0	0	0	0.064421559	2.831964276	0	0	1.217981232	1.43448097	1.500616319	0	0	2.310307327	0	0.378293751	0.731950354	4.449619344	8.442406279	0.160618777	0.61004835	0	0	5.121027275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.2537
H4461_015_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin	T		V				O	O	O	O	O	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	YES	207.10047	3.093404	709.450685	2489.25002	201.436646	0.821438	9.931562	247.821308	510.74952	692.496479	774.184843	2.242967	1.184244	895.861385	6290.436639	7130.701403	102.095074	591.945527			20.308429	5.849942	0.58		1.5				0.04	0.25	0.05	0.55	2.01	0.32	0.4	0.42					3350	$500/Admit:1a	$500/Admit:1b	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$25/Visit:8a. $0 Lab -- FSL,8a. $25 Lab -- OP"	"$0-$100/Visit:14h. $25 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $25 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $25 OP Other,5. $25 Partial Hospitalization,7h. $25 Psych -- OP,8b. $25 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	$15/Visit:7i			20% Coins:15		Transportation		"VIS734: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					500	500	69.3508	0	100	0.2	0.2	50	0	23.057157	52.656393	100	0.2	26.579403	15	25	25	15			0.2	0	0		0				0	0	0	0	0	0	0	0					NO	449.2305	449.2305	35.900135	0	87.8177	0.175635	0.175635	43.90885	0	20.248265	46.241633	87.8177	0.175635	23.34142	13.172655	21.954425	21.954425	13.172655			0.175635	0	0		0				0	0	0	0	0	0	0	0						7.753	0.115804285	2.122447947	0	1.474141912	0.144273263	1.744329892	0.90679572	0	1.168487685	2.983297615	0.01641435	0.207994695	1.742556404	6.90514597	13.04587076	0.186786554	0.649791184	0	0	3.566870927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.734	0	7.686526	7.753	0.115804285	2.122447947	0	1.474141912	0.144273263	1.744329892	0.90679572	0	1.168487685	2.983297615	0.01641435	0.207994695	1.742556404	6.90514597	13.04587076	0.186786554	0.649791184	0	0	3.566870927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.734	NO																																																																																		0	0	0	7.753	0.115804285	2.122447947	0	1.474141912	0.144273263	1.744329892	0.90679572	0	1.168487685	2.983297615	0.01641435	0.207994695	1.742556404	6.90514597	13.04587076	0.186786554	0.649791184	0	0	3.566870927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.734
H4461_016_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Other				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin	T						O	O	V	V	O	O	O	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		0	YES	2245.547576	83.429365	1030.782525	4160.164167	375.272515	1.722544	23.083121	450.313844	81.063689	5.533478	9.01288	1.186153	4.958214	46.152015	9300.092291	12330.81217	416.478665	1.845329			43.442403	6.906711	0.58						0.04	0.25	502.88062	0	0.05	0.55	2.01	438.564872	0.32	0.4	0.42		4900	$220/Day(Days 1-7):1a	$220/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$0/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	20% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	$20/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	20% Coins:7i			20% Coins:15		Transportation						$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$40/Visit:14h. 20% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	"$40/Visit:3, 5, 7h, 8b, 9a, 9d"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$20/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		155.22936	137.27912	58.254672	0	0	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	20	40	40	0.2			0.2	0	0						0	0	22.792659	0	0	0	0	20	0	0	0		NO	113.381232	100.270179	24.065704	0	0	0.153181	0.153181	38.2952	0.153181	0.153181	0.153181	0.153181	0.153181	0.153181	15.31808	30.63616	30.63616	0.153181			0.153181	0	0						0	0	17.456989	0	0	0	0	15.31808	0	0	0			21.2169	0.697123114	2.067208928	0	0	0.263861012	3.535895558	1.43707156	12.41741694	0.847623694	1.380601971	0.181696103	0.759504179	7.06961181	11.87162981	31.48072787	1.063275585	0.282669342	0	0	6.654550734	0	0	0	0	0	0	0	0	0	0.731565121	0	0	0	0	0.559830983	0	0	0	0	104.5188	0	35.641095	21.2169	0.697123114	2.067208928	0	0	0.263861012	3.535895558	1.43707156	12.41741694	0.847623694	1.380601971	0.181696103	0.759504179	7.06961181	11.87162981	31.48072787	1.063275585	0.282669342	0	0	6.654550734	0	0	0	0	0	0	0	0	0	0.731565121	0	0	0	0	0.559830983	0	0	0	0	104.5188	NO																																																																																		0	0	0	21.2169	0.697123114	2.067208928	0	0	0.263861012	3.535895558	1.43707156	12.41741694	0.847623694	1.380601971	0.181696103	0.759504179	7.06961181	11.87162981	31.48072787	1.063275585	0.282669342	0	0	6.654550734	0	0	0	0	0	0	0	0	0	0.731565121	0	0	0	0	0.559830983	0	0	0	0	104.5188
H4461_806_0	2010	3	N/A																															A	A	D	V	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	NO	195.7764392	2.93754383	29.601384	7.587494	6.153049	6.177092203	2.610876797	16.508368	49.062343	6.401182468	20.98728486	3.249092126	0.692759802	11.46647074	78.11977252	96.90898411	0.339016927	6.590789451			17.67933	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																			0.086046579	0.086046579	0.166076448	0	0.207625509	0.219410127	0.219410127	0.222919468	0.23668045	0.236719174	0.236719174	0.236719174	0.236719174	0.236719174	0.229418512	0.229418512	0.229418512	0.229418512			0.235374551	0.233																			NO	0.086046579	0.086046579	0.166076448	0	0.207625509	0.219410127	0.219410127	0.222919468	0.23668045	0.236719174	0.236719174	0.236719174	0.236719174	0.236719174	0.229418512	0.229418512	0.229418512	0.229418512			0.235374551	0.233																				0.0014	2.11E-05	0.000409674	0	1.277529933	1.355316584	0.572852809	3.680036618	11.61209743	1.515282625	4.968092732	0.769122404	0.163989528	2.71433348	17.92212195	22.23271491	0.077776759	1.512049107	0	0	4.161264363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5364	0	0	0.0014	2.11E-05	0.000409674	0	1.277529933	1.355316584	0.572852809	3.680036618	11.61209743	1.515282625	4.968092732	0.769122404	0.163989528	2.71433348	17.92212195	22.23271491	0.077776759	1.512049107	0	0	4.161264363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5364	NO																																																																																		0	0	0	0.0014	2.11E-05	0.000409674	0	1.277529933	1.355316584	0.572852809	3.680036618	11.61209743	1.515282625	4.968092732	0.769122404	0.163989528	2.71433348	17.92212195	22.23271491	0.077776759	1.512049107	0	0	4.161264363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5364
H4461_807_0	2010	3	N/A																															A	A	D	V	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	NO	195.7764392	2.93754383	29.601384	7.587494	6.153049	6.177092203	2.610876797	16.508368	49.062343	6.401182468	20.98728486	3.249092126	0.692759802	11.46647074	78.11977252	96.90898411	0.339016927	6.590789451			17.67933	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																			0.086046579	0.086046579	0.166076448	0	0.207625509	0.219410127	0.219410127	0.222919468	0.23668045	0.236719174	0.236719174	0.236719174	0.236719174	0.236719174	0.229418512	0.229418512	0.229418512	0.229418512			0.235374551	0.233																			NO	0.086046579	0.086046579	0.166076448	0	0.207625509	0.219410127	0.219410127	0.222919468	0.23668045	0.236719174	0.236719174	0.236719174	0.236719174	0.236719174	0.229418512	0.229418512	0.229418512	0.229418512			0.235374551	0.233																				0.0014	2.11E-05	0.000409674	0	1.277529933	1.355316584	0.572852809	3.680036618	11.61209743	1.515282625	4.968092732	0.769122404	0.163989528	2.71433348	17.92212195	22.23271491	0.077776759	1.512049107	0	0	4.161264363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5364	0	0	0.0014	2.11E-05	0.000409674	0	1.277529933	1.355316584	0.572852809	3.680036618	11.61209743	1.515282625	4.968092732	0.769122404	0.163989528	2.71433348	17.92212195	22.23271491	0.077776759	1.512049107	0	0	4.161264363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5364	NO																																																																																		0	0	0	0.0014	2.11E-05	0.000409674	0	1.277529933	1.355316584	0.572852809	3.680036618	11.61209743	1.515282625	4.968092732	0.769122404	0.163989528	2.71433348	17.92212195	22.23271491	0.077776759	1.512049107	0	0	4.161264363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5364
H4461_808_0	2010	3	N/A																															A	A	D	V	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	NO	195.7764392	2.93754383	29.601384	7.587494	6.153049	6.177092203	2.610876797	16.508368	49.062343	6.401182468	20.98728486	3.249092126	0.692759802	11.46647074	78.11977252	96.90898411	0.339016927	6.590789451			17.67933	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																			0.086046579	0.086046579	0.166076448	0	0.207625509	0.219410127	0.219410127	0.222919468	0.23668045	0.236719174	0.236719174	0.236719174	0.236719174	0.236719174	0.229418512	0.229418512	0.229418512	0.229418512			0.235374551	0.233																			NO	0.086046579	0.086046579	0.166076448	0	0.207625509	0.219410127	0.219410127	0.222919468	0.23668045	0.236719174	0.236719174	0.236719174	0.236719174	0.236719174	0.229418512	0.229418512	0.229418512	0.229418512			0.235374551	0.233																				0.0014	2.11E-05	0.000409674	0	1.277529933	1.355316584	0.572852809	3.680036618	11.61209743	1.515282625	4.968092732	0.769122404	0.163989528	2.71433348	17.92212195	22.23271491	0.077776759	1.512049107	0	0	4.161264363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5364	0	0	0.0014	2.11E-05	0.000409674	0	1.277529933	1.355316584	0.572852809	3.680036618	11.61209743	1.515282625	4.968092732	0.769122404	0.163989528	2.71433348	17.92212195	22.23271491	0.077776759	1.512049107	0	0	4.161264363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5364	NO																																																																																		0	0	0	0.0014	2.11E-05	0.000409674	0	1.277529933	1.355316584	0.572852809	3.680036618	11.61209743	1.515282625	4.968092732	0.769122404	0.163989528	2.71433348	17.92212195	22.23271491	0.077776759	1.512049107	0	0	4.161264363	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5364
H4506_003_0	2010	7	N/A																															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	V	V	V	V	V																																																			0	YES	1785.008448	87.19486962	630.6003152		137.184801	15.63781611	0.253079939	329.4683532	273.5243306		276.2374819	105.5470444	16.99642233	28.90890525	17.50675571	3109.04226	203.5951246	76.37584724		379.3989957	17.39928574	855.6283226		1324.084196	114.4353951																3000	(1a/1a1) $250/Admit	(1b) $250/Admit	(2a/2a2) $100/Day Days 21-100	(6a) 0%	(10a) $150	(11a) 10%	(11b) 20% (11c) 20%	(4a) $50 (4a1) n/c (4b) $25 (4b1) n/c	(9b) $100	(8a) $0	(8b1) $0 (8b2) $125/$125/$0/$25/$300 (8b3) $50	(9a) $150	(12) $50	(3) $25 (5) $25 (9a) $150 (9c) 35 Ind/20 Grp (9d) $25	(7a) $0 (14b) $0 (14c) $0 (14d) $0 (14d1) $0 (14d2) $0 (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $10 (14j) $10	(7b) $30 (7d) $25 (7f) $25	(7e) 35 Ind/20 Grp (7h) 35 Ind/20 Grp	(7c) $25 (7i) $25		(7d) $25 (7g) $25	(15) 10%	(13a) $0 (16b) $0 (17a) $25 (17b) $0 (18a) $25	(10b) $0	(16a) $15	(17a1) $25	(17b1) $0		(18b) n/c	(14a) $0  (14a6) $0												43.84250104	36.57292583	64.98915146		150	0.1	0.2	49.84951996	100		68.54912569	150	50	85.10372735	10	25.0106016	31.25	25		25	0.1	25		15	25																NO	40.42469425	33.72182949	59.92282636		138.3065289	0.092204353	0.184408705	45.96342715	92.20435259		63.20527755	138.3065289	46.1021763	78.46934083	9.220435259	23.06086328	28.81386019	23.05108815		23.05108815	0.092204353	23.05108815		13.83065289	23.05108815																	6.0132	0.245030877	3.148946099	0	1.581129471	1.44187471	0.046670144	1.261957888	2.101677818	0	1.454972226	1.216487112	0.065297672	0.189038562	0.013451659	5.974766541	0.488863455	0.146712199	0	0.728796641	1.604289878	1.64359699	0	1.526079076	0.219821698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1127	0	2.630497796	6.0132	0.245030877	3.148946099	0	1.581129471	1.44187471	0.046670144	1.261957888	2.101677818	0	1.454972226	1.216487112	0.065297672	0.189038562	0.013451659	5.974766541	0.488863455	0.146712199	0	0.728796641	1.604289878	1.64359699	0	1.526079076	0.219821698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1127	NO																																																																																		0	0	0	6.0132	0.245030877	3.148946099	0	1.581129471	1.44187471	0.046670144	1.261957888	2.101677818	0	1.454972226	1.216487112	0.065297672	0.189038562	0.013451659	5.974766541	0.488863455	0.146712199	0	0.728796641	1.604289878	1.64359699	0	1.526079076	0.219821698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.1127
H4506_010_0	2010	2	N/A																															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	V	V	V	V	V																																																			0	YES	1327.39107	86.1355186	386.9143633		94.02396932	7.752236663	0.177673889	217.5665415	156.894928		83.02332506	55.19177608	3.916718833	33.03991644	11.54282817	1971.049918	206.1306179	28.65866602		229.4547453	14.85336156	501.9615146		1180.619166	115.7938155																3000	(1a/1a1) $300/Admit	(1b) $300/Admit	(2a/2a2) $100/Day Days 21-100	(6a) 0%	(10a) $150	(11a) 10%	(11b) 20% (11c) 0-20%	(4a) $50 (4a1) n/c (4b) $25 (4b1) n/c	(9b) $100	(8a) $0	(8b1) $0 (8b2) $125/$125/$0/$25/$300 (8b3) $50	(9a) $150	(12) $50	(3) $25 (5) $25 (9a) $150 (9c) 35 Ind/20 Grp (9d) $25	(7a) $0 (14b) $0 (14c) $0 (14d) $0 (14d1) $0 (14d2) $0 (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $10 (14j) $10	(7b) $30 (7d) $25 (7f) $25	(7e) 35 Ind/20 Grp (7h) 35 Ind/20 Grp	(7c) $25 (7i) $25		(7d) $25 (7g) $25	(15) 10%	(13a) $0 (16b) $0 (17a) $25 (17b) $0 (18a) $25	(10b) $0	(16a) $15	(17a1) $25	(17b1) $0		(18b) n/c	(14a) $0  (14a6) $0												52.61100125	43.887511	64.98915146		150	0.1	0.2	49.85130362	100		82.45110595	150	50	61.71401746	10	25.03654572	31.25	25		25	0.1	25		15	25																NO	50.54082419	42.16059236	62.43190968		144.0976877	0.096065125	0.19213025	47.88971721	96.06512514		79.20675811	144.0976877	48.03256257	59.2856481	9.606512514	24.05138897	30.02035161	24.01628128		24.01628128	0.096065125	24.01628128		14.40976877	24.01628128																	5.5906	0.302627041	2.012983548	0	1.129053047	0.744719585	0.034136529	0.868266679	1.256010907	0	0.548000702	0.66275061	0.015677504	0.163232738	0.009240527	3.950540688	0.515676135	0.057356215	0	0.459220809	1.426890037	1.004604077	0	1.417704099	0.231744737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4011	0	0.917558296	5.5906	0.302627041	2.012983548	0	1.129053047	0.744719585	0.034136529	0.868266679	1.256010907	0	0.548000702	0.66275061	0.015677504	0.163232738	0.009240527	3.950540688	0.515676135	0.057356215	0	0.459220809	1.426890037	1.004604077	0	1.417704099	0.231744737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4011	NO																																																																																		0	0	0	5.5906	0.302627041	2.012983548	0	1.129053047	0.744719585	0.034136529	0.868266679	1.256010907	0	0.548000702	0.66275061	0.015677504	0.163232738	0.009240527	3.950540688	0.515676135	0.057356215	0	0.459220809	1.426890037	1.004604077	0	1.417704099	0.231744737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.4011
H4506_025_0	2010	6	N/A																															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	V	V	V	V	V																																																			0	YES	1634.116601	79.82403902			125.5881792		0.001107973	301.6174552	250.4025401			96.62485223	15.55966635	26.46515317	16.0268598	2846.226065	186.384649	69.9195794		347.3273183	15.94238223	783.2996242		1587.602138	113.0201154																2500	(1a/1a1) $125/Admit	(1b) $125/Admit	(2a/2a2) $0 Days 1-100	(6a) 0%	(10a) $100	(11a) 0%	(11b) 0% (11c) 20%	(4a) $40 (4a1) n/c (4b) $20 (4b1) n/c	(9b) $75	(8a) $0	(8b1) $0 (8b2) $0 (8b3) $0	(9a) $125	(12) $50	(3) $25 (5) $25 (9a) $125 (9c) $20 (9d) $25	(7a) $0 (14b) $0 (14c) $0 (14d) $0 (14d1) $0 (14d2) $0 (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $10 (14j) $10	(7b) $25 (7d) $15 (7f) $20	(7e) $20 (7h) $15	(7c) $25 (7i) $25		(7d) $15 (7g) $15	(15) 10%	(13a) $0 (16b) $0 (17a) $10 (17b) $0 (18a) $25	(10b) $0	(16a) $5	(17a1) $10	(17b1) $0		(18b) n/c	(14a) $0  (14a6) $0												21.92125052	18.28646292			100		0.2	39.87961597	75			125	50	72.20789602	10	15.03285992	16.80702952	25		15	0.1	10.00028633		4.25	10																NO	21.37371396	17.82971402			97.50225673		0.195004513	38.88352555	73.12669255			121.8778209	48.75112837	70.40432816	9.750225673	14.65737767	16.38723307	24.37556418		14.62533851	0.097502257	9.750504852		4.143845911	9.750225673																	2.9106	0.118603316	0	0	1.020427574	0	0.00021606	0.977329169	1.525925797	0	0	0.98136887	0.063212608	0.155271777	0.013022125	3.476517531	0.25452739	0.142027433	0	0.423314967	1.554418245	0.636463899	0	0.548231552	0.091830969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.8933	0	0.381526048	2.9106	0.118603316	0	0	1.020427574	0	0.00021606	0.977329169	1.525925797	0	0	0.98136887	0.063212608	0.155271777	0.013022125	3.476517531	0.25452739	0.142027433	0	0.423314967	1.554418245	0.636463899	0	0.548231552	0.091830969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.8933	NO																																																																																		0	0	0	2.9106	0.118603316	0	0	1.020427574	0	0.00021606	0.977329169	1.525925797	0	0	0.98136887	0.063212608	0.155271777	0.013022125	3.476517531	0.25452739	0.142027433	0	0.423314967	1.554418245	0.636463899	0	0.548231552	0.091830969	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.8933
H4506_801_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																										0	NO	287.7888748	5.528463472	32.40623249		10.70028023	21.0069018	0.348710315	17.25976257	43.40199597	23.31004747	54.8502465	5.165298168	0.451209381	10.06894253	49.11835305	139.6272881	1.772520265	2.89450401		8.908723875	20.26918044	8.406377535																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																		0.069434491	0.069434491	0.179926982		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.069434491	0.069434491	0.179926982		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				19.9825	0.383866045	5.830755611	0	2.493165293	4.894608118	0.081249503	4.021524678	10.11266506	5.431241062	12.78010743	1.203514473	0.105131786	2.346063609	11.44457626	32.53315813	0.412997222	0.674419434	0	2.075732663	4.722719043	1.958685966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4887	0	0	19.9825	0.383866045	5.830755611	0	2.493165293	4.894608118	0.081249503	4.021524678	10.11266506	5.431241062	12.78010743	1.203514473	0.105131786	2.346063609	11.44457626	32.53315813	0.412997222	0.674419434	0	2.075732663	4.722719043	1.958685966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4887	NO																																																																																		0	0	0	19.9825	0.383866045	5.830755611	0	2.493165293	4.894608118	0.081249503	4.021524678	10.11266506	5.431241062	12.78010743	1.203514473	0.105131786	2.346063609	11.44457626	32.53315813	0.412997222	0.674419434	0	2.075732663	4.722719043	1.958685966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4887
H4506_806_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																										0	NO	287.7888748	5.528463472	32.40623249		10.70028023	21.0069018	0.348710315	17.25976257	43.40199597	23.31004747	54.8502465	5.165298168	0.451209381	10.06894253	49.11835305	139.6272881	1.772520265	2.89450401		8.908723875	20.26918044	8.406377535																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																		0.069434491	0.069434491	0.179926982		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.069434491	0.069434491	0.179926982		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				19.9825	0.383866045	5.830755611	0	2.493165293	4.894608118	0.081249503	4.021524678	10.11266506	5.431241062	12.78010743	1.203514473	0.105131786	2.346063609	11.44457626	32.53315813	0.412997222	0.674419434	0	2.075732663	4.722719043	1.958685966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4887	0	0	19.9825	0.383866045	5.830755611	0	2.493165293	4.894608118	0.081249503	4.021524678	10.11266506	5.431241062	12.78010743	1.203514473	0.105131786	2.346063609	11.44457626	32.53315813	0.412997222	0.674419434	0	2.075732663	4.722719043	1.958685966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4887	NO																																																																																		0	0	0	19.9825	0.383866045	5.830755611	0	2.493165293	4.894608118	0.081249503	4.021524678	10.11266506	5.431241062	12.78010743	1.203514473	0.105131786	2.346063609	11.44457626	32.53315813	0.412997222	0.674419434	0	2.075732663	4.722719043	1.958685966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4887
H4506_808_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																										0	NO	287.7888748	5.528463472	32.40623249		10.70028023	21.0069018	0.348710315	17.25976257	43.40199597	23.31004747	54.8502465	5.165298168	0.451209381	10.06894253	49.11835305	139.6272881	1.772520265	2.89450401		8.908723875	20.26918044	8.406377535																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																		0.069434491	0.069434491	0.179926982		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.069434491	0.069434491	0.179926982		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				19.9825	0.383866045	5.830755611	0	2.493165293	4.894608118	0.081249503	4.021524678	10.11266506	5.431241062	12.78010743	1.203514473	0.105131786	2.346063609	11.44457626	32.53315813	0.412997222	0.674419434	0	2.075732663	4.722719043	1.958685966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4887	0	0	19.9825	0.383866045	5.830755611	0	2.493165293	4.894608118	0.081249503	4.021524678	10.11266506	5.431241062	12.78010743	1.203514473	0.105131786	2.346063609	11.44457626	32.53315813	0.412997222	0.674419434	0	2.075732663	4.722719043	1.958685966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4887	NO																																																																																		0	0	0	19.9825	0.383866045	5.830755611	0	2.493165293	4.894608118	0.081249503	4.021524678	10.11266506	5.431241062	12.78010743	1.203514473	0.105131786	2.346063609	11.44457626	32.53315813	0.412997222	0.674419434	0	2.075732663	4.722719043	1.958685966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4887
H4510_012_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.			DME/Prosthetics/Supplies	OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Prosthetics/Supplies	Renal Dialysis									A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V					O	O	P	O	O	O	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	YES	268.403771	9.264795	686.223508	2136.744152	269.105382	11.454611	2.213789	429.399067	323.662573	317.839467	2057.757294	84.351342	0.000244	189.61171	5183.119854	5252.372348	126.702857	1120.146712			50.326948	0			3.45					0.04	100.293133	19.472895	0.05	0.25	0.35	0.55	0.8	1.93			3400	$65/Admit:1a	$65/Admit:1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	0% Coins:11b	$50/Visit:4a	"$0-$50/Visit:9b. $0 Surgery ASC -- Physician,9b. $30 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $50 Surgery OP -- Facility"	"$0-$30/Visit:8a. $0 Lab -- FSL,8a. $30 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$30-$100/Visit:9d. $30 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$10/Visit:7b, 7d, 7f"	$10/Visit:7e	"$10-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $10 Therapy (AT,PT,ST,OT) - Specialist"			0% Coins:15				"$0 copay for 1 exam/fitting per year, $200 benefit"					$0: Nurse hotline 14a	:11b	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: OTC items 13c	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: Membership in health club/fitness class 14a			65	65	48.2281	0	100	0.2	0	50	41.640237	8.949714	43.476187	50	0.2	45.148861	5	10	10	12.48312			0	0			0					0	10	0	0	0	0	0	0	0			NO	62.050625	62.050625	36.008498	0	93.5586	0.187117	0	46.7793	38.958023	8.373227	40.675712	46.7793	0.187117	42.240642	4.67793	9.35586	9.35586	11.679033			0	0			0					0	9.35586	0	0	0	0	0	0	0				1.3879	0.047907193	2.059156485	0	2.098093566	2.143352446	0	1.673915648	1.050771164	0.221778501	6.975061921	0.328824728	4.57E-05	0.667443363	2.020522655	4.095038363	0.098784516	1.090185868	0	0	0	0	0	0	0	0	0	0	0	0	0.078194043	0	0	0	0	0	0	0	0	0	26.037	0	2.319019	1.3879	0.047907193	2.059156485	0	2.098093566	2.143352446	0	1.673915648	1.050771164	0.221778501	6.975061921	0.328824728	4.57E-05	0.667443363	2.020522655	4.095038363	0.098784516	1.090185868	0	0	0	0	0	0	0	0	0	0	0	0	0.078194043	0	0	0	0	0	0	0	0	0	26.037	NO																																																																																		0	0	0	1.3879	0.047907193	2.059156485	0	2.098093566	2.143352446	0	1.673915648	1.050771164	0.221778501	6.975061921	0.328824728	4.57E-05	0.667443363	2.020522655	4.095038363	0.098784516	1.090185868	0	0	0	0	0	0	0	0	0	0	0	0	0.078194043	0	0	0	0	0	0	0	0	0	26.037
H4510_015_0	2010	6	N/A	r.	s.	t.	u.	v.	w.					Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin			V					O	O	O	O	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	YES	1683.138635	46.822673	686.732608	1443.803062	259.40654	13.265116	4.538822	368.388595	350.195226	3456.01769	2192.119088	91.942433	23.682794	195.041592	5703.96955	5418.340682	67.021814	733.498379			50.26205	0			3.45					0.04	0.05	0.25	0.35	0.55	0.8	1.93					3400	$65/Day(Days 1-5):1a	$65/Day(Days 1-5):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$50/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$40/Visit:9b. $0 Surgery ASC -- Physician,9b. $30 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $40 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	"$0-$40/Proc:12. $0 Dialysis -- Dialysis Center,12. $40 Dialysis -- OP Hosp"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $20 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$20/Visit:7b, 7d, 7f"	$20/Visit:7e	"$20-$40/Visit:7i. $40 Therapy (AT,PT,ST,OT) -- OP,7i. $20 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"$0 copay for 1 exam/fitting per year, $200 benefit"					$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: OTC items 13c	$0: Health Education Materials 14a	$0: Nutritional benefit 14a	$0: Membership in health club/fitness class 14a					39.433615	32.93628	48.2281	0	50	0.2	0.082333	50	33.754369	1.472601	33.345559	50	1.392734	31.231778	5	20	20	22.489829			0.2	0			0					0	0	0	0	0	0	0					NO	36.490014	30.477686	31.889143	0	44.8845	0.179538	0.07391	44.8845	30.30096	1.32194	29.933975	44.8845	1.250244	28.036455	4.48845	17.9538	17.9538	20.188894			0.179538	0			0					0	0	0	0	0	0	0						5.1181	0.11892056	1.824942862	0	0.970277737	2.381592396	0.335464334	1.377911491	0.884270961	0.380720669	5.468236498	0.343899178	0.002467439	0.455689568	2.133498511	8.106650411	0.100274687	1.234043419	0	0	9.023947933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.261	0	5.141203	5.1181	0.11892056	1.824942862	0	0.970277737	2.381592396	0.335464334	1.377911491	0.884270961	0.380720669	5.468236498	0.343899178	0.002467439	0.455689568	2.133498511	8.106650411	0.100274687	1.234043419	0	0	9.023947933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.261	NO																																																																																		0	0	0	5.1181	0.11892056	1.824942862	0	0.970277737	2.381592396	0.335464334	1.377911491	0.884270961	0.380720669	5.468236498	0.343899178	0.002467439	0.455689568	2.133498511	8.106650411	0.100274687	1.234043419	0	0	9.023947933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.261
H4510_017_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.			DME/Prosthetics/Supplies	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Prosthetics/Supplies										A	A	D	V	T	O	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin	T	Coin	V				O	O	O	O	O	O	O	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	0			0	NO	515.458798	48.383422	1375.519776	1851.311992	634.454013	2421.040289	3.098933	845.671784	546.470278	514.107972	2534.376066	107.710794	16.503825	494.042388	8262.558048	5834.941162	278.719166	1151.363263			65.810369	0	7.9	1.2	3.45				0.04	0.25	244.512634	0.05	0.55	1.93	0.32	0.35	0.4	0.8				$0/Admit:1a	$0/Admit:1b	$0/Day(Days 1-20) $0(Days 21-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	0% Coins:11b	$0/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			0% Coins:15		$0: Other - Transportation 10b	"DEN772: Dental 16a, 16b"	"$0 copay for 1 exam/fitting per year, $200 benefit"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0	0			NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0	0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H4510_018_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin								O	P	O	O	O	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	YES	1830.541563	106.139567	641.846693	1561.676219	244.805753	12.535155	3.177979	399.440971	245.869561	1666.982191	1543.012334	76.242059	0.018392	189.979704	5330.329018	3864.469235	81.780971	534.153323			29.850236	0								0.04	41.849659	0.05	0.25	0.35	0.42	0.55	1.93				7500	$175/Day(Days 1-5):1a	$175/Day(Days 1-5):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $20 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15									$0: Nurse hotline 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: OTC items 13c	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				106.167425	88.6746	48.2281	0	100	0.2	0.065926	50	100	3.744598	41.081202	50	0.2	35.223118	10	30	30	32.393626			0.2	0								0	0	0	0	0	0	0	0				NO	102.919976	85.962221	44.326833	0	95.0705	0.190141	0.062676	47.53525	95.0705	3.560008	39.056104	47.53525	0.190141	33.486795	9.50705	28.52115	28.52115	30.796782			0.190141	0								0	0	0	0	0	0	0	0					15.6999	0.760332743	2.370919264	0	1.939483778	2.383446907	0.199183012	1.582293868	1.947911842	0.494539161	5.022004182	0.302015445	0.003497073	0.53015095	4.222975374	9.18492556	0.194373945	1.370850287	0	0	5.675753723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8846	0	2.545594	15.6999	0.760332743	2.370919264	0	1.939483778	2.383446907	0.199183012	1.582293868	1.947911842	0.494539161	5.022004182	0.302015445	0.003497073	0.53015095	4.222975374	9.18492556	0.194373945	1.370850287	0	0	5.675753723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8846	NO																																																																																		0	0	0	15.6999	0.760332743	2.370919264	0	1.939483778	2.383446907	0.199183012	1.582293868	1.947911842	0.494539161	5.022004182	0.302015445	0.003497073	0.53015095	4.222975374	9.18492556	0.194373945	1.370850287	0	0	5.675753723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8846
H4510_019_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.			DME/Prosthetics/Supplies	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Prosthetics/Supplies										A	A	D	V	T	O	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin	T	Coin	V				O	O	O	O	O	O	O	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	0			0	NO	489.06463	31.395637	1349.84683	1562.665219	635.73201	2223.778226	2.61965	990.089209	435.796611	798.499568	2272.770579	117.827996	10.1934	595.9308	8112.09787	3370.4833	131.368643	960.947821			54.783904	0	7.9	2.24	2.47				0.04	0.25	106.412274	0.05	0.55	1.93	0.32	0.35	0.4	0.42				$0/Admit:1a	$0/Admit:1b	$0/Day(Days 1-20) $0(Days 21-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	0% Coins:11b	$0/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			0% Coins:15		$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS735: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0	0			NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0	0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H4510_020_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered		Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin								O	P	O	O	O	O	O	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	YES	1622.665722	45.140397	662.059227	1391.929156	250.086411	13.317903	4.556884	355.152887	337.613182	3331.847613	2113.359191	88.639065	0.037223	188.03401	5499.033577	5223.666972	64.61381	707.144767			50.462066	0								0.04	22.036934	0.05	0.25	0.32	0.35	0.4	0.42	0.55	1.93		3400	$175/Day(Days 1-5):1a	$175/Day(Days 1-5):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $20 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15									$0: Nurse hotline 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a		106.167425	88.6746	48.2281	0	100	0.2	0.082333	50	100	1.472601	33.345559	50	0.2	31.231778	10	30	30	32.489829			0.2	0								0	0	0	0	0	0	0	0	0	0		NO	91.675784	76.570694	27.231756	0	85.1325	0.170265	0.070092	42.56625	85.1325	1.253662	28.387908	42.56625	0.170265	26.588393	8.51325	25.53975	25.53975	27.659404			0.170265	0								0	0	0	0	0	0	0	0	0	0			12.3966	0.28803596	1.502419611	0	1.774206782	2.267572754	0.319401113	1.259793881	2.395154518	0.348084229	4.99948719	0.314419383	0.006337774	0.416626846	3.901220633	11.11759571	0.137518379	1.629933566	0	0	8.591923667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6663	0	10.058165	12.3966	0.28803596	1.502419611	0	1.774206782	2.267572754	0.319401113	1.259793881	2.395154518	0.348084229	4.99948719	0.314419383	0.006337774	0.416626846	3.901220633	11.11759571	0.137518379	1.629933566	0	0	8.591923667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6663	NO																																																																																		0	0	0	12.3966	0.28803596	1.502419611	0	1.774206782	2.267572754	0.319401113	1.259793881	2.395154518	0.348084229	4.99948719	0.314419383	0.006337774	0.416626846	3.901220633	11.11759571	0.137518379	1.629933566	0	0	8.591923667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6663
H4510_021_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.			DME/Prosthetics/Supplies	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Prosthetics/Supplies										A	A	D	V	T	O	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin	T						O	O	O	O	O	O	O	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	NO	715.367934	52.285914	1934.424224	1608.492527	899.414216	2197.43258	2.134851	1155.204338	555.557186	1042.155759	3434.089243	196.229324	16.975966	956.564825	11110.35589	4654.171196	218.779754	1400.324218			65.192233	0	7.9						0.04	0.25	177.217718	0.05	0.55	1.93	0.32	0.35	0.4	0.42				$0/Admit:1a	$0/Admit:1b	$0/Day(Days 1-20) $0(Days 21-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	0% Coins:11b	$0/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			0% Coins:15		$0: Other - Transportation 10b						$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0						0	0	0	0	0	0	0	0	0	0			NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0						0	0	0	0	0	0	0	0	0	0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H4510_022_0	2010	6	N/A	r.	s.	t.	u.	v.	w.					Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin			V					O	O	O	O	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	YES	1694.992205	47.152424	691.56895	1453.971102	261.233421	11.885704	4.066839	370.982986	352.66149	3480.356831	2207.557173	92.589941	23.849582	196.415181	5744.139979	5456.49956	67.493818	738.66407			45.035406	0			1.5					0.04	0.05	0.25	0.35	0.42	0.55	1.93					4000	$125/Day(Days 1-5):1a	$125/Day(Days 1-5):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$200/Visit:8a. $0 Lab -- FSL,8a. $200 Lab -- OP"	"$0-$200/Visit:14h. $200 DMAM -- OP,8b. $0 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $200 Radiology OP -- Facility"	$200/Visit:9a	"$0-$40/Proc:12. $0 Dialysis -- Dialysis Center,12. $40 Dialysis -- OP Hosp"	"$15-$200/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $200 OP Other,5. $20 Partial Hospitalization,7h. $200 Psych -- OP,8b. $200 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$40/Visit:7i. $40 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"VIS734: Vision 7a, 7b"					$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: OTC items 13c	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a					75.833875	63.339	48.2281	0	100	0.2	0.082333	50	168.771846	5.890406	53.515858	200	1.392736	80.294454	0	30	30	31.244914			0.2	0			0					0	0	0	0	0	0	0					NO	68.565577	57.268274	31.180962	0	87.6477	0.175295	0.072163	43.82385	147.924641	5.162805	46.905418	175.2954	1.220701	70.376242	0	26.29431	26.29431	27.385449			0.175295	0			0					0	0	0	0	0	0	0						9.6848	0.225028161	1.796982096	0	1.908042376	2.083504483	0.293475303	1.354825228	4.347277025	1.497366971	8.628865997	1.352549229	0.002426101	1.151913526	0	11.95624091	0.147891948	1.685720601	0	0	7.894481495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0114	0	8.276839	9.6848	0.225028161	1.796982096	0	1.908042376	2.083504483	0.293475303	1.354825228	4.347277025	1.497366971	8.628865997	1.352549229	0.002426101	1.151913526	0	11.95624091	0.147891948	1.685720601	0	0	7.894481495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0114	NO																																																																																		0	0	0	9.6848	0.225028161	1.796982096	0	1.908042376	2.083504483	0.293475303	1.354825228	4.347277025	1.497366971	8.628865997	1.352549229	0.002426101	1.151913526	0	11.95624091	0.147891948	1.685720601	0	0	7.894481495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0114
H4510_023_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.			DME/Prosthetics/Supplies	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Prosthetics/Supplies										A	A	D	V	T	O	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin	T	Coin	V				O	O	O	O	O	O	O	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	0			0	NO	570.331533	41.68527	1542.231738	1282.380667	717.063575	1751.916785	2.091684	920.99384	442.92142	830.865157	2737.848997	156.445049	13.534194	762.627253	8857.800302	3710.566919	174.423519	1116.417188			63.874052	0	7.9	2.24	2.47				0.04	0.25	141.287927	0.05	0.55	1.93	0.32	0.35	0.4	0.42				$0/Admit:1a	$0/Admit:1b	$0/Day(Days 1-20) $0(Days 21-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	0% Coins:11b	$0/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			0% Coins:15		$0: Other - Transportation 10b	"DEN766: Dental 16a, 16b"	"VIS735: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0	0			NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0	0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H4510_024_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.	y.			DME/Prosthetics/Supplies	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Prosthetics/Supplies										A	A	D	V	T	O	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin	T	Coin	V				O	O	O	O	O	O	O	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	0			0	NO	633.006593	46.266162	1711.711174	1423.304463	795.863361	1944.438998	2.116932	1022.203997	491.595086	922.170863	3038.717595	173.637159	15.021498	846.434137	9831.204597	4118.329755	193.591325	1239.102871			64.645053	0	7.9	1.2	3.45				0.04	0.25	156.814386	0.05	0.55	1.93	0.32	0.35	0.4	0.8				$0/Admit:1a	$0/Admit:1b	$0/Day(Days 1-20) $0(Days 21-100):2	$0/Visit:6	$0/Trip:10a	$0/Service:11a	0% Coins:11b	$0/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			0% Coins:15		$0: Other - Transportation 10b	"DEN772: Dental 16a, 16b"	"$0 copay for 1 exam/fitting per year, $200 benefit"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Service:11b	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0	0			NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0				0	0	0	0	0	0	0	0	0	0				0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H4510_801_0	2010	4	N/A																															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	NO	281.547136	1.732587	27.118175	13.11799	6.389694	6.218627	2.628432	25.741234	72.776382	10.464724	34.310248	5.311651	1.13253	18.745512	86.902157	107.803691	0.377129	7.331742			27.713203	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																			0.075169776	0.075169776	0.189601012	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.075169776	0.075169776	0.189601012	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.1638	0.130238177	5.141633432	0	1.488798702	1.448940091	0.612424656	5.997707522	16.95689701	2.438280692	7.994287784	1.237614683	0.26387949	4.367704296	20.24820258	25.11826	0.087871057	1.708295886	0	0	6.457176299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.862	0	0	21.1638	0.130238177	5.141633432	0	1.488798702	1.448940091	0.612424656	5.997707522	16.95689701	2.438280692	7.994287784	1.237614683	0.26387949	4.367704296	20.24820258	25.11826	0.087871057	1.708295886	0	0	6.457176299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.862	NO																																																																																		0	0	0	21.1638	0.130238177	5.141633432	0	1.488798702	1.448940091	0.612424656	5.997707522	16.95689701	2.438280692	7.994287784	1.237614683	0.26387949	4.367704296	20.24820258	25.11826	0.087871057	1.708295886	0	0	6.457176299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.862
H4510_802_0	2010	4	N/A																															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	NO	281.547136	1.732587	27.118175	13.11799	6.389694	6.218627	2.628432	25.741234	72.776382	10.464724	34.310248	5.311651	1.13253	18.745512	86.902157	107.803691	0.377129	7.331742			27.713203	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																			0.075169776	0.075169776	0.189601012	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.075169776	0.075169776	0.189601012	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.1638	0.130238177	5.141633432	0	1.488798702	1.448940091	0.612424656	5.997707522	16.95689701	2.438280692	7.994287784	1.237614683	0.26387949	4.367704296	20.24820258	25.11826	0.087871057	1.708295886	0	0	6.457176299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.862	0	0	21.1638	0.130238177	5.141633432	0	1.488798702	1.448940091	0.612424656	5.997707522	16.95689701	2.438280692	7.994287784	1.237614683	0.26387949	4.367704296	20.24820258	25.11826	0.087871057	1.708295886	0	0	6.457176299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.862	NO																																																																																		0	0	0	21.1638	0.130238177	5.141633432	0	1.488798702	1.448940091	0.612424656	5.997707522	16.95689701	2.438280692	7.994287784	1.237614683	0.26387949	4.367704296	20.24820258	25.11826	0.087871057	1.708295886	0	0	6.457176299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.862
H4510_803_0	2010	4	N/A																															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	NO	281.547136	1.732587	27.118175	13.11799	6.389694	6.218627	2.628432	25.741234	72.776382	10.464724	34.310248	5.311651	1.13253	18.745512	86.902157	107.803691	0.377129	7.331742			27.713203	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																			0.075169776	0.075169776	0.189601012	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.075169776	0.075169776	0.189601012	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.1638	0.130238177	5.141633432	0	1.488798702	1.448940091	0.612424656	5.997707522	16.95689701	2.438280692	7.994287784	1.237614683	0.26387949	4.367704296	20.24820258	25.11826	0.087871057	1.708295886	0	0	6.457176299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.862	0	0	21.1638	0.130238177	5.141633432	0	1.488798702	1.448940091	0.612424656	5.997707522	16.95689701	2.438280692	7.994287784	1.237614683	0.26387949	4.367704296	20.24820258	25.11826	0.087871057	1.708295886	0	0	6.457176299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.862	NO																																																																																		0	0	0	21.1638	0.130238177	5.141633432	0	1.488798702	1.448940091	0.612424656	5.997707522	16.95689701	2.438280692	7.994287784	1.237614683	0.26387949	4.367704296	20.24820258	25.11826	0.087871057	1.708295886	0	0	6.457176299	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.862
H4513_001_0	2010	5	N/A																															A	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	V	V	Coin	O																																																											0	NO	229.3842088	47.86854572	771.5983261	1712.840219	433.6444796	9.948322228	0.326140357	217.2503175	257.5969717	529.1742276	65.82400272	135.7527607	8.283470006	440.6880003	5392.141654	7402.241896	1.386989375	450.0485015	1695.764901	1451.926591	28.05405592	0																				$300 per admit	"$150 per day, days 1-7"	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	$200 Amb. Surg and $300 OP Hosp Surg per visit	No Cost Sharing	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	No Cost Sharing	$30 copay	$30 copay	$5 copay	$30 copay	20% Coinsurance	$30 copay	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	$30 copay	15% Coinsurance	No Cost Sharing																			300	150	25	0	50	0.1	0.1	50	250.0700035	0	24.13	0	30	30	5	30	0.2	30	24.13	30	0.15	0																			NO	285.3	142.65	23.775	0	47.55	0.0951	0.0951	50	237.8165733	0	22.94763	0	28.53	28.53	5	30	0.2	30	24.13	30	0.14265	0																				5.4536	0.569037337	1.528729184	0	1.71831625	0.946085444	0.031015948	0.905209656	5.105069093	0	0.125875405	0	0.01969395	1.047735721	2.246725689	18.50560474	0.277397875	1.125121254	3.409900588	3.629816478	4.001911077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6469	0	1.05	5.4536	0.569037337	1.528729184	0	1.71831625	0.946085444	0.031015948	0.905209656	5.105069093	0	0.125875405	0	0.01969395	1.047735721	2.246725689	18.50560474	0.277397875	1.125121254	3.409900588	3.629816478	4.001911077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6469	NO																																																																																		0	0	0	5.4536	0.569037337	1.528729184	0	1.71831625	0.946085444	0.031015948	0.905209656	5.105069093	0	0.125875405	0	0.01969395	1.047735721	2.246725689	18.50560474	0.277397875	1.125121254	3.409900588	3.629816478	4.001911077	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6469
H4513_009_0	2010	2	N/A																															A	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	V	V	V	V	O	O																																																			0	NO	183.2655612	3.894718628	585.632641	1062.66371	345.9220218	6.143862468	0.096766685	198.2528327	176.3270643	466.3749641	40.81209775	68.42028153	0	336.0996285	4066.365694	5159.76982	1.083850839	240.9989022	1158.739465	900.9694233	13.48843307	0	370.3479576																			$500 per admit	"$150 per day, days 1-7"	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	$200 Amb. Surg and $300 OP Hosp Surg per visit	No Cost Sharing	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	No Cost Sharing	$35 copay	$35 copay	$15 copay	$35 copay	20% coinsurance	$35 copay	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	$35 copay	10% Coinsurance	No Cost Sharing	No Cost Sharing																		500	150	25	0	50	0.1	0.1	50	250.0700035	30	24.13	0	35	35	15	35	0.2	35	24.13	35	0.1	0	0																		NO	475.5	142.65	23.775	0	47.55	0.0951	0.0951	50	237.8165733	28.53	22.94763	0	33.285	33.285	15	35	0.2	35	24.13	35	0.0951	0	0																			7.2619	0.046298468	1.16028467	0	1.370716011	0.584281321	0.009202512	0.82605347	3.494458185	1.108806477	0.078045077	0	0	0.932256345	5.082957117	15.04932864	0.216770168	0.702913465	2.33003194	2.627827485	1.282749985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1649	0	0.91	7.2619	0.046298468	1.16028467	0	1.370716011	0.584281321	0.009202512	0.82605347	3.494458185	1.108806477	0.078045077	0	0	0.932256345	5.082957117	15.04932864	0.216770168	0.702913465	2.33003194	2.627827485	1.282749985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1649	NO																																																																																		0	0	0	7.2619	0.046298468	1.16028467	0	1.370716011	0.584281321	0.009202512	0.82605347	3.494458185	1.108806477	0.078045077	0	0	0.932256345	5.082957117	15.04932864	0.216770168	0.702913465	2.33003194	2.627827485	1.282749985	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1649
H4513_010_0	2010	6	N/A																																																																																																															0	NO																																																																																																																										NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H4513_014_0	2010	5	N/A																															A	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	V	V	V	V	O	O																																																			0	NO	185.980141	69.05822523	364.8692081	1408.214874	227.7534279	8.43067178	0.28423572	154.1743936	307.5135622	1199.303455	63.44493302	61.91613945	167.4028956	473.9260057	7903.997114	7281.850863	1.276747682	721.2023313	1621.616424	1104.135814	21.60511611	0	0	0	0	0	0	0	0	0												$500 per admit	"$125 per day, days 1-7"	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	$200 Amb. Surg and $300 OP Hosp Surg per visit	No Cost Sharing	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	No Cost Sharing	$35 copay	$35 copay	$15 copay	$35 copay	20% Coinsurance	$35 copay	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	$35 copay	15% Coinsurance	No Cost Sharing	No Cost Sharing	0	0	0	0	0	0	0											500	125	25	0	50	0.1	0.1	50	250.0700035	0	24.13	0	35	35	15	35	0.2	35	24.13	35	0.15	0	0	0	0	0	0	0	0	0											NO	475.5	118.875	23.775	0	47.55	0.0951	0.0951	50	237.8165733	0	22.94763	0	33.285	33.285	15	35	0.2	35	24.13	35	0.14265	0	0	0	0	0	0	0	0	0												7.3695	0.684108044	0.722897119	0	0.902472958	0.801756886	0.027030817	0.642393307	6.094318467	0	0.121325904	0	0.464333782	1.314552258	9.879996392	21.23873168	0.255349536	2.1035068	3.260800359	3.220396125	3.081969812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1854	0	1.1	7.3695	0.684108044	0.722897119	0	0.902472958	0.801756886	0.027030817	0.642393307	6.094318467	0	0.121325904	0	0.464333782	1.314552258	9.879996392	21.23873168	0.255349536	2.1035068	3.260800359	3.220396125	3.081969812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1854	NO																																																																																		0	0	0	7.3695	0.684108044	0.722897119	0	0.902472958	0.801756886	0.027030817	0.642393307	6.094318467	0	0.121325904	0	0.464333782	1.314552258	9.879996392	21.23873168	0.255349536	2.1035068	3.260800359	3.220396125	3.081969812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1854
H4513_019_0	2010	6	N/A																															A	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	V	V	V	V	O	O																																																			0	NO	322.8325033	80.07452824	982.2820548	2811.263614	525.8617537	15.30446193	0.500511084	256.4863228	325.5059939	1105.130737	120.977892	157.5148393	21.11023619	820.0514829	9274.264104	9710.118993	0.982728789	556.0050135	2253.150984	1816.065063	42.8294883	0	0	0	0	0	0	0	0	0												$650 per admit	"$75 per day, days 1-7"	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	$200 Amb. Surg and $300 OP Hosp Surg per visit	No Cost Sharing	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	No Cost Sharing	$35 copay	$35 copay	$10 copay	$35 copay	20% coinsurance	$35 copay	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	$35 copay	15% Coinsurance	No Cost Sharing	No Cost Sharing	0	0	0	0	0	0	0											650	75	25	0	50	0.1	0.1	50	250.0700035	0	24.13	0	35	35	10	35	0.2	35	24.13	35	0.15	0	0	0	0	0	0	0	0	0											NO	579.8	66.9	22.3	0	44.6	0.0892	0.0892	50	223.0624431	0	21.52396	0	31.22	31.22	10	35	0.2	35	24.13	35	0.1338	0	0	0	0	0	0	0	0	0												15.5982	0.446415495	1.825407485	0	1.954452851	1.365158005	0.044645589	1.068693012	6.050680188	0	0.216993609	0	0.054921798	2.133500608	7.72855342	28.3211804	0.196545758	1.621681289	4.530711104	5.296856434	5.730585534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1852	0	4.27	15.5982	0.446415495	1.825407485	0	1.954452851	1.365158005	0.044645589	1.068693012	6.050680188	0	0.216993609	0	0.054921798	2.133500608	7.72855342	28.3211804	0.196545758	1.621681289	4.530711104	5.296856434	5.730585534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1852	NO																																																																																		0	0	0	15.5982	0.446415495	1.825407485	0	1.954452851	1.365158005	0.044645589	1.068693012	6.050680188	0	0.216993609	0	0.054921798	2.133500608	7.72855342	28.3211804	0.196545758	1.621681289	4.530711104	5.296856434	5.730585534	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1852
H4513_020_0	2010	3	N/A																															A	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	V	V	V	V	O	O																																																			0	NO	302.2138713	58.97500587	523.4956422	1733.168514	444.0055211	14.90717709	0.228482957	174.133208	454.4655665	4468.736705	76.05668398	155.1556353	2.02817824	531.8897433	7404.051784	11057.27757	1.21077288	879.7959416	3336.448403	2650.589658	22.72826591	0	0	0	0	0	0	0	0	0												$550 per admit	"$175 per day, days 1-7"	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	$200 Amb. Surg and $300 OP Hosp Surg per visit	No Cost Sharing	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	No Cost Sharing	$40 copay	$40 copay	$15 copay	$40 copay	20% coinsurance	$40 copay	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	$40 copay	15% Coinsurance	No Cost Sharing	No Cost Sharing	0	0	0	0	0	0	0											550	175	25	0	50	0.1	0.1	50	250.0700035	0	24.13	0	40	40	15	40	0.2	40	24.13	40	0.15	0	0	0	0	0	0	0	0	0											NO	523.05	166.425	23.775	0	47.55	0.0951	0.0951	50	237.8165733	0	22.94763	0	38.04	38.04	15	40	0.2	40	24.13	40	0.14265	0	0	0	0	0	0	0	0	0												13.1727	0.817909613	1.037175741	0	1.759371877	1.417672541	0.021728729	0.725555033	9.00662031	0	0.145443387	0	0.006429325	1.686090486	9.255064731	36.85759191	0.242154576	2.932653139	6.709041664	8.835298859	3.242187133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8707	0	1.58	13.1727	0.817909613	1.037175741	0	1.759371877	1.417672541	0.021728729	0.725555033	9.00662031	0	0.145443387	0	0.006429325	1.686090486	9.255064731	36.85759191	0.242154576	2.932653139	6.709041664	8.835298859	3.242187133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8707	NO																																																																																		0	0	0	13.1727	0.817909613	1.037175741	0	1.759371877	1.417672541	0.021728729	0.725555033	9.00662031	0	0.145443387	0	0.006429325	1.686090486	9.255064731	36.85759191	0.242154576	2.932653139	6.709041664	8.835298859	3.242187133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8707
H4513_022_0	2010	6	N/A																															A	D	D	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	V	V	V	V	O	O																																																			0	NO	270.5849579	40.90105258	973.0268298	1614.077582	520.2154586	10.16406206	0.585819927	278.8194762	260.3371885	349.7964327	69.46153715	153.576604	9.895890223	459.2073675	5407.13262	7818.660375	1.402221686	485.0144873	1838.773412	1495.637455	35.54710028	0	970.1717555	0	0	0	0	0	0	0												$550 per admit	"$150 per day, days 1-7"	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	$200 Amb. Surg and $300 OP Hosp Surg per visit	No Cost Sharing	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	No Cost Sharing	$35 copay	$35 copay	$10 copay	$35 copay	20% coinsurance	$35 copay	"$0 copay for all x-rays; $100 copay for CAT scans, MRI's, and Cardiac Nuclear Medecine; $150 copay for PET scans"	$35 copay	15% Coinsurance	No Cost Sharing	No Cost Sharing	0	0	0	0	0	0	0											550	150	25	0	50	0.1	0.1	50	250.0700035	0	24.13	0	35	35	10	35	0.2	35	24.13	35	0.15	0	0	0	0	0	0	0	0	0											NO	523.05	142.65	23.775	0	47.55	0.0951	0.0951	50	237.8165733	0	22.94763	0	33.285	33.285	10	35	0.2	35	24.13	35	0.14265	0	0	0	0	0	0	0	0	0												11.7941	0.486211263	1.927809406	0	2.061353755	0.966602302	0.055711475	1.161747817	5.159374839	0	0.132831471	0	0.027448726	1.273726436	4.50594385	22.80442609	0.280444337	1.414625588	3.697466869	4.362275912	5.070793855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1829	0	1.43	11.7941	0.486211263	1.927809406	0	2.061353755	0.966602302	0.055711475	1.161747817	5.159374839	0	0.132831471	0	0.027448726	1.273726436	4.50594385	22.80442609	0.280444337	1.414625588	3.697466869	4.362275912	5.070793855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1829	NO																																																																																		0	0	0	11.7941	0.486211263	1.927809406	0	2.061353755	0.966602302	0.055711475	1.161747817	5.159374839	0	0.132831471	0	0.027448726	1.273726436	4.50594385	22.80442609	0.280444337	1.414625588	3.697466869	4.362275912	5.070793855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1829
H4513_802_0	2010	1	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			11.5125	0.5957	4.2786	0	0.211	0.3589	0.0102	0.2847	0.955	0.1147	0.0389	0.6241	0.0088	0.6896	5.492	0.4566	0	0.03	0.0345	0.455	1.6038	0																			27.7546	NO	1079.960526	55.87892899	770.4681787	1065.225219	6.410002002	10.90411842	0.31126034	9.309115738	29.03256092	3.485773262	1.182835593	18.95915471	0.268429757	20.95069739	277.279542	23.05108526	0	1.513393158	1.742402954	22.97323138	48.59888552	0																				Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits																			9.628457365	9.628457365	5.015811542	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																			NO	9.628457365	9.628457365	5.015811542	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																				0.8665	0.044835657	0.322043599	0	1.2820004	2.180823684	0.062252068	1.861823148	5.806512183	0.697154652	0.236567119	3.791830941	0.053685951	4.190139478	55.4559084	4.610217052	0	0.302678632	0.348480591	4.594646276	9.719777104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4279	0		12.379	0.640509387	4.600622838	0	1.492991971	2.539743552	0.072497511	2.146559502	6.761471493	0.811892335	0.275501325	4.415890314	0.062521583	4.879752453	60.94793834	5.066786078	0	0.332654159	0.382992077	5.049673263	11.32354033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.1825	NO																																																																																		0			12.379	0.640509387	4.600622838	0	1.492991971	2.539743552	0.072497511	2.146559502	6.761471493	0.811892335	0.275501325	4.415890314	0.062521583	4.879752453	60.94793834	5.066786078	0	0.332654159	0.382992077	5.049673263	11.32354033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.1825
H4513_804_0	2010	1	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			11.5125	0.5957	4.2786	0	0.211	0.3589	0.0102	0.2847	0.955	0.1147	0.0389	0.6241	0.0088	0.6896	5.492	0.4566	0	0.03	0.0345	0.455	1.6138	0																			27.7646	NO	1079.960526	55.87892899	770.4681787	1065.225219	6.410002002	10.90411842	0.31126034	9.309115738	29.03256092	3.485773262	1.182835593	18.95915471	0.268429757	20.95069739	277.279542	23.05108526	0	1.513393158	1.742402954	22.97323138	48.54888552	0																				Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits																			9.628457365	9.628457365	5.015811542	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																			NO	9.628457365	9.628457365	5.015811542	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																				0.8665	0.044835657	0.322043599	0	1.2820004	2.180823684	0.062252068	1.861823148	5.806512183	0.697154652	0.236567119	3.791830941	0.053685951	4.190139478	55.4559084	4.610217052	0	0.302678632	0.348480591	4.594646276	9.709777104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4179	0		12.379	0.640509387	4.600622838	0	1.492991971	2.539743552	0.072497511	2.146559502	6.761471493	0.811892335	0.275501325	4.415890314	0.062521583	4.879752453	60.94793834	5.066786078	0	0.332654159	0.382992077	5.049673263	11.32354033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.1825	NO																																																																																		0			12.379	0.640509387	4.600622838	0	1.492991971	2.539743552	0.072497511	2.146559502	6.761471493	0.811892335	0.275501325	4.415890314	0.062521583	4.879752453	60.94793834	5.066786078	0	0.332654159	0.382992077	5.049673263	11.32354033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.1825
H4514_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2232.789782	423.6461558	385.6915539	355.3831859	406.8513111	15.38087499	13.89133562	554.8680575	208.549091	6833.194471	4162.096001	0	0.344052778	1098.015142	5170.341369	2636.581375	1408.197554	335.9585391	0	0	8.606906215	452.6145904	532.2684786	237.4101151	617.8187481	561.0874576	16.96689355	0.450165535	73.24103043	0											2500	"$125 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $0 (4b)"	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 9a, 9c, 9d); $30 (5)"	"$0 (7a, 7a1, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											115.5040857	107.7736219	0	0	50	0.2	0.2	49.92947924	0	0	0	0	0.2	0.007410808	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	105.7145997	106.9985827	0	0	42.79943308	0.171197732	0.171197732	42.7390681	0	0	0	0	0.171197732	0.006343567	0	0	0	0	0	0	0.171197732	0	0	0	0	0	0	0	0	0												19.6699	3.77746152	0	0	1.451083788	2.633170919	2.378165156	1.976211975	0	0	0	0	0.058901055	0.000580444	0	0	0	0	0	0	1.473482826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4189	0	5.622393356	19.6699	3.77746152	0	0	1.451083788	2.633170919	2.378165156	1.976211975	0	0	0	0	0.058901055	0.000580444	0	0	0	0	0	0	1.473482826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4189	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.6699	3.77746152	0	0	1.451083788	2.633170919	2.378165156	1.976211975	0	0	0	0	0.058901055	0.000580444	0	0	0	0	0	0	1.473482826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4189
H4514_004_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2700.708079	223.6683605	24.98328438	1221.355594	364.92289	16.72466768	22.56333549	648.5243335	399.1927841	12446.75432	54.65364441	0	0.226465727	2111.93482	7804.434001	5135.848374	898.8990601	465.2323358	0	0	39.87317039	699.0208844	580.1831765	0	8.916911952	0	17.26764822	4.74593894	78.3079925	0											2800	"$175 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$100 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $100 (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											158.6613559	122.8528282	0.17986366	0	150	0.2	0.12931862	49.97590527	100	3	0.176427499	0	0.2	39.80313152	11.66596767	25	38.5	25	0	0	0.2	24.75438042	0	0	25	0	0	0	0	0											NO	111.7481189	79.40180716	0.116248847	0	96.94747159	0.129263295	0.083580755	32.30025104	64.63164772	1.938949432	0.114028	0	0.129263295	25.79048133	11.65688832	25	38.5	16.15791193	0	0	0.129263295	24.75438042	0	0	25	0	0	0	0	0												25.1499	1.479972669	2.90427801	0	2.948195959	2.161885659	1.88586061	1.745624898	2.150040616	2.011135601	6.232045752	0	0.029273706	4.538984629	7.581284628	10.69968411	2.883967818	0.626431926	0	0	5.154137404	1.441985741	0	0	0.0185769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6433	0	32.28447037	25.1499	1.479972669	2.90427801	0	2.948195959	2.161885659	1.88586061	1.745624898	2.150040616	2.011135601	6.232045752	0	0.029273706	4.538984629	7.581284628	10.69968411	2.883967818	0.626431926	0	0	5.154137404	1.441985741	0	0	0.0185769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6433	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.1499	1.479972669	2.90427801	0	2.948195959	2.161885659	1.88586061	1.745624898	2.150040616	2.011135601	6.232045752	0	0.029273706	4.538984629	7.581284628	10.69968411	2.883967818	0.626431926	0	0	5.154137404	1.441985741	0	0	0.0185769	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.6433
H4514_007_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1718.102597	6.977769169	1013.264212	686.4778868	217.7827008	10.16629973	9.828193254	410.8543007	270.9872793	9772.392352	46.17611913	0	0.146407895	519.8933701	6148.351012	4620.698104	235.325926	362.8334327	0	0	21.64330653	967.0394945	0	0	120.1337166	0	17.53480143	4.725194747	77.96571332	0											2800	"$175 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$100 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $100 (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											158.6613559	122.8528282	76.91990366	0	150	0.2	0.125049013	49.71112748	100	3	0.173923449	0	0.2	39.49452761	10.1747084	25	38.5	25	0	0	0.2	24.20054524	0	0	25	0	0	0	0	0											NO	129.3536053	91.91125653	74.81411527	0	112.2211729	0.149628231	0.093554313	37.19094022	74.81411527	2.244423458	0.13011929	0	0.149628231	29.63979627	10.11237433	25	38.5	18.70352882	0	0	0.149628231	24.20054524	0	0	25	0	0	0	0	0												18.5202	0.053444628	6.317205464	0	2.036652511	1.521165439	0.919469867	1.273338145	1.689472796	1.82778222	6.008403829	0	0.021906754	1.284127798	5.181202245	9.626454383	0.755004012	0.56552213	0	0	3.238449659	1.950240253	0	0	0.250278576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0404	0	15.26897779	18.5202	0.053444628	6.317205464	0	2.036652511	1.521165439	0.919469867	1.273338145	1.689472796	1.82778222	6.008403829	0	0.021906754	1.284127798	5.181202245	9.626454383	0.755004012	0.56552213	0	0	3.238449659	1.950240253	0	0	0.250278576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0404	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.5202	0.053444628	6.317205464	0	2.036652511	1.521165439	0.919469867	1.273338145	1.689472796	1.82778222	6.008403829	0	0.021906754	1.284127798	5.181202245	9.626454383	0.755004012	0.56552213	0	0	3.238449659	1.950240253	0	0	0.250278576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0404
H4514_801_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	302.9452109	5.729298631	31.89317391	712.7380229	7.732439163	10.39590578	10.05016317	19.27189549	32.55798047	17.98611435	46.90803447	0	0.148728535	19.51418114	34.00936224	129.8635261	2.844961004	4.554446346	0	0	21.94971568	6.160864546	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071684692	0.071684692	0.1836188	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071684692	0.071684692	0.1836188	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834	0	0	21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834
H4514_803_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	302.9452109	5.729298631	31.89317391	712.7380229	7.732439163	10.39590578	10.05016317	19.27189549	32.55798047	17.98611435	46.90803447	0	0.148728535	19.51418114	34.00936224	129.8635261	2.844961004	4.554446346	0	0	21.94971568	6.160864546	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071684692	0.071684692	0.1836188	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071684692	0.071684692	0.1836188	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834	0	0	21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834
H4514_806_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	302.9452109	5.729298631	31.89317391	712.7380229	7.732439163	10.39590578	10.05016317	19.27189549	32.55798047	17.98611435	46.90803447	0	0.148728535	19.51418114	34.00936224	129.8635261	2.844961004	4.554446346	0	0	21.94971568	6.160864546	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071684692	0.071684692	0.1836188	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071684692	0.071684692	0.1836188	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834	0	0	21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834
H4514_810_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	302.9452109	5.729298631	31.89317391	712.7380229	7.732439163	10.39590578	10.05016317	19.27189549	32.55798047	17.98611435	46.90803447	0	0.148728535	19.51418114	34.00936224	129.8635261	2.844961004	4.554446346	0	0	21.94971568	6.160864546	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071684692	0.071684692	0.1836188	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071684692	0.071684692	0.1836188	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834	0	0	21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.7165	0.410703008	5.85618633	0	1.801658325	2.422246047	2.341688018	4.490351649	7.586009449	4.190764643	10.92957203	0	0.034653749	4.546804206	7.924181402	30.25820159	0.662875914	1.061185999	0	0	5.114283753	1.435481439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7834
H4520_001_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	P	O	O	O	O	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	YES	1293.578638	62.745218	504.800253	729.958314	47.691467	7.610373	6.142063	262.822129	440.664746	2931.276263	1874.967735	53.517059	0.004635	351.175555	3633.325809	5839.775297	85.489178	950.8823			37.742588	0			2.69				0.04	0.25	0	0.05	0.55	1.93	0.32	0.35	0.4	0.8			5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			158.7573	140.3991	48.2281	0	100	0.2	0.2	50	116.242423	8.985091	82.988623	100	0.2	66.25557	15	40	40	46.049773			0.2	0			0				0	0	0	0	0	0	0	0	0	0			NO	136.444914	120.666849	29.471951	0	84.3714	0.168743	0.168743	42.1857	98.07536	7.580847	70.018663	84.3714	0.168743	55.900752	12.65571	33.74856	33.74856	38.852838			0.168743	0			0				0	0	0	0	0	0	0	0	0	0				14.7085	0.630938979	1.23978736	0	0.33531632	1.284197171	1.036430137	0.923944624	3.601529467	1.851796405	10.94022783	0.376275766	0.000782124	1.635914801	3.831859815	16.42366725	0.240428054	3.07870633	0	0	6.368797527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5091	0	12.916687	14.7085	0.630938979	1.23978736	0	0.33531632	1.284197171	1.036430137	0.923944624	3.601529467	1.851796405	10.94022783	0.376275766	0.000782124	1.635914801	3.831859815	16.42366725	0.240428054	3.07870633	0	0	6.368797527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5091	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins			"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			7500	3.7503	0.1748	0.5156	1.9181	1.5923	1.5078	1.2169	0.1936	3.7403	0.4265	2.1074	0.2542	0.0002	0.4769	1.8744	4.7221	0.0352	0.3625			1.8859	0			0				0	0	0	0	0	0	0	0	0	0			26.755	500	5.793473	18.4589	0.805715979	1.75539236	1.918095	1.92764532	2.792020171	2.253341137	1.117513624	7.341817467	2.278273405	13.04758283	0.630483766	0.000954124	2.112803801	5.706280815	21.14580425	0.275624054	3.44121433	0	0	8.254713527	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.2641
H4520_002_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	O	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	YES	1255.12014	51.253095	302.232761	872.318783	38.504008	9.684707	4.094236	309.996175	408.709293	2232.370957	1551.252737	79.440614	0.085373	568.456747	3993.946399	4543.603284	110.65744	935.130411			27.248745	0							0.04	0.25	11.726737	0.05	0.55	1.93	0.32	0.35	0.4	0.8			3400	$100/Day(Days 1-5):1a	$100/Day(Days 1-5):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$30-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			60.6671	50.6712	48.2281	0	100	0.2	0.2	50	124.395832	16.399965	79.25439	100	0.2	80.025445	10	30	30	41.006663			0.2	0							0	0	0	0	0	0	0	0	0	0			NO	52.920882	44.201298	31.639177	0	83.9605	0.167921	0.167921	41.98025	104.443362	13.769493	66.542382	83.9605	0.167921	67.189764	8.39605	25.18815	25.18815	34.429399			0.167921	0							0	0	0	0	0	0	0	0	0	0				5.5352	0.188787777	0.796866318	0	0.269401314	1.626265684	0.687508203	1.08447641	3.55724772	2.561551355	8.60200435	0.555822806	0.01433592	3.18287289	2.794447805	9.537080088	0.23227135	2.68299817	0	0	4.575636509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4847	0	9.272278	5.5352	0.188787777	0.796866318	0	0.269401314	1.626265684	0.687508203	1.08447641	3.55724772	2.561551355	8.60200435	0.555822806	0.01433592	3.18287289	2.794447805	9.537080088	0.23227135	2.68299817	0	0	4.575636509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4847	YES	$150/Day(Days 1-5)	$150/Day(Days 1-5)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	1.3234	0.0451	0.3151	1.7272	0.9696	1.4472	0.6118	0.1722	3.0688	0.2914	1.6969	0.3649	0.0024	0.8632	1.6568	2.8673	0.0356	0.3108			1.0344	0							0	0	0	0	0	0	0	0	0	0			18.8041	0	6.421519	6.8586	0.233926777	1.111985318	1.727249	1.238992314	3.073442684	1.299306203	1.25667141	6.62605672	2.852917355	10.29885535	0.920679806	0.01673092	4.04607089	4.451241805	12.40439109	0.26789135	2.99378217	0	0	5.609993509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2888
H4520_003_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	O	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	YES	1091.77567	64.91882	428.864887	593.669513	30.148873	10.570385	3.825451	346.594242	385.97596	4189.332844	1307.142107	98.377508	0.104605	461.879096	3467.106127	5398.349877	119.125213	1010.23299			28.580055	0							0.04	0.25	12.121191	0.05	0.55	1.93	0.32	0.35	0.4	0.42			5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			158.7573	140.3991	48.2281	0	100	0.2	0.2	50	120.495093	7.059507	86.147227	100	0.2	67.6174	15	40	40	55.841972			0.2	0							0	0	0	0	0	0	0	0	0	0			NO	140.959654	124.659518	32.830459	0	86.2224	0.172445	0.172445	43.1112	103.893761	6.086876	74.278206	86.2224	0.172445	58.301345	12.93336	34.48896	34.48896	48.148288			0.172445	0							0	0	0	0	0	0	0	0	0	0				12.8247	0.674395734	1.173319257	0	0.216625682	1.822810041	0.659679898	1.245174474	3.341707845	2.124995795	8.091014225	0.70686207	0.018038609	2.244014377	3.736777642	15.51528941	0.342375392	4.053415746	0	0	4.928487584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7197	0	10.092029	12.8247	0.674395734	1.173319257	0	0.216625682	1.822810041	0.659679898	1.245174474	3.341707845	2.124995795	8.091014225	0.70686207	0.018038609	2.244014377	3.736777642	15.51528941	0.342375392	4.053415746	0	0	4.928487584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.7197	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			7500	3.271	0.1869	0.5045	2.018	1.0148	2.1113	0.7641	0.2573	3.7179	0.4038	2.3653	0.311	0.0039	0.4771	1.9207	4.8219	0.0625	0.4083			1.4541	0							0	0	0	0	0	0	0	0	0	0			26.0744	500	5.283896	16.0957	0.861267734	1.677820257	2.017971	1.231400682	3.934071041	1.423750898	1.502511474	7.059640845	2.528844795	10.45633622	1.01789007	0.021961609	2.721113377	5.657467642	20.33723141	0.404856392	4.461665746	0	0	6.382631584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7941
H4520_005_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	O	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	YES	1751.394262	68.179886	346.566101	566.122211	42.687567	9.173907	5.238585	301.417826	384.332388	2286.678487	1301.184527	129.203286	0.662289	477.834439	3605.907526	4955.380325	116.525971	856.054154			37.59058	0							0.04	0.25	0.789973	0.05	0.55	1.93	0.32	0.35	0.4	0.42			3400	$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			197.25885	150.313725	48.2281	0	100	0.2	0.2	50	127.696225	17.510817	85.510102	100	0.2	81.607267	15	40	40	60.514124			0.2	0							0	0	0	0	0	0	0	0	0	0			NO	124.681204	95.008646	19.097797	0	73.268	0.146536	0.146536	36.634	93.56047	12.829826	62.651542	73.268	0.146536	59.792013	10.9902	29.3072	29.3072	44.337488			0.146536	0							0	0	0	0	0	0	0	0	0	0				18.1972	0.539806554	0.551554087	0	0.260636055	1.344307636	0.767641292	0.920178386	2.996526571	2.444807259	6.793434754	0.788872197	0.097049181	2.380890249	3.302470408	12.10236019	0.284587495	3.162940898	0	0	5.508373231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4436	0	27.493426	18.1972	0.539806554	0.551554087	0	0.260636055	1.344307636	0.767641292	0.920178386	2.996526571	2.444807259	6.793434754	0.788872197	0.097049181	2.380890249	3.302470408	12.10236019	0.284587495	3.162940898	0	0	5.508373231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4436	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	3.6946	0.1382	0.2513	2.2854	1.196	1.5252	0.8709	0.1863	3.4178	0.3984	1.8518	0.6105	0.0207	0.8587	1.7854	3.9743	0.0409	0.3194			1.6135	0							0	0	0	0	0	0	0	0	0	0			25.0392	500	11.370432	21.8917	0.677992554	0.802842087	2.285393	1.456589055	2.869482636	1.638563292	1.106457386	6.414357571	2.843206259	8.645266754	1.399353197	0.117723181	3.239605249	5.087898408	16.07664819	0.325505495	3.482304898	0	0	7.121885231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.4828
H4520_006_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	O	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			0	YES	1361.366674	62.390781	502.946467	634.710433	32.396989	9.067521	3.17284	337.046108	397.314353	1436.129835	1341.446525	44.090007	0.000408	522.475201	4004.35302	4675.271074	148.100028	850.44781			35.439331	0		1.37	2.69				0.04	0.25	85.391169	0.05	0.55	1.93	0.32	0.35	0.4	0.42			3400	$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			197.25885	150.313725	48.2281	0	100	0.2	0.2	50	128.146276	18.704431	82.482133	100	0.2	83.069044	15	40	40	60.676049			0.2	0		0	0				0	0	0	0	0	0	0	0	0	0			NO	137.731061	104.952801	19.035293	0	75.8699	0.15174	0.15174	37.93495	97.224451	14.191033	62.579112	75.8699	0.15174	63.0244	11.380485	30.34796	30.34796	46.034857			0.15174	0		0	0				0	0	0	0	0	0	0	0	0	0				15.6252	0.545673935	0.797811114	0	0.204829693	1.375905637	0.481446742	1.065485605	3.21905582	1.698347157	6.995544361	0.278758702	6.19E-05	2.744057171	3.79762329	11.82374496	0.374544477	3.262520277	0	0	5.377564086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6682	0	21.79303	15.6252	0.545673935	0.797811114	0	0.204829693	1.375905637	0.481446742	1.065485605	3.21905582	1.698347157	6.995544361	0.278758702	6.19E-05	2.744057171	3.79762329	11.82374496	0.374544477	3.262520277	0	0	5.377564086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6682	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	3.1583	0.1391	0.2988	2.4396	0.9467	1.5724	0.5502	0.2173	3.9596	0.3435	1.79	0.3729	0	0.619	2.0854	3.7045	0.0443	0.3382			1.6003	0		0	0				0	0	0	0	0	0	0	0	0	0			24.18	500	9.757674	18.7835	0.684741935	1.096627114	2.439568	1.151537693	2.948266637	1.031635742	1.282747605	7.17870582	2.041869157	8.785525361	0.651656702	7.49E-05	3.363007171	5.88301329	15.52827396	0.418886477	3.600677277	0	0	6.977835086	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.8482
H4520_016_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	O	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	YES	1674.508795	35.863029	355.609205	918.311045	34.784329	12.113746	4.86213	371.390186	427.769079	1602.737153	1186.988132	71.043062	0.08667	783.780155	3692.803252	4180.983428	87.780827	714.835224			20.95271	0							0.04	0.25	11.706653	0.05	0.55	1.93	0.32	0.35	0.4	0.42			3400	$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			197.25885	150.313725	48.2281	0	100	0.2	0.2	50	128.926316	35.825531	83.666202	100	0.2	89.486811	15	40	40	59.850096			0.2	0							0	0	0	0	0	0	0	0	0	0			NO	129.313631	98.538613	19.785482	0	74.3935	0.148787	0.148787	37.19675	95.912799	26.651866	62.242216	74.3935	0.148787	66.572371	11.159025	29.7574	29.7574	44.524581			0.148787	0							0	0	0	0	0	0	0	0	0	0				18.0447	0.294491095	0.58632496	0	0.215643998	1.802367926	0.723421736	1.151208992	3.419044141	3.55966132	6.156730975	0.440428503	0.012895369	4.348175272	3.434006984	10.36793302	0.217677432	2.652311569	0	0	3.117490863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5445	0	24.804246	18.0447	0.294491095	0.58632496	0	0.215643998	1.802367926	0.723421736	1.151208992	3.419044141	3.55966132	6.156730975	0.440428503	0.012895369	4.348175272	3.434006984	10.36793302	0.217677432	2.652311569	0	0	3.117490863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5445	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	3.7621	0.0774	0.2664	2.7109	1.0295	2.1275	0.8539	0.2425	3.6894	0.401	1.7592	0.253	0.0029	0.9299	1.9329	3.1782	0.0316	0.2685			0.916	0							0	0	0	0	0	0	0	0	0	0			24.4327	500	9.690545	21.8069	0.371905095	0.85269796	2.710933	1.245127998	3.929853926	1.577336736	1.393673992	7.108416141	3.96065432	7.915913975	0.693427503	0.015753369	5.278045272	5.366894984	13.54613802	0.249296432	2.920786569	0	0	4.033531863	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.9772
H4520_018_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	P	O	O	O	O	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	YES	1668.481039	63.344728	484.158956	816.263657	54.616243	11.634451	4.897147	364.394223	428.656002	1361.62756	1261.074472	69.625334	0.086933	492.193493	4251.467687	4653.234683	120.041109	813.791634			21.450669	0			2.69				0.04	0.25	21.954964	0.05	0.55	1.93	0.32	0.35	0.4	0.42			3400	$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			197.25885	150.313725	48.2281	0	100	0.2	0.2	50	128.048797	32.922498	83.981587	100	0.2	81.817612	15	40	40	55.134939			0.2	0			0				0	0	0	0	0	0	0	0	0	0			NO	128.295578	97.762844	17.853416	0	74.1878	0.148376	0.148376	37.0939	94.996585	24.424477	62.304092	74.1878	0.148376	60.698686	11.12817	29.67512	29.67512	40.903398			0.148376	0			0				0	0	0	0	0	0	0	0	0	0				17.8382	0.516063397	0.720324271	0	0.337654909	1.726273302	0.726619083	1.126400239	3.393404694	2.771420085	6.547508327	0.430445863	0.012898771	2.489624857	3.942587931	11.50710813	0.29685286	2.773903591	0	0	3.182764464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3401	0	25.449085	17.8382	0.516063397	0.720324271	0	0.337654909	1.726273302	0.726619083	1.126400239	3.393404694	2.771420085	6.547508327	0.430445863	0.012898771	2.489624857	3.942587931	11.50710813	0.29685286	2.773903591	0	0	3.182764464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3401	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins			"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	3.6807	0.1343	0.2804	2.7691	1.5933	2.014	0.8477	0.2345	3.7196	0.3535	1.6957	0.2542	0.0028	0.6591	2.2696	3.5168	0.0388	0.324			0.9269	0			0				0	0	0	0	0	0	0	0	0	0			25.3151	500	10.545041	21.519	0.650324397	1.000713271	2.76905	1.930928909	3.740308302	1.574362083	1.360889239	7.112993694	3.124967085	8.243233327	0.684597863	0.015724771	3.148754857	6.212165931	15.02386513	0.33568986	3.097941591	0	0	4.109666464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6551
H4520_020_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	P	O	O	O	O	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	YES	1261.384186	54.503408	420.26555	591.62987	36.934995	9.20768	3.930089	310.854214	381.754862	1783.251262	1171.455529	70.122165	0.130084	556.772138	3486.544436	4345.759366	103.957813	831.78334			27.534663	0			2.69				0.04	0.25	17.791372	0.05	0.55	1.93	0.32	0.35	0.4	0.42			3400	$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			197.25885	150.313725	48.2281	0	100	0.2	0.2	50	126.788993	24.77636	82.950976	100	0.2	80.565864	15	40	40	56.091744			0.2	0			0				0	0	0	0	0	0	0	0	0	0			NO	143.707806	109.507156	21.359068	0	77.3986	0.154797	0.154797	38.6993	98.132906	19.176555	64.202894	77.3986	0.154797	62.356851	11.60979	30.95944	30.95944	43.414224			0.154797	0			0				0	0	0	0	0	0	0	0	0	0				15.1059	0.4973761	0.748040038	0	0.238226409	1.425321241	0.608365987	1.002486707	3.121892832	2.849717992	6.267569596	0.452279783	0.020136613	2.893213104	3.373170727	11.21185636	0.268206306	3.00926902	0	0	4.262283228	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3553	0	18.729095	15.1059	0.4973761	0.748040038	0	0.238226409	1.425321241	0.608365987	1.002486707	3.121892832	2.849717992	6.267569596	0.452279783	0.020136613	2.893213104	3.373170727	11.21185636	0.268206306	3.00926902	0	0	4.262283228	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3553	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins			"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	3.1492	0.1307	0.3061	2.0526	1.1435	1.6917	0.722	0.2123	3.4986	0.4062	1.7456	0.338	0.0045	0.7446	1.8129	3.397	0.0406	0.3256			1.2856	0			0				0	0	0	0	0	0	0	0	0	0			23.0073	500	7.879207	18.255	0.6281121	1.054153038	2.05262	1.381752409	3.116971241	1.330408987	1.214785707	6.620446832	3.255964992	8.013158596	0.790252783	0.024624613	3.637859104	5.186028727	14.60882836	0.308801306	3.33489602	0	0	5.547863228	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.3626
H4520_021_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	P	O	O	O	O	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	YES	1304.057669	56.347295	434.483419	611.64511	38.18453	9.908375	4.229164	321.370623	394.669889	1843.579863	1211.086663	72.494445	0.139984	575.608118	3604.4966	4492.779355	107.474777	859.923136			29.630024	0			2.69				0.04	0.25	18.393266	0.05	0.55	1.93	0.32	0.35	0.4	0.42			3400	$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			197.25885	150.313725	48.2281	0	100	0.2	0.2	50	126.788993	24.77636	82.950976	100	0.2	80.565864	15	40	40	56.091744			0.2	0			0				0	0	0	0	0	0	0	0	0	0			NO	140.696256	107.212317	20.547534	0	76.5558	0.153112	0.153112	38.2779	97.064328	18.96774	63.503784	76.5558	0.153112	61.677842	11.48337	30.62232	30.62232	42.941483			0.153112	0			0				0	0	0	0	0	0	0	0	0	0				15.2897	0.503427004	0.743963569	0	0.243603937	1.517091113	0.647535758	1.025116048	3.192363963	2.914045293	6.409048821	0.462489186	0.02143323	2.958522213	3.44931401	11.46494392	0.274260584	3.077197894	0	0	4.536712235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7307	0	20.272605	15.2897	0.503427004	0.743963569	0	0.243603937	1.517091113	0.647535758	1.025116048	3.192363963	2.914045293	6.409048821	0.462489186	0.02143323	2.958522213	3.44931401	11.46494392	0.274260584	3.077197894	0	0	4.536712235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7307	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins			"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	3.1491	0.1307	0.3028	2.1413	1.1461	1.7647	0.7532	0.2128	3.6496	0.4238	1.821	0.3526	0.0047	0.7768	1.8911	3.5437	0.0423	0.3397			1.3411	0			0				0	0	0	0	0	0	0	0	0	0			23.787	500	8.878765	18.4388	0.634161004	1.046737569	2.141261	1.389654937	3.281793113	1.400758758	1.237883048	6.841999963	3.337835293	8.230018821	0.815057186	0.02611423	3.735325213	5.34045801	15.00860992	0.316608584	3.416886894	0	0	5.877808235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5177
H4520_801_0	2010	5	N/A																															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	NO	280.220769	0.955864	48.654344	15.721951	1.843725	8.52514	4.167195	20.554294	58.526769	12.635221	30.123333	10.648776	0.935564	19.280195	35.781609	78.472675	0.377099	5.839705			25.5055	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																			0.075780105	0.075780105	0.192819442	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.075780105	0.075780105	0.192819442	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.2352	0.072435475	9.381503461	0	0.429587925	1.98635762	0.970956435	4.789150502	13.63673718	2.944006493	7.018736589	2.481164808	0.217986412	4.492285435	8.337114897	18.28413328	0.087864067	1.360651265	0	0	5.9427815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6686	0	0	21.2352	0.072435475	9.381503461	0	0.429587925	1.98635762	0.970956435	4.789150502	13.63673718	2.944006493	7.018736589	2.481164808	0.217986412	4.492285435	8.337114897	18.28413328	0.087864067	1.360651265	0	0	5.9427815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6686	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.953	0.0135	1.7464	0	1.7184	1.3097	0.6402	1.2626	3.286	0.7762	1.6827	0.6541	0.0574	1.1757	1.5709	3.445	0.0165	0.2922			1.1197	0																			24.7203	0	0	25.1882	0.085924333	11.12786915	0	2.147962925	3.29605062	1.611123935	6.051777502	16.92273618	3.720245993	8.701462589	3.135312308	0.275420912	5.668003435	9.908000897	21.72915478	0.104407067	1.652833265	0	0	7.062463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.3889
H4520_804_0	2010	6	N/A																															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	NO	280.220769	0.955864	48.654344	15.721951	1.843725	8.52514	4.167195	20.554294	58.526769	12.635221	30.123333	10.648776	0.935564	19.280195	35.781609	78.472675	0.377099	5.839705			25.5055	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																			0.075780105	0.075780105	0.192819442	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.075780105	0.075780105	0.192819442	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.2352	0.072435475	9.381503461	0	0.429587925	1.98635762	0.970956435	4.789150502	13.63673718	2.944006493	7.018736589	2.481164808	0.217986412	4.492285435	8.337114897	18.28413328	0.087864067	1.360651265	0	0	5.9427815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6686	0	0	21.2352	0.072435475	9.381503461	0	0.429587925	1.98635762	0.970956435	4.789150502	13.63673718	2.944006493	7.018736589	2.481164808	0.217986412	4.492285435	8.337114897	18.28413328	0.087864067	1.360651265	0	0	5.9427815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6686	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.953	0.0135	1.7464	0	1.7184	1.3097	0.6402	1.2626	3.286	0.7762	1.6827	0.6541	0.0574	1.1757	1.5709	3.445	0.0165	0.2922			1.1197	0																			24.7203	0	0	25.1882	0.085924333	11.12786915	0	2.147962925	3.29605062	1.611123935	6.051777502	16.92273618	3.720245993	8.701462589	3.135312308	0.275420912	5.668003435	9.908000897	21.72915478	0.104407067	1.652833265	0	0	7.062463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.3889
H4520_805_0	2010	6	N/A																															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	NO	280.220769	0.955864	48.654344	15.721951	1.843725	8.52514	4.167195	20.554294	58.526769	12.635221	30.123333	10.648776	0.935564	19.280195	35.781609	78.472675	0.377099	5.839705			25.5055	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																			0.075780105	0.075780105	0.192819442	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.075780105	0.075780105	0.192819442	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.2352	0.072435475	9.381503461	0	0.429587925	1.98635762	0.970956435	4.789150502	13.63673718	2.944006493	7.018736589	2.481164808	0.217986412	4.492285435	8.337114897	18.28413328	0.087864067	1.360651265	0	0	5.9427815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6686	0	0	21.2352	0.072435475	9.381503461	0	0.429587925	1.98635762	0.970956435	4.789150502	13.63673718	2.944006493	7.018736589	2.481164808	0.217986412	4.492285435	8.337114897	18.28413328	0.087864067	1.360651265	0	0	5.9427815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.6686	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.953	0.0135	1.7464	0	1.7184	1.3097	0.6402	1.2626	3.286	0.7762	1.6827	0.6541	0.0574	1.1757	1.5709	3.445	0.0165	0.2922			1.1197	0																			24.7203	0	0	25.1882	0.085924333	11.12786915	0	2.147962925	3.29605062	1.611123935	6.051777502	16.92273618	3.720245993	8.701462589	3.135312308	0.275420912	5.668003435	9.908000897	21.72915478	0.104407067	1.652833265	0	0	7.062463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.3889
H4522_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	856.5710913	101.1354406	234.4786232	357.1326707	96.97389599	10.48594122	8.832849706	331.7072526	22.36887021	7582.522737	30.24602087	0	0.037164142	7.884355574	4524.1061	3610.188649	448.4314858	384.533439	0	0	7.09136904	762.8059526	631.1735597	0	251.1892594	105.8847687	14.16778809	6.569644416	361.4257148	0											2500	"$120 Days 1-21 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$120 Days 1-21 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											112.6129444	104.4707577	73.00996713	0	150	0.2	0.119429968	49.97804185	0.2	3	0.174913759	0	0.2	0.150827249	10.68818646	29.93431729	38.5	30	0	0	0.2	29.88933601	0	0	30	0	0	0	0	0											YES	100.0477574	101.2629123	84.38576027	0	126.5786404	0.168771521	0.100781886	42.17435058	0.168771521	2.531572808	0.147602306	0	0.168771521	0.127655889	10.68411127	29.93431729	38.5	25.31572808	0	0	0.168771521	29.88933601	0	0	30	0	0	0	0	0											3000	7.1415	0.853439105	1.648888074	0	1.022901992	1.769728243	0.890191253	1.16579483	3.775228238	1.599642365	4.464382414	0	0.006272249	1.00648442	4.028004412	9.005711041	1.438717684	0.811228665	0	0	1.196821136	1.899980286	0	0	0.627973148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3529	0	5.059138632	7.1415	0.853439105	1.648888074	0	1.022901992	1.769728243	0.890191253	1.16579483	3.775228238	1.599642365	4.464382414	0	0.006272249	1.00648442	4.028004412	9.005711041	1.438717684	0.811228665	0	0	1.196821136	1.899980286	0	0	0.627973148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3529	NO	"$275 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-18 (2a, 2a2); $0 n/c (2a1)"	"40% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	40% (9b)	40%/40%/$10 (8a1); $10 (8a2)	"$21 (8b1); 40% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 40% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 40% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.4549	0.0544	0.9704	0.0761	0.1069	0.2774	0.2337	0.1883	0.789	0.1672	0.8893	0	0.0007	0.2084	1.5609	2.4333	0.3329	0.1698	0	0	0.2818	0.5189	0	0	0.1715	0.026	0.0097	0.0081	0	0											9.9295	0	2.640315282	7.5964	0.907800515	2.619331588	0.076147076	1.12979729	2.047138438	1.123868183	1.354065118	4.564265993	1.766808181	5.353665338	0	0.006927711	1.214841026	5.588890964	11.43903434	1.771664555	0.981005665	0	0	1.478605791	2.418863593	0	0	0.799467824	0.026044787	0.009672787	0.008068332	0	0	0	0	0	0	0	0	0	0	0	0	54.2824
H4522_007_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	277.6609452	18.57366322	557.8260473	908.8644027	7.887362748	18.09148375	14.05682917	18.69121679	27.06075173	12.09711615	36.12299573	0	0.103701158	12.75586088	24.58429384	83.32135758	7.704739724	3.642054926	0	0	14.01529619	5.633201323	420.996927	242.5392367	156.1172537	125.2911155	0	0	69.40575366	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$133.5 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.069337133	0.070179285	43.47002967	0	0.2	0.2	0.2	0.124891787	0.2	0	0.167688252	0	0.2	0.149908324	0.168613334	0.199915964	0.2	0	0	0	0.2	0.199803105	0	0	0	0	0	0	0	0											NO	0.069337133	0.070179285	43.47002967	0	0.2	0.2	0.2	0.124891787	0.2	0	0.167688252	0	0.2	0.149908324	0.168613334	0.199915964	0.2	0	0	0	0.2	0.199803105	0	0	0	0	0	0	0	0												19.2522	1.303486401	2.020726236	0	1.57747255	3.618296751	2.811365833	2.33437946	5.412150346	0	6.057401993	0	0.020740232	1.91220973	4.145239737	16.65726955	1.540947945	0	0	0	2.803059237	1.125531117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5925	0	0	19.2522	1.303486401	2.020726236	0	1.57747255	3.618296751	2.811365833	2.33437946	5.412150346	0	6.057401993	0	0.020740232	1.91220973	4.145239737	16.65726955	1.540947945	0	0	0	2.803059237	1.125531117	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5925	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.2698	0.4194	3.7848	0.2401	0.2925	0.6708	0.5212	0.2883	1.0034	0.1346	1.123	0	0.0026	0.3545	1.8318	6.2491	0.5779	0.2732	0	0	1.0511	0.4221	0	0.0427	0.0578	0.0241	0	0	0	0											25.6346	0	0	25.522	1.722891699	5.805523553	0.240093875	1.869925326	4.289104575	3.332574106	2.622659991	6.415526534	0.134563427	7.180403486	0	0.023303631	2.266720523	5.977026301	22.90637137	2.118803424	0.273154119	0	0	3.854206451	1.547605285	0	0.042709292	0.057849101	0.024136358	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.2271
H4522_008_0	2010	5	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2003.618447	207.9499319	26.83509371	1206.068617	228.4380905	17.35432014	17.73681124	505.8480272	39.80852824	13754.16539	51.31563877	0	0.162359861	27.76345144	7911.173331	5510.92627	841.8810538	499.6672435	0	0	19.46051678	1103.642427	673.7285663	0	152.4424382	165.1168598	14.70778452	4.571729557	79.40372389	0											2500	"$175 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											155.7024695	122.8528282	0.197753388	0	150	0.2	0.102348425	49.67823055	0.2	3	0.175121992	0	0.2	0.14957018	10.43902885	29.92663315	38.5	30	0	0	0.2	29.82030669	0	0	30	0	0	0	0	0											NO	109.5970708	77.87339568	0.125351024	0	95.08132227	0.126775096	0.064876157	31.48981232	0.126775096	1.901626445	0.111005537	0	0.126775096	0.095194706	10.30889734	29.92663315	38.5	19.01626445	0	0	0.126775096	29.82030669	0	0	30	0	0	0	0	0												18.2992	1.349480611	3.36380647	0	1.810016308	2.200095608	1.15069615	1.32742162	5.046730004	2.179607054	5.696320034	0	0.020583187	2.642933584	6.796289478	13.7436224	2.701035048	0.791817037	0	0	2.46710889	2.742579638	0	0	0.381106096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7105	0	27.99330087	18.2992	1.349480611	3.36380647	0	1.810016308	2.200095608	1.15069615	1.32742162	5.046730004	2.179607054	5.696320034	0	0.020583187	2.642933584	6.796289478	13.7436224	2.701035048	0.791817037	0	0	2.46710889	2.742579638	0	0	0.381106096	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.7105	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												12.0951	0.3302	1.3653	0.3073	0.3529	0.6435	0.6577	0.2588	1.476	0.425	1.6364	0	0.004	0.7792	2.0094	6.7826	0.5813	0.2763	0	0	1.112	0.3662	0	0	0.0459	0.0302	0.0037	0.003	0	0											31.5421	0	0	30.3943	1.679727917	4.729100711	0.307261463	2.162940325	2.8435704	1.808353196	1.586247448	6.522776557	2.60459531	7.332736233	0	0.024596577	3.422123332	8.805703232	20.52626247	3.28233387	1.068095739	0	0	3.579138421	3.108765725	0	0	0.42700227	0.030219704	0.003666962	0.003007717	0	0	0	0	0	0	0	0	0	0	0	0	106.2525
H4522_801_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	249.3789424	5.509668081	10.3996593	411.9693449	5.783129083	13.38391321	11.27396115	12.82941796	28.55089604	15.43567431	38.60503412	0	0.047435099	10.03661673	26.39668165	86.77787785	2.34509916	4.463572784	0	0	9.051192052	5.672027883	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.074971313	0.074971313	0.190745715	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074971313	0.074971313	0.190745715	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.6963	0.413067053	1.983690452	0	1.347469076	3.118451779	2.626832948	2.989254384	6.652358778	3.596512114	8.994972949	0	0.011052378	2.338531697	6.150426826	20.21924554	0.546408104	1.040012459	0	0	2.108927748	1.321582497	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	0	0	18.6963	0.413067053	1.983690452	0	1.347469076	3.118451779	2.626832948	2.989254384	6.652358778	3.596512114	8.994972949	0	0.011052378	2.338531697	6.150426826	20.21924554	0.546408104	1.040012459	0	0	2.108927748	1.321582497	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.6781	0.015	0.8705	0	0.1837	0.4252	0.3582	0.4076	0.9071	0.4904	1.2266	0	0.0015	0.3189	1.2597	4.1413	0.1119	0.213	0	0	0.4319	0.2707	0	0	0	0	0	0	0	0											12.3116	0	0	19.3744	0.428048759	2.854230867	0	1.531214859	3.543695203	2.985037441	3.396879982	7.559498612	4.086945584	10.22156017	0	0.01255952	2.657422383	7.410152802	24.36053679	0.658323017	1.253027059	0	0	2.540876805	1.592268068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4666
H4522_803_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	249.378942	5.509668081	10.39965928	411.9693446	5.783129074	13.38391319	11.27396113	12.82941794	28.550896	15.43567429	38.60503406	0	0.047435099	10.03661671	26.39668161	86.77787771	2.34509916	4.463572778	0	0	9.051192037	5.672027875	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.074971313	0.074971313	0.190745715	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074971313	0.074971313	0.190745715	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.6963	0.413067053	1.983690451	0	1.347469074	3.118451774	2.626832944	2.989254379	6.652358768	3.596512109	8.994972935	0	0.011052378	2.338531693	6.150426816	20.21924551	0.546408104	1.040012457	0	0	2.108927745	1.321582495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	0	0	18.6963	0.413067053	1.983690451	0	1.347469074	3.118451774	2.626832944	2.989254379	6.652358768	3.596512109	8.994972935	0	0.011052378	2.338531693	6.150426816	20.21924551	0.546408104	1.040012457	0	0	2.108927745	1.321582495	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.6781	0.015	0.8705	0	0.1837	0.4252	0.3582	0.4076	0.9071	0.4904	1.2266	0	0.0015	0.3189	1.2597	4.1413	0.1119	0.213	0	0	0.4319	0.2707	0	0	0	0	0	0	0	0											12.3116	0	0	19.3744	0.428048759	2.854230864	0	1.531214857	3.543695198	2.985037436	3.396879977	7.5594986	4.086945578	10.22156015	0	0.01255952	2.657422379	7.41015279	24.36053676	0.658323017	1.253027057	0	0	2.540876801	1.592268066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4666
H4522_804_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	249.3789423	5.509668081	10.3996593	411.9693448	5.78312908	13.38391321	11.27396115	12.82941795	28.55089603	15.4356743	38.6050341	0	0.047435099	10.03661672	26.39668164	86.77787782	2.34509916	4.463572783	0	0	9.051192048	5.672027881	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.074971313	0.074971313	0.190745715	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074971313	0.074971313	0.190745715	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.6963	0.413067053	1.983690452	0	1.347469076	3.118451777	2.626832947	2.989254383	6.652358776	3.596512113	8.994972946	0	0.011052378	2.338531696	6.150426823	20.21924553	0.546408104	1.040012458	0	0	2.108927747	1.321582496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	0	0	18.6963	0.413067053	1.983690452	0	1.347469076	3.118451777	2.626832947	2.989254383	6.652358776	3.596512113	8.994972946	0	0.011052378	2.338531696	6.150426823	20.21924553	0.546408104	1.040012458	0	0	2.108927747	1.321582496	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.6781	0.015	0.8705	0	0.1837	0.4252	0.3582	0.4076	0.9071	0.4904	1.2266	0	0.0015	0.3189	1.2597	4.1413	0.1119	0.213	0	0	0.4319	0.2707	0	0	0	0	0	0	0	0											12.3116	0	0	19.3744	0.428048759	2.854230866	0	1.531214859	3.543695202	2.98503744	3.396879981	7.559498609	4.086945583	10.22156017	0	0.01255952	2.657422382	7.410152799	24.36053678	0.658323017	1.253027058	0	0	2.540876804	1.592268068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4666
H4522_806_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	249.3789408	5.509668081	10.39965923	411.9693435	5.783129044	13.38391312	11.27396108	12.82941787	28.55089586	15.43567421	38.60503386	0	0.047435098	10.03661666	26.39668148	86.77787728	2.34509916	4.463572755	0	0	9.051191992	5.672027846	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.074971314	0.074971314	0.190745716	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074971314	0.074971314	0.190745716	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.6963	0.413067054	1.983690444	0	1.347469067	3.118451758	2.626832931	2.989254364	6.652358734	3.596512091	8.99497289	0	0.011052378	2.338531682	6.150426785	20.21924541	0.546408104	1.040012452	0	0	2.108927734	1.321582488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	0	0	18.6963	0.413067054	1.983690444	0	1.347469067	3.118451758	2.626832931	2.989254364	6.652358734	3.596512091	8.99497289	0	0.011052378	2.338531682	6.150426785	20.21924541	0.546408104	1.040012452	0	0	2.108927734	1.321582488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.6781	0.015	0.8705	0	0.1837	0.4252	0.3582	0.4076	0.9071	0.4904	1.2266	0	0.0015	0.3189	1.2597	4.1413	0.1119	0.213	0	0	0.4319	0.2707	0	0	0	0	0	0	0	0											12.3116	0	0	19.3744	0.428048761	2.854230855	0	1.531214849	3.54369518	2.985037421	3.396879959	7.559498562	4.086945557	10.2215601	0	0.01255952	2.657422366	7.410152753	24.36053663	0.658323017	1.253027051	0	0	2.540876788	1.592268058	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4666
H4522_807_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	249.3789408	5.509668081	10.39965923	411.9693435	5.783129044	13.38391312	11.27396108	12.82941787	28.55089586	15.43567421	38.60503386	0	0.047435098	10.03661666	26.39668148	86.77787728	2.34509916	4.463572755	0	0	9.051191992	5.672027846	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.074971314	0.074971314	0.190745716	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074971314	0.074971314	0.190745716	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.6963	0.413067054	1.983690444	0	1.347469067	3.118451758	2.626832931	2.989254364	6.652358734	3.596512091	8.99497289	0	0.011052378	2.338531682	6.150426785	20.21924541	0.546408104	1.040012452	0	0	2.108927734	1.321582488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	0	0	18.6963	0.413067054	1.983690444	0	1.347469067	3.118451758	2.626832931	2.989254364	6.652358734	3.596512091	8.99497289	0	0.011052378	2.338531682	6.150426785	20.21924541	0.546408104	1.040012452	0	0	2.108927734	1.321582488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.6781	0.015	0.8705	0	0.1837	0.4252	0.3582	0.4076	0.9071	0.4904	1.2266	0	0.0015	0.3189	1.2597	4.1413	0.1119	0.213	0	0	0.4319	0.2707	0	0	0	0	0	0	0	0											12.3116	0	0	19.3744	0.428048761	2.854230855	0	1.531214849	3.54369518	2.985037421	3.396879959	7.559498562	4.086945557	10.2215601	0	0.01255952	2.657422366	7.410152753	24.36053663	0.658323017	1.253027051	0	0	2.540876788	1.592268058	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4666
H4522_808_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	249.3789408	5.509668081	10.39965923	411.9693435	5.783129044	13.38391312	11.27396108	12.82941787	28.55089586	15.43567421	38.60503386	0	0.047435098	10.03661666	26.39668148	86.77787728	2.34509916	4.463572755	0	0	9.051191992	5.672027846	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.074971314	0.074971314	0.190745716	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074971314	0.074971314	0.190745716	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.6963	0.413067054	1.983690444	0	1.347469067	3.118451758	2.626832931	2.989254364	6.652358734	3.596512091	8.99497289	0	0.011052378	2.338531682	6.150426785	20.21924541	0.546408104	1.040012452	0	0	2.108927734	1.321582488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	0	0	18.6963	0.413067054	1.983690444	0	1.347469067	3.118451758	2.626832931	2.989254364	6.652358734	3.596512091	8.99497289	0	0.011052378	2.338531682	6.150426785	20.21924541	0.546408104	1.040012452	0	0	2.108927734	1.321582488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.1551	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.6781	0.015	0.8705	0	0.1837	0.4252	0.3582	0.4076	0.9071	0.4904	1.2266	0	0.0015	0.3189	1.2597	4.1413	0.1119	0.213	0	0	0.4319	0.2707	0	0	0	0	0	0	0	0											12.3116	0	0	19.3744	0.428048761	2.854230855	0	1.531214849	3.54369518	2.985037421	3.396879959	7.559498562	4.086945557	10.2215601	0	0.01255952	2.657422366	7.410152753	24.36053663	0.658323017	1.253027051	0	0	2.540876788	1.592268058	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.4666
H4523_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1748.903416	133.4130514	773.5808942	618.9089067	195.5851957	12.09615545	0	370.9818447	397.2393673	2836.915278	2751.110501	32.53892222	0.07049058	211.9323869	3934.103002	4653.291682	265.4130998	625.8385362	0	0	265.1682193	0	0	0	652.2565098	0	54.92847195	0	48.00891408	0											3400	$100 per stay	$100 per stay	$0/d 1-20; $120/d 21-100	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$0 per visit	$25 X-ray; $160 Complex Radiology	$20 per visit	$20 per visit	$20 per visit	$5 PCP visit; $20 if no PCP selected	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$45 per script	0	Not Covered	0	$0 per visit	$200 Every 2 Years	$0 per visit	$750 Every 3 Years	Fitness Only	0											16.9076929	16.9076929	48.3976065	0	150	0.2	0.2	47.5	100	0	39.5	20	20	20	5	20	20	20	20	20	$45 	0	0	0	0	0	0	0	0	0											NO	9.144300772	9.144300772	26.17520161	0	150	0.108167339	0.108167339	47.5	54.08366964	0	39.5	20	20	20	5	20	20	20	20	20	$45 	0	0	0	0	0	0	0	0	0												1.3327	0.101664089	1.687386322	0	2.444814946	1.30840895	0	1.468469802	1.790346892	0	9.055738732	0.054231537	0.000117484	0.353220645	1.639209584	7.755486137	0.442355166	1.043064227	0	0	0.994380822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4716	0	5.281135699	1.3327	0.101664089	1.687386322	0	2.444814946	1.30840895	0	1.468469802	1.790346892	0	9.055738732	0.054231537	0.000117484	0.353220645	1.639209584	7.755486137	0.442355166	1.043064227	0	0	0.994380822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4716	NO																																																																																		0			1.3327	0.101664089	1.687386322	0	2.444814946	1.30840895	0	1.468469802	1.790346892	0	9.055738732	0.054231537	0.000117484	0.353220645	1.639209584	7.755486137	0.442355166	1.043064227	0	0	0.994380822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4716
H4523_005_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1784.005456	142.0137129	938.6931902	647.0619933	203.776405	12.55855658	0	384.6228662	409.9600062	2944.634747	2765.715051	59.30357835	0.105405066	247.3884157	4130.830755	4965.529642	274.1498574	569.5872933	0	0	278	0	0	0	679.0453174	0	37.27044804	0	56.71974572	0											3400	$150/day 1-5	$150/day 1-5	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$0 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$150 Every 2 Years	$0 per visit	$1000 Every 3 Years	Fitness Only	0											91.92581111	91.92581111	52.43074037	0	150	0.2	0.2	47.5	150	0	45.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	43.67714082	43.67714082	24.91166303	0	150	0.095026936	0.095026936	47.5	71.27020195	0	45.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												6.4934	0.516896078	1.948700704	0	2.547205062	1.193401152	0	1.522465512	2.434827703	0	10.48666957	0.17296877	0.000219594	0.721549546	6.884717925	14.48279479	0.799603751	1.661296272	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9092	0	13.9046354	6.4934	0.516896078	1.948700704	0	2.547205062	1.193401152	0	1.522465512	2.434827703	0	10.48666957	0.17296877	0.000219594	0.721549546	6.884717925	14.48279479	0.799603751	1.661296272	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9092	NO																																																																																		0			6.4934	0.516896078	1.948700704	0	2.547205062	1.193401152	0	1.522465512	2.434827703	0	10.48666957	0.17296877	0.000219594	0.721549546	6.884717925	14.48279479	0.799603751	1.661296272	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9092
H4523_014_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	2197.258674	131.9295063	1082.613357	1053.556135	286.5543399	18.70648256	0	441.0436509	445.3714853	2706.322663	3289.403443	75.4523257	0.215578884	117.4530787	4819.125981	5710.431993	332.590811	658.5619512	0	0	302.0966977	0	0	3654.500699	843.7404061	0	51.541785	0	133.349502	0												$0 	$0 	$0/d 1-100	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $0 Urgent Care Ctr	$0 per procedure	$0 per visit	$0 X-ray; $0 Complex Radiology	$0 per visit	$0 per visit	$0 per visit	$0 PCP visit; $0 if no PCP selected	$0 per visit	$0 per visit	$0 per visit	$0 per visit	$0 per visit	$45 per script	0	$0 per Trip/50 One Way Trips	Not Covered	$0 per visit	$150 Every 2 Years	$0 per visit	$1000 Every 3 Years	Not Covered	0											0	0	0	0	100	0.2	0.2	45	0	0	0	0	0	0	0	0	0	0	0	0	$45 	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	100	0.2	0.2	45	0	0	0	0	0	0	0	0	0	0	0	0	$45 	0	0	0	0	0	0	0	0	0												0	0	0	0	2.387952832	3.741296511	0	1.653913691	0	0	0	0	0	0	0	0	0	0	0	0	1.132862616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.916	0	0	0	0	0	0	2.387952832	3.741296511	0	1.653913691	0	0	0	0	0	0	0	0	0	0	0	0	1.132862616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.916	NO																																																																																		0			0	0	0	0	2.387952832	3.741296511	0	1.653913691	0	0	0	0	0	0	0	0	0	0	0	0	1.132862616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.916
H4523_015_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	12.3250203	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0											3400	$100/day 1-5	$100/day 1-5	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$0 per visit	$30 X-ray; $115 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$10 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$150 Every 2 Years	$0 per visit	$750 Every 3 Years	Fitness Only	0											61.28387407	61.28387407	52.43074037	0	150	0.2	0.2	47.5	150	0	32	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											NO	25.999223	25.999223	22.24334756	0	150	0.084848497	0.084848497	47.5	63.63637269	0	32	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0												3.7114	0.164975308	2.164188425	0	2.934333973	1.045759447	0	0.957869753	2.129153976	0	7.721394922	0.13467127	0.000725633	0	3.851098073	14.66959615	0.541802791	1.386687469	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4561	0	12.50668271	3.7114	0.164975308	2.164188425	0	2.934333973	1.045759447	0	0.957869753	2.129153976	0	7.721394922	0.13467127	0.000725633	0	3.851098073	14.66959615	0.541802791	1.386687469	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4561	NO																																																																																		0			3.7114	0.164975308	2.164188425	0	2.934333973	1.045759447	0	0.957869753	2.129153976	0	7.721394922	0.13467127	0.000725633	0	3.851098073	14.66959615	0.541802791	1.386687469	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4561
H4523_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	380.2482396	5.843373856	50.92403615	7.892473269	10.09687753	12.74794023	0	12.74113392	43.56639432	15.07532065	66.24741426	0.884190244	0.01682113	29.04426291	23.07125738	145.421662	2.79937459	7.220401432	0	-1.14E-08	75.69378838	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.073581425	0.073581425	0.185059669	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073581425	0.073581425	0.185059669	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												27.9792	0.429963778	9.423985268	0	2.352572465	2.970270074	0	2.968684202	10.15096988	3.512549712	15.43564752	0.206016327	0.003919323	6.767313258	5.375602969	33.88324725	0.652254279	1.682353534	0	-2.66E-09	17.63665269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.4312			27.9792	0.429963778	9.423985268	0	2.352572465	2.970270074	0	2.968684202	10.15096988	3.512549712	15.43564752	0.206016327	0.003919323	6.767313258	5.375602969	33.88324725	0.652254279	1.682353534	0	-2.66E-09	17.63665269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.4312	NO																																																																																		0			27.9792	0.429963778	9.423985268	0	2.352572465	2.970270074	0	2.968684202	10.15096988	3.512549712	15.43564752	0.206016327	0.003919323	6.767313258	5.375602969	33.88324725	0.652254279	1.682353534	0	-2.66E-09	17.63665269	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.4312
H4523_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	246.5876694	2.512816147	26.02100522	7.260593764	5.272028979	12.74467827	0	13.15929127	29.70525209	17.49787276	53.39376486	0.53537586	0.005334207	19.80350207	36.9914545	116.1903491	1.673746085	6.902049796	0	-3.62E-09	50.2730979	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.073926653	0.073926653	0.187025386	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073926653	0.073926653	0.187025386	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.2294	0.185764088	4.866588536	0	1.228382752	2.969510037	0	3.066114866	6.921323737	4.077004353	12.44074721	0.124742575	0.00124287	4.614215982	8.619008899	27.07235133	0.389982838	1.608177603	0	-8.44E-10	11.71363181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1282			18.2294	0.185764088	4.866588536	0	1.228382752	2.969510037	0	3.066114866	6.921323737	4.077004353	12.44074721	0.124742575	0.00124287	4.614215982	8.619008899	27.07235133	0.389982838	1.608177603	0	-8.44E-10	11.71363181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1282	NO																																																																																		0			18.2294	0.185764088	4.866588536	0	1.228382752	2.969510037	0	3.066114866	6.921323737	4.077004353	12.44074721	0.124742575	0.00124287	4.614215982	8.619008899	27.07235133	0.389982838	1.608177603	0	-8.44E-10	11.71363181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.1282
H4524_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1347.399883	88.52158605	1126.359722	731.786405	191.7307815	8.836644864	0	241.9940223	359.6016114	2496.905626	2546.089415	64.80458891	0.190313816	154.5168835	3533.108197	4702.049749	172.3019759	647.2219846	0	0	244.64	0	0	0	734.9578002	0	48.18050677	0	92.91136998	0											3400	$150/day 1-5	$150/day 1-5	$0/d 1-20; $120/d 21-100	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$35 per visit	$35 X-ray; $125 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$750 Every 3 Years	Fitness Only	0											91.92581111	91.92581111	48.3976065	0	150	0.2	0.2	47.5	200	5.25	35.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											YES	32.08420787	32.08420787	16.89187018	0	150	0.069804568	0.069804568	47.5	69.80456845	5.25	35.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											7500	3.6025	0.236678747	1.585526851	0	2.396634769	0.616838181	0	0.957893005	2.091819608	1.092396211	7.532181186	0.189013384	0.000396487	0.450674244	5.888513661	13.71431177	0.50254743	1.887730789	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6631	0	15.16991765	3.6025	0.236678747	1.585526851	0	2.396634769	0.616838181	0	0.957893005	2.091819608	1.092396211	7.532181186	0.189013384	0.000396487	0.450674244	5.888513661	13.71431177	0.50254743	1.887730789	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.6631	NO	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$150 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$50 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$25 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP		0	0	$750 ded; 20% coinsurance; $7500 max OOP	0	$750 ded; 20% coinsurance; $7500 max OOP	0	0													7.1092	0	1.0781	0.1903	0.2844	0.2392	0	0.2047	0.7475	0.3868	1.449	0.0239	0.0001	0.4984	0.6364	2.7746	0.053	0.1961	0	0	1.1856	0	0	0	0.1858	0	0.0084	0	0	0											17.2515	750	2.922157043	10.7117	0.236678747	2.66361871	0.190288639	2.680988263	0.856087732	0	1.162593897	2.839346027	1.479209503	8.981225452	0.212878435	0.000495824	0.949025189	6.524886888	16.48894301	0.55555114	2.083815649	0	0	2.103034348	0	0	0	0.185823217	0	0.008409974	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9146
H4524_002_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1541.949757	81.2857921	893.8203739	1427.990767	186.7598687	17.46844276	0	220.4165878	367.8837636	2985.702908	2812.262308	42.52715982	0.186387986	235.4686381	3745.203746	5398.316619	406.5100748	845.6137252	0	0	244.64	0	0	0	795.1867822	0	54.05131884	0	94.74835704	0											3400	$150/day 1-5	$150/day 1-5	$0/d 1-20; $120/d 21-100	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$35 per visit	$35 X-ray; $125 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$750 Every 3 Years	Fitness Only	0											91.92581111	91.92581111	48.3976065	0	150	0.2	0.2	47.5	200	5.25	35.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											YES	29.66560237	29.66560237	15.61850946	0	150	0.064542487	0.064542487	47.5	64.54248706	5.25	35.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											7500	3.8119	0.200949332	1.163345164	0	2.334498359	1.127456741	0	0.872482327	1.978677754	1.306245022	8.319609328	0.124037549	0.000388308	0.686783528	6.242006243	15.74509014	1.185654385	2.466373365	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4829	0	17.38241753	3.8119	0.200949332	1.163345164	0	2.334498359	1.127456741	0	0.872482327	1.978677754	1.306245022	8.319609328	0.124037549	0.000388308	0.686783528	6.242006243	15.74509014	1.185654385	2.466373365	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4829	NO	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$150 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$50 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$25 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP		0	0	$750 ded; 20% coinsurance; $7500 max OOP	0	$750 ded; 20% coinsurance; $7500 max OOP	0	0													7.4232	0	0.8873	0.5323	0.2711	0.4558	0	0.1932	0.8815	0.4337	1.4169	0.0336	0.0001	0.5876	0.6927	3.1302	0.1164	0.2132	0	0	1.562	0	0	0	0.1911	0	0.0077	0	0	0											19.0296	750	3.343631656	11.2351	0.200949332	2.050659621	0.532278024	2.605614489	1.583241713	0	1.065725345	2.860150142	1.739955764	9.736536648	0.157653893	0.000480727	1.274431773	6.93469634	18.87524647	1.302094798	2.679603523	0	0	2.479356042	0	0	0	0.191115151	0	0.007657337	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5125
H4524_007_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1407.838341	69.87777566	845.1241031	915.2860708	196.1336966	14.4146002	0	244.3316345	357.3001236	2379.091722	2500.749041	49.2216578	0.212305125	71.21415668	3630.252926	4851.558869	248.801747	696.1581734	0	0	244.64	0	0	0	751.3276024	0	38.13116719	0	113.974114	0											3400	$100/day 1-5	$100/day 1-5	"$0/d 1-20, $130/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$30 per visit	$30 X-ray; $100 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$15 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$150 Every 2 Years	$0 per visit	$750 Every 3 Years	Fitness Only	0											61.28387407	61.28387407	52.43074037	0	100	0.2	0.2	47.5	100	4.5	29	30	25	30	15	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											YES	18.61328716	18.61328716	15.92439187	0	100	0.060744486	0.060744486	47.5	30.37224301	4.5	29	30	25	30	15	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											7500	2.1837	0.108387925	1.121507283	0	1.634447472	0.87560748	0	0.967146053	0.904333848	0.892159396	6.04347685	0.123054144	0.000442302	0.178035392	4.537816158	12.12889717	0.622004367	1.740395433	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9788	0	11.90609716	2.1837	0.108387925	1.121507283	0	1.634447472	0.87560748	0	0.967146053	0.904333848	0.892159396	6.04347685	0.123054144	0.000442302	0.178035392	4.537816158	12.12889717	0.622004367	1.740395433	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.9788	NO	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$100 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$50 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$25 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP		0	0	$750 ded; 20% coinsurance; $7500 max OOP	0	$750 ded; 20% coinsurance; $7500 max OOP	0	0													7.5657	0	0.9613	0.3053	0.2118	0.3775	0	0.1884	0.9585	0.417	1.4343	0.0241	0.0001	0.639	0.6495	3.1185	0.0792	0.1797	0	0	1.4874	0	0	0	0.1909	0	0.001	0	0	0											18.7893	750	3.287505313	9.7494	0.108387925	2.082809913	0.305325049	1.846268243	1.253096512	0	1.155549626	1.862859118	1.309150451	7.477818288	0.147173157	0.000553936	0.817052234	5.187292815	15.24741807	0.701243666	1.920142402	0	0	2.404769199	0	0	0	0.190855363	0	0.00103492	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7682
H4524_008_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1541.084133	56.61329661	1085.276922	773.8938307	227.4674169	11.68483076	0	269.0772727	350.113757	2485.568161	2683.704771	76.50885985	0.248892632	411.9884441	3971.198689	5433.937599	253.0734221	607.3764005	0	0	244.64	0	0	0	787.774091	0	41.73205181	0	169.9493114	0											3400	$750 per stay	$750 per stay	"$0/d 1-20, $130/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$40 per visit	$40 X-ray; $100 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$20 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	$150 Every 2 Years	$0 per visit	$750 Every 3 Years	Fitness Only	0											126.8076968	126.8076968	52.43074037	0	100	0.2	0.2	47.5	100	6	32	40	25	40	20	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0											YES	37.00390987	37.00390987	15.2998788	0	100	0.058362246	0.058362246	47.5	29.18112293	6	32	40	25	40	20	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0											7500	4.7522	0.17457611	1.383717114	0	1.895561807	0.681952965	0	1.065097538	0.851392715	1.24278408	7.156546055	0.255029533	0.000518526	1.373294814	6.618664481	18.11312533	0.843578074	2.024588002	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.35	0	19.03594733	4.7522	0.17457611	1.383717114	0	1.895561807	0.681952965	0	1.065097538	0.851392715	1.24278408	7.156546055	0.255029533	0.000518526	1.373294814	6.618664481	18.11312533	0.843578074	2.024588002	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.35	NO	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$100 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$50 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$25 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP		0	0	$750 ded; 20% coinsurance; $7500 max OOP	0	$750 ded; 20% coinsurance; $7500 max OOP	0	0													8.3853	0	1.123	0.174	0.2225	0.2811	0	0.1561	0.9607	0.3324	1.4609	0.0195	0.0002	0.6405	0.5088	3.2069	0.0617	0.1592	0	0	1.6692	0	0	0	0.2047	0	0.0013	0	0	0											19.5681	750	3.472423192	13.1375	0.17457611	2.506706994	0.174046841	2.11805007	0.963073806	0	1.221158889	1.812129995	1.57522891	8.617450992	0.274527922	0.000672855	2.013786334	7.127437754	21.32000105	0.905310599	2.183814142	0	0	2.586618797	0	0	0	0.204713112	0	0.001326207	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9181
H4524_013_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	11.39586334	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											3400	$150/day 1-5	$150/day 1-5	"$0/d 1-20, $130/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$35 per visit	$35 X-ray; $100 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$10 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$150 Every 2 Years	$0 per visit	$750 Every 3 Years	Fitness Only	0											91.92581111	91.92581111	52.43074037	0	100	0.2	0.2	47.5	150	5.25	30.5	35	25	35	10	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											YES	32.56875308	32.56875308	18.57589088	0	100	0.070858778	0.070858778	47.5	53.14408328	5.25	30.5	35	25	35	10	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											7500	4.0913	0.181862176	1.590476459	0	1.721475931	0.807496947	0	0.842925383	1.56472941	0.842488183	6.476319991	0.138262504	0.000638557	0	3.388966304	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.605	0	15.00994045	4.0913	0.181862176	1.590476459	0	1.721475931	0.807496947	0	0.842925383	1.56472941	0.842488183	6.476319991	0.138262504	0.000638557	0	3.388966304	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.605	NO	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$100 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$50 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$25 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP		0	0	$750 ded; 20% coinsurance; $7500 max OOP	0	$750 ded; 20% coinsurance; $7500 max OOP	0	0													8.6848	0	1.1631	0.1803	0.2225	0.2912	0	0.1561	0.9951	0.3443	1.5131	0.0202	0.0002	0.6634	0.5269	3.3214	0.0639	0.1649	0	0	1.7288	0	0	0	0.212	0	0	0	0	0											20.2522	750	3.634729699	12.7761	0.181862176	2.753578739	0.18026367	1.943964193	1.098659225	0	0.998986734	2.559783541	1.186807705	7.989407412	0.158457362	0.000792885	0.663369421	3.915912597	18.38220842	0.620188433	1.588579387	0	0	2.646242104	0	0	0	0.212025319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8572
H4524_014_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	11.38393795	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											3400	$150/day 1-7	$150/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$35 per visit	$35 X-ray; $100 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$10 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$150 Every 2 Years	$0 per visit	$750 Every 3 Years	Fitness Only	0											108.4282617	108.4282617	52.43074037	0	100	0.2	0.2	47.5	100	5.25	30.5	35	25	35	10	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											YES	40.50510653	40.50510653	19.58633931	0	100	0.07471319	0.07471319	47.5	37.35659495	5.25	30.5	35	25	35	10	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											7500	5.0882	0.226178349	1.676991526	0	1.721475931	0.850530318	0	0.842925383	1.099895965	0.842488183	6.476319991	0.138262504	0.000638557	0	3.388966304	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.311	0	14.99458451	5.0882	0.226178349	1.676991526	0	1.721475931	0.850530318	0	0.842925383	1.099895965	0.842488183	6.476319991	0.138262504	0.000638557	0	3.388966304	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.311	NO	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$100 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$50 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$25 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP		0	0	$750 ded; 20% coinsurance; $7500 max OOP	0	$750 ded; 20% coinsurance; $7500 max OOP	0	0													8.6779	0	1.1622	0.1801	0.2225	0.2909	0	0.1561	0.9943	0.344	1.5119	0.0202	0.0002	0.6628	0.5265	3.3188	0.0639	0.1648	0	0	1.7275	0	0	0	0.2119	0	0	0	0	0											20.2364	750	3.63098878	13.7662	0.226178349	2.839169275	0.180120382	1.943964193	1.141461155	0	0.998986734	2.094159145	1.186534012	7.988204685	0.158441309	0.000792885	0.66284212	3.915493736	18.37956827	0.62013761	1.5884483	0	0	2.644867877	0	0	0	0.211856784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5474
H4524_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	353.4022607	5.430824698	47.32873851	7.33525525	9.384025945	11.84792046	0	11.84159468	40.49055496	14.01098505	61.57026787	0.821765359	0.015633539	26.99370333	21.44239911	135.1547194	2.601735408	6.710632486	0	0	70.34971671	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.075353425	0.075353425	0.189522387	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075353425	0.075353425	0.189522387	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												26.6301	0.409231244	8.96985549	0	2.186478045	2.760565467	0	2.75909156	9.434299306	3.264559516	14.34587241	0.191471329	0.003642614	6.289532877	4.996078993	31.49104961	0.60620435	1.563577369	0	0	16.39148399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2931			26.6301	0.409231244	8.96985549	0	2.186478045	2.760565467	0	2.75909156	9.434299306	3.264559516	14.34587241	0.191471329	0.003642614	6.289532877	4.996078993	31.49104961	0.60620435	1.563577369	0	0	16.39148399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.2931	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.6314	0.0558	1.2232	0	0.2982	0.3764	0	0.3762	1.2865	0.4452	1.9563	0.0261	0.0005	0.8577	0.6813	4.2942	0.0827	0.2132	0	0	2.2352	0	0	0	0	0	0	0	0												18.04			30.2614	0.465035504	10.1930176	0	2.484634142	3.137006212	0	3.135331318	10.72079467	3.709726723	16.30212774	0.217581055	0.004139335	7.147196451	5.677362492	35.78528365	0.68886858	1.776792465	0	0	18.62668636	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.333
H4524_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	376.3222408	4.233770523	54.96665703	9.322465564	8.793258972	13.09572577	0	12.34307689	46.82050789	17.65702291	58.07108848	0.64063308	0.012187618	31.21367138	31.48120266	148.5602148	2.319850746	9.405565484	0	0	58.08809806	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.072994465	0.072994465	0.186590917	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072994465	0.072994465	0.186590917	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												27.4694	0.309041815	10.25627893	0	2.048829341	3.051304104	0	2.875936916	10.90917834	4.114086338	13.53056362	0.149267508	0.002839715	7.272785432	7.335120219	34.61453004	0.540525224	2.191496758	0	0	13.53452685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.2058			27.4694	0.309041815	10.25627893	0	2.048829341	3.051304104	0	2.875936916	10.90917834	4.114086338	13.53056362	0.149267508	0.002839715	7.272785432	7.335120219	34.61453004	0.540525224	2.191496758	0	0	13.53452685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.2058	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.7458	0.0421	1.3986	0	0.2794	0.4161	0	0.3922	1.4876	0.561	1.8451	0.0204	0.0004	0.9917	1.0002	4.7202	0.0737	0.2988	0	0	1.8456	0	0	0	0	0	0	0	0												19.119			31.2153	0.351183881	11.65486243	0	2.32821516	3.467391027	0	3.268110132	12.39679357	4.675098111	15.37564047	0.169622168	0.003226949	8.264528901	8.335363886	39.33469323	0.614233209	2.490337225	0	0	15.38014414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	159.3247
H4524_804_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	377.7050323	5.804291727	50.58344186	7.839686187	10.02934677	12.66267842	0	12.65591763	43.27501002	14.97449266	65.80433292	0.878276531	0.016708626	28.85000671	22.91695031	144.449041	2.780651585	7.172109356	0	0	75.18752702	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.069413561	0.069413561	0.17986366	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.069413561	0.069413561	0.17986366	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												26.2179	0.402896559	9.098122999	0	2.336837798	2.950404072	0	2.948828807	10.08307733	3.489056791	15.33240957	0.204638432	0.00389311	6.722051562	5.339649423	33.65662655	0.647891819	1.67110148	0	0	17.5186938	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.624			26.2179	0.402896559	9.098122999	0	2.336837798	2.950404072	0	2.948828807	10.08307733	3.489056791	15.33240957	0.204638432	0.00389311	6.722051562	5.339649423	33.65662655	0.647891819	1.67110148	0	0	17.5186938	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.624	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.5752	0.0549	1.2407	0	0.3187	0.4023	0	0.4021	1.375	0.4758	2.0908	0.0279	0.0005	0.9166	0.7281	4.5895	0.0883	0.2279	0	0	2.3889	0	0	0	0	0	0	0	0												18.9033			29.793	0.457836999	10.33877614	0	2.655497498	3.3527319	0	3.350941826	11.45804243	3.964837262	17.42319269	0.232543672	0.004423988	7.638694957	6.067783436	38.24616654	0.736240704	1.898978954	0	0	19.90760659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.5273
H4524_805_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	332.5512753	5.110402169	44.53630919	6.902469961	8.830361723	11.1488847	0	11.14293215	38.10158335	13.18432694	57.93757816	0.773280617	0.014711149	25.40105559	20.17728227	127.1804945	2.448231164	6.314700385	0	0	66.19903327	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	2.057474282	2.597690136	0	2.596303191	8.877668921	3.071948177	13.49945571	0.180174384	0.003427698	5.918445953	4.70130677	29.63305523	0.570437861	1.47132519	0	0	15.42437475	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6031			0	0	0	0	2.057474282	2.597690136	0	2.596303191	8.877668921	3.071948177	13.49945571	0.180174384	0.003427698	5.918445953	4.70130677	29.63305523	0.570437861	1.47132519	0	0	15.42437475	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.6031	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2806	0.3542	0	0.354	1.2106	0.4189	1.8408	0.0246	0.0005	0.8071	0.6411	4.0409	0.0778	0.2006	0	0	2.1033	0	0	0	0	0	0	0	0												12.355			0	0	0	0	2.338038956	2.951920609	0	2.950344535	10.08826014	3.490850201	15.34029058	0.204743618	0.003895111	6.725506764	5.342394057	33.6739264	0.648224842	1.671960443	0	0	17.52769858	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.9581
H4524_806_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	340.8248652	5.237544582	45.64433428	7.07419748	9.050053533	11.42625937	0	11.42015872	39.04951799	13.51234166	59.37901531	0.792519174	0.015077149	26.03301202	20.67927571	130.3446359	2.509141051	6.471804703	0	0	67.84600831	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	2.108662473	2.662318434	0	2.660896982	9.098537693	3.148375607	13.83531057	0.184656968	0.003512976	6.065691801	4.818271241	30.37030017	0.584629865	1.507930496	0	0	15.80811994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8572			0	0	0	0	2.108662473	2.662318434	0	2.660896982	9.098537693	3.148375607	13.83531057	0.184656968	0.003512976	6.065691801	4.818271241	30.37030017	0.584629865	1.507930496	0	0	15.80811994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8572	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2875	0.363	0	0.3628	1.2407	0.4293	1.8866	0.0252	0.0005	0.8271	0.657	4.1414	0.0797	0.2056	0	0	2.1557	0	0	0	0	0	0	0	0												12.6623			0	0	0	0	2.396207356	3.025361856	0	3.023746571	10.33924738	3.577699553	15.72194383	0.209837463	0.003992018	6.892831592	5.475308229	34.51170474	0.664352119	1.713557381	0	0	17.96377266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5196
H4524_807_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	340.8255576	5.237555223	45.64442701	7.074211852	9.050071919	11.42628259	0	11.42018192	39.04959733	13.51236911	59.37913594	0.792520784	0.01507718	26.03306491	20.67931773	130.3449007	2.509146148	6.471817851	0	0	67.84614615	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	2.108666757	2.662323842	0	2.660902388	9.098556177	3.148382003	13.83533867	0.184657343	0.003512983	6.065704124	4.81828103	30.37036187	0.584631053	1.507933559	0	0	15.80815205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8574			0	0	0	0	2.108666757	2.662323842	0	2.660902388	9.098556177	3.148382003	13.83533867	0.184657343	0.003512983	6.065704124	4.81828103	30.37036187	0.584631053	1.507933559	0	0	15.80815205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8574	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2875	0.363	0	0.3629	1.2407	0.4293	1.8866	0.0252	0.0005	0.8271	0.657	4.1414	0.0797	0.2056	0	0	2.1557	0	0	0	0	0	0	0	0												12.6624			0	0	0	0	2.396212224	3.025368003	0	3.023752714	10.33926838	3.577706822	15.72197577	0.209837889	0.003992026	6.892845595	5.475319353	34.51177486	0.664353469	1.713560863	0	0	17.96380915	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.5198
H4525_001_0	2010	6	N/A																															D	D	D	V	T	COIN	COIN	V	V	V	P	V	V	V	V	V	V	V	V	V	COIN	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	YES	1695.167564	157.0663488	1997.575011	3718.57577	723.3500025	37.21098409	0.090934238	175.3860368	211.3996594	999.8028109	481.7271368	0	0	427.6795504	2752.08065	8670.165801	710.893926	2509.164707	5122.069621	32219.25015	16.51581521	1640.638202	0	0	0	0	0	0	0	0											3400	Days 1-30 $75; no cost sharing on lifetime reserve days	Days 1-30 $75; no cost sharing on lifetime reserve days	No prior hosp stay required; Days 1-20 $25/day ; Days 21-100 $125/day	No Cost Sharing	$100 copay	20% Coinsurance	20% Coinsurance	"$50 copay USA, waived if admitted within 3 days ; $25 copay USA for urgent care"	$100 per surgery	No cost sharing for Lab Services.	X-rays $10 copay; MRI/CT/PET/Nuc/Stress/UI $75 per visit ; Radiation / Chemo 20% coinsurance per visit			"PT/OT/ST $20 copay ; CORF $20 copay ; Partial Hospitalization $25 copay ; No cost sharing for Cardiac Rehabilitation, Diabetes monitoring training, renal dialysis."	$10 copay per visit	$35 SPC copay per visit; Opthalmology $30 copay per visit	Ind. Visits 1-20 $25 copay; Group visits 1-020 $15 copay ; All visits 21 and up $50 copay	No Cost Sharing	No Cost Sharing	"Chiropractor $25 copay ; Podiatry $20 copay; Diabetes Mon. Supp. 20% coinsurance; No Cost Sharing for Immunizations.  Annual coverage with no cost sharing of routine physicals, Pap/Pelvic exams, and Prostate Screening.  No cost sharing on Medicare Coverage of Colorectal screenings, bone mass measurements, and mammogram screening."	20% Coinsurance	Hearing Exam $10 copay per Medicare covered visit; Eye exam $30 copay per Medicare covered visit; no Cost sharing for Medicare covered eyewear.																			71.88946002	71.88946002	76.34889327	0	100	0.2	0.2	39.78892766	100	0	15.32670671	0	0	9.561100669	10	34.83770395	19.94293627	0	0	1.118093213	0.2	28.66202913	0	0	0	0	0	0	0	0											NO	65.12411027	65.12411027	69.16387664	0	90.58923277	0.181178466	0.181178466	36.04448429	90.58923277	0	13.88434602	0	0	8.66132774	9.058923277	31.55920872	18.06615296	0	0	1.012872063	0.181178466	25.96471228	0	0	0	0	0	0	0	0												9.1997	0.852400518	11.51333597	0	5.460643479	6.741828998	0.016475326	0.526808271	1.595877746	0	0.557372188	0	0	0.308689396	2.077573955	22.80196435	1.070259867	0	0	2.719498198	2.992310058	3.549891573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9846		7.478046572	9.1997	0.852400518	11.51333597	0	5.460643479	6.741828998	0.016475326	0.526808271	1.595877746	0	0.557372188	0	0	0.308689396	2.077573955	22.80196435	1.070259867	0	0	2.719498198	2.992310058	3.549891573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9846	NO																																																																																		0			9.1997	0.852400518	11.51333597	0	5.460643479	6.741828998	0.016475326	0.526808271	1.595877746	0	0.557372188	0	0	0.308689396	2.077573955	22.80196435	1.070259867	0	0	2.719498198	2.992310058	3.549891573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9846
H4525_002_0	2010	5	N/A																															D	D	D	V	T	COIN	COIN	V	V	V	P	V	V	V	V	V	V	V	V	V	COIN	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	YES	1921.098262	94.40116691	1371.738273	4541.579386	549.8157686	27.24713258	2.401946104	293.1199134	355.2082778	4253.722981	2024.585613	0	0	1008.922869	2526.670416	8321.915402	454.8746306	1660.860349	5539.902506	27486.43482	26.36578679	1273.540705	0	0	0	0	0	0	0	0											3400	Days 1-30 $75; no cost sharing on lifetime reserve days	Days 1-30 $75; no cost sharing on lifetime reserve days	No prior hosp stay required; Days 1-20 $25/day; Days 21-100 $125/day	No Cost Sharing	$100 copay per trip	20% coinsurance	20% coinsurance	ER $50 USA waived if admitted within 3 days ; Urgent care $25 USA	$100 per surgery	No cost sharing for Lab Services.	X-rays $10 ; MRI/CT/PET/Nuc/Stress/Ultrsnd $75 per visit ; Radiation/Chemo 20% coinsurance per visit			"PT/ST/OT $20 copay ; CORF $20 copay; Partial Hospitalization $25 ; No cost sharing for Cardiac Rehabilitation, Diabetes monitoring training, renal dialysis."	$10 copay	$35 SPC copay ; Opthalmology $30 copay	Ind. Visits 1-20 $25; Group visits 1-20 $15 ; All visits 21 and up $50	No Cost Sharing	No Cost Sharing	"Chiropractor $25;  Podiatry $20; Diabetes Mon. Supp. 20% coinsurance; No Cost Sharing for Immunizations.  Annual coverage with no cost sharing of routine physicals, Pap/Pelvic exams, and Prostate Screening.  No cost sharing on Medicare Coverage of Colorectal screenings, bone mass measurements, and mammogram screening."	20% coinsurance	Hearing Exam $10 copay per Medicare covered visit; Eye exam $30 copay per Medicare covered visit; no Cost sharing for Medicare covered eyewear.																			71.88946002	71.88946002	76.34889327	0	100	0.2	0.2	39.89372001	100	0	11.99331694	0	0	10.72213777	10	34.83513221	19.94541233	0	0	0.839732518	0.2	28.57719814	0	0	0	0	0	0	0	0											NO	65.12411027	65.12411027	69.16387664	0	90.58923277	0.181178466	0.181178466	36.13941488	90.58923277	0	10.8646538	0	0	9.713102346	9.058923277	31.556879	18.068396	0	0	0.760707246	0.181178466	25.88786454	0	0	0	0	0	0	0	0												10.4258	0.512316	7.906228057	0	4.15061572	4.936593671	0.435180909	0.88276518	2.68150378	0	1.833035148	0	0	0.81664759	1.907409454	21.88447312	0.68490458	0	0	1.74242751	4.776912794	2.747437439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3243		7.097794859	10.4258	0.512316	7.906228057	0	4.15061572	4.936593671	0.435180909	0.88276518	2.68150378	0	1.833035148	0	0	0.81664759	1.907409454	21.88447312	0.68490458	0	0	1.74242751	4.776912794	2.747437439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3243	NO																																																																																		0			10.4258	0.512316	7.906228057	0	4.15061572	4.936593671	0.435180909	0.88276518	2.68150378	0	1.833035148	0	0	0.81664759	1.907409454	21.88447312	0.68490458	0	0	1.74242751	4.776912794	2.747437439	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.3243
H4525_003_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	378.7048333	4.264123407	29.15045173	41.48465362	13.33554667	36.31445791	4.726145352	26.58969256	62.80671275	13.04556143	23.47929572	0	0	32.47733763	16.0998978	56.51844433	2.16371884	3.154083721	33.58942229	124.6268706	18.59664272	8.751299376	0	0.793085954	0.446838942	2.343911749	0	2.878333333	0	0												2010 Part A Deductible - No copays	2010 Part A Deductible - No copays	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing		$200 limit	limit one eye exam annually	$200 limit		$500 limit													0.075469397	0.075469397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0.075469397	0.075469397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												28.5806	0.321810823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9024		0	28.5806	0.321810823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9024	NO																																																																																		0			28.5806	0.321810823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.9024
H4525_004_0	2010	2	N/A																															D	D	D	V	T	COIN	COIN	V	V	V	P	V	V	V	V	V	V	V	V	V	COIN	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	YES	1389.039456	128.701941	1636.835535	3047.043003	592.7211654	30.49110082	0.074512542	143.7133003	173.2232696	819.2497204	394.7326591	0	0	350.4454561	2255.085981	7104.431825	582.5145156	2056.037913	4197.081723	26400.81763	13.5332456	1344.357481	0	0	0	0	0	0	0	0											3400	Days 1-30 $75 copay per day; no cost sharing on lifetime reserve days	Days 1-30 $75  copay per day; no cost sharing on lifetime reserve days	No prior hosp stay required; Days 1-20 $25/day ; Days 21-100 $125/day	No Cost Sharing	$100 Copay per Visit	20% Coinsurance	20% Coinsurance	ER $50 Copay USA waived if admitted within 3 days ; Urgent Care $25 Copay USA	$100 Copay per surgery	No cost sharing for Lab Services.	X-rays $10 copay ; MRI/CT/PET/Nuc/Stress/Ultrsnd $75/visit ; Radiation/Chemo 20% per visit			"PT/OT/ST $20 per visit ; CORF $20 per visit ; Partial Hospitalization $25 ; No cost sharing for Cardiac Rehabilitation, Diabetes monitoring training, renal dialysis."	$10 copay	$35 SPC copay ; Opthalmology $30 copay	Ind visits 1-20 $25 ; Group visits 1-20 $15; All visits 21 and up $50	No Cost Sharing	No Cost Sharing	"Chiropractor $25 copay per visit; Podiatry $20 copay per visit; Diabetes Mon Supply 20% coinsurance; No Cost Sharing for Immunizations.  Annual coverage with no cost sharing of routine physicals, Pap/Pelvic exams, and Prostate Screening.  No Cost Sharing on Medicare Coverage of Colorectal screenings, bone mass measurements, and mammogram screening."	20% Coinsurance	Hearing exam $10 copay per Medicare covered visit; Eye exam $30 copay per Medicare covered visit; no Cost sharing for Medicare covered eyewear.																			71.88946002	71.88946002	76.34889327	0	100	0.2	0.2	39.78892766	100	0	15.32670671	0	0	9.561100669	10	34.83770395	19.94293627	0	0	1.118093213	0.2	28.66202913	0	0	0	0	0	0	0	0											NO	65.12411027	65.12411027	69.16387664	0	90.58923277	0.181178466	0.181178466	36.04448429	90.58923277	0	13.88434602	0	0	8.66132774	9.058923277	31.55920872	18.06615296	0	0	1.012872063	0.181178466	25.96471228	0	0	0	0	0	0	0	0												7.5383	0.698466616	9.434157587	0	4.474512969	5.524330859	0.013500068	0.43167265	1.307680258	0	0.456717069	0	0	0.252943579	1.702387574	18.68418723	0.876983028	0	0	2.228387552	2.451932672	2.908821266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.985		6.127595858	7.5383	0.698466616	9.434157587	0	4.474512969	5.524330859	0.013500068	0.43167265	1.307680258	0	0.456717069	0	0	0.252943579	1.702387574	18.68418723	0.876983028	0	0	2.228387552	2.451932672	2.908821266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.985	NO																																																																																		0			7.5383	0.698466616	9.434157587	0	4.474512969	5.524330859	0.013500068	0.43167265	1.307680258	0	0.456717069	0	0	0.252943579	1.702387574	18.68418723	0.876983028	0	0	2.228387552	2.451932672	2.908821266	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.985
H4525_005_0	2010	2	N/A																															D	D	D	V	T	COIN	COIN	V	V	V	P	V	V	V	V	V	V	V	V	V	COIN	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	YES	1304.087269	120.8306661	1753.702422	4902.539631	566.7213628	31.21721904	0.078771968	188.9145113	227.7060596	1076.923014	518.8853587	0	0	460.6687893	2156.166297	6792.794859	556.9624291	1965.849502	4012.976105	25242.74181	14.30685838	1285.387039	0	0	0	0	0	0	0	0											3400	Days 1-30 $75 copay per day; no cost sharing on lifetime reserve days	Days 1-30 $75  copay per day; no cost sharing on lifetime reserve days	No prior hosp stay required ; Days 1-20 $25/day ; Days 21-100 $125/day	No Cost Sharing	$100 copay per visit	20% coinsurance	20% coinsurance	$50 ER copay USA waived if admitted within 3 days ; $25 Urgent Care copay USA	$100 copay per surgery	No cost sharing for Lab Services.	X-ray $10 copay ; MRI/CT/PET/Nuc/Stress/Ultrsnd $75 per visit ;  Radiation/Chemo 20% coinsurance per visit			"PT/OT/ST $20 copay ; CORF $20 copay ; Partial Hospitalization $25 copay ; No cost sharing for Cardiac Rehabilitation, Diabetes monitoring training, renal dialysis."	$10 copay	$35 SPC copay ; Opthalmology $30 copay	Ind visits 1-20 $25 copay ; group visits 1-20 $15 copay ; All visits 21 and up $50 copay	No Cost Sharing	No Cost Sharing	"Chiropractor $25 copay; Podiatry $20; Diabetes Mon. Supp. 20% coinsurance; No Cost Sharing for Immunizations.  Annual coverage with no cost sharing of routine physicals, Pap/Pelvic exams, and Prostate Screening.  No cost sharing on Medicare Coverage of Colorectal screenings, bone mass measurements, and mammogram screening."	20% coinsurance	Hearing exam $10 copay per Medicare covered visit; Eye exam $30 copay per Medicare covered visit; no Cost sharing for Medicare covered eyewear.																			71.88946002	71.88946002	76.34889327	0	100	0.2	0.2	39.78892766	100	0	14.9124743	0	0	9.561100669	10	34.83770395	19.94293627	0	0	1.118093213	0.2	28.66202913	0	0	0	0	0	0	0	0											NO	65.12411027	65.12411027	69.16387664	0	90.58923277	0.181178466	0.181178466	36.04448429	90.58923277	0	13.50909605	0	0	8.66132774	9.058923277	31.55920872	18.06615296	0	0	1.012872063	0.181178466	25.96471228	0	0	0	0	0	0	0	0												7.0773	0.655749135	10.10773817	0	4.278237787	5.655887844	0.014271784	0.567443844	1.718976436	0	0.584139346	0	0	0.33250028	1.627712088	17.86460256	0.838514036	0	0	2.130638998	2.592094648	2.781225386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.827		6.111183759	7.0773	0.655749135	10.10773817	0	4.278237787	5.655887844	0.014271784	0.567443844	1.718976436	0	0.584139346	0	0	0.33250028	1.627712088	17.86460256	0.838514036	0	0	2.130638998	2.592094648	2.781225386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.827	NO																																																																																		0			7.0773	0.655749135	10.10773817	0	4.278237787	5.655887844	0.014271784	0.567443844	1.718976436	0	0.584139346	0	0	0.33250028	1.627712088	17.86460256	0.838514036	0	0	2.130638998	2.592094648	2.781225386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.827
H4525_007_0	2010	3	N/A																															D	D	D	V	T	COIN	COIN	V	V	V	P	V	V	V	V	V	V	V	V	V	COIN	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	YES	2046.909295	96.36525276	1399.380642	4444.940391	616.3371069	31.33707444	0.810292693	290.4673051	404.5309335	3639.829326	1207.303032	0	0	1391.361003	2553.141525	10342.6471	455.3365963	1761.010731	5385.090356	25728.6775	21.37067141	1567.337211	0	119.0621247	102.8692836	342.7304221	0	0	0	0											3400	No Cost Sharing	No Cost Sharing	No prior hosp stay required ;  days 1-4 $0/day ; days 5-30 $50/day ; days 31-100 $0/day	No Cost Sharing	$50 copay	10% coinsurance	10% coinsurance	$50 ER copay USA waived if admitted within 3 days ; $25 urgent care copay USA	$50 copay per surgery	No Cost Sharing	MRI/CT/PET/Nuc/Stress/Ultrsnd $50 copay ; Radiation/Chemo $25 copay			PT/OT/ST $25 copay ; CORF $25 copay ; Partial Hospitalization $25	$5 copay	$30 SPC copay ; $25 opthalmology copay	$25 copay per visit	No Cost Sharing	No Cost Sharing	Chiropractor $25 copay ; Podiatry $25 copay ; Diabetes Mon. Supp. 10% coinsurance	20% coinsurance	$10 hearing exam copay ; $25 eye exam copay		$50 limit	$25  eye exam ; limit one annually	$100 limit															0	0	26.45180194	0	50	0.1	0.1	39.89051801	50	0	7.68625	0	0	18.24099564	5	29.81641487	24.93041641	0	0	1.303708762	0.2	24.09656631	0	0	25	0	0	0	0	0											NO	0	0	25.55304316	0	48.30113884	0.096602278	0.096602278	38.53514897	48.30113884	0	7.425092568	0	0	17.62121726	4.830113884	28.80333589	24.08335009	0	0	1.259412358	0.193204555	23.2778319	0	0	24.15056942	0	0	0	0	0												0	0	2.979869496	0	2.480815348	3.027232767	0.07827612	0.932766739	1.628275399	0	0.747028064	0	0	2.043122877	1.027663694	24.82522819	0.913835888	0	0	2.700251201	4.128911067	3.040351011	0	0	0.207029315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7607		1.785368026	0	0	2.979869496	0	2.480815348	3.027232767	0.07827612	0.932766739	1.628275399	0	0.747028064	0	0	2.043122877	1.027663694	24.82522819	0.913835888	0	0	2.700251201	4.128911067	3.040351011	0	0	0.207029315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7607	NO																																																																																		0			0	0	2.979869496	0	2.480815348	3.027232767	0.07827612	0.932766739	1.628275399	0	0.747028064	0	0	2.043122877	1.027663694	24.82522819	0.913835888	0	0	2.700251201	4.128911067	3.040351011	0	0	0.207029315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.7607
H4525_008_0	2010	3	N/A																															D	D	D	V	T	COIN	COIN	V	V	V	P	V	V	V	V	V	V	V	V	V	COIN	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	NO	1863.990446	968.0976103	2196.514855	4088.911242	0	38.87100856	0.094990918	192.8528507	232.4530943	1099.373848	529.7026677	0	0	470.2724456	3026.162221	13106.74412	781.6923322	2759.054115	5632.179994	32518.00166	17.25260459	1804.030469	0	144.3640562	116.1143103	423.3334229	53.86681107	0	0	0												No Cost Sharing	No Cost Sharing	No prior hosp stay required ; days 1-100 $0/day	No Cost Sharing		10% coinsurance	10% coinsurance	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing			PT/OT/ST $25 copay	No Cost Sharing	No Cost Sharing	$25 copay per visit	No Cost Sharing	No Cost Sharing	No Cost Sharing	20% coinsurance	No Cost Sharing		$50 limit	$25 eye exam copay; limit one per year	$100 limit	$25 hearing exam copay ; limit one per year														0	0	0	0	0	0.1	0.1	0	0	0	0	0	0	10.41701218	0	0	24.92867034	0	0	0	0.2	0	0	0	25	0	25	0	0	0											NO	0	0	0	0	0	0.099553537	0.099553537	0	0	0	0	0	0	10.37050408	0	0	24.81737306	0	0	0	0.199107074	0	0	0	24.88838426	0	24.88838426	0	0	0												0	0	0	0	0	3.869746391	0.009456682	0	0	0	0	0	0	0.406413526	0	0	1.616629185	0	0	0	3.43511562	0	0	0	0.240824798	0	0.111721491	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6899		0.043455862	0	0	0	0	0	3.869746391	0.009456682	0	0	0	0	0	0	0.406413526	0	0	1.616629185	0	0	0	3.43511562	0	0	0	0.240824798	0	0.111721491	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6899	NO																																																																																		0			0	0	0	0	0	3.869746391	0.009456682	0	0	0	0	0	0	0.406413526	0	0	1.616629185	0	0	0	3.43511562	0	0	0	0.240824798	0	0.111721491	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6899
H4525_009_0	2010	3	N/A																															D	D	D	V	T	COIN	COIN	V	V	V	P	V	V	V	V	V	V	V	V	V	COIN	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	YES	2044.661935	123.0923053	1933.570725	5905.201568	715.4122299	38.03629584	1.088876161	290.7020847	478.9248048	3319.690306	1598.743144	0	0	1635.033042	2958.457259	12166.86384	705.7762709	2360.367496	5850.58932	30929.80356	38.70430812	1707.763392	0	116.9388475	91.9199588	335.1248498	42.10257917	0	0	0											3400	No Cost Sharing	No Cost Sharing	No prior hosp stay required ; days 0-100 $0/day	No Cost Sharing	No Cost Sharing	10% coinsurance	10% coinsurance	No Cost Sharing	No Cost Sharing	No Cost Sharing	No Cost Sharing			PT/OT/ST $25 copay	No Cost Sharing	No Cost Sharing	$25 per visit	No Cost Sharing	No Cost Sharing	No Cost Sharing	20% coinsurance	No Cost Sharing		$50 limit	$25 eye exam copay ; limit one annually	$100 limit	$25 hearing exam copay ; limit one annually														0	0	0	0	0	0.1	0.1	0	0	0	0	0	0	12.20665327	0	0	24.94265669	0	0	0	0.2	0	0	0	25	0	25	0	0	0											NO	0	0	0	0	0	0.099545269	0.099545269	0	0	0	0	0	0	12.15114578	0	0	24.82923459	0	0	0	0.199090537	0	0	0	24.88631714	0	24.88631714	0	0	0												0	0	0	0	0	3.786333285	0.10839247	0	0	0	0	0	0	1.655627071	0	0	1.460323716	0	0	0	7.705661493	0	0	0	0.190629104	0	0.087314845	0	0	0	0	0	0	0	0	0	0	0	0	0	14.9943		0.068495182	0	0	0	0	0	3.786333285	0.10839247	0	0	0	0	0	0	1.655627071	0	0	1.460323716	0	0	0	7.705661493	0	0	0	0.190629104	0	0.087314845	0	0	0	0	0	0	0	0	0	0	0	0	0	14.9943	NO																																																																																		0			0	0	0	0	0	3.786333285	0.10839247	0	0	0	0	0	0	1.655627071	0	0	1.460323716	0	0	0	7.705661493	0	0	0	0.190629104	0	0.087314845	0	0	0	0	0	0	0	0	0	0	0	0	0	14.9943
H4525_802_0	2010	1	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	317.548455	11.65564518	89.19058013	60.59787247	14.13381224	54.0612679	0.132112072	11.32059179	42.83340836	12.56185008	26.47959447	0	0	26.98488621	14.82623803	49.59649166	3.412831749	5.559975679	37.74478978	144.3829367	23.99468686	9.926868711	0	0	0	0	0	0	0	0											0	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing	Traditional Medicare FFS Cost Sharing																			0.074879867	0.074879867	0.190725219	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074879867	0.074879867	0.190725219	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.778	0.872773165	17.01089294	0	3.293178252	12.59627542	0.030782113	2.637697887	9.980184149	2.926911068	6.169745511	0	0	6.287478487	3.454513461	11.55598256	0.795189798	1.295474333	8.79453602	33.64122424	5.590762038	2.31296041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.0245		0	23.778	0.872773165	17.01089294	0	3.293178252	12.59627542	0.030782113	2.637697887	9.980184149	2.926911068	6.169745511	0	0	6.287478487	3.454513461	11.55598256	0.795189798	1.295474333	8.79453602	33.64122424	5.590762038	2.31296041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.0245	NO																																																																																		0			23.778	0.872773165	17.01089294	0	3.293178252	12.59627542	0.030782113	2.637697887	9.980184149	2.926911068	6.169745511	0	0	6.287478487	3.454513461	11.55598256	0.795189798	1.295474333	8.79453602	33.64122424	5.590762038	2.31296041	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.0245
H4527_001_0	2010	5	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	5.291981791	0	0	95.36319953	24.73431706	0	363.0749593	0	0	0	0	0	0	0	0	0	0	0	0	0.690380464	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	5% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care; $20/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	5% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $800 for Comprehensive Dental: Restorative Services every five years. Complete dentures will be paid in full if the covered service is rendered at a participating provider location.	No Cost-Sharing	Max Plan Benefit of $275 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $2000 every three years	No Cost-Sharing	Max Plan Benefit of $125 every three months											0	900	0	0	50	0.028535811	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.001288139	0	0	0	0	0	0	0	0	0											NO	0	900	0	0	50	0.028535811	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.001288139	0	0	0	0	0	0	0	0	0												0	0.396898634	0	0	0.397346665	0.705813797	0	1.512812331	0	0	0	0	0	0	0	0	0	0	0	0	0.000889306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0138	0	0	0	0.396898634	0	0	0.397346665	0.705813797	0	1.512812331	0	0	0	0	0	0	0	0	0	0	0	0	0.000889306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0138	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.396898634	0	0	0.397346665	0.705813797	0	1.512812331	0	0	0	0	0	0	0	0	0	0	0	0	0.000889306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.0138
H4527_002_0	2010	7	N/A																															D	A	D	V	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	P	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	YES	758.5590409	5.687503086	142.0506227	0	68.72718355	20.61917004	1.196478189	413.0913042	320.1410231	0	3.875453344	0	0	236.0810345	0	3500.790129	53.5228928	897.6713663	46.74694491	23.02220258	1.290063236	0	0	0	0	278.078143	0	0	0	0											3350	$200/Days Custom for IP Medical; $200/Days Custom for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$100/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$125/Case for OP Fac - Surgery; $125/Case for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	No Cost-Sharing	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$5/Service for Vision Hardware; Max Plan Benefit of $150 for glasses and/or contacts every two years	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											200	900	100	0	100	0.140473761	0.2	49.88211666	125	0	0.044117888	0	0	25	0	25	25	25	0.173354777	25	0.001423638	0	0	0	0	5	0	0	0	0											NO	198.0357052	891.1606734	99.01785258	0	99.01785259	0.139094102	0.198035705	49.39220074	123.7723157	0	0.043684585	0	0	24.75446314	0	24.75446315	24.75446316	24.75446315	0.171652178	24.75446315	0.001409656	0	0	0	0	4.950892628	0	0	0	0												12.5185	0.422373257	1.172128968	0	0.567101511	2.868004934	0.236945402	1.700290718	3.302049649	0	0.169297572	0	0	0.487004939	0	7.221681686	0.110410873	1.851781063	8.024214896	0.047491855	0.001818546	0	0	0	0	0.114727919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8158	0	0.404847573	12.5185	0.422373257	1.172128968	0	0.567101511	2.868004934	0.236945402	1.700290718	3.302049649	0	0.169297572	0	0	0.487004939	0	7.221681686	0.110410873	1.851781063	8.024214896	0.047491855	0.001818546	0	0	0	0	0.114727919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8158	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.5185	0.422373257	1.172128968	0	0.567101511	2.868004934	0.236945402	1.700290718	3.302049649	0	0.169297572	0	0	0.487004939	0	7.221681686	0.110410873	1.851781063	8.024214896	0.047491855	0.001818546	0	0	0	0	0.114727919	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8158
H4527_003_0	2010	3	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	P	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	YES	0	12.82686649	0	0	160.117861	36.59280712	0	421.3061741	0	0	0	0	0	0	0	0	0	0	0	0	2.80631482	0	0	0	0	368.4058355	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	5% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	5% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Service for Vision Hardware; Max Plan Benefit of $150 for glasses and/or contacts every two years	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $50 every three months											0	900	0	0	50	0.028027668	0	49.66718683	0	0	0	0	0	0	0	0	0	0	0	0	0.026594511	0	0	0	0	10	0	0	0	0											NO	0	899.9796631	0	0	49.99887017	0.028027035	0	49.66606452	0	0	0	0	0	0	0	0	0	0	0	0	0.026593911	0	0	0	0	9.999774033	0	0	0	0												0	0.961993249	0	0	0.667142678	1.025587884	0	1.743718302	0	0	0	0	0	0	0	0	0	0	0	0	0.074630885	0	0	0	0	0.306997926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.7801	0	0.000108016	0	0.961993249	0	0	0.667142678	1.025587884	0	1.743718302	0	0	0	0	0	0	0	0	0	0	0	0	0.074630885	0	0	0	0	0.306997926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.7801	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.961993249	0	0	0.667142678	1.025587884	0	1.743718302	0	0	0	0	0	0	0	0	0	0	0	0	0.074630885	0	0	0	0	0.306997926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.7801
H4527_004_0	2010	4	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	19.65718079	0	0	129.2522608	41.37001744	0	465.5527222	0	0	0	0	0	0	0	0	0	0	0	0	17.94495684	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	5% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care; $20/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	5% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $800 for Comprehensive Dental: Restorative Services every five years. Complete dentures will be paid in full if the covered service is rendered at a participating provider location.	No Cost-Sharing	Max Plan Benefit of $300 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $2000 every three years	No Cost-Sharing	Max Plan Benefit of $125 every three months											0	900	0	0	50	0.01900995	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.008971774	0	0	0	0	0	0	0	0	0											NO	0	899.9782378	0	0	49.99879099	0.01900949	0	49.99879099	0	0	0	0	0	0	0	0	0	0	0	0	0.008971557	0	0	0	0	0	0	0	0	0												0	1.47425291	0	0	0.538538065	0.786422932	0	1.939756104	0	0	0	0	0	0	0	0	0	0	0	0	0.160994211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.9	0	0.000118485	0	1.47425291	0	0	0.538538065	0.786422932	0	1.939756104	0	0	0	0	0	0	0	0	0	0	0	0	0.160994211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.9	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	1.47425291	0	0	0.538538065	0.786422932	0	1.939756104	0	0	0	0	0	0	0	0	0	0	0	0	0.160994211	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.9
H4527_005_0	2010	4	N/A																															D	A	D	V	T	Coin	Coin	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	490.6105459	1.877879194	144.6685218	0	83.60442103	11.87102303	2.07846171	241.622229	39.22399863	0	19.00707487	0	0	260.9607782	0	1978.379653	24.3381433	407.4326408	23.09108144	77.73208008	7.790145895	0	0	0	0	0	0	0	0	0											3350	$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	No Cost-Sharing	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	900	75	0	100	0.102265656	0.2	49.30610868	0.091763849	0	0.178848346	0	0	25	0	25	25	25	0.138090629	25	0.005087051	0	0	0	0	0	0	0	0	0											NO	149.3711923	896.2271535	74.68559613	0	99.58079485	0.101836953	0.19916159	49.09941493	0.09137917	0	0.178098604	0	0	24.89519872	0	24.89519871	24.89519873	24.89519871	0.137511746	24.89519871	0.005065726	0	0	0	0	0	0	0	0	0												6.1069	0.140250527	0.900387899	0	0.693782892	1.20890882	0.413949738	0.98862584	3.58425645	0	3.385133501	0	0	0.541389203	0	4.104346215	0.05049191	0.845259713	3.175294932	0.161262965	0.039462745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.3397	0	0.110882318	6.1069	0.140250527	0.900387899	0	0.693782892	1.20890882	0.413949738	0.98862584	3.58425645	0	3.385133501	0	0	0.541389203	0	4.104346215	0.05049191	0.845259713	3.175294932	0.161262965	0.039462745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.3397	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.1069	0.140250527	0.900387899	0	0.693782892	1.20890882	0.413949738	0.98862584	3.58425645	0	3.385133501	0	0	0.541389203	0	4.104346215	0.05049191	0.845259713	3.175294932	0.161262965	0.039462745	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.3397
H4527_006_0	2010	3	N/A																															D	A	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	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	YES	0	6.745732782	0	0	141.0208938	17.65874903	3.552009066	256.6738604	0	0	0	0	0	0	0	0	0	0	0	0	3.915810212	0	0	0	0	352.5879919	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	5% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Service for Vision Hardware; Max Plan Benefit of $200 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	No Cost-Sharing											0	900	0	0	100	0.016055147	0.090864526	49.22199393	0	0	0	0	0	0	0	0	0	0	0	0	0.1	0	0	0	0	10	0	0	0	0											NO	0	899.9899161	0	0	99.99887957	0.016054967	0.090863508	49.22144243	0	0	0	0	0	0	0	0	0	0	0	0	0.09999888	0	0	0	0	9.999887956	0	0	0	0												0	0.50592429	0	0	1.175160948	0.283510626	0.322748004	1.05282147	0	0	0	0	0	0	0	0	0	0	0	0	0.391576634	0	0	0	0	0.293820034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.0256	0	4.51E-05	0	0.50592429	0	0	1.175160948	0.283510626	0.322748004	1.05282147	0	0	0	0	0	0	0	0	0	0	0	0	0.391576634	0	0	0	0	0.293820034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.0256	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.50592429	0	0	1.175160948	0.283510626	0.322748004	1.05282147	0	0	0	0	0	0	0	0	0	0	0	0	0.391576634	0	0	0	0	0.293820034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.0256
H4527_008_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	343.4251032	7.707936988	550.417694	0	368.551552	26.60847727	12.1837873	385.6390233	668.0021641	0	12.19657919	0	0	677.0038168	0	5553.509552	327.1305822	926.8655042	37.53853568	976.469371	8.860547915	0	0	0	0	0	0	0	0	0											3350	$75/Admit for IP Medical; $75/Admit for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$50/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care; $20/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology;	No Cost-Sharing	No Cost-Sharing	$50/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	No Cost-Sharing	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $250 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	No Cost-Sharing											75	900	50	0	100	0.2	0.2	47.86535827	50	0	0.2	0	0	30.62908624	0	25	25	25	0.2	25	0.2	0	0	0	0	0	0	0	0	0											NO	73.99529197	887.9435036	49.33019464	0	98.66038929	0.197320779	0.197320779	47.2241488	49.33019464	0	0.197320779	0	0	30.21877572	0	24.66509732	24.66509732	24.66509732	0.197320779	24.66509732	0.197320779	0	0	0	0	0	0	0	0	0												2.1177	0.570351048	2.262684331	0	3.030119966	5.250405451	2.404114397	1.517622885	2.746056398	0	2.406638501	0	0	1.704852208	0	11.41482113	0.672392304	1.905102322	7.407133086	2.007059339	1.748370213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1654	0	0.667567463	2.1177	0.570351048	2.262684331	0	3.030119966	5.250405451	2.404114397	1.517622885	2.746056398	0	2.406638501	0	0	1.704852208	0	11.41482113	0.672392304	1.905102322	7.407133086	2.007059339	1.748370213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1654	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.1177	0.570351048	2.262684331	0	3.030119966	5.250405451	2.404114397	1.517622885	2.746056398	0	2.406638501	0	0	1.704852208	0	11.41482113	0.672392304	1.905102322	7.407133086	2.007059339	1.748370213	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1654
H4527_012_0	2010	4	N/A																															D	A	D	V	T	Coin	Coin	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	643.7483377	2.999479261	265.0069527	0	176.5106617	9.418369253	5.471437992	194.5500395	35.3751023	0	23.77438348	0	0	326.1298673	3989.459345	3342.293827	186.7842173	529.9535304	31.16899217	0	7.183781575	0	0	0	0	0	0	0	0	0											3350	$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$5/Visit for PCP - Office Visits; $5/Consult for PCP - Consults;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	No Cost-Sharing	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $150 for glasses and/or contacts every two years	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	900	75	0	100	0.2	0.2	48.26237168	0.2	0	0.2	0	0	25	5	25	25	25	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	148.2890403	889.7342417	74.14452015	0	98.8593602	0.19771872	0.19771872	47.71187186	0.19771872	0	0.19771872	0	0	24.71484005	4.94296801	24.71484005	24.71484005	24.71484005	0.19771872	0	0.19771872	0	0	0	0	0	0	0	0	0												7.9551	0.22239495	1.637401112	0	1.454144257	1.862187917	1.081805719	0.77352888	6.994319962	0	4.70064068	0	0	0.671687292	1.64331416	6.883688112	0.384695171	1.091476395	6.162693249	0	1.420368101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9394	0	0.518511193	7.9551	0.22239495	1.637401112	0	1.454144257	1.862187917	1.081805719	0.77352888	6.994319962	0	4.70064068	0	0	0.671687292	1.64331416	6.883688112	0.384695171	1.091476395	6.162693249	0	1.420368101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9394	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.9551	0.22239495	1.637401112	0	1.454144257	1.862187917	1.081805719	0.77352888	6.994319962	0	4.70064068	0	0	0.671687292	1.64331416	6.883688112	0.384695171	1.091476395	6.162693249	0	1.420368101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9394
H4527_013_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	204.3987341	2.253799227	694.1458567	0	137.8656207	9.289853565	4.086509357	182.2991009	58.4732545	0	36.35613359	0	0	332.4500086	4030.018915	2492.304943	74.96122138	1219.576289	4348.747689	378.6286367	5.015759635	0	0	0	0	0	0	0	0	0											3350	$500/Admit for IP Medical; $500/Admit for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$150/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC	No Cost-Sharing	$18/Case for OP Fac - Radiology; $38/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$5/Visit for PCP - Office Visits; $5/Consult for PCP - Consults;	$20/Visit for Speclst - Office Visits; $20/Consult for Speclst - Consults;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	$18/Procedure for Prof Radiology (IP); $18/Procedure for Prof Radiology (OP); $18/Procedure for Prof Radiology (Office);	$20/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $140 for glasses and/or contacts every two years	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											500	900	75	0	100	0.091283348	0.199993088	48.71753189	124.9270937	0	25.34276233	0	0	20	5	20	20	20	20.03520426	20	0.2	0	0	0	0	0	0	0	0	0											NO	496.401683	893.5230295	74.46025245	0	99.2803366	0.090626416	0.198553811	48.36692965	124.0280392	0	25.16037974	0	0	19.85606733	4.96401683	19.85606732	19.85606731	19.85606732	19.89101823	19.85606732	0.198560673	0	0	0	0	0	0	0	0	0												8.4553	0.167818459	4.307189644	0	1.140612102	0.841906129	0.811392007	0.734770649	0.604360258	0	0.076227844	0	0	0.550095813	1.667090143	4.123947894	0.124036255	2.017999075	7.208418296	0.626506308	0.99593261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4536	0	0.249747481	8.4553	0.167818459	4.307189644	0	1.140612102	0.841906129	0.811392007	0.734770649	0.604360258	0	0.076227844	0	0	0.550095813	1.667090143	4.123947894	0.124036255	2.017999075	7.208418296	0.626506308	0.99593261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4536	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.4553	0.167818459	4.307189644	0	1.140612102	0.841906129	0.811392007	0.734770649	0.604360258	0	0.076227844	0	0	0.550095813	1.667090143	4.123947894	0.124036255	2.017999075	7.208418296	0.626506308	0.99593261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4536
H4527_014_0	2010	5	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	0	2.990098858	370.1282525	0	216.047381	12.35180842	0	264.4429937	392.3625581	0	735.599024	0	0	512.3852019	0	4715.0982	243.190925	749.0426253	6035.579235	486.8363125	10.8242909	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	10% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC	No Cost-Sharing	$10/Case for OP Fac - Radiology; $18/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	No Cost-Sharing	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	$10/Procedure for Prof Radiology (IP); $10/Procedure for Prof Radiology (OP); $10/Procedure for Prof Radiology (Office);	$10/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $250 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	Max Plan Benefit of $100 every three months											0	900	75	0	100	0.1	0	48.25010425	100	0	11.63259638	0	0	10	0	10	10	10	10.90352391	10	0.2	0	0	0	0	0	0	0	0	0											NO	0	897.0221062	74.75184218	0	99.66912291	0.099669123	0	48.09045571	99.66912291	0	11.59410678	0	0	9.96691229	0	9.966912291	9.966912293	9.966912292	10.86744665	9.966912291	0.199338246	0	0	0	0	0	0	0	0	0												0	0.223515398	2.305647393	0	1.794437748	1.231093911	0	1.059765339	3.258869336	0	0.710717803	0	0	0.425574864	0	3.916247517	0.201988552	0.622136846	5.465944609	0.404354569	2.157695161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.778	0	0.078937102	0	0.223515398	2.305647393	0	1.794437748	1.231093911	0	1.059765339	3.258869336	0	0.710717803	0	0	0.425574864	0	3.916247517	0.201988552	0.622136846	5.465944609	0.404354569	2.157695161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.778	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.223515398	2.305647393	0	1.794437748	1.231093911	0	1.059765339	3.258869336	0	0.710717803	0	0	0.425574864	0	3.916247517	0.201988552	0.622136846	5.465944609	0.404354569	2.157695161	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.778
H4527_015_0	2010	5	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	2.876353313	423.6371528	0	232.6913607	15.70449596	0	187.1366164	0	0	0	0	0	0	0	0	0	0	0	0	8.360633971	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	5% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $225 for glasses and/or contacts every two years	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	900	75	0	100	0.010387388	0	47.97902526	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	899.8883148	74.99069289	0	99.98759052	0.010386099	0	47.97307132	0	0	0	0	0	0	0	0	0	0	0	0	0.199975181	0	0	0	0	0	0	0	0	0												0	0.215699728	2.647403635	0	1.938854041	0.16310845	0	0.748126521	0	0	0	0	0	0	0	0	0	0	0	0	1.671919292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3851	0	0.000916568	0	0.215699728	2.647403635	0	1.938854041	0.16310845	0	0.748126521	0	0	0	0	0	0	0	0	0	0	0	0	1.671919292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3851	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.215699728	2.647403635	0	1.938854041	0.16310845	0	0.748126521	0	0	0	0	0	0	0	0	0	0	0	0	1.671919292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3851
H4527_020_0	2010	2	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	10.39883503	168.9646562	0	205.010485	12.40375267	0	273.9943415	0	0	0	0	0	0	0	0	0	0	0	0	8.585358691	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$100/Days 21-100 for SNF	No Cost-Sharing	$75/Run for Ambulance	10% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care; $20/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $300 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	Max Plan Benefit of $100 every three months											0	900	100	0	75	0.075611363	0	48.12859658	0	0	0	0	0	0	0	0	0	0	0	0	0.046714764	0	0	0	0	0	0	0	0	0											NO	0	899.9521533	99.99468371	0	74.99601278	0.075607344	0	48.12603792	0	0	0	0	0	0	0	0	0	0	0	0	0.04671228	0	0	0	0	0	0	0	0	0												0	0.779871165	1.407963946	0	1.281247413	0.93781479	0	1.098855173	0	0	0	0	0	0	0	0	0	0	0	0	0.40104168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9068	0	0.000314039	0	0.779871165	1.407963946	0	1.281247413	0.93781479	0	1.098855173	0	0	0	0	0	0	0	0	0	0	0	0	0.40104168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9068	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.779871165	1.407963946	0	1.281247413	0.93781479	0	1.098855173	0	0	0	0	0	0	0	0	0	0	0	0	0.40104168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9068
H4527_022_0	2010	2	N/A																															D	A	D	V	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	719.5946892	2.702833929	264.2009236	0	150.5977629	10.11235962	5.092371481	236.8463187	300.3286511	0	10.97614098	0	0	554.3611436	0	3080.337507	196.18205	432.6812365	36.76692775	340.7297908	5.37339437	0	0	0	0	0	0	0	0	0											3350	$200/Days Custom for IP Medical; $200/Days Custom for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$100/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$125/Case for OP Fac - Surgery; $125/Case for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	No Cost-Sharing	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $150 for glasses and/or contacts every two years	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											200	900	100	0	100	0.2	0.2	48.69804734	125	0	0.2	0	0	25	0	25	25	25	0.2	25	0.2	0	0	0	0	0	0	0	0	0											NO	197.9045745	890.5705851	98.95228723	0	98.95228723	0.197904574	0.197904574	48.18783168	123.690359	0	0.197904574	0	0	24.73807181	0	24.73807181	24.7380718	24.73807181	0.197904574	24.73807181	0.197904574	0	0	0	0	0	0	0	0	0												11.8676	0.200588699	2.17860714	0	1.241832757	2.001282227	1.007803611	0.951092545	3.095646558	0	2.172228509	0	0	1.142818815	0	6.350134204	0.40443047	0.891974958	7.27634319	0.702416503	1.063419326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5482	0	0.450503002	11.8676	0.200588699	2.17860714	0	1.241832757	2.001282227	1.007803611	0.951092545	3.095646558	0	2.172228509	0	0	1.142818815	0	6.350134204	0.40443047	0.891974958	7.27634319	0.702416503	1.063419326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5482	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.8676	0.200588699	2.17860714	0	1.241832757	2.001282227	1.007803611	0.951092545	3.095646558	0	2.172228509	0	0	1.142818815	0	6.350134204	0.40443047	0.891974958	7.27634319	0.702416503	1.063419326	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5482
H4527_023_0	2010	4	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	2.74636635	450.4192602	0	198.2843232	19.67004172	0	338.8235322	0	0	0	0	0	0	0	0	0	0	0	0	11.53905718	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$50/Days 21-100 for SNF	No Cost-Sharing	$75/Run for Ambulance	10% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $250 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	No Cost-Sharing											0	900	50	0	75	0.099199628	0	48.7859832	0	0	0	0	0	0	0	0	0	0	0	0	3.20E-07	0	0	0	0	0	0	0	0	0											NO	0	899.9232277	49.99573486	0	74.99360229	0.099191166	0	48.78182162	0	0	0	0	0	0	0	0	0	0	0	0	3.20E-07	0	0	0	0	0	0	0	0	0												0	0.205959906	1.876586826	0	1.239171306	1.951094368	0	1.377369092	0	0	0	0	0	0	0	0	0	0	0	0	3.70E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6502	0	0.000567328	0	0.205959906	1.876586826	0	1.239171306	1.951094368	0	1.377369092	0	0	0	0	0	0	0	0	0	0	0	0	3.70E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6502	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.205959906	1.876586826	0	1.239171306	1.951094368	0	1.377369092	0	0	0	0	0	0	0	0	0	0	0	0	3.70E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6502
H4527_024_0	2010	2	N/A																															D	A	D	V	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	660.3269077	7.393883849	209.6544834	0	153.9961482	9.541169387	5.493426189	205.7312493	296.640526	0	13.43423059	0	0	334.9831011	0	3049.680444	130.9935597	365.0795515	25.481076	0	5.443782908	0	0	0	0	0	0	0	0	0											3350	$50/Days 1-5 for IP Medical; $50/Days 1-5 for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	No Cost-Sharing	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	No Cost-Sharing	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $300 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	No Cost-Sharing											50	900	75	0	100	0.2	0.2	47.9777719	50	0	0.2	0	0	10	0	10	10	10	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	49.8447942	897.2062957	74.7671913	0	99.6895884	0.199379177	0.199379177	47.82884333	49.8447942	0	0.199379177	0	0	9.96895884	0	9.96895884	9.968958834	9.96895884	0.199379177	0	0.199379177	0	0	0	0	0	0	0	0	0												2.7428	0.552819928	1.306273072	0	1.279317719	1.902310498	1.095274791	0.819990641	1.232165497	0	2.678505835	0	0	0.278286062	0	2.533511569	0.10882245	0.303288585	5.080395957	0	1.085376955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9992	0	0.071614363	2.7428	0.552819928	1.306273072	0	1.279317719	1.902310498	1.095274791	0.819990641	1.232165497	0	2.678505835	0	0	0.278286062	0	2.533511569	0.10882245	0.303288585	5.080395957	0	1.085376955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9992	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.7428	0.552819928	1.306273072	0	1.279317719	1.902310498	1.095274791	0.819990641	1.232165497	0	2.678505835	0	0	0.278286062	0	2.533511569	0.10882245	0.303288585	5.080395957	0	1.085376955	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.9992
H4527_026_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	238.7813136	3.310659325	328.9468506	0	189.1467279	11.00275066	6.833187352	245.9456897	360.1622414	0	8.6310058	0	0	524.3744085	0	3757.086318	185.4561372	546.4756495	28.38231402	438.8803507	7.329541117	0	0	0	0	0	0	0	0	0											3350	$75/Admit for IP Medical; $75/Admit for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$50/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care; $20/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology;	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	No Cost-Sharing	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $275 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	Max Plan Benefit of $100 every three months											75	900	50	0	100	0.2	0.2	47.37992903	50	0	0.2	0	0	25	0	25	25	25	0.2	25	0.2	0	0	0	0	0	0	0	0	0											NO	74.57259233	894.8711083	49.71506156	0	99.43012311	0.198860246	0.198860246	47.10992177	49.71506155	0	0.198860246	0	0	24.85753078	0	24.85753078	24.85753078	24.85753078	0.198860246	24.85753078	0.198860246	0	0	0	0	0	0	0	0	0												1.4839	0.246884448	1.362801077	0	1.567240204	2.188009705	1.358849319	0.965540184	1.492124	0	1.716363939	0	0	1.086221083	0	7.782657399	0.384165137	1.13200294	5.644113955	0.909123485	1.457554351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7775	0	0.176399287	1.4839	0.246884448	1.362801077	0	1.567240204	2.188009705	1.358849319	0.965540184	1.492124	0	1.716363939	0	0	1.086221083	0	7.782657399	0.384165137	1.13200294	5.644113955	0.909123485	1.457554351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7775	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.4839	0.246884448	1.362801077	0	1.567240204	2.188009705	1.358849319	0.965540184	1.492124	0	1.716363939	0	0	1.086221083	0	7.782657399	0.384165137	1.13200294	5.644113955	0.909123485	1.457554351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7775
H4527_027_0	2010	4	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	3.721389184	345.5634719	0	217.9039431	11.4344441	0	224.2990375	0	0	0	0	0	431.1467102	0	3857.974628	183.0593856	619.8846096	0	577.8711986	6.009450541	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$50/Days 21-100 for SNF	No Cost-Sharing	$75/Run for Ambulance	10% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Cardiovascular; $5/Case for OP Fac - Occ Therapy; $5/Case for OP Fac - Physical/Speech Therapy;	No Cost-Sharing	$5/Visit for Speclst - Office Visits; $5/Consult for Speclst - Consults;	$5/Visit for OP Psych - Non-Physician; $5/Visit for OP Psych - Psychiatrist;	$5/Visit for PT/ST (PCP); $5/Visit for Occ Therapy (PCP); $5/Visit for PT/ST (Specialist); $5/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$5/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $275 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	No Cost-Sharing											0	900	50	0	75	0.1	0	48.20597075	0	0	0	0	0	8.757281194	0	5	5	5	0	5	0.2	0	0	0	0	0	0	0	0	0											NO	0	899.7905437	49.98836354	0	74.98254532	0.099976727	0	48.19475182	0	0	0	0	0	8.755243122	0	4.998836354	4.998836351	4.998836356	0	4.998836355	0.199953454	0	0	0	0	0	0	0	0	0												0	0.279039233	1.439512705	0	1.361582691	1.143178297	0	0.90083637	0	0	0	0	0	0.314566189	0	1.607115319	0.076256993	0.258225144	0	0.24072363	1.201610393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8226	0	0.002053765	0	0.279039233	1.439512705	0	1.361582691	1.143178297	0	0.90083637	0	0	0	0	0	0.314566189	0	1.607115319	0.076256993	0.258225144	0	0.24072363	1.201610393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8226	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.279039233	1.439512705	0	1.361582691	1.143178297	0	0.90083637	0	0	0	0	0	0.314566189	0	1.607115319	0.076256993	0.258225144	0	0.24072363	1.201610393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.8226
H4527_028_0	2010	4	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	2.967920891	248.84221	0	160.6740135	9.988436579	0	199.8711026	0	0	0	0	0	314.5988198	0	3439.272599	133.3351027	418.6107115	0	301.883353	6.190255458	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$50/Days 21-100 for SNF	No Cost-Sharing	$75/Run for Ambulance	10% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Case for OP Fac - Cardiovascular; $5/Case for OP Fac - Occ Therapy; $5/Case for OP Fac - Physical/Speech Therapy;	No Cost-Sharing	$5/Visit for Speclst - Office Visits; $5/Consult for Speclst - Consults;	$5/Visit for OP Psych - Non-Physician; $5/Visit for OP Psych - Psychiatrist;	$5/Visit for PT/ST (PCP); $5/Visit for Occ Therapy (PCP); $5/Visit for PT/ST (Specialist); $5/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$5/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $275 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	No Cost-Sharing											0	900	50	0	75	0.1	0	48.16240328	0	0	0	0	0	10.07776339	0	5	5	5	0	5	0.2	0	0	0	0	0	0	0	0	0											NO	0	899.8903163	49.99390647	0	74.9908597	0.099987813	0	48.15653369	0	0	0	0	0	10.07653521	0	4.999390646	4.999390654	4.999390647	0	4.999390645	0.199975626	0	0	0	0	0	0	0	0	0												0	0.222566939	1.036716181	0	1.0040902	0.998721928	0	0.802091624	0	0	0	0	0	0.264172174	0	1.432855605	0.055549522	0.174399873	0	0.125769401	1.23790021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3548	0	0.000896448	0	0.222566939	1.036716181	0	1.0040902	0.998721928	0	0.802091624	0	0	0	0	0	0.264172174	0	1.432855605	0.055549522	0.174399873	0	0.125769401	1.23790021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3548	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.222566939	1.036716181	0	1.0040902	0.998721928	0	0.802091624	0	0	0	0	0	0.264172174	0	1.432855605	0.055549522	0.174399873	0	0.125769401	1.23790021	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.3548
H4527_030_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	239.8363635	3.320874081	330.4020209	0	209.3546487	10.64916848	6.590124453	226.4654853	326.8658564	0	10.86658532	0	0	410.8326646	0	3844.150725	203.23518	606.6135888	21.2989071	507.7193777	9.13743141	0	0	0	0	0	0	0	0	0											3350	$75/Admit for IP Medical; $75/Admit for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$50/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care; $20/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology;	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	No Cost-Sharing	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $275 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	Max Plan Benefit of $100 every three months											75	900	50	0	100	0.2	0.2	47.09017587	50	0	0.2	0	0	25	0	25	25	25	0.2	25	0.2	0	0	0	0	0	0	0	0	0											NO	74.59022019	895.0826425	49.72681346	0	99.45362692	0.198907254	0.198907254	46.83288782	49.72681346	0	0.198907254	0	0	24.86340673	0	24.86340673	24.86340673	24.86340673	0.198907254	24.86340673	0.198907254	0	0	0	0	0	0	0	0	0												1.4908	0.247704729	1.369153305	0	1.735089927	2.118196859	1.310823557	0.883836056	1.354499789	0	2.161442644	0	0	0.85122497	0	7.96489025	0.421093245	1.256873366	4.236507122	1.051969449	1.817501389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2716	0	0.166304484	1.4908	0.247704729	1.369153305	0	1.735089927	2.118196859	1.310823557	0.883836056	1.354499789	0	2.161442644	0	0	0.85122497	0	7.96489025	0.421093245	1.256873366	4.236507122	1.051969449	1.817501389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2716	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	1.4908	0.247704729	1.369153305	0	1.735089927	2.118196859	1.310823557	0.883836056	1.354499789	0	2.161442644	0	0	0.85122497	0	7.96489025	0.421093245	1.256873366	4.236507122	1.051969449	1.817501389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2716
H4527_031_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.70947905	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	5% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $275 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $2000 every three years	No Cost-Sharing	Max Plan Benefit of $125 every three months											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.05	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.05	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.585473952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.585473952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5855	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.585473952	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.5855
H4528_001_0	2010	3	N/A																															A	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	254.9370488	6.595097664	164.464613	10.08499905	211.1232549	9.775375337	5.584816307	319.4653093	288.9284439	2.077619054	875.0560489	0	1.142069126	1599.485043	0.927413725	4933.37492	280.2507184	296.3162959	26.61695956	71.68041742	22.02838744	0	0	0	0	0	0	0	0	0												1a:  Acute - $400/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $35/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/7b:  Routine Chiropractic Care - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $35/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $35/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit											400	0.069964676	85	0	50	0.2	0.2	40.04395696	145.8908583	0	55.95910187	0	0.2	43.60380135	35	31.9418073	35	35	0	35	0.2	0	0	0	0	0	0	0	0	0											NO	400	0.069964676	85	0	50	0.2	0.2	40.04395696	145.8908583	0	55.95910187	0	0.2	43.60380135	35	31.9418073	35	35	0	35	0.2	0	0	0	0	0	0	0	0	0												8.4979	0.461423871	1.164957675	0	0.879680229	1.955075067	1.116963261	1.066054591	3.512668223	0	4.080612549	0	0.228413825	5.811969008	0.002704957	13.13174259	0.817397929	0.864255863	0	0.209067884	4.405677488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2066		0	8.4979	0.461423871	1.164957675	0	0.879680229	1.955075067	1.116963261	1.066054591	3.512668223	0	4.080612549	0	0.228413825	5.811969008	0.002704957	13.13174259	0.817397929	0.864255863	0	0.209067884	4.405677488	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2066	NO	1a:  Acute - 20.0% for 1-90/1a:  Additional Days - 20.0% for 91-999		2:  Skilled Nursing Services - 20.0% for 1-100/2:  Non-Medicare Covered Stay - 20.0% for 1-100	6:  Home Health Services - 20.0%	10a:  Ambulance - 20.0%			4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - 20.0%/14c:  Routine Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%		7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%																				5.8418	0	0.1628	0.2709	0.2049	0	0	0.1483	0.6269	0.0475	0.3294	0	0.0288	0.0282	0.6558	1.3693	0	0.0637	0.5898	0.5224	0.5049	0.0068	0	0	0	0	0	0	0	0											11.4021		0	14.3397	0.461423871	1.32776456	0.270860776	1.084619588	1.955075067	1.116963261	1.214347652	4.139550871	0.047468112	4.409992316	0	0.257251988	5.840185952	0.6584842	14.5010853	0.817397929	0.927989597	0.589763849	0.731426573	4.910569524	0.006795482	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.6087
H4528_002_0	2010	4	N/A																															A	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	455.4198599	5.60268919	6.408393898	13.84825248	10.6112756	14.68851924	6.282178716	131.7581178	29.00779178	3.175249919	13.86301017	0	0.235936883	14.720563	0	0	2.535241014	1.932830573	33.83453456	0	12.40108408	0	0	0	0	0	0	0	0	0												1a:  Acute - $500/admit for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - MC Cost Shares for 1-100/2:  Non-Medicare Covered Stay - MC Cost Shares for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $0/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $0/visit/7h:  Psychiatric Services - Individual - $0/visit/7h:  Psychiatric Services - Group - $0/visit	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit		9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/ /18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit											500	0.068940297	0.193650977	0	0.2	0.2	0.2	50	0.2	0	0.113546246	0	0.2	0.11303161	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	500	0.068940297	0.193650977	0	0.2	0.2	0.2	50	0.2	0	0.113546246	0	0.2	0.11303161	0	0	0	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0												18.9758	0.386251057	1.24099174	0	2.122255119	2.937703848	1.256435743	0.548992157	5.801558356	0	1.574092768	0	0.047187377	1.663888937	0	0	0	0	0	0	2.480216815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0354		0	18.9758	0.386251057	1.24099174	0	2.122255119	2.937703848	1.256435743	0.548992157	5.801558356	0	1.574092768	0	0.047187377	1.663888937	0	0	0	0	0	0	2.480216815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0354	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	18.9758	0.386251057	1.24099174	0	2.122255119	2.937703848	1.256435743	0.548992157	5.801558356	0	1.574092768	0	0.047187377	1.663888937	0	0	0	0	0	0	2.480216815	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0354
H4528_005_0	2010	3	N/A																															A	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	210.0551348	5.835983803	438.3275931	18.5095114	164.188695	9.833410693	5.985196205	262.7989202	315.7644851	1.451695901	407.2153463	0	0.104853954	970.9424928	0.710124809	4401.886182	279.1060664	503.7622271	35.61167973	86.67839214	11.57402332	0	0	0	0	0	0	0	0	0												1a:  Acute - $100/admit for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $60/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $50/visit/8b:  Outpatient Therapeutic Radiological Services - $50/visit/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $30/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/ Visits/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $30/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $30/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit												100	0.072124889	85	0	50	0.2	0.2	36.5330424	142.5221102	0	19.358318	0	0.2	42.23155264	30	29.91054301	30	30	0	29.93486544	0.2	0	0	0	0	0	0	0	0	0											NO	100	0.072124889	85	0	50	0.2	0.2	36.5330424	142.5221102	0	19.358318	0	0.2	42.23155264	30	29.91054301	30	30	0	29.93486544	0.2	0	0	0	0	0	0	0	0	0												1.7505	0.420919685	3.104820451	0	0.684119563	1.966682139	1.197039241	0.800070341	3.75028506	0	0.656917014	0	0.020970791	3.417034083	0.001775312	10.9719005	0.697765166	1.259405568	0	0.2162255	2.314804664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2312		0	1.7505	0.420919685	3.104820451	0	0.684119563	1.966682139	1.197039241	0.800070341	3.75028506	0	0.656917014	0	0.020970791	3.417034083	0.001775312	10.9719005	0.697765166	1.259405568	0	0.2162255	2.314804664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2312	NO	1a:  Acute - 20.0% for 1-90		2:  Skilled Nursing Services - 20.0% for 1-100/2:  Non-Medicare Covered Stay - 20.0% for 1-100	6:  Home Health Services - 20.0%	10a:  Ambulance - 20.0%			4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - 20.0%/14c:  Routine Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%		7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%																				5.2098	0	0.6456	0.4394	0.2173	0	0	0.1201	0.889	0.0658	0.3045	0	0.0027	0.0844	0.68	1.5012	0	0.0992	0.7372	0.7329	0.3413	0.0104	0	0	0	0	0	0	0	0											12.0808		0	6.9602	0.420919685	3.750446592	0.439391336	0.901382925	1.966682139	1.197039241	0.920178449	4.639298094	0.065824266	0.961368613	0	0.023696615	3.501468324	0.68177647	12.47308117	0.697765166	1.358610499	0.737212243	0.949138001	2.656143104	0.010369963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.312
H4528_006_0	2010	3	N/A																															A	coin	coin	coin	T	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	465.9185792	5.474059333	31.40971469	25.46116632	335.9113324	15.81260663	6.484648696	128.0712781	36.26039726	1.605524222	10.70871256	0	0.753403889	23.52281996	0	0	2.63675659	5.389652858	46.42510788	6.978463937	6.45367955	0.11863603	0	0	0	0	0	0	0	0												1a:  Acute - $500/admit for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - MC Cost Shares for 1-100/2:  Non-Medicare Covered Stay - MC Cost Shares for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $0/visit/9b:  Ambulatory Surgical Center Services - $0/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $0/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $0/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $0/visit/7h:  Psychiatric Services - Individual - $0/visit/7h:  Psychiatric Services - Group - $0/visit	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit		9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/ /18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Home Safety - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit14a:  Home Safety - $0/service/											500	0.072124889	0.190847712	0	50	0.2	0.2	50	0	0	0.07411831	0	0.2	0	0	0	0	0	0	15.79254831	0.2	0.2	0	0	0	0	0	0	0	0											NO	500	0.072124889	0.190847712	0	50	0.2	0.2	50	0	0	0.07411831	0	0.2	0	0	0	0	0	0	15.79254831	0.2	0.2	0	0	0	0	0	0	0	0												19.4133	0.394815923	5.994472181	0	1.399630552	3.162521326	1.296929739	0.533630325	0	0	0.793711682	0	0.150680778	0	0	0	0	0	0	0.009183977	1.29073591	0.023727206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4633		0	19.4133	0.394815923	5.994472181	0	1.399630552	3.162521326	1.296929739	0.533630325	0	0	0.793711682	0	0.150680778	0	0	0	0	0	0	0.009183977	1.29073591	0.023727206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4633	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	19.4133	0.394815923	5.994472181	0	1.399630552	3.162521326	1.296929739	0.533630325	0	0	0.793711682	0	0.150680778	0	0	0	0	0	0	0.009183977	1.29073591	0.023727206	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4633
H4528_012_0	2010	3	N/A																															A	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	424.3681261	5.635811152	66.28779743	94.50984473	19.12662355	33.63367063	12.51204104	129.5472518	29.78916836	3.986033857	17.87117489	0	0.263163324	35.38858472	0	0	2.491611713	6.327468829	28.10114565	25.7451145	8.895433732	1.022243563	0	0	0	0	0	0	0	0												1a:  Acute - $500/admit for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - MC Cost Shares for 1-100/2:  Non-Medicare Covered Stay - MC Cost Shares for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/17a:  Vision Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $0/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $0/visit/7h:  Psychiatric Services - Individual - $0/visit/7h:  Psychiatric Services - Group - $0/visit	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit		9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/ /18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit											500	0.073001535	0.183398851	0	0.2	0.2	0.2	50	0.2	0	0.137336329	0	0.2	0.121468673	0	0	0	0	0	15.22086903	0.2	0.2	0	0	0	0	0	0	0	0											NO	500	0.073001535	0.183398851	0	0.2	0.2	0.2	50	0.2	0	0.137336329	0	0.2	0.121468673	0	0	0	0	0	15.22086903	0.2	0.2	0	0	0	0	0	0	0	0												17.682	0.411422865	12.15710588	0	3.825324711	6.726734125	2.502408209	0.539780216	5.957833672	0	2.454361547	0	0.052632665	4.29860442	0	0	0	0	0	0.032655251	1.779086746	0.204448713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6244		0	17.682	0.411422865	12.15710588	0	3.825324711	6.726734125	2.502408209	0.539780216	5.957833672	0	2.454361547	0	0.052632665	4.29860442	0	0	0	0	0	0.032655251	1.779086746	0.204448713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6244	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	17.682	0.411422865	12.15710588	0	3.825324711	6.726734125	2.502408209	0.539780216	5.957833672	0	2.454361547	0	0.052632665	4.29860442	0	0	0	0	0	0.032655251	1.779086746	0.204448713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6244
H4528_013_0	2010	3	N/A																															A	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	772.5055537	5.602115161	326.2284675	5.047626844	62.0694572	8.842735676	16.05254609	91.05347656	11.81612501	5.820688191	7.33874156	0	0.179131023	81.28801048	0	0	2.519084516	0.973066473	23.04030395	6.969686152	2.354639359	1.24556283	0	0	0	0	0	0	0	0												1a:  Acute - $500/admit for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/7-12 Additional Visits/17a:  Vision Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/7f:  Routine Footcare - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $0/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $0/visit/7h:  Psychiatric Services - Individual - $0/visit/7h:  Psychiatric Services - Group - $0/visit	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit		9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/ /18a:  Hearing Exams - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit											500	0.072329766	0	0	0.2	0.2	0.2	50	0.2	0	0.136850958	0	0.2	0.021810103	0	0	0	0	0	17.11369757	0.2	0.2	0	0	0	0	0	0	0	0											NO	500	0.072329766	0	0	0.2	0.2	0.2	50	0.2	0	0.136850958	0	0.2	0.021810103	0	0	0	0	0	17.11369757	0.2	0.2	0	0	0	0	0	0	0	0												32.1877	0.405199677	0	0	12.41389144	1.768547135	3.210509218	0.379389486	2.363225003	0	1.004313816	0	0.035826205	1.772899919	0	0	0	0	0	0.009939758	0.470927872	0.249112566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2715		0	32.1877	0.405199677	0	0	12.41389144	1.768547135	3.210509218	0.379389486	2.363225003	0	1.004313816	0	0.035826205	1.772899919	0	0	0	0	0	0.009939758	0.470927872	0.249112566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2715	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	32.1877	0.405199677	0	0	12.41389144	1.768547135	3.210509218	0.379389486	2.363225003	0	1.004313816	0	0.035826205	1.772899919	0	0	0	0	0	0.009939758	0.470927872	0.249112566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2715
H4528_014_0	2010	2	N/A																															A	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	390.5479947	6.339962633	728.5218383	48.70319294	313.647062	20.59271068	7.834254631	334.6793055	376.9178122	3.62938756	763.3695535	0	0.927696211	1423.217578	0.966822926	6811.293727	278.538058	628.0014237	40.81997541	107.2671082	14.86438196	0	0	0	0	0	0	0	0	0												1a:  Acute - $400/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $15/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $35/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/ Visits/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/7b:  Routine Chiropractic Care - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $35/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $35/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit											400	0.072261301	85	0	50	0.2	0.099234773	40.04480105	145.8908583	0	37.79755727	0	0.2	45.43005553	35	32.54048834	35	35	0	34.70456253	0.2	0	0	0	0	0	0	0	0	0											NO	400	0.072261301	85	0	50	0.2	0.099234773	40.04480105	145.8908583	0	37.79755727	0	0.2	45.43005553	35	32.54048834	35	35	0	34.70456253	0.2	0	0	0	0	0	0	0	0	0												13.0183	0.45813395	5.160363021	0	1.306862759	4.118542136	0.777430478	1.116847184	4.582405262	0	2.404458702	0	0.185539242	5.388071133	0.0028199	18.47023534	0.812402669	1.831670819	0	0.310221505	2.972876391	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9171		0	13.0183	0.45813395	5.160363021	0	1.306862759	4.118542136	0.777430478	1.116847184	4.582405262	0	2.404458702	0	0.185539242	5.388071133	0.0028199	18.47023534	0.812402669	1.831670819	0	0.310221505	2.972876391	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9171	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	13.0183	0.45813395	5.160363021	0	1.306862759	4.118542136	0.777430478	1.116847184	4.582405262	0	2.404458702	0	0.185539242	5.388071133	0.0028199	18.47023534	0.812402669	1.831670819	0	0.310221505	2.972876391	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9171
H4528_015_0	2010	2	N/A																															A	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	329.9073214	6.167725365	748.7098994	45.2803228	226.9779955	19.40772496	12.17896945	292.6297617	356.9895548	2.735942664	365.5266575	0	1.154057649	1051.015452	0.854164319	6136.109088	282.2124681	717.3594775	42.73720062	85.1544595	7.400583617	0	0	0	0	0	0	0	0	0												1a:  Acute - $100/admit for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $50/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $60/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $50/visit/8b:  Outpatient Therapeutic Radiological Services - $50/visit/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $30/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/ Visits/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $30/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $30/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit											100	0.072124889	85	0	50	0.2	0.06192771	36.62040479	142.5481651	0	20.72706661	0	0.2	42.50681794	30	30	30	30	0	29.89226797	0.2	0	0	0	0	0	0	0	0	0											NO	100	0.072124889	85	0	50	0.2	0.06192771	36.62040479	142.5481651	0	20.72706661	0	0.2	42.50681794	30	30	30	30	0	29.89226797	0.2	0	0	0	0	0	0	0	0	0												2.7492	0.444846509	5.303361787	0	0.945741648	3.881544993	0.754215689	0.893018361	4.240683831	0	0.631357948	0	0.23081153	3.722943541	0.002135411	15.34027272	0.70553117	1.793398694	0	0.21212166	1.480116723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3313		0	2.7492	0.444846509	5.303361787	0	0.945741648	3.881544993	0.754215689	0.893018361	4.240683831	0	0.631357948	0	0.23081153	3.722943541	0.002135411	15.34027272	0.70553117	1.793398694	0	0.21212166	1.480116723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3313	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	2.7492	0.444846509	5.303361787	0	0.945741648	3.881544993	0.754215689	0.893018361	4.240683831	0	0.631357948	0	0.23081153	3.722943541	0.002135411	15.34027272	0.70553117	1.793398694	0	0.21212166	1.480116723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.3313
H4528_801_0	2010	1	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	308.3456191	3.530352611	61.09528055	43.95516231	9.905956217	17.53686153	4.335943814	10.59874381	44.92464594	6.914271277	21.55034988	0	0.064996982	26.39934821	44.79009383	112.516626	1.466816676	5.795253553	32.28537246	38.70929292	8.440335374	1.476716213	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.6007	0.270212027	10.07036942	0	2.308087798	4.086088736	1.010274909	2.469507309	10.4674425	1.611025208	5.021231521	0	0.015144297	6.151048134	10.43609186	26.21637385	0.341768286	1.350294078	7.522491784	9.019265251	1.966598142	0.344074878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2781		0	23.6007	0.270212027	10.07036942	0	2.308087798	4.086088736	1.010274909	2.469507309	10.4674425	1.611025208	5.021231521	0	0.015144297	6.151048134	10.43609186	26.21637385	0.341768286	1.350294078	7.522491784	9.019265251	1.966598142	0.344074878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2781	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	23.6007	0.270212027	10.07036942	0	2.308087798	4.086088736	1.010274909	2.469507309	10.4674425	1.611025208	5.021231521	0	0.015144297	6.151048134	10.43609186	26.21637385	0.341768286	1.350294078	7.522491784	9.019265251	1.966598142	0.344074878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2781
H4528_802_0	2010	1	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	308.3456191	3.530352611	61.09528055	43.95516231	9.905956217	17.53686153	4.335943814	10.59874381	44.92464594	6.914271277	21.55034988	0	0.064996982	26.39934821	44.79009383	112.516626	1.466816676	5.795253553	32.28537246	38.70929292	8.440335374	1.476716213	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076539671	0.076539671	0.164830562	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.6007	0.270212027	10.07036942	0	2.308087798	4.086088736	1.010274909	2.469507309	10.4674425	1.611025208	5.021231521	0	0.015144297	6.151048134	10.43609186	26.21637385	0.341768286	1.350294078	7.522491784	9.019265251	1.966598142	0.344074878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2781		0	23.6007	0.270212027	10.07036942	0	2.308087798	4.086088736	1.010274909	2.469507309	10.4674425	1.611025208	5.021231521	0	0.015144297	6.151048134	10.43609186	26.21637385	0.341768286	1.350294078	7.522491784	9.019265251	1.966598142	0.344074878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2781	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	23.6007	0.270212027	10.07036942	0	2.308087798	4.086088736	1.010274909	2.469507309	10.4674425	1.611025208	5.021231521	0	0.015144297	6.151048134	10.43609186	26.21637385	0.341768286	1.350294078	7.522491784	9.019265251	1.966598142	0.344074878	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2781
H4529_002_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	932.2542087	30.72796992	178.379908	994.3078317	105.1754199	8.718704942	4.026534382	291.0536376	158.9912684	2.927401552	6.959726097	0.256992324	0.330958764	4.351516918	4458.718406	2735.606824	74.56655656	72.13553175	21.41782131	80.08233086	4.49063329	0	0	0	401	1.110789713	0	0	0	0											3200	1a (IP Acute): $125 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $200 Copay per day (days 1-5);	2a (SNF): $30 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $10 Copay per visit;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 15% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $35 Copay per visit; 5 (Partial Hosp): $45 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 15% Coinsurance; 9c (OP SA): $30 Copay per visit; 9d (OP Cardiac Rehab): $10 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $25 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $15 Copay per visit; 7i (PT/ST): $10 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 25 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $25 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 25 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): 25 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $5.0 OTC per month											82.66811805	108.4507042	16.68292683	10	125	0.2	0.087665994	48.9368987	200	0	0.187034284	0.15	0.2	0.148018473	0	25	40	10.2680352	0.2	0.025055174	0.2	0	0	0	5	0	0	0	0	0											NO	75.25657762	98.72764777	15.18723309	9.103458431	113.7932304	0.182069169	0.079806374	44.54950231	182.0691686	0	0.170265883	0.136551876	0.182069169	0.134748001	0	22.75864608	36.41383372	9.347463158	0.182069169	0.022808874	0.182069169	0	0	0	5	0	0	0	0	0												5.8465	0.252808349	0.225758103	0.754303334	0.997354232	1.58740736	0.321343107	1.080524558	2.412284004	0	1.185003906	0.035092784	0.060257387	0.586358208	0	5.188225626	0.226271183	0.056190352	3.899524919	1.826587785	0.81760587	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5265	0	2.761173333	5.8465	0.252808349	0.225758103	0.754303334	0.997354232	1.58740736	0.321343107	1.080524558	2.412284004	0	1.185003906	0.035092784	0.060257387	0.586358208	0	5.188225626	0.226271183	0.056190352	3.899524919	1.826587785	0.81760587	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5265	YES	1a (IP Acute): 20% Coinsurance; 1a1 (Add'l Days): 20% coin per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): 20% Coinsurance;	2a (SNF): 20% Coinsurance; 2a2 (Waiver 3 Day): 20% coin;	6a (Home Health): 20% Coinsurance;	10a (Ambulance): 20% Coinsurance;	11a (DME): Not Covered; 11b (Prosthetics): Not Covered;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 20% Coinsurance;	4a (ER): Not Covered; 4a (ER) - Worldwide Coverage: n/a; 4b (UC): Not Covered;	9b (OP Surg): 20% Coinsurance;	8a (OP Diag Proc/Test/Lab): 20% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): Not Covered; 8b (X-Ray): 20% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): Not Covered;	3 (CORF): Not Covered; 5 (Partial Hosp): 20% Coinsurance; 9a (OP Chemo): Not Covered; 9a (OP Services): 20% Coinsurance; 9c (OP SA): Not Covered; 9d (OP Cardiac Rehab): 20% Coinsurance;	14b (Immunizations): 20% Coinsurance; 14c (Medicare Covered Physical Exam): 20% coin; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 20% coin; 14e (Prostate Screening): 20% coin; 14f (Colorectal Screening): 20% coin; 14g (Bone Mass): 20% coin; 14i (Diabetes Educ.): 20% coin; 14j (Nutrition Therapy Diabetes): 20% coin; 14h (Mammography): 20% Coinsurance; 7a (PCP w/Copay): $40 Copay per visit;	7d (SPC w/Copay): $40 Copay per visit;	7h (Psych): Not Covered; 7e (MH Non-Phys): n/a per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20% Coinsurance; 8b (X-Ray): 20% Coinsurance; 9a (OP Chemo): Not Covered; 9b (OP ASC): 20% Coinsurance; All other Services: No Cost Sharing;	15 (Part B Rx): Not Covered;	13a (Blood): 20% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): Not Covered;	17a1 (Routine Eye Exam): Not Covered;	17b1 (Non MCR Covered): Not Covered;	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;	18b (Hearing Aids) - Enhanced Benefit Limit ( $ allowance/ # years): 0% Coinsurance; 18b (Hearing Aids): Not Covered;		13c (OTC Rx): Not Covered;											3900	1.4771	0.0223	0.0487	0.1737	0.0304	0	0.0336	0	0.1905	0.0245	0.058	0.0021	0	0.0352	0.5289	0.369	0	0.0101	0.1789	0.5728	0	0	0	0	0	0	0	0	0	0											3.7559	0	1.206652268	7.3236	0.275105792	0.274499803	0.927965047	1.027742889	1.58740736	0.354981165	1.080524558	2.602792483	0.024455795	1.243027167	0.037239723	0.060257387	0.621605012	0.528928585	5.557224189	0.226271183	0.066295436	4.078451468	2.399378069	0.81760587	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2824
H4529_004_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	1381.454859	70.5449593	313.2283179	948.8491255	232.6415999	9.190350521	4.439993624	598.3884747	153.627663	1.588297002	3.460741505	0.198052163	0.111761926	5.74772772	4629.159847	3215.860691	139.3587677	19.00811882	32.45930733	120.6463316	16.38002511	0	0	0	295	4.475133123	0	0	0	0												1a (IP Acute): $215 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $450 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $7 Copay per visit;	7d (SPC w/Copay): $34 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): $40 Copay per visit; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $150 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											119.8617834	217.2514023	40.60807027	0	150	0.2	0.189835471	49.38481062	450	0	0.176468588	0.2	0.2	0.198060728	5.79724947	34	40	40	0.2	0.178476181	0.2	0	0	0	25	0	0	0	0	0											NO	119.8617834	217.2514023	40.60807027	0	150	0.2	0.189835471	49.38481062	450	0	0.176468588	0.2	0.2	0.198060728	5.79724947	34	40	40	0.2	0.178476181	0.2	0	0	0	25	0	0	0	0	0												13.7986	1.277165944	1.059966462	0	2.908019999	1.838070104	0.84286828	2.462608458	5.761037364	0	0.610712165	0.039610433	0.022352385	1.138399134	2.236366206	9.111605293	0.464529226	0.063360396	6.491861466	21.53249656	3.276005022	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5503	0	0	13.7986	1.277165944	1.059966462	0	2.908019999	1.838070104	0.84286828	2.462608458	5.761037364	0	0.610712165	0.039610433	0.022352385	1.138399134	2.236366206	9.111605293	0.464529226	0.063360396	6.491861466	21.53249656	3.276005022	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5503	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.7986	1.277165944	1.059966462	0	2.908019999	1.838070104	0.84286828	2.462608458	5.761037364	0	0.610712165	0.039610433	0.022352385	1.138399134	2.236366206	9.111605293	0.464529226	0.063360396	6.491861466	21.53249656	3.276005022	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5503
H4529_007_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	339.3771109	2.600728888	19.98962853	2098.541363	11.29991025	17.04597037	7.434725427	18.67902438	23.56985016	6.021490936	10.78126349	0.343344787	0	8.237957286	4774.384851	3228.440975	1.171506479	0.923599476	27.4197613	104.790165	6.107015942	0	0	0	401	0.010984241	0	0	0	0												1a (IP Acute): 6.87% Coin MC CS; 1a1 (Add'l Days): 6.87% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 6.87% Coin MC CS;	2a (SNF): 20.48% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): 20.00% Coin MC CS; 7e (MH Non-Phys): 20.00% Coin MC CS per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): 20.00% Coin MC CS; 7f1 (Routine Podiatry): 0 copay (3 visits) (per year); 7g (Prof. Other): 20.00% Coin MC CS per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $20.0 OTC per month (cumulative benefit)											0.0687	0.0687	0.2048	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	0.2	0.2	0.2	0.157605234	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0687	0.0687	0.2048	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	0.2	0.2	0.2	0.157605234	0.2	0	0	0	5	0.2	0	0	0	0												23.3152	0.178670075	4.093875922	0	2.259982049	3.409194074	1.486945085	3.735804876	4.713970031	0	2.156252698	0.068668957	0	1.647591457	0	2.690367479	0.234301296	0.184719895	5.483952259	16.51547847	1.221403188	0	0	0	0.167083333	0.002196848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5657	0	0	23.3152	0.178670075	4.093875922	0	2.259982049	3.409194074	1.486945085	3.735804876	4.713970031	0	2.156252698	0.068668957	0	1.647591457	0	2.690367479	0.234301296	0.184719895	5.483952259	16.51547847	1.221403188	0	0	0	0.167083333	0.002196848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5657	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.3152	0.178670075	4.093875922	0	2.259982049	3.409194074	1.486945085	3.735804876	4.713970031	0	2.156252698	0.068668957	0	1.647591457	0	2.690367479	0.234301296	0.184719895	5.483952259	16.51547847	1.221403188	0	0	0	0.167083333	0.002196848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5657
H4529_014_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1441.679698	63.94907632	525.3097749	1743.677657	130.5426937	14.84610476	4.275717789	481.2620062	332.2100831	3.830647383	14.20069851	0.447435026	0.009222522	16.91438095	4999.168713	3067.545254	105.5711153	126.9265348	29.17955557	113.4873299	9.490839869	0	0	0	401	5.536528751	0	0	0	0											3400	1a (IP Acute): $125 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-6);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $15 Copay per visit;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $20 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $20 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $20 Copay per visit; 7i (PT/ST): $20 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 20 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $20 Copay per visit; 7b (Chiro): $20 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $20 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 20 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $20 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 20 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 20 copay; 18a1 (Routine Hearing Exam): 20 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											74.59766035	152.3953649	53.55324303	15	150	0.2	0.188914089	49.77581845	200	0	0.190699047	0.2	0.2	0.19799694	0	20	40	20	0.2	0.019715757	0.2	0	0	0	5	0	0	0	0	0											NO	67.43729482	137.767473	48.41285668	13.56020306	135.6020306	0.180802708	0.170780894	44.99801372	180.8027075	0	0.17239452	0.180802708	0.180802708	0.178991914	0	18.08027075	36.1605415	18.08027075	0.180802708	0.017823311	0.180802708	0	0	0	5	0	0	0	0	0												8.1019	0.73417522	2.119312237	1.970385259	1.475154529	2.684215936	0.730210907	1.804652863	5.00537354	0	2.448122601	0.080897464	0.001667457	3.027537418	0	4.621837394	0.318125725	0.191238843	5.27574265	2.022719972	1.715969545	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4963	0	4.706714939	8.1019	0.73417522	2.119312237	1.970385259	1.475154529	2.684215936	0.730210907	1.804652863	5.00537354	0	2.448122601	0.080897464	0.001667457	3.027537418	0	4.621837394	0.318125725	0.191238843	5.27574265	2.022719972	1.715969545	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4963	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.1019	0.73417522	2.119312237	1.970385259	1.475154529	2.684215936	0.730210907	1.804652863	5.00537354	0	2.448122601	0.080897464	0.001667457	3.027537418	0	4.621837394	0.318125725	0.191238843	5.27574265	2.022719972	1.715969545	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4963
H4529_027_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	1245.872653	44.49860427	496.9827239	991.2814538	161.9238008	12.50971149	5.197188915	420.6867491	204.4248533	3.348396098	10.88095175	0.377616432	0.173279608	9.167071432	4849.994876	3437.154358	103.7518901	73.9810617	23.17954869	106.743271	8.582820831	0	0	0	295	5.414766943	0	0	0	0												1a (IP Acute): $195 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $275 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $20 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $35 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $35 Copay per visit; 7i (PT/ST): $35 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 35 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $35 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $35 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 35 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): $5.0 OTC per month											134.5491722	154.9390105	54.14906235	0	150	0.2	0.182477584	48.77883199	275	0	0.187834062	0.2	0.2	0.19785669	0	35	40	35	0.2	0.03009147	0.2	0	0	0	25	0	0	0	0	0											NO	134.5491722	154.9390105	54.14906235	0	150	0.2	0.182477584	48.77883199	275	0	0.187834062	0.2	0.2	0.19785669	0	35	40	35	0.2	0.03009147	0.2	0	0	0	25	0	0	0	0	0												13.9693	0.574547476	2.242595709	0	2.02404751	2.501942299	0.948370476	1.710050688	4.684736222	0	2.043813365	0.075523286	0.034655922	1.813766409	0	10.02503354	0.345839634	0.215778097	4.635909738	3.212061946	1.716564166	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3891	0	0	13.9693	0.574547476	2.242595709	0	2.02404751	2.501942299	0.948370476	1.710050688	4.684736222	0	2.043813365	0.075523286	0.034655922	1.813766409	0	10.02503354	0.345839634	0.215778097	4.635909738	3.212061946	1.716564166	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3891	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.9693	0.574547476	2.242595709	0	2.02404751	2.501942299	0.948370476	1.710050688	4.684736222	0	2.043813365	0.075523286	0.034655922	1.813766409	0	10.02503354	0.345839634	0.215778097	4.635909738	3.212061946	1.716564166	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.3891
H4529_028_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1482.561779	52.95238625	591.3987998	1179.603704	192.6858557	15.22409739	6.324886888	500.6082235	243.2611982	4.074938765	13.24192562	0.459552512	0.210878214	11.15616362	5771.390051	4090.140088	123.4625276	88.0358793	28.20910034	129.9046708	10.44514098	0	0	0	401	6.443456718	0	0	0	0											3400	1a (IP Acute): $125 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $200 Copay per day (days 1-5);	2a (SNF): $25 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 15% Coinsurance; 8b (X-Ray): 0% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $30 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $15 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $15 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $15 Copay per visit; 7i (PT/ST): $15 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 15 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $15 Copay per visit; 7b (Chiro): $15 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $15 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 15 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 0% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $15 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 15 copay; 18a1 (Routine Hearing Exam): 15 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											74.11594871	90.20631408	15.04140621	0	125	0.2	0.091238792	48.77883199	200	0	0.175598805	0.2	0.2	0.19743765	0	15	40	15	0.2	0.02084907	0.2	0	0	0	5	0	0	0	0	0											NO	68.96604088	83.93837566	13.99626199	0	116.3144406	0.186103105	0.084899112	45.38946043	186.1031049	0	0.163397414	0.186103105	0.186103105	0.183718798	0	13.95773287	37.22062098	13.95773287	0.186103105	0.019400383	0.186103105	0	0	0	5	0	0	0	0	0												8.5205	0.370394774	0.689781045	0	1.86767896	2.833251794	0.536977282	1.893528096	3.77263869	0	2.163696408	0.085524149	0.03924509	2.049596973	0	4.757423561	0.382945996	0.102398441	5.249801159	2.520200399	1.943873168	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9466	0	2.970447136	8.5205	0.370394774	0.689781045	0	1.86767896	2.833251794	0.536977282	1.893528096	3.77263869	0	2.163696408	0.085524149	0.03924509	2.049596973	0	4.757423561	0.382945996	0.102398441	5.249801159	2.520200399	1.943873168	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9466	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.5205	0.370394774	0.689781045	0	1.86767896	2.833251794	0.536977282	1.893528096	3.77263869	0	2.163696408	0.085524149	0.03924509	2.049596973	0	4.757423561	0.382945996	0.102398441	5.249801159	2.520200399	1.943873168	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9466
H4529_030_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	1555.465865	56.80265344	778.3712728	2277.544229	189.9755455	14.39036317	4.778526751	464.3789944	211.724921	2.180151528	10.94388256	0.311774124	0.038250362	7.090731391	5592.510225	3121.327383	112.6218649	84.98729782	16.56942094	115.8892441	14.35967804	0	0	0	295	1.93481014	0	0	0	0												1a (IP Acute): $195 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $450 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $20 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $35 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $35 Copay per visit; 7i (PT/ST): $35 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 35 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $35 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $35 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 35 copay per visit; 7g1 (Prof. Other Coins): $35 Copay per visit; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $150 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): $5.0 OTC per month											149.1390438	130.6265005	50.40205957	0	150	0.2	0.193230972	49.62952207	450	0	0.188519563	0.2	0.2	0.196254525	0	35	40	35	0.2	0.161066125	0.2	0	0	0	25	0	0	0	0	0											NO	149.1390438	130.6265005	50.40205957	0	150	0.2	0.193230972	49.62952207	450	0	0.188519563	0.2	0.2	0.196254525	0	35	40	35	0.2	0.161066125	0.2	0	0	0	25	0	0	0	0	0												19.3317	0.618327653	3.269292938	0	2.374694319	2.878072634	0.923359368	1.920575629	7.939684537	0	2.063135953	0.062354825	0.007650072	1.39158812	0	9.103871534	0.375406216	0.247879619	3.313884188	18.66583144	2.871935608	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9739	0	0	19.3317	0.618327653	3.269292938	0	2.374694319	2.878072634	0.923359368	1.920575629	7.939684537	0	2.063135953	0.062354825	0.007650072	1.39158812	0	9.103871534	0.375406216	0.247879619	3.313884188	18.66583144	2.871935608	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9739	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.3317	0.618327653	3.269292938	0	2.374694319	2.878072634	0.923359368	1.920575629	7.939684537	0	2.063135953	0.062354825	0.007650072	1.39158812	0	9.103871534	0.375406216	0.247879619	3.313884188	18.66583144	2.871935608	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9739
H4529_031_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	520.7826347	12.80891622	49.21850188	3112.478402	19.45678911	22.28396797	8.420788176	37.05624245	32.95386312	7.633098474	15.6397197	0.895151994	0	15.62481595	5557.773188	3955.135828	412.4703704	1.859551239	27.29910032	133.1495986	21.49221763	0	0	0	401	0.054098766	0	0	0	0												1a (IP Acute): 7.80% Coin MC CS; 1a1 (Add'l Days): 7.80% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.80% Coin MC CS;	2a (SNF): 19.52% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $18.5 OTC per month (cumulative benefit)											0.078	0.078	0.1952	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.151712293	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.078	0.078	0.1952	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.151712293	0.2	0	0	0	5	0.2	0	0	0	0												40.621	0.999095465	9.607451567	0	3.891357822	4.456793594	1.684157635	7.411248489	6.590772623	0	3.127943939	0.179030399	0	3.12496319	0	3.295946523	0.343725309	0.371910248	5.459820063	20.20043093	4.298443526	0	0	0	0.167083333	0.010819753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.842	0	0	40.621	0.999095465	9.607451567	0	3.891357822	4.456793594	1.684157635	7.411248489	6.590772623	0	3.127943939	0.179030399	0	3.12496319	0	3.295946523	0.343725309	0.371910248	5.459820063	20.20043093	4.298443526	0	0	0	0.167083333	0.010819753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.842	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	40.621	0.999095465	9.607451567	0	3.891357822	4.456793594	1.684157635	7.411248489	6.590772623	0	3.127943939	0.179030399	0	3.12496319	0	3.295946523	0.343725309	0.371910248	5.459820063	20.20043093	4.298443526	0	0	0	0.167083333	0.010819753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.842
H4529_032_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	345.7295724	7.892044761	31.42789892	1960.241421	12.57637723	15.50220285	6.011009542	24.34205417	26.73035961	5.005242045	11.5638794	0.582076015	0.056396295	10.99842785	4496.273974	3195.10649	250.84429	1.541674127	21.54740451	103.0412623	13.81800612	0	0	0	401	0.050207448	0	0	0	0												1a (IP Acute): 7.80% Coin MC CS; 1a1 (Add'l Days): 7.80% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.80% Coin MC CS;	2a (SNF): 19.40% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $20.0 OTC per month											0.078	0.078	0.194	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155369972	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.078	0.078	0.194	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155369972	0.2	0	0	0	5	0.2	0	0	0	0												26.9669	0.615579491	6.09701239	0	2.515275446	3.100440569	1.202201908	4.868410834	5.346071922	0	2.31277588	0.116415203	0.011279259	2.19968557	0	2.662588742	0.209036908	0.308334825	4.309480902	16.00951801	2.763601225	0	0	0	0.167083333	0.01004149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7917	0	0	26.9669	0.615579491	6.09701239	0	2.515275446	3.100440569	1.202201908	4.868410834	5.346071922	0	2.31277588	0.116415203	0.011279259	2.19968557	0	2.662588742	0.209036908	0.308334825	4.309480902	16.00951801	2.763601225	0	0	0	0.167083333	0.01004149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7917	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.9669	0.615579491	6.09701239	0	2.515275446	3.100440569	1.202201908	4.868410834	5.346071922	0	2.31277588	0.116415203	0.011279259	2.19968557	0	2.662588742	0.209036908	0.308334825	4.309480902	16.00951801	2.763601225	0	0	0	0.167083333	0.01004149	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7917
H4529_801_0	2010	2	N/A																															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	NO	232.9972708	4.32505402	21.0834091	24.21150117	8.071249623	12.82802441	5.148678825	17.30552942	28.74664214	3.274119117	10.22658193	0.3607178	0.14836198	8.584042377	28.46987518	34.44916166	0.899077172	1.837800599	22.13935278	102.1359003	7.996045637	0																				FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312
H4590_010_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	310.1191075	19.71266882	851.6394379	400.1756065	404.9963683	10.126829	11.48601145	305.066458	268.9326321	18116.55338	88.71453314	0	23.12731978	953.9175699	8153.45351	6525.38406	838.4081804	654.0709949	0	0	27.25483849	1113.169392	0	0	442.2718064	254.7709285	17.44905532	4.795797903	657.685185	0												"$100 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$100 Days 1-Unlimited (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-17/$100 Days 18-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$100 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $60 (5); $100 (9a); $40/$30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $20 (7a1); $0 n/c (14b1, 14e1, 14h1); $0/$100 (14f, 14f1)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$0 n/c (17b1, 17b3, 17b4, 17b5); $20 (17b2)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											100	100	40.57513939	0	150	0.2	0.096565253	49.99855962	100	0	0.12917978	0	0	38.47411554	0.912672873	20	38.5	7.680683729	0	0	0.2	19.41340684	0	0	20	20	0	0	0	0											NO	100	100	40.57513939	0	150	0.2	0.096565253	49.99855962	100	0	0.12917978	0	0	38.47411554	0.912672873	20	38.5	7.680683729	0	0	0.2	19.41340684	0	0	20	20	0	0	0	0												2.5843	0.16427224	2.879615742	0	5.062454604	2.025365799	1.109149599	1.271073624	2.241105268	0	11.46012385	0	0	3.0584279	0.620119653	10.8756401	2.689892912	0.418642704	0	0	5.450967698	1.800867524	0	0	0.737119677	0.424618214	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8738	0	0	2.5843	0.16427224	2.879615742	0	5.062454604	2.025365799	1.109149599	1.271073624	2.241105268	0	11.46012385	0	0	3.0584279	0.620119653	10.8756401	2.689892912	0.418642704	0	0	5.450967698	1.800867524	0	0	0.737119677	0.424618214	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8738	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.5843	0.16427224	2.879615742	0	5.062454604	2.025365799	1.109149599	1.271073624	2.241105268	0	11.46012385	0	0	3.0584279	0.620119653	10.8756401	2.689892912	0.418642704	0	0	5.450967698	1.800867524	0	0	0.737119677	0.424618214	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8738
H4590_012_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1792.005555	150.374864	836.6991196	745.966669	285.5141679	14.50432802	11.90553192	321.7540761	330.5590513	15412.23882	61.75079372	0	0.20554656	893.6752117	6797.027338	6369.013333	676.2914404	849.8743028	0	0	31.42553514	1221.678284	0	0	280.313141	119.7566529	17.31362353	4.758575058	648.4740494	0												"$125 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$105 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $125 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$125 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											86.64022403	63.88511081	49.79671843	0	150	0.2	0.116262645	49.99735415	125	3	0.155080739	0	0.2	47.91146644	7.433472432	30	38.5	25	0	0	0.2	29.14208991	0	0	30	30	0	0	0	0											NO	86.64022403	63.88511081	49.79671843	0	150	0.2	0.116262645	49.99735415	125	3	0.155080739	0	0.2	47.91146644	7.433472432	30	38.5	25	0	0	0.2	29.14208991	0	0	30	30	0	0	0	0												12.9383	0.800559571	3.472072539	0	3.568927099	2.900865603	1.384168633	1.340571041	3.443323451	3.853059706	9.576358708	0	0.041109312	3.568107492	4.210459611	15.92253333	2.169768371	1.770571464	0	0	6.285107027	2.966854866	0	0	0.700782853	0.299391632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2129	0	0	12.9383	0.800559571	3.472072539	0	3.568927099	2.900865603	1.384168633	1.340571041	3.443323451	3.853059706	9.576358708	0	0.041109312	3.568107492	4.210459611	15.92253333	2.169768371	1.770571464	0	0	6.285107027	2.966854866	0	0	0.700782853	0.299391632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2129	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.9383	0.800559571	3.472072539	0	3.568927099	2.900865603	1.384168633	1.340571041	3.443323451	3.853059706	9.576358708	0	0.041109312	3.568107492	4.210459611	15.92253333	2.169768371	1.770571464	0	0	6.285107027	2.966854866	0	0	0.700782853	0.299391632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2129
H4590_020_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2814.330742	33.67481619	1249.089328	1076.645439	575.0044857	34.39832228	20.37712532	679.7275273	354.0131391	21965.66584	70.40376866	0	0.238713395	1672.255664	9036.562129	11780.16165	168.8715993	1223.762259	0	0	31.6926878	1478.252252	582.5792892	34.45806056	263.7548443	192.9470324	19.69121932	12.07727569	0	0												"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$0 (9b)	"$0 (8a1, 8a2)"	$0 (8b1); 20% (8b2); $20 (8b3)	Included in h.5.	20% (12)	"$0 (3, 9a, 9d); $10 (5, 9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $50 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$10 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	0	0	50	0.2	0.117697317	50	0	0	0.106482325	0	0.2	0.012662341	5.86E-05	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	50	0.2	0.117697317	50	0	0	0.106482325	0	0.2	0.012662341	5.86E-05	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	0												0	0	0	0	2.395852024	6.879664457	2.39833298	2.832198031	0	0	7.496756957	0	0.047742679	0.001764556	4.41E-05	0	0.140726333	0	0	0	6.338537559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.5316	0	0	0	0	0	0	2.395852024	6.879664457	2.39833298	2.832198031	0	0	7.496756957	0	0.047742679	0.001764556	4.41E-05	0	0.140726333	0	0	0	6.338537559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.5316	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	2.395852024	6.879664457	2.39833298	2.832198031	0	0	7.496756957	0	0.047742679	0.001764556	4.41E-05	0	0.140726333	0	0	0	6.338537559	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.5316
H4590_022_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	3248.75726	167.5366884	1589.214738	871.4003208	631.1598753	20.84113154	19.64657995	913.0830684	487.6292572	36029.09458	108.2093701	0	0.389022271	1969.669362	17932.36811	20455.80911	753.6321892	1700.093434	0	0	43.26321936	1685.242237	604.3639856	30.3470153	878.041027	329.6780016	19.68732776	5.821581709	421.871116	0												"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$0 (9b)	"$0 (8a1, 8a2)"	$0 (8b1); 20% (8b2); $20 (8b3)	Included in h.5.	20% (12)	"$0 (3, 9a, 9d); $10 (5, 9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $50 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$10 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6, 14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	0	0	50	0.2	0.100155984	50	0	0	0.108653317	0	0.2	0.56960862	0.025735413	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	50	0.2	0.100155984	50	0	0	0.108653317	0	0.2	0.56960862	0.025735413	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	0												0	0	0	0	2.629832814	4.168226309	1.967722551	3.804512785	0	0	11.75730699	0	0.077804454	0.093495054	0.038458074	0	0.628026824	0	0	0	8.652643872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.818	0	0	0	0	0	0	2.629832814	4.168226309	1.967722551	3.804512785	0	0	11.75730699	0	0.077804454	0.093495054	0.038458074	0	0.628026824	0	0	0	8.652643872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.818	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	2.629832814	4.168226309	1.967722551	3.804512785	0	0	11.75730699	0	0.077804454	0.093495054	0.038458074	0	0.628026824	0	0	0	8.652643872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.818
H4590_025_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	324.840652	14.60743527	712.3219425	572.7656904	352.1112575	12.17053369	12.13408656	372.5896621	342.6440681	13947.23307	49.49965861	0	0.358913398	872.5003004	6124.357154	6069.279203	660.6556605	734.7196822	0	0	27.26086474	1209.716932	0	0	166.5067079	106.9775067	17.22625012	4.734560851	36.27463713	0												"$150 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-Unlimited (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$75 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$15 (3, 9d); $60 (5); $75 (9a); $40/$30 (9c)"	"$10 (7a); $20 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$75 (14f, 14f1)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											149.2606993	150	52.47946026	0	150	0.2	0.112518094	49.99898445	75	3	0.155919576	0	0.2	28.66936605	7.431116834	20	38.5	15	0	0	0.2	19.53615094	0	0	20	30	0	0	0	0											NO	149.2606993	150	52.47946026	0	150	0.2	0.112518094	49.99898445	75	3	0.155919576	0	0.2	28.66936605	7.431116834	20	38.5	15	0	0	0.2	19.53615094	0	0	20	30	0	0	0	0												4.0405	0.182592941	3.115189256	0	4.401390718	2.434106737	1.365304297	1.552425393	2.141525425	3.486808268	7.717965782	0	0.07178268	2.084502541	3.792567795	10.11546534	2.119603577	0.918399603	0	0	5.452172949	1.969434383	0	0	0.27751118	0.267443767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5067	0	0	4.0405	0.182592941	3.115189256	0	4.401390718	2.434106737	1.365304297	1.552425393	2.141525425	3.486808268	7.717965782	0	0.07178268	2.084502541	3.792567795	10.11546534	2.119603577	0.918399603	0	0	5.452172949	1.969434383	0	0	0.27751118	0.267443767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5067	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.0405	0.182592941	3.115189256	0	4.401390718	2.434106737	1.365304297	1.552425393	2.141525425	3.486808268	7.717965782	0	0.07178268	2.084502541	3.792567795	10.11546534	2.119603577	0.918399603	0	0	5.452172949	1.969434383	0	0	0.27751118	0.267443767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5067
H4590_027_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1537.855699	149.3516515	609.7213805	646.7592718	225.6422462	12.57668816	8.583732224	297.4615476	338.8882046	14283.56444	59.51090164	0	0.239005806	768.0003048	6206.230915	5799.951449	680.015422	852.5653214	0	0	29.38997529	1064.272387	0	0	265.1623957	114.2283291	0	0	651.6048355	0												"$125 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$105 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $125 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$125 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											86.64022403	63.88511081	49.79671843	0	150	0.2	0.132337963	49.99860465	125	3	0.154876501	0	0.2	47.40500987	7.49867189	30	38.5	25	0	0	0.2	29.39998234	0	0	30	30	0	0	0	0											NO	86.64022403	63.88511081	49.79671843	0	150	0.2	0.132337963	49.99860465	125	3	0.154876501	0	0.2	47.40500987	7.49867189	30	38.5	25	0	0	0.2	29.39998234	0	0	30	30	0	0	0	0												11.1033	0.795112234	2.530176992	0	2.820528077	2.515337632	1.135953636	1.239388527	3.530085464	3.57089111	9.216840237	0	0.047801161	3.033921835	3.878207442	14.49987862	2.181716146	1.776177753	0	0	5.877995059	2.607465781	0	0	0.662905989	0.285570823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3093	0	0	11.1033	0.795112234	2.530176992	0	2.820528077	2.515337632	1.135953636	1.239388527	3.530085464	3.57089111	9.216840237	0	0.047801161	3.033921835	3.878207442	14.49987862	2.181716146	1.776177753	0	0	5.877995059	2.607465781	0	0	0.662905989	0.285570823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3093	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.1033	0.795112234	2.530176992	0	2.820528077	2.515337632	1.135953636	1.239388527	3.530085464	3.57089111	9.216840237	0	0.047801161	3.033921835	3.878207442	14.49987862	2.181716146	1.776177753	0	0	5.877995059	2.607465781	0	0	0.662905989	0.285570823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3093
H4590_029_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	295.0434918	19.54668982	810.3371067	378.8234243	381.3814049	9.511525766	9.263260965	287.1263703	246.9693053	17353.86846	87.67152109	0	20.18964309	909.1450627	7511.343459	6383.246344	833.6947794	628.190048	0	0	23.94579233	1028.558091	0	514.0497676	260.6253071	150.9747502	17.98926613	3.7926165	573.4814694	331.1728188												"$0 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$0 Days 1-Unlimited (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-20/$100 Days 21-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $60 (5); $0 (9a); $40/$30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $20 (7a1); $0 n/c (14b1, 14e1, 14h1)"	"$20 (7b, 7f, 7f1); $10 (7b1); $0 (7d)"	"$40/$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 n/c (10b)	"$20 (16a1); $0 n/c (16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 n/c (17b1, 17b3, 17b4, 17b5); $20 (17b2)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13d, 13e)"											0	0	34.69599585	0	150	0.2	0.115506746	49.99851664	0	0	0.130213841	0	0	1.05253529	0.000532658	1.093080933	38.5	7.680683729	0	0	0.2	19.41175627	0	20	0	20	0	0	0	10											NO	0	0	34.69599585	0	150	0.2	0.115506746	49.99851664	0	0	0.130213841	0	0	1.05253529	0.000532658	1.093080933	38.5	7.680683729	0	0	0.2	19.41175627	0	20	0	20	0	0	0	10												0	0	2.342954408	0	4.767267561	1.902305153	1.069969135	1.196324384	0	0	11.41604554	0	0	0.079742272	0.000333415	0.581450406	2.67477075	0.402077423	0	0	4.789158467	1.663843248	0	0.856749613	0	0.251624584	0	0	0	0.275977349	0	0	0	0	0	0	0	0	0	0	34.2706	0	0	0	0	2.342954408	0	4.767267561	1.902305153	1.069969135	1.196324384	0	0	11.41604554	0	0	0.079742272	0.000333415	0.581450406	2.67477075	0.402077423	0	0	4.789158467	1.663843248	0	0.856749613	0	0.251624584	0	0	0	0.275977349	0	0	0	0	0	0	0	0	0	0	34.2706	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	2.342954408	0	4.767267561	1.902305153	1.069969135	1.196324384	0	0	11.41604554	0	0	0.079742272	0.000333415	0.581450406	2.67477075	0.402077423	0	0	4.789158467	1.663843248	0	0.856749613	0	0.251624584	0	0	0	0.275977349	0	0	0	0	0	0	0	0	0	0	34.2706
H4590_033_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2646.785372	39.6451552	1234.658976	840.5275234	572.5805244	27.17004738	17.31988707	602.680609	318.4184327	18078.29749	50.02349151	0	0.241757943	1106.370424	7323.746272	9691.537792	135.4141264	920.839278	0	0	19.82538588	1353.584915	578.34063	86.22510374	104.4044209	104.3062734	16.83517181	3.560110566	41.49187342	0												"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1, 4b)"	$0 (9b)	"$0 (8a1, 8a2)"	$0 (8b1); 20% (8b2); $20 (8b3)	Included in h.5.	20% (12)	"$0 (3, 9a, 9d); $10 (5, 9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $50 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$10 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	0	0	50	0.2	0.119443577	50	0	0	0.106756823	0	0.2	0.017176457	3.85E-05	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	50	0.2	0.119443577	50	0	0	0.106756823	0	0.2	0.017176457	3.85E-05	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	0												0	0	0	0	2.385752185	5.434009477	2.068749269	2.511169204	0	0	5.340349021	0	0.048351589	0.001583627	2.35E-05	0	0.112845105	0	0	0	3.965077176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.8679	0	0	0	0	0	0	2.385752185	5.434009477	2.068749269	2.511169204	0	0	5.340349021	0	0.048351589	0.001583627	2.35E-05	0	0.112845105	0	0	0	3.965077176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.8679	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	2.385752185	5.434009477	2.068749269	2.511169204	0	0	5.340349021	0	0.048351589	0.001583627	2.35E-05	0	0.112845105	0	0	0	3.965077176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.8679
H4590_035_0	2010	6	N/A																															D	D	Coin	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2545.128667	146.2642772	45.13521224	837.7440657	417.4976871	24.34628242	18.35937969	524.509993	412.8664679	22743.68611	73.77199867	0	0.355176509	1717.355678	9324.623464	9232.42693	525.8364175	876.0248327	0	0	33.2200059	1468.646388	597.3208982	0	349.9779091	202.6051609	17.39446582	4.780794212	0	0												"$125 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$125 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$125 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $125 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$125 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											86.64022403	63.88511081	0.18609298	0	150	0.2	0.104629162	49.99903322	125	3	0.157249988	0	0.2	49.31962183	7.427200262	30	38.5	25	0	0	0.2	29.16355185	0	0	30	30	0	0	0	0											NO	86.64022403	63.88511081	0.18609298	0	150	0.2	0.104629162	49.99903322	125	3	0.157249988	0	0.2	49.31962183	7.427200262	30	38.5	25	0	0	0.2	29.16355185	0	0	30	30	0	0	0	0												18.3759	0.778675796	8.399346144	0	5.218721089	4.869256484	1.920926513	2.185416047	4.300692374	5.685921528	11.60064593	0	0.071035302	7.058277715	5.771320487	23.08106732	1.687058506	1.825051735	0	0	6.644001181	3.569245423	0	0	0.874944773	0.506512902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.424	0	0	18.3759	0.778675796	8.399346144	0	5.218721089	4.869256484	1.920926513	2.185416047	4.300692374	5.685921528	11.60064593	0	0.071035302	7.058277715	5.771320487	23.08106732	1.687058506	1.825051735	0	0	6.644001181	3.569245423	0	0	0.874944773	0.506512902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.424	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.3759	0.778675796	8.399346144	0	5.218721089	4.869256484	1.920926513	2.185416047	4.300692374	5.685921528	11.60064593	0	0.071035302	7.058277715	5.771320487	23.08106732	1.687058506	1.825051735	0	0	6.644001181	3.569245423	0	0	0.874944773	0.506512902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.424
H4590_036_0	2010	5	N/A																															D	D	Coin	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	2422.306967	139.20592	40.90426941	797.3165809	397.3502673	22.09986049	16.66792804	499.2237978	392.9425394	21646.13131	67.07145499	0	0.322722561	1634.480283	8707.643547	8789.691579	500.4608348	833.7500115	0	0	30.3059584	1397.773096	528.2777605	0	119.5198553	172.1655059	17.39446582	4.780794212	78.88310451	0												"$100 Days 1-5 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$100 Days 1-5 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$100 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$15 (3, 9d); $60 (5); $100 (9a); $40/$30 (9c)"	"$10 (7a); $20 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$100 (14f, 14f1)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$15 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											63.74290693	45.31962557	0.196643055	0	150	0.2	0.104651863	49.99903327	100	3	0.1584502	0	0.2	39.35508215	7.376495086	20	38.5	15	0	0	0.2	19.47752181	0	0	20	30	0	0	0	0											NO	63.74290693	45.31962557	0.196643055	0	150	0.2	0.104651863	49.99903327	100	3	0.1584502	0	0.2	39.35508215	7.376495086	20	38.5	15	0	0	0.2	19.47752181	0	0	20	30	0	0	0	0												12.8671	0.525730014	8.043540505	0	4.966878342	4.419972098	1.74432972	2.08005894	3.274521162	5.411532827	10.62748546	0	0.064544512	5.360425483	5.352657486	14.64948597	1.605645178	1.042187514	0	0	6.06119168	2.268762997	0	0	0.199199759	0.430413765	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9956	0	0	12.8671	0.525730014	8.043540505	0	4.966878342	4.419972098	1.74432972	2.08005894	3.274521162	5.411532827	10.62748546	0	0.064544512	5.360425483	5.352657486	14.64948597	1.605645178	1.042187514	0	0	6.06119168	2.268762997	0	0	0.199199759	0.430413765	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9956	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.8671	0.525730014	8.043540505	0	4.966878342	4.419972098	1.74432972	2.08005894	3.274521162	5.411532827	10.62748546	0	0.064544512	5.360425483	5.352657486	14.64948597	1.605645178	1.042187514	0	0	6.06119168	2.268762997	0	0	0.199199759	0.430413765	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9956
H4590_037_0	2010	5	N/A																															A	A	Coin	V	T	Coin	Coin	V	V	O	Coin	V	O	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	329.9815969	20.22167556	18.09377213	446.1273666	486.8796635	8.528192143	14.89341182	388.1976548	255.6364652	44715.56607	62.88734814	0	17.56231735	958.5546133	22513.64776	10576.06388	686.2519397	626.836151	0	0	20.31083131	956.736528	551.8222509	0	291.4975277	157.4612775	17.29674115	4.753935006	418.6118907	0												"$100 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$100 Days 1-Unlimited (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$100 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 Visits 1-12/$30 Visits 13-Unlimited (3, 9d); $150 (5); $100 (9a); $30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $20 (7a1); $0 n/c (14b1, 14e1, 14h1); $0/$100 (14f, 14f1)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$30 (7e, 7h)"	"$0 Visits 1-12/$30 Visits 13-Unlimited (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$0 n/c (17b1, 17b3, 17b4, 17b5); $20 (17b2)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6, 14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											100	100	0.190847712	0	150	0.2	0.062466639	49.98860071	100	0	0.122865052	0	0	38.31829807	0.329441652	20	30	14.57483632	0	0	0.2	19.17655506	0	0	20	20	0	0	0	0											NO	100	100	0.190847712	0	150	0.2	0.062466639	49.98860071	100	0	0.122865052	0	0	38.31829807	0.329441652	20	30	14.57483632	0	0	0.2	19.17655506	0	0	20	20	0	0	0	0												2.7498	0.168513963	3.453155011	0	6.085995794	1.705638429	0.93034138	1.617121464	2.130303876	0	7.726657282	0	0	3.060848449	0.618077776	17.62677313	1.715629849	0.761336192	0	0	4.062166262	1.528909226	0	0	0.485829213	0.262435463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6896	0	0	2.7498	0.168513963	3.453155011	0	6.085995794	1.705638429	0.93034138	1.617121464	2.130303876	0	7.726657282	0	0	3.060848449	0.618077776	17.62677313	1.715629849	0.761336192	0	0	4.062166262	1.528909226	0	0	0.485829213	0.262435463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6896	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.7498	0.168513963	3.453155011	0	6.085995794	1.705638429	0.93034138	1.617121464	2.130303876	0	7.726657282	0	0	3.060848449	0.618077776	17.62677313	1.715629849	0.761336192	0	0	4.062166262	1.528909226	0	0	0.485829213	0.262435463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.6896
H4590_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	276.1985562	24.60120479	30.77672253	771.9125483	6.366130911	16.25526683	13.84377968	13.96832652	48.83548646	29.84391783	75.39204609	0	0.227554891	20.01253277	30.25151753	182.5565082	5.248187543	7.758428035	0	0	46.49132928	14.96885906	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077142576	0.077142576	0.186310191	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077142576	0.077142576	0.186310191	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.3067	1.897800307	5.734017052	0	1.483308502	3.787477171	3.225600666	3.25462008	11.37866835	6.953632855	17.56634674	0	0.053020289	4.662920136	7.048603585	42.53566641	1.222827697	1.807713732	0	0	10.83247972	3.48774416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.2391	0	0	21.3067	1.897800307	5.734017052	0	1.483308502	3.787477171	3.225600666	3.25462008	11.37866835	6.953632855	17.56634674	0	0.053020289	4.662920136	7.048603585	42.53566641	1.222827697	1.807713732	0	0	10.83247972	3.48774416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.2391	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.3067	1.897800307	5.734017052	0	1.483308502	3.787477171	3.225600666	3.25462008	11.37866835	6.953632855	17.56634674	0	0.053020289	4.662920136	7.048603585	42.53566641	1.222827697	1.807713732	0	0	10.83247972	3.48774416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.2391
H4590_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	300.1639997	24.38619107	33.99584244	865.1892903	7.416718346	17.86696178	15.183958	13.43455335	47.17100285	28.71429221	80.565265	0	0.282376986	18.39848769	30.54238585	194.3748083	5.202464642	6.292347343	0	0	50.9826817	16.19564833	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07704404	0.07704404	0.186410026	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07704404	0.07704404	0.186410026	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												23.1258	1.878810685	6.337165876	0	1.728095375	4.163002095	3.537862213	3.13025093	10.99084366	6.690430084	18.77170674	0	0.065793838	4.286847631	7.116375903	45.28933034	1.212174262	1.466116931	0	0	11.87896484	3.773586061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.4432	0	0	23.1258	1.878810685	6.337165876	0	1.728095375	4.163002095	3.537862213	3.13025093	10.99084366	6.690430084	18.77170674	0	0.065793838	4.286847631	7.116375903	45.28933034	1.212174262	1.466116931	0	0	11.87896484	3.773586061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.4432	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.1258	1.878810685	6.337165876	0	1.728095375	4.163002095	3.537862213	3.13025093	10.99084366	6.690430084	18.77170674	0	0.065793838	4.286847631	7.116375903	45.28933034	1.212174262	1.466116931	0	0	11.87896484	3.773586061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	155.4432
H4590_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	295.1507772	24.07125089	33.5406654	860.2718106	7.26842346	17.60952206	14.94391664	13.13451202	46.41410964	27.9328003	78.5283507	0	0.266201269	18.06823375	29.36565716	185.7312257	5.136503356	6.162955205	0	0	50.06341939	15.3704937	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07608774	0.07608774	0.187809752	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07608774	0.07608774	0.187809752	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.4574	1.831527074	6.299264062	0	1.693542666	4.103018639	3.481932578	3.0603413	10.81448754	6.50834247	18.29710571	0	0.062024896	4.209898465	6.842198119	43.27537558	1.196805282	1.435968563	0	0	11.66477672	3.581325031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.8153	0	0	22.4574	1.831527074	6.299264062	0	1.693542666	4.103018639	3.481932578	3.0603413	10.81448754	6.50834247	18.29710571	0	0.062024896	4.209898465	6.842198119	43.27537558	1.196805282	1.435968563	0	0	11.66477672	3.581325031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.8153	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.4574	1.831527074	6.299264062	0	1.693542666	4.103018639	3.481932578	3.0603413	10.81448754	6.50834247	18.29710571	0	0.062024896	4.209898465	6.842198119	43.27537558	1.196805282	1.435968563	0	0	11.66477672	3.581325031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.8153
H4590_805_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	295.1507772	24.07125089	33.5406654	860.2718106	7.26842346	17.60952206	14.94391664	13.13451202	46.41410964	27.9328003	78.5283507	0	0.266201269	18.06823375	29.36565716	185.7312257	5.136503356	6.162955205	0	0	50.06341939	15.3704937	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07608774	0.07608774	0.187809752	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07608774	0.07608774	0.187809752	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.4574	1.831527074	6.299264062	0	1.693542666	4.103018639	3.481932578	3.0603413	10.81448754	6.50834247	18.29710571	0	0.062024896	4.209898465	6.842198119	43.27537558	1.196805282	1.435968563	0	0	11.66477672	3.581325031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.8153	0	0	22.4574	1.831527074	6.299264062	0	1.693542666	4.103018639	3.481932578	3.0603413	10.81448754	6.50834247	18.29710571	0	0.062024896	4.209898465	6.842198119	43.27537558	1.196805282	1.435968563	0	0	11.66477672	3.581325031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.8153	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.4574	1.831527074	6.299264062	0	1.693542666	4.103018639	3.481932578	3.0603413	10.81448754	6.50834247	18.29710571	0	0.062024896	4.209898465	6.842198119	43.27537558	1.196805282	1.435968563	0	0	11.66477672	3.581325031	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.8153
H4604_003_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	705.8837491	93.13858416	848.8073715	176.6877079	93.23412745	12.44894609	6.18302968	243.963552	231.2542317	6024.419664	21.2334329	0	0.058478511	674.6575954	4653.014093	3568.036364	482.6042717	328.0434193	0	0	13.76623345	751.5663559	0	316.9529098	349.4670891	209.7785817	15.46162134	16.54675659	260.979447	0											3200	"$135 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$135 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-7/$75 Days 8-50 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$130 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $130 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$25 (16a1, 16a2); $0 n/c (16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											99.48970019	75.77346188	45.2996793	0	150	0.2	0.110075073	49.54065781	130	3	0.174597421	0	0.2	51.50107583	6.579450811	34.4970991	38.5	35	0	0	0.2	34.82434274	0	25	35	0	0	0	0	0											YES	88.90271737	67.71019164	40.47921119	0	134.0380721	0.178717429	0.09836167	44.26889509	116.1663291	2.680761442	0.156018011	0	0.178717429	46.05463156	6.531655952	34.4970991	38.5	31.27555015	0	0	0.178717429	34.82434274	0	25	35	0	0	0	0	0											5000	5.2296	0.525535949	2.863254404	0	1.041410225	2.224843644	0.608173126	0.899999741	2.238662933	1.345835995	3.312797977	0	0.010451129	2.589258915	2.532657266	10.257242	1.548355372	0.854978201	0	0	2.460265855	2.181067031	0	0.660318562	1.01927901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.404	0	3.137026804	5.2296	0.525535949	2.863254404	0	1.041410225	2.224843644	0.608173126	0.899999741	2.238662933	1.345835995	3.312797977	0	0.010451129	2.589258915	2.532657266	10.257242	1.548355372	0.854978201	0	0	2.460265855	2.181067031	0	0.660318562	1.01927901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.404	NO	"$350 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-15 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-29 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.3062	0.308	2.6907	0.0642	0.1962	0.6287	0.3123	0.212	1.5672	0.2536	0.9139	0	0.002	0.7863	1.196	2.1857	0.2967	0.1656	0	0	0.5559	0.4755	0	0	0.2222	0	0.0098	0	0	0											15.3486	0	2.835140947	7.5358	0.833530731	5.553919947	0.064236139	1.237607961	2.853571801	0.920444126	1.112008085	3.805848722	1.599386392	4.226699244	0	0.012420082	3.375606749	3.728621035	12.44289444	1.845044109	1.020551177	0	0	3.016123063	2.656576485	0	0.660318562	1.241527817	0	0.009833049	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7526
H4604_005_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	661.0380481	127.76173	837.1833503	196.8707308	92.41017545	11.92154386	5.611514155	246.356698	230.0564181	5836.376219	21.75129273	0	0.043072047	730.86001	4582.15298	3555.360121	483.5031988	309.3118899	0	0	13.52686419	722.4522453	0	318.3790868	352.0357813	203.0665273	15.54888069	15.27792114	105.4540832	0											2400	"$120 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$120 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-7/$50 Days 8-55 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$100 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); $100 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$25 (16a1, 16a2); $0 n/c (16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											88.43528905	67.35418834	31.13005177	0	150	0.2	0.114115823	49.55469777	100	3	0.174246908	0	0.2	39.86904677	6.606293381	34.43655021	38.5	35	0	0	0.2	34.87508043	0	25	35	0	0	0	0	0											YES	76.46548359	58.23773109	26.9165679	0	129.6973489	0.172929799	0.098670131	42.8474195	86.46489925	2.593946978	0.150662414	0	0.172929799	34.51280282	6.545860772	34.43655021	38.5	30.26271474	0	0	0.172929799	34.87508043	0	25	35	0	0	0	0	0											5000	4.2122	0.620046106	1.877841874	0	0.998779564	2.061590177	0.55368884	0.879645732	1.657650418	1.261604204	3.277102268	0	0.00744844	2.102002285	2.499511287	10.20286145	1.55123943	0.780051458	0	0	2.339197898	2.09963168	0	0.663289764	1.026771029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6722	0	3.562545951	4.2122	0.620046106	1.877841874	0	0.998779564	2.061590177	0.55368884	0.879645732	1.657650418	1.261604204	3.277102268	0	0.00744844	2.102002285	2.499511287	10.20286145	1.55123943	0.780051458	0	0	2.339197898	2.09963168	0	0.663289764	1.026771029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6722	NO	"$350 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$350 Days 1-15 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-29 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.1682	0.4241	2.6642	0.0769	0.1952	0.6045	0.2845	0.2142	1.573	0.2466	0.9385	0	0.0015	0.7471	1.179	2.1706	0.2972	0.1567	0	0	0.5483	0.4578	0	0	0.2239	0	0.0099	0	0	0											15.182	0	2.74883248	6.3804	1.044191134	4.542067657	0.076903028	1.194006054	2.666043395	0.838207173	1.093869512	3.230685119	1.508203724	4.215583866	0	0.00890435	2.849112673	3.678482047	12.37344803	1.848480797	0.936782351	0	0	2.887531815	2.557426946	0	0.663289764	1.250653433	0	0.009888543	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8542
H4604_006_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.4932	1.2611	0.6183	0	1.2354	0	1.3313	0	0.0019	0.9224	1.2443	4.4867	0.3826	0.1654	0	0	0.8002	0.1812	0	0	0	0	0	0	0	0											13.1239	NO	343.3249777	20.99398876	72.17780644	1381.39967	13.33083756	34.02363456	16.70339736	35.2221522	33.36322084	13.96677752	35.97901936	0	0.051791824	24.91921619	36.22054378	121.395746	10.29352841	4.466121645	0	0	21.64035836	5.351686468	546.6066586	160.9230856	173.5642639	198.919163	0	0	73.24774933	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081666216	0.082658113	0.165142664	0	0.192596261	0.192596261	0.192596261	0.109111555	0.192596261	0	0.160556144	0	0.192596261	0.144539577	0.162846466	0.19235416	0.192596261	0	0	0	0.192596261	0.192034977	0	0	0	0	0	0	0	0											NO	0.081666216	0.082658113	0.165142664	0	0.192596261	0.192596261	0.192596261	0.109111555	0.192596261	0	0.160556144	0	0.192596261	0.144539577	0.162846466	0.19235416	0.192596261	0	0	0	0.192596261	0.192034977	0	0	0	0	0	0	0	0												28.0381	1.735323502	11.91963526	0	2.567469476	6.552824816	3.217011884	3.843143809	6.425631602	0	5.776652622	0	0.009974912	3.601812972	5.898387556	23.35097674	1.982495088	0	0	0	4.167852115	1.027710987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.115	146	0	28.0381	1.735323502	11.91963526	0	3.060692277	7.81389442	3.835289811	3.843143809	7.660993185	0	7.107986751	0	0.011885824	4.524213182	7.142668814	27.83768507	2.365102106	0.16540299	0	0	4.968039782	1.208862154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2389	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	28.0381	1.735323502	11.91963526	0	3.060692277	7.81389442	3.835289811	3.843143809	7.660993185	0	7.107986751	0	0.011885824	4.524213182	7.142668814	27.83768507	2.365102106	0.16540299	0	0	4.968039782	1.208862154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2389
H4604_008_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1461.602764	196.3779284	43.81400763	860.6733997	194.947779	24.86160818	15.00521766	472.2232234	41.73548017	10636.80428	36.34928545	0	0.140588482	28.24573583	7287.783499	5556.66182	855.1853245	419.3117187	0	0	22.74294669	1021.635565	672.1926527	0	240.2983889	230.5131908	14.67425486	4.801376091	79.2227055	0											3200	"$150 Days 1-22 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$150 Days 1-13 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											141.1206248	112.6710137	0.167169951	0	150	0.2	0.101153974	49.49577816	0.2	3	0.176307616	0	0.2	0.150164316	6.921134155	34.47205328	38.5	35	0	0	0.2	34.65688826	0	0	35	0	0	0	0	0											NO	108.6097914	82.57203301	0.122512102	0	109.9289387	0.146571918	0.07413166	36.27345574	0.146571918	2.198578773	0.129208727	0	0.146571918	0.110312069	6.766783671	34.47205328	38.5	25.65008569	0	0	0.146571918	34.65688826	0	0	35	0	0	0	0	0												13.2287	1.351277066	5.36774618	0	1.78586687	3.6440136	1.11236169	1.427430683	6.117249386	1.948821009	4.69664491	0	0.020606323	3.115845571	4.109571198	15.96246186	2.743719583	0.896281793	0	0	3.333477323	2.950559134	0	0	0.700870301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5135	0	17.59735579	13.2287	1.351277066	5.36774618	0	1.78586687	3.6440136	1.11236169	1.427430683	6.117249386	1.948821009	4.69664491	0	0.020606323	3.115845571	4.109571198	15.96246186	2.743719583	0.896281793	0	0	3.333477323	2.950559134	0	0	0.700870301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5135	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												10.0893	0.3638	2.2291	0.3204	0.3641	1.1145	0.6726	0.291	1.8709	0.3974	1.4032	0	0.0042	0.9583	1.8628	6.5006	0.5905	0.3272	0	0	1.2996	0.366	0	0	0.0657	0	0.0037	0	0	0											31.0949	0	0	23.318	1.715041322	7.596879902	0.320443069	2.149993468	4.758499484	1.785009378	1.718474482	7.988150221	2.346172893	6.099855249	0	0.024807818	4.074122345	5.972371476	22.46304291	3.334204688	1.223494681	0	0	4.633074277	3.316591108	0	0	0.766529609	0	0.003658603	0	0	0	0	0	0	0	0	0	0	0	0	0	105.6084
H4604_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	170.2837462	5.863230649	39.69459382	227.1881104	4.452818238	16.05163112	7.972378618	14.52059276	40.01075493	27.1760927	27.37832021	0	0.075402004	26.79381892	28.20774988	91.77982278	2.896774395	4.955469915	0	0	17.12732538	5.895045671	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08306579	0.08306579	0.160415651	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08306579	0.08306579	0.160415651	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.1448	0.487033885	6.367634116	0	1.037506649	3.74003005	1.857564218	3.383298113	9.322505898	6.3320296	6.379148608	0	0.017568667	6.242959809	6.572405723	21.38469871	0.674948434	1.15462449	0	0	3.990666813	1.373545641	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4629	0	0	14.1448	0.487033885	6.367634116	0	1.037506649	3.74003005	1.857564218	3.383298113	9.322505898	6.3320296	6.379148608	0	0.017568667	6.242959809	6.572405723	21.38469871	0.674948434	1.15462449	0	0	3.990666813	1.373545641	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4629	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.1448	0.487033885	6.367634116	0	1.037506649	3.74003005	1.857564218	3.383298113	9.322505898	6.3320296	6.379148608	0	0.017568667	6.242959809	6.572405723	21.38469871	0.674948434	1.15462449	0	0	3.990666813	1.373545641	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4629
H4604_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	169.763537	5.863230649	39.57332861	226.8408202	4.439215077	16.0025941	7.948023357	14.476233	39.88852386	27.09307096	27.29468066	0	0.075171655	26.71202582	28.12157647	91.49943952	2.876865293	4.940331176	0	0	17.07500216	5.87703657	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08268156	0.08268156	0.164889217	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08268156	0.08268156	0.164889217	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.0363	0.484781058	6.525215166	0	1.034337113	3.728604425	1.851889442	3.372962288	9.294026059	6.312685533	6.359660594	0	0.017514996	6.223902017	6.552327317	21.31936941	0.670309613	1.151097164	0	0	3.978475504	1.369349521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2828	0	0	14.0363	0.484781058	6.525215166	0	1.034337113	3.728604425	1.851889442	3.372962288	9.294026059	6.312685533	6.359660594	0	0.017514996	6.223902017	6.552327317	21.31936941	0.670309613	1.151097164	0	0	3.978475504	1.369349521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2828	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.0363	0.484781058	6.525215166	0	1.034337113	3.728604425	1.851889442	3.372962288	9.294026059	6.312685533	6.359660594	0	0.017514996	6.223902017	6.552327317	21.31936941	0.670309613	1.151097164	0	0	3.978475504	1.369349521	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2828
H4604_805_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	170.2837537	5.863230649	39.69459558	227.1881154	4.452818435	16.05163183	7.972378971	14.5205934	40.0107567	27.17609391	27.37832142	0	0.075402008	26.79382011	28.20775114	91.77982685	2.876865293	4.955470135	0	0	17.12732614	5.895045933	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08306579	0.08306579	0.160415651	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08306579	0.08306579	0.160415651	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.1448	0.487033885	6.367634395	0	1.037506695	3.740030216	1.8575643	3.383298263	9.322506311	6.332029881	6.379148891	0	0.017568668	6.242960086	6.572406015	21.38469966	0.670309613	1.154624541	0	0	3.99066699	1.373545702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4583	0	0	14.1448	0.487033885	6.367634395	0	1.037506695	3.740030216	1.8575643	3.383298263	9.322506311	6.332029881	6.379148891	0	0.017568668	6.242960086	6.572406015	21.38469966	0.670309613	1.154624541	0	0	3.99066699	1.373545702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4583	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.1448	0.487033885	6.367634395	0	1.037506695	3.740030216	1.8575643	3.383298263	9.322506311	6.332029881	6.379148891	0	0.017568668	6.242960086	6.572406015	21.38469966	0.670309613	1.154624541	0	0	3.99066699	1.373545702	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.4583
H4605_001_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	402.6959669	13.20724533	0	0	0	0	0	246.9894691	187.4692178	0	0	0	0	353.8345619	2888.701936	3376.496101	95.32152864	963.0330116	0	1254.094745	0	0	0	0	248.6024777	0	0	0	0	0											2000	$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical;	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals; $10/Procedure for PCP - Cardio;	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											125	125	0	0	0	0	0	50	100	0	0	0	0	10	10	10	10	10	0	10	0	0	0	0	10	0	0	0	0	0											YES	123.9279734	123.9279734	0	0	0	0	0	49.57118938	99.14237875	0	0	0	0	9.914237876	9.914237875	9.914237875	9.914237884	9.914237873	0	9.914237875	0	0	0	0	9.914237873	0	0	0	0	0											3500	4.1588	0.136395596	0	0	0	0	0	1.020296812	1.54884535	0	0	0	0	0.292333335	2.386606512	2.789615461	0.078753359	0.795644863	0	1.036116135	0	0	0	0	0.205392008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4488	0	0.124987677	4.1588	0.136395596	0	0	0	0	0	1.020296812	1.54884535	0	0	0	0	0.292333335	2.386606512	2.789615461	0.078753359	0.795644863	0	1.036116135	0	0	0	0	0.205392008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.4488	NO	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical;	No Cost-Sharing	$25/Days Custom for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.1095	0	0.1699	0.4695	0.5379	0.3365	0.0074	0.0553	0.2242	0.1467	0.0186	0	0	0.0373	0.0872	0.19	0.0062	0.0158	0.0545	0.5029	0	0	0	0	0.0125	0	0	0	0	0											2.9821	0	0.040410498	4.2683	0.136395596	0.169933088	0.469473262	0.537949266	0.33646906	0.00737147	1.075588468	1.773086366	0.146655073	0.018641296	0	0	0.329614954	2.473842967	2.979622544	0.084956326	0.811462428	0.054515464	1.539012941	0	0	0	0	0.217935785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.4308
H4605_002_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	O											0.9982	0.0202	0.2278	0.0748	0	0.1319	0.0071	0.111	0.3294	0.0572	0.1778	0	0.0002	0.151	0.3681	0.5645	0.0102	0.0561	0.1187	0.1575	0.0753	0.005	0	0	0.016	0.003	0	0	0	0											3.6607	YES	494.5572736	12.59530752	961.7223215	12.40119021	0	21.88236328	1.073916804	279.2690409	454.0638544	9.494455096	0	0	0.034806414	474.5101704	3460.814456	3589.938546	186.9276609	1185.53795	0	1009.123881	12.49303325	0	0	0	246.152811	0	0	0	0	0											2500	$175/Days 1-5 for IP Medical; $175/Days 1-5 for IP Surgical;	$175/Days 1-5 for IP Psych; $175/Days 1-5 for IP Substance Abuse;	$10/Day for SNF	10% Coinsurance for Home Health	No Cost-Sharing	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $35/Visit for Urgent Care; $35/Visit for Urgent Care - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams;	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											175	175	10	0.1	0	0.078058534	0.1	50	200	0.1	0	0	0.1	25	25	25	25	25	0	25	0.001966204	0	0	0	25	0	0	0	0	0											YES	168.6709365	168.6709366	9.638339231	0.096383392	0	0.075235463	0.096383392	48.19169616	192.7667846	0.096383392	0	0	0.096383393	24.09584808	24.09584808	24.09584808	24.09584809	24.09584808	0	24.09584808	0.001895094	0	0	0	24.09584808	0	0	0	0	0											4000	6.9515	0.177038526	0.772450498	1.195268781	0	1.646329725	0.103507745	1.121537397	7.294035769	0.91510779	0	0	0.00335476	0.952810415	6.949271614	7.208551152	0.375348377	2.380545195	0	2.026307977	0.023675475	0	0	0	0.494271728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5909	50	1.523096822	7.9496	0.197204372	1.00022684	1.270036049	0	1.77825936	0.110598425	1.232490787	7.623403595	0.972350237	0.177779325	0	0.00356461	1.103763524	7.317328715	7.7730727	0.385563568	2.436602264	0.1186624	2.183792892	0.098996468	0.005015859	0	0	0.510224881	0.003034793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2516	NO	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$30/Days Custom for SNF	20% Coinsurance for Home Health	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$300/Case for OP Fac - Surgery; $300/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	$35/Case for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; $35/Procedure for PCP - Cardio;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults; $35/Procedure for Speclst - Cardio;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.2406	0.0119	0.2882	1.4042	0.7589	0.7202	0.0157	0.0742	0.3902	0.2827	0.0868	0	0.014	0.1398	0.089	0.2975	0.0636	0.0673	0.1528	0.7183	0.0318	0	0	0.0597	0.0075	0.003	0	0	0	0											5.9176	50	0.181817164	8.1902	0.209091147	1.288402346	2.674197445	0.758858602	2.498454401	0.126256939	1.306652154	8.01364695	1.255007986	0.264567619	0	0.017530216	1.24358982	7.406335749	8.070532872	0.449177642	2.503871479	0.271466456	2.902088419	0.130774609	0.005015859	0	0.059669089	0.517740929	0.006074409	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1692
H4605_004_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	527.8778786	12.37174976	0	0	0	0	0	297.9201517	248.7482469	0	0	0	0	543.924743	4446.582849	4339.211761	245.2276957	1492.869141	0	1077.90727	0	0	0	0	261.5627454	0	0	0	0	0											2000	$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical;	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals; $10/Procedure for PCP - Cardio;	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											125	125	0	0	0	0	0	50	100	0	0	0	0	10	10	10	10	10	0	10	0	0	0	0	10	0	0	0	0	0											YES	123.1290031	123.1290031	0	0	0	0	0	49.25160122	98.50320245	0	0	0	0	9.850320246	9.850320245	9.850320245	9.850320249	9.850320245	0	9.850320245	0	0	0	0	9.850320244	0	0	0	0	0											3500	5.4164	0.126943435	0	0	0	0	0	1.222753709	2.04187491	0	0	0	0	0.446486076	3.650022088	3.561885455	0.201297611	1.225436593	0	0.884810983	0	0	0	0	0.214706401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9926	0	0.28860115	5.4164	0.126943435	0	0	0	0	0	1.222753709	2.04187491	0	0	0	0	0.446486076	3.650022088	3.561885455	0.201297611	1.225436593	0	0.884810983	0	0	0	0	0.214706401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9926	NO	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical;	$225/Days 1-5 for IP Psych; $225/Days 1-5 for IP Substance Abuse;	$25/Days Custom for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.1765	0.0187	0.2444	0.6334	0.6858	0.4699	0.0481	0.0892	0.2992	0.1654	0.2338	0	0	0.0723	0.1078	0.3019	0.0531	0.05	0.1007	0.5081	0	0	0	0	0.0062	0	0	0	0	0											4.2645	0	0.101622724	5.5929	0.145689948	0.244354855	0.633399302	0.685814105	0.469890301	0.048111706	1.311976666	2.341074131	0.16543043	0.233797001	0	0	0.518749779	3.757848183	3.863775913	0.254409298	1.275421182	0.100672926	1.392956366	0	0	0	0	0.220869142	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.2572
H4606_001_0	2010	8	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered																	D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	O		Coin					O	O	O	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	YES	675.537597	49.712309	599.578681	388.925268	20.408136	9.964795	1.930946	297.164826	351.31628	1104.421424	805.916459	40.587952	3.180209	691.13714	2608.243025	2827.005454	51.577243	702.46665			15.280119	0		2.3					0.04	0.25	0.05	0.55	2.76	0.42							4000	$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$125/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$125/Visit:9a	"$0-$100/Proc:12. $0 Dialysis -- Dialysis Center,12. $100 Dialysis -- OP Hosp"	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN749: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							144.519765	143.64207	58.254672	0	100	0.2	0.2	50	125	36.129244	58.555332	125	19.968782	49.970402	10	35	35	38.92179			0.2	0		0					0	0	0	0	0	0							NO	132.797333	131.990831	34.540477	0	89.5448	0.17909	0.17909	44.7724	111.931	32.35186	52.433255	111.931	17.881006	44.745896	8.95448	31.34068	31.34068	34.852439			0.17909	0		0					0	0	0	0	0	0								7.4758	0.546797415	1.725811137	0	0.152286871	1.784595137	0.345813119	1.108731871	3.276931878	2.977507274	3.521401934	0.378587505	0.004738778	2.577129216	1.946288334	7.383356108	0.134705489	2.040223006	0	0	2.736516512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1172	0	5.438903	7.4758	0.546797415	1.725811137	0	0.152286871	1.784595137	0.345813119	1.108731871	3.276931878	2.977507274	3.521401934	0.378587505	0.004738778	2.577129216	1.946288334	7.383356108	0.134705489	2.040223006	0	0	2.736516512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1172	YES	$225/Day(Days 1-10)	$225/Day(Days 1-10)	40% Coins(Days 1-7) 40%(Days 8-100)	25% Coins	$100/Trip	35% Coins	35% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$100/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-80%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							6000	1.5459	0.1054	0.5712	1.2227	0.5695	1.9251	0.373	0.1829	2.8209	0.455	1.1772	0.1652	0.0008	0.7804	1.2276	1.8234	0.0172	0.2451			0.5201	0		0					0	0	0	0	0	0							15.7289	0	4.052674	9.0217	0.652157415	2.297013137	1.222745	0.721783871	3.709706137	0.718855119	1.291654871	6.097858878	3.432496274	4.698588934	0.543812505	0.005520778	3.357568216	3.173876334	9.206795108	0.151923489	2.285361006	0	0	3.256658512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8461
H4606_006_0	2010	5	N/A	r.	s.	t.	u.							Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered																	D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	O		Coin					O	O	O	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	YES	714.502476	34.662304	494.987399	283.804703	23.398734	6.35408	1.973851	226.951553	266.600851	995.736699	728.445351	43.664307	39.584758	586.419628	2195.068911	2445.636772	70.146749	613.967936			14.672833	0		2.3					0.04	0.25	0.05	0.55	2.76	0.42							4000	$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$125/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$125/Visit:9a	"$0-$100/Proc:12. $0 Dialysis -- Dialysis Center,12. $100 Dialysis -- OP Hosp"	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN749: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							144.519765	143.64207	58.254672	0	100	0.2	0.2	50	125	30.680638	59.251302	125	3.013342	50.886015	10	35	35	39.000416			0.2	0		0					0	0	0	0	0	0							NO	134.922785	134.103375	38.913189	0	91.0926	0.182185	0.182185	45.5463	113.86575	27.947791	53.973552	113.86575	2.744931	46.353394	9.10926	31.88241	31.88241	35.526493			0.182185	0		0					0	0	0	0	0	0								8.0336	0.387360996	1.605128184	0	0.17762096	1.157618065	0.359606044	0.861400293	2.529725487	2.31905343	3.276398586	0.414322422	0.009054786	2.265211672	1.666287786	6.497732856	0.186370618	1.817677298	0	0	2.67317008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2373	0	3.959833	8.0336	0.387360996	1.605128184	0	0.17762096	1.157618065	0.359606044	0.861400293	2.529725487	2.31905343	3.276398586	0.414322422	0.009054786	2.265211672	1.666287786	6.497732856	0.186370618	1.817677298	0	0	2.67317008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2373	YES	$225/Day(Days 1-10)	$225/Day(Days 1-10)	40% Coins(Days 1-7) 40%(Days 8-100)	25% Coins	$100/Trip	35% Coins	35% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$100/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-80%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a							6000	1.6837	0.0756	0.5803	0.9517	0.6751	1.2691	0.3942	0.1444	2.0996	0.3608	1.0026	0.1365	0.0015	0.6299	1.0162	1.7495	0.0249	0.2262			0.5051	0		0					0	0	0	0	0	0							13.5272	0	2.821761	9.7173	0.463008996	2.185452184	0.951703	0.85268496	2.426743065	0.753850044	1.005833293	4.629367487	2.67986743	4.279044586	0.550863422	0.010572786	2.895077672	2.682439786	8.247265856	0.211296618	2.043873298	0	0	3.17826908	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7645
H4606_801_0	2010	4	N/A																															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	NO	209.720335	0.715379	36.413451	11.766483	1.379865	6.380309	3.118775	15.383061	43.802083	9.456339	22.54464	7.969661	0.700186	14.429511	26.779353	58.729822	0.282225	4.370499			19.088598	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																			0.083349361	0.083349361	0.159035841	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083349361	0.083349361	0.159035841	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				17.4801	0.059626383	5.791043811	0	0.321508545	1.486611997	0.726674575	3.584253213	10.20588534	2.203326987	5.25290112	1.856931013	0.163143338	3.362076063	6.239589249	13.68404853	0.065758425	1.018326267	0	0	4.447643334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9494	0	0	17.4801	0.059626383	5.791043811	0	0.321508545	1.486611997	0.726674575	3.584253213	10.20588534	2.203326987	5.25290112	1.856931013	0.163143338	3.362076063	6.239589249	13.68404853	0.065758425	1.018326267	0	0	4.447643334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9494	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.254	0.0111	1.078	0	1.286	0.9802	0.4792	0.945	2.4592	0.5809	1.2594	0.4895	0.043	0.8799	1.1756	2.5784	0.0123	0.2187			0.838	0																			18.5684	0	0	20.734	0.070711848	6.869068261	0	1.607552045	2.466842997	1.205839075	4.529301213	12.66508384	2.784195987	6.51226612	2.346464013	0.206131838	4.242000563	7.415190749	16.26242653	0.078107425	1.236996767	0	0	5.285627834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5178
H4606_802_0	2010	3	N/A																															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	NO	209.720335	0.715379	36.413451	11.766483	1.379865	6.380309	3.118775	15.383061	43.802083	9.456339	22.54464	7.969661	0.700186	14.429511	26.779353	58.729822	0.282225	4.370499			19.088598	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																			0.083351721	0.083351721	0.15902262	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083351721	0.083351721	0.15902262	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				17.4806	0.059628071	5.79056237	0	0.321508545	1.486611997	0.726674575	3.584253213	10.20588534	2.203326987	5.25290112	1.856931013	0.163143338	3.362076063	6.239589249	13.68404853	0.065758425	1.018326267	0	0	4.447643334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9494	0	0	17.4806	0.059628071	5.79056237	0	0.321508545	1.486611997	0.726674575	3.584253213	10.20588534	2.203326987	5.25290112	1.856931013	0.163143338	3.362076063	6.239589249	13.68404853	0.065758425	1.018326267	0	0	4.447643334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9494	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.2541	0.0111	1.0779	0	1.286	0.9802	0.4792	0.945	2.4592	0.5809	1.2594	0.4895	0.043	0.8799	1.1756	2.5784	0.0123	0.2187			0.838	0																			18.5684	0	0	20.7346	0.07071385	6.868497198	0	1.607552045	2.466842997	1.205839075	4.529301213	12.66508384	2.784195987	6.51226612	2.346464013	0.206131838	4.242000563	7.415190749	16.26242653	0.078107425	1.236996767	0	0	5.285627834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5178
H4606_803_0	2010	3	N/A																															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	NO	209.720335	0.715379	36.413451	11.766483	1.379865	6.380309	3.118775	15.383061	43.802083	9.456339	22.54464	7.969661	0.700186	14.429511	26.779353	58.729822	0.282225	4.370499			19.088598	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																			0.083351721	0.083351721	0.15902262	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083351721	0.083351721	0.15902262	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				17.4806	0.059628071	5.79056237	0	0.321508545	1.486611997	0.726674575	3.584253213	10.20588534	2.203326987	5.25290112	1.856931013	0.163143338	3.362076063	6.239589249	13.68404853	0.065758425	1.018326267	0	0	4.447643334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9494	0	0	17.4806	0.059628071	5.79056237	0	0.321508545	1.486611997	0.726674575	3.584253213	10.20588534	2.203326987	5.25290112	1.856931013	0.163143338	3.362076063	6.239589249	13.68404853	0.065758425	1.018326267	0	0	4.447643334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9494	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.2541	0.0111	1.0779	0	1.286	0.9802	0.4792	0.945	2.4592	0.5809	1.2594	0.4895	0.043	0.8799	1.1756	2.5784	0.0123	0.2187			0.838	0																			18.5684	0	0	20.7346	0.07071385	6.868497198	0	1.607552045	2.466842997	1.205839075	4.529301213	12.66508384	2.784195987	6.51226612	2.346464013	0.206131838	4.242000563	7.415190749	16.26242653	0.078107425	1.236996767	0	0	5.285627834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.5178
H4720_801_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	308.7639419	2.122379574	44.0134544	125.6586712	7.538574278	16.02030733	11.77809722	16.342508	47.4675108	24.02862638	49.08459606	0	0.126530584	25.66019883	28.91825118	129.6107736	1.31300876	9.341623344	0	0	35.380985	6.759043599	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081061646	0.081061646	0.168647189	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081061646	0.081061646	0.168647189	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												25.0289	0.172043581	7.422745376	0	1.756487807	3.732731608	2.744296653	3.807804364	11.05993002	5.598669947	11.43671088	0	0.029481626	5.978826328	6.737952525	30.19931024	0.305931041	2.176598239	0	0	8.243769505	1.574857159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0071	0	0	25.0289	0.172043581	7.422745376	0	1.756487807	3.732731608	2.744296653	3.807804364	11.05993002	5.598669947	11.43671088	0	0.029481626	5.978826328	6.737952525	30.19931024	0.305931041	2.176598239	0	0	8.243769505	1.574857159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0071	NO	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.0289	0.172043581	7.422745376	0	1.756487807	3.732731608	2.744296653	3.807804364	11.05993002	5.598669947	11.43671088	0	0.029481626	5.978826328	6.737952525	30.19931024	0.305931041	2.176598239	0	0	8.243769505	1.574857159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0071
H4720_803_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	308.7639419	2.122379574	44.0134544	125.6586712	7.538574278	16.02030733	11.77809722	16.342508	47.4675108	24.02862638	49.08459606	0	0.126530584	25.66019883	28.91825118	129.6107736	1.31300876	9.341623344	0	0	35.380985	6.759043599	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081061646	0.081061646	0.168647189	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081061646	0.081061646	0.168647189	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												25.0289	0.172043581	7.422745376	0	1.756487807	3.732731608	2.744296653	3.807804364	11.05993002	5.598669947	11.43671088	0	0.029481626	5.978826328	6.737952525	30.19931024	0.305931041	2.176598239	0	0	8.243769505	1.574857159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0071	0	0	25.0289	0.172043581	7.422745376	0	1.756487807	3.732731608	2.744296653	3.807804364	11.05993002	5.598669947	11.43671088	0	0.029481626	5.978826328	6.737952525	30.19931024	0.305931041	2.176598239	0	0	8.243769505	1.574857159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0071	NO	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.0289	0.172043581	7.422745376	0	1.756487807	3.732731608	2.744296653	3.807804364	11.05993002	5.598669947	11.43671088	0	0.029481626	5.978826328	6.737952525	30.19931024	0.305931041	2.176598239	0	0	8.243769505	1.574857159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0071
H4754_001_0	2010	5	N/A																															A	A	D		T	Coin	Coin	V	Coin	Coin	V			V	V	V	V	V	V	Coin	Coin				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	YES	187.1189628	3.121379947	63.85341345		128.5915034	12.42976703	4.943593231	205.8953562	37.93509888	30.86619986	105.9085764			2.08205227	4386.683007	4300.477736	199.8687771	2036.718129	919.879087	135.6837285	38.80031219				8.389123881	0	8.13330412	20.64200829		0											3400	$500/Admit	$500/Admit	$0 Days 1-20 & $50 per Days 21-100		$50 Ambulance	20% DME	20% Prosthetics/$0 Supplies	$50 ER Waived	10% Coin OP Surg/ASC ($400 MOOP)	"10% Diag/Lab ($100CT, $150MRI, $300PET)"	"10% Diag/Lab ($100CT, $150MRI, $300PET)/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms"			$30 ($20 group) Copay OP MH/SA Visits/$125 Copay Partial Hospitalization/$30 Copay Urgent Care	$20 PCP / $30 Specialist	$20 PCP / $30 Specialist/$30 Copay Chiro/$30 Copay Podiatry	$30 ($20 group) Copay OP MH/SA Visits	$30 PT/ST/OT	"10% Diag/Lab ($100CT, $150MRI, $300PET)/$0 Bone Mass/$0 Colorectal Screening/$0 Mammograms"	"Medicare Hospice/$30 Copay Urgent Care/10% Diag/Lab ($100CT, $150MRI, $300PET)/$0 Pap & Pelvic Exams/$0 Prostate Exams/$30 Copay Dental/$30 Copay Hearing/$30 Copay Vision/$0 Copay Physical Exams"	$0 Immunizations/10% Part B Rx				$30 Copay Mand Suppl Vision Exams	$100 Vision Hardware Coverage	$30 Copay Mand Suppl Hearing Exams	$250 Hearing Aids Coverage		No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/$0 Copay Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//											500	500	50		50	0.2	0.135603303	50	0.1	0.1	115.9193199			29.52631579	20	30	29	30	115.9193199	0.023625997	0.093240839				30	0	30	0		0											YES	464.7140033	464.7140033	46.47140033		46.47140033	0.185885601	0.126033508	46.47140033	0.092942801	0.092942801	107.7386624			27.44258483	18.58856013	27.8828402	26.95341219	27.8828402	107.7386624	0.021958663	0.086660647				30	0	27.8828402	0		0											10000	7.2464	0.120879081	0.247279795	0	0.497985603	2.310514718	0.623058396	0.797353794	3.525794334	2.868791061	0.950870697	0	0	0.004761408	6.795176738	9.992461125	0.448928794	4.732457178	8.258878534	2.979433292	3.362460162	0	0	0	0.02097281	0	0.018898302	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8034	0	4.235587855	7.2464	0.120879081	0.247279795	0	0.497985603	2.310514718	0.623058396	0.797353794	3.525794334	2.868791061	0.950870697	0	0	0.004761408	6.795176738	9.992461125	0.448928794	4.732457178	8.258878534	2.979433292	3.362460162	0	0	0	0.02097281	0	0.018898302	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8034	NO	OON 15%	OON 15%	OON 15%	OON 15%	OON $50 Ambulance	OON 20% DME	OON 20% Prosthetics/OON 15% Supplies	$50 ER	OON 15% Coin OP Surg/ASC	OON 15% Diagnostic	OON 15% Diagnostic/OON 15% Bone Mass/OON 15% Coloretal Screening/OON 15% Mammograms			OON 15% OP MH/SA Visits/OON 15% Partial Hospitalization/$30 Copay Urgent Care	OON $30 PCP / $40 Specialist	OON $30 PCP / $40 Specialist/OON $30 Copay Chiro/OON 15% Podiatry	OON 15% OP MH/SA Visits	OON 15%	OON 15% Diagnostic/OON 15% Bone Mass/OON 15% Coloretal Screening/OON 15% Mammograms	OON $0 Copay Hospice/$30 Copay Urgent Care/OON 15% Diagnostic/OON 15% Pap & Pelvic Exams/OON 15% Prostate Exams/OON 15% Coin Dental/OON 15% Coin Hearing/15% Coin Vision/OON 15% Coin Physical Exams	OON 15% Immunizations/OON 15% Part B Rx		No Transportation	No Coverage Mand Suppl Dental	OON 15% Coin Mand Suppl Vision Exams	$100 Vision Hardware Coverage	15% Coin Mand Suppl Hearing Exams	$250 Hearing Aids Coverage	No Health & Wellness Ed	No Coverage Mand Suppl Chiro/No Coverage Mand Suppl Podiatry/OON 15% Coin Mandatory Suppl Physical Exams/No Coverage Accupuncture/No Fitness//												1.5233	0.0066	0.0425	0.1846	0.0295	0.137	0.0501	0.0597	0.3184	0.2332	0.161	0	0	0.166	0.6043	0.7327	0.0131	0.0725	0.3119	0.077	0.3189	0	0	0	0.0034	0	0.0011	0	0	0.01											5.0569	0	0.284452064	8.7697	0.127494364	0.289787756	0.18458704	0.527508906	2.447494635	0.673152928	0.857045518	3.844214145	3.101967429	1.111891984	0	0	0.170780841	7.399459459	10.72520034	0.462040061	4.804998155	8.570816692	3.056408824	3.681317514	0	0	0	0.024360464	0	0.020014419	0	0	0.010012115	0	0	0	0	0	0	0	0	0	0	60.8602
H4774_001_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1661.581058	81.783424	997.001973	259.420817	215.327127	10.773554	9.769971	513.410694	48.869764	13.243643	18.45156	5.02993	0.456153	24.010396	4338.365979	4148.923103	136.806743	2.613046			25.154045	0							0.04	0.25	544.417936	365.662472	0	0.05	0.55	1.2	449.147992	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.241304	0.25	0.243918	0.25	0.2	0.229246	15	35	35	0.25			0.2	0							0	0	0	31.379879	0	0	0	0	35	0	0		NO	143.630111	127.021172	30.559981	0	130.87575	0.174501	0.174501	43.62525	0.210539	0.218126	0.21282	0.218126	0.174501	0.200018	13.087575	30.537675	30.537675	0.218126			0.174501	0							0	0	0	27.379101	0	0	0	0	30.537675	0	0			19.8878	0.865685531	2.539030113	0	2.348424937	1.879995947	1.704869709	1.86647249	10.28899124	2.888782873	3.926860999	1.097158511	0.079599155	4.802511387	4.731557511	10.55820544	0.348146655	0.569973272	0	0	4.389406007	0	0	0	0	0	0	0	0	0	0	0.834292479	0	0	0	0	1.142994617	0	0	0	76.7507	0	11.67536	19.8878	0.865685531	2.539030113	0	2.348424937	1.879995947	1.704869709	1.86647249	10.28899124	2.888782873	3.926860999	1.097158511	0.079599155	4.802511387	4.731557511	10.55820544	0.348146655	0.569973272	0	0	4.389406007	0	0	0	0	0	0	0	0	0	0	0.834292479	0	0	0	0	1.142994617	0	0	0	76.7507	YES						20% Coins																									$0/Visit										6000						1.2679																									0										1.2679	0	0.051344	19.8878	0.865685531	2.539030113	0	2.348424937	3.147862947	1.704869709	1.86647249	10.28899124	2.888782873	3.926860999	1.097158511	0.079599155	4.802511387	4.731557511	10.55820544	0.348146655	0.569973272	0	0	4.389406007	0	0	0	0	0	0	0	0	0	0	0.834292479	0	0	0	0	1.142994617	0	0	0	78.0186
H4774_002_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	276.114593	4.318005	997.020586	9.148475	8.193025	10.773755	9.770153	513.420279	66.396144	1.279256	28.459422	5.030024	0.456162	24.010844	36.255135	55.3713	0.889158	5.632926			25.154514	0							0.04	0.25	13.243889	212.673857	0.05	0.55	1.2	0.32	0.4					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863622	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.06444	0.06444	25.658539	0	0.169775	0.169775	0.169775	42.44365	0.169775	0	0.169775	0.169775	0.169775	0.169775	0.169775	0.169775	0.169775	0.169775			0.169775	0							0	0	0.169775	0	0	0	0	0	0					17.7928	0.278252242	2.131840966	0	1.390970819	1.829114255	1.658727726	1.815952552	11.27240535	0	4.83169837	0.853972325	0.077444904	4.07644104	6.155215545	9.400662458	0.150956799	0.956330012	0	0	4.270607614	0	0	0	0	0	0	0	0	0	2.248481255	0	0	0	0	0	0	0	0	0	71.1919	0	13.435328	17.7928	0.278252242	2.131840966	0	1.390970819	1.829114255	1.658727726	1.815952552	11.27240535	0	4.83169837	0.853972325	0.077444904	4.07644104	6.155215545	9.400662458	0.150956799	0.956330012	0	0	4.270607614	0	0	0	0	0	0	0	0	0	2.248481255	0	0	0	0	0	0	0	0	0	71.1919	YES						20% Coins				$0/Visit																															5000						1.2626				0																															1.2626	0	0.056659	17.7928	0.278252242	2.131840966	0	1.390970819	3.091691255	1.658727726	1.815952552	11.27240535	0	4.83169837	0.853972325	0.077444904	4.07644104	6.155215545	9.400662458	0.150956799	0.956330012	0	0	4.270607614	0	0	0	0	0	0	0	0	0	2.248481255	0	0	0	0	0	0	0	0	0	72.4545
H4774_003_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1362.166301	67.04615635	961.580597	250.204143	207.677008	10.44601	9.472939	495.170296	41.05414241	10.2728008	15.21248869	3.9016056	0.442283	20.43925284	4184.232988	4001.520618	131.946288	2.294264152			24.389296	0							0.04	0.25	525.075915	352.671255	0	0.05	0.55	1.2	433.190711	0.32	0.4			$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		144.519765	143.64207	50.7565	0	150	0.2	0.2	50	0.241304	0.25	0.243918	0.25	0.2	0.229246	15	35	35	0.25			0.2	0							0	0	0	31.379879	0	0	0	0	35	0	0		NO	127.242283	126.469517	27.134425	0	127.6542	0.170206	0.170206	42.5514	0.205356	0.212757	0.207581	0.212757	0.170206	0.195095	12.76542	29.78598	29.78598	0.212757			0.170206	0							0	0	0	26.705155	0	0	0	0	29.78598	0	0			14.4438	0.706607918	2.174328049	0	2.20923686	1.777973578	1.612351055	1.755849111	8.430714469	2.18561028	3.157823616	0.830093903	0.07527922	3.987596033	4.451124289	9.932434425	0.327512458	0.488120758	0	0	4.151204515	0	0	0	0	0	0	0	0	0	0	0.784845044	0	0	0	0	1.075250821	0	0	0	64.5577	0	13.14398	14.4438	0.706607918	2.174328049	0	2.20923686	1.777973578	1.612351055	1.755849111	8.430714469	2.18561028	3.157823616	0.830093903	0.07527922	3.987596033	4.451124289	9.932434425	0.327512458	0.488120758	0	0	4.151204515	0	0	0	0	0	0	0	0	0	0	0.784845044	0	0	0	0	1.075250821	0	0	0	64.5577	YES	25% Coins	25% Coins		$0/Visit		20% Coins			25% Surgery OP -- Facility	25% Lab -- OP	"25% Coins:  25% DMAM -- OP,$0 SMAM -- OP,25% Advanced Imaging -- OP,25% Radiology OP -- Facility"	25% Coins		"25% Coins:25% Cardiac Rehab,25% Nuclear Medicine,25% OP Other,25% Psych -- OP"				25% Coins: Therapy (PT/OT/ST) -- OP													$0/Visit										5000	9.0922	0.1422		0		1.2251			1.2882	0.5415	0.5509	0.2057		0.5493				0.0505													0										13.6456	0	0.054023	23.536	0.848795848	2.174328049	0	2.20923686	3.003054578	1.612351055	1.755849111	9.718953408	2.727122997	3.708769211	1.035760214	0.07527922	4.536932669	4.451124289	9.932434425	0.327512458	0.538586072	0	0	4.151204515	0	0	0	0	0	0	0	0	0	0	0.784845044	0	0	0	0	1.075250821	0	0	0	78.2034
H4774_004_0	2010	3	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered				Lab	Radiology									Coin	Coin	D	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin	Coin							O	O	Coin	V	O	O	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	NO	227.5593404	3.5586763	961.587345	8.870235	7.943843	10.446083	9.473005	495.173771	55.77692327	1.24035	23.4632543	3.9016328	0.37594395	20.43939502	35.152475	53.687243	0.862116	4.945672801			24.389468	0							0.04	0.25	10.2728736	205.115613	0.05	0.55	1.2	0.32	0.4					Medicare FFS:1a	Medicare FFS:1b	"$0/Day(Days 1-20) $133(Days 21-100):2. $0 SNF 1,2. $133 SNF 2"	0% Coins:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	0% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	20% Coins:7a	"20% Coins:7b, 7d, 7f"	20% Coins:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	20% Coins:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				0.0734	0.0734	47.863621	0	0.2	0.2	0.2	50	0.2	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2			0.2	0							0	0	0.2	0	0	0	0	0	0				NO	0.06495	0.06495	26.502949	0	0.170882	0.170882	0.170882	42.7204	0.170882	0	0.170882	0.170882	0.170882	0.170882	0.170882	0.170882	0.170882	0.170882			0.170882	0							0	0	0.170882	0	0	0	0	0	0					14.78	0.231136026	2.123741697	0	1.35745978	1.785047555	1.61876604	1.762835131	9.531272202	0	4.009447822	0.666718816	0.064242054	3.4927247	6.006925233	9.174183458	0.147320106	0.84512646	0	0	4.167721071	0	0	0	0	0	0	0	0	0	1.755449187	0	0	0	0	0	0	0	0	0	63.5201	0	12.486988	14.78	0.231136026	2.123741697	0	1.35745978	1.785047555	1.61876604	1.762835131	9.531272202	0	4.009447822	0.666718816	0.064242054	3.4927247	6.006925233	9.174183458	0.147320106	0.84512646	0	0	4.167721071	0	0	0	0	0	0	0	0	0	1.755449187	0	0	0	0	0	0	0	0	0	63.5201	YES	25% Coins	25% Coins		$0/Visit		20% Coins			25% Coins	$0/Visit	25% Coins	25% Coins	20% Coins	25% Coins				25% Coins													25% Coins										5000	8.8836	0.1389		0		1.2251			1.837	0	0.8823	0.2083	0.0113	0.6069				0.1102													0.5486										14.4523	0	0.054023	23.6636	0.370062151	2.123741697	0	1.35745978	3.010136555	1.61876604	1.762835131	11.36822289	0	4.891755739	0.875068446	0.075578887	4.099609128	6.006925233	9.174183458	0.147320106	0.955331508	0	0	4.167721071	0	0	0	0	0	0	0	0	0	2.304027057	0	0	0	0	0	0	0	0	0	77.9723
H4774_005_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Lab	Radiology					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	V	O	O	O	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	0	0	0	0	0	0		0	NO	1681.249954	82.751531	1008.803942	262.4917	217.876052	10.904047	9.888308	519.488172	49.46169	13.404054	18.675053	5.090854	0.461678	24.301218	4389.721203	4198.035806	138.426187	2.644696			25.458718	0							0.04	0.25	550.86246	369.990985	0	0.05	0.55	1.2	454.464762	0.32	0.4			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	25% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. 20% Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. 20% Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$75/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0.241304	0.25	0.243918	0.25	0.2	0.229246	15	35	35	0.25			0.2	0							0	0	0	31.379879	0	0	0	0	35	0	0		NO	143.29418	126.724087	30.247778	0	130.59885	0.174132	0.174132	43.53295	0.210093	0.217665	0.21237	0.217665	0.174132	0.199595	13.059885	30.473065	30.473065	0.217665			0.174132	0							0	0	0	27.321174	0	0	0	0	30.473065	0	0			20.0761	0.873884351	2.542839807	0	2.371196819	1.898743512	1.721870849	1.884571051	10.39155484	2.917593414	3.966021006	1.108100736	0.080392913	4.850401607	4.777437841	10.66058483	0.351522516	0.575657755	0	0	4.433177483	0	0	0	0	0	0	0	0	0	0	0.84238234	0	0	0	0	1.154077853	0	0	0	77.4781	0	12.00466	20.0761	0.873884351	2.542839807	0	2.371196819	1.898743512	1.721870849	1.884571051	10.39155484	2.917593414	3.966021006	1.108100736	0.080392913	4.850401607	4.777437841	10.66058483	0.351522516	0.575657755	0	0	4.433177483	0	0	0	0	0	0	0	0	0	0	0.84238234	0	0	0	0	1.154077853	0	0	0	77.4781	YES						20% Coins																									$0/Visit										6000						1.2829																									0										1.2829	0	0.052296	20.0761	0.873884351	2.542839807	0	2.371196819	3.181637512	1.721870849	1.884571051	10.39155484	2.917593414	3.966021006	1.108100736	0.080392913	4.850401607	4.777437841	10.66058483	0.351522516	0.575657755	0	0	4.433177483	0	0	0	0	0	0	0	0	0	0	0.84238234	0	0	0	0	1.154077853	0	0	0	78.761
H4779_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2288.365117	156.8782729	2997.32318	3807.321704	634.3252792	7.501917814	6.177175977	430.0561494	281.6427229	12725.80612	5027.75681	0	11.87962724	648.1736574	5577.244579	6680.538232	727.3246565	574.9829416	0	0	724.1540457	1736.294953	1576.881712	367.028654	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.01992806	100	0	13.14050144	0	0	38.98208798	1.767731729	28.76622832	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.4848988	0	0	0.182362767	0.182362767	42.87342099	91.18138364	0	11.98169103	0	0	35.54440719	1.611842249	26.229445	17.08789605	0	0	0	0	26.91965415	0	30	30	0	30	0	0	0												0	0	4.866878236	0	0	1.368070492	1.126486905	1.536498195	2.140047764	0	5.020085721	0	0	1.919912367	0.749136537	14.60223418	1.035704011	0	0	0	0	3.895038303	0	0.917571635	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4904	0	3.700328576	0	0	4.866878236	0	0	1.368070492	1.126486905	1.536498195	2.140047764	0	5.020085721	0	0	1.919912367	0.749136537	14.60223418	1.035704011	0	0	0	0	3.895038303	0	0.917571635	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4904	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.6427	0.114	0.574	0	0	0	0	0	0	0	0	0	0	0	0.7777	3.9269	0.183	0	0	0	0.4637	0.3504	0	0	0.0202	0	0.0021	0	0	0											11.0548	0	0	4.6427	0.113962905	5.440895667	0	0	1.368070492	1.126486905	1.536498195	2.140047764	0	5.020085721	0	0	1.919912367	1.526875371	18.52911851	1.21870659	0	0	0	0.463734213	4.245433927	0	0.917571635	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5451
H4779_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2288.365117	156.8782729	2997.32318	3807.321704	634.3252792	7.501917814	6.177175977	430.0561494	281.6427229	12725.80612	5027.75681	0	11.87962724	648.1736574	5577.244579	6680.538232	727.3246565	574.9829416	0	0	724.1540457	1736.294953	1576.881712	367.028654	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.01992806	100	0	13.14050144	0	0	38.98208798	1.767731729	28.76622832	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.4848988	0	0	0.182362767	0.182362767	42.87342099	91.18138364	0	11.98169103	0	0	35.54440719	1.611842249	26.229445	17.08789605	0	0	0	0	26.91965415	0	30	30	0	30	0	0	0												0	0	4.866878236	0	0	1.368070492	1.126486905	1.536498195	2.140047764	0	5.020085721	0	0	1.919912367	0.749136537	14.60223418	1.035704011	0	0	0	0	3.895038303	0	0.917571635	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4904	0	3.700328576	0	0	4.866878236	0	0	1.368070492	1.126486905	1.536498195	2.140047764	0	5.020085721	0	0	1.919912367	0.749136537	14.60223418	1.035704011	0	0	0	0	3.895038303	0	0.917571635	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4904	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.6427	0.114	0.574	0	0	0	0	0	0	0	0	0	0	0	0.7777	3.9269	0.183	0	0	0	0.4637	0.3504	0	0	0.0202	0	0.0021	0	0	0											11.0548	0	0	4.6427	0.113962905	5.440895667	0	0	1.368070492	1.126486905	1.536498195	2.140047764	0	5.020085721	0	0	1.919912367	1.526875371	18.52911851	1.21870659	0	0	0	0.463734213	4.245433927	0	0.917571635	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5451
H4779_003_0	2010	3	N/A																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	3329.826806	451.0317753	1824.880911	2742.066956	424.1967247	2892.220852	27.42311563	803.4309711	561.5457697	25872.60396	9995.070968	0	16.38082484	1343.717663	15332.40254	9819.719904	1561.615746	899.0695472	0	0	2860.850776	2116.817208	783.191333	378.1906779	134.6297443	140.2668666	16.27378537	13.81292132	2105.381621	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0	0.10915137	49.02560096	100	0	13.5215317	0	0	38.88260906	0.392789021	29.7551979	19.40197704	0	0	0	0	29.6528122	0	30	0	0	30	0	0	0											NO	0	0	13.77124232	0	0	0	0.070341291	31.59396043	64.4438004	0	8.7137889	0	0	25.05743097	0.253128173	19.17538035	12.50337136	0	0	0	0	19.10939911	0	30	0	0	30	0	0	0												0	0	2.094239769	0	0	0	1.928977362	2.115297192	3.015678625	0	7.257911538	0	0	2.805842715	0.32342192	15.69140534	1.6271218	0	0	0	0	3.370925406	0	0.945476695	0	0	0.040684463	0	0	0	0	0	0	0	0	0	0	0	0	0	41.217	0	22.19693929	0	0	2.094239769	0	0	0	1.928977362	2.115297192	3.015678625	0	7.257911538	0	0	2.805842715	0.32342192	15.69140534	1.6271218	0	0	0	0	3.370925406	0	0.945476695	0	0	0.040684463	0	0	0	0	0	0	0	0	0	0	0	0	0	41.217	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.6282	0.4361	0.3819	0	0	0	0	0	0	0	0	0	0	0	2.3199	7.2817	0.3634	0	0	0	1.3778	0.416	0	0	0.0211	0	0.0021	0	0	0											20.2281	0	0	7.6282	0.436101666	2.476126371	0	0	0	1.928977362	2.115297192	3.015678625	0	7.257911538	0	0	2.805842715	2.643273526	22.97307831	1.990484292	0	0	0	1.377830675	3.786935815	0	0.945476695	0.021116849	0	0.042753918	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4451
H4836_801_0	2010	1	N/A																															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																																																			0	NO	350.4748076	2.976951155	110.288244		13.82933323	15.25788949	12.62765642	18.22932034	42.0924385	15.00542103	25.05994109	5.540424783	0.053543681	32.33574216	61.57188125	170.7503925	1.478794178	31.84234958	33.91889045	4.149747168	31.04123261	0.024770504																				Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing											0.080413623	0.080413623	0.167883081		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080413623	0.080413623	0.167883081		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				28.1829	0.239387429	18.51553021	0	3.222234643	3.555088251	2.942243945	4.247431639	9.807538171	3.4962631	5.838966274	1.290918974	0.012475678	7.534227923	14.34624833	39.78484145	0.344559043	7.419267452	7.903101474	0.96689109	7.232607198	0.005771528	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.8885	0	0	28.1829	0.239387429	18.51553021	0	3.222234643	3.555088251	2.942243945	4.247431639	9.807538171	3.4962631	5.838966274	1.290918974	0.012475678	7.534227923	14.34624833	39.78484145	0.344559043	7.419267452	7.903101474	0.96689109	7.232607198	0.005771528	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.8885	NO																																																																																		0	0	0	28.1829	0.239387429	18.51553021	0	3.222234643	3.555088251	2.942243945	4.247431639	9.807538171	3.4962631	5.838966274	1.290918974	0.012475678	7.534227923	14.34624833	39.78484145	0.344559043	7.419267452	7.903101474	0.96689109	7.232607198	0.005771528	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.8885
H4836_802_0	2010	2	N/A																															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																																																			0	NO	202.9830461	1.682043619	41.16182852		7.546426388	11.82800094	9.886067846	12.55392968	35.01428876	11.62402939	22.56476139	7.323385478	0.344272534	23.62765958	45.94712819	131.4934227	1.393708239	19.48788418	26.36591641	3.017551574	30.8570776	0.012045526																				Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing											0.079892642	0.079892642	0.170051784		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.079892642	0.079892642	0.170051784		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				16.2169	0.134382909	6.999642385	0	1.758317348	2.75592422	2.303453808	2.925065615	8.158329281	2.708398848	5.257589403	1.706348816	0.0802155	5.505244683	10.70568087	30.63796749	0.32473402	4.540677015	6.143258523	0.703089517	7.189699081	0.002806607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7577	0	0	16.2169	0.134382909	6.999642385	0	1.758317348	2.75592422	2.303453808	2.925065615	8.158329281	2.708398848	5.257589403	1.706348816	0.0802155	5.505244683	10.70568087	30.63796749	0.32473402	4.540677015	6.143258523	0.703089517	7.189699081	0.002806607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7577	NO																																																																																		0	0	0	16.2169	0.134382909	6.999642385	0	1.758317348	2.75592422	2.303453808	2.925065615	8.158329281	2.708398848	5.257589403	1.706348816	0.0802155	5.505244683	10.70568087	30.63796749	0.32473402	4.540677015	6.143258523	0.703089517	7.189699081	0.002806607	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7577
H4836_803_0	2010	1	N/A																															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																																																			0	NO	350.4748302	2.976951297	110.297772		13.82933418	15.25789054	12.62765711	18.23884487	42.08638083	15.00542207	25.05994262	5.540425114	0.053543681	32.33574429	61.57188529	170.7364837	1.476651827	31.84235195	33.91889261	4.149747455	31.04123454	0.024770507																				Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing											0.080413623	0.080413623	0.167883081		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080413623	0.080413623	0.167883081		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				28.183	0.23938744	18.5171298	0	3.222234865	3.555088495	2.942244108	4.249650855	9.806126735	3.496263343	5.838966631	1.290919052	0.012475678	7.534228419	14.34624927	39.78160069	0.344059876	7.419268005	7.903101979	0.966891157	7.232607648	0.005771528	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.8872	0	0	28.183	0.23938744	18.5171298	0	3.222234865	3.555088495	2.942244108	4.249650855	9.806126735	3.496263343	5.838966631	1.290919052	0.012475678	7.534228419	14.34624927	39.78160069	0.344059876	7.419268005	7.903101979	0.966891157	7.232607648	0.005771528	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.8872	NO																																																																																		0	0	0	28.183	0.23938744	18.5171298	0	3.222234865	3.555088495	2.942244108	4.249650855	9.806126735	3.496263343	5.838966631	1.290919052	0.012475678	7.534228419	14.34624927	39.78160069	0.344059876	7.419268005	7.903101979	0.966891157	7.232607648	0.005771528	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	166.8872
H4837_001_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.4262	0.9014	0.471	0	0.9665	0	1.1836	0	0.0824	1.1403	1.5436	2.7909	0.5032	0.1735	0	0	0.7324	0.1187	0	0	0	0	0	0	0	0											11.0337	NO	231.379123	14.17614657	15.36680731	1861.225407	7.307641065	16.64759677	8.903089203	15.69172029	38.57553144	16.43253405	41.6096901	0	0.702816133	33.46647512	37.83479859	87.1066132	8.631868709	4.578272051	0	0	25.39116216	5.790221623	479.5582798	0	85.6354071	0	0	0	2854.51357	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14e, 14f, 14g, 14h, 14i, 14j); $0/20% (14b, 14d); $0 n/c (14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14c)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 18a); $0 n/c (13a1); $0 (17a, 17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.075393538	0.075393538	0.153993856	0	0.192939344	0.192939344	0.192939344	0.112758505	0.192939344	0	0.163602875	0	0.192939344	0.144359678	0.187932035	0.192678533	0.434113524	0.192939344	0	0	0.192939344	0.018633312	0	0	0	0	0	0	0	0											NO	0.075393538	0.075393538	0.153993856	0	0.192939344	0.192939344	0.192939344	0.112758505	0.192939344	0	0.163602875	0	0.192939344	0.144359678	0.187932035	0.192678533	0.434113524	0.192939344	0	0	0.192939344	0.018633312	0	0	0	0	0	0	0	0												17.4445	1.068789841	2.366393906	0	1.409931475	3.211976402	1.717756192	1.769374918	7.442737738	0	6.807464926	0	0.135600884	4.831209566	7.110370699	16.78357447	3.747210948	0.883328807	0	0	4.898954175	0.107891003	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.7371	146	0	17.4445	1.068789841	2.366393906	0	1.836124105	4.113327615	2.188709802	1.769374918	8.409259739	0	7.991105033	0	0.217975155	5.97154777	8.653964586	19.57448283	4.250408445	1.056866029	0	0	5.631352556	0.226585979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.7708	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	17.4445	1.068789841	2.366393906	0	1.836124105	4.113327615	2.188709802	1.769374918	8.409259739	0	7.991105033	0	0.217975155	5.97154777	8.653964586	19.57448283	4.250408445	1.056866029	0	0	5.631352556	0.226585979	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.7708
H4837_002_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.4254	0.8997	0.4701	0	0.9648	0	1.1815	0	0.0822	1.1383	1.5408	2.7858	0.5023	0.1732	0	0	0.7311	0.1185	0	0	0	0	0	0	0	0											11.0136	NO	226.7662959	13.89352768	15.06045113	1842.579098	7.161954265	16.31570648	8.725595185	15.3791014	37.80648084	16.1049313	40.78014982	0	0.68880463	32.79927983	37.08051541	85.37238334	8.459781805	4.486998574	0	0	24.88495816	5.674786443	479.5582798	0	85.6354071	0	0	0	2854.51357	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14e, 14f, 14g, 14h, 14i, 14j); $0/20% (14b, 14d); $0 n/c (14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14c)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 18a); $0 n/c (13a1); $0 (17a, 17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07644888	0.07644888	0.153682643	0	0.192808823	0.192808823	0.192808823	0.113494513	0.192808823	0	0.163492199	0	0.192808823	0.14426202	0.187810955	0.192542894	0.433819851	0.192808823	0	0	0.192808823	0.018633288	0	0	0	0	0	0	0	0											NO	0.07644888	0.07644888	0.153682643	0	0.192808823	0.192808823	0.192808823	0.113494513	0.192808823	0	0.163492199	0	0.192808823	0.14426202	0.187810955	0.192542894	0.433819851	0.192808823	0	0	0.192808823	0.018633288	0	0	0	0	0	0	0	0												17.336	1.062144633	2.314529934	0	1.380887971	3.14581216	1.682371737	1.745443621	7.289423069	0	6.667236388	0	0.13280761	4.731690368	6.964127021	16.43784575	3.670021286	0.865132913	0	0	4.79803949	0.105739931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.3293	146	0	17.336	1.062144633	2.314529934	0	1.806305338	4.045523774	2.15246866	1.745443621	8.254186922	0	7.848723399	0	0.215032038	5.869954244	8.504913039	19.22367732	4.172303444	1.038354463	0	0	5.529105604	0.224218996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3429	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	17.336	1.062144633	2.314529934	0	1.806305338	4.045523774	2.15246866	1.745443621	8.254186922	0	7.848723399	0	0.215032038	5.869954244	8.504913039	19.22367732	4.172303444	1.038354463	0	0	5.529105604	0.224218996	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.3429
H4875_001_0	2010	7	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	799.2658407	47.87595186	880.7394317	812.0383786	127.8661859	0	15.13564817	562.1143673	242.5452671	2982.775002	1448.958063	4.427166153	0	1543.689923	4127.626041	7242.707057	239.3119183	0	2703.709761	4054.955715	25.06828863	0	0	0	0	327.5361359	140.4161261	23.24196706	0	0											3400	"$25 days 1-5, $0 days 6+, unlimited coverage"	"$25 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $25 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$25 copay	10% coinsurance	"10% coinsurance, 0% Diab Mon Supp"	"$50 ER, $20 Urgent Care"	$5 copay	$5 copay	$5 copay	$5 copay	$5 copay	"5% for Partial Hosp, $0 - $5 copay for other"	"$5 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$5 Specialist, $0 Screening/Exams"	$5 copay	$5 copay	$5 copay	$0 - $5 copay	0% - 10% coinsurance	$5 copay	Not Covered	Not Covered	$5 copay	$100 every two years	$5 copay	$350 every three years	Not Covered	Not Covered											20.42036227	8.957120809	10.75035041	0	25	0	0.078725987	19.99923185	4.639043418	1.67196854	3.215173534	0	0	1.865680529	4.574926843	3.68679594	2.775743461	0	0.883331452	1.397321249	0.089927771	0	0	0	0	0	5	0	0	0											YES	19.68717161	8.635516459	10.36436036	0	24.10237799	0	0.07589934	19.28116182	4.47247912	1.61193671	3.099733113	0	0	1.798693493	4.410664643	3.554421974	2.676080724	0	0.851615542	1.347150597	0.086698925	0	0	0	0	0	4.820475599	0	0	0											3400	1.3113	0.034452798	0.760691738	0	0.256823262	0	1.148785707	0.90318484	0.09039822	0.400670377	0.374281941	0	0	0.231385418	1.517131186	2.145303093	0.053368168	0	0.191876771	0.455219668	2.173393672	0	0	0	0	0	0.056406042	0	0	0	0	0	0	0	0	0	0	0	0	0	12.1046	0	0.450801872	1.3113	0.034452798	0.760691738	0	0.256823262	0	1.148785707	0.90318484	0.09039822	0.400670377	0.374281941	0	0	0.231385418	1.517131186	2.145303093	0.053368168	0	0.191876771	0.455219668	2.173393672	0	0	0	0	0	0.056406042	0	0	0	0	0	0	0	0	0	0	0	0	0	12.1046	NO	"$75 days 1-5, $0 days 6+, unlimited coverage"	"$75 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $50 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$25 copay	20% coinsurance	"20% coinsurance, $10 Diab Mon Supp"	"$50 ER, $20 Urgent Care"	$15 copay	$15 copay	$15 copay	$15 copay	$5 copay	"15% for Partial Hosp, $0 - $15 copay for other"	"$15 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams"	"$15 Specialist, $10 Screening/Exams"	$15 copay	$15 copay	$15 copay	$0 - $15 copay	10% coinsurance	$15 copay	Not Covered	Not Covered	$15 copay	$100 every two years	$15 copay	$350 every three years	Not Covered	Not Covered												0.165	0.1089	0.083	0	0.0317	0	0.56	0.1329	0.0056	0.0396	0.0261	0	0	0.0441	0	1.0679	0.0432	0	0.0208	0.1052	0.0564	0	0	0	0	0	0	0	0	0											2.4903	300	0.092745188	1.4762	0.143328809	0.84370711	0	0.288528717	0	1.708787743	1.036087661	0.096021892	0.440255569	0.400331972	0	0	0.275498649	1.517131186	3.213165381	0.096582427	0	0.212658455	0.560401129	2.229841669	0	0	0	0	0	0.056406042	0	0	0	0	0	0	0	0	0	0	0	0	0	14.595
H4875_003_0	2010	7	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	893.2430185	53.50517634	806.7474157	661.9969587	134.8483732	0	16.37132063	649.0835751	280.0713845	3444.26397	1673.137949	5.112128423	0	1782.526533	4353.016809	7638.198143	252.379647	0	2851.346978	4276.378289	27.11486065	0	0	0	0	345.4213853	148.0836082	24.51110451	0	0											3400	"$25 days 1-5, $0 days 6+, unlimited coverage"	"$25 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $25 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$25 copay	10% coinsurance	"10% coinsurance, 0% Diab Mon Supp"	"$50 ER, $20 Urgent Care"	$5 copay	$5 copay	$5 copay	$5 copay	$5 copay	"5% for Partial Hosp, $0 - $5 copay for other"	"$5 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$5 Specialist, $0 Screening/Exams"	$5 copay	$5 copay	$5 copay	$0 - $5 copay	0% - 10% coinsurance	$5 copay	Not Covered	Not Covered	$5 copay	$100 every two years	$5 copay	$350 every three years	Not Covered	Not Covered											20.42036227	8.957120809	10.75035041	0	25	0	0.078725987	19.99923185	4.639043418	1.67196854	3.215173534	0	0	1.867042182	4.574926843	3.68679594	2.775743461	0	0.883331452	1.397321249	0.089927771	0	0	0	0	0	5	0	0	0											YES	19.68717161	8.635516459	10.36436036	0	24.10237799	0	0.07589934	19.28116182	4.47247912	1.61193671	3.099733113	0	0	1.800006256	4.410664643	3.554421974	2.676080724	0	0.851615542	1.347150597	0.086698925	0	0	0	0	0	4.820475599	0	0	0											3400	1.4655	0.038503736	0.696785078	0	0.270847205	0	1.242572432	1.042923788	0.104384452	0.462661294	0.432190092	0	0	0.267379909	1.599974777	2.262448277	0.056282359	0	0.202354283	0.48007713	2.350829266	0	0	0	0	0	0.059486118	0	0	0	0	0	0	0	0	0	0	0	0	0	13.0352	0	0.485455826	1.4655	0.038503736	0.696785078	0	0.270847205	0	1.242572432	1.042923788	0.104384452	0.462661294	0.432190092	0	0	0.267379909	1.599974777	2.262448277	0.056282359	0	0.202354283	0.48007713	2.350829266	0	0	0	0	0	0.059486118	0	0	0	0	0	0	0	0	0	0	0	0	0	13.0352	NO	"$75 days 1-5, $0 days 6+, unlimited coverage"	"$75 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $50 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$25 copay	20% coinsurance	"20% coinsurance, $10 Diab Mon Supp"	"$50 ER, $20 Urgent Care"	$15 copay	$15 copay	$15 copay	$15 copay	$5 copay	"15% for Partial Hosp, $0 - $15 copay for other"	"$15 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams"	"$15 Specialist, $10 Screening/Exams"	$15 copay	$15 copay	$15 copay	$0 - $15 copay	10% coinsurance	$15 copay	Not Covered	Not Covered	$15 copay	$100 every two years	$15 copay	$350 every three years	Not Covered	Not Covered												0.1844	0.1217	0.076	0	0.0334	0	0.6057	0.1535	0.0065	0.0457	0.0301	0	0	0.0509	0	1.1262	0.0456	0	0.0219	0.1109	0.0611	0	0	0	0	0	0	0	0	0											2.6736	300	0.099569597	1.6498	0.16018132	0.772826226	0	0.30428395	0	1.848292966	1.196389067	0.110878207	0.508371028	0.462270532	0	0	0.318318251	1.599974777	3.388621637	0.101856352	0	0.22427076	0.59100207	2.411885671	0	0	0	0	0	0.059486118	0	0	0	0	0	0	0	0	0	0	0	0	0	15.7087
H4875_005_0	2010	6	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	823.4346569	49.32366177	733.4413443	579.1043768	123.4441372	0	15.13580178	649.4570813	280.2325477	3446.245924	1674.100733	5.115070126	0	1783.552263	3984.878657	6992.229549	231.0356961	0	2610.206258	3914.721519	25.06854304	0	0	0	0	316.2088194	135.5600576	22.43818058	0	0											3400	"$25 days 1-5, $0 days 6+, unlimited coverage"	"$25 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $25 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$25 copay	10% coinsurance	"10% coinsurance, 0% Diab Mon Supp"	"$50 ER, $20 Urgent Care"	$5 copay	$5 copay	$5 copay	$5 copay	$5 copay	"5% for Partial Hosp, $0 - $5 copay for other"	"$5 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$5 Specialist, $0 Screening/Exams"	$5 copay	$5 copay	$5 copay	$0 - $5 copay	0% - 10% coinsurance	$5 copay	Not Covered	Not Covered	$5 copay	$100 every two years	$5 copay	$350 every three years	Not Covered	Not Covered											20.42036227	8.957120809	10.75035041	0	25	0	0.078725987	19.99923185	4.639043418	1.67196854	3.215173534	0	0	1.865781647	4.574926843	3.68679594	2.775743461	0	0.883331452	1.397321249	0.089927771	0	0	0	0	0	5	0	0	0											YES	19.68717161	8.635516459	10.36436036	0	24.10237799	0	0.07589934	19.28116182	4.47247912	1.61193671	3.099733113	0	0	1.79879098	4.410664643	3.554421974	2.676080724	0	0.851615542	1.347150597	0.086698925	0	0	0	0	0	4.820475599	0	0	0											3400	1.3509	0.035494608	0.633470866	0	0.247941438	0	1.148797366	1.043523924	0.104444518	0.462927526	0.43243879	0	0	0.267353144	1.464663616	2.071111196	0.051522514	0	0.185241018	0.439476619	2.17341573	0	0	0	0	0	0.054455329	0	0	0	0	0	0	0	0	0	0	0	0	0	12.1672	0	0.453131608	1.3509	0.035494608	0.633470866	0	0.247941438	0	1.148797366	1.043523924	0.104444518	0.462927526	0.43243879	0	0	0.267353144	1.464663616	2.071111196	0.051522514	0	0.185241018	0.439476619	2.17341573	0	0	0	0	0	0.054455329	0	0	0	0	0	0	0	0	0	0	0	0	0	12.1672	NO	"$75 days 1-5, $0 days 6+, unlimited coverage"	"$75 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $50 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$25 copay	20% coinsurance	"20% coinsurance, $10 Diab Mon Supp"	"$50 ER, $20 Urgent Care"	$15 copay	$15 copay	$15 copay	$15 copay	$5 copay	"15% for Partial Hosp, $0 - $15 copay for other"	"$15 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams"	"$15 Specialist, $10 Screening/Exams"	$15 copay	$15 copay	$15 copay	$0 - $15 copay	10% coinsurance	$15 copay	Not Covered	Not Covered	$15 copay	$100 every two years	$15 copay	$350 every three years	Not Covered	Not Covered												0.17	0.1122	0.0691	0	0.0306	0	0.56	0.1536	0.0065	0.0457	0.0301	0	0	0.051	0	1.0309	0.0417	0	0.0201	0.1015	0.0564	0	0	0	0	0	0	0	0	0											2.4794	300	0.092339375	1.5209	0.147662896	0.702602444	0	0.27855041	0	1.708805086	1.197077512	0.11094201	0.508663563	0.462536539	0	0	0.318320797	1.464663616	3.102043165	0.093242278	0	0.205304	0.541020547	2.2298643	0	0	0	0	0	0.054455329	0	0	0	0	0	0	0	0	0	0	0	0	0	14.6466
H4875_007_0	2010	6	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	958.2343588	57.39815177	712.1439886	656.7437349	131.8659395	0	15.65094441	840.6349837	362.7234038	4460.702593	2166.898603	6.620771436	0	2308.568912	4256.741389	7469.264559	246.797781	0	2788.283902	4181.797879	25.92174365	0	0	0	0	337.7817206	144.8084516	23.96899384	0	0											3400	"$25 days 1-5, $0 days 6+, unlimited coverage"	"$25 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $25 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$25 copay	10% coinsurance	"10% coinsurance, 0% Diab Mon Supp"	"$50 ER, $20 Urgent Care"	$5 copay	$5 copay	$5 copay	$5 copay	$5 copay	"5% for Partial Hosp, $0 - $5 copay for other"	"$5 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$5 Specialist, $0 Screening/Exams"	$5 copay	$5 copay	$5 copay	$0 - $5 copay	0% - 10% coinsurance	$5 copay	Not Covered	Not Covered	$5 copay	$100 every two years	$5 copay	$350 every three years	Not Covered	Not Covered											20.42036227	8.957120809	10.75035041	0	25	0	0.078725987	19.99923185	4.639043418	1.67196854	3.215173534	0	0	1.863288523	4.574926843	3.68679594	2.775743461	0	0.883331452	1.397321249	0.089927771	0	0	0	0	0	5	0	0	0											YES	19.68717161	8.635516459	10.36436036	0	24.10237799	0	0.07589934	19.28116182	4.47247912	1.61193671	3.099733113	0	0	1.796387372	4.410664643	3.554421974	2.676080724	0	0.851615542	1.347150597	0.086698925	0	0	0	0	0	4.820475599	0	0	0											3400	1.5721	0.041305224	0.615076411	0	0.264856893	0	1.187896352	1.350701596	0.135189404	0.599197522	0.559733946	0	0	0.345590337	1.564588228	2.212409839	0.055037565	0	0.197878825	0.469459292	2.247387305	0	0	0	0	0	0.058170467	0	0	0	0	0	0	0	0	0	0	0	0	0	13.4766	0	0.501894603	1.5721	0.041305224	0.615076411	0	0.264856893	0	1.187896352	1.350701596	0.135189404	0.599197522	0.559733946	0	0	0.345590337	1.564588228	2.212409839	0.055037565	0	0.197878825	0.469459292	2.247387305	0	0	0	0	0	0.058170467	0	0	0	0	0	0	0	0	0	0	0	0	0	13.4766	NO	"$75 days 1-5, $0 days 6+, unlimited coverage"	"$75 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $50 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$25 copay	20% coinsurance	"20% coinsurance, $10 Diab Mon Supp"	"$50 ER, $20 Urgent Care"	$15 copay	$15 copay	$15 copay	$15 copay	$5 copay	"15% for Partial Hosp, $0 - $15 copay for other"	"$15 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams"	"$15 Specialist, $10 Screening/Exams"	$15 copay	$15 copay	$15 copay	$0 - $15 copay	10% coinsurance	$15 copay	Not Covered	Not Covered	$15 copay	$100 every two years	$15 copay	$350 every three years	Not Covered	Not Covered												0.1978	0.1305	0.0671	0	0.0327	0	0.5791	0.1988	0.0084	0.0592	0.039	0	0	0.066	0	1.1013	0.0446	0	0.0214	0.1085	0.0584	0	0	0	0	0	0	0	0	0											2.7126	300	0.101022875	1.7699	0.17183593	0.682200575	0	0.29755412	0	1.766963772	1.549456098	0.143599535	0.65839668	0.598691441	0	0	0.41156112	1.564588228	3.313675689	0.099603601	0	0.219310577	0.577930912	2.305757086	0	0	0	0	0	0.058170467	0	0	0	0	0	0	0	0	0	0	0	0	0	16.1892
H4875_009_0	2010	6	N/A																															D	D	D	V	P	Coin	Coin	P	P	P	P	P	P	P	P	P	P	P	P	P	Coin	O	0	0	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	YES	1224.377344	73.3400926	1115.700472	936.5438223	173.9782561	0	22.61690761	561.8201431	242.4183131	2981.213746	1448.199643	4.424848868	0	1542.881918	5616.161732	9854.626802	325.6143906	0	3678.742004	5517.284484	37.0037849	0	0	0	0	445.6546921	191.0540505	31.62366083	0	0											3400	"$25 days 1-5, $0 days 6+, unlimited coverage"	"$25 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $25 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$25 copay	10% coinsurance	"10% coinsurance, 0% Diab Mon Supp"	"$50 ER, $20 Urgent Care"	$5 copay	$5 copay	$5 copay	$5 copay	$5 copay	"5% for Partial Hosp, $0 - $5 copay for other"	"$5 PCP & Physical Exam, $0 Immun/Screenings/Exams"	"$5 Specialist, $0 Screening/Exams"	$5 copay	$5 copay	$5 copay	$0 - $5 copay	0% - 10% coinsurance	$5 copay	Not Covered	Not Covered	$5 copay	$100 every two years	$5 copay	$350 every three years	Not Covered	Not Covered											20.42036227	8.957120809	10.75035041	0	25	0	0.078725987	19.99923185	4.639043418	1.67196854	3.215173534	0	0	1.867910818	4.574926843	3.68679594	2.775743461	0	0.883331452	1.397321249	0.089927771	0	0	0	0	0	5	0	0	0											YES	19.68717161	8.635516459	10.36436036	0	24.10237799	0	0.07589934	19.28116182	4.47247912	1.61193671	3.099733113	0	0	1.800843704	4.410664643	3.554421974	2.676080724	0	0.851615542	1.347150597	0.086698925	0	0	0	0	0	4.820475599	0	0	0											3400	2.0087	0.052777465	0.963626812	0	0.349440808	0	1.716608361	0.902712091	0.090350904	0.400460657	0.374086032	0	0	0.231540766	2.064250498	2.918958504	0.0726142	0	0.261072822	0.619384424	3.208188366	0	0	0	0	0	0.076747616	0	0	0	0	0	0	0	0	0	0	0	0	0	16.3115	0	0.607474876	2.0087	0.052777465	0.963626812	0	0.349440808	0	1.716608361	0.902712091	0.090350904	0.400460657	0.374086032	0	0	0.231540766	2.064250498	2.918958504	0.0726142	0	0.261072822	0.619384424	3.208188366	0	0	0	0	0	0.076747616	0	0	0	0	0	0	0	0	0	0	0	0	0	16.3115	NO	"$75 days 1-5, $0 days 6+, unlimited coverage"	"$75 days 1-5, $0 days 6-90, plus LTR days"	"$0 copay days 1-20, $50 copay days 21-100, coverage for Non-Medicare Covered Stay"	$0 copay	$25 copay	20% coinsurance	"20% coinsurance, $10 Diab Mon Supp"	"$50 ER, $20 Urgent Care"	$15 copay	$15 copay	$15 copay	$15 copay	$5 copay	"15% for Partial Hosp, $0 - $15 copay for other"	"$15 PCP, $15 Physical Exam, $10 Immun/Screenings/Exams"	"$15 Specialist, $10 Screening/Exams"	$15 copay	$15 copay	$15 copay	$0 - $15 copay	10% coinsurance	$15 copay	Not Covered	Not Covered	$15 copay	$100 every two years	$15 copay	$350 every three years	Not Covered	Not Covered												0.2527	0.1668	0.1052	0	0.0431	0	0.8038	0.1328	0.0056	0.0396	0.026	0	0	0.0441	0	1.453	0.0588	0	0.0283	0.1431	0.0833	0	0	0	0	0	0	0	0	0											3.3863	300	0.126111205	2.2614	0.219562175	1.068788778	0	0.392580124	0	2.520442059	1.035545348	0.095971632	0.440025129	0.400122428	0	0	0.275630907	2.064250498	4.371921359	0.131412712	0	0.289348954	0.762497219	3.291512345	0	0	0	0	0	0.076747616	0	0	0	0	0	0	0	0	0	0	0	0	0	19.6978
H4875_801_0	2010	5	N/A																															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	NO	168.0783709	1.032506013	27.11872694	10.16507063	3.243347418	0	17.86470565	7.954305417	32.68388723	13.06867093	27.05207565	0.032320392	0.066400842	27.92907945	35.49731013	58.93418575	1.135250634	0	18.06893307	67.53693254	26.94018278	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												12.888	0.079170729	4.593338695	0	0.755699948	0	4.162476418	1.853353162	7.615345725	3.045000326	6.303133628	0.007530651	0.015471396	6.507475513	8.27087326	13.73166528	0.264513398	0	4.210061406	15.73610528	6.277062587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3162	146		12.888	0.079170729	4.593338695	0	0.755699948	0	4.162476418	1.853353162	7.615345725	3.045000326	6.303133628	0.007530651	0.015471396	6.507475513	8.27087326	13.73166528	0.264513398	0	4.210061406	15.73610528	6.277062587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3162	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				1.1644	0.0456	0.3193	0	0.4186	0	0.3289	0.2215	0.2338	0.1166	0.1748	0.0022	0	0.2447	0.0006	2.1401	0.0614	0	0.2476	2.0705	0.2078	0	0	0	0	0	0	0	0	0											7.9982			14.0523	0.124739	4.912604813	0	1.174275015	0	4.49136899	2.074819858	7.849137139	3.161553644	6.477900584	0.009746997	0.015471396	6.752173112	8.271505933	15.87176554	0.325915293	0	4.457635802	17.80658421	6.484862313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3144
H4875_802_0	2010	5	N/A																															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	NO	168.0783709	1.032506013	27.11872694	10.16507063	3.243347418	0	17.86470565	7.954305417	32.68388723	13.06867093	27.05207565	0.032320392	0.066400842	27.92907945	35.49731013	58.93418575	1.135250634	0	18.06893307	67.53693254	26.94018278	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076678226	0.076678226	0.169378847	0	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												12.888	0.079170729	4.593338695	0	0.755699948	0	4.162476418	1.853353162	7.615345725	3.045000326	6.303133628	0.007530651	0.015471396	6.507475513	8.27087326	13.73166528	0.264513398	0	4.210061406	15.73610528	6.277062587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3162	146		12.888	0.079170729	4.593338695	0	0.755699948	0	4.162476418	1.853353162	7.615345725	3.045000326	6.303133628	0.007530651	0.015471396	6.507475513	8.27087326	13.73166528	0.264513398	0	4.210061406	15.73610528	6.277062587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3162	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				1.1644	0.0456	0.3193	0	0.4186	0	0.3289	0.2215	0.2338	0.1166	0.1748	0.0022	0	0.2447	0.0006	2.1401	0.0614	0	0.2476	2.0705	0.2078	0	0	0	0	0	0	0	0	0											7.9982			14.0523	0.124739	4.912604813	0	1.174275015	0	4.49136899	2.074819858	7.849137139	3.161553644	6.477900584	0.009746997	0.015471396	6.752173112	8.271505933	15.87176554	0.325915293	0	4.457635802	17.80658421	6.484862313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.3144
H4908_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	V	P	V	V	V	V	V	P	Coin	O	V	P	V	P	V	P	O	O																																																			0	NO	893.4896744	15.94301179	389.0404091	7246.225275	75.52715371	16.11240646	2.664444397	480.0042373	431.4698578	5834.5387	1259.279578	0	0	4770.192788	7046.006387	9979.923914	427.3566301	3809.034781	1579.888643	2770.036954	0.062442656	0	0	0	49.89799903	0	0	0	0	0												$100 for days 1-5	$100 for days 1-5	$60 for days 4-100	$0 	$50 per trip	0	10% Diabetic Supplies	"$50 per visit, $10 UC"	$0 	$0 	0	0	$10 per visit	$0 	$10 per office visit	$10 per office visit	$10 per visit	$10  per visit	0		10%				$10 per visit																64.84414681	43.0044636	45.45259775	0	40	0	0.05	30.7	0	0	13.63636364	0	0	0	9.5	5.31	10	10	0		0.2	0	0	0	10	0	0	0													NO	62.45650808	41.42098802	43.77897896	0	38.52715235	0	0.04815894	29.56958943	0	0	13.13425648	0	0	0	9.150198683	5.114479475	9.631788088	9.631788088	0	0	0.192635762	0	0	0	9.631788088	0	0	0	0	0												4.6504	0.055031275	1.41931599	0	0.24248718	0	0.128316819	1.182794019	0	0	1.378308414	0	0	0	5.37269653	4.253509668	0.343017375	3.057317986	0	0	0.012028689	0	0	0	0.040050579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.1352	0	0.846203702	4.6504	0.055031275	1.41931599	0	0.24248718	0	0.128316819	1.182794019	0	0	1.378308414	0	0	0	5.37269653	4.253509668	0.343017375	3.057317986	0	0	0.012028689	0	0	0	0.040050579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.1352	YES	$100 for days 1-5	$100 for days 1-5	$60 for days 4-100	$15 per visit	$50 per trip	0.2	20% / 15% Diab Supplies	"$50 per visit, $10 UC"	$250 per admit	$15 per visit	$15/$100 for MRI/CT/PET	$0 	$10 per visit	$0 	$15 per office visit	$15 per office visit	$15 per office visit	$15  per visit	$15 per visit	0	0.2	0	0	0	$10 per visit	0	0	0	0	0											3000	1.8654	0.0221	0	0	0	0	0	0.5705	0	1.342	0.7373	0	0	0	2.0517	1.6243	0.131	1.1675	0.7264	0	0	0	0	0	0	0	0	0	0	0											10.2381	0	0.391388641	6.5157	0.077105675	1.41931599	0	0.24248718	0	0.128316819	1.753325479	0	1.342005415	2.115593162	0	0	0	7.424356165	5.877787914	0.474004654	4.224809183	0.726367514	0	0.012028689	0	0	0	0.040050579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3733
H4908_002_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	V	P	V	V	V	V	V	P	Coin	O	V	P	V	P	V	P	O	O																																																			0	NO	1013.194232	27.66264297	533.2869873	7658.009767	97.70905947	22.17512343	3.355177423	606.02006	467.9141976	8121.122637	1760.060102	0	0	6228.980321	9005.088705	12463.9802	698.4381195	4226.035357	2042.625906	3074.055042	0.108343952	0	0	0	70.66666667	0	0	0	0	0												$100 for days 1-5	$100 for days 1-5	$60 for days 4-100	$0 	$50 per trip	0	10% Diabetic Supplies	"$50 per visit, $10 UC"	$0 	$0 	$50 for MRI/CT/PET	0	$10 per visit	$0 	$10 per office visit	$10 per office visit	$10 per visit	$10  per visit	0		10%				$10 per visit																64.84414681	43.0044636	45.45259775	0	40	0	0.05	30.7	0	0	13.63636364	0	0	0	9.5	5.31	10	10	0		0.2	0	0	0	10	0	0	0													NO	61.11490089	40.53123774	42.83857747	0	37.69956358	0	0.047124454	28.93441505	0	0	12.85212395	0	0	0	8.953646351	5.004617065	9.424890895	9.424890895	0	0	0.188497818	0	0	0	9.424890895	0	0	0	0	0												5.1601	0.09343343	1.903771327	0	0.306965742	0	0.158110906	1.461236329	0	0	1.885042549	0	0	0	6.719031635	5.198120668	0.548558589	3.31916018	0	0	0.020422599	0	0	0	0.055502135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8295	0	1.637140181	5.1601	0.09343343	1.903771327	0	0.306965742	0	0.158110906	1.461236329	0	0	1.885042549	0	0	0	6.719031635	5.198120668	0.548558589	3.31916018	0	0	0.020422599	0	0	0	0.055502135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.8295	YES	$100 for days 1-5	$100 for days 1-5	$60 for days 4-100	$15 per visit	$50 per trip	0.2	20% / 15% Diab Supplies	"$50 per visit, $10 UC"	$250 per admit	$15 per visit	$15/$100 for MRI/CT/PET	$0 	$10 per visit	$0 	$15 per office visit	$15 per office visit	$15 per office visit	$15  per visit	$15 per visit	0	0.2	0	0	0	$10 per visit	0	0	0	0	0											3000	2.0698	0.0375	0	0	0	0	0	0.7203	0	1.8679	1.0305	0	0	0	2.6221	2.0286	0.2141	1.2953	0.9391	0	0	0	0	0	0	0	0	0	0	0											12.8252	0	0.782598861	7.23	0.130911879	1.903771327	0	0.306965742	0	0.158110906	2.181549782	0	1.867943828	2.915524971	0	0	0	9.341137832	7.226690432	0.762633914	4.614464466	0.939114987	0	0.020422599	0	0	0	0.055502135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.6547
H4908_005_0	2010	5	N/A																															D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	V	V	V	Coin	Coin	P	Coin	O	V	P	V	P	V	P	O	O																																																			0	NO	608.0201843	14.08285503	271.492617	4988.876707	2.164729603	13.47170576	1.708096993	374.7308568	21.51699521	9.941710018	8.908573206	0	0	27.17760462	4685.865777	7852.95513	878.2238657	5.490553507	5.270123835	3918.135299	0.055157136	0	0	0	0	0	0	0	0	0												$200 for days 1-5	$200 for days 1-5	$120 for days 4-100	$0 	0.2	"20%, $25 Med cvrd Eyewear"	0.2	"$50 per visit, $10 UC"	0.2	0.2	0.2	0.2	0.2	0.2	"$10 per office visit, $30 Eye exams"	$10 per office visit	$10 per visit	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0											129.6882936	86.0089272	90.9051955	0	0.16	0.2	0.2	33.8	0.2	0.2	0.2	0	0	0.2	9.5	5.31	10	0.2	0.2		0.2	0	0	0	0	0	0	0													NO	119.1886362	79.04558265	83.54544556	0	0.147046285	0.183807856	0.183807856	31.06352772	0.183807856	0.183807856	0.183807856	0	0	0.183807856	8.730873174	4.880098585	9.190392815	0.183807856	0.183807856	0	0.183807856	0	0	0	0	0	0	0	0	0												6.0391	0.092765623	1.890164305	0	0.318315446	2.476205356	0.313961647	0.97003853	3.954992764	1.827364406	1.637465744	0	0	4.995457245	3.409308318	3.193599601	0.672601859	1.00920687	0.968690165	0	0.010138315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7794	0	2.975718148	6.0391	0.092765623	1.890164305	0	0.318315446	2.476205356	0.313961647	0.97003853	3.954992764	1.827364406	1.637465744	0	0	4.995457245	3.409308318	3.193599601	0.672601859	1.00920687	0.968690165	0	0.010138315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.7794	YES	$200 for days 1-5	$200 for days 1-5	$120 for days 4-100	$15 per visit	0.3	0.3	0.3	"$50 per visit, $10 UC"	0.3	0.3	0.3	0.3	0.2	0.3	0.3	0.3	0.3	0.3	0.3	0	0.3	0	0	0	0	0	0	0	0	0											3250	2.4224	0.0238	0	0	0	0	0	0.855	0.0001	0.0001	0	0	0	0	2.1155	1.303	0.0967	0	0.0001	0	0	0	0	0	0	0	0	0	0	0											6.8167	0	0.516396722	8.4615	0.116551244	1.890164305	0	0.318315446	2.476205356	0.313961647	1.825086652	3.955056691	1.827419278	1.637513735	0	0	4.995457245	5.524806476	4.496599015	0.76930301	1.009243237	0.968775836	0	0.010138315	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.5961
H4908_006_0	2010	6	N/A																															D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	V	Coin	V	V	V	Coin	Coin	P	Coin	O	V	P	V	P	V	P	O	O																																																			0	NO	1029.075174	9.281793021	252.8456274	4900.174436	2.403342099	15.04481074	1.729883336	653.3978586	23.02300288	11.9280254	10.43238629	0	0	32.92412524	7265.246768	8005.915884	315.4953539	5.932419926	9.316942139	3793.803086	0.03635322	0	0	0	0	0	0	0	0	0												$200 for days 1-6	$200 for days 1-6	$120 for days 4-100	$0 	0.2	"20%, $25 Med cvrd Eyewear"	0.2	"$50 per visit, $10 UC"	0.2	0.2	0.2	0.2	0.2	0.2	"$10 per office visit, $30 Eye exams"	$10 per office visit	$10 per visit	0.2	0.2	0	0.2	0	0	0	0	0	0	0	0	0											141.2016597	96.47529629	90.9051955	0	0.2	0.2	0.2	33.8	0.2	0.2	0.2	0	0	0.2	9.5	5.31	10	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0	0											NO	125.341059	85.63862369	80.69418938	0	0.177534824	0.177534824	0.177534824	30.00338524	0.177534824	0.177534824	0.177534824	0	0	0.177534824	8.432904136	4.713549575	8.876741196	0.177534824	0.177534824	0.177534824	0.177534824	0	0	0	0	0	0	0	0	0												10.7488	0.066239998	1.700264412	0	0.426676916	2.670977825	0.307114533	1.633678972	4.087384761	2.11763989	1.852111862	0	0	5.845178776	5.105594127	3.144690118	0.233380884	1.053211127	1.654081682	0.05612768	0.006453962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7096	0	5.40445196	10.7488	0.066239998	1.700264412	0	0.426676916	2.670977825	0.307114533	1.633678972	4.087384761	2.11763989	1.852111862	0	0	5.845178776	5.105594127	3.144690118	0.233380884	1.053211127	1.654081682	0.05612768	0.006453962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.7096	YES	$200 for days 1-6	$200 for days 1-6	$120 for days 4-100	$15 per visit	0.3	0.3	0.3	"$50 per visit, $10 UC"	0.3	0.3	0.3	0.3	0.2	0.3	0.3	0.3	0.3	0.3	0.3	0	0.3	0	0	0	0	0	0	0	0	0											3250	4.3116	0.0266	0	0	0	0	0	0.855	0.0001	0.0001	0	0	0	0	2.1155	1.303	0.0967	0	0.0001	0	0	0	0	0	0	0	0	0	0	0											8.7087	0	1.101995822	15.0604	0.092810493	1.700264412	0	0.426676916	2.670977825	0.307114533	2.488727095	4.087448688	2.117694761	1.852159854	0	0	5.845178776	7.221092285	4.447689531	0.330082035	1.053247493	1.654167353	0.05612768	0.006453962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.4183
H4909_001_0	2010	9	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13	I.14	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies\Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Partial Hosp	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	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	0	0	0	0	0	0	0	0	0	0	NO	1012.635142	81.83535702	219.9092238	829.5353745	50.24962016	9.324832717	0.576557365	261.886724	269.6777494	3589.113163	681.8184164	56.09234892	0.000228004	66.64942735	2955.617793	2875.063843	21.41780624	1228.000586	1826.653408	0	33.8542197	0	0	0	302.4	239.2	129.6	0	0	0	0.017013573	0.004569897	199.2069026	280.2640777	89.06006681	0.756849848	506.2638027	19.28602044	2.947689336	17.64875079		$220/day (days 1-10) w/$2200 yrly max	$220/day (days 1-10) w/$2200 yrly max	$128/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$175 copay	$0 copay	$50/$100 copay for Lower/Higher Tier	$175 copay	20% coinsurance	$30 copay	$15 coapy	$30 copay	$40 copay	$50/$30 OP/PR copay	$50/$100 copay for Lower/Higher Tier		20% coinsurance				$30 copay/ $50 limit	$30 copay/ $75 limit	$30 copay/ $50 limit		Silver Sneakers		$30 copay	$0 copay	$30 copay	$30 copay	$0 copay	20% coinsurance	$30 copay	$30 copay	$40 copay	20% coinsurance	220	220	128	0	100	0.2	0.2	50	175	0	70.77705953	175	0.2	30	15	30	40	39.99733505	54.55151057	0	0.2	0	0	0	30	30	30	0	0	0	30	0	30	30	0	0.2	30	30	40	0.2	NO	129.6649095	91.95724132	112.5431985	0	87.9243738	0.175848748	0.175848748	43.9621869	153.8676542	0	62.23028639	153.8676542	0.175848748	26.37731214	13.18865607	26.37731214	35.16974952	35.16740638	47.96407407	0	0.175848748	0	0	0	30	30	30	0	0	0	26.37731214	0	26.37731214	26.37731214	0	0.175848748	26.37731214	26.37731214	35.16974952	0.175848748		10.9419	0.627112806	2.062440618	0	0.368180532	1.639760155	0.101386891	0.959426092	3.457890224	0	3.535812943	0.719233179	4.01E-05	0.146502729	3.248385546	6.3197047	0.062771573	3.598799636	7.301144945	0	5.953222136	0	0	0	0.756	0.598	0.324	0	0	0	3.74E-05	0	0.437878554	0.616051088	0	0.133091098	1.112823196	0.042392782	0.008639125	3.103510722	58.1762		7.960025856	10.9419	0.627112806	2.062440618	0	0.368180532	1.639760155	0.101386891	0.959426092	3.457890224	0	3.535812943	0.719233179	4.01E-05	0.146502729	3.248385546	6.3197047	0.062771573	3.598799636	7.301144945	0	5.953222136	0	0	0	0.756	0.598	0.324	0	0	0	3.74E-05	0	0.437878554	0.616051088	0	0.133091098	1.112823196	0.042392782	0.008639125	3.103510722	58.1762	YES	$275/day (Days 1-10)	$275/day (Days 1-10)	30% Coinsurance	$0 copay	$100 copay	30% Coinsurance	30% Coinsurance	$50 copay	$250 copay	0% Coinsurance	30% Coinsurance	$250 copay	20% Coinsurance	$40 copay	$25 copay	$40 copay	$50 copay	$80/$40 OP/PR copay	30% Coinsurance		20% Coinsurance				$40 copay / $50 limit	$40 copay / $75 limit	$40 copay / $50 limit		Silver Sneakers		$40 copay	$0 copay	$40 copay	$40 copay	$0 copay	30% Coinsurance	$40 copay	$40 copay	$50 copay	20% coinsurance	3400	9.7143	0.8799	0.7607		0.4973	0.4407	0.0235	0.4799	2.4419		1.9629	0.2162	0.0008	0.1941	1.1039	0.8128	0.0213	1.3091	6.0238		1.092			0	0.252	0.1993	0.108	0			0.0009		0.594	0.1433		0.8135	0.1225	0.0504		1.1434	31.4021		4.242762135	20.6562	1.506980738	2.823145382	0	0.865442595	2.080446496	0.124917544	1.439278572	5.899821818	0	5.498682575	0.935401227	0.000801884	0.340652177	4.352236404	7.13245803	0.084077011	4.907871157	13.32497951	0	7.045188887	0	0	0	1.008	0.797333333	0.432	0	0	0	0.000984806	0	1.031915119	0.75930114	0	0.946606763	1.235287279	0.092798546	0.008639125	4.2468712	89.5783
H4909_004_0	2010	9	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	1097.399579	56.89533143	247.0656263	330.9352431	47.50182225	11.2099551	0.507365839	250.267326	260.996249	3836.136108	662.376847	67.53159756	0.000200642	60.50390834	3121.759009	3484.544295	57.57570061	1112.083782	1797.819729	0	47.43378055	0	0	745.9758882	302.4	239.2	129.6	0	0	0	0.014971807	0.004743357	151.8549908	271.0439062	100.8272026	0.685479126	494.4285709	23.47827082	9.657429149	0		$200/day (days 1-10) w/$2000 yrly max	$200/day (days 1-10) w/$2000 yrly max	$128/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$150 copay	$0 copay	$50/$100 copay for Lower/Higher Tier	$150 copay	20% coinsurance	$25 copay	$10 copay	$25 copay	$40 copay	$50/$25 OP/PR copay	$50/$100 copay for Lower/Higher Tier		20% coinsurance			$20 deduct 1 exam/1 cleaning	$25 copay; $75 yrly limit	$25 copay; $125 yrly limit	$25 copay; $75 yrly limit		Silver Sneakers		$25 copay	$0 copay	$25 copay	$25 copay	$0 copay	20% coinsurance	$25 copay	$25 copay	20% coinsurance		200	200	128	0	100	0.2	0.2	50	150	0	70.13539916	150	0.2	25	10	25	40	39.48283083	54.84019039	0	0.2	0	0	10	25	25	25	0	0	0	25	0	25	25	0	0.2	25	25	0.2	0	NO	109.4094002	107.8865594	112.6485622	0	88.00668919	0.176013378	0.176013378	44.0033446	132.0100338	0	61.72384275	132.0100338	0.176013378	22.0016723	8.800668919	22.0016723	35.20267568	34.74753222	48.26303591	0	0.176013378	0	0	10	25	25	25	0	0	0	22.0016723	0	22.0016723	22.0016723	0	0.176013378	22.0016723	22.0016723	0.176013378	0		10.0055	0.51152013	2.319298963	0	0.348373176	1.973102068	0.089303175	0.917716616	2.871176971	0	3.407037029	0.74290404	3.53E-05	0.110932264	2.289463957	6.388816808	0.16890156	3.220180586	7.23068651	0	8.348979964	0	0	0.621646573	0.63	0.498333333	0.27	0	0	0	2.75E-05	0	0.278421979	0.4969516	0	0.120653497	0.906521283	0.043046768	1.699836731	0	56.5094		7.591261584	10.0055	0.51152013	2.319298963	0	0.348373176	1.973102068	0.089303175	0.917716616	2.871176971	0	3.407037029	0.74290404	3.53E-05	0.110932264	2.289463957	6.388816808	0.16890156	3.220180586	7.23068651	0	8.348979964	0	0	0.621646573	0.63	0.498333333	0.27	0	0	0	2.75E-05	0	0.278421979	0.4969516	0	0.120653497	0.906521283	0.043046768	1.699836731	0	56.5094	YES	$250/day (days 1-10)	$250/day (days 1-10)	30% Coinsurance	$0 copay	$100 copay	30% Coinsurance	30% Coinsurance	$50 copay	$250 copay	$0 copay	30% Coinsurance	$250 copay	20% Coinsurance	$35 copay	$20 copay	$35 copay	$50 copay	$70/$35 copay	30% Coinsurance		20% Coinsurance			20% coinsurance	$35 copay; $75 yrly limit	$35 copay; $125 yrly limit	$35 copay; $75 yrly limit		Silver Sneakers		$35 copay	$0 copay	$35 copay	$35 copay	$0 copay	30% coinsurance	$35 copay	$35 copay	20% coinsurance		3350	9.1603	0.8447	1.2952		0.4302	0.4026	0.0207	0.3706	2.6663		2.0352	0.2457	0.0007	0.24	1.0305	0.6292	0.082	1.1465	7.2391		1.3407			0.6015	0.2205	0.1744	0.0945	0			0.0007		0.4491	0.1104		0.438	0.0998	0.0307	0.6795		32.0794		4.228603707	19.1658	1.356176109	3.614453135	0	0.778606058	2.375706911	0.110029347	1.28835894	5.537513544	0	5.442194539	0.988645969	0.000706312	0.35093494	3.31998099	7.017984064	0.250914054	4.366680732	14.46975155	0	9.689638251	0	0	1.223148305	0.8505	0.67275	0.3645	0	0	0	0.000757631	0	0.72754769	0.607356396	0	0.558682307	1.0063293	0.073724149	2.379334161	0	88.5887
H4909_007_0	2010	5	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13	I.14	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies\Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Partial Hosp	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	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	0	0	0	0	0	0	0	0	0	0	NO	1234.487318	77.0195651	394.8820699	533.2831342	85.02937569	11.48886123	1.070767191	281.8478865	367.6249554	4201.862375	808.5200491	83.54388609	0	118.2675604	3147.310005	3325.814911	39.53004845	1387.594072	2091.141907	0	48.33536327	0	0	1101.053247	302.4	239.2	129.6	0	0	0	0	0.005389602	228.3725293	363.4743049	102.216794	0.906789711	592.9236724	24.93294571	5.519317369	12.52814133		$240/day (days 1-10) w/$2400 yrly max	$240/day (days 1-10) w/$2400 yrly max	$128/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$100 copay	$0 copay	$50/$100 copay for Lower/Higher Tier	$100 copay	20% coinsurance	$25 copay	$15 coapy	$25 copay	$40 copay	$50/$25 copay	$50/$100 copay for Lower/Higher Tier		20% coinsurance			$0 deduct 1 exam & 2 cleanings/yr	$25 copay/ $50 limit	$25 copay/ $100 limit	$25 copay/ $50 limit		Silver Sneakers		$25 copay	$0 copay	$25 copay	$25 copay	$0 copay	20% coinsurance	$25 copay	$30 copay	$40 copay	20% coinsurance	240	240	128	0	100	0.2	0.2	50	100	0	68.03638813	100	0.2	25	15	25	40	41.85971643	55.34066336	0	0.2	0	0	0	25	25	25	0	0	0	25	0	25	25	0	0.2	25	30	40	0.2	NO	143.2698034	125.9906059	112.1206171	0	87.5942321	0.175188464	0.175188464	43.79711605	87.5942321	0	59.59595173	87.5942321	0	21.89855803	13.13913482	21.89855803	35.03769284	36.66669716	48.47522911	0	0.175188464	0	0	0	25	25	25	0	0	0	0	0	21.89855803	21.89855803	0	0.175188464	21.89855803	26.27826963	35.03769284	0.175188464		14.7387	0.808645139	3.689535113	0	0.620673572	2.012715955	0.18758606	1.02867705	2.683485472	0	4.015376818	0.609830212	0	0.215824086	3.446077539	6.069212568	0.115420141	4.239874301	8.447381919	0	8.467798059	0	0	0	0.63	0.498333333	0.27	0	0	0	0	0	0.416752424	0.66329693	0	0.158859097	1.082014454	0.054599556	0.016115346	2.19478584	67.3816		9.516350871	14.7387	0.808645139	3.689535113	0	0.620673572	2.012715955	0.18758606	1.02867705	2.683485472	0	4.015376818	0.609830212	0	0.215824086	3.446077539	6.069212568	0.115420141	4.239874301	8.447381919	0	8.467798059	0	0	0	0.63	0.498333333	0.27	0	0	0	0	0	0.416752424	0.66329693	0	0.158859097	1.082014454	0.054599556	0.016115346	2.19478584	67.3816	YES	$300/day (Days 1-10)	$300/day (Days 1-10)	30% Coinsurance	$0 copay	$100 copay	30% Coinsurance	30% Coinsurance	$50 copay	$225 copay	$0 copay	30% Coinsurance	$225 copay	20% Coinsurance	$35 copay	$25 copay	$35 copay	$50 copay	$70/$35 OP/PR copay	30% Coinsurance		20% Coinsurance			20% Coinsurance	$35 copay / $50 limit	$35 copay / $100 limit	$35 copay / $50 limit		Silver Sneakers		$35 copay	$0 copay	$35 copay	$35 copay	$0 copay	30% Coinsurance	$40 copay	$40 copay	$50 copay	20% coinsurance	3350	6.0685	0.3791	1.2031		0.9591	0.8485	0.0462	0.25	1.2374		1.3796	0.2708	0.0015	0.0971	1.3515	1.3964	0.0418	1.0748	4.1022		1.1462			0.4409	0.2205	0.1744	0.0945	0			0.0016		0.691	0.2461		0.426	0.2266	0.0297		0.4204	24.8255		3.392135675	20.8072	1.187697548	4.892657673	0	1.579775536	2.861166028	0.233790134	1.278655116	3.920876899	0	5.395016734	0.880591339	0.001495827	0.312879524	4.797616459	7.465623011	0.157254849	5.314676296	12.54957934	0	9.614031674	0	0	0.440890688	0.8505	0.67275	0.3645	0	0	0	0.001627764	0	1.107711919	0.909418183	0	0.584813913	1.308635866	0.084348151	0.016115346	2.615186356	92.2071
H4909_804_0	2010	7	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	204.741836	2.344158084	38.75783558	26.79101111	6.221865107	11.00397024	2.720703279	7.932997673	28.31800211	4.258251099	18.72810794	0	0.044519044	16.42988787	31.20782856	76.8399175	1.012861002	3.986973885	16.69653171	25.66225391	6.356306287	1.112749379	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.083459442	0.083459442	0.179852475	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083459442	0.083459442	0.179852475	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.0876	0.195642125	6.97069265	0	1.44969457	2.563925065	0.633923864	1.848388458	6.598094491	0.992172506	4.363649149	0	0.010372937	3.828163873	7.271424054	17.90370078	0.235996613	0.928964915	3.890291888	5.979305162	1.481019365	0.259270605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4923	0	0	17.0876	0.195642125	6.97069265	0	1.44969457	2.563925065	0.633923864	1.848388458	6.598094491	0.992172506	4.363649149	0	0.010372937	3.828163873	7.271424054	17.90370078	0.235996613	0.928964915	3.890291888	5.979305162	1.481019365	0.259270605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4923	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.3382	0.084	3.2084	0	0.6329	1.1183	0.2765	0.7186	3.0446	0.4673	1.4516	0	0.0045	1.7825	3.0915	7.6892	0.1017	0.4015	2.2405	2.6702	0.5708	0.0996	0	0	0	0	0	0	0	0											36.9925	0	0	24.4259	0.279660078	10.17913737	0	2.082601314	3.682274922	0.910432984	2.567025775	9.642645781	1.459452363	5.815213111	0	0.014871796	5.610638443	10.36295717	25.59289884	0.337699027	1.330481248	6.130768388	8.649496466	2.051793476	0.35891773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.4848
H4909_805_0	2010	6	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	204.741836	2.344158084	38.75783558	26.79101111	6.221865107	11.00397024	2.720703279	7.932997673	28.31800211	4.258251099	18.72810794	0	0.044519044	16.42988787	31.20782856	76.8399175	1.012861002	3.986973885	16.69653171	25.66225391	6.356306287	1.112749379	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.083459442	0.083459442	0.179852475	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083459442	0.083459442	0.179852475	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.0876	0.195642125	6.97069265	0	1.44969457	2.563925065	0.633923864	1.848388458	6.598094491	0.992172506	4.363649149	0	0.010372937	3.828163873	7.271424054	17.90370078	0.235996613	0.928964915	3.890291888	5.979305162	1.481019365	0.259270605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4923	0	0	17.0876	0.195642125	6.97069265	0	1.44969457	2.563925065	0.633923864	1.848388458	6.598094491	0.992172506	4.363649149	0	0.010372937	3.828163873	7.271424054	17.90370078	0.235996613	0.928964915	3.890291888	5.979305162	1.481019365	0.259270605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4923	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.3382	0.084	3.2084	0	0.6329	1.1183	0.2765	0.7186	3.0446	0.4673	1.4516	0	0.0045	1.7825	3.0915	7.6892	0.1017	0.4015	2.2405	2.6702	0.5708	0.0996	0	0	0	0	0	0	0	0											36.9925	0	0	24.4259	0.279660078	10.17913737	0	2.082601314	3.682274922	0.910432984	2.567025775	9.642645781	1.459452363	5.815213111	0	0.014871796	5.610638443	10.36295717	25.59289884	0.337699027	1.330481248	6.130768388	8.649496466	2.051793476	0.35891773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.4848
H4909_806_0	2010	6	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	204.741836	2.344158084	38.75783558	26.79101111	6.221865107	11.00397024	2.720703279	7.932997673	28.31800211	4.258251099	18.72810794	0	0.044519044	16.42988787	31.20782856	76.8399175	1.012861002	3.986973885	16.69653171	25.66225391	6.356306287	1.112749379	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.083459442	0.083459442	0.179852475	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083459442	0.083459442	0.179852475	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.0876	0.195642125	6.97069265	0	1.44969457	2.563925065	0.633923864	1.848388458	6.598094491	0.992172506	4.363649149	0	0.010372937	3.828163873	7.271424054	17.90370078	0.235996613	0.928964915	3.890291888	5.979305162	1.481019365	0.259270605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4923	0	0	17.0876	0.195642125	6.97069265	0	1.44969457	2.563925065	0.633923864	1.848388458	6.598094491	0.992172506	4.363649149	0	0.010372937	3.828163873	7.271424054	17.90370078	0.235996613	0.928964915	3.890291888	5.979305162	1.481019365	0.259270605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4923	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.3382	0.084	3.2084	0	0.6329	1.1183	0.2765	0.7186	3.0446	0.4673	1.4516	0	0.0045	1.7825	3.0915	7.6892	0.1017	0.4015	2.2405	2.6702	0.5708	0.0996	0	0	0	0	0	0	0	0											36.9925	0	0	24.4259	0.279660078	10.17913737	0	2.082601314	3.682274922	0.910432984	2.567025775	9.642645781	1.459452363	5.815213111	0	0.014871796	5.610638443	10.36295717	25.59289884	0.337699027	1.330481248	6.130768388	8.649496466	2.051793476	0.35891773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.4848
H4910_004_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1738.256114	78.10164986	1047.729746	673.7161899	235.9415028	10.55802712	0	258.9760251	404.9539873	2166.46845	2739.393801	41.93406998	0.271137904	7.188922756	4418.395913	5453.337829	179.3475469	570.1142026	0	0	282.8740469	0	0	0	849.671103	0	60.78647606	0	194.4288887	0												$225/day 1-7	$225/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$125 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$0 per visit	$40 X-ray; $150 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$25 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											162.6423925	162.6423925	47.8866492	0	125	0.2	0.2	48.5	200	0	42	40	25	40	25	40	40	40	40	40	45	0	0	0	0	0	0	0	0	0											NO	162.6423925	162.6423925	47.8866492	0	125	0.2	0.2	48.5	200	0	42	40	25	40	25	40	40	40	40	40	45	0	0	0	0	0	0	0	0	0												23.5595	1.058553266	4.181022235	0	2.457723987	2.111605424	0	1.046694768	6.749233122	0	9.587878305	0.139780233	0.000564871	0.023963076	9.204991486	18.17779276	0.597825156	1.900380675	0	0	1.060777676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8583	0	0	23.5595	1.058553266	4.181022235	0	2.457723987	2.111605424	0	1.046694768	6.749233122	0	9.587878305	0.139780233	0.000564871	0.023963076	9.204991486	18.17779276	0.597825156	1.900380675	0	0	1.060777676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8583	NO																																																																																		0			23.5595	1.058553266	4.181022235	0	2.457723987	2.111605424	0	1.046694768	6.749233122	0	9.587878305	0.139780233	0.000564871	0.023963076	9.204991486	18.17779276	0.597825156	1.900380675	0	0	1.060777676	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.8583
H4910_005_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1563.11034	72.66260529	1094.211406	1530.151978	207.7996483	14.15767434	0	228.2588527	404.5602801	2236.024984	2782.946086	40.82090736	0.263940401	101.3232587	4389.413224	5568.96755	208.4055057	707.4755617	0	0	283.3286646	0	0	0	902.0125441	0	51.11302043	0	176.8689599	0												$150/day 1-10	$150/day 1-10	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$0 per visit	$35 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											122.9471107	122.9471107	47.8866492	0	100	0.2	0.2	48.5	200	0	40.5	35	25	35	20	35	35	35	35	35	45	0	0	0	0	0	0	0	0	0											NO	122.9471107	122.9471107	47.8866492	0	100	0.2	0.2	48.5	200	0	40.5	35	25	35	20	35	35	35	35	35	45	0	0	0	0	0	0	0	0	0												16.015	0.744471448	4.366509814	0	1.731663736	2.831534868	0	0.922546196	6.742671334	0	9.392443039	0.11906098	0.000549876	0.295526171	7.315688707	16.24282202	0.607849392	2.063470388	0	0	1.062482492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4543	0	0	16.015	0.744471448	4.366509814	0	1.731663736	2.831534868	0	0.922546196	6.742671334	0	9.392443039	0.11906098	0.000549876	0.295526171	7.315688707	16.24282202	0.607849392	2.063470388	0	0	1.062482492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4543	NO																																																																																		0			16.015	0.744471448	4.366509814	0	1.731663736	2.831534868	0	0.922546196	6.742671334	0	9.392443039	0.11906098	0.000549876	0.295526171	7.315688707	16.24282202	0.607849392	2.063470388	0	0	1.062482492	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4543
H4910_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	324.3776861	4.984796491	43.4416765	6.732818065	8.61332527	10.87486259	0	10.86905634	37.16510614	12.86027684	56.51356328	0.754274591	0.014349572	24.77673745	19.68135629	124.0545973	2.388057478	6.159494945	0	-9.74E-09	64.57196477	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.066973886	0.066973886	0.14528928	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.066973886	0.066973886	0.14528928	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.7248	0.333851194	6.311609903	0	2.006904788	2.533842983	0	2.532490127	8.65946973	2.996444505	13.16766024	0.17574598	0.00334345	5.772979826	4.585756017	28.90472117	0.556417392	1.435162322	0	-2.27E-09	15.04526779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7465			21.7248	0.333851194	6.311609903	0	2.006904788	2.533842983	0	2.532490127	8.65946973	2.996444505	13.16766024	0.17574598	0.00334345	5.772979826	4.585756017	28.90472117	0.556417392	1.435162322	0	-2.27E-09	15.04526779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7465	NO																																																																																		0			21.7248	0.333851194	6.311609903	0	2.006904788	2.533842983	0	2.532490127	8.65946973	2.996444505	13.16766024	0.17574598	0.00334345	5.772979826	4.585756017	28.90472117	0.556417392	1.435162322	0	-2.27E-09	15.04526779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.7465
H4910_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	366.6477448	5.634371507	49.10261526	7.610179941	9.735738372	12.29197942	0	12.28541655	42.00813723	14.53611547	63.87791583	0.852565049	0.016219482	28.00542485	22.24605825	140.2203058	2.699248211	6.962146373	0	-1.10E-08	72.98641761	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.066973886	0.066973886	0.14528928	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.066973886	0.066973886	0.14528928	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.5558	0.377355757	7.13408362	0	2.268427041	2.864031206	0	2.862502057	9.787895974	3.386914906	14.88355439	0.198647656	0.003779139	6.525263989	5.183331573	32.67133124	0.628924833	1.622180105	0	-2.57E-09	17.0058353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.9599			24.5558	0.377355757	7.13408362	0	2.268427041	2.864031206	0	2.862502057	9.787895974	3.386914906	14.88355439	0.198647656	0.003779139	6.525263989	5.183331573	32.67133124	0.628924833	1.622180105	0	-2.57E-09	17.0058353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.9599	NO																																																																																		0			24.5558	0.377355757	7.13408362	0	2.268427041	2.864031206	0	2.862502057	9.787895974	3.386914906	14.88355439	0.198647656	0.003779139	6.525263989	5.183331573	32.67133124	0.628924833	1.622180105	0	-2.57E-09	17.0058353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.9599
H4917_001_0	2010	8	N/A		e.2.			h.2.							DME/Prosthetics/Supplies			OP Facility - Other							Diabetic supplies			MRI/PET/CAT						D	D	D		T	Coin	Coin	V	V	V	V		Coin	V	V	V	V	V			Coin				V							Coin			Coin																																														0	NO	2054.453353	138.8456414	1649.703297		313.514899	30.38191971	2.749007609	298.8657804	263.8634741	2605.111248	1645.044801		0	5603.274054	4444.573851	5911.127555	458.9215969	1411.674444			19.54262171				541.6277603							5.950745016			8.764327583							$250 Days 1-5	$350 Days 1-5	"$50 days 11-20, $124 days 21-100"		$100 waived if admitted	30%	"20% to 30%, varies by service"	"$50 ER, $10 UC / waived if admitted"	"$225 Surgery, $150 ASC"	$20 to $40 varies by service	$0 to $30 or 20% / varies by service		20%	$0 to $50 varies by service	$15 	$40 / $0 for preventive	"$75 Individual, $60 Group"	$40 			20%				$15 							20%			20%						162.110367	32.2533477	25.92798905		80	0.3	0.273064855	30.7	187.5	25.83	15.64363636		0.2	8.5	9.875	33.4	75	40			0.2				15							0.2			0.2						NO	137.4093415	27.33885161	21.97729835		67.8102673	0.254288502	0.23145751	26.02219008	158.930314	21.89424005	13.25998954		0.169525668	7.204840901	8.37032987	28.3107866	63.57212559	33.90513365			0.169525668				12.71442512							0.169525668			0.169525668							23.5251	0.316323366	3.021335129	0	1.771627425	7.725772862	0.636278456	0.648095179	3.494658732	4.753077587	1.817773071	0	0	3.36422484	3.100212438	13.94572256	2.43121845	3.988584225	0	0	3.312976005	0	0	0	0.5738738	0	0	0	0	0	0	1.008804025	0	0	1.48577849	0	0	0	0	0	80.9214	0	14.55	23.5251	0.316323366	3.021335129	0	1.771627425	7.725772862	0.636278456	0.648095179	3.494658732	4.753077587	1.817773071	0	0	3.36422484	3.100212438	13.94572256	2.43121845	3.988584225	0	0	3.312976005	0	0	0	0.5738738	0	0	0	0	0	0	1.008804025	0	0	1.48577849	0	0	0	0	0	80.9214	YES																																									3400																																									0	0	0	23.5251	0.316323366	3.021335129	0	1.771627425	7.725772862	0.636278456	0.648095179	3.494658732	4.753077587	1.817773071	0	0	3.36422484	3.100212438	13.94572256	2.43121845	3.988584225	0	0	3.312976005	0	0	0	0.5738738	0	0	0	0	0	0	1.008804025	0	0	1.48577849	0	0	0	0	0	80.9214
H4917_002_0	2010	7	N/A		e.2.			h.2.							DME/Prosthetics/Supplies			OP Facility - Other							Diabetic supplies			MRI/PET/CAT						D	D	D		T	Coin	Coin	V	V		V		Coin	V	V	V	V	V			Coin				V							Coin			V																																														0	NO	2054.389602	138.841333	1649.652106		313.5186293	30.3822812	2.749040317	298.8693364	263.8666136		1645.064374		0	5603.340724	4444.626734	5911.197888	458.9270573	1411.691241			19.54285424				541.6277603							5.95081582			352.4240968							$175 Days 1-7	$300 Days 1-5	"$50 days 11-20, $124 days 21-100"		$100 waived if admitted	25%	"20% to 25%, varies by service"	"$50 ER, $10 UC / waived if admitted"	"$85 Surgery, $75 ASC"		"$20 to $60, or 20% varies by service"		20%	$0 to $50 varies by service	$5 	$30 / $0 for preventive	$50 	$30 			20%				$10 							20%			$60 						131.4623006	32.2533477	25.92798905		80	0.25	0.236532427	30.7	80		47.27272727		0.2	8	5	25.2	50	30			0.2				10							0.2			60						NO	115.8092226	28.41297547	22.84077063		70.47448405	0.220232763	0.20836876	27.04458325	70.47448405		41.6440133		0.17618621	7.047448405	4.404655253	22.19946248	44.04655253	26.42793152			0.17618621				8.809310506							0.17618621			52.85586304							19.8264	0.328741282	3.139943781	0	1.841255303	6.691173725	0.572814122	0.673566388	1.549655288	0	5.708923557	0	0	3.290771221	1.631420708	10.93545131	1.684512895	3.10900662	0	0	3.443181423	0	0	0	0.397613927	0	0	0	0	0	0	1.048451687	0	0	1.552306649	0	0	0	0	0	67.4252	0	9.113370571	19.8264	0.328741282	3.139943781	0	1.841255303	6.691173725	0.572814122	0.673566388	1.549655288	0	5.708923557	0	0	3.290771221	1.631420708	10.93545131	1.684512895	3.10900662	0	0	3.443181423	0	0	0	0.397613927	0	0	0	0	0	0	1.048451687	0	0	1.552306649	0	0	0	0	0	67.4252	YES																																									3400																																									0	0	0	19.8264	0.328741282	3.139943781	0	1.841255303	6.691173725	0.572814122	0.673566388	1.549655288	0	5.708923557	0	0	3.290771221	1.631420708	10.93545131	1.684512895	3.10900662	0	0	3.443181423	0	0	0	0.397613927	0	0	0	0	0	0	1.048451687	0	0	1.552306649	0	0	0	0	0	67.4252
H4917_003_0	2010	6	N/A		e.2.			h.2.							DME/Prosthetics/Supplies			OP Facility - Other							Diabetic supplies			MRI/PET/CAT						D	D		V	T	Coin	Coin	V	Coin	V	V		Coin		V	V	V	V			Coin				V							Coin			V																																														0	NO	2042.474312	138.0360647		2713.55936	314.22	30.45003972	2.755171223	299.5358743	23.92239625	2610.952229	1648.733194		0		4454.539133	5924.381032	459.9505557	1414.839592			19.58643868				541.6277603							5.96408732			353.2100725							$75 Days 1-3	$75 Days 1-3		$5 	"$50, waived if admitted"	25%	"20% to 25%, varies by service"	$5 Copay	"$5 or 20%, varies by service"	$5 	"$5 or 20%, varies by service"		20%		$5 	$10 / $0 for preventive	$5 	$5 			20%				$10 							20%			$60 						35.89800192	22.23333846		5	40	0.25	0.236532427	28	0.105	5	11.36363636		0.2		4.75	8	5	5			0.2				10							0.2			5						NO	34.67938661	21.47859209		4.830266973	38.64213578	0.241513349	0.228502954	27.04949505	0.101435606	4.830266973	10.97787948		0.193210679		4.588753624	7.728427156	4.830266973	4.830266973		0	0.193210679				9.660533945							0.193210679			4.830266973							5.9026	0.247068361	0	1.092268013	1.011844325	7.354091058	0.629564764	0.675191179	2.426582771	1.05096636	1.508299525	0	0	0	1.703398549	3.815512271	0.185140332	0.569504413	0	0	3.784309115	0	0	0	0.436034447	0	0	0	0	0	0	1.15232536	0	0	0.142174912	0	0	0	0	0	33.6869	0	1.18	5.9026	0.247068361	0	1.092268013	1.011844325	7.354091058	0.629564764	0.675191179	2.426582771	1.05096636	1.508299525	0	0	0	1.703398549	3.815512271	0.185140332	0.569504413	0	0	3.784309115	0	0	0	0.436034447	0	0	0	0	0	0	1.15232536	0	0	0.142174912	0	0	0	0	0	33.6869	YES																																									3400																																									0	0	0	5.9026	0.247068361	0	1.092268013	1.011844325	7.354091058	0.629564764	0.675191179	2.426582771	1.05096636	1.508299525	0	0	0	1.703398549	3.815512271	0.185140332	0.569504413	0	0	3.784309115	0	0	0	0.436034447	0	0	0	0	0	0	1.15232536	0	0	0.142174912	0	0	0	0	0	33.6869
H4956_001_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	996.157617	55.898191	374.140978	223.375156	36.663138	8.36599	3.691587	304.986773	362.329928	686.960681	891.999902	66.977594	12.0498	513.436177	3528.068778	4531.329809	70.901344	867.677973			27.030251	0							0.04	0.25	0.05	0.55	1.61	0.32	0.4	0.42					3900	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$10-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $30 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$10/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					137.58966	121.67922	58.254672	0	100	0.2	0.2	50	175	48.853712	70.085961	50	5.007513	58.576118	10	30	30	10			0.2	0							0	0	0	0	0	0	0	0					NO	122.981491	108.760294	39.093545	0	87.0071	0.174014	0.174014	43.50355	152.262425	42.506198	60.979762	43.50355	4.356891	50.965381	8.70071	26.10213	26.10213	8.70071			0.174014	0							0	0	0	0	0	0	0	0						10.2091	0.506625307	1.218874763	0	0.265829443	1.455799384	0.64238782	1.105667277	4.597436124	2.43334056	4.532828477	0.242813592	0.004374972	2.180622532	2.558058608	9.856446646	0.154223008	0.629117868	0	0	4.703642098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2972	0	7.151007	10.2091	0.506625307	1.218874763	0	0.265829443	1.455799384	0.64238782	1.105667277	4.597436124	2.43334056	4.532828477	0.242813592	0.004374972	2.180622532	2.558058608	9.856446646	0.154223008	0.629117868	0	0	4.703642098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2972	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					7000	7.761	0.1348	0.3093	1.2384	0.8681	1.5673	0.6916	0.1593	2.7125	0.302	1.2346	0.2096	0.0006	0.5471	1.636	2.893	0.0244	0.3136			0.9701	0							0	0	0	0	0	0	0	0					23.5734	0	12.150279	17.97	0.641399307	1.528206763	1.238434	1.133933443	3.023093384	1.33397382	1.264963277	7.309978124	2.73534256	5.767386477	0.452457592	0.005004972	2.727737532	4.194034608	12.74947265	0.178632008	0.942737868	0	0	5.673726098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8706
H4956_002_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	986.245042	55.341959	370.417972	221.152392	36.29831	7.384107	3.258319	301.951908	358.724451	680.124866	883.12378	66.311113	11.929895	508.327071	3492.961637	4486.239408	70.195818	859.043875			23.857817	0							0.04	0.25	0.05	0.55	1.61	0.32	0.4	0.42					3900	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$10-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$10/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					137.58966	121.67922	58.254672	0	100	0.2	0.2	50	150	48.853712	70.085961	50	5.007511	60.111526	10	35	35	10			0.2	0							0	0	0	0	0	0	0	0					NO	123.105184	108.869683	39.278387	0	87.0574	0.174115	0.174115	43.5287	130.5861	42.530771	61.015015	43.5287	4.359408	52.331531	8.70574	30.47009	30.47009	8.70574			0.174115	0							0	0	0	0	0	0	0	0						10.1177	0.502088461	1.212451705	0	0.263336374	1.28568379	0.567322213	1.095297835	3.903702253	2.410519577	4.490317557	0.240536379	0.00433394	2.21679449	2.534067987	11.39134321	0.178239408	0.623217719	0	0	4.154003807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1909	0	7.091964	10.1177	0.502088461	1.212451705	0	0.263336374	1.28568379	0.567322213	1.095297835	3.903702253	2.410519577	4.490317557	0.240536379	0.00433394	2.21679449	2.534067987	11.39134321	0.178239408	0.623217719	0	0	4.154003807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.1909	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					7000	7.4878	0.13	0.3174	1.1382	0.8949	1.4404	0.6356	0.1642	2.493	0.2776	1.1346	0.1927	0.0006	0.5028	1.5035	2.6588	0.0224	0.2882			0.8916	0							0	0	0	0	0	0	0	0					22.1745	0	9.511915	17.6054	0.632118461	1.529808705	1.138187	1.158265374	2.72610979	1.202926213	1.259516835	6.396673253	2.688075577	5.624941557	0.433210379	0.00498394	2.71962249	4.037616987	14.05018821	0.200672408	0.911450719	0	0	5.045562807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.3654
H4956_003_0	2010	3	N/A	r.	s.	t.			w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)			Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	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	YES	1021.650695	57.328705	383.715773	229.091641	37.6014	7.231356	3.190918	312.791815	371.602461	704.540974	914.827437	68.691645	12.358172	526.575732	3618.357034	4647.29293	72.71581	889.883076			23.364287	0							0.04	0.25	0.05	0.55	1.61			0.42					3400	$175/Day(Days 1-5):1a	$175/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$10-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$10/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a			$0: Nutritional benefit 14a					106.167425	88.6746	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	5.007512	60.111526	10	35	35	10			0.2	0							0	0	0	0	0			0					NO	93.267658	77.900281	36.247805	0	85.4806	0.170961	0.170961	42.7403	106.85075	41.760446	59.9099	42.7403	4.280452	51.383693	8.54806	29.91821	29.91821	8.54806			0.170961	0							0	0	0	0	0			0						7.9406	0.372160186	1.15907121	0	0.267849186	1.236279853	0.545522532	1.114068001	3.308833472	2.451828775	4.567268356	0.24465846	0.004408214	2.254783813	2.577494419	11.58655715	0.181293906	0.633897827	0	0	3.99438187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4409	0	7.793148	7.9406	0.372160186	1.15907121	0	0.267849186	1.236279853	0.545522532	1.114068001	3.308833472	2.451828775	4.567268356	0.24465846	0.004408214	2.254783813	2.577494419	11.58655715	0.181293906	0.633897827	0	0	3.99438187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4409	YES	20% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a			$0: Nutritional benefit 14a					6000	5.2408	0.1365	0.3122	1.1285	0.9386	1.4281	0.6302	0.1722	2.4717	0.2752	1.1249	0.191	0.0007	0.4985	1.4907	2.6362	0.0222	0.2858			0.884	0							0	0	0	0	0			0					19.8681	0	7.546156	13.1814	0.508674186	1.47130821	1.128478	1.206413186	2.664418853	1.175705532	1.286293001	5.780538472	2.727016775	5.692214356	0.43568846	0.005089214	2.753322813	4.068218419	14.22272115	0.203534906	0.919671827	0	0	4.87833587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.309
H4956_004_0	2010	3	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1005.465676	56.420502	377.636937	225.462364	37.005717	6.66224	2.939789	307.836558	365.715524	693.379616	900.334716	67.60343	12.162393	518.233705	3561.034918	4573.670382	71.563844	875.785523			21.52549	0							0.04	0.25	0.05	0.55	1.61	0.32	0.4	0.42					3400	$175/Day(Days 1-5):1a	$175/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$10-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$10/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					106.167425	88.6746	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	5.00751	60.111526	10	35	35	10			0.2	0							0	0	0	0	0	0	0	0					NO	93.77758	78.326186	36.81002	0	85.8714	0.171743	0.171743	42.9357	107.33925	41.951366	60.183796	42.9357	4.300019	51.618609	8.58714	30.05499	30.05499	8.58714			0.171743	0							0	0	0	0	0	0	0	0						7.8575	0.368266894	1.158401934	0	0.264811061	1.144193084	0.504888182	1.101431509	3.271302505	2.424018504	4.515463407	0.241883382	0.00435821	2.229208582	2.548258782	11.4551348	0.179237551	0.626707741	0	0	3.696852229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5919	0	7.389911	7.8575	0.368266894	1.158401934	0	0.264811061	1.144193084	0.504888182	1.101431509	3.271302505	2.424018504	4.515463407	0.241883382	0.00435821	2.229208582	2.548258782	11.4551348	0.179237551	0.626707741	0	0	3.696852229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5919	YES	20% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					6000	5.0595	0.1318	0.3163	1.0664	0.9474	1.3495	0.5955	0.1738	2.3356	0.26	1.063	0.1805	0.0007	0.4711	1.4087	2.491	0.021	0.27			0.8353	0							0	0	0	0	0	0	0	0					18.9773	0	6.372733	12.917	0.500058894	1.474741934	1.066353	1.212217061	2.493710084	1.100378182	1.275279509	5.606935505	2.684056504	5.578479407	0.422397382	0.00504621	2.700301582	3.956914782	13.9461738	0.200254551	0.896749741	0	0	4.532142229	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.5692
H4956_801_0	2010	4	N/A																															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	NO	243.92729	0.832062	42.352758	13.685684	1.604931	7.420986	3.627471	17.892154	50.94653	10.99874	26.221836	9.269574	0.814391	16.783072	31.147267	68.309096	0.328257	5.08336			22.202092	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																			0.085023236	0.085023236	0.187648979	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.085023236	0.085023236	0.187648979	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.7395	0.070744604	7.947451809	0	0.373948923	1.729089738	0.845200743	4.168871882	11.87054149	2.56270642	6.109687788	2.159810742	0.189753103	3.910455776	7.257313211	15.91601937	0.076483881	1.18442288	0	0	5.173087436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2851	0	0	20.7395	0.070744604	7.947451809	0	0.373948923	1.729089738	0.845200743	4.168871882	11.87054149	2.56270642	6.109687788	2.159810742	0.189753103	3.910455776	7.257313211	15.91601937	0.076483881	1.18442288	0	0	5.173087436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2851	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.8607	0.0132	1.4794	0	1.4957	1.1401	0.5572	1.0992	2.8604	0.6757	1.4649	0.5695	0.05	1.0235	1.3674	2.9988	0.0144	0.2543			0.9748	0																			21.8991	0	0	24.6002	0.083923206	9.426876362	0	1.869692423	2.869158738	1.402420243	5.268049382	14.73096599	3.23840642	7.574558788	2.729262742	0.239731603	4.933908276	8.624673711	18.91484587	0.090929881	1.43874238	0	0	6.147842936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.1842
H4956_802_0	2010	3	N/A																															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	NO	243.92729	0.832062	42.352758	13.685684	1.604931	7.420986	3.627471	17.892154	50.94653	10.99874	26.221836	9.269574	0.814391	16.783072	31.147267	68.309096	0.328257	5.08336			22.202092	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																			0.085022877	0.085022877	0.187646185	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.085022877	0.085022877	0.187646185	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.7394	0.070744305	7.947333443	0	0.373948923	1.729089738	0.845200743	4.168871882	11.87054149	2.56270642	6.109687788	2.159810742	0.189753103	3.910455776	7.257313211	15.91601937	0.076483881	1.18442288	0	0	5.173087436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2849	0	0	20.7394	0.070744305	7.947333443	0	0.373948923	1.729089738	0.845200743	4.168871882	11.87054149	2.56270642	6.109687788	2.159810742	0.189753103	3.910455776	7.257313211	15.91601937	0.076483881	1.18442288	0	0	5.173087436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2849	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.8607	0.0132	1.4794	0	1.4957	1.1401	0.5572	1.0992	2.8604	0.6757	1.4649	0.5695	0.05	1.0235	1.3674	2.9988	0.0144	0.2543			0.9748	0																			21.8991	0	0	24.6001	0.083922851	9.426735962	0	1.869692423	2.869158738	1.402420243	5.268049382	14.73096599	3.23840642	7.574558788	2.729262742	0.239731603	4.933908276	8.624673711	18.91484587	0.090929881	1.43874238	0	0	6.147842936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.1839
H4956_803_0	2010	3	N/A																															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	NO	243.92729	0.832062	42.352758	13.685684	1.604931	7.420986	3.627471	17.892154	50.94653	10.99874	26.221836	9.269574	0.814391	16.783072	31.147267	68.309096	0.328257	5.08336			22.202092	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																			0.085022877	0.085022877	0.187646185	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.085022877	0.085022877	0.187646185	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.7394	0.070744305	7.947333443	0	0.373948923	1.729089738	0.845200743	4.168871882	11.87054149	2.56270642	6.109687788	2.159810742	0.189753103	3.910455776	7.257313211	15.91601937	0.076483881	1.18442288	0	0	5.173087436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2849	0	0	20.7394	0.070744305	7.947333443	0	0.373948923	1.729089738	0.845200743	4.168871882	11.87054149	2.56270642	6.109687788	2.159810742	0.189753103	3.910455776	7.257313211	15.91601937	0.076483881	1.18442288	0	0	5.173087436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.2849	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.8607	0.0132	1.4794	0	1.4957	1.1401	0.5572	1.0992	2.8604	0.6757	1.4649	0.5695	0.05	1.0235	1.3674	2.9988	0.0144	0.2543			0.9748	0																			21.8991	0	0	24.6001	0.083922851	9.426735962	0	1.869692423	2.869158738	1.402420243	5.268049382	14.73096599	3.23840642	7.574558788	2.729262742	0.239731603	4.933908276	8.624673711	18.91484587	0.090929881	1.43874238	0	0	6.147842936	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.1839
H4971_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1453.054186	85.15114849	770.312134	877.4821445	176.9403869	9.70699154	8.250138872	288.3353981	21.79783045	8678.727492	26.11066734	0	0.034511904	16.11517245	5193.797311	3918.538306	208.7158399	256.28389	0	0	16.36115403	838.1893746	0	0	88.86092386	0	12.93248137	4.707863516	77.67974801	0											3900	"$175 Days 1-23 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.3702884	122.8528282	69.22791329	0	150	0.2	0.12410433	49.48631539	0.2	3	0.178141344	0	0.2	0.148617963	6.941242643	25	38.5	25	0	0	0.2	23.81708963	0	0	25	0	0	0	0	0											YES	142.2321382	101.0620037	56.94872255	0	123.3939892	0.164525319	0.102091522	40.7087591	0.164525319	2.467879783	0.146543807	0	0.164525319	0.122386825	6.854191467	25	38.5	20.56566486	0	0	0.164525319	23.81708963	0	0	25	0	0	0	0	0											5900	17.2226	0.717128807	3.655691	0	1.819448348	1.597045878	0.842269236	0.978148022	3.586295006	1.78483801	3.826356596	0	0.005678082	1.97228479	2.966606767	8.163621471	0.669629986	0.439220716	0	0	2.691824084	1.663602622	0	0	0.185126925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7874	0	8.905419305	17.2226	0.717128807	3.655691	0	1.819448348	1.597045878	0.842269236	0.978148022	3.586295006	1.78483801	3.826356596	0	0.005678082	1.97228479	2.966606767	8.163621471	0.669629986	0.439220716	0	0	2.691824084	1.663602622	0	0	0.185126925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7874	NO	"$225 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-27 (1b); $0 n/c (1b1, 1b2)"	"$140 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"25% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25%/25%/$10 (8a1); $10 (8a2)	"$21 (8b1); 25% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$20 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $30 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.832	0.168	2.231	0.4568	0.6129	0.807	0.6859	0.4038	1.5102	0.6013	1.6258	0	0.0019	0.8298	2.1118	3.1789	0.2455	0.1683	0	0	1.2896	0.6618	0	0	0.0721	0	0.0105	0	0	0											20.505	0	3.308396768	20.0546	0.885105671	5.886663387	0.45677042	2.432396881	2.40408192	1.528183032	1.381923387	5.096515305	2.386126769	5.452109971	0	0.007590954	2.802049315	5.078446327	11.34256811	0.915147543	0.607559259	0	0	3.981431249	2.325448485	0	0	0.257216085	0	0.010491583	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2924
H4971_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	235.6289779	5.069192041	24.59918176	918.5153028	5.922140564	10.12958303	8.609306639	12.97754153	22.74679364	12.5022037	27.24738882	0	0.036014371	16.8084812	26.28139216	87.62083603	2.14006725	3.048744016	0	0	17.07343284	5.192704605	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07567072	0.07567072	0.169551945	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07567072	0.07567072	0.169551945	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.8302	0.383589413	4.17083911	0	1.379858751	2.360192846	2.005968447	3.023767175	5.300002918	2.913013463	6.348641595	0	0.008391349	3.916376119	6.123564373	20.41565479	0.498635669	0.710357356	0	0	3.978109853	1.209900173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5771	0	0	17.8302	0.383589413	4.17083911	0	1.379858751	2.360192846	2.005968447	3.023767175	5.300002918	2.913013463	6.348641595	0	0.008391349	3.916376119	6.123564373	20.41565479	0.498635669	0.710357356	0	0	3.978109853	1.209900173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5771	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.3169	0.0498	1.6625	0	0.4723	0.8079	0.6866	1.035	1.8141	0.9971	2.173	0	0.0029	1.3405	1.9871	6.6249	0.1618	0.2305	0	0	1.2909	0.3926	0	0	0	0	0	0	0	0											24.0465	0	0	20.1471	0.433434365	5.833341413	0	1.852159398	3.168044088	2.692575096	4.058747886	7.114097877	3.910085185	8.52166657	0	0.011263555	5.256880697	8.110681288	27.04060238	0.660444595	0.94087067	0	0	5.269019673	1.602516785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6236
H4971_802_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	235.6289779	5.069192041	24.59918176	918.5153028	5.922140564	10.12958303	8.609306639	12.97754153	22.74679364	12.5022037	27.24738882	0	0.036014371	16.8084812	26.28139216	87.62083603	2.14006725	3.048744016	0	0	17.07343284	5.192704605	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07567072	0.07567072	0.169551945	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07567072	0.07567072	0.169551945	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.8302	0.383589413	4.17083911	0	1.379858751	2.360192846	2.005968447	3.023767175	5.300002918	2.913013463	6.348641595	0	0.008391349	3.916376119	6.123564373	20.41565479	0.498635669	0.710357356	0	0	3.978109853	1.209900173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5771	0	0	17.8302	0.383589413	4.17083911	0	1.379858751	2.360192846	2.005968447	3.023767175	5.300002918	2.913013463	6.348641595	0	0.008391349	3.916376119	6.123564373	20.41565479	0.498635669	0.710357356	0	0	3.978109853	1.209900173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5771	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.3169	0.0498	1.6625	0	0.4723	0.8079	0.6866	1.035	1.8141	0.9971	2.173	0	0.0029	1.3405	1.9871	6.6249	0.1618	0.2305	0	0	1.2909	0.3926	0	0	0	0	0	0	0	0											24.0465	0	0	20.1471	0.433434365	5.833341413	0	1.852159398	3.168044088	2.692575096	4.058747886	7.114097877	3.910085185	8.52166657	0	0.011263555	5.256880697	8.110681288	27.04060238	0.660444595	0.94087067	0	0	5.269019673	1.602516785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6236
H4971_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	235.6289779	5.069192041	24.59918176	918.5153028	5.922140564	10.12958303	8.609306639	12.97754153	22.74679364	12.5022037	27.24738882	0	0.036014371	16.8084812	26.28139216	87.62083603	2.14006725	3.048744016	0	0	17.07343284	5.192704605	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07567072	0.07567072	0.169551945	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07567072	0.07567072	0.169551945	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												17.8302	0.383589413	4.17083911	0	1.379858751	2.360192846	2.005968447	3.023767175	5.300002918	2.913013463	6.348641595	0	0.008391349	3.916376119	6.123564373	20.41565479	0.498635669	0.710357356	0	0	3.978109853	1.209900173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5771	0	0	17.8302	0.383589413	4.17083911	0	1.379858751	2.360192846	2.005968447	3.023767175	5.300002918	2.913013463	6.348641595	0	0.008391349	3.916376119	6.123564373	20.41565479	0.498635669	0.710357356	0	0	3.978109853	1.209900173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5771	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.3169	0.0498	1.6625	0	0.4723	0.8079	0.6866	1.035	1.8141	0.9971	2.173	0	0.0029	1.3405	1.9871	6.6249	0.1618	0.2305	0	0	1.2909	0.3926	0	0	0	0	0	0	0	0											24.0465	0	0	20.1471	0.433434365	5.833341413	0	1.852159398	3.168044088	2.692575096	4.058747886	7.114097877	3.910085185	8.52166657	0	0.011263555	5.256880697	8.110681288	27.04060238	0.660444595	0.94087067	0	0	5.269019673	1.602516785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.6236
H4979_001_1	2010	2	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	703.2109853	19.84359368	258.0215517	15.8051893	162.7539358	19.30476801	6.11104124	207.3548839	395.3518202	10.33591828	16.66965045	0	12.98918585	211.1349849	3623.943251	3913.43974	219.7117104	186.4113928	21.7810658	32.58438692	6.803447609	0	0	0	0	0	0	0	0	0											5000	1a:  Acute - $215/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $215/$0/day for 1-5/6-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $250/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $20/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - $30/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												215	215	125	0	200	0.2	0.046903622	37.32604277	250	0	0.115300926	0	20	30	30	43.33061155	30	30	0	0.001664689	0.092797871	0	0	0	0	0	0	0	0	0											NO	197.502031	197.502031	114.8267622	0	183.7228195	0.18372282	0.043086328	34.35788831	229.6535244	0	0.105917057	0	18.37228195	27.55842293	27.55842293	39.80411063	27.55842293	27.55842293	0	0.001529206	0.085245432	0	0	0	0	0	0	0	0	0												11.5738	0.326595838	2.468981614	0	2.491800998	3.546726409	0.263302327	0.593689662	7.566161575	0	1.765600309	0	0.019886749	0.484878934	8.322513399	12.9809157	0.504575687	0.428100334	0	0.049828255	0.579962834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9673	0	4.78	11.5738	0.326595838	2.468981614	0	2.491800998	3.546726409	0.263302327	0.593689662	7.566161575	0	1.765600309	0	0.019886749	0.484878934	8.322513399	12.9809157	0.504575687	0.428100334	0	0.049828255	0.579962834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9673	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.5738	0.326595838	2.468981614	0	2.491800998	3.546726409	0.263302327	0.593689662	7.566161575	0	1.765600309	0	0.019886749	0.484878934	8.322513399	12.9809157	0.504575687	0.428100334	0	0.049828255	0.579962834	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9673
H4979_001_3	2010	2	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	745.6235022	21.04041337	294.2797607	16.59256917	184.4323463	22.43861119	7.09345079	245.905621	434.1278067	11.24421156	19.31693753	0	13.78980931	220.4392277	3860.046957	4163.626295	233.3159899	197.9537575	21.34599075	33.42899118	7.449519995	0	0	0	0	0	0	0	0	0											5000	1a:  Acute - $215/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $215/$0/day for 1-5/6-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $250/visit/9b:  Ambulatory Surgical Center Services - $250/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $20/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - $30/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												215	215	125	0	200	0.2	0.046903622	37.25759516	250	0	0.115300926	0	20	30	30	43.27119912	30	30	0	0.001722517	0.092797871	0	0	0	0	0	0	0	0	0											NO	194.9764532	194.9764532	113.358403	0	181.3734448	0.181373445	0.042535357	33.86023	226.716806	0	0.104562631	0	18.13734448	27.20601672	27.20601672	39.24123223	27.20601672	27.20601672	0	0.001562094	0.084155348	0	0	0	0	0	0	0	0	0												12.1149	0.341865431	2.779923642	0	2.787594165	4.069768209	0.301722462	0.693868407	8.202005813	0	2.019829813	0	0.020842543	0.499772776	8.751375172	13.61548553	0.52896656	0.448794436	0	0.052219241	0.626916945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8559	0	5.94	12.1149	0.341865431	2.779923642	0	2.787594165	4.069768209	0.301722462	0.693868407	8.202005813	0	2.019829813	0	0.020842543	0.499772776	8.751375172	13.61548553	0.52896656	0.448794436	0	0.052219241	0.626916945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8559	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.1149	0.341865431	2.779923642	0	2.787594165	4.069768209	0.301722462	0.693868407	8.202005813	0	2.019829813	0	0.020842543	0.499772776	8.751375172	13.61548553	0.52896656	0.448794436	0	0.052219241	0.626916945	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8559
H4979_003_1	2010	2	N/A																															D	D	coin	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	816.8670504	19.91228346	34.56191984	24.43724187	260.7589348	31.4070827	9.467509846	349.5802724	618.3414477	15.88325818	27.32832271	0	0.082018137	331.1709249	5932.675051	6063.414464	354.6199221	300.8724181	31.98724857	47.91318851	10.48234061	0	0	878.1066433	472.4673575	0	66.97450598	0	0	0											2500	1a:  Acute - $100/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 10.0%/11b:  Medical Supplies - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $10/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	0	0	100	0.1	0.023827889	22.85791158	100	0	0	0	0	10	10	24.93876712	10	10	0	0.000760589	0.046398935	0	0	0	10	0	10	0	0	0											NO	87.74152961	87.74152961	0	0	87.74152961	0.08774153	0.020906955	20.15063737	87.74152961	0	0	0	0	8.774152961	8.774152961	21.88165573	8.774152961	8.774152961	0	0.000667353	0.040711136	0	0	0	10	0	10	0	0	0												5.9728	0.145594517	0	0	1.90661565	2.755705476	0.197936799	0.587022108	4.52118537	0	0	0	0	0.242145363	4.337849863	11.05646232	0.259290787	0.219991718	0	0.031974991	0.426747991	0	0	0	0.393722798	0	0.055812088	0	0	0	0	0	0	0	0	0	0	0	0	0	33.1108	0	4.56	5.9728	0.145594517	0	0	1.90661565	2.755705476	0.197936799	0.587022108	4.52118537	0	0	0	0	0.242145363	4.337849863	11.05646232	0.259290787	0.219991718	0	0.031974991	0.426747991	0	0	0	0.393722798	0	0.055812088	0	0	0	0	0	0	0	0	0	0	0	0	0	33.1108	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.9728	0.145594517	0	0	1.90661565	2.755705476	0.197936799	0.587022108	4.52118537	0	0	0	0	0.242145363	4.337849863	11.05646232	0.259290787	0.219991718	0	0.031974991	0.426747991	0	0	0	0.393722798	0	0.055812088	0	0	0	0	0	0	0	0	0	0	0	0	0	33.1108
H4979_003_4	2010	2	N/A																															D	D	coin	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	717.2891502	17.48493206	29.36356564	20.04991483	226.0911126	29.6178737	8.949279949	339.6331198	568.974453	13.90436572	25.12328493	0	0.07691689	295.5910174	5355.755316	5582.139604	341.1101765	289.4102594	27.74784586	43.477182	9.421816403	0	0	878.1066433	429.6991323	0	60.74080474	0	0	0											2500	1a:  Acute - $100/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 10.0%/11b:  Medical Supplies - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $0/visit/8b:  Outpatient Therapeutic Radiological Services - $0/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $10/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	0	0	100	0.1	0.023827889	22.8174989	100	0	0	0	0	10	10	24.93602168	10	10	0	0.000755272	0.046398935	0	0	0	10	0	10	0	0	0											NO	89.48408352	89.48408352	0	0	89.48408352	0.089484084	0.021322169	20.4946854	89.48408352	0	0	0	0	8.948408352	8.948408352	22.31377047	8.948408352	8.948408352	0	0.000675848	0.041519662	0	0	0	10	0	10	0	0	0												5.3488	0.13038526	0	0	1.685963	2.650328284	0.190818055	0.580056162	4.242846456	0	0	0	0	0.220422427	3.993790467	10.37988182	0.254366096	0.215813432	0	0.029383961	0.391190634	0	0	0	0.35808261	0	0.050617337	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7228	0	3.56	5.3488	0.13038526	0	0	1.685963	2.650328284	0.190818055	0.580056162	4.242846456	0	0	0	0	0.220422427	3.993790467	10.37988182	0.254366096	0.215813432	0	0.029383961	0.391190634	0	0	0	0.35808261	0	0.050617337	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7228	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.3488	0.13038526	0	0	1.685963	2.650328284	0.190818055	0.580056162	4.242846456	0	0	0	0	0.220422427	3.993790467	10.37988182	0.254366096	0.215813432	0	0.029383961	0.391190634	0	0	0	0.35808261	0	0.050617337	0	0	0	0	0	0	0	0	0	0	0	0	0	30.7228
H4979_801_0	2010	1	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	259.8899865	5.042233756	43.51696907	28.26064701	10.30196597	22.55901562	7.105527148	12.49985067	49.61239399	14.44964458	17.62501435	0	0.047513774	20.74801096	51.50852577	129.2135585	1.43442482	2.636610695	28.48422631	32.5028042	8.749456844	0	0	0	0	0	0	0	0	0												Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share											0.081315389	0.081315389	0.180644268	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081315389	0.081315389	0.180644268	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												21.1331	0.410011199	7.861091026	0	2.400358071	5.256250638	1.655587826	2.912465206	11.5596878	3.366767187	4.106628343	0	0.011070709	4.834286553	12.0014865	30.10675912	0.334220983	0.614330292	6.63682473	7.573153378	2.038623445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.8127	0	0	21.1331	0.410011199	7.861091026	0	2.400358071	5.256250638	1.655587826	2.912465206	11.5596878	3.366767187	4.106628343	0	0.011070709	4.834286553	12.0014865	30.10675912	0.334220983	0.614330292	6.63682473	7.573153378	2.038623445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.8127	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.1331	0.410011199	7.861091026	0	2.400358071	5.256250638	1.655587826	2.912465206	11.5596878	3.366767187	4.106628343	0	0.011070709	4.834286553	12.0014865	30.10675912	0.334220983	0.614330292	6.63682473	7.573153378	2.038623445	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.8127
H5005_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1378.127608	96.60759111	1337.338576	339.7109093	383.5468978	10.44452973	8.807686456	339.3841637	174.0801918	14553.04464	46.11701094	0	0.075410234	1233.001959	6386.242629	5099.990148	412.7773083	673.4930584	0	0	18.02536669	1127.171643	0	0	332.5576411	120.1582574	16.90474709	4.646197123	0	0												"$175 Days 1-10 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-10 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$95 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$175 (14f, 14f1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											144.1013049	117.7704216	45.05417382	0	150	0.2	0.099873617	49.99751384	175	3	0.154827374	0	0.2	68.09073275	10.76887922	30	38.5	25	0	0	0.2	29.35469815	0	0	30	30	0	0	0	0											NO	144.1013049	117.7704216	45.05417382	0	150	0.2	0.099873617	49.99751384	175	3	0.154827374	0	0.2	68.09073275	10.76887922	30	38.5	25	0	0	0.2	29.35469815	0	0	30	30	0	0	0	0												16.5492	0.948126395	5.021057053	0	4.794336223	2.088905946	0.879655504	1.414030368	2.538669463	3.638261161	7.140175711	0	0.015082047	6.996333904	5.731056297	12.74997537	1.324327198	1.403110538	0	0	3.605073337	2.757315278	0	0	0.831394103	0.300395643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7264	0	0	16.5492	0.948126395	5.021057053	0	4.794336223	2.088905946	0.879655504	1.414030368	2.538669463	3.638261161	7.140175711	0	0.015082047	6.996333904	5.731056297	12.74997537	1.324327198	1.403110538	0	0	3.605073337	2.757315278	0	0	0.831394103	0.300395643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7264	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.5492	0.948126395	5.021057053	0	4.794336223	2.088905946	0.879655504	1.414030368	2.538669463	3.638261161	7.140175711	0	0.015082047	6.996333904	5.731056297	12.74997537	1.324327198	1.403110538	0	0	3.605073337	2.757315278	0	0	0.831394103	0.300395643	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.7264
H5005_010_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1667.461098	100.4593378	1235.353245	327.9408422	416.9993273	13.14814778	9.983632124	404.3683423	121.5756703	13565.79194	46.32534351	0	0.032818691	782.2097811	5879.834766	5211.202408	405.3391246	549.6681083	0	0	15.86734341	966.0280103	0	0	296.6573276	171.5122643	17.5359483	13.16657983	11.52791916	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$95 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $200 (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$200 (14f, 14f1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	45.05417382	0	150	0.2	0.097528771	49.99808062	200	3	0.153137728	0	0.2	78.0090703	14.685378	34.98936491	38.5	30	0	0	0.2	34.18500244	0	0	35	30	0	0	0	0											NO	184.2401855	140.3212257	45.05417382	0	150	0.2	0.097528771	49.99808062	200	3	0.153137728	0	0.2	78.0090703	14.685378	34.98936491	38.5	30	0	0	0.2	34.18500244	0	0	35	30	0	0	0	0												25.6011	1.174714785	4.638151654	0	5.212491591	2.629629555	0.973691375	1.684803415	2.026261172	3.391447985	7.094157839	0	0.006563738	5.084954817	7.19563301	15.19472189	1.300463025	1.374170271	0	0	3.173468681	2.751972491	0	0	0.865250539	0.428780661	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8024	0	0	25.6011	1.174714785	4.638151654	0	5.212491591	2.629629555	0.973691375	1.684803415	2.026261172	3.391447985	7.094157839	0	0.006563738	5.084954817	7.19563301	15.19472189	1.300463025	1.374170271	0	0	3.173468681	2.751972491	0	0	0.865250539	0.428780661	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8024	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.6011	1.174714785	4.638151654	0	5.212491591	2.629629555	0.973691375	1.684803415	2.026261172	3.391447985	7.094157839	0	0.006563738	5.084954817	7.19563301	15.19472189	1.300463025	1.374170271	0	0	3.173468681	2.751972491	0	0	0.865250539	0.428780661	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8024
H5005_011_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1171.28913	87.2743689	1583.253403	354.3506741	392.6496324	14.27194025	9.722058212	336.5060108	161.077594	13774.66524	47.76941234	0	0.080295349	934.9050807	6515.030841	5140.258936	391.1785395	725.7679795	0	0	19.31782357	1395.879075	0	0	447.9617303	108.7336073	17.91293757	18.54546185	0	0												"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-14/$95 Days 15-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $200 (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$200 (14f, 14f1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	45.05417382	0	150	0.2	0.100915922	49.99901757	200	3	0.159061944	0	0.2	78.51896955	13.99254908	34.9891006	38.5	30	0	0	0.2	33.78286925	0	0	35	30	0	0	0	0											NO	165.816167	126.2891031	45.05417382	0	150	0.2	0.100915922	49.99901757	200	3	0.159061944	0	0.2	78.51896955	13.99254908	34.9891006	38.5	30	0	0	0.2	33.78286925	0	0	35	30	0	0	0	0												16.1849	0.918483481	5.944347833	0	4.908120406	2.854388049	0.981110466	1.402080829	2.684626567	3.443666311	7.598295581	0	0.01605907	6.117315297	7.596824065	14.98775309	1.255031148	1.814419949	0	0	3.863564714	3.929733356	0	0	1.306555047	0.271834018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0791	0	0	16.1849	0.918483481	5.944347833	0	4.908120406	2.854388049	0.981110466	1.402080829	2.684626567	3.443666311	7.598295581	0	0.01605907	6.117315297	7.596824065	14.98775309	1.255031148	1.814419949	0	0	3.863564714	3.929733356	0	0	1.306555047	0.271834018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0791	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.1849	0.918483481	5.944347833	0	4.908120406	2.854388049	0.981110466	1.402080829	2.684626567	3.443666311	7.598295581	0	0.01605907	6.117315297	7.596824065	14.98775309	1.255031148	1.814419949	0	0	3.863564714	3.929733356	0	0	1.306555047	0.271834018	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0791
H5005_018_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1236.12436	92.82314761	1184.157775	286.6568246	332.9276231	8.837772844	7.216163161	330.1051912	158.4384441	13399.99567	44.4035651	0	0.052780227	1067.644811	5961.670233	4857.62615	404.2593522	627.8025019	0	0	15.88589871	1080.135622	0	0	160.1679006	136.533379	0	0	58.80901408	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$90 Days 11-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$200 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $200 (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/$200 (14f, 14f1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	52.47946026	0	150	0.2	0.10374221	49.99809908	200	3	0.155974605	0	0.2	78.01129603	14.57859921	34.98809567	38.5	30	0	0	0.2	34.34439262	0	0	35	30	0	0	0	0											NO	184.2401855	140.3212257	52.47946026	0	150	0.2	0.10374221	49.99809908	200	3	0.155974605	0	0.2	78.01129603	14.57859921	34.98809567	38.5	30	0	0	0.2	34.34439262	0	0	35	30	0	0	0	0												18.9786	1.085421487	5.178663407	0	4.161595288	1.767554569	0.748620717	1.375386005	2.640640735	3.349998917	6.925828513	0	0.010556045	6.940696282	7.242733414	14.16325737	1.296998755	1.569506255	0	0	3.177179743	3.091383492	0	0	0.467156377	0.341333448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5132	0	0	18.9786	1.085421487	5.178663407	0	4.161595288	1.767554569	0.748620717	1.375386005	2.640640735	3.349998917	6.925828513	0	0.010556045	6.940696282	7.242733414	14.16325737	1.296998755	1.569506255	0	0	3.177179743	3.091383492	0	0	0.467156377	0.341333448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5132	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.9786	1.085421487	5.178663407	0	4.161595288	1.767554569	0.748620717	1.375386005	2.640640735	3.349998917	6.925828513	0	0.010556045	6.940696282	7.242733414	14.16325737	1.296998755	1.569506255	0	0	3.177179743	3.091383492	0	0	0.467156377	0.341333448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.5132
H5005_019_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	Coin	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	928.728297	81.92894769	755.2536237	167.5661783	207.8155429	8.696955108	9.018792081	285.9735974	28.34090173	11080.98411	44.80868919	0	0.069359612	23.24701542	30.96669047	4358.282729	458.8595134	586.9449865	0	0	15.37126049	892.4110286	0	0	300.4961004	0	17.08979149	4.697055782	618.3876093	0											3900	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$15 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1); $0/20% (14f, 14f1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	81.80667226	0	150	0.2	0.091053517	49.99244152	0.2	3	0.158185555	0	0.2	0.153586337	0.153305033	34.62746085	38.5	30	0	0	0.2	34.21974137	0	0	35	0	0	0	0	0											NO	171.6499621	126.5679651	69.85940577	0	128.0935965	0.170791462	0.077755816	42.69141088	0.170791462	2.56187193	0.135083711	0	0.170791462	0.131289201	0.151731196	34.62746085	38.5	25.6187193	0	0	0.170791462	34.21974137	0	0	35	0	0	0	0	0												13.2847	0.864131683	4.396797446	0	2.218320025	1.485365678	0.701263541	1.017384696	4.840384041	2.365671846	6.052924013	0	0.011846029	3.052082083	4.698612996	12.57635538	1.472174272	1.253064904	0	0	2.625280051	2.544839549	0	0	0.87644696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3376	0	7.598874998	13.2847	0.864131683	4.396797446	0	2.218320025	1.485365678	0.701263541	1.017384696	4.840384041	2.365671846	6.052924013	0	0.011846029	3.052082083	4.698612996	12.57635538	1.472174272	1.253064904	0	0	2.625280051	2.544839549	0	0	0.87644696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3376	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.2847	0.864131683	4.396797446	0	2.218320025	1.485365678	0.701263541	1.017384696	4.840384041	2.365671846	6.052924013	0	0.011846029	3.052082083	4.698612996	12.57635538	1.472174272	1.253064904	0	0	2.625280051	2.544839549	0	0	0.87644696	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.3376
H5005_024_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1273.185071	100.8005478	1157.697616	324.2701733	360.0999099	9.349314557	8.356663801	319.216291	175.5499155	14553.99435	49.35071558	0	0.132293384	1117.540519	6263.876671	4904.083022	455.1683	634.4124676	0	0	17.6380768	1043.870979	0	0	204.2739765	198.1545826	17.46622905	4.800518028	59.78586835	0											1000	"$100 Days 1-3 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$100 Days 1-3 (1b); $0 n/c (1b1, 1b2)"	"$0 Days 1-10/$60 Days 11-27 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$5 (3, 9d); $60 (5); $0 (9a); $40/$30 (9c)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14e1, 14h1)"	"$0 (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"$40/$30 (7e, 7h)"	"$5 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											47.14227526	30.61844948	20.25848005	0	50	0.2	0.098556063	49.99773825	0	0	0.128322227	0	0.2	0.486228365	0.001624146	0	38.5	5	0	0	0.2	0	0	0	30	0	0	0	0	0											NO	31.23595551	20.28744944	13.4230471	0	33.12945264	0.132517811	0.065302168	33.12795403	0	0	0.085024903	0	0.132517811	0.322169592	0.001076142	0	25.50967853	3.312945264	0	0	0.132517811	0	0	0	30	0	0	0	0	0												3.3141	0.170415501	1.294985802	0	0.994159409	1.238950695	0.545708266	0.881248551	0	0	4.196039812	0	0.01753123	0.030003131	0.000561735	0	0.967599751	0.175147815	0	0	2.33735932	0	0	0	0.510684941	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6745	0	8.231113118	3.3141	0.170415501	1.294985802	0	0.994159409	1.238950695	0.545708266	0.881248551	0	0	4.196039812	0	0.01753123	0.030003131	0.000561735	0	0.967599751	0.175147815	0	0	2.33735932	0	0	0	0.510684941	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6745	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.3141	0.170415501	1.294985802	0	0.994159409	1.238950695	0.545708266	0.881248551	0	0	4.196039812	0	0.01753123	0.030003131	0.000561735	0	0.967599751	0.175147815	0	0	2.33735932	0	0	0	0.510684941	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.6745
H5005_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	286.1035829	8.245757656	36.30097397	335.1436714	9.128190182	15.21318206	11.82887952	20.47212989	48.49881784	27.41181631	68.23248733	0	0.049359713	38.72295503	40.47697663	151.9805169	3.052215791	9.64024003	0	0	29.33109161	12.44259349	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.073626718	0.073626718	0.141399101	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073626718	0.073626718	0.141399101	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.0649	0.607108072	5.13292509	0	2.126868312	3.54467142	2.756128928	4.770006265	11.30022456	6.386953201	15.89816955	0	0.011500813	9.022448521	9.431135556	35.41146044	0.711166279	2.246175927	0	0	6.834144346	2.899124283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.1551	0	0	21.0649	0.607108072	5.13292509	0	2.126868312	3.54467142	2.756128928	4.770006265	11.30022456	6.386953201	15.89816955	0	0.011500813	9.022448521	9.431135556	35.41146044	0.711166279	2.246175927	0	0	6.834144346	2.899124283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.1551	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.0649	0.607108072	5.13292509	0	2.126868312	3.54467142	2.756128928	4.770006265	11.30022456	6.386953201	15.89816955	0	0.011500813	9.022448521	9.431135556	35.41146044	0.711166279	2.246175927	0	0	6.834144346	2.899124283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.1551
H5005_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	279.4676718	8.334297823	29.5563865	302.8291274	8.212563921	16.1397735	12.67410536	19.76920422	50.93519084	27.48247067	67.53653997	0	0.038612784	33.32022564	39.69394961	153.6793536	3.065962041	8.168804963	0	0	33.48575	11.16628307	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07416391	0.07416391	0.140634726	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07416391	0.07416391	0.140634726	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.7264	0.618104113	4.156654322	0	1.913527394	3.760567226	2.95306655	4.606224583	11.86789947	6.403415666	15.73601381	0	0.008996779	7.763612573	9.248690259	35.8072894	0.714369156	1.903331556	0	0	7.80217975	2.601743956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5921	0	0	20.7264	0.618104113	4.156654322	0	1.913527394	3.760567226	2.95306655	4.606224583	11.86789947	6.403415666	15.73601381	0	0.008996779	7.763612573	9.248690259	35.8072894	0.714369156	1.903331556	0	0	7.80217975	2.601743956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5921	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.7264	0.618104113	4.156654322	0	1.913527394	3.760567226	2.95306655	4.606224583	11.86789947	6.403415666	15.73601381	0	0.008996779	7.763612573	9.248690259	35.8072894	0.714369156	1.903331556	0	0	7.80217975	2.601743956	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5921
H5005_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	264.2386627	7.88013761	27.94577274	294.8649998	7.765037344	15.26027014	11.98345637	18.69192258	48.15958363	25.98487063	63.85627679	0	0.036508661	31.50450929	37.53091045	145.3049171	2.898888821	7.723662939	0	0	31.66101375	10.55779972	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.084434679	0.084434679	0.132068204	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.084434679	0.084434679	0.132068204	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.3109	0.665356886	3.69074802	0	1.809253701	3.555642942	2.792145335	4.355217962	11.22118299	6.054474858	14.87851249	0	0.008506518	7.340550665	8.744702134	33.85604569	0.675441095	1.799613465	0	0	7.377016204	2.459967334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.5953	0	0	22.3109	0.665356886	3.69074802	0	1.809253701	3.555642942	2.792145335	4.355217962	11.22118299	6.054474858	14.87851249	0	0.008506518	7.340550665	8.744702134	33.85604569	0.675441095	1.799613465	0	0	7.377016204	2.459967334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.5953	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.3109	0.665356886	3.69074802	0	1.809253701	3.555642942	2.792145335	4.355217962	11.22118299	6.054474858	14.87851249	0	0.008506518	7.340550665	8.744702134	33.85604569	0.675441095	1.799613465	0	0	7.377016204	2.459967334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.5953
H5005_805_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	289.5884016	8.346193204	36.74312961	337.274392	9.239373996	15.39848271	11.97295846	20.72148594	49.0895465	27.74569962	69.0635774	0	0.049960927	39.19461104	40.96999711	153.8316805	3.089392601	9.757660749	0	0	29.68835221	12.59414763	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07416391	0.07416391	0.140634726	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07416391	0.07416391	0.140634726	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.477	0.61898632	5.16735998	0	2.152774141	3.587846472	2.78969932	4.828106225	11.43786433	6.464748011	16.09181353	0	0.011640896	9.132344373	9.546009326	35.84278157	0.719828476	2.273534955	0	0	6.917386064	2.934436398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.9942	0	0	21.477	0.61898632	5.16735998	0	2.152774141	3.587846472	2.78969932	4.828106225	11.43786433	6.464748011	16.09181353	0	0.011640896	9.132344373	9.546009326	35.84278157	0.719828476	2.273534955	0	0	6.917386064	2.934436398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.9942	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.477	0.61898632	5.16735998	0	2.152774141	3.587846472	2.78969932	4.828106225	11.43786433	6.464748011	16.09181353	0	0.011640896	9.132344373	9.546009326	35.84278157	0.719828476	2.273534955	0	0	6.917386064	2.934436398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.9942
H5006_014_1	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	858.2463353	25.69473865	487.4772111	26.45618948	200.3283555	14.12205157	12.37401335	609.2381457	86.36331156	27.0001285	30.29822123	0.011478538	0.11890716	0.021022276	4558.866814	2115.997849	1.961873607	6.96121096	0	4.533582681	21.42668413	0.565907557																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	10% Coinsurance	0% Coinsurance	10% Coinsurance	50% Coinsurance	10% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	10% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	10% Coinsurance																			150	150	50	0	100	0.2	0.2	50	0.1	0	0.1	0.5	0.1	0.5	20	40	0.5	0.1	40	0	0.2	0.1																			NO	150	150	50	0	100	0.2	0.2	50	0.1	0	0.1	0.5	0.1	0.5	20	40	0.5	0.1	40	0	0.2	0.1																				10.7281	0.321184233	2.031155046	0	1.669402963	2.824410314	2.474802669	2.538492274	8.636331156	0	3.029822123	0.005739269	0.011890716	0.010511138	7.598111357	7.053326163	0.980936803	0.696121096	0	0	4.285336826	0.056590756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9522			10.7281	0.321184233	2.031155046	0	1.669402963	2.824410314	2.474802669	2.538492274	8.636331156	0	3.029822123	0.005739269	0.011890716	0.010511138	7.598111357	7.053326163	0.980936803	0.696121096	0	0	4.285336826	0.056590756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9522	NO																																																																																		0			10.7281	0.321184233	2.031155046	0	1.669402963	2.824410314	2.474802669	2.538492274	8.636331156	0	3.029822123	0.005739269	0.011890716	0.010511138	7.598111357	7.053326163	0.980936803	0.696121096	0	0	4.285336826	0.056590756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9522
H5006_014_2	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	838.3360138	21.9692174	350.0413513	20.69009089	196.1348523	15.32304644	15.78413542	544.490218	92.6685726	26.46832738	27.9596321	0.001710785	0.004331267	0	5482.543392	1786.650744	1.077576218	5.993127676	0	4.570101347	19.24844877	0.60946076																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	10% Coinsurance	0% Coinsurance	10% Coinsurance	50% Coinsurance	10% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	10% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	10% Coinsurance																			150	150	50	0	100	0.2	0.2	50	0.1	0	0.1	0.5	0.1	0.5	20	40	0.5	0.1	40	0	0.2	0.1																			NO	150	150	50	0	100	0.2	0.2	50	0.1	0	0.1	0.5	0.1	0.5	20	40	0.5	0.1	40	0	0.2	0.1																				10.4792	0.274615218	1.458505631	0	1.634457103	3.064609287	3.156827084	2.268709242	9.26685726	0	2.79596321	0.000855392	0.000433127	0	9.13757232	5.95550248	0.538788109	0.599312768	0	0	3.849689754	0.060946076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5428			10.4792	0.274615218	1.458505631	0	1.634457103	3.064609287	3.156827084	2.268709242	9.26685726	0	2.79596321	0.000855392	0.000433127	0	9.13757232	5.95550248	0.538788109	0.599312768	0	0	3.849689754	0.060946076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5428	NO																																																																																		0			10.4792	0.274615218	1.458505631	0	1.634457103	3.064609287	3.156827084	2.268709242	9.26685726	0	2.79596321	0.000855392	0.000433127	0	9.13757232	5.95550248	0.538788109	0.599312768	0	0	3.849689754	0.060946076	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5428
H5006_014_3	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	903.0651204	14.80868737	518.7326866	15.21677366	232.0530798	13.06227034	13.77879625	641.6434019	96.18659262	29.79599742	35.0470721	0.000337314	0.348796753	0	5013.119195	2516.729542	1.422749859	8.049816386	0	4.907298125	24.9157558	0.713177339																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	10% Coinsurance	0% Coinsurance	10% Coinsurance	50% Coinsurance	10% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	10% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	10% Coinsurance																			150	150	50	0	100	0.2	0.2	50	0.1	0	0.1	0.5	0.1	0.5	20	40	0.5	0.1	40	0	0.2	0.1																			NO	150	150	50	0	100	0.2	0.2	50	0.1	0	0.1	0.5	0.1	0.5	20	40	0.5	0.1	40	0	0.2	0.1																				11.2883	0.185108592	2.161386194	0	1.933775665	2.612454068	2.75575925	2.673514174	9.618659262	0	3.50470721	0.000168657	0.034879675	0	8.355198658	8.389098472	0.711374929	0.804981639	0	0	4.983151161	0.071317734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.0838			11.2883	0.185108592	2.161386194	0	1.933775665	2.612454068	2.75575925	2.673514174	9.618659262	0	3.50470721	0.000168657	0.034879675	0	8.355198658	8.389098472	0.711374929	0.804981639	0	0	4.983151161	0.071317734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.0838	NO																																																																																		0			11.2883	0.185108592	2.161386194	0	1.933775665	2.612454068	2.75575925	2.673514174	9.618659262	0	3.50470721	0.000168657	0.034879675	0	8.355198658	8.389098472	0.711374929	0.804981639	0	0	4.983151161	0.071317734	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.0838
H5006_016_1	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	576.5662444	7.426348522	373.1048969	13.0930272	115.7307391	10.1035492	12.4246622	470.4438341	77.10061317	29.94453663	34.97000502	0	0	0	4929.357435	2116.782621	0.721807091	7.483958694	0	7.147611058	33.33187476	0.395642889																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			NO	133.774689	133.774689	44.59156299	0	133.774689	0.178366252	0.178366252	44.59156299	0.133774689	0	0.133774689	0.44591563	0.133774689	0	17.8366252	35.67325039	0.44591563	0.133774689	35.67325039	0	0.178366252	0.133774689																				6.4275	0.082788122	1.386444209	0	1.290153635	1.802132202	2.216140428	1.748152155	10.31411055	0	4.678101545	0	0	0	7.326925086	6.292709706	0.321865064	1.001164247	0	0	5.945281572	0.052927004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.8864		6.171926543	6.4275	0.082788122	1.386444209	0	1.290153635	1.802132202	2.216140428	1.748152155	10.31411055	0	4.678101545	0	0	0	7.326925086	6.292709706	0.321865064	1.001164247	0	0	5.945281572	0.052927004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.8864	YES																																									4000																																									0			6.4275	0.082788122	1.386444209	0	1.290153635	1.802132202	2.216140428	1.748152155	10.31411055	0	4.678101545	0	0	0	7.326925086	6.292709706	0.321865064	1.001164247	0	0	5.945281572	0.052927004	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.8864
H5006_016_2	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	609.4195579	14.18039968	302.9763149	13.08593444	113.6122637	9.063286884	10.89732154	469.8968233	70.931283	27.35833136	31.73860231	0	0	0	4915.057884	2238.122324	0.860020058	6.801122897	0	6.133523316	28.44648039	0.485835719																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			NO	134.4769277	134.4769277	44.82564258	0	134.4769277	0.17930257	0.17930257	44.82564258	0.134476928	0	0.134476928	0.448256426	0.134476928	0	17.93025703	35.86051407	0.448256426	0.134476928	35.86051407	0	0.17930257	0.134476928																				6.8294	0.158911382	1.131759	0	1.273185681	1.625070634	1.953917763	1.755285588	9.538621019	0	4.26810973	0	0	0	7.344020932	6.688351424	0.385509517	0.914594112	0	0	5.10052705	0.065333695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0326		5.659979428	6.8294	0.158911382	1.131759	0	1.273185681	1.625070634	1.953917763	1.755285588	9.538621019	0	4.26810973	0	0	0	7.344020932	6.688351424	0.385509517	0.914594112	0	0	5.10052705	0.065333695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0326	YES																																									4000																																									0			6.8294	0.158911382	1.131759	0	1.273185681	1.625070634	1.953917763	1.755285588	9.538621019	0	4.26810973	0	0	0	7.344020932	6.688351424	0.385509517	0.914594112	0	0	5.10052705	0.065333695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0326
H5006_016_3	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	609.4195579	14.18039968	302.9763149	17.44791259	113.6122637	12.08438251	14.52976206	469.8968233	94.575044	36.47777514	42.31813642	0	0	0	4915.057884	2238.122324	1.14669341	9.068163863	0	8.178031088	37.92864052	0.647780959																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			NO	131.2987779	131.2987779	43.76625932	0	131.2987779	0.175065037	0.175065037	43.76625932	0.131298778	0	0.131298778	0.437662593	0.131298778	0	17.50650373	35.01300745	0.437662593	0.131298778	0	0	0.175065037	0.131298778																				6.668	0.155155762	1.105011664	0	1.243095948	2.115552875	2.543653336	1.713802185	12.4175877	0	5.556319597	0	0	0	7.170456596	6.530282802	0.501864811	1.190638833	0	0	6.639978866	0.085052848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6365		7.924443477	6.668	0.155155762	1.105011664	0	1.243095948	2.115552875	2.543653336	1.713802185	12.4175877	0	5.556319597	0	0	0	7.170456596	6.530282802	0.501864811	1.190638833	0	0	6.639978866	0.085052848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6365	YES																																									4000																																									0			6.668	0.155155762	1.105011664	0	1.243095948	2.115552875	2.543653336	1.713802185	12.4175877	0	5.556319597	0	0	0	7.170456596	6.530282802	0.501864811	1.190638833	0	0	6.639978866	0.085052848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6365
H5006_017_1	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	773.2537954	22.787756	339.8182603	27.98403834	161.0582234	14.9566748	13.67439153	587.0941622	71.39532474	29.20465424	33.88438078	0.012174215	0.075403134	0	4744.578212	1946.594423	1.777133611	6.474158277	0	5.403087545	18.98953711	0.420146175																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			NO	150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																				9.6657	0.28484695	1.415909418	0	2.013227793	2.991334961	2.734878307	2.446225676	10.70929871	0	5.082657118	0.006087108	0.01131047	0	7.907630354	6.488648077	0.888566806	0.971123742	0	0	3.797907422	0.063021926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4783			9.6657	0.28484695	1.415909418	0	2.013227793	2.991334961	2.734878307	2.446225676	10.70929871	0	5.082657118	0.006087108	0.01131047	0	7.907630354	6.488648077	0.888566806	0.971123742	0	0	3.797907422	0.063021926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4783	NO																																																																																		0			9.6657	0.28484695	1.415909418	0	2.013227793	2.991334961	2.734878307	2.446225676	10.70929871	0	5.082657118	0.006087108	0.01131047	0	7.907630354	6.488648077	0.888566806	0.971123742	0	0	3.797907422	0.063021926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4783
H5006_017_2	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	711.7312946	35.37859017	146.7232121	24.6907311	123.9642719	13.11586666	12.38029491	511.8219507	68.7571149	28.85746706	32.29957306	0.011452041	0.004847242	0	5215.898804	1870.823763	2.737783765	6.816263541	0	4.645318086	12.19898425	0.351164512																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			NO	150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																				8.8966	0.442232377	0.611346717	0	1.549553399	2.623173333	2.476058982	2.132591461	10.31356723	0	4.844935959	0.005726021	0.000727086	0	8.693164674	6.23607921	1.368891882	1.022439531	0	0	2.439796851	0.052674677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7096			8.8966	0.442232377	0.611346717	0	1.549553399	2.623173333	2.476058982	2.132591461	10.31356723	0	4.844935959	0.005726021	0.000727086	0	8.693164674	6.23607921	1.368891882	1.022439531	0	0	2.439796851	0.052674677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7096	NO																																																																																		0			8.8966	0.442232377	0.611346717	0	1.549553399	2.623173333	2.476058982	2.132591461	10.31356723	0	4.844935959	0.005726021	0.000727086	0	8.693164674	6.23607921	1.368891882	1.022439531	0	0	2.439796851	0.052674677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.7096
H5006_017_3	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	809.8669621	45.2066322	225.4160065	19.37215503	146.4871936	15.65986511	16.56381763	519.0225611	78.2211091	31.11119792	41.51098763	0.002562018	0.06482448	0	4921.80396	2492.712066	1.084174061	6.747868747	0	5.321112029	21.82757098	0.134593319																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			NO	150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																				10.1233	0.565082903	0.93923336	0	1.83108992	3.131973022	3.312763526	2.162594004	11.73316637	0	6.226648144	0.001281009	0.009723672	0	8.203006601	8.309040219	0.54208703	1.012180312	0	0	4.365514197	0.020188998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4889			10.1233	0.565082903	0.93923336	0	1.83108992	3.131973022	3.312763526	2.162594004	11.73316637	0	6.226648144	0.001281009	0.009723672	0	8.203006601	8.309040219	0.54208703	1.012180312	0	0	4.365514197	0.020188998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4889	NO																																																																																		0			10.1233	0.565082903	0.93923336	0	1.83108992	3.131973022	3.312763526	2.162594004	11.73316637	0	6.226648144	0.001281009	0.009723672	0	8.203006601	8.309040219	0.54208703	1.012180312	0	0	4.365514197	0.020188998	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4889
H5006_018_1	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	858.2463353	25.69473865	487.4772111	25.13338001	200.3283555	13.41594899	11.75531268	609.2381457	82.04514598	25.65012208	28.78725043	0.010904611	0.112961802	0.019971162	4558.866814	2115.997849	1.863779926	6.613150412	0	4.306903547	20.35534992	0.537612179																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			200	200	50	0	100	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			NO	181.0639108	181.0639108	45.26597771	0	90.53195542	0.181063911	0.181063911	45.26597771	0.135797933	0	0.135797933	0.452659777	0.135797933	0.452659777	18.10639108	36.21278217	0.452659777	0.135797933	36.21278217	0	0.181063911	0.135797933																				12.9498	0.387699156	1.838844381	0	1.511343146	2.429144192	2.128462887	2.298146693	11.14156125	0	3.909249109	0.004936079	0.015339979	0.009040142	6.878718786	6.385514097	0.843658206	0.898052157	0	0	3.685619263	0.073006623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3881		6	12.9498	0.387699156	1.838844381	0	1.511343146	2.429144192	2.128462887	2.298146693	11.14156125	0	3.909249109	0.004936079	0.015339979	0.009040142	6.878718786	6.385514097	0.843658206	0.898052157	0	0	3.685619263	0.073006623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3881	YES																																									5000																																									0			12.9498	0.387699156	1.838844381	0	1.511343146	2.429144192	2.128462887	2.298146693	11.14156125	0	3.909249109	0.004936079	0.015339979	0.009040142	6.878718786	6.385514097	0.843658206	0.898052157	0	0	3.685619263	0.073006623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3881
H5006_018_2	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	838.3360138	21.9692174	350.0413513	19.65558635	196.1348523	14.55689411	14.99492865	544.490218	88.03514397	25.14491101	26.56616761	0.001625246	0.004114703	0	5482.543392	1786.650744	1.023697407	5.693471292	0	4.34159628	18.28602633	0.578987722																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			200	200	50	0	100	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			NO	181.2055193	181.2055193	45.30137983	0	90.60275967	0.181205519	0.181205519	45.30137983	0.13590414	0	0.13590414	0.453013798	0.13590414	0	18.12055193	36.24110387	0.453013798	0.13590414	36.24110387	0	0.181205519	0.13590414																				12.6593	0.331745287	1.321446351	0	1.480863241	2.637789558	2.717163833	2.055513182	11.96434049	0	3.610452149	0.000736259	0.000559205	0	8.278892689	5.395849599	0.463749051	0.773766317	0	0	3.313528898	0.078686828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0843		6.067827586	12.6593	0.331745287	1.321446351	0	1.480863241	2.637789558	2.717163833	2.055513182	11.96434049	0	3.610452149	0.000736259	0.000559205	0	8.278892689	5.395849599	0.463749051	0.773766317	0	0	3.313528898	0.078686828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0843	YES																																									5000																																									0			12.6593	0.331745287	1.321446351	0	1.480863241	2.637789558	2.717163833	2.055513182	11.96434049	0	3.610452149	0.000736259	0.000559205	0	8.278892689	5.395849599	0.463749051	0.773766317	0	0	3.313528898	0.078686828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0843
H5006_018_3	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	903.0651204	14.80868737	518.7326866	14.45593498	232.0530798	12.40915682	13.08985644	641.6434019	91.37726299	28.30619755	33.31432903	0.000320448	0.331356916	0	5013.119195	2516.729542	1.351612366	7.647325567	0	4.661933219	23.66996801	0.677518472																				$200 - days 1-5	$200 - days 1-5	$50 - days 11-100	0% Coinsurance	$100 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			200	200	50	0	100	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			NO	178.9907926	178.9907926	44.74769815	0	89.4953963	0.178990793	0.178990793	44.74769815	0.134243094	0	0.134243094	0.447476981	0.134243094	0	17.89907926	35.79815852	0.447476981	0.134243094	35.79815852	0	0.178990793	0.134243094																				13.47	0.220884891	1.93434114	0	1.730640195	2.221124815	2.342963778	2.392672105	12.26676655	0	4.472218618	0.000143393	0.044482378	0	7.477518151	7.507856923	0.604815422	1.026600648	0	0	4.236706335	0.090952176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0407		7.282085581	13.47	0.220884891	1.93434114	0	1.730640195	2.221124815	2.342963778	2.392672105	12.26676655	0	4.472218618	0.000143393	0.044482378	0	7.477518151	7.507856923	0.604815422	1.026600648	0	0	4.236706335	0.090952176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0407	YES																																									5000																																									0			13.47	0.220884891	1.93434114	0	1.730640195	2.221124815	2.342963778	2.392672105	12.26676655	0	4.472218618	0.000143393	0.044482378	0	7.477518151	7.507856923	0.604815422	1.026600648	0	0	4.236706335	0.090952176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.0407
H5006_801_0	2010	2	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	V	Coin	Coin																																																											0	NO	885.0875962	25.65683167	503.199039	24.3804197	212.7259498	14.22490947	12.97250542	607.2307467	88.24972728	0	30.87580726	0.00836387	0.162440688	0.014851368	4747.270134	2155.756885	1.85880283	7.189175557	0	0.219531123	21.61847654	0.607108911																				$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	$40 Per Visit	$40 Per Visit	20% Coinsurance	20% 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	40	40	0.2	0.2																			NO	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	40	40	0.2	0.2																				18.4393	0.534517326	3.144993994	4.876083941	2.659074372	2.844981894	2.594501085	2.530128111	17.64994546	0	6.175161453	0.004181935	0.032488138	0.002970274	7.91211689	7.185856282	0.929401415	1.437835111	0	0.00073177	4.323695308	0.121421782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3994			18.4393	0.534517326	3.144993994	4.876083941	2.659074372	2.844981894	2.594501085	2.530128111	17.64994546	0	6.175161453	0.004181935	0.032488138	0.002970274	7.91211689	7.185856282	0.929401415	1.437835111	0	0.00073177	4.323695308	0.121421782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3994	NO																																																																																		0			18.4393	0.534517326	3.144993994	4.876083941	2.659074372	2.844981894	2.594501085	2.530128111	17.64994546	0	6.175161453	0.004181935	0.032488138	0.002970274	7.91211689	7.185856282	0.929401415	1.437835111	0	0.00073177	4.323695308	0.121421782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3994
H5006_803_0	2010	2	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	V	Coin	Coin																																																											0	NO	885.0875962	25.65683167	503.199039	24.3804197	212.7259498	14.22490947	12.97250542	607.2307467	88.24972728	0	30.87580726	0.00836387	0.162440688	0.014851368	4747.270134	2155.756885	1.85880283	7.189175557	0	0.219531123	21.61847654	0.607108911																				$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	$40 Per Visit	$40 Per Visit	20% Coinsurance	20% 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	40	40	0.2	0.2																			NO	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	40	40	0.2	0.2																				18.4393	0.534517326	3.144993994	4.876083941	2.659074372	2.844981894	2.594501085	2.530128111	17.64994546	0	6.175161453	0.004181935	0.032488138	0.002970274	7.91211689	7.185856282	0.929401415	1.437835111	0	0.00073177	4.323695308	0.121421782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3994			18.4393	0.534517326	3.144993994	4.876083941	2.659074372	2.844981894	2.594501085	2.530128111	17.64994546	0	6.175161453	0.004181935	0.032488138	0.002970274	7.91211689	7.185856282	0.929401415	1.437835111	0	0.00073177	4.323695308	0.121421782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3994	NO																																																																																		0			18.4393	0.534517326	3.144993994	4.876083941	2.659074372	2.844981894	2.594501085	2.530128111	17.64994546	0	6.175161453	0.004181935	0.032488138	0.002970274	7.91211689	7.185856282	0.929401415	1.437835111	0	0.00073177	4.323695308	0.121421782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3994
H5008_001_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	289.6575371	37.46390273	10887.33734	131.5426996	23.58870625	15.35851565	16.23808434	16.67758733	7.814939786	37.25117475	25.25070913	0	0.014024253	9.09651471	1.436610291	111.1775615	15.4849482	22.52914221	0	0	5.307309451	8.337086939	475.2267957	0	144.5027641	125.0028314	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071187171	0.072051793	0	0	0.2	0.2	0.091907082	0.050214207	0.2	0	0.068420304	0	0.2	0.151281954	0.001941698	0.198721702	0.075334608	0	0	0	0.2	0.190902418	0	0	0	0	0	0	0	0											NO	0.071187171	0.072051793	0	0	0.2	0.2	0.091907082	0.050214207	0.2	0	0.068420304	0	0.2	0.151281954	0.001941698	0.198721702	0.075334608	0	0	0	0.2	0.190902418	0	0	0	0	0	0	0	0												20.6199	2.699341362	0	0	4.71774125	3.071703129	1.49239495	0.837451825	1.562987957	0	1.7276612	0	0.002804851	1.376138518	0.002789463	22.09339423	1.166552503	0	0	0	1.06146189	1.591570056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0239	0	0	20.6199	2.699341362	0	0	4.71774125	3.071703129	1.49239495	0.837451825	1.562987957	0	1.7276612	0	0.002804851	1.376138518	0.002789463	22.09339423	1.166552503	0	0	0	1.06146189	1.591570056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0239	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.6199	2.699341362	0	0	4.71774125	3.071703129	1.49239495	0.837451825	1.562987957	0	1.7276612	0	0.002804851	1.376138518	0.002789463	22.09339423	1.166552503	0	0	0	1.06146189	1.591570056	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0239
H5008_002_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5747	0.6741	0.5141	0	1.238	0	1.4105	0	0.0014	0.763	1.2438	4.5833	0.3622	0.1724	0	0	0.7151	0.1597	0	0	0	0	0	0	0	0											12.4122	NO	341.1077165	19.02354597	88.6084409	1121.446181	15.46824093	18.33469772	13.94993185	35.86345211	33.30148155	17.56329396	38.07021179	0	0.040443056	20.72291052	36.60054259	124.0181476	9.443952858	4.627539193	0	0	19.56592986	4.76165576	478.5634408	147.5087789	172.5999562	171.6430353	0	0	67.14192696	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07107375	0.071936994	0.144387017	0	0.192596095	0.192596095	0.192596095	0.088707812	0.192596095	0	0.160426512	0	0.192596095	0.143873388	0.161115038	0.192378867	0.192596095	0	0	0	0.192596095	0.192903504	0	0	0	0	0	0	0	0											NO	0.07107375	0.071936994	0.144387017	0	0.192596095	0.192596095	0.192596095	0.088707812	0.192596095	0	0.160426512	0	0.192596095	0.143873388	0.161115038	0.192378867	0.192596095	0	0	0	0.192596095	0.192903504	0	0	0	0	0	0	0	0												24.2438	1.36849671	12.79390845	0	2.979122799	3.531191182	2.686702399	3.181368358	6.413735302	0	6.107471286	0	0.007789175	2.981475337	5.896897794	23.85847077	1.818868441	0	0	0	3.768321684	0.91854008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.5562	146	0	24.2438	1.36849671	12.79390845	0	3.553856258	4.205329744	3.200757371	3.181368358	7.651691536	0	7.517923678	0	0.009222951	3.744465769	7.140673761	28.44175634	2.181060008	0.172397921	0	0	4.48344272	1.078201872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9684	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	24.2438	1.36849671	12.79390845	0	3.553856258	4.205329744	3.200757371	3.181368358	7.651691536	0	7.517923678	0	0.009222951	3.744465769	7.140673761	28.44175634	2.181060008	0.172397921	0	0	4.48344272	1.078201872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.9684
H5008_004_0	2010	3	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1819.050264	227.9643416	56.24579504	564.7821256	269.2173343	12.50491349	14.60282381	463.6701059	51.6191187	13107.76822	52.6932886	0	0.0961649	29.11012083	9138.916526	5949.335307	1011.466489	498.1639771	0	0	26.62602663	1158.442452	668.514751	0	260.6351762	168.1480604	17.37376748	4.775105365	78.78923852	0											3900	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	0.142188556	0	150	0.2	0.092563685	49.42078478	0.2	3	0.171866875	0	0.2	0.149254061	7.04863467	34.9501018	38.5	35	0	0	0.2	34.48621111	0	0	35	30	0	0	0	0											NO	151.0059211	111.3458571	0.10681963	0	112.6880034	0.150250671	0.069538779	37.12753043	0.150250671	2.253760069	0.129115566	0	0.150250671	0.112396416	6.936167514	34.9501018	38.5	26.29386747	0	0	0.150250671	34.48621111	0	0	35	30	0	0	0	0												22.8906	2.115240416	6.008154989	0	2.528130324	1.878871646	1.015462534	1.434577164	7.755807234	2.461813717	6.803523799	0	0.014448841	3.271873239	5.282421327	17.32748955	3.245121652	1.091554799	0	0	4.000578374	3.329190913	0	0	0.760185931	0.420370151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6354	0	21.02470969	22.8906	2.115240416	6.008154989	0	2.528130324	1.878871646	1.015462534	1.434577164	7.755807234	2.461813717	6.803523799	0	0.014448841	3.271873239	5.282421327	17.32748955	3.245121652	1.091554799	0	0	4.000578374	3.329190913	0	0	0.760185931	0.420370151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6354	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.8906	2.115240416	6.008154989	0	2.528130324	1.878871646	1.015462534	1.434577164	7.755807234	2.461813717	6.803523799	0	0.014448841	3.271873239	5.282421327	17.32748955	3.245121652	1.091554799	0	0	4.000578374	3.329190913	0	0	0.760185931	0.420370151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.6354
H5008_006_0	2010	3	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2080.677382	208.0994548	38.58030829	1129.560729	250.4134521	17.98534773	16.57309929	515.2694505	46.72024947	14614.46348	49.4517113	0	0.187462751	26.39617823	8999.179753	6169.633754	979.6721564	464.4253147	0	0	26.7835998	1217.571565	654.9554252	0	154.2611156	175.3719891	17.02137949	4.678253037	77.19117511	0											2700	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	0.156700721	0	150	0.2	0.105394544	49.46291777	0.2	3	0.174931382	0	0.2	0.149513016	6.879388978	25	38.5	25	0	0	0.2	24.76345973	0	0	25	0	0	0	0	0											NO	111.1286146	84.63790553	0.105019519	0	100.5287512	0.134038335	0.070634546	33.1496357	0.134038335	2.010575024	0.117237556	0	0.134038335	0.100586696	6.749352035	25	38.5	16.75479187	0	0	0.134038335	24.76345973	0	0	25	0	0	0	0	0												19.2686	1.467758499	4.05168541	0	2.097812636	2.410726063	1.170633344	1.423416214	6.262304448	2.448622939	5.797597759	0	0.025127195	2.655104347	5.061552681	12.85340366	3.143114835	0.64844579	0	0	3.590029121	2.512607034	0	0	0.321377324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2099	0	26.3206433	19.2686	1.467758499	4.05168541	0	2.097812636	2.410726063	1.170633344	1.423416214	6.262304448	2.448622939	5.797597759	0	0.025127195	2.655104347	5.061552681	12.85340366	3.143114835	0.64844579	0	0	3.590029121	2.512607034	0	0	0.321377324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2099	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.2686	1.467758499	4.05168541	0	2.097812636	2.410726063	1.170633344	1.423416214	6.262304448	2.448622939	5.797597759	0	0.025127195	2.655104347	5.061552681	12.85340366	3.143114835	0.64844579	0	0	3.590029121	2.512607034	0	0	0.321377324	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2099
H5009_001_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	347.4692413	9.431996395	0	0	28.03009123	0	0	137.9746591	218.4893853	0	0	0	0	322.4017	3500.351997	3007.630757	160.9715758	909.3404194	0	1272.771154	0	0	0	0	216.1449937	0	0	0	0	0											2000	$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical;	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals; $10/Procedure for PCP - Cardio;	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											125	125	0	0	100	0	0	49.5403157	100	0	0	0	0	10	10	10	10	10	0	10	0	0	0	0	10	0	0	0	0	0											YES	123.9094983	123.9094983	0	0	99.12759864	0	0	49.10812531	99.12759863	0	0	0	0	9.912759864	9.912759864	9.912759863	9.91275987	9.912759863	0	9.912759863	0	0	0	0	9.912759861	0	0	0	0	0											3500	3.5879	0.097392828	0	0	0.231546303	0	0	0.564639738	1.804860674	0	0	0	0	0.266324219	2.891512399	2.484493454	0.132972715	0.751172768	0	1.051389567	0	0	0	0	0.178549451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.0427	0	0.123587312	3.5879	0.097392828	0	0	0.231546303	0	0	0.564639738	1.804860674	0	0	0	0	0.266324219	2.891512399	2.484493454	0.132972715	0.751172768	0	1.051389567	0	0	0	0	0.178549451	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.0427	NO	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical;	$225/Days 1-5 for IP Psych; $225/Days 1-5 for IP Substance Abuse;	$25/Days Custom for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.2782	0.0094	0.4569	0.0428	0.5555	0.0355	0.0105	0.0841	0.1376	0.1546	0.1819	0	0	0.0764	0.2707	0.3334	0.0852	0.0493	0.1292	0.3173	0	0	0	0	0.0198	0	0	0	0	0											3.2286	0	0.026376393	3.8661	0.106840711	0.456917951	0.042823653	0.787015789	0.035504243	0.010526001	0.648751441	1.942483916	0.154617415	0.181916304	0	0	0.342735782	3.162202569	2.81792743	0.218189482	0.800486347	0.129229951	1.368694295	0	0	0	0	0.198393027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.2714
H5009_002_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	O											1.1725	0.0082	0.179	0.061	0	0.0669	0.0104	0.1181	0.3475	0.0337	0.1103	0	0.0001	0.1093	0.3772	0.4549	0.0192	0.0573	0.1565	0.1807	0.0918	0.0067	0	0	0.0137	0.0043	0	0	0	0											3.5794	YES	447.3850945	9.280533175	759.7807928	10.9238504	0	11.98479659	1.700900336	240.8950268	525.7517928	6.037794923	0	0	0.016288064	402.9215544	4090.661171	3349.57548	382.7860927	1422.112746	0	1389.473535	16.43553484	0	0	0	201.0522925	0	0	0	0	0											2500	$175/Days 1-5 for IP Medical; $175/Days 1-5 for IP Surgical;	$175/Days 1-5 for IP Psych; $175/Days 1-5 for IP Substance Abuse;	$10/Day for SNF	10% Coinsurance for Home Health	No Cost-Sharing	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $35/Visit for Urgent Care; $35/Visit for Urgent Care - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams;	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											175	175	10	0.1	0	0.061263419	0.1	50	200	0.1	0	0	0.1	25	25	25	25	25	0	25	0.000227823	0	0	0	25	0	0	0	0	0											YES	168.2407738	168.2407737	9.6137585	0.096137585	0	0.058897171	0.096137585	48.06879251	192.27517	0.096137585	0	0	0.096137582	24.03439625	24.03439625	24.03439625	24.03439625	24.03439625	0	24.03439625	0.000219023	0	0	0	24.03439625	0	0	0	0	0											4000	6.2724	0.130113674	0.608695755	1.050192596	0	0.705870616	0.163520451	0.964961088	8.424084612	0.580459023	0	0	0.001565895	0.806998025	8.193047626	6.70875203	0.766669386	2.848301772	0	2.782929793	0.003599765	0	0	0	0.402680872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4148	50	1.663877728	7.4448	0.138321026	0.787652909	1.111202464	0	0.772805884	0.17392378	1.083045226	8.771561602	0.614180198	0.110317481	0	0.001656864	0.916301123	8.570288394	7.16365315	0.785887764	2.905632266	0.156462333	2.963630306	0.095392473	0.006727735	0	0	0.416378794	0.004337436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9942	NO	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	No Cost-Sharing	$30/Days Custom for SNF	20% Coinsurance for Home Health	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$300/Case for OP Fac - Surgery; $300/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$35/Case for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; $35/Procedure for PCP - Cardio;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults; $35/Procedure for Speclst - Cardio;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.2862	0	0.5354	0.0321	1.2097	0.1864	0.0051	0.1546	0.2483	0.3481	0.7279	0	0	0.2253	0.3612	0.4704	0.2518	0.087	0.3567	0.8805	0.0156	0.0001	0	0.0884	0.011	0.0051	0	0	0	0											6.4868	50	0.156727012	7.7311	0.138321026	1.323052838	1.143346552	1.20965436	0.959226187	0.179045464	1.237634499	9.019842688	0.962321204	0.838262866	0	0.001656864	1.141560405	8.931537889	7.634061109	1.037643248	2.992589933	0.51320902	3.844082671	0.110952409	0.006778572	0	0.088378043	0.427384566	0.009435958	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.481
H5009_004_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	487.7389267	6.776913034	0	0	0	0	0	275.5022119	298.7062758	0	0	0	0	435.7953425	5257.848776	4133.765419	397.4893249	1657.134903	0	1556.46114	0	0	0	0	237.7346885	0	0	0	0	0											2000	$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical;	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals; $10/Procedure for PCP - Cardio;	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											125	125	0	0	0	0	0	50	100	0	0	0	0	10	10	10	10	10	0	10	0	0	0	0	10	0	0	0	0	0											YES	122.8886283	122.8886282	0	0	0	0	0	49.15545131	98.31090262	0	0	0	0	9.831090265	9.831090262	9.831090262	9.831090262	9.831090262	0	9.831090262	0	0	0	0	9.83109026	0	0	0	0	0											3500	4.9948	0.069400462	0	0	0	0	0	1.128536297	2.447173633	0	0	0	0	0.357028612	4.307532159	3.386618413	0.325646119	1.357620234	0	1.275142496	0	0	0	0	0.194765932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.8443	0	0.340947844	4.9948	0.069400462	0	0	0	0	0	1.128536297	2.447173633	0	0	0	0	0.357028612	4.307532159	3.386618413	0.325646119	1.357620234	0	1.275142496	0	0	0	0	0.194765932	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.8443	NO	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical;	$225/Days 1-5 for IP Psych; $225/Days 1-5 for IP Substance Abuse;	$25/Days Custom for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.2317	0.0831	0.4209	0.0122	1.057	0.0681	0.0104	0.1428	0.2128	0.3331	0.4876	0	0	0.1066	0.2755	0.3889	0.1424	0.1019	0.2293	0.517	0	0	0	0	0.0086	0	0	0	0	0											4.8298	0	0.105126643	5.2265	0.152465586	0.420948383	0.012159523	1.057009462	0.068131297	0.010371605	1.271339093	2.660008635	0.333066569	0.487563087	0	0	0.463628657	4.582987986	3.775491558	0.468064113	1.459567203	0.229254108	1.792173473	0	0	0	0	0.203393598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.6741
H5010_001_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	509.557359	28.1510349	0	0	157.9133792	0	0	126.6861294	225.8155997	0	0	0	0	212.9982903	2869.01597	3402.41433	131.3309542	1054.827732	0	1001.660154	0	0	0	0	291.7013765	0	0	0	0	0											2000	$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical;	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals; $10/Procedure for PCP - Cardio;	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											125	125	0	0	100	0	0	48.12350772	100	0	0	0	0	10	10	10	10	10	0	10	0	0	0	0	10	0	0	0	0	0											YES	123.4457803	123.4457803	0	0	98.75662425	0	0	47.5251517	98.75662425	0	0	0	0	9.875662427	9.875662425	9.875662425	9.875662437	9.875662425	0	9.875662425	0	0	0	0	9.875662424	0	0	0	0	0											3500	5.2419	0.289593872	0	0	1.299582688	0	0	0.50173146	1.85839886	0	0	0	0	0.175291601	2.361119434	2.800091279	0.108081681	0.86809355	0	0.824338129	0	0	0	0	0.240062027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.5683	0	0.208599612	5.2419	0.289593872	0	0	1.299582688	0	0	0.50173146	1.85839886	0	0	0	0	0.175291601	2.361119434	2.800091279	0.108081681	0.86809355	0	0.824338129	0	0	0	0	0.240062027	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.5683	NO	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical;	$225/Days 1-5 for IP Psych; $225/Days 1-5 for IP Substance Abuse;	$25/Days Custom for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0.8944	0.0373	0.6132	0.1537	0.239	0.0144	0.0553	0.1145	0.6654	0.0459	0.0684	0	0	0.0659	0.4726	0.6796	0.0244	0.1155	0.3086	0.403	0	0	0	0	0.0541	0	0	0	0	0											5.025	0	0.090507222	6.1362	0.326871524	0.613230919	0.153670758	1.538535815	0.014364784	0.055290711	0.616190122	2.523787347	0.0458606	0.068416801	0	0	0.241206461	2.833717961	3.479713494	0.132495472	0.983580995	0.308564237	1.227336166	0	0	0	0	0.294172616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.5932
H5010_002_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	O											1.2032	0.0179	0.1947	0.1046	0.0248	0.0846	0.0222	0.0942	0.3047	0.0271	0.0523	0	0.0011	0.1135	0.2615	0.4939	0.0106	0.047	0.1923	0.2059	0.0431	0.0023	0	0	0.014	0.0089	0	0	0	0											3.524	YES	452.8431213	17.85543064	820.6171493	18.5558657	130.3824248	15.00626857	3.58583505	300.4906978	468.255763	4.812688976	0	0	0.194593222	384.0170222	3395.199654	3715.361272	226.4782667	1495.733558	0	1330.090944	7.647301579	0	0	0	237.9328311	0	0	0	0	0											2500	$175/Days 1-5 for IP Medical; $175/Days 1-5 for IP Surgical;	$175/Days 1-5 for IP Psych; $175/Days 1-5 for IP Substance Abuse;	$10/Day for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $35/Visit for Urgent Care; $35/Visit for Urgent Care - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	No Cost-Sharing	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Visit for Prof - CORF;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams;	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											175	175	10	0.1	100	0.068598969	0.1	49.62654525	200	0.1	0	0	0.1	25	25	25	25	25	0	25	0.000712787	0	0	0	25	0	0	0	0	0											YES	167.9380881	167.9380881	9.596462178	0.095964622	95.96462179	0.065830741	0.095964622	47.62392646	191.9292436	0.095964622	0	0	0.095964621	23.99115544	23.99115545	23.99115545	23.99115544	23.99115545	0	23.99115545	0.000684024	0	0	0	23.99115545	0	0	0	0	0											4000	6.3375	0.249883907	0.656251786	1.780706634	1.042675007	0.987873782	0.344113304	1.192545574	7.489331199	0.461847877	0	0	0.018674065	0.767751006	6.787896889	7.427984151	0.452789608	2.990364692	0	2.65920155	0.005230936	0	0	0	0.475690295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1283	50	1.771523073	7.5406	0.267758957	0.850932801	1.885279072	1.06743997	1.072442302	0.366343452	1.28669687	7.794012321	0.488970008	0.052311021	0	0.019770704	0.881239311	7.049347656	7.92186429	0.463340643	3.037346811	0.192276693	2.86512673	0.048327657	0.002307409	0	0	0.489667816	0.008853994	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6523	NO	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$30/Days Custom for SNF	20% Coinsurance for Home Health	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$300/Case for OP Fac - Surgery; $300/Case for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	10% Coinsurance for Renal Dialysis - Fac; 10% Coinsurance for Renal Dialysis - Prof	$35/Case for OP Fac - Cardiovascular; $35/Case for OP Fac - Occ Therapy; $35/Case for OP Fac - Physical/Speech Therapy;	$35/Visit for PCP - Office Visits; $35/Consult for PCP - Consults; $35/Exam for PCP - Routine Physicals; $35/Procedure for PCP - Cardio;	$35/Visit for Speclst - Office Visits; $35/Consult for Speclst - Consults; $35/Procedure for Speclst - Cardio;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$35/Visit for PT/ST (PCP); $35/Visit for Occ Therapy (PCP); $35/Visit for PT/ST (Specialist); $35/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$35/Visit for Chiropractor; $35/Exam for Vision Exams; $35/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (IP); 20% Coinsurance for Prof Path (OP); 20% Coinsurance for Prof Path (Office); 20% Coinsurance for Prof Path (Labs)	10% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$35/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												1.0244	0.0338	0.8568	0.6695	0.6581	0.2304	0.0794	0.1606	0.8109	0.0838	0.1915	0	0.0021	0.1345	0.9207	1.1697	0.531	0.4687	0.5536	0.705	0.0234	0.0001	0	0.0778	0.0612	0.0037	0	0	0	0											9.4507	50	0.354800346	8.5651	0.301542612	1.707707535	2.554765339	1.725528655	1.302801403	0.445771389	1.44730019	8.60490794	0.572736667	0.243824118	0	0.021894931	1.015692156	7.970057985	9.091581083	0.994345982	3.506037656	0.74591544	3.57014664	0.07174346	0.002448429	0	0.07782757	0.550847765	0.012516937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.103
H5010_004_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	YES	754.430716	22.07703236	0	0	122.6337661	0	0	357.2544918	246.3886823	0	0	0	0	411.8010406	4267.890157	4137.694862	231.2869046	1444.437266	0	1558.01273	0	0	0	0	247.7033952	0	0	0	0	0											2000	$125/Days 1-5 for IP Medical; $125/Days 1-5 for IP Surgical;	$125/Days 1-5 for IP Psych; $125/Days 1-5 for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$100/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $25/Visit for Urgent Care; $25/Visit for Urgent Care - Worldwide;	$100/Case for OP Fac - Surgery;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals; $10/Procedure for PCP - Cardio;	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults; $10/Procedure for Speclst - Cardio;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											125	125	0	0	100	0	0	49.47464373	100	0	0	0	0	10	10	10	10	10	0	10	0	0	0	0	10	0	0	0	0	0											YES	122.2769494	122.2769494	0	0	97.82155954	0	0	48.39686807	97.82155954	0	0	0	0	9.782155951	9.782155954	9.782155954	9.782155957	9.782155955	0	9.782155954	0	0	0	0	9.782155955	0	0	0	0	0											3500	7.6875	0.224959347	0	0	0.999685521	0	0	1.440833209	2.00851043	0	0	0	0	0.335691833	3.479097259	3.372964703	0.188540381	1.177475884	0	1.270060292	0	0	0	0	0.20192277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3872	0	0.498552466	7.6875	0.224959347	0	0	0.999685521	0	0	1.440833209	2.00851043	0	0	0	0	0.335691833	3.479097259	3.372964703	0.188540381	1.177475884	0	1.270060292	0	0	0	0	0.20192277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3872	NO	$225/Days 1-5 for IP Medical; $225/Days 1-5 for IP Surgical;	$225/Days 1-5 for IP Psych; $225/Days 1-5 for IP Substance Abuse;	$25/Days Custom for SNF	10% Coinsurance for Home Health	$100/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	10% Coinsurance for OP Fac - Pathology	10% Coinsurance for OP Fac - Radiology; 10% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy;	$25/Visit for PCP - Office Visits; $25/Consult for PCP - Consults; $25/Exam for PCP - Routine Physicals; $25/Procedure for PCP - Cardio;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults; $25/Procedure for Speclst - Cardio;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	10% Coinsurance for Prof Radiology (IP); 10% Coinsurance for Prof Radiology (OP); 10% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams; 10% Coinsurance for Prof Path (IP); 10% Coinsurance for Prof Path (OP); 10% Coinsurance for Prof Path (Office); 10% Coinsurance for Prof Path (Labs)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												1.34	0.029	0.4795	0.0533	0.5483	0.2244	0.0354	0.1232	0.3192	0.0556	0.239	0	0	0.0754	0.6352	0.8526	0.271	0.2084	0.4602	0.4492	0	0	0	0	0.0445	0	0	0	0	0											6.4433	0	0.164270311	9.0275	0.25392626	0.479453201	0.053338204	1.547937386	0.22436868	0.035401656	1.563989344	2.327723545	0.055638122	0.23902165	0	0	0.411109666	4.114263801	4.225515975	0.459495161	1.385850855	0.46018939	1.719292382	0	0	0	0	0.246453023	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8305
H5041_001_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	O	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	YES	1201.501536	54.730578	653.538041	509.855044	42.895789	8.713411	4.082574	335.888611	417.064103	1429.319107	1037.116046	95.545355	0.04087	587.299305	3645.4201	4192.313949	79.015395	684.891656			17.290555	0		2.74					0.04	0.25	9.424321	0.05	0.55	1.17	0.32	0.4	0.42				4000	$195/Day(Days 1-8):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				144.519765	121.67922	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0					0	0	0	0	0	0	0	0	0				NO	119.792578	100.860027	24.195776	0	123.6258	0.164834	0.164834	41.2086	108.66055	64.177348	84.436594	123.6258	0.164834	93.968467	8.24172	24.72516	24.72516	41.711812			0.164834	0		0					0	0	0	0	0	0	0	0	0					11.9942	0.460010631	1.317738337	0	0.441918853	1.436266389	0.672947003	1.153458285	3.776534568	7.644159144	7.297545542	0.984322579	0.006736766	4.598967947	2.503710979	8.63796943	0.16280569	2.380672666	0	0	2.850071343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3201	0	13.521147	11.9942	0.460010631	1.317738337	0	0.441918853	1.436266389	0.672947003	1.153458285	3.776534568	7.644159144	7.297545542	0.984322579	0.006736766	4.598967947	2.503710979	8.63796943	0.16280569	2.380672666	0	0	2.850071343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3201	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.9996	0.0951	0.3175	1.7038	1.9525	1.569	0.7351	0.2248	3.0254	0.4013	1.2878	0.2156	0.0014	0.8762	1.5391	2.6426	0.0262	0.2549			0.7637	0		0					0	0	0	0	0	0	0	0	0				24.6317	500	12.759631	18.9938	0.555111631	1.635256337	1.703752	2.394416853	3.005274389	1.408089003	1.378292285	6.801958568	8.045438144	8.585383542	1.199873579	0.008118766	5.475133947	4.042805979	11.28056743	0.18903569	2.635607666	0	0	3.613781343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9517
H5041_002_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	P	O	O	O	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	YES	1097.82736	50.008031	597.146089	465.861091	39.194433	7.685189	3.600813	306.905731	381.076819	1305.987195	947.626232	87.301016	0.036048	536.622907	3330.867089	3830.571012	72.197379	625.794288			15.250191	0			2.69				0.04	0.25	8.611122	0.05	0.55	1.17	0.32	0.4	0.42				3400	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0			0				0	0	0	0	0	0	0	0	0				NO	101.664047	89.907933	25.713243	0	122.6262	0.163502	0.163502	40.8754	107.781954	63.65843	83.753866	122.6262	0.163502	93.208667	8.17508	24.52524	24.52524	41.374543			0.163502	0			0				0	0	0	0	0	0	0	0	0					9.3008	0.374676558	1.279546874	0	0.400522032	1.256543772	0.588740127	1.045407876	3.422767015	6.928091203	6.613946704	0.892115987	0.00589392	4.16815882	2.26917541	7.828806117	0.147554837	2.157662723	0	0	2.493436729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1738	0	12.300282	9.3008	0.374676558	1.279546874	0	0.400522032	1.256543772	0.588740127	1.045407876	3.422767015	6.928091203	6.613946704	0.892115987	0.00589392	4.16815882	2.26917541	7.828806117	0.147554837	2.157662723	0	0	2.493436729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1738	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins			"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.8127	0.0926	0.3326	1.5921	1.8901	1.4661	0.6869	0.2177	2.8271	0.375	1.2034	0.2014	0.0013	0.8187	1.4382	2.4694	0.0245	0.2382			0.7136	0			0				0	0	0	0	0	0	0	0	0				23.4016	500	10.127777	16.1135	0.467238558	1.612111874	1.592057	2.290628032	2.722690772	1.275687127	1.263057876	6.249849015	7.303062203	7.817355704	1.093535987	0.00718492	4.98688482	3.70736941	10.29816012	0.172064837	2.395885723	0	0	3.207079729	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5754
H5041_801_0	2010	4	N/A																															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	NO	247.290957	0.843536	42.936787	13.874405	1.627062	7.523318	3.677492	18.13888	51.649064	11.150408	26.583425	9.397397	0.825622	17.014505	31.576776	69.251052	0.332784	5.153457			22.50825	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																			0.077814097	0.077814097	0.179215383	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.077814097	0.077814097	0.179215383	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.2427	0.065638992	7.694932743	0	0.379105446	1.752933094	0.856855636	4.22635904	12.03423191	2.598045064	6.193938025	2.189593501	0.192369926	3.964379665	7.357388808	16.13549512	0.077538672	1.200755481	0	0	5.24442225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4067	0	0	19.2427	0.065638992	7.694932743	0	0.379105446	1.752933094	0.856855636	4.22635904	12.03423191	2.598045064	6.193938025	2.189593501	0.192369926	3.964379665	7.357388808	16.13549512	0.077538672	1.200755481	0	0	5.24442225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4067	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.5821	0.0122	1.4325	0	1.5164	1.1558	0.5649	1.1143	2.8998	0.685	1.485	0.5773	0.0507	1.0375	1.3862	3.0402	0.0146	0.2578			0.9882	0																			21.8004	0	0	22.8248	0.077855805	9.127401303	0	1.895469446	2.908729594	1.421764136	5.34068154	14.93403341	3.283065064	7.678963525	2.766851001	0.243047426	5.001928665	8.743622308	19.17567912	0.092101172	1.458569981	0	0	6.23257525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.2072
H5041_802_0	2010	3	N/A																															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	NO	247.290957	0.843536	42.936787	13.874405	1.627062	7.523318	3.677492	18.13888	51.649064	11.150408	26.583425	9.397397	0.825622	17.014505	31.576776	69.251052	0.332784	5.153457			22.50825	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																			0.077813829	0.077813829	0.179214684	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.077813829	0.077813829	0.179214684	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.2427	0.065638766	7.694902718	0	0.379105446	1.752933094	0.856855636	4.22635904	12.03423191	2.598045064	6.193938025	2.189593501	0.192369926	3.964379665	7.357388808	16.13549512	0.077538672	1.200755481	0	0	5.24442225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4066	0	0	19.2427	0.065638766	7.694902718	0	0.379105446	1.752933094	0.856855636	4.22635904	12.03423191	2.598045064	6.193938025	2.189593501	0.192369926	3.964379665	7.357388808	16.13549512	0.077538672	1.200755481	0	0	5.24442225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4066	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.5821	0.0122	1.4325	0	1.5164	1.1558	0.5649	1.1143	2.8998	0.685	1.485	0.5773	0.0507	1.0375	1.3862	3.0402	0.0146	0.2578			0.9882	0																			21.8004	0	0	22.8247	0.077855537	9.127365688	0	1.895469446	2.908729594	1.421764136	5.34068154	14.93403341	3.283065064	7.678963525	2.766851001	0.243047426	5.001928665	8.743622308	19.17567912	0.092101172	1.458569981	0	0	6.23257525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.207
H5041_803_0	2010	3	N/A																															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	NO	247.290957	0.843536	42.936787	13.874405	1.627062	7.523318	3.677492	18.13888	51.649064	11.150408	26.583425	9.397397	0.825622	17.014505	31.576776	69.251052	0.332784	5.153457			22.50825	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																			0.077813829	0.077813829	0.179214684	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.077813829	0.077813829	0.179214684	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.2427	0.065638766	7.694902718	0	0.379105446	1.752933094	0.856855636	4.22635904	12.03423191	2.598045064	6.193938025	2.189593501	0.192369926	3.964379665	7.357388808	16.13549512	0.077538672	1.200755481	0	0	5.24442225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4066	0	0	19.2427	0.065638766	7.694902718	0	0.379105446	1.752933094	0.856855636	4.22635904	12.03423191	2.598045064	6.193938025	2.189593501	0.192369926	3.964379665	7.357388808	16.13549512	0.077538672	1.200755481	0	0	5.24442225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4066	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.5821	0.0122	1.4325	0	1.5164	1.1558	0.5649	1.1143	2.8998	0.685	1.485	0.5773	0.0507	1.0375	1.3862	3.0402	0.0146	0.2578			0.9882	0																			21.8004	0	0	22.8247	0.077855537	9.127365688	0	1.895469446	2.908729594	1.421764136	5.34068154	14.93403341	3.283065064	7.678963525	2.766851001	0.243047426	5.001928665	8.743622308	19.17567912	0.092101172	1.458569981	0	0	6.23257525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.207
H5042_001_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	221.977613	9.5	587.3113255	648.212381	343.3528792	12.22120287	3.237850123	313.7236607	274.7239056				0.096618089	494.5511094	2904.542366	8584.323088	513.0497689	998.5104847			1100.885051				532.8448548																	1A: $500/admit - $1500 annual max	1B: $500/admit - $1500 annual max	"2: $10/day days 1-20, $40/day days 21-100"	"6: $0/day days 1-20, $20/day days 21+"	10A: $75	11A: 20%	11B: 20%	4A: $50; 4B: $15-$35	9A: $150	"8A: $0-$25 for lab, x-rays"	"8A: $0-$25 for lab, x-rays; 8B: $0-$25"		12: $25	7I: $25; 9C: $25	7A: $15;	"7B, 7D, 7F: $25, 18A: $25, 18B: $0 ($600 Limit)"	"7E, 7H: $25"	7C: $25; 7I: $25	"8A: $0-$25 for lab, x-rays"		15: $15			16A: $0 ($250 Limit)	17A: $25	17B: $0 ($100 Limit)			14A: $0-$25												500	444	19.33	2	37.5	0.2	0.2	40.92821059	150				25	25	15	25	25	25			7.5				12.5																YES	408.6866781	389.2120069	15.79982698	1.634746713	30.65150086	0.163474671	0.163474671	33.45362885	122.6060034				20.43433391	20.43433391	12.26060034	20.43433391	20.43433391	20.43433391			6.130300172				10.21716695																	7.5599	0.308126172	0.773284777	0.088305255	0.877023423	1.997857121	0.529306484	0.874599576	2.80690001	0	0	0	0.000164527	0.842151875	2.967619427	14.61791036	0.873652524	1.700324721	0	0	0.562396318	0	0	0	0.453680404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8332	0	8.427652917	7.5599	0.308126172	0.773284777	0.088305255	0.877023423	1.997857121	0.529306484	0.874599576	2.80690001	0	0	0	0.000164527	0.842151875	2.967619427	14.61791036	0.873652524	1.700324721	0	0	0.562396318	0	0	0	0.453680404	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8332	YES	1A: $750/admit - $2250 annual max	1B: $750/admit - $2250 annual max	"2: $10/day days 1-20, $40/day days 21-100"	"6: $0/day days 1-20, $20/day days 21+"	10A: $75	11A: 20%	11B: 20%	4A: $50; 4B: $15-$35	9A: $150	"8A: $0-$25 for lab, x-rays"	"8A: $0-$25 for lab, x-rays; 8B: $0-$25"		12: $25	7I: $25; 9C: $25	7A: $15;	"7B, 7D, 7F: $25"	"7E, 7H: $25"	7C: $25; 7I: $25	"8A: $0-$25 for lab, x-rays"		15: $15			16A: $0 ($250 Limit)	17A: $25	17B: $0 ($100 Limit)	18A: $25	18B: $0 ($600 Limit)	14A: $0-$25												2500	0.6447	0.0213	0.0448	0.0051	0.0506	0.1118	0.0298	0.0495	0.161					0.0467	0.167	0.8303	0.046	0.0969			0.032				0.0258																2.3634	0	0.526714753	8.2046	0.329451923	0.818121306	0.093419607	0.927626942	2.109651852	0.55912286	0.92408872	2.967900867	0	0	0	0.000164527	0.888841705	3.134651908	15.44824729	0.91963494	1.797228855	0	0	0.594361061	0	0	0	0.479502725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1966
H5042_002_0	2010	10	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	250.1030847	9.5	839.3898019	915.1444171	464.7896022	10.87618279	3.205289718	359.1579249	346.921642				0.21448015	371.1578989	2834.607337	9553.654677	513.1104809	1162.921496			1236.612228				305.0156328																	1A: $650/admit - $1950 annual max	1B: $650/admit - $1950 annual max	"2: $30 days 1-20, $65 days 21-100"	"6: $0 days 1-20, $25 after 20 days"	10A: $125	11A: 30%	11B: 30%	4A: $50; 4B: $20-$35	9A: $200	"8A: $0-$35 for labs,& x-rays"	"8A: $0-$35 for labs,& x-rays; 8B: $0-$35"		12: $35	7I: $35; 9C: $35	7A: $20	"7B, 7D, 7F: $35, 18A: $35"	"7E, 7H: $35"	7C: $35; 7I: $35	"8A: $0-$35 for labs,& x-rays"		15: $15			16A: $0 ($100)	17A: $35				14A: $0-$35												650	534	40.885	2.5	62.5	0.3	0.3	39.2847623	200				35	35	20	35	35	35			7.5				17.5																YES	510.5092346	450.3055408	32.11103086	1.963497056	49.08742641	0.235619647	0.235619647	30.85420605	157.0797645				27.48895879	27.48895879	15.70797645	27.48895879	27.48895879	27.48895879			5.890491169				13.74447939																	10.64	0.356491886	2.246139319	0.149740281	1.901277116	2.562642348	0.755229231	0.923461052	4.541197485	0	0	0	0.00049132	0.850228682	3.710495442	21.88500164	1.175406072	2.663958424	0	0	0.607021117	0	0	0	0.349356757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3181	0	15.0838931	10.64	0.356491886	2.246139319	0.149740281	1.901277116	2.562642348	0.755229231	0.923461052	4.541197485	0	0	0	0.00049132	0.850228682	3.710495442	21.88500164	1.175406072	2.663958424	0	0	0.607021117	0	0	0	0.349356757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3181	YES	1A: $1000/admit - $3000 annual max	1B: $1000/admit - $3000 annual max	"2: $30 days 1-20, $65 days 21-100"	"6: $0 days 1-20, $25 after 20 days"	10A: $125	11A: 30%	11B: 30%	4A: $50; 4B: $20-$35	9A: $200	"8A: $0-$35 for labs,& x-rays"	"8A: $0-$35 for labs,& x-rays; 8B: $0-$35"		12: $35	7I: $35; 9C: $35	7A: $20	"7B, 7D, 7F: $35"	"7E, 7H: $35"	7C: $35; 7I: $35	"8A: $0-$35 for labs,& x-rays"		15: $15			16A: $0 ($250)	17A: $35		18A: $35		14A: $0-$35												3350	0.9976	0.0256	0.1369	0.0091	0.1159	0.1562	0.046	0.0563	0.2767					0.0518	0.2261	1.3339	0.0619	0.1623			0.037				0.0213																3.7147	0	1.01335769	11.6376	0.382126857	2.383023156	0.158865727	2.01714442	2.718814458	0.801254281	0.979738457	4.817946362	0	0	0	0.00049132	0.902043173	3.936619818	23.21892525	1.237271653	2.826304921	0	0	0.644014094	0	0	0	0.370647196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0328
H5042_004_0	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	260.9175282	9.5	875.6849707	954.7152112	484.887079	11.24523455	3.31405194	374.6878938	361.9225146				0.223754259	387.2067459	2957.175602	9978.349791	513.115258	1213.206158			1290.083272				636.408984																	1A: $500/admit - $1500 annual max	1B: $500/admit - $1500 annual max	"2: $10/day days 1-20, $40/day days 21-100"	"6: $0/day days 1-20, $20/day days 21+"	10A: $75	11A: 20%	11B: 20%	4A: $50; 4B: $15-$35	9A: $150	"8A: $0-$25 for lab, x-rays"	"8A: $0-$25 for lab, x-rays; 8B: $0-$25"		12: $25	7I: $25; 9C: $25	7A: $15;	"7B, 7D, 7F: $25; 18A: $25, 18B: $0 ($600 Limit)"	"7E, 7H: $25"	7C: $25; 7I: $25	"8A: $0-$25 for lab, x-rays"		15: $15			16A: $0 ($250 Limit)	17A: $25	17B: $0 ($100 Limit)			14A: $0-$25												500	444	19.33	2	37.5	0.2	0.2	37.75401406	150				25	25	15	25	25	25			7.5				12.5																YES	426.5358644	399.9215187	16.48987652	1.706143458	31.99018983	0.170614346	0.170614346	32.20688204	127.9607593				21.32679322	21.32679322	12.79607593	21.32679322	21.32679322	21.32679322			6.398037966				10.66339661																	9.2742	0.316604536	1.203328086	0.135740093	1.292635809	1.918598336	0.565424804	1.0056274	3.859323316	0	0	0	0.000397663	0.688156517	3.153353629	17.73385022	0.911925251	2.156149738	0	0	0.68783348	0	0	0	0.56552345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4687	0	7.811637451	9.2742	0.316604536	1.203328086	0.135740093	1.292635809	1.918598336	0.565424804	1.0056274	3.859323316	0	0	0	0.000397663	0.688156517	3.153353629	17.73385022	0.911925251	2.156149738	0	0	0.68783348	0	0	0	0.56552345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4687	YES	1A: $750/admit - $2250 annual max	1B: $750/admit - $2250 annual max	"2: $10/day days 1-20, $40/day days 21-100"	"6: $0/day days 1-20, $20/day days 21+"	10A: $75	11A: 20%	11B: 20%	4A: $50; 4B: $15-$35	9A: $150	"8A: $0-$25 for lab, x-rays"	"8A: $0-$25 for lab, x-rays; 8B: $0-$25"		12: $25	7I: $25; 9C: $25	7A: $15;	"7B, 7D, 7F: $25"	"7E, 7H: $25"	7C: $25; 7I: $25	"8A: $0-$25 for lab, x-rays"		15: $15			16A: $0 ($250 Limit)	17A: $25	17B: $0 ($100 Limit)	18A: $25	18B: $0 ($600 Limit)	14A: $0-$25												3400	0.8478	0.022	0.0733	0.0083	0.0788	0.1169	0.0345	0.0613	0.2352					0.0419	0.1922	1.0807	0.048	0.1314			0.0419				0.0345																3.0486	0	0.524051236	10.122	0.338599631	1.2766611	0.144012342	1.371411398	2.035521227	0.599882825	1.066912172	4.094517534	0	0	0	0.000397663	0.730094033	3.345524765	18.81458348	0.959923019	2.287549445	0	0	0.729751309	0	0	0	0.599987483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5173
H5042_005_0	2010	11	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	247.3551876	9.5	830.1673775	905.0896723	459.6829319	10.63850122	3.135243238	355.211836	343.1099938				0.212123644	367.0799655	2803.463342	9448.565998	513.109267	1150.14441			1223.025497				603.3288168																	1A: $650/admit - $1950 annual max	1B: $650/admit - $1950 annual max	"2: $30 days 1-20, $65 days 21-100"	"6: $0 days 1-20, $25 after 20 days"	10A: $125	11A: 30%	11B: 30%	4A: $50; 4B: $20-$35	9A: $200	"8A: $0-$35 for labs,& x-rays"	"8A: $0-$35 for labs,& x-rays; 8B: $0-$35"		12: $35	7I: $35; 9C: $35	7A: $20	"7B, 7D, 7F: $35, 18A: $35"	"7E, 7H: $35"	7C: $35; 7I: $35	"8A: $0-$35 for labs,& x-rays"		15: $15			16A: $0 ($250)	17A: $35				14A: $0-$35												650	534	40.885	2.5	62.5	0.3	0.3	39.2847623	200				35	35	20	35	35	35			7.5				17.5																YES	511.2232888	450.7339733	32.15594487	1.966243419	49.15608547	0.23594921	0.23594921	30.89736213	157.2994735				27.52740786	27.52740786	15.72994735	27.52740786	27.52740786	27.52740786			5.898730256				13.76370393																	10.5378	0.356831062	2.224568035	0.148302218	1.883017791	2.51014596	0.739758166	0.914592394	4.497585114	0	0	0	0.000486601	0.842063327	3.674860897	21.67454416	1.177047339	2.638374524	0	0	0.601191459	0	0	0	0.692003267	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1132	0	14.93008231	10.5378	0.356831062	2.224568035	0.148302218	1.883017791	2.51014596	0.739758166	0.914592394	4.497585114	0	0	0	0.000486601	0.842063327	3.674860897	21.67454416	1.177047339	2.638374524	0	0	0.601191459	0	0	0	0.692003267	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.1132	YES	1A: $1000/admit - $3000 annual max	1B: $1000/admit - $3000 annual max	"2: $30 days 1-20, $65 days 21-100"	"6: $0 days 1-20, $25 after 20 days"	10A: $125	11A: 30%	11B: 30%	4A: $50; 4B: $20-$35	9A: $200	"8A: $0-$35 for labs,& x-rays"	"8A: $0-$35 for labs,& x-rays; 8B: $0-$35"		12: $35	7I: $35; 9C: $35	7A: $20	"7B, 7D, 7F: $35"	"7E, 7H: $35"	7C: $35; 7I: $35	"8A: $0-$35 for labs,& x-rays"		15: $15			16A: $0 ($250)	17A: $35		18A: $35		14A: $0-$35												3350	0.988	0.0257	0.1356	0.009	0.1148	0.153	0.0451	0.0557	0.2741					0.0513	0.224	1.3211	0.062	0.1608			0.0366				0.0422																3.6988	0	1.002459579	11.5258	0.382493496	2.360137278	0.157340026	1.997772338	2.663118844	0.784840381	0.970329327	4.771676174	0	0	0	0.000486601	0.893380206	3.898813639	22.9956424	1.238999282	2.799161891	0	0	0.637829165	0	0	0	0.734175212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.812
H5042_006_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	299.2311323	9.5	1004.272143	1094.907328	556.088779	12.80541255	3.773847679	429.7077451	415.0678745				0.256610742	444.0648883		9028.345726	513.1321827	1391.355555			1479.521445				729.8604358																	1A: $150/admit - $450 annual max	1B: $150/admit - $450 annual max	"2: $0/day days 1-20, $30/day days 21-100"	"6: $0/day days 1-20, $10/day days 21+"	10A: $50	11A: 20%	11B: 20%	4A: $50; 4B: $0-$35	9A: $50	"8A: $0 lab, $0 x-rays"	"8A: $0 lab, $0 x-rays; 8B: $0"		12: $10	7I: $10; 9C: $10	7A: $0	"7B, 7D, 7F: $10, 18A: $10, 18B: $0 ($600 Limit)"	"7E, 7H:$10"	7C: $10; 7I: $10	"8A: $0 lab, $0 x-rays"		15: $15			16A: $0 ($250 Limit)	17A: $10	17B: $0 ($125 Limit)			14A: $0-$10												150	150	9.33	1	10	0.2	0.2	33.16176933	50				10	10		10	10	10			7.5				5																YES	141.4851585	141.4851585	8.800376857	0.94323439	9.432343899	0.188646878	0.188646878	31.27932126	47.16171949				9.432343899	9.432343899		9.432343899	9.432343899	9.432343899			7.074257924				4.716171949																	3.5281	0.112009084	0.736497777	0.086062854	0.437101717	2.4157011	0.711924583	1.12008055	1.631276222	0	0	0	0.000201703	0.349047728	0	7.096538477	0.403336601	1.09364534	0	0	0.872209692	0	0	0	0.28684561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.8805	0	1.256630123	3.5281	0.112009084	0.736497777	0.086062854	0.437101717	2.4157011	0.711924583	1.12008055	1.631276222	0	0	0	0.000201703	0.349047728	0	7.096538477	0.403336601	1.09364534	0	0	0.872209692	0	0	0	0.28684561	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.8805	YES	1A: $250/admit - $750 annual max	1B: $250/admit - $750 annual max	"2: $0/day days 1-20, $30/day days 21-100"	"6: $0/day days 1-20, $10/day days 21+"	10A: $50	11A: 20%	11B: 20%	4A: $50; 4B: $0-$35	9A: $50	"8A: $0 lab, $0 x-rays"	"8A: $0 lab, $0 x-rays; 8B: $0"		12: $10	7I: $10; 9C: $10	7A: $0	"7B, 7D, 7F: $10"	"7E, 7H:$10"	7C: $10; 7I: $10	"8A: $0 lab, $0 x-rays"		15: $15			16A: $0 ($250 Limit)	17A: $10	17B: $0 ($125 Limit)	18A: $10	18B: $0 ($600 Limit)	14A: $0-$10												2500	0.3583	0.0098	0.0449	0.0052	0.0266	0.1472	0.0434	0.0683	0.0994					0.0213		0.4325	0.0212	0.0666			0.0532				0.0175																1.4155	0	0.08518651	3.8864	0.121834442	0.781381298	0.091307681	0.463739495	2.562918341	0.755310568	1.188340307	1.730689178	0	0	0	0.000201703	0.370319335	0	7.529014506	0.424565707	1.160294086	0	0	0.925363745	0	0	0	0.304326505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.296
H5042_007_0	2010	9	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	298.9292549	9.5	1003.25899	1093.802738	555.5277723	12.77958827	3.766237076	429.2742372	414.6491359				0.256351861	443.6168962		9019.237537	513.1320494	1389.951895			1478.028839				729.1241208																	1A: $150/admit - $450 annual max	1B: $150/admit - $450 annual max	"2: $0/day days 1-20, $30/day days 21-100"	"6: $0/day days 1-20, $10/day days 21+"	10A: $50	11A: 20%	11B: 20%	4A: $50; 4B: $0-$35	9A: $50	"8A: $0 lab, $0 x-rays"	"8A: $0 lab, $0 x-rays; 8B: $0"		12: $10	7I: $10; 9C: $10	7A: $0	"7B, 7D, 7F: $10, 18A: $10, 18B: $0 ($600 Limit)"	"7E, 7H:$10"	7C: $10; 7I: $10	"8A: $0 lab, $0 x-rays"		15: $15			16A: $0 ($250 Limit)	17A: $10	17B: $0 ($125 Limit)			14A: $0-$10												150	150	9.33	1	10	0.2	0.2	33.16176933	50				10	10		10	10	10			7.5				5																YES	141.5049302	141.5049302	8.801606658	0.943366201	9.433662013	0.18867324	0.18867324	31.28369236	47.16831006				9.433662013	9.433662013		9.433662013	9.433662013	9.433662013			7.07524651				4.716831006																	3.525	0.112024736	0.735857584	0.085988044	0.43672177	2.411166328	0.710588153	1.119106931	1.629858251	0	0	0	0.000201528	0.348744322	0	7.090369878	0.40339286	1.092694699	0	0	0.871451532	0	0	0	0.286596272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.8598	0	1.252289342	3.525	0.112024736	0.735857584	0.085988044	0.43672177	2.411166328	0.710588153	1.119106931	1.629858251	0	0	0	0.000201528	0.348744322	0	7.090369878	0.40339286	1.092694699	0	0	0.871451532	0	0	0	0.286596272	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	20.8598	YES	1A: $250/admit - $750 annual max	1B: $250/admit - $750 annual max	"2: $0/day days 1-20, $30/day days 21-100"	"6: $0/day days 1-20, $10/day days 21+"	10A: $50	11A: 20%	11B: 20%	4A: $50; 4B: $0-$35	9A: $50	"8A: $0 lab, $0 x-rays"	"8A: $0 lab, $0 x-rays; 8B: $0"		12: $10	7I: $10; 9C: $10	7A: $0	"7B, 7D, 7F: $10"	"7E, 7H:$10"	7C: $10; 7I: $10	"8A: $0 lab, $0 x-rays"		15: $15			16A: $0 ($250 Limit)	17A: $10	17B: $0 ($125 Limit)	18A: $10	18B: $0 ($600 Limit)	14A: $0-$10												2500	0.358	0.0098	0.0448	0.0052	0.0266	0.1469	0.0433	0.0682	0.0993					0.0213		0.4321	0.0212	0.0666			0.0531				0.0175																1.4141	0	0.084893311	3.883	0.121851468	0.78070209	0.091228313	0.463336393	2.558107212	0.753892694	1.187307353	1.729184792	0	0	0	0.000201528	0.369997438	0	7.522469981	0.424624926	1.159285512	0	0	0.924559381	0	0	0	0.304061972	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.2738
H5042_801_0	2010	5	N/A																															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																																																			0	NO	177.3258842	3.4485	19.11685737		6.947951569	8.466134107	1.764368219	5.049177658	41.68885548	9.008200935	27.94031008		0.00253429	9.956656803	44.01362823	105.3757742	5.852	5.593608268	22.68397378	77.31836979																						Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.091807963	0.091807963	0.197299859		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					NO	0.091807963	0.091807963	0.197299859		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																						16.2799	0.31659976	3.771753269	0	1.618872716	1.972609247	0.411097795	1.176458394	9.713503328	2.098910818	6.510092248	0	0.00059049	2.319901035	10.25517538	24.55255538	1.363516	1.303310727	5.285365891	18.01518016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9654	0	0	16.2799	0.31659976	3.771753269	0	1.618872716	1.972609247	0.411097795	1.176458394	9.713503328	2.098910818	6.510092248	0	0.00059049	2.319901035	10.25517538	24.55255538	1.363516	1.303310727	5.285365891	18.01518016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9654	NO	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																				0.9921	0.0167	0.2299		0.0987	0.1202	0.0251	0.0717	0.592	0.1224	0.3967			0.1414	0.6221	1.4963	0.0718	0.0794	0.3221	1.0979																					6.4963	0	0	17.2721	0.333262905	4.001610809	0	1.717529779	2.092823661	0.436150846	1.24815392	10.30546198	2.221322254	6.906829171	0	0.00059049	2.461280046	10.87727494	26.04883299	1.43528	1.382736865	5.607465751	19.11305818	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4617
H5042_802_0	2010	5	N/A																															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																																																			0	NO	177.3249709	3.4485	19.11675892		6.947915787	8.466090506	1.764359133	5.049151654	41.68864079	9.008169171	27.94016618		0.002534277	9.956605526	44.0134092	105.3752315	5.852	5.593579461	22.68385696	77.3179716																						Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.091808447	0.091808447	0.197301073		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					NO	0.091808447	0.091808447	0.197301073		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																						16.2799	0.31660143	3.771757042	0	1.618864378	1.972599088	0.411095678	1.176452335	9.713453303	2.098903417	6.51005872	0	0.000590487	2.319889088	10.25512434	24.55242893	1.363516	1.303304014	5.285338671	18.01508738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.965	0	0	16.2799	0.31660143	3.771757042	0	1.618864378	1.972599088	0.411095678	1.176452335	9.713453303	2.098903417	6.51005872	0	0.000590487	2.319889088	10.25512434	24.55242893	1.363516	1.303304014	5.285338671	18.01508738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.965	NO	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																				0.9921	0.0167	0.2299		0.0987	0.1202	0.0251	0.0717	0.592	0.1224	0.3967			0.1414	0.6221	1.4963	0.0718	0.0794	0.3221	1.0979																					6.4963	0	0	17.2721	0.333264664	4.001614812	0	1.717520933	2.092812883	0.4361486	1.248147492	10.30540891	2.221314402	6.906793601	0	0.000590487	2.46126737	10.87722079	26.04869884	1.43528	1.382729744	5.607436872	19.11295974	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4613
H5042_803_0	2010	5	N/A																															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																																																			0	NO	177.3619723	3.4485	19.1207479		6.949365566	8.467857073	1.764727291	5.05020523	41.6973397	9.009456141	27.94599629		0.002534806	9.95868311	44.02228396	105.3972195	5.852	5.594746639	22.68859026	77.33410507																						Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.091788826	0.091788826	0.197251932		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					NO	0.091788826	0.091788826	0.197251932		0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																						16.2798	0.316533768	3.771604458	0	1.619202177	1.973010698	0.411181459	1.176697819	9.71548015	2.099203281	6.511417135	0	0.00059061	2.320373165	10.25719216	24.55755214	1.363516	1.303575967	5.28644153	18.01884648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9823	0	0	16.2798	0.316533768	3.771604458	0	1.619202177	1.973010698	0.411181459	1.176697819	9.71548015	2.099203281	6.511417135	0	0.00059061	2.320373165	10.25719216	24.55755214	1.363516	1.303575967	5.28644153	18.01884648	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9823	NO	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																				0.9921	0.0167	0.2298		0.0987	0.1202	0.0251	0.0717	0.5921	0.1224	0.3968			0.1414	0.6222	1.4966	0.0718	0.0794	0.3222	1.0981																					6.4973	0	0	17.272	0.33319344	4.001452929	0	1.717879318	2.093249577	0.436239609	1.248407935	10.30755927	2.22163254	6.908234799	0	0.00059061	2.461780948	10.87941463	26.05413426	1.43528	1.38301827	5.608606942	19.11694793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.4796
H5050_001_0	2010	6	N/A																															D	D	D		T	Coin	Coin	V	V		P				V	V	V	V	P	V		V	T		V		V																																																						0	YES	520.5375859	7.926968313	180.1544523	0	201.9871558	3.512839385	1.756419693	132.277175	132.277175	0	776.4659114	0	0	0	3462.182684	2440.770398	92.69204004	180.6144897	87.83245736	260.167658	0	483.9011898	8.684731196	0	323	0	101.7332636	0	0	0											2500	$200 per day for days 1-5	$200 per day for days 1-5	$60 per day for days 11-100	$0 Copay	$150 per trip	20% Coinsurance	20% Coinsurance	$50 per visit	$200 per visit	$0 Copay	$75 per High End Radiology Procedure	$0 Copay	$0 Copay	$0 Copay	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$75 per High End Radiology Procedure	$20 per visit	$0 Copay	$20 per visit	$150 per trip	$0 Copay	$20 per visit	$0 Copay	$20 per visit	$0 Copay	$0 Copay	$0 Copay											200	200	60	0	150	0.2	0.2	50	200	0	75	0	0	0	20	20	20	20	75	20	0	20	150	0	20	0	20	0	0	0											NO	198.2	198.2	59.46	0	148.65	0.1982	0.1982	49.55	198.2	0	74.325	0	0	0	19.82	19.82	19.82	19.82	74.325	19.82	0	19.82	148.65	0	19.82	0	19.82	0	0	0												8.5975	0.130927093	0.892665311	0	2.502115893	0.696244766	0.348122383	0.546194502	2.184778007	0	4.809235739	0	0	0	5.718371733	4.031339107	0.153096353	0.298314932	0.544012283	0.429710248	0	0.799243465	0.107582108	0	0.533488333	0	0.16802944	0	0	0	0	0	0	0	0	0	0	0	0	0	33.491		0.3	8.5975	0.130927093	0.892665311	0	2.502115893	0.696244766	0.348122383	0.546194502	2.184778007	0	4.809235739	0	0	0	5.718371733	4.031339107	0.153096353	0.298314932	0.544012283	0.429710248	0	0.799243465	0.107582108	0	0.533488333	0	0.16802944	0	0	0	0	0	0	0	0	0	0	0	0	0	33.491	NO																																																																																		0			8.5975	0.130927093	0.892665311	0	2.502115893	0.696244766	0.348122383	0.546194502	2.184778007	0	4.809235739	0	0	0	5.718371733	4.031339107	0.153096353	0.298314932	0.544012283	0.429710248	0	0.799243465	0.107582108	0	0.533488333	0	0.16802944	0	0	0	0	0	0	0	0	0	0	0	0	0	33.491
H5050_004_0	2010	8	N/A																															D	D	D		T	Coin	Coin	V	V		P				V	V	V	V	P	V		V	T		V		V																																																						0	YES	887.1548625	13.50997252	436.0419813	0	499.7714579	10.19059054	5.095295269	243.267516	172.7160811	0	1046.660856	0	0	0	4843.517901	3466.649827	223.5764795	249.9096726	97.27941732	305.0048485	0	662.0783109	22.77878729	0	378.4587341	0	101.7332636	0	0	0											1000	$100 per day for days 1-3	$100 per day for days 1-3	$25 per day for days 11-100	$0 Copay	$75 per trip	20% Coinsurance	20% Coinsurance	$50 per visit	$100 per visit	$0 Copay	$40 per High End Radiology Procedure	$0 Copay	$0 Copay	$0 Copay	$15 per visit	$15 per visit	$15 per visit	$15 per visit	$40 per High End Radiology Procedure	$15 per visit	$0 Copay	$15 per visit	$75 per trip	$0 Copay	$15 per visit	$0 Copay	$15 per visit	$0 Copay	$0 Copay	$0 Copay											100	100	25	0	75	0.2	0.2	50	100	0	40	0	0	0	15	15	15	15	40	15	0	15	75	0	15	0	15	0	0	0											NO	95.5	95.5	23.875	0	71.625	0.191	0.191	47.75	95.5	0	38.2	0	0	0	14.325	14.325	14.325	14.325	38.2	14.325	0	14.325	71.625	0	14.325	0	14.325	0	0	0												7.0603	0.107516865	0.867541859	0	2.983010889	1.946402793	0.973201396	0.968001991	1.374532145	0	3.331870392	0	0	0	5.781949494	4.138313231	0.266894422	0.298329672	0.309672812	0.364099538	0	0.790355984	0.135960887	0	0.451785114	0	0.121444083	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2712		1.52	7.0603	0.107516865	0.867541859	0	2.983010889	1.946402793	0.973201396	0.968001991	1.374532145	0	3.331870392	0	0	0	5.781949494	4.138313231	0.266894422	0.298329672	0.309672812	0.364099538	0	0.790355984	0.135960887	0	0.451785114	0	0.121444083	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2712	NO																																																																																		0			7.0603	0.107516865	0.867541859	0	2.983010889	1.946402793	0.973201396	0.968001991	1.374532145	0	3.331870392	0	0	0	5.781949494	4.138313231	0.266894422	0.298329672	0.309672812	0.364099538	0	0.790355984	0.135960887	0	0.451785114	0	0.121444083	0	0	0	0	0	0	0	0	0	0	0	0	0	32.2712
H5050_009_0	2010	8	N/A																															D	D	D		T	Coin	Coin	V	V		P				V	V	V	V	P	V		V	T		V		V																																																						0	YES	835.0331946	12.71624154	228.4567315	0	337.3166653	7.849794923	3.924897462	197.0494792	153.7755601	0	979.6564562	0	0	0	4379.015678	3034.000398	330.4178482	237.9823193	109.5909364	296.5770444	0	523.6065675	20.60936285	0	357	0	101.7332636	0	0	0											2500	$200 per day for days 1-5	$200 per day for days 1-5	$50 per day for days 11-100	$0 Copay	$150 per trip	20% Coinsurance	20% Coinsurance	$50 per visit	$200 per visit	$0 Copay	$50 per High End Radiology Procedure	$0 Copay	$0 Copay	$0 Copay	$15 per visit	$15 per visit	$15 per visit	$15 per visit	$50 per High End Radiology Procedure	$15 per visit	$0 Copay	$15 per visit	$150 per trip	$0 Copay	$15 per visit	$0 Copay	$15 per visit	$0 Copay	$0 Copay	$0 Copay											200	200	50	0	150	0.2	0.2	50	200	0	50	0	0	0	15	15	15	15	50	15	0	15	150	0	15	0	15	0	0	0											NO	198.2	198.2	49.55	0	148.65	0.1982	0.1982	49.55	198.2	0	49.55	0	0	0	14.865	14.865	14.865	14.865	49.55	14.865	0	14.865	148.65	0	14.865	0	14.865	0	0	0												13.792	0.210029923	0.943335921	0	4.178510191	1.555829354	0.777914677	0.813650141	2.539859668	0	4.045164784	0	0	0	5.424505672	3.758367993	0.409305109	0.294800598	0.452519241	0.367384814	0	0.648617636	0.255298482	0	0.44223375	0	0.12602208	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0353		0.37	13.792	0.210029923	0.943335921	0	4.178510191	1.555829354	0.777914677	0.813650141	2.539859668	0	4.045164784	0	0	0	5.424505672	3.758367993	0.409305109	0.294800598	0.452519241	0.367384814	0	0.648617636	0.255298482	0	0.44223375	0	0.12602208	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0353	NO																																																																																		0			13.792	0.210029923	0.943335921	0	4.178510191	1.555829354	0.777914677	0.813650141	2.539859668	0	4.045164784	0	0	0	5.424505672	3.758367993	0.409305109	0.294800598	0.452519241	0.367384814	0	0.648617636	0.255298482	0	0.44223375	0	0.12602208	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0353
H5050_012_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	YES	708.6419008	23.32363732	719.1960194	0	269.1800734	0	0	278.6465902	453.5950478	0	197.4454951	0	0	444.1384811	3922.796394	4586.559111	181.9084464	509.6473818	455.0491929	1217.889483	0	0	89.262592	0	0	0	127.1050248	0	0	0											2500	$100/Days 1-5 for IP Medical; $100/Days 1-5 for IP Surgical;	$100/Days 1-5 for IP Psych; $100/Days 1-5 for IP Substance Abuse;	$25/Days Custom for SNF	No Cost-Sharing	$150/Run for Ambulance	No Cost-Sharing	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care; $15/Visit for Urgent Care - Worldwide;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	No Cost-Sharing	$40/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$15/Case for OP Fac - Cardiovascular; $15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Procedure for PCP - Cardio;	$15/Visit for Speclst - Office Visits; $15/Consult for Speclst - Consults; $15/Procedure for Speclst - Cardio;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $15/Visit for Occ Therapy (Specialist);	$40/Procedure for Prof Radiology (OP); $40/Procedure for Prof Radiology (Office);	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	$150/Run for Non-Emergent Transport	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	25	0	150	0	0	47.44243284	200	0	40	0	0	15	15	15	15	15	40	15	0	0	150	0	0	0	15	0	0	0											NO	99.34531384	99.34531383	24.83632846	0	149.0179708	0	0	47.1318338	198.6906277	0	39.73812553	0	0	14.90179707	14.90179708	14.90179708	14.90179707	14.90179708	39.73812553	14.90179708	0	0	149.0179708	0	0	0	14.90179707	0	0	0												5.8667	0.193091172	1.488515714	0	3.342722358	0	0	1.094427065	7.51042373	0	0.653842823	0	0	0.55153846	4.871392986	5.695664429	0.225896896	0.632888489	1.506900163	1.512395161	0	0	1.108477527	0	0	0	0.157841107	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4127	0	0.239959931	5.8667	0.193091172	1.488515714	0	3.342722358	0	0	1.094427065	7.51042373	0	0.653842823	0	0	0.55153846	4.871392986	5.695664429	0.225896896	0.632888489	1.506900163	1.512395161	0	0	1.108477527	0	0	0	0.157841107	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4127	YES	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											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	5.8667	0.193091172	1.488515714	0	3.342722358	0	0	1.094427065	7.51042373	0	0.653842823	0	0	0.55153846	4.871392986	5.695664429	0.225896896	0.632888489	1.506900163	1.512395161	0	0	1.108477527	0	0	0	0.157841107	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4127
H5050_013_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	V	O	V	T	V	V	V	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	YES	485.0051995	8.676810723	1174.354272	0	178.5114745	8.74542605	5.871895122	239.0772678	381.9519297	0	118.9423995	0	0	320.7806463	3757.57624	4413.333494	156.9638982	479.6236226	455.7439147	1033.832675	0	0	160.9771851	0	0	0	147.6110394	0	0	0											3200	$350/Days 1-3 for IP Medical; $350/Days 1-3 for IP Surgical;	$350/Days 1-3 for IP Psych; $350/Days 1-3 for IP Substance Abuse;	$75/Day for SNF	No Cost-Sharing	$200/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$300/Case for OP Fac - Surgery; $300/Case for OP Fac - ASC	No Cost-Sharing	$150/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$30/Case for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy;	$30/Visit for PCP - Office Visits; $30/Consult for PCP - Consults; $30/Procedure for PCP - Cardio;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults; $30/Procedure for Speclst - Cardio;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	$150/Procedure for Prof Radiology (OP); $150/Procedure for Prof Radiology (Office);	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	$200/Run for Non-Emergent Transport	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											350	350	75	0	200	0.2	0.2	48.55524427	300	0	150	0	0	30	30	30	30	30	150	30	0	0	200	0	0	0	30	0	0	0											NO	345.8312326	345.8312326	74.1066927	0	197.6178472	0.197617847	0.197617847	47.97691421	296.4267708	0	148.2133854	0	0	29.64267709	29.64267708	29.64267708	29.64267708	29.64267708	148.2133854	29.64267708	0	0	197.6178472	0	0	0	29.64267708	0	0	0												13.9775	0.250059346	7.252292597	0	2.939754442	1.728252269	1.160391273	0.95584913	9.435064762	0	1.469071309	0	0	0.79239976	9.282051592	10.9019183	0.387735846	1.184777347	5.628945706	2.553797346	0	0	2.650997065	0	0	0	0.364632198	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9155	0	0.878948083	13.9775	0.250059346	7.252292597	0	2.939754442	1.728252269	1.160391273	0.95584913	9.435064762	0	1.469071309	0	0	0.79239976	9.282051592	10.9019183	0.387735846	1.184777347	5.628945706	2.553797346	0	0	2.650997065	0	0	0	0.364632198	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9155	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.9775	0.250059346	7.252292597	0	2.939754442	1.728252269	1.160391273	0.95584913	9.435064762	0	1.469071309	0	0	0.79239976	9.282051592	10.9019183	0.387735846	1.184777347	5.628945706	2.553797346	0	0	2.650997065	0	0	0	0.364632198	0	0	0	0	0	0	0	0	0	0	0	0	0	72.9155
H5050_801_0	2010	5	N/A																															D	D	D		T	Coin	Coin	V	V		P				V	V	V	V	P	V		V	T		V		V																																																						0	YES	669.3106993	10.19254872	0	0	248.6661546	8.236944675	4.118472337	160.2488986	154.0514274	0	0	0	0	0	4390.073275	3110.231937	231.0940182	256.8239513	0	817.6533016	0	549.6861851	13.03389278	0	0	0	0	0	0	0											2500	$200 per day for 1st 5 days	$200 per day for 1st 5 days	$0 Copay	$0 Copay	$150 per trip	20% Coinsurance	20% Coinsurance	$50 per visit	$200 per visit	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$0 Copay	$20 per visit	$0 Copay	$20 per visit	$150 per trip	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay											200	200	0	0	150	0.2	0.2	50	200	0	0	0	0	0	20	20	20	20	0	20	0	20	150	0	0	0	0	0	0	0											NO	198.2	198.2	0	0	148.65	0.1982	0.1982	49.55	198.2	0	0	0	0	0	19.82	19.82	19.82	19.82	0	19.82	0	19.82	148.65	0	0	0	0	0	0	0												11.0548	0.16834693	0	0	3.08035199	1.632562435	0.816281217	0.66169441	2.544416075	0	0	0	0	0	7.250937693	5.137066417	0.381690287	0.42418756	0	1.350490703	0	0.907898349	0.161457347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5722		0.32	11.0548	0.16834693	0	0	3.08035199	1.632562435	0.816281217	0.66169441	2.544416075	0	0	0	0	0	7.250937693	5.137066417	0.381690287	0.42418756	0	1.350490703	0	0.907898349	0.161457347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5722	NO																																																																																		0			11.0548	0.16834693	0	0	3.08035199	1.632562435	0.816281217	0.66169441	2.544416075	0	0	0	0	0	7.250937693	5.137066417	0.381690287	0.42418756	0	1.350490703	0	0.907898349	0.161457347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.5722
H5050_802_0	2010	5	N/A																															D	D	D		T	Coin	Coin	V	V		P				V	V	V	V	P	V		V	T		V		V																																																						0	YES	706.6971749	7.909959042	0	0	224.4121479	6.733652204	3.366826102	138.6449141	158.6330406	0	0	0	0	0	3912.838803	3144.557048	228.648793	231.9203973	0	398.5904634	0	545.1307238	19.43332984	0	0	0	0	0	0	0											2500	$200 per day for 1st 5 days	$200 per day for 1st 5 days	$0 Copay	$0 Copay	$150 per trip	20% Coinsurance	20% Coinsurance	$50 per visit	$200 per visit	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$0 Copay	$20 per visit	$0 Copay	$20 per visit	$150 per trip	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay											200	200	0	0	150	0.2	0.2	50	200	0	0	0	0	0	20	20	20	20	0	20	0	20	150	0	20	0	20	0	0	0											NO	198.2	198.2	0	0	148.65	0.1982	0.1982	49.55	198.2	0	0	0	0	0	19.82	19.82	19.82	19.82	0	19.82	0	19.82	148.65	0	19.82	0	19.82	0	0	0												11.6723	0.130646157	0	0	2.779905483	1.334609867	0.667304933	0.572487958	2.620089054	0	0	0	0	0	6.462705424	5.193760058	0.37765159	0.38305519	0	0.658338582	0	0.900374245	0.240730373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9939		0.31	11.6723	0.130646157	0	0	2.779905483	1.334609867	0.667304933	0.572487958	2.620089054	0	0	0	0	0	6.462705424	5.193760058	0.37765159	0.38305519	0	0.658338582	0	0.900374245	0.240730373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9939	NO																																																																																		0			11.6723	0.130646157	0	0	2.779905483	1.334609867	0.667304933	0.572487958	2.620089054	0	0	0	0	0	6.462705424	5.193760058	0.37765159	0.38305519	0	0.658338582	0	0.900374245	0.240730373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.9939
H5087_001_0	2010	11	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	T	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	914.352645	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	16A - schedule of copays	$0 copay	17B - $150 max	$0 copay	18B - $750 max	$0 copay	$0 copay											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.676313182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6763			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.676313182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6763	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.676313182	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.6763
H5087_002_0	2010	13	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	T	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1006.385272	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	16A - schedule of copays	17A - $10 copay	"17B - $25 copay, $150 max"	18A - $10 copay	"18B - $50 copay, $1000 max"	$0 copay	$0 copay											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.25798159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.258			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.25798159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.258	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.25798159	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.258
H5087_005_0	2010	15	N/A																															Coin	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	P	P	P	P	P	P	Coin	P	T	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	NO	0	0	0	0	119.2340401	6.56	0.9	128.8035651	171.7298513	0	31.84617244	0	0.09	15.69368576	0	165.5841936	116.6361213	0	2127.630347	4678.400106	7.24	0	0	1019.633555	297.8444694	231.1286674	0	16.40754555	0	592.1717957												$0 copay	$0 copay	$0 copay	$0 copay	10A - $50 copay	11A - 20% coinsurance	$0 copay	4A - $50 copay	"9A - $50 copay, 9B -$0 outpatient"	$0 copay	8B - $25 copay	$0 copay	12 - 20% coinsurance	9D - $10 copay	$0 copay	"17A - $10 copay, 18A - copay"	$10 copay	7C & 7I - $10 copay	"8b - $5 copay, $50 for MRI"	8B - $5 copay	15 - 20% coinsurance	$0 copay	10B - $5 copay	16A - schedule of copays	17A - $10 copay	"17B - $25 copay, $150 max"	18A - $10 copay	"18B - $50 copay, $750 max"	$0 copay	13B-$10 copay											0	0	0	0	50	0.13	0.1	50	25	0	25	0	0.2	10	0	10	18	0	10.69	5	0.2	0	0	15	10	25	0	50	0	10.26											NO	0	0	0	0	50	0.13	0.1	50	25	0	25	0	0.2	10	0	10	18	0	10.69	5	0.2	0	0	15	10	25	0	50	0	10.26												0	0	0	0	0.496808501	0.8528	0.09	0.536681521	0.357770524	0	0.066346193	0	0.018	0.013078071	0	0.137986828	0.174954182	0	1.895364034	1.949333378	1.448	0	0	1.274541944	0.248203724	0.481518057	0	0.068364773	0	0.506306885	0	0	0	0	0	0	0	0	0	0	10.6161			0	0	0	0	0.496808501	0.8528	0.09	0.536681521	0.357770524	0	0.066346193	0	0.018	0.013078071	0	0.137986828	0.174954182	0	1.895364034	1.949333378	1.448	0	0	1.274541944	0.248203724	0.481518057	0	0.068364773	0	0.506306885	0	0	0	0	0	0	0	0	0	0	10.6161	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0.496808501	0.8528	0.09	0.536681521	0.357770524	0	0.066346193	0	0.018	0.013078071	0	0.137986828	0.174954182	0	1.895364034	1.949333378	1.448	0	0	1.274541944	0.248203724	0.481518057	0	0.068364773	0	0.506306885	0	0	0	0	0	0	0	0	0	0	10.6161
H5106_013_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	208.9512847	0	154.8794973	0	230.6841695	10.81142895	0	595.692485	429.3491504	3452.958799	1415.501263	0	0	577.9017732	3179.357399	3293.413464	0	0	0	1030.204131	18.89628254	0	0	0	400.5772241	0	271.1774609	0	0	0												"$250/admit $750max; PBP 1a, 1b"		$50 days 16-55; PBP 2	$0; PBP 6	$75; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$100; PBP 9a, 9b"	$20-$50; PBP 8a	$0-$50; PBP 8b			"$0-$30; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$30; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$30; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	20%; PBP 15			"$0; PBP 16a, 16b"	"$0-$30; PBP 17a, 17b"		"$0-$30; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											250	0	50	0	75	0.15	0	50	100	15	23	0	0	30	15	30	0	0	0	30	0.2	0	0	0	30	0	30	0	0	0											NO	239.8849898	0	47.97699796	0	75	0.135369596	0	47.97699796	95.95399591	14.39309939	22.06941906	0	0	28.78619877	14.39309939	28.78619877	0	0	0	28.78619877	0.191907992	0	0	0	30	0	30	0	0	0												4.177	0	0.61922111	0	1.441776059	1.463538768	0	2.381628095	3.433147218	4.141564931	2.603274213	0	0	1.38629961	3.813400586	7.900404553	0	0	0	2.471305073	3.626347635	0	0	0	1.00144306	0	0.677943652	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1383	0	1.699498358	4.177	0	0.61922111	0	1.441776059	1.463538768	0	2.381628095	3.433147218	4.141564931	2.603274213	0	0	1.38629961	3.813400586	7.900404553	0	0	0	2.471305073	3.626347635	0	0	0	1.00144306	0	0.677943652	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1383	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	5.5717	0	0.9055	0.3753	0.6805	1.4304	0	0.0578	0.7079	0.4608	0.5288	0	0	0.2337	0.2218	0.5755	0	0	0	1.5246	0.2152	0	0	0	0	0	0.0623	0	0	0											13.5518	500	5.591420265	9.7488	0	1.52472046	0.375252372	2.12222648	2.893950435	0	2.439380708	4.141071443	4.602393096	3.132101231	0	0	1.619996818	4.035176198	8.475921223	0	0	0	3.99589327	3.841554004	0	0	0	1.00144306	0	0.740275493	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6901
H5106_014_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	260.8307693	0	219.1112868	0	290.8381108	17.67225575	0	399.2507884	611.302982	0	0	0	0	557.1992639	3955.67837	4956.856724	0	0	0	1853.839332	32.12630119	0	0	10.33823529	420	0	274.8592265	0	0	0												"$200/admit $600max; PBP 1a, 1b"		$35 days 16-55; PBP 2	$0; PBP 6	$75; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$75; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b			"$0-$25; PBP 7d, 12, 3, 5,  9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$25; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$25; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	20%; PBP 15			"$0-$25; 0%-40%; PBP 16a, 16b"	"$0-$25; PBP 17a, 17b"		"$0-$25; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											200	0	35	0	75	0.15	0	50	75	0	0	0	0	25	15	25	0	0	0	25	0.2	0	0	0.32	25	0	25	0	0	0											NO	192.2929562	0	33.65126733	0	75	0.135369596	0	48.07323905	72.10985857	0	0	0	0	24.03661952	14.42197171	24.03661952	0	0	0	24.03661952	0.192292956	0	0	0.32	25	0	25	0	0	0												4.1797	0	0.614447707	0	1.817738192	2.392286119	0	1.599439882	3.673414298	0	0	0	0	1.116098892	4.754056797	9.928839927	0	0	0	3.713335889	6.177661428	0	0	3.308235294	0.875	0	0.572623388	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7228	0	1.691680229	4.1797	0	0.614447707	0	1.817738192	2.392286119	0	1.599439882	3.673414298	0	0	0	0	1.116098892	4.754056797	9.928839927	0	0	0	3.713335889	6.177661428	0	0	3.308235294	0.875	0	0.572623388	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7228	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	6.661	0	1.0936	0.5757	0.6786	2.3381	0	0.0328	0.8265	0.5017	0.5883	0	0	0.2018	0.2377	0.681	0	0	0	1.8312	0.3016	0	0	0	0	0	0.0632	0	0	0											16.6129	500	10.00676329	10.8407	0	1.708031623	0.575748307	2.496364982	4.730423006	0	1.632224311	4.499887254	0.501699777	0.588289204	0	0	1.317883316	4.99175406	10.60986066	0	0	0	5.544566564	6.479239406	0	0	3.308235294	0.875	0	0.635849666	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3357
H5106_015_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	261.6927622	0	91.9785856	0	223.6637655	13.54728127	0	659.8210548	455.3360921	4120.612086	1741.264536	0	0	550.2663213	3596.985724	3828.083214	0	0	0	933.7682844	28.81641085	0	0	0	415.7812551	0	281.7518488	0	0	0												"$250/admit $750max; PBP 1a, 1b"		$50 days 16-55; PBP 2	$0; PBP 6	$75; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$100; PBP 9a, 9b"	$20-$50; PBP 8a	$0-$50; PBP 8b			"$0-$30; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$30; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$30; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	20%; PBP 15			"$0; PBP 16a, 16b"	"$0-$30; PBP 17a, 17b"		"$0-$30; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											250	0	50	0	75	0.15	0	50	100	15	23	0	0	30	15	30	0	0	0	30	0.2	0	0	0	30	0	30	0	0	0											NO	236.7011799	0	47.34023597	0	75	0.135369596	0	47.34023597	94.68047195	14.20207079	21.77650855	0	0	28.40414158	14.20207079	28.40414158	0	0	0	28.40414158	0.189360944	0	0	0	30	0	30	0	0	0												5.1619	0	0.362857329	0	1.397898534	1.833889991	0	2.603007036	3.592619674	4.876768713	3.159888504	0	0	1.302486875	4.257053825	9.061118134	0	0	0	2.210240546	5.456702758	0	0	0	1.039453138	0	0.704379622	0	0	0	0	0	0	0	0	0	0	0	0	0	47.0203	0	2.560439499	5.1619	0	0.362857329	0	1.397898534	1.833889991	0	2.603007036	3.592619674	4.876768713	3.159888504	0	0	1.302486875	4.257053825	9.061118134	0	0	0	2.210240546	5.456702758	0	0	0	1.039453138	0	0.704379622	0	0	0	0	0	0	0	0	0	0	0	0	0	47.0203	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	6.4206	0	0.8419	0.4799	0.6415	1.7924	0	0.0572	0.7489	0.5077	0.5861	0	0	0.2692	0.2218	0.5952	0	0	0	1.6527	0.288	0	0	0	0	0	0.0648	0	0	0											15.1676	500	8.27726563	11.5825	0	1.204717438	0.479894937	2.039396554	3.626270008	0	2.660175169	4.341470556	5.384443865	3.745960732	0	0	1.571664383	4.478812669	9.656287729	0	0	0	3.862926227	5.744730198	0	0	0	1.039453138	0	0.769144384	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1879
H5106_016_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	295.7587233	0	257.994135	0	257.3032128	12.68636126	0	431.7495421	496.0078091	0	0	0	0	736.4051124	3886.450069	5159.405605	0	0	0	1006.422286	52.7098396	0	0	10.33823529	422.1678571	0	276.5838041	0	0	0												"$200/admit $600max; PBP 1a, 1b"		$35 days 16-55; PBP 2	$0; PBP 6	$75; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$75; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b			"$0-$25; PBP 7d, 12, 3, 5,  9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$25; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$25; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	20%; PBP 15			"$0-$25; 0%-40%; PBP 16a, 16b"	"$0-$25; PBP 17a, 17b"		"$0-$25; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											200	0	35	0	75	0.15	0	50	75	0	0	0	0	25	15	25	0	0	0	25	0.2	0	0	0.32	25	0	25	0	0	0											NO	191.225774	0	33.46451044	0	75	0.135369596	0	47.80644349	71.70966524	0	0	0	0	23.90322175	14.34193305	23.90322175	0	0	0	23.90322175	0.191225774	0	0	0.32	25	0	25	0	0	0												4.7131	0	0.719470619	0	1.60814508	1.717347597	0	1.720034174	2.964046162	0	0	0	0	1.466871225	4.644933891	10.27720135	0	0	0	2.004727922	10.07947987	0	0	3.308235294	0.879516369	0	0.576216259	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6793	0	1.956266585	4.7131	0	0.719470619	0	1.60814508	1.717347597	0	1.720034174	2.964046162	0	0	0	0	1.466871225	4.644933891	10.27720135	0	0	0	2.004727922	10.07947987	0	0	3.308235294	0.879516369	0	0.576216259	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6793	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	6.5089	0	1.6505	0.6923	0.6876	1.6785	0	0.0347	0.6301	0.5447	0.5697	0	0	0.2185	0.2301	0.6655	0	0	0	1.7752	0.4827	0	0	0	0	0	0.0636	0	0	0											16.4325	500	10.8603167	11.222	0	2.369963377	0.692295691	2.295727404	3.395823148	0	1.754727997	3.594118786	0.544739804	0.569666452	0	0	1.685359884	4.874990164	10.94267526	0	0	0	3.779910673	10.56220398	0	0	3.308235294	0.879516369	0	0.63982649	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1118
H5106_017_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	203.4298346	0	130.6356019	0	180.1418074	9.172378383	0	405.2152526	368.3842386	2857.389362	1253.444037	0	0	391.91384	2678.001646	3051.079052	0	0	0	824.4810495	18.99556125	0	0	0	347.738723	0	229.031813	0	0	0												"$250/admit $750max; PBP 1a, 1b"		$50 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$250; PBP 9a, 9b"	$20-$50; PBP 8a	$0-$50; PBP 8b			"$0-$35; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$35; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$35; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	20%; PBP 15			"$0; PBP 16a, 16b"	"$0-$35; PBP 17a, 17b"		"$0-$35; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											250	0	50	0	100	0.15	0	50	250	15	23	0	0	35	15	35	0	0	0	35	0.2	0	0	0	35	0	35	0	0	0											NO	239.1934531	0	47.83869061	0	100	0.135369596	0	47.83869061	239.1934531	14.35160718	22.00579768	0	0	33.48708343	14.35160718	33.48708343	0	0	0	33.48708343	0.191354762	0	0	0	35	0	35	0	0	0												4.0549	0	0.520786345	0	1.501181728	1.241661155	0	1.615413925	7.34292484	3.417344142	2.298586324	0	0	1.093670955	3.202802304	8.514311563	0	0	0	2.300788807	3.63489111	0	0	0	1.014237942	0	0.668009455	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4215	0	1.850841067	4.0549	0	0.520786345	0	1.501181728	1.241661155	0	1.615413925	7.34292484	3.417344142	2.298586324	0	0	1.093670955	3.202802304	8.514311563	0	0	0	2.300788807	3.63489111	0	0	0	1.014237942	0	0.668009455	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4215	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	6.4014	0	0.8775	0.3993	0.4887	1.2136	0	0.0394	0.6052	0.3939	0.4715	0	0	0.168	0.188	0.5502	0	0	0	1.4533	0.2172	0	0	0	0	0	0.0526	0	0	0											13.5197	500	5.728437534	10.4563	0	1.398284345	0.399273676	1.989900613	2.455217395	0	1.654798311	7.948136277	3.81122915	2.770069886	0	0	1.261641263	3.390806137	9.064544575	0	0	0	3.754068776	3.852122221	0	0	0	1.014237942	0	0.720612418	0	0	0	0	0	0	0	0	0	0	0	0	0	55.9412
H5106_018_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	NO	256.2387787	0	129.6140198	0	230.0381042	11.81834267	0	502.8955704	450.3255783	3472.251666	1426.676793	0	0	540.9004333	3196.754632	3827.895765	0	0	0	1059.513423	25.67604844	0	0	0	393.4270726	0	257.5605302	0	0	0												"$250/admit $750max; PBP 1a, 1b"		$50 days 16-55; PBP 2	$0; PBP 6	$100; PBP 10a	"15% $750max; PBP 11a, 11b, 11c"		"$50; PBP 4a, 4b"	"$250; PBP 9a, 9b"	$20-$50; PBP 8a	$0-$50; PBP 8b			"$0-$35; PBP 7d, 12, 3, 5, 9c, 9d, 13a"	"$0-$15; PBP 7a, 14c-j"	"$0-$35; PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"$0-$35; PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	20%; PBP 15			"$0; PBP 16a, 16b"	"$0-$35; PBP 17a, 17b"		"$0-$35; PBP 18a, 18b"		$0; PBP 14a	$0; PBP 13b-e											250	0	50	0	100	0.15	0	50	250	15	23	0	0	35	15	35	0	0	0	35	0.2	0	0	0	35	0	35	0	0	0											NO	234.2530962	0	46.85061923	0	100	0.135369596	0	46.85061923	234.2530962	14.05518577	21.55128485	0	0	32.79543346	14.05518577	32.79543346	0	0	0	32.79543346	0.187402477	0	0	0	35	0	35	0	0	0												5.0021	0	0.506041424	0	1.916984202	1.599844271	0	1.963414073	8.790846749	4.066928517	2.562226497	0	0	1.478255348	3.744248351	10.46145841	0	0	0	2.895600165	4.811755075	0	0	0	1.147495628	0	0.751218213	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6984	0	3.284120461	5.0021	0	0.506041424	0	1.916984202	1.599844271	0	1.963414073	8.790846749	4.066928517	2.562226497	0	0	1.478255348	3.744248351	10.46145841	0	0	0	2.895600165	4.811755075	0	0	0	1.147495628	0	0.751218213	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6984	YES	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											3400	7.054	0	0.9116	0.4751	0.6009	1.5636	0	0.0438	0.715	0.412	0.4992	0	0	0.2077	0.1991	0.5711	0	0	0	1.6692	0.2579	0	0	0	0	0	0.0591	0	0	0											15.2392	500	8.413808845	12.0561	0	1.417616363	0.475125064	2.517840374	3.163476176	0	2.007179465	9.505811335	4.478949977	3.061422478	0	0	1.685943258	3.94331813	11.03256894	0	0	0	4.564775121	5.069641437	0	0	0	1.147495628	0	0.810360302	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9376
H5106_806_0	2010	4	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	249.5292222	0	25.30234473	7.183261043	9.886191203	25.92882299	0	23.1087431	52.30140743	21.8748153	45.71731329	0	0	26.98182832	25.02443248	43.1379955	0	0	0	89.29099461	35.84318832	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.077198036	0	0.181178503	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.077198036	0	0.181178503	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												19.2632	0	4.584240931	0	2.30348255	6.041415756	0	5.384337142	12.18622793	5.096831964	10.652134	0	0	6.286765998	5.830692768	10.05115295	0	0	0	20.80480174	8.351462879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8367		0	19.2632	0	4.584240931	0	2.30348255	6.041415756	0	5.384337142	12.18622793	5.096831964	10.652134	0	0	6.286765998	5.830692768	10.05115295	0	0	0	20.80480174	8.351462879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8367	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e												2.6266	0	1.1035	0	0.4855	0.9857	0	0.2137	0.8998	0.6074	0.6962	0	0	0.2621	0.288	0.8717	0	0	0	2.2029	0.4047	0	0	0	0	0	0	0	0	0											11.6479		0	21.8898	0	5.687722803	0	2.78899068	7.027161445	0	5.598039073	13.08602475	5.704212502	11.34828832	0	0	6.548858135	6.118725003	10.9228581	0	0	0	23.0076962	8.756205722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4846
H5106_807_0	2010	4	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	249.5292222	0	25.30234473	7.183261043	9.886191203	25.92882299	0	23.1087431	52.30140743	21.8748153	45.71731329	0	0	26.98182832	25.02443248	43.1379955	0	0	0	89.29099461	35.84318832	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.077198036	0	0.181178503	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.077198036	0	0.181178503	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												19.2632	0	4.584240931	0	2.30348255	6.041415756	0	5.384337142	12.18622793	5.096831964	10.652134	0	0	6.286765998	5.830692768	10.05115295	0	0	0	20.80480174	8.351462879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8367		0	19.2632	0	4.584240931	0	2.30348255	6.041415756	0	5.384337142	12.18622793	5.096831964	10.652134	0	0	6.286765998	5.830692768	10.05115295	0	0	0	20.80480174	8.351462879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8367	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e												2.6266	0	1.1035	0	0.4855	0.9857	0	0.2137	0.8998	0.6074	0.6962	0	0	0.2621	0.288	0.8717	0	0	0	2.2029	0.4047	0	0	0	0	0	0	0	0	0											11.6479		0	21.8898	0	5.687722803	0	2.78899068	7.027161445	0	5.598039073	13.08602475	5.704212502	11.34828832	0	0	6.548858135	6.118725003	10.9228581	0	0	0	23.0076962	8.756205722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4846
H5106_808_0	2010	4	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	286.3462293	0	24.34639264	8.647218912	10.62386148	22.87144939	0	20.63161769	56.56895978	19.89427398	43.83561007	0	0	25.26201874	24.25182623	43.06314828	0	0	0	87.4800308	32.59081032	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.076062951	0	0.180282855	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.076062951	0	0.180282855	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												21.7803	0	4.389237185	0	2.475359725	5.329047707	0	4.807166922	13.18056763	4.635365838	10.21369715	0	0	5.886050367	5.650675511	10.03371355	0	0	0	20.38284718	7.593658803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3577		0	21.7803	0	4.389237185	0	2.475359725	5.329047707	0	4.807166922	13.18056763	4.635365838	10.21369715	0	0	5.886050367	5.650675511	10.03371355	0	0	0	20.38284718	7.593658803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3577	NO	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e												2.9699	0	1.0565	0	0.5217	0.8695	0	0.1908	0.9732	0.5524	0.6675	0	0	0.2454	0.2791	0.8702	0	0	0	2.1582	0.368	0	0	0	0	0	0	0	0	0											11.7225		0	24.7502	0	5.445779311	0	2.99709464	6.198560089	0	4.997961225	14.1537837	5.187754266	10.88119808	0	0	6.13143687	5.929815017	10.90390623	0	0	0	22.54106342	7.961675653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.0802
H5151_002_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	YES	2285.5	89.6	2805.5	2399.7	450.6	19.38674425	0	405.4	385	15792.5	667.9	250.7	294	6742.2	3803.8	3421	174.7	33.3	944.9	0	21.12786808	0	0	0.1	267.9	157.6	0	0	0	0											3400	$100 / days 1-10	$100 / days 1-10	$75 / days 21-100	$0.00 	125	20%	20%	$50.00 	$150.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$30 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											72.9663106	72.9663106	23.02544002	$0.00 	125	20%	20%	$50.00 	$150.00 	$0.00 	5	$0.00 	$0.00 	3	15	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	62.38619556	62.38619556	19.68675122	0	106.875	0.171	0.171	42.75	128.25	0	4.275	0	0	2.565	12.825	25.65	25.65	25.65	0	0	0.1539	0	0	0	25.65	12.825	0	0	0	0												11.882	0.465816927	4.602598379	0	4.01315625	3.315133267	0	1.4442375	4.1146875	0	0.237939375	0	0	1.44114525	4.06531125	7.3123875	0.37342125	0.07117875	0	0	3.251578898	0	0	0	0.57263625	0.168435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3316		8.027002287	11.882	0.465816927	4.602598379	0	4.01315625	3.315133267	0	1.4442375	4.1146875	0	0.237939375	0	0	1.44114525	4.06531125	7.3123875	0.37342125	0.07117875	0	0	3.251578898	0	0	0	0.57263625	0.168435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3316	NO																																																																																		0		0	11.882	0.465816927	4.602598379	0	4.01315625	3.315133267	0	1.4442375	4.1146875	0	0.237939375	0	0	1.44114525	4.06531125	7.3123875	0.37342125	0.07117875	0	0	3.251578898	0	0	0	0.57263625	0.168435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3316
H5151_004_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	YES	2206.4	42.5	2515.2	1954.4	419.7	15.64831787	0	394	338.9	13427.2	610.5	159.7	244.2	6136.4	3518.1	3137.1	108.4	50.1	716.3	0	11.79302426	0	0	0.1	265.7	165.1	0	0	0	0											3400	$150 / days 1-10	$150 / days 1-10	$75 / days 21-100	$0.00 	$125.00 	20%	20%	$50.00 	$200.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$35 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											109.4494659	109.4494659	23.02544002	$0.00 	$125.00 	20%	20%	$50.00 	$200.00 	$0.00 	5	$0.00 	$0.00 	3.5	15	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	89.52966311	89.52966311	18.83480994	0	102.25	0.1636	0.1636	40.9	163.6	0	4.09	0	0	2.863	12.27	28.63	28.63	28.63	0	0	0.14724	0	0	0	28.63	12.27	0	0	0	0												16.4615	0.317084224	3.947776163	0	3.57619375	2.560064803	0	1.342883333	4.620336667	0	0.20807875	0	0	1.464042767	3.59725725	7.48459775	0.258624333	0.11953025	0	0	1.736404892	0	0	0	0.633915917	0.16881475	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4971		10.79031417	16.4615	0.317084224	3.947776163	0	3.57619375	2.560064803	0	1.342883333	4.620336667	0	0.20807875	0	0	1.464042767	3.59725725	7.48459775	0.258624333	0.11953025	0	0	1.736404892	0	0	0	0.633915917	0.16881475	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4971	NO																																																																																		0		0	16.4615	0.317084224	3.947776163	0	3.57619375	2.560064803	0	1.342883333	4.620336667	0	0.20807875	0	0	1.464042767	3.59725725	7.48459775	0.258624333	0.11953025	0	0	1.736404892	0	0	0	0.633915917	0.16881475	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4971
H5151_802_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	YES	2281.3	89.4	2806	2400.1	450.7	19.39015395	0	405.4	383.5	15876.1	671.4	252.1	295.6	6777.9	3872.6	3482.9	177.8	33.9	962	0	21.13158401	0	0	0.1	266.3	156.6	0	0	0	0											3400	$150 / days 1-10	$150 / days 1-10	$75 / days 21-100	$0.00 	125	20%	20%	$50.00 	$200.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$35 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											109.4494659	109.4494659	23.02544002	$0.00 	125	20%	20%	$50.00 	$200.00 	$0.00 	5	$0.00 	$0.00 	3.5	15	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	89.52966311	89.52966311	18.83480994	0	102.25	0.1636	0.1636	40.9	163.6	0	4.09	0	0	2.863	12.27	28.63	28.63	28.63	0	0	0.14724	0	0	0	28.63	12.27	0	0	0	0												17.0203	0.66699599	4.404206391	0	3.840339583	3.172229186	0	1.381738333	5.228383333	0	0.2288355	0	0	1.617093975	3.9597335	8.309618917	0.424201167	0.08087975	0	0	3.11141443	0	0	0	0.635347417	0.1601235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2415		12.06839686	17.0203	0.66699599	4.404206391	0	3.840339583	3.172229186	0	1.381738333	5.228383333	0	0.2288355	0	0	1.617093975	3.9597335	8.309618917	0.424201167	0.08087975	0	0	3.11141443	0	0	0	0.635347417	0.1601235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2415	NO																																																																																		0		0	17.0203	0.66699599	4.404206391	0	3.840339583	3.172229186	0	1.381738333	5.228383333	0	0.2288355	0	0	1.617093975	3.9597335	8.309618917	0.424201167	0.08087975	0	0	3.11141443	0	0	0	0.635347417	0.1601235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2415
H5151_803_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	YES	1401.6	44.4	1139.6	1175.5	175.9	13.29243983	0	335.2	389.5	14400.9	662.1	149.3	43.7	6422.1	3412.7	3391.8	126.3	41.2	915.2	0	15.37290254	0	0	0	293.9	187	0	0	0	0											3400	$100 / days 1-10	$100 / days 1-10	$50 / days 21-100	$0.00 	100	20%	20%	$50.00 	$150.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$30 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											72.9663106	72.9663106	15.35029335	$0.00 	100	20%	20%	$50.00 	$150.00 	$0.00 	5	$0.00 	$0.00 	3	15	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	63.26179129	63.26179129	13.30870433	0	86.7	0.1734	0.1734	43.35	130.05	0	4.335	0	0	2.601	13.005	26.01	26.01	26.01	0	0	0.15606	0	0	0	26.01	13.005	0	0	0	0												7.389	0.234068628	1.263883288	0	1.2708775	2.304909066	0	1.21091	4.22120625	0	0.239183625	0	0	1.391990175	3.698513625	7.3517265	0.27375525	0.089301	0	0	2.39909517	0	0	0	0.63702825	0.20266125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1781		5.243005241	7.389	0.234068628	1.263883288	0	1.2708775	2.304909066	0	1.21091	4.22120625	0	0.239183625	0	0	1.391990175	3.698513625	7.3517265	0.27375525	0.089301	0	0	2.39909517	0	0	0	0.63702825	0.20266125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1781	NO																																																																																		0		0	7.389	0.234068628	1.263883288	0	1.2708775	2.304909066	0	1.21091	4.22120625	0	0.239183625	0	0	1.391990175	3.698513625	7.3517265	0.27375525	0.089301	0	0	2.39909517	0	0	0	0.63702825	0.20266125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1781
H5162_001_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.4217018	23.12526479	438.72949	26.45618948	200.3283555	12.70984641	11.13661201	548.3143311	77.7269804	24.30011565	27.27213199	0.010330684	0.107016444	0.018920049	4102.980133	1904.398064	1.961873607	6.968172171	0	4.533582681	21.42668413	0.565907557																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	133.8791187	133.8791187	44.6263729	0	133.8791187	0.178505492	0.178505492	44.6263729	0.133879119	0	0.133879119	0.446263729	0.133879119	0.446263729	17.85054916	35.70109832	0.446263729	0.133879119	35.70109832	0	0.178505492	0.133879119																			4000	8.6176	0.257999172	1.631575485	0	2.234981974	2.268777382	1.987946402	2.03910665	10.40601963	0	3.651168995	0.00461021	0.014327267	0.008443331	6.103370713	5.665758543	0.875513031	0.932892749	0	0	3.824780783	0.075763205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6006		6.099809592	8.6176	0.257999172	1.631575485	0	2.234981974	2.268777382	1.987946402	2.03910665	10.40601963	0	3.651168995	0.00461021	0.014327267	0.008443331	6.103370713	5.665758543	0.875513031	0.932892749	0	0	3.824780783	0.075763205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6006	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2408	0.0371	0.2227	0	0.0284	0.3479	0.3049	0.2752	1.6934	0	0.5941	0.0006	0.0023	0.0011	0.936	0.7892	0.0998	0.1377	0	0.0001	0.0486	0.001																			6.7609		0.00770778	9.8584	0.295146777	1.854256001	0	2.263381085	2.616717852	2.292818538	2.314272528	12.09946669	0	4.24527523	0.005187544	0.016658847	0.009500686	7.039385721	6.45497021	0.975301646	1.070587065	0	6.20E-05	3.873380896	0.076725901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.3615
H5162_002_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.4217018	23.12526479	438.72949	25.6625038	200.3283555	12.32855102	10.80251365	548.3143311	75.39517099	23.57111218	26.45034713	0.010020764	0.103805951	0.018352447	4102.980133	1904.398064	1.903017399	6.759127006	0	4.3975752	20.7838836	0.54893033																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	134.1153048	134.1153048	44.70510161	0	134.1153048	0.178820406	0.178820406	44.70510161	0.134115305	0	0.134115305	0.447051016	0.134115305	0.447051016	17.88204064	35.76408129	0.447051016	0.134115305	35.76408129	0	0.178820406	0.134115305																			4000	8.6328	0.258454328	1.634453869	0	2.238924872	2.204596504	1.931709882	2.04270399	10.11164634	0	3.547396368	0.004479793	0.013921967	0.00820448	6.114138124	5.67575393	0.850745862	0.906502379	0	0	3.716582513	0.073619959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9666		5.918192819	8.6328	0.258454328	1.634453869	0	2.238924872	2.204596504	1.931709882	2.04270399	10.11164634	0	3.547396368	0.004479793	0.013921967	0.00820448	6.114138124	5.67575393	0.850745862	0.906502379	0	0	3.716582513	0.073619959	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9666	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2425	0.0372	0.223	0	0.0283	0.3476	0.3045	0.2755	1.6919	0	0.594	0.0006	0.0023	0.0011	0.9373	0.7903	0.0996	0.1375	0	0.0001	0.047	0.0009																			6.7613		0.00770778	9.8753	0.295653138	1.857437208	0	2.267264198	2.552160725	2.236252341	2.318242951	11.80353509	0	4.141441328	0.00505614	0.016251401	0.009260027	7.051462664	6.466044516	0.950330128	1.044032765	0	6.83E-05	3.763625379	0.074551808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.728
H5162_003_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.5062768	23.12219987	438.6713429	26.71720993	200.3390185	12.83524353	11.24813434	548.2416601	78.50794373	24.54431964	27.54569337	0.010432608	0.108072283	0.019106716	4102.880472	1904.375953	1.783106753	6.32831221	0	4.578725001	21.63808413	0.57149088																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	133.8605404	133.8605404	44.62018015	0	133.8605404	0.178480721	0.178480721	44.62018015	0.13386054	0	0.13386054	0.446201801	0.13386054	0.446201801	17.84807206	35.69614412	0.446201801	0.13386054	35.69614412	0	0.178480721	0.13386054																			4000	8.6173	0.257929181	1.631132862	0	2.234790774	2.290843514	2.007575122	2.03855347	10.50911578	0	3.687281401	0.004655049	0.014466614	0.008525451	6.102375526	5.66490654	0.795625445	0.847111292	0	0	3.861980849	0.076500078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6507		6.106975216	8.6173	0.257929181	1.631132862	0	2.234790774	2.290843514	2.007575122	2.03855347	10.50911578	0	3.687281401	0.004655049	0.014466614	0.008525451	6.102375526	5.66490654	0.795625445	0.847111292	0	0	3.861980849	0.076500078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6507	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2408	0.0371	0.2226	0	0.0284	0.3481	0.3051	0.2751	1.6947	0	0.5945	0.0006	0.0023	0.0011	0.9359	0.7891	0.0988	0.1366	0	0.0001	0.0491	0.001																			6.7609		0.01	9.8581	0.295067807	1.853759868	0	2.26319588	2.638987623	2.312670362	2.313653311	12.20377506	0	4.28180315	0.005232832	0.016799444	0.009583628	7.038264111	6.454023551	0.894378233	0.983713176	0	6.82E-05	3.911068207	0.077472425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4117
H5162_004_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.5062768	23.12219987	438.6713429	26.4526831	200.3390185	12.70816191	11.13676667	548.2416601	77.73063736	24.30130657	27.27296373	0.010329315	0.107002261	0.018917541	4102.880472	1904.375953	1.76545223	6.265655653	0	4.53339109	21.42384568	0.565832554																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	133.9378015	133.9378015	44.64593384	0	133.9378015	0.178583735	0.178583735	44.64593384	0.133937802	0	0.133937802	0.446459338	0.133937802	0.446459338	17.85837353	35.71674707	0.446459338	0.133937802	35.71674707	0	0.178583735	0.133937802																			4000	8.6223	0.258078051	1.632074313	0	2.236080641	2.269471023	1.988845391	2.039730074	10.41107068	0	3.652880802	0.004611619	0.014331648	0.008445913	6.10589767	5.668176187	0.788202635	0.839208143	0	0	3.825950386	0.075786368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4412		6.06	8.6223	0.258078051	1.632074313	0	2.236080641	2.269471023	1.988845391	2.039730074	10.41107068	0	3.652880802	0.004611619	0.014331648	0.008445913	6.10589767	5.668176187	0.788202635	0.839208143	0	0	3.825950386	0.075786368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4412	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2414	0.0372	0.2227	0	0.0284	0.348	0.305	0.2752	1.6941	0	0.5943	0.0006	0.0023	0.0011	0.9363	0.7895	0.0987	0.1366	0	0.0001	0.0486	0.001																			6.7609		0.005042476	9.8637	0.295233637	1.854801696	0	2.264467814	2.617487934	2.293829162	2.314953603	12.10520128	0	4.247217014	0.005189071	0.01666375	0.009503482	7.042219671	6.457650763	0.886898792	0.975767412	0	6.82E-05	3.874521048	0.076748481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2021
H5162_005_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	812.7586084	13.32781863	466.8594179	14.45593498	232.0530798	11.16824114	11.78087079	577.4790617	82.23953669	25.47557779	29.98289613	0.000288404	0.298221224	0	4511.807275	2265.056587	1.351612366	7.888216322	0	4.661933219	23.66996801	0.677518472																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	132.3809225	132.3809225	44.12697418	0	132.3809225	0.176507897	0.176507897	44.12697418	0.132380923	0	0.132380923	0.441269742	0.132380923	0	17.65078967	35.30157934	0.441269742	0.132380923	35.30157934	0	0.176507897	0.132380923																			4000	8.9661	0.147029077	1.71675779	0	2.559950065	1.971282754	2.079416725	2.123533637	10.88694574	0	3.96916345	0.000127264	0.039478801	0	6.636413438	6.66333957	0.59642564	1.044249354	0	0	4.177936269	0.08969052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6679		7.16	8.9661	0.147029077	1.71675779	0	2.559950065	1.971282754	2.079416725	2.123533637	10.88694574	0	3.96916345	0.000127264	0.039478801	0	6.636413438	6.66333957	0.59642564	1.044249354	0	0	4.177936269	0.08969052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6679	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.3052	0.0214	0.237	0	0.0361	0.3201	0.3376	0.2744	1.8754	0	0.6834	0	0.0068	0	1.0284	0.9387	0.0721	0.1588	0	0	0.059	0.0013																			7.3557		0.016703395	10.2714	0.168432465	1.953774289	0	2.596079531	2.291370842	2.417063125	2.397898386	12.76232751	0	4.65252077	0.000144155	0.046279406	0	7.664808151	7.6020543	0.668510908	1.203078128	0	0	4.236900938	0.090956354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0236
H5162_006_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	812.7586084	13.32781863	466.8594179	14.30376725	232.0530798	11.05068071	11.65686163	577.4790617	81.37385736	25.20741382	29.66728669	0.000285368	0.295082053	0	4511.807275	2265.056587	1.337384867	7.805182466	0	4.612860237	23.42081046	0.670386698																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	132.5034437	132.5034437	44.16781458	0	132.5034437	0.176671258	0.176671258	44.16781458	0.132503444	0	0.132503444	0.441678146	0.132503444	0	17.66712583	35.33425167	0.441678146	0.132503444	35.33425167	0	0.176671258	0.132503444																			4000	8.9744	0.147165156	1.718346684	0	2.56231935	1.952337666	2.059432412	2.12549901	10.78231633	0	3.931017654	0.000126041	0.039099388	0	6.642555572	6.669506625	0.590693668	1.034213556	0	0	4.137784054	0.088828546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4557		7.08	8.9744	0.147165156	1.718346684	0	2.56231935	1.952337666	2.059432412	2.12549901	10.78231633	0	3.931017654	0.000126041	0.039099388	0	6.642555572	6.669506625	0.590693668	1.034213556	0	0	4.137784054	0.088828546	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4557	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.3059	0.0214	0.2371	0	0.036	0.32	0.3375	0.2745	1.8749	0	0.6832	0	0.0068	0	1.029	0.9392	0.072	0.1588	0	0	0.0582	0.0012																			7.3557		0.016703395	10.2803	0.168579726	1.955482476	0	2.598349287	2.272312592	2.396959441	2.399994872	12.65716722	0	4.614181098	0.000142921	0.045898069	0	7.671509504	7.608700787	0.662723051	1.192973001	0	0	4.195967316	0.090077605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8114
H5206_002_0	2010	6	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	555.0746387		233.2984127		35.75471797	67.85946386		51.93466826	22.69992597	129.6009149					335.410024						58.07271304	1.481453811																				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																			0.084423725		0.151735372		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			NO	0.084423725		0.151735372		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																				46.8615	0	35.39962132	0	8.330849287	15.81125508	0	12.1007777	5.28908275	30.19701317	0	0	0	0	78.15053558	0	0	0	0	0	13.53094214	0.345178738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.0167	0	0	46.8615	0	35.39962132	0	8.330849287	15.81125508	0	12.1007777	5.28908275	30.19701317	0	0	0	0	78.15053558	0	0	0	0	0	13.53094214	0.345178738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.0167	NO																																																																																		0	0	0	46.8615	0	35.39962132	0	8.330849287	15.81125508	0	12.1007777	5.28908275	30.19701317	0	0	0	0	78.15053558	0	0	0	0	0	13.53094214	0.345178738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.0167
H5206_003_0	2010	5	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	605.0523847		273.2824662		77.26064476	37.65810988		31.92016203	21.88384004	204.5523867					330.6129507						47.53383725	6.757709196																				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																			0.080820393		0.12715202		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			NO	0.080820393		0.12715202		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																				48.9006	0	34.74841755	0	18.00173023	8.774339602	0	7.437397753	5.09893473	47.6607061	0	0	0	0	77.03281751	0	0	0	0	0	11.07538408	1.574546243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	260.3048	0	0	48.9006	0	34.74841755	0	18.00173023	8.774339602	0	7.437397753	5.09893473	47.6607061	0	0	0	0	77.03281751	0	0	0	0	0	11.07538408	1.574546243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	260.3048	NO																																																																																		0	0	0	48.9006	0	34.74841755	0	18.00173023	8.774339602	0	7.437397753	5.09893473	47.6607061	0	0	0	0	77.03281751	0	0	0	0	0	11.07538408	1.574546243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	260.3048
H5207_001_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	777.0757132	28.95715723	379.0922004	77.21532449	41.71572933	42.04325403	38.8007595	29.91234274	56.91885166	21.12829548	49.41026581	4.414205565	9.626960881	151.5137242	95.23274017	173.8664723	5.749983173	9.623085046	39.34941315	60.17954087	26.14141336	8.177200018	0	0	0	0	0	0	0	5.620361556												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	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	0	0	0	0	0	13c: Home Modification											0.078085663	0.078090581	0.153590717	0	0.233011222	0.232999984	0.233003328	0.233004019	0.233000029	0.232969268	0.232998011	0.232999801	0.232999997	0.233000639	0.233000181	0.233000244	0.233007665	0.233010921	0.233005776	0.23298235	0.23300246	0.232998744	0	0	0	0	0	0	0	0.2											NO	0.078085663	0.078090581	0.153590717	0	0.233011222	0.232999984	0.233003328	0.233004019	0.233000029	0.232969268	0.232998011	0.232999801	0.232999997	0.233000639	0.233000181	0.233000244	0.233007665	0.233010921	0.233005776	0.23298235	0.23300246	0.232998744	0	0	0	0	0	0	0	0.2												60.6785	2.261281246	58.22504269	0	9.720233073	9.796077501	9.040706079	6.969696076	13.2620941	4.922243523	11.51249367	1.02850902	2.243081857	35.30279459	22.18924573	40.51093041	1.339790155	2.242283908	9.16864054	14.02077082	6.091013627	1.905277334	0	0	0	0	0	0	0	1.124072311	0	0	0	0	0	0	0	0	0	0	323.5548	0	0	60.6785	2.261281246	58.22504269	0	9.720233073	9.796077501	9.040706079	6.969696076	13.2620941	4.922243523	11.51249367	1.02850902	2.243081857	35.30279459	22.18924573	40.51093041	1.339790155	2.242283908	9.16864054	14.02077082	6.091013627	1.905277334	0	0	0	0	0	0	0	1.124072311	0	0	0	0	0	0	0	0	0	0	323.5548	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	60.6785	2.261281246	58.22504269	0	9.720233073	9.796077501	9.040706079	6.969696076	13.2620941	4.922243523	11.51249367	1.02850902	2.243081857	35.30279459	22.18924573	40.51093041	1.339790155	2.242283908	9.16864054	14.02077082	6.091013627	1.905277334	0	0	0	0	0	0	0	1.124072311	0	0	0	0	0	0	0	0	0	0	323.5548
H5209_002_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	572.7767937		272.5144428		81.25651388	16.98270494		23.22525702	16.75850217	189.3621278					417.1673012						31.91925943	22.19160422																				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																			0.07514738		0.142572166		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			NO	0.07514738		0.142572166		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																				43.0427	0	38.85297443	0	18.93276774	3.956970251	0	5.411484886	3.904731006	44.12137579	0	0	0	0	97.19998118	0	0	0	0	0	7.437187448	5.170643782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	268.0308	0	0	43.0427	0	38.85297443	0	18.93276774	3.956970251	0	5.411484886	3.904731006	44.12137579	0	0	0	0	97.19998118	0	0	0	0	0	7.437187448	5.170643782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	268.0308	NO																																																																																		0	0	0	43.0427	0	38.85297443	0	18.93276774	3.956970251	0	5.411484886	3.904731006	44.12137579	0	0	0	0	97.19998118	0	0	0	0	0	7.437187448	5.170643782	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	268.0308
H5211_001_0	2010	7	N/A																															D	D			T			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	YES	1665.024573	19.6643754	2889.095551	0	0	0	0	325.2607407	0	0	1030.772205	0	0	0	3024.66616	5984.279638	83.07923291	0	0	0	0	0	0	0	1.232593801	0	0	0	0	0											900	$50 each of days 1-5/admit (PBP 1A)	$50 each of days 1-5/admit (PBP 1B)	$100 each of days 15-25/admit (PBP 2)	no cost sharing	no cost sharing	no cost sharing	no cost sharing	$50 per visit if not admitted (PBP 4A); excluded from OOP max	no cost sharing	no cost sharing	"$100 per visit on MRI, CT, & Pet Scans each separately (PBP Cat 8b); taken on hospital outpatient bill or professional bill if no hospital outpatient bill received (all put here)"	no cost sharing	no cost sharing	no cost sharing	$15 per visit (PBP 4B & 7A)	"$15 per visit (PBP 4B, 7B, 7D, 7F, & 7G)"	"$15 per visit (PBP 5, 7E, 7H, & 9C)"	no cost sharing	see service category h.2. notes	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	$15 per visit (PBP 17A)	no cost sharing	$15 per visit (PBP 18A)	no cost sharing	no cost sharing	no cost sharing											38.83788449	21.56311672	21.44227821	0	0	0	0	49.60686744	0	0	48.99954468	0	0	0	14.85126397	14.78557355	14.82403676	0	0	0	0	0	0	0	15	0	15	0	0	0											NO	31.08147458	17.25669338	12.45800717	0	0	0	0	49.60686744	0	0	43.03100238	0	0	0	14.21164596	13.95776052	13.74415783	0	0	0	0	0	0	0	15	0	15	0	0	0												4.3126	0.028278508	2.999364424	0	0	0	0	1.344597204	0	0	3.696263435	0	0	0	3.582123718	6.960595173	0.095154507	0	0	0	0	0	0	0	0.001540742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.0205	0	3.990592798	4.3126	0.028278508	2.999364424	0	0	0	0	1.344597204	0	0	3.696263435	0	0	0	3.582123718	6.960595173	0.095154507	0	0	0	0	0	0	0	0.001540742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.0205	NO																																																																																		0			4.3126	0.028278508	2.999364424	0	0	0	0	1.344597204	0	0	3.696263435	0	0	0	3.582123718	6.960595173	0.095154507	0	0	0	0	0	0	0	0.001540742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.0205
H5211_002_0	2010	5	N/A																															D	D	D		T	Coin	Coin	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	YES	739.6189327	8.480593025	747.5886247	0	86.41547817	4.29153579	8.532617548	279.3020824	468.3493905	0	881.7269058	0	0	0	3292.181121	6502.030128	91.00219868	0	0	0	0	0	0	0	4.083807427	0	0	0	0	0											4000	$300 each of days 1-5/admit (PBP 1A)	$300 each of days 1-5/admit (PBP 1B)	$180 each of days 15-30/admit (PBP 2)	no cost sharing	$150 per trip (PBP 10A)	20% coinsurance (PBP 11A)	20% coinsurance (PBP 11B)	$50 per visit if not admitted (PBP 4A); excluded from OOP max	$250 Hosp OP surgery & ASC copay (PBP 9A & 9B)	no cost sharing	"$100 per visit on MRI, CT, & Pet Scans each separately (PBP Cat 8b); taken on hospital outpatient bill or professional bill if no hospital outpatient bill received (all put here)"	no cost sharing	no cost sharing	no cost sharing	$20 per visit (PBP 4B & 7A)	"$20 per visit (PBP 4B, 7B, 7D, 7F, & 7G)"	"$20 per visit (PBP 5, 7E, 7H, & 9C)"	no cost sharing	see service category h.2. notes	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	$20 per visit (PBP 17A)	no cost sharing	$20 per visit (PBP 18A)	no cost sharing	no cost sharing	no cost sharing											213.1741344	118.4332622	51.17115832	0	173.4852849	0.195004464	0.194932166	49.60812975	209.11658	0	56.29489163	0	0	0	19.78312158	19.69005235	19.76425324	0	0	0	0	0	0	0	20	0	20	0	0	0											NO	181.4541863	100.8105946	35.55244683	0	148.931173	0.178590944	0.178524731	49.60812975	200.5833388	0	52.73242562	0	0	0	19.26559274	19.17471745	19.0584876	0	0	0	0	0	0	0	20	0	20	0	0	0												11.1839	0.071244469	2.214883736	0	1.072496544	0.766429428	1.523283253	1.154637829	7.828590371	0	3.874633206	0	0	0	5.285485059	10.38954921	0.144530356	0	0	0	0	0	0	0	0.006806346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5165	0	4.52183615	11.1839	0.071244469	2.214883736	0	1.072496544	0.766429428	1.523283253	1.154637829	7.828590371	0	3.874633206	0	0	0	5.285485059	10.38954921	0.144530356	0	0	0	0	0	0	0	0.006806346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5165	NO																																																																																		0			11.1839	0.071244469	2.214883736	0	1.072496544	0.766429428	1.523283253	1.154637829	7.828590371	0	3.874633206	0	0	0	5.285485059	10.38954921	0.144530356	0	0	0	0	0	0	0	0.006806346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5165
H5211_003_0	2010	5	N/A																															D	D	D		T	Coin	Coin	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	YES	637.0288516	7.304278185	531.5205236	0	75.84668185	4.522923644	8.992672913	311.3180531	371.9471364	0	832.4455232	0	0	0	3007.020802	5938.840888	83.11982069	0	0	0	0	0	0	0	4.083807427	0	0	0	0	0											4000	$300 each of days 1-5/admit (PBP 1A)	$300 each of days 1-5/admit (PBP 1B)	$180 each of days 15-30/admit (PBP 2)	no cost sharing	$150 per trip (PBP 10A)	20% coinsurance (PBP 11A)	20% coinsurance (PBP 11B)	$50 per visit if not admitted (PBP 4A); excluded from OOP max	$250 Hosp OP surgery & ASC copay (PBP 9A & 9B)	no cost sharing	"$100 per visit on MRI, CT, & Pet Scans each separately (PBP Cat 8b); taken on hospital outpatient bill or professional bill if no hospital outpatient bill received (all put here)"	no cost sharing	no cost sharing	no cost sharing	$20 per visit (PBP 4B & 7A)	"$20 per visit (PBP 4B, 7B, 7D, 7F, & 7G)"	"$20 per visit (PBP 5, 7E, 7H, & 9C)"	no cost sharing	see service category h.2. notes	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	$20 per visit (PBP 17A)	no cost sharing	$20 per visit (PBP 18A)	no cost sharing	no cost sharing	no cost sharing											213.1741344	118.4332622	51.17115832	0	173.4852849	0.195004464	0.194932166	49.60812975	209.11658	0	56.29489163	0	0	0	19.78312158	19.69005235	19.76425324	0	0	0	0	0	0	0	20	0	20	0	0	0											NO	181.4541863	100.8105946	35.55244683	0	148.931173	0.178590944	0.178524731	49.60812975	200.5833388	0	52.73242562	0	0	0	19.26559274	19.17471745	19.0584876	0	0	0	0	0	0	0	20	0	20	0	0	0												9.6326	0.061362386	1.57473793	0	0.941327941	0.807753203	1.605414513	1.286992198	6.217199871	0	3.658072636	0	0	0	4.827669845	9.489633001	0.132011506	0	0	0	0	0	0	0	0.006806346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2416	0	3.997803877	9.6326	0.061362386	1.57473793	0	0.941327941	0.807753203	1.605414513	1.286992198	6.217199871	0	3.658072636	0	0	0	4.827669845	9.489633001	0.132011506	0	0	0	0	0	0	0	0.006806346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2416	NO																																																																																		0			9.6326	0.061362386	1.57473793	0	0.941327941	0.807753203	1.605414513	1.286992198	6.217199871	0	3.658072636	0	0	0	4.827669845	9.489633001	0.132011506	0	0	0	0	0	0	0	0.006806346	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2416
H5211_004_0	2010	5	N/A																															D	D			T			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	YES	1406.063121	16.60597297	1956.556102	0	0	0	0	311.0236837	0	0	1129.026278	0	0	0	3290.618484	6510.464345	90.38420936	0	0	0	0	0	0	0	2.431689612	0	0	0	0	0											900	$50 each of days 1-5/admit (PBP 1A)	$50 each of days 1-5/admit (PBP 1B)	$100 each of days 15-25/admit (PBP 2)	no cost sharing	no cost sharing	no cost sharing	no cost sharing	$50 per visit if not admitted (PBP 4A); excluded from OOP max	no cost sharing	no cost sharing	"$100 per visit on MRI, CT, & Pet Scans each separately (PBP Cat 8b); taken on hospital outpatient bill or professional bill if no hospital outpatient bill received (all put here)"	no cost sharing	no cost sharing	no cost sharing	$15 per visit (PBP 4B & 7A)	"$15 per visit (PBP 4B, 7B, 7D, 7F, & 7G)"	"$15 per visit (PBP 5, 7E, 7H, & 9C)"	no cost sharing	see service category h.2. notes	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	$15 per visit (PBP 17A)	no cost sharing	$15 per visit (PBP 18A)	no cost sharing	no cost sharing	no cost sharing											38.83788449	21.56311672	21.44227821	0	0	0	0	49.60686744	0	0	48.99954468	0	0	0	14.85126397	14.78557355	14.82403676	0	0	0	0	0	0	0	15	0	15	0	0	0											NO	31.08147458	17.25669338	12.45800717	0	0	0	0	49.60686744	0	0	43.03100238	0	0	0	14.21164596	13.95776052	13.74415783	0	0	0	0	0	0	0	15	0	15	0	0	0												3.6419	0.023880349	2.031232496	0	0	0	0	1.285742554	0	0	4.048594371	0	0	0	3.897092074	7.572625184	0.103521237	0	0	0	0	0	0	0	0.003039612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6076	0	3.919011375	3.6419	0.023880349	2.031232496	0	0	0	0	1.285742554	0	0	4.048594371	0	0	0	3.897092074	7.572625184	0.103521237	0	0	0	0	0	0	0	0.003039612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6076	NO																																																																																		0			3.6419	0.023880349	2.031232496	0	0	0	0	1.285742554	0	0	4.048594371	0	0	0	3.897092074	7.572625184	0.103521237	0	0	0	0	0	0	0	0.003039612	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.6076
H5211_005_0	2010	5	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5211_006_0	2010	5	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing	no cost sharing											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5214_003_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	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	YES	974.349768	61.945129	419.184535	157.836181	37.85087	7.156613	3.185652	298.598819	368.649553	645.291725	903.522422	60.83399	0.006809	521.16103	3620.661231	4994.497209	70.50948	956.345007			25.335082	0							0.04	0.25	13.362564	0.05	0.55	2.18	0.32	0.4	0.42				4900	$195/Day(Days 1-5):1a	$195/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				118.300845	98.80884	58.254672	0	100	0.2	0.2	50	125	50.330471	69.223578	50	0.2	59.074424	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0	0				NO	109.697416	91.622967	42.700383	0	88.6766	0.177353	0.177353	44.3383	110.84575	44.631351	61.385115	44.3383	0.177353	52.385191	13.30149	31.03681	31.03681	13.30149			0.177353	0							0	0	0	0	0	0	0	0	0					8.907	0.472966376	1.491611683	0	0.279707205	1.269246785	0.564984939	1.103280335	3.405269682	2.400020123	4.621902315	0.224772975	0.001207597	2.275093342	4.013349096	12.91777174	0.182365778	1.060067796	0	0	4.493252798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6838	0	6.235068	8.907	0.472966376	1.491611683	0	0.279707205	1.269246785	0.564984939	1.103280335	3.405269682	2.400020123	4.621902315	0.224772975	0.001207597	2.275093342	4.013349096	12.91777174	0.182365778	1.060067796	0	0	4.493252798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6838	YES	20% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	5.503	0.1732	0.331	1.658	1.4256	1.3329	0.5933	0.2481	3.8168	0.4366	1.7978	0.3026	0.0003	0.7554	2.3106	4.4303	0.034	0.4916			1.4552	0							0	0	0	0	0	0	0	0	0				27.0961	1000	8.668631	14.4099	0.646141376	1.822587683	1.657983	1.705281205	2.602130785	1.158296939	1.351356335	7.222111682	2.836646123	6.419751315	0.527345975	0.001493597	3.030456342	6.323913096	17.34807874	0.216363778	1.551634796	0	0	5.948424798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.7799
H5214_004_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	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	YES	1080.632537	45.753396	306.239254	403.903625	35.605357	6.589358	2.725306	328.643397	409.467071	915.455831	902.05653	72.923095	0.005524	597.935578	3663.580825	4531.032977	83.717204	873.321016			21.069353	0							0.04	0.25	9.204402	0.05	0.55	2.18	0.32	0.4	0.42				4900	$195/Day(Days 1-5):1a	$195/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				118.300845	98.80884	58.254672	0	100	0.2	0.2	50	125	46.713409	70.647877	50	0.2	61.946735	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0	0				NO	109.95472	91.837876	45.869146	0	88.7511	0.177502	0.177502	44.37555	110.938875	41.458664	62.700768	44.37555	0.177502	54.978409	13.312665	31.062885	31.062885	13.312665			0.177502	0							0	0	0	0	0	0	0	0	0					9.9017	0.350157892	1.170577754	0	0.26333455	1.169624224	0.483747266	1.215310958	3.785484684	3.162797975	4.713303101	0.269666871	0.000980521	2.73946223	4.064335352	11.72891302	0.216708157	0.96885251	0	0	3.739852296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9448	0	5.976826	9.9017	0.350157892	1.170577754	0	0.26333455	1.169624224	0.483747266	1.215310958	3.785484684	3.162797975	4.713303101	0.269666871	0.000980521	2.73946223	4.064335352	11.72891302	0.216708157	0.96885251	0	0	3.739852296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9448	YES	20% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	5.6679	0.1119	0.2725	2.9212	1.3598	1.2445	0.5147	0.2769	4.0501	0.5094	1.5648	0.2629	0.0002	0.9091	2.2335	3.7546	0.0319	0.3943			1.22	0							0	0	0	0	0	0	0	0	0				27.3001	1000	8.111002	15.5697	0.462067892	1.443037754	2.921201	1.62316755	2.414094224	0.998450266	1.492181958	7.835552684	3.672190975	6.278098101	0.532528871	0.001215521	3.64858723	6.297800352	15.48355002	0.248564157	1.36312551	0	0	4.959818296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.2449
H5214_008_0	2010	5	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1027.258575	57.643384	385.822003	230.349133	37.807795	6.691647	2.952764	314.508741	373.642201	708.408226	919.84896	69.068696	12.426006	529.466127	3638.218333	4672.802097	73.114949	894.767678			21.6205	0							0.04	0.25	0.05	0.55	2.18	0.32	0.4	0.42					3900	$175/Day(Days 1-5):1a	$175/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					106.167425	88.6746	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	5.007512	60.445636	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	95.622027	79.866729	37.709065	0	85.8856	0.171771	0.171771	42.9428	107.357	41.958304	60.193748	42.9428	4.300732	51.914097	12.88284	30.05996	30.05996	12.88284			0.171771	0							0	0	0	0	0	0	0	0						8.1857	0.383649044	1.212415582	0	0.27059543	1.149430897	0.507199225	1.125490497	3.342758814	2.476967309	4.614096375	0.247166933	0.00445341	2.29056299	3.905882056	11.70535368	0.183152704	0.960595736	0	0	3.713774906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2793	0	7.603608	8.1857	0.383649044	1.212415582	0	0.27059543	1.149430897	0.507199225	1.125490497	3.342758814	2.476967309	4.614096375	0.247166933	0.00445341	2.29056299	3.905882056	11.70535368	0.183152704	0.960595736	0	0	3.713774906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2793	YES	20% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					5000	4.7064	0.1226	0.2553	1.333	1.2047	1.2653	0.5583	0.2211	2.9198	0.3251	1.3289	0.2257	0.0009	0.5889	1.761	3.1141	0.0263	0.3376			1.0442	0							0	0	0	0	0	0	0	0					21.339	500	8.118782	12.8922	0.506245044	1.467729582	1.333049	1.47530143	2.414706897	1.065516225	1.346552497	6.262537814	2.802042309	5.942974375	0.472827933	0.00532841	2.87947699	5.666846056	14.81940668	0.209426704	1.298175736	0	0	4.757972906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.6183
H5214_009_0	2010	5	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V				O	O	O	O	O	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	YES	1104.088587	61.954608	414.678136	247.577247	40.63549	6.957433	3.070046	338.031261	401.58739	761.391004	988.645666	74.234434	13.355363	569.065592	3910.325441	5022.287079	78.583312	961.688523			22.479248	0		3.25	2.69				0.04	0.25	0.05	0.55	2.18	0.32	0.4	0.42					3900	$175/Day(Days 1-5):1a	$175/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					106.167425	88.6746	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	5.007511	60.445636	15	35	35	15			0.2	0		0	0				0	0	0	0	0	0	0	0					NO	94.204904	78.683101	35.571002	0	84.7144	0.169429	0.169429	42.3572	105.893	41.386129	59.372901	42.3572	4.242083	51.206158	12.70716	29.65004	29.65004	12.70716			0.169429	0		0	0				0	0	0	0	0	0	0	0						8.6675	0.406231723	1.229209734	0	0.286867596	1.178790916	0.520154824	1.193171477	3.543774457	2.625918859	4.891563438	0.262030231	0.004721213	2.428305218	4.140760919	12.40925107	0.194166529	1.018360828	0	0	3.808636509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8095	0	8.88408	8.6675	0.406231723	1.229209734	0	0.286867596	1.178790916	0.520154824	1.193171477	3.543774457	2.625918859	4.891563438	0.262030231	0.004721213	2.428305218	4.140760919	12.40925107	0.194166529	1.018360828	0	0	3.808636509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.8095	YES	20% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	35% Coins	35% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					5000	4.7254	0.1231	0.2507	1.3454	1.2569	1.4898	0.6574	0.2306	2.9468	0.3281	1.3412	0.2277	0.0009	0.5944	1.7772	3.1428	0.0265	0.3407			1.0538	0		0	0				0	0	0	0	0	0	0	0					21.8594	500	8.952298	13.3929	0.529319723	1.479923734	1.345372	1.543723596	2.668590916	1.177546824	1.423803477	6.490543457	2.953997859	6.232725438	0.489776231	0.005634213	3.022663218	5.918002919	15.55208907	0.220682529	1.359061828	0	0	4.862486509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6688
H5214_010_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered														A	A	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin								O	O	O	O	O	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	NO	209.310405	9.432207	427.673484	255.335921	41.908941	7.208812	3.180969	348.624619	414.172495	785.251777	1019.628238	76.560822	13.773898	586.899193	4032.868773	5179.677506	81.045987	991.8263			23.291446	0								0.04	0.05	0.25	0.32	0.4	0.42	0.55	2.18					$0/Admit:1a	$0/Admit:1b	$0/Day(Days 1-20) $0(Days 21-100):2	$0/Visit:6	$0/Trip:10a	20% Coins:11a	0% Coins:11b	$0/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			20% Coins:15									$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0			0.2	0								0	0	0	0	0	0	0	0				NO	0	0	0	0	0	0.194408	0	0	0	0	0	0	0	0	0	0	0	0			0.194408	0								0	0	0	0	0	0	0	0					0	0	0	0	0	1.401450723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.528043434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9295	0	0.170551	0	0	0	0	0	1.401450723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.528043434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9295	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$0/Trip	30% Coins	30% Coins	$0/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins								$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				5000	5.914	0.1027	0.2154	1.6659	0	1.5812	0.6977	0	3.6488	0.4062	1.6607	0.282	0	0.736	2.2006	3.8916	0.0328	0.4219			1.3049	0								0	0	0	0	0	0	0	0				24.7624	1000	12.601809	5.914	0.102701	0.215402	1.665887	0	2.982641723	0.697718	0	3.648794	0.40624	1.660673	0.282004	0	0.735955	2.200644	3.891573	0.032834	0.421867	0	0	5.832958434	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6919
H5214_801_0	2010	4	N/A																															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	NO	240.807347	0.82142	41.811046	13.510638	1.584402	7.326068	3.581072	17.663305	50.294901	10.85806	25.88645	9.151011	0.803976	16.56841	30.748878	67.43539	0.324059	5.018343			21.918117	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																			0.081306884	0.081306884	0.177483367	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.081306884	0.081306884	0.177483367	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.5793	0.0667871	7.420765208	0	0.369165666	1.706973844	0.834389776	4.115550065	11.71871193	2.52992798	6.03154285	2.132185563	0.187326408	3.86043953	7.164488574	15.71244587	0.075505747	1.169273919	0	0	5.106921261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7817	0	0	19.5793	0.0667871	7.420765208	0	0.369165666	1.706973844	0.834389776	4.115550065	11.71871193	2.52992798	6.03154285	2.132185563	0.187326408	3.86043953	7.164488574	15.71244587	0.075505747	1.169273919	0	0	5.106921261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7817	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.6447	0.0124	1.3814	0	1.4766	1.1255	0.5501	1.0851	2.8238	0.6671	1.4461	0.5621	0.0494	1.0103	1.3499	2.9605	0.0142	0.2511			0.9623	0																			21.3727	0	0	23.224	0.079227054	8.802118251	0	1.845803166	2.832480344	1.384502776	5.200631065	14.54255543	3.19700698	7.47765735	2.694298063	0.236722408	4.87072753	8.514374074	18.67294387	0.089718747	1.420331419	0	0	6.069211261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1543
H5214_803_0	2010	4	N/A																															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	NO	240.807347	0.82142	41.811046	13.510638	1.584402	7.326068	3.581072	17.663305	50.294901	10.85806	25.88645	9.151011	0.803976	16.56841	30.748878	67.43539	0.324059	5.018343			21.918117	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																			0.081306884	0.081306884	0.177483367	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.081306884	0.081306884	0.177483367	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.5793	0.0667871	7.420765208	0	0.369165666	1.706973844	0.834389776	4.115550065	11.71871193	2.52992798	6.03154285	2.132185563	0.187326408	3.86043953	7.164488574	15.71244587	0.075505747	1.169273919	0	0	5.106921261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7817	0	0	19.5793	0.0667871	7.420765208	0	0.369165666	1.706973844	0.834389776	4.115550065	11.71871193	2.52992798	6.03154285	2.132185563	0.187326408	3.86043953	7.164488574	15.71244587	0.075505747	1.169273919	0	0	5.106921261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7817	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.6447	0.0124	1.3814	0	1.4766	1.1255	0.5501	1.0851	2.8238	0.6671	1.4461	0.5621	0.0494	1.0103	1.3499	2.9605	0.0142	0.2511			0.9623	0																			21.3727	0	0	23.224	0.079227054	8.802118251	0	1.845803166	2.832480344	1.384502776	5.200631065	14.54255543	3.19700698	7.47765735	2.694298063	0.236722408	4.87072753	8.514374074	18.67294387	0.089718747	1.420331419	0	0	6.069211261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1543
H5214_804_0	2010	4	N/A																															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	NO	240.807347	0.82142	41.811046	13.510638	1.584402	7.326068	3.581072	17.663305	50.294901	10.85806	25.88645	9.151011	0.803976	16.56841	30.748878	67.43539	0.324059	5.018343			21.918117	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																			0.081306884	0.081306884	0.177483367	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.081306884	0.081306884	0.177483367	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.5793	0.0667871	7.420765208	0	0.369165666	1.706973844	0.834389776	4.115550065	11.71871193	2.52992798	6.03154285	2.132185563	0.187326408	3.86043953	7.164488574	15.71244587	0.075505747	1.169273919	0	0	5.106921261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7817	0	0	19.5793	0.0667871	7.420765208	0	0.369165666	1.706973844	0.834389776	4.115550065	11.71871193	2.52992798	6.03154285	2.132185563	0.187326408	3.86043953	7.164488574	15.71244587	0.075505747	1.169273919	0	0	5.106921261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7817	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.6447	0.0124	1.3814	0	1.4766	1.1255	0.5501	1.0851	2.8238	0.6671	1.4461	0.5621	0.0494	1.0103	1.3499	2.9605	0.0142	0.2511			0.9623	0																			21.3727	0	0	23.224	0.079227054	8.802118251	0	1.845803166	2.832480344	1.384502776	5.200631065	14.54255543	3.19700698	7.47765735	2.694298063	0.236722408	4.87072753	8.514374074	18.67294387	0.089718747	1.420331419	0	0	6.069211261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1543
H5215_001_0	2010	4	N/A																															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	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	0	0	0	0	0											0	NO	0	0	0	0	3.289360112	6.409103286	0.110758464	252.9200481	0	2407.020668	806.343317	0	0	1088.435349	6605.108971	3467.580639	47.67884325	157.77933	367.1177735	497.6662797	5.000856422	0	0	0	0	0	0	0	0	0												1A IP Acute: $0 Per Day	1B IP Psych: $0 Per Day	2 SNF: $0	6 Home Health: $0	10A Ambulance: $25	"11A DME: 10%, 11C Diabetes Monitoring Supplies: $10"	11B Prosthetics/Medical Supplies: 10%	"4A ER: $50, 4B Urgent Care: $10"	"9A OP Hospital: $0, 9B ASC Services: $0"	8A OP Diagnostic Procedures/Tests: $5	8B OP Radiology: min 5.00/ max 50.00	5 Partial Hosp: $10	12 Renal Dialysis: $10	"3 CORF: $10, 9C OP Substance Abuse: $10, 9D Cardiac Rehab: $10"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $15, 7D Physician Specialist (excl. Radiology): $15, 7F Podiatry: $15, 16B Comprehensive Dental (Medicare Covered): $15, 17A Routine Eye Exams (Medicare Covered): $15, 17B Eye Wear (Medicare Covered): $15"	"7E Mental Health: $15, 7H Psychiatric: $15"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $15	"7G Other Health Care: $15, 18A Hearing Exams (Medicare Covered): $15"	15 Part B Drugs: 10%	13A Blood: $0	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (non Medicare Covered): $100 allowance	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 Copay$0"											0	0	0	0	25	0.102051868	0.1	46.88578844	0	5	20.304401	10	10	10	0	15	15	15	15	15	0.1	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	25	0.102051868	0.1	46.88578844	0	5	20.304401	10	10	10	0	15	15	15	15	15	0.1	0	0	0	0	0	0	0	0	0												0	0	0	0	0.006852834	0.654060963	0.011075846	0.988196322	0	1.002925278	1.364359838	0	0	0.907029457	0	4.334475798	0.059598554	0.197224162	0.458897217	0.62208285	0.500085642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.1069	0	0	0	0	0	0	0.006852834	0.654060963	0.011075846	0.988196322	0	1.002925278	1.364359838	0	0	0.907029457	0	4.334475798	0.059598554	0.197224162	0.458897217	0.62208285	0.500085642	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.1069	YES	1A IP Acute: 75.00/0.00 Per Day for days 1-7/8-999	1B IP Psych: 125.00/0.00 Per Day for days 1-7/8-190	2 SNF: $50	6 Home Health: $15	10A Ambulance: $25	"11A DME: 20%, 11C Diabetes Monitoring Supplies: 20%"	11B Prosthetics/Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $15"	"9A OP Hospital: $75, 9B ASC Services: $75"	8A OP Diagnostic Procedures/Tests: $10	8B OP Radiology: $10 min/$100max	5 Partial Hosp: $15	12 Renal Dialysis: $15	"3 CORF: $15, 9C OP Substance Abuse: $15, 9D Cardiac Rehab: $15"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $10, 14E Prostate Screening: $10, 14F Colorectal Screening: $10, 14G Bone Mass Measurement: $10, 14H Mammography: $10, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $15"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20, 17B Eye Wear (Medicare Covered): $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 20%	13A Blood: $10	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (non Medicare Covered): $100 allowance	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: 50%	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 Copay$10"											2000	1.0382	0.0852	0.6453	0.0475	0.2728	0.2717	0.0047	0.1934	0.2106	0.0864	0.2011	0	0	0.1793	0.776	1.5148	0.0815	0.1235	0.2334	0.0158	0.212	0	0	0	0	0	0	0	0.0004	0											6.1937	0	0	1.0382	0.085241056	0.645282131	0.047514663	0.279680036	0.925780854	0.015771554	1.181620329	0.21061806	1.089291334	1.565427447	0	0	1.086323449	0.775952532	5.84928906	0.141069604	0.320769788	0.692316128	0.637894296	0.712101598	0	0	0	0	0	0	0	0.000401253	0	0	0	0	0	0	0	0	0	0	0	17.3005
H5215_002_0	2010	4	N/A																															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	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	0	0	0	0	0											0	NO	0	0	0	0	2.616933797	7.435333314	0.176410528	227.0446841	0	2598.628035	911.9591082	0	0	1303.568492	6467.415882	3439.225852	66.34473357	158.7623179	353.9339608	683.0416621	8.623307188	0	0	0	0	0	0	0	0	0												1A IP Acute: $0 Per Day	1B IP Psych: $0 Per Day	2 SNF: $0	6 Home Health: $0	10A Ambulance: $25	"11A DME: 10%, 11C Diabetes Monitoring Supplies: $10"	11B Prosthetics/Medical Supplies: 10%	"4A ER: $50, 4B Urgent Care: $10"	"9A OP Hospital: $0, 9B ASC Services: $0"	8A OP Diagnostic Procedures/Tests: $5	8B OP Radiology: min 5.00/ max 50.00	5 Partial Hosp: $10	12 Renal Dialysis: $10	"3 CORF: $10, 9C OP Substance Abuse: $10, 9D Cardiac Rehab: $10"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $15, 7D Physician Specialist (excl. Radiology): $15, 7F Podiatry: $15, 16B Comprehensive Dental (Medicare Covered): $15, 17A Routine Eye Exams (Medicare Covered): $15, 17B Eye Wear (Medicare Covered): $15"	"7E Mental Health: $15, 7H Psychiatric: $15"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $15	"7G Other Health Care: $15, 18A Hearing Exams (Medicare Covered): $15"	15 Part B Drugs: 10%	13A Blood: $0	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (non Medicare Covered): $100 allowance	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 Copay$0"											0	0	0	0	25	0.090766351	0.1	46.88578844	0	5	16.92941478	10	10	10	0	15	15	15	15	15	0.1	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	25	0.090766351	0.1	46.88578844	0	5	16.92941478	10	10	10	0	15	15	15	15	15	0.1	0	0	0	0	0	0	0	0	0												0	0	0	0	0.005451945	0.674878072	0.017641053	0.887097419	0	1.082761681	1.286577833	0	0	1.086307077	0	4.299032315	0.082930917	0.198452897	0.442417451	0.853802078	0.862330719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.7797	0	0	0	0	0	0	0.005451945	0.674878072	0.017641053	0.887097419	0	1.082761681	1.286577833	0	0	1.086307077	0	4.299032315	0.082930917	0.198452897	0.442417451	0.853802078	0.862330719	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.7797	YES	1A IP Acute: 75.00/0.00 Per Day for days 1-7/8-999	1B IP Psych: 125.00/0.00 Per Day for days 1-7/8-190	2 SNF: $50	6 Home Health: $15	10A Ambulance: $25	"11A DME: 20%, 11C Diabetes Monitoring Supplies: 20%"	11B Prosthetics/Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $15"	"9A OP Hospital: $75, 9B ASC Services: $75"	8A OP Diagnostic Procedures/Tests: $10	8B OP Radiology: $10 min/$100max	5 Partial Hosp: $15	12 Renal Dialysis: $15	"3 CORF: $15, 9C OP Substance Abuse: $15, 9D Cardiac Rehab: $15"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $10, 14E Prostate Screening: $10, 14F Colorectal Screening: $10, 14G Bone Mass Measurement: $10, 14H Mammography: $10, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $15"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20, 17B Eye Wear (Medicare Covered): $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 20%	13A Blood: $10	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (non Medicare Covered): $100 allowance	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: 50%	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 Copay$10"											2000	0.4846	0.0545	0.6182	0.0519	0.2245	0.305	0.0072	0.1338	0.2322	0.0956	0.226	0.0043	0	0.2114	0.7069	1.5728	0.0771	0.2434	0.2282	0.1115	0.3538	0	0	0	0	0	0	0	0.0006	0											5.9434	0	0	0.4846	0.054514214	0.618168679	0.051866145	0.229939796	0.979906572	0.024878151	1.020898861	0.232196182	1.178319103	1.512549188	0.004314205	0	1.297748462	0.706901151	5.871839117	0.160027298	0.441819397	0.670569673	0.965302871	1.216094881	0	0	0	0	0	0	0	0.000599147	0	0	0	0	0	0	0	0	0	0	0	17.7231
H5215_005_0	2010	4	N/A																															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	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	0	0	0	0	0											0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												1A IP Acute: $0 Per Day	1B IP Psych: $0 Per Day	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	"11A DME: $0, 11C Diabetes Monitoring Supplies: $0"	11B Prosthetics/Medical Supplies: $0	"4A ER: $0, 4B Urgent Care: $0"	"9A OP Hospital: $0, 9B ASC Services: $0"	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	5 Partial Hosp: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0, 17B Eye Wear (Medicare Covered): $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: $0	13A Blood: $0	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (non Medicare Covered): $100 allowance	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $100 allowance	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 Copay$0"											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											YES	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											1000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1A IP Acute: 75.00/0.00 Per Day for days 1-7/8-999	1B IP Psych: 125.00/0.00 Per Day for days 1-7/8-190	2 SNF: $25	6 Home Health: $15	10A Ambulance: $0	"11A DME: 10%, 11C Diabetes Monitoring Supplies: 10%"	11B Prosthetics/Medical Supplies: 10%	"4A ER: $0, 4B Urgent Care: $15"	"9A OP Hospital: $75, 9B ASC Services: $75"	8A OP Diagnostic Procedures/Tests: $5	8B OP Radiology: $5 min / $25 max	5 Partial Hosp: $10	12 Renal Dialysis: $10	"3 CORF: $10, 9C OP Substance Abuse: $10, 9D Cardiac Rehab: $10"	"7A PCP: $5, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $10, 14E Prostate Screening: $10, 14F Colorectal Screening: $10, 14G Bone Mass Measurement: $10, 14H Mammography: $10, 14I Diabetes Monitoring: $10, 14J Nutrition Therapy: $10"	"7B Chiropractic: $10, 7D Physician Specialist (excl. Radiology): $10, 7F Podiatry: $10, 16B Comprehensive Dental (Medicare Covered): $5, 17A Routine Eye Exams (Medicare Covered): $10, 17B Eye Wear (Medicare Covered): $10"	"7E Mental Health: $10, 7H Psychiatric: $10"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $10	"7G Other Health Care: $10, 18A Hearing Exams (Medicare Covered): $10"	15 Part B Drugs: 10%	13A Blood: $10	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (non Medicare Covered): $100 allowance	18A Routine Hearing Exams (Non Medicare Covered): $10	18B Hearing Aids (Non Medicare Covered): $100 allowance	14A Health Education/Wellness Program: 50%	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 Copay$10"												0.6415	0.0298	0.6049	0.0247	0	0.2852	0.0074	0.0058	0.22	0.0803	0.1107	0	0	0.1951	0.4943	0.8981	0.097	0.1053	0.1315	0.0514	0.3311	0	0	0	0	0	0	0	0.0007	0											4.3146	0	0	0.6415	0.029775012	0.604884946	0.024656473	0	0.285160991	0.007448259	0.005845628	0.219962436	0.080265757	0.110700326	0	0	0.195112271	0.494309052	0.89810441	0.096952716	0.105310709	0.131473853	0.05139473	0.331068142	0	0	0	0	0	0	0	0.000718127	0	0	0	0	0	0	0	0	0	0	0	4.3146
H5215_006_0	2010	3	N/A																															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	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	0	0	0	0	0											0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												1A IP Acute: $0 Per Day	1B IP Psych: $0 Per Day	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	"11A DME: $0, 11C Diabetes Monitoring Supplies: $0"	11B Prosthetics/Medical Supplies: $0	"4A ER: $0, 4B Urgent Care: $0"	"9A OP Hospital: $0, 9B ASC Services: $0"	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	5 Partial Hosp: $0	12 Renal Dialysis: $0	"3 CORF: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0, 17B Eye Wear (Medicare Covered): $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: $0	13A Blood: $0	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (non Medicare Covered): $100 allowance	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $100 allowance	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 Copay$0"											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											YES	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											1000	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1A IP Acute: 75.00/0.00 Per Day for days 1-7/8-999	1B IP Psych: 125.00/0.00 Per Day for days 1-7/8-190	2 SNF: $25	6 Home Health: $15	10A Ambulance: $0	"11A DME: 10%, 11C Diabetes Monitoring Supplies: 10%"	11B Prosthetics/Medical Supplies: 10%	"4A ER: $0, 4B Urgent Care: $15"	"9A OP Hospital: $75, 9B ASC Services: $75"	8A OP Diagnostic Procedures/Tests: $5	8B OP Radiology: $5 min / $25 max	5 Partial Hosp: $10	12 Renal Dialysis: $10	"3 CORF: $10, 9C OP Substance Abuse: $10, 9D Cardiac Rehab: $10"	"7A PCP: $5, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $10, 14E Prostate Screening: $10, 14F Colorectal Screening: $10, 14G Bone Mass Measurement: $10, 14H Mammography: $10, 14I Diabetes Monitoring: $10, 14J Nutrition Therapy: $10"	"7B Chiropractic: $10, 7D Physician Specialist (excl. Radiology): $10, 7F Podiatry: $10, 16B Comprehensive Dental (Medicare Covered): $5, 17A Routine Eye Exams (Medicare Covered): $10, 17B Eye Wear (Medicare Covered): $10"	"7E Mental Health: $10, 7H Psychiatric: $10"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $10	"7G Other Health Care: $10, 18A Hearing Exams (Medicare Covered): $10"	15 Part B Drugs: 10%	13A Blood: $10	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (non Medicare Covered): $100 allowance	18A Routine Hearing Exams (Non Medicare Covered): $10	18B Hearing Aids (Non Medicare Covered): $100 allowance	14A Health Education/Wellness Program: 50%	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 Copay$10"												0.4642	0	0.3452	0.0262	0	0.2058	0.0027	0.0206	0.1396	0.0333	0.0879	0	0	0.0865	0.4051	0.7839	0.0288	0.0902	0.0793	0.013	0.2742	0	0	0	0	0	0	0	0.0005	0											3.0873	0	0	0.4642	0	0.345240261	0.026191485	0	0.205777964	0.002691401	0.020592909	0.139618077	0.033262005	0.087883627	0	0	0.086545025	0.405141813	0.783931813	0.028836723	0.0902393	0.079327317	0.013048408	0.274218519	0	0	0	0	0	0	0	0.000533774	0	0	0	0	0	0	0	0	0	0	0	3.0873
H5215_007_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	273.0754599	17.43708892	131.8686107	22.01330487	14.81791164	20.87787573	12.44023377	25.61367323	33.60159519	10.75411205	22.82289558	0.858216086	1.424426017	44.46936318	41.18125641	86.32190178	6.56538907	5.498026726	15.46309275	25.70563474	6.240143591	2.455723248	0	44.21416667	0.836066383	5.879753539	0	0	2.678194768	10.15207144												Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Non Covered	"Preventive 100%; Basic 80%; Major 50%; $1,350 Annual Maximum"	0% Cost Sharing	0% Cost Sharing	Non Covered	Non Covered	0% Cost Sharing	0% Cost Sharing											0.084423725	0.084423725	0.151735372	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.25	0	0	0	0	0	0											NO	0.084423725	0.084423725	0.151735372	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.25	0	0	0	0	0	0												23.054	1.472103997	20.00913264	0	3.452573411	4.864545045	2.898574467	5.967985862	7.829171678	2.505708109	5.317734669	0.199964348	0.331891262	10.36136162	9.595232743	20.11300311	1.529735653	1.281040227	3.602900611	5.989412894	1.453953457	0.572183517	0	11.05354167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.4558	135	0	23.054	1.472103997	20.00913264	0	3.452573411	4.864545045	2.898574467	5.967985862	7.829171678	2.505708109	5.317734669	0.199964348	0.331891262	10.36136162	9.595232743	20.11300311	1.529735653	1.281040227	3.602900611	5.989412894	1.453953457	0.572183517	0	11.05354167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.4558	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered	Non Covered												7.7208	0.493	6.701	0	1.1563	1.6291	0.9707	1.9987	2.622	0.8392	1.7809	0.067	0	3.47	3.2134	6.7358	0.5123	0.429	1.2066	2.0058	0.4869	0.1916	0	0	0	0	0	0	0	0											44.2303	0	0	30.7748	1.965110418	26.71017475	0	4.608837416	6.493677193	3.86930468	7.966659434	10.45115485	3.3448677	7.09863965	0.266932244	0.331891262	13.83137313	12.80866832	26.84883137	2.04204287	1.710059549	4.809509072	7.995262362	1.940881277	0.763807307	0	11.05354167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	187.6861
H5215_008_0	2010	6	N/A																															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	V	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	NO	234.214415	12.99900144	685.1758109	162.8645819	52.17535358	5.430877017	0.133023656	159.2367589	219.7974155	1681.937039	611.6751825	11.22233769	0	881.8517779	4203.427125	2544.699994	69.4389882	219.097667	221.0748112	470.0032857	6.633203351	54.13000366	0	0	0	0	0	0	3.743809087	0												1A IP Acute: 150.00/0.00 Per Day for days 1-4/5-90	1B IP Psych: 175.00/0.00 Per Day for days 1-5/6-90	2 SNF: $30	6 Home Health: $10	10A Ambulance: $75	"11A DME: 20%, 11C Diabetes Monitoring Supplies: $15"	11B Prosthetics/Medical Supplies: 20%	"4A ER: $50, 4B Urgent Care: $25"	"9A OP Hospital: $100, 9B ASC Services: $100"	"8A OP Medicare covered lab services:  0%, x-rays 5%"	"8B OP Radiology: x-rays:  5%, Therapeutic Radiological services:  5%, CAT, PET, MRI, MRA, and NUC:  $60"	5 Partial Hosp: $25	12 Renal Dialysis: $20	"3 CORF: $30, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $30"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $30, 17B Eye Wear (Medicare Covered): $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): $30	"7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 20%	13A Blood: $0	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (non Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 Copay$0"											150	175	30	10	75	0.158841114	0.2	48.055	100	3.088513912	18.3119956	25	20	30	9.8	30	30	30	30	30	0.2	0	0	25	0	0	0	0	0	0											NO	144.6981732	168.8145353	28.93963463	9.646544877	72.34908658	0.153226793	0.192930898	46.35647141	96.46544877	2.979348805	17.66474873	24.11636219	19.29308975	28.93963463	9.453613979	28.93963463	28.93963463	28.93963463	28.93963463	28.93963463	0.192930898	0	0	24.11636219	0	0	0	0	0	0												2.8242	0.182868366	1.652394802	0.130923375	0.314569931	0.832155871	0.025664373	0.615137855	1.766904694	0.417589759	0.900424034	0.022553497	0	2.126705688	3.311464786	6.136890673	0.167461579	0.528383869	0.533152022	1.133476947	1.279749876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.9027	0	0.855028048	2.8242	0.182868366	1.652394802	0.130923375	0.314569931	0.832155871	0.025664373	0.615137855	1.766904694	0.417589759	0.900424034	0.022553497	0	2.126705688	3.311464786	6.136890673	0.167461579	0.528383869	0.533152022	1.133476947	1.279749876	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.9027	YES	1A IP Acute: $200 Per Day for days 1-7/8-90	1B IP Psych: $300 Per Day for days 1-7/8-190	2 SNF: $70/day (reduced to $50 with prenotification)	6 Home Health: $25	10A Ambulance: $75	"11A DME: 30%, 11C Diabetes Monitoring Supplies: $35"	11B Prosthetics/Medical Supplies: 30%	"4A ER: $50, 4B Urgent Care: $35"	"9A OP Hospital: $200, 9B ASC Services: $200"	"8A OP Diagnostic Procedures/Tests: $10, 10%"	"8B OP Radiology: 10%, $110 copay"	5 Partial Hosp: $35	12 Renal Dialysis: $35	"3 CORF: $40, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $40"	"7A PCP: $20, 14B Immunizations: $5, 14C Physical Exams: $20, 14D Pap Smears and Pelvic Exams: $5, 14E Prostate Screening: $5, 14F Colorectal Screening: $5, 14G Bone Mass Measurement: $5, 14H Mammography: $5, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $5"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40, 17B Eye Wear (Medicare Covered): $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $40	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 30%	13A Blood: $35	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (non Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: 50%	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 Copay$35"											3400	0.8684	0.0249	0.5739	0.029	0.0831	0.3258	0.0079	0.1277	0.1619	0.292	0.3482	0.003	0	0.6531	1.1632	1.7128	0.0401	0.0971	0.4945	0.2123	0.3922	0.0311	0	0	0	0	0	0	0.0004	0											7.6426	0	0.290339886	3.6926	0.207761496	2.226251739	0.159938069	0.397652644	1.157986694	0.033528723	0.742837054	1.928790052	0.709561306	1.2486101	0.02559454	0	2.779839948	4.474662747	7.84969998	0.207570596	0.625450832	1.027657836	1.345746865	1.671904418	0.031112688	0	0	0	0	0	0	0.000442799	0	0	0	0	0	0	0	0	0	0	0	32.5452
H5215_801_0	2010	7	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	208.4865676	2.090405653	70.1097949	3.72895288	6.428353609	13.4923386	0.333389474	24.72868884	48.15369085	14.55985625	32.96691195	0.574191435	0	47.52755384	50.05295944	101.1617029	1.299694084	2.513709751	15.91023455	28.10323889	15.90187069	3.310974737	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.084423725	0.084423725	0.151735372	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.084423725	0.084423725	0.151735372	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.6012	0.176479832	10.63813578	0	1.497806391	3.143714893	0.077679747	5.761784499	11.21980997	3.392446507	7.681290484	0.133786604	0	11.07392005	11.66233955	23.57067678	0.302828722	0.585694372	3.707084651	6.548054662	3.70513587	0.771457114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2513	0	0	17.6012	0.176479832	10.63813578	0	1.497806391	3.143714893	0.077679747	5.761784499	11.21980997	3.392446507	7.681290484	0.133786604	0	11.07392005	11.66233955	23.57067678	0.302828722	0.585694372	3.707084651	6.548054662	3.70513587	0.771457114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2513	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	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	0	0	17.6012	0.176479832	10.63813578	0	1.497806391	3.143714893	0.077679747	5.761784499	11.21980997	3.392446507	7.681290484	0.133786604	0	11.07392005	11.66233955	23.57067678	0.302828722	0.585694372	3.707084651	6.548054662	3.70513587	0.771457114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2513
H5215_804_0	2010	6	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	208.4865676	2.090405653	70.1097949	3.72895288	6.428353609	13.4923386	0.333389474	24.72868884	48.15369085	14.55985625	32.96691195	0.574191435	0	47.52755384	50.05295944	101.1617029	1.299694084	2.513709751	15.91023455	28.10323889	15.90187069	3.310974737	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.084423725	0.084423725	0.151735372	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.084423725	0.084423725	0.151735372	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.6012	0.176479832	10.63813578	0	1.497806391	3.143714893	0.077679747	5.761784499	11.21980997	3.392446507	7.681290484	0.133786604	0	11.07392005	11.66233955	23.57067678	0.302828722	0.585694372	3.707084651	6.548054662	3.70513587	0.771457114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2513	0	0	17.6012	0.176479832	10.63813578	0	1.497806391	3.143714893	0.077679747	5.761784499	11.21980997	3.392446507	7.681290484	0.133786604	0	11.07392005	11.66233955	23.57067678	0.302828722	0.585694372	3.707084651	6.548054662	3.70513587	0.771457114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2513	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	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	0	0	17.6012	0.176479832	10.63813578	0	1.497806391	3.143714893	0.077679747	5.761784499	11.21980997	3.392446507	7.681290484	0.133786604	0	11.07392005	11.66233955	23.57067678	0.302828722	0.585694372	3.707084651	6.548054662	3.70513587	0.771457114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2513
H5215_805_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	208.4865676	2.090405653	70.1097949	3.72895288	6.428353609	13.4923386	0.333389474	24.72868884	48.15369085	14.55985625	32.96691195	0.574191435	0	47.52755384	50.05295944	101.1617029	1.299694084	2.513709751	15.91023455	28.10323889	15.90187069	3.310974737	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.084423725	0.084423725	0.151735372	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.084423725	0.084423725	0.151735372	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.6012	0.176479832	10.63813578	0	1.497806391	3.143714893	0.077679747	5.761784499	11.21980997	3.392446507	7.681290484	0.133786604	0	11.07392005	11.66233955	23.57067678	0.302828722	0.585694372	3.707084651	6.548054662	3.70513587	0.771457114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2513	0	0	17.6012	0.176479832	10.63813578	0	1.497806391	3.143714893	0.077679747	5.761784499	11.21980997	3.392446507	7.681290484	0.133786604	0	11.07392005	11.66233955	23.57067678	0.302828722	0.585694372	3.707084651	6.548054662	3.70513587	0.771457114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2513	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	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	0	0	17.6012	0.176479832	10.63813578	0	1.497806391	3.143714893	0.077679747	5.761784499	11.21980997	3.392446507	7.681290484	0.133786604	0	11.07392005	11.66233955	23.57067678	0.302828722	0.585694372	3.707084651	6.548054662	3.70513587	0.771457114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2513
H5216_001_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	V	P	O	O	O	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	0		0	YES	1190.064142	38.604165	775.270555	279.790934	43.401834	6.662893	2.885503	283.076483	478.256012	2001.980359	140.615606	107.343425	0.34538	1434.320327	2673.722348	2980.349496	144.236571	385.340617			27.770389	0		3.28	2.69				0.04	0.25	937.65418	49.692065	0.05	0.55	3.45	415.638197	0.32	0.4	0.49		5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$35/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		158.7573	140.3991	50.7565	0	100	0.2	0.2	50	136.407926	33.878374	35	50	0.2	46.818908	10	35	35	50			0.2	0		0	0				0	0	50	0	0	0	0	35	0	0	0		NO	143.146853	126.593797	31.219156	0	88.198	0.176396	0.176396	44.099	120.309063	29.880048	30.8693	44.099	0.176396	41.293341	8.8198	30.8693	30.8693	44.099			0.176396	0		0	0				0	0	44.099	0	0	0	0	30.8693	0	0	0			14.1962	0.407253986	2.016941033	0	0.318996246	1.175307674	0.508991187	1.040282485	4.794877723	4.984939102	0.361725444	0.394478142	0.06092365	4.935656531	1.965141364	7.666775225	0.371040165	1.416094656	0	0	4.898585538	0	0	0	0	0	0	0	0	0	3.445800974	0	0	0	0	1.069205016	0	0	0	0	56.0292	0	8.128155	14.1962	0.407253986	2.016941033	0	0.318996246	1.175307674	0.508991187	1.040282485	4.794877723	4.984939102	0.361725444	0.394478142	0.06092365	4.935656531	1.965141364	7.666775225	0.371040165	1.416094656	0	0	4.898585538	0	0	0	0	0	0	0	0	0	3.445800974	0	0	0	0	1.069205016	0	0	0	0	56.0292	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$40/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		50%-80%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		10000	10.9441	0.1033	0.6407	1.5057	1.501	1.3674	0.5922	0.216	3.751	0.7716	0.0858	0.2376	0.0133	1.2575	1.6318	1.819	0.088	0.1521			1.4708	0		0	0				0	0	1.4026	0	0	0	0	0.2537	0	0	0		29.8052	500	8.56413	25.1403	0.510565986	2.657603033	1.505739	1.820043246	2.542725674	1.101179187	1.256241485	8.545886723	5.756536102	0.447546444	0.632108142	0.07423265	6.193109531	3.596970364	9.485745225	0.459071165	1.568201656	0	0	6.369385538	0	0	0	0	0	0	0	0	0	4.848362974	0	0	0	0	1.322878016	0	0	0	0	85.8344
H5216_003_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis					Therapy (PT/OT/ST)				A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	V	P	O	O	O	O	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	0	0	0	0	0	0	0	0		0	YES	215.108974	7.591373	525.718873	466.934609	37.661373	7.299166	3.107556	317.381489	380.506932	1459.375329	156.474873	74.532513	0.057486	592.354293	3452.002505	4113.770803	87.417097	207.631188			18.73078	0		3.28	2.69				0.04	0.32	911.591834	21.302586	0.05	0.55	2.09	3.45	577.060595	0.4	0.42		5000	$650/Admit:1a	$650/Admit:1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: LifeSynch Wellness Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		650	650	50.7565	0	100	0.2	0.2	50	86.852636	20.640951	30	50	0.2	44.714967	10	30	30	50			0.2	0		0	0				0	0	50	0	0	0	0	0	30	0	0		NO	610.17905	610.17905	38.848518	0	91.4035	0.182807	0.182807	45.70175	79.386349	18.866552	27.42105	45.70175	0.182807	40.871045	9.14035	27.42105	27.42105	45.70175			0.182807	0		0	0				0	0	45.70175	0	0	0	0	0	27.42105	0	0			10.9379	0.386008064	1.701949925	0	0.286865109	1.334338639	0.56808299	1.208740789	2.517254675	2.294448378	0.357558776	0.283855523	0.010508843	2.01751158	2.629375925	9.40032624	0.199755716	0.790759054	0	0	3.424117699	0	0	0	0	0	0	0	0	0	3.471778508	0	0	0	0	0	1.318633952	0	0	0	45.1398	0	4.281009	10.9379	0.386008064	1.701949925	0	0.286865109	1.334338639	0.56808299	1.208740789	2.517254675	2.294448378	0.357558776	0.283855523	0.010508843	2.01751158	2.629375925	9.40032624	0.199755716	0.790759054	0	0	3.424117699	0	0	0	0	0	0	0	0	0	3.471778508	0	0	0	0	0	1.318633952	0	0	0	45.1398	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			30% Coins	0% Coins		50%-80%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: LifeSynch Wellness Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		10000	9.1565	0.1321	0.5592	1.8202	1.4125	1.3537	0.5763	0.2626	3.2624	0.4366	0.0906	0.2616	0.0024	0.8241	1.9991	2.3823	0.0506	0.0933			1.1419	0		0	0				0	0	1.277	0	0	0	0	0	0.3342	0	0		27.4291	500	4.409868	20.0944	0.518110064	2.261154925	1.82016	1.699320109	2.688039639	1.14440999	1.471308789	5.779663675	2.731014378	0.448174776	0.545482523	0.012910843	2.84160258	4.628454925	11.78263924	0.250379716	0.884028054	0	0	4.566030699	0	0	0	0	0	0	0	0	0	4.748812508	0	0	0	0	0	1.652813952	0	0	0	72.5689
H5216_006_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Radiology	Renal Dialysis					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	V	P	O	O	O	O	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	0	0	0	YES	1110.825964	50.635201	511.869933	454.634215	36.669265	7.613556	3.241405	309.020752	370.48329	1420.931204	152.352877	72.569113	0.059962	576.749986	3361.066876	4005.402304	85.114281	202.161588			19.537551	0		3.28	2.69				0.04	0.25	887.577897	20.741415	0.05	0.55	2.09	3.45	561.859167	0.32	0.4	0.49	5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$35/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	158.7573	140.3991	50.7565	0	100	0.2	0.2	50	129.63159	20.640951	35	50	0.2	44.714967	10	35	35	50			0.2	0		0	0				0	0	50	0	0	0	0	0	35	0	0	0	NO	147.01561	130.015183	37.362113	0	90.2145	0.180429	0.180429	45.10725	116.946491	18.621131	31.575075	45.10725	0.180429	40.339384	9.02145	31.575075	31.575075	45.10725			0.180429	0		0	0				0	0	45.10725	0	0	0	0	0	31.575075	0	0	0		13.6091	0.548612077	1.593711857	0	0.275674951	1.373706296	0.584843463	1.161589693	3.610560062	2.204945508	0.40087946	0.27278276	0.010818884	1.938811596	2.526808064	10.53923985	0.223957484	0.759912774	0	0	3.525140789	0	0	0	0	0	0	0	0	0	3.336349841	0	0	0	0	0	1.478395445	0	0	0	49.9758	0	5.414376	13.6091	0.548612077	1.593711857	0	0.275674951	1.373706296	0.584843463	1.161589693	3.610560062	2.204945508	0.40087946	0.27278276	0.010818884	1.938811596	2.526808064	10.53923985	0.223957484	0.759912774	0	0	3.525140789	0	0	0	0	0	0	0	0	0	3.336349841	0	0	0	0	0	1.478395445	0	0	0	49.9758	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$40/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		50%-80%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	10000	9.3459	0.1348	0.555	1.8442	1.3359	1.6459	0.7007	0.2483	3.3055	0.4423	0.0979	0.2651	0.0024	0.835	2.1608	2.575	0.0547	0.0945			1.0645	0		0	0				0	0	1.2939	0	0	0	0	0	0.3612	0	0	0	28.3638	500	5.093262	22.9549	0.683446077	2.148753857	1.844218	1.611559951	3.019618296	1.285576463	1.409923693	6.916090062	2.647282508	0.49882646	0.53786776	0.013252884	2.773794596	4.687616064	13.11428685	0.278676484	0.854414774	0	0	4.589622789	0	0	0	0	0	0	0	0	0	4.630262841	0	0	0	0	0	1.839611445	0	0	0	78.3396
H5216_007_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Radiology	Renal Dialysis					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	V	P	O	O	O	O	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	0	0	0	YES	1102.21768	50.242807	507.903226	451.111052	36.385098	7.581216	3.227636	306.626013	367.612251	1409.919777	151.172227	72.006743	0.059706	572.280494	3335.020475	3974.36266	84.454692	200.594948			19.454565	0		3.28	2.69				0.04	0.25	880.69966	20.580681	0.05	0.55	2.09	3.45	557.505071	0.32	0.4	0.49	5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$35/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	158.7573	140.3991	50.7565	0	100	0.2	0.2	50	129.63159	20.640951	35	50	0.2	44.714967	10	35	35	50			0.2	0		0	0				0	0	50	0	0	0	0	0	35	0	0	0	NO	147.172304	130.153756	37.546715	0	90.3059	0.180612	0.180612	45.15295	117.064974	18.639997	31.607065	45.15295	0.180612	40.380254	9.03059	31.607065	31.607065	45.15295			0.180612	0		0	0				0	0	45.15295	0	0	0	0	0	31.607065	0	0	0		13.518	0.544940837	1.589174806	0	0.273815752	1.369258584	0.582949793	1.153755753	3.586209884	2.190075034	0.398175867	0.270943072	0.01078362	1.925735976	2.509766879	10.46816158	0.222447078	0.754787805	0	0	3.513727894	0	0	0	0	0	0	0	0	0	3.313848976	0	0	0	0	0	1.468424918	0	0	0	49.665	0	5.317291	13.518	0.544940837	1.589174806	0	0.273815752	1.369258584	0.582949793	1.153755753	3.586209884	2.190075034	0.398175867	0.270943072	0.01078362	1.925735976	2.509766879	10.46816158	0.222447078	0.754787805	0	0	3.513727894	0	0	0	0	0	0	0	0	0	3.313848976	0	0	0	0	0	1.468424918	0	0	0	49.665	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$40/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		50%-80%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	10000	9.3261	0.1345	0.5553	1.8406	1.3286	1.6427	0.6994	0.247	3.2991	0.4415	0.0974	0.2646	0.0024	0.8334	2.149	2.561	0.0544	0.0943			1.0624	0		0	0				0	0	1.2914	0	0	0	0	0	0.3592	0	0	0	28.2843	500	5.028495	22.8441	0.679488837	2.144480806	1.840621	1.602405752	3.011959584	1.282315793	1.400733753	6.885290884	2.631548034	0.495587867	0.535511072	0.01321262	2.759090976	4.658775879	13.02914758	0.276868078	0.849105805	0	0	4.576133894	0	0	0	0	0	0	0	0	0	4.605237976	0	0	0	0	0	1.827667918	0	0	0	77.9492
H5216_008_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Radiology	Renal Dialysis					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	V	P	O	O	O	O	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	0	0	0	YES	1179.426954	53.762266	543.481351	482.710942	38.933839	7.608837	3.239396	328.104866	393.36313	1508.683282	161.761694	77.050745	0.059924	612.368185	3568.635407	4252.76289	90.370661	214.646429			19.525444	0		3.28	2.69				0.04	0.25	942.391811	22.022337	0.05	0.55	2.09	3.45	596.557757	0.32	0.4	0.49	5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$35/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	158.7573	140.3991	50.7565	0	100	0.2	0.2	50	129.63159	20.640951	35	50	0.2	44.714967	10	35	35	50			0.2	0		0	0				0	0	50	0	0	0	0	0	35	0	0	0	NO	145.747139	128.893394	36.003362	0	89.5248	0.17905	0.17905	44.7624	116.052422	18.47877	31.33368	44.7624	0.17905	40.030985	8.95248	31.33368	31.33368	44.7624			0.17905	0		0	0				0	0	44.7624	0	0	0	0	0	31.33368	0	0	0		14.3248	0.577466744	1.630596318	0	0.290462012	1.362362265	0.580013854	1.223896771	3.804228664	2.323217614	0.42238243	0.287414689	0.010729392	2.042808469	2.662344759	11.10455929	0.235970448	0.800674109	0	0	3.496030748	0	0	0	0	0	0	0	0	0	3.515309933	0	0	0	0	0	1.557695822	0	0	0	52.253	0	6.178	14.3248	0.577466744	1.630596318	0	0.290462012	1.362362265	0.580013854	1.223896771	3.804228664	2.323217614	0.42238243	0.287414689	0.010729392	2.042808469	2.662344759	11.10455929	0.235970448	0.800674109	0	0	3.496030748	0	0	0	0	0	0	0	0	0	3.515309933	0	0	0	0	0	1.557695822	0	0	0	52.253	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$40/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		50%-80%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	10000	9.3116	0.1343	0.5523	1.826	1.4052	1.6297	0.6938	0.2612	3.2729	0.438	0.103	0.2625	0.0024	0.8267	2.273	2.7088	0.0576	0.0936			1.054	0		0	0				0	0	1.2811	0	0	0	0	0	0.38	0	0	0	28.5677	500	5.222907	23.6365	0.711805744	2.182905318	1.826004	1.695709012	2.992018265	1.273825854	1.485124771	7.077111664	2.761184614	0.52541443	0.549881689	0.013139392	2.869545469	4.935346759	13.81330929	0.293531448	0.894243109	0	0	4.549999748	0	0	0	0	0	0	0	0	0	4.796443933	0	0	0	0	0	1.937666822	0	0	0	80.8207
H5216_801_0	2010	3	N/A																															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	NO	222.992241	0.760651	38.717834	12.51111	1.467187	6.78408	3.316142	16.356561	46.574047	10.054772	23.971348	8.474013	0.744497	15.342667	28.474054	62.44647	0.300085	4.647081			20.296599	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																			0.080674507	0.080674507	0.150683285	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080674507	0.080674507	0.150683285	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				17.9898	0.061365144	5.83413041	0	0.341854571	1.58069064	0.772661086	3.811078713	10.85175295	2.342761876	5.585324084	1.974445029	0.173467801	3.574841411	6.634454582	14.55002751	0.069919805	1.082769873	0	0	4.729107567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9604	0	0	17.9898	0.061365144	5.83413041	0	0.341854571	1.58069064	0.772661086	3.811078713	10.85175295	2.342761876	5.585324084	1.974445029	0.173467801	3.574841411	6.634454582	14.55002751	0.069919805	1.082769873	0	0	4.729107567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9604	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.3488	0.0114	1.086	0	1.3675	1.0422	0.5095	1.0048	2.6148	0.6177	1.3391	0.5205	0.0458	0.9356	1.25	2.7415	0.0132	0.2324			0.8911	0																			19.572	0	0	21.3386	0.072780587	6.920180186	0	1.709331571	2.62289964	1.282115586	4.815891213	13.46659545	2.960444876	6.924375084	2.494967029	0.219252301	4.510452911	7.884499582	17.29150551	0.083084305	1.315187373	0	0	5.620216067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5324
H5216_802_0	2010	3	N/A																															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	NO	222.992241	0.760651	38.717834	12.51111	1.467187	6.78408	3.316142	16.356561	46.574047	10.054772	23.971348	8.474013	0.744497	15.342667	28.474054	62.44647	0.300085	4.647081			20.296599	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																			0.080673659	0.080673659	0.150683546	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080673659	0.080673659	0.150683546	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				17.9896	0.061364499	5.834140514	0	0.341854571	1.58069064	0.772661086	3.811078713	10.85175295	2.342761876	5.585324084	1.974445029	0.173467801	3.574841411	6.634454582	14.55002751	0.069919805	1.082769873	0	0	4.729107567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9603	0	0	17.9896	0.061364499	5.834140514	0	0.341854571	1.58069064	0.772661086	3.811078713	10.85175295	2.342761876	5.585324084	1.974445029	0.173467801	3.574841411	6.634454582	14.55002751	0.069919805	1.082769873	0	0	4.729107567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9603	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.3488	0.0114	1.0861	0	1.3675	1.0422	0.5095	1.0048	2.6148	0.6177	1.3391	0.5205	0.0458	0.9356	1.25	2.7415	0.0132	0.2324			0.8911	0																			19.5719	0	0	21.3384	0.072779822	6.92019217	0	1.709331571	2.62289964	1.282115586	4.815891213	13.46659545	2.960444876	6.924375084	2.494967029	0.219252301	4.510452911	7.884499582	17.29150551	0.083084305	1.315187373	0	0	5.620216067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5322
H5216_803_0	2010	3	N/A																															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	NO	222.992241	0.760651	38.717834	12.51111	1.467187	6.78408	3.316142	16.356561	46.574047	10.054772	23.971348	8.474013	0.744497	15.342667	28.474054	62.44647	0.300085	4.647081			20.296599	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																			0.080673659	0.080673659	0.150683546	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080673659	0.080673659	0.150683546	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				17.9896	0.061364499	5.834140514	0	0.341854571	1.58069064	0.772661086	3.811078713	10.85175295	2.342761876	5.585324084	1.974445029	0.173467801	3.574841411	6.634454582	14.55002751	0.069919805	1.082769873	0	0	4.729107567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9603	0	0	17.9896	0.061364499	5.834140514	0	0.341854571	1.58069064	0.772661086	3.811078713	10.85175295	2.342761876	5.585324084	1.974445029	0.173467801	3.574841411	6.634454582	14.55002751	0.069919805	1.082769873	0	0	4.729107567	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.9603	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.3488	0.0114	1.0861	0	1.3675	1.0422	0.5095	1.0048	2.6148	0.6177	1.3391	0.5205	0.0458	0.9356	1.25	2.7415	0.0132	0.2324			0.8911	0																			19.5719	0	0	21.3384	0.072779822	6.92019217	0	1.709331571	2.62289964	1.282115586	4.815891213	13.46659545	2.960444876	6.924375084	2.494967029	0.219252301	4.510452911	7.884499582	17.29150551	0.083084305	1.315187373	0	0	5.620216067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5322
H5253_004_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1251.771919	148.6326308	984.1845616	454.9015555	221.7209115	5.902058574	6.545048079	242.2572688	35.42242709	9662.386344	34.05551051	0	0.549950051	19.61672735	5239.598155	4114.86879	683.0721658	490.3509056	0	0	19.14411369	727.5225014	0	0	364.0692749	191.4423549	17.24382052	9.924213396	570.9930975	0											3950	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$80 Days 1-23 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	56.07207207	0	150	0.2	0.102097871	49.63732446	0.2	3	0.172537005	0	0.2	0.152067085	12.10130337	39.52088804	38.5	40	0	0	0.2	39.69903406	0	0	40	15	0	0	0	0											NO	154.7964521	117.896255	47.11110007	0	126.0282481	0.168037664	0.085781438	41.70470028	0.168037664	2.520564962	0.144963577	0	0.168037664	0.12798252	12.05944489	39.52088804	38.5	33.60753283	0	0	0.168037664	39.69903406	0	0	40	15	0	0	0	0												16.1475	1.460269211	3.863834781	0	2.328591504	0.991768136	0.561443639	0.841938899	5.952301906	2.029556039	4.936808611	0	0.092412322	2.510598206	5.265553765	13.55193906	2.191523199	1.373290346	0	0	3.216932146	2.40682838	0	0	1.21356425	0.239302944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1759	0	8.821266926	16.1475	1.460269211	3.863834781	0	2.328591504	0.991768136	0.561443639	0.841938899	5.952301906	2.029556039	4.936808611	0	0.092412322	2.510598206	5.265553765	13.55193906	2.191523199	1.373290346	0	0	3.216932146	2.40682838	0	0	1.21356425	0.239302944	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1759	NO	"$325 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-23 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.2149	0.1454	1.0657	0.0286	0.0422	0.027	0.0299	0.0153	0.1618	0.0368	0.1315	0	0.0017	0.0675	0.2896	0.549	0.0898	0.0667	0	0	0.2083	0.0982	0	0	0.0495	0	0.0023	0	0	0											4.3216	0	0	17.3623	1.605692396	4.929561509	0.028622132	2.370797261	1.018731856	0.591344873	0.857199054	6.114130253	2.066341774	5.068285515	0	0.094087297	2.578066287	5.55510607	14.10091354	2.281331262	1.439983151	0	0	3.425235974	2.505039551	0	0	1.263081444	0.239302944	0.002345338	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4975
H5253_007_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	327.7055681	36.64135455	12060.19266	64.30619393	25.57465899	9.206704257	17.34744717	13.04628761	14.82625949	32.72276601	23.44879052	0	0.00913063	8.792805397	2.323573598	101.1253223	16.15693763	36.88305724	0	0	7.020232062	8.552816851	1193.928361	0	105.485991	87.19226519	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076317831	0.077244768	0	0	0.2	0.2	0.018773289	0.061371851	0.2	0	0.070113164	0	0.2	0.151277396	0.008189781	0.198623881	0.2	0	0	0	0.2	0.194826722	0	0	0	0	0	0	0	0											NO	0.076317831	0.077244768	0	0	0.2	0.2	0.018773289	0.061371851	0.2	0	0.070113164	0	0.2	0.151277396	0.008189781	0.198623881	0.2	0	0	0	0.2	0.194826722	0	0	0	0	0	0	0	0												25.0098	2.830352942	0	0	5.114931797	1.841340851	0.32566864	0.800674816	2.965251898	0	1.644068905	0	0.001826126	1.330152703	0.019029559	20.08590393	3.231387525	0	0	0	1.404046412	1.666317275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2707	0	0	25.0098	2.830352942	0	0	5.114931797	1.841340851	0.32566864	0.800674816	2.965251898	0	1.644068905	0	0.001826126	1.330152703	0.019029559	20.08590393	3.231387525	0	0	0	1.404046412	1.666317275	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.2707	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.0406	0.34	0	0.0096	0.2783	0.1002	0.1888	0.029	0.1613	0.1068	0.2019	0	0.0001	0.0724	0.0784	3.5592	0.5687	0	0	0	0.2471	0.2932	0	0	0.0232	0	0	0	0	0											9.2986	0	0	28.0503	3.170324273	0	0.009586849	5.393205289	1.941517426	0.514423246	0.829714835	3.126573892	0.106815247	1.845948457	0	0.001892359	1.402518523	0.097460188	23.64506332	3.80003952	0	0	0	1.651127206	1.959551879	0	0	0.023203971	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.5693
H5253_011_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1194.173932	22.41295038	1073.254409	536.3973467	158.2843425	9.187854546	9.154932592	274.0958206	33.37454374	9857.748734	30.25038805	0	0.017427654	17.52351328	5494.272573	4359.726015	263.9694447	321.1975568	0	0	19.46249722	879.8341971	0	0	295.7792594	193.3573937	16.41834073	3.407572565	520.9519681	0											2900	"$175 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											159.4762409	122.8528282	66.93273185	0	150	0.2	0.129024959	49.51250646	0.2	3	0.177385941	0	0.2	0.148901083	9.09025602	25	38.5	25	0	0	0.2	24.3561949	0	0	25	15	0	0	0	0											YES	126.3567248	97.33914543	53.03235598	0	118.8484793	0.158464639	0.102229468	39.22990733	0.158464639	2.376969586	0.140546996	0	0.158464639	0.118214444	9.02136635	25	38.5	19.80807989	0	0	0.158464639	24.3561949	0	0	25	15	0	0	0	0											3750	12.5743	0.181804786	4.743100822	0	1.567654451	1.455950055	0.935903885	0.896062804	5.288685028	1.952630744	4.251601164	0	0.002761667	2.071532375	4.130487142	9.082762532	0.846901969	0.530192239	0	0	3.084117597	1.785784432	0	0	0.61620679	0.241696742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2402	0	10.38922155	12.5743	0.181804786	4.743100822	0	1.567654451	1.455950055	0.935903885	0.896062804	5.288685028	1.952630744	4.251601164	0	0.002761667	2.071532375	4.130487142	9.082762532	0.846901969	0.530192239	0	0	3.084117597	1.785784432	0	0	0.61620679	0.241696742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2402	NO	"$250 Days 1-15 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-15 (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"25% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	25% (9b)	25%/25%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $75 (5); 25% (9a); $45/$35 (9c)"	"$20 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 25% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$20 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $30 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.5235	0.0087	0	0.0555	0.0957	0.1334	0.1329	0.0715	0.4038	0.1193	0.3811	0	0.0002	0.158	0.4476	0.7577	0.0665	0.0423	0	0	0.3077	0.1504	0	0	0.0514	0	0	0	0	0											3.9071	0	0.770070653	13.0978	0.190464873	4.743100822	0.055467131	1.663400089	1.589334871	1.068810756	0.967562272	5.692447895	2.071889091	4.63269399	0	0.002930338	2.229494157	4.57808208	9.840468925	0.91342368	0.572513794	0	0	3.391847144	1.936217798	0	0	0.667612277	0.241696742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1472
H5253_021_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1442.217097	145.6295189	1139.097722	429.4473791	232.4255009	6.213546957	6.129961052	251.9869374	33.01692002	9928.701747	31.48481524	0	0.368965347	21.98623754	5244.445763	4381.247231	696.5837768	530.5313318	0	0	17.09061644	762.0663506	0	0	372.0779986	196.6677068	17.45621264	8.176267821	102.6327492	0											3600	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$80 Days 1-23 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	56.07207207	0	150	0.2	0.099703755	49.66153615	0.2	3	0.173935797	0	0.2	0.151854239	12.3967561	39.57434142	38.5	40	0	0	0.2	39.5976405	0	0	40	15	0	0	0	0											NO	149.2759963	113.691759	45.43099216	0	121.5337435	0.162044991	0.080782471	40.23701597	0.162044991	2.43067487	0.140927124	0	0.162044991	0.123270861	12.34854936	39.57434142	38.5	32.40899826	0	0	0.162044991	39.5976405	0	0	40	15	0	0	0	0												17.9407	1.379739681	4.312528308	0	2.353961767	1.006874163	0.495193398	0.844933536	5.350226519	2.011120485	4.437064458	0	0.059788986	2.710262423	5.396774782	14.44874781	2.234872951	1.432832417	0	0	2.769448793	2.514669116	0	0	1.240259995	0.245834633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1858	0	11.04779589	17.9407	1.379739681	4.312528308	0	2.353961767	1.006874163	0.495193398	0.844933536	5.350226519	2.011120485	4.437064458	0	0.059788986	2.710262423	5.396774782	14.44874781	2.234872951	1.432832417	0	0	2.769448793	2.514669116	0	0	1.240259995	0.245834633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1858	NO	"$325 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-24 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.3997	0.1425	1.2598	0.0267	0.0442	0.0284	0.028	0.0159	0.1508	0.0378	0.1223	0	0.0011	0.0756	0.2925	0.5857	0.0916	0.0722	0	0	0.186	0.1026	0	0	0.0506	0	0	0	0	0											4.714	0	0	19.3404	1.522224601	5.572330398	0.026690469	2.3982052	1.035260926	0.523198296	0.86081432	5.50106524	2.048920111	4.559388917	0	0.060912739	2.785847582	5.689251465	15.03447761	2.326457476	1.504990176	0	0	2.955408868	2.617278849	0	0	1.290866459	0.245834633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8998
H5253_024_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5558	0.686	0.672	0	1.8235	0	1.4878	0	0.009	1.1884	1.1556	4.5172	0.3741	0.2341	0	0	0.8433	0.1676	0	0	0	0	0	0	0	0											13.7144	NO	418.9721256	22.20864414	57.58619696	1148.5784	15.95017289	19.58786239	19.3063887	35.56716597	52.67872312	16.72843253	42.70591481	0	0.25976222	34.23571278	36.44698083	129.767547	10.9321239	6.764464623	0	0	24.11452251	6.059287339	554.3656888	171.2141817	274.1552969	179.9295177	0	0	77.93197234	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07642667	0.077354929	0.153353523	0	0.19303747	0.19303747	0.19303747	0.08640786	0.19303747	0	0.160841676	0	0.19303747	0.144834432	0.159607173	0.192622035	0.19303747	0	0	0	0.19303747	0.170093891	0	0	0	0	0	0	0	0											NO	0.07642667	0.077354929	0.153353523	0	0.19303747	0.19303747	0.19303747	0.08640786	0.19303747	0	0.160841676	0	0.19303747	0.144834432	0.159607173	0.192622035	0.19303747	0	0	0	0.19303747	0.170093891	0	0	0	0	0	0	0	0												32.0206	1.717948092	8.831046162	0	3.078981025	3.781191405	3.726856436	3.073282704	10.16896745	0	6.86889092	0	0.050143842	4.958510031	5.817199565	24.99608895	2.110309542	0	0	0	4.655006423	1.030647758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.8857	146	0	32.0206	1.717948092	8.831046162	0	3.634785159	4.467156046	4.398833937	3.073282704	11.99250819	0	8.356667635	0	0.059095458	6.146958656	6.972802918	29.51330417	2.484419237	0.234090822	0	0	5.498318087	1.19822504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.6001	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	32.0206	1.717948092	8.831046162	0	3.634785159	4.467156046	4.398833937	3.073282704	11.99250819	0	8.356667635	0	0.059095458	6.146958656	6.972802918	29.51330417	2.484419237	0.234090822	0	0	5.498318087	1.19822504	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.6001
H5253_027_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2190.834979	221.5396742	32.61607345	913.1458544	296.3661902	16.75277247	18.70410281	507.1175483	49.97217727	14884.97648	52.81741974	0	0.20088934	33.81098627	8519.934949	6460.500587	939.469155	506.6601772	0	0	42.87487535	1072.369281	348.166034	0	229.83946	207.6785798	15.663264	4.783312032	78.92464854	0											3950	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	0.153831429	0	150	0.2	0.087325608	49.54261576	0.2	3	0.173364869	0	0.2	0.148814988	13.02610537	39.45136018	38.5	40	0	0	0.2	39.64670094	0	0	40	15	0	0	0	0											NO	133.508184	101.6826593	0.111472721	0	108.6963061	0.144928408	0.063279807	35.90066219	0.144928408	2.173926122	0.125627473	0	0.144928408	0.10808928	12.90469893	39.45136018	38.5	28.98568163	0	0	0.144928408	39.64670094	0	0	40	15	0	0	0	0												24.3745	1.877228602	3.635802449	0	2.684492511	2.427952646	1.183592013	1.517154649	7.242388104	2.696569934	6.635318955	0	0.029114572	3.654605173	9.162266286	21.23962797	3.014130206	1.223824216	0	0	6.213787434	3.542992016	0	0	0.766131533	0.259598225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3811	0	24.92453022	24.3745	1.877228602	3.635802449	0	2.684492511	2.427952646	1.183592013	1.517154649	7.242388104	2.696569934	6.635318955	0	0.029114572	3.654605173	9.162266286	21.23962797	3.014130206	1.223824216	0	0	6.213787434	3.542992016	0	0	0.766131533	0.259598225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.3811	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.0071	0.1698	0.4611	0.1242	0.195	0.2645	0.2953	0.1102	0.789	0.1959	0.708	0	0.0021	0.4058	1.2965	4.4964	0.3784	0.2078	0	0	1.4292	0.2174	0	0	0.0353	0	0.0023	0	0	0											17.7912	0	0	30.3817	2.047036179	4.096867361	0.124158622	2.879470268	2.692470106	1.478919952	1.627347324	8.031422482	2.892424887	7.343325971	0	0.031229197	4.060408023	10.4588077	25.73600295	3.392527504	1.431599511	0	0	7.642949945	3.760409987	0	0	0.801427557	0.259598225	0.002278024	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1723
H5253_028_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1253.619382	120.2421844	780.7309497	714.1218732	167.1283923	8.34061099	7.070127019	282.6227261	23.74762237	9322.766251	25.89411047	0	0.032877276	16.01735255	5849.636529	4048.909477	318.1957567	314.6818443	0	0	22.80950628	886.6351086	0	0	204.6554285	159.443354	16.29952586	3.407572565	84.8660041	0											2900	"$175 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 1-19 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											159.4762409	122.8528282	47.41865943	0	150	0.2	0.11600626	49.3963459	0.2	3	0.179956276	0	0.2	0.149218972	9.217657581	25	38.5	25	0	0	0.2	22.59795574	0	0	25	15	0	0	0	0											NO	129.3551649	99.64899949	38.46245982	0	121.668749	0.162224999	0.094095577	40.06661074	0.162224999	2.43337498	0.145967033	0	0.162224999	0.12133765	9.14252196	25	38.5	20.27812484	0	0	0.162224999	22.59795574	0	0	25	15	0	0	0	0												13.5135	0.998501114	2.502402732	0	1.694525202	1.353055607	0.66526768	0.943644563	3.852458007	1.890482179	3.779686481	0	0.005333516	1.943507923	4.456702535	8.435228078	1.020878053	0.531763144	0	0	3.700272127	1.669678411	0	0	0.426365476	0.199304192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5826	0	8.733496156	13.5135	0.998501114	2.502402732	0	1.694525202	1.353055607	0.66526768	0.943644563	3.852458007	1.890482179	3.779686481	0	0.005333516	1.943507923	4.456702535	8.435228078	1.020878053	0.531763144	0	0	3.700272127	1.669678411	0	0	0.426365476	0.199304192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5826	NO	"$295 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$20 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.9417	0.0911	0	0.0919	0.1333	0.1597	0.1354	0.0743	0.4547	0.1488	0.4357	0	0.0004	0.228	0.4996	0.8122	0.0802	0.0638	0	0	0.4757	0.1722	0	0	0.0415	0	0	0	0	0											5.0401	0	0	14.4552	1.089560306	2.502402732	0.091856788	1.827872323	1.512769434	0.800653091	1.017902701	4.307199712	2.039249725	4.215366233	0	0.005753226	2.171505416	4.956337781	9.247387956	1.101065085	0.595568954	0	0	4.175978408	1.841875737	0	0	0.467862009	0.199304192	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6227
H5253_029_0	2010	4	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1812.784102	225.4510947	31.67195513	843.4202761	245.3614003	15.09779965	15.33844828	473.7443651	42.15952388	13759.01358	45.84667436	0	0.1434807	23.20631504	7924.133059	5671.704559	964.0475366	370.8378175	0	0	29.62621281	1291.435995	669.6636845	0	229.4910687	160.8673392	15.663264	4.783312032	78.92464854	0											3350	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$15 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	0.151735372	0	150	0.2	0.098989825	49.56544764	0.2	3	0.176472534	0	0.2	0.15000059	9.693503132	25	38.5	25	0	0	0.2	21.82584567	0	0	25	15	0	0	0	0											NO	134.3970067	102.3596055	0.11068584	0	109.4199452	0.14589326	0.072209742	36.15632375	0.14589326	2.188398903	0.128730767	0	0.14589326	0.10978074	9.598647076	25	38.5	18.23665753	0	0	0.14589326	21.82584567	0	0	25	15	0	0	0	0												20.3027	1.923090425	3.505636964	0	2.237285914	2.202667213	1.107585387	1.427404553	6.150790388	2.509184185	5.901877546	0	0.020932867	2.547606445	6.338413052	11.81605116	3.092985847	0.56357019	0	0	4.322264774	2.348890227	0	0	0.478106393	0.201084174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9982	0	20.34589383	20.3027	1.923090425	3.505636964	0	2.237285914	2.202667213	1.107585387	1.427404553	6.150790388	2.509184185	5.901877546	0	0.020932867	2.547606445	6.338413052	11.81605116	3.092985847	0.56357019	0	0	4.322264774	2.348890227	0	0	0.478106393	0.201084174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9982	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.6315	0.1706	0.4477	0.0993	0.1614	0.2384	0.2422	0.103	0.6657	0.181	0.626	0	0.0015	0.2777	1.117	3.6849	0.3883	0.1531	0	0	0.9875	0.2453	0	0	0.0347	0	0.0023	0	0	0											14.4591	0	0	24.9342	2.093645395	3.953355701	0.099267982	2.398707887	2.441053523	1.349771412	1.530392937	6.816467081	2.690223837	6.52790062	0	0.02244319	2.825328203	7.455366245	15.50097921	3.481282771	0.716659805	0	0	5.309805201	2.594142771	0	0	0.512842624	0.201084174	0.002278024	0	0	0	0	0	0	0	0	0	0	0	0	0	93.4572
H5253_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	218.7784946	7.529082415	27.99794956	438.032434	5.250503635	5.284198975	6.54671296	9.447283119	42.87207616	15.47873705	37.91689089	0	0.095519119	31.73497228	26.44645013	96.77732622	3.739544254	7.298376493	0	0	24.72838214	5.173213518	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076033673	0.076033673	0.153803308	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076033673	0.076033673	0.153803308	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.6345	0.572463792	4.306177252	0	1.223367347	1.231218361	1.52538412	2.201216967	9.989193745	3.606545733	8.834635577	0	0.022255955	7.394248541	6.162022881	22.54911701	0.871313811	1.700521723	0	0	5.76171304	1.20535875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7913	0	0	16.6345	0.572463792	4.306177252	0	1.223367347	1.231218361	1.52538412	2.201216967	9.989193745	3.606545733	8.834635577	0	0.022255955	7.394248541	6.162022881	22.54911701	0.871313811	1.700521723	0	0	5.76171304	1.20535875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7913	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.6345	0.572463792	4.306177252	0	1.223367347	1.231218361	1.52538412	2.201216967	9.989193745	3.606545733	8.834635577	0	0.022255955	7.394248541	6.162022881	22.54911701	0.871313811	1.700521723	0	0	5.76171304	1.20535875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.7913
H5253_802_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	218.2968295	7.529082415	27.93630897	437.0757986	5.238944069	5.272565226	6.532299646	9.426483879	42.77768853	15.4446589	37.83341265	0	0.095308823	31.66517026	26.38822534	96.56426021	3.739544254	7.282308308	0	0	24.67393987	5.161824115	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076035802	0.076035802	0.153802683	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076035802	0.076035802	0.153802683	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.5984	0.572479823	4.296679278	0	1.220673968	1.228507698	1.522025817	2.196370744	9.967201428	3.598605523	8.815185148	0	0.022206956	7.377984671	6.148456505	22.49947263	0.871313811	1.696777836	0	0	5.74902799	1.202705019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.584	0	0	16.5984	0.572479823	4.296679278	0	1.220673968	1.228507698	1.522025817	2.196370744	9.967201428	3.598605523	8.815185148	0	0.022206956	7.377984671	6.148456505	22.49947263	0.871313811	1.696777836	0	0	5.74902799	1.202705019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.584	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.5984	0.572479823	4.296679278	0	1.220673968	1.228507698	1.522025817	2.196370744	9.967201428	3.598605523	8.815185148	0	0.022206956	7.377984671	6.148456505	22.49947263	0.871313811	1.696777836	0	0	5.74902799	1.202705019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.584
H5253_805_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	204.2954061	7.55907876	26.14449142	422.826644	4.902921442	4.934386159	6.113321993	8.821875043	40.03395409	14.45404804	35.406801	0	0.089195774	29.63610981	24.69570092	90.37068839	3.739544254	6.815225565	0	0	23.09136865	4.830747915	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079551201	0.079551201	0.152847642	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079551201	0.079551201	0.152847642	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.2519	0.601333794	3.996123872	0	1.142380696	1.149711975	1.424404024	2.055496885	9.327911304	3.367793194	8.249784634	0	0.020782615	6.905213585	5.754098314	21.05637039	0.871313811	1.587947557	0	0	5.380288896	1.125564264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2685	0	0	16.2519	0.601333794	3.996123872	0	1.142380696	1.149711975	1.424404024	2.055496885	9.327911304	3.367793194	8.249784634	0	0.020782615	6.905213585	5.754098314	21.05637039	0.871313811	1.587947557	0	0	5.380288896	1.125564264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2685	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.2519	0.601333794	3.996123872	0	1.142380696	1.149711975	1.424404024	2.055496885	9.327911304	3.367793194	8.249784634	0	0.020782615	6.905213585	5.754098314	21.05637039	0.871313811	1.587947557	0	0	5.380288896	1.125564264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2685
H5262_001_0	2010	3	N/A	f.	e.3.	e.4.								Professional	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies								Urgently Needed Services	Preferred Diabetic Supplies	Non-Preferred Diabetic Supplies								A	A	Coin	V	P	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	V	V	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	YES	0	0	30.16176218	0	0	11.36884893	1.090115063	301.5278848	0	0	0	0	0	604.3328907	5797.845203	1338.525843	129.4836508	268.7333259	0	0	0	728.9609825	0	0	4.48340706	0	0	0	0	0	1.776181766	3.89962689	1.29987563								2500	1A IP Acute: $0 per admit	1B IP Psych: $0 per admit	2 SNF: 10% for days 1 - 20 only	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	11B Prosthetic Medical Supplies: 10%	4A ER: $50	9B ASC Services: $0	8A OP C/D/T: $0	8B OP X-Ray: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP substance Abuse: $15, 9D Cardiac Rehab: $10"	"7A PCP: $15, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Meaurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $15, 14J Nutrition Therapy: $15"	"7B Chiropractic: $15, 7D Physician Specialist (excl. Radiology) $15, 7F Podiatry: $15"	"7E Mental Health: $15, 7H Psychiatric: $15"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D physician Specialist (Radiology): $0	"7G Other Health Care: $15, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Medicare Covered Comp Dental Services: $15, 17A medicare Covered Eye Exams: $15"	10B Transportation: Not Covered	"16A Preventative Dental Services: Not Covered, 16B Non Medicare Covered Comp Dental: Not Covered"	17A Routine Eye Exams: $15	"17B Eye Wear: Medicare Covered: $0, Routine: $0"	18A Routine Hearing Exams: $0	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered	4B Urgent Care: $15	11C Preferred Diabetes Monitoring Supplies: 5%	11C Non-Preferred Diabetes Monitoring Supplies: 25%										0.1			0.1	0.1	50						10	15	15	15	15		15		15			15						15	0.05	0.25								NO			0.099875584			0.099875584	0.099875584	49.93779205						9.987558409	14.98133761	14.98133761	14.98133761	14.98133761		14.98133761		14.98133761			14.98133761						14.98133761	0.049937792	0.24968896									0	0	3.012423615	0	0	1.135470427	0.108875879	1.254803067	0	0	0	0	0	0.50298417	7.238289702	1.671075629	0.161653191	0.335498724	0	0	0	0.910067549	0	0	0.005597286	0	0	0	0	0	0.002217465	0.194738757	0.324564595	0	0	0	0	0	0	0	16.8583	0	0.021000489	0	0	3.012423615	0	0	1.135470427	0.108875879	1.254803067	0	0	0	0	0	0.50298417	7.238289702	1.671075629	0.161653191	0.335498724	0	0	0	0.910067549	0	0	0.005597286	0	0	0	0	0	0.002217465	0.194738757	0.324564595	0	0	0	0	0	0	0	16.8583	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0			0	0	3.012423615	0	0	1.135470427	0.108875879	1.254803067	0	0	0	0	0	0.50298417	7.238289702	1.671075629	0.161653191	0.335498724	0	0	0	0.910067549	0	0	0.005597286	0	0	0	0	0	0.002217465	0.194738757	0.324564595	0	0	0	0	0	0	0	16.8583
H5262_003_0	2010	3	N/A	f.	e.3.	e.4.								Professional	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies									Preferred Diabetic Supplies	Non-Preferred Diabetic Supplies								A	A	Coin	V	P	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	V	V	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	YES	178.3570859	2.300454151	23.1574841	0	0	7.392790567	0.776877208	292.8046798	147.718728	14.20489784	5.041129237	0	0	457.8339989	3532.403859	933.6377353	84.47641051	179.4747247	0	0	0	520.5464317	0	0	3.000935426	0	0	0	0	0	2.012897382	2.253351796	0.751117265								2500	1A IP Acute: $200 per admit	1B IP Psych: $200 per admit	2 SNF: 10% for days 1 - 20 only	6 Home Health: $0	10A Ambulance: $0	11A DME: 20%	"11B Prosthetic Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	4A ER: $50	9B ASC Services: $75	8A OP C/D/T: 10%	8B OP X-Ray: 10%	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP substance Abuse: $30, 9D Cardiac Rehab: $15"	"7A PCP: $30, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Meaurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $30, 14J Nutrition Therapy: $30"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology) $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D physician Specialist (Radiology): $0	"7G Other Health Care: $30, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Medicare Covered Comp Dental Services: $30, 17A medicare Covered Eye Exams: $30"	10B Transportation: Not Covered	"16A Preventative Dental Services: Not Covered, 16B Non Medicare Covered Comp Dental: Not Covered"	17A Routine Eye Exams: $30	"17B Eye Wear: Medicare Covered: $0, Routine: $0"	18A Routine Hearing Exams: $0	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered	4B Urgent Care: $30	11C Preferred Diabetes Monitoring Supplies: 15%	11C Non-Preferred Diabetes Monitoring Supplies: 35%								200	200	0.1			0.2	0.2	50	75	0.1	0.1			15	30	30	30	30		30		30			30						30	0.15	0.35								NO	199.457787	199.457787	0.099728893			0.199457787	0.199457787	49.86444675	74.79667012	0.099728893	0.099728893			14.95933402	29.91866805	29.91866805	29.91866805	29.91866805		29.91866805		29.91866805			29.91866805						29.91866805	0.14959334	0.349051127									2.9646	0.038236958	2.309470265	0	0	1.474549646	0.154954209	1.216711947	0.92073908	1.416638743	0.502746241	0	0	0.570740976	8.807068206	2.327766457	0.210618474	0.447470393	0	0	0	1.297837991	0	0	0.007481999	0	0	0	0	0	0.005018601	0.337086422	0.262178328	0	0	0	0	0	0	0	25.2719	0	0.068700036	2.9646	0.038236958	2.309470265	0	0	1.474549646	0.154954209	1.216711947	0.92073908	1.416638743	0.502746241	0	0	0.570740976	8.807068206	2.327766457	0.210618474	0.447470393	0	0	0	1.297837991	0	0	0.007481999	0	0	0	0	0	0.005018601	0.337086422	0.262178328	0	0	0	0	0	0	0	25.2719	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0			2.9646	0.038236958	2.309470265	0	0	1.474549646	0.154954209	1.216711947	0.92073908	1.416638743	0.502746241	0	0	0.570740976	8.807068206	2.327766457	0.210618474	0.447470393	0	0	0	1.297837991	0	0	0.007481999	0	0	0	0	0	0.005018601	0.337086422	0.262178328	0	0	0	0	0	0	0	25.2719
H5262_004_0	2010	2	N/A	f.	e.3.	e.4.								Professional	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies									Preferred Diabetic Supplies	Non-Preferred Diabetic Supplies								A	A	Coin	V	P	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	V	V	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	YES	180.9136544	2.333428835	23.48942322	0	0	7.498758746	0.788012958	297.0017389	149.8361266	14.40851069	5.113388729	0	0	464.3965865	3583.037297	947.0204884	85.68729446	182.0473134	0	0	0	528.0079385	0	0	3.043950801	0	0	0	0	0	2.041750231	2.285651316	0.761883772								2500	1A IP Acute: $200 per admit	1B IP Psych: $200 per admit	2 SNF: 10% for days 1 - 20 only	6 Home Health: $0	10A Ambulance: $0	11A DME: 20%	"11B Prosthetic Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	4A ER: $50	9B ASC Services: $75	8A OP C/D/T: 10%	8B OP X-Ray: 10%	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP substance Abuse: $30, 9D Cardiac Rehab: $15"	"7A PCP: $30, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Meaurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $30, 14J Nutrition Therapy: $30"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology) $30, 7F Podiatry: $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D physician Specialist (Radiology): $0	"7G Other Health Care: $30, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Medicare Covered Comp Dental Services: $30, 17A medicare Covered Eye Exams: $30"	10B Transportation: Not Covered	"16A Preventative Dental Services: Not Covered, 16B Non Medicare Covered Comp Dental: Not Covered"	17A Routine Eye Exams: $30	"17B Eye Wear: Medicare Covered: $0, Routine: $0"	18A Routine Hearing Exams: $0	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered	4B Urgent Care: $30	11C Preferred Diabetes Monitoring Supplies: 15%	11C Non-Preferred Diabetes Monitoring Supplies: 35%								200	200	0.1			0.2	0.2	50	75	0.1	0.1			15	30	30	30	30		30		30			30						30	0.15	0.35								NO	199.457787	199.457787	0.099728893			0.199457787	0.199457787	49.86444675	74.79667012	0.099728893	0.099728893			14.95933402	29.91866805	29.91866805	29.91866805	29.91866805		29.91866805		29.91866805			29.91866805						29.91866805	0.14959334	0.349051127									3.0071	0.038785046	2.342574186	0	0	1.495685825	0.157175321	1.234152283	0.933936944	1.436944828	0.5099526	0	0	0.578921971	8.933308626	2.361132636	0.213637477	0.453884428	0	0	0	1.316441187	0	0	0.007589246	0	0	0	0	0	0.005090537	0.341918215	0.265936389	0	0	0	0	0	0	0	25.6341	0	0.068700036	3.0071	0.038785046	2.342574186	0	0	1.495685825	0.157175321	1.234152283	0.933936944	1.436944828	0.5099526	0	0	0.578921971	8.933308626	2.361132636	0.213637477	0.453884428	0	0	0	1.316441187	0	0	0.007589246	0	0	0	0	0	0.005090537	0.341918215	0.265936389	0	0	0	0	0	0	0	25.6341	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0			3.0071	0.038785046	2.342574186	0	0	1.495685825	0.157175321	1.234152283	0.933936944	1.436944828	0.5099526	0	0	0.578921971	8.933308626	2.361132636	0.213637477	0.453884428	0	0	0	1.316441187	0	0	0.007589246	0	0	0	0	0	0.005090537	0.341918215	0.265936389	0	0	0	0	0	0	0	25.6341
H5262_005_0	2010	2	N/A	f.	e.3.	e.4.								Professional	DME/Prosthetics/Supplies	DME/Prosthetics/Supplies									Preferred Diabetic Supplies	Non-Preferred Diabetic Supplies								A	A	Coin	V	P	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	V	V	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	YES	0	0	39.45611366	0	0	10.32748153	1.231493141	305.5295397	0	0	0	0	0	723.7144391	6000.461624	1285.669499	64.5376448	200.4423097	0	0	0	763.9712654	0	0	3.556814555	0	0	0	0	0	2.941886942	2.443369714	0.814456571								2500	1A IP Acute: $0 per admit	1B IP Psych: $0 per admit	2 SNF: 10% for days 1 - 20 only	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	"11B Prosthetic Medical Supplies: 10%, 11C Diabetes Monitoring Supplies: 10%"	4A ER: $50	9B ASC Services: $0	8A OP C/D/T: $0	8B OP X-Ray: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP substance Abuse: $15, 9D Cardiac Rehab: $10"	"7A PCP: $15, 14B Immunizations: $0, 14C Routine Physical Exams: $0, 14D Pap Smears: $0, 14D Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Meaurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $15, 14J Nutrition Therapy: $15"	"7B Chiropractic: $15, 7D Physician Specialist (excl. Radiology) $15, 7F Podiatry: $15"	"7E Mental Health: $15, 7H Psychiatric: $15"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D physician Specialist (Radiology): $0	"7G Other Health Care: $15, 18A Medicare Covered Hearing Exams: $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Medicare Covered Comp Dental Services: $15, 17A medicare Covered Eye Exams: $15"	10B Transportation: Not Covered	"16A Preventative Dental Services: Not Covered, 16B Non Medicare Covered Comp Dental: Not Covered"	17A Routine Eye Exams: $15	"17B Eye Wear: Medicare Covered: $0, Routine: $0"	18A Routine Hearing Exams: $0	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0	13B Acupuncture: Not Covered	4B Urgent Care: $15	11C Preferred Diabetes Monitoring Supplies: 5%	11C Non-Preferred Diabetes Monitoring Supplies: 25%										0.1			0.1	0.1	50						10	15	15	15	15		15		15			15						15	0.05	0.25								NO			0.099875584			0.099875584	0.099875584	49.93779205						9.987558409	14.98133761	14.98133761	14.98133761	14.98133761		14.98133761		14.98133761			14.98133761						14.98133761	0.049937792	0.24968896									0	0	3.940702398	0	0	1.03146325	0.122996097	1.271455885	0	0	0	0	0	0.602345019	7.491245119	1.605087402	0.080571687	0.25024116	0	0	0	0.953775954	0	0	0.004440487	0	0	0	0	0	0.003672783	0.122016489	0.203360814	0	0	0	0	0	0	0	17.6834	0	0.021000489	0	0	3.940702398	0	0	1.03146325	0.122996097	1.271455885	0	0	0	0	0	0.602345019	7.491245119	1.605087402	0.080571687	0.25024116	0	0	0	0.953775954	0	0	0.004440487	0	0	0	0	0	0.003672783	0.122016489	0.203360814	0	0	0	0	0	0	0	17.6834	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0									0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0								0			0	0	3.940702398	0	0	1.03146325	0.122996097	1.271455885	0	0	0	0	0	0.602345019	7.491245119	1.605087402	0.080571687	0.25024116	0	0	0	0.953775954	0	0	0.004440487	0	0	0	0	0	0.003672783	0.122016489	0.203360814	0	0	0	0	0	0	0	17.6834
H5291_001_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	O	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	YES	1303.809026	101.136581	682.240334	891.340031	212.646118	13.181427	4.151293	397.81931	319.997644	1833.565958	1558.836928	75.055766	0.01701	247.991903	5193.658871	4016.41999	49.941726	572.8753			31.332643	0							0.04	0.25	10.873487	0.05	0.55	3.77	0.32	0.35	0.4	0.42			7500	$175/Day(Days 1-15):1a	$175/Day(Days 1-11):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	"0%-20% Coins:11b. 0% Supplies,11b. 20% Prosthetics"	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$35-$100/Visit:9d. $50 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			153.42355	133.708575	48.2281	0	100	0.2	0.099081	50	116.332019	3.859336	49.459442	100	0.2	47.861546	10	30	30	31.75194			0.2	0							0	0	0	0	0	0	0	0	0	0			NO	148.206229	129.161681	43.433552	0	94.6229	0.189246	0.093753	47.31145	110.07673	3.651816	46.799958	94.6229	0.189246	45.287983	9.46229	28.38687	28.38687	30.044607			0.189246	0							0	0	0	0	0	0	0	0	0	0				16.1027	1.088580901	2.469343419	0	1.67676603	2.494532334	0.389196173	1.5684507	2.935357855	0.557987125	6.079458563	0.591832853	0.003219074	0.935921091	4.095325533	9.501132677	0.118140774	1.434317771	0	0	5.929577357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9719	0	3.054868	16.1027	1.088580901	2.469343419	0	1.67676603	2.494532334	0.389196173	1.5684507	2.935357855	0.557987125	6.079458563	0.591832853	0.003219074	0.935921091	4.095325533	9.501132677	0.118140774	1.434317771	0	0	5.929577357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9719	NO																																																																																		0	0	0	16.1027	1.088580901	2.469343419	0	1.67676603	2.494532334	0.389196173	1.5684507	2.935357855	0.557987125	6.079458563	0.591832853	0.003219074	0.935921091	4.095325533	9.501132677	0.118140774	1.434317771	0	0	5.929577357	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9719
H5291_801_0	2010	3	N/A																															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	NO	302.204309	1.859707	29.107842	14.08046	6.858507	6.67489	2.821281	27.629873	78.116	11.232524	36.827597	5.701369	1.215624	20.120874	93.278187	115.71327	0.4048	7.869673			29.746525	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																			0.074688334	0.074688334	0.149610085	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.074688334	0.074688334	0.149610085	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.5711	0.138898418	4.354826721	0	1.598032131	1.55524937	0.657358473	6.437760409	18.201028	2.617178092	8.580830101	1.328418977	0.283240392	4.688163642	21.73381757	26.96119191	0.0943184	1.833633809	0	0	6.930940325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.566	0	0	22.5711	0.138898418	4.354826721	0	1.598032131	1.55524937	0.657358473	6.437760409	18.201028	2.617178092	8.580830101	1.328418977	0.283240392	4.688163642	21.73381757	26.96119191	0.0943184	1.833633809	0	0	6.930940325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.566	NO																																																																																		0	0	0	22.5711	0.138898418	4.354826721	0	1.598032131	1.55524937	0.657358473	6.437760409	18.201028	2.617178092	8.580830101	1.328418977	0.283240392	4.688163642	21.73381757	26.96119191	0.0943184	1.833633809	0	0	6.930940325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.566
H5291_802_0	2010	3	N/A																															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	NO	302.204309	1.859707	29.107842	14.08046	6.858507	6.67489	2.821281	27.629873	78.116	11.232524	36.827597	5.701369	1.215624	20.120874	93.278187	115.71327	0.4048	7.869673			29.746525	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																			0.074688334	0.074688334	0.149610085	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.074688334	0.074688334	0.149610085	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.5711	0.138898418	4.354826721	0	1.598032131	1.55524937	0.657358473	6.437760409	18.201028	2.617178092	8.580830101	1.328418977	0.283240392	4.688163642	21.73381757	26.96119191	0.0943184	1.833633809	0	0	6.930940325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.566	0	0	22.5711	0.138898418	4.354826721	0	1.598032131	1.55524937	0.657358473	6.437760409	18.201028	2.617178092	8.580830101	1.328418977	0.283240392	4.688163642	21.73381757	26.96119191	0.0943184	1.833633809	0	0	6.930940325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.566	NO																																																																																		0	0	0	22.5711	0.138898418	4.354826721	0	1.598032131	1.55524937	0.657358473	6.437760409	18.201028	2.617178092	8.580830101	1.328418977	0.283240392	4.688163642	21.73381757	26.96119191	0.0943184	1.833633809	0	0	6.930940325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.566
H5291_803_0	2010	3	N/A																															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	NO	302.204309	1.859707	29.107842	14.08046	6.858507	6.67489	2.821281	27.629873	78.116	11.232524	36.827597	5.701369	1.215624	20.120874	93.278187	115.71327	0.4048	7.869673			29.746525	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																			0.074688334	0.074688334	0.149610085	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.074688334	0.074688334	0.149610085	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.5711	0.138898418	4.354826721	0	1.598032131	1.55524937	0.657358473	6.437760409	18.201028	2.617178092	8.580830101	1.328418977	0.283240392	4.688163642	21.73381757	26.96119191	0.0943184	1.833633809	0	0	6.930940325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.566	0	0	22.5711	0.138898418	4.354826721	0	1.598032131	1.55524937	0.657358473	6.437760409	18.201028	2.617178092	8.580830101	1.328418977	0.283240392	4.688163642	21.73381757	26.96119191	0.0943184	1.833633809	0	0	6.930940325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.566	NO																																																																																		0	0	0	22.5711	0.138898418	4.354826721	0	1.598032131	1.55524937	0.657358473	6.437760409	18.201028	2.617178092	8.580830101	1.328418977	0.283240392	4.688163642	21.73381757	26.96119191	0.0943184	1.833633809	0	0	6.930940325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.566
H5294_001_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	405.071857	34.25121271	88.06762375	0	24.41931768	35.12526132	26.02591202	23.1140894	39.74198101	4.677644592	12.61466121	0	3.632497488	35.48256428	65.94108901	132.5836865	13.6841397	8.248031437	41.14162457	48.10662411	6.967844474	0.530144459	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.072124889	0.072124889	0.190847712	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072124889	0.072124889	0.190847712	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												29.2158	2.470364923	16.80750449	0	5.689701019	8.184185887	6.0640375	5.385582831	9.259881575	1.08989119	2.939216063	0	0.846371915	8.267437476	15.36427374	30.89199896	3.188404551	1.921791325	9.585998525	11.20884342	1.623507763	0.123523659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.1283	0	0	29.2158	2.470364923	16.80750449	0	5.689701019	8.184185887	6.0640375	5.385582831	9.259881575	1.08989119	2.939216063	0	0.846371915	8.267437476	15.36427374	30.89199896	3.188404551	1.921791325	9.585998525	11.20884342	1.623507763	0.123523659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.1283	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.2158	2.470364923	16.80750449	0	5.689701019	8.184185887	6.0640375	5.385582831	9.259881575	1.08989119	2.939216063	0	0.846371915	8.267437476	15.36427374	30.89199896	3.188404551	1.921791325	9.585998525	11.20884342	1.623507763	0.123523659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	170.1283
H5302_003_0	2010	10	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	COIN	O	COIN	COIN	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	YES	1171.876289	60.08582866	343.873619	0	61.02247735	7.33178634	7.646407098	302.0108693	307.9906227	1200.389087	608.184408	80.81054171	0.37010668	366.1319353	26.4017066	109.4148121	180.2833324	561.1339806	1352.997324	1175.615204	18.48924558	0	0	0	0	0	9.34801016	0	0	0											5000	$195/day days 1 - 7; $0 after day 7	$195/day days 1 - 7; $0 after day 7	$0 days 1 - 5; $75/day days 6 - 100	$0 copay	$100 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $35/visit	(9a) $205/visit (9b) $205/visit	$35 copay	"$35 copay except: MRI, CT, PET @ $300 copay"	$205/visit	20% coinsurance	$35/visit	"(7a) $20/visit, 14(b) - 14(h) $0 copay, 14(i) 20%, 14(j) $0 copay"	"(7b, 7d, 7f, 7g) $35/visit, (14d, 14e, 14f, 14g, 14h, 14j) $0 copay, (14i) 20% coinsurance"	$35/visit	$35/visit	$35/visit	"(7b, 7d, 7f, 7g) $35/visit, (14d, 14e, 14f, 14g, 14h, 14j) $0 copay, (14i) 20% coinsurance"	20% coinsurance	$0 copay	not covered	not covered	not covered	not covered	$35 copay	not covered	$0 copay	"Immunizations $0 copay, Physicals not covered"											151.2511747	142.3925914	47.29956961	0	60	0.2	0.2	50	185.0652574	35	90.39486661	205	0.2	34.59711821	0.193930439	0.157314749	35	35	9.43311375	0.045588788	0.2	0	0	0	0	0	35	0	0	0											NO	137.2484923	129.2100277	42.92062277	0	54.44526002	0.1814842	0.1814842	45.37105001	167.932101	31.75973501	82.02620028	186.0213051	0.1814842	31.39415161	0.175976553	0.142750707	31.75973501	31.75973501	8.559805514	0.041368224	0.1814842	0	0	0	0	0	31.75973501	0	0	0												13.4032	0.646974299	1.229939157	0	0.276865387	1.330603379	1.387702075	1.141879188	4.31012603	3.177003277	4.157254672	1.252706869	0.067168515	0.957866791	4.646081315	15.6190418	0.477145905	1.485122211	0.965116163	0.004052759	3.355505943	0	0	0	0	0	0.02474086	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9161	0	6.112897058	13.4032	0.646974299	1.229939157	0	0.276865387	1.330603379	1.387702075	1.141879188	4.31012603	3.177003277	4.157254672	1.252706869	0.067168515	0.957866791	4.646081315	15.6190418	0.477145905	1.485122211	0.965116163	0.004052759	3.355505943	0	0	0	0	0	0.02474086	0	0	0	0	0	0	0	0	0	0	0	0	0	59.9161	NO	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	$100 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $35/visit	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	not covered	not covered	not covered	not covered	20% coinsurance	not covered	not covered	not covered												6.9675	0.1017	0.2893	0	0.4027	0.2293	0.2268	0.3418	0.6897	0.056	0.3635	0.0589	0.0079	0.188	0.6507	3.6067	0.0437	0.1404	0.777	0.2498	0.4091	0	0	0	0	0	0	0	0	0											15.8006	0	0	20.3707	0.748689686	1.51921234	0	0.679541919	1.559929595	1.614465636	1.483631924	4.99986952	3.233031503	4.520785671	1.311629514	0.07509167	1.145910226	5.29681274	19.22569325	0.520849589	1.625488343	1.742149422	0.253861035	3.764655233	0	0	0	0	0	0.02474086	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7167
H5302_004_0	2010	10	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	COIN	O	COIN	COIN	P	P	P	P	COIN	V	T	V	V	V	V	V	P	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.26	0	0	0	0	0	0											0.26	YES	1392.10552	40.7563239	349.2303096	0	51.33741866	7.438449584	7.659677576	279.0222006	369.8055347	1567.434574	640.9961599	97.90633923	0.992306193	352.9053318	25.76600316	118.3174646	130.2184862	701.2194447	1670.128914	0	24.73753015	0	0	0	74.48796607	171.2589543	0	128.6158881	0	307.0358764											4500	$195/day days 1 - 7; $0 after day 7	$195/day days 1 - 7; $0 after day 7	$0 days 1 - 5; $75/day days 6 - 100	$0 copay	$100 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $35/visit	(9a) $175/visit (9b) $175/visit	$35 copay	"$35 copay except: MRI, CT, PET @ $300 copay"	$175/visit	20% coinsurance	$35/visit	"(7a) $15/visit, 14(b) - 14(h) $0 copay, 14(i) 20%, 14(j) $0 copay"	"(7b, 7d, 7f, 7g) $35/visit, (14d, 14e, 14f, 14g, 14h, 14j) $0 copay, (14i) 20% coinsurance"	$35/visit	$35/visit	$35/visit	"(7b, 7d, 7f, 7g) $35/visit, (14d, 14e, 14f, 14g, 14h, 14j) $0 copay, (14i) 20% coinsurance"	20% coinsurance	$0 copay	not covered	"(16a) $25 Deductible, (16b) not covered"	$35 copay	$35 copay	$35 copay	$35 copay (eval and fitting only)	$0 copay	"Immunizations $0 copay, Physicals $0 copay"											150.7210587	142.3925914	46.93144038	0	60	0.2	0.2	48.60417736	157.154496	30.84932141	108.6008044	175	0.2	34.33503908	0.165330675	0.176159937	35	35	14.31477258	0	0.2	0	0	0	35	35	0	35	0	11.69570163											NO	128.609413	121.5027797	40.04632829	0	51.19765509	0.17065885	0.17065885	41.47366514	134.099028	26.32354862	92.66844206	149.326494	0.17065885	29.29789148	0.141075715	0.150316261	29.8652988	29.8652988	12.21471316	0	0.17065885	0	0	0	29.8652988	29.8652988	0	29.8652988	0	9.979874969												14.9198	0.41266722	1.165449302	0	0.219029621	1.269437254	1.307191769	0.964339443	4.132546897	3.438370018	4.950009626	1.218334198	0.169345834	0.861615176	3.634957312	17.78503893	0.3240845	1.745177353	1.700012135	0	4.221678455	0	0	0	0.18538378	0.426224987	0	0.320095994	0	0.255348305	0	0	0	0	0	0	0	0	0	0	65.6262	25	11.28301877	14.9198	0.41266722	1.165449302	0	0.219029621	1.269437254	1.307191769	0.964339443	4.132546897	3.438370018	4.950009626	1.218334198	0.169345834	0.861615176	3.634957312	17.78503893	0.3240845	1.745177353	1.700012135	0	4.221678455	0	0	0.26	0.18538378	0.426224987	0	0.320095994	0	0.255348305	0	0	0	0	0	0	0	0	0	0	65.8862	NO	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	$100 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $35/visit	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	not covered	"(16a) $0 copay, (16b) not covered"	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	not covered	not covered												5.8174	0.0707	0.2505	0	0.9134	0.6652	0.3287	0.199	1.0679	0.0716	0.6264	0.0221	0.0188	0.1394	0.5499	4.2218	0.0743	0.1757	0.7022	0.3482	0.4683	0	0	0	0.0177	0.0071	0.0012	0.0194	0	0.0674											16.8444	0	0	20.7372	0.483406187	1.415961876	0	1.132470933	1.934622793	1.635906775	1.163314529	5.200487156	3.509964569	5.576458035	1.240416788	0.188133281	1.001026378	4.184843217	22.00680211	0.398361755	1.920866263	2.402197238	0.348205037	4.690003978	0	0	0.26	0.203093084	0.433352321	0.001245371	0.339507299	0	0.322735322	0	0	0	0	0	0	0	0	0	0	82.7306
H5302_005_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	P	T	V	V	O	V	P	O	O																																																			0	YES	1311.727619	78.30020336	397.4109533		90.70155809	8.295532948	9.923233206	253.1431908	296.4860794	532.5261105	285.7970897	31.48514194	0.039470415	323.7438027	3399.143987	5087.89288	175.9539547	323.770747	3524.390656	8390.679404	15.67687255				138.5246787		239.5322569														3000	"1a: Days 1-8: $180/day, then $0;1a1: Days 1-8: $180/day, then $0"	"1b: Days 1-8: $180/day, then $0"	"2: Days 1-5: $0/day, then $100/day"	6: $0/visit	10a: $100/trip	11a: 20%	11b: 20%;11c: 20%	4a: $50/visit;4a1: $50/visit;4b: $30/visit	9a: $160/visit;9b: $160/visit	8a: $30/visit	8b: $30/visit;8b: $100/visit	9a: $160/visit	12a: 20%	3: $30/visit;5: $160/visit;9a: $30/visit;9c: $30/visit;9d: $30/visit;7i: $30/visit;7e: $30/visit;7c: $30/visit	7a: $15/visit;14b: $0/visit;14c: $0/visit;14c1: $0/visit;14d: $0/visit;14d1: $0/visit;14e: $0/visit;14e1: $0/visit;14f: $0/visit;14f1: $0/visit;14g: $0/visit;14g1: $0/visit	7b: $30/visit;7b1: $30/visit;7d: $30/visit;7f: $30/visit;7f1: $30/visit;16b: $30/visit;17a: $30/visit;18a: $30/visit	7e: $30/visit;7h: $30/visit;7a: $15/visit;7d: $30/visit	7c: $30/visit;7i: $30/visit;7a: $15/visit;7d: $30/visit	14h: $0/visit;14h1: $0/visit;7a: $15/visit;7d: $30/visit	7g: $30/visit;14b: $0/visit;14i: 20%;14j: $0/visit7a: $15/visit;7d: $30/visit;8a: $30/visit;12a: 20%	15: 20%	13a: $0/visit;17b: $30/visit		16a: $25 deductible	17a1: $30/visit	17b1: $100 allowance	18a1: $30/visit		14a: $0/visit	13c: $10/Month											145.5721059	126.3267337	58.04586175		100	0.2	0.2	46	151.2016687	30	63.35757559	160	0.2	30	15	30	30	29.09586267	7.871340951	7.798573843	0.2				30		30														NO	128.1980626	111.2496272	51.11808317		88.06499143	0.176129983	0.176129983	40.50989606	133.1557366	26.41949743	55.79584351	140.9039863	0.176129983	26.41949743	13.20974871	26.41949743	26.41949743	25.62326897	6.931895734	6.867813387	0.176129983				30		26.41949743															14.0134	0.725905703	1.69290718	0	0.665635995	1.461092076	1.747778894	0.854567029	3.289901858	1.172422684	1.328857474	0.369698501	0.006951923	0.71276238	3.741819826	11.20163107	0.387384588	0.691338745	2.035892379	4.802135028	2.761167293	0	0	0	0.346311697	0	0.527360154	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5369	0	7.344184477	14.0134	0.725905703	1.69290718	0	0.665635995	1.461092076	1.747778894	0.854567029	3.289901858	1.172422684	1.328857474	0.369698501	0.006951923	0.71276238	3.741819826	11.20163107	0.387384588	0.691338745	2.035892379	4.802135028	2.761167293	0	0	0	0.346311697	0	0.527360154	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5369	NO	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: $100/trip	OON: 30%	OON: 30%	OON: $50/visit;OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: $30/visit	OON: $50/visit;OON: 30%	OON: 30%	OON: 30%	OON: $30/visit	OON: 30%;OON: $30/visit	OON: 30%	OON: 30%		OON: $25 deductible	OON: $30/visit		OON: 30%															6.6185	0.164	0.3816	0.6104	0.0884	0.2911	0.3482	0.1894	1.7759	0.1082	0.5833	0.0937	0.0019	0.7263	1.0838	2.4808	0.0857	0.154	0.5498	1.1814	0.5501				0.0385		0.0447														18.1496	0	0	20.6319	0.889931238	2.074474875	0.610395385	0.754039073	1.752163407	2.095962516	1.043970884	5.06582506	1.280659582	1.912155522	0.463382748	0.00882442	1.439089595	4.825595397	13.68240396	0.473132129	0.845317559	2.585688232	5.983544918	3.311232997	0	0	0	0.384790774	0	0.572076507	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6865
H5302_006_0	2010	10	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	O	O	COIN	O	COIN	COIN	P	P	P	P	COIN	V	T	V	V	V	V	V	P	O											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.26	0	0	0	0	0	0											0.26	YES	1229.70833	96.88579917	561.0282573	0	101.885483	9.198357278	7.220566949	226.6856413	275.8938833	546.0075577	467.3461173	23.33575386	0.347377901	377.2543572	25.57184314	108.3810735	282.340451	580.7669276	1250.972679	0	26.26157579	0	0	0	135	310.3851542	0	233.1	0	341.1											4500	$195/day days 1 - 7; $0 after day 7	$195/day days 1 - 7; $0 after day 7	$0 days 1 - 5; $75/day days 6 - 100	$0 copay	$100 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $35/visit	(9a) $175/visit (9b) $175/visit	$35 copay	"$35 copay except: MRI, CT, PET @ $300 copay"	$175/visit	20% coinsurance	$35/visit	"(7a) $15/visit, 14(b) - 14(h) $0 copay, 14(i) 20%, 14(j) $0 copay"	"(7b, 7d, 7f, 7g) $35/visit, (14d, 14e, 14f, 14g, 14h, 14j) $0 copay, (14i) 20% coinsurance"	$35/visit	$35/visit	$35/visit	"(7b, 7d, 7f, 7g) $35/visit, (14d, 14e, 14f, 14g, 14h, 14j) $0 copay, (14i) 20% coinsurance"	20% coinsurance	$0 copay	not covered	"(16a) $25 Deductible, (16b) not covered"	$35 copay	$35 copay	$35 copay	$35 copay (eval and fitting only)	$0 copay	"Immunizations $0 copay, Physicals $0 copay"											152.7993778	142.3925914	52.47872726	0	60	0.2	0.2	46.98344828	161.3287872	27.65884581	78.79548061	175	0.2	41.80698149	0.137897727	0.172566128	34.75524213	33.09038323	4.503139063	0	0.2	0	0	0	35	35	0	35	0	10.52770449											NO	135.5087534	126.2795885	46.54028708	0	53.21046013	0.1773682	0.1773682	41.66684836	143.0729833	24.52899854	69.879063	155.1971754	0.1773682	37.07614536	0.122293358	0.153038718	30.82237376	29.34590863	3.99356836	0	0.1773682	0	0	0	31.03943508	31.03943508	0	31.03943508	0	9.336399997												13.8864	1.019558237	2.175868013	0	0.451781119	1.631496078	1.280698966	0.787106353	3.289413413	1.116084882	2.721475731	0.30180359	0.061613793	1.165594782	3.127266571	16.58650053	0.725200242	1.420261099	0.416320409	0	4.657968438	0	0	0	0.349193645	0.80284832	0	0.602941026	0	0.26538717	0	0	0	0	0	0	0	0	0	0	58.8427	25	7.508206107	13.8864	1.019558237	2.175868013	0	0.451781119	1.631496078	1.280698966	0.787106353	3.289413413	1.116084882	2.721475731	0.30180359	0.061613793	1.165594782	3.127266571	16.58650053	0.725200242	1.420261099	0.416320409	0	4.657968438	0	0	0.26	0.349193645	0.80284832	0	0.602941026	0	0.26538717	0	0	0	0	0	0	0	0	0	0	59.1027	NO	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	$100 copay	20% coinsurance	20% coinsurance	(4a) $50/visit; waive if admitted; (4b) $35/visit	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	not covered	"(16a) $0 copay, (16b) not covered"	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	not covered	not covered												5.2604	0.1612	0.5293	0	0.0627	0.2265	0.1778	0.2362	0.8237	0.0631	0.3125	0.041	0.0079	0.269	0.6297	2.8285	0.0702	0.2037	0.8031	0.1442	0.6466	0	0	0	0.0216	0	0	0.0286	0	0.0768											13.6241	0	0	19.1467	1.18072238	2.705197565	0	0.514499176	1.857986869	1.458490704	1.023282459	4.113071311	1.179183193	3.033970261	0.342833402	0.069487955	1.434630289	3.756921065	19.41501271	0.795396952	1.623965529	1.219375099	0.144166947	5.304606192	0	0	0.26	0.370793645	0.80284832	0	0.631541026	0	0.34218717	0	0	0	0	0	0	0	0	0	0	72.7269
H5302_809_0	2010	2	N/A																															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																																																			0	NO	244.3518658	6.375571357	23.91867764		5.967046252	11.02567404	10.92041003	10.39289439	33.6673199	2.62275222	12.49559147	1.712580037	0.487586518	16.12897624	29.09470959	120.6555963	3.859642551	4.747143645	36.23683677	16.1969882	28.4496423																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.080574241	0.080574241	0.177314786		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.080574241	0.080574241	0.177314786		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.6885	0.513706824	4.24113521	0	1.390321777	2.568982051	2.544455537	2.421544394	7.844485536	0.611101267	2.911472812	0.399031149	0.113607659	3.758051463	6.779067335	28.11275394	0.899296714	1.106084469	8.443182968	3.773898251	6.628766655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7494	0	0	19.6885	0.513706824	4.24113521	0	1.390321777	2.568982051	2.544455537	2.421544394	7.844485536	0.611101267	2.911472812	0.399031149	0.113607659	3.758051463	6.779067335	28.11275394	0.899296714	1.106084469	8.443182968	3.773898251	6.628766655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7494	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.056	0.0536	0.4429		0.1723	0.3005	0.2976	0.4342	1.413	0.1097	0.5233	0.0705	0.0194	0.6737	0.7929	3.288	0.0605	0.1294	0.9875	0.4414	0.7753																				13.0415	0	0	21.7444	0.567351751	4.684026288	0	1.562657389	2.869447788	2.842052675	2.855729693	9.257466391	0.720788183	3.434731366	0.469485214	0.132990912	4.431799718	7.571940708	31.40079533	0.959788217	1.235451074	9.430689748	4.215289859	7.404061001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.791
H5302_810_0	2010	2	N/A																															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																																																			0	NO	244.3518658	6.375571357	23.91867764		5.967046252	11.02567404	10.92041003	10.39289439	33.6673199	2.62275222	12.49559147	1.712580037	0.487586518	16.12897624	29.09470959	120.6555963	3.859642551	4.747143645	36.23683677	16.1969882	28.4496423																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.080574241	0.080574241	0.177314786		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.080574241	0.080574241	0.177314786		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.6885	0.513706824	4.24113521	0	1.390321777	2.568982051	2.544455537	2.421544394	7.844485536	0.611101267	2.911472812	0.399031149	0.113607659	3.758051463	6.779067335	28.11275394	0.899296714	1.106084469	8.443182968	3.773898251	6.628766655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7494	0	0	19.6885	0.513706824	4.24113521	0	1.390321777	2.568982051	2.544455537	2.421544394	7.844485536	0.611101267	2.911472812	0.399031149	0.113607659	3.758051463	6.779067335	28.11275394	0.899296714	1.106084469	8.443182968	3.773898251	6.628766655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7494	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.056	0.0536	0.4429		0.1723	0.3005	0.2976	0.4342	1.413	0.1097	0.5233	0.0705	0.0194	0.6737	0.7929	3.288	0.0605	0.1294	0.9875	0.4414	0.7753																				13.0415	0	0	21.7444	0.567351751	4.684026288	0	1.562657389	2.869447788	2.842052675	2.855729693	9.257466391	0.720788183	3.434731366	0.469485214	0.132990912	4.431799718	7.571940708	31.40079533	0.959788217	1.235451074	9.430689748	4.215289859	7.404061001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.791
H5302_811_0	2010	2	N/A																															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																																																			0	NO	244.3518658	6.375571357	23.91867764		5.967046252	11.02567404	10.92041003	10.39289439	33.6673199	2.62275222	12.49559147	1.712580037	0.487586518	16.12897624	29.09470959	120.6555963	3.859642551	4.747143645	36.23683677	16.1969882	28.4496423																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.080574241	0.080574241	0.177314786		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.080574241	0.080574241	0.177314786		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.6885	0.513706824	4.24113521	0	1.390321777	2.568982051	2.544455537	2.421544394	7.844485536	0.611101267	2.911472812	0.399031149	0.113607659	3.758051463	6.779067335	28.11275394	0.899296714	1.106084469	8.443182968	3.773898251	6.628766655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7494	0	0	19.6885	0.513706824	4.24113521	0	1.390321777	2.568982051	2.544455537	2.421544394	7.844485536	0.611101267	2.911472812	0.399031149	0.113607659	3.758051463	6.779067335	28.11275394	0.899296714	1.106084469	8.443182968	3.773898251	6.628766655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7494	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.056	0.0536	0.4429		0.1723	0.3005	0.2976	0.4342	1.413	0.1097	0.5233	0.0705	0.0194	0.6737	0.7929	3.288	0.0605	0.1294	0.9875	0.4414	0.7753																				13.0415	0	0	21.7444	0.567351751	4.684026288	0	1.562657389	2.869447788	2.842052675	2.855729693	9.257466391	0.720788183	3.434731366	0.469485214	0.132990912	4.431799718	7.571940708	31.40079533	0.959788217	1.235451074	9.430689748	4.215289859	7.404061001	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.791
H5304_801_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	293.0048645	3.508236732	27.58114613	6.019904053	4.875979653	10.44205911	1.899318177	9.758389565	39.10678855	5.741932728	17.99025907	0	0.195259298	24.12145704	47.95284003	138.6270773	1.449277277	6.911408811	36.34573801	43.16825157	62.87681665	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.072583237	0.072583237	0.157659786	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.072583237	0.072583237	0.157659786	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				21.2672	0.254639178	4.348437589	0	1.136103259	2.432999772	0.442541135	2.273704769	9.111881733	1.337870326	4.191730363	0	0.045495416	5.620299491	11.17301173	32.30010901	0.337681605	1.610358253	8.468556957	10.05820262	14.65029828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.0612			21.2672	0.254639178	4.348437589	0	1.136103259	2.432999772	0.442541135	2.273704769	9.111881733	1.337870326	4.191730363	0	0.045495416	5.620299491	11.17301173	32.30010901	0.337681605	1.610358253	8.468556957	10.05820262	14.65029828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.0612	NO																																																																																		0			21.2672	0.254639178	4.348437589	0	1.136103259	2.432999772	0.442541135	2.273704769	9.111881733	1.337870326	4.191730363	0	0.045495416	5.620299491	11.17301173	32.30010901	0.337681605	1.610358253	8.468556957	10.05820262	14.65029828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.0612
H5304_802_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	517.8666195	6.200575201	49.30752691	11.52244544	8.829181457	18.40342461	3.190144094	15.62730639	69.8535678	9.605328058	30.09480403	0	0.326637337	40.35131011	89.89372768	259.8741749	2.716855493	12.95631919	68.1347314	80.92440507	113.8362872	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.08309771	0.08309771	0.177896739	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.08309771	0.08309771	0.177896739	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				43.0335	0.515253601	8.771648267	0	2.057199279	4.287997935	0.743303574	3.64116239	16.2758813	2.238041438	7.012089339	0	0.076106499	9.401855255	20.94523855	60.55068275	0.63302733	3.018822371	15.87539242	18.85538638	26.52385493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	244.4565			43.0335	0.515253601	8.771648267	0	2.057199279	4.287997935	0.743303574	3.64116239	16.2758813	2.238041438	7.012089339	0	0.076106499	9.401855255	20.94523855	60.55068275	0.63302733	3.018822371	15.87539242	18.85538638	26.52385493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	244.4565	NO																																																																																		0			43.0335	0.515253601	8.771648267	0	2.057199279	4.287997935	0.743303574	3.64116239	16.2758813	2.238041438	7.012089339	0	0.076106499	9.401855255	20.94523855	60.55068275	0.63302733	3.018822371	15.87539242	18.85538638	26.52385493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	244.4565
H5378_004_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1779.940686	51.6053269	1053.507469	3637.05494	248.6188506	16.97688275	1.023023183	226.30832	338.1752918	798.3928352	18.75558064	0	36.4932964	1298.646302	4358.565398	16225.2122	1.320763281	1753.207414	30.53645889	17019.31918	10.51991236	0	0	0	1011.096061	0	229.4591911	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.70004084	112.5	0	0.2	0	0	4.843257638	8.857336155	8.040467755	0.5	0	0.035462276	0	0.2	0	0	0	20	0	20	0	0	0											NO	100.3695374	64.9971274	22.78534876	0	136.2090461	0.181612061	0.181612061	45.13063436	102.1567846	0	0.181612061	0	0	4.397970019	8.042995391	7.30122962	0.454030154	0	0.032201885	0	0.181612061	0	0	0	18.16120615	0	18.16120615	0	0	0												14.8877	0.279516501	2.000377925	0	2.822011373	3.083206673	0.185793349	0.851119837	2.87890837	0	3.406239664	0	0	0.475950625	2.921326784	9.871999995	0.599666355	0	0.983331545	0	1.91054297	0	0	0	1.530226999	0	0.347271306	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0351	0	6.193618454	14.8877	0.279516501	2.000377925	0	2.822011373	3.083206673	0.185793349	0.851119837	2.87890837	0	3.406239664	0	0	0.475950625	2.921326784	9.871999995	0.599666355	0	0.983331545	0	1.91054297	0	0	0	1.530226999	0	0.347271306	0	0	0	0	0	0	0	0	0	0	0	0	0	49.0351	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.5792	0.0372	0.7023	2.7828	0.4393	0.9207	0.056	0.2256	1.9367	0.1961	0.9528	0	0.0733	2.7428	1.1624	5.6375	0.1521	0.2173	1.536	1.7084	0.4855	0	0	0	0.2515	0	0.013	0	0	0											25.8083	0	0	18.4668	0.316723059	2.702629164	2.78280559	3.261308965	4.003891692	0.241832468	1.076728831	4.815560697	0.196106578	4.359012422	0	0.073315744	3.218703195	4.083769177	15.50947291	0.751801498	0.217256515	2.519333865	1.70835498	2.396068737	0	0	0	1.781739197	0	0.360227796	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8435
H5378_005_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1554.449998	44.70140661	1331.004118	4323.939238	239.5803043	18.00105368	1.088925151	245.5511437	361.6571478	631.1661144	13.04778735	0	41.7461087	1433.051745	4321.113323	16170.54818	1.415346035	2049.974982	34.99456583	19264.43983	8.696312312	0	0	0	986.5547261	0	223.319916	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.69213709	112.5	0	0.2	0	0	4.61947865	8.690886784	8.108801501	0.5	0	0.033247309	0	0.2	0	0	0	20	0	20	0	0	0											NO	99.53001548	64.45347128	22.59476505	0	135.0697514	0.180093002	0.180093002	44.7460307	101.3023136	0	0.180093002	0	0	4.159678887	7.825839451	7.301692021	0.450232505	0	0.029938038	0	0.180093002	0	0	0	18.00930019	0	18.00930019	0	0	0												12.8929	0.240096736	2.506143777	0	2.696671012	3.241863794	0.196107799	0.915619918	3.053058816	0	2.349815192	0	0	0.496752924	2.81802826	9.839363554	0.637234791	0	1.047668644	0	1.56614499	0	0	0	1.480596685	0	0.33515295	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3132	0	6.383885247	12.8929	0.240096736	2.506143777	0	2.696671012	3.241863794	0.196107799	0.915619918	3.053058816	0	2.349815192	0	0	0.496752924	2.81802826	9.839363554	0.637234791	0	1.047668644	0	1.56614499	0	0	0	1.480596685	0	0.33515295	0	0	0	0	0	0	0	0	0	0	0	0	0	46.3132	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.3345	0.0345	0.8796	2.89	0.4159	0.8713	0.0532	0.2435	1.7802	0.13	0.7016	0	0.0715	2.6056	1.1382	5.7226	0.173	0.2487	1.7512	1.9335	0.4251	0	0	0	0.2394	0	0.0123	0	0	0											25.6555	0	0	16.2274	0.274643385	3.385772429	2.889993724	3.112530958	4.113152772	0.249342466	1.159091294	4.833304504	0.130014649	3.05142821	0	0.071548718	3.102386824	3.956185027	15.56197733	0.810216089	0.248714145	2.79884376	1.933534155	1.991284667	0	0	0	1.719946954	0	0.347425005	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9687
H5378_010_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1655.59178	48.91637148	942.1575929	3337.975575	228.8814218	15.65843313	0.917372578	203.9946688	305.3246219	752.9683407	16.83985316	0	32.3966432	1151.824726	4079.971029	14901.01829	1.203401077	1598.717884	27.51484067	16041.31517	9.394592315	0	0	0	875.1199854	0	203.0295106	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.68987736	112.5	0	0.2	0	0	4.850148002	0	8.25007532	0.5	0	0.035682009	0	0.2	0	0	0	20	0	20	0	0	0											NO	109.5207671	70.92326453	21.75495994	0	130.0494617	0.173399282	0.173399282	43.08094535	97.53709629	0	0.173399282	0	0	4.205060913	0	7.152785696	0.433498206	0	0.030936174	0	0.173399282	0	0	0	17.33992823	0	17.33992823	0	0	0												15.1101	0.289109063	1.708050058	0	2.480492141	2.715161067	0.159071747	0.732356932	2.48170642	0	2.920018452	0	0	0.403624428	0	8.88198254	0.521672208	0	0.851203892	0	1.629015565	0	0	0	1.264543145	0	0.293376429	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4415	0	6.496725293	15.1101	0.289109063	1.708050058	0	2.480492141	2.715161067	0.159071747	0.732356932	2.48170642	0	2.920018452	0	0	0.403624428	0	8.88198254	0.521672208	0	0.851203892	0	1.629015565	0	0	0	1.264543145	0	0.293376429	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4415	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	6.4188	0.1228	0.7256	0	1.0537	1.2816	0.0751	0.3106	1.0542	0	1.2092	0	0	0.1715	1.0527	3.5888	0.2071	0	0.3526	0	0.6481	0	0	0	0.5372	0	0.1246	0	0	0											18.9341	0	2.78431084	21.5289	0.411922969	2.433631947	0	3.534208433	3.996721019	0.234153841	1.042998282	3.53593854	0	4.129208254	0	0	0.575084611	1.052699545	12.47073351	0.728781585	0	1.203843237	0	2.277070595	0	0	0	1.80172272	0	0.418003117	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3757
H5378_011_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1437.266698	42.23532098	1209.677544	4000.94668	220.1300582	16.57217191	0.973409975	222.49627	327.8862126	575.7341139	11.59899591	0	37.45660082	1280.877586	4034.350621	14841.06088	1.300493733	1884.976257	31.57759974	18289.77678	7.774740479	0	0	0	850.497312	0	196.9573935	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.68928667	112.5	0	0.2	0	0	4.607727472	0	8.308686817	0.5	0	0.033453937	0	0.2	0	0	0	20	0	20	0	0	0											NO	108.7292901	70.41072128	21.59774273	0	129.1096294	0.172146173	0.172146173	42.76910259	96.83222207	0	0.172146173	0	0	3.966013243	0	7.151543173	0.430365431	0	0.028794836	0	0.172146173	0	0	0	17.21461726	0	17.21461726	0	0	0												13.0227	0.247818284	2.177192032	0	2.368409187	2.852835965	0.167568802	0.79299715	2.645829213	0	1.996722752	0	0	0.423331456	0	8.844707299	0.559687546	0	0.909271799	0	1.338391816	0	0	0	1.220082142	0	0.282545512	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8501	0	6.43069473	13.0227	0.247818284	2.177192032	0	2.368409187	2.852835965	0.167568802	0.79299715	2.645829213	0	1.996722752	0	0	0.423331456	0	8.844707299	0.559687546	0	0.909271799	0	1.338391816	0	0	0	1.220082142	0	0.282545512	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8501	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	5.4815	0.1043	0.9164	0	0.9969	1.2008	0.0705	0.3338	1.1137	0	0.876	0	0	0.1782	1.0042	3.5479	0.2356	0	0.3994	0	0.5634	0	0	0	0.5136	0	0.1189	0	0	0											17.655	0	2.756012027	18.5042	0.35212902	3.093607472	0	3.365311027	4.053640894	0.238101228	1.126782512	3.759501642	0	2.87273199	0	0	0.601518532	1.004226821	12.39257551	0.795269113	0	1.308690867	0	1.90174264	0	0	0	1.733634505	0	0.401473501	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5052
H5378_016_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1545.661822	45.03198213	921.4389963	3179.516476	217.3296006	14.8397555	0.894729954	197.9081355	292.4919647	698.6157479	16.5714048	0	31.56066931	1117.724661	3798.811038	14039.96528	1.154775946	1430.715566	26.91510559	14783.25658	9.201342455	0	0	0	884.8882308	0	200.7346988	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.7002366	195	0	0.2	0	0	11.38929399	8.866303737	10.40732233	0.5	0	0.035547113	0	0.2	0	0	0	20	0	20	0	0	0											NO	153.785327	99.58802988	20.36504867	0	121.74068	0.162320907	0.162320907	40.33693734	158.262884	0	0.162320907	0	0	9.243602639	7.195932308	8.446629983	0.405802267	0	0.028850198	0	0.162320907	0	0	0	16.23209067	0	16.23209067	0	0	0												19.8083	0.373720532	1.563762501	0	2.204821114	2.408802568	0.145233377	0.665250672	3.857551825	0	2.689885453	0	0	0.860983552	2.277998924	9.882532644	0.468610696	0	0.776506131	0	1.49357025	0	0	0	1.1969655	0	0.271528653	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9461	0	11.73143565	19.8083	0.373720532	1.563762501	0	2.204821114	2.408802568	0.145233377	0.665250672	3.857551825	0	2.689885453	0	0	0.860983552	2.277998924	9.882532644	0.468610696	0	0.776506131	0	1.49357025	0	0	0	1.1969655	0	0.271528653	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9461	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	8.4131	0.1587	0.6642	0	0.9364	1.1368	0.0685	0.2821	1.6384	0	1.0786	0	0	0.3657	1.8791	4.0943	0.186	0	0.3114	0	0.5939	0	0	0	0.5084	0	0.1153	0	0	0											22.4308	0	5.027758134	28.2214	0.532448479	2.227929412	0	3.141260777	3.545553023	0.21377121	0.947363311	5.495945302	0	3.76844578	0	0	1.226663626	4.157056094	13.97681861	0.654620083	0	1.087908223	0	2.087426357	0	0	0	1.705345051	0	0.386853292	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3768
H5378_017_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1350.12417	39.01021295	1163.784408	3779.37099	209.436052	15.73553213	0.952423464	214.7140992	312.7447428	552.5889897	11.52755598	0	36.08379097	1232.223793	3765.516951	13985.4246	1.237264695	1670.479807	30.84757002	16725.49183	7.606142386	0	0	0	863.4740908	0	195.375834	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.69219244	195	0	0.2	0	0	10.87190708	8.701860704	10.49867185	0.5	0	0.033323603	0	0.2	0	0	0	20	0	20	0	0	0											NO	152.0798652	98.48360994	20.13920259	0	120.3905897	0.160520786	0.160520786	39.88314901	156.5077666	0	0.160520786	0	0	8.725835363	6.984147611	8.426275303	0.401301966	0	0.026745655	0	0.160520786	0	0	0	16.05207863	0	16.05207863	0	0	0												17.1106	0.32015555	1.95314083	0	2.101177484	2.525879991	0.152883763	0.713622868	4.078915101	0	1.850412349	0	0	0.896015162	2.191577185	9.820419825	0.496516754	0	0.825038453	0	1.220943956	0	0	0	1.155046167	0	0.261349021	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6737	0	11.60843352	17.1106	0.32015555	1.95314083	0	2.101177484	2.525879991	0.152883763	0.713622868	4.078915101	0	1.850412349	0	0	0.896015162	2.191577185	9.820419825	0.496516754	0	0.825038453	0	1.220943956	0	0	0	1.155046167	0	0.261349021	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6737	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	7.1973	0.1347	0.8216	0	0.8838	1.0625	0.0643	0.3002	1.7157	0	0.7861	0	0	0.3769	1.7907	4.0333	0.2089	0	0.3506	0	0.5136	0	0	0	0.4859	0	0.1099	0	0	0											20.8359	0	4.975042936	24.3079	0.454824135	2.774699952	0	2.985005983	3.58835317	0.217192004	1.013797524	5.794648988	0	2.636466004	0	0	1.272910375	3.982325046	13.85373682	0.70536901	0	1.175666945	0	1.734515548	0	0	0	1.64089885	0	0.37128153	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5095
H5378_061_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1159.413927	31.46265458	1260.244351	1428.212949	142.3931297	11.01088014	0.749031101	200.6947051	323.834981	1129.31842	17.23977045	0	38.72969433	1774.201099	3649.989096	12090.40536	0.935071657	1394.246794	19.42725271	13715.07248	11.08821528	0	0	0	895.074057	0	193.2445905	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.80625695	112.5	0	0.2	0	0	4.913596556	8.821639428	8.835225158	0.5	0	0.033280085	0	0.2	0	0	0	20	0	20	0	0	0											NO	95.85297025	62.07229684	21.76002215	0	130.0797232	0.173439631	0.173439631	43.19189412	97.55979241	0	0.173439631	0	0	4.261061867	7.650109434	7.661890954	0.433599077	0	0.028860429	0	0.173439631	0	0	0	17.3439631	0	17.3439631	0	0	0												9.2611	0.162746603	2.285245417	0	1.543538242	1.909722989	0.129911678	0.722365371	2.632772793	0	2.990059425	0	0	0.629998387	2.326901335	7.719613958	0.405446208	0	0.560678842	0	1.923135967	0	0	0	1.293677618	0	0.279302254	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7762	0	7.01811471	9.2611	0.162746603	2.285245417	0	1.543538242	1.909722989	0.129911678	0.722365371	2.632772793	0	2.990059425	0	0	0.629998387	2.326901335	7.719613958	0.405446208	0	0.560678842	0	1.923135967	0	0	0	1.293677618	0	0.279302254	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7762	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.0065	0.0302	0.847	1.0624	0.2888	0.6029	0.0414	0.2019	1.8236	0.2755	0.9389	0	0.1088	4.1458	0.9424	4.3819	0.1162	0.1656	0.9888	1.3028	0.5511	0	0	0	0.219	0	0.0103	0	0	0											22.0517	0	0	12.2676	0.192948214	3.132265627	1.062402516	1.832290083	2.512642723	0.171274166	0.924280159	4.456347664	0.275533056	3.928991069	0	0.108804241	4.7758353	3.269303475	12.10146611	0.521626968	0.165585195	1.549463613	1.302794702	2.474211286	0	0	0	1.512641752	0	0.289607329	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8279
H5378_092_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1078.08788	30.51681218	1170.515194	1176.956219	127.7416878	9.922117832	0.635124846	182.0765465	297.5583039	1121.426104	15.80463687	0	35.02893126	1653.879953	3338.449857	10996.89274	0.85482254	1276.469571	17.49655151	12786.78673	10.18965154	0	0	0	750.2271	0	167.6019278	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.81581693	112.5	0	0.2	0	0	4.929093979	0	9.014000935	0.5	0	0.033632826	0	0.2	0	0	0	20	0	20	0	0	0											NO	103.4078441	66.96466866	20.5407026	0	122.7907256	0.163720967	0.163720967	40.77946871	92.0930442	0	0.163720967	0	0	4.034980175	0	7.378904769	0.409302419	0	0.027531994	0	0.163720967	0	0	0	16.37209675	0	16.37209675	0	0	0												9.2902	0.170295685	2.003600374	0	1.307124544	1.624458731	0.103983254	0.618748736	2.283587503	0	2.587550438	0	0	0.556114402	0	6.762085355	0.349880933	0	0.48171495	0	1.668259608	0	0	0	1.023565889	0	0.228666248	0	0	0	0	0	0	0	0	0	0	0	0	0	31.0599	0	6.858604599	9.2902	0.170295685	2.003600374	0	1.307124544	1.624458731	0.103983254	0.618748736	2.283587503	0	2.587550438	0	0	0.556114402	0	6.762085355	0.349880933	0	0.48171495	0	1.668259608	0	0	0	1.023565889	0	0.228666248	0	0	0	0	0	0	0	0	0	0	0	0	0	31.0599	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	4.0042	0.0734	0.8636	0	0.5634	0.7779	0.0498	0.2667	0.9842	0	1.1614	0	0	0.2397	0.8266	2.7842	0.1508	0	0.216	0	0.719	0	0	0	0.4412	0	0.0986	0	0	0											14.2207	0	2.939401971	13.2944	0.243694365	2.867166732	0	1.870504746	2.402407118	0.153780521	0.885433949	3.267830354	0	3.748949927	0	0	0.795803761	0.826606759	9.546300348	0.500682164	0	0.69775958	0	2.387291654	0	0	0	1.464730244	0	0.327223067	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2806
H5378_154_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1001.240484	27.22386196	1099.285495	1253.363859	124.4348281	9.619978021	0.656427519	175.2807843	279.7963674	985.6183751	15.19193401	0	33.51571119	1529.13362	3184.326777	10469.37262	0.816335294	1144.725096	17.09300435	11913.53726	9.677071018	0	0	0	784.8565275	0	169.16421	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.80575482	195	0	0.2	0	0	11.50293031	8.828914542	11.43214605	0.5	0	0.033336325	0	0.2	0	0	0	20	0	20	0	0	0											NO	141.0183047	91.3203842	18.67437353	0	111.6339553	0.148845274	0.148845274	37.06675603	145.1241418	0	0.148845274	0	0	8.560784052	6.570711007	8.508104536	0.372113184	0	0.024809772	0	0.148845274	0	0	0	14.88452737	0	14.88452737	0	0	0												11.7661	0.207174461	1.710705662	0	1.157596003	1.431888261	0.097706134	0.541424172	3.383767309	0	2.261247576	0	0	1.090881892	1.743607584	7.422876393	0.303769126	0	0.424073544	0	1.440386284	0	0	0	0.973518205	0	0.209827443	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1666	0	12.32424089	11.7661	0.207174461	1.710705662	0	1.157596003	1.431888261	0.097706134	0.541424172	3.383767309	0	2.261247576	0	0	1.090881892	1.743607584	7.422876393	0.303769126	0	0.424073544	0	1.440386284	0	0	0	0.973518205	0	0.209827443	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1666	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	5.08	0.0894	0.7386	0	0.4998	0.6869	0.0469	0.2338	1.461	0	0.9856	0	0	0.471	1.4685	3.1365	0.1312	0	0.1848	0	0.6219	0	0	0	0.4203	0	0.0906	0	0	0											16.3466	0	5.281817524	16.8462	0.29662265	2.449307909	0	1.657391513	2.118801602	0.14457826	0.775185666	4.844718888	0	3.246799429	0	0	1.561873387	3.212085888	10.55935911	0.434922347	0	0.608854497	0	2.062277337	0	0	0	1.39383758	0	0.300421064	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5132
H5378_175_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1507.052779	43.41859209	1038.313404	3422.419012	182.8333305	14.22605045	0.878192155	206.3486763	364.6154629	784.3232872	13.44106808	0	30.08087464	1054.320056	3861.95816	13620.4885	1.067952717	1546.983449	24.01873461	14521.71438	5.97436958	0	0	0	900.7760579	0	203.4117158	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.67660238	112.5	0	0.2	0	0	5.802457033	8.853243718	8.469033167	0.5	0	0.034106617	0	0.2	0	0	0	20	0	20	0	0	0											NO	96.13503362	62.25495494	21.82405465	0	130.4625045	0.173950006	0.173950006	43.20622642	97.84687839	0	0.173950006	0	0	5.046687179	7.70010899	7.365941852	0.434875015	0	0.029664231	0	0.173950006	0	0	0	17.3950006	0	17.3950006	0	0	0												12.0734	0.225251875	1.888350707	0	1.987741184	2.474621561	0.152761531	0.742962302	2.973040405	0	2.338073873	0	0	0.443401959	2.478124896	8.360643858	0.464425954	0	0.712497289	0	1.039241624	0	0	0	1.305750006	0	0.294862243	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9551	0	7.456728239	12.0734	0.225251875	1.888350707	0	1.987741184	2.474621561	0.152761531	0.742962302	2.973040405	0	2.338073873	0	0	0.443401959	2.478124896	8.360643858	0.464425954	0	0.712497289	0	1.039241624	0	0	0	1.305750006	0	0.294862243	0	0	0	0	0	0	0	0	0	0	0	0	0	39.9551	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.7072	0.0385	0.7585	2.4139	0.3912	0.8204	0.0511	0.2256	2.067	0.1894	0.788	0	0.0504	2.0247	1.094	5.4211	0.1422	0.2032	1.3437	1.6096	0.3184	0	0	0	0.2385	0	0.0122	0	0	0											23.9087	0	0	15.7806	0.263784482	2.646856729	2.413886882	2.378955451	3.294995825	0.203899135	0.96858127	5.040001845	0.189415558	3.126031559	0	0.050369887	2.468116833	3.572125514	13.78175965	0.606629974	0.203219115	2.056193632	1.609605708	1.357623174	0	0	0	1.54421726	0	0.307034963	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8639
H5378_176_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1176.248671	32.44004405	1122.319988	2369.4255	174.3661702	14.34387622	0.923747729	214.1647923	314.3338835	827.1632696	12.61746069	0	34.62408855	1244.948382	3827.064787	13387.3131	1.127438867	1619.706959	26.11786116	15923.78488	7.831624146	0	0	0	912.2136474	0	200.469232	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.78155665	112.5	0	0.2	0	0	5.015210174	8.75871275	8.495263683	0.5	0	0.033819159	0	0.2	0	0	0	20	0	20	0	0	0											NO	96.17396325	62.28016492	21.83289225	0	130.515335	0.174020447	0.174020447	43.31504361	97.88650122	0	0.174020447	0	0	4.363745572	7.620975523	7.391747901	0.435051117	0	0.029426126	0	0.174020447	0	0	0	17.40204466	0	17.40204466	0	0	0												9.427	0.168364274	2.041957613	0	1.896454926	2.496127747	0.160750992	0.773046443	2.564087006	0	2.195696145	0	0	0.452719832	2.430497255	8.246303627	0.490493538	0	0.768547477	0	1.362862732	0	0	0	1.322865219	0	0.290714544	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0885	0	6.900632281	9.427	0.168364274	2.041957613	0	1.896454926	2.496127747	0.160750992	0.773046443	2.564087006	0	2.195696145	0	0	0.452719832	2.430497255	8.246303627	0.490493538	0	0.768547477	0	1.362862732	0	0	0	1.322865219	0	0.290714544	0	0	0	0	0	0	0	0	0	0	0	0	0	37.0885	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													2.9034	0.0293	0.7729	1.7276	0.3478	0.7277	0.0473	0.221	1.7295	0.1944	0.6821	0	0.0664	2.5039	1.0238	4.9713	0.1395	0.2003	1.346	1.5663	0.3881	0	0	0	0.2291	0	0.0111	0	0	0											21.8288	0	0	12.3304	0.197684847	2.814843732	1.727622687	2.244224972	3.223804123	0.208045793	0.994035718	4.293597258	0.194377096	2.877806026	0	0.066398857	2.956586455	3.454337044	13.21760662	0.63003375	0.200348251	2.114594694	1.566253738	1.751010841	0	0	0	1.551918321	0	0.301845324	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9174
H5378_177_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1144.813748	31.52335865	1104.673538	1841.712959	208.1214026	15.63141089	0.981774607	209.628117	276.2070837	1126.593188	14.11785461	0	30.82233644	1211.430006	3732.552095	12840.17867	1.032337686	1409.095053	22.28384003	13971.56508	7.918648082	0	0	0	900.2820566	0	197.8030067	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.76559853	112.5	0	0.2	0	0	5.768102563	8.860666826	8.55566601	0.5	0	0.033053902	0	0.2	0	0	0	20	0	20	0	0	0											NO	94.65902252	61.29912228	21.48897861	0	128.4594459	0.171279261	0.171279261	42.61907475	96.34458445	0	0.171279261	0	0	4.939781728	7.58824234	7.327040768	0.428198153	0	0.028307239	0	0.171279261	0	0	0	17.12792612	0	17.12792612	0	0	0												9.0306	0.161029518	1.978192169	0	2.227930005	2.677336509	0.168157629	0.744513033	2.217588059	0	2.418095709	0	0	0.498683318	2.360292487	7.840042714	0.44204509	0	0.630793992	0	1.356300194	0	0	0	1.284997046	0	0.282329607	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3189	0	7.610027553	9.0306	0.161029518	1.978192169	0	2.227930005	2.677336509	0.168157629	0.744513033	2.217588059	0	2.418095709	0	0	0.498683318	2.360292487	7.840042714	0.44204509	0	0.630793992	0	1.356300194	0	0	0	1.284997046	0	0.282329607	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3189	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													2.942	0.0297	0.7851	1.6124	0.3801	0.7947	0.0504	0.2232	1.5843	0.2831	0.7874	0	0.0619	2.4519	1.0691	5.1071	0.1315	0.1875	1.1551	1.4601	0.404	0	0	0	0.244	0	0.0119	0	0	0											21.7566	0	0	11.9726	0.190724025	2.763297539	1.612436009	2.607987307	3.472039297	0.218547905	0.967715594	3.801886479	0.283108545	3.205479883	0	0.061908798	2.950578515	3.429423301	12.94717253	0.573555088	0.187461828	1.785890287	1.460146815	1.760302062	0	0	0	1.52903125	0	0.29418466	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0755
H5378_178_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1277.595138	35.80357544	1179.460818	1843.434262	195.839666	14.51987576	0.911092568	230.4855475	379.4580982	1177.279051	15.22427473	0	35.38177849	1438.251	3874.792879	13506.90858	1.080689091	1524.064308	23.49485052	14521.69269	8.857378228	0	0	0	921.5793503	0	204.4997137	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.75648841	112.5	0	0.2	0	0	5.153004156	8.841423426	8.502207869	0.5	0	0.033545339	0	0.2	0	0	0	20	0	20	0	0	0											NO	94.87595065	61.43960022	21.53822446	0	128.7538338	0.171671778	0.171671778	42.70892426	96.56537535	0	0.171671778	0	0	4.423126937	7.589114416	7.297945726	0.429179446	0	0.02879394	0	0.171671778	0	0	0	17.16717784	0	17.16717784	0	0	0												10.1011	0.183313113	2.116957653	0	2.101258984	2.492652895	0.156408881	0.820315816	3.053542807	0	2.613578317	0	0	0.530130562	2.450520541	8.214390479	0.463809545	0	0.676509313	0	1.520561872	0	0	0	1.318409717	0	0.292556913	0	0	0	0	0	0	0	0	0	0	0	0	0	39.106	0	8.05231868	10.1011	0.183313113	2.116957653	0	2.101258984	2.492652895	0.156408881	0.820315816	3.053542807	0	2.613578317	0	0	0.530130562	2.450520541	8.214390479	0.463809545	0	0.676509313	0	1.520561872	0	0	0	1.318409717	0	0.292556913	0	0	0	0	0	0	0	0	0	0	0	0	0	39.106	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.1435	0.0321	0.8135	1.4696	0.3508	0.7337	0.0465	0.2386	1.921	0.2571	0.8424	0	0.0727	2.756	1.0645	5.2185	0.1359	0.194	1.2205	1.5108	0.4458	0	0	0	0.238	0	0.0118	0	0	0											22.7172	0	0	13.2445	0.215414837	2.93049851	1.469622058	2.452080663	3.226368912	0.202888361	1.058919289	4.974581908	0.257091921	3.456023095	0	0.072689667	3.286149112	3.514971598	13.43285779	0.59971237	0.193950076	1.897016904	1.51076703	1.966346174	0	0	0	1.556384829	0	0.304326569	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8232
H5378_179_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1442.024999	41.10214921	1403.220583	3302.448314	275.4548637	18.29467567	1.099048357	272.1030656	343.2267793	1432.688245	17.73815846	0	46.41487812	1898.860392	3982.150334	14713.62518	1.213588278	1802.243344	24.85308219	15441.627	10.09082199	0	0	0	924.1723988	0	206.987553	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.80325274	112.5	0	0.2	0	0	3.826718629	8.723298851	8.146468241	0.5	0	0.033656899	0	0.2	0	0	0	20	0	20	0	0	0											NO	99.07703177	64.16012889	22.49193114	0	134.4550183	0.179273358	0.179273358	44.64198172	100.8412637	0	0.179273358	0	0	3.430143489	7.819275378	7.302223576	0.448183394	0	0.030168926	0	0.179273358	0	0	0	17.92733577	0	17.92733577	0	0	0												11.906	0.219759933	2.63009506	0	3.086357396	3.279747937	0.197030089	1.01226834	2.884285181	0	3.179979227	0	0	0.542780301	2.594794171	8.953515056	0.543910114	0	0.749790805	0	1.809015541	0	0	0	1.380662409	0	0.309227947	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2792	0	6.520704435	11.906	0.219759933	2.63009506	0	3.086357396	3.279747937	0.197030089	1.01226834	2.884285181	0	3.179979227	0	0	0.542780301	2.594794171	8.953515056	0.543910114	0	0.749790805	0	1.809015541	0	0	0	1.380662409	0	0.309227947	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2792	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.476	0.036	0.9289	2.25	0.4239	0.8869	0.0538	0.2714	1.8257	0.3348	0.9528	0	0.1215	4.3212	1.0207	5.1565	0.1478	0.2119	1.2542	1.582	0.4917	0	0	0	0.2193	0	0.011	0	0	0											25.9782	0	0	15.382	0.255740347	3.558975605	2.250016496	3.510299449	4.166627266	0.250847847	1.283658393	4.709954127	0.334815555	4.132753055	0	0.121546927	4.86401681	3.615534326	14.11005999	0.691703083	0.211905521	2.003986626	1.582034256	2.300677573	0	0	0	1.600003914	0	0.320258483	0	0	0	0	0	0	0	0	0	0	0	0	0	71.2574
H5378_180_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1665.470591	47.73373491	1513.558058	2843.036107	236.1900038	16.7777302	1.027984516	251.8611826	365.5584454	1484.629251	19.83468621	0	40.23884636	1505.342206	4464.343383	15520.90742	1.267365044	1875.728955	26.2893008	15984.91737	10.71017216	0	0	0	1039.672242	0	233.9773922	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.69132321	112.5	0	0.2	0	0	5.008591857	8.803772344	8.615365116	0.5	0	0.033668001	0	0.2	0	0	0	20	0	20	0	0	0											NO	97.44299766	63.10196398	22.12098157	0	132.2375106	0.176316681	0.176316681	43.80704585	99.17813292	0	0.176316681	0	0	4.415491457	7.761259589	7.595162903	0.440791702	0	0.029681151	0	0.176316681	0	0	0	17.63166807	0	17.63166807	0	0	0												13.524	0.251007702	2.790115824	0	2.602764844	2.958193698	0.181250818	0.919441198	3.021283674	0	3.497186036	0	0	0.553902137	2.887410657	9.82365169	0.558643995	0	0.780296702	0	1.888382005	0	0	0	1.527596323	0	0.34378431	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1089	0	8.051182509	13.524	0.251007702	2.790115824	0	2.602764844	2.958193698	0.181250818	0.919441198	3.021283674	0	3.497186036	0	0	0.553902137	2.887410657	9.82365169	0.558643995	0	0.780296702	0	1.888382005	0	0	0	1.527596323	0	0.34378431	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1089	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													3.6446	0.0378	0.9497	1.7086	0.3686	0.7711	0.0477	0.237	1.9002	0.3386	1.0154	0	0.077	2.9371	1.0832	5.2195	0.1471	0.2107	1.2647	1.4817	0.4971	0	0	0	0.2352	0	0.0119	0	0	0											24.1845	0	0	17.1687	0.288802516	3.739790592	1.708575816	2.971324093	3.729317342	0.228964295	1.156400755	4.921501783	0.338567198	4.512619757	0	0.07697381	3.491026121	3.970604194	15.04313469	0.705704557	0.210709723	2.04504355	1.481717699	2.385490223	0	0	0	1.762840334	0	0.355718207	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2935
H5378_181_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1401.541912	41.24144571	935.4550132	3154.325962	166.7061027	13.00206579	0.775011124	186.2957929	333.4537613	745.8678009	12.02661806	0	26.45839599	925.0187631	3606.167708	12470.72482	0.97313049	1410.86316	21.78112453	13611.13831	5.217946243	0	0	0	776.8662325	0	179.5871269	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.67054588	112.5	0	0.2	0	0	5.912328337	0	8.701746948	0.5	0	0.034318293	0	0.2	0	0	0	20	0	20	0	0	0											NO	103.6913033	67.14823067	20.59700831	0	123.1273167	0.164169756	0.164169756	40.77200689	92.34548753	0	0.164169756	0	0	4.853127491	0	7.142818349	0.410424389	0	0.028170129	0	0.164169756	0	0	0	16.41697556	0	16.41697556	0	0	0												12.1106	0.230774176	1.605631223	0	1.710506259	2.134545963	0.127233387	0.632971113	2.566079179	0	1.974406948	0	0	0.374102832	0	7.423010173	0.399396487	0	0.613577091	0	0.85662896	0	0	0	1.062816163	0	0.24568979	0	0	0	0	0	0	0	0	0	0	0	0	0	34.068	0	7.411030699	12.1106	0.230774176	1.605631223	0	1.710506259	2.134545963	0.127233387	0.632971113	2.566079179	0	1.974406948	0	0	0.374102832	0	7.423010173	0.399396487	0	0.613577091	0	0.85662896	0	0	0	1.062816163	0	0.24568979	0	0	0	0	0	0	0	0	0	0	0	0	0	34.068	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	5.7614	0.1098	0.7638	0	0.8137	1.0944	0.0652	0.301	1.2208	0	0.9653	0	0	0.178	0.9866	3.3602	0.1873	0	0.3003	0	0.402	0	0	0	0.5056	0	0.1169	0	0	0											17.1323	0	3.176156014	17.872	0.340559594	2.369472735	0	2.524239617	3.228940511	0.192466709	0.933999649	3.78683135	0	2.93970711	0	0	0.552073508	0.986621052	10.78318118	0.586698166	0	0.913894304	0	1.258588412	0	0	0	1.568426102	0	0.362570962	0	0	0	0	0	0	0	0	0	0	0	0	0	51.2003
H5378_182_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1088.416313	31.13065667	1024.841631	2142.217231	159.9537698	13.20303209	0.810085888	195.2942502	286.7925549	785.4033413	11.19650063	0	30.84582546	1109.901514	3545.753398	12310.77981	1.04255818	1499.498816	23.64446819	15145.70368	6.970236956	0	0	0	775.5459936	0	175.7417138	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.78177197	112.5	0	0.2	0	0	5.048031489	0	8.664708504	0.5	0	0.034125218	0	0.2	0	0	0	20	0	20	0	0	0											NO	103.6841401	67.14359196	20.59558543	0	123.1188109	0.164158415	0.164158415	40.86048379	92.33910816	0	0.164158415	0	0	4.143384228	0	7.11192405	0.410396036	0	0.028009709	0	0.164158415	0	0	0	16.41584145	0	16.41584145	0	0	0												9.4043	0.174185342	1.758934446	0	1.641109828	2.167388814	0.132982415	0.664984795	2.206847395	0	1.837999791	0	0	0.383229035	0	7.296110919	0.427861745	0	0.662274668	0	1.144223047	0	0	0	1.060936672	0	0.240412343	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2038	0	6.78975333	9.4043	0.174185342	1.758934446	0	1.641109828	2.167388814	0.132982415	0.664984795	2.206847395	0	1.837999791	0	0	0.383229035	0	7.296110919	0.427861745	0	0.662274668	0	1.144223047	0	0	0	1.060936672	0	0.240412343	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2038	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	4.166	0.0772	0.7792	0	0.727	0.9653	0.0592	0.2944	0.9776	0	0.8233	0	0	0.1698	0.8957	3.0849	0.1843	0	0.2971	0	0.4934	0	0	0	0.47	0	0.1065	0	0	0											14.5709	0	2.909894284	13.5703	0.251347611	2.538123842	0	2.368104161	3.132720093	0.192211329	0.959384509	3.1844575	0	2.661336148	0	0	0.552995453	0.895652513	10.3810419	0.612129507	0	0.959421023	0	1.637592439	0	0	0	1.530920421	0	0.346912473	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7746
H5378_183_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1022.133705	28.79757556	1038.384799	1239.265988	144.3505265	12.04415825	0.758980202	193.8592999	274.5253207	1099.537818	13.08021285	0	31.37711405	1300.147075	3333.726218	10973.25414	0.895811211	1308.722261	16.78637987	13530.24751	7.288943047	0	0	0	747.7934103	0	166.9485727	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.83942509	112.5	0	0.2	0	0	4.868748265	0	9.037456859	0.5	0	0.033367971	0	0.2	0	0	0	20	0	20	0	0	0											NO	100.7772234	65.261136	20.01816201	0	119.6670185	0.159556025	0.159556025	39.76090269	89.75026387	0	0.159556025	0	0	3.884190591	0	7.209903447	0.398890062	0	0.026620304	0	0.159556025	0	0	0	15.95560246	0	15.95560246	0	0	0												8.584	0.156613541	1.732212927	0	1.439499761	1.92171801	0.121099864	0.642335063	2.053226664	0	2.087026765	0	0	0.420834919	0	6.593008572	0.357330189	0	0.446858531	0	1.162994776	0	0	0	0.994291198	0	0.221980422	0	0	0	0	0	0	0	0	0	0	0	0	0	28.935	0	7.314120989	8.584	0.156613541	1.732212927	0	1.439499761	1.92171801	0.121099864	0.642335063	2.053226664	0	2.087026765	0	0	0.420834919	0	6.593008572	0.357330189	0	0.446858531	0	1.162994776	0	0	0	0.994291198	0	0.221980422	0	0	0	0	0	0	0	0	0	0	0	0	0	28.935	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	3.8408	0.0701	0.775	0	0.6441	0.8598	0.0542	0.2872	0.9187	0	0.9405	0	0	0.1883	0.8329	2.8189	0.1547	0	0.2013	0	0.5042	0	0	0	0.4449	0	0.0993	0	0	0											13.6349	0	3.134623281	12.4247	0.226687639	2.507262498	0	2.083579743	2.781558446	0.175283963	0.929530715	2.971908438	0	3.027562769	0	0	0.609130434	0.832914374	9.411911982	0.512053225	0	0.648149121	0	1.667208081	0	0	0	1.43917009	0	0.321301832	0	0	0	0	0	0	0	0	0	0	0	0	0	42.57
H5378_184_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1067.078736	30.50998312	1012.139092	1617.906218	194.9936464	14.68868769	0.883785932	191.6824321	249.5842263	1121.312757	12.71015866	0	27.13861113	1081.452575	3464.755899	11815.71831	0.946489194	1293.598748	20.09863823	13147.20206	7.071047621	0	0	0	767.1979346	0	173.905685	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.76361789	112.5	0	0.2	0	0	5.904349117	0	8.734631518	0.5	0	0.033372726	0	0.2	0	0	0	20	0	20	0	0	0											NO	102.8047706	66.5741314	20.42090944	0	122.0746113	0.162766148	0.162766148	40.49916209	91.55595851	0	0.162766148	0	0	4.805140825	0	7.108511652	0.406915371	0	0.02715975	0	0.162766148	0	0	0	16.27661485	0	16.27661485	0	0	0												9.1417	0.169264635	1.722400061	0	1.9836478	2.390821121	0.143850432	0.646914824	1.904243589	0	2.068783571	0	0	0.433044326	0	6.999347607	0.385141002	0	0.545873994	0	1.150927187	0	0	0	1.040615441	0	0.235882988	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9625	0	7.07922511	9.1417	0.169264635	1.722400061	0	1.9836478	2.390821121	0.143850432	0.646914824	1.904243589	0	2.068783571	0	0	0.433044326	0	6.999347607	0.385141002	0	0.545873994	0	1.150927187	0	0	0	1.040615441	0	0.235882988	0	0	0	0	0	0	0	0	0	0	0	0	0	30.9625	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	4.2061	0.0779	0.7925	0	0.9127	1.0743	0.0646	0.2974	0.8761	0	0.9607	0	0	0.1992	0.9128	3.0703	0.1718	0	0.2536	0	0.5141	0	0	0	0.4788	0	0.1085	0	0	0											14.9716	0	3.033953619	13.3479	0.247143912	2.514882613	0	2.89633139	3.465134424	0.208489494	0.944364093	2.780393012	0	3.029485732	0	0	0.632289601	0.912783877	10.06965287	0.556957817	0	0.799480094	0	1.665053535	0	0	0	1.519406402	0	0.344413611	0	0	0	0	0	0	0	0	0	0	0	0	0	45.9341
H5378_185_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1188.037561	34.34248082	1077.247734	1612.233041	180.5405821	13.42341396	0.808380832	210.7098873	350.337108	1166.258852	13.83439737	0	31.54834072	1300.131462	3598.775823	12388.11398	0.988649609	1395.817173	21.28111799	13608.19757	8.013029164	0	0	0	787.5029488	0	179.7549655	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.75643144	112.5	0	0.2	0	0	5.191755659	0	8.699212655	0.5	0	0.033816194	0	0.2	0	0	0	20	0	20	0	0	0											NO	103.1830032	66.8190666	20.49604072	0	122.5237403	0.163364987	0.163364987	40.64229389	91.89280523	0	0.163364987	0	0	4.24075548	0	7.105733815	0.408412468	0	0.02762191	0	0.163364987	0	0	0	16.33649871	0	16.33649871	0	0	0												10.2154	0.191227709	1.839942785	0	1.843375616	2.192915848	0.132061124	0.71364443	2.682788303	0	2.260056147	0	0	0.459461635	0	7.335553366	0.403776826	0	0.587825128	0	1.309048406	0	0	0	1.072086742	0	0.244713897	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4839	0	7.494027048	10.2154	0.191227709	1.839942785	0	1.843375616	2.192915848	0.132061124	0.71364443	2.682788303	0	2.260056147	0	0	0.459461635	0	7.335553366	0.403776826	0	0.587825128	0	1.309048406	0	0	0	1.072086742	0	0.244713897	0	0	0	0	0	0	0	0	0	0	0	0	0	33.4839	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	4.5355	0.0849	0.8169	0	0.8184	0.9737	0.0586	0.3168	1.1911	0	1.0315	0	0	0.204	0.915	3.1035	0.1768	0	0.2683	0	0.5734	0	0	0	0.476	0	0.1087	0	0	0											15.6532	0	3.211725878	14.751	0.276130835	2.656858359	0	2.661815332	3.166611685	0.190698745	1.030406051	3.873918574	0	3.291567	0	0	0.663457851	0.914987812	10.43903182	0.580556243	0	0.856116784	0	1.882490198	0	0	0	1.548082172	0	0.353364337	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1371
H5378_186_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1548.852475	45.42262043	1387.492521	2568.322589	217.1765793	15.46184362	0.916284572	228.5234111	331.5364291	1476.952495	17.96393797	0	35.89664739	1347.892995	4165.476362	14208.23273	1.160031589	1718.37766	23.7378017	14854.35242	9.624460022	0	0	0	895.062541	0	206.399056	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.68805883	112.5	0	0.2	0	0	5.030113989	0	8.852482799	0.5	0	0.033897886	0	0.2	0	0	0	20	0	20	0	0	0											NO	106.9093686	69.23217974	21.2362376	0	126.9485798	0.169264773	0.169264773	42.05219002	95.21143487	0	0.169264773	0	0	4.257105515	0	7.492067462	0.423161933	0	0.02868859	0	0.169264773	0	0	0	16.92647731	0	16.92647731	0	0	0												13.7989	0.262058918	2.455426737	0	2.297521527	2.617145452	0.1550947	0.800825825	2.630504927	0	3.040661885	0	0	0.478176892	0	8.870753176	0.490881209	0	0.681004065	0	1.629082042	0	0	0	1.262521316	0	0.291134078	0	0	0	0	0	0	0	0	0	0	0	0	0	41.7617	0	7.556152477	13.7989	0.262058918	2.455426737	0	2.297521527	2.617145452	0.1550947	0.800825825	2.630504927	0	3.040661885	0	0	0.478176892	0	8.870753176	0.490881209	0	0.681004065	0	1.629082042	0	0	0	1.262521316	0	0.291134078	0	0	0	0	0	0	0	0	0	0	0	0	0	41.7617	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	5.4665	0.1038	0.9727	0	0.9102	1.0368	0.0614	0.3173	1.0421	0	1.2566	0	0	0.1894	0.9731	3.3465	0.1945	0	0.2814	0	0.6454	0	0	0	0.5002	0	0.1153	0	0	0											17.4133	0	3.238351062	19.2654	0.365875197	3.428159388	0	3.207699041	3.653943982	0.216536435	1.118077982	3.672595898	0	4.297306451	0	0	0.667609656	0.973121128	12.21723937	0.685346869	0	0.962439772	0	2.274453076	0	0	0	1.762677027	0	0.406468663	0	0	0	0	0	0	0	0	0	0	0	0	0	59.175
H5378_187_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	YES	1097.504175	29.54662315	1124.693675	1483.8577	157.5538988	13.08977443	0.87510373	210.8144119	299.6159967	1102.828415	14.30705288	0	34.99158086	1421.955212	3629.099681	11998.66037	0.971004187	1416.452906	18.60478748	14304.6111	8.04792245	0	0	0	889.6160123	0	191.7379041	0	0	0											3250	1a: $175 Per Day (Days 1-5)	1b: $175 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												110.5317968	71.57798538	25.09232986	0	150	0.2	0.2	49.8333158	112.5	0	0.2	0	0	4.856202696	8.80022544	8.861749769	0.5	0	0.032999371	0	0.2	0	0	0	20	0	20	0	0	0											NO	94.29439902	61.06300004	21.40620376	0	127.9646243	0.170619499	0.170619499	42.51267689	95.97346822	0	0.170619499	0	0	4.142814357	7.507450281	7.559936532	0.426548748	0	0.028151681	0	0.170619499	0	0	0	17.06194991	0	17.06194991	0	0	0												8.624	0.150350454	2.006285164	0	1.680110455	2.233370755	0.14930976	0.746857081	2.396265528	0	2.441062196	0	0	0.490908039	2.270440452	7.559092572	0.41418062	0	0.523756041	0	1.373132497	0	0	0	1.264881986	0	0.272618543	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5967	0	7.429214743	8.624	0.150350454	2.006285164	0	1.680110455	2.233370755	0.14930976	0.746857081	2.396265528	0	2.441062196	0	0	0.490908039	2.270440452	7.559092572	0.41418062	0	0.523756041	0	1.373132497	0	0	0	1.264881986	0	0.272618543	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5967	NO	"1a: $1,000 Per Stay"	"1b: $1,000 Per Stay"	2: $130 Per Day (Days 21-100)	6: 20%	10a: 20%	11a: 20%; 11c: 20%	11b: 20%	4a: $50; 4b: $35	9a: 20%; 9b: 20%	8a: 20%	8b: 20%		12: 20%	3: 20%; 5: 20%; 7c: 20%; 7i: 20%; 9d: 20%	7a: 20%;  14b: 20%; 14c: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7b: 20%; 7d: 20%; 7f: 20%; 7g: 20%; 14b: 20%; 14d: 20%; 14e: 20%; 14f: 20%; 14g: 20%; 14h: 20%; 14i: 20%; 14j: 20%	7e: 50%; 7h: 50%; 9c: 50%	7c: 20%; 7i: 20%	8b: 20%	8a: 20%	13a: 20%; 15: 20%				17a: 20%	17b: 20%	18a: 20%		14a2: Newsletters; 14a8: Nurseline													2.8509	0.0284	0.7797	1.2858	0.3184	0.6651	0.0449	0.2191	1.5258	0.2442	0.7761	0	0.0762	2.8639	0.9559	4.5607	0.1204	0.1723	0.9371	1.3471	0.3997	0	0	0	0.2223	0	0.0104	0	0	0											20.4044	0	0	11.4749	0.17876425	2.785982725	1.285783731	1.998534412	2.898488887	0.194163492	0.965969739	3.922088931	0.24415192	3.217159841	0	0.076194776	3.35482447	3.226352952	12.11983371	0.534589143	0.17229358	1.460871309	1.347084381	1.772792546	0	0	0	1.487205289	0	0.283049392	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0011
H5378_188_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1327.038431	38.75865644	1283.478177	3024.092026	255.8436018	17.02341406	0.994758861	248.9302892	310.8632852	1425.916198	16.02546953	0	42.06309393	1736.224258	3688.134222	13448.62613	1.110853466	1651.083126	22.35110141	14373.74278	9.072720346	0	0	0	789.0284872	0	181.2207584	0	0	0												1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	3: $15; 5: $200; 7c: $15; 7i: $15; 9d: $15	7a: $0;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												126.3220535	81.80341186	25.09232986	0	150	0.2	0.2	49.80703969	112.5	0	0.2	0	0	3.766765829	0	8.327829451	0.5	0	0.033890541	0	0.2	0	0	0	20	0	20	0	0	0											NO	107.9730851	69.92101938	21.44753187	0	128.2116805	0.170948907	0.170948907	42.57229508	96.1587604	0	0.170948907	0	0	3.219622514	0	7.118166727	0.427372268	0	0.028967755	0	0.170948907	0	0	0	17.09489074	0	17.09489074	0	0	0												11.9404	0.225837064	2.293953258	0	2.733511511	2.910134034	0.17005294	0.883127811	2.491019013	0	2.739536506	0	0	0.465832226	0	7.977463585	0.474747966	0	0.64746122	0	1.55097163	0	0	0	1.124029648	0	0.258162422	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8862	0	6.583108513	11.9404	0.225837064	2.293953258	0	2.733511511	2.910134034	0.17005294	0.883127811	2.491019013	0	2.739536506	0	0	0.465832226	0	7.977463585	0.474747966	0	0.64746122	0	1.55097163	0	0	0	1.124029648	0	0.258162422	0	0	0	0	0	0	0	0	0	0	0	0	0	38.8862	YES	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $150; 9b: $75	8a: 0%	8b: 20%		12: $0	"3: $15; 5: $200, 7c: $15; 7i: $15; 9d: $15"	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g: $35; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $15; 7i: $15	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3250	5.0347	0.0952	0.9672	0	1.1526	1.2271	0.0717	0.3723	1.0503	0	1.1987	0	0	0.1964	0.9178	3.2072	0.1991	0	0.2833	0	0.6507	0	0	0	0.4739	0	0.1089	0	0	0											17.2072	0	2.82133222	16.975	0.321061616	3.261202248	0	3.886100929	4.137196614	0.241756029	1.255465807	3.541361088	0	3.93819775	0	0	0.662251115	0.917765379	11.18467095	0.673884262	0	0.930719408	0	2.201689779	0	0	0	1.597978513	0	0.367017012	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0934
H5378_189_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1308.644679	37.88122872	907.97293	2991.347233	159.8414573	12.43644767	0.768283171	180.4375741	315.1905574	686.1971895	11.87388307	0	26.01697985	907.0931194	3366.197795	11790.58514	0.933666977	1263.196566	21.16861496	12611.93057	5.227770617	0	0	0	788.4106348	0	177.9524594	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.67673039	195	0	0.2	0	0	13.64730252	8.862075189	10.95821653	0.5	0	0.03418599	0	0.2	0	0	0	20	0	20	0	0	0											NO	140.9915071	91.30303063	18.67082485	0	111.6127415	0.148816989	0.148816989	36.96370712	145.096564	0	0.148816989	0	0	10.15475232	6.594136716	8.15384393	0.372042472	0	0.025437281	0	0.148816989	0	0	0	14.88169887	0	14.88169887	0	0	0												15.3756	0.288222582	1.412716962	0	1.486695272	1.850754692	0.114333588	0.55580347	3.811088907	0	1.767035522	0	0	0.76760883	1.849764039	8.011549254	0.34736377	0	0.538472	0	0.777981081	0	0	0	0.977740804	0	0.220686243	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1535	0	13.68755568	15.3756	0.288222582	1.412716962	0	1.486695272	1.850754692	0.114333588	0.55580347	3.811088907	0	1.767035522	0	0	0.76760883	1.849764039	8.011549254	0.34736377	0	0.538472	0	0.777981081	0	0	0	0.977740804	0	0.220686243	0	0	0	0	0	0	0	0	0	0	0	0	0	40.1535	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	7.3951	0.1386	0.6795	0	0.715	0.9593	0.0593	0.2672	1.833	0	0.8461	0	0	0.3692	1.7286	3.7598	0.1647	0	0.2579	0	0.3691	0	0	0	0.4703	0	0.1061	0	0	0											20.1189	0	5.866095293	22.7708	0.426846666	2.09218001	0	2.201739069	2.810090158	0.173598204	0.82303884	5.644077506	0	2.613179335	0	0	1.136799439	3.578340328	11.77136247	0.512056785	0	0.796419945	0	1.147039681	0	0	0	1.447996889	0	0.32682792	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2723
H5378_190_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1016.251174	28.10637553	980.2200167	2070.331431	152.2582479	12.52332078	0.808202883	187.060198	271.7185094	723.5330369	11.13506045	0	29.95411289	1072.26161	3336.137589	11580.96681	0.984139386	1324.273636	22.98815887	13820.07846	6.847649961	0	0	0	799.144146	0	175.3965784	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.78154715	195	0	0.2	0	0	11.78170632	8.767881073	10.9959098	0.5	0	0.033884887	0	0.2	0	0	0	20	0	20	0	0	0											NO	141.5544063	91.66755195	18.74536688	0	112.058348	0.149411131	0.149411131	37.18958623	145.6758524	0	0.149411131	0	0	8.801590315	6.550095125	8.214556582	0.373527827	0	0.025313897	0	0.149411131	0	0	0	14.94111307	0	14.94111307	0	0	0												11.9879	0.214703553	1.53121532	0	1.421817311	1.871123517	0.120754507	0.57972428	3.29856879	0	1.663701972	0	0	0.786467283	1.821001546	7.927708929	0.367603446	0	0.581919876	0	1.023115123	0	0	0	0.995008587	0	0.218385009	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4107	0	12.20868675	11.9879	0.214703553	1.53121532	0	1.421817311	1.871123517	0.120754507	0.57972428	3.29856879	0	1.663701972	0	0	0.786467283	1.821001546	7.927708929	0.367603446	0	0.581919876	0	1.023115123	0	0	0	0.995008587	0	0.218385009	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4107	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	5.3327	0.0955	0.6811	0	0.6325	0.8369	0.054	0.2577	1.4673	0	0.7261	0	0	0.3499	1.5776	3.4484	0.159	0	0.2541	0	0.443	0	0	0	0.4426	0	0.0971	0	0	0											16.8555	0	5.232294322	17.3206	0.310212324	2.212361447	0	2.054298805	2.707983218	0.174761941	0.83744303	4.765904785	0	2.389754603	0	0	1.136319546	3.39864345	11.37609378	0.526581115	0	0.836012159	0	1.466069228	0	0	0	1.437628404	0	0.31553144	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2662
H5378_191_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	947.6711705	25.5527982	981.2252743	1301.513699	137.5150517	11.42219649	0.766073364	183.9637261	258.9394763	962.143377	12.6051683	0	30.28682777	1225.629497	3165.342342	10386.82198	0.847176763	1162.075994	16.36521384	12417.91815	7.028626261	0	0	0	780.0397042	0	167.8143123	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.832974	195	0	0.2	0	0	11.3840283	8.807839058	11.46602849	0.5	0	0.033052178	0	0.2	0	0	0	20	0	20	0	0	0											NO	136.0352237	88.09344945	18.01448816	0	107.6892118	0.143585616	0.143585616	35.77649127	139.9959753	0	0.143585616	0	0	8.172913565	6.323394972	8.231783803	0.358964039	0	0.023729087	0	0.143585616	0	0	0	14.35856157	0	14.35856157	0	0	0												10.7431	0.187586178	1.473022591	0	1.23407396	1.640063116	0.109997116	0.54846472	3.020873712	0	1.809920851	0	0	0.834746995	1.667975821	7.125172745	0.304105993	0	0.388331575	0	1.009209629	0	0	0	0.93335401	0	0.200797678	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2308	0	12.94708605	10.7431	0.187586178	1.473022591	0	1.23407396	1.640063116	0.109997116	0.54846472	3.020873712	0	1.809920851	0	0	0.834746995	1.667975821	7.125172745	0.304105993	0	0.388331575	0	1.009209629	0	0	0	0.93335401	0	0.200797678	0	0	0	0	0	0	0	0	0	0	0	0	0	33.2308	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	4.8345	0.0844	0.6629	0	0.5554	0.7381	0.0495	0.2466	1.3594	0	0.7955	0	0	0.3756	1.4644	3.1387	0.1324	0	0.1707	0	0.44	0	0	0	0.42	0	0.0904	0	0	0											15.5586	0	5.548751164	15.5776	0.272002529	2.135902947	0	1.789424158	2.378113998	0.159497326	0.795094568	4.380308289	0	2.6054256	0	0	1.210394584	3.13241179	10.26387479	0.436542521	0	0.558987156	0	1.449229944	0	0	0	1.353376108	0	0.291159385	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7893
H5378_192_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	993.8549058	27.46292707	965.1699785	1611.29918	181.7046447	13.6459746	0.858282076	183.1672816	239.0177529	984.1865201	12.45857063	0	26.69026478	1044.586762	3254.355208	11120.12132	0.901949523	1155.086171	19.62192797	12137.54092	6.92433714	0	0	0	788.3871191	0	173.051828	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.76566311	195	0	0.2	0	0	13.52730888	8.868218631	11.0662952	0.5	0	0.03311911	0	0.2	0	0	0	20	0	20	0	0	0											NO	138.0556147	89.40181063	18.28203878	0	109.2886086	0.145718145	0.145718145	36.25880052	142.0751912	0	0.145718145	0	0	9.855871773	6.461301834	8.062800034	0.364295362	0	0.024130276	0	0.145718145	0	0	0	14.57181448	0	14.57181448	0	0	0												11.4339	0.20460295	1.470439582	0	1.654853983	1.988466104	0.125067272	0.553452161	2.829874412	0	1.815439799	0	0	0.857942765	1.752280939	7.471609548	0.328576028	0	0.473482544	0	1.009001562	0	0	0	0.95735257	0	0.210139928	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1365	0	13.00103465	11.4339	0.20460295	1.470439582	0	1.654853983	1.988466104	0.125067272	0.553452161	2.829874412	0	1.815439799	0	0	0.857942765	1.752280939	7.471609548	0.328576028	0	0.473482544	0	1.009001562	0	0	0	0.95735257	0	0.210139928	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1365	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	5.3103	0.095	0.6829	0	0.7686	0.9019	0.0567	0.2569	1.3143	0	0.8252	0	0	0.3985	1.585	3.3915	0.148	0	0.2152	0	0.4549	0	0	0	0.4446	0	0.0976	0	0	0											16.947	0	5.571871995	16.7442	0.299627204	2.153359469	0	2.423421906	2.890388061	0.181794876	0.810313842	4.144159977	0	2.640604975	0	0	1.256399243	3.337235761	10.86310221	0.476537513	0	0.688725399	0	1.463925374	0	0	0	1.401978189	0	0.307735734	0	0	0	0	0	0	0	0	0	0	0	0	0	52.0835
H5378_193_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1109.270659	31.21199947	1030.795034	1613.026031	171.1093361	12.68529646	0.796901248	201.4284597	327.9264715	1028.840289	13.44030074	0	30.62114903	1239.952454	3378.043506	11693.93681	0.944429029	1247.164432	20.69477995	12613.13582	7.742940622	0	0	0	806.8967803	0	178.9149496	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.75649004	195	0	0.2	0	0	12.08730925	8.849716314	11.00029719	0.5	0	0.033617181	0	0.2	0	0	0	20	0	20	0	0	0											NO	138.7294044	89.83814219	18.37126551	0	109.821999	0.146429332	0.146429332	36.42904801	142.7685988	0	0.146429332	0	0	8.849683099	6.479290244	8.053830853	0.36607333	0	0.024612707	0	0.146429332	0	0	0	14.64293321	0	14.64293321	0	0	0												12.824	0.233669004	1.578084105	0	1.565964112	1.857499488	0.116689717	0.611487252	3.901466903	0	1.96805426	0	0	0.91443219	1.823943694	7.848415754	0.34573028	0	0.509354557	0	1.133793623	0	0	0	0.984611305	0	0.218319971	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4356	0	13.95119708	12.824	0.233669004	1.578084105	0	1.565964112	1.857499488	0.116689717	0.611487252	3.901466903	0	1.96805426	0	0	0.91443219	1.823943694	7.848415754	0.34573028	0	0.509354557	0	1.133793623	0	0	0	0.984611305	0	0.218319971	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4356	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	5.7241	0.1043	0.7044	0	0.699	0.8292	0.0521	0.2729	1.7414	0	0.8748	0	0	0.4082	1.5842	3.4221	0.1522	0	0.2264	0	0.4993	0	0	0	0.4395	0	0.0974	0	0	0											17.8313	0	5.979084463	18.5481	0.337968422	2.282470439	0	2.264940623	2.686658773	0.168778218	0.884347564	5.642907655	0	2.842870197	0	0	1.32259392	3.408127063	11.27046803	0.497902593	0	0.735767564	0	1.633096158	0	0	0	1.424097861	0	0.315768266	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2669
H5378_194_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1246.365663	35.67216952	1226.240404	2885.831493	240.6029377	15.97905629	0.960729381	237.7829355	296.7707329	1251.89612	15.66568311	0	40.14084426	1636.695648	3470.976933	12728.27894	1.060501938	1470.503351	21.89882842	13400.0106	8.822495161	0	0	0	809.207016	0	181.111086	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.80314037	195	0	0.2	0	0	8.979900121	8.733584887	10.54626045	0.5	0	0.033730946	0	0.2	0	0	0	20	0	20	0	0	0											NO	149.8861017	97.06297647	19.84869308	0	118.6539464	0.158205262	0.158205262	39.39559432	154.2501303	0	0.158205262	0	0	7.103337252	6.908495421	8.342369486	0.395513155	0	0.026682066	0	0.158205262	0	0	0	15.82052619	0	15.82052619	0	0	0												15.5677	0.288537246	2.028272453	0	2.379040673	2.527970786	0.151992443	0.780633339	3.814743685	0	2.478393498	0	0	0.96883343	1.998269021	8.848667152	0.419442467	0	0.584305975	0	1.395765157	0	0	0	1.066840066	0	0.238772723	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5382	0	11.91080091	15.5677	0.288537246	2.028272453	0	2.379040673	2.527970786	0.151992443	0.780633339	3.814743685	0	2.478393498	0	0	0.96883343	1.998269021	8.848667152	0.419442467	0	0.584305975	0	1.395765157	0	0	0	1.066840066	0	0.238772723	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5382	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	6.5611	0.1216	0.8548	0	1.0027	1.0654	0.0641	0.329	1.6078	0	1.0497	0	0	0.4083	1.6375	3.643	0.1759	0	0.2475	0	0.5853	0	0	0	0.4496	0	0.1006	0	0	0											19.9039	0	5.104628961	22.1289	0.410143522	2.883103718	0	3.381705945	3.593403816	0.216050846	1.109605692	5.422497204	0	3.528053132	0	0	1.377155846	3.63575321	12.49169052	0.595299645	0	0.831763575	0	1.981090953	0	0	0	1.516468143	0	0.339405352	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4421
H5378_195_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	P	P	P	Coin	P	P	P	V	V	Coin	V	Coin	P	Coin	P	T	P	V	P	V	P	V	O																																																			0	NO	1446.188918	41.6406806	1322.999586	2485.91405	206.4392097	14.66363567	0.89912358	220.2025894	316.1444625	1297.71075	17.52079759	0	34.80256417	1296.236455	3891.09625	13427.92067	1.10784083	1531.274974	23.16779136	13873.8626	9.365872383	0	0	0	910.029695	0	204.694168	0	0	0												1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $10; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												189.4830803	122.7051178	25.09232986	0	150	0.2	0.2	49.6913964	195	0	0.2	0	0	11.76781712	8.813130442	11.15308905	0.5	0	0.033744267	0	0.2	0	0	0	20	0	20	0	0	0											NO	147.2187134	95.33563389	19.49546373	0	116.5423687	0.155389825	0.155389825	38.60768695	151.5050794	0	0.155389825	0	0	9.142995214	6.847353985	8.665382775	0.388474562	0	0.026217579	0	0.155389825	0	0	0	15.5389825	0	15.5389825	0	0	0												17.7422	0.330820057	2.149374203	0	2.004909541	2.27857978	0.139714656	0.708459386	3.991457656	0	2.722553672	0	0	0.987623642	2.220309451	9.69650604	0.430367982	0	0.607403401	0	1.45536127	0	0	0	1.178411292	0	0.265061591	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9091	0	13.9095963	17.7422	0.330820057	2.149374203	0	2.004909541	2.27857978	0.139714656	0.708459386	3.991457656	0	2.722553672	0	0	0.987623642	2.220309451	9.69650604	0.430367982	0	0.607403401	0	1.45536127	0	0	0	1.178411292	0	0.265061591	0	0	0	0	0	0	0	0	0	0	0	0	0	48.9091	YES	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100 Per Day (Days 21-100)	6: 0%	10a: $150	11a: 20%; 11c: 0-20%	11b: 20%	4a: $50; 4b: $35	9a: $245; 9b: $145	8a: 0%	8b: 20%		12: $0	3: $35; 5: $300; 7c: $35; 7i: $35; 9d: $35	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$45; 14b: $0; 14d: $0; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7e: 50%; 7h: 50%; 9c: 50%	7c: $35; 7i: $35	8b: 20%	8a: 0%	13a: $0; 15: 20%				17a: $20	17b: $20	18a: $20		14a2: Newsletters; 14a8: Nurseline												3400	6.9843	0.1302	0.8461	0	0.7892	0.897	0.055	0.2789	1.5713	0	1.0827	0	0	0.3888	1.6987	3.7262	0.1694	0	0.2415	0	0.5729	0	0	0	0.4639	0	0.1043	0	0	0											20.0004	0	5.961255555	24.7265	0.461048873	2.995485108	0	2.794151277	3.175553047	0.194713964	0.987347638	5.562713069	0	3.805228024	0	0	1.376406169	3.919006211	13.4226884	0.59978429	0	0.848945808	0	2.028270837	0	0	0	1.642298243	0	0.369404289	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9095
H5378_801_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	237.7932347	2.760379267	42.37526482	38.47730519	7.179474209	15.06761194	0.959838315	8.25652233	34.19425995	5.474904641	16.7350813	0	0.363932518	20.52071398	20.99562125	103.6629479	1.094865926	3.928620016	27.19881123	32.71628101	8.30634306	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	0	0	18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.6669	0.0542	1.8684	0	0.4182	0.8777	0.0559	0.4809	1.9918	0.3086	0.9748	0	0.0212	1.1953	1.223	5.9734	0.1288	0.2288	1.5843	1.902	0.4838	0																			24.4381	0	0	23.3345	0.270874828	9.341871808	0	2.091021864	4.388441979	0.279552909	2.404712129	9.959078211	1.584281092	4.874092428	0	0.105995346	5.976657947	6.11497469	30.12684094	0.383872347	1.14421058	7.921653771	9.524855158	2.419222416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2468
H5378_802_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	237.7932347	2.760379267	42.37526482	38.47730519	7.179474209	15.06761194	0.959838315	8.25652233	34.19425995	5.474904641	16.7350813	0	0.363932518	20.52071398	20.99562125	103.6629479	1.094865926	3.928620016	27.19881123	32.71628101	8.30634306	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	0	0	18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.6669	0.0542	1.8684	0	0.4182	0.8777	0.0559	0.4809	1.9918	0.3086	0.9748	0	0.0212	1.1953	1.223	5.9734	0.1288	0.2288	1.5843	1.902	0.4838	0																			24.4381	0	0	23.3345	0.270874828	9.341871808	0	2.091021864	4.388441979	0.279552909	2.404712129	9.959078211	1.584281092	4.874092428	0	0.105995346	5.976657947	6.11497469	30.12684094	0.383872347	1.14421058	7.921653771	9.524855158	2.419222416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2468
H5378_803_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	237.7932347	2.760379267	42.37526482	38.47730519	7.179474209	15.06761194	0.959838315	8.25652233	34.19425995	5.474904641	16.7350813	0	0.363932518	20.52071398	20.99562125	103.6629479	1.094865926	3.928620016	27.19881123	32.71628101	8.30634306	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.078503655	0.078503655	0.176364619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	0	0	18.6676	0.216699863	7.473497447	0	1.672817491	3.510753583	0.223642327	1.923769703	7.967262569	1.275652781	3.899273943	0	0.084796277	4.781326357	4.891979752	24.15346687	0.255103761	0.915368464	6.337323017	7.622893475	1.935377933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8086	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.6669	0.0542	1.8684	0	0.4182	0.8777	0.0559	0.4809	1.9918	0.3086	0.9748	0	0.0212	1.1953	1.223	5.9734	0.1288	0.2288	1.5843	1.902	0.4838	0																			24.4381	0	0	23.3345	0.270874828	9.341871808	0	2.091021864	4.388441979	0.279552909	2.404712129	9.959078211	1.584281092	4.874092428	0	0.105995346	5.976657947	6.11497469	30.12684094	0.383872347	1.14421058	7.921653771	9.524855158	2.419222416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.2468
H5402_007_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	O	V	Coin	V	V	V	V	V	P	P	Coin	V	T	V	V	P	V	P	O	V																																																			0	YES	1456.898177	156.9968877	673.176508		212.7679312		6.943880889	238.6663653	291.9014458	947.1324437	56.20095885	40.75412855	0.140724223	59.99569177		4776.655383	516.8596405	424.6417625	5889.108157	1106.325351	17.95938464				157.9468878	722	262.4038419														3000	1a: $115/d (1-5) then $0	1b: $115/d (1-5) then $0	"2: $0 (1-10), $90/d (11-100)"	6: $0/visit	10a: $100/trip	11a: 0%-20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $20/visit	9a: $150/visit;9b: $75/visit	8a: $0 - $175 per visit;8a: $175/visit	"8b: $5/visit;8b: CT Scans $100, Other Imaging $150;8b: 150 nuclear medicine, 20% chemotherapy ;8b: 20%"	9a: $150/visit	12a: 20%	3: $15/visit;5: $125/visit;9a: $150/visit;9c: $25/visit;9d: $25/visit;13a: 20%	7a: $0/visit;14c: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $5/visit;7d: $20/visit;7f: $5/visit;16b: $0/visit;17a: $15-$20;18a: $15/visit	7e: $25/visit;7h: $25/visit	7c: $20/visit;7i: $20/visit	"8b: $5/visit, 8b: 20% chemotherapy 14h: $0/visit"	7g: $20/visit;14b: 20%;14i: 20%;14j: 20%	15: 20%	17b: $15/copay	10b: $10 allowance/trip	16a: $0/visit	17a1: $15/visit	17b1: $15/copay	"18a1: $0 hearing test, $15 copay for fitting every 2 years"	"18b: $1,000 Allowance /2 yr"	14a: $0/copay	13b: $0/visit;14c1: $0/visit											84.27423348	70.32381799	33.97160805		100		0.2	49.90394877	82.19895288	17.5	51.62348628	150	0.2	46.87055114		18.48354642	25	20	5.353929101	13.46488852	0.2				15	15	15														NO	84.27423348	70.32381799	33.97160805		99.55178539		0.199103571	49.68055899	81.83052516	17.42156244	51.62348628	149.3276781	0.2	46.66047048		18.40070046	24.88794635	19.91035708	5.353929101	13.404986	0.2				14.93276781	14.93276781	14.93276781															10.2316	0.920051713	1.905740707	0	1.765118952	0	1.38255148	0.98808987	1.990537383	1.375043917	0.241774119	0.507143282	0.028144845	0.2332856	0	7.324483742	1.071964584	0.704564093	2.627488962	1.235856321	3.591876928	0	0	0	0.196548684	0.898454863	0.326534637	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5468	0	0.09	10.2316	0.920051713	1.905740707	0	1.765118952	0	1.38255148	0.98808987	1.990537383	1.375043917	0.241774119	0.507143282	0.028144845	0.2332856	0	7.324483742	1.071964584	0.704564093	2.627488962	1.235856321	3.591876928	0	0	0	0.196548684	0.898454863	0.326534637	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5468	NO																																																																																		0	0	0	10.2316	0.920051713	1.905740707	0	1.765118952	0	1.38255148	0.98808987	1.990537383	1.375043917	0.241774119	0.507143282	0.028144845	0.2332856	0	7.324483742	1.071964584	0.704564093	2.627488962	1.235856321	3.591876928	0	0	0	0.196548684	0.898454863	0.326534637	0	0	0	0	0	0	0	0	0	0	0	0	0	39.5468
H5402_032_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	Coin	Coin	Coin	Coin	T	V	V	P	V	P	O	V																																																			0	NO	1388.484686				109.9558401		0.843018538	167.8534486	304.9848553	633.9272933	6.255814916	64.82674938	0.152168036	210.902287		229.1917358			1.76519546	0.080903529	34.17050151																					1a: $25/day days 1-5 then $0	1b: $0/day	2: $0/day	6: $0/visit	10a: $100/trip	11a: $0/visit	11b: $0/visit;11c: 20%	4a: $50/visit;4b: $0/visit	9a: $150/visit;9b: $25/visit	8a: $0 - $175 per visit;8a: $175/visit	8b: $0/visit;8b: 20%	9a: $150/visit	12a: 20%	3: $0/visit;5: $0/visit;9a: $150/visit;9c: $0/visit;9d: $0/visit;13a: 20%	7a: $0/visit;14c: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $5/visit;7d: $0/visit;7f: $0/visit;16b: $0/visit;17a: $0/visit;18a: $0/visit	7e: $0/visit;7h: $0/visit	7c: $0/visit;7i: $0/visit	"8b: $0/visit, 8b: 20%14h: $0/visit"	7g: $0/visit;14b: $0/visit;14i: 20%;14j: 20%	15: 20%	17b: $0/copay	10b: $10 allowance/trip	16a: $0/visit	17a1: $0/visit	17b1: $0/copay	18a1: $0/visit	"18b: $1,000 Allowance /2 yr"	14a: $0/copay	13b: $0/visit;13c: $30/Qtr;14c1: $0/visit											17.16835469				100		0.2	50	78.27557162	17.5	0.2	150	0.2	138.4974087		5			0.2	0.2	0.2																				NO	17.16835469				100		0.2	50	78.27557162	17.5	0.2	150	0.2	138.4974087		5			0.2	0.2	0.2																					1.9865	0	0	0	0.916298667	0	0.168603708	0.699389369	1.989405324	0.924477303	1.251162983	0.810334367	0.030433607	2.434118354	0	0.095496557	0	0	0.353039092	0.016180706	6.834100302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.5095	0	0	1.9865	0	0	0	0.916298667	0	0.168603708	0.699389369	1.989405324	0.924477303	1.251162983	0.810334367	0.030433607	2.434118354	0	0.095496557	0	0	0.353039092	0.016180706	6.834100302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.5095	NO																																																																																		0	0	0	1.9865	0	0	0	0.916298667	0	0.168603708	0.699389369	1.989405324	0.924477303	1.251162983	0.810334367	0.030433607	2.434118354	0	0.095496557	0	0	0.353039092	0.016180706	6.834100302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.5095
H5402_035_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	O	V	Coin	V	V	V	V	V	P	P	Coin	V	T	V	V	P	V	P	O	V																																																			0	YES	2604.630672	87.66979533	1565.992242		226.7721084		11.15500743	316.8585474	337.8645484	1512.153449	415.1479307	61.12827465	0.352090893	803.9881583		7100.246689	346.9322519	805.0242636	6382.598619	1785.295559	37.43019002				157.9468878	772	273.1164936														3000	1a: $100/d (1-5) then $0	1b: $100/d (1-5) then $0	"2: $0 (1-10), $90/d (11-100)"	6: $0/visit	10a: $100/trip	11a: 0%-20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $20/visit	9a: $150/visit;9b: $75/visit	8a: $0 - $175 per visit;8a: $175/visit	"8b: X-rays $5, Other Diagnostic Radiological Services $5, ultrasounds $40;8b: CAT $100, MRI $150;8b: Nuclear Medicine $150, Chemo/Radiation 20%;8b: 20%"	9a: $150/visit	12a: 20%	3: $15/visit;5: $125/visit;9a: $150/visit;9c: $25/visit;9d: $25/visit;13a: 20%	7a: $0/visit;14c: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $5/visit;7d: $10/visit;7f: $5/visit;16b: $0/visit;17a: $5-$15;18a: $15/visit	7e: $25/visit;7h: $25/visit	7c: $15/visit;7i: $15/visit	"8b: X-rays $5, Other Diagnostic Radiological Services $5, ultrasounds $40, 8b: Nuclear Medicine $150, Chemo/Radiation 20%14h: $0/visit"	7g: $5/visit;14b: 20%;14i: 20%;14j: 20%	15: 20%	17b: $15/copay		16a: $0/visit	17a1: $15/visit	17b1: $0/copay	"18a1: $0 hearing test, $15 copay for fitting every 2 years"	"18b: $1,000 Allowance /2 yr"	14a: $0/copay	13b: $0/visit;13c: $30/Qtr;14c1: $0/visit											69.70635613	53.28377181	34.94462363		100		0.2	44	117.0792272	10.33525536	88.48429087	150	0.2	88.56968785		9.454445733	25	15	5.936923353	6.528442961	0.2				15	15	7.5														NO	69.70635613	53.28377181	34.94462363		99.00262576		0.198005252	43.60105031	115.9115091	10.23217418	88.48429087	148.5039386	0.2	87.6863166		9.360149527	24.75065644	14.85039386	5.936923353	6.465543108	0.2				14.85039386	14.85039386	7.425196932															15.1299	0.389281447	4.560250793	0	1.870919515	0	2.208750052	1.151280455	3.263532473	1.28938479	3.061172521	0.756482462	0.070418179	5.874896682	0	5.538280891	0.715566748	0.996243949	3.157749899	0.961908783	7.486038004	0	0	0	0.195464458	0.955375339	0.168995313	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8019	0	0.26	15.1299	0.389281447	4.560250793	0	1.870919515	0	2.208750052	1.151280455	3.263532473	1.28938479	3.061172521	0.756482462	0.070418179	5.874896682	0	5.538280891	0.715566748	0.996243949	3.157749899	0.961908783	7.486038004	0	0	0	0.195464458	0.955375339	0.168995313	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8019	NO																																																																																		0	0	0	15.1299	0.389281447	4.560250793	0	1.870919515	0	2.208750052	1.151280455	3.263532473	1.28938479	3.061172521	0.756482462	0.070418179	5.874896682	0	5.538280891	0.715566748	0.996243949	3.157749899	0.961908783	7.486038004	0	0	0	0.195464458	0.955375339	0.168995313	0	0	0	0	0	0	0	0	0	0	0	0	0	59.8019
H5402_036_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	O	V	Coin	V	V	V	V	V	P	V	Coin	V	T	V	V	P	V	P	O	V																																																			0	YES	904.150477	148.6908463	310.7769199		161.1435881		7.397090533	200.4372216	210.7567618	935.6001634	170.2078306	21.43289103	0.335043399	69.22568068		5279.970158	508.2894753	353.6427019	7215.534793	725.2823722	19.61272461				157.9468878	772	262.1997305														3000	1a: $100/d (1-5) then $0	1b: $100/d (1-5) then $0	"2: $0 (1-10), $90/d (11-100)"	6: $0/visit	10a: $100/trip	11a: 0%-20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $20/visit	9a: $150/visit;9b: $75/visit	8a: $0 - $175 per visit;8a: $175/visit	"8b: $5/visit;8b: CT Scans $100, Other Imaging $150;8b: 150 nuclear medicine, 20% chemotherapy ;8b: 20%"	9a: $150/visit	12a: 20%	3: $15/visit;5: $125/visit;9a: $150/visit;9c: $25/visit;9d: $25/visit;13a: 20%	7a: $0/visit;14c: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $5/visit;7d: $20/visit;7f: $5/visit;16b: $0/visit;17a: $15-$20;18a: $15/visit	7e: $25/visit;7h: $25/visit	7c: $20/visit;7i: $20/visit	"8b: $5/visit, 8b: 20% chemotherapy 14h: $0/visit"	7g: $20/visit;14b: 20%;14i: 20%;14j: 20%	15: 20%	17b: $15/copay	10b: $10 allowance/trip	16a: $0/visit	17a1: $15/visit	17b1: $15/copay	"18a1: $0 hearing test, $15 copay for fitting every 2 years"	"18b: $1,000 Allowance /2 yr"	14a: $0/copay	13b: $0/visit;13c: $30/Qtr;14c1: $0/visit											73.57698641	62.981969	33.09185859		100		0.2	49.94059406	94.79755179	17.5	41.54868039	150	0.2	44.64141002		18.65159292	25	17.48597082	5.205440096	15.48236356	0.2				15	15	15														NO	73.57698641	62.981969	33.09185859		99.64105529		0.199282111	49.7614771	94.65601874	17.5	41.54868039	150	0.2	44.53896997		18.58464402	24.91026382	17.42320585	5.205440096	15.42703496	0.2				14.94615829	14.94615829	14.94615829															5.5437	0.780403523	0.85701549	0	1.338043098	0	1.474107814	0.831171018	1.662449666	1.364416905	0.589325896	0.267911138	0.06700868	0.256936709	0	8.17719715	1.055135411	0.513465799	3.130002844	0.932413043	3.922544922	0	0	0	0.196724932	0.961536184	0.326573223	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2481	0	0.06	5.5437	0.780403523	0.85701549	0	1.338043098	0	1.474107814	0.831171018	1.662449666	1.364416905	0.589325896	0.267911138	0.06700868	0.256936709	0	8.17719715	1.055135411	0.513465799	3.130002844	0.932413043	3.922544922	0	0	0	0.196724932	0.961536184	0.326573223	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2481	NO																																																																																		0	0	0	5.5437	0.780403523	0.85701549	0	1.338043098	0	1.474107814	0.831171018	1.662449666	1.364416905	0.589325896	0.267911138	0.06700868	0.256936709	0	8.17719715	1.055135411	0.513465799	3.130002844	0.932413043	3.922544922	0	0	0	0.196724932	0.961536184	0.326573223	0	0	0	0	0	0	0	0	0	0	0	0	0	34.2481
H5402_038_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	O	V	Coin	V	V	V	V	V	P	P	Coin	Coin	T	V	V	P	V	P	O	V																																																			0	YES	1443.418932	131.0212663	874.5888333		166.475762		8.219522685	244.4956851	289.6590534	858.2164363	128.917974	23.72144457	0.059749204	239.6735158	9206.760182	4600.019687	394.7891719	405.0646288	4660.278731	1155.013838	18.95853371				157.9468878	772	268.9844741														3000	1a: $150/d (1-7) then $0	1b: $150/d (1-7) then $0	"2: $0 (1-7), $80/d (8-100)"	6: $0/visit	10a: $125/trip	11a: 0%-20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $30/visit	9a: $200/visit;9b: $100/visit	8a: $0 - $175 per visit;8a: $175/visit	8b: $7/visit;8b: MRIs $150 CT $100;8b: 20%;8b: $0/visit	9a: $200/visit	12a: 20%	3: $15/visit;5: $125/visit;9a: $200/visit;9c: $25/visit;9d: $25/visit;13a: 20%	7a: $5/visit;14c: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $5/visit;7d: $25/visit;7f: $5/visit;16b: $0/visit;17a: $20/visit;18a: $15/visit	7e: $25/visit;7h: $25/visit	7c: $25/visit;7i: $25/visit	"8b: $7/visit, 8b: 20%14h: $0/visit"	7g: $20/visit;14b: 20%;14i: 20%;14j: 20%	15: 20%	17b: $25/copay	10b: $10 allowance/trip	16a: $0/visit	17a1: $20/visit	17b1: $25/copay	18a1: $15/visit	"18b: $1,000 Allowance /2 yr"	14a: $0/copay	13b: $0/visit;14c1: $0/visit											119.7581692	106.4344701	40.35523225		125		0.2	48.6854826	123.5357836	17.5	80.51145468	200	0.2	61.83656566	4.998351542	22.89033	25	25	7.478298931	15.23467875	0.2				20	25	15														NO	119.7581692	106.4344701	40.35523225		124.6890053		0.199502409	48.56926089	123.2284318	17.45646075	80.51145468	199.5024085	0.2	61.68271892	4.985915857	22.83337984	24.93780107	24.93780107	7.478298931	15.19698896	0.2				19.95024085	24.93780107	14.96268064															14.4051	1.162098255	2.941186291	0	1.729808098	0	1.639814573	0.989581226	2.974519242	1.248451794	0.864947801	0.394373777	0.011949841	1.231976176	3.825344298	8.752833064	0.820431153	0.841785094	2.904246454	1.462727713	3.791706743	0	0	0	0.262589871	1.604331869	0.335394065	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1952	0	0.07	14.4051	1.162098255	2.941186291	0	1.729808098	0	1.639814573	0.989581226	2.974519242	1.248451794	0.864947801	0.394373777	0.011949841	1.231976176	3.825344298	8.752833064	0.820431153	0.841785094	2.904246454	1.462727713	3.791706743	0	0	0	0.262589871	1.604331869	0.335394065	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1952	NO																																																																																		0	0	0	14.4051	1.162098255	2.941186291	0	1.729808098	0	1.639814573	0.989581226	2.974519242	1.248451794	0.864947801	0.394373777	0.011949841	1.231976176	3.825344298	8.752833064	0.820431153	0.841785094	2.904246454	1.462727713	3.791706743	0	0	0	0.262589871	1.604331869	0.335394065	0	0	0	0	0	0	0	0	0	0	0	0	0	54.1952
H5402_039_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	P	Coin	V	T	V	V	P	V	P	O	O																																																			0	YES	856.0303269	164.6675554	496.159192		98.96448091		7.308369523	168.1918462	236.1231338	1.151375189	3.704462346	18.94714714	0.041028476	184.5001913	7169.077333	3582.44348	371.663794	327.0878597	36.75911576	848.5895217	14.33614681				157.9468878	772	267.8955963														3500	1a: $260/d (1-5) then $0	1b: $260/d (1-5) then $0	"2: $0 (1-5), $75/d (6-100)"	6: $0/visit	10a: $125/trip	11a: 0%-20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $35/visit	9a: $200/visit;9b: $100/visit	8a: 20%	8b: 20%	9a: $200/visit	12a: 20%	3: $25/visit;5: $200/visit;9a: $200/visit;9c: $25/visit;9d: $25/visit;13a: 20%	7a: $15/visit;14c: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $35/visit;7d: $35/visit;7f: $35/visit;16b: $0/visit;17a: $15-$35;18a: $20/visit	7e: $25/visit;7h: $25/visit	7c: $35/visit;7i: $35/visit	"8b: 20%, 14h: $0/visit"	7g: $35/visit;14b: 20%;14i: 20%;14j: 20%	15: 20%	17b: $15/copay	10b: $10 allowance/trip	16a: $0/visit	17a1: $15/visit	17b1: $15/copay	18a1: $20/visit	"18b: $1,000 Allowance /2 yr"	14a: $0/copay	13b: $0/visit;14c1: $0/visit											189.8790067	159.0229552	44.06005935		125		0.2	48.54876218	122.0008242	0.02	0.2	200	0.2	62.96668641	15	34.99979072	25	35	0.2	18.04186811	0.2				15	15	20														NO	178.7222824	149.6792404	41.47122161		117.6553726		0.188248596	45.89514593	114.8324194	0.01882486	0.192371012	188.2485962	0.2	59.26695163	14.11864472	32.94330736	23.53107453	32.94350434	0.188634819	16.98442718	0.2				14.11864472	14.11864472	18.82485962															12.7493	2.053942885	1.714693984	0	0.970308573	0	1.375790304	0.643265777	2.259549228	0.021674476	0.712631172	0.297231154	0.008205695	0.911230326	8.434804652	9.834794722	0.728804036	0.897951694	6.934049138	1.201067245	2.867229361	0	0	0	0.185832999	0.908299477	0.420258083	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1309	0	3.29	12.7493	2.053942885	1.714693984	0	0.970308573	0	1.375790304	0.643265777	2.259549228	0.021674476	0.712631172	0.297231154	0.008205695	0.911230326	8.434804652	9.834794722	0.728804036	0.897951694	6.934049138	1.201067245	2.867229361	0	0	0	0.185832999	0.908299477	0.420258083	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1309	NO																																																																																		0	0	0	12.7493	2.053942885	1.714693984	0	0.970308573	0	1.375790304	0.643265777	2.259549228	0.021674476	0.712631172	0.297231154	0.008205695	0.911230326	8.434804652	9.834794722	0.728804036	0.897951694	6.934049138	1.201067245	2.867229361	0	0	0	0.185832999	0.908299477	0.420258083	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1309
H5402_040_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	P	T	V	V	P	V	P	O	V																																																			0	YES	1139.919303	79.07398407	705.6569984		96.67834965		8.09084709	218.3562731	311.7253603	790.4617102	205.973223	35.59995247	0.0910213	326.5544375		4562.703822	357.5806163	629.409487	3849.84132	5.453861807	24.08745983				157.9468878	772	270.8276112														3000	1a: $110/d (1-5) then $0	1b: $110/d (1-5) then $0	"2: $0 (1-10), $75/d (11-100)"	6: $0/visit	10a: $100/trip	11a: 0%-20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $20/visit	9a: $150/visit;9b: $50/visit	8a: $0 - $175 per visit;8a: $175/visit	"8b: X-rays $5, Other Diagnostic Radiological Services $5, ultrasounds $40;8b: CAT $100, MRI $150;8b: Nuclear Medicine $150, Chemo/Radiation 20%;8b: $20/visit"	9a: $150/visit	12a: 20%	3: $15/visit;5: $125/visit;9a: $150/visit;9c: $25/visit;9d: $25/visit;13a: 20%	7a: $0/visit;14c: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $5/visit;7d: $5/visit;7f: $5/visit;16b: $0/visit;17a: $5-$15;18a: $15/visit	7e: $25/visit;7h: $25/visit	7c: $15/visit;7i: $15/visit	"8b: X-rays $5, Other Diagnostic Radiological Services $5, ultrasounds $40, 8b: Nuclear Medicine $150, Chemo/Radiation 20%14h: $0/visit"	7g: $5/visit;14b: 20%;14i: 20%;14j: 20%	15: 20%	17b: $15/copay	10b: $10 allowance/trip	16a: $0/visit	17a1: $15/visit	17b1: $15/copay	"18a1: $0 hearing test, $15 copay for fitting every 2 years"	"18b: $1,000 Allowance /2 yr"	14a: $0/copay	13b: $0/visit;13c: $30/Qtr;14c1: $0/visit											78.91385795	63.30858496	29.22136639		100		0.2	46.13051801	77.96405204	17.5	90.02433188	150	0.2	58.61591028		5.000163546	25	15	5.711813304	0.09508693	0.2				15	15	7.5														NO	76.77232305	61.59054015	28.42836783		97.28623723		0.194572474	44.94865089	77.21217329	17.5	90.02433188	150	0.2	58.30013781		4.864470969	24.32155931	14.59293558	5.711813304	0.092536805	0.2				14.59293558	14.59293558	7.296467792															7.2929	0.405850783	1.671723059	0	0.783789405	0	1.574256139	0.817901658	2.005749378	1.152756661	1.545216816	0.444999406	0.01820426	1.586514059	0	1.849595024	0.724743181	0.765411008	1.832464572	0.504682945	4.817491966	0	0	0	0.19207573	0.938812189	0.164673745	0	0	0	0	0	0	0	0	0	0	0	0	0	31.0898	0	0.52	7.2929	0.405850783	1.671723059	0	0.783789405	0	1.574256139	0.817901658	2.005749378	1.152756661	1.545216816	0.444999406	0.01820426	1.586514059	0	1.849595024	0.724743181	0.765411008	1.832464572	0.504682945	4.817491966	0	0	0	0.19207573	0.938812189	0.164673745	0	0	0	0	0	0	0	0	0	0	0	0	0	31.0898	NO																																																																																		0	0	0	7.2929	0.405850783	1.671723059	0	0.783789405	0	1.574256139	0.817901658	2.005749378	1.152756661	1.545216816	0.444999406	0.01820426	1.586514059	0	1.849595024	0.724743181	0.765411008	1.832464572	0.504682945	4.817491966	0	0	0	0.19207573	0.938812189	0.164673745	0	0	0	0	0	0	0	0	0	0	0	0	0	31.0898
H5402_041_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	O	V	Coin	V	V	V	V	V	P	Coin	Coin	Coin	T	V	V	P	V	P	O	V																																																			0	YES	1079.027155	53.53483	553.5949554		134.2177274		6.317814076	160.2113789	246.8932825	571.4864915	18.58757286	36.46474031	0.096930131	122.3738328					212.6237918	0.968987908	29.64857686																				3000	1a: $75/d (1-5) then $0	1b: $50/d (1-5) then $0	"2: $0 (1-25), $40/d (26-100)"	6: $0/visit	10a: $100/trip	11a: 0%-20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $0/visit	9a: $150/visit;9b: $25/visit	8a: $0 - $175 per visit;8a: $175/visit	8b: $0/visit;8b: $15/visit	9a: $150/visit	12a: 20%	3: $0/visit;5: $25/visit;9a: $150/visit;9c: $0/visit;9d: $0/visit;13a: 20%	7a: $0/visit;14c: $0/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $0/visit;7d: $0/visit;7f: $0/visit;16b: $0/visit;17a: $0/visit;18a: $0/visit	7e: $0/visit;7h: $0/visit	7c: $0/visit;7i: $0/visit	"8b: $0/visit, 8b: $15/visit14h: $0/visit"	7g: $0/visit;14b: 20%;14i: 20%;14j: 20%	15: 20%	17b: $0/copay		16a: $0/visit	17a1: $0/visit	17b1: $0/copay	18a1: $0/visit	"18b: $1,000 Allowance /2 yr"	14a: $0/copay	13b: $0/visit;13c: $30/Qtr;14c1: $0/visit											54.05873837	28.95087849	4.722435402		100		0.2	50	67.87762998	17.5	15	150	0.2	136.6052332					15	0.2	0.2																				NO	54.05873837	28.95087849	4.722435402		98.73457408		0.197469148	49.36728704	67.01868886	17.5	15	148.1018611	0.2	135.0761179					15	0.197548083	0.2																					4.8609	0.129156697	0.217859701	0	1.104327513	0	1.247573364	0.659100094	1.378872007	0.8334178	0.023234466	0.450041325	0.019386026	1.377481855	0	0	0	0	0.26577974	0.191421704	5.929715372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6883	0	0.08	4.8609	0.129156697	0.217859701	0	1.104327513	0	1.247573364	0.659100094	1.378872007	0.8334178	0.023234466	0.450041325	0.019386026	1.377481855	0	0	0	0	0.26577974	0.191421704	5.929715372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6883	NO																																																																																		0	0	0	4.8609	0.129156697	0.217859701	0	1.104327513	0	1.247573364	0.659100094	1.378872007	0.8334178	0.023234466	0.450041325	0.019386026	1.377481855	0	0	0	0	0.26577974	0.191421704	5.929715372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6883
H5404_001_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1085.419806	32.96692358	491.0625277	633.6206065	148.0800751	3.119565478	3.46776167	254.9262435	29.65198528	190.1927146	208.3400628	0	0.818926061	79.21864668	10420.4906	15448.05833	286.5132894	1097.325329	6476.237317	18607.22695	4.853920283	13.29873464	0	2924.911305	438.3955918	292.2637279	20.36181565	2.199330303	492.9230769	2417.572689											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.145803683	45	0.199618441	37.5	23.54587338	0	0.2	44.40660898	4.290940884	17.38470066	25	25	4.364440937	15.03377807	0.2	0	0	4	0	10	10	0	0	0											NO	48.04067323	132.2528736	65.83964129	15.39303479	125	0.127286454	0.102195406	45	0.16136895	37.5	0	0	0.2	0	0.449259063	12.53565501	25	25	1.562385905	13.50950503	0.2	0	0	4	0	10	10	0	0	0												4.3454	0.363330865	2.694281723	0.81277867	1.542500782	0.397078429	0.354389311	0.955973413	4.784909737	0.594352233	0	0	0.163785212	0	0.390124987	16.13762748	0.596902686	2.286094435	0.843198492	20.94786883	0.970784057	0	0	0.974970435	0	0.243553107	0.01696818	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4168		15.12231114	4.3454	0.363330865	2.694281723	0.81277867	1.542500782	0.397078429	0.354389311	0.955973413	4.784909737	0.594352233	0	0	0.163785212	0	0.390124987	16.13762748	0.596902686	2.286094435	0.843198492	20.94786883	0.970784057	0	0	0.974970435	0	0.243553107	0.01696818	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4168	NO																																																																																		0			4.3454	0.363330865	2.694281723	0.81277867	1.542500782	0.397078429	0.354389311	0.955973413	4.784909737	0.594352233	0	0	0.163785212	0	0.390124987	16.13762748	0.596902686	2.286094435	0.843198492	20.94786883	0.970784057	0	0	0.974970435	0	0.243553107	0.01696818	0	0	0	0	0	0	0	0	0	0	0	0	0	60.4168
H5404_002_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1620.501895	49.21870952	778.4492516	645.5245009	188.3202911	2.33141828	2.591643934	258.3636265	27.20617476	168.0038693	184.1970862	0	0.750626939	69.97659813	11223.15233	19001.8592	406.9919284	1558.749867	7486.186068	23031.02803	4.481731026	17.10264628	0	2924.911305	525.8408968	350.5605978	15.66718998	1.928910473	492.9230769	2386.181164											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-14"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	47.76880759	20	125	0.2	0.145803683	45	0.199518882	37.5	21.28578724	0	0.2	41.16622632	4.867636014	17.50706601	25	25	4.364440937	15.33606276	0.2	0	0	4	0	10	10	0	0	0											NO	87.81979222	132.2528736	47.58203869	16.65412762	125	0.126446207	0.101691487	45	0.168003121	37.5	0	0	0.2	0	2.754781989	14.71627267	25	25	1.478213194	14.51138897	0.2	0	0	4	0	10	10	0	0	0												11.8593	0.542442981	3.086683534	0.895887285	1.961669699	0.294798999	0.263548125	0.968863599	4.57072228	0.525012091	0	0	0.150125388	0	2.576444824	23.3030451	0.847899851	3.247395555	0.922181585	27.85101719	0.896346205	0	0	0.974970435	0	0.292133832	0.013055992	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0436		11.4323105	11.8593	0.542442981	3.086683534	0.895887285	1.961669699	0.294798999	0.263548125	0.968863599	4.57072228	0.525012091	0	0	0.150125388	0	2.576444824	23.3030451	0.847899851	3.247395555	0.922181585	27.85101719	0.896346205	0	0	0.974970435	0	0.292133832	0.013055992	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0436	NO																																																																																		0			11.8593	0.542442981	3.086683534	0.895887285	1.961669699	0.294798999	0.263548125	0.968863599	4.57072228	0.525012091	0	0	0.150125388	0	2.576444824	23.3030451	0.847899851	3.247395555	0.922181585	27.85101719	0.896346205	0	0	0.974970435	0	0.292133832	0.013055992	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0436
H5404_003_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	988.3905277	30.0199009	538.6024567	632.0795831	143.7672753	2.215737784	2.463051542	290.0714577	25.85940956	319.7985232	350.6590706	0	0.713382273	133.2017699	7554.950353	12791.24605	273.9697122	1049.284329	5039.383093	15514.02091	4.262859537	11.16539464	0	2924.911305	498.1553809	332.1035873	10.16280276	1.25122225	724.5087501	2335.041515											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.145803683	45	0.199506748	37.5	21.00979502	0	0.2	40.770858	4.848055461	17.37250197	25	25	4.364440937	15.05292447	0.2	0	0	4	0	10	10	0	0	0											NO	72.7688013	132.2528736	65.99084125	16.94423414	125	0.127357258	0.102237869	45	0.168385143	37.5	9.993469613	0	0.2	16.60342121	3.265870127	15.79031664	25	25	1.80925091	14.63792627	0.2	0	0	4	0	10	10	0	0	0												5.9937	0.330851513	2.961902435	0.892508704	1.497575784	0.282190289	0.251817141	1.087767966	4.354340366	0.999370385	0.292025064	0	0.142676455	0.184300424	2.056123889	16.83148544	0.570770234	2.186009018	0.75979237	18.92442452	0.852571907	0	0	0.974970435	0	0.276752989	0.008469002	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7124		10.73048452	5.9937	0.330851513	2.961902435	0.892508704	1.497575784	0.282190289	0.251817141	1.087767966	4.354340366	0.999370385	0.292025064	0	0.142676455	0.184300424	2.056123889	16.83148544	0.570770234	2.186009018	0.75979237	18.92442452	0.852571907	0	0	0.974970435	0	0.276752989	0.008469002	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7124	NO																																																																																		0			5.9937	0.330851513	2.961902435	0.892508704	1.497575784	0.282190289	0.251817141	1.087767966	4.354340366	0.999370385	0.292025064	0	0.142676455	0.184300424	2.056123889	16.83148544	0.570770234	2.186009018	0.75979237	18.92442452	0.852571907	0	0	0.974970435	0	0.276752989	0.008469002	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7124
H5404_004_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1381.04243	41.94572461	487.509952	608.6158716	175.0113162	3.142667678	3.493442467	314.7164505	24.66040765	667.3060931	731.6249119	0	0.680388565	277.9448504	6038.755513	8173.534863	111.2333401	426.0157068	3679.024889	10564.87618	4.062356513	37.30712375	0	2924.911305	467.7048755	311.8032504	41.36273105	4.836689595	3537.09251	1952.435542											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.145803683	45	0.199518903	37.5	21.28626081	0	0.2	41.16690479	4.012868805	17.83135065	25	25	4.364440937	13.59634331	0.2	0	0	4	0	10	10	0	0	0											NO	91.38796683	132.2528736	65.98380583	17.04294357	125	0.152277501	0.117183211	45	0.169110655	37.5	16.36649537	0	0.2	30.37512676	1.902358077	15.72083993	25	25	1.103229914	13.02851476	0.2	0	0	4	0	10	10	0	0	0												10.5176	0.462286884	2.680646835	0.86438383	1.823034543	0.478557579	0.409372806	1.180186689	4.170337691	2.085331541	0.997844645	0	0.136077713	0.703550838	0.957322944	10.70790277	0.231736125	0.887532722	0.338234193	11.47038711	0.812471303	0	0	0.974970435	0	0.259836042	0.034468943	0	0	0	0	0	0	0	0	0	0	0	0	0	53.184		9.998397101	10.5176	0.462286884	2.680646835	0.86438383	1.823034543	0.478557579	0.409372806	1.180186689	4.170337691	2.085331541	0.997844645	0	0.136077713	0.703550838	0.957322944	10.70790277	0.231736125	0.887532722	0.338234193	11.47038711	0.812471303	0	0	0.974970435	0	0.259836042	0.034468943	0	0	0	0	0	0	0	0	0	0	0	0	0	53.184	NO																																																																																		0			10.5176	0.462286884	2.680646835	0.86438383	1.823034543	0.478557579	0.409372806	1.180186689	4.170337691	2.085331541	0.997844645	0	0.136077713	0.703550838	0.957322944	10.70790277	0.231736125	0.887532722	0.338234193	11.47038711	0.812471303	0	0	0.974970435	0	0.259836042	0.034468943	0	0	0	0	0	0	0	0	0	0	0	0	0	53.184
H5404_013_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1250.375862	37.97705301	561.1348243	574.4939348	139.1861837	3.382880134	3.760466689	305.6589952	23.63612027	453.6344031	496.783374	0	0.652972218	188.9467931	6923.22165	10921.01008	218.9658362	838.6234326	5267.35634	15815.81432	3.861921877	28.36047497	0	2924.911305	443.9238723	295.9492482	31.27046687	3.745051409	2694.48624	2046.985767											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.145803683	45	0.199647713	37.5	24.20884652	0	0.2	45.35811158	4.533219497	17.09022054	25	25	4.364440937	13.23376341	0.2	0	0	4	0	10	10	0	0	0											NO	79.65653198	132.2528736	65.97539235	16.27093629	125	0.147226318	0.114153881	45	0.161881989	37.5	15.58406318	0	0.2	26.46104143	2.532269915	15.08927096	25	25	1.652992862	12.78224815	0.2	0	0	4	0	10	10	0	0	0												8.3001	0.418547866	3.08509085	0.778962851	1.44985608	0.498048987	0.429271866	1.146221232	3.826262161	1.41760751	0.645158624	0	0.130594444	0.416644077	1.460955491	13.73250669	0.456178825	1.747132151	0.725575203	16.84680528	0.772384375	0	0	0.974970435	0	0.246624373	0.026058722	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5315		11.90180267	8.3001	0.418547866	3.08509085	0.778962851	1.44985608	0.498048987	0.429271866	1.146221232	3.826262161	1.41760751	0.645158624	0	0.130594444	0.416644077	1.460955491	13.73250669	0.456178825	1.747132151	0.725575203	16.84680528	0.772384375	0	0	0.974970435	0	0.246624373	0.026058722	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5315	NO																																																																																		0			8.3001	0.418547866	3.08509085	0.778962851	1.44985608	0.498048987	0.429271866	1.146221232	3.826262161	1.41760751	0.645158624	0	0.130594444	0.416644077	1.460955491	13.73250669	0.456178825	1.747132151	0.725575203	16.84680528	0.772384375	0	0	0.974970435	0	0.246624373	0.026058722	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5315
H5404_016_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1266.408968	38.46401866	484.9210323	620.3763631	175.6843713	2.653991438	2.950221705	226.6588326	25.12930813	231.1822931	253.357568	0	0.693670442	96.29153479	8304.461858	12310.01316	228.196287	873.9753965	5186.474811	14904.35342	4.126706348	12.86727375	0	2924.911305	448.0656012	298.7104008	24.12405666	2.610540442	1227.725728	2276.842817											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.145803683	45	0.199568389	37.5	22.4106757	0	0.2	42.77837391	4.237097873	16.95855319	25	25	4.364440937	14.07548117	0.2	0	0	4	0	10	10	0	0	0											NO	82.12400196	132.2528736	65.94663401	16.67857259	125	0.13530075	0.107001796	45	0.165402854	37.5	6.144849691	0	0.2	7.113503629	2.571168911	15.29262423	25	25	1.715840319	13.61464601	0.2	0	0	4	0	10	10	0	0	0												8.6669	0.42391475	2.664909154	0.86224935	1.830045535	0.359087033	0.31567902	0.849970622	4.156459276	0.722444666	0.129737014	0	0.138734088	0.057080849	1.779347846	15.68770046	0.475408931	1.820782076	0.741596883	16.90979131	0.82534127	0	0	0.974970435	0	0.248925334	0.020103381	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6612		11.44741699	8.6669	0.42391475	2.664909154	0.86224935	1.830045535	0.359087033	0.31567902	0.849970622	4.156459276	0.722444666	0.129737014	0	0.138734088	0.057080849	1.779347846	15.68770046	0.475408931	1.820782076	0.741596883	16.90979131	0.82534127	0	0	0.974970435	0	0.248925334	0.020103381	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6612	NO																																																																																		0			8.6669	0.42391475	2.664909154	0.86224935	1.830045535	0.359087033	0.31567902	0.849970622	4.156459276	0.722444666	0.129737014	0	0.138734088	0.057080849	1.779347846	15.68770046	0.475408931	1.820782076	0.741596883	16.90979131	0.82534127	0	0	0.974970435	0	0.248925334	0.020103381	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6612
H5404_022_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1355.058472	41.15652661	965.6769238	628.0052813	253.8552329	2.863025475	3.182587471	267.7989194	27.22209019	218.5360307	239.4573181	0	0.751581011	91.02414167	9881.914424	14649.63564	271.7050393	1040.610794	6141.51727	17671.32846	4.465058383	6.818230256	0	2924.911305	434.2231199	289.4820799	7.694780819	0.831132396	628.8914767	2399.593362											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-16"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	54.82379254	20	125	0.2	0.145803683	45	0.199587116	37.5	22.83564196	0	0.2	43.38775773	4.255270342	17.10336522	25	25	4.364440937	14.42302098	0.2	0	0	4	0	10	10	0	0	0											NO	78.88241179	132.2528736	54.66098036	16.24468221	125	0.13135585	0.104635932	45	0.163489603	37.5	3.138107382	0	0.2	0.205817955	2.653007544	15.50110242	25	25	1.804422732	13.9781649	0.2	0	0	4	0	10	10	0	0	0												8.9075	0.453589076	4.398737281	0.850145519	2.644325343	0.376075145	0.333013007	1.004245948	4.450528716	0.682925096	0.062620231	0	0.150316202	0.0015612	2.184732793	18.92379187	0.566052165	2.167939154	0.923491114	20.58439526	0.893011677	0	0	0.974970435	0	0.241235067	0.006412317	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7816		13.10199668	8.9075	0.453589076	4.398737281	0.850145519	2.644325343	0.376075145	0.333013007	1.004245948	4.450528716	0.682925096	0.062620231	0	0.150316202	0.0015612	2.184732793	18.92379187	0.566052165	2.167939154	0.923491114	20.58439526	0.893011677	0	0	0.974970435	0	0.241235067	0.006412317	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7816	NO																																																																																		0			8.9075	0.453589076	4.398737281	0.850145519	2.644325343	0.376075145	0.333013007	1.004245948	4.450528716	0.682925096	0.062620231	0	0.150316202	0.0015612	2.184732793	18.92379187	0.566052165	2.167939154	0.923491114	20.58439526	0.893011677	0	0	0.974970435	0	0.241235067	0.006412317	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7816
H5404_025_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1066.213263	32.38357267	393.2878543	523.6496379	91.05444769	2.730550969	3.035326573	272.2388436	28.02994826	1066.513279	1169.414469	0	0.773274241	444.22174	6817.858844	10599.40711	248.1340192	950.3354793	4508.076444	13623.06112	4.620207041	65.26170163	0	2924.911305	473.9635499	315.9757	69.60575285	7.594330054	5089.213425	1744.158528											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.145803683	45	0.199508475	37.5	21.04908881	0	0.2	40.82714355	4.74056548	18.2386979	25	25	4.364440937	14.00387962	0.2	0	0	4	0	10	10	0	0	0											NO	53.07795799	132.2528736	65.75229308	14.6192178	125	0.114008666	0.094232358	45	0.157624038	37.5	16.23019059	0	0.2	30.2556789	2.044347584	15.54248	25	25	0.19763101	13.31444949	0.2	0	0	4	0	10	10	0	0	0												4.716	0.356901712	2.154964855	0.637945676	0.94848383	0.311306473	0.286025979	1.020895663	4.418193632	3.332853997	1.581651643	0	0.154654848	1.120019194	1.161506104	13.72842276	0.516945873	1.979865582	0.074244642	15.1152966	0.924041408	0	0	0.974970435	0	0.263313083	0.058004794	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8365		15.6535814	4.716	0.356901712	2.154964855	0.637945676	0.94848383	0.311306473	0.286025979	1.020895663	4.418193632	3.332853997	1.581651643	0	0.154654848	1.120019194	1.161506104	13.72842276	0.516945873	1.979865582	0.074244642	15.1152966	0.924041408	0	0	0.974970435	0	0.263313083	0.058004794	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8365	NO																																																																																		0			4.716	0.356901712	2.154964855	0.637945676	0.94848383	0.311306473	0.286025979	1.020895663	4.418193632	3.332853997	1.581651643	0	0.154654848	1.120019194	1.161506104	13.72842276	0.516945873	1.979865582	0.074244642	15.1152966	0.924041408	0	0	0.974970435	0	0.263313083	0.058004794	0	0	0	0	0	0	0	0	0	0	0	0	0	55.8365
H5404_028_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1288.518189	39.1355312	441.1185375	492.1360766	97.60026386	3.081897538	3.425889352	203.7790728	26.34798578	935.0760998	1025.073342	0	0.727058179	389.4758183	7829.644903	10870.12116	198.3519928	759.6738924	4812.95766	13406.10155	4.336352245	60.89208769	0	2924.911305	501.9010822	334.6007214	60.74475654	6.691991264	5019.511354	1783.451718											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.145803683	45	0.199533796	37.5	21.62486608	0	0.2	41.65206178	4.135628465	17.66523575	25	25	4.364440937	12.95123911	0.2	0	0	4	0	10	10	0	0	0											NO	82.78683103	132.2528736	65.91758104	15.80066186	125	0.144118686	0.11229015	45	0.166851889	37.5	17.59267499	0	0.2	32.80835569	2.293675121	15.82328241	25	25	1.501827212	12.4373821	0.2	0	0	4	0	10	10	0	0	0												8.8894	0.431315538	2.423122245	0.648006311	1.016669415	0.444159024	0.384693629	0.764171523	4.396211209	2.922112812	1.502815178	0	0.145411636	1.064838432	1.496555143	14.33341642	0.413233318	1.582653942	0.602352565	13.89473395	0.867270449	0	0	0.974970435	0	0.278833935	0.05062063	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5275		11.48136555	8.8894	0.431315538	2.423122245	0.648006311	1.016669415	0.444159024	0.384693629	0.764171523	4.396211209	2.922112812	1.502815178	0	0.145411636	1.064838432	1.496555143	14.33341642	0.413233318	1.582653942	0.602352565	13.89473395	0.867270449	0	0	0.974970435	0	0.278833935	0.05062063	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5275	NO																																																																																		0			8.8894	0.431315538	2.423122245	0.648006311	1.016669415	0.444159024	0.384693629	0.764171523	4.396211209	2.922112812	1.502815178	0	0.145411636	1.064838432	1.496555143	14.33341642	0.413233318	1.582653942	0.602352565	13.89473395	0.867270449	0	0	0.974970435	0	0.278833935	0.05062063	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5275
H5404_034_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1159.071567	35.1767932	401.7305139	805.3650773	80.84243763	3.332596299	3.704570329	233.1295796	328.5665977	1274.001397	1391.848709	0	0.895357881	523.1883049	7937.231907	12081.17555	248.6039022	952.1350973	5084.431131	17023.1233	5.320029943	78.59941826	0	2924.911305	480	320	82.03369821	8.520230935	5955	1651.27764											3400	"$150 copay, days 1-10"	"$150 copay, days 1-10"	"$125 copay, days 6-20"	$0 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$50 copay to $150 copay	$37.5 copay to 20% coinsurance	$5 copay to $50 copay	$0 copay	20% coinsurance	Varies	$0 copay	$20 copay	"$20 copay Group, $20 copay Individual"	$20 copay	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											108.0927273	116.7739464	55.191596	0	125	0.2	0.145803683	45	116.2691652	37.5	20.91830334	0	0.2	28.73897977	0.830144096	9.758024935	20	20	2.199307829	14.56195525	0.2	0	0	4	0	10	10	0	0	0											NO	62.93590237	116.7739464	54.88977613	0	125	0.154671195	0.118618775	45	88.60870614	37.5	18.28360937	0	0.2	22.93938357	0	7.999761615	20	20	0	14.15719137	0.2	0	0	4	0	10	10	0	0	0												6.0789	0.34231108	1.837574831	0	0.842108725	0.515456653	0.439431593	0.874235923	2.426155092	3.981254366	2.120668174	0	0.179071576	1.000134767	0	8.053877035	0.414339837	1.586891829	0	20.08330119	1.064005989	0	0	0.974970435	0	0.266666667	0.068361415	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1498		10.07084047	6.0789	0.34231108	1.837574831	0	0.842108725	0.515456653	0.439431593	0.874235923	2.426155092	3.981254366	2.120668174	0	0.179071576	1.000134767	0	8.053877035	0.414339837	1.586891829	0	20.08330119	1.064005989	0	0	0.974970435	0	0.266666667	0.068361415	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1498	NO																																																																																		0			6.0789	0.34231108	1.837574831	0	0.842108725	0.515456653	0.439431593	0.874235923	2.426155092	3.981254366	2.120668174	0	0.179071576	1.000134767	0	8.053877035	0.414339837	1.586891829	0	20.08330119	1.064005989	0	0	0.974970435	0	0.266666667	0.068361415	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1498
H5404_037_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1310.186226	39.79364388	838.7739141	626.1297773	197.3535674	2.91471135	3.240042362	234.2357511	27.71147135	212.481623	232.8073447	0	0.765149218	88.50237323	10962.57208	16251.67754	301.4179187	1154.408989	6813.135883	19597.05993	4.543190476	20.82409971	0	2924.911305	426.5022648	284.3348432	11.67673726	1.261233405	937.0187365	2332.681774											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-16"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	54.82379254	20	125	0.2	0.145803683	45	0.199594505	37.5	23.00324783	0	0.2	43.62814969	4.263686597	17.16974466	25	25	4.364440937	14.56717976	0.2	0	0	4	0	10	10	0	0	0											NO	74.78048988	132.2528736	54.62901919	16.0988644	125	0.130832961	0.104322342	45	0.163219325	37.5	2.145472184	0	0.2	0	2.531253676	15.31628825	25	25	1.997226117	14.03114406	0.2	0	0	4	0	10	10	0	0	0												8.1647	0.438568646	3.818449687	0.839998199	2.055766327	0.381340317	0.338008807	0.878384066	4.523047643	0.664005072	0.041623474	0	0.153029844	0	2.312420906	20.74294814	0.627953997	2.405018727	1.133947744	22.91409758	0.908638095	0	0	0.974970435	0	0.236945703	0.009730614	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5636		13.4401302	8.1647	0.438568646	3.818449687	0.839998199	2.055766327	0.381340317	0.338008807	0.878384066	4.523047643	0.664005072	0.041623474	0	0.153029844	0	2.312420906	20.74294814	0.627953997	2.405018727	1.133947744	22.91409758	0.908638095	0	0	0.974970435	0	0.236945703	0.009730614	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5636	NO																																																																																		0			8.1647	0.438568646	3.818449687	0.839998199	2.055766327	0.381340317	0.338008807	0.878384066	4.523047643	0.664005072	0.041623474	0	0.153029844	0	2.312420906	20.74294814	0.627953997	2.405018727	1.133947744	22.91409758	0.908638095	0	0	0.974970435	0	0.236945703	0.009730614	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5636
H5404_086_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1313.409878	37.51607656	810.8277152	1139.731042	174.6235434	8.318376092	9.306784397	291.8144346	32.41428031	605.2002254	686.73189	0	0.940470352	259.8172624	12043.79416	19097.30204	397.6777957	1497.575408	8012.905997	23077.09636	5.58985577	7.905988703	0	2924.911305	256.5800561	171.0533707	1.183133341	0.138355801	492.9230769	2186.490356											3400	"$300 copay, days 1-7"	"$300 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$150 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$5 copay to $50 copay	$0 copay	20% coinsurance	Varies	$15 copay	$35 copay	"$35 copay Group, $35 copay Individual"	$35 copay	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											192.9872727	198.3793103	66.2299152	20	150	0.2	0.2	45	0.199564345	37.5	19.60128967	0	0.2	50.21542502	10.91507218	22.9758381	35	35	2.233493079	15.13427232	0.2	37.56055413	0	4	0	10	10	0	0	0											NO	47.8817498	198.3793103	65.68462843	14.16285577	150	0.134073661	0.160716823	45	0.114971986	37.5	0.435728531	0	0.2	7.895884185	6.985987238	18.80836207	35	35	0	13.97322094	0.2	37.56055413	0	4	0	10	10	0	0	0												5.2407	0.620201116	4.438243099	1.345153864	2.182794293	1.115275134	1.495756823	1.09430413	3.726734185	1.891250704	0.024935723	0	0.18809407	0.170957251	7.011482692	29.93241429	1.159893571	4.367928274	0	26.87178051	1.117971154	0.02474611	0	0.974970435	0	0.142544476	0.000985944	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1391		36.56000563	5.2407	0.620201116	4.438243099	1.345153864	2.182794293	1.115275134	1.495756823	1.09430413	3.726734185	1.891250704	0.024935723	0	0.18809407	0.170957251	7.011482692	29.93241429	1.159893571	4.367928274	0	26.87178051	1.117971154	0.02474611	0	0.974970435	0	0.142544476	0.000985944	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1391	NO																																																																																		0			5.2407	0.620201116	4.438243099	1.345153864	2.182794293	1.115275134	1.495756823	1.09430413	3.726734185	1.891250704	0.024935723	0	0.18809407	0.170957251	7.011482692	29.93241429	1.159893571	4.367928274	0	26.87178051	1.117971154	0.02474611	0	0.974970435	0	0.142544476	0.000985944	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1391
H5404_110_0	2010	5	N/A																															Coin	Coin	Coin	V	T	P	P	Coin	V	V	V	V	V	V	V	V	Coin	V	V	V	S	O	T	V	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	0	0	0	0	0											0	YES	448.9892157	14.1627593	110.9644692	7544.960926	624.0435381	2317.84475	2606.564917	23.52898919	236.9657628	1457.752445	2211.806345	0	1004.310497	612.9945487	12986.78331	14627.1555	8.977009204	1392.77558	5675.970883	15050.2108	199.3555499	74.29122813	0	2924.911305	496.2665301	330.8443534	191.2557124	29.90379172	5955	1711.539057											3400	"$0 copay, days 1-1"	"$0 copay, days 1-1"	"$0 copay, days 1-1"	$0 copay	$0 copay	$0 copay	$0 copay	"$0 copay, waived if admitted"	$0 copay	$0 copay	0% coinsurance	$0 copay	$0 copay	Varies	$0 copay	$0 copay	"$0 copay Group, $0 copay Individual"	$0 copay	0% coinsurance	Varies	$0 copay	Varies	Not Covered	$4 copay	$0 copay	$0 copay; and $85 credit covered every 2 years	$0 copay	$250 credit	Varies	Varies											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.974970435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.975		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.974970435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.975	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.974970435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.975
H5404_111_0	2010	5	N/A																															Coin	Coin	Coin	V	T	P	P	Coin	V	V	V	V	V	V	V	V	Coin	V	V	V	S	O	T	V	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	0	0	0	0	0											0	YES	285.0134175	8.65692864	97.74137142	4352.69295	386.5200232	1360.879521	1534.754218	13.22363593	237.4603856	1042.70153	1593.410789	0	724.7592098	441.5126231	9280.599765	10922.76291	5.630457476	1013.062221	4479.192127	10705.31702	406.4841714	55.67408387	0	2924.911305	554.0621989	369.3747993	126.2517333	22.04904626	5955	1436.40303											3400	"$0 copay, days 1-1"	"$0 copay, days 1-1"	"$0 copay, days 11-100"	$0 copay	$0 copay	$0 copay	$0 copay	"$0 copay, waived if admitted"	$0 copay	$0 copay	0% coinsurance	$0 copay	$0 copay	Varies	$0 copay	$0 copay	"$0 copay Group, $0 copay Individual"	$0 copay	0% coinsurance	Varies	$0 copay	Varies	Not Covered	$4 copay	$0 copay	$0 copay; and $80 credit covered every 2 years	$0 copay	$250 credit	Varies	Varies											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.974970435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.975		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.974970435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.975	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.974970435	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.975
H5404_112_0	2010	4	N/A																															D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	Coin	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	4437.870449	607.8729996	14450.40652	313.8928127	96.25520783	8.21330955	63.70792688	492.3658863	19.28705761	21.43889611	34.4655774	0	10.89552851	2853.727168	183.1958284	160.8968411	16.39768871	2.139331733	48.59454288	30263.613	3.599256	133.477653	0	2924.911305	480	320	255.8882356	44.06935685	5955	1736.007732											3400	"$275 copay, days 1-10"	"$275 copay, days 1-8"	"$149 copay, days 7-100"	$0 copay	25% coinsurance	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	25% coinsurance	20% coinsurance	20% coinsurance	$0 copay	20% coinsurance	Varies	25% coinsurance	25% coinsurance	"50% coinsurance Group, 50% coinsurance Individual"	25% coinsurance	0-20% coinsurance	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$0 copay; and $100 credit covered every 2 years	$0 copay	$250 credit	Varies	Varies											181.6558333	115.3824138	121.5737087	0	0.25	0.2	0.2	45	0.25	0.2	0.20471531	0	0.2	119.8320406	0.026395265	0.08082294	0.5	0.25	0.058004016	3.514873868	0.2	96.69599361	0	4	0	0	0	0	0	0.441723698											NO	37.05100982	115.3824138	38.07163417	0	0.25	0.062631361	0.062631361	45	0.078289201	0.2	0.064107992	0	0.2	37.52621894	0	0.055363687	0.5	0.25	0.018164352	1.10070667	0.2	96.69599361	0	4	0	0	0	0	0	0.441723698												13.7023	5.844821165	45.84588254	0	24.06380196	0.514410755	3.990114164	1.846372074	1.509968333	4.287779223	2.209518973	0	2.179105701	8.924132543	0	8.907842303	8.198844353	0.534832933	0.882688401	2.775946723	0.7198512	1.075562857	0	0.974970435	0	0	0	0	0	0.06390298	0	0	0	0	0	0	0	0	0	0	139.0526		208.5984517	13.7023	5.844821165	45.84588254	0	24.06380196	0.514410755	3.990114164	1.846372074	1.509968333	4.287779223	2.209518973	0	2.179105701	8.924132543	0	8.907842303	8.198844353	0.534832933	0.882688401	2.775946723	0.7198512	1.075562857	0	0.974970435	0	0	0	0	0	0.06390298	0	0	0	0	0	0	0	0	0	0	139.0526	NO																																																																																		0			13.7023	5.844821165	45.84588254	0	24.06380196	0.514410755	3.990114164	1.846372074	1.509968333	4.287779223	2.209518973	0	2.179105701	8.924132543	0	8.907842303	8.198844353	0.534832933	0.882688401	2.775946723	0.7198512	1.075562857	0	0.974970435	0	0	0	0	0	0.06390298	0	0	0	0	0	0	0	0	0	0	139.0526
H5404_113_0	2010	4	N/A																															D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	Coin	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	2938.282963	394.6923397	14898.48815	174.3304553	53.51402835	4.545710015	35.30114309	405.173572	11.62086855	13.1618836	21.15928365	0	6.591478824	2306.469097	97.73728649	100.278756	10.79117219	1.363085793	36.14258241	20793.32042	2.187232595	108.4318828	0	2924.911305	496.7122709	331.141514	177.9614185	39.43471963	5955	1609.396774											3400	"$265 copay, days 1-10"	"$265 copay, days 1-8"	"$139 copay, days 16-100"	$0 copay	25% coinsurance	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	25% coinsurance	20% coinsurance	20% coinsurance	$0 copay	20% coinsurance	Varies	25% coinsurance	25% coinsurance	"50% coinsurance Group, 50% coinsurance Individual"	25% coinsurance	0-20% coinsurance	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$0 copay; and $100 credit covered every 2 years	$0 copay	$250 credit	Varies	Varies											175.0501667	111.1866897	75.03599853	0	0.25	0.2	0.2	45	0.25	0.2	0.204886637	0	0.2	86.77743248	0.032147437	0.092369108	0.5	0.25	0.05797989	3.366725051	0.2	70.00380858	0	4	0	0	0	0	0	0.278387105											NO	57.99090043	111.1866897	31.72782917	0	0.25	0.084566954	0.084566954	45	0.105708692	0.2	0.086633194	0	0.2	36.6925157	0	0.070389561	0.5	0.25	0.024515913	1.423568413	0.2	70.00380858	0	4	0	0	0	0	0	0.278387105												14.1995	3.657044557	39.39139058	0	13.37850709	0.38441685	2.985310143	1.519400895	1.22842682	2.63237672	1.83309633	0	1.318295765	7.052512795	0	7.058577639	5.395586093	0.340771448	0.886068421	2.466726178	0.437446519	0.63255373	0	0.974970435	0	0	0	0	0	0.037336276	0	0	0	0	0	0	0	0	0	0	107.8103		110.7594421	14.1995	3.657044557	39.39139058	0	13.37850709	0.38441685	2.985310143	1.519400895	1.22842682	2.63237672	1.83309633	0	1.318295765	7.052512795	0	7.058577639	5.395586093	0.340771448	0.886068421	2.466726178	0.437446519	0.63255373	0	0.974970435	0	0	0	0	0	0.037336276	0	0	0	0	0	0	0	0	0	0	107.8103	NO																																																																																		0			14.1995	3.657044557	39.39139058	0	13.37850709	0.38441685	2.985310143	1.519400895	1.22842682	2.63237672	1.83309633	0	1.318295765	7.052512795	0	7.058577639	5.395586093	0.340771448	0.886068421	2.466726178	0.437446519	0.63255373	0	0.974970435	0	0	0	0	0	0.037336276	0	0	0	0	0	0	0	0	0	0	107.8103
H5404_114_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1034.259752	31.41306436	483.7103944	491.1786067	73.66278737	3.228112724	3.588424623	182.582677	25.93940785	980.6266475	1074.392764	0	0.716248698	408.4484312	6708.507798	9305.61909	173.7500757	665.4503161	4520.687516	12639.58315	4.251596984	61.53386829	0	2924.911305	480	320	69.90000804	8.217421484	5955	1628.902006											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.145803683	45	0.199598458	37.5	23.09288237	0	0.2	43.75672101	4.194327601	18.02762516	25	25	4.364440937	14.34070258	0.2	0	0	4	0	10	10	0	0	0											NO	72.02584806	132.2528736	65.94765388	15.83045556	125	0.147131363	0.114096934	45	0.166701423	37.5	19.280513	0	0.2	35.39992949	2.062885526	15.89618308	25	25	1.344264584	13.80060275	0.2	0	0	4	0	10	10	0	0	0												6.2078	0.346205669	2.658297139	0.647965092	0.767320702	0.474956626	0.409428246	0.684685039	4.324136198	3.064458273	1.726236972	0	0.14324974	1.204920472	1.153240303	12.3269854	0.361979324	1.386354825	0.506416677	14.5361555	0.850319397	0	0	0.974970435	0	0.266666667	0.058250007	0	0	0	0	0	0	0	0	0	0	0	0	0	55.081		11.37772795	6.2078	0.346205669	2.658297139	0.647965092	0.767320702	0.474956626	0.409428246	0.684685039	4.324136198	3.064458273	1.726236972	0	0.14324974	1.204920472	1.153240303	12.3269854	0.361979324	1.386354825	0.506416677	14.5361555	0.850319397	0	0	0.974970435	0	0.266666667	0.058250007	0	0	0	0	0	0	0	0	0	0	0	0	0	55.081	NO																																																																																		0			6.2078	0.346205669	2.658297139	0.647965092	0.767320702	0.474956626	0.409428246	0.684685039	4.324136198	3.064458273	1.726236972	0	0.14324974	1.204920472	1.153240303	12.3269854	0.361979324	1.386354825	0.506416677	14.5361555	0.850319397	0	0	0.974970435	0	0.266666667	0.058250007	0	0	0	0	0	0	0	0	0	0	0	0	0	55.081
H5404_116_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1135.818623	25.7825175	1191.605412	2261.872658	190.2084548	7.004499761	8.012022731	197.9891067	28.81086191	1077.957951	1328.084371	0	1.02054881	502.3508218	7343.986859	9966.290271	183.4339071	639.6659057	4261.449763	10581.42315	5.959644233	77.32869136	0	2924.911305	480	320	173.829639	21.28841801	5955	1886.339112											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.146810684	45	0.199808484	37.5	24.276133	0	0.2	42.37007025	4.519150488	19.38540867	25	25	4.647760335	14.80050906	0.2	0	0	4	0	10	10	0	0	0											NO	49.58464655	132.2528736	66.05420884	18.60923376	125	0.162704214	0.125073492	45	0.154471708	37.5	19.5456414	0	0.2	31.96142325	1.466846577	16.32096417	25	25	0	13.79694497	0.2	0	0	4	0	10	10	0	0	0												4.6933	0.284151002	6.559212726	3.507643086	1.981338071	1.139661631	1.002091658	0.74245915	4.45046304	3.368618598	2.163188406	0	0.204109762	1.33798727	0.897708499	13.55495554	0.382153973	1.332637304	0	12.16594273	1.191928847	0	0	0.974970435	0	0.266666667	0.144858033	0	0	0	0	0	0	0	0	0	0	0	0	0	62.346		17.41588809	4.6933	0.284151002	6.559212726	3.507643086	1.981338071	1.139661631	1.002091658	0.74245915	4.45046304	3.368618598	2.163188406	0	0.204109762	1.33798727	0.897708499	13.55495554	0.382153973	1.332637304	0	12.16594273	1.191928847	0	0	0.974970435	0	0.266666667	0.144858033	0	0	0	0	0	0	0	0	0	0	0	0	0	62.346	NO																																																																																		0			4.6933	0.284151002	6.559212726	3.507643086	1.981338071	1.139661631	1.002091658	0.74245915	4.45046304	3.368618598	2.163188406	0	0.204109762	1.33798727	0.897708499	13.55495554	0.382153973	1.332637304	0	12.16594273	1.191928847	0	0	0.974970435	0	0.266666667	0.144858033	0	0	0	0	0	0	0	0	0	0	0	0	0	62.346
H5404_117_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	928.0080871	19.82814183	1011.69008	1973.895095	161.1699897	6.042514701	6.937848194	199.156585	24.88619902	1083.732498	1329.026506	0	0.872902624	502.5679845	6599.340508	9421.580934	185.4258281	649.8728276	3923.816748	10013.29988	5.112274738	77.2938266	0	2924.911305	480	320	159.4927558	20.4155173	5955	1857.203319											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.146943248	45	0.199737217	37.5	21.92772414	0	0.2	39.77743746	4.74149003	19.39132053	25	25	4.659522426	15.24510707	0.2	0	0	4	0	10	10	0	0	0											NO	50.30553558	132.2528736	66.06238209	18.71200158	125	0.164937697	0.12658492	45	0.157170556	37.5	18.10180533	0	0.2	31.34616105	2.096642413	16.74647292	25	25	0.339963322	14.39877476	0.2	0	0	4	0	10	10	0	0	0												3.8903	0.218527395	5.56955472	3.077960678	1.678854059	0.996638461	0.87822696	0.746837194	3.911377728	3.386664055	2.004814923	0	0.174580525	1.312798082	1.153038101	13.14818749	0.386303808	1.353901724	0.111162815	12.01493747	1.022454948	0	0	0.974970435	0	0.266666667	0.13291063	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4117		14.12429863	3.8903	0.218527395	5.56955472	3.077960678	1.678854059	0.996638461	0.87822696	0.746837194	3.911377728	3.386664055	2.004814923	0	0.174580525	1.312798082	1.153038101	13.14818749	0.386303808	1.353901724	0.111162815	12.01493747	1.022454948	0	0	0.974970435	0	0.266666667	0.13291063	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4117	NO																																																																																		0			3.8903	0.218527395	5.56955472	3.077960678	1.678854059	0.996638461	0.87822696	0.746837194	3.911377728	3.386664055	2.004814923	0	0.174580525	1.312798082	1.153038101	13.14818749	0.386303808	1.353901724	0.111162815	12.01493747	1.022454948	0	0	0.974970435	0	0.266666667	0.13291063	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4117
H5404_118_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	911.3651037	19.47254209	993.5463362	1938.495076	158.2795521	5.802621673	6.662409656	195.5848922	23.90020374	1064.296738	1305.273688	0	0.83824764	493.5548835	6480.987322	9252.613425	182.100384	638.2179478	3853.446653	9838.035774	4.911849469	75.90763192	0	2924.911305	480	320	156.6323979	20.04938351	5955	1850.797202											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.146943248	45	0.199728836	37.5	21.61496351	0	0.2	39.41962804	4.725724688	19.26412097	25	25	4.659522426	14.95964713	0.2	0	0	4	0	10	10	0	0	0											NO	53.60758411	132.2528736	66.06944251	18.76628224	125	0.165654091	0.127000882	45	0.158035402	37.5	17.95051241	0	0.2	31.34367447	2.192339997	16.73073628	25	25	0.522004318	14.14933776	0.2	0	0	4	0	10	10	0	0	0												4.0713	0.214608304	5.470254378	3.031528811	1.648745334	0.961228018	0.846131903	0.733443346	3.777078298	3.325927306	1.952527628	0	0.167649528	1.289151967	1.184043977	12.90025293	0.3793758	1.329620725	0.167626316	11.60014092	0.982369894	0	0	0.974970435	0	0.266666667	0.130526998	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4052		13.28642109	4.0713	0.214608304	5.470254378	3.031528811	1.648745334	0.961228018	0.846131903	0.733443346	3.777078298	3.325927306	1.952527628	0	0.167649528	1.289151967	1.184043977	12.90025293	0.3793758	1.329620725	0.167626316	11.60014092	0.982369894	0	0	0.974970435	0	0.266666667	0.130526998	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4052	NO																																																																																		0			4.0713	0.214608304	5.470254378	3.031528811	1.648745334	0.961228018	0.846131903	0.733443346	3.777078298	3.325927306	1.952527628	0	0.167649528	1.289151967	1.184043977	12.90025293	0.3793758	1.329620725	0.167626316	11.60014092	0.982369894	0	0	0.974970435	0	0.266666667	0.130526998	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4052
H5404_119_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1014.895662	22.93090447	1032.532227	1974.786799	173.6493635	7.175209211	8.205441287	187.9351135	22.26050566	1022.679803	1254.460393	0	0.780781589	474.2988298	6242.117608	8245.964237	139.7341367	478.2226515	3679.865922	8798.421961	4.578399255	72.9472954	0	2924.911305	480	320	151.205323	19.28267244	5955	1838.420037											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.146802794	45	0.199717655	37.5	21.18994115	0	0.2	38.93226125	4.446154344	19.51716556	25	25	4.661625005	13.15643966	0.2	0	0	4	0	10	10	0	0	0											NO	69.2991469	132.2528736	66.09391256	18.9333499	125	0.175536061	0.13254121	45	0.160290455	37.5	17.83167404	0	0.2	31.53043492	2.023005715	17.09401693	25	25	0.845532093	12.35841529	0.2	0	0	4	0	10	10	0	0	0												5.861	0.252723167	5.687007894	3.115777453	1.808847536	1.259507964	1.087559119	0.704756676	3.568146588	3.195874384	1.864094069	0	0.156156318	1.246237365	1.052319966	11.74638769	0.291112785	0.996297191	0.259287061	9.061212711	0.915679851	0	0	0.974970435	0	0.266666667	0.126004436	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4976		11.70225855	5.861	0.252723167	5.687007894	3.115777453	1.808847536	1.259507964	1.087559119	0.704756676	3.568146588	3.195874384	1.864094069	0	0.156156318	1.246237365	1.052319966	11.74638769	0.291112785	0.996297191	0.259287061	9.061212711	0.915679851	0	0	0.974970435	0	0.266666667	0.126004436	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4976	NO																																																																																		0			5.861	0.252723167	5.687007894	3.115777453	1.808847536	1.259507964	1.087559119	0.704756676	3.568146588	3.195874384	1.864094069	0	0.156156318	1.246237365	1.052319966	11.74638769	0.291112785	0.996297191	0.259287061	9.061212711	0.915679851	0	0	0.974970435	0	0.266666667	0.126004436	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4976
H5404_120_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1010.517077	22.43852509	1122.222681	1973.964371	200.7573965	6.520698874	7.436697169	169.1467038	24.96494399	922.0745341	1149.615744	0	0.87502664	434.5954695	6584.477082	9127.745495	173.9130167	606.5325914	4155.515038	10618.6053	5.28840813	67.03384257	0	2924.911305	480	320	158.9268182	20.16055361	5955	1855.371839											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.14670731	45	0.199834258	37.5	24.02754762	0	0.2	42.46377221	4.578070991	18.95755633	25	25	4.639589906	12.98724016	0.2	0	0	4	0	10	10	0	0	0											NO	58.7295985	132.2528736	66.08313683	18.74832077	125	0.168424011	0.128249518	45	0.15859693	37.5	19.72911971	0	0.2	32.98840807	1.957213052	16.33669839	25	25	0.675748801	12.21162977	0.2	0	0	4	0	10	10	0	0	0												4.9456	0.247296618	6.179999583	3.084043102	2.09122288	1.098242258	0.953752824	0.634300139	3.959363483	2.881482919	1.890075553	0	0.175005328	1.194717724	1.073935374	12.42643543	0.362318785	1.263609565	0.234007025	10.80587305	1.057681626	0	0	0.974970435	0	0.266666667	0.132439015	0	0	0	0	0	0	0	0	0	0	0	0	0	57.933		13.7265011	4.9456	0.247296618	6.179999583	3.084043102	2.09122288	1.098242258	0.953752824	0.634300139	3.959363483	2.881482919	1.890075553	0	0.175005328	1.194717724	1.073935374	12.42643543	0.362318785	1.263609565	0.234007025	10.80587305	1.057681626	0	0	0.974970435	0	0.266666667	0.132439015	0	0	0	0	0	0	0	0	0	0	0	0	0	57.933	NO																																																																																		0			4.9456	0.247296618	6.179999583	3.084043102	2.09122288	1.098242258	0.953752824	0.634300139	3.959363483	2.881482919	1.890075553	0	0.175005328	1.194717724	1.073935374	12.42643543	0.362318785	1.263609565	0.234007025	10.80587305	1.057681626	0	0	0.974970435	0	0.266666667	0.132439015	0	0	0	0	0	0	0	0	0	0	0	0	0	57.933
H5404_121_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1008.250435	22.43492898	1120.698629	1950.453617	186.6852811	6.111556163	6.982078007	180.8741474	22.69089727	985.097276	1218.033685	0	0.80790454	460.4460563	6617.791086	8929.859883	162.6515984	563.872876	4187.464448	10040.70856	4.737303092	70.91596451	0	2924.911305	480	320	158.9142955	20.001174	5955	1854.856262											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.146767688	45	0.199755501	37.5	22.00046958	0	0.2	39.74079412	4.53273474	19.4975947	25	25	4.635331983	13.79102449	0.2	0	0	4	0	10	10	0	0	0											NO	60.34774894	132.2528736	66.08666035	18.76532176	125	0.167163537	0.127606068	45	0.155534709	37.5	18.04625603	0	0.2	31.0239473	1.951227249	16.91608721	25	25	0.801376812	12.99155148	0.2	0	0	4	0	10	10	0	0	0												5.0705	0.247256986	6.171935806	3.050074141	1.944638345	1.021629346	0.89095552	0.678278053	3.529222107	3.078428988	1.831745645	0	0.161580908	1.190404515	1.076067858	12.58819072	0.338857497	1.174735158	0.279644742	10.87036518	0.947460618	0	0	0.974970435	0	0.266666667	0.13242858	0	0	0	0	0	0	0	0	0	0	0	0	0	57.516		13.37879248	5.0705	0.247256986	6.171935806	3.050074141	1.944638345	1.021629346	0.89095552	0.678278053	3.529222107	3.078428988	1.831745645	0	0.161580908	1.190404515	1.076067858	12.58819072	0.338857497	1.174735158	0.279644742	10.87036518	0.947460618	0	0	0.974970435	0	0.266666667	0.13242858	0	0	0	0	0	0	0	0	0	0	0	0	0	57.516	NO																																																																																		0			5.0705	0.247256986	6.171935806	3.050074141	1.944638345	1.021629346	0.89095552	0.678278053	3.529222107	3.078428988	1.831745645	0	0.161580908	1.190404515	1.076067858	12.58819072	0.338857497	1.174735158	0.279644742	10.87036518	0.947460618	0	0	0.974970435	0	0.266666667	0.13242858	0	0	0	0	0	0	0	0	0	0	0	0	0	57.516
H5404_122_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1075.985553	24.42433659	1128.833585	2142.720901	180.1885841	6.314779397	7.223093411	187.5593639	25.97930533	1021.172887	1258.33408	0	0.920057223	475.8878011	6957.117627	9441.282378	173.7709085	605.9693507	4036.96355	10033.49058	5.379669465	73.25514221	0	2924.911305	480	320	164.6725776	20.16697892	5955	1865.987399											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.146810684	45	0.199787751	37.5	23.47891413	0	0.2	41.46507622	4.486736508	19.10958227	25	25	4.647760335	14.19551401	0.2	0	0	4	0	10	10	0	0	0											NO	57.18139208	132.2528736	66.07110285	18.74501123	125	0.164513267	0.126127866	45	0.156659021	37.5	19.20486527	0	0.2	32.04727275	1.753654145	16.37649991	25	25	0.20697931	13.30214241	0.2	0	0	4	0	10	10	0	0	0												5.1272	0.269182392	6.215273324	3.347110612	1.876964417	1.03886499	0.911033359	0.703347615	4.069892542	3.191165272	2.013844705	0	0.184011445	1.270908847	1.016698181	12.88459666	0.362022726	1.262436147	0.069630661	11.12224338	1.075933893	0	0	0.974970435	0	0.266666667	0.137227148	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3912		14.93939261	5.1272	0.269182392	6.215273324	3.347110612	1.876964417	1.03886499	0.911033359	0.703347615	4.069892542	3.191165272	2.013844705	0	0.184011445	1.270908847	1.016698181	12.88459666	0.362022726	1.262436147	0.069630661	11.12224338	1.075933893	0	0	0.974970435	0	0.266666667	0.137227148	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3912	NO																																																																																		0			5.1272	0.269182392	6.215273324	3.347110612	1.876964417	1.03886499	0.911033359	0.703347615	4.069892542	3.191165272	2.013844705	0	0.184011445	1.270908847	1.016698181	12.88459666	0.362022726	1.262436147	0.069630661	11.12224338	1.075933893	0	0	0.974970435	0	0.266666667	0.137227148	0	0	0	0	0	0	0	0	0	0	0	0	0	59.3912
H5404_123_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	962.0030313	20.96746337	982.9485747	1885.580965	162.4116402	5.923360659	6.796549472	196.577038	23.23876957	1069.697663	1312.040557	0	0.814977068	496.0682384	6659.379523	9428.861664	180.6160602	632.2223089	4035.934158	10121.04683	4.779062788	76.29442272	0	2924.911305	480	320	161.5901157	20.15461391	5955	1860.264849											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.146920108	45	0.199716789	37.5	21.16373063	0	0.2	38.90323305	4.751275099	19.78687256	25	25	4.647658841	14.89149511	0.2	0	0	4	0	10	10	0	0	0											NO	54.07001254	132.2528736	66.05975488	18.66943784	125	0.164703558	0.126412294	45	0.154733005	37.5	17.33933255	0	0.2	30.47400733	2.152189778	17.18778724	25	25	0.503417645	14.06520289	0.2	0	0	4	0	10	10	0	0	0												4.3346	0.23108394	5.411111825	2.933561384	1.691787919	0.975598574	0.85916741	0.737163892	3.595804659	3.342805197	1.895825628	0	0.162995414	1.259765594	1.194354045	13.50510568	0.376283459	1.31712981	0.169313372	11.86288143	0.955812558	0	0	0.974970435	0	0.266666667	0.13465843	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1885		13.93823717	4.3346	0.23108394	5.411111825	2.933561384	1.691787919	0.975598574	0.85916741	0.737163892	3.595804659	3.342805197	1.895825628	0	0.162995414	1.259765594	1.194354045	13.50510568	0.376283459	1.31712981	0.169313372	11.86288143	0.955812558	0	0	0.974970435	0	0.266666667	0.13465843	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1885	NO																																																																																		0			4.3346	0.23108394	5.411111825	2.933561384	1.691787919	0.975598574	0.85916741	0.737163892	3.595804659	3.342805197	1.895825628	0	0.162995414	1.259765594	1.194354045	13.50510568	0.376283459	1.31712981	0.169313372	11.86288143	0.955812558	0	0	0.974970435	0	0.266666667	0.13465843	0	0	0	0	0	0	0	0	0	0	0	0	0	58.1885
H5404_124_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1050.600244	23.69397284	1086.606751	1953.706606	187.54785	6.892328891	7.873784329	194.4075546	24.44033775	1057.971117	1298.362212	0	0.858399662	490.96601	6673.454858	8857.582767	160.3432274	554.8355663	3955.569853	9477.333366	5.027252634	75.51902754	0	2924.911305	480	320	159.278904	20.06767904	5955	1855.734134											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.146766446	45	0.199741009	37.5	22.01482051	0	0.2	39.86685878	4.47410625	19.52210115	25	25	4.652166456	13.21183194	0.2	0	0	4	0	10	10	0	0	0											NO	62.63196661	132.2528736	66.08110791	18.75855203	125	0.170674824	0.129653221	45	0.158391589	37.5	18.27869037	0	0.2	31.63334551	1.871334136	16.91932904	25	25	0.564386123	12.35877021	0.2	0	0	4	0	10	10	0	0	0												5.4834	0.261132999	5.983681498	3.054058918	1.953623437	1.17634702	1.020861503	0.72902833	3.871143921	3.306159741	1.977696737	0	0.171679932	1.294241452	1.040688657	12.48869644	0.33404839	1.15590743	0.186039061	9.760682108	1.005450527	0	0	0.974970435	0	0.266666667	0.13273242	0	0	0	0	0	0	0	0	0	0	0	0	0	57.629		13.47458388	5.4834	0.261132999	5.983681498	3.054058918	1.953623437	1.17634702	1.020861503	0.72902833	3.871143921	3.306159741	1.977696737	0	0.171679932	1.294241452	1.040688657	12.48869644	0.33404839	1.15590743	0.186039061	9.760682108	1.005450527	0	0	0.974970435	0	0.266666667	0.13273242	0	0	0	0	0	0	0	0	0	0	0	0	0	57.629	NO																																																																																		0			5.4834	0.261132999	5.983681498	3.054058918	1.953623437	1.17634702	1.020861503	0.72902833	3.871143921	3.306159741	1.977696737	0	0.171679932	1.294241452	1.040688657	12.48869644	0.33404839	1.15590743	0.186039061	9.760682108	1.005450527	0	0	0.974970435	0	0.266666667	0.13273242	0	0	0	0	0	0	0	0	0	0	0	0	0	57.629
H5404_125_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1013.63134	22.58678297	1113.181308	1971.868456	171.0389824	7.356419658	8.425746707	180.2939611	25.18881584	981.9912667	1214.424284	0	0.898082707	459.223237	6668.563463	8769.411796	161.7723995	560.4220845	3996.981387	9786.146126	5.253172516	70.73393297	0	2924.911305	480	320	158.8679037	20.02945453	5955	1854.858098											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.146857273	45	0.199797827	37.5	23.62869315	0	0.2	41.56925432	4.486849349	19.80141448	25	25	4.648643042	14.0255923	0.2	0	0	4	0	10	10	0	0	0											NO	58.48456011	132.2528736	66.08096855	18.73872453	125	0.171826543	0.130458665	45	0.15865739	37.5	19.5328111	0	0.2	32.54289158	1.80183694	17.11640207	25	25	0.50039704	13.17845279	0.2	0	0	4	0	10	10	0	0	0												4.9401	0.248930579	6.130008249	3.07919165	1.781656067	1.264028156	1.099211666	0.676102354	3.996391791	3.068722708	1.976760011	0	0.179616541	1.245371001	1.001305332	12.50839818	0.337025832	1.167546009	0.166673138	10.74718872	1.050634503	0	0	0.974970435	0	0.266666667	0.13238992	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0389		13.81705171	4.9401	0.248930579	6.130008249	3.07919165	1.781656067	1.264028156	1.099211666	0.676102354	3.996391791	3.068722708	1.976760011	0	0.179616541	1.245371001	1.001305332	12.50839818	0.337025832	1.167546009	0.166673138	10.74718872	1.050634503	0	0	0.974970435	0	0.266666667	0.13238992	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0389	NO																																																																																		0			4.9401	0.248930579	6.130008249	3.07919165	1.781656067	1.264028156	1.099211666	0.676102354	3.996391791	3.068722708	1.976760011	0	0.179616541	1.245371001	1.001305332	12.50839818	0.337025832	1.167546009	0.166673138	10.74718872	1.050634503	0	0	0.974970435	0	0.266666667	0.13238992	0	0	0	0	0	0	0	0	0	0	0	0	0	58.0389
H5404_127_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1076.062028	24.42607253	1128.913816	2142.873193	180.2013909	6.390909073	7.310173533	187.5726946	26.29121789	1021.245466	1258.373725	0	0.931149243	475.9216245	6957.6121	9441.953411	173.7832591	606.0124195	4037.250475	10031.96719	5.442887779	73.26034877	0	2924.911305	480	320	164.6842816	20.16841228	5955	1866.013411											3400	"$200 copay, days 1-7"	"$200 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$10 copay to $50 copay	$0 copay	20% coinsurance	Varies	$5 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$10 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	20	125	0.2	0.146810684	45	0.199792642	37.5	23.66703085	0	0.2	41.67860423	4.494384396	19.17466188	25	25	4.647760335	14.33829391	0.2	0	0	4	0	10	10	0	0	0											NO	56.51176401	132.2528736	66.06961502	18.73325391	125	0.16460498	0.126181319	45	0.156773267	37.5	19.35277	0	0.2	32.17257037	1.735697236	16.41597472	25	25	0.165375991	13.43635175	0.2	0	0	4	0	10	10	0	0	0												5.0675	0.269201524	6.215575101	3.345248968	1.877097822	1.051975461	0.922407342	0.703397605	4.121760111	3.191392082	2.029418105	0	0.186229849	1.275968496	1.006359008	12.91657238	0.362048457	1.262525874	0.055638692	11.23275332	1.088577556	0	0	0.974970435	0	0.266666667	0.137236901	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5605		15.0804236	5.0675	0.269201524	6.215575101	3.345248968	1.877097822	1.051975461	0.922407342	0.703397605	4.121760111	3.191392082	2.029418105	0	0.186229849	1.275968496	1.006359008	12.91657238	0.362048457	1.262525874	0.055638692	11.23275332	1.088577556	0	0	0.974970435	0	0.266666667	0.137236901	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5605	NO																																																																																		0			5.0675	0.269201524	6.215575101	3.345248968	1.877097822	1.051975461	0.922407342	0.703397605	4.121760111	3.191392082	2.029418105	0	0.186229849	1.275968496	1.006359008	12.91657238	0.362048457	1.262525874	0.055638692	11.23275332	1.088577556	0	0	0.974970435	0	0.266666667	0.137236901	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5605
H5404_128_0	2010	4	N/A																															Coin	Coin	Coin	V	T	P	P	V	Coin	V	Coin	V	Coin	V	V	V	Coin	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	348.4830571	3.255934739	52.42434835	3057.759907	263.0862966	1198.902004	1298.445327	235.6365391	47.52888646	1261.569403	42.68426203	0	1.65190132	562.8414612	9400.906337	12127.73444	2.340295046	929.3679999	5232.007469	14410.92918	9.598482319	85.94908091	0	2924.911305	480	320	204.9806144	23.52449526	5955	1950.693854											3400	"$0 copay, days 1-1"	"$0 copay, days 1-1"	"$0 copay, days 1-1"	$0 copay	$0 copay	$0 copay	$0 copay	"$25 copay, waived if admitted"	$0 copay to $25 copay	$37.5 copay to 20% coinsurance	0% coinsurance to $40 copay	$0 copay	20% coinsurance	Varies	$0 copay	$0 copay	"$0 copay Group, $0 copay Individual"	$0 copay	0% coinsurance	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											0	0	0	0	0	0	0	22.5	0.008263568	37.5	0.115835993	0	0.2	1.389645043	0.000438453	0.000933361	0	0	0	13.07831995	0.2	0	0	4	0	10	10	0	0	0											NO	0	0	0	0	0	0	0	22.5	0.006758386	37.5	0.115165585	0	0.2	0.881227418	0	0	0	0	0	12.77413783	0.2	0	0	4	0	10	10	0	0	0												0	0	0	0	0	0	0	0.441818511	0.321218559	3.942404385	4.915758011	0	0.330380264	0.041332611	0	0	0	0	0	15.34059964	1.919696464	0	0	0.974970435	0	0.266666667	0.170817179	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6657		0.95386173	0	0	0	0	0	0	0	0.441818511	0.321218559	3.942404385	4.915758011	0	0.330380264	0.041332611	0	0	0	0	0	15.34059964	1.919696464	0	0	0.974970435	0	0.266666667	0.170817179	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6657	NO																																																																																		0			0	0	0	0	0	0	0	0.441818511	0.321218559	3.942404385	4.915758011	0	0.330380264	0.041332611	0	0	0	0	0	15.34059964	1.919696464	0	0	0.974970435	0	0.266666667	0.170817179	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6657
H5404_133_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1091.886526	24.6326421	1044.160088	2500.230247	182.1731561	7.374566995	8.440047485	204.6873656	261.5253713	1124.897437	1374.69707	0	1.006520792	516.7809088	7327.106214	10073.57969	195.2315745	685.9839141	4319.688515	11708.06022	5.876692755	79.34445411	0	2924.911305	480	320	172.1292082	20.78740577	5955	1881.655231											3400	"$150 copay, days 1-10"	"$150 copay, days 1-10"	"$125 copay, days 6-20"	$0 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$50 copay to $150 copay	$37.5 copay to 20% coinsurance	$5 copay to $40 copay	$0 copay	20% coinsurance	Varies	$0 copay	$20 copay	"$20 copay Group, $20 copay Individual"	$20 copay	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											108.0927273	116.7739464	55.191596	0	125	0.2	0.148663774	45	116.4172106	37.5	21.0257314	0	0.2	27.14130895	0.687907548	11.26236723	20	20	2.329835991	14.31785631	0.2	0	0	4	0	10	10	0	0	0											NO	67.297798	116.7739464	55.09220094	0	125	0.182580812	0.138516994	45	86.87267523	37.5	18.75381958	0	0.2	22.14544902	0	9.542345072	20	20	0	13.83027459	0.2	0	0	4	0	10	10	0	0	0												6.1235	0.239704236	4.793756447	0	1.897637043	1.346454433	1.169090003	0.767577621	1.893284054	3.515304492	2.148401736	0	0.201304158	0.953695439	0	8.010464458	0.325385958	1.143306524	0	13.49380731	1.175338551	0	0	0.974970435	0	0.266666667	0.143441007	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5831		8.563931093	6.1235	0.239704236	4.793756447	0	1.897637043	1.346454433	1.169090003	0.767577621	1.893284054	3.515304492	2.148401736	0	0.201304158	0.953695439	0	8.010464458	0.325385958	1.143306524	0	13.49380731	1.175338551	0	0	0.974970435	0	0.266666667	0.143441007	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5831	NO																																																																																		0			6.1235	0.239704236	4.793756447	0	1.897637043	1.346454433	1.169090003	0.767577621	1.893284054	3.515304492	2.148401736	0	0.201304158	0.953695439	0	8.010464458	0.325385958	1.143306524	0	13.49380731	1.175338551	0	0	0.974970435	0	0.266666667	0.143441007	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5831
H5404_135_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	2233.585397	28.07111821	1068.064428	588.4846337	291.6604865	10.5012653	4.385805211	324.0110629	345.9272608	319.0301088	325.7543519	0	6.343861317	153.1643379	10955.51016	28638.04721	58.01519266	896.156952	19855.52195	14352.74898	10.33559455	11.72550484	0	2924.911305	480	320	0	8.718715586	5955	1560.256733											3400	"$150 copay, days 1-7"	"$150 copay, days 1-7"	"$100 copay, days 6-20"	$0 copay	$100 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$50 copay to $200 copay	$37.5 copay to 20% coinsurance	$5 copay to $50 copay	$0 copay	20% coinsurance	Varies	$0 copay	$20 copay	"$20 copay Group, $20 copay Individual"	$20 copay	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											96.49363636	99.18965517	44.1532768	0	100	0.2	0.103362959	45	100.4319654	37.5	59.11537161	0	0.2	87.28029003	0.626115842	5.179843686	20	20	4.35744382	11.71610971	0.2	0	0	4	0	10	0	0	0	0											NO	62.90075784	99.18965517	35.51077054	0	100	0.178095622	0.068398086	45	68.48096739	37.5	53.46078065	0	0.2	75.26023135	0	3.878385289	20	20	3.374840613	10.71266235	0.2	0	0	4	0	10	0	0	0	0												11.7079	0.232030378	3.160649236	0	2.430504054	1.870229376	0.299980684	1.215041486	1.974119456	0.99696909	1.451256829	0	1.268772263	0.960598626	0	9.255781752	0.096691988	1.49359492	5.584101823	12.8130128	2.067118909	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1199		15.33491223	11.7079	0.232030378	3.160649236	0	2.430504054	1.870229376	0.299980684	1.215041486	1.974119456	0.99696909	1.451256829	0	1.268772263	0.960598626	0	9.255781752	0.096691988	1.49359492	5.584101823	12.8130128	2.067118909	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1199	NO																																																																																		0			11.7079	0.232030378	3.160649236	0	2.430504054	1.870229376	0.299980684	1.215041486	1.974119456	0.99696909	1.451256829	0	1.268772263	0.960598626	0	9.255781752	0.096691988	1.49359492	5.584101823	12.8130128	2.067118909	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1199
H5404_136_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	3980.471125	189.4401151	3857.091355	1889.780772	778.0950481	13.3305539	1.119245659	580.9833792	308.8499004	518.3494833	354.205438	0	9.237709424	196.5408457	13892.97215	26915.70346	144.6437485	925.8706609	16289.20469	13732.57139	11.04948625	21.18454785	0	2924.911305	480	320	0	15.1208884	5955	1531.63272											3400	"$175 copay, days 1-7"	"$175 copay, days 1-7"	"$125 copay, days 6-20"	$0 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$50 copay to $200 copay	$37.5 copay to 20% coinsurance	$5 copay to $50 copay	$0 copay	20% coinsurance	Varies	$0 copay	$20 copay	"$20 copay Group, $20 copay Individual"	$20 copay	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											112.5759091	115.7212644	55.191596	0	125	0.2	0.181043956	45	111.8881119	37.5	32.91362038	0	0.2	122.5200537	0.558313041	5.614136137	20	20	3.738541524	12.4446372	0.2	0	0	4	0	10	0	0	0	0											NO	65.04269103	115.7212644	49.14003647	0	125	0.157232652	0	45	23.11687181	37.5	20.00935537	0	0.2	99.28635214	0	2.124044273	20	20	0.938589284	9.744911345	0.2	0	0	4	0	10	0	0	0	0												21.575	1.826854137	15.79480082	0	8.105156751	2.09599834	0	2.178687672	0.594970296	1.619842135	0.59061854	0	1.847541885	1.626151968	0	4.764178816	0.241072914	1.543117768	1.274072748	11.1518909	2.209897251	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2815		38.00749598	21.575	1.826854137	15.79480082	0	8.105156751	2.09599834	0	2.178687672	0.594970296	1.619842135	0.59061854	0	1.847541885	1.626151968	0	4.764178816	0.241072914	1.543117768	1.274072748	11.1518909	2.209897251	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2815	NO																																																																																		0			21.575	1.826854137	15.79480082	0	8.105156751	2.09599834	0	2.178687672	0.594970296	1.619842135	0.59061854	0	1.847541885	1.626151968	0	4.764178816	0.241072914	1.543117768	1.274072748	11.1518909	2.209897251	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2815
H5404_137_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	3409.214029	33.82854127	1240.849491	594.5700322	427.1481382	15.68920848	2.414910152	429.3890827	425.1377056	389.4261384	449.3704925	0	10.06360297	129.2418625	13695.52286	29462.79713	46.78239326	885.6289542	26803.4694	14594.35775	19.05429793	25.02007721	0	2924.911305	480	320	0	10.62670125	5955	1564.516596											3400	"$175 copay, days 1-7"	"$175 copay, days 1-7"	"$125 copay, days 6-20"	$0 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$50 copay to $200 copay	$37.5 copay to 20% coinsurance	$5 copay to $50 copay	$0 copay	20% coinsurance	Varies	$0 copay	$20 copay	"$20 copay Group, $20 copay Individual"	$20 copay	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											112.5759091	115.7212644	55.191596	0	125	0.2	0.173766667	45	106.4	37.5	41.49386829	0	0.2	90.19414944	0.602919596	6.078949959	20	20	4.314122313	12.23867915	0.2	0	0	4	0	10	0	0	0	0											NO	68.97710788	115.7212644	40.53889938	0	125	0.171181869	0.048949417	45	55.25876276	37.5	33.42913151	0	0.2	62.19178014	0	3.595093782	20	20	2.809194979	10.26329028	0.2	0	0	4	0	10	0	0	0	0												19.5965	0.326223464	4.191889387	0	4.449459773	2.685708033	0.118208445	1.61020906	1.957715302	1.216956682	1.251838774	0	2.012720593	0.669815125	0	8.82679323	0.077970655	1.476048257	6.274680972	12.4821775	3.810859586	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2774		30.14224423	19.5965	0.326223464	4.191889387	0	4.449459773	2.685708033	0.118208445	1.61020906	1.957715302	1.216956682	1.251838774	0	2.012720593	0.669815125	0	8.82679323	0.077970655	1.476048257	6.274680972	12.4821775	3.810859586	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2774	NO																																																																																		0			19.5965	0.326223464	4.191889387	0	4.449459773	2.685708033	0.118208445	1.61020906	1.957715302	1.216956682	1.251838774	0	2.012720593	0.669815125	0	8.82679323	0.077970655	1.476048257	6.274680972	12.4821775	3.810859586	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2774
H5404_138_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	813.3803821	17.27984381	554.8745321	1026.417534	91.93912036	4.241238958	4.912014184	158.8623386	200.6934208	887.7999257	1083.804478	0	0.911382481	409.1867748	6010.797428	8047.095634	152.6006708	528.1050243	3516.597422	8643.663036	5.307165764	62.92573068	0	2924.911305	480	320	106.1204737	13.46233451	5955	1748.462358											3400	"$100 copay, days 1-5"	"$100 copay, days 1-5"	"$100 copay, days 6-20"	$0 copay	$100 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$25 copay to $100 copay	$37.5 copay to 20% coinsurance	$25 copay to $150 copay	$0 copay	20% coinsurance	Varies	$0 copay	$15 copay	"$15 copay Group, $15 copay Individual"	$15 copay	$25 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											56.1	53.30779055	44.1532768	0	100	0.2	0.127236104	45	74.85719331	37.5	39.74733834	0	0.2	19.53923707	0.429924799	8.712267941	15	15	11.54796443	16.05260869	0.2	0	0	4	0	10	10	0	0	0											NO	34.89980696	53.30779055	44.08097251	0	100	0.188223492	0.120457217	45	59.90294287	37.5	38.63253076	0	0.2	17.09064758	0	7.928588161	15	15	10.38247139	15.80685267	0.2	0	0	4	0	10	10	0	0	0												2.3656	0.076762525	2.038284083	0	0.766159336	0.798300807	0.59168756	0.59573377	1.001843877	2.774374768	3.48917582	0	0.182276496	0.582772247	0	5.316842264	0.190750838	0.66013128	3.042581009	11.38575901	1.061433153	0	0	0.974970435	0	0.266666667	0.088433728	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2505		3.329798978	2.3656	0.076762525	2.038284083	0	0.766159336	0.798300807	0.59168756	0.59573377	1.001843877	2.774374768	3.48917582	0	0.182276496	0.582772247	0	5.316842264	0.190750838	0.66013128	3.042581009	11.38575901	1.061433153	0	0	0.974970435	0	0.266666667	0.088433728	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2505	NO																																																																																		0			2.3656	0.076762525	2.038284083	0	0.766159336	0.798300807	0.59168756	0.59573377	1.001843877	2.774374768	3.48917582	0	0.182276496	0.582772247	0	5.316842264	0.190750838	0.66013128	3.042581009	11.38575901	1.061433153	0	0	0.974970435	0	0.266666667	0.088433728	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2505
H5404_139_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	971.2818733	21.46485602	563.2781981	1225.661412	106.7040274	6.15090362	7.103677096	179.125211	228.3538294	1001.323975	1213.644991	0	1.467048637	459.9180547	7131.013684	9451.955529	189.1916728	663.1871841	3992.043886	10685.05552	8.5032006	70.52163609	0	2924.911305	480	320	120.4657724	14.55502937	5955	1779.19929											3400	"$50 copay, days 1-7"	"$50 copay, days 1-7"	"$50 copay, days 6-20"	$0 copay	$100 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	$25 copay to $50 copay	$37.5 copay to 20% coinsurance	$25 copay to $150 copay	$0 copay	20% coinsurance	Varies	$0 copay	$10 copay	"$10 copay Group, $10 copay Individual"	$10 copay	$25 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											32.16454545	33.06321839	22.0766384	0	100	0.2	0.127100365	45	41.65031075	37.5	47.7403769	0	0.2	12.18501932	0.753874802	5.516733977	10	10	11.50661573	17.16749784	0.2	0	0	4	0	10	10	0	0	0											NO	10.92987103	33.06321839	21.991287	0	100	0.190229772	0.121460495	45	25.86014958	37.5	46.55197542	0	0.2	9.57169597	0.029086271	4.791945446	10	10	10.30230573	16.94252669	0.2	0	0	4	0	10	10	0	0	0												0.8847	0.059141435	1.032267709	0	0.889200229	1.170084995	0.862816135	0.671719541	0.492105349	3.129137423	4.708130981	0	0.293409727	0.366849649	0.01728455	3.774437937	0.157659727	0.552655987	3.427271384	15.08598653	1.70064012	0	0	0.974970435	0	0.266666667	0.100388144	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6175		4.006381966	0.8847	0.059141435	1.032267709	0	0.889200229	1.170084995	0.862816135	0.671719541	0.492105349	3.129137423	4.708130981	0	0.293409727	0.366849649	0.01728455	3.774437937	0.157659727	0.552655987	3.427271384	15.08598653	1.70064012	0	0	0.974970435	0	0.266666667	0.100388144	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6175	NO																																																																																		0			0.8847	0.059141435	1.032267709	0	0.889200229	1.170084995	0.862816135	0.671719541	0.492105349	3.129137423	4.708130981	0	0.293409727	0.366849649	0.01728455	3.774437937	0.157659727	0.552655987	3.427271384	15.08598653	1.70064012	0	0	0.974970435	0	0.266666667	0.100388144	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6175
H5407_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	2342.277906	113.4240367	1069.754386		7.213593319	2.995557118	3.847202457	407.6364783	256.1446198	116.3839625	69.72281134			63.45717209		4670.284848	128.1912388	431.6480346	283.2658384		12.84147456									7.812426513											3400	"$150 days 1-7, $0 days 8-90"	"$150 days 1-7, $0 days 8-90"	"$0 days, 1-14, $100 days 15-45, $0 days 46-100"	No cost sharing	$150 per Trip	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $25 per Visit	$250 per Visit	$75 per Visit	"$250 per Visit for Major Diag. Radiology, $50 per Visit for others"	No cost sharing	No cost sharing	OP Rehab - $35 per visit; Partial Hosp - $0	No cost sharing	$10 per Visit	$25 days 1-999	$35 per Visit	$25 per Visit	No cost sharing	20% Coinsurance	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$175 annual maximum	No cost sharing	"$1,000 annual maximum"	No cost sharing	ER/Urgent Care Worldwide Access $50 copay											78.64036554	84.19273542	38.52		40.34809204	0.2	0.2	49.92987825	250	39.19477374	89.51799989			35		10	24.78812494	34.66102931	25		0.2									32.32837215											NO	74.0392179	79.26672568	36.26624385		40.34809204	0.188298255	0.188298255	47.00854466	235.3728183	39.19477374	84.28041571			32.95219457		10	24.78812494	34.66102931	25		0.188298255									32.32837215												14.4517	0.749229334	3.232997786	0	0.024254561	0.564058177	0.724421508	1.596866466	5.024123421	0.380136923	0.48968896	0	0	0.174254423	0	3.89190404	0.264801704	1.246780431	0.590137163	0	2.418027247	0	0	0	0	0	0	0	0	0.021046919	0	0	0	0	0	0	0	0	0	0	35.8444	0	1.828631809	14.4517	0.749229334	3.232997786	0	0.024254561	0.564058177	0.724421508	1.596866466	5.024123421	0.380136923	0.48968896	0	0	0.174254423	0	3.89190404	0.264801704	1.246780431	0.590137163	0	2.418027247	0	0	0	0	0	0	0	0	0.021046919	0	0	0	0	0	0	0	0	0	0	35.8444	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $25 per Visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered												1.4664	1.0222			1.8426	0.0391	0.0071	0.5523	0.7211	0.0102	0.2031			0.0262	0.0521	0.893	0.004	0.0066	0.2526	0.5721		0.0004																			7.6708	0	0	15.9181	1.771471101	3.232997786	0	1.866804953	0.603154645	0.731501224	2.149125933	5.745267359	0.390302572	0.692761083	0	0	0.200493046	0.052092985	4.784860734	0.268805266	1.253345063	0.84270075	0.572080096	2.418027247	0.000351445	0	0	0	0	0	0	0	0.021046919	0	0	0	0	0	0	0	0	0	0	43.5153
H5407_004_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	2157.575291	41.44225904	1084.39518		4.444751857	4.309167068	4.645877313	368.8230327	321.9348446	127.8538776	85.46965474			81.60048077		4988.337097	94.38510199	419.4992972	284.6288224		6.847217999									7.584826718											3400	"$145 days 1-10, $0 days 11-90"	"$145 days 1-7, $0 days 8-90"	"$0 days, 1-14, $90 days 15-45, $0 days 46-100"	No cost sharing	$100 per Trip	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $20 per Visit	$250 per Visit	$50 per Visit	"$250 per visit for Major Diag. Radiology, $100 for others"	No cost sharing	No cost sharing	OP Rehab - $25 per visit; Partial Hosp - $0	No cost sharing	$25 per Visit	$25 days 1-999	$25 per Visit	$50 per visit	No cost sharing	20% Coinsurance	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$175 annual maximum	No cost sharing	"$1,000 annual maximum"	No cost sharing	ER/Urgent Care WW Access $50 copay											91.09236133	70.16061285	34.66		82.62452035	0.2	0.2	49.9499315	250	50	115.4597355			25		24.68381094	24.93478343	24.97043239	50		0.2									31.08115379											NO	86.19398365	66.38781374	32.7962019		82.62452035	0.18924525	0.18924525	47.26393647	236.556563	47.3113126	109.2510328			23.6556563		24.68381094	24.93478343	24.97043239	50		0.18924525									31.08115379												15.4975	0.229271748	2.963670273	0	0.030603791	0.815489401	0.879210215	1.452669032	6.346316695	0.504077898	0.778137338	0	0	0.160859411	0	10.26093082	0.196122673	0.872923237	1.185953427	0	1.295803485	0	0	0	0	0	0	0	0	0.01964543	0	0	0	0	0	0	0	0	0	0	43.4892	0	1.75734497	15.4975	0.229271748	2.963670273	0	0.030603791	0.815489401	0.879210215	1.452669032	6.346316695	0.504077898	0.778137338	0	0	0.160859411	0	10.26093082	0.196122673	0.872923237	1.185953427	0	1.295803485	0	0	0	0	0	0	0	0	0.01964543	0	0	0	0	0	0	0	0	0	0	43.4892	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $25 per Visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered												1.1706	0.2754			1.3736	0.0734	0.0127	0.5691	0.7903	0.0049	0.1337			0.0533	0.0675	0.7758	0.0017	0.019	0.1821	0.5391		0.0022																			6.0446	0	0	16.6681	0.504630888	2.963670273	0	1.404248359	0.888919948	0.891932731	2.021795191	7.13660779	0.509026233	0.911834446	0	0	0.214157353	0.067500471	11.03677661	0.197841793	0.891901083	1.368031954	0.539123984	1.295803485	0.002187464	0	0	0	0	0	0	0	0.01964543	0	0	0	0	0	0	0	0	0	0	49.5338
H5407_005_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	1233.77141	29.78597291	708.0691105		0.813058915	1.968305095	2.024291981	245.4024503	188.6638292	78.44080673	68.86133281			43.25839264		3022.030714	48.05614116	309.6778928	213.6026146		4.629039921									2.54680354											3400	"$200 days 1-10, $0 days 11-90"	"$200 days 1-10, $0 days 11-90"	"$0 days 1-6, $65 days 7-40, $0 days 41-100"	No cost sharing	$150 per Trip	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $20 per Visit	$250 per Visit	$50 per Visit	"$250 per visit for Major Diag. Radiology, $150 for others"	No cost sharing	No cost sharing	OP Rehab - $35 per visit; Partial Hosp - $0	No cost sharing	$35 per Visit	$35 days 1-999	$35 per Visit	$50 per viist	No cost sharing	20% Coinsurance	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$175 annual maximum	No cost sharing	"$1,000 annual maximum"	No cost sharing	ER/Urgent Care WW Access $50 copay											125.67	134.59	37.36		4.920942711	0.2	0.2	49.75095525	250	50	139.1510273			27.83802961		34.28795747	28.11559995	35	50		0.2									50											NO	121.6760585	130.3125703	36.17265493		4.920942711	0.193643763	0.193643763	48.16981094	242.0547038	48.41094076	134.9060132			26.95330404		34.28795747	28.11559995	35	50		0.193643763									50												12.51	0.323457224	2.134394967	0	0.000333418	0.381150005	0.391991517	0.98508247	3.805580608	0.316449437	0.774150656	0	0	0.097163051	0	8.634938383	0.112593937	0.903227187	0.890010894	0	0.896384709	0	0	0	0	0	0	0	0	0.010611681	0	0	0	0	0	0	0	0	0	0	33.1676	0	0.741299794	12.51	0.323457224	2.134394967	0	0.000333418	0.381150005	0.391991517	0.98508247	3.805580608	0.316449437	0.774150656	0	0	0.097163051	0	8.634938383	0.112593937	0.903227187	0.890010894	0	0.896384709	0	0	0	0	0	0	0	0	0.010611681	0	0	0	0	0	0	0	0	0	0	33.1676	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $25 per Visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered												0.3224	0.0484			0.8992	0.2495	0.0038	0.3184	0.3939	0.0331	0.2035			0.0537	0.0328	0.4474	0.0028	0.0157	0.099			0.0269																			3.1506	0	0	12.8325	0.37190041	2.134394967	0	0.89956879	0.630646142	0.395759338	1.303456513	4.199433887	0.349542655	0.977685302	0	0	0.150828807	0.032801117	9.082382185	0.115430704	0.918926714	0.988971133	0	0.896384709	0.026923432	0	0	0	0	0	0	0	0.010611681	0	0	0	0	0	0	0	0	0	0	36.3181
H5407_009_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	2205.064051	26.20662723	974.8877295		4.619834278	3.785276566	5.911523239	275.273333		165.0091971	89.28087285			257.4607712				828.3127712	359.7191328		12.85969539									7.611303603											3400	"$50 days 1-7, $0 days 8-90"	"$50 days 1-7, $0 days 8-90"	"$0 days, 1-15, $50 days 16-100"	No cost sharing	$150 per Trip	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $25 per Visit	No cost sharing	$50 per Visit	"$100 per visit for major diag. radiology, $50 for others"	No cost sharing	No cost sharing	OP Rehab - $25 per visit	No cost sharing	No cost sharing	No cost sharing	$25 per Visit	$25 per Visit	No cost sharing	20% Coinsurance	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$175 annual maximum	No cost sharing	"$1,000 annual maximum"	No cost sharing	ER/Urgent Care WW Access $50 copay											26.21345518	28.06424514	25.94938566		148.2292736	0.2	0.2	49.81590904		41.77614344	46.17352856			28.40067573				25	25		0.2									33.60754334											NO	25.91232691	27.74185583	25.6512909		146.526483	0.197702491	0.197702491	49.24364649		41.77614344	45.64310802			28.07442166				25	25		0.197702491									33.60754334												4.7615	0.06058504	2.083927395	0	0.056410672	0.748358605	1.168722869	1.129621892	0	0.574453991	0.339588044	0	0	0.602338521	0	0	0	1.725651607	0.74941486	0	2.54239381	0	0	0	0	0	0	0	0	0.021316435	0	0	0	0	0	0	0	0	0	0	16.5643	0	0.156808261	4.7615	0.06058504	2.083927395	0	0.056410672	0.748358605	1.168722869	1.129621892	0	0.574453991	0.339588044	0	0	0.602338521	0	0	0	1.725651607	0.74941486	0	2.54239381	0	0	0	0	0	0	0	0	0.021316435	0	0	0	0	0	0	0	0	0	0	16.5643	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $25 per Visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered												0.0085	0.1961		0.0001	1.4255	0.0656	0.0522	0.3247	0.7813	0.0091	0.1268			0.1552	0.0331	0.8237	0.0052	0.0285	0.1982	0.6683		0.012																			4.9142	0	0	4.77	0.25670854	2.083927395	5.39E-05	1.481907687	0.813917398	1.220884038	1.454371527	0.781280666	0.583586765	0.466426219	0	0	0.757545109	0.033146849	0.823689471	0.005235477	1.754180272	0.947605679	0.668324092	2.54239381	0.011956934	0	0	0	0	0	0	0	0.021316435	0	0	0	0	0	0	0	0	0	0	21.4785
H5407_011_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	V																																																			0	NO						4.98794806	5.151800641	683.5121699													16.48878969									0.428977436												No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	ER - $50 per Visit	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$175 annual maximum	No cost sharing	"$1,000 annual maximum"	No cost sharing	ER/Urgent Care WW Access $50 copay;																0.2	0.2	50													0.2									50											NO						0.2	0.2	50													0.2									50												0	0	0	0	0	0.997589612	1.030360128	2.847967374	0	0	0	0	0	0	0	0	0	0	0	0	3.297757938	0	0	0	0	0	0	0	0	0.001787406	0	0	0	0	0	0	0	0	0	0	8.1755	0	0	0	0	0	0	0	0.997589612	1.030360128	2.847967374	0	0	0	0	0	0	0	0	0	0	0	0	3.297757938	0	0	0	0	0	0	0	0	0.001787406	0	0	0	0	0	0	0	0	0	0	8.1755	NO																																																																																		0	0	0	0	0	0	0	0	0.997589612	1.030360128	2.847967374	0	0	0	0	0	0	0	0	0	0	0	0	3.297757938	0	0	0	0	0	0	0	0	0.001787406	0	0	0	0	0	0	0	0	0	0	8.1755
H5407_014_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	1304.658247	27.15366561	662.3808647		1.462120456	1.662133912	3.09719792	210.3364713	207.7773428	81.46099684	44.33734071			34.00223783		2809.141849	46.822297	258.233567	196.1902994		9.944282004									0.222394418											3400	"$200 days 1-10, $0 days 11-90"	"$200 days 1-10, $0 days 11-90"	"$0 days 1-6, $65 days 7-40, $0 days 41-100"	No cost sharing	$150 per Trip	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $35 per Visit	$250 per Visit	$100 per Visit	"$250 per Visit for major diag. radiology, $100 for others"	No cost sharing	No cost sharing	OP Rehab - $35 per visit; Partial Hosp - $0	No cost sharing	$35 per Visit	$35 days 1-999	$35 per Visit	$25 per visit	No cost sharing	20% Coinsurance	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$175 annual maximum	No cost sharing	"$1,000 annual maximum"	No cost sharing	ER/Urgent Care WW access $50 copay											125.64	134.595	37.36		150	0.2	0.2	50	250	67.45201529	113.5025063			35		34.43428574	34.37545975	35	25		0.2									50											NO	121.0547867	129.6829753	35.9965523		144.5257721	0.192701029	0.192701029	48.17525736	240.8762868	67.45201529	109.360249			33.72268015		34.43428574	34.37545975	35	25		0.192701029									50												13.1613	0.293447346	1.986952287	0	0.017609507	0.320294916	0.596833228	0.844417803	4.170719568	0.457892367	0.404061885	0	0	0.095553883	0	8.060899424	0.134128165	0.753181237	0.40872979	0	1.916273379	0	0	0	0	0	0	0	0	0.000926643	0	0	0	0	0	0	0	0	0	0	33.6232	0	0.901757968	13.1613	0.293447346	1.986952287	0	0.017609507	0.320294916	0.596833228	0.844417803	4.170719568	0.457892367	0.404061885	0	0	0.095553883	0	8.060899424	0.134128165	0.753181237	0.40872979	0	1.916273379	0	0	0	0	0	0	0	0	0.000926643	0	0	0	0	0	0	0	0	0	0	33.6232	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $35 per Visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered													0.0902			0.9497	0.0958	0.0083	0.1816	0.5389	0.01	0.2618			0.0426	0.0178	0.541	0.0008	0.0266	0.1493	0.4154																					3.33	0	0	13.1613	0.383676428	1.986952287	0	0.967320319	0.416112425	0.605158641	1.026054028	4.709587354	0.467901837	0.66583475	0	0	0.138140345	0.017794343	8.601912799	0.134925768	0.779786833	0.558072287	0.415443367	1.916273379	0	0	0	0	0	0	0	0	0.000926643	0	0	0	0	0	0	0	0	0	0	36.9531
H5407_016_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	1709.203451	68.1424082	834.9991057		3.299199448	0.97556982	1.398498096	227.633525	175.333727	61.829627	68.0838255			43.87030321			91.9973733	455.4305746	189.5895847		4.431874927									593.9094309											3400	"$50 days 1-7, $0 days 8-90"	"$50 days 1-7, $0 days 8-90"	"$0 days, 1-14, $65 days 15-30, $90 days 31-100"	No cost sharing	$150 per Trip	20% Coinsurance	20% Coinsurance	ER - $50 per Visit;	$50 per Visit	$25 per Visit	"$100 per visit for major diag. radiology, $50 for others"	No cost sharing	No cost sharing	OP Rehab - $15 per visit; Partial Hosp - $0	No cost sharing	No cost sharing	$15 per Visit	$15 per Visit	$25 per Visit	No cost sharing	20% Coinsurance	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$175 annual max	No cost sharing	"$1,000 annual max"	No cost sharing	ER/Urgent Care WW Access $50 copay; OTC Medical Items $15 copay											26.21345518	28.06424514	42.12		1.34801688	0.2	0.2	50	50	25	55.18124439			15			14.94720686	15	25		0.2									15											NO	26.07895429	27.92024787	41.90388284		1.34801688	0.198973803	0.198973803	49.74345066	49.74345066	24.87172533	54.89811015			14.9230352			14.94720686	15	25		0.198973803									15												3.7145	0.158546077	2.915808724	0	0.000370615	0.194112837	0.278264484	0.943606418	0.726808716	0.128150792	0.311472779	0	0	0.054556507	0	0	0.114591981	0.569288218	0.394978301	0	0.881827007	0	0	0	0	0	0	0	0	0.742386789	0	0	0	0	0	0	0	0	0	0	12.1293	0	0.053161311	3.7145	0.158546077	2.915808724	0	0.000370615	0.194112837	0.278264484	0.943606418	0.726808716	0.128150792	0.311472779	0	0	0.054556507	0	0	0.114591981	0.569288218	0.394978301	0	0.881827007	0	0	0	0	0	0	0	0	0.742386789	0	0	0	0	0	0	0	0	0	0	12.1293	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $25 per Visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered	Not covered													0.2027			1.0717	0.1119	0.0107	0.2924	1.0118	0.0067	0.1968			0.0223	0.046	0.8681	0.0033	0.0662	0.1928	0.5557		0.0023																			4.6616	0	0	3.7145	0.36126474	2.915808724	0	1.072082563	0.306027419	0.289006254	1.236030492	1.73862799	0.13484343	0.508272311	0	0	0.076887066	0.045950385	0.868105541	0.117921551	0.635519873	0.587792163	0.555712548	0.881827007	0.002316266	0	0	0	0	0	0	0	0.742386789	0	0	0	0	0	0	0	0	0	0	16.7909
H5407_024_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	789.0376443	41.94572831	261.8392067		1.25628197	1.561842781	2.344759438	245.0965478	191.0513448	83.12038432	56.47896941			34.39277222		3314.906593	67.52275786	336.4587633	223.0924143		13.73540287									2.798893556											3400	"$150 days 1-5, $0 days 6-90"	"$150 days 1-5, $0 days 6-90"	"$0 days, 1-14, $75 days 15-60, $0 days 61-100"	No cost sharing	$100 per Trip	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $25 per Visit	$150 per Visit	$20 per Visit	$150 per visit	No cost sharing	No cost sharing	OP Rehab - $25 per visit; Partial Hosp - $25 per Visit; OP Chemo -50	No cost sharing	$20 per Visit	$20 days 1-999	$25 per Visit	$50 per Visit	No cost sharing	20% Coinsurance	No cost sharing	No cost sharing	No cost sharing	No cost sharing	$100 max	No cost sharing	$800 max	No cost sharing	ER/Urgent Care WW Access $50 copay											64.25	67.98	34.45		5.275050566	0.2	0.2	49.97437169	150	20	110.2837365			25		19.49962575	19.8511575	25	50		0.2									50											NO	63.63461808	67.32889241	34.12004036		5.275050566	0.198084414	0.198084414	49.49572072	148.5633107	19.80844143	109.2868545			24.76055178		19.49962575	19.8511575	25	50		0.198084414									50												4.1842	0.235346619	0.744497025	0	0.000552246	0.309376712	0.4644603	1.010935857	2.365268358	0.137207105	0.51436741	0	0	0.070965335	0	5.386619829	0.111700408	0.700955757	0.929551726	0	2.720769233	0	0	0	0	0	0	0	0	0.011662056	0	0	0	0	0	0	0	0	0	0	19.8984	0	0.123088503	4.1842	0.235346619	0.744497025	0	0.000552246	0.309376712	0.4644603	1.010935857	2.365268358	0.137207105	0.51436741	0	0	0.070965335	0	5.386619829	0.111700408	0.700955757	0.929551726	0	2.720769233	0	0	0	0	0	0	0	0	0.011662056	0	0	0	0	0	0	0	0	0	0	19.8984	NO																																																																																		0	0	0	4.1842	0.235346619	0.744497025	0	0.000552246	0.309376712	0.4644603	1.010935857	2.365268358	0.137207105	0.51436741	0	0	0.070965335	0	5.386619829	0.111700408	0.700955757	0.929551726	0	2.720769233	0	0	0	0	0	0	0	0	0.011662056	0	0	0	0	0	0	0	0	0	0	19.8984
H5410_001_0	2010	7	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	P	V	V	O	V																																																			0	NO																																										"$0 copay, unlimited days, 30% coinsurance for gastric restrictive surgery"	$0 copay	$0 copay up to 100 days with 3-day hospital stay	$0 copay for Medicare covered visits	$0 copay for Medicare covered benefits	$0 copay for Medicare covered items	$0 copay for Medicare covered items	"$0 copay, worldwide coverage"	$0 copay for Medicare covered OP facility and ASC visits	$0 copay for Medicare covered services	$0 copay for Medicare covered services	$0 copay for Medicare covered services	$0 copay for dialysis	$0 copay for Medicare covered services	$0 copay	"$0 copay, 30% coinsurance for gastric restrictive surgery"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay for each round trip to plan-approved location	"Comprehensive dental with $0 copay and $2,000 max annual allowable benefit, 90 days waiting period for Denture"	$0 copay for exams	"$0 copay for 1 pair of contacts with a $150 deductible, up to 2 pairs of basic glasses every year"	$0 copay for exams	$1800 limit for hearing aids every 3 years	No cost sharing	$25 limit for vitamins every 3 months																																																			NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5410_003_0	2010	4	N/A																															A	D	D		T	COIN		P	P		P		COIN		V	V	COIN	V			COIN																																																												0	NO	264.5644273	10.40021234	498.7196628		240.6323737	12.38496247		389.4904519	420.0992399		2764.363674		0.570123412		3776.424267	5568.965403	1.54019382	98.24656672			48.66825307																					$300 per admit	$185 / day days 1-10	$0 days 1-5; $50 days 6-35		$50 per trip	20% Coinsurance		$50 per visit	$50 per visit		"$25/Xray; $100/MRI,MRA,CT,PET, NUC Scan"		20% Coinsurance		$0 per visit	$15 per visit	20% Coinsurance	$15 per visit			20% per script																				300	185	50		50	0.2		50	50		46.14835788		0.2		0	15	0.2	15			0.2																				NO	284.4446345	175.4075246	47.40743908		47.40743908	0.189629756		50	47.40743908		43.75550929		0.189629756		0	15	0.2	15			0.189629756																					6.2712	0.152022959	1.970251836	0	0.95064705	2.348557415	0	1.622876883	1.659652427	0	10.07967837	0	0.108112364	0	0	6.961206754	0.308038764	0.122808208	0	0	9.22894897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.784		1.79203337	6.2712	0.152022959	1.970251836	0	0.95064705	2.348557415	0	1.622876883	1.659652427	0	10.07967837	0	0.108112364	0	0	6.961206754	0.308038764	0.122808208	0	0	9.22894897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.784	NO																																																																																		0			6.2712	0.152022959	1.970251836	0	0.95064705	2.348557415	0	1.622876883	1.659652427	0	10.07967837	0	0.108112364	0	0	6.961206754	0.308038764	0.122808208	0	0	9.22894897	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.784
H5410_004_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	P	P	O	V	O	Coin	O	V	V	COIN	V			Coin																																																												0	NO	1019.62	56.94411253	205.3673853		227.4692881	8.666426094		417.5987518	384.8544475		2418.294063		0.2142		4627.223901	6732.700691	1.247107035	115.809031			35.75053493																					$185 per day 1-6	$185 per day 1-10	$0 for days 1-5; $95 for days 6 - 35		$150 per trip	20% coinsurance		$50 per visit	$100 per visit		"$25/Xray; $100/MRI,MRA,PET,CT, and NUC Scan"		20%  coinsurance		$5 per visit	$30 per visit	20% coinsurance	$30 per visit			20% per script																				185	185	95		150	0.2		50	100		46.90962147		0.2		5	30	0.2	30			0.2																				NO	175.4075246	175.4075246	90.07413425		142.2223172	0.189629756		50	94.81487815		44.47730044		0.189629756		5	30	0.2	30			0.189629756																					14.9041	0.832368818	1.541524119	0	2.695934105	1.643412268	0	1.739994799	3.040827295	0	8.963265967	0	0.040618694	0	1.928009959	16.83175173	0.249421407	0.289522578	0	0	6.779365226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4801		2.211610651	14.9041	0.832368818	1.541524119	0	2.695934105	1.643412268	0	1.739994799	3.040827295	0	8.963265967	0	0.040618694	0	1.928009959	16.83175173	0.249421407	0.289522578	0	0	6.779365226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4801	NO																																																																																		0			14.9041	0.832368818	1.541524119	0	2.695934105	1.643412268	0	1.739994799	3.040827295	0	8.963265967	0	0.040618694	0	1.928009959	16.83175173	0.249421407	0.289522578	0	0	6.779365226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4801
H5410_005_0	2010	5	N/A																															D	D	D		T	Coin		P	P		V		Coin		V	V	Coin	V			Coin																																																												0	NO	1064.99	56.94411253	498.7196628		240.6323737	12.38496247		389.4904519	420.0992399		2804.865324		0.570123412		3776.424267	5568.965403	1.535049309	98.24656672			48.26300911																					$195days 1-6	$185days 1-10	"$0/day; days 1-5, $75/day ;days 6-35"		$150 Per Trip	20% Coinsurance		$50 per visit	$250  per visit		"$25/Xray; $100/MRI,MRA,PET,CT, and NUC Scans"		20% Coinsurance		$5 per visit	$30 per visit	20% Coinsurance	$30 per visit			20% Script																				195	185	75		150	0.2		50	250		46.22808858		0.2		5	30	0.2	30			0.2																				NO	184.8795	175.4075246	71.1075		142.2223172	0.189629756		50	237.025		43.83110586		0.189629756		5	30	0.2	30			0.189629756																					16.4079	0.832368818	2.955225702	0	2.851941149	2.348557415	0	1.622876883	8.297835194	0	10.24502908	0	0.108112364	0	1.573510111	13.92241351	0.307009862	0.245616417	0	0	9.152102656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8705		2.906445883	16.4079	0.832368818	2.955225702	0	2.851941149	2.348557415	0	1.622876883	8.297835194	0	10.24502908	0	0.108112364	0	1.573510111	13.92241351	0.307009862	0.245616417	0	0	9.152102656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8705	NO																																																																																		0			16.4079	0.832368818	2.955225702	0	2.851941149	2.348557415	0	1.622876883	8.297835194	0	10.24502908	0	0.108112364	0	1.573510111	13.92241351	0.307009862	0.245616417	0	0	9.152102656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8705
H5410_010_0	2010	7	N/A																															D	D	D		COIN	COIN		V	COIN	COIN	COIN		COIN	COIN	V	V	COIN	V	V	V	COIN		T	V																																																									0	NO	2029.452643	104.2459997	931.663865		15.07818618	25.20842882		846.1367193	64.44487908		20.72835722		2.141743134		6317.245921	9352.057757	3.635407126	190.5829582			47.69607562																					$130 Days 1-6	$130 Days 1-10	$0 Days 1-5; $80 days 6-35		20% Coinsurance	20% Coinsurance		$50 per visit	20% Coinsurance		20% Coinsurance		20% Coinsurance		$0/visit	$0/visit	20% Coinsurance	$0/visit			20% Coinsurance																				130	130	80		0.2	0.2		50	0.2		0.2		0.2		0	0	0.2	0			0.2																				NO	130	130	80		0.2	0.2		50	0.2		0.2		0.2		0	0	0.2	0			0.2																					21.9857	1.129331663	6.211092433	0	3.015637235	5.041685763	0	3.525569664	12.88897582	0	4.145671445	0	0.428348627	0	0	0	0.727081425	0	0	0	9.539215123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6383		0	21.9857	1.129331663	6.211092433	0	3.015637235	5.041685763	0	3.525569664	12.88897582	0	4.145671445	0	0.428348627	0	0	0	0.727081425	0	0	0	9.539215123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6383	NO																																																																																		0			21.9857	1.129331663	6.211092433	0	3.015637235	5.041685763	0	3.525569664	12.88897582	0	4.145671445	0	0.428348627	0	0	0	0.727081425	0	0	0	9.539215123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6383
H5414_002_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1764.22033	76.95546409	1162.131702	908.1160319	229.7341688	13.4235119	0	289.6640196	403.5466343	2902.862021	3334.394142	36.03960507	0.233025389	177.6826201	4508.717593	6946.012739	301.5263124	865.0236968	0	0	278	0	0	0	840.7101149	0	56.12747956	0	61.17945252	0												$185/day 1-8	$185/day 1-8	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											140.9388989	140.9388989	47.56208437	0	150	0.2	0.2	48.5	250	5.25	45.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	140.9388989	140.9388989	47.56208437	0	150	0.2	0.2	48.5	250	5.25	45.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												20.7206	0.903834865	4.60611717	0	2.87167711	2.684702381	0	1.170725413	8.407221547	1.270002134	12.64291112	0.105115515	0.00048547	0.518240975	7.514529322	20.25920382	0.879451745	2.522985782	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1203	0	0	20.7206	0.903834865	4.60611717	0	2.87167711	2.684702381	0	1.170725413	8.407221547	1.270002134	12.64291112	0.105115515	0.00048547	0.518240975	7.514529322	20.25920382	0.879451745	2.522985782	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1203	NO																												0	0																																								0	0	0											0			20.7206	0.903834865	4.60611717	0	2.87167711	2.684702381	0	1.170725413	8.407221547	1.270002134	12.64291112	0.105115515	0.00048547	0.518240975	7.514529322	20.25920382	0.879451745	2.522985782	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1203
H5414_009_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1552.776513	109.1713211	1023.908246	692.7415591	219.4941029	9.608521889	0	272.6359283	403.2833234	2515.555121	2897.231248	37.2337867	0.23647529	91.61177202	4176.068803	6134.068494	231.5667804	592.6109851	0	0	278	0	0	0	822.6053894	0	48.77905591	0	53.40197663	0												$250/day 1-7	$250/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$40 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$30 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											180.7137695	180.7137695	47.56208437	0	150	0.2	0.2	48.5	250	6	47	40	25	40	30	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.56208437	0	150	0.2	0.2	48.5	250	6	47	40	25	40	30	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0												23.384	1.644063413	4.058267531	0	2.743676286	1.921704378	0	1.101903543	8.401735905	1.257777561	11.34748906	0.124112622	0.000492657	0.305372573	10.44017201	20.44689498	0.771889268	1.97536995	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9674	0	0	23.384	1.644063413	4.058267531	0	2.743676286	1.921704378	0	1.101903543	8.401735905	1.257777561	11.34748906	0.124112622	0.000492657	0.305372573	10.44017201	20.44689498	0.771889268	1.97536995	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9674	NO																												0	0																																								0	0	0											0			23.384	1.644063413	4.058267531	0	2.743676286	1.921704378	0	1.101903543	8.401735905	1.257777561	11.34748906	0.124112622	0.000492657	0.305372573	10.44017201	20.44689498	0.771889268	1.97536995	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.9674
H5414_010_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1745.369833	101.1734531	1032.100599	683.8090512	232.3355231	12.49345044	0	266.363076	409.5344517	2680.163462	2936.376234	78.61764041	0.256536021	88.18039772	4345.441862	6719.989053	235.3446432	661.8617822	0	0	278	0	0	0	881.5162939	0	46.8825325	0	157.9004132	0												$250/day 1-7	$250/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$40 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$30 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											180.7137695	180.7137695	47.56208437	0	150	0.2	0.2	48.5	250	6	47	40	25	40	30	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.56208437	0	150	0.2	0.2	48.5	250	6	47	40	25	40	30	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0												26.2844	1.523619673	4.09073798	0	2.904194039	2.498690088	0	1.076550765	8.531967744	1.340081731	11.50080692	0.262058801	0.00053445	0.293934659	10.86360466	22.39996351	0.784482144	2.206205941	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6043	0	0	26.2844	1.523619673	4.09073798	0	2.904194039	2.498690088	0	1.076550765	8.531967744	1.340081731	11.50080692	0.262058801	0.00053445	0.293934659	10.86360466	22.39996351	0.784482144	2.206205941	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6043	NO																												0	0																																								0	0	0											0			26.2844	1.523619673	4.09073798	0	2.904194039	2.498690088	0	1.076550765	8.531967744	1.340081731	11.50080692	0.262058801	0.00053445	0.293934659	10.86360466	22.39996351	0.784482144	2.206205941	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.6043
H5414_012_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	11.85188853	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6572.318665	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$185/day 1-8	$185/day 1-8	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $30 Urgent Care Ctr	$250 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											140.9388989	140.9388989	47.56208437	0	150	0.2	0.2	48	250	5.25	45.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	140.9388989	140.9388989	47.56208437	0	150	0.2	0.2	48	250	5.25	45.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												20.119	0.894312814	4.627599879	0	2.934333973	2.370377706	0	0.967952593	8.364532289	0.957372935	10.97885841	0.157116481	0.000725633	0	7.702196146	19.16926277	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.536	0	0	20.119	0.894312814	4.627599879	0	2.934333973	2.370377706	0	0.967952593	8.364532289	0.957372935	10.97885841	0.157116481	0.000725633	0	7.702196146	19.16926277	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.536	NO																												0	0																																								0	0	0											0			20.119	0.894312814	4.627599879	0	2.934333973	2.370377706	0	0.967952593	8.364532289	0.957372935	10.97885841	0.157116481	0.000725633	0	7.702196146	19.16926277	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.536
H5414_019_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.46197085	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6718.531537	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$250/day 1-7	$250/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$40 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$30 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											180.7137695	180.7137695	47.56208437	0	150	0.2	0.2	48.5	250	6	47	40	25	40	30	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.56208437	0	150	0.2	0.2	48.5	250	6	47	40	25	40	30	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0												25.7968	1.146700031	4.627599879	0	2.934333973	2.09239417	0	0.978035432	8.364532289	1.094140497	11.34079879	0.179561693	0.000725633	0	11.55329422	22.39510512	0.722403722	1.848916626	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.1178	0	0	25.7968	1.146700031	4.627599879	0	2.934333973	2.09239417	0	0.978035432	8.364532289	1.094140497	11.34079879	0.179561693	0.000725633	0	11.55329422	22.39510512	0.722403722	1.848916626	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.1178	NO																												0	0																																								0	0	0											0			25.7968	1.146700031	4.627599879	0	2.934333973	2.09239417	0	0.978035432	8.364532289	1.094140497	11.34079879	0.179561693	0.000725633	0	11.55329422	22.39510512	0.722403722	1.848916626	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.1178
H5414_020_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1789.946713	90.23221458	1128.502281	878.3498982	236.8681572	12.76762401	0	293.4315141	393.7530135	2818.4286	3331.236816	36.84799152	0.238252266	169.3495929	4516.445709	6929.930673	338.0799087	892.3756982	0	0	278	0	0	0	832.7368201	0	55.7819353	0	88.03100476	0												$185/day 1-8	$185/day 1-8	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											140.9388989	140.9388989	47.56208437	0	150	0.2	0.2	48.5	250	5.25	45.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	140.9388989	140.9388989	47.56208437	0	150	0.2	0.2	48.5	250	5.25	45.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												21.0228	1.059769081	4.472826724	0	2.960851965	2.553524802	0	1.185952369	8.203187782	1.233062513	12.63093959	0.107473309	0.000496359	0.493936313	7.527409514	20.21229779	0.9860664	2.602762453	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2958	0	0	21.0228	1.059769081	4.472826724	0	2.960851965	2.553524802	0	1.185952369	8.203187782	1.233062513	12.63093959	0.107473309	0.000496359	0.493936313	7.527409514	20.21229779	0.9860664	2.602762453	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2958	NO																												0	0																																								0	0	0											0			21.0228	1.059769081	4.472826724	0	2.960851965	2.553524802	0	1.185952369	8.203187782	1.233062513	12.63093959	0.107473309	0.000496359	0.493936313	7.527409514	20.21229779	0.9860664	2.602762453	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.2958
H5414_801_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	331.5180972	4.682661094	42.7665913	7.831709177	8.497715271	10.80271132	0	12.85523535	42.41446499	16.13138518	81.17068307	0.708556967	0.013479824	28.27630959	25.14738131	135.6072255	2.375071516	6.374035504	0	-9.15E-09	81.37462872	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.082814121	0.082814121	0.159007565	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082814121	0.082814121	0.159007565	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												27.4544	0.387790461	6.800211529	0	1.979967658	2.517031738	0	2.995269836	9.882570342	3.758612747	18.91276915	0.165093773	0.003140799	6.588380134	5.859339845	31.59648354	0.553391663	1.485150273	0	-2.13E-09	18.96028849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.8999			27.4544	0.387790461	6.800211529	0	1.979967658	2.517031738	0	2.995269836	9.882570342	3.758612747	18.91276915	0.165093773	0.003140799	6.588380134	5.859339845	31.59648354	0.553391663	1.485150273	0	-2.13E-09	18.96028849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.8999	NO																																																																																		0			27.4544	0.387790461	6.800211529	0	1.979967658	2.517031738	0	2.995269836	9.882570342	3.758612747	18.91276915	0.165093773	0.003140799	6.588380134	5.859339845	31.59648354	0.553391663	1.485150273	0	-2.13E-09	18.96028849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.8999
H5414_803_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	243.9370175	4.060668261	26.05533975	8.492329572	5.943105596	9.769034404	0	8.62334068	37.1033011	13.8675356	54.87126042	0.377430233	0.007180359	24.73553475	30.76587612	122.3705505	1.697533649	5.809185617	0	-4.87E-09	50.85748853	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.08348354	0.08348354	0.158499218	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08348354	0.08348354	0.158499218	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.3647	0.338998961	4.129750984	0	1.384743604	2.276185016	0	2.009238379	8.645069156	3.231135795	12.78500368	0.087941244	0.001673024	5.763379596	7.168449136	28.51233827	0.39552534	1.353540249	0	-1.14E-09	11.84979483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2975			20.3647	0.338998961	4.129750984	0	1.384743604	2.276185016	0	2.009238379	8.645069156	3.231135795	12.78500368	0.087941244	0.001673024	5.763379596	7.168449136	28.51233827	0.39552534	1.353540249	0	-1.14E-09	11.84979483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2975	NO																																																																																		0			20.3647	0.338998961	4.129750984	0	1.384743604	2.276185016	0	2.009238379	8.645069156	3.231135795	12.78500368	0.087941244	0.001673024	5.763379596	7.168449136	28.51233827	0.39552534	1.353540249	0	-1.14E-09	11.84979483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.2975
H5415_039_0	2010	6	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered					Renal Dialysis				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	Coin	O	O	O	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	YES	1144.742023	50.443046	427.203162	715.258674	27.866905	7.496648	2.660994	302.793508	410.199885	1270.681372	1856.010938	79.202194	0.016654	778.915087	3853.436041	5722.719907	83.266375	201.79759			20.863279	0		1.38					0.04	0.25	0.197516	0.05	0.55	4.1	980.168818	0.42					6000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$200/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $150 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $150 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$150/Visit:7i			20% Coins:15			"DEN762: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	0% Coins:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: Nutritional benefit 14a					158.7573	140.3991	50.7565	0	150	0.2	0.2	50	124.003951	47.783577	77.742319	200	0.2	117.993196	15	35	35	150			0.2	0		0					0	0	0	0	0	0	35	0					NO	143.604551	126.998568	37.150256	0	129.1368	0.172182	0.172182	43.0456	106.75649	41.137455	66.929295	172.1824	0.172182	101.581759	12.91368	30.13192	30.13192	129.1368			0.172182	0		0					0	0	0	0	0	0	30.13192	0						13.6992	0.533849551	1.322558903	0	0.299886911	1.290787846	0.458175269	1.086160686	3.64929166	4.356049813	10.35179197	1.136435321	0.002867519	6.593630387	4.146836661	14.36971154	0.209081313	2.171624585	0	0	3.592281105	0	0	0	0	0	0	0	0	0	0	0	0	0	2.461197368	0	0	0	0	0	71.7314	0	11.061919	13.6992	0.533849551	1.322558903	0	0.299886911	1.290787846	0.458175269	1.086160686	3.64929166	4.356049813	10.35179197	1.136435321	0.002867519	6.593630387	4.146836661	14.36971154	0.209081313	2.171624585	0	0	3.592281105	0	0	0	0	0	0	0	0	0	0	0	0	0	2.461197368	0	0	0	0	0	71.7314	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: Nutritional benefit 14a					7500	2.3406	0.0912	0.5115	1.6619	1.1627	1.2374	0.4392	0.1858	3.0032	0.3675	1.9923	0.2912	0.0005	0.9118	1.8916	2.8092	0.0409	0.0657			0.8661	0		0					0	0	0	0	0	0	0.4811	0					20.3515	0	4.27325	16.0398	0.625061551	1.834043903	1.6619	1.462624911	2.528219846	0.897411269	1.271954686	6.65244766	4.723591813	12.34412597	1.427622321	0.003383519	7.505387387	6.038406661	17.17887354	0.249955313	2.237364585	0	0	4.458362105	0	0	0	0	0	0	0	0	0	0	0	0	0	2.942341368	0	0	0	0	0	92.0829
H5415_801_0	2010	4	N/A																															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	NO	284.98223	0.97210627	20.23269794	15.60013004	2.15635028	9.355550586	4.573131586	25.95897869	71.72490462	14.49651181	34.80294478	12.21740334	1.073354502	22.1328199	44.68333077	97.99508385	0.470870061	7.23634374			24.59975598	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																			0.083469789	0.083469789	0.165976935	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083469789	0.083469789	0.165976935	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.7874	0.081141505	3.358161199	0	0.502429615	2.179843286	1.06553966	6.048442036	16.71190278	3.377687252	8.109086133	2.846654979	0.250091599	5.156947037	10.41121607	22.83285454	0.109712724	1.686068091	0	0	5.731743144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2469	0	0	23.7874	0.081141505	3.358161199	0	0.502429615	2.179843286	1.06553966	6.048442036	16.71190278	3.377687252	8.109086133	2.846654979	0.250091599	5.156947037	10.41121607	22.83285454	0.109712724	1.686068091	0	0	5.731743144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2469	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.4217	0.0014	0.1204	0	0.8517	0.458	0.2239	0.4936	1.2445	0.2757	0.6008	0.2323	0.0204	0.4177	0.604	1.3246	0.0064	0.1117			0.0074	0																			7.4161	0	0	24.2091	0.082579931	3.478532709	0	1.354079635	2.637815196	1.289396776	6.542075235	17.95644677	3.653356432	8.709882455	3.078994422	0.270509933	5.574688996	11.01518811	24.15741768	0.116087952	1.797723451	0	0	5.739144303	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.663
H5415_803_0	2010	4	N/A																															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	NO	284.98223	0.97210627	20.23269794	15.60013004	2.15635028	9.355550586	4.573131586	25.95897869	71.72490462	14.49651181	34.80294478	12.21740334	1.073354502	22.1328199	44.68333077	97.99508385	0.470870061	7.23634374			24.59975598	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																			0.083469789	0.083469789	0.165976935	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083469789	0.083469789	0.165976935	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.7874	0.081141505	3.358161199	0	0.502429615	2.179843286	1.06553966	6.048442036	16.71190278	3.377687252	8.109086133	2.846654979	0.250091599	5.156947037	10.41121607	22.83285454	0.109712724	1.686068091	0	0	5.731743144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2469	0	0	23.7874	0.081141505	3.358161199	0	0.502429615	2.179843286	1.06553966	6.048442036	16.71190278	3.377687252	8.109086133	2.846654979	0.250091599	5.156947037	10.41121607	22.83285454	0.109712724	1.686068091	0	0	5.731743144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2469	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.4217	0.0014	0.1204	0	0.8517	0.458	0.2239	0.4936	1.2445	0.2757	0.6008	0.2323	0.0204	0.4177	0.604	1.3246	0.0064	0.1117			0.0074	0																			7.4161	0	0	24.2091	0.082579931	3.478532709	0	1.354079635	2.637815196	1.289396776	6.542075235	17.95644677	3.653356432	8.709882455	3.078994422	0.270509933	5.574688996	11.01518811	24.15741768	0.116087952	1.797723451	0	0	5.739144303	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.663
H5415_804_0	2010	4	N/A																															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	NO	284.98223	0.97210627	20.23269794	15.60013004	2.15635028	9.355550586	4.573131586	25.95897869	71.72490462	14.49651181	34.80294478	12.21740334	1.073354502	22.1328199	44.68333077	97.99508385	0.470870061	7.23634374			24.59975598	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																			0.083469789	0.083469789	0.165976935	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083469789	0.083469789	0.165976935	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.7874	0.081141505	3.358161199	0	0.502429615	2.179843286	1.06553966	6.048442036	16.71190278	3.377687252	8.109086133	2.846654979	0.250091599	5.156947037	10.41121607	22.83285454	0.109712724	1.686068091	0	0	5.731743144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2469	0	0	23.7874	0.081141505	3.358161199	0	0.502429615	2.179843286	1.06553966	6.048442036	16.71190278	3.377687252	8.109086133	2.846654979	0.250091599	5.156947037	10.41121607	22.83285454	0.109712724	1.686068091	0	0	5.731743144	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.2469	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.4217	0.0014	0.1204	0	0.8517	0.458	0.2239	0.4936	1.2445	0.2757	0.6008	0.2323	0.0204	0.4177	0.604	1.3246	0.0064	0.1117			0.0074	0																			7.4161	0	0	24.2091	0.082579931	3.478532709	0	1.354079635	2.637815196	1.289396776	6.542075235	17.95644677	3.653356432	8.709882455	3.078994422	0.270509933	5.574688996	11.01518811	24.15741768	0.116087952	1.797723451	0	0	5.739144303	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.663
H5416_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1304.572587	70.84606945	1008.755889	1008.982963	201.0660471	14.06819873	5.877279044	428.81039	191.2721423	2.005842305	7.082923288	0.792042536	0.074436936	5.28413737	5194.4414	4581.317365	175.763157	78.77973543	28.92347285	119.0659564	10.25058339	0	0	0	401	10.71163016	0	0	0	0											3950	1a (IP Acute): $125 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $200 Copay per day (days 1-5);	2a (SNF): $25 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0 Copay;	10a (Ambulance): $100 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 15% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 15% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 15% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $25 Copay per visit; 5 (Partial Hosp): $40 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 15% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $15 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 15% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 30 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);			13c (OTC Rx): $5.0 OTC per month											76.4152099	81.55558201	15.27871124	0	100	0.195166473	0.1	48.35135731	200	0	0.145551114	0.15	0.2	0.149681307	4.04061247	30	40	29.85945159	0.15	0.030078037	0.2	0	0	0	5	0	0	0	0	0											NO	70.99567103	75.77147637	14.19511061	0	92.90777468	0.181324827	0.092907775	44.92217011	185.8155494	0	0.135228301	0.139361662	0.185815549	0.139065572	3.75404313	27.8723324	37.16310987	27.741752	0.139361662	0.027944835	0.185815549	0	0	0	5	0	0	0	0	0												7.7183	0.447342606	1.193283451	0	1.556716583	2.550913702	0.546044917	1.605257774	2.961778184	0	0.957811682	0.110380364	0.01383154	0.734841584	1.625013087	10.64100004	0.544325459	0.18212399	4.030823248	3.327278518	1.904717784	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8188	0	3.255866668	7.7183	0.447342606	1.193283451	0	1.556716583	2.550913702	0.546044917	1.605257774	2.961778184	0	0.957811682	0.110380364	0.01383154	0.734841584	1.625013087	10.64100004	0.544325459	0.18212399	4.030823248	3.327278518	1.904717784	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8188	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.7183	0.447342606	1.193283451	0	1.556716583	2.550913702	0.546044917	1.605257774	2.961778184	0	0.957811682	0.110380364	0.01383154	0.734841584	1.625013087	10.64100004	0.544325459	0.18212399	4.030823248	3.327278518	1.904717784	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.8188
H5416_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	814.2079669	110.2454723	603.8683153	661.8148685	152.8127298	10.25444756	4.66553307	375.9620515	99.00075533	1.283349323	3.97649644	1.115125272	0.009992856	6.661139385	4398.655021	3922.990005	107.5676605	42.96597762	34.71523617	101.9461475	16.38461623	0	0	0	295	6.228202179	0	0	0	0											3950	1a (IP Acute): $195 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $250 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 15% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $250 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $35 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $35 Copay per visit; 7i (PT/ST): $35 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 35 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $35 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $35 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 35 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $125 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 35 copay;"	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): $5.0 OTC per month											144.919782	32.717409	21.34349879	0	125	0.2	0.144799313	46.96929617	250	0	0.196073509	0.2	0.2	0.198958957	0	35	40	35	0.2	0.051156053	0.2	0	0	0	25	0	0	0	0	0											NO	131.2817174	29.63844953	19.33491163	0	113.2365399	0.181178464	0.131172585	42.54912465	226.4730799	0	0.177621486	0.181178464	0.181178464	0.180235391	0	31.70623118	36.23569278	31.70623118	0.181178464	0.046341876	0.181178464	0	0	0	25	0	0	0	0	0												8.9076	0.272292072	0.972978376	0	1.441998732	1.857885057	0.611990034	1.333071349	1.868417164	0	0.706311206	0.202036684	0.00181049	1.200573063	0	10.365269	0.324815725	0.113524102	6.289653164	4.724375694	2.968539601	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7777	0	4.587836214	8.9076	0.272292072	0.972978376	0	1.441998732	1.857885057	0.611990034	1.333071349	1.868417164	0	0.706311206	0.202036684	0.00181049	1.200573063	0	10.365269	0.324815725	0.113524102	6.289653164	4.724375694	2.968539601	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7777	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.9076	0.272292072	0.972978376	0	1.441998732	1.857885057	0.611990034	1.333071349	1.868417164	0	0.706311206	0.202036684	0.00181049	1.200573063	0	10.365269	0.324815725	0.113524102	6.289653164	4.724375694	2.968539601	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7777
H5416_003_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	932.0452222	61.82679277	348.6286599	885.8746761	154.4612689	11.23288183	3.237582222	346.6757198	139.9387279	1.889530573	6.027425762	0.227179655	0.093750411	5.532869459	3629.901217	2648.503732	78.64793796	47.69576479	22.08555142	81.85180447	5.792096004	0	0	0	265	6.395555298	0	0	0	0											4950	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $200 Copay per day (days 1-5);	2a (SNF): $25 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $100 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 15% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 15% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $20 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 15% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $20 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $8 Copay per visit;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $20 Copay per visit; 7i (PT/ST): $20 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 15% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $12 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 30 copay;"	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 70 allowance (every 2 years);	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);			13c (OTC Rx): Not Covered;											95.76071141	86.19444344	14.77328227	0	100	0.2	0.191482951	48.85317871	200	0	0.143951073	0.15	0.2	0.149851502	6.449660259	30	40	20	0.15	0.029071656	0.2	0	0	0	25	0	0	0	0	0											NO	90.29750685	81.27700006	13.93045788	0	94.29494155	0.188589883	0.180558736	46.06607631	188.5898831	0	0.135738581	0.141442412	0.188589883	0.141302387	6.081703372	28.28848246	37.71797662	18.85898831	0.141442412	0.027413101	0.188589883	0	0	0	25	0	0	0	0	0												7.0134	0.41875802	0.404713072	0	1.213743027	2.118407872	0.584573755	1.330832514	2.199252361	0	0.818154217	0.032132838	0.017680379	0.781807659	1.839665206	6.243512615	0.247203424	0.074957823	3.123833671	2.243811806	1.092330708	0	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3509	0	1.923896563	7.0134	0.41875802	0.404713072	0	1.213743027	2.118407872	0.584573755	1.330832514	2.199252361	0	0.818154217	0.032132838	0.017680379	0.781807659	1.839665206	6.243512615	0.247203424	0.074957823	3.123833671	2.243811806	1.092330708	0	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3509	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.0134	0.41875802	0.404713072	0	1.213743027	2.118407872	0.584573755	1.330832514	2.199252361	0	0.818154217	0.032132838	0.017680379	0.781807659	1.839665206	6.243512615	0.247203424	0.074957823	3.123833671	2.243811806	1.092330708	0	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.3509
H5416_004_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1041.806181	20.43119904	696.2279549	653.3404355	168.9515549	13.1089501	5.164537376	475.684884	293.8097171	3.50565244	13.05514776	0.557418439	0.067775582	20.26435722	4805.105597	3624.197069	118.0417511	104.2358462	18.88243044	98.92690802	9.114096239	0	0	0	295	3.389247433	0	0	0	0											4950	1a (IP Acute): $195 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $175 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $350 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 20% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $29 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $35 Copay per visit; 7i (PT/ST): $35 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 35 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $35 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $35 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 35 copay per visit; 7g1 (Prof. Other Coins): $35 Copay per visit; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $125 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											153.4289577	161.6578612	64.36201619	0	175	0.2	0.195358835	49.02810209	350	0	0.185568994	0.2	0.2	0.199681918	4.130620802	29	40	35	0.2	0.165776083	0.2	0	0	0	25	0	0	0	0	0											NO	137.117249	144.4713014	57.51940657	0	156.3949787	0.178737118	0.174589376	43.81570846	312.7899573	0	0.165840336	0.178737118	0.178737118	0.178452854	3.691476298	25.91688218	35.7474237	31.27899573	0.178737118	0.148151697	0.178737118	0	0	0	25	0	0	0	0	0												11.9041	0.245976826	3.337218233	0	2.201931235	2.343055967	0.901673357	1.736872516	7.658394072	0	2.165070089	0.099631366	0.012114012	3.616232372	1.478161118	7.827324036	0.351640708	0.271699382	3.374991207	14.65618928	1.629027299	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4259	0	7.796980565	11.9041	0.245976826	3.337218233	0	2.201931235	2.343055967	0.901673357	1.736872516	7.658394072	0	2.165070089	0.099631366	0.012114012	3.616232372	1.478161118	7.827324036	0.351640708	0.271699382	3.374991207	14.65618928	1.629027299	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4259	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.9041	0.245976826	3.337218233	0	2.201931235	2.343055967	0.901673357	1.736872516	7.658394072	0	2.165070089	0.099631366	0.012114012	3.616232372	1.478161118	7.827324036	0.351640708	0.271699382	3.374991207	14.65618928	1.629027299	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.4259
H5416_009_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	897.6550542	29.60227082	602.1609458	611.4375571	141.2738009	12.10235053	4.5728451	423.1385734	161.649316	5.632904553	9.893512104	0.265929377	0.08002539	10.00111436	4750.541617	3509.959537	77.7927391	45.12931122	14.66252698	94.97834386	10.24739049	0	0	0	295	7.904182986	0	0	0	0											4950	1a (IP Acute): $190 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $50 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $175 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $55 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $45 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 20% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $29 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											144.5238171	148.707686	32.15632729	0	175	0.2	0.1949396	49.24418018	200	0	0.188049245	0.2	0.2	0.200560558	4.054893549	29	40	40	0.2	0.043236401	0.2	0	0	0	25	0	0	0	0	0											NO	133.6374554	137.5061713	29.73412853	0	161.8179976	0.184934854	0.180255633	45.53482647	184.9348544	0	0.173884299	0.184934854	0.184934854	0.185453188	3.749455741	26.81555389	36.98697089	36.98697089	0.184934854	0.039979587	0.184934854	0	0	0	25	0	0	0	0	0												9.9967	0.33920791	1.492060913	0	1.905053631	2.238146434	0.824281087	1.605628459	2.491216061	0	1.720326416	0.049179611	0.014799484	1.854738544	1.484328795	7.843459093	0.239776481	0.13909971	2.711612292	3.797194986	1.895099669	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2565	0	3.473685754	9.9967	0.33920791	1.492060913	0	1.905053631	2.238146434	0.824281087	1.605628459	2.491216061	0	1.720326416	0.049179611	0.014799484	1.854738544	1.484328795	7.843459093	0.239776481	0.13909971	2.711612292	3.797194986	1.895099669	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2565	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.9967	0.33920791	1.492060913	0	1.905053631	2.238146434	0.824281087	1.605628459	2.491216061	0	1.720326416	0.049179611	0.014799484	1.854738544	1.484328795	7.843459093	0.239776481	0.13909971	2.711612292	3.797194986	1.895099669	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.2565
H5416_011_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1091.516881	38.98550759	435.409696	868.4679279	141.8624622	10.04192236	4.171940145	368.5663118	179.0979021	612.1906959	8.734467835	0.303124089	0.139096762	7.358684464	4249.111071	3011.312591	90.89768469	64.81527433	30.35236994	139.7745613	6.889688902	0	0	0	265	4.743911438	0	0	0	0											3400	1a (IP Acute): $200 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $250 Copay per day (days 1-5);	2a (SNF): $75 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): $10 Copay per visit;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $250 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $35 Copay per visit; 5 (Partial Hosp): $45 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $15 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $20 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 20 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $20 Copay per visit; 17b (MCR Eyewear): 0% Coinsurance; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $125 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $20 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 20 copay;"	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  70 allowance (every 2 years);"	18a (Hearing Exam): 20 copay; 18a1 (Routine Hearing Exam): 20 copay (1 exam per year);	18b (Hearing Aids): Not Covered;		13c (OTC Rx): Not Covered;											118.5855179	112.7578926	45.12421863	10	125	0.2	0.182477584	48.77883199	250	0	0.187834062	0.2	0.2	0.197571742	4.062823105	20	40	30	0.2	0.022686749	0.2	0	0	0	25	0	0	0	0	0											NO	106.2740241	101.0514201	40.43944302	8.961804604	112.0225575	0.179236092	0.163532845	43.71463611	224.0451151	0	0.168333216	0.179236092	0.179236092	0.177059934	3.64102268	17.92360921	35.84721841	26.88541381	0.179236092	0.020331517	0.179236092	0	0	0	25	0	0	0	0	0												9.6667	0.328295075	1.467310466	0.648586656	1.32431632	1.799874921	0.682249242	1.342645183	3.343834174	0	1.470301062	0.054330777	0.02493116	1.302928183	1.289259149	4.497799174	0.271535763	0.145215456	5.440240174	2.841828816	1.234880914	0	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7291	0	4.603522104	9.6667	0.328295075	1.467310466	0.648586656	1.32431632	1.799874921	0.682249242	1.342645183	3.343834174	0	1.470301062	0.054330777	0.02493116	1.302928183	1.289259149	4.497799174	0.271535763	0.145215456	5.440240174	2.841828816	1.234880914	0	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7291	NO																																																																																		0	0	0	9.6667	0.328295075	1.467310466	0.648586656	1.32431632	1.799874921	0.682249242	1.342645183	3.343834174	0	1.470301062	0.054330777	0.02493116	1.302928183	1.289259149	4.497799174	0.271535763	0.145215456	5.440240174	2.841828816	1.234880914	0	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7291
H5416_013_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1149.224983	41.04665724	458.4296487	914.3835123	149.3626791	10.52115936	4.371040276	388.052279	188.5667432	2.816132807	9.151308352	0.317590271	0.145734965	7.709867603	4473.760033	3170.519596	95.70341231	68.24203437	19.49491207	89.77528896	7.21848987	0	0	0	390	4.994720315	0	0	0	0											3400	1a (IP Acute): $125 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $200 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $100 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 15% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 0% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $25 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $25 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 25 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $25 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $25 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 25 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 0% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 10 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): 25 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											74.11594871	90.20631408	21.05796869	0	100	0.2	0.091238792	48.77883199	200	0	0.131820412	0.2	0.2	0.198439672	4.062823105	25	40	25.10863345	0.2	0.026852495	0.2	0	0	0	10	0	0	0	0	0											NO	67.69895369	82.39620738	19.23475948	0	91.34195119	0.182683902	0.083339293	44.55553691	182.6839024	0	0.120407336	0.182683902	0.182683902	0.181258669	3.711061897	22.8354878	36.53678048	22.93471571	0.182683902	0.024527593	0.182683902	0	0	0	10	0	0	0	0	0												6.4834	0.28184074	0.734815336	0	1.136923212	1.922046449	0.364279405	1.440823136	2.870675709	0	1.10188466	0.05801863	0.026623432	1.397480338	1.383533366	6.033363462	0.291391214	0.130425971	3.561406613	2.201971768	1.318701899	0	0	0	0.325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0646	0	3.103289813	6.4834	0.28184074	0.734815336	0	1.136923212	1.922046449	0.364279405	1.440823136	2.870675709	0	1.10188466	0.05801863	0.026623432	1.397480338	1.383533366	6.033363462	0.291391214	0.130425971	3.561406613	2.201971768	1.318701899	0	0	0	0.325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0646	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.4834	0.28184074	0.734815336	0	1.136923212	1.922046449	0.364279405	1.440823136	2.870675709	0	1.10188466	0.05801863	0.026623432	1.397480338	1.383533366	6.033363462	0.291391214	0.130425971	3.561406613	2.201971768	1.318701899	0	0	0	0.325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.0646
H5416_014_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	415.0965993	10.20951393	39.23024962	2707.98061	15.50828783	17.76172765	6.711899174	29.53616192	26.26630691	6.084060811	12.46584281	0.713492586	0	12.45396358	4835.484808	3441.12625	358.865708	1.482179597	21.75910438	106.1286262	17.13065271	0	0	0	401	0.043120128	0	0	0	0												1a (IP Acute): 7.30% Coin MC CS; 1a1 (Add'l Days): 7.30% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.30% Coin MC CS;	2a (SNF): 15.28% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $18.5 OTC per month (cumulative benefit)											0.073	0.073	0.1528	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.151996727	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.073	0.073	0.1528	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.151996727	0.2	0	0	0	5	0.2	0	0	0	0												30.3021	0.745294517	5.994382141	0	3.101657566	3.552345531	1.342379835	5.907232384	5.253261381	0	2.493168561	0.142698517	0	2.490792716	0	2.867605208	0.299054757	0.296435919	4.351820875	16.13120378	3.426130542	0	0	0	0.167083333	0.008624026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8732	0	0	30.3021	0.745294517	5.994382141	0	3.101657566	3.552345531	1.342379835	5.907232384	5.253261381	0	2.493168561	0.142698517	0	2.490792716	0	2.867605208	0.299054757	0.296435919	4.351820875	16.13120378	3.426130542	0	0	0	0.167083333	0.008624026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8732	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	30.3021	0.745294517	5.994382141	0	3.101657566	3.552345531	1.342379835	5.907232384	5.253261381	0	2.493168561	0.142698517	0	2.490792716	0	2.867605208	0.299054757	0.296435919	4.351820875	16.13120378	3.426130542	0	0	0	0.167083333	0.008624026	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.8732
H5416_015_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	407.2730205	10.017089	38.49085317	2645.703395	15.21599367	17.42696154	6.585395915	28.97947586	25.7712498	5.969390805	12.23089146	0.700044956	0	12.21923613	4724.279978	3361.988402	350.6126368	1.454244054	21.34899726	104.1283552	16.80778084	0	0	0	401	0.042307417	0	0	0	0												1a (IP Acute): 7.48% Coin MC CS; 1a1 (Add'l Days): 7.48% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.48% Coin MC CS;	2a (SNF): 15.63% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $16.0 OTC per month (cumulative benefit)											0.0748	0.0748	0.1563	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.151982383	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0748	0.0748	0.1563	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.151982383	0.2	0	0	0	5	0.2	0	0	0	0												30.464	0.749278257	6.01612035	0	3.043198733	3.485392307	1.317079183	5.795895171	5.154249959	0	2.446178292	0.140008991	0	2.443847226	0	2.801657002	0.292177197	0.290848811	4.269799452	15.82567559	3.361556169	0	0	0	0.167083333	0.008461483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0725	0	0	30.464	0.749278257	6.01612035	0	3.043198733	3.485392307	1.317079183	5.795895171	5.154249959	0	2.446178292	0.140008991	0	2.443847226	0	2.801657002	0.292177197	0.290848811	4.269799452	15.82567559	3.361556169	0	0	0	0.167083333	0.008461483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0725	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	30.464	0.749278257	6.01612035	0	3.043198733	3.485392307	1.317079183	5.795895171	5.154249959	0	2.446178292	0.140008991	0	2.443847226	0	2.801657002	0.292177197	0.290848811	4.269799452	15.82567559	3.361556169	0	0	0	0.167083333	0.008461483	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0725
H5416_016_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1148.3285	41.01463774	458.0720389	913.6702239	149.2461649	10.69193967	4.441991358	387.7495688	188.4196469	2.861844504	9.299853135	0.322745422	0.148100547	7.835014803	4470.270161	3168.04635	95.6287564	68.18880042	19.81135507	91.23252877	7.335660986	0	0	0	314	4.990824055	0	0	0	0											3400	1a (IP Acute): $175 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $15 Copay per visit;	10a (Ambulance): $130 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 15% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $35 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $40 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $10 Copay per visit;	7d (SPC w/Copay): $20 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $20 Copay per visit; 7i (PT/ST): $20 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 20 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $20 Copay per visit; 7b (Chiro): $20 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $20 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 20 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $20 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  125 allowance (every 2 years);"	18a (Hearing Exam): 20 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): $5.0 OTC per month											103.7623282	117.2682083	21.05796869	15	130	0.2	0.195619396	48.77883199	200	0	0.187834062	0.2	0.2	0.199674682	8.125646209	20	40	20	0.2	0.026866178	0.2	0	0	0	25	0	0	0	0	0											NO	93.50934577	105.6806804	18.97718478	13.51781722	117.1544159	0.180237563	0.176289816	43.958889	180.2375629	0	0.169273768	0.180237563	0.180237563	0.17994439	7.322733349	18.02375629	36.04751258	18.02375629	0.180237563	0.024211473	0.180237563	0	0	0	25	0	0	0	0	0												8.9483	0.361204568	0.724409811	1.02923559	1.457070606	1.92708915	0.783077839	1.420420021	2.83002483	0	1.57422118	0.058170848	0.026693282	1.409866958	2.727883032	4.758341278	0.2872649	0.102418193	3.570750356	2.208873869	1.322161658	0	0	0	0.654166667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1816	0	4.114747514	8.9483	0.361204568	0.724409811	1.02923559	1.457070606	1.92708915	0.783077839	1.420420021	2.83002483	0	1.57422118	0.058170848	0.026693282	1.409866958	2.727883032	4.758341278	0.2872649	0.102418193	3.570750356	2.208873869	1.322161658	0	0	0	0.654166667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1816	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.9483	0.361204568	0.724409811	1.02923559	1.457070606	1.92708915	0.783077839	1.420420021	2.83002483	0	1.57422118	0.058170848	0.026693282	1.409866958	2.727883032	4.758341278	0.2872649	0.102418193	3.570750356	2.208873869	1.322161658	0	0	0	0.654166667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1816
H5416_017_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1242.639182	44.38311498	495.6928817	988.7087352	161.5035525	11.46976088	4.765138997	419.5949214	203.8943	3.070039032	9.976402309	0.346224626	0.15887462	8.404999373	4837.407459	3428.233752	103.482618	73.78905523	21.25259889	97.8695467	7.869318379	0	0	0	265	5.400713748	0	0	0	0											4950	1a (IP Acute): $175 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $250 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $35 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $35 Copay per visit; 7i (PT/ST): $35 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 35 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $35 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $35 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 35 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 35 copay;"	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  70 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): $5.0 OTC per month											103.7623282	117.2682083	54.14906235	0	125	0.2	0.1	48.77883199	250	0	0.187834062	0.2	0.2	0.199276923	0	35	40	35	0.2	0.032438553	0.2	0	0	0	25	0	0	0	0	0											NO	96.4475926	109.0013744	50.33181884	0	116.1881126	0.18590098	0.09295049	45.3401634	232.3762253	0	0.174592681	0.18590098	0.18590098	0.185228877	0	32.53267154	37.18019604	32.53267154	0.18590098	0.030151794	0.18590098	0	0	0	25	0	0	0	0	0												9.9875	0.403151711	2.079093693	0	1.563732745	2.13223979	0.442922005	1.585375191	3.948348983	0	1.741806828	0.064363497	0.029534948	1.556848592	0	9.294133551	0.320625335	0.200046258	3.950878967	2.950942414	1.462914	0	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2665	0	3.315360779	9.9875	0.403151711	2.079093693	0	1.563732745	2.13223979	0.442922005	1.585375191	3.948348983	0	1.741806828	0.064363497	0.029534948	1.556848592	0	9.294133551	0.320625335	0.200046258	3.950878967	2.950942414	1.462914	0	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2665	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.9875	0.403151711	2.079093693	0	1.563732745	2.13223979	0.442922005	1.585375191	3.948348983	0	1.741806828	0.064363497	0.029534948	1.556848592	0	9.294133551	0.320625335	0.200046258	3.950878967	2.950942414	1.462914	0	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2665
H5416_018_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1156.842442	41.31872863	461.4682785	920.4443615	150.3527065	10.60517966	4.405946709	390.6244233	189.8166286	2.838621996	9.224389246	0.320126496	0.146898781	7.771437381	4503.413656	3191.534893	96.33776752	68.6943661	19.65059534	90.49222016	7.276135583	0	0	0	346	5.027827044	0	0	0	0											4450	1a (IP Acute): $175 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 30 copay;"	17a1 (Routine Eye Exam): 10 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): $5.0 OTC per month											103.7623282	117.2682083	54.14906235	0	125	0.2	0.1	48.77883199	200	0	0.187834062	0.2	0.2	0.198867096	0	30	40	30	0.2	0.030836482	0.2	0	0	0	10	0	0	0	0	0											NO	95.95204665	108.4413273	50.07321489	0	115.5911403	0.184945824	0.092472912	45.10720648	184.9458244	0	0.173695627	0.184945824	0.184945824	0.183898195	0	27.74187366	36.98916488	27.74187366	0.184945824	0.028515393	0.184945824	0	0	0	10	0	0	0	0	0												9.2501	0.373388148	1.925600023	0	1.448286732	1.961383696	0.407430723	1.468331376	2.925482739	0	1.602236076	0.059206059	0.027168316	1.42915331	0	7.378263149	0.296954464	0.158809202	3.634295555	2.580421176	1.345690894	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5606	0	3.11526382	9.2501	0.373388148	1.925600023	0	1.448286732	1.961383696	0.407430723	1.468331376	2.925482739	0	1.602236076	0.059206059	0.027168316	1.42915331	0	7.378263149	0.296954464	0.158809202	3.634295555	2.580421176	1.345690894	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5606	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.2501	0.373388148	1.925600023	0	1.448286732	1.961383696	0.407430723	1.468331376	2.925482739	0	1.602236076	0.059206059	0.027168316	1.42915331	0	7.378263149	0.296954464	0.158809202	3.634295555	2.580421176	1.345690894	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5606
H5416_019_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	410.6935715	10.1012192	38.81412508	2705.808959	15.34378775	17.57332481	6.640704472	29.22286486	25.98769398	6.019525739	12.33361466	0.705924401	0	12.32186144	4831.607017	3438.366657	358.5779175	1.466457768	21.52830041	105.0028948	16.94894382	0	0	0	358	0.042662743	0	0	0	0												1a (IP Acute): 8.13% Coin MC CS; 1a1 (Add'l Days): 8.13% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.13% Coin MC CS;	2a (SNF): 19.14% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $20.0 OTC per month (cumulative benefit)											0.0813	0.0813	0.1914	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.152030333	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0813	0.0813	0.1914	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.152030333	0.2	0	0	0	5	0.2	0	0	0	0												33.3894	0.821229121	7.42902354	0	3.06875755	3.514664961	1.328140894	5.844572973	5.197538795	0	2.466722933	0.14118488	0	2.464372289	0	2.865305548	0.298814931	0.293291554	4.305660082	15.96362509	3.389788764	0	0	0	0.149166667	0.008532549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9398	0	0	33.3894	0.821229121	7.42902354	0	3.06875755	3.514664961	1.328140894	5.844572973	5.197538795	0	2.466722933	0.14118488	0	2.464372289	0	2.865305548	0.298814931	0.293291554	4.305660082	15.96362509	3.389788764	0	0	0	0.149166667	0.008532549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9398	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	33.3894	0.821229121	7.42902354	0	3.06875755	3.514664961	1.328140894	5.844572973	5.197538795	0	2.466722933	0.14118488	0	2.464372289	0	2.865305548	0.298814931	0.293291554	4.305660082	15.96362509	3.389788764	0	0	0	0.149166667	0.008532549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9398
H5416_020_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1229.918087	43.92875798	490.6183949	978.5871668	159.8502149	11.59318951	4.816417712	415.2994615	201.8070017	3.103076401	10.08376058	0.349950426	0.160584305	8.49544743	4787.886151	3393.138379	102.42325	73.03366495	21.48130281	98.92274254	7.954001855	0	0	0	401	5.345425783	0	0	0	0											3400	1a (IP Acute): $180 Copay per day (days 1-6); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $8 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $15 Copay per visit; 7i (PT/ST): $15 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 15 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $15 Copay per visit; 7b (Chiro): $15 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $15 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 15 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $15 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 15 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 15 copay; 18a1 (Routine Hearing Exam): 15 copay (1 exam per year);			13c (OTC Rx): Not Covered											116.3900652	117.2682083	21.05796869	0	150	0.2	0.182477584	48.77883199	200	0	0.187834062	0.2	0.2	0.198377733	4.062823105	8	40	15	0.2	0.024827437	0.2	0	0	0	5	0	0	0	0	0											NO	106.2116489	107.0129975	19.21643031	0	136.8823645	0.182509819	0.166519754	44.51307906	182.5098193	0	0.171407804	0.182509819	0.182509819	0.181029421	3.707525554	7.300392773	36.50196386	13.68823645	0.182509819	0.022656255	0.182509819	0	0	0	5	0	0	0	0	0												10.886	0.391745673	0.785661183	0	1.823389615	2.115870923	0.802028694	1.54052148	3.069313285	0	1.728435253	0.063869389	0.029308213	1.537925932	1.479267521	2.064270241	0.311554148	0.083308506	3.920548695	2.241218889	1.451683441	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.493	0	3.481151653	10.886	0.391745673	0.785661183	0	1.823389615	2.115870923	0.802028694	1.54052148	3.069313285	0	1.728435253	0.063869389	0.029308213	1.537925932	1.479267521	2.064270241	0.311554148	0.083308506	3.920548695	2.241218889	1.451683441	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.493	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.886	0.391745673	0.785661183	0	1.823389615	2.115870923	0.802028694	1.54052148	3.069313285	0	1.728435253	0.063869389	0.029308213	1.537925932	1.479267521	2.064270241	0.311554148	0.083308506	3.920548695	2.241218889	1.451683441	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.493
H5416_021_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1180.554469	42.16564674	470.9270846	939.3108906	153.4345155	11.68336851	4.853882788	398.6311289	193.7073374	3.127214049	10.16219831	0.352672556	0.161833429	8.561530275	4595.721012	3256.952411	98.31242169	70.10240804	21.64839767	99.69222482	8.015873001	0	0	0	401	5.130883404	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $10 Copay per visit; 7i (PT/ST): $10 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 25 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											88.93913845	117.2682083	21.05796869	0	150	0.2	0.182477584	48.77883199	200	0	0.187834062	0.2	0.2	0.198278242	0	10	40	10	0.2	0.022138778	0.2	0	0	0	5	0	0	0	0	0											NO	82.23635594	108.4304423	19.47096227	0	138.6954451	0.18492726	0.168725398	45.10267875	184.9272601	0	0.173678192	0.18492726	0.18492726	0.18333526	0	9.246363005	36.98545202	9.246363005	0.18492726	0.020470318	0.18492726	0	0	0	5	0	0	0	0	0												8.0904	0.38100331	0.764116958	0	1.773389034	2.160573327	0.818973306	1.498277646	2.985147264	0	1.764952231	0.06521877	0.029927413	1.569630382	0	2.509580357	0.30301078	0.054016026	4.003378867	2.040731517	1.482353431	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4617	0	2.632209262	8.0904	0.38100331	0.764116958	0	1.773389034	2.160573327	0.818973306	1.498277646	2.985147264	0	1.764952231	0.06521877	0.029927413	1.569630382	0	2.509580357	0.30301078	0.054016026	4.003378867	2.040731517	1.482353431	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4617	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.0904	0.38100331	0.764116958	0	1.773389034	2.160573327	0.818973306	1.498277646	2.985147264	0	1.764952231	0.06521877	0.029927413	1.569630382	0	2.509580357	0.30301078	0.054016026	4.003378867	2.040731517	1.482353431	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.4617
H5416_022_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	396.9159243	9.762350899	37.51201723	2598.440169	14.82904559	16.98378777	6.41792698	28.24251759	25.11587785	5.817587097	11.91985559	0.682242566	0	11.90849666	4639.884761	3301.929358	344.3492423	1.417262116	20.80608475	101.4803345	16.38035306	0	0	0	401	0.041231524	0	0	0	0												1a (IP Acute): 6.41% Coin MC CS; 1a1 (Add'l Days): 6.41% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 6.41% Coin MC CS;	2a (SNF): 12.94% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $22.0 OTC per month (cumulative benefit)											0.0641	0.0641	0.1294	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.152008599	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0641	0.0641	0.1294	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.152008599	0.2	0	0	0	5	0.2	0	0	0	0												25.4423	0.625766693	4.85405503	0	2.965809119	3.396757555	1.283585396	5.648503518	5.023175569	0	2.383971118	0.136448513	0	2.381699331	0	2.751607798	0.286957702	0.283452423	4.16121695	15.42588346	3.276070613	0	0	0	0.167083333	0.008246305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5026	0	0	25.4423	0.625766693	4.85405503	0	2.965809119	3.396757555	1.283585396	5.648503518	5.023175569	0	2.383971118	0.136448513	0	2.381699331	0	2.751607798	0.286957702	0.283452423	4.16121695	15.42588346	3.276070613	0	0	0	0.167083333	0.008246305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5026	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.4423	0.625766693	4.85405503	0	2.965809119	3.396757555	1.283585396	5.648503518	5.023175569	0	2.383971118	0.136448513	0	2.381699331	0	2.751607798	0.286957702	0.283452423	4.16121695	15.42588346	3.276070613	0	0	0	0.167083333	0.008246305	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.5026
H5416_023_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1275.944268	45.57266663	508.9783909	1015.208004	165.8321539	11.75376219	4.883128009	430.840861	209.3590539	3.146055885	10.22342676	0.35479745	0.162808495	8.613114512	4967.059153	3520.116918	106.2561484	75.76674184	21.77883184	100.2928823	8.064169589	0	0	0	390	5.545463118	0	0	0	0											3400	1a (IP Acute): $100 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $200 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $100 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $100 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 15% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 0% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $15 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $15 Copay per visit; 7i (PT/ST): $15 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 15 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $15 Copay per visit; 7b (Chiro): $15 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $15 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 15 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 0% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $75 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $15 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 10 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 15 copay; 18a1 (Routine Hearing Exam): 15 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											59.29275896	90.20631408	21.05796869	0	100	0.2	0.091238792	48.77883199	100	0	0.131820412	0.2	0.2	0.198426385	0	15	40	15	0.2	0.018964498	0.2	0	0	0	10	0	0	0	0	0											NO	55.42923876	84.32846453	19.68583002	0	93.4839932	0.186967986	0.085293666	45.60039998	93.4839932	0	0.123230985	0.186967986	0.186967986	0.185496908	0	14.02259898	37.39359728	14.02259898	0.186967986	0.01772877	0.186967986	0	0	0	10	0	0	0	0	0												5.8937	0.320256083	0.834971841	0	1.291887663	2.19757725	0.41649989	1.637209632	1.630976698	0	1.259842946	0.066335765	0.030439976	1.597706113	0	4.113432326	0.331108302	0.08853722	4.071944336	1.778069489	1.50774155	0	0	0	0.325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3933	0	2.026102465	5.8937	0.320256083	0.834971841	0	1.291887663	2.19757725	0.41649989	1.637209632	1.630976698	0	1.259842946	0.066335765	0.030439976	1.597706113	0	4.113432326	0.331108302	0.08853722	4.071944336	1.778069489	1.50774155	0	0	0	0.325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3933	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.8937	0.320256083	0.834971841	0	1.291887663	2.19757725	0.41649989	1.637209632	1.630976698	0	1.259842946	0.066335765	0.030439976	1.597706113	0	4.113432326	0.331108302	0.08853722	4.071944336	1.778069489	1.50774155	0	0	0	0.325	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3933
H5416_024_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	265.4761328	6.060081897	24.13261038	1646.322717	9.657050651	11.90371085	4.615687216	18.69158707	20.52550046	3.843386299	8.879581697	0.446959999	0.043305148	8.445387164	3776.227715	2683.432939	210.6733632	1.183808728	16.54565324	79.12252242	10.61046298	0	0	0	401	0.038552904	0	0	0	0												1a (IP Acute): 6.41% Coin MC CS; 1a1 (Add'l Days): 6.41% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 6.41% Coin MC CS;	2a (SNF): 12.94% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $11.5 OTC per month (cumulative benefit)											0.0641	0.0641	0.1294	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155671517	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0641	0.0641	0.1294	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155671517	0.2	0	0	0	5	0.2	0	0	0	0												17.017	0.38845125	3.122759783	0	1.93141013	2.38074217	0.923137443	3.738317414	4.105100092	0	1.775916339	0.089392	0.00866103	1.689077433	0	2.236194116	0.175561136	0.236761746	3.309130648	12.31712312	2.122092596	0	0	0	0.167083333	0.007710581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7416	0	0	17.017	0.38845125	3.122759783	0	1.93141013	2.38074217	0.923137443	3.738317414	4.105100092	0	1.775916339	0.089392	0.00866103	1.689077433	0	2.236194116	0.175561136	0.236761746	3.309130648	12.31712312	2.122092596	0	0	0	0.167083333	0.007710581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7416	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.017	0.38845125	3.122759783	0	1.93141013	2.38074217	0.923137443	3.738317414	4.105100092	0	1.775916339	0.089392	0.00866103	1.689077433	0	2.236194116	0.175561136	0.236761746	3.309130648	12.31712312	2.122092596	0	0	0	0.167083333	0.007710581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7416
H5416_025_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	274.8515841	6.27409738	24.98486821	1715.700231	9.998095277	12.32409765	4.778693021	19.35169185	21.25037101	3.979117827	9.193169534	0.462744664	0.044834496	8.743641156	3935.361335	2796.515208	219.5513276	1.225615654	17.12997307	81.9167825	10.98517794	0	0	0	401	0.039914423	0	0	0	0												1a (IP Acute): 8.13% Coin MC CS; 1a1 (Add'l Days): 8.13% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.13% Coin MC CS;	2a (SNF): 19.14% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $20.0 OTC per month											0.0813	0.0813	0.1914	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155694711	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0813	0.0813	0.1914	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155694711	0.2	0	0	0	5	0.2	0	0	0	0												22.3454	0.510084117	4.782103776	0	1.999619055	2.46481953	0.955738604	3.870338371	4.250074202	0	1.838633907	0.092548933	0.008966899	1.748728231	0	2.33042934	0.18295944	0.245123131	3.425994613	12.75400975	2.197035588	0	0	0	0.167083333	0.007982885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1777	0	0	22.3454	0.510084117	4.782103776	0	1.999619055	2.46481953	0.955738604	3.870338371	4.250074202	0	1.838633907	0.092548933	0.008966899	1.748728231	0	2.33042934	0.18295944	0.245123131	3.425994613	12.75400975	2.197035588	0	0	0	0.167083333	0.007982885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1777	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.3454	0.510084117	4.782103776	0	1.999619055	2.46481953	0.955738604	3.870338371	4.250074202	0	1.838633907	0.092548933	0.008966899	1.748728231	0	2.33042934	0.18295944	0.245123131	3.425994613	12.75400975	2.197035588	0	0	0	0.167083333	0.007982885	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.1777
H5416_026_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	277.6913927	6.338922314	25.24301569	1715.922681	10.10139713	12.45143211	4.828067209	19.55163649	21.4699331	4.020230681	9.288154767	0.467525813	0.045297733	8.833981794	3935.871575	2796.87779	219.5797935	1.238278903	17.30696257	82.76315922	11.09867848	0	0	0	401	0.040326825	0	0	0	0												1a (IP Acute): 7.30% Coin MC CS; 1a1 (Add'l Days): 7.30% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.30% Coin MC CS;	2a (SNF): 15.28% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											0.073	0.073	0.1528	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155658949	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.073	0.073	0.1528	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155658949	0.2	0	0	0	5	0.2	0	0	0	0												20.2715	0.462741329	3.857132798	0	2.020279425	2.490286422	0.965613442	3.910327299	4.293986619	0	1.857630953	0.093505163	0.009059547	1.766796359	0	2.330731492	0.182983161	0.247655781	3.461392513	12.88282642	2.219735696	0	0	0	0.167083333	0.008065365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4993	0	0	20.2715	0.462741329	3.857132798	0	2.020279425	2.490286422	0.965613442	3.910327299	4.293986619	0	1.857630953	0.093505163	0.009059547	1.766796359	0	2.330731492	0.182983161	0.247655781	3.461392513	12.88282642	2.219735696	0	0	0	0.167083333	0.008065365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4993	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.2715	0.462741329	3.857132798	0	2.020279425	2.490286422	0.965613442	3.910327299	4.293986619	0	1.857630953	0.093505163	0.009059547	1.766796359	0	2.330731492	0.182983161	0.247655781	3.461392513	12.88282642	2.219735696	0	0	0	0.167083333	0.008065365	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4993
H5416_027_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	289.4496016	6.607329527	26.31187364	1803.886934	10.52911776	12.97865961	5.032500707	20.37950596	22.37902846	4.190458183	9.681440504	0.487322127	0.047215762	9.208036611	4137.638245	2940.255618	230.8362288	1.290711	18.03978644	86.2675765	11.56862672	0	0	0	401	0.042034373	0	0	0	0												1a (IP Acute): 8.78% Coin MC CS; 1a1 (Add'l Days): 8.78% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.78% Coin MC CS;	2a (SNF): 17.54% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $20.0 OTC per month											0.0878	0.0878	0.1754	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155688952	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0878	0.0878	0.1754	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155688952	0.2	0	0	0	5	0.2	0	0	0	0												25.4137	0.580123532	4.615102636	0	2.105823551	2.595731923	1.006500141	4.075901193	4.475805692	0	1.936288101	0.097464425	0.009443152	1.841607322	0	2.450213015	0.192363524	0.2581422	3.607957288	13.43090857	2.313725343	0	0	0	0.167083333	0.008406875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1823	0	0	25.4137	0.580123532	4.615102636	0	2.105823551	2.595731923	1.006500141	4.075901193	4.475805692	0	1.936288101	0.097464425	0.009443152	1.841607322	0	2.450213015	0.192363524	0.2581422	3.607957288	13.43090857	2.313725343	0	0	0	0.167083333	0.008406875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1823	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.4137	0.580123532	4.615102636	0	2.105823551	2.595731923	1.006500141	4.075901193	4.475805692	0	1.936288101	0.097464425	0.009443152	1.841607322	0	2.450213015	0.192363524	0.2581422	3.607957288	13.43090857	2.313725343	0	0	0	0.167083333	0.008406875	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.1823
H5416_028_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	272.372884	6.217515551	24.75954663	1676.140906	9.907929236	12.21295497	4.73559723	19.17717207	21.05872833	3.943232862	9.110262572	0.458571484	0.044430164	8.664788186	3844.622734	2732.035264	214.4890782	1.214562658	16.97548945	81.17803059	10.88611007	0	0	0	401	0.039554462	0	0	0	0												1a (IP Acute): 7.48% Coin MC CS; 1a1 (Add'l Days): 7.48% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.48% Coin MC CS;	2a (SNF): 15.63% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $12.5 OTC per month											0.0748	0.0748	0.1563	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155644541	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0748	0.0748	0.1563	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155644541	0.2	0	0	0	5	0.2	0	0	0	0												20.3735	0.465070163	3.869917138	0	1.981585847	2.442590994	0.947119446	3.835434414	4.211745665	0	1.822052514	0.091714297	0.008886033	1.732957637	0	2.276696053	0.178740899	0.242912532	3.395097891	12.63491734	2.177222014	0	0	0	0.167083333	0.007910892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8631	0	0	20.3735	0.465070163	3.869917138	0	1.981585847	2.442590994	0.947119446	3.835434414	4.211745665	0	1.822052514	0.091714297	0.008886033	1.732957637	0	2.276696053	0.178740899	0.242912532	3.395097891	12.63491734	2.177222014	0	0	0	0.167083333	0.007910892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8631	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.3735	0.465070163	3.869917138	0	1.981585847	2.442590994	0.947119446	3.835434414	4.211745665	0	1.822052514	0.091714297	0.008886033	1.732957637	0	2.276696053	0.178740899	0.242912532	3.395097891	12.63491734	2.177222014	0	0	0	0.167083333	0.007910892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8631
H5416_029_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1175.930343	42.00048766	469.0825051	935.6316934	152.8335261	11.34754224	4.47864483	417.9171415	192.948603	2.885459259	9.37727585	0.325408583	0.157181696	7.907486248	4577.719982	3244.195219	103.0814112	69.82782314	19.97483016	92.01326643	7.785465074	0	0	0	401	5.379774937	0	0	0	0											2950	1a (IP Acute): $165 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);	18b (Hearing Aids): 500 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											97.83305229	117.2682083	21.05796869	0	125	0.2	0.1	48.77883199	200	0	0.18783495	0.2	0.2	0.198868217	0	30	40	30	0.2	0.03088782	0.2	0	0	0	5	0	0	0	0	0											NO	87.11735439	104.4237691	18.75147998	0	111.3086942	0.178093911	0.089046955	43.43606474	178.0939107	0	0.167261304	0.178093911	0.178093911	0.177086092	0	26.7140866	35.61878214	26.7140866	0.178093911	0.027504663	0.178093911	0	0	0	5	0	0	0	0	0												8.537	0.365487435	0.732999267	0	1.417641685	2.020928174	0.398809686	1.512723001	2.863580939	0	1.568455384	0.057953287	0.027993103	1.400305838	0	7.222142669	0.305969527	0.155448876	3.557395619	2.530793921	1.386543922	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2293	0	4.331187415	8.537	0.365487435	0.732999267	0	1.417641685	2.020928174	0.398809686	1.512723001	2.863580939	0	1.568455384	0.057953287	0.027993103	1.400305838	0	7.222142669	0.305969527	0.155448876	3.557395619	2.530793921	1.386543922	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2293	NO	1a (IP Acute): 30% Coinsurance; 1a1 (Add'l Days): 30% coin per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): 30% Coinsurance;	2a (SNF): 25% Coinsurance; 2a2 (Waiver 3 Day): 25% coin;	6a (Home Health): 25% Coinsurance;	10a (Ambulance): 25% Coinsurance;	11a (DME): Not Covered; 11b (Prosthetics): Not Covered;	11b (Medical Supplies): 25% Coinsurance; 11c (Diabetic Supplies): 25% Coinsurance;	4a (ER): Not Covered; 4a (ER) - Worldwide Coverage: n/a; 4b (UC): Not Covered;	9b (OP Surg): 25% Coinsurance;	8a (OP Diag Proc/Test/Lab): 25% Coinsurance;	8b (OP Diag): 25% Coinsurance; 8b (OP Therap Rad): Not Covered; 8b (X-Ray): 25% Coinsurance;	9a (OP Observation): 25% Coinsurance;	12 (Renal Dialysis): Not Covered;	3 (CORF): Not Covered; 5 (Partial Hosp): 25% Coinsurance; 9a (OP Chemo): Not Covered; 9a (OP Services): 25% Coinsurance; 9c (OP SA): Not Covered; 9d (OP Cardiac Rehab): 25% Coinsurance;	14b (Immunizations): 25% Coinsurance; 14c (Medicare Covered Physical Exam): 25% coin; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 25% coin; 14e (Prostate Screening): 25% coin; 14f (Colorectal Screening): 25% coin; 14g (Bone Mass): 25% coin; 14i (Diabetes Educ.): 25% coin; 14j (Nutrition Therapy Diabetes): 25% coin; 14h (Mammography): 25% Coinsurance; 7a (PCP w/Copay): $40 Copay per visit;	7d (SPC w/Copay): $40 Copay per visit;	7h (Psych): Not Covered; 7e (MH Non-Phys): n/a per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 25% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 25% Coinsurance; 8a (OP Diag Proc/Test/Lab): 25% Coinsurance; 8b (X-Ray): 25% Coinsurance; 9a (OP Chemo): Not Covered; 9b (OP ASC): 25% Coinsurance; All other Services: No Cost Sharing;	15 (Part B Rx): Not Covered;	13a (Blood): 25% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): Not Covered;	17a1 (Routine Eye Exam): Not Covered;	17b1 (Non MCR Covered): Not Covered;	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;	18b (Hearing Aids) - Enhanced Benefit Limit ( $ allowance/ # years): 0% Coinsurance; 18b (Hearing Aids): Not Covered;		13c (OTC Rx): Not Covered;												3.0486	0.0513	0.2093	0.2572	0.0879	0	0.0573	0	0.3328	0.0369	0.1198	0.0042	0	0.0992	0.5726	0.5061	0	0.014	0.2555	1.0437	0	0	0	0	0	0	0	0	0	0											6.6964	500	2.09871303	11.5856	0.416754969	0.942347008	0.257190572	1.505564156	2.020928174	0.456101176	1.512723001	3.196403986	0.036911223	1.688235846	0.062115962	0.027993103	1.499458846	0.572578212	7.728267986	0.305969527	0.169418505	3.812916611	3.574537907	1.386543922	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9257
H5416_030_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1256.647668	44.88345351	501.2809133	999.8546198	163.32421	12.16186947	4.800043276	446.6034953	206.1928357	3.092526833	10.05021197	0.348760695	0.168461437	8.474946694	4891.940391	3466.880825	110.1570479	74.62089201	21.40827256	98.61636223	8.344168984	0	0	0	401	5.749049398	0	0	0	0											3950	1a (IP Acute): $175 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $100 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 15% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 0% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 0% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);	18b (Hearing Aids): 500 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											103.7623282	117.2682083	21.05796869	0	100	0.2	0.091238792	48.77883199	200	0	0.131825386	0.2	0.2	0.198860705	0	30	40	30	0.2	0.02859117	0.2	0	0	0	5	0	0	0	0	0											NO	95.37009214	107.7836246	19.35481257	0	91.91205884	0.183824118	0.083859452	44.83362876	183.8241177	0	0.121163426	0.183824118	0.183824118	0.182776968	0	27.57361765	36.76482354	27.57361765	0.183824118	0.026278733	0.183824118	0	0	0	5	0	0	0	0	0												9.9872	0.403141775	0.80851651	0	1.250955366	2.235644925	0.402528999	1.668571276	3.158601342	0	1.217718119	0.064110627	0.030967275	1.549025062	0	7.966203858	0.337492036	0.171463995	3.935356814	2.591513052	1.533859501	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.48	0	3.377495794	9.9872	0.403141775	0.80851651	0	1.250955366	2.235644925	0.402528999	1.668571276	3.158601342	0	1.217718119	0.064110627	0.030967275	1.549025062	0	7.966203858	0.337492036	0.171463995	3.935356814	2.591513052	1.533859501	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.48	NO	1a (IP Acute): 30% Coinsurance; 1a1 (Add'l Days): 30% coin per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): 30% Coinsurance;	2a (SNF): 25% Coinsurance; 2a2 (Waiver 3 Day): 25% coin;	6a (Home Health): 25% Coinsurance;	10a (Ambulance): 25% Coinsurance;	11a (DME): Not Covered; 11b (Prosthetics): Not Covered;	11b (Medical Supplies): 25% Coinsurance; 11c (Diabetic Supplies): 25% Coinsurance;	4a (ER): Not Covered; 4a (ER) - Worldwide Coverage: n/a; 4b (UC): Not Covered;	9b (OP Surg): 25% Coinsurance;	8a (OP Diag Proc/Test/Lab): 25% Coinsurance;	8b (OP Diag): 25% Coinsurance; 8b (OP Therap Rad): Not Covered; 8b (X-Ray): 25% Coinsurance;	9a (OP Observation): 25% Coinsurance;	12 (Renal Dialysis): Not Covered;	3 (CORF): Not Covered; 5 (Partial Hosp): 25% Coinsurance; 9a (OP Chemo): Not Covered; 9a (OP Services): 25% Coinsurance; 9c (OP SA): Not Covered; 9d (OP Cardiac Rehab): 25% Coinsurance;	14b (Immunizations): 25% Coinsurance; 14c (Medicare Covered Physical Exam): 25% coin; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 25% coin; 14e (Prostate Screening): 25% coin; 14f (Colorectal Screening): 25% coin; 14g (Bone Mass): 25% coin; 14i (Diabetes Educ.): 25% coin; 14j (Nutrition Therapy Diabetes): 25% coin; 14h (Mammography): 25% Coinsurance; 7a (PCP w/Copay): $40 Copay per visit;	7d (SPC w/Copay): $40 Copay per visit;	7h (Psych): Not Covered; 7e (MH Non-Phys): n/a per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 25% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 25% Coinsurance; 8a (OP Diag Proc/Test/Lab): 25% Coinsurance; 8b (X-Ray): 25% Coinsurance; 9a (OP Chemo): Not Covered; 9b (OP ASC): 25% Coinsurance; All other Services: No Cost Sharing;	15 (Part B Rx): Not Covered;	13a (Blood): 25% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): Not Covered;	17a1 (Routine Eye Exam): Not Covered;	17b1 (Non MCR Covered): Not Covered;	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;	18b (Hearing Aids) - Enhanced Benefit Limit ( $ allowance/ # years): 0% Coinsurance; 18b (Hearing Aids): Not Covered;		13c (OTC Rx): Not Covered;												3.1059	0.0522	0.2076	0.255	0.0872	0	0.0568	0	0.33	0.0366	0.1188	0.0041	0	0.0983	0.6185	0.5227	0	0.0126	0.2534	1.0078	0	0	0	0	0	0	0	0	0	0											6.7675	150	1.600861346	13.0931	0.455371425	1.016106153	0.255030691	1.338139467	2.235644925	0.459339356	1.668571276	3.488629348	0.036601244	1.336492667	0.068238344	0.030967275	1.647345385	0.618489836	8.488891293	0.337492036	0.184014674	4.188731947	3.599308947	1.533859501	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.2474
H5416_801_0	2010	2	N/A																															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	NO	232.9972708	4.32505402	21.0834091	24.21150117	8.071249623	12.82802441	5.148678825	17.30552942	28.74664214	3.274119117	10.22658193	0.3607178	0.14836198	8.584042377	28.46987518	34.44916166	0.899077172	1.837800599	22.13935278	102.1359003	7.996045637	0																				FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312
H5416_802_0	2010	2	N/A																															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	NO	232.9972708	4.32505402	21.0834091	24.21150117	8.071249623	12.82802441	5.148678825	17.30552942	28.74664214	3.274119117	10.22658193	0.3607178	0.14836198	8.584042377	28.46987518	34.44916166	0.899077172	1.837800599	22.13935278	102.1359003	7.996045637	0																				FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312
H5416_803_0	2010	2	N/A																															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	NO	232.9972708	4.32505402	21.0834091	24.21150117	8.071249623	12.82802441	5.148678825	17.30552942	28.74664214	3.274119117	10.22658193	0.3607178	0.14836198	8.584042377	28.46987518	34.44916166	0.899077172	1.837800599	22.13935278	102.1359003	7.996045637	0																				FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312
H5416_804_0	2010	2	N/A																															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	NO	232.9972708	4.32505402	21.0834091	24.21150117	8.071249623	12.82802441	5.148678825	17.30552942	28.74664214	3.274119117	10.22658193	0.3607178	0.14836198	8.584042377	28.46987518	34.44916166	0.899077172	1.837800599	22.13935278	102.1359003	7.996045637	0																				FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312
H5416_805_0	2010	2	N/A																															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	NO	232.9972708	4.32505402	21.0834091	24.21150117	8.071249623	12.82802441	5.148678825	17.30552942	28.74664214	3.274119117	10.22658193	0.3607178	0.14836198	8.584042377	28.46987518	34.44916166	0.899077172	1.837800599	22.13935278	102.1359003	7.996045637	0																				FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312
H5417_001_0	2010	3	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	399.3966961	37.35892913	11452.03077	113.1981878	19.67404017	32.18213485	16.65892324	15.01132416	19.55155685	54.86830349	41.08769399	0	0.016672375	4.64632204	1.212479135	172.6836171	16.93014089	18.41417076	0	0	6.350881461	10.39414127	958.940606	0	111.1996117	191.799614	0	0	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08367631	0.084691858	0	0	0.2	0.2	0.097045431	0.045813865	0.2	0	0.065951402	0	0.2	0.151976598	0.000448664	0.19977667	0.2	0	0	0	0.2	0.198231959	0	0	0	0	0	0	0	0											NO	0.08367631	0.084691858	0	0	0.2	0.2	0.097045431	0.045813865	0.2	0	0.065951402	0	0.2	0.151976598	0.000448664	0.19977667	0.2	0	0	0	0.2	0.198231959	0	0	0	0	0	0	0	0												33.42	3.163997116	0	0	3.934808033	6.436426971	1.616672383	0.687726779	3.91031137	0	2.70979101	0	0.003334475	0.706132216	0.000543996	34.49815798	3.386028178	0	0	0	1.270176292	2.060450986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8046	0	0	33.42	3.163997116	0	0	3.934808033	6.436426971	1.616672383	0.687726779	3.91031137	0	2.70979101	0	0.003334475	0.706132216	0.000543996	34.49815798	3.386028178	0	0	0	1.270176292	2.060450986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8046	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.4453	0.2287	0	0.006	0.1205	0.197	0.102	0.014	0.1197	0.1008	0.1984	0	0.0001	0.0216	0.0232	3.3067	0.3242	0	0	0	0.1216	0.1973	0	0	0.0133	0	0	0	0	0											7.5404	0	0	35.8653	3.392725254	0	0.005964885	4.055261341	6.633460449	1.71866579	0.70176202	4.030014779	0.100778517	2.908218144	0	0.003402526	0.727748508	0.023709597	37.80486554	3.710222365	0	0	0	1.391788916	2.257728208	0	0	0.013308464	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.345
H5417_005_0	2010	3	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1717.366489	224.7809571	51.08171505	2448.341337	277.4639543	17.1851905	18.32365823	332.4187	73.59680203	15673.54171	89.40708964	0	0.075283193	20.95028339	7266.697255	9082.021185	914.0105594	741.811047	0	0	56.83237967	1888.13312	667.4204131	0	297.2671389	0	16.2178809	4.528924232	78.66026298	0											4250	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20%/30% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20%/30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20%/30% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	0.159991005	0	150	0.2	0.118529249	49.66894469	0.285	3	0.194084356	0	0.2	0.222261234	10.66245113	34.8138749	38.5	35	0	0	0.2	34.7405865	0	0	35	0	0	0	0	0											NO	139.8321207	103.1067339	0.111299947	0	104.3495671	0.139132756	0.082456506	34.55288586	0.198264178	2.086991343	0.135017457	0	0.139132756	0.155045559	10.59396161	34.8138749	38.5	24.34823233	0	0	0.139132756	34.7405865	0	0	35	0	0	0	0	0												20.0119	1.931369195	5.685392199	0	2.412770294	2.39102292	1.510904829	0.957168783	14.59160943	2.725878821	12.07151788	0	0.010474358	3.248248398	6.415259314	26.34836245	2.932450545	1.505148977	0	0	7.907245625	5.466237665	0	0	0.867029155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.99	0	33.69707754	20.0119	1.931369195	5.685392199	0	2.412770294	2.39102292	1.510904829	0.957168783	14.59160943	2.725878821	12.07151788	0	0.010474358	3.248248398	6.415259314	26.34836245	2.932450545	1.505148977	0	0	7.907245625	5.466237665	0	0	0.867029155	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.99	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.6677	0.1186	0.474	0.2581	0.1445	0.2148	0.229	0.0573	0.92	0.1633	0.9325	0	0.0006	0.1989	0.7245	3.7872	0.2303	0.1421	0	0	1.1853	0.2081	0	0	0.0292	0	0.0015	0.003	0	0											13.6905	0	0	23.6796	2.049940603	6.159346256	0.25814113	2.55728277	2.605837801	1.739950557	1.014498249	15.51156945	2.889144881	13.00400731	0	0.011101718	3.447166017	7.139751674	30.13553787	3.162786093	1.647268748	0	0	9.092519853	5.67438427	0	0	0.896246202	0	0.001475755	0.002979555	0	0	0	0	0	0	0	0	0	0	0	0	132.6805
H5419_001_0	2010	6	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1988.768887	42.26274044	767.8910913	74.17313369	325.8204213	20.28622717	2.458946296	318.1634307	248.7670902	4193.667436	652.7758626	53.77426889	0	378.3111026	3962.754951	2591.22022	13.06437065	1242.485279	3513.647273	0	71.61077594	0	0	0	302.4	0	162	0	0	0	174.6158611	10.06605138	895.2512328	478.71256	387.1744138	0.755000544	2.587830545	24.61883778	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	90.51390821	250	0.2	35	25	35	40	37.80000743	80.08281844	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	117.6292197	66.05781775	115.1680192	0	110.73848	0.177181568	0.177181568	44.295392	221.47696	31.0067744	80.18698092	221.47696	0	31.0067744	22.147696	31.0067744	35.4363136	33.48732294	70.94599671	0	0.177181568	0	0	0	35	0	35	0	0	0	177.181568	31.0067744	31.0067744	31.0067744	31.0067744	31.0067744	0.177181568	0.177181568	0	0		19.4948	0.232648701	7.369707996	0	3.006738184	3.594345538	0.43567996	1.174431157	4.591348241	10.83600834	4.36201047	0.992480133	0	0.977517251	7.313824331	6.695448398	0.038579428	3.46729215	20.77326732	0	12.68810957	0	0	0	0.882	0	0.4725	0	0	0	2.578226005	0.026009649	2.313237751	1.236944363	1.000419142	0.001950844	0.458515874	4.36200428	0	0	121.376		15.60939862	19.4948	0.232648701	7.369707996	0	3.006738184	3.594345538	0.43567996	1.174431157	4.591348241	10.83600834	4.36201047	0.992480133	0	0.977517251	7.313824331	6.695448398	0.038579428	3.46729215	20.77326732	0	12.68810957	0	0	0	0.882	0	0.4725	0	0	0	2.578226005	0.026009649	2.313237751	1.236944363	1.000419142	0.001950844	0.458515874	4.36200428	0	0	121.376	YES																																									5000																								0	0	0	0	0													0			19.4948	0.232648701	7.369707996	0	3.006738184	3.594345538	0.43567996	1.174431157	4.591348241	10.83600834	4.36201047	0.992480133	0	0.977517251	7.313824331	6.695448398	0.038579428	3.46729215	20.77326732	0	12.68810957	0	0	0	0.882	0	0.4725	0	0	0	2.578226005	0.026009649	2.313237751	1.236944363	1.000419142	0.001950844	0.458515874	4.36200428	0	0	121.376
H5419_004_0	2010	14	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1088.195995	58.12233414	289.3897845	44.8707591	191.3436488	16.68201056	0.26986296	276.5372221	204.2304171	3843.504987	650.2685573	41.37052996	0	392.0620488	3788.652062	2343.788744	50.04498352	1037.743193	3089.33828	0	52.69001113	0	0	0	302.4	0	162	0	0	0	171.4547015	9.111426497	420.8108434	358.2351591	312.9172206	0.019442582	1.750047145	27.51744974	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	88.34581427	250	0.2	35	25	35	40	38.37552757	79.89842857	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	142.99163	78.90265227	117.8968459	0	113.3623518	0.181379763	0.181379763	45.34494072	226.7247036	31.74145851	80.12071423	226.7247036	0	31.74145851	22.67247036	31.74145851	36.27595258	34.80272046	72.45979015	0	0.181379763	0	0	0	35	0	35	0	0	0	181.3797629	31.74145851	31.74145851	31.74145851	31.74145851	31.74145851	0.181379763	0.181379763	0	0		12.9669	0.382167193	2.843178568	0	1.807597169	3.025779121	0.04894768	1.044963662	3.858673398	10.16653784	4.341665104	0.781643429	0	1.037051771	7.158175133	6.199606096	0.151285787	3.009690522	18.65440029	0	9.556901726	0	0	0	0.882	0	0.4725	0	0	0	2.591534426	0.024100831	1.113095827	0.947575537	0.827704081	5.14E-05	0.317423136	4.99110851	0	0	99.2023		10.16922263	12.9669	0.382167193	2.843178568	0	1.807597169	3.025779121	0.04894768	1.044963662	3.858673398	10.16653784	4.341665104	0.781643429	0	1.037051771	7.158175133	6.199606096	0.151285787	3.009690522	18.65440029	0	9.556901726	0	0	0	0.882	0	0.4725	0	0	0	2.591534426	0.024100831	1.113095827	0.947575537	0.827704081	5.14E-05	0.317423136	4.99110851	0	0	99.2023	YES																																									5000																								0	0	0	0	0													0			12.9669	0.382167193	2.843178568	0	1.807597169	3.025779121	0.04894768	1.044963662	3.858673398	10.16653784	4.341665104	0.781643429	0	1.037051771	7.158175133	6.199606096	0.151285787	3.009690522	18.65440029	0	9.556901726	0	0	0	0.882	0	0.4725	0	0	0	2.591534426	0.024100831	1.113095827	0.947575537	0.827704081	5.14E-05	0.317423136	4.99110851	0	0	99.2023
H5419_805_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	313.4044755	3.752487504	51.32885248	11.72255302	11.42638736	18.66292935	2.014440609	12.22889525	58.51449273	6.17340925	19.34213391	0	0.209932023	25.93405967	47.25758974	136.6171752	1.428264747	6.811202879	35.81877475	42.54237124	46.90221458	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.066518445	0.066518445	0.145790436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.066518445	0.066518445	0.145790436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				20.8472	0.249609634	7.483255791	0	2.662348256	4.348462539	0.469364662	2.849332592	13.63387681	1.438404355	4.506717202	0	0.048914161	6.042635904	11.01101841	31.83180181	0.332785686	1.587010271	8.345774517	9.912372498	10.928216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5291			20.8472	0.249609634	7.483255791	0	2.662348256	4.348462539	0.469364662	2.849332592	13.63387681	1.438404355	4.506717202	0	0.048914161	6.042635904	11.01101841	31.83180181	0.332785686	1.587010271	8.345774517	9.912372498	10.928216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5291	NO																																																																																		0			20.8472	0.249609634	7.483255791	0	2.662348256	4.348462539	0.469364662	2.849332592	13.63387681	1.438404355	4.506717202	0	0.048914161	6.042635904	11.01101841	31.83180181	0.332785686	1.587010271	8.345774517	9.912372498	10.928216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5291
H5419_806_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	313.4044755	3.752487504	51.32885248	11.72255302	11.42638736	18.66292935	2.014440609	12.22889525	58.51449273	6.17340925	19.34213391	0	0.209932023	25.93405967	47.25758974	136.6171752	1.428264747	6.811202879	35.81877475	42.54237124	46.90221458	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.066518445	0.066518445	0.145790436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.066518445	0.066518445	0.145790436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				20.8472	0.249609634	7.483255791	0	2.662348256	4.348462539	0.469364662	2.849332592	13.63387681	1.438404355	4.506717202	0	0.048914161	6.042635904	11.01101841	31.83180181	0.332785686	1.587010271	8.345774517	9.912372498	10.928216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5291			20.8472	0.249609634	7.483255791	0	2.662348256	4.348462539	0.469364662	2.849332592	13.63387681	1.438404355	4.506717202	0	0.048914161	6.042635904	11.01101841	31.83180181	0.332785686	1.587010271	8.345774517	9.912372498	10.928216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5291	NO																																																																																		0			20.8472	0.249609634	7.483255791	0	2.662348256	4.348462539	0.469364662	2.849332592	13.63387681	1.438404355	4.506717202	0	0.048914161	6.042635904	11.01101841	31.83180181	0.332785686	1.587010271	8.345774517	9.912372498	10.928216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5291
H5420_001_0	2010	6	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic	Podiatry														D	D	D	V	T	P	P	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	P	V	V	V	V	V	V	V																																												0	YES								827.1382815																																	500								$25 (waived if admitted)																																								14																																	NO								14																																		0	0	0	0	0	0	0	0.964994662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.965	0	0	0	0	0	0	0	0	0	0.964994662	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.965	YES								$25 (waived if admitted)																																	500								0.1915																																	0.1915			0	0	0	0	0	0	0	1.156461857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1565
H5420_003_0	2010	4	N/A																															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	V	V	V	V	P																																																			0	YES			665.7689723		217.4497507	4.361867544	1.048831272	1214.075046			3451.626361		2.466349349				1578.66499	1376.504052			11.08843533																				2500			$25/day (7-21)		$40 (waived if admitted)	20% High Cost	20%	$50/$10 (waived if omitted)			$25 for MRI/A/Pet/Rad		0.2				10	$10 			20%																						13.69279295		32	0.2	0.199433769	30.7			2.947141959		0.2				10	10			0.2																				NO			13.51797173		31.59144353	0.197446522	0.19688752	30.30804113			2.909514649		0.197446522				9.872326102	9.872326102			0.197446522																					0	0	0.749987179	0	0.572462627	0.861235576	0.206501788	3.066353036	0	0	0.836879788	0	0.486972101	0	0	0	1.298757966	1.132441407	0	0	2.189372991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.401	0	0.288368831	0	0	0.749987179	0	0.572462627	0.861235576	0.206501788	3.066353036	0	0	0.836879788	0	0.486972101	0	0	0	1.298757966	1.132441407	0	0	2.189372991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.401	NO																																																																																		0			0	0	0.749987179	0	0.572462627	0.861235576	0.206501788	3.066353036	0	0	0.836879788	0	0.486972101	0	0	0	1.298757966	1.132441407	0	0	2.189372991	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.401
H5420_004_0	2010	4	N/A																															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	V	V	V	V	P																																																			0	YES								599.5817514																																	2500								$50 (waived if admitted)																																								28																																	NO								27.99131779																																		0	0	0	0	0	0	0	1.398590279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.3986	0	0.000959613	0	0	0	0	0	0	0	1.398590279	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.3986	NO								$50 (waived if admitted)																																									0.1554																																	0.1554			0	0	0	0	0	0	0	1.553989198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.554
H5420_005_0	2010	6	N/A																															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	V	V	V	V	P																																																			0	YES		147.0516206	491.0371055		163.1465666	3.817657003	0.917973325	877.1293072	252.9447419		2751.374228		5.624378649				281.5983752	245.5374047			22.26648305																				3500		$175/day (1-5)	$25/day (7-100)		$25 (waived if admitted)	20% (high cost)	20% Prosthetics	$50/$25 (waived if admitted)	$100 OP/$0ASC		"$50 MRI/A, Rad"		0.2				25	25			20%																					75.2578113	14.01148604		20	0.2	0.197735076	34.75	99.40060461		6.276809741		0.197735076				25	25			0.2																				NO		68.63259316	12.7780041		18.23932745	0.182393274	0.18032774	31.69083144	90.6500088		5.72423941		0.182393274				22.79915931	22.79915931			0.182393274																					0	0.841044504	0.522872846	0	0.247973637	0.696314962	0.165536055	2.316413086	1.910786923	0	1.312460399	0	1.025848839	0	0	0	0.535017185	0.466503867	0	0	4.061256755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.102	0	1.361292272	0	0.841044504	0.522872846	0	0.247973637	0.696314962	0.165536055	2.316413086	1.910786923	0	1.312460399	0	1.025848839	0	0	0	0.535017185	0.466503867	0	0	4.061256755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.102	NO																																																																																		0			0	0.841044504	0.522872846	0	0.247973637	0.696314962	0.165536055	2.316413086	1.910786923	0	1.312460399	0	1.025848839	0	0	0	0.535017185	0.466503867	0	0	4.061256755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	14.102
H5420_006_0	2010	6	N/A																															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	V	V	V	V	P																																																			0	YES								1651.887676																																	500								$25 (waived if admitted)																																								14																																	NO								12.73701683																																		0	0	0	0	0	0	0	1.753343428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7533	0	0	0	0	0	0	0	0	0	1.753343428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.7533	NO								$25 (waived if admitted)																																									0.1948																																	0.1948			0	0	0	0	0	0	0	1.948159364	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.9482
H5420_007_0	2010	3	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic	Podiatry														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	V	V	V	V	P	V	V	V	V	V	V	V																																												0	YES					87.34752504	51.89856377	2.64933963	423.4344575			178.1773216		0					1382.928415														1.880334467									2500					$25 waived if admitted	20% High Cost	20% prosthetics	$25/$10 (waived if admitted)			$0-$25 (PET/MRI/A)		0.2					25														$0/25 preferred/non-preferred													20	0.031803035	0.01891757	16.7			5.525723129		0					25														24.71688447									NO					17.76167974	0.028243766	0.016800391	14.83100258			4.907306227		0					22.20209967														21.9506693										0	0	0	0	0.129286564	1.465810892	0.044509942	0.523329794	0	0	0.072864223	0	0	0	0	0	0	2.558659542	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00343955	0	0	0	0	0	0	0	0	4.7979	0	3.814420009	0	0	0	0	0.129286564	1.465810892	0.044509942	0.523329794	0	0	0.072864223	0	0	0	0	0	0	2.558659542	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00343955	0	0	0	0	0	0	0	0	4.7979	NO																																																																																		0			0	0	0	0	0.129286564	1.465810892	0.044509942	0.523329794	0	0	0.072864223	0	0	0	0	0	0	2.558659542	0	0	0	0	0	0	0	0	0	0	0	0	0	0.00343955	0	0	0	0	0	0	0	0	4.7979
H5420_008_0	2010	3	N/A																															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	V	V	V	V	P																																																			0	YES		45.41132626	307.9780588		81.74893676	2.85163866	0.685689736	454.047705	145.1406692		308.9151396		0				199.0574935	173.5665567			7.249236835																				3350		$175/day (1-5)	$25/day (7-100)		$100 (waived if admitted)	20% (High Cost)	20%	$50/$15 (waived if amitted)	$100 OP/$100ASC		$0-$50 MRI/A/PET/Radiation		0.2				10	25			20%																					75.2578113	14.01148604		80	0.2	0.197735076	32.05	100		6.334072582		0.2				10	25			0.2				0																NO		73.4444551	13.67387571		78.07237955	0.195180949	0.192970599	31.27774706	97.59047444		6.181451484		0.2				9.759047444	24.39761861			0.195180949				0																	0	0.277934176	0.350937808	0	0.531861168	0.55658554	0.132317959	1.183465772	1.18036223	0	0.159128662	0	0	0	0	0	0.161884294	0.352884221	0	0	1.414912924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.3023	0	0.151854921	0	0.277934176	0.350937808	0	0.531861168	0.55658554	0.132317959	1.183465772	1.18036223	0	0.159128662	0	0	0	0	0	0.161884294	0.352884221	0	0	1.414912924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.3023	NO																																																																																		0			0	0.277934176	0.350937808	0	0.531861168	0.55658554	0.132317959	1.183465772	1.18036223	0	0.159128662	0	0	0	0	0	0.161884294	0.352884221	0	0	1.414912924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.3023
H5420_009_0	2010	9	N/A																															D	D	D	V	T		Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	P																																																			0	YES	780.1180745	64.68800645	374.9249899		105.6637241		0.818406378	456.9624976	207.2660512		328.8690892		0			5283.316778	132.7143019	200.3618832			8.652341364																				3350	$75/day (1-5)	$175/day (1-5)	$75/day (8-30)		$100 (waived if admitted)		20% on Prosthetics	$50 (waived if admitted)	$50 OP/$50 ASC		$0-$100		0.2			10	25	20			20%																				48.63311011	75.2578113	37.4004642		80		0.197735076	28	50		16.60887952		0			7.9	25	20			0.2																				NO	44.72661915	69.21267129	34.39624393		73.57394014		0.181851858	25.75087905	45.98371259		15.27475885		0			7.265426589	22.99185629	18.39348503			0.18393485																					2.9077	0.373102477	1.074667617	0	0.647841376	0	0.14882872	0.980598834	0.794238544	0	0.418616336	0	0	0	0	3.19879585	0.254279013	0.307112775	0	0	1.591467114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.6972	0	3.032090136	2.9077	0.373102477	1.074667617	0	0.647841376	0	0.14882872	0.980598834	0.794238544	0	0.418616336	0	0	0	0	3.19879585	0.254279013	0.307112775	0	0	1.591467114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.6972	NO																																																																																		0			2.9077	0.373102477	1.074667617	0	0.647841376	0	0.14882872	0.980598834	0.794238544	0	0.418616336	0	0	0	0	3.19879585	0.254279013	0.307112775	0	0	1.591467114	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.6972
H5421_046_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1962.339346	20.90087321	321.3949327	10.16630226	218.7995881	22.51365236	20.72501502	72.34715468	1878.024623		12.70980794		6.836471553		6988.635716	4105.455421	1.179318157	670.0512718	16.83965224		2.274020021				1330.969373		21.26316332														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.47475133		0.2		50		10	34.39545842	0.5	15	0.2		0.2				20		20														NO	107.6119625	96.60388255	26.96389221	0.130395785	86.93052322	0.173861046	0.173861046	43.46526161	25.62255555		0.173861046		43.46526161		8.693052322	30.40190863	0.434652616	13.03957848	0.173861046		0.173861046				17.38610464		17.38610464															17.5976	0.168258792	0.722171527	1.325642961	1.585030223	3.914247159	3.603272798	0.262049	4.009982518	0	2.209740509	0	0.024762419	0	5.062714662	10.40114005	0.512593722	0.728098846	2.927759559	0	0.3953635	0	0	0	1.9283644	0	0.030806965	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4096	0	8.433714939	17.5976	0.168258792	0.722171527	1.325642961	1.585030223	3.914247159	3.603272798	0.262049	4.009982518	0	2.209740509	0	0.024762419	0	5.062714662	10.40114005	0.512593722	0.728098846	2.927759559	0	0.3953635	0	0	0	1.9283644	0	0.030806965	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4096	NO																																																																																		0	0	0	17.5976	0.168258792	0.722171527	1.325642961	1.585030223	3.914247159	3.603272798	0.262049	4.009982518	0	2.209740509	0	0.024762419	0	5.062714662	10.40114005	0.512593722	0.728098846	2.927759559	0	0.3953635	0	0	0	1.9283644	0	0.030806965	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4096
H5421_047_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1887.063827	40.23293589	295.8388278	7.753310226	227.0413346	22.39761212	23.48164567	73.55216254	1992.57953		15.60688209		4.742601822		7095.712753	3742.393101	1.163130808	653.3984586	15.20737316		2.67640211				1339.935097		18.67024261														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.7242162		0.2		50		10	34.2781193	0.5	15	0.2		0.2				20		20														NO	107.8269168	96.7968483	27.01775244	0.13065625	87.10416649	0.174208333	0.174208333	43.55208324	25.89103077		0.174208333		43.55208324		8.710416649	30.47720073	0.435520832	13.06562497	0.174208333		0.174208333				17.4208333		17.4208333															16.9564	0.324535116	0.666075018	1.013018437	1.648020517	3.901850669	4.090698348	0.266945825	4.299161493	0	2.718848912	0	0.017212516	0	5.150551208	9.50480548	0.506567698	0.711421601	2.649251127	0	0.46625155	0	0	0	1.945232163	0	0.027104265	0	0	0	0	0	0	0	0	0	0	0	0	0	56.8639	0	8.196926295	16.9564	0.324535116	0.666075018	1.013018437	1.648020517	3.901850669	4.090698348	0.266945825	4.299161493	0	2.718848912	0	0.017212516	0	5.150551208	9.50480548	0.506567698	0.711421601	2.649251127	0	0.46625155	0	0	0	1.945232163	0	0.027104265	0	0	0	0	0	0	0	0	0	0	0	0	0	56.8639	NO																																																																																		0	0	0	16.9564	0.324535116	0.666075018	1.013018437	1.648020517	3.901850669	4.090698348	0.266945825	4.299161493	0	2.718848912	0	0.017212516	0	5.150551208	9.50480548	0.506567698	0.711421601	2.649251127	0	0.46625155	0	0	0	1.945232163	0	0.027104265	0	0	0	0	0	0	0	0	0	0	0	0	0	56.8639
H5421_048_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2506.330077	33.82869031	256.2342128	14.13078041	211.4086446	22.41354784	23.26503442	59.38183093	1956.667985		12.92057537		1.167699911		7119.46636	4418.576465	1.515356611	644.9595844	18.98325656		6.958333312				1515.285252		19.46166519														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.32559011		0.2		50		10	34.82131472	0.5	15	0.2		0.2				20		20														NO	104.8258237	94.10274962	26.26578074	0.127019759	84.67983942	0.169359679	0.169359679	42.33991971	24.83286261		0.169359679		42.33991971		8.467983942	29.63346812	0.423399197	12.70197591	0.169359679		0.169359679				16.93596788		16.93596788															21.894	0.265281064	0.560849304	1.794888323	1.491837506	3.795951263	3.940158758	0.209518496	4.049138937	0	2.188224495	0	0.004120027	0	5.023960567	10.91147873	0.641600772	0.682688425	3.214998234	0	1.178461095	0	0	0	2.13856853	0	0.027466845	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0132	0	11.51733227	21.894	0.265281064	0.560849304	1.794888323	1.491837506	3.795951263	3.940158758	0.209518496	4.049138937	0	2.188224495	0	0.004120027	0	5.023960567	10.91147873	0.641600772	0.682688425	3.214998234	0	1.178461095	0	0	0	2.13856853	0	0.027466845	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0132	NO																																																																																		0	0	0	21.894	0.265281064	0.560849304	1.794888323	1.491837506	3.795951263	3.940158758	0.209518496	4.049138937	0	2.188224495	0	0.004120027	0	5.023960567	10.91147873	0.641600772	0.682688425	3.214998234	0	1.178461095	0	0	0	2.13856853	0	0.027466845	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0132
H5421_049_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2089.213212	21.44681522	311.353788	11.26436309	230.1701203	23.35981427	24.69529313	60.4287971	2048.515784		15.2821483		2.459635029	0.003568986	6959.75434	4280.488372	0.94399216	679.8720588	17.93070784		2.652460458				1426.877685		18.59194713														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.5270877		0.2		50	0.5	10	34.52361999	0.5	15	0.2		0.2				20		20														NO	106.3625104	95.48224221	26.65082209	0.128881796	85.92119752	0.171842395	0.171842395	42.96059876	25.37002734		0.171842395		42.96059876	0.429605988	8.592119752	30.0536896	0.429605988	12.88817963	0.171842395		0.171842395				17.1842395		17.1842395															18.5178	0.170649167	0.691486201	1.451771349	1.648041031	4.014206432	4.243698317	0.216338109	4.330908454	0	2.626120966	0	0.008805616	0.001533258	4.983253562	10.72037241	0.405544684	0.730192768	3.08125578	0	0.455805158	0	0	0	2.043317324	0	0.026624039	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3678	0	9.729535628	18.5178	0.170649167	0.691486201	1.451771349	1.648041031	4.014206432	4.243698317	0.216338109	4.330908454	0	2.626120966	0	0.008805616	0.001533258	4.983253562	10.72037241	0.405544684	0.730192768	3.08125578	0	0.455805158	0	0	0	2.043317324	0	0.026624039	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3678	NO																																																																																		0	0	0	18.5178	0.170649167	0.691486201	1.451771349	1.648041031	4.014206432	4.243698317	0.216338109	4.330908454	0	2.626120966	0	0.008805616	0.001533258	4.983253562	10.72037241	0.405544684	0.730192768	3.08125578	0	0.455805158	0	0	0	2.043317324	0	0.026624039	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3678
H5421_050_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1856.306094	31.01065012	241.6049226	11.6201095	236.0793108	25.58722835	27.66290298	57.96722282	2313.754768		19.59821567		1.719892161	0.001443229	7717.859356	4599.780133	0.966077318	776.0090354	18.72582799		2.420003105				1425.550816		33.08235685														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.64084596		0.2		39.43364854	0.5	10	34.80570127	0.5	15	0.2		0.2				20		20														NO	105.7430763	94.92617258	26.49561299	0.128131214	85.42080952	0.170841619	0.170841619	42.71040476	25.31945057		0.170841619		34.74332848	0.427104048	8.542080952	29.89093588	0.427104048	12.81312143	0.170841619		0.170841619				17.0841619		17.0841619															16.3576	0.245310194	0.533455877	1.48889874	1.680507153	4.371363518	4.725975132	0.206316962	4.881916623	0	3.348190895	0	0.004979565	0.000616409	5.493881616	11.45764442	0.412615533	0.8285915	3.199150771	0	0.413437248	0	0	0	2.029528412	0	0.047098695	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7271	0	10.46346236	16.3576	0.245310194	0.533455877	1.48889874	1.680507153	4.371363518	4.725975132	0.206316962	4.881916623	0	3.348190895	0	0.004979565	0.000616409	5.493881616	11.45764442	0.412615533	0.8285915	3.199150771	0	0.413437248	0	0	0	2.029528412	0	0.047098695	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7271	NO																																																																																		0	0	0	16.3576	0.245310194	0.533455877	1.48889874	1.680507153	4.371363518	4.725975132	0.206316962	4.881916623	0	3.348190895	0	0.004979565	0.000616409	5.493881616	11.45764442	0.412615533	0.8285915	3.199150771	0	0.413437248	0	0	0	2.029528412	0	0.047098695	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7271
H5421_051_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2161.634285	45.76574836	352.5358208	12.32526078	223.7448709	26.70098333	26.95183495	74.52785537	2503.911189		14.63723155		2.579734927	0.003143212	7990.767659	4937.16366	1.901811638	985.2031628	21.31164439		4.780234266				1511.973969		21.59202935														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.63006043		0.2		45.61848428	0.5	10	34.51617241	0.5	15	0.2		0.2				20		20														NO	104.0413126	93.39848951	26.06920899	0.12606915	84.04609987	0.1680922	0.1680922	42.02304994	24.90291018		0.1680922		40.02286844	0.420230499	8.404609987	29.31618629	0.420230499	12.60691498	0.1680922		0.1680922				16.80921997		16.80921997															18.7416	0.356204314	0.765860832	1.553835148	1.567073647	4.488227024	4.530393225	0.260990649	5.196222955	0	2.46040445	0	0.008604033	0.001320874	5.596607139	12.06156747	0.799199254	1.035031043	3.582321185	0	0.803520093	0	0	0	2.117925253	0	0.030245431	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9572	0	12.36963567	18.7416	0.356204314	0.765860832	1.553835148	1.567073647	4.488227024	4.530393225	0.260990649	5.196222955	0	2.46040445	0	0.008604033	0.001320874	5.596607139	12.06156747	0.799199254	1.035031043	3.582321185	0	0.803520093	0	0	0	2.117925253	0	0.030245431	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9572	NO																																																																																		0	0	0	18.7416	0.356204314	0.765860832	1.553835148	1.567073647	4.488227024	4.530393225	0.260990649	5.196222955	0	2.46040445	0	0.008604033	0.001320874	5.596607139	12.06156747	0.799199254	1.035031043	3.582321185	0	0.803520093	0	0	0	2.117925253	0	0.030245431	0	0	0	0	0	0	0	0	0	0	0	0	0	65.9572
H5421_052_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2278.998923	28.66525989	461.1598316	17.65655868	321.1493025	25.74433481	21.47651599	79.96127197	1653.897374		12.7684297		4.418603803		5342.484829	2576.688008	1.354203656	450.7355645	13.5663569		2.910965782				874.9921892		11.21803309														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.47698995		0.2		49.45636613		20	44.10732441	0.5	35	0.2		0.2				20		20														NO	153.2494116	138.7487219	25.59938828	0.165062833	123.7971247	0.165062833	0.165062833	41.26570824	40.00874647		0.165062833		40.86007152		16.5062833	36.73031812	0.412657082	28.88599577	0.165062833		0.165062833				16.5062833		16.5062833															29.1046	0.331439014	0.983784132	2.914441596	3.313113355	4.249432836	3.544974571	0.274971543	5.514196728	0	2.107593178	0	0.015045372	0	7.348714007	7.886880854	0.55882173	1.084995467	2.239301304	0	0.480492259	0	0	0	1.203572413	0	0.015430669	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1718	0	15.40219536	29.1046	0.331439014	0.983784132	2.914441596	3.313113355	4.249432836	3.544974571	0.274971543	5.514196728	0	2.107593178	0	0.015045372	0	7.348714007	7.886880854	0.55882173	1.084995467	2.239301304	0	0.480492259	0	0	0	1.203572413	0	0.015430669	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1718	NO																																																																																		0	0	0	29.1046	0.331439014	0.983784132	2.914441596	3.313113355	4.249432836	3.544974571	0.274971543	5.514196728	0	2.107593178	0	0.015045372	0	7.348714007	7.886880854	0.55882173	1.084995467	2.239301304	0	0.480492259	0	0	0	1.203572413	0	0.015430669	0	0	0	0	0	0	0	0	0	0	0	0	0	73.1718
H5421_053_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1418.270533	53.34730696	306.4984235	9.194071754	260.079387	25.64544852	20.63896483	91.62327163	1578.612294		12.6429909		1.25922892		5407.76228	2686.74322	1.114366947	399.3712735	12.73101211		2.319248707				759.0079438		16.90434222														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42802638		0.2		48.6465662		20	44.07244595	0.5	35	0.2		0.2				20		20														NO	158.7772789	143.753534	26.52278511	0.171016823	128.262617	0.171016823	0.171016823	42.75420568	41.41003602		0.171016823		41.68578113		17.10168227	37.97461053	0.427542057	29.92794398	0.171016823		0.171016823				17.10168227		17.10168227															18.7658	0.639071992	0.677432652	1.572340939	2.779871902	4.385803124	3.529610189	0.326440017	5.447532663	0	2.162164133	0	0.004374328	0	7.706819359	8.502335614	0.476438737	0.996030092	2.177217241	0	0.396630545	0	0	0	1.081692725	0	0.024091057	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6517	0	10.81998579	18.7658	0.639071992	0.677432652	1.572340939	2.779871902	4.385803124	3.529610189	0.326440017	5.447532663	0	2.162164133	0	0.004374328	0	7.706819359	8.502335614	0.476438737	0.996030092	2.177217241	0	0.396630545	0	0	0	1.081692725	0	0.024091057	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6517	NO																																																																																		0	0	0	18.7658	0.639071992	0.677432652	1.572340939	2.779871902	4.385803124	3.529610189	0.326440017	5.447532663	0	2.162164133	0	0.004374328	0	7.706819359	8.502335614	0.476438737	0.996030092	2.177217241	0	0.396630545	0	0	0	1.081692725	0	0.024091057	0	0	0	0	0	0	0	0	0	0	0	0	0	61.6517
H5421_054_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1846.960118	42.6933121	336.2812707	16.12764439	242.3719327	26.41520664	20.51271807	79.66803486	1679.869055		14.27613424		3.770105167		5685.510247	3075.511744	1.290404069	429.1351407	15.23089814		2.39153304				883.6675718		14.95609433														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.440736		0.2		48.05158208		20	44.04257978	0.5	35	0.2		0.2				20		20														NO	155.4256962	140.7190831	25.96292347	0.167406879	125.5551594	0.167406879	0.167406879	41.85171979	40.54656218		0.167406879		41.85171979		16.74068791	37.14407015	0.418517198	29.29620385	0.167406879		0.167406879				16.74068791		16.74068791															23.9221	0.500646978	0.727570408	2.699878615	2.535920553	4.422087306	3.433970115	0.277853689	5.67607626	0	2.389923079	0	0.013148782	0	7.931612723	9.519751998	0.540056295	1.047669213	2.549757124	0	0.400359083	0	0	0	1.23276692	0	0.020864609	0	0	0	0	0	0	0	0	0	0	0	0	0	69.842	0	13.51180746	23.9221	0.500646978	0.727570408	2.699878615	2.535920553	4.422087306	3.433970115	0.277853689	5.67607626	0	2.389923079	0	0.013148782	0	7.931612723	9.519751998	0.540056295	1.047669213	2.549757124	0	0.400359083	0	0	0	1.23276692	0	0.020864609	0	0	0	0	0	0	0	0	0	0	0	0	0	69.842	NO																																																																																		0	0	0	23.9221	0.500646978	0.727570408	2.699878615	2.535920553	4.422087306	3.433970115	0.277853689	5.67607626	0	2.389923079	0	0.013148782	0	7.931612723	9.519751998	0.540056295	1.047669213	2.549757124	0	0.400359083	0	0	0	1.23276692	0	0.020864609	0	0	0	0	0	0	0	0	0	0	0	0	0	69.842
H5421_055_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1610.446032	41.23272653	285.8846561	14.93880871	236.0721846	22.86224968	35.14171522	73.48789714	1669.885361		12.83929163		3.435485808		6089.643987	3217.087068	1.320296657	315.083127	13.93331213		2.266620451				808.811516		4.907836869														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.53501246		0.2		50		20	43.57879879	0.5	35	0.2		0.2				20		20														NO	156.2999343	141.5105995	26.10895966	0.168348509	126.2613817	0.168348509	0.168348509	42.08712724	40.8539849		0.168348509		42.08712724		16.8348509	37.01020904	0.420871272	29.46098907	0.168348509		0.168348509				16.8348509		16.8348509															20.9761	0.486238988	0.62201258	2.514926172	2.483900017	3.848825645	5.91605536	0.257741206	5.685122609	0	2.161475602	0	0.012049144	0	8.543187377	9.922088739	0.555674934	0.773555047	2.345652323	0	0.381582173	0	0	0	1.134685106	0	0.006885225	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6277	0	12.79832115	20.9761	0.486238988	0.62201258	2.514926172	2.483900017	3.848825645	5.91605536	0.257741206	5.685122609	0	2.161475602	0	0.012049144	0	8.543187377	9.922088739	0.555674934	0.773555047	2.345652323	0	0.381582173	0	0	0	1.134685106	0	0.006885225	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6277	NO																																																																																		0	0	0	20.9761	0.486238988	0.62201258	2.514926172	2.483900017	3.848825645	5.91605536	0.257741206	5.685122609	0	2.161475602	0	0.012049144	0	8.543187377	9.922088739	0.555674934	0.773555047	2.345652323	0	0.381582173	0	0	0	1.134685106	0	0.006885225	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6277
H5421_056_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2499.625221	22.46136965	291.5460635	14.19063129	275.8225959	22.95940831	26.73455258	87.74239922	2041.508881		15.16202437		5.225467694		6284.62726	3331.282409	1.440843826	507.8488835	17.0446733		2.403160969				979.5527698		14.21742233														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.51139334		0.2		49.2727641		20	44.09982594	0.5	35	0.2		0.2				20		20														NO	149.4366865	135.2967625	24.96249558	0.160956199	120.7171493	0.160956199	0.160956199	40.23904978	39.04104743		0.160956199		39.71811584		16.09561991	35.81026297	0.402390498	28.16733485	0.160956199		0.160956199				16.09561991		16.09561991															31.128	0.253245883	0.606476443	2.284070076	2.774709792	3.695459095	4.303091969	0.294222564	6.641887089	0	2.440421814	0	0.017295478	0	8.429580972	9.941174924	0.579781864	1.192062463	2.743445829	0	0.386803655	0	0	0	1.313875755	0	0.019069852	0	0	0	0	0	0	0	0	0	0	0	0	0	79.0447	0	19.06391658	31.128	0.253245883	0.606476443	2.284070076	2.774709792	3.695459095	4.303091969	0.294222564	6.641887089	0	2.440421814	0	0.017295478	0	8.429580972	9.941174924	0.579781864	1.192062463	2.743445829	0	0.386803655	0	0	0	1.313875755	0	0.019069852	0	0	0	0	0	0	0	0	0	0	0	0	0	79.0447	NO																																																																																		0	0	0	31.128	0.253245883	0.606476443	2.284070076	2.774709792	3.695459095	4.303091969	0.294222564	6.641887089	0	2.440421814	0	0.017295478	0	8.429580972	9.941174924	0.579781864	1.192062463	2.743445829	0	0.386803655	0	0	0	1.313875755	0	0.019069852	0	0	0	0	0	0	0	0	0	0	0	0	0	79.0447
H5421_057_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2329.000251	22.55776731	295.6035476	13.08384688	296.1946219	28.71699642	29.04200011	72.55796657	2005.015242		14.29316063		20.50074832		6793.759657	3537.459009	1.030516761	445.1964518	18.1050853		3.55700644				1125.115819		10.6010446														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.3285075		0.2		49.81383817		20	43.86962141	0.5	35	0.2		0.2				20		20														NO	149.2233201	135.1035851	24.92685401	0.160726385	120.5447888	0.160726385	0.160726385	40.18159628	38.83833154		0.160726385		40.0485556		16.07263851	35.61919809	0.401815963	28.12711739	0.160726385		0.160726385				16.07263851		16.07263851															28.9618	0.253969603	0.614038873	2.102919412	2.975393179	4.615579025	4.667815693	0.24295791	6.489287226	0	2.29728804	0	0.06841878	0	9.099470258	10.5001211	0.414078084	1.043507738	2.909964912	0	0.571704787	0	0	0	1.506964986	0	0.014198896	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3494	0	19.25547652	28.9618	0.253969603	0.614038873	2.102919412	2.975393179	4.615579025	4.667815693	0.24295791	6.489287226	0	2.29728804	0	0.06841878	0	9.099470258	10.5001211	0.414078084	1.043507738	2.909964912	0	0.571704787	0	0	0	1.506964986	0	0.014198896	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3494	NO																																																																																		0	0	0	28.9618	0.253969603	0.614038873	2.102919412	2.975393179	4.615579025	4.667815693	0.24295791	6.489287226	0	2.29728804	0	0.06841878	0	9.099470258	10.5001211	0.414078084	1.043507738	2.909964912	0	0.571704787	0	0	0	1.506964986	0	0.014198896	0	0	0	0	0	0	0	0	0	0	0	0	0	79.3494
H5421_064_0	2010	7	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2243.349915	41.84267343	281.0507024	11.11591937	244.3120452	24.44967403	24.0345796	58.62516661	2150.019877		14.53087518		3.565110605	0.03114524	7890.960964	4663.713149	1.374220874	735.5097417	19.18173477		1.865946724				1466.631655		23.85881712														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.45945946		0.2		50	0.5	10	34.02386584	0.5	15	0.2		0.2				20		20														NO	105.1773931	94.4183555	26.35387205	0.127445763	84.96384233	0.169927685	0.169927685	42.48192117	25.02988869		0.169927685		42.48192117	0.424819212	8.496384233	29.46863332	0.424819212	12.74457635	0.169927685		0.169927685				16.99276847		16.99276847															19.6625	0.329226368	0.617231187	1.416676831	1.729807508	4.154676499	4.084140463	0.207542476	4.484563183	0	2.469197976	0	0.012621062	0.013231096	5.587053027	11.45277106	0.583795428	0.781146672	3.259507777	0	0.317076007	0	0	0	2.076844345	0	0.033785613	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2734	0	10.94111436	19.6625	0.329226368	0.617231187	1.416676831	1.729807508	4.154676499	4.084140463	0.207542476	4.484563183	0	2.469197976	0	0.012621062	0.013231096	5.587053027	11.45277106	0.583795428	0.781146672	3.259507777	0	0.317076007	0	0	0	2.076844345	0	0.033785613	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2734	NO																																																																																		0	0	0	19.6625	0.329226368	0.617231187	1.416676831	1.729807508	4.154676499	4.084140463	0.207542476	4.484563183	0	2.469197976	0	0.012621062	0.013231096	5.587053027	11.45277106	0.583795428	0.781146672	3.259507777	0	0.317076007	0	0	0	2.076844345	0	0.033785613	0	0	0	0	0	0	0	0	0	0	0	0	0	63.2734
H5421_065_0	2010	7	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2040.041813	65.68092978	237.6645027	9.913901364	282.429265	29.89443712	21.64459574	53.69659552	2177.780496		15.08350964		3.665495141		7939.462474	4472.718626	1.301977361	738.3936322	17.01456462		3.965222683				1423.841223		23.62207979														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.59580838		0.2		50		10	34.49300178	0.5	15	0.2		0.2				20		20														NO	105.5983593	94.79625928	26.45935183	0.127955857	85.30390499	0.17060781	0.17060781	42.6519525	25.24638026		0.17060781		42.6519525		8.530390499	29.8532597	0.426519525	12.79558575	0.17060781		0.17060781				17.060781		17.060781															17.9521	0.518858871	0.524037391	1.26854175	2.007693266	5.100224448	3.692737076	0.190855387	4.58175621	0	2.573364547	0	0.013028377	0	5.643892938	11.12710256	0.555318766	0.787348253	2.902817608	0	0.676497958	0	0	0	2.024320274	0	0.033584261	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1741	0	10.52368949	17.9521	0.518858871	0.524037391	1.26854175	2.007693266	5.100224448	3.692737076	0.190855387	4.58175621	0	2.573364547	0	0.013028377	0	5.643892938	11.12710256	0.555318766	0.787348253	2.902817608	0	0.676497958	0	0	0	2.024320274	0	0.033584261	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1741	NO																																																																																		0	0	0	17.9521	0.518858871	0.524037391	1.26854175	2.007693266	5.100224448	3.692737076	0.190855387	4.58175621	0	2.573364547	0	0.013028377	0	5.643892938	11.12710256	0.555318766	0.787348253	2.902817608	0	0.676497958	0	0	0	2.024320274	0	0.033584261	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1741
H5421_066_0	2010	7	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2059.593833	13.73213408	265.2848367	13.33755201	238.254206	27.67268487	26.27495889	72.43976029	2261.844174		15.54863116		4.5867433	0.003562562	7592.793795	5025.956855	1.372176189	1024.573156	19.82416398		4.294524111				1533.818004		30.84496913														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.38590967		0.2		50	0.5	10	34.52842375	0.5	15	0.2		0.2				20		20														NO	104.7050322	93.99431441	26.23551451	0.126873393	84.58226229	0.169164525	0.169164525	42.29113114	24.85526719		0.169164525		42.29113114	0.422911311	8.458226229	29.59970816	0.422911311	12.68733934	0.169164525		0.169164525				16.91645246		16.91645246															17.9708	0.107561877	0.579990348	1.692180484	1.679339978	4.681236581	4.444790929	0.255296617	4.684895107	0	2.630276798	0	0.01616488	0.001506648	5.351797303	12.39723801	0.580308832	1.083258942	3.353545275	0	0.72648113	0	0	0	2.162229946	0	0.043482288	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4424	0	11.55113616	17.9708	0.107561877	0.579990348	1.692180484	1.679339978	4.681236581	4.444790929	0.255296617	4.684895107	0	2.630276798	0	0.01616488	0.001506648	5.351797303	12.39723801	0.580308832	1.083258942	3.353545275	0	0.72648113	0	0	0	2.162229946	0	0.043482288	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4424	NO																																																																																		0	0	0	17.9708	0.107561877	0.579990348	1.692180484	1.679339978	4.681236581	4.444790929	0.255296617	4.684895107	0	2.630276798	0	0.01616488	0.001506648	5.351797303	12.39723801	0.580308832	1.083258942	3.353545275	0	0.72648113	0	0	0	2.162229946	0	0.043482288	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4424
H5421_067_0	2010	7	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2001.096827	28.02057975	348.779534	12.10027057	224.4885872	27.93749638	25.38083857	50.94642157	2267.11576		16.63299804		0.983608829		7863.706687	5089.437984	1.07385863	826.2314165	20.19284751		3.067990031				1443.937761		24.34431852														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.46067416		0.2		50		10	34.4988153	0.5	15	0.2		0.2				20		20														NO	104.935183	94.20092215	26.29318246	0.127152272	84.76818151	0.169536363	0.169536363	42.38409075	24.97327774		0.169536363		42.38409075		8.476818151	29.66722526	0.423840908	12.71522723	0.169536363		0.169536363				16.9536363		16.9536363															17.4988	0.219963704	0.764210327	1.538576898	1.585790776	4.736421527	4.302975061	0.179943146	4.718109296	0	2.819897994	0	0.003474114	0	5.554934298	12.58245859	0.455145216	0.875476684	3.423421926	0	0.520135872	0	0	0	2.039999637	0	0.034393727	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8541	0	11.26207103	17.4988	0.219963704	0.764210327	1.538576898	1.585790776	4.736421527	4.302975061	0.179943146	4.718109296	0	2.819897994	0	0.003474114	0	5.554934298	12.58245859	0.455145216	0.875476684	3.423421926	0	0.520135872	0	0	0	2.039999637	0	0.034393727	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8541	NO																																																																																		0	0	0	17.4988	0.219963704	0.764210327	1.538576898	1.585790776	4.736421527	4.302975061	0.179943146	4.718109296	0	2.819897994	0	0.003474114	0	5.554934298	12.58245859	0.455145216	0.875476684	3.423421926	0	0.520135872	0	0	0	2.039999637	0	0.034393727	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8541
H5421_068_0	2010	7	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2005.655464	13.47813201	262.8624245	10.53177923	228.6084824	25.13777958	23.33456915	48.98777449	2011.791392		16.71469744		11.19515125	0.004900586	7791.218621	4580.415249	1.216999412	663.8985828	19.46663116		2.082065775				1378.668761		25.62189151														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.59773363		0.2		50	0.5	10	34.83973327	0.5	15	0.2		0.2				20		20														NO	106.0578209	95.20872062	26.57447726	0.128512597	85.67506482	0.17135013	0.17135013	42.83753241	25.35787747		0.17135013		42.83753241	0.428375324	8.567506482	29.97224083	0.428375324	12.85125972	0.17135013		0.17135013				17.13501296		17.13501296															17.7263	0.106936309	0.582119294	1.353466302	1.632170545	4.307361791	3.998381448	0.174876281	4.251229967	0	2.864065574	0	0.039964388	0.00209929	5.56260967	11.44044241	0.521332518	0.710994426	3.335609773	0	0.35676224	0	0	0	1.968625591	0	0.036585954	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9719	0	10.13962849	17.7263	0.106936309	0.582119294	1.353466302	1.632170545	4.307361791	3.998381448	0.174876281	4.251229967	0	2.864065574	0	0.039964388	0.00209929	5.56260967	11.44044241	0.521332518	0.710994426	3.335609773	0	0.35676224	0	0	0	1.968625591	0	0.036585954	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9719	NO																																																																																		0	0	0	17.7263	0.106936309	0.582119294	1.353466302	1.632170545	4.307361791	3.998381448	0.174876281	4.251229967	0	2.864065574	0	0.039964388	0.00209929	5.56260967	11.44044241	0.521332518	0.710994426	3.335609773	0	0.35676224	0	0	0	1.968625591	0	0.036585954	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9719
H5421_069_0	2010	7	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2562.194585	33.29262417	316.3463407	11.51687241	297.2994125	31.19380013	34.11792043	86.88808922	2611.09838		18.59453677		2.653494332	0.007119998	8664.319162	5903.354817	1.825485027	1010.748921	25.357775		3.235013659				1625.90114		26.70008735														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.5632842		0.2		50	0.5	10	34.76107686	0.5	15	0.2		0.2				20		20														NO	100.7061152	90.40446345	25.23352212	0.122027818	81.35187843	0.162703757	0.162703757	40.67593922	24.05028703		0.162703757		40.67593922	0.406759392	8.135187843	28.46647443	0.406759392	12.20278176	0.162703757		0.162703757				16.27037569		16.27037569															21.5024	0.250816819	0.665211032	1.405378806	2.015488805	5.075348473	5.551113831	0.29452122	5.233138791	0	3.025400989	0	0.008994448	0.002896126	5.873821993	14.00397491	0.74253318	1.027829042	4.125805259	0	0.526348876	0	0	0	2.204501865	0	0.036201704	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5717	0	16.75119484	21.5024	0.250816819	0.665211032	1.405378806	2.015488805	5.075348473	5.551113831	0.29452122	5.233138791	0	3.025400989	0	0.008994448	0.002896126	5.873821993	14.00397491	0.74253318	1.027829042	4.125805259	0	0.526348876	0	0	0	2.204501865	0	0.036201704	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5717	NO																																																																																		0	0	0	21.5024	0.250816819	0.665211032	1.405378806	2.015488805	5.075348473	5.551113831	0.29452122	5.233138791	0	3.025400989	0	0.008994448	0.002896126	5.873821993	14.00397491	0.74253318	1.027829042	4.125805259	0	0.526348876	0	0	0	2.204501865	0	0.036201704	0	0	0	0	0	0	0	0	0	0	0	0	0	73.5717
H5421_070_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1823.97921	29.0052383	211.1694156	9.799989417	248.7221373	21.53887394	23.51306368	55.19335402	1560.170457		11.37567274		3.692917015		5537.085871	2765.085938	1.415962383	391.7131149	14.25270719		2.295595267				963.3846055		12.65009589														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.31194932		0.2		49.36408238		20	42.46593852	0.5	35	0.2		0.2				20		20														NO	157.6814052	142.7613536	26.33972604	0.169836472	127.3773542	0.169836472	0.169836472	42.45911807	41.02565521		0.169836472		41.96256713		16.98364723	36.52043036	0.424591181	29.72138265	0.169836472		0.169836472				16.98364723		16.98364723															23.9673	0.345068923	0.463512046	1.664395631	2.640130649	3.658086366	3.993375788	0.195288428	5.333917936	0	1.932004128	0	0.01291369	0	7.836659425	8.415177369	0.60120514	0.970187948	2.420629509	0	0.389875802	0	0	0	1.363482024	0	0.017903731	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2211	0	11.6364996	23.9673	0.345068923	0.463512046	1.664395631	2.640130649	3.658086366	3.993375788	0.195288428	5.333917936	0	1.932004128	0	0.01291369	0	7.836659425	8.415177369	0.60120514	0.970187948	2.420629509	0	0.389875802	0	0	0	1.363482024	0	0.017903731	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2211	NO																																																																																		0	0	0	23.9673	0.345068923	0.463512046	1.664395631	2.640130649	3.658086366	3.993375788	0.195288428	5.333917936	0	1.932004128	0	0.01291369	0	7.836659425	8.415177369	0.60120514	0.970187948	2.420629509	0	0.389875802	0	0	0	1.363482024	0	0.017903731	0	0	0	0	0	0	0	0	0	0	0	0	0	66.2211
H5421_071_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1377.852377	13.68479967	217.0069378	9.586676403	193.7016321	20.16136792	25.37245972	81.44127675	1418.312705		10.22090641		2.385801845		5550.363637	2715.020548	0.863519254	424.6633477	11.87022345		1.98176024				1045.836544		18.3482347														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.46668788		0.2		49.15145601		20	43.47456187	0.5	35	0.2		0.2				20		20														NO	161.3948627	146.1234381	26.96003667	0.173836186	130.3771397	0.173836186	0.173836186	43.45904655	42.1263209		0.173836186		42.77180888		17.38361862	38.17293956	0.434590466	30.42133259	0.173836186		0.173836186				17.38361862		17.38361862															18.5315	0.166639165	0.487542917	1.666511264	2.104522062	3.504775307	4.410651632	0.294946686	4.979024677	0	1.776763389	0	0.008503755	0	8.04045039	8.636692942	0.375277235	1.076568745	2.063474374	0	0.344501642	0	0	0	1.515035302	0	0.026579893	0	0	0	0	0	0	0	0	0	0	0	0	0	60.01	0	8.931603983	18.5315	0.166639165	0.487542917	1.666511264	2.104522062	3.504775307	4.410651632	0.294946686	4.979024677	0	1.776763389	0	0.008503755	0	8.04045039	8.636692942	0.375277235	1.076568745	2.063474374	0	0.344501642	0	0	0	1.515035302	0	0.026579893	0	0	0	0	0	0	0	0	0	0	0	0	0	60.01	NO																																																																																		0	0	0	18.5315	0.166639165	0.487542917	1.666511264	2.104522062	3.504775307	4.410651632	0.294946686	4.979024677	0	1.776763389	0	0.008503755	0	8.04045039	8.636692942	0.375277235	1.076568745	2.063474374	0	0.344501642	0	0	0	1.515035302	0	0.026579893	0	0	0	0	0	0	0	0	0	0	0	0	0	60.01
H5421_072_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1937.716076	32.02909178	239.0102043	10.17549037	222.8450524	21.6538079	28.96238504	81.1552373	1759.582683		11.67561374		2.862453176		5816.866641	2990.682471	1.208342122	477.3901351	15.43925435		2.176128257				1027.046849		12.71635666														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.38011869		0.2		48.6465662		20	44.1201388	0.5	35	0.2		0.2				20		20														NO	155.2657599	140.5742802	25.93620707	0.167234614	125.4259604	0.167234614	0.167234614	41.80865347	40.45415234		0.167234614		40.77742169		16.72346139	37.17709573	0.418086535	29.26605743	0.167234614		0.167234614				16.72346139		16.72346139															25.0717	0.375205544	0.516584846	1.701694203	2.329212894	3.621266204	4.84351328	0.282749266	5.931868825	0	1.952566755	0	0.009726955	0	8.106512057	9.265407378	0.50519157	1.164277259	2.581977739	0	0.363923969	0	0	0	1.431314861	0	0.017721792	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0725	0	13.64394306	25.0717	0.375205544	0.516584846	1.701694203	2.329212894	3.621266204	4.84351328	0.282749266	5.931868825	0	1.952566755	0	0.009726955	0	8.106512057	9.265407378	0.50519157	1.164277259	2.581977739	0	0.363923969	0	0	0	1.431314861	0	0.017721792	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0725	NO																																																																																		0	0	0	25.0717	0.375205544	0.516584846	1.701694203	2.329212894	3.621266204	4.84351328	0.282749266	5.931868825	0	1.952566755	0	0.009726955	0	8.106512057	9.265407378	0.50519157	1.164277259	2.581977739	0	0.363923969	0	0	0	1.431314861	0	0.017721792	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0725
H5421_073_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1746.9847	32.04553814	332.9694488	9.998630544	228.3631763	22.0989387	23.40009721	59.34279556	1669.258302		12.45937524		1.83395042		6231.31147	3241.064205	1.143984258	483.2253417	14.44692798		2.879271592				899.1222412		12.18594412														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42046439		0.2		49.16289464		20	44.21290694	0.5	35	0.2		0.2				20		20														NO	156.4655471	141.6605418	26.13662428	0.168526888	126.3951662	0.168526888	0.168526888	42.13172206	40.80075095		0.168526888		41.48604042		16.85268882	37.47710784	0.421317221	29.49220544	0.168526888		0.168526888				16.85268882		16.85268882															22.7786	0.378299025	0.725224782	1.685038092	2.405333468	3.724265372	3.943545567	0.208351181	5.675582687	0	2.099739738	0	0.006340278	0	8.751196098	10.12214273	0.481980268	1.187615088	2.434695817	0	0.485234682	0	0	0	1.262718945	0	0.017113827	0	0	0	0	0	0	0	0	0	0	0	0	0	68.373	0	12.69784605	22.7786	0.378299025	0.725224782	1.685038092	2.405333468	3.724265372	3.943545567	0.208351181	5.675582687	0	2.099739738	0	0.006340278	0	8.751196098	10.12214273	0.481980268	1.187615088	2.434695817	0	0.485234682	0	0	0	1.262718945	0	0.017113827	0	0	0	0	0	0	0	0	0	0	0	0	0	68.373	NO																																																																																		0	0	0	22.7786	0.378299025	0.725224782	1.685038092	2.405333468	3.724265372	3.943545567	0.208351181	5.675582687	0	2.099739738	0	0.006340278	0	8.751196098	10.12214273	0.481980268	1.187615088	2.434695817	0	0.485234682	0	0	0	1.262718945	0	0.017113827	0	0	0	0	0	0	0	0	0	0	0	0	0	68.373
H5421_074_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1437.059087	31.13046963	226.8296806	10.1644211	247.2395642	25.28894486	22.24015995	67.66190329	1527.566279		12.84843716		2.8949402		5536.607275	2929.1711	0.895050326	391.417783	13.91234959		1.987599107				903.080743		14.62640116														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.1858298		0.2		48.6465662		20	43.75874496	0.5	35	0.2		0.2				20		20														NO	159.6485696	144.5423819	26.66832897	0.171955278	128.9664585	0.171955278	0.171955278	42.9888195	41.42903879		0.171955278		41.91116655		17.1955278	37.89373925	0.429888195	30.09217365	0.171955278		0.171955278				17.1955278		17.1955278															19.1187	0.374972686	0.504097378	1.747825856	2.65713425	4.348567544	3.824312887	0.242392112	5.273800218	0	2.209356584	0	0.01011086	0	7.93374036	9.249770489	0.384771569	0.981550991	2.392301942	0	0.341778157	0	0	0	1.294079169	0	0.020959057	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9102	0	10.18326024	19.1187	0.374972686	0.504097378	1.747825856	2.65713425	4.348567544	3.824312887	0.242392112	5.273800218	0	2.209356584	0	0.01011086	0	7.93374036	9.249770489	0.384771569	0.981550991	2.392301942	0	0.341778157	0	0	0	1.294079169	0	0.020959057	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9102	NO																																																																																		0	0	0	19.1187	0.374972686	0.504097378	1.747825856	2.65713425	4.348567544	3.824312887	0.242392112	5.273800218	0	2.209356584	0	0.01011086	0	7.93374036	9.249770489	0.384771569	0.981550991	2.392301942	0	0.341778157	0	0	0	1.294079169	0	0.020959057	0	0	0	0	0	0	0	0	0	0	0	0	0	62.9102
H5421_075_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2125.781996	27.98486207	329.0601875	10.66647192	249.6777203	28.55370311	26.71638853	93.68673928	1878.603658		14.11598633		7.569787305		6355.087549	3186.616926	1.106630095	450.4302091	15.967961		2.32994858				992.0902888		13.7249698														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.35553737		0.2		49.37453396		20	43.97152249	0.5	35	0.2		0.2				20		20														NO	152.423195	138.0006831	25.46137378	0.164172926	123.1296948	0.164172926	0.164172926	41.04323159	39.69335038		0.164172926		40.58057928		16.41729264	36.40621709	0.410432316	28.73026211	0.164172926		0.164172926				16.41729264		16.41729264															27.0015	0.321827507	0.698193703	1.751145909	2.561895124	4.687744998	4.386107686	0.320433878	6.214006103	0	2.317462785	0	0.025598863	0	8.694444335	9.667722298	0.454196753	1.078414831	2.621506885	0	0.382514477	0	0	0	1.357286383	0	0.018777237	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5608	0	16.17040741	27.0015	0.321827507	0.698193703	1.751145909	2.561895124	4.687744998	4.386107686	0.320433878	6.214006103	0	2.317462785	0	0.025598863	0	8.694444335	9.667722298	0.454196753	1.078414831	2.621506885	0	0.382514477	0	0	0	1.357286383	0	0.018777237	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5608	NO																																																																																		0	0	0	27.0015	0.321827507	0.698193703	1.751145909	2.561895124	4.687744998	4.386107686	0.320433878	6.214006103	0	2.317462785	0	0.025598863	0	8.694444335	9.667722298	0.454196753	1.078414831	2.621506885	0	0.382514477	0	0	0	1.357286383	0	0.018777237	0	0	0	0	0	0	0	0	0	0	0	0	0	74.5608
H5421_100_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2271.079304	27.60346234	312.2387987	11.12869609	262.0379084	29.82256184	29.23964266	82.19712266	2412.649322		17.22040853		2.977486237	0.00798935	8211.284368	5934.129744	1.307253251	843.4461074	25.5262886		3.049671938				1770.65708		22.38451904														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.50960465		0.2		50	0.5	10	34.28593504	0.5	15	0.2		0.2				20		20														NO	102.3219029	91.85496544	25.63838348	0.123985703	82.65713546	0.165314271	0.165314271	41.32856773	24.39179389		0.165314271		41.32856773	0.413285677	8.265713546	28.92241758	0.413285677	12.39857032	0.165314271		0.165314271				16.53142709		16.53142709															19.3651	0.211292923	0.667108172	1.37979921	1.804941908	4.930095067	4.833730208	0.283090779	4.904070415	0	2.846779281	0	0.010254603	0.003301884	5.656010369	14.3024482	0.540269045	0.871460489	4.21985979	0	0.504154293	0	0	0	2.439290702	0	0.030837337	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8039	0	14.29745846	19.3651	0.211292923	0.667108172	1.37979921	1.804941908	4.930095067	4.833730208	0.283090779	4.904070415	0	2.846779281	0	0.010254603	0.003301884	5.656010369	14.3024482	0.540269045	0.871460489	4.21985979	0	0.504154293	0	0	0	2.439290702	0	0.030837337	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8039	NO																																																																																		0	0	0	19.3651	0.211292923	0.667108172	1.37979921	1.804941908	4.930095067	4.833730208	0.283090779	4.904070415	0	2.846779281	0	0.010254603	0.003301884	5.656010369	14.3024482	0.540269045	0.871460489	4.21985979	0	0.504154293	0	0	0	2.439290702	0	0.030837337	0	0	0	0	0	0	0	0	0	0	0	0	0	69.8039
H5421_101_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	3277.003233	63.35305337	620.5189603	20.09191803	463.6249989	43.63904292	45.31343066	138.309084	3102.713016		24.16453538		7.919445455		10787.50551	5614.76888	2.25996781	863.0048509	28.1230674		4.819788998				1729.758541		26.46239482														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	130.2899092	117.9616821	21.76414213	0.140333469	105.2501016	0.140333469	0.140333469	35.08336719	33.97780847		0.140333469		34.31667077		14.03334688	31.38868026	0.350833672	24.55835703	0.140333469		0.140333469				14.03334688		14.03334688															35.58	0.622769395	1.125421904	2.819568552	4.066381519	6.124018266	6.358990905	0.404362365	8.785282384	0	3.391093071	0	0.022647417	0	12.61540056	14.68668209	0.792872805	1.766165104	3.9466076	0	0.676377709	0	0	0	2.022858468	0	0.03094633	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8385	0	44.56637337	35.58	0.622769395	1.125421904	2.819568552	4.066381519	6.124018266	6.358990905	0.404362365	8.785282384	0	3.391093071	0	0.022647417	0	12.61540056	14.68668209	0.792872805	1.766165104	3.9466076	0	0.676377709	0	0	0	2.022858468	0	0.03094633	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8385	NO																																																																																		0	0	0	35.58	0.622769395	1.125421904	2.819568552	4.066381519	6.124018266	6.358990905	0.404362365	8.785282384	0	3.391093071	0	0.022647417	0	12.61540056	14.68668209	0.792872805	1.766165104	3.9466076	0	0.676377709	0	0	0	2.022858468	0	0.03094633	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8385
H5421_103_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	3488.324804	25.04046987	645.767042	13.40239125	294.5357566	34.11711153	30.2896826	90.62158444	3121.295386		21.1851712		3.393119141	0.009104599	10177.77265	7032.114284	2.053000105	1105.095823	29.72223907		3.513052728				1937.307886		27.54204396														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.49494446		0.2		50	0.5	10	34.4789726	0.5	15	0.2		0.2				20		20														NO	95.75159648	85.95676325	23.99208849	0.116024318	77.34954545	0.154699091	0.154699091	38.67477273	22.81420547		0.154699091		38.67477273	0.386747727	7.734954545	27.06551976	0.386747727	11.60243182	0.154699091		0.154699091				15.46990909		15.46990909															27.8344	0.179366478	1.291108335	1.555003307	1.898517241	5.277886139	4.685786362	0.292064099	5.934156189	0	3.277326726	0	0.010935676	0.003521183	6.560384071	15.86065234	0.793993124	1.068483245	4.598003364	0	0.543466063	0	0	0	2.497498074	0	0.035506076	0	0	0	0	0	0	0	0	0	0	0	0	0	84.198	0	24.35575864	27.8344	0.179366478	1.291108335	1.555003307	1.898517241	5.277886139	4.685786362	0.292064099	5.934156189	0	3.277326726	0	0.010935676	0.003521183	6.560384071	15.86065234	0.793993124	1.068483245	4.598003364	0	0.543466063	0	0	0	2.497498074	0	0.035506076	0	0	0	0	0	0	0	0	0	0	0	0	0	84.198	NO																																																																																		0	0	0	27.8344	0.179366478	1.291108335	1.555003307	1.898517241	5.277886139	4.685786362	0.292064099	5.934156189	0	3.277326726	0	0.010935676	0.003521183	6.560384071	15.86065234	0.793993124	1.068483245	4.598003364	0	0.543466063	0	0	0	2.497498074	0	0.035506076	0	0	0	0	0	0	0	0	0	0	0	0	0	84.198
H5421_104_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2418.123055	46.74865054	457.8851766	14.82596347	342.1120515	32.20154766	33.4370898	102.0592172	2289.513115		17.83117561		5.843812862		7960.173951	4143.176284	1.667645674	636.8171706	20.75220341		3.556555203				1276.400635		19.52678177														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	144.5189934	130.844389	24.14102467	0.15565942	116.7445647	0.15565942	0.15565942	38.9148549	37.68855706		0.15565942		37.99744906		15.56594196	34.57867988	0.389148549	27.24039843	0.15565942		0.15565942				15.56594196		15.56594196															29.1221	0.509733218	0.921151445	2.307800868	3.328310211	5.012474219	5.204797991	0.330968302	7.190703806	0	2.775590446	0	0.018504165	0	10.32563381	11.9387972	0.648961894	1.445596121	3.230275938	0	0.553611319	0	0	0	1.655698184	0	0.025329396	0	0	0	0	0	0	0	0	0	0	0	0	0	86.546	0	24.43877345	29.1221	0.509733218	0.921151445	2.307800868	3.328310211	5.012474219	5.204797991	0.330968302	7.190703806	0	2.775590446	0	0.018504165	0	10.32563381	11.9387972	0.648961894	1.445596121	3.230275938	0	0.553611319	0	0	0	1.655698184	0	0.025329396	0	0	0	0	0	0	0	0	0	0	0	0	0	86.546	NO																																																																																		0	0	0	29.1221	0.509733218	0.921151445	2.307800868	3.328310211	5.012474219	5.204797991	0.330968302	7.190703806	0	2.775590446	0	0.018504165	0	10.32563381	11.9387972	0.648961894	1.445596121	3.230275938	0	0.553611319	0	0	0	1.655698184	0	0.025329396	0	0	0	0	0	0	0	0	0	0	0	0	0	86.546
H5421_106_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2719.49143	17.5709213	609.2995202	21.69965644	241.8999903	29.85643232	25.66750057	82.32049266	2523.802528		16.02374514		2.380954898	0.006388705	8036.231278	6205.059042	2.105443197	990.9659474	34.50174513		3.404587519				1769.625818		21.70547604														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.49800634		0.2		50	0.5	10	33.10035693	0.5	15	0.2		0.2				20		20														NO	99.98372795	89.75597221	25.05251648	0.121152485	80.76832339	0.161536647	0.161536647	40.3841617	23.82504516		0.161536647		40.3841617	0.403841617	8.076832339	27.54277299	0.403841617	12.11524851	0.161536647		0.161536647				16.15366468		16.15366468															22.6587	0.131424594	1.272040523	2.628967303	1.62815472	4.822907962	4.146241974	0.277037007	5.010809099	0	2.588422058	0	0.008012739	0.002580025	5.408941056	14.24204438	0.850265585	1.000483226	5.573296216	0	0.549965652	0	0	0	2.382161839	0	0.029218582	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2117	0	17.39119777	22.6587	0.131424594	1.272040523	2.628967303	1.62815472	4.822907962	4.146241974	0.277037007	5.010809099	0	2.588422058	0	0.008012739	0.002580025	5.408941056	14.24204438	0.850265585	1.000483226	5.573296216	0	0.549965652	0	0	0	2.382161839	0	0.029218582	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2117	NO																																																																																		0	0	0	22.6587	0.131424594	1.272040523	2.628967303	1.62815472	4.822907962	4.146241974	0.277037007	5.010809099	0	2.588422058	0	0.008012739	0.002580025	5.408941056	14.24204438	0.850265585	1.000483226	5.573296216	0	0.549965652	0	0	0	2.382161839	0	0.029218582	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2117
H5421_107_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2734.758945	52.63895042	442.7323142	18.33247827	410.5421993	41.68698164	36.89609615	130.1112071	2641.669977		20.3904747		5.650422691		9090.752887	4935.402973	2.216338088	700.4614914	23.97678204		4.018755333				1419.001114		24.01504006														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.37119589		0.2		48.6465662		20	44.05309408	0.5	35	0.2		0.2				20		20														NO	137.6846966	124.6567636	22.99939668	0.148298293	111.2237194	0.148298293	0.148298293	37.07457314	35.86682879		0.148298293		36.22955375		14.82982925	33.13970927	0.370745731	25.95220119	0.148298293		0.148298293				14.82982925		14.82982925															31.3779	0.546816767	0.84854801	2.718675225	3.805169198	6.182108199	5.471628061	0.401984789	7.895693733	0	3.023872582	0	0.017059358	0	11.23452609	13.6298183	0.821697886	1.514876463	3.555715838	0	0.595974554	0	0	0	1.753628687	0	0.029678245	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4253	0	33.00503048	31.3779	0.546816767	0.84854801	2.718675225	3.805169198	6.182108199	5.471628061	0.401984789	7.895693733	0	3.023872582	0	0.017059358	0	11.23452609	13.6298183	0.821697886	1.514876463	3.555715838	0	0.595974554	0	0	0	1.753628687	0	0.029678245	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4253	NO																																																																																		0	0	0	31.3779	0.546816767	0.84854801	2.718675225	3.805169198	6.182108199	5.471628061	0.401984789	7.895693733	0	3.023872582	0	0.017059358	0	11.23452609	13.6298183	0.821697886	1.514876463	3.555715838	0	0.595974554	0	0	0	1.753628687	0	0.029678245	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4253
H5421_109_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2841.499501	24.18009443	717.9141353	21.49060994	295.1550027	33.24395789	31.16156939	102.624375	2744.241032		20.49975564		3.276533615	0.00879177	9923.984434	6473.162378	2.613943924	1392.716009	31.31306862		3.647547274				1954.584865		25.04533658														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.49417774		0.2		50	0.5	10	34.4872854	0.5	15	0.2		0.2				20		20														NO	97.48554411	87.51333809	24.42655671	0.118125381	78.75025381	0.157500508	0.157500508	39.3751269	23.22673982		0.157500508		39.3751269	0.393751269	7.875025381	27.55530372	0.393751269	11.81253807	0.157500508		0.157500508				15.75005076		15.75005076															23.0838	0.176340065	1.461347528	2.53858648	1.936960948	5.235940243	4.907962997	0.336737316	5.311647706	0	3.228721919	0	0.010751161	0.003461771	6.512635775	14.86416294	1.029243737	1.37095924	4.931824203	0	0.574490547	0	0	0	2.565400903	0	0.03287211	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1138	0	21.34610029	23.0838	0.176340065	1.461347528	2.53858648	1.936960948	5.235940243	4.907962997	0.336737316	5.311647706	0	3.228721919	0	0.010751161	0.003461771	6.512635775	14.86416294	1.029243737	1.37095924	4.931824203	0	0.574490547	0	0	0	2.565400903	0	0.03287211	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1138	NO																																																																																		0	0	0	23.0838	0.176340065	1.461347528	2.53858648	1.936960948	5.235940243	4.907962997	0.336737316	5.311647706	0	3.228721919	0	0.010751161	0.003461771	6.512635775	14.86416294	1.029243737	1.37095924	4.931824203	0	0.574490547	0	0	0	2.565400903	0	0.03287211	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1138
H5421_110_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2407.676635	46.5466939	455.9070884	14.76191452	340.6341093	32.06243527	33.2926398	101.618316	2279.622297		17.75414399		5.81856728		7925.785578	4125.277543	1.660441356	634.0660866	20.66255279		3.541190696				1270.886517		19.44242504														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	144.6815669	130.9915795	24.1681816	0.155834525	116.875894	0.155834525	0.155834525	38.95863133	37.73095399		0.155834525		38.03950357		15.58345253	34.61512703	0.389586313	27.27104193	0.155834525		0.155834525				15.58345253		15.58345253															29.0289	0.50810208	0.918203775	2.300415942	3.31765967	4.99643438	5.18814272	0.329909209	7.167693667	0	2.766708601	0	0.018444618	0	10.29259194	11.89975051	0.646885226	1.440970236	3.219939105	0	0.551839771	0	0	0	1.650399976	0	0.025248342	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2682	0	24.23710224	29.0289	0.50810208	0.918203775	2.300415942	3.31765967	4.99643438	5.18814272	0.329909209	7.167693667	0	2.766708601	0	0.018444618	0	10.29259194	11.89975051	0.646885226	1.440970236	3.219939105	0	0.551839771	0	0	0	1.650399976	0	0.025248342	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2682	NO																																																																																		0	0	0	29.0289	0.50810208	0.918203775	2.300415942	3.31765967	4.99643438	5.18814272	0.329909209	7.167693667	0	2.766708601	0	0.018444618	0	10.29259194	11.89975051	0.646885226	1.440970236	3.219939105	0	0.551839771	0	0	0	1.650399976	0	0.025248342	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2682
H5421_112_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2285.757205	51.89334147	416.3580321	6.691650791	247.8365924	18.80371801	20.6330275	87.73089674	2270.798953		15.43034907		2.168404747	0.005818379	7338.661292	4561.597881	1.99539511	865.243722	17.83934711		2.755601517				1385.339558		32.34145347														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.51481342		0.2		50	0.5	10	34.18135549	0.5	15	0.2		0.2				20		20														NO	105.5661493	94.76734421	26.45128112	0.127916828	85.27788531	0.170555771	0.170555771	42.63894266	25.16960873		0.170555771		42.63894266	0.426389427	8.527788531	29.80722953	0.426389427	12.7916828	0.170555771		0.170555771				17.05557706		17.05557706															20.1082	0.409816179	0.917766946	0.855974743	1.761248375	3.207082616	3.519081906	0.31172939	4.762926763	0	2.631735077	0	0.007704874	0.002480895	5.215212633	11.33071625	0.850815377	0.922326936	3.042603594	0	0.46998374	0	0	0	1.968980466	0	0.045966846	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3424	0	10.46924688	20.1082	0.409816179	0.917766946	0.855974743	1.761248375	3.207082616	3.519081906	0.31172939	4.762926763	0	2.631735077	0	0.007704874	0.002480895	5.215212633	11.33071625	0.850815377	0.922326936	3.042603594	0	0.46998374	0	0	0	1.968980466	0	0.045966846	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3424	NO																																																																																		0	0	0	20.1082	0.409816179	0.917766946	0.855974743	1.761248375	3.207082616	3.519081906	0.31172939	4.762926763	0	2.631735077	0	0.007704874	0.002480895	5.215212633	11.33071625	0.850815377	0.922326936	3.042603594	0	0.46998374	0	0	0	1.968980466	0	0.045966846	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3424
H5421_113_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2558.698284	49.46633782	484.5038855	15.68785642	362.0004024	34.07355327	35.38092245	107.9923304	2422.61173		18.86777364		6.183537231		8422.930912	4384.035803	1.764592631	673.8379166	21.95861254		3.763312076				1350.602943		20.66195222														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	141.9343644	128.5043215	23.70927802	0.152875551	114.6566635	0.152875551	0.152875551	38.21888783	37.01452153		0.152875551		37.32885746		15.28755513	33.99923532	0.382188878	26.75322148	0.152875551		0.152875551				15.28755513		15.28755513															30.2639	0.529719848	0.957269777	2.398289698	3.458813193	5.209013241	5.408878026	0.343945563	7.472651171	0	2.884421297	0	0.019235365	0	10.73050172	12.42115541	0.674407678	1.502277919	3.356934998	0	0.575318408	0	0	0	1.720618079	0	0.026322561	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9537	0	27.48305421	30.2639	0.529719848	0.957269777	2.398289698	3.458813193	5.209013241	5.408878026	0.343945563	7.472651171	0	2.884421297	0	0.019235365	0	10.73050172	12.42115541	0.674407678	1.502277919	3.356934998	0	0.575318408	0	0	0	1.720618079	0	0.026322561	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9537	NO																																																																																		0	0	0	30.2639	0.529719848	0.957269777	2.398289698	3.458813193	5.209013241	5.408878026	0.343945563	7.472651171	0	2.884421297	0	0.019235365	0	10.73050172	12.42115541	0.674407678	1.502277919	3.356934998	0	0.575318408	0	0	0	1.720618079	0	0.026322561	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9537
H5421_115_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1951.453566	19.84262687	473.1875158	8.844490618	239.8910077	22.51231678	26.74337706	67.09029195	2235.324942		15.38206798		2.688783294	0.007214687	7286.671015	4445.953465	1.469026694	777.670983	19.22497179		2.308944568				1318.140663		30.07757656														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.50549511		0.2		50	0.5	10	34.57849229	0.5	15	0.2		0.2				20		20														NO	106.1727448	95.31188854	26.6032733	0.128651853	85.7679021	0.171535804	0.171535804	42.88395105	25.30624415		0.171535804		42.88395105	0.42883951	8.57679021	30.00928587	0.42883951	12.86518531	0.171535804		0.171535804				17.15358042		17.15358042															17.2659	0.157603187	1.049028067	1.137860108	1.714579039	3.861668364	4.587446691	0.239758066	4.71397323	0	2.638575402	0	0.009608804	0.003093943	5.208020718	11.11832404	0.629976688	0.833740109	3.297770996	0	0.396066663	0	0	0	1.884235989	0	0.042994844	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7903	0	9.935301858	17.2659	0.157603187	1.049028067	1.137860108	1.714579039	3.861668364	4.587446691	0.239758066	4.71397323	0	2.638575402	0	0.009608804	0.003093943	5.208020718	11.11832404	0.629976688	0.833740109	3.297770996	0	0.396066663	0	0	0	1.884235989	0	0.042994844	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7903	NO																																																																																		0	0	0	17.2659	0.157603187	1.049028067	1.137860108	1.714579039	3.861668364	4.587446691	0.239758066	4.71397323	0	2.638575402	0	0.009608804	0.003093943	5.208020718	11.11832404	0.629976688	0.833740109	3.297770996	0	0.396066663	0	0	0	1.884235989	0	0.042994844	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7903
H5421_116_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2031.906302	39.28206939	384.7528661	12.45799652	287.4707439	27.05839452	28.09659887	85.7585664	1923.83763		14.98322346		4.910453236		6688.794263	3481.438211	1.401293349	535.1062757	17.43771178		2.988510827				1072.53702		16.40801152														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	151.5038538	137.1683314	25.3078034	0.163182717	122.3870375	0.163182717	0.163182717	40.79567916	39.51011217		0.163182717		39.80429216		16.31827166	36.14460652	0.407956792	28.55697541	0.163182717		0.163182717				16.31827166		16.31827166															25.6535	0.449021326	0.811437491	2.032929716	2.931891059	4.415462326	4.584879332	0.291548247	6.334253378	0	2.445003109	0	0.016288093	0	9.095796824	10.48626786	0.571667139	1.273418063	2.84553318	0	0.487673315	0	0	0	1.458495871	0	0.022312532	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2073	0	17.05120404	25.6535	0.449021326	0.811437491	2.032929716	2.931891059	4.415462326	4.584879332	0.291548247	6.334253378	0	2.445003109	0	0.016288093	0	9.095796824	10.48626786	0.571667139	1.273418063	2.84553318	0	0.487673315	0	0	0	1.458495871	0	0.022312532	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2073	NO																																																																																		0	0	0	25.6535	0.449021326	0.811437491	2.032929716	2.931891059	4.415462326	4.584879332	0.291548247	6.334253378	0	2.445003109	0	0.016288093	0	9.095796824	10.48626786	0.571667139	1.273418063	2.84553318	0	0.487673315	0	0	0	1.458495871	0	0.022312532	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2073
H5421_124_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2006.985318	104.6602745	310.5760943	12.94870754	266.3123625	30.30091624	24.37282514	85.92775855	2421.656103		17.41000869		2.564634293	0.006881564	7690.370351	5169.007913	1.884381738	778.6042094	20.78013083		3.805290378				1678.643776		15.51426688														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.70161395		0.2		50	0.5	10	34.47421162	0.5	15	0.2		0.2				20		20														NO	104.0387459	93.39618532	26.06856585	0.12606604	84.04402642	0.168088053	0.168088053	42.02201321	24.96243227		0.168088053		42.02201321	0.420220132	8.404402642	29.40778826	0.420220132	12.60660396	0.168088053		0.168088053				16.80880528		16.80880528															17.4004	0.814572533	0.674689447	1.632392278	1.865163603	5.09322201	4.09678072	0.300904784	5.037535538	0	2.926414461	0	0.008980925	0.002891772	5.386080741	12.66742418	0.791855143	0.817962909	3.492891728	0	0.63962385	0	0	0	2.35133303	0	0.021731358	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0228	0	12.31202066	17.4004	0.814572533	0.674689447	1.632392278	1.865163603	5.09322201	4.09678072	0.300904784	5.037535538	0	2.926414461	0	0.008980925	0.002891772	5.386080741	12.66742418	0.791855143	0.817962909	3.492891728	0	0.63962385	0	0	0	2.35133303	0	0.021731358	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0228	NO																																																																																		0	0	0	17.4004	0.814572533	0.674689447	1.632392278	1.865163603	5.09322201	4.09678072	0.300904784	5.037535538	0	2.926414461	0	0.008980925	0.002891772	5.386080741	12.66742418	0.791855143	0.817962909	3.492891728	0	0.63962385	0	0	0	2.35133303	0	0.021731358	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0228
H5421_125_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2265.631144	43.80058261	429.0099772	13.89100712	320.5377481	30.17085054	31.3284768	95.62314894	2145.131617		16.70670429		5.475289768		7458.18869	3881.8989	1.562480441	596.6581444	19.44352594		3.332271374				1195.908135		18.29538197														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	147.0409531	133.127717	24.56230279	0.158375788	118.7818407	0.158375788	0.158375788	39.59394691	38.3462493		0.158375788		38.64982937		15.83757876	35.14407469	0.395939469	27.71576284	0.158375788		0.158375788				15.83757876		15.83757876															27.7617	0.48592263	0.878122747	2.199999194	3.172838645	4.778332218	4.961672189	0.315508157	6.854812646	0	2.64593745	0	0.017634918	0	9.843304234	11.36881207	0.618647676	1.378069635	3.079383736	0	0.527751103	0	0	0	1.57835744	0	0.024146213	0	0	0	0	0	0	0	0	0	0	0	0	0	82.491	0	21.49487227	27.7617	0.48592263	0.878122747	2.199999194	3.172838645	4.778332218	4.961672189	0.315508157	6.854812646	0	2.64593745	0	0.017634918	0	9.843304234	11.36881207	0.618647676	1.378069635	3.079383736	0	0.527751103	0	0	0	1.57835744	0	0.024146213	0	0	0	0	0	0	0	0	0	0	0	0	0	82.491	NO																																																																																		0	0	0	27.7617	0.48592263	0.878122747	2.199999194	3.172838645	4.778332218	4.961672189	0.315508157	6.854812646	0	2.64593745	0	0.017634918	0	9.843304234	11.36881207	0.618647676	1.378069635	3.079383736	0	0.527751103	0	0	0	1.57835744	0	0.024146213	0	0	0	0	0	0	0	0	0	0	0	0	0	82.491
H5421_127_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2920.568632	25.74663503	455.3022533	17.2564152	301.5918482	34.60586565	32.76485067	88.7094706	2403.35041		17.64703912		3.488808342	0.009361357	8888.805208	5343.135948	2.096390614	1017.294006	23.12644055		3.12067127				1656.356154		21.10488183														3250	1a: $200 Per Day (Days 1-5)	1b: $200 Per Day (Days 1-5)	2a: $100/ days 21-100; 2a2: $100/ days 21-100	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175;  9c: 50%; 9d: $15	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $35; 7d: $35; 7f: $35; 7g:$35;13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												123.7907681	111.1276902	31.01774982	0.15	100	0.2	0.2	50	29.60057289		0.2		50	0.5	10	34.53965045	0.5	15	0.2		0.2				20		20														NO	99.82555161	89.6139764	25.01288288	0.120960819	80.64054623	0.161281092	0.161281092	40.32027311	23.87006367		0.161281092		40.32027311	0.403202731	8.064054623	28.21456795	0.403202731	12.09608193	0.161281092		0.161281092				16.12810925		16.12810925															24.2956	0.192271529	0.949035161	2.087350122	2.026710948	5.581271818	5.284350909	0.29806584	4.780677275	0	2.846133748	0	0.011722475	0.003774525	5.973317561	12.56285602	0.845270421	1.025439304	3.729857597	0	0.503305272	0	0	0	2.22615775	0	0.028365153	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2515	0	17.86604943	24.2956	0.192271529	0.949035161	2.087350122	2.026710948	5.581271818	5.284350909	0.29806584	4.780677275	0	2.846133748	0	0.011722475	0.003774525	5.973317561	12.56285602	0.845270421	1.025439304	3.729857597	0	0.503305272	0	0	0	2.22615775	0	0.028365153	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2515	NO																																																																																		0	0	0	24.2956	0.192271529	0.949035161	2.087350122	2.026710948	5.581271818	5.284350909	0.29806584	4.780677275	0	2.846133748	0	0.011722475	0.003774525	5.973317561	12.56285602	0.845270421	1.025439304	3.729857597	0	0.503305272	0	0	0	2.22615775	0	0.028365153	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2515
H5421_128_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2099.436182	40.58759879	397.540028	12.87203481	297.0247596	27.95767325	29.03038205	88.60873014	1987.775875		15.48118701		5.073650878		6911.094607	3597.142908	1.447864971	552.8903941	18.01724961		3.08783321				1108.18251		16.95332753														3400	1a: $300 Per Day (Days 1-5)	1b: $300 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1:  $250 Ded; 4b: $35; 4b1: $35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $35	7a: $20;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $45; 7d: $45; 7f: $45;  7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $35, 7c: $35"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												185.6861522	168.1162493	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		20	43.80789092	0.5	35	0.2		0.2				20		20														NO	150.2067635	135.9939737	25.09113229	0.161785638	121.3392289	0.161785638	0.161785638	40.44640962	39.17184892		0.161785638		39.46876094		16.17856385	35.85381355	0.404464096	28.31248673	0.161785638		0.161785638				16.17856385		16.17856385															26.2791	0.459972403	0.831227453	2.08251037	3.003396273	4.523150018	4.696698896	0.29865875	6.488738022	0	2.504633726	0	0.016687559	0	9.317632114	10.74760759	0.585609397	1.304475162	2.914932232	0	0.499567067	0	0	0	1.494066791	0	0.022856708	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0715	0	18.28642965	26.2791	0.459972403	0.831227453	2.08251037	3.003396273	4.523150018	4.696698896	0.29865875	6.488738022	0	2.504633726	0	0.016687559	0	9.317632114	10.74760759	0.585609397	1.304475162	2.914932232	0	0.499567067	0	0	0	1.494066791	0	0.022856708	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0715	NO																																																																																		0	0	0	26.2791	0.459972403	0.831227453	2.08251037	3.003396273	4.523150018	4.696698896	0.29865875	6.488738022	0	2.504633726	0	0.016687559	0	9.317632114	10.74760759	0.585609397	1.304475162	2.914932232	0	0.499567067	0	0	0	1.494066791	0	0.022856708	0	0	0	0	0	0	0	0	0	0	0	0	0	78.0715
H5421_130_0	2010	7	N/A																															A	A	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	95.34537745	3.384360718	200.3433734	3.386205315	90.50709996	10.06091529	18.29962844	28.44084854	886.7257138		8.684431806		1.161049358	0.00311539	4331.631826	2404.530736	0.521242978	318.3279197	9.355672727		2.164143744				838.4068922		11.28758001														3250	1a: $195 Per Admit	1b: $195 Per Admit	2: $100/ days 21-100;	6a: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $75; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $20	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $25; 7d: $35; 7f: $35; 7g: $35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $20, 7c: $20"	8b: 20%	8a: $0	15: 20%	13a: $0; 17a: $20; 17b: $20 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												195	195	31.0177	0.15	150	0.2	0.2	50	15		0.2		50	0.5	10	24.99658648	0.5	20	0.2		0.2				20		20														YES	185.4676492	185.4676492	29.5014354	0.142667422	142.6674225	0.19022323	0.19022323	47.55580749	14.26674225		0.19022323		47.55580749	0.475558075	9.511161499	23.77488878	0.475558075	19.022323	0.19022323		0.19022323				19.022323		19.022323														7000	1.4736	0.052307452	0.492534757	0.483101184	1.076034556	1.913819803	3.481014429	0.112710626	1.054223934	0	1.651980669	0	0.00460122	0.001481549	3.433237488	4.763954234	0.247881307	0.504611376	1.779666285	0	0.411670413	0	0	0	1.329037226	0	0.017892999	0	0	0	0	0	0	0	0	0	0	0	0	0	24.2854	0	1.248130106	1.4736	0.052307452	0.492534757	0.483101184	1.076034556	1.913819803	3.481014429	0.112710626	1.054223934	0	1.651980669	0	0.00460122	0.001481549	3.433237488	4.763954234	0.247881307	0.504611376	1.779666285	0	0.411670413	0	0	0	1.329037226	0	0.017892999	0	0	0	0	0	0	0	0	0	0	0	0	0	24.2854	NO	1a: $1000 Per Admit	1b: $1000 Per Admit	2: 30%	6a: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $20%; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175; 7c: $20; 7i: $20; 9c: 50%; 9d: $20	7a: 20%; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 20%; 7d: $35; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	7i: $20	8b: 20%	8a: $0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline													1.9269	0.0133	0.9815	0.1232	0.2744	0.488	0.8876	0.0287	1.1575		0.4212		0.0012	0.0004	1.1453	0.5822	0.0632	0.1287	0.4538		0.105				0.2542		0.0046														9.0406	0	0.279124373	3.4005	0.065644638	1.473996171	0.606280765	1.350398373	2.401799399	4.368592252	0.141449218	2.2116784	0	2.073197367	0	0.005774424	0.001859309	4.578549718	5.346171867	0.311085283	0.633275555	2.233439849	0	0.516636806	0	0	0	1.583192442	0	0.022455299	0	0	0	0	0	0	0	0	0	0	0	0	0	33.326
H5421_131_0	2010	7	N/A																															A	A	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	106.5526113	3.03291536	166.7473329	5.399148067	124.5864139	11.72678755	12.17673301	37.16674646	833.7684316		6.493551501		2.128132245		2898.844173	1508.932584	0.607303932	231.908719	7.557297652		1.295185179				464.824835		7.111037761														3400	1a: $495 Per Admit	1b: $495 Per Admit	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $125; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $20	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $45; 7f: $45; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $20, 7C: $20"	8b: 20%	8a: $0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												495	495	31.0177	0.2	150	0.2	0.2	50	25.11512332		0.2		48.6465662		20	39.17321471	0.5	20	0.2		0.2				20		20														YES	468.0521185	468.0521185	29.32909131	0.189111967	141.8339753	0.189111967	0.189111967	47.27799177	23.74785188		0.189111967		46.03162663		18.91119671	37.15935515	0.472779918	18.91119671	0.189111967		0.189111967				18.91119671		18.91119671														7000	4.156	0.118296872	0.407545646	1.021043512	1.472548863	2.217675861	2.302765932	0.146430761	1.650017434	0	1.228008298	0	0.008163449	0	4.568384365	4.672580147	0.287121103	0.365472617	1.429175425	0	0.244935017	0	0	0	0.732532824	0	0.011206519	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0399	0	1.541014336	4.156	0.118296872	0.407545646	1.021043512	1.472548863	2.217675861	2.302765932	0.146430761	1.650017434	0	1.228008298	0	0.008163449	0	4.568384365	4.672580147	0.287121103	0.365472617	1.429175425	0	0.244935017	0	0	0	0.732532824	0	0.011206519	0	0	0	0	0	0	0	0	0	0	0	0	0	27.0399	NO	1a: $1000 Per Admit	1b: $1000 Per Admit	2: 30%;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: 20%; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 7c: $20; 7i: $20; 9c: 50%; 9d: $20	7a: 20%; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 20%; 7d: $45; 7f: $45; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	7i: $20	8b: 20%	8a: $0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline													2.1644	0.0616	1.0939	0.2632	0.3796	0.5717	0.5936	0.0377	0.9759		0.3166		0.0021		0.7338	0.403	0.074	0.0942	0.3684		0.0631				0.1416		0.0029														8.3413	0	0.213756242	6.3204	0.179903856	1.501437433	1.284255786	1.852153583	2.789365021	2.896390251	0.184178784	2.625869475	0	1.544573511	0	0.010267037	0	5.302149654	5.075568764	0.36113734	0.459686896	1.797599013	0	0.308076208	0	0	0	0.874161189	0	0.01409542	0	0	0	0	0	0	0	0	0	0	0	0	0	35.3813
H5421_133_0	2010	9	N/A																															A	A	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	131.4017278	2.430284835	223.2335383	5.4483372	142.4380338	13.98829379	14.37553026	41.10154907	1241.090316		9.196202517		2.128738615	0.005711945	4371.03456	2717.984073	0.807224399	464.4182469	11.64060759		1.757430021				866.7981012		12.87739896														3250	1a: $195 Per Admit	1b: $195 Per Admit	2: $100/ days 21-100;	6a: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $75; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $20	7a: $10;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $25; 7d: $35; 7f: $35; 7g: $35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $20, 7c: $20"	8b: 20%	8a: $0	15: 20%	13a: $0; 17a: $20; 17b: $20 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												195	195	31.0177	0.15	150	0.2	0.2	50	15		0.2		50	0.5	10	24.99446322	0.5	20	0.2		0.2				20		20														YES	183.2341452	183.2341452	29.14616279	0.140949342	140.9493424	0.187932457	0.187932457	46.98311415	14.09493424		0.187932457		46.98311415	0.469831141	9.39662283	23.48681822	0.469831141	18.79324566	0.187932457		0.187932457				18.79324566		18.79324566														7000	2.0064	0.037109264	0.542200087	0.767939546	1.6730456	2.628854416	2.701628716	0.160923231	1.4577572	0	1.72826493	0	0.008334564	0.00268365	3.422746928	5.319733153	0.379259161	0.727327183	2.187647981	0	0.330278141	0	0	0	1.357495804	0	0.020167344	0	0	0	0	0	0	0	0	0	0	0	0	0	27.4598	0	1.763142839	2.0064	0.037109264	0.542200087	0.767939546	1.6730456	2.628854416	2.701628716	0.160923231	1.4577572	0	1.72826493	0	0.008334564	0.00268365	3.422746928	5.319733153	0.379259161	0.727327183	2.187647981	0	0.330278141	0	0	0	1.357495804	0	0.020167344	0	0	0	0	0	0	0	0	0	0	0	0	0	27.4598	NO	1a: $1000 Per Admit	1b: $1000 Per Admit	2: 30%	6a: 15%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $20%; 9b: $75	8a: $0	8a: $0 ; 8b: 20%		12: $50	3: $15; 5: $175; 7c: $20; 7i: $20; 9c: 50%; 9d: $20	7a: 20%; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 20%; 7d: $35; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	7i: $20	8b: 20%	8a: $0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline													2.6249	0.0095	1.1945	0.1959	0.4268	0.6706	0.6892	0.0411	1.4333		0.4409		0.0021	0.0007	1.0855	0.6834	0.0968	0.1855	0.5581		0.0843				0.2597		0.0051														10.688	0	0.458477587	4.6314	0.046576197	1.736719401	0.963848379	2.099855775	3.299500699	3.390840429	0.201976309	2.891081816	0	2.169162092	0	0.010460792	0.003368275	4.508222217	6.003132124	0.476011855	0.912875409	2.745738219	0	0.414535301	0	0	0	1.617228573	0	0.025312229	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1478
H5421_134_0	2010	8	N/A																															A	A	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	185.6584386	5.284584987	290.5423817	9.407534806	217.080734	20.43288324	21.21687314	64.75974665	1452.767259		11.31443535		3.708080963		5050.977879	2629.180683	1.058173032	404.0802954	13.16791831		2.256744861				809.9158903		12.39035018														3400	1a: $495 Per Admit	1b: $495 Per Admit	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: $125; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $20	7a: $20; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $45; 7f: $45; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	"7i: $20, 7C: $20"	8b: 20%	8a: $0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline												495	495	31.0177	0.2	150	0.2	0.2	50	25.11512332		0.2		48.6465662		20	39.17321471	0.5	20	0.2		0.2				20		20														YES	437.7589674	437.7589674	27.43086126	0.17687231	132.6542325	0.17687231	0.17687231	44.21807751	22.2108494		0.17687231		43.09207239		17.68723101	34.89549807	0.442180775	17.68723101	0.17687231		0.17687231				17.68723101		17.68723101														7000	6.7728	0.192781206	0.664152313	1.663932413	2.399723181	3.614011259	3.752677365	0.238629291	2.688932901	0	2.001210318	0	0.013315741	0	7.444817712	7.645547452	0.467903772	0.595588461	2.32904013	0	0.399155677	0	0	0	1.193764121	0	0.018262582	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0962	0	5.703482409	6.7728	0.192781206	0.664152313	1.663932413	2.399723181	3.614011259	3.752677365	0.238629291	2.688932901	0	2.001210318	0	0.013315741	0	7.444817712	7.645547452	0.467903772	0.595588461	2.32904013	0	0.399155677	0	0	0	1.193764121	0	0.018262582	0	0	0	0	0	0	0	0	0	0	0	0	0	44.0962	NO	1a: $1000 Per Admit	1b: $1000 Per Admit	2: 30%;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4a1: $50 - $250 Ded; 4b: $35; 4b1: $35	9a: 20%; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 7c: $20; 7i: $20; 9c: 50%; 9d: $20	7a: 20%; 14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: 20%; 7d: $45; 7f: $45; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $20	7e: 50%; 7h: 50%	7i: $20	8b: 20%	8a: $0	15: 20%	13a: $0; 17a: $20; 17b: $20; 18a: $20			17a: $20		18a: $20		14a2: Newsletters; 14a8: Nurseline													3.5966	0.1024	1.8178	0.4374	0.6308	0.95	0.9864	0.0627	1.6216		0.526		0.0035		1.2193	0.6697	0.123	0.1566	0.6122		0.1049				0.2353		0.0048														13.8611	0	1.045406118	10.3694	0.295155607	2.481909147	2.101321117	3.030525131	4.564006396	4.739122893	0.301356452	4.310539111	0	2.527257398	0	0.016813538	0	8.664140213	8.315207213	0.590899046	0.752147503	2.941262019	0	0.50407952	0	0	0	1.429112746	0	0.023063166	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9573
H5421_139_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1430.640712	12.20683201	306.1766868	8.486645938	208.2042016	18.75200188	20.63260176	59.95369336	1888.649561		15.56906301		3.447456979		7226.78915	3543.526113	0.998543135	538.2629496	16.14662599		1.981141161				1133.983516		28.49897769														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.57368783		0.2		50		15	38.62053259	0.5	15	0.2		0.2				25		25														NO	135.2031678	121.9950915	27.10184674	0.131062925	131.0629248	0.174750566	0.174750566	43.68764159	25.84009349		0.174750566		43.68764159		13.10629248	34.65694633	0.436876416	13.10629248	0.174750566		0.174750566				21.84382079		21.84382079															16.1189	0.124097799	0.691496137	1.112284638	2.273987634	3.276922949	3.605558843	0.218269622	4.066906767	0	2.720702579	0	0.012550939	0	7.893034355	10.23398286	0.436239946	0.587885971	2.821632037	0	0.34620554	0	0	0	2.064211058	0	0.051877213	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6568	0	8.16695569	16.1189	0.124097799	0.691496137	1.112284638	2.273987634	3.276922949	3.605558843	0.218269622	4.066906767	0	2.720702579	0	0.012550939	0	7.893034355	10.23398286	0.436239946	0.587885971	2.821632037	0	0.34620554	0	0	0	2.064211058	0	0.051877213	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6568	NO																																																																																		0	0	0	16.1189	0.124097799	0.691496137	1.112284638	2.273987634	3.276922949	3.605558843	0.218269622	4.066906767	0	2.720702579	0	0.012550939	0	7.893034355	10.23398286	0.436239946	0.587885971	2.821632037	0	0.34620554	0	0	0	2.064211058	0	0.051877213	0	0	0	0	0	0	0	0	0	0	0	0	0	58.6568
H5421_140_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1426.139498	4.366820622	335.2086452	7.312575837	172.3590255	20.19401891	22.82094604	87.83740097	1886.367779		13.51268465		1.225634101	0.001587756	7595.921926	3864.197434	0.734736925	667.2812851	18.41104853		2.254724114				1407.332382		22.59673323														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.38490362		0.2		50	0.5	15	38.33922703	0.5	15	0.2		0.2				25		25														NO	134.4737282	121.3369113	26.95562858	0.130355822	130.3558224	0.173807763	0.173807763	43.4519408	25.53662185		0.173807763		43.4519408	0.434519408	13.03558224	34.06086657	0.434519408	13.03558224	0.173807763		0.173807763				21.7259704		21.7259704															15.9815	0.044154711	0.752979978	0.953236837	1.872333543	3.509877256	3.966457586	0.318058796	4.014288386	0	2.348609494	0	0.004438015	0.000689911	8.251438747	10.96815943	0.319257454	0.724866673	3.199983164	0	0.391888555	0	0	0	2.547971806	0	0.04091133	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2111	0	8.798449518	15.9815	0.044154711	0.752979978	0.953236837	1.872333543	3.509877256	3.966457586	0.318058796	4.014288386	0	2.348609494	0	0.004438015	0.000689911	8.251438747	10.96815943	0.319257454	0.724866673	3.199983164	0	0.391888555	0	0	0	2.547971806	0	0.04091133	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2111	NO																																																																																		0	0	0	15.9815	0.044154711	0.752979978	0.953236837	1.872333543	3.509877256	3.966457586	0.318058796	4.014288386	0	2.348609494	0	0.004438015	0.000689911	8.251438747	10.96815943	0.319257454	0.724866673	3.199983164	0	0.391888555	0	0	0	2.547971806	0	0.04091133	0	0	0	0	0	0	0	0	0	0	0	0	0	60.2111
H5421_141_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1434.095738	17.38513302	578.6868831	8.743819515	209.8252365	19.0718435	17.94707423	101.959026	1442.458343		9.894960441		2.173227735		4841.59171	2214.648792	0.710570291	500.0053308	12.61125377		2.169474884				750.8714952		18.83018016														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.56582385		0.2		48.6465662		25	48.47686499	0.5	50	0.2		0.2				25		25														NO	184.3346825	167.3178644	26.39117039	0.170168181	127.626136	0.170168181	0.170168181	42.54204535	41.32178961		0.170168181		41.48196601		21.27102267	41.64624544	0.425420453	42.54204535	0.170168181		0.170168181				21.27102267		21.27102267															22.0295	0.242403611	1.272685344	1.487919865	2.231598681	3.245420924	3.054020983	0.361462126	4.967080014	0	1.683807423	0	0.00751248	0	8.582133921	7.68598393	0.302291136	1.772604121	2.14603412	0	0.369175596	0	0	0	1.330983717	0	0.033378099	0	0	0	0	0	0	0	0	0	0	0	0	0	62.806	0	11.41865427	22.0295	0.242403611	1.272685344	1.487919865	2.231598681	3.245420924	3.054020983	0.361462126	4.967080014	0	1.683807423	0	0.00751248	0	8.582133921	7.68598393	0.302291136	1.772604121	2.14603412	0	0.369175596	0	0	0	1.330983717	0	0.033378099	0	0	0	0	0	0	0	0	0	0	0	0	0	62.806	NO																																																																																		0	0	0	22.0295	0.242403611	1.272685344	1.487919865	2.231598681	3.245420924	3.054020983	0.361462126	4.967080014	0	1.683807423	0	0.00751248	0	8.582133921	7.68598393	0.302291136	1.772604121	2.14603412	0	0.369175596	0	0	0	1.330983717	0	0.033378099	0	0	0	0	0	0	0	0	0	0	0	0	0	62.806
H5421_142_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1133.291328	51.31866461	185.8900654	8.427563479	176.643783	17.77406276	15.28057951	63.1158942	1120.68486		10.8637847		2.372443596		4677.951335	2152.969902	0.790667199	329.6967114	11.65422595		1.833267037				698.1918881		16.29970595														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.38188026		0.2		48.6465662		25	47.87044231	0.5	50	0.2		0.2				25		25														NO	190.9649778	173.3360854	27.34042883	0.176288925	132.2166936	0.176288925	0.176288925	44.07223121	42.64594827		0.176288925		42.95196287		22.03611561	42.53166407	0.440722312	44.07223121	0.176288925		0.176288925				22.03611561		22.03611561															18.0349	0.741281369	0.423526175	1.485686105	1.946271412	3.133370414	2.693796933	0.231804857	3.98272238	0	1.915164924	0	0.008491759	0	8.590323034	7.63078272	0.348464676	1.210872475	2.054510962	0	0.323184675	0	0	0	1.282119763	0	0.02993185	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0672	0	7.47259582	18.0349	0.741281369	0.423526175	1.485686105	1.946271412	3.133370414	2.693796933	0.231804857	3.98272238	0	1.915164924	0	0.008491759	0	8.590323034	7.63078272	0.348464676	1.210872475	2.054510962	0	0.323184675	0	0	0	1.282119763	0	0.02993185	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0672	NO																																																																																		0	0	0	18.0349	0.741281369	0.423526175	1.485686105	1.946271412	3.133370414	2.693796933	0.231804857	3.98272238	0	1.915164924	0	0.008491759	0	8.590323034	7.63078272	0.348464676	1.210872475	2.054510962	0	0.323184675	0	0	0	1.282119763	0	0.02993185	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0672
H5421_147_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1640.391313	25.31251061	278.7223394	6.950444998	236.6492257	19.52314451	21.56806548	57.36950246	1786.911435		14.06257112				6931.170372	3759.258278	0.943506532	722.5328874	17.56825642		2.020478901				1348.469171		23.78509337														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.29393707		0.2				15	38.10079567	0.5	15	0.2		0.2				25		25														NO	133.9863287	120.8971261	26.85792799	0.129883348	129.8833482	0.173177798	0.173177798	43.29444939	25.36529751		0.173177798				12.98833482	33.88931679	0.432944494	12.98833482	0.173177798		0.173177798				21.64722469		21.64722469															18.3158	0.255017482	0.623825377	0.902747068	2.561399481	3.380975167	3.735110078	0.206981752	3.777128349	0	2.435325095	0	0	0	7.502030122	10.61655789	0.408485958	0.782041588	3.042431953	0	0.349902086	0	0	0	2.432551261	0	0.042906772	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3713	0	9.180347974	18.3158	0.255017482	0.623825377	0.902747068	2.561399481	3.380975167	3.735110078	0.206981752	3.777128349	0	2.435325095	0	0	0	7.502030122	10.61655789	0.408485958	0.782041588	3.042431953	0	0.349902086	0	0	0	2.432551261	0	0.042906772	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3713	NO																																																																																		0	0	0	18.3158	0.255017482	0.623825377	0.902747068	2.561399481	3.380975167	3.735110078	0.206981752	3.777128349	0	2.435325095	0	0	0	7.502030122	10.61655789	0.408485958	0.782041588	3.042431953	0	0.349902086	0	0	0	2.432551261	0	0.042906772	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3713
H5421_148_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1376.143147	28.32335465	204.9849764	6.697295023	168.6428318	18.92397258	23.81215564	61.29232025	1828.792368		17.93244765		0.830772208	0.002229172	7423.997727	4232.833575	0.945530491	916.64401	18.27300541		2.969526963				1368.255756		21.73918502														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.33587941		0.2		50	0.5	15	37.97014965	0.5	15	0.2		0.2				25		25														NO	134.1525588	121.0471171	26.89124928	0.130044488	130.044488	0.173392651	0.173392651	43.34816265	25.43312944		0.173392651		43.34816265	0.433481627	13.0044488	33.62627649	0.433481627	13.0044488	0.173392651		0.173392651				21.67408133		21.67408133															15.3844	0.285705036	0.459358508	0.870946302	1.827589226	3.281277765	4.128852784	0.221409122	3.87599275	0	3.109354629	0	0.003001037	0.000966305	8.045416524	11.86120268	0.409870095	0.993370841	3.168404842	0	0.514894151	0	0	0	2.471307211	0	0.039264739	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9526	0	9.065387684	15.3844	0.285705036	0.459358508	0.870946302	1.827589226	3.281277765	4.128852784	0.221409122	3.87599275	0	3.109354629	0	0.003001037	0.000966305	8.045416524	11.86120268	0.409870095	0.993370841	3.168404842	0	0.514894151	0	0	0	2.471307211	0	0.039264739	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9526	NO																																																																																		0	0	0	15.3844	0.285705036	0.459358508	0.870946302	1.827589226	3.281277765	4.128852784	0.221409122	3.87599275	0	3.109354629	0	0.003001037	0.000966305	8.045416524	11.86120268	0.409870095	0.993370841	3.168404842	0	0.514894151	0	0	0	2.471307211	0	0.039264739	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9526
H5421_149_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1709.373751	63.43543405	297.0307128	9.256665953	225.3654614	22.2251032	20.17892965	68.48716022	1474.068938		10.71657055		2.031322916		5124.060247	2636.247118	0.893710038	398.7513059	12.16773607		3.405657682				778.2818384		13.16092638														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.45849647		0.2		48.6465662		25	48.52429955	0.5	50	0.2		0.2				25		25														NO	180.0293439	163.4099722	25.77477567	0.166193717	124.6452877	0.166193717	0.166193717	41.54842925	40.26748824		0.166193717		40.52743324		20.77421462	40.94305975	0.415484292	41.54842925	0.166193717		0.166193717				20.77421462		20.77421462															25.6448	0.863831876	0.637991666	1.538399722	2.340895232	3.693672512	3.353611324	0.237127828	4.946421134	0	1.781026692	0	0.006860359	0	8.870693942	8.994668605	0.371322483	1.380624202	2.022201284	0	0.565998909	0	0	0	1.347349496	0	0.022783992	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6203	0	14.39037793	25.6448	0.863831876	0.637991666	1.538399722	2.340895232	3.693672512	3.353611324	0.237127828	4.946421134	0	1.781026692	0	0.006860359	0	8.870693942	8.994668605	0.371322483	1.380624202	2.022201284	0	0.565998909	0	0	0	1.347349496	0	0.022783992	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6203	NO																																																																																		0	0	0	25.6448	0.863831876	0.637991666	1.538399722	2.340895232	3.693672512	3.353611324	0.237127828	4.946421134	0	1.781026692	0	0.006860359	0	8.870693942	8.994668605	0.371322483	1.380624202	2.022201284	0	0.565998909	0	0	0	1.347349496	0	0.022783992	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6203
H5421_150_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1169.049296	50.57176899	173.2510031	6.628479449	166.6716272	17.42651175	16.62679106	57.56566034	1259.85028		10.36147957		2.211136092		4635.573814	2434.443053	0.869958723	394.188297	11.23992547		2.541951785				735.2495018		7.388390587														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.32652085		0.2		48.6465662		25	47.45837291	0.5	50	0.2		0.2				25		25														NO	189.8682038	172.3405598	27.18340385	0.17527644	131.4573301	0.17527644	0.17527644	43.81911004	42.3525027		0.17527644		42.70879807		21.90955502	41.94114021	0.4381911	43.81911004	0.17527644		0.17527644				21.90955502		21.90955502															18.4971	0.726297248	0.392462665	1.161816281	1.825850593	3.054456943	2.914284748	0.210206334	4.446484365	0	1.816123254	0	0.00786958	0	8.463613294	8.508609786	0.38120817	1.43941503	1.970094124	0	0.44554426	0	0	0	1.342415784	0	0.013489696	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6173	0	8.0462834	18.4971	0.726297248	0.392462665	1.161816281	1.825850593	3.054456943	2.914284748	0.210206334	4.446484365	0	1.816123254	0	0.00786958	0	8.463613294	8.508609786	0.38120817	1.43941503	1.970094124	0	0.44554426	0	0	0	1.342415784	0	0.013489696	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6173	NO																																																																																		0	0	0	18.4971	0.726297248	0.392462665	1.161816281	1.825850593	3.054456943	2.914284748	0.210206334	4.446484365	0	1.816123254	0	0.00786958	0	8.463613294	8.508609786	0.38120817	1.43941503	1.970094124	0	0.44554426	0	0	0	1.342415784	0	0.013489696	0	0	0	0	0	0	0	0	0	0	0	0	0	57.6173
H5421_155_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2519.456949	11.25666742	294.4000735	11.75263114	287.1248427	25.03428782	26.47113509	54.82273157	2252.275883		15.78474768		2.956907803	0.002404532	7643.217611	4572.632293	1.036408424	867.3190767	21.11753883		1.886244123				1411.76949		26.71569066														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.62705784		0.2		50	0.5	15	38.17441543	0.5	15	0.2		0.2				25		25														NO	126.8453434	114.4537478	25.42649785	0.122961037	122.9610368	0.163948049	0.163948049	40.98701228	24.28649167		0.163948049		40.98701228	0.409870123	12.29610368	32.08893957	0.409870123	12.29610368	0.163948049		0.163948049				20.49350614		20.49350614															26.6318	0.107363981	0.623796903	1.44511571	2.942097363	4.104322649	4.339890957	0.187251664	4.558323289	0	2.587878588	0	0.010099568	0.000985546	7.831816352	12.22757678	0.424792848	0.888720441	3.462179293	0	0.309246044	0	0	0	2.411008893	0	0.045624848	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1399	0	16.15321462	26.6318	0.107363981	0.623796903	1.44511571	2.942097363	4.104322649	4.339890957	0.187251664	4.558323289	0	2.587878588	0	0.010099568	0.000985546	7.831816352	12.22757678	0.424792848	0.888720441	3.462179293	0	0.309246044	0	0	0	2.411008893	0	0.045624848	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1399	NO																																																																																		0	0	0	26.6318	0.107363981	0.623796903	1.44511571	2.942097363	4.104322649	4.339890957	0.187251664	4.558323289	0	2.587878588	0	0.010099568	0.000985546	7.831816352	12.22757678	0.424792848	0.888720441	3.462179293	0	0.309246044	0	0	0	2.411008893	0	0.045624848	0	0	0	0	0	0	0	0	0	0	0	0	0	75.1399
H5421_156_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2187.36554	31.64587637	312.7026433	10.4736163	240.2193998	28.73048505	34.70835087	55.90135233	2097.357369		16.01383575		2.377225074	0.006378697	8242.768548	4692.108656	1.135622699	906.2913088	19.9207263		2.759559572				1382.192914		22.34622354														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.49287398		0.2		50	0.5	15	38.74479052	0.5	15	0.2		0.2				25		25														NO	127.292382	114.857115	25.51610798	0.123394386	123.3943861	0.164525848	0.164525848	41.13146204	24.26170053		0.164525848		41.13146204	0.41131462	12.33943861	32.70515662	0.41131462	12.33943861	0.164525848		0.164525848				20.56573102		20.56573102															23.2029	0.302896172	0.664912868	1.292385453	2.470143781	4.726907421	5.710420864	0.191608696	4.2404547	0	2.634689909	0	0.008148229	0.002623651	8.47592804	12.78801237	0.467098219	0.931927164	3.277474391	0	0.454018879	0	0	0	2.368817306	0	0.038297202	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2497	0	15.61357568	23.2029	0.302896172	0.664912868	1.292385453	2.470143781	4.726907421	5.710420864	0.191608696	4.2404547	0	2.634689909	0	0.008148229	0.002623651	8.47592804	12.78801237	0.467098219	0.931927164	3.277474391	0	0.454018879	0	0	0	2.368817306	0	0.038297202	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2497	NO																																																																																		0	0	0	23.2029	0.302896172	0.664912868	1.292385453	2.470143781	4.726907421	5.710420864	0.191608696	4.2404547	0	2.634689909	0	0.008148229	0.002623651	8.47592804	12.78801237	0.467098219	0.931927164	3.277474391	0	0.454018879	0	0	0	2.368817306	0	0.038297202	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2497
H5421_157_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1678.742983	103.8721297	319.9242843	13.24815871	253.653247	24.07211085	27.97121786	100.8061014	1709.48788		13.4355		3.131187014		5851.951338	2974.180884	1.106675547	478.3446633	18.61437542		2.465274936				989.1890793		16.99269855														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.31713324		0.2		48.6465662		25	48.51050343	0.5	50	0.2		0.2				25		25														NO	177.2339848	160.8726661	25.3745645	0.163613187	122.7098902	0.163613187	0.163613187	40.90329674	39.52660077		0.163613187		39.90767666		20.45164837	40.08725096	0.409032967	40.90329674	0.163613187		0.163613187				20.45164837		20.45164837															24.7942	1.392515536	0.676494949	2.167573468	2.593813508	3.938514773	4.576460098	0.34360849	5.630853748	0	2.198224974	0	0.0104132	0	9.973504255	9.935561291	0.452666783	1.630489476	3.045557287	0	0.403351489	0	0	0	1.685878935	0	0.028960725	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4786	0	16.66412943	24.7942	1.392515536	0.676494949	2.167573468	2.593813508	3.938514773	4.576460098	0.34360849	5.630853748	0	2.198224974	0	0.0104132	0	9.973504255	9.935561291	0.452666783	1.630489476	3.045557287	0	0.403351489	0	0	0	1.685878935	0	0.028960725	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4786	NO																																																																																		0	0	0	24.7942	1.392515536	0.676494949	2.167573468	2.593813508	3.938514773	4.576460098	0.34360849	5.630853748	0	2.198224974	0	0.0104132	0	9.973504255	9.935561291	0.452666783	1.630489476	3.045557287	0	0.403351489	0	0	0	1.685878935	0	0.028960725	0	0	0	0	0	0	0	0	0	0	0	0	0	75.4786
H5421_158_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1928.672262	26.85828694	406.2424426	11.07627352	215.2883314	23.64397634	21.83704416	76.24313433	1704.949857		13.31023264		8.031644571		5699.810475	2980.997992	1.116858114	438.3181347	15.17441722		2.230435384				882.8998012		13.55574486														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.50427037		0.2		49.43423241		25	48.29808476	0.5	50	0.2		0.2				25		25														NO	177.3694623	160.995637	25.3939608	0.163738253	122.8036896	0.163738253	0.163738253	40.93456319	39.71002241		0.163738253		40.51785615		20.46728159	39.92421527	0.409345632	40.93456319	0.163738253		0.163738253				20.46728159		20.46728159															28.5073	0.360338918	0.859675389	1.813609674	2.203183451	3.871423374	3.575559457	0.260081617	5.641966417	0	2.179394236	0	0.027118752	0	9.721635502	9.917833796	0.45718099	1.495196782	2.484632561	0	0.365207593	0	0	0	1.505879904	0	0.023120771	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2703	0	16.55324377	28.5073	0.360338918	0.859675389	1.813609674	2.203183451	3.871423374	3.575559457	0.260081617	5.641966417	0	2.179394236	0	0.027118752	0	9.721635502	9.917833796	0.45718099	1.495196782	2.484632561	0	0.365207593	0	0	0	1.505879904	0	0.023120771	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2703	NO																																																																																		0	0	0	28.5073	0.360338918	0.859675389	1.813609674	2.203183451	3.871423374	3.575559457	0.260081617	5.641966417	0	2.179394236	0	0.027118752	0	9.721635502	9.917833796	0.45718099	1.495196782	2.484632561	0	0.365207593	0	0	0	1.505879904	0	0.023120771	0	0	0	0	0	0	0	0	0	0	0	0	0	75.2703
H5421_163_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1943.378866	19.08887803	402.2217707	9.574682069	242.0431129	24.01949063	25.71563043	69.50877417	2074.717066		15.42937133		2.625043219	0.000458448	7056.677556	4674.843148	1.303033016	772.7069559	20.39821438		2.629892134				1377.603815		19.59764019														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.51536506		0.2		48.47821281	0.5	15	38.11915963	0.5	15	0.2		0.2				25		25														NO	130.0201934	117.3184448	26.06290527	0.126038665	126.0386654	0.168051554	0.168051554	42.01288846	24.80051481		0.168051554		40.73419495	0.420128885	12.60386654	32.92974288	0.420128885	12.60386654	0.168051554		0.168051554				21.00644423		21.00644423															21.0565	0.186623124	0.873588992	1.206780149	2.542232576	4.036512723	4.321551652	0.243355365	4.28783761	0	2.592929828	0	0.008910752	0.000192607	7.411785176	12.82844857	0.547441808	0.811591279	3.427951622	0	0.44195746	0	0	0	2.411546476	0	0.034306395	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2721	0	12.75219776	21.0565	0.186623124	0.873588992	1.206780149	2.542232576	4.036512723	4.321551652	0.243355365	4.28783761	0	2.592929828	0	0.008910752	0.000192607	7.411785176	12.82844857	0.547441808	0.811591279	3.427951622	0	0.44195746	0	0	0	2.411546476	0	0.034306395	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2721	NO																																																																																		0	0	0	21.0565	0.186623124	0.873588992	1.206780149	2.542232576	4.036512723	4.321551652	0.243355365	4.28783761	0	2.592929828	0	0.008910752	0.000192607	7.411785176	12.82844857	0.547441808	0.811591279	3.427951622	0	0.44195746	0	0	0	2.411546476	0	0.034306395	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2721
H5421_164_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2194.650948	5.734923489	376.4316614	11.15824237	270.7820086	29.14868652	26.05271717	71.43436067	2285.899541		16.19175512		2.15954497		8121.238804	5120.281125	2.023187561	923.4754179	24.2447244		2.635405683				1477.668646		22.13533595														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.3894573		0.2		39.79843863		15	38.62533614	0.5	15	0.2		0.2				25		25														NO	126.66617	114.292078	25.39058206	0.12278735	122.7873502	0.163716467	0.163716467	40.92911673	24.05769057		0.163716467		39.79843863		12.27873502	32.49335592	0.409291167	12.27873502	0.163716467		0.163716467				20.46455836		20.46455836															23.1657	0.05462136	0.796484916	1.370091014	2.770717109	4.772119973	4.265258808	0.243645441	4.582788653	0	2.650856941	0	0.00716221	0	8.309878275	13.86459308	0.828072798	0.944925829	3.969260621	0	0.431459307	0	0	0	2.519986354	0	0.037749156	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5853	0	16.29368006	23.1657	0.05462136	0.796484916	1.370091014	2.770717109	4.772119973	4.265258808	0.243645441	4.582788653	0	2.650856941	0	0.00716221	0	8.309878275	13.86459308	0.828072798	0.944925829	3.969260621	0	0.431459307	0	0	0	2.519986354	0	0.037749156	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5853	NO																																																																																		0	0	0	23.1657	0.05462136	0.796484916	1.370091014	2.770717109	4.772119973	4.265258808	0.243645441	4.582788653	0	2.650856941	0	0.00716221	0	8.309878275	13.86459308	0.828072798	0.944925829	3.969260621	0	0.431459307	0	0	0	2.519986354	0	0.037749156	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5853
H5421_165_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1667.567675	11.25534132	306.3764146	11.36637795	260.0316529	29.34751732	24.25803862	108.6072489	1693.810924		15.26123898		14.03764502		5788.423776	3234.057879	1.034272905	409.7781986	14.24868918		2.941903016				849.6149777		11.65536793														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.37244202		0.2		45.88465066		25	48.19377834	0.5	50	0.2		0.2				25		25														NO	178.0652148	161.6271613	25.49357159	0.164380535	123.2854014	0.164380535	0.164380535	41.09513382	39.75743956		0.164380535		37.71271718		20.54756691	39.96285783	0.410951338	41.09513382	0.164380535		0.164380535				20.54756691		20.54756691															24.7446	0.151597406	0.650885755	1.868411291	2.671508893	4.824160606	3.987549373	0.371935786	5.611798787	0	2.508650633	0	0.044116478	0	9.911502069	10.77018294	0.425035834	1.403324159	2.342207154	0	0.483591592	0	0	0	1.454793383	0	0.019957454	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2459	0	15.97275783	24.7446	0.151597406	0.650885755	1.868411291	2.671508893	4.824160606	3.987549373	0.371935786	5.611798787	0	2.508650633	0	0.044116478	0	9.911502069	10.77018294	0.425035834	1.403324159	2.342207154	0	0.483591592	0	0	0	1.454793383	0	0.019957454	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2459	NO																																																																																		0	0	0	24.7446	0.151597406	0.650885755	1.868411291	2.671508893	4.824160606	3.987549373	0.371935786	5.611798787	0	2.508650633	0	0.044116478	0	9.911502069	10.77018294	0.425035834	1.403324159	2.342207154	0	0.483591592	0	0	0	1.454793383	0	0.019957454	0	0	0	0	0	0	0	0	0	0	0	0	0	74.2459
H5421_166_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1783.106188	25.71746731	229.9252527	8.83780486	297.5296558	23.36164516	25.96686156	62.38160039	1575.444728		12.26710268		4.716703859		5847.238908	3128.432062	1.274514971	373.3886667	16.23242092		1.366692896				882.306883		15.96971227														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.20415505		0.2		49.67127238		25	47.42166182	0.5	50	0.2		0.2				25		25														NO	178.2725794	161.815383	25.52325994	0.164571963	123.4289726	0.164571963	0.164571963	41.14299085	39.66526221		0.164571963		40.89888054		20.57149543	39.47295033	0.411429909	41.14299085	0.164571963		0.164571963				20.57149543		20.57149543															26.4899	0.346790152	0.489036833	1.454454898	3.060314977	3.844671812	4.27341739	0.213880468	5.207535686	0	2.018821173	0	0.016075659	0	10.0238707	10.29070362	0.524373578	1.280193875	2.671401382	0	0.224919333	0	0	0	1.512531001	0	0.027376739	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9703	0	15.7807841	26.4899	0.346790152	0.489036833	1.454454898	3.060314977	3.844671812	4.27341739	0.213880468	5.207535686	0	2.018821173	0	0.016075659	0	10.0238707	10.29070362	0.524373578	1.280193875	2.671401382	0	0.224919333	0	0	0	1.512531001	0	0.027376739	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9703	NO																																																																																		0	0	0	26.4899	0.346790152	0.489036833	1.454454898	3.060314977	3.844671812	4.27341739	0.213880468	5.207535686	0	2.018821173	0	0.016075659	0	10.0238707	10.29070362	0.524373578	1.280193875	2.671401382	0	0.224919333	0	0	0	1.512531001	0	0.027376739	0	0	0	0	0	0	0	0	0	0	0	0	0	73.9703
H5421_171_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2706.411451	14.18454639	468.060294	10.14855029	250.2333291	24.09717347	24.76603087	65.47544164	2405.37714		16.09617826		2.899698658		7296.683396	4762.070057	1.618723497	738.3509815	22.6828628		3.344537592				1484.862341		24.48113334														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.4057508		0.2		50		15	38.90096309	0.5	15	0.2		0.2				25		25														NO	125.7882302	113.4999046	25.2145966	0.121936295	121.936295	0.162581727	0.162581727	40.64543165	23.90418869		0.162581727		40.64543165		12.1936295	32.50965884	0.406454317	12.1936295	0.162581727		0.162581727				20.32271583		20.32271583															28.3696	0.134162055	0.983495958	1.237476622	2.542710419	3.917760069	4.02650406	0.221773132	4.791549085	0	2.616944453	0	0.009821625	0	7.414421156	12.90110608	0.657937153	0.750264859	3.687818998	0	0.543760696	0	0	0	2.51470295	0	0.04146026	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3632	0	17.37231265	28.3696	0.134162055	0.983495958	1.237476622	2.542710419	3.917760069	4.02650406	0.221773132	4.791549085	0	2.616944453	0	0.009821625	0	7.414421156	12.90110608	0.657937153	0.750264859	3.687818998	0	0.543760696	0	0	0	2.51470295	0	0.04146026	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3632	NO																																																																																		0	0	0	28.3696	0.134162055	0.983495958	1.237476622	2.542710419	3.917760069	4.02650406	0.221773132	4.791549085	0	2.616944453	0	0.009821625	0	7.414421156	12.90110608	0.657937153	0.750264859	3.687818998	0	0.543760696	0	0	0	2.51470295	0	0.04146026	0	0	0	0	0	0	0	0	0	0	0	0	0	77.3632
H5421_172_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2127.001772	40.12805248	347.4590038	8.150969105	238.4478275	27.93154881	26.68017024	56.85148598	2333.392535		16.46976712		0.683705881	0.001834556	8506.892638	5330.817333	2.413124827	685.9583706	25.67084097		3.524371503				1431.540006		37.33343171														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.24330929		0.2		50	0.5	15	38.90245808	0.5	15	0.2		0.2				25		25														NO	126.6241258	114.2541411	25.38215418	0.122746593	122.7465935	0.163662125	0.163662125	40.91553116	23.93011065		0.163662125		40.91553116	0.409155312	12.27465935	32.50668228	0.409155312	12.27465935	0.163662125		0.163662125				20.45776558		20.45776558															22.4441	0.382066347	0.734938167	1.000503691	2.439054879	4.571336623	4.366533347	0.193842396	4.653195129	0	2.695477079	0	0.002331182	0.000750618	8.70160077	14.44059878	0.987342841	0.701658777	4.201344375	0	0.576806128	0	0	0	2.440509155	0	0.06364655	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5977	0	16.41992341	22.4441	0.382066347	0.734938167	1.000503691	2.439054879	4.571336623	4.366533347	0.193842396	4.653195129	0	2.695477079	0	0.002331182	0.000750618	8.70160077	14.44059878	0.987342841	0.701658777	4.201344375	0	0.576806128	0	0	0	2.440509155	0	0.06364655	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5977	NO																																																																																		0	0	0	22.4441	0.382066347	0.734938167	1.000503691	2.439054879	4.571336623	4.366533347	0.193842396	4.653195129	0	2.695477079	0	0.002331182	0.000750618	8.70160077	14.44059878	0.987342841	0.701658777	4.201344375	0	0.576806128	0	0	0	2.440509155	0	0.06364655	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5977
H5421_173_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2320.232622	18.38960989	344.9850784	11.64903461	273.7347522	28.50788937	26.21536772	87.95095985	1705.344552		12.89638012		3.62554989		6191.463101	3254.354863	1.71040217	478.2126496	16.80305947		4.418912895				991.4195392		15.01542697														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.37516166		0.2		49.29948416		25	48.56804792	0.5	50	0.2		0.2				25		25														NO	171.1655628	155.3644492	24.50574939	0.158011136	118.5083518	0.158011136	0.158011136	39.50278394	38.21907119		0.158011136		39.01597968		19.75139197	38.80981314	0.395027839	39.50278394	0.158011136		0.158011136				19.75139197		19.75139197															33.0953	0.238090968	0.704509823	1.84067719	2.703321193	4.504563978	4.142320029	0.289525647	5.431390403	0	2.03777167	0	0.011787865	0	10.19083455	10.52507535	0.675656474	1.574227581	2.655070512	0	0.698237445	0	0	0	1.631826327	0	0.024714632	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9749	0	21.89872968	33.0953	0.238090968	0.704509823	1.84067719	2.703321193	4.504563978	4.142320029	0.289525647	5.431390403	0	2.03777167	0	0.011787865	0	10.19083455	10.52507535	0.675656474	1.574227581	2.655070512	0	0.698237445	0	0	0	1.631826327	0	0.024714632	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9749	NO																																																																																		0	0	0	33.0953	0.238090968	0.704509823	1.84067719	2.703321193	4.504563978	4.142320029	0.289525647	5.431390403	0	2.03777167	0	0.011787865	0	10.19083455	10.52507535	0.675656474	1.574227581	2.655070512	0	0.698237445	0	0	0	1.631826327	0	0.024714632	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9749
H5421_174_0	2010	5	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1854.869272	31.51298916	481.9826099	10.09022133	239.6221651	25.65695096	27.88266767	54.77982893	1674.394565		13.03643551		2.488648087		6019.249078	3074.270993	1.223641705	446.6438492	17.09843109		2.143379094				954.5509168		19.1310112														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.36742791		0.2		48.6465662		25	48.84355817	0.5	50	0.2		0.2				25		25														NO	176.4765035	160.1851116	25.26611602	0.16291392	122.1854398	0.16291392	0.16291392	40.72847993	39.39863633		0.16291392		39.73973617		20.36423996	40.22800102	0.407284799	40.72847993	0.16291392		0.16291392				20.36423996		20.36423996															27.2784	0.420659307	1.014819045	1.643837508	2.439861636	4.179874448	4.542474682	0.18592493	5.497405212	0	2.123816808	0	0.008241518	0	10.21478605	10.30598139	0.498370666	1.515927087	2.785572429	0	0.34918629	0	0	0	1.619891994	0	0.032465709	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6575	0	17.31158877	27.2784	0.420659307	1.014819045	1.643837508	2.439861636	4.179874448	4.542474682	0.18592493	5.497405212	0	2.123816808	0	0.008241518	0	10.21478605	10.30598139	0.498370666	1.515927087	2.785572429	0	0.34918629	0	0	0	1.619891994	0	0.032465709	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6575	NO																																																																																		0	0	0	27.2784	0.420659307	1.014819045	1.643837508	2.439861636	4.179874448	4.542474682	0.18592493	5.497405212	0	2.123816808	0	0.008241518	0	10.21478605	10.30598139	0.498370666	1.515927087	2.785572429	0	0.34918629	0	0	0	1.619891994	0	0.032465709	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6575
H5421_179_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2271.478894	39.1634292	549.0985511	12.53767705	229.7609547	24.99449484	28.3632515	80.92244696	2158.057966		14.96712155		1.606152017		7629.623621	5247.700179	1.78105853	971.7219705	22.48610413		3.442567352				1543.512089		22.08459024														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.37445243		0.2		50		15	39.61426913	0.5	15	0.2		0.2				25		25														NO	126.4419854	114.0897941	25.34564364	0.122570031	122.5700306	0.163426708	0.163426708	40.85667688	24.00285023		0.163426708		40.85667688		12.25700306	32.68033954	0.408566769	12.25700306	0.163426708		0.163426708				20.42833844		20.42833844															23.9342	0.372345631	1.15977135	1.53674346	2.346817272	4.084767997	4.635312808	0.275518522	4.316628512	0	2.446027395	0	0.005468503	0	7.793026675	14.2913853	0.727681329	0.992533264	3.674829963	0	0.562607448	0	0	0	2.627615611	0	0.037595957	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8209	0	16.80195954	23.9342	0.372345631	1.15977135	1.53674346	2.346817272	4.084767997	4.635312808	0.275518522	4.316628512	0	2.446027395	0	0.005468503	0	7.793026675	14.2913853	0.727681329	0.992533264	3.674829963	0	0.562607448	0	0	0	2.627615611	0	0.037595957	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8209	NO																																																																																		0	0	0	23.9342	0.372345631	1.15977135	1.53674346	2.346817272	4.084767997	4.635312808	0.275518522	4.316628512	0	2.446027395	0	0.005468503	0	7.793026675	14.2913853	0.727681329	0.992533264	3.674829963	0	0.562607448	0	0	0	2.627615611	0	0.037595957	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8209
H5421_180_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	2082.152693	43.28302886	280.225048	11.94600937	252.0927452	30.95112063	28.79215023	72.58390536	2541.489516		17.46595281		4.14275861	0.003451616	8948.983781	5753.503414	2.410932292	1219.681556	25.47715736		10.56331288				1692.058171		37.0596978														3400	1a: $250 Per Day (Days 1-5)	1b: $250 Per Day (Days 1-5)	2a: $100/ days 21-100;	6: 15%	10a: $150	11a: 20%	11b: 20%; 11c:0- 20%	4a: $50; 4a1: $250 Ded; 4b: $35; 4b1: $35	9a: $150; 9b: $75	8a: $0	8a: $0; 8b: 20%		12: $50	3: $15; 5: $175; 9c: 50%; 9d: $15	7a: $15;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $40; 7d: $40; 7f: $35; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $15, 7c: $15"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												154.7384602	139.6219698	31.01774982	0.15	150	0.2	0.2	50	29.36924155		0.2		50	0.5	15	38.81746176	0.5	15	0.2		0.2				25		25														NO	124.4468797	112.2895914	24.94571921	0.12063602	120.6360198	0.160848026	0.160848026	40.2120066	23.61992271		0.160848026		40.2120066	0.402120066	12.06360198	31.89356431	0.402120066	12.06360198	0.160848026		0.160848026				20.1060033		20.1060033															21.5931	0.405019469	0.582534614	1.441119023	2.534288783	4.978426669	4.631160541	0.243228707	5.002482161	0	2.809364038	0	0.013882386	0.001387964	8.996414872	15.29164426	0.969484253	1.226146069	4.097950481	0	1.699088029	0	0	0	2.835043931	0	0.062093534	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4139	0	18.92769721	21.5931	0.405019469	0.582534614	1.441119023	2.534288783	4.978426669	4.631160541	0.243228707	5.002482161	0	2.809364038	0	0.013882386	0.001387964	8.996414872	15.29164426	0.969484253	1.226146069	4.097950481	0	1.699088029	0	0	0	2.835043931	0	0.062093534	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4139	NO																																																																																		0	0	0	21.5931	0.405019469	0.582534614	1.441119023	2.534288783	4.978426669	4.631160541	0.243228707	5.002482161	0	2.809364038	0	0.013882386	0.001387964	8.996414872	15.29164426	0.969484253	1.226146069	4.097950481	0	1.699088029	0	0	0	2.835043931	0	0.062093534	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4139
H5421_181_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1784.128245	70.84385693	191.5090582	15.68946649	231.3857518	27.88578573	28.81070864	76.56811568	2073.515758		14.76887195		2.11395182		6995.224809	3434.598426	1.332466221	765.6617581	17.70151642		3.544871268				1015.069643		22.52973776														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.5749659		0.2		48.6465662		25	48.63476988	0.5	50	0.2		0.2				25		25														NO	172.6224101	156.686808	24.714326	0.159356021	119.517016	0.159356021	0.159356021	39.83900533	38.70356651		0.159356021		38.88524855		19.91950266	39.10336375	0.398390053	39.83900533	0.159356021		0.159356021				19.91950266		19.91950266															25.665	0.925024817	0.394418108	2.500210956	2.304544549	4.443767865	4.591159901	0.254199797	6.687704587	0	2.353508674	0	0.006850128	0	11.61178327	11.1920293	0.530841289	2.541933572	2.820843227	0	0.564896581	0	0	0	1.684973539	0	0.037398431	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1111	0	20.56098448	25.665	0.925024817	0.394418108	2.500210956	2.304544549	4.443767865	4.591159901	0.254199797	6.687704587	0	2.353508674	0	0.006850128	0	11.61178327	11.1920293	0.530841289	2.541933572	2.820843227	0	0.564896581	0	0	0	1.684973539	0	0.037398431	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1111	NO																																																																																		0	0	0	25.665	0.925024817	0.394418108	2.500210956	2.304544549	4.443767865	4.591159901	0.254199797	6.687704587	0	2.353508674	0	0.006850128	0	11.61178327	11.1920293	0.530841289	2.541933572	2.820843227	0	0.564896581	0	0	0	1.684973539	0	0.037398431	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1111
H5421_182_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	Coin	P	P	Coin	V	Coin	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	YES	1719.988373	33.25187906	325.689455	10.54556952	243.341111	22.90466048	23.78349008	72.59376918	1628.509322		12.68314888		4.156649578		5661.99748	2947.002644	1.186180812	452.9621132	14.76084871		2.529744541				907.8918656		13.88921773														3400	1a: $350 Per Day (Days 1-5)	1b: $350 Per Day (Days 1-5)	2: $100/ days 21-100;	6: 20%	10a: $150	11a: 20%	11b: 20%; 11c:0-20%	4a: $50; 4a1: $250 Ded; 7a:$35	9a: $245; 9b: $145	8a: $0	8a: $0; 8b: 20%		12: $50	3: $35; 5: $195; 9c: 50%; 9d: $50	7a: $25;  14b: $0; 14c: $0 - 1 exam per year; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0	7b: $50; 7d: $50; 7f: $50; 7g:$35; 13b: $0; 14b: $0; 14d: $0 - 1 per year; 14e: $0; 14f: $0; 14g: $0; 14h: $0; 14i: $0; 14j: $0; 18a: $25	7e: 50%; 7h: 50%	"7i: $50, 7c: $50"	8b:20%	8a.:$0	15: 20%	13a: $0; 17a: $25; 17b: $25; 18a: $25			17a: $25		18a: $25		14a2: Newsletters; 14a8: Nurseline												216.65	196.65	31.01774982	0.2	150	0.2	0.2	50	48.42438339		0.2		48.6465662		25	48.43330576	0.5	50	0.2		0.2				25		25														NO	179.1128833	162.5781144	25.64356613	0.165347688	124.0107662	0.165347688	0.165347688	41.33692206	40.03429923		0.165347688		40.32424556		20.66846103	40.4192399	0.413369221	41.33692206	0.165347688		0.165347688				20.66846103		20.66846103															25.6727	0.450502317	0.69598659	1.743685541	2.514743135	3.787232659	3.932545102	0.250066915	5.433019125	0	2.097129347	0	0.013967813	0	9.752064521	9.926300571	0.490330638	1.560338297	2.44067221	0	0.418287412	0	0	0	1.563727304	0	0.023922396	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7672	0	15.13779528	25.6727	0.450502317	0.69598659	1.743685541	2.514743135	3.787232659	3.932545102	0.250066915	5.433019125	0	2.097129347	0	0.013967813	0	9.752064521	9.926300571	0.490330638	1.560338297	2.44067221	0	0.418287412	0	0	0	1.563727304	0	0.023922396	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7672	NO																																																																																		0	0	0	25.6727	0.450502317	0.69598659	1.743685541	2.514743135	3.787232659	3.932545102	0.250066915	5.433019125	0	2.097129347	0	0.013967813	0	9.752064521	9.926300571	0.490330638	1.560338297	2.44067221	0	0.418287412	0	0	0	1.563727304	0	0.023922396	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7672
H5421_801_0	2010	6	N/A																															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																																																			0	NO	344.7005756	0.78239659	39.64003555		11.95953206	31.38415374	21.88028578	0.544818446	74.33305651	11.02146751	18.61117588	0.916263027	0.038415778	4.554955795	46.54527487	60.32461918	0.602058757	7.632461617	22.32832629	150.7549445	6.711537299																					Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.07607857	0.07607857	0.16561336		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.07607857	0.07607857	0.16561336		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					26.2243	0.059523614	6.56491946	0	2.78657097	7.312507822	5.098106586	0.126942698	17.31960217	2.56800193	4.336403981	0.213489285	0.008950876	1.0613047	10.84504905	14.05563627	0.14027969	1.778363557	5.202500027	35.12590208	1.563788191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.3922	0	0	26.2243	0.059523614	6.56491946	0	2.78657097	7.312507822	5.098106586	0.126942698	17.31960217	2.56800193	4.336403981	0.213489285	0.008950876	1.0613047	10.84504905	14.05563627	0.14027969	1.778363557	5.202500027	35.12590208	1.563788191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.3922	NO																																																																																		0	0	0	26.2243	0.059523614	6.56491946	0	2.78657097	7.312507822	5.098106586	0.126942698	17.31960217	2.56800193	4.336403981	0.213489285	0.008950876	1.0613047	10.84504905	14.05563627	0.14027969	1.778363557	5.202500027	35.12590208	1.563788191	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.3922
H5421_804_0	2010	7	N/A																															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																																																			0	NO	215.1525082	0.601366901	22.50161407		7.535612787	19.03090923	15.3161618	0.307776679	39.61004266	7.532376165	10.98588269	0.609087506	0.029527196	3.20034591	27.99482976	32.89859688	0.362905893	4.481608966	12.26714251	86.23337761	5.000398217																					Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.084419267	0.084419267	0.151755469		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.084419267	0.084419267	0.151755469		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					18.163	0.050766953	3.414742988	0	1.755797779	4.434201852	3.5686657	0.071711966	9.22913994	1.755043647	2.559710667	0.141917389	0.006879837	0.745680597	6.522795335	7.665373073	0.084557073	1.044214889	2.858244204	20.09237698	1.165092785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3299	0	0	18.163	0.050766953	3.414742988	0	1.755797779	4.434201852	3.5686657	0.071711966	9.22913994	1.755043647	2.559710667	0.141917389	0.006879837	0.745680597	6.522795335	7.665373073	0.084557073	1.044214889	2.858244204	20.09237698	1.165092785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3299	NO																																																																																		0	0	0	18.163	0.050766953	3.414742988	0	1.755797779	4.434201852	3.5686657	0.071711966	9.22913994	1.755043647	2.559710667	0.141917389	0.006879837	0.745680597	6.522795335	7.665373073	0.084557073	1.044214889	2.858244204	20.09237698	1.165092785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3299
H5421_805_0	2010	7	N/A																															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																																																			0	NO	215.1525082	0.601366901	22.50161407		7.535612787	19.03090923	15.3161618	0.307776679	39.61004266	7.532376165	10.98588269	0.609087506	0.029527196	3.20034591	27.99482976	32.89859688	0.362905893	4.481608966	12.26714251	86.23337761	5.000398217																					Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.084419267	0.084419267	0.151755469		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.084419267	0.084419267	0.151755469		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					18.163	0.050766953	3.414742988	0	1.755797779	4.434201852	3.5686657	0.071711966	9.22913994	1.755043647	2.559710667	0.141917389	0.006879837	0.745680597	6.522795335	7.665373073	0.084557073	1.044214889	2.858244204	20.09237698	1.165092785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3299	0	0	18.163	0.050766953	3.414742988	0	1.755797779	4.434201852	3.5686657	0.071711966	9.22913994	1.755043647	2.559710667	0.141917389	0.006879837	0.745680597	6.522795335	7.665373073	0.084557073	1.044214889	2.858244204	20.09237698	1.165092785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3299	NO																																																																																		0	0	0	18.163	0.050766953	3.414742988	0	1.755797779	4.434201852	3.5686657	0.071711966	9.22913994	1.755043647	2.559710667	0.141917389	0.006879837	0.745680597	6.522795335	7.665373073	0.084557073	1.044214889	2.858244204	20.09237698	1.165092785	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3299
H5422_002_0	2010	10	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	CORFand CR	ASC	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo-Radiation	D	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	1528.111217	13.69995894	245.5768053	635.0228028	190.9164741	10.27038456	0.890104816	275.5134164	222.8234595	11515.8199	594.2395901	35.74424246	0.007733204	56.60682318	4800.502885	3209.115934	23.77862232	1152.44283	4387.6887	0	37.7838184	0	0	0	378	179.4	129.6	0	0	0	0.96643912	72.54572226	136.3026295	101.2638221	306.7755066	159.7055537	0.907536692	380.8859217	3.63114176	21.69921538		"$250/day (days 1-7), w/$1750 yrly Max"	$1068/admit	$130/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$5 copay	$40/$150 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$40 copay	$20 coapy	$40 copay	$40 copay	$50/$40 OP/PR copay	$40/$150 copay for Lower/Higher Tier		20% coinsurance			1 exam/2cleanings/yr $0	$20 copay	$100/$80/$0 lenses/frames/glass lenses	$40 copay		SilverSneakers		$40 copay	$40 copay	$175 copay	$40 copay	$40 copay	$0 copay	20% coinsurance	$40 copay	$40 copay	20% coinsurance	250	1068	130	0	100	0.2	0.2	50	200	5	83.73315499	200	0.2	40	20	40	40	47.17427589	52.2905322	0	0.2	0	0	0	20	0	40	0	0	0	40	40	175	40	40	0	0.2	40	40	0.2	NO	117.2854335	939.8454442	114.4006627	0	88.00050975	0.17600102	0.17600102	44.00025488	176.0010195	4.400025488	73.68560322	176.0010195	0.17600102	35.2002039	17.60010195	35.2002039	35.2002039	41.51360325	46.01593489	0	0.17600102	0	0	0	20	0	40	0	0	0	35.2002039	35.2002039	154.0008921	35.2002039	35.2002039	0	0.17600102	35.2002039	35.2002039	0.17600102		14.9354	1.072987	2.341179106	0	1.400062253	1.807598153	0.156659355	1.010221712	3.268096336	4.222491755	3.648908554	0.524251926	0.001361052	0.166047643	7.040778349	9.41346127	0.06975103	3.98683787	16.8252998	0	6.649990559	0	0	0	0.63	0	0.432	0	0	0	0.002834905	0.212802018	1.749227211	0.297042266	0.899880032	0	0.159727383	1.117271842	0.010651411	3.819084029	87.8719		11.83503834	14.9354	1.072987	2.341179106	0	1.400062253	1.807598153	0.156659355	1.010221712	3.268096336	4.222491755	3.648908554	0.524251926	0.001361052	0.166047643	7.040778349	9.41346127	0.06975103	3.98683787	16.8252998	0	6.649990559	0	0	0	0.63	0	0.432	0	0	0	0.002834905	0.212802018	1.749227211	0.297042266	0.899880032	0	0.159727383	1.117271842	0.010651411	3.819084029	87.8719	YES																																									3350																								0	0	0	0	0													0			14.9354	1.072987	2.341179106	0	1.400062253	1.807598153	0.156659355	1.010221712	3.268096336	4.222491755	3.648908554	0.524251926	0.001361052	0.166047643	7.040778349	9.41346127	0.06975103	3.98683787	16.8252998	0	6.649990559	0	0	0	0.63	0	0.432	0	0	0	0.002834905	0.212802018	1.749227211	0.297042266	0.899880032	0	0.159727383	1.117271842	0.010651411	3.819084029	87.8719
H5422_006_0	2010	10	N/A	H.6	H.7	H.8	H.9	I.7	I.8	I.9	I.10	I.11	I.12	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	CORFand CR	Radiology	ASC	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo-Radiation	Radiology	Partial Hosp	D	A	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	Coin	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	Coin	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	0	0	0	0	0	NO	2290.005003	9.485334054	1084.978589	977.9443661	408.8539632	14.25054029	1.538477535	360.5400549	264.0607027	5928.851445	24.27361748	100.9558352	0.070979797	190.8358793	4461.978808	5158.184482	27.86020726	1951.121791	49.58635951	0	45.99261341	0	0	0	378	0	162	0	0	0	2.893550405	124.6657941	638.9584334	165.9634238	0.801236368	802.5564993	33.32870904	14.95109339	2779.531346	1.286654146		$280/day (days 1-6) w/$1680 yrly max	$1225/admit	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$255 copay	$5 copay	30% coinsurance/Tier 2	$255 copay	20% coinsurance	$45 copay	$25 coapy	$45 copay	$40 copay	$50/$45 OP/PR copay	30% coinsurance/Tier 2		20% coinsurance				$20 copay	$100/$80/$0 lenses/frames/glass lenses	$35 copay		SilverSneakers		$45 copay	$45 copay	$45 copay/Tier 1	$230 copay	20% coinsurance	$45 copay	$45 copay	20% coinsurance	$45 copay/Tier 1	$45 copay	280	1225	130	0	125	0.2	0.2	50	255	5	0.3	255	0.2	45	25	45	40	48.83898884	0.3	0	0.2	0	0	0	20	0	35	0	0	0	45	45	45	230	0.2	45	45	0.2	45	45	NO	119.8013309	1068.150242	113.362037	0	109.0019587	0.174403134	0.174403134	43.60078347	222.3639957	4.360078347	0.261604701	222.3639957	0.174403134	39.24070512	21.80039174	39.24070512	34.88062678	42.58836355	0.261604701	0	0.174403134	0	0	0	20	0	35	0	0	0	39.24070512	39.24070512	39.24070512	200.563604	0.174403134	39.24070512	39.24070512	0.174403134	39.24070512	39.24070512		22.8621	0.844313489	10.24961525	0	3.713823567	2.485338885	0.268315304	1.309985739	4.893132747	2.154188067	6.350092438	1.870745242	0.012379099	0.624044539	8.106073828	16.86756635	0.080981791	6.924590348	12.97202474	0	8.021255913	0	0	0	0.63	0	0.4725	0	0	0	0.00946208	0.407664472	2.089431623	2.773851866	0.139738134	2.624406911	0.108986837	2.607517542	9.089230827	0.004207435	131.5676		19.1459029	22.8621	0.844313489	10.24961525	0	3.713823567	2.485338885	0.268315304	1.309985739	4.893132747	2.154188067	6.350092438	1.870745242	0.012379099	0.624044539	8.106073828	16.86756635	0.080981791	6.924590348	12.97202474	0	8.021255913	0	0	0	0.63	0	0.4725	0	0	0	0.00946208	0.407664472	2.089431623	2.773851866	0.139738134	2.624406911	0.108986837	2.607517542	9.089230827	0.004207435	131.5676	YES																																									4500																								0	0	0	0	0													0			22.8621	0.844313489	10.24961525	0	3.713823567	2.485338885	0.268315304	1.309985739	4.893132747	2.154188067	6.350092438	1.870745242	0.012379099	0.624044539	8.106073828	16.86756635	0.080981791	6.924590348	12.97202474	0	8.021255913	0	0	0	0.63	0	0.4725	0	0	0	0.00946208	0.407664472	2.089431623	2.773851866	0.139738134	2.624406911	0.108986837	2.607517542	9.089230827	0.004207435	131.5676
H5422_803_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	299.7592179	3.432044019	47.26040843	45.09915263	10.18027155	18.01104771	4.453185125	11.41032164	49.84058129	3.899208823	21.65981576	0	0.071914305	17.96592656	51.3877731	125.0627055	1.617063581	6.398941113	38.39259851	44.22341834	6.403736399	1.117945851	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.08004117	0.08004117	0.173116673	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08004117	0.08004117	0.173116673	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.9931	0.274704818	8.181564668	0	2.37200327	4.196574116	1.037592134	2.658604943	11.61285544	0.908515656	5.046737071	0	0.016756033	4.186060888	11.97335113	29.13961037	0.376775814	1.490953279	8.945475453	10.30405647	1.492070581	0.260481383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4678	0	0	23.9931	0.274704818	8.181564668	0	2.37200327	4.196574116	1.037592134	2.658604943	11.61285544	0.908515656	5.046737071	0	0.016756033	4.186060888	11.97335113	29.13961037	0.376775814	1.490953279	8.945475453	10.30405647	1.492070581	0.260481383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4678	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.9931	0.274704818	8.181564668	0	2.37200327	4.196574116	1.037592134	2.658604943	11.61285544	0.908515656	5.046737071	0	0.016756033	4.186060888	11.97335113	29.13961037	0.376775814	1.490953279	8.945475453	10.30405647	1.492070581	0.260481383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4678
H5422_804_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	299.7592179	3.432044019	47.26040843	45.09915263	10.18027155	18.01104771	4.453185125	11.41032164	49.84058129	3.899208823	21.65981576	0	0.071914305	17.96592656	51.3877731	125.0627055	1.617063581	6.398941113	38.39259851	44.22341834	6.403736399	1.117945851	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.08004117	0.08004117	0.173116673	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08004117	0.08004117	0.173116673	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.9931	0.274704818	8.181564668	0	2.37200327	4.196574116	1.037592134	2.658604943	11.61285544	0.908515656	5.046737071	0	0.016756033	4.186060888	11.97335113	29.13961037	0.376775814	1.490953279	8.945475453	10.30405647	1.492070581	0.260481383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4678	0	0	23.9931	0.274704818	8.181564668	0	2.37200327	4.196574116	1.037592134	2.658604943	11.61285544	0.908515656	5.046737071	0	0.016756033	4.186060888	11.97335113	29.13961037	0.376775814	1.490953279	8.945475453	10.30405647	1.492070581	0.260481383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4678	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.9931	0.274704818	8.181564668	0	2.37200327	4.196574116	1.037592134	2.658604943	11.61285544	0.908515656	5.046737071	0	0.016756033	4.186060888	11.97335113	29.13961037	0.376775814	1.490953279	8.945475453	10.30405647	1.492070581	0.260481383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4678
H5422_805_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	299.7592179	3.432044019	47.26040843	45.09915263	10.18027155	18.01104771	4.453185125	11.41032164	49.84058129	3.899208823	21.65981576	0	0.071914305	17.96592656	51.3877731	125.0627055	1.617063581	6.398941113	38.39259851	44.22341834	6.403736399	1.117945851	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.08004117	0.08004117	0.173116673	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08004117	0.08004117	0.173116673	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.9931	0.274704818	8.181564668	0	2.37200327	4.196574116	1.037592134	2.658604943	11.61285544	0.908515656	5.046737071	0	0.016756033	4.186060888	11.97335113	29.13961037	0.376775814	1.490953279	8.945475453	10.30405647	1.492070581	0.260481383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4678	0	0	23.9931	0.274704818	8.181564668	0	2.37200327	4.196574116	1.037592134	2.658604943	11.61285544	0.908515656	5.046737071	0	0.016756033	4.186060888	11.97335113	29.13961037	0.376775814	1.490953279	8.945475453	10.30405647	1.492070581	0.260481383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4678	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.9931	0.274704818	8.181564668	0	2.37200327	4.196574116	1.037592134	2.658604943	11.61285544	0.908515656	5.046737071	0	0.016756033	4.186060888	11.97335113	29.13961037	0.376775814	1.490953279	8.945475453	10.30405647	1.492070581	0.260481383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.4678
H5424_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	998.6423495	105.7866849	328.3132192	0.845351163	90.12320698	2.944206688	5.471421545	390.4753538	27.41908755	9771.168745	27.51499625	0	0.038003326	17.93467392	5143.31567	3642.361402	409.5276882	443.3677125	0	0	4.692547733	1057.593619	487.8466219	609.0330422	195.2243181	126.8310405	12.61112665	11.57060093	91.70033385	0											3000	"$195 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$95 Days 1-30 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											143.7073447	109.450556	75.20887061	0	150	0.2	0.102735943	49.96071171	0.2	3	0.170404372	0	0.2	0.151110994	6.833921708	30	38.5	30	0	0	0.2	29.86110458	0	0	30	0	0	0	0	0											YES	123.4260879	94.00392152	64.59472685	0	128.8306678	0.171774224	0.088236934	42.90981236	0.171774224	2.576613356	0.146355394	0	0.171774224	0.129933752	6.829671456	30	38.5	25.76613356	0	0	0.171774224	29.86110458	0	0	30	0	0	0	0	0											4000	10.2715	0.828696936	1.767275226	0	0.967552745	0.505738818	0.482781464	1.39626868	4.70989248	2.098043658	4.026968111	0	0.006527992	2.330319468	2.927263019	9.105903504	1.313901333	0.951989308	0	0	0.806058744	2.631742805	0	0	0.488060795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6165	0	5.117194602	10.2715	0.828696936	1.767275226	0	0.967552745	0.505738818	0.482781464	1.39626868	4.70989248	2.098043658	4.026968111	0	0.006527992	2.330319468	2.927263019	9.105903504	1.313901333	0.951989308	0	0	0.806058744	2.631742805	0	0	0.488060795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6165	NO	"$375 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-32 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.115	0.0123	0.2208	0.0003	0.1034	0.081	0.1506	0.2008	0.7548	0.2241	0.6331	0	0.0007	0.373	2.4892	4.1536	0.456	0.3792	0	0	0.3211	1.2131	0	0.0958	0.1869	0	0.0145	0.014	0	0											12.1934	0	1.241804772	10.3866	0.841029902	1.988054803	0.000258476	1.070921415	0.586784864	0.633394898	1.597110675	5.464665785	2.322188526	4.660078496	0	0.007225411	2.703333527	5.416498861	13.25949091	1.769935842	1.33116576	0	0	1.127111189	3.84485756	0	0.095801615	0.674920776	0	0.014527523	0.014016051	0	0	0	0	0	0	0	0	0	0	0	0	59.8099
H5424_003_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1064.066901	118.2971604	396.0020442	4.03271853	96.88208161	3.787727251	6.300220864	449.5382855	29.54997566	10157.70038	26.93893988	0	0.023321949	19.15383462	5207.757694	4577.525857	427.5648425	488.3027501	0	0	5.849319445	1188.614527	606.648093	522.5063467	205.5037793	234.5022955	13.25824974	12.05477952	85.56075029	385.2224253											3000	"$195 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$25 Days 1-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $10 (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13d, 13e)"											143.7073447	109.450556	24.94650485	0	150	0.2	0.11956901	49.97906601	0.2	3	0.169983517	0	0.2	0.151277821	6.707249968	27.61996997	38.5	30	0	0	0.2	29.78671629	0	0	30	0	0	0	0	10											YES	123.4680275	94.03586359	21.43311292	0	128.8744438	0.171832592	0.102729265	42.94016224	0.171832592	2.577488877	0.146043542	0	0.171832592	0.130113888	6.704679611	27.61996997	38.5	25.77488877	0	0	0.171832592	29.78671629	0	0	30	0	0	0	0	10											4000	10.9482	0.927014637	0.707296378	0	1.040468699	0.65085499	0.647217056	1.608603909	5.077648905	2.18177998	3.934258187	0	0.004007471	2.492179883	2.909695569	10.53592722	1.371770536	1.048829089	0	0	1.00510372	2.950410308	0	0	0.513759448	0	0	0	0	0.321018688	0	0	0	0	0	0	0	0	0	0	50.876	0	5.288337388	10.9482	0.927014637	0.707296378	0	1.040468699	0.65085499	0.647217056	1.608603909	5.077648905	2.18177998	3.934258187	0	0.004007471	2.492179883	2.909695569	10.53592722	1.371770536	1.048829089	0	0	1.00510372	2.950410308	0	0	0.513759448	0	0	0	0	0.321018688	0	0	0	0	0	0	0	0	0	0	50.876	NO	"$375 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-32 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); 50% (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"50% (13b); $0 n/c (13c, 13d, 13e)"												0.1219	0.0137	0.2648	0.0022	0.1105	0.1037	0.1725	0.2314	0.8089	0.2317	0.6138	0	0.0004	0.3966	2.518	4.8288	0.4761	0.4153	0	0	0.398	1.3602	0	0.0991	0.2367	0	0.0153	0.0187	0	0.1676											13.6058	0	1.373021184	11.0701	0.940728957	0.972104559	0.002248228	1.150967915	0.754537542	0.81967482	1.839956224	5.886528918	2.413488034	4.548011847	0	0.00443307	2.888774268	5.427720847	15.36475802	1.847890537	1.464098468	0	0	1.403060645	4.310601136	0	0.099060542	0.750491743	0	0.015272984	0.018701216	0	0.488627139	0	0	0	0	0	0	0	0	0	0	64.4818
H5424_005_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.4843	0.6074	0.5834	0	1.0848	0	1.2599	0	0.0131	0.9331	1.2299	3.7829	0.3701	0.2049	0	0	0.5988	0.2557	0	0	0	0	0	0	0	0											11.4083	YES	312.4447085	19.48115649	35.90310356	652.8212712	10.6042549	13.15677819	12.80677382	26.36417566	23.82658378	13.6823278	27.57288938	0	0.297272994	20.5414415	28.96640621	82.84238167	8.452540135	4.567612712	0	0	12.9023468	6.058880693	567.6243757	328.2943856	154.5616641	129.9486914	0	0	78.83662235	0											3400	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071928986	0.072802617	0.142238508	0	0.2	0.2	0.2	0.109309868	0.2	0	0.166583288	0	0.2	0.150255429	0.172365359	0.199696663	0.2	0	0	0	0.2	0.199598813	0	0	0	0	0	0	0	0											NO	0.053851034	0.054505095	0.106489624	0	0.149733888	0.149733888	0.149733888	0.081836957	0.149733888	0	0.124715817	0	0.149733888	0.112491648	0.129044677	0.149506789	0.149733888	0	0	0	0.149733888	0.15094036	0	0	0	0	0	0	0	0												16.8255	1.06182228	3.823307997	0	1.587816317	1.970015553	1.917608038	2.157563921	3.56764703	0	3.438775431	0	0.044511841	2.310740607	3.737960539	12.38549846	1.265631699	0	0	0	1.931918552	0.914529634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.9408	146	19.7744136	16.8255	1.06182228	3.823307997	0	2.072126141	2.577454963	2.501006566	2.157563921	4.652471086	0	4.698639065	0	0.057653352	3.243837826	4.967842684	16.16838551	1.63576562	0.204881159	0	0	2.53072067	1.170210827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3492	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												15.8963	0.9911	3.4952	0.2701	0.6965	0.8652	0.8409	0.569	1.5644	0.2433	1.5429	0	0.0137	1.0509	2.9127	8.4586	0.859	0.052	0	0	1.3198	0.6125	0	0.0643	0.0581	0.0224	0	0	0	0											42.3989	146	0	32.7218	2.052968838	7.318510793	0.27008608	2.768619345	3.442669295	3.341916949	2.726601436	6.216864297	0.243332417	6.241505095	0	0.071337981	4.294718546	7.880514415	24.62702794	2.494772201	0.256891206	0	0	3.850531401	1.782725876	0	0.064294226	0.058059935	0.022369393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.7481
H5424_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	192.2761147	5.565183845	13.94880752	0.902346142	3.856060627	3.142709992	5.840313871	14.30759274	29.26772796	19.63986899	29.37010298	0	0.040565573	19.12444656	27.37202849	61.21970874	2.124676079	6.276243832	0	0	5.008927093	7.323050446	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												13.9982	0.405159949	1.984057565	0	0.898462126	0.732251428	1.360793132	3.333669109	6.819380615	4.576089474	6.843233995	0	0.009451779	4.455996049	6.377682639	14.26419214	0.495049526	1.462364813	0	0	1.167080013	1.706270754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8894	0	0	13.9982	0.405159949	1.984057565	0	0.898462126	0.732251428	1.360793132	3.333669109	6.819380615	4.576089474	6.843233995	0	0.009451779	4.455996049	6.377682639	14.26419214	0.495049526	1.462364813	0	0	1.167080013	1.706270754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8894	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.0703	0.002	0.1725	0	0.111	0.0905	0.1682	0.412	0.8428	0.5656	0.8458	0	0.0012	0.5507	1.9592	4.3818	0.1521	0.4492	0	0	0.3585	0.5241	0	0	0	0	0	0	0	0											11.6577	0	0	14.0685	0.407195929	2.15658431	0	1.009508007	0.822754414	1.528981047	3.745695628	7.66222541	5.141673567	7.68902696	0	0.010619976	5.006737134	8.336840051	18.64600279	0.647123564	1.911587991	0	0	1.525594788	2.230419286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5471
H5424_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	192.2761147	5.565183845	13.94880752	0.902346142	3.856060627	3.142709992	5.840313871	14.30759274	29.26772796	19.63986899	29.37010298	0	0.040565573	19.12444656	27.37202849	61.21970874	2.124676079	6.276243832	0	0	5.008927093	7.323050446	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												13.9982	0.405159949	1.984057565	0	0.898462126	0.732251428	1.360793132	3.333669109	6.819380615	4.576089474	6.843233995	0	0.009451779	4.455996049	6.377682639	14.26419214	0.495049526	1.462364813	0	0	1.167080013	1.706270754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8894	0	0	13.9982	0.405159949	1.984057565	0	0.898462126	0.732251428	1.360793132	3.333669109	6.819380615	4.576089474	6.843233995	0	0.009451779	4.455996049	6.377682639	14.26419214	0.495049526	1.462364813	0	0	1.167080013	1.706270754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8894	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.0703	0.002	0.1725	0	0.111	0.0905	0.1682	0.412	0.8428	0.5656	0.8458	0	0.0012	0.5507	1.9592	4.3818	0.1521	0.4492	0	0	0.3585	0.5241	0	0	0	0	0	0	0	0											11.6577	0	0	14.0685	0.407195929	2.15658431	0	1.009508007	0.822754414	1.528981047	3.745695628	7.66222541	5.141673567	7.68902696	0	0.010619976	5.006737134	8.336840051	18.64600279	0.647123564	1.911587991	0	0	1.525594788	2.230419286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5471
H5424_804_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	192.2761147	5.565183845	13.94880752	0.902346142	3.856060627	3.142709992	5.840313871	14.30759274	29.26772796	19.63986899	29.37010298	0	0.040565573	19.12444656	27.37202849	61.21970874	2.124676079	6.276243832	0	0	5.008927093	7.323050446	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072802617	0.072802617	0.142238508	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												13.9982	0.405159949	1.984057565	0	0.898462126	0.732251428	1.360793132	3.333669109	6.819380615	4.576089474	6.843233995	0	0.009451779	4.455996049	6.377682639	14.26419214	0.495049526	1.462364813	0	0	1.167080013	1.706270754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8894	0	0	13.9982	0.405159949	1.984057565	0	0.898462126	0.732251428	1.360793132	3.333669109	6.819380615	4.576089474	6.843233995	0	0.009451779	4.455996049	6.377682639	14.26419214	0.495049526	1.462364813	0	0	1.167080013	1.706270754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8894	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.0703	0.002	0.1725	0	0.111	0.0905	0.1682	0.412	0.8428	0.5656	0.8458	0	0.0012	0.5507	1.9592	4.3818	0.1521	0.4492	0	0	0.3585	0.5241	0	0	0	0	0	0	0	0											11.6577	0	0	14.0685	0.407195929	2.15658431	0	1.009508007	0.822754414	1.528981047	3.745695628	7.66222541	5.141673567	7.68902696	0	0.010619976	5.006737134	8.336840051	18.64600279	0.647123564	1.911587991	0	0	1.525594788	2.230419286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5471
H5425_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	538.3910648	14.844356	300.2077301	0	146.6753018	3.590082925	0.433264513	148.071214	192.6468659	0	16.83388235	0	0	163.0847331	4204.108936	3809.723796	183.030028	1570.126053	58.43029618	2720	7.475484963	2599.031707	0	0	279.96875	111.9875	83	13.61471164	0	209.6												$200/day (1-5) - for CMI Hosp; $125/day (1-5)-other hosp	$125/day copay/days 1-5	$50 copay/days 11-100	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$150/OP hospital and $100/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$10/visit	$10/visit	$25/visit	$10/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain IHRB services											143.75	125	50	0	100	0.06	0.05570521	45.05	116.5	0	0.098	0	0	10	10	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15											NO	143.75	125	50	0	100	0.06	0.05570521	45.05	116.5	0	0.098	0	0	10	10	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15												6.4495	0.154628708	1.250865542	0	1.222294182	0.215404975	0.024135091	0.555884016	1.87027999	0	1.64972047	0	0	0.135903944	3.503424113	3.17476983	0.381312558	1.439282215	5.726169026	2.266666667	1.495096993	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.262	0	0	0	0	0	0	0	0	0	0	32.3952			6.4495	0.154628708	1.250865542	0	1.222294182	0.215404975	0.024135091	0.555884016	1.87027999	0	1.64972047	0	0	0.135903944	3.503424113	3.17476983	0.381312558	1.439282215	5.726169026	2.266666667	1.495096993	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.262	0	0	0	0	0	0	0	0	0	0	32.3952	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			6.4495	0.154628708	1.250865542	0	1.222294182	0.215404975	0.024135091	0.555884016	1.87027999	0	1.64972047	0	0	0.135903944	3.503424113	3.17476983	0.381312558	1.439282215	5.726169026	2.266666667	1.495096993	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.262	0	0	0	0	0	0	0	0	0	0	32.3952
H5425_003_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	537.1537172	9.562779438	433.1030939	0	193.1358838	1.713694055	0.336466789	302.4217646	190.7107011	0	13.07294313	0	0	173.1834795	3922.793103	3548.465387	179.0957259	1535.214278	82.92759459	2720	2.603537589	1497.361426	0	0	279.96875	111.9875	83	13.61471164	0	450												$100 copay/days 1-4	$100 copay/days 1-4	$50 copay/days 11-100	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$150/OP hospital and $100/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$5/visit	$10/visit	$25/visit	$10/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain IHRB services											100	100	50	0	100	0.06	0.055684211	46.25	116.5	0	0.088	0	0	10	5	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15											NO	100	100	50	0	100	0.06	0.055684211	46.25	116.5	0	0.088	0	0	10	5	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15												4.4763	0.079689829	1.804596225	0	1.609465699	0.102821643	0.018735888	1.165583884	1.851483056	0	1.150418995	0	0	0.144319566	1.634497126	2.957054489	0.373116096	1.407279754	8.12690427	2.266666667	0.520707518	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.5625	0	0	0	0	0	0	0	0	0	0	30.87			4.4763	0.079689829	1.804596225	0	1.609465699	0.102821643	0.018735888	1.165583884	1.851483056	0	1.150418995	0	0	0.144319566	1.634497126	2.957054489	0.373116096	1.407279754	8.12690427	2.266666667	0.520707518	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.5625	0	0	0	0	0	0	0	0	0	0	30.87	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			4.4763	0.079689829	1.804596225	0	1.609465699	0.102821643	0.018735888	1.165583884	1.851483056	0	1.150418995	0	0	0.144319566	1.634497126	2.957054489	0.373116096	1.407279754	8.12690427	2.266666667	0.520707518	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.5625	0	0	0	0	0	0	0	0	0	0	30.87
H5425_004_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	475.2994474	0	685.8902002	0	125.3917672	16.03561031	0.385915762	300.9190364	198.3951166	0	14.99421332	0	0	180.1218822	3281.257505	2969.505956	142.9033771	1224.028492	48.11519193	2720	4.901476868	632.1277098	0	0	279.96875	111.9875	83	13.61471164	0	209.6												$200 copay/days 1-5	$0 Copay	$20 per day (1-10);$75 per day (11-100)	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$200/OP hospital and $200/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$25/visit cardiac rehab	$15/visit	$35/visit	$25/visit	$25/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	"$10/visit for hearing/vision/dental, $25/visit for chiropractic/podiatry"	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain IHRB services											200	0	33.75	0	100	0.2	0.2	46.25	200	0	0.088	0	0	25	15	35	25	24.5	0.088	20.05	0.2	0	0	0	15	25	5	0	0	15											NO	200	0	33.75	0	100	0.2	0.2	46.25	200	0	0.088	0	0	25	15	35	25	24.5	0.088	20.05	0.2	0	0	0	15	25	5	0	0	15												7.9217	0	1.929066188	0	1.044931393	3.207122063	0.077183152	1.159792119	3.306585277	0	1.319490772	0	0	0.375253921	4.101571881	8.661059037	0.297715369	2.499058171	4.23413689	4.544666667	0.980295374	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.262	0	0	0	0	0	0	0	0	0	0	46.5394			7.9217	0	1.929066188	0	1.044931393	3.207122063	0.077183152	1.159792119	3.306585277	0	1.319490772	0	0	0.375253921	4.101571881	8.661059037	0.297715369	2.499058171	4.23413689	4.544666667	0.980295374	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.262	0	0	0	0	0	0	0	0	0	0	46.5394	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			7.9217	0	1.929066188	0	1.044931393	3.207122063	0.077183152	1.159792119	3.306585277	0	1.319490772	0	0	0.375253921	4.101571881	8.661059037	0.297715369	2.499058171	4.23413689	4.544666667	0.980295374	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.262	0	0	0	0	0	0	0	0	0	0	46.5394
H5425_005_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	474.9664296	0	663.1321811	0	162.4918989	16.07110077	0.36667623	333.6962648	220.0050557	0	14.2466884	0	0	199.7414321	4057.342889	3671.85564	176.7029866	1513.536591	53.20542805	2720	7.658271114	644.902913	0	0	279.96875	111.9875	83	13.61471164	0	209.6												$50 copay/days 1-5	$0 Copay	$0 Copay	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$25 Urgent care"	$100/OP hospital and $100/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$25/visit cardiac rehab	$10/visit	$25/visit	$25/visit	$25/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	"$10/visit for hearing/vision/dental, $25/visit for chiropractic/podiatry"	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain IHRB services											50	0	0	0	100	0.2	0.2	43.75	100	0	0.088	0	0	25	10	25	25	24.5	0.088	20.05	0.2	0	0	0	15	25	5	0	0	15											NO	50	0	0	0	100	0.2	0.2	43.75	100	0	0.088	0	0	25	10	25	25	24.5	0.088	20.05	0.2	0	0	0	15	25	5	0	0	15												1.979	0	0	0	1.354099157	3.214220154	0.073335246	1.216600965	1.833375464	0	1.253708579	0	0	0.416127984	3.381119074	7.649699249	0.368131222	3.090137206	4.682077668	4.544666667	1.531654223	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.262	0	0	0	0	0	0	0	0	0	0	37.4678			1.979	0	0	0	1.354099157	3.214220154	0.073335246	1.216600965	1.833375464	0	1.253708579	0	0	0.416127984	3.381119074	7.649699249	0.368131222	3.090137206	4.682077668	4.544666667	1.531654223	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.262	0	0	0	0	0	0	0	0	0	0	37.4678	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			1.979	0	0	0	1.354099157	3.214220154	0.073335246	1.216600965	1.833375464	0	1.253708579	0	0	0.416127984	3.381119074	7.649699249	0.368131222	3.090137206	4.682077668	4.544666667	1.531654223	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.262	0	0	0	0	0	0	0	0	0	0	37.4678
H5425_006_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	615.5304312	7.960898552	354.208241	0	247.2857329	3.722981539	0.472474905	796.9276111	194.7011077	0	18.35734688	0	0	104.9765415	5816.608889	5271.473881	263.8490148	2265.430584	72.52941952	2720	0.534539851	0	0	0	279.96875	111.9875	83	13.61471164	0	450												$100 copay/days 1-8	$100 copay/days 1-8	$50 copay/days 11-100	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$5/visit	$10/visit	$25/visit	$10/visit PT/OT/ST; $20/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain IHRB services											100	100	50	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	5	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15											NO	100	100	50	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	5	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15												5.1294	0.066340821	1.475867671	0	2.060714441	0.223378892	0.026318048	3.071491835	1.078968639	0	0.82608061	0	0	0.087480451	2.423587037	4.392894901	0.549685447	2.076644702	7.107883113	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.5625	0	0	0	0	0	0	0	0	0	0	34.1507			5.1294	0.066340821	1.475867671	0	2.060714441	0.223378892	0.026318048	3.071491835	1.078968639	0	0.82608061	0	0	0.087480451	2.423587037	4.392894901	0.549685447	2.076644702	7.107883113	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.5625	0	0	0	0	0	0	0	0	0	0	34.1507	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			5.1294	0.066340821	1.475867671	0	2.060714441	0.223378892	0.026318048	3.071491835	1.078968639	0	0.82608061	0	0	0.087480451	2.423587037	4.392894901	0.549685447	2.076644702	7.107883113	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.5625	0	0	0	0	0	0	0	0	0	0	34.1507
H5425_007_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	1021.943669	14.95390095	243.7512327	0	196.5233032	4.444326383	0.32019007	554.9872335	214.4868046	0	12.44053413	0	0	0	3295.247329	2986.111829	156.3631516	1344.200806	69.18367062	2720	0.534539851	0	0	0	279.96875	111.9875	83	13.61471164	0	218.7585564												$100 copay/days 1-10	$100 copay/days 1-10	$50 copay/days 11-100	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$5/visit	$10/visit	$25/visit	$10/visit PT/OT/ST; $20/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain IHRB services											100	100	50	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	5	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15											NO	100	100	50	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	5	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15												8.5162	0.124615841	1.015630136	0	1.637694193	0.266659583	0.017835397	2.139013296	1.188614376	0	0.559824036	0	0	0	1.37301972	2.488426524	0.325756566	1.232184072	6.779999721	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.273448196	0	0	0	0	0	0	0	0	0	0	30.9303			8.5162	0.124615841	1.015630136	0	1.637694193	0.266659583	0.017835397	2.139013296	1.188614376	0	0.559824036	0	0	0	1.37301972	2.488426524	0.325756566	1.232184072	6.779999721	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.273448196	0	0	0	0	0	0	0	0	0	0	30.9303	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			8.5162	0.124615841	1.015630136	0	1.637694193	0.266659583	0.017835397	2.139013296	1.188614376	0	0.559824036	0	0	0	1.37301972	2.488426524	0.325756566	1.232184072	6.779999721	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.273448196	0	0	0	0	0	0	0	0	0	0	30.9303
H5425_008_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	640.8302005	9.772196145	270.3699994	0	176.5595466	5.396164257	0.416143955	841.0339964	212.2477235	0	9.054017135	0	0	0	3980.141966	3603.199012	191.4529985	1555.265405	41.59440933	2720	0.961471027	0	0	0	279.96875	111.9875	83	13.61471164	0	353.4218197												$100 copay/days 1-10	$100 copay/days 1-10	$50 copay/days 11-100	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$10/visit	$10/visit	$25/visit	$10/visit PT/OT/ST; $20/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain IHRB services											100	100	50	0	100	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	10	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15											NO	100	100	50	0	100	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	10	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15												5.3403	0.081434968	1.126541664	0	1.471329555	0.323769855	0.023176087	3.241485195	1.176206134	0	0.679051285	0	0	0	3.316784972	3.002665844	0.398860414	1.425659955	4.076252114	2.266666667	0.192294205	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.441777275	0	0	0	0	0	0	0	0	0	0	29.2021			5.3403	0.081434968	1.126541664	0	1.471329555	0.323769855	0.023176087	3.241485195	1.176206134	0	0.679051285	0	0	0	3.316784972	3.002665844	0.398860414	1.425659955	4.076252114	2.266666667	0.192294205	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.441777275	0	0	0	0	0	0	0	0	0	0	29.2021	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			5.3403	0.081434968	1.126541664	0	1.471329555	0.323769855	0.023176087	3.241485195	1.176206134	0	0.679051285	0	0	0	3.316784972	3.002665844	0.398860414	1.425659955	4.076252114	2.266666667	0.192294205	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.441777275	0	0	0	0	0	0	0	0	0	0	29.2021
H5425_009_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	501.5147903	8.801464618	294.7643074	0	222.6724815	5.576752252	0.391728876	1431.143657	115.4122264	0	13.28742208	0	0	0	3587.654931	3247.882818	180.7146458	1468.032567	79.64695422	2720	0.579598659	0	0	0	279.96875	111.9875	83	13.61471164	0	454.1658911												$100 copay/days 1-10	$100 copay/days 1-10	$50 copay/days 11-100	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$10/visit	$10/visit	$25/visit	$10/visit PT/OT/ST; $20/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain IHRB services											100	100	50	0	100	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	10	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15											NO	100	100	50	0	100	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	10	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	15												4.1793	0.073345538	1.228184614	0	1.855604013	0.334605135	0.021816351	5.515866177	0.639576088	0	0.996556656	0	0	0	2.989712443	2.706569015	0.376488845	1.34569652	7.805401513	2.266666667	0.115919732	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.567707364	0	0	0	0	0	0	0	0	0	0	33.6369			4.1793	0.073345538	1.228184614	0	1.855604013	0.334605135	0.021816351	5.515866177	0.639576088	0	0.996556656	0	0	0	2.989712443	2.706569015	0.376488845	1.34569652	7.805401513	2.266666667	0.115919732	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.567707364	0	0	0	0	0	0	0	0	0	0	33.6369	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			4.1793	0.073345538	1.228184614	0	1.855604013	0.334605135	0.021816351	5.515866177	0.639576088	0	0.996556656	0	0	0	2.989712443	2.706569015	0.376488845	1.34569652	7.805401513	2.266666667	0.115919732	0	0	0	0.349960938	0.233307292	0.034583333	0	0	0.567707364	0	0	0	0	0	0	0	0	0	0	33.6369
H5425_010_0	2010	12	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	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	NO	319.3490771	1.987863417	55.26668673	25.67283168	11.94874162	4.64837447	0.474440112	20.78875296	18.29615849	1.468522224	18.43370225	0.130858216	0.261716432	25.04734572	236.0213111	193.5349048	3.310886135	9.328460127	65.62021889	34.34047352	0.127278121	40.00993963	0	0	0	0	0	0	0	400												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 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$10/visit for Acupuncture/Chiropractic											0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10											NO	0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10												20.8096	0.129534229	8.596563762	0	2.784056796	1.083071252	0.110544546	4.843779439	4.263004928	0.342165678	4.295052625	0.030489964	0.060979929	5.836031552	54.99296548	45.09363283	0.771436469	2.17353121	15.289511	8.00133033	0.029655802	9.322315935	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	189.1926			20.8096	0.129534229	8.596563762	0	2.784056796	1.083071252	0.110544546	4.843779439	4.263004928	0.342165678	4.295052625	0.030489964	0.060979929	5.836031552	54.99296548	45.09363283	0.771436469	2.17353121	15.289511	8.00133033	0.029655802	9.322315935	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	189.1926	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			20.8096	0.129534229	8.596563762	0	2.784056796	1.083071252	0.110544546	4.843779439	4.263004928	0.342165678	4.295052625	0.030489964	0.060979929	5.836031552	54.99296548	45.09363283	0.771436469	2.17353121	15.289511	8.00133033	0.029655802	9.322315935	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	189.1926
H5425_011_0	2010	12	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	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	NO	284.0137917	1.613406576	41.44455173	24.39721222	9.230688704	8.443370848	0.38506911	23.13073508	25.92669346	32.49198452	14.96131785	0.106208256	0.212416512	22.4690038	152.6281482	204.0277611	3.490392009	9.834220013	69.1779416	36.20230642	0	47.55059432	0	0	0	0	0	0	0	400												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 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$10/visit for Acupuncture/Chiropractic											0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10											NO	0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10												18.5071	0.10513367	6.44657302	0	2.150750468	1.967305408	0.089721103	5.389461273	6.040919576	7.570632394	3.485987059	0.024746524	0.049493047	5.235277885	35.56235853	47.53846834	0.813261338	2.291373263	16.11846039	8.435137396	0	11.07928848	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	179.2347			18.5071	0.10513367	6.44657302	0	2.150750468	1.967305408	0.089721103	5.389461273	6.040919576	7.570632394	3.485987059	0.024746524	0.049493047	5.235277885	35.56235853	47.53846834	0.813261338	2.291373263	16.11846039	8.435137396	0	11.07928848	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	179.2347	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			18.5071	0.10513367	6.44657302	0	2.150750468	1.967305408	0.089721103	5.389461273	6.040919576	7.570632394	3.485987059	0.024746524	0.049493047	5.235277885	35.56235853	47.53846834	0.813261338	2.291373263	16.11846039	8.435137396	0	11.07928848	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	179.2347
H5425_012_0	2010	12	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	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	NO	321.9877687	1.614726538	23.74454619	16.75605495	14.671471	7.630466259	0.385384143	44.31550004	15.57028836	39.13221421	14.97355803	0.106295147	0.212590294	22.48738617	137.8490967	262.3552006	4.488224988	12.64562602	88.95452582	46.55181878	0	30.31735097	0	0	0	0	0	0	0	400												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 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$10/visit for Acupuncture/Chiropractic											0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10											NO	0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10												20.9815	0.105219682	3.693391398	0	3.418452742	1.777898638	0.089794505	10.32551151	3.627877189	9.11780591	3.48883902	0.024766769	0.049533539	5.239560978	32.11883952	61.12876173	1.045756422	2.946430862	20.72640452	10.84657378	0	7.063942777	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	198.1502			20.9815	0.105219682	3.693391398	0	3.418452742	1.777898638	0.089794505	10.32551151	3.627877189	9.11780591	3.48883902	0.024766769	0.049533539	5.239560978	32.11883952	61.12876173	1.045756422	2.946430862	20.72640452	10.84657378	0	7.063942777	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	198.1502	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			20.9815	0.105219682	3.693391398	0	3.418452742	1.777898638	0.089794505	10.32551151	3.627877189	9.11780591	3.48883902	0.024766769	0.049533539	5.239560978	32.11883952	61.12876173	1.045756422	2.946430862	20.72640452	10.84657378	0	7.063942777	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	198.1502
H5425_013_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	0	6.120819594	354.208241	0	247.2857329	3.43366586	0.435758527	796.9276111	194.7011077	0	16.93078373	0	0	104.9765415	5816.608889	5271.473881	263.8490148	2265.430584	53.36584066	2720	0.534539851	0	0	0	279.96875	111.9875	0	0	0	837.5												$0 Copay	$150 copay/days 1-8	$75 copay/days 11-100	$0 Copay	$150/run	20%DME	0.2Prosthetics	"$50 ER,$35 Urgent care"	$150/OP hospital and $100/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$0/visit	$0/visit	$35/visit	$10/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay			$15/visit for routine vision	$25/service			$0 Copay	$15/service for certain IHRB services; $10/visit for chiropractic and acupuncture											0	150	75	0	150	0.2	0.2	46.25	116.5	0	0.2	0	0	10	0	0	35	11	0.098	10	0.2	0	0	0	15	25	0	0	0	12.62089552											NO	0	150	75	0	150	0.2	0.2	46.25	116.5	0	0.2	0	0	10	0	0	35	11	0.098	10	0.2	0	0	0	15	25	0	0	0	12.62089552												0	0.076510245	2.213801506	0	3.091071662	0.686733172	0.087151705	3.071491835	1.890223254	0	3.386156745	0	0	0.087480451	0	0	0.769559626	2.076644702	5.229852385	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	26.5044			0	0.076510245	2.213801506	0	3.091071662	0.686733172	0.087151705	3.071491835	1.890223254	0	3.386156745	0	0	0.087480451	0	0	0.769559626	2.076644702	5.229852385	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	26.5044	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.076510245	2.213801506	0	3.091071662	0.686733172	0.087151705	3.071491835	1.890223254	0	3.386156745	0	0	0.087480451	0	0	0.769559626	2.076644702	5.229852385	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	26.5044
H5425_014_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	0	15.00041586	243.7512327	0	196.5233032	3.970872229	0.286080217	554.9872335	214.4868046	0	11.11524385	0	0	0	3295.247329	2986.111829	156.3631516	1344.200806	50.95678688	2720	0.534539851	0	0	0	279.96875	111.9875	0	0	0	837.5												$0 Copay	$150 copay/days 1-10	$75 copay/days 11-100	$0 Copay	$150/run	20%DME	0.2Prosthetics	"$50 ER,$35 Urgent care"	$150/OP hospital and $100/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$0/visit	$0/visit	$35/visit	$10/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay			$15/visit for routine vision	$25/service			$0 Copay	$15/service for certain IHRB services; $10/visit for chiropractic and acupuncture											0	150	75	0	150	0.2	0.2	46.25	116.5	0	0.2	0	0	10	0	0	35	11	0.098	10	0.2	0	0	0	15	25	0	0	0	12.62089552											NO	0	150	75	0	150	0.2	0.2	46.25	116.5	0	0.2	0	0	10	0	0	35	11	0.098	10	0.2	0	0	0	15	25	0	0	0	12.62089552												0	0.187505198	1.523445204	0	2.45654129	0.794174446	0.057216043	2.139013296	2.082309395	0	2.22304877	0	0	0	0	0	0.456059192	1.232184072	4.993765114	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	21.9829			0	0.187505198	1.523445204	0	2.45654129	0.794174446	0.057216043	2.139013296	2.082309395	0	2.22304877	0	0	0	0	0	0.456059192	1.232184072	4.993765114	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	21.9829	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.187505198	1.523445204	0	2.45654129	0.794174446	0.057216043	2.139013296	2.082309395	0	2.22304877	0	0	0	0	0	0.456059192	1.232184072	4.993765114	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	21.9829
H5425_015_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	0	8.996784755	270.3699994	0	176.5595466	5.280421008	0.407218012	841.0339964	212.2477235	0	8.859815974	0	0	0	3980.141966	3603.199012	191.4529985	1555.265405	39.73510625	2720	0.961471027	0	0	0	279.96875	111.9875	0	0	0	837.5												$0 Copay	$150 copay/days 1-10	$75 copay/days 11-100	$0 Copay	$150/run	20%DME	0.2Prosthetics	"$50 ER,$35 Urgent care"	$150/OP hospital and $100/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$0/visit	$0/visit	$35/visit	$10/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay			$15/visit for routine vision	$25/service			$0 Copay	$15/service for certain IHRB services; $10/visit for chiropractic and acupuncture											0	150	75	0	150	0.2	0.2	46.25	116.5	0	0.2	0	0	10	0	0	35	11	0.098	10	0.2	0	0	0	15	25	0	0	0	12.62089552											NO	0	150	75	0	150	0.2	0.2	46.25	116.5	0	0.2	0	0	10	0	0	35	11	0.098	10	0.2	0	0	0	15	25	0	0	0	12.62089552												0	0.112459809	1.689812496	0	2.206994332	1.056084202	0.081443602	3.241485195	2.060571649	0	1.771963195	0	0	0	0	0	0.558404579	1.425659955	3.894040412	2.266666667	0.192294205	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	22.022			0	0.112459809	1.689812496	0	2.206994332	1.056084202	0.081443602	3.241485195	2.060571649	0	1.771963195	0	0	0	0	0	0.558404579	1.425659955	3.894040412	2.266666667	0.192294205	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	22.022	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.112459809	1.689812496	0	2.206994332	1.056084202	0.081443602	3.241485195	2.060571649	0	1.771963195	0	0	0	0	0	0.558404579	1.425659955	3.894040412	2.266666667	0.192294205	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	22.022
H5425_016_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	0	8.918955748	294.7643074	0	222.6724815	5.872808654	0.412524823	1567.991367	115.4122264	0	13.99281945	0	0	0	3587.654931	3247.882818	180.7146458	1468.032567	79.68643086	2720	0.579598659	0	0	0	279.96875	111.9875	0	0	0	837.5												$0 Copay	$150 copay/days 1-10	$75 copay/days 11-100	$0 Copay	$150/run	20%DME	0.2Prosthetics	"$50 ER,$35 Urgent care"	$150/OP hospital and $100/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$0/visit	$0/visit	$35/visit	$10/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay			$15/visit for routine vision	$25/service			$0 Copay	$15/service for certain IHRB services; $10/visit for chiropractic and acupuncture											0	150	75	0	150	0.2	0.2	46.25	116.5	0	0.2	0	0	10	0	0	35	11	0.098	10	0.2	0	0	0	15	25	0	0	0	12.62089552											NO	0	150	75	0	150	0.2	0.2	46.25	116.5	0	0.2	0	0	10	0	0	35	11	0.098	10	0.2	0	0	0	15	25	0	0	0	12.62089552												0	0.111486947	1.842276921	0	2.783406019	1.174561731	0.082504965	6.043300062	1.120460365	0	2.798563891	0	0	0	0	0	0.527084384	1.34569652	7.809270225	2.266666667	0.115919732	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	29.4853			0	0.111486947	1.842276921	0	2.783406019	1.174561731	0.082504965	6.043300062	1.120460365	0	2.798563891	0	0	0	0	0	0.527084384	1.34569652	7.809270225	2.266666667	0.115919732	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	29.4853	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.111486947	1.842276921	0	2.783406019	1.174561731	0.082504965	6.043300062	1.120460365	0	2.798563891	0	0	0	0	0	0.527084384	1.34569652	7.809270225	2.266666667	0.115919732	0	0	0	0.349960938	0.233307292	0	0	0	0.880833333	0	0	0	0	0	0	0	0	0	0	29.4853
H5425_018_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	P	V	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	NO	734.4545652	20.33584052	253.1806587	0	149.6141247	13.40226727	8.140516084	242.8929711	357.3538912	9.610527941	10.40534084	0	0	459.2723469	4246.29913	3847.375194	194.1023536	621.8736282	19.58523454	8443.673263	9.914701755	0	0	0	374.8636168	306.2638666	160.122235	0	0	0												$150/Days 1-5 for IP Medical/Surgical	$225/Days 1-8 IP Psych/Substance Abuse	$75/Days 21-100 for SNF	No cost-sharing	$125/Run for Ambulance	20% Coinsurance for DME Items Over $100	20% Coinsurance for Prosthetics/Supplies Items Over $100	$50/Case for ER; $35/Visit for Urgent Care	$200/Case for OP Fac - Surgery; $175/Case for OP Fac - ASC	20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for OP Fac - CT/MRI/PET	No cost-sharing	No cost-sharing	$15/Case for Cardiovascular/PT/OT/ST/CORF	$10/Visit for PCP - Office Visits/Consults	$15/Visit for Speclst - Office Visits/Consults	$25/Visit for OP Psych/SA	$15/Visit for PT/OT/ST	20% Coinsurance for CT/MRI/PET	$15/Visit for Chiropractor; $10/Exam for Vision Exams/Hearing/Speech Exams; 20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for Part B Rx	No cost-sharing	No cost-sharing	No cost-sharing	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$5/Exam for Routine Hearing Exams	No cost-sharing	No cost-sharing	No cost-sharing											150	225	75	0	125	0.1	0.1	48.73558673	187.4834615	0.02	0.2	0	0	15	10	15	25	15	0.2	2.417615797	0.2	0	0	0	15	25	5	0	0	0											NO	150	225	75	0	125	0.1	0.1	48.73558673	187.4834615	0.02	0.2	0	0	15	10	15	25	15	0.2	2.417615797	0.2	0	0	0	15	25	5	0	0	0												9.1807	0.38129701	1.582379117	0	1.558480466	1.340226728	0.814051608	0.986460955	5.583162043	0.192210559	2.081068168	0	0	0.574090434	3.538582608	4.809218993	0.404379903	0.777342035	3.917046907	1.701129823	1.982940351	0	0	0	0.468579521	0.638049722	0.066717598	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5781	0	0	9.1807	0.38129701	1.582379117	0	1.558480466	1.340226728	0.814051608	0.986460955	5.583162043	0.192210559	2.081068168	0	0	0.574090434	3.538582608	4.809218993	0.404379903	0.777342035	3.917046907	1.701129823	1.982940351	0	0	0	0.468579521	0.638049722	0.066717598	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5781	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.1807	0.38129701	1.582379117	0	1.558480466	1.340226728	0.814051608	0.986460955	5.583162043	0.192210559	2.081068168	0	0	0.574090434	3.538582608	4.809218993	0.404379903	0.777342035	3.917046907	1.701129823	1.982940351	0	0	0	0.468579521	0.638049722	0.066717598	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5781
H5425_019_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	P	V	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	NO	675.0931608	18.37921618	225.0276786	0	131.0949999	12.78494465	7.83172556	241.0694485	369.3095797	8.565114678	10.88544722	0	0	511.2874668	4145.492131	3753.486892	167.3336089	523.6298254	13.7683432	8011.924964	9.831229328	0	0	0	359.2629533	306.2638666	153.4721825	0	0	0												$150/Days 1-5 for IP Medical/Surgical	$225/Days 1-8 IP Psych/Substance Abuse	$75/Days 21-100 for SNF	No cost-sharing	$125/Run for Ambulance	20% Coinsurance for DME Items Over $100	20% Coinsurance for Prosthetics/Supplies Items Over $100	$50/Case for ER; $35/Visit for Urgent Care	$200/Case for OP Fac - Surgery; $175/Case for OP Fac - ASC	20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for OP Fac - CT/MRI/PET	No cost-sharing	No cost-sharing	$15/Case for Cardiovascular/PT/OT/ST/CORF	$10/Visit for PCP - Office Visits/Consults	$15/Visit for Speclst - Office Visits/Consults	$25/Visit for OP Psych/SA	$15/Visit for PT/OT/ST	20% Coinsurance for CT/MRI/PET	$15/Visit for Chiropractor; $10/Exam for Vision Exams/Hearing/Speech Exams; 20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for Part B Rx	No cost-sharing	No cost-sharing	No cost-sharing	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$5/Exam for Routine Hearing Exams	No cost-sharing	No cost-sharing	No cost-sharing											150	225	75	0	125	0.1	0.1	48.75345685	187.4833749	0.02	0.2	0	0	15	10	15	25	15	0.2	2.241351087	0.2	0	0	0	15	25	5	0	0	0											NO	150	225	75	0	125	0.1	0.1	48.75345685	187.4833749	0.02	0.2	0	0	15	10	15	25	15	0.2	2.241351087	0.2	0	0	0	15	25	5	0	0	0												8.4387	0.344610303	1.406422991	0	1.365572916	1.278494465	0.783172556	0.97941408	5.769950533	0.171302294	2.177089444	0	0	0.639109334	3.454576776	4.691858615	0.348611685	0.654537282	2.75366864	1.496461394	1.966245866	0	0	0	0.449078692	0.638049722	0.063946743	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8708	0	0	8.4387	0.344610303	1.406422991	0	1.365572916	1.278494465	0.783172556	0.97941408	5.769950533	0.171302294	2.177089444	0	0	0.639109334	3.454576776	4.691858615	0.348611685	0.654537282	2.75366864	1.496461394	1.966245866	0	0	0	0.449078692	0.638049722	0.063946743	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8708	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.4387	0.344610303	1.406422991	0	1.365572916	1.278494465	0.783172556	0.97941408	5.769950533	0.171302294	2.177089444	0	0	0.639109334	3.454576776	4.691858615	0.348611685	0.654537282	2.75366864	1.496461394	1.966245866	0	0	0	0.449078692	0.638049722	0.063946743	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8708
H5425_020_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	P	V	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	NO	639.830723	17.16993147	259.736587	0	155.0450205	11.96748305	7.263867589	229.1743378	351.146759	6.894875312	10.03971604	0	0	436.1646266	4127.522722	3736.96872	196.5819448	629.1097411	16.32526229	9951.019154	9.300923312	0	0	0	355.1592818	306.2638666	151.7229216	0	0	0												$150/Days 1-5 for IP Medical/Surgical	$225/Days 1-8 IP Psych/Substance Abuse	$75/Days 21-100 for SNF	No cost-sharing	$125/Run for Ambulance	20% Coinsurance for DME Items Over $100	20% Coinsurance for Prosthetics/Supplies Items Over $100	$50/Case for ER; $35/Visit for Urgent Care	$200/Case for OP Fac - Surgery; $175/Case for OP Fac - ASC	20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for OP Fac - CT/MRI/PET	No cost-sharing	No cost-sharing	$15/Case for Cardiovascular/PT/OT/ST/CORF	$10/Visit for PCP - Office Visits/Consults	$15/Visit for Speclst - Office Visits/Consults	$25/Visit for OP Psych/SA	$15/Visit for PT/OT/ST	20% Coinsurance for CT/MRI/PET	$15/Visit for Chiropractor; $10/Exam for Vision Exams/Hearing/Speech Exams; 20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for Part B Rx	No cost-sharing	No cost-sharing	No cost-sharing	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	$5/Exam for Routine Hearing Exams	No cost-sharing	No cost-sharing	No cost-sharing											150	225	75	0	125	0.1	0.1	48.69415264	187.4837688	0.02	0.2	0	0	15	10	15	25	15	0.2	1.971906345	0.2	0	0	0	15	25	5	0	0	0											NO	150	225	75	0	125	0.1	0.1	48.69415264	187.4837688	0.02	0.2	0	0	15	10	15	25	15	0.2	1.971906345	0.2	0	0	0	15	25	5	0	0	0												7.9979	0.321936215	1.623353669	0	1.615052297	1.196748305	0.726386759	0.929954182	5.486193149	0.137897506	2.007943207	0	0	0.545205783	3.439602268	4.6712109	0.409545718	0.786387176	3.265052459	1.635206484	1.860184662	0	0	0	0.443949102	0.638049722	0.063217884	0	0	0	0	0	0	0	0	0	0	0	0	0	39.801	0	0	7.9979	0.321936215	1.623353669	0	1.615052297	1.196748305	0.726386759	0.929954182	5.486193149	0.137897506	2.007943207	0	0	0.545205783	3.439602268	4.6712109	0.409545718	0.786387176	3.265052459	1.635206484	1.860184662	0	0	0	0.443949102	0.638049722	0.063217884	0	0	0	0	0	0	0	0	0	0	0	0	0	39.801	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.9979	0.321936215	1.623353669	0	1.615052297	1.196748305	0.726386759	0.929954182	5.486193149	0.137897506	2.007943207	0	0	0.545205783	3.439602268	4.6712109	0.409545718	0.786387176	3.265052459	1.635206484	1.860184662	0	0	0	0.443949102	0.638049722	0.063217884	0	0	0	0	0	0	0	0	0	0	0	0	0	39.801
H5425_022_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	P	V	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	NO	661.2039418	17.91615274	214.1643466	0	126.6511633	11.00566164	6.821895757	206.0502154	303.1493497	8.152773392	8.827026618	0	0	288.5981502	0	0	164.6603094	527.5459163	17.90251842	7616.253652	8.410809183	0	0	0	374.8636168	306.2638666	0	0	0	577.6831148												$100/Days 1-5 for IP Medical/Surgical	$225/Days 1-8 IP Psych/Substance Abuse	$100/Days 21-100 for SNF	No cost-sharing	$150/Run for Ambulance	20% Coinsurance for DME Items Over $100	20% Coinsurance for Prosthetics/Supplies Items Over $100	$50/Case for ER; $35/Visit for Urgent Care	$200/Case for OP Fac - Surgery; $175/Case for OP Fac - ASC	20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for OP Fac - CT/MRI/PET	No cost-sharing	No cost-sharing	$15/Case for PT/OT/ST/CORF	No cost-sharing	No cost-sharing	$25/Visit for OP Psych/SA	$15/Visit for PT/OT/ST	20% Coinsurance for CT/MRI/PET	$15/Visit for Chiropractor; $10/Exam for Vision Exams/Hearing/Speech Exams; 20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for Part B Rx	No cost-sharing	No cost-sharing	No cost-sharing	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	No cost-sharing	No cost-sharing	No cost-sharing	$10/Visit for Acupuncture											100	225	100	0	150	0.2	0.2	48.73558673	187.4834615	0.02	0.2	0	0	15	0	0	25	15	0.2	2.307562085	0.2	0	0	0	15	25	0	0	0	10											NO	100	225	100	0	150	0.2	0.2	48.73558673	187.4834615	0.02	0.2	0	0	15	0	0	25	15	0.2	2.307562085	0.2	0	0	0	15	25	0	0	0	10												5.51	0.335927864	1.784702889	0	1.583139541	2.201132328	1.364379152	0.836831512	4.736290787	0.163055468	1.765405324	0	0	0.360747688	0	0	0.343042311	0.659432395	3.580503685	1.464581513	1.682161837	0	0	0	0.468579521	0.638049722	0	0	0	0.481402596	0	0	0	0	0	0	0	0	0	0	29.9594	0	0	5.51	0.335927864	1.784702889	0	1.583139541	2.201132328	1.364379152	0.836831512	4.736290787	0.163055468	1.765405324	0	0	0.360747688	0	0	0.343042311	0.659432395	3.580503685	1.464581513	1.682161837	0	0	0	0.468579521	0.638049722	0	0	0	0.481402596	0	0	0	0	0	0	0	0	0	0	29.9594	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.51	0.335927864	1.784702889	0	1.583139541	2.201132328	1.364379152	0.836831512	4.736290787	0.163055468	1.765405324	0	0	0.360747688	0	0	0.343042311	0.659432395	3.580503685	1.464581513	1.682161837	0	0	0	0.468579521	0.638049722	0	0	0	0.481402596	0	0	0	0	0	0	0	0	0	0	29.9594
H5425_023_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	P	V	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	NO	608.1976077	16.19614625	190.5112472	0	111.0753667	10.54473459	6.576751026	204.639481	313.5002016	7.270770449	9.240458643	0	0	316.1792072	0	0	142.0464646	444.4998582	12.56206666	7220.673988	8.345552203	0	0	0	359.2629533	306.2638666	0	0	0	635.4416854												$100/Days 1-5 for IP Medical/Surgical	$225/Days 1-8 IP Psych/Substance Abuse	$100/Days 21-100 for SNF	No cost-sharing	$150/Run for Ambulance	20% Coinsurance for DME Items Over $100	20% Coinsurance for Prosthetics/Supplies Items Over $100	$50/Case for ER; $35/Visit for Urgent Care	$200/Case for OP Fac - Surgery; $175/Case for OP Fac - ASC	20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for OP Fac - CT/MRI/PET	No cost-sharing	No cost-sharing	$15/Case for PT/OT/ST/CORF	No cost-sharing	No cost-sharing	$25/Visit for OP Psych/SA	$15/Visit for PT/OT/ST	20% Coinsurance for CT/MRI/PET	$15/Visit for Chiropractor; $10/Exam for Vision Exams/Hearing/Speech Exams; 20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for Part B Rx	No cost-sharing	No cost-sharing	No cost-sharing	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	No cost-sharing	No cost-sharing	No cost-sharing	$10/Visit for Acupuncture											100	225	100	0	150	0.2	0.2	48.75345685	187.4833749	0.02	0.2	0	0	15	0	0	25	15	0.2	2.141539532	0.2	0	0	0	15	25	0	0	0	10											NO	100	225	100	0	150	0.2	0.2	48.75345685	187.4833749	0.02	0.2	0	0	15	0	0	25	15	0.2	2.141539532	0.2	0	0	0	15	25	0	0	0	10												5.0683	0.303677742	1.587593727	0	1.388442084	2.108946917	1.315350205	0.831406842	4.89800632	0.145415409	1.848091729	0	0	0.395224009	0	0	0.295930135	0.555624823	2.512413333	1.288613232	1.669110441	0	0	0	0.449078692	0.638049722	0	0	0	0.529534738	0	0	0	0	0	0	0	0	0	0	27.8288	0	0	5.0683	0.303677742	1.587593727	0	1.388442084	2.108946917	1.315350205	0.831406842	4.89800632	0.145415409	1.848091729	0	0	0.395224009	0	0	0.295930135	0.555624823	2.512413333	1.288613232	1.669110441	0	0	0	0.449078692	0.638049722	0	0	0	0.529534738	0	0	0	0	0	0	0	0	0	0	27.8288	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.0683	0.303677742	1.587593727	0	1.388442084	2.108946917	1.315350205	0.831406842	4.89800632	0.145415409	1.848091729	0	0	0.395224009	0	0	0.295930135	0.555624823	2.512413333	1.288613232	1.669110441	0	0	0	0.449078692	0.638049722	0	0	0	0.529534738	0	0	0	0	0	0	0	0	0	0	27.8288
H5425_024_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	P	V	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	NO	576.1576623	15.11090853	219.8207331	0	131.3126224	9.829404613	6.089624641	194.5114048	298.03533	5.852015962	8.521195212	0	0	269.0649333	0	0	166.848656	533.9560298	14.90763263	9044.005739	7.894145901	0	0	0	355.1592818	306.2638666	0	0	0	659.250849												$100/Days 1-5 for IP Medical/Surgical	$225/Days 1-8 IP Psych/Substance Abuse	$100/Days 21-100 for SNF	No cost-sharing	$150/Run for Ambulance	20% Coinsurance for DME Items Over $100	20% Coinsurance for Prosthetics/Supplies Items Over $100	$50/Case for ER; $35/Visit for Urgent Care	$200/Case for OP Fac - Surgery; $175/Case for OP Fac - ASC	20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for OP Fac - CT/MRI/PET	No cost-sharing	No cost-sharing	$15/Case for PT/OT/ST/CORF	No cost-sharing	No cost-sharing	$25/Visit for OP Psych/SA	$15/Visit for PT/OT/ST	20% Coinsurance for CT/MRI/PET	$15/Visit for Chiropractor; $10/Exam for Vision Exams/Hearing/Speech Exams; 20% Coinsurance for Specialized Laboratory Services	20% Coinsurance for Part B Rx	No cost-sharing	No cost-sharing	No cost-sharing	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	No cost-sharing	No cost-sharing	No cost-sharing	$10/Visit for Acupuncture											100	225	100	0	150	0.2	0.2	48.69415264	187.4837688	0.02	0.2	0	0	15	0	0	25	15	0.2	1.86750361	0.2	0	0	0	15	25	0	0	0	10											NO	100	225	100	0	150	0.2	0.2	48.69415264	187.4837688	0.02	0.2	0	0	15	0	0	25	15	0.2	1.86750361	0.2	0	0	0	15	25	0	0	0	10												4.8013	0.283329535	1.831839443	0	1.64140778	1.965880923	1.217924928	0.789297336	4.656398909	0.117040319	1.704239043	0	0	0.336331167	0	0	0.347601367	0.667445037	2.981526527	1.407476114	1.57882918	0	0	0	0.443949102	0.638049722	0	0	0	0.549375708	0	0	0	0	0	0	0	0	0	0	27.9593	0	0	4.8013	0.283329535	1.831839443	0	1.64140778	1.965880923	1.217924928	0.789297336	4.656398909	0.117040319	1.704239043	0	0	0.336331167	0	0	0.347601367	0.667445037	2.981526527	1.407476114	1.57882918	0	0	0	0.443949102	0.638049722	0	0	0	0.549375708	0	0	0	0	0	0	0	0	0	0	27.9593	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.8013	0.283329535	1.831839443	0	1.64140778	1.965880923	1.217924928	0.789297336	4.656398909	0.117040319	1.704239043	0	0	0.336331167	0	0	0.347601367	0.667445037	2.981526527	1.407476114	1.57882918	0	0	0	0.443949102	0.638049722	0	0	0	0.549375708	0	0	0	0	0	0	0	0	0	0	27.9593
H5425_025_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	YES	650.8592748	8.860863645	739.6806269	868.8764456	222.5571596	3.466468761	0.439921466	717.23485	148.4972304	0	15.383276	0	0	94.47888732	5234.948	4744.326493	263.8490148	2038.887526	70.74712075	2084.005707	0.065888338	0	0	0	279.96875	111.9875	83	0	0	777.5											1050	$100 copay/days 1-10	$100 copay/days 1-10	$30 copay/days 1-20; $100 copay/days 21-100	$10Copay	$100/run	10% coinsurance for DME items over $100	10% coinsurance for Prosthetic items over $100	"$50 ER,$25 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 10% coinsurance for diagnostic and therapeutic radiology	"10% Copay, 24 hrs or under"	$0 Copay	$20/visit cardiac rehab	$10/visit	$20/visit	$25/visit	$20/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 10% coinsurance for diagnostic and therapeutic radiology	"$25/visit for hearing/vision/dental, $20/visit for chiropractic/podiatry"	20% coinsurance	$0 Copay			$30/visit for routine vision	$25 (every 2 yrs)/service	$25/visit for routine hearing	$0 Copay (every 3 yrs)	$0 Copay	$15/service for certain IHRB services; $10/visit for chiropractic and acupuncture											100	100	53.1	10	100	0.05	0.045702532	43.75	66.5	0	0.045	0	0	20	10	20	25	20	0.088	22.25	0.2	0	0	0	30	25	25	0	0	15											NO	80	80	42.48	8	80	0.04	0.036562025	35	53.2	0	0.036	0	0	16	8	16	20	16	0.0704	17.8	0.16	0	0	0	24	20	20	0	0	12												4.3391	0.059072424	2.618469419	0.579250964	1.483714398	0.13865875	0.01608442	2.091934979	0.658337721	0	0.553797936	0	0	0.12597185	3.489965334	6.325768658	0.439748358	2.718516701	4.980597301	3.091275133	0.010542134	0	0	0	0.5599375	0.186645833	0.138333333	0	0	0.7775	0	0	0	0	0	0	0	0	0	0	35.3832		8.845796244	4.3391	0.059072424	2.618469419	0.579250964	1.483714398	0.13865875	0.01608442	2.091934979	0.658337721	0	0.553797936	0	0	0.12597185	3.489965334	6.325768658	0.439748358	2.718516701	4.980597301	3.091275133	0.010542134	0	0	0	0.5599375	0.186645833	0.138333333	0	0	0.7775	0	0	0	0	0	0	0	0	0	0	35.3832	NO	copay/days 20%		copay/days 20%	$20%Copay	$20%/run	DME	Prosthetics	"50% ER,$40 Urgent care"	$20%/OP hospital and $100/ASC visits	20%	20%	"20% Copay, 24 hrs or under"	20%	$20%/visit cardiac rehab	$40/visit	$40/visit	$/visit	$20% PT/OT/ST/CORF	20%	"$20% hearing/vision/dental, $0.4 chiro/pod, $0.4 other"	30% coinsurance																					3.0247	0	1.0375	0.453	0.2307	0	0	0.3943	0.3708	0.0821	0.4273	0.003	0.0061	0.3399	2.4236	2.1964	0	0.2794	1.9652	1.0284	0.0027	0.04	0	0	0	0	0	0	0	0											14.305			7.3637	0.059072424	3.655944245	1.032261353	1.714368967	0.13865875	0.01608442	2.48624812	1.029109262	0.082053577	0.981111158	0.003033435	0.006066871	0.465894613	5.913552371	8.522216108	0.439748358	2.99788592	6.945795099	4.119705456	0.013287481	0.039973642	0	0	0.5599375	0.186645833	0.138333333	0	0	0.7775	0	0	0	0	0	0	0	0	0	0	49.6882
H5425_026_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	YES	740.6587836	11.40833104	500.0483565	959.344985	134.9348652	3.971392794	0.286117721	381.0597844	99.0417	0	10.00503091	0	0	0	3938.479608	3569.000858	207.6502654	1606.588803	68.47327189	3465.856581	0.01849861	0	0	0	279.96875	111.9875	83	0	0	777.5											1050	$100 copay/days 1-10	$100 copay/days 1-10	$30 copay/days 1-20; $100 copay/days 21-100	$10Copay	$100/run	10% coinsurance for DME items over $100	10% coinsurance for Prosthetic items over $100	"$50 ER,$25 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 10% coinsurance for diagnostic and therapeutic radiology	"10% Copay, 24 hrs or under"	$0 Copay	$20/visit cardiac rehab	$10/visit	$20/visit	$25/visit	$20/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 10% coinsurance for diagnostic and therapeutic radiology	"$25/visit for hearing/vision/dental, $20/visit for chiropractic/podiatry"	20% coinsurance	$0 Copay			$30/visit for routine vision	$25 (every 2 yrs)/service	$25/visit for routine hearing	$0 Copay (every 3 yrs)	$0 Copay	$15/service for certain IHRB services; $10/visit for chiropractic and acupuncture											100	100	53.1	10	100	0.05	0.045702532	43.75	66.5	0	0.045	0	0	20	10	20	25	20	0.088	22.25	0.2	0	0	0	30	25	25	0	0	15											NO	80	80	42.48	8	80	0.04	0.036562025	35	53.2	0	0.036	0	0	16	8	16	20	16	0.0704	17.8	0.16	0	0	0	24	20	20	0	0	12												4.9377	0.07605554	1.770171182	0.639563323	0.899565768	0.158855712	0.010461043	1.111424371	0.43908487	0	0.360181113	0	0	0	2.625653072	4.75866781	0.346083776	2.142118404	4.820518341	5.141020596	0.002959778	0	0	0	0.5599375	0.186645833	0.138333333	0	0	0.7775	0	0	0	0	0	0	0	0	0	0	31.9025		7.975631647	4.9377	0.07605554	1.770171182	0.639563323	0.899565768	0.158855712	0.010461043	1.111424371	0.43908487	0	0.360181113	0	0	0	2.625653072	4.75866781	0.346083776	2.142118404	4.820518341	5.141020596	0.002959778	0	0	0	0.5599375	0.186645833	0.138333333	0	0	0.7775	0	0	0	0	0	0	0	0	0	0	31.9025	NO	copay/days 20%		copay/days 20%	$20%Copay	$20%/run	DME	Prosthetics	"50% ER,$40 Urgent care"	$20%/OP hospital and $100/ASC visits	20%	20%	"20% Copay, 24 hrs or under"	20%	$20%/visit cardiac rehab	$40/visit	$40/visit	$/visit	$20% PT/OT/ST/CORF	20%	"$20% hearing/vision/dental, $0.4 chiro/pod, $0.4 other"	30% coinsurance																					4.6194	0	0.8463	0.616	0.2035	0	0	0.2746	0.4531	0.1247	0.3643	0.0026	0.0052	0.5471	1.373	1.2442	0	0.2036	1.4323	0.7495	0.0008	0.2224	0	0	0	0	0	0	0	0											13.2825			9.5571	0.07605554	2.616437225	1.255522046	1.103079381	0.158855712	0.010461043	1.386027429	0.892136856	0.124738422	0.72447201	0.002586049	0.005172098	0.547094422	3.998672792	6.002881072	0.346083776	2.345725443	6.25277386	5.890550749	0.003730553	0.222443389	0	0	0.5599375	0.186645833	0.138333333	0	0	0.7775	0	0	0	0	0	0	0	0	0	0	45.185
H5425_027_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	YES	667.6585569	10.71716751	726.2323456	884.9038166	174.2695693	5.333429471	0.411305944	830.1257855	161.4230893	0	8.053881157	0	0	0	5119.218795	4634.398538	273.6054802	2000.366812	42.8569361	11127.48564	0.865323924	0	0	0	279.96875	111.9875	83	0	0	777.5											1050	$100 copay/days 1-10	$100 copay/days 1-10	$30 copay/days 1-20; $100 copay/days 21-100	$10Copay	$100/run	10% coinsurance for DME items over $100	10% coinsurance for Prosthetic items over $100	"$50 ER,$25 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	20% coinsurance for specialized diagnostics; 10% coinsurance for diagnostic and therapeutic radiology	"10% Copay, 24 hrs or under"	$0 Copay	$20/visit cardiac rehab	$10/visit	$20/visit	$25/visit	$20/visit PT/OT/ST; $20/visit CORF	20% coinsurance for specialized diagnostics; 10% coinsurance for diagnostic and therapeutic radiology	"$25/visit for hearing/vision/dental, $20/visit for chiropractic/podiatry"	20% coinsurance	$0 Copay			$30/visit for routine vision	$25 (every 2 yrs)/service	$25/visit for routine hearing	$0 Copay (every 3 yrs)	$0 Copay	$15/service for certain IHRB services; $10/visit for chiropractic and acupuncture											100	100	53.1	10	100	0.05	0.045692475	43.75	66.5	0	0.075	0	0	20	10	20	25	20	0.088	22.25	0.2	0	0	0	30	25	25	0	0	15											NO	80	80	42.48	8	80	0.04	0.03655398	35	53.2	0	0.06	0	0	16	8	16	20	16	0.0704	17.8	0.16	0	0	0	24	20	20	0	0	12												4.4511	0.071447783	2.570862503	0.589935878	1.161797128	0.213337179	0.015034869	2.421200208	0.715642362	0	0.483232869	0	0	0	3.41281253	6.17919805	0.456009134	2.667155749	3.017128302	16.50577036	0.138451828	0	0	0	0.5599375	0.186645833	0.138333333	0	0	0.7775	0	0	0	0	0	0	0	0	0	0	46.7325		11.68312261	4.4511	0.071447783	2.570862503	0.589935878	1.161797128	0.213337179	0.015034869	2.421200208	0.715642362	0	0.483232869	0	0	0	3.41281253	6.17919805	0.456009134	2.667155749	3.017128302	16.50577036	0.138451828	0	0	0	0.5599375	0.186645833	0.138333333	0	0	0.7775	0	0	0	0	0	0	0	0	0	0	46.7325	NO	copay/days 20%		copay/days 20%	$20%Copay	$20%/run	DME	Prosthetics	"50% ER,$40 Urgent care"	$20%/OP hospital and $100/ASC visits	20%	20%	"20% Copay, 24 hrs or under"	20%	$20%/visit cardiac rehab	$40/visit	$40/visit	$/visit	$20% PT/OT/ST/CORF	20%	"$20% hearing/vision/dental, $0.4 chiro/pod, $0.4 other"	30% coinsurance																					2.8076	0	0.6328	0.4561	0.1764	0	0	0.4161	0.4073	0.0713	0.204	0.0014	0.0029	0.3064	1.6584	1.5013	0	0.1184	0.833	0.4359	0.0361	0.0753	0	0	0	0	0	0	0	0											10.1409			7.2587	0.071447783	3.203678613	1.046028327	1.338209276	0.213337179	0.015034869	2.837336821	1.122957366	0.071339234	0.687225685	0.001448116	0.002896232	0.306357729	5.071205016	7.680530972	0.456009134	2.785576629	3.850149397	16.94170824	0.174506991	0.075342802	0	0	0.5599375	0.186645833	0.138333333	0	0	0.7775	0	0	0	0	0	0	0	0	0	0	56.8734
H5425_801_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	277.5130276	1.727445091	48.02652227	22.30958459	10.38340706	4.039418196	0.412286496	18.06534037	15.89928608	1.276139741	16.01881104	0.113715249	0.227430498	21.76603987	190.2347428	155.9904174	2.668596193	7.518800759	52.89033183	27.67864951	0.127278121	40.00993963	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																			0.065810822	0.065810822	0.147674024	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065810822	0.065810822	0.147674024	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.2634	0.113684581	7.092269782	0	2.419333845	0.94118444	0.096062754	4.209224306	3.704533657	0.29734056	3.732382973	0.026495653	0.052991306	5.071487289	44.32469507	36.34576727	0.621782913	1.751880577	12.32344732	6.449125337	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.189			18.2634	0.113684581	7.092269782	0	2.419333845	0.94118444	0.096062754	4.209224306	3.704533657	0.29734056	3.732382973	0.026495653	0.052991306	5.071487289	44.32469507	36.34576727	0.621782913	1.751880577	12.32344732	6.449125337	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.189	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			18.2634	0.113684581	7.092269782	0	2.419333845	0.94118444	0.096062754	4.209224306	3.704533657	0.29734056	3.732382973	0.026495653	0.052991306	5.071487289	44.32469507	36.34576727	0.621782913	1.751880577	12.32344732	6.449125337	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.189
H5425_803_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	267.2389541	1.663491704	46.24848674	21.48364025	9.998993081	3.889871056	0.397022846	17.39652624	15.3106635	1.228894559	15.42576342	0.109505289	0.219010577	20.96021862	176.0053225	144.3224478	2.46898714	6.956399935	48.93417351	25.60830668	0.127278121	40.00993963	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																			0.065880216	0.065880216	0.152824652	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065880216	0.065880216	0.152824652	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.6058	0.109591193	7.067908908	0	2.329765388	0.906339956	0.092506323	4.053390613	3.567384596	0.286332432	3.594202876	0.025514732	0.051029464	4.883730939	41.00924014	33.62713033	0.575274004	1.620841185	11.40166243	5.966735456	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.1263			17.6058	0.109591193	7.067908908	0	2.329765388	0.906339956	0.092506323	4.053390613	3.567384596	0.286332432	3.594202876	0.025514732	0.051029464	4.883730939	41.00924014	33.62713033	0.575274004	1.620841185	11.40166243	5.966735456	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.1263	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			17.6058	0.109591193	7.067908908	0	2.329765388	0.906339956	0.092506323	4.053390613	3.567384596	0.286332432	3.594202876	0.025514732	0.051029464	4.883730939	41.00924014	33.62713033	0.575274004	1.620841185	11.40166243	5.966735456	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.1263
H5425_804_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	286.3586634	1.782506831	49.55735175	23.0206952	10.71437472	4.168173312	0.425427992	18.64116711	16.40607055	1.316816273	16.52940534	0.117339885	0.234679769	22.45982518	187.2889246	153.5748786	2.627272515	7.402370816	52.07131581	27.25004079	0.127278121	40.00993963	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																			0.068221323	0.068221323	0.141210675	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.068221323	0.068221323	0.141210675	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.5358	0.121604975	6.998027109	0	2.49644931	0.971184382	0.099124722	4.343391936	3.822614439	0.306818192	3.851351443	0.027340193	0.054680386	5.233139266	43.63831942	35.78294671	0.612154496	1.7247524	12.13261658	6.349259505	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.4535			19.5358	0.121604975	6.998027109	0	2.49644931	0.971184382	0.099124722	4.343391936	3.822614439	0.306818192	3.851351443	0.027340193	0.054680386	5.233139266	43.63831942	35.78294671	0.612154496	1.7247524	12.13261658	6.349259505	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.4535	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			19.5358	0.121604975	6.998027109	0	2.49644931	0.971184382	0.099124722	4.343391936	3.822614439	0.306818192	3.851351443	0.027340193	0.054680386	5.233139266	43.63831942	35.78294671	0.612154496	1.7247524	12.13261658	6.349259505	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	157.4535
H5426_001_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis	Other				Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	V	O	O	O	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	0	0	0	0	0	0		0	NO	1399.560488	3.093134	703.943358	77.133811	164.21164	0.364613	4.024177	257.661448	327.756179	85.837588	78.711047	17.863141	0.005558	70.045785	4172.26068	8270.12197	2.51845	527.811046			26.049212	0.10675							0.04	0.14	165.367544	23.499256	284.023036	0.05	0.55	2.7	884.743896	0.25				$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0/Visit:14h, 8a, 8b, 9a"	$100/Visit:9a	20% Coins:12	"$25-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $25 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	$75/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: OTC items 13c	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $75 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$25/Proc:12	"$75/Visit:3, 5, 7h, 8b, 9a, 9d"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$25/Visit:7i	$0: Member Incentive Program 14a			119.30775	110.4939	50.7565	0	150	0.2	0.2	50	0	69.161651	0	100	0.2	122.624609	0	25	25	75			0.2	0.2							0	0	88.294238	25	75	0	0	0	25	0	0		NO	115.261786	106.746831	44.04979	0	141.37425	0.188499	0.188499	47.12475	0	65.18451	0	94.2495	0.188499	115.573081	0	23.562375	23.562375	70.687125			0.188499	0.188499							0	0	83.216878	23.562375	70.687125	0	0	0	23.562375	0	0			13.443	0.027515188	2.584046424	0	1.934608121	0.068729186	0.75855334	1.01185261	0	0.466273426	0	0.140299342	0.001047677	0.674617265	0	16.23864293	0.004945055	3.109120449	0	0	4.910250413	0.020122268	0	0	0	0	0	0	0	0	1.146780895	0.046141524	1.673064321	0	0	0	1.737222288	0	0	0	49.9968	0	2.937218	13.443	0.027515188	2.584046424	0	1.934608121	0.068729186	0.75855334	1.01185261	0	0.466273426	0	0.140299342	0.001047677	0.674617265	0	16.23864293	0.004945055	3.109120449	0	0	4.910250413	0.020122268	0	0	0	0	0	0	0	0	1.146780895	0.046141524	1.673064321	0	0	0	1.737222288	0	0	0	49.9968	YES	20% Coins	$150/Day(Days 1-10)	20% Coins(Days 1-13) 20%(Days 14-100)	$0/Visit	$150/Trip	20% Coins	20% Coins	$50/Visit	20% Coins	$0-$75/Visit	20% Coins	20% Coins	20% Coins	$25-$150/Visit	20% Coins	20% Coins	$25/Visit	$75/Visit			20% Coins	20% Coins									$0-$150/Visit	$25/Proc	20% Coins				20% Coins				7500	4.5769	0.0024	0.2367	0	0.6938	0.0379	0.4185	0.0941	0.7106	0.0433	0.0107	0.0588	0.0001	0.0627	0.7421	3.3073	0.0003	0.2891			0.341	0									0.0943	0.0043	0.1329				0.061				11.9187	0	3.583132	18.0198	0.029943188	2.820708424	0	2.628362121	0.106647186	1.17704334	1.10592561	0.710618	0.509623426	0.010707	0.199103342	0.001150677	0.737337265	0.742086	19.54597593	0.005280055	3.398178449	0	0	5.251205413	0.020122268	0	0	0	0	0	0	0	0	1.241047895	0.050431524	1.805961321	0	0	0	1.798221288	0	0	0	61.9155
H5426_002_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered		Radiology	Renal Dialysis	Other					Therapy (PT/OT/ST)			D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	V	P	V	V	O	O	O	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	NO	1461.062185	4.889582002	614.520208	1553.670909	189.0492034	0.738690067	4.201309489	358.3771642	0	182.2371348	46.174209	19.358266	0.002135923	0	4210.661826	7405.245975	8.299427325	249.5559784			20.077368	188.395525							0.04	0.25	119.785414	16.371093	262.750507	363.055882	0.05	0.55	2.7	381.631247	0.42			$175/Day(Days 1-10):1a	$175/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0/Visit:9a, 9b"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0/Visit:14h, 8a, 8b, 9a"	$100/Visit:9a	20% Coins:12	"$25/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	$75/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $75 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$25/Proc:12	"$25-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $25 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$25/Visit:7i	$0: Nutritional benefit 14a		139.192375	128.90955	50.7565	0	150	0.2	0.2	50	0	69.161411	0	100	0.2	0	0	25	25	75			0.2	25							0	0	88.130611	25	79.104776	0	0	0	0	25	0		NO	133.971826	124.074668	45.469804	0	141.63735	0.18885	0.18885	47.21245	0	65.305593	0	94.4249	0.18885	0	0	23.606225	23.606225	70.818675			0.18885	23.606225							0	0	83.217242	23.606225	74.694606	0	0	0	0	23.606225	0			16.3118	0.050556105	2.328509451	0	2.231369016	0.139501619	0.793417297	1.409988662	0	0.99175868	0	0.152325194	0.000403369	0	0	14.56749189	0.016326512	1.472768644	0	0	3.791610947	0.370608929	0	0	0	0	0	0	0	0	0.830684315	0.032204975	1.6355038	0	0	0	0	0.750739424	0	0	47.8775	0	3.162501	16.3118	0.050556105	2.328509451	0	2.231369016	0.139501619	0.793417297	1.409988662	0	0.99175868	0	0.152325194	0.000403369	0	0	14.56749189	0.016326512	1.472768644	0	0	3.791610947	0.370608929	0	0	0	0	0	0	0	0	0.830684315	0.032204975	1.6355038	0	0	0	0	0.750739424	0	0	47.8775	YES	20% Coins		20% Coins(Days 1-6) 20%(Days 7-100)						$25/Visit		20% Coins	20% Coins			20% Coins	20% Coins					20% Coins	$25/Service									$0-$150/Visit	$25/Proc	$0-$150/Visit	20% Coins				25% Coins			7500	4.3526		0.2319						0		0.0064	0.0153			0.8436	3.2053					0.2722	0									0.0708	0.0031	0.0735	0.8302				0.0322			9.9372	0	2.703185	20.6644	0.050556105	2.560378451	0	2.231369016	0.139501619	0.793417297	1.409988662	0	0.99175868	0.006416	0.167612194	0.000403369	0	0.843631	17.77275389	0.016326512	1.472768644	0	0	4.063842947	0.370608929	0	0	0	0	0	0	0	0	0.901515315	0.035300975	1.7089878	0.830217	0	0	0	0.782941424	0	0	57.8147
H5426_008_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered				Radiology	Renal Dialysis				Specialist excl. MH					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	NO	1864.122082	1.940218	712.904896	355.926799	165.602615	0.280368	3.160821	297.593497	330.321987	84.456652	75.798021	23.231949	0.003486	294.808717	4791.056218	205.66117	1.579655	1035.316477			24.38073	1.208802							0.04	0.25	185.10805	14.740259	0.05	0.55	2.7	9238.269408	0.42					$250/Day(Days 1-7):1a	$250/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	20% Coins:12	"$40-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $40 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$0/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $75 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$25/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	"$40/Visit:7b, 7d, 7f"	$0: Nutritional benefit 14a				176.397	155.999	50.7565	0	150	0.2	0.2	50	0	69.162461	0	150	0.2	84.016232	0	40	40	53.077996			0.2	0							0	0	85.102404	25	0	0	0	40	0				NO	165.701168	146.540001	38.485913	0	136.6434	0.182191	0.182191	45.5478	0	63.003959	0	136.6434	0.182191	76.535091	0	36.43824	36.43824	48.351719			0.182191	0							0	0	77.524545	22.7739	0	0	0	36.43824	0					25.7406	0.023693296	2.28639965	0	1.885708697	0.051080526	0.575873139	1.129560757	0	0.443425287	0	0.264541042	0.000635118	1.880267665	0	0.624494256	0.004796654	4.171610948	0	0	4.441949579	0	0	0	0	0	0	0	0	0	1.195868113	0.027974432	0	0	0	28.05218982	0	0	0	0	72.8007	0	6.766254	25.7406	0.023693296	2.28639965	0	1.885708697	0.051080526	0.575873139	1.129560757	0	0.443425287	0	0.264541042	0.000635118	1.880267665	0	0.624494256	0.004796654	4.171610948	0	0	4.441949579	0	0	0	0	0	0	0	0	0	1.195868113	0.027974432	0	0	0	28.05218982	0	0	0	0	72.8007	YES	30% Coins		30% Coins(Days 1-6) 30%(Days 7-100)						30% Coins		30% Coins	30% Coins			30% Coins																$0-$150/Visit	$25/Proc				30% Coins					7500	6.0885		0.2328						0.9208		0.013	0.0664			1.1891																0.0762	0.0035				3.987					12.5771	0	6.867503	31.8291	0.023693296	2.51916365	0	1.885708697	0.051080526	0.575873139	1.129560757	0.920788	0.443425287	0.012974	0.330898042	0.000635118	1.880267665	1.189081	0.624494256	0.004796654	4.171610948	0	0	4.441949579	0	0	0	0	0	0	0	0	0	1.272039113	0.031445432	0	0	0	32.03922182	0	0	0	0	85.3778
H5426_013_0	2010	6	N/A	r.	s.	t.	u.	v.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered																D	D	D	V	T	O	O	V	V	V	V	V	P	V	V	V	V	V			S	Coin								O	O	O	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	NO	3882.419485	7.006117	3139.137753	98.536344	704.643508	974.326858	4052.302195	833.094328	616.989652	255.969356	2907.079204	92.848911	26.36019	928.589424	16429.75516	18636.74847	0.037649	1660.677439			3525.170262	0								0.04	0.05	0.25	0.42	0.55	2.7							$0/Day(Days 1-1):1a	$0/Day(Days 1-1):1b	$0/Day(Days 1-100) $0(Days 100-100):2	$0/Visit:6	$25/Trip:10a	:11a	:11b	$25/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			$0/Script:15									$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0								0	0	0	0	0	0						NO	0	0	0	0	25	0	0	25	0	0	0	0	0	0	0	0	0	0			0	0								0	0	0	0	0	0							0	0	0	0	1.468007308	0	0	1.735613183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.2036	0	0	0	0	0	0	1.468007308	0	0	1.735613183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.2036	NO																																																																																		0	0	0	0	0	0	0	1.468007308	0	0	1.735613183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.2036
H5426_019_0	2010	5	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered					Renal Dialysis				Specialist excl. MH						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	P	O	O	O	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	YES	1514.310885	4.690177	636.916518	1610.294752	142.938245	0.487509	2.772719	338.862627	376.287525	172.313796	172.008056	20.063782	0.002011	272.326501	4364.120227	207.564232	8.038154	631.506882			20.809093	195.261637							0.04	0.25	16.96774	0.05	0.55	2.7	7467.567394						7500	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $75 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $40 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$25/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	"$40/Visit:7b, 7d, 7f"						158.7573	140.3991	50.7565	0	150	0.2	0.2	50	0	69.161411	50.311186	100	0.2	79.104776	10	40	40	53.077997			0.2	25							0	0	25	0	0	0	40	0					NO	151.696887	134.155131	42.355944	0	139.06185	0.185416	0.185416	46.35395	0	64.118092	46.642444	92.7079	0.185416	73.336377	9.27079	37.08316	37.08316	49.207497			0.185416	23.176975							0	0	23.176975	0	0	0	37.08316	0						19.143	0.052434276	2.248100031	0	1.656438065	0.090391969	0.514106466	1.308968439	0	0.920702652	0.66857301	0.155005925	0.000372872	1.664286579	3.37157018	0.641428135	0.024840013	2.58957275	0	0	3.858338788	0.377131173	0	0	0	0	0	0	0	0	0.03277174	0	0	0	23.07674971	0	0	0	0	0	62.3948	0	4.560373	19.143	0.052434276	2.248100031	0	1.656438065	0.090391969	0.514106466	1.308968439	0	0.920702652	0.66857301	0.155005925	0.000372872	1.664286579	3.37157018	0.641428135	0.024840013	2.58957275	0	0	3.858338788	0.377131173	0	0	0	0	0	0	0	0	0.03277174	0	0	0	23.07674971	0	0	0	0	0	62.3948	NO																																																																																		0	0	0	19.143	0.052434276	2.248100031	0	1.656438065	0.090391969	0.514106466	1.308968439	0	0.920702652	0.66857301	0.155005925	0.000372872	1.664286579	3.37157018	0.641428135	0.024840013	2.58957275	0	0	3.858338788	0.377131173	0	0	0	0	0	0	0	0	0.03277174	0	0	0	23.07674971	0	0	0	0	0	62.3948
H5427_052_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	956.960223	12.37795929	357.483124	381.058173	208.3020614	1.416446839	3.042812929	224.8109542	173.027746	56.18911737	44.83630007	0	0.022779712	50.73135043	3986.309303	10287.45945	0.370533364	225.0893931	39.02484012	0	4.627538099	0	0	0.049622022	5.656910562	0	0.19848809	0.148866067	0	0											3400	$250 per day for days 1-10	$250 per day for days 1-10	$125/day days 9-35	$0-$25 per visit	"$100 per trip, no copay if admitted to the hospital within 24 hours"	20% coins	20% coins	$50 per visit; $10 UC	$195 per visit; $50 ASC	0	"$0 X-ray, $25-$200 other diagnostic; 20% therapeutic"	195	20% coins	"$25 MH/SA, Cardiac rehab"	0	$25 copay	$25 copay	$25-$50 per visit	20% coins		20% coins	$10 copay for Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"												209.7805787	156.687702	55.87395108	12.5	80	0.2	0.2	31	122.5	0	102.2727273	195	0.2	16.66666667	0	25	25	37.5	0.2		0.2	10	0	4.166666667	0	10	0	0	0												NO	181.4976256	135.5628155	48.34093565	10.81473001	69.21427207	0.17303568	0.17303568	26.82053043	105.9843541	0	88.48415464	168.7097882	0.17303568	14.41964002	0	21.62946002	21.62946002	32.44419003	0.17303568	0	0.17303568	8.651784009	0	3.604910004	0	8.651784009	0	0	0	0												14.4738	0.139832584	1.440089058	0.343420105	1.201456296	0.245095842	0.526515205	0.50246242	1.528186158	0	0.330608509	0	0.003941703	0.060960651	0	18.54268275	0.00066787	0.608570254	6.752689755	0	0.800729203	0	0	1.49E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5018	0	7.402245447	14.4738	0.139832584	1.440089058	0.343420105	1.201456296	0.245095842	0.526515205	0.50246242	1.528186158	0	0.330608509	0	0.003941703	0.060960651	0	18.54268275	0.00066787	0.608570254	6.752689755	0	0.800729203	0	0	1.49E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5018	NO																																																																																		0	0	0	14.4738	0.139832584	1.440089058	0.343420105	1.201456296	0.245095842	0.526515205	0.50246242	1.528186158	0	0.330608509	0	0.003941703	0.060960651	0	18.54268275	0.00066787	0.608570254	6.752689755	0	0.800729203	0	0	1.49E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5018
H5427_053_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	P	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	904.8039593	9.047694772	340.9523001	302.8632904	192.1163284	1.330373424	4.916707603	204.0014897	154.6396493	65.41070074	56.37150014	0	0.028165898	58.3164979	3819.959371	10968.68414	2.123472226	289.7705834	37.53286776	0	5.485800461	0	0	0	6.739818211	0	0	0	0	0											3400	$225 per day for days 1-10	$225 per day for days 1-10	"$0/day days 1-8, $125/day days 9-35"	$0-$25 per visit	"$100 per trip, no copay if admitted to the hospital within 24 hours"	20% coins	20% coins	$50 per visit; $10 UC	$200 OP hospital; $50 ASC	0	"$0 X-ray, $25-$200 other diagnostic; 20% therapeutic"		20% coins	$30 MH/SA	$0 per visit	$30 copay	$30 copay for individual or group therapy	$25-$50 per visit	20% coins		20% coins	$10 copay for Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	$20/month OTC											188.8025208	141.0189318	55.87395108	12.5	80	0.2	0.2	31	125	0	102.2727273	0	0.2	10	0	30	30	37.5	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	160.4631477	119.8519044	47.48723706	10.6237424	67.99195137	0.169979878	0.169979878	26.34688116	106.237424	0	86.92152874	0	0.169979878	8.498993921	0	25.49698176	25.49698176	31.8712272	0.169979878	0	0.169979878	8.498993921	0	3.541247467	0	8.498993921	0	0	0	0												12.099	0.090365287	1.349240225	0.268128465	1.088530338	0.226136713	0.835741361	0.44790025	1.369043166	0	0.408324747	0	0.004787636	0.04130263	0	23.30569495	0.004511844	0.769612008	6.379832298	0	0.932475695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6206	0	8.763487275	12.099	0.090365287	1.349240225	0.268128465	1.088530338	0.226136713	0.835741361	0.44790025	1.369043166	0	0.408324747	0	0.004787636	0.04130263	0	23.30569495	0.004511844	0.769612008	6.379832298	0	0.932475695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6206	NO																																																																																		0	0	0	12.099	0.090365287	1.349240225	0.268128465	1.088530338	0.226136713	0.835741361	0.44790025	1.369043166	0	0.408324747	0	0.004787636	0.04130263	0	23.30569495	0.004511844	0.769612008	6.379832298	0	0.932475695	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.6206
H5427_054_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	1420.678985	19.24765276	642.6060614	429.4398331	265.31969	2.038325012	3.826625148	265.1385415	254.6838574	78.36423893	79.40062535	0	0.059918845	73.40794221	5603.006642	14849.2174	0.871088937	437.7765517	50.60494443	0	7.878341302	0	0	0	0	0	0	0	0	0											3400	$195/day days 1-10	$195/day days 1-10	"$0/day days 1-8, $125/day days 9-35"	$0-$25 per visit	"$100/trip, no copay if admitted to the hospital within 24 hours"	20% coins	20% coins	$50/visit; $10 UC	$200/Procedure; $50 ASC	0	"$0 X-ray, $25-$200 other diagnostic; 20% therapeutic"		20% coins	$25 MH/SA	$0/visit	$25 copay	$25 copay	$25-$50/visit	20% coins		20% coins		$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	$20/month OTC											163.6288514	122.2164076	55.87395108	12.5	80	0.2	0.2	31	125	0	102.2727273	0	0.2	8.333333333	0	25	25	37.5	0.2		0.2	0	0	4.166666667	0	10	0	0	0	0											NO	135.8493562	101.46756	46.38815356	10.37785781	66.41828997	0.166045725	0.166045725	25.73708736	103.7785781	0	84.9097457	0	0.166045725	6.918571872	0	20.75571561	20.75571561	31.13357342	0.166045725	0	0.166045725	0	0	3.459285936	0	8.302286246	0	0	0	0												16.0832	0.16275103	2.484109054	0.371388794	1.468506675	0.338455154	0.635394747	0.568657817	2.202560715	0	0.561823909	0	0.009949268	0.042323177	0	25.68384445	0.001506673	1.135795701	8.402734682	0	1.308164893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4612	0	12.56803903	16.0832	0.16275103	2.484109054	0.371388794	1.468506675	0.338455154	0.635394747	0.568657817	2.202560715	0	0.561823909	0	0.009949268	0.042323177	0	25.68384445	0.001506673	1.135795701	8.402734682	0	1.308164893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4612	NO																																																																																		0	0	0	16.0832	0.16275103	2.484109054	0.371388794	1.468506675	0.338455154	0.635394747	0.568657817	2.202560715	0	0.561823909	0	0.009949268	0.042323177	0	25.68384445	0.001506673	1.135795701	8.402734682	0	1.308164893	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4612
H5427_059_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	1140.487114	11.92563303	502.6880394	223.5470174	256.1886416	4.601099626	4.942084255	237.7996237	161.0702486	117.5891077	50.33538866	0	0.042103982	64.42648846	3119.447359	12109.74528	1.741080395	410.2981517	40.87903423	0	7.254798778	0	0	0	12.05714857	0	2.411429715	3.617144572	0	0											3400	$150 per day for days 1-7	$150 per day for days 1-7	"$0/day days 1-8, $125/day days 9-35"	$0-$20 per visit	"$100 per trip, no copay if admitted to the hospital within 24 hours"	20% coins	20% coins	$50 per visit ER; $10 Urgent Care	$200 OP hospital; $50 ASC	0	"$0 X-ray, $25-150 other diagnostic; 20% therapeutic"		20% coins	$25 MH/SA	$0 copay	$25 copay	$25 copay	$20-$40 per visit	20% coins		20% coins	$10 copay for Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	$30/month OTC											112.681972	78.82099431	55.87395108	10	80	0.2	0.2	31	125	0	79.54545455	0	0.2	8.333333333	0	25	25	30	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	96.00753067	67.15722928	47.60584127	8.520221024	68.16176819	0.17040442	0.17040442	26.41268517	106.5027628	0	67.77448542	0	0.17040442	7.100184187	0	21.30055256	21.30055256	25.56066307	0.17040442	0	0.17040442	8.520221024	0	3.550092093	0	8.520221024	0	0	0	0												9.1246	0.066741039	1.994240584	0.1587225	1.455189234	0.784047715	0.842153003	0.52341055	1.42953554	0	0.284287922	0	0.007174705	0.038119995	0	21.49535549	0.003090498	0.873957734	6.965968138	0	1.236249781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2829	0	8.212014407	9.1246	0.066741039	1.994240584	0.1587225	1.455189234	0.784047715	0.842153003	0.52341055	1.42953554	0	0.284287922	0	0.007174705	0.038119995	0	21.49535549	0.003090498	0.873957734	6.965968138	0	1.236249781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2829	NO																																																																																		0	0	0	9.1246	0.066741039	1.994240584	0.1587225	1.455189234	0.784047715	0.842153003	0.52341055	1.42953554	0	0.284287922	0	0.007174705	0.038119995	0	21.49535549	0.003090498	0.873957734	6.965968138	0	1.236249781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2829
H5427_060_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P		Coin	V	V	V	V	V	Coin		Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	1854.834755	28.10370502	957.8565966	257.2018743	455.6816937	5.185458859	6.89995215	323.0075591	226.5554009	91.96808073	71.21897068	0	0.123853772	105.9871106	4877.280578	17691.33189	1.513697308	532.2637366	59.24414566	0	14.27559476	0	0	0	0	0	0	0	0	0											3400	$100 per day for days 1-7	$100 per day for days 1-7	$95 per day for days 9-35	$0-$15 per visit	$100 per trip	20% coins	20% coins	$50 per visit; $10 UC	$200 OP hospital; $50 ASC	0	"$0 X-ray, $25-150 other diagnostic; 20% therapeutic"		20% coins	$15 MH/SA	$0 copay	$20 copay	$20 copay	$20-$40 per visit	20% coins		20% coins	$10 copay for Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	$30/month OTC											75.12131465	52.54732954	42.46420282	7.5	80	0.2	0.2	31	125	0	79.54545455	0	0.2	5	0	18.5	20	30	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	75.06771994	52.50984006	42.43390707	7.494649184	79.94292463	0.199857312	0.199857312	30.97788329	124.9108197	0	79.48870347	0	0.199857312	4.996432789	0	18.48680132	19.98573116	29.97859674	0.199857312	0	0.199857312	9.992865578	0	4.163693991	0	9.992865578	0	0	0	0												11.6032	0.122976755	3.38713315	0.160636485	3.035710608	1.036351867	1.379005887	0.833840872	2.358268404	0	0.471758637	0	0.024753082	0.04412979	0	27.25467814	0.002521029	1.329709993	11.84037568	0	2.85308199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7381	0	0.048361731	11.6032	0.122976755	3.38713315	0.160636485	3.035710608	1.036351867	1.379005887	0.833840872	2.358268404	0	0.471758637	0	0.024753082	0.04412979	0	27.25467814	0.002521029	1.329709993	11.84037568	0	2.85308199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7381	NO																																																																																		0	0	0	11.6032	0.122976755	3.38713315	0.160636485	3.035710608	1.036351867	1.379005887	0.833840872	2.358268404	0	0.471758637	0	0.024753082	0.04412979	0	27.25467814	0.002521029	1.329709993	11.84037568	0	2.85308199	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7381
H5427_062_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	P	V	V	V	V	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	2567.22114	38.89749501	1325.74058	355.9853981	630.6953618	7.177038043	9.550016772	447.0650724	313.5685338	127.2902615	98.57204075	0	0.171422291	146.6935801	6750.49773	24486.04172	2.095063033	736.69027	6631.490734	0	19.75842244	0	0	0	0	0	0	0	0	0											3400	"$0 per day for days 1-30, $25 per day 31-90"	"$0 per day for days 1-30, $25 per day 31-90"	"$0 per day for days 1-30, $25 per day for days 31-100"	$0 per visit	$25 per trip	0%-10% coins	20% Prosthetics/medical supplies; 0% diabetic monitoring supplies	$25 per visit: $0 UC	$50 OP hospital; $0 ASC	0	$0-50 copay	50	20% coins	$0 MH/SA	$0 copay	$0 copay	$0 copay for individual or group therapy	$0-$25 per visit	$25 copay		20% coins	$10 copay for Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	$30/month OTC											0.66342119	2.843620132	0.268702017	0	20	0.05	0.1	14	25	0	22.72727273	50	0.2	0	0	0	0	12.5	25		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	0.660883653	2.832743496	0.267674252	0	19.92350148	0.049808754	0.099617507	13.94645103	24.90437685	0	22.64034259	49.8087537	0.199235015	0	0	0	0	12.45218842	24.90437685	0	0.199235015	9.961750739	0	4.150729475	0	9.961750739	0	0	0	0												0.1414	0.009182219	0.029572218	0	1.047138331	0.35747932	0.951348866	0.519580928	0.650769078	0	0.185975398	0	0.034153323	0	0	0	0	0.764450504	13.76276202	0	3.936569587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3904	0	0.085970333	0.1414	0.009182219	0.029572218	0	1.047138331	0.35747932	0.951348866	0.519580928	0.650769078	0	0.185975398	0	0.034153323	0	0	0	0	0.764450504	13.76276202	0	3.936569587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3904	NO																																																																																		0	0	0	0.1414	0.009182219	0.029572218	0	1.047138331	0.35747932	0.951348866	0.519580928	0.650769078	0	0.185975398	0	0.034153323	0	0	0	0	0.764450504	13.76276202	0	3.936569587	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	22.3904
H5427_070_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	T	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	2890.748662	30.21993667	1231.611743	669.4218559	622.1014694	5.586951433	12.60555768	378.8916659	303.5929209	121.5669129	85.4375885	0	0.106869189	123.4965465	6045.730516	22959.34927	0.520908368	731.4661464	87.89033085	0	12.88286243	0	0	0	221.537025	0	0	0	0	0											3400	$95/days 1-7	$95/days 1-7	$125/days 9-35	$0 per visit	$100 per trip	20% coins	20% proshtetics/supplies; 0% diabetic monitoring supplies	$50 per visit; $10 Urgent Care	$200/OP hospital; $50 ASC	0	"$0 X-ray, $25-$150 other diag., 20% therap"	200	20% coins	"$15 MH/SA, Cardiac rehab"	$0 copay	$15 per visit	$15 per visit	$20-$40 copay	20% coins		20% coins	$10 copay Med-covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	"$50 copay for ER worldwide coverage, $0 copay for up to 2 routine physical exam, $30 OTC"											71.36524892	49.91996306	55.87395108	0	80	0.2	0.1	31	125	0	79.54545455	200	0.2	10	0	4.5	15	30	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	57.6641347	40.33603915	45.14694603	0	64.64113621	0.161602841	0.08080142	25.04844028	101.0017753	0	64.27385703	161.6028405	0.161602841	8.080142026	0	3.636063912	12.12021304	24.24042608	0.161602841	0	0.161602841	8.080142026	0	3.366725844	0	8.080142026	0	0	0	0												13.891	0.101579379	4.633625742	0	3.351112152	0.902867222	1.018546964	0.790887106	2.555285332	0	0.457616946	0	0.017270365	0.083155803	0	6.95680511	0.000526127	1.477587588	14.20332712	0	2.081907163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5231	0	12.47960438	13.891	0.101579379	4.633625742	0	3.351112152	0.902867222	1.018546964	0.790887106	2.555285332	0	0.457616946	0	0.017270365	0.083155803	0	6.95680511	0.000526127	1.477587588	14.20332712	0	2.081907163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5231	NO																																																																																		0	0	0	13.891	0.101579379	4.633625742	0	3.351112152	0.902867222	1.018546964	0.790887106	2.555285332	0	0.457616946	0	0.017270365	0.083155803	0	6.95680511	0.000526127	1.477587588	14.20332712	0	2.081907163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.5231
H5427_072_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	2127.055824	22.3586807	850.375156	487.0465946	449.4094821	4.524843781	10.18249178	290.2902045	234.020858	93.90645895	65.58546339	0	0.083513712	95.39703766	4307.399837	16380.34213	0.372644678	522.4478391	70.39652435	0	10.42614712	0	0	0	0	0	0	0	0	0											3400	$195/day days 1-10	$195/day days1-10	$125/day days 9-35	$0-25/visit	"$100/trip, no copay if admitted to the hospital within 24 hours"	20% coins	20% proshtetics/supplies; 0% diabetic monitoring supplies	$50/visit ER; $10 Urgent Care	$200 OP hospital; $50 ASC	0	"$0 X-ray, $25-$200 other diagnostic; 20% therapeutic"	200	20% coins	"$25 MH/SA, Cardiac Rehab"	$0/visit	$25 copay	$25 copay	$25-$50/visit	20% coins		20% coins	$10 copay Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	"$50 copay ER worldwide coverage, $20/month OTC"											163.6288514	122.2164076	55.87395108	12.5	80	0.2	0.1	31	125	0	102.2727273	200	0.2	16.66666667	0	7.5	25	37.5	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	130.3355716	97.34924619	44.50537475	9.956646587	63.72253816	0.159306345	0.079653173	24.69248354	99.56646587	0	81.46347208	159.3063454	0.159306345	13.27552878	0	5.973987952	19.91329317	29.86993976	0.159306345	0	0.159306345	7.96531727	0	3.318882196	0	7.96531727	0	0	0	0												23.1026	0.181383393	3.153855416	0.404112568	2.386459406	0.720836326	0.811067776	0.597332175	1.941719148	0	0.445234964	0	0.013304264	0.105537177	0	8.154663877	0.000618382	1.300457123	11.21461302	0	1.660951395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1947	0	14.35453837	23.1026	0.181383393	3.153855416	0.404112568	2.386459406	0.720836326	0.811067776	0.597332175	1.941719148	0	0.445234964	0	0.013304264	0.105537177	0	8.154663877	0.000618382	1.300457123	11.21461302	0	1.660951395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1947	NO																																																																																		0	0	0	23.1026	0.181383393	3.153855416	0.404112568	2.386459406	0.720836326	0.811067776	0.597332175	1.941719148	0	0.445234964	0	0.013304264	0.105537177	0	8.154663877	0.000618382	1.300457123	11.21461302	0	1.660951395	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1947
H5427_076_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	5221.482025	73.88431091	1750.377655	780.1599935	1025.144814	8.438040312	27.47431953	680.9994709	489.9696408	179.3638863	167.6979425	0	0.18450781	172.5587524	9493.647871	34069.41679	1.458242978	734.4683801	97.5948319	0	19.69673829	0	0	0	0	0	0	0	0	0											3400	$95/day days 1-7	$95/day days 1-7	$125/day days 9-35	0	"$100/trip, no copay if admitted to the hospital within 24 hours"	0-20% coins	20% coins	$50/visit ER; $10 Urgent Care	$200 OP hospital; $50 ASC	0	"$0 X-ray, $25-150 other diagnostic; 20% therapeutic"	200	20% coins	"$15 MH/SA, Cardiac Rehab"	$0/visit	$15 copay	$15 copay	$20-$40 copay	20% coins		20% coins	$10 copay Med-covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	"$50 copay ER worldwide coverage, $30/month OTC"											71.36524892	49.91996306	55.87395108	0	80	0.1	0.2	31	125	0	79.54545455	200	0.2	10	0	4.5	15	30	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	50.58833378	35.38651923	39.6070935	0	56.7092074	0.070886509	0.141773019	21.97481787	88.60813657	0	56.386996	141.7730185	0.141773019	7.088650925	0	3.189892916	10.63297639	21.26595278	0.141773019	0	0.141773019	7.088650925	0	2.953604552	0	7.088650925	0	0	0	0												22.0122	0.217875716	5.777280954	0	4.844595822	0.598143223	3.895117211	1.247069945	3.617941404	0	0.787998601	0	0.026158229	0.101934063	0	9.056482606	0.001292122	1.301597491	13.83631391	0	2.792466042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1144	0	28.79639765	22.0122	0.217875716	5.777280954	0	4.844595822	0.598143223	3.895117211	1.247069945	3.617941404	0	0.787998601	0	0.026158229	0.101934063	0	9.056482606	0.001292122	1.301597491	13.83631391	0	2.792466042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1144	NO																																																																																		0	0	0	22.0122	0.217875716	5.777280954	0	4.844595822	0.598143223	3.895117211	1.247069945	3.617941404	0	0.787998601	0	0.026158229	0.101934063	0	9.056482606	0.001292122	1.301597491	13.83631391	0	2.792466042	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1144
H5427_077_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	4325.952848	61.2125147	1450.172799	646.3558295	849.3236414	6.990843662	22.76223689	564.2021914	405.9356238	148.6014337	138.9362998	0	0.15286313	142.9634389	7865.405425	28226.21813	1.208141737	608.5007218	80.85647695	0	16.31857789	0	0	0	0	0	0	0	0	0											3400	$195/day days 1-10	$195/day days1-10	$125/day days 9-35	$0-25/visit	"$100/trip, no copay if admitted to the hospital within 24 hours"	0-20% coins	20% coins	$50/visit ER; $10 Urgent Care	$200 OP hospital; $50 ASC	0	"$0 X-ray, $25-200 other diagnostic; 20% therapeutic"		20% coins	"$25 MH/SA, Cardiac rehab"	$0/visit	$25copay	$25 copay	$25-$50/visit	20% coins		20% coins	$10 copay Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	"$50 copay ER worldwide coverage, $20/month OTC"											163.6288514	122.2164076	55.87395108	12.5	80	0.1	0.2	31	125	0	102.2727273	0	0.2	16.66666667	0	7.5	25	37.5	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	105.811009	79.03154787	36.13103124	8.083156493	51.73220155	0.064665252	0.129330504	20.0462281	80.83156493	0	66.13491676	0	0.129330504	10.77754199	0	4.849893896	16.16631299	24.24946948	0.129330504	0	0.129330504	6.466525194	0	2.694385498	0	6.466525194	0	0	0	0												38.1445	0.403143315	4.366353224	0.435382943	3.661448483	0.452064667	2.943851567	0.942510485	2.734367644	0	0.765711719	0	0.019769866	0.128399539	0	11.40784692	0.0016276	1.22965164	10.45720891	0	2.110489901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2043	0	43.8256713	38.1445	0.403143315	4.366353224	0.435382943	3.661448483	0.452064667	2.943851567	0.942510485	2.734367644	0	0.765711719	0	0.019769866	0.128399539	0	11.40784692	0.0016276	1.22965164	10.45720891	0	2.110489901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2043	NO																																																																																		0	0	0	38.1445	0.403143315	4.366353224	0.435382943	3.661448483	0.452064667	2.943851567	0.942510485	2.734367644	0	0.765711719	0	0.019769866	0.128399539	0	11.40784692	0.0016276	1.22965164	10.45720891	0	2.110489901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2043
H5427_078_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	P	V	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	3708.64926	307.6879942	2478.952823	3086.175825	768.4301468	21.54798573	13.28204993	926.5994362	254.5208323	283.0802477	498.6615928	408.7869945	0.157127763	2519.551538	3951.609807	15148.30071	167.2489404	598.3488169	67.95220226	2343.8504	15.3947475	0	0	0	0	0	0	0	0	0											3400	$60/days 1-5	$60/days 1-5	$40/days 17-100	$0-20 copay	$100 copay	0.2	20% prosthetics/medical supplies; 0% diabetic monitoring supplies	$50 ER; $25 Urgent Care	$75 OP hospital; $50 ASC	0	$0-$50 copay diagnostic; 20% therapeutic	$0-$75	0.2	"$10-20 MH/SA, $15 Cardiac Rehab"	$0 copay	20	$10-20	20	0.2		20% coins	$10 copay	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	$35/month OTC											38.90648809	25.80267816	6.364101649	10	80	0.2	0.1	35.5	62.5	0	22.72727273	75	0.2	10	0	6	16.5	20	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	32.11866344	21.30101113	5.253787967	8.255348921	66.04279136	0.165106978	0.082553489	29.30648867	51.59593075	0	18.76215664	61.9151169	0.165106978	8.255348921	0	4.953209352	13.62132572	16.51069784	0.165106978	0	0.165106978	8.255348921	0	3.439728717	0	8.255348921	0	0	0	0												9.9264	0.546172116	1.085324376	2.123121522	4.229105989	3.557722815	1.096479566	2.26294799	1.09435327	0	0.779663909	2.109174546	0.02594289	1.733314756	0	6.252725397	0.189846024	0.823263043	11.21938279	0	2.541780243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5967	0	10.90423732	9.9264	0.546172116	1.085324376	2.123121522	4.229105989	3.557722815	1.096479566	2.26294799	1.09435327	0	0.779663909	2.109174546	0.02594289	1.733314756	0	6.252725397	0.189846024	0.823263043	11.21938279	0	2.541780243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5967	NO																																																																																		0	0	0	9.9264	0.546172116	1.085324376	2.123121522	4.229105989	3.557722815	1.096479566	2.26294799	1.09435327	0	0.779663909	2.109174546	0.02594289	1.733314756	0	6.252725397	0.189846024	0.823263043	11.21938279	0	2.541780243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5967
H5427_080_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	2920.149908	30.69533891	1167.446056	668.6467992	616.976312	6.211977138	13.9791359	398.5278168	321.2778805	128.9204234	90.03966079	0	0.114652637	130.9667793	5913.45704	22487.91687	0.511588982	717.2477524	96.64457404	0	14.31364058	0	0	0	0	0	0	0	0	0											3400	$150/day days 1-7	$150/day days1-7	$125/day days 9-35	$0/visit	"$100/trip, no copay if admitted to the hospital within 24 hours"	20% coins	20% proshtetics/supplies; 0% diabetic monitoring supplies	$50/visit ER; $10 Urgent Care	$200 OP hospital; $50 ASC	0	"$0 X-ray, 25-150 other diagnostic; 20% therapeutic"	200	20% coins	"$25 MH/SA, Cardiac Rehab"	$0/visit	$25 copay	$25 copay	$20-$40 copay	20% coins		20% coins	$10 copay Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	"$50 copay ER worldwide coverage, $30/month OTC"											112.681972	78.82099431	55.87395108	0	80	0.2	0.1	31	125	0	79.54545455	200	0.2	16.66666667	0	7.5	25	30	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	85.122545	59.54318616	42.20846362	0	60.43383409	0.151084585	0.075542293	23.41811071	94.42786577	0	60.09046003	151.0845852	0.151084585	12.5903821	0	5.665671946	18.88557315	22.66268778	0.151084585	0	0.151084585	7.554229261	0	3.147595526	0	7.554229261	0	0	0	0												20.7142	0.15230819	4.106342033	0	3.107187007	0.938533989	1.056015975	0.777730711	2.528132048	0	0.450877053	0	0.017322246	0.13741015	0	10.61742998	0.000805138	1.35456349	14.60150538	0	2.16257045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7229	0	20.3072941	20.7142	0.15230819	4.106342033	0	3.107187007	0.938533989	1.056015975	0.777730711	2.528132048	0	0.450877053	0	0.017322246	0.13741015	0	10.61742998	0.000805138	1.35456349	14.60150538	0	2.16257045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7229	NO																																																																																		0	0	0	20.7142	0.15230819	4.106342033	0	3.107187007	0.938533989	1.056015975	0.777730711	2.528132048	0	0.450877053	0	0.017322246	0.13741015	0	10.61742998	0.000805138	1.35456349	14.60150538	0	2.16257045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7229
H5427_081_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	P	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	5886.630033	83.29619856	1973.352704	879.5420967	1155.734755	9.512935462	30.97418581	767.7498302	552.3853168	202.212482	189.0604507	0	0.208011674	194.5404637	10703.01351	38409.41156	1.644003919	828.0299739	110.0271275	0	22.20584321	0	0	0	0	0	0	0	0	0											3400	$150/day days 1-7	$150/day days 1-7	"$0/day days 1-8, $125/day days 9-35"	0	"$100/trip, no copay if admitted to the hospital within 24 hours"	0-20% coins	20% coins	$50/visit ER; $10 Urgent Care	$200 OP hospital; $50 ASC	0	"$0 X-ray, $25-$150 other diagnostic; 20% therapeutic"	200	20% coins	"$25 MH/SA, Cardiac rehab"	$0/visit	$25 copay	$25 copay	$20-$40 copay	20% coins		20% coins	$10 copay Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	"$50 copay ER worldwide coverage, $30/month OTC"											112.681972	78.82099431	55.87395108	0	80	0.1	0.2	31	125	0	79.54545455	200	0.2	16.66666667	0	25	25	30	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	58.79550561	41.12743264	29.15406206	0	41.74261744	0.052178272	0.104356544	16.17526426	65.22283975	0	41.50544348	104.3565436	0.104356544	8.696378633	0	13.04456795	13.04456795	15.65348154	0.104356544	0	0.104356544	5.21782718	0	2.174094658	0	5.21782718	0	0	0	0												28.8423	0.2854799	4.7942706	0	4.020282812	0.496368532	3.232358972	1.034879699	3.002344916	0	0.653919821	0	0.021707379	0.140983128	0	41.75284825	0.00178711	1.080129326	11.48205073	0	2.317325045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.159	0	94.54591693	28.8423	0.2854799	4.7942706	0	4.020282812	0.496368532	3.232358972	1.034879699	3.002344916	0	0.653919821	0	0.021707379	0.140983128	0	41.75284825	0.00178711	1.080129326	11.48205073	0	2.317325045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.159	NO																																																																																		0	0	0	28.8423	0.2854799	4.7942706	0	4.020282812	0.496368532	3.232358972	1.034879699	3.002344916	0	0.653919821	0	0.021707379	0.140983128	0	41.75284825	0.00178711	1.080129326	11.48205073	0	2.317325045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.159
H5427_082_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	2425.163727	25.49226062	969.5556457	555.3064106	512.3944385	5.159002827	11.60957293	330.9745171	266.8189945	107.0674946	74.77729783	0	0.0952182	108.7669787	4911.084009	18676.055	0.42487101	595.6691566	80.2626313	0	11.88737669	0	0	0	0	0	0	0	0	0											3400	$195/day days 1-10	$195/day days1-10	$125/day days 9-35	$0-25/visit	"$100/trip, no copay if admitted to the hospital within 24 hours"	20% coins	20% Prosthetics/Medical supplies; 0% Diabetic monitoring supplies	$50/visit ER; $10 Urgent care	$200 OP hospital; $50 ASC	0	"$0 X-ray, $25-$200 other diagnostinc; 20% therapeutic"	200	20% coins	"$25 MH/SA, Cardiac Rehab"	$0/visit	$25 copay	$25 copay	$25-$50/visit	20% coins		20% coins	$10 copay Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit (cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	"$50 copay ER worldwide coverage, $20/month OTC"											163.6288514	122.2164076	55.87395108	12.5	80	0.2	0.1	31	125	0	102.2727273	200	0.2	16.66666667	0	7.5	25	37.5	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	124.8572866	93.25744758	42.63471793	9.538147274	61.04414255	0.152610356	0.076305178	23.65460524	95.38147274	0	78.03938679	152.6103564	0.152610356	12.7175297	0	5.722888364	19.07629455	28.61444182	0.152610356	0	0.152610356	7.630517819	0	3.179382425	0	7.630517819	0	0	0	0												25.2333	0.19811193	3.444727623	0.441382861	2.606556596	0.78731726	0.885870531	0.652422629	2.120799054	0	0.486297872	0	0.014531283	0.115270607	0	8.906748156	0.000675414	1.420395035	12.24890877	0	1.814136793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3774	0	19.05935303	25.2333	0.19811193	3.444727623	0.441382861	2.606556596	0.78731726	0.885870531	0.652422629	2.120799054	0	0.486297872	0	0.014531283	0.115270607	0	8.906748156	0.000675414	1.420395035	12.24890877	0	1.814136793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3774	NO																																																																																		0	0	0	25.2333	0.19811193	3.444727623	0.441382861	2.606556596	0.78731726	0.885870531	0.652422629	2.120799054	0	0.486297872	0	0.014531283	0.115270607	0	8.906748156	0.000675414	1.420395035	12.24890877	0	1.814136793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.3774
H5427_083_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	P	V	V	V	Coin	P	Coin	O	T	P	P	P	P	P	O	V																																																			0	YES	4910.237662	69.48018289	1646.040385	733.6558785	964.0375376	7.935061949	25.83661838	640.4061594	460.7633181	168.6722861	157.7017309	0	0.173509589	162.2727956	8927.746395	32038.59223	1.371319399	690.6878707	91.77735686	0	18.52264658	0	0	0	0	0	0	0	0	0											3400	$195/day days 1-10	$195/day days1-10	$125/day days 9-35	$0-25/visit	"$100/trip, no copay if admitted to the hospital within 24 hours"	0-20% coins	20% coins	$50/visit ER; $10 Urgent Care	$200 OP hospital; $50 ASC	0	"$0 X-ray, $25-$200 other diagnostic; 20% therapeutic"	200	20% coins	"$25 MH/SA, cardiac rehab"	$0/visit	$25 copay	$25 copay	$25-$50/visit	20% coins		20% coins	$10 copay Med- covered eyewear	$0 copay (cap)	"$0 copay for preventative services, e.g. cleaning, exams. Up to $75 copay for one X-ray (cap)"	$0 copay for one routine eye exam (cap)	$10 copay for one pair of frames or contacts per year (cap)	$0 copay for routine hearing test (cap)	$0 copay for hearing aids w/ $500 limit cap)	"written manuals, smoking cessation, and nursing hotline (cap)"	"$50 copay ER worldwide coverage, $20/month OTC"											163.6288514	122.2164076	56.26078676	12.5	80	0.1	0.2	31	125	0	102.2727273	200	0.2	16.66666667	0	7.5	25	37.5	0.2		0.2	10	0	4.166666667	0	10	0	0	0	0											NO	100.0098262	74.6985729	34.38654895	7.639990242	48.89593755	0.061119922	0.122239844	18.9471758	76.39990242	0	62.50901107	122.2398439	0.122239844	10.18665366	0	4.583994145	15.27998048	22.91997072	0.122239844	0	0.122239844	6.111992193	0	2.546663414	0	6.111992193	0	0	0	0												40.9227	0.432505876	4.716804024	0.467093646	3.928126602	0.484990367	3.158264197	1.01115734	2.933522712	0	0.821481603	0	0.021209785	0.137751397	0	12.2387266	0.001746144	1.319212148	11.21884977	0	2.264205426	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0783	0	54.75680472	40.9227	0.432505876	4.716804024	0.467093646	3.928126602	0.484990367	3.158264197	1.01115734	2.933522712	0	0.821481603	0	0.021209785	0.137751397	0	12.2387266	0.001746144	1.319212148	11.21884977	0	2.264205426	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0783	NO																																																																																		0	0	0	40.9227	0.432505876	4.716804024	0.467093646	3.928126602	0.484990367	3.158264197	1.01115734	2.933522712	0	0.821481603	0	0.021209785	0.137751397	0	12.2387266	0.001746144	1.319212148	11.21884977	0	2.264205426	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0783
H5428_001_0	2010	7	N/A																															A	A	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	P	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	NO	328.4100694	41.41164746	1517.36256	28.85476039	17.47758599	19.93846561	4.071970911	11.73061403	35.49785812	23.4867294	26.80190293	0	0.969050724	47.73849885	70.74519322	122.0691504	37.40548494	1.550763493	20.45403572	3.088158335	4.273990121	0.539658795	0	4423.220031	0	0	0	0	0	0												1A IP Acute: Standard FFS	1B IP Psych: Standard FFS	2 SNF: Standard FFS	6 Home Health: Standard FFS	10A Ambulance: Standard FFS	11A DME: Standard FFS	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Standard FFS"	"4A ER, 4B Urgent Care: Standard FFS"	9B ASC Services: Standard FFS	8A OP Diagnostic Procedures/Tests: Standard FFS	8B OP Radiology: Standard FFS	9A OP Hospital: Standard FFS	12 Renal Dialysis: Standard FFS	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Standard FFS"	"7A PCP, 14B Immunizations, 14C Physical Exams, 14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Standard FFS"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Standard FFS"	"7E Mental Health, 7H Psychiatric: 20.0% Member Cost-Sharing"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Standard FFS"	7D Physician Specialist (Radiology): Standard FFS	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Standard FFS"	15 Part B Drugs: Standard FFS	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Standard FFS"	10B Transportation: 50 one-way trips per member at $0	16A Preventative Dental Services (Non Medicare Covered): $0; 16B Comprehensive Dental (Non Medicare Covered): $0 - $20	17A Routine Eye Exams (Non Medicare Covered): $0	"17B Eye Wear (Medicare Covered): $0, Up to $125 covered for frames, glasses, and contacts"	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture, 13C Other 1, 13D Other 2, 13E Other 3: Not Covered"											753	753	65	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.173892279	0.173892279	0.233	0.233	0.233	0.233	0.233	0	4.096563108	0	0	0	0	0	0											NO	753	753	65	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.173892279	0.173892279	0.233	0.233	0.233	0.233	0.233	0	4.096563108	0	0	0	0	0	0												20.6077	2.598580878	8.219047199	0	4.072277536	4.645662486	0.948769222	2.73323307	8.271000941	5.47240795	6.244843383	0	0.225788819	11.12307023	16.48363002	21.22688281	6.504525034	0.361327894	4.765790323	0.719540892	0.995839698	0.125740499	0	1.51	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8557	0	0	20.6077	2.598580878	8.219047199	0	4.072277536	4.645662486	0.948769222	2.73323307	8.271000941	5.47240795	6.244843383	0	0.225788819	11.12307023	16.48363002	21.22688281	6.504525034	0.361327894	4.765790323	0.719540892	0.995839698	0.125740499	0	1.51	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8557	NO	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	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	0	0	20.6077	2.598580878	8.219047199	0	4.072277536	4.645662486	0.948769222	2.73323307	8.271000941	5.47240795	6.244843383	0	0.225788819	11.12307023	16.48363002	21.22688281	6.504525034	0.361327894	4.765790323	0.719540892	0.995839698	0.125740499	0	1.51	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8557
H5429_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1177.344066	31.62039909	847.1327423	1200.123695	165.531024	7.521150609	8.463940522	279.5899703	29.91452818	506.6633235	588.6454696	0	0.917587423	221.8433809	11142.11398	16968.4184	326.2731477	1241.177153	7089.467695	19825.84789	5.418241002	25.71885339	0	2924.911305	541.6824424	361.1216282	45.39377813	5.47979601	1948.649421	2089.025405											3400	"$250 - $350 copay, days 1-10"	"$250 - $350 copay, days 1-10"	$0 - $200 copay days 1-35	$20 copay to 30%	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	"25-30%, or 10-30% coinsurance"	$0-$75 copay	$5 copay to $50 copay	$0 copay	20% coinsurance	20% - 30% coinsurance	$15 to $30 copay	$30 to $45 copay	$30 to $45 copay	Varies	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											201.7730909	217.9780332	48.97592133	36	125	0.2	0.2	45	0.216498782	37.5	24.23675114	0	0.2	62.83841436	13.88572899	24.68798277	38	30	2.262111325	14.85318382	0.2	20.50797254	0	4	0	10	10	0	0	0											NO	119.745053	217.9780332	36.89056095	31.18233531	125	0.136970215	0.184855513	45	0.170401263	37.5	15.16734067	0	0.2	42.99958411	10.46988358	21.23037582	38	30	0	13.44711834	0.2	20.50797254	0	4	0	10	10	0	0	0												11.7484	0.574379367	2.604266839	3.118554957	1.7242815	1.030173613	1.564606064	1.048462389	5.097473393	1.583322886	0.744015531	0	0.183517485	0.794931093	9.721386352	30.02049164	1.033198301	3.102942882	0	22.21671023	1.0836482	0.043953462	0	0.974970435	0	0.30093469	0.037828148	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3525		23.83909108	11.7484	0.574379367	2.604266839	3.118554957	1.7242815	1.030173613	1.564606064	1.048462389	5.097473393	1.583322886	0.744015531	0	0.183517485	0.794931093	9.721386352	30.02049164	1.033198301	3.102942882	0	22.21671023	1.0836482	0.043953462	0	0.974970435	0	0.30093469	0.037828148	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3525	YES																																									7500																																									0			11.7484	0.574379367	2.604266839	3.118554957	1.7242815	1.030173613	1.564606064	1.048462389	5.097473393	1.583322886	0.744015531	0	0.183517485	0.794931093	9.721386352	30.02049164	1.033198301	3.102942882	0	22.21671023	1.0836482	0.043953462	0	0.974970435	0	0.30093469	0.037828148	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3525
H5429_005_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1212.166024	32.97340713	1008.184275	1849.832252	184.2883031	8.944595199	10.05531484	233.7310178	30.81183605	941.7646898	1089.495117	0	0.93637791	410.7913045	7921.204308	11613.47512	207.1405623	784.9795452	5022.171349	14310.31369	5.536339586	53.40321248	0	2924.911305	494.0669101	329.3779401	101.3067992	11.95604479	3811.816226	1957.132272											3400	"$250 - $350 copay, days 1-10"	"$250 - $350 copay, days 1-10"	$0 - $200 copay days 1-35	$20 copay to 30%	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	"25-30%, or 10-30% coinsurance"	$0-$75 copay	$5 copay to $50 copay	$0 copay	20% coinsurance	20% - 30% coinsurance	$15 to $30 copay	$30 to $45 copay	$30 to $45 copay	Varies	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											201.7730909	217.9780332	59.16539091	35.47709232	125	0.2	0.2	45	0.216467578	37.5	23.44508065	0	0.2	60.43901446	13.57236166	24.97434373	38	30	2.26079652	14.15967795	0.2	19.56225228	0	4	0	10	10	0	0	0											NO	116.4196237	217.9780332	48.29507053	32.1130289	125	0.143586336	0.186431045	45	0.168829195	37.5	18.19361726	0	0.2	49.00563062	8.161395158	19.42298168	38	30	0	11.9591168	0.2	19.56225228	0	4	0	10	10	0	0	0												11.76	0.598956536	4.057527557	4.950309714	1.919669824	1.284321651	1.874622857	0.876491317	5.201937482	2.943014655	1.651821431	0	0.187275582	1.677590577	5.387339873	18.79735954	0.655945114	1.962448863	0	14.26155941	1.107267917	0.08705726	0	0.974970435	0	0.274481617	0.084422333	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5764		25.37491392	11.76	0.598956536	4.057527557	4.950309714	1.919669824	1.284321651	1.874622857	0.876491317	5.201937482	2.943014655	1.651821431	0	0.187275582	1.677590577	5.387339873	18.79735954	0.655945114	1.962448863	0	14.26155941	1.107267917	0.08705726	0	0.974970435	0	0.274481617	0.084422333	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5764	YES																																									7500																																									0			11.76	0.598956536	4.057527557	4.950309714	1.919669824	1.284321651	1.874622857	0.876491317	5.201937482	2.943014655	1.651821431	0	0.187275582	1.677590577	5.387339873	18.79735954	0.655945114	1.962448863	0	14.26155941	1.107267917	0.08705726	0	0.974970435	0	0.274481617	0.084422333	0	0	0	0	0	0	0	0	0	0	0	0	0	82.5764
H5429_020_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1178.205784	31.31404076	1080.173537	2058.133009	192.3613337	8.064872587	9.090816959	287.0435999	32.59852449	1192.944747	1382.554648	0	0.992875982	521.6081702	9052.661873	14205.33489	274.4148278	1044.018779	6105.252249	16256.65602	5.885336001	78.06968314	0	2924.911305	491.7389705	327.8259803	143.8013525	17.36437503	4590.846972	1944.995626											3400	"$250 - $350 copay, days 1-10"	"$250 - $350 copay, days 1-10"	$0 - $200 copay days 1-35	$20 copay to 30%	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	"25-30%, or 10-30% coinsurance"	$0-$75 copay	$5 copay to $50 copay	$0 copay	20% coinsurance	20% - 30% coinsurance	$15 to $30 copay	$30 to $45 copay	$30 to $45 copay	Varies	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											201.7730909	217.9780332	59.16539091	36	125	0.2	0.2	45	0.216426406	37.5	22.17956964	0	0.2	56.51662625	14.43055205	25.45917425	38	30	2.260632606	15.76591945	0.2	18.09068413	0	4	0	10	10	0	0	0											NO	94.4110618	217.9780332	46.74972397	32.30077649	125	0.123371974	0.18161857	45	0.161280053	37.5	17.10909372	0	0.2	45.48694772	8.880474851	19.74184987	38	30	0	13.40658223	0.2	18.09068413	0	4	0	10	10	0	0	0												9.2696	0.568814418	4.208151226	5.539941192	2.003763893	0.994979251	1.651061174	1.0764135	5.257491751	3.727952333	1.971188087	0	0.198575196	1.977196964	6.699328009	23.36996572	0.868980288	2.610046946	0	18.16218298	1.1770672	0.117694498	0	0.974970435	0	0.273188317	0.11983446	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8184		31.07740359	9.2696	0.568814418	4.208151226	5.539941192	2.003763893	0.994979251	1.651061174	1.0764135	5.257491751	3.727952333	1.971188087	0	0.198575196	1.977196964	6.699328009	23.36996572	0.868980288	2.610046946	0	18.16218298	1.1770672	0.117694498	0	0.974970435	0	0.273188317	0.11983446	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8184	YES																																									7500																																									0			9.2696	0.568814418	4.208151226	5.539941192	2.003763893	0.994979251	1.651061174	1.0764135	5.257491751	3.727952333	1.971188087	0	0.198575196	1.977196964	6.699328009	23.36996572	0.868980288	2.610046946	0	18.16218298	1.1770672	0.117694498	0	0.974970435	0	0.273188317	0.11983446	0	0	0	0	0	0	0	0	0	0	0	0	0	92.8184
H5429_053_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1242.288374	33.60442412	1283.969331	2246.632926	208.6446281	8.181353345	9.205861113	231.9559199	30.63746723	1240.013984	1437.432318	0	0.93537882	541.7949357	7351.807105	10968.26981	199.6488434	757.490806	4657.507063	13117.64522	5.524424991	82.44012952	0	2924.911305	480	320	166.164613	19.71442849	5955	1837.209498											3400	"$250 - $350 copay, days 1-10"	"$250 - $350 copay, days 1-10"	$0 - $200 copay days 1-35	$20 copay to 30%	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	"25-30%, or 10-30% coinsurance"	$0-$75 copay	$5 copay to $50 copay	$0 copay	20% coinsurance	20% - 30% coinsurance	$15 to $30 copay	$30 to $45 copay	$30 to $45 copay	Varies	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											201.7730909	217.9780332	59.16539091	36	125	0.2	0.2	45	0.216490862	37.5	24.06596113	0	0.2	62.33959018	13.73997157	24.94227157	38	30	2.261495733	14.59108233	0.2	20.29864174	0	4	0	10	10	0	0	0											NO	120.2895944	217.9780332	50.79891688	33.27987465	125	0.139748649	0.185521466	45	0.169688403	37.5	20.16175846	0	0.2	53.85798873	8.084724026	19.12341028	38	30	0	12.23530247	0.2	20.29864174	0	4	0	10	10	0	0	0												12.4529	0.610418856	5.435354277	6.230638514	2.173381542	1.143333075	1.70788485	0.8698347	5.198822884	3.875043701	2.415096934	0	0.187075764	2.431665462	4.953110961	17.47922696	0.632221338	1.893727015	0	13.37486307	1.104884998	0.139451888	0	0.974970435	0	0.266666667	0.138470511	0	0	0	0	0	0	0	0	0	0	0	0	0	85.689		24.78857263	12.4529	0.610418856	5.435354277	6.230638514	2.173381542	1.143333075	1.70788485	0.8698347	5.198822884	3.875043701	2.415096934	0	0.187075764	2.431665462	4.953110961	17.47922696	0.632221338	1.893727015	0	13.37486307	1.104884998	0.139451888	0	0.974970435	0	0.266666667	0.138470511	0	0	0	0	0	0	0	0	0	0	0	0	0	85.689	YES																																									7500																																									0			12.4529	0.610418856	5.435354277	6.230638514	2.173381542	1.143333075	1.70788485	0.8698347	5.198822884	3.875043701	2.415096934	0	0.187075764	2.431665462	4.953110961	17.47922696	0.632221338	1.893727015	0	13.37486307	1.104884998	0.139451888	0	0.974970435	0	0.266666667	0.138470511	0	0	0	0	0	0	0	0	0	0	0	0	0	85.689
H5429_059_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	2444.503298	30.72187933	1206.040546	655.8655647	310.9894901	11.12422319	4.645980713	377.3999032	57.55633771	371.5982137	379.4304422	0	7.408686415	178.4019527	12298.06546	33255.11314	67.14730137	1037.220048	22688.00966	16710.04783	12.07043709	13.65757192	0	2924.911305	480	320	0	9.916818232	5955	1568.816665											3400	"$175 copay, days 1-7, 30%"	"$175 copay, days 1-7, 30%"	"$125 copay, days 6-20, 30%"	"$0 copay, 30%"	"$125 copay, 30%"	"20% coinsurance, 30%"	0%-30% coinsurance	"$50 copay, waived if admitted"	10%-30% coinsurance	"$0-$75 copay, 30%"	"$0-100 copay, 0%-30%"	"$0 copay, 30%"	20%-30% coinsurance	Varies	"$5 copay, 30%"	"$25 copay, 30%"	"$25 copay Group/Individual, 30%"	"$25 copay, 20%-30%"	"$0-100 copay, 0%-30%"	Varies	20% coinsurance	Varies	Not Covered	$4 copay	"$0 copay, 30%"	"$10 copay, 30%; and $100 credit covered every 1 years"	"$10 copay, 30%"	$250 credit	Varies	Varies											112.5759091	115.7212644	55.191596	0	125	0.2	0.103362959	45	0.150431965	37.5	59.2576802	0	0.2	179.0159157	4.125470169	8.430446977	25	25	4.35744382	12.64245324	0.2	0	0	4	0	10	0	0	0	0											NO	40.83197806	115.7212644	37.23893339	0	125	0.151341234	0.025691382	45	0.112813799	37.5	47.84497494	0	0.2	154.7430435	1.748946765	6.053923573	25	25	2.448802265	10.69886463	0.2	0	0	4	0	10	0	0	0	0												8.3178	0.29626456	3.742638629	0	3.239473856	1.683553662	0.119361666	1.415249637	6.493149105	1.161244418	1.51282	0	1.481737283	2.300538427	1.792388483	16.77699278	0.139890211	2.160875101	4.629870787	14.89821165	2.414087417	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8178		36.08606502	8.3178	0.29626456	3.742638629	0	3.239473856	1.683553662	0.119361666	1.415249637	6.493149105	1.161244418	1.51282	0	1.481737283	2.300538427	1.792388483	16.77699278	0.139890211	2.160875101	4.629870787	14.89821165	2.414087417	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8178	NO																																																																																		0			8.3178	0.29626456	3.742638629	0	3.239473856	1.683553662	0.119361666	1.415249637	6.493149105	1.161244418	1.51282	0	1.481737283	2.300538427	1.792388483	16.77699278	0.139890211	2.160875101	4.629870787	14.89821165	2.414087417	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8178
H5429_060_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	4255.037369	202.5073776	4254.075736	2057.178434	810.3667304	13.79294783	1.158068682	660.9772147	57.87484184	589.7194481	402.9749081	0	10.53738055	223.6019574	15115.92051	30391.48497	163.518663	1046.689775	18180.08067	15621.66569	12.60405975	24.10138385	0	2924.911305	480	320	0	16.79878939	5955	1535.286242											3400	"$200 copay, days 1-7, 30%"	"$200 copay, days 1-7, 30%"	"$150 copay, days 6-20, 30%"	"$0 copay, 30%"	"$150 copay, 30%"	20%-30% coinsurance	0%-30% coinsurance	"$50 copay, waived if admitted"	10%-30% coinsurance	"$0-$75 copay, 30%"	"$0-100 copay, 0%-30%"	"$0 copay, 30%"	20%-30% coinsurance	Varies	"$5 copay, 30%"	"$25 copay, 30%"	"$25 copay Group/Individual, 30%"	"$25 copay, 20%-30%"	"$0-100 copay, 0%-30%"	Varies	20% coinsurance	Varies	Not Covered	$4 copay	"$0 copay, 30%"	"$10 copay, 30%; and $100 credit covered every 1 years"	"$10 copay, 30%"	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	0	150	0.2	0.181043956	45	0.161888112	37.5	32.9804231	0	0.2	101.766	3.349180428	8.869263119	25	25	3.738541524	13.38024991	0.2	0	0	4	0	10	0	0	0	0											NO	50.60201566	132.2528736	56.59120422	0	150	0.126740126	0	45	0.092049848	37.5	12.89271986	0	0.2	65.58605341	0	3.740759556	25	25	0	9.292937887	0.2	0	0	4	0	10	0	0	0	0												17.9428	2.23184855	20.06193906	0	10.12958413	1.74811995	0	2.478664555	5.327370413	1.842873275	0.43295355	0	2.10747611	1.222097493	0	9.473936485	0.340663881	2.180603698	0	12.09759741	2.52081195	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.381		67.36464098	17.9428	2.23184855	20.06193906	0	10.12958413	1.74811995	0	2.478664555	5.327370413	1.842873275	0.43295355	0	2.10747611	1.222097493	0	9.473936485	0.340663881	2.180603698	0	12.09759741	2.52081195	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.381	NO																																																																																		0			17.9428	2.23184855	20.06193906	0	10.12958413	1.74811995	0	2.478664555	5.327370413	1.842873275	0.43295355	0	2.10747611	1.222097493	0	9.473936485	0.340663881	2.180603698	0	12.09759741	2.52081195	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.381
H5429_061_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	3644.375914	36.1619775	1368.561754	647.2373231	444.8642116	16.23341653	2.498675597	488.5103603	77.90372691	443.0450397	511.2429497	0	11.47947065	147.0367817	14977.224	33328.57932	52.88714152	1001.19683	29914.85742	16604.3366	21.7350838	28.4650156	0	2924.911305	480	320	0	11.80590131	5955	1571.968147											3400	"$200 copay, days 1-7, 30%"	"$200 copay, days 1-7, 30%"	"$150 copay, days 6-20, 30%"	"$0 copay, 30%"	"$150 copay, 30%"	20%-30% coinsurance	0%-30% coinsurance	"$50 copay, waived if admitted"	10%-30% coinsurance	"$0-$75 copay, 30%"	"$0-100 copay, 0%-30%"	"$0 copay, 30%"	20%-30% coinsurance	Varies	"$5 copay, 30%"	"$25 copay, 30%"	"$25 copay Group/Individual, 30%"	"$25 copay, 20%-30%"	"$0-100 copay, 0%-30%"	Varies	20% coinsurance	Varies	Not Covered	$4 copay	"$0 copay, 30%"	"$10 copay, 30%; and $100 credit covered every 1 years"	"$10 copay, 30%"	$250 credit	Varies	Varies											128.6581818	132.2528736	66.2299152	0	150	0.2	0.173766667	45	0.1564	37.5	41.58642356	0	0.2	174.1828326	3.859135353	9.691944669	25	25	4.314122313	13.15848733	0.2	0	0	4	0	10	0	0	0	0											NO	49.70176878	132.2528736	40.27907425	0	150	0.145313527	0	45	0.110818186	37.5	27.69402746	0	0.2	125.8812972	0.177487595	6.002806752	25	25	1.940055718	9.944681736	0.2	0	0	4	0	10	0	0	0	0												15.0943	0.398543786	4.593700041	0	5.560802645	2.35893501	0	1.831913851	8.633149705	1.384515749	1.179864691	0	2.295894129	1.542431735	0.221522623	16.67208508	0.110181545	2.085826729	4.836374183	13.76040358	4.34701676	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1491		59.18321974	15.0943	0.398543786	4.593700041	0	5.560802645	2.35893501	0	1.831913851	8.633149705	1.384515749	1.179864691	0	2.295894129	1.542431735	0.221522623	16.67208508	0.110181545	2.085826729	4.836374183	13.76040358	4.34701676	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1491	NO																																																																																		0			15.0943	0.398543786	4.593700041	0	5.560802645	2.35893501	0	1.831913851	8.633149705	1.384515749	1.179864691	0	2.295894129	1.542431735	0.221522623	16.67208508	0.110181545	2.085826729	4.836374183	13.76040358	4.34701676	0	0	0.974970435	0	0.266666667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.1491
H5429_062_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1319.172533	36.07666425	1356.114345	2583.33569	219.5004913	8.243180072	9.274196089	231.3892732	31.79670714	1237.237628	1436.743652	0	0.974928859	543.8157705	8003.57163	11921.61534	229.93657	876.2006944	4989.1557	14887.42547	5.750461457	82.42133352	0	2924.911305	480	320	178.8256975	20.51371906	5955	1861.805896											3400	"$800 - $1,000 copay per admit"	"$800 - $1,000 copay per admit"	$0 - $200 copay days 1-35	$20 copay to 30%	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	"25-30%, or 10-30% coinsurance"	$0-$75 copay	$5 copay to $50 copay	$0 copay	20% coinsurance	"$35 - 20%, or 25% - 30% coinsurance"	$15 to $30 copay	$35 - $45 copay	$35 - $45 copay	Varies	$5 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1 years	$10 copay	$250 credit	Varies	Varies											156.3636364	109.8339719	59.16539091	36	125	0.2	0.2	45	0.216516955	37.5	24.78913671	0	0.2	53.5239031	13.7726199	25.69880493	40	35	2.25988044	14.97105231	0.2	21.15207501	0	4	0	10	10	0	0	0											NO	72.5879991	109.8339719	50.51761633	33.41303487	125	0.134721254	0.184311285	45	0.167288747	37.5	20.52761824	0	0.2	44.30140815	8.084122605	19.8408222	40	35	0	12.68667816	0.2	21.15207501	0	4	0	10	10	0	0	0												7.9797	0.330203611	5.708972015	7.193090459	2.286463451	1.110531559	1.709338997	0.867709774	5.319231291	3.866367586	2.457743767	0	0.194985772	2.007650367	5.391821195	19.71122085	0.766455233	2.555585359	0	15.7393313	1.150092291	0.145281852	0	0.974970435	0	0.266666667	0.149021415	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8824		27.05989871	7.9797	0.330203611	5.708972015	7.193090459	2.286463451	1.110531559	1.709338997	0.867709774	5.319231291	3.866367586	2.457743767	0	0.194985772	2.007650367	5.391821195	19.71122085	0.766455233	2.555585359	0	15.7393313	1.150092291	0.145281852	0	0.974970435	0	0.266666667	0.149021415	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8824	YES																																									7500																																									0			7.9797	0.330203611	5.708972015	7.193090459	2.286463451	1.110531559	1.709338997	0.867709774	5.319231291	3.866367586	2.457743767	0	0.194985772	2.007650367	5.391821195	19.71122085	0.766455233	2.555585359	0	15.7393313	1.150092291	0.145281852	0	0.974970435	0	0.266666667	0.149021415	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8824
H5430_001_0	2010	5	N/A																															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																																																			0	NO	305.653742	11.23389021	34.0897054	15.98341963	12.44044556	10.25577815	0.041744813	25.46847549	3.289255322	9.760553017	9.113472068	0	0	15.74705176	51.99285603	0	6.646309631	8.064719324	35.98439959	146.3017685	72.22871607	2.245631897	0	2.104681961	2.241705516	0	0.289808243	2.826263318	0	0												FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS	FFS											0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.1286	0.886813977	4.523991491	0	2.898623815	2.389596309	0.009726541	5.934154789	0.76639649	2.274208853	2.123438992	0	0	3.669063061	12.11433546	0	1.548590144	1.879079603	8.384365104	34.08831207	16.82929084	0.523232232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.9718			24.1286	0.886813977	4.523991491	0	2.898623815	2.389596309	0.009726541	5.934154789	0.76639649	2.274208853	2.123438992	0	0	3.669063061	12.11433546	0	1.548590144	1.879079603	8.384365104	34.08831207	16.82929084	0.523232232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.9718	NO																																																																																		0			24.1286	0.886813977	4.523991491	0	2.898623815	2.389596309	0.009726541	5.934154789	0.76639649	2.274208853	2.123438992	0	0	3.669063061	12.11433546	0	1.548590144	1.879079603	8.384365104	34.08831207	16.82929084	0.523232232	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.9718
H5431_001_0	2010	4	N/A	X1	X2	X3	X4	X5	X6					Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Professional										Chiropractic (Non-Covered)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	Coin	Coin	V	Coin	Coin	V	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V																																													0	YES	2343.722829	190.0315807	811.3499756	1023.215331	152.1074035	37.597331	0.628666436	52.74709601	762.4607885	923.3856922	894.5738099	67.25309976	0.011596474	0	3750.662695	1626.496798	58.92615744	12.84296014	945.5583588	99.38163247	10.12723259	0	1203.174477	939.2999428	453.1804018	850.8635309	110.1085552	45.49859014	12000	0	4568.63621	0	0	0	0	116.4012705					3400	0	$200 days 1-5	0	0	25	0	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	1/yr	$100 limit/yr	1/yr	$700 limit every 2 years	0		0	0	0	0	0	12 visits/yr					0	86.0089272	0	0	25	0	0	50	0	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					NO	0	85.99632965	0	0	24.9963383	0	0	49.9926766	0	0	0	0	0	0	0	0	0	0	0	0	0.199970706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0						0	1.361834872	0	0	0.31684401	0	0	0.219747376	0	0	0	0	0	0	0	0	0	0	0	0	2.025149854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9236	0	0.01	0	1.361834872	0	0	0.31684401	0	0	0.219747376	0	0	0	0	0	0	0	0	0	0	0	0	2.025149854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9236	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	0	1.361834872	0	0	0.31684401	0	0	0.219747376	0	0	0	0	0	0	0	0	0	0	0	0	2.025149854	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3.9236
H5431_002_0	2010	4	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Professional	Podiatry Covered									Non-Covered Chiro					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	Coin	Coin	V	Coin	Coin	V	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	2347.865791	235.1264317	1527.91414	7078.729318	197.1340394	14.45390482	1.318230419	278.5910694	474.9183675	4110.391195	1415.779886	1049.399196	0	17126.61108	5713.297807	9090.413672	27.39497609	14.19306095	5868.656517	124.7539595	29.0657683	0	1319.816597	939.2999428	636.9495536	636.9495536	50.33533953	222.3116002	0	0	13894.66671	2.611301929	0	0.511621948	270.1363883	116.4012705	1027.464776				3400	0	"$75, days 1-5"	"$25, days 7-25"	0	25	0	0	25	50	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	10	0	0	0	0		0	0	25	50	0	0	0				0	32.2533477	12.43349402	0	25	0	0	25	50	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	10	0	0	0	0	0	0	0	25	50	0	0	0				NO	0	32.11065259	12.37848581	0	24.88939512	0	0	24.88939512	49.77879023	0	0	0	0	0	0	0	0	0	0	0	0.199115161	0	0	0	9.955758047	0	0	0	0	0	0	0	24.88939512	49.77879023	0	0	0					0	0.62917193	1.576105292	0	0.408878917	0	0	0.577830267	1.970071816	0	0	0	0	0	0	0	0	0	0	0	5.787435132	0	0	0	0.52844297	0	0	0	0	0	0	0	0	0.002122327	0	0	0	0	0	0	11.4801	0	0.051015725	0	0.62917193	1.576105292	0	0.408878917	0	0	0.577830267	1.970071816	0	0	0	0	0	0	0	0	0	0	0	5.787435132	0	0	0	0.52844297	0	0	0	0	0	0	0	0	0.002122327	0	0	0	0	0	0	11.4801	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	0	0.62917193	1.576105292	0	0.408878917	0	0	0.577830267	1.970071816	0	0	0	0	0	0	0	0	0	0	0	5.787435132	0	0	0	0.52844297	0	0	0	0	0	0	0	0	0.002122327	0	0	0	0	0	0	11.4801
H5431_005_0	2010	4	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered														D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	Coin	Coin	V	Coin	Coin	V	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	1730.460673	140.3076221	599.0508807	755.4792181	112.306744	27.75955497	0.4641686	38.94520893	562.9541142	681.7711576	660.4982372	49.65554921	0.008562123	0	2769.258468	1200.905119	43.50744755	9.482451237	698.1420898	73.37728014	7.477325176	0	888.349974	693.5212607	453.1804018	850.8635309	81.29737962	33.59335837	12000	0	3373.199763	0	0	0	0	116	0				3400	"$50, days 1-5"	"$200, days 1-5"	0	0	25	0	0	25	"$100 OP Facility, $0 ASC"	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0		0	0	0	0	0		0	0	25	0	0	0	0				32.42207341	86.0089272	0	0	25	0	0	25	50	0	0	0	0	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	25	0	0	0	0				NO	32.3323095	85.77080247	0	0	25	0	0	24.93078488	50	0	0	0	0	0	0	0	0	0	0	0	0.199446279	0	0	0	0	0	0	0	0	0	0	0	24.93078488	0	0	0	0					4.6625	1.002858112	0	0	0.233972383	0	0	0.080911219	2.345642142	0	0	0	0	0	0	0	0	0	0	0	1.491324684	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.8172	0	0.02009362	4.6625	1.002858112	0	0	0.233972383	0	0	0.080911219	2.345642142	0	0	0	0	0	0	0	0	0	0	0	1.491324684	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.8172	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	4.6625	1.002858112	0	0	0.233972383	0	0	0.080911219	2.345642142	0	0	0	0	0	0	0	0	0	0	0	1.491324684	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.8172
H5431_006_0	2010	6	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered														Coin	D	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	V	V	V	P	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																												0	YES	385.4533026	190.0315807	15.86759122	49.61573905	6.812585022	37.597331	0.628666436	52.74709601	13.97750013	9.048114546	7.104718309	0.499837706	0.011596474	0	308.0825243	58.34751261	58.92615744	12.84296014	44.95429142	99.38163247	10.12723259	0	1323.491924	939.2999428	453.1804018	850.8635309	110.1085552	45.49859014	12000	0	5.901708632	0	0	0	0	0.582753994	0				3400	0	"$200, days 1-5"	0	0	0	0	0	"$50 ER, $0 urgent care"	0	0	0	0	0	0	0	0	0	0	0	0	0.1	0	0		0	0	0	0	0		0	0	0	0	0	0	0				0	86.0089272	0	0	0	0	0	35	0	0	0	0	0	0	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				NO	0	86.0089272	0	0	0	0	0	35	0	0	0	0	0	0	0	0	0	0	0	0	0.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	1.362034366	0	0	0	0	0	0.153845697	0	0	0	0	0	0	0	0	0	0	0	0	1.012723259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5286	0	0.01	0	1.362034366	0	0	0	0	0	0.153845697	0	0	0	0	0	0	0	0	0	0	0	0	1.012723259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5286	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	0	1.362034366	0	0	0	0	0	0.153845697	0	0	0	0	0	0	0	0	0	0	0	0	1.012723259	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5286
H5433_001_0	2010	7	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	254.1397468	0	35.33684003	6.338376549	11.87330526	6.752537675	0	16.57735682	12.47300934	0	0	0	0	12.3607315	328.8548373	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												1A IP Acute	1B IP Psych	2 SNF	6 Home Health	10A Ambulance	11A DME	"11B Prosthetics/Medical Supplies , 11C Diabetes Monitoring Supplies"	"4A ER , 4B Urgent Care"	9B ASC Services	8A OP Diagnostic Procedures/Tests	8B OP Radiology	9A OP Hospital	12 Renal Dialysis	"3 CORF , 5 Partial Hosp , 9C OP Substance Abuse , 9D Cardiac Rehab"	"7A PCP , 14B Immunizations , 14C Physical Exams , 14D Pap Smears and Pelvic Exams , 14E Prostate Screening , 14F Colorectal Screening , 14G Bone Mass Measurement , 14H Mammography , 14I Diabetes Monitoring , 14J Nutrition Therapy"	"7B Chiropractic , 7D Physician Specialist (excl. Radiology) , 7F Podiatry"	"7E Mental Health , 7H Psychiatric"	"7C Occupational Therapy , 7I Physical and Speech Therapy"	7D Physician Specialist (Radiology)	"7G Other Health Care , 18A Hearing Exams (Medicare Covered)"	15 Part B Drugs	"13A Blood , 16B Comprehensive Dental (Medicare Covered) , 17A Routine Eye Exams (Medicare Covered)"	10B Transportation	"16A Preventative Dental Services (Non Medicare Covered) , 16B Comprehensive Dental (Non Medicare Covered)"	17A Routine Eye Exams (Non Medicare Covered)	17B Eye Wear (Medicare Covered)	18A Routine Hearing Exams (Non Medicare Covered)	18B Hearing Aids (Non Medicare Covered)	14A Health Education/Wellness Program	"13B Acupuncture , 13C Other 1 Copay, 13D Other 2 Copay, 13E Other 3 Copay"											0.023135788	0.023135788	0.055226529	0	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0	0	0	0	0	0	0	0											NO	0.023135788	0.023135788	0.055226529	0	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0.082726035	0	0	0	0	0	0	0	0												5.8797	0	1.951531029	0	0.982231472	0.558610671	0	1.371379009	1.031842614	0	0	0	0	1.022554313	27.20485694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0027	0	0	5.8797	0	1.951531029	0	0.982231472	0.558610671	0	1.371379009	1.031842614	0	0	0	0	1.022554313	27.20485694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0027	NO	1A IP Acute 0%	1B IP Psych 0%	2 SNF $0	6 Home Health $0	10A Ambulance $0	11A DME 0%	"11B Prosthetics/Medical Supplies 0%, 11C Diabetes Monitoring Supplies $0"	"4A ER $0, 4B Urgent Care $0"	9B ASC Services $0	8A OP Diagnostic Procedures/Tests $0	8B OP Radiology $0	9A OP Hospital $0	12 Renal Dialysis $0	"3 CORF $0, 5 Partial Hosp $0, 9C OP Substance Abuse $0, 9D Cardiac Rehab $0"	"7A PCP $0, 14B Immunizations $0, 14C Physical Exams $0, 14D Pap Smears and Pelvic Exams $0, 14E Prostate Screening $0, 14F Colorectal Screening $0, 14G Bone Mass Measurement $0, 14H Mammography $0, 14I Diabetes Monitoring $0, 14J Nutrition Therapy $0"	"7B Chiropractic $0, 7D Physician Specialist (excl. Radiology) $0, 7F Podiatry $0"	"7E Mental Health $0, 7H Psychiatric $0"	"7C Occupational Therapy $0, 7I Physical and Speech Therapy $0"	7D Physician Specialist (Radiology) $0	"7G Other Health Care $0, 18A Hearing Exams (Medicare Covered) $0"	15 Part B Drugs 0%	"13A Blood $0, 16B Comprehensive Dental (Medicare Covered) $0, 17A Routine Eye Exams (Medicare Covered) $0"	10B Transportation $0	"16A Preventative Dental Services (Non Medicare Covered) $0, 16B Comprehensive Dental (Non Medicare Covered) $0"	17A Routine Eye Exams (Non Medicare Covered) $0	17B Eye Wear (Medicare Covered) $0	18A Routine Hearing Exams (Non Medicare Covered) $0	18B Hearing Aids (Non Medicare Covered) $0	14A Health Education/Wellness Program $0	"13B Acupuncture $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.8797	0	1.951531029	0	0.982231472	0.558610671	0	1.371379009	1.031842614	0	0	0	0	1.022554313	27.20485694	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0027
H5434_002_0	2010	6	N/A	e.3.	i.9.	q.1.	q.2.	i.2.	g.1.	h.6.	h.7.	h.8.	h.9.	DME/Prosthetics/Supplies	Professional	Other Non-Covered	Other Non-Covered	Professional	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Electric Wheelchairs	Urgent Care	Worldwide ER	Worldwide Urgent Care	Allergy Shots	Ambulatory Surgical Center	Rehab	Radiation Therapy	IDTF - non-AIX	IDTF - AIX	D	D	D		T	O	O	V	V	V			V	V	V	V	V	V	V		Coin									V	Coin	V	V	V	V	V	V	V	V	V																																									0	YES	765.5670829	29.20144393	444.3721478		42.46686793			111.9816297	89.82968796	81.89553419			1.676400166	266.1325322	3096.50912	5960.041733	161.6639359	341.2167073	27.6942273		34.72926464									288.2747062	0.021017713	52.6144075	1.455042557	0.687563194	77.36944643	177.1659818	59.38141456	7.925355813	206.7663908	142.5165576	3400	"175/day, days 1 - 7"	"175/day, days 1 - 7"	"125/day, days 7 - 25"		100 per trip			50 copay	150 copay	15 copay			30 copay	150 copay	10 copay	25 copay	25 copay	25 copay	100 copay		20% of allowed amount									"uncovered pod, phys exams, uncovered rehab"	20% of allowed amount	25 copay	50 copay	25 copay	5 per shot	100 copay	25 copay	150 copay	75 copay	100 copay	125.0028699	125.0028699	63.88879666		100			50	150	15			30	150	10	25	25	25	100		0.2									15.53588332	0.2	25	50	25	5	100	25	50	75	100	YES	106.036492	106.036492	54.19510673		84.82724602			42.41362301	127.240869	12.7240869			25.44817381	127.240869	8.482724602	21.20681151	21.20681151	21.20681151	84.82724602		0.169654492									13.17866197	0.169654492	21.20681151	42.41362301	21.20681151	0	84.82724602	21.20681151	42.41362301	63.62043452	84.82724602	6000	6.7648	0.25803489	2.006899665	0	0.300195621	0	0	0.395795552	0.95250063	0.086837158	0	0	0.00355511	2.821911223	2.188902841	10.53279013	0.285698051	0.603009866	0.195768753	0	5.891975752	0	0	0	0	0	0	0	0	0.316589576	0.003565749	0.092981985	0.005142802	0.001215085	0	1.252375194	0.104940872	0.028011921	1.096213969	1.007440591	37.1972	0	6.312352263	6.7648	0.25803489	2.006899665	0	0.300195621	0	0	0.395795552	0.95250063	0.086837158	0	0	0.00355511	2.821911223	2.188902841	10.53279013	0.285698051	0.603009866	0.195768753	0	5.891975752	0	0	0	0	0	0	0	0	0.316589576	0.003565749	0.092981985	0.005142802	0.001215085	0	1.252375194	0.104940872	0.028011921	1.096213969	1.007440591	37.1972	NO	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	100 per trip	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	50 copay	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded			30 copay	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded		30% of allowed amount after $500 ded	30% of allowed amount after $500 ded								30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	0	0	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded		19.7107	0.1211	0.3814	0.3698	1.1298	3.0186	0.6613	0.2153	2.7709	0.3597			0.0018	2.7011	3.9953	8.6345	0.5443	1.1585	0.8206		1.8968	0.0282								0.4025	0	0.0313	0	0	0.0156	5.622	0.8584	0.1981	1.0536	1.8857	58.5869	500	21.78715673	26.4756	0.379119756	2.388309772	0.369819307	1.430042781	3.018649193	0.661260575	0.611144528	3.72339609	0.446513586	0	0	0.005321089	5.522974448	6.184216224	19.16729136	0.829971165	1.761517629	1.016339312	0	7.788759053	0.028225424	0	0	0	0	0	0	0	0.719106993	0.003565749	0.124273147	0.005142802	0.001215085	0.01563072	6.874377837	0.963293535	0.226157904	2.149815653	2.893100477	95.7841
H5434_801_0	2010	5	N/A																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																																																											0	NO	152.438883		13.13288584		0.681802412	10.76917505		4.311226984	27.9840141					52.32890362						211.9499355	33.49408261	0.148636788																				8.5% coinsurance		16.2% coinsurance		23.3% coinsurance	23.3% coinsurance		23.3% coinsurance	23.3% coinsurance					23.3% coinsurance						23.3% coinsurance	23.3% coinsurance	23.3% coinsurance																																																											NO	0.084998351		0.162239966		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																				12.9571	0	2.130678951	0	0.158859962	2.509217788	0	1.004515887	6.520275285	0	0	0	0	12.19263454	0	0	0	0	0	49.38433497	7.804121248	0.034632372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.6963		0	12.9571	0	2.130678951	0	0.158859962	2.509217788	0	1.004515887	6.520275285	0	0	0	0	12.19263454	0	0	0	0	0	49.38433497	7.804121248	0.034632372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.6963	NO	8.5% coinsurance		16.2% coinsurance		23.3% coinsurance	23.3% coinsurance		23.3% coinsurance	23.3% coinsurance					23.3% coinsurance						23.3% coinsurance	23.3% coinsurance	23.3% coinsurance																				4.2337		0.1331		0.6361	2.7162		0.263	5.506					4.3182						14.1524	1.0851	0.0329																			33.0766		0	17.1908	0	2.263750719	0	0.794910344	5.225388427	0	1.26751846	12.02626107	0	0	0	0	16.51082417	0	0	0	0	0	63.53677812	8.889213974	0.0675387	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.7729
H5434_802_0	2010	5	N/A																															Coin		Coin		Coin	Coin		Coin	Coin					Coin						Coin	Coin	Coin																																																											0	NO	191.7624779		25.17250523		1.717235126	10.47195847		7.562214561	26.20669619					57.96210129						217.43401	26.89259027	0.293597592																				8.5% coinsurance		16.2% coinsurance		23.3% coinsurance	23.3% coinsurance		23.3% coinsurance	23.3% coinsurance					23.3% coinsurance						23.3% coinsurance	23.3% coinsurance	23.3% coinsurance																																																											NO	0.084956149		0.162289239		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																				16.2914	0	4.085226714	0	0.400115784	2.439966323	0	1.761995993	6.106160211	0	0	0	0	13.5051696	0	0	0	0	0	50.66212433	6.265973533	0.068408239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5865		0	16.2914	0	4.085226714	0	0.400115784	2.439966323	0	1.761995993	6.106160211	0	0	0	0	13.5051696	0	0	0	0	0	50.66212433	6.265973533	0.068408239	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.5865	NO	8.5% coinsurance		16.2% coinsurance		23.3% coinsurance	23.3% coinsurance		23.3% coinsurance	23.3% coinsurance					23.3% coinsurance						23.3% coinsurance	23.3% coinsurance	23.3% coinsurance																				5.3232		0.2551		1.602	2.6412		0.4613	5.1563					4.783						14.5186	0.8712	0.065																			35.6771		0	21.6146	0	4.340369961	0	2.002116656	5.081173841	0	2.223322175	11.26245038	0	0	0	0	18.28821161	0	0	0	0	0	65.18075326	7.137200682	0.133407078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.2636
H5435_001_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1688.445899	58.17950083	1345.919998	204.7222382	166.6439019	15.09582674	10.83334524	462.0681441	35.983823	8189.521032	33.93431163	0	0.052192359	20.68798323	4960.000792	4154.73999	236.4416378	404.7155846	0	0	17.38815109	802.0266901	0	0	163.4816261	0	17.72795176	0	0	0												"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$95 Days 1-30 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 (14a1); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	75.20887061	0	150	0.2	0.145069262	50	0.2	3	0.172665558	0	0.2	0.149334918	10.36676129	29.99838073	38.5	30	0	0	0.2	29.69740653	0	0	30	0	30	0	0	0											NO	137.9067988	105.0327375	62.55008048	0	124.7527319	0.166336976	0.120651912	41.58424396	0.166336976	2.495054638	0.143603334	0	0.166336976	0.124274602	10.36676129	29.99838073	38.5	24.95054638	0	0	0.166336976	29.69740653	0	0	30	0	30	0	0	0												19.404	0.509229353	7.015617013	0	1.732440168	2.510994167	1.307063814	1.601229536	5.985440298	1.702775203	4.873080289	0	0.008681519	2.570990879	4.284928684	10.38628934	0.758583588	0.84148958	0	0	2.892292467	1.984842722	0	0	0.408704065	0	0.044319879	0	0	0	0	0	0	0	0	0	0	0	0	0	70.823	0	10.71515499	19.404	0.509229353	7.015617013	0	1.732440168	2.510994167	1.307063814	1.601229536	5.985440298	1.702775203	4.873080289	0	0.008681519	2.570990879	4.284928684	10.38628934	0.758583588	0.84148958	0	0	2.892292467	1.984842722	0	0	0.408704065	0	0.044319879	0	0	0	0	0	0	0	0	0	0	0	0	0	70.823	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											4250	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.404	0.509229353	7.015617013	0	1.732440168	2.510994167	1.307063814	1.601229536	5.985440298	1.702775203	4.873080289	0	0.008681519	2.570990879	4.284928684	10.38628934	0.758583588	0.84148958	0	0	2.892292467	1.984842722	0	0	0.408704065	0	0.044319879	0	0	0	0	0	0	0	0	0	0	0	0	0	70.823
H5435_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1864.434777	80.73772628	1527.170937	216.2144874	206.7449938	16.10452437	10.15742386	476.8738431	34.73757135	7821.308279	33.47711114	0	0.246807069	22.08767272	4936.795708	4045.46441	310.5556	398.5980452	0	0	14.35407162	788.6973988	0	0	151.1649273	0	17.65017221	0	0	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 (14a1); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	81.80667226	0	150	0.2	0.136660104	50	0.2	3	0.172889213	0	0.2	0.150694698	10.52437859	29.99855464	38.5	30	0	0	0.2	29.72045433	0	0	30	0	30	0	0	0											NO	151.6558292	115.5042901	67.33850533	0	123.4712954	0.164628394	0.112490668	41.15709848	0.164628394	2.469425909	0.142312367	0	0.164628394	0.124464941	10.52437859	29.99855464	38.5	24.69425909	0	0	0.164628394	29.72045433	0	0	30	0	30	0	0	0												23.5627	0.77712948	8.569784024	0	2.127256017	2.651261982	1.14261539	1.635561977	5.71879058	1.609511775	4.764206926	0	0.040631451	2.749140875	4.329725586	10.11317376	0.996365883	0.82025695	0	0	2.363087757	1.953370418	0	0	0.377912318	0	0.044125431	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3466	0	12.56469283	23.5627	0.77712948	8.569784024	0	2.127256017	2.651261982	1.14261539	1.635561977	5.71879058	1.609511775	4.764206926	0	0.040631451	2.749140875	4.329725586	10.11317376	0.996365883	0.82025695	0	0	2.363087757	1.953370418	0	0	0.377912318	0	0.044125431	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3466	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											4600	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.5627	0.77712948	8.569784024	0	2.127256017	2.651261982	1.14261539	1.635561977	5.71879058	1.609511775	4.764206926	0	0.040631451	2.749140875	4.329725586	10.11317376	0.996365883	0.82025695	0	0	2.363087757	1.953370418	0	0	0.377912318	0	0.044125431	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3466
H5435_003_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1773.258318	111.4938068	1528.561052	207.1259522	207.9676301	14.17043073	10.10234695	472.2956276	31.76411261	8245.149151	34.20927375	0	0.05084319	20.28913248	4943.844616	3952.235637	208.5225696	454.0930395	0	0	14.73593307	748.3050398	0	0	155.4401037	0	17.42899025	0	0	0												"$275 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 (14a1); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											190.6084929	140.5472438	81.80667226	0	150	0.2	0.140965648	50	0.2	3	0.172472161	0	0.2	0.149569791	10.53863128	34.63152291	38.5	35	0	0	0.2	34.61987587	0	0	35	0	35	0	0	0											NO	159.6288433	117.7040624	68.51061181	0	125.6204597	0.167493946	0.118054464	41.87348655	0.167493946	2.512409193	0.144440214	0	0.167493946	0.125328195	10.53863128	34.63152291	38.5	29.31144059	0	0	0.167493946	34.61987587	0	0	35	0	35	0	0	0												23.5886	1.093606167	8.726887741	0	2.17708244	2.373461362	1.19262715	1.648055384	5.320296568	1.72626571	4.941194823	0	0.008515927	2.54280036	4.341779627	11.40599492	0.669009911	1.109176762	0	0	2.468179581	2.158852299	0	0	0.453366969	0	0.050834555	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9966	0	11.43250244	23.5886	1.093606167	8.726887741	0	2.17708244	2.373461362	1.19262715	1.648055384	5.320296568	1.72626571	4.941194823	0	0.008515927	2.54280036	4.341779627	11.40599492	0.669009911	1.109176762	0	0	2.468179581	2.158852299	0	0	0.453366969	0	0.050834555	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9966	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											4900	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.5886	1.093606167	8.726887741	0	2.17708244	2.373461362	1.19262715	1.648055384	5.320296568	1.72626571	4.941194823	0	0.008515927	2.54280036	4.341779627	11.40599492	0.669009911	1.109176762	0	0	2.468179581	2.158852299	0	0	0.453366969	0	0.050834555	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9966
H5435_014_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1321.234702	47.69410315	1360.584224	88.13793909	125.1852974	11.38257873	8.444291794	408.5588357	41.09302442	8595.517885	34.44358759	0	0.036982821	21.81187705	5243.591157	4385.323663	211.9325456	450.6242509	0	0	15.63651415	837.0141202	0	0	288.5975384	0	18.51697266	0	0	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 (14a1); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	81.80667226	0	150	0.2	0.106777189	50	0.2	3	0.170875108	0	0.2	0.149060331	8.886861779	30	38.5	30	0	0	0.2	29.62595354	0	0	30	0	30	0	0	0											NO	158.1342664	120.438405	70.21507313	0	128.7457451	0.171660993	0.091647391	42.91524835	0.171660993	2.574914901	0.146662954	0	0.171660993	0.128050637	8.886861779	30	38.5	25.74914901	0	0	0.171660993	29.62595354	0	0	30	0	30	0	0	0												17.411	0.478683476	7.961126732	0	1.343089532	1.953944772	0.773897314	1.461116992	7.054069395	1.844393924	5.051598292	0	0.006348508	2.793024746	3.88325582	10.96330916	0.67995025	0.966932582	0	0	2.684179553	2.06644512	0	0	0.721493846	0	0.046292432	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1442	0	8.545944855	17.411	0.478683476	7.961126732	0	1.343089532	1.953944772	0.773897314	1.461116992	7.054069395	1.844393924	5.051598292	0	0.006348508	2.793024746	3.88325582	10.96330916	0.67995025	0.966932582	0	0	2.684179553	2.06644512	0	0	0.721493846	0	0.046292432	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1442	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											4600	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.411	0.478683476	7.961126732	0	1.343089532	1.953944772	0.773897314	1.461116992	7.054069395	1.844393924	5.051598292	0	0.006348508	2.793024746	3.88325582	10.96330916	0.67995025	0.966932582	0	0	2.684179553	2.06644512	0	0	0.721493846	0	0.046292432	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1442
H5435_020_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1967.518244	46.53134126	1567.030462	280.9504166	182.2180323	14.68911697	9.077157597	464.8370329	369.4651023	9453.283291	42.9918521	0	0.06506936	926.9498535	5541.879174	5208.890375	264.307717	419.9617609	0	0	18.75966281	858.6574714	0	0	181.4993197	0	17.60082814	0	0	0												"$175 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$80 Days 1-36 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	$150 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $150 (9a); $40/$30 (9c)"	"$15 (7a); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 (14a1); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											162.6190857	122.8528282	67.62425646	0	150	0.2	0.141847172	50	150	3	0.17247836	0	0.2	58.87722761	10.10069471	25	38.5	25	0	0	0.2	24.78633633	0	0	25	0	25	0	0	0											NO	131.8802823	93.70656838	51.58071738	0	114.4132004	0.152550934	0.108194593	38.13773347	114.4132004	2.288264008	0.131558674	0	0.152550934	44.94539756	10.10069471	25	38.5	19.06886674	0	0	0.152550934	24.78633633	0	0	25	0	25	0	0	0												21.6231	0.363357693	6.735712951	0	1.737345687	2.240838512	0.982099371	1.477319239	3.5226404	1.802633993	5.655951069	0	0.009926392	3.47184414	4.664735803	10.85185495	0.847987259	0.667349571	0	0	2.86180408	1.773581073	0	0	0.378123583	0	0.036668392	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7048	0	16.52853607	21.6231	0.363357693	6.735712951	0	1.737345687	2.240838512	0.982099371	1.477319239	3.5226404	1.802633993	5.655951069	0	0.009926392	3.47184414	4.664735803	10.85185495	0.847987259	0.667349571	0	0	2.86180408	1.773581073	0	0	0.378123583	0	0.036668392	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7048	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											3350	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.6231	0.363357693	6.735712951	0	1.737345687	2.240838512	0.982099371	1.477319239	3.5226404	1.802633993	5.655951069	0	0.009926392	3.47184414	4.664735803	10.85185495	0.847987259	0.667349571	0	0	2.86180408	1.773581073	0	0	0.378123583	0	0.036668392	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7048
H5435_024_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1607.629642	83.79766534	1461.860671	115.9302682	158.1148587	14.10764972	11.61702215	447.3803948	34.76552021	7720.894387	32.68209622	0	0.090088237	17.51109617	5247.528519	4082.403006	275.9033241	464.392551	0	0	17.47370664	731.6780497	0	0	192.5338829	0	17.63995259	0	0	0												"$275 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 (14a1); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											190.6084929	140.5472438	81.80667226	0	150	0.2	0.11859855	50	0.2	3	0.171452804	0	0.2	0.149973909	10.22258052	34.4355576	38.5	35	0	0	0.2	34.69399027	0	0	35	0	35	0	0	0											NO	162.0214942	119.4683096	69.53750632	0	127.5033645	0.170004486	0.100811428	42.50112149	0.170004486	2.550067289	0.145738729	0	0.170004486	0.127491974	10.22258052	34.4355576	38.5	29.75078504	0	0	0.170004486	34.69399027	0	0	35	0	35	0	0	0												21.7059	0.834263786	8.471178804	0	1.680014705	2.398363739	1.171128587	1.584514043	5.910294391	1.640733352	4.763047158	0	0.015315404	2.232524226	4.470273567	11.71498532	0.885189832	1.151336913	0	0	2.970608515	2.115402595	0	0	0.561557158	0	0.051449862	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3281	0	9.973764641	21.7059	0.834263786	8.471178804	0	1.680014705	2.398363739	1.171128587	1.584514043	5.910294391	1.640733352	4.763047158	0	0.015315404	2.232524226	4.470273567	11.71498532	0.885189832	1.151336913	0	0	2.970608515	2.115402595	0	0	0.561557158	0	0.051449862	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3281	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											4900	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.7059	0.834263786	8.471178804	0	1.680014705	2.398363739	1.171128587	1.584514043	5.910294391	1.640733352	4.763047158	0	0.015315404	2.232524226	4.470273567	11.71498532	0.885189832	1.151336913	0	0	2.970608515	2.115402595	0	0	0.561557158	0	0.051449862	0	0	0	0	0	0	0	0	0	0	0	0	0	76.3281
H5435_027_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1318.731241	44.95424181	1074.021843	80.68627892	116.2152239	10.02543439	7.844566969	391.692606	316.1984442	8683.580184	37.55772329	0	0.047623178	914.1113223	5518.326155	4647.533615	188.578413	530.6765879	0	0	14.15936846	828.5840164	0	0	191.754244	0	17.6240437	0	0	0												"$195 Days 1-8 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$195 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$95 Days 1-30 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	$180 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $180 (9a); $40/$30 (9c)"	"$15 (7a); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$25 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 (14a1); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											150.4803109	117.6802144	75.20887061	0	150	0.2	0.113927076	50	180	3	0.17099673	0	0.2	70.04662793	9.063803896	25	38.5	25	0	0	0.2	24.77728555	0	0	25	0	25	0	0	0											NO	131.8706556	103.1268937	65.90791192	0	131.449744	0.175266325	0.0998379	43.81658133	157.7396928	2.62899488	0.149849843	0	0.175266325	61.40097959	9.063803896	25	38.5	21.90829066	0	0	0.175266325	24.77728555	0	0	25	0	25	0	0	0												14.4918	0.38633261	5.898878088	0	1.273038453	1.757121045	0.78318509	1.430219244	4.156420455	1.902423987	5.628018934	0	0.008346739	4.677277554	4.168085509	9.682361697	0.605022408	0.968851411	0	0	2.481660478	1.710838565	0	0	0.399488008	0	0.036716758	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4461	0	6.46800368	14.4918	0.38633261	5.898878088	0	1.273038453	1.757121045	0.78318509	1.430219244	4.156420455	1.902423987	5.628018934	0	0.008346739	4.677277554	4.168085509	9.682361697	0.605022408	0.968851411	0	0	2.481660478	1.710838565	0	0	0.399488008	0	0.036716758	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4461	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											4300	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.4918	0.38633261	5.898878088	0	1.273038453	1.757121045	0.78318509	1.430219244	4.156420455	1.902423987	5.628018934	0	0.008346739	4.677277554	4.168085509	9.682361697	0.605022408	0.968851411	0	0	2.481660478	1.710838565	0	0	0.399488008	0	0.036716758	0	0	0	0	0	0	0	0	0	0	0	0	0	62.4461
H5435_030_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1613.166983	62.42732683	1646.600571	108.4463617	160.0134489	13.82450702	11.05369383	474.976079	47.07758257	9616.56644	43.48118607	0	0.055825485	25.84060924	6081.404213	4960.799096	255.0818882	540.5195579	0	0	18.88460332	938.7918215	0	0	120.0006162	0	17.46443394	0	0	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 (14a1); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	81.80667226	0	150	0.2	0.110777616	50	0.2	3	0.169154399	0	0.2	0.149555888	9.470297573	34.4762322	38.5	35	0	0	0.2	34.60616811	0	0	35	0	35	0	0	0											NO	151.8233373	115.6318678	67.4128826	0	123.607673	0.164810231	0.091286422	41.20255766	0.164810231	2.472153459	0.139391877	0	0.164810231	0.123341363	9.470297573	34.4762322	38.5	28.84179036	0	0	0.164810231	34.60616811	0	0	35	0	35	0	0	0												20.4097	0.601549034	9.250174251	0	1.648240838	2.27842019	1.009052158	1.63085244	7.75886724	1.981135666	6.06092416	0	0.009200611	3.187215972	4.799392297	14.25247179	0.818387724	1.299129315	0	0	3.112375829	2.707332299	0	0	0.350001797	0	0.050937932	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2154	0	12.85845753	20.4097	0.601549034	9.250174251	0	1.648240838	2.27842019	1.009052158	1.63085244	7.75886724	1.981135666	6.06092416	0	0.009200611	3.187215972	4.799392297	14.25247179	0.818387724	1.299129315	0	0	3.112375829	2.707332299	0	0	0.350001797	0	0.050937932	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2154	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											4600	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.4097	0.601549034	9.250174251	0	1.648240838	2.27842019	1.009052158	1.63085244	7.75886724	1.981135666	6.06092416	0	0.009200611	3.187215972	4.799392297	14.25247179	0.818387724	1.299129315	0	0	3.112375829	2.707332299	0	0	0.350001797	0	0.050937932	0	0	0	0	0	0	0	0	0	0	0	0	0	83.2154
H5435_031_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1498.529168	77.24233224	1451.103867	97.80745578	139.776739	11.88488515	9.642844188	449.5881529	40.87469233	8715.852578	42.31292834	0	0.041337766	33.01213151	5331.535093	4437.81192	239.1072345	480.7649489	0	0	18.97514719	889.9939176	0	0	147.8232959	0	17.3816648	0	0	0												"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$105 Days 1-20 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $0 n/c (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 (14a1); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	68.34452473	0	150	0.2	0.114715595	50	0.2	3	0.168444839	0	0.2	0.152412562	9.393593011	34.23566057	38.5	35	0	0	0.2	33.96559508	0	0	35	0	35	0	0	0											NO	201.0053198	148.2134571	68.34452473	0	150	0.2	0.114715595	50	0.2	3	0.168444839	0	0.2	0.152412562	9.393593011	34.23566057	38.5	35	0	0	0.2	33.96559508	0	0	35	0	35	0	0	0												25.101	0.954029424	8.264583675	0	1.747209238	2.37697703	1.106184609	1.87328397	8.174938466	2.178963144	7.12739439	0	0.008267553	5.031463546	4.173522566	12.66095188	0.767135711	1.402231101	0	0	3.795029439	2.519097752	0	0	0.43115128	0	0.050696522	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7441	0	0	25.101	0.954029424	8.264583675	0	1.747209238	2.37697703	1.106184609	1.87328397	8.174938466	2.178963144	7.12739439	0	0.008267553	5.031463546	4.173522566	12.66095188	0.767135711	1.402231101	0	0	3.795029439	2.519097752	0	0	0.43115128	0	0.050696522	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7441	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											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	25.101	0.954029424	8.264583675	0	1.747209238	2.37697703	1.106184609	1.87328397	8.174938466	2.178963144	7.12739439	0	0.008267553	5.031463546	4.173522566	12.66095188	0.767135711	1.402231101	0	0	3.795029439	2.519097752	0	0	0.43115128	0	0.050696522	0	0	0	0	0	0	0	0	0	0	0	0	0	89.7441
H5435_849_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	296.0385849	1.2861917	30.93829153	120.8418292	5.788304206	14.55554807	12.07919643	14.80149693	46.61895888	24.2945156	46.61407211	0	0.08031543	22.74232838	28.55977835	130.4617368	1.046039989	8.826376745	0	0	37.41039909	7.745149406	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.07477288	0.07477288	0.163937265	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07477288	0.07477288	0.163937265	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.1357	0.096172257	5.071938885	0	1.34867488	3.3914427	2.814452769	3.448748784	10.86221742	5.660622135	10.8610788	0	0.018713495	5.298962512	6.654428355	30.39758468	0.243727318	2.056545782	0	0	8.716622989	1.804619812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8822	0	0	22.1357	0.096172257	5.071938885	0	1.34867488	3.3914427	2.814452769	3.448748784	10.86221742	5.660622135	10.8610788	0	0.018713495	5.298962512	6.654428355	30.39758468	0.243727318	2.056545782	0	0	8.716622989	1.804619812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8822	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											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	22.1357	0.096172257	5.071938885	0	1.34867488	3.3914427	2.814452769	3.448748784	10.86221742	5.660622135	10.8610788	0	0.018713495	5.298962512	6.654428355	30.39758468	0.243727318	2.056545782	0	0	8.716622989	1.804619812	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.8822
H5435_869_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	312.541426	2.14834522	44.55192441	126.8091129	7.630802808	16.2163032	11.92219298	16.54244574	48.04823847	24.32259773	49.6851075	0	0.128078586	25.97413119	29.27204325	131.1964595	1.32907239	9.455910762	0	0	35.81384354	6.841735184	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.074800449	0.074800449	0.151208785	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074800449	0.074800449	0.151208785	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												23.3782	0.160697188	6.736642339	0	1.777977054	3.778398645	2.777870965	3.854389857	11.19523956	5.667165272	11.57663005	0	0.029842311	6.051972568	6.820386077	30.56877506	0.309673867	2.203227208	0	0	8.344625544	1.594124298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.8259	0	0	23.3782	0.160697188	6.736642339	0	1.777977054	3.778398645	2.777870965	3.854389857	11.19523956	5.667165272	11.57663005	0	0.029842311	6.051972568	6.820386077	30.56877506	0.309673867	2.203227208	0	0	8.344625544	1.594124298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.8259	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											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	23.3782	0.160697188	6.736642339	0	1.777977054	3.778398645	2.777870965	3.854389857	11.19523956	5.667165272	11.57663005	0	0.029842311	6.051972568	6.820386077	30.56877506	0.309673867	2.203227208	0	0	8.344625544	1.594124298	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.8259
H5435_870_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	298.0566835	2.124332509	46.14783168	130.5194514	6.302506922	15.83314418	12.47448835	15.41053877	46.33230343	23.67749472	49.40721838	0	0.833338817	25.37098835	29.4967767	129.8566985	1.353921772	10.1412922	0	0	34.7723321	6.928871713	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077059754	0.077059754	0.164310722	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077059754	0.077059754	0.164310722	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.9682	0.163700542	7.582583544	0	1.468484113	3.689122594	2.906555785	3.590655535	10.7954267	5.51685627	11.51188188	0	0.194167944	5.911440285	6.872748971	30.25661076	0.315463773	2.362921083	0	0	8.10195338	1.614427109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8232	0	0	22.9682	0.163700542	7.582583544	0	1.468484113	3.689122594	2.906555785	3.590655535	10.7954267	5.51685627	11.51188188	0	0.194167944	5.911440285	6.872748971	30.25661076	0.315463773	2.362921083	0	0	8.10195338	1.614427109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8232	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											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	22.9682	0.163700542	7.582583544	0	1.468484113	3.689122594	2.906555785	3.590655535	10.7954267	5.51685627	11.51188188	0	0.194167944	5.911440285	6.872748971	30.25661076	0.315463773	2.362921083	0	0	8.10195338	1.614427109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.8232
H5435_871_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	310.6508874	2.135350049	44.28243332	126.0420546	7.58464468	16.11821205	11.85007657	16.44238178	47.75759845	24.17547225	49.38456619	0	0.127303849	25.81701571	29.09497896	130.4028624	1.321032936	9.3987127	0	0	35.59720841	6.800350065	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.074800449	0.074800449	0.151208785	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074800449	0.074800449	0.151208785	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												23.2368	0.159725143	6.695892919	0	1.767222211	3.755543409	2.761067841	3.831074956	11.12752044	5.632885034	11.50660392	0	0.029661797	6.015364661	6.779130097	30.38386694	0.307800674	2.189900059	0	0	8.294149559	1.584481565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0587	0	0	23.2368	0.159725143	6.695892919	0	1.767222211	3.755543409	2.761067841	3.831074956	11.12752044	5.632885034	11.50660392	0	0.029661797	6.015364661	6.779130097	30.38386694	0.307800674	2.189900059	0	0	8.294149559	1.584481565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0587	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											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	23.2368	0.159725143	6.695892919	0	1.767222211	3.755543409	2.761067841	3.831074956	11.12752044	5.632885034	11.50660392	0	0.029661797	6.015364661	6.779130097	30.38386694	0.307800674	2.189900059	0	0	8.294149559	1.584481565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0587
H5435_872_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	310.6508874	2.135350049	44.28243332	126.0420546	7.58464468	16.11821205	11.85007657	16.44238178	47.75759845	24.17547225	49.38456619	0	0.127303849	25.81701571	29.09497896	130.4028624	1.321032936	9.3987127	0	0	35.59720841	6.800350065	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.074800449	0.074800449	0.151208785	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074800449	0.074800449	0.151208785	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												23.2368	0.159725143	6.695892919	0	1.767222211	3.755543409	2.761067841	3.831074956	11.12752044	5.632885034	11.50660392	0	0.029661797	6.015364661	6.779130097	30.38386694	0.307800674	2.189900059	0	0	8.294149559	1.584481565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0587	0	0	23.2368	0.159725143	6.695892919	0	1.767222211	3.755543409	2.761067841	3.831074956	11.12752044	5.632885034	11.50660392	0	0.029661797	6.015364661	6.779130097	30.38386694	0.307800674	2.189900059	0	0	8.294149559	1.584481565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0587	YES	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"											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	23.2368	0.159725143	6.695892919	0	1.767222211	3.755543409	2.761067841	3.831074956	11.12752044	5.632885034	11.50660392	0	0.029661797	6.015364661	6.779130097	30.38386694	0.307800674	2.189900059	0	0	8.294149559	1.584481565	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.0587
H5439_001_0	2010	6	N/A																															A	A	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											23.1043	0	3.3195	1.843	0	1.1131	0.3056	0.0078	4.4619	0.3396	2.9974	0	0	0.9914	1.047	5.9929	0	0	0.6833	2.1123	0.4104	0.0827	0	0	0	0	0	0	0	0											48.8123	YES	168.6091656	2.721197146	27.4282662	16.26953238	131.3329121	9.87385479	2.716823757	185.0779366	317.6524744	3.012646409	26.87745078	0	41.09680722	188.7504296	3401.093267	5598.259177	211.1375832	631.1726109	26.25634934	41.3940886	3.641212813	0	0	0	226.9500904	0	68.48584711	0	1000	0											1500	1a:  Acute - $50/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - $50/admit for 1-190	2:  Skilled Nursing Services - $50/admit/2:  Non-Medicare Covered Stay - $50/admit	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $50/visit/9b:  Ambulatory Surgical Center Services - $50/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $15/visit/8b:  Outpatient Therapeutic Radiological Services - $15/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $15/service/14i:  Diabetes Monitoring - $15/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $15/visit	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/16b:  Comprehensive Dental - $15/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $25/visit/7-12 Additional Visits/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $20/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $20/visit		14b:  Other Immunizations - $0/visit/14a:  Nursing Hotline - $0/service/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												50	50	50	0	100	0.2	0.2	33.08038894	50	0	0.008519444	0	15	25	15.00048031	21.02977917	25	25	0	20.18674121	0.2	0	0	0	20	0	20	0	0	0											YES	39.9418205	50	40.03396443	0	79.67825337	0.159925937	0.159767034	26.43354577	39.89713222	1.15E-18	0.006789552	0	11.91442212	20.02073051	11.96040927	16.76863638	19.92197915	19.95769509	-1.06E-18	16.20319839	0.159916926	0	0	0	15.99296855	0	16.05896428	0	0	0											2500	0.5612	0.011338321	0.091505186	0	0.87203142	1.579085482	0.434058874	0.407688842	1.056118564	3.47E-18	0.182485848	0	0.040803726	0.314910124	3.389872288	7.822931041	0.350523211	1.04972921	-2.78E-17	0.055893052	0.582291559	0	0	0	0.302467138	0	0.091650981	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1966	850	4.858909713	23.6655	0.011338321	3.411049789	1.842989546	0.87203142	2.692207572	0.739681102	0.415456607	5.517981434	0.339612309	3.179932264	0	0.040803726	1.306289342	4.436845727	13.81580975	0.350523211	1.04972921	0.683326938	2.168198913	0.992731195	0.082729092	0	0	0.302467138	0	0.091650981	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0089	NO	1a:  Acute - $200/$0/admit for 1-90/1a:  Additional Days - $0/admit for 91-190	1b:  Psych - $200/$0/admit for 1-190	2:  Skilled Nursing Services - 10.0% for 1-100/2:  Non-Medicare Covered Stay - 10.0% for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 10.0%/9b:  Ambulatory Surgical Center Services - 10.0%	8a:  Outpatient Diagnostic Procedures/Tests - 10.0%/8a:  Outpatient Lab Services - 10.0%	8b:  Outpatient Diagnostic Radiological Services - 10.0%/8b:  Outpatient Therapeutic Radiological Services - 10.0%/8b:  Outpatient X-Ray Services - 10.0%		12:  Renal Dialysis - $15/service/14i:  Diabetes Monitoring - 10.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 10.0%	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $50/day	7a:  Primary Care - 10.0%/17a:  Vision Exams - 10.0%/18a:  Hearing Exams - 10.0%/:  Routine Exams - 10.0%/14d:  Pap Smears and Pelvic Exams Screening - 10.0%/14f:  Colorectal Screening - 10.0%/14g:  Bone Mass Measurement - 10.0%/14b:  Immunizations (Hepatitis B) - 10.0%	7d:  Physician Specialist Services - 10.0%/7b:  Chiropractic Services - $50/visit/7f:  Podiatry Services - $35/visit/7-12 Additional Visits/17a:  Vision Exams - 10.0%/18a:  Hearing Exams - 10.0%/14d:  Pap Smears and Pelvic Exams Screening - 10.0%/14f:  Colorectal Screening - 10.0%/14g:  Bone Mass Measurement - 10.0%/14b:  Immunizations (Hepatitis B) - 10.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - $50/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $50/visit/7h:  Psychiatric Services - Individual - $50/visit/7h:  Psychiatric Services - Group - $50/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 10.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 10.0%"	9c:  Outpatient Substance Abuse Svcs - Individual - $50/visit/9c:  Outpatient Substance Abuse Svcs - Group - $50/visit/7g:  Other Health Care Professional Services - 10.0%	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 10.0%			17a:  Routine Eye Exams - 10.0%		18a:  Routine Hearing Test - 10.0%/18a:  Fitting for Hearing Aid - 10.0%		14b:  Other Immunizations - $0/visit/:  Routine Exams - 10.0%/14c:  Routine Exams - 10.0%													5.1581	0.0379	1.1556	0.4027	0.3898	0.4643	0.1276	0.254	1.277	0.1428	0.8947	0	0.0215	0.4521	1.0971	3.7686	0.1121	0.2871	0.6564	1.2575	0.2389	0.0323	0	0	0.0692	0	0.0146	0	0.0533	0											18.365	1200	2.190647974	28.8236	0.04923434	4.566640091	2.245722186	1.261793855	3.156468996	0.867277939	0.669477742	6.794954398	0.482457445	4.074644144	0	0.062340514	1.758361713	5.53391649	17.58445182	0.462616064	1.336820516	1.339705461	3.425653199	1.231621176	0.114981741	0	0	0.371654183	0	0.106214824	0	0.053250349	0	0	0	0	0	0	0	0	0	0	0	86.3739
H5440_001_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.6309	0.8455	0.6431	0	1.6152	0	1.8087	0	0.0024	0.8369	1.0684	5.3833	0.3371	0.1411	0	0	0.8673	0.1956	0	0	0	0	0	0	0	0											14.3753	NO	517.0705663	24.49870523	107.4324842	3316.499578	20.85003407	27.61656995	21.09296163	51.502645	53.66855922	23.53549339	59.61185455	0	0.074688898	26.83040263	37.69191749	178.4687818	11.89937111	4.627660069	0	0	28.16028839	6.74715842	620.7312288	253.3577359	197.175517	192.168638	0	0	85.28780019	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083726574	0.084743496	0.160563642	0	0.193933929	0.193933929	0.193933929	0.064125223	0.193933929	0	0.161933421	0	0.193933929	0.144524041	0.162123985	0.193808675	0.193933929	0	0	0	0.193933929	0.193946647	0	0	0	0	0	0	0	0											NO	0.083726574	0.084743496	0.160563642	0	0.193933929	0.193933929	0.193933929	0.064125223	0.193933929	0	0.161933421	0	0.193933929	0.144524041	0.162123985	0.193808675	0.193933929	0	0	0	0.193933929	0.193946647	0	0	0	0	0	0	0	0												43.2925	2.076105934	17.24975088	0	4.043529026	5.355789915	4.090640923	3.302618597	10.40815455	0	9.653151529	0	0.014484711	3.877638208	6.11076385	34.58879819	2.307691792	0	0	0	5.461235368	1.308588754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.1415	146	0	43.2925	2.076105934	17.24975088	0	4.674400146	6.201241538	4.73372004	3.302618597	12.02331899	0	11.46181775	0	0.016884205	4.714534135	7.179118414	39.97207771	2.644772364	0.14111061	0	0	6.328562903	1.504204962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.5168	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	43.2925	2.076105934	17.24975088	0	4.674400146	6.201241538	4.73372004	3.302618597	12.02331899	0	11.46181775	0	0.016884205	4.714534135	7.179118414	39.97207771	2.644772364	0.14111061	0	0	6.328562903	1.504204962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.5168
H5470_002_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	O	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	0	0	0	0	0	0		0	YES	1147.912751	52.325742	528.959569	469.81294	37.89353	8.704575	3.705898	319.337927	382.852496	1468.371375	157.439433	74.991955	0.068554	596.00575	3473.281728	4139.129374	87.955963	208.911092			22.337275	0							0.04	0.32	917.211171	21.433902	0.05	0.55	1.66	2.09	580.617777	0.4	0.42		5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: LifeSynch Wellness Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		158.7573	140.3991	50.7565	0	100	0.2	0.2	50	97.036841	20.640951	30	50	0.2	44.714967	10	30	30	50			0.2	0							0	0	50	0	0	0	0	0	30	0	0		NO	147.07689	130.069377	37.038236	0	90.3649	0.18073	0.18073	45.18245	87.687244	18.652175	27.10947	45.18245	0.18073	40.406635	9.03649	27.10947	27.10947	45.18245			0.18073	0							0	0	45.18245	0	0	0	0	0	27.10947	0	0			14.0693	0.567164722	1.632644113	0	0.285353754	1.57317784	0.669766946	1.202372493	2.797606686	2.282359988	0.355674965	0.282360021	0.012389764	2.006882233	2.615522967	9.350800299	0.198703295	0.786592914	0	0	4.037015711	0	0	0	0	0	0	0	0	0	3.453487323	0	0	0	0	0	1.311686684	0	0	0	49.4908	0	5.309332	14.0693	0.567164722	1.632644113	0	0.285353754	1.57317784	0.669766946	1.202372493	2.797606686	2.282359988	0.355674965	0.282360021	0.012389764	2.006882233	2.615522967	9.350800299	0.198703295	0.786592914	0	0	4.037015711	0	0	0	0	0	0	0	0	0	3.453487323	0	0	0	0	0	1.311686684	0	0	0	49.4908	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: LifeSynch Wellness Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		10000	10.1443	0.1464	0.5606	2.0721	1.3567	1.5411	0.6561	0.2522	3.714	0.497	0.087	0.2978	0.0027	0.9382	1.9201	2.2882	0.0486	0.1062			1.196	0							0	0	1.4538	0	0	0	0	0	0.321	0	0		29.6001	500	6.488211	24.2136	0.713517722	2.193230113	2.072109	1.642016754	3.11425884	1.325869946	1.454569493	6.511601686	2.779355988	0.442710965	0.580201021	0.015124764	2.945044233	4.535637967	11.6390123	0.247327295	0.892772914	0	0	5.233035711	0	0	0	0	0	0	0	0	0	4.907290323	0	0	0	0	0	1.632666684	0	0	0	79.091
H5470_004_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	YES	1276.739652	58.198108	588.323159	522.538677	42.14621	9.829018	4.18462	355.176292	425.818916	1633.162413	175.108401	83.408083	0.07741	662.893739	3863.07801	4603.651796	97.827005	232.356574			25.222769	0							0.04	0.25	1020.147107	23.839367	0.05	0.55	2.09	645.778818	0.32	0.4	0.49		5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		158.7573	140.3991	50.7565	0	100	0.2	0.2	50	97.036841	20.640951	30	50	0.2	44.714967	10	30	30	50			0.2	0							0	0	50	0	0	0	0	30	0	0	0		NO	144.396591	127.699019	34.44869	0	88.9285	0.177857	0.177857	44.46425	86.293407	18.355688	26.67855	44.46425	0.177857	39.76435	8.89285	26.67855	26.67855	44.46425			0.177857	0							0	0	44.46425	0	0	0	0	26.67855	0	0	0			15.3631	0.619320108	1.68891351	0	0.31233327	1.748159654	0.744263959	1.316053953	3.062113752	2.498151642	0.389303186	0.309056488	0.01376791	2.196628221	2.86281444	10.23489622	0.21749022	0.8609634	0	0	4.486046026	0	0	0	0	0	0	0	0	0	3.780006334	0	0	0	0	1.43570354	0	0	0	0	54.1391	0	6.929218	15.3631	0.619320108	1.68891351	0	0.31233327	1.748159654	0.744263959	1.316053953	3.062113752	2.498151642	0.389303186	0.309056488	0.01376791	2.196628221	2.86281444	10.23489622	0.21749022	0.8609634	0	0	4.486046026	0	0	0	0	0	0	0	0	0	3.780006334	0	0	0	0	1.43570354	0	0	0	0	54.1391	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		10000	10.5223	0.1518	0.5481	1.7326	1.1174	1.5463	0.6583	0.2077	3.1055	0.4156	0.0717	0.249	0.0023	0.7845	1.5814	1.8846	0.04	0.0888			1.0001	0							0	0	1.2156	0	0	0	0	0.2644	0	0	0		27.188	0	8.470727	25.8853	0.771125108	2.23705051	1.732625	1.42969827	3.294478654	1.402595959	1.523766953	6.167626752	2.913722642	0.460987186	0.558101488	0.01605391	2.981086221	4.44424544	12.11949722	0.25753822	0.9497474	0	0	5.486116026	0	0	0	0	0	0	0	0	0	4.995625334	0	0	0	0	1.70006654	0	0	0	0	81.3271
H5470_005_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	YES	1149.147756	52.382038	529.528661	470.318398	37.934298	8.390584	3.572218	319.681494	383.264396	1469.951151	157.608817	75.072636	0.066081	596.646975	3477.018527	4143.582538	88.050593	209.135853			21.531526	0							0.04	0.25	918.197972	21.456962	0.05	0.55	2.09	581.242447	0.32	0.4	0.49		5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		158.7573	140.3991	50.7565	0	100	0.2	0.2	50	97.036841	20.640951	30	50	0.2	44.714967	10	30	30	50			0.2	0							0	0	50	0	0	0	0	30	0	0	0		NO	147.131662	130.117814	37.062295	0	90.4112	0.180822	0.180822	45.2056	87.732172	18.661731	27.12336	45.2056	0.180822	40.427338	9.04112	27.12336	27.12336	45.2056			0.180822	0							0	0	45.2056	0	0	0	0	27.12336	0	0	0			14.0897	0.567986356	1.635462287	0	0.285807117	1.51720218	0.645935603	1.204282812	2.802051493	2.28598608	0.356240057	0.282808629	0.011948899	2.010070744	2.619678479	9.365656739	0.199018994	0.787842643	0	0	3.893373594	0	0	0	0	0	0	0	0	0	3.458974187	0	0	0	0	1.313770678	0	0	0	0	49.3338	0	5.26668	14.0897	0.567986356	1.635462287	0	0.285807117	1.51720218	0.645935603	1.204282812	2.802051493	2.28598608	0.356240057	0.282808629	0.011948899	2.010070744	2.619678479	9.365656739	0.199018994	0.787842643	0	0	3.893373594	0	0	0	0	0	0	0	0	0	3.458974187	0	0	0	0	1.313770678	0	0	0	0	49.3338	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		10000	9.7538	0.1407	0.5556	1.5452	1.0507	1.379	0.5871	0.1953	2.7695	0.3706	0.0674	0.2221	0.002	0.6996	1.487	1.7721	0.0377	0.0792			0.8919	0							0	0	1.0841	0	0	0	0	0.2486	0	0	0		24.9391	0	5.802686	23.8434	0.708704356	2.191046287	1.545173	1.336459117	2.89622518	1.233042603	1.399593812	5.571580493	2.65659608	0.423644057	0.504909629	0.013987899	2.709659744	4.106690479	11.13773674	0.236674994	0.867020643	0	0	4.785247594	0	0	0	0	0	0	0	0	0	4.543076187	0	0	0	0	1.562349678	0	0	0	0	74.2728
H5470_007_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	NO	1122.058613	51.147223	517.045951	459.231467	37.040064	7.329709	3.12056	312.145563	374.22961	1435.299631	153.893466	73.30293	0.057726	582.58207	3395.053915	4045.904849	85.974954	204.205842			18.809159	0							0.04	0.25	896.553066	20.951152	0.05	0.55	2.09	567.540675	0.32	0.4	0.49			$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		158.7573	140.3991	50.7565	0	100	0.2	0.2	50	97.036841	20.640951	30	50	0.2	44.714967	10	30	30	50			0.2	0							0	0	50	0	0	0	0	30	0	0	0		NO	135.33393	119.684336	26.059047	0	83.5168	0.167034	0.167034	41.7584	81.042064	17.238662	25.05504	41.7584	0.167034	37.34451	8.35168	25.05504	25.05504	41.7584			0.167034	0							0	0	41.7584	0	0	0	0	25.05504	0	0	0			12.6544	0.510126785	1.122810395	0	0.257788968	1.224310613	0.521239619	1.08622494	2.527361667	2.061887101	0.321317246	0.255084423	0.009642205	1.813020162	2.36286699	8.447525652	0.179508826	0.710609103	0	0	3.141769064	0	0	0	0	0	0	0	0	0	3.119885129	0	0	0	0	1.184979526	0	0	0	0	43.5123	0	9.110598	12.6544	0.510126785	1.122810395	0	0.257788968	1.224310613	0.521239619	1.08622494	2.527361667	2.061887101	0.321317246	0.255084423	0.009642205	1.813020162	2.36286699	8.447525652	0.179508826	0.710609103	0	0	3.141769064	0	0	0	0	0	0	0	0	0	3.119885129	0	0	0	0	1.184979526	0	0	0	0	43.5123	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		3400	4.1722	0.0602	0.1353	0.9829	0.747	0.8772	0.3735	0.1389	1.7617	0.2357	0.0479	0.1413	0.0013	0.445	1.0573	1.26	0.0268	0.0504			0.5673	0							0	0	0.6896	0	0	0	0	0.1767	0	0	0		13.9482	0	13.508153	16.8266	0.570319785	1.258138395	0.982894	1.004811968	2.101515613	0.894702619	1.22509294	4.289076667	2.297635101	0.369242246	0.396364423	0.010939205	2.258033162	3.42014499	9.707489652	0.206282826	0.760975103	0	0	3.709095064	0	0	0	0	0	0	0	0	0	3.809489129	0	0	0	0	1.361721526	0	0	0	0	57.4606
H5470_801_0	2010	4	N/A																															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	NO	252.612895	0.861688871	24.31390506	14.567184	2.497316996	11.01811983	5.385726739	22.77591028	66.42290326	10.76281398	25.83910734	9.070692731	0.79696975	16.43236763	31.91417516	69.99116626	0.33632881	5.168367169			25.38434362	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																			0.078722743	0.078722743	0.169378828	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.078722743	0.078722743	0.169378828	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.8864	0.067834511	4.118260735	0	0.58187486	2.567221919	1.25487433	5.306787095	15.47653646	2.507735658	6.02051201	2.113471406	0.185693952	3.828741658	7.436002812	16.30794174	0.078364613	1.20422955	0	0	5.914552062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.857	0	0	19.8864	0.067834511	4.118260735	0	0.58187486	2.567221919	1.25487433	5.306787095	15.47653646	2.507735658	6.02051201	2.113471406	0.185693952	3.828741658	7.436002812	16.30794174	0.078364613	1.20422955	0	0	5.914552062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.857	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3167	0.0011	0.1573	0	0.9863	0.5394	0.2637	0.4331	1.1526	0.2047	0.4461	0.1725	0.0151	0.3101	0.4314	0.946	0.0045	0.0798			0.0084	0																			6.4688	0	0	20.2031	0.068915009	4.275603831	0	1.568204636	3.106593237	1.518541575	5.739912128	16.6290928	2.712399583	6.46656791	2.285969797	0.20083726	4.138874314	7.867390366	17.25397988	0.082913547	1.283990115	0	0	5.922968345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.3259
H5470_802_0	2010	4	N/A																															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	NO	252.612895	0.861688871	24.31390506	14.567184	2.497316996	11.01811983	5.385726739	22.77591028	66.42290326	10.76281398	25.83910734	9.070692731	0.79696975	16.43236763	31.91417516	69.99116626	0.33632881	5.168367169			25.38434362	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																			0.078722743	0.078722743	0.169378828	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.078722743	0.078722743	0.169378828	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.8864	0.067834511	4.118260735	0	0.58187486	2.567221919	1.25487433	5.306787095	15.47653646	2.507735658	6.02051201	2.113471406	0.185693952	3.828741658	7.436002812	16.30794174	0.078364613	1.20422955	0	0	5.914552062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.857	0	0	19.8864	0.067834511	4.118260735	0	0.58187486	2.567221919	1.25487433	5.306787095	15.47653646	2.507735658	6.02051201	2.113471406	0.185693952	3.828741658	7.436002812	16.30794174	0.078364613	1.20422955	0	0	5.914552062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.857	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3167	0.0011	0.1573	0	0.9863	0.5394	0.2637	0.4331	1.1526	0.2047	0.4461	0.1725	0.0151	0.3101	0.4314	0.946	0.0045	0.0798			0.0084	0																			6.4688	0	0	20.2031	0.068915009	4.275603831	0	1.568204636	3.106593237	1.518541575	5.739912128	16.6290928	2.712399583	6.46656791	2.285969797	0.20083726	4.138874314	7.867390366	17.25397988	0.082913547	1.283990115	0	0	5.922968345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.3259
H5470_803_0	2010	4	N/A																															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	NO	252.612895	0.861688871	24.31390506	14.567184	2.497316996	11.01811983	5.385726739	22.77591028	66.42290326	10.76281398	25.83910734	9.070692731	0.79696975	16.43236763	31.91417516	69.99116626	0.33632881	5.168367169			25.38434362	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																			0.078722743	0.078722743	0.169378828	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.078722743	0.078722743	0.169378828	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.8864	0.067834511	4.118260735	0	0.58187486	2.567221919	1.25487433	5.306787095	15.47653646	2.507735658	6.02051201	2.113471406	0.185693952	3.828741658	7.436002812	16.30794174	0.078364613	1.20422955	0	0	5.914552062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.857	0	0	19.8864	0.067834511	4.118260735	0	0.58187486	2.567221919	1.25487433	5.306787095	15.47653646	2.507735658	6.02051201	2.113471406	0.185693952	3.828741658	7.436002812	16.30794174	0.078364613	1.20422955	0	0	5.914552062	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.857	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3167	0.0011	0.1573	0	0.9863	0.5394	0.2637	0.4331	1.1526	0.2047	0.4461	0.1725	0.0151	0.3101	0.4314	0.946	0.0045	0.0798			0.0084	0																			6.4688	0	0	20.2031	0.068915009	4.275603831	0	1.568204636	3.106593237	1.518541575	5.739912128	16.6290928	2.712399583	6.46656791	2.285969797	0.20083726	4.138874314	7.867390366	17.25397988	0.082913547	1.283990115	0	0	5.922968345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.3259
H5485_801_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	342.9283255	3.432380501	76.24553561	0	11.48394667	19.37502339	6.231358385	17.48075526	49.90819122	12.71031687	34.93237642	0	0.260430557	27.49994457	49.43390628	136.8812202	1.185492174	4.947975703	36.17389187	40.479353	12.47928353	1.810852737	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	18% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081740198	0.081740198	0.17539371	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999707	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081740198	0.081740198	0.17539371	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999707	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												28.031	0.280563462	13.37298733	0	2.675759574	4.51438045	1.451906504	4.073015976	11.62860855	2.961503831	8.139243706	0	0.06068032	6.407487085	11.51810016	31.89328416	0.276219676	1.152878339	8.428516805	9.43168925	2.907673063	0.421928688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.6275	0	0	28.031	0.280563462	13.37298733	0	2.675759574	4.51438045	1.451906504	4.073015976	11.62860855	2.961503831	8.139243706	0	0.06068032	6.407487085	11.51810016	31.89328416	0.276219676	1.152878339	8.428516805	9.43168925	2.907673063	0.421928688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.6275	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.031	0.280563462	13.37298733	0	2.675759574	4.51438045	1.451906504	4.073015976	11.62860855	2.961503831	8.139243706	0	0.06068032	6.407487085	11.51810016	31.89328416	0.276219676	1.152878339	8.428516805	9.43168925	2.907673063	0.421928688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.6275
H5485_802_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	342.9283255	3.432380501	76.24553561	0	11.48394667	19.37502339	6.231358385	17.48075526	49.90819122	12.71031687	34.93237642	0	0.260430557	27.49994457	49.43390628	136.8812202	1.185492174	4.947975703	36.17389187	40.479353	12.47928353	1.810852737	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	18% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081740198	0.081740198	0.17539371	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999707	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081740198	0.081740198	0.17539371	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999707	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												28.031	0.280563462	13.37298733	0	2.675759574	4.51438045	1.451906504	4.073015976	11.62860855	2.961503831	8.139243706	0	0.06068032	6.407487085	11.51810016	31.89328416	0.276219676	1.152878339	8.428516805	9.43168925	2.907673063	0.421928688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.6275	0	0	28.031	0.280563462	13.37298733	0	2.675759574	4.51438045	1.451906504	4.073015976	11.62860855	2.961503831	8.139243706	0	0.06068032	6.407487085	11.51810016	31.89328416	0.276219676	1.152878339	8.428516805	9.43168925	2.907673063	0.421928688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.6275	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.031	0.280563462	13.37298733	0	2.675759574	4.51438045	1.451906504	4.073015976	11.62860855	2.961503831	8.139243706	0	0.06068032	6.407487085	11.51810016	31.89328416	0.276219676	1.152878339	8.428516805	9.43168925	2.907673063	0.421928688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.6275
H5485_803_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	322.7167872	4.059869836	72.62385497	0	9.527630603	13.95599302	8.647065922	17.58079231	48.95798363	12.17382009	25.87509157	0	0.34725305	29.27432461	49.67081555	125.1666131	1.617449682	5.199481638	31.89001555	45.43955103	10.25869557	1.143916193	0	0	0	0	0	0	0	0												8% Coinsurance for IP Medical; 8% Coinsurance for IP Surgical;	8% Coinsurance for IP Psych; 8% Coinsurance for IP Substance Abuse;	17% Coinsurance for SNF	No Cost-Sharing	23% Coinsurance for Ambulance	23% Coinsurance for DME	23% Coinsurance for Prosthetics/Supplies; 23% Coinsurance for Diabetes Monitoring Supplies; 23% Coinsurance for Prosthetics;	23% Coinsurance for ER - Facility; 23% Coinsurance for Urgent Care;	23% Coinsurance for OP Fac - Surgery; 23% Coinsurance for OP Fac - ASC	23% Coinsurance for OP Fac - Pathology	23% Coinsurance for OP Fac - Radiology; 23% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	23% Coinsurance for Renal Dialysis - Fac; 23% Coinsurance for Renal Dialysis - Prof	23% Coinsurance for OP Fac - Cardiovascular; 23% Coinsurance for OP Fac - Occ Therapy; 23% Coinsurance for OP Fac - Physical/Speech Therapy; 23% Coinsurance for OP Fac - CORF; 23% Coinsurance for OP Fac - Other; 23% Coinsurance for Prof - CORF; 23% Coinsurance for Prof - CORF;	23% Coinsurance for PCP - Office Visits; 23% Coinsurance for PCP - Consults; 23% Coinsurance for PCP - Primary Surgeon (IP); 23% Coinsurance for PCP - Asst Surgeon (IP); 23% Coinsurance for PCP - Primary Surgeon (OP); 23% Coinsurance for PCP - Asst Surgeon (OP); 23% Coinsurance for PCP - IP Visits; 23% Coinsurance for PCP - Tx Injections; 23% Coinsurance for PCP - Allergy Testing; 23% Coinsurance for PCP - Allergy Tx; 23% Coinsurance for PCP - ER Visits; 23% Coinsurance for PCP - Cardio; 23% Coinsurance for PCP - Immunizations;	23% Coinsurance for Speclst - Office Visits; 23% Coinsurance for Speclst - Primary Surgeon (IP); 23% Coinsurance for Speclst - Asst Surgeon (IP); 23% Coinsurance for Speclst - Anesthesia (IP); 23% Coinsurance for Speclst - Primary Surgeon (OP); 23% Coinsurance for Speclst - Asst Surgeon (OP); 23% Coinsurance for Speclst - Anesthesia (OP); 23% Coinsurance for Speclst - IP Visits; 23% Coinsurance for Speclst - Tx Injections; 23% Coinsurance for Speclst - Allergy Testing; 23% Coinsurance for Speclst - Allergy Tx; 23% Coinsurance for Speclst - ER Visits; 23% Coinsurance for Speclst - Consults; 23% Coinsurance for Speclst - Cardio; 23% Coinsurance for Speclst - Immunizations;	23% Coinsurance for OP Psych - Non-Physician; 23% Coinsurance for OP Psych - Psychiatrist; 23% Coinsurance for OP Substance Abuse;	23% Coinsurance for PT/ST (PCP); 23% Coinsurance for Occ Therapy (PCP); 23% Coinsurance for PT/ST (Specialist); 23% Coinsurance for Occ Therapy (Specialist);	23% Coinsurance for Prof Radiology (IP); 23% Coinsurance for Prof Radiology (OP); 23% Coinsurance for Prof Radiology (Office);	23% Coinsurance for Chiropractor; 23% Coinsurance for Vision Exams; 23% Coinsurance for Hearing/Speech Exams; 23% Coinsurance for Misc. Medical (PCP); 23% Coinsurance for Misc. Medical; 23% Coinsurance for Prof Path (IP); 23% Coinsurance for Prof Path (OP); 23% Coinsurance for Prof Path (Office); 23% Coinsurance for Prof Path (Labs)	23% Coinsurance for Part B Rx	23% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.081715921	0.081715921	0.174445534	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999679	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081715921	0.081715921	0.174445534	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.232999679	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												26.3711	0.331756002	12.66890719	0	2.219937931	3.251746374	2.01476636	4.096324607	11.40721019	2.836500081	6.028896335	0	0.080909961	6.820917635	11.57330002	29.16378071	0.376865776	1.211479222	7.430373624	10.58741539	2.390276069	0.266532473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.129	0	0	26.3711	0.331756002	12.66890719	0	2.219937931	3.251746374	2.01476636	4.096324607	11.40721019	2.836500081	6.028896335	0	0.080909961	6.820917635	11.57330002	29.16378071	0.376865776	1.211479222	7.430373624	10.58741539	2.390276069	0.266532473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.129	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	26.3711	0.331756002	12.66890719	0	2.219937931	3.251746374	2.01476636	4.096324607	11.40721019	2.836500081	6.028896335	0	0.080909961	6.820917635	11.57330002	29.16378071	0.376865776	1.211479222	7.430373624	10.58741539	2.390276069	0.266532473	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.129
H5507_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1529.131628	115.7043958	783.3429054	775.1934209	180.1274066	7.529599271	9.340321416	257.6194591	37.31080697	8893.478654	60.36837607	0	0.462668349	30.53887274	4925.133538	5088.814982	469.9679449	399.802295	0	0	19.57020022	3156.653592	0	0	31.98602452	0	15.63623695	9.469182418	101.4620505	0											3900	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$115 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	83.9614622	0	150	0.2	0.115828139	49.52598311	0.2	3	0.164654733	0	0.2	0.148722971	12.40051267	34.66697459	38.5	35	0	0	0.2	33.35729326	0	0	35	0	0	0	0	0											NO	160.346939	118.2335582	66.97814503	0	119.6587278	0.15954497	0.092398985	39.50810756	0.15954497	2.393174557	0.131349173	0	0.15954497	0.11878074	12.32824325	34.66697459	38.5	27.92036983	0	0	0.15954497	33.35729326	0	0	35	0	0	0	0	0												20.4326	1.140011868	4.372237894	0	1.79615136	1.201309693	0.863036216	0.848171442	5.952751595	1.773637236	7.929336261	0	0.073816408	3.627429913	5.059853694	14.70115164	1.507813823	0.930218995	0	0	3.122327016	8.774784965	0	0	0.093292572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2	0	13.7327786	20.4326	1.140011868	4.372237894	0	1.79615136	1.201309693	0.863036216	0.848171442	5.952751595	1.773637236	7.929336261	0	0.073816408	3.627429913	5.059853694	14.70115164	1.507813823	0.930218995	0	0	3.122327016	8.774784965	0	0	0.093292572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); 30% (16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.784	0.0186	0.0346	0.0197	0.0227	0.0228	0.0283	0.0107	0.1131	0.0225	0.1483	0	0.0009	0.0702	0.6327	2.8366	0.1583	0.1543	0	0	0.5454	0.5256	0	0	0.0032	0	0.0017	0.0083	0	0											6.1626	0	0	21.2166	1.158641238	4.406866479	0.019713668	1.81889472	1.224126661	0.891340221	0.85891122	6.065814647	1.796095516	8.077667099	0	0.074751092	3.697617618	5.692550588	17.53771156	1.666074887	1.084537891	0	0	3.667726038	9.300372349	0	0	0.096535679	0	0.001714041	0.0083063	0	0	0	0	0	0	0	0	0	0	0	0	90.3626
H5507_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	273.6623669	5.456940314	24.59253881	826.4834396	6.506837617	8.061366391	9.999968182	12.12424065	39.94582905	20.63819571	64.6318058	0	0.495343635	32.67311331	24.3955934	108.9646718	2.480726442	5.928390737	0	0	20.95231746	20.45627671	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083599646	0.083599646	0.176885752	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083599646	0.083599646	0.176885752	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.8781	0.456198281	4.350069724	0	1.516093165	1.878298369	2.329992587	2.824948071	9.307378168	4.8086996	15.05921075	0	0.115415067	7.612835402	5.684173262	25.38876853	0.578009261	1.381315042	0	0	4.881889969	4.766312474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8177	0	0	22.8781	0.456198281	4.350069724	0	1.516093165	1.878298369	2.329992587	2.824948071	9.307378168	4.8086996	15.05921075	0	0.115415067	7.612835402	5.684173262	25.38876853	0.578009261	1.381315042	0	0	4.881889969	4.766312474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8177	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.2311	0.0046	0.0219	0	0.0153	0.019	0.0235	0.0285	0.094	0.0486	0.1521	0	0.0012	0.0769	0.528	2.3585	0.0537	0.1283	0	0	0.4535	0.4428	0	0	0	0	0	0	0	0											4.6815	0	0	23.1092	0.460806344	4.371929371	0	1.531407237	1.89727108	2.353527865	2.8534829	9.401392089	4.857272323	15.21132399	0	0.116580876	7.689732729	6.212211215	27.74728801	0.63170411	1.509633925	0	0	5.335398873	5.20908467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4992
H5507_802_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	273.6623669	5.456940314	24.59253881	826.4834396	6.506837617	8.061366391	9.999968182	12.12424065	39.94582905	20.63819571	64.6318058	0	0.495343635	32.67311331	24.3955934	108.9646718	2.480726442	5.928390737	0	0	20.95231746	20.45627671	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083599646	0.083599646	0.176885752	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083599646	0.083599646	0.176885752	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.8781	0.456198281	4.350069724	0	1.516093165	1.878298369	2.329992587	2.824948071	9.307378168	4.8086996	15.05921075	0	0.115415067	7.612835402	5.684173262	25.38876853	0.578009261	1.381315042	0	0	4.881889969	4.766312474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8177	0	0	22.8781	0.456198281	4.350069724	0	1.516093165	1.878298369	2.329992587	2.824948071	9.307378168	4.8086996	15.05921075	0	0.115415067	7.612835402	5.684173262	25.38876853	0.578009261	1.381315042	0	0	4.881889969	4.766312474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8177	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.2311	0.0046	0.0219	0	0.0153	0.019	0.0235	0.0285	0.094	0.0486	0.1521	0	0.0012	0.0769	0.528	2.3585	0.0537	0.1283	0	0	0.4535	0.4428	0	0	0	0	0	0	0	0											4.6815	0	0	23.1092	0.460806344	4.371929371	0	1.531407237	1.89727108	2.353527865	2.8534829	9.401392089	4.857272323	15.21132399	0	0.116580876	7.689732729	6.212211215	27.74728801	0.63170411	1.509633925	0	0	5.335398873	5.20908467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4992
H5507_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	273.6623669	5.456940314	24.59253881	826.4834396	6.506837617	8.061366391	9.999968182	12.12424065	39.94582905	20.63819571	64.6318058	0	0.495343635	32.67311331	24.3955934	108.9646718	2.480726442	5.928390737	0	0	20.95231746	20.45627671	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083599646	0.083599646	0.176885752	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083599646	0.083599646	0.176885752	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.8781	0.456198281	4.350069724	0	1.516093165	1.878298369	2.329992587	2.824948071	9.307378168	4.8086996	15.05921075	0	0.115415067	7.612835402	5.684173262	25.38876853	0.578009261	1.381315042	0	0	4.881889969	4.766312474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8177	0	0	22.8781	0.456198281	4.350069724	0	1.516093165	1.878298369	2.329992587	2.824948071	9.307378168	4.8086996	15.05921075	0	0.115415067	7.612835402	5.684173262	25.38876853	0.578009261	1.381315042	0	0	4.881889969	4.766312474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8177	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.2311	0.0046	0.0219	0	0.0153	0.019	0.0235	0.0285	0.094	0.0486	0.1521	0	0.0012	0.0769	0.528	2.3585	0.0537	0.1283	0	0	0.4535	0.4428	0	0	0	0	0	0	0	0											4.6815	0	0	23.1092	0.460806344	4.371929371	0	1.531407237	1.89727108	2.353527865	2.8534829	9.401392089	4.857272323	15.21132399	0	0.116580876	7.689732729	6.212211215	27.74728801	0.63170411	1.509633925	0	0	5.335398873	5.20908467	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4992
H5508_001_0	2010	7	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	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	YES	1299.970184	133.9860929	319.9803159	336.2982251	34.51134139	10.89546474	0	278.9634869	355.3946593	6166.112847	2073.049973	0	0	2635.717519	3269.924705	3037.154429	190.6262217	0	4394.347956	23076.82031	31.59458606	1025.435833	0	374.9972153	440.8568513	0	0	0	0	4.349067964											3500	Days 1-5: $125 copay	Days 1-5: $125 copay	Days 21-100: $75 copay	$0 copay	$50 copay	20% coinsurance	-	$50 copay; waived if admitted within 72 hours	$150 copay	$0 copay	-	-	-	-	$10 copay	$30 copay	$25 copay	-	$0 copay for Medicare covered x-rays; $100 copay for all other	"$25 copay for chiropractic, $25 copay for podiatry, $25 copay for physical medicine; $0 for all other"	20% coinsurance	"$25 copay for Medicare covered vision, $0 copay for Medicare covered hearing, $25 copay for vision exams, $0 copay for Medicare covered vision hardware"	-	$10 copay	$20 copay	-	-	-	-	-											76.09469562	53.58633459	42.41746569	0	50	0.2	0	42.3	150	0	0	0	0	0	10	30	25	0	37.09347282	1.217915207	0.2	18.53921969	0	10	20	0	0	0	0	0											NO	73.81185475	51.97874455	41.14494172	0	48.5	0.194	0	41.031	145.5	0	0	0	0	0	9.7	29.1	24.25	0	35.98066864	1.181377751	0.194	17.9830431	0	9.7	19.4	0	0	0	0	0												7.9961	0.580369075	1.097130954	0	0.139483338	2.113720159	0	0.953845903	4.309160244	0	0	0	0	0	2.643189137	7.36509949	0.385223823	0	13.17596481	2.271870174	6.129349696	1.536704732	0	0.303122749	0.712718576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7131	0	1.599372796	7.9961	0.580369075	1.097130954	0	0.139483338	2.113720159	0	0.953845903	4.309160244	0	0	0	0	0	2.643189137	7.36509949	0.385223823	0	13.17596481	2.271870174	6.129349696	1.536704732	0	0.303122749	0.712718576	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.7131	NO	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing												1.3241	1.9269	2.7597	0	0	0.9489	0	0.1088	0.199	0.0984	0.2524	0	0	0.6021	0.6393	0.6099	0.1535	0	0.8518	8.9445	0.1477	0.3215	0	0	0	0	0	0	0	0.0126											19.9011	0	0	9.3202	2.507293701	3.856784046	0	0.139483338	3.062589175	0	1.062641029	4.508200755	0.098364161	0.252356535	0	0	0.602096993	3.282452419	7.975006341	0.53876812	0	14.02779169	11.21640026	6.277045016	1.858248992	0	0.303122749	0.712718576	0	0	0	0	0.012557812	0	0	0	0	0	0	0	0	0	0	71.6141
H5508_002_0	2010	6	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	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	YES	1191.784781	86.09019204	303.5535766	221.2304998	33.479778	8.751407129	0	239.0460604	335.8024674	4754.842601	1858.196523	0	0	2050.899403	2689.52454	2498.070171	145.7569111	0	3751.108279	19351.82925	20.42295026	856.5303538	0	374.9972153	410.6618007	0	0	0	0	4.989292635											3500	Days 1-5: $125 copay	Days 1-5: $125 copay	Days 21-100: $75 copay	$0 copay	$50 copay	20% coinsurance	-	$50 copay; waived if admitted within 72 hours	$150 copay	$0 copay	-	-	-	-	$10 copay	$30 copay	$25 copay	-	$0 copay for Medicare covered x-rays; $100 copay for all other	"$25 copay for chiropractic, $25 copay for podiatry, $25 copay for physical medicine; $0 for all other"	20% coinsurance	"$25 copay for Medicare covered vision, $0 copay for Medicare covered hearing, $25 copay for vision exams, $0 copay for Medicare covered vision hardware"	-	$10 copay	$20 copay	-	-	-	-	-											76.09469562	54.81926277	42.41746569	0	50	0.2	0	42.3	150	0	0	0	0	0	10	30	25	0	25.70694087	1.12248351	0.2	19.25962996	0	10	20	0	0	0	0	0											NO	73.81185475	53.17468489	41.14494172	0	48.5	0.194	0	41.031	145.5	0	0	0	0	0	9.7	29.1	24.25	0	24.93573265	1.088809005	0.194	18.68184107	0	9.7	19.4	0	0	0	0	0												7.3307	0.381484903	1.040807851	0	0.135314103	1.697772983	0	0.817358242	4.071604917	0	0	0	0	0	2.174032337	6.057820165	0.294550425	0	7.794719432	1.755870496	3.96205235	1.333463661	0	0.303122749	0.663903244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8145	0	1.231377267	7.3307	0.381484903	1.040807851	0	0.135314103	1.697772983	0	0.817358242	4.071604917	0	0	0	0	0	2.174032337	6.057820165	0.294550425	0	7.794719432	1.755870496	3.96205235	1.333463661	0	0.303122749	0.663903244	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.8145	NO	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing												0.886	0.6409	1.6125	0	1.4547	0.8194	0	0.0563	0.0973	0.0841	0.1574	0	0	0.3186	0.5725	0.5462	0.1723	0	0.6578	7.8158	0.2187	0.2345	0	0	0	0	0	0	0	0.0054											16.3506	0	0	8.2167	1.022360773	2.653326746	0	1.590029676	2.517203	0	0.873642767	4.168875947	0.084116264	0.157426238	0	0	0.318638725	2.746565457	6.604061256	0.466806889	0	8.452525953	9.571683666	4.180719176	1.567991509	0	0.303122749	0.663903244	0	0	0	0	0.005436681	0	0	0	0	0	0	0	0	0	0	56.1651
H5508_003_0	2010	5	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	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	YES	1286.395423	120.4571938	320.0068381	304.0409281	34.75852304	10.34464457	0	270.537171	354.9198448	5805.252657	2037.428759	0	0	2487.551632	3134.017303	2910.921623	179.0609514	0	4256.845173	22240.17107	28.39891787	987.1420544	0	374.9972153	433.4909185	0	0	0	0	4.634469739											3500	Days 1-5: $125 copay	Days 1-5: $125 copay	Days 21-100: $75 copay	$0 copay	$50 copay	20% coinsurance	-	$50 copay; waived if admitted within 72 hours	$150 copay	$0 copay	-	-	-	-	$10 copay	$30 copay	$25 copay	-	$0 copay for Medicare covered x-rays; $100 copay for all other	"$25 copay for chiropractic, $25 copay for podiatry, $25 copay for physical medicine; $0 for all other"	20% coinsurance	"$25 copay for Medicare covered vision, $0 copay for Medicare covered hearing, $25 copay for vision exams, $0 copay for Medicare covered vision hardware"	-	$10 copay	$20 copay	-	-	-	-	-											76.09469562	53.87721093	42.41746569	0	50	0.2	0	42.3	150	0	0	0	0	0	10	30	25	0	35.38164251	1.190504122	0.2	18.74556409	0	10	20	0	0	0	0	0											NO	73.81185475	52.2608946	41.14494172	0	48.5	0.194	0	41.031	145.5	0	0	0	0	0	9.7	29.1	24.25	0	34.32019324	1.154788998	0.194	18.18319717	0	9.7	19.4	0	0	0	0	0												7.9126	0.524600059	1.097221892	0	0.140482364	2.006861046	0	0.925034222	4.303403118	0	0	0	0	0	2.533330653	7.058984936	0.361852339	0	12.17464574	2.140225406	5.509390066	1.495783217	0	0.303122749	0.700810318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1884	0	1.5212892	7.9126	0.524600059	1.097221892	0	0.140482364	2.006861046	0	0.925034222	4.303403118	0	0	0	0	0	2.533330653	7.058984936	0.361852339	0	12.17464574	2.140225406	5.509390066	1.495783217	0	0.303122749	0.700810318	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.1884	NO	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing												1.1995	0.4099	2.425	0	1.5958	0.9194	0	0.0933	0.1674	0.095	0.225	0	0	0.5184	0.626	0.5973	0.1616	0	0.8002	8.6961	0.1725	0.2976	0	0	0	0	0	0	0	0.0104											19.0104	0	0	9.1121	0.934508701	3.522264779	0	1.736250139	2.92624134	0	1.018295	4.47084262	0.095039554	0.224993098	0	0	0.518432316	3.159332659	7.656239499	0.523419556	0	12.97489302	10.83628137	5.681893023	1.793412114	0	0.303122749	0.700810318	0	0	0	0	0.010422745	0	0	0	0	0	0	0	0	0	0	68.1987
H5508_004_0	2010	6	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	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	NO	1274.648622	111.8629119	289.9761082	265.875463	30.42783774	9.046108305	0	245.8231991	327.12403	5076.534425	1781.675638	0	0	2175.295761	2902.810386	2822.469255	184.5773111	0	3823.004196	19477.99134	25.34403277	863.2286857	0	374.9972153	433.4909185	0	0	0	0	4.052716834												-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	$10 copay	$20 copay	-	-	-	-	-											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	20	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.85	19.7	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.307810214	0.711647591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.307810214	0.711647591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0195	NO	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing	Fee For Service Cost Sharing												3.4981	0.5707	3.0461	0	1.6139	1.2219	0	0.2295	1.0443	0.264	1.0058	0	0	1.1275	1.1202	1.1967	0.2056	0	1.7749	12.1876	0.8843	0.4808	0	0	0	0	0	0	0	0.0105											31.4824	0	0	3.4981	0.570673637	3.046091685	0	1.613855674	1.221939244	0	0.229549938	1.044341976	0.26397802	1.005765939	0	0	1.127488321	1.120241866	1.196722278	0.205567725	0	1.774851437	12.18757848	0.884291184	0.480803577	0	0.307810214	0.711647591	0	0	0	0	0.010494928	0	0	0	0	0	0	0	0	0	0	32.5018
H5508_801_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	239.2433669	16.93547835	26.65277499	12.12045996	0.618223928	10.34112221	0	4.658209084	29.97153334	5.774124427	26.68592682	0	0	20.81684377	16.89237848	20.48912654	1.503872939	0	33.31086056	119.0090914	28.38924803	6.260703095	0	2.5	2.867272748	0	0	0	0	0												Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service											0.078148632	0.078148632	0.183733867	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0	0	0	0											NO	0.078148632	0.078148632	0.183733867	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0	0	0	0	0												18.6965	1.323484457	4.897017424	0	0.144046175	2.409481476	0	1.085362717	6.983367268	1.345370991	6.217820948	0	0	4.850324599	3.935924185	4.773966484	0.350402395	0	7.761430509	27.72911829	6.614694792	1.458743821	0	0.5825	0.66807455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8277	0	0	18.6965	1.323484457	4.897017424	0	0.144046175	2.409481476	0	1.085362717	6.983367268	1.345370991	6.217820948	0	0	4.850324599	3.935924185	4.773966484	0.350402395	0	7.761430509	27.72911829	6.614694792	1.458743821	0	0.5825	0.66807455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8277	NO	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service	Medicare Fee For Service												1.2246	0.4236	2.406	0	1.5952	0.9191	0	0.0914	0.1674	0.095	0.2249	0	0	0.5183	0.6258	0.5971	0.1615	0	0.8	8.629	0.1724	0.2975	0	0	0	0	0	0	0	0											18.9487	0	0	19.9212	1.74708152	7.30303564	0	1.739270591	3.328548721	0	1.176727159	7.150749757	1.440378185	6.442737436	0	0	5.368580388	4.561713037	5.371017681	0.511914598	0	8.561405304	36.3580857	6.787139011	1.756271375	0	0.5825	0.66807455	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.7764
H5509_001_0	2010	10	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	YES	1304.867422	46.8650136	863.3666729	0	209.5540389	12.31551141	2.962422551	567.7292094	567.5577886	3269.621084	20.06544941	0	0	715.3262394	5412.363863	11086.51632	225.8159605	692.1925975	3126.103455	781.0154702	20.38957025	0	0	0	0	0	0	0	0	422.559222											8500	1a $250 days 1-7	1b $195 days 1-10	2 $165 days 3-14	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $275, 9b $275"	8a $10	"8b 20% Ther., $400 Diag."	5 $0	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, 14b $0"	"7a $25, 14b $0, 14c $25, 14d - 14g $10, 14i - 14j $10"	"17a $40, 18a $40, 7b $40, 7d $40, 7f $40, 14d - 14g $10, 14i - 14j $10"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $400, 14h $10"	7g $40	15 20%								14a $0	"14c $25, 7f $25"											197.0860254	179.4801027	72.95039164	0	144.3053092	0.2	0.2	49.69184934	275	10	0.387576964	0	0	3.494482994	15.50692242	18.62852189	40	40	36.65795696	0.712556879	0.195044604	0	0	0	0	0	0	0	0	10.62533937											NO	178.4108654	162.4732164	66.03787599	0	130.6314593	0.181048722	0.181048722	44.98322916	248.9419932	9.052436115	0.35085157	0	0	3.163358406	14.03754246	16.86335044	36.20974446	36.20974446	33.18438135	0.645037562	0.176562881	0	0	0	0	0	0	0	0	9.618520582												19.4002	0.634525791	4.751241774	0	2.281195825	2.229707605	0.536342818	2.128191094	11.77408059	2.466502999	7.03999444	0	0	0.188569439	6.331357293	15.57965081	0.681394852	2.088676423	8.644817433	0.041982026	3.600041272	0	0	0	0	0	0	0	0	0.338699548	0	0	0	0	0	0	0	0	0	0	90.7372	0	9.49791593	19.4002	0.634525791	4.751241774	0	2.281195825	2.229707605	0.536342818	2.128191094	11.77408059	2.466502999	7.03999444	0	0	0.188569439	6.331357293	15.57965081	0.681394852	2.088676423	8.644817433	0.041982026	3.600041272	0	0	0	0	0	0	0	0	0.338699548	0	0	0	0	0	0	0	0	0	0	90.7372	NO	20%	20%	20%	0.25	10a $150	0.25	0.25	"4a $50, 4b $40"	0.25	0.25	0.25	0.25	0.25	4b $40; 25%	0.25	0.25	0.25	0.25	0.25	0.25	0.25									0.25												5.0736	0.1314	0.6485	0	0.005	0.375	0.0902	0.0071	1.6354	0.4621	0.6109	0.0094	0.0122	0.2497	0.9876	2.9997	0.0666	0.1535	0.9718	0.039	0.6208	0	0	0	0	0	0	0	0	0.0239											15.1735	0	0	24.4738	0.765941504	5.399717552	0	2.286187497	2.604661949	0.626535841	2.135292904	13.40949729	2.928650717	7.650901057	0.009380051	0.012156667	0.438285921	7.318986685	18.57939355	0.748023106	2.242128177	9.616643923	0.081028545	4.220815975	0	0	0	0	0	0	0	0	0.362639709	0	0	0	0	0	0	0	0	0	0	105.9107
H5509_003_0	2010	8	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	YES	1462.686923	43.2762384	530.2597569	0	164.2891896	13.60283888	2.779542111	525.2180444	427.3792164	1438.579299	12.78086574	0	0	238.158579	7021.511644	12510.73996	196.8163833	692.4135109	3210.651106	990.1632577	33.59930767	0	0	0	0	0	0	0	0	282.3115721											8000	1a $250 days 1-7	1b $195 days 1-10	2 $165 days 3-15	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $250, 9b $250"	8a $10	"8b 20% Ther., $250 Diag."	5 $0	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, 14b $0"	"7a $25, 14b $0, 14c $25, 14d - 14d $10, 14i - 14j $10"	"17a $40, 18a $40, 7b $40, 7d $40, 7f $40, 14d - 14g $10, 14i - 14j $10"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	"8b $250, 14h $10"	7g $40	15 20%								14a $0	"14c $25, 7f $25"											197.0521529	179.4801027	77.14180809	0	149.1202597	0.2	0.2	49.85189284	250	10	0.318226534	0	0	10.09402471	13.5449618	19.26096955	40	39.85681214	39.08233696	0.711815601	0.213318842	0	0	0	0	0	0	0	0	18.07119786											NO	176.8879572	161.1140414	69.24794602	0	133.8608978	0.179534153	0.179534153	44.75058687	224.4176917	8.976707668	0.285662657	0	0	9.061110898	12.15891624	17.29000931	35.90683067	35.77829511	35.08307139	0.638976056	0.191490089	0	0	0	0	0	0	0	0	16.22198604												21.561	0.581034139	3.059949919	0	1.832658202	2.442174161	0.49902274	1.95865131	7.992621435	1.076142152	3.65101606	0	0	0.179831775	7.114497666	18.02590086	0.588921046	2.064447911	9.386625162	0.052724218	6.433934412	0	0	0	0	0	0	0	0	0.381637865	0	0	0	0	0	0	0	0	0	0	88.8828	0	10.13211708	21.561	0.581034139	3.059949919	0	1.832658202	2.442174161	0.49902274	1.95865131	7.992621435	1.076142152	3.65101606	0	0	0.179831775	7.114497666	18.02590086	0.588921046	2.064447911	9.386625162	0.052724218	6.433934412	0	0	0	0	0	0	0	0	0.381637865	0	0	0	0	0	0	0	0	0	0	88.8828	NO	20%	20%	20%	20%	10a $150	20%	20%	"4a $50, 4b $40"	20%	20%	20%	20%	20%	4b $40; 20%	20%	20%	20%	20%	20%	20%	20%									20%												5.3601	0.111	0.3981	0	0.0005	0.3313	0.0677	0.0032	1.0399	0.1406	0.3113	0.0176	0.0033	0.0664	0.9599	2.3322	0.039	0.1237	0.7523	0.0374	0.8949	0	0	0	0	0	0	0	0	0.0258											13.0163	0	0	26.921	0.692063283	3.458096225	0	1.833167275	2.773492503	0.56672282	1.961809079	9.032552528	1.216780077	3.962313965	0.017562064	0.003316173	0.246247741	8.074440488	20.35807268	0.627921068	2.188138906	10.13894615	0.090124035	7.328809765	0	0	0	0	0	0	0	0	0.407417685	0	0	0	0	0	0	0	0	0	0	101.899
H5509_010_0	2010	9	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	NO	1499.724258	29.77434163	649.0074497	0	172.7083191	9.438636925	1.622130418	497.1370107	505.0153051	0	26.37705521	0	0	551.7730764	5483.146953	10165.74244	146.624184	553.8934403	2910.274694	730.9707804	9.145335259	0	0	0	0	0	0	0	0	285.6462498												1a $160 days 1-7	1b $195 days 1-10	2 $165 days 3-11	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $250, 9b $250"	8a $10	"8b 20% Ther., $425 Diag."	5 $0	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, 14b $0"	"7a $25, 14b $0, 14c $25, 14d - 14g $10, 14i - 14j $10"	"17a $40, 18a $40, 7b $40, 7d $40, 7f $40, 14d - 14g $10, 14i - 14j $10"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b $425, 14h $10"	7g $40	15 20%								14a $0	"14c $25, 7f $25"											126.1576013	179.4801027	58.89523499	0	146.6258023	0.2	0.2	49.46786635	250	0	0.366779407	0	0	1.811932993	15.58002832	15.94275708	40	40	29.16977398	0.557631606	0.248246012	0	0	0	0	0	0	0	0	18.80083388											NO	126.1576013	179.4801027	58.89523499	0	146.6258023	0.2	0.2	49.46786635	250	0	0.366779407	0	0	1.811932993	15.58002832	15.94275708	40	40	29.16977398	0.557631606	0.248246012	0	0	0	0	0	0	0	0	18.80083388												15.7668	0.445325158	3.185287188	0	2.11029132	1.887727385	0.324426084	2.049358933	10.52115219	0	9.674560669	0	0	0.083314653	7.118965401	13.50583018	0.48874728	1.846311468	7.074337921	0.033967701	2.270293008	0	0	0	0	0	0	0	0	0.447532308	0	0	0	0	0	0	0	0	0	0	78.8342	0	0	15.7668	0.445325158	3.185287188	0	2.11029132	1.887727385	0.324426084	2.049358933	10.52115219	0	9.674560669	0	0	0.083314653	7.118965401	13.50583018	0.48874728	1.846311468	7.074337921	0.033967701	2.270293008	0	0	0	0	0	0	0	0	0.447532308	0	0	0	0	0	0	0	0	0	0	78.8342	NO	0.25	0.25	0.25	0.25	10a $150	0.25	0.25	"4a $50, 4b $40"	0.25	0.25	0.25	0.25	0.25	4b $40; 25%	0.25	0.25	0.25	0.25	0.25	0.25	0.25									0.25												7.3265	0.0843	0.5909	0	0.0022	0.2874	0.0494	0.0107	1.4333	0.2338	0.8031	0.0431	0.0071	0.3195	0.9071	2.6951	0.039	0.1148	0.6357	0.0836	0.3653	0	0	0	0	0	0	0	0	0.0389											16.0709	0	0	23.0933	0.529658317	3.776226134	0	2.112490514	2.175093277	0.373812977	2.060097875	11.95449132	0.233848263	10.47762853	0.043062425	0.007105695	0.402780011	8.026072179	16.20091489	0.527787229	1.961128317	7.710042484	0.117571968	2.635569248	0	0	0	0	0	0	0	0	0.486445494	0	0	0	0	0	0	0	0	0	0	94.9051
H5509_011_0	2010	9	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	YES	1445.340885	42.80903955	1010.161444	0	247.0765117	11.07565235	2.76492372	574.2907955	557.1682439	2358.999874	19.19061176	0	0	689.4320603	5418.192038	10974.92441	202.2860212	701.8233005	3187.147587	782.6963061	16.21348759	0	0	0	0	0	0	0	0	428.5034889											4000	1a $170 days 1-7	1b $195 days 1-10	2 $170 days 8-23	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $10"	"9a $275, 9b $275"	8a $10	"8b 20% Ther., $400 Diag."	5 $0	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, 14b $0"	"7a $10, 14b $0, 14c $10, 14d - 14g $10, 14i - 14j $10"	"17a $30, 18a $30, 7b $30, 7d $30, 7f $30, 14d - 14g $5, 14i - 14j $5"	"7e $30, 7h $30, 9c $30"	"7c $40,7i $40"	"8b $400, 14h $5"	7g $30	15 20%								14a $0	"14c $5, 7f $5"											134.0444053	179.4801027	69.14110096	0	144.6785865	0.2	0.2	49.10574934	275	10	0.407863486	0	0	3.271793225	6.180381549	13.31519957	30	40	33.04929649	0.429040736	0.230809461	0	0	0	0	0	0	0	0	6.875455208											NO	106.1780011	142.1681009	54.76740246	0	114.6014492	0.15842213	0.15842213	38.89718706	217.8304289	7.921106505	0.323073012	0	0	2.59162226	4.895546049	10.54711139	23.76331952	31.68442602	26.17869974	0.339847736	0.182826632	0	0	0	0	0	0	0	0	5.446121297												12.7886	0.507173321	4.610326531	0	2.359610526	1.754628438	0.438025105	1.861524708	10.11401646	1.557157437	6.199968733	0	0	0.148895623	2.210417385	9.646145852	0.40058228	1.85307237	6.952948309	0.022166464	2.964257329	0	0	0	0	0	0	0	0	0.194473498	0	0	0	0	0	0	0	0	0	0	66.584	0	17.47496515	12.7886	0.507173321	4.610326531	0	2.359610526	1.754628438	0.438025105	1.861524708	10.11401646	1.557157437	6.199968733	0	0	0.148895623	2.210417385	9.646145852	0.40058228	1.85307237	6.952948309	0.022166464	2.964257329	0	0	0	0	0	0	0	0	0.194473498	0	0	0	0	0	0	0	0	0	0	66.584	NO	20%	20%	20%	20%	10a $150	20%	20%	"4a $50, 4b $10"	20%	20%	20%	20%	20%	4b $40; 20%	20%	20%	20%	20%	20%	20%	20%									20%												5.0299	0.0953	0.7015	0	0.0051	0.3372	0.0842	0.0013	1.4715	0.3004	0.5843	0.0089	0.0091	0.2309	0.9484	2.7963	0.056	0.145	0.8743	0.039	0.579	0	0	0	0	0	0	0	0	0.0716											14.3693	0	0	17.8185	0.602509567	5.311823503	0	2.364737705	2.091834407	0.522205138	1.862827682	11.58555132	1.857581801	6.784240308	0.008934083	0.00905292	0.379836493	3.15884947	12.44241258	0.456578192	1.998116018	7.82722883	0.061121922	3.543242055	0	0	0	0	0	0	0	0	0.266102471	0	0	0	0	0	0	0	0	0	0	80.9533
H5509_012_0	2010	8	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	NO	1410.026781	41.76308361	985.4801065	0	241.0396758	10.77018528	2.688666978	560.2591125	543.5549173	2301.362283	18.66133367	0	0	672.5871236	5285.809013	10706.77339	197.3435542	684.6756079	3109.27581	763.5726383	15.76631874	0	0	0	0	0	0	0	0	418.0338363												1a $170 days 1-7	1b $195 days 1-10	2 $165 days 3-8	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $250, 9b $250"	8a $10	"8b 20% Ther., $400 Diag."	5 $0	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, 14b $0"	"7a $25, 14b $0, 14c $25, 14d - 14g $10, 14i - 14j $10"	"17a $40, 18a $40, 7b $40, 7d $40, 7f $40, 14d - 14g $10, 14i - 14j $10"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b $400, 14h $10"	7g $40	15 20%								14a $0	"14c $25, 7f $25"											134.0444053	179.4801027	42.62320496	0	144.6785865	0.2	0.2	49.77643734	250	10	0.41350688	0	0	3.271793225	15.38875615	16.93584455	40	40	33.6387909	0.764454665	0.230817594	0	0	0	0	0	0	0	0	20.12927895											NO	134.0444053	179.4801027	42.62320496	0	144.6785865	0.2	0.2	49.77643734	250	10	0.41350688	0	0	3.271793225	15.38875615	16.93584455	40	40	33.6387909	0.764454665	0.230817594	0	0	0	0	0	0	0	0	20.12927895												15.7505	0.624636878	3.500360047	0	2.906106631	2.154037055	0.537733396	2.323975217	11.32406078	1.917801902	7.716589855	0	0	0.1833805	6.778502164	15.11068748	0.657811847	2.282252026	8.716023237	0.048643055	3.639143751	0	0	0	0	0	0	0	0	0.701226642	0	0	0	0	0	0	0	0	0	0	86.8735	0	0	15.7505	0.624636878	3.500360047	0	2.906106631	2.154037055	0.537733396	2.323975217	11.32406078	1.917801902	7.716589855	0	0	0.1833805	6.778502164	15.11068748	0.657811847	2.282252026	8.716023237	0.048643055	3.639143751	0	0	0	0	0	0	0	0	0.701226642	0	0	0	0	0	0	0	0	0	0	86.8735	NO	20%	20%	20%	20%	10a $150	20%	20%	"4a $50, 4b $40"	20%	20%	20%	20%	20%	4b $40; 20%	20%	20%	20%	20%	20%	20%	20%									20%												4.8911	0.0927	0.6821	0.2289	0.004	0.2623	0.0655	0.0051	1.1448	0.2337	0.4545	0.007	0.007	0.1797	0.7378	2.1753	0.0436	0.1128	0.6801	0.0303	0.4504	0	0	0	0	0	0	0	0	0.0557											12.5446	0	0	20.6417	0.717343745	4.182509696	0.22892692	2.910095248	2.416361704	0.60322007	2.329059771	12.46882065	2.151512817	8.171115722	0.006950144	0.007042592	0.363037707	7.516321586	17.28600392	0.701373081	2.395086695	9.396157491	0.078947907	4.089556789	0	0	0	0	0	0	0	0	0.756949395	0	0	0	0	0	0	0	0	0	0	99.4181
H5509_013_0	2010	9	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	YES	1351.812061	48.5510555	894.4276345	0	217.093072	12.75858112	3.069000319	588.1541525	587.9765646	3387.250798	20.78733523	0	0	741.0612157	5607.082088	11461.46517	233.9400416	717.095305	3238.569899	809.113719	18.02077367	0	0	0	0	0	0	0	0	437.7614485											5000	1a $225 days 1-5	1b $195 days 1-10	2 $165 days 3-14	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $225, 9b $225"	8a $10	"8b 20% Ther., $400 Diag."	5 $0	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, 14b $0"	"7a $15, 14b $0, 14c $15, 14d - 14g $10, 14i - 14j $10"	"17a $40, 18a $40, 7b $40, 7d $40, 7f $40, 14d - 14g $10, 14i - 14j $10"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b $400, 14h $10"	7g $40	15 20%				17a $10	17b $0	18a $10	18b $0	14a $0	"14c $15, 7f $15"											155.3024114	179.4801027	72.95039164	0	144.3053092	0.2	0.2	49.69184934	225	10	0.387576964	0	0	3.494482994	9.363221056	18.66737649	40	40	36.65626381	0.573143576	0.225196456	0	0	0	0	0	0	0	0	12.02081448											NO	127.034212	146.8110714	59.67193575	0	118.0388062	0.16359593	0.16359593	40.64692148	184.045421	8.179796489	0.317030069	0	0	2.858415973	7.658924272	15.26953406	32.71918596	32.71918596	29.9840778	0.468819781	0.184206118	0	0	0	0	0	0	0	0	9.832781608												14.3105	0.59398604	4.447685695	0	2.135450587	2.087251941	0.502075961	1.992221305	9.017866197	2.308918516	6.590210318	0	0	0.176521768	3.578684759	14.58426941	0.637860644	1.955231219	8.092127651	0.03161071	3.319536754	0	0	0	0	0	0	0	0	0.35870106	0	0	0	0	0	0	0	0	0	0	76.7207	0	17.07222967	14.3105	0.59398604	4.447685695	0	2.135450587	2.087251941	0.502075961	1.992221305	9.017866197	2.308918516	6.590210318	0	0	0.176521768	3.578684759	14.58426941	0.637860644	1.955231219	8.092127651	0.03161071	3.319536754	0	0	0	0	0	0	0	0	0.35870106	0	0	0	0	0	0	0	0	0	0	76.7207	NO	0.3	0.3	0.3	0.3	10a $150	0.3	0.3	"4a $50, 4b $40"	0.3	0.3	0.3	0.3	0.3	4b $40; 30%	0.3	0.3	0.3	0.3	0.3	0.3	0.3				0.3	17b $0	0.3	18b $0		0.3												7.8842	0.2042	1.0077	0	0.0062	0.4661	0.1121	0.0074	2.0331	0.5745	0.7595	0.0117	0.0151	0.3104	1.2278	3.7292	0.0828	0.1908	1.2081	0.0485	0.7717	0	0	0	0	0	0	0	0	0.0944											20.7457	0	0	22.1948	0.798201437	5.455394252	0	2.141656094	2.553384634	0.61420139	1.999578613	11.05097023	2.883447559	7.34967224	0.011661016	0.015112827	0.486962273	4.806477836	18.31346519	0.720691014	2.145998124	9.300275006	0.080152244	4.091266402	0	0	0	0	0	0	0	0	0.453072274	0	0	0	0	0	0	0	0	0	0	97.4664
H5509_014_0	2010	11	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	YES	1439.761662	42.64379053	1006.262076	0	246.1227609	10.65327212	2.659480801	572.0739508	555.0174947	2349.893797	18.45876006	0	0	686.7707538	5397.277041	10932.55963	201.5051682	699.1141621	3174.844741	779.6749863	15.59517127	0	0	0	0	0	0	0	0	426.849404											6750	1a $250 days 1-7	1b $195 days 1-10	2 $165 days 3-9	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $270, 9b $270"	8a $10	"8b 20% Ther., $300 Diag."	5 $0	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, 14b $0"	"7a $25, 14b $0, 14c $25, 14d - 14g $10, 14i - 14j $10"	"17a $40, 18a $40, 7b $40, 7d $40, 7f $40, 14d - 14g $10, 14i - 14j $10"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b $300, 14h $10"	7g $40	15 20%								14a $0	"14c $25, 7f $25"											197.0972868	179.4801027	48.32245431	0	144.6785865	0.2	0.2	49.77643734	270	10	0.332407389	0	0	3.271793225	15.41567008	17.79316384	40	40	31.98132018	0.764454665	0.230899013	0	0	0	0	0	0	0	0	20.12927895											NO	172.2092695	156.8166557	42.22064488	0	126.4096228	0.174745449	0.174745449	43.49102947	235.9063562	8.737272452	0.290433393	0	0	2.858654881	13.46909095	15.54637202	34.94908981	34.94908981	27.94295077	0.667924868	0.201742758	0	0	0	0	0	0	0	0	17.58749945												20.6617	0.557271385	3.540419482	0	2.592690447	1.861610821	0.464732167	2.073340421	10.9110129	1.710971861	5.361040308	0	0	0.163603381	6.058034614	14.16346993	0.586868518	2.03611697	7.392877525	0.043397026	3.14621287	0	0	0	0	0	0	0	0	0.625601138	0	0	0	0	0	0	0	0	0	0	83.951	0	12.13275599	20.6617	0.557271385	3.540419482	0	2.592690447	1.861610821	0.464732167	2.073340421	10.9110129	1.710971861	5.361040308	0	0	0.163603381	6.058034614	14.16346993	0.586868518	2.03611697	7.392877525	0.043397026	3.14621287	0	0	0	0	0	0	0	0	0.625601138	0	0	0	0	0	0	0	0	0	0	83.951	NO	20%	20%	20%	20%	10a $150	20%	20%	"4a $50, 4b $40"	20%	20%	20%	20%	20%	4b $40; 20%	20%	20%	20%	20%	20%	20%	20%									20%												4.8381	0.1153	0.6747	0	0.0039	0.2595	0.0648	0.0052	1.1323	0.2312	0.4496	0.0069	0.007	0.1777	0.7298	2.1517	0.0431	0.1116	0.6728	0.03	0.4455	0	0	0	0	0	0	0	0	0.0551											12.2057	0	0	25.4997	0.67255792	4.21516422	0	2.596635767	2.121087868	0.529507967	2.078532199	12.04334611	1.942145784	5.810632179	0.006874699	0.006966143	0.341310362	6.787844815	16.31517274	0.629956884	2.147726789	8.065628746	0.07337291	3.591736557	0	0	0	0	0	0	0	0	0.680719007	0	0	0	0	0	0	0	0	0	0	96.1567
H5509_015_0	2010	8	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	P	P	COIN	V	T	V	V	V	V	V	P	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	NO	1439.761662	42.64379053	1006.262076	0	246.1227609	10.73631545	2.68021172	572.0739508	555.0174947	2349.893797	18.60264794	0	0	686.7707538	5397.277041	10932.55963	201.5051682	699.1141621	3174.844741	779.6749863	15.71673719	0	0	0	0	0	0	0	0	426.849404												1a $150 days 1-5	1b $195 days 1-10	2 $200 days 7-17	6 $0	10a $150	11a 20%	"11b 20%, 11c $10"	"4a $50, 4b $40"	"9a $260, 9b $260"	8a $10	"8b 20% Ther., $325 Diag."	5 $0	12 $0	"3 $40, 4b $40, 9d $40, 13a $0, 14b $0"	"7a $25, 14b $0, 14c $25, 14d - 14g $10, 14i - 14j $10"	"17a $40, 18a $40, 7b $40, 7d $40, 7f $40, 14d - 14g $10, 14i - 14j $10"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b $325, 14h $10"	7g $40	15 20%								14a $0	"14c $25, 7f $25"											103.5547971	179.4801027	66.73194082	0	144.6785865	0.2	0.2	49.77643734	260	10	0.353254775	0	0	3.271793225	15.41567008	17.80226989	40	40	32.39035658	0.764454665	0.230878882	0	0	0	0	0	0	0	0	20.12927895											NO	103.5547971	179.4801027	66.73194082	0	144.6785865	0.2	0.2	49.77643734	260	10	0.353254775	0	0	3.271793225	15.41567008	17.80226989	40	40	32.39035658	0.764454665	0.230878882	0	0	0	0	0	0	0	0	20.12927895												12.4245	0.637809325	5.595818445	0	2.967391096	2.14726309	0.536042344	2.372983597	12.02537905	1.958244831	6.571474213	0	0	0.187247658	6.933553518	16.21869809	0.671683894	2.33038054	8.569529436	0.049668848	3.628662714	0	0	0	0	0	0	0	0	0.716014227	0	0	0	0	0	0	0	0	0	0	86.5424	0	0	12.4245	0.637809325	5.595818445	0	2.967391096	2.14726309	0.536042344	2.372983597	12.02537905	1.958244831	6.571474213	0	0	0.187247658	6.933553518	16.21869809	0.671683894	2.33038054	8.569529436	0.049668848	3.628662714	0	0	0	0	0	0	0	0	0.716014227	0	0	0	0	0	0	0	0	0	0	86.5424	NO	20%	20%	20%	20%	10a $150	20%	20%	"4a $50, 4b $40"	20%	20%	20%	20%	20%	4b $40; 20%	20%	20%	20%	20%	20%	20%	20%									20%												4.8758	0.1162	0.68	0	0.004	0.2615	0.0653	0.0052	1.1412	0.233	0.4531	0.0069	0.007	0.1791	0.7355	2.1685	0.0434	0.1125	0.678	0.0302	0.449	0	0	0	0	0	0	0	0	0.0555											12.3008	0	0	17.3003	0.75399453	6.275822885	0	2.971367169	2.408762786	0.601323078	2.378175375	13.16653891	2.191220777	7.024570697	0.006928288	0.007020445	0.366339884	7.669052662	18.38717364	0.715108137	2.442860369	9.24752482	0.079878398	4.077659303	0	0	0	0	0	0	0	0	0.771561745	0	0	0	0	0	0	0	0	0	0	98.8432
H5509_801_0	2010	5	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	193.7536496	3.39501334	18.83902925	0	5.305482919	9.848692188	2.64649908	14.19693781	51.42873112	13.12158352	21.26715684	0.603562646	4.197436503	6.525600508	30.60793937	95.16428194	1.516316993	4.699025332	32.63766175	2.554499984	18.97929524	0	0	0	0	0	0	0	0	0												FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.125612924	0.233	0	0	0	0	0	0	0	0	0											NO	0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.125612924	0.233	0	0	0	0	0	0	0	0	0												16.6675	0.292053127	3.19314117	0	1.23617752	2.29474528	0.616634286	3.30788651	11.98289435	3.05732896	4.955247543	0.140630097	0.978002705	1.520464918	7.131649872	22.17327769	0.353301859	1.094872902	7.604575187	0.320878212	4.422175791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3434	0	0	16.6675	0.292053127	3.19314117	0	1.23617752	2.29474528	0.616634286	3.30788651	11.98289435	3.05732896	4.955247543	0.140630097	0.978002705	1.520464918	7.131649872	22.17327769	0.353301859	1.094872902	7.604575187	0.320878212	4.422175791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3434	NO	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																				2.0298	0.0356	0.3889	0	0.0057	0.2795	0.0751	0.0029	1.4593	0.372	0.6035	0.0171	0.1191	0.1852	0.8685	2.6922	0.043	0.1333	0.9261	0.0391	0.5385	0	0	0	0	0	0	0	0	0											10.8144	0	0	18.6973	0.327620173	3.58201082	0	1.241896113	2.574205769	0.691729731	3.31081409	13.44220469	3.429313673	5.558711429	0.157756423	1.097106606	1.705631383	8.000162112	24.86548523	0.396327946	1.228209582	8.530681593	0.359955656	4.96072071	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.1578
H5509_802_0	2010	5	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	198.7217534	4.330852997	26.81881661	0	7.145097568	11.81577432	3.041230837	14.54213324	50.51527702	13.370866	20.4512824	0.242702496	0.247264872	9.399214606	34.69981347	100.1339945	1.674322885	5.077229258	33.03751656	2.446953339	22.33974312	0	0	0	0	0	0	0	0	0												FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.12713956	0.233	0	0	0	0	0	0	0	0	0											NO	0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.12713956	0.233	0	0	0	0	0	0	0	0	0												17.0949	0.372557935	4.545683659	0	1.664807733	2.753075418	0.708606785	3.388317045	11.77005955	3.115411777	4.7651488	0.056549682	0.057612715	2.190017003	8.085056539	23.33122073	0.390117232	1.182994417	7.697741358	0.311104572	5.205160146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6861	0	0	17.0949	0.372557935	4.545683659	0	1.664807733	2.753075418	0.708606785	3.388317045	11.77005955	3.115411777	4.7651488	0.056549682	0.057612715	2.190017003	8.085056539	23.33122073	0.390117232	1.182994417	7.697741358	0.311104572	5.205160146	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6861	NO	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																				0.3594	0.0033	0.0803	0	0.0032	0.0694	0.0203	0.0018	0.2991	0.1473	0.1299	0	0	0.0887	0.2369	0.624	0.0035	0.0311	0.2482	0.0072	0.1703	0	0	0	0	0	0	0	0	0											2.5238	0	0	17.4543	0.375863394	4.625946643	0	1.667976872	2.822493045	0.728938765	3.39016591	12.06912744	3.26269632	4.895080083	0.056549682	0.057612715	2.27870416	8.321915449	23.95526754	0.393590436	1.214120237	7.945894443	0.318278533	5.37542351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.2099
H5509_803_0	2010	5	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	225.507727	13.9798519	28.79153878	0	8.778313171	16.25034774	3.163047067	19.2497586	59.12741679	11.4516273	19.99626549	0.293345233	0.297247188	8.426857642	34.18746059	107.6578878	4.754303643	5.925299928	37.84279834	2.546876482	30.95004781	0	0	0	0	0	0	0	0	0												FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																			0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.141331804	0.233	0	0	0	0	0	0	0	0	0											NO	0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.141331804	0.233	0	0	0	0	0	0	0	0	0												19.3991	1.202604837	4.880052289	0	2.045346969	3.786331023	0.736989967	4.485193754	13.77668811	2.668229161	4.65912986	0.068349439	0.069258595	1.963457831	7.965678318	25.08428785	1.107752749	1.380594883	8.817372014	0.359954647	7.211361139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6677	0	0	19.3991	1.202604837	4.880052289	0	2.045346969	3.786331023	0.736989967	4.485193754	13.77668811	2.668229161	4.65912986	0.068349439	0.069258595	1.963457831	7.965678318	25.08428785	1.107752749	1.380594883	8.817372014	0.359954647	7.211361139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6677	NO	FFS Medicare 8.6%	FFS Medicare 8.6%	FFS Medicare 16.9%	FFS Medicare 0.0%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%	FFS Medicare 23.3%																				2.3625	0.1465	0.5943	0	0.0048	0.4611	0.0898	0.0021	1.6778	0.3243	0.5674	0.0083	0.0084	0.2391	0.9701	3.039	0.1349	0.1681	1.0738	0.0438	0.8782	0	0	0	0	0	0	0	0	0											12.7942	0	0	21.7616	1.349061413	5.474358687	0	2.050123905	4.24744099	0.826742663	4.487274992	15.45445167	2.99249681	5.226531707	0.076673225	0.0776931	2.202573209	8.935760871	28.12326544	1.242657973	1.548727584	9.891176204	0.403790929	8.089580839	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.462
H5516_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1480.999537	145.764667	958.432973	939.0211206	204.5127851	10.56595453	8.556441074	284.8578309	31.81355248	11177.3304	34.34426228	0	0.145475784	20.79339104	5945.836261	4850.354959	578.0630593	369.855468	0	0	20.15773196	1039.436834	0	0	185.6007715	0	16.17978503	4.542577628	114.5161092	0											4200	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$115 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	83.9614622	0	150	0.2	0.121106232	49.26254005	0.2	3	0.176267038	0	0.2	0.15056469	12.89331338	34.71393763	38.5	35	0	0	0.2	33.69181519	0	0	35	0	0	0	0	0											YES	165.1179328	121.7515023	68.97102569	0	123.2190767	0.164292102	0.099483987	40.46723135	0.164292102	2.464381535	0.144796411	0	0.164292102	0.12391189	12.79763673	34.71393763	38.5	28.75111791	0	0	0.164292102	33.69181519	0	0	35	0	0	0	0	0											6500	20.3783	1.478922265	5.508675434	0	2.099989713	1.735902882	0.851228876	0.960617312	5.226715419	2.295433887	4.972925921	0	0.023900522	2.576548385	6.341054378	14.0312433	1.854618982	0.886146514	0	0	3.311756161	2.918376144	0	0	0.541335583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9937	0	11.41023576	20.3783	1.478922265	5.508675434	0	2.099989713	1.735902882	0.851228876	0.960617312	5.226715419	2.295433887	4.972925921	0	0.023900522	2.576548385	6.341054378	14.0312433	1.854618982	0.886146514	0	0	3.311756161	2.918376144	0	0	0.541335583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.9937	NO	"$375 Days 1-18 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-18 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-38 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$30 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$30 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.9264	0.1919	0.4662	0.075	0.0853	0.1057	0.0856	0.0481	0.3183	0.0932	0.2964	0	0.001	0.156	0.8106	1.3395	0.1577	0.0836	0	0	0.3643	0.2875	0	0	0.0524	0	0.0046	0.003	0	0											6.9522	0	1.080090433	22.3047	1.670824948	5.97484044	0.074980834	2.185250944	1.841621411	0.936841053	1.008760154	5.545028541	2.388630304	5.269283608	0	0.024870902	2.732559997	7.151658498	15.37077262	2.012343177	0.969708887	0	0	3.676099114	3.20587165	0	0	0.593722898	0	0.004566875	0.002988538	0	0	0	0	0	0	0	0	0	0	0	0	84.9459
H5516_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	226.1718794	7.767852905	29.53353452	976.8373143	6.237588011	10.66914319	9.067888087	16.23759061	28.4609471	15.6428446	34.09212322	0	0.045061433	21.06318141	29.98131	99.95617553	4.527313726	3.477948919	0	0	19.47704596	5.923738195	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081502178	0.081502178	0.187963464	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081502178	0.081502178	0.187963464	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.4335	0.633096929	5.551225457	0	1.453358007	2.485910363	2.112817924	3.783358612	6.631400674	3.644782793	7.943464711	0	0.010499314	4.907721267	6.985645231	23.2897889	1.054864098	0.810362098	0	0	4.538151709	1.380230999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6502	0	0	18.4335	0.633096929	5.551225457	0	1.453358007	2.485910363	2.112817924	3.783358612	6.631400674	3.644782793	7.943464711	0	0.010499314	4.907721267	6.985645231	23.2897889	1.054864098	0.810362098	0	0	4.538151709	1.380230999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6502	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.9702	0.0333	0.2313	0	0.0606	0.1036	0.088	0.1576	0.2763	0.1519	0.331	0	0.0004	0.2045	0.5258	1.753	0.0794	0.061	0	0	0.3416	0.1039	0	0	0	0	0	0	0	0											5.4734	0	0	19.4037	0.66641782	5.782526517	0	1.51391459	2.589489961	2.200852005	3.940998554	6.907709035	3.796648743	8.274442407	0	0.010936785	5.112209654	7.511446485	25.04278376	1.134262471	0.871357095	0	0	4.87973302	1.484119354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.1235
H5516_802_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	248.7890673	6.25214083	32.48688797	1172.204777	7.485105613	12.80297183	10.8814657	17.86134967	31.30704181	17.20712906	37.50133555	0	0.049567576	23.13269581	32.979441	109.9517931	3.019211721	3.825743811	0	0	21.42475056	6.516112014	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081502178	0.081502178	0.187963464	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081502178	0.081502178	0.187963464	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												20.2769	0.509563094	6.106348002	0	1.744029608	2.983092435	2.535381509	4.161694473	7.294540741	4.009261072	8.737811182	0	0.011549245	5.389918123	7.684209754	25.61876779	0.703476331	0.891398308	0	0	4.99196688	1.518254099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1681	0	0	20.2769	0.509563094	6.106348002	0	1.744029608	2.983092435	2.535381509	4.161694473	7.294540741	4.009261072	8.737811182	0	0.011549245	5.389918123	7.684209754	25.61876779	0.703476331	0.891398308	0	0	4.99196688	1.518254099	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1681	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.0672	0.0268	0.2544	0	0.0727	0.1243	0.1056	0.1734	0.3039	0.1671	0.3641	0	0.0005	0.2246	0.5784	1.9283	0.0529	0.0671	0	0	0.3757	0.1143	0	0	0	0	0	0	0	0											6.0013	0	0	21.3441	0.536382204	6.360779169	0	1.816697508	3.107387953	2.641022405	4.33509841	7.598479939	4.176313617	9.101886648	0	0.012030464	5.614498045	8.262591133	27.54706214	0.756426162	0.958492804	0	0	5.367706322	1.63253129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.1694
H5516_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	226.1718794	7.767852905	29.53353452	976.8373143	6.237588011	10.66914319	9.067888087	16.23759061	28.4609471	15.6428446	34.09212322	0	0.045061433	21.06318141	29.98131	99.95617553	4.527313726	3.477948919	0	0	19.47704596	5.923738195	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081502178	0.081502178	0.187963464	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081502178	0.081502178	0.187963464	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.4335	0.633096929	5.551225457	0	1.453358007	2.485910363	2.112817924	3.783358612	6.631400674	3.644782793	7.943464711	0	0.010499314	4.907721267	6.985645231	23.2897889	1.054864098	0.810362098	0	0	4.538151709	1.380230999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6502	0	0	18.4335	0.633096929	5.551225457	0	1.453358007	2.485910363	2.112817924	3.783358612	6.631400674	3.644782793	7.943464711	0	0.010499314	4.907721267	6.985645231	23.2897889	1.054864098	0.810362098	0	0	4.538151709	1.380230999	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.6502	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												0.9702	0.0333	0.2313	0	0.0606	0.1036	0.088	0.1576	0.2763	0.1519	0.331	0	0.0004	0.2045	0.5258	1.753	0.0794	0.061	0	0	0.3416	0.1039	0	0	0	0	0	0	0	0											5.4734	0	0	19.4037	0.66641782	5.782526517	0	1.51391459	2.589489961	2.200852005	3.940998554	6.907709035	3.796648743	8.274442407	0	0.010936785	5.112209654	7.511446485	25.04278376	1.134262471	0.871357095	0	0	4.87973302	1.484119354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.1235
H5520_001_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	YES	433.7626323	9.138050422	168.398358	9.210351083	137.768146	8.336771811	2.127102703	333.0586394	330.0156564	6.5446213	14.63163331	0	0.10647779	314.0949126	2566.540824	3609.24043	251.3856234	70.38287649	11.26373876	25.75115655	0.11684299	0	0	1588.406233	589.44	0	0	0	2750	0											1500	1a:  Acute - $100/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $100/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $100/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	"11a:  Durable Medical Equipment - Tiered Copays: $20 - $600, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $20 - $600, depending on price/11b:  Medical Supplies - Tiered Copays: $20 - $600, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered Copays: $20 - $600, depending on price/visit/8a:  Outpatient Lab Services - $0/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient X-Ray Services - $10/visit"		"12:  Renal Dialysis - Tiered Copays: $20 - $600, depending on price/14i:  Diabetes Monitoring - $10/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $10/visit"	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/7-12 Additional Visits/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $10/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $20 - $600, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $20 - $600, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $12/service/16a:  Preventive Dental - Prophylaxis - $12/service/16a:  Preventive Dental - X-Rays - $12/service	17a:  Routine Eye Exams - $10/visit	17b:  Wear - $0/service			14b:  Other Immunizations - $0/visit/14a:  Alternative Medicine Program - $15/service/14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												100	100	100	0	75	0.12	0.029474793	33.12783477	100	0	0.098328841	0	0.12	25	10	13.25713822	25	25	0	11.07220519	0.12	0	0	11.65319023	7.125407166	0	0	0	3.545454545	0											YES	88.94756978	89.01448995	89.04981078	0	75	0.12	0.029474793	29.4888228	88.95413597	0	0.087408312	0	0.106951875	22.23326937	8.891166509	11.78784984	22.25235618	22.19866565	0	9.844635893	0.102733281	0	0	11.65319023	7.125407166	0	0	0	3.545454545	0											3000	3.2152	0.067784908	1.249653493	0	0.861050912	1.000412617	0.062695911	0.818458933	2.446354798	0	1.278926374	0	0.011387999	0.5819464	1.901628485	3.545432017	0.466160202	0.130200495	0	0.021125897	0.012003664	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	20.3754	0	1.957626721	3.2152	0.067784908	1.249653493	0	0.861050912	1.000412617	0.062695911	0.818458933	2.446354798	0	1.278926374	0	0.011387999	0.5819464	1.901628485	3.545432017	0.466160202	0.130200495	0	0.021125897	0.012003664	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	20.3754	NO	1a:  Acute - $200/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $200/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $200/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	"11a:  Durable Medical Equipment - Tiered Copays: $30 - $900, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $30 - $900, depending on price/11b:  Medical Supplies - Tiered Copays: $30 - $900, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered copays: $30-$900, depending on price/visit/8a:  Outpatient Lab Services - $0/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient X-Ray Services - $20/visit"		"12:  Renal Dialysis - Tiered Copays: $30 - $900, depending on price/14i:  Diabetes Monitoring - $20/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $20/visit"	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/7-12 Additional Visits/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $50/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $50/visit/7h:  Psychiatric Services - Individual - $50/visit/7h:  Psychiatric Services - Group - $50/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $50/visit/9c:  Outpatient Substance Abuse Svcs - Group - $50/visit/7g:  Other Health Care Professional Services - $20/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $30 - $900, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $30 - $900, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/14c:  Routine Exams - $0/visit													1.7352	0.0366	0.5558	0	0.1772	0.2388	0.0153	0.1727	0.8215	0	0.4	0	0.0035	0.1561	0.7457	1.192	0.1917	0.0387	0	0.0083	0.0038	0	0	0	0	0	0	0	0	0											6.4927	0	0.912043661	4.9504	0.104376892	1.805465372	0	1.038213289	1.23916591	0.077956743	0.99112235	3.267844544	0	1.678918527	0	0.014848189	0.738032345	2.647371866	4.737405909	0.657824808	0.168922296	0	0.029448312	0.015768761	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	26.8681
H5520_002_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											2.0088	0.0183	0.2742	0.1249	0.0823	0.1459	0.0377	0.2575	0.6405	0.1003	0.2458	0	0	0.178	0.0667	0.5245	0	0	0.0475	0.2125	0.0166	0.0075	0	0	0	0	0	0	0	0											4.9895	YES	509.4223411	8.850149974	145.446379	10.17571449	147.500374	11.88449492	3.07465934	356.5280524	376.4969156	1130.217958	20.02886813	0	0.068659878	384.8102224	3253.54134	4226.30171	241.8875891	113.3276512	14.83520796	33.31023938	1.354007908	0	0	1588.406233	589.44	0	0	0	2650	0											2000	1a:  Acute - $150/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $150/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $150/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	"11a:  Durable Medical Equipment - Tiered Copays: $20 - $600, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $20 - $600, depending on price/11b:  Medical Supplies - Tiered Copays: $20 - $600, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $150/visit	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered Copays: $20 - $600, depending on price/visit/8a:  Outpatient Lab Services - $12/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient X-Ray Services - $12/visit"		"12:  Renal Dialysis - Tiered Copays: $20 - $600, depending on price/14i:  Diabetes Monitoring - $12/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $12/visit"	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $12/visit/17a:  Vision Exams - $12/visit/18a:  Hearing Exams - $12/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $12/visit/14g:  Bone Mass Measurement - $12/visit/14f:  Colorectal Screening - $12/visit/14g:  Bone Mass Measurement - $12/visit/14b:  Immunizations (Hepatitis B) - $12/visit	7d:  Physician Specialist Services - $12/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $12/visit/18a:  Hearing Exams - $12/visit/14d:  Pap Smears and Pelvic Exams Screening - $12/visit/14g:  Bone Mass Measurement - $12/visit/14f:  Colorectal Screening - $12/visit/14b:  Immunizations (Hepatitis B) - $12/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $12/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $20 - $600, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $20 - $600, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $12/service/16a:  Preventive Dental - Prophylaxis - $12/service/16a:  Preventive Dental - X-Rays - $12/service	17a:  Routine Eye Exams - $10/visit	17b:  Wear - $0/service			14b:  Other Immunizations - $0/visit/14a:  Alternative Medicine Program - $15/service/14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												150	150	150	0	150	0.12	0.030722135	40.04000093	150	12	0.104215954	0	0.12	25	12	14.14537494	25	25	0	12.69122929	0.12	0	0	11.65319023	7.125407166	0	0	0	3.679245283	0											YES	128.6791303	128.6791303	128.6791303	0	150	0.12	0.030722135	34.36930238	128.6791303	10.29433042	0.089402789	0	0.102943304	21.44652171	10.29433042	12.13476363	21.44652171	21.44652171	0	10.88730898	0.102943304	0	0	11.65319023	7.125407166	0	0	0	3.679245283	0											3000	5.4627	0.094902467	1.559659463	0	1.843754675	1.426139391	0.094460098	1.021135037	4.037274638	0.969569759	1.790636669	0	0.007068075	0.687736733	2.7910858	4.273764357	0.432303953	0.202540328	0	0.030221572	0.139386048	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	29.5693	75	3.893	7.4715	0.11317135	1.833887617	0.124894366	1.926021957	1.572006933	0.132197756	1.278608836	4.677744181	1.069835389	2.036466365	0	0.007068075	0.865745087	2.857822696	4.798226996	0.432303953	0.202540328	0.047501569	0.24276188	0.156004828	0.007483574	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	34.5588	NO	1a:  Acute - $200/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $200/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $200/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	"11a:  Durable Medical Equipment - Tiered Copays: $30 - $900, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $30 - $900, depending on price/11b:  Medical Supplies - Tiered Copays: $30 - $900, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered copays: $30-$900, depending on price/visit/8a:  Outpatient Lab Services - $20/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient X-Ray Services - $20/visit"		"12:  Renal Dialysis - Tiered Copays: $30 - $900, depending on price/14i:  Diabetes Monitoring - $20/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $20/visit"	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $50/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $50/visit/7h:  Psychiatric Services - Individual - $50/visit/7h:  Psychiatric Services - Group - $50/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $50/visit/9c:  Outpatient Substance Abuse Svcs - Group - $50/visit/7g:  Other Health Care Professional Services - $20/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $30 - $900, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $30 - $900, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/14c:  Routine Exams - $0/visit													2.3208	0.0372	0.5081	0.0257	0.3927	0.3626	0.0286	0.2143	0.9941	0.2547	0.5812	0	0.0021	0.2106	0.9261	1.388	0.1752	0.0595	0.0097	0.047	0.0463	0.0014	0	0	0	0	0	0	0	0											8.5858	75	1.4745	9.7923	0.150330994	2.34199792	0.150557064	2.318682881	1.934578035	0.160847564	1.492932148	5.671794519	1.324506632	2.617666437	0	0.009216766	1.076368332	3.78396343	6.186180986	0.607465251	0.262013656	0.057190297	0.289791659	0.202299852	0.008933543	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	43.1446
H5520_003_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	YES	567.2104974	9.308147164	185.1724224	11.27474523	151.186404	12.13431276	3.496815821	363.658147	377.8891183	7.613569623	9.724432182	0	0.00490636	296.8781878	3245.644892	4864.625992	253.8772708	148.2097972	12.51445221	35.41158674	0.584788843	0	0	1588.406233	589.44	0	0	0	2750	0											1500	1a:  Acute - $100/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-8/9-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $100/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $100/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	"11a:  Durable Medical Equipment - Tiered Copays: $20 - $600, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $20 - $600, depending on price/11b:  Medical Supplies - Tiered Copays: $20 - $600, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient X-Ray Services - $10/visit"		"12:  Renal Dialysis - Tiered Copays: $20 - $600, depending on price/14i:  Diabetes Monitoring - $10/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $10/visit"	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/7-12 Additional Visits/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $0/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $20 - $600, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $20 - $600, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $12/service/16a:  Preventive Dental - Prophylaxis - $12/service/16a:  Preventive Dental - X-Rays - $12/service	17a:  Routine Eye Exams - $10/visit	17b:  Wear - $0/service			14b:  Other Immunizations - $0/visit/14a:  Alternative Medicine Program - $15/service/14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												100	100	100	0	75	0.12	0.03985019	33.12375666	100	0	0.122100661	0	0.12	25	10	13.13089965	25	25	0	10.78743124	0.12	0	0	11.65319023	7.125407166	0	0	0	3.545454545	0											YES	85.40632621	85.39836051	85.48216428	0	75	0.12	0.03985019	28.29077445	85.32709921	0	0.103695496	0	0.100431207	21.34364573	8.521118876	11.19309784	21.34812103	21.23871074	0	9.198902741	0.100431207	0	0	11.65319023	7.125407166	0	0	0	3.545454545	0											3000	4.0369	0.066241709	1.319078286	0	0.944915025	1.456117531	0.139348774	0.857347551	2.68701519	0	1.008379818	0	0.000492752	0.528038572	2.304710496	4.537519555	0.451650225	0.262315418	0	0.027145645	0.058731049	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	23.391	0	3.128612905	4.0369	0.066241709	1.319078286	0	0.944915025	1.456117531	0.139348774	0.857347551	2.68701519	0	1.008379818	0	0.000492752	0.528038572	2.304710496	4.537519555	0.451650225	0.262315418	0	0.027145645	0.058731049	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	23.391	NO	1a:  Acute - $200/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-8/9-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $200/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $200/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	"11a:  Durable Medical Equipment - Tiered Copays: $30 - $900, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $30 - $900, depending on price/11b:  Medical Supplies - Tiered Copays: $30 - $900, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient X-Ray Services - $20/visit"		"12:  Renal Dialysis - Tiered Copays: $30 - $900, depending on price/14i:  Diabetes Monitoring - $20/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $20/visit"	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $50/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/7-12 Additional Visits/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $50/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $50/visit/7h:  Psychiatric Services - Individual - $50/visit/7h:  Psychiatric Services - Group - $50/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $50/visit/9c:  Outpatient Substance Abuse Svcs - Group - $50/visit/7g:  Other Health Care Professional Services - $0/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $30 - $900, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $30 - $900, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/14c:  Routine Exams - $0/visit													2.0026	0.0329	0.5456	0	0.1802	0.3234	0.0316	0.1722	0.8708	0	0.2355	0	0.0001	0.1339	0.8281	1.4061	0.1706	0.0718	0	0.0098	0.0161	0	0	0	0	0	0	0	0	0											7.0313	0	1.157369049	6.0395	0.099102136	1.864692702	0	1.125083016	1.779563922	0.17093225	1.029541994	3.557787599	0	1.243926901	0	0.000631811	0.661953389	3.132761969	5.943596234	0.622249575	0.334093921	0	0.036933995	0.074872853	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	30.4223
H5520_004_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	V	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	YES	550.5184285	9.097811038	166.498035	13.59931724	165.2427898	15.0103143	3.82681955	362.1095749	389.5281934	1827.450883	14.27885973	0	0.011833538	296.4184872	3635.027372	5030.994478	247.8949917	200.1019663	11.76823361	38.05277736	1.447478917	0	0	1588.406233	589.44	0	0	0	2650	0											2000	1a:  Acute - $150/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $150/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $150/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $150/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	"11a:  Durable Medical Equipment - Tiered Copays: $20 - $600, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $20 - $600, depending on price/11b:  Medical Supplies - Tiered Copays: $20 - $600, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $150/visit/9b:  Ambulatory Surgical Center Services - $150/visit	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered Copays: $20 - $600, depending on price/visit/8a:  Outpatient Lab Services - $12/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient X-Ray Services - $12/visit"		"12:  Renal Dialysis - Tiered Copays: $20 - $600, depending on price/14i:  Diabetes Monitoring - $12/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $12/visit"	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $12/visit/17a:  Vision Exams - $12/visit/18a:  Hearing Exams - $12/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $12/visit/14g:  Bone Mass Measurement - $12/visit/14f:  Colorectal Screening - $12/visit/14g:  Bone Mass Measurement - $12/visit/14b:  Immunizations (Hepatitis B) - $12/visit	7d:  Physician Specialist Services - $12/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $12/visit/18a:  Hearing Exams - $12/visit/14d:  Pap Smears and Pelvic Exams Screening - $12/visit/14g:  Bone Mass Measurement - $12/visit/14f:  Colorectal Screening - $12/visit/14b:  Immunizations (Hepatitis B) - $12/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $12/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $20 - $600, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $20 - $600, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $12/service/16a:  Preventive Dental - Prophylaxis - $12/service/16a:  Preventive Dental - X-Rays - $12/service	17a:  Routine Eye Exams - $10/visit	17b:  Wear - $0/service			14b:  Other Immunizations - $0/visit/14a:  Alternative Medicine Program - $15/service/14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												150	150	150	0	150	0.12	0.029403405	40.03734818	150	12	0.122491756	0	0.12	25	12	14.06091564	25	25	0	12.62010851	0.12	0	0	11.65319023	7.125407166	0	0	0	3.679245283	0											YES	126.0902591	126.0902591	126.0902591	0	150	0.12	0.029403405	33.67639543	126.0902591	10.08722073	0.102966782	0	0.100872207	21.01504319	10.08722073	11.81962998	21.01504319	21.01504319	0	10.60848501	0.100872207	0	0	11.65319023	7.125407166	0	0	0	3.679245283	0											3000	5.7846	0.095595446	1.749481698	0	2.065534873	1.801237715	0.112521526	1.016212103	4.092975904	1.536158369	1.470248231	0	0.001193675	0.519103943	3.055610288	4.95537443	0.434126996	0.350429289	0	0.033640193	0.146010393	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	31.925	0	4.7855	5.7846	0.095595446	1.749481698	0	2.065534873	1.801237715	0.112521526	1.016212103	4.092975904	1.536158369	1.470248231	0	0.001193675	0.519103943	3.055610288	4.95537443	0.434126996	0.350429289	0	0.033640193	0.146010393	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	31.925	NO	1a:  Acute - $200/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $200/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $200/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	"11a:  Durable Medical Equipment - Tiered Copays: $30 - $900, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $30 - $900, depending on price/11b:  Medical Supplies - Tiered Copays: $30 - $900, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered copays: $30-$900, depending on price/visit/8a:  Outpatient Lab Services - $20/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient X-Ray Services - $20/visit"		"12:  Renal Dialysis - Tiered Copays: $30 - $900, depending on price/14i:  Diabetes Monitoring - $20/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $20/visit"	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $50/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $50/visit/7h:  Psychiatric Services - Individual - $50/visit/7h:  Psychiatric Services - Group - $50/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $50/visit/9c:  Outpatient Substance Abuse Svcs - Group - $50/visit/7g:  Other Health Care Professional Services - $20/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $30 - $900, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $30 - $900, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/14c:  Routine Exams - $0/visit													1.9066	0.0315	0.4817	0	0.3931	0.4003	0.0255	0.1733	0.888	0.3411	0.3194	0	0.0003	0.1342	0.9242	1.3938	0.1637	0.0958	0	0.0104	0.0394	0	0	0	0	0	0	0	0	0											7.7223	0	1.395	7.6912	0.127104327	2.231209607	0	2.458621687	2.201573702	0.138033668	1.189507127	4.980953226	1.877216863	1.789611882	0	0.001532752	0.653291589	3.979823145	6.34921365	0.597848639	0.446204139	0	0.044026884	0.18536983	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	39.6474
H5520_005_0	2010	8	N/A																															D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											1.8475	0.0262	0.2887	0.0824	0.0732	0.163	0.0474	0.3194	0.6239	0.1113	0.2818	0	0	0.1842	0.0707	0.5196	0	0	0.0401	0.2476	0.0221	0.0057	0	0	0	0	0	0	0	0											4.9549	YES	340.0460946	8.367842186	116.6741259	4.96047053	95.06503528	9.375243485	2.704784156	326.5263517	36.16092205	861.7358944	16.1909737	0	0.019589111	297.9534456	2491.36603	3203.595426	236.0317112	72.52160179	9.019264839	27.30281703	1.246907245	0	0	1588.406233	420	0	0	0	2650	0											2500	1a:  Acute - $200/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $200/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $200/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	"11a:  Durable Medical Equipment - Tiered Copays: $20 - $600, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $20 - $600, depending on price/11b:  Medical Supplies - Tiered Copays: $20 - $600, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 10.0%/9b:  Ambulatory Surgical Center Services - 10.0%	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered Copays: $20 - $600, depending on price/visit/8a:  Outpatient Lab Services - $15/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient X-Ray Services - $15/visit"		"12:  Renal Dialysis - Tiered Copays: $20 - $600, depending on price/14i:  Diabetes Monitoring - $15/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $15/visit"	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $15/visit/18a:  Hearing Exams - $15/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $15/visit/14g:  Bone Mass Measurement - $15/visit/14f:  Colorectal Screening - $15/visit/14g:  Bone Mass Measurement - $15/visit/14b:  Immunizations (Hepatitis B) - $15/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $15/visit/18a:  Hearing Exams - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $15/visit/14g:  Bone Mass Measurement - $15/visit/14f:  Colorectal Screening - $15/visit/14b:  Immunizations (Hepatitis B) - $15/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $15/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $20 - $600, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $20 - $600, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $12/service/16a:  Preventive Dental - Prophylaxis - $12/service/16a:  Preventive Dental - X-Rays - $12/service	17a:  Routine Eye Exams - $10/visit				14b:  Other Immunizations - $0/visit/14a:  Alternative Medicine Program - $15/service/14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												200	200	200	0	200	0.12	0.037888233	39.73946534	0.1	15	0.105835391	0	0.12	25	15	16.32060547	25	25	0	15.63300311	0.12	0	0	11.65319023	10	0	0	0	3.679245283	0											YES	183.7625268	184.3361187	184.0349283	0	200	0.12	0.037888233	36.63228406	0.091925614	13.79180284	0.097363764	0	0.108406734	23.00145947	13.80547832	15.01939562	23.05281541	22.96481722	0	14.39814203	0.110661335	0	0	11.65319023	10	0	0	0	3.679245283	0											3500	5.2073	0.128541296	1.789342866	0	1.584417255	1.125029218	0.102479492	0.996783839	3.324114977	0.990407629	1.57641415	0	0.002123592	0.571113675	2.866208309	4.009672258	0.453432956	0.138787111	0	0.032759153	0.13798442	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	27.7419	75	1.93700569	7.0548	0.154766583	2.078008638	0.082358941	1.657638219	1.287986195	0.149864221	1.316191997	3.94803322	1.10170039	1.858243687	0	0.002123592	0.755321474	2.936945562	4.529298402	0.453432956	0.138787111	0.040084078	0.280403064	0.160071557	0.005727482	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	32.6968	NO	1a:  Acute - $250/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $250/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $250/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	"11a:  Durable Medical Equipment - Tiered Copays: $30 - $900, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $30 - $900, depending on price/11b:  Medical Supplies - Tiered Copays: $30 - $900, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 15.0%/9b:  Ambulatory Surgical Center Services - 15.0%	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered copays: $30-$900, depending on price/visit/8a:  Outpatient Lab Services - $20/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient X-Ray Services - $20/visit"		"12:  Renal Dialysis - Tiered Copays: $30 - $900, depending on price/14i:  Diabetes Monitoring - $20/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $20/visit"	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $50/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $50/visit/7h:  Psychiatric Services - Individual - $50/visit/7h:  Psychiatric Services - Group - $50/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $50/visit/9c:  Outpatient Substance Abuse Svcs - Group - $50/visit/7g:  Other Health Care Professional Services - $20/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $30 - $900, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $30 - $900, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/14c:  Routine Exams - $0/visit													2.1217	0.0487	0.5542	0.023	0.3478	0.2945	0.0323	0.2104	0.911	0.2099	0.5013	0	0.0007	0.1839	0.79	1.1754	0.1845	0.0422	0.0083	0.0533	0.0477	0.0011	0	0	0	0	0	0	0	0											7.7416	75	0.730982388	9.1765	0.203426593	2.632178171	0.105373148	2.005443075	1.5825281	0.18212882	1.526549525	4.859027523	1.311643327	2.359550563	0	0.002796508	0.939231727	3.726898805	5.7046564	0.637914826	0.180957458	0.048382147	0.333653327	0.207721914	0.006831221	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	40.4383
H5520_006_0	2010	7	N/A																															D	D	D	coin	T	coin	coin	V	coin	P	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	P	V	V	V	V	O	O											1.8889	0.0229	0.3032	0.2374	0.0889	0.1722	0.0461	0.1858	0.5562	0.115	0.1616	0	0	0.1245	0.0835	0.6808	0	0	0.0406	0.2277	0.0138	0.0084	0	0	0	0	0	0	0	0											4.9573	YES	461.7412918	8.281660906	133.5166101	14.22913945	132.736542	11.24283289	2.999423184	306.221915	35.6116111	1567.435832	10.31511528	0	0.006886431	241.1317927	2884.178144	4057.635358	230.2284717	157.9602108	9.762542646	30.93868099	0.896572114	0	0	0	420	0	0	0	2650	0											2500	1a:  Acute - $200/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $200/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $200/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	"11a:  Durable Medical Equipment - Tiered Copays: $20 - $600, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $20 - $600, depending on price/11b:  Medical Supplies - Tiered Copays: $20 - $600, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $35/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 10.0%/9b:  Ambulatory Surgical Center Services - 10.0%	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered Copays: $20 - $600, depending on price/visit/8a:  Outpatient Lab Services - $15/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient X-Ray Services - $15/visit"		"12:  Renal Dialysis - Tiered Copays: $20 - $600, depending on price/14i:  Diabetes Monitoring - $15/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $15/visit"	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $15/visit/18a:  Hearing Exams - $15/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $15/visit/14g:  Bone Mass Measurement - $15/visit/14f:  Colorectal Screening - $15/visit/14g:  Bone Mass Measurement - $15/visit/14b:  Immunizations (Hepatitis B) - $15/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $15/visit/18a:  Hearing Exams - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $15/visit/14g:  Bone Mass Measurement - $15/visit/14f:  Colorectal Screening - $15/visit/14b:  Immunizations (Hepatitis B) - $15/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $15/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $20 - $600, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $20 - $600, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit				14b:  Other Immunizations - $0/visit/14a:  Alternative Medicine Program - $15/service/14a:  Written health education materials - $0/service/14a:  Nursing Hotline - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												200	200	200	0	200	0.12	0.031203986	39.93190467	0.1	15	0.138193681	0	0.12	25	15	16.2939832	25	25	0	15.54487914	0.12	0	0	0	10	0	0	0	3.679245283	0											YES	178.2962288	178.7457123	177.8960754	0	200	0.12	0.031203986	35.64330779	0.088972235	13.39721909	0.123129486	0	0.105978095	22.25499917	13.37000236	14.52495751	22.35194105	22.26658679	0	13.86333938	0.10651825	0	0	0	10	0	0	0	3.679245283	0											3500	6.8606	0.123359281	1.979340078	0	2.212275699	1.349139947	0.09359396	0.909563498	3.168444621	1.749940104	1.270094842	0	0.000729811	0.447198987	3.213455716	4.911415096	0.428837769	0.293102895	0	0.035742786	0.095501293	0	0	0	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	30.3048	75	3.111033765	8.7495	0.146285442	2.282494005	0.237414846	2.301202347	1.521343962	0.139677861	1.095397584	3.724615786	1.864907444	1.431660867	0	0.000729811	0.571741019	3.296909331	5.592226782	0.428837769	0.293102895	0.040596844	0.263413985	0.109260608	0.008362997	0	0	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	35.2621	NO	1a:  Acute - $250/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $250/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $250/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $250/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	"11a:  Durable Medical Equipment - Tiered Copays: $30 - $900, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $30 - $900, depending on price/11b:  Medical Supplies - Tiered Copays: $30 - $900, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 15.0%/9b:  Ambulatory Surgical Center Services - 15.0%	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered copays: $30-$900, depending on price/visit/8a:  Outpatient Lab Services - $20/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient X-Ray Services - $20/visit"		"12:  Renal Dialysis - Tiered Copays: $30 - $900, depending on price/14i:  Diabetes Monitoring - $20/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $20/visit"	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14f:  Colorectal Screening - $20/visit/14g:  Bone Mass Measurement - $20/visit/14b:  Immunizations (Hepatitis B) - $20/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $50/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $50/visit/7h:  Psychiatric Services - Individual - $50/visit/7h:  Psychiatric Services - Group - $50/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $50/visit/9c:  Outpatient Substance Abuse Svcs - Group - $50/visit/7g:  Other Health Care Professional Services - $20/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $30 - $900, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $30 - $900, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/14c:  Routine Exams - $0/visit													2.4804	0.0425	0.5657	0.0646	0.4349	0.3201	0.0278	0.1757	0.8246	0.3278	0.2783	0	0.0002	0.1359	0.8187	1.3267	0.1601	0.08	0.0085	0.0419	0.0284	0.0015	0	0	0	0	0	0	0	0											8.1442	75	0.860747842	11.2298	0.188798959	2.848170792	0.301992491	2.736099461	1.841415998	0.167441892	1.271062928	4.54922077	2.192671188	1.709990897	0	0.000937069	0.707677247	4.115630609	6.918932823	0.588894286	0.373152647	0.049087623	0.305359702	0.137626093	0.00983863	0	0	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	43.4063
H5520_009_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	YES	550.9423559	9.765362278	163.297075	10.94314196	159.2754974	12.44633759	3.216470222	402.6704374	414.8297458	9.653847486	22.3613757	0	0.076395901	418.2805481	3534.864617	4566.886576	263.0092079	117.5692885	15.61342311	36.09186134	1.354310443	0	0	1588.406233	589.44	0	0	0	2750	0											1500	1a:  Acute - $100/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $100/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $100/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	"11a:  Durable Medical Equipment - Tiered Copays: $20 - $600, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $20 - $600, depending on price/11b:  Medical Supplies - Tiered Copays: $20 - $600, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered Copays: $20 - $600, depending on price/visit/8a:  Outpatient Lab Services - $0/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		"12:  Renal Dialysis - Tiered Copays: $20 - $600, depending on price/14i:  Diabetes Monitoring - $10/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $10/visit"	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $10/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $20 - $600, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $20 - $600, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $12/service/16a:  Preventive Dental - Prophylaxis - $12/service/16a:  Preventive Dental - X-Rays - $12/service	17a:  Routine Eye Exams - $10/visit	17b:  Wear - $0/service		"18b:  Hearing Aids - $0/service, $250/Per Three Years"	14b:  Other Immunizations - $0/visit/14a:  Alternative Medicine Program - $15/service/14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												100	100	100	0	75	0.12	0.030623753	33.12852499	100	0	0.083428128	0	0.12	25	10	12.62632172	25	25	0	10.80037936	0.12	0	0	11.65319023	7.125407166	0	0	0	3.545454545	0											YES	84.48749249	84.48749249	84.48749249	0	75	0.12	0.030623753	28.01145551	84.48749249	0	0.070486333	0	0.101384991	21.12187312	8.448749249	10.66766261	21.12187312	21.12187312	0	9.124969698	0.101384991	0	0	11.65319023	7.125407166	0	0	0	3.545454545	0											1500	3.879	0.068754248	1.149713366	0	0.995471859	1.49356051	0.09850039	0.939948754	2.920660419	0	1.576171376	0	0.007745398	0.736239056	2.488765398	4.059833765	0.46293726	0.2069403	0	0.027444762	0.137306752	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	23.954	0	3.4255	3.879	0.068754248	1.149713366	0	0.995471859	1.49356051	0.09850039	0.939948754	2.920660419	0	1.576171376	0	0.007745398	0.736239056	2.488765398	4.059833765	0.46293726	0.2069403	0	0.027444762	0.137306752	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	23.954	NO	1a:  Acute - $100/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $100/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $100/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	"11a:  Durable Medical Equipment - Tiered Copays: $30 - $900, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $30 - $900, depending on price/11b:  Medical Supplies - Tiered Copays: $30 - $900, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered copays: $30-$900, depending on price/visit/8a:  Outpatient Lab Services - $0/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		"12:  Renal Dialysis - Tiered Copays: $30 - $900, depending on price/14i:  Diabetes Monitoring - $10/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $10/visit"	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $50/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $50/visit/7h:  Psychiatric Services - Individual - $50/visit/7h:  Psychiatric Services - Group - $50/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $50/visit/9c:  Outpatient Substance Abuse Svcs - Group - $50/visit/7g:  Other Health Care Professional Services - $10/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $30 - $900, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $30 - $900, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service						"18b:  Hearing Aids - $0/service, $250/Per Three Years"	14b:  Other Immunizations - $0/visit/14c:  Routine Exams - $0/visit													0.9823	0.0174	0.239	0	0.2134	0.369	0.0248	0.185	0.4633	0	0.4206	0	0.0022	0.1834	0.4861	0.891	0.1814	0.0588	0	0.006	0.0399	0	0	0	0	0	0	0	0	0											4.7636	0	1.305	4.8613	0.086164991	1.388713271	0	1.208832019	1.862559978	0.123325922	1.124938691	3.38396255	0	1.996768141	0	0.009985349	0.919618927	2.974830609	4.950837304	0.644377355	0.26571873	0	0.033471327	0.177241189	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	28.7176
H5520_010_0	2010	7	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	YES	597.9543195	9.864512836	184.4283141	14.04973062	176.2440818	15.4287733	4.039412912	400.7283707	419.3787724	9.322045127	14.4013605	0	0.010934538	319.6968459	3853.017285	5351.160832	268.8508351	202.098223	12.943548	40.70759936	1.334495951	0	0	1588.406233	589.44	0	0	0	2750	0											1500	1a:  Acute - $100/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $100/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $100/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	"11a:  Durable Medical Equipment - Tiered Copays: $20 - $600, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $20 - $600, depending on price/11b:  Medical Supplies - Tiered Copays: $20 - $600, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered Copays: $20 - $600, depending on price/visit/8a:  Outpatient Lab Services - $0/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $20 - $600, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		"12:  Renal Dialysis - Tiered Copays: $20 - $600, depending on price/14i:  Diabetes Monitoring - $10/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $10/visit"	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $10/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $20 - $600, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $20 - $600, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $12/service/16a:  Preventive Dental - Prophylaxis - $12/service/16a:  Preventive Dental - X-Rays - $12/service	17a:  Routine Eye Exams - $10/visit	17b:  Wear - $0/service		"18b:  Hearing Aids - $0/service, $250/Per Three Years"	14b:  Other Immunizations - $0/visit/14a:  Alternative Medicine Program - $15/service/14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14a:  Nursing Hotline - $0/service/14d:  Additional Pap - $0/visit/14d:  Addition Pelvic - $0/visit/14c:  Routine Exams - $0/visit												100	100	100	0	75	0.12	0.031778747	33.12361996	100	0	0.08287995	0	0.12	25	10	12.5439431	25	25	0	10.72538756	0.12	0	0	11.65319023	7.125407166	0	0	0	3.545454545	0											YES	83.58427473	83.58427473	83.58427473	0	75	0.12	0.031778747	27.70703415	83.58427473	0	0.069274605	0	0.10030113	20.89606868	8.358427473	10.48476386	20.89606868	20.89606868	0	8.964737405	0.10030113	0	0	11.65319023	7.125407166	0	0	0	3.545454545	0											1500	4.165	0.068709846	1.284608906	0	1.101525511	1.851452796	0.128367481	0.925249554	2.921122544	0	0.997648566	0	0.001096747	0.556700604	2.683763794	4.675471477	0.46816046	0.351921529	0	0.030411078	0.133851451	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	25.05	0	3.7825	4.165	0.068709846	1.284608906	0	1.101525511	1.851452796	0.128367481	0.925249554	2.921122544	0	0.997648566	0	0.001096747	0.556700604	2.683763794	4.675471477	0.46816046	0.351921529	0	0.030411078	0.133851451	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	25.05	NO	1a:  Acute - $100/$0/day for 1-8/9-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-8/9-190	2:  Skilled Nursing Services - $100/$0/day for 1-8/9-100/2:  Non-Medicare Covered Stay - $100/$0/day for 1-8/9-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	"11a:  Durable Medical Equipment - Tiered Copays: $30 - $900, depending on price"	"11b:  Prosthetics Devices - Tiered Copays: $30 - $900, depending on price/11b:  Medical Supplies - Tiered Copays: $30 - $900, depending on price/11c:  Diabetes Monitoring Supplies - $0/service"	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $50/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	"8a:  Outpatient Diagnostic Procedures/Tests - Tiered copays: $30-$900, depending on price/visit/8a:  Outpatient Lab Services - $0/visit"	"8b:  Outpatient Diagnostic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient Therapeutic Radiological Services - Tiered Copays: $30 - $900, depending on price/8b:  Outpatient X-Ray Services - $0/visit"		"12:  Renal Dialysis - Tiered Copays: $30 - $900, depending on price/14i:  Diabetes Monitoring - $10/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $10/visit"	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $0/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7d:  Physician Specialist Services - $10/visit/7b:  Chiropractic Services - $15/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14f:  Colorectal Screening - $10/visit/14g:  Bone Mass Measurement - $10/visit/14b:  Immunizations (Hepatitis B) - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $50/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $50/visit/7h:  Psychiatric Services - Individual - $50/visit/7h:  Psychiatric Services - Group - $50/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $50/visit/9c:  Outpatient Substance Abuse Svcs - Group - $50/visit/7g:  Other Health Care Professional Services - $10/visit	"15:  Medicare Part B Rx Drugs - Chemo - Tiered Copays: $30 - $900, depending on price/Medicare Part B Rx Drugs - Non-Chemo - Tiered Copays: $30 - $900, depending on price"	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service						"18b:  Hearing Aids - $0/service, $250/Per Three Years"	14b:  Other Immunizations - $0/visit/14c:  Routine Exams - $0/visit													0.9758	0.0161	0.2513	0	0.2097	0.4115	0.0291	0.1751	0.454	0	0.196	0	0.0003	0.1357	0.4847	0.94	0.1673	0.0911	0	0.0061	0.0342	0	0	0	0	0	0	0	0	0											4.578	0	1.08	5.1408	0.084808203	1.535919111	0	1.311239375	2.262904039	0.157469189	1.100325083	3.375115148	0	1.193679925	0	0.001391716	0.692370255	3.168503318	5.615434347	0.63542131	0.443040162	0	0.036509459	0.16809101	0	0	1.5425	0.35	0	0	0	0.8125	0	0	0	0	0	0	0	0	0	0	0	29.628
H5521_011_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	O																																																			0	NO	1441.526944	63.1879446	997.3066643	629.0741276	199.5901435	12.56036556	0	198.0914698	331.5566436	2010.493698	2247.281464	54.10184115	0.219139285	247.0012944	3793.559336	4820.989706	205.547987	512.8474416	0	0	251.0135806	0	0	0	747.7969966	0	42.65892633	0	42.8883075	0												$175/day 1-10	$175/day 1-10	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$35 per visit	$40 X-ray; $125 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$40 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 eyewear reimbursement/2 years	$0 per visit	Not Covered	Not Covered	0											143.4382958	143.4382958	47.8866492	0	100	0.2	0.2	48.5	200	5.25	37	35	25	35	15	35	35	35	40	35	$45 	0	0	0	0	0	0	0	0	0											YES	143.4382958	143.4382958	47.8866492	0	100	0.2	0.2	48.5	200	5.25	37	35	25	35	15	35	35	35	40	35	$45 	0	0	0	0	0	0	0	0	0											7500	17.2308	0.755297591	3.979806198	0	1.663251196	2.512073111	0	0.80061969	5.525944061	0.879590993	6.929117846	0.157797037	0.00045654	0.720420442	4.74194917	14.06121998	0.599514962	1.495805038	0	0	0.941300927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.995			17.2308	0.755297591	3.979806198	0	1.663251196	2.512073111	0	0.80061969	5.525944061	0.879590993	6.929117846	0.157797037	0.00045654	0.720420442	4.74194917	14.06121998	0.599514962	1.495805038	0	0	0.941300927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.995	NO	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$100 copay	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$50 copay	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$25 copay	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP		0	0	$500 ded; 30% coinsurance; $7500 max OOP	0	$500 ded; 30% coinsurance; $7500 max OOP	0	0													9.428	0	1.2955	0.1762	0.167	0.3565	0	0.1068	1.1367	0.4471	1.7171	0.0236	0.0001	0.7578	0.6809	3.4246	0.0757	0.1937	0	0	2.1234	0	0	0	0.2088	0	0.014	0	0	0											22.3332	500	8.780059775	26.6588	0.755297591	5.275298821	0.176162365	1.830255027	2.86858692	0	0.907393074	6.662605262	1.326654088	8.646237871	0.181382178	0.00053428	1.478194579	5.422831592	17.48579266	0.675185192	1.689515352	0	-2.16E-10	3.064734163	0	0	0	0.208770781	0	0.013951019	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3282
H5521_012_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	O																																																			0	NO	1853.472821	164.4201009	1053.805056	1168.01138	243.8085346	11.8685386	0	239.5838951	337.8928527	2814.38464	2296.942161	61.93124253	0.10598499	726.7880208	4024.655737	6137.529595	299.8870072	834.1593965	0	0	259.2682941	0	0	0	846.8729669	0	42.68537449	0	32.50965259													$150/day 1-8	$150/day 1-8	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$30 per visit	$35 X-ray; $125 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$15 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$35 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 eyewear reimbursement/2 years	$0 per visit	Not Covered	Not Covered												114.2747829	114.2747829	47.8866492	0	100	0.2	0.2	48.5	200	4.5	35.5	30	25	30	15	30	30	30	35	30	$45 	0	0	0	0	0	0	0	0	0											YES	114.2747829	114.2747829	47.8866492	0	100	0.2	0.2	48.5	200	4.5	35.5	30	25	30	15	30	30	30	35	30	$45 	0	0	0	0	0	0	0	0	0											5000	17.6504	1.565755945	4.205266086	0	2.031737788	2.37370772	0	0.968318243	5.631547546	1.05539424	6.79512056	0.154828106	0.000220802	1.816970052	5.030819672	15.34382399	0.749717518	2.085398491	0	0	0.972256103	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4313			17.6504	1.565755945	4.205266086	0	2.031737788	2.37370772	0	0.968318243	5.631547546	1.05539424	6.79512056	0.154828106	0.000220802	1.816970052	5.030819672	15.34382399	0.749717518	2.085398491	0	0	0.972256103	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.4313	NO	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$100 copay	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$50 copay	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$25 copay	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP	$250 ded; 20% coinsurance; $5000 max OOP		0	0	$250 ded; 20% coinsurance; $5000 max OOP	0	$250 ded; 20% coinsurance; $5000 max OOP	0	0	Not Covered												6.9875	0	0.7931	0.2074	0.1839	0.2174	0	0.1044	0.8146	0.4144	1.4093	0.0123	0	0.543	0.6203	2.4866	0.0681	0.1874	0	0	1.6877	0	0	0	0.1334	0	0.008	0	0	0											16.879	250	6.897904249	24.638	1.565755945	4.998337307	0.207388871	2.215643557	2.591157092	0	1.072750222	6.446114922	1.469783425	8.204447877	0.167087831	0.000249112	2.360014971	5.651114258	17.8304305	0.81786091	2.272843353	0	-6.92E-11	2.659963657	0	0	0	0.133413282	0	0.008024387	0	0	0	0	0	0	0	0	0	0	0	0	0	85.3103
H5521_013_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	9.440316355	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											5000	$150/day 1-7	$150/day 1-7	"$0/d 1-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$15 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Coaching Only	0											108.4282617	108.4282617	40.33133874	0	150	0.2	0.2	48.5	175	4.5	26.78125	30	25	30	15	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											YES	64.08315311	64.08315311	23.83658389	0	150	0.118203782	0.118203782	48.5	103.4283094	4.5	26.78125	30	25	30	15	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											5000	8.0501	0.357836901	2.040899453	0	2.582213896	1.115881098	0	0.860671181	3.045255605	0.722132728	5.686686714	0.118510717	0.000638557	0	5.083449457	12.90924461	0.476786456	1.220284973	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.188	0	10.11	8.0501	0.357836901	2.040899453	0	2.582213896	1.115881098	0	0.860671181	3.045255605	0.722132728	5.686686714	0.118510717	0.000638557	0	5.083449457	12.90924461	0.476786456	1.220284973	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.188	NO	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$150 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$50 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$25 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP		0	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	Not Covered	0												8.0956	0	1.0842	0.168	0.2392	0.2714	0	0.1321	0.9275	0.321	1.4104	0.0188	0.0001	0.6184	0.4912	3.0961	0.0596	0.1537	0	0	1.6115	0	0	0	0.1976	0	0.0128	0	0	0											18.9094	1000	9.530414352	16.1457	0.357836901	3.125084489	0.168032663	2.821457193	1.387287826	0	0.99279273	3.972794668	1.043089948	7.097110172	0.137335341	0.000774834	0.618359376	5.574642101	16.00530694	0.536385818	1.374009064	0	-2.43E-10	2.528939046	0	0	0	0.197639264	0	0.012803798	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0974
H5521_014_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	9.730181171	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											3500	$75/day 1-7	$75/day 1-7	"$0/d 1-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$20 per visit	$20 X-ray; $175 Complex Radiology	$20 per visit	$20 per visit	$20 per visit	$5 PCP visit; $20 if no PCP selected	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Coaching Only	0											54.21413085	54.21413085	40.33133874	0	150	0.2	0.2	48.5	175	3	22.59375	20	20	20	5	20	20	20	20	20	$45 	0	0	0	0	0	0	0	0	0											YES	29.78458544	29.78458544	22.15754796	0	150	0.109877572	0.109877572	48.5	96.14287585	3	22.59375	20	20	20	5	20	20	20	20	20	$45 	0	0	0	0	0	0	0	0	0											3500	3.7415	0.166315533	1.897139612	0	2.582213896	1.069128686	0	0.860671181	2.830749467	0.481421819	4.79751983	0.079007145	0.000510846	0	1.694483152	8.606163076	0.317857638	0.813523315	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.8556	0	7.96	3.7415	0.166315533	1.897139612	0	2.582213896	1.069128686	0	0.860671181	2.830749467	0.481421819	4.79751983	0.079007145	0.000510846	0	1.694483152	8.606163076	0.317857638	0.813523315	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.8556	NO	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$150 copay	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$50 copay	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$20 copay	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP		0	0	$1000 ded; 30% coinsurance; $3500 max OOP	0	$1000 ded; 30% coinsurance; $3500 max OOP	0	Not Covered	0												7.1996	0	0.9642	0.1494	0.2077	0.2414	0	0.1172	0.8249	0.2854	1.2543	0.0167	0.0001	0.5499	0.4368	2.7534	0.053	0.1367	0	0	1.4332	0	0	0	0.1758	0	0.0114	0	0	0											16.8111	1000	11.95149496	10.9411	0.166315533	2.861326549	0.149434731	2.789891199	1.310495993	0	0.977900434	3.655628079	0.766855346	6.051836971	0.095748251	0.000625265	0.549919076	2.131310369	11.3595518	0.370860514	0.950233154	0	-2.16E-10	2.350573163	0	0	0	0.175764459	0	0.011386668	0	0	0	0	0	0	0	0	0	0	0	0	0	47.6667
H5521_015_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	10.83107058	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0												$100/day 1-7	$100/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$35 per visit	$35 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											72.2855078	72.2855078	47.8866492	0	100	0.2	0.2	48.5	250	5.25	40.5	35	25	35	15	35	35	35	35	35	45	0	0	0	0	0	0	0	0	0											YES	72.2855078	72.2855078	47.8866492	0	100	0.2	0.2	48.5	250	5.25	40.5	35	25	35	15	35	35	35	35	35	45	0	0	0	0	0	0	0	0	0											7500	9.0805	0.403638411	4.100077286	0	1.721475931	2.166214117	0	0.860671181	7.360788414	0.842488183	8.599703595	0.138262504	0.000638557	0	5.083449457	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.316	0	0	9.0805	0.403638411	4.100077286	0	1.721475931	2.166214117	0	0.860671181	7.360788414	0.842488183	8.599703595	0.138262504	0.000638557	0	5.083449457	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.316	NO	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$100 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$50 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$25 copay	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP	$750 ded; 20% coinsurance; $7500 max OOP		0	0	$750 ded; 20% coinsurance; $7500 max OOP	0	$750 ded; 20% coinsurance; $7500 max OOP	0	0	$Not Covered copay												8.3579	0	1.1193	0.1735	0.2225	0.2802	0	0.1561	0.9576	0.3314	1.4561	0.0194	0.0348	0.6384	0.5071	3.1964	0.0615	0.1587	0	0	1.6638	0	0	0	0.204	0	0.0132	0	0	0											19.5519	750	3.465747896	17.4384	0.403638411	5.219393349	0.173477453	1.943964193	2.446415282	0	1.016732532	8.31838268	1.173845432	10.05582924	0.157697105	0.035401578	0.638396177	5.590558298	18.25716993	0.617781435	1.582371041	0	-2.51E-10	2.581158013	0	0	0	0.204043402	0	0.013218682	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8678
H5521_016_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1625.700181	94.2531649	1345.159842	752.249214	178.3738612	10.90310449	0	237.7107577	355.2352427	2608.952509	2463.952683	26.50469431	0.171374428	409.6412368	3707.747772	5231.210522	362.7868063	742.6322544	0	0	244.64	0	0	0	650.8239675	0	36.33815784	0	78.84934732	0											5000	$200/day 1-8	$200/day 1-8	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$250 per procedure	$50 per visit	$50 X-ray; $250 Complex Radiology	$50 per visit	$25 per visit	$50 per visit	$25 PCP visit; $50 if no PCP selected	$50 per visit	$40 per visit	$50 per visit	$50 per visit	$50 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											152.3663772	152.3663772	47.56208437	0	100	0.2	0.2	47.5	250	7.5	44	50	25	50	25	50	40	50	50	50	$45 	0	0	0	0	0	0	0	0	0											YES	86.73748732	86.73748732	27.07563024	0	100	0.113853842	0.113853842	47.5	142.3173027	7.5	44	50	25	50	25	50	40	50	50	50	$45 	0	0	0	0	0	0	0	0	0											5000	11.7508	0.681273558	3.035087542	0	1.486448844	1.241360338	0	0.940938416	4.213010131	1.630595318	9.034493172	0.110436226	0.00035703	1.706838487	7.724474525	21.79671051	1.209289354	3.09430106	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5738	0	15.83	11.7508	0.681273558	3.035087542	0	1.486448844	1.241360338	0	0.940938416	4.213010131	1.630595318	9.034493172	0.110436226	0.00035703	1.706838487	7.724474525	21.79671051	1.209289354	3.09430106	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.5738	NO	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$100 copay	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$50 copay	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$25 copay	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP	$500 ded; 35% coinsurance; $5000 max OOP		0	0	$500 ded; 35% coinsurance; $5000 max OOP	0	$500 ded; 35% coinsurance; $5000 max OOP	0	Not Covered	0												9.2271	0	1.2028	0.2589	0.1178	0.2796	0	0.0976	0.9308	0.4169	1.3602	0.0121	0	0.6205	0.8214	3.247	0.1141	0.2	0	0	1.3873	0	0	0	0.174	0	0.0101	0	0	0											20.4781	500	15.42375675	20.9778	0.681273558	4.237919662	0.258918727	1.604264893	1.52094042	0	1.038491614	5.143769488	2.047467102	10.39468434	0.122504819	0.00040689	2.327344727	8.545857011	25.04373059	1.323357579	3.29432106	0	-1.56E-10	2.304743028	0	0	0	0.173988864	0	0.010056384	0	0	0	0	0	0	0	0	0	0	0	0	0	91.0519
H5521_017_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	11.98331743	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											3500	$125/day 1-10	$125/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$30 per visit	$50 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$5 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$50 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											102.4559256	102.4559256	47.56208437	0	100	0.2	0.2	47.5	200	4.5	36.875	30	25	30	5	30	30	30	50	30	$45 	0	0	0	0	0	0	0	0	0											YES	33.87441108	33.87441108	15.72517733	0	100	0.066124845	0.066124845	47.5	66.1248452	4.5	36.875	30	25	30	5	30	30	30	50	30	$45 	0	0	0	0	0	0	0	0	0											3500	4.2553	0.1891529	1.346397033	0	1.721475931	0.79239501	0	0.842925383	1.946923978	0.722132728	7.829977039	0.118510717	0.000638557	0	1.694483152	12.90924461	0.476786456	1.220284973	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.984	0	17.27	4.2553	0.1891529	1.346397033	0	1.721475931	0.79239501	0	0.842925383	1.946923978	0.722132728	7.829977039	0.118510717	0.000638557	0	1.694483152	12.90924461	0.476786456	1.220284973	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.984	NO	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$100 copay	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$50 copay	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$25 copay	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP	$500 ded; 35% coinsurance; $3500 max OOP		0	0	$500 ded; 35% coinsurance; $3500 max OOP	0	$500 ded; 35% coinsurance; $3500 max OOP	0	Not Covered	0												7.7445	0	1.0372	0.1607	0.1186	0.2596	0	0.0799	0.8873	0.307	1.3493	0.018	0.0001	0.5915	0.4699	2.9618	0.057	0.1471	0	0	1.5417	0	0	0	0.1891	0	0.0122	0	0	0											17.9326	500	18.97601403	11.9998	0.1891529	2.383568623	0.160746274	1.840121434	1.052032746	0	0.922791815	2.834242225	1.029172301	9.179240396	0.13651905	0.000715033	0.591545499	2.164376242	15.87105259	0.533801415	1.367343137	0	-2.33E-10	2.459057983	0	0	0	0.189069045	0	0.012248588	0	0	0	0	0	0	0	0	0	0	0	0	0	54.9166
H5521_018_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1445.894549	54.64424354	1137.081305	704.516309	202.6189643	8.055036618	0	200.9844554	350.1416839	2160.152968	2506.128929	38.65801403	0.249955535	120.9513189	3866.077105	4974.073553	286.6865217	753.278762	0	0	244.64	0	0	0	796.4254567	0	48.79723649	0	174.8557508	0											5000	$50/day 1-5	$50/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$100 per procedure	$15 per visit	$15 X-ray; $175 Complex Radiology	$15 per visit	$15 per visit	$15 per visit	$0 PCP visit; $15 if no PCP selected	$15 per visit	$15 per visit	$15 per visit	$15 per visit	$15 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$750 Every 3 Yrs	Coaching Only	0											30.64193704	30.64193704	47.56208437	0	100	0.2	0.2	47.5	100	2.25	20.5	15	15	15	0	15	15	15	15	15	$45 	0	0	0	0	0	0	0	0	0											YES	23.81349516	23.81349516	36.9630505	0	100	0.155430743	0.155430743	47.5	77.71537137	2.25	20.5	15	15	15	0	15	15	15	15	15	$45 	0	0	0	0	0	0	0	0	0											5000	2.8693	0.108439202	3.502499475	0	1.688491369	1.252000324	0	0.795563469	2.267615916	0.405028681	4.281303588	0.048322518	0.000312444	0.151189149	0	6.217591942	0.358358152	0.941598453	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.805	0	2.867430547	2.8693	0.108439202	3.502499475	0	1.688491369	1.252000324	0	0.795563469	2.267615916	0.405028681	4.281303588	0.048322518	0.000312444	0.151189149	0	6.217591942	0.358358152	0.941598453	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.805	NO	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$100 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$50 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$20 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP		0	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	0	$Not Covered copay												7.3829	0	0.9887	0.1532	0.1776	0.2475	0	0.1321	0.8459	0.2927	1.2863	0.0172	0.0001	0.5639	0.448	2.8235	0.0544	0.1402	0	0	1.4697	0	0	0	0.1802	0	0.0117	0	0	0											17.2158	1000	8.385587609	10.2522	0.108439202	4.491239307	0.153240067	1.866105609	1.499514018	0	0.927685019	3.113499956	0.697730736	5.567561752	0.065489934	0.000439577	0.715111842	0.447950965	9.041095351	0.41271074	1.081789589	0	-2.22E-10	2.387068732	0	0	0	0.180240278	0	0.011676628	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0208
H5521_020_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1492.09241	53.4601011	902.8890638	782.583286	191.9529844	11.49473356	0	254.7111551	350.9813687	2445.574887	2670.711872	37.82029367	0.244538991	246.2976493	3991.608552	5058.114807	194.903397	627.5891934	0	0	244.64	0	0	0	741.4565168	0	42.22146881	0	258.431246	0											3000	$200/day 1-5	$200/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$35 per visit	$50 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$50 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											122.5677481	122.5677481	47.56208437	0	100	0.2	0.2	47.5	200	5.25	36.875	35	25	35	15	35	35	35	50	35	$45 	0	0	0	0	0	0	0	0	0											YES	32.35754876	32.35754876	12.5562596	0	100	0.052799451	0.052799451	47.5	52.7994505	5.25	36.875	35	25	35	15	35	35	35	50	35	$45 	0	0	0	0	0	0	0	0	0											3000	4.0234	0.144153152	0.944742456	0	1.599608203	0.606915616	0	1.008231656	1.54430195	1.069939013	8.206875022	0.11030919	0.000509456	0.718368144	4.98951069	14.75283485	0.568468241	1.830468481	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.036	0	20.25	4.0234	0.144153152	0.944742456	0	1.599608203	0.606915616	0	1.008231656	1.54430195	1.069939013	8.206875022	0.11030919	0.000509456	0.718368144	4.98951069	14.75283485	0.568468241	1.830468481	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.036	NO	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$100 copay	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$50 copay	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$25 copay	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP	$500 ded; 30% coinsurance; $3000 max OOP		0	0	$500 ded; 30% coinsurance; $3000 max OOP	0	$500 ded; 30% coinsurance; $3000 max OOP	0	Not Covered	0												6.0251	0	0.6941	0.1431	0.1122	0.2273	0	0.0973	0.6562	0.2782	1.1156	0.0114	0.0001	0.4375	0.4519	2.2775	0.0454	0.147	0	0	1.2506	0	0	0	0.1361	0	0.0082	0	0	0											14.1147	500	13.89233644	10.0484	0.144153152	1.638852663	0.143136866	1.711825531	0.834242099	0	1.105553291	2.200492667	1.34809662	9.322458915	0.121718334	0.000573551	1.1558286	5.44141865	17.03034191	0.613892133	1.977422629	0	-1.47E-10	2.168017635	0	0	0	0.136066075	0	0.008169019	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1507
H5521_021_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	9.348668834	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											3000	$200/day 1-5	$200/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$35 per visit	$50 X-ray; $125 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$50 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											122.5677481	122.5677481	47.56208437	0	100	0.2	0.2	47.5	200	5.25	32.125	35	25	35	15	35	35	35	50	35	$45 	0	0	0	0	0	0	0	0	0											YES	49.62949231	49.62949231	19.25859075	0	100	0.080982955	0.080982955	47.5	80.98295524	5.25	32.125	35	25	35	15	35	35	35	50	35	$45 	0	0	0	0	0	0	0	0	0											3000	6.2344	0.277128432	1.648929541	0	1.721475931	0.75708283	0	0.842925383	2.384393595	0.842488183	6.821369827	0.138262504	0.000638557	0	5.083449457	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7107	0	16.61	6.2344	0.277128432	1.648929541	0	1.721475931	0.75708283	0	0.842925383	2.384393595	0.842488183	6.821369827	0.138262504	0.000638557	0	5.083449457	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.7107	NO	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$100 copay	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$50 copay	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$25 copay	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP	$0 ded; 30% coinsurance; $3000 max OOP		0	0	$0 ded; 30% coinsurance; $3000 max OOP	0	$0 ded; 30% coinsurance; $3000 max OOP	0	Not Covered	0												4.314	0	0.5777	0.0895	0.0888	0.1446	0	0.0458	0.4943	0.171	0.7516	0.01	0	0.3295	0.2617	1.6498	0.0318	0.0819	0	0	0.8588	0	0	0	0.1053	0	0.0068	0	0	0											10.013	0	13.28759839	10.5484	0.277128432	2.226669637	0.08954118	1.810248673	0.901709941	0	0.888680978	2.878660247	1.01351974	7.572955727	0.148293762	0.000671486	0.329511102	5.345196001	16.71061386	0.58801015	1.505582235	0	-1.30E-10	1.776156295	0	0	0	0.105317933	0	0.006822883	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7237
H5521_022_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1590.425205	48.76912563	1017.304541	754.9387022	204.5208557	12.71432557	0	227.2247505	356.7138445	2391.018616	2729.758387	34.50166789	0.223081373	108.8608424	3854.163124	5571.461375	159.4886574	787.6363795	0	0	244.64	0	0	0	797.6481202	0	50.19550308	0	126.7516004	0												$200/day 1-5	$200/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$40 per visit	$40 X-ray; $200 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$20 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness Only	0											122.5677481	122.5677481	40.33133874	0	100	0.2	0.2	47.5	200	6	52	40	25	40	20	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0											YES	122.5677481	122.5677481	40.33133874	0	100	0.2	0.2	47.5	200	6	52	40	25	40	20	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0											7500	16.2446	0.498126826	3.419104504	0	1.704340465	2.542865114	0	0.899431304	5.945230741	1.195509308	11.82895301	0.11500556	0.000464753	0.362869475	6.423605206	18.57153792	0.531628858	2.625454598	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8261	0	0	16.2446	0.498126826	3.419104504	0	1.704340465	2.542865114	0	0.899431304	5.945230741	1.195509308	11.82895301	0.11500556	0.000464753	0.362869475	6.423605206	18.57153792	0.531628858	2.625454598	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.8261	NO	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$100 copay	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$50 copay	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$25 copay	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP				$750 ded; 30% coinsurance; $7500 max OOP		$750 ded; 30% coinsurance; $7500 max OOP	0	Not Covered	0												9.1654	0	1.1323	0.2124	0.1873	0.3918	0	0.1412	1.0387	0.4706	1.659	0.0157	0.0001	0.6924	0.7943	3.7391	0.0615	0.2795	0	0	1.4703	0			0.2223		0.0136	0	0	0											21.6877	750	7.672401602	25.41	0.498126826	4.551430475	0.212409431	1.891688978	2.934706229	0	1.040632977	6.983891709	1.666074025	13.48798708	0.130723641	0.000559379	1.055310094	7.217904165	22.31065084	0.593151678	2.904954598	0	0	2.387702116	0	0	0	0.222274049	0	0.013578457	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5138
H5521_026_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1657.395079	101.4079474	934.9064502	911.4855566	240.8796347	10.90505908	0	257.6311112	346.5351474	2571.626132	2736.932542	34.765613	0.224787993	208.1201464	3679.719106	5659.228832	438.7903696	737.3398522	0	0	259.3997831	0	0	0	802.2258621	0	48.9340666	0	127.8023085	0												$185/day 1-8	$185/day 1-8	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$35 per visit	$35 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											140.9388989	140.9388989	47.8866492	0	100	0.2	0.2	48.5	250	5.25	40.5	35	25	35	20	35	35	35	35	35	45	0	0	0	0	0	0	0	0	0											YES	140.9388989	140.9388989	47.8866492	0	100	0.2	0.2	48.5	250	5.25	40.5	35	25	35	20	35	35	35	35	35	45	0	0	0	0	0	0	0	0	0											5000	19.466	1.191027038	3.730794768	0	2.007330289	2.181011817	0	1.041259074	7.219482238	1.125086433	9.237147329	0.101399705	0.000468308	0.607017094	6.132865177	16.50608409	1.279805245	2.150574569	0	0	0.972749186	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9501	0	0	19.466	1.191027038	3.730794768	0	2.007330289	2.181011817	0	1.041259074	7.219482238	1.125086433	9.237147329	0.101399705	0.000468308	0.607017094	6.132865177	16.50608409	1.279805245	2.150574569	0	0	0.972749186	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9501	NO	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$100 copay	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$50 copay	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$25 copay	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP		0	0	$500 ded; 20% coinsurance; $5000 max OOP	0	$500 ded; 20% coinsurance; $5000 max OOP	0	0	0												6.9965	0	0.7788	0.2126	0.2047	0.2245	0	0.137	0.7038	0.3673	1.3287	0.0113	0.0221	0.4692	0.509	2.7741	0.1051	0.2039	0	0	2.4134	0	0	0	0.1639	0	0.0105	0	0	0											17.6363	500	6.13933777	26.4624	1.191027038	4.509585262	0.21255631	2.212022956	2.405548176	0	1.178227579	7.923252996	1.492366103	10.56586372	0.112743751	0.022550716	1.076197584	6.641874628	19.28016513	1.384901994	2.354437528	0	-1.46E-10	3.386172453	0	0	0	0.163897232	0	0.010530044	0	0	0	0	0	0	0	0	0	0	0	0	0	92.5863
H5521_027_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	10.83107058	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0												$200/day 1-7	$200/day 1-7	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$40 per visit	$40 X-ray; $150 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$25 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											144.5710156	144.5710156	47.8866492	0	100	0.2	0.2	48.5	250	6	42	40	25	40	25	40	40	40	40	40	45	0	0	0	0	0	0	0	0	0											YES	144.5710156	144.5710156	47.8866492	0	100	0.2	0.2	48.5	250	6	42	40	25	40	25	40	40	40	40	40	45	0	0	0	0	0	0	0	0	0											7500	18.1609	0.807276822	4.100077286	0	1.721475931	2.166214117	0	0.860671181	7.360788414	0.962843637	8.918211135	0.15801429	0.000638557	0	8.472415761	17.21232615	0.635715275	1.627046631	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0821	0	0	18.1609	0.807276822	4.100077286	0	1.721475931	2.166214117	0	0.860671181	7.360788414	0.962843637	8.918211135	0.15801429	0.000638557	0	8.472415761	17.21232615	0.635715275	1.627046631	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0821	NO	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$100 copay	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$50 copay	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$25 copay	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP	$750 ded; 30% coinsurance; $7500 max OOP		$750 ded; 30% coinsurance; $7500 max OOP				$750 ded; 30% coinsurance; $7500 max OOP		$750 ded; 30% coinsurance; $7500 max OOP															9.8404	0	1.3179	0.2042	0.1901	0.3299	0	0.1325	1.1274	0.3901	1.7144	0.0229	0.0299	0.7516	0.5971	3.7633	0.0724	0.1869	0		1.9589	0	0	0	0.2402	0	0.0156	0	0	0											22.8857	750	8.194818529	28.0013	0.807276822	5.417930952	0.204247849	1.911565719	2.496115693	0	0.993163035	8.488235035	1.352975058	10.63261566	0.180896085	0.030572224	0.751631081	9.069472542	20.97566631	0.70815977	1.813902057	0	0	2.87626548	0	0	0	0.240235402	0	0.015563333	0	0	0	0	0	0	0	0	0	0	0	0	0	96.9678
H5521_028_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	9.367570358	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											4000	$200/day 1-5	$200/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$35 per visit	$50 X-ray; $125 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$50 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											122.5677481	122.5677481	47.56208437	0	100	0.2	0.2	47.5	200	5.25	32.125	35	25	35	15	35	35	35	50	35	$45 	0	0	0	0	0	0	0	0	0											YES	62.28438638	62.28438638	24.16928829	0	100	0.101632587	0.101632587	47.5	101.6325866	5.25	32.125	35	25	35	15	35	35	35	50	35	$45 	0	0	0	0	0	0	0	0	0											4000	7.8241	0.347792684	2.069385759	0	1.721475931	0.952050405	0	0.842925383	2.992383863	0.842488183	6.821369827	0.138262504	0.000638557	0	5.083449457	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5945	0	13.73	7.8241	0.347792684	2.069385759	0	1.721475931	0.952050405	0	0.842925383	2.992383863	0.842488183	6.821369827	0.138262504	0.000638557	0	5.083449457	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5945	NO	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$100 copay	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$50 copay	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$25 copay	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP	$500 ded; 30% coinsurance; $4000 max OOP		0	0	$500 ded; 30% coinsurance; $4000 max OOP	0	$500 ded; 30% coinsurance; $4000 max OOP	0	Not Covered	0												6.3525	0	0.8507	0.1319	0.1368	0.213	0	0.0916	0.7278	0.2519	1.1067	0.0148	0.0001	0.4852	0.3854	2.4294	0.0468	0.1206	0	0	1.2646	0	0	0	0.1551	0	0.01	0	0	0											14.775	500	11.06627941	14.1767	0.347792684	2.920135141	0.131853586	1.858320315	1.165020608	0	0.93449564	3.720214685	1.094340171	7.928115305	0.153034002	0.000725815	0.485220548	5.468883516	17.49023518	0.603017901	1.544291591	0	-1.91E-10	2.181958911	0	0	0	0.155085595	0	0.010047015	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3694
H5521_029_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1638.196631	54.22024278	1134.768613	710.2333706	203.815556	11.0053244	0	206.4436821	355.2945861	2358.617691	2644.420139	50.99938868	0.248016056	155.5963745	3932.239064	5443.665852	196.0366308	559.5566206	0	0	244.64	0	0	0	820.2026766	0	43.17337899	0	98.85351789	0												$200/day 1-7	$200/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$225 per procedure	$35 per visit	$35 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	48.5	225	5.25	40.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											YES	144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	48.5	225	5.25	40.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											5000	19.7363	0.653222964	4.497663375	0	1.698462967	2.201064879	0	0.834376549	6.661773489	1.03189524	8.92491797	0.148748217	0.0005167	0.453822759	6.553731773	15.87735874	0.571773506	1.632040143	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3951	0	0	19.7363	0.653222964	4.497663375	0	1.698462967	2.201064879	0	0.834376549	6.661773489	1.03189524	8.92491797	0.148748217	0.0005167	0.453822759	6.553731773	15.87735874	0.571773506	1.632040143	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3951	NO	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$100 copay	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$50 copay	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$25 copay	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP		0	0	$500 ded; 30% coinsurance; $5000 max OOP	0	$500 ded; 30% coinsurance; $5000 max OOP	0	0	$Not Covered copay												7.3366	0	0.9825	0.1523	0.1499	0.246	0	0.0994	0.8406	0.2909	1.2782	0.0171	0.0001	0.5604	0.4451	2.8058	0.054	0.1393	0	0	1.4604	0	0	0	0.1791	0	0.0116	0	0	0											17.0493	500	2.624763757	27.0729	0.653222964	5.48020101	0.152278818	1.848402192	2.447025961	0	0.933797659	7.502351441	1.322761224	10.20310765	0.165807945	0.000610727	1.014208061	6.998872818	18.68315079	0.62578515	1.771351884	0	-2.20E-10	2.377849748	0	0	0	0.179109661	0	0.011603382	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4444
H5521_030_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1181.237807	244.1407624	638.8837502	440.4659006	155.7573368	7.085836988	0	202.5541692	250.5038005	1636.064639	1897.9924	86.67173683	0.172328541	14.51858267	2755.058108	3677.534082	259.1953649	371.6653755	0	0	179.1830788	0	0	0	534.7639289	0	34.56535081	0	92.83876877	0												$200/day 1-7	$200/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$225 per procedure	$35 per visit	$35 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	48.5	225	5.25	40.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											YES	144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	48.5	225	5.25	40.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											5000	14.2311	2.941306497	2.532220236	0	1.297977806	1.417167398	0	0.818656434	4.696946259	0.71577828	6.40572435	0.252792566	0.000359018	0.042345866	4.591763514	10.72614107	0.755986481	1.084024012	0	0	0.671936545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1822	0	0	14.2311	2.941306497	2.532220236	0	1.297977806	1.417167398	0	0.818656434	4.696946259	0.71577828	6.40572435	0.252792566	0.000359018	0.042345866	4.591763514	10.72614107	0.755986481	1.084024012	0	0	0.671936545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.1822	NO	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$100 copay	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$50 copay	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$25 copay	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP		0	0	$500 ded; 30% coinsurance; $5000 max OOP	0	$500 ded; 30% coinsurance; $5000 max OOP	0	0	$Not Covered copay												7.9395	0	0.9032	0.1386	0.1514	0.2345	0	0.1279	0.7966	0.4529	1.3518	0.12	0.0001	0.5311	0.604	3.0975	0.1036	0.1447	0	0	2.2304	0	0	0	0.1849	0	0.0133	0	0	0											19.1259	500	2.624763757	22.1705	2.941306497	3.435402416	0.138600638	1.44938795	1.651681159	0	0.946562103	5.493591528	1.168650964	7.757525393	0.372752043	0.00043047	0.573442691	5.19574645	13.82368617	0.859557736	1.228744237	0	-1.87E-10	2.902294501	0	0	0	0.184885518	0	0.013303429	0	0	0	0	0	0	0	0	0	0	0	0	0	72.3081
H5521_031_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	11.05540183	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											3500	$125/day 1-7	$125/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$25 per visit	$25 X-ray; $125 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$15 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											90.35688474	90.35688474	47.56208437	0	100	0.2	0.2	48.5	200	3.75	32.5	25	25	25	15	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											YES	43.9884652	43.9884652	23.15466164	0	100	0.097366051	0.097366051	48.5	97.36605091	3.75	32.5	25	25	25	15	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											3500	5.5258	0.245629238	1.982512952	0	1.721475931	1.076420817	0	0.860671181	2.866763598	0.601777273	6.900996712	0.098758931	0.000638557	0	5.083449457	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0542	0	12.33	5.5258	0.245629238	1.982512952	0	1.721475931	1.076420817	0	0.860671181	2.866763598	0.601777273	6.900996712	0.098758931	0.000638557	0	5.083449457	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0542	NO	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$100 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$50 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$25 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP		0	0	$500 ded; 30% coinsurance; $3500 max OOP	0	$500 ded; 30% coinsurance; $3500 max OOP	0	0	$Not Covered copay												6.9059	0	0.9249	0.1433	0.1297	0.2315	0	0.0876	0.7912	0.2738	1.2032	0.0161	0.0001	0.5275	0.419	2.6411	0.0508	0.1311	0	0	1.3747	0	0	0	0.1686	0	0.0109	0	0	0											16.0311	500	2.453692745	12.4318	0.245629238	2.907378953	0.143340567	1.851203497	1.307944817	0	0.948231802	3.65800247	0.875570409	8.104160989	0.114817311	0.000722583	0.527492582	5.502462229	13.3988054	0.44816339	1.148038758	0	-2.07E-10	2.292126292	0	0	0	0.168596531	0	0.010922303	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0854
H5521_032_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	10.30307144	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0												$125/day 1-7	$125/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$25 per visit	$25 X-ray; $125 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$15 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											90.35688474	90.35688474	47.56208437	0	100	0.2	0.2	47.5	200	3.75	32.5	25	25	25	15	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											YES	90.35688474	90.35688474	47.56208437	0	100	0.2	0.2	47.5	200	3.75	32.5	25	25	25	15	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											3500	11.3506	0.504548014	4.072287893	0	1.721475931	2.060614288	0	0.842925383	5.888630731	0.601777273	6.900996712	0.098758931	0.000638557	0	5.083449457	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.216	0	0	11.3506	0.504548014	4.072287893	0	1.721475931	2.060614288	0	0.842925383	5.888630731	0.601777273	6.900996712	0.098758931	0.000638557	0	5.083449457	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.216	NO	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$100 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$50 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$25 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP		0	0	$500 ded; 30% coinsurance; $3500 max OOP	0	$500 ded; 30% coinsurance; $3500 max OOP	0	0	$Not Covered copay												6.507	0	0.8714	0.1351	0.1297	0.2182	0	0.0876	0.7455	0.258	1.1337	0.0151	0.0001	0.497	0.3948	2.4885	0.0479	0.1236	0	0	1.2953	0	0	0	0.1589	0	0.0103	0	0	0											15.1177	500	2.453692745	17.8576	0.504548014	4.943731707	0.135060917	1.851203497	2.278764978	0	0.930486005	6.634165997	0.859755547	8.034663713	0.113889745	0.000722583	0.497023511	5.478259178	13.24624987	0.445226688	1.140464149	0	-1.95E-10	2.212719237	0	0	0	0.158858044	0	0.010291408	0	0	0	0	0	0	0	0	0	0	0	0	0	67.3337
H5521_033_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	10.76914322	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0												$200/day 1-7	$200/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$225 per procedure	$35 per visit	$35 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	48.5	225	5.25	40.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											YES	144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	48.5	225	5.25	40.5	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											5000	18.1609	0.807276822	4.072287893	0	1.721475931	2.153828645	0	0.860671181	6.624709573	0.842488183	8.599703595	0.138262504	0.000638557	0	6.777932609	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7183	0	0	18.1609	0.807276822	4.072287893	0	1.721475931	2.153828645	0	0.860671181	6.624709573	0.842488183	8.599703595	0.138262504	0.000638557	0	6.777932609	15.06078538	0.556250866	1.423665802	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7183	NO	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$100 copay	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$50 copay	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$25 copay	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP	$500 ded; 30% coinsurance; $5000 max OOP		0	0	$500 ded; 30% coinsurance; $5000 max OOP	0	$500 ded; 30% coinsurance; $5000 max OOP	0	0	$Not Covered copay												7.8502	0	1.0513	0.1629	0.1499	0.2632	0	0.0994	0.8994	0.3112	1.3677	0.0183	0.0001	0.5996	0.4763	3.0022	0.0578	0.1491	0	0	1.5627	0	0	0	0.1916	0	0.0124	0	0	0											18.2254	500	2.624763757	26.0111	0.807276822	5.123610217	0.162939428	1.871415156	2.417008769	0	0.960092291	7.524134017	1.153716874	9.967375735	0.156516535	0.000732583	0.599616297	7.254236723	18.06300302	0.614043712	1.572730365	0	-2.36E-10	2.480091717	0	0	0	0.191648624	0	0.012415703	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9437
H5521_034_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	10.7822002	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0												$125/day 1-7	$125/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$25 per visit	$25 X-ray; $125 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$15 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Fitness/Coaching	0											90.35688474	90.35688474	47.56208437	0	100	0.2	0.2	48.5	200	3.75	32.5	25	25	25	15	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											YES	90.35688474	90.35688474	47.56208437	0	100	0.2	0.2	48.5	200	3.75	32.5	25	25	25	15	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											3500	11.3506	0.504548014	4.072287893	0	1.721475931	2.156440039	0	0.860671181	5.888630731	0.601777273	6.900996712	0.098758931	0.000638557	0	5.083449457	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3296	0	0	11.3506	0.504548014	4.072287893	0	1.721475931	2.156440039	0	0.860671181	5.888630731	0.601777273	6.900996712	0.098758931	0.000638557	0	5.083449457	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3296	NO	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$100 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$50 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$25 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP		0	0	$500 ded; 30% coinsurance; $3500 max OOP	0	$500 ded; 30% coinsurance; $3500 max OOP	0	0	$Not Covered copay												6.7611	0	0.9055	0.1403	0.1297	0.2267	0	0.0876	0.7746	0.2681	1.1779	0.0157	0.0001	0.5164	0.4102	2.5857	0.0498	0.1284	0	0	1.3459	0	0	0	0.1651	0	0.0107	0	0	0											15.6994	500	2.453692745	18.1117	0.504548014	4.977754135	0.14033389	1.851203497	2.383107649	0	0.948231802	6.663272773	0.869827392	8.078923714	0.114480474	0.000722583	0.516428028	5.493673121	13.34340631	0.447096954	1.145288111	0	-2.03E-10	2.263290375	0	0	0	0.165060092	0	0.0106932	0	0	0	0	0	0	0	0	0	0	0	0	0	68.029
H5521_035_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1502.959534	64.0923002	935.8655998	801.0677581	161.0636264	13.04671288	0	245.4666165	350.7686302	2609.810371	2739.673659	79.06509403	0.144058436	423.7443744	3755.764508	5803.38259	414.8759828	993.8552568	0	0	273.9808	0	0	0	857.5638616	0	55.14342881	0	23.5784223	0												$175/day 1-8	$175/day 1-8	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$35 per visit	$40 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$40 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											133.3205801	133.3205801	47.8866492	0	100	0.2	0.2	48.5	250	35	84	35	25	35	15	35	35	35	40	35	45	0	0	0	0	0	0	0	0	0											YES	133.3205801	133.3205801	47.8866492	0	100	0.2	0.2	48.5	250	35	84	35	25	35	15	35	35	35	40	35	45	0	0	0	0	0	0	0	0	0											5000	16.698	0.712068553	3.734622307	0	1.342196887	2.609342576	0	0.992094242	7.307679796	7.611946915	19.17771561	0.230606524	0.000300122	1.235921092	4.694705635	16.92653255	1.21005495	2.898744499	0	0	1.027428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.4099	0	0	16.698	0.712068553	3.734622307	0	1.342196887	2.609342576	0	0.992094242	7.307679796	7.611946915	19.17771561	0.230606524	0.000300122	1.235921092	4.694705635	16.92653255	1.21005495	2.898744499	0	0	1.027428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.4099	NO	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$100 copay	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$50 copay	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$25 copay	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP				$500 ded; 20% coinsurance; $5000 max OOP		$500 ded; 20% coinsurance; $5000 max OOP															7.6246	0	0.8011	0.1565	0.1353	0.2678	0	0.1354	0.9184	0.3881	1.2622	0.0557	0.0142	0.6122	0.6556	2.7587	0.0947	0.2499	0	0	1.716				0.1776		0.0113														18.0352	500	6.26739603	24.3225	0.712068553	4.535762151	0.156467084	1.477524534	2.877104978	0	1.127489506	8.226052087	8.000026145	20.43994229	0.286295204	0.014479478	1.848169289	5.350299645	19.68518976	1.304772014	3.148616096	0	-9.36E-11	2.743416525	0	0	0	0.177649148	0	0.011280776	0	0	0	0	0	0	0	0	0	0	0	0	0	106.4451
H5521_036_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1441.743989	47.46500006	900.6674067	677.4838898	163.5928296	10.5552664	0	220.8608143	351.1259882	2209.853517	2473.222147	42.96374219	37.00544262	203.6604556	3587.655894	4925.206008	184.4523966	669.4548976	0	0	266.784	0	0	0	781.4014582	0	44.83633627	0	23.93836101	0												$250/day 1-6	$250/day 1-6	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$35 per visit	$45 X-ray; $150 Complex Radiology	$45 per visit	$25 per visit	$45 per visit	$20 PCP visit; $45 if no PCP selected	$45 per visit	$40 per visit	$45 per visit	$35 per visit	$45 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											168.4846508	168.4846508	47.8866492	0	100	0.2	0.2	48.5	250	35	87	45	25	45	20	45	40	45	35	45	45	0	0	0	0	0	0	0	0	0											YES	168.4846508	168.4846508	47.8866492	0	100	0.2	0.2	48.5	250	35	87	45	25	45	20	45	40	45	35	45	45	0	0	0	0	0	0	0	0	0											7500	20.2426	0.666426996	3.594162013	0	1.36327358	2.11105328	0	0.892645791	7.315124755	6.445406091	17.93086056	0.161114033	0.077094672	0.763726709	5.979426489	18.46952253	0.614841322	2.510455866	0	0	1.00044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1382	0	0	20.2426	0.666426996	3.594162013	0	1.36327358	2.11105328	0	0.892645791	7.315124755	6.445406091	17.93086056	0.161114033	0.077094672	0.763726709	5.979426489	18.46952253	0.614841322	2.510455866	0	0	1.00044	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.1382	NO	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$100 copay	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$50 copay	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$25 copay	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP	$500 ded; 30% coinsurance; $7500 max OOP				$500 ded; 30% coinsurance; $7500 max OOP		$500 ded; 30% coinsurance; $7500 max OOP															9.3306	0	1.062	0.1964	0.1364	0.3018	0	0.1195	1.0321	0.5043	1.5665	0.0231	2.3838	0.688	0.7401	3.2966	0.0617	0.2413	0	0	2.0104				0.224		0.0119														23.9305	500	9.434464514	29.5732	0.666426996	4.656178641	0.196391859	1.499638048	2.412807493	0	1.012151611	8.347193127	6.949745599	19.49737091	0.184207269	2.46087554	1.451772292	6.719501515	21.76615777	0.676521822	2.751790024	0	-1.66E-10	3.010854671	0	0	0	0.224001125	0	0.011872081	0	0	0	0	0	0	0	0	0	0	0	0	0	114.0687
H5521_037_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1590.348299	69.11066716	1346.654233	815.5930072	218.0567123	8.510882625	0	201.8331145	332.467722	2412.008762	3254.407484	45.5716987	0.060425013	405.0758308	3493.991239	5780.427726	168.0125866	541.4316807	0	0	244.64	0	0	0	736.8102841	0	38.72763751	0	19.98499215	0											5000	$200/day 1-8	$200/day 1-8	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											152.3663772	152.3663772	52.43074037	0	150	0.2	0.2	47.5	150	5.25	28.875	35	25	35	15	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											YES	88.51730247	88.51730247	30.45965776	0	150	0.116190073	0.116190073	47.5	87.14255477	5.25	28.875	35	25	35	15	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											5000	11.7311	0.509790819	3.418218923	0	2.725708904	0.988880074	0	0.798922745	2.414340556	1.055253834	7.830918008	0.132917455	0.000125885	1.181471173	4.367489048	16.85958087	0.490036711	1.579175735	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0013	0	13.75	11.7311	0.509790819	3.418218923	0	2.725708904	0.988880074	0	0.798922745	2.414340556	1.055253834	7.830918008	0.132917455	0.000125885	1.181471173	4.367489048	16.85958087	0.490036711	1.579175735	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.0013	NO	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$150 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$50 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$25 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP		0	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	Not Covered	0												8.0228	0	1.3022	0.1751	0.2475	0.2408	0	0.1197	0.8243	0.5613	1.5615	0.0241	0	0.5495	0.8371	3.4288	0.0628	0.1482	0	0	1.5656	0	0	0	0.1949	0	0.0101	0	0	0											19.8765	1000	10.18418757	19.7539	0.509790819	4.72044282	0.175128113	2.973252644	1.229691522	0	0.918666181	3.238647538	1.616560347	9.392401343	0.157018994	0.000153298	1.731009164	5.204596172	20.28841577	0.552788278	1.72740355	0	-5.19E-11	2.482970509	0	0	0	0.194933432	0	0.010128331	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8779
H5521_038_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1367.513768	67.46322812	1136.220111	915.1661311	191.5258093	12.89326696	0	197.2054644	339.0919532	3164.575254	3783.310197	67.56439908	0.003668109	654.9604855	3528.198155	6717.872274	496.793985	902.4818168	0	0	244.64	0	0	0	903.7126964	0	53.69285816	0	18.33173671	0											3500	$200/day 1-8	$200/day 1-8	"$0/d 1-20, $130/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$10 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											152.3663772	152.3663772	52.43074037	0	150	0.2	0.2	47.5	150	4.5	26.78125	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											YES	65.1167435	65.1167435	22.40729966	0	150	0.085473901	0.085473901	47.5	64.10542605	4.5	26.78125	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											3500	7.4207	0.366082143	2.121635376	0	2.394072616	1.102037829	0	0.780604963	1.811469511	1.18671572	8.443481352	0.168910998	7.64E-06	1.637401214	2.940165129	16.79468068	1.241984963	2.256204542	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5835	0	17.18	7.4207	0.366082143	2.121635376	0	2.394072616	1.102037829	0	0.780604963	1.811469511	1.18671572	8.443481352	0.168910998	7.64E-06	1.637401214	2.940165129	16.79468068	1.241984963	2.256204542	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5835	NO	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$150 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$50 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$25 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP		0	0	$500 ded; 30% coinsurance; $3500 max OOP	0	$500 ded; 30% coinsurance; $3500 max OOP	0	Not Covered	0												5.3607	0	0.7742	0.1261	0.1653	0.2713	0	0.0736	0.7441	0.565	1.3333	0.0386	0	0.4961	0.7228	3.058	0.1266	0.1652	0	0	1.533	0	0	0	0.1773	0	0.0103	0	0	0											15.7414	500	13.62285317	12.7814	0.366082143	2.89580868	0.126106395	2.559336763	1.373318281	0	0.854206868	2.555595821	1.751706836	9.776771377	0.207476924	8.63E-06	2.133485418	3.66298453	19.85268183	1.368550674	2.421424271	0	-2.32E-12	2.450432036	0	0	0	0.177301636	0	0.01028123	0	0	0	0	0	0	0	0	0	0	0	0	0	67.325
H5521_039_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	8.117382515	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											5000	$75/day 1-7	$75/day 1-7	"$0/d 1-20, $130/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$100 per procedure	$10 per visit	$10 X-ray; $125 Complex Radiology	$10 per visit	$10 per visit	$10 per visit	$0 PCP visit; $10 if no PCP selected	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$10 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Coaching Only	0											54.21413085	54.21413085	52.43074037	0	100	0.2	0.2	48.5	100	1.5	14.34375	10	10	10	0	10	10	10	10	10	$45 	0	0	0	0	0	0	0	0	0											YES	46.7407265	46.7407265	45.20317595	0	100	0.17243005	0.17243005	48.5	86.21502506	1.5	14.34375	10	10	10	0	10	10	10	10	10	$45 	0	0	0	0	0	0	0	0	0											5000	5.8715	0.260997718	3.870317051	0	1.721475931	1.399680674	0	0.860671181	2.53844223	0.240710909	3.045728357	0.039503572	0.000255423	0	0	4.303081538	0.158928819	0.406761658	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.6355	0	2.229033126	5.8715	0.260997718	3.870317051	0	1.721475931	1.399680674	0	0.860671181	2.53844223	0.240710909	3.045728357	0.039503572	0.000255423	0	0	4.303081538	0.158928819	0.406761658	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.6355	NO	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$100 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$50 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$15 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP		0	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	Not Covered	0												7.248	0	0.9707	0.1504	0.1776	0.243	0	0.1321	0.8304	0.2874	1.2627	0.0169	0.0116	0.5536	0.4398	2.7719	0.0534	0.1376	0	0	1.4428	0	0	0	0.1769	0	0.0115	0	0	0											16.9183	1000	8.184476751	13.1195	0.260997718	4.840986173	0.150439373	1.89909017	1.642670682	0	0.99279273	3.368866464	0.528063393	4.308478214	0.056357228	0.011849664	0.553616156	0.439763986	7.074981166	0.212288031	0.54439059	0	-2.18E-10	2.36020832	0	0	0	0.176946115	0	0.01146322	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5538
H5521_040_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	12.03467486	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											5000	$125/day 1-10	$125/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$150 per procedure	$25 per visit	$25 X-ray; $175 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$10 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											102.4559256	102.4559256	47.56208437	0	150	0.2	0.2	48.5	150	3.75	24.6875	25	25	25	10	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											YES	55.30769634	55.30769634	25.67493588	0	150	0.10796388	0.10796388	48.5	80.97291011	3.75	24.6875	25	25	25	10	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											5000	6.9477	0.308835219	2.19830001	0	2.582213896	1.299310194	0	0.860671181	2.384097835	0.601777273	5.242103272	0.098758931	0.000638557	0	3.388966304	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0027	0	11.2	6.9477	0.308835219	2.19830001	0	2.582213896	1.299310194	0	0.860671181	2.384097835	0.601777273	5.242103272	0.098758931	0.000638557	0	3.388966304	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0027	NO	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$150 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$50 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$25 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP		0	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	Not Covered	0												9.7578	0	1.3068	0.2025	0.2392	0.3271	0	0.1321	1.118	0.3869	1.7	0.0227	0.0285	0.7453	0.592	3.7318	0.0718	0.1853	0	0	1.9424	0	0	0	0.2382	0	0.0154	0	0	0											22.7441	1000	12.12256046	16.7055	0.308835219	3.505097068	0.202534238	2.821457193	1.626443942	0	0.99279273	3.502085336	0.988635546	6.942124178	0.121448751	0.02915435	0.745325002	3.981013863	14.48947011	0.469158742	1.20219188	0	-2.93E-10	2.859830873	0	0	0	0.238219861	0	0.015432759	0	0	0	0	0	0	0	0	0	0	0	0	0	61.7468
H5521_041_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1547.189414	84.11958486	862.8403991	631.3449284	190.4350866	10.56526963	0	215.5655007	354.7314633	2162.508237	2574.97543	138.7041085	0.257402327	119.8319285	3784.813758	5272.25448	399.2023797	643.8699669	0	0	244.64	0	0	0	843.7625313	0	52.17358286	0	216.1130668	0											3500	$75/day 1-10	$75/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$150 per procedure	$25 per visit	$25 X-ray; $175 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$10 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$75 Every 2 Years	$0 per visit	$300 Every 3 Yrs	Coaching Only	0											61.47355533	61.47355533	47.56208437	0	150	0.2	0.2	48.5	150	3.75	24.6875	25	25	25	10	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											YES	16.82086326	16.82086326	13.01430043	0	150	0.054725526	0.054725526	48.5	41.04414452	3.75	24.6875	25	25	25	10	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											3500	2.1688	0.11791367	0.935772015	0	2.380438583	0.578189938	0	0.871243899	1.213304121	0.675783824	5.297475494	0.288966893	0.000536255	0.249649851	3.154011465	10.9838635	0.831671624	1.341395764	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0064	0	13.31	2.1688	0.11791367	0.935772015	0	2.380438583	0.578189938	0	0.871243899	1.213304121	0.675783824	5.297475494	0.288966893	0.000536255	0.249649851	3.154011465	10.9838635	0.831671624	1.341395764	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0064	NO	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$150 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$50 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$25 copay	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP	$500 ded; 30% coinsurance; $3500 max OOP		0	0	$500 ded; 30% coinsurance; $3500 max OOP	0	$500 ded; 30% coinsurance; $3500 max OOP	0	Not Covered	0												7.4509	0	0.9978	0.1547	0.1807	0.2498	0	0.0876	0.8537	0.2954	1.2981	0.0173	0.0237	0.5691	0.4521	2.8495	0.0549	0.1415	0	0	1.4832	0	0	0	0.1819	0	0.0118	0	0	0											17.3536	500	15.2756565	9.6196	0.11791367	1.933618906	0.154651526	2.5611673	0.827983425	0	0.95880452	2.066979406	0.971181891	6.595581091	0.306292434	0.024200554	0.818766709	3.606088405	13.83337356	0.886524842	1.48287817	0	-2.24E-10	2.400605518	0	0	0	0.181900431	0	0.011784179	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3599
H5521_043_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	11.01610656	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											5000	$175/day 1-10	$175/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$15 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$125 Every 2 Years	$0 per visit	$750 Every 3 Yrs	Coaching Only	0											143.4382958	143.4382958	47.56208437	0	150	0.2	0.2	48.5	175	4.5	26.78125	30	25	30	15	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											YES	80.04773206	80.04773206	26.5426814	0	150	0.111612776	0.111612776	48.5	97.66117922	4.5	26.78125	30	25	30	15	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											5000	10.0556	0.446982256	2.272596787	0	2.582213896	1.229538236	0	0.860671181	2.875453106	0.722132728	5.686686714	0.118510717	0.000638557	0	5.083449457	12.90924461	0.476786456	1.220284973	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4581	0	13.36753603	10.0556	0.446982256	2.272596787	0	2.582213896	1.229538236	0	0.860671181	2.875453106	0.722132728	5.686686714	0.118510717	0.000638557	0	5.083449457	12.90924461	0.476786456	1.220284973	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4581	NO	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$150 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$50 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$25 copay	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP	$1000 ded; 30% coinsurance; $5000 max OOP		0	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	$1000 ded; 30% coinsurance; $5000 max OOP	0	Not Covered	0												9.1052	0	1.2194	0.189	0.2392	0.3053	0	0.1321	1.0432	0.361	1.5863	0.0212	0.0261	0.6955	0.5525	3.4822	0.067	0.1729	0	0	1.8125	0	0	0	0.2223	0	0.0144	0	0	0											21.2473	1000	11.11076622	19.1608	0.446982256	3.491994378	0.188988612	2.821457193	1.534793059	0	0.99279273	3.918668851	1.083117659	7.273009077	0.139683027	0.026748548	0.695477164	5.635900476	16.39142784	0.543818665	1.39318054	0	-2.73E-10	2.729919788	0	0	0	0.222287556	0	0.014400605	0	0	0	0	0	0	0	0	0	0	0	0	0	68.7054
H5521_044_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	11.15488353	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											3500	$150/day 1-10	$150/day 1-10	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$25 per visit	$25 X-ray; $175 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$10 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$750 Every 3 Yrs	Coaching Only	0											122.9471107	122.9471107	47.56208437	0	150	0.2	0.2	48.5	175	3.75	24.6875	25	25	25	10	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											YES	59.61712263	59.61712263	23.06288128	0	150	0.096980112	0.096980112	48.5	84.85759774	3.75	24.6875	25	25	25	10	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											3500	7.4891	0.332898825	1.974654674	0	2.582213896	1.081801851	0	0.860671181	2.498475289	0.601777273	5.242103272	0.098758931	0.000638557	0	3.388966304	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2414	0	14.21	7.4891	0.332898825	1.974654674	0	2.582213896	1.081801851	0	0.860671181	2.498475289	0.601777273	5.242103272	0.098758931	0.000638557	0	3.388966304	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2414	NO	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$150 copay	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$50 copay	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$25 copay	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP	$1000 ded; 30% coinsurance; $3500 max OOP		0	0	$1000 ded; 30% coinsurance; $3500 max OOP	0	$1000 ded; 30% coinsurance; $3500 max OOP	0	Not Covered	0												7.9783	0	1.0685	0.1656	0.2077	0.2675	0	0.1172	0.9141	0.3163	1.39	0.0186	0.0226	0.6094	0.4841	3.0512	0.0587	0.1515	0	0	1.5882	0	0	0	0.1948	0	0.0126	0	0	0											18.6167	1000	13.69315933	15.4674	0.332898825	3.043131438	0.165598113	2.789891199	1.349276289	0	0.977900434	3.412575655	0.918084288	6.632091737	0.117310814	0.023198546	0.609400244	3.873042279	13.80890871	0.4560579	1.168400996	0	-2.40E-10	2.505590179	0	0	0	0.194775757	0	0.01261829	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8581
H5521_045_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	9.834761313	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0											2500	$100/day 1-5	$100/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$25 per visit	$50 X-ray; $125 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$0 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$50 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											61.28387407	61.28387407	47.56208437	0	100	0.2	0.2	47.5	150	3.75	32.125	25	25	25	0	25	25	25	50	25	$45 	0	0	0	0	0	0	0	0	0											YES	20.92798066	20.92798066	16.242093	0	100	0.068298491	0.068298491	47.5	51.22386839	3.75	32.125	25	25	25	0	25	25	25	50	25	$45 	0	0	0	0	0	0	0	0	0											2500	2.629	0.116860725	1.390655594	0	1.721475931	0.671699359	0	0.842925383	1.508192228	0.601777273	6.821369827	0.098758931	0.000638557	0	0	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4926	0	12.18	2.629	0.116860725	1.390655594	0	1.721475931	0.671699359	0	0.842925383	1.508192228	0.601777273	6.821369827	0.098758931	0.000638557	0	0	10.75770385	0.397322047	1.016904144	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4926	NO	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$100 copay	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$50 copay	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$25 copay	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP	$0 ded; 30% coinsurance; $2500 max OOP		0	0	$0 ded; 30% coinsurance; $2500 max OOP	0	$0 ded; 30% coinsurance; $2500 max OOP	0	Not Covered	0												4.1009	0	0.5492	0.0851	0.0802	0.1375	0	0.0413	0.4699	0.1626	0.7145	0.0095	0	0.3132	0.2488	1.5683	0.0302	0.0779	0	0	0.8163	0	0	0	0.1001	0	0.0065	0	0	0											9.5121	0	14.98377992	6.7298	0.116860725	1.939857547	0.085118189	1.801692697	0.809182445	0	0.884271023	1.978044004	0.764360528	7.535830267	0.108294684	0.000668312	0.313234518	0.248817269	12.32603713	0.427512545	1.09477422	0	-1.23E-10	1.73373703	0	0	0	0.100115632	0	0.006485859	0	0	0	0	0	0	0	0	0	0	0	0	0	39.0047
H5521_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	289.0588366	3.559396944	35.39747109	6.201353375	6.824782025	9.989110761	0	9.875334986	40.97072696	16.17863903	77.62128422	0.538590227	0.01024632	27.3138193	23.49941448	124.0646773	3.079764763	10.34628344	0	0	106.8821101	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.078424339	0.078424339	0.167476855	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078424339	0.078424339	0.167476855	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.6692	0.279143352	5.928257139	0	1.590174212	2.327462807	0	2.300953052	9.546179381	3.769622895	18.08575922	0.125491523	0.002387393	6.364119898	5.475363575	28.90706982	0.71758519	2.410684042	0	0	24.90353165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.403			22.6692	0.279143352	5.928257139	0	1.590174212	2.327462807	0	2.300953052	9.546179381	3.769622895	18.08575922	0.125491523	0.002387393	6.364119898	5.475363575	28.90706982	0.71758519	2.410684042	0	0	24.90353165	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.403	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.0913	0.0381	0.8084	0	0.2168	0.3174	0	0.3138	1.3018	0.514	2.4662	0.0171	0.0003	0.8678	0.7466	3.9419	0.0979	0.3287	0	0	3.3959	0	0	0	0	0	0	0	0												18.464			25.7605	0.317208355	6.73665584	0	1.80701615	2.644844099	0	2.614719377	10.84793112	4.28366238	20.55199912	0.142604003	0.002712946	7.231954429	6.222004062	32.84894298	0.815437716	2.739413684	0	0	28.29946779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.8671
H5521_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	309.8366797	1.330325522	32.81750895	8.661521343	6.113627454	10.88528609	0	10.33591138	43.26424948	26.61379989	77.90589735	0.473750296	0	28.84283308	25.47940258	123.3364817	2.879560471	11.98190727	0	0	85.55097353	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.073818603	0.073818603	0.15817453	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073818603	0.073818603	0.15817453	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.8717	0.098202772	5.190894044	0	1.424475197	2.536271659	0	2.408267351	10.08057013	6.201015373	18.15207408	0.110383819	0	6.720380109	5.936700801	28.73740023	0.67093759	2.791784393	0	0	19.93337683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.8644			22.8717	0.098202772	5.190894044	0	1.424475197	2.536271659	0	2.408267351	10.08057013	6.201015373	18.15207408	0.110383819	0	6.720380109	5.936700801	28.73740023	0.67093759	2.791784393	0	0	19.93337683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.8644	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.1189	0.0134	0.7078	0	0.1942	0.3459	0	0.3284	1.3746	0.8456	2.4753	0.0151	0	0.9164	0.8096	3.9187	0.0915	0.3807	0	0	2.7182	0	0	0	0	0	0	0	0												18.2542			25.9906	0.111594059	5.898743232	0	1.618721815	2.882126885	0	2.736667444	11.45519333	7.046608379	20.62735691	0.125436158	0	7.636795578	6.74625091	32.65613662	0.762429079	3.172482265	0	0	22.65156458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.1187
H5521_804_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	355.040826	5.456004958	47.54818031	7.369265488	9.427535399	11.90285387	0	11.89649876	40.67829122	14.0759476	61.85574115	0.825575511	0.015706024	27.11886084	21.54181775	135.7813702	2.61379847	6.741746632	0	0	70.6758963	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.073438285	0.073438285	0.151763286	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073438285	0.073438285	0.151763286	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												26.0736	0.400679647	7.216068109	0	2.196615748	2.773364951	0	2.771884211	9.478041855	3.279695791	14.41238769	0.192359094	0.003659504	6.318694576	5.019243535	31.63705926	0.609015043	1.570826965	0	0	16.46748384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4207			26.0736	0.400679647	7.216068109	0	2.196615748	2.773364951	0	2.771884211	9.478041855	3.279695791	14.41238769	0.192359094	0.003659504	6.318694576	5.019243535	31.63705926	0.609015043	1.570826965	0	0	16.46748384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	130.4207	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.5555	0.0546	0.984	0	0.2995	0.3782	0	0.378	1.2925	0.4472	1.9653	0.0262	0.0005	0.8616	0.6844	4.3141	0.083	0.2142	0	0	2.2456	0	0	0	0	0	0	0	0												17.7846			29.6291	0.455317781	8.200077396	0	2.496154259	3.151551081	0	3.149868421	10.77050211	3.726927036	16.37771328	0.21858988	0.004158527	7.180334745	5.703685835	35.95120371	0.692062549	1.785030642	0	0	18.71304982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.2053
H5521_805_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	313.5837348	4.818923027	41.99611671	6.508777653	8.326709335	10.51299202	0	10.50737898	35.92840471	12.43233988	54.63302502	0.729175444	0.013872077	23.95226983	19.02644194	119.926572	2.308592776	5.954532361	0	0	62.42327614	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.940123275	2.449527141	0	2.448219302	8.371318299	2.896735192	12.72949483	0.169897879	0.003232194	5.580878871	4.433160973	27.94289128	0.537902117	1.38740604	0	0	14.54462334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4354			0	0	0	0	1.940123275	2.449527141	0	2.448219302	8.371318299	2.896735192	12.72949483	0.169897879	0.003232194	5.580878871	4.433160973	27.94289128	0.537902117	1.38740604	0	0	14.54462334	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.4354	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2646	0.334	0	0.3338	1.1415	0.395	1.7358	0.0232	0.0004	0.761	0.6045	3.8104	0.0734	0.1892	0	0	1.9834	0	0	0	0	0	0	0	0												11.6503			0	0	0	0	2.20468554	2.783553569	0	2.782067389	9.512861703	3.291744536	14.46533503	0.193065771	0.003672948	6.341907808	5.037682924	31.75328555	0.611252406	1.576597773	0	0	16.52798107	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.0857
H5521_806_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	312.5121657	4.802455945	41.85260882	6.486536051	8.29825555	10.47706733	0	10.47147347	35.80563123	12.38985646	54.44633466	0.726683727	0.013824674	23.87042084	18.96142535	119.5167625	2.300703921	5.934184709	0	0	62.20996517	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.933493543	2.441156689	0	2.439853319	8.342712077	2.886836554	12.68599598	0.169317308	0.003221149	5.561808056	4.418012106	27.84740566	0.536064014	1.382665037	0	0	14.49492188	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.1435			0	0	0	0	1.933493543	2.441156689	0	2.439853319	8.342712077	2.886836554	12.68599598	0.169317308	0.003221149	5.561808056	4.418012106	27.84740566	0.536064014	1.382665037	0	0	14.49492188	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.1435	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2637	0.3329	0	0.3327	1.1376	0.3937	1.7299	0.0231	0.0004	0.7584	0.6025	3.7974	0.0731	0.1885	0	0	1.9766	0	0	0	0	0	0	0	0												11.6105			0	0	0	0	2.197151754	2.774041692	0	2.77256059	9.480354633	3.280496084	14.41590452	0.192406032	0.003660397	6.320236428	5.020468303	31.64477916	0.609163652	1.57121027	0	0	16.47150214	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7539
H5521_807_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	312.513058	4.802469658	41.85272832	6.486554572	8.298279244	10.47709725	0	10.47150337	35.80573347	12.38989183	54.44649012	0.726685802	0.013824713	23.870489	18.96147949	119.5171037	2.300710491	5.934201653	0	0	62.2101428	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.933499064	2.441163659	0	2.439860286	8.342735898	2.886844797	12.6860322	0.169317792	0.003221158	5.561823937	4.418024721	27.84748517	0.536065544	1.382668985	0	0	14.49496327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.1437			0	0	0	0	1.933499064	2.441163659	0	2.439860286	8.342735898	2.886844797	12.6860322	0.169317792	0.003221158	5.561823937	4.418024721	27.84748517	0.536065544	1.382668985	0	0	14.49496327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.1437	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2637	0.3329	0	0.3327	1.1376	0.3937	1.7299	0.0231	0.0004	0.7584	0.6025	3.7974	0.0731	0.1885	0	0	1.9766	0	0	0	0	0	0	0	0												11.6105			0	0	0	0	2.197158027	2.774049613	0	2.772568507	9.480381703	3.280505451	14.41594568	0.192406582	0.003660407	6.320254474	5.020482638	31.64486951	0.609165391	1.571214756	0	0	16.47154917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7542
H5522_001_0	2010	7	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	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	NO	2011.549132	195.3623872	1309.142055	0	237.4884231	8.590407657	5.679151946	101.8929256	704.1687087	704.1820348	32.205485	0	0	379.2961472	6012.075934	21500.60751	285.0434771	2077.598341	38.24307406	1664.006891	36.25478202	0	0	0	289.5365697	0	196.879881	0	0	651.5930178												1a $160 days 1-5	1b $160 days 1-5	2 $70 days 6-100	6 $0	10a $75	11a 20%	11b 20%	4a $50	"9a $175, 9b $175"	8a $10	8b $75 15B Outpatient Chemotherapy Drugs 15%	5 $0	12 $0	4b $50	7a $10	"16b $25, 17a $25, 18a $25, 7b $30, 7d $30, 7f $30"	"7e $30, 7h $30, 9c $30"	"7c $30, 7i $30"	8b $75 15B Physician Chemotherapy Drugs 15%	7g $30	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%		10b $0	16a $25 deductible	17a $25	17b 1 pair of glasses after cataract surgery - Medicare Covered Only	18a $25	"18b $750 Allowance every 3 yrs ($500 for 1st aid, $250 for 2nd aid)"	14a $0	"14c $10, 7f $30"											106.4478134	76.05900843	53.56306922	0	69.69072882	0.198850442	0.2	45.79184192	121.7194418	10	0.125631305	0	0	2.903899839	5.619698151	7.747813972	27.26930296	4.791595975	0.288082359	0.638078182	0.211019921	0	0	0	12.27978306	0	24.93165872	0	0	2.82296944											NO	106.4478134	76.05900843	53.56306922	0	69.69072882	0.198850442	0.2	45.79184192	121.7194418	10	0.125631305	0	0	2.903899839	5.619698151	7.747813972	27.26930296	4.791595975	0.288082359	0.638078182	0.211019921	0	0	0	12.27978306	0	24.93165872	0	0	2.82296944												17.8438	1.238255788	5.843472211	0	1.379228441	1.708206361	1.135830389	0.388822062	7.142585182	0.586818362	4.046017109	0	0	0.091786502	2.815504334	13.88189227	0.647744745	0.82958432	11.017155	0.088480541	7.650481235	0	0	0	0.296287189	0	0.409045167	0	0	0.153285598	0	0	0	0	0	0	0	0	0	0	79.1942	0	0	17.8438	1.238255788	5.843472211	0	1.379228441	1.708206361	1.135830389	0.388822062	7.142585182	0.586818362	4.046017109	0	0	0.091786502	2.815504334	13.88189227	0.647744745	0.82958432	11.017155	0.088480541	7.650481235	0	0	0	0.296287189	0	0.409045167	0	0	0.153285598	0	0	0	0	0	0	0	0	0	0	79.1942	NO	0.2	0.2	0.2	0	75	0.2	0.2	50	0.2	0.2	0.2	0.45	0.2	50	0.2	0.2	0.45	0.2	0.2	0.2	0.2		0	0	0.2	1 pair of glasses after cataract surgery - Medicare Covered Only	0.2	$375 maximum benefit every three years	0.45	0.2												7.3468	0.0648	1.6682	0	0.5096	0.1592	0.112	0.0228	0.8844	0.1662	0.6489	0.0602	0.0037	0.1322	0.5034	1.648	0.0016	0.3528	0.7524	0.1447	0.8466	0	0	0	0.005	0	0.001	0	0	0.0571											16.0914	750	0	25.1905	1.303072084	7.511634835	0	1.888839866	1.867437155	1.247809459	0.411631308	8.026979194	0.752984425	4.694895105	0.060193808	0.003702365	0.223994134	3.318856496	15.52988426	0.64931656	1.182432964	11.76956803	0.233138494	8.497120456	0	0	0	0.301270242	2.20E-06	0.410014033	0	0	0.210335894	0	0	0	0	0	0	0	0	0	0	95.2856
H5522_002_0	2010	7	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	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	NO	1492.23416	22.69276162	695.2731429	0	22.85920593	6.968137313	4.531659902	67.06131607	828.0573784	3251.226737	22.27831998	0	0	443.9160858	7161.646479	18711.35833	194.4505846	1634.945225	39.10299862	1708.694944	23.77266287	0	0	0	310.2755181	0	204.2058674	0	0	995.2609024												1a $100 days 1-5	1b $100 days 1-5	2 $75 days 11-100	6 $0	10a $60	11a 15%	11b 15%	4a $50	"9a $150, 9b $150"	8a $10	8b $90 15B Outpatient Chemotherapy Drugs 15%	5 $0	12 $0	4b $50	7a $10	"16b $25, 17a $25, 18a $25, 7b $30, 7d $30, 7f $30"	"7e $30, 7h $30, 9c $30"	"7c $30, 7i $30"	8b $90 15B Physician Chemotherapy Drugs 15%	7g $30	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%		10b $0	16a $25 deductible	17a $25	17b 1 pair of glasses after cataract surgery - Medicare Covered Only	18a $25	"18b $750 Allowance every 3 yrs ($500 for 1st aid, $250 for 2nd aid)"	14a $0	"14c $10, 7f $30"											65.82341008	47.56327918	43.24112022	0	58.80251409	0.149998848	0.15	43.96016825	148.7392157	10	0.222659578	0	0	0.177802259	6.51481303	9.473086143	26.84671735	7.22939261	0.259147368	0.524543319	0.218349837	0	0	0	12.09738233	0	24.81171067	0	0	2.478472319											NO	65.82341008	47.56327918	43.24112022	0	58.80251409	0.149998848	0.15	43.96016825	148.7392157	10	0.222659578	0	0	0.177802259	6.51481303	9.473086143	26.84671735	7.22939261	0.259147368	0.524543319	0.218349837	0	0	0	12.09738233	0	24.81171067	0	0	2.478472319												8.1853	0.08994518	2.505365797	0	0.112014898	1.045212573	0.679748985	0.245668895	10.26371708	2.709355615	4.960481324	0	0	0.00657744	3.88806565	14.77119244	0.43502999	0.984971744	10.13343916	0.074690376	5.190757052	0	0	0	0.312793464	0	0.422224742	0	0	0.20556055	0	0	0	0	0	0	0	0	0	0	67.2221	0	0	8.1853	0.08994518	2.505365797	0	0.112014898	1.045212573	0.679748985	0.245668895	10.26371708	2.709355615	4.960481324	0	0	0.00657744	3.88806565	14.77119244	0.43502999	0.984971744	10.13343916	0.074690376	5.190757052	0	0	0	0.312793464	0	0.422224742	0	0	0.20556055	0	0	0	0	0	0	0	0	0	0	67.2221	NO	0.2	0.2	0.2	0	60	0.2	0.2	50	0.2	0.2	0.2		0.2	50	0.2	0.2	0.45	0.2	0.2	0.2	0.2			0	0.2	1 pair of glasses after cataract surgery - Medicare Covered Only	0.2	$375 maximum benefit every three years	0.45	0.2												5.2662	0.0539	1.5596	0	0.7762	0.385	0.3035	0.0092	3.0193	0.0633	0.1598	0	0	0.0318	0.5384	3.0451	0	0.751	0.6756	0.2762	0.492	0	0	0	0.0168	0.0009	0	0	0	0.1394											17.5634	1000	0	13.4516	0.143851732	4.064936115	0	0.888224507	1.430235559	0.983243361	0.25488278	13.28301026	2.77260678	5.120305636	0	0	0.038418052	4.426494672	17.81633941	0.43502999	1.735981576	10.80906461	0.350912442	5.682760641	0	0	0	0.329585882	0.000902097	0.422224742	0	0	0.344963975	0	0	0	0	0	0	0	0	0	0	84.7855
H5522_003_0	2010	8	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	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	NO	1741.239827	82.41623685	1058.746194	0	108.3368501	10.45008426	6.754942176	142.0511551	865.6697139	1384.853305	28.36343845	0	0	495.8577743	6043.874049	28521.41181	148.49086	1746.423829	58.12156062	1678.387961	19.08802068	0	0	0	284.1666687	0	206.5109999	0	0	508.2412203												1a $170 days 1-5	1b $170 days 1-5	2 $85 days 11-100	6 $0	10a $75	11a 20%	11b 20%	4a $50	"9a $175, 9b $175"	8a $10	8b $75 15B Outpatient Chemotherapy Drugs 15%	5 $0	12 $0	4b $50	7a $10	"16b $25, 17a $25, 18a $25, 7b $35, 7d $35, 7f $35"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	8b $75 15B Physician Chemotherapy Drugs 15%	7g $35	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%		10b $0	16a $25 deductible	17a $25	17b 1 pair of glasses after cataract surgery - Medicare Covered Only	18a $25	"18b $750 Allowance every 3 yrs ($500 for 1st aid, $250 for 2nd aid)"	14a $0	"14c $15, 7f $35"											113.3808131	80.85757461	49.00660291	0	72.49939923	0.199085045	0.2	45.79184192	121.7970914	10	0.181892055	0	0	0.196484714	6.615096502	7.396938332	31.38190732	6.313771137	0.222507921	0.470219082	0.222572597	0	0	0	10.47298554	0	24.94731134	0	0	3.18927288											NO	113.3808131	80.85757461	49.00660291	0	72.49939923	0.199085045	0.2	45.79184192	121.7970914	10	0.181892055	0	0	0.196484714	6.615096502	7.396938332	31.38190732	6.313771137	0.222507921	0.470219082	0.222572597	0	0	0	10.47298554	0	24.94731134	0	0	3.18927288												16.4519	0.555331418	4.323796191	0	0.654529712	2.080455497	1.350988435	0.542065336	8.786337775	1.154044421	5.159084107	0	0	0.008119039	3.331734173	17.58092703	0.388327201	0.918876697	12.93250762	0.065767504	4.248470332	0	0	0	0.248006118	0	0.429324517	0	0	0.135076662	0	0	0	0	0	0	0	0	0	0	81.3457	0	0	16.4519	0.555331418	4.323796191	0	0.654529712	2.080455497	1.350988435	0.542065336	8.786337775	1.154044421	5.159084107	0	0	0.008119039	3.331734173	17.58092703	0.388327201	0.918876697	12.93250762	0.065767504	4.248470332	0	0	0	0.248006118	0	0.429324517	0	0	0.135076662	0	0	0	0	0	0	0	0	0	0	81.3457	NO	0.2	0.2	0.2	0	75	0.2	0.2	50	0.2	0.2	0.2	0.45	0.2	50	0.2	0.2	0.45	0.2	0.2	0.2	0.2		0	0	0.2	1 pair of glasses after cataract surgery - Medicare Covered Only	0.2	$375 maximum benefit every three years	0.45	0.2												2.969	0.004	0.6585	0	0.8118	0.1597	0.2484	0.0237	0.6192	0.0571	0.1687	0.0469	0.0002	0.0333	0.586	1.2817	0.0002	0.0943	0.4801	0.083	0.1435	0	0	0	0.0004	0.0013	0	0	0	0.0245											8.4955	750	0	19.4209	0.559291045	4.982256435	0	1.466289348	2.24015428	1.599387176	0.565767367	9.405582489	1.211194032	5.327805765	0.046877697	0.000183879	0.04146897	3.917748428	18.86266533	0.388501743	1.013141554	13.41258717	0.148720499	4.392017143	0	0	0	0.248373907	0.001341539	0.429371472	0	0	0.159559636	0	0	0	0	0	0	0	0	0	0	89.8412
H5522_004_0	2010	6	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	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	NO	1184.253307	16.54584669	688.3234583	0	55.6686916	3.827890229	2.658553328	51.21267277	706.4431222	2563.523062	23.08528121	0	0	369.8104628	5375.598438	12914.36468	125.3329066	987.5479518	39.25509526	1328.713279	24.34882913	0	0	0	0	0	0	0	0	778.3277791												1a $100 days 1-5	1b $100 days 1-5	2 $85 days 11-100	6 $0	10a $60	11a 15%	11b 15%	4a $50	"9a $150, 9b $150"	8a $10	8b $95 15B Outpatient Chemotherapy Drugs 15%	5 $0	12 $0	4b $50	7a $15	"16b $25, 17a $25, 18a $25, 7b $35, 7d $35, 7f $35"	"7e $35, 7h $35, 9c $35"	"7c $35, 7i $35"	8b $95 15B Physician Chemotherapy Drugs 15%	7g $35	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%		10b $0		17a $25	17b 1 pair of glasses after cataract surgery	18a $25		14a $0	"14c $15, 7f $35"											67.16882935	47.56327918	49.00660291	0	57.50303571	0.149999583	0.15	50	148.839528	10	0.211323993	0	0	0.372825638	9.771734305	10.41730264	31.2002397	29.24729273	0.249547814	1.751203078	0.217965943	0	0	0	0	0	0	0	0	8.606777366											NO	67.16882935	47.56327918	49.00660291	0	57.50303571	0.149999583	0.15	50	148.839528	10	0.211323993	0	0	0.372825638	9.771734305	10.41730264	31.2002397	29.24729273	0.249547814	1.751203078	0.217965943	0	0	0	0	0	0	0	0	8.606777366												6.6287	0.065581227	2.811032867	0	0.266759897	0.574181937	0.398782999	0.213386137	8.762221741	2.136269218	4.878473795	0	0	0.011489568	4.377409973	11.21107044	0.325868061	2.406925336	9.796023194	0.193903899	5.307215492	0	0	0	0	0	0	0	0	0.558241159	0	0	0	0	0	0	0	0	0	0	60.9236	0	0	6.6287	0.065581227	2.811032867	0	0.266759897	0.574181937	0.398782999	0.213386137	8.762221741	2.136269218	4.878473795	0	0	0.011489568	4.377409973	11.21107044	0.325868061	2.406925336	9.796023194	0.193903899	5.307215492	0	0	0	0	0	0	0	0	0.558241159	0	0	0	0	0	0	0	0	0	0	60.9236	NO	0.2	0.2	0.2	0	60	0.2	0.2	50	0.2	0.2	0.2		0.2	50	0.2	0.2	0.45	0.2	0.2	0.2	0.2				0.2	1 pair of glasses after cataract surgery	0.2		0.45	0.2												5.9985	0.3663	1.2627	0	0.5208	0.5422	0.3737	0.0367	1.9581	0.2524	0.4357	0.0022	0	0.0695	0.5323	1.9669	0.0002	0.3709	0.7388	0.1238	0.2832	0	0	0	0	0	0.0004	0	0	0.0891											15.9242	1000	0	12.6273	0.431856431	4.073734968	0	0.787564915	1.116337604	0.772475223	0.250057168	10.72035941	2.388641365	5.314208697	0.002172435	1.04E-05	0.080948668	4.909680459	13.17795958	0.326043405	2.777812176	10.53482542	0.317701929	5.590451911	0	0	0	0	0	0.00037327	0	0	0.647311066	0	0	0	0	0	0	0	0	0	0	76.8478
H5522_005_0	2010	6	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	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	NO	1705.696371	95.02708759	1050.06525	0	252.7553663	10.38825791	5.607779184	137.1428693	659.661733	1073.621081	21.77261307	0	0	364.8683843	5380.914924	15459.26054	194.1233327	1507.394781	42.50498192	1323.568877	34.69227673	0	0	0	0	0	0	0	0	364.7036414												1a $140 days 1-5	1b $140 days 1-5	2 $70 days 6-100	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $150, 9b $150"	8a $10	8b $95 15B Outpatient Chemotherapy Drugs 15%	5 $0	12 $0	4b $50	7a $15	"16b $25, 17a $25, 18a $25, 7b $40, 7d $40, 7f $40"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	8b $95 15B Physician Chemotherapy Drugs 15%	7g $40	15A 20% coinsurance 15B Physician Chemotherapy Drugs 15%		10b $0		17a $25	17b 1 pair of glasses after cataract surgery.			14a $0	"14c $15, 7f $40"											93.10884309	66.58859086	53.54871457	0	97.1047986	0.199017654	0.2	50	149.4860992	10	0.218826782	0	0	0.417663004	9.010638706	10.97847623	34.90648617	24.02260571	0.300338188	1.623573269	0.210478089	0	0	0	0	0	0	0	0	5.761666993											NO	93.10884309	66.58859086	53.54871457	0	97.1047986	0.199017654	0.2	50	149.4860992	10	0.218826782	0	0	0.417663004	9.010638706	10.97847623	34.90648617	24.02260571	0.300338188	1.623573269	0.210478089	0	0	0	0	0	0	0	0	5.761666993												13.2346	0.527309988	4.685803695	0	2.045313245	2.067446717	1.121555837	0.571428622	8.217521606	0.894684234	4.764430845	0	0	0.012699335	4.04045669	14.14326037	0.564680286	3.017629206	12.76586927	0.179075921	7.30196411	0	0	0	0	0	0	0	0	0.175108411	0	0	0	0	0	0	0	0	0	0	80.3309	0	0	13.2346	0.527309988	4.685803695	0	2.045313245	2.067446717	1.121555837	0.571428622	8.217521606	0.894684234	4.764430845	0	0	0.012699335	4.04045669	14.14326037	0.564680286	3.017629206	12.76586927	0.179075921	7.30196411	0	0	0	0	0	0	0	0	0.175108411	0	0	0	0	0	0	0	0	0	0	80.3309	NO	0.2	0.2	0.2	0	100	0.2	0.2	50	0.2	0.2	0.2	0.45	0.2	50	0.2	0.2	0.45	0.2	0.2	0.2	0.2		0		0.2	1 pair of glasses after cataract surgery.			0.45	0.2												7.0313	0.0485	0.9191	0	0.1665	0.3131	0.1698	0.0395	1.2301	0.2248	0.6594	0.0619	0.0025	0.1628	0.563	1.6762	0.0021	0.2782	1.0573	0.1088	1.1057	0	0	0	0	0	0.0007	0	0	0.0499											15.8711	1000	0	20.2659	0.575823775	5.604928838	0	2.211801986	2.380524136	1.291395187	0.610895521	9.447631952	1.119469781	5.423844552	0.061879485	0.002470942	0.175518604	4.603454927	15.81949342	0.566789517	3.295797484	13.8231687	0.287839342	8.407640167	0	0	0	0	0	0.000688342	0	0	0.224965844	0	0	0	0	0	0	0	0	0	0	96.202
H5522_007_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	O	O	O	O	O	P	P	P	P	P	P	S	V	T	V	V	V	V	V	P	O											15.3351	0	2.6301	0	2.69	1.8192	1.4779	0	11.9939	2.3509	8.5505	0.9555	0.0589	1.4889	0.0028	0.2396	0	3.8851	7.3923	0	8.0121	0	0	0	0	0	0.001	0	0	0.137											69.0207	YES	0	0	0	0	0	0	0	112.943181	0	0	0	0	0	0	6303.62942	17714.66751	0	0	0	1657.217617	0	0	0	0	316.6585082	0	0	0	0	568.9633755											2000	1a $0 per admit	1b $0 per admit	2 0% days 6-100	6 $0	10a $0	11a 0%	11b 0%	4a $50	"9a $0, 9b $0"	8a $0	8b $0	5 $0	12 $0	4b $50	7a $15	"16b $0, 17a $30, 18a $0, 7b $0, 7d $30, 7f $0"	"7e $0, 7h $0, 9c $0"	"7c $0, 7i $0"	8b $0	7g $0	15 $0		10b $0		17a $30	17b 1 pair of glasses after cataract surgery - Medicare Covered Only			14a $0	"14c $15, 7f $0"											0	0	0	0	0	0	0	50	0	0	0	0	0	0	7.972560532	8.323774784	0	0	0	1.431370328	0	0	0	0	12.13445782	0	0	0	0	2.912350598											NO	0	0	0	0	0	0	0	46.52493101	0	0	0	0	0	0	7.418456575	7.745260952	0	0	0	1.331888115	0	0	0	0	11.29109626	0	0	0	0	2.709938213												0	0	0	0	0	0	0	0.437889475	0	0	0	0	0	0	3.896933427	11.43372688	0	0	0	0.183935704	0	0	0	0	0.297951808	0	0	0	0	0.128487966	0	0	0	0	0	0	0	0	0	0	16.3789	1500	1.223384838	15.3351	0	2.630130679	0	2.689979609	1.819166543	1.47787572	0.437889475	11.99389893	2.35087674	8.550463527	0.955471872	0.05894987	1.488917347	3.899772766	11.67330247	0	3.885126277	7.392253682	0.183935704	8.012104623	0	0	0	0.297951808	0	0.000972595	0	0	0.265440905	0	0	0	0	0	0	0	0	0	0	85.3996	NO	0.3	0.3	0.3	0	0	0.3	0.3	50	0.3	0.3	0.3	0.45	0.3	50	0.3	0.3	0.45	0.3	0.3	0.3	0.3		0		0.3	1 pair of glasses after cataract surgery - Medicare Covered Only			0.45	0.3												8.1814	0.1338	1.4032	0	0.2109	0.4161	0.2957	0.0325	2.0191	0.3832	1.4394	0.1608	0.01	0.2508	1.8258	5.3831	0.0024	0.6585	2.3538	0.3406	1.8325	0	0	0	0.0127	0	0.0018	0	0	0.1338											27.4819	2000	0	23.5165	0.133828948	4.03332014	0	2.900865727	2.235304951	1.773540501	0.470392201	14.01296141	2.734101816	9.989855354	1.116316766	0.06893309	1.73976528	5.725566781	17.05644794	0.002404753	4.543662187	9.74602404	0.524513764	9.844576138	0	0	0	0.310613996	5.59E-06	0.002775906	0	0	0.399202823	0	0	0	0	0	0	0	0	0	0	112.8815
H5522_008_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	O	O	O	O	O	P	P	P	P	P	P	S	V	T	V	V	V	V	V	P	O											13.1388	0	2.0137	0	1.8595	1.5155	1.0071	0	15.3762	4.3799	6.1155	0.0798	0.0004	1.4946	0.0122	0.5253	0	2.6048	6.8567	0	4.8117	0	0	0	0	0	0.0007	0	0	0.3197											62.112	YES	0	0	0	0	0	0	0	63.72101425	0	0	0	0	0	0	6655.959281	18325.86615	0	0	4270.16173	1553.927667	0	0	0	0	304.5751469	0	0	0	0	936.841135											2000	1a $0 per admit	1b $0 per admit	2 0% days 11-100	6 $0	10a $0	11a 0%	11b 0%	4a $50	"9a $0, 9b $0"	8a $0	8b $0	5 $0	12 $0	4b $50	7a $10	"16b $0, 17a $30, 18a $0, 7b $0, 7d $30, 7f $0"	"7e $0, 7h $0, 9c $0"	"7c $0, 7i $0"	8b $0	7g $0	15 $0		10b $0		17a $30	17b 1 pair of glasses after cataract surgery - Medicare Covered Only			14a $0	"14c $10, 7f $0"											0	0	0	0	0	0	0	50	0	0	0	0	0	0	6.255617696	7.817871703	0	0	0.005482729	1.191997934	0	0	0	0	12.73268841	0	0	0	0	0.683299618											NO	0	0	0	0	0	0	0	47.00876737	0	0	0	0	0	0	5.881377541	7.350170244	0	0	0.005154727	1.120687071	0	0	0	0	11.97095974	0	0	0	0	0.642421456												0	0	0	0	0	0	0	0.249620528	0	0	0	0	0	0	3.262184119	11.22485301	0	0	0.001834293	0.145122221	0	0	0	0	0.303838069	0	0	0	0	0.050153904	0	0	0	0	0	0	0	0	0	0	15.2376	1350	0.969589871	13.1388	0	2.013662945	0	1.859452506	1.515519028	1.007141768	0.249620528	15.37617144	4.379941323	6.115523698	0.079766694	0.000383974	1.494554668	3.274336392	11.75018317	0	2.604829784	6.858500742	0.145122221	4.811712048	0	0	0	0.303838069	0	0.000704042	0	0	0.369834959	0	0	0	0	0	0	0	0	0	0	77.3496	NO	0.3	0.3	0.3	0	0	0.3	0.3	50	0.3	0.3	0.3	0.45	0.3	50	0.3	0.3	0.45	0.3	0.3	0.3	0.3		0		0.3	1 pair of glasses after cataract surgery - Medicare Covered Only			0.45	0.3												6.6399	0.0467	1.0176	0	0.1616	0.3543	0.2262	0.0184	2.6979	0.7685	1.073	0.014	0.0001	0.2623	1.9209	4.7062	0.0008	0.4577	1.8096	0.3127	1.1247	0	0	0	0.0102	0.0001	0.0013	0.0005	0	0.1548											23.7797	2000	0	19.7788	0.046695923	3.031298979	0	2.021012183	1.869771003	1.233297716	0.268029234	18.07403701	5.148419979	7.188538582	0.093762364	0.000451493	1.7568507	5.1951992	16.45639251	0.000789332	3.062520732	8.668102025	0.457808348	5.936446483	0	0	0	0.314003051	0.000120346	0.001958912	0.000531813	0	0.524586148	0	0	0	0	0	0	0	0	0	0	101.1294
H5522_009_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	O	O	O	O	O	P	P	P	P	P	P	S	V	T	V	V	V	V	V	P	O											12.4266	0	1.6978	0	2.6849	1.8125	1.1892	0	10.8066	2.1439	5.9137	0.5549	0.0226	1.4592	0.0034	0.2565	0	2.7502	7.0966	0	5.8373	0	0	0	0	0	0.0004	0	0	0.0725											56.7289	YES	0	0	0	0	0	0	0	136.5286177	0	0	0	0	0	0	5690.238155	17276.30793	0	0	5081.544883	1399.527997	0	0	0	0	262.612346	0	0	0	0	355.8087605											2000	1a $0 per admit	1b $0 per admit	2 0% days 11-100	6 $0	10a $0	11a 0%	11b 0%	4a $50	"9a $0, 9b $0"	8a $0	8b $0	5 $0	12 $0	4b $50	7a $10	"16b $0, 17a $30, 18a $0, 7b $0, 7d $30, 7f $0"	"7e $0, 7h $0, 9c $0"	"7c $0, 7i $0"	8b $0	7g $0	15 $0		10b $0		17a $30	17b 1 pair of glasses after cataract surgery - Medicare Covered Only			14a $0	"14c $10, 7f $0"											0	0	0	0	0	0	0	50	0	0	0	0	0	0	6.014466833	7.712385989	0	0	0.004136667	1.192045248	0	0	0	0	9.947596988	0	0	0	0	1.528363807											NO	0	0	0	0	0	0	0	47.44504333	0	0	0	0	0	0	5.707132791	7.318289749	0	0	0.003925286	1.131132769	0	0	0	0	9.439283403	0	0	0	0	1.450265741												0	0	0	0	0	0	0	0.539800515	0	0	0	0	0	0	2.706245397	10.5360856	0	0	0.00166221	0.131920998	0	0	0	0	0.206572697	0	0	0	0	0.043001438	0	0	0	0	0	0	0	0	0	0	14.1653	1200	0.762813071	12.4266	0	1.697837837	0	2.684948943	1.812515871	1.189204361	0.539800515	10.8066136	2.143913602	5.913687426	0.554941345	0.022552217	1.459220469	2.709597435	10.79263164	0	2.750232036	7.098229082	0.131920998	5.837274406	0	0	0	0.206572697	0	0.000368371	0	0	0.115527048	0	0	0	0	0	0	0	0	0	0	70.8942	NO	0.3	0.3	0.3	0	0	0.3	0.3	50	0.3	0.3	0.3	0.45	0.3	50	0.3	0.3	0.45	0.3	0.3	0.3	0.3		0		0.3	1 pair of glasses after cataract surgery - Medicare Covered Only			0.45	0.3												7.4369	0.0693	1.0161	0	0.2478	0.4643	0.2702	0.0393	2.0547	0.3951	1.1244	0.1055	0.0042	0.2776	1.7502	4.9763	0.0022	0.518	2.4052	0.3027	1.4952	0	0	0	0.0074	0.0001	0.0007	0	0	0.0849											25.0483	2000	0	19.8636	0.069311005	2.713937728	0	2.932714088	2.276798124	1.459385103	0.579090645	12.86133266	2.539018699	7.038088344	0.660455302	0.026796108	1.736852149	4.459814047	15.76891335	0.002230279	3.268187136	9.503442029	0.434585044	7.332454376	0	0	0	0.213941603	8.92E-05	0.001090197	0	0	0.200469529	0	0	0	0	0	0	0	0	0	0	95.9426
H5522_802_0	2010	4	N/A																															COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	302.0225128	6.395578961	50.53161662	0	12.61035529	13.87950925	6.791682595	3.814638417	53.1325186	9.606999493	35.33193672	3.723350886	0.229328319	7.713634826	41.78421683	133.1514852	1.923040988	15.58630966	58.91008871	8.332771601	46.59140997	0	0	0	0	0	0	0	0	0												FFS 8.7%	FFS 8.7%	FFS 17.4%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%											0.086959411	0.086959411	0.174185429	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23267181	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.086959411	0.086959411	0.174185429	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23267181	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												26.2637	0.556155778	8.8018713	0	2.938212784	3.233925654	1.582462045	0.888810751	12.37987683	2.238430882	8.232341256	0.867540756	0.053433498	1.797276915	9.73572252	31.02429604	0.447437427	3.631610152	13.72605067	1.941535783	10.85579852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.1965	0	0	26.2637	0.556155778	8.8018713	0	2.938212784	3.233925654	1.582462045	0.888810751	12.37987683	2.238430882	8.232341256	0.867540756	0.053433498	1.797276915	9.73572252	31.02429604	0.447437427	3.631610152	13.72605067	1.941535783	10.85579852	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.1965	NO	FFS 8.7%	FFS 8.7%	FFS 17.4%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%												2.3873	0.0356	0.8001	0	0.2671	0.294	0.1438	0.0808	1.1252	0.1929	0.7483	0.0789	0.0049	0.1634	0.885	2.7842	0.0001	0.3301	1.2477	0.1762	1.0316	0	0	0	0	0	0	0	0	0											12.7771	0	0	28.651	0.591721299	9.601948603	0	3.205296133	3.527889284	1.726307741	0.96960359	13.50507319	2.431335587	8.980660535	0.946400154	0.0582906	1.960634719	10.62068732	33.80848878	0.447577543	3.961722576	14.97374513	2.117721547	11.88741947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.9736
H5522_803_0	2010	4	N/A																															COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	289.8688743	6.796632118	40.54179854	0	10.24841546	13.73364161	6.1313272	3.363268526	48.83285777	10.57669515	29.96725514	2.794910826	0.117864198	6.597752603	38.45056495	125.1639919	1.525148888	14.20977787	59.67661739	7.779903889	51.34579331	0	0	0	0	0	0	0	0	0												FFS 8.3%	FFS 8.3%	FFS 17.6%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%											0.083282208	0.083282208	0.176196366	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23278732	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.083282208	0.083282208	0.176196366	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23278732	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												24.1409	0.566038532	7.143317585	0	2.387880803	3.199938494	1.428599238	0.783641567	11.37805586	2.464369969	6.982370448	0.651214223	0.027462358	1.537276356	8.958981633	29.16321011	0.355035323	3.310878244	13.90465185	1.812717606	11.96356984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.1601	0	0	24.1409	0.566038532	7.143317585	0	2.387880803	3.199938494	1.428599238	0.783641567	11.37805586	2.464369969	6.982370448	0.651214223	0.027462358	1.537276356	8.958981633	29.16321011	0.355035323	3.310878244	13.90465185	1.812717606	11.96356984	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.1601	NO	FFS 8.3%	FFS 8.3%	FFS 17.6%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%												2.1059	0.032	0.6291	0	0.2101	0.2787	0.125	0.0687	0.9946	0.2082	0.613	0.0576	0.0025	0.1348	0.7831	2.5215	0.0001	0.2896	1.2099	0.1582	1.0806	0	0	0	0	0	0	0	0	0											11.503	0	0	26.2468	0.598063271	7.772369	0	2.598009925	3.478673027	1.553601789	0.852294533	12.37266077	2.672559078	7.595348706	0.708788629	0.029958685	1.672066876	9.742119953	31.68469545	0.355107336	3.60043406	15.11450607	1.970906789	13.04416416	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.6631
H5522_805_0	2010	4	N/A																															COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	302.0210566	4.499389128	50.53137299	0	12.6102945	13.87944233	6.79164985	3.814620025	53.12595269	9.107962533	35.33176637	3.723332934	0.229327214	7.712910691	41.78354981	131.4554613	0.006615546	15.58623452	58.90980468	8.318598232	46.52177817	0	0	0	0	0	0	0	0	0												FFS 8.7%	FFS 8.7%	FFS 17.4%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%											0.08731033	0.08731033	0.173570355	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.08731033	0.08731033	0.173570355	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												26.3696	0.392843152	8.770748335	0	2.938198618	3.233910062	1.582454415	0.888806466	12.37834698	2.12215527	8.232301565	0.867536574	0.053433241	1.797108191	9.735567105	30.62912247	0.001541422	3.631592643	13.72598449	1.938233388	10.83957431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.129	0	0	26.3696	0.392843152	8.770748335	0	2.938198618	3.233910062	1.582454415	0.888806466	12.37834698	2.12215527	8.232301565	0.867536574	0.053433241	1.797108191	9.735567105	30.62912247	0.001541422	3.631592643	13.72598449	1.938233388	10.83957431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.129	NO	FFS 8.7%	FFS 8.7%	FFS 17.4%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%												2.397	0.0357	0.7972	0	0.2671	0.294	0.1438	0.0808	1.1252	0.1929	0.7483	0.0789	0.0049	0.1634	0.885	2.7842	0.0001	0.3301	1.2477	0.1762	1.0316	0	0	0	0	0	0	0	0	0											12.784	0	0	28.7665	0.428552023	9.567996605	0	3.205280679	3.527872275	1.726299418	0.969598915	13.5035379	2.315059045	8.980617236	0.946395591	0.058290319	1.960465208	10.62052764	33.41330179	0.001681537	3.961703475	14.97367293	2.114418302	11.87119029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.913
H5525_004_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered			Radiology				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin			V		O	O	V	O	O	O	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			0	YES	1447.044934	65.961198	666.800037	592.240512	47.768125	10.236386	4.358052	402.55353	482.619228	1851.0112	198.466245	94.533951	34.100544	751.317643	4378.376948	5217.73644	110.876224	263.350796			26.268136	0		1.54			0.81		0.04	0.25	1156.225312	0.05	0.55	2.09	731.919749	0.32	0.4	0.49			4000	$175/Day(Days 1-10):1a	$175/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	$0/Visit:8a	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $30 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$30/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"			"HER833: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			139.192375	128.90955	50.7565	0	100	0.2	0.2	50	100	0	30	50	10.382864	42.978944	10	30	30	30			0.2	0		0			0		0	0	39.443039	0	0	0	30	0	0	0			NO	119.086872	110.289339	25.271408	0	83.6934	0.167387	0.167387	41.8467	83.6934	0	25.10802	41.8467	8.689772	35.970539	8.36934	25.10802	25.10802	25.10802			0.167387	0		0			0		0	0	33.01122	0	0	0	25.10802	0	0	0				14.3603	0.606234744	1.404247982	0	0.333156399	1.713437943	0.72948125	1.403794734	3.366003675	0	0.415257871	0.329661157	0.024693829	2.252108382	3.05367711	10.91725257	0.231990204	0.551018088	0	0	4.396944481	0	0	0	0	0	0	0	0	0	3.180700679	0	0	0	1.531421308	0	0	0	0	0	50.8014	0	10.651301	14.3603	0.606234744	1.404247982	0	0.333156399	1.713437943	0.72948125	1.403794734	3.366003675	0	0.415257871	0.329661157	0.024693829	2.252108382	3.05367711	10.91725257	0.231990204	0.551018088	0	0	4.396944481	0	0	0	0	0	0	0	0	0	3.180700679	0	0	0	1.531421308	0	0	0	0	0	50.8014	YES	$200/Day(Days 1-10)	$200/Day(Days 1-10)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		0.5			"HER833: Hearing 18a, 18b"		$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			6000	2.6958	0.1138	0.4518	1.7685	1.2412	1.5783	0.672	0.2307	3.1698	0.4242	0.0796	0.2542	0.0041	0.8007	1.7567	2.0934	0.0445	0.0906			1.0208	0		0			0		0	0	1.2408	0	0	0	0.2937	0	0	0			20.0249	0	6.457648	17.0561	0.720039744	1.856078982	1.768475	1.574330399	3.291750943	1.40143525	1.634522734	6.535773675	0.424169	0.494884871	0.583859157	0.028752829	3.052798382	4.81033811	13.01067457	0.276475204	0.641639088	0	0	5.417707481	0	0	0	0	0	0	0	0	0	4.421471679	0	0	0	1.825077308	0	0	0	0	0	70.8264
H5525_801_0	2010	3	N/A																															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	NO	307.7889823	1.049906884	29.53969071	17.771744	3.046773444	13.44186201	6.570495029	27.78619889	81.03490037	13.13041121	31.52336621	11.06604264	0.97216596	20.04718859	38.93488065	85.38800575	0.410413195	6.30528436	0	0	30.95174386	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																			0.084605285	0.084605285	0.184780039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.084605285	0.084605285	0.184780039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				26.0406	0.088827672	5.458345191	0	0.709898212	3.131953847	1.530925342	6.474184342	18.88113179	3.059385813	7.344944328	2.578387935	0.226514669	4.670994942	9.071827192	19.89540534	0.095626274	1.469131256	0	0	7.211756319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9398	0	0	26.0406	0.088827672	5.458345191	0	0.709898212	3.131953847	1.530925342	6.474184342	18.88113179	3.059385813	7.344944328	2.578387935	0.226514669	4.670994942	9.071827192	19.89540534	0.095626274	1.469131256	0	0	7.211756319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9398	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.4487	0.0015	0.2321	0	1.2033	0.658	0.3217	0.5284	1.4061	0.2497	0.5442	0.2105	0.0185	0.3784	0.5263	1.1542	0.0055	0.0973	0	0	0.0142	0																			7.9985	0	0	26.4893	0.090357642	5.690465744	0	1.913185601	3.789997006	1.852597779	7.002605766	20.2872415	3.309085956	7.889114946	2.788848443	0.245018321	5.04936316	9.59809719	21.04959468	0.101153123	1.566448561	0	0	7.225931606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9384
H5525_802_0	2010	3	N/A																															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	NO	307.7889823	1.049906884	29.53969071	17.771744	3.046773444	13.44186201	6.570495029	27.78619889	81.03490037	13.13041121	31.52336621	11.06604264	0.97216596	20.04718859	38.93488065	85.38800575	0.410413195	6.30528436	0	0	30.95174386	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																			0.084605285	0.084605285	0.184780039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.084605285	0.084605285	0.184780039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				26.0406	0.088827672	5.458345191	0	0.709898212	3.131953847	1.530925342	6.474184342	18.88113179	3.059385813	7.344944328	2.578387935	0.226514669	4.670994942	9.071827192	19.89540534	0.095626274	1.469131256	0	0	7.211756319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9398	0	0	26.0406	0.088827672	5.458345191	0	0.709898212	3.131953847	1.530925342	6.474184342	18.88113179	3.059385813	7.344944328	2.578387935	0.226514669	4.670994942	9.071827192	19.89540534	0.095626274	1.469131256	0	0	7.211756319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9398	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.4487	0.0015	0.2321	0	1.2033	0.658	0.3217	0.5284	1.4061	0.2497	0.5442	0.2105	0.0185	0.3784	0.5263	1.1542	0.0055	0.0973	0	0	0.0142	0																			7.9985	0	0	26.4893	0.090357642	5.690465744	0	1.913185601	3.789997006	1.852597779	7.002605766	20.2872415	3.309085956	7.889114946	2.788848443	0.245018321	5.04936316	9.59809719	21.04959468	0.101153123	1.566448561	0	0	7.225931606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9384
H5525_805_0	2010	3	N/A																															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	NO	307.7889823	1.049906884	29.53969071	17.771744	3.046773444	13.44186201	6.570495029	27.78619889	81.03490037	13.13041121	31.52336621	11.06604264	0.97216596	20.04718859	38.93488065	85.38800575	0.410413195	6.30528436	0	0	30.95174386	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																			0.084605285	0.084605285	0.184780039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.084605285	0.084605285	0.184780039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				26.0406	0.088827672	5.458345191	0	0.709898212	3.131953847	1.530925342	6.474184342	18.88113179	3.059385813	7.344944328	2.578387935	0.226514669	4.670994942	9.071827192	19.89540534	0.095626274	1.469131256	0	0	7.211756319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9398	0	0	26.0406	0.088827672	5.458345191	0	0.709898212	3.131953847	1.530925342	6.474184342	18.88113179	3.059385813	7.344944328	2.578387935	0.226514669	4.670994942	9.071827192	19.89540534	0.095626274	1.469131256	0	0	7.211756319	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9398	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.4487	0.0015	0.2321	0	1.2033	0.658	0.3217	0.5284	1.4061	0.2497	0.5442	0.2105	0.0185	0.3784	0.5263	1.1542	0.0055	0.0973	0	0	0.0142	0																			7.9985	0	0	26.4893	0.090357642	5.690465744	0	1.913185601	3.789997006	1.852597779	7.002605766	20.2872415	3.309085956	7.889114946	2.788848443	0.245018321	5.04936316	9.59809719	21.04959468	0.101153123	1.566448561	0	0	7.225931606	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.9384
H5526_001_0	2010	5	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	222.5980566	2.399842457	2.963552119		147.1712405	10.661097	0.197492068	247.2376499	368.5323349		790.339138	0.167032869		6.141538774	4246.573172	6129.250718	0.463049202	925.4899074	900.6109964	1871.177887	0.00701314	14.6984126									157.7197601											$350 Copay	$350 Copay	$350 Copay		$100 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	$150 Copay		$20 Copay	50% Coinsurance		50% Coinsurance	$15 Copay	$20 Copay	20% Coinsurance	$20 Copay	$20 Copay	$20 Copay	20% Coinsurance	"$0 Copay for Blood, $20 Copay for other"									$20 Copay										350	350	350		100	0.25	0.25	50	150		20	0.5		0.5	15	20	0.2	20	20	20	0.2	20									20										NO	317.742038	317.742038	317.742038		90.78343943	0.226958599	0.226958599	45.39171972	136.1751591		18.15668789	0.453917197		0.453917197	13.61751591	18.15668789	0.181566879	18.15668789	18.15668789	18.15668789	0.181566879	18.15668789									18.15668789											5.8941	0.063544236	0.078470424	0	1.113392616	2.419627634	0.044822523	0.935211842	4.182079113	0	1.195828421	0.075819092	0	2.787750066	4.818981479	9.273907688	0.084074398	1.400319283	1.362676064	2.831199406	0.001273354	0.022239541	0	0	0	0	0	0	0	0	0.238639038	0	0	0	0	0	0	0	0	0	38.8239	0	3.853922598	5.8941	0.063544236	0.078470424	0	1.113392616	2.419627634	0.044822523	0.935211842	4.182079113	0	1.195828421	0.075819092	0	2.787750066	4.818981479	9.273907688	0.084074398	1.400319283	1.362676064	2.831199406	0.001273354	0.022239541	0	0	0	0	0	0	0	0	0.238639038	0	0	0	0	0	0	0	0	0	38.8239	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$25 Copay	$100 Copay	50% Coinsurance	50% Coinsurance	$50 Copay	20% Coinsurance	$25 Copay	$25 Copay	55% Coinsurance	$25 Copay	55% Coinsurance	$25 Copay	$25 Copay	50% Coinsurance	$25 Copay	$25 Copay	$25 Copay	20% Coinsurance	$25 Copay									$25 Copay										3350	1.6947	0.0055	0.0634	0.0189	0.1315	0.1848	0.0047	0.0375	0.2811	0.548	0.1	0.0925	0.0083	0.5278	0.3033	0.8143	0.0207	0.0866	0.3786	0.9204	0.0324	0.002									0.1525										6.4095	0	0.538420722	7.5887	0.069007268	0.141882195	0.018876627	1.244864932	2.604389523	0.049569644	0.972723972	4.463219282	0.547973337	1.295826321	0.168338042	0.008284359	3.315588077	5.122316481	10.08819857	0.104796576	1.486904595	1.741307222	3.751575695	0.033661767	0.024201141	0	0	0	0	0	0	0	0	0.391150476	0	0	0	0	0	0	0	0	0	45.2334
H5526_002_0	2010	6	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	230.0646861	1.847976496	76.08559373		236.669082	14.51463461	0.763560618	289.6186581	379.7322708		702.0265528	0.07823925		4.104490842	4886.911328	5709.916285	0.549847362	950.0002278	926.0099563	1537.041041	0.007428028	32.64472232									223.7912331											$350 Copay	$350 Copay	$350 Copay		$75 Copay	30% Coinsurance	30% Coinsurance	$50 Copay	$125 Copay		$25 Copay	50% Coinsurance		50% Coinsurance	$15 Copay	$25 Copay	20% Coinsurance	$25 Copay	$25 Copay	$25 Copay	20% Coinsurance	"$0 Copay for Blood, $25 Copay for other"									$25 Copay										350	350	350		75	0.3	0.3	50	125		25	0.5		0.5	15	25	0.2	25	25	25	0.2	25									25										NO	305.3249242	305.3249242	305.3249242		65.42676947	0.261707078	0.261707078	43.61784631	109.0446158		21.80892316	0.436178463		0.436178463	13.08535389	21.80892316	0.174471385	21.80892316	21.80892316	21.80892316	0.174471385	21.80892316									21.80892316											5.8537	0.04701944	1.935902345	0	1.290374456	3.79858261	0.199829218	1.052711843	3.450646631	0	1.275870262	0.034126276	0	1.790290507	5.328913682	10.37726046	0.095932631	1.726540164	1.682939998	2.793434163	0.001295978	0.059328853	0	0	0	0	0	0	0	0	0.406720484	0	0	0	0	0	0	0	0	0	43.2014	0	5.831141247	5.8537	0.04701944	1.935902345	0	1.290374456	3.79858261	0.199829218	1.052711843	3.450646631	0	1.275870262	0.034126276	0	1.790290507	5.328913682	10.37726046	0.095932631	1.726540164	1.682939998	2.793434163	0.001295978	0.059328853	0	0	0	0	0	0	0	0	0.406720484	0	0	0	0	0	0	0	0	0	43.2014	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$30 Copay	$75 Copay	35% Coinsurance	35% Coinsurance	$50 Copay	20% Coinsurance	$30 Copay	$30 Copay	55% Coinsurance	$30 Copay	55% Coinsurance	$30 Copay	$30 Copay	50% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	$30 Copay									$30 Copay										3350	2.6891	0.007	0.4868	0.0221	0.2541	0.2513	0.0201	0.0664	0.3897	0.2984	0.1518	0.0671	0.0195	0.7444	0.6842	1.5498	0.0266	0.1221	0.7057	2.5861	0.0458	0.0064									0.233										11.4274	0	1.458163903	8.5428	0.054055313	2.422701251	0.022137651	1.544522746	4.049890293	0.219913052	1.119124798	3.840307921	0.29835153	1.427633198	0.101181082	0.019470465	2.534666274	6.013100472	11.9271071	0.122516914	1.848634376	2.388602189	5.37956474	0.047096467	0.065740572	0	0	0	0	0	0	0	0	0.639725934	0	0	0	0	0	0	0	0	0	54.6288
H5526_003_0	2010	9	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	213.5101336	0.426953057	3.117344911		175.0085467	10.19784937	0.377963286	254.1935091	373.0510822		827.2303259	0.127701264		5.582987093	4161.632691	6457.136205	0.570483119	1279.177701	881.5237004	2126.384483	0.005071908	25.31928329									194.7172737											$350 Copay	$350 Copay	$350 Copay		$50 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	$100 Copay		$20 Copay	50% Coinsurance		50% Coinsurance	$15 Copay	$20 Copay	20% Coinsurance	$20 Copay	$20 Copay	$20 Copay	20% Coinsurance	"$0 Copay for Blood, $20 Copay for other"									$20 Copay										350	350	350		50	0.25	0.25	50	100		20	0.5		0.5	15	20	0.2	20	20	20	0.2	20									20										NO	317.1393339	317.1393339	317.1393339		45.30561913	0.226528096	0.226528096	45.30561913	90.61123826		18.12224765	0.453056191		0.453056191	13.59168574	18.12224765	0.181222477	18.12224765	18.12224765	18.12224765	0.181222477	18.12224765									18.12224765											5.6427	0.011283634	0.082386057	0	0.660739213	2.310099398	0.085619303	0.959699526	2.816885041	0	1.249272736	0.057855848	0	2.529406868	4.713633642	9.75148512	0.103384364	1.931797924	1.331265901	3.21123885	0.000919144	0.03823686	0	0	0	0	0	0	0	0	0.294059555	0	0	0	0	0	0	0	0	0	37.782	0	3.827471731	5.6427	0.011283634	0.082386057	0	0.660739213	2.310099398	0.085619303	0.959699526	2.816885041	0	1.249272736	0.057855848	0	2.529406868	4.713633642	9.75148512	0.103384364	1.931797924	1.331265901	3.21123885	0.000919144	0.03823686	0	0	0	0	0	0	0	0	0.294059555	0	0	0	0	0	0	0	0	0	37.782	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$25 Copay	$50 Copay	50% Coinsurance	50% Coinsurance	$50 Copay	20% Coinsurance	$25 Copay	$25 Copay	55% Coinsurance	$25 Copay	55% Coinsurance	$25 Copay	$25 Copay	50% Coinsurance	$25 Copay	$25 Copay	$25 Copay	20% Coinsurance	$25 Copay									$25 Copay										3350	1.6947	0.0055	0.0634	0.0189	0.0657	0.1848	0.0047	0.0375	0.2811	0.548	0.1	0.0925	0.0083	0.5278	0.3033	0.8143	0.0207	0.0866	0.3786	0.9204	0.0324	0.002									0.1525										6.3437	0	0.564871589	7.3374	0.016746666	0.145797829	0.018876627	0.726475371	2.494861287	0.090366424	0.997211656	3.09802521	0.547973337	1.349270636	0.150374799	0.008284359	3.057244879	5.016968644	10.56577601	0.124106541	2.018383236	1.709897059	4.131615139	0.033307557	0.040198461	0	0	0	0	0	0	0	0	0.446570992	0	0	0	0	0	0	0	0	0	44.1257
H5526_004_0	2010	9	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	185.4928344	3.065997262	52.28294898		191.96534	10.59283265	0.908606933	235.5286722	402.362112		630.806439	0.060453742		5.608623094	4186.06445	5492.290063	1.07745473	1081.876255	988.5144318	1421.660212	0.00570547	16.53860424									211.4859119											$250 Copay	$250 Copay	$250 Copay		$75 Copay	30% Coinsurance	30% Coinsurance	$50 Copay	$125 Copay		$20 Copay	50% Coinsurance		50% Coinsurance	$10 Copay	$20 Copay	20% Coinsurance	$20 Copay	$20 Copay	$20 Copay	20% Coinsurance	"$0 Copay for Blood, $20 Copay for other"									$20 Copay										250	250	250		75	0.3	0.3	50	125		20	0.5		0.5	10	20	0.2	20	20	20	0.2	20									20										NO	213.2558762	213.2558762	213.2558762		63.97676286	0.255907051	0.255907051	42.65117524	106.6279381		17.0604701	0.426511752		0.426511752	8.530235048	17.0604701	0.170604701	17.0604701	17.0604701	17.0604701	0.170604701	17.0604701									17.0604701											3.2965	0.054486828	0.929137175	0	1.023443419	2.71078057	0.232518921	0.837131223	3.575253531	0	0.896821199	0.025784231	0	2.392143665	2.975676141	7.808420865	0.183818842	1.538109792	1.405376742	2.021182628	0.00097338	0.02351303	0	0	0	0	0	0	0	0	0.300670756	0	0	0	0	0	0	0	0	0	32.2317	0	5.225465938	3.2965	0.054486828	0.929137175	0	1.023443419	2.71078057	0.232518921	0.837131223	3.575253531	0	0.896821199	0.025784231	0	2.392143665	2.975676141	7.808420865	0.183818842	1.538109792	1.405376742	2.021182628	0.00097338	0.02351303	0	0	0	0	0	0	0	0	0.300670756	0	0	0	0	0	0	0	0	0	32.2317	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$25 Copay	$75 Copay	35% Coinsurance	35% Coinsurance	$50 Copay	20% Coinsurance	$25 Copay	$25 Copay	55% Coinsurance	$25 Copay	55% Coinsurance	$25 Copay	$25 Copay	50% Coinsurance	$25 Copay	$25 Copay	$25 Copay	20% Coinsurance	$25 Copay									$25 Copay										3350	2.0629	0.016	0.3113	0.0187	0.1746	0.1775	0.0261	0.057	0.3954	0.2934	0.1188	0.0473	0.0114	0.6394	0.4776	1.137	0.0414	0.1239	0.5445	2.0199	0.0129	0.0022									0.2022										8.9114	0	1.332258759	5.3593	0.070455764	1.240427608	0.018721918	1.197998775	2.888300466	0.258587929	0.894139646	3.970654797	0.293358896	1.015637597	0.073114365	0.011357719	3.031530459	3.45332319	8.94538953	0.225244343	1.661989054	1.94987937	4.041110465	0.013922378	0.025714894	0	0	0	0	0	0	0	0	0.502911434	0	0	0	0	0	0	0	0	0	41.1431
H5526_007_0	2010	8	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	201.3871912	0.470278461	3.396959304		157.7028396	11.23905669	0.291273816	257.2760354	417.2716595		852.047308	0.188257202		6.440845646	4349.35991	6944.960815	0.702800755	1368.338579	985.4711062	1838.681961	0.019519412	24.87473825									133.5040651											$250 Copay	$250 Copay	$250 Copay		$50 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	$75 Copay		$25 Copay	50% Coinsurance		50% Coinsurance	$15 Copay	$25 Copay	20% Coinsurance	$25 Copay	$25 Copay	$25 Copay	20% Coinsurance	"$0 Copay for Blood, $25 Copay for other"									$25 Copay										250	250	250		50	0.25	0.25	50	75		25	0.5		0.5	15	25	0.2	25	25	25	0.2	25									25										NO	228.4172336	228.4172336	228.4172336		45.68344671	0.228417234	0.228417234	45.68344671	68.52517007		22.84172336	0.456834467		0.456834467	13.70503401	22.84172336	0.182733787	22.84172336	22.84172336	22.84172336	0.182733787	22.84172336									22.84172336											3.8334	0.008951642	0.064660337	0	0.600367439	2.567194237	0.066531959	0.979438005	2.382800953	0	1.621852408	0.086002379	0	2.942400289	4.967343792	13.21957281	0.128425443	2.604600941	1.875821532	3.499888724	0.003566856	0.047348491	0	0	0	0	0	0	0	0	0.25412191	0	0	0	0	0	0	0	0	0	41.7542	0	3.838092092	3.8334	0.008951642	0.064660337	0	0.600367439	2.567194237	0.066531959	0.979438005	2.382800953	0	1.621852408	0.086002379	0	2.942400289	4.967343792	13.21957281	0.128425443	2.604600941	1.875821532	3.499888724	0.003566856	0.047348491	0	0	0	0	0	0	0	0	0.25412191	0	0	0	0	0	0	0	0	0	41.7542	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$30 Copay	$50 Copay	50% Coinsurance	50% Coinsurance	$50 Copay	20% Coinsurance	$30 Copay	$30 Copay	55% Coinsurance	$30 Copay	55% Coinsurance	$30 Copay	$30 Copay	50% Coinsurance	$30 Copay	$30 Copay	$30 Copay	20% Coinsurance	$30 Copay									$30 Copay										3350	1.6947	0.0055	0.0634	0.0227	0.0657	0.1848	0.0047	0.0375	0.2811	0.6576	0.12	0.0925	0.0099	0.5278	0.364	0.9771	0.0207	0.1039	0.4544	1.1045	0.0324	0.0024									0.183										7.0103	0	0.554251228	5.528	0.014414674	0.128072108	0.022651953	0.666103597	2.751956126	0.07127908	1.016950135	2.663941122	0.657568005	1.741849888	0.178521329	0.009941231	3.470238299	5.331345794	14.19672187	0.149147621	2.708503315	2.330178921	4.604340271	0.035955269	0.049702411	0	0	0	0	0	0	0	0	0.437135635	0	0	0	0	0	0	0	0	0	48.7646
H5526_008_0	2010	12	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	252.0977847	15.70774139	65.48501075		212.6520223	17.68576387	0.851322067	286.819547	462.1898655		652.0621509	0.094342237		2.348010497	4711.165927	7962.767607	1.655072902	1858.922372	1211.380751	2685.000845	0.004784085	81.11183246									97.22868037											$250 Copay	$250 Copay	$250 Copay		$75 Copay	20% Coinsurance	30% Coinsurance	$50 Copay	$125 Copay		$15 Copay	50% Coinsurance		50% Coinsurance	$5 Copay	$15 Copay	20% Coinsurance	$15 Copay	$15 Copay	$15 Copay	20% Coinsurance	"$0 Copay for Blood, $15 Copay for other"									$15 Copay										250	250	250		75	0.2	0.3	50	125		15	0.5		0.5	5	15	0.2	15	15	15	0.2	15									15										NO	241.7291	241.7291	241.7291		72.51872999	0.19338328	0.29007492	48.34582	120.86455		14.503746	0.4834582		0.4834582	4.834582	14.503746	0.19338328	14.503746	14.503746	14.503746	0.19338328	14.503746									14.503746											5.0783	0.316418182	1.319136059	0	1.285104549	3.420131026	0.24694718	1.155543849	4.655197509	0	0.788111984	0.045610528	0	1.135164928	1.898043165	9.624163236	0.320063426	2.24677816	1.464129893	3.245214189	0.000925162	0.098035451	0	0	0	0	0	0	0	0	0.117515007	0	0	0	0	0	0	0	0	0	38.4605	0	1.127988244	5.0783	0.316418182	1.319136059	0	1.285104549	3.420131026	0.24694718	1.155543849	4.655197509	0	0.788111984	0.045610528	0	1.135164928	1.898043165	9.624163236	0.320063426	2.24677816	1.464129893	3.245214189	0.000925162	0.098035451	0	0	0	0	0	0	0	0	0.117515007	0	0	0	0	0	0	0	0	0	38.4605	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$20 Copay	$75 Copay	35% Coinsurance	35% Coinsurance	$50 Copay	20% Coinsurance	$20 Copay	$20 Copay	55% Coinsurance	$20 Copay	55% Coinsurance	$20 Copay	$20 Copay	50% Coinsurance	$20 Copay	$20 Copay	$20 Copay	20% Coinsurance	$20 Copay									$20 Copay										3350	2.5543	0.0145	0.3758	0.019	0.206	0.3089	0.0165	0.0699	0.5224	0.4	0.1014	0.065	0.0278	0.9892	0.4478	1.1521	0.0631	0.1802	0.5025	1.9095	0.1062	0.0195									0.2377										10.2893	0	0.246985583	7.6326	0.330877458	1.694936008	0.019039549	1.491065331	3.729061803	0.263477138	1.225441292	5.177620853	0.399967747	0.889553328	0.11058289	0.027821755	2.124408372	2.345798464	10.7762184	0.383138356	2.427007649	1.966644753	5.154741208	0.10708063	0.11754227	0	0	0	0	0	0	0	0	0.355183465	0	0	0	0	0	0	0	0	0	48.7498
H5526_010_0	2010	10	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	226.8060951	6.854574846	65.72221334		214.2182556	13.67337132	0.845704452	268.5322849	426.5333192		671.8045403	0.076735733		4.105765551	4707.749193	6600.608159	1.099355194	1312.32239	1059.110906	1898.216695	0.0059416	42.57736861									184.2986059											$100 Copay	$100 Copay	$100 Copay		$50 Copay	30% Coinsurance	30% Coinsurance	$50 Copay	$35 Copay		$10 Copay	50% Coinsurance		50% Coinsurance	$5 Copay	$10 Copay	20% Coinsurance	$10 Copay	$10 Copay	$10 Copay	20% Coinsurance	"$0 Copay for Blood, $10 Copay for other"									$10 Copay										100	100	100		50	0.3	0.3	50	35		10	0.5		0.5	5	10	0.2	10	10	10	0.2	10									10										NO	84.13208879	84.13208879	84.13208879		42.0660444	0.252396266	0.252396266	42.0660444	29.44623108		8.413208879	0.420660444		0.420660444	4.20660444	8.413208879	0.168264178	8.413208879	8.413208879	8.413208879	0.168264178	8.413208879									8.413208879											1.5901	0.048057475	0.460778924	0	0.750942888	3.451107871	0.213452646	0.941340918	1.04664989	0	0.47100266	0.032279687	0	1.72713316	1.650303221	4.627691265	0.184982098	0.920070198	0.74254344	1.330841129	0.000999758	0.029851025	0	0	0	0	0	0	0	0	0.129211889	0	0	0	0	0	0	0	0	0	20.3494	0	2.766711291	1.5901	0.048057475	0.460778924	0	0.750942888	3.451107871	0.213452646	0.941340918	1.04664989	0	0.47100266	0.032279687	0	1.72713316	1.650303221	4.627691265	0.184982098	0.920070198	0.74254344	1.330841129	0.000999758	0.029851025	0	0	0	0	0	0	0	0	0.129211889	0	0	0	0	0	0	0	0	0	20.3494	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$25 Copay	$50 Copay	35% Coinsurance	35% Coinsurance	$50 Copay	20% Coinsurance	$25 Copay	$25 Copay	55% Coinsurance	$25 Copay	55% Coinsurance	$25 Copay	$25 Copay	50% Coinsurance	$25 Copay	$25 Copay	$25 Copay	20% Coinsurance	$25 Copay									$25 Copay										3350	3.3741	0.016	0.5322	0.0273	0.1878	0.3658	0.0256	0.0925	0.6414	0.5375	0.1875	0.0891	0.0303	1.0949	0.7691	1.8435	0.0567	0.2394	0.8585	3.1482	0.075	0.0117									0.3282										14.532	0	1.808456939	4.9643	0.064043983	0.992934022	0.027287759	0.93878279	3.81686305	0.239062582	1.03383206	1.688044402	0.537534662	0.658460676	0.121391623	0.03026958	2.82198588	2.419421369	6.471173027	0.24166169	1.15950076	1.601003204	4.479016174	0.075970356	0.041517482	0	0	0	0	0	0	0	0	0.457403616	0	0	0	0	0	0	0	0	0	34.8814
H5526_011_0	2010	10	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A		T	COIN	COIN	V	V		V	COIN		COIN	V	V	COIN	V	V	V	COIN	V									V																																																		0	NO	212.4864089	0	3.445187161		170.6066966	10.39673619	0.357414676	257.597323	418.8213123		875.1480439	0.154414497		5.961105462	4558.632456	7253.766911	0.672976687	1458.15459	966.4282532	2086.345452	0.013143401	28.15898922									174.3687149											$100 Copay	$100 Copay	$100 Copay		$50 Copay	30% Coinsurance	30% Coinsurance	$50 Copay	$35 Copay		$10 Copay	50% Coinsurance		50% Coinsurance	$5 Copay	$10 Copay	20% Coinsurance	$10 Copay	$10 Copay	$10 Copay	20% Coinsurance	"$0 Copay for Blood, $10 Copay for other"									$10 Copay										100	100	100		50	0.3	0.3	50	35		10	0.5		0.5	5	10	0.2	10	10	10	0.2	10									10										NO	84.41527088	84.41527088	84.41527088		42.20763544	0.253245813	0.253245813	42.20763544	29.54534481		8.441527088	0.422076354		0.422076354	4.220763544	8.441527088	0.168830542	8.441527088	8.441527088	8.441527088	0.168830542	8.441527088									8.441527088											1.4948	0	0.024235534	0	0.600075438	2.632929905	0.09051377	0.906047825	1.031185007	0	0.61563216	0.065174708	0	2.516041662	1.60340914	5.102739156	0.113619019	1.025754289	0.67984419	1.467661804	0.002219008	0.019808739	0	0	0	0	0	0	0	0	0.122661519	0	0	0	0	0	0	0	0	0	20.1143	0	3.922192421	1.4948	0	0.024235534	0	0.600075438	2.632929905	0.09051377	0.906047825	1.031185007	0	0.61563216	0.065174708	0	2.516041662	1.60340914	5.102739156	0.113619019	1.025754289	0.67984419	1.467661804	0.002219008	0.019808739	0	0	0	0	0	0	0	0	0.122661519	0	0	0	0	0	0	0	0	0	20.1143	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$15 Copay	$50 Copay	35% Coinsurance	35% Coinsurance	$50 Copay	20% Coinsurance	$15 Copay	$15 Copay	55% Coinsurance	$15 Copay	55% Coinsurance	$15 Copay	$15 Copay	50% Coinsurance	$15 Copay	$15 Copay	$15 Copay	20% Coinsurance	$15 Copay									$15 Copay										3350	1.0592	0	0.0323	0.0039	0.0414	0.0796	0.0027	0.0249	0.1661	0.2003	0.0369	0.0606	0.0017	0.3209	0.1113	0.3233	0.0126	0.0354	0.1465	0.378	0.0162	0.0009									0.0605										3.1153	0	0.543984069	2.554	0	0.056529949	0.003917489	0.641501378	2.712519325	0.09326365	0.930992518	1.197284637	0.200256496	0.652496733	0.125789213	0.001682511	2.83697893	1.714718554	5.426027536	0.126234473	1.061108966	0.826346411	1.845668189	0.018408499	0.020689878	0	0	0	0	0	0	0	0	0.183181697	0	0	0	0	0	0	0	0	0	23.2296
H5526_806_0	2010	8	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A	V	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									COIN										0.135	0.0012	0.0348	0.0003	0.0173	0.0351	0.0009	0.0143	0.0601	0.0023	0.0282	0.01	0	0.0944	0.1056	0.2813	0.0364	0.0742	0.048	0.0659	0	0.0004									0.0308										1.0764	NO	180.9688002	1.640875843	46.59344173	9.456370126	139.122512	7.84060585	0.193724507	230.2960322	20.06828223	0	647.1485544	1.343511299	0	12.44891256	4165.368861	6162.914165	4.827228985	1683.401964	1098.703023	1497.824382	-0.003149085	8.836175623									4.10933626											$600 Copay	$600 Copay	$600 Copay	$20 Copay	$100 Copay	30% Coinsurance	30% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$35 Copay	50% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$35 Copay	50% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									50% Coinsurance										600	600	600	20	100	0.3	0.3	50	0.2	0	35	0.5	0	0.5	20	35	0.5	35	35	35	0.2	35									0.5										NO	580.2628348	580.2628348	580.2628348	19.34209449	96.71047246	0.290131417	0.290131417	48.35523623	0.193420945	0	33.84866536	0.483552362	0	0.483552362	19.34209449	33.84866536	0.483552362	33.84866536	33.84866536	33.84866536	0.193420945	33.84866536									0.483552362											8.7508	0.079344939	2.253036882	0.015242167	1.121216989	2.274806088	0.056205566	0.928001586	3.881626111	0	1.825426238	0.649658062	0	6.019701077	6.713913176	17.38386827	2.334217979	4.748409145	3.099135914	4.224946355	-0.000609099	0.024924396	0	0	0	0	0	0	0	0	1.987079256	0	0	0	0	0	0	0	0	0	68.3709	250	2.148634477	8.8858	0.080569253	2.287803243	0.01549237	1.138545073	2.309906906	0.057072831	0.942320879	3.941709363	0.002292845	1.853658924	0.659683639	0	6.114104765	6.819506524	17.6651397	2.370576793	4.822605904	3.147113333	4.290858168	-0.000618486	0.025309024	0	0	0	0	0	0	0	0	2.017900213	0	0	0	0	0	0	0	0	0	69.4474	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$30 Copay	$100 Copay	50% Coinsurance	50% Coinsurance	$50 Copay	25% Coinsurance	$45 Copay	$45 Copay	55% Coinsurance	$30 Copay	55% Coinsurance	$30 Copay	$45 Copay	55% Coinsurance	$45 Copay	$45 Copay	$45 Copay	30% Coinsurance	$45 Copay									$45 Copay										3350	1.6621	0.0072	0.2	0.0154	0.1462	0.2489	0.0078	0.0415	0.3982	0.7022	0.1849	0.0586	0.0118	0.489	0.4262	1.5062	0.024	0.2211	0.7322	2.2944	0.0484	0.0038									0.4275										9.8576	250	0.304985167	10.5479	0.087733588	2.487769323	0.03093662	1.284794385	2.558831628	0.064873373	0.983822533	4.339901978	0.704469126	2.038567281	0.718308518	0.011763694	6.603085861	7.245746704	19.17129554	2.394550883	5.043722693	3.879291245	6.585238782	0.047806905	0.029121446	0	0	0	0	0	0	0	0	2.445440809	0	0	0	0	0	0	0	0	0	79.305
H5526_808_0	2010	7	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A	V	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									COIN										0.1519	0.0021	0.0146	0	0.0089	0.0377	0.0015	0.0146	0.0649	0.0026	0.0342	0.0085	0	0.0773	0.0993	0.2374	0.0231	0.0596	0.0377	0.0645	-0.0002	0.001									0.0224										0.9635	NO	216.5915377	2.940690699	20.88881294	0.321347553	76.2944813	8.97239385	0.351223464	249.2494692	23.05922586	0	831.9739075	1.206206249	0	10.87741931	4112.062419	5551.554515	3.272594639	1442.306854	918.1335513	1558.26214	-0.087661558	23.81812847									3.183192791											$600 Copay	$600 Copay	$600 Copay	$20 Copay	$100 Copay	30% Coinsurance	30% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$35 Copay	50% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$35 Copay	50% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									50% Coinsurance										600	600	600	20	100	0.3	0.3	50	0.2	0	35	0.5	0	0.5	20	35	0.5	35	35	35	0.2	35									0.5										NO	581.2376186	581.2376186	581.2376186	19.37458729	96.87293644	0.290618809	0.290618809	48.43646822	0.193745873	0	33.90552775	0.484364682	0	0.484364682	19.37458729	33.90552775	0.484364682	33.90552775	33.90552775	33.90552775	0.193745873	33.90552775									0.484364682											10.4909	0.142436672	1.011780324	0.000518831	0.61590587	2.607546417	0.102072145	1.006063666	4.467629841	0	2.350709534	0.584243706	0	5.268637749	6.639126022	15.68569881	1.585129262	4.075181255	2.594150217	4.402808352	-0.016984065	0.067297185	0	0	0	0	0	0	0	0	1.541826164	0	0	0	0	0	0	0	0	0	65.2227	250	1.950261322	10.6428	0.144498104	1.026423655	0.000526819	0.624827113	2.645284358	0.103549393	1.02062401	4.53252491	0.002649798	2.384899673	0.592700192	0	5.345940354	6.738437517	15.92305765	1.608207291	4.13481268	2.631889303	4.467291983	-0.017229856	0.068271333	0	0	0	0	0	0	0	0	1.564232414	0	0	0	0	0	0	0	0	0	66.1862	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$30 Copay	$100 Copay	50% Coinsurance	50% Coinsurance	$50 Copay	25% Coinsurance	$45 Copay	$45 Copay	55% Coinsurance	$30 Copay	55% Coinsurance	$30 Copay	$45 Copay	55% Coinsurance	$45 Copay	$45 Copay	$45 Copay	30% Coinsurance	$45 Copay									$45 Copay										3350	1.5611	0.0083	0.1352	0.0164	0.126	0.2422	0.0084	0.039	0.3775	0.7132	0.1863	0.057	0.0107	0.4681	0.3923	1.3824	0.0235	0.206	0.6716	2.0049	0.0449	0.0048									0.4196										9.0993	250	0.268123129	12.2039	0.152769277	1.161592871	0.016965614	0.750819746	2.887511985	0.111932816	1.059608432	4.910038915	0.715855655	2.571188589	0.649728741	0.010741406	5.814018799	7.130720994	17.30549608	1.631697116	4.340784633	3.303504847	6.472162298	0.027636359	0.073023946	0	0	0	0	0	0	0	0	1.983826814	0	0	0	0	0	0	0	0	0	75.2855
H5526_810_0	2010	7	N/A	h.6.										OP Facility - Other										Cardiac Rehab and CORF										A	A	A	V	T	COIN	COIN	V	COIN	COIN	V	COIN	COIN	COIN	V	V	COIN	V	V	V	COIN	V									COIN										0.1584	0.0013	0.0518	0.0001	0.0109	0.0384	0.0013	0.0204	0.0828	0.0027	0.0434	0.0108	0	0.106	0.1153	0.3135	0.0267	0.1119	0.0524	0.0874	0.001	0.0008									0.0228										1.26	NO	218.6629043	1.843410883	71.44595068	2.650140191	90.44903962	8.844616709	0.296402999	338.7197741	28.46007806	0	1022.257903	1.487052679	0	14.36754369	4637.351311	7010.602298	3.654016042	2579.387492	1232.965882	2034.519451	0.333838233	18.10499925									3.140505584											$600 Copay	$600 Copay	$600 Copay	$20 Copay	$100 Copay	30% Coinsurance	30% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	$35 Copay	50% Coinsurance	0% Coinsurance	50% Coinsurance	$20 Copay	$35 Copay	50% Coinsurance	$35 Copay	$35 Copay	$35 Copay	20% Coinsurance	"$0 Copay for Blood, $35 Copay for other"									50% Coinsurance										600	600	600	20	100	0.3	0.3	50	0.2	0	35	0.5	0	0.5	20	35	0.5	35	35	35	0.2	35									0.5										NO	583.5371572	583.5371572	583.5371572	19.45123857	97.25619286	0.291768579	0.291768579	48.62809643	0.194512386	0	34.0396675	0.486280964	0	0.486280964	19.45123857	34.0396675	0.486280964	34.0396675	34.0396675	34.0396675	0.194512386	34.0396675									0.486280964											10.6332	0.089641562	3.474280579	0.004295709	0.73306077	2.580581245	0.086481082	1.372608153	5.535837681	0	2.899776594	0.723125411	0	6.986662998	7.516852224	19.8865476	1.776878444	7.316791048	3.497479056	5.771197136	0.064935671	0.051357346	0	0	0	0	0	0	0	0	1.527168084	0	0	0	0	0	0	0	0	0	82.5287	250	2.189108213	10.7916	0.090976944	3.526043262	0.004363786	0.743993246	2.619023824	0.087769379	1.393055716	5.61868361	0.002673548	2.943183865	0.733899391	0	7.092706141	7.632127543	20.2000052	1.803534034	7.42866328	3.549840457	5.858583267	0.065903486	0.052122532	0	0	0	0	0	0	0	0	1.550013315	0	0	0	0	0	0	0	0	0	83.7888	YES	20% Coinsurance	20% Coinsurance	20% Coinsurance	$30 Copay	$100 Copay	50% Coinsurance	50% Coinsurance	$50 Copay	25% Coinsurance	$45 Copay	$45 Copay	55% Coinsurance	$30 Copay	55% Coinsurance	$30 Copay	$45 Copay	55% Coinsurance	$45 Copay	$45 Copay	$45 Copay	30% Coinsurance	$45 Copay									$45 Copay											1.7199	0.0074	0.2069	0.0156	0.1497	0.254	0.008	0.042	0.4165	0.7105	0.1871	0.0613	0.0119	0.5115	0.4313	1.5416	0.0245	0.2263	0.7494	2.3484	0.0494	0.0038									0.4473										10.1243	250	0.264511431	12.5115	0.098390264	3.732958829	0.019990046	0.893684146	2.873060828	0.095730124	1.435046464	6.03523341	0.713124939	3.130271358	0.795226952	0.011902328	7.604229887	8.063390941	21.74160439	1.828000492	7.654983462	4.299248222	8.206956002	0.115323412	0.055934955	0	0	0	0	0	0	0	0	1.997264075	0	0	0	0	0	0	0	0	0	93.913
H5528_001_0	2010	3	N/A	i.6.	i.6.	i.6.	i.6.	i.6.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	381.1361399	2.247190455	2131.729335	597.0520413	0.184474029	2.4	0	253.8268456	278.5178699	423.7134759	642.0888185	0	0	200.8662855	5254.89608	9262.04719	527.8845483	620.196431	24.18608592	816.3796702	17.73488652	0	0	0	414	105	0	0	0	135.2158446	444.7123642	277.1472917	56.2538321	301.438064	149.6446766							1A IP Acute: $50 days 1-7	1B IP Psych: $50 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $75 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - $75; 9A Outpatient Hospital - $75	8A Outpatient C/D/T - $20	8B Outpatient X-Rays - $20; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $30; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $30; 12 Renal Dialysis - $0	7A Primary Care - $5; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $20	7E Mental Health - $30; 7H Psychiatric Services - $30	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - $20	7G Other Health Care - $20	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		"14C Routine Physical Exams - $0, 13C Over the Counter Meds - $175 benefit per year"	7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50 copayment	17A Eye Exams (Medicare Covered) - $20						215.4724314	212.5	27.68892182	0	75	0.2	0.2	50	75	20	20			20	5	20	30	20	20	20	0.2				20	40				0	20	20	20	50	20						NO	215.4724314	212.5	27.68892182	0	75	0.2	0.2	50	75	20	20			20	5	20	30	20	20	20	0.2				20	40				0	20	20	20	50	20							6.8437	0.039793998	4.918773907	0	0.001152963	0.48	0	1.057611857	1.740736687	0.706189127	1.070148031	0	0	0.334777142	2.189540033	15.43674532	1.319711371	1.033660718	0.040310143	1.360632784	3.546977303	0	0	0	0.69	0.35	0	0	0	0	0.741187274	0.461912153	0.093756387	1.255991933	0.249407794	0	0	0	0	0	45.9627			6.8437	0.039793998	4.918773907	0	0.001152963	0.48	0	1.057611857	1.740736687	0.706189127	1.070148031	0	0	0.334777142	2.189540033	15.43674532	1.319711371	1.033660718	0.040310143	1.360632784	3.546977303	0	0	0	0.69	0.35	0	0	0	0	0.741187274	0.461912153	0.093756387	1.255991933	0.249407794	0	0	0	0	0	45.9627	NO	1A IP Acute: 25%; $2500 OOP Max	1B IP Psych: 25%; $2500 OOP Max	2 SNF: 25%	6 Home Health - $0 per day	10A Ambulance - $75	11A DME - 50%	11B Pros./Med Supp. - 50%; 11C Diabetes Mon Supplies - 50%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - $200; 9A Outpatient Hospital - $200	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%			3 CORF - 50%; 5 Partial Hosp - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 50%; 12 Renal Dialysis - 25%	7A Primary Care - 25%; 14B Immunizations - 25%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%	7D Physician Specialist - 25%	7E Mental Health - 50%; 7H Psychiatric Services - 50%	7C Occupational Therapy - 50%; 7I PT and ST Services - 50%	7D Physician Specialist - 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%				14C Routine Physical Exams - 25%	7B Chiropractic Services - $40	7F Podiatry Services - $40	18A Hearing Exams (Medicare Covered) - $40		17A Eye Exams (Medicare Covered) - 50%							0.29	0	0.39	0	6.38	0.84	0	0	0.28	0	0.02	0	0	0	0.9213	2.0287	3.6	0.17	0.74	2.36	0.31	0	0	0	0	0	0	0	0	0.05	0.03	0.08	0.01	0	0.27						18.77		0.096877495	7.1337	0.039793998	5.308773907	0	6.381152963	1.32	0	1.057611857	2.020736687	0.706189127	1.090148031	0	0	0.334777142	3.110883551	17.4654018	4.919711371	1.203660718	0.780310143	3.720632784	3.856977303	0	0	0	0.69	0.35	0	0	0	0.05	0.771187274	0.541912153	0.103756387	1.255991933	0.519407794	0	0	0	0	0	64.7327
H5528_002_0	2010	4	N/A	i.7.	i.8.	i.9.	i.10.	i.11.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	331.5	1.4	1703.5	481	0.4	2.1	0	217.5	256.9	418.9	524.5	0	0	187.4	4859.817615	8455.142385	564.6	565.2	21.05538889	728.965	23.4	0	0	0	326.4	102	0	0	0	161.9	247.1	250.56	54.54	262.4192969	137.54							1A IP Acute: $125 days 1-7	1B IP Psych: $125 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $150 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $25/$25/$25	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $25; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $25; 12 Renal Dialysis - $0	7A Primary Care - $10; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $25	7E Mental Health - $25; 7H Psychiatric Services - $25	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - $25	7G Other Health Care - $25	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $25	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		14C Routine Physical Exams - $0	7B Chiropractic Services - $25	7F Podiatry Services - $25	18A Hearing Exams (Medicare Covered) - $25	7D High Tech Radiology: $50 copayment	17A Eye Exams (Medicare Covered) - $25						538.6810785	531.25	27.68892182	0	150	0.2	0.2	50	100	25	25			20	10	25	25	20	25	25	0.2				25	40					25	25	25	50	25						NO	538.6810785	531.25	27.68892182	0	150	0.2	0.2	50	100	25	25			20	10	25	25	20	25	25	0.2				25	40					25	25	25	50	25							14.8811	0.061979167	3.930673193	0	0.005	0.42	0	0.90625	2.140833333	0.872708333	1.092708333	0	0	0.312333333	4.049848012	17.61487997	1.17625	0.942	0.043865394	1.518677083	4.68	0	0	0	0.68	0.34	0	0	0	0	0.514791667	0.522	0.113625	1.093413737	0.286541667	0	0	0	0	0	58.1994	0	0	14.8811	0.061979167	3.930673193	0	0.005	0.42	0	0.90625	2.140833333	0.872708333	1.092708333	0	0	0.312333333	4.049848012	17.61487997	1.17625	0.942	0.043865394	1.518677083	4.68	0	0	0	0.68	0.34	0	0	0	0	0.514791667	0.522	0.113625	1.093413737	0.286541667	0	0	0	0	0	58.1994	NO	1A IP Acute: 25%; $2500 OOP Max	1B IP Psych: 25%; $2500 OOP Max	2 SNF: 25%	6 Home Health - $0 per day	10A Ambulance - $150	11A DME - 50%	11B Pros./Med Supp. - 50%; 11C Diabetes Mon Supplies - 50%	4A Emergency Care - $50; 4B Urgent Care - $25/$25/$25	9B ASC Services - $200; 9A Outpatient Hospital - $200	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%			3 CORF - 50%; 5 Partial Hosp - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 50%; 12 Renal Dialysis - 25%	7A Primary Care - 25%; 14B Immunizations - 25%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%	7D Physician Specialist - 25%	7E Mental Health - 50%; 7H Psychiatric Services - 50%	7C Occupational Therapy - 50%; 7I PT and ST Services - 50%	7D Physician Specialist - 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%				14C Routine Physical Exams - 25%	7B Chiropractic Services - $40	7F Podiatry Services - $40	18A Hearing Exams (Medicare Covered) - $40		17A Eye Exams (Medicare Covered) - 50%							0.4207	0	0.64	0	8.976	0.28	0	0	0.28	0	0.04	0	0	0.01	0.7366	1.8934	3.38	0.21	0.75	2.61	0.27	0	0	0	0	0	0	0	0	0.02	0.03	0.07	0.01	0	0.35						20.9767	0	0.096877495	15.3018	0.061979167	4.570673193	0	8.981	0.7	0	0.90625	2.420833333	0.872708333	1.132708333	0	0	0.322333333	4.786427454	19.50830053	4.55625	1.152	0.793865394	4.128677083	4.95	0	0	0	0.68	0.34	0	0	0	0.02	0.544791667	0.592	0.123625	1.093413737	0.636541667	0	0	0	0	0	79.1762
H5528_003_0	2010	4	N/A	i.7.	i.8.	i.9.	i.10.	i.11.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	337.5	0.65	1836.7	499.6	0.15	2.95	0	216.55	278.05	358.2	608.2	0	0	179.4	5212.962879	8808.932121	742.3	702.225	21.43623014	783.155	24.47	0	0	0	408	101.7	0	0	0	140.05	319	295.19	61.75	267.1658296	148.5							1A IP Acute: $50 days 1-7	1B IP Psych: $50 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $100 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $20; 12 Renal Dialysis - $0	7A Primary Care - $10; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $20	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - $20	7G Other Health Care - $20	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		14C Routine Physical Exams - $0	7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50 copayment	17A Eye Exams (Medicare Covered) - $30						215.4724314	212.5	27.68892182	0	100	0.2	0.2	50	50	10	10			20	10	20	20	20	20	20	0.2				20	40					20	20	20	50	20						NO	215.4724314	212.5	27.68892182	0	100	0.2	0.2	50	50	10	10			20	10	20	20	20	20	20	0.2				20	40					20	20	20	50	20							6.0602	0.011510417	4.238020225	0	0.00125	0.59	0	0.902291667	1.158541667	0.2985	0.506833333	0	0	0.299	4.344135732	14.68155354	1.237166667	1.170375	0.03572705	1.305258333	4.894	0	0	0	0.68	0.339	0	0	0	0	0.531666667	0.491983333	0.102916667	1.113190957	0.2475	0	0	0	0	0	45.2406	0	0	6.0602	0.011510417	4.238020225	0	0.00125	0.59	0	0.902291667	1.158541667	0.2985	0.506833333	0	0	0.299	4.344135732	14.68155354	1.237166667	1.170375	0.03572705	1.305258333	4.894	0	0	0	0.68	0.339	0	0	0	0	0.531666667	0.491983333	0.102916667	1.113190957	0.2475	0	0	0	0	0	45.2406	NO	1A IP Acute: 25%; $2500 OOP Max	1B IP Psych: 25%; $2500 OOP Max	2 SNF: 25%	6 Home Health - $0 per day	10A Ambulance - $100	11A DME - 50%	11B Pros./Med Supp. - 50%; 11C Diabetes Mon Supplies - 50%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%			3 CORF - 50%; 5 Partial Hosp - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 50%; 12 Renal Dialysis - 25%	7A Primary Care - 25%; 14B Immunizations - 25%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%	7D Physician Specialist - 25%	7E Mental Health - 50%; 7H Psychiatric Services - 50%	7C Occupational Therapy - 50%; 7I PT and ST Services - 50%	7D Physician Specialist - 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%				14C Routine Physical Exams - 25%	7B Chiropractic Services - $40	7F Podiatry Services - $40	18A Hearing Exams (Medicare Covered) - $40		17A Eye Exams (Medicare Covered) - 50%							0.21	0	0.59	0	7.57	0.57	0	0	1.09	0	0.02	0	0	0	0.8439	2.0061	3.71	0.2	0.59	2.82	0.39	0	0	0	0	0	0	0	0	0.03	0.09	0.1	0.01	0	0.32						21.16	0	0.096877495	6.2702	0.011510417	4.828020225	0	7.57125	1.16	0	0.902291667	2.248541667	0.2985	0.526833333	0	0	0.299	5.188064207	16.68762506	4.947166667	1.370375	0.62572705	4.125258333	5.284	0	0	0	0.68	0.339	0	0	0	0.03	0.621666667	0.591983333	0.112916667	1.113190957	0.5675	0	0	0	0	0	66.4006
H5528_004_0	2010	2	N/A	i.6.	i.6.	i.6.	i.6.	i.6.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	333.4596994	0	1158.72052	472.5153538	1.130363181	3.2	0	278.4607264	339.2879336	395.2913588	440.652154	0	0	93.3387226	5153.560404	8374.064699	923.9385034	668.508087	21.97448363	1405.617573	17.59346712	0	0	0	372	105	0	0	0	226.0446838	453.7080839	0	54.43901315	273.8742359	118.6957508							1A IP Acute: $150 days 1-7	1B IP Psych: $150 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $75 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $20	8B Outpatient X-Rays - $20; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $30; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $30; 12 Renal Dialysis - $0	7A Primary Care - $5; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $20	7E Mental Health - $30; 7H Psychiatric Services - $30	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - $20	7G Other Health Care - $20	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		14C Routine Physical Exams - $0	7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50 copayment	17A Eye Exams (Medicare Covered) - $20						646.4172941	637.5	27.68892182	0	75	0.2	0.2	50	100	20	20			20	5	20	30	20	20	20	0.2				20	40					20	20	20	50	20						NO	646.4172941	637.5	27.68892182	0	75	0.2	0.2	50	100	20	20			20	5	20	30	20	20	20	0.2				20	40					20	20	20	50	20							17.9628	0	2.67364349	0	0.00706477	0.64	0	1.160253027	2.827399447	0.658818931	0.734420257	0	0	0.155564538	2.147316835	13.9567745	2.309846259	1.114180145	0.036624139	2.342695954	3.518693425	0	0	0	0.62	0.35	0	0	0	0	0.75618014	0	0.090731689	1.14114265	0.197826251	0	0	0	0	0	55.402			17.9628	0	2.67364349	0	0.00706477	0.64	0	1.160253027	2.827399447	0.658818931	0.734420257	0	0	0.155564538	2.147316835	13.9567745	2.309846259	1.114180145	0.036624139	2.342695954	3.518693425	0	0	0	0.62	0.35	0	0	0	0	0.75618014	0	0.090731689	1.14114265	0.197826251	0	0	0	0	0	55.402	NO	1A IP Acute: 25%; $2500 OOP Max	1B IP Psych: 25%; $2500 OOP Max	2 SNF: 25%	6 Home Health - $0 per day	10A Ambulance - $75	11A DME - 50%	11B Pros./Med Supp. - 50%; 11C Diabetes Mon Supplies - 50%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - $200; 9A Outpatient Hospital - $200	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%			3 CORF - 50%; 5 Partial Hosp - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 50%; 12 Renal Dialysis - 25%	7A Primary Care - 25%; 14B Immunizations - 25%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%	7D Physician Specialist - 25%	7E Mental Health - 50%; 7H Psychiatric Services - 50%	7C Occupational Therapy - 25%; 7I PT and ST Services - 25%	7D Physician Specialist - 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%				14C Routine Physical Exams - 25%	7B Chiropractic Services - $40	7F Podiatry Services - $40	18A Hearing Exams (Medicare Covered) - $40		17A Eye Exams (Medicare Covered) - 50%							0.494	0	0.57	0	6.875	0.58	0	0	0.41	0	0.01	0	0	0.01	0.68	3.95	2.7	0.32	0.49	2.13	0.22	0	0	0	0	0	0	0	0	0.02	0.08	0	0.01	0	0.24						19.789		0.096877495	18.4569	0	3.24364349	0	6.88206477	1.22	0	1.160253027	3.237399447	0.658818931	0.744420257	0	0	0.165564538	2.827297249	17.90679408	5.009846259	1.434180145	0.526624139	4.472695954	3.738693425	0	0	0	0.62	0.35	0	0	0	0.02	0.83618014	0	0.100731689	1.14114265	0.437826251	0	0	0	0	0	75.191
H5528_005_0	2010	5	N/A	i.7.	i.8.	i.9.	i.10.	i.11.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	303.7	0	1413.7	434	2.14	2.65	0	264.98	329.64	420.08	461	0	0	107.24	4963.845291	7815.422709	1040.86	614.63	21.25591126	1360.543	23.73	0	0	0	321.6	102	0	0	0	272.4	462.68	0	48.836	264.9184642	108.836							1A IP Acute: $75 days 1-7	1B IP Psych: $75 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $150 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $25/$25/$25	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $25; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $25; 12 Renal Dialysis - $0	7A Primary Care - $10; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $25	7E Mental Health - $25; 7H Psychiatric Services - $25	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - $25	7G Other Health Care - $25	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $25	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		14C Routine Physical Exams - $0	7B Chiropractic Services - $25	7F Podiatry Services - $25	18A Hearing Exams (Medicare Covered) - $25	7D High Tech Radiology: $50 copayment	17A Eye Exams (Medicare Covered) - $25						323.2086471	318.75	27.68892182	0	90	0.2	0.2	50	100	25	25			20	10	25	25	20	25	25	0.2				25	40					25	25	25	50	25						NO	323.2086471	318.75	27.68892182	0	90	0.2	0.2	50	100	25	25			20	10	25	25	20	25	25	0.2				25	40					25	25	25	50	25							8.1799	0	3.261985731	0	0.01605	0.53	0	1.104083333	2.747	0.875166667	0.960416667	0	0	0.178733333	4.136537743	16.28213064	2.168458333	1.024383333	0.044283148	2.834464583	4.746	0	0	0	0.67	0.34	0	0	0	0	0.963916667	0	0.101741667	1.103826934	0.226741667	0	0	0	0	0	52.4958	0	0	8.1799	0	3.261985731	0	0.01605	0.53	0	1.104083333	2.747	0.875166667	0.960416667	0	0	0.178733333	4.136537743	16.28213064	2.168458333	1.024383333	0.044283148	2.834464583	4.746	0	0	0	0.67	0.34	0	0	0	0	0.963916667	0	0.101741667	1.103826934	0.226741667	0	0	0	0	0	52.4958	NO	1A IP Acute: 25%; $2500 OOP Max	1B IP Psych: 25%; $2500 OOP Max	2 SNF: 25%	6 Home Health - $0 per day	10A Ambulance - $150	11A DME - 50%	11B Pros./Med Supp. - 50%; 11C Diabetes Mon Supplies - 50%	4A Emergency Care - $50; 4B Urgent Care - $25/$25/$25	9B ASC Services - $200; 9A Outpatient Hospital - $200	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%			3 CORF - 50%; 5 Partial Hosp - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 50%; 12 Renal Dialysis - 25%	7A Primary Care - 25%; 14B Immunizations - 25%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%	7D Physician Specialist - 25%	7E Mental Health - 50%; 7H Psychiatric Services - 50%	7C Occupational Therapy - 50%; 7I PT and ST Services - 50%	7D Physician Specialist - 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%				14C Routine Physical Exams - 25%	7B Chiropractic Services - $40	7F Podiatry Services - $40	18A Hearing Exams (Medicare Covered) - $40		17A Eye Exams (Medicare Covered) - 50%							0.39	0	0.87	0	6.325	0.445	0	0	0.35	0	0.01	0	0	0.01	0.7211	3.7789	1.99	0.32	0.5	2.29	0.13	0	0	0	0	0	0	0	0	0.02	0.08	0	0.01	0	0.24						18.48	0	0.096877495	8.5699	0	4.131985731	0	6.34105	0.975	0	1.104083333	3.097	0.875166667	0.970416667	0	0	0.188733333	4.857634175	20.06103421	4.158458333	1.344383333	0.544283148	5.124464583	4.876	0	0	0	0.67	0.34	0	0	0	0.02	1.043916667	0	0.111741667	1.103826934	0.466741667	0	0	0	0	0	70.9758
H5528_008_0	2010	5	N/A	i.7.	i.8.	i.9.	i.10.	i.11.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	310.53	0	1698.45	413.45	0.85	3.2	0	240.75	392.15	402.9	441.05	0	0	122.75	5116.338137	7853.441863	1040.3	697.05	21.26552683	1387.595	36.59	0	0	0	360	102	0	0	0	273.1	469.7	0	53.12	265.0383057	109.53							1A IP Acute: $75 days 1-7	1B IP Psych: $100 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $100 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $30; 12 Renal Dialysis - $0	7A Primary Care - $10; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $20	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - $20	7G Other Health Care - $20	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		14C Routine Physical Exams - $0	7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50 copayment	17A Eye Exams (Medicare Covered) - $20						323.2086471	425	27.68892182	0	100	0.2	0.2	50	50	10	10			20	10	20	20	20	20	20	0.2				20	40					20	20	20	50	20						NO	323.2086471	425	27.68892182	0	100	0.2	0.2	50	50	10	10			20	10	20	20	20	20	20	0.2				20	40					20	20	20	50	20							8.3638	0	3.919020772	0	0.007083333	0.64	0	1.003125	1.633958333	0.33575	0.367541667	0	0	0.204583333	4.263615114	13.08906977	1.733833333	1.16175	0.035442545	2.312658333	7.318	0	0	0	0.6	0.34	0	0	0	0	0.782833333	0	0.088533333	1.104326274	0.18255	0	0	0	0	0	49.4875	0	0	8.3638	0	3.919020772	0	0.007083333	0.64	0	1.003125	1.633958333	0.33575	0.367541667	0	0	0.204583333	4.263615114	13.08906977	1.733833333	1.16175	0.035442545	2.312658333	7.318	0	0	0	0.6	0.34	0	0	0	0	0.782833333	0	0.088533333	1.104326274	0.18255	0	0	0	0	0	49.4875	NO	1A IP Acute: 25%; $2500 OOP Max	1B IP Psych: 25%; $2500 OOP Max	2 SNF: 25%	6 Home Health - $0 per day	10A Ambulance - $100	11A DME - 50%	11B Pros./Med Supp. - 50%; 11C Diabetes Mon Supplies - 50%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - 25%; 9A Outpatient Hospital - 25%	8A Outpatient C/D/T - 25%	8B Outpatient X-Rays - 25%			3 CORF - 50%; 5 Partial Hosp - 50%; 9D Cardiac Rehab Svcs - 50%; 9C Outpatient Sub Abuse - 50%; 12 Renal Dialysis - 25%	7A Primary Care - 25%; 14B Immunizations - 25%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%	7D Physician Specialist - 25%	7E Mental Health - 50%; 7H Psychiatric Services - 50%	7C Occupational Therapy - 25%; 7I PT and ST Services - 25%	7D Physician Specialist - 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%				14C Routine Physical Exams - 25%	7B Chiropractic Services - $40	7F Podiatry Services - $40	18A Hearing Exams (Medicare Covered) - $40		17A Eye Exams (Medicare Covered) - 50%							0.3999	0	0.85	0	5.985	0.66	0	0	0.32	0	0.02	0	0	0.01	1.2997	4.4503	2.66	0.29	0.66	2.63	0.25	0	0	0	0	0	0	0	0	0.03	0.21	0	0.01	0	0.26						20.9949	0	0.096877495	8.7637	0	4.769020772	0	5.992083333	1.3	0	1.003125	1.953958333	0.33575	0.387541667	0	0	0.214583333	5.563295151	17.53938973	4.393833333	1.45175	0.695442545	4.942658333	7.568	0	0	0	0.6	0.34	0	0	0	0.03	0.992833333	0	0.098533333	1.104326274	0.44255	0	0	0	0	0	70.4824
H5528_009_0	2010	2	N/A	i.6.	i.6.	i.6.	i.6.	i.6.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	313.9144202	0	1054.392785	224.6935761	0	3.05	0	260.1927909	280.263011	285.1620715	386.2437313	0	0	177.944829	5513.712753	8865.261991	608.6926484	602.901961	24.13906083	1416.862102	18.3594205	0	0	0	472.2253907	225.1625413	0	0	0	242.850003	446.3757066	298.0416602	51.80573723	300.8519768	151.4058931							1A IP Acute: $50 days 1-7	1B IP Psych: $50 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $75 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $20	8B Outpatient X-Rays - $20; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $30; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $30; 12 Renal Dialysis - $0	7A Primary Care - $5; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $20	7E Mental Health - $30; 7H Psychiatric Services - $30	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - $20	7G Other Health Care - $20	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		14C Routine Physical Exams - $0	7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50 copayment	17A Eye Exams (Medicare Covered) - $20						215.4724314	212.5	27.68892182	0	75	0.2	0.2	50	50	20	20			20	5	20	30	20	20	20	0.2				17.534	17.534					20	20	20	50	20						NO	215.4724314	212.5	27.68892182	0	75	0.2	0.2	50	50	20	20			20	5	20	30	20	20	20	0.2				17.534	17.534					20	20	20	50	20							5.6367	0	2.432916616	0	0	0.61	0	1.084136629	1.167762546	0.475270119	0.643739552	0	0	0.296574715	2.297380314	14.77543665	1.521731621	1.004836602	0.040231768	2.361436837	3.6718841	0	0	0	0.69	0.329	0	0	0	0	0.743959511	0.4967361	0.086342895	1.253549904	0.252343155	0	0	0	0	0	41.8719			5.6367	0	2.432916616	0	0	0.61	0	1.084136629	1.167762546	0.475270119	0.643739552	0	0	0.296574715	2.297380314	14.77543665	1.521731621	1.004836602	0.040231768	2.361436837	3.6718841	0	0	0	0.69	0.329	0	0	0	0	0.743959511	0.4967361	0.086342895	1.253549904	0.252343155	0	0	0	0	0	41.8719	NO	1A IP Acute: $50 days 1-7	1B IP Psych: 25%; $2500 OOP Max	2 SNF: 25%	6 Home Health - $0 per day	10A Ambulance - $75	11A DME - 50%	11B Pros./Med Supp. - 50%; 11C Diabetes Mon Supplies - 50%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $20	8B Outpatient X-Rays - $20; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $30; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $30; 12 Renal Dialysis - $0	7A Primary Care - 25%; 14B Immunizations - 25%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%	7D Physician Specialist - 25%	7E Mental Health - 50%; 7H Psychiatric Services - 50%	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%				14C Routine Physical Exams - 25%	7B Chiropractic Services - $40	7F Podiatry Services - $40	18A Hearing Exams (Medicare Covered) - $40		17A Eye Exams (Medicare Covered) - 50%							0.01	0	3.64	0	3.79	0.46	0	0	0.13	0	0	0	0	0	0.8159	4.4041	3.24	0.47	0.37	2.57	0.19	0	0	0	0	0	0	0	0	0.02	0.14	0.03	0.01	0	0.2						20.49		0.096877495	5.6467	0	6.072916616	0	3.79	1.07	0	1.084136629	1.297762546	0.475270119	0.643739552	0	0	0.296574715	3.113302116	19.17951485	4.761731621	1.474836602	0.410231768	4.931436837	3.8618841	0	0	0	0.69	0.329	0	0	0	0.02	0.883959511	0.5267361	0.096342895	1.253549904	0.452343155	0	0	0	0	0	62.3619
H5528_010_0	2010	7	N/A	i.7.	i.8.	i.9.	i.10.	i.11.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	283.9833658	0	921.6376966	251.7770669	0	3.1	0	252.370866	235.4213574	279.4007869	363.1731296	0	0	165.5399602	5043.133194	7717.961679	889.8093514	546.9247038	22.88461571	1275.652838	32.60456702	0	0	0	288	102	0	0	0	296.2730316	321.0416319	0	54.30277553	285.2174707	125.2804525							1A IP Acute: $75 days 1-7	1B IP Psych: $75 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $150 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $25/$25/$25	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $25; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $25; 12 Renal Dialysis - $0	7A Primary Care - $10; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $25	7E Mental Health - $25; 7H Psychiatric Services - $25	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - $25	7G Other Health Care - $25	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $25	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		14C Routine Physical Exams - $0	7B Chiropractic Services - $25	7F Podiatry Services - $25	18A Hearing Exams (Medicare Covered) - $25	7D High Tech Radiology: $50 copayment	17A Eye Exams (Medicare Covered) - $25						323.2086471	318.75	27.68892182	0	150	0.2	0.2	50	100	25	25			20	10	25	25	25	25	25	0.2				25	40					25	25	25	50	25						NO	323.2086471	318.75	27.68892182	0	150	0.2	0.2	50	100	25	25			20	10	25	25	25	25	25	0.2				25	40					25	25	25	50	25							7.6488	0	2.126596177	0	0	0.62	0	1.051545275	1.961844645	0.582084973	0.756610687	0	0	0.275899934	4.202610995	16.07908683	1.853769482	1.139426466	0.047676283	2.657610079	6.520913405	0	0	0	0.6	0.34	0	0	0	0	0.668836733	0	0.113130782	1.188406128	0.261000943	0	0	0	0	0	50.6959	0	0	7.6488	0	2.126596177	0	0	0.62	0	1.051545275	1.961844645	0.582084973	0.756610687	0	0	0.275899934	4.202610995	16.07908683	1.853769482	1.139426466	0.047676283	2.657610079	6.520913405	0	0	0	0.6	0.34	0	0	0	0	0.668836733	0	0.113130782	1.188406128	0.261000943	0	0	0	0	0	50.6959	NO	1A IP Acute: $75 days 1-7	1B IP Psych: 25%; $2500 OOP Max	2 SNF: 25%	6 Home Health - $0 per day	10A Ambulance - $150	11A DME - 50%	11B Pros./Med Supp. - 50%; 11C Diabetes Mon Supplies - 50%	4A Emergency Care - $50; 4B Urgent Care - $25/$25/$25	9B ASC Services - $100; 9A Outpatient Hospital - $100	8A Outpatient C/D/T - $25	8B Outpatient X-Rays - $25; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $25; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $25; 12 Renal Dialysis - $0	7A Primary Care - 25%; 14B Immunizations - 25%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%	7D Physician Specialist - 25%	7E Mental Health - 50%; 7H Psychiatric Services - 50%	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%				14C Routine Physical Exams - 25%	7B Chiropractic Services - $40	7F Podiatry Services - $40	18A Hearing Exams (Medicare Covered) - $40		17A Eye Exams (Medicare Covered) - 50%							0.03	0	0.35	0	2.636	0.485	0	0	0.11	0	0	0	0	0	0.8174	3.9126	1.53	0.39	0.48	2.74	0.38	0	0	0	0	0	0	0	0	0.03	0.11	0	0.01	0	0.31						14.321	0	0.096877495	7.6788	0	2.476596177	0	2.636	1.105	0	1.051545275	2.071844645	0.582084973	0.756610687	0	0	0.275899934	5.019977636	19.99172019	3.383769482	1.529426466	0.527676283	5.397610079	6.900913405	0	0	0	0.6	0.34	0	0	0	0.03	0.778836733	0	0.123130782	1.188406128	0.571000943	0	0	0	0	0	65.0169
H5528_011_0	2010	4	N/A	i.7.	i.8.	i.9.	i.10.	i.11.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	321.8775	0	881.225	261.775	0	2.95	0	268.6	328.875	341.025	392.1	0	0	212.125	5698.845609	9389.634391	845.575	632.675	24.8141029	835.47125	25.51	0	0	0	408	100.5	0	0	0	308.175	514.95	281.9	62.355	309.2652181	142.15							1A IP Acute: $75 days 1-7	1B IP Psych: $100 days 1-7	"2 SNF: $25 days 1-20, $50 days 21-100"	6 Home Health - $0	10A Ambulance - $100 per trip one way	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $20; 12 Renal Dialysis - $0	7A Primary Care - $10; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $20	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - $20	7G Other Health Care - $20	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - $0; 16B Comp Dental - NA	17A Eye Exams (Routine) - $20	17B Eye Wear - $40; Eyewear every year	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		14C Routine Physical Exams - $0	7B Chiropractic Services - $20	7F Podiatry Services - $20	18A Hearing Exams (Medicare Covered) - $20	7D High Tech Radiology: $50 copayment	17A Eye Exams (Medicare Covered) - $20						161.6043235	212.5	27.68892182	0	100	0.2	0.2	50	50	10	10			20	10	20	20	20	20	20	0.2				20	40					20	20	20	50	20						NO	161.6043235	212.5	27.68892182	0	100	0.2	0.2	50	50	10	10			20	10	20	20	20	20	20	0.2				20	40					20	20	20	50	20							4.3347	0	2.033347511	0	0	0.59	0	1.119166667	1.3703125	0.2841875	0.32675	0	0	0.353541667	4.749038008	15.64939065	1.409291667	1.054458333	0.041356838	1.392452083	5.102	0	0	0	0.68	0.335	0	0	0	0	0.85825	0.469833333	0.103925	1.288605075	0.236916667	0	0	0	0	0	43.7826	0	0	4.3347	0	2.033347511	0	0	0.59	0	1.119166667	1.3703125	0.2841875	0.32675	0	0	0.353541667	4.749038008	15.64939065	1.409291667	1.054458333	0.041356838	1.392452083	5.102	0	0	0	0.68	0.335	0	0	0	0	0.85825	0.469833333	0.103925	1.288605075	0.236916667	0	0	0	0	0	43.7826	NO	1A IP Acute: $75 days 1-7	1B IP Psych: 25%; $2500 OOP Max	2 SNF: 25%	6 Home Health - $0 per day	10A Ambulance - $100 per trip one way	11A DME - 50%	11B Pros./Med Supp. - 50%; 11C Diabetes Mon Supplies - 50%	4A Emergency Care - $50; 4B Urgent Care - $20/$20/$20	9B ASC Services - $50; 9A Outpatient Hospital - $50	8A Outpatient C/D/T - $10	8B Outpatient X-Rays - $10; Outpatient Radiology Therapy - $50; $50 High-tech Radiology			3 CORF - $20; 5 Partial Hosp - $20; 9D Cardiac Rehab Svcs - $20; 9C Outpatient Sub Abuse - $20; 12 Renal Dialysis - $0	7A Primary Care - 25%; 14B Immunizations - 25%; 14D Pap/Pelvic - 25%; 14E Prostate Screening - 25%; 14F Colorectal Screening - 25%; 14G Bone Mass Meas. - 25%; 14H Mammography - 25%; 14I Diabetes Monitoring - 25%	7D Physician Specialist - 25%	7E Mental Health - 50%; 7H Psychiatric Services - 50%	7C Occupational Therapy - $20; 7I PT and ST Services - $20	7D Physician Specialist - 25%	7G Other Health Care - 25%	15 Medicare Part B Rx Drugs - 50%		10B Transportation - NA	16A Preventative Dental - 50%	17A Eye Exams (Routine) - 50%	17B Eye Wear - 50%				14C Routine Physical Exams - 25%	7B Chiropractic Services - $40	7F Podiatry Services - $40	18A Hearing Exams (Medicare Covered) - $40		17A Eye Exams (Medicare Covered) - 50%							0.015	0	0.32	0	2.415	0.89	0	0	0.12	0	0	0	0	0	0.9453	2.2547	2.69	0.27	0.48	2.7	0.36	0	0	0	0	0	0	0	0	0.04	0.36	0.05	0.02	0	0.24						14.17	0	0.096877495	4.3497	0	2.353347511	0	2.415	1.48	0	1.119166667	1.4903125	0.2841875	0.32675	0	0	0.353541667	5.694363292	17.90406537	4.099291667	1.324458333	0.521356838	4.092452083	5.462	0	0	0	0.68	0.335	0	0	0	0.04	1.21825	0.519833333	0.123925	1.288605075	0.476916667	0	0	0	0	0	57.9526
H5528_013_0	2010	3	N/A	i.6.	i.6.	i.6.	i.6.	i.6.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	428.6403058	1.460522035	1561.583779	702.1726255	0.157911862	0	0	295.4223599	370.5624958	581.0740897	588.5616608	0	0	198.4450237	4809.706291	8306.531584	1091.312154	561.093538	19.99986675	559.1776016	15.19100938	0	0	0	0	0	0	0	0	168.5884205	165.7469544	280.9888081	50.83021006	249.2640245	149.1529193							1A IP Acute - $0 per day (unlimited days)	1B IP Psych - $0 per day (190 day lifetime limit)	2 SNF - $0 per day for days 1-100	6 Home Health - $0 per day	10A Ambulance - $0 per trip	11A DME - 0%	11B Pros./Med Supp. - 0%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $10	9B ASC Services - $0;  9A Outpatient Hospital - $0	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0			3 CORF - $10; 5 Partial Hosp - $20; 9D Cardiac Rehab Svcs - $10; 9C Outpatient Sub Abuse - $20; 12 Renal Dialysis - $0	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $10	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $10; 7I PT and ST Services - $10	7D Physician Specialist - $10	7B Chiropractic Services - $10; 7F Podiatry Services - $10; 7G Other Health Care - $10; 18A Hearing Exams (Medicare Covered) - $0; 17A Eye Exams (Medicare Covered) - $0	15 Medicare Part B Rx Drugs - $0	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - NA; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0	17B Eye Wear - $0	18A Hearing Exams (Routine) - $0	18B Hearing Aids - $0	14A Health Ed/Wellness - $0	13B Acupuncture - not covered; Respite Care - not covered; 14C Routine Physical Exams - $0	7B Chiropractic Services - $10	7F Podiatry Services - $10	18A Hearing Exams (Medicare Covered) - $0	7D High Tech Radiology: $0	17A Eye Exams (Medicare Covered) - 30						0	0	0	0	0	0	0	50	0	0	0			10	0	10	20	10	10	10	0				0	0					10	10	0	0	0						NO	0	0	0	0	0	0	0	50	0	0	0			10	0	10	20	10	10	10	0				0	0					10	10	0	0	0							0	0	0	0	0	0	0	1.2309265	0	0	0	0	0	0.165370853	0	6.922109654	1.81885359	0.467577948	0.016666556	0.465981335	0	0	0	0	0	0	0	0	0	0	0.138122462	0.23415734	0	0	0	0	0	0	0	0	11.4598			0	0	0	0	0	0	0	1.2309265	0	0	0	0	0	0.165370853	0	6.922109654	1.81885359	0.467577948	0.016666556	0.465981335	0	0	0	0	0	0	0	0	0	0	0.138122462	0.23415734	0	0	0	0	0	0	0	0	11.4598	NO	1A IP Acute - $0 per day (unlimited days)	1B IP Psych - $0 per day (190 day lifetime limit)	2 SNF - $0 per day for days 1-100	6 Home Health - $0 per day	10A Ambulance - $0 per trip	11A DME - 0%	11B Pros./Med Supp. - 0%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $10	9B ASC Services - $0;  9A Outpatient Hospital - $0	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0			3 CORF - $10; 5 Partial Hosp - $20; 9D Cardiac Rehab Svcs - $10; 9C Outpatient Sub Abuse - $20; 12 Renal Dialysis - $0	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $10	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $10; 7I PT and ST Services - $10	7D Physician Specialist - $10	7B Chiropractic Services - $10; 7F Podiatry Services - $10; 7G Other Health Care - $10; 18A Hearing Exams (Medicare Covered) - $0; 17A Eye Exams (Medicare Covered) - $0	15 Medicare Part B Rx Drugs - $0	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - NA; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0	17B Eye Wear - $0	18A Hearing Exams (Routine) - $0	18B Hearing Aids - $0	14A Health Ed/Wellness - $0	13B Acupuncture - not covered; Respite Care - not covered; 14C Routine Physical Exams - $0	7B Chiropractic Services - $10	7F Podiatry Services - $10	18A Hearing Exams (Medicare Covered) - $0		17A Eye Exams (Medicare Covered) - 30							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.7729	1.43	0.12	0	0.24	0	0	0	0	0	0	0	0	0	0	0.01	0.04	0	0	0						2.6129			0	0	0	0	0	0	0	1.2309265	0	0	0	0	0	0.165370853	0	7.694992356	3.24885359	0.587577948	0.016666556	0.705981335	0	0	0	0	0	0	0	0	0	0	0.148122462	0.27415734	0	0	0	0	0	0	0	0	14.0726
H5528_014_0	2010	3	N/A	i.6.	i.6.	i.6.	i.6.	i.6.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	305.8784265	2.506272132	1182.709776	522.8834075	1.404272821	0	0	282.3350127	356.0569253	436.6004836	532.2378498	0	0	99.01839752	5101.817889	8489.861194	1092.559827	571.9429473	22.702799	834.071276	23.96940668	0	0	0	0	0	0	0	0	232.2221144	386.8639325	239.4258228	45.1576412	282.9514374	121.313344							1A IP Acute - $0 per day (unlimited days)	1B IP Psych - $0 per day (190 day lifetime limit)	2 SNF - $0 per day for days 1-100	6 Home Health - $0 per day	10A Ambulance - $0 per trip	11A DME - 0%	11B Pros./Med Supp. - 0%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $10	9B ASC Services - $0;  9A Outpatient Hospital - $0	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0			3 CORF - $10; 5 Partial Hosp - $20; 9D Cardiac Rehab Svcs - $10; 9C Outpatient Sub Abuse - $20; 12 Renal Dialysis - $0	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $10	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $10; 7I PT and ST Services - $10	7D Physician Specialist - $10	7B Chiropractic Services - $10; 7F Podiatry Services - $10; 7G Other Health Care - $10; 18A Hearing Exams (Medicare Covered) - $0; 17A Eye Exams (Medicare Covered) - $0	15 Medicare Part B Rx Drugs - $0	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - NA; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0	17B Eye Wear - $0	18A Hearing Exams (Routine) - $0	18B Hearing Aids - $0	14A Health Ed/Wellness - $0	13B Acupuncture - not covered; Respite Care - not covered; 14C Routine Physical Exams - $0	7B Chiropractic Services - $10	7F Podiatry Services - $10	18A Hearing Exams (Medicare Covered) - $0	7D High Tech Radiology: $0	17A Eye Exams (Medicare Covered) - 30						0	0	0	0	0	0	0	50	0	0	0			10	0	10	20	10	10	10	0				0	0					10	10	0	0	0						NO	0	0	0	0	0	0	0	50	0	0	0			10	0	10	20	10	10	10	0				0	0					10	10	0	0	0							0	0	0	0	0	0	0	1.176395886	0	0	0	0	0	0.082515331	0	7.074884328	1.820933045	0.476619123	0.018918999	0.695059397	0	0	0	0	0	0	0	0	0	0	0.32238661	0.199521519	0	0	0	0	0	0	0	0	11.8672			0	0	0	0	0	0	0	1.176395886	0	0	0	0	0	0.082515331	0	7.074884328	1.820933045	0.476619123	0.018918999	0.695059397	0	0	0	0	0	0	0	0	0	0	0.32238661	0.199521519	0	0	0	0	0	0	0	0	11.8672	NO	1A IP Acute - $0 per day (unlimited days)	1B IP Psych - $0 per day (190 day lifetime limit)	2 SNF - $0 per day for days 1-100	6 Home Health - $0 per day	10A Ambulance - $0 per trip	11A DME - 0%	11B Pros./Med Supp. - 0%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $10	9B ASC Services - $0;  9A Outpatient Hospital - $0	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0			3 CORF - $10; 5 Partial Hosp - $20; 9D Cardiac Rehab Svcs - $10; 9C Outpatient Sub Abuse - $20; 12 Renal Dialysis - $0	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $10	7E Mental Health - $20; 7H Psychiatric Services - $20	7C Occupational Therapy - $10; 7I PT and ST Services - $10	7D Physician Specialist - $10	7B Chiropractic Services - $10; 7F Podiatry Services - $10; 7G Other Health Care - $10; 18A Hearing Exams (Medicare Covered) - $0; 17A Eye Exams (Medicare Covered) - $0	15 Medicare Part B Rx Drugs - $0	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - NA; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0	17B Eye Wear - $0	18A Hearing Exams (Routine) - $0	18B Hearing Aids - $0	14A Health Ed/Wellness - $0	13B Acupuncture - not covered; Respite Care - not covered; 14C Routine Physical Exams - $0	7B Chiropractic Services - $10	7F Podiatry Services - $10	18A Hearing Exams (Medicare Covered) - $0		17A Eye Exams (Medicare Covered) - 30							0	0	0	0	0	0	0	0	0	0	0			0	0	0.7152	1.04	0.15	0	0.28	0	0	0	0	0	0	0	0	0	0	0.02	0.01	0		0						2.2152			0	0	0	0	0	0	0	1.176395886	0	0	0	0	0	0.082515331	0	7.790045866	2.860933045	0.626619123	0.018918999	0.975059397	0	0	0	0	0	0	0	0	0	0	0.34238661	0.209521519	0	0	0	0	0	0	0	0	14.0824
H5528_018_0	2010	4	N/A	i.6.	i.6.	i.6.	i.6.	i.6.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	High Tech Radiology	Vision Exams						A	A	D	V	T	Coin	Coin	V	V	V	V			V	V	V	V	V	V	V	Coin				V	V				Coin	V	V	V	V	V																																														0	NO	421.1	2.5	1100.3	759.4	0	0	0	311.7	391.8	611.9	563.5	0	0	167.9	4191.619722	7173.500278	1265.8	440.75	17.57811926	406.81	8.04	0	0	0	0	0	0	0	0	170.1	64.2	244.74	38.68	219.0810971	137.9							1A IP Acute - $0 per day (unlimited days)	1B IP Psych - $0 per day (190 day lifetime limit)	2 SNF - $0 per day for days 1-100	6 Home Health - $0 per day	10A Ambulance - $0 per trip	11A DME - 0%	11B Pros./Med Supp. - 0%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $0; 4B Urgent Care - $0	9B ASC Services - $0;  9A Outpatient Hospital - $0	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0			3 CORF - $0; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - $0; 9C Outpatient Sub Abuse - $0; 12 Renal Dialysis - $0	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $0	7E Mental Health - $0; 7H Psychiatric Services - $0	7C Occupational Therapy - $0; 7I PT and ST Services - $0	7D Physician Specialist - $0	7B Chiropractic Services - $0; 7F Podiatry Services - $0; 7G Other Health Care - $0; 18A Hearing Exams (Medicare Covered) - $0; 17A Eye Exams (Medicare Covered) - $0	15 Medicare Part B Rx Drugs - $0	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - NA; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0	17B Eye Wear - $0	18A Hearing Exams (Routine) - $0	18B Hearing Aids - $0	14A Health Ed/Wellness - $0	13B Acupuncture - not covered; Respite Care - not covered; 14C Routine Physical Exams - $0	7B Chiropractic Services - $0	7F Podiatry Services - $0	18A Hearing Exams (Medicare Covered) - $0	7D High Tech Radiology: $0	17A Eye Exams (Medicare 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						NO	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0				0	0					0	0	0	0	0							0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	1A IP Acute - $0 per day (unlimited days)	1B IP Psych - $0 per day (190 day lifetime limit)	2 SNF - $0 per day for days 1-100	6 Home Health - $0 per day	10A Ambulance - $0 per trip	11A DME - 0%	11B Pros./Med Supp. - 0%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $0; 4B Urgent Care - $0	9B ASC Services - $0;  9A Outpatient Hospital - $0	8A Outpatient C/D/T - $0	8B Outpatient X-Rays - $0			3 CORF - $0; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - $0; 9C Outpatient Sub Abuse - $0; 12 Renal Dialysis - $0	7A Primary Care - $0; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0	7D Physician Specialist - $0	7E Mental Health - $0; 7H Psychiatric Services - $0	7C Occupational Therapy - $0; 7I PT and ST Services - $0	7D Physician Specialist - $0	7B Chiropractic Services - $0; 7F Podiatry Services - $0; 7G Other Health Care - $0; 18A Hearing Exams (Medicare Covered) - $0; 17A Eye Exams (Medicare Covered) - $0	15 Medicare Part B Rx Drugs - $0	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - NA; 16B Comp Dental - NA	17A Eye Exams (Routine) - $0	17B Eye Wear - $0	18A Hearing Exams (Routine) - $0	18B Hearing Aids - $0	14A Health Ed/Wellness - $0	13B Acupuncture - not covered; Respite Care - not covered; 14C Routine Physical Exams - $0	7B Chiropractic Services - $0	7F Podiatry Services - $0	18A Hearing Exams (Medicare Covered) - $0	7D High Tech Radiology: $0	17A Eye Exams (Medicare 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	0	0	0	0	0						0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5528_804_0	2010	5	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																												0	NO	445.96	2.23	37.91	14.64	8.72	5.415	5.415	7.71	38.77	6.03	31.57	0	0	5.3	61.63	114.13	10.94	3.48	44.66	43.84	23.47																					Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	0%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	0%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	50%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												27.4565	0.137294664	5.483253454	0	2.03176	1.261695	1.261695	1.79643	9.03341	1.40499	7.35581	0	0	1.2349	14.35979	26.59229	2.54902	0.81084	10.40578	10.21472	5.46851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8587			27.4565	0.137294664	5.483253454	0	2.03176	1.261695	1.261695	1.79643	9.03341	1.40499	7.35581	0	0	1.2349	14.35979	26.59229	2.54902	0.81084	10.40578	10.21472	5.46851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8587	NO																																																																																		0			27.4565	0.137294664	5.483253454	0	2.03176	1.261695	1.261695	1.79643	9.03341	1.40499	7.35581	0	0	1.2349	14.35979	26.59229	2.54902	0.81084	10.40578	10.21472	5.46851	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.8587
H5528_807_0	2010	6	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																												0	NO	545.33	1.638517801	53.84278846	17.35340111	10.42652519	5.873217246	5.873217246	8.169588897	43.14678141	6.46	28.45	0	0	5.693195464	67.07	128.53	11.01	3.3	56.64	46.87156281	20.61039025																					Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	Medicare Defined Cost Sharing	0%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	0%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	50%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	20%Coinsurance	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered											0.062008365	0.062008365	0.14589506	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.062008365	0.062008365	0.14589506	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												33.815	0.10160181	7.855396872	0	2.429380369	1.368459618	1.368459618	1.903514213	10.05320007	1.50518	6.62885	0	0	1.326514543	15.62731	29.94749	2.56533	0.7689	13.19712	10.92107413	4.802220927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.185			33.815	0.10160181	7.855396872	0	2.429380369	1.368459618	1.368459618	1.903514213	10.05320007	1.50518	6.62885	0	0	1.326514543	15.62731	29.94749	2.56533	0.7689	13.19712	10.92107413	4.802220927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.185	NO																																																																																		0			33.815	0.10160181	7.855396872	0	2.429380369	1.368459618	1.368459618	1.903514213	10.05320007	1.50518	6.62885	0	0	1.326514543	15.62731	29.94749	2.56533	0.7689	13.19712	10.92107413	4.802220927	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.185
H5529_001_0	2010	12	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13	I.14	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies\Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Partial Hosp	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	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	0	0	0	0	0	0	0	0	0	0	NO	1392.247635	90.17434649	490.7418091	578.6792546	118.3530318	12.93493228	1.549195192	301.7996968	427.9005035	4643.483606	889.1385912	71.09695988	0	149.4918249	3537.447538	3673.310366	35.62149744	1598.301881	2404.521685	0	49.19661349	0	0	745.9758882	302.4	239.2	129.6	0	0	0	0.019205013	76.34356656	207.1623989	463.114831	113.2542585	0.996359966	693.2884235	25.62812613	1.660287162	15.16711819		$240/day (days 1-7) w/$1680 yrly max	$240/day (days 1-7) w/$1680 yrly max	$128/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$35 copay	$20 coapy	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay/ $50 limit	$35 copay/ $75 limit	$35 copay/ $50 limit		Silver Sneakers		$35 copay	$0 copay	$35 copay	$35 copay	$0 copay	20% coinsurance	$35 copay	$35 copay	$40 copay	20% coinsurance	240	240	128	0	125	0.2	0.2	50	200	0	92.52124442	200	0.2	35	20	35	40	44.98177704	80.40563867	0	0.2	0	0	10	35	35	35	0	0	0	35	0	35	35	0	0.2	35	35	40	0.2	NO	122.3123985	101.0239198	113.3932974	0	110.735642	0.177177027	0.177177027	44.29425679	177.1770272	0	81.96319517	177.1770272	0	31.00597975	17.71770272	31.00597975	35.43540543	39.84868766	71.23016012	0	0.177177027	0	0	10	35	35	35	0	0	0	31.00597975	0	31.00597975	31.00597975	0	0.177177027	31.00597975	31.00597975	35.43540543	0.177177027		14.1908	0.759147163	4.637235991	0	1.092158247	2.291772847	0.274481799	1.113999439	6.317844927	0	6.073053324	1.049728999	0	0.386261708	5.222953655	9.491215568	0.105188517	5.307519369	14.27287205	0	8.716509723	0	0	0.621646573	0.882	0.697666667	0.378	0	0	0	4.96E-05	0	0.535272762	1.196610756	0	0.176532097	1.791340569	0.066218763	0.004902746	2.687264912	90.3402		11.5262708	14.1908	0.759147163	4.637235991	0	1.092158247	2.291772847	0.274481799	1.113999439	6.317844927	0	6.073053324	1.049728999	0	0.386261708	5.222953655	9.491215568	0.105188517	5.307519369	14.27287205	0	8.716509723	0	0	0.621646573	0.882	0.697666667	0.378	0	0	0	4.96E-05	0	0.535272762	1.196610756	0	0.176532097	1.791340569	0.066218763	0.004902746	2.687264912	90.3402	YES	$300/day (Days 1-7)	$300/day (Days 1-7)	30% Coinsurance	$0 copay	$125 copay	30% Coinsurance	30% Coinsurance	$50 copay	$275 copay	$0 copay	30% Coinsurance	$275 copay	20% Coinsurance	$40 copay	$30 copay	$45 copay	$50 copay	$90/$45 OP/PR copay	30% Coinsurance		20% Coinsurance				$45 copay / $50 limit	$45 copay / $75 limit	$45 copay / $50 limit		Silver Sneakers		$45 copay	$0 copay	$45 copay	$45 copay	$0 copay	20% Coinsurance	$45 copay	$45 copay	$50 copay	20% coinsurance	4500	4.1627	0.2503	1.3397		1.3118	0.7822	0.0662	0.1639	0.647		1.0227	0.3111		0.0833	1.3198	1.2135	0.0199	1.2214	2.8042		0.8864			0.5964	0.2835	0.2243	0.1215	0			0.0012		0.9659	0.39		0.2065	0.1734	0.0264		0.1948	20.79		2.528927948	18.3535	1.009493616	5.976930635	0	2.403977593	3.074006376	0.340654106	1.277871909	6.96480446	0	7.095759241	1.360862209	0	0.469589737	6.54271964	10.70476004	0.125084261	6.528891009	17.07709883	0	9.602875059	0	0	1.218047091	1.1655	0.921916667	0.4995	0	0	0	0.00126183	0	1.501130586	1.586640713	0	0.382983405	1.964735261	0.092595512	0.004902746	2.882084254	111.1302
H5529_004_0	2010	9	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	1392.157766	90.16852576	490.7101318	578.641901	118.3453922	12.93409733	1.549095192	301.7804879	427.8728827	4643.183871	889.0811976	71.09237059	0	149.4821752	3537.219197	3673.073255	37.29520052	1598.198711	2404.366474	0	49.19309856	0	0	1101.053247	302.4	239.2	129.6	0	0	0	0.019203774	0.006361553	207.1490266	463.084937	113.246948	0.996295652	693.243672	25.62647184	15.16613916	0		$200/day (days 1-5) w/$1000 yrly max	$200/day (days 1-5) w/$1000 yrly max	$115/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$175 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$175 copay	20% coinsurance	$20 copay	$10 copay	$20 copay	$40 copay	$40/$20 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance			$0 deduct 1 exam/2 cleanings	$20 copay; $100 limit	$20 copay; $125 limit	$20 copay; $100 limit		Silver Sneakers		$20 copay	$0 copay	$20 copay	$20 copay	$0 copay	20% coinsurance	$20 copay	$20 copay	20% coinsurance		200	200	115	0	100	0.2	0.2	50	175	0	92.5152722	175	0.2	20	10	20	40	33.30688597	80.4004485	0	0.2	0	0	0	20	20	20	0	0	0	20	0	20	20	0	0.2	20	20	0.2	0	NO	85.02124898	67.84088101	102.543265	0	89.16805653	0.178336113	0.178336113	44.58402827	156.0440989	0	82.49407022	156.0440989	0	17.83361131	8.916805653	17.83361131	35.66722261	29.69910291	71.69151738	0	0.178336113	0	0	0	20	20	20	0	0	0	17.83361131	0	17.83361131	17.83361131	0	0.178336113	17.83361131	17.83361131	0.178336113	0		9.8636	0.509759352	4.193251591	0	0.879385718	2.306616644	0.276259615	1.121215817	5.563919869	0	6.111993895	0.924462076	0	0.222150584	2.628391345	5.45868006	0.110851352	3.955422331	14.36439007	0	8.772905986	0	0	0	0.504	0.398666667	0.216	0	0	0	2.85E-05	0	0.307851269	0.688206397	0	0.177675494	1.030253182	0.038084378	2.704670308	0	73.3287		8.89118594	9.8636	0.509759352	4.193251591	0	0.879385718	2.306616644	0.276259615	1.121215817	5.563919869	0	6.111993895	0.924462076	0	0.222150584	2.628391345	5.45868006	0.110851352	3.955422331	14.36439007	0	8.772905986	0	0	0	0.504	0.398666667	0.216	0	0	0	2.85E-05	0	0.307851269	0.688206397	0	0.177675494	1.030253182	0.038084378	2.704670308	0	73.3287	YES	$250/day (days 1-5)	$250/day (days 1-5)	25% Coinsurance	$0 copay	$100 copay	25% Coinsurance	25% Coinsurance	$50 copay	$225 copay	$0 copay	25% Coinsurance	$225 copay	20% Coinsurance	$25 copay	$15 copay	$25 copay	$50 copay	$50/$25 OP/PR copay	25% Coinsurance		20% Coinsurance			20% Coinsurance	$25 copay; $100 limit	$25 copay; $125 limit	$25 copay; $100 limit		Silver Sneakers		$25 copay	$0 copay	$25 copay	$25 copay	$0 copay	25% coinsurance	$25 copay	$25 copay	20% coinsurance		3850	3.0517	0.1318	1.1236		1.0563	0.6561	0.0555	0.1649	0.5328		0.8578	0.2562		0.0524	0.6642	0.6786	0.02	0.6829	2.352		0.8921			0.4358	0.1575	0.1246	0.0675	0			0.0007		0.5401	0.2181		0.2597	0.097	0.0147	0.1961		15.3406		1.772757161	12.9153	0.641594534	5.316894789	0	1.935638512	2.962700019	0.33176037	1.286149688	6.096678866	0	6.969768875	1.180674418	0	0.274567924	3.292548395	6.137238164	0.13087596	4.638312945	16.71638151	0	9.665012304	0	0	0.435789474	0.6615	0.52325	0.2835	0	0	0	0.00070635	0	0.847914423	0.906293163	0	0.437411108	1.127207498	0.05283304	2.900751493	0	88.6693
H5529_804_0	2010	7	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	217.3830221	2.488891271	55.25456113	24.33932794	6.597596231	11.65655606	2.882053441	8.13359877	33.31129058	6.205641689	19.02030087	0	0.03467542	18.66328815	29.80499974	70.53102141	0.791272786	3.108931735	17.43029741	22.21161143	6.402516518	1.117760344	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.079585617	0.079585617	0.169141279	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079585617	0.079585617	0.169141279	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.3006	0.198079947	9.345827128	0	1.537239922	2.715977561	0.671518452	1.895128513	7.761530705	1.445914514	4.431730104	0	0.008079373	4.348546139	6.944564939	16.43372799	0.184366559	0.724381094	4.061259297	5.175305463	1.491786349	0.26043816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.936	0	0	17.3006	0.198079947	9.345827128	0	1.537239922	2.715977561	0.671518452	1.895128513	7.761530705	1.445914514	4.431730104	0	0.008079373	4.348546139	6.944564939	16.43372799	0.184366559	0.724381094	4.061259297	5.175305463	1.491786349	0.26043816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.936	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				6.5762	0.0753	2.8356	0	0.5947	1.051	0.2599	0.6751	2.8612	0.4391	1.3641	0	0.0042	1.6748	2.9038	7.2247	0.0955	0.3772	2.1048	2.5085	0.5362	0.0936	0	0	0	0	0	0	0	0											34.2555	0	0	23.8767	0.27337264	12.18145591	0	2.131948793	3.766969318	0.931373455	2.570202824	10.62270898	1.885050151	5.795866514	0	0.012307266	6.023390103	9.848332562	23.65838815	0.27987032	1.101550975	6.166104414	7.683763428	2.027980989	0.354083548	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1914
H5529_805_0	2010	6	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	217.3830221	2.488891271	55.25456113	24.33932794	6.597596231	11.65655606	2.882053441	8.13359877	33.31129058	6.205641689	19.02030087	0	0.03467542	18.66328815	29.80499974	70.53102141	0.791272786	3.108931735	17.43029741	22.21161143	6.402516518	1.117760344	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.079585617	0.079585617	0.169141279	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079585617	0.079585617	0.169141279	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.3006	0.198079947	9.345827128	0	1.537239922	2.715977561	0.671518452	1.895128513	7.761530705	1.445914514	4.431730104	0	0.008079373	4.348546139	6.944564939	16.43372799	0.184366559	0.724381094	4.061259297	5.175305463	1.491786349	0.26043816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.936	0	0	17.3006	0.198079947	9.345827128	0	1.537239922	2.715977561	0.671518452	1.895128513	7.761530705	1.445914514	4.431730104	0	0.008079373	4.348546139	6.944564939	16.43372799	0.184366559	0.724381094	4.061259297	5.175305463	1.491786349	0.26043816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.936	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				6.5762	0.0753	2.8356	0	0.5947	1.051	0.2599	0.6751	2.8612	0.4391	1.3641	0	0.0042	1.6748	2.9038	7.2247	0.0955	0.3772	2.1048	2.5085	0.5362	0.0936	0	0	0	0	0	0	0	0											34.2555	0	0	23.8767	0.27337264	12.18145591	0	2.131948793	3.766969318	0.931373455	2.570202824	10.62270898	1.885050151	5.795866514	0	0.012307266	6.023390103	9.848332562	23.65838815	0.27987032	1.101550975	6.166104414	7.683763428	2.027980989	0.354083548	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1914
H5529_806_0	2010	6	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	217.3830221	2.488891271	55.25456113	24.33932794	6.597596231	11.65655606	2.882053441	8.13359877	33.31129058	6.205641689	19.02030087	0	0.03467542	18.66328815	29.80499974	70.53102141	0.791272786	3.108931735	17.43029741	22.21161143	6.402516518	1.117760344	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.079585617	0.079585617	0.169141279	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079585617	0.079585617	0.169141279	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.3006	0.198079947	9.345827128	0	1.537239922	2.715977561	0.671518452	1.895128513	7.761530705	1.445914514	4.431730104	0	0.008079373	4.348546139	6.944564939	16.43372799	0.184366559	0.724381094	4.061259297	5.175305463	1.491786349	0.26043816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.936	0	0	17.3006	0.198079947	9.345827128	0	1.537239922	2.715977561	0.671518452	1.895128513	7.761530705	1.445914514	4.431730104	0	0.008079373	4.348546139	6.944564939	16.43372799	0.184366559	0.724381094	4.061259297	5.175305463	1.491786349	0.26043816	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.936	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				6.5762	0.0753	2.8356	0	0.5947	1.051	0.2599	0.6751	2.8612	0.4391	1.3641	0	0.0042	1.6748	2.9038	7.2247	0.0955	0.3772	2.1048	2.5085	0.5362	0.0936	0	0	0	0	0	0	0	0											34.2555	0	0	23.8767	0.27337264	12.18145591	0	2.131948793	3.766969318	0.931373455	2.570202824	10.62270898	1.885050151	5.795866514	0	0.012307266	6.023390103	9.848332562	23.65838815	0.27987032	1.101550975	6.166104414	7.683763428	2.027980989	0.354083548	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.1914
H5530_001_0	2010	10	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13	I.14	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Professional	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies\Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Partial Hosp	Chemo/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	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	0	0	0	0	0	0	0	0	0	0	NO	1559.87316	83.57938739	319.3681387	744.8339408	131.7973963	13.93255795	0.559142368	300.7086265	394.9998754	4897.973189	821.5127718	122.1914861	0.003569697	136.2066384	3493.694403	3748.605093	70.15320822	1329.410005	2324.298873	0	40.19529143	0	0	0	302.4	239.2	129.6	0	0	0	0.168288626	58.2062536	350.0083414	326.5526184	101.8770746	1.047247951	565.2878743	30.48947633	35.16451703	11.91775904		$215/day (days 1-8) w/$1720 yrly max	$215/day (days 1-8) w/$1720 yrly max	$128/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$30 copay	$10 coapy	$30 copay	$40 copay	$50$30 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$30 copay/ $50 limit	$30 copay/ $75 limit	$30 copay/ $50 limit		Silver Sneakers & Nurse Hotline		$30 copay	$0 copay	$30 copay	$30 copay	$0 copay	20% coinsurance	$30 copay	$30 copay	$40 copay	20% coinsurance	215	215	128	0	100	0.2	0.2	50	200	0	94.56066449	200	0.2	30	10	30	40	43.43212706	80.61005173	0	0.2	0	0	0	30	30	30	0	0	0	30	0	30	30	0	0.2	30	30	40	0.2	NO	120.3074435	90.95724092	114.7975791	0	89.68560866	0.179371217	0.179371217	44.84280433	179.3712173	0	84.8073075	179.3712173	0.179371217	26.9056826	8.968560866	26.9056826	35.87424346	38.95236751	72.29561554	0	0.179371217	0	0	0	30	30	30	0	0	0	26.9056826	0	26.9056826	26.9056826	0	0.179371217	26.9056826	26.9056826	35.87424346	0.179371217		15.6387	0.63351254	3.055224096	0	0.985027475	2.49909988	0.100294047	1.123718175	5.904300708	0	5.805857188	1.826469634	0.000640301	0.305394382	2.611117575	8.404898236	0.209724439	4.31530559	14.00305147	0	7.209878355	0	0	0	0.756	0.598	0.324	0	0	0	0.000377327	0	0.784767778	0.732176759	0	0.18784614	1.267454677	0.068361681	0.105125037	2.137702947	81.594		9.362092242	15.6387	0.63351254	3.055224096	0	0.985027475	2.49909988	0.100294047	1.123718175	5.904300708	0	5.805857188	1.826469634	0.000640301	0.305394382	2.611117575	8.404898236	0.209724439	4.31530559	14.00305147	0	7.209878355	0	0	0	0.756	0.598	0.324	0	0	0	0.000377327	0	0.784767778	0.732176759	0	0.18784614	1.267454677	0.068361681	0.105125037	2.137702947	81.594	YES	$285/day (Days 1-8)	$285/day (Days 1-8)	30% Coinsurance	$0 copay	$100 copay	30% Coinsurance	30% Coinsurance	$50 copay	$275 copay	$0 copay	30% Coinsurance	$275 copay	20% Coinsurance	$40 copay	$20 copay	$40 copay	$50 copay	$80/$40 OP/PR copay	30% Coinsurance		20% Coinsurance				$40 copay / $50 limit	$40 copay / $75 limit	$40 copay / $50 limit		Silver Sneakers & Nurse Hotline		$40 copay	$0 copay	$40 copay	$40 copay	$0 copay	20% Coinsurance	$40 copay	$40 copay	$50 copay	20% coinsurance	4500	2.427	0.1058	0.4521		0.8281	0.3734	0.0095	0.1482	1.0269		0.9449	0.3934	0.0122	0.0349	0.7223	1.805	0.0384	0.6719	3.5342		1.0451			0	0.252	0.1993	0.108	0			0.0096		0.8454	0.1768		0.248	0.1553	0.0082		0.2253	16.8012		1.875257518	18.0657	0.739280872	3.507276918	0	1.813144203	2.872535006	0.109747218	1.271930827	6.931211494	0	6.750795013	2.219885941	0.012806019	0.340289551	3.33339833	10.20988769	0.248087037	4.987235149	17.53726878	0	8.254955431	0	0	0	1.008	0.797333333	0.432	0	0	0	0.00993627	0	1.630181143	0.909024182	0	0.435842751	1.422712495	0.076609954	0.105125037	2.363023104	98.3952
H5530_004_0	2010	9	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	NO	1252.253666	78.19032939	395.1109896	534.6880514	91.59899979	11.65029692	1.0795585	285.2724691	371.3919962	4242.550056	808.782555	84.36817514	0.000426919	120.1670091	3184.340907	3353.143725	45.72947161	1400.493288	2091.922437	0	43.40607043	0	0	1101.053247	302.4	239.2	129.6	0	0	0	0.031856582	0.005445028	228.3725293	368.2910849	103.691234	0.98783668	596.8044315	25.44237301	12.64812655	0		$175/day (days 1-5) w/$875 yrly max	$175/day (days 1-5) w/$875 yrly max	$120/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$150 copay	$0 copay	$50/$75 copay for Lower/Higher Tier	$150 copay	20% coinsurance	$15 copay	$5 copay	$15 copay	$40 copay	$30/$15 OP/PR copay	$50/$75 copay for Lower/Higher Tier		20% coinsurance			$0 deduct 1 exam/2cleanings	$15 copay; $100 limit	$15 copay; $125 limit	$15 copay; $100 limit		Silver Sneakers		$15 copay	$0 copay	$15 copay	$15 copay	$0 copay	20% coinsurance	$15 copay	$15 copay	20% coinsurance		175	175	120	0	100	0.2	0.2	50	150	0	59.01658032	150	0.2	15	5	15	40	25.11582986	52.66871794	0	0.2	0	0	0	15	15	15	0	0	0	15	0	15	15	0	0.2	15	15	0.2	0	NO	76.63662712	60.93141246	109.6389812	0	91.36581766	0.182731635	0.182731635	45.68290883	137.0487265	0	53.92098116	137.0487265	0.182731635	13.70487265	4.568290883	13.70487265	36.54632706	22.94728331	48.12120479	0	0.182731635	0	0	0	15	15	15	0	0	0	13.70487265	0	13.70487265	13.70487265	0	0.182731635	13.70487265	13.70487265	0.182731635	0		7.9974	0.397020601	3.609963863	0	0.697418126	2.128877807	0.19726949	1.08600635	4.241566675	0	3.634195743	0.963545913	7.80E-05	0.137239463	1.212249628	3.829533977	0.139270352	2.678126355	8.388819	0	7.931662232	0	0	0	0.378	0.299	0.162	0	0	0	3.64E-05	0	0.260818036	0.420615201	0	0.180509012	0.681594061	0.02905704	2.311212848	0	53.9931		5.094047665	7.9974	0.397020601	3.609963863	0	0.697418126	2.128877807	0.19726949	1.08600635	4.241566675	0	3.634195743	0.963545913	7.80E-05	0.137239463	1.212249628	3.829533977	0.139270352	2.678126355	8.388819	0	7.931662232	0	0	0	0.378	0.299	0.162	0	0	0	3.64E-05	0	0.260818036	0.420615201	0	0.180509012	0.681594061	0.02905704	2.311212848	0	53.9931	YES	$250/day (days 1-5)	$250/day (days 1-5)	25% Coinsurance	$0 copay	$100 copay	25% Coinsurance	25% Coinsurance	$50 copay	$225 copay	$0 copay	25% Coinsurance	$225 copay	20% Coinsurance	$25 copay	$15 copay	$25 copay	$50 copay	$50/$25 OP/PR copay	25% Coinsurance		20% Coinsurance			20% Coinsurance	$25 copay; $100 limit	$25 copay; $125 limit	$25 copay; $100 limit		Silver Sneakers		$25 copay	$0 copay	$25 copay	$25 copay	$0 copay	20% coinsurance	$25 copay	$25 copay	20% coinsurance		3850	3.8634	0.2177	0.9935		0.9504	0.7006	0.0382	0.2477	1.2261		1.1392	0.2683	0.0015	0.0687	0.8035	0.9884	0.0415	0.7607	3.3874		1.1358			0.4278	0.1575	0.1246	0.0675	0			0.0012		0.5148	0.1742		0.2814	0.1404	0.0184	0.4166		19.1569		1.740822236	11.8608	0.614762498	4.60344692	0	1.647796666	2.829488702	0.235422681	1.333710763	5.467703522	0	4.773438682	1.231844356	0.001560233	0.205934233	2.015797301	4.81789792	0.180724556	3.438859377	11.77622422	0	9.067470385	0	0	0.427773279	0.5355	0.423583333	0.2295	0	0	0	0.001188496	0	0.775611221	0.594817116	0	0.461896067	0.821944185	0.047480802	2.72778965	0	73.1499
H5530_804_0	2010	6	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	220.2965545	2.522249282	49.29506486	28.65443657	7.930736833	13.96479349	3.452759198	7.736972294	37.29014657	3.086472472	16.61751006	0	0.040460286	15.66072173	32.59051583	77.44153466	0.919080972	3.62089214	20.82762898	25.86433846	6.041636989	1.054501277	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.080128952	0.080128952	0.18407524	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080128952	0.080128952	0.18407524	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.6521	0.202105192	9.074000872	0	1.847861682	3.253796883	0.804492893	1.802714545	8.688604151	0.719148086	3.871879844	0	0.009427247	3.648948163	7.593590189	18.04387758	0.214145866	0.843667869	4.852837552	6.026390862	1.407701418	0.245698798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.803	0	0	17.6521	0.202105192	9.074000872	0	1.847861682	3.253796883	0.804492893	1.802714545	8.688604151	0.719148086	3.871879844	0	0.009427247	3.648948163	7.593590189	18.04387758	0.214145866	0.843667869	4.852837552	6.026390862	1.407701418	0.245698798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.803	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.0941	0.0812	3.3065	0	0.637	1.1261	0.2784	0.7227	3.0656	0.4705	1.4616	0	0.0045	1.7939	3.108	7.7378	0.1022	0.4038	2.2538	2.6858	0.5741	0.1003	0	0	0	0	0	0	0	0											37.0079	0	0	24.7462	0.283327562	12.38045948	0	2.484894408	4.379871738	1.082911999	2.525434414	11.75418567	1.189655677	5.333470479	0	0.013957181	5.442876472	10.70155066	25.78171691	0.316320221	1.247443218	7.106621786	8.712163616	1.981781863	0.346034234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8109
H5530_805_0	2010	5	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	220.2965545	2.522249282	49.29506486	28.65443657	7.930736833	13.96479349	3.452759198	7.736972294	37.29014657	3.086472472	16.61751006	0	0.040460286	15.66072173	32.59051583	77.44153466	0.919080972	3.62089214	20.82762898	25.86433846	6.041636989	1.054501277	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.080128952	0.080128952	0.18407524	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080128952	0.080128952	0.18407524	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.6521	0.202105192	9.074000872	0	1.847861682	3.253796883	0.804492893	1.802714545	8.688604151	0.719148086	3.871879844	0	0.009427247	3.648948163	7.593590189	18.04387758	0.214145866	0.843667869	4.852837552	6.026390862	1.407701418	0.245698798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.803	0	0	17.6521	0.202105192	9.074000872	0	1.847861682	3.253796883	0.804492893	1.802714545	8.688604151	0.719148086	3.871879844	0	0.009427247	3.648948163	7.593590189	18.04387758	0.214145866	0.843667869	4.852837552	6.026390862	1.407701418	0.245698798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.803	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.0941	0.0812	3.3065	0	0.637	1.1261	0.2784	0.7227	3.0656	0.4705	1.4616	0	0.0045	1.7939	3.108	7.7378	0.1022	0.4038	2.2538	2.6858	0.5741	0.1003	0	0	0	0	0	0	0	0											37.0079	0	0	24.7462	0.283327562	12.38045948	0	2.484894408	4.379871738	1.082911999	2.525434414	11.75418567	1.189655677	5.333470479	0	0.013957181	5.442876472	10.70155066	25.78171691	0.316320221	1.247443218	7.106621786	8.712163616	1.981781863	0.346034234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8109
H5530_806_0	2010	5	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	220.2965545	2.522249282	49.29506486	28.65443657	7.930736833	13.96479349	3.452759198	7.736972294	37.29014657	3.086472472	16.61751006	0	0.040460286	15.66072173	32.59051583	77.44153466	0.919080972	3.62089214	20.82762898	25.86433846	6.041636989	1.054501277	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.080128952	0.080128952	0.18407524	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080128952	0.080128952	0.18407524	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.6521	0.202105192	9.074000872	0	1.847861682	3.253796883	0.804492893	1.802714545	8.688604151	0.719148086	3.871879844	0	0.009427247	3.648948163	7.593590189	18.04387758	0.214145866	0.843667869	4.852837552	6.026390862	1.407701418	0.245698798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.803	0	0	17.6521	0.202105192	9.074000872	0	1.847861682	3.253796883	0.804492893	1.802714545	8.688604151	0.719148086	3.871879844	0	0.009427247	3.648948163	7.593590189	18.04387758	0.214145866	0.843667869	4.852837552	6.026390862	1.407701418	0.245698798	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.803	NO	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																				7.0941	0.0812	3.3065	0	0.637	1.1261	0.2784	0.7227	3.0656	0.4705	1.4616	0	0.0045	1.7939	3.108	7.7378	0.1022	0.4038	2.2538	2.6858	0.5741	0.1003	0	0	0	0	0	0	0	0											37.0079	0	0	24.7462	0.283327562	12.38045948	0	2.484894408	4.379871738	1.082911999	2.525434414	11.75418567	1.189655677	5.333470479	0	0.013957181	5.442876472	10.70155066	25.78171691	0.316320221	1.247443218	7.106621786	8.712163616	1.981781863	0.346034234	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8109
H5532_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1275.318574	101.7318124	1223.455996	2272.383004	231.8557939	9.131732298	8.679632674	248.316399	55.74608051	11657.38876	62.57962238	0	0.249773991	18.97153763	6176.529551	6955.133578	420.9630338	592.4379735	0	0	22.8955411	1899.191374	0	0	162.8958271	0	16.06282464	4.536317881	89.34463537	0											4200	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$115 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20%/30% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20%/30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20%/30% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	83.9614622	0	150	0.2	0.136295571	49.53916128	0.285	3	0.19351568	0	0.2	0.222009684	10.36727095	34.99271455	38.5	35	0	0	0.2	33.92708233	0	0	35	0	0	0	0	0											NO	155.0724905	114.3443862	64.77496749	0	115.7226764	0.154296902	0.105149922	38.21869554	0.219873085	2.314453529	0.14929435	0	0.154296902	0.171466177	10.30255872	34.99271455	38.5	27.00195784	0	0	0.154296902	33.92708233	0	0	35	0	0	0	0	0												16.4806	0.969371805	6.604110196	0	2.235914418	1.408998003	0.912662697	0.790860738	12.25706271	2.248373712	9.342784033	0	0.038539353	3.252977031	5.302838197	20.28158367	1.350589733	1.333082098	0	0	3.53271106	5.369501844	0	0	0.475112829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.1876	0	18.21785299	16.4806	0.969371805	6.604110196	0	2.235914418	1.408998003	0.912662697	0.790860738	12.25706271	2.248373712	9.342784033	0	0.038539353	3.252977031	5.302838197	20.28158367	1.350589733	1.333082098	0	0	3.53271106	5.369501844	0	0	0.475112829	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.1876	NO	"$325 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$180 Days 1-100 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$40 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.7961	0.1444	0.763	0.2321	0.1208	0.1141	0.1085	0.0427	0.6968	0.1214	0.6524	0	0.0021	0.1758	1.1711	1.7436	0.1149	0.1486	0	0	0.517	0.4679	0	0	0.0409	0	0.004	0.003	0	0											9.1812	0	0	18.2766	1.113809961	7.367133969	0.232075992	2.356672644	1.523144656	1.021158106	0.833573884	12.95388872	2.369804845	9.995189807	0	0.040620803	3.428798464	6.473899589	22.02519028	1.465449271	1.48172245	0	0	4.04970715	5.837404368	0	0	0.51598275	0	0.004030099	0.00298442	0	0	0	0	0	0	0	0	0	0	0	0	103.3689
H5532_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	229.3813332	4.602412366	34.64829811	1952.868861	7.007897587	8.087563901	8.009356961	20.42864053	50.4479654	22.33207935	65.24201836	0	0.287216791	14.31480843	29.89522775	136.5596617	2.206596628	4.994761711	0	0	27.06918244	9.074634744	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085700544	0.085700544	0.16081643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085700544	0.085700544	0.16081643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.6581	0.394429243	5.572015615	0	1.632840138	1.884402389	1.866180172	4.759873244	11.75437594	5.20337449	15.20139028	0	0.066921512	3.335350365	6.965588065	31.81840118	0.514137014	1.163779479	0	0	6.307119509	2.114389895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2127	0	0	19.6581	0.394429243	5.572015615	0	1.632840138	1.884402389	1.866180172	4.759873244	11.75437594	5.20337449	15.20139028	0	0.066921512	3.335350365	6.965588065	31.81840118	0.514137014	1.163779479	0	0	6.307119509	2.114389895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2127	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.0346	0.0208	0.2322	0	0.068	0.0785	0.0778	0.1983	0.4898	0.2168	0.6334	0	0.0028	0.139	0.5243	2.3949	0.0387	0.0876	0	0	0.4747	0.1591	0	0	0	0	0	0	0	0											6.8713	0	0	20.6927	0.415188676	5.804182932	0	1.700875143	1.962919155	1.943937679	4.958201296	12.2441416	5.42018176	15.83478154	0	0.069709909	3.474323297	7.489879639	34.2133346	0.552835499	1.251375783	0	0	6.781848934	2.273537522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.084
H5532_802_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	229.3813332	4.602412366	34.64829811	1952.868861	7.007897587	8.087563901	8.009356961	20.42864053	50.4479654	22.33207935	65.24201836	0	0.287216791	14.31480843	29.89522775	136.5596617	2.206596628	4.994761711	0	0	27.06918244	9.074634744	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085700544	0.085700544	0.16081643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085700544	0.085700544	0.16081643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.6581	0.394429243	5.572015615	0	1.632840138	1.884402389	1.866180172	4.759873244	11.75437594	5.20337449	15.20139028	0	0.066921512	3.335350365	6.965588065	31.81840118	0.514137014	1.163779479	0	0	6.307119509	2.114389895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2127	0	0	19.6581	0.394429243	5.572015615	0	1.632840138	1.884402389	1.866180172	4.759873244	11.75437594	5.20337449	15.20139028	0	0.066921512	3.335350365	6.965588065	31.81840118	0.514137014	1.163779479	0	0	6.307119509	2.114389895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2127	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.0346	0.0208	0.2322	0	0.068	0.0785	0.0778	0.1983	0.4898	0.2168	0.6334	0	0.0028	0.139	0.5243	2.3949	0.0387	0.0876	0	0	0.4747	0.1591	0	0	0	0	0	0	0	0											6.8713	0	0	20.6927	0.415188676	5.804182932	0	1.700875143	1.962919155	1.943937679	4.958201296	12.2441416	5.42018176	15.83478154	0	0.069709909	3.474323297	7.489879639	34.2133346	0.552835499	1.251375783	0	0	6.781848934	2.273537522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.084
H5532_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	229.3813332	4.602412366	34.64829811	1952.868861	7.007897587	8.087563901	8.009356961	20.42864053	50.4479654	22.33207935	65.24201836	0	0.287216791	14.31480843	29.89522775	136.5596617	2.206596628	4.994761711	0	0	27.06918244	9.074634744	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085700544	0.085700544	0.16081643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085700544	0.085700544	0.16081643	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.6581	0.394429243	5.572015615	0	1.632840138	1.884402389	1.866180172	4.759873244	11.75437594	5.20337449	15.20139028	0	0.066921512	3.335350365	6.965588065	31.81840118	0.514137014	1.163779479	0	0	6.307119509	2.114389895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2127	0	0	19.6581	0.394429243	5.572015615	0	1.632840138	1.884402389	1.866180172	4.759873244	11.75437594	5.20337449	15.20139028	0	0.066921512	3.335350365	6.965588065	31.81840118	0.514137014	1.163779479	0	0	6.307119509	2.114389895	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2127	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												1.0346	0.0208	0.2322	0	0.068	0.0785	0.0778	0.1983	0.4898	0.2168	0.6334	0	0.0028	0.139	0.5243	2.3949	0.0387	0.0876	0	0	0.4747	0.1591	0	0	0	0	0	0	0	0											6.8713	0	0	20.6927	0.415188676	5.804182932	0	1.700875143	1.962919155	1.943937679	4.958201296	12.2441416	5.42018176	15.83478154	0	0.069709909	3.474323297	7.489879639	34.2133346	0.552835499	1.251375783	0	0	6.781848934	2.273537522	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.084
H5533_002_0	2010	10	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			S	P	T				V														0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0				0														0	YES	397.1429732	9.558916261	1146.697385		370.923692	21.24423253	0	2873.811055	1170.082342		9321.326982	553.6404644		5609.438666	43175.22596	9259.744118	57.50028166	2292.986937			3818.308582	795.8197393	0				3.266056608														3200	1A: $100/stay - $200 annual max	1B: $100/stay - $200 annual max	"2: $25/day days 1-10, $60/day days 11-60, $0/day days 61-100 - $3200 annual max"	6: $0	10a:  $100 per Trip	11a: 20% coinsurance	"11b: 20% coinsurance & $0 supplies; Diabetic supplies refer to row ""k"""	4A: $50; 4B: $50	9A: $60 - $120 combined max; 9B: $60 - $120 combined max	8a: $0	"8B: $20 x-rays, $50 advanced imaging, $0 ther rad; $200 annual max"	$100 observation stay copay - no PBP code - $200 annual max; 5: $0	12: $0	3: $0; 5: $0; 7C: $20; 7I: $20; 9C: $30; 9D: $0	7A: $5; 14B: $0; 14C: $5; 14D: $0; 14E: $0; 14F: $0-$60; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7a: $30; 7b: $30; 7d: $30; 7f: $30; 7g: $30, 14a: $30; 16b: $30 (Medicare-covered); 17a: $30 (Medicare-covered); 18a: $30 (Medicare-covered)"	7e: $30; 7h: $30; 9c: $30	7c: $20; 7i: $20			"15: $5 per drug, per visit and in pharmacy $30 copay (31-day supply)"	11c: $15/$45 copay supplies; 13a: $0	10b: not covered	16a: not covered; 16b: routine not covered	17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)	18a: $30	"18b: $1,000 per 3 yrs combined IN & OON allowance"	14a: $0 copay	13b: not covered											78.6836163	82.23214286	44.29659529		53.72150525	0.173756583	0	6.820603021	13.87879523		6.391974852	0.340131368		2.175008869	0.42624238	16.02031313	0.00802583	17.46690832			5	18.2423415	0				11.89285714														NO	77.51691662	81.01282657	43.63977718		52.92493709	0.171180166	0	6.719468938	13.67300415		6.297196353	0.335087991		2.142758417	0.419922172	15.78276819	0.007906825	17.20791366			4.925861333	17.97184892	0				11.71651303															2.5654	0.064532902	4.170134864	0	1.635926089	3.636591258	0	1.60920701	1.333211727	0	4.891518857	0.015459856	0	1.001639326	1.510852887	12.17869958	3.79E-05	3.288126769	0	0	1.56737155	1.191862677	0	0	0	0	0.0031889	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6638	0	0.735084573	2.5654	0.064532902	4.170134864	0	1.635926089	3.636591258	0	1.60920701	1.333211727	0	4.891518857	0.015459856	0	1.001639326	1.510852887	12.17869958	3.79E-05	3.288126769	0	0	1.56737155	1.191862677	0	0	0	0	0.0031889	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6638	NO	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	50% coinsurance	50% coinsurance	$50 Copay	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	$45 copay	$45 copay	$45 copay	20% coinsurance			20% coinsurance	50% coinsurance	not covered	no routine exams	$250 limit/2 yrs for glasses and exam (combined IN and OON)	$250 limit/2 yrs for glasses and exam (combined IN and OON)	45	"50% and $1,000 per 3 yrs combined IN & OON allowance"	0.5	not covered												1.5569	0	0.0292		0.4847	0.1362	0	0.1399	0.1266	0.1107	0.3654	0	0.1399	0.9481	0.5575	0.9502	0.0221	0.3997	0	0	0.0193	0	0						0												5.9867	250	0.108221581	4.1224	0.064532902	4.199341608	0	2.120621788	3.77278277	0	1.749114373	1.4598111	0.110742459	5.256934498	0.015459856	0.139907363	1.949764064	2.068374202	13.12894938	0.022186578	3.687838931	0	0	1.586666304	1.191862677	0	0	0	0	0.0031889	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6505
H5533_003_0	2010	7	N/A																															Ded	Ded	Ded	Ded	Ded	Ded	Ded	V	Ded	Ded	Ded	Ded	Ded	Ded	V	Ded	Ded	Ded	Ded	Ded	Ded	Ded				Ded															11.7592	0.5291	0.5278	1.799	3.2035	5.083	0	0	8.3275	0	26.5323	2.4694	0.034	15.9124	0.0305	28.0152	0.0183	1.7935	0	0.0526	1.9467	1.8771	0	0	0	1.1956		0	0	0.1054											111.2122	NO	383.7745238	15.09847202	1304.520999	276.3710599	314.4454986	1142.995548	0	1525.985508	1028.113469	0	7603.455679	1880.038272	12.33119602	4457.660346	26817.06271	11259.85635	72.64682876	889.5885654	0	50.73214886	677.3935062	777.9819119	0	0	0	515.1573679		0	0	97.24220344												1A: $0	1B: $0	2: $0/day days 1-100	6: $0	10A: $0	11A: 0%	"11B: 0% prosthetics, $0 medical supplies; 11C: $0 training"	4A: $50; 4B: $50	9A: $0; 9B: $0	8A: $0 labs	"8B: $0 x-rays, $0 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $0; 7I: $0; 9C: $0; 9D: $0	7A: $16; 14B: $0; 14C: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $0; 7D: $0; 7F, 7G: $0; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $0"	"7E: $0; 7H, 9C: $0"	"7I, 7C: $0"			15: 0%	13A: $0; 16B: $0; 17A: $0			17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)			14A: $0												0	0	0	0	0	0	0	20.61209412	0	0	0	0	0	0	2.293323332	0	0	0	0	0	0	0	0	0	0	0		0	0	0											NO	0	0	0	0	0	0	0	20.61207351	0	0	0	0	0	0	2.293323332	0	0	0	0	0	0	0	0	0	0	0		0	0	0												0	0	0	0	0	0	0	2.621143789	0	0	0	0	0	0	5.125016301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	7.7462	2000	0.01	11.7592	0.529148755	0.52780838	1.79900497	3.20354298	5.083015355	0	2.621143789	8.327514911	0	26.53225327	2.469410989	0.034002222	15.9124476	5.155499819	28.01520446	0.018251046	1.793547695	0	0.052598327	1.946677239	1.877052285	0	0	0	1.195570587	0	0	0	0.105402107	0	0	0	0	0	0	0	0	0	0	118.9583	YES	1A: 20%	1B: 20%	2: 20%	6: 20%	10A: 20%	11A: 50%	11B: 50%; 11C: 50%	4A: $50; 4B: $50	9A: 20%; 9B: 20%	8A: 20%	8A: 20%; 8B: 20%	9A: 20%; 9B: 20%	12: 20%	3: 20%; 5: 20%; 7C: 20%; 7I: 20%; 9C: 20%	7A: 20%; 14B: $0; 14C: 20%; 14D: 20%; 14E: 20%; 14F:20%; 14G: 20%; 14H: $20%; 14I: 50%; 14J: 50%	7B: 20%; 7D: 20%; 7F: 20%; 14B: $0; 14D: 20%; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 50%; 14J: 50%; 18A: 20%	7E: 20%; 7H: 20%	7C: 20%; 7I: 20%	8A: 20%; 8B: 20%	8A: 20%; 7d: 20%	15: 20%	13A: 20%; 16B: $20%; 17A: 20%		16A: no routine exams; 16B: 20%	17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)			14A: $50%												3400	0.49	0.022	0.022	0.075	0.1335	0.2118	0	0.8588	0.347	0	1.1055	0.1029	0.0014	0.663	0.0891	1.1673	0.0008	0.0747	0	0.0022	0.0811	0.0782	0.0004	0	0	0.0498		0	0	0											5.5765	2000	0	12.2492	0.55119662	0.549800396	1.87396351	3.337023938	5.294807661	0	3.479981044	8.674494699	0	27.63776382	2.572303113	0.035418981	16.57546625	5.244617458	29.18250465	0.019011506	1.868278849	0	0.054789924	2.02778879	1.955262797	0.000414932	0	0	1.245386028	0	0	0	0.105402107	0	0	0	0	0	0	0	0	0	0	124.5349
H5533_801_0	2010	3	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			coin	P	T	V			V														0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0	0			0														0	NO	334.7358452	7.015108423	1341.351552		283.5278271	21.13667256	0	1329.454435	1094.978		9469.937231	1793.340458		4228.876834	33739.83327	8681.772993	40.75038732	1447.824608			44.39229173	805.2811616	57.89142325	332.2100585			1.500536872															"1a:  $150 per Admit,"	"1b:  $150 per Admit,"	2:  $60 days 11-50		10a:  $75 per Trip	11a:  20% Coinsurance	11b:  20% Coinsurance	"4a,b:  $50 Copay"	"9a,b:  $100 Copay,"		8b:  $10/$50 Copay depending on type of Service	"9a:  $150 Observation copay- no PBP code,"		"7c,i:  $25 Copay"	"7a, 14c:  $15 Copay"	"7a,b,d,f,g 14a, 16b, 17a, 18a:  $25 Copay"	"7e,h 9c:  $25 Copay"	"7c,i:  $25 Copay"			15: 20% Coinsurance	11c:  $20/$60 Copay per 31/90 day supply	10a:  $75 per Trip	"16a: $25 copay, 16b: 20%"			18a:  $25 copay														123.9057617	130.3522388	36.8154033		66.24	0.170737494	0	9.491746221	22.08		3.840937673	8.64		1.293394856	1.585829283	14.44709283	23.52	23.04			0.192	56.85925455	38.16	16.99629482			20.57142857														NO	122.0685201	128.4194106	36.26951431		65.25781094	0.168205844	0	9.351005139	21.75260365		3.783985273	8.511888383		1.274216741	1.562315029	14.23287519	23.17125171	22.69836902			0.189153075	56.01616068	37.59417369	16.74427829			20.26640091															3.4051	0.075073007	4.054180777	0	1.541867111	3.555311856	0	1.035977938	1.984885203	0	2.986175251	1.272059484	0	0.449042138	4.392687383	10.29721595	0.078686457	2.738604769	0	0	8.396938494	3.759063245	0.181365018	0.463551473	0	0	0.002534207	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6703	0	0.914198233	3.4051	0.075073007	4.054180777	0	1.541867111	3.555311856	0	1.035977938	1.984885203	0	2.986175251	1.272059484	0	0.449042138	4.392687383	10.29721595	0.078686457	2.738604769	0	0	8.396938494	3.759063245	0.181365018	0.463551473	0	0	0.002534207	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6703	YES	20% coinsurance	20% coinsurance	20% coinsurance		20% coinsurance	50% coinsurance	50% coinsurance	$50 Copay	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	50% coinsurance			50% coinsurance		50% coinsurance												3400	0.1473	0.0032	0.1754		0.0667	0.1538	0	0.0448	0.0859	0	0.1292	0.055	0	0.0194	0.19	0.4455	0.0034	0.1185	0	0	0.3633	0.1626	0.0078	0.0201			0.0001		0												2.1921	500	0.039549281	3.5524	0.078320753	4.229569363	0	1.60857008	3.70911879	0	1.080795551	2.07075365	0	3.115360673	1.32709026	0	0.468468225	4.582720159	10.74268552	0.082090525	2.857080003	0	0	8.760199841	3.921684703	0.189211081	0.48360525	0	0	0.00264384	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8623
H5533_802_0	2010	3	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			coin	P	T	V			V														0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0	0			0														0	NO	440.1133029	5.436162861	1880.732333		304.7200815	25.24732625	0	2567.598137	1123.464732		9845.472138	877.9895991		5239.157599	35839.89623	10070.43462	66.32295409	2872.868834			50.34330701	706.1203438	66.47096518	346.0521443			0.734637844															"1a:  $150 per Admit,"	"1b:  $150 per Admit,"	2:  $60 days 11-50		10a:  $75 per Trip	11a:  20% Coinsurance	11b:  20% Coinsurance	"4a,b:  $50 Copay"	"9a,b:  $100 Copay,"		8b:  $10/$50 Copay depending on type of Service	"9a:  $150 Observation copay- no PBP code,"		"7c,i:  $25 Copay"	"7a, 14c:  $15 Copay"	"7a,b,d,f,g 14a, 16b, 17a, 18a:  $25 Copay"	"7e,h 9c:  $25 Copay"	"7c,i:  $25 Copay"			15: 20% Coinsurance	11c:  $20/$60 Copay per 31/90 day supply	10a:  $75 per Trip	"16a: $25 copay, 16b: 20%"			18a:  $25 copay														101.4721958	136.1632836	35.00327573		38.49027019	0.176154221	0	6.958635647	15.61409357		2.487521384	4.23		1.568265215	1.609145895	14.16829638	11.515	16.28873556			0.2	41.32962934	24.4823473	8.321102671			10.07142857														NO	99.96759314	134.1442907	34.48425649		37.91954672	0.173542253	0	6.855454852	15.38257195		2.45063708	4.167278688		1.545011397	1.585285908	13.95821266	11.34425865	16.04721053			0.197034453	40.71680462	24.11932958	8.197719579			9.922092114															3.6664	0.060769184	5.404638012	0	0.962903947	4.381477879	0	1.466837759	1.440148089	0	2.010639924	0.304902279	0	0.674546517	4.734706871	11.71377233	0.062698729	3.841794249	0	0	9.919365975	2.395913673	0.133602926	0.236403203	0	0	0.000607429	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4122	0	0.963667369	3.6664	0.060769184	5.404638012	0	0.962903947	4.381477879	0	1.466837759	1.440148089	0	2.010639924	0.304902279	0	0.674546517	4.734706871	11.71377233	0.062698729	3.841794249	0	0	9.919365975	2.395913673	0.133602926	0.236403203	0	0	0.000607429	0	0	0	0	0	0	0	0	0	0	0	0	0	53.4122	YES	20% coinsurance	20% coinsurance	20% coinsurance		20% coinsurance	50% coinsurance	50% coinsurance	$50 Copay	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	50% coinsurance			50% coinsurance		50% coinsurance												3400	0.232	0	0		0.4525	0.4904	0	0.0497	0.0441	0.1095	0.0728	0	0.0497	0.2585	0.0965	0.1561	0.0072	0.205	0	0	0.0536	0	0	0			0		0												2.2776	500	0.041092792	3.8984	0.060769184	5.404638012	0	1.41542033	4.871865063	0	1.516573618	1.484235555	0.109477678	2.083466784	0.304902279	0.049735859	0.933039527	4.831193498	11.86989599	0.069891049	4.046754977	0	0	9.972954986	2.395913673	0.133602926	0.236403203	0	0	0.000607429	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6898
H5533_803_0	2010	3	N/A																															A	A	D		T	coin	coin	V	V		P	V		V	V	V	V	V			coin	P	T	V			V														0	0	0		0	0	0	0	0		0	0		0	0	0	0	0			0	0	0	0			0														0	NO	334.7358452	7.015108423	1341.351552		283.5278271	21.13667256	0	1329.454435	1094.978		9469.937231	1793.340458		4228.876834	33739.83327	8681.772993	40.75038732	1447.824608			44.39229173	805.2811616	57.89142325	332.2100585			1.500536872															"1a:  $150 per Admit,"	"1b:  $150 per Admit,"	2:  $60 days 11-50		10a:  $75 per Trip	11a:  20% Coinsurance	11b:  20% Coinsurance	"4a,b:  $50 Copay"	"9a,b:  $100 Copay,"		8b:  $10/$50 Copay depending on type of Service	"9a:  $150 Observation copay- no PBP code,"		"7c,i:  $25 Copay"	"7a, 14c:  $15 Copay"	"7a,b,d,f,g 14a, 16b, 17a, 18a:  $25 Copay"	"7e,h 9c:  $25 Copay"	"7c,i:  $25 Copay"			15: 20% Coinsurance	11c:  $20/$60 Copay per 31/90 day supply	10a:  $75 per Trip	"16a: $25 copay, 16b: 20%"			18a:  $25 copay														123.9057617	130.3522388	36.8154033		66.24	0.170737494	0	9.491746221	22.08		3.840937673	8.64		1.293394856	1.585829283	14.44709283	23.52	23.04			0.192	56.85925455	38.16	16.99629482			20.57142857														NO	122.0685201	128.4194106	36.26951431		65.25781094	0.168205844	0	9.351005139	21.75260365		3.783985273	8.511888383		1.274216741	1.562315029	14.23287519	23.17125171	22.69836902			0.189153075	56.01616068	37.59417369	16.74427829			20.26640091															3.4051	0.075073007	4.054180777	0	1.541867111	3.555311856	0	1.035977938	1.984885203	0	2.986175251	1.272059484	0	0.449042138	4.392687383	10.29721595	0.078686457	2.738604769	0	0	8.396938494	3.759063245	0.181365018	0.463551473	0	0	0.002534207	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6703	0	0.914198233	3.4051	0.075073007	4.054180777	0	1.541867111	3.555311856	0	1.035977938	1.984885203	0	2.986175251	1.272059484	0	0.449042138	4.392687383	10.29721595	0.078686457	2.738604769	0	0	8.396938494	3.759063245	0.181365018	0.463551473	0	0	0.002534207	0	0	0	0	0	0	0	0	0	0	0	0	0	50.6703	YES	20% coinsurance	20% coinsurance	20% coinsurance		20% coinsurance	50% coinsurance	50% coinsurance	$50 Copay	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	20% coinsurance	50% coinsurance			50% coinsurance		50% coinsurance												3400	0.1473	0.0032	0.1754		0.0667	0.1538	0	0.0448	0.0859	0	0.1292	0.055	0	0.0194	0.19	0.4455	0.0034	0.1185	0	0	0.3633	0.1626	0.0078	0.0201			0.0001		0												2.1921	500	0.039549281	3.5524	0.078320753	4.229569363	0	1.60857008	3.70911879	0	1.080795551	2.07075365	0	3.115360673	1.32709026	0	0.468468225	4.582720159	10.74268552	0.082090525	2.857080003	0	0	8.760199841	3.921684703	0.189211081	0.48360525	0	0	0.00264384	0	0	0	0	0	0	0	0	0	0	0	0	0	52.8623
H5549_001_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	979.2221368		77.7899023		40.65222302	40.41355097		11.86263592	28.00037727	83.70656447					463.2699011						16.37625363	19.18282434																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	"Medicare Cost Share, Worldwide Coverage - $1,200/yr"	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	"Medicare Cost Share, Annual Physical, Routine Podiatry"	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share				"$120 for frames, plus the cost of standard lenses"				"OTC - $25/month, Respite - 1 day per month capped @ 7 days"											0.061567114		0.144638709		0.2	0.2		0.2	0.2	0.2					0.2						0.2	0.2																			NO	0.061567114		0.144638709		0.2	0.2		0.2	0.2	0.2					0.2						0.2	0.2																				60.2879	0	11.25143103	0	8.130444604	8.082710194	0	2.372527184	5.600075453	16.74131289	0	0	0	0	92.65398022	0	0	0	0	0	3.275250726	3.836564868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	212.2322	0	0	60.2879	0	11.25143103	0	8.130444604	8.082710194	0	2.372527184	5.600075453	16.74131289	0	0	0	0	92.65398022	0	0	0	0	0	3.275250726	3.836564868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	212.2322	NO																																																																																		0	0	0	60.2879	0	11.25143103	0	8.130444604	8.082710194	0	2.372527184	5.600075453	16.74131289	0	0	0	0	92.65398022	0	0	0	0	0	3.275250726	3.836564868	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	212.2322
H5549_002_0	2010	3	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	777.0921147		68.23156584		34.09905259	30.04993942		9.901584377	27.87598428	73.44824788					386.0883525						13.71299694	15.50621215																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	"Medicare Cost Share, Worldwide - $1,200/yr"	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	"Medicare Cost Share, Annual Physical, Routine Podiatry"	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	4 roundtrips/qtr	Enhanced Dental - $3000 cap for comp. services		"$120 for frames, plus cost of standard lenses"			Health Club	"OTC - $65/month, Audiology - $1000/3 yrs"											0.061567114		0.144638709		0.2	0.2		0.2	0.2	0.2					0.2						0.2	0.2																			NO	0.061567114		0.144638709		0.2	0.2		0.2	0.2	0.2					0.2						0.2	0.2																				47.8433	0	9.868925589	0	6.819810518	6.009987883	0	1.980316875	5.575196856	14.68964958	0	0	0	0	77.2176705	0	0	0	0	0	2.742599389	3.10124243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	175.8487	0	0	47.8433	0	9.868925589	0	6.819810518	6.009987883	0	1.980316875	5.575196856	14.68964958	0	0	0	0	77.2176705	0	0	0	0	0	2.742599389	3.10124243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	175.8487	NO																																																																																		0	0	0	47.8433	0	9.868925589	0	6.819810518	6.009987883	0	1.980316875	5.575196856	14.68964958	0	0	0	0	77.2176705	0	0	0	0	0	2.742599389	3.10124243	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	175.8487
H5549_003_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	YES								12.63925022						17.03354953	109.6506991		8.103480406	28.59481593																							3400	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																										0.486287541						0.055248178	0.052780666		0.207237355	0.154570968																							NO								0.485229806						0.055128007	0.052665861		0.206786588	0.154234757																								0	0	0	0	0	0	0	6.132940933	0	0	0	0	0	0.939025635	5.774848503	0	1.675691065	4.410314485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9328	0	0.041270958	0	0	0	0	0	0	0	6.132940933	0	0	0	0	0	0.939025635	5.774848503	0	1.675691065	4.410314485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9328	NO																																																																																		0	0	0	0	0	0	0	0	0	0	6.132940933	0	0	0	0	0	0.939025635	5.774848503	0	1.675691065	4.410314485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.9328
H5549_004_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	V	V	V	V	V	Coin	V	Coin	Coin																																																											0	YES	2263.794878	188.2355144	1176.957618		291.4911741	8.835904307	8.963015854	207.8840953	210.3140287	30.01573688	13.66808735	3.116576378	0.907394697	1830.753995		6927.661836	1504.406171	2637.337066	52.11350841	3.388711493	26.05169413	0.357323788																			3400	$150 per day 1-6	$150 per day 1-6	"$0 Days 1-20, $75 Days 21-100"		50	0.2	0.2	"ER - $50, UC $25, Worldwide coverage - $1,200/yr"	200	0.2	0.2	0.2	0.2	0.2	"$0, 1 Routine Physical/yr"	25	25	25	0.2	25	0.2	0.2		$1000 cap for prev. and comp. services		"$120 for frames, plus cost of standard lenses"															116.7	116.7	23.325		50	0.2	0.2	45	200	0.2	0.2	0.2	0.2	38.80968444		25	27.10131197	25	0.2	25	0.2	0.2																			NO	87.05393405	87.05393405	17.39959736		37.29817226	0.149192689	0.149192689	33.56835503	149.192689	0.149192689	0.149192689	0.149192689	0.149192689	28.95060591		18.64908613	20.21658804	18.64908613	0.149192689	18.64908613	0.149192689	0.149192689																				16.4227	1.365553505	1.706549054	0	0.906007335	1.318252324	1.337216437	0.58152726	2.614776291	4.478128498	2.039178705	0.46497041	0.135376655	4.416786453	0	10.76621352	2.53449665	4.098660507	7.774954454	0.005266364	3.886722301	0.053310097	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9066	0	22.78493804	16.4227	1.365553505	1.706549054	0	0.906007335	1.318252324	1.337216437	0.58152726	2.614776291	4.478128498	2.039178705	0.46497041	0.135376655	4.416786453	0	10.76621352	2.53449665	4.098660507	7.774954454	0.005266364	3.886722301	0.053310097	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9066	NO																																																																																		0	0	0	16.4227	1.365553505	1.706549054	0	0.906007335	1.318252324	1.337216437	0.58152726	2.614776291	4.478128498	2.039178705	0.46497041	0.135376655	4.416786453	0	10.76621352	2.53449665	4.098660507	7.774954454	0.005266364	3.886722301	0.053310097	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9066
H5575_005_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	430.9358489	24.58033362	299.4957858	11.20161924	57.10992199	6.150073012	29.94705496	24.24684992	14.79851423	12.16400961	8.59896025	0.742081089	1.132247435	106.9208794	85.06092023	132.6201206	9.17265818	1.032292721	26.55941701	45.77480867	8.98897771	4.277143281	20.2658461	0	0	0	0	0	0	0												1A IP Acute: Medicare Cost Sharing	1B IP Psych: Medicare Cost Sharing	2 SNF: $0	6 Home Health: Medicare Cost Sharing	10A Ambulance: Medicare Cost Sharing	11A DME: Medicare Cost Sharing	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Medicare Cost Sharing"	"4A ER, 4B Urgent Care: Medicare Cost Sharing"	9B ASC Services: Medicare Cost Sharing	8A OP Diagnostic Procedures/Tests: Medicare Cost Sharing	8B OP Radiology: Medicare Cost Sharing	9A OP Hospital: Medicare Cost Sharing	12 Renal Dialysis: Medicare Cost Sharing	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Medicare Cost Sharing"	"7A PCP, 14C Physical Exams: $0, 14B Immunizations,14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Medicare Cost Sharing"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Medicare Cost Sharing"	"7E Mental Health, 7H Psychiatric: Medicare Cost Sharing"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Medicare Cost Sharing"	7D Physician Specialist (Radiology): Medicare Cost Sharing	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Medicare Cost Sharing"	15 Part B Drugs: Medicare Cost Sharing	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Medicare Cost Sharing"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											0.080428735	0.080451206	0	0	0.233013317	0.232999993	0.232996801	0.232952311	0.232999996	0.233065112	0.232888475	0.232999735	0.232999987	0.232992326	0	0.233004835	0.233007351	0.232979456	0.232996231	0.232197911	0.233001771	0.232999186	0	0	0	0	0	0	0	0											NO	0.080428735	0.080451206	0	0	0.233013317	0.232999993	0.232996801	0.232952311	0.232999996	0.233065112	0.232888475	0.232999735	0.232999987	0.232992326	0	0.233004835	0.233007351	0.232979456	0.232996231	0.232197911	0.233001771	0.232999186	0	0	0	0	0	0	0	0												34.6596	1.977517483	0	0	13.30737234	1.432966971	6.977568013	5.648359733	3.44805375	2.835006257	2.002598742	0.172904697	0.263813637	24.91174444	0	30.90112926	2.137296788	0.240502997	6.188244072	10.62881495	2.094447722	0.996570904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.8245	0	0	34.6596	1.977517483	0	0	13.30737234	1.432966971	6.977568013	5.648359733	3.44805375	2.835006257	2.002598742	0.172904697	0.263813637	24.91174444	0	30.90112926	2.137296788	0.240502997	6.188244072	10.62881495	2.094447722	0.996570904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.8245	NO	1A IP Acute:	1B IP Psych:	2 SNF:	6 Home Health:	10A Ambulance:	11A DME:	"11B Prosthetics/Medical Supplies: , 11C Diabetes Monitoring Supplies:"	"4A ER: , 4B Urgent Care:"	9B ASC Services:	8A OP Diagnostic Procedures/Tests:	8B OP Radiology:	9A OP Hospital:	12 Renal Dialysis:	"3 CORF: , 5 Partial Hosp: , 9C OP Substance Abuse: , 9D Cardiac Rehab:"	"7A PCP: , 14B Immunizations: , 14C Physical Exams: , 14D Pap Smears and Pelvic Exams: , 14E Prostate Screening: , 14F Colorectal Screening: , 14G Bone Mass Measurement: , 14H Mammography: , 14I Diabetes Monitoring: , 14J Nutrition Therapy:"	"7B Chiropractic: , 7D Physician Specialist (excl. Radiology): , 7F Podiatry:"	"7E Mental Health: , 7H Psychiatric:"	"7C Occupational Therapy: , 7I Physical and Speech Therapy:"	7D Physician Specialist (Radiology):	"7G Other Health Care: , 18A Hearing Exams (Medicare Covered):"	15 Part B Drugs:	"13A Blood: , 16B Comprehensive Dental (Medicare Covered): , 17A Routine Eye Exams (Medicare Covered):"	10B Transportation:	"16A Preventative Dental Services (Non Medicare Covered): , 16B Comprehensive Dental (Non Medicare Covered):"	17A Routine Eye Exams (Non Medicare Covered):	17B Eye Wear (Medicare Covered):	18A Routine Hearing Exams (Non Medicare Covered):	18B Hearing Aids (Non Medicare Covered):	14A Health Education/Wellness Program:	"13B Acupuncture: , 13C Other 1 Copay, 13D Other 2 Copay, 13E Other 3 Copay"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	34.6596	1.977517483	0	0	13.30737234	1.432966971	6.977568013	5.648359733	3.44805375	2.835006257	2.002598742	0.172904697	0.263813637	24.91174444	0	30.90112926	2.137296788	0.240502997	6.188244072	10.62881495	2.094447722	0.996570904	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.8245
H5575_006_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1686.78	151.02	0	0	1601.18	0	0	287.08	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	1A IP Acute: $25 Per Day for days 1-20	1B IP Psych: $25 Per Day for days 1-20	2 SNF: $0	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	13B Acupuncture: Not Covered											25	25	0	0	50	0	0	49.59453811	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	20.5719273	20.5719273	0	0	41.14385461	0	0	40.8102093	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												2.8917	0.258897705	0	0	5.489893093	0	0	0.976316241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6168	0	2.07	2.8917	0.258897705	0	0	5.489893093	0	0	0.976316241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6168	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.8917	0.258897705	0	0	5.489893093	0	0	0.976316241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6168
H5575_007_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1543.92	127.15	0	0	1494.73	0	0	267.22	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	1A IP Acute: $25 Per Day for days 1-20	1B IP Psych: $25 Per Day for days 1-20	2 SNF: $0	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											25	25	0	0	50	0	0	49.57113988	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	20.8384598	20.8384598	0	0	41.6769196	0	0	41.31944823	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												2.6811	0.220800847	0	0	5.191311836	0	0	0.920115246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.0133	0	1.8	2.6811	0.220800847	0	0	5.191311836	0	0	0.920115246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.0133	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.6811	0.220800847	0	0	5.191311836	0	0	0.920115246	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.0133
H5576_005_0	2010	7	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	Coin	Coin	V	Coin	Coin	V	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	2512.301339	128.6652777	1409.229794	15883.61882	321.7756101	17.00059234	4.903917837	464.2682354	278.7917724	4857.2405	1236.23376	363.7984385	0	18133.08717	5807.540572	5478.601799	2.195523164	4.623991551	6865.735129	83.9224622	10.27669366	0	0	0	795.9673545	0	0	0	11760	0	5867.58351	3.022676441	0	2.602912517	233.9450323	0	140.3874555				3600	$250 per admit	$250 per admit	"$100, 21+"	0	150	0.2	0.2	50	"150, 20% facility allergy services"	0	"0, $150 (max.$300) for major diagnostic radiology services"	0	"0.2, applies to facility and professional"	20% to $350 per day for all services except pain mgmt.	"10, 20% pain mgmt."	"30, 20% for professional allergy & pain mgt"	0.5	0.2	0	E&M services under PCP and specialist	0.2	0.2 Chemo	0		"30, 1 exam/yr"	0	0	0	newsletters		0	0.2	50	150	"150, $150 (max.$300) for major diagnostic radiology services"	30	30				47.66435107	27.78205326	10.39695293	0	150	0.2	0.2	50	150	0	0	0	0.2	0	10	30	0.5	0.2	0	0	0.2	0	0	0	30	0	0	0	0	0	0	0.2	50	150	150	30	30				NO	42.51180224	24.77879437	9.273035229	0	133.7848978	0.178379864	0.178379864	44.59496593	133.7848978	0	0	0	0.178379864	0	8.918993185	26.75697956	0.445949659	0.178379864	0	0	0.178379864	0	0	0	30	0	0	0	0	0	0	0.178379864	50	133.7848978	133.7848978	26.75697956	26.75697956					8.9002	0.265680872	1.088986461	0	3.587393092	3.032563344	0.874760195	1.725335512	3.108177398	0	0	0	0	0	4.316451232	12.21590303	0.979092807	0.824826983	0	0	1.833155214	0	0	0	1.989918386	0	0	0	0	0	0	0.539184612	0	0.029019199	2.608192686	0	0.31302869	0	0	0	48.2319	0	5.604653873	8.9002	0.265680872	1.088986461	0	3.587393092	3.032563344	0.874760195	1.725335512	3.108177398	0	0	0	0	0	4.316451232	12.21590303	0.979092807	0.824826983	0	0	1.833155214	0	0	0	1.989918386	0	0	0	0	0	0	0.539184612	0	0.029019199	2.608192686	0	0.31302869	0	0	0	48.2319	NO	0.2 plus in-network cost share	0	0	0	0.2 plus in-network cost share	0	0	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0	0.2 plus in-network cost share	E&M services under PCP and specialist	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0					1.5747	0	0	0	0.1145	0	0	0	0.1642	0.034	0.0499	0.0015	0	0.1329	0.2367	0.5012	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0012	0.0804	0	0				2.8913	0	0	10.4749	0.265680872	1.088986461	0	3.701930904	3.032563344	0.874760195	1.725335512	3.272392298	0.034038551	0.049867317	0.001476874	0	0.132943347	4.553192092	12.71709884	0.979092807	0.824826983	0	0	1.833155214	0	0	0	1.989918386	0	0	0	0	0	0	0.539184612	0	0.030240352	2.688619287	0	0.31302869	0	0	0	51.1232
H5576_006_0	2010	7	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies and monitoring	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	Coin	Coin	V	V	Coin	V	T	V	V	coin	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	2824.092053	163.4035793	1364.2152	13226.90889	338.4657147	17.04700902	13.52786992	430.074851	384.4974603	4156.944635	1387.121811	270.1717397	0.090383998	13652.01009	6346.135663	5791.690027	1.882901956	5.398615374	7641.54532	18491.25515	16.93517067	0	0	0	602.9475155	1.933557834	0	0	11760	0	4357.509754	2.244764315	0	1.933030295	173.7372393	0	104.2575203				3400	$150 per admit	$150 per admit	"$50, 21+"	0	150	0.2	0.2	50	"100, 20% facility allergy services"	0	"0, $50 copay (max. 2)  for major diagnostic radiology services"	0	"0.2, applies to facility and professional"	20% to $350 per day for all services except pain mgmt.	"5, 20% pain management"	"25, 20% for professional allergy and pain mgt"	0.5	0.2	0	E&M services under PCP and specialist	0.2	0 Chemo	0		"25, 1/yr"	"0.2 , max. $100"	0	0	newsletters		0	0.2	50	"100, 20% facility allergy services"	"50, Max. 2 copays"	25	25				28.59861064	16.66923195	5.198476463	0	150	0.2	0.2	50	100	0	0	0	0.2	0	5	25	0.5	0.2	0	0	0.2	0	0	0	25	0.2	0	0	0	0	0	0.2	50	100	50	25	25				NO	25.91968795	15.10777205	4.711518662	0	135.9490236	0.181265365	0.181265365	45.3163412	90.63268239	0	0	0	0.181265365	0	4.53163412	22.6581706	0.453163412	0.181265365	0	0	0.181265365	0	0	0	25	0.2	0	0	0	0	0	0.181265365	45.3163412	90.63268239	45.3163412	22.6581706	22.6581706					6.1	0.205722002	0.535627115	0	3.834506952	3.090032309	2.452134276	1.624118224	2.904003017	0	0	0	0.016383488	0	2.396530408	10.93575839	0.853262275	0.978581985	0	0	3.06975989	0	0	0	1.256140657	0.386711567	0	0	0	0	0	0.406898022	0	0.014599643	0.656094668	0	0.196857057	0	0	0	41.9137	0	4.16218182	6.1	0.205722002	0.535627115	0	3.834506952	3.090032309	2.452134276	1.624118224	2.904003017	0	0	0	0.016383488	0	2.396530408	10.93575839	0.853262275	0.978581985	0	0	3.06975989	0	0	0	1.256140657	0.386711567	0	0	0	0	0	0.406898022	0	0.014599643	0.656094668	0	0.196857057	0	0	0	41.9137	NO	0.2 plus in-network cost share	0	0	0	0.2 plus in-network cost share	0	0	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0	0.2 plus in-network cost share	E&M services under PCP and specialist	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0					1.7038	0	0	0	0.1184	0	0	0	0.226	0.0351	0.0844	0.0011	0	0.1098	0.2277	0.6296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0007	0.0302	0	0				3.1668	0	0	7.8038	0.205722002	0.535627115	0	3.952902733	3.090032309	2.452134276	1.624118224	3.129979654	0.035121852	0.084359715	0.001096787	0.016383488	0.109774213	2.624228863	11.56536933	0.853262275	0.978581985	0	0	3.06975989	0	0	0	1.256140657	0.386711567	0	0	0	0	0	0.406898022	0	0.015342149	0.686275632	0	0.196857057	0	0	0	45.0805
H5576_007_0	2010	5	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	Coin	coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	T	V	V	V	V	V	V	P	V	Coin	V	V	Coin	V	V																																												0	YES	2107.496138	111.6231854	1480.029778	17983.04781	218.3077074	19.60231711	0.898630127	428.0399012	229.2384776	5933.717433	8.364595344	0.469859745	0	37.10891842	5459.924872	5353.005839	2.423416272	5.016773785	30.36045765	108.1702769	10.92686599	0	0	0	602.9475155	0	0	0	11760	0	7619.353335	3.925097918	0	3.380013277	6.600470551	0	182.3001966				4800	$125 days 1-3	$125 days 1-3	"$125, 21+"	0	150 per day	0.2	0.2	50	"150, 20% for physician pain mgmt and allergy services, 25% all other"	0	"0.25, major diag. rad. Svcs., 20% chemo and radiation treatment"	0.25	0.2	20% to $350 per day for all services except pain mgmt.	"5, 20% pain mgmt."	"35, 20% allergy and pain mgmt."	0.5	"0.2, applied to both facility and professional"	0.25	"E&M codes incl. in PCP, specialist"	"0.2, no charge if in a PCP office"	0.2 Chemo	0	0	"35, 1 per year"	0	0	0	newsletters			"0.2, applied to both facility and professional"	50	"150, 20% for physician  pain mgmt. and allergy services (incl. facility for allergy)"	0.25	35	35				67.07430474	37.05556411	12.99619116	0	150	0.2	0.2	50	150	0	0.25	0.25	0.2	0.25	5	35	0.5	0.2	0.25	0	0.2	0	0	0	35	0	0	0	0	0	0	0.2	50	150	0.25	35	35				NO	60.29469137	37.05556411	11.68258602	0	134.8385755	0.2	0.179784767	44.94619184	134.8385755	0	0.224730959	0.224730959	0.179784767	0.224730959	4.494619184	31.46233429	0.449461918	0.179784767	0.25	0	0.179784767	0	0	0	31.46233429	0	0	0	0	0	0	0.179784767	50	134.8385755	0.224730959	31.46233429	31.46233429					10.5892	0.344688342	1.440881266	0	2.453025024	3.920463421	0.161560008	1.603230293	2.575849148	0	1.879783535	0.105592031	0	8.339522832	2.04502359	14.03483826	1.089233327	0.901939508	7.590114412	0	1.964484061	0	0	0	1.580844691	0	0	0	0	0	0	0.705672816	0	0.037979681	1.483330078	0	0.477965811	0	0	0	65.3253	0	6.01223528	10.5892	0.344688342	1.440881266	0	2.453025024	3.920463421	0.161560008	1.603230293	2.575849148	0	1.879783535	0.105592031	0	8.339522832	2.04502359	14.03483826	1.089233327	0.901939508	7.590114412	0	1.964484061	0	0	0	1.580844691	0	0	0	0	0	0	0.705672816	0	0.037979681	1.483330078	0	0.477965811	0	0	0	65.3253	NO	0.2 plus in-network cost share	0	0	0	0.2 plus in-network cost share	0	0	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0	0.2 plus in-network cost share	"E&M codes incl. in PCP, specialist"	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0					1.3222	0	0	0	0.0819	0	0	0	0.1168	0	0.0768	0.0043	0	0.3408	0.0464	0.3186	0	0	0.1549	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0016	0.0606	0	0				2.525	0	0	11.9114	0.344688342	1.440881266	0	2.534924437	3.920463421	0.161560008	1.603230293	2.692672725	0	1.956601247	0.10990707	0	8.680319022	2.091451522	14.35346956	1.089233327	0.901939508	7.745014706	0	1.964484061	0	0	0	1.580844691	0	0	0	0	0	0	0.705672816	0	0.03956541	1.543946645	0	0.477965811	0	0	0	67.8503
H5576_008_0	2010	5	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				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	V	P	Coin	Coin	V	Coin	Coin	Coin	Coin																																												0	NO	429.9664097	38.9678675	120.3782002	163.5378437	15.44350077	48.36544372	8.384265395	1060.448451	16.52362804	9.730874266	12.04936431	1.126330175	0	101.3020762	36.61161189	27.8658877	6.467029167	2.422109539	33.58916302	109.208799	7.749068921	0	0	14.39535591	4.108232651	4.064391942	0.685755587	7.836866118	11760	0	10.57100558	6.697432042	0	0.164317253	6.970027924	0	0.876349801					std medicare	std medicare	std medicare	std medicare	std medicare	std medicare	std medicare	50	std medicare	std medicare	std medicare	std medicare	std medicare	std medicare	0	std medicare	0.5	std medicare	std medicare	std medicare	std medicare	0.2 Chemo	0	"0.2, oral exam & prophy, 2/ year; 20% coinsurance on each, max of $100 each 6 months, x-ray with 20% coinsurance max of $ 50 /each year"	0.2	"0.2, $100 max,."	"0.2, 1/year"	"0.2, $750 max"	newsletters		std medicare	std medicare	50	std medicare	std medicare	std medicare	std medicare				0.078942311	0.078942311	0.078942311	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.2	0.2	0.2	0.2	0.2	0	0	0.233	0.233	50	0.233	0.233	0.233	0.233				NO	0.078942311	0.078942311	0.078942311	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.2	0.2	0.2	0.2	0.2	0	0	0.233	0.233	50	0.233	0.233	0.233	0.233					33.9425	3.076213526	9.502933351	0	3.598335679	11.26914839	1.953533837	4.418535211	3.850005332	2.267293704	2.807501885	0.262434931	0	23.60338375	0	6.492751834	1.506817796	0.564351523	7.826274984	25.44565016	1.805533059	0	0	2.879071183	0.82164653	0.812878388	0.137151117	1.567373224	0	0	2.463044299	1.560501666	0	0.03828592	1.624016506	0	0.204189504	0	0	0	156.3014	0	0	33.9425	3.076213526	9.502933351	0	3.598335679	11.26914839	1.953533837	4.418535211	3.850005332	2.267293704	2.807501885	0.262434931	0	23.60338375	0	6.492751834	1.506817796	0.564351523	7.826274984	25.44565016	1.805533059	0	0	2.879071183	0.82164653	0.812878388	0.137151117	1.567373224	0	0	2.463044299	1.560501666	0	0.03828592	1.624016506	0	0.204189504	0	0	0	156.3014	NO	0.2 plus in-network	in network cost share	0	0	0.2 plus in-network	0	0	in network cost share	0.2 plus in-network	0.2 plus in-network	0.2 plus in-network	0.2 plus in-network	in network cost share	0.2 plus in-network	0.2 plus in-network	0.2 plus in-network	0	0	0.2 plus in-network	0	in network cost share	0	0	0.2 plus in-network	0.2 plus in-network	0.2 plus in-network	0.2 plus in-network	0.2 plus in-network	newsletters	0	0.2 plus in-network	0	in network cost share	0.2 plus in-network	0.2 plus in-network	in network cost share	in network cost share					2.4477	0	0	0	0.1365	0	0	0	0.146	0.086	0.1065	0.01	0	0.8952	0.1494	0.2462	0	0	0.1597	0	0	0	0	0.1175	0.0168	0.0332	0.0028	0.064	0	0	0.0503	0	0	0.0015	0.0616	0	0				4.7307	0	0	36.3902	3.076213526	9.502933351	0	3.734805798	11.26914839	1.953533837	4.418535211	3.996020249	2.353282858	2.913978921	0.272388012	0	24.49856332	0.149435151	6.738995291	1.506817796	0.564351523	7.985994882	25.44565016	1.805533059	0	0	2.996584292	0.838414827	0.846057098	0.13995012	1.631347641	0	0	2.513310509	1.560501666	0	0.039737948	1.685608794	0	0.204189504	0	0	0	161.0321
H5576_009_0	2010	6	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	Coin	Coin	V	T	V	V	V	V	V	V	P	V	Coin	V	V	Coin	V	V																																												0	YES	2512.301339	128.6652777	1409.229794	15883.61882	321.7756101	17.00059234	4.903917837	464.2682354	278.7917724	4857.2405	12.21749257	0.361834026	0	32.5711199	5807.540572	5478.601799	2.195523164	4.623991551	6865.735129	83.9224622	10.27669366	0	0	0	602.9475155	0	0	0	11760	0	5867.58351	3.022676441	0	2.602912517	5.082952642	0	140.3874555				3600	$250 per admit	$250 per admit	$100 days 21+	0	200	0.2	0.2	50	150	0	"0.2, Max. $350 per day"	"0.2 , max. $350 per day"	0.2 prof. and facility	20% to $350 per day for all services except pain mgmt.	"15, 20% for allergy"	"35 , 20% allergy, pain mgmt."	0.5	0.2	0	E&M services under PCP and specialist	0.2	0.2 Chemo	0		"35 ,1 per year"	0	0	0	newsletters		0	0.2	50	"150, 20% allergy facility svcs."	"0.2, max. $350 per day"	35	35				47.66435107	27.78205326	10.39695293	0	200	0.2	0.2	50	150	0	0.2	0.2	0.2	0.2	15	35	0.5	0.2	0	0	0.2	0	0	0	35	0	0	0	0	0	0	0.2	50	150	0.2	35	35				NO	40.73847164	23.74517565	8.886221302	0	170.9389542	0.170938954	0.170938954	42.73473856	128.2042157	0	0.170938954	0.170938954	0.170938954	0.170938954	12.82042157	29.91431699	0.427347386	0.170938954	0	0	0.170938954	0	0	0	35	0	0	0	0	0	0	0.170938954	42.73473856	128.2042157	0.170938954	29.91431699	29.91431699					8.5289	0.254598302	1.043560652	0	4.583665525	2.906063476	0.838270587	1.653365138	2.978523377	0	2.088445404	0.06185153	0	5.567673175	6.2045932	13.65738591	0.938251084	0.79042028	0	0	1.756687267	0	0	0	1.75859692	0	0	0	0	0	0	0.51669315	0	0.027808696	0.868874609	0	0.349966237	0	0	0	57.3742	0	9.455122066	8.5289	0.254598302	1.043560652	0	4.583665525	2.906063476	0.838270587	1.653365138	2.978523377	0	2.088445404	0.06185153	0	5.567673175	6.2045932	13.65738591	0.938251084	0.79042028	0	0	1.756687267	0	0	0	1.75859692	0	0	0	0	0	0	0.51669315	0	0.027808696	0.868874609	0	0.349966237	0	0	0	57.3742	NO	0.2 plus in-network cost share	0	0	0	0.2 plus in-network cost share	0	0	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0	0.2 plus in-network cost share	E&M Codes in PCP and specialist	0	0	0	0	0	0	0	0	0	0	0	0	0	0.2 plus in-network cost share	0.2 plus in-network cost share	0	0					1.5747	0	0	0	0.1419	0	0	0	0.1642	0.034	0.0997	0.003	0	0.2659	0.2861	0.5478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.0012	0.0415	0	0				3.16	0	0	10.1036	0.254598302	1.043560652	0	4.725565208	2.906063476	0.838270587	1.653365138	3.142738277	0.034038551	2.188180037	0.064805277	0	5.833559868	6.490717909	14.20516847	0.938251084	0.79042028	0	0	1.756687267	0	0	0	1.75859692	0	0	0	0	0	0	0.51669315	0	0.02902985	0.9103681	0	0.349966237	0	0	0	60.5343
H5576_010_0	2010	4	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				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	V	P	Coin	Coin	V	Coin	Coin	Coin	Coin																																												0	NO	429.9664097	38.9678675	120.3782002	163.5378437	15.44350077	48.36544372	8.384265395	1060.448451	16.52362804	9.730874266	12.04936431	1.126330175	0	101.3020762	36.61161189	27.8658877	6.467029167	2.422109539	33.58916302	109.208799	7.749068921	0	0	14.39535591	4.108232651	4.064391942	0.685755587	7.836866118	11760	0	10.57100558	6.697432042	0	0.164317253	6.970027924	0	0.876349801					std medicare	std medicare	std medicare	std medicare	std medicare	std medicare	std medicare	50	std medicare	std medicare	std medicare	std medicare	std medicare	std medicare	0	std medicare	0.5	std medicare	std medicare	std medicare	std medicare	0.2 Chemo	0	"0.2, oral exam & prophy, 2/ year; 20% coinsurance on each, max of $100 each 6 months, x-ray with 20% coinsurance max of $50 /each year"	0.2	"0.2, $100 max,."	"0.2, 1/year"	0.2$750 max	newsletters		std medicare	std medicare	50	std medicare	std medicare	std medicare	std medicare				0.078942311	0.078942311	0.078942311	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.2	0.2	0.2	0.2	0.2	0	0	0.233	0.233	50	0.233	0.233	0.233	0.233				NO	0.078942311	0.078942311	0.078942311	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.2	0.2	0.2	0.2	0.2	0	0	0.233	0.233	50	0.233	0.233	0.233	0.233					33.9425	3.076213526	9.502933351	0	3.598335679	11.26914839	1.953533837	4.418535211	3.850005332	2.267293704	2.807501885	0.262434931	0	23.60338375	0	6.492751834	1.506817796	0.564351523	7.826274984	25.44565016	1.805533059	0	0	2.879071183	0.82164653	0.812878388	0.137151117	1.567373224	0	0	2.463044299	1.560501666	0	0.03828592	1.624016506	0	0.204189504	0	0	0	156.3014	0	0	33.9425	3.076213526	9.502933351	0	3.598335679	11.26914839	1.953533837	4.418535211	3.850005332	2.267293704	2.807501885	0.262434931	0	23.60338375	0	6.492751834	1.506817796	0.564351523	7.826274984	25.44565016	1.805533059	0	0	2.879071183	0.82164653	0.812878388	0.137151117	1.567373224	0	0	2.463044299	1.560501666	0	0.03828592	1.624016506	0	0.204189504	0	0	0	156.3014	NO	0.2 plus in-network	in network cost share	0	0	0.2 plus in-network	0	0	in network cost share	0.2 plus in-network	0.2 plus in-network	0.2 plus in-network	0.2 plus in-network	in network cost share	0.2 plus in-network	0.2 plus in-network	0.2 plus in-network	0	0	0.2 plus in-network	0	in network cost share	0	0	0.20 plus in-network	0.20 plus in-netowrk	0.20 plus in-network	0.20 plus in-netowrk	0.20 plus in-network	newsletters	0	0.2 plus in-netowrk	0	in network cost share	0.2 plus in-network	0.2 plus in-network	in network cost share	in network cost share					2.4477	0	0	0	0.1365	0	0	0	0.146	0.086	0.1065	0.01	0	0.8952	0.1494	0.2462	0	0	0.1597	0	0	0	0	0.1175	0.0168	0.0332	0.0028	0.064	0	0	0.0503	0	0	0.0015	0.0616	0	0				4.7307	0	0	36.3902	3.076213526	9.502933351	0	3.734805798	11.26914839	1.953533837	4.418535211	3.996020249	2.353282858	2.913978921	0.272388012	0	24.49856332	0.149435151	6.738995291	1.506817796	0.564351523	7.985994882	25.44565016	1.805533059	0	0	2.996584292	0.838414827	0.846057098	0.13995012	1.631347641	0	0	2.513310509	1.560501666	0	0.039737948	1.685608794	0	0.204189504	0	0	0	161.0321
H5576_801_0	2010	2	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				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																																												0	NO	286.129505	10.34906705	38.9061649	52.83401183	6.408985511	16.21129876	4.683535985	5.691531354	27.96844825	6.76934606	11.1140402	0.351340856	0	31.34087954	31.39598935	59.19648005	1.921346708	5.402987277	29.49073933	81.83016777	9.159219137	0	0	0	0	0	0	0	0	0	6.537268383	2.935018963	0	0.132542001	4.935547249	0	0.454045532					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS										Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS				0.078945978	0.078945978	0.218414895	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233				NO	0.078945978	0.078945978	0.218414895	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233					22.5888	0.817017218	8.497685935	0	1.493293624	3.77723261	1.091263884	1.326126806	6.516648443	1.577257632	2.589571367	0.081862419	0	7.302424934	7.315265519	13.79277985	0.447673783	1.258896035	6.871342263	19.06642909	2.134098059	0	0	0	0	0	0	0	0	0	1.523183533	0.683859418	0	0.030882286	1.149982509	0	0.105792609	0	0	0	112.0393	0	0	22.5888	0.817017218	8.497685935	0	1.493293624	3.77723261	1.091263884	1.326126806	6.516648443	1.577257632	2.589571367	0.081862419	0	7.302424934	7.315265519	13.79277985	0.447673783	1.258896035	6.871342263	19.06642909	2.134098059	0	0	0	0	0	0	0	0	0	1.523183533	0.683859418	0	0.030882286	1.149982509	0	0.105792609	0	0	0	112.0393	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	22.5888	0.817017218	8.497685935	0	1.493293624	3.77723261	1.091263884	1.326126806	6.516648443	1.577257632	2.589571367	0.081862419	0	7.302424934	7.315265519	13.79277985	0.447673783	1.258896035	6.871342263	19.06642909	2.134098059	0	0	0	0	0	0	0	0	0	1.523183533	0.683859418	0	0.030882286	1.149982509	0	0.105792609	0	0	0	112.0393
H5576_802_0	2010	2	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				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																																												0	YES	304.2448632	4.156295343	35.90003814	55.28891537	6.882227949	13.63784364	6.018802916	7.515874997	27.74057822	7.143006156	14.38521207	0.253109065	0.320956281	23.57677429	33.15426442	83.38356157	1.511364891	5.228275679	31.29682516	61.18740827	75.82872488	0	0	0	0	0	0	0	0	0	4.709506051	2.11441366	0	0.095484431	3.555611958	0	0.327098423				0	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS										Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS				0.078945978	0.078945978	0.218414895	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233				NO	0.078945978	0.078945978	0.218414895	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233					24.0189	0.3281228	7.841103073	0	1.603559112	3.177617569	1.40238108	1.751198874	6.463554725	1.664320434	3.351754412	0.058974412	0.074782813	5.493388409	7.724943609	19.42836985	0.35214802	1.218188233	7.292160263	14.25666613	17.6680929	0	0	0	0	0	0	0	0	0	1.09731491	0.492658383	0	0.022247873	0.828457586	0	0.076213933	0	0	0	127.6871	0	0	24.0189	0.3281228	7.841103073	0	1.603559112	3.177617569	1.40238108	1.751198874	6.463554725	1.664320434	3.351754412	0.058974412	0.074782813	5.493388409	7.724943609	19.42836985	0.35214802	1.218188233	7.292160263	14.25666613	17.6680929	0	0	0	0	0	0	0	0	0	1.09731491	0.492658383	0	0.022247873	0.828457586	0	0.076213933	0	0	0	127.6871	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	24.0189	0.3281228	7.841103073	0	1.603559112	3.177617569	1.40238108	1.751198874	6.463554725	1.664320434	3.351754412	0.058974412	0.074782813	5.493388409	7.724943609	19.42836985	0.35214802	1.218188233	7.292160263	14.25666613	17.6680929	0	0	0	0	0	0	0	0	0	1.09731491	0.492658383	0	0.022247873	0.828457586	0	0.076213933	0	0	0	127.6871
H5576_803_0	2010	2	N/A	X1	X2	X3	X4	X5	X6	X7				Professional	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				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																																												0	NO	291.3794976	7.581845784	54.49122095	64.50777026	7.059183583	21.11917099	0.968167345	4.413454816	15.71478519	6.913334997	9.195774569	0.516549111	0	40.79638456	28.4830464	24.64496554	2.664228072	5.51528423	33.3773378	118.9190201	12.0126548	0	0	0	0	0	0	0	0	0	9.611236839	4.315129918	0	0.194866187	7.256350934	0	0.667547802					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS										Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS				0.078945978	0.078945978	0.218414895	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233				NO	0.078945978	0.078945978	0.218414895	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233					23.0032	0.598556229	11.90169432	0	1.644789775	4.920766841	0.225582991	1.028334972	3.66154495	1.610807054	2.142615475	0.120355943	0	9.505557601	6.636549812	5.742276971	0.620765141	1.285061226	7.776919707	27.70813168	2.798948569	0	0	0	0	0	0	0	0	0	2.239418184	1.005425271	0	0.045403821	1.690729768	0	0.155538638	0	0	0	118.069	0	0	23.0032	0.598556229	11.90169432	0	1.644789775	4.920766841	0.225582991	1.028334972	3.66154495	1.610807054	2.142615475	0.120355943	0	9.505557601	6.636549812	5.742276971	0.620765141	1.285061226	7.776919707	27.70813168	2.798948569	0	0	0	0	0	0	0	0	0	2.239418184	1.005425271	0	0.045403821	1.690729768	0	0.155538638	0	0	0	118.069	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	23.0032	0.598556229	11.90169432	0	1.644789775	4.920766841	0.225582991	1.028334972	3.66154495	1.610807054	2.142615475	0.120355943	0	9.505557601	6.636549812	5.742276971	0.620765141	1.285061226	7.776919707	27.70813168	2.798948569	0	0	0	0	0	0	0	0	0	2.239418184	1.005425271	0	0.045403821	1.690729768	0	0.155538638	0	0	0	118.069
H5577_002_0	2010	8	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	Coin	O	T	P	P	P	P	P	O	O																																																			0	YES	336.2129933	0.295846396	7.740572327	147.9371901		14.6532931	15.83823786	692.9710493	117.8727182	257.3196379	410.935647			16.63104873	11976.43779	4264.146352	1239.570996	3058.572927	4687.232714	13017.41872				597.2877124	314.1903142					73.86939937											3400	"1a (IP Acute) - $3, 1a (additional days)"	1b (IP Psych) - $3	2 (SNF) - $3; 2a2 (Waiver 3 Day) - $0	6a (Home Health) - $1	10a (Ambulance) - $0	11a (Medical Equip) - 10%	"11b (Med Supp), 11c (Diab Supp) - 10%"	"4a (ER) $1 (WW coverage), 4b (UC) - $1 (WW coverage)"	9a (OP Surgery) - $1 9b (ASC) - $1	8a (OP Diag Proc/Test/Lab) - $0.5	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - $1, 8b (OP x-rays) - $.5"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA) - $1, 9d (Cardiac Rehab) - $1, 3 (CORF)- $1; 5 (Partial Hospitalization) - $1, 9a (OP Other excluding Surgery) - $0"	7a (PCP) - $1	"7b (Chiro) - $1, 7d (Spec) - $1, 7f (Pod) - $1; 17a (MCR Eye Exam) - $1; 18a (MCR Hearing Exam) - $1, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $0; 14i (Diab Mon.) - $0;"	"7e (MH), 7h (Psychiatric) - $1"	"7c (OT), 7i (PT/ST) - $1"	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - $1, 8b (OP x-rays) - $.5"	"7g (Prof. Other)  - $1; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0; Labs - $0.5"	15 (Part B Rx) - 0%	13a (Blood) - $0	1 Round trip per year	16a (Preventive) - $1; 16b (Comp. Dental) - $0	17a1 (Rountine Eye Exam) - $1	17b1 (Non MCR Covered) - $250/2yr limit	18a1 (Hearing Exam Non-covered) - $1	18b (Hearing Aids) - $300/2yr limit	14a (Health Ed & Wellness) - $0	13C OTC - $25/Qtr;  14c (Routine Physical) - $1; 13b/14a Alivia - $15											3	3	3	1		0.1	0.1	1	1	0.5	1			1	1	1	1	1	0.25	0.1				1	1					1.239687039											NO	2.994621944	2.994621944	2.994621944	0.998207315		0.099820731	0.099820731	0.998207315	0.998207315	0.499103657	0.998207315			0.998207315	0.998207315	0.998207315	0.998207315	0.998207315	0.249551829	0.099820731				1	0.998207315					1.23746467												0.0839	7.38E-05	0.001931674	0.012305999	0	1.462702436	1.580984488	0.057644064	0.009805117	0.010702431	0.034183247	0	0	0.001383436	0.996247317	0.354708507	0.103112403	0.254424156	0.097475625	0.108284022	0	0	0	0.049773976	0.026135589	0	0	0	0	0.007617564	0	0	0	0	0	0	0	0	0	0	5.2534	0	0.009345214	0.0839	7.38E-05	0.001931674	0.012305999	0	1.462702436	1.580984488	0.057644064	0.009805117	0.010702431	0.034183247	0	0	0.001383436	0.996247317	0.354708507	0.103112403	0.254424156	0.097475625	0.108284022	0	0	0	0.049773976	0.026135589	0	0	0	0	0.007617564	0	0	0	0	0	0	0	0	0	0	5.2534	NO																																																																																		0	0	0	0.0839	7.38E-05	0.001931674	0.012305999	0	1.462702436	1.580984488	0.057644064	0.009805117	0.010702431	0.034183247	0	0	0.001383436	0.996247317	0.354708507	0.103112403	0.254424156	0.097475625	0.108284022	0	0	0	0.049773976	0.026135589	0	0	0	0	0.007617564	0	0	0	0	0	0	0	0	0	0	5.2534
H5578_002_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1370.68711	185.7118993	707.8196365	697.6323947	278.0011763	17.37079818	5.924893968	770.721812	242.1728111	5.193588479	9.532098078	0.175409739	0.263764039	9.374092579	4302.20418	3107.697363	83.39977397	63.10034449	12.49608532	95.22870665	6.440501922	0	0	0	401	8.522403089	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $225 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $5 Copay per visit;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $25 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $25 Copay per visit; 7i (PT/ST): $25 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 25 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $25 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $25 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 25 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): 25 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											88.59155478	63.74819015	22.01662259	5	125	0.2	0.087715159	48.97505064	200	0	0.183082497	0.2	0.2	0.19729425	0	25	40	25	0.2	0.019520263	0.2	0	0	0	5	0	0	0	0	0											NO	81.2365491	58.4557184	20.18876908	4.584892392	114.6223098	0.183395696	0.080432913	44.90906741	183.3956957	0	0.16788271	0.183395696	0.183395696	0.180914581	0	22.92446196	36.67913913	22.92446196	0.183395696	0.017899661	0.183395696	0	0	0	5	0	0	0	0	0												9.2792	0.904660207	1.190833933	0.266547455	2.655428079	3.185729616	0.476556481	2.884366484	3.70112093	0	1.600274454	0.032169391	0.04837319	1.69591003	0	5.936857498	0.254919326	0.120545121	2.291728261	1.704561531	1.18116033	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.578	0	3.567348098	9.2792	0.904660207	1.190833933	0.266547455	2.655428079	3.185729616	0.476556481	2.884366484	3.70112093	0	1.600274454	0.032169391	0.04837319	1.69591003	0	5.936857498	0.254919326	0.120545121	2.291728261	1.704561531	1.18116033	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.578	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.2792	0.904660207	1.190833933	0.266547455	2.655428079	3.185729616	0.476556481	2.884366484	3.70112093	0	1.600274454	0.032169391	0.04837319	1.69591003	0	5.936857498	0.254919326	0.120545121	2.291728261	1.704561531	1.18116033	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.578
H5578_006_0	2010	11	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1887.945468	93.87847079	396.2709235	734.2174036	215.2812733	18.95209625	4.878393783	695.8753752	266.4405799	6.199612744	7.33422184	0.206781722	0.852604729	9.209885254	4096.890928	3024.528707	98.87064357	72.86954015	20.07492278	85.97910288	15.55477378	0	0	0	346	9.170903996	0	0	0	0											4950	1a (IP Acute): $195 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $32 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $35 Copay per visit; 7i (PT/ST): $35 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 35 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $35 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $35 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 35 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 10 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											98.17972682	124.150224	21.47579065	0	125	0.2	0.1	48.8942135	200	0	0.177493587	0.2	0.2	0.199737123	4.185402454	32	40	35	0.2	0.022162645	0.2	0	0	0	10	0	0	0	0	0											NO	91.01908586	115.0954506	19.90947517	0	115.883249	0.185413198	0.092706599	45.32816255	185.4131985	0	0.164548268	0.185413198	0.185413198	0.185169494	3.880144279	29.66611175	37.08263969	32.44730973	0.185413198	0.020546234	0.185413198	0	0	0	10	0	0	0	0	0												14.3199	0.900415408	0.657462176	0	2.078957784	3.513968784	0.452259297	2.628562677	4.116800009	0	1.206833502	0.038340061	0.15808417	1.705389795	1.324710658	7.477167219	0.305532038	0.197035045	3.722155641	1.766546807	2.884060359	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7425	0	3.888202656	14.3199	0.900415408	0.657462176	0	2.078957784	3.513968784	0.452259297	2.628562677	4.116800009	0	1.206833502	0.038340061	0.15808417	1.705389795	1.324710658	7.477167219	0.305532038	0.197035045	3.722155641	1.766546807	2.884060359	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7425	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.3199	0.900415408	0.657462176	0	2.078957784	3.513968784	0.452259297	2.628562677	4.116800009	0	1.206833502	0.038340061	0.15808417	1.705389795	1.324710658	7.477167219	0.305532038	0.197035045	3.722155641	1.766546807	2.884060359	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7425
H5578_007_0	2010	10	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	458.8676312	5.583658724	42.41342791	1988.130872	14.60758808	21.874615	5.858046746	36.86351595	30.00786331	6.540701755	10.90909883	0.707272563	0	9.767107312	4776.919711	3426.469742	211.7051541	1.426146442	25.82033307	109.1606579	23.20938847	0	0	0	401	0.020221321	0	0	0	0												1a (IP Acute): 8.20% Coin MC CS; 1a1 (Add'l Days): 8.20% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.20% Coin MC CS;	2a (SNF): 19.03% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $18.5 OTC per month (cumulative benefit)											0.082	0.082	0.1903	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.150687971	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.082	0.082	0.1903	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.150687971	0.2	0	0	0	5	0.2	0	0	0	0												37.6271	0.457860015	8.071275331	0	2.921517616	4.374923	1.171609349	7.37270319	6.001572661	0	2.181819765	0.141454513	0	1.953421462	0	2.855391451	0.176420962	0.285229288	5.164066613	16.44919805	4.641877693	0	0	0	0.167083333	0.004044264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.0186	0	0	37.6271	0.457860015	8.071275331	0	2.921517616	4.374923	1.171609349	7.37270319	6.001572661	0	2.181819765	0.141454513	0	1.953421462	0	2.855391451	0.176420962	0.285229288	5.164066613	16.44919805	4.641877693	0	0	0	0.167083333	0.004044264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.0186	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	37.6271	0.457860015	8.071275331	0	2.921517616	4.374923	1.171609349	7.37270319	6.001572661	0	2.181819765	0.141454513	0	1.953421462	0	2.855391451	0.176420962	0.285229288	5.164066613	16.44919805	4.641877693	0	0	0	0.167083333	0.004044264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.0186
H5578_009_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1508.643088	107.6442831	463.2202644	624.3727414	218.2389356	15.43007147	4.602645132	661.785919	230.0778957	5.221170315	7.801841949	0.181243948	0.505264783	7.978273379	3829.949255	2745.229812	76.87376284	60.22917219	16.07964573	79.76912241	10.08017477	0	0	0	346	7.74391079	0	0	0	0											3400	1a (IP Acute): $185 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $15 Copay per visit;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0 copay;	7d (SPC w/Copay): $16 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $20 Copay per visit; 7i (PT/ST): $20 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 20 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $20 Copay per visit; 7b (Chiro): $20 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $20 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 20 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $150 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $20 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 20 copay;"	17a1 (Routine Eye Exam): 10 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 20 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											100.0729813	95.54514608	21.93630069	15	125	0.2	0.1	48.96064837	200	0	0.181324281	0.2	0.2	0.198842605	0	16	40	20	0.2	0.022085115	0.2	0	0	0	10	0	0	0	0	0											NO	90.56125017	86.46377636	19.85130041	13.57428084	113.119007	0.180990411	0.090495206	44.3070394	180.9904111	0	0.164089781	0.180990411	0.180990411	0.179943024	0	14.47923289	36.19808223	18.09904111	0.180990411	0.01998597	0.180990411	0	0	0	10	0	0	0	0	0												11.3854	0.775610935	0.766293719	0.706284245	2.057247639	2.79269498	0.416517317	2.443481232	3.470157744	0	1.280202538	0.032803417	0.091448081	1.435634637	0	3.312401816	0.231890232	0.090840855	2.910261691	1.594263324	1.824414976	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9062	0	3.949224053	11.3854	0.775610935	0.766293719	0.706284245	2.057247639	2.79269498	0.416517317	2.443481232	3.470157744	0	1.280202538	0.032803417	0.091448081	1.435634637	0	3.312401816	0.231890232	0.090840855	2.910261691	1.594263324	1.824414976	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9062	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.3854	0.775610935	0.766293719	0.706284245	2.057247639	2.79269498	0.416517317	2.443481232	3.470157744	0	1.280202538	0.032803417	0.091448081	1.435634637	0	3.312401816	0.231890232	0.090840855	2.910261691	1.594263324	1.824414976	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9062
H5578_010_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	416.4595745	10.24303701	39.35906266	2717.148124	15.5592095	17.82004852	6.733937783	29.6331443	26.35255267	6.104037905	12.50677457	0.715835348	0	12.49485633	4851.854709	3452.775732	360.0806008	1.487046354	21.83055068	106.4771009	17.18690143	0	0	0	401	0.043261714	0	0	0	0												1a (IP Acute): 7.99% Coin MC CS; 1a1 (Add'l Days): 7.99% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.99% Coin MC CS;	2a (SNF): 19.02% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $18.5 OTC per month (cumulative benefit)											0.0799	0.0799	0.1902	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.151997071	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0799	0.0799	0.1902	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.151997071	0.2	0	0	0	5	0.2	0	0	0	0												33.2751	0.818418657	7.486093718	0	3.111841899	3.564009704	1.346787557	5.92662886	5.270510534	0	2.501354913	0.14316707	0	2.498971267	0	2.87731311	0.300067167	0.297409271	4.366110137	16.18420746	3.437380286	0	0	0	0.167083333	0.008652343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5811	0	0	33.2751	0.818418657	7.486093718	0	3.111841899	3.564009704	1.346787557	5.92662886	5.270510534	0	2.501354913	0.14316707	0	2.498971267	0	2.87731311	0.300067167	0.297409271	4.366110137	16.18420746	3.437380286	0	0	0	0.167083333	0.008652343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5811	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	33.2751	0.818418657	7.486093718	0	3.111841899	3.564009704	1.346787557	5.92662886	5.270510534	0	2.501354913	0.14316707	0	2.498971267	0	2.87731311	0.300067167	0.297409271	4.366110137	16.18420746	3.437380286	0	0	0	0.167083333	0.008652343	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5811
H5578_011_0	2010	10	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	311.4783998	8.080107388	26.85833375	1790.459846	11.28196764	15.08179247	5.309951527	24.43800115	24.6676406	5.145731856	9.625440874	0.46683814	0.16013351	9.674541059	4055.856195	2892.536626	235.4181476	1.138038399	17.58132575	86.17700211	13.0241444	0	0	0	401	0.075674916	0	0	0	0												1a (IP Acute): 8.04% Coin MC CS; 1a1 (Add'l Days): 8.04% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.04% Coin MC CS;	2a (SNF): 19.03% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $18.0 OTC per month											0.0804	0.0804	0.1903	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.153571393	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0804	0.0804	0.1903	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.153571393	0.2	0	0	0	5	0.2	0	0	0	0												25.0429	0.649640634	5.111140913	0	2.256393528	3.016358494	1.061990305	4.887600231	4.93352812	0	1.925088175	0.093367628	0.032026702	1.934908212	0	2.410447188	0.19618179	0.22760768	3.51626515	13.23432223	2.604828881	0	0	0	0.167083333	0.015134983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3168	0	0	25.0429	0.649640634	5.111140913	0	2.256393528	3.016358494	1.061990305	4.887600231	4.93352812	0	1.925088175	0.093367628	0.032026702	1.934908212	0	2.410447188	0.19618179	0.22760768	3.51626515	13.23432223	2.604828881	0	0	0	0.167083333	0.015134983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3168	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.0429	0.649640634	5.111140913	0	2.256393528	3.016358494	1.061990305	4.887600231	4.93352812	0	1.925088175	0.093367628	0.032026702	1.934908212	0	2.410447188	0.19618179	0.22760768	3.51626515	13.23432223	2.604828881	0	0	0	0.167083333	0.015134983	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.3168
H5578_012_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1495.105682	84.20925323	519.2938513	545.8866384	242.0814138	14.36881018	4.454985875	758.2479141	260.0137322	6.191634912	11.3125304	0.297384949	0.403676169	7.441084455	4227.249889	2744.605538	62.48913781	56.57244234	14.9991724	83.98042218	9.009664083	0	0	0	295	6.057998864	0	0	0	0											5500	1a (IP Acute): $190 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $350 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $33 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): $40 Copay per visit; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $125 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											123.6175558	133.4544222	58.31730188	0	125	0.2	0.189731523	49.29036072	350	0	0.186944796	0.2	0.2	0.198962455	4.064193433	33	40	40	0.2	0.178685218	0.2	0	0	0	25	0	0	0	0	0											NO	112.2759533	121.2103118	52.96683487	0	113.5315617	0.181650499	0.172324129	44.76809305	317.8883729	0	0.169793077	0.181650499	0.181650499	0.180708146	3.691313821	29.9723323	36.33009976	36.33009976	0.181650499	0.162291295	0.181650499	0	0	0	25	0	0	0	0	0												13.9887	0.85058582	2.292112639	0	2.290323414	2.610101535	0.767701559	2.828776098	6.887945187	0	1.920789344	0.054020124	0.073327977	1.344664578	1.300342162	6.855185768	0.189186384	0.171273539	2.724607148	13.62929146	1.636609974	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0301	0	6.274777282	13.9887	0.85058582	2.292112639	0	2.290323414	2.610101535	0.767701559	2.828776098	6.887945187	0	1.920789344	0.054020124	0.073327977	1.344664578	1.300342162	6.855185768	0.189186384	0.171273539	2.724607148	13.62929146	1.636609974	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0301	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.9887	0.85058582	2.292112639	0	2.290323414	2.610101535	0.767701559	2.828776098	6.887945187	0	1.920789344	0.054020124	0.073327977	1.344664578	1.300342162	6.855185768	0.189186384	0.171273539	2.724607148	13.62929146	1.636609974	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0301
H5578_013_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1497.624492	79.71127818	404.0440422	586.0253986	208.6040551	12.10873638	4.167233957	632.4009424	206.6263745	4.453934746	7.55042001	0.131504003	0.366601711	6.176207789	3959.193016	2742.787503	56.92551168	55.54483817	22.0064075	76.73013177	8.439942989	0	0	0	346	7.987776374	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $15 Copay per visit;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $10 Copay per visit;	7d (SPC w/Copay): $35 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $35 Copay per visit; 7i (PT/ST): $35 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 35 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $35 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $35 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 35 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 30 copay;"	17a1 (Routine Eye Exam): 10 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											86.8901492	95.54514608	22.14730736	15	125	0.2	0.1	48.79022524	200	0	0.181650875	0.2	0.2	0.198965066	8.428731081	35	40	35	0.2	0.024084318	0.2	0	0	0	10	0	0	0	0	0											NO	77.46910998	85.18569133	19.74599199	13.37362935	111.4469113	0.178315058	0.089157529	43.50015922	178.315058	0	0.161955432	0.178315058	0.178315058	0.177392337	7.514848359	31.20513515	35.6630116	31.20513515	0.178315058	0.021472983	0.178315058	0	0	0	10	0	0	0	0	0												9.6683	0.565855028	0.664854202	0.653107206	1.937356468	2.15917003	0.371540282	2.292461807	3.07038283	0	1.222831531	0.023449144	0.065370605	1.095611931	2.479394595	7.132421226	0.169177932	0.144440348	3.92407383	1.647624807	1.504968924	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0807	0	4.959142786	9.6683	0.565855028	0.664854202	0.653107206	1.937356468	2.15917003	0.371540282	2.292461807	3.07038283	0	1.222831531	0.023449144	0.065370605	1.095611931	2.479394595	7.132421226	0.169177932	0.144440348	3.92407383	1.647624807	1.504968924	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0807	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.6683	0.565855028	0.664854202	0.653107206	1.937356468	2.15917003	0.371540282	2.292461807	3.07038283	0	1.222831531	0.023449144	0.065370605	1.095611931	2.479394595	7.132421226	0.169177932	0.144440348	3.92407383	1.647624807	1.504968924	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0807
H5578_801_0	2010	3	N/A																															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	NO	267.5141275	8.97290817	21.35728792	18.18019597	8.897597745	16.14489228	5.022202048	26.93720964	33.14493848	5.880639918	8.640162671	0.203064238	0.516423974	8.831079429	26.06142836	28.99326753	0.602981506	1.208550456	17.28300306	88.91459245	11.69957152	0	0	0	0	0	0	0	0	0												FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.8633	0.733335147	3.600787804	0	2.073140275	3.761759902	1.170173077	6.276369846	7.722770667	1.370189101	2.013157902	0.047313967	0.120326786	2.057641507	6.072312808	6.755431334	0.140494691	0.281592256	4.026939713	20.71710004	2.726000163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5302		0	21.8633	0.733335147	3.600787804	0	2.073140275	3.761759902	1.170173077	6.276369846	7.722770667	1.370189101	2.013157902	0.047313967	0.120326786	2.057641507	6.072312808	6.755431334	0.140494691	0.281592256	4.026939713	20.71710004	2.726000163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5302	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	21.8633	0.733335147	3.600787804	0	2.073140275	3.761759902	1.170173077	6.276369846	7.722770667	1.370189101	2.013157902	0.047313967	0.120326786	2.057641507	6.072312808	6.755431334	0.140494691	0.281592256	4.026939713	20.71710004	2.726000163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5302
H5580_001_0	2010	6	N/A																															Coin	Coin	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																																																			0	NO	680.1703432	28.70943664	158.7647898		33.21777394	60.9089684	31.29341931	18.20828522	25.00144424	21.22012628	4.495502851	2.406986752		44.85343261	89.94603308	196.4596887	8.024091842	23.013678	77.34057121	0.292810859	36.35665267	1.193400849																				Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing		"16a (Preventive Dental), 16b (Restorative Dental) - $100 max"	17a1 (Routine Eye Exam) - $0	17a2 (Non MCR Covered) - $200 MAB per year		18b (Non MCR Covered) - $1200 MAB per year													0.077602686	0.077602686	0.135055016		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.077602686	0.077602686	0.135055016		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				52.783	2.227929395	21.44198125	0	7.739741328	14.19178964	7.291366699	4.242530457	5.825336507	4.944289424	1.047452164	0.560827913	0	10.4508498	20.95742571	45.77510747	1.869613399	5.362186973	18.02035309	0.06822493	8.471100073	0.278062398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	233.5492	0	0	52.783	2.227929395	21.44198125	0	7.739741328	14.19178964	7.291366699	4.242530457	5.825336507	4.944289424	1.047452164	0.560827913	0	10.4508498	20.95742571	45.77510747	1.869613399	5.362186973	18.02035309	0.06822493	8.471100073	0.278062398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	233.5492	NO																																																																																		0	0	0	52.783	2.227929395	21.44198125	0	7.739741328	14.19178964	7.291366699	4.242530457	5.825336507	4.944289424	1.047452164	0.560827913	0	10.4508498	20.95742571	45.77510747	1.869613399	5.362186973	18.02035309	0.06822493	8.471100073	0.278062398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	233.5492
H5587_001_0	2010	9	N/A																															Ded	Ded	D		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	P	P		P	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	NO	2138.624285	413.4333344	1064.38668	0	17.0160491	16.13321686	1.852532148	13.29468336	14.63141922	14.26399797	40.85862069	1.20298778	1.482252801	16.77738315	46.09781252	100.0020428	1.681126219	1.39816438	0.998688843	21.1899817	21.84376098	12.13925456		9.820049135	3.443701912	3.738360333		13.85339063	3.491161647	23.46666667												Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share		2 Comprehensive exams & 2 cleanings & One X Rays/ year - No Cost Sharing	One Exam /Year - No Cost Sharing	$100 toward hardware - No Cost sharing		$1500 toward hearing aid per year	Silver Sneaker Program	$110 / quarter for OTC drugs											150.6855576	41.02485292	44.41009169	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0	0		0	0	0											NO	150.6855576	41.02485292	44.41009169	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0	0		0	0	0												26.855	1.413420145	3.939125839	0	3.96473944	3.759039528	0.43163999	3.097661224	3.409120679	3.323511527	9.52005862	0.280296153	0.345364903	3.909130274	10.74079032	23.30047598	0.391702409	0.325772301	0.2326945	4.937265737	5.089596307	2.828446311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.0948			26.855	1.413420145	3.939125839	0	3.96473944	3.759039528	0.43163999	3.097661224	3.409120679	3.323511527	9.52005862	0.280296153	0.345364903	3.909130274	10.74079032	23.30047598	0.391702409	0.325772301	0.2326945	4.937265737	5.089596307	2.828446311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.0948	NO																																																																																		0			26.855	1.413420145	3.939125839	0	3.96473944	3.759039528	0.43163999	3.097661224	3.409120679	3.323511527	9.52005862	0.280296153	0.345364903	3.909130274	10.74079032	23.30047598	0.391702409	0.325772301	0.2326945	4.937265737	5.089596307	2.828446311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.0948
H5587_002_0	2010	9	N/A																															Ded	Ded	D		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		V	P	P		P	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	NO	2138.624285	413.4333344	1064.38668	0	17.0160491	16.13321686	1.852532148	13.29468336	14.63141922	14.26399797	40.85862069	1.20298778	1.482252801	16.77738315	46.09781252	100.0020428	1.681126219	1.39816438	0.998688843	21.1899817	21.84376098	12.13925456		9.820049135	3.443701912	3.738360333		13.85339063	3.491161647	23.46666667												Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share	Medicare FFS Cost Share		2 Comprehensive exams & 2 cleanings & One X Rays/ year - No Cost Sharing	One Exam /Year - No Cost Sharing	$100 toward hardware - No Cost sharing		$1500 toward hearing aid per year	Silver Sneaker Program	$110 / quarter for OTC drugs											149.4726072	40.69462146	44.82383008	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0	0		0	0	0											NO	149.4726072	40.69462146	44.82383008	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0	0	0		0	0	0												26.6388	1.402042753	3.975823975	0	3.96473944	3.759039528	0.43163999	3.097661224	3.409120679	3.323511527	9.52005862	0.280296153	0.345364903	3.909130274	10.74079032	23.30047598	0.391702409	0.325772301	0.2326945	4.937265737	5.089596307	2.828446311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.904			26.6388	1.402042753	3.975823975	0	3.96473944	3.759039528	0.43163999	3.097661224	3.409120679	3.323511527	9.52005862	0.280296153	0.345364903	3.909130274	10.74079032	23.30047598	0.391702409	0.325772301	0.2326945	4.937265737	5.089596307	2.828446311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.904	NO																																																																																		0			26.6388	1.402042753	3.975823975	0	3.96473944	3.759039528	0.43163999	3.097661224	3.409120679	3.323511527	9.52005862	0.280296153	0.345364903	3.909130274	10.74079032	23.30047598	0.391702409	0.325772301	0.2326945	4.937265737	5.089596307	2.828446311	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.904
H5590_001_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	472.6989379	33.21191033	101.2664337	0	27.32508706	37.99778688	29.71374503	27.21744087	48.92873214	6.848843052	19.17317922	0	4.882099815	40.69048145	91.55731121	181.0089822	16.18138938	9.317831623	47.46717906	59.34741869	10.20363871	0.776338012	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.077454895	0.077454895	0.135566798	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077454895	0.077454895	0.135566798	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												36.6128	2.572425018	13.72836613	0	6.366745284	8.853484343	6.923302592	6.341663723	11.40039459	1.595780431	4.467350759	0	1.137529257	9.480882178	21.33285351	42.17509286	3.770263725	2.171054768	11.05985272	13.82794856	2.37744782	0.180886757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	206.3762	0	0	36.6128	2.572425018	13.72836613	0	6.366745284	8.853484343	6.923302592	6.341663723	11.40039459	1.595780431	4.467350759	0	1.137529257	9.480882178	21.33285351	42.17509286	3.770263725	2.171054768	11.05985272	13.82794856	2.37744782	0.180886757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	206.3762	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	36.6128	2.572425018	13.72836613	0	6.366745284	8.853484343	6.923302592	6.341663723	11.40039459	1.595780431	4.467350759	0	1.137529257	9.480882178	21.33285351	42.17509286	3.770263725	2.171054768	11.05985272	13.82794856	2.37744782	0.180886757	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	206.3762
H5590_002_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	476.7423042	35.28799092	94.24708495	0	27.57222214	38.64115904	29.84700646	29.08403977	49.36914184	7.415484454	20.31989968	0	5.074972119	43.21115073	92.350316	181.3905705	15.71061712	9.022821188	47.52098179	58.53276035	10.84273713	0.82496345	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.074345375	0.074345375	0.141684746	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074345375	0.074345375	0.141684746	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												35.4436	2.623498907	13.35337425	0	6.424327758	9.003390057	6.954352506	6.776581267	11.50301005	1.727807878	4.734536626	0	1.182468504	10.06819812	21.51762363	42.26400293	3.660573789	2.102317337	11.07238876	13.63813316	2.526357752	0.192216484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	206.7687	0	0	35.4436	2.623498907	13.35337425	0	6.424327758	9.003390057	6.954352506	6.776581267	11.50301005	1.727807878	4.734536626	0	1.182468504	10.06819812	21.51762363	42.26400293	3.660573789	2.102317337	11.07238876	13.63813316	2.526357752	0.192216484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	206.7687	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	35.4436	2.623498907	13.35337425	0	6.424327758	9.003390057	6.954352506	6.776581267	11.50301005	1.727807878	4.734536626	0	1.182468504	10.06819812	21.51762363	42.26400293	3.660573789	2.102317337	11.07238876	13.63813316	2.526357752	0.192216484	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	206.7687
H5591_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	NO	1470.156393	12.54512819	1192.242949		55.87671789	2.814926797	3.430811083	300.6652132	275.5775548		17.11870972	147.8478764	1.398413033	1149.60827		3059.013276	273.8245407	825.6277678		88.00668636	19.49816633	595.4540922			101.4660387																	$100 per day for days 1-7; $0 per day for days 8-90	$100 per day for days 1-7; $0 per day for days 8-90	$0 per day for days 1-20; $125 per day for days 21-100	$0 per Visit	$100 per Trip	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $35 per Visit	$75 per Visit	0% Coinsurance	"PET, MRI, CAT, Thera Rad - 20% Coinsurance"	$50 per Visit	$75 per Visit	OP Rehab - $20 per visit; Partial Hosp - $50 per Visit; OP Chemo - 20% Coinsurance	$0 per Visit; 1 Physical per Year - $0 Copay	$15 per Visit	Group- $15 per visit; Individual- $0 per visit	$15 per Visit	No cost sharing	$15 per Visit	20% Coinsurance	"$15 Eye Exam, $15 Hearing Exam"	No cost sharing	$100 every 6 months	1 Routine Eye Exam - $0 Copay	Eyewear - $100 MAB every 2 years	1 Routine Hearing Exam - $0 Copay	Hearing Aid - $500 MAB every 3 years	No cost sharing	No cost sharing											52.42691036	56.12849028	52.78170262		100	0.2	0.2	48.35627814	75		0.2	50	36.38600196	9.892311745		15	13.5	15		15	0.2	15			15																NO	46.23267864	49.49691744	46.54555224		88.18501476	0.17637003	0.17637003	42.64299101	66.13876107		0.182684149	44.09250738	32.0870012	8.955728873		13.22775221	11.90497699	13.22775221		13.22775221	0.17637003	13.22775221			13.22775221																	5.6641	0.051745431	4.624467206	0	0.410624099	0.496468722	0.605092252	1.068438665	1.518863171	0	3.127316925	0.543248632	0.00373924	0.857964998	0	3.371989136	0.271656238	0.910099961	0	0.097010887	3.438892171	0.656376599	0	0	0.111847301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.8299	0	3.580846935	5.6641	0.051745431	4.624467206	0	0.410624099	0.496468722	0.605092252	1.068438665	1.518863171	0	3.127316925	0.543248632	0.00373924	0.857964998	0	3.371989136	0.271656238	0.910099961	0	0.097010887	3.438892171	0.656376599	0	0	0.111847301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.8299	YES					$100 per Trip	30% Coinsurance	30% Coinsurance	ER - $50 per Visit; UC - $35 per Visit	$125 per Visit	0% Coinsurance	"PET, MRI, CAT, Thera Rad - 30% Coinsurance"	$125 per Visit	$125 per Visit	OP Rehab - $30 per visit; Partial Hosp - $50 per Visit; OP Chemo - 30% Coinsurance	$30 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	No cost sharing	$30 per Visit	20% Coinsurance	"$30 Eye Exam, $30 Hearing Exam"	No cost sharing		1 Routine Eye Exam - $0 Copay		1 Routine Hearing Exam - $0 Copay														2500					1.4117	0.2321	0.1675	0.0885	0.3462		0.2989	0.1368	0.0008	0.0355	0.2647	0.7778	0.2065	0.3021		1.2526	0.0023	0.1359			0.0353																5.6952	0	0.758092959	5.6641	0.051745431	4.624467206	0	1.822274582	0.728526795	0.772565734	1.156898338	1.865035266	0	3.426247575	0.680085703	0.004553835	0.893499949	0.264666666	4.14975226	0.478197885	1.212237398	0	1.349617291	3.44114375	0.79230165	0	0	0.147195663	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5251
H5591_003_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	P	P	Coin	P	T	V	V	O	V	O	O	O																																																			0	YES	1459.008368	15.134788	1217.371588		182.5047542	2.483724014	3.020041412	222.2906004	277.9924632		15.47602098	40.56183578	3.052612326	117.040491	2306.210355	3852.217166	227.1554366	843.9779046		94.81419809	22.75458395	593.8847077			150.4981276																3000	$125 per day for days 1-7	$125 per day for days 1-7	$0 per day for days 1-20; $125 per day for days 21-100	No cost sharing	$150 per Trip	20% Coinsurance	20% Coinsurance	ER - $50 per Visit; UC - $35 per Visit	$100 per Visit	0% Coinsurance	"PET, MRI, CAT, Thera Rad - 20% Coinsurance"	$50 per Visit	$100 per Visit	OP Rehab - $25 per visit; Partial Hosp - $50 per Visit; OP Chemo - 20% Coinsurance	$20 per Visit; 1 Physical per Year - $0 Copay	$25 per Visit	Individual - $25 per Visit; Group - $15 per Visit	$25 per Visit	No cost sharing	$25 per Visit	20% Coinsurance	"$25 Eye Exam, $25 Hearing Exam"		$100 benefit every six months	1 Routine Eye Exam - $0 Copay		1 Routine Hearing Exam - $0 Copay			Travel benefit has the same cost sharing as in network benefits											65.53363795	70.16061285	52.78170262		150	0.2	0.2	48.24354835	100		0.2	50	30.57257246	38.49930108	20	24.99911329	24	24.79736104		25	0.2	25			24.51379686																NO	57.70648863	61.78083095	46.47760779		132.0844312	0.176112575	0.176112575	42.48147763	88.05628748		0.176112575	44.02814374	26.92107229	33.90105524	17.6112575	22.01329107	21.133509	21.83563552		22.01407187	0.176112575	22.01407187			22.01407187																	7.0162	0.077919982	4.715043267	0	2.008836388	0.437415032	0.53186727	0.786936097	2.039915355	0	2.725521905	0.148821861	0.0068483	0.330649679	3.384605367	7.066664812	0.400049289	1.535732826	0	0.173937214	4.007368371	1.089485053	0	0	0.276089716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7599	0	5.251187811	7.0162	0.077919982	4.715043267	0	2.008836388	0.437415032	0.53186727	0.786936097	2.039915355	0	2.725521905	0.148821861	0.0068483	0.330649679	3.384605367	7.066664812	0.400049289	1.535732826	0	0.173937214	4.007368371	1.089485053	0	0	0.276089716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7599	NO																																																																																		0	0	0	7.0162	0.077919982	4.715043267	0	2.008836388	0.437415032	0.53186727	0.786936097	2.039915355	0	2.725521905	0.148821861	0.0068483	0.330649679	3.384605367	7.066664812	0.400049289	1.535732826	0	0.173937214	4.007368371	1.089485053	0	0	0.276089716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7599
H5594_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	V	V	V	V	O	O																																																			0	YES	1317.876769	7.044023475	494.7445609	390.5482183	233.5947228	1.623567148	2.381564039	258.0867375	253.9228714	53.97384153	38.55274395	0	0	24.09546497	28.62031985	21722.30698	0	968.4075497	2801.966976	0	10.83503565	0	0	0	0	0	0	0	0												3400	$100 days 1-7	$100 days 1-7	$50 8-100	$0-$25 Copay	100	20%	20% prosthetics/medical supplies; 0% diabetic supplies	50 ER/20 UC	250 OP/ 50 ASC	$0-75 copay	"$0 X-ray, $25-250 other diagnostic; 20% therapeutic"		0.2	20 Rehab/20 Sub Abs	0	20	20	20	20	20	20% coin		$0 copay (cap)	$0-75 copay (cap)	$0 copay (cap)	$10 copay; $100 limit (cap)	$0 copay 1/ 2 years (capitated)	$0 copay 1 aid/2 years; $500 limit (cap)	"newsletter, health club, nutrition & smoking cessation"												75.12131465	52.54732954	25.25441885	12.5	80	0.2	0.1	34	150	37.5	125	0	0.2	20	0	16	20	20	20	20	0.2	0	0	4.166666667	0	10	0	0	0												NO	64.49317388	45.11294932	21.68143135	10.7315038	68.68162431	0.171704061	0.08585203	29.18969033	128.7780456	32.1945114	107.315038	0	0.171704061	17.17040608	0	13.73632486	17.17040608	17.17040608	17.17040608	17.17040608	0.171704061	0	0	3.577167933	0	8.585203039	0	0	0													7.0828	0.02648139	0.893897519	0.349264141	1.336972082	0.278773072	0.204462108	0.627789329	2.724974258	0.144805121	0.344774098	0	0	0.03447741	0	24.86538878	0	1.385662573	4.009242566	0	1.86041962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1702	0	7.608613279	7.0828	0.02648139	0.893897519	0.349264141	1.336972082	0.278773072	0.204462108	0.627789329	2.724974258	0.144805121	0.344774098	0	0	0.03447741	0	24.86538878	0	1.385662573	4.009242566	0	1.86041962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1702	NO																																																																																		0	0	0	7.0828	0.02648139	0.893897519	0.349264141	1.336972082	0.278773072	0.204462108	0.627789329	2.724974258	0.144805121	0.344774098	0	0	0.03447741	0	24.86538878	0	1.385662573	4.009242566	0	1.86041962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1702
H5594_002_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O	O																																																			0	YES	2134.755844	8.659086496	1400.977573	297.2291427	458.2291237	5.084021514	7.472116421	408.6092503	420.1552299	107.6831759	48.15347645	0	0	34.29944173	70.11078706	38120.95079	0	2862.429052	5008.549338	0	16.97963502	0	0	0	0	0	0	4.139295973	0	0											3400	$50 (6-10)		$100 (21-100)		100	0.2	20% prosthetics/medical supplies; 0% diabetic monitoring supplies	50 ER/10 UC	200 OP/ 0 ASC	$0-$75	$0-$50 diagnostic/20% therapeutic		0.2								20% coin		$0 copay (cap)	$0-75 copay (cap)	$0 copay (cap)	$10 copay; $100 limit (cap)	$0 copay 1/ 2 years (capitated)	$0 copay 1 aid/2 years; $500 limit (cap)	"newsletter, health club, nutrition & smoking cessation"	$30 OTC											9.534042337	0	10.39695293	0	80	0.2	0.1	31	100	24.356775	22.72727273	0	0.2	0	0	0	0	0	0		0.2	0	0	4.166666667	0	0	10	0	0	0											NO	9.40754452	0	10.259006	0	78.9385588	0.197346397	0.098673198	30.58869153	98.6731985	24.03360894	22.42572693	0	0.197346397	0	0	0	0	0	0	0	0.197346397	0	0	4.111383271	0	0	9.86731985	0	0	0												1.6736	0	1.197719777	0	3.014328886	1.003313328	0.737297627	1.041568526	3.454838367	0.215667945	0.089989726	0	0	0	0	0	0	0	0	0	3.350869794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.7792	0	0.21217327	1.6736	0	1.197719777	0	3.014328886	1.003313328	0.737297627	1.041568526	3.454838367	0.215667945	0.089989726	0	0	0	0	0	0	0	0	0	3.350869794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.7792	NO																																																																																		0	0	0	1.6736	0	1.197719777	0	3.014328886	1.003313328	0.737297627	1.041568526	3.454838367	0.215667945	0.089989726	0	0	0	0	0	0	0	0	0	3.350869794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.7792
H5594_006_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O	O																																																			0	YES	2271.711105	9.21461019	1490.857289	316.2978784	487.6268132	5.410186915	7.95149005	434.8235767	447.1102887	114.5915901	51.24276273	0	0	36.49992241	74.60874461	40566.60039	0	3046.068188	5329.87282	0	18.06896351	0	0	0	0	0	0	4.404852506	0	0											3400	$75 day 1-7	$75 day 1-7	$50 8-100		100	0.2	20% prosthetics/medical supplies; 0% diabetic monitoring supplies	50 ER/20 UC	150 OP/ 50 ASC	$0-75	"$0 X-ray, $25-250 other diagnostic; 20% therapeutic"		0.2	$15 MH/SA	0	15	15	20	15	15	20% coin		$0 copay (cap)	$0-75 copay (cap)	$0 copay (cap)	$10 copay; $100 limit (cap)	$0 copay 1/ 2 years (capitated)	$0 copay 1 aid/2 years; $500 limit (cap)	"newsletter, health club, nutrition & smoking cessation"	$30 OTC											56.34098599	39.41049715	25.25441885	0	80	0.2	0.1	34	100	24.36	125	15	0.2	10	0	12.57142857	15	20	15	15	0.2	0	0	4.166666667	0	10	0	0	0												NO	42.63594906	29.82382931	19.11124019	0	60.53986925	0.151349673	0.075674837	25.72944443	75.67483656	18.43439019	94.5935457	11.35122548	0.151349673	7.567483656	0	9.513408024	11.35122548	15.13496731	11.35122548	11.35122548	0.151349673	0	0	3.15311819	0	7.567483656	0	0	0	0												8.0714	0.022901247	2.374344312	0	2.460071959	0.818830021	0.60172771	0.932314088	2.819583168	0.176035507	0.403936218	0	0	0.023017714	0	32.1605518	0	3.841845204	5.041715682	0	2.734731721	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.483	0	20.08473255	8.0714	0.022901247	2.374344312	0	2.460071959	0.818830021	0.60172771	0.932314088	2.819583168	0.176035507	0.403936218	0	0	0.023017714	0	32.1605518	0	3.841845204	5.041715682	0	2.734731721	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.483	NO																																																																																		0	0	0	8.0714	0.022901247	2.374344312	0	2.460071959	0.818830021	0.60172771	0.932314088	2.819583168	0.176035507	0.403936218	0	0	0.023017714	0	32.1605518	0	3.841845204	5.041715682	0	2.734731721	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.483
H5594_016_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O	O																																																			0	YES	4298.703026	342.070944	2765.023918	3337.470082	904.2283757	23.75001781	15.62848592	1064.887749	296.6642783	317.8635956	542.6477973	437.1854759	0.186206116	2706.208263	4645.390953	17913.05985	179.5239952	696.2717329	5844.298098	2506.677967	17.29353772	0																			3400	$60/day (1-5)	$60/day (1-5)	$40/day (9-100)	$0-20	$0-100	0-20%	0-20%	$0-50 ER; $0-25 Urgent Care	$0-75 OP hospital; $0-50 ASC	$0-75	$0-50 diagnostic; 20% therapeutic		0-20%	$0-20	0	$0-20	$0-20	$0-20	$0-20	$0-20	0-20%		$0 copay (cap)	$0-75 copay (cap)	$0 copay (cap)	$10 copay; $100 limit (cap)	$0 copay 1/ 2 years (capitated)	$0 copay 1 aid/2 years; $500 limit (cap)	"newsletter, health club, nutrition & smoking cessation"	$35 Non-Rx											38.90648809	25.80267816	18.16294709	10	40	0.1	0.05	17.75	31.25	37.5	22.72727273	0	0.1	0	0	8.285714286	10	10	10	0	0.1	0	0	4.166666667	0	10	0	0	0	0											NO	33.69880463	22.34895651	15.73181327	8.661487143	34.64594857	0.086614871	0.043307436	15.37413968	27.06714732	32.48057678	19.68519805	0	0.086614871	0	0	7.176660775	8.661487143	8.661487143	8.661487143	0	0.086614871	0	0	3.608952976	0	8.661487143	0	0	0	0												12.0718	0.637077388	3.624903331	2.408954517	2.61065415	2.057104739	0.676829649	1.364311083	0.669154644	0.860366077	0.890177447	0	0.016128219	0	0	10.71299617	0.129578731	0.502562389	4.218359403	0	1.497877547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9488	0	6.946214133	12.0718	0.637077388	3.624903331	2.408954517	2.61065415	2.057104739	0.676829649	1.364311083	0.669154644	0.860366077	0.890177447	0	0.016128219	0	0	10.71299617	0.129578731	0.502562389	4.218359403	0	1.497877547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9488	NO																																																																																		0	0	0	12.0718	0.637077388	3.624903331	2.408954517	2.61065415	2.057104739	0.676829649	1.364311083	0.669154644	0.860366077	0.890177447	0	0.016128219	0	0	10.71299617	0.129578731	0.502562389	4.218359403	0	1.497877547	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.9488
H5594_017_0	2010	5	N/A																															D	D	D						V	P	P		Coin								Coin																																																												0	YES	3264.053841	259.7383378	2099.513943	2534.178792	686.5908356	18.03365722	11.86688617	808.5813155	225.2605428	241.3574243	412.0386117	331.9598779	0.14138841	2054.854551	3527.297906	13601.58901	136.3146006	528.6870041	4437.641665	1903.34894	13.13117884	0	0	0	0	0	0	0	0	0											3400	$0/day	$0/day	$0/day						$0 copay	$0 copay	$0 copay		0%		$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	0%		$0 copay (cap)	$0-75 copay (cap)	$0 copay (cap)	$10 copay; $100 limit (cap)	$0 copay 1/ 2 years (capitated)	$0 copay 1 aid/2 years; $500 limit (cap)	"newsletter, health club, nutrition & smoking cessation"	$35 Non-Rx											0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	4.166666667	0	10	0	0	0	0											NO	0	0	0	0	0	0	0	0	0		0	0	0	0	0	0	0	0	0	0	0	0	0	4.166666667	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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5594_018_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	V			O	V	V	V	V	V		Coin					V																																																							0	YES	1419.294431	7.586098735	532.8177995	420.6029914	251.5710853	1.751500057	2.56922515	277.9478915	273.4635936	58.12741715	41.51958368	0	0	25.9497398	30.82280645	23393.95461	0	1042.931687	3017.593313	0	11.68880855	0	0	0	0	0	0														3400	$250 days 1-7	$250 days 1-7	"$0/day days 1-8, $125/day days 9-35"	$0-$25	100	20%	20% prosthetics/medical supplies; 0% diabetic monitoring supplies	50 ER/20 UC	250 OP/ 100 ASC	$0-75	$0 X-ray; $25-250 other diagnostic; 20% therapeutic		0.2	25 Rehab/25 Sub Abs	0	30	30	25	30	30	20% coin		$0 copay (cap)	$0-75 copay (cap)	$0 copay (cap)	$10 copay; $100 limit (cap)	$0 copay 1/ 2 years (capitated)	$0 copay 1 aid/2 years; $500 limit (cap)													187.8032866	131.3683238	55.87395108	12.5	80	0.2	0.1	34	175	37.5	125	0	0.2	30	0	24.57142857	30	25	30	30	0.2	0	0	4.166666667	0	10	0														NO	136.1260046	95.22008571	40.49927909	9.060411495	57.98663356	0.144966584	0.072483292	24.64431927	126.8457609	27.18123448	90.60411495	0	0.144966584	21.74498759	0	17.81018031	21.74498759	18.12082299	21.74498759	21.74498759	0.144966584	0	0	3.020137165	0	7.248329196	0															16.1002	0.060195748	1.798228064	0.317569682	1.215646695	0.25390898	0.186225897	0.570819715	2.890641468	0.13166458	0.313487094	0	0	0.047023064	0	34.72087915	0	1.574898375	5.468127427	0	1.694486646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.344	0	25.56570361	16.1002	0.060195748	1.798228064	0.317569682	1.215646695	0.25390898	0.186225897	0.570819715	2.890641468	0.13166458	0.313487094	0	0	0.047023064	0	34.72087915	0	1.574898375	5.468127427	0	1.694486646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.344	NO	1.001129776	1.001129776	1.001129776	1.001129776	1.001129776																																																																													0	0	0	16.1002	0.060195748	1.798228064	0.317569682	1.215646695	0.25390898	0.186225897	0.570819715	2.890641468	0.13166458	0.313487094	0	0	0.047023064	0	34.72087915	0	1.574898375	5.468127427	0	1.694486646	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.344
H5594_019_0	2010	4	N/A																															D		D			Coin	Coin	V	V		V			O					P		Coin																																																												0	YES	2350.899873	9.535819004	1542.826552	327.3235934	504.6248225	5.598778693	8.228668209	449.9809368	462.695947	118.5860975	53.02901594	0	0	37.7722602	77.20950425	41980.69706	0	3152.249994	5515.664958	0	18.69882307	0	0	0	0	0	0	4.55839969	0	0											3400	$150 day 1-7	$150 day 1-7	"$0/day days 1-8, $125/day days 9-35"	0	100	20%	20% / 0% for Diabetes Supplies	50 ER/20 UC	200 OP/ 50 ASC	$0 - $75	"$0 X-ray, 25-250 other diagnostic; 20% therapeutic"		0.2	20 Rehab/20 Sub Abs		20	20	20	20	20	20% coin		$0 copay (cap)	$0-75 copay (cap)	$0 copay (cap)	$10 copay; $100 limit (cap)	$0 copay 1/ 2 years (capitated)	$0 copay 1 aid/2 years; $500 limit (cap)	"newsletter, health club, nutrition & smoking cessation"	$30 OTC											112.681972	78.82099431	55.87395108	0	80	0.2	0.1	34	125		125	0	0.2	20	0	16.57142857	20	20	20	20	0.2	0	0	4.166666667	0	10	0	0	0												NO	74.51717554	52.12473447	36.94973515	0	52.90441708	0.132261043	0.066130521	22.48437726	82.66315169		82.66315169	0	0.132261043	13.22610427	0	10.95877211	13.22610427	13.22610427	13.22610427	13.22610427	0.132261043	0	0	2.75543839	0	6.613052135	0	0	0	0												14.5985	0.041421003	4.750586041	0	2.224740173	0.740500308	0.544166119	0.843128429	3.187325438	0	0.365295466	0	0	0.041631654	0	38.33807434	0	3.474332258	6.079229988	0	2.473125837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7021	0	39.87450821	14.5985	0.041421003	4.750586041	0	2.224740173	0.740500308	0.544166119	0.843128429	3.187325438	0	0.365295466	0	0	0.041631654	0	38.33807434	0	3.474332258	6.079229988	0	2.473125837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7021	NO																																																																																		0	0	0	14.5985	0.041421003	4.750586041	0	2.224740173	0.740500308	0.544166119	0.843128429	3.187325438	0	0.365295466	0	0	0.041631654	0	38.33807434	0	3.474332258	6.079229988	0	2.473125837	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7021
H5608_001_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	236.8405484	0.987037988	29.19782992	0	6.947153591	32.20883819	2.350908781	9.057166393	30.64434991	10.64377564	20.11176761	0	0.109973557	17.05368344	33.33815359	73.21553466	1.11363387	1.664298435	13.86016511	15.96938305	10.43117717	0.215788555	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	"$1625 Max, all services except implants"	No Cost-Sharing	$200 Allowance / 2 years	1 exam / 3 years	$1500 Allowance / 3 years	No Cost-Sharing	No Cost-Sharing											0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.5437	0.073113925	4.317502453	0	1.618686787	7.504659297	0.547761746	2.11031977	7.140133529	2.479999725	4.686041853	0	0.025623839	3.973508241	7.767789787	17.05921958	0.259476692	0.387781535	3.229418471	3.72086625	2.430464281	0.050278733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9264	0	0	17.5437	0.073113925	4.317502453	0	1.618686787	7.504659297	0.547761746	2.11031977	7.140133529	2.479999725	4.686041853	0	0.025623839	3.973508241	7.767789787	17.05921958	0.259476692	0.387781535	3.229418471	3.72086625	2.430464281	0.050278733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9264	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.5437	0.073113925	4.317502453	0	1.618686787	7.504659297	0.547761746	2.11031977	7.140133529	2.479999725	4.686041853	0	0.025623839	3.973508241	7.767789787	17.05921958	0.259476692	0.387781535	3.229418471	3.72086625	2.430464281	0.050278733	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9264
H5608_002_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	378.2126826	7.236756452	26.91209032	0	9.068351578	23.1761525	7.804704095	16.69806116	29.86294392	13.24234608	24.02298091	0	12.97413968	26.75059061	5471.925822	92.20142041	1.484731267	1.744784917	16.26284623	18.28643286	18.01167999	1.858370368	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing; UC copay waived if admitted	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	$10 Copay; this includes Preventive Services if performed by a PCP	Medicare FFS Cost-Sharing; this includes Preventive Services if performed by a specialist	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	"$1300 Max, all services except implants"	1 exam / 2 years	$200 Allowance / 2 years	1 exam / 3 years	$1500 Allowance / 3 years	No Cost-Sharing	No Cost-Sharing											0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.232556007	0.233	0.233	0.233	0	0.230586448	0.232943468	10	0.233	0.233	0.225482177	0.233	0.235542815	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.232556007	0.233	0.233	0.233	0	0.230586448	0.232943468	10	0.233	0.233	0.225482177	0.233	0.235542815	0.233	0.233	0	0	0	0	0	0	0	0												28.0158	0.536056033	3.979508624	0	2.112925918	5.400043534	1.818496054	3.883234429	6.958065932	3.085466635	5.597354551	0	2.991660786	6.231375359	4.559938185	21.48293096	0.345942385	0.393417901	3.789243171	4.307237878	4.196721438	0.433000296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1184	0	0	28.0158	0.536056033	3.979508624	0	2.112925918	5.400043534	1.818496054	3.883234429	6.958065932	3.085466635	5.597354551	0	2.991660786	6.231375359	4.559938185	21.48293096	0.345942385	0.393417901	3.789243171	4.307237878	4.196721438	0.433000296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1184	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.0158	0.536056033	3.979508624	0	2.112925918	5.400043534	1.818496054	3.883234429	6.958065932	3.085466635	5.597354551	0	2.991660786	6.231375359	4.559938185	21.48293096	0.345942385	0.393417901	3.789243171	4.307237878	4.196721438	0.433000296	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.1184
H5609_001_0	2010	7	N/A																															D	A	D	V	T	Coin	Coin	V	V						V	V	V	V	V		Coin			V	V		V																																																						0	YES	1640.111518	6.445521121	1441.45983		169.0952812	0.040225398	30.29709138	302.2773075	710.3892693						13569.89757	15492.59355	42.85871824	338.0462797	2618.542255		20.08514876			57.90368505	251.6766976		323.4212614														3350	$200 days 1-5	$948.48 per admit	$75 days 15-100		$175 waived if admitted	20% coinsurance	"Pros/Med Supplies 20%, Diabetic Supplies 0%"	"$50 ER, $10 UC waived if admitted"	$100 						$5 / $0 preventive	$10 / $0 preventive	$30 	$10 	10		20%				"$10 covered, $20 non-covered"		$10 														129.6882936	948.48	15.38386002		140	0.2	0.14612971	30.7	100						4.75	9	30	10	10		0.2				20		10														NO	118.8684599	869.3487567	14.10039177		128.3198654	0.183314093	0.133938176	28.13871334	91.65704672						4.353709719	8.249134205	27.49711402	9.165704672	9.165704672		0.183314093				18.33140934		9.165704672															16.2465	0.466950481	1.69376236	0	1.808190311	0.007373882	4.05793717	0.708807876	5.426015204	0	0	0	0	0	4.923282912	10.65004028	0.098207588	0.258202697	2.000065415	0	3.681890836	0	0	0	0.384465714	0	0.247031981	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6587	0	4.81327925	16.2465	0.466950481	1.69376236	0	1.808190311	0.007373882	4.05793717	0.708807876	5.426015204	0	0	0	0	0	4.923282912	10.65004028	0.098207588	0.258202697	2.000065415	0	3.681890836	0	0	0	0.384465714	0	0.247031981	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6587	NO																																																																																		0			16.2465	0.466950481	1.69376236	0	1.808190311	0.007373882	4.05793717	0.708807876	5.426015204	0	0	0	0	0	4.923282912	10.65004028	0.098207588	0.258202697	2.000065415	0	3.681890836	0	0	0	0.384465714	0	0.247031981	0	0	0	0	0	0	0	0	0	0	0	0	0	52.6587
H5609_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																												0	NO	183.5300429	2.778965774	24.71227121	8.804439647	12.20900168	0.021850748	23.50139079	7.248021992	49.94829979	8.082513576	2.582038492	0	0.035559198	0.000348313	76.87139077	120.3022794	0.381295453	2.506607077	7.058235219	0	13.96271476																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				6.403657406	6.403657406	17.26043056	0	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	23.3	23.3	23.3																				NO	6.403657406	6.403657406	17.26043056	0	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	23.3	23.3	23.3																					11.7526	0.177955448	4.265444412	0	2.844697392	0.005091224	5.475824055	1.688789124	11.63795385	1.883225663	0.601614969	0	0.008285293	8.12E-05	17.91103405	28.03043111	0.088841841	0.584039449	1.644568806	0	3.253312538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8538			11.7526	0.177955448	4.265444412	0	2.844697392	0.005091224	5.475824055	1.688789124	11.63795385	1.883225663	0.601614969	0	0.008285293	8.12E-05	17.91103405	28.03043111	0.088841841	0.584039449	1.644568806	0	3.253312538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8538	NO																																																																																		0			11.7526	0.177955448	4.265444412	0	2.844697392	0.005091224	5.475824055	1.688789124	11.63795385	1.883225663	0.601614969	0	0.008285293	8.12E-05	17.91103405	28.03043111	0.088841841	0.584039449	1.644568806	0	3.253312538	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8538
H5619_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1225.784076	16.88113071	316.8537063	777.2264157	142.7505431	7.474988516	6.200861726	348.2531598	247.4622323	6.1988733	11.60131773	0.627038604	0.052031227	7.787800565	4995.248894	3466.558436	123.603225	79.01307946	12.93382396	82.22069086	3.845707729	0	0	0	295	6.563247178	0	0	0	0											4950	1a (IP Acute): $160 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 15% Coinsurance; 11c (Diabetic Supplies): 15% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $400 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $30 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $29 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $175 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 25 copay;"	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											63.03836287	138.7614403	23.49624518	0	125	0.2	0.15	49.36347301	400	0	0.183566918	0.2	0.2	0.19609576	3.746461548	29	40	30	0.2	0.050743753	0.2	0	0	0	25	0	0	0	0	0											NO	58.24399039	128.2079614	21.70924206	0	115.4931452	0.184789032	0.138591774	45.60914207	369.5780648	0	0.169605766	0.184789032	0.184789032	0.181181729	3.461525022	26.7944097	36.95780648	27.71835486	0.184789032	0.046884445	0.184789032	0	0	0	25	0	0	0	0	0												5.9495	0.180357946	0.57322115	0	1.373892434	1.381295895	0.859388429	1.32362732	7.621384409	0	1.967650375	0.115869857	0.0096148	1.411007172	1.440931586	7.740365582	0.380675339	0.182509381	2.390028814	3.854871438	0.71064461	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0815	0	3.248555926	5.9495	0.180357946	0.57322115	0	1.373892434	1.381295895	0.859388429	1.32362732	7.621384409	0	1.967650375	0.115869857	0.0096148	1.411007172	1.440931586	7.740365582	0.380675339	0.182509381	2.390028814	3.854871438	0.71064461	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0815	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.9495	0.180357946	0.57322115	0	1.373892434	1.381295895	0.859388429	1.32362732	7.621384409	0	1.967650375	0.115869857	0.0096148	1.411007172	1.440931586	7.740365582	0.380675339	0.182509381	2.390028814	3.854871438	0.71064461	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0815
H5619_003_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	470.9645132	14.4489261	38.12239723	2964.042856	19.07063945	18.5471311	9.921581162	35.1694463	47.03665552	12.45672109	20.47539458	2.195739979	0	22.60205427	6602.19236	4379.649772	246.00954	2.095944361	17.4682245	126.8358667	15.28531571	0	0	0	401	0.081894293	0	0	0	0												1a (IP Acute): 7.96% Coin MC CS; 1a1 (Add'l Days): 7.96% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.96% Coin MC CS;	2a (SNF): 13.92% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $8 Copay per visit;	7h (Psych): $8 Copay per visit; 7e (MH Non-Phys): 8 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 8 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $8 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $8 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 8 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $8 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 8 copay; 18a1 (Routine Hearing Exam): 8 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $16.0 OTC per month (cumulative benefit)											0.0796	0.0796	0.1392	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.151185441	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0796	0.0796	0.1392	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.151185441	0.2	0	0	0	5	0.2	0	0	0	0												37.4888	1.150134518	5.306637695	0	3.81412789	3.70942622	1.984316232	7.03388926	9.407331104	0	4.095078916	0.439147996	0	4.520410854	0	2.919766515	0.16400636	0.419188872	3.4936449	19.17573645	3.057063143	0	0	0	0.167083333	0.016378859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3621	0	0	37.4888	1.150134518	5.306637695	0	3.81412789	3.70942622	1.984316232	7.03388926	9.407331104	0	4.095078916	0.439147996	0	4.520410854	0	2.919766515	0.16400636	0.419188872	3.4936449	19.17573645	3.057063143	0	0	0	0.167083333	0.016378859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3621	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	37.4888	1.150134518	5.306637695	0	3.81412789	3.70942622	1.984316232	7.03388926	9.407331104	0	4.095078916	0.439147996	0	4.520410854	0	2.919766515	0.16400636	0.419188872	3.4936449	19.17573645	3.057063143	0	0	0	0.167083333	0.016378859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.3621
H5619_004_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1287.045504	35.25870827	653.3749907	1142.319065	167.5988914	10.92181368	5.632661587	451.4249159	196.1788918	4.927924514	12.24617073	0.355998317	0.129859671	10.88086613	4685.909006	3235.951961	85.33946629	111.8398969	18.52232197	94.97740132	6.83298896	0	0	0	295	4.290419692	0	0	0	0											4950	1a (IP Acute): $185 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-7);	2a (SNF): $50 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $130 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 15% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $350 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $35 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $40 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $35 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $150 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											130.1767891	146.4877918	31.19217779	0	130	0.2	0.196180279	49.09828616	350	0	0.185421598	0.2	0.2	0.199752685	3.997046246	35	40	40	0.2	0.040585342	0.2	0	0	0	25	0	0	0	0	0											NO	119.7929282	134.802845	28.70405961	0	119.6302411	0.184046525	0.180531493	45.1818447	322.0814183	0	0.170631003	0.184046525	0.184046525	0.183818937	3.678212354	32.20814183	36.80930495	36.80930495	0.184046525	0.037347956	0.184046525	0	0	0	25	0	0	0	0	0												12.8482	0.396081182	1.562876223	0	1.670824649	2.010121852	1.016872806	1.699684204	5.265464644	0	2.089576399	0.065520253	0.023900221	2.000109248	1.436314033	8.685333311	0.26177387	0.343062406	3.408968988	3.547211798	1.257587872	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2041	0	4.298499218	12.8482	0.396081182	1.562876223	0	1.670824649	2.010121852	1.016872806	1.699684204	5.265464644	0	2.089576399	0.065520253	0.023900221	2.000109248	1.436314033	8.685333311	0.26177387	0.343062406	3.408968988	3.547211798	1.257587872	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2041	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.8482	0.396081182	1.562876223	0	1.670824649	2.010121852	1.016872806	1.699684204	5.265464644	0	2.089576399	0.065520253	0.023900221	2.000109248	1.436314033	8.685333311	0.26177387	0.343062406	3.408968988	3.547211798	1.257587872	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2041
H5619_007_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1139.048893	40.68319972	454.3703729	906.286883	148.0401113	10.55960587	4.387012969	384.6161765	186.8970335	2.826423543	9.184749141	0.318750812	0.146267511	7.738041067	4434.146046	3142.445466	94.85598337	67.63776883	19.56615054	90.10334659	7.244867737	0	0	0	295	4.95049336	0	0	0	0											4950	1a (IP Acute): $185 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-7);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $130 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 15% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $350 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $35 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $40 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $34 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $150 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											127.6492146	146.4877918	21.05796869	0	130	0.2	0.195619396	48.77883199	350	0	0.187834062	0.2	0.2	0.199689425	4.062823105	34	40	40	0.2	0.042329457	0.2	0	0	0	25	0	0	0	0	0											NO	117.40097	134.7271028	19.36734166	0	119.563024	0.183943114	0.179914204	44.86265121	321.9004491	0	0.172753911	0.183943114	0.183943114	0.183657474	3.736641663	31.27032934	36.78862276	36.78862276	0.183943114	0.03893106	0.183943114	0	0	0	25	0	0	0	0	0												11.1438	0.456760802	0.733328854	0	1.475010281	1.942366784	0.789285946	1.437908448	5.01351992	0	1.586701337	0.058632017	0.026904901	1.421149073	1.380734571	8.188775388	0.290801749	0.207358363	3.599058656	3.50781881	1.332643531	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2071	0	3.892593194	11.1438	0.456760802	0.733328854	0	1.475010281	1.942366784	0.789285946	1.437908448	5.01351992	0	1.586701337	0.058632017	0.026904901	1.421149073	1.380734571	8.188775388	0.290801749	0.207358363	3.599058656	3.50781881	1.332643531	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2071	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.1438	0.456760802	0.733328854	0	1.475010281	1.942366784	0.789285946	1.437908448	5.01351992	0	1.586701337	0.058632017	0.026904901	1.421149073	1.380734571	8.188775388	0.290801749	0.207358363	3.599058656	3.50781881	1.332643531	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2071
H5619_008_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	1171.094868	41.82777989	467.1536182	931.7843367	152.2050682	11.28966437	4.690317483	395.4369589	192.1551903	3.021833729	9.819754302	0.340788257	0.156379994	8.273025304	4558.896205	3230.854952	97.52465935	69.54068821	20.9188937	96.33281342	7.745755495	0	0	0	295	5.089770423	0	0	0	0												1a (IP Acute): $185 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $275 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $35 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $20 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $5 Copay per visit;	7d (SPC w/Copay): $35 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $35 Copay per visit; 7i (PT/ST): $35 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 35 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $35 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $35 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 35 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											127.6492146	154.9390105	54.14906235	0	150	0.2	0.182477584	48.77883199	275	0	0.187834062	0.2	0.2	0.197922005	4.062823105	35	40	35	0.2	0.031202	0.2	0	0	0	25	0	0	0	0	0											NO	127.6492146	154.9390105	54.14906235	0	150	0.2	0.182477584	48.77883199	275	0	0.187834062	0.2	0.2	0.197922005	4.062823105	35	40	35	0.2	0.031202	0.2	0	0	0	25	0	0	0	0	0												12.4574	0.540062902	2.1079942	0	1.902563353	2.257932874	0.855877802	1.607412748	4.403556443	0	1.844484338	0.068157651	0.031275999	1.637413754	1.54349907	9.423326943	0.325082198	0.202827007	4.18377874	3.005776442	1.549151099	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5622	0	0	12.4574	0.540062902	2.1079942	0	1.902563353	2.257932874	0.855877802	1.607412748	4.403556443	0	1.844484338	0.068157651	0.031275999	1.637413754	1.54349907	9.423326943	0.325082198	0.202827007	4.18377874	3.005776442	1.549151099	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5622	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.4574	0.540062902	2.1079942	0	1.902563353	2.257932874	0.855877802	1.607412748	4.403556443	0	1.844484338	0.068157651	0.031275999	1.637413754	1.54349907	9.423326943	0.325082198	0.202827007	4.18377874	3.005776442	1.549151099	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5622
H5619_009_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	414.0143913	10.18289647	39.12797151	2689.688323	15.46785581	17.71542064	6.694400424	29.4591575	26.1978274	6.068198914	12.43334282	0.711632423	0	12.42149456	4802.821326	3417.881597	356.4415863	1.478315372	21.70237571	105.8519358	17.08599098	0	0	0	401	0.043007709	0	0	0	0												1a (IP Acute): 7.90% Coin MC CS; 1a1 (Add'l Days): 7.90% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.90% Coin MC CS;	2a (SNF): 13.82% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $8 Copay per visit;	7h (Psych): $8 Copay per visit; 7e (MH Non-Phys): 8 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 8 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $8 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $8 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 8 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $8 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 8 copay; 18a1 (Routine Hearing Exam): 8 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $16.0 OTC per month (cumulative benefit)											0.079	0.079	0.1382	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.151307235	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.079	0.079	0.1382	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.151307235	0.2	0	0	0	5	0.2	0	0	0	0												32.7071	0.804448821	5.407485663	0	3.093571162	3.543084127	1.338880085	5.8918315	5.239565481	0	2.486668563	0.142326485	0	2.484298912	0	2.278587731	0.237627724	0.295663074	4.340475141	16.01616367	3.417198196	0	0	0	0.167083333	0.008601542	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9007	0	0	32.7071	0.804448821	5.407485663	0	3.093571162	3.543084127	1.338880085	5.8918315	5.239565481	0	2.486668563	0.142326485	0	2.484298912	0	2.278587731	0.237627724	0.295663074	4.340475141	16.01616367	3.417198196	0	0	0	0.167083333	0.008601542	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9007	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	32.7071	0.804448821	5.407485663	0	3.093571162	3.543084127	1.338880085	5.8918315	5.239565481	0	2.486668563	0.142326485	0	2.484298912	0	2.278587731	0.237627724	0.295663074	4.340475141	16.01616367	3.417198196	0	0	0	0.167083333	0.008601542	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.9007
H5619_010_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	276.9207309	6.321330249	25.17296013	1704.170767	10.07336327	12.41687633	4.814668137	19.4973759	21.41034876	4.009073554	9.262377859	0.466228314	0.04517202	8.809465326	3908.915801	2777.722692	218.0759478	1.234842375	17.2589315	82.53347115	11.06787692	0	0	0	401	0.040214908	0	0	0	0												1a (IP Acute): 7.90% Coin MC CS; 1a1 (Add'l Days): 7.90% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.90% Coin MC CS;	2a (SNF): 13.82% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $8 Copay per visit;	7h (Psych): $8 Copay per visit; 7e (MH Non-Phys): 8 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 8 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $8 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $8 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 8 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $8 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 8 copay; 18a1 (Routine Hearing Exam): 8 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $12.0 OTC per month											0.079	0.079	0.1382	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	8	8	0.2	0.2	0.154946373	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.079	0.079	0.1382	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	8	8	0.2	0.2	0.154946373	0.2	0	0	0	5	0.2	0	0	0	0												21.8767	0.49938509	3.47890309	0	2.014672654	2.483375266	0.962933627	3.899475181	4.282069752	0	1.852475572	0.093245663	0.009034404	1.761893065	0	1.851815128	0.145383965	0.246968475	3.4517863	12.788262	2.213575385	0	0	0	0.167083333	0.008042982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0871	0	0	21.8767	0.49938509	3.47890309	0	2.014672654	2.483375266	0.962933627	3.899475181	4.282069752	0	1.852475572	0.093245663	0.009034404	1.761893065	0	1.851815128	0.145383965	0.246968475	3.4517863	12.788262	2.213575385	0	0	0	0.167083333	0.008042982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0871	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.8767	0.49938509	3.47890309	0	2.014672654	2.483375266	0.962933627	3.899475181	4.282069752	0	1.852475572	0.093245663	0.009034404	1.761893065	0	1.851815128	0.145383965	0.246968475	3.4517863	12.788262	2.213575385	0	0	0	0.167083333	0.008042982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.0871
H5619_801_0	2010	3	N/A																															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	NO	232.9972708	4.32505402	21.0834091	24.21150117	8.071249623	12.82802441	5.148678825	17.30552942	28.74664214	3.274119117	10.22658193	0.3607178	0.14836198	8.584042377	28.46987518	34.44916166	0.899077172	1.837800599	22.13935278	102.1359003	7.996045637	0	0	0	0	0	0	0	0	0												FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312
H5628_001_0	2010	3	N/A																															Coin	D	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	T	V	V	V	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	NO	352.8653922	0	68.13198957	0	13.00108403	52.18357944	0.191033188	57.38152439	39.888258	6.146644312	15.21785026	0	0.03051442	17.25174884	36.22690045	152.827807	4.593233646	8.132448539	21.32255294	27.1158923	4.619547579	0	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.082691848	0	0.164777344	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233000001	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.082691848	0	0.164777344	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233000001	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												29.1791	0	11.22660826	0	3.029252579	12.15877401	0.044510733	13.36989518	9.293964114	1.432168125	3.54575911	0	0.00710986	4.01965748	8.440867806	35.60887903	1.07022344	1.89486051	4.968154835	6.318002907	1.076354586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.6841	0	0	29.1791	0	11.22660826	0	3.029252579	12.15877401	0.044510733	13.36989518	9.293964114	1.432168125	3.54575911	0	0.00710986	4.01965748	8.440867806	35.60887903	1.07022344	1.89486051	4.968154835	6.318002907	1.076354586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.6841	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.1791	0	11.22660826	0	3.029252579	12.15877401	0.044510733	13.36989518	9.293964114	1.432168125	3.54575911	0	0.00710986	4.01965748	8.440867806	35.60887903	1.07022344	1.89486051	4.968154835	6.318002907	1.076354586	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.6841
H5628_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V	P	V	Coin	V	V	V	V	V	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	YES	713.6967713	10.56413685	1002.370359	0	147.7005893	12.78008838	8.763234752	202.6578222	302.3928123	0	548.0327407	0	0.404870637	13.39799496	3923.783517	5197.51551	137.8295098	382.2710091	1600.917486	851.4588682	7.241504124	0	1056	2721.810775	371.4786495	0	160.7232154	83.42433069	0	0											2500	$175/Days 1-10 for IP Medical; $175/Days 1-10 for IP Surgical;	$325/Days 1-8 for IP Psych; $325/Days 1-8 for IP Substance Abuse;	$89/Day for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $35/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $75/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	20% Coinsurance for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $30/Visit for Prof - CORF; $30/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $10/Visit for PCP - Consults; $10/Exam for Physical Exams (Routine); $3/Procedure for PCP - Asst Surgeon (OP); $10/Visit for PCP - Tx Injections; $10/Visit for PCP - Allergy Testing; $10/Visit for PCP - Allergy Tx;	$25/Visit for Speclst - Office Visits; $25/Procedure for Speclst - Asst Surgeon (IP); $10/Procedure for Speclst - Asst Surgeon (OP); $25/Visit for Speclst - Tx Injections; $25/Visit for Speclst - Allergy Testing; $25/Visit for Speclst - Allergy Tx; $25/Visit for Speclst - Consults;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	$23/Procedure for Prof Radiology (Office);	$30/Visit for Chiropractor; $25/Exam for Vision Exams; $25/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	$2/Run for Non-Emergent Transportation (Routine);	$5/Visit for Dental: Preventive Services; $51/Service for Dental: Comprehensive Services;	$15/Exam for Vision Exams (Refractions);	No Cost-Sharing	$15/Exam for Hearing Exam;	$0/Unit for Hearing Aids;	No Cost-Sharing	No Cost-Sharing											175	325	89.18836889	0	100	0.2	0.2	48.74721783	87.48483882	0	76.6961765	0	0.2	0.131239019	9.698221012	20.27048717	35	30	24.39282612	26.40322365	0.2	0	2	16.14190137	15	0	15	400	0	0											NO	169.2295029	314.2833624	86.24744759	0	96.70257306	0.193405146	0.193405146	47.13981394	84.60009018	0	74.16717612	0	0.193405146	0.126911508	9.37842926	19.60208267	33.84590058	29.01077192	23.5884905	25.53259665	0.193405146	0	1.934051461	15.60963397	14.50538596	0	14.50538596	386.8102923	0	0												10.0649	0.276677704	7.204323752	0	1.190252253	2.471734862	1.694854698	0.796104336	2.131871599	0	3.387170066	0	0.078304065	1.700359745	3.066577179	8.490177391	0.388746991	0.924164755	3.146935575	1.811662987	1.400544163	0	0.170196529	3.540539161	0.449036766	0	0.194279356	2.689115811	0	0	0	0	0	0	0	0	0	0	0	0	57.2685	0	1.952778686	10.0649	0.276677704	7.204323752	0	1.190252253	2.471734862	1.694854698	0.796104336	2.131871599	0	3.387170066	0	0.078304065	1.700359745	3.066577179	8.490177391	0.388746991	0.924164755	3.146935575	1.811662987	1.400544163	0	0.170196529	3.540539161	0.449036766	0	0.194279356	2.689115811	0	0	0	0	0	0	0	0	0	0	0	0	57.2685	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.0649	0.276677704	7.204323752	0	1.190252253	2.471734862	1.694854698	0.796104336	2.131871599	0	3.387170066	0	0.078304065	1.700359745	3.066577179	8.490177391	0.388746991	0.924164755	3.146935575	1.811662987	1.400544163	0	0.170196529	3.540539161	0.449036766	0	0.194279356	2.689115811	0	0	0	0	0	0	0	0	0	0	0	0	57.2685
H5628_006_0	2010	3	N/A																															Coin	D	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	T	V	V	V	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	NO	357.9924877	0	68.79382706	0	13.11903709	52.89948228	0.192978369	58.03205066	40.1757631	6.025320419	15.37280484	0	0.03082513	17.42741344	37.10096244	154.3839643	4.640003893	8.215256568	21.53966819	27.39199778	4.643909615	0	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.082382025	0.082382025	0.167977308	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.082382025	0.082382025	0.167977308	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												29.4921	0	11.55580191	0	3.056735641	12.32557937	0.04496396	13.5214678	9.360952802	1.403899658	3.581863528	0	0.007182255	4.060587332	8.644524248	35.97146369	1.081120907	1.91415478	5.018742688	6.382335483	1.08203094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.5056	0	0	29.4921	0	11.55580191	0	3.056735641	12.32557937	0.04496396	13.5214678	9.360952802	1.403899658	3.581863528	0	0.007182255	4.060587332	8.644524248	35.97146369	1.081120907	1.91415478	5.018742688	6.382335483	1.08203094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.5056	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.4921	0	11.55580191	0	3.056735641	12.32557937	0.04496396	13.5214678	9.360952802	1.403899658	3.581863528	0	0.007182255	4.060587332	8.644524248	35.97146369	1.081120907	1.91415478	5.018742688	6.382335483	1.08203094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.5056
H5640_001_0	2010	2	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	T	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5649_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	P	P	P	P	P	P	Coin	P	T	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	NO	0	0	0	0	51.73708172	11.72447888	1.144165154	35.85288996	0	0	3.784644819	0	0.061262236	929.8843264	10004.05101	0	143.2710507	0	0	0	9.618904685	0	0	0	0	0	0	0	0	43.65895311												$0 copay	$0 copay	$0 copay	$0 copay	10A - $50 copay	11A - 10% coinsurance	"11B - 10% coinsurance, prosthetics"	4A - $50 copay	$0 copay	$0 copay	8B - 20% coinsurance radiation therapy	$0 copay	12 - 20% coinsurance	5 - $10 copay	4B- $5 copay	$0 copay	7E & 7H & 9C- $10 copay	$0 copay	$0 copay	$0 copay	15 - 20% coinsurance	$0 copay	$0 copay	$0 copay	$0 copay	17B - $100 max	$0 copay	$0 copay	$0 copay	"$10 copay - acupuncture, 4A - $50 worldwide emerg."											0	0	0	0	50	0.1	0.1	50	0	0	0.2	0	0.2	0.15	0.02	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	9.54											NO	0	0	0	0	50	0.1	0.1	50	0	0	0.2	0	0.2	0.15	0.02	0	10	0	0	0	0.2	0	0	0	0	0	0	0	0	9.54												0	0	0	0	0.215571174	1.172447888	0.114416515	0.149387042	0	0	0.756928964	0	0.012252447	0.011623554	0.016673418	0	0.119392542	0	0	0	1.923780937	0	0	0	0	0	0	0	0	0.034708868	0	0	0	0	0	0	0	0	0	0	4.5272			0	0	0	0	0.215571174	1.172447888	0.114416515	0.149387042	0	0	0.756928964	0	0.012252447	0.011623554	0.016673418	0	0.119392542	0	0	0	1.923780937	0	0	0	0	0	0	0	0	0.034708868	0	0	0	0	0	0	0	0	0	0	4.5272	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0.215571174	1.172447888	0.114416515	0.149387042	0	0	0.756928964	0	0.012252447	0.011623554	0.016673418	0	0.119392542	0	0	0	1.923780937	0	0	0	0	0	0	0	0	0.034708868	0	0	0	0	0	0	0	0	0	0	4.5272
H5649_002_0	2010	4	N/A																															D	D	D	V	T	P	P	V	V	V	Coin	V	V	V	P	P	P	P	P	P	Coin	P	T	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	18B - $500 every 2 yrs	$0 copay	$0 copay											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5649_003_0	2010	6	N/A																															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	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	NO	147.4	1.07	31.05	0	4.81	11.73	1.15	128.8872129	23.68	4.71	20.85	0	0.11	23.21	41.73	117.03	1.09	4.73	31.74	8.64	8.72	5.56	0	0	0	0	0	0	0	253.7470201												Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	4A - $50 copay	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	"Medicare cost sharing, 4B - $20 copay"	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	Medicare cost sharing	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0.065614846	0.065614846	0.153552511	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.22	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	70.45											NO	0.065614846	0.065614846	0.153552511	0	0.233	0.233	0.233	50	0.233	0.233	0.233	0.233	0.233	0.233	0.22	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	70.45												9.6716	0.070207886	4.767805474	0	1.12073	2.73309	0.26795	0.537030054	5.51744	1.09743	4.85805	0	0.02563	5.40793	9.1806	27.26799	0.25397	1.10209	7.39542	2.01312	2.03176	1.29548	0	0	0	0	0	0	0	1.489706464	0	0	0	0	0	0	0	0	0	0	88.1051			9.6716	0.070207886	4.767805474	0	1.12073	2.73309	0.26795	0.537030054	5.51744	1.09743	4.85805	0	0.02563	5.40793	9.1806	27.26799	0.25397	1.10209	7.39542	2.01312	2.03176	1.29548	0	0	0	0	0	0	0	1.489706464	0	0	0	0	0	0	0	0	0	0	88.1051	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			9.6716	0.070207886	4.767805474	0	1.12073	2.73309	0.26795	0.537030054	5.51744	1.09743	4.85805	0	0.02563	5.40793	9.1806	27.26799	0.25397	1.10209	7.39542	2.01312	2.03176	1.29548	0	0	0	0	0	0	0	1.489706464	0	0	0	0	0	0	0	0	0	0	88.1051
H5652_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1799.917801	111.9531612	2954.803922	2854.344111	546.5140379	6.9335212	6.047906287	345.0039203	318.0253549	13667.5558	4870.995512	0	12.325306	560.4880212	7035.138395	7559.496666	766.1282949	1663.934361	0	0	742.7014242	1808.602514	1215.817125	409.5820478	138.5709239	152.3214825	16.15098011	20.43568521	2022.720145	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.49876093	100	0	12.93046951	0	0	38.85602853	0.943606067	29.17832454	22.85237541	0	0	0	0	29.62444091	0	30	30	0	30	0	0	0											NO	0	0	19.38145305	0	0	0.181394599	0.181394599	43.08009356	90.6972997	0	11.72758668	0	0	35.24136865	0.855825222	26.46395245	20.72648741	0	0	0	0	26.86856796	0	30	30	0	30	0	0	0												0	0	4.772366123	0	0	1.257703301	1.097057538	1.238566764	2.403670077	0	4.760418509	0	0	1.646030415	0.501737407	16.67118003	1.323262372	0	0	0	0	4.04954663	0	1.023955119	0.34642731	0	0.04037745	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1323	0	4.074184957	0	0	4.772366123	0	0	1.257703301	1.097057538	1.238566764	2.403670077	0	4.760418509	0	0	1.646030415	0.501737407	16.67118003	1.323262372	0	0	0	0	4.04954663	0	1.023955119	0.34642731	0	0.04037745	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1323	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.2044	0.0889	0.6507	0	0	0	0	0	0	0	0	0	0	0	1.0731	4.0471	0.1861	0	0	0	0.385	0.3909	0	0	0.0194	0	0.002	0	0	0											11.0475	0	0	4.2044	0.088908714	5.423030036	0	0	1.257703301	1.097057538	1.238566764	2.403670077	0	4.760418509	0	0	1.646030415	1.574827707	20.71828224	1.509334373	0	0	0	0.384995069	4.440447629	0	1.023955119	0.365794577	0	0.042399779	0	0	0	0	0	0	0	0	0	0	0	0	0	52.1798
H5652_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2260.350645	154.9577481	2960.629548	3765.857331	626.5597842	7.319363161	6.026858119	424.7978081	278.194815	12570.01509	4966.206338	0	11.73419526	640.2386287	5509.876565	6601.585146	718.4206507	567.9439235	0	0	715.288855	1715.038998	1576.881712	394.7348034	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.0199734	100	0	13.14050144	0	0	38.98148668	1.767439979	28.7538925	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.51661799	0	0	0.182659633	0.182659633	42.94325543	91.32981652	0	12.00119585	0	0	35.60172026	1.61419969	26.26087726	17.1157132	0	0	0	0	26.96347627	0	30	30	0	30	0	0	0												0	0	4.815122992	0	0	1.336952189	1.100863692	1.520183399	2.117290117	0	4.966701242	0	0	1.89946638	0.741170087	14.44695144	1.024690151	0	0	0	0	3.853617777	0	0.986837009	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1226	0	3.590639338	0	0	4.815122992	0	0	1.336952189	1.100863692	1.520183399	2.117290117	0	4.966701242	0	0	1.89946638	0.741170087	14.44695144	1.024690151	0	0	0	0	3.853617777	0	0.986837009	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1226	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.5011	0.1105	0.5565	0	0	0	0	0	0	0	0	0	0	0	0.7922	3.9995	0.1864	0	0	0	0.4723	0.3569	0	0	0.0202	0	0.0021	0	0	0											10.9977	0	0	4.5011	0.110486736	5.371631378	0	0	1.336952189	1.100863692	1.520183399	2.117290117	0	4.966701242	0	0	1.89946638	1.533352441	18.44640159	1.211091303	0	0	0	0.472346301	4.210520657	0	0.986837009	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1203
H5652_003_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1244.999864	313.4925847	9384.774048	89.52100436	712.3130324	2020.975403	1783.858574	181.751513	95.49084265	32875.92236	4630.810716	0	2.53770154	396.9413533	169.4931102	5161.383945	1813.291388	55.90546239	0	0	246.4227027	1824.68233	1138.292512	0	86.625514	113.6122422	15.76213337	9.098246684	0	0											500	"$25 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$25 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $20 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											23.38815764	21.55472438	0	0	50	0	0	49.92331377	0	0	0	0	0	0	0.322315628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	21.07930152	21.33532543	0	0	42.67065086	0	0	42.60520583	0	0	0	0	0	0	0.275068353	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												2.187	0.557372193	0	0	2.532905059	0	0	0.645296718	0	0	0	0	0	0	0.003885183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9264	0	1.017957801	2.187	0.557372193	0	0	2.532905059	0	0	0.645296718	0	0	0	0	0	0	0.003885183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.9264	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.4176	0.5022	0.5286	0.0432	0.6673	0.4562	0.3981	0.0658	0.2937	0.3323	0.5641	0	0.0005	0.2006	0.0195	3.2894	0.3051	0	0	0	0.0629	0.2602	0	0	0.0118	0	0.0015	0	0	0											13.4205	0	0	7.6045	1.059531314	0.528600151	0.043204503	3.200187161	0.45622726	0.398106218	0.711047717	0.293702194	0.332340356	0.564109052	0	0.00053232	0.200611372	0.023420973	3.289412104	0.305053176	0	0	0	0.062898187	0.260181232	0	0	0.011763846	0	0.001513473	0	0	0	0	0	0	0	0	0	0	0	0	0	19.347
H5652_004_0	2010	3	N/A																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	3032.171047	407.9254973	2416.061016	2409.930908	461.8361114	2946.816253	25.93305502	749.8629206	613.7109545	24886.42415	8943.068771	0	17.24679503	1240.104459	13773.60167	9645.368773	1718.937051	1755.571541	0	0	2860.667564	2119.535841	789.9216152	398.0354876	138.2187764	157.9521467	15.74970481	14.17342697	2039.594788	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0	0.109776442	49.09283336	100	0	13.77487755	0	0	38.92405034	0.379931731	29.77518794	21.49028108	0	0	0	0	29.70982203	0	30	0	0	30	0	0	0											NO	0	0	13.791622	0	0	0	0.070848804	31.68410668	64.53916898	0	8.8901915	0	0	25.12125862	0.245204782	19.21665886	13.86964882	0	0	0	0	19.17447225	0	30	0	0	30	0	0	0												0	0	2.776783355	0	0	0	1.837325921	1.979894731	3.300699583	0	6.625466164	0	0	2.596082069	0.281446083	15.44598011	1.986754437	0	0	0	0	3.38674843	0	0.995088719	0	0	0.039374262	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2516	0	22.09719583	0	0	2.776783355	0	0	0	1.837325921	1.979894731	3.300699583	0	6.625466164	0	0	2.596082069	0.281446083	15.44598011	1.986754437	0	0	0	0	3.38674843	0	0.995088719	0	0	0.039374262	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2516	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.2789	0.3921	0.6219	0	0	0	0	0	0	0	0	0	0	0	2.2029	7.0351	0.41	0	0	0	1.4254	0.4607	0	0	0.0191	0	0.002	0	0	0											19.8482	0	0	7.2789	0.392145306	3.398713805	0	0	0	1.837325921	1.979894731	3.300699583	0	6.625466164	0	0	2.596082069	2.484391377	22.48112552	2.39675114	0	0	0	1.425372988	3.84742948	0	0.995088719	0.019058041	0	0.041357488	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0998
H5656_001_0	2010	9	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	2065.300617	132.3223441	693.3170652		76.03448693	10.87318652	0.483860611	360.6913233	136.513161		38.64188789	35.76383133	11.77589568	42.02317761	0.922282758	2271.553731	299.5542675	139.9859622		315.9941959	9.051334687	673.6924928		1223.55976	122.3875438																3000	(1a/1a1) $60/Day Days 1 - 7	(1b) $60/Day Days 1 - 7	(2a/2a2) $125/Day Days 21-100	(6a) 0%	(10a) $100	(11a) 15%	(11b) 15% (11c) 0%-20%	(4a) $50 (4a1) $50 (4b) $25 (4b1) n/c	(9b) $75	(8a) $0	(8b1) 20% (8b2) 20% (8b3) 20%	(9a) $150	(12) $50	(3) $20 (5) $20 (9a) $150 (9c) 35 Ind/20 Grp (9d) $20	(7a) $0 (14b) $0 (14c) $0 (14d) $0 (14d1) $0 (14d2) $0 (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $10 (14j) $10	(7b) $25 (7d) $20 (7f) $20	(7e) 35 Ind/20 Grp (7h) 35 Ind/20 Grp	(7c) $20 (7i) $20		(7d) $20 (7g) $20	(15) 20%	(13a) $0 (16b) $0 (17a) $25 (17b) $0 (18a) $20	(10b) n/c	(16a) $15	(17a1) $25	(17b1) $0		(18b) n/c	(14a) $0  (14a6) n/c												27.7733796	23.61308905	81.23643933		100	0.15	0.15	49.96977025	75		0.2	150	50	45.02767153	10	20.14921017	31.25	20		20	0.2	25		15	25																NO	25.67586609	21.82977085	75.10126488		92.44775559	0.138671633	0.138671633	46.19593107	69.33581669		0.184895511	138.6716334	46.2238778	41.62707172	9.244775559	18.62749257	28.88992362	18.48955112		18.48955112	0.184895511	23.1119389		13.86716334	23.1119389																	4.419	0.240713871	4.33908238	0	0.585768139	1.507802535	0.067097741	1.388539292	0.788770959	0	7.144711615	0.413285742	0.04536063	0.145775152	0.000710525	3.52611252	0.721174992	0.2156898	0	0.48688257	1.673551154	1.297528311	0	1.41394192	0.235717786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6572	0	2.504452807	4.419	0.240713871	4.33908238	0	0.585768139	1.507802535	0.067097741	1.388539292	0.788770959	0	7.144711615	0.413285742	0.04536063	0.145775152	0.000710525	3.52611252	0.721174992	0.2156898	0	0.48688257	1.673551154	1.297528311	0	1.41394192	0.235717786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6572	NO																																																																																		0	0	0	4.419	0.240713871	4.33908238	0	0.585768139	1.507802535	0.067097741	1.388539292	0.788770959	0	7.144711615	0.413285742	0.04536063	0.145775152	0.000710525	3.52611252	0.721174992	0.2156898	0	0.48688257	1.673551154	1.297528311	0	1.41394192	0.235717786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6572
H5656_003_0	2010	3	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	1929.369704	121.6693446	470.2479555		69.65673604	8.090275207	0.252533524	282.0382498	107.1116254		38.52377208	38.06382252	21.42508704	27.11815993	0.479224781	1867.567487	275.9317503	112.6320498		271.3249889	10.76246332	483.6559152		1292.818412	106.3642949																3000	(1a/1a1) $75/Day Days 1 - 7	(1b) $75/Day Days 1 - 7	(2a/2a2) $125/Day Days 21-100	(6a) 0%	(10a) $100	(11a) 15%	(11b) 15% (11c) 0%-20%	(4a) $50 (4a1) $50 (4b) $25 (4b1) n/c	(9b) $75	(8a) $0	(8b1) 20% (8b2) 20% (8b3) 20%	(9a) $150	(12) $50	(3) $20 (5) $20 (9a) $150 (9c) 35 Ind/20 Grp (9d) $20	(7a) $0 (14b) $0 (14c) $0 (14d) $0 (14d1) $0 (14d2) $0 (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $10 (14j) $10	(7b) $25 (7d) $20 (7f) $20	(7e) 35 Ind/20 Grp (7h) 35 Ind/20 Grp	(7c) $20 (7i) $20		(7d) $20 (7g) $20	(15) 20%	(13a) $0 (16b) $0 (17a) $25 (17b) $0 (18a) $20	(10b) n/c	(16a) $15	(17a1) $25	(17b1) $0		(18b) n/c	(14a) $0  (14a6) n/c												34.7167245	29.51636131	81.23643933		100	0.15	0.15	49.97991197	75		0.2	150	50	60.6235511	10	20.30306293	31.25	20		20	0.2	25		15	25																NO	32.44392324	27.58401245	75.91812995		93.45329581	0.140179944	0.140179944	46.70787498	70.08997186		0.186906592	140.1799437	46.72664791	56.65470654	9.345329581	18.97388146	29.20415494	18.69065916		18.69065916	0.186906592	23.36332395		14.01799437	23.36332395																	5.2164	0.279677393	2.975028783	0	0.542470963	1.134094323	0.035400135	1.097783943	0.625620901	0	7.200346935	0.444648708	0.083426875	0.128030949	0.000373209	2.952917011	0.671529466	0.175430604	0	0.422603574	2.011575336	0.941650819	0	1.510226769	0.20708529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6563	0	2.007464809	5.2164	0.279677393	2.975028783	0	0.542470963	1.134094323	0.035400135	1.097783943	0.625620901	0	7.200346935	0.444648708	0.083426875	0.128030949	0.000373209	2.952917011	0.671529466	0.175430604	0	0.422603574	2.011575336	0.941650819	0	1.510226769	0.20708529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6563	NO																																																																																		0	0	0	5.2164	0.279677393	2.975028783	0	0.542470963	1.134094323	0.035400135	1.097783943	0.625620901	0	7.200346935	0.444648708	0.083426875	0.128030949	0.000373209	2.952917011	0.671529466	0.175430604	0	0.422603574	2.011575336	0.941650819	0	1.510226769	0.20708529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.6563
H5656_009_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	2286.132912	146.4709125			84.16447542	12.02117071	0.534946309	399.2582476	151.1098325			39.58787945	13.03503348	46.51650641	1.020897853	2514.439642	331.5841114	154.953963		349.7818793	10.0069689	745.7270712		1649.99508	124.6184334																2500	(1a/1a1) $50/Day Days 1 - 7	(1b) $50/Day Days 1 - 7	(2a/2a2) $0/Day Days 1-100	(6a) 0%	(10a) $75	(11a) 10%	(11b) 10% (11c) 0%-20%	(4a) $25 (4a1) $25 (4b) $15 (4b1) n/c	(9b) $50	(8a) $0	(8b1) $0 (8b2) $0 (8b3) $0	(9a) $100	(12) $50	(3) $20 (5) $20 (9a) $100 (9c) $15 (9d) $20	(7a) $0 (14b) $0 (14c) $0 (14d) $0 (14d1) $0 (14d2) $0 (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $10 (14j) $10	(7b) $20 (7d) $15 (7f) $15	(7e) $15 (7h) $15	(7c) $20 (7i) $15		(7d) $15 (7g) $15	(15) 20%	(13a) $0 (16b) $0 (17a) $10 (17b) $0 (18a) $15	(10b) n/c	(16a) $15	(17a1) $10	(17b1) $0		(18b) n/c	(14a) $0  (14a6) n/c	(13c) n/c											23.144483	19.67757421			75	0.1	0.1	24.9879081	50			100	50	34.61566794	10	15.14921017	15	15.73217275		15	0.2	10		12.75	10																NO	22.4154184	19.05771924			72.63745662	0.096849942	0.096849942	24.20077454	48.42497108			96.84994216	48.42497108	33.52525438	9.684994216	14.67200128	14.52749132	15.23660021		14.52749132	0.193699884	9.684994216		12.34836763	9.684994216																	4.2704	0.232616794	0	0	0.509457786	1.164249688	0.051809519	0.80519657	0.609790773	0	0	0.319506986	0.05260176	0.129956476	0.000823949	3.074321805	0.401423775	0.196747632	0	0.423454435	1.938348719	0.601863531	0	1.697895486	0.100577401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.581	0	0.539300261	4.2704	0.232616794	0	0	0.509457786	1.164249688	0.051809519	0.80519657	0.609790773	0	0	0.319506986	0.05260176	0.129956476	0.000823949	3.074321805	0.401423775	0.196747632	0	0.423454435	1.938348719	0.601863531	0	1.697895486	0.100577401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.581	NO																																																																																		0	0	0	4.2704	0.232616794	0	0	0.509457786	1.164249688	0.051809519	0.80519657	0.609790773	0	0	0.319506986	0.05260176	0.129956476	0.000823949	3.074321805	0.401423775	0.196747632	0	0.423454435	1.938348719	0.601863531	0	1.697895486	0.100577401	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.581
H5656_801_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																										0	NO	287.4644928	8.965248804	30.12516671		10.30292394	12.82945998	0.570915465	20.31619804	23.63855753	20.47572775	45.59422883	1.944959347	0.443184389	5.405453517	50.90422821	110.6509892	2.856496342	6.556886495		7.9921198	10.67982563	4.737571745																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																		0.077403451	0.077403451	0.18609298		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.077403451	0.077403451	0.18609298		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				22.2507	0.693941197	5.606082042	0	2.400581278	2.989264175	0.133023303	4.733674143	5.507783904	4.770844566	10.62345532	0.453175528	0.103261963	1.25947067	11.86068517	25.78168049	0.665563648	1.527754553	0	1.862163914	2.488399373	1.103854217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8154	0	0	22.2507	0.693941197	5.606082042	0	2.400581278	2.989264175	0.133023303	4.733674143	5.507783904	4.770844566	10.62345532	0.453175528	0.103261963	1.25947067	11.86068517	25.78168049	0.665563648	1.527754553	0	1.862163914	2.488399373	1.103854217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8154	NO																																																																																		0	0	0	22.2507	0.693941197	5.606082042	0	2.400581278	2.989264175	0.133023303	4.733674143	5.507783904	4.770844566	10.62345532	0.453175528	0.103261963	1.25947067	11.86068517	25.78168049	0.665563648	1.527754553	0	1.862163914	2.488399373	1.103854217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8154
H5656_802_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																										0	NO	287.4644928	8.965248804	30.12516671		10.30292394	12.82945998	0.570915465	20.31619804	23.63855753	20.47572775	45.59422883	1.944959347	0.443184389	5.405453517	50.90422821	110.6509892	2.856496342	6.556886495		7.9921198	10.67982563	4.737571745																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																		0.077403451	0.077403451	0.18609298		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.077403451	0.077403451	0.18609298		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				22.2507	0.693941197	5.606082042	0	2.400581278	2.989264175	0.133023303	4.733674143	5.507783904	4.770844566	10.62345532	0.453175528	0.103261963	1.25947067	11.86068517	25.78168049	0.665563648	1.527754553	0	1.862163914	2.488399373	1.103854217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8154	0	0	22.2507	0.693941197	5.606082042	0	2.400581278	2.989264175	0.133023303	4.733674143	5.507783904	4.770844566	10.62345532	0.453175528	0.103261963	1.25947067	11.86068517	25.78168049	0.665563648	1.527754553	0	1.862163914	2.488399373	1.103854217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8154	NO																																																																																		0	0	0	22.2507	0.693941197	5.606082042	0	2.400581278	2.989264175	0.133023303	4.733674143	5.507783904	4.770844566	10.62345532	0.453175528	0.103261963	1.25947067	11.86068517	25.78168049	0.665563648	1.527754553	0	1.862163914	2.488399373	1.103854217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8154
H5656_803_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																										0	NO	287.4644928	8.965248804	30.12516671		10.30292394	12.82945998	0.570915465	20.31619804	23.63855753	20.47572775	45.59422883	1.944959347	0.443184389	5.405453517	50.90422821	110.6509892	2.856496342	6.556886495		7.9921198	10.67982563	4.737571745																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																		0.077403451	0.077403451	0.18609298		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.077403451	0.077403451	0.18609298		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				22.2507	0.693941197	5.606082042	0	2.400581278	2.989264175	0.133023303	4.733674143	5.507783904	4.770844566	10.62345532	0.453175528	0.103261963	1.25947067	11.86068517	25.78168049	0.665563648	1.527754553	0	1.862163914	2.488399373	1.103854217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8154	0	0	22.2507	0.693941197	5.606082042	0	2.400581278	2.989264175	0.133023303	4.733674143	5.507783904	4.770844566	10.62345532	0.453175528	0.103261963	1.25947067	11.86068517	25.78168049	0.665563648	1.527754553	0	1.862163914	2.488399373	1.103854217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8154	NO																																																																																		0	0	0	22.2507	0.693941197	5.606082042	0	2.400581278	2.989264175	0.133023303	4.733674143	5.507783904	4.770844566	10.62345532	0.453175528	0.103261963	1.25947067	11.86068517	25.78168049	0.665563648	1.527754553	0	1.862163914	2.488399373	1.103854217	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.8154
H5657_805_0	2010	4	N/A																															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	NO	286.556988	2.648597	58.514066	26.822796	9.331008	14.121912	5.403404	21.327469	74.530823	15.997893	34.189358	5.59527	1.345023	22.805569	37.91055	79.319442	0.547188	10.320974			33.163136	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																			0.084594602	0.084594602	0.169661208	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.084594602	0.084594602	0.169661208	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				24.2412	0.224057008	9.927567108	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6496	0	0	24.2412	0.224057008	9.927567108	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6496	NO																																																																																		0	0	0	24.2412	0.224057008	9.927567108	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.6496
H5657_806_0	2010	4	N/A																															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	NO	365.641018	3.379557	74.662784	34.225353	11.906182	18.019278	6.894636	27.213426	95.099848	20.412994	43.624939	7.139453	1.716222	29.099454	48.373108	101.210032	0.6982	13.169359			42.315502	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																			0.072410547	0.072410547	0.157781811	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.072410547	0.072410547	0.157781811	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				26.4763	0.244715572	11.78042924	0	2.774140406	4.198491774	1.606450188	6.340728258	22.15826458	4.756227602	10.16461079	1.663492549	0.399879726	6.780172782	11.27093416	23.58193746	0.1626806	3.068460647	0	0	9.859511966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.2874	0	0	26.4763	0.244715572	11.78042924	0	2.774140406	4.198491774	1.606450188	6.340728258	22.15826458	4.756227602	10.16461079	1.663492549	0.399879726	6.780172782	11.27093416	23.58193746	0.1626806	3.068460647	0	0	9.859511966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.2874	NO																																																																																		0	0	0	26.4763	0.244715572	11.78042924	0	2.774140406	4.198491774	1.606450188	6.340728258	22.15826458	4.756227602	10.16461079	1.663492549	0.399879726	6.780172782	11.27093416	23.58193746	0.1626806	3.068460647	0	0	9.859511966	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.2874
H5657_807_0	2010	4	N/A																															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	NO	286.556988	2.648597	58.514066	26.822796	9.331008	14.121912	5.403404	21.327469	74.530823	15.997893	34.189358	5.59527	1.345023	22.805569	37.91055	79.319442	0.547188	10.320974			33.163136	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																			0.090673139	0.090673139	0.171780527	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.090673139	0.090673139	0.171780527	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				25.983	0.240156603	10.05157708	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5316	0	0	25.983	0.240156603	10.05157708	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5316	NO																																																																																		0	0	0	25.983	0.240156603	10.05157708	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.5316
H5657_809_0	2010	5	N/A																																		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	NO				26.822796	9.331008	14.121912	5.403404	21.327469	74.530823	15.997893	34.189358	5.59527	1.345023	22.805569	37.91055	79.319442	0.547188	10.320974			33.163136	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2568	0	0	0	0	0	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2568	NO																																																																																		0	0	0	0	0	0	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2568
H5657_810_0	2010	5	N/A																																		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	NO				26.822796	9.331008	14.121912	5.403404	21.327469	74.530823	15.997893	34.189358	5.59527	1.345023	22.805569	37.91055	79.319442	0.547188	10.320974			33.163136	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2568	0	0	0	0	0	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2568	NO																																																																																		0	0	0	0	0	0	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2568
H5657_811_0	2010	5	N/A																																		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	NO				26.822796	9.331008	14.121912	5.403404	21.327469	74.530823	15.997893	34.189358	5.59527	1.345023	22.805569	37.91055	79.319442	0.547188	10.320974			33.163136	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	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO				0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				0	0	0	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2568	0	0	0	0	0	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2568	NO																																																																																		0	0	0	0	0	0	0	2.174124864	3.290405496	1.258993132	4.969300277	17.36568176	3.727509069	7.966120414	1.30369791	0.313390359	5.313697577	8.83315815	18.48142999	0.127494804	2.404786942	0	0	7.727010688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.2568
H5665_002_0	2010	5	N/A																															D	A	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	S	V	T	V	V	V	V	V	O	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	YES	2570.062976	8.29100612	565.5942304	469.3232198	566.1325441	25.11535586	16.90262297	534.0479891	245.5145643	10.60873611	27.83181536	0	0	166.9362549	4722.791091	3609.742979	170.1979779	833.1183953	38.67396114	17023.61469	459.2486577	553.9946789	400	712.0418848	2148.691099	0	0	0	0	12000											3400	1A IP Acute: $245 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: $0	10A Ambulance: $175	11A DME: 35%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $30"	"9A OP Hospital: $225, 9B ASC Services: $225"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $45, 5 Partial Hosp: $45, 9C OP Substance Abuse: $45, OP Substance Abuse (Group): $30, 9D Cardiac Rehab: $45"	"7A PCP: $30, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $45	"7E Mental Health: $45, MH (Group): $30, 7H Psychiatric: $45, Psychiatric (Group): $30"	"7C Occupational Therapy: $45, 7I Physical and Speech Therapy: $45"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $45, 7F Podiatry: $45, 7G Other Health Care: $45, 18A Hearing Exams (Medicare Covered): $45"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $45"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $45	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											254.5191447	1056.989771	144.1717385	0	182.0759476	0.377024202	0.053798781	113.4793953	481.5210902	0.261064063	0.276501915	0	0	227.1461905	32.99255918	57.04133465	51.8685777	40.80084749	0.22497472	7.060451286	29.08931633	144.0280789	0	10	25	0	0	0	0	0											NO	239.8876482	984.4313803	134.887966	0	181.7355908	0.37352912	0.053533075	112.7983181	466.8145925	0.256648722	0.272132276	0	0	222.3398539	32.72291775	56.71354724	51.32769336	40.80084749	0.220655401	6.91127775	28.65472783	143.7261852	0	10	25	0	0	0	0	0												51.3772	0.68016055	6.35765461	0	8.573869364	9.381316768	0.904849387	5.019976247	9.550815107	2.72271856	7.573935246	0	0	3.093048545	12.87862537	17.06011075	0.727989135	2.832661382	8.533618388	9.804577454	1.096637108	6.635295154	0	0.593368237	4.476439791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	169.8749	0	4.950091801	51.3772	0.68016055	6.35765461	0	8.573869364	9.381316768	0.904849387	5.019976247	9.550815107	2.72271856	7.573935246	0	0	3.093048545	12.87862537	17.06011075	0.727989135	2.832661382	8.533618388	9.804577454	1.096637108	6.635295154	0	0.593368237	4.476439791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	169.8749	NO	1A IP Acute: $245 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: $0	10A Ambulance: $175	11A DME: 35%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $30"	"9A OP Hospital: $225, 9B ASC Services: $225"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $45, 5 Partial Hosp: $45, 9C OP Substance Abuse: $45, OP Substance Abuse (Group): $30, 9D Cardiac Rehab: $45"	"7A PCP: $30, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $45	"7E Mental Health: $45, MH (Group): $30, 7H Psychiatric: $45, Psychiatric (Group): $30"	"7C Occupational Therapy: $45, 7I Physical and Speech Therapy: $45"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $45, 7F Podiatry: $45, 7G Other Health Care: $45, 18A Hearing Exams (Medicare Covered): $45"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $45"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $45	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"												0	0	0	0	0	0	0	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.03	0	0	51.3772	0.68016055	6.35765461	0	8.573869364	9.381316768	0.904849387	5.049976247	9.550815107	2.72271856	7.573935246	0	0	3.093048545	12.87862537	17.06011075	0.727989135	2.832661382	8.533618388	9.804577454	1.096637108	6.635295154	0	0.593368237	4.476439791	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	169.9049
H5678_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2058.447663	141.1163419	2696.175033	3467.019625	570.5931186	6.070176553	4.998261739	386.9004393	253.3454126	11447.21429	4522.606196	0	10.68605301	583.0501175	5024.348835	6032.562699	654.2486286	517.213046	0	0	651.3965765	1561.845294	1576.881712	414.6583266	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02033666	100	0	13.14050144	0	0	38.97958915	1.765105927	28.65543746	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.79396717	0	0	0.185255395	0.185255395	43.55385526	92.62769762	0	12.17174394	0	0	36.10589597	1.634976981	26.54287197	17.3589433	0	0	0	0	27.34665219	0	30	30	0	30	0	0	0												0	0	4.447333341	0	0	1.124532956	0.925954954	1.404250478	1.955566856	0	4.587333711	0	0	1.754295574	0.684557891	13.34346161	0.946422071	0	0	0	0	3.559270002	0	1.036645817	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0824	0	2.764421805	0	0	4.447333341	0	0	1.124532956	0.925954954	1.404250478	1.955566856	0	4.587333711	0	0	1.754295574	0.684557891	13.34346161	0.946422071	0	0	0	0	3.559270002	0	1.036645817	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0824	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.7329	0.0916	0.4615	0	0	0	0	0	0	0	0	0	0	0	0.6641	3.3562	0.1563	0	0	0	0.396	0.2992	0	0	0.0202	0	0.0021	0	0	0											9.1802	0	0	3.7329	0.091630102	4.908863132	0	0	1.124532956	0.925954954	1.404250478	1.955566856	0	4.587333711	0	0	1.754295574	1.348705593	16.69965177	1.102696565	0	0	0	0.396004416	3.858489275	0	1.036645817	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2626
H5678_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2058.447663	141.1163419	2696.175033	3467.019625	570.5931186	6.070176553	4.998261739	386.9004393	253.3454126	11447.21429	4522.606196	0	10.68605301	583.0501175	5024.348835	6032.562699	654.2486286	517.213046	0	0	651.3965765	1561.845294	1576.881712	414.6583266	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02033666	100	0	13.14050144	0	0	38.97958915	1.765105927	28.65543746	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.79396717	0	0	0.185255395	0.185255395	43.55385526	92.62769762	0	12.17174394	0	0	36.10589597	1.634976981	26.54287197	17.3589433	0	0	0	0	27.34665219	0	30	30	0	30	0	0	0												0	0	4.447333341	0	0	1.124532956	0.925954954	1.404250478	1.955566856	0	4.587333711	0	0	1.754295574	0.684557891	13.34346161	0.946422071	0	0	0	0	3.559270002	0	1.036645817	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0824	0	2.764421805	0	0	4.447333341	0	0	1.124532956	0.925954954	1.404250478	1.955566856	0	4.587333711	0	0	1.754295574	0.684557891	13.34346161	0.946422071	0	0	0	0	3.559270002	0	1.036645817	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	36.0824	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.7329	0.0916	0.4615	0	0	0	0	0	0	0	0	0	0	0	0.6641	3.3562	0.1563	0	0	0	0.396	0.2992	0	0	0.0202	0	0.0021	0	0	0											9.1802	0	0	3.7329	0.091630102	4.908863132	0	0	1.124532956	0.925954954	1.404250478	1.955566856	0	4.587333711	0	0	1.754295574	1.348705593	16.69965177	1.102696565	0	0	0	0.396004416	3.858489275	0	1.036645817	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	45.2626
H5678_003_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1304.239985	378.0836293	10909.81027	105.5774424	781.4595237	2040.930823	1848.09872	192.669424	83.81230595	33349.9995	4731.157585	0	3.060561734	466.6670111	162.3580083	5117.431255	1987.144133	31.05890417	0	0	140.9836213	2059.959408	1533.383865	0	108.5215448	141.8948371	15.79381348	9.237945123	0	0											500	"$25 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$25 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $20 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											23.38815764	21.55472438	0	0	50	0	0	49.91275447	0	0	0	0	0	0	0.405807714	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	20.66376959	20.91474655	0	0	41.8294931	0	0	41.75650437	0	0	0	0	0	0	0.33949462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												2.2459	0.658960274	0	0	2.724004647	0	0	0.67043347	0	0	0	0	0	0	0.004593306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.3039	0	1.231327286	2.2459	0.658960274	0	0	2.724004647	0	0	0.67043347	0	0	0	0	0	0	0.004593306	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.3039	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.1151	0.5485	0.5631	0.0469	0.6951	0.4559	0.4115	0.0697	0.1443	0.3376	0.5266	0	0.0006	0.2133	0.0168	2.3891	0.3148	0	0	0	0.0302	0.2549	0	0	0.0153	0	0.0016	0	0	0											12.1509	0	0	7.361	1.20744669	0.563102151	0.04689953	3.419118283	0.455934304	0.411540153	0.740119424	0.144271279	0.337571093	0.526620489	0	0.000581429	0.213271784	0.021428404	2.389140158	0.314833386	0	0	0	0.030158344	0.254875465	0	0	0.015315541	0	0.001556039	0	0	0	0	0	0	0	0	0	0	0	0	0	18.4548
H5678_004_0	2010	3	N/A																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	3311.068985	487.7205929	1694.451164	2478.655218	397.3240969	2688.473414	24.71581403	828.1036198	558.8971014	23358.79479	9175.49452	0	17.71330988	1289.129196	13119.50702	8680.408541	1660.52534	552.4303435	0	0	2914.916497	1886.147963	807.4176058	413.0769535	108.7835464	145.3635082	15.8319442	9.463770065	2177.165208	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0	0.107182926	48.9949861	100	0	13.81836735	0	0	38.92501562	0.488003988	29.6871901	19.22251364	0	0	0	0	29.73838588	0	30	0	0	30	0	0	0											NO	0	0	14.20414112	0	0	0	0.071244052	32.56676653	66.4695903	0	9.185012162	0	0	25.87329841	0.324374251	19.73295363	12.77712606	0	0	0	0	19.76698325	0	30	0	0	30	0	0	0												0	0	2.005685287	0	0	0	1.760854731	2.247388104	3.095805113	0	7.02308573	0	0	2.779502031	0.354635856	14.27417494	1.7680618	0	0	0	0	3.1069546	0	1.032692384	0	0	0.03957986	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4884	0	19.37892474	0	0	2.005685287	0	0	0	1.760854731	2.247388104	3.095805113	0	7.02308573	0	0	2.779502031	0.354635856	14.27417494	1.7680618	0	0	0	0	3.1069546	0	1.032692384	0	0	0.03957986	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4884	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.7621	0.4222	0.3364	0	0	0	0	0	0	0	0	0	0	0	1.9257	6.291	0.3672	0	0	0	1.2898	0.3412	0	0	0.0202	0	0.002	0	0	0											17.7577	0	0	6.7621	0.422168218	2.342067898	0	0	0	1.760854731	2.247388104	3.095805113	0	7.02308573	0	0	2.779502031	2.280338214	20.56514896	2.135293961	0	0	0	1.289755567	3.44811172	0	1.032692384	0.020172773	0	0.041629389	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2461
H5679_001_0	2010	7	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	"CORF, PH and CR"	ASC	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo-Radiation	D	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	1968.904573	6.387573992	906.5232133	788.2812776	340.3676489	13.26883332	1.091900532	328.9511489	217.226211	6824.141598	838.7431069	103.1439741	0.04919564	340.0203602	4562.3737	3702.466185	34.65210509	1571.495725	3041.461929	0	75.55000334	0	0	0	378	0	162	0	0	0	1.995905432	115.0796702	160.9716062	146.3783654	474.8136508	134.6401876	2.03677341	613.0010788	23.09991337	28.02323793		$250/day (days 1-5)	$1250/admit	$130/day (for days 21-100)	$0 copay	$80 copay	20% coinsurance	20% coinsurance	$50 copay	$225 copay	$20 copay	$35/$175 copay for Lower/Higher Tier	$225 copay	20% coinsurance	$35 copay	$20 coapy	$35 copay	$40 copay	$50/$35 OP/PR copay	$35/$175 copay for Lower/Higher Tier		20% coinsurance				$20 copay	0	$20 copay		Silver Sneakers		$35 copay	$35 copay	$100 copay	$35 copay	$35 copay	$0 copay	20% coinsurance	$35 copay	$35 copay	20% coinsurance	250	1250	130	0	80	0.2	0.2	50	225	20	80.36787402	225	0.2	35	20	35	40	45.30068105	48.08247735	0	0.2	0	0	0	20	0	20	0	0	0	35	35	100	35	35	0	0.2	35	35	0.2	NO	145.6683881	725.1704985	111.0188552	0	68.31929548	0.170798239	0.170798239	42.69955967	192.1480185	17.07982387	68.63345665	192.1480185	0.170798239	29.88969177	17.07982387	29.88969177	34.15964774	38.68638268	41.06201222	0	0.170798239	0	0	0	20	0	20	0	0	0	29.88969177	29.88969177	85.39911935	29.88969177	29.88969177	0	0.170798239	29.88969177	29.88969177	0.170798239		23.9006	0.386006685	8.386764109	0	1.937806498	2.266293361	0.186494688	1.170505768	3.478298835	9.712928047	4.797153222	1.651575854	0.008402529	0.846925314	6.493711602	9.222131089	0.098641975	5.066290416	10.40737891	0	12.9038075	0	0	0	0.63	0	0.27	0	0	0	0.004971417	0.286641323	1.14556945	0.364600352	1.182669473	0	0.347877311	1.526867775	0.057537441	4.786319681	113.5248		19.2531451	23.9006	0.386006685	8.386764109	0	1.937806498	2.266293361	0.186494688	1.170505768	3.478298835	9.712928047	4.797153222	1.651575854	0.008402529	0.846925314	6.493711602	9.222131089	0.098641975	5.066290416	10.40737891	0	12.9038075	0	0	0	0.63	0	0.27	0	0	0	0.004971417	0.286641323	1.14556945	0.364600352	1.182669473	0	0.347877311	1.526867775	0.057537441	4.786319681	113.5248	YES																																									3350																								0	0	0	0	0													0			23.9006	0.386006685	8.386764109	0	1.937806498	2.266293361	0.186494688	1.170505768	3.478298835	9.712928047	4.797153222	1.651575854	0.008402529	0.846925314	6.493711602	9.222131089	0.098641975	5.066290416	10.40737891	0	12.9038075	0	0	0	0.63	0	0.27	0	0	0	0.004971417	0.286641323	1.14556945	0.364600352	1.182669473	0	0.347877311	1.526867775	0.057537441	4.786319681	113.5248
H5679_002_0	2010	7	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	"CORF, PH and CR"	ASC	Chiropractic	Podiatric	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Hearing Exam Dental	Chemo-Radiation	D	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	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	0	0	0	0	0	0	0	0	0	0	NO	2305.740003	9.377815763	1102.517525	984.6202242	413.3623441	14.34171095	1.550288338	362.413756	264.7938011	5822.688525	906.6468747	102.4603807	0.072225801	195.0734073	4459.973051	4440.335116	28.38059494	1966.946164	3034.061033	0	46.44650814	0	0	1065.67984	378	179.4	162	0	0	0	2.930257003	126.7773759	166.6998094	142.4860992	599.6057533	0.809531464	810.8392466	33.91377258	0	14.92541525		$200/day (days 1-5); $2000 yrly max	$1068/admit	$130/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$175 copay	$0 copay	$35/$150 copay for Lower/Higher Tier	$175 copay	20% coinsurance	$35 copay	$10 coapy	$35 copay	$40 copay	$50/$35 OP/PR copay	$35/$150 copay for Lower/Higher Tier		20% coinsurance			$0 deduct 2 exams/2cleanings/yr	$20 copay	$100/$80 glasses/contacts	$20 copay		Silver Sneakers		$35 copay	$35 copay	$75 copay	$35 copay	$35 copay	20% coinsurance	$35 copay	$35 copay	$35 copay	20% coinsurance	200	1068	130	0	100	0.2	0.2	50	175	0	74.33039444	175	0.2	35	10	35	40	46.52837878	44.42770325	0	0.2	0	0	0	20	0	20	0	0	0	35	35	75	35	35	0.2	35	35	35	0.2	NO	99.85830285	932.8617183	113.5579138	0	87.3522414	0.174704483	0.174704483	43.6761207	152.8664224	0	64.92926558	152.8664224	0.174704483	30.57328449	8.73522414	30.57328449	34.94089656	40.64358175	38.80859459	0	0.174704483	0	0	0	20	0	20	0	0	0	30.57328449	30.57328449	65.51418105	30.57328449	30.57328449	0.174704483	30.57328449	30.57328449	0	0.174704483		19.1873	0.729017111	10.43329917	0	3.009010606	2.505561194	0.270842322	1.319068913	3.373173421	0	4.905659643	1.30522932	0.012618171	0.497002898	3.246572022	11.31296906	0.082636953	6.6619781	9.812303718	0	8.114413183	0	0	0	0.63	0	0.27	0	0	0	0.007465632	0.323000065	0.910100125	0.363022337	1.527659773	0.141428776	2.065834913	0.086404618	0	2.607536952	95.7111		13.72550373	19.1873	0.729017111	10.43329917	0	3.009010606	2.505561194	0.270842322	1.319068913	3.373173421	0	4.905659643	1.30522932	0.012618171	0.497002898	3.246572022	11.31296906	0.082636953	6.6619781	9.812303718	0	8.114413183	0	0	0	0.63	0	0.27	0	0	0	0.007465632	0.323000065	0.910100125	0.363022337	1.527659773	0.141428776	2.065834913	0.086404618	0	2.607536952	95.7111	YES																																									3350																								0	0	0	0	0													0			19.1873	0.729017111	10.43329917	0	3.009010606	2.505561194	0.270842322	1.319068913	3.373173421	0	4.905659643	1.30522932	0.012618171	0.497002898	3.246572022	11.31296906	0.082636953	6.6619781	9.812303718	0	8.114413183	0	0	0	0.63	0	0.27	0	0	0	0.007465632	0.323000065	0.910100125	0.363022337	1.527659773	0.141428776	2.065834913	0.086404618	0	2.607536952	95.7111
H5679_801_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	295.8937978	3.387787525	80.37901255	45.73040562	11.69573789	20.91009885	5.169968048	10.20775926	42.11414638	3.124440872	22.4425747	0	0.07544109	30.99382967	46.71421802	116.7054312	1.698791256	6.718164332	33.01366295	42.43219154	10.23433368	1.783525354	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.9181	0.250947224	11.88569783	0	2.725106929	4.872053033	1.204602555	2.378407908	9.812596107	0.727994723	5.229119906	0	0.017577774	7.221562313	10.8844128	27.19236547	0.395818363	1.565332289	7.692183467	9.886700629	2.384599747	0.415561407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6607	0	0	21.9181	0.250947224	11.88569783	0	2.725106929	4.872053033	1.204602555	2.378407908	9.812596107	0.727994723	5.229119906	0	0.017577774	7.221562313	10.8844128	27.19236547	0.395818363	1.565332289	7.692183467	9.886700629	2.384599747	0.415561407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6607	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.9181	0.250947224	11.88569783	0	2.725106929	4.872053033	1.204602555	2.378407908	9.812596107	0.727994723	5.229119906	0	0.017577774	7.221562313	10.8844128	27.19236547	0.395818363	1.565332289	7.692183467	9.886700629	2.384599747	0.415561407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6607
H5679_802_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	295.8937978	3.387787525	80.37901255	45.73040562	11.69573789	20.91009885	5.169968048	10.20775926	42.11414638	3.124440872	22.4425747	0	0.07544109	30.99382967	46.71421802	116.7054312	1.698791256	6.718164332	33.01366295	42.43219154	10.23433368	1.783525354	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.9181	0.250947224	11.88569783	0	2.725106929	4.872053033	1.204602555	2.378407908	9.812596107	0.727994723	5.229119906	0	0.017577774	7.221562313	10.8844128	27.19236547	0.395818363	1.565332289	7.692183467	9.886700629	2.384599747	0.415561407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6607	0	0	21.9181	0.250947224	11.88569783	0	2.725106929	4.872053033	1.204602555	2.378407908	9.812596107	0.727994723	5.229119906	0	0.017577774	7.221562313	10.8844128	27.19236547	0.395818363	1.565332289	7.692183467	9.886700629	2.384599747	0.415561407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6607	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.9181	0.250947224	11.88569783	0	2.725106929	4.872053033	1.204602555	2.378407908	9.812596107	0.727994723	5.229119906	0	0.017577774	7.221562313	10.8844128	27.19236547	0.395818363	1.565332289	7.692183467	9.886700629	2.384599747	0.415561407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6607
H5679_803_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	295.8937978	3.387787525	80.37901255	45.73040562	11.69573789	20.91009885	5.169968048	10.20775926	42.11414638	3.124440872	22.4425747	0	0.07544109	30.99382967	46.71421802	116.7054312	1.698791256	6.718164332	33.01366295	42.43219154	10.23433368	1.783525354	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074074074	0.074074074	0.147870662	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.9181	0.250947224	11.88569783	0	2.725106929	4.872053033	1.204602555	2.378407908	9.812596107	0.727994723	5.229119906	0	0.017577774	7.221562313	10.8844128	27.19236547	0.395818363	1.565332289	7.692183467	9.886700629	2.384599747	0.415561407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6607	0	0	21.9181	0.250947224	11.88569783	0	2.725106929	4.872053033	1.204602555	2.378407908	9.812596107	0.727994723	5.229119906	0	0.017577774	7.221562313	10.8844128	27.19236547	0.395818363	1.565332289	7.692183467	9.886700629	2.384599747	0.415561407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6607	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	21.9181	0.250947224	11.88569783	0	2.725106929	4.872053033	1.204602555	2.378407908	9.812596107	0.727994723	5.229119906	0	0.017577774	7.221562313	10.8844128	27.19236547	0.395818363	1.565332289	7.692183467	9.886700629	2.384599747	0.415561407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	128.6607
H5685_001_0	2010	2	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	300.9261924	29.11210165	41.59706082	47.2086908	12.74796024	11.82915497	9.95580419	17.7663516	18.2599502	6.421875579	19.07373288	0.94881337	1.471960297	37.54720621	48.38370932	86.85059161	8.743182244	3.997497803	18.8194254	18.56574322	5.052838256	1.905519512	9.183475	0	0.52	0.79	0	0	0.5	1.7175												1A IP Acute: Standard FFS	1B IP Psych: Standard FFS	2 SNF: Standard FFS	6 Home Health: Standard FFS	10A Ambulance: Standard FFS	11A DME: Standard FFS	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Standard FFS"	"4A ER, 4B Urgent Care: Standard FFS"	9B ASC Services: Standard FFS	8A OP Diagnostic Procedures/Tests: Standard FFS	8B OP Radiology: Standard FFS	9A OP Hospital: Standard FFS	12 Renal Dialysis: Standard FFS	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Standard FFS"	"7A PCP, 14B Immunizations, 14C Physical Exams, 14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Standard FFS"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Standard FFS"	"7E Mental Health, 7H Psychiatric: Standard FFS"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Standard FFS"	7D Physician Specialist (Radiology): Standard FFS	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Standard FFS"	15 Part B Drugs: Standard FFS	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Standard FFS"	10B Transportation: 14 two-way trips per member at $0	"16A Preventative Dental Services (Non Medicare Covered), 16B Comprehensive Dental (Non Medicare Covered): Not covered"	"17A Routine Eye Exams (Non Medicare Covered): $0, 1 exam / 2 years"	17B Eye Wear (Medicare Covered): $0 frames and glasses / 2 years	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Written materials at $0	"7F Podiatry: 6 routine visits at $0; 13B Acupuncture, not covered; 13E Other 1: Emergency Response Service at $0"											0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.1094	2.042154236	6.894677243	0	2.970274737	2.756193108	2.319702376	4.139559923	4.254568396	1.49629701	4.44417976	0.221073515	0.342966749	8.748499048	11.27340427	20.23618784	2.037161463	0.931416988	4.384926118	4.325818171	1.177311314	0.443986046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5497	0	0	21.1094	2.042154236	6.894677243	0	2.970274737	2.756193108	2.319702376	4.139559923	4.254568396	1.49629701	4.44417976	0.221073515	0.342966749	8.748499048	11.27340427	20.23618784	2.037161463	0.931416988	4.384926118	4.325818171	1.177311314	0.443986046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5497	NO	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	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	0	0	21.1094	2.042154236	6.894677243	0	2.970274737	2.756193108	2.319702376	4.139559923	4.254568396	1.49629701	4.44417976	0.221073515	0.342966749	8.748499048	11.27340427	20.23618784	2.037161463	0.931416988	4.384926118	4.325818171	1.177311314	0.443986046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5497
H5696_001_0	2010	7	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional					Diabetes Supplies	Urgent Care Facility	ASC	MRI/MRA/PET	Chiropractic	Podiatrist				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	1259.964664	113.4239351	515.7397561	556.2151244	140.0476538	8.804968378	16.35296893	432.4179925	584.8770922	2730.770336	802.2507717	145.5088946	0.017213054	1563.222554	2147.261687	3220.892531	126.3866372	647.0010173	3511.118832	637.0245936	25.49898801	0	0	0	579.6806368	19.92457613	41.24528601	4.358501029	0	0	0	1.077662906	34.24536522	49.11172079	210.0354452	283.3025669	141.7313753				3400	$175 Copay Days 1-5	$175 Copay Days 1-5	$75 Copay Days 1-39	$0 Copay	$100 Per Trip	0.2	0.2	"$50 Per visit, no waiver"	$175 OP Per Procedure	"$13 Weighted Average, Copays $0 - $25"	"$20 weighted avg X-rays, 100 Chemo Rad Th Nuc Med, & 100 Therapeutic and Diagnostic"	175	0.2	80	0	$25 Includes Medicare Covered Hearing and Vision	25	25	$0-$25	25	0.2	0.2	0	Medicare Covered included with Specialist	$10 per non-Medicare Covered visit (Medicare Covered included with Specialist)	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years				0%-20% for Diabetic Supplies	$30 Copay per visit	$80 per ASC procedure	$100 per procedure	$25 per Medicare Covered Chiropractic visit	$25 per Medicare Covered Podiatrist visit				113.4772569	75.2578113	74.568827	0	100	0.2	0.2	50	175	13	75.18166667	175	0.2	80	0	25	25	25	2.821601942	25	0.2	0	0	0	10	10	10	0	0	0	0	0.08	30	80	100	25	25				NO	98.0039126	64.995931	64.40089408	0	100	0.2	0.2	43.18218261	69.09149217	11.22736748	64.93016917	175	0.17272873	69.09149217	0	25	25	21.5910913	2.821601942	25	0.17272873	0	0	0	10	10	10	0	0	0	0	0.08	30	69.09149217	86.36436521	25	25					10.2901	0.614341188	2.767841784	0	1.167063781	1.760993676	3.270593786	1.556062726	3.367502586	2.554946839	4.340856527	2.122004714	0.002973189	9.000448238	0	6.710192773	0.263305494	1.164121503	0.825581643	1.32713457	4.404407826	0	0	0	0.483067197	0.016603813	0.034371072	0	0	0	0	0.086213033	0.085613413	0.282766839	1.511631492	0.590213681	0.295273699	0	0	0	60.8962	0	11.23902948	10.2901	0.614341188	2.767841784	0	1.167063781	1.760993676	3.270593786	1.556062726	3.367502586	2.554946839	4.340856527	2.122004714	0.002973189	9.000448238	0	6.710192773	0.263305494	1.164121503	0.825581643	1.32713457	4.404407826	0	0	0	0.483067197	0.016603813	0.034371072	0	0	0	0	0.086213033	0.085613413	0.282766839	1.511631492	0.590213681	0.295273699	0	0	0	60.8962	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	10.2901	0.614341188	2.767841784	0	1.167063781	1.760993676	3.270593786	1.556062726	3.367502586	2.554946839	4.340856527	2.122004714	0.002973189	9.000448238	0	6.710192773	0.263305494	1.164121503	0.825581643	1.32713457	4.404407826	0	0	0	0.483067197	0.016603813	0.034371072	0	0	0	0	0.086213033	0.085613413	0.282766839	1.511631492	0.590213681	0.295273699	0	0	0	60.8962
H5696_002_0	2010	5	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	979.9678713	88.21819797	271.6076585	358.3824231	102.983312	5.063457013	7.227781017	307.5031768	335.9850196	1962.963447	560.1637694	101.2318085	0.005008208	1172.540103	1718.313265	2577.469897	101.13897	517.7526507	2809.719048	509.7691705	11.08046847	0	0	0	3.128881084	31.71000637	0.481366321	4.813663206	0	0	0	0.735962495	2.406831603	41.15682041	132.7798808	221.1878243	61.61488904				4200	$290 Copay Days 1-6	$300 Copay Days 1-6	$100 Copay Days 1-29	$0 Copay per visit	$125 Per Trip	0.2	0.2	"$50 Per visit, no waiver"	$200 OP Per Procedure	"$18 Weighted Average, Copays $0 - $30"	"$18 weighted avg X-rays, 125 Chemo Rad Th Nuc Med, & 85 Therapeutic and Diagnostic"	200	0.2	100	10; $0 Copay Physicals	$35 Includes Medicare Covered Hearing and Vision	35	30	Copays $0 - $40	35	0.2	0.2	0		$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Mediczre Covered visit	$375 benefit limit every 2 years				0%-20% for Diabetic Supplies	$30 Copay per visit	$100 per ASC procedure	$125 per procedure	$35 per Medicare Covered Chiropractic visit	$35 per Medicare Covered Podiatrist visit				204.7424066	139.8891796	98.85853717	0	125	0.2	0.2	50	200	18	74.24933333	200	0.2	100	9.712479796	35	35	30	4.514563107	35	0.2	0	0	0	10	10	10	0	0	0	0	0.08	30	100	125	35	35				NO	185.5130871	126.7508476	89.57378554	0	125	0.2	0.2	45.30402134	181.2160853	16.30944768	67.27586763	200	0.181216085	90.60804267	8.800287838	35	35	27.1824128	4.514563107	35	0.181216085	0	0	0	10	10	10	0	0	0	0	0.08	30	90.60804267	113.2600533	35	35					15.1497	0.931810947	2.027410513	0	1.072742834	1.012691403	1.445556203	1.16092754	5.073824165	2.667904137	3.140458633	1.687196809	0.000907568	8.85346364	1.260137611	7.517620533	0.294988662	1.172813857	1.057054496	1.486826747	2.007959121	0	0	0	0.002607401	0.026425005	0.000401139	0	0	0	0	0.058877	0.006017079	0.310761578	1.253221365	0.645131154	0.179710093	0	0	0	61.5052	0	4.665640784	15.1497	0.931810947	2.027410513	0	1.072742834	1.012691403	1.445556203	1.16092754	5.073824165	2.667904137	3.140458633	1.687196809	0.000907568	8.85346364	1.260137611	7.517620533	0.294988662	1.172813857	1.057054496	1.486826747	2.007959121	0	0	0	0.002607401	0.026425005	0.000401139	0	0	0	0	0.058877	0.006017079	0.310761578	1.253221365	0.645131154	0.179710093	0	0	0	61.5052	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	15.1497	0.931810947	2.027410513	0	1.072742834	1.012691403	1.445556203	1.16092754	5.073824165	2.667904137	3.140458633	1.687196809	0.000907568	8.85346364	1.260137611	7.517620533	0.294988662	1.172813857	1.057054496	1.486826747	2.007959121	0	0	0	0.002607401	0.026425005	0.000401139	0	0	0	0	0.058877	0.006017079	0.310761578	1.253221365	0.645131154	0.179710093	0	0	0	61.5052
H5696_003_0	2010	6	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V																																												0	YES	1163.204422	104.7134309	476.1330075	513.5000296	129.2925546	5.473281757	8.514898257	399.2100218	539.9608729	2521.058107	740.6411241	134.3343941	0.008979529	1443.17332	2242.310545	3363.465817	131.9811605	675.6406133	3666.539028	665.2225818	15.66763157	0	0	0	535.1634845	18.39444845	38.07781316	4.023785598	0		0	0.585310338	31.61545827	45.34013725	193.9055639	261.5460639	130.8469731				3400	$80 Copay Days 1-10	$80 Copay Days 1-10	$75 Copay Days 1-39	$0 Copay	$100 Per Trip	0.2	0.2	"$50 Per visit, no waiver"	$145 OP Per Procedure	"$18 Weighted Average, Copays $0 - $20"	"$15 weighted avg X-rays, 50 Chemo Rad Th Nuc Med, & 65 Therapeutic and Diagnostic"	145	0.2	$50 	0	$10 Copay	20	20	$0-$20	20	0.2	0.2	0		$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years		$0 Copay		0%-20% on Diabetic Supplies	$25 Copay per visit	$50 per ASC procedure	$90 per procedure	$20 per Medicare Covered Chiropractic visit	$20 per Medicare Covered Podiatrist visit				67.12978519	50.14006465	74.568827	0	100	0.2	0.2	50	145	18	46.64218686	145	0.2	50	0	20	20	20	2.821601942	20	0.2	0	0	0	10	10	10	0	0	0	0	0.08	25	50	90	20	20				NO	64.42232221	48.11782715	71.5613343	0	100	0.2	0.2	47.98341156	47.98341156	17.27402816	44.76102496	145	0.191933646	47.98341156	0	20	20	19.19336462	2.821601942	20	0.191933646	0	0	0	10	10	10	0	0	0	0	0.08	25	47.98341156	86.3701408	20	20					6.2447	0.419881897	2.839392777	0	1.077437955	1.094656351	1.702979651	1.596288231	2.159097066	3.629069061	2.762654654	1.623207261	0.001723474	5.77069828	0	5.605776361	0.219968601	1.080651387	0.862126137	1.108704303	3.007145654	0	0	0	0.44596957	0.015328707	0.031731511	0	0	0	0	0.046824827	0.065865538	0.181297872	1.395637571	0.435910106	0.218078289	0	0	0	45.6428	0	5.58122864	6.2447	0.419881897	2.839392777	0	1.077437955	1.094656351	1.702979651	1.596288231	2.159097066	3.629069061	2.762654654	1.623207261	0.001723474	5.77069828	0	5.605776361	0.219968601	1.080651387	0.862126137	1.108704303	3.007145654	0	0	0	0.44596957	0.015328707	0.031731511	0	0	0	0	0.046824827	0.065865538	0.181297872	1.395637571	0.435910106	0.218078289	0	0	0	45.6428	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	6.2447	0.419881897	2.839392777	0	1.077437955	1.094656351	1.702979651	1.596288231	2.159097066	3.629069061	2.762654654	1.623207261	0.001723474	5.77069828	0	5.605776361	0.219968601	1.080651387	0.862126137	1.108704303	3.007145654	0	0	0	0.44596957	0.015328707	0.031731511	0	0	0	0	0.046824827	0.065865538	0.181297872	1.395637571	0.435910106	0.218078289	0	0	0	45.6428
H5696_004_0	2010	6	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	728.2174352	65.55524089	242.2783629	283.2956303	91.82386881	3.866101044	7.090977072	793.3375407	355.0949187	1471.518479	422.9331673	48.00865187	0.006528149	1199.628269	1919.44809	2879.172135	112.9776547	578.357484	3138.606895	569.4395084	9.19034075	0			4.217580007	417.9463729	1.095940779	3.865045689					1	16.205088	40.16043547	198.6884702	29.2396153				4200	$225 Copay Days 1-7	$225 Copay Days 1-7	$75 Copay Days 1-39	$0 Copay per visit	$125 Per Trip	0.2	0.2	"$50 Per visit, no waiver"	$200 OP Per Procedure	"$21 Weighted Average, Copays $0 - $30"	"$15 weighted avg X-rays, 60 Chemo Rad Th Nuc Med, & 75 Therapeutic and Diagnostic"	200	0.2	80	5	$30 Includes Medicare Covered Hearing and Vision	30	30	Copays $0 - $30	30	0.2	0.2	0		$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years				0%-20% Diabetic Supplies	$30 Copay per visit	$90 per ASC procedure	$125 per procedure	$30 per Medicare Covered Chiropractic visit	$30 per Medicare Covered Podiatrist visit				169.022958	118.2314915	72.88335	0	125	0.2	0.2	50	200	21	75	200	0.2	80	4.856239898	30	30	30	2.821601942	30	0.2	0	0	0	10	10	10	0	0	0	0	0.08	30	90	125	30	30				NO	162.0991311	113.3882773	69.8977692	0	125	0.2	0.2	47.95180874	86.31325574	20.13975967	71.92771311	200	0.191807235	80	4.657309736	30	30	28.77108525	2.821601942	30	0.191807235	0	0	0	10	10	10	0	0	0	0	0.08	30	86.31325574	119.8795219	30	30					9.837	0.619432986	1.411226424	0	0.956498633	0.773220209	1.418195414	3.170164168	2.554116544	2.469669043	2.535051293	0.800144198	0.001252146	7.997521796	0.744955356	7.197930338	0.282444137	1.386664373	0.737991609	1.423598771	1.762773848	0	0	0	0.00351465	0.348288644	0.000913284	0	0	0	0	0	0.0025	0.116559492	0.40120115	0.496721176	0.073099038	0	0	0	49.5226	0	4.451813695	9.837	0.619432986	1.411226424	0	0.956498633	0.773220209	1.418195414	3.170164168	2.554116544	2.469669043	2.535051293	0.800144198	0.001252146	7.997521796	0.744955356	7.197930338	0.282444137	1.386664373	0.737991609	1.423598771	1.762773848	0	0	0	0.00351465	0.348288644	0.000913284	0	0	0	0	0	0.0025	0.116559492	0.40120115	0.496721176	0.073099038	0	0	0	49.5226	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	9.837	0.619432986	1.411226424	0	0.956498633	0.773220209	1.418195414	3.170164168	2.554116544	2.469669043	2.535051293	0.800144198	0.001252146	7.997521796	0.744955356	7.197930338	0.282444137	1.386664373	0.737991609	1.423598771	1.762773848	0	0	0	0.00351465	0.348288644	0.000913284	0	0	0	0	0	0.0025	0.116559492	0.40120115	0.496721176	0.073099038	0	0	0	49.5226
H5696_019_0	2010	3	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	574.8337805	51.74741105	129.409293	193.7876708	68.16174921	0.356788255	0.413697633	234.654999	194.3328712	1129.526005	312.5609698	57.8299262	0	669.0425666	1486.370276	2229.555414	87.48693371	447.864872	2430.45489	440.9590255	0.195992459	0			116.0019315	16	20.22983431	2.298343089				0.264436096	1.149171544	20.80000495	81.03237828	115.6859966	29.41879154				4400	$250 Copay Days 1-5	$250 Copay Days 1-5	$50 Copay Days 1-88	$0 Copay	$125 Per Trip	0.2	0.2	"$50 Per visit, no waiver"	$200 OP Per Procedure	"$18 Weighted Average, Copays $0 - $30"	"$30 weighted avg X-rays, 75 Chemo Rad Th Nuc Med, & 75 Therapeutic and Diagnostic"	200	0.2	100	10	$35 Includes Medicare Covered Hearing and Vision	35	35	Copays vary $0 - $40	35	0.2				$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years				0%-20% Diabetic Supplies	$35 Copay per visit	$150 per ASC procedure	$125 per procedure	$35 per Medicare Covered Chiropractic visit	$35 per Medicare Covered Podiatrist visit				162.110367	107.511159	49.98571684	0	125	0.2	0.2	50	200	18	75	200	0.2	100	9.712479796	35	35	35	4.514563107	35	0.2	0	0	0	10	10	10	0	0	0	0	0	35	150	125	35	35				NO	155.22176	102.9426534	47.86165798	0	125	0.2	0.2	47.87533421	143.6260026	17.23512031	71.81300131	200	0.191501337	100	9.299764325	35	35	33.51273395	4.514563107	35	0.191501337	0	0	0	10	10	10	0	0	0	0	0	33.51273395	143.6260026	119.6883355	35	35					7.4356	0.443917983	0.516145277	0	0.710018221	0.071357651	0.082739527	0.936182208	2.325937789	1.62229305	1.870495111	0.963832103	0	5.575354722	1.151907772	6.502869958	0.255170223	1.250764692	0.914370165	1.286130491	0.037532818	0	0	0	0.096668276	0.013333333	0.016858195	0	0	0	0	0	0.003209323	0.248951797	0.808219207	0.33741749	0.085804809	0	0	0	35.563	0	1.6367995	7.4356	0.443917983	0.516145277	0	0.710018221	0.071357651	0.082739527	0.936182208	2.325937789	1.62229305	1.870495111	0.963832103	0	5.575354722	1.151907772	6.502869958	0.255170223	1.250764692	0.914370165	1.286130491	0.037532818	0	0	0	0.096668276	0.013333333	0.016858195	0	0	0	0	0	0.003209323	0.248951797	0.808219207	0.33741749	0.085804809	0	0	0	35.563	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	7.4356	0.443917983	0.516145277	0	0.710018221	0.071357651	0.082739527	0.936182208	2.325937789	1.62229305	1.870495111	0.963832103	0	5.575354722	1.151907772	6.502869958	0.255170223	1.250764692	0.914370165	1.286130491	0.037532818	0	0	0	0.096668276	0.013333333	0.016858195	0	0	0	0	0	0.003209323	0.248951797	0.808219207	0.33741749	0.085804809	0	0	0	35.563
H5696_021_0	2010	5	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	NO	2124.923968	191.2888869	159.1750028	575.0115599	144.780349	11.06267546	17.02774007	480.3821468	389.0284321	2823.052524	829.3616038	150.4261442	0.00811356	1645.155806	5481.711838	507.7700722	130.6576795	668.8654225	1711.889605	2567.834407	14.09984603	0	0	0	0	1.287368535	1.287368535	4.505789874	0	0	0	1.193105652	0	50.77137593	217.1332704	292.8763418	146.5209694					$0 	$0 	$0 	$0 Copay	$0 Per Trip	0.1	"10% Prosthetics, 20% Medical Supplies"	$25 	$0 	$0 	$0 	$0 	0.2	$0 	0	$0 Copay	0	0	0	0	0.2				$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years				0%-20% on Diabetic Supplies	$0 Copay per visit	$0 per ASC procedure	$0 per procedure	$0 per Medicare Covered Chiropractic visit	$0 per Medicare Covered Podiatrist visit				0	0	0	0	0	0.1	0.1	25	0	0	0	0	0.2	0	0	0	0	0	0	0	0.2	0	0	0	10	10	10	0	0	0	0	0.08	0	0	0	0	0				NO	0	0	0	0	0	0.1	0.1	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10	10	10	0	0	0	0	0.08	0	0	0	0	0					0	0	0	0	0	1.106267546	1.702774007	1.000796139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.001072807	0.001072807	0	0	0	0	0.095448452	0	0	0	0	0	0	0	0	3.9074	0	2.821591917	0	0	0	0	0	1.106267546	1.702774007	1.000796139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.001072807	0.001072807	0	0	0	0	0.095448452	0	0	0	0	0	0	0	0	3.9074	NO																																																																																		0	0	0	0	0	0	0	0	1.106267546	1.702774007	1.000796139	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.001072807	0.001072807	0	0	0	0	0.095448452	0	0	0	0	0	0	0	0	3.9074
H5696_023_0	2010	5	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V																																												0	YES	1163.204422	104.7134309	476.1330075	513.5000296	129.2925546	9.044022211	16.79695007	428.9935434	347.4123397	2521.058107	740.6411241	134.3343941	0.017680387	1469.166212	2139.504214	3209.25632	116.6380142	597.0956697	3240.29452	580.2119512	26.19128247	0	0	0	0	1.149653028	1.149653028	4.023785598	0	0	0	1.106921325	0	45.34013725	193.9055639	261.5460639	130.8469731				3400	$175 Copay Days 1-8	$175 Copay Days 1-8	$75 Copay Days 1-39		$100 Per Trip	0.2	0.2	"$50 Per visit, no waiver"	$175 OP Per Procedure	"$18 Weighted Average, Copays $0 - $25"	"$12 weighted avg X-rays, 50 Chemo Rad Th Nuc Med, & 65 Therapeutic and Diagnostic"	175	0.2	$80 	0	$25 Copay	25	25	$0-$25 copay	25	0.2		0		$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years				0%-20% Diabetic Supplies	$30 Copay per visit	$80 per ASC procedure	$120 per procedure	$25 per Medicare Covered Chiropractic visit	$25 per Medicare Covered Podiatrist visit				137.697991	98.36847776	74.568827	0	100	0.2	0.2	50	175	18	45.74745002	175	0.2	80	0	25	25	25	2.821601942	25	0.2	0	0	0	10	10	10	0	0	0	0	0.08	30	80	120	25	25				NO	116.7114561	83.37614946	63.20380071	0	100	0.2	0.2	42.37950579	67.80720927	15.25662208	38.77508646	175	0.169518023	67.80720927	0	25	25	21.1897529	2.821601942	25	0.169518023	0	0	0	10	10	10	0	0	0	0	0.08	30	67.80720927	101.7108139	25	25					11.3133	0.727550222	2.507784643	0	1.077437955	1.808804442	3.359390014	1.51504453	1.963088435	3.205235899	2.393201969	1.959043247	0.002997144	8.301671729	0	6.685950667	0.242995863	1.054359141	0.761901776	1.208774898	4.439894428	0	0	0	0	0.000958044	0.000958044	0	0	0	0	0.088553706	0	0.256199015	1.643524393	0.544887633	0.272597861	0	0	0	57.3361	0	9.821382979	11.3133	0.727550222	2.507784643	0	1.077437955	1.808804442	3.359390014	1.51504453	1.963088435	3.205235899	2.393201969	1.959043247	0.002997144	8.301671729	0	6.685950667	0.242995863	1.054359141	0.761901776	1.208774898	4.439894428	0	0	0	0	0.000958044	0.000958044	0	0	0	0	0.088553706	0	0.256199015	1.643524393	0.544887633	0.272597861	0	0	0	57.3361	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	11.3133	0.727550222	2.507784643	0	1.077437955	1.808804442	3.359390014	1.51504453	1.963088435	3.205235899	2.393201969	1.959043247	0.002997144	8.301671729	0	6.685950667	0.242995863	1.054359141	0.761901776	1.208774898	4.439894428	0	0	0	0	0.000958044	0.000958044	0	0	0	0	0.088553706	0	0.256199015	1.643524393	0.544887633	0.272597861	0	0	0	57.3361
H5696_024_0	2010	6	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	807.0604268	72.65280688	223.6846729	295.1487286	84.81273538	3.960184515	5.652925736	253.2467159	276.7031667	1616.614344	461.3273802	83.3702706	0.003916973	965.6548378	5262.606312	6337.812668	48.62561502	248.9252271	1350.857308	0	9.125408983	0	0	0	2.576815197	26.11503093	0.396433107	3.964331072	0	0	0	0.606107835	1.982165536	33.89503066	109.3519394	182.1610127	50.74343772				4000	$290 Copay Days 1-6	$300 Copay Days 1-6	$100 Copay Days 1-29		$125 Per Trip	0.2	0.2	"$50 Per visit, no waiver"	$200 OP Per Procedure	"$22 Weighted Average, Copays $0 - $30"	"$18 weighted avg X-rays, 150 Chemo Rad Th Nuc Med, & 85 Therapeutic and Diagnostic"	200	0.2	$100 	10	$35 Copay	35	30	$0-$40	35	0.2				$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years				0%-20% Diabetic Supplies	$30 Copay per visit	$100 per ASC procedure	$150 per procedure	$35 per Medicare Covered Chiropractic visit	$35 per Medicare Covered Podiatrist visit				204.7424066	144.7129444	98.85853717	0	125	0.2	0.2	50	200	22	85	200	0.2	100	9.84894754	35	35	30	4.514563107	35	0.2	0	0	0	10	10	10	0	0	0	0	0.08	30	100	150	35	35				NO	190.4163049	134.587185	91.94127228	0	125	0.2	0.2	46.50143271	93.00286543	20.46063039	79.05243561	200	0.186005731	93.00286543	9.159803427	35	35	27.90085963	4.514563107	35	0.186005731	0	0	0	10	10	10	0	0	0	0	0.08	30	93.00286543	139.5042981	35	35					12.8065	0.81484473	1.713821118	0	0.883465994	0.792036903	1.130585147	0.98136126	2.144515615	2.756412382	3.039087752	1.38950451	0.00072858	7.484055578	4.017036611	18.48528695	0.14182471	0.578768985	0.508210881	0	1.697378367	0	0	0	0.002147346	0.021762526	0.000330361	0	0	0	0	0.048488627	0.004955414	0.262694581	1.271255463	0.531302954	0.148001693	0	0	0	63.6563	0	5.234328127	12.8065	0.81484473	1.713821118	0	0.883465994	0.792036903	1.130585147	0.98136126	2.144515615	2.756412382	3.039087752	1.38950451	0.00072858	7.484055578	4.017036611	18.48528695	0.14182471	0.578768985	0.508210881	0	1.697378367	0	0	0	0.002147346	0.021762526	0.000330361	0	0	0	0	0.048488627	0.004955414	0.262694581	1.271255463	0.531302954	0.148001693	0	0	0	63.6563	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	12.8065	0.81484473	1.713821118	0	0.883465994	0.792036903	1.130585147	0.98136126	2.144515615	2.756412382	3.039087752	1.38950451	0.00072858	7.484055578	4.017036611	18.48528695	0.14182471	0.578768985	0.508210881	0	1.697378367	0	0	0	0.002147346	0.021762526	0.000330361	0	0	0	0	0.048488627	0.004955414	0.262694581	1.271255463	0.531302954	0.148001693	0	0	0	63.6563
H5696_025_0	2010	5	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V																																												0	YES	1363.50517	122.7448088	558.1218613	601.9233865	151.5563931	9.044022211	16.79695007	502.8651052	407.2358325	2955.177694	868.1775811	157.466424	0.017680387	1722.152776	2507.921222	3761.881833	136.772751	700.1698197	3799.653129	680.3715348	25.92936965	0	0	0	0	1.347620261	1.347620261	4.716670913	0	0	0	1.095852111	0	53.14758984	227.2955929	306.5836094	153.3784783				3000	$0 Copay	$0 Copay	$25 Copay Days 11-100	$0 Copay	$50 Per Trip	0.1	10% Medical Supplies 20%	"$50 Per visit, no waiver"	$50 OP Per Procedure	"$3 Weighted Average, Copays $0 - $25"	"$3 weighted avg X-rays, 50 Chemo Rad Th Nuc Med, & 50 Therapeutic and Diagnostic"	50	0.2	$25 	0	$0 Copay	0	5	$0-$10	0	0.2			$10 copay for preventive	$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years				0%-20% Diabetic Supplies	$0 Copay per visit	$25 per ASC procedure	$50 per procedure	$0 per Medicare Covered Chiropractic visit	$0 per Medicare Covered Podiatrist visit				0	0	9.117121943	0	50	0.1	0.12	50	50	3	32.99592003	50	0.2	25	0	0	0	5	1.72	0	0.2	0	0	10	10	10	10	0	0	0	0	0	0	25	50	0	0				NO	0	0	8.843436173	0	50	0.1	0.12	48.49905611	24.24952805	2.909943366	32.00541954	50	0.193996224	24.24952805	0	0	0	4.849905611	1.72	0	0.193996224	0	0	10	10	10	10	0	0	0	0	0	0	24.24952805	48.49905611	0	0					0	0	0.411309588	0	0.631484971	0.904402221	2.015634008	2.032373579	0.822939729	0.716616644	2.31553231	0.6561101	0.003429928	3.480116004	0	0	0	0.282979795	0.544616948	0	5.030199813	0	0	0	0	0.001123017	0.001123017	0	0	0	0	0	0	0.107400331	0.918635143	0	0	0	0	0	20.876	0	1.347335556	0	0	0.411309588	0	0.631484971	0.904402221	2.015634008	2.032373579	0.822939729	0.716616644	2.31553231	0.6561101	0.003429928	3.480116004	0	0	0	0.282979795	0.544616948	0	5.030199813	0	0	0	0	0.001123017	0.001123017	0	0	0	0	0	0	0.107400331	0.918635143	0	0	0	0	0	20.876	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	0	0	0.411309588	0	0.631484971	0.904402221	2.015634008	2.032373579	0.822939729	0.716616644	2.31553231	0.6561101	0.003429928	3.480116004	0	0	0	0.282979795	0.544616948	0	5.030199813	0	0	0	0	0.001123017	0.001123017	0	0	0	0	0	0	0.107400331	0.918635143	0	0	0	0	0	20.876
H5696_026_0	2010	6	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	1060.526747	95.47023043	293.9353369	387.8434756	111.44912	5.063457013	7.227781017	332.7816689	363.6048795	2124.330092	606.2123844	109.5536331	0.005008208	1268.9295	4391.059458	182.0441354	50.63558421	494.0623739	2996.496348	454.2158653	11.08046847	0	0	0	3.386092722	34.31674739	0.520937342	5.209373418	0	0	0	0.735962495	2.604686709	44.54014272	143.6951344	239.3707086	66.67997975				4200	$75 Copay Days 1-7	$75 Copay Days 1-7	$35 Copay Days 1-100		$100 Per Trip	0.2	0.2	"$50 Per visit, no waiver"	$100 OP Per Procedure	"$12 Weighted Average, Copays $0 - $20"	"$9 weighted avg X-rays, 70 Chemo Rad Th Nuc Med, & 75 Therapeutic and Diagnostic"	100	0.2	$40 	0	$5 Copay	10	15	$0-$25	5	0.2				$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years				0%-20% Diabetic Supplies	$0 Copay per visit	$65 per ASC procedure	$100 per procedure	$10 per Medicare Covered Chiropractic visit	$10 per Medicare Covered Podiatrist visit				56.34098599	39.41049715	35	0	100	0.2	0.2	50	100	12	70	100	0.2	40	0	5	10	15	2.821601942	5	0.2	0	0	0	10	10	10	0	0	0	0	0.08	0	65	100	10	10				NO	53.60854235	37.49915392	33.30255851	0	100	0.2	0.2	47.57508358	61.84760866	11.41802006	66.60511702	100	0.190300334	38.06006687	0	5	10	14.27252508	2.821601942	5	0.190300334	0	0	0	10	10	10	0	0	0	0	0.08	0	61.84760866	95.15016717	10	10					4.7378	0.298337739	0.81573323	0	0.928742666	1.012691403	1.445556203	1.319342976	1.874007691	2.021303634	3.364737234	0.912946942	0.000953064	4.024628467	0	0.075851723	0.04219632	0.587626468	0.704576659	0.189256611	2.108616855	0	0	0	0.002821744	0.028597289	0.000434114	0	0	0	0	0.058877	0	0.229558443	1.139384672	0.19947559	0.05556665	0	0	0	28.1796	0	2.20846764	4.7378	0.298337739	0.81573323	0	0.928742666	1.012691403	1.445556203	1.319342976	1.874007691	2.021303634	3.364737234	0.912946942	0.000953064	4.024628467	0	0.075851723	0.04219632	0.587626468	0.704576659	0.189256611	2.108616855	0	0	0	0.002821744	0.028597289	0.000434114	0	0	0	0	0.058877	0	0.229558443	1.139384672	0.19947559	0.05556665	0	0	0	28.1796	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	4.7378	0.298337739	0.81573323	0	0.928742666	1.012691403	1.445556203	1.319342976	1.874007691	2.021303634	3.364737234	0.912946942	0.000953064	4.024628467	0	0.075851723	0.04219632	0.587626468	0.704576659	0.189256611	2.108616855	0	0	0	0.002821744	0.028597289	0.000434114	0	0	0	0	0.058877	0	0.229558443	1.139384672	0.19947559	0.05556665	0	0	0	28.1796
H5696_027_0	2010	7	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	V	V	Coin	V	V	V	V	V																																												0	YES	1439.594613	129.5944962	589.2674577	635.513296	160.0138906	9.044022211	16.79695007	530.9271373	429.9613406	3120.089298	916.6256179	166.2537266	0.017680387	1818.256295	2647.873995	3971.810992	144.4052577	739.242302	4011.690088	718.3391878	25.92936965	0	0	0	0	1.422823258	1.422823258	4.979881403	0	0	0	1.095852111	0	56.11345356	239.9796629	323.6922912	161.937656				3000	$50 Copay Days 1-6	$50 Copay Days 1-6	$25 Copay Days 11-100		$50 Per Trip	0.1	10% Medical Supplies 20%	"$50 Per visit, no waiver"	$75 OP Per Procedure	"$9 Weighted Average, Copays $0 - $15"	"$9 weighted avg X-rays, 50 Chemo Rad Th Nuc Med, & 50 Therapeutic and Diagnostic"	75	0.2	$25 	0	$5 Copay	5	5	$0-$10	5	0.2			$10 	$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years				0%-20% Diabetic Supplies	$5 Copay per visit	$50 per ASC procedure	$75 per procedure	$5 per Medicare Covered Chiropractic visit	$5 per Medicare Covered Podiatrist visit				35.30041493	24.11882407	9.117121943	0	50	0.1	0.14	50	75	9	34.78539372	75	0.2	25	0	5	5	5	1.128640777	5	0.2	0	0	10	10	10	10	0	0	0	0	0.08	5	50	75	5	5				NO	32.91703979	22.49039546	8.501561989	0	50	0.1	0.14	46.62415422	46.62415422	8.392347759	32.43679122	75	0.186496617	23.31207711	0	5	5	4.662415422	1.128640777	5	0.186496617	0	0	10	10	10	10	0	0	0	0	0.08	5	46.62415422	69.93623132	5	5					3.9489	0.242885956	0.417474485	0	0.666724544	0.904402221	2.35157301	2.062835727	1.670548654	2.182072869	2.477699483	1.039085791	0.003297332	3.53227758	0	1.654921247	0.060168857	0.287221226	0.377313085	0.299307995	4.835739716	0	0	0	0	0.001185686	0.001185686	0	0	0	0	0.087668169	0	0.218020193	1.398606102	0.134871788	0.067474023	0	0	0	30.9235	0	2.581180227	3.9489	0.242885956	0.417474485	0	0.666724544	0.904402221	2.35157301	2.062835727	1.670548654	2.182072869	2.477699483	1.039085791	0.003297332	3.53227758	0	1.654921247	0.060168857	0.287221226	0.377313085	0.299307995	4.835739716	0	0	0	0	0.001185686	0.001185686	0	0	0	0	0.087668169	0	0.218020193	1.398606102	0.134871788	0.067474023	0	0	0	30.9235	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	3.9489	0.242885956	0.417474485	0	0.666724544	0.904402221	2.35157301	2.062835727	1.670548654	2.182072869	2.477699483	1.039085791	0.003297332	3.53227758	0	1.654921247	0.060168857	0.287221226	0.377313085	0.299307995	4.835739716	0	0	0	0	0.001185686	0.001185686	0	0	0	0	0.087668169	0	0.218020193	1.398606102	0.134871788	0.067474023	0	0	0	30.9235
H5696_028_0	2010	6	N/A	X1	X2	X3	X4	X5	X6	X7				Non-facility lab	DME/Prosthetics/Supplies	OP Facility - Emergency	OP Facility - Surgery	OP Facility - Other	Professional	Professional				Non-facility lab	Diabetic supplies	Urgent care	Ambulatory surgical center	MRI/PET/CAT	Chiropractic Covered	Podiatry Covered				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	V	V	V	V	V	V	P	V	Coin	V	V	V	V	V																																												0	YES	1130.04471	101.7283432	309.7350354	419.2470313	120.5131047	5.882137041	8.396397625	361.9528157	391.6011273	2298.90646	657.1450995	117.7286434	0.005817955	1369.075829	4730.473448	768.3891208	56.04108216	533.6747064	3230.616313	491.2318602	12.87200303	0	0	0	0.279597778	0.279597778	0.559195557	5.591955569	0	0	0	0.854955861	0	50.6071979	154.2482641	256.9503584	71.57703128				4200	$125 Copay Days 1-7	$125 Copay Days 1-7	$35 Copay Days 1-100		$100 Per Trip	0.2	0.2	"$50 Per visit, no waiver"	$100 OP Per Procedure	"$15 Weighted Average, Copays $0 - $25"	"$9 weighted avg X-rays, 75 Chemo Rad Th Nuc Med, & 75 Therapeutic and Diagnostic"	100	0.2	$50 	0	$20 Copay	20	15	$0-$25	20	0.2				$10 per non-Medicare Covered visit	"$10 Copay, $100 benefit limit"	$10 per non-Medicare Covered visit	$375 benefit limit every 2 years				0%-20% Diabetic Supplies	$0 Copay per visit	$65 per ASC procedure	$100 per procedure	$20 per Medicare Covered Chiropractic visit	$20 per Medicare Covered Podiatrist visit				93.90164332	65.68416192	35	0	100	0.2	0.2	50	100	15	75	100	0.2	50	0	20	20	15	2.821601942	20	0.2	0	0	0	10	10	10	0	0	0	0	0	0	65	100	20	20				NO	87.13177294	60.9486403	32.47666329	0	100	0.2	0.2	46.39523328	60.31380326	13.91856998	69.59284992	100	0.185580933	46.39523328	0	20	20	13.91856998	2.821601942	20	0.185580933	0	0	0	10	10	10	0	0	0	0	0	0	60.31380326	92.79046656	20	20					8.2052	0.516683683	0.838263371	0	1.004275873	1.176427408	1.679279525	1.39940711	1.968246112	2.666457537	3.811050024	0.981072029	0.001079701	5.293216037	0	1.280648535	0.093401804	0.618999062	0.759626105	0.818719767	2.388798334	0	0	0	0.000232998	0.000232998	0.000465996	0	0	0	0	0	0	0.254359381	1.1927307	0.428250597	0.119295052	0	0	0	37.4965	0	3.407386693	8.2052	0.516683683	0.838263371	0	1.004275873	1.176427408	1.679279525	1.39940711	1.968246112	2.666457537	3.811050024	0.981072029	0.001079701	5.293216037	0	1.280648535	0.093401804	0.618999062	0.759626105	0.818719767	2.388798334	0	0	0	0.000232998	0.000232998	0.000465996	0	0	0	0	0	0	0.254359381	1.1927307	0.428250597	0.119295052	0	0	0	37.4965	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0				0	0	0	8.2052	0.516683683	0.838263371	0	1.004275873	1.176427408	1.679279525	1.39940711	1.968246112	2.666457537	3.811050024	0.981072029	0.001079701	5.293216037	0	1.280648535	0.093401804	0.618999062	0.759626105	0.818719767	2.388798334	0	0	0	0.000232998	0.000232998	0.000465996	0	0	0	0	0	0	0.254359381	1.1927307	0.428250597	0.119295052	0	0	0	37.4965
H5697_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1861.781586	104.6657599	2416.568629	2950.559937	517.3425344	8.158671797	5.132685149	333.1309668	375.0325665	13720.92129	5207.664307	0	7.925828035	553.5292932	7179.586205	7514.95834	663.1699752	1184.615452	0	0	802.3713303	1774.412798	1473.68424	346.8006132	170.8544638	200.1867037	16.13328852	13.78192106	2041.257191	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.43327857	100	0	14.01380472	0	0	38.81187396	0.916175058	28.60359606	21.76123101	0	0	0	0	29.68871728	0	30	30	0	30	0	0	0											NO	0	0	19.39512229	0	0	0.181522532	0.181522532	43.05104422	90.76126619	0	12.7191066	0	0	35.22614824	0.831532083	25.96098596	19.75076881	0	0	0	0	26.94585572	0	30	30	0	30	0	0	0												0	0	3.905803675	0	0	1.480982765	0.931698006	1.195136332	2.836535883	0	5.519736457	0	0	1.624892078	0.497504689	16.25797733	1.091509738	0	0	0	0	3.984422602	0	0.867001533	0.427136159	0	0.040333221	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6607	0	4.003076474	0	0	3.905803675	0	0	1.480982765	0.931698006	1.195136332	2.836535883	0	5.519736457	0	0	1.624892078	0.497504689	16.25797733	1.091509738	0	0	0	0	3.984422602	0	0.867001533	0.427136159	0	0.040333221	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6607	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.6816	0.0717	0.4903	0	0	0	0	0	0	0	0	0	0	0	1.0571	4.0841	0.1581	0	0	0	0.558	0.3325	0	0	0.0237	0	0.002	0	0	0											10.4591	0	0	3.6816	0.071733716	4.396069076	0	0	1.480982765	0.931698006	1.195136332	2.836535883	0	5.519736457	0	0	1.624892078	1.554617518	20.34210938	1.249609994	0	0	0	0.557958042	4.316872982	0	0.867001533	0.45082792	0	0.042360387	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1197
H5697_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2134.448243	146.3265418	2795.721342	3579.508499	591.660163	6.526689032	5.374160008	401.1658157	262.6992566	11869.86041	4689.586732	0	11.08059606	604.5770905	5207.111808	6246.754862	678.4043438	536.3092282	0	0	675.4469903	1619.510665	1576.881712	375.4338903	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02019186	100	0	13.14050144	0	0	38.98061307	1.766035599	28.69460316	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.68637502	0	0	0.18424842	0.18424842	43.3169804	92.12421022	0	12.10558317	0	0	35.91058193	1.626946348	26.43467654	17.26458697	0	0	0	0	27.19800664	0	30	30	0	30	0	0	0												0	0	4.586468233	0	0	1.202532145	0.990180493	1.448107648	2.016746795	0	4.730848517	0	0	1.809226262	0.705974295	13.76091202	0.9760309	0	0	0	0	3.670621819	0	0.938584726	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	37.149	0	3.068925502	0	0	4.586468233	0	0	1.202532145	0.990180493	1.448107648	2.016746795	0	4.730848517	0	0	1.809226262	0.705974295	13.76091202	0.9760309	0	0	0	0	3.670621819	0	0.938584726	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	37.149	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.0855	0.1003	0.5051	0	0	0	0	0	0	0	0	0	0	0	0.6855	3.4635	0.1613	0	0	0	0.4087	0.3088	0	0	0.0202	0	0.0021	0	0	0											9.7411	0	0	4.0855	0.100286346	5.091598486	0	0	1.202532145	0.990180493	1.448107648	2.016746795	0	4.730848517	0	0	1.809226262	1.391472941	17.22437163	1.137329288	0	0	0	0.40873512	3.979460358	0	0.938584726	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	46.8901
H5697_003_0	2010	3	N/A																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2915.625722	381.8613936	1906.919559	2586.033029	443.1592909	2733.653006	23.8179374	684.4423603	602.3394027	25091.76351	8848.409734	0	13.15116909	1140.767884	14416.2658	10179.14083	1394.148502	1545.657102	0	0	2834.3237	1996.151789	997.54258	343.5047823	168.3521369	191.6200095	16.02874968	12.2426798	2034.271521	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0	0.108176809	49.05553423	100	0	14.0959619	0	0	38.83922871	0.344948657	29.5141809	20.46943617	0	0	0	0	29.73611117	0	30	0	0	30	0	0	0											NO	0	0	13.9358193	0	0	0	0.070546374	31.99105333	65.2139536	0	9.192534055	0	0	25.32859659	0.224954657	19.24736424	13.34892861	0	0	0	0	19.39209374	0	30	0	0	30	0	0	0												0	0	2.214540533	0	0	0	1.680269123	1.824669337	3.273411155	0	6.77827565	0	0	2.407837462	0.270250511	16.3268026	1.550865735	0	0	0	0	3.225796885	0	0.858761956	0	0	0.040071874	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4516	0	21.09798045	0	0	2.214540533	0	0	0	1.680269123	1.824669337	3.273411155	0	6.77827565	0	0	2.407837462	0.270250511	16.3268026	1.550865735	0	0	0	0	3.225796885	0	0.858761956	0	0	0.040071874	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4516	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.3938	0.3408	0.5121	0	0	0	0	0	0	0	0	0	0	0	2.1765	6.8351	0.3122	0	0	0	1.613	0.3655	0	0	0.0226	0	0.002	0	0	0											18.5736	0	0	6.3938	0.340778914	2.726636278	0	0	0	1.680269123	1.824669337	3.273411155	0	6.77827565	0	0	2.407837462	2.446781047	23.16192711	1.863026751	0	0	0	1.613027744	3.591252667	0	0.858761956	0.022599438	0	0.042084025	0	0	0	0	0	0	0	0	0	0	0	0	0	59.0251
H5697_004_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1336.927168	387.5592542	11183.23462	108.2234502	801.0446545	2092.081133	1894.416224	197.4981525	85.91283057	34185.82539	4849.73102	0	3.137266285	478.3627345	165.599128	5239.926012	2036.946428	31.83731006	0	0	144.5169875	2111.586617	1533.383865	0	108.5215448	141.8948371	15.79381348	9.237945123	0	0											500	"$25 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$25 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $20 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											23.38815764	21.55472438	0	0	50	0	0	49.91275447	0	0	0	0	0	0	0.407836608	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	20.56003678	20.80975382	0	0	41.61950765	0	0	41.54688532	0	0	0	0	0	0	0.339479177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												2.2906	0.672084389	0	0	2.77825701	0	0	0.683786091	0	0	0	0	0	0	0.004684788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4294	0	1.294625852	2.2906	0.672084389	0	0	2.77825701	0	0	0.683786091	0	0	0	0	0	0	0.004684788	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.4294	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.471	0.5866	0.6023	0.0493	0.7304	0.4791	0.4324	0.0714	0.1539	0.3602	0.5619	0	0.0006	0.2276	0.017	2.4097	0.3176	0	0	0	0.0304	0.2571	0	0	0.0153	0	0.0016	0	0	0											12.7754	0	0	7.7616	1.258733471	0.602281751	0.049279803	3.508649477	0.479074159	0.432426889	0.755218532	0.153933479	0.360179056	0.561889552	0	0.000620369	0.227555117	0.021665913	2.409735909	0.317564235	0	0	0	0.030419936	0.257086242	0	0	0.015315541	0	0.001556039	0	0	0	0	0	0	0	0	0	0	0	0	0	19.2048
H5698_003_0	2010	3	N/A																															D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	NO	2939.088489	241.8457922	1652.032622		18.47181643	33.48978987	7.312921684	36.88552983	43.38382413	24.06835048		0.24237773		41.63555452	41.77719553	138.007071		6.334757961	22.68855625		30.53152485	0.000771932			175		249															"Medicare FFS Cost Sharing, unlimited days"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost Sharing	Preventive Dental	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$500 Allowance for hearing aid	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;											144.8223812	98.81655749	74.23113034		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10														NO	144.8223812	98.81655749	74.23113034		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10															35.4705	1.991530719	10.21935407	0	4.303933228	7.80312104	1.703910752	8.594328449	10.10843102	5.607925662	0	0.056474011	0	9.701084203	9.734086559	32.15564754	0	1.475998605	5.286433607	0	7.11384529	0.00017986	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	151.6801	0	0	35.4705	1.991530719	10.21935407	0	4.303933228	7.80312104	1.703910752	8.594328449	10.10843102	5.607925662	0	0.056474011	0	9.701084203	9.734086559	32.15564754	0	1.475998605	5.286433607	0	7.11384529	0.00017986	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	151.6801	NO																																																																																		0	0	0	35.4705	1.991530719	10.21935407	0	4.303933228	7.80312104	1.703910752	8.594328449	10.10843102	5.607925662	0	0.056474011	0	9.701084203	9.734086559	32.15564754	0	1.475998605	5.286433607	0	7.11384529	0.00017986	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	151.6801
H5698_009_0	2010	3	N/A																															D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	NO	2895.213828	112.5016163	787.0924916		14.36929504	25.30215858	9.371922148	26.87889624	27.77477049	12.63210808		0.016427449		33.51816268	43.89233501	119.1128522		3.531945415	21.07179298		23.43032213	0.00375486			175		249															"Medicare FFS Cost Sharing, unlimited days"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost Sharing	Preventive Dental	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$500 Allowance for hearing aids	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;											121.8720473	203.2129427	83.48892889		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10														NO	121.8720473	203.2129427	83.48892889		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10															29.4038	1.905148708	5.476125755	0	3.348045745	5.89540295	2.18365786	6.262782825	6.471521524	2.943281181	0	0.003827596	0	7.809731905	10.22691406	27.75329457	0	0.822943282	4.909727764	0	5.459265056	0.000874882	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2297	0	0	29.4038	1.905148708	5.476125755	0	3.348045745	5.89540295	2.18365786	6.262782825	6.471521524	2.943281181	0	0.003827596	0	7.809731905	10.22691406	27.75329457	0	0.822943282	4.909727764	0	5.459265056	0.000874882	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2297	NO																																																																																		0	0	0	29.4038	1.905148708	5.476125755	0	3.348045745	5.89540295	2.18365786	6.262782825	6.471521524	2.943281181	0	0.003827596	0	7.809731905	10.22691406	27.75329457	0	0.822943282	4.909727764	0	5.459265056	0.000874882	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	121.2297
H5698_020_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1472.507763	61.50987773	514.4378287		877.195526	12.25454858	4.051286365	413.7512567	229.256896	186.9635338		0.756132277		48.43879499	2736.034303	2612.722094		171.8149485			16.32847743		234.9153904		150		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 20% or $300 /visit; ASC: 20% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$20/visit	$20/visit	Individual: $20/visit; Group: $15/visit	$20/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	$3/visit	Not Covered	Routine Eye Exam: $30	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $30	$500 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing;											62.86	79.55	31.06		50	0.168	0.2	50	145.5691469	75		50		20	19.96950494	19.9902437		20			0.2		3		30		30														NO	58.84384057	74.46750744	29.07555979		46.80547293	0.157266389	0.187221892	46.80547293	136.2686553	70.2082094		46.80547293		18.72218917	18.69554026	18.71374288		18.72218917			0.187221892		2.808328376		28.08328376		28.08328376															7.2207	0.381707273	1.246463987	0	3.421462621	1.927228605	0.758489497	1.613818604	2.603377412	1.093864578	0	0.002949261	0	0.075573357	4.262636622	4.074484123	0	0.268062664	0	0	3.057048434	0	0.05497663	0	0.351041047	0	0.582728138	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9966	0	2.251432419	7.2207	0.381707273	1.246463987	0	3.421462621	1.927228605	0.758489497	1.613818604	2.603377412	1.093864578	0	0.002949261	0	0.075573357	4.262636622	4.074484123	0	0.268062664	0	0	3.057048434	0	0.05497663	0	0.351041047	0	0.582728138	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9966	NO																																																																																		0	0	0	7.2207	0.381707273	1.246463987	0	3.421462621	1.927228605	0.758489497	1.613818604	2.603377412	1.093864578	0	0.002949261	0	0.075573357	4.262636622	4.074484123	0	0.268062664	0	0	3.057048434	0	0.05497663	0	0.351041047	0	0.582728138	0	0	0	0	0	0	0	0	0	0	0	0	0	32.9966
H5698_022_0	2010	3	N/A																															D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	NO	3317.443875	127.5700608	1071.738723		13.70312092	31.54278156	12.50733803	32.77125797	40.97967214	16.78252206		0.125278874		16.22639222	41.89680483	135.8874898		3.956641791	26.64078975		27.73928169				175																	"Medicare FFS Cost Sharing, unlimited days"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost Sharing	Preventive Dental	Routine Eye Exam: $10	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: Not Covered	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;											126.6349567	107.2463001	72.84003501		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233				10																NO	126.6349567	107.2463001	72.84003501		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233				10																	35.0087	1.140118086	6.505457173	0	3.192827176	7.349468103	2.914209762	7.635703108	9.548263608	3.91032764	0	0.029189978	0	3.780749388	9.761955525	31.66178512	0	0.921897537	6.207304011	0	6.463252634	0	0	0	0.145833333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.177	0	0	35.0087	1.140118086	6.505457173	0	3.192827176	7.349468103	2.914209762	7.635703108	9.548263608	3.91032764	0	0.029189978	0	3.780749388	9.761955525	31.66178512	0	0.921897537	6.207304011	0	6.463252634	0	0	0	0.145833333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.177	NO																																																																																		0	0	0	35.0087	1.140118086	6.505457173	0	3.192827176	7.349468103	2.914209762	7.635703108	9.548263608	3.91032764	0	0.029189978	0	3.780749388	9.761955525	31.66178512	0	0.921897537	6.207304011	0	6.463252634	0	0	0	0.145833333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.177
H5698_028_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1581.171558	65.7586148	488.0231891		867.3084069	14.0286915	6.605674862	460.144033	207.7167663	174.6850735		2.787126905		138.2185936	2572.617756	2365.020421		171.6082591			17.64545936		179.2299422		150		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 20% or $300 /visit; ASC: 20% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$20/visit	$20/visit	Individual: $20/visit; Group: $15/visit	$20/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	$3/visit	Not Covered	Routine Eye Exam: $30	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $30	$500 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing;											62.86	79.55	31.06		50	0.168	0.2	50	140.491841	75		50		20	19.98387231	19.98424477		20			0.2		3		30		30														NO	58.68965315	74.27238162	28.99937364		46.68282943	0.156854307	0.186731318	46.68282943	131.171133	70.02424414		46.68282943		18.67313177	18.66058056	18.65878303		18.67313177			0.186731318		2.800969766		28.00969766		28.00969766															7.7332	0.407004078	1.179363901	0	3.374034202	2.200460682	1.233486371	1.790068783	2.270536964	1.019349186	0	0.010842581	0	0.215081168	4.000545074	3.677366907	0	0.267038636	0	0	3.294959878	0	0.041834804	0	0.350121221	0	0.581201226	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6465	0	2.390188041	7.7332	0.407004078	1.179363901	0	3.374034202	2.200460682	1.233486371	1.790068783	2.270536964	1.019349186	0	0.010842581	0	0.215081168	4.000545074	3.677366907	0	0.267038636	0	0	3.294959878	0	0.041834804	0	0.350121221	0	0.581201226	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6465	NO																																																																																		0	0	0	7.7332	0.407004078	1.179363901	0	3.374034202	2.200460682	1.233486371	1.790068783	2.270536964	1.019349186	0	0.010842581	0	0.215081168	4.000545074	3.677366907	0	0.267038636	0	0	3.294959878	0	0.041834804	0	0.350121221	0	0.581201226	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6465
H5698_030_0	2010	5	N/A																															D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	NO	2670.80023	170.412437	618.1499261		12.65593993	24.91386576	6.994219934	30.7984773	28.99926988	24.27277227		0.371895202		38.90479806	35.77241504	91.32195341		6.712860266	13.86030786		23.08722712				175		249															"Medicare FFS Cost Sharing, unlimited days"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost Sharing	Preventive Dental	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$1600 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $120 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;											130.5914515	111.8934233	74.87205891		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233				10		10														NO	130.5914515	111.8934233	74.87205891		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233				10		10															29.0653	1.589002579	3.856846473	0	2.948834004	5.804930723	1.629653245	7.176045211	6.756829883	5.655555939	0	0.086651582	0	9.064817947	8.334972705	21.27801515	0	1.564096442	3.229451731	0	5.379323918	0	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7737	0	0	29.0653	1.589002579	3.856846473	0	2.948834004	5.804930723	1.629653245	7.176045211	6.756829883	5.655555939	0	0.086651582	0	9.064817947	8.334972705	21.27801515	0	1.564096442	3.229451731	0	5.379323918	0	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7737	NO																																																																																		0	0	0	29.0653	1.589002579	3.856846473	0	2.948834004	5.804930723	1.629653245	7.176045211	6.756829883	5.655555939	0	0.086651582	0	9.064817947	8.334972705	21.27801515	0	1.564096442	3.229451731	0	5.379323918	0	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7737
H5698_035_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1347.669074	62.35217971	637.4728809		1090.506344	8.473903606	2.652127056	327.4034086	171.816299	138.0884007		1.237720891		45.70285021	1858.630511	1961.619507		184.5805888			13.33049332				150		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Medicare FFS Cost Sharing	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$35/visit	Surgery: 20% or $300 /visit; ASC: 20% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit	$50/observation	$0/visit	$0/visit	$20/visit	$30/visit	Individual: $30/visit; Group: $20/visit	$30/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	Not Covered	Not Covered	Routine Eye Exam: $30	"Contact Lens: $100 Annual Allowance; Lens & Frames, Lens, Frames: $100 Annual Allowance"	Routine Hearing Tests: $30	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: Not Covered; MedAlert Program: Not Covered; Fitness Program: No Cost Sharing											62.86	86.00800841	31.06		50	0.2	0.2	35	165.8656981	75		50		23.85240355	19.98383847	21.33409105		30			0.2				30		30														NO	59.72958791	81.72483136	29.51321986		47.51001265	0.190040051	0.190040051	33.25700886	157.6056283	71.26501898		47.51001265		22.66455989	18.98970006	20.27185095		28.50600759			0.190040051				28.50600759		28.50600759															6.708	0.424643448	1.567823108	0	4.317497515	1.61038107	0.50401036	0.907371505	2.256601313	0.820072708	0	0.004900345	0	0.086319582	2.941236328	3.313804856	0	0.438471306	0	0	2.533327625	0	0	0	0.356325095	0	0.591499658	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3823	0	1.539712189	6.708	0.424643448	1.567823108	0	4.317497515	1.61038107	0.50401036	0.907371505	2.256601313	0.820072708	0	0.004900345	0	0.086319582	2.941236328	3.313804856	0	0.438471306	0	0	2.533327625	0	0	0	0.356325095	0	0.591499658	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3823	NO																																																																																		0	0	0	6.708	0.424643448	1.567823108	0	4.317497515	1.61038107	0.50401036	0.907371505	2.256601313	0.820072708	0	0.004900345	0	0.086319582	2.941236328	3.313804856	0	0.438471306	0	0	2.533327625	0	0	0	0.356325095	0	0.591499658	0	0	0	0	0	0	0	0	0	0	0	0	0	29.3823
H5698_036_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1921.203582	78.08504718	864.217643		2186.194515	12.90455757	4.638133179	420.3007503	258.6867517	177.4675187		0.221450802		36.5450331	2953.584038	2954.757173		257.8725472			16.78224926		547.0904396		150		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 20% or $300 /visit; ASC: 20% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$20/visit	$20/visit	Individual: $20/visit; Group: $15/visit	$20/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	$3/visit	Not Covered	Routine Eye Exam: $30	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $30	$500 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing;											62.86	79.55	31.06		40.60349364	0.168	0.2	50	161.0861114	75		50		20	19.97801302	19.99569374		20			0.2		3		30		30														NO	56.78037164	71.85616551	28.0559711		40.33195108	0.15175155	0.180656607	45.1641518	145.5063517	67.74622769		45.1641518		18.06566072	18.04897231	18.06283723		18.06566072			0.180656607		2.709849108		27.09849108		27.09849108															9.0906	0.467574339	2.020538768	0	7.347790852	1.958286614	0.837909404	1.58187724	3.13671379	1.001896244	0	0.00083347	0	0.055017514	4.442429711	4.447608157	0	0.388219829	0	0	3.031824213	0	0.123544378	0	0.338731138	0	0.56229369	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8336	0	3.633736475	9.0906	0.467574339	2.020538768	0	7.347790852	1.958286614	0.837909404	1.58187724	3.13671379	1.001896244	0	0.00083347	0	0.055017514	4.442429711	4.447608157	0	0.388219829	0	0	3.031824213	0	0.123544378	0	0.338731138	0	0.56229369	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8336	NO																																																																																		0	0	0	9.0906	0.467574339	2.020538768	0	7.347790852	1.958286614	0.837909404	1.58187724	3.13671379	1.001896244	0	0.00083347	0	0.055017514	4.442429711	4.447608157	0	0.388219829	0	0	3.031824213	0	0.123544378	0	0.338731138	0	0.56229369	0	0	0	0	0	0	0	0	0	0	0	0	0	40.8336
H5698_038_0	2010	3	N/A																															D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	NO	2853.275337	128.2880169	1115.218717		18.21441336	31.97220101	7.223596265	30.38930535	37.84431761	21.21893914		0.063219426		26.96073363	43.41388569	139.7179591		4.590645864	18.83586221		26.84143906	0.000594172			175		249															"Medicare FFS Cost Sharing, unlimited days"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost Sharing	Preventive Dental	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$500 allowance for hearing aids	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;											131.034501	138.0299901	77.5370077		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10														NO	131.034501	138.0299901	77.5370077		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10															31.1565	1.475632808	7.205893522	0	4.243958312	7.449522835	1.68309793	7.080708146	8.817726003	4.944012821	0	0.014730126	0	6.281850935	10.11543537	32.55428446	0	1.069620486	4.388755896	0	6.2540553	0.000138442	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	135.0892	0	0	31.1565	1.475632808	7.205893522	0	4.243958312	7.449522835	1.68309793	7.080708146	8.817726003	4.944012821	0	0.014730126	0	6.281850935	10.11543537	32.55428446	0	1.069620486	4.388755896	0	6.2540553	0.000138442	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	135.0892	NO																																																																																		0	0	0	31.1565	1.475632808	7.205893522	0	4.243958312	7.449522835	1.68309793	7.080708146	8.817726003	4.944012821	0	0.014730126	0	6.281850935	10.11543537	32.55428446	0	1.069620486	4.388755896	0	6.2540553	0.000138442	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	135.0892
H5698_058_0	2010	3	N/A																															D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	NO	2710.467319	122.660484	1045.864894		13.57024647	29.3542877	6.932022297	26.70319919	45.34889742	16.37024577		0.075826219		20.75377765	36.95330076	106.437267		6.062366668	21.24838965		21.59188329	0.000712658			175		249															"Medicare FFS Cost Sharing, unlimited days"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost Sharing	Preventive Dental	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$500 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;											129.053347	110.4299895	73.38767368		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10														NO	129.053347	110.4299895	73.38767368		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10															29.1496	1.128782997	6.396132632	0	3.161867427	6.839549034	1.615161195	6.221845412	10.5662931	3.814267264	0	0.017667509	0	4.835630192	8.610119078	24.79988322	0	1.412531434	4.950874788	0	5.030908807	0.000166049	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	118.9046	0	0	29.1496	1.128782997	6.396132632	0	3.161867427	6.839549034	1.615161195	6.221845412	10.5662931	3.814267264	0	0.017667509	0	4.835630192	8.610119078	24.79988322	0	1.412531434	4.950874788	0	5.030908807	0.000166049	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	118.9046	NO																																																																																		0	0	0	29.1496	1.128782997	6.396132632	0	3.161867427	6.839549034	1.615161195	6.221845412	10.5662931	3.814267264	0	0.017667509	0	4.835630192	8.610119078	24.79988322	0	1.412531434	4.950874788	0	5.030908807	0.000166049	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	118.9046
H5698_061_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1799.354838	74.09535464	686.7462856		1497.257462	14.40310097	5.755238615	459.7507822	246.7060232	188.698658		1.397767837		82.81774434	2924.385913	2813.950943		219.426801			18.56450403				150																3400	Days 1-5: $175/day; Days 6-60: $0/day; Days 61+: $100/day	Medicare FFS Cost Sharing	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	$300/visit; ASC: $300/visit	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	$0/visit	$15/visit	$30/visit	Individual: $30/visit; Group: $20/visit	$30/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	Not Covered	Not Covered	Routine Eye Exam: $30	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Not Covered	$500 allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: Not Covered; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing											109.39	131.4343477	31.06		50	0.168	0.2	50	300	75		100		30	14.99334995	29.98179179		30			0.2				30																NO	94.81265017	113.9193603	26.92093349		43.33698244	0.145612261	0.17334793	43.33698244	260.0218946	65.00547365		86.67396487		26.00218946	12.99999509	25.98765195		26.00218946			0.17334793				26.00218946																	14.2168	0.70340795	1.540654257	0	5.407218362	2.097268098	0.997658699	1.660350965	5.345747298	1.022203803	0	0.01009584	0	0.179453557	3.168083543	6.093998143	0	0.475464771	0	0	3.218118341	0	0	0	0.325027368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4616	0	7.141768791	14.2168	0.70340795	1.540654257	0	5.407218362	2.097268098	0.997658699	1.660350965	5.345747298	1.022203803	0	0.01009584	0	0.179453557	3.168083543	6.093998143	0	0.475464771	0	0	3.218118341	0	0	0	0.325027368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4616	NO																																																																																		0	0	0	14.2168	0.70340795	1.540654257	0	5.407218362	2.097268098	0.997658699	1.660350965	5.345747298	1.022203803	0	0.01009584	0	0.179453557	3.168083543	6.093998143	0	0.475464771	0	0	3.218118341	0	0	0	0.325027368	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.4616
H5698_062_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1646.72873	71.69004901	890.0375968		870.1589708	10.69314708	2.873763673	391.1947942	220.8494795	161.4606793		1.718503822		70.44260978	2904.329834	2402.086887		179.9955572			19.11259217				150																3400	Days 1-5: $175/day; Days 6-60: $0/day; Days 61+: $100/day	Medicare FFS Cost Sharing	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	$300/visit; ASC: $300/visit	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	$0/visit	$15/visit	$30/visit	Individual: $30/visit; Group: $20/visit	$30/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	Not Covered	Not Covered	Routine Eye Exam: $30	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Not Covered	$500 allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: Not Covered; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing											109.39	91.81579683	31.06		50	0.168	0.2	50	300	75		100		30	14.99020933	29.95564586		30			0.2				30																NO	97.7034199	82.00674058	27.74173345		44.65829596	0.150051874	0.178633184	44.65829596	267.9497758	66.98744394		89.31659192		26.79497758	13.39048619	26.77272863		26.79497758			0.178633184				26.79497758																	13.4076	0.489922271	2.057598814	0	3.238318071	1.604526763	0.513349554	1.455841075	4.93138071	0.90131985	0	0.012790909	0	0.157292346	3.240865711	5.359201697	0	0.401914743	0	0	3.41414319	0	0	0	0.33493722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.521	0	4.962077676	13.4076	0.489922271	2.057598814	0	3.238318071	1.604526763	0.513349554	1.455841075	4.93138071	0.90131985	0	0.012790909	0	0.157292346	3.240865711	5.359201697	0	0.401914743	0	0	3.41414319	0	0	0	0.33493722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.521	NO																																																																																		0	0	0	13.4076	0.489922271	2.057598814	0	3.238318071	1.604526763	0.513349554	1.455841075	4.93138071	0.90131985	0	0.012790909	0	0.157292346	3.240865711	5.359201697	0	0.401914743	0	0	3.41414319	0	0	0	0.33493722	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.521
H5698_063_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1549.057149	50.47150551	444.4009792		936.0196695	11.07242101	3.339655404	404.7194831	263.9666474	186.8727575		3.870454049		58.46768001	2724.540929	2440.888537		216.7945564			12.15078894				150																3400	Days 1-5: $175/day; Days 6-60: $0/day; Days 61+: $100/day	Medicare FFS Cost Sharing	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	$300/visit; ASC: $300/visit	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	$0/visit	$15/visit	$30/visit	Individual: $30/visit; Group: $20/visit	$30/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	Not Covered	Not Covered	Routine Eye Exam: $30	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Not Covered	$500 allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: Not Covered; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing											109.39	124.8813622	31.06		50	0.168	0.2	50	300	75		100		30	14.99351216	29.982398		30			0.2				30																NO	98.43423768	112.3740898	27.94924054		44.99233828	0.151174257	0.179969353	44.99233828	269.9540297	67.48850741		89.98467655		26.99540297	13.49388198	26.98414853		26.99540297			0.179969353				26.99540297																	12.7067	0.472640791	1.035055822	0	3.509476134	1.673865015	0.601035623	1.517439658	5.938238346	1.05098029	0	0.029023463	0	0.131529882	3.063719479	5.488774903	0	0.487704701	0	0	2.186769625	0	0	0	0.337442537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2304	0	4.47610908	12.7067	0.472640791	1.035055822	0	3.509476134	1.673865015	0.601035623	1.517439658	5.938238346	1.05098029	0	0.029023463	0	0.131529882	3.063719479	5.488774903	0	0.487704701	0	0	2.186769625	0	0	0	0.337442537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2304	NO																																																																																		0	0	0	12.7067	0.472640791	1.035055822	0	3.509476134	1.673865015	0.601035623	1.517439658	5.938238346	1.05098029	0	0.029023463	0	0.131529882	3.063719479	5.488774903	0	0.487704701	0	0	2.186769625	0	0	0	0.337442537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2304
H5698_067_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1827.930555		765.6515457		558.4894647			455.1331433	308.5547604			5.656797991		34.41218778		3657.992732					27.3904183						249														3400	"Days 1-5: $0/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days : $0/day	Days 11 - 100 : $50/day	No Cost Sharing	$100/trip	0% Coinsurance	0% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $0/visit; PET Scan: $0/visit; CT Scan: $0/visit; MRI: $0/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $15/visit; Group: $10/visit	$0/visit	No Cost Sharing	No Cost Sharing	10% Coinsurance	No Cost Sharing	Not Covered	$250 Annual Allowance	No Cost Sharing	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $10	$750 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;											1		27.59		55.53171958			50	95.36669547			50		15		15					0.1						10														NO	0.984971908		27.17537494		54.92166832			49.2485954	93.93351599			49.2485954		14.77457862		14.77457862					0.098497191						9.849719079															0.15	0	1.733905652	0	2.556097762	0	0	1.867889002	2.415302794	0	0	0.02321578	0	0.042368798	0	4.5037751	0	0	0	0	2.697879257	0	0	0	0	0	0.204381671	0	0	0	0	0	0	0	0	0	0	0	0	0	16.1949	0	0.236483976	0.15	0	1.733905652	0	2.556097762	0	0	1.867889002	2.415302794	0	0	0.02321578	0	0.042368798	0	4.5037751	0	0	0	0	2.697879257	0	0	0	0	0	0.204381671	0	0	0	0	0	0	0	0	0	0	0	0	0	16.1949	NO																																																																																		0	0	0	0.15	0	1.733905652	0	2.556097762	0	0	1.867889002	2.415302794	0	0	0.02321578	0	0.042368798	0	4.5037751	0	0	0	0	2.697879257	0	0	0	0	0	0.204381671	0	0	0	0	0	0	0	0	0	0	0	0	0	16.1949
H5698_068_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	2171.808303	51.21703861	1592.968786		3476.430041	23.34504806	8.045997908	433.3628392	403.9948132	293.995098		2.070388014		69.15095968		4778.537791		98.13639188			42.03795761				175		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 11 - 100 : $50/day	No Cost Sharing	$50/trip	10% Coinsurance	10% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $50/visit; PET Scan: $50/visit; CT Scan: $50/visit; MRI: $50/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $15/visit; Group: $10/visit	$15/visit	No Cost Sharing	No Cost Sharing	10% Coinsurance	No Cost Sharing	Not Covered	$250 Annual Allowance	Routine Eye Exam: $10	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $10	$500 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;											62.86	79.55	27.59		35.25404611	0.1	0.1	50	102.0497576	50		50		15		14.98218842		15			0.1				10		10														NO	56.26467279	71.20354312	24.69523262		34.74829889	0.089507911	0.089507911	44.75395545	91.34260612	44.75395545		44.75395545		13.42618663		13.41240842		13.42618663			0.089507911				8.95079109		8.95079109															10.183	0.303902885	3.278227893	0	10.06666918	2.089566482	0.720180464	1.6162251	3.075161592	1.096453627	0	0.007721504	0	0.077369474	0	5.340975042	0	0.109799793	0	0	3.762729764	0	0	0	0.13053237	0	0.185728915	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0443	0	3.893955309	10.183	0.303902885	3.278227893	0	10.06666918	2.089566482	0.720180464	1.6162251	3.075161592	1.096453627	0	0.007721504	0	0.077369474	0	5.340975042	0	0.109799793	0	0	3.762729764	0	0	0	0.13053237	0	0.185728915	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0443	NO																																																																																		0	0	0	10.183	0.303902885	3.278227893	0	10.06666918	2.089566482	0.720180464	1.6162251	3.075161592	1.096453627	0	0.007721504	0	0.077369474	0	5.340975042	0	0.109799793	0	0	3.762729764	0	0	0	0.13053237	0	0.185728915	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0443
H5698_069_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	2113.386767	95.53547296	588.2893306		392.345807	25.85670571	5.204527013	423.5370888	488.5629807	278.6261981		4.583278878		10.1159772		4026.046391		84.77806499			33.78743922				175		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 11 - 100 : $50/day	No Cost Sharing	$50/trip	10% Coinsurance	10% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $50/visit; PET Scan: $50/visit; CT Scan: $50/visit; MRI: $50/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $15/visit; Group: $10/visit	$15/visit	No Cost Sharing	No Cost Sharing	10% Coinsurance	No Cost Sharing	Not Covered	$250 Annual Allowance	Routine Eye Exam: $10	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $10	$500 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;											62.86	79.55	27.59		50	0.1	0.1	50	86.93092641	50		50		15		14.99636535		15			0.1				10		10														NO	59.14452859	74.84803133	25.9592355		47.04464571	0.094089291	0.094089291	47.04464571	81.79269268	47.04464571		47.04464571		14.11339371		14.11046893		14.11339371			0.094089291				9.408929142		9.408929142															10.4163	0.595886839	1.27262844	0	1.538147457	2.432839119	0.489690259	1.660429357	3.330073478	1.092322565	0	0.017968228	0	0.011897564	0	4.734116876	0	0.099708851	0	0	3.179036215	0	0	0	0.13721355	0	0.19523528	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2035	0	1.960031618	10.4163	0.595886839	1.27262844	0	1.538147457	2.432839119	0.489690259	1.660429357	3.330073478	1.092322565	0	0.017968228	0	0.011897564	0	4.734116876	0	0.099708851	0	0	3.179036215	0	0	0	0.13721355	0	0.19523528	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2035	NO																																																																																		0	0	0	10.4163	0.595886839	1.27262844	0	1.538147457	2.432839119	0.489690259	1.660429357	3.330073478	1.092322565	0	0.017968228	0	0.011897564	0	4.734116876	0	0.099708851	0	0	3.179036215	0	0	0	0.13721355	0	0.19523528	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2035
H5698_122_0	2010	4	N/A																															D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	NO	2939.968368	158.2251846	1032.08052		15.48401443	29.23312751	8.728860972	31.58851971	35.65184931	19.32296023		0.160664588		33.83185004	42.15947466	123.6782387		5.176042905	20.98425543		26.23923536	0.001510017			175		249															"Medicare FFS Cost Sharing, unlimited days"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost Sharing	Preventive Dental	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$500 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;											140.8670111	140.8345067	72.76786751		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10														NO	140.8670111	140.8345067	72.76786751		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10															34.512	1.856963819	6.258524878	0	3.607775362	6.81131871	2.033824607	7.360125093	8.30688089	4.502249733	0	0.037434849	0	7.88282106	9.823157596	28.81702962	0	1.206017997	4.889331514	0	6.113741838	0.000351834	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	134.3729	0	0	34.512	1.856963819	6.258524878	0	3.607775362	6.81131871	2.033824607	7.360125093	8.30688089	4.502249733	0	0.037434849	0	7.88282106	9.823157596	28.81702962	0	1.206017997	4.889331514	0	6.113741838	0.000351834	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	134.3729	NO																																																																																		0	0	0	34.512	1.856963819	6.258524878	0	3.607775362	6.81131871	2.033824607	7.360125093	8.30688089	4.502249733	0	0.037434849	0	7.88282106	9.823157596	28.81702962	0	1.206017997	4.889331514	0	6.113741838	0.000351834	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	134.3729
H5698_123_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1663.525595	2446.430628	433.5070102		188.8435252	9.629341884	13.0532612	647.3335153	359.3849911	289.5319476		14.69400565				4104.874178					14.45122306				153.5173052		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 5 : $100/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$20/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $0/visit; Group: $0/visit	$0/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	No Cost Sharing	$250 Annual Allowance	Routine Eye Exam: $30	"Contact Lens: $100 Annual Allowance; Lens & Frames, Lens, Frames: $100 Annual Allowance"	Routine Hearing Tests: $30	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: No Cost Sharing;											62.86	56.99	31.06		50	0.2	0.177551456	50	105.1883278	75		20				15					0.2				30		30														NO	57.1158248	51.78222805	28.22172317		45.43097741	0.18172391	0.161326724	45.43097741	95.57617089	68.14646612		18.17239096				13.62929322					0.18172391				27.25858645		27.25858645															7.9178	10.55680239	1.019526236	0	0.714945494	1.749881654	2.105839864	2.450749526	2.862386777	1.644214922	0	0.022252101	0	0	0	4.662211152	0	0	0	0	2.626132753	0	0	0	0.348722061	0	0.565615669	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2471	0	3.947104418	7.9178	10.55680239	1.019526236	0	0.714945494	1.749881654	2.105839864	2.450749526	2.862386777	1.644214922	0	0.022252101	0	0	0	4.662211152	0	0	0	0	2.626132753	0	0	0	0.348722061	0	0.565615669	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2471	NO																																																																																		0	0	0	7.9178	10.55680239	1.019526236	0	0.714945494	1.749881654	2.105839864	2.450749526	2.862386777	1.644214922	0	0.022252101	0	0	0	4.662211152	0	0	0	0	2.626132753	0	0	0	0.348722061	0	0.565615669	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2471
H5698_128_0	2010	4	N/A																															D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	NO	3179.420177	120.163001	1074.580645		13.3938675	31.24337573	11.17649735	30.88255972	43.59193776	16.25241239		0.101775565		14.91080417	40.1912943	127.733059		4.521448287	25.73967647		25.86049454				175																	"Medicare FFS Cost Sharing, unlimited days"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost Sharing	Preventive Dental	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: Not Covered	Allowance of $500 for hearing aids	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;											128.8896389	105.7582108	72.73934026		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233				10																NO	128.8896389	105.7582108	72.73934026		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233				10																	34.1495	1.059018666	6.513690599	0	3.120771128	7.279706544	2.604123882	7.195636414	10.1569215	3.786812087	0	0.023713707	0	3.474217371	9.364571571	29.76180275	0	1.053497451	5.997344618	0	6.025495228	0	0	0	0.145833333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7127	0	0	34.1495	1.059018666	6.513690599	0	3.120771128	7.279706544	2.604123882	7.195636414	10.1569215	3.786812087	0	0.023713707	0	3.474217371	9.364571571	29.76180275	0	1.053497451	5.997344618	0	6.025495228	0	0	0	0.145833333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7127	NO																																																																																		0	0	0	34.1495	1.059018666	6.513690599	0	3.120771128	7.279706544	2.604123882	7.195636414	10.1569215	3.786812087	0	0.023713707	0	3.474217371	9.364571571	29.76180275	0	1.053497451	5.997344618	0	6.025495228	0	0	0	0.145833333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7127
H5698_129_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1499.605677	1533.035125	431.1421931		560.6852822	14.32537033	10.96498045	636.0822585	427.8878194	277.4775576		6.72773896				3279.483787					9.124392217				150		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 5 : $100/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$20/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $0/visit; Group: $0/visit	$0/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	No Cost Sharing	$250 Annual Allowance	Routine Eye Exam: $30	"Contact Lens: $100 Annual Allowance; Lens & Frames, Lens, Frames: $100 Annual Allowance"	Routine Hearing Tests: $30	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: No Cost Sharing;											62.86	56.99	31.06		50	0.2	0.186579355	50	111.5309134	75		20				15					0.2				30		30														NO	58.06296481	52.64092212	28.68971822		46.18434999	0.1847374	0.172340925	46.18434999	103.0196548	69.27652499		18.47374				13.855305					0.1847374				27.71061		27.71061															7.256	6.725031885	1.030779002	0	2.157907109	2.646431669	1.889714871	2.448087137	3.673404621	1.60189008	0	0.010357208	0	0	0	3.786520675	0	0	0	0	1.685616494	0	0	0	0.346382625	0	0.574995157	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8331	0	2.960450812	7.256	6.725031885	1.030779002	0	2.157907109	2.646431669	1.889714871	2.448087137	3.673404621	1.60189008	0	0.010357208	0	0	0	3.786520675	0	0	0	0	1.685616494	0	0	0	0.346382625	0	0.574995157	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8331	NO																																																																																		0	0	0	7.256	6.725031885	1.030779002	0	2.157907109	2.646431669	1.889714871	2.448087137	3.673404621	1.60189008	0	0.010357208	0	0	0	3.786520675	0	0	0	0	1.685616494	0	0	0	0.346382625	0	0.574995157	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8331
H5698_134_0	2010	3	N/A																															D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	NO	2710.206054	153.7174756	585.7656101		13.08420846	25.12284968	8.844543213	27.94539923	26.6995907	20.00523376		0.282620754		35.25874598	37.11295873	95.75402746		5.567093673	13.76678544		22.24256559				175		249															"Medicare FFS Cost Sharing, unlimited days"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost Sharing	Preventive Dental	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$500 Allowance on hearing aids	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;											127.0954345	122.170139	74.55067968		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233				10		10														NO	127.0954345	122.170139	74.55067968		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233				10		10															28.7046	1.56497378	3.639102031	0	3.048620571	5.853623976	2.060778569	6.51127802	6.221004632	4.661219467	0	0.065850636	0	8.215287812	8.647319383	22.3106884	0	1.297132826	3.207661008	0	5.182517782	0	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	111.545	0	0	28.7046	1.56497378	3.639102031	0	3.048620571	5.853623976	2.060778569	6.51127802	6.221004632	4.661219467	0	0.065850636	0	8.215287812	8.647319383	22.3106884	0	1.297132826	3.207661008	0	5.182517782	0	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	111.545	NO																																																																																		0	0	0	28.7046	1.56497378	3.639102031	0	3.048620571	5.853623976	2.060778569	6.51127802	6.221004632	4.661219467	0	0.065850636	0	8.215287812	8.647319383	22.3106884	0	1.297132826	3.207661008	0	5.182517782	0	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	111.545
H5698_135_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1675.718111	1855.808705	682.7808326		581.4880529	17.63574302	7.578056422	796.6593803	479.4197378	269.0056755		10.01493643				3885.566753					21.35913304				150		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 5 : $100/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$20/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $0/visit; Group: $0/visit	$0/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	No Cost Sharing	$250 Annual Allowance	Routine Eye Exam: $30	"Contact Lens: $100 Annual Allowance; Lens & Frames, Lens, Frames: $100 Annual Allowance"	Routine Hearing Tests: $30	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: No Cost Sharing;											62.86	56.99	31.06		50	0.2	0.171623795	50	99.62073691	75		20				15					0.2				30		30														NO	56.4659305	51.19302226	27.90060136		44.91403954	0.179656158	0.154166358	44.91403954	89.48739433	67.3710593		17.96561581				13.47421186					0.179656158				26.94842372		26.94842372															7.8851	7.91703803	1.587499652	0	2.176414783	3.168369837	1.168281358	2.981765909	3.575168594	1.510266443	0	0.014993708	0	0	0	4.362912469	0	0	0	0	3.837299783	0	0	0	0.336855297	0	0.559179792	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0811	0	4.6519305	7.8851	7.91703803	1.587499652	0	2.176414783	3.168369837	1.168281358	2.981765909	3.575168594	1.510266443	0	0.014993708	0	0	0	4.362912469	0	0	0	0	3.837299783	0	0	0	0.336855297	0	0.559179792	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0811	NO																																																																																		0	0	0	7.8851	7.91703803	1.587499652	0	2.176414783	3.168369837	1.168281358	2.981765909	3.575168594	1.510266443	0	0.014993708	0	0	0	4.362912469	0	0	0	0	3.837299783	0	0	0	0.336855297	0	0.559179792	0	0	0	0	0	0	0	0	0	0	0	0	0	41.0811
H5698_140_0	2010	3	N/A																															D	D	D	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	NO	2844.593236	163.1348274	1186.877973		15.88666411	28.26025309	7.299763704	30.90535998	34.8295709	18.25876972		0.105368116		35.5393384	41.63139979	125.7925996		4.740874979	21.42206901		26.10425807	0.002518762			175		249															"Medicare FFS Cost Sharing, unlimited days"	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	No Cost Sharing	Preventive Dental	Routine Eye Exam: $10	"Contact Lens: $200 Annual Allowance; Lens & Frames, Lens, Frames: $200 Annual Allowance"	Routine Hearing Tests: $10	$500 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: Not Covered;											137.5070491	143.7297098	79.30240001		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10														NO	137.5070491	143.7297098	79.30240001		0.233	0.233	0.233	0.233	0.233	0.233		0.233		0.233	0.233	0.233		0.233	0.233		0.233	0.233			10		10															32.596	1.95394345	7.843522646	0	3.701592739	6.58463897	1.700844943	7.200948876	8.115290019	4.254293346	0	0.024550771	0	8.280665847	9.700116151	29.30967571	0	1.10462387	4.991342079	0	6.082292131	0.000586872	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	133.7982	0	0	32.596	1.95394345	7.843522646	0	3.701592739	6.58463897	1.700844943	7.200948876	8.115290019	4.254293346	0	0.024550771	0	8.280665847	9.700116151	29.30967571	0	1.10462387	4.991342079	0	6.082292131	0.000586872	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	133.7982	NO																																																																																		0	0	0	32.596	1.95394345	7.843522646	0	3.701592739	6.58463897	1.700844943	7.200948876	8.115290019	4.254293346	0	0.024550771	0	8.280665847	9.700116151	29.30967571	0	1.10462387	4.991342079	0	6.082292131	0.000586872	0	0	0.145833333	0	0.2075	0	0	0	0	0	0	0	0	0	0	0	0	0	133.7982
H5698_141_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1958.844389	1236.391951	1329.078374		713.11511	16.94177132	12.23197298	771.1662447	460.7525775	381.0301501		18.45919497				4637.193228					15.22626517				150		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 5 : $100/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$20/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $0/visit; Group: $0/visit	$0/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	No Cost Sharing	$250 Annual Allowance	Routine Eye Exam: $30	"Contact Lens: $100 Annual Allowance; Lens & Frames, Lens, Frames: $100 Annual Allowance"	Routine Hearing Tests: $30	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: No Cost Sharing;											62.86	56.99	31.06		50	0.2	0.186400599	50	119.7108669	75		20				15					0.2				30		30														NO	55.88548337	50.66677851	27.61379436		44.45234121	0.177809365	0.16571886	44.45234121	106.428566	66.67851182		17.78093648				13.33570236					0.177809365				26.67140473		26.67140473															9.1226	5.220333093	3.058408075	0	2.641636349	3.012405598	2.02706862	2.856678753	4.086436342	2.117210281	0	0.027351814	0	0	0	5.153352391	0	0	0	0	2.707372538	0	0	0	0.333392559	0	0.553431648	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9177	0	5.356130161	9.1226	5.220333093	3.058408075	0	2.641636349	3.012405598	2.02706862	2.856678753	4.086436342	2.117210281	0	0.027351814	0	0	0	5.153352391	0	0	0	0	2.707372538	0	0	0	0.333392559	0	0.553431648	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9177	NO																																																																																		0	0	0	9.1226	5.220333093	3.058408075	0	2.641636349	3.012405598	2.02706862	2.856678753	4.086436342	2.117210281	0	0.027351814	0	0	0	5.153352391	0	0	0	0	2.707372538	0	0	0	0.333392559	0	0.553431648	0	0	0	0	0	0	0	0	0	0	0	0	0	42.9177
H5698_150_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1702.386496	70.10231031	649.737105		1416.569335	13.42346236	5.363791386	435.0404439	233.4108836	178.529571		1.322441267		78.35464505	2766.788953	2662.305392		207.6017555			17.30182421				150																3400	Days 1-5: $175/day; Days 6-60: $0/day; Days 61+: $100/day	Medicare FFS Cost Sharing	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	$300/visit; ASC: $300/visit	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$100/observation	$0/visit	$0/visit	$15/visit	$30/visit	Individual: $30/visit; Group: $20/visit	$30/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	Not Covered	Not Covered	Routine Eye Exam: $30	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Not Covered	$500 allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: Not Covered; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing											109.39	130.0105063	31.06		50	0.168	0.2	50	300	75		100		30	14.99282739	29.98165239		30			0.2				30																NO	96.20079271	114.3350742	27.31508019		43.97147486	0.147744156	0.175885899	43.97147486	263.8288492	65.95721229		87.94294973		26.38288492	13.18929172	26.36785846		26.38288492			0.175885899				26.38288492																	13.6476	0.667929404	1.478968427	0	5.190720241	1.983238111	0.943415272	1.594114162	5.1317104	0.981276068	0	0.009691615	0	0.172268465	3.040998886	5.84994098	0	0.456427769	0	0	3.043146914	0	0	0	0.329786061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5212	0	6.102524665	13.6476	0.667929404	1.478968427	0	5.190720241	1.983238111	0.943415272	1.594114162	5.1317104	0.981276068	0	0.009691615	0	0.172268465	3.040998886	5.84994098	0	0.456427769	0	0	3.043146914	0	0	0	0.329786061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5212	NO																																																																																		0	0	0	13.6476	0.667929404	1.478968427	0	5.190720241	1.983238111	0.943415272	1.594114162	5.1317104	0.981276068	0	0.009691615	0	0.172268465	3.040998886	5.84994098	0	0.456427769	0	0	3.043146914	0	0	0	0.329786061	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.5212
H5698_151_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	1694.740349	69.78745079	646.8188572		1410.206915	13.31884284	5.321987172	433.0883844	232.3625352	177.7277182		1.316501616		78.00272075	2754.362118	2650.347838		206.669327			17.16697759		346.8318933		150		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 21 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 20% or $300 /visit; ASC: 20% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$20/visit	$20/visit	Individual: $20/visit; Group: $15/visit	$20/visit	No Cost Sharing	No Cost Sharing	20% Coinsurance	No Cost Sharing	$3/visit	Not Covered	Routine Eye Exam: $30	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $30	$500 Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20 installation fee; Fitness Program: No Cost Sharing;											62.86	79.55	31.06		50	0.168	0.2	50	152.755074	75		50		20	19.97882939	19.99080365		20			0.2		3		30		30														NO	57.77581675	73.11591191	28.54783437		45.95594715	0.154411982	0.183823789	45.95594715	140.4000821	68.93392072		45.95594715		18.38237886	18.36569994	18.37466777		18.38237886			0.183823789		2.757356829		27.57356829		27.57356829															8.1596	0.425214425	1.538773133	0	5.400616203	2.056588926	0.978307845	1.658582242	2.718643252	1.020955703	0	0.005041757	0	0.11948963	4.215482349	4.05827175	0	0.316589489	0	0	3.155698859	0	0.079694941	0	0.344669604	0	0.572151542	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8244	0	3.239614546	8.1596	0.425214425	1.538773133	0	5.400616203	2.056588926	0.978307845	1.658582242	2.718643252	1.020955703	0	0.005041757	0	0.11948963	4.215482349	4.05827175	0	0.316589489	0	0	3.155698859	0	0.079694941	0	0.344669604	0	0.572151542	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8244	NO																																																																																		0	0	0	8.1596	0.425214425	1.538773133	0	5.400616203	2.056588926	0.978307845	1.658582242	2.718643252	1.020955703	0	0.005041757	0	0.11948963	4.215482349	4.05827175	0	0.316589489	0	0	3.155698859	0	0.079694941	0	0.344669604	0	0.572151542	0	0	0	0	0	0	0	0	0	0	0	0	0	36.8244
H5698_152_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	2106.834891	77.82875233	1056.997674		1669.95003	22.36872205	6.433855273	447.6758292	403.951629	298.6650123		4.065774416		47.77284939		4281.560253		101.8137677			36.5539834				175		249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 11 - 100 : $50/day	No Cost Sharing	$50/trip	10% Coinsurance	10% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $50/visit; PET Scan: $50/visit; CT Scan: $50/visit; MRI: $50/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $15/visit; Group: $10/visit	$15/visit	No Cost Sharing	No Cost Sharing	10% Coinsurance	No Cost Sharing	Not Covered	$250 Annual Allowance	Routine Eye Exam: $10	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $10	$500 Annual Allowance	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $20/installation; Fitness Program: No Cost Sharing;											62.86	79.55	27.59		50	0.1	0.1	50	97.67068594	50		50		15		14.99162091		15			0.1				10		10														NO	57.69864601	73.01825152	25.32462048		45.89456412	0.091789128	0.091789128	45.89456412	89.65107118	45.89456412		45.89456412		13.76836924		13.76163728		13.76836924			0.091789128				9.178912824		9.178912824															10.1301	0.473576618	2.230672078	0	6.386802396	2.053205497	0.590557967	1.712157254	3.017891354	1.14225838	0	0.015549745	0	0.054812852	0	4.910106601	0	0.116817462	0	0	3.35525827	0	0	0	0.133859145	0	0.190462441	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5141	0	3.265947695	10.1301	0.473576618	2.230672078	0	6.386802396	2.053205497	0.590557967	1.712157254	3.017891354	1.14225838	0	0.015549745	0	0.054812852	0	4.910106601	0	0.116817462	0	0	3.35525827	0	0	0	0.133859145	0	0.190462441	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5141	NO																																																																																		0	0	0	10.1301	0.473576618	2.230672078	0	6.386802396	2.053205497	0.590557967	1.712157254	3.017891354	1.14225838	0	0.015549745	0	0.054812852	0	4.910106601	0	0.116817462	0	0	3.35525827	0	0	0	0.133859145	0	0.190462441	0	0	0	0	0	0	0	0	0	0	0	0	0	36.5141
H5698_153_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	2266.594234	104.3266044	518.481233		191.4285031	20.33376675	16.53754036	360.7467371	405.3909791	457.570266		20.17957845		4.342377629		4796.773234	158.2108814				37.87205798		50				249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 11 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $15/visit; Group: $10/visit	$0/visit	No Cost Sharing	No Cost Sharing	10% Coinsurance	No Cost Sharing	$3/visit	$200 Annual Allowance	Routine Eye Exam: $0	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $30	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: No Cost Sharing;											62.86	79.55	55.18		50	0.15	0.2	50	114.1572746	75		50		15		11.55188024	15				0.1		3				30														NO	57.78693343	73.12998018	50.72674175		45.96478956	0.137894369	0.183859158	45.96478956	104.9443021	68.94718433		45.96478956		13.78943687		10.61959489	13.78943687				0.091929579		2.757887373				27.57887373															10.915	0.635783543	2.191738634	0	0.733247571	2.803911928	3.04057825	1.381803988	3.545289449	2.629015123	0	0.07729584	0	0.004989912	0	4.244982375	0.181803247	0	0	0	3.481562351	0	0.011491197	0	0	0	0.57226163	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4507	0	3.199977871	10.915	0.635783543	2.191738634	0	0.733247571	2.803911928	3.04057825	1.381803988	3.545289449	2.629015123	0	0.07729584	0	0.004989912	0	4.244982375	0.181803247	0	0	0	3.481562351	0	0.011491197	0	0	0	0.57226163	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4507	NO																																																																																		0	0	0	10.915	0.635783543	2.191738634	0	0.733247571	2.803911928	3.04057825	1.381803988	3.545289449	2.629015123	0	0.07729584	0	0.004989912	0	4.244982375	0.181803247	0	0	0	3.481562351	0	0.011491197	0	0	0	0.57226163	0	0	0	0	0	0	0	0	0	0	0	0	0	36.4507
H5698_154_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	2319.83156	91.25097413	757.6238327		483.3747301	18.35571043	19.40764365	331.386534	402.4597958	333.3339044		73.65193033		3.800912388		4105.283088	109.9590922				36.27320051		50				249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 11 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $15/visit; Group: $10/visit	$0/visit	No Cost Sharing	No Cost Sharing	10% Coinsurance	No Cost Sharing	$3/visit	$200 Annual Allowance	Routine Eye Exam: $0	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $30	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: No Cost Sharing;											62.86	79.55	55.18		50	0.15	0.2	50	120.400485	75		50		15		11.61025501	15				0.1		3				30														NO	57.48558285	72.74861781	50.46220906		45.72508976	0.137175269	0.182900359	45.72508976	110.1064597	68.58763464		45.72508976		13.71752693		10.61759905	13.71752693				0.09145018		2.743505386				27.43505386															11.1131	0.55319852	3.185947686	0	1.841862743	2.517949521	3.549664992	1.262723251	3.692785274	1.905215337	0	0.280645094	0	0.004344927	0	3.63235415	0.125697234	0	0	0	3.317190699	0	0.011431272	0	0	0	0.569277368	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5634	0	3.511857393	11.1131	0.55319852	3.185947686	0	1.841862743	2.517949521	3.549664992	1.262723251	3.692785274	1.905215337	0	0.280645094	0	0.004344927	0	3.63235415	0.125697234	0	0	0	3.317190699	0	0.011431272	0	0	0	0.569277368	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5634	NO																																																																																		0	0	0	11.1131	0.55319852	3.185947686	0	1.841862743	2.517949521	3.549664992	1.262723251	3.692785274	1.905215337	0	0.280645094	0	0.004344927	0	3.63235415	0.125697234	0	0	0	3.317190699	0	0.011431272	0	0	0	0.569277368	0	0	0	0	0	0	0	0	0	0	0	0	0	37.5634
H5698_155_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	2382.127634	104.6815088	831.1532652		486.2322168	18.74113158	17.86917758	426.2493909	425.5676582	459.430072		36.16618686		12.75886623		4380.484291	127.7867208				29.43328305		50				249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 11 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $15/visit; Group: $10/visit	$0/visit	No Cost Sharing	No Cost Sharing	10% Coinsurance	No Cost Sharing	$3/visit	$200 Annual Allowance	Routine Eye Exam: $0	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $30	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: No Cost Sharing;											62.86	79.55	55.18		50	0.15	0.2	50	106.4251258	75		50		15		11.65182998	15				0.1		3				30														NO	57.30401582	72.51884281	50.30282522		45.58066801	0.136742004	0.182322672	45.58066801	97.01856657	68.37100202		45.58066801		13.6742004		10.62196388	13.6742004				0.091161336		2.734840081				27.34840081															11.3755	0.632615157	3.484113119	0	1.846899104	2.56269989	3.257956203	1.619060998	3.440663681	2.617641198	0	0.137373246	0	0.014538941	0	3.877445495	0.145615102	0	0	0	2.683177407	0	0.011395167	0	0	0	0.567479317	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2741	0	3.710917311	11.3755	0.632615157	3.484113119	0	1.846899104	2.56269989	3.257956203	1.619060998	3.440663681	2.617641198	0	0.137373246	0	0.014538941	0	3.877445495	0.145615102	0	0	0	2.683177407	0	0.011395167	0	0	0	0.567479317	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2741	NO																																																																																		0	0	0	11.3755	0.632615157	3.484113119	0	1.846899104	2.56269989	3.257956203	1.619060998	3.440663681	2.617641198	0	0.137373246	0	0.014538941	0	3.877445495	0.145615102	0	0	0	2.683177407	0	0.011395167	0	0	0	0.567479317	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2741
H5698_156_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	P	P	P	P	V	V	V	V	P	P	Coin	Coin	T	V	V	O	V	O	V	O																																																			0	YES	2242.397351	79.23745901	1016.154989		534.3202277	16.52330948	17.8163758	378.6121512	407.0022709	468.4626995		23.80786278		11.23908564		4748.135183	193.1520671				30.37599019		50				249														3400	"Days 1-5: $100/day; Days 6-60: $0/day; Days 61+: $100/day, unlimited days"	Days 1 - 10 : $100/day	Days 11 - 100 : $100/day	No Cost Sharing	$50/trip	20% Coinsurance	20% Coinsurance	$50/visit	Surgery: 10% or $300 /visit; ASC: 10% or $300	$0/visit	Diagnostic Radiology: $0/visit; Therapeutic Radiology: $0/visit; Nuclear Medicine: $75/visit; PET Scan: $75/visit; CT Scan: $75/visit; MRI: $75/visit; Other Imaging: $0/visit;	$50/observation	$0/visit	$0/visit	$0/visit	$15/visit	Individual: $15/visit; Group: $10/visit	$0/visit	No Cost Sharing	No Cost Sharing	10% Coinsurance	No Cost Sharing	$3/visit	$200 Annual Allowance	Routine Eye Exam: $0	"Contact Lens: $150 Annual Allowance; Lens & Frames, Lens, Frames: $150 Annual Allowance"	Routine Hearing Tests: $30	Not Covered	Not Covered	Meals on Wheels: No Cost Sharing; OTC: $60 Quarterly Allowance; MedAlert Program: $0/installation; Fitness Program: No Cost Sharing;											62.86	79.55	55.18		50	0.15	0.2	50	114.7796272	75		50		15		11.70882535	15				0.1		3				30														NO	57.24856933	72.44867468	50.25415297		45.53656485	0.136609695	0.182146259	45.53656485	104.5333987	68.30484727		45.53656485		13.66096945		10.6635937	13.66096945				0.09107313		2.732193891				27.32193891															10.6978	0.478387407	4.255500688	0	2.027592308	2.257244261	3.245186207	1.436724731	3.545444223	2.666522762	0	0.090344024	0	0.012794734	0	4.219348703	0.219887041	0	0	0	2.766436494	0	0.011384141	0	0	0	0.566930232	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4976	0	3.773481461	10.6978	0.478387407	4.255500688	0	2.027592308	2.257244261	3.245186207	1.436724731	3.545444223	2.666522762	0	0.090344024	0	0.012794734	0	4.219348703	0.219887041	0	0	0	2.766436494	0	0.011384141	0	0	0	0.566930232	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4976	NO																																																																																		0	0	0	10.6978	0.478387407	4.255500688	0	2.027592308	2.257244261	3.245186207	1.436724731	3.545444223	2.666522762	0	0.090344024	0	0.012794734	0	4.219348703	0.219887041	0	0	0	2.766436494	0	0.011384141	0	0	0	0.566930232	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4976
H5698_801_0	2010	2	N/A																																																																																																															0	NO	1382.991842	83.38166296	635.3773116		141.9624245	1310.013541	1124.466374	254.2589984	342.9573933	3789.006498		23.91296691		1649.651383	9831.20179	17651.05331	193.2512386	492.101251	3282.372812		1432.844135	0.998796419																																																												154.9880011	61.32825375	73.34857383		119.8041298	23.34310976	30.34352984	119.11286	295.5997463	13.3286413		197.5071992		28.2988225	9.142533122	15.62874081	17.44293639	44.85627732	19.02483139		49.35845852	8.151186625																			NO	154.9880011	61.32825375	73.34857383		119.8041298	23.34310976	30.34352984	119.11286	295.5997463	13.3286413		197.5071992		28.2988225	9.142533122	15.62874081	17.44293639	44.85627732	19.02483139		49.35845852	8.151186625																				17.8623	0.426137649	3.883668304	0	1.417307062	2.548315823	2.843356581	2.52379304	8.448176538	4.208525707	0	0.393581927	0	3.890265973	7.490174	22.98864476	0.280905755	1.839485849	5.203882443	0	5.893581486	0.000678448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1427	0	0	17.8623	0.426137649	3.883668304	0	1.417307062	2.548315823	2.843356581	2.52379304	8.448176538	4.208525707	0	0.393581927	0	3.890265973	7.490174	22.98864476	0.280905755	1.839485849	5.203882443	0	5.893581486	0.000678448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1427	NO																																																																																		0	0	0	17.8623	0.426137649	3.883668304	0	1.417307062	2.548315823	2.843356581	2.52379304	8.448176538	4.208525707	0	0.393581927	0	3.890265973	7.490174	22.98864476	0.280905755	1.839485849	5.203882443	0	5.893581486	0.000678448	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1427
H5700_002_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	YES	1303.82348	78.45007876	395.8262995	1108.46018	142.5204394	15.32663673	5.39899901	346.8310183	215.9181918	4.620754498	9.700409043	0.06099233	0.003459684	7.118353107	4793.969822	3425.155592	104.7574975	138.3419023	16.03682923	91.07846497	6.521081327	0.074781721	0	0	401	16.79679635	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $15 Copay per visit;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $25 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $25 Copay per visit; 7i (PT/ST): $25 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 25 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $25 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $25 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 25 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 25 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): 25 copay (1 exam per year);	18b (Hearing Aids): 500 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											104.6911573	110.5916938	19.90567119	15	125	0.2	0.1	49.74905976	200	0	0.189426853	0.2	0.2	0.199615467	0	25	40	25	0.2	0.028975335	0.2	25	0	0	5	0	0	0	0	0											NO	94.40405723	99.72479873	17.949712	13.52607895	112.7173245	0.180347719	0.09017386	44.86064732	180.3477193	0	0.170813505	0.180347719	0.180347719	0.180000971	0	22.54346491	36.06954385	22.54346491	0.180347719	0.026128178	0.180347719	22.54346491	0	0	5	0	0	0	0	0												10.2572	0.651951526	0.592080673	1.249426658	1.338710219	2.764123978	0.486848579	1.296588666	3.245029454	0	1.656960867	0.010999828	0.000623946	1.281310474	0	6.434572907	0.314879596	0.259892152	2.892205576	2.379714342	1.176062144	0.000140487	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4564	0	4.17176941	10.2572	0.651951526	0.592080673	1.249426658	1.338710219	2.764123978	0.486848579	1.296588666	3.245029454	0	1.656960867	0.010999828	0.000623946	1.281310474	0	6.434572907	0.314879596	0.259892152	2.892205576	2.379714342	1.176062144	0.000140487	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4564	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.2572	0.651951526	0.592080673	1.249426658	1.338710219	2.764123978	0.486848579	1.296588666	3.245029454	0	1.656960867	0.010999828	0.000623946	1.281310474	0	6.434572907	0.314879596	0.259892152	2.892205576	2.379714342	1.176062144	0.000140487	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4564
H5700_005_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	YES	1515.562729	34.64705836	583.6564921	665.2973867	128.2403469	16.04883642	3.748748645	329.110051	271.0052933	3.068133607	10.19633494	0.104751707	0.001927378	7.525657043	4786.032352	2973.80694	67.65907746	52.62452643	15.75810313	85.62114786	10.07295505	0.041612365	0	0	295	15.55662384	0	0	0	0											4950	1a (IP Acute): $195 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $35 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $35 Copay per visit; 7i (PT/ST): $35 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 35 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $35 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $35 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 35 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): $5.0 OTC per month											129.7774761	84.45046415	55.48653642	0	125	0.2	0.1	49.87252458	200	0	0.19257031	0.2	0.2	0.197561289	0	35	40	35	0.2	0.024168385	0.2	35	0	0	25	0	0	0	0	0											NO	119.558261	77.80048536	51.11729708	0	115.1569831	0.184251173	0.092125586	45.94535575	184.2511729	0	0.177406527	0.184251173	0.184251173	0.182004497	0	32.24395526	36.85023458	32.24395526	0.184251173	0.022265266	0.184251173	32.24395526	0	0	25	0	0	0	0	0												15.0998	0.22462983	2.486245191	0	1.230647622	2.957016935	0.345355667	1.260089865	4.16108693	0	1.808896372	0.019300625	0.000355122	1.369703421	0	7.99060816	0.207771073	0.141401906	2.903448985	1.906377654	1.855953782	0.000111812	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5834	0	3.92909775	15.0998	0.22462983	2.486245191	0	1.230647622	2.957016935	0.345355667	1.260089865	4.16108693	0	1.808896372	0.019300625	0.000355122	1.369703421	0	7.99060816	0.207771073	0.141401906	2.903448985	1.906377654	1.855953782	0.000111812	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5834	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.0998	0.22462983	2.486245191	0	1.230647622	2.957016935	0.345355667	1.260089865	4.16108693	0	1.808896372	0.019300625	0.000355122	1.369703421	0	7.99060816	0.207771073	0.141401906	2.903448985	1.906377654	1.855953782	0.000111812	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5834
H5700_009_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	YES	1252.653931	46.45262318	983.9154212	1348.25296	120.3992904	15.0196049	4.10700019	365.1841652	270.6840756	6.147886905	11.76910396	0.105738585	0.003477041	10.61430503	4455.702805	2776.924899	66.09814011	85.86563191	12.06562995	80.08939729	6.207735338	0.075389838	0	0	401	7.747462084	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $15 Copay per visit;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $25 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $25 Copay per visit; 7i (PT/ST): $25 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 25 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $25 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $25 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 25 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 25 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): 25 copay (1 exam per year);	18b (Hearing Aids): 500 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											95.42674084	72.60119004	25.61457561	15	125	0.2	0.1	49.87107097	200	0	0.189751005	0.2	0.2	0.199849855	0	25	40	25	0.2	0.02654747	0.2	25	0	0	5	0	0	0	0	0											NO	85.82577806	65.29672468	23.03747211	13.49083768	112.4236473	0.179877836	0.089938918	44.85350156	179.8778357	0	0.170660001	0.179877836	0.179877836	0.179742797	0	22.48472946	35.97556714	22.48472946	0.179877836	0.023876507	0.179877836	22.48472946	0	0	5	0	0	0	0	0												8.9592	0.252767012	1.88891034	1.515755152	1.12797728	2.701694023	0.369379153	1.364982377	4.057505474	0	2.008515289	0.019020028	0.000625443	1.907844871	0	5.203200424	0.19815984	0.160888792	2.170339402	1.912255039	1.116633997	0.00014126	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1028	0	4.131486469	8.9592	0.252767012	1.88891034	1.515755152	1.12797728	2.701694023	0.369379153	1.364982377	4.057505474	0	2.008515289	0.019020028	0.000625443	1.907844871	0	5.203200424	0.19815984	0.160888792	2.170339402	1.912255039	1.116633997	0.00014126	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1028	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.9592	0.252767012	1.88891034	1.515755152	1.12797728	2.701694023	0.369379153	1.364982377	4.057505474	0	2.008515289	0.019020028	0.000625443	1.907844871	0	5.203200424	0.19815984	0.160888792	2.170339402	1.912255039	1.116633997	0.00014126	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1028
H5700_018_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	339.5981991	6.412908304	34.39606676	2434.996912	11.69330785	15.02489909	5.200421772	25.34854714	17.66423612	5.22734462	9.644300462	0.631300025	0	9.900430949	4361.601304	2649.67171	247.4452482	1.082046587	14.92854743	92.69356536	12.02027071	0	0	0	401	0.027085073	0	0	0	0												1a (IP Acute): 8.27% Coin MC CS; 1a1 (Add'l Days): 8.27% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.27% Coin MC CS;	2a (SNF): 19.18% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $19.0 OTC per month (cumulative benefit)											0.0827	0.0827	0.1918	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.15521144	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0827	0.0827	0.1918	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.15521144	0.2	0	0	0	5	0.2	0	0	0	0												28.0848	0.530347517	6.597165605	0	2.338661571	3.004979818	1.040084354	5.069709428	3.532847224	0	1.928860092	0.126260005	0	1.98008619	0	2.208059759	0.206204374	0.216409317	2.985709486	14.38710174	2.404054141	0	0	0	0.167083333	0.005417015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8138	0	0	28.0848	0.530347517	6.597165605	0	2.338661571	3.004979818	1.040084354	5.069709428	3.532847224	0	1.928860092	0.126260005	0	1.98008619	0	2.208059759	0.206204374	0.216409317	2.985709486	14.38710174	2.404054141	0	0	0	0.167083333	0.005417015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8138	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.0848	0.530347517	6.597165605	0	2.338661571	3.004979818	1.040084354	5.069709428	3.532847224	0	1.928860092	0.126260005	0	1.98008619	0	2.208059759	0.206204374	0.216409317	2.985709486	14.38710174	2.404054141	0	0	0	0.167083333	0.005417015	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.8138
H5700_020_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	YES	1698.669207	223.4167962	855.644571	1315.341468	229.1293291	17.864483	5.754594782	582.3341705	196.2786671	4.50911893	12.39908139	0.139783794	0.000214692	11.08465576	4699.878473	2631.219787	96.71257078	88.65768099	15.01435302	99.53841536	9.544387152	0.004396539	0	0	401	19.5502993	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $225 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $15 Copay per visit;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $25 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $25 Copay per visit; 7i (PT/ST): $25 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 25 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $25 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $25 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 25 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 25 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): 25 copay (1 exam per year);	18b (Hearing Aids): 1000 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											89.51422548	33.66568859	20.34140325	15	125	0.2	0.088264785	49.56426907	200	0	0.190124092	0.2	0.2	0.198515617	0	25	40	25	0.2	0.021282526	0.2	25	0	0	5	0	0	0	0	0											NO	81.20492374	30.54061698	18.45317982	13.60760091	113.3966742	0.181434679	0.080071464	44.9633862	181.4346788	0	0.172475518	0.181434679	0.181434679	0.180088086	0	22.67933485	36.28693576	22.67933485	0.181434679	0.019306942	0.181434679	22.67933485	0	0	5	0	0	0	0	0												11.495	0.568607233	1.315780261	1.49155348	2.165208657	3.241236735	0.460778831	2.18197635	2.96764641	0	2.138537981	0.025361628	3.90E-05	1.996214445	0	4.972859551	0.292450237	0.167558103	2.724124318	1.921782366	1.731682817	8.31E-06	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0255	0	4.283091615	11.495	0.568607233	1.315780261	1.49155348	2.165208657	3.241236735	0.460778831	2.18197635	2.96764641	0	2.138537981	0.025361628	3.90E-05	1.996214445	0	4.972859551	0.292450237	0.167558103	2.724124318	1.921782366	1.731682817	8.31E-06	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0255	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.495	0.568607233	1.315780261	1.49155348	2.165208657	3.241236735	0.460778831	2.18197635	2.96764641	0	2.138537981	0.025361628	3.90E-05	1.996214445	0	4.972859551	0.292450237	0.167558103	2.724124318	1.921782366	1.731682817	8.31E-06	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0255
H5700_025_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	YES	1382.912556	95.70697924	594.2204019	1052.101145	136.5155706	14.22122539	4.145206775	402.2156509	265.7401732	4.148402005	9.370383902	0.077123898	0.007550218	9.031102984	4142.718109	2675.516496	94.23643143	78.42516728	14.57482053	82.60996009	8.408720668	0.155326721	0	0	401	11.91223952	0	0	0	0											3950	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 10% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);	18b (Hearing Aids): 500 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											93.04975958	72.60119004	20.95755883	0	125	0.2	0.1	49.74622772	200	0	0.190327973	0.2	0.2	0.199205422	0	30	40	30	0.2	0.026701298	0.2	30	0	0	5	0	0	0	0	0											NO	85.09240567	66.39254033	19.1653273	0	114.3103513	0.182896562	0.091448281	45.49207014	182.8965621	0	0.17405166	0.182896562	0.182896562	0.182169935	0	27.43448432	36.57931243	27.43448432	0.182896562	0.024417878	0.182896562	27.43448432	0	0	5	0	0	0	0	0												9.8063	0.529519123	0.949035708	0	1.30042857	2.601013234	0.379072034	1.524801884	4.050247008	0	1.63093087	0.014105696	0.001380909	1.64519544	0	6.116784612	0.287258656	0.179296168	2.665684568	2.01715995	1.537926102	0.000355109	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4036	0	3.396935607	9.8063	0.529519123	0.949035708	0	1.30042857	2.601013234	0.379072034	1.524801884	4.050247008	0	1.63093087	0.014105696	0.001380909	1.64519544	0	6.116784612	0.287258656	0.179296168	2.665684568	2.01715995	1.537926102	0.000355109	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4036	NO	1a (IP Acute): 30% Coinsurance; 1a1 (Add'l Days): 30% coin per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): 30% Coinsurance;	2a (SNF): 25% Coinsurance; 2a2 (Waiver 3 Day): 25% coin;	6a (Home Health): 25% Coinsurance;	10a (Ambulance): 25% Coinsurance;	11a (DME): Not Covered; 11b (Prosthetics): Not Covered;	11b (Medical Supplies): 25% Coinsurance; 11c (Diabetic Supplies): 25% Coinsurance;	4a (ER): Not Covered; 4a (ER) - Worldwide Coverage: n/a; 4b (UC): Not Covered;	9b (OP Surg): 25% Coinsurance;	8a (OP Diag Proc/Test/Lab): 25% Coinsurance;	8b (OP Diag): 25% Coinsurance; 8b (OP Therap Rad): Not Covered; 8b (X-Ray): 25% Coinsurance;	9a (OP Observation): 25% Coinsurance;	12 (Renal Dialysis): Not Covered;	3 (CORF): Not Covered; 5 (Partial Hosp): 25% Coinsurance; 9a (OP Chemo): Not Covered; 9a (OP Services): 25% Coinsurance; 9c (OP SA): Not Covered; 9d (OP Cardiac Rehab): 25% Coinsurance;	14b (Immunizations): 25% Coinsurance; 14c (Medicare Covered Physical Exam): 25% coin; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 25% coin; 14e (Prostate Screening): 25% coin; 14f (Colorectal Screening): 25% coin; 14g (Bone Mass): 25% coin; 14i (Diabetes Educ.): 25% coin; 14j (Nutrition Therapy Diabetes): 25% coin; 14h (Mammography): 25% Coinsurance; 7a (PCP w/Copay): $40 Copay per visit;	7d (SPC w/Copay): $40 Copay per visit;	7h (Psych): Not Covered; 7e (MH Non-Phys): n/a per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 25% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 25% Coinsurance; 8a (OP Diag Proc/Test/Lab): 25% Coinsurance; 8b (X-Ray): 25% Coinsurance; 9a (OP Chemo): Not Covered; 9b (OP ASC): 25% Coinsurance; All other Services: No Cost Sharing;	15 (Part B Rx): Not Covered;	13a (Blood): 25% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): Not Covered;	17a1 (Routine Eye Exam): Not Covered;	17b (MCR Eyewear): Not Covered; 17b1 (Non MCR Covered): Not Covered;	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;	18b (Hearing Aids) - Enhanced Benefit Limit ( $ allowance/ # years): 0% Coinsurance; 18b (Hearing Aids): Not Covered;		13c (OTC Rx): Not Covered;												3.1939	0.077	0.2268	0.2356	0.0794	0	0.0544	0	0.3352	0.0544	0.1229	0.001	0	0.115	0.5142	0.4284	0	0.0152	0.1912	0.9482	0	0.0001	0	0	0	0	0	0	0	0											6.5928	500	1.852628947	13.0002	0.606522737	1.175879633	0.235648919	1.379864012	2.601013234	0.433439374	1.524801884	4.385428479	0.054409248	1.75378788	0.015117231	0.001380909	1.760242173	0.514210047	6.545138346	0.287258656	0.194479454	2.856843723	2.965349184	1.537926102	0.000416005	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.9964
H5700_027_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	NO	1653.467108	99.26379273	595.6271908	787.4956091	121.5958375	12.36766043	4.691105308	409.4076721	408.2382967	4.759763686	9.391562708	0.05802619	0.027036547	13.23481117	4298.10558	3267.02191	143.2561414	95.64856972	17.91834923	108.9098211	12.20567541	0.564594996	0	0	265	5.125876388	0	0	0	0												1a (IP Acute): $185 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $175 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $350 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $40 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0 copay;	7d (SPC w/Copay): $32 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  70 allowance (every 2 years);"	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											127.4946159	155	46.75097276	0	175	0.2	0.184007721	49.78171652	350	0	0.190057012	0.2	0.2	0.199647998	0	32	40	40	0.2	0.02984077	0.2	40	0	0	25	0	0	0	0	0											NO	127.4946159	155	46.75097276	0	175	0.2	0.184007721	49.78171652	350	0	0.190057012	0.2	0.2	0.199647998	0	32	40	40	0.2	0.02984077	0.2	40	0	0	25	0	0	0	0	0												17.5673	1.282157323	2.320512548	0	1.77327263	2.473532087	0.863199595	1.698418056	11.90695032	0	1.784932345	0.011605238	0.005407309	2.642303558	0	8.712058427	0.477520471	0.318828566	3.583669846	3.249952895	2.441135082	0.001881983	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6668	0	0	17.5673	1.282157323	2.320512548	0	1.77327263	2.473532087	0.863199595	1.698418056	11.90695032	0	1.784932345	0.011605238	0.005407309	2.642303558	0	8.712058427	0.477520471	0.318828566	3.583669846	3.249952895	2.441135082	0.001881983	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6668	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.5673	1.282157323	2.320512548	0	1.77327263	2.473532087	0.863199595	1.698418056	11.90695032	0	1.784932345	0.011605238	0.005407309	2.642303558	0	8.712058427	0.477520471	0.318828566	3.583669846	3.249952895	2.441135082	0.001881983	0	0	0.552083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.6668
H5700_028_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	442.1924331	10.87594988	41.79104227	2812.446319	16.52060638	18.92114168	7.150024913	31.46416358	27.98086561	6.481203791	13.27956281	0.760066508	0	13.26690815	5022.0232	3573.874502	372.7096625	1.578930311	23.17945105	113.0562754	18.24887271	0	0	0	401	0.045934836	0	0	0	0												1a (IP Acute): 7.97% Coin MC CS; 1a1 (Add'l Days): 7.97% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.97% Coin MC CS;	2a (SNF): 18.87% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $19.0 OTC per month (cumulative benefit)											0.0797	0.0797	0.1887	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.151911737	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0797	0.0797	0.1887	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	10	10	0.2	0.2	0.151911737	0.2	0	0	0	5	0.2	0	0	0	0												35.2427	0.866813205	7.885969677	0	3.304121277	3.784228336	1.430004983	6.292832717	5.596173122	0	2.655912561	0.152013302	0	2.65338163	0	2.978228752	0.310591385	0.315786062	4.635890211	17.17457514	3.649774541	0	0	0	0.167083333	0.009186967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.1053	0	0	35.2427	0.866813205	7.885969677	0	3.304121277	3.784228336	1.430004983	6.292832717	5.596173122	0	2.655912561	0.152013302	0	2.65338163	0	2.978228752	0.310591385	0.315786062	4.635890211	17.17457514	3.649774541	0	0	0	0.167083333	0.009186967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.1053	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	35.2427	0.866813205	7.885969677	0	3.304121277	3.784228336	1.430004983	6.292832717	5.596173122	0	2.655912561	0.152013302	0	2.65338163	0	2.978228752	0.310591385	0.315786062	4.635890211	17.17457514	3.649774541	0	0	0	0.167083333	0.009186967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.1053
H5700_029_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	Coin	Coin	V	Coin	V	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	NO	313.2859871	7.669556354	28.6361883	1899.904597	11.04917039	14.93767924	5.311295265	21.47011966	24.0268363	4.950244536	10.44502219	0.438353952	0.002491069	10.31588908	4148.091104	2860.975863	235.12547	1.388514626	17.61326755	89.89114879	12.65591259	0.051834605	0	0	401	0.059783677	0	0	0	0												1a (IP Acute): 7.94% Coin MC CS; 1a1 (Add'l Days): 7.94% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.94% Coin MC CS;	2a (SNF): 19.01% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $10 Copay per visit;	7h (Psych): $10 Copay per visit; 7e (MH Non-Phys): 10 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 10 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $10 Copay per visit; 7b (Chiro): $10 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $10 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 10 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $10 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 10 copay; 18a1 (Routine Hearing Exam): 10 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $19.0 OTC per month											0.0794	0.0794	0.1901	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155862113	0.2	10	0	0	5	0.2	0	0	0	0											NO	0.0794	0.0794	0.1901	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	10	10	0.2	0.2	0.155862113	0.2	10	0	0	5	0.2	0	0	0	0												24.8749	0.608962774	5.443739397	0	2.209834077	2.987535848	1.062259053	4.294023932	4.80536726	0	2.089004438	0.08767079	0.000498214	2.063177816	0	2.384146552	0.195937892	0.277702925	3.522653511	14.01062441	2.531182518	4.32E-05	0	0	0.167083333	0.011956735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6283	0	0	24.8749	0.608962774	5.443739397	0	2.209834077	2.987535848	1.062259053	4.294023932	4.80536726	0	2.089004438	0.08767079	0.000498214	2.063177816	0	2.384146552	0.195937892	0.277702925	3.522653511	14.01062441	2.531182518	4.32E-05	0	0	0.167083333	0.011956735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6283	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.8749	0.608962774	5.443739397	0	2.209834077	2.987535848	1.062259053	4.294023932	4.80536726	0	2.089004438	0.08767079	0.000498214	2.063177816	0	2.384146552	0.195937892	0.277702925	3.522653511	14.01062441	2.531182518	4.32E-05	0	0	0.167083333	0.011956735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.6283
H5700_801_0	2010	3	N/A																															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	NO	257.1584589	7.732909138	20.55426694	21.98831037	7.501648673	16.79319316	4.787591591	16.21046714	28.00215124	4.637151278	10.28877316	0.096967875	0.007121505	9.922290329	24.1396676	29.51875504	0.930349923	1.74297678	15.98164243	95.89305106	9.712174254	0.060746642	0	0	0	0	0	0	0	0												FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												21.017	0.631992878	3.465400383	0	1.747884141	3.912814006	1.115508841	3.777038843	6.524501238	1.080456248	2.397284146	0.022593515	0.001659311	2.311893647	5.62454255	6.877869924	0.216771532	0.40611359	3.723722687	22.3430809	2.262936601	0.014153968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4752		0	21.017	0.631992878	3.465400383	0	1.747884141	3.912814006	1.115508841	3.777038843	6.524501238	1.080456248	2.397284146	0.022593515	0.001659311	2.311893647	5.62454255	6.877869924	0.216771532	0.40611359	3.723722687	22.3430809	2.262936601	0.014153968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4752	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	21.017	0.631992878	3.465400383	0	1.747884141	3.912814006	1.115508841	3.777038843	6.524501238	1.080456248	2.397284146	0.022593515	0.001659311	2.311893647	5.62454255	6.877869924	0.216771532	0.40611359	3.723722687	22.3430809	2.262936601	0.014153968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4752
H5703_001_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	P	V	P	O	O																																																			0	NO	338.9445626		59.43141973		16.48747565	38.46347484		27.95432734	50.69850068					90.17413963						253.7326025	12.97665126	2.193237062																				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																			0.08138379		0.13755679		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																			NO	0.08138379		0.13755679		0.233	0.233		0.233	0.233					0.233						0.233	0.233	0.233																				27.5846	0	8.175195293	0	3.841581827	8.961989639	0	6.513358269	11.81275066	0	0	0	0	21.01057453	0	0	0	0	0	59.11969639	3.023559743	0.511024236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.5543	0	0	27.5846	0	8.175195293	0	3.841581827	8.961989639	0	6.513358269	11.81275066	0	0	0	0	21.01057453	0	0	0	0	0	59.11969639	3.023559743	0.511024236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.5543	NO																																																																																		0	0	0	27.5846	0	8.175195293	0	3.841581827	8.961989639	0	6.513358269	11.81275066	0	0	0	0	21.01057453	0	0	0	0	0	59.11969639	3.023559743	0.511024236	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.5543
H5732_001_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	0	0	0	0	0	0	0	562.6354968	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Case for ER - Facility;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	1.172157285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1722	0	0	0	0	0	0	0	0	0	1.172157285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1722	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	1.172157285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1722
H5736_002_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1621.623264	93.83735444	1107.649596	736.742213	227.1816018	12.73380419	0	264.6038885	405.3690807	2462.037566	2833.741556	61.54404113	0.305984855	221.0042632	4478.810103	5700.965474	233.949312	607.8573304	0	0	438.0716443	0	0	0	915.568076	0	54.9473241	0	33.05549607	0											4000	$200/day 1-7	$200/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$25 per visit	$25 X-ray; $150 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$25 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$125 Every 2 Years	$0 per visit	$500 Every 3 Yrs	N/A	0											144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	47.5	200	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											NO	101.6123574	101.6123574	33.42921467	0	100	0.140570856	0.140570856	47.5	140.5708564	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0												13.7314	0.794586233	3.085654676	0	1.893180015	1.790001761	0	1.047390392	4.748589903	0.769386739	8.855442362	0.128216752	0.000637468	0.460425548	9.33085438	11.8770114	0.4873944	1.266369438	0	0	1.642768666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9093	0	10.21	13.7314	0.794586233	3.085654676	0	1.893180015	1.790001761	0	1.047390392	4.748589903	0.769386739	8.855442362	0.128216752	0.000637468	0.460425548	9.33085438	11.8770114	0.4873944	1.266369438	0	0	1.642768666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9093	NO																																																																																		0			13.7314	0.794586233	3.085654676	0	1.893180015	1.790001761	0	1.047390392	4.748589903	0.769386739	8.855442362	0.128216752	0.000637468	0.460425548	9.33085438	11.8770114	0.4873944	1.266369438	0	0	1.642768666	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9093
H5736_003_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1560.902374	63.58452787	989.6049195	670.0803186	208.1907441	12.59827724	0	241.2746614	369.8174965	2458.019279	2687.106344	40.12788047	0.258441391	194.256741	3991.672433	5379.108888	206.8132544	732.6674567	0	0	609.0269361	0	0	0	821.3478565	0	48.43639194	0	16.02205443	0											4000	$200/day 1-7	$200/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$25 per visit	$25 X-ray; $150 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$25 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$125 Every 2 Years	$0 per visit	$500 Every 3 Yrs	N/A	0											144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	47.5	200	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											NO	92.90116955	92.90116955	30.56334111	0	100	0.128519772	0.128519772	47.5	128.5197716	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0												12.0841	0.492256417	2.520469393	0	1.734922868	1.619127714	0	0.955045535	3.96073835	0.768131025	8.397207324	0.083599751	0.00053842	0.404701544	8.315984236	11.20647685	0.430860947	1.526390535	0	0	2.28385101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7844	0	11.5	12.0841	0.492256417	2.520469393	0	1.734922868	1.619127714	0	0.955045535	3.96073835	0.768131025	8.397207324	0.083599751	0.00053842	0.404701544	8.315984236	11.20647685	0.430860947	1.526390535	0	0	2.28385101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7844	NO																																																																																		0			12.0841	0.492256417	2.520469393	0	1.734922868	1.619127714	0	0.955045535	3.96073835	0.768131025	8.397207324	0.083599751	0.00053842	0.404701544	8.315984236	11.20647685	0.430860947	1.526390535	0	0	2.28385101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7844
H5736_015_0	2010	1	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1625.030581	70.71142109	1132.359949	748.4618445	222.6819731	12.2963266	0	251.6708236	399.3014093	2349.354374	2835.965024	51.34377525	0.312776778	163.8617956	4450.131998	5646.257194	206.1979976	645.8060053	0	0	408.0009183	0	0	0	914.6520934	0	52.63379983	0	13.05430828	0											4000	$200/day 1-7	$200/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$25 per visit	$25 X-ray; $150 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$25 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$125 Every 2 Years	$0 per visit	$500 Every 3 Yrs	N/A	0											144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	47.5	200	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											NO	99.37133372	99.37133372	32.69194547	0	100	0.137470617	0.137470617	47.5	137.4706172	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0												13.4568	0.585557352	3.084920808	0	1.855683109	1.690383608	0	0.99619701	4.574350932	0.734173242	8.862390701	0.106966198	0.000651618	0.341378741	9.271108329	11.76303582	0.429579162	1.345429178	0	0	1.530003444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6286	0	10.64	13.4568	0.585557352	3.084920808	0	1.855683109	1.690383608	0	0.99619701	4.574350932	0.734173242	8.862390701	0.106966198	0.000651618	0.341378741	9.271108329	11.76303582	0.429579162	1.345429178	0	0	1.530003444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6286	NO																																																																																		0			13.4568	0.585557352	3.084920808	0	1.855683109	1.690383608	0	0.99619701	4.574350932	0.734173242	8.862390701	0.106966198	0.000651618	0.341378741	9.271108329	11.76303582	0.429579162	1.345429178	0	0	1.530003444	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6286
H5736_018_0	2010	1	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1630.719961	66.51241771	1076.170879	765.1458448	217.5383547	12.60945889	0	236.1059958	388.4387294	2301.746431	2775.553527	48.27836684	0.304243336	148.1540432	4335.823693	5576.561446	205.7594815	635.9697392	0	0	410.7966926	0	0	0	865.4405055	0	51.2471111	0	23.32359213	0											4000	$200/day 1-7	$200/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$25 per visit	$25 X-ray; $150 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$25 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$125 Every 2 Years	$0 per visit	$500 Every 3 Yrs	N/A	0											144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	47.5	200	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											NO	95.93582976	95.93582976	31.56170696	0	100	0.13271793	0.13271793	47.5	132.7179302	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0												13.037	0.531743665	2.830482494	0	1.812819622	1.673501285	0	0.934586233	4.296065347	0.71929576	8.673604773	0.100579931	0.00063384	0.308654257	9.032966026	11.61783635	0.428665586	1.324936957	0	0	1.540487597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8639	0	11.34	13.037	0.531743665	2.830482494	0	1.812819622	1.673501285	0	0.934586233	4.296065347	0.71929576	8.673604773	0.100579931	0.00063384	0.308654257	9.032966026	11.61783635	0.428665586	1.324936957	0	0	1.540487597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8639	NO																																																																																		0			13.037	0.531743665	2.830482494	0	1.812819622	1.673501285	0	0.934586233	4.296065347	0.71929576	8.673604773	0.100579931	0.00063384	0.308654257	9.032966026	11.61783635	0.428665586	1.324936957	0	0	1.540487597	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.8639
H5736_020_0	2010	1	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1645.828114	73.61954787	1123.172125	738.3585889	234.0397606	12.54239115	0	265.0310522	396.1982186	2370.022141	2859.726208	48.07764332	0.310861108	112.8891686	4453.960174	5781.00838	228.5179548	596.9342733	0	0	382.0773355	0	0	0	889.4483912	0	54.07675051	0	75.8228618	0											4000	$200/day 1-7	$200/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$25 per visit	$25 X-ray; $150 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$25 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$125 Every 2 Years	$0 per visit	$500 Every 3 Yrs	N/A	0											144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	47.5	200	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											NO	98.7687409	98.7687409	32.49369985	0	100	0.136636988	0.136636988	47.5	136.6369884	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0												13.5464	0.605942504	3.041334826	0	1.950331338	1.713754554	0	1.049081248	4.511277617	0.740631919	8.9366444	0.100161757	0.000647627	0.235185768	9.279083696	12.04376746	0.476079073	1.243613069	0	0	1.432790008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9067	0	10.86	13.5464	0.605942504	3.041334826	0	1.950331338	1.713754554	0	1.049081248	4.511277617	0.740631919	8.9366444	0.100161757	0.000647627	0.235185768	9.279083696	12.04376746	0.476079073	1.243613069	0	0	1.432790008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9067	NO																																																																																		0			13.5464	0.605942504	3.041334826	0	1.950331338	1.713754554	0	1.049081248	4.511277617	0.740631919	8.9366444	0.100161757	0.000647627	0.235185768	9.279083696	12.04376746	0.476079073	1.243613069	0	0	1.432790008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.9067
H5736_025_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1628.36228	117.026952	1067.884254	724.3848811	220.5196526	13.98662299	0	261.2581282	409.195928	2656.574186	2897.182853	69.64634293	0.288047211	311.0188317	4399.062726	5776.275204	289.6555456	717.7953733	0	0	649.4778114	0	0	0	911.1832029	0	52.17243585	0	52.95979063	0											4000	$200/day 1-7	$200/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$25 per visit	$25 X-ray; $150 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$25 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	$125 Every 2 Years	$0 per visit	$500 Every 3 Yrs	N/A	0											144.5710156	144.5710156	47.56208437	0	100	0.2	0.2	47.5	200	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0											NO	93.58625332	93.58625332	30.78872524	0	100	0.129467519	0.129467519	47.5	129.4675187	3.75	37.5	25	25	25	25	25	25	25	25	25	$45 	0	0	0	0	0	0	0	0	0												12.6994	0.912676165	2.739899574	0	1.837663772	1.810813374	0	1.034146757	4.414798455	0.830179433	9.053696415	0.145096548	0.000600098	0.647955899	9.164714013	12.03390668	0.603449053	1.495407028	0	0	2.435541793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8599	0	12.3	12.6994	0.912676165	2.739899574	0	1.837663772	1.810813374	0	1.034146757	4.414798455	0.830179433	9.053696415	0.145096548	0.000600098	0.647955899	9.164714013	12.03390668	0.603449053	1.495407028	0	0	2.435541793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8599	NO																																																																																		0			12.6994	0.912676165	2.739899574	0	1.837663772	1.810813374	0	1.034146757	4.414798455	0.830179433	9.053696415	0.145096548	0.000600098	0.647955899	9.164714013	12.03390668	0.603449053	1.495407028	0	0	2.435541793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8599
H5736_801_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	421.2868157	3.172485931	9.025635372	41.83527124	13.34443884	21.98522455	0	16.31810892	35.34543921	24.53622523	47.67132017	0.173424656	0.003154651	23.56362614	47.54696242	115.553374	1.721654081	8.420241049	0	0	43.07706776	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.078427304	0.078427304	0.167910402	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078427304	0.078427304	0.167910402	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												33.0404	0.248809518	1.515498064	0	3.109254249	5.12255732	0	3.802119379	8.235487335	5.716940478	11.1074176	0.040407945	0.000735034	5.490324891	11.07844224	26.92393614	0.401145401	1.961916164	0	0	10.03695679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8323			33.0404	0.248809518	1.515498064	0	3.109254249	5.12255732	0	3.802119379	8.235487335	5.716940478	11.1074176	0.040407945	0.000735034	5.490324891	11.07844224	26.92393614	0.401145401	1.961916164	0	0	10.03695679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8323	NO																																																																																		0			33.0404	0.248809518	1.515498064	0	3.109254249	5.12255732	0	3.802119379	8.235487335	5.716940478	11.1074176	0.040407945	0.000735034	5.490324891	11.07844224	26.92393614	0.401145401	1.961916164	0	0	10.03695679	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8323
H5736_802_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	316.6374335	2.440006385	15.62316611	29.536537	9.465739558	18.71464873	0	11.63302285	32.39834599	27.40546309	52.24424725	0.310102979	0	21.5988973	44.10147981	122.4055707	2.350440154	11.11124064	0	0	61.50496129	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.07556785	0.07556785	0.164912435	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07556785	0.07556785	0.164912435	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.9276	0.184386036	2.576454373	0	2.205517317	4.360513155	0	2.710494325	7.548814615	6.385472899	12.17290961	0.072253994	0	5.032543071	10.2756448	28.52049797	0.547652556	2.588919069	0	0	14.33065598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4403			23.9276	0.184386036	2.576454373	0	2.205517317	4.360513155	0	2.710494325	7.548814615	6.385472899	12.17290961	0.072253994	0	5.032543071	10.2756448	28.52049797	0.547652556	2.588919069	0	0	14.33065598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4403	NO																																																																																		0			23.9276	0.184386036	2.576454373	0	2.205517317	4.360513155	0	2.710494325	7.548814615	6.385472899	12.17290961	0.072253994	0	5.032543071	10.2756448	28.52049797	0.547652556	2.588919069	0	0	14.33065598	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4403
H5736_808_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	399.3857374	3.530006189	7.409461451	52.78217313	14.58262047	19.76171136	0	15.68145472	33.72676275	23.07232607	45.69843477	0.00589528	0	22.48450843	46.489458	98.38572605	2.46641909	8.650867012	0	0	34.248468	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	3.397750569	4.604478748	0	3.653778949	7.858335721	5.375851974	10.6477353	0.0013736	0	5.238890463	10.83204371	22.92387417	0.574675648	2.015652014	0	0	7.979893045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.1043			0	0	0	0	3.397750569	4.604478748	0	3.653778949	7.858335721	5.375851974	10.6477353	0.0013736	0	5.238890463	10.83204371	22.92387417	0.574675648	2.015652014	0	0	7.979893045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.1043	NO																																																																																		0			0	0	0	0	3.397750569	4.604478748	0	3.653778949	7.858335721	5.375851974	10.6477353	0.0013736	0	5.238890463	10.83204371	22.92387417	0.574675648	2.015652014	0	0	7.979893045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.1043
H5736_809_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	316.4592583	4.863111946	42.38121583	6.568462328	8.403064215	10.60939484	0	10.60373032	36.25786368	12.54634288	55.134003	0.735861892	0.013999282	24.17190914	19.20091203	121.0262836	2.329762282	6.009134676	0	-9.50E-09	62.99568975	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.957913962	2.471988997	0	2.470669166	8.448082237	2.92329789	12.8462227	0.171455821	0.003261833	5.63205483	4.473812503	28.19912409	0.542834612	1.400128379	0	-2.21E-09	14.67799571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2188			0	0	0	0	1.957913962	2.471988997	0	2.470669166	8.448082237	2.92329789	12.8462227	0.171455821	0.003261833	5.63205483	4.473812503	28.19912409	0.542834612	1.400128379	0	-2.21E-09	14.67799571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2188	NO																																																																																		0			0	0	0	0	1.957913962	2.471988997	0	2.470669166	8.448082237	2.92329789	12.8462227	0.171455821	0.003261833	5.63205483	4.473812503	28.19912409	0.542834612	1.400128379	0	-2.21E-09	14.67799571	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.2188
H5736_810_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	319.2591774	4.906139034	42.75618977	6.62657775	8.477411543	10.703263	0	10.69754837	36.57866038	12.65734846	55.62180908	0.742372536	0.014123143	24.38577361	19.37079488	122.0970812	2.350375192	6.062301366	0	-9.59E-09	63.55305324	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.081061646	0.081061646	0.168647189	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081061646	0.081061646	0.168647189	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.8797	0.397699703	7.210711231	0	1.97523689	2.493860278	0	2.492528769	8.522827869	2.949162192	12.95988152	0.172972801	0.003290692	5.681885251	4.513395207	28.44861992	0.54763742	1.412516218	0	-2.23E-09	14.80786141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4698			25.8797	0.397699703	7.210711231	0	1.97523689	2.493860278	0	2.492528769	8.522827869	2.949162192	12.95988152	0.172972801	0.003290692	5.681885251	4.513395207	28.44861992	0.54763742	1.412516218	0	-2.23E-09	14.80786141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4698	NO																																																																																		0			25.8797	0.397699703	7.210711231	0	1.97523689	2.493860278	0	2.492528769	8.522827869	2.949162192	12.95988152	0.172972801	0.003290692	5.681885251	4.513395207	28.44861992	0.54763742	1.412516218	0	-2.23E-09	14.80786141	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.4698
H5736_811_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	320.4176173	4.923941081	42.91133167	6.650622451	8.508172041	10.74210005	0	10.73636468	36.71138695	12.70327597	55.82363419	0.745066253	0.014174389	24.47425799	19.44108229	122.5401135	2.358903586	6.084298576	0	-9.62E-09	63.78365707	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.982404086	2.502909312	0	2.501572971	8.55375316	2.9598633	13.00690677	0.173600437	0.003302633	5.702502112	4.529772173	28.55184645	0.549624536	1.417641568	0	-2.24E-09	14.8615921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2973			0	0	0	0	1.982404086	2.502909312	0	2.501572971	8.55375316	2.9598633	13.00690677	0.173600437	0.003302633	5.702502112	4.529772173	28.55184645	0.549624536	1.417641568	0	-2.24E-09	14.8615921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2973	NO																																																																																		0			0	0	0	0	1.982404086	2.502909312	0	2.501572971	8.55375316	2.9598633	13.00690677	0.173600437	0.003302633	5.702502112	4.529772173	28.55184645	0.549624536	1.417641568	0	-2.24E-09	14.8615921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.2973
H5746_006_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	267.18	14.64	67.15	60.03	20.09	19.04	16.7	12.68	22.56	5.8	14.42	2.66	4.75	59.21	41.98	81.7	4.83	4.72	23.02	31.25	12.82	3.4	7.961	4.81	1.29	2.14	0.29	0	0.5	15.66666667												1A IP Acute: Std. Medicare	1B IP Psych: Std. Medicare	2 SNF: Std. Medicare	6 Home Health: Std. Medicare	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: 20%, 4B Urgent Care: 20%"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 20%, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: 20%"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: 20%"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C OTC Rx: $0, 13D Welcome Home: $0, 13E PERS : $0"											0.076349874	0.076358676	0.158983335	0	0.200036109	0.200000003	0.162661838	0.196384201	0.200000026	0.199956883	0.200119082	0.200000382	0.199999987	0.199994984	0	0	0	0	0	0	0	0.037646704	0	0	0	0	0	0	0	0											NO	0.076349874	0.076358676	0.158983335	0	0.200036109	0.200000003	0.162661838	0.196384201	0.200000026	0.199956883	0.200119082	0.200000382	0.199999987	0.199994984	0	0	0	0	0	0	0	0.037646704	0	0	0	0	0	0	0	0												20.3992	1.117891016	10.67573097	0	4.018725427	3.808000048	2.7164527	2.490151667	4.512000596	1.15974992	2.885717165	0.532001015	0.949999939	11.84170301	0	0	0	0	0	0	0	0.127998795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2353	0	0	20.3992	1.117891016	10.67573097	0	4.018725427	3.808000048	2.7164527	2.490151667	4.512000596	1.15974992	2.885717165	0.532001015	0.949999939	11.84170301	0	0	0	0	0	0	0	0.127998795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2353	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.3992	1.117891016	10.67573097	0	4.018725427	3.808000048	2.7164527	2.490151667	4.512000596	1.15974992	2.885717165	0.532001015	0.949999939	11.84170301	0	0	0	0	0	0	0	0.127998795	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2353
H5746_012_0	2010	8	N/A																															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	V	V	V	O	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	NO	414.099	7.938	484.13	0	113.24	7.75	5.86	148.253	209.552	0	424.263	146.42	0.36	2062.33	2782.34	1759.611	93.289	322.777	922.194	716.555	12.35	308.195	0	0	0	0	0	0	0	0												1A IP Acute: $125 Per Day for days 1-5	1B IP Psych: $125 Per Day for days 1-5	2 SNF: $125 for days 20-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: $175	8A OP Diagnostic Procedures/Tests: $200	8B OP Radiology: $65	9A OP Hospital: $200	12 Renal Dialysis: 20%	"3 CORF: $200, 5 Partial Hosp: $200, 9C OP Substance Abuse: $25, 9D Cardiac Rehab: $200"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $25"	"7B Chiropractic: $25, 7D Physician Specialist (excl. Radiology): $25, 7F Podiatry: $25"	"7E Mental Health: $25, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $65	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $25, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC Rx: $0, 13D Welcome Home: Not Covered, 13E PERS : $0"											125	125	125	0	100	0.200000006	0.158782592	48.2895793	175	0	65	65.15392102	0.199999967	54.01651726	10	25	25	25	65	25	0.19999717	25	0	0	0	0	0	0	0	0											NO	125	125	125	0	100	0.200000006	0.158782592	48.2895793	175	0	65	65.15392102	0.199999967	54.01651726	10	25	25	25	65	25	0.19999717	25	0	0	0	0	0	0	0	0												4.3135	0.0826875	5.043020833	0	0.943666667	1.550000045	0.930465989	0.596589583	3.055966667	0	2.29809125	0.794986426	0.071999988	9.283323671	2.318616667	3.66585625	0.194352083	0.672452083	4.9952175	1.492822917	2.46996505	0.642072917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4157	0	0	4.3135	0.0826875	5.043020833	0	0.943666667	1.550000045	0.930465989	0.596589583	3.055966667	0	2.29809125	0.794986426	0.071999988	9.283323671	2.318616667	3.66585625	0.194352083	0.672452083	4.9952175	1.492822917	2.46996505	0.642072917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4157	NO	1A IP Acute: $225 Per Day for days 1-5	1B IP Psych: $225 Per Day for days 1-5	2 SNF: Not Covered	6 Home Health: Not Covered	10A Ambulance: Not Covered	11A DME: Not Covered	"11B Prosthetics/Medical Supplies: Not Covered, 11C Diabetes Monitoring Supplies: Not Covered"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: Not Covered	8B OP Radiology: $115	9A OP Hospital: Not Covered	12 Renal Dialysis: Not Covered	"3 CORF: Not Covered, 5 Partial Hosp: Not Covered, 9C OP Substance Abuse: Not Covered, 9D Cardiac Rehab: Not Covered"	"7A PCP: Not Covered, 14B Immunizations: Not Covered, 14C Physical Exams: Not Covered, 14D Pap Smears and Pelvic Exams: Not Covered, 14E Prostate Screening: Not Covered, 14F Colorectal Screening: Not Covered, 14G Bone Mass Measurement: Not Covered, 14H Mammography: Not Covered, 14I Diabetes Monitoring: Not Covered, 14J Nutrition Therapy: Not Covered"	"7B Chiropractic: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): $115	"7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: Not Covered	"13A Blood: Not Covered, 16B Comprehensive Dental (Medicare Covered): $35, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC Rx: Not Covered, 13D Welcome Home: Not Covered, 13E PERS : Not Covered"												3.1121	0.0629	0	0	0	0	0	0.304	1.9507	0	1.7751	0	0	0	0	2.4218	0.1305	0.4677	2.6022	1.0566	0	0.4461	0	0	0	0	0	0	0	0											14.3297	0	0	7.4256	0.14563125	5.043020833	0	0.943666667	1.550000045	0.930465989	0.900625833	5.006616667	0	4.0732025	0.794986426	0.071999988	9.283323671	2.318616667	6.08768125	0.324849583	1.140113333	7.597406093	2.549437917	2.46996505	1.088174167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.7454
H5749_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1406.38026	90.50674624	894.9323862	699.0334195	240.2912488	9.232309438	8.249120577	278.9079114	21.20370804	7990.446637	26.05031701	0	0.040549057	13.70347691	4829.658865	3603.667208	410.4437797	274.0431176	0	0	14.04915655	773.1138957	0	0	96.70060016	0	13.31741557	4.802528509	86.98104774	0											2800	"$175 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											158.6613559	122.8528282	65.70897042	0	150	0.2	0.124979695	49.57421048	0.2	3	0.177458908	0	0.2	0.149838462	10.16205541	34.90869642	38.5	35	0	0	0.2	33.61164242	0	0	35	0	0	0	0	0											NO	129.4502294	91.97991204	49.19630591	0	112.3049994	0.149739999	0.093572298	37.11621121	0.149739999	2.246099989	0.132863484	0	0.149739999	0.112472435	10.03444395	34.90869642	38.5	26.20449987	0	0	0.149739999	33.61164242	0	0	35	0	0	0	0	0												15.1714	0.693733547	3.668947287	0	2.248825714	1.382446008	0.771889165	0.862667079	3.175043226	1.495611842	3.461135866	0	0.006071816	1.541263413	4.038578431	10.48327705	1.31684046	0.598430237	0	0	2.103720691	2.165468984	0	0	0.282043417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4673	0	12.52587425	15.1714	0.693733547	3.668947287	0	2.248825714	1.382446008	0.771889165	0.862667079	3.175043226	1.495611842	3.461135866	0	0.006071816	1.541263413	4.038578431	10.48327705	1.31684046	0.598430237	0	0	2.103720691	2.165468984	0	0	0.282043417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.4673	NO	"$325 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$140 Days 1-25 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$30 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$30 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.8901	0.3173	3.0385	0.6041	1.0281	0.948	0.8471	0.3944	2.1773	0.6837	2.3224	0	0.0028	1.0498	2.9443	4.31	0.4828	0.3335	0	0	1.3677	0.9172	0	0	0.1177	0	0.0162	0	0	0											28.7929	0	0	20.0614	1.010992786	6.707438505	0.604147553	3.276917466	2.330461675	1.618946513	1.257051092	5.352336736	2.179358114	5.783562973	0	0.008847657	2.591088334	6.982847935	14.79325519	1.799655535	0.931909858	0	0	3.471420038	3.082628154	0	0	0.399717161	0	0.016205795	0	0	0	0	0	0	0	0	0	0	0	0	0	84.2602
H5749_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	226.3192485	4.905482714	28.0997219	735.1447356	6.139021353	9.712289234	8.677985233	11.965317	22.30607051	12.00103752	27.4046505	0	0.042657167	14.3994509	25.39647913	86.63059871	2.05468178	3.480610772	0	0	14.77956007	4.993542886	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.4689	0.421989967	4.762792056	0	1.430391975	2.262963391	2.021970559	2.78791886	5.197314429	2.796241741	6.385283566	0	0.00993912	3.355072059	5.917379638	20.1849295	0.478740855	0.81098231	0	0	3.443637496	1.163495493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9	0	0	19.4689	0.421989967	4.762792056	0	1.430391975	2.262963391	2.021970559	2.78791886	5.197314429	2.796241741	6.385283566	0	0.00993912	3.355072059	5.917379638	20.1849295	0.478740855	0.81098231	0	0	3.443637496	1.163495493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.5299	0.0548	1.8985	0	0.4896	0.7746	0.6921	0.9543	1.7789	0.9571	2.1856	0	0.0034	1.1484	1.9202	6.5501	0.1554	0.2632	0	0	1.1175	0.3776	0	0	0	0	0	0	0	0											23.8509	0	0	21.9988	0.476824821	6.66124763	0	1.919989228	3.037534754	2.714054442	3.742172966	6.976260978	3.753344619	8.570850424	0	0.013341101	4.503452428	7.837588924	26.73500596	0.634093847	1.074148755	0	0	4.561109266	1.541053632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7509
H5749_802_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	226.3192485	4.905482714	28.0997219	735.1447356	6.139021353	9.712289234	8.677985233	11.965317	22.30607051	12.00103752	27.4046505	0	0.042657167	14.3994509	25.39647913	86.63059871	2.05468178	3.480610772	0	0	14.77956007	4.993542886	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.4689	0.421989967	4.762792056	0	1.430391975	2.262963391	2.021970559	2.78791886	5.197314429	2.796241741	6.385283566	0	0.00993912	3.355072059	5.917379638	20.1849295	0.478740855	0.81098231	0	0	3.443637496	1.163495493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9	0	0	19.4689	0.421989967	4.762792056	0	1.430391975	2.262963391	2.021970559	2.78791886	5.197314429	2.796241741	6.385283566	0	0.00993912	3.355072059	5.917379638	20.1849295	0.478740855	0.81098231	0	0	3.443637496	1.163495493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.5299	0.0548	1.8985	0	0.4896	0.7746	0.6921	0.9543	1.7789	0.9571	2.1856	0	0.0034	1.1484	1.9202	6.5501	0.1554	0.2632	0	0	1.1175	0.3776	0	0	0	0	0	0	0	0											23.8509	0	0	21.9988	0.476824821	6.66124763	0	1.919989228	3.037534754	2.714054442	3.742172966	6.976260978	3.753344619	8.570850424	0	0.013341101	4.503452428	7.837588924	26.73500596	0.634093847	1.074148755	0	0	4.561109266	1.541053632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7509
H5749_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	226.3192485	4.905482714	28.0997219	735.1447356	6.139021353	9.712289234	8.677985233	11.965317	22.30607051	12.00103752	27.4046505	0	0.042657167	14.3994509	25.39647913	86.63059871	2.05468178	3.480610772	0	0	14.77956007	4.993542886	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.086024147	0.086024147	0.169496057	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.4689	0.421989967	4.762792056	0	1.430391975	2.262963391	2.021970559	2.78791886	5.197314429	2.796241741	6.385283566	0	0.00993912	3.355072059	5.917379638	20.1849295	0.478740855	0.81098231	0	0	3.443637496	1.163495493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9	0	0	19.4689	0.421989967	4.762792056	0	1.430391975	2.262963391	2.021970559	2.78791886	5.197314429	2.796241741	6.385283566	0	0.00993912	3.355072059	5.917379638	20.1849295	0.478740855	0.81098231	0	0	3.443637496	1.163495493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.5299	0.0548	1.8985	0	0.4896	0.7746	0.6921	0.9543	1.7789	0.9571	2.1856	0	0.0034	1.1484	1.9202	6.5501	0.1554	0.2632	0	0	1.1175	0.3776	0	0	0	0	0	0	0	0											23.8509	0	0	21.9988	0.476824821	6.66124763	0	1.919989228	3.037534754	2.714054442	3.742172966	6.976260978	3.753344619	8.570850424	0	0.013341101	4.503452428	7.837588924	26.73500596	0.634093847	1.074148755	0	0	4.561109266	1.541053632	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.7509
H5750_003_0	2010	4	N/A																															A	A	A		T	Coin	Coin	V	V	V	V			V		V	V								V		V																																																						0	NO	242.3524088	10.81075036	56.43219987		138.0821527	24.92926413	8.646457719	258.2092494	175.0898752	359.3054226	509.7851795			239.9647743		7355.716366	531.701851								476.4767235		239.8641496															$250 per admit	$250 per admit	$250 per admit		$50 per trip	20% coinsurance	20% coinsurance	$50 per visit	$100 per visit	$25 per visit	$50 per visit			$50 per visit		$25 per visit	$25 per visit								$25 per visit		$25 per visit														250	250	250		50	0.2	0.2	50	100	25	50			50		25	25								25		25														NO	244.6652696	244.6652696	244.6652696		48.93305392	0.195732216	0.195732216	48.93305392	97.86610785	24.46652696	48.93305392			48.93305392		24.46652696	24.46652696								24.46652696		24.46652696															4.9413	0.220417929	1.150583283	0	0.563065118	4.879460105	1.692390327	1.052913927	1.427947051	0.732579651	2.078778807	0	0	0.978517437	0	14.99740273	1.084074806	0	0	0	0	0	0	0	0.97147755	0	0.489053557	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2599		0.81242296	4.9413	0.220417929	1.150583283	0	0.563065118	4.879460105	1.692390327	1.052913927	1.427947051	0.732579651	2.078778807	0	0	0.978517437	0	14.99740273	1.084074806	0	0	0	0	0	0	0	0.97147755	0	0.489053557	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2599	YES																																									3350																																									0		0.01	4.9413	0.220417929	1.150583283	0	0.563065118	4.879460105	1.692390327	1.052913927	1.427947051	0.732579651	2.078778807	0	0	0.978517437	0	14.99740273	1.084074806	0	0	0	0	0	0	0	0.97147755	0	0.489053557	0	0	0	0	0	0	0	0	0	0	0	0	0	37.2599
H5750_004_0	2010	4	N/A																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin			Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	332.2719991	26.36284234	49.31590615		6.265828071	25.11872182	1.673500264	17.3417804	58.13603222	15.62599483	31.03830787			39.49273547		151.8709156	4.389609091	0.295108711	16.03276952	0.065609852	12.10592202	0.754441688																				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																			0.080820393	0.080820393	0.12715202		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080820393	0.080820393	0.12715202		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233																				26.8544	2.130655285	6.270617075	0	1.459937941	5.852662183	0.389925561	4.040634832	13.54569551	3.640856795	7.231925734	0	0	9.201807364	0	35.38592334	1.022778918	0.06876033	3.735635297	0.015287095	2.820679832	0.175784913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.8439		0	26.8544	2.130655285	6.270617075	0	1.459937941	5.852662183	0.389925561	4.040634832	13.54569551	3.640856795	7.231925734	0	0	9.201807364	0	35.38592334	1.022778918	0.06876033	3.735635297	0.015287095	2.820679832	0.175784913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.8439	NO																																																																																		0			26.8544	2.130655285	6.270617075	0	1.459937941	5.852662183	0.389925561	4.040634832	13.54569551	3.640856795	7.231925734	0	0	9.201807364	0	35.38592334	1.022778918	0.06876033	3.735635297	0.015287095	2.820679832	0.175784913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.8439
H5754_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1920.422882	126.0990927	2946.388963	3097.541877	638.0835084	6.0428377	5.258507062	409.9636534	296.8993793	13654.08026	4883.269889	0	9.150766518	786.0087344	6801.059402	6950.820075	850.1408765	784.9735696	0	0	826.7193325	1670.286708	1476.943463	403.5923565	164.8505868	168.6713759	16.05796531	13.08043119	2083.130024	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.59197375	100	0	13.09632673	0	0	39.10936324	1.116642465	28.98417723	22.57991105	0	0	0	0	29.49986979	0	30	30	0	30	0	0	0											NO	0	0	19.44214791	0	0	0.181962654	0.181962654	43.29980922	90.98132691	0	11.91521183	0	0	35.58221762	1.015936132	26.37018904	20.54350269	0	0	0	0	26.83937297	0	30	30	0	30	0	0	0												0	0	4.773677501	0	0	1.099570784	0.9568519	1.479278998	2.251024957	0	4.848766263	0	0	2.330661154	0.575786832	15.27453661	1.455405948	0	0	0	0	3.735787327	0	1.008980891	0.412126467	0	0.040144913	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2426	0	3.844264688	0	0	4.773677501	0	0	1.099570784	0.9568519	1.479278998	2.251024957	0	4.848766263	0	0	2.330661154	0.575786832	15.27453661	1.455405948	0	0	0	0	3.735787327	0	1.008980891	0.412126467	0	0.040144913	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2426	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.9186	0.0934	0.5514	0	0	0	0	0	0	0	0	0	0	0	1.034	4.1054	0.225	0	0	0	0.52	0.3813	0	0	0.0225	0	0.002	0	0	0											10.8537	0	0	3.9186	0.093407976	5.325071299	0	0	1.099570784	0.9568519	1.479278998	2.251024957	0	4.848766263	0	0	2.330661154	1.609813252	19.37991443	1.680404288	0	0	0	0.519962482	4.117069975	0	1.008980891	0.434666073	0	0.042180209	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0963
H5754_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2212.230347	151.6588736	2897.601108	3694.634215	613.2210381	7.011038554	5.772979658	415.7655855	272.2723633	12302.41375	4860.481446	0	11.48438757	626.6086755	5394.158912	6465.967884	703.126291	555.8530424	0	0	700.0611677	1678.527765	1576.881712	399.7156842	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02005397	100	0	13.14050144	0	0	38.98588968	1.766921833	28.73200018	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.58309056	0	0	0.183281762	0.183281762	43.08959173	91.64088106	0	12.04207129	0	0	35.72701279	1.619222735	26.33025811	17.17400841	0	0	0	0	27.05531245	0	30	30	0	30	0	0	0												0	0	4.728665409	0	0	1.2849955	1.058081884	1.492930778	2.079273272	0	4.877522007	0	0	1.865571347	0.727862062	14.18755028	1.006291403	0	0	0	0	3.784424429	0	0.999289211	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4052	0	3.383492201	0	0	4.728665409	0	0	1.2849955	1.058081884	1.492930778	2.079273272	0	4.877522007	0	0	1.865571347	0.727862062	14.18755028	1.006291403	0	0	0	0	3.784424429	0	0.999289211	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4052	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.338	0.1065	0.5363	0	0	0	0	0	0	0	0	0	0	0	0.808	4.079	0.1901	0	0	0	0.4818	0.364	0	0	0.0202	0	0.0021	0	0	0											10.9261	0	0	4.338	0.106483026	5.265007594	0	0	1.2849955	1.058081884	1.492930778	2.079273272	0	4.877522007	0	0	1.865571347	1.53588015	18.26656087	1.196418716	0	0	0	0.481788508	4.148461802	0	0.999289211	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	49.3313
H5754_003_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1389.900297	402.915533	11626.34845	112.5115931	832.784485	2174.975764	1969.478769	205.3236312	89.31695875	35540.37198	5041.892143	0	3.261574336	497.3169239	170.8517144	5438.442065	2117.656453	33.09880131	0	0	150.2431909	2195.254114	1533.383865	0	108.5215448	141.8948371	15.79381348	9.237945123	0	0											500	"$25 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$25 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $20 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											23.38815764	21.55472438	0	0	50	0	0	49.91275447	0	0	0	0	0	0	0.410961189	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	20.40087614	20.64866006	0	0	41.29732013	0	0	41.22525999	0	0	0	0	0	0	0.339431916	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												2.3629	0.69330549	0	0	2.865980623	0	0	0.705376673	0	0	0	0	0	0	0.00483271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6324	0	1.397666797	2.3629	0.69330549	0	0	2.865980623	0	0	0.705376673	0	0	0	0	0	0	0.00483271	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.6324	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.8448	0.6267	0.6434	0.0533	0.7894	0.5178	0.4674	0.0743	0.2021	0.4729	0.7377	0	0.0008	0.2988	0.0201	2.8552	0.3766	0	0	0	0.0361	0.3049	0	0	0.0153	0	0.0016	0	0	0											14.3391	0	0	8.2077	1.320033833	0.643429021	0.053262404	3.655400546	0.517791055	0.467373936	0.779639485	0.20210672	0.472896526	0.737732006	0	0.000814513	0.298768134	0.024971961	2.855160741	0.37662438	0	0	0	0.036077392	0.304898776	0	0	0.015315541	0	0.001556039	0	0	0	0	0	0	0	0	0	0	0	0	0	20.9716
H5754_004_0	2010	3	N/A																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	3092.119295	421.7139735	2293.579142	2395.228505	482.2254493	2558.358671	25.47026293	773.3671812	585.8996392	25734.4691	9165.989307	0	14.67567606	1488.115894	14618.12768	9604.459246	1681.328094	868.0598999	0	0	2577.905027	1946.646788	896.7342994	408.0004229	184.8810517	167.8018458	16.23477791	19.26953645	2073.970331	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0	0.108522327	49.10840134	100	0	13.80987234	0	0	39.11753932	0.362867049	29.76920321	21.18121172	0	0	0	0	29.770527	0	30	0	0	30	0	0	0											NO	0	0	13.79007361	0	0	0	0.070031545	31.69059582	64.53192317	0	8.911776206	0	0	25.24330042	0.234165085	19.21063934	13.66864328	0	0	0	0	19.21149361	0	30	0	0	30	0	0	0												0	0	2.635718767	0	0	0	1.783721854	2.04237223	3.150769209	0	6.807103784	0	0	3.130413048	0.285254593	15.37565022	1.915122829	0	0	0	0	3.11649936	0	1.020001057	0	0	0.040586945	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3032	0	22.11817775	0	0	2.635718767	0	0	0	1.783721854	2.04237223	3.150769209	0	6.807103784	0	0	3.130413048	0.285254593	15.37565022	1.915122829	0	0	0	0	3.11649936	0	1.020001057	0	0	0.040586945	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3032	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.971	0.3905	0.4748	0	0	0	0	0	0	0	0	0	0	0	2.3664	7.1174	0.4263	0	0	0	1.2669	0.4063	0	0	0.0246	0	0.0021	0	0	0											19.4463	0	0	6.971	0.39053968	3.110539078	0	0	0	1.783721854	2.04237223	3.150769209	0	6.807103784	0	0	3.130413048	2.651606638	22.49306125	2.341395874	0	0	0	1.266853427	3.522813742	0	1.020001057	0.024635376	0	0.042639155	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7495
H5774_003_0	2010	7	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	V	V	P	V	P	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	NO	1878.652766	210.0560424	0.80249665	2765.782405	230.9747498	34845.88509	132.3087986	418.0562061	132.1904269	1352.940713	1192.079342	89.03365864	6968.502575	4181.57751	8202.973554	10590.33989	633.9979438	5559.076386	2960.943185	36805.9092	22221.92998	45579.19652	0	1876.768329	262.1733108	253.8495598	113.0430849	4.110273799	3636.153072	121042.5212												PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b"	"PBP 9a, 9b"	PBP 8a	PBP 8b	PBP 9a	PBP 12	"PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"PBP 4b, 7a, 14b-i"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"	PBP 7d	"PBP 7d, 7g"	PBP 15	PBP 7g	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"PBP 13c, 13d"											0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0.870950429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.871	0	0	0	0	0	0	0	0	0	0.870950429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.871	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0.870950429	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.871
H5774_005_0	2010	4	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	V	V	P	V	P	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	NO	1827.807777	225.7100388	0.711902489	1594.089255	237.3406537	50587.18911	93.41612086	499.2074904	480.1974301	1289.827549	1355.501177	53.95110322	3431.059076	13925.46451	8547.089485	11897.72818	580.5119492	1470.372449	3681.72257	43389.40482	28933.18733	40174.83796	250	1754.669779	277.9187521	266.6538385	111.2275612	6.133422324	2776.868318	100												PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b"	"PBP 9a, 9b"	PBP 8a	PBP 8b	PBP 9a	PBP 12	"PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"PBP 4b, 7a, 14b-i"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"	PBP 7d	"PBP 7d, 7g"	PBP 15	PBP 7g	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"PBP 13c, 13d"											0	0	0	0	0	0	68.38984576	25	0	0	0	0	0	0	0	4.021254936	10	0	0	0	0	0	0	0	5	0	5	0	0	0											NO	0	0	0	0	0	0	68.38984576	25	0	0	0	0	0	0	0	4.021254936	10	0	0	0	0	0	0	0	5	0	5	0	0	0												0	0	0	0	0	0	0.532392841	1.040015605	0	0	0	0	0	0	0	3.98698318	0.483759958	0	0	0	0	0	0	0	0.11579948	0	0.046344817	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2053	0	0	0	0	0	0	0	0	0.532392841	1.040015605	0	0	0	0	0	0	0	3.98698318	0.483759958	0	0	0	0	0	0	0	0.11579948	0	0.046344817	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2053	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0.532392841	1.040015605	0	0	0	0	0	0	0	3.98698318	0.483759958	0	0	0	0	0	0	0	0.11579948	0	0.046344817	0	0	0	0	0	0	0	0	0	0	0	0	0	6.2053
H5774_008_0	2010	4	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	V	V	P	V	P	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	NO	2719.112075	223.3483586	3.177347641	3618.346724	439.9976108	50456.94853	124.0166677	509.9184823	91.34759632	901.9459346	1156.608463	44.04741156	6490.662968	2618.660903	10222.69151	10137.93352	887.0614778	1871.820219	2728.621185	47290.74173	25758.31574	120887.3609	0	1663.257917	229.5949245	190.9032335	133.2602108	9.4218928	545.9383412	201992.4185												PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b"	"PBP 9a, 9b"	PBP 8a	PBP 8b	PBP 9a	PBP 12	"PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"PBP 4b, 7a, 14b-i"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"	PBP 7d	"PBP 7d, 7g"	PBP 15	PBP 7g	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"PBP 13c, 13d"											0	0	0	0	0	0.246864159	8.208195562	25	0	0	0	0	0	0	0	7.731570085	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0.246864159	8.208195562	25	0	0	0	0	0	0	0	7.731570085	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	1.038001015	0.084829422	1.062330171	0	0	0	0	0	0	0	6.531845292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.717	0	0	0	0	0	0	0	1.038001015	0.084829422	1.062330171	0	0	0	0	0	0	0	6.531845292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.717	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	1.038001015	0.084829422	1.062330171	0	0	0	0	0	0	0	6.531845292	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.717
H5774_009_0	2010	6	N/A																															A	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	V	V	P	V	P	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	NO	403.1736098	7.373163839	9.412735842	2583.067169	509.7166996	43827.33853	212.7627917	579.6819798	159.4001687	1207.877054	1426.681013	50.98825271	3978.568806	5939.297598	10387.66197	11712.6709	576.8284946	1592.173082	3588.286496	52256.07256	33325.02575	155715.5343	0	2049.664928	320.4877762	281.0672569	149.0032891	6.796641258	598.9594862	100000.2027												$100 copay; PBP 1a	$100 copay; PBP 1b	$0; PBP 2	$0; PBP 6	$25 copay; PBP 10a	20% coinsurance; PBP 11a	"$0 or 20% coinsurance prosthetics/medical supplies; PBP 11b, 11c"	"$0 - $50 ER, $25 Urgent Care; PBP 4a, 4b"	"$0; PBP 9a, 9b"	$0; PBP 8a	$0; PBP 8b	$0; PBP 9a	$0; PBP 12	"$0 - $10; PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"$0; PBP 4b, 7a, 14b-j"	"$0 - $5 copay; PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"$10 copay; PBP 7e, 7h"	"$0-5; PBP 7c, 7i"	$0; PBP 7d	"$0; PBP 7d, 7g"	$0; PBP 15	$0; PBP 7g	$0; PBP 10b	"$0; PBP 16a, 16b"	$0; PBP 17a	$0; PBP 17b	$0; PBP 18a	$0; PBP 18b	$0; PBP 14a	$0; PBP 13c-e											100	100	0	0	25	1.296321449	63.47175211	50	0	0	0	0	0	0	0	3.483562307	10	5	0	0	0	0.20154936	0	0	0	0	0	0	0	0											NO	100	100	0	0	25	1.296321449	63.47175211	50	0	0	0	0	0	0	0	3.483562307	10	5	0	0	0	0.20154936	0	0	0	0	0	0	0	0												3.3598	0.061443032	0	0	1.061909791	4.734526584	1.125368931	2.415341583	0	0	0	0	0	0	0	3.40015157	0.480690412	0.663405451	0	0	0	2.615363862	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.918	0	0	3.3598	0.061443032	0	0	1.061909791	4.734526584	1.125368931	2.415341583	0	0	0	0	0	0	0	3.40015157	0.480690412	0.663405451	0	0	0	2.615363862	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.918	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.3598	0.061443032	0	0	1.061909791	4.734526584	1.125368931	2.415341583	0	0	0	0	0	0	0	3.40015157	0.480690412	0.663405451	0	0	0	2.615363862	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.918
H5774_014_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	V	V	P	V	P	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	NO	1294.725849	215.9342987	0.11548482	541.1665196	129.2119556	23964.54229	107.1636948	434.5934879	152.6997647	1376.131694	1400.768324	63.89599062	650.5937095	5689.855283	7935.211771	12764.93407	451.5226703	1263.494486	3542.290898	38885.08534	18024.83458	15444.86716	250	2326.627824	432.6643348	414.5377938	171.7923403	4.837454277	2706.687304	0												PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b"	"PBP 9a, 9b"	PBP 8a	PBP 8b	PBP 9a	PBP 12	"PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"PBP 4b, 7a, 14b-i"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"	PBP 7d	"PBP 7d, 7g"	PBP 15	PBP 7g	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"PBP 13c, 13d"											0	0	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											NO	0	0	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	0	0	0	0	0	0	0.9054031	0	0	0	0	0	0	0	0	0.376268892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2817	0	0	0	0	0	0	0	0	0	0.9054031	0	0	0	0	0	0	0	0	0.376268892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2817	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0.9054031	0	0	0	0	0	0	0	0	0.376268892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.2817
H5774_019_0	2010	9	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	V	P	P	S	O	T	V	V	P	V	P	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	NO	2958.890372	357.2418364	5.656520581	2749.648672	719.3793545	15985.78051	721.1744037	833.2479033	113.2950376	1188.555814	1582.379035	68.94407364	5192.314073	4675.483847	10749.3808	11606.08119	854.2478247	1185.73215	3253.509347	46517.40501	19280.04988	51200.29763	250	2004.83679	329.3549923	336.4345856	88.82471088	3.60575559	642.8389862	51926.96107												PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b"	"PBP 9a, 9b"	PBP 8a	PBP 8b	PBP 9a	PBP 12	"PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"PBP 4b, 7a, 14b-i"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"	PBP 7d	"PBP 7d, 7g"	PBP 15	PBP 7g	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"PBP 13c, 13d"											0	0	0	0	0	0	22.16810388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	22.16810388	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	1.332255758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.3323	0	0	0	0	0	0	0	0	1.332255758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.3323	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	1.332255758	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.3323
H5774_802_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	V	V	P	V	P	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	NO	2047.131285	228.7361597	1.431512884	2190.559223	281.6553206	41308.05435	121.5863157	490.0249204	198.4530148	1244.02034	1333.459711	61.13196057	4219.008707	6230.561813	9209.835759	12446.17001	683.8785833	6372.271514	3344.015244	44112.88406	24291.16791	63167.31151	0	0	0	0	0	0	0	0												PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b"	"PBP 9a, 9b"	PBP 8a	PBP 8b	PBP 9a	PBP 12	"PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"PBP 4b, 7a, 14b-i"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"	PBP 7d	"PBP 7d, 7g"	PBP 15	PBP 7g	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"PBP 13c, 13d"											120.6941617	32.73163534	141.5072202	0	52.27201617	1.56005248	80.9941318	36.70795403	157.2273674	3.801675946	18.81802215	93.06497354	6.025742916	10.85411742	17.09719658	14.90412804	18.24499028	4.752941366	17.46948167	4.104672545	1.123345375	0.436734297	0	0	0	0	0	0	0	0											NO	120.6941617	32.73163534	141.5072202	0	52.27201617	1.56005248	80.9941318	36.70795403	157.2273674	3.801675946	18.81802215	93.06497354	6.025742916	10.85411742	17.09719658	14.90412804	18.24499028	4.752941366	17.46948167	4.104672545	1.123345375	0.436734297	0	0	0	0	0	0	0	0												20.5897	0.623909047	0.016880784	0	1.226890956	5.370227719	0.820648173	1.498984355	2.600187089	0.394113517	2.091089532	0.474103691	2.118555152	5.635604124	13.12186437	15.45827595	1.039779842	2.523919406	4.868184417	15.08907867	2.273947594	2.29894428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1349	0	0	20.5897	0.623909047	0.016880784	0	1.226890956	5.370227719	0.820648173	1.498984355	2.600187089	0.394113517	2.091089532	0.474103691	2.118555152	5.635604124	13.12186437	15.45827595	1.039779842	2.523919406	4.868184417	15.08907867	2.273947594	2.29894428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1349	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.5897	0.623909047	0.016880784	0	1.226890956	5.370227719	0.820648173	1.498984355	2.600187089	0.394113517	2.091089532	0.474103691	2.118555152	5.635604124	13.12186437	15.45827595	1.039779842	2.523919406	4.868184417	15.08907867	2.273947594	2.29894428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1349
H5774_806_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	V	V	P	V	P	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	NO	2000.66059	232.6331894	0.951415449	2621.30891	461.788975	40461.76672	80.80898219	559.0194732	177.5518321	1425.217191	1466.724497	47.15188467	3438.333132	6923.769864	9341.533056	13636.59328	652.6839942	5830.088684	3553.985833	46855.50888	30548.8939	61005.34979	0	2749.611679	346.9091676	333.1164913	132.9760425	6.595094993	2925.75482	2000												PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b"	"PBP 9a, 9b"	PBP 8a	PBP 8b	PBP 9a	PBP 12	"PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"PBP 4b, 7a, 14b-i"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"	PBP 7d	"PBP 7d, 7g"	PBP 15	PBP 7g	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"PBP 13c, 13d"											0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	1.164623902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1646	0	0	0	0	0	0	0	0	0	1.164623902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1646	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	1.164623902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.1646
H5774_808_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	V	V	P	V	P	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	NO	2047.131285	228.7361597	1.431512884	2190.559223	281.6553206	41308.05435	121.5863157	490.0249204	198.4530148	1244.02034	1333.459711	61.13196057	4219.008707	6230.561813	9209.835759	12446.17001	683.8785833	6372.271514	3344.015244	44112.88406	24291.16791	63167.31151	0	0	0	0	0	0	0	0												PBP 1a	PBP 1b	PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	"PBP 4a, 4b"	"PBP 9a, 9b"	PBP 8a	PBP 8b	PBP 9a	PBP 12	"PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"PBP 4b, 7a, 14b-i"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"	PBP 7d	"PBP 7d, 7g"	PBP 15	PBP 7g	PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	"PBP 13c, 13d"											120.6941617	32.73163534	141.5072202	0	52.27201617	1.56005248	80.9941318	36.70795403	157.2273674	3.801675946	18.81802215	93.06497354	6.025742916	10.85411742	17.09719658	14.90412804	18.24499028	4.752941366	17.46948167	4.104672545	1.123345375	0.436734297	0	0	0	0	0	0	0	0											NO	120.6941617	32.73163534	141.5072202	0	52.27201617	1.56005248	80.9941318	36.70795403	157.2273674	3.801675946	18.81802215	93.06497354	6.025742916	10.85411742	17.09719658	14.90412804	18.24499028	4.752941366	17.46948167	4.104672545	1.123345375	0.436734297	0	0	0	0	0	0	0	0												20.5897	0.623909047	0.016880784	0	1.226890956	5.370227719	0.820648173	1.498984355	2.600187089	0.394113517	2.091089532	0.474103691	2.118555152	5.635604124	13.12186437	15.45827595	1.039779842	2.523919406	4.868184417	15.08907867	2.273947594	2.29894428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1349	0	0	20.5897	0.623909047	0.016880784	0	1.226890956	5.370227719	0.820648173	1.498984355	2.600187089	0.394113517	2.091089532	0.474103691	2.118555152	5.635604124	13.12186437	15.45827595	1.039779842	2.523919406	4.868184417	15.08907867	2.273947594	2.29894428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1349	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	20.5897	0.623909047	0.016880784	0	1.226890956	5.370227719	0.820648173	1.498984355	2.600187089	0.394113517	2.091089532	0.474103691	2.118555152	5.635604124	13.12186437	15.45827595	1.039779842	2.523919406	4.868184417	15.08907867	2.273947594	2.29894428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1349
H5782_001_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5783_002_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1425.233348	11.66974763	460.2358338	956.9361023	217.9562603	17.34392337	8.165034859	478.4017353	248.3460186	4.690132917	12.44638979	0.016748441	0.004610413	13.89032546	5224.887609	3485.378577	114.1763276	73.07856184	11.6452966	95.83912734	6.282214862	0	0	0	346	1.52372498	0	0	0	0											3300	1a (IP Acute): $165 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $250 Copay per day (days 1-5);	2a (SNF): $25 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $15 Copay per visit;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $35 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): $10 Copay per visit;	7d (SPC w/Copay): $29 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $15 Copay per visit; 7i (PT/ST): $15 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): 0 copay 3 visits/year (per year); 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 10 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);	18b (Hearing Aids): 750 allowance (every 3 years);		13c (OTC Rx): Not Covered											82.36950779	220.750056	15.20110578	15	125	0.2	0.092649976	48.87155127	200	0	0.189195621	0.2	0.2	0.201687597	8.316937571	29	40	15	0.2	0.022857153	0.2	0	0	0	10	0	0	0	0	0											NO	73.60304909	197.2559706	13.58327572	13.40357331	111.6964443	0.178714311	0.082789383	43.67022802	178.7143108	0	0.169059825	0.178714311	0.178714311	0.180222299	7.431778831	25.91357507	35.74286217	13.40357331	0.178714311	0.020424502	0.178714311	0	0	0	10	0	0	0	0	0												8.7418	0.191827283	0.520959185	1.0688636	2.02874494	3.099607312	0.675978198	1.740992739	3.698582297	0	2.104184484	0.002993186	0.000823947	2.503346394	3.23585076	7.526551617	0.340082395	0.081626155	2.081181157	1.957466444	1.122721699	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0125	0	5.0886439	8.7418	0.191827283	0.520959185	1.0688636	2.02874494	3.099607312	0.675978198	1.740992739	3.698582297	0	2.104184484	0.002993186	0.000823947	2.503346394	3.23585076	7.526551617	0.340082395	0.081626155	2.081181157	1.957466444	1.122721699	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0125	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.7418	0.191827283	0.520959185	1.0688636	2.02874494	3.099607312	0.675978198	1.740992739	3.698582297	0	2.104184484	0.002993186	0.000823947	2.503346394	3.23585076	7.526551617	0.340082395	0.081626155	2.081181157	1.957466444	1.122721699	0	0	0	0.288333333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0125
H5783_006_0	2010	13	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1263.007883	83.3620939	829.3622033	798.811628	182.2863571	12.78071181	5.335190396	485.3121359	218.7849841	2.285870423	12.12866526	0.434950651	0.023297902	10.42012604	5501.007515	3841.359091	166.0980373	54.53576397	20.19551504	104.3831742	5.136905714	0	0	0	401	5.916252046	0	0	0	0											4950	1a (IP Acute): $185 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $275 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0 copay;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);			13c (OTC Rx): Not Covered											135.5883055	149.7101964	61.52693117	0	150	0.2	0.083639199	49.58527015	275	0	0.19213439	0.2	0.2	0.199182719	0	30	40	30	0.2	0.026830736	0.2	0	0	0	5	0	0	0	0	0											NO	124.7728347	137.7682649	56.61911319	0	138.0349518	0.184046602	0.076967552	45.6300025	253.0640783	0	0.176808408	0.184046602	0.184046602	0.183294513	0	27.60699036	36.80932048	27.60699036	0.184046602	0.024690529	0.184046602	0	0	0	5	0	0	0	0	0												13.1324	0.957054253	3.913146039	0	2.096824043	2.352246585	0.410636547	1.845399498	4.613885028	0	2.144449997	0.08005119	0.0042879	1.90995193	0	8.837363616	0.509496324	0.125464026	3.716915927	2.577275757	0.945430044	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3394	0	4.348661638	13.1324	0.957054253	3.913146039	0	2.096824043	2.352246585	0.410636547	1.845399498	4.613885028	0	2.144449997	0.08005119	0.0042879	1.90995193	0	8.837363616	0.509496324	0.125464026	3.716915927	2.577275757	0.945430044	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3394	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.1324	0.957054253	3.913146039	0	2.096824043	2.352246585	0.410636547	1.845399498	4.613885028	0	2.144449997	0.08005119	0.0042879	1.90995193	0	8.837363616	0.509496324	0.125464026	3.716915927	2.577275757	0.945430044	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3394
H5783_008_0	2010	10	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	481.2121025	16.87257672	73.66916587	2429.160459	20.22155997	22.55253204	8.93744529	45.51808496	30.44730205	4.451086761	17.05741804	1.065125846	0	9.916472203	5258.410032	4169.259515	393.1735621	2.178368065	32.81770378	128.9206645	21.67434004	0	0	0	401	0.039305866	0	0	0	0												1a (IP Acute): 7.99% Coin MC CS; 1a1 (Add'l Days): 7.99% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.99% Coin MC CS;	2a (SNF): 18.13% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $8 Copay per visit;	7h (Psych): $8 Copay per visit; 7e (MH Non-Phys): 8 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 8 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $8 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $8 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 8 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $8 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 8 copay; 18a1 (Routine Hearing Exam): 8 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $20.0 OTC per month (cumulative benefit)											0.0799	0.0799	0.1813	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.146166716	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0799	0.0799	0.1813	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.146166716	0.2	0	0	0	5	0.2	0	0	0	0												38.4488	1.34811888	13.35621977	0	4.044311995	4.510506408	1.787489058	9.103616992	6.089460411	0	3.411483607	0.213025169	0	1.983294441	0	2.779506343	0.262115708	0.435673613	6.563540755	18.8439101	4.334868007	0	0	0	0.167083333	0.007861173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.6909	0	0	38.4488	1.34811888	13.35621977	0	4.044311995	4.510506408	1.787489058	9.103616992	6.089460411	0	3.411483607	0.213025169	0	1.983294441	0	2.779506343	0.262115708	0.435673613	6.563540755	18.8439101	4.334868007	0	0	0	0.167083333	0.007861173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.6909	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	38.4488	1.34811888	13.35621977	0	4.044311995	4.510506408	1.787489058	9.103616992	6.089460411	0	3.411483607	0.213025169	0	1.983294441	0	2.779506343	0.262115708	0.435673613	6.563540755	18.8439101	4.334868007	0	0	0	0.167083333	0.007861173	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.6909
H5783_009_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1579.894663	110.7293755	476.4961883	642.2673061	245.5039997	17.31409308	5.568231627	730.0259658	236.6719436	7.261654791	9.226966943	0.203261601	0.566644733	12.41670439	4030.190578	3005.035197	79.07697004	61.95534431	18.92513517	91.42890461	11.30838353	0	0	0	401	7.965851793	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $225 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): $5 Copay per visit;	10a (Ambulance): $125 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $200 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $35 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $25 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $25 Copay per visit; 7i (PT/ST): $25 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 25 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $25 Copay per visit; 7b (Chiro): $25 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $25 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 25 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $25 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 25 copay; 18a1 (Routine Hearing Exam): 25 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											82.36123559	82.68329949	21.93630069	5	125	0.2	0.091256173	49.03079958	200	0	0.178321116	0.2	0.2	0.199011947	0	25	40	25	0.2	0.019340985	0.2	0	0	0	5	0	0	0	0	0											NO	75.48719372	75.7823775	20.10545092	4.582689489	114.5672372	0.18330758	0.083639741	44.93858597	183.3075795	0	0.163438061	0.18330758	0.18330758	0.182401992	0	22.91344744	36.66151591	22.91344744	0.18330758	0.017726746	0.18330758	0	0	0	5	0	0	0	0	0												9.9385	0.699277944	0.798347561	0.245275969	2.343892914	3.173804495	0.465725449	2.733861218	3.615313427	0	1.508037585	0.037259392	0.103870274	2.264831612	0	5.737976338	0.241590133	0.118300877	3.46912072	1.620736944	2.072912413	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3557	0	3.749075507	9.9385	0.699277944	0.798347561	0.245275969	2.343892914	3.173804495	0.465725449	2.733861218	3.615313427	0	1.508037585	0.037259392	0.103870274	2.264831612	0	5.737976338	0.241590133	0.118300877	3.46912072	1.620736944	2.072912413	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3557	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.9385	0.699277944	0.798347561	0.245275969	2.343892914	3.173804495	0.465725449	2.733861218	3.615313427	0	1.508037585	0.037259392	0.103870274	2.264831612	0	5.737976338	0.241590133	0.118300877	3.46912072	1.620736944	2.072912413	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3557
H5783_010_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1247.057897	44.54093741	497.4555217	992.224496	162.0778448	12.27785146	5.10086212	421.0869638	204.6193301	699.4277914	10.6792798	0.370617537	0.170067974	8.997165234	4854.608853	3440.424249	103.8505931	74.05144259	22.74992959	104.7648482	8.423743369	0	0	0	295	5.419918208	0	0	0	0											4950	1a (IP Acute): $185 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $275 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $20 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0 copay;	7d (SPC w/Copay): $35 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $35 Copay per visit; 7i (PT/ST): $35 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 35 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $35 Copay per visit; 7b (Chiro): $35 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $35 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 35 copay per visit; 7g1 (Prof. Other Coins): $35 Copay per visit; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $35 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 25 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  100 allowance (every 2 years);"	18a (Hearing Exam): 35 copay; 18a1 (Routine Hearing Exam): Not Covered;			13c (OTC Rx): Not Covered											127.6492146	154.9390105	54.14906235	0	150	0.2	0.182477584	48.77883199	275	0	0.187834062	0.2	0.2	0.197887891	0	35	40	35	0.2	0.11064307	0.2	0	0	0	25	0	0	0	0	0											NO	116.7077726	141.6584259	49.50767989	0	137.1427622	0.182857016	0.166836533	44.59775838	251.4283974	0	0.171733881	0.182857016	0.182857016	0.180925946	0	31.99997785	36.57140326	31.99997785	0.182857016	0.101159308	0.182857016	0	0	0	25	0	0	0	0	0												12.1284	0.525799923	2.052322394	0	1.852316945	2.245091284	0.85101015	1.564961222	4.287259188	0	1.833994163	0.067770017	0.031098122	1.627820635	0	9.174458313	0.316496826	0.197470377	4.159984245	10.59793955	1.540340579	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6692	0	5.150781065	12.1284	0.525799923	2.052322394	0	1.852316945	2.245091284	0.85101015	1.564961222	4.287259188	0	1.833994163	0.067770017	0.031098122	1.627820635	0	9.174458313	0.316496826	0.197470377	4.159984245	10.59793955	1.540340579	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6692	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.1284	0.525799923	2.052322394	0	1.852316945	2.245091284	0.85101015	1.564961222	4.287259188	0	1.833994163	0.067770017	0.031098122	1.627820635	0	9.174458313	0.316496826	0.197470377	4.159984245	10.59793955	1.540340579	0	0	0	0.614583333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.6692
H5783_011_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	460.1296689	11.3171254	43.48626753	2847.797343	17.19075356	19.68866495	7.440060819	32.74048602	29.11589042	6.744109422	13.81823926	0.790898089	0	13.80507127	5085.147486	3618.796293	377.3944341	1.642978546	24.11970975	117.6423264	18.98912584	0	0	0	401	0.047798152	0	0	0	0												1a (IP Acute): 8.01% Coin MC CS; 1a1 (Add'l Days): 8.01% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 8.01% Coin MC CS;	2a (SNF): 18.91% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $8 Copay per visit;	7h (Psych): $8 Copay per visit; 7e (MH Non-Phys): 8 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 8 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $8 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $8 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 8 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $8 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 8 copay; 18a1 (Routine Hearing Exam): 8 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $20.0 OTC per month (cumulative benefit)											0.0801	0.0801	0.1891	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.151179369	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0801	0.0801	0.1891	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.151179369	0.2	0	0	0	5	0.2	0	0	0	0												36.8564	0.906501744	8.223253189	0	3.438150713	3.937732989	1.488012164	6.548097203	5.823178084	0	2.763647851	0.158179618	0	2.761014255	0	2.412530862	0.251596289	0.328595709	4.823941949	17.78509264	3.797825167	0	0	0	0.167083333	0.00955963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4804	0	0	36.8564	0.906501744	8.223253189	0	3.438150713	3.937732989	1.488012164	6.548097203	5.823178084	0	2.763647851	0.158179618	0	2.761014255	0	2.412530862	0.251596289	0.328595709	4.823941949	17.78509264	3.797825167	0	0	0	0.167083333	0.00955963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4804	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	36.8564	0.906501744	8.223253189	0	3.438150713	3.937732989	1.488012164	6.548097203	5.823178084	0	2.763647851	0.158179618	0	2.761014255	0	2.412530862	0.251596289	0.328595709	4.823941949	17.78509264	3.797825167	0	0	0	0.167083333	0.00955963	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.4804
H5783_012_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1320.554491	33.46239261	734.0828233	768.7078861	250.5910813	13.83270822	5.26123442	531.3428154	251.760907	3.704448487	11.25501914	0.217187031	0.084568741	6.257118696	5130.43146	3524.938246	137.3253177	86.92558073	23.70649086	94.42067346	6.971499594	0	0	0	401	5.702433108	0	0	0	0											4950	1a (IP Acute): $185 Copay per day (days 1-7); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $275 Copay per day (days 1-7);	2a (SNF): $90 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0 Copay;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 10% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $275 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0 copay;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): ;	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);			13c (OTC Rx): Not Covered											138.1785334	194.4583049	49.60621951	0	150	0.2	0.086191136	49.15341781	275	0	0.185367549	0.2	0.2	0.195127313	0	30	40	30	0.2	0.023931885	0.2	0	0	0	5	0	0	0	0	0											NO	127.5968982	179.5667962	45.80740285	0	138.5130835	0.184684111	0.079590667	45.38927645	253.9406531	0	0.171172206	0.184684111	0.184684111	0.180184572	0	27.70261671	36.93682228	27.70261671	0.184684111	0.022099195	0.184684111	0	0	0	5	0	0	0	0	0												14.0416	0.500727886	2.802202301	0	2.892511948	2.554681426	0.418745157	2.009772161	5.327694098	0	1.926546451	0.040110994	0.015618503	1.127436255	0	8.137501095	0.422696738	0.20067217	4.378212199	2.086620857	1.287525207	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3379	0	4.16067157	14.0416	0.500727886	2.802202301	0	2.892511948	2.554681426	0.418745157	2.009772161	5.327694098	0	1.926546451	0.040110994	0.015618503	1.127436255	0	8.137501095	0.422696738	0.20067217	4.378212199	2.086620857	1.287525207	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3379	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.0416	0.500727886	2.802202301	0	2.892511948	2.554681426	0.418745157	2.009772161	5.327694098	0	1.926546451	0.040110994	0.015618503	1.127436255	0	8.137501095	0.422696738	0.20067217	4.378212199	2.086620857	1.287525207	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3379
H5783_013_0	2010	9	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	307.2889939	7.014553247	27.93353017	1802.859533	11.1780496	13.77856191	5.342664389	21.6355381	23.75829541	4.448725001	10.2781282	0.517356823	0.050125769	9.77554742	4135.28166	2938.581	230.7047564	1.370260254	19.1516167	91.58443005	12.28162569	0	0	0	401	0.04462504	0	0	0	0												1a (IP Acute): 7.98% Coin MC CS; 1a1 (Add'l Days): 7.98% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.98% Coin MC CS;	2a (SNF): 18.99% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $8 Copay per visit;	7h (Psych): $8 Copay per visit; 7e (MH Non-Phys): 8 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 8 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $8 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $8 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 8 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $8 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 8 copay; 18a1 (Routine Hearing Exam): 8 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $21.5 OTC per month											0.0798	0.0798	0.1899	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	8	8	0.2	0.2	0.154816108	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0798	0.0798	0.1899	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	8	8	0.2	0.2	0.154816108	0.2	0	0	0	5	0.2	0	0	0	0												24.5217	0.559761349	5.304577379	0	2.235609919	2.755712382	1.068532878	4.32710762	4.751659081	0	2.05562564	0.103471365	0.010025154	1.955109484	0	1.959054	0.153803171	0.274052051	3.830323341	14.17874502	2.456325139	0	0	0	0.167083333	0.008925008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6772	0	0	24.5217	0.559761349	5.304577379	0	2.235609919	2.755712382	1.068532878	4.32710762	4.751659081	0	2.05562564	0.103471365	0.010025154	1.955109484	0	1.959054	0.153803171	0.274052051	3.830323341	14.17874502	2.456325139	0	0	0	0.167083333	0.008925008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6772	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.5217	0.559761349	5.304577379	0	2.235609919	2.755712382	1.068532878	4.32710762	4.751659081	0	2.05562564	0.103471365	0.010025154	1.955109484	0	1.959054	0.153803171	0.274052051	3.830323341	14.17874502	2.456325139	0	0	0	0.167083333	0.008925008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6772
H5783_801_0	2010	3	N/A																															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	NO	232.9972708	4.32505402	21.0834091	24.21150117	8.071249623	12.82802441	5.148678825	17.30552942	28.74664214	3.274119117	10.22658193	0.3607178	0.14836198	8.584042377	28.46987518	34.44916166	0.899077172	1.837800599	22.13935278	102.1359003	7.996045637	0	0	0	0	0	0	0	0	0												FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	19.0423	0.353476718	3.554612488	0	1.880601162	2.988929689	1.199642166	4.032188354	6.697967619	0.762869754	2.38279359	0.084047247	0.034568341	2.000081874	6.633480917	8.026654668	0.209484981	0.42820754	5.158469199	23.79766477	1.863078633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.1312
H5793_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.39159885	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6573.07558	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$200/day 1-7	$200/day 1-7	"$0/d 1-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$200 per procedure	$35 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$20 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Coaching Only	0											144.5710156	144.5710156	40.33133874	0	150	0.2	0.2	48.5	200	5.25	28.875	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	144.5710156	144.5710156	40.33133874	0	150	0.2	0.2	48.5	200	5.25	28.875	35	25	35	20	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												20.6374	0.917360025	3.924077355	0	2.934333973	2.07831977	0	0.978035432	6.691625831	0.957372935	6.96735245	0.157116481	0.000725633	0	7.702196146	19.17147044	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4098	0	0	20.6374	0.917360025	3.924077355	0	2.934333973	2.07831977	0	0.978035432	6.691625831	0.957372935	6.96735245	0.157116481	0.000725633	0	7.702196146	19.17147044	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4098	NO																																																																																		0			20.6374	0.917360025	3.924077355	0	2.934333973	2.07831977	0	0.978035432	6.691625831	0.957372935	6.96735245	0.157116481	0.000725633	0	7.702196146	19.17147044	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.4098
H5793_003_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.6065302	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6573.07558	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$125/day 1-7	$125/day 1-7	"$0/d 1-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$20 per visit	$20 X-ray; $175 Complex Radiology	$20 per visit	$20 per visit	$20 per visit	$5 PCP visit; $20 if no PCP selected	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$20 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Coaching Only	0											90.35688474	90.35688474	40.33133874	0	150	0.2	0.2	48.5	175	3	22.59375	20	20	20	5	20	20	20	20	20	$45 	0	0	0	0	0	0	0	0	0											NO	90.35688474	90.35688474	40.33133874	0	150	0.2	0.2	48.5	175	3	22.59375	20	20	20	5	20	20	20	20	20	$45 	0	0	0	0	0	0	0	0	0												12.8984	0.573350015	3.924077355	0	2.934333973	2.121306041	0	0.978035432	5.855172602	0.547070249	5.451727079	0.089780847	0.000580506	0	1.925549037	10.95512597	0.361201861	0.924458313	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5827	0	0	12.8984	0.573350015	3.924077355	0	2.934333973	2.121306041	0	0.978035432	5.855172602	0.547070249	5.451727079	0.089780847	0.000580506	0	1.925549037	10.95512597	0.361201861	0.924458313	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5827	NO																																																																																		0			12.8984	0.573350015	3.924077355	0	2.934333973	2.121306041	0	0.978035432	5.855172602	0.547070249	5.451727079	0.089780847	0.000580506	0	1.925549037	10.95512597	0.361201861	0.924458313	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.5827
H5793_008_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.36644581	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6466.624694	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$150/day 1-7	$150/day 1-7	"$0/d 1-20, $100/d 21-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$175 per procedure	$30 per visit	$30 X-ray; $175 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$10 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Coaching Only	0											108.4282617	108.4282617	40.33133874	0	150	0.2	0.2	48.5	175	4.5	26.78125	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0											NO	108.4282617	108.4282617	40.33133874	0	150	0.2	0.2	48.5	175	4.5	26.78125	30	25	30	10	30	30	30	30	30	$45 	0	0	0	0	0	0	0	0	0												15.4781	0.688020018	3.924077355	0	2.934333973	2.073289161	0	0.978035432	5.855172602	0.820605373	6.462143993	0.13467127	0.000725633	0	3.851098073	16.16656174	0.541802791	1.386687469	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3378	0	0	15.4781	0.688020018	3.924077355	0	2.934333973	2.073289161	0	0.978035432	5.855172602	0.820605373	6.462143993	0.13467127	0.000725633	0	3.851098073	16.16656174	0.541802791	1.386687469	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3378	NO																																																																																		0			15.4781	0.688020018	3.924077355	0	2.934333973	2.073289161	0	0.978035432	5.855172602	0.820605373	6.462143993	0.13467127	0.000725633	0	3.851098073	16.16656174	0.541802791	1.386687469	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.3378
H5793_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	326.6415597	5.019586027	43.74486154	6.779807268	8.673438774	10.95075965	0	10.94491288	37.42448619	12.95003037	56.9079787	0.75953877	0.014449719	24.94965748	19.81871501	124.9203903	2.404724038	6.202482852	0	-9.81E-09	65.02262081	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.067592704	0.067592704	0.15638514	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.067592704	0.067592704	0.15638514	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.0786	0.339287395	6.841046285	0	2.020911234	2.551526999	0	2.550164701	8.719905282	3.017357076	13.25955904	0.176972534	0.003366785	5.813270194	4.617760597	29.10645093	0.560300701	1.445178504	0	-2.29E-09	15.15027065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2519			22.0786	0.339287395	6.841046285	0	2.020911234	2.551526999	0	2.550164701	8.719905282	3.017357076	13.25955904	0.176972534	0.003366785	5.813270194	4.617760597	29.10645093	0.560300701	1.445178504	0	-2.29E-09	15.15027065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2519	NO																																																																																		0			22.0786	0.339287395	6.841046285	0	2.020911234	2.551526999	0	2.550164701	8.719905282	3.017357076	13.25955904	0.176972534	0.003366785	5.813270194	4.617760597	29.10645093	0.560300701	1.445178504	0	-2.29E-09	15.15027065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.2519
H5793_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	326.8766674	5.023198988	43.7763479	6.784687189	8.679681679	10.95864171	0	10.95279073	37.45142332	12.95935145	56.94893952	0.760085466	0.01446012	24.96761557	19.83297998	125.0103046	2.406454893	6.20694723	0	-9.82E-09	65.06942232	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.067546156	0.067546156	0.156311965	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.067546156	0.067546156	0.156311965	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.0793	0.339297782	6.842766955	0	2.022365831	2.553363519	0	2.55200024	8.726181633	3.019528887	13.26910291	0.177099914	0.003369208	5.817454427	4.621084336	29.12740096	0.56070399	1.446218705	0	-2.29E-09	15.1611754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.3184			22.0793	0.339297782	6.842766955	0	2.022365831	2.553363519	0	2.55200024	8.726181633	3.019528887	13.26910291	0.177099914	0.003369208	5.817454427	4.621084336	29.12740096	0.56070399	1.446218705	0	-2.29E-09	15.1611754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.3184	NO																																																																																		0			22.0793	0.339297782	6.842766955	0	2.022365831	2.553363519	0	2.55200024	8.726181633	3.019528887	13.26910291	0.177099914	0.003369208	5.817454427	4.621084336	29.12740096	0.56070399	1.446218705	0	-2.29E-09	15.1611754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.3184
H5810_001_0	2010	11	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	170.3281081	0.528031174	9.917878815	0	22.33186845	26.85719556	14.37705136	30.1514807	9.645473342	10.17608149	21.71762588	0	3.436204081	14.08113532	64.37322214	131.2362355	0.601931781	5.525448202	20.68434771	45.72922656	8.604510892	0.148481413	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.068215178	0.068215178	0.146011596	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.068215178	0.068215178	0.146011596	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												11.619	0.03601974	1.448125311	0	5.203325348	6.257726566	3.349852967	7.025295002	2.247395289	2.371026988	5.06020683	0	0.800635551	3.280904529	14.99896076	30.57804287	0.140250105	1.287429431	4.819453017	10.65490979	2.004851038	0.034596169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.218	0	0	11.619	0.03601974	1.448125311	0	5.203325348	6.257726566	3.349852967	7.025295002	2.247395289	2.371026988	5.06020683	0	0.800635551	3.280904529	14.99896076	30.57804287	0.140250105	1.287429431	4.819453017	10.65490979	2.004851038	0.034596169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.218	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.619	0.03601974	1.448125311	0	5.203325348	6.257726566	3.349852967	7.025295002	2.247395289	2.371026988	5.06020683	0	0.800635551	3.280904529	14.99896076	30.57804287	0.140250105	1.287429431	4.819453017	10.65490979	2.004851038	0.034596169	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.218
H5810_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	423.324306	14.1109509	768.782282	0	202.0972802	10.02560783	6.275228936	222.5836853	239.0343732	0	21.32113983	0	0	498.7256738	5004.234428	7635.411516	125.6528888	1361.837424	59.65677448	483.6464249	6.320972465	0	0	0	1030	0	192.8232588	0	0	0											3350	$200/Days 1-8 for IP Medical; $200/Days 1-8 for IP Surgical;	$100/Days 1-8 for IP Psych; $100/Days 1-8 for IP Substance Abuse;	$50/Days 11-100 for SNF	No Cost-Sharing	$50/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $25/Visit for Urgent Care;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$30/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	$5/Visit for PCP - Office Visits; $5/Visit for PCP - Consults; $3/Exam for Physical Exams (Routine); $2/Procedure for PCP - Asst Surgeon (OP); $5/Visit for PCP - Tx Injections; $5/Visit for PCP - Allergy Testing; $5/Visit for PCP - Allergy Tx;	$10/Visit for Speclst - Office Visits; $3/Procedure for Speclst - Asst Surgeon (OP); $10/Visit for Speclst - Tx Injections; $10/Visit for Speclst - Allergy Testing; $10/Visit for Speclst - Allergy Tx; $10/Consult for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	$23/Procedure for Prof Radiology (Office);	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision Exams (Refractions);	No Cost-Sharing	$10/Exam for Hearing Exam;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											200	100	50	0	50	0.188948164	0.183046371	46.04483399	50	0	76.96678073	0	0	13.33330771	4.859141457	8.575914624	15	10	24.56258439	10	0.2	0	0	0	10	0	10	0	0	0											NO	192.3817984	96.19089923	48.09544961	0	48.09544961	0.181750938	0.176073951	44.29093985	48.09544961	0	74.03503849	0	0	12.82542859	4.674051862	8.249249393	14.42863488	9.619089921	23.6269708	9.619089922	0.192381798	0	0	0	9.619089921	0	9.619089919	0	0	0												6.7867	0.113112088	3.081244125	0	0.80999663	1.822163632	1.104904349	0.821536718	0.958038804	0	0.131542617	0	0	0.533030876	1.949170937	5.248867818	0.151083305	1.091636386	0.117459072	0.387686538	1.21604005	0	0	0	0.825638552	0	0.154565355	0	0	0	0	0	0	0	0	0	0	0	0	0	27.3044	0	1.081236572	6.7867	0.113112088	3.081244125	0	0.80999663	1.822163632	1.104904349	0.821536718	0.958038804	0	0.131542617	0	0	0.533030876	1.949170937	5.248867818	0.151083305	1.091636386	0.117459072	0.387686538	1.21604005	0	0	0	0.825638552	0	0.154565355	0	0	0	0	0	0	0	0	0	0	0	0	0	27.3044	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.7867	0.113112088	3.081244125	0	0.80999663	1.822163632	1.104904349	0.821536718	0.958038804	0	0.131542617	0	0	0.533030876	1.949170937	5.248867818	0.151083305	1.091636386	0.117459072	0.387686538	1.21604005	0	0	0	0.825638552	0	0.154565355	0	0	0	0	0	0	0	0	0	0	0	0	0	27.3044
H5810_007_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	223.9310751	1.768781454	58.27971583	0	11.11121175	16.09365282	9.761332586	18.69137938	46.04934498	11.95505767	17.52929857	0	0.560944066	23.04430654	50.46034061	144.9076758	1.788678145	7.412456965	59.56181435	63.51892944	10.14004796	0.869758581	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.063545274	0.063545274	0.12359199	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.063545274	0.063545274	0.12359199	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												14.2298	0.112397702	7.202906056	0	2.588912337	3.749821106	2.274390493	4.355091396	10.72949738	2.785528437	4.084326567	0	0.130699967	5.369323423	11.75725936	33.76348847	0.416762008	1.727102473	13.87790274	14.79991056	2.362631175	0.20265375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5204	0	0	14.2298	0.112397702	7.202906056	0	2.588912337	3.749821106	2.274390493	4.355091396	10.72949738	2.785528437	4.084326567	0	0.130699967	5.369323423	11.75725936	33.76348847	0.416762008	1.727102473	13.87790274	14.79991056	2.362631175	0.20265375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5204	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.2298	0.112397702	7.202906056	0	2.588912337	3.749821106	2.274390493	4.355091396	10.72949738	2.785528437	4.084326567	0	0.130699967	5.369323423	11.75725936	33.76348847	0.416762008	1.727102473	13.87790274	14.79991056	2.362631175	0.20265375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.5204
H5810_008_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	384.8833613	3.744173503	74.98821076	0	13.4576182	19.23264887	12.0642711	17.61550058	69.18780903	9.300635105	31.75611675	0	0.728736479	30.53913726	91.42815286	238.1245049	3.723407745	13.28575142	74.36742951	114.8313022	12.74545807	1.295810175	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.08	0.243979854	11.66418639	0	3.135625041	4.481207187	2.810975165	4.104411635	16.1207595	2.16704798	7.399175204	0	0.1697956	7.11561898	21.30275962	55.48300965	0.867554005	3.095580081	17.32761108	26.75569342	2.969691731	0.301923771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	212.5966	0	0	25.08	0.243979854	11.66418639	0	3.135625041	4.481207187	2.810975165	4.104411635	16.1207595	2.16704798	7.399175204	0	0.1697956	7.11561898	21.30275962	55.48300965	0.867554005	3.095580081	17.32761108	26.75569342	2.969691731	0.301923771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	212.5966	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.08	0.243979854	11.66418639	0	3.135625041	4.481207187	2.810975165	4.104411635	16.1207595	2.16704798	7.399175204	0	0.1697956	7.11561898	21.30275962	55.48300965	0.867554005	3.095580081	17.32761108	26.75569342	2.969691731	0.301923771	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	212.5966
H5810_009_0	2010	5	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	197.1960889	2.656733093	197.5957662	0	124.5010304	11.0906415	7.529462403	188.8369811	285.8869745	0	434.1231232	0	0.351113231	367.5658929	3684.185951	4913.355105	145.1638729	421.8630825	1454.382434	886.8596552	6.16510534	0	0	0	1030	0	192.8232588	0	0	0											3350	$300/Admit for IP Medical; $300/Admit for IP Surgical;	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse;	$50/Days 11-20 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $25/Visit for Urgent Care;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$30/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Visit for Prof - CORF; $15/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $10/Visit for PCP - Consults; $10/Exam for Physical Exams (Routine); $3/Procedure for PCP - Asst Surgeon (OP); $10/Visit for PCP - Tx Injections; $10/Visit for PCP - Allergy Testing; $10/Visit for PCP - Allergy Tx;	$15/Visit for Speclst - Office Visits; $5/Procedure for Speclst - Asst Surgeon (OP); $15/Visit for Speclst - Tx Injections; $15/Visit for Speclst - Allergy Testing; $15/Visit for Speclst - Allergy Tx; $15/Consult for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	$23/Procedure for Prof Radiology (Office);	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision Exams (Refractions);	No Cost-Sharing	$15/Exam for Hearing Exam;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											300	500	50	0	100	0.2	0.2	47.89452629	50	0	76.62086931	0	0.2	17.79891402	9.699999666	11.88676408	15	10.16069234	24.39668885	15	0.2	0	0	0	15	0	15	0	0	0											NO	288.8420791	481.4034648	48.14034651	0	96.28069303	0.192561386	0.192561386	46.11318183	48.14034651	0	73.77110398	0	0.192561386	17.13691777	9.339226903	11.44465884	14.44210396	9.782785005	23.4893011	14.44210395	0.192561386	0	0	0	14.44210395	0	14.44210396	0	0	0												4.7465	0.106580043	0.792694055	0	0.998920457	2.135629299	1.449883717	0.72565617	1.146891501	0	2.668811838	0	0.06761085	0.524912207	2.867287379	4.685972745	0.174705979	0.34391632	2.846868909	1.067343278	1.18716123	0	0	0	1.239613923	0	0.232064462	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0091	0	1.159245263	4.7465	0.106580043	0.792694055	0	0.998920457	2.135629299	1.449883717	0.72565617	1.146891501	0	2.668811838	0	0.06761085	0.524912207	2.867287379	4.685972745	0.174705979	0.34391632	2.846868909	1.067343278	1.18716123	0	0	0	1.239613923	0	0.232064462	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0091	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.7465	0.106580043	0.792694055	0	0.998920457	2.135629299	1.449883717	0.72565617	1.146891501	0	2.668811838	0	0.06761085	0.524912207	2.867287379	4.685972745	0.174705979	0.34391632	2.846868909	1.067343278	1.18716123	0	0	0	1.239613923	0	0.232064462	0	0	0	0	0	0	0	0	0	0	0	0	0	30.0091
H5811_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	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	YES	604.8730275	7.877060826	473.8237091	488.3301427	231.2998145	6.597453996	5.455615758	224.348854	409.1160808	47.5056505	5.734181491	7.19058118	0.02019196	130.6964535	6370.92263	4121.276867	70.55926604	430.0655661	465.137495	139.8741915	28.99945939	513.8895054	0	0	231.884813	155.3348289	0	0	0	43.24293945											3000	"1A IP Acute: $200/day days 1-3, $100/day days 4-5"	"1B IP Psych: $200/day days 1-3, $100/day days 4-5"	"2 SNF: $0/day days 1-10, $50/day days 11-20, $100/day days 21-100"	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $30"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: 9%	9A OP Hospital: $30	12 Renal Dialysis: 20%	"3 CORF: $30, 5 Partial Hosp: $30 9A OP Hospital: $30, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $30"	"7A PCP: $10, 14B Immunizations: $10, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $10, 14E Prostate Screening: $10, 14F Colorectal Screening: $10, 14G Bone Mass Measurement: $10, 14H Mammography: $10, 14I Diabetes Monitoring: $10, 14J Nutrition Therapy: $10"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30, 18A Hearing Exams (Medicare Covered): $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): $30	7G Other Health Care: $30	15 Part B Drugs: 20%	"13A Blood: $30, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $30"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											173.5421	161.7647	61	0	150	0.200000004	0.199857996	48.5996842	200	0	0.087641152	30	0.200000002	30	10	30	30	30	30	30	0.200001061	30	0	0	30	0	0	0	0	30											NO	165.0900231	153.8862216	58.02909731	0	142.6945016	0.190259339	0.190124247	46.23271809	190.2593354	0	0.083372737	28.53890032	0.190259337	28.53890032	9.512966772	28.53890032	28.53890032	28.53890032	28.53890032	28.53890032	0.190260345	28.53890032	0	0	28.53890032	0	0	0	0	28.53890032												8.3215	0.101014261	2.291296844	0	2.750434312	1.255227236	1.03724484	0.864354777	6.486512804	0	0.478074404	0.01710094	0.003841709	0.310827755	5.050531274	9.801392472	0.167806988	1.02279986	1.106209384	0.332654634	5.517447139	1.222153447	0	0	0.55147813	0	0	0	0	0.102842162	0	0	0	0	0	0	0	0	0	0	48.7928	0	2.266008713	8.3215	0.101014261	2.291296844	0	2.750434312	1.255227236	1.03724484	0.864354777	6.486512804	0	0.478074404	0.01710094	0.003841709	0.310827755	5.050531274	9.801392472	0.167806988	1.02279986	1.106209384	0.332654634	5.517447139	1.222153447	0	0	0.55147813	0	0	0	0	0.102842162	0	0	0	0	0	0	0	0	0	0	48.7928	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days Per Day	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $20	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.3215	0.101014261	2.291296844	0	2.750434312	1.255227236	1.03724484	0.864354777	6.486512804	0	0.478074404	0.01710094	0.003841709	0.310827755	5.050531274	9.801392472	0.167806988	1.02279986	1.106209384	0.332654634	5.517447139	1.222153447	0	0	0.55147813	0	0	0	0	0.102842162	0	0	0	0	0	0	0	0	0	0	48.7928
H5811_002_0	2010	7	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	NO	303.6572026	9.690649916	93.40104634	25.72314138	20.78909279	19.08975939	15.75271986	17.76838703	33.94056531	9.335218988	8.752174366	0.355503273	0.705999458	30.78342927	64.2406266	800	4.227714017	6.464037152	36.58395207	22.09160911	18.424945	5.271181994	7.525827023	3.401156564	2.271565275	0.856749666	0.466421685	0	0	3.608796279												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7B Routine Chiropractic: $10, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0, 18A Routine Hearing Exams (Non Medicare Covered): $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0	0											0.065043444	0.065065669	0.150147451	0	0.23297507	0.232999995	0.232989676	0.233014683	0.232999974	0.233002201	0.233058707	0.232999998	0.232999991	0.233003572	0	10	0	0	0.232994823	0.233008092	0.232998539	0	0	0	0	0	0	0	0	0											NO	0.065043444	0.065065669	0.150147451	0	0.23297507	0.232999995	0.232989676	0.233014683	0.232999974	0.233002201	0.233058707	0.232999998	0.232999991	0.233003572	0	10	0	0	0.232994823	0.233008092	0.232998539	0	0	0	0	0	0	0	0	0												19.7509	0.630528616	14.02392905	0	4.843340342	4.447913833	3.67022109	4.140295078	7.90815082	2.175126569	2.03977044	0.082832262	0.164497868	7.172648979	0	0.666666667	0	0	8.523871443	5.147523695	4.292985261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6812	0	0	19.7509	0.630528616	14.02392905	0	4.843340342	4.447913833	3.67022109	4.140295078	7.90815082	2.175126569	2.03977044	0.082832262	0.164497868	7.172648979	0	0.666666667	0	0	8.523871443	5.147523695	4.292985261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6812	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.7509	0.630528616	14.02392905	0	4.843340342	4.447913833	3.67022109	4.140295078	7.90815082	2.175126569	2.03977044	0.082832262	0.164497868	7.172648979	0	0.666666667	0	0	8.523871443	5.147523695	4.292985261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.6812
H5811_003_0	2010	1	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	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	YES	507.7208922	11.49316148	823.5147367	98.77040756	137.9121631	6.164476562	4.617667898	199.3199655	229.3244241	0	8.11667312	20.34113795	0.058595871	37.57558281	3408.756338	3306.750542	97.87184563	363.5851974	1473.084566	395.664431	5.173654985	412.3299373	0	0	185.6735724	0	35.23327444	30.06624058	0	35.99460624											3000	"1A IP Acute: $200/day days 1-3, $100/day days 4-5"	"1B IP Psych: $200/day days 1-3, $100/day days 4-5"	"2 SNF: $0/day days 1-10, $50/day days 11-20, $100/day days 21-100"	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $49, 4B Urgent Care: $30"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: 9%	9A OP Hospital: $30	12 Renal Dialysis: 20%	"3 CORF: $30, 5 Partial Hosp: $30, 9A OP Hospital: $30, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $30"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $10, 14E Prostate Screening: $10, 14F Colorectal Screening: $10, 14G Bone Mass Measurement: $0, 14H Mammography: $10, 14I Diabetes Monitoring: $10, 14J Nutrition Therapy: $10"	"7B Chiropractic: $30, 7D Physician Specialist (excl. Radiology): $30, 7F Podiatry: $30, 18A Hearing Exams (Medicare Covered): $30"	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): $30	7G Other Health Care: $30	15 Part B Drugs: 20%	"13A Blood: $30, 16B Comprehensive Dental (Medicare Covered): $30, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $30"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $30, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											173.5421	161.7647	61	0	150	0.199999998	0.200080847	48.61811492	200	0	0.087596158	30	0.199999995	30	10	30	30	30	30	30	0.200001789	30	0	0	30	0	0	0	0	30											NO	166.5759796	155.2713339	58.5514106	0	143.9788785	0.191971836	0.192049439	46.66654442	191.971838	0	0.084079977	28.7957757	0.191971833	28.7957757	9.598591901	28.7957757	28.7957757	28.7957757	28.7957757	28.7957757	0.191973555	28.7957757	0	0	28.7957757	0	0	0	0	28.7957757												7.0478	0.14871321	4.018162457	0	1.654703215	1.183405884	0.886820531	0.775131168	3.6686526	0	0.682449689	0.04881157	0.011248757	0.090168171	2.726605082	7.935037244	0.234857976	0.872476483	3.534884395	0.949455351	0.99320494	0.989446699	0	0	0.445551212	0	0	0	0	0.086374384	0	0	0	0	0	0	0	0	0	0	38.984	0	1.504459244	7.0478	0.14871321	4.018162457	0	1.654703215	1.183405884	0.886820531	0.775131168	3.6686526	0	0.682449689	0.04881157	0.011248757	0.090168171	2.726605082	7.935037244	0.234857976	0.872476483	3.534884395	0.949455351	0.99320494	0.989446699	0	0	0.445551212	0	0	0	0	0.086374384	0	0	0	0	0	0	0	0	0	0	38.984	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $20	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.0478	0.14871321	4.018162457	0	1.654703215	1.183405884	0.886820531	0.775131168	3.6686526	0	0.682449689	0.04881157	0.011248757	0.090168171	2.726605082	7.935037244	0.234857976	0.872476483	3.534884395	0.949455351	0.99320494	0.989446699	0	0	0.445551212	0	0	0	0	0.086374384	0	0	0	0	0	0	0	0	0	0	38.984
H5812_044_0	2010	5	N/A																															D	D	D	V	P	Coin	Coin	V	V	Coin	V	Coin	V	V	P	P	Coin	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	662.7343565	7.137505668	1163.822163	1114.115265	92.12120839	10.86670344	2.027181929	239.5733481	313.4089055	14.7443285	479.6162587	0.247664741	0	1137.850791	1511.21287	1783.666337	0.636028924	757.9557642	1298.701862	38.3255567	12.51341158	4.624524457	0	523.6332635	550.0086375	0	18.99789404	0	0	0											3000	$200 Copay Days 1-5 (PBP 1a)	$200 Copay Days 1-5 (PBP 1b)	$65 Copay Days 4-100 (PBP 2)	$20 Copay (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"OP Surgery $375 Copay, ASC $200 Copay (PBP 9a, 9b)"	20% Coinsurance (PBP 8a)	"$25 General, 20% CT/MRI/PT (PBP 8b)"	45% Coinsurance (PBP 5)	CIF (PBP 12)	"CORF $25 Copay, OP Facility SA 45% Coinsurance, Other Services 20% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$15 Copay (PBP 7a, 14b-i)"	"$30 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA 45% Coinsurance (PBP 7e, 7h)"	"$25 Copay (PBP 7c, 7i)"	"$25 Office General, 20% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 20% Coinsurance (PBP 7g)"	"20% Coinsurance, $1000 OOP Max (PBP 15)"	20% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$30 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$30 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												200	200	65	20	100	0.2	0.2	50	299.75	0.2	67.665504	0.45	0	29.43824	15	30	0.45	25	27.686096	0.2	0.2	0.2	0	20	30	0	30	0	0	0											NO	179.5543276	179.5543276	58.35515648	17.95543276	89.77716382	0.179554328	0.179554328	44.88858191	269.1070486	0.179554328	60.74817038	0.403997237	0	26.42881695	13.46657457	26.93314915	0.403997237	22.44429096	24.85579176	0.179554328	0.161	0.179554328	0	17.95543276	26.93314915	0	26.93314915	0	0	0												9.9164	0.106797503	5.659585372	1.667035145	0.689198401	1.95116363	0.363989288	0.896175655	7.028378795	2.64740799	2.427984183	0.100055871	0	2.50600419	1.695905068	4.003312623	0.256953928	1.417648309	2.69002192	6.881519565	2.014659264	0.83035338	0	0.783505155	1.234455389	0	0.042639426	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8112	None	6.84151406	9.9164	0.106797503	5.659585372	1.667035145	0.689198401	1.95116363	0.363989288	0.896175655	7.028378795	2.64740799	2.427984183	0.100055871	0	2.50600419	1.695905068	4.003312623	0.256953928	1.417648309	2.69002192	6.881519565	2.014659264	0.83035338	0	0.783505155	1.234455389	0	0.042639426	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8112	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	9.9164	0.106797503	5.659585372	1.667035145	0.689198401	1.95116363	0.363989288	0.896175655	7.028378795	2.64740799	2.427984183	0.100055871	0	2.50600419	1.695905068	4.003312623	0.256953928	1.417648309	2.69002192	6.881519565	2.014659264	0.83035338	0	0.783505155	1.234455389	0	0.042639426	0	0	0	0	0	0	0	0	0	0	0	0	0	57.8112
H5812_054_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	Coin	V	Coin	V	V	P	P	Coin	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	811.7788419	7.137505668	1130.384852	1543.592292	77.37106974	11.9936888	1.07543962	273.7741197	349.0662343	10.08527727	645.8569302	0.051820462	0	1244.501081	2705.053622	2748.647826	0.574012066	683.6331095	1847.236245	35.64906196	17.76778555	9.977057802	0	523.6332635	462.0940054	0	27.45985731	0	0	0											3000	$200 Copay Days 1-5 (PBP 1a)	$200 Copay Days 1-5 (PBP 1b)	$65 Copay Days 4-100 (PBP 2)	$20 Copay (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"OP Surgery $375 Copay, ASC $200 Copay (PBP 9a, 9b)"	20% Coinsurance (PBP 8a)	"$25 General, 20% CT/MRI/PT (PBP 8b)"	45% Coinsurance (PBP 5)	CIF (PBP 12)	"CORF $25 Copay, OP Facility SA 45% Coinsurance, Other Services 20% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$15 Copay (PBP 7a, 14b-i)"	"$30 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA 45% Coinsurance (PBP 7e, 7h)"	"$25 Copay (PBP 7c, 7i)"	"$25 Office General, 20% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 20% Coinsurance (PBP 7g)"	"20% Coinsurance, $1000 OOP Max (PBP 15)"	20% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$30 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$30 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												200	200	65	20	100	0.2	0.2	50	299.75	0.2	67.665504	0.45	0	29.43824	15	30	0.45	25	27.686096	0.2	0.2	0.2	0	20	30	0	30	0	0	0											NO	179.5543276	179.5543276	58.35515648	17.95543276	89.77716382	0.179554328	0.179554328	44.88858191	269.1070486	0.179554328	60.74817038	0.403997237	0	26.42881695	13.46657457	26.93314915	0.403997237	22.44429096	24.85579176	0.179554328	0.161	0.179554328	0	17.95543276	26.93314915	0	26.93314915	0	0	0												12.1465	0.106797503	5.496982079	2.309655634	0.578846267	2.153518729	0.193099838	1.024111	7.82801534	1.81085518	3.269552236	0.020935323	0	2.74089094	3.035650527	6.169145154	0.231899289	1.278638368	3.826209953	6.400943352	2.860613473	1.791423905	0	0.783505155	1.037137231	0	0.061631703	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1566	None	8.014262621	12.1465	0.106797503	5.496982079	2.309655634	0.578846267	2.153518729	0.193099838	1.024111	7.82801534	1.81085518	3.269552236	0.020935323	0	2.74089094	3.035650527	6.169145154	0.231899289	1.278638368	3.826209953	6.400943352	2.860613473	1.791423905	0	0.783505155	1.037137231	0	0.061631703	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1566	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	12.1465	0.106797503	5.496982079	2.309655634	0.578846267	2.153518729	0.193099838	1.024111	7.82801534	1.81085518	3.269552236	0.020935323	0	2.74089094	3.035650527	6.169145154	0.231899289	1.278638368	3.826209953	6.400943352	2.860613473	1.791423905	0	0.783505155	1.037137231	0	0.061631703	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1566
H5812_057_0	2010	2	N/A																															D	D	D	V	P	Coin	Coin	V	V	Coin	V	Coin	V	V	P	P	Coin	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	658.5083896	7.137505668	1136.421632	1262.224559	118.2299896	11.31585385	1.017935361	289.284599	382.6609301	6.812874879	507.2691257	0	0	1139.278519	2387.603545	2183.684073	0.540947205	634.9245179	1606.292924	34.18077773	15.80400822	9.374275103	0	523.6332635	393.1111264	0	24.29612687	0	0	0											3000	$200 Copay Days 1-5 (PBP 1a)	$200 Copay Days 1-5 (PBP 1b)	$65 Copay Days 4-100 (PBP 2)	$20 Copay (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"OP Surgery $375 Copay, ASC $200 Copay (PBP 9a, 9b)"	20% Coinsurance (PBP 8a)	"$25 General, 20% CT/MRI/PT (PBP 8b)"	45% Coinsurance (PBP 5)	CIF (PBP 12)	"CORF $25 Copay, OP Facility SA 45% Coinsurance, Other Services 20% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$15 Copay (PBP 7a, 14b-i)"	"$30 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA 45% Coinsurance (PBP 7e, 7h)"	"$25 Copay (PBP 7c, 7i)"	"$25 Office General, 20% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 20% Coinsurance (PBP 7g)"	"20% Coinsurance, $1000 OOP Max (PBP 15)"	20% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$30 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$30 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												200	200	65	20	100	0.2	0.2	50	299.75	0.2	67.665504	0.45	0	29.43824	15	30	0.45	25	27.686096	0.2	0.2	0.2	0	20	30	0	30	0	0	0											NO	179.5543276	179.5543276	58.35515648	17.95543276	89.77716382	0.179554328	0.179554328	44.88858191	269.1070486	0.179554328	60.74817038	0.403997237	0	26.42881695	13.46657457	26.93314915	0.403997237	22.44429096	24.85579176	0.179554328	0.161	0.179554328	0	17.95543276	26.93314915	0	26.93314915	0	0	0												9.8532	0.106797503	5.526338514	1.888649016	0.884529429	2.031810529	0.182774699	1.082131285	8.581396124	1.223281168	2.567972606	0	0	2.50914862	2.679403432	4.90112407	0.218541176	1.187535885	3.327140201	6.137306563	2.544445324	1.683191663	0	0.783505155	0.88231005	0	0.054530934	0	0	0	0	0	0	0	0	0	0	0	0	0	60.837	None	7.254075212	9.8532	0.106797503	5.526338514	1.888649016	0.884529429	2.031810529	0.182774699	1.082131285	8.581396124	1.223281168	2.567972606	0	0	2.50914862	2.679403432	4.90112407	0.218541176	1.187535885	3.327140201	6.137306563	2.544445324	1.683191663	0	0.783505155	0.88231005	0	0.054530934	0	0	0	0	0	0	0	0	0	0	0	0	0	60.837	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	9.8532	0.106797503	5.526338514	1.888649016	0.884529429	2.031810529	0.182774699	1.082131285	8.581396124	1.223281168	2.567972606	0	0	2.50914862	2.679403432	4.90112407	0.218541176	1.187535885	3.327140201	6.137306563	2.544445324	1.683191663	0	0.783505155	0.88231005	0	0.054530934	0	0	0	0	0	0	0	0	0	0	0	0	0	60.837
H5812_058_0	2010	2	N/A																															D	D	D	V	P	Coin	Coin	V	V	Coin	V	Coin	V	V	P	P	Coin	P	P	Coin	Coin	Coin	O	O	V	O	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	YES	765.3034992	7.137505668	1409.646201	1785.041476	77.92015026	14.82415264	0.747641749	289.9407819	358.1664405	7.091255283	550.723962	0	0	1356.912158	3270.439112	2748.518324	0.540947205	769.6603857	1911.36876	32.46438064	22.98134483	13.51361389	0	523.6332635	261.7824655	0	31.78681207	0	0	0											3000	$200 Copay Days 1-5 (PBP 1a)	$200 Copay Days 1-5 (PBP 1b)	$65 Copay Days 4-100 (PBP 2)	$20 Copay (PBP 6)	$100 Copay (PBP 10a)	20% Coinsurance (PBP 11a)	"20% Coinsurance (PBP 11b, 11c)"	"$50 Copay (PBP 4a, 4b)"	"OP Surgery $375 Copay, ASC $200 Copay (PBP 9a, 9b)"	20% Coinsurance (PBP 8a)	"$25 General, 20% CT/MRI/PT (PBP 8b)"	45% Coinsurance (PBP 5)	CIF (PBP 12)	"CORF $25 Copay, OP Facility SA 45% Coinsurance, Other Services 20% Coinsurance (PBP 3, 9a, 9c, 9d)"	"$15 Copay (PBP 7a, 14b-i)"	"$30 Copay (PBP 7b, 7d, 7f, 7g, 14d-i)"	"OP MH/SA 45% Coinsurance (PBP 7e, 7h)"	"$25 Copay (PBP 7c, 7i)"	"$25 Office General, 20% Office CT/MRI/PT (PBP 7d)"	"Inpatient Professional CIF, Other Professional 20% Coinsurance (PBP 7g)"	"20% Coinsurance, $1000 OOP Max (PBP 15)"	20% Coinsurance (PBP 13a)	N/A (PBP 10b)	"$20 Copay (PBP 16a, 16b)"	$30 Copay (PBP 17a)	$200 Max per 2 Years (PBP 17b)	$30 Copay (PBP 18a)	$800 Max per 3 Years (PBP 18b)	CIF (PBP 14a)												200	200	65	20	100	0.2	0.2	50	299.75	0.2	67.665504	0.45	0	29.43824	15	30	0.45	25	27.686096	0.2	0.2	0.2	0	20	30	0	30	0	0	0											NO	179.5543276	179.5543276	58.35515648	17.95543276	89.77716382	0.179554328	0.179554328	44.88858191	269.1070486	0.179554328	60.74817038	0.403997237	0	26.42881695	13.46657457	26.93314915	0.403997237	22.44429096	24.85579176	0.179554328	0.161	0.179554328	0	17.95543276	26.93314915	0	26.93314915	0	0	0												11.4511	0.106797503	6.855010386	2.670932684	0.582954175	2.66174076	0.134242312	1.084585878	8.032092808	1.273265575	2.78795609	0	0	2.988465254	3.670134349	6.168854495	0.218541176	1.439540136	3.959048656	5.829120039	3.699996517	2.426427855	0	0.783505155	0.587552182	0	0.071343246	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4832	None	8.386944467	11.4511	0.106797503	6.855010386	2.670932684	0.582954175	2.66174076	0.134242312	1.084585878	8.032092808	1.273265575	2.78795609	0	0	2.988465254	3.670134349	6.168854495	0.218541176	1.439540136	3.959048656	5.829120039	3.699996517	2.426427855	0	0.783505155	0.587552182	0	0.071343246	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4832	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	11.4511	0.106797503	6.855010386	2.670932684	0.582954175	2.66174076	0.134242312	1.084585878	8.032092808	1.273265575	2.78795609	0	0	2.988465254	3.670134349	6.168854495	0.218541176	1.439540136	3.959048656	5.829120039	3.699996517	2.426427855	0	0.783505155	0.587552182	0	0.071343246	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4832
H5812_801_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	O	V	O	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	NO	257.9634592	1.357971002	61.38523226	0	7.903836015	16.67610421	0.930667433	10.1752471	38.45668397	11.1648419	22.97393111	0	7.620429969	16.14763226	24.21074464	40.68186789	0.937944963	4.676840838	28.86200167	79.07355084	24.03973653	21.48532354	0	0	0	0	0	0	0	0												Medicare FFS Benefits (PBP 1a)	Medicare FFS Benefits (PBP 1b)	Medicare FFS Benefits (PBP 2)	Medicare FFS Benefits (PBP 6)	Medicare FFS Benefits (PBP 10a)	Medicare FFS Benefits (PBP 11a)	"Medicare FFS Benefits (PBP 11b, 11c)"	"Medicare FFS Benefits (PBP 4a, 4b)"	"Medicare FFS Benefits (PBP 9a, 9b)"	Medicare FFS Benefits (PBP 8a)	Medicare FFS Benefits (PBP 8b)	Medicare FFS Benefits (PBP 5)	Medicare FFS Benefits (PBP 12)	"Medicare FFS Benefits (PBP 3, 9a, 9c, 9d)"	"Medicare FFS Benefits (PBP 7a, 14b-i)"	"Medicare FFS Benefits (PBP 7b, 7d, 7f, 7g, 14d-i)"	"Medicare FFS Benefits (PBP 7e, 7h)"	"Medicare FFS Benefits (PBP 7c, 7i)"	Medicare FFS Benefits (PBP 7d)	Medicare FFS Benefits (PBP 7g)	Medicare FFS Benefits (PBP 15)	Medicare FFS Benefits (PBP 13a)	N/A (PBP 10b)	"N/A (PBP 16a, 16b)"	N/A (PBP 17a)	N/A (PBP 17b)	N/A (PBP 18a)	N/A (PBP 18b)	N/A (PBP 14a)												0.078644907	0.078644907	0.178624223	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078644907	0.078644907	0.178624223	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.2875	0.106797503	10.96488944	0	1.841593792	3.885532282	0.216845512	2.370832575	8.960407365	2.601408162	5.352925949	0	1.775560183	3.762398316	5.641103502	9.478875217	0.218541176	1.089703915	6.724846389	18.42413735	5.601258613	5.006080386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3112	146	0	20.2875	0.106797503	10.96488944	0	1.841593792	3.885532282	0.216845512	2.370832575	8.960407365	2.601408162	5.352925949	0	1.775560183	3.762398316	5.641103502	9.478875217	0.218541176	1.089703915	6.724846389	18.42413735	5.601258613	5.006080386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3112	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	20.2875	0.106797503	10.96488944	0	1.841593792	3.885532282	0.216845512	2.370832575	8.960407365	2.601408162	5.352925949	0	1.775560183	3.762398316	5.641103502	9.478875217	0.218541176	1.089703915	6.724846389	18.42413735	5.601258613	5.006080386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3112
H5812_802_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	O	V	O	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	NO	257.9634592	1.357971002	61.38523226	0	7.903836015	16.67610421	0.930667433	10.1752471	38.45668397	11.1648419	22.97393111	0	7.620429969	16.14763226	24.21074464	40.68186789	0.937944963	4.676840838	28.86200167	79.07355084	24.03973653	21.48532354	0	0	0	0	0	0	0	0												Medicare FFS Benefits (PBP 1a)	Medicare FFS Benefits (PBP 1b)	Medicare FFS Benefits (PBP 2)	Medicare FFS Benefits (PBP 6)	Medicare FFS Benefits (PBP 10a)	Medicare FFS Benefits (PBP 11a)	"Medicare FFS Benefits (PBP 11b, 11c)"	"Medicare FFS Benefits (PBP 4a, 4b)"	"Medicare FFS Benefits (PBP 9a, 9b)"	Medicare FFS Benefits (PBP 8a)	Medicare FFS Benefits (PBP 8b)	Medicare FFS Benefits (PBP 5)	Medicare FFS Benefits (PBP 12)	"Medicare FFS Benefits (PBP 3, 9a, 9c, 9d)"	"Medicare FFS Benefits (PBP 7a, 14b-i)"	"Medicare FFS Benefits (PBP 7b, 7d, 7f, 7g, 14d-i)"	"Medicare FFS Benefits (PBP 7e, 7h)"	"Medicare FFS Benefits (PBP 7c, 7i)"	Medicare FFS Benefits (PBP 7d)	Medicare FFS Benefits (PBP 7g)	Medicare FFS Benefits (PBP 15)	Medicare FFS Benefits (PBP 13a)	N/A (PBP 10b)	"N/A (PBP 16a, 16b)"	N/A (PBP 17a)	N/A (PBP 17b)	N/A (PBP 18a)	N/A (PBP 18b)	N/A (PBP 14a)												0.078644907	0.078644907	0.178624223	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078644907	0.078644907	0.178624223	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.2875	0.106797503	10.96488944	0	1.841593792	3.885532282	0.216845512	2.370832575	8.960407365	2.601408162	5.352925949	0	1.775560183	3.762398316	5.641103502	9.478875217	0.218541176	1.089703915	6.724846389	18.42413735	5.601258613	5.006080386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3112	146	0	20.2875	0.106797503	10.96488944	0	1.841593792	3.885532282	0.216845512	2.370832575	8.960407365	2.601408162	5.352925949	0	1.775560183	3.762398316	5.641103502	9.478875217	0.218541176	1.089703915	6.724846389	18.42413735	5.601258613	5.006080386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3112	NO	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	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	None	0	20.2875	0.106797503	10.96488944	0	1.841593792	3.885532282	0.216845512	2.370832575	8.960407365	2.601408162	5.352925949	0	1.775560183	3.762398316	5.641103502	9.478875217	0.218541176	1.089703915	6.724846389	18.42413735	5.601258613	5.006080386	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3112
H5813_003_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1643.776919	49.73995676	878.5855448	812.3725463	267.136613	14.88577404	0	372.1790025	417.1340377	2363.345327	2802.128088	35.18848138	0.227522182	66.96067673	4577.804258	5159.51772	264.2806912	723.085108	0	0	579.8739352	0	0	0	797.0150542	0	48.42884798	0	119.040348	0												$250/day 1-6	$250/day 1-6	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$125 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$35 X-ray; $150 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$0 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											168.4846508	0	47.8866492	0	125	0.2	0.2	48.5	250	0	40.5	35	25	35	0	35	35	35	35	35	45	0	0	0	0	0	0	0	0	0											NO	168.4846508	168.4846508	47.8866492	0	125	0.2	0.2	48.5	250	0	40.5	35	25	35	0	35	35	35	35	35	45	0	0	0	0	0	0	0	0	0												23.0793	0.69836827	3.506043148	0	2.782673052	2.977154808	0	1.504223469	8.690292452	0	9.457182296	0.102633071	0.000474005	0.195301974	0	15.04859335	0.770818683	2.108998232	0	0	2.174527257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0965	0	0	23.0793	0.69836827	3.506043148	0	2.782673052	2.977154808	0	1.504223469	8.690292452	0	9.457182296	0.102633071	0.000474005	0.195301974	0	15.04859335	0.770818683	2.108998232	0	0	2.174527257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0965	NO																																																																																		0			23.0793	0.69836827	3.506043148	0	2.782673052	2.977154808	0	1.504223469	8.690292452	0	9.457182296	0.102633071	0.000474005	0.195301974	0	15.04859335	0.770818683	2.108998232	0	0	2.174527257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0965
H5813_006_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	2020.536127	75.59113385	1226.964148	853.0627246	289.8419932	14.00970938	0	258.0741478	416.572526	2321.248184	3024.249904	37.48346666	0.214535164	141.9869598	4908.744751	6050.492031	295.4568767	889.2186265	0	0	871.4537499	0	0	0	877.540047	0	46.39742063	0	106.269924	0												$150/day 1-10	$150/day 1-10	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$0 per visit	$35 X-ray; $150 Complex Radiology	$30 per visit	$0 per visit	$30 per visit	$10 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$35 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											122.9471107	122.9471107	47.8866492	0	100	0.2	0.2	48.5	250	0	40.5	30	0	30	10	30	30	30	35	30	45	0	0	0	0	0	0	0	0	0											NO	122.9471107	122.9471107	47.8866492	0	100	0.2	0.2	48.5	250	0	40.5	30	0	30	10	30	30	30	35	30	45	0	0	0	0	0	0	0	0	0												20.7016	0.774475958	4.896266812	0	2.415349943	2.801941876	0	1.043049681	8.678594291	0	10.20684343	0.093708667	0	0.3549674	4.090620626	15.12623008	0.738642192	2.223046566	0	0	3.267951562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4133	0	0	20.7016	0.774475958	4.896266812	0	2.415349943	2.801941876	0	1.043049681	8.678594291	0	10.20684343	0.093708667	0	0.3549674	4.090620626	15.12623008	0.738642192	2.223046566	0	0	3.267951562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4133	NO																																																																																		0			20.7016	0.774475958	4.896266812	0	2.415349943	2.801941876	0	1.043049681	8.678594291	0	10.20684343	0.093708667	0	0.3549674	4.090620626	15.12623008	0.738642192	2.223046566	0	0	3.267951562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4133
H5813_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	337.9108709	5.192764471	45.25408302	7.013714301	8.972677122	11.32856681	0	11.32251832	38.71565129	13.39681345	58.87133488	0.785743271	0.014948242	25.81043422	20.50247144	129.2302116	2.487688324	6.416471879	0	-1.01E-08	67.26593654	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.9866	0.383975483	6.768799303	0	2.090633769	2.639556066	0	2.638146768	9.02074675	3.121457534	13.71702103	0.183078182	0.00348294	6.013831172	4.777075846	30.1106393	0.579631379	1.495037948	0	-2.36E-09	15.67296321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2027			24.9866	0.383975483	6.768799303	0	2.090633769	2.639556066	0	2.638146768	9.02074675	3.121457534	13.71702103	0.183078182	0.00348294	6.013831172	4.777075846	30.1106393	0.579631379	1.495037948	0	-2.36E-09	15.67296321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2027	NO																																																																																		0			24.9866	0.383975483	6.768799303	0	2.090633769	2.639556066	0	2.638146768	9.02074675	3.121457534	13.71702103	0.183078182	0.00348294	6.013831172	4.777075846	30.1106393	0.579631379	1.495037948	0	-2.36E-09	15.67296321	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.2027
H5813_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	341.9577586	5.25495405	45.79605491	7.097711937	9.080135686	11.46423997	0	11.45811905	39.17931762	13.55725635	59.57638968	0.795153488	0.015127265	26.1195451	20.74801311	130.7778983	2.517481373	6.49331682	0	-1.03E-08	68.07152676	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.073944329	0.073944329	0.149573229	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.2858	0.38857405	6.849863788	0	2.115671615	2.671167914	0	2.669741738	9.128781005	3.158840729	13.88129879	0.185270763	0.003524653	6.085854009	4.834287055	30.47125029	0.58657316	1.512942819	0	-2.39E-09	15.86066573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6901			25.2858	0.38857405	6.849863788	0	2.115671615	2.671167914	0	2.669741738	9.128781005	3.158840729	13.88129879	0.185270763	0.003524653	6.085854009	4.834287055	30.47125029	0.58657316	1.512942819	0	-2.39E-09	15.86066573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6901	NO																																																																																		0			25.2858	0.38857405	6.849863788	0	2.115671615	2.671167914	0	2.669741738	9.128781005	3.158840729	13.88129879	0.185270763	0.003524653	6.085854009	4.834287055	30.47125029	0.58657316	1.512942819	0	-2.39E-09	15.86066573	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.6901
H5817_009_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	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	0	0	0	0	0											0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: $0, 13E PERS: $0"											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5817_010_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	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	0	0	0	0	0											0	NO	238.13	3.35	589.75	0	260.92	8.83	6.75	206.75	266.64	0	550.87	40.31	0.17	635.44	0	5114.39	174.82	671.45	1665.81	90.12	11.05	651.49	0	0	0	0	0	0	0	0												1A IP Acute: $300 Per Admit	1B IP Psych: $300 Per Admit	2 SNF: $100 for days 14-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: $150	8A OP Diagnostic Procedures/Tests: $150	8B OP Radiology: $80	9A OP Hospital: $150	12 Renal Dialysis: 20%	"3 CORF: $150, 5 Partial Hosp: $150, 9C OP Substance Abuse: $25, 9D Cardiac Rehab: $150"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $25"	"7B Chiropractic: $25, 7D Physician Specialist (excl. Radiology): $25, 7F Podiatry: $25"	"7E Mental Health: $25, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $80	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $25, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: Not Covered, 13E PERS: $0"											300	300	100	0	100	0.199999989	0.15931338	47.31076179	150	0	80	108.2790698	0.200000004	88.19999833	0	25	25	25	80	25	0.199999865	25	0	0	0	0	0	0	0	0											NO	300	300	100	0	100	0.199999989	0.15931338	47.31076179	150	0	80	108.2790698	0.200000004	88.19999833	0	25	25	25	80	25	0.199999865	25	0	0	0	0	0	0	0	0												5.9532	0.08375	4.914583333	0	2.174333333	1.765999902	1.075365312	0.815125	3.333	0	3.672466667	0.363727442	0.034000001	4.670483912	0	10.65497917	0.364208333	1.398854167	11.1054	0.18775	2.209998505	1.357270833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1345	0	0	5.9532	0.08375	4.914583333	0	2.174333333	1.765999902	1.075365312	0.815125	3.333	0	3.672466667	0.363727442	0.034000001	4.670483912	0	10.65497917	0.364208333	1.398854167	11.1054	0.18775	2.209998505	1.357270833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1345	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.9532	0.08375	4.914583333	0	2.174333333	1.765999902	1.075365312	0.815125	3.333	0	3.672466667	0.363727442	0.034000001	4.670483912	0	10.65497917	0.364208333	1.398854167	11.1054	0.18775	2.209998505	1.357270833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.1345
H5817_011_0	2010	4	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	O											18.2752	0.1898	1.5913	3.9977	0	0	0	0	10.3231	1.1462	6.011	0.2802	0	4.1338	0	0	0	0	0	0	0	0.2318	0	0	0	0	0	0	0	0											46.18	YES	0	0	0	0	272.57	0	0	221.44	0	0	0	0	0.19	580.98	0	5489.76	189.27	744.32	0	101.45	11.59	733.2	0	0	0	0	0	0	0	0											3400	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $100	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $5"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: 20%	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $5, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $5"	"7B Chiropractic: $5, 7D Physician Specialist (excl. Radiology): $5, 7F Podiatry: $5"	"7E Mental Health: $5, 7H Psychiatric: $5"	"7C Occupational Therapy: $5, 7I Physical and Speech Therapy: $5"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $5, 18A Hearing Exams (Medicare Covered): $5"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $5, 17A Routine Eye Exams (Medicare Covered): $5"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): Not covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: Not Covered, 13E PERS: $0"											0	0	0	0	100	0	0	45.23053649	0	0	0	0	0.200000021	2.5	0	5	5	5	0	5	0.200000233	5	0	0	0	0	0	0	0	0											NO	0	0	0	0	100	0	0	45.23053649	0	0	0	0	0.200000021	2.5	0	5	5	5	0	5	0.200000233	5	0	0	0	0	0	0	0	0												0	0	0	0	2.271416667	0	0	0.834654167	0	0	0	0	0.038000004	0.1210375	0	2.2874	0.0788625	0.310133333	0	0.042270833	2.3180027	0.3055	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	8.6073	900	0	18.2752	0.189826424	1.591296276	3.997727867	2.271416667	0	0	0.834654167	10.32305328	1.146156915	6.010956264	0.28017169	0.038000004	4.254843439	0	2.2874	0.0788625	0.310133333	0	0.042270833	2.3180027	0.537278398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7873	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.2752	0.189826424	1.591296276	3.997727867	2.271416667	0	0	0.834654167	10.32305328	1.146156915	6.010956264	0.28017169	0.038000004	4.254843439	0	2.2874	0.0788625	0.310133333	0	0.042270833	2.3180027	0.537278398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7873
H5820_002_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1755.07904	48.79449238	1188.317248	2578.93737	280.4398756	7.919261205	8.925212646	445.7349087	28.95344267	989.400706	1082.888516	0	0.877441481	411.2410146	11035.49124	13998.70968	248.6947703	910.7829888	6112.925921	14946.00305	5.194113917	10.66092431	0	2924.911305	216.3276465	162.3340361	0.710850764	0	5955	54.55224019											3400	"$300 copay, days 1-7"	"$300 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$15 copay	$40 copay	"$40 copay Group, $40 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$40 copay	Not Covered	Varies	Varies											192.9872727	198.3793103	66.2299152	20	125	0.2	0.2	45	0.199610943	4.633710764	36.65577024	0	0.2	60.72014707	11.0187439	25.22772926	40	43	4.505566802	4.763505415	0.2	0	0	4	0	20	40	0	0	0											NO	129.1216976	198.3793103	52.25242579	14.67612459	125	0.105077172	0.17277674	45	0.156361604	4.633710764	29.24191207	0	0.2	47.95302036	8.274070544	22.48305591	40	43	1.993511131	3.585373494	0.2	0	0	4	0	20	40	0	0	0												18.8849	0.806651479	5.174371568	3.15406718	2.921248705	0.832133575	1.542069146	1.671505908	4.527206737	0.382049725	2.638810898	0	0.175488296	1.643354062	7.609036084	26.22781436	0.828982568	3.263639043	1.015515489	4.465583599	1.038822783	0	0	0.974970435	0	0.270556727	0.002369503	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0511		23.69545857	18.8849	0.806651479	5.174371568	3.15406718	2.921248705	0.832133575	1.542069146	1.671505908	4.527206737	0.382049725	2.638810898	0	0.175488296	1.643354062	7.609036084	26.22781436	0.828982568	3.263639043	1.015515489	4.465583599	1.038822783	0	0	0.974970435	0	0.270556727	0.002369503	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0511	NO																																																																																		0			18.8849	0.806651479	5.174371568	3.15406718	2.921248705	0.832133575	1.542069146	1.671505908	4.527206737	0.382049725	2.638810898	0	0.175488296	1.643354062	7.609036084	26.22781436	0.828982568	3.263639043	1.015515489	4.465583599	1.038822783	0	0	0.974970435	0	0.270556727	0.002369503	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0511
H5820_003_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1668.637827	46.18654581	988.4334206	2192.841573	272.0437387	9.003823532	10.12255374	396.2506673	30.06585949	859.9825178	942.0654619	0	0.912224014	357.7510797	12014.28663	15906.22615	275.8973624	1009.536269	6863.016634	18187.35925	5.396731567	9.305308105	0	2924.911305	223.0675878	167.3917432	0.131989438	0	5955	37.43823852											3400	"$300 copay, days 1-7"	"$300 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$15 copay	$40 copay	"$40 copay Group, $40 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$40 copay	Not Covered	Varies	Varies											192.9872727	198.3793103	66.2299152	20	125	0.2	0.2	45	0.199621301	4.722879007	36.76024983	0	0.2	61.04561101	11.23385906	24.8438857	40	43	4.506433077	4.53450156	0.2	0	0	4	0	20	40	0	0	0											NO	123.5268184	198.3793103	48.85389357	13.52562844	125	0.11366944	0.175179827	45	0.156554535	4.722879007	27.94807435	0	0.2	45.87004724	8.689155445	22.29918209	40	43	2.192773079	3.533382935	0.2	0	0	4	0	20	40	0	0	0												17.1768	0.763537925	4.024068428	2.47163003	2.833788945	1.023459582	1.773267212	1.485940002	4.706946648	0.338466115	2.194076298	0	0.182444803	1.367504911	8.699500341	29.5579861	0.919657875	3.617504962	1.25408651	5.355242066	1.079346313	0	0	0.974970435	0	0.278986239	0.000439965	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0796		24.50198754	17.1768	0.763537925	4.024068428	2.47163003	2.833788945	1.023459582	1.773267212	1.485940002	4.706946648	0.338466115	2.194076298	0	0.182444803	1.367504911	8.699500341	29.5579861	0.919657875	3.617504962	1.25408651	5.355242066	1.079346313	0	0	0.974970435	0	0.278986239	0.000439965	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0796	NO																																																																																		0			17.1768	0.763537925	4.024068428	2.47163003	2.833788945	1.023459582	1.773267212	1.485940002	4.706946648	0.338466115	2.194076298	0	0.182444803	1.367504911	8.699500341	29.5579861	0.919657875	3.617504962	1.25408651	5.355242066	1.079346313	0	0	0.974970435	0	0.278986239	0.000439965	0	0	0	0	0	0	0	0	0	0	0	0	0	92.0796
H5820_004_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1748.858479	48.40219501	1129.746517	2385.954719	383.6549353	9.751599166	10.96488102	407.2652921	32.34989994	943.323555	1028.777804	0	0.974744381	390.7551187	12879.73454	17154.69538	296.7337266	1085.637669	7739.939045	18270.54647	5.766727392	12.05146451	0	2924.911305	218.5492181	164.0011216	0.409093754	0	5955	44.24316235											3400	"$300 copay, days 1-7"	"$300 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$15 copay	$40 copay	"$40 copay Group, $40 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$40 copay	Not Covered	Varies	Varies											192.9872727	198.3793103	66.2299152	20	125	0.2	0.2	45	0.19961172	4.684261687	36.69186681	0	0.2	60.96459828	11.19011517	24.89208136	40	43	4.500750759	4.739595114	0.2	0	0	4	0	20	40	0	0	0											NO	123.822416	198.3793103	50.36428953	13.79012121	125	0.116812871	0.176087146	45	0.157839901	4.684261687	28.27049043	0	0.2	46.46481349	8.721339386	22.42330558	40	43	2.359746685	3.699569359	0.2	0	0	4	0	20	40	0	0	0												18.0457	0.800166172	4.74157339	2.741883732	3.996405576	1.139112299	1.930774602	1.527244845	5.106104995	0.368231199	2.423671088	0	0.194948876	1.513030309	9.360711343	32.05541472	0.989112422	3.890201646	1.522024625	5.632762823	1.153345478	0	0	0.974970435	0	0.273335203	0.001363646	0	0	0	0	0	0	0	0	0	0	0	0	0	100.382		25.5706495	18.0457	0.800166172	4.74157339	2.741883732	3.996405576	1.139112299	1.930774602	1.527244845	5.106104995	0.368231199	2.423671088	0	0.194948876	1.513030309	9.360711343	32.05541472	0.989112422	3.890201646	1.522024625	5.632762823	1.153345478	0	0	0.974970435	0	0.273335203	0.001363646	0	0	0	0	0	0	0	0	0	0	0	0	0	100.382	NO																																																																																		0			18.0457	0.800166172	4.74157339	2.741883732	3.996405576	1.139112299	1.930774602	1.527244845	5.106104995	0.368231199	2.423671088	0	0.194948876	1.513030309	9.360711343	32.05541472	0.989112422	3.890201646	1.522024625	5.632762823	1.153345478	0	0	0.974970435	0	0.273335203	0.001363646	0	0	0	0	0	0	0	0	0	0	0	0	0	100.382
H5820_008_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1794.395213	50.2246899	1284.393609	2644.600904	609.5186894	8.329070789	9.394295631	293.6733505	31.52771293	1379.847992	1502.597287	0	0.955366481	570.0180055	9918.270981	12620.12759	233.2246151	856.2708276	5320.346705	13432.43091	5.646262199	64.95146444	0	2924.911305	213.3752371	160.118524	123.388175	0	5955	284.7483267											3400	"$900 copay, days 1-1"	"$900 copay, days 1-1"	"$150 copay, days 6-20"	$10 copay	$100 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$10 copay	$30 copay	"$30 copay Group, $30 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$30 copay	Not Covered	Varies	Varies											163.6363636	114.9425287	66.2299152	10	100	0.2	0.2	45	0.199634546	4.856999855	36.8660404	0	0.2	60.40817578	7.102660907	20.87698094	30	33	4.496807679	4.692612168	0.2	0	0	4	0	20	30	0	0	0											NO	113.2265326	114.9425287	55.79393435	5.810343928	100	0.12716693	0.179127988	45	0.167582404	4.856999855	32.55427366	0	0.2	52.97506076	4.642456562	18.41677659	30	33	2.167599564	3.634737517	0.2	0	0	4	0	20	30	0	0	0												16.9311	0.481079405	5.97178106	1.2805034	5.079322411	1.05918236	1.682781276	1.101275064	5.283489919	0.558493458	4.076330273	0	0.191073296	2.516394873	3.837095183	19.36850587	0.583061538	2.354744776	0.961031767	4.068613381	1.12925244	0	0	0.974970435	0	0.266864207	0.308470437	0	0	0	0	0	0	0	0	0	0	0	0	0	80.0654		19.12207223	16.9311	0.481079405	5.97178106	1.2805034	5.079322411	1.05918236	1.682781276	1.101275064	5.283489919	0.558493458	4.076330273	0	0.191073296	2.516394873	3.837095183	19.36850587	0.583061538	2.354744776	0.961031767	4.068613381	1.12925244	0	0	0.974970435	0	0.266864207	0.308470437	0	0	0	0	0	0	0	0	0	0	0	0	0	80.0654	NO																																																																																		0			16.9311	0.481079405	5.97178106	1.2805034	5.079322411	1.05918236	1.682781276	1.101275064	5.283489919	0.558493458	4.076330273	0	0.191073296	2.516394873	3.837095183	19.36850587	0.583061538	2.354744776	0.961031767	4.068613381	1.12925244	0	0	0.974970435	0	0.266864207	0.308470437	0	0	0	0	0	0	0	0	0	0	0	0	0	80.0654
H5820_009_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1474.258547	41.12166039	1279.027212	2297.225741	207.2256159	9.110479123	10.24898841	246.6425789	31.202128	1392.12434	1512.641128	0	0.942860865	573.8646775	7239.076031	9465.100298	166.1991746	607.9404862	4096.372095	10265.77065	5.579817576	87.88978265	0	2924.911305	210.197456	157.733891	152.6671506	0	5955	330.6740519											3400	"$900 copay, days 1-1"	"$900 copay, days 1-1"	"$150 copay, days 6-20"	$10 copay	$100 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$10 copay	$30 copay	"$30 copay Group, $30 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$30 copay	Not Covered	Varies	Varies											163.6363636	114.9425287	66.2299152	10	100	0.2	0.2	45	0.199611293	4.658659994	36.63264666	0	0.2	59.68752126	7.152170146	20.40989032	30	33	4.497421775	4.355848034	0.2	0	0	4	0	20	30	0	0	0											NO	105.4819116	114.9425287	56.29704173	5.428506363	100	0.136888685	0.181866952	45	0.168914812	4.658659994	32.57302807	0	0.2	52.68953297	4.005925798	17.26364598	30	33	1.630128552	3.043888176	0.2	0	0	4	0	20	30	0	0	0												12.959	0.393885636	6.000454026	1.039208713	1.726880132	1.247121504	1.863952282	0.924909671	5.270501587	0.540452831	4.105941827	0	0.188572173	2.519721821	2.416600119	13.61684506	0.415497937	1.671836337	0.556467759	2.603988159	1.115963515	0	0	0.974970435	0	0.262889818	0.381667877	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7973		18.1241744	12.959	0.393885636	6.000454026	1.039208713	1.726880132	1.247121504	1.863952282	0.924909671	5.270501587	0.540452831	4.105941827	0	0.188572173	2.519721821	2.416600119	13.61684506	0.415497937	1.671836337	0.556467759	2.603988159	1.115963515	0	0	0.974970435	0	0.262889818	0.381667877	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7973	NO																																																																																		0			12.959	0.393885636	6.000454026	1.039208713	1.726880132	1.247121504	1.863952282	0.924909671	5.270501587	0.540452831	4.105941827	0	0.188572173	2.519721821	2.416600119	13.61684506	0.415497937	1.671836337	0.556467759	2.603988159	1.115963515	0	0	0.974970435	0	0.262889818	0.381667877	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7973
H5820_010_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1462.344851	41.03344979	1204.648367	2531.185346	215.8522112	9.047017674	10.16470186	245.560855	30.46932819	1386.959553	1501.333083	0	0.915704449	569.651661	6889.203385	8843.27288	154.8922265	566.6055727	3935.960968	9040.584953	5.421739294	87.20780144	0	2924.911305	197.328224	148.076714	141.8137229	0	5955	307.2173552											3400	"$900 copay, days 1-1"	"$900 copay, days 1-1"	"$150 copay, days 6-20"	$10 copay	$100 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$10 copay	$30 copay	"$30 copay Group, $30 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$30 copay	Not Covered	Varies	Varies											163.6363636	114.9425287	66.2299152	10	100	0.2	0.2	45	0.199596177	4.559425917	36.49917582	0	0.2	59.36533225	6.997316565	20.43509886	30	33	4.493279207	4.511767085	0.2	0	0	4	0	20	30	0	0	0											NO	108.9892503	114.9425287	56.39988629	6.132785601	100	0.140761587	0.182958117	45	0.170295994	4.559425917	32.68672293	0	0.2	52.79429784	3.883587411	17.3213697	30	33	1.711765988	3.123170871	0.2	0	0	4	0	20	30	0	0	0												13.2817	0.393040707	5.661835912	1.29360142	1.798768426	1.273472567	1.859714713	0.920853206	5.188804536	0.526978278	4.089471543	0	0.18314089	2.506196621	2.229568628	12.76479991	0.387230566	1.558165325	0.561453676	2.352940965	1.084347859	0	0	0.974970435	0	0.246794523	0.354534307	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4923		16.89346112	13.2817	0.393040707	5.661835912	1.29360142	1.798768426	1.273472567	1.859714713	0.920853206	5.188804536	0.526978278	4.089471543	0	0.18314089	2.506196621	2.229568628	12.76479991	0.387230566	1.558165325	0.561453676	2.352940965	1.084347859	0	0	0.974970435	0	0.246794523	0.354534307	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4923	NO																																																																																		0			13.2817	0.393040707	5.661835912	1.29360142	1.798768426	1.273472567	1.859714713	0.920853206	5.188804536	0.526978278	4.089471543	0	0.18314089	2.506196621	2.229568628	12.76479991	0.387230566	1.558165325	0.561453676	2.352940965	1.084347859	0	0	0.974970435	0	0.246794523	0.354534307	0	0	0	0	0	0	0	0	0	0	0	0	0	61.4923
H5820_011_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1653.307075	45.4471172	797.9072394	2059.020853	204.1876324	8.659920374	9.734338585	380.1527169	32.51799895	924.0992305	1012.193595	0	0.985604919	384.3969797	11264.14276	15597.15292	277.4547814	1017.517397	7042.996434	18398.61243	5.816674429	9.565340854	0	2924.911305	217.109091	162.9204385	0.233105755	0	5955	39.09447647											3400	"$300 copay, days 1-7"	"$300 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$15 copay	$40 copay	"$40 copay Group, $40 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$40 copay	Not Covered	Varies	Varies											192.9872727	198.3793103	66.2299152	20	125	0.2	0.2	45	0.199655723	5.054891403	37.13091657	0	0.2	62.3084527	11.63093911	25.12756649	40	43	4.497685666	4.59052275	0.2	0	0	4	0	20	40	0	0	0											NO	123.4416481	198.3793103	44.87641878	13.15981634	125	0.110956696	0.174395749	45	0.16015403	5.054891403	28.99466691	0	0.2	48.29744238	9.006978746	22.50360612	40	43	2.261124637	3.60878894	0.2	0	0	4	0	20	40	0	0	0												17.0072	0.751313981	2.983934952	2.258028022	2.126954504	0.960876155	1.697627265	1.425572688	5.207888594	0.389268438	2.445684678	0	0.197120984	1.547115915	8.454657867	29.24934883	0.924849271	3.646104005	1.327091063	5.533059087	1.163334886	0	0	0.974970435	0	0.271534064	0.000777019	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5444		24.30664102	17.0072	0.751313981	2.983934952	2.258028022	2.126954504	0.960876155	1.697627265	1.425572688	5.207888594	0.389268438	2.445684678	0	0.197120984	1.547115915	8.454657867	29.24934883	0.924849271	3.646104005	1.327091063	5.533059087	1.163334886	0	0	0.974970435	0	0.271534064	0.000777019	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5444	NO																																																																																		0			17.0072	0.751313981	2.983934952	2.258028022	2.126954504	0.960876155	1.697627265	1.425572688	5.207888594	0.389268438	2.445684678	0	0.197120984	1.547115915	8.454657867	29.24934883	0.924849271	3.646104005	1.327091063	5.533059087	1.163334886	0	0	0.974970435	0	0.271534064	0.000777019	0	0	0	0	0	0	0	0	0	0	0	0	0	90.5444
H5820_013_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1394.090587	38.71874172	1217.038538	2402.578077	219.9835205	8.719426607	9.800858269	238.8665844	34.94557833	1345.365531	1466.306606	0	1.058535989	556.2639902	6940.069666	9344.445335	169.29043	620.1463857	4228.81124	10723.75132	6.231469477	85.20481546	0	2924.911305	205.907712	154.514832	148.0004171	0	5955	320.9838606											3400	"$900 copay, days 1-1"	"$900 copay, days 1-1"	"$150 copay, days 6-20"	$10 copay	$100 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$10 copay	$30 copay	"$30 copay Group, $30 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$30 copay	Not Covered	Varies	Varies											163.6363636	114.9425287	66.2299152	10	100	0.2	0.2	45	0.199691491	5.39506241	37.47049531	0	0.2	62.44454587	7.360045586	20.81759359	30	33	4.491567916	4.368010632	0.2	0	0	4	0	20	30	0	0	0											NO	102.4602076	114.9425287	55.84586174	5.651886802	100	0.134404042	0.181137282	45	0.172427017	5.39506241	33.30455633	0	0.2	55.26299375	4.149644869	17.60719288	30	33	1.728638658	3.118666941	0.2	0	0	4	0	20	30	0	0	0												11.9032	0.370869174	5.663880493	1.13159161	1.833196004	1.171926178	1.775300831	0.895749692	6.025561814	0.604860917	4.06955758	0	0.211707198	2.561734451	2.39990204	13.71078761	0.423226075	1.705402561	0.609173882	2.786984061	1.246293895	0	0	0.974970435	0	0.25752472	0.370001043	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7034		18.02913085	11.9032	0.370869174	5.663880493	1.13159161	1.833196004	1.171926178	1.775300831	0.895749692	6.025561814	0.604860917	4.06955758	0	0.211707198	2.561734451	2.39990204	13.71078761	0.423226075	1.705402561	0.609173882	2.786984061	1.246293895	0	0	0.974970435	0	0.25752472	0.370001043	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7034	NO																																																																																		0			11.9032	0.370869174	5.663880493	1.13159161	1.833196004	1.171926178	1.775300831	0.895749692	6.025561814	0.604860917	4.06955758	0	0.211707198	2.561734451	2.39990204	13.71078761	0.423226075	1.705402561	0.609173882	2.786984061	1.246293895	0	0	0.974970435	0	0.25752472	0.370001043	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7034
H5820_026_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1450.631777	40.14864359	1326.133127	2243.90502	169.4006153	8.481497466	9.564624592	238.8682733	31.18481392	1338.219461	1464.028904	0	0.943974454	556.0046035	7282.936178	9450.283243	168.6956681	618.1297017	4063.433685	9927.733718	5.580570764	85.20254327	0	2924.911305	208.052584	156.1243615	150.0763716	0	5955	333.1816695											3400	"$300 copay, days 1-7"	"$300 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$15 copay	$40 copay	"$40 copay Group, $40 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$40 copay	Not Covered	Varies	Varies											192.9872727	198.3793103	66.2299152	20	125	0.2	0.2	45	0.199628891	4.811302068	36.85195349	0	0.2	61.4015036	11.23148744	25.37638724	40	43	4.506701244	4.999410376	0.2	0	0	4	0	20	40	0	0	0											NO	112.5576457	198.3793103	53.19271954	13.63096049	125	0.107744444	0.173557622	45	0.157831779	4.811302068	31.14389907	0	0.2	51.57224101	6.957289529	21.10218933	40	43	0.573058174	3.153210982	0.2	0	0	4	0	20	40	0	0	0												13.6066	0.663721686	5.878385623	2.548881723	1.764589743	0.913834226	1.660013501	0.895756025	4.921954675	0.536548172	3.799630702	0	0.188794891	2.389533618	4.222457968	16.61847218	0.562318894	2.214964765	0.194048657	2.608686582	1.116114153	0	0	0.974970435	0	0.260207269	0.500254572	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0408		24.66464405	13.6066	0.663721686	5.878385623	2.548881723	1.764589743	0.913834226	1.660013501	0.895756025	4.921954675	0.536548172	3.799630702	0	0.188794891	2.389533618	4.222457968	16.61847218	0.562318894	2.214964765	0.194048657	2.608686582	1.116114153	0	0	0.974970435	0	0.260207269	0.500254572	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0408	NO																																																																																		0			13.6066	0.663721686	5.878385623	2.548881723	1.764589743	0.913834226	1.660013501	0.895756025	4.921954675	0.536548172	3.799630702	0	0.188794891	2.389533618	4.222457968	16.61847218	0.562318894	2.214964765	0.194048657	2.608686582	1.116114153	0	0	0.974970435	0	0.260207269	0.500254572	0	0	0	0	0	0	0	0	0	0	0	0	0	69.0408
H5820_027_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1423.977661	39.34571263	1212.085832	2215.571033	211.0561909	8.996431945	10.1163561	239.5757541	30.11593688	1342.767908	1468.03429	0	0.91108302	557.5318416	6975.141551	9267.509899	158.7494926	580.0824236	4000.074437	10193.60902	5.39306087	85.43403018	0	2924.911305	208.052584	156.1243615	145.7543452	0	5955	324.146214											3400	"$300 copay, days 1-7"	"$300 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$15 copay	$40 copay	"$40 copay Group, $40 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$40 copay	Not Covered	Varies	Varies											192.9872727	198.3793103	66.2299152	20	125	0.2	0.2	45	0.199609276	4.631072236	36.64663629	0	0.2	60.72604706	11.27113457	24.85722157	40	43	4.508548836	4.617044531	0.2	0	0	4	0	20	40	0	0	0											NO	115.1814288	198.3793103	52.68488166	13.87459389	125	0.117408202	0.176259685	45	0.158509903	4.631072236	31.24103874	0	0.2	51.41771642	7.089757229	20.67584423	40	43	0.713982006	2.909614544	0.2	0	0	4	0	20	40	0	0	0												13.668	0.650447945	5.321549887	2.561679027	2.198501988	1.056254897	1.783105738	0.898409078	4.773674224	0.518204598	3.821909678	0	0.182216604	2.388917844	4.12100502	15.96779925	0.529164975	2.078628684	0.237998431	2.471622755	1.078612174	0	0	0.974970435	0	0.260207269	0.485847817	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0287		23.42162399	13.668	0.650447945	5.321549887	2.561679027	2.198501988	1.056254897	1.783105738	0.898409078	4.773674224	0.518204598	3.821909678	0	0.182216604	2.388917844	4.12100502	15.96779925	0.529164975	2.078628684	0.237998431	2.471622755	1.078612174	0	0	0.974970435	0	0.260207269	0.485847817	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0287	NO																																																																																		0			13.668	0.650447945	5.321549887	2.561679027	2.198501988	1.056254897	1.783105738	0.898409078	4.773674224	0.518204598	3.821909678	0	0.182216604	2.388917844	4.12100502	15.96779925	0.529164975	2.078628684	0.237998431	2.471622755	1.078612174	0	0	0.974970435	0	0.260207269	0.485847817	0	0	0	0	0	0	0	0	0	0	0	0	0	68.0287
H5820_028_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1458.005811	40.42412661	1267.743008	2588.916233	214.0510546	9.753654042	10.96462597	256.6179368	32.05198483	1438.980197	1566.524756	0	0.963336529	595.0459161	6943.683964	9107.802192	154.9941817	566.023967	4143.123775	9317.317061	5.702499157	91.13678962	0	2924.911305	208.052584	156.1243615	142.1962307	0	5955	316.4966801											3400	"$300 copay, days 1-7"	"$300 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$15 copay	$40 copay	"$40 copay Group, $40 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$40 copay	Not Covered	Varies	Varies											192.9872727	198.3793103	66.2299152	20	125	0.2	0.2	45	0.199599504	4.589812659	36.57519924	0	0.2	60.62941817	11.03906371	24.81043321	40	43	4.502502383	4.800197453	0.2	0	0	4	0	20	40	0	0	0											NO	113.1902321	198.3793103	52.63073019	14.4953056	125	0.120003586	0.176998963	45	0.159047969	4.589812659	31.25566888	0	0.2	51.47097522	6.595906456	20.36727596	40	43	0.655406438	2.83859657	0.2	0	0	4	0	20	40	0	0	0												13.7527	0.668275863	5.560186682	3.127260998	2.229698485	1.17047346	1.940727429	0.962317263	5.097803098	0.55038746	4.080231589	0	0.192667306	2.552299467	3.816657491	15.45842672	0.516647272	2.028252548	0.226285833	2.204008688	1.140499831	0	0	0.974970435	0	0.260207269	0.473987436	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9849		24.59504666	13.7527	0.668275863	5.560186682	3.127260998	2.229698485	1.17047346	1.940727429	0.962317263	5.097803098	0.55038746	4.080231589	0	0.192667306	2.552299467	3.816657491	15.45842672	0.516647272	2.028252548	0.226285833	2.204008688	1.140499831	0	0	0.974970435	0	0.260207269	0.473987436	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9849	NO																																																																																		0			13.7527	0.668275863	5.560186682	3.127260998	2.229698485	1.17047346	1.940727429	0.962317263	5.097803098	0.55038746	4.080231589	0	0.192667306	2.552299467	3.816657491	15.45842672	0.516647272	2.028252548	0.226285833	2.204008688	1.140499831	0	0	0.974970435	0	0.260207269	0.473987436	0	0	0	0	0	0	0	0	0	0	0	0	0	68.9849
H5820_029_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1420.537915	39.1164866	1230.35997	2418.61979	239.572849	9.170116068	10.30087828	250.7136934	34.44041294	1403.903423	1535.248198	0	1.04116744	583.0774702	7086.325799	9711.14624	170.4672989	624.0657105	4367.950016	11050.25941	6.143641639	89.34056597	0	2924.911305	208.052584	156.1243615	148.7425261	0	5955	331.0295886											3400	"$300 copay, days 1-7"	"$300 copay, days 1-7"	"$150 copay, days 6-20"	$20 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	5-25% coinsurance to Varies	Varies	$0 copay	20% coinsurance	Varies	$15 copay	$40 copay	"$40 copay Group, $40 copay Individual"	Varies	Varies	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$0 copay	$10 copay; and $100 credit covered every 1years	$40 copay	Not Covered	Varies	Varies											192.9872727	198.3793103	66.2299152	20	125	0.2	0.2	45	0.199654502	5.060852481	37.12905004	0	0.2	62.35828739	11.55410411	25.14525377	40	43	4.501296209	4.654511662	0.2	0	0	4	0	20	40	0	0	0											NO	106.6860111	198.3793103	51.46483374	13.7912018	125	0.110342429	0.17420171	45	0.159887962	5.060852481	31.40957863	0	0.2	52.50979401	7.080197232	20.67134689	40	43	0.656200094	2.911689861	0.2	0	0	4	0	20	40	0	0	0												12.6293	0.64665847	5.276689276	2.779639467	2.49555051	1.01185288	1.794430614	0.94017635	5.506607418	0.59207901	4.018458251	0	0.208233488	2.551439821	4.181048692	16.72853939	0.56822433	2.236235463	0.238854101	2.681244024	1.228728328	0	0	0.974970435	0	0.260207269	0.49580842	0	0	0	0	0	0	0	0	0	0	0	0	0	70.045		25.91621567	12.6293	0.64665847	5.276689276	2.779639467	2.49555051	1.01185288	1.794430614	0.94017635	5.506607418	0.59207901	4.018458251	0	0.208233488	2.551439821	4.181048692	16.72853939	0.56822433	2.236235463	0.238854101	2.681244024	1.228728328	0	0	0.974970435	0	0.260207269	0.49580842	0	0	0	0	0	0	0	0	0	0	0	0	0	70.045	NO																																																																																		0			12.6293	0.64665847	5.276689276	2.779639467	2.49555051	1.01185288	1.794430614	0.94017635	5.506607418	0.59207901	4.018458251	0	0.208233488	2.551439821	4.181048692	16.72853939	0.56822433	2.236235463	0.238854101	2.681244024	1.228728328	0	0	0.974970435	0	0.260207269	0.49580842	0	0	0	0	0	0	0	0	0	0	0	0	0	70.045
H5820_801_0	2010	3	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			18.77	0.21	0	0	0.28	0.29	0.33	0.29	1.03	0.18	0.8	0	0.03	0.54	1.52	3.2	0.05	0.18	1.08	1.23	0.18	0.09																			30.28	NO	1394.272671	39.05934904	1171.643813	2699.492361	8.512021062	8.933961286	10.04097063	8.90755209	31.14738248	5.370693281	24.35514272	0	0.94829208	16.23097245	46.173521	97.01738034	1.363842588	5.309017796	32.83776604	37.14613301	5.563123012	2.740045663	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											11.75029849	4.773388001	76.9428474	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	0											NO	11.75029849	4.773388001	76.9428474	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	0												1.3653	0.015537119	7.51246759	0	1.702404212	1.786792257	2.008194126	1.781510418	6.229476496	1.074138656	4.871028544	0	0.189658416	3.24619449	9.234704201	19.40347607	0.272768518	1.061803559	6.567553208	7.429226602	1.112624602	0.548009133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.4128	Medicare Standard Deductible(s)		20.1353	0.225537119	7.51246759	0	1.982404212	2.076792257	2.338194126	2.071510418	7.259476496	1.254138656	5.671028544	0	0.219658416	3.78619449	10.7547042	22.60347607	0.322768518	1.241803559	7.647553208	8.659226602	1.292624602	0.638009133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.6928	NO																																																																																		0			20.1353	0.225537119	7.51246759	0	1.982404212	2.076792257	2.338194126	2.071510418	7.259476496	1.254138656	5.671028544	0	0.219658416	3.78619449	10.7547042	22.60347607	0.322768518	1.241803559	7.647553208	8.659226602	1.292624602	0.638009133	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.6928
H5821_001_0	2010	5	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	P	P	P	P	P	P	P																																																			0	NO	182.3685455	128.9576814	37.46562642			1290.878375	1794.82323	3.775558462			0.134841374						288.5158266	4020.914401	4469.641974	14861.28806	1375.452124	727.6112981																				1a (IP Acute) - $85	1b (IP Psych) - Medicare costshare	2 (SNF) - Medicare costshare	6 (Home Health)- $0	10a (Ambulance) - $0	"11a-11c (DME,supplies,prosth/orthotics,diabetic monitoring supplies) - 20%"	"11a-11c (DME,supplies,prosth/orthotics,diabetic monitoring supplies) - 20%"	4 (ER) -$25 (UC) - $25	"9a,9b - $0"	8a (OP Diag Proc/Test/Lab) - $3	"8b (OP Radiation Therapy,OP nuclear med,CT Scan,MRI,Diagnostic Radiology,Other Imaging) - $3"	5 - 0%	12 (OP - Other Renal Dialysis) - 0%	"3,9d - $0, 9c - 20%"	"7a,14b-14j - $0"	"7b,7d,7f,7g - $0"	"7e,7h - 42%"	"7c,7i - $3"	(Prof/Specialist) Radiology - $3	"(Prof/Specialist) Lab/Path - $3; Cardiovascular, chemo, other med - $0"	15 (Part B Rx) - $25	"13a,13b,14a - 0%"	10b (Transportation) - 0%	"16a, 16b - 0%"	17a (Routine Eye Exam) - 0%	17b (Eyewear) - 0%	"18a (Hearing Exam), (Routine Hearing Exam) - 0%"	18b (Hearing Aids) - 0%	14a (Health & Education) - 0%	(other)											85	3.258811428	50.1599519			15.79449102	16.99673923	25			3						61.50644737	3	3	3	25	67.3226752																			NO	85	3.258811428	50.1599519			15.79449102	16.99673923	25			3						61.50644737	3	3	3	25	67.3226752																				1.2918	0.03502073	0.156606168	0	0	1.69906391	2.542178533	0.007865747	0	0	3.37E-05	0	0	0	0	0	1.478798625	1.0052286	1.117410494	3.715322014	2.865525259	4.082061591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9969	0	0	1.2918	0.03502073	0.156606168	0	0	1.69906391	2.542178533	0.007865747	0	0	3.37E-05	0	0	0	0	0	1.478798625	1.0052286	1.117410494	3.715322014	2.865525259	4.082061591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	19.9969	NO	"1a (IP Acute), (Add'l Days) - 20%"	1b (IP Psych) - 20%	2 (SNF) - 20%	6 (Home Health)- 0%	10a (Ambulance) - 0%	11a - 11c (Medical Equip) - 0%	"11a - 11c (Med Supp), (Diab Supp) - 0%"	"4 (ER), (UC) - 0%"	"9a,9b (OP Surg/ASC) - 20%"	8a (OP Diag Proc/Test/Lab) - 20%	8b (OP Diag & Therap Rad) - 20%	5 (OP Observation) -20%	12 (Renal Dialysis) - 0%	"3,9c,9d (OP Other) - 20%"	7a(PCP) - 20% 14b-14j (Nutrition Therap) - 0%	"7b,7d,7f,7g (Spec) - 20%"	"7e (MH), 7h (Psychiatric) -0%"	"7c (OT), 7i (PT/ST) - 20%"	(Prof/Specialist Radiology) - 20%	"(Prof/Specialist) Lab/Path, Cardiovascular, chemo, other med - 20%"	15 (Part B Rx) - 0%	"13a (Blood), 14a (Education/Wellness), 16b(Comp Den),  17a (Eye Exam), 17b (MCR Eyewear), 18a (MCR Hearing Exam) - 20% 14j (Nutrient Therapy) - 0%"	10b(Transportation) - 0%	16a(Preventative Den) - 20%	17a1(Routine Eye Exam) - 20%	17b1(Non MCR Covered) - 20%	"18a(Hearing Exam), 18a1(Routine Hearing Exam) - 20%"	18b(Hearing Aids) - 20%	14a (Health & Education) - 20%	(Other) - 0%												1.2961								0.0523						1.5705	1.3545		0.3507	0.4021	1.8496		0.2319		0.0233	0.0216			0.0034													7.1561	0	0	2.5879	0.03502073	0.156606168	0	0	1.69906391	2.542178533	0.007865747	0.052308473	0	3.37E-05	0	0	0	1.570537514	1.354529919	1.478798625	1.35594961	1.519554642	5.564883062	2.865525259	4.313983539	0	0.023297281	0.021592782	0	0	0.003377497	0	0	0	0	0	0	0	0	0	0	0	0	27.153
H5821_004_0	2010	5	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	P	P	P	P	P	P	P																																																			0	NO						2064.309857	1587.690451	8.058621109																																		"1a (IP Acute) , (Add'l Days) - 0%"	1b (IP Psych) - 0%	"2 (SNF), 2a2 (Waiver 3 Day) - 0%"	6 (Home Health)- $0	10a (Ambulance) - 0%	11a (Medical Equip) - 20%	"11b (Med Supp) - 20%, (Diab Supp) - 0%"	"4 (ER), -$25"	9b (OP Surg/ASC) - 0%	8a (OP Diag Proc/Test/Lab) - 0%	8b (OP Diag & Therap Rad) - 0%	9a (OP Observation) -0%	12 (Renal Dialysis) - 0%	(OP - Other) - 0%	7 (PCP) - 0%	7d (Specialist) - 0%	"7e (MH),(Psychiatric) -0%"	"7c(OT), 7i (PT/ST) - 0%"	Professional Radiology - 0%	7g (Prof Others) - 0%	15 (Part B Rx) - 0%	"13a (Blood), 14a (Education/Wellness) - 0%"	10b (Transportation) - 0%	16a (Preventative Den) - 0%	17a (Routine Eye Exam) - 0%	17b (Non MCR Covered) - 0%	"18a (Hearing Exam), (Routine Hearing Exam) - 0%"	18b (Hearing Aids) - 0%	14a (Health & Education)  - 0%	(Other)																15.39306095	15.99815571	25																																	NO						15.39306095	15.99815571	25																																		0	0	0	0	0	2.648003955	2.116676588	0.016788794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.7815	0	0	0	0	0	0	0	2.648003955	2.116676588	0.016788794	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.7815	NO	"1a (IP Acute) , (Add'l Days) - 20%"	1b (IP Psych) - 0%	"2 (SNF), (Waiver 3 Day) - 20%"	6 (Home Health)- 0%	10a (Ambulance) - 0%	11a (Medical Equip) - 0%	"11b (Med Supp), (Diab Supp) - 0%"	"4 (ER), 4(b) - 0%"	9b (OP Surg/ASC) - 20%	8a (OP Diag Proc/Test/Lab) - 20%	8b (OP Diag & Therap Rad) - 20%	9a (OP Observation) -20%	12 (Renal Dialysis) - 20%	(OP Other) - 20%	7 (PCP) - 20% ;	7d (Spec) - 20%	7e (MH) / (SA) - 0%	"7c (OT), (PT/ST) - 20%"	Professional Radiology - 20%	7g (Prof Others) - 20%	15 (Part B Rx) - 0%	13a (Blood) - 20% (Nutrient Therapy) - 0%	10b (Transportation) - 0%	16a (Preventative Den) - 20%	17a (Routine Eye Exam) - 20%	17b (Non MCR Covered) - 20%	"18a (Hearing Exam), 18a1(Routine Hearing Exam) - 20%"	18b (Hearing Aids) - 20%	14a (Health & Education) - 20%	(Other) - 20%												1.3547						0.3516		0.0286						1.9309	2.4512		0.4264	0.6031	2.0593		0.2112		0.2163	0.0203			0.0172													9.6708	0	0	1.3547	0	0	0	0	2.648003955	2.4682628	0.016788794	0.02856545	0	0	0	0	0	1.930870807	2.451152183	0	0.426446123	0.603143964	2.059255149	0	0.21118294	0	0.216309784	0.020279758	0	0	0.017227492	0	0	0	0	0	0	0	0	0	0	0	0	14.4522
H5821_013_0	2010	8	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	P	P	P	P	P	P	P																																																			0	NO						1420.605223	1285.444137	3.985934426											4021.481983	18127.42542	1954.463237	937.3619255		1497.474381																		"1a (IP Acute) , (Add'l Days) - 0%"	1b (IP Psych) - 0%	"2 (SNF), 2a2 (Waiver 3 Day) - 0%"	6 (Home Health)- $0	10a (Ambulance) - 0%	11a (Medical Equip) - 20%	"11b (Med Supp) - 20%, (Diab Supp) - 0%"	"4 (ER), (UC) -$25"	9b (OP Surg/ASC) - 0%	8a (OP Diag Proc/Test/Lab) - $5	8b (OP Diag & Therap Rad) - $5	9a (OP Observation) - 0%	12 (Renal Dialysis) - 0%	(OP - Other) - 0%	7 (PCP) - 0%	7d (Specialist) - 0%	"7e (MH),(Psychiatric) -0%"	"7c(OT), 7i (PT/ST) - 0%"	Professional Radiology - 0%	7g (Prof Others) - 0%	15 (Part B Rx) - $19	"13a (Blood), 14a (Education/Wellness) - 0%; 17b Med Cov Eyewear, 16b Comp Dental (exluding Diagnostic, ER) - 50%"	10b (Transportation) - 0%	16a (Preventative Den) - 0%	17a (Routine Eye Exam) - 0%	17b (Non MCR Covered) - 0%	"18a (Hearing Exam), (Routine Hearing Exam) - 0%"	18b (Hearing Aids) - 0%	14a (Health & Education)  - 0%	(Other)																15.81745535	14.96478015	25											5	5	19	65.33887842		39.00125369																	NO						15.81745535	14.96478015	25											5	5	19	65.33887842		39.00125369																		0	0	0	0	0	1.872529974	1.603032408	0.00830403	0	0	0	0	0	0	0	0	0	0	1.675617493	7.553093923	3.094566791	5.103848074	0	4.866948187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.7779	0	0	0	0	0	0	0	1.872529974	1.603032408	0.00830403	0	0	0	0	0	0	0	0	0	0	1.675617493	7.553093923	3.094566791	5.103848074	0	4.866948187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	25.7779	NO	"1a (IP Acute) , (Add'l Days) - 20%"	1b (IP Psych) - 0%	"2 (SNF), (Waiver 3 Day) - 20%"	6 (Home Health)- 0%	10a (Ambulance) - 0%	11a (Medical Equip) - 0%	"11b (Med Supp), (Diab Supp) - 0%"	"4 (ER), (UC) 4(b) - 0%"	9b (OP Surg/ASC) - 20%	8a (OP Diag Proc/Test/Lab) - 20%	8b (OP Diag & Therap Rad) - 20%	9a (OP Observation) -20%	12 (Renal Dialysis) - 0%	(OP Other) - 20%	7 (PCP) - 20% ;	7d (Spec) - 20%	7e (MH) / (SA) - 0%	"7c (OT), (PT/ST) - 20%"	Professional Radiology - 20%	7g (Prof Others) - 20%	15 (Part B Rx) - 0%	13a (Blood) - 20% (Nutrient Therapy) - 0%	10b (Transportation) - 0%	16a (Preventative Den) - 20%	17a (Routine Eye Exam) - 20%	17b (Non MCR Covered) - 20%	"18a (Hearing Exam), 18a1(Routine Hearing Exam) - 20%"	18b (Hearing Aids) - 20%	14a (Health & Education) - 20%	(Other) - 20%												1.439						0.4876		0.0511						1.5446	1.7822		0.5245	0.4989	1.611		0.2026		0.2242	0.0206			0.0012													8.3874	0	0	1.439	0	0	0	0	1.872529974	2.090653215	0.00830403	0.051105896	0	0	0	0	0	1.544575935	1.782204978	0	0.524499947	2.174468935	9.164132439	3.094566791	5.306441144	0	5.091106845	0.020622291	0	0	0.001187569	0	0	0	0	0	0	0	0	0	0	0	0	34.1654
H5821_804_0	2010	2	N/A																															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																																																			0	NO	1508.40077	11.26834967	1.239741183		1.373864144	15.31878731	28.56678227	0.097245362	9.225551766		0.022259662	0.009126462	0.013162092	0.427036361	63.98695852	66.99414213	2.428906995	8.821027502	45.95932312	81.5540539	16.61188783	17.00869289																				1a (IP Acute) - medicare cost share	1b (IP Psych) - medicare cost share	2 (SNF) - medicare cost share	6 (Home Health) 0%	10a (Ambulance) - medicare cost share	11a (Medical Equip) - medicare cost share	"11b (Med Supp), 11c (Diab Supp) - medicare cost share"	"4a (ER) -23%, 4(b) -medicare cost share"	9b (OP Surg/ASC) - medicare cost share	8a (OP Diag Proc/Test/Lab) - medicare cost share	8b (OP Diag & Therap Rad) - medicare cost share	9a (OP Observation) -medicare cost share	12 (Renal Dialysis) - medicare cost share	"3 (CORF), 5 (Partial Hospital),9a (OP Other), 9c (OP SA), 9d (Cardiac Rehab) - medicare cost share"	"7a (PCP), 7a(UC w/o Copay), 7a(PCP w/o Copay), 14b (Immunizations), 14c(Routine Physical), 14d (Pap & Pelvic),14e (Prostrate Screen), 14f (Colorectal Screen), 14g (Bone Mass), 14h (Mamm), 14i (Diab Mon.), 14j (Nutrition Therap) - medicare cost share"	"7b (Chiro), 7d (Spec), 7f (Pod) - medicare cost share"	"7e (MH), 7h (Psychiatric) -medicare cost share"	"7c (OT), 7i (PT/ST) - medicare cost share"	Professional Radiology - medicare cost share	7g (Prof Others) - medicare cost share	15 (Part B Rx) - medicare cost share	"13a (Blood), 14a (Education/Wellness), 14j (Nutrient Therapy), 16b(Comp Den),  17a (Eye Exam), 17b (MCR Eyewear), 18a (MCR Hearing Exam) - medicare cost share"	10b(Transportation) - medicare cost share	16a(Preventative Den) - medicare cost share	17a1(Routine Eye Exam) - medicare cost share	17b1(Non MCR Covered) - medicare cost share	"18a(Hearing Exam), 18a1(Routine Hearing Exam) - medicare cost share"	18b(Hearing Aids) - medicare cost share	19a (Health & Education) - medicare cost share	13b (Other) - medicare cost share											120.4306369	73.24030089	0.153278496		0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	120.4306369	73.24030089	0.153278496		0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				15.1381	0.068774777	0.190025664	0	0.320110345	3.569277442	6.65606027	0.022658169	2.149553562	0	0.005186501	0.002126466	0.003066767	0.099499472	14.90896133	15.60963512	0.56593533	2.055299408	10.70852229	19.00209456	3.870569865	3.963025442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9085	0	0	15.1381	0.068774777	0.190025664	0	0.320110345	3.569277442	6.65606027	0.022658169	2.149553562	0	0.005186501	0.002126466	0.003066767	0.099499472	14.90896133	15.60963512	0.56593533	2.055299408	10.70852229	19.00209456	3.870569865	3.963025442	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9085	NO	1a (IP Acute) - medicare cost share	1b (IP Psych) - medicare cost share	2 (SNF) - medicare cost share	6 (Home Health) 0%	10a (Ambulance) - medicare cost share	11a (Medical Equip) - medicare cost share	"11b (Med Supp), 11c (Diab Supp) - medicare cost share"	"4a (ER) -23%, 4(b) -medicare cost share"	9b (OP Surg/ASC) - medicare cost share	8a (OP Diag Proc/Test/Lab) - medicare cost share	8b (OP Diag & Therap Rad) - medicare cost share	9a (OP Observation) -medicare cost share	12 (Renal Dialysis) - medicare cost share	"3 (CORF), 5 (Partial Hospital),9a (OP Other), 9c (OP SA), 9d (Cardiac Rehab) - medicare cost share"	"7a (PCP), 7a(UC w/o Copay), 7a(PCP w/o Copay), 14b (Immunizations), 14c(Routine Physical), 14d (Pap & Pelvic),14e (Prostrate Screen), 14f (Colorectal Screen), 14g (Bone Mass), 14h (Mamm), 14i (Diab Mon.), 14j (Nutrition Therap) - medicare cost share"	"7b (Chiro), 7d (Spec), 7f (Pod) - medicare cost share"	"7e (MH), 7h (Psychiatric) -medicare cost share"	"7c (OT), 7i (PT/ST) - medicare cost share"	Professional Radiology - medicare cost share	7g (Prof Others) - medicare cost share	15 (Part B Rx) - medicare cost share	"13a (Blood), 14a (Education/Wellness), 14j (Nutrient Therapy), 16b(Comp Den),  17a (Eye Exam), 17b (MCR Eyewear), 18a (MCR Hearing Exam) - medicare cost share"	10b(Transportation) - medicare cost share	16a(Preventative Den) - medicare cost share	17a1(Routine Eye Exam) - medicare cost share	17b1(Non MCR Covered) - medicare cost share	"18a(Hearing Exam), 18a1(Routine Hearing Exam) - medicare cost share"	18b(Hearing Aids) - medicare cost share	19a (Health & Education) - medicare cost share	13b (Other) - medicare cost share												0.6012				0.6574		0.8718		0.0595						2.0569	2.4658		0.6692	0.7654	2.2039	0.3276	0.3173			0.0004																10.9963	0	0	15.7393	0.068774777	0.190025664	0	0.977468632	3.569277442	7.527888177	0.022658169	2.209072374	0	0.005186501	0.002126466	0.003066767	0.099499472	16.96587913	18.07542482	0.56593533	2.724461451	11.47391741	21.20600384	4.198120168	4.280325818	0	0	0.000398802	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.9048
H5823_002_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	801.4019761	49.57123799	573.6819113	0	177.6927853	10.63648946	5.453168409	284.829285	321.0276148	0	576.964574	0	0.462233143	489.5972395	5183.134029	8158.754608	160.9254726	1265.449471	1545.057629	996.782432	12.46098163	0	0	2817.618887	370.9333796	0	0	0	0	0											3400	$250/Days 1-5 for IP Medical; $250/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$150/Days 11-27 for SNF	No Cost-Sharing	$125/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $30/Visit for Urgent Care;	$300/Case for OP Fac - Surgery; $300/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$30/Case for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $10/Visit for PCP - Consults; $3/Procedure for PCP - Asst Surgeon (OP); $10/Visit for PCP - Tx Injections; $10/Visit for PCP - Allergy Testing; $10/Visit for PCP - Allergy Tx;	$30/Visit for Speclst - Office Visits; $10/Procedure for Speclst - Asst Surgeon (OP); $30/Visit for Speclst - Tx Injections; $30/Visit for Speclst - Allergy Testing; $30/Visit for Speclst - Allergy Tx; $30/Visit for Speclst - Consults; $30/Visit for Speclst - Cardio;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	$23/Procedure for Prof Radiology (Office);	$15/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	$5/Visit for Dental: Preventive Services;	$25/Exam for Vision Exams (Refractions);	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											250	250	150	0	125	0.174442992	0.2	46.4605899	300	0	73.3405449	0	0.08	26.46333977	9.811269595	26.5397491	20	30	24.46075487	24.51195592	0.193640981	0	0	5.151304002	25	0	0	0	0	0											NO	243.3852952	243.3852952	146.0311771	0	121.6926476	0.169827436	0.194708236	45.23129754	292.0623542	0	71.40004067	0	0.077883295	25.76315105	9.551674985	25.83753867	19.47082361	29.20623542	23.81355217	23.86339851	0.188517469	0	0	5.01500658	24.33852952	0	0	0	0	0												16.2541	1.005409199	6.981287066	0	1.801992125	1.806367738	1.061776802	1.073599845	7.813340077	0	3.43294117	0	0.03600024	1.051130636	4.125634304	17.56684481	0.261112624	3.07991793	3.066109205	1.982218033	2.349112718	0	0	1.177531438	0.752331084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6788	0	2.083969315	16.2541	1.005409199	6.981287066	0	1.801992125	1.806367738	1.061776802	1.073599845	7.813340077	0	3.43294117	0	0.03600024	1.051130636	4.125634304	17.56684481	0.261112624	3.07991793	3.066109205	1.982218033	2.349112718	0	0	1.177531438	0.752331084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6788	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.2541	1.005409199	6.981287066	0	1.801992125	1.806367738	1.061776802	1.073599845	7.813340077	0	3.43294117	0	0.03600024	1.051130636	4.125634304	17.56684481	0.261112624	3.07991793	3.066109205	1.982218033	2.349112718	0	0	1.177531438	0.752331084	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.6788
H5823_004_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	600.5985922	11.06002676	305.5454728	0	177.8015399	8.012260459	4.99212632	217.1270998	333.7613415	0	461.0244869	0	0.466292299	398.2256934	4077.585183	6554.885463	157.3087939	440.614317	1667.040889	959.9126174	6.651248093	0	0	2388.956812	375.7566432	0	0	0	0	0											3300	$200/Days 1-5 for IP Medical; $200/Days 1-5 for IP Surgical;	$250/Days 1-5 for IP Psych; $250/Days 1-5 for IP Substance Abuse;	$150/Days 11-27 for SNF	No Cost-Sharing	$125/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $25/Visit for Urgent Care;	$300/Case for OP Fac - Surgery; $300/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$30/Case for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$5/Visit for PCP - Office Visits; $5/Visit for PCP - Consults; $2/Procedure for PCP - Asst Surgeon (OP); $5/Visit for PCP - Tx Injections; $5/Visit for PCP - Allergy Testing; $5/Visit for PCP - Allergy Tx;	$25/Visit for Speclst - Office Visits; $8/Procedure for Speclst - Asst Surgeon (OP); $25/Visit for Speclst - Tx Injections; $25/Visit for Speclst - Allergy Testing; $25/Visit for Speclst - Allergy Tx; $25/Visit for Speclst - Consults; $30/Visit for Speclst - Cardio;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	$23/Procedure for Prof Radiology (Office);	$15/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	$6/Visit for Dental: Preventive Services;	$25/Exam for Vision Exams (Refractions);	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											200	250	150	0	125	0.2	0.2	47.96673129	300	0	76.58166167	0	0.2	28.1351699	4.857516275	21.88350025	20	30	24.40056776	24.85474852	0.2	0	0	5.640019617	25	0	0	0	0	0											NO	193.7654707	242.2068385	145.3241031	0	121.1034192	0.193765471	0.193765471	46.47148134	290.6482061	0	74.19440862	0	0.193765471	27.2581222	4.706094638	21.20133363	19.37654707	29.06482061	23.63993749	24.07996023	0.193765471	0	0	5.46420528	24.22068384	0	0	0	0	0												9.6979	0.22323451	3.700260147	0	1.794364535	1.552499419	0.967301706	0.840851497	8.08392793	0	2.850453264	0	0.090351347	0.904573718	1.599125147	11.58102614	0.254008437	1.067198007	3.284061866	1.926221471	1.288782218	0	0	1.087812536	0.758423572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5524	0	1.723083618	9.6979	0.22323451	3.700260147	0	1.794364535	1.552499419	0.967301706	0.840851497	8.08392793	0	2.850453264	0	0.090351347	0.904573718	1.599125147	11.58102614	0.254008437	1.067198007	3.284061866	1.926221471	1.288782218	0	0	1.087812536	0.758423572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5524	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.6979	0.22323451	3.700260147	0	1.794364535	1.552499419	0.967301706	0.840851497	8.08392793	0	2.850453264	0	0.090351347	0.904573718	1.599125147	11.58102614	0.254008437	1.067198007	3.284061866	1.926221471	1.288782218	0	0	1.087812536	0.758423572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.5524
H5823_006_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	873.492275	1.001505467	125.7149407	0	39.50510224	5.072359433	2.592781992	64.87777537	33.92204262	7.427363787	7.154300186	0	0.214424743	10.63025583	38.61535089	131.8665676	2.018738279	3.218814105	24.23341385	29.06387558	3.490828847	0.389251793	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.071981851	0.071981851	0.144836415	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.071981851	0.071981851	0.144836415	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												62.8756	0.072090217	18.20810132	0	9.204688822	1.181859748	0.604118204	15.11652166	7.903835931	1.730575762	1.666951943	0	0.049960965	2.476849608	8.997376757	30.72491025	0.470366019	0.749983687	5.646385427	6.77188301	0.813363121	0.090695668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	175.3561	0	0	62.8756	0.072090217	18.20810132	0	9.204688822	1.181859748	0.604118204	15.11652166	7.903835931	1.730575762	1.666951943	0	0.049960965	2.476849608	8.997376757	30.72491025	0.470366019	0.749983687	5.646385427	6.77188301	0.813363121	0.090695668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	175.3561	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	62.8756	0.072090217	18.20810132	0	9.204688822	1.181859748	0.604118204	15.11652166	7.903835931	1.730575762	1.666951943	0	0.049960965	2.476849608	8.997376757	30.72491025	0.470366019	0.749983687	5.646385427	6.77188301	0.813363121	0.090695668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	175.3561
H5826_005_0	2010	4	N/A	Exclude										Exclude																				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																																																			0	NO	289.1805522	8.999700893	39.32332628		14.8716512	15.86597767	13.77446412	49.00857812	46.31921888	5.808542438	19.48593074	9.331066549	0.101767166	32.1408666	49.50385817	147.4134322	4.482587666	8.894355647	43.70148445	21.69945548	32.660879																					MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	4a1: 20%;MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	14c: 0%;MEDICARE FFS	7f: 0%;MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS		16: $1200 combined	17a1: $0/visit	17b1: $200/yr	18a1: $0/visit	18b: $2000 every 2 yrs	14a: $0/visit												0.072493399	0.072493399	0.145307961		0.233	0.233	0.233	0.232992455	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.072493399	0.072493399	0.145307961		0.233	0.233	0.233	0.232992455	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					20.9637	0.652418905	5.713992366	0	3.465094729	3.696772796	3.209450139	11.41862893	10.792378	1.353390388	4.540221863	2.174138506	0.02371175	7.488821917	11.53439895	34.34732969	1.044442926	2.072384866	10.18244588	5.055973127	7.609984807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.3397	0	0	20.9637	0.652418905	5.713992366	0	3.465094729	3.696772796	3.209450139	11.41862893	10.792378	1.353390388	4.540221863	2.174138506	0.02371175	7.488821917	11.53439895	34.34732969	1.044442926	2.072384866	10.18244588	5.055973127	7.609984807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.3397	NO																																																																																		0	0	0	20.9637	0.652418905	5.713992366	0	3.465094729	3.696772796	3.209450139	11.41862893	10.792378	1.353390388	4.540221863	2.174138506	0.02371175	7.488821917	11.53439895	34.34732969	1.044442926	2.072384866	10.18244588	5.055973127	7.609984807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	147.3397
H5826_006_0	2010	4	N/A	Exclude										Exclude																				D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																			0	YES	1030.943584	52.8460066	1071.561996		197.7481871	5.819274111	5.295531331	277.7640142	30.14135773		11.17563745	5.965549257	0.105505067	15.42859581		3907.57649	189.5216414	610.6624113	27.09732267	0.020344107	20.84161658																				3400	1b: Days 1-10: $225/day; Days 11-90: $0/day	1b: Days 1-10: $225/day; Days 11-90: $0/day	2: Days 1-20: $0/day; Days 21-55: $100/day;2: 3 day requirement waived	6: 0%	10a: $100/trip	11a: 20%	11b: 20%;11c: 0%	4a: $50/visit;4a1: 20%;4b: $40/visit	9a: 20%;9b: 20%	8a: 0%	8b: 20%	9a: 20%	12a: 20%	3: 20%;5: 20%;7c: $20/visit;7e: $20/visit;7i: $20/visit;9a: 20%;9c: 20%;9d: 20%;13a: 0%	7a: $0/visit;14c: 0%;14d: 0%;14e: 0%;14f: 0%;14g: 0%;14h: 0%;14j: 0%	7b: $20/visit;7d: $20/visit;7f: $20/visit;7f1: $0/visit;14c1: 0%;14j: 0%;16b: 20%;17a: $20/visit;18a: $20/visit	7e: $20/visit;7h: $20/visit	7c: $20/visit;7i: $20/visit	8b: 20%	7g: $20/visit;8a: 0%;12a: 20%;14b: 0%;14i: 0%	15: 20%	7d: $20/visit;17b: 20%			17a1: $0/visit	17b1: $100/3yrs			14a: $0/visit	13a1: 0%											201.3093141	145.7693639	19.78761749		100	0.2	0.2	48.84186717	0.2		0.2	0.2	0.2	0.171357255		20	20	20	0.2	0.2	0.2																				NO	175.6474904	126.9786429	17.23740761		87.10927965	0.174218559	0.174218559	42.55827911	0.174218559		0.174218559	0.174218559	0.174218559	0.14926807		17.42185593	17.42185593	17.42185593	0.174218559	0.174218559	0.174218559																					15.0902	0.55919285	1.539245908	0	1.435475178	1.013825552	0.922579839	0.985096537	5.251183919	0	1.947003455	1.039309397	0.018380941	2.302996721	0	5.673102888	0.275151561	0.886572713	4.720856517	0.003544321	3.630996414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2947	0	6.97	15.0902	0.55919285	1.539245908	0	1.435475178	1.013825552	0.922579839	0.985096537	5.251183919	0	1.947003455	1.039309397	0.018380941	2.302996721	0	5.673102888	0.275151561	0.886572713	4.720856517	0.003544321	3.630996414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2947	NO																																																																																		0	0	0	15.0902	0.55919285	1.539245908	0	1.435475178	1.013825552	0.922579839	0.985096537	5.251183919	0	1.947003455	1.039309397	0.018380941	2.302996721	0	5.673102888	0.275151561	0.886572713	4.720856517	0.003544321	3.630996414	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.2947
H5826_008_0	2010	4	N/A	Exclude										Exclude																				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																			0	YES	1063.764914	111.2789342	539.1707888		129.7278885	8.804671785	6.226928322	392.0635499	30.49513884		12.37332512	9.347109297	0.066575043	13.84281643		2698.147686	300.5001071	579.0032919	29.12740481	0.012837391	20.57499578																				3400	1b: Days 1-10: $160/day; Days 11-90: $0/day	1b: Days 1-10: $160/day; Days 11-90: $0/day	2: Days 1-20: $0/day; Days 21-55: $100/day;2: 3 day requirement waived	6: 0%	10a: $100/trip	11a: 20%	11b: 20%;11c: 0%	4a: $50/visit;4a1: 20%;4b: $40/visit	9a: 20%;9b: 20%	8a: 0%	8b: 15%	9a: 20%	12a: 20%	3: 20%;5: 20%;7c: $5/visit;7e: $5/visit;7i: $5/visit;9a: 20%;9c: 20%;9d: 20%;13a: 0%	7a: $0/visit;14c: 0%; 14d: 0%;14e: 0%;14f: 0%;14g: 0%;14h: 0%;14j: 0%	7b: $5/visit;7d: $5/visit;7f: $5/visit;7f1: $0/visit;14c1: 0%;14j: 0%;16b: 20%;17a: $5/visit;18a: $5/visit	7e: $5/visit;7h: $5/visit	7c: $5/visit;7i: $5/visit	8b: 15%	7g: $5/visit;8a: 0%;12a: 20%;14b: 0%;14i: 0%	15: 20%	7d: $5/visit;17b: 20%			17a1: $0/visit	17b1: $270/yr			14a: $0/visit	13a1: 0%;13b: $250/yr;13e: $250/yr											143.15329	103.6582144	19.78761749		100	0.2	0.2	49.52418705	0.2		0.15	0.2	0.2	0.164954407		5	5	5	0.15	0.2	0.2																				NO	124.5084731	89.99929883	17.18082882		86.82312288	0.173646246	0.173646246	43.00748404	0.173646246		0.130234684	0.173646246	0.173646246	0.143218567		4.341156144	4.341156144	4.341156144	0.130234684	0.173646246	0.173646246																					11.0373	0.834585505	0.771950085	0	0.938615034	1.528898201	1.081282726	1.405138905	5.295366373	0	1.611436091	1.623090438	0.011560506	1.982548337	0	0.976090034	0.108709824	0.209461975	3.793398371	0.002229165	3.572770775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7844	0	5.56	11.0373	0.834585505	0.771950085	0	0.938615034	1.528898201	1.081282726	1.405138905	5.295366373	0	1.611436091	1.623090438	0.011560506	1.982548337	0	0.976090034	0.108709824	0.209461975	3.793398371	0.002229165	3.572770775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7844	NO																																																																																		0	0	0	11.0373	0.834585505	0.771950085	0	0.938615034	1.528898201	1.081282726	1.405138905	5.295366373	0	1.611436091	1.623090438	0.011560506	1.982548337	0	0.976090034	0.108709824	0.209461975	3.793398371	0.002229165	3.572770775	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7844
H5826_009_0	2010	4	N/A	Exclude										Exclude																				Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																			0	NO	244.0976254	2.053199838	20.70648723		9.182200237	9.618866921	5.243680522	24.92308902	36.51851945	6.402211031	15.71142561	7.29298516	0.000928237	34.03536002		95.41577198	1.355722579	4.21136989	32.26796291	14.24874182	22.36311889									1.075694655												MEDICARE FFS	MEDICARE FFS	2: 3 day requirement waived;MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	11c: 0%;MEDICARE FFS	4a: $50/visit;4a1: 20%	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	7a: $0/visit;14j: 0%;MEDICARE FFS	7f1: 0%;14c1: 0%;14j: 0%;MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	MEDICARE FFS	14i: 0%;MEDICARE FFS	MEDICARE FFS	MEDICARE FFS							14a: $0/visit	13a1: 20%											0.072778902	0.072778902	0.144054141		0.233	0.233	0.233	0.079195081	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233									0.2											NO	0.072778902	0.072778902	0.144054141		0.233	0.233	0.233	0.079195081	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233									0.2												17.7652	0.149429629	2.982855234	0	2.139452655	2.241195993	1.221777562	1.973786044	8.508815031	1.49171517	3.660762167	1.699265542	0.000216279	7.930238885	0	22.23187487	0.315883361	0.981249184	7.518435357	3.319956843	5.210606701	0	0	0	0	0	0	0	0	0.215138931	0	0	0	0	0	0	0	0	0	0	91.5578	0	0	17.7652	0.149429629	2.982855234	0	2.139452655	2.241195993	1.221777562	1.973786044	8.508815031	1.49171517	3.660762167	1.699265542	0.000216279	7.930238885	0	22.23187487	0.315883361	0.981249184	7.518435357	3.319956843	5.210606701	0	0	0	0	0	0	0	0	0.215138931	0	0	0	0	0	0	0	0	0	0	91.5578	NO																																																																																		0	0	0	17.7652	0.149429629	2.982855234	0	2.139452655	2.241195993	1.221777562	1.973786044	8.508815031	1.49171517	3.660762167	1.699265542	0.000216279	7.930238885	0	22.23187487	0.315883361	0.981249184	7.518435357	3.319956843	5.210606701	0	0	0	0	0	0	0	0	0.215138931	0	0	0	0	0	0	0	0	0	0	91.5578
H5826_010_0	2010	8	N/A	Exclude										Exclude																				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																			0	YES	997.4418492	75.61963302	1019.317415		111.7891547	7.904329107	8.093456847	251.8253738	36.02481979		9.654899596	6.902731111	0.166026902	20.24656879	3461.299349	5314.251176	1.737613441	6.852870909	33.01552839	0.032014283	30.79445483																				4000	1a: Days 1-7: $250/day; Days 8-90: $0/day;1a1: Days 1-7: $250/day; Days 8-90: $0/day	1b: Days 1-7: $275/day; Days 8-90: $0/day	2: Days 1-20: $0/day; Days 21-60: $100/day;2: 3 day requirement waived	6: 0%	10a: $175/trip	11a: 20%	11b: 20%;11c: 0%	4a: $50/visit;4a1: 20%;4b: $40/visit	9a: 20%;9b: 20%	8a: 0%	8b: 20%	9a: 20%	12a: 20%	3: 20%;5: 20%;7c: 20%;7e: 20%;7i: 20%;9a: 20%;9c: 20%;9d: 20%;13a: 0%	7a: $20/visit;14c: 0%;14d: 0%;14e: 0%;14f: 0%;14g: 0%;14h: 0%;14j: 0%	7b: 20%;7d: $40/visit;7f: 20%;14c1: 0%;14j: 0%;16b: 20%;17a: 20%;18a: 20%	7e: 20%;7h: 20%	7c: 20%;7i: 20%	8b: 20%	7g: 20%;8a: 0%;12a: 20%;14b: 0%;14i: 0%	15: 20%	7d: $40/visit;17b: 20%			17a1: $0/visit	17b1: $145 every 2 yrs			14a: $0/visit	13a1: 0%											208.531657	146.7143286	19.78761749		175	0.2	0.2	48.06448354	0.2		0.2	0.2	0.2	0.2	20	33.11141636	0.200907365	0.2	0.2	0.2	0.2																				NO	182.2909989	128.0309346	19.78761749		175	0.174530921	0.174530921	48.06448354	0.174530921		0.174530921	0.174530921	0.174530921	0.174530921	20	32.59195516	0.175589718	0.174530921	0.174530921	0.174530921	0.174530921																					15.1521	0.806804358	1.680821926	0	1.630258506	1.379549841	1.41255848	1.008654711	6.287444987	0	1.685078521	1.20474002	0.028976828	3.533652303	5.768832249	14.43348634	0.305107053	1.196037873	5.762230585	0.005587482	5.374584572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6565	0	6.64	15.1521	0.806804358	1.680821926	0	1.630258506	1.379549841	1.41255848	1.008654711	6.287444987	0	1.685078521	1.20474002	0.028976828	3.533652303	5.768832249	14.43348634	0.305107053	1.196037873	5.762230585	0.005587482	5.374584572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6565	NO																																																																																		0	0	0	15.1521	0.806804358	1.680821926	0	1.630258506	1.379549841	1.41255848	1.008654711	6.287444987	0	1.685078521	1.20474002	0.028976828	3.533652303	5.768832249	14.43348634	0.305107053	1.196037873	5.762230585	0.005587482	5.374584572	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6565
H5826_011_0	2010	6	N/A	Exclude										Exclude																				D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	T	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																			0	YES	1055.713677	77.72943543	1082.136159		109.1106666	6.362083632	6.552918729	250.51971	30.19882346		10.39069877	6.212238362		17.73141021		4304.137533	203.162185	673.7219402	34.19233527	0.012312762	25.10638931																				3400	1b: Days 1-10: $225/day; Days 11-90: $0/day	1b: Days 1-10: $225/day; Days 11-90: $0/day	2: Days 1-20: $0/day; Days 21-55: $100/day;2: 3 day requirement waived	6: 0%	10a: $100/trip	11a: 20%	11b: 20%;11c: 0%	4a: $50/visit;4a1: 20%;4b: $40/visit	9a: 20%;9b: 20%	8a: 0%	8b: 20%	9a: 20%	12a: 20%	3: 20%;5: 20%;7c: $15/visit;7e: $15/visit;7i: $15/visit;9a: 20%;9c: 20%;9d: 20%;13a: 0%	7a: $0/visit;14c: 0%;14d: 0%;14e: 0%;14f: 0%;14g: 0%;14h: 0%;14j: 0%	7b: $15/visit;7d: $15/visit;7f: $15/visit;7f1: $0/visit;14c1: 0%;14j: 0%;16b: 20%;17a: $15/visit;18a: $15/visit	7e: $15/visit;7h: $15/visit	7c: $15/visit;7i: $15/visit	8b: 20%	7g: $15/visit;8a: 0%;12a: 20%;14b: 0%;14i: 0%	15: 20%	7d: $15/visit;17b: 20%			17a1: $0/visit	17b1: $200/2yrs			14a: $0/visit	13a1: 0%											200.8367954	146.3861592	19.33585389		100	0.2	0.2	48.06515189	0.2		0.2	0.2		0.167775729		15	15	15	0.2	0.2	0.2																				YES	166.8990381	121.3527277	16.03020636		82.89904479	0.16579809	0.16579809	39.86390904	0.16579809		0.16579809	0.16579809		0.139084476		12.43485672	12.43485672	12.43485672	0.16579809	0.16579809	0.16579809																					14.6831	0.786056584	1.445572161	0	0.75376417	1.054821312	1.086461407	0.832224578	5.006907237	0	1.722758005	1.029977252	0	2.466163906	0	4.460111127	0.210524388	0.698136316	5.669023866	0.002041432	4.162591384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0703	0	9.459888049	14.6831	0.786056584	1.445572161	0	0.75376417	1.054821312	1.086461407	0.832224578	5.006907237	0	1.722758005	1.029977252	0	2.466163906	0	4.460111127	0.210524388	0.698136316	5.669023866	0.002041432	4.162591384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.0703	NO						OON: 25%	OON: 25%		OON: 25%			OON: 25%		OON: 25%		OON: 25%	OON: 25%	OON: 25%		OON: 25%		OON: 25%																									0.3277	0.4349		1.8712			0.3849		1.0987		4.2171	0.073	0.283		0.001																					8.6913	0	2.709781347	14.6831	0.786056584	1.445572161	0	0.75376417	1.38252125	1.521320858	0.832224578	6.878057962	0	1.722758005	1.414894047	0	3.56482065	0	8.677182749	0.28349138	0.981090593	5.669023866	0.003065223	4.162591384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7616
H5832_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.91273274	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	5867.838461	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0											3400	$175/day 1-5	$175/day 1-5	"$0/d 1-20, $130/d 21-100"	$0 per visit	$180 per trip	0.2	0.2	$50 Emer Rm; $30 Urgent Care Ctr	$250 per procedure	$0 per visit	$40 X-ray; $175 Complex Radiology	$40 per visit	$25 per visit	$40 per visit	$20 PCP visit; $40 if no PCP selected	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$40 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$750 Every 3 Years	Not Covered	0											107.2467796	107.2467796	52.43074037	0	180	0.2	0.2	48	250	0	47	40	25	40	20	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0											NO	47.22859586	47.22859586	23.08908721	0	180	0.088074618	0.088074618	48	110.0932728	0	47	40	25	40	20	40	40	40	40	40	$45 	0	0	0	0	0	0	0	0	0												6.7419	0.299684039	2.246475498	0	3.521200767	0.96113477	0	0.967952593	3.68351494	0	11.34079879	0.179561693	0.000725633	0	7.702196146	19.55946154	0.722403722	1.848916626	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8184	0	17.70565766	6.7419	0.299684039	2.246475498	0	3.521200767	0.96113477	0	0.967952593	3.68351494	0	11.34079879	0.179561693	0.000725633	0	7.702196146	19.55946154	0.722403722	1.848916626	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8184	NO																												0	0																																								0	0	0											0			6.7419	0.299684039	2.246475498	0	3.521200767	0.96113477	0	0.967952593	3.68351494	0	11.34079879	0.179561693	0.000725633	0	7.702196146	19.55946154	0.722403722	1.848916626	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.8184
H5832_801_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	353.5942893	5.433775652	47.35445558	7.339241017	9.389124955	11.85435828	0	11.84802906	40.51255637	14.01859821	61.60372338	0.822211883	0.015642033	27.00837094	21.45405029	135.2281585	2.603149116	6.714278851	0	-1.06E-08	70.38794273	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.083438729	0.083438729	0.19171027	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.083438729	0.083438729	0.19171027	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												29.5035	0.453387331	9.078335467	0	2.187666115	2.762065479	0	2.760590771	9.439425634	3.266333384	14.35366755	0.191575369	0.003644594	6.292950428	4.998793718	31.50816094	0.606533744	1.564426972	0	-2.47E-09	16.40039066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3714			29.5035	0.453387331	9.078335467	0	2.187666115	2.762065479	0	2.760590771	9.439425634	3.266333384	14.35366755	0.191575369	0.003644594	6.292950428	4.998793718	31.50816094	0.606533744	1.564426972	0	-2.47E-09	16.40039066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3714	NO																																																																																		0			29.5035	0.453387331	9.078335467	0	2.187666115	2.762065479	0	2.760590771	9.439425634	3.266333384	14.35366755	0.191575369	0.003644594	6.292950428	4.998793718	31.50816094	0.606533744	1.564426972	0	-2.47E-09	16.40039066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.3714
H5832_802_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	357.4205884	5.492575388	47.86688556	7.418660093	9.490726145	11.98263614	0	11.97623844	40.95094908	14.17029566	62.27034691	0.831109166	0.015811298	27.30063274	21.68620793	136.6914836	2.6313182	6.786935113	0	-1.07E-08	71.14962167	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.082878822	0.082878822	0.191270088	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082878822	0.082878822	0.191270088	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												29.6226	0.455218176	9.155503396	0	2.211339192	2.791954221	0	2.790463556	9.541571135	3.301678888	14.50899083	0.193648436	0.003684033	6.361047429	5.052886447	31.84911568	0.613097141	1.581355881	0	-2.50E-09	16.57786185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.612			29.6226	0.455218176	9.155503396	0	2.211339192	2.791954221	0	2.790463556	9.541571135	3.301678888	14.50899083	0.193648436	0.003684033	6.361047429	5.052886447	31.84911568	0.613097141	1.581355881	0	-2.50E-09	16.57786185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.612	NO																																																																																		0			29.6226	0.455218176	9.155503396	0	2.211339192	2.791954221	0	2.790463556	9.541571135	3.301678888	14.50899083	0.193648436	0.003684033	6.361047429	5.052886447	31.84911568	0.613097141	1.581355881	0	-2.50E-09	16.57786185	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.612
H5839_001_0	2010	8	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	NO	719.6247361	26.93782434	221.8485548	0	95.48516038	11.88807462	6.296834565	676.9648509	102.2883791	21.02143099	19.60975918	0	0	0	2132.759074	1341.640029	2.913820275	3.086859315	0	6.427497684	6.210214729	0.307778008																				$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			NO	150	150	50	0	150	0.2	0.2	50	0.15	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																				8.9953	0.336722804	0.924368978	0	1.193564505	2.377614924	1.259366913	2.820686879	15.34325687	0	2.941463876	0	0	0	3.554598457	4.472133431	1.456910137	0.463028897	0	0	1.242042946	0.046166701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4272			8.9953	0.336722804	0.924368978	0	1.193564505	2.377614924	1.259366913	2.820686879	15.34325687	0	2.941463876	0	0	0	3.554598457	4.472133431	1.456910137	0.463028897	0	0	1.242042946	0.046166701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4272	NO	$500 per day								20% Coinsurance																																	0.5997								0.4092																																1.0088			9.595	0.336722804	0.924368978	0	1.193564505	2.377614924	1.259366913	2.820686879	15.75241039	0	2.941463876	0	0	0	3.554598457	4.472133431	1.456910137	0.463028897	0	0	1.242042946	0.046166701	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.4361
H5850_001_0	2010	7	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1138.451806	0	688.1252373	0	234.7560028	0	0	201.1616129	311.4456238	0	1723.255582	52.5195753	0	41.93450329	9646.621248	11606.08285	0	0	0	0	607.6134493	0	0	701.3173445	0	0	0	0	0	0												$0 copay	$0 copay	$30 per day (days 8 through 100)  PBP L.2	$0 copay	$0 copay	$0 copay	$0 copay	$50 copay PBP L.4a	$0 copay	$0 copay	$0 copay	$0 copay	$25 copay @ Hospital; $0 copay @ Freestanding facility PBP L.12	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0	0	17.32153726	0	0	0	0	50	0	0	0	50	0	0	0	0	0	0	0	0	94.82633473	0	0	79.65242276	0	0	0	0	0	0											NO	0	0	17.32153726	0	0	0	0	50	0	0	0	50	0	0	0	0	0	0	0	0	94.82633473	0	0	79.65242276	0	0	0	0	0	0												0	0	0.993282245	0	0	0	0	0.838173387	0	0	0	0.218831564	0	0	0	0	0	0	0	0	4.801479694	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5069			0	0	0.993282245	0	0	0	0	0.838173387	0	0	0	0.218831564	0	0	0	0	0	0	0	0	4.801479694	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5069	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0.993282245	0	0	0	0	0.838173387	0	0	0	0.218831564	0	0	0	0	0	0	0	0	4.801479694	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	11.5069
H5850_002_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2100.591872	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.60651183	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.60651183	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.132303906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1323			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.132303906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1323	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.132303906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1323
H5850_003_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1347.009184	0	907.5481666	0	337.8205072	0	0	245.1681154	283.6156508	0	1579.462674	72.47478681	0	19.95134401	8417.868459	12743.87035	0	0	0	0	721.5312242	0	0	701.3173445	0	0	0	0	0	0												$0 copay	$0 copay	$30 per day (days 11 through 100)  PBP L.2	$0 copay	$0 copay	$0 copay	$0 copay	$50 copay PBP L.4a	$100 copay @ Hospital PBP L.9a	$0 copay	$50 diag copay (hosp); $25 therap. copay PBP L.8a/8b	$100 copay PBP L.9a	$25 copay @ Hospital PBP L.12	"$25 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0	0	13.27710634	0	0	0	0	50	26.30419184	0	2.157039738	46.53208551	0	25	0	0	0	0	0	0	126.7253931	0	0	79.65242276	0	0	0	0	0	0											NO	0	0	13.27710634	0	0	0	0	50	26.30419184	0	2.157039738	46.53208551	0	25	0	0	0	0	0	0	126.7253931	0	0	79.65242276	0	0	0	0	0	0												0	0	1.00413446	0	0	0	0	1.021533814	0.621690041	0	0.283913646	0.281033581	0	0.0415653	0	0	0	0	0	0	7.619694003	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.5287			0	0	1.00413446	0	0	0	0	1.021533814	0.621690041	0	0.283913646	0.281033581	0	0.0415653	0	0	0	0	0	0	7.619694003	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.5287	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	1.00413446	0	0	0	0	1.021533814	0.621690041	0	0.283913646	0.281033581	0	0.0415653	0	0	0	0	0	0	7.619694003	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.5287
H5850_004_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1461.691918	0	1197.073172	0	317.6221647	0	0	225.771622	326.919361	0	1495.720596	49.07572526	9.599775862	46.56954473	10148.6228	12401.97625	0	0	0	0	761.8916377	0	0	701.3173445	0	0	0	0	0	0												$50 copay (days 1-5) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$50 copay PBP L.4a	$75 copay (hosp.); $50 copay (ASC) PBP L.9a	$0 copay	$50 copay (diagnostic); $100 copay (therapy) PBP L.8a/8b	$75 copay PBP L.9a	$25 copay @ Hospital PBP L.12	"$100 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$15 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											34.87182073	0	28.86922876	0	100	0	0	50	57.60016875	0	3.51618163	50	0	100	0	7.002033491	0	0	0	0	119.8062229	0	0	79.65242276	0	0	0	0	0	0											NO	34.87182073	0	28.86922876	0	100	0	0	50	57.60016875	0	3.51618163	50	0	100	0	7.002033491	0	0	0	0	119.8062229	0	0	79.65242276	0	0	0	0	0	0												4.2477	0	2.879881604	0	2.646851372	0	0	0.940715092	1.56921753	0	0.438268774	0.204482189	0	0.388079539	0	7.236587753	0	0	0	0	7.60661328	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8135			4.2477	0	2.879881604	0	2.646851372	0	0	0.940715092	1.56921753	0	0.438268774	0.204482189	0	0.388079539	0	7.236587753	0	0	0	0	7.60661328	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8135	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			4.2477	0	2.879881604	0	2.646851372	0	0	0.940715092	1.56921753	0	0.438268774	0.204482189	0	0.388079539	0	7.236587753	0	0	0	0	7.60661328	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.8135
H5850_005_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1314.415467	0	1045.40684	0	352.4312287	0	0	227.4251585	437.1970713	0	1696.96142	22.15682275	0	54.76742741	16710.9067	11972.19763	0	0	0	0	546.0601485	0	0	841.5808134	0	0	0	0	0	0												$75 per day (days 1-5) PBP L.1a	$0 copay	$40 per day (days 8 through 34)  PBP L.2	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$50 copay PBP L.4a	$150 copay @ Hospital PBP L.9a	$0 copay	$175 diag copay (hosp); $50 therap. Copay PBP L.8a/8b	$150 copay PBP L.9a	$25 copay @ Hospital PBP L.12	"$50 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$20 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											52.30773109	0	23.09538301	0	100	0	0	50	36.75823926	0	4.843931131	46.57037974	0	72.94319363	0	10.35404517	0	0	0	0	157.8636318	0	0	90.48197032	0	0	0	0	0	0											NO	52.30773109	0	23.09538301	0	100	0	0	50	36.75823926	0	4.843931131	46.57037974	0	72.94319363	0	10.35404517	0	0	0	0	157.8636318	0	0	90.48197032	0	0	0	0	0	0												5.7295	0	2.012005949	0	2.936926906	0	0	0.947604827	1.339216213	0	0.684997021	0.085987637	0	0.332909255	0	10.33005625	0	0	0	0	7.183586518	0	0	6.345657515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9285			5.7295	0	2.012005949	0	2.936926906	0	0	0.947604827	1.339216213	0	0.684997021	0.085987637	0	0.332909255	0	10.33005625	0	0	0	0	7.183586518	0	0	6.345657515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9285	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			5.7295	0	2.012005949	0	2.936926906	0	0	0.947604827	1.339216213	0	0.684997021	0.085987637	0	0.332909255	0	10.33005625	0	0	0	0	7.183586518	0	0	6.345657515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.9285
H5850_006_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	908.3105174	0	415.4581377	0	164.6209664	0	0	162.847261	248.0257142	0	1383.679144	41.6646254	0	26.83893015	10322.84298	9011.636331	0	0	0	0	412.2460444	0	0	701.3173445	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$50 copay PBP L.4a	$0 copay	$0 copay	$0 copay	$0 copay	$25 copay @ Hospital PBP L.12	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0	0	0	0	0	0	0	50	0	0	0	50	0	0	0	0	0	0	0	0	120.3790174	0	0	79.65242276	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	50	0	0	0	50	0	0	0	0	0	0	0	0	120.3790174	0	0	79.65242276	0	0	0	0	0	0												0	0	0	0	0	0	0	0.678530254	0	0	0	0.173602606	0	0	0	0	0	0	0	0	4.135481146	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6427			0	0	0	0	0	0	0	0.678530254	0	0	0	0.173602606	0	0	0	0	0	0	0	0	4.135481146	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6427	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0.678530254	0	0	0	0.173602606	0	0	0	0	0	0	0	0	4.135481146	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	9.6427
H5850_007_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1646.3271	0	993.4384987	0	377.9682518	0	0	242.6717942	407.1855327	0	1820.548003	21.45476098	0	60.51147391	19026.76376	12614.54363	0	0	0	0	641.1729159	0	0	841.5808134	0	0	0	0	0	0												$50 copay (days 1-5) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$50 copay PBP L.4a	$100 copay (hosp.); $50 copay (ASC) PBP L.9a	$0 copay	$100 diag copay (hosp); $50 therap. Copay PBP L.8a/8b	$100 copay PBP L.9a	$25 copay @ Hospital; $0 copay @ Freestanding facility PBP L.12	"$50 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$15 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											34.87182073	0	28.86922876	0	100	0	0	50	62.47225665	0	2.082876107	46.70636373	0	75	0	7.948422288	0	0	0	0	139.507068	0	0	90.48197032	0	0	0	0	0	0											NO	34.87182073	0	28.86922876	0	100	0	0	50	62.47225665	0	2.082876107	46.70636373	0	75	0	7.948422288	0	0	0	0	139.507068	0	0	90.48197032	0	0	0	0	0	0												4.7842	0	2.389983607	0	3.149735432	0	0	1.011132476	2.119816592	0	0.315997995	0.083506156	0	0.378196712	0	8.355476646	0	0	0	0	7.454012796	0	0	6.345657515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3877			4.7842	0	2.389983607	0	3.149735432	0	0	1.011132476	2.119816592	0	0.315997995	0.083506156	0	0.378196712	0	8.355476646	0	0	0	0	7.454012796	0	0	6.345657515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3877	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			4.7842	0	2.389983607	0	3.149735432	0	0	1.011132476	2.119816592	0	0.315997995	0.083506156	0	0.378196712	0	8.355476646	0	0	0	0	7.454012796	0	0	6.345657515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.3877
H5850_010_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1069.005652	0	584.9850287	0	240.5979272	0	0	198.2392931	224.1605744	0	1253.223733	50.09049085	0	13.16640715	8338.852039	10043.80405	0	0	0	0	549.5389243	0	0	701.3173445	0	0	0	0	0	0												$150 copay (days 1-7) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$0 copay	$0 copay	$0 copay	$50 copay PBP L.4a	$150 copay @ Hospital PBP L.9a	$0 copay	$150 diag copay (hosp); $50 therapy vopay PBP L.8a/8b	$150 copay PBP L.9a	$25 copay @ Hospital; $0 copay @ Freestanding facility PBP L.12	"$50 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											119.9364775	0	28.86922876	0	0	0	0	50	41.44035758	0	5.192648377	50	0	50	0	0	0	0	0	0	155.2644204	0	0	79.65242276	0	0	0	0	0	0											NO	119.9364775	0	28.86922876	0	0	0	0	50	41.44035758	0	5.192648377	50	0	50	0	0	0	0	0	0	155.2644204	0	0	79.65242276	0	0	0	0	0	0												10.6844	0	1.407338885	0	0	0	0	0.825997055	0.774107863	0	0.542295848	0.208710379	0	0.05486003	0	0	0	0	0	0	7.110320213	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.2632			10.6844	0	1.407338885	0	0	0	0	0.825997055	0.774107863	0	0.542295848	0.208710379	0	0.05486003	0	0	0	0	0	0	7.110320213	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.2632	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			10.6844	0	1.407338885	0	0	0	0	0.825997055	0.774107863	0	0.542295848	0.208710379	0	0.05486003	0	0	0	0	0	0	7.110320213	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.2632
H5850_012_0	2010	6	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1499.397288	0	939.1925973	0	295.7943897	0	0	175.6073667	301.6523691	0	1659.893572	43.07282578	0	47.28735633	9333.617809	11686.82711	0	0	0	0	545.9355149	0	0	701.3173445	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$50 copay PBP L.4a	$0 copay	$0 copay	$0 copay	$0 copay	$25 copay @ Hospital PBP L.12	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0	0	0	0	0	0	0	50	0	0	0	44.08512294	0	0	0	0	0	0	0	0	100.4645979	0	0	79.65242276	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	50	0	0	0	44.08512294	0	0	0	0	0	0	0	0	100.4645979	0	0	79.65242276	0	0	0	0	0	0												0	0	0	0	0	0	0	0.731697361	0	0	0	0.158239235	0	0	0	0	0	0	0	0	4.57059933	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.1157			0	0	0	0	0	0	0	0.731697361	0	0	0	0.158239235	0	0	0	0	0	0	0	0	4.57059933	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.1157	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0.731697361	0	0	0	0.158239235	0	0	0	0	0	0	0	0	4.57059933	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	10.1157
H5850_014_0	2010	4	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1034.341297	0	668.1690979	0	247.508682	0	0	158.8263638	288.7507142	0	1234.852241	15.03169467	0	37.18583631	7279.562911	8596.838236	0	0	0	0	481.3178887	0	0	841.5808134	0	0	0	0	0	0												$100 copay (days 1-10) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$0 copay	$100 copay @ Hospital PBP L.9a	$0 copay	$0 copay	$100 copay PBP L.9a	$0 copay	$0 copay	$0 copay	$10 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											88.1172645	0	28.86922876	0	100	0	0	50	25.2764009	0	2.894648674	50	0	94.14738488	0	9.813898361	0	0	0	0	173.0151342	0	0	90.48197032	0	0	0	0	0	0											NO	88.1172645	0	28.86922876	0	100	0	0	50	25.2764009	0	2.894648674	50	0	94.14738488	0	9.813898361	0	0	0	0	173.0151342	0	0	90.48197032	0	0	0	0	0	0												7.5953	0	1.607460545	0	2.06257235	0	0	0.661776516	0.608214901	0	0.29787195	0.062632061	0	0.29174577	0	7.030708056	0	0	0	0	6.939606594	0	0	6.345657515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5035			7.5953	0	1.607460545	0	2.06257235	0	0	0.661776516	0.608214901	0	0.29787195	0.062632061	0	0.29174577	0	7.030708056	0	0	0	0	6.939606594	0	0	6.345657515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5035	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			7.5953	0	1.607460545	0	2.06257235	0	0	0.661776516	0.608214901	0	0.29787195	0.062632061	0	0.29174577	0	7.030708056	0	0	0	0	6.939606594	0	0	6.345657515	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.5035
H5850_015_0	2010	5	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1665.4862	0	804.0430257	0	290.7582935	0	0	171.1574266	240.5134431	0	1257.627242	44.43973259	0.63635404	24.81267869	5331.3596	9224.61153	0	0	0	0	654.5749365	0	0	701.3173445	0	0	0	0	0	0												$100 copay (days 1-7) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$50 copay PBP L.4a	$75 copay (hosp.); $50 copay (ASC) PBP L.9a	$0 copay	$50 diag copay (hosp); $25 therap. copay PBP L.8a/8b	$75 copay PBP L.9a	$0 copay	"$25 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$10 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											79.95765169	0	28.86922876	0	100	0	0	50	58.46434663	0	2.496293812	50	0	25	0	9.907861395	0	0	0	0	134.522221	0	0	79.65242276	0	0	0	0	0	0											NO	79.95765169	0	28.86922876	0	100	0	0	50	58.46434663	0	2.496293812	50	0	25	0	9.907861395	0	0	0	0	134.522221	0	0	79.65242276	0	0	0	0	0	0												11.0974	0	1.934341837	0	2.422985779	0	0	0.713155944	1.171788442	0	0.261617258	0.185165552	0	0.051693081	0	7.616347704	0	0	0	0	7.337906187	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4475			11.0974	0	1.934341837	0	2.422985779	0	0	0.713155944	1.171788442	0	0.261617258	0.185165552	0	0.051693081	0	7.616347704	0	0	0	0	7.337906187	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4475	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			11.0974	0	1.934341837	0	2.422985779	0	0	0.713155944	1.171788442	0	0.261617258	0.185165552	0	0.051693081	0	7.616347704	0	0	0	0	7.337906187	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4475
H5850_016_0	2010	5	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	YES	1665.4862	0	804.0430257	0	290.7582935	0	0	171.1574266	240.5134431	0	1257.627242	44.43973259	0.63635404	24.81267869	5331.3596	9224.61153	0	0	0	0	654.5749365	0	0	701.3173445	0	0	0	0	0	0											3400	$75 copay (days 1-7) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$50 copay PBP L.4a	$100 copay (Hospital); $25 copay (ASC) PBP L.9a/9b	$0 copay	$100 diag copay (hosp); $25 therap. copay PBP L.8a/8b	$100 copay PBP L.9a	$0 copay	"$25 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$20 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											59.96823876	0	28.86922876	0	100	0	0	50	50.39303988	0	2.894309398	50	0	25	0	10.67489588	0	0	0	0	134.522221	0	0	79.65242276	0	0	0	0	0	0											NO	54.68250254	0	27.99270207	0	100	0	0	49.0700501	49.45577982	0	2.840478143	49.0700501	0	24.53502505	0	9.843528928	0	0	0	0	134.522221	0	0	79.65242276	0	0	0	0	0	0												7.5894	0	1.875611406	0	2.422985779	0	0	0.699891958	0.991231657	0	0.297688558	0.181721659	0	0.050731641	0	7.566894203	0	0	0	0	7.337906187	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6692		1.473523184	7.5894	0	1.875611406	0	2.422985779	0	0	0.699891958	0.991231657	0	0.297688558	0.181721659	0	0.050731641	0	7.566894203	0	0	0	0	7.337906187	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6692	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			7.5894	0	1.875611406	0	2.422985779	0	0	0.699891958	0.991231657	0	0.297688558	0.181721659	0	0.050731641	0	7.566894203	0	0	0	0	7.337906187	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6692
H5850_017_0	2010	7	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1582.21189	0	804.9891781	0	291.1004415	0	0	171.358835	240.7964658	0	1259.107147	44.49202676	0.637102865	24.84187685	5341.783243	9222.832315	0	0	0	0	641.8692687	0	0	549.8327981	0	0	0	0	0	0												$100 copay (days 1-7) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$50 copay PBP L.4a	$150 copay (Hospital); $50 copay (ASC) PBP L.9a/9b	$0 copay	$150 diag copay (hosp); $25 diag copay (freest); $50 therap. copay PBP L.8a/8b	$150 copay PBP L.9a	$25 copay @ Hospital; $15 copay @ Freestanding facility PBP L.12	"$50 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$20 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											79.95765169	0	28.86922876	0	100	0	0	50	83.8573865	0	28.55721076	50	15	50	0	11.09314234	0	0	0	0	131.4959984	0	0	79.65242276	0	0	0	0	0	0											YES	79.95765169	0	28.86922876	0	100	0	0	50	83.8573865	0	28.55721076	50	15	50	0	11.09314234	0	0	0	0	131.4959984	0	0	79.65242276	0	0	0	0	0	0												10.5425	0	1.936618061	0	2.425837012	0	0	0.713995146	1.682713525	0	2.996382347	0.185383445	0.000796379	0.10350782	0	8.525849308	0	0	0	0	7.03360336	0	0	3.649626207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7968			10.5425	0	1.936618061	0	2.425837012	0	0	0.713995146	1.682713525	0	2.996382347	0.185383445	0.000796379	0.10350782	0	8.525849308	0	0	0	0	7.03360336	0	0	3.649626207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.7968	NO	20% coinsurance subject to $3000 MOOP	Included in a.1.	20% coinsurance subject to $3000 MOOP	0% coinsurance	20% coinsurance subject to $3000 MOOP	0% coinsurance	0% coinsurance	20% coinsurance subject to $3000 MOOP	20% coinsurance subject to $3000 MOOP	20% coinsurance subject to $3000 MOOP	20% coinsurance subject to $3000 MOOP	20% coinsurance subject to $3000 MOOP	20% coinsurance subject to $3000 MOOP	20% coinsurance subject to $3000 MOOP	20% coinsurance subject to $3000 MOOP	20% coinsurance subject to $3000 MOOP	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% coinsurance subject to $3000 MOOP	20% coinsurance subject to $3000 MOOP	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered												2.6777	0	0.2228	0	0.0699	0	0	0.0371	0.3547	0	0.2579	0.0967	0.0001	0.0131	0.8092	1.3507	0	0	0	0	0.443	0	0	0	0	0	0	0	0	0											6.3329		2.274370896	13.2202	0	2.159439831	0	2.495728252	0	0	0.75114208	2.037439826	0	3.254283166	0.282060356	0.000885012	0.116594398	0.809227439	9.876507858	0	0	0	0	7.476573871	0	0	3.649626207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.1297
H5850_019_0	2010	5	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1153.320281	0	578.3585395	0	209.1461982	0	0	123.1157489	173.0044279	0	904.6275281	31.96607397	0.457737685	17.84808045	3834.91586	6692.226622	0	0	0	0	544.7551411	0	0	701.3173445	0	0	0	0	0	0												$150 copay (days 1-7) PBP L.1a	$0 copay	$50 per day (days 8 through 100)  PBP L.2	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$50 copay PBP L.4a	$200 copay (Hospital); $50 copay (ASC) PBP L.9a/9b	$0 copay	$150 diag copay (hosp); $25 diag copay (freest); $50 therap. copay PBP L.8a/8b	$200 copay PBP L.9a	$25 copay @ Hospital; $0 copay @ Freestanding facility PBP L.12	"$50 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$30 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											119.9364775	0	28.86922876	0	100	0	0	50	100.7860798	0	53.97740819	50	15	50	0	15.68374336	0	0	0	0	154.0789347	0	0	79.65242276	0	0	0	0	0	0											NO	119.9364775	0	28.86922876	0	100	0	0	50	100.7860798	0	53.97740819	50	15	50	0	15.68374336	0	0	0	0	154.0789347	0	0	79.65242276	0	0	0	0	0	0												11.5271	0	1.391397082	0	1.742884985	0	0	0.512982287	1.453036506	0	4.069120779	0.133191975	0.000572172	0.074367002	0	8.746597069	0	0	0	0	6.994607652	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.301			11.5271	0	1.391397082	0	1.742884985	0	0	0.512982287	1.453036506	0	4.069120779	0.133191975	0.000572172	0.074367002	0	8.746597069	0	0	0	0	6.994607652	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.301	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			11.5271	0	1.391397082	0	1.742884985	0	0	0.512982287	1.453036506	0	4.069120779	0.133191975	0.000572172	0.074367002	0	8.746597069	0	0	0	0	6.994607652	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.301
H5850_020_0	2010	5	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	1846.517309	0	891.4390068	0	322.3624559	0	0	189.7614947	266.6562087	0	1394.325855	49.2701383	0.705522957	27.50970899	5910.855208	10191.42647	0	0	0	0	697.1024887	0	0	701.3173445	0	0	0	0	0	0												$50 copay (days 1-5) PBP L.1a	$0 copay	$0 copay	$0 copay	$100 copay PBP L.10a	$0 copay	$0 copay	$50 copay PBP L.4a	$50 copay (Hospital) PBP L.9a	$0 copay	$50 diag copay (hosp); $25 therap. copay PBP L.8a/8b	$50 copay PBP L.9a	$0 copay	"$25 copay @ Hospital PBP L.9a, 7c, 7i"	$0 copay	$10 copay PBP L.7a thru 7f	Included in i.2.	Included in i.2.	Included in i.2.	Included in i.2.	20% chemo; $50 copay Part B Rx PBP L.15	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											34.87182073	0	0	0	100	0	0	50	16.92869325	0	1.811210611	50	0	50	0	9.916602171	0	0	0	0	128.6040114	0	0	79.65242276	0	0	0	0	0	0											NO	34.87182073	0	0	0	100	0	0	50	16.92869325	0	1.811210611	50	0	50	0	9.916602171	0	0	0	0	128.6040114	0	0	79.65242276	0	0	0	0	0	0												5.366	0	0	0	2.686353799	0	0	0.790672894	0.37617843	0	0.210451482	0.205292243	0	0.114623787	0	8.422026818	0	0	0	0	7.470848033	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2975			5.366	0	0	0	2.686353799	0	0	0.790672894	0.37617843	0	0.210451482	0.205292243	0	0.114623787	0	8.422026818	0	0	0	0	7.470848033	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2975	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			5.366	0	0	0	2.686353799	0	0	0.790672894	0.37617843	0	0.210451482	0.205292243	0	0.114623787	0	8.422026818	0	0	0	0	7.470848033	0	0	4.655135468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.2975
H5850_021_0	2010	5	N/A																															D	D	D	V	T	P	P	V	V	P	V	V	V	V	V	V	V	V	V	V	S	O	V	P	V	V	V	V	V	V																																																			0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2100.591872	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	"Various copays PBP L.16a,b"	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.60651183	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	23.60651183	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.132303906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1323			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.132303906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1323	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.132303906	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.1323
H5850_802_0	2010	3	N/A																															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																																																			0	NO	258.8827666	0	24.76218741	4.956604033	8.625580102	7.701193323	0	13.79805056	40.24052691	0	0	0	0	43.89540012	0	0	0	0	0	314.6802875	50.85289581	0	0	0	0	0	0	0	0	0												Medicare FFS cost sharing	included in a.1	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	included in e.1.	Medicare FFS cost sharing	Medicare FFS cost sharing	included in h.5	included in h.5	included in h.5	included in h.5	Medicare FFS cost sharing	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	Medicare FFS cost sharing	Medicare FFS cost sharing	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered											0.078237506	0	0.159843264	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.078237506	0	0.159843264	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												20.2543	0	3.958068869	0	2.009760164	1.794378044	0	3.214945781	9.376042771	0	0	0	0	10.22762823	0	0	0	0	0	73.32050699	11.84872472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0044			20.2543	0	3.958068869	0	2.009760164	1.794378044	0	3.214945781	9.376042771	0	0	0	0	10.22762823	0	0	0	0	0	73.32050699	11.84872472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0044	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			20.2543	0	3.958068869	0	2.009760164	1.794378044	0	3.214945781	9.376042771	0	0	0	0	10.22762823	0	0	0	0	0	73.32050699	11.84872472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0044
H5850_803_0	2010	3	N/A																															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																																																			0	NO	258.8827666	0	24.76218741	4.956604033	8.625580102	7.701193323	0	13.79805056	40.24052691	0	0	0	0	43.89540012	0	0	0	0	0	314.6802875	50.85289581	0	0	0	0	0	0	0	0	0												Medicare FFS cost sharing	included in a.1	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	included in e.1.	Medicare FFS cost sharing	Medicare FFS cost sharing	included in h.5	included in h.5	included in h.5	included in h.5	Medicare FFS cost sharing	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	Medicare FFS cost sharing	Medicare FFS cost sharing	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered											0.078237506	0	0.159843264	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.078237506	0	0.159843264	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												20.2543	0	3.958068869	0	2.009760164	1.794378044	0	3.214945781	9.376042771	0	0	0	0	10.22762823	0	0	0	0	0	73.32050699	11.84872472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0044			20.2543	0	3.958068869	0	2.009760164	1.794378044	0	3.214945781	9.376042771	0	0	0	0	10.22762823	0	0	0	0	0	73.32050699	11.84872472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0044	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			20.2543	0	3.958068869	0	2.009760164	1.794378044	0	3.214945781	9.376042771	0	0	0	0	10.22762823	0	0	0	0	0	73.32050699	11.84872472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0044
H5850_805_0	2010	3	N/A																															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																																																			0	NO	258.8827666	0	24.76218741	4.956604033	8.625580102	7.701193323	0	13.79805056	40.24052691	0	0	0	0	43.89540012	0	0	0	0	0	314.6802875	50.85289581	0	0	0	0	0	0	0	0	0												Medicare FFS cost sharing	included in a.1	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	included in e.1.	Medicare FFS cost sharing	Medicare FFS cost sharing	included in h.5	included in h.5	included in h.5	included in h.5	Medicare FFS cost sharing	included in i.6.	included in i.6.	included in i.6.	included in i.6.	included in i.6.	Medicare FFS cost sharing	Medicare FFS cost sharing	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered	not covered											0.078237506	0	0.159843264	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.078237506	0	0.159843264	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												20.2543	0	3.958068869	0	2.009760164	1.794378044	0	3.214945781	9.376042771	0	0	0	0	10.22762823	0	0	0	0	0	73.32050699	11.84872472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0044			20.2543	0	3.958068869	0	2.009760164	1.794378044	0	3.214945781	9.376042771	0	0	0	0	10.22762823	0	0	0	0	0	73.32050699	11.84872472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0044	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			20.2543	0	3.958068869	0	2.009760164	1.794378044	0	3.214945781	9.376042771	0	0	0	0	10.22762823	0	0	0	0	0	73.32050699	11.84872472	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.0044
H5852_001_0	2010	7	N/A																																																																																																															0	NO																																																																																																																										NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5854_002_0	2010	7	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	Therapy (PT/OT/ST)	Ambulatory Surgery	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	0	V	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	887.798926	25.31555485	619.7105105	1018.385309	218.9938843	7.761932134	0.044588199	287.0201145	229.18993	5712.272446	331.7853587	17.5230224	0	48.45335972	4043.785401	3132.704691	322.7340986	775.9244734	1153.340576	0	34.6783663	0	0	0	378	179.4	162	14.7	4196.545893	0	17.4002288	216.3283183	79.50958063	643.8015118	457.5187537	551.8829058	2.221147824	925.7435261	19.11774112	13.36404215		$200/day (days 1-7)	$200/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$175 copay	20% coinsurance	20% coinsurance	$50 copay	$275 copay	$0 copay	$90 copay - Radiology	$275 copay	10% coinsurance	$30 copay	$20 coapy	$30 copay	$40 copay	$30 copay	$30 copay - Radiology	0	20% coinsurance	0	0	0	$20 copay	$80 contacts/$100 frames yrly	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$30 copay	$50 copay	$275 copay	$30 copay	$30 copay	$0 copay	20% coinsurance	$30 copay	$0 copay (1/yr)	20% coinsurance	200	200	60	0	175	0.2	0.2	50	275	0	90	275	0.1	30	20	30	40	30	30	0	0.2	0	0	0	20	0	0	0	0	0	30	50	275	30	30	0	0.2	30	0	0.2	NO	152.3712095	176.5013052	56.00905989	0	163.359758	0.186696866	0.186696866	46.67421658	256.7081912	0	84.01358984	256.7081912	0	28.00452995	18.66968663	28.00452995	37.33937326	28.00452995	28.00452995	0	0.186696866	0	0	0	20	0	0	0	0	0	28.00452995	46.67421658	256.7081912	28.00452995	28.00452995	0	0.186696866	28.00452995	0	0.186696866		11.2729	0.372352373	2.892450258	0	2.981232329	1.449128406	0.008324477	1.116369915	4.90291103	0	2.322873253	0.374858615	0	0.11307613	6.29135052	7.310826861	1.004224081	1.810783346	2.691563393	0	6.474342317	0	0	0	0.63	0	0	0	0	0	0.040607102	0.841412898	1.700896719	1.50244656	1.06771647	0	0.414681338	2.160417692	0	2.49502479	64.2428		4.531552345	11.2729	0.372352373	2.892450258	0	2.981232329	1.449128406	0.008324477	1.116369915	4.90291103	0	2.322873253	0.374858615	0	0.11307613	6.29135052	7.310826861	1.004224081	1.810783346	2.691563393	0	6.474342317	0	0	0	0.63	0	0	0	0	0	0.040607102	0.841412898	1.700896719	1.50244656	1.06771647	0	0.414681338	2.160417692	0	2.49502479	64.2428	YES																																									4000																																									0			11.2729	0.372352373	2.892450258	0	2.981232329	1.449128406	0.008324477	1.116369915	4.90291103	0	2.322873253	0.374858615	0	0.11307613	6.29135052	7.310826861	1.004224081	1.810783346	2.691563393	0	6.474342317	0	0	0	0.63	0	0	0	0	0	0.040607102	0.841412898	1.700896719	1.50244656	1.06771647	0	0.414681338	2.160417692	0	2.49502479	64.2428
H5854_003_0	2010	7	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	Therapy (PT/OT/ST)	Ambulatory Surgery	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	V	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	1125.133415	27.21149329	787.6084184	1613.295203	244.8034223	7.528803437	0.032518176	329.2918793	283.1817155	6708.107894	374.3523952	31.89109206	0	39.08324531	4603.558442	3926.288383	338.6749446	1065.723385	1356.012317	0	53.1646558	0	0	1572.93321	378	179.4	162	14.7	4196.545893	0	12.63451341	327.0296294	99.39215948	562.0244864	645.9638042	564.3081313	3.198898772	1215.709309	19.62843888	14.03453207		$100/day (days 1-7)	$100/day (days 1-7)	$50/day (for days 1-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$100 copay	$0 copay	$60 copay - Radiology	$100 copay	10% coinsurance	$20 copay	$10 coapy	$20 copay	$40 copay	$20 copay	$20 copay - Radiology	0	20% coinsurance	0	0	$0 copay 1 exam/2 cleanings/1 x-ray	$20 copay	$80 contacts/$100 frames yrly	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$20 copay	$40 copay	$100 copay	$20 copay	$20 copay	$0 copay	20% coinsurance	$20 copay	$0 copay (1/yr)	20% coinsurance	100	100	50	0	100	0.2	0.2	50	100	0	60	100	0.1	20	10	20	40	20	20	0	0.2	0	0	0	20	0	0	0	0	0	20	40	100	20	20	0	0.2	20	0	0.2	NO	78.33879664	86.57486129	47.43153005	0	94.8630601	0.18972612	0.18972612	47.43153005	94.8630601	0	56.91783606	94.8630601	0	18.97261202	9.48630601	18.97261202	37.94522404	18.97261202	18.97261202	0	0.18972612	0	0	0	20	0	0	0	0	0	18.97261202	37.94522404	94.8630601	18.97261202	18.97261202	0	0.18972612	18.97261202	0	0.18972612		7.3451	0.196319271	3.113122697	0	1.93523348	1.428410666	0.006169547	1.301568139	2.238623675	0	1.775610688	0.252107215	0	0.061792604	3.639230343	6.207662181	1.070924721	1.684963025	2.143924632	0	10.08672388	0	0	0	0.63	0	0	0	0	0	0.01997581	1.034101046	0.785720367	0.888589377	1.02130172	0	0.606914653	1.92209842	0	2.662717319	54.0589		2.892314677	7.3451	0.196319271	3.113122697	0	1.93523348	1.428410666	0.006169547	1.301568139	2.238623675	0	1.775610688	0.252107215	0	0.061792604	3.639230343	6.207662181	1.070924721	1.684963025	2.143924632	0	10.08672388	0	0	0	0.63	0	0	0	0	0	0.01997581	1.034101046	0.785720367	0.888589377	1.02130172	0	0.606914653	1.92209842	0	2.662717319	54.0589	YES																																									4000																																									0			7.3451	0.196319271	3.113122697	0	1.93523348	1.428410666	0.006169547	1.301568139	2.238623675	0	1.775610688	0.252107215	0	0.061792604	3.639230343	6.207662181	1.070924721	1.684963025	2.143924632	0	10.08672388	0	0	0	0.63	0	0	0	0	0	0.01997581	1.034101046	0.785720367	0.888589377	1.02130172	0	0.606914653	1.92209842	0	2.662717319	54.0589
H5854_004_0	2010	5	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	Therapy (PT/OT/ST)	Ambulatory Surgery	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	V	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	970.389189	16.42381765	645.7692499	1068.454525	194.4675426	5.916624264	0.024233536	253.0834648	239.1667506	5496.635257	303.9711293	19.40964095	0	37.63674658	3840.827544	3094.121802	221.9447867	698.8564825	1074.367501	0	33.08185048	0	0	1572.93321	378	179.4	162	14.7	4196.545893	0	13.50463442	306.9431576	83.81854883	808.7434664	434.2243983	491.3559165	2.001107509	1023.092071	12.1223416	25.79767611		$250/day (days 1-7)	$250/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$175 copay	20% coinsurance	20% coinsurance	$50 copay	$300 copay	$0 copay	$105 copay - Radiology	$300 copay	10% coinsurance	$35 copay	$25 coapy	$35 copay	$40 copay	$35 copay	$35 copay - Radiology	0	20% coinsurance	0	0	$0 copay 1 exam/ 2 cleainings/1 x-ray	$20 copay	$80 contacts/$100 frames yrly	$0 copay	$1000/3yrs Hearing Aids	Silver Sneakers	0	$35 copay	$50 copay	$300 copay	$35 copay	$35 copay	$0 copay	20% coinsurance	$35 copay	$0 copay (1/yr)	20% coinsurance	250	250	60	0	175	0.2	0.2	50	300	0	105	300	0.1	35	25	35	40	35	35	0	0.2	0	0	0	20	0	0	0	0	0	35	50	300	35	35	0	0.2	35	0	0.2	NO	195.6069262	149.3153626	57.23889818	0	166.9467864	0.190796327	0.190796327	47.69908182	286.1944909	0	100.1680718	286.1944909	0	33.38935727	23.84954091	33.38935727	38.15926545	33.38935727	33.38935727	0	0.190796327	0	0	0	20	0	0	0	0	0	33.38935727	47.69908182	286.1944909	33.38935727	33.38935727	0	0.190796327	33.38935727	0	0.190796327		15.8179	0.204360691	3.080260028	0	2.705477608	1.128870179	0.00462367	1.005987408	5.704017203	0	2.537350159	0.462911026	0	0.104722231	7.633497802	8.60922819	0.705770836	1.944530731	2.989370028	0	6.31189557	0	0	0	0.63	0	0	0	0	0	0.037575922	1.220075565	1.999033909	2.250285378	1.208206131	0	0.381803963	2.846698889	0	4.922101854	76.4466		3.656429267	15.8179	0.204360691	3.080260028	0	2.705477608	1.128870179	0.00462367	1.005987408	5.704017203	0	2.537350159	0.462911026	0	0.104722231	7.633497802	8.60922819	0.705770836	1.944530731	2.989370028	0	6.31189557	0	0	0	0.63	0	0	0	0	0	0.037575922	1.220075565	1.999033909	2.250285378	1.208206131	0	0.381803963	2.846698889	0	4.922101854	76.4466	YES																																									6000																																									0			15.8179	0.204360691	3.080260028	0	2.705477608	1.128870179	0.00462367	1.005987408	5.704017203	0	2.537350159	0.462911026	0	0.104722231	7.633497802	8.60922819	0.705770836	1.944530731	2.989370028	0	6.31189557	0	0	0	0.63	0	0	0	0	0	0.037575922	1.220075565	1.999033909	2.250285378	1.208206131	0	0.381803963	2.846698889	0	4.922101854	76.4466
H5854_005_0	2010	7	N/A	H.6	H.7	H.8	I.7	I.8	I.9	I.10	I.11	I.12	I.13	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	Urgent Care	Therapy (PT/OT/ST)	Ambulatory Surgery	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Training	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	NO	996.9273558	24.35773644	690.715812	1261.962726	224.4391429	7.316469337	0.035940127	297.1367003	252.32724	6062.421932	343.1869403	23.53594647	0	42.6931122	4224.907381	3437.340569	309.6912205	875.1386736	1217.886822	0	40.80067776	0	0	0	378	179.4	0	0	4196.275007	0	14.77838499	277.2142386	88.15180808	643.1602313	527.1710102	545.1493394	2.704740073	1058.401643	17.97832928	16.00710009		$250/day (days 1-7)	$250/day (days 1-7)	$60/day (for days 1-100)	$0 copay	$175 copay	20% coinsurance	20% coinsurance	$50 copay	$300 copay	$0 copay	$105 copay - Radiology	$300 copay	10% coinsurance	$35 copay	$25 coapy	$35 copay	$40 copay	$35 copay	$45 copay - Radiology	0	20% coinsurance	0	0	0	$30 copay	$30 copay w/ $80 allowance 1 pair glasses / contacts every 2 years	0	0	Silver Sneakers	0	$35 copay	$50 copay	$300 copay	$35 copay	$35 copay	$0 copay	20% coinsurance	$35 copay	$0 copay (1/yr)	20% coinsurance	250	250	60	0	175	0.2	0.2	50	300	0	105	300	0.1	35	25	35	40	35	45	0	0.2	0	0	0	30	30	0	0	0	0	35	50	300	35	35	0	0.2	35	0	0.2	NO	194.5192118	219.8968447	56.83854569	0	165.7790916	0.189461819	0.189461819	47.36545474	284.1927284	0	99.46745495	284.1927284	0	33.15581832	23.68272737	33.15581832	37.89236379	33.15581832	42.62890926	0	0.189461819	0	0	0	30	30	0	0	0	0	33.15581832	47.36545474	284.1927284	33.15581832	33.15581832	0	0.189461819	33.15581832	0	0.189461819		16.1601	0.446349116	3.271606853	0	3.100609769	1.386191589	0.006809282	1.172834577	5.975797234	0	2.844660961	0.557395404	0	0.117960423	8.338110805	9.49731995	0.977911032	2.417994905	4.326432236	0	7.730170622	0	0	0	0.945	0.4485	0	0	0	0	0.040832454	1.094198206	2.087675238	1.777041982	1.45656552	0	0.512444974	2.924347715	0	3.032734299	82.6476		4.51854392	16.1601	0.446349116	3.271606853	0	3.100609769	1.386191589	0.006809282	1.172834577	5.975797234	0	2.844660961	0.557395404	0	0.117960423	8.338110805	9.49731995	0.977911032	2.417994905	4.326432236	0	7.730170622	0	0	0	0.945	0.4485	0	0	0	0	0.040832454	1.094198206	2.087675238	1.777041982	1.45656552	0	0.512444974	2.924347715	0	3.032734299	82.6476	YES																																									6000																																									0			16.1601	0.446349116	3.271606853	0	3.100609769	1.386191589	0.006809282	1.172834577	5.975797234	0	2.844660961	0.557395404	0	0.117960423	8.338110805	9.49731995	0.977911032	2.417994905	4.326432236	0	7.730170622	0	0	0	0.945	0.4485	0	0	0	0	0.040832454	1.094198206	2.087675238	1.777041982	1.45656552	0	0.512444974	2.924347715	0	3.032734299	82.6476
H5854_801_0	2010	4	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	325.7648481	3.729791218	107.9199003	51.32605739	8.461139075	15.03177412	3.716567407	12.03115753	43.47523913	8.419488965	20.09903809	0	0.076775643	24.11922295	45.27948657	117.8955455	1.719234939	6.815570953	33.39020239	40.55783055	10.29887291	1.813287495	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.068209822	0.068209822	0.160855619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.068209822	0.068209822	0.160855619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.2204	0.254408396	17.35952236	0	1.971445404	3.502403369	0.865960206	2.803259704	10.12973072	1.961740929	4.683075875	0	0.017888725	5.619778948	10.55012037	27.46966211	0.400581741	1.588028032	7.779917156	9.449974519	2.399637387	0.422495986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.45	0	0	22.2204	0.254408396	17.35952236	0	1.971445404	3.502403369	0.865960206	2.803259704	10.12973072	1.961740929	4.683075875	0	0.017888725	5.619778948	10.55012037	27.46966211	0.400581741	1.588028032	7.779917156	9.449974519	2.399637387	0.422495986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.45	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.2204	0.254408396	17.35952236	0	1.971445404	3.502403369	0.865960206	2.803259704	10.12973072	1.961740929	4.683075875	0	0.017888725	5.619778948	10.55012037	27.46966211	0.400581741	1.588028032	7.779917156	9.449974519	2.399637387	0.422495986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.45
H5854_803_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	325.7648481	3.729791218	107.9199003	51.32605739	8.461139075	15.03177412	3.716567407	12.03115753	43.47523913	8.419488965	20.09903809	0	0.076775643	24.11922295	45.27948657	117.8955455	1.719234939	6.815570953	33.39020239	40.55783055	10.29887291	1.813287495	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.068209822	0.068209822	0.160855619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.068209822	0.068209822	0.160855619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.2204	0.254408396	17.35952236	0	1.971445404	3.502403369	0.865960206	2.803259704	10.12973072	1.961740929	4.683075875	0	0.017888725	5.619778948	10.55012037	27.46966211	0.400581741	1.588028032	7.779917156	9.449974519	2.399637387	0.422495986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.45	0	0	22.2204	0.254408396	17.35952236	0	1.971445404	3.502403369	0.865960206	2.803259704	10.12973072	1.961740929	4.683075875	0	0.017888725	5.619778948	10.55012037	27.46966211	0.400581741	1.588028032	7.779917156	9.449974519	2.399637387	0.422495986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.45	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.2204	0.254408396	17.35952236	0	1.971445404	3.502403369	0.865960206	2.803259704	10.12973072	1.961740929	4.683075875	0	0.017888725	5.619778948	10.55012037	27.46966211	0.400581741	1.588028032	7.779917156	9.449974519	2.399637387	0.422495986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.45
H5854_805_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	325.7648481	3.729791218	107.9199003	51.32605739	8.461139075	15.03177412	3.716567407	12.03115753	43.47523913	8.419488965	20.09903809	0	0.076775643	24.11922295	45.27948657	117.8955455	1.719234939	6.815570953	33.39020239	40.55783055	10.29887291	1.813287495	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.068209822	0.068209822	0.160855619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.068209822	0.068209822	0.160855619	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.2204	0.254408396	17.35952236	0	1.971445404	3.502403369	0.865960206	2.803259704	10.12973072	1.961740929	4.683075875	0	0.017888725	5.619778948	10.55012037	27.46966211	0.400581741	1.588028032	7.779917156	9.449974519	2.399637387	0.422495986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.45	0	0	22.2204	0.254408396	17.35952236	0	1.971445404	3.502403369	0.865960206	2.803259704	10.12973072	1.961740929	4.683075875	0	0.017888725	5.619778948	10.55012037	27.46966211	0.400581741	1.588028032	7.779917156	9.449974519	2.399637387	0.422495986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.45	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.2204	0.254408396	17.35952236	0	1.971445404	3.502403369	0.865960206	2.803259704	10.12973072	1.961740929	4.683075875	0	0.017888725	5.619778948	10.55012037	27.46966211	0.400581741	1.588028032	7.779917156	9.449974519	2.399637387	0.422495986	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.45
H5859_001_0	2010	3	N/A																															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																																																			0	NO	280.9749318	39.30340949	37.77681739	33.74857988	28.0006039	52.58935138	9.377038094	80.38143974	44.65386031	15.62791144	25.10130811	2.847274956	0.443320605	22.46699375	35.9722856	57.05972479	3.023320314	0.705830803	16.93055656	48.10058016	23.5552357	3.178702117	12.141	0	0.725	2.175	0.0945	1.29555667	0.159731096	0.121646513												Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS											8.428547244	8.428547244	13.16185012	0	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	23.3	23.3	23.3	23.3	0	0	0	0	0	0	0	0											NO	8.428547244	8.428547244	13.16185012	0	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	23.3	23.3	23.3	23.3	0	0	0	0	0	0	0	0												23.6821	3.312706437	4.972128083	0	6.524140709	12.25331887	2.184849876	18.72887546	10.40434945	3.641303365	5.848604791	0.663415065	0.103293701	5.234809544	8.381542544	13.29491588	0.704433633	0.164458577	3.944819679	11.20743518	5.488369919	0.740637593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.4805	0	0	23.6821	3.312706437	4.972128083	0	6.524140709	12.25331887	2.184849876	18.72887546	10.40434945	3.641303365	5.848604791	0.663415065	0.103293701	5.234809544	8.381542544	13.29491588	0.704433633	0.164458577	3.944819679	11.20743518	5.488369919	0.740637593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.4805	NO																																																																																		0			23.6821	3.312706437	4.972128083	0	6.524140709	12.25331887	2.184849876	18.72887546	10.40434945	3.641303365	5.848604791	0.663415065	0.103293701	5.234809544	8.381542544	13.29491588	0.704433633	0.164458577	3.944819679	11.20743518	5.488369919	0.740637593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.4805
H5859_003_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	P	T	V	V	V	V	V	V	V	V	V	V	V	V	V	V																																												0	NO	880.7763434	56.49836724	976.5903358	3514.001841	90.67680122	15.13549173	3.960208893	104.3039024	120.8518649	7698.165129	19.93942716	72.76744799	0	31.02110433	4599.997716	3724.079664	397.416192	1381.516688	4210.210775	25173.92169	12.59943155	2827.583381	1170	0	900	720	0	0	95.8386577	0	0	0	0	0	0	0	0					"Days 1-5 $200, Day 6 and on $0"	"Days 1-5 $200, Day 6 and on $0"	"Days 1-20 $0, Days 21-100 $100"	6: $0	10A: $150/trip	11A: 20% coinsurance	"11B: 20% coinsurance, 11C: 0% coinsurance"	"4A: $50 ER copay, 4B: $30 Urgent Care copay"	"9A, 9B: $150 Copay"	8A: $0 copay	8B: 20% coinsurance	$150 copay	12: 20% coinsurance	"3: $30 CORF, 5: $75 Partial hospitalization, 9C: $30 OP SA, 9D: $0 Cardiac Rehab, 8B: 20% coinsurance all other."	"7A: $15 copay. 14B, 14C, 14D, 14E, 14F, 14G, 14H, 14I, 14J: $0 copay"	"7B, 7D, 7F, 7G:$30 copay"	"7E, 7H: $30 copay"	"7C, 7I: $30 copay"	0	0	15: 20% coinsurance	"$0 copay except 17A: $20 copay eye exam, 18A: $20 copay hearing exam"	"10B: $0 Copay, 12 trip limit per year, and 4 trip limit per month"		17A: $20 copay. One eye exam every year.	"17B: $0 copay, $75 max benefit (lenses & frames) every two years."			0												129.6882936	86.0089272	10.39695293	0	150	0.2	0.1	44	150	0	0.2	150	0.2	0.1975	14.25	30	30	30	0	0	0.2	0.5	0		20	0			0												NO	129.6882936	86.0089272	10.39695293	0	150	0.2	0.1	44	150	0	0.2	150	0.2	0.1975	14.25	30	30	30	0	0	0.2	0.5	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0					9.5189	0.404946996	0.846130312	0	1.133460015	3.027098347	0.396020889	0.382447642	1.510648311	0	3.987885433	0.9095931	0	6.126668105	5.462497288	9.310199161	0.99354048	3.453791719	0	0	2.519886309	0.117815974	0	0	1.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6015	0	0	9.5189	0.404946996	0.846130312	0	1.133460015	3.027098347	0.396020889	0.382447642	1.510648311	0	3.987885433	0.9095931	0	6.126668105	5.462497288	9.310199161	0.99354048	3.453791719	0	0	2.519886309	0.117815974	0	0	1.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6015	NO																																																																																		0			9.5189	0.404946996	0.846130312	0	1.133460015	3.027098347	0.396020889	0.382447642	1.510648311	0	3.987885433	0.9095931	0	6.126668105	5.462497288	9.310199161	0.99354048	3.453791719	0	0	2.519886309	0.117815974	0	0	1.5	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6015
H5862_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	V	Coin	Coin	V	V	V	V	P	Coin	Coin	Coin	T	V	V	V	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	YES	453.2067277	14.52571953	147.8081227	0	122.737251	5.106722615	2.864998487	268.8035448	37.9059931	6.937188025	16.58586597	0	0.211518179	26.27160283	877.8180756	6037.952728	37.49524597	560.1691222	1325.379994	4.453182391	5.75877199	7.621220992	0	0	0	0	13.24264832	0	0	0											3000	$150/Days 1-10 for IP Medical; $150/Days 1-10 for IP Surgical;	$150/Days 1-10 for IP Psych; $150/Days 1-10 for IP Substance Abuse;	$128 days 20 - 100	No Cost-Sharing	$150/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $250/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	20% Coinsurance for OP Fac - Pathology	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$10/Case for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; 20% Coinsurance for OP Fac - CORF; 20% Coinsurance for OP Fac - Other; 20% Coinsurance for Prof - CORF; 20% Coinsurance for Prof - CORF;	$30/Visit for PCP - Office Visits; $30/Consult for PCP - Consults; $30/Exam for PCP - Routine Physicals;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (OP); $30/Procedure for Prof Radiology (Office);	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; 20% Coinsurance for Prof Path (OP); $30/Procedure for Prof Path (Office); $30/Procedure for Prof Path (Labs)	20% Coinsurance for Part B Rx	20% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	$0/ for Vision (Refractions)	No Cost-Sharing	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	150	128	0	150	0.2	0.2	50.55951379	0.2	0.2	0.2	0	0.2	0.139556488	30	30	30	30	22.33072079	0.024027986	0.2	0.2	0	0	0	0	30	0	0	0											NO	137.534295	137.534295	117.3625984	0	137.534295	0.18337906	0.18337906	46.35778058	0.18337906	0.18337906	0.18337906	0	0.18337906	0.127958688	27.50685901	27.50685901	27.50685904	27.50685901	20.47493295	0.022031148	0.18337906	0.18337906	0	0	0	0	27.50685899	0	0	0												5.1943	0.16648205	1.445595446	0	1.406715108	0.936465993	0.52538073	1.038427979	6.951165386	1.27213502	3.041500511	0	0.038788005	3.361679833	2.01216817	13.8404262	0.085948037	1.284041089	2.261422208	0.09810872	1.056038195	1.397572342	0	0	0	0	0.030355305	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4447	0	4.300248877	5.1943	0.16648205	1.445595446	0	1.406715108	0.936465993	0.52538073	1.038427979	6.951165386	1.27213502	3.041500511	0	0.038788005	3.361679833	2.01216817	13.8404262	0.085948037	1.284041089	2.261422208	0.09810872	1.056038195	1.397572342	0	0	0	0	0.030355305	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4447	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.1943	0.16648205	1.445595446	0	1.406715108	0.936465993	0.52538073	1.038427979	6.951165386	1.27213502	3.041500511	0	0.038788005	3.361679833	2.01216817	13.8404262	0.085948037	1.284041089	2.261422208	0.09810872	1.056038195	1.397572342	0	0	0	0	0.030355305	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4447
H5868_001_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	YES	1268.781689	39.877391	576.453342	361.191969	31.976622	9.01991	4.122425	287.021319	338.728798	1150.900746	216.417927	63.936272	0.048006	527.447721	3597.041366	4063.558899	77.717653	252.436265			19.754946	0							0.04	0.25	661.97282	8.325039	0.05	0.55	2.91	448.300382	0.32	0.4	0.42		3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-9):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		175.3412	141.0078	48.2281	0	100	0.2	0.2	50	150	19.160552	30	50	0.2	43.619066	10	30	30	50			0.2	0							0	0	39.523886	0	0	0	0	30	0	0	0		NO	144.171496	115.941407	22.669329	0	83.6535	0.167307	0.167307	41.82675	125.48025	16.028472	25.09605	41.82675	0.167307	36.488876	8.36535	25.09605	25.09605	41.82675			0.167307	0							0	0	33.063114	0	0	0	0	25.09605	0	0	0			15.2435	0.385286735	1.088984205	0	0.222913029	1.509094082	0.689710559	1.000430746	3.541981188	1.537265032	0.452602926	0.222853872	0.00803174	1.603831207	2.507542499	8.498273109	0.162533842	0.879882379	0	0	3.30514075	0	0	0	0	0	0	0	0	0	1.823906901	0	0	0	0	0.9375474	0	0	0	0	45.6213	0	10.254675	15.2435	0.385286735	1.088984205	0	0.222913029	1.509094082	0.689710559	1.000430746	3.541981188	1.537265032	0.452602926	0.222853872	0.00803174	1.603831207	2.507542499	8.498273109	0.162533842	0.879882379	0	0	3.30514075	0	0	0	0	0	0	0	0	0	1.823906901	0	0	0	0	0.9375474	0	0	0	0	45.6213	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		5000	6.0891	0.0664	0.2467	1.7723	1.0027	1.6784	0.7671	0.1985	2.8265	0.3298	0.1048	0.168	0.0017	0.4715	1.7417	1.9676	0.0376	0.1083			0.9126	0							0	0	0.8089	0	0	0	0	0.2171	0	0	0		21.5172	500	12.014895	21.3326	0.451694735	1.335726205	1.772286	1.225628029	3.187510082	1.456807559	1.198967746	6.368432188	1.867093032	0.557392926	0.390835872	0.00970874	2.075304207	4.249232499	10.46585211	0.200164842	0.988139379	0	0	4.21771175	0	0	0	0	0	0	0	0	0	2.632784901	0	0	0	0	1.1546144	0	0	0	0	67.1385
H5868_004_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	YES	1116.335097	48.235952	371.938374	523.597168	32.687766	6.537243	2.790274	275.108467	337.856107	1578.191634	179.942171	62.058677	0.092357	492.747798	3085.619721	3846.031809	92.003496	197.428237			19.548983	0							0.04	0.25	856.805344	15.745507	0.05	0.55	2.91	538.706674	0.32	0.4	0.42		3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-9):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		175.3412	141.0078	48.2281	0	100	0.2	0.2	50	150	12.38818	30	50	0.2	43.521955	10	30	30	50			0.2	0							0	0	39.685211	0	0	0	0	30	0	0	0		NO	149.991772	120.62202	28.318672	0	85.4145	0.170829	0.170829	42.70725	128.12175	10.581302	25.62435	42.70725	0.170829	37.17406	8.54145	25.62435	25.62435	42.70725			0.170829	0							0	0	33.896924	0	0	0	0	25.62435	0	0	0			13.9534	0.484859831	0.877733401	0	0.232667432	1.116750684	0.476659717	0.97909384	3.607226306	1.391610191	0.384241764	0.220862953	0.015777254	1.526453017	2.196305547	8.212672099	0.196460815	0.702634756	0	0	3.339533217	0	0	0	0	0	0	0	0	0	2.420255469	0	0	0	0	1.15033403	0	0	0	0	43.4856	0	7.867509	13.9534	0.484859831	0.877733401	0	0.232667432	1.116750684	0.476659717	0.97909384	3.607226306	1.391610191	0.384241764	0.220862953	0.015777254	1.526453017	2.196305547	8.212672099	0.196460815	0.702634756	0	0	3.339533217	0	0	0	0	0	0	0	0	0	2.420255469	0	0	0	0	1.15033403	0	0	0	0	43.4856	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		5000	5.8279	0.0873	0.2193	1.544	1.0722	1.2725	0.5431	0.1991	2.6316	0.3056	0.0911	0.2542	0.0034	0.5601	1.5629	1.948	0.0466	0.0713			0.967	0							0	0	1.0502	0	0	0	0	0.2729	0	0	0		20.5304	500	9.202023	19.7813	0.572157831	1.097067401	1.544001	1.304897432	2.389226684	1.019786717	1.17815584	6.238873306	1.697193191	0.475382764	0.475089953	0.019153254	2.086583017	3.759184547	10.1607031	0.243060815	0.773888756	0	0	4.306559217	0	0	0	0	0	0	0	0	0	3.470487469	0	0	0	0	1.42319103	0	0	0	0	64.0159
H5868_801_0	2010	4	N/A																															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	NO	239.0345628	0.815362053	24.72086903	14.75754424	2.20619079	12.10439143	5.916797815	18.31803782	59.87100656	7.616922503	18.28672914	6.419423779	0.563962915	11.6293804	31.72840731	69.58347285	0.334336932	5.138289777			23.27577748	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																			0.089130832	0.089130832	0.109197688	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.089130832	0.089130832	0.109197688	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.3053	0.072673898	2.699461752	0	0.514042454	2.820323202	1.378613891	4.268102811	13.94994453	1.774742943	4.26080789	1.495725741	0.131403359	2.709645633	7.392718902	16.21294917	0.077900505	1.197221518	0	0	5.423256153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6849	0	0	21.3053	0.072673898	2.699461752	0	0.514042454	2.820323202	1.378613891	4.268102811	13.94994453	1.774742943	4.26080789	1.495725741	0.131403359	2.709645633	7.392718902	16.21294917	0.077900505	1.197221518	0	0	5.423256153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6849	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3887	0.0013	0.0618	0	0.8713	0.5926	0.2897	0.3483	1.0389	0.1449	0.3157	0.1221	0.0107	0.2195	0.4289	0.9406	0.0045	0.0793			0.011	0																			5.8696	0	0	21.6941	0.074000775	2.761215014	0	1.38534818	3.412903094	1.668269954	4.616449336	14.98882419	1.919602905	4.576480629	1.617812767	0.142135339	2.929139161	7.821574871	17.15350172	0.082430758	1.276512551	0	0	5.434259907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5545
H5868_802_0	2010	4	N/A																															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	NO	239.0345628	0.815362053	24.72086903	14.75754424	2.20619079	12.10439143	5.916797815	18.31803782	59.87100656	7.616922503	18.28672914	6.419423779	0.563962915	11.6293804	31.72840731	69.58347285	0.334336932	5.138289777			23.27577748	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																			0.089130832	0.089130832	0.109197688	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.089130832	0.089130832	0.109197688	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.3053	0.072673898	2.699461752	0	0.514042454	2.820323202	1.378613891	4.268102811	13.94994453	1.774742943	4.26080789	1.495725741	0.131403359	2.709645633	7.392718902	16.21294917	0.077900505	1.197221518	0	0	5.423256153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6849	0	0	21.3053	0.072673898	2.699461752	0	0.514042454	2.820323202	1.378613891	4.268102811	13.94994453	1.774742943	4.26080789	1.495725741	0.131403359	2.709645633	7.392718902	16.21294917	0.077900505	1.197221518	0	0	5.423256153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6849	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3887	0.0013	0.0618	0	0.8713	0.5926	0.2897	0.3483	1.0389	0.1449	0.3157	0.1221	0.0107	0.2195	0.4289	0.9406	0.0045	0.0793			0.011	0																			5.8696	0	0	21.6941	0.074000775	2.761215014	0	1.38534818	3.412903094	1.668269954	4.616449336	14.98882419	1.919602905	4.576480629	1.617812767	0.142135339	2.929139161	7.821574871	17.15350172	0.082430758	1.276512551	0	0	5.434259907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5545
H5868_803_0	2010	4	N/A																															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	NO	239.0345628	0.815362053	24.72086903	14.75754424	2.20619079	12.10439143	5.916797815	18.31803782	59.87100656	7.616922503	18.28672914	6.419423779	0.563962915	11.6293804	31.72840731	69.58347285	0.334336932	5.138289777			23.27577748	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																			0.089130832	0.089130832	0.109197688	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.089130832	0.089130832	0.109197688	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				21.3053	0.072673898	2.699461752	0	0.514042454	2.820323202	1.378613891	4.268102811	13.94994453	1.774742943	4.26080789	1.495725741	0.131403359	2.709645633	7.392718902	16.21294917	0.077900505	1.197221518	0	0	5.423256153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6849	0	0	21.3053	0.072673898	2.699461752	0	0.514042454	2.820323202	1.378613891	4.268102811	13.94994453	1.774742943	4.26080789	1.495725741	0.131403359	2.709645633	7.392718902	16.21294917	0.077900505	1.197221518	0	0	5.423256153	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6849	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3887	0.0013	0.0618	0	0.8713	0.5926	0.2897	0.3483	1.0389	0.1449	0.3157	0.1221	0.0107	0.2195	0.4289	0.9406	0.0045	0.0793			0.011	0																			5.8696	0	0	21.6941	0.074000775	2.761215014	0	1.38534818	3.412903094	1.668269954	4.616449336	14.98882419	1.919602905	4.576480629	1.617812767	0.142135339	2.929139161	7.821574871	17.15350172	0.082430758	1.276512551	0	0	5.434259907	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5545
H5883_001_1	2010	7	N/A																															A	A	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	V											5.0056	0.091	0.6633	0.2015	0.18	0	0	0.3297	1.0275	0	0.3087	0	0.0004	0.4517	0.0354	0.3086	0.0167	0.0174	0.4985	2.088	0.2277	0.4608	0	0	0	0	0	0	0	0.0366											11.9492	NO	207.9029364	9.915233108	249.8977646	162.7875471	195.0821443	17.42623938	0.041725465	259.4827895	331.8721157	3450.901267	483.3213312	0	3.976652725	404.5213081	7229.72553	772.6642521	103.2771711	92.37928666	316.2672236	3670.207558	533.8804527	939.9307426	0	0	0	0	0	0	0	14.57988018												$700 copay per admit	$700 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$100 OP surgery		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			"Either no cost sharing or $35 copay per service, depending on the service"	$20 copay	$35 copay	$30 copay	$30 copay	$20 copay	"$50 office surgery, $30 allergy, $30 cardiovascular"		"Either no cost sharing or $35 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														690.8796388	0	130	0	50	0.053333333	0.142666667	48.49849781	100	0	0	0	0	17.87608064	18.76947918	34.70520551	34.98737918	35	23.47444194	8.013998962	0	0.503808109	0	0	0	0	0	0	0	0											NO	685.2605892	0	128.9426864	0	49.59334092	0.053333333	0.142666667	48.10405072	99.18668184	0	0	0	0	17.73069123	18.6168236	34.42893581	34.70282047	34.71533864	23.28352004	7.948819653	0	0.499710546	0	0	0	0	0	0	0	0												11.8723	0	2.685207424	0	0.806231274	0.929399434	0.005952833	1.040181105	2.74310783	0	0	0	0	0.597703534	11.21621041	2.216833995	0.298667427	0.267248185	0.613651187	2.431151497	0	0.039141109	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.763	150	0.301592864	16.8779	0.091016518	3.348488056	0.201461861	0.986184298	0.929399434	0.005952833	1.369878336	3.770646724	0	0.308742132	0	0.000351939	1.049433788	11.25164627	2.525404929	0.315393572	0.284645679	1.11217551	4.519168935	0.227722427	0.499929942	0	0	0	0	0	0	0	0.036618747	0	0	0	0	0	0	0	0	0	0	49.7122	NO																																																																																		0	0	0	16.8779	0.091016518	3.348488056	0.201461861	0.986184298	0.929399434	0.005952833	1.369878336	3.770646724	0	0.308742132	0	0.000351939	1.049433788	11.25164627	2.525404929	0.315393572	0.284645679	1.11217551	4.519168935	0.227722427	0.499929942	0	0	0	0	0	0	0	0.036618747	0	0	0	0	0	0	0	0	0	0	49.7122
H5883_001_2	2010	8	N/A																															A	A	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	V											5.0884	0.0551	0.8092	0.1812	0.1664	0	0	0.2877	1.083	0	0.29	0	0.0004	0.4453	0.0325	0.2965	0.0174	0.024	0.4798	1.8922	0.2246	0.5326	0	0	0	0	0	0	0	0.0442											11.9506	NO	203.9106082	5.432757423	269.2850461	162.5550485	169.9429441	16.77696468	0.04676214	5017.520938	334.978661	3451.589602	461.9247047	0	4.408954088	317.1114524	7539.710333	756.2942063	104.8200366	101.2385892	317.6980086	3501.287722	489.0161111	1045.447694	0	0	0	0	0	0	0	24.28852718												$700 copay per admit	$700 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 101"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$100 OP surgery		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			"Either no cost sharing or $35 copay per service, depending on the service"	$20 copay	$35 copay	$30 copay	$30 copay	$20 copay	"$50 office surgery, $30 allergy, $30 cardiovascular"		"Either no cost sharing or $35 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														681.7293171	0	130	0	50	0.053333333	0.142666667	35.60269568	100	0	0	0	0	18.70954497	18.84360292	34.61565405	34.98621314	35	23.60001199	7.124302378	0	2.213880314	0	0	0	0	0	0	0	0											NO	663.2943717	0	126.4846122	0	48.64792778	0.053333333	0.142666667	34.63994737	97.29585556	0	0	0	0	18.20361185	18.33404468	33.70557994	34.0401354	34.05354945	22.96183358	6.931650951	0	2.154013792	0	0	0	0	0	0	0	0												11.2711	0	2.838367887	0	0.688947673	0.89477145	0.006671399	14.48388844	2.716002951	0	0	0	0	0.481047816	11.51944884	2.124277902	0.297340687	0.287294442	0.607910734	2.022475364	0	0.187659063	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.4272	150	1.374785754	16.3595	0.055069058	3.647612464	0.181233308	0.855392582	0.89477145	0.006671399	14.77154208	3.799044089	0	0.29003333	0	0.000392867	0.926320218	11.55195224	2.420824337	0.314787538	0.311262937	1.087692637	3.914682007	0.224556508	0.720235603	0	0	0	0	0	0	0	0.044227312	0	0	0	0	0	0	0	0	0	0	62.3778	NO																																																																																		0	0	0	16.3595	0.055069058	3.647612464	0.181233308	0.855392582	0.89477145	0.006671399	14.77154208	3.799044089	0	0.29003333	0	0.000392867	0.926320218	11.55195224	2.420824337	0.314787538	0.311262937	1.087692637	3.914682007	0.224556508	0.720235603	0	0	0	0	0	0	0	0.044227312	0	0	0	0	0	0	0	0	0	0	62.3778
H5883_001_3	2010	7	N/A																															A	A	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	V											5.0205	0.0554	0.7796	0.1665	0.1739	0	0	0.2905	1.0367	0	0.3034	0	0.0004	0.4653	0.0341	0.3168	0.023	0.019	0.5029	2.0195	0.2226	0.4834	0	0	0	0	0	0	0	0.0416											11.9551	NO	200.5099651	5.553308725	301.62318	160.7954781	196.4735126	18.31689663	0.047624007	335.3966674	340.2910163	3455.132147	483.8691527	0	4.506787492	346.6689185	7634.623443	779.3166467	140.280954	98.1400593	330.0356792	3702.149298	525.7996453	985.3863467	0	0	0	0	0	0	0	16.70175699												$700 copay per admit	$700 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 102"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$100 OP surgery		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			"Either no cost sharing or $35 copay per service, depending on the service"	$20 copay	$35 copay	$30 copay	$30 copay	$20 copay	"$50 office surgery, $30 allergy, $30 cardiovascular"		"Either no cost sharing or $35 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														682.3988263	0	130	0	50	0.053333333	0.142666667	45.40548414	100	0	0	0	0	19.20218401	18.76834375	34.57322564	34.98946966	35	23.51309447	7.815417366	0	0.544632911	0	0	0	0	0	0	0	0											NO	675.7654025	0	128.7363034	0	49.51396284	0.053333333	0.142666667	44.96410909	99.02792567	0	0	0	0	19.01552451	18.5859015	34.2475196	34.649346	34.65977399	23.28452971	7.7394457	0	0.539338675	0	0	0	0	0	0	0	0												11.2915	0	3.2358211	0	0.81068185	0.976901154	0.006794358	1.256734362	2.808192789	0	0	0	0	0.549340943	11.82469661	2.224138511	0.405053609	0.283459356	0.640393798	2.387715289	0	0.044288081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7457	150	0.369997722	16.312	0.055398213	4.015383202	0.166505675	0.984606467	0.976901154	0.006794358	1.547244043	3.844847212	0	0.30342667	0	0.000395216	1.014651455	11.85881984	2.540950491	0.428048955	0.302500803	1.143291247	4.407199108	0.222556087	0.527681479	0	0	0	0	0	0	0	0.04161549	0	0	0	0	0	0	0	0	0	0	50.7008	NO																																																																																		0	0	0	16.312	0.055398213	4.015383202	0.166505675	0.984606467	0.976901154	0.006794358	1.547244043	3.844847212	0	0.30342667	0	0.000395216	1.014651455	11.85881984	2.540950491	0.428048955	0.302500803	1.143291247	4.407199108	0.222556087	0.527681479	0	0	0	0	0	0	0	0.04161549	0	0	0	0	0	0	0	0	0	0	50.7008
H5883_001_4	2010	8	N/A																															A	A	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	V											4.8727	0.0617	0.6139	0.21	0.1558	0	0	0.3233	1.0381	0	0.2942	0	0.0006	0.4612	0.0357	0.3346	0.0243	0.0223	0.5636	2.0857	0.2304	0.5573	0	0	0	0	0	0	0	0.0375											11.9229	NO	179.0861339	5.376979112	189.328958	141.6598548	154.709427	17.52496298	0.048395568	240.0425229	305.6801105	3451.53194	420.6891454	0	6.290366136	304.1692435	7404.348794	699.4306373	132.6995646	91.9356981	356.3591781	3401.503356	485.5841915	1027.185038	0	0	0	0	0	0	0	19.32987189												$700 copay per admit	$700 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 103"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$100 OP surgery		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			"Either no cost sharing or $35 copay per service, depending on the service"	$20 copay	$35 copay	$30 copay	$30 copay	$20 copay	"$50 office surgery, $30 allergy, $30 cardiovascular"		"Either no cost sharing or $35 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														688.3815914	0	130	0	50	0.053333333	0.142666667	47.32216709	100	0	0	0	0	20.56164346	18.89571698	34.67762406	34.9892215	35	23.79713639	7.904265272	0	0.505880884	0	0	0	0	0	0	0	0											NO	685.8196785	0	129.516186	0	49.81391768	0.053333333	0.142666667	47.14605072	99.62783537	0	0	0	0	20.4851203	18.82539381	34.55156564	34.85900399	34.86974238	23.70857187	7.874848392	0	0.503998174	0	0	0	0	0	0	0	0												10.2351	0	2.043430378	0	0.642223555	0.934664692	0.006904434	0.94308808	2.537853977	0	0	0	0	0.519245295	11.61581516	2.013868631	0.385481221	0.267147842	0.704063932	2.232193603	0	0.043141615	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1242	150	0.127515363	15.1077	0.061727244	2.657332738	0.209956587	0.798062553	0.934664692	0.006904434	1.26639139	3.575929245	0	0.294217345	0	0.000590404	0.980476916	11.65153328	2.348445434	0.409747328	0.28944017	1.267706964	4.317926897	0.230444833	0.600409897	0	0	0	0	0	0	0	0.037486128	0	0	0	0	0	0	0	0	0	0	47.0471	NO																																																																																		0	0	0	15.1077	0.061727244	2.657332738	0.209956587	0.798062553	0.934664692	0.006904434	1.26639139	3.575929245	0	0.294217345	0	0.000590404	0.980476916	11.65153328	2.348445434	0.409747328	0.28944017	1.267706964	4.317926897	0.230444833	0.600409897	0	0	0	0	0	0	0	0.037486128	0	0	0	0	0	0	0	0	0	0	47.0471
H5883_001_5	2010	7	N/A																															A	A	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	V											4.9826	0.0783	0.5517	0.1926	0.1465	0	0	0.2935	0.9578	0	0.2747	0	0.0005	0.4155	0.0312	0.335	0.0385	0.0281	0.4891	2.1369	0.2095	0.7587	0	0	0	0	0	0	0	0.0428											11.9632	NO	196.9530737	9.179732682	194.6406263	151.6248722	166.0362622	17.16876857	0.043226758	285.6998069	331.4590861	3452.128839	448.1173525	0	7.547292334	307.4373735	7960.730967	787.9378059	235.9666907	133.0816288	334.5617215	3931.782854	485.3031729	1281.35688	0	0	0	0	0	0	0	17.00849592												$700 copay per admit	$700 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 104"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$100 OP surgery		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			"Either no cost sharing or $35 copay per service, depending on the service"	$20 copay	$35 copay	$30 copay	$30 copay	$20 copay	"$50 office surgery, $30 allergy, $30 cardiovascular"		"Either no cost sharing or $35 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														690.3443738	0	130	0	50	0.053333333	0.142666667	47.30666161	100	0	0	0	0	18.85103053	18.83863855	34.67301268	34.99445998	35	23.59725757	7.67182051	0	0.370647817	0	0	0	0	0	0	0	0											NO	683.9225426	0	128.7906933	0	49.53488205	0.053333333	0.142666667	46.86659806	99.0697641	0	0	0	0	18.67567148	18.66339477	34.35807625	34.66892895	34.67441743	23.3777474	7.600454482	0	0.367199918	0	0	0	0	0	0	0	0												11.2251	0	2.088991768	0	0.685382222	0.915667657	0.006167017	1.115814835	2.736464456	0	0	0	0	0.478466616	12.38118873	2.256002268	0.681726036	0.384543996	0.651774951	2.490278051	0	0.039209512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1367	150	0.34893292	16.2076	0.078274881	2.640655298	0.192594751	0.83188966	0.915667657	0.006167017	1.40926631	3.694248877	0	0.274696982	0	0.000516287	0.893962082	12.41234866	2.590963301	0.720268718	0.412601219	1.140846371	4.627184418	0.209491937	0.797901686	0	0	0	0	0	0	0	0.042771261	0	0	0	0	0	0	0	0	0	0	50.1	NO																																																																																		0	0	0	16.2076	0.078274881	2.640655298	0.192594751	0.83188966	0.915667657	0.006167017	1.40926631	3.694248877	0	0.274696982	0	0.000516287	0.893962082	12.41234866	2.590963301	0.720268718	0.412601219	1.140846371	4.627184418	0.209491937	0.797901686	0	0	0	0	0	0	0	0.042771261	0	0	0	0	0	0	0	0	0	0	50.1
H5883_002_1	2010	9	N/A																															A	A	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	V											3.2578	0.0421	0.3655	0.13	0.0936	0	0	0.2042	0.7765	0	0.2554	0	0.0021	0.3679	0.0277	0.2263	0.0146	0.0125	0.3163	1.4067	0.1724	0.3529	0	0	0	0	0	0	0	0.0242											8.0487	NO	188.8058171	5.705432753	196.2371686	143.8345738	137.9894472	17.74654488	0.062945319	251.6054127	353.7880766	3476.372585	568.9715444	0	4.680939729	425.1517269	7482.227996	722.413742	130.6295583	86.6057892	287.3339178	3373.021724	628.0586484	989.3789618	0	0	0	0	0	0	0	11.34506124												$500 copay per admit	$500 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$100 OP surgery		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			"Either no cost sharing or $30 copay per service, depending on the service"	$15 copay	$30 copay	$30 copay	$30 copay	$20 copay	"$50 office surgery, $30 allergy, $30 cardiovascular"		"Either no cost sharing or $30 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														491.972403	0	130	0	50	0.053333333	0.142666667	48.81015587	100	0	0	0	0	25.10692572	14.08440719	29.82765964	29.99391334	30	13.98460978	7.925173325	0	0.295397352	0	0	0	0	0	0	0	0											NO	489.6730766	0	129.3924203	0	49.76631551	0.053333333	0.142666667	48.58203234	99.53263101	0	0	0	0	24.98958373	14.01858104	29.69228173	29.85373109	29.8597893	13.91925005	7.888133523	0	0.294016756	0	0	0	0	0	0	0	0												7.7044	0	2.11596685	0	0.572268864	0.946482394	0.008980199	1.018625191	2.93445484	0	0	0	0	0.885363723	8.740851624	1.787509363	0.324981642	0.215502552	0.333289387	2.217237145	0	0.024241166	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	29.8302	100	0.135341579	10.9622	0.042119117	2.481508106	0.130003601	0.665885942	0.946482394	0.008980199	1.22281554	3.710936311	0	0.255382978	0	0.002120162	1.253289735	8.768593377	2.013859089	0.339570958	0.228001007	0.649548539	3.623927979	0.172352277	0.377159757	0	0	0	0	0	0	0	0.024180142	0	0	0	0	0	0	0	0	0	0	37.8789	NO																																																																																		0	0	0	10.9622	0.042119117	2.481508106	0.130003601	0.665885942	0.946482394	0.008980199	1.22281554	3.710936311	0	0.255382978	0	0.002120162	1.253289735	8.768593377	2.013859089	0.339570958	0.228001007	0.649548539	3.623927979	0.172352277	0.377159757	0	0	0	0	0	0	0	0.024180142	0	0	0	0	0	0	0	0	0	0	37.8789
H5883_002_2	2010	10	N/A																															A	A	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	V											3.4582	0.0535	0.3648	0.1086	0.0982	0	0	0.172	0.6646	0	0.2175	0	0.0002	0.3552	0.0247	0.2083	0.0198	0.0123	0.3917	1.311	0.149	0.4276	0	0	0	0	0	0	0	0.0248											8.0621	NO	193.8862184	9.089178123	220.9089432	155.4139596	167.1664839	16.80577576	0.04010089	5022.709102	320.1690384	3451.837238	556.7545702	0	6.257303038	358.6003586	8487.221681	735.544929	171.1873186	98.85627391	373.607152	3700.800117	538.1940594	1099.996579	0	0	0	0	0	0	0	13.70658764												$500 copay per admit	$500 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$100 OP surgery		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			"Either no cost sharing or $30 copay per service, depending on the service"	$15 copay	$30 copay	$30 copay	$30 copay	$20 copay	"$50 office surgery, $30 allergy, $30 cardiovascular"		"Either no cost sharing or $30 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														493.2916073	0	130	0	50	0.053333333	0.142666667	35.64967988	100	0	0	0	0	20.11399147	14.22667317	29.82802814	29.9937325	30	14.16814723	7.785263642	0	1.341278706	0	0	0	0	0	0	0	0											NO	479.9970417	0	126.496406	0	48.65246384	0.053333333	0.142666667	34.68889522	97.30492768	0	0	0	0	19.57190485	13.84325404	29.04731504	29.18537972	29.1914783	13.78630541	7.575445157	0	1.305130274	0	0	0	0	0	0	0	0												7.7554	0	2.328682281	0	0.677755109	0.896308041	0.00572106	14.51935248	2.596168761	0	0	0	0	0.584874341	9.790897154	1.780467107	0.416347241	0.240480065	0.429221858	2.33626736	0	0.11963657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4776	100	1.205460195	11.2136	0.053479575	2.693520852	0.108639921	0.775953135	0.896308041	0.00572106	14.69135305	3.260749393	0	0.217500761	0	0.000227468	0.940114397	9.815622095	1.988801674	0.436156032	0.252813221	0.820944073	3.647274178	0.149005423	0.547213891	0	0	0	0	0	0	0	0.024758001	0	0	0	0	0	0	0	0	0	0	52.5397	NO																																																																																		0	0	0	11.2136	0.053479575	2.693520852	0.108639921	0.775953135	0.896308041	0.00572106	14.69135305	3.260749393	0	0.217500761	0	0.000227468	0.940114397	9.815622095	1.988801674	0.436156032	0.252813221	0.820944073	3.647274178	0.149005423	0.547213891	0	0	0	0	0	0	0	0.024758001	0	0	0	0	0	0	0	0	0	0	52.5397
H5883_002_3	2010	10	N/A																															A	A	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	V											3.131	0.0592	0.3277	0.0865	0.0929	0	0	0.2297	0.8479	0	0.2789	0	0.0006	0.3422	0.0291	0.246	0.0165	0.0228	0.372	1.4556	0.1747	0.3043	0	0	0	0	0	0	0	0.0395											8.0569	NO	187.8582948	8.910160359	181.6274484	115.3419828	141.0945659	17.35092076	0.026712496	336.4258806	363.9757413	3452.675768	609.0812475	0	9.768538454	444.397811	8637.558786	900.0845376	136.7759283	195.733308	332.0382552	3662.102438	584.513937	1035.610288	0	0	0	0	0	0	0	24.84618981												$500 copay per admit	$500 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$100 OP surgery		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			"Either no cost sharing or $30 copay per service, depending on the service"	$15 copay	$30 copay	$30 copay	$30 copay	$20 copay	"$50 office surgery, $30 allergy, $30 cardiovascular"		"Either no cost sharing or $30 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														482.6487116	0	130	0	50	0.053333333	0.142666667	45.478766	100	0	0	0	0	18.19742729	13.95068974	29.77215991	29.99475922	30	14.0930914	8.963657946	0	0.254423975	0	0	0	0	0	0	0	0											NO	478.6738321	0	128.929378	0	49.58822231	0.053333333	0.142666667	45.10422317	99.17644461	0	0	0	0	18.0475614	13.83579808	29.53635163	29.74773576	29.75293338	13.97702699	8.889837258	0	0.252328652	0	0	0	0	0	0	0	0												7.4936	0	1.951426163	0	0.583052392	0.92538244	0.003810983	1.264519	3.008151662	0	0	0	0	0.668358065	9.958959941	2.21543445	0.339064515	0.485303339	0.386742305	2.712957892	0	0.021776179	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0185	100	0.25745431	10.6246	0.059240215	2.279154626	0.086515269	0.675923707	0.92538244	0.003810983	1.494176969	3.856046213	0	0.278850415	0	0.00055604	1.01051479	9.988089222	2.461482039	0.355525993	0.508062178	0.758729757	4.168548265	0.174670869	0.326065317	0	0	0	0	0	0	0	0.039500413	0	0	0	0	0	0	0	0	0	0	40.0754	NO																																																																																		0	0	0	10.6246	0.059240215	2.279154626	0.086515269	0.675923707	0.92538244	0.003810983	1.494176969	3.856046213	0	0.278850415	0	0.00055604	1.01051479	9.988089222	2.461482039	0.355525993	0.508062178	0.758729757	4.168548265	0.174670869	0.326065317	0	0	0	0	0	0	0	0.039500413	0	0	0	0	0	0	0	0	0	0	40.0754
H5883_002_4	2010	9	N/A																															A	A	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	V											3.6193	0.0689	0.347	0.1117	0.0955	0	0	0.1546	0.6912	0	0.1768	0	0.0002	0.2682	0.0223	0.2044	0.016	0.014	0.3707	1.3332	0.1376	0.4547	0	0	0	0	0	0	0	0.0221											8.1085	NO	264.6794291	12.94960438	256.544026	181.0527531	210.1918548	17.40986605	0.045796863	305.7539959	429.8526756	3473.030939	536.7806639	0	5.292438961	458.1543869	9801.872136	910.3747497	193.174927	144.3682672	529.1778166	4871.886411	631.7715563	1451.500021	0	0	0	0	0	0	0	21.07934113												$500 copay per admit	$500 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$100 OP surgery		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			"Either no cost sharing or $30 copay per service, depending on the service"	$15 copay	$30 copay	$30 copay	$30 copay	$20 copay	"$50 office surgery, $30 allergy, $30 cardiovascular"		"Either no cost sharing or $30 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														489.7175277	0	130	0	50	0.053333333	0.142666667	47.31230852	100	0	0	0	0	19.34647798	14.21836642	29.86412328	29.99387182	30	14.27584443	6.682432907	0	0.299787956	0	0	0	0	0	0	0	0											NO	480.2399683	0	127.4840951	0	49.03234428	0.053333333	0.142666667	46.396668	98.06468856	0	0	0	0	18.97206338	13.94319674	29.29930767	29.41339698	29.41940657	13.99956238	6.553107018	0	0.293986126	0	0	0	0	0	0	0	0												10.5925	0	2.725440251	0	0.858849949	0.928526189	0.006533686	1.182163887	3.51278073	0	0	0	0	0.724344506	11.3891193	2.222779157	0.473494235	0.353935729	0.617354821	2.660499419	0	0.035560072	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.2839	100	0.736063079	14.2118	0.068931274	3.072452385	0.11166052	0.954378874	0.928526189	0.006533686	1.336729086	4.204002922	0	0.176838883	0	0.000207248	0.992577591	11.41139962	2.42722889	0.4894582	0.367915088	0.98803408	3.993693916	0.137605132	0.490246456	0	0	0	0	0	0	0	0.022131317	0	0	0	0	0	0	0	0	0	0	46.3924	NO																																																																																		0	0	0	14.2118	0.068931274	3.072452385	0.11166052	0.954378874	0.928526189	0.006533686	1.336729086	4.204002922	0	0.176838883	0	0.000207248	0.992577591	11.41139962	2.42722889	0.4894582	0.367915088	0.98803408	3.993693916	0.137605132	0.490246456	0	0	0	0	0	0	0	0.022131317	0	0	0	0	0	0	0	0	0	0	46.3924
H5883_002_7	2010	11	N/A																															A	A	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	V											2.843	0.0644	0.4583	0.096	0.0919	0	0	0.1719	0.7494	0	0.2808	0	0.0003	0.3574	0.0277	0.2514	0.0181	0.0157	0.4459	1.5791	0.1616	0.4269	0	0	0	0	0	0	0	0.0304											8.0703	NO	209.8197353	13.15024435	254.0024647	140.955966	169.0048066	17.59175539	0.072118097	264.3610883	397.9203978	3451.419516	581.9708897	0	10.97262011	370.9282272	10308.68272	948.9380807	173.8444549	124.4141023	438.3196486	4589.388406	531.8452674	1575.375451	0	0	0	0	0	0	0	25.33601128												$500 copay per admit	$500 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$100 OP surgery		"$20 copay for low-tech radiology, $40 copay for high-tech radiology"			"Either no cost sharing or $30 copay per service, depending on the service"	$15 copay	$30 copay	$30 copay	$30 copay	$20 copay	"$50 office surgery, $30 allergy, $30 cardiovascular"		"Either no cost sharing or $30 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														491.6052984	0	130	0	50	0.053333333	0.142666667	47.68911225	100	0	0	0	0	12.49414686	13.99736579	29.80820073	30	30	14.28745795	8.132004074	0	1.384114639	0	0	0	0	0	0	0	0											NO	484.3910648	0	128.0922696	0	49.26625755	0.053333333	0.142666667	46.98928173	98.53251509	0	0	0	0	12.31079714	13.79195656	29.38484301	29.55975453	29.55975453	14.07779166	8.012668142	0	1.363802966	0	0	0	0	0	0	0	0												8.4696	0	2.711312683	0	0.693852861	0.938226954	0.010288848	1.035178138	3.267341467	0	0	0	0	0.38053518	11.84807536	2.323699711	0.428233285	0.30647086	0.514214391	3.064437189	0	0.179041809	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.1705	100	0.523445554	11.3125	0.064397855	3.169608334	0.096000798	0.785753975	0.938226954	0.010288848	1.207127623	4.016785809	0	0.280785503	0	0.000282054	0.737983782	11.87582164	2.57507846	0.446381768	0.322151598	0.960138801	4.643525628	0.161581287	0.605959337	0	0	0	0	0	0	0	0.030401191	0	0	0	0	0	0	0	0	0	0	44.2408	NO																																																																																		0	0	0	11.3125	0.064397855	3.169608334	0.096000798	0.785753975	0.938226954	0.010288848	1.207127623	4.016785809	0	0.280785503	0	0.000282054	0.737983782	11.87582164	2.57507846	0.446381768	0.322151598	0.960138801	4.643525628	0.161581287	0.605959337	0	0	0	0	0	0	0	0.030401191	0	0	0	0	0	0	0	0	0	0	44.2408
H5883_003_1	2010	10	N/A																															A	A	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	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	NO	253.3201201	9.50893004	314.1185622	307.3439622	201.2384632	17.98221716	0.010350387	366.5009061	425.8076723	3457.034176	771.8960923	0	2.004858449	753.2369123	9987.466791	1018.62569	178.9122745	247.6158578	378.0553067	4501.37185	904.9100158	1204.653649	0	0	0	0	0	0	0	10.12119864												$300 copay per admit	$300 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$50 OP surgery		"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$25 copay (PBP Section B-05, #5)"		"Either no cost sharing or $25 copay per service, depending on the service"	"$10 copay (PBP Section B-07, #7a & PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b, #14d-14j)"	"$25 copay (PBP Section B-07, #7b, #7d, #7e-f)"	"$25 copay (PBP Section B-07, #7e & #7h)"	"$25 copay (PBP Section B-07, #7c & 7i)"	$15 copay	"$30 office surgery, $20 allergy, $20 cardiovascular"		"Either no cost sharing or $25 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														289.4023044	0	130	0	50	0.053333333	0.142666667	49.37658417	50	0	0	0	0	11.45118353	9.477137948	25	24.91321304	25	13.91583824	5.843910991	0	0.839559695	0	0	0	0	0	0	0	0											NO	284.8119668	0	127.9380127	0	49.20692795	0.053333333	0.142666667	48.59340039	49.20692795	0	0	0	0	11.26955125	9.326816883	24.61467656	24.51805358	24.60346397	13.69511299	5.751218141	0	0.826243069	0	0	0	0	0	0	0	0												6.0124	0	3.348975383	0	0.82519388	0.959051582	0.001476655	1.484127106	1.746057288	0	0	0	0	0.707386833	7.762606157	2.089428491	0.365548394	0.507683986	0.431459179	2.157364287	0	0.082944727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.4817	0	0.442593631	6.0124	0	3.348975383	0	0.82519388	0.959051582	0.001476655	1.484127106	1.746057288	0	0	0	0	0.707386833	7.762606157	2.089428491	0.365548394	0.507683986	0.431459179	2.157364287	0	0.082944727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.4817	NO																																																																																		0	0	0	6.0124	0	3.348975383	0	0.82519388	0.959051582	0.001476655	1.484127106	1.746057288	0	0	0	0	0.707386833	7.762606157	2.089428491	0.365548394	0.507683986	0.431459179	2.157364287	0	0.082944727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	28.4817
H5883_003_2	2010	10	N/A																															A	A	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	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	NO	344.78274	9.833283461	628.0368271	357.2216789	272.4853344	17.15850672	0.096446316	5163.023611	473.9761333	3456.388425	636.9709595	0	7.579617406	695.6537462	11994.05437	1054.886572	217.3738624	221.8737486	625.9671386	5482.670906	783.7165513	1698.510619	0	0	0	0	0	0	0	25.85913855												$300 copay per admit	$300 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$50 OP surgery		"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$25 copay (PBP Section B-05, #5)"		"Either no cost sharing or $25 copay per service, depending on the service"	"$10 copay (PBP Section B-07, #7a & PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b, #14d-14j)"	"$25 copay (PBP Section B-07, #7b, #7d, #7e-f)"	"$25 copay (PBP Section B-07, #7e & #7h)"	"$25 copay (PBP Section B-07, #7c & 7i)"	$15 copay	"$30 office surgery, $20 allergy, $20 cardiovascular"		"Either no cost sharing or $25 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														294.3748629	0	130	0	50	0.053333333	0.142666667	35.94706584	50	0	0	0	0	7.368778569	9.504263742	25	24.99751616	25	14.31962689	4.103366681	0	0.415164257	0	0	0	0	0	0	0	0											NO	280.9916594	0	124.0897927	0	47.72684335	0.053333333	0.142666667	34.3127996	47.72684335	0	0	0	0	7.033770809	9.072170136	23.89704176	23.86105076	23.86342168	13.66861179	3.916814776	0	0.396289589	0	0	0	0	0	0	0	0												8.0734	0	6.494413307	0	1.083738739	0.915120358	0.013759674	14.76314954	1.885115389	0	0	0	0	0.407755751	9.067675159	2.100722372	0.43223073	0.441222235	0.713008484	1.789550535	0	0.05609184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.237	0	2.250116185	8.0734	0	6.494413307	0	1.083738739	0.915120358	0.013759674	14.76314954	1.885115389	0	0	0	0	0.407755751	9.067675159	2.100722372	0.43223073	0.441222235	0.713008484	1.789550535	0	0.05609184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.237	NO																																																																																		0	0	0	8.0734	0	6.494413307	0	1.083738739	0.915120358	0.013759674	14.76314954	1.885115389	0	0	0	0	0.407755751	9.067675159	2.100722372	0.43223073	0.441222235	0.713008484	1.789550535	0	0.05609184	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.237
H5883_003_3	2010	10	N/A																															A	A	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	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	NO	286.7408317	10.78015942	413.2782264	273.665246	211.7342832	17.41568257	0.017612834	446.5904916	521.6394001	3455.636566	805.33735	0	12.33377324	523.9820902	11400.96885	1207.064072	200.9421702	403.6166266	435.2904187	5072.822376	834.2451804	1315.928192	0	0	0	0	0	0	0	27.4104232												$300 copay per admit	$300 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$50 OP surgery		"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$25 copay (PBP Section B-05, #5)"		"Either no cost sharing or $25 copay per service, depending on the service"	"$10 copay (PBP Section B-07, #7a & PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b, #14d-14j)"	"$25 copay (PBP Section B-07, #7b, #7d, #7e-f)"	"$25 copay (PBP Section B-07, #7e & #7h)"	"$25 copay (PBP Section B-07, #7c & 7i)"	$15 copay	"$30 office surgery, $20 allergy, $20 cardiovascular"		"Either no cost sharing or $25 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														291.801623	0	130	0	50	0.053333333	0.142666667	46.29701141	50	0	0	0	0	14.02690639	9.370111229	25	24.9980069	25	14.03925633	5.313604118	0	0.414296704	0	0	0	0	0	0	0	0											NO	285.6542087	0	127.2612768	0	48.94664493	0.053333333	0.142666667	45.32166757	48.94664493	0	0	0	0	13.73140013	9.172710145	24.48962191	24.47137135	24.47332246	13.74348989	5.201661881	0	0.405568674	0	0	0	0	0	0	0	0												6.8257	0	4.382859565	0	0.863640231	0.928836404	0.002512764	1.686685483	2.127708208	0	0	0	0	0.599583978	8.714815222	2.463378562	0.409777539	0.823153321	0.498534122	2.198925565	0	0.044474938	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5706	0	0.679217179	6.8257	0	4.382859565	0	0.863640231	0.928836404	0.002512764	1.686685483	2.127708208	0	0	0	0	0.599583978	8.714815222	2.463378562	0.409777539	0.823153321	0.498534122	2.198925565	0	0.044474938	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5706	NO																																																																																		0	0	0	6.8257	0	4.382859565	0	0.863640231	0.928836404	0.002512764	1.686685483	2.127708208	0	0	0	0	0.599583978	8.714815222	2.463378562	0.409777539	0.823153321	0.498534122	2.198925565	0	0.044474938	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5706
H5883_003_4	2010	10	N/A																															A	A	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	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	NO	321.2887708	9.57476899	318.2027204	258.5933657	238.776318	17.22569923	0.477945887	359.2363647	545.4917517	3454.347475	569.6495713	0	5.652584575	589.672372	11689.65976	1068.028181	225.9887166	115.8266514	632.3748584	5545.222789	774.6914053	1541.308827	0	0	0	0	0	0	0	22.38736127												$300 copay per admit	$300 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$50 OP surgery		"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$25 copay (PBP Section B-05, #5)"		"Either no cost sharing or $25 copay per service, depending on the service"	"$10 copay (PBP Section B-07, #7a & PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b, #14d-14j)"	"$25 copay (PBP Section B-07, #7b, #7d, #7e-f)"	"$25 copay (PBP Section B-07, #7e & #7h)"	"$25 copay (PBP Section B-07, #7c & 7i)"	$15 copay	"$30 office surgery, $20 allergy, $20 cardiovascular"		"Either no cost sharing or $25 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														296.0363736	0	130	0	50	0.053333333	0.142666667	47.16649645	50	0	0	0	0	12.40612049	9.51258753	25	24.99771769	25	14.36537249	4.083117163	0	0.210472385	0	0	0	0	0	0	0	0											NO	290.0813585	0	127.3849431	0	48.99420888	0.053333333	0.142666667	46.21770359	48.99420888	0	0	0	0	12.15656117	9.321234009	24.51256992	24.49486804	24.49710444	14.07640121	4.000981904	0	0.20623856	0	0	0	0	0	0	0	0												7.7667	0	3.377852953	0	0.974888067	0.918703959	0.068186947	1.383589985	2.227161402	0	0	0	0	0.597365689	9.080171179	2.181676288	0.461296983	0.236451465	0.741796852	1.848861336	0	0.026489776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8911	0	0.633021872	7.7667	0	3.377852953	0	0.974888067	0.918703959	0.068186947	1.383589985	2.227161402	0	0	0	0	0.597365689	9.080171179	2.181676288	0.461296983	0.236451465	0.741796852	1.848861336	0	0.026489776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8911	NO																																																																																		0	0	0	7.7667	0	3.377852953	0	0.974888067	0.918703959	0.068186947	1.383589985	2.227161402	0	0	0	0	0.597365689	9.080171179	2.181676288	0.461296983	0.236451465	0.741796852	1.848861336	0	0.026489776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.8911
H5883_003_5	2010	10	N/A																															A	A	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	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	NO	329.3553732	9.818412461	348.4467802	236.7694358	303.9659228	17.5924433	0.054805422	325.9182709	499.3842164	3459.123706	688.3617643	0	10.76224708	431.8846787	13022.53829	1263.192106	236.497266	125.9636409	531.380001	6798.508447	677.5383743	2081.989599	0	0	0	0	0	0	0	28.44341155												$300 copay per admit	$300 copay per admit	"$0 copay days 1-20, $130 copay days 21 - 100"		$50 copay	20% coinsurance	20% coinsurance	"$50 ER copay, $35 urgent care copay"	$50 OP surgery		"$10 copay for low-tech radiology, $20 copay for high-tech radiology"	"$25 copay (PBP Section B-05, #5)"		"Either no cost sharing or $25 copay per service, depending on the service"	"$10 copay (PBP Section B-07, #7a & PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b, #14d-14j)"	"$25 copay (PBP Section B-07, #7b, #7d, #7e-f)"	"$25 copay (PBP Section B-07, #7e & #7h)"	"$25 copay (PBP Section B-07, #7c & 7i)"	$15 copay	"$30 office surgery, $20 allergy, $20 cardiovascular"		"Either no cost sharing or $25 copay per service, depending on the service"		No copay			"$25 copay on exam, $0 on hearing aid/fitting"														294.7257465	0	130	0	50	0.053333333	0.142666667	48.25808075	50	0	0	0	0	8.691120105	9.410701826	25	25	25	14.10408813	4.262985324	0	0.202212159	0	0	0	0	0	0	0	0											NO	287.977764	0	127.0235457	0	48.85520987	0.053333333	0.142666667	47.15317326	48.85520987	0	0	0	0	8.492129935	9.195236255	24.4458553	24.42760494	24.42760494	13.78116371	4.165380854	0	0.19758235	0	0	0	0	0	0	0	0												7.9039	0	3.688412124	0	1.237526579	0.938263643	0.007818907	1.280673391	2.033126725	0	0	0	0	0.305635067	9.97877635	2.573317619	0.481421815	0.256415838	0.610252899	2.359864743	0	0.034280366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6897	0	0.765292348	7.9039	0	3.688412124	0	1.237526579	0.938263643	0.007818907	1.280673391	2.033126725	0	0	0	0	0.305635067	9.97877635	2.573317619	0.481421815	0.256415838	0.610252899	2.359864743	0	0.034280366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6897	NO																																																																																		0	0	0	7.9039	0	3.688412124	0	1.237526579	0.938263643	0.007818907	1.280673391	2.033126725	0	0	0	0	0.305635067	9.97877635	2.573317619	0.481421815	0.256415838	0.610252899	2.359864743	0	0.034280366	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	33.6897
H5883_801_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	280.1816691	1.953902897	34.8495679	8.772936444	7.84124422	21.17589629	0.067058764	33.70209192	58.43660703	20.82276197	16.48934708	0	0.017412804	65.03087291	51.51457518	17.58132159	2.012311962	1.355441434	36.1716212	114.4165925	15.98412066	31.53900129	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.072724269	0.072724269	0.168268819	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072724269	0.072724269	0.168268819	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.376	0.142096161	5.864095625	0	1.827009903	4.933983835	0.015624692	7.852587417	13.61572944	4.85170354	3.842017869	0	0.004057183	15.15219339	12.00289602	4.09644793	0.468868687	0.315817854	8.427987741	26.65906605	3.724300115	7.348587301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5211	0	0	20.376	0.142096161	5.864095625	0	1.827009903	4.933983835	0.015624692	7.852587417	13.61572944	4.85170354	3.842017869	0	0.004057183	15.15219339	12.00289602	4.09644793	0.468868687	0.315817854	8.427987741	26.65906605	3.724300115	7.348587301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5211	NO																																																																																		0	0	0	20.376	0.142096161	5.864095625	0	1.827009903	4.933983835	0.015624692	7.852587417	13.61572944	4.85170354	3.842017869	0	0.004057183	15.15219339	12.00289602	4.09644793	0.468868687	0.315817854	8.427987741	26.65906605	3.724300115	7.348587301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.5211
H5883_805_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	245.9199219	0.90972631	37.84514483	12.01516418	10.52713302	21.59045535	0.010521816	30.080717	49.68204191	20.78341651	16.4838735	0	0.019994751	47.02130116	49.41448231	17.63280224	1.709711429	1.311271277	32.9580144	107.280186	13.64914007	28.65329601	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.074800759	0.074800759	0.169425035	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074800759	0.074800759	0.169425035	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												18.395	0.068048218	6.411914974	0	2.452821994	5.030576095	0.002451583	7.008807062	11.57591576	4.842536046	3.840742526	0	0.004658777	10.95596317	11.51357438	4.108442921	0.398362763	0.305526208	7.679217356	24.99628335	3.180249636	6.67621797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.4473	0	0	18.395	0.068048218	6.411914974	0	2.452821994	5.030576095	0.002451583	7.008807062	11.57591576	4.842536046	3.840742526	0	0.004658777	10.95596317	11.51357438	4.108442921	0.398362763	0.305526208	7.679217356	24.99628335	3.180249636	6.67621797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.4473	NO																																																																																		0	0	0	18.395	0.068048218	6.411914974	0	2.452821994	5.030576095	0.002451583	7.008807062	11.57591576	4.842536046	3.840742526	0	0.004658777	10.95596317	11.51357438	4.108442921	0.398362763	0.305526208	7.679217356	24.99628335	3.180249636	6.67621797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.4473
H5883_807_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	236.9810183	4.229574678	43.94835051	11.12417775	8.973668147	21.248316	0.014556232	15.77102379	57.13192605	20.8868939	16.33164107	0	0.009626734	48.59806415	44.23753066	16.32019548	0.87858376	1.017880754	27.98152856	101.5646345	14.52980647	25.1701003	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.075029009	0.075029009	0.168175118	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075029009	0.075029009	0.168175118	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.7805	0.317340796	7.391019023	0	2.090864678	4.950857627	0.003391602	3.674648544	13.31173877	4.866646278	3.805272369	0	0.002243029	11.32334895	10.30734464	3.802605548	0.204710016	0.237166216	6.519696155	23.66455983	3.385444908	5.86463337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.504	0	0	17.7805	0.317340796	7.391019023	0	2.090864678	4.950857627	0.003391602	3.674648544	13.31173877	4.866646278	3.805272369	0	0.002243029	11.32334895	10.30734464	3.802605548	0.204710016	0.237166216	6.519696155	23.66455983	3.385444908	5.86463337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.504	NO																																																																																		0	0	0	17.7805	0.317340796	7.391019023	0	2.090864678	4.950857627	0.003391602	3.674648544	13.31173877	4.866646278	3.805272369	0	0.002243029	11.32334895	10.30734464	3.802605548	0.204710016	0.237166216	6.519696155	23.66455983	3.385444908	5.86463337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.504
H5884_003_1	2010	4	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	892.5535113	37.80641453	234.1315402	16.87595694	195.3708733	19.17874779	5.33051336	225.792925	520.1934465	12.42339341	19.04901445	0	24.01358228	241.8140586	4044.328239	4250.541423	386.7416287	200.0336486	24.8987091	36.28003573	7.796365207	0	0	921.7504592	340.9746339	0	55.33120381	0	0	0											3400	1a:  Acute - $100/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-7/8-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 15.0%/8b:  Outpatient Therapeutic Radiological Services - 15.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $10/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	75	0	100	0.2	0.034198394	30.12146788	200	0	0.087616497	0	10	20	20	34.6213036	20	20	0	0.001656981	0.092797871	0	0	0	20	0	20	0	0	0											NO	89.09407267	89.02441663	66.74372584	0	89.2174691	0.178203784	0.030326671	26.9451743	178.3815758	0	0.078071412	0	8.910404817	17.82201348	17.82166679	30.8353159	17.8706629	17.80759076	0	0.00147871	0.082761188	0	0	0	20	0	20	0	0	0												6.6268	0.2804745	1.302234278	0	1.452541238	3.417725422	0.161656724	0.507002477	7.732743892	0	1.487183448	0	0.017830895	0.359134451	6.006389189	10.92223229	0.575944106	0.296843113	0	0.053647646	0.645236449	0	0	0	0.568291056	0	0.092218673	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5061	0	5.110949938	6.6268	0.2804745	1.302234278	0	1.452541238	3.417725422	0.161656724	0.507002477	7.732743892	0	1.487183448	0	0.017830895	0.359134451	6.006389189	10.92223229	0.575944106	0.296843113	0	0.053647646	0.645236449	0	0	0	0.568291056	0	0.092218673	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5061	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.6268	0.2804745	1.302234278	0	1.452541238	3.417725422	0.161656724	0.507002477	7.732743892	0	1.487183448	0	0.017830895	0.359134451	6.006389189	10.92223229	0.575944106	0.296843113	0	0.053647646	0.645236449	0	0	0	0.568291056	0	0.092218673	0	0	0	0	0	0	0	0	0	0	0	0	0	42.5061
H5884_003_2	2010	4	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	856.9703456	42.38998027	285.3859635	12.42121572	216.2268596	21.12104586	5.362749993	256.4931369	430.2908555	10.93371595	17.04772317	0	23.25835614	219.0524688	4093.883187	4335.723915	304.567448	138.3330672	22.06823471	35.09009875	8.302972633	0	0	921.7504592	351.461069	0	44.75492159	0	0	0											3400	1a:  Acute - $100/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-7/8-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 15.0%/8b:  Outpatient Therapeutic Radiological Services - 15.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $10/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	75	0	100	0.2	0.025010111	29.95300101	200	0	0.08778839	0	10	20	20	34.63683749	20	20	0	0.001392286	0.092797871	0	0	0	20	0	20	0	0	0											NO	89.50637035	89.51990981	67.13245221	0	89.5441916	0.178997193	0.022310343	26.88956473	178.9945795	0	0.078551148	0	8.949982594	17.90123872	17.90224254	31.00032969	17.90794442	17.87720068	0	0.001246179	0.083077194	0	0	0	20	0	20	0	0	0												6.392	0.316228934	1.596554963	0	1.613488278	3.780607931	0.119644793	0.574749067	6.418310894	0	1.339118228	0	0.017346824	0.326775878	6.107474146	11.20073924	0.454514744	0.206084	0	0.043728538	0.689787665	0	0	0	0.585768448	0	0.074591536	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8575	0	4.829485718	6.392	0.316228934	1.596554963	0	1.613488278	3.780607931	0.119644793	0.574749067	6.418310894	0	1.339118228	0	0.017346824	0.326775878	6.107474146	11.20073924	0.454514744	0.206084	0	0.043728538	0.689787665	0	0	0	0.585768448	0	0.074591536	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8575	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.392	0.316228934	1.596554963	0	1.613488278	3.780607931	0.119644793	0.574749067	6.418310894	0	1.339118228	0	0.017346824	0.326775878	6.107474146	11.20073924	0.454514744	0.206084	0	0.043728538	0.689787665	0	0	0	0.585768448	0	0.074591536	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8575
H5884_004_1	2010	5	N/A																															D	D	coin	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	724.5258523	35.29768406	29.1297537	21.65783993	187.6558713	28.34962006	8.679599734	289.3308899	629.37938	16.25214353	23.16384175	0	0.052615046	257.1384722	4944.06175	5409.856907	380.0303631	303.549596	28.87173412	31.85685089	12.33847325	0	0	878.1066433	379.4019641	0	64.15584546	0	0	0											2500	1a:  Acute - $100/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 10.0%/11b:  Medical Supplies - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 10.0%/8b:  Outpatient Therapeutic Radiological Services - 10.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $10/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	0	0	100	0.1	0.032510819	23.10376875	100	0	0.059065773	0	0	10	10	24.95549964	10	10	0	0.001087269	0.046398935	0	0	0	10	0	10	0	0	0											NO	88.88992476	88.88992476	0	0	88.88992476	0.088889925	0.028898843	20.63463792	88.88992476	0	0.052503521	0	0	8.888992476	8.888992476	22.18292486	8.888992476	8.888992476	0	0.000966473	0.041243979	0	0	0	10	0	10	0	0	0												5.3669	0.261467373	0	0	1.39005969	2.519995594	0.250830387	0.497519846	4.662123811	0	1.216183257	0	0	0.190475162	3.662310641	10.00053744	0.281507253	0.224854173	0	0.030788779	0.508887729	0	0	0	0.316168303	0	0.053463205	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4341	0	3.88	5.3669	0.261467373	0	0	1.39005969	2.519995594	0.250830387	0.497519846	4.662123811	0	1.216183257	0	0	0.190475162	3.662310641	10.00053744	0.281507253	0.224854173	0	0.030788779	0.508887729	0	0	0	0.316168303	0	0.053463205	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4341	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.3669	0.261467373	0	0	1.39005969	2.519995594	0.250830387	0.497519846	4.662123811	0	1.216183257	0	0	0.190475162	3.662310641	10.00053744	0.281507253	0.224854173	0	0.030788779	0.508887729	0	0	0	0.316168303	0	0.053463205	0	0	0	0	0	0	0	0	0	0	0	0	0	31.4341
H5884_004_2	2010	4	N/A																															D	D	coin	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	727.7534771	15.47194992	31.5232409	20.42802945	227.2746056	27.71008574	8.738198604	318.9551941	528.5105288	12.28061675	24.29580087	0	0.088467025	324.3928219	5441.405838	5625.371745	288.6369824	289.8351778	27.35558024	49.67051934	7.635472507	0	0	878.1066433	438.0967056	0	54.6578905	0	0	0											2500	1a:  Acute - $100/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 10.0%/11b:  Medical Supplies - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 10.0%/8b:  Outpatient Therapeutic Radiological Services - 10.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $10/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	0	0	100	0.1	0.022055922	22.95930746	100	0	0.057663373	0	0	10	10	24.93011064	10	10	0	0.000591339	0.046398935	0	0	0	10	0	10	0	0	0											NO	88.96693604	88.96693604	0	0	88.96693604	0.088966936	0.019622478	20.50733569	88.96693604	0	0.051301336	0	0	8.896693604	8.896693604	22.17955559	8.896693604	8.896693604	0	0.000526096	0.041279711	0	0	0	10	0	10	0	0	0												5.3955	0.114707665	0	0	1.684993775	2.465281426	0.17146511	0.54507677	3.918330201	0	1.246407054	0	0	0.240501962	4.034210043	10.39735378	0.2139929	0.214881231	0	0.026131456	0.3151901	0	0	0	0.365080588	0	0.045548242	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3947	0	3.84	5.3955	0.114707665	0	0	1.684993775	2.465281426	0.17146511	0.54507677	3.918330201	0	1.246407054	0	0	0.240501962	4.034210043	10.39735378	0.2139929	0.214881231	0	0.026131456	0.3151901	0	0	0	0.365080588	0	0.045548242	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3947	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.3955	0.114707665	0	0	1.684993775	2.465281426	0.17146511	0.54507677	3.918330201	0	1.246407054	0	0	0.240501962	4.034210043	10.39735378	0.2139929	0.214881231	0	0.026131456	0.3151901	0	0	0	0.365080588	0	0.045548242	0	0	0	0	0	0	0	0	0	0	0	0	0	31.3947
H5884_802_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	266.4834546	5.554279558	37.37867655	27.80164994	13.00640348	26.63425223	8.314152204	15.33346988	49.6109329	14.38192223	17.36588574	0	0.044217062	18.15954988	51.06587498	128.7792198	1.484351077	2.532851249	27.46154712	29.63548917	6.228944404	0	0	0	0	0	0	0	0	0												Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share											0.082763366	0.082763366	0.188843639	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.082763366	0.082763366	0.188843639	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												22.0551	0.45969087	7.058725312	0	3.030492012	6.205780769	1.937197464	3.572698481	11.55934737	3.35098788	4.046251377	0	0.010302575	4.231175121	11.89834887	30.00555822	0.345853801	0.590154341	6.398540478	6.905068976	1.451344046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.1126	0	0	22.0551	0.45969087	7.058725312	0	3.030492012	6.205780769	1.937197464	3.572698481	11.55934737	3.35098788	4.046251377	0	0.010302575	4.231175121	11.89834887	30.00555822	0.345853801	0.590154341	6.398540478	6.905068976	1.451344046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.1126	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.0551	0.45969087	7.058725312	0	3.030492012	6.205780769	1.937197464	3.572698481	11.55934737	3.35098788	4.046251377	0	0.010302575	4.231175121	11.89834887	30.00555822	0.345853801	0.590154341	6.398540478	6.905068976	1.451344046	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.1126
H5884_803_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	284.0673362	3.481637888	63.74568656	32.61677715	10.38501134	24.5420722	6.435406523	13.19206995	56.03404653	16.10799703	18.6813821	0	0.062786815	21.53022526	60.30156482	147.0161992	1.881015837	3.215145827	30.92495261	42.49259421	10.30194985	0	0	0	0	0	0	0	0	0												Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share											0.081874603	0.081874603	0.185221487	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081874603	0.081874603	0.185221487	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												23.2579	0.28505772	11.80707086	0	2.419707643	5.718302823	1.49944972	3.073752298	13.05593284	3.753163307	4.35276203	0	0.014629328	5.016542485	14.0502646	34.25477441	0.43827669	0.749128978	7.205513958	9.900774452	2.400354316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.2534	0	0	23.2579	0.28505772	11.80707086	0	2.419707643	5.718302823	1.49944972	3.073752298	13.05593284	3.753163307	4.35276203	0	0.014629328	5.016542485	14.0502646	34.25477441	0.43827669	0.749128978	7.205513958	9.900774452	2.400354316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.2534	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.2579	0.28505772	11.80707086	0	2.419707643	5.718302823	1.49944972	3.073752298	13.05593284	3.753163307	4.35276203	0	0.014629328	5.016542485	14.0502646	34.25477441	0.43827669	0.749128978	7.205513958	9.900774452	2.400354316	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	143.2534
H5884_804_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	226.2751799	5.563882021	35.52300442	22.12073402	9.155429109	24.15173932	9.152563855	12.5815378	52.85871455	12.70778585	21.21457777	0	0.046366063	23.89685833	49.12363984	122.6111252	0.967564604	2.656870601	27.12640035	32.21545543	13.23763383	0	0	0	0	0	0	0	0	0												Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share											0.079013495	0.079013495	0.186987502	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.079013495	0.079013495	0.186987502	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												17.8788	0.439621765	6.642357843	0	2.133214982	5.627355262	2.132547378	2.931498307	12.31608049	2.960914103	4.942996621	0	0.010803293	5.56796799	11.44580808	28.56839218	0.225442553	0.61905085	6.320451283	7.506201116	3.084368683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3539	0	0	17.8788	0.439621765	6.642357843	0	2.133214982	5.627355262	2.132547378	2.931498307	12.31608049	2.960914103	4.942996621	0	0.010803293	5.56796799	11.44580808	28.56839218	0.225442553	0.61905085	6.320451283	7.506201116	3.084368683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3539	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	17.8788	0.439621765	6.642357843	0	2.133214982	5.627355262	2.132547378	2.931498307	12.31608049	2.960914103	4.942996621	0	0.010803293	5.56796799	11.44580808	28.56839218	0.225442553	0.61905085	6.320451283	7.506201116	3.084368683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.3539
H5887_001_0	2010	5	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	O	O	O	O	V	O	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	NO	131.2867053	0	0	0	0	0	0	400.6125158	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0.834609408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8346	0	0	0	0	0	0	0	0	0	0.834609408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8346	NO																																																																																		0			0	0	0	0	0	0	0	0.834609408	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.8346
H5887_006_0	2010	5	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	O	O	O	O	V	O	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	NO	0	0	0	0	0	0	0	467.4120584	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0.973775122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.9738	0	0	0	0	0	0	0	0	0	0.973775122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.9738	NO																																																																																		0			0	0	0	0	0	0	0	0.973775122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.9738
H5887_007_0	2010	5	N/A																															D	D	D	V	P	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	O	O	O	O	V	O	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	NO	0	0	0	0	0	0	0	504.1165221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	PBP 11a	"PBP 11b, 11c"	PBP 4a	"PBP 9a, 9b"	PBP 8a	"PBP 7d, 8b"				"PBP 4b, 7a, 14b-j"	"PBP 4b, 7b, 7d, 7f, 7g, 14d-j, 17a, 18a"	"PBP 7e, 7h"	"PBP 7c, 7i"		"PBP 3, 5, 7d, 7g, 9a, 9c, 9d, 12, 13a, 13b"	PBP 15		PBP 10b	"PBP 16a, 16b"	PBP 17a	PBP 17b	PBP 18a	PBP 18b	PBP 14a	PBP 13b-e											0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	25	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	1.050242754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0502	0	0	0	0	0	0	0	0	0	1.050242754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0502	NO																																																																																		0			0	0	0	0	0	0	0	1.050242754	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	1.0502
H5895_001_0	2010	2	N/A																																																																																																															0	NO																																										0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance	0% Coinsurance					0% Coinsurance																																																						NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5896_007_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	414.87	24.53	89.71	71.58	20.45	19.38	17	26.93	57.25	11.12	18.32	1.07	1.91	50.88	74.32	138.78	7.33	9.43	46.67	50.06	9.01	5.55	11.1454	21.76573363	2.43	2.56	0.55	1.78	0.5	11.66666667												1A IP Acute: Std. Medicare	1B IP Psych: Std. Medicare	2 SNF: Std. Medicare	6 Home Health: Std. Medicare	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: 20%, 4B Urgent Care: 20%"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 20%, 9C OP Substance Abuse: 20%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: 20%"	"7B Chiropractic: 20%, 7D Physician Specialist (excl. Radiology): 20%, 7F Podiatry: 20%"	"7E Mental Health: 20%, 7H Psychiatric: 20%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 0%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): 20%, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C OTC Rx: $0, 13D Welcome Home: $0, 13E PERS : $0"											0.059087678	0.059112393	0.140618616	0	0.199994505	0.200000015	0.162613402	0.199113779	0.199999982	0.199995396	0.200021864	0.19999982	0.199999997	0.200013386	0.197718686	0.199999917	0.200007383	0.199971857	0.199999625	0.193320792	0	0.200003228	0	0	0	0	0	0	0	0											NO	0.059087678	0.059112393	0.140618616	0	0.199994505	0.200000015	0.162613402	0.199113779	0.199999982	0.199995396	0.200021864	0.19999982	0.199999997	0.200013386	0.197718686	0.199999917	0.200007383	0.199971857	0.199999625	0.193320792	0	0.200003228	0	0	0	0	0	0	0	0												24.5137	1.450027009	12.61489605	0	4.089887633	3.876000297	2.764427827	5.36213407	11.44999898	2.2239488	3.664400543	0.213999808	0.381999995	10.17668107	14.69445277	27.75598848	1.466054117	1.885734613	9.333982503	9.677638835	0	1.110017913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.706	0	0	24.5137	1.450027009	12.61489605	0	4.089887633	3.876000297	2.764427827	5.36213407	11.44999898	2.2239488	3.664400543	0.213999808	0.381999995	10.17668107	14.69445277	27.75598848	1.466054117	1.885734613	9.333982503	9.677638835	0	1.110017913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.706	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.5137	1.450027009	12.61489605	0	4.089887633	3.876000297	2.764427827	5.36213407	11.44999898	2.2239488	3.664400543	0.213999808	0.381999995	10.17668107	14.69445277	27.75598848	1.466054117	1.885734613	9.333982503	9.677638835	0	1.110017913	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	148.706
H5896_008_0	2010	4	N/A																															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	V	V	V	O	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	NO	687.35	13.36	550.84	0	187.62	7.18	5.52	216.57	312.69	0	88.79	32.59	0.17	526.67	4128.4	3695.73	169.67	668.46	1680.6	1400.65	8.99	646.98	0	0	0	0	0	0	0	0												1A IP Acute: $250 Per Day for days 1-5	1B IP Psych: $250 Per Day for days 1-5	2 SNF: $125 for days 20-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $40"	9B ASC Services: $160	8A OP Diagnostic Procedures/Tests: $200	8B OP Radiology: $100	9A OP Hospital: $200	12 Renal Dialysis: 20%	"3 CORF: $200, 5 Partial Hosp: $200, 9C OP Substance Abuse: $40, 9D Cardiac Rehab: $200"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): $100	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC Rx: $0, 13D Welcome Home: Not Covered, 13E PERS : $0"											250	250	125	0	100	0.199999984	0.1597354	49.00540241	160	0	100	132.566168	0.200000006	112.4546138	10	40	40	40	11.8	40	0.200000414	40	0	0	0	0	0	0	0	0											NO	250	250	125	0	100	0.199999984	0.1597354	49.00540241	160	0	100	132.566168	0.200000006	112.4546138	10	40	40	40	11.8	40	0.200000414	40	0	0	0	0	0	0	0	0												14.3198	0.278333333	5.737916667	0	1.5635	1.435999883	0.881739407	0.884425	4.1692	0	0.739916667	0.360027618	0.034000001	4.93553929	3.440333333	12.3191	0.565566667	2.2282	1.65259	4.668833333	1.798003725	2.1566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1696	0	0	14.3198	0.278333333	5.737916667	0	1.5635	1.435999883	0.881739407	0.884425	4.1692	0	0.739916667	0.360027618	0.034000001	4.93553929	3.440333333	12.3191	0.565566667	2.2282	1.65259	4.668833333	1.798003725	2.1566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1696	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.3198	0.278333333	5.737916667	0	1.5635	1.435999883	0.881739407	0.884425	4.1692	0	0.739916667	0.360027618	0.034000001	4.93553929	3.440333333	12.3191	0.565566667	2.2282	1.65259	4.668833333	1.798003725	2.1566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1696
H5896_012_0	2010	6	N/A																															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	V	V	V	O	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	NO	504.33	9.8025	541.93	0	181.83	7	5.4	159.0825	230.5125	0	273.585	31.83	0.16	513.74	3943.96	2650.665	124.965	484.2375	1178.325	1018.5225	8.75	467.5875	0	0	0	0	0	0	0	0												1A IP Acute: $300 Per Day for days 1-5	1B IP Psych: $300 Per Day for days 1-5	2 SNF: $125 for days 20-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $45"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $200	8B OP Radiology: $200	9A OP Hospital: $200	12 Renal Dialysis: 20%	"3 CORF: $200, 5 Partial Hosp: $200, 9C OP Substance Abuse: $45, 9D Cardiac Rehab: $200"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $45"	"7B Chiropractic: $45, 7D Physician Specialist (excl. Radiology): $45, 7F Podiatry: $45"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $45, 7I Physical and Speech Therapy: $45"	7D Physician Specialist (Radiology): $200	"7G Other Health Care: $45, 18A Hearing Exams (Medicare Covered): $45"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $45, 17A Routine Eye Exams (Medicare Covered): $45"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC Rx: $0, 13D Welcome Home: Not Covered, 13E PERS : $0"											300	300	125	0	100	0.199999993	0.159665493	49.51511008	200	0	84.89911728	134.3072573	0.200000007	113.1510846	15	45	40	45	67.7	45	0.199998933	45	0	0	0	0	0	0	0	0											NO	300	300	125	0	100	0.199999993	0.159665493	49.51511008	200	0	84.89911728	134.3072573	0.200000007	113.1510846	15	45	40	45	67.7	45	0.199998933	45	0	0	0	0	0	0	0	0												12.6082	0.2450625	5.645104167	0	1.51525	1.399999948	0.86219366	0.656415625	3.841875	0	1.93559375	0.35625	0.032000001	4.844186515	4.92995	9.93999375	0.41655	1.815890625	6.647716875	3.819459375	1.749990662	1.753453125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0152	0	0	12.6082	0.2450625	5.645104167	0	1.51525	1.399999948	0.86219366	0.656415625	3.841875	0	1.93559375	0.35625	0.032000001	4.844186515	4.92995	9.93999375	0.41655	1.815890625	6.647716875	3.819459375	1.749990662	1.753453125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0152	NO	1A IP Acute: $400 Per Day for days 1-5	1B IP Psych: $400 Per Day for days 1-5	2 SNF: Not Covered	6 Home Health: Not Covered	10A Ambulance: Not Covered	11A DME: Not Covered	"11B Prosthetics/Medical Supplies: Not Covered, 11C Diabetes Monitoring Supplies: Not Covered"	"4A ER: $50, 4B Urgent Care: $55"	9B ASC Services: $300	8A OP Diagnostic Procedures/Tests: Not Covered	8B OP Radiology: $250	9A OP Hospital: Not Covered	12 Renal Dialysis: Not Covered	"3 CORF: Not Covered, 5 Partial Hosp: Not Covered, 9C OP Substance Abuse: Not Covered, 9D Cardiac Rehab: Not Covered"	"7A PCP: Not Covered, 14B Immunizations: Not Covered, 14C Physical Exams: Not Covered, 14D Pap Smears and Pelvic Exams: Not Covered, 14E Prostate Screening: Not Covered, 14F Colorectal Screening: Not Covered, 14G Bone Mass Measurement: Not Covered, 14H Mammography: Not Covered, 14I Diabetes Monitoring: Not Covered, 14J Nutrition Therapy: Not Covered"	"7B Chiropractic: $55, 7D Physician Specialist (excl. Radiology): $55, 7F Podiatry: $55"	"7E Mental Health: $40, 7H Psychiatric: $40"	"7C Occupational Therapy: $55, 7I Physical and Speech Therapy: $55"	7D Physician Specialist (Radiology): $250	"7G Other Health Care: $55, 18A Hearing Exams (Medicare Covered): $55"	15 Part B Drugs: Not Covered	"13A Blood: Not Covered, 16B Comprehensive Dental (Medicare Covered): $55, 17A Routine Eye Exams (Medicare Covered): $55"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	17B Eye Wear (Medicare Covered): Not Covered	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC Rx: Not Covered, 13D Welcome Home: Not Covered, 13E PERS : Not Covered"												7.1208	0.1492	0	0	0	0	0	0.2732	2.9393	0	0.8778	0	0	0	0	4.7812	0.1741	1.0005	3.8792	2.2503	0	0.8807	0	0	0	0	0	0	0	0											24.3263	0	0	19.729	0.3943125	5.645104167	0	1.51525	1.399999948	0.86219366	0.929605208	6.7811875	0	2.813411458	0.35625	0.032000001	4.844186515	4.92995	14.72118958	0.5906	2.816386458	10.52696204	6.069727083	1.749990662	2.634152083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.3415
H5918_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1978.780216	115.851827	2664.220482	3349.573351	621.565042	8.236602851	6.067951329	400.9466119	261.3978109	12932.75585	4807.186099	0	8.772894394	602.8732504	6593.794223	7841.214496	697.4003607	1316.031103	0	0	733.2655077	1984.148432	1402.435585	470.83102	190.0973004	161.1584935	16.08699262	20.97922895	2070.716788	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.63949214	100	0	12.93398234	0	0	38.76838535	1.104182209	28.95686103	21.32831948	0	0	0	0	29.60211209	0	30	30	0	30	0	0	0											NO	0	0	19.34141333	0	0	0.18101986	0.18101986	43.11847104	90.50993011	0	11.70653838	0	0	35.08923849	0.999394545	26.20883468	19.30424706	0	0	0	0	26.79285096	0	30	30	0	30	0	0	0												0	0	4.294149128	0	0	1.490988697	1.098419701	1.44068374	1.971591467	0	4.689625713	0	0	1.762863605	0.549150165	17.12575787	1.121899072	0	0	0	0	4.430082768	0	1.17707755	0.475243251	0	0.040217482	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6678	0	4.191446777	0	0	4.294149128	0	0	1.490988697	1.098419701	1.44068374	1.971591467	0	4.689625713	0	0	1.762863605	0.549150165	17.12575787	1.121899072	0	0	0	0	4.430082768	0	1.17707755	0.475243251	0	0.040217482	0	0	0	0	0	0	0	0	0	0	0	0	0	41.6678	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.0355	0.0811	0.4907	0	0	0	0	0	0	0	0	0	0	0	0.9617	4.0927	0.1641	0	0	0	0.4249	0.3751	0	0	0.0253	0	0.002	0	0	0											10.6532	0	0	4.0355	0.081057002	4.784886132	0	0	1.490988697	1.098419701	1.44068374	1.971591467	0	4.689625713	0	0	1.762863605	1.510894546	21.21847943	1.285958435	0	0	0	0.424923043	4.805201889	0	1.17707755	0.500539449	0	0.042251571	0	0	0	0	0	0	0	0	0	0	0	0	0	52.321
H5918_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2183.007858	149.6555336	2859.325205	3651.381851	605.120686	6.827037091	5.621470477	410.2804985	268.6757777	12139.90484	4796.276846	0	11.33268439	618.3314792	5323.885911	6383.61025	693.8383342	548.5104937	0	0	690.8136996	1656.355229	1576.881712	454.8166781	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02010462	100	0	13.14050144	0	0	38.98101786	1.766596181	28.71825145	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.62102333	0	0	0.183636782	0.183636782	43.17310349	91.81839096	0	12.06539698	0	0	35.79174338	1.622060188	26.36863639	17.20727475	0	0	0	0	27.10771904	0	30	30	0	30	0	0	0												0	0	4.675240546	0	0	1.253695121	1.032308748	1.476090202	2.055781466	0	4.822415349	0	0	1.844263469	0.719638615	14.02725813	0.994922237	0	0	0	0	3.741667681	0	1.137041695	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0931	0	3.265152011	0	0	4.675240546	0	0	1.253695121	1.032308748	1.476090202	2.055781466	0	4.822415349	0	0	1.844263469	0.719638615	14.02725813	0.994922237	0	0	0	0	3.741667681	0	1.137041695	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0931	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.2657	0.1047	0.5274	0	0	0	0	0	0	0	0	0	0	0	0.6967	3.52	0.1639	0	0	0	0.4154	0.3139	0	0	0.0202	0	0.0021	0	0	0											10.0301	0	0	4.2657	0.104708136	5.202642823	0	0	1.253695121	1.032308748	1.476090202	2.055781466	0	4.822415349	0	0	1.844263469	1.416387582	17.54724058	1.158867836	0	0	0	0.415443231	4.055574841	0	1.137041695	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	48.1232
H5918_003_0	2010	3	N/A																															D	D	D	V	T	O	O	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	1380.837996	400.2884799	11550.5434	111.7780053	827.3546396	2160.794685	1956.637553	203.9848988	88.73460246	35308.64489	5009.018458	0	3.240308517	494.0743635	169.9531358	5404.481219	2103.849103	32.88299353	0	0	149.263589	2180.940819	1533.383865	0	108.5215448	141.8948371	15.79381348	9.237945123	0	0											500	"$25 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$25 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$50 (10a)	$0 (11a)	"$0 (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	$0 (9b)	"$0 (8a1, 8a2)"	"$0 (8b1, 8b2, 8b3)"	Included in h.5.	$0 (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $20 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											23.38815764	21.55472438	0	0	50	0	0	49.91275447	0	0	0	0	0	0	0.41044035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	20.42822896	20.67634511	0	0	41.35269021	0	0	41.28053346	0	0	0	0	0	0	0.339456253	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												2.3507	0.689708563	0	0	2.851111675	0	0	0.70171712	0	0	0	0	0	0	0.004807638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.598	0	1.379719298	2.3507	0.689708563	0	0	2.851111675	0	0	0.70171712	0	0	0	0	0	0	0.004807638	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.598	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $20 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.8255	0.6247	0.6413	0.0526	0.7792	0.5111	0.4613	0.0738	0.1637	0.3831	0.5977	0	0.0007	0.2421	0.0176	2.4973	0.3292	0	0	0	0.0315	0.2665	0	0	0.0153	0	0.0016	0	0	0											13.5157	0	0	8.1762	1.314374226	0.641311376	0.052570115	3.630270951	0.511060959	0.461299147	0.77549573	0.163749154	0.383146123	0.597718828	0	0.000659927	0.242065327	0.022409832	2.497332072	0.329178859	0	0	0	0.031532518	0.266488938	0	0	0.015315541	0	0.001556039	0	0	0	0	0	0	0	0	0	0	0	0	0	20.1137
H5918_004_0	2010	4	N/A																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	3210.879792	417.1869567	2350.122052	2969.015322	623.6926048	2947.680873	26.44026298	789.5693596	534.349455	23544.6002	9239.824843	0	15.15162975	1263.682131	13657.91373	9969.599325	1586.776134	1280.488692	0	0	2720.714734	2112.126762	804.9871277	464.1969348	174.3799154	166.9300603	15.90581412	15.38809339	2081.72373	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0	0.112144091	49.09837469	100	0	13.81504926	0	0	39.00524876	0.400973943	29.68757238	20.35267391	0	0	0	0	29.80016268	0	30	0	0	30	0	0	0											NO	0	0	13.75451785	0	0	0	0.072182146	31.60243239	64.36553671	0	8.892130603	0	0	25.10593771	0.25808903	19.1085653	13.1001078	0	0	0	0	19.18103465	0	30	0	0	30	0	0	0												0	0	2.693732976	0	0	0	1.908514926	2.079359359	2.866140789	0	6.846810771	0	0	2.643827072	0.293746476	15.87539498	1.732244867	0	0	0	0	3.376064717	0	1.160492337	0	0	0.039764535	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5161	0	22.31991348	0	0	2.693732976	0	0	0	1.908514926	2.079359359	2.866140789	0	6.846810771	0	0	2.643827072	0.293746476	15.87539498	1.732244867	0	0	0	0	3.376064717	0	1.160492337	0	0	0.039764535	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5161	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												7.272	0.3879	0.5111	0	0	0	0	0	0	0	0	0	0	0	2.0359	6.7367	0.3513	0	0	0	1.1582	0.3746	0	0	0.0234	0	0.002	0	0	0											18.853	0	0	7.272	0.387907331	3.20481549	0	0	0	1.908514926	2.079359359	2.866140789	0	6.846810771	0	0	2.643827072	2.329626705	22.61210842	2.083517996	0	0	0	1.158150783	3.750676653	0	1.160492337	0.023369012	0	0.041781883	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3691
H5926_001_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	391.5045565	0.622706204	27.71944573	0	27.43365469	21.14038749	2.315360188	50.44863481	32.98031942	8.457863361	20.5057773	0	0.087060691	21.23622085	75.47091669	135.3793502	5.034351369	3.214173114	28.87508144	36.88758523	17.53700824	0.179862174	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.070174883	0.070174883	0.165693635	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070174883	0.070174883	0.165693635	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												27.4738	0.043698335	4.592935732	0	6.392041542	4.925710284	0.539478924	11.75453191	7.684414424	1.970682163	4.777846111	0	0.020285141	4.948039458	17.58472359	31.5433886	1.173003869	0.748902336	6.727893976	8.594807359	4.086122921	0.041907887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.6242	0	0	27.4738	0.043698335	4.592935732	0	6.392041542	4.925710284	0.539478924	11.75453191	7.684414424	1.970682163	4.777846111	0	0.020285141	4.948039458	17.58472359	31.5433886	1.173003869	0.748902336	6.727893976	8.594807359	4.086122921	0.041907887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.6242	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	27.4738	0.043698335	4.592935732	0	6.392041542	4.925710284	0.539478924	11.75453191	7.684414424	1.970682163	4.777846111	0	0.020285141	4.948039458	17.58472359	31.5433886	1.173003869	0.748902336	6.727893976	8.594807359	4.086122921	0.041907887	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.6242
H5926_002_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	295.8208476	3.936694934	821.2280393	0	198.7426969	14.92547811	7.248928959	303.8455368	353.8773145	0	417.8025203	0	0.510696608	15.7652538	4836.424964	5432.837011	561.1149238	1360.312142	1187.900858	1237.543468	8.77572432	0	0	0	389.4010097	0	0	0	0	0											3000	$500/Admit for IP Medical; $500/Admit for IP Surgical;	$500/Admit for IP Psych; $500/Admit for IP Substance Abuse;	$130/Days 11-100 for SNF	No Cost-Sharing	$75/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $30/Visit for Urgent Care;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$100/Case for OP Fac - Radiology (diag); $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	20% Coinsurance for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $10/Visit for PCP - Consults; $3/Procedure for PCP - Asst Surgeon (OP); $10/Visit for PCP - Tx Injections; $10/Visit for PCP - Allergy Testing; $10/Visit for PCP - Allergy Tx;	$20/Visit for Speclst - Office Visits; $7/Procedure for Speclst - Asst Surgeon (OP); $20/Visit for Speclst - Tx Injections; $20/Visit for Speclst - Allergy Testing; $20/Visit for Speclst - Allergy Tx; $20/Visit for Speclst - Consults;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	$100/visit for Prof Radiology -diag/ther. (Office);	$20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$20/Exam for Vision Exams (Refractions);	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											500	500	130	0	75	0.193617021	0.2	48.05571177	50	0	77.53751411	0	0.2	0.113856053	9.831223898	17.5010129	30	30	24.39888931	20	0.2	0	0	0	20	0	0	0	0	0											NO	484.2068892	484.2068893	125.8937912	0	72.63103337	0.187501391	0.193682756	46.53781341	48.42068892	0	75.08839701	0	0.193682756	0.11025977	9.520692681	16.94822203	29.05241335	29.05241335	23.62822059	19.36827557	0.193682756	0	0	0	19.36827557	0	0	0	0	0												11.9365	0.158847901	8.615625942	0	1.202907288	2.798547909	1.403992536	1.178358908	1.42791528	0	2.614343459	0	0.098913126	1.738273265	3.837176313	7.673077325	1.358478559	3.293362552	2.338998627	1.997423576	1.699706469	0	0	0	0.628502172	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.001	0	1.826553682	11.9365	0.158847901	8.615625942	0	1.202907288	2.798547909	1.403992536	1.178358908	1.42791528	0	2.614343459	0	0.098913126	1.738273265	3.837176313	7.673077325	1.358478559	3.293362552	2.338998627	1.997423576	1.699706469	0	0	0	0.628502172	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.001	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.9365	0.158847901	8.615625942	0	1.202907288	2.798547909	1.403992536	1.178358908	1.42791528	0	2.614343459	0	0.098913126	1.738273265	3.837176313	7.673077325	1.358478559	3.293362552	2.338998627	1.997423576	1.699706469	0	0	0	0.628502172	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.001
H5926_003_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	425.7822266	4.648748034	78.45630048	0	12.55475873	17.83229965	11.41286451	18.52507589	52.23598341	11.73292501	30.17981222	0	0.856894298	43.8764863	65.39473874	162.2375508	2.303609203	7.23745796	43.23627735	63.71990873	14.47359641	1.613907069	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070147949	0.070147949	0.165749144	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												29.8678	0.326100142	13.00406468	0	2.925258785	4.154925819	2.65919743	4.316342683	12.17098414	2.733771528	7.031896248	0	0.199656372	10.22322131	15.23697413	37.80134934	0.536740944	1.686327705	10.07405262	14.84673874	3.372347964	0.376040347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	173.5437	0	0	29.8678	0.326100142	13.00406468	0	2.925258785	4.154925819	2.65919743	4.316342683	12.17098414	2.733771528	7.031896248	0	0.199656372	10.22322131	15.23697413	37.80134934	0.536740944	1.686327705	10.07405262	14.84673874	3.372347964	0.376040347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	173.5437	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.8678	0.326100142	13.00406468	0	2.925258785	4.154925819	2.65919743	4.316342683	12.17098414	2.733771528	7.031896248	0	0.199656372	10.22322131	15.23697413	37.80134934	0.536740944	1.686327705	10.07405262	14.84673874	3.372347964	0.376040347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	173.5437
H5928_001_0	2010	10	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5928_002_0	2010	8	N/A																															D	A	A	D	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V			V	P	V	V																																																					0	NO	1636.425718	37.60516644	1090.026998	176.4099297	295.1551734	2.033141554	0.008275639	391.816778	240.2852201	1231.571114	593.3982381	0	0	572.8907004	3294.293722	7686.685352	973.834285	3439.07106	6687.296683	47700.57428	44.68752857	1938.079705	0	0	451.0157855	340.0533826	11.46654541	22.34149635	0	0												$50/day for days 1-3	$50/day for days 1-3	$50/day after day 20	No Cost Sharing	$50 copay	20% coinsurance	20% coinsurance	$50 ER; $15/$25 urgent care	$20/$50 copay	$20 copay	$20 copay	No Cost Sharing	No Cost Sharing	$20 copay on other OP services	$0 Copay for PCP services	$5 Copay	$10 copay	No Cost Sharing	$0 copay or 10% min coinsurance for therapeutic radiological services	"$5 Chiropractic, $5 Podiatry"	20% coinsurance	$10 copay	Non-Covered	Non-Covered	$5 copay	No Cost Sharing	$10 copay	No Cost Sharing	Non-Covered	Non-Covered											21.52398208	21.52398208	11.1	0	50	0.2	0.2	39.75499337	27.5	20	20	0	0	20	0	5	9.974472635	0	0.228324346	1.201003094	0.2	0.65353254	0	0	0	0	10	0	0	0											NO	21.52398208	21.52398208	11.1	0	50	0.2	0.2	39.75499337	27.5	20	20	0	0	20	0	5	9.974472635	0	0.228324346	1.201003094	0.2	0.65353254	0	0	0	0	10	0	0	0												2.9352	0.067451077	1.008274974	0	1.229813223	0.406628311	0.001655128	1.298056117	0.550653629	2.052618523	0.988997064	0	0	0.954817834	0	3.202785563	0.809456952	0	0.127239387	4.774044776	8.937505713	0.105549846	0	0	0	0	0.009555455	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4603			2.9352	0.067451077	1.008274974	0	1.229813223	0.406628311	0.001655128	1.298056117	0.550653629	2.052618523	0.988997064	0	0	0.954817834	0	3.202785563	0.809456952	0	0.127239387	4.774044776	8.937505713	0.105549846	0	0	0	0	0.009555455	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4603	NO																																																																																		0			2.9352	0.067451077	1.008274974	0	1.229813223	0.406628311	0.001655128	1.298056117	0.550653629	2.052618523	0.988997064	0	0	0.954817834	0	3.202785563	0.809456952	0	0.127239387	4.774044776	8.937505713	0.105549846	0	0	0	0	0.009555455	0	0	0	0	0	0	0	0	0	0	0	0	0	29.4603
H5928_004_0	2010	7	N/A																															D	A	A	D	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V			V	P	V	V																																																					0	NO	1613.339524	160.5837082	1372.406903	22.71270475	83.19076212	0.102344665	0.000416638	297.7466186	207.4449752	1063.249912	512.2973553	0	0	487.1651693	2843.317808	6634.408218	840.7384731	2968.689771	5698.316304	41074.35657	12.05534523	1682.9717	0	0	389.2822169	293.6820995	12.89984307	19.28804091	0	0												$50/day for days 1-3	$50/day for days 1-3	$50/day after day 20	No Cost Sharing	$50 copay	20% coinsurance	20% coinsurance	$50 ER; $15/$25 urgent care	$20/$50 copay	$20 copay	$20 copay	No Cost Sharing	No Cost Sharing	$20 copay on other OP services	$0 Copay for PCP services	$5 Copay	$10 copay	No Cost Sharing	$0 copay or 10% min coinsurance for therapeutic radiological services	"$5 Chiropractic, $5 Podiatry"	20% coinsurance	$10 copay	Non-Covered	Non-Covered	$5 copay	No Cost Sharing	$10 copay	No Cost Sharing	Non-Covered	Non-Covered											21.52398208	21.52370285	11.1	0	50	0.2	0.2	39.76941626	27.5	20	20	0	0	20	0	5	9.974472635	0	0.066408405	1.203089027	0.2	0.707807883	0	0	5	0	10	0	0	0											NO	21.52398208	21.52370285	11.1	0	50	0.2	0.2	39.76941626	27.5	20	20	0	0	20	0	5	9.974472635	0	0.066408405	1.203089027	0.2	0.707807883	0	0	5	0	10	0	0	0												2.8938	0.288029668	1.269476385	0	0.346628175	0.020468933	8.33E-05	0.986767435	0.475394735	1.772083187	0.853828926	0	0	0.811941949	0	2.764336758	0.698826908	0	0.031534675	4.118008975	2.411069046	0.099268386	0	0	0.162200924	0	0.010749869	0	0	0	0	0	0	0	0	0	0	0	0	0	20.0145			2.8938	0.288029668	1.269476385	0	0.346628175	0.020468933	8.33E-05	0.986767435	0.475394735	1.772083187	0.853828926	0	0	0.811941949	0	2.764336758	0.698826908	0	0.031534675	4.118008975	2.411069046	0.099268386	0	0	0.162200924	0	0.010749869	0	0	0	0	0	0	0	0	0	0	0	0	0	20.0145	NO																																																																																		0			2.8938	0.288029668	1.269476385	0	0.346628175	0.020468933	8.33E-05	0.986767435	0.475394735	1.772083187	0.853828926	0	0	0.811941949	0	2.764336758	0.698826908	0	0.031534675	4.118008975	2.411069046	0.099268386	0	0	0.162200924	0	0.010749869	0	0	0	0	0	0	0	0	0	0	0	0	0	20.0145
H5928_005_0	2010	5	N/A																																																																																																															0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5928_006_0	2010	4	N/A																															D	A	A	D	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V			V	P	V	V																																																					0	NO	1584.451126	191.4594668	823.7563284	162.5778013	305.6900907	0.680323341	0.002773182	533.0205481	261.2016427	1338.7773	645.0525527	0	0	677.7969556	3580.929692	8355.502615	1058.604915	3738.203707	7439.228659	52313.75289	34.39544447	2122.556647	0	0	491.578509	371.0092821	22.62561974	24.28628588	0	0												$50/day for days 1-3	$50/day for days 1-3	$50/day after day 20	No Cost Sharing	$50 copay	20% coinsurance	20% coinsurance	$50 ER; $15/$25 urgent care	$20/$50 copay	$20 copay	$20 copay	No Cost Sharing	No Cost Sharing	$20 copay on other OP services	$0 Copay for PCP services	$5 Copay	$10 copay	No Cost Sharing	$0 copay or 10% min coinsurance for therapeutic radiological services	"$5 Chiropractic, $5 Podiatry"	20% coinsurance	$10 copay	Non-Covered	Non-Covered	$5 copay	No Cost Sharing	$10 copay	No Cost Sharing	Non-Covered	Non-Covered											21.52398208	21.52398208	11.1	0	50	0.2	0.2	39.77592855	27.5	20	20	0	0	20	0	5	9.974472635	0	0.883578123	1.195944669	0.2	0.722975828	0	0	5	0	10	0	0	0											NO	21.52398208	21.52398208	11.1	0	50	0.2	0.2	39.77592855	27.5	20	20	0	0	20	0	5	9.974472635	0	0.883578123	1.195944669	0.2	0.722975828	0	0	5	0	10	0	0	0												2.842	0.343414178	0.761974604	0	1.273708711	0.136064668	0.000554636	1.76678227	0.598587098	2.231295499	1.075087588	0	0	1.129661593	0	3.481459423	0.879918813	0	0.547761641	5.213696159	6.879088893	0.127879762	0	0	0.204824379	0	0.018854683	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5126			2.842	0.343414178	0.761974604	0	1.273708711	0.136064668	0.000554636	1.76678227	0.598587098	2.231295499	1.075087588	0	0	1.129661593	0	3.481459423	0.879918813	0	0.547761641	5.213696159	6.879088893	0.127879762	0	0	0.204824379	0	0.018854683	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5126	NO																																																																																		0			2.842	0.343414178	0.761974604	0	1.273708711	0.136064668	0.000554636	1.76678227	0.598587098	2.231295499	1.075087588	0	0	1.129661593	0	3.481459423	0.879918813	0	0.547761641	5.213696159	6.879088893	0.127879762	0	0	0.204824379	0	0.018854683	0	0	0	0	0	0	0	0	0	0	0	0	0	29.5126
H5928_007_0	2010	5	N/A																																																																																																															0	NO	1444.64626	175.0158822	569.2112462	120.3371339	288.2639426	41.8010787	0.443643114	525.8855733	276.9611373	1419.551882	683.9715354	0	0	658.5490794	12658.43746	0	1122.475411	3964.645856	7719.416508	54951.53954	152.2735451	2239.699928	0	0	520.1442073	392.4512163	3.872557398	25.75158903	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5928_008_0	2010	5	N/A																															D	A	A	D	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V			V	P	V	V																																																					0	NO	1393.754511	168.6899683	819.5516006	195.1516334	314.0262048	1.699880647	0.006930101	376.8036703	206.8972984	1055.302132	508.4679388	0	0	501.2581264	2822.476775	6585.779142	834.4539632	2946.994793	5834.125547	41018.58312	46.38789007	1667.017454	0	0	386.5529028	291.6425053	6.587496929	19.14386304	0	0												$50/day for days 1-3	$50/day for days 1-3	$50/day after day 20	No Cost Sharing	$50 copay	20% coinsurance	20% coinsurance	$50 ER; $15/$25 urgent care	$20/$50 copay	$20 copay	$20 copay	No Cost Sharing	No Cost Sharing	$20 copay on other OP services	$0 Copay for PCP services	$5 Copay	$10 copay	No Cost Sharing	$0 copay or 10% min coinsurance for therapeutic radiological services	"$5 Chiropractic, $5 Podiatry"	20% coinsurance	$10 copay	Non-Covered	Non-Covered	$5 copay	No Cost Sharing	$10 copay	No Cost Sharing	Non-Covered	Non-Covered											21.52398208	21.52398208	11.1	0	50	0.2	0.2	39.82935716	27.5	20	20	0	0	20	0	5	9.974472635	0	0.199354926	1.1980114	0.2	0.689000435	0	0	5	0	10	0	0	0											NO	21.52398208	21.52398208	11.1	0	50	0.2	0.2	39.82935716	27.5	20	20	0	0	20	0	5	9.974472635	0	0.199354926	1.1980114	0.2	0.689000435	0	0	5	0	10	0	0	0												2.4999	0.302573321	0.758085231	0	1.30844252	0.339976129	0.00138602	1.250653997	0.474139642	1.758836886	0.847446565	0	0	0.835430211	0	2.744074642	0.693603185	0	0.096921806	4.095060848	9.277578014	0.095714646	0	0	0.161063709	0	0.005489581	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5464			2.4999	0.302573321	0.758085231	0	1.30844252	0.339976129	0.00138602	1.250653997	0.474139642	1.758836886	0.847446565	0	0	0.835430211	0	2.744074642	0.693603185	0	0.096921806	4.095060848	9.277578014	0.095714646	0	0	0.161063709	0	0.005489581	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5464	NO																																																																																		0			2.4999	0.302573321	0.758085231	0	1.30844252	0.339976129	0.00138602	1.250653997	0.474139642	1.758836886	0.847446565	0	0	0.835430211	0	2.744074642	0.693603185	0	0.096921806	4.095060848	9.277578014	0.095714646	0	0	0.161063709	0	0.005489581	0	0	0	0	0	0	0	0	0	0	0	0	0	27.5464
H5928_009_0	2010	6	N/A																																																																																																															0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H5928_010_0	2010	6	N/A																															D	A	A	D	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V			V	P	V	V																																																					0	NO	1019.546965	123.4880543	526.122415	83.72335375	232.071354	0.15186208	0.000618135	401.5409302	181.8092566	922.3043691	445.3183755	0	0	439.1991217	2552.085742	5954.86673	729.289284	2580.968478	5011.706003	35880.49679	41.60007119	1460.82086	0	0	339.7944017	256.5754806	12.93203342	16.73119763	0	0												$50/day for days 1-3	$50/day for days 1-3	$50/day after day 20	No Cost Sharing	$50 copay	20% coinsurance	20% coinsurance	$50 ER; $15/$25 urgent care	$20/$50 copay	$20 copay	$20 copay	No Cost Sharing	No Cost Sharing	$20 copay on other OP services	$0 Copay for PCP services	$5 Copay	$10 copay	No Cost Sharing	$0 copay or 10% min coinsurance for therapeutic radiological services	"$5 Chiropractic, $5 Podiatry"	20% coinsurance	$10 copay	Non-Covered	Non-Covered	$5 copay	No Cost Sharing	$10 copay	No Cost Sharing	Non-Covered	Non-Covered											21.52398208	21.52398208	11.1	0	50	0.2	0.2	39.86005067	27.5	20	20	0	0	20	0	5	9.974472635	0	0.162280768	1.196814812	0.2	0.713823324	0	0	5	0	10	0	0	0											NO	21.52398208	21.52398208	11.1	0	50	0.2	0.2	39.86005067	27.5	20	20	0	0	20	0	5	9.974472635	0	0.162280768	1.196814812	0.2	0.713823324	0	0	5	0	10	0	0	0												1.8287	0.221496222	0.486663234	0	0.966963975	0.030372416	0.000123627	1.333786819	0.416646213	1.537173949	0.742197293	0	0	0.731998536	0	2.481194471	0.606189667	0	0.067775292	3.578525835	8.320014238	0.086897333	0	0	0.141581001	0	0.010776695	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5891			1.8287	0.221496222	0.486663234	0	0.966963975	0.030372416	0.000123627	1.333786819	0.416646213	1.537173949	0.742197293	0	0	0.731998536	0	2.481194471	0.606189667	0	0.067775292	3.578525835	8.320014238	0.086897333	0	0	0.141581001	0	0.010776695	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5891	NO																																																																																		0			1.8287	0.221496222	0.486663234	0	0.966963975	0.030372416	0.000123627	1.333786819	0.416646213	1.537173949	0.742197293	0	0	0.731998536	0	2.481194471	0.606189667	0	0.067775292	3.578525835	8.320014238	0.086897333	0	0	0.141581001	0	0.010776695	0	0	0	0	0	0	0	0	0	0	0	0	0	23.5891
H5928_012_0	2010	6	N/A																															D	A	A	D	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V			V	P	V	V																																																					0	NO	845.7649727	9.295079802	241.5595428	60.78549184	149.0159444	0.343219809	0.001397032	357.0044345	214.0865779	1097.291149	528.699177	0	0	507.7903402	2935.421544	6849.316937	867.6557359	3064.662985	5924.327579	42437.67103	15.36811256	1732.506779	0	0	402.0830707	302.9768745	5.303936279	19.90557096	0	0												$50/day for days 1-3	$50/day for days 1-3	$50/day after day 20	No Cost Sharing	$50 copay	20% coinsurance	20% coinsurance	$50 ER; $15/$25 urgent care	$20/$50 copay	$20 copay	$20 copay	No Cost Sharing	No Cost Sharing	$20 copay on other OP services	$0 Copay for PCP services	$5 Copay	$10 copay	No Cost Sharing	$0 copay or 10% min coinsurance for therapeutic radiological services	"$5 Chiropractic, $5 Podiatry"	20% coinsurance	$10 copay	Non-Covered	Non-Covered	$5 copay	No Cost Sharing	$10 copay	No Cost Sharing	Non-Covered	Non-Covered											21.52398208	21.52398208	11.1	0	50	0.2	0.2	39.75716596	27.5	20	20	0	0	20	0	5	9.974472635	0	0	1.201842825	0.2	0.684491396	0	0	0	0	10	0	0	0											NO	21.52398208	21.52398208	11.1	0	50	0.2	0.2	39.75716596	27.5	20	20	0	0	20	0	5	9.974472635	0	0	1.201842825	0.2	0.684491396	0	0	0	0	10	0	0	0												1.517	0.016672261	0.223442577	0	0.620899768	0.068643962	0.000279406	1.182790379	0.490615074	1.828818581	0.881165295	0	0	0.846317234	0	2.853882057	0.7212007	0	0	4.250284202	3.073622512	0.098823832	0	0	0	0	0.004419947	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6789			1.517	0.016672261	0.223442577	0	0.620899768	0.068643962	0.000279406	1.182790379	0.490615074	1.828818581	0.881165295	0	0	0.846317234	0	2.853882057	0.7212007	0	0	4.250284202	3.073622512	0.098823832	0	0	0	0	0.004419947	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6789	NO																																																																																		0			1.517	0.016672261	0.223442577	0	0.620899768	0.068643962	0.000279406	1.182790379	0.490615074	1.828818581	0.881165295	0	0	0.846317234	0	2.853882057	0.7212007	0	0	4.250284202	3.073622512	0.098823832	0	0	0	0	0.004419947	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6789
H5928_013_0	2010	8	N/A																															D	A	A	D	T	COIN	COIN	V	V	V	V	V	COIN	V	V	V	V	V	V	V	COIN	V			V	P	V	V																																																					0	NO	873.3265938	9.597986019	249.4314372	62.76635739	153.8720465	0.349907492	0.001424253	368.6384242	221.0631888	1133.049455	545.9283209	0	0	524.338111	3031.080479	7072.521119	895.930729	3164.533614	6117.388391	43820.62143	15.66756225	1788.965366	0	0	415.1860741	312.8502248	5.476779903	20.55424975	0	0												$50/day for days 1-3	$50/day for days 1-3	$50/day after day 20	No Cost Sharing	$50 copay	20% coinsurance	20% coinsurance	$50 ER; $15/$25 urgent care	$20/$50 copay	$20 copay	$20 copay	No Cost Sharing	No Cost Sharing	$20 copay on other OP services	$0 Copay for PCP services	$5 Copay	$10 copay	No Cost Sharing	$0 copay or 10% min coinsurance for therapeutic radiological services	"$5 Chiropractic, $5 Podiatry"	20% coinsurance	$10 copay	Non-Covered	Non-Covered	$5 copay	No Cost Sharing	$10 copay	No Cost Sharing	Non-Covered	Non-Covered											21.52398208	21.52150094	11.1	0	50	0.2	0.2	39.75716596	27.5	20	20	0	0	20	0	5	9.974472635	0	0.001001683	1.201842825	0.2	0.684491396	0	0	5	0	10	0	0	0											NO	21.52398208	21.52150094	11.1	0	50	0.2	0.2	39.75716596	27.5	20	20	0	0	20	0	5	9.974472635	0	0.001001683	1.201842825	0.2	0.684491396	0	0	5	0	10	0	0	0												1.5665	0.017213589	0.230724079	0	0.641133527	0.069981498	0.000284851	1.221334918	0.506603141	1.888415758	0.909880535	0	0	0.873896852	0	2.946883799	0.744703045	0	0.00051064	4.38879162	3.13351245	0.102044283	0	0	0.172994198	0	0.004563983	0	0	0	0	0	0	0	0	0	0	0	0	0	19.4199			1.5665	0.017213589	0.230724079	0	0.641133527	0.069981498	0.000284851	1.221334918	0.506603141	1.888415758	0.909880535	0	0	0.873896852	0	2.946883799	0.744703045	0	0.00051064	4.38879162	3.13351245	0.102044283	0	0	0.172994198	0	0.004563983	0	0	0	0	0	0	0	0	0	0	0	0	0	19.4199	NO																																																																																		0			1.5665	0.017213589	0.230724079	0	0.641133527	0.069981498	0.000284851	1.221334918	0.506603141	1.888415758	0.909880535	0	0	0.873896852	0	2.946883799	0.744703045	0	0.00051064	4.38879162	3.13351245	0.102044283	0	0	0.172994198	0	0.004563983	0	0	0	0	0	0	0	0	0	0	0	0	0	19.4199
H5932_001_0	2010	3	N/A																															D	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	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	NO	3386.616906	316.7162574	58.06804896	26.30318874	23.51342716	26.24946795	13.78014116	1673.932404	27.97395088	16.98426704	24.41074482	0.368495974	0.483384272	51.92389609	35.67720105	146.9270403	13.2896884	0.331043264	0.873156628	10.12731377	39.33813017	0.009038713	4.25	5.275656499	5.167955313	0	0	0.881255899	2.568344106	0.844451884												"$195/day for days 1-8, $90 per day after day 8: PBP 1a"	$130/day: PBP 1b	FFS Medicare: PBP 2	FFS Medicare: PBP 6	FFS Medicare: PBP 10a	FFS Medicare: PBP 11a	"FFS Medicare: PBP 11b, 11c"	"$50 copay: PBP 4a, 4b"	"FFS Medicare: PBP 9a, 9b"	FFS Medicare: PBP 8a	FFS Medicare: PBP 8b	FFS Medicare:	FFS Medicare: PBP 12	"FFS Medicare: PBP 3, 5, 9a, 9c, 9d, 13a, 13b"	"FFS Medicare: PBP 4b, 7a, 14b-i"	"FFS Medicare: PBP 4b, 7b, 7d, 7f, 7g, 14d-i, 17a, 18a"	"FFS Medicare: PBP 7e, 7h"	"FFS Medicare: PBP 7c, 7i"	FFS Medicare: PBP 7d	"FFS Medicare: PBP 7d, 7g"	FFS Medicare: PBP 15	FFS Medicare: PBP 7g																			164.8656113	130	0.123486289	0.000519495	0.200930941	0.2143841	0.211734299	35.78229731	0.186959427	4.59E-07	0.211190115	0.21190019	0.196829723	0.26670353	0.274643361	0.227089614	0.292070386	0.210124059	0.210139378	4.37E-05	0.225875702	0.178930983	0	0.013092049	0	0	0	0	0	0.004325489											NO	164.8656113	130	0.123486289	0.000519495	0.200930941	0.2143841	0.211734299	35.78229731	0.186959427	4.59E-07	0.211190115	0.21190019	0.196829723	0.26670353	0.274643361	0.227089614	0.292070386	0.210124059	0.210139378	4.37E-05	0.225875702	0.178930983	0	0.013092049	0	0	0	0	0	0.004325489												46.5281	3.431092789	7.170607886	0.01366438	4.724575048	5.627468569	2.917728525	4.991428914	5.229993818	7.80E-06	5.155308006	0.078084367	0.095144392	13.84828638	9.7985064	33.36560483	3.881524416	0.069560155	0.183484591	0.000443037	8.885527767	0.001617306	0	0.069069153	0	0	0	0	0	0.003652667	0	0	0	0	0	0	0	0	0	0	156.0704	146		46.5281	3.431092789	7.170607886	0.01366438	4.724575048	5.627468569	2.917728525	4.991428914	5.229993818	7.80E-06	5.155308006	0.078084367	0.095144392	13.84828638	9.7985064	33.36560483	3.881524416	0.069560155	0.183484591	0.000443037	8.885527767	0.001617306	0	0.069069153	0	0	0	0	0	0.003652667	0	0	0	0	0	0	0	0	0	0	156.0704	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			46.5281	3.431092789	7.170607886	0.01366438	4.724575048	5.627468569	2.917728525	4.991428914	5.229993818	7.80E-06	5.155308006	0.078084367	0.095144392	13.84828638	9.7985064	33.36560483	3.881524416	0.069560155	0.183484591	0.000443037	8.885527767	0.001617306	0	0.069069153	0	0	0	0	0	0.003652667	0	0	0	0	0	0	0	0	0	0	156.0704
H5938_001_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	V	P	Coin	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	0	0	0	0	0											0	YES	966.6927107	26.11506979	1410.009724	522.4428009	166.7414351	8.519338637	9.618890403	245.5481164	201.3414179	467.7536015	531.5689124	0	33.32000825	220.4164418	5331.729172	6977.815959	56.73238999	336.6124314	3146.232826	8849.713306	732.0067256	0	0	0	0	3.019824974	0	0	0	0											3400	"$250 per admit, $100 copay, days 6-10"	"$250 per admit, $100 copay, days 6-10"	"$75 copay, days 7-100"	$0 copay	$100 copay	20% coinsurance	20% coinsurance	"$20 to $50 copay, waived if admitted"	$100 copay	$10 copay to 20% coinsurance	$0-$100 copay	$0 copay	$0 copay	Varies	$15 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$0-$100 copay	Varies	$0 copay	Varies	Not Covered	Not Covered	Not Covered	$0 copay; and $150 credit covered every 2years	Not Covered	Not Covered	Varies	Varies											61.41636364	56.46998723	51.23965901	0	100	0.2	0.2	42.84688824	100	10	22.85326759	0	0	23.55371674	9.453279096	12.92458723	25	25	0	10.6108496	0	0	0	0	0	0	0	0	0	0											NO	48.62501701	56.46998723	47.95103766	0	100	0.154642527	0.173218278	42.84688824	76.96952704	10	14.13005603	0	0	9.528785739	8.699881951	12.17119009	25	25	0	10.26153598	0	0	0	0	0	0	0	0	0	0												3.9171	0.122893138	5.634285782	0	1.389511959	1.317452054	1.666167632	0.876747725	1.291429476	0.389794668	0.625924876	0	0	0.175025087	3.865451199	7.07736037	0.118192479	0.701275899	0	7.567637622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7363		5.152208978	3.9171	0.122893138	5.634285782	0	1.389511959	1.317452054	1.666167632	0.876747725	1.291429476	0.389794668	0.625924876	0	0	0.175025087	3.865451199	7.07736037	0.118192479	0.701275899	0	7.567637622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7363	NO																																																																																		0			3.9171	0.122893138	5.634285782	0	1.389511959	1.317452054	1.666167632	0.876747725	1.291429476	0.389794668	0.625924876	0	0	0.175025087	3.865451199	7.07736037	0.118192479	0.701275899	0	7.567637622	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7363
H5938_006_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	P	P	P	P	P	P	S	O	T	V	P	Coin	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	0	0	0	0	0											0	YES	1119.686333	30.24817132	1803.902534	1211.097977	172.0924489	8.397697136	9.481549194	247.7537173	240.012176	711.7544476	808.8569997	0	50.70118966	335.3953497	5796.087047	7585.536961	61.67340091	365.9291181	3420.248618	9620.464021	712.5832959	0	0	0	0	2.975073772	0	0	0	96.30625865											3400	"$250 per admit, $100 copay, days 6-10"	"$250 per admit, $100 copay, days 6-10"	"$75 copay, days 7-100"	$0 copay	$100 copay	20% coinsurance	20% coinsurance	"$20 to $50 copay, waived if admitted"	$100 copay	$10 copay to 20% coinsurance	$0-$100 copay	$0 copay	$0 copay	Varies	$15 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$0-$100 copay	Varies	$0 copay	Varies	Not Covered	Not Covered	Not Covered	$0 copay; and $150 credit covered every 2years	Not Covered	Not Covered	Varies	Varies											61.41636364	56.46998723	51.23965901	0	100	0.2	0.2	42.84688824	100	10	22.86050103	0	0	23.55371674	9.453306468	12.92466628	25	25	0	10.6108496	0	0	0	0	0	0	0	0	0	0											NO	50.82919082	56.46998723	48.77535333	0	100	0.155887041	0.173953112	42.84688824	81.47857605	10	17.36463802	0	0	14.71764259	8.788907698	12.26026751	25	25	0	10.3028002	0	0	0	0	0	0	0	0	0	0												4.7427	0.142342821	7.332165287	0	1.434103741	1.309092155	1.649344991	0.884622986	1.629654195	0.593128706	1.170459084	0	0	0.411352407	4.245106172	7.750059361	0.128486252	0.762352329	0	8.259809883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4448		4.939296961	4.7427	0.142342821	7.332165287	0	1.434103741	1.309092155	1.649344991	0.884622986	1.629654195	0.593128706	1.170459084	0	0	0.411352407	4.245106172	7.750059361	0.128486252	0.762352329	0	8.259809883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4448	NO																																																																																		0			4.7427	0.142342821	7.332165287	0	1.434103741	1.309092155	1.649344991	0.884622986	1.629654195	0.593128706	1.170459084	0	0	0.411352407	4.245106172	7.750059361	0.128486252	0.762352329	0	8.259809883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.4448
H5938_802_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			16.75	0.19	0	0	0.28	0.29	0.33	0.25	0.83	0.15	0.66	0	0.03	0.45	1.35	2.89	0.02	0.11	1.06	0.98	0.15	0																			26.77	NO	943.9342356	25.77962615	1201.118442	641.1339141	8.425001976	8.843668237	9.98507973	7.423899123	25.22082075	4.399778701	20.0845089	0	0.788354151	13.78257727	40.96790682	87.5424622	0.520422919	3.18360631	32.24813461	29.73292498	4.637294414	0	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											16.18651766	6.551707661	78.17192103	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	0											NO	16.18651766	6.551707661	78.17192103	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	0												1.2733	0.014075048	7.824478003	0	1.685000395	1.768733647	1.997015946	1.484779825	5.044164151	0.87995574	4.01690178	0	0.15767083	2.756515455	8.193581365	17.50849244	0.104084584	0.636721262	6.449626923	5.946584996	0.927458883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.6691	Medicare Standard Deductible(s)		18.0233	0.204075048	7.824478003	0	1.965000395	2.058733647	2.327015946	1.734779825	5.874164151	1.02995574	4.67690178	0	0.18767083	3.206515455	9.543581365	20.39849244	0.124084584	0.746721262	7.509626923	6.926584996	1.077458883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4391	NO																																																																																		0			18.0233	0.204075048	7.824478003	0	1.965000395	2.058733647	2.327015946	1.734779825	5.874164151	1.02995574	4.67690178	0	0.18767083	3.206515455	9.543581365	20.39849244	0.124084584	0.746721262	7.509626923	6.926584996	1.077458883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4391
H5938_803_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			17.63	0.19	0	0	0.29	0.31	0.35	0.26	0.88	0.15	0.7	0	0.03	0.48	1.42	3.04	0.02	0.11	1.12	1.03	0.16	0																			28.17	NO	1346.065325	36.762109	1309.18058	2652.626767	8.86837579	9.309062054	10.51053978	7.814632055	26.5480544	4.631324639	21.1414521	0	0.829840912	14.50790714	43.12383687	92.14936157	0.547809926	3.351142071	33.94523549	31.29762886	4.881345734	0	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											11.94822721	4.836202024	78.16490049	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	0											NO	11.94822721	4.836202024	78.16490049	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	0												1.3403	0.014815749	8.527664147	0	1.773675158	1.861812411	2.102107956	1.562926411	5.30961088	0.926264928	4.22829042	0	0.165968182	2.901581429	8.624767375	18.42987231	0.109561985	0.670228414	6.789047097	6.259525772	0.976269147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.5742	Medicare Standard Deductible(s)		18.9703	0.204815749	8.527664147	0	2.063675158	2.171812411	2.452107956	1.822926411	6.18961088	1.076264928	4.92829042	0	0.195968182	3.381581429	10.04476737	21.46987231	0.129561985	0.780228414	7.909047097	7.289525772	1.136269147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7442	NO																																																																																		0			18.9703	0.204815749	8.527664147	0	2.063675158	2.171812411	2.452107956	1.822926411	6.18961088	1.076264928	4.92829042	0	0.195968182	3.381581429	10.04476737	21.46987231	0.129561985	0.780228414	7.909047097	7.289525772	1.136269147	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.7442
H5938_804_0	2010	2	N/A																															D	D	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																			16.71	0.18	0	0	0.28	0.29	0.33	0.24	0.83	0.14	0.66	0	0.03	0.45	1.35	2.88	0.02	0.1	1.06	0.98	0.15	0																			26.68	NO	1062.807314	29.02531423	1377.221137	1327.396171	8.404522308	8.821918508	9.960522863	7.406708967	25.15879378	4.389150362	20.03522335	0	0.786415308	13.74924335	40.86742053	87.32754334	0.519143013	3.175776688	32.16998027	29.66025576	4.626205654	0	0	0	0	0	0	0	0	0												Standard Medicare benefits	Standard Medicare benefits	Standard Medicare benefits	$0 per visit	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	20% Coinsurance	0	0	0	0	0	0	0	0											14.34139505	5.804835256	78.02483772	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	0											NO	14.34139505	5.804835256	78.02483772	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	0												1.2702	0.014040597	8.954787977	0	1.680904462	1.764383702	1.992104573	1.481341793	5.031758755	0.877830072	4.00704467	0	0.157283062	2.749848671	8.173484106	17.46550867	0.103828603	0.635155338	6.433996054	5.932051152	0.925241131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.6508	Medicare Standard Deductible(s)		17.9802	0.194040597	8.954787977	0	1.960904462	2.054383702	2.322104573	1.721341793	5.861758755	1.017830072	4.66704467	0	0.187283062	3.199848671	9.523484106	20.34550867	0.123828603	0.735155338	7.493996054	6.912051152	1.075241131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3308	NO																																																																																		0			17.9802	0.194040597	8.954787977	0	1.960904462	2.054383702	2.322104573	1.721341793	5.861758755	1.017830072	4.66704467	0	0.187283062	3.199848671	9.523484106	20.34550867	0.123828603	0.735155338	7.493996054	6.912051152	1.075241131	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3308
H5948_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	P	P	P	P	P	P	Coin	P	T	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	NO	0	1.228079129	0	0	137.3307513	7.19	1.06	147.5944564	0	0	451.526299	0	0.1	0	38.3721895	3725.993366	6.411330707	0	0	0	8.09	0	0	1176.50581	0	0	0	0	0	4.525022347												$0 copay	1B - $250 per admit	$0 copay	$0 copay	10A - $50 copay	11A - 20% coin on items >$150	11B - 20% coin on items >$150	4A - $50 copay	$0 copay	$0 copay	8B - $25 copay	$0 copay	12 - 20% coinsurance	$0 copay	4B- $25 copay	7D - $10 Specialist copay	9C- $30 copay	$0 copay	$0 copay	$0 copay	20% Coinsurance for Part B Rx	$0 copay	$0 copay	16A - $15 copay	$0 copay	17B - $160 max	$0 copay	$0 copay	$0 copay	4A - $50 copay (foreign travel)											0	250	0	0	50	0.1	0.2	50	0	0	25	0	0.2	0	25	10	30	0	0	0	0.2	0	0	15	0	0	0	0	0	50											NO	0	250	0	0	50	0.1	0.2	50	0	0	25	0	0.2	0	25	10	30	0	0	0	0.2	0	0	15	0	0	0	0	0	50												0	0.025584982	0	0	0.572211464	0.719	0.212	0.614976902	0	0	0.94067979	0	0.02	0	0.079942061	3.104994472	0.016028327	0	0	0	1.618	0	0	1.470632263	0	0	0	0	0	0.01885426	0	0	0	0	0	0	0	0	0	0	9.4129			0	0.025584982	0	0	0.572211464	0.719	0.212	0.614976902	0	0	0.94067979	0	0.02	0	0.079942061	3.104994472	0.016028327	0	0	0	1.618	0	0	1.470632263	0	0	0	0	0	0.01885426	0	0	0	0	0	0	0	0	0	0	9.4129	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.025584982	0	0	0.572211464	0.719	0.212	0.614976902	0	0	0.94067979	0	0.02	0	0.079942061	3.104994472	0.016028327	0	0	0	1.618	0	0	1.470632263	0	0	0	0	0	0.01885426	0	0	0	0	0	0	0	0	0	0	9.4129
H5948_002_0	2010	5	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	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	NO	317.72	3.02	63.77	0	9.49	17.55	1.21	14.26	52.89	7.16	37.1	0	0.12	37.76	83.57	251.48	3.11	12.57	61.46	23.09	13.76	12.04	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	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0.065503436	0.065503436	0.154043769	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065503436	0.065503436	0.154043769	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												20.8118	0.197820378	9.823371124	0	2.21117	4.08915	0.28193	3.32258	12.32337	1.66828	8.6443	0	0.02796	8.79808	19.47181	58.59484	0.72463	2.92881	14.32018	5.37997	3.20608	2.80532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	179.6314			20.8118	0.197820378	9.823371124	0	2.21117	4.08915	0.28193	3.32258	12.32337	1.66828	8.6443	0	0.02796	8.79808	19.47181	58.59484	0.72463	2.92881	14.32018	5.37997	3.20608	2.80532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	179.6314	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			20.8118	0.197820378	9.823371124	0	2.21117	4.08915	0.28193	3.32258	12.32337	1.66828	8.6443	0	0.02796	8.79808	19.47181	58.59484	0.72463	2.92881	14.32018	5.37997	3.20608	2.80532	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	179.6314
H5950_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.45010088	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6718.531537	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0												$250/day 1-7	$250/day 1-7	"$0/d 1-10, $75/d 11-100"	$0 per visit	$150 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$225 per procedure	$35 per visit	$40 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$25 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$40 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	$500 Every 3 Yrs	Coaching Only	0											180.7137695	180.7137695	47.56208437	0	150	0.2	0.2	47.5	225	5.25	47	35	25	35	25	35	35	35	40	35	$45 	0	0	0	0	0	0	0	0	0											NO	180.7137695	180.7137695	47.56208437	0	150	0.2	0.2	47.5	225	5.25	47	35	25	35	25	35	35	35	40	35	$45 	0	0	0	0	0	0	0	0	0												25.7968	1.146700031	4.627599879	0	2.934333973	2.090020175	0	0.957869753	7.52807906	0.957372935	11.34079879	0.157116481	0.000725633	0	9.627745183	19.59571698	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0533	0	0	25.7968	1.146700031	4.627599879	0	2.934333973	2.090020175	0	0.957869753	7.52807906	0.957372935	11.34079879	0.157116481	0.000725633	0	9.627745183	19.59571698	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0533	NO																												0	0																																								0	0	0											0			25.7968	1.146700031	4.627599879	0	2.934333973	2.090020175	0	0.957869753	7.52807906	0.957372935	11.34079879	0.157116481	0.000725633	0	9.627745183	19.59571698	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0533
H5950_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	318.6778202	4.897205165	42.67833259	6.614511036	8.461974541	10.68377281	0	10.67806859	36.51205221	12.63429997	55.52052416	0.741020708	0.014097425	24.34136816	19.33552149	121.8747477	2.346095259	6.051262175	0	-9.57E-09	63.43732586	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.076961799	0.076961799	0.207383628	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076961799	0.076961799	0.207383628	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.526	0.376897718	8.850787432	0	1.971640068	2.489319066	0	2.487989981	8.507308165	2.943791894	12.93628213	0.172657825	0.0032847	5.671538782	4.505176508	28.39681621	0.546640195	1.409944087	0	-2.23E-09	14.78089693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.577			24.526	0.376897718	8.850787432	0	1.971640068	2.489319066	0	2.487989981	8.507308165	2.943791894	12.93628213	0.172657825	0.0032847	5.671538782	4.505176508	28.39681621	0.546640195	1.409944087	0	-2.23E-09	14.78089693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.577	NO																																																																																		0			24.526	0.376897718	8.850787432	0	1.971640068	2.489319066	0	2.487989981	8.507308165	2.943791894	12.93628213	0.172657825	0.0032847	5.671538782	4.505176508	28.39681621	0.546640195	1.409944087	0	-2.23E-09	14.78089693	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.577
H5950_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	323.6236315	4.973208738	43.34069115	6.717166828	8.593302569	10.84958267	0	10.84378992	37.07871142	12.8303816	56.38219077	0.75252119	0.014316214	24.71914097	19.63560464	123.7662176	2.382506154	6.145176465	0	-9.72E-09	64.42185954	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.078806609	0.078806609	0.190837089	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078806609	0.078806609	0.190837089	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.5037	0.391921716	8.271011318	0	2.002239499	2.527952763	0	2.526603052	8.639339762	2.989478913	13.13705045	0.175337437	0.003335678	5.759559846	4.575095881	28.8375287	0.555123934	1.431826116	0	-2.26E-09	15.01029327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.3374			25.5037	0.391921716	8.271011318	0	2.002239499	2.527952763	0	2.526603052	8.639339762	2.989478913	13.13705045	0.175337437	0.003335678	5.759559846	4.575095881	28.8375287	0.555123934	1.431826116	0	-2.26E-09	15.01029327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.3374	NO																																																																																		0			25.5037	0.391921716	8.271011318	0	2.002239499	2.527952763	0	2.526603052	8.639339762	2.989478913	13.13705045	0.175337437	0.003335678	5.759559846	4.575095881	28.8375287	0.555123934	1.431826116	0	-2.26E-09	15.01029327	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.3374
H5969_001_0	2010	6	N/A																															D	D	D	V	Coin	Coin	Coin	V	Coin	V	Coin	V	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	T	V	V	Coin	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	YES	841.0582146	16.64738971	566.3816974	0	9.466438615	7.891105186	2.399168893	215.900525	27.55021277	0	15.57738379	0	0.206960281	14.87569182	42.35159432	6336.727838	117.4934537	378.0731015	16.86260174	18.93482617	11.11664579	1.180294569	0	0	258.0915468	4.794028709	148.8257758	4.020179843	0	691.5394014											3400	$230/Days 1-10 for IP Medical; $230/Days 1-10 for IP Surgical;	$210/Days 1-10 for IP Psych; $210/Days 1-10 for IP Substance Abuse;	$80/Days 1-10 for SNF	No Cost-Sharing	25% Coinsurance for Ambulance	25% Coinsurance for DME	25% Coinsurance for Prosthetics/Supplies; 25% Coinsurance for Diabetes Monitoring Supplies; 25% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care;	25% Coinsurance for OP Fac - Surgery; 25% Coinsurance for OP Fac - ASC	No Cost-Sharing	25% Coinsurance for OP Fac - Radiology; 25% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 25% Coinsurance for Renal Dialysis - Prof	25% Coinsurance for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; 25% Coinsurance for OP Fac - Other; $30/Visit for Prof - CORF; $30/Visit for Prof - CORF;	$2/Visit for PCP - Office Visits; $2/Consult for PCP - Consults; 25% Coinsurance for PCP - Primary Surgeon (IP); 25% Coinsurance for PCP - Asst Surgeon (IP); 25% Coinsurance for PCP - Primary Surgeon (OP); 25% Coinsurance for PCP - Asst Surgeon (OP); 25% Coinsurance for PCP - IP Visits; 25% Coinsurance for PCP - Tx Injections; 25% Coinsurance for PCP - Allergy Testing; 25% Coinsurance for PCP - Allergy Tx; 25% Coinsurance for PCP - Cardio;	$20/Visit for Speclst - Office Visits; 25% Coinsurance for Speclst - Primary Surgeon (IP); 25% Coinsurance for Speclst - Asst Surgeon (IP); 25% Coinsurance for Speclst - Anesthesia (IP); 25% Coinsurance for Speclst - Primary Surgeon (OP); 25% Coinsurance for Speclst - Asst Surgeon (OP); 25% Coinsurance for Speclst - Anesthesia (OP); 25% Coinsurance for Speclst - IP Visits; 25% Coinsurance for Speclst - Tx Injections; 25% Coinsurance for Speclst - Allergy Testing; 25% Coinsurance for Speclst - Allergy Tx; $20/Consult for Speclst - Consults; 25% Coinsurance for Speclst - Cardio;	$35/Visit for OP Psych - Non-Physician; $35/Visit for OP Psych - Psychiatrist; $35/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	25% Coinsurance for Prof Radiology (IP); 25% Coinsurance for Prof Radiology (OP); 25% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor; 25% Coinsurance for Vision Exams; $30/Service for Podiatrist; $30/Exam for Hearing/Speech Exams; 25% Coinsurance for Misc. Medical (PCP); 25% Coinsurance for Misc. Medical; 25% Coinsurance for Prof Path (IP); 25% Coinsurance for Prof Path (OP); 25% Coinsurance for Prof Path (Office);	20% Coinsurance for Part B Rx	25% Coinsurance for Blood Products	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	$100 Benefit Maximum for Vision Hardware	$30/Exam for Routine Hearing Exams	$500 Benefit Maximum for Hearing Aids	No Cost-Sharing	$15/Visit for Acupuncture;											230	210	80	0	0.25	0.25	0.25	49.38685379	0.25	0	0.25	0	0.213041976	0.227417307	0.07878876	32.60309636	35	30	0.25	0.265957073	0.2	0.25	0	0	25	0.7172	30	0.7512	0	15											NO	195.423136	178.4298198	67.97326468	0	0.212416452	0.212416452	0.212416452	41.96232106	0.212416452	0	0.212416452	0	0.181014483	0.19322871	0.066944116	27.70173622	29.73830329	25.48997425	0.212416452	0.225974632	0.169933162	0.212416452	0	0	21.24164521	0.609380318	25.48997425	0.638268955	0	12.74498713												13.6969	0.247532562	3.208234419	0	2.010827305	1.676200567	0.509622944	0.754973929	5.852118453	0	3.308892598	0	0.037462808	2.874410738	2.835190033	14.62819693	0.29117133	0.803089469	3.581894036	4.278790371	1.889086766	0.250713985	0	0	0.456857423	2.921386739	0.316130433	2.565955989	0	0.734471731	0	0	0	0	0	0	0	0	0	0	69.7301	0	12.33757172	13.6969	0.247532562	3.208234419	0	2.010827305	1.676200567	0.509622944	0.754973929	5.852118453	0	3.308892598	0	0.037462808	2.874410738	2.835190033	14.62819693	0.29117133	0.803089469	3.581894036	4.278790371	1.889086766	0.250713985	0	0	0.456857423	2.921386739	0.316130433	2.565955989	0	0.734471731	0	0	0	0	0	0	0	0	0	0	69.7301	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.6969	0.247532562	3.208234419	0	2.010827305	1.676200567	0.509622944	0.754973929	5.852118453	0	3.308892598	0	0.037462808	2.874410738	2.835190033	14.62819693	0.29117133	0.803089469	3.581894036	4.278790371	1.889086766	0.250713985	0	0	0.456857423	2.921386739	0.316130433	2.565955989	0	0.734471731	0	0	0	0	0	0	0	0	0	0	69.7301
H5969_002_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	321.8057295	11.04651928	24.72033008	0	17.83260889	10.7150864	5.235912433	13.311877	32.93874468	12.05487897	26.44809132	0	0.464772528	27.43386796	52.50620564	105.5039874	2.227876108	2.963831985	26.86248122	38.91684273	62.22076818	0.97426857	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.07275554	0.07275554	0.14231172	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07275554	0.07275554	0.14231172	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.4131	0.803695477	3.517992699	0	4.154997872	2.49661513	1.219967597	3.101667341	7.674727509	2.8087868	6.162405277	0	0.108291999	6.392091234	12.23394591	24.58242906	0.519095133	0.690572852	6.258958125	9.067624357	14.49743899	0.227004577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9315	0	0	23.4131	0.803695477	3.517992699	0	4.154997872	2.49661513	1.219967597	3.101667341	7.674727509	2.8087868	6.162405277	0	0.108291999	6.392091234	12.23394591	24.58242906	0.519095133	0.690572852	6.258958125	9.067624357	14.49743899	0.227004577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9315	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.4131	0.803695477	3.517992699	0	4.154997872	2.49661513	1.219967597	3.101667341	7.674727509	2.8087868	6.162405277	0	0.108291999	6.392091234	12.23394591	24.58242906	0.519095133	0.690572852	6.258958125	9.067624357	14.49743899	0.227004577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.9315
H5970_001_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	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	YES	1216.173216	55.398899	661.518473	516.080945	43.419595	7.39211	3.463493	339.990187	422.156923	1446.772693	1049.780396	96.71207	0.034673	594.470889	3689.934762	4243.506798	79.980261	693.254949			14.668619	0		4.3	2.69				0.04	0.25	9.539402	0.05	0.55	1.2	0.32	0.4	0.42				3400	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	98.173204	86.82076	23.55934	0	119.8896	0.159853	0.159853	39.9632	105.376627	62.23779	81.884764	119.8896	0.159853	91.128567	7.99264	23.97792	23.97792	40.451204			0.159853	0		0	0				0	0	0	0	0	0	0	0	0					9.9496	0.400814543	1.298744885	0	0.43379649	1.18165096	0.553649747	1.132257987	3.707122718	7.503661254	7.163418332	0.966230949	0.005542583	4.51444002	2.457693348	8.479205543	0.159813358	2.336916447	0	0	2.344822753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5894	0	14.951656	9.9496	0.400814543	1.298744885	0	0.43379649	1.18165096	0.553649747	1.132257987	3.707122718	7.503661254	7.163418332	0.966230949	0.005542583	4.51444002	2.457693348	8.479205543	0.159813358	2.336916447	0	0	2.344822753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5894	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.72	0.0913	0.3351	1.5451	2.1127	1.4229	0.6667	0.2433	2.7437	0.3639	1.1679	0.1955	0.0013	0.7946	1.3958	2.3966	0.0238	0.2312			0.6926	0		0	0				0	0	0	0	0	0	0	0	0				23.144	500	9.543871	16.6696	0.492115543	1.633882885	1.545128	2.54650449	2.60457996	1.220347747	1.375540987	6.450870718	7.867579254	8.331354332	1.161713949	0.006795583	5.30903302	3.853494348	10.87577054	0.183601358	2.568116447	0	0	3.037429753	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7334
H5970_002_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	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	YES	1213.268235	55.266572	659.938354	514.848222	43.315882	8.147316	3.817335	339.178078	421.148549	1443.316897	1047.272866	96.481062	0.038215	593.05092	3681.120894	4233.370654	79.789218	691.599024			16.167218	0		4.3	2.69				0.04	0.25	9.516616	0.05	0.55	1.2	0.32	0.4	0.42				3400	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	98.02466	86.689393	23.534216	0	119.7348	0.159646	0.159646	39.9116	105.240566	62.157429	81.779035	119.7348	0.159646	91.010903	7.98232	23.94696	23.94696	40.398974			0.159646	0		0	0				0	0	0	0	0	0	0	0	0					9.9109	0.399252132	1.294260981	0	0.432201539	1.30068641	0.609422263	1.128094981	3.693492639	7.476072296	7.137080364	0.962678389	0.006100872	4.497841646	2.448657078	8.44802981	0.159225768	2.328324249	0	0	2.581031685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8133	0	15.096093	9.9109	0.399252132	1.294260981	0	0.432201539	1.30068641	0.609422263	1.128094981	3.693492639	7.476072296	7.137080364	0.962678389	0.006100872	4.497841646	2.448657078	8.44802981	0.159225768	2.328324249	0	0	2.581031685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8133	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.8458	0.093	0.3253	1.2471	1.5435	1.1485	0.5381	0.1777	2.2146	0.2937	0.9427	0.1578	0.001	0.6414	1.1266	1.9344	0.0192	0.1866			0.559	0		0	0				0	0	0	0	0	0	0	0	0				19.9962	0	10.799845	16.7567	0.492264132	1.619558981	1.247147	1.975706539	2.44920141	1.147546263	1.305832981	5.908103639	7.769808296	8.079778364	1.120462389	0.007111872	5.139194646	3.575275078	10.38241281	0.178425768	2.514937249	0	0	3.140067685	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8095
H5970_801_0	2010	4	N/A																															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	NO	231.994424	0.791358	40.28087	13.016184	1.526417	7.057953	3.450015	17.016874	48.454238	10.460683	24.939072	8.816108	0.774553	15.962051	29.62355	64.967429	0.3122	4.834683			21.11597	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																			0.087187214	0.087187214	0.177843264	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.087187214	0.087187214	0.177843264	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.2269	0.068996299	7.163681401	0	0.355655161	1.644503049	0.803853495	3.964931642	11.28983745	2.437339139	5.810803776	2.054153164	0.180470849	3.719157883	6.90228715	15.13741096	0.0727426	1.126481139	0	0	4.92002101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8793	0	0	20.2269	0.068996299	7.163681401	0	0.355655161	1.644503049	0.803853495	3.964931642	11.28983745	2.437339139	5.810803776	2.054153164	0.180470849	3.719157883	6.90228715	15.13741096	0.0727426	1.126481139	0	0	4.92002101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8793	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7653	0.0129	1.3336	0	1.4226	1.0843	0.53	1.0454	2.7204	0.6426	1.3931	0.5416	0.0475	0.9734	1.3005	2.8522	0.0137	0.2419			0.927	0																			20.8477	0	0	23.9923	0.081856413	8.497239117	0	1.778236661	2.728768549	1.333811995	5.010286142	14.01022895	3.079953139	7.203910776	2.595761664	0.228002849	4.692515383	8.20277665	17.98956396	0.0864896	1.368335139	0	0	5.84701151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.727
H5970_802_0	2010	4	N/A																															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	NO	231.994424	0.791358	40.28087	13.016184	1.526417	7.057953	3.450015	17.016874	48.454238	10.460683	24.939072	8.816108	0.774553	15.962051	29.62355	64.967429	0.3122	4.834683			21.11597	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																			0.087187214	0.087187214	0.177843264	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.087187214	0.087187214	0.177843264	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.2269	0.068996299	7.163681401	0	0.355655161	1.644503049	0.803853495	3.964931642	11.28983745	2.437339139	5.810803776	2.054153164	0.180470849	3.719157883	6.90228715	15.13741096	0.0727426	1.126481139	0	0	4.92002101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8793	0	0	20.2269	0.068996299	7.163681401	0	0.355655161	1.644503049	0.803853495	3.964931642	11.28983745	2.437339139	5.810803776	2.054153164	0.180470849	3.719157883	6.90228715	15.13741096	0.0727426	1.126481139	0	0	4.92002101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8793	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7653	0.0129	1.3336	0	1.4226	1.0843	0.53	1.0454	2.7204	0.6426	1.3931	0.5416	0.0475	0.9734	1.3005	2.8522	0.0137	0.2419			0.927	0																			20.8477	0	0	23.9923	0.081856413	8.497239117	0	1.778236661	2.728768549	1.333811995	5.010286142	14.01022895	3.079953139	7.203910776	2.595761664	0.228002849	4.692515383	8.20277665	17.98956396	0.0864896	1.368335139	0	0	5.84701151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.727
H5970_803_0	2010	4	N/A																															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	NO	231.994424	0.791358	40.28087	13.016184	1.526417	7.057953	3.450015	17.016874	48.454238	10.460683	24.939072	8.816108	0.774553	15.962051	29.62355	64.967429	0.3122	4.834683			21.11597	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																			0.087187214	0.087187214	0.177843264	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.087187214	0.087187214	0.177843264	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.2269	0.068996299	7.163681401	0	0.355655161	1.644503049	0.803853495	3.964931642	11.28983745	2.437339139	5.810803776	2.054153164	0.180470849	3.719157883	6.90228715	15.13741096	0.0727426	1.126481139	0	0	4.92002101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8793	0	0	20.2269	0.068996299	7.163681401	0	0.355655161	1.644503049	0.803853495	3.964931642	11.28983745	2.437339139	5.810803776	2.054153164	0.180470849	3.719157883	6.90228715	15.13741096	0.0727426	1.126481139	0	0	4.92002101	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.8793	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.7653	0.0129	1.3336	0	1.4226	1.0843	0.53	1.0454	2.7204	0.6426	1.3931	0.5416	0.0475	0.9734	1.3005	2.8522	0.0137	0.2419			0.927	0																			20.8477	0	0	23.9923	0.081856413	8.497239117	0	1.778236661	2.728768549	1.333811995	5.010286142	14.01022895	3.079953139	7.203910776	2.595761664	0.228002849	4.692515383	8.20277665	17.98956396	0.0864896	1.368335139	0	0	5.84701151	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.727
H5980_005_0	2010	17	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	684.12439	49.12755225	460.5324374	7.459237771	81.27382267	9.097077267	44.35247894	23.62654857	23.6277	8.728228702	10.87002652	0.619994105	0.982328323	121.3175478	129.3196036	167.9236332	12.53364936	1.266025188	33.57888344	53.14384191	2.973264659	5.831091822	28.50273759	0	0	0	0	0	0	0												1A IP Acute: Medicare Cost Sharing	1B IP Psych: Medicare Cost Sharing	2 SNF: $0	6 Home Health: Medicare Cost Sharing	10A Ambulance: Medicare Cost Sharing	11A DME: Medicare Cost Sharing	"11B Prosthetics/Medical Supplies, 11C Diabetes Monitoring Supplies: Medicare Cost Sharing"	"4A ER, 4B Urgent Care: Medicare Cost Sharing"	9B ASC Services: Medicare Cost Sharing	8A OP Diagnostic Procedures/Tests: Medicare Cost Sharing	8B OP Radiology: Medicare Cost Sharing	9A OP Hospital: Medicare Cost Sharing	12 Renal Dialysis: Medicare Cost Sharing	"3 CORF, 5 Partial Hosp, 9C OP Substance Abuse, 9D Cardiac Rehab: Medicare Cost Sharing"	"7A PCP, 14C Physical Exams: $0, 14B Immunizations,14D Pap Smears and Pelvic Exams, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Measurement, 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy: Medicare Cost Sharing"	"7B Chiropractic, 7D Physician Specialist (excl. Radiology), 7F Podiatry: Medicare Cost Sharing"	"7E Mental Health, 7H Psychiatric: Medicare Cost Sharing"	"7C Occupational Therapy, 7I Physical and Speech Therapy: Medicare Cost Sharing"	7D Physician Specialist (Radiology): Medicare Cost Sharing	"7G Other Health Care, 18A Hearing Exams (Medicare Covered): Medicare Cost Sharing"	15 Part B Drugs: Medicare Cost Sharing	"13A Blood, 16B Comprehensive Dental (Medicare Covered), 17A Routine Eye Exams (Medicare Covered): Medicare Cost Sharing"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											0.071106373	0.071102637	0	0	0.232996157	0.232999989	0.232994811	0.233006508	0.232999964	0.233003826	0.232905055	0.233000061	0.23300002	0.23299804	0	0.232999372	0.232984344	0.233024177	0.232983464	0.231742575	0.233003512	0.233007908	0	0	0	0	0	0	0	0											NO	0.071106373	0.071102637	0	0	0.232996157	0.232999989	0.232994811	0.233006508	0.232999964	0.233003826	0.232905055	0.233000061	0.23300002	0.23299804	0	0.232999372	0.232984344	0.233024177	0.232983464	0.231742575	0.233003512	0.233007908	0	0	0	0	0	0	0	0												48.6456	3.493098531	0	0	18.93648837	2.1196189	10.33389747	5.505139589	5.505253241	2.033710683	2.531684125	0.144458664	0.228882519	28.26675086	0	39.12610113	2.920144067	0.295014477	7.823324564	12.31569075	0.692781109	1.358690509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	192.2763	0	0	48.6456	3.493098531	0	0	18.93648837	2.1196189	10.33389747	5.505139589	5.505253241	2.033710683	2.531684125	0.144458664	0.228882519	28.26675086	0	39.12610113	2.920144067	0.295014477	7.823324564	12.31569075	0.692781109	1.358690509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	192.2763	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	48.6456	3.493098531	0	0	18.93648837	2.1196189	10.33389747	5.505139589	5.505253241	2.033710683	2.531684125	0.144458664	0.228882519	28.26675086	0	39.12610113	2.920144067	0.295014477	7.823324564	12.31569075	0.692781109	1.358690509	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	192.2763
H5980_006_0	2010	18	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	2911.65	365.36	0	0	2268.59	0	0	382.24	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	1A IP Acute: $25 Per Day for days 1-20	1B IP Psych: $25 Per Day for days 1-20	2 SNF: $0	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	13B Acupuncture: Not Covered											25	25	0	0	50	0	0	49.58481582	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	18.50467703	18.50467703	0	0	37.00935406	0	0	36.70204009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												4.4899	0.563405733	0	0	6.996587544	0	0	1.169082317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.219	0	4.64	4.4899	0.563405733	0	0	6.996587544	0	0	1.169082317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.219	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.4899	0.563405733	0	0	6.996587544	0	0	1.169082317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.219
H5980_007_0	2010	18	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	2686.4	325.84	0	0	2133.95	0	0	357.1	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											500	1A IP Acute: $25 Per Day for days 1-20	1B IP Psych: $25 Per Day for days 1-20	2 SNF: $0	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: $0	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											25	25	0	0	50	0	0	49.57238869	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	18.79587373	18.79587373	0	0	37.59174746	0	0	37.27025433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												4.2078	0.510370625	0	0	6.684909124	0	0	1.109100652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.5121	0	4.13	4.2078	0.510370625	0	0	6.684909124	0	0	1.109100652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.5121	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.2078	0.510370625	0	0	6.684909124	0	0	1.109100652	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.5121
H5985_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	V	V	V	V	V	V	V	V	Coin	Coin	T	P	V	P	V	P	O	O																																																			0	NO	1249.73488	54.56934171	640.7517148		133.5154234	8.787433336	11.19727508	225.2001559	402.5815705		329.9419538	89.54176764		499.4655827	3787.739503	6666.487396	232.2298659	1215.428095	288.8518735	6.260725313	25.98860793				153.9163096																	"1a: $150, 1-5 days then $0 days 6+"	1b: Medicare FFS	"2: $0, 1-20 days then $75 , 21+ days"	6: 0%	10a: $150/trip	11a: 20%	11b: 20%;11c: 20%	4a: $50/visit;4b: $35/visit	9a: $250/visit;9b: $150/visit	8a: 0%;8a: 20%	8b: 0%;8b: $150/visit;8b: 20%	9a: $250/visit	12a: $0 - $25/visit	3: $20/visit;5: $35/visit;9a: $250/visit;9c: $35/visit;9d: $20/visit;7i: $30/visit;7e: $35/visit;7c: $30/visit	7a: $10/visit;14c: 0%;14d: 0%;14e: 0%;14f: $25/visit;14g: 0%	7b: $30/visit;7d: $35/visit;7f: $30/visit;14c1: 0%;16b: $35/visit;17a: $30/visit;18a: $30/visit	7e: $35/visit;7h: $35/visit;7a: $10/visit;7d: $35/visit	7c: $30/visit;7i: $30/visit;7a: $10/visit;7d: $35/visit	14h: 0%;7a: $10/visit;7d: $35/visit	7g: $30/visit;14b: 0%;14i: 20%;14j: $5/visit7a: $10/visit;7d: $35/visit;8a: 0%;12a: 0%	15: 20%;15a: 0%	13a: 20%;17b: 0%			17a1: $10/visit																113.9895347	63.23662467	10.35740092		150	0.2	0.2	47	159.9849722		92.16373186	250		104.3220012	10.01506983	33.34418467	35	30	14.98082043	9.842006796	0.2				10																NO	113.9895347	63.23662467	10.35740092		150	0.2	0.2	47	159.9849722		92.16373186	250		104.3220012	10.01506983	33.34418467	35	30	14.98082043	9.842006796	0.2				10																	11.8714	0.287565082	0.553043533	0	1.668942793	1.757486667	2.239455015	0.882033944	5.367250113	0	2.534056813	1.865453493	0	4.342104093	3.161206302	18.5240489	0.677337109	3.038570237	0.36060317	0.005134842	5.197721586	0	0	0	0.128263591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4617	0	0	11.8714	0.287565082	0.553043533	0	1.668942793	1.757486667	2.239455015	0.882033944	5.367250113	0	2.534056813	1.865453493	0	4.342104093	3.161206302	18.5240489	0.677337109	3.038570237	0.36060317	0.005134842	5.197721586	0	0	0	0.128263591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4617	NO																																																																																		0	0	0	11.8714	0.287565082	0.553043533	0	1.668942793	1.757486667	2.239455015	0.882033944	5.367250113	0	2.534056813	1.865453493	0	4.342104093	3.161206302	18.5240489	0.677337109	3.038570237	0.36060317	0.005134842	5.197721586	0	0	0	0.128263591	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.4617
H5985_002_0	2010	6	N/A																															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	O	Coin	Coin	Coin	V																																																			0	NO	328.7066736		17.6163071		23.08379331	0.947929487	0.00406009	35.7328122	119.6602944	0.66180934	6.827035987			20.48947198	45.81932427	128.0945981	2.351028732	0.737493869	40.91539694	7.651320877	1.081201937																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS			17a1 $0 copay	17b1 $250 allowance	18a1 $0 copay	18b1 $1000 allowance		14c1 $0 copay; 7b1 $0 copay; 13c $23.50/month											0.078940951		0.132708436		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.078940951		0.132708436		0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					25.9484	0	2.337832565	0	5.378523842	0.22086757	0.000946001	8.325745242	27.88084859	0.154201576	1.590699385	0	0	4.774046971	10.67590256	29.84604135	0.547789694	0.171836072	9.533287486	1.782757764	0.251920051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.4217	0	0	25.9484	0	2.337832565	0	5.378523842	0.22086757	0.000946001	8.325745242	27.88084859	0.154201576	1.590699385	0	0	4.774046971	10.67590256	29.84604135	0.547789694	0.171836072	9.533287486	1.782757764	0.251920051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.4217	NO																																																																																		0	0	0	25.9484	0	2.337832565	0	5.378523842	0.22086757	0.000946001	8.325745242	27.88084859	0.154201576	1.590699385	0	0	4.774046971	10.67590256	29.84604135	0.547789694	0.171836072	9.533287486	1.782757764	0.251920051	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	129.4217
H5989_002_0	2010	10	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	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	NO	514.21	33.67	518.23	0	35.37	4.16	20.56	17.15	11.02	9.91	7.74	0.62	0.98	76.69	11339.38	117.22	10.21	1.16	25.72	43.19	2.32	4.82	0	0	0	0	0	0	0	0												1A IP Acute: Medicare FFS Copay Per Day	1B IP Psych: Medicare FFS Copay Per Day	2 SNF: Medicare FFS Copay for days 21+	6 Home Health: Medicare FFS Copay	10A Ambulance: Medicare FFS Copay	11A DME: Medicare FFS Copay	"11B Prosthetics/Medical Supplies: Medicare FFS Copay, 11C Diabetes Monitoring Supplies: Medicare FFS Copay"	"4A ER: Medicare FFS Copay, 4B Urgent Care: Medicare FFS Copay"	9B ASC Services: Medicare FFS Copay	8A OP Diagnostic Procedures/Tests: Medicare FFS Copay	8B OP Radiology: Medicare FFS Copay	9A OP Hospital: Medicare FFS Copay	12 Renal Dialysis: Medicare FFS Copay	"3 CORF: Medicare FFS Copay, 5 Partial Hosp: Medicare FFS Copay, 9C OP Substance Abuse: Medicare FFS Copay, 9D Cardiac Rehab: Medicare FFS Copay"	"7A PCP: $0, 14B Immunizations: Medicare FFS Copay, 14C Physical Exams: Medicare FFS Copay, 14D Pap Smears and Pelvic Exams: Medicare FFS Copay, 14E Prostate Screening: Medicare FFS Copay, 14F Colorectal Screening: Medicare FFS Copay, 14G Bone Mass Measurement: Medicare FFS Copay, 14H Mammography: Medicare FFS Copay, 14I Diabetes Monitoring: Medicare FFS Copay, 14J Nutrition Therapy: Medicare FFS Copay"	7D Physician Specialist (excl. Radiology): Medicare FFS Copay	"7E Mental Health: Medicare FFS Copay, 7H Psychiatric: Medicare FFS Copay"	"7C Occupational Therapy: Medicare FFS Copay, 7I Physical and Speech Therapy: Medicare FFS Copay"	7D Physician Specialist (Radiology): Medicare FFS Copay	"7B Chiropractic: Medicare FFS Copay, 7F Podiatry: Medicare FFS Copay, 7G Other Health Care: Medicare FFS Copay, 18A Hearing Exams (Medicare Covered): Medicare FFS Copay"	15 Part B Drugs: Medicare FFS Copay	"13A Blood: Medicare FFS Copay, 16B Comprehensive Dental (Medicare Covered): Medicare FFS Copay, 17A Routine Eye Exams (Medicare Covered): Medicare FFS Copay"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): Not Covered	"17B Eye Wear (Medicare Covered): Medicare FFS Copay, 17B Eye Wear (Non Medicare Covered): $100 vision hardware benefit maximum per two years"	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: $0, 13C OTC Drug Card:$0 cost sharing, $400 per year benefit, 13D None, 13E Enhanced DME:$0 cost sharing with benefit maximum of $50 every three months"											0.061567238	0.06156765	0.144638902	0	0.232969061	0.232999983	0.233044042	0.232920221	0.232999991	0.232955404	0.233036007	0.232999827	0.233000013	0.232998433	19.55441942	0.232999488	0.233010254	0.233013365	0.233011057	0.232983874	0.233002858	0.232992056	0	0	0	0	0	0	0	0											NO	0.061567238	0.06156765	0.144638902	0	0.232969061	0.232999983	0.233044042	0.232920221	0.232999991	0.232955404	0.233036007	0.232999827	0.233000013	0.232998433	19.55441942	0.232999488	0.233010254	0.233013365	0.233011057	0.232983874	0.233002858	0.232992056	0	0	0	0	0	0	0	0												31.6585	2.072982759	74.95621799	0	8.240115696	0.969279928	4.791385497	3.994581795	2.567659898	2.308588058	1.803698697	0.144459893	0.228340013	17.86864981	18.47791604	27.31219995	2.379034695	0.270295504	5.993044384	10.06257351	0.54056663	1.123021712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	217.7631	0	0	31.6585	2.072982759	74.95621799	0	8.240115696	0.969279928	4.791385497	3.994581795	2.567659898	2.308588058	1.803698697	0.144459893	0.228340013	17.86864981	18.47791604	27.31219995	2.379034695	0.270295504	5.993044384	10.06257351	0.54056663	1.123021712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	217.7631	NO																																																																																		0	0	0	31.6585	2.072982759	74.95621799	0	8.240115696	0.969279928	4.791385497	3.994581795	2.567659898	2.308588058	1.803698697	0.144459893	0.228340013	17.86864981	18.47791604	27.31219995	2.379034695	0.270295504	5.993044384	10.06257351	0.54056663	1.123021712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	217.7631
H5989_003_0	2010	7	N/A																															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	V	V	V	O	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	YES	2461.3	323.29	4767.62	0	789.88	3.82	18.93	244.53	0	1808.32	299.03	0	0.89	69.64	917.82	1346.93	1389.74	115.87	0	2538.4	2.14	0	0	0	0	0	122.82	0	0	169.36											3400	1A IP Acute: $200 Per Day for days 1-7	1B IP Psych: $200 Per Day for days 1-7	2 SNF: $50 for days 21+	6 Home Health: $0	10A Ambulance: $50	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $50"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $25	8B OP Radiology: $100	9A OP Hospital: $0	12 Renal Dialysis: 20%	"3 CORF: $25, 5 Partial Hosp: $0, 9C OP Substance Abuse: $25, 9D Cardiac Rehab: $25"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $10, 14E Prostate Screening: $10, 14F Colorectal Screening: $10, 14G Bone Mass Measurement: $10, 14H Mammography: $10, 14I Diabetes Monitoring: $10, 14J Nutrition Therapy: $10"	7D Physician Specialist (excl. Radiology): $25	"7E Mental Health: $25, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $0	"7B Chiropractic: $25, 7F Podiatry: $25, 7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $25	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $25, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											200	200	50	0	50	0.199999986	0.200026846	50	0	25	100	0	0.199999981	25	10	25	25	25	0	25	0.200002995	0	0	0	0	0	25	0	0	25											NO	159.6202614	159.6202614	39.90506535	0	39.90506535	0.15962025	0.159641687	39.90506535	0	19.95253267	79.8101307	0	0.159620246	19.95253267	7.98101307	19.95253267	19.95253267	19.95253267	0	19.95253267	0.159622652	0	0	0	0	0	19.95253267	0	0	19.95253267												32.7394	4.300302859	15.85434897	0	2.626684418	0.609749356	3.022017143	0.813165469	0	3.006713657	1.988801949	0	0.142062019	0.115791198	0.610427785	2.239555403	2.310736063	0.19265833	0	4.220625745	0.341592475	0	0	0	0	0	0.204214172	0	0	0.281596744	0	0	0	0	0	0	0	0	0	0	75.6205	0	19.13	32.7394	4.300302859	15.85434897	0	2.626684418	0.609749356	3.022017143	0.813165469	0	3.006713657	1.988801949	0	0.142062019	0.115791198	0.610427785	2.239555403	2.310736063	0.19265833	0	4.220625745	0.341592475	0	0	0	0	0	0.204214172	0	0	0.281596744	0	0	0	0	0	0	0	0	0	0	75.6205	NO																																																																																		0	0	0	32.7394	4.300302859	15.85434897	0	2.626684418	0.609749356	3.022017143	0.813165469	0	3.006713657	1.988801949	0	0.142062019	0.115791198	0.610427785	2.239555403	2.310736063	0.19265833	0	4.220625745	0.341592475	0	0	0	0	0	0.204214172	0	0	0.281596744	0	0	0	0	0	0	0	0	0	0	75.6205
H5989_004_0	2010	10	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	V	V	O	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	YES	1243.28	30.35	424.82	0	152.34	9.01	6.8	192.62	231.21	5.3	17.26	0	0.18	83.58	4178.92	3584.87	209.82	546.97	43.19	1635.94	8.75	0	0	0	0	0	155.41	0	0	105.27											3400	1A IP Acute: $200 Per Day for days 1-7	1B IP Psych: $200 Per Day for days 1-7	2 SNF: $100 for days 21+	6 Home Health: $0	10A Ambulance: $50	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $200	12 Renal Dialysis: 20%	"3 CORF: $30, 5 Partial Hosp: $0, 9C OP Substance Abuse: $30, 9D Cardiac Rehab: $30"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $30	"7E Mental Health: $30, 7H Psychiatric: $30"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $30, 7F Podiatry: $30, 7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $30	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $30, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											200	200	100	0	50	0.200000009	0.199884051	46.63742083	200	0.199977087	0.20000235	0	0.200000015	30	10	30	30	30	0.162207456	30	0.199999872	0	0	0	0	0	30	0	0	30											NO	154.2248102	154.2248102	77.11240512	0	38.55620256	0.154224817	0.154135399	35.96323689	154.2248102	0.154207142	0.154226622	0	0.154224822	23.13372154	7.711240512	23.13372154	23.13372154	23.13372154	0.125082071	23.13372154	0.154224712	0	0	0	0	0	23.13372154	0	0	23.13372154												15.9787	0.390060249	2.729907662	0	0.489470992	1.3895656	1.048120716	0.577269891	2.971526531	0.817297852	2.661951502	0	0.027760468	0.161126371	2.6853881	6.910948694	0.404493121	1.054454306	5.402294644	3.153781701	1.349466226	0	0	0	0	0	0.299600972	0	0	0.202940572	0	0	0	0	0	0	0	0	0	0	50.7061	0	15.05	15.9787	0.390060249	2.729907662	0	0.489470992	1.3895656	1.048120716	0.577269891	2.971526531	0.817297852	2.661951502	0	0.027760468	0.161126371	2.6853881	6.910948694	0.404493121	1.054454306	5.402294644	3.153781701	1.349466226	0	0	0	0	0	0.299600972	0	0	0.202940572	0	0	0	0	0	0	0	0	0	0	50.7061	NO																																																																																		0	0	0	15.9787	0.390060249	2.729907662	0	0.489470992	1.3895656	1.048120716	0.577269891	2.971526531	0.817297852	2.661951502	0	0.027760468	0.161126371	2.6853881	6.910948694	0.404493121	1.054454306	5.402294644	3.153781701	1.349466226	0	0	0	0	0	0.299600972	0	0	0.202940572	0	0	0	0	0	0	0	0	0	0	50.7061
H5989_005_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	V	V	O	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	YES	1295.96	31.64	440.27	0	155.08	9.4	7.09	196.96	236.39	5.42	17.62	0	0.19	87.68	4237.64	3681.12	204.06	541.97	41.59	1616.23	8.93	0	0	0	0	0	159.17	0	0	105.9											3400	1A IP Acute: $200 Per Day for days 1-7	1B IP Psych: $200 Per Day for days 1-7	2 SNF: $50 for days 21+	6 Home Health: $0	10A Ambulance: $50	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $200	12 Renal Dialysis: 20%	"3 CORF: $20, 5 Partial Hosp: $0, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $20"	"7A PCP: $5, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $20	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $20, 7F Podiatry: $20, 7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $20	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $20, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											200	200	50	0	50	0.200000012	0.199870093	46.61707961	200	0.200095258	0.199933172	0	0.199999995	20	5	20	20	20	0.162204735	20	0.199999836	0	0	0	0	0	20	0	0	20											NO	159.9743547	159.9743547	39.99358868	0	39.99358868	0.159974364	0.159870445	37.28768614	159.9743547	0.160050549	0.159920901	0	0.15997435	15.99743547	3.999358868	15.99743547	15.99743547	15.99743547	0.129742989	15.99743547	0.159974223	0	0	0	0	0	15.99743547	0	0	15.99743547												17.2767	0.421799049	1.467331441	0	0.516850478	1.503759022	1.133481458	0.612015222	3.151361476	0.867473976	2.817806272	0	0.030395127	0.116887929	1.412320259	4.907373305	0.27203639	0.722510842	5.396010901	2.154627928	1.428569814	0	0	0	0	0	0.21219265	0	0	0.141177368	0	0	0	0	0	0	0	0	0	0	46.5627	0	11.65	17.2767	0.421799049	1.467331441	0	0.516850478	1.503759022	1.133481458	0.612015222	3.151361476	0.867473976	2.817806272	0	0.030395127	0.116887929	1.412320259	4.907373305	0.27203639	0.722510842	5.396010901	2.154627928	1.428569814	0	0	0	0	0	0.21219265	0	0	0.141177368	0	0	0	0	0	0	0	0	0	0	46.5627	NO																																																																																		0	0	0	17.2767	0.421799049	1.467331441	0	0.516850478	1.503759022	1.133481458	0.612015222	3.151361476	0.867473976	2.817806272	0	0.030395127	0.116887929	1.412320259	4.907373305	0.27203639	0.722510842	5.396010901	2.154627928	1.428569814	0	0	0	0	0	0.21219265	0	0	0.141177368	0	0	0	0	0	0	0	0	0	0	46.5627
H5989_006_0	2010	10	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	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	NO	2597.72	328.97	4834.38	0	855.81	0	0	263.25	97.62	0	0	0	0.89	70.65	1034.96	1498.8	1631.56	136.29	0	2827.02	2.41	0	0	0	0	0	0	0	0	0												1A IP Acute: $175 Per Day for days 1-7	1B IP Psych: $175 Per Day for days 1-7	2 SNF: $125 for days 21+	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $10"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $200	12 Renal Dialysis: 20%	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $50, 9D Cardiac Rehab: $50"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $10, 14E Prostate Screening: $10, 14F Colorectal Screening: $10, 14G Bone Mass Measurement: $10, 14H Mammography: $10, 14I Diabetes Monitoring: $10, 14J Nutrition Therapy: $10"	7D Physician Specialist (excl. Radiology): $50	"7E Mental Health: $50, 7H Psychiatric: $50"	"7C Occupational Therapy: $50, 7I Physical and Speech Therapy: $50"	7D Physician Specialist (Radiology): $0	"7B Chiropractic: $50, 7F Podiatry: $50, 7G Other Health Care: $50, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay$0, 13D Other 2 Copay$0, 13E Other 3 Copay$0"											175	175	125	0	50	0	0	49.26153846	200	0	0	0	0.199999981	27.46638358	10	50	50	50	0	50	0.20000334	0	0	0	0	0	0	0	0	0											NO	175	175	125	0	50	0	0	49.26153846	200	0	0	0	0.199999981	27.46638358	10	50	50	50	0	50	0.20000334	0	0	0	0	0	0	0	0	0												37.8834	4.797479167	50.358125	0	3.565875	0	0	1.080675	1.627	0	0	0	0.177999983	0.161708333	0.862466667	6.245	6.798166667	0.567875	0	11.77925	0.48200805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.387	0	0	37.8834	4.797479167	50.358125	0	3.565875	0	0	1.080675	1.627	0	0	0	0.177999983	0.161708333	0.862466667	6.245	6.798166667	0.567875	0	11.77925	0.48200805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.387	NO																																																																																		0	0	0	37.8834	4.797479167	50.358125	0	3.565875	0	0	1.080675	1.627	0	0	0	0.177999983	0.161708333	0.862466667	6.245	6.798166667	0.567875	0	11.77925	0.48200805	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.387
H5991_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	Coin																																																											0	NO								507.9465728						1071.155948		8632.171015	1545.747608	2284.303257		5052.033423																													4a ER $50 copay;4b UC $10 copay						5 Partial Hosp $20 copay; 9c OP SA $20 copay; 3 CORF $10 copay		7b Chiro $10 copay; 7d SPC $10 copay;7f Podiatry $10 copay	7e MH $20 copay; 7h Psych $20 copay	7c OT $10 copay; 7i PT/ST $10 copay		7g Prof Other $10 copay																												48.87681214						8.240925844		10	20	10		10																					NO								48.87681214						8.240925844		10	20	10		10																						0	0	0	0	0	0	0	2.068900768	0	0	0	0	0	0.735609728	0	7.193475846	2.576246014	1.903586047	0	4.210027853	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6878	0	0	0	0	0	0	0	0	0	2.068900768	0	0	0	0	0	0.735609728	0	7.193475846	2.576246014	1.903586047	0	4.210027853	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6878	NO																																																																																		0	0	0	0	0	0	0	0	0	0	2.068900768	0	0	0	0	0	0.735609728	0	7.193475846	2.576246014	1.903586047	0	4.210027853	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6878
H5991_002_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	P	V	Coin	V	V	V	V	V	V	V	Coin	O																																																											0	YES	366.5422127	18.38121723	1020.33718			4.350600614	6.956394219	557.7462317	246.1980048		291.4190244					8551.025756	1160.117893	3534.092077	4428.411831	5233.719447	29.20902748																				3400	1a IP Acute $250 per Admit	1b IP Psych $250 per Admit	$0 from 1-20 days; $25 from 21-100 days			11a DME 20%	Prosthetic/Supplies 20%	4a ER $50 copay	OutP Surg $100		$25 Complex Rad--MRI/CAT/PET;  $0 Diag Rad					2i Spec $10 per Visit	3i Spec $10 per Visit	4i Spec $10 per Visit	5i Spec $10 per Visit	6i Spec $10 per Visit	15 Part B 20%																				250	250	6.1			0.2	0.2	50	100		25					10	10	10	10	10	0.2																				NO	228.4209057	228.4209057	5.573470099			0.182736725	0.182736725	45.68418114	91.36836227		22.84209057					9.136836227	9.136836227	9.136836227	9.136836227	9.136836227	0.182736725																					6.9772	0.349887857	0.473901564	0	0	0.795014506	1.271188694	2.123348323	1.874559041	0	0.554718312	0	0	0	0	6.510776826	0.883317266	2.690868376	3.371806137	3.984969787	5.337562008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1991	0	3.514224747	6.9772	0.349887857	0.473901564	0	0	0.795014506	1.271188694	2.123348323	1.874559041	0	0.554718312	0	0	0	0	6.510776826	0.883317266	2.690868376	3.371806137	3.984969787	5.337562008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1991	NO																																																																																		0	0	0	6.9772	0.349887857	0.473901564	0	0	0.795014506	1.271188694	2.123348323	1.874559041	0	0.554718312	0	0	0	0	6.510776826	0.883317266	2.690868376	3.371806137	3.984969787	5.337562008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.1991
H5992_005_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	432.75	12.32	131.27	69.8	39.31	39.62	36.56	15.29	26.02	17.06	28.1	1.43	3.11	51.62	92.87	155.09	4.05	9.73	40.99	63.37	10.6	8.07	0	0	0	3.98	0	0	0	9.395156667												29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing	29% of Standard Medicare Cost Sharing											0.026136701	0.026138195	0.057037204	0	0.068693327	0.068693273	0.068689971	0.068715606	0.068693262	0.068701179	0.068692503	0.06869328	0.06869327	0.068692391	0.068695805	0.068693705	0.068691259	0.068682364	0.068695174	0.06628223	0.068692761	0.068690114	0	0	0	0	0	0	0	0											NO	0.026136701	0.026138195	0.057037204	0	0.068693327	0.068693273	0.068689971	0.068715606	0.068693262	0.068701179	0.068692503	0.06869328	0.06869327	0.068692391	0.068695805	0.068693705	0.068691259	0.068682364	0.068695174	0.06628223	0.068692761	0.068690114	0	0	0	0	0	0	0	0												11.3107	0.322022562	7.487273746	0	2.700334694	2.721627457	2.511305329	1.050661617	1.78739867	1.17204211	1.930259336	0.098231391	0.213636069	3.545901198	6.379779395	10.65370664	0.2781996	0.668279402	2.815815188	4.20030494	0.728143268	0.554329219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1299	0	0	11.3107	0.322022562	7.487273746	0	2.700334694	2.721627457	2.511305329	1.050661617	1.78739867	1.17204211	1.930259336	0.098231391	0.213636069	3.545901198	6.379779395	10.65370664	0.2781996	0.668279402	2.815815188	4.20030494	0.728143268	0.554329219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1299	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	11.3107	0.322022562	7.487273746	0	2.700334694	2.721627457	2.511305329	1.050661617	1.78739867	1.17204211	1.930259336	0.098231391	0.213636069	3.545901198	6.379779395	10.65370664	0.2781996	0.668279402	2.815815188	4.20030494	0.728143268	0.554329219	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1299
H5995_001_0	2010	5	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	307.8267603	15.3127256	69.38397292	0	24.96085299	18.6538555	13.44026605	36.43682605	55.12777032	9.328600433	16.89908871	0	2.671203326	24.6544186	56.2684965	108.2270205	14.37760451	4.390229042	19.68447763	28.94116238	20.19129534	15.66179019	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.082225702	0.082225702	0.124309392	0	0.231	0.231	0.231	0.232999698	0.233	0.233	0.233	0	0.232791481	0.232959038	0.233	0.231	0.23100654	0.231054847	0.23107366	0.231173073	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082225702	0.082225702	0.124309392	0	0.231	0.231	0.231	0.232999698	0.233	0.233	0.233	0	0.232791481	0.232959038	0.233	0.231	0.23100654	0.231054847	0.23107366	0.231173073	0.233	0.233	0	0	0	0	0	0	0	0												25.3113	1.25909961	8.625079506	0	5.76595704	4.30904062	3.104701457	8.489769471	12.84477048	2.173563901	3.937487669	0	0.621833379	5.743469632	13.11055968	25.00044175	3.321320666	1.0143837	4.548564294	6.690417455	4.704571814	3.649197115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.2255	0	0	25.3113	1.25909961	8.625079506	0	5.76595704	4.30904062	3.104701457	8.489769471	12.84477048	2.173563901	3.937487669	0	0.621833379	5.743469632	13.11055968	25.00044175	3.321320666	1.0143837	4.548564294	6.690417455	4.704571814	3.649197115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.2255	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.3113	1.25909961	8.625079506	0	5.76595704	4.30904062	3.104701457	8.489769471	12.84477048	2.173563901	3.937487669	0	0.621833379	5.743469632	13.11055968	25.00044175	3.321320666	1.0143837	4.548564294	6.690417455	4.704571814	3.649197115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.2255
H5995_002_0	2010	4	N/A																															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	V	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	YES	771.5842482	7.540549132	0	0	159.9036105	5.375590399	3.152994952	243.7940123	352.5967598	0	0	0	0	384.2122691	3644.790186	2763.477262	107.6167695	1360.360986	0	876.88374	7.716187562	0	0	0	126.644629	0	0	0	0	0											2500	$100/Days Custom for IP Medical; $100/Days Custom for IP Surgical;	$100/Days Custom for IP Psych; $100/Days Custom for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Visit for Prof - CORF; $15/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals;	$15/Visit for Speclst - Office Visits; $15/Consult for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $15/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	0	0	50	0.1	0.1	48.42804076	80.73756008	0	0	0	0	15	10.0840838	15	15	15	0	15	0.2	0	0	0	15	0	0	0	0	0											NO	94.64109931	94.64109941	0	0	47.32054966	0.094641099	0.094641099	45.83283015	76.41091441	0	0	0	0	14.1961649	9.595314168	14.1961649	14.19616489	14.1961649	0	14.1961649	0.189282199	0	0	0	15	0	0	0	0	0												6.0853	0.059470488	0	0	0.630560562	0.508751785	0.298402908	0.931147463	2.245186736	0	0	0	0	0.454528394	2.914408909	3.269231574	0.127312117	1.60932574	0	1.037365514	1.460536947	0	0	0	0.158305786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7898	0	1.208282102	6.0853	0.059470488	0	0	0.630560562	0.508751785	0.298402908	0.931147463	2.245186736	0	0	0	0	0.454528394	2.914408909	3.269231574	0.127312117	1.60932574	0	1.037365514	1.460536947	0	0	0	0.158305786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7898	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.0853	0.059470488	0	0	0.630560562	0.508751785	0.298402908	0.931147463	2.245186736	0	0	0	0	0.454528394	2.914408909	3.269231574	0.127312117	1.60932574	0	1.037365514	1.460536947	0	0	0	0.158305786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.7898
H5995_003_0	2010	4	N/A																															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	V	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	YES	567.5032233	10.0821552	0	0	114.0769291	6.141191581	3.660506216	204.6535202	316.8516648	0	0	0	0	368.3552267	2934.405108	2293.897318	97.93147491	1019.344998	0	737.5881125	6.789769369	0	0	0	162.6917441	0	0	0	0	0											2500	$100/Days Custom for IP Medical; $100/Days Custom for IP Surgical;	$100/Days Custom for IP Psych; $100/Days Custom for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Visit for Prof - CORF; $15/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $10/Exam for PCP - Routine Physicals;	$15/Visit for Speclst - Office Visits; $15/Consult for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $15/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	0	0	50	0.1	0.1	48.38870885	81.40369516	0	0	0	0	15	10.09400456	15	15	15	0	15	0.2	0	0	0	15	0	0	0	0	0											NO	96.44944929	96.44944926	0	0	48.22472464	0.096449449	0.096449449	46.6706432	78.51341568	0	0	0	0	14.4674174	9.775075646	14.46741739	14.46741739	14.46741739	0	14.46741739	0.192898899	0	0	0	15	0	0	0	0	0												4.5613	0.08103486	0	0	0.458444041	0.592314546	0.353053809	0.795942619	2.073092205	0	0	0	0	0.444095735	2.390335993	2.765564163	0.11806796	1.228940796	0	0.889249591	1.309739033	0	0	0	0.20336468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2645	0	0.654871835	4.5613	0.08103486	0	0	0.458444041	0.592314546	0.353053809	0.795942619	2.073092205	0	0	0	0	0.444095735	2.390335993	2.765564163	0.11806796	1.228940796	0	0.889249591	1.309739033	0	0	0	0.20336468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2645	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.5613	0.08103486	0	0	0.458444041	0.592314546	0.353053809	0.795942619	2.073092205	0	0	0	0	0.444095735	2.390335993	2.765564163	0.11806796	1.228940796	0	0.889249591	1.309739033	0	0	0	0.20336468	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.2645
H5998_003_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5801	0.8146	0.5957	0	1.3348	0	1.3856	0	0.1849	0.9706	2.0326	3.7112	0.2056	0.0972	0	0	0.539	0.1687	0	0	0	0	0	0	0	0											12.6205	NO	268.4310649	23.26305919	16.6292287	931.4586098	11.74299774	15.76571025	11.39607545	28.7355698	30.11831966	18.33141677	30.77608186	0	3.955728416	21.30619638	45.3206233	81.73332011	3.809905932	2.248450546	0	0	13.29714849	4.573108299	649.1849449	1762.073422	115.925883	178.0290346	16.87141274	3.245924724	3940.707183	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14c, 14e, 14f, 14g, 14h, 14i, 14j); $0/20% (14b, 14d); $0 (14b1); $0 n/c (14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a); $0 n/c (13a1); $0 (16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 (18a1, 18a2)"	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 (14a1, 14a7, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077485197	0.077485197	0.207545558	0	0.19075988	0.19075988	0.19075988	0.109933964	0.19075988	0.082683795	0.160653109	0	0.19075988	0.143421071	0.183652901	0.190387856	0.429209731	0.19075988	0	0	0.19075988	0.008865982	0	0	0	0	0	0	0	0											NO	0.077485197	0.077485197	0.207545558	0	0.19075988	0.19075988	0.19075988	0.109933964	0.19075988	0.082683795	0.160653109	0	0.19075988	0.143421071	0.183652901	0.190387856	0.429209731	0.19075988	0	0	0.19075988	0.008865982	0	0	0	0	0	0	0	0												20.7994	1.80254273	3.451322558	0	2.240092845	3.007465002	2.17391399	3.15901509	5.745367057	1.5157111	4.944273229	0	0.75459428	3.05575751	8.323263956	15.56103161	1.6352487	0.428914157	0	0	2.536562457	0.040545098	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1751	146	0	20.7994	1.80254273	3.451322558	0	2.820212104	3.822067128	2.769595059	3.15901509	7.080133179	1.5157111	6.32988396	0	0.939474677	4.026397186	10.35589317	19.27222203	1.840843868	0.526077532	0	0	3.075522128	0.209212048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7956	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	20.7994	1.80254273	3.451322558	0	2.820212104	3.822067128	2.769595059	3.15901509	7.080133179	1.5157111	6.32988396	0	0.939474677	4.026397186	10.35589317	19.27222203	1.840843868	0.526077532	0	0	3.075522128	0.209212048	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7956
H6120_001_0	2010	3	N/A																															D	A	D	V	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	795.5940572	3.731772651	359.6031229	0	211.1898097	12.04308379	7.476101143	254.8661482	429.3000607	0	24.09489577	0	0	649.3972499	0	4804.016375	267.4070867	815.0138105	58.72847019	0	10.73942745	0	0	0	0	0	0	0	0	0											3350	$50/Days 1-5 for IP Medical; $50/Days 1-5 for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	No Cost-Sharing	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	No Cost-Sharing	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $300 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $800 every three years	No Cost-Sharing	Max Plan Benefit of $100 every three months											50	900	75	0	100	0.2	0.2	47.98554191	50	0	0.2	0	0	10	0	10	10	10	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	49.56554214	892.1797586	74.34831322	0	99.13108429	0.198262169	0.198262169	47.568588	49.56554214	0	0.198262169	0	0	9.913108427	0	9.913108429	9.913108431	9.913108427	0.198262169	0	0.198262169	0	0	0	0	0	0	0	0	0												3.2862	0.277451002	2.227990468	0	1.744622902	2.387687909	1.482228025	1.0103019	1.773207521	0	4.777106288	0	0	0.536462113	0	3.968561269	0.220902954	0.673276689	11.64363386	0	2.129222176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1388	0	0.334299028	3.2862	0.277451002	2.227990468	0	1.744622902	2.387687909	1.482228025	1.0103019	1.773207521	0	4.777106288	0	0	0.536462113	0	3.968561269	0.220902954	0.673276689	11.64363386	0	2.129222176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1388	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.2862	0.277451002	2.227990468	0	1.744622902	2.387687909	1.482228025	1.0103019	1.773207521	0	4.777106288	0	0	0.536462113	0	3.968561269	0.220902954	0.673276689	11.64363386	0	2.129222176	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.1388
H6120_002_0	2010	4	N/A																															D	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	V	Coin	V	T	V	V	P	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	YES	746.6157651	3.418976636	349.3697626	0	200.9519988	11.41639037	7.144690297	246.5200661	396.4355466	0	699.7066909	0	0	593.6425514	0	4438.865806	230.4183436	676.4919867	4786.40848	536.745395	10.4861975	0	0	0	0	311.9086961	0	0	0	0											3350	$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$150/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC	No Cost-Sharing	$18/Case for OP Fac - Radiology; $38/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	No Cost-Sharing	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	$18/Procedure for Prof Radiology (IP); $18/Procedure for Prof Radiology (OP); $18/Procedure for Prof Radiology (Office);	$25/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$5/Service for Vision Hardware; Max Plan Benefit of $275 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $800 every three years	No Cost-Sharing	Max Plan Benefit of $50 every three months											150	900	75	0	100	0.2	0.2	47.97137767	124.9504605	0	21.98748525	0	0	25	0	25	25	25	19.84805456	25	0.2	0	0	0	0	5	0	0	0	0											NO	148.1642005	888.985203	74.08210024	0	98.77613366	0.197552267	0.197552267	47.38427213	123.4212339	0	21.71838782	0	0	24.69403342	0	24.69403342	24.69403342	24.69403341	19.6051409	24.69403341	0.197552267	0	0	0	0	4.938806685	0	0	0	0												9.2185	0.25328497	2.156837148	0	1.654105124	2.255333802	1.411449768	0.973431158	4.07738036	0	1.266375106	0	0	1.221619084	0	9.134458379	0.47416319	1.392109644	7.819851055	1.10453406	2.071572092	0	0	0	0	0.128371396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6134	0	0.57755363	9.2185	0.25328497	2.156837148	0	1.654105124	2.255333802	1.411449768	0.973431158	4.07738036	0	1.266375106	0	0	1.221619084	0	9.134458379	0.47416319	1.392109644	7.819851055	1.10453406	2.071572092	0	0	0	0	0.128371396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6134	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.2185	0.25328497	2.156837148	0	1.654105124	2.255333802	1.411449768	0.973431158	4.07738036	0	1.266375106	0	0	1.221619084	0	9.134458379	0.47416319	1.392109644	7.819851055	1.10453406	2.071572092	0	0	0	0	0.128371396	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6134
H6120_003_0	2010	5	N/A																															D	A	D	V	T	Coin	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	3.719142316	405.1985984	0	234.1468998	13.79591338	0	285.5417811	0	0	0	0	0	0	0	0	0	0	0	0	12.10618899	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$50/Days 21-100 for SNF	No Cost-Sharing	$50/Run for Ambulance	5% Coinsurance for DME	No Cost-Sharing	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $20/Visit for Urgent Care; $20/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	5% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $800 for Comprehensive Dental: Restorative Services every five years. Complete dentures will be paid in full if the covered service is rendered at a participating provider location.	No Cost-Sharing	Max Plan Benefit of $300 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $2000 every three years	No Cost-Sharing	Max Plan Benefit of $125 every three months											0	900	50	0	50	0.05	0	46.91165291	0	0	0	0	0	0	0	0	0	0	0	0	0.05	0	0	0	0	0	0	0	0	0											NO	0	899.9683621	49.99824235	0	49.99824235	0.049998242	0	46.91000382	0	0	0	0	0	0	0	0	0	0	0	0	0.049998242	0	0	0	0	0	0	0	0	0												0	0.278925868	1.688268144	0	0.975577787	0.689771421	0	1.116230504	0	0	0	0	0	0	0	0	0	0	0	0	0.605288171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3541	0	0.000188218	0	0.278925868	1.688268144	0	0.975577787	0.689771421	0	1.116230504	0	0	0	0	0	0	0	0	0	0	0	0	0.605288171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3541	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.278925868	1.688268144	0	0.975577787	0.689771421	0	1.116230504	0	0	0	0	0	0	0	0	0	0	0	0	0.605288171	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3541
H6178_001_0	2010	9	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	1848.409708	410.2979334	2384.618644	0	556.0406016	12506.60728	3152.489276	844.4183313	316.9907611	1868.894774	948.3149861	0	153.6734535	2492.083433	8922.644737	12895.48776	1010.92327	1403.85475	4923.518775	16531.42499	349.3992135	11.46904976	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											154.826529	71.72001203	70.77403569	0	89.04923159	6.495535104	11.91686794	93.63614456	301.118556	14.61889366	60.92098748	0	42.9648377	33.38631561	19.23921463	22.62646305	17.10446883	6.727527372	11.24106498	4.415550916	93.69571412	165.8008944	0	0	0	0	0	0	0	0											NO	154.826529	71.72001203	70.77403569	0	89.04923159	6.495535104	11.91686794	93.63614456	301.118556	14.61889366	60.92098748	0	42.9648377	33.38631561	19.23921463	22.62646305	17.10446883	6.727527372	11.24106498	4.415550916	93.69571412	165.8008944	0	0	0	0	0	0	0	0												23.8486	2.452214394	14.06409041	0	4.126249026	6.769758884	3.130649866	6.589006411	7.954316687	2.276764497	4.814357116	0	0.550212916	6.933457001	14.30538976	24.31493978	1.44094213	0.787039271	4.612132874	6.082945728	2.728100735	0.158464892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.9396	0	0	23.8486	2.452214394	14.06409041	0	4.126249026	6.769758884	3.130649866	6.589006411	7.954316687	2.276764497	4.814357116	0	0.550212916	6.933457001	14.30538976	24.31493978	1.44094213	0.787039271	4.612132874	6.082945728	2.728100735	0.158464892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.9396	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.8486	2.452214394	14.06409041	0	4.126249026	6.769758884	3.130649866	6.589006411	7.954316687	2.276764497	4.814357116	0	0.550212916	6.933457001	14.30538976	24.31493978	1.44094213	0.787039271	4.612132874	6.082945728	2.728100735	0.158464892	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	137.9396
H6181_007_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	486.95	21.85	116.22	80.42	15.98	15.09	12.83	15.9	26.74	6.57	16.51	1.13	2.24	34.54	81.75	151.29	6.15	10.49	40.75	46.15	6.6	5.94	7.961	8.06	2.76	2.47	0.58	1.54	0	0.5												1A IP Acute: 38% of Medicare	1B IP Psych: 38% of Medicare	2 SNF: 38% of Medicare for days	6 Home Health: 38% of Medicare	10A Ambulance: 38% of Medicare	11A DME: 38% of Medicare	"11B Prosthetics/Medical Supplies: 38% of Medicare, 11C Diabetes Monitoring Supplies: $0"	"4A ER: 38% of Medicare, 4B Urgent Care: 38% of Medicare"	9B ASC Services: 38% of Medicare	8A OP Diagnostic Procedures/Tests: 38% of Medicare	8B OP Radiology: 38% of Medicare	9A OP Hospital: 38% of Medicare	12 Renal Dialysis: 38% of Medicare	"3 CORF: 38% of Medicare, 5 Partial Hosp: 38% of Medicare, 9C OP Substance Abuse: 38% of Medicare, 9D Cardiac Rehab: 38% of Medicare"	"7A PCP: 38% of Medicare, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: 38% of Medicare"	"7B Chiropractic: 38% of Medicare, 7D Physician Specialist (excl. Radiology): 38% of Medicare, 7F Podiatry: 38% of Medicare"	"7E Mental Health: 38% of Medicare, 7H Psychiatric: 38% of Medicare"	"7C Occupational Therapy: 38% of Medicare, 7I Physical and Speech Therapy: 38% of Medicare"	7D Physician Specialist (Radiology): 38% of Medicare	"7G Other Health Care: 38% of Medicare, 18A Hearing Exams (Medicare Covered): 38% of Medicare"	15 Part B Drugs: 38% of Medicare	"13A Blood: 38% of Medicare, 16B Comprehensive Dental (Medicare Covered): 38% of Medicare, 17A Routine Eye Exams (Medicare Covered): 38% of Medicare"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): 38% of Medicare	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: $0, 13E PERS: $0"											0.026749598	0.026758479	0.062842235	0	0.086911536	0.086905449	0.070493627	0.086373276	0.086898676	0.08686436	0.086936799	0.086899098	0.086899152	0.086895435	0.085963501	0.086895628	0.086900334	0.086901601	0.086896031	0.083469975	0	0.086911504	0	0	0	0	0	0	0	0											NO	0.026749598	0.026758479	0.062842235	0	0.086911536	0.086905449	0.070493627	0.086373276	0.086898676	0.08686436	0.086936799	0.086899098	0.086899152	0.086895435	0.085963501	0.086895628	0.086900334	0.086901601	0.086896031	0.083469975	0	0.086911504	0	0	0	0	0	0	0	0												13.0257	0.584672757	7.303524581	0	1.388846347	1.311403232	0.904433232	1.373335096	2.323670587	0.570698843	1.435326553	0.098195981	0.1946541	3.001368322	7.02751624	13.14643954	0.534437053	0.91159779	3.54101328	3.852139345	0	0.516254337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0452	0	0	13.0257	0.584672757	7.303524581	0	1.388846347	1.311403232	0.904433232	1.373335096	2.323670587	0.570698843	1.435326553	0.098195981	0.1946541	3.001368322	7.02751624	13.14643954	0.534437053	0.91159779	3.54101328	3.852139345	0	0.516254337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0452	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.0257	0.584672757	7.303524581	0	1.388846347	1.311403232	0.904433232	1.373335096	2.323670587	0.570698843	1.435326553	0.098195981	0.1946541	3.001368322	7.02751624	13.14643954	0.534437053	0.91159779	3.54101328	3.852139345	0	0.516254337	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.0452
H6181_008_0	2010	3	N/A																															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	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	0	0	0	0	0											0	NO	1044.06	18.78	840.56	0	150.72	6.5	5.04	208.43	260.3	0	438.64	41.69	0.18	662.85	0	5939.98	219.26	806.87	1572.51	102.99	7.82	744.3	0	0	0	0	0	0	0	0												1A IP Acute: $100 Per Day for days 1-6	1B IP Psych: $100 Per Day for days 1-6	2 SNF: $100 for days 14-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $100	8B OP Radiology: $100	9A OP Hospital: $100	12 Renal Dialysis: 20%	"3 CORF: $100, 5 Partial Hosp: $100, 9C OP Substance Abuse: $25, 9D Cardiac Rehab: $100"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $25"	"7B Chiropractic: $25, 7D Physician Specialist (excl. Radiology): $25, 7F Podiatry: $25"	"7E Mental Health: $25, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $100	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $25, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: Not Covered, 13E PERS: $0"											100	100	100	0	50	0.200000006	0.159783078	46.95341362	100	0	100	100	0.2	68.4362978	0	25	25	25	100	25	0.200000731	25	0	0	0	0	0	0	0	0											NO	100	100	100	0	50	0.200000006	0.159783078	46.95341362	100	0	100	100	0.2	68.4362978	0	25	25	25	100	25	0.200000731	25	0	0	0	0	0	0	0	0												8.7005	0.1565	7.004666667	0	0.628	1.30000004	0.805306713	0.815541667	2.169166667	0	3.655333333	0.347416667	0.036	3.78025	0	12.37495833	0.456791667	1.680979167	13.10425	0.2145625	1.56400572	1.550625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3449	0	0	8.7005	0.1565	7.004666667	0	0.628	1.30000004	0.805306713	0.815541667	2.169166667	0	3.655333333	0.347416667	0.036	3.78025	0	12.37495833	0.456791667	1.680979167	13.10425	0.2145625	1.56400572	1.550625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3449	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.7005	0.1565	7.004666667	0	0.628	1.30000004	0.805306713	0.815541667	2.169166667	0	3.655333333	0.347416667	0.036	3.78025	0	12.37495833	0.456791667	1.680979167	13.10425	0.2145625	1.56400572	1.550625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.3449
H6181_009_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	O											30.2637	0.3392	3.0636	4.3498	0	0	0	0	11.1548	1.7435	5.7086	0.3437	0	4.6494	0	0	0	0	0	0	0	0.1937	0	0	0	0	0	0	0	0											61.81	YES	0	0	0	0	151.98	0	0	224.92	0	0	0	0	0.19	581.81	0	6358.33	243.76	905.85	0	114.9	7.82	830.21	0	0	0	0	0	0	0	0											3400	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: 20%	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $20"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: Not Covered, 13E PERS: $0"											0	0	0	0	50	0	0	46.4614085	0	0	0	0	0.200000021	10	0	20	20	20	0	20	0.199999668	20	0	0	0	0	0	0	0	0											NO	0	0	0	0	50	0	0	46.4614085	0	0	0	0	0.200000021	10	0	20	20	20	0	20	0.199999668	20	0	0	0	0	0	0	0	0												0	0	0	0	0.63325	0	0	0.870841667	0	0	0	0	0.038000004	0.484841667	0	10.59721667	0.406266667	1.50975	0	0.1915	1.563997405	1.383683333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.6793	1200	0	30.2637	0.339235306	3.063637447	4.34979115	0.63325	0	0	0.870841667	11.1547517	1.743515811	5.708608221	0.343703834	0.038000004	5.134217163	0	10.59721667	0.406266667	1.50975	0	0.1915	1.563997405	1.577407312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4893	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	30.2637	0.339235306	3.063637447	4.34979115	0.63325	0	0	0.870841667	11.1547517	1.743515811	5.708608221	0.343703834	0.038000004	5.134217163	0	10.59721667	0.406266667	1.50975	0	0.1915	1.563997405	1.577407312	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.4893
H6228_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2094.825665	143.6102263	2743.823299	3520.862905	580.6769492	6.286623278	5.176486767	393.7286226	257.82267	11649.51566	4602.532142	0	10.87490272	593.3540949	5111.829111	6135.086691	665.8108647	526.3535151	0	0	662.9084097	1589.44707	1576.881712	437.0722902	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02026604	100	0	13.14050144	0	0	38.97977837	1.765559213	28.67452551	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.734624	0	0	0.184699992	0.184699992	43.42321372	92.3499958	0	12.13525252	0	0	35.99782369	1.630493859	26.48092311	17.30690044	0	0	0	0	27.26466575	0	30	30	0	30	0	0	0												0	0	4.512360094	0	0	1.161139267	0.956097062	1.424746844	1.984160207	0	4.654407483	0	0	1.779954675	0.694567165	13.53856325	0.960260196	0	0	0	0	3.611311924	0	1.092680726	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	36.683	0	2.922290816	0	0	4.512360094	0	0	1.161139267	0.956097062	1.424746844	1.984160207	0	4.654407483	0	0	1.779954675	0.694567165	13.53856325	0.960260196	0	0	0	0	3.611311924	0	1.092680726	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	36.683	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.8297	0.094	0.4735	0	0	0	0	0	0	0	0	0	0	0	0.7458	3.7664	0.1755	0	0	0	0.4447	0.336	0	0	0.0202	0	0.0021	0	0	0											9.8879	0	0	3.8297	0.094006251	4.985858265	0	0	1.161139267	0.956097062	1.424746844	1.984160207	0	4.654407483	0	0	1.779954675	1.440358314	17.30493894	1.135745459	0	0	0	0.444685101	3.947314118	0	1.092680726	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5708
H6228_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2094.825665	143.6102263	2743.823299	3520.862905	580.6769492	6.286623278	5.176486767	393.7286226	257.82267	11649.51566	4602.532142	0	10.87490272	593.3540949	5111.829111	6135.086691	665.8108647	526.3535151	0	0	662.9084097	1589.44707	1576.881712	437.0722902	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02026604	100	0	13.14050144	0	0	38.97977837	1.765559213	28.67452551	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.734624	0	0	0.184699992	0.184699992	43.42321372	92.3499958	0	12.13525252	0	0	35.99782369	1.630493859	26.48092311	17.30690044	0	0	0	0	27.26466575	0	30	30	0	30	0	0	0												0	0	4.512360094	0	0	1.161139267	0.956097062	1.424746844	1.984160207	0	4.654407483	0	0	1.779954675	0.694567165	13.53856325	0.960260196	0	0	0	0	3.611311924	0	1.092680726	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	36.683	0	2.922290816	0	0	4.512360094	0	0	1.161139267	0.956097062	1.424746844	1.984160207	0	4.654407483	0	0	1.779954675	0.694567165	13.53856325	0.960260196	0	0	0	0	3.611311924	0	1.092680726	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	36.683	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.8297	0.094	0.4735	0	0	0	0	0	0	0	0	0	0	0	0.7458	3.7664	0.1755	0	0	0	0.4447	0.336	0	0	0.0202	0	0.0021	0	0	0											9.8879	0	0	3.8297	0.094006251	4.985858265	0	0	1.161139267	0.956097062	1.424746844	1.984160207	0	4.654407483	0	0	1.779954675	1.440358314	17.30493894	1.135745459	0	0	0	0.444685101	3.947314118	0	1.092680726	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	46.5708
H6228_003_0	2010	3	N/A																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	3369.58399	496.3398554	1724.396423	2511.359312	404.3458235	2735.985572	25.59711574	842.7290202	568.7742337	23771.60407	9337.648829	0	18.02634909	1311.911385	13350.05433	8832.880453	1689.871043	562.1931917	0	0	2966.43048	1919.480991	807.4176058	435.4054375	108.7835464	145.3635082	15.8319442	9.463770065	2177.165208	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0	0.107182926	48.99497502	100	0	13.81836735	0	0	38.92515437	0.488051791	29.72482978	19.22251364	0	0	0	0	29.73838588	0	30	0	0	30	0	0	0											NO	0	0	14.077968	0	0	0	0.070611202	32.27747384	65.87915154	0	9.103423165	0	0	25.64356144	0.321524379	19.58246565	12.66362889	0	0	0	0	19.5913963	0	30	0	0	30	0	0	0												0	0	2.022999805	0	0	0	1.807443113	2.266763658	3.122530328	0	7.083714055	0	0	2.803506684	0.357697327	14.41413151	1.78332498	0	0	0	0	3.133776065	0	1.088513594	0	0	0.03957986	0	0	0	0	0	0	0	0	0	0	0	0	0	39.924	0	20.09358906	0	0	2.022999805	0	0	0	1.807443113	2.266763658	3.122530328	0	7.083714055	0	0	2.803506684	0.357697327	14.41413151	1.78332498	0	0	0	0	3.133776065	0	1.088513594	0	0	0.03957986	0	0	0	0	0	0	0	0	0	0	0	0	0	39.924	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.9374	0.4331	0.3451	0	0	0	0	0	0	0	0	0	0	0	2.1624	7.0638	0.4124	0	0	0	1.4483	0.3831	0	0	0.0202	0	0.002	0	0	0											19.2078	0	0	6.9374	0.433115873	2.36810548	0	0	0	1.807443113	2.266763658	3.122530328	0	7.083714055	0	0	2.803506684	2.520125609	21.47790722	2.195700864	0	0	0	1.448304772	3.516871512	0	1.088513594	0.020172773	0	0.041629389	0	0	0	0	0	0	0	0	0	0	0	0	0	59.1318
H6264_001_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	394.0867251	13.3636459	48.4953574		8.939338473	8.710040313	9.023398201	7.848975999	33.10682076	4.117282923	14.18184332	3.559682854	0.808126452	25.48836126	46.83586759	116.403362	13.16628534	21.62291264	57.60561768	102.5962105	28.70535406	16.75190042																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	"Medicare Cost Share, Worldwide ER & UC"	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	4 round trips/qtr	"2 Oral Exams, 2 Cleanings, 1 X-Ray/yr - $0; Restorative Dental/2 yrs - $0"	Eye Exam (1/yr) - $0	Eyewear ($100/yr)	Hearing Test (1/yr) -  $0	Hearing Aids ($500/2 yrs)	"Smoking Cessation, Materials/Newsletters - $0"	"Routine Physical (1/yr) - $0, OTC ($50/mo)"											0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.129502372	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.129502372	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				24.2628	0.822761108	7.014305881	0	2.082865864	2.029439393	2.102451781	1.016461009	7.713889237	0.959326921	3.304369493	0.829406105	0.188293463	5.938788173	10.91275715	27.12198336	3.067744484	5.038138645	13.42210892	23.90491705	6.688347496	3.903192797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.3243	0	0	24.2628	0.822761108	7.014305881	0	2.082865864	2.029439393	2.102451781	1.016461009	7.713889237	0.959326921	3.304369493	0.829406105	0.188293463	5.938788173	10.91275715	27.12198336	3.067744484	5.038138645	13.42210892	23.90491705	6.688347496	3.903192797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.3243	NO																																																																																		0	0	0	24.2628	0.822761108	7.014305881	0	2.082865864	2.029439393	2.102451781	1.016461009	7.713889237	0.959326921	3.304369493	0.829406105	0.188293463	5.938788173	10.91275715	27.12198336	3.067744484	5.038138645	13.42210892	23.90491705	6.688347496	3.903192797	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.3243
H6264_002_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	465.529719	55.91453859	45.86271451		18.03103457	15.04839601	13.55541215	12.64133279	26.41528986	6.068395518	12.4163358	2.194444349	9.914568723	40.2254063	71.48245029	99.57131357	27.52803957	33.00254752	47.03464487	87.41481844	13.20056016	15.05743064																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	"Medicare Cost Share, Worldwide ER & UC"	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	4 round trips/qtr	"2 Oral Exams, 2 Cleanings, 1 X-Ray/yr - $0; Restorative Dental/2 yrs - $0"	Eye Exam (1/yr) - $0	Eyewear ($100/yr)	Hearing Test (1/yr) -  $0	Hearing Aids ($500/2 yrs)	"Smoking Cessation, Materials/Newsletters - $0"	"Routine Physical (1/yr) - $0, OTC ($50/mo)"											0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.061567114	0.061567114	0.144638709		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				28.6613	3.442496762	6.633523813	0	4.201231055	3.50627627	3.15841103	2.945430541	6.154762537	1.413936156	2.893006242	0.511305533	2.310094512	9.372519669	16.65541092	23.20011606	6.41403322	7.689593572	10.95907225	20.3676527	3.075730518	3.508381339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0743	0	0	28.6613	3.442496762	6.633523813	0	4.201231055	3.50627627	3.15841103	2.945430541	6.154762537	1.413936156	2.893006242	0.511305533	2.310094512	9.372519669	16.65541092	23.20011606	6.41403322	7.689593572	10.95907225	20.3676527	3.075730518	3.508381339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0743	NO																																																																																		0	0	0	28.6613	3.442496762	6.633523813	0	4.201231055	3.50627627	3.15841103	2.945430541	6.154762537	1.413936156	2.893006242	0.511305533	2.310094512	9.372519669	16.65541092	23.20011606	6.41403322	7.689593572	10.95907225	20.3676527	3.075730518	3.508381339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0743
H6328_001_0	2010	9	N/A																															D	D	D		T	Coin	Coin	V	V		V		V	V	V	V	V	V			Coin				V		V																																																						0	YES	1738.951068	106.1182891	756.235103		237.2237545	22.02500177	0.800901852	115.4937396	133.0167983		371.5334301		0	19611.26562	4219.780442	4577.991431	933.2535151	815.7460678			26.53925741				168		54														3000	$100 days 1-5	$975 per admission	"$0 days 1-20, $100 days 21-100"		$100 	"20% to 30%, varies by service"	"20% to 30%, varies by service"	"$50 ER waived if admitted, $30 UC"	"$100 Hosp, $50 ASC"		"$125 or 20%, varies by service"		$25 	"$5 to $125 or 20%, varies by service"	"$0 to $5, varies by service"	$20 / $0 for preventive	$30 	$10 			20%				$20 		$20 														64.84414681	108.3500077	10.39695293		100	0.25	0.25	36.1	75		86.02857607		25	3	4.75	16.75	30	10			0.2				20		20														YES	60.63377057	101.3147652	9.721871429		93.50692938	0.233767323	0.233767323	33.75600151	70.13019703		80.44267987		23.37673234	2.805207881	4.441579145	15.66241067	28.05207881	9.350692938			0.187013859				18.70138588		18.70138588														5000	8.7866	0.895945795	0.61266837	0	1.848505405	5.148725714	0.187224682	0.324883904	0.777374523	0	2.490595398	0	0	4.584473075	1.561874068	5.975198487	2.181641763	0.63564925	0	0	4.963208937	0	0	0	0.261819402	0	0.084156236	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3205	0	2.869276075	8.7866	0.895945795	0.61266837	0	1.848505405	5.148725714	0.187224682	0.324883904	0.777374523	0	2.490595398	0	0	4.584473075	1.561874068	5.975198487	2.181641763	0.63564925	0	0	4.963208937	0	0	0	0.261819402	0	0.084156236	0	0	0	0	0	0	0	0	0	0	0	0	0	41.3205	NO	$300 days 1-5	Medicare FFS	"$0 days 1-10, $125 days 11-100"	$40 	$100 	"30 to 40%, varies by service"	"30 to 40%, varies by service"	"$50 ER, $30 UC"	"$150 Hosp, $100 ASC"	"$10 to $25, varies by service"	"$200 or 30%, varies by service"		$50 	"$10 to $200 or 30%, varies by service"	"$20 to $30, varies by service"	$30 / $0 preventive	$50 	$20 	"$10 to $200 or 30%, varies by service"	"$20 to $30, varies by service"	30%				$35 		$30 															4.4904	0.1672	0.3122	2.3301	0.225	1.2188	0.0392	0.0618	0.2275	0.3647	0.6002	0	0	1.1946	1.0439	1.5666	0.5631	0.1969	0	0	0.8093	0	0	0	0.0448	0	0.0144	0	0	0	0	0	0	0	0	0	0				15.4708	0	0.635895893	13.277	1.063129345	0.924842862	2.330140576	2.073550432	6.367558117	0.226429229	0.386685105	1.004876758	0.364678855	3.090782303	0	0	5.779108222	2.605773713	7.541796799	2.744740655	0.832528532	0	0	5.772462259	0	0	0	0.306643655	0	0.098564032	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7913
H6328_002_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V		V		V	V	V	V	V	V			Coin				V																																																								0	YES	1746.802128	106.5964588	754.446949	4827.94457	234.0556646	22.29877328	0.818415566	117.3027049	134.5084699		368.2892197		0	19597.27088	4426.876809	4735.739727	944.1593233	860.1892626			25.77016332				168																3400	$150 days 1-5	$975 per admission	"$0 days 1-20, $100 days 21-100"	$10 	$100 	"20 to 30%, varies by service"	"20 to 30%, varies by service"	"$50 ER, $30 UC"	"$125 Hosp, $50 ASC"		"$150 or 20%, varies by service"		$25 	"$5 to $150 or 20%, varies by service"	"$0 to $15, varies by service"	$30 / $0 for preventive	$35 	$10 			20%				$30 																97.26622022	108.3500077	10.39695293	10	100	0.25	0.25	36.1	87.5		101.5023475		25	3.5	14.25	25	35	10			0.2				30																YES	88.50434189	98.58968615	9.460380739	9.099185893	90.99185893	0.227479647	0.227479647	32.84806107	79.61787656		92.35887289		22.74796473	3.184715063	12.9663399	22.74796473	31.84715063	9.099185893			0.181983718				27.29755768																5000	12.8833	0.875775951	0.594779615	3.66086376	1.774763335	5.072517081	0.186172884	0.321097201	0.892439896	0	2.834564769	0	0	5.20097698	4.783365782	8.977370024	2.505732015	0.652251834	0	0	4.689750131	0	0	0	0.382165808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2879	0	5.572467831	12.8833	0.875775951	0.594779615	3.66086376	1.774763335	5.072517081	0.186172884	0.321097201	0.892439896	0	2.834564769	0	0	5.20097698	4.783365782	8.977370024	2.505732015	0.652251834	0	0	4.689750131	0	0	0	0.382165808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.2879	NO	$300 days 1-5	Medicare FFS	"$0 days 1-10, $125 days 11-100"	$40 	$100 	"30 to 40%, varies by service"	"30 to 40%, varies by service"	"$50 ER, $30 UC"	"$200 Hosp, $100 ASC"	"$10 to $25, varies by service"	"$200 or 30%, varies by service"		$50 	"$10 to $200 or 30%, varies by service"	"$25 to $30, varies by service"	$40 / $30 for preventive	$55 	$20 			30%				$40 																	4.4041	0.164	0.3041	2.2359	0.2168	1.2048	0.0391	0.0613	0.2695	0.3583	0.5949		0	1.2821	1.2688	1.9678	0.5894	0.1953			0.7672				0.0584																15.982	0	1.059562121	17.2874	1.039744868	0.89885743	5.896797726	1.991556632	6.277343437	0.225288166	0.382383296	1.161981312	0.358337166	3.429483159	0	0	6.483110915	6.052172162	10.94519773	3.095178674	0.847533084	0	0	5.456985019	0	0	0	0.440519352	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2699
H6328_003_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V		V		V	V	V	V	V	V			Coin																																																												0	YES	1751.5942	106.6610615	752.8714875	4777.312873	231.3011319	22.4577071	0.826657233	118.4053036	135.3984192		396.2053365		0	21200.92861	4545.34231	4823.490114	947.3632153	886.5908699			25.30132806																				3400	$175 days 1-5	$975 per admission	"$0 days 1-14, $100 days 15-100"	$25 	$100 	"20 to 30%, varies by service"	"20 to 30%, varies by service"	"$50 ER, $30 UC"	"$150 Hosp, $75 ASC"		"$175 or 20%, varies by service"		$35 	"$5 to $200 or 20%, varies by service"	"$0 to $20, varies by service"	$35 / $0 for preventive	$35 	$15 			20%																				113.4772569	108.3500077	23.11134916	25	100	0.25	0.25	36.1	112.5		116.5246307		35	3.5	19	29.125	35	15			0.2																				YES	100.0102788	95.4915088	20.36859663	22.03311076	88.13244303	0.220331108	0.220331108	31.81581193	99.14899841		102.6960038		30.84635506	3.084635506	16.74516418	25.66857403	30.84635506	13.21986645			0.176264886																				5000	14.5981	0.848768808	1.277911304	8.771588637	1.698761152	4.948131479	0.182138304	0.313930073	1.118718137	0	3.390725394	0	0	5.449761428	6.342708602	10.31767609	2.435225176	0.976717742	0	0	4.459735708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1306	0	9.039536307	14.5981	0.848768808	1.277911304	8.771588637	1.698761152	4.948131479	0.182138304	0.313930073	1.118718137	0	3.390725394	0	0	5.449761428	6.342708602	10.31767609	2.435225176	0.976717742	0	0	4.459735708	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.1306	NO	$300 per day (1-5)	Medicare FFS	"$0 days 1-10, $150 days 11-100"	$45 	$100 	"30 to 40%, varies by service"	"30 to 40%, varies by service"	"$50 ER, $30 UC"	"$250 Hosp, $150 ASC"	"$10 to $25, varies by service"	"$200 or 30%, varies by service"		$50 	"$15 to $250 or 30%, varies by service"	$30 	$45 / $35 for preventive	$60 	$25 			30%																					4.3213	0.1605	0.792	2.4356	0.2096	1.1874	0.0387	0.0605	0.354	0.3517	0.6311		0	1.3682	1.4836	2.1375	0.6184	0.2411			0.7371																				17.1284	0	1.536448818	18.9195	1.009313251	2.069952865	11.20717498	1.908401599	6.135483581	0.220798912	0.374463561	1.472714523	0.351670189	4.021829441	0	0	6.817955289	7.826269612	12.45519042	3.053647742	1.217864164	0	0	5.196833506	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.259
H6328_005_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin				V		V																																																						0	YES	1757.42538	106.4472502	750.329076	4717.096608	226.8898308	22.63982113	0.833470866	119.7406144	136.4508873	1730.461191	363.2177076	1029.950167	0	19585.2779	4385.114656	4611.162677	887.7354903	860.083427	5742.895311	36926.74909	24.73299762				168		54														3000	$100 days 1-5	$975 per admission	"$0 days 1-20, $100 days 21-100"	$0 	$100 	"20 to 30%, varies by service"	"20 to 30%, varies by service"	"$50 ER, $30 UC"	"$100 Hosp, $50 ASC"		"$125 or 20%, varies by service"		$25 	"$5 to $125 or 20%, varies by service"	"$0 to $5, varies by service"	$20 / $0 for preventive	$30 	$10 			20%				$20 		$20 														64.84414681	108.3500077	10.39695293	0	100	0.25	0.25	36.1	75	0	86.11111505	0	25	3	4.75	16.75	30	10	0		0.2				20		20														YES	60.66620398	101.3689591	9.727071725	0	93.55694688	0.233892367	0.233892367	33.77405782	70.16771016	0	80.56293016	0	23.38923672	2.806708406	4.443954977	15.6707886	28.06708406	9.355694688	0	0	0.187113894				18.71138938		18.71138938														5000	8.8847	0.899203913	0.608208728	0	1.768926654	5.295281357	0.194942474	0.337010536	0.797870526	0	2.438490235	0	0	4.580847009	1.623937675	6.02171296	2.076345553	0.670556496	0	0	4.627887488	0	0	0	0.261959451	0	0.084201252	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1721	0	2.835426796	8.8847	0.899203913	0.608208728	0	1.768926654	5.295281357	0.194942474	0.337010536	0.797870526	0	2.438490235	0	0	4.580847009	1.623937675	6.02171296	2.076345553	0.670556496	0	0	4.627887488	0	0	0	0.261959451	0	0.084201252	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1721	NO	$300 days 1-5	Medicare FFS	"$0 days 1-10, $125 days 11-100"	$40 	$100 	"30 to 40%, varies by service"	"30 to 40%, varies by service"	"$50 ER, $30 UC"	"$150 Hosp, $100 ASC"	"$10 to $25, varies by service"	"$200 or 30%, varies by service"		$50 	"$10 to $200 or 30%, varies by service"	"$20 to $30, varies by service"	$30 / $0 for preventive	$50 	$20 	"$10 to $200 or 30%, varies by service"	"$20 to $30, varies by service"	30%				$40 		$35 															4.5396	0.1678	0.3098	2.2382	0.2153	1.2533	0.0408	0.0641	0.2335	0.3691	0.5873	0	0	1.1934	1.0678	1.5531	0.5272	0.2043	0	0	0.7544	0	0	0	0.0448	0	0.0144	0	0	0	0	0	0	0	0	0	0				15.3782	0	0.626953491	13.4243	1.06695954	0.918044605	2.23818184	1.984237359	6.548539046	0.235754382	0.401104821	1.03132107	0.369061652	3.025823413	0	0	5.774281957	2.691700669	7.57479424	2.603567691	0.874876376	0	0	5.382305114	0	0	0	0.306798089	0	0.098613671	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5502
H6328_006_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V		V		V	V	V	V	V	V			Coin				V																																																								0	YES	1760.152342	106.4959202	749.4592638	4688.009024	225.3509527	22.73206211	0.83835024	120.3770758	136.9662911		361.9827945		0	19581.76837	4505.359221	4715.741748	899.8025094	885.5186485			24.4637352				168																3400	$150 days 1-5	$975 per admission	"$0 days 1-20, $100 days 21-100"	$10 	$100 	"20 to 30%, varies by service"	"20 to 30%, varies by service"	"$50 ER, $30 UC"	"$125 Hosp, $50 ASC"		"$125 or 20%, varies by service"		$25 	"$0 to $150 or 20%, varies by service"	"$0 to $15, varies by service"	$30 / $0 for preventive	$35 	$10 			20%				$30 																97.26622022	108.3500077	10.39695293	10	100	0.25	0.25	36.1	87.5		101.5783114		25	3.5	14.25	25	35	10			0.2				30																YES	88.56493262	98.65718139	9.466857386	9.105415264	91.05415264	0.227635382	0.227635382	32.8705491	79.67238356		92.49127068		22.76353816	3.186895342	12.97521675	22.76353816	31.86895342	9.105415264			0.182108305				27.31624579																5000	12.9906	0.875548943	0.591251997	3.557189077	1.709928337	5.174621632	0.190838177	0.329738382	0.90936924	0	2.790020719	0	0	5.200420535	4.871501036	8.945580602	2.389647022	0.671917918	0	0	4.455049358	0	0	0	0.382427441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0357	0	5.50537003	12.9906	0.875548943	0.591251997	3.557189077	1.709928337	5.174621632	0.190838177	0.329738382	0.90936924	0	2.790020719	0	0	5.200420535	4.871501036	8.945580602	2.389647022	0.671917918	0	0	4.455049358	0	0	0	0.382427441	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0357	NO	$300 days 1-5	Medicare FFS	"$0 days 1-10, $125 days 11-100"	$40 	$100 	"30 to 40%, varies by service"	"30 to 40%, varies by service"	"$50 ER, $30 UC"	"$200 Hosp, $100 ASC"	"$10 to $25, varies by service"	"$200 or 30%, varies by service"		$50 	"$10 to $200 or 30%, varies by service"	"$25 to $30, varies by service"	$40 / $30 for preventive	$55 	$20 		"$20 to $30, varies by service"	30%				$40 																	4.4398	0.1639	0.3022	2.1721	0.2088	1.2288	0.0401	0.0629	0.2746	0.361	0.5854		0	1.2817	1.2885	1.9553	0.5606	0.2006		0	0.7287				0.0584																15.9134	0	1.047119794	17.4305	1.039439463	0.893460146	5.729326242	1.918756083	6.403430766	0.230924866	0.392659991	1.183963641	0.361022535	3.375374785	0	0	6.48213657	6.160033965	10.90083475	2.950197342	0.872518608	0	0	5.183728014	0	0	0	0.440808148	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.9491
H6328_801_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	275.4004315	7.152603705	39.55074356	74.06350161	7.465975541	26.26329905	5.62515109	5.901586809	14.85041651	6.437909022	11.53908196	1.296734565	0	41.28548076	35.84415361	34.25167078	7.896786619	5.444118089	47.59012132	190.9576794	27.63687521	0																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			7.740345111	7.740345111	18.60929799	0	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	23.3	23.3	23.3	23.3																			NO	7.740345111	7.740345111	18.60929799	0	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	23.3	23.3	23.3	23.3																				21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076	0	0	21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076	NO																																																																																		0	0	0	21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076
H6328_802_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	275.4004315	7.152603705	39.55074356	74.06350161	7.465975541	26.26329905	5.62515109	5.901586809	14.85041651	6.437909022	11.53908196	1.296734565	0	41.28548076	35.84415361	34.25167078	7.896786619	5.444118089	47.59012132	190.9576794	27.63687521	0																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			7.740345111	7.740345111	18.60929799	0	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	23.3	23.3	23.3	23.3																			NO	7.740345111	7.740345111	18.60929799	0	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	23.3	23.3	23.3	23.3																				21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076	0	0	21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076	NO																																																																																		0	0	0	21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076
H6328_803_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	275.4004315	7.152603705	39.55074356	74.06350161	7.465975541	26.26329905	5.62515109	5.901586809	14.85041651	6.437909022	11.53908196	1.296734565	0	41.28548076	35.84415361	34.25167078	7.896786619	5.444118089	47.59012132	190.9576794	27.63687521	0																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			7.740345111	7.740345111	18.60929799	0	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	23.3	23.3	23.3	23.3																			NO	7.740345111	7.740345111	18.60929799	0	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	23.3	23.3	23.3	23.3																				21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076	0	0	21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076	NO																																																																																		0	0	0	21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076
H6328_804_0	2010	4	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	275.4004315	7.152603705	39.55074356	74.06350161	7.465975541	26.26329905	5.62515109	5.901586809	14.85041651	6.437909022	11.53908196	1.296734565	0	41.28548076	35.84415361	34.25167078	7.896786619	5.444118089	47.59012132	190.9576794	27.63687521	0																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			7.740345111	7.740345111	18.60929799	0	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	23.3	23.3	23.3	23.3																			NO	7.740345111	7.740345111	18.60929799	0	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	23.3	23.3	23.3	23.3																				21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076	0	0	21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076	NO																																																																																		0	0	0	21.3169	0.553636211	7.360115725	0	1.739572301	6.119348678	1.310660204	1.375069726	3.460147047	1.500032802	2.688606096	0.302139154	0	9.619517018	8.351687791	7.980639292	1.839951282	1.268479515	11.08849827	44.4931393	6.439391924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.8076
H6411_002_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	P	O	O	O	O	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	YES	1350.972006	58.374427	450.114247	633.649447	39.558244	8.434816	3.60021	332.932144	408.868398	1909.903867	1254.656307	75.102481	0.119165	596.316	3734.170748	4654.41006	111.341253	890.859438			25.223491	0			2.69				0.04	0.25	19.054976	0.05	0.55	1.65	0.32	0.35	0.4	0.42			5000	$175/Day(Days 1-15):1a	$175/Day(Days 1-11):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $75 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$75/Visit:9a	20% Coins:12	"$30-$100/Visit:9d. $75 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $30 Partial Hospitalization,7h. $75 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15				"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			153.42355	133.708575	48.2281	0	100	0.2	0.2	50	63.394496	0	59.603129	75	0.2	59.128994	15	30	30	42.068808			0.2	0			0				0	0	0	0	0	0	0	0	0	0			NO	140.257201	122.234106	34.405155	0	89.1709	0.178342	0.178342	44.58545	56.529443	0	53.148647	66.878175	0.178342	52.725856	13.375635	26.75127	26.75127	37.513134			0.178342	0			0				0	0	0	0	0	0	0	0	0	0				15.7903	0.594612158	1.29052087	0	0.293953685	1.504281955	0.642068652	1.236994122	1.9260919	0	5.556940431	0.418559739	0.021252124	2.620105962	4.162242079	10.37594835	0.248209993	2.784910789	0	0	4.498407832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9654	0	6.463719	15.7903	0.594612158	1.29052087	0	0.293953685	1.504281955	0.642068652	1.236994122	1.9260919	0	5.556940431	0.418559739	0.021252124	2.620105962	4.162242079	10.37594835	0.248209993	2.784910789	0	0	4.498407832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.9654	YES	$225/Day(Days 1-15)	$225/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins			"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			7500	3.812	0.1583	0.4854	2.1308	1.3879	1.7561	0.7495	0.2577	3.6318	0.4217	1.8121	0.3508	0.0047	0.773	1.8819	3.5264	0.0421	0.338			1.3346	0			0				0	0	0	0	0	0	0	0	0	0			24.8548	500	4.367941	19.6023	0.752865158	1.77594787	2.13081	1.681845685	3.260370955	1.391615652	1.494660122	5.5579149	0.421722	7.369022431	0.769406739	0.025911124	3.393116962	6.044156079	13.90231835	0.290350993	3.122940789	0	0	5.832958832	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.8202
H6411_007_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	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	YES	1219.775461	52.705528	406.402435	572.114036	35.716636	6.910728	2.949688	300.600203	369.162082	1724.427938	1132.813239	67.809076	0.097634	538.406142	3371.535328	4202.407713	100.528603	804.345669			20.665855	0		1.59	1.72				0.04	0.25	17.204496	0.05	0.55	1.65	0.35	0.42					3400	$150/Day(Days 1-5):1a	$150/Day(Days 1-5):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $75 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$75/Visit:9a	20% Coins:12	"$30-$100/Visit:9d. $75 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $30 Partial Hospitalization,7h. $75 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: OTC items 13c	$0: Nutritional benefit 14a					91.00065	76.0068	48.2281	0	100	0.2	0.2	50	63.394497	0	59.603129	75	0.2	59.128994	15	30	30	42.068808			0.2	0		0	0				0	0	0	0	0	0	0	0					NO	81.526117	68.093352	32.309451	0	87.0091	0.174018	0.174018	43.50455	55.158981	0	51.860146	65.256825	0.174018	51.447605	13.051365	26.10273	26.10273	36.603691			0.174018	0		0	0				0	0	0	0	0	0	0	0						8.287	0.299074673	1.094219963	0	0.258972696	1.202591065	0.513298806	1.089789713	1.696883689	0	4.895654997	0.368750417	0.016990073	2.308308877	3.666928181	9.141192824	0.218672582	2.453501694	0	0	3.596230755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.108	0	6.229266	8.287	0.299074673	1.094219963	0	0.258972696	1.202591065	0.513298806	1.089789713	1.696883689	0	4.895654997	0.368750417	0.016990073	2.308308877	3.666928181	9.141192824	0.218672582	2.453501694	0	0	3.596230755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.108	YES	$200/Day(Days 1-5)	$200/Day(Days 1-5)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: OTC items 13c	$0: Nutritional benefit 14a					5000	2.253	0.0813	0.3397	1.7571	1.2612	1.4481	0.6181	0.2342	2.9949	0.3478	1.4943	0.2893	0.0038	0.6374	1.5519	2.9079	0.0348	0.2787			1.1005	0		0	0				0	0	0	0	0	0	0	0					19.6341	500	4.133165	10.5399	0.380383673	1.433873963	1.757125	1.520216696	2.650711065	1.131396806	1.323942713	4.691785689	0.347763	6.389947997	0.658069417	0.020832073	2.945755877	5.218807181	12.04913582	0.253423582	2.732251694	0	0	4.696738755	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.7421
H6411_008_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	O	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			0	YES	1102.928828	47.656678	367.471699	517.309196	32.295212	6.518835	2.782417	271.80464	333.798732	1559.238847	1024.297027	61.313403	0.092097	486.830301	3048.563959	3799.844121	90.89861	727.294535			19.493937	0		1.37	1.72				0.04	0.25	15.556416	0.05	0.55	1.65	0.32	0.35	0.4	0.42			3400	$150/Day(Days 1-5):1a	$150/Day(Days 1-5):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$75/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $75 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $50 DMAM -- OP,8b. $30 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$75/Visit:9a	20% Coins:12	"$30-$100/Visit:9d. $75 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $30 Partial Hospitalization,7h. $75 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			91.00065	76.0068	48.2281	0	100	0.2	0.2	50	63.394497	0	59.603129	75	0.2	59.128994	15	30	30	42.068808			0.2	0		0	0				0	0	0	0	0	0	0	0	0	0			NO	83.062754	69.376803	33.163957	0	88.3993	0.176799	0.176799	44.19965	56.040291	0	52.688749	66.299475	0.176799	52.269617	13.259895	26.51979	26.51979	37.188532			0.176799	0		0	0				0	0	0	0	0	0	0	0	0	0				7.6344	0.27552233	1.015567969	0	0.237906178	1.152523509	0.491928543	1.001139163	1.558848173	0	4.497410746	0.338753869	0.016282658	2.120536115	3.3686365	8.39758901	0.200884337	2.253918007	0	0	3.446508568	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0083	0	5.033775	7.6344	0.27552233	1.015567969	0	0.237906178	1.152523509	0.491928543	1.001139163	1.558848173	0	4.497410746	0.338753869	0.016282658	2.120536115	3.3686365	8.39758901	0.200884337	2.253918007	0	0	3.446508568	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0083	YES	$200/Day(Days 1-5)	$200/Day(Days 1-5)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	2.1251	0.0767	0.3438	1.703	1.1717	1.4035	0.5991	0.2175	2.9027	0.3371	1.4483	0.2804	0.0037	0.6178	1.5041	2.8184	0.0337	0.2702			1.0666	0		0	0				0	0	0	0	0	0	0	0	0	0			18.9234	500	3.59676	9.7595	0.35221733	1.359393969	1.703007	1.409654178	2.556042509	1.090989543	1.218677163	4.461510173	0.337052	5.945681746	0.619161869	0.020005658	2.738349115	4.8727185	11.21597001	0.234564337	2.524082007	0	0	4.513121568	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9317
H6411_801_0	2010	5	N/A																															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	NO	201.66304	0.687894	35.014475	11.314423	1.326851	6.135182	2.998953	14.792056	42.119241	9.093035	21.67849	7.663473	0.673287	13.87514	25.750511	56.473468	0.271382	4.202588			18.355228	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																			0.076718382	0.076718382	0.170196474	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.076718382	0.076718382	0.170196474	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				15.4713	0.052774115	5.959340192	0	0.309156283	1.429497406	0.698756049	3.446549048	9.813783153	2.118677155	5.05108817	1.785589209	0.156875871	3.23290762	5.999869063	13.15831804	0.063232006	0.979203004	0	0	4.276768124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0036	0	0	15.4713	0.052774115	5.959340192	0	0.309156283	1.429497406	0.698756049	3.446549048	9.813783153	2.118677155	5.05108817	1.785589209	0.156875871	3.23290762	5.999869063	13.15831804	0.063232006	0.979203004	0	0	4.276768124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0036	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				2.88	0.0098	1.1093	0	1.2366	0.9425	0.4608	0.9087	2.3647	0.5586	1.211	0.4708	0.0414	0.8461	1.1305	2.4792	0.0119	0.2103			0.8058	0																			17.6781	0	0	18.3513	0.062594068	7.068680811	0	1.545803783	2.371982406	1.159513549	4.355249048	12.17850015	2.677294655	6.26210567	2.256365709	0.198233371	4.07904712	7.130385063	15.63755454	0.075115006	1.189485504	0	0	5.082598624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6818
H6411_802_0	2010	5	N/A																															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	NO	201.66304	0.687894	35.014475	11.314423	1.326851	6.135182	2.998953	14.792056	42.119241	9.093035	21.67849	7.663473	0.673287	13.87514	25.750511	56.473468	0.271382	4.202588			18.355228	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																			0.076718382	0.076718382	0.170196474	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.076718382	0.076718382	0.170196474	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				15.4713	0.052774115	5.959340192	0	0.309156283	1.429497406	0.698756049	3.446549048	9.813783153	2.118677155	5.05108817	1.785589209	0.156875871	3.23290762	5.999869063	13.15831804	0.063232006	0.979203004	0	0	4.276768124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0036	0	0	15.4713	0.052774115	5.959340192	0	0.309156283	1.429497406	0.698756049	3.446549048	9.813783153	2.118677155	5.05108817	1.785589209	0.156875871	3.23290762	5.999869063	13.15831804	0.063232006	0.979203004	0	0	4.276768124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0036	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				2.88	0.0098	1.1093	0	1.2366	0.9425	0.4608	0.9087	2.3647	0.5586	1.211	0.4708	0.0414	0.8461	1.1305	2.4792	0.0119	0.2103			0.8058	0																			17.6781	0	0	18.3513	0.062594068	7.068680811	0	1.545803783	2.371982406	1.159513549	4.355249048	12.17850015	2.677294655	6.26210567	2.256365709	0.198233371	4.07904712	7.130385063	15.63755454	0.075115006	1.189485504	0	0	5.082598624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6818
H6411_803_0	2010	5	N/A																															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	NO	201.66304	0.687894	35.014475	11.314423	1.326851	6.135182	2.998953	14.792056	42.119241	9.093035	21.67849	7.663473	0.673287	13.87514	25.750511	56.473468	0.271382	4.202588			18.355228	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																			0.076718382	0.076718382	0.170196474	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.076718382	0.076718382	0.170196474	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				15.4713	0.052774115	5.959340192	0	0.309156283	1.429497406	0.698756049	3.446549048	9.813783153	2.118677155	5.05108817	1.785589209	0.156875871	3.23290762	5.999869063	13.15831804	0.063232006	0.979203004	0	0	4.276768124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0036	0	0	15.4713	0.052774115	5.959340192	0	0.309156283	1.429497406	0.698756049	3.446549048	9.813783153	2.118677155	5.05108817	1.785589209	0.156875871	3.23290762	5.999869063	13.15831804	0.063232006	0.979203004	0	0	4.276768124	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.0036	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				2.88	0.0098	1.1093	0	1.2366	0.9425	0.4608	0.9087	2.3647	0.5586	1.211	0.4708	0.0414	0.8461	1.1305	2.4792	0.0119	0.2103			0.8058	0																			17.6781	0	0	18.3513	0.062594068	7.068680811	0	1.545803783	2.371982406	1.159513549	4.355249048	12.17850015	2.677294655	6.26210567	2.256365709	0.198233371	4.07904712	7.130385063	15.63755454	0.075115006	1.189485504	0	0	5.082598624	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6818
H6421_012_0	2010	4	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	947.9548331	3.784263794	983.3508066	34.24436362	185.5203371	13.36490519	3.304438362	270.2422267	529.7492732	8.360368919	22.44334888	0	0.065442628	1013.17774	3587.307619	5480.540306	178.2616967	682.657008	40.28145058	88.70074699	7.675453408	1.3449609	0	0	0	0	0	0	0	0												1a:  Acute - $250/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$90/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$90/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $30/visit/17a:  Vision Exams - $30/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/ Visits/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $30/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $30/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%							/14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit												250	0.065478003	90	0	150	0.2	0.2	36.61796198	195.890634	0	0.2	0	0.2	47.53238663	30	30	30	30	0	29.84055465	0.2	0.2	0	0	0	0	0	0	0	0											NO	250	0.065478003	90	0	150	0.2	0.2	36.61796198	195.890634	0	0.2	0	0.2	47.53238663	30	30	30	30	0	29.84055465	0.2	0.2	0	0	0	0	0	0	0	0												19.7491	0.247786036	7.375131049	0	2.319004214	2.672981039	0.660887672	0.824643299	8.647743415	0	4.488669775	0	0.013088526	4.013229672	8.968269049	13.70135077	0.445654242	1.70664252	0	0.220573291	1.535090682	0.26899218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8588		0	19.7491	0.247786036	7.375131049	0	2.319004214	2.672981039	0.660887672	0.824643299	8.647743415	0	4.488669775	0	0.013088526	4.013229672	8.968269049	13.70135077	0.445654242	1.70664252	0	0.220573291	1.535090682	0.26899218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8588	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	19.7491	0.247786036	7.375131049	0	2.319004214	2.672981039	0.660887672	0.824643299	8.647743415	0	4.488669775	0	0.013088526	4.013229672	8.968269049	13.70135077	0.445654242	1.70664252	0	0.220573291	1.535090682	0.26899218	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8588
H6528_001_0	2010	4	N/A																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	V	V	O	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	NO	939.29	5.13	476.47	15.26872328	9.07	8.134021402	8.41	266.98	436.14	3.1	15.07	59.58	0.13	88.51	3204.81	2909.59	166.86	593.14	28.24	1309.47	6.53	517.62	0	280	377.13	0	0	0	0	0												1A IP Acute: $285 Per Day for days 1-10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $40"	"9A OP Hospital: $175, 9B ASC Services: $175"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: $50	12 Renal Dialysis: 20%	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35 OP Substance Abuse (Group): $20, 9D Cardiac Rehab: $35"	"7A PCP: $20, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $35	"7E Mental Health: $35 MH (Group): $20, 7H Psychiatric: $35 Psychiatric (Group): $20"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $35, 7F Podiatry: $35, 7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $35	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											285	1000	130	0	0.398125689	0.2	0.04469679	49.3752341	175	0.199723133	0.199896744	50	0.199999987	35	20	35	35	35	0.16220608	35	0.199997414	34.98068081	0	10	30	0	0	0	0	0											NO	283.097923	993.3260457	129.1323859	0	0.395468616	0.2	0.044398485	48.8931614	173.832058	0.19839019	0.198562642	49.66630229	0.198665196	34.7664116	19.86652091	34.7664116	34.7664116	34.7664116	0.161123524	34.7664116	0.198662641	34.74722134	0	9.933260457	29.79978137	0	0	0	0	0												22.1593	0.424646885	5.127308994	0	3.586900351	1.62680428	0.373391261	1.087791353	6.317926148	0.61500959	2.992339015	0.246593191	0.025826476	0.256431258	5.305702074	8.429666961	0.483426953	1.718445781	4.550128308	3.79379775	1.297267045	1.498821393	0	0.231776077	0.936532629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0858	0	0.48888463	22.1593	0.424646885	5.127308994	0	3.586900351	1.62680428	0.373391261	1.087791353	6.317926148	0.61500959	2.992339015	0.246593191	0.025826476	0.256431258	5.305702074	8.429666961	0.483426953	1.718445781	4.550128308	3.79379775	1.297267045	1.498821393	0	0.231776077	0.936532629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.0858	YES	1A IP Acute: $285 Per Day for days 1-10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $40"	"9A OP Hospital: $175, 9B ASC Services: $175"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: $50	12 Renal Dialysis: 20%	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35 OP Substance Abuse (Group): $20, 9D Cardiac Rehab: $35"	"7A PCP: $20, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $35	"7E Mental Health: $35 MH (Group): $20, 7H Psychiatric: $35 Psychiatric (Group): $20"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $35, 7F Podiatry: $35, 7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $35	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											3400	0	0	0	5.8411	0	1.456	0	0.0034	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											7.3005	0	0.05111537	22.1593	0.424646885	5.127308994	5.841141246	3.586900351	3.082802517	0.373391261	1.091185217	6.317926148	0.61500959	2.992339015	0.246593191	0.025826476	0.256431258	5.305702074	8.429666961	0.483426953	1.718445781	4.550128308	3.79379775	1.297267045	1.498821393	0	0.231776077	0.936532629	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.3863
H6609_001_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	YES	1162.011596	50.209597	387.156782	545.02092	34.025234	6.762807	2.88655	286.364936	351.679989	1642.765676	187.30477	64.597899	0.095543	512.9093	3211.872409	4003.39788	95.767955	205.506305			20.22351	0							0.04	0.25	891.862799	16.389757	0.05	0.55	1.34	560.748653	0.32	0.4	0.42		3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-9):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		175.3412	141.0078	48.2281	0	100	0.2	0.2	50	85.715597	12.38818	30	50	0.2	43.521955	10	30	30	50			0.2	0							0	0	39.685211	0	0	0	0	30	0	0	0		NO	149.27147	120.04276	27.718136	0	85.3033	0.170607	0.170607	42.65165	73.118233	10.567526	25.59099	42.65165	0.170607	37.125664	8.53033	25.59099	25.59099	42.65165			0.170607	0							0	0	33.852794	0	0	0	0	25.59099	0	0	0			14.4546	0.502274884	0.894272028	0	0.241872062	1.153782214	0.492465636	1.017828085	2.142851615	1.446664083	0.399442875	0.229600582	0.016300305	1.586841528	2.283194297	8.537576259	0.204233065	0.730431916	0	0	3.450272371	0	0	0	0	0	0	0	0	0	2.516003968	0	0	0	0	1.195842764	0	0	0	0	43.4963	0	8.036801	14.4546	0.502274884	0.894272028	0	0.241872062	1.153782214	0.492465636	1.017828085	2.142851615	1.446664083	0.399442875	0.229600582	0.016300305	1.586841528	2.283194297	8.537576259	0.204233065	0.730431916	0	0	3.450272371	0	0	0	0	0	0	0	0	0	2.516003968	0	0	0	0	1.195842764	0	0	0	0	43.4963	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		5000	5.8616	0.0878	0.2171	1.5687	1.0961	1.2928	0.5518	0.2035	2.6738	0.3105	0.0932	0.2583	0.0034	0.5691	1.5977	1.9915	0.0476	0.0724			0.9825	0							0	0	1.067	0	0	0	0	0.2789	0	0	0		20.8255	500	9.824131	20.3162	0.590077884	1.111403028	1.568717	1.338018062	2.446627214	1.044287636	1.221330085	4.816624615	1.757138083	0.492616875	0.487896582	0.019730305	2.155937528	3.880933297	10.52905726	0.251873065	0.802825916	0	0	4.432778371	0	0	0	0	0	0	0	0	0	3.583047968	0	0	0	0	1.474785764	0	0	0	0	64.3219
H6609_002_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	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	YES	1002.503578	43.317383	334.012209	470.206515	29.354628	5.834484	2.490318	247.055945	303.405275	1417.26509	931.031459	55.730619	0.082429	442.502822	2770.982316	3453.855981	82.621996	661.072007			17.447452	0							0.04	0.25	14.139954	0.05	0.55	1.34	0.32	0.4	0.42				3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-9):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$35-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				175.3412	141.0078	48.2281	0	100	0.2	0.2	50	85.715597	12.38818	38.872026	50	0.2	45.141466	10	35	35	39.022936			0.2	0							0	0	0	0	0	0	0	0	0				NO	155.100338	124.730283	31.170448	0	87.2981	0.174596	0.174596	43.64905	74.828088	10.814646	33.93454	43.64905	0.174596	39.407642	8.72981	30.554335	30.554335	34.066282			0.174596	0							0	0	0	0	0	0	0	0	0					12.9574	0.45024912	0.867609183	0	0.213550271	1.018677568	0.434799562	0.898646441	1.891936385	1.277268353	2.632843691	0.202715715	0.014391774	1.453166066	2.015845761	8.79418939	0.210371679	1.876688784	0	0	3.046255329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2566	0	6.004804	12.9574	0.45024912	0.867609183	0	0.213550271	1.018677568	0.434799562	0.898646441	1.891936385	1.277268353	2.632843691	0.202715715	0.014391774	1.453166066	2.015845761	8.79418939	0.210371679	1.876688784	0	0	3.046255329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.2566	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				5000	5.6441	0.0845	0.2235	1.4333	1.0016	1.1813	0.5042	0.1859	2.443	0.2837	1.2189	0.236	0.0031	0.52	1.2659	2.3721	0.0283	0.2274			0.8977	0							0	0	0	0	0	0	0	0	0				19.7547	500	7.580503	18.6015	0.53479512	1.091078183	1.433342	1.215102271	2.199954568	0.939000562	1.084587441	4.334970385	1.560949353	3.851785691	0.438721715	0.017525774	1.973151066	3.281761761	11.16628839	0.238718679	2.104072784	0	0	3.943974329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.0113
H6609_003_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	YES	1283.807387	55.472297	427.736469	602.147074	37.591575	8.534665	3.642829	316.380165	388.541189	1814.951517	206.937047	71.368703	0.120576	566.66969	3548.523559	4423.012463	105.805836	227.046368			25.52208	0							0.04	0.25	985.343051	18.107643	0.05	0.55	2.63	619.523304	0.32	0.4	0.42		3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-9):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		175.3412	141.0078	48.2281	0	100	0.2	0.2	50	150	12.38818	30	50	0.2	43.521955	10	30	30	50			0.2	0							0	0	39.685211	0	0	0	0	30	0	0	0		NO	141.217523	113.565849	24.514247	0	80.5718	0.161144	0.161144	40.2859	120.8577	9.981379	24.17154	40.2859	0.161144	35.066422	8.05718	24.17154	24.17154	40.2859			0.161144	0							0	0	31.975089	0	0	0	0	24.17154	0	0	0			15.108	0.524979875	0.873803121	0	0.252401739	1.375310057	0.587020036	1.062138307	3.913182871	1.509643246	0.416832259	0.239596036	0.019430099	1.655923207	2.382591087	8.909251889	0.213124166	0.762230606	0	0	4.11273006	0	0	0	0	0	0	0	0	0	2.625535979	0	0	0	0	1.247902694	0	0	0	0	47.7916	0	12.166496	15.108	0.524979875	0.873803121	0	0.252401739	1.375310057	0.587020036	1.062138307	3.913182871	1.509643246	0.416832259	0.239596036	0.019430099	1.655923207	2.382591087	8.909251889	0.213124166	0.762230606	0	0	4.11273006	0	0	0	0	0	0	0	0	0	2.625535979	0	0	0	0	1.247902694	0	0	0	0	47.7916	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		5000	6.1178	0.0916	0.2029	1.8024	1.1026	1.4855	0.634	0.2047	3.0721	0.3567	0.0937	0.2968	0.0039	0.6539	1.6071	2.0032	0.0479	0.0832			1.1289	0							0	0	1.226	0	0	0	0	0.2806	0	0	0		22.4955	500	14.310156	21.2258	0.616621875	1.076667121	1.802426	1.354983739	2.860764057	1.221053036	1.266835307	6.985296871	1.866372246	0.510553259	0.536373036	0.023370099	2.309804207	3.989712087	10.91242789	0.261043166	0.845409606	0	0	5.24161006	0	0	0	0	0	0	0	0	0	3.851549979	0	0	0	0	1.528483694	0	0	0	0	70.2872
H6609_004_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	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	YES	1107.645078	47.860463	369.043051	519.521269	32.43331	7.36355	3.142964	272.966908	335.226094	1565.906332	1028.677039	61.575586	0.10403	488.912042	3061.599968	3816.092691	91.287303	730.404529			22.019975	0							0.04	0.25	15.622937	0.05	0.55	2.63	0.32	0.4	0.42				3400	$200/Day(Days 1-15):1a	$200/Day(Days 1-9):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$35-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				175.3412	141.0078	48.2281	0	100	0.2	0.2	50	150	12.38818	38.872026	50	0.2	45.141466	10	35	35	39.022936			0.2	0							0	0	0	0	0	0	0	0	0				NO	148.357592	119.307828	29.705809	0	84.6171	0.169234	0.169234	42.30855	126.92565	10.482518	32.892381	42.30855	0.169234	38.197399	8.46171	29.615985	29.615985	33.020077			0.169234	0							0	0	0	0	0	0	0	0	0					13.694	0.475843991	0.913560199	0	0.228701053	1.246163021	0.53189637	0.96240284	3.54573249	1.367886776	2.819636424	0.217097813	0.017605413	1.556264029	2.158864255	9.418111991	0.22529695	2.009834482	0	0	3.726528449	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1154	0	8.606515	13.694	0.475843991	0.913560199	0	0.228701053	1.246163021	0.53189637	0.96240284	3.54573249	1.367886776	2.819636424	0.217097813	0.017605413	1.556264029	2.158864255	9.418111991	0.22529695	2.009834482	0	0	3.726528449	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1154	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				7500	8.0321	0.1203	0.3455	1.8049	1.1041	1.4875	0.6349	0.205	3.0763	0.3572	1.5349	0.2972	0.0039	0.6548	1.594	2.9869	0.0357	0.2863			1.1304	0							0	0	0	0	0	0	0	0	0				25.6918	500	7.609182	21.726	0.596159991	1.259027199	1.80486	1.332772053	2.733623021	1.16678537	1.16737684	6.62199549	1.725097776	4.354524424	0.514275813	0.021551413	2.211028029	3.752901255	12.40505299	0.26099195	2.296156482	0	0	4.856932449	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.8072
H6609_005_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	V	O	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	0	YES	1186.668618	51.275008	395.371961	556.585858	34.747224	8.308375	3.546241	292.441387	359.142377	1677.623942	191.279238	65.968619	0.11738	523.792854	3280.025953	4088.347007	97.80008	209.866996			24.845381	0							0.04	0.25	910.787466	16.737536	0.05	0.55	3.01	572.647323	0.32	0.4	0.42	0.45	4000	$200/Day(Days 1-8):1a	$200/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	148.2254	133.6122	48.2281	0	100	0.2	0.2	50	150	12.38818	30	50	0.2	43.521955	10	30	30	50			0.2	0							0	0	39.685211	0	0	0	0	30	0	0	0	0	NO	132.838862	119.742586	32.148803	0	87.7412	0.175482	0.175482	43.8706	131.6118	10.869538	26.32236	43.8706	0.175482	38.186685	8.77412	26.32236	26.32236	43.8706			0.175482	0							0	0	34.82028	0	0	0	0	26.32236	0	0	0	0		13.1363	0.511650171	1.05922794	0	0.254063594	1.457970262	0.622301463	1.069131593	3.938947891	1.519583099	0.419576747	0.241173575	0.020598077	1.66682606	2.398278443	8.96791181	0.214527409	0.767249253	0	0	4.359917149	0	0	0	0	0	0	0	0	0	2.642822882	0	0	0	0	1.256119082	0	0	0	0	46.5242	0	6.555925	13.1363	0.511650171	1.05922794	0	0.254063594	1.457970262	0.622301463	1.069131593	3.938947891	1.519583099	0.419576747	0.241173575	0.020598077	1.66682606	2.398278443	8.96791181	0.214527409	0.767249253	0	0	4.359917149	0	0	0	0	0	0	0	0	0	2.642822882	0	0	0	0	1.256119082	0	0	0	0	46.5242	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a	$0: OTC items 13c	6000	7.1576	0.1072	0.2633	1.8847	1.0947	1.5533	0.663	0.2032	3.2124	0.373	0.0931	0.3103	0.0041	0.6837	1.5957	1.9889	0.0476	0.087			1.1804	0							0	0	1.282	0	0	0	0	0.2786	0	0	0	0	24.0638	500	11.608758	20.2939	0.618867171	1.32251394	1.884723	1.348778594	3.011248262	1.285283463	1.272368593	7.151330891	1.892600099	0.512629747	0.551501575	0.024718077	2.35056206	3.993931443	10.95679381	0.262104409	0.854226253	0	0	5.540341149	0	0	0	0	0	0	0	0	0	3.924814882	0	0	0	0	1.534698082	0	0	0	0	70.588
H6609_006_0	2010	5	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Lab	Radiology	Renal Dialysis	Other					Therapy (PT/OT/ST)		D	D	D	V	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	Coin							O	O	V	V	P	V	V	O	O	O	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	YES	1025.572868	44.314188	341.69839	481.026755	30.030128	7.180474	3.064824	252.741117	8.116412	5.088708	13.15412	5.09345	0.101444	10.231549	2834.747268	3533.335001	84.523267	1.427567			21.472504	0							0.04	0.25	1090.651568	633.252373	14.465338	146.625877	310.387139	0.05	0.55	3.01	494.907802	0.42	6000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$125/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20% Coins:9a, 9b"	20% Coins:8a	"20% Coins:14h, 8a, 8b, 9a"	20% Coins:9a	20% Coins:12	"20% Coins:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	20% Coins:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$50/Visit:14h. 20% DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 20% Advanced Imaging -- OP,8a. 20% Radiology OP -- Physician,8a. 20% Radiology OP -- Facility"	$0/Proc:12	"$35/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. 20% Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: Nutritional benefit 14a	158.7573	140.3991	48.2281	0	125	0.2	0.2	50	0.2	0.2	0.2	0.2	0.2	0.2	15	35	35	0.2			0.2	0							0	0	0	33.262746	0	35	150	0	0	0	35	0	NO	151.398264	133.89104	42.391053	0	114.8905	0.183825	0.183825	45.9562	0.183825	0.183825	0.183825	0.183825	0.183825	0.183825	13.78686	32.16934	32.16934	0.183825			0.183825	0							0	0	0	30.572588	0	32.16934	137.8686	0	0	0	32.16934	0		12.9392	0.494439393	1.207079547	0	0.287514702	1.319950633	0.563391272	0.967918443	1.491999436	0.935431748	2.418056109	0.936303446	0.018647943	1.880814495	3.25685531	9.472087915	0.226588143	0.262422504	0	0	3.947183048	0	0	0	0	0	0	0	0	0	0	1.613346992	0	0.393071474	3.566053359	0	0	0	1.326738113	0	49.5251	0	3.888741	12.9392	0.494439393	1.207079547	0	0.287514702	1.319950633	0.563391272	0.967918443	1.491999436	0.935431748	2.418056109	0.936303446	0.018647943	1.880814495	3.25685531	9.472087915	0.226588143	0.262422504	0	0	3.947183048	0	0	0	0	0	0	0	0	0	0	1.613346992	0	0.393071474	3.566053359	0	0	0	1.326738113	0	49.5251	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$125/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	30% Coins	$0: Nutritional benefit 14a	7500	7.9455	0.119	0.3456	1.7713	1.286	1.4598	0.6231	0.191	0.452	0.2914	0.747	0.2917	0.0039	0.5859	1.5644	2.9314	0.035	0.0817			1.1094	0							0	0	0.0592	0.7593	0	0.0567	2.5671	0	0	0	0.1993	0	25.4767	500	7.266982	20.8847	0.613459393	1.552636547	1.771301	1.573558702	2.779753633	1.186474272	1.158924443	1.944013436	1.226812748	3.165087109	1.227956446	0.022519943	2.466675495	4.82125331	12.40349092	0.261619143	0.344165504	0	0	5.056569048	0	0	0	0	0	0	0	0	0	0.059188	2.372664992	0	0.449799474	6.133103359	0	0	0	1.525993113	0	75.0017
H6609_007_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	YES	1199.676261	51.837058	399.705823	562.686863	35.128105	7.992275	3.411322	295.646977	363.079108	1696.013181	193.375942	66.691732	0.112914	529.534399	3315.979888	4133.161334	98.872114	212.167449			23.900113	0							0.04	0.25	920.771043	16.921004	0.05	0.55	2.91	578.924384	0.32	0.4	0.42		4000	$200/Day(Days 1-8):1a	$200/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		148.2254	133.6122	48.2281	0	100	0.2	0.2	50	150	12.38818	30	50	0.2	43.521955	10	30	30	50			0.2	0							0	0	39.685211	0	0	0	0	30	0	0	0		NO	132.651802	119.573967	31.951309	0	87.6722	0.175344	0.175344	43.8361	131.5083	10.86099	26.30166	43.8361	0.175344	38.156655	8.76722	26.30166	26.30166	43.8361			0.175344	0							0	0	34.792897	0	0	0	0	26.30166	0	0	0			13.2616	0.516530222	1.064260355	0	0.256646521	1.401397468	0.598154845	1.080000871	3.978993022	1.53503185	0.423842357	0.243625453	0.019798792	1.683771781	2.422660433	9.059083678	0.216708394	0.775049459	0	0	4.190741414	0	0	0	0	0	0	0	0	0	2.669691005	0	0	0	0	1.268889359	0	0	0	0	46.6665	0	6.634607	13.2616	0.516530222	1.064260355	0	0.256646521	1.401397468	0.598154845	1.080000871	3.978993022	1.53503185	0.423842357	0.243625453	0.019798792	1.683771781	2.422660433	9.059083678	0.216708394	0.775049459	0	0	4.190741414	0	0	0	0	0	0	0	0	0	2.669691005	0	0	0	0	1.268889359	0	0	0	0	46.6665	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		6000	7.0814	0.1061	0.265	1.834	1.1195	1.5115	0.6451	0.2078	3.1259	0.363	0.0952	0.302	0.004	0.6653	1.6318	2.0339	0.0487	0.0846			1.1486	0							0	0	1.2475	0	0	0	0	0.2849	0	0	0		23.8057	500	10.92466	20.343	0.622605222	1.329262355	1.833979	1.376156521	2.912856468	1.243286845	1.287840871	7.104887022	1.89800585	0.519002357	0.545598453	0.023807792	2.349099781	4.054455433	11.09301468	0.265363394	0.859685459	0	0	5.339383414	0	0	0	0	0	0	0	0	0	3.917167005	0	0	0	0	1.553778359	0	0	0	0	70.4722
H6609_008_0	2010	6	N/A	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	YES	1035.056209	44.723956	344.858031	485.474748	30.307812	6.895571	2.943219	255.078182	313.257249	1463.28558	166.840818	57.540266	0.09742	456.871479	2860.959813	3566.007298	85.304843	183.053747			20.620531	0							0.04	0.25	794.422475	14.599097	0.05	0.55	3.01	499.484151	0.32	0.4	0.42		4000	$200/Day(Days 1-8):1a	$200/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		148.2254	133.6122	48.2281	0	100	0.2	0.2	50	150	12.38818	30	50	0.2	43.521955	10	30	30	50			0.2	0							0	0	39.685211	0	0	0	0	30	0	0	0		NO	136.778545	123.293864	35.664776	0	89.8292	0.179658	0.179658	44.9146	134.7438	11.128203	26.94876	44.9146	0.179658	39.095424	8.98292	26.94876	26.94876	44.9146			0.179658	0							0	0	35.648907	0	0	0	0	26.94876	0	0	0			11.7978	0.459515779	1.024940369	0	0.226877209	1.238844495	0.528772839	0.954727876	3.517456009	1.356978248	0.37467943	0.215366503	0.017502282	1.488465349	2.14164776	8.008289569	0.191571645	0.685148819	0	0	3.704643358	0	0	0	0	0	0	0	0	0	2.360024411	0	0	0	0	1.121706542	0	0	0	0	41.4149	0	4.572138	11.7978	0.459515779	1.024940369	0	0.226877209	1.238844495	0.528772839	0.954727876	3.517456009	1.356978248	0.37467943	0.215366503	0.017502282	1.488465349	2.14164776	8.008289569	0.191571645	0.685148819	0	0	3.704643358	0	0	0	0	0	0	0	0	0	2.360024411	0	0	0	0	1.121706542	0	0	0	0	41.4149	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a		6000	6.8404	0.1025	0.2742	1.7	1.0377	1.401	0.598	0.1927	2.8975	0.3365	0.0882	0.2799	0.0037	0.6167	1.5126	1.8853	0.0451	0.0785			1.0647	0							0	0	1.1563	0	0	0	0	0.2641	0	0	0		22.3754	500	8.16248	18.6382	0.561980779	1.299171369	1.699969	1.264584209	2.639859495	1.126764839	1.147380876	6.414939009	1.693429248	0.46288643	0.495273503	0.021218282	2.105177349	3.65420676	9.893599569	0.236671645	0.763599819	0	0	4.769353358	0	0	0	0	0	0	0	0	0	3.516347411	0	0	0	0	1.385778542	0	0	0	0	63.7904
H6609_009_0	2010	7	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	P	O	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	NO	940.720925	45.636728	651.705234	373.660038	30.807002	7.709641	2.394946	298.806627	351.009279	1310.996644	959.078251	57.488853	0.046328	772.085796	2890.049126	3219.949215	92.355894	808.35617			17.803091	0							0.04	0.25	50.547194	0.05	0.55	2.87	0.42							$250/Day(Days 1-5):1a	$250/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$125/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$30-$125/Visit:9d. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						151.66775	126.678	45.891712	0	100	0.2	0.2	50	125	30.680638	57.896197	125	0.2	51.881224	10	25	25	31.66736			0.2	0							0	0	0	0	0	0	0						NO	142.250396	118.81231	32.849425	0	90.6322	0.181264	0.181264	45.3161	113.29025	27.806537	52.472597	113.29025	0.181264	47.021095	9.06322	22.65805	22.65805	28.700825			0.181264	0							0	0	0	0	0	0	0							11.1515	0.451850423	1.784011851	0	0.232675531	1.397480366	0.434117492	1.128395916	3.313827414	3.037856391	4.193777213	0.542743877	0.008397599	3.025359963	2.182762587	6.079814193	0.174383705	1.933374081	0	0	3.227059487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2994	0	4.67157	11.1515	0.451850423	1.784011851	0	0.232675531	1.397480366	0.434117492	1.128395916	3.313827414	3.037856391	4.193777213	0.542743877	0.008397599	3.025359963	2.182762587	6.079814193	0.174383705	1.933374081	0	0	3.227059487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2994	YES	$275/Day(Days 1-5)	$275/Day(Days 1-5)	40% Coins(Days 1-20) 40%(Days 21-100)	25% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	$0/Service							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						5000	1.8933	0.0767	0.4422	1.0658	0.8204	1.6244	0.5046	0.1755	2.3515	0.4041	1.1229	0.1529	0.0014	0.7054	1.138	1.9594	0.0279	0.2533			0.5657	0							0	0	0	0	0	0	0						15.2854	0	4.999371	13.0448	0.528565423	2.226236851	1.065843	1.053049531	3.021860366	0.938719492	1.303918916	5.665282414	3.441943391	5.316673213	0.695660877	0.009772599	3.730766963	3.320783587	8.039171193	0.202299705	2.186698081	0	0	3.792736487	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	59.5848
H6609_010_0	2010	5	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	P	O	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	NO	928.229468	45.030736	643.051502	368.698356	30.397928	8.236201	2.558518	294.838894	346.348368	1293.588445	946.343034	56.725481	0.049492	761.833579	2851.673321	3177.192798	91.129537	797.622331			19.019024	0							0.04	0.25	49.875998	0.05	0.55	2.87	0.42							$250/Day(Days 1-5):1a	$250/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$125/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$30-$125/Visit:9d. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						151.66775	126.678	45.891712	0	100	0.2	0.2	50	125	30.680638	57.896197	125	0.2	51.881225	10	25	25	31.66736			0.2	0							0	0	0	0	0	0	0						NO	142.340032	118.887176	33.06709	0	90.6742	0.181348	0.181348	45.3371	113.34275	27.819423	52.496913	113.34275	0.181348	47.042885	9.06742	22.66855	22.66855	28.714126			0.181348	0							0	0	0	0	0	0	0							11.0104	0.44613142	1.771986824	0	0.229692317	1.493618579	0.463982122	1.113928368	3.271339707	2.998907012	4.140007327	0.535785168	0.008975275	2.986570787	2.154776642	6.001862817	0.172147872	1.908585676	0	0	3.449061964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1577	0	4.619057	11.0104	0.44613142	1.771986824	0	0.229692317	1.493618579	0.463982122	1.113928368	3.271339707	2.998907012	4.140007327	0.535785168	0.008975275	2.986570787	2.154776642	6.001862817	0.172147872	1.908585676	0	0	3.449061964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.1577	YES	$275/Day(Days 1-5)	$275/Day(Days 1-5)	40% Coins(Days 1-20) 40%(Days 21-100)	25% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	$0/Service							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						5000	1.8426	0.0747	0.4377	1.1246	0.7995	1.7139	0.5324	0.1711	2.4811	0.4264	1.1848	0.1613	0.0014	0.7443	1.2008	2.0674	0.0295	0.2673			0.5969	0							0	0	0	0	0	0	0						15.8575	0	5.515065	12.853	0.52079342	2.209666824	1.124597	1.029190317	3.207541579	0.996400122	1.284985368	5.752417707	3.425268012	5.324802327	0.697131168	0.010425275	3.730862787	3.355530642	8.069228817	0.201602872	2.175873676	0	0	4.045920964	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.0152
H6609_011_0	2010	5	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	P	O	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	NO	895.067345	43.421958	620.077707	355.52616	29.311925	7.67892	2.385402	284.305417	333.974652	1247.373429	912.533784	54.698895	0.046143	734.616151	2749.793833	3063.683731	87.873823	769.126306			17.732152	0							0.04	0.25	48.094118	0.05	0.55	2.87	0.42							$250/Day(Days 1-5):1a	$250/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$125/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$30-$125/Visit:9d. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						151.66775	126.678	45.891712	0	100	0.2	0.2	50	125	30.680638	57.896197	125	0.2	51.881225	10	25	25	31.66736			0.2	0							0	0	0	0	0	0	0						NO	142.956864	119.402376	33.933341	0	91.1349	0.18227	0.18227	45.56745	113.918625	27.960769	52.763641	113.918625	0.18227	47.281902	9.11349	22.783725	22.783725	28.860017			0.18227	0							0	0	0	0	0	0	0							10.663	0.43205708	1.753442357	0	0.222611613	1.399636748	0.434787223	1.079589406	3.170494428	2.906460025	4.012383748	0.519268576	0.008410485	2.894504072	2.08835155	5.816843968	0.166841085	1.849749856	0	0	3.232039345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6505	0	4.192958	10.663	0.43205708	1.753442357	0	0.222611613	1.399636748	0.434787223	1.079589406	3.170494428	2.906460025	4.012383748	0.519268576	0.008410485	2.894504072	2.08835155	5.816843968	0.166841085	1.849749856	0	0	3.232039345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6505	YES	$275/Day(Days 1-5)	$275/Day(Days 1-5)	40% Coins(Days 1-20) 40%(Days 21-100)	25% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	$0/Service							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						5000	1.8115	0.0734	0.4464	1.0654	0.7834	1.6237	0.5044	0.1676	2.3505	0.4039	1.1224	0.1529	0.0014	0.7051	1.1376	1.9586	0.0279	0.2532			0.5654	0							0	0	0	0	0	0	0						15.1546	0	4.886849	12.4745	0.50545608	2.199810357	1.065404	1.005972613	3.023348748	0.939181223	1.247193406	5.520982428	3.310380025	5.134817748	0.672122576	0.009784485	3.599621072	3.22590455	7.775394968	0.194745085	2.102969856	0	0	3.797483345	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.805
H6609_012_0	2010	5	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	P	O	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	NO	799.664319	38.793719	553.98515	317.631502	26.187639	6.724696	2.08898	254.002002	298.377116	1114.418965	815.269052	48.868674	0.04041	656.315222	2456.700077	2737.133223	78.507569	687.147027			15.528658	0							0.04	0.25	42.967884	0.05	0.55	2.87	0.42							$250/Day(Days 1-7):1a	$250/Day(Days 1-7):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$125/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$125/Visit:9a	20% Coins:12	"$30-$125/Visit:9d. $30 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						176.397	155.999	45.891712	0	100	0.2	0.2	50	125	30.680638	57.896197	125	0.2	51.881225	10	25	25	31.66736			0.2	0							0	0	0	0	0	0	0						NO	167.425096	148.064579	35.703018	0	91.9968	0.183994	0.183994	45.9984	114.996	28.225205	53.262649	114.996	0.183994	47.729066	9.19968	22.9992	22.9992	29.132958			0.183994	0							0	0	0	0	0	0	0							11.157	0.478664639	1.648245149	0	0.200764916	1.237303716	0.384359786	0.973640474	2.859347903	2.621225312	3.61861578	0.468308503	0.007435198	2.610442712	1.883404547	5.245989535	0.150467607	1.66821879	0	0	2.8571799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0706	0	3.42418	11.157	0.478664639	1.648245149	0	0.200764916	1.237303716	0.384359786	0.973640474	2.859347903	2.621225312	3.61861578	0.468308503	0.007435198	2.610442712	1.883404547	5.245989535	0.150467607	1.66821879	0	0	2.8571799	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.0706	YES	$275/Day(Days 1-7)	$275/Day(Days 1-7)	40% Coins(Days 1-20) 40%(Days 21-100)	25% Coins	$100/Trip	35% Coins	35% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	$0/Service							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						5000	1.9384	0.0832	0.4557	0.9594	0.7197	1.2794	0.3974	0.154	2.1167	0.3637	1.0108	0.1376	0.0012	0.635	1.0244	1.7637	0.0251	0.228			0.5092	0							0	0	0	0	0	0	0						13.8026	0	3.857413	13.0954	0.561826639	2.103902149	0.95942	0.920438916	2.516717716	0.781800786	1.127618474	4.976012903	2.984964312	4.62939178	0.605956503	0.008672198	3.245414712	2.907795547	7.009707535	0.175596607	1.89624879	0	0	3.3663749	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8732
H6609_013_0	2010	6	N/A	r.	s.	t.	u.	v.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered																D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	O								O	O	O	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	YES	965.154923	46.822082	668.632427	383.36537	31.607173	8.681145	2.696737	306.56774	360.126287	1345.048071	983.989055	58.982051	53.471366	792.139717	2965.114381	3303.583193	94.754717	829.352165			20.04649	0								0.04	0.05	0.25	0.42	0.55	1.67						1500	$150/Day(Days 1-6):1a	$150/Day(Days 1-6):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$50/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $50 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$15-$50/Visit:9d. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $25 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	"$15-$25/Visit:7i. $25 Therapy (AT,PT,ST,OT) -- OP,7i. $15 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15									$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						99.23445	85.58535	45.891712	0	100	0.2	0.2	50	50	30.680638	36.128471	50	1.506671	42.161832	5	15	15	17.666944			0.2	0								0	0	0	0	0	0						NO	71.115575	61.334056	13.856773	0	76.2784	0.152557	0.152557	38.1392	38.1392	23.4027	27.55822	38.1392	1.149264	32.160371	3.81392	11.44176	11.44176	13.476062			0.152557	0								0	0	0	0	0	0							5.7198	0.239315683	0.772090647	0	0.200912049	1.324369438	0.411406107	0.974354029	1.144577374	2.623146374	2.259748905	0.187460687	0.00512106	2.122958932	0.94239242	3.149900503	0.090346728	0.931366766	0	0	3.058232375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1575	0	10.182504	5.7198	0.239315683	0.772090647	0	0.200912049	1.324369438	0.411406107	0.974354029	1.144577374	2.623146374	2.259748905	0.187460687	0.00512106	2.122958932	0.94239242	3.149900503	0.090346728	0.931366766	0	0	3.058232375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1575	YES	$150/Day(Days 1-6)	$150/Day(Days 1-6)	$0/Day(Days 1-20) $128(Days 21-100)	20% Coins	$100/Trip	40% Coins	20%-40% Coins	$50/Visit	$0-$50/Visit	20% Coins	$0-$50/Visit	$50/Visit	$0-$50/Proc	$15-$50/Visit	$15/Visit	$15/Visit	$15/Visit	$15-$25/Visit			20% Coins									$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						3000	1.1912	0.0498	0.2038	0.9779	0.8573	1.8629	0.3976	0.1834	0.2155	0.309	0.4254	0.0353	0.001	0.3996	0.5322	0.593	0.017	0.1753			0.5892									0	0	0	0	0	0						9.0164	0	2.20758	6.911	0.289157683	0.975878647	0.977899	1.058179049	3.187307438	0.808991107	1.157771029	1.360037374	2.932100374	2.685133905	0.222748687	0.00608506	2.522593932	1.47459342	3.742851503	0.107353728	1.106691766	0	0	3.647450375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.1739
H6609_014_0	2010	5	N/A	r.	s.	t.	u.	v.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered																D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	O								O	O	O	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	YES	994.867217	48.2635	689.216277	395.167273	32.5802	8.681145	2.696737	316.005427	371.212775	1386.455377	1014.281158	60.797813	55.117482	816.525739	3056.395427	3405.284002	97.671741	854.883772			20.04649	0								0.04	0.05	0.25	0.42	0.55	1.67						3000	$250/Day(Days 1-5):1a	$250/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$125/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$125/Visit:9a	"$0-$100/Proc:12. $0 Dialysis -- Dialysis Center,12. $100 Dialysis -- OP Hosp"	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15									$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						151.66775	126.678	45.891712	0	100	0.2	0.2	50	125	30.680638	57.896197	125	3.013342	50.886015	10	25	25	31.66736			0.2	0								0	0	0	0	0	0						NO	125.384487	104.725336	21.867309	0	82.9692	0.165938	0.165938	41.4846	103.7115	25.45548	48.036011	103.7115	2.500145	42.21972	8.29692	20.7423	20.7423	26.274155			0.165938	0								0	0	0	0	0	0							10.3951	0.421200938	1.255942108	0	0.225262761	1.440531839	0.447491144	1.092446561	3.20825281	2.941073927	4.060168405	0.525452699	0.011483475	2.872790673	2.113222362	5.88611853	0.168828046	1.871779061	0	0	3.326474458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2636	0	9.84444	10.3951	0.421200938	1.255942108	0	0.225262761	1.440531839	0.447491144	1.092446561	3.20825281	2.941073927	4.060168405	0.525452699	0.011483475	2.872790673	2.113222362	5.88611853	0.168828046	1.871779061	0	0	3.326474458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.2636	YES	$250/Day(Days 1-5)	$250/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	25% Coins	$100/Trip	40% Coins	20% Coins	$50/Visit	$0-$125/Visit	20%-30% Coins	$0-$125/Visit	$125/Visit	$0-$100/Proc	$15-$125/Visit	$25/Visit	$25/Visit	$25/Visit	$25-$50/Visit			20% Coins									$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						5000	1.9965	0.0809	0.291	1.2924	0.9343	1.9697	0.3059	0.1999	0.5871	0.3513	0.7429	0.0961	0.0021	0.5257	0.9667	1.0771	0.0309	0.3425			0.623									0	0	0	0	0	0						12.4161	0	2.037035	12.3916	0.502098938	1.546990108	1.292424	1.159559761	3.410228839	0.753427144	1.292344561	3.79530481	3.292353927	4.803105405	0.621600699	0.013584475	3.398458673	3.079925362	6.96317153	0.199720046	2.214280061	0	0	3.949458458	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.6796
H6609_015_0	2010	7	N/A	r.	s.	t.	u.	v.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered																D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	O								O	O	O	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	YES	982.577673	47.667304	680.702423	390.285792	32.177738	8.174255	2.539276	312.101828	366.627202	1369.328564	1001.751795	60.046781	54.436619	806.439238	3018.639929	3363.218701	96.465207	844.323437			18.875981	0								0.04	0.05	0.25	0.42	0.55	0.93						1500	$150/Day(Days 1-6):1a	$150/Day(Days 1-6):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$50/Visit:9b. $0 Surgery ASC -- Physician,9b. $50 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $50 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $15 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$15-$50/Visit:9d. $15 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $25 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $25 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$15/Visit:7b, 7d, 7f"	$15/Visit:7e	"$15-$25/Visit:7i. $25 Therapy (AT,PT,ST,OT) -- OP,7i. $15 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15									$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						99.23445	85.58535	45.891712	0	100	0.2	0.2	50	50	30.680638	36.128471	50	1.506671	42.161832	5	15	15	17.666944			0.2	0								0	0	0	0	0	0						NO	70.804872	61.066089	13.682522	0	76.1614	0.152323	0.152323	38.0807	38.0807	23.366803	27.51595	38.0807	1.147501	32.111041	3.80807	11.42421	11.42421	13.455392			0.152323	0								0	0	0	0	0	0							5.7976	0.242571319	0.776143823	0	0.204225131	1.245127044	0.386790138	0.99042134	1.163451708	2.666402566	2.297012692	0.190551954	0.005205506	2.157966953	0.95793268	3.20184306	0.091836565	0.946725235	0	0	2.875246054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1971	0	10.318515	5.7976	0.242571319	0.776143823	0	0.204225131	1.245127044	0.386790138	0.99042134	1.163451708	2.666402566	2.297012692	0.190551954	0.005205506	2.157966953	0.95793268	3.20184306	0.091836565	0.946725235	0	0	2.875246054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.1971	YES	$150/Day(Days 1-6)	$150/Day(Days 1-6)	$0/Day(Days 1-20) $128(Days 21-100)	20% Coins	$100/Trip	40% Coins	20%-40% Coins	$50/Visit	$0-$50/Visit	20% Coins	$0-$50/Visit	$50/Visit	$0-$50/Proc	$15-$50/Visit	$15/Visit	$15/Visit	$15/Visit	$15-$25/Visit			20% Coins									$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						3000	1.2164	0.0509	0.2067	0.9242	0.8759	1.7605	0.3757	0.1874	0.2201	0.292	0.4346	0.0361	0.001	0.4083	0.5438	0.6059	0.0174	0.1791			0.5568									0	0	0	0	0	0						8.8929	0	2.145047	7.014	0.293466319	0.982846823	0.924151	1.080144131	3.005674044	0.762523138	1.17782934	1.383599708	2.958375566	2.731653692	0.226607954	0.006190506	2.566296953	1.50171268	3.80769606	0.109213565	1.125864235	0	0	3.432079054	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.09
H6609_016_0	2010	5	N/A	r.	s.	t.	u.	v.						Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered																D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	O								O	O	O	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	YES	963.27767	46.731012	667.331919	382.619714	31.545696	8.013696	2.489399	305.971457	359.425832	1342.431916	982.075171	58.867329	53.367363	790.598984	2959.347151	3297.157632	94.570417	827.739053			18.505214	0								0.04	0.05	0.25	0.42	0.55	0.93						3000	$250/Day(Days 1-5):1a	$250/Day(Days 1-5):1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$125/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $125 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$125/Visit:9a	"$0-$100/Proc:12. $0 Dialysis -- Dialysis Center,12. $100 Dialysis -- OP Hosp"	"$15-$125/Visit:9d. $15 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $50 OP Other,5. $50 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15									$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						151.66775	126.678	45.891712	0	100	0.2	0.2	50	125	30.680638	57.896197	125	3.013342	50.886015	10	25	25	31.66736			0.2	0								0	0	0	0	0	0						NO	127.005361	106.079144	22.559218	0	83.688	0.167376	0.167376	41.844	104.61	25.676012	48.452169	104.61	2.521805	42.585488	8.3688	20.922	20.922	26.50178			0.167376	0								0	0	0	0	0	0							10.1951	0.413098813	1.25454052	0	0.219999684	1.341300382	0.416665647	1.066922471	3.13329469	2.872358165	3.965306013	0.513175941	0.011215174	2.805670295	2.063848703	5.748594331	0.164883522	1.828046523	0	0	3.097328698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1114	0	9.058462	10.1951	0.413098813	1.25454052	0	0.219999684	1.341300382	0.416665647	1.066922471	3.13329469	2.872358165	3.965306013	0.513175941	0.011215174	2.805670295	2.063848703	5.748594331	0.164883522	1.828046523	0	0	3.097328698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.1114	YES	$250/Day(Days 1-5)	$250/Day(Days 1-5)	$0/Day(Days 1-20) $128(Days 21-100)	25% Coins	$100/Trip	40% Coins	20% Coins	$50/Visit	$0-$125/Visit	20%-30% Coins	$0-$125/Visit	$125/Visit	$0-$100/Proc	$15-$125/Visit	$25/Visit	$25/Visit	$25/Visit	$25-$50/Visit			20% Coins									$0: Nurse hotline 14a	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a						5000	1.9502	0.079	0.2911	1.2038	0.9128	1.8346	0.285	0.1953	0.5735	0.3272	0.7258	0.0939	0.0021	0.5136	0.9444	1.0522	0.0302	0.3346			0.5803									0	0	0	0	0	0						11.9295	0	1.826335	12.1453	0.492117813	1.54567452	1.203789	1.132768684	3.175915382	0.701620647	1.262214471	3.70681969	3.199547165	4.691125013	0.607108941	0.013268174	3.319226295	3.008277703	6.800830331	0.195064522	2.162656523	0	0	3.677588698	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0409
H6609_801_0	2010	5	N/A																															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	NO	235.034079	0.801727	40.808642	13.186725	1.546417	7.150428	3.495219	17.239833	49.0891	10.597742	25.265831	8.931619	0.784701	16.171188	30.011686	65.818653	0.31629	4.898029			21.392638	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																			0.079140595	0.079140595	0.139330246	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079140595	0.079140595	0.139330246	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				18.6007	0.063449152	5.685878143	0	0.360315161	1.666049724	0.814386027	4.016881089	11.4377603	2.469273886	5.886938623	2.081067227	0.182835333	3.767886804	6.992722838	15.33574615	0.07369557	1.141240757	0	0	4.984484654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5613	0	0	18.6007	0.063449152	5.685878143	0	0.360315161	1.666049724	0.814386027	4.016881089	11.4377603	2.469273886	5.886938623	2.081067227	0.182835333	3.767886804	6.992722838	15.33574615	0.07369557	1.141240757	0	0	4.984484654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5613	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.4626	0.0118	1.0584	0	1.4412	1.0985	0.5369	1.0591	2.756	0.651	1.4114	0.5487	0.0482	0.9861	1.3176	2.8895	0.0139	0.245			0.9392	0																			20.4752	0	0	22.0633	0.075241101	6.744300359	0	1.801536661	2.764528224	1.351334527	5.075982589	14.1938008	3.120275886	7.298336123	2.629782227	0.231066333	4.753942804	8.310337838	18.22529565	0.08755907	1.386240257	0	0	5.923707654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0366
H6609_802_0	2010	3	N/A																															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	NO	235.034079	0.801727	40.808642	13.186725	1.546417	7.150428	3.495219	17.239833	49.0891	10.597742	25.265831	8.931619	0.784701	16.171188	30.011686	65.818653	0.31629	4.898029			21.392638	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																			0.079140595	0.079140595	0.139330246	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079140595	0.079140595	0.139330246	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				18.6007	0.063449152	5.685878143	0	0.360315161	1.666049724	0.814386027	4.016881089	11.4377603	2.469273886	5.886938623	2.081067227	0.182835333	3.767886804	6.992722838	15.33574615	0.07369557	1.141240757	0	0	4.984484654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5613	0	0	18.6007	0.063449152	5.685878143	0	0.360315161	1.666049724	0.814386027	4.016881089	11.4377603	2.469273886	5.886938623	2.081067227	0.182835333	3.767886804	6.992722838	15.33574615	0.07369557	1.141240757	0	0	4.984484654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5613	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.4626	0.0118	1.0584	0	1.4412	1.0985	0.5369	1.0591	2.756	0.651	1.4114	0.5487	0.0482	0.9861	1.3176	2.8895	0.0139	0.245			0.9392	0																			20.4752	0	0	22.0633	0.075241101	6.744300359	0	1.801536661	2.764528224	1.351334527	5.075982589	14.1938008	3.120275886	7.298336123	2.629782227	0.231066333	4.753942804	8.310337838	18.22529565	0.08755907	1.386240257	0	0	5.923707654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0366
H6609_803_0	2010	3	N/A																															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	NO	235.034079	0.801727	40.808642	13.186725	1.546417	7.150428	3.495219	17.239833	49.0891	10.597742	25.265831	8.931619	0.784701	16.171188	30.011686	65.818653	0.31629	4.898029			21.392638	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																			0.079140595	0.079140595	0.139330246	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079140595	0.079140595	0.139330246	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				18.6007	0.063449152	5.685878143	0	0.360315161	1.666049724	0.814386027	4.016881089	11.4377603	2.469273886	5.886938623	2.081067227	0.182835333	3.767886804	6.992722838	15.33574615	0.07369557	1.141240757	0	0	4.984484654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5613	0	0	18.6007	0.063449152	5.685878143	0	0.360315161	1.666049724	0.814386027	4.016881089	11.4377603	2.469273886	5.886938623	2.081067227	0.182835333	3.767886804	6.992722838	15.33574615	0.07369557	1.141240757	0	0	4.984484654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.5613	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.4626	0.0118	1.0584	0	1.4412	1.0985	0.5369	1.0591	2.756	0.651	1.4114	0.5487	0.0482	0.9861	1.3176	2.8895	0.0139	0.245			0.9392	0																			20.4752	0	0	22.0633	0.075241101	6.744300359	0	1.801536661	2.764528224	1.351334527	5.075982589	14.1938008	3.120275886	7.298336123	2.629782227	0.231066333	4.753942804	8.310337838	18.22529565	0.08755907	1.386240257	0	0	5.923707654	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0366
H6642_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1764.899538	48.94517394	1103.962871	3412.87227	246.6526167	9.369587672	10.54016541	217.4453726	34.41066535	1190.514963	1362.162867	0	1.074214941	519.1054041	8490.268857	10205.2858	181.2557254	659.9571107	4502.532561	11641.74834	6.297905726	78.9634834	0	2924.911305	402.3348295	276.6379536	172.4292127	20.48813619	5955	1853.597794											3400	"$200 copay, days 1-5"	"$200 copay, days 1-5"	"$150 copay, days 6-20"	$0 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$25 copay to $150 copay	$0 copay	20% coinsurance	Varies	$0 copay	$20 copay	"$20 copay Group, $20 copay Individual"	$20 copay	$25 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$10 copay	$10 copay; and $100 credit covered every 1years	$10 copay	$250 credit	Varies	Varies											78.54	74.63090677	46.36094064	0	87.5	0.14	0.102357109	31.5	0.139832509	26.25	28.13584706	0	0.14	28.1988128	0.688033393	10.76919472	14	14	7.766050169	8.747420869	0.14	0	0	2.8	7	14	7	0	0	0											NO	40.00518846	74.63090677	38.26173836	0	87.5	0.122881495	0.085238604	31.5	0.122714004	26.25	23.90450519	0	0.14	20.81015876	0	8.845578495	14	14	6.166844102	8.03245733	0.14	0	0	2.8	7	14	7	0	0	0												5.8838	0.304401893	3.519961543	0	1.798508663	1.15134894	0.898428987	0.570794103	4.222670516	2.604251482	2.713485777	0	0.150390092	0.900222156	0	7.52263805	0.211465013	0.769949962	2.313868031	7.792653901	0.881706802	0	0	0.682479305	0.234695317	0.322744279	0.100583707	0	0	0	0	0	0	0	0	0	0	0	0	0	45.551		12.92936268	5.8838	0.304401893	3.519961543	0	1.798508663	1.15134894	0.898428987	0.570794103	4.222670516	2.604251482	2.713485777	0	0.150390092	0.900222156	0	7.52263805	0.211465013	0.769949962	2.313868031	7.792653901	0.881706802	0	0	0.682479305	0.234695317	0.322744279	0.100583707	0	0	0	0	0	0	0	0	0	0	0	0	0	45.551	NO	"30% copay, days 1-180"	"30% copay, days 1-180"	"30% copay, days 1-180"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, waived if admitted"	30% coinsurance	30% coinsurance	30% coinsurance	$0 copay	30% coinsurance	Varies	30% coinsurance	30% coinsurance	"30% coinsurance Group, 30% coinsurance Individual"	30% coinsurance	30% coinsurance	Varies	30% coinsurance	Varies	Not Covered	$4 copay	30% coinsurance	30% coinsurance; and 30% coinsurance covered every 1years	30% coinsurance	$250 credit	Varies	Varies												24.3071	0.3657	3.5133	5.0973	0.8509	0.9009	1.0026	0.6913	3.0243	0.4957	2.238	0	0.0849	1.4681	4.541	8.1472	0.1132	0.4402	2.7483	2.2091	0.4965	0.2446	0	0.2925	0.3077	0.0011	0.082	0	0	0.0895											63.7531			30.1908	0.670076629	7.033310028	5.097343574	2.649425411	2.052224085	1.901036692	1.262119403	7.246955461	3.099905794	4.951493558	0	0.235314285	2.368347004	4.541022347	15.66983702	0.3246647	1.210192262	5.062166289	10.00172177	1.378221916	0.244552221	0	0.974970435	0.542414677	0.3238735	0.182591336	0	0	0.089515964	0	0	0	0	0	0	0	0	0	0	109.3041
H6642_002_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1575.692077	43.12181617	1371.540135	3462.351038	246.9272422	9.684015698	10.89561321	219.7793003	30.31679503	1187.416183	1370.315133	0	0.946090841	523.2167146	7792.809286	10186.60919	196.3991232	717.6534516	4603.437811	12383.61647	5.575172519	79.83184639	0	2924.911305	396.6507738	280.6485652	169.9931888	20.78516686	5955	1849.621988											3400	"$200 copay, days 1-5"	"$200 copay, days 1-5"	"$100 copay, days 11-50"	$0 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$25 copay to $150 copay	$0 copay	20% coinsurance	Varies	$5 copay	$30 copay	"$30 copay Group, $30 copay Individual"	$30 copay	$25 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$10 copay	$10 copay; and $100 credit covered every 1years	$10 copay	$250 credit	Varies	Varies											78.54	74.63090677	32.86526535	0	87.5	0.14	0.102361045	31.5	0.139778682	26.25	26.53502217	0	0.14	31.83842486	3.061339822	14.79848282	21	21	7.776423151	9.469101009	0.14	0	0	2.8	7	14	7	0	0	0											NO	31.4395105	74.63090677	22.93555452	0	87.5	0.118862595	0.08122364	31.5	0.118641277	26.25	22.04477338	0	0.14	23.91707666	0.960414638	12.69755764	21	21	5.621684523	8.643203967	0.14	0	0	2.8	7	14	7	0	0	0												4.1282	0.26818502	2.621419461	0	1.800511141	1.151067238	0.884981371	0.576920663	3.596823285	2.5974729	2.517357215	0	0.132452718	1.042817856	0.623694009	10.77875478	0.343698466	1.25589354	2.156589591	8.919510253	0.780524153	0	0	0.682479305	0.231379618	0.327423326	0.099162693	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5174		15.18738623	4.1282	0.26818502	2.621419461	0	1.800511141	1.151067238	0.884981371	0.576920663	3.596823285	2.5974729	2.517357215	0	0.132452718	1.042817856	0.623694009	10.77875478	0.343698466	1.25589354	2.156589591	8.919510253	0.780524153	0	0	0.682479305	0.231379618	0.327423326	0.099162693	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5174	NO	"30% copay, days 1-180"	"30% copay, days 1-180"	"30% copay, days 1-180"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, waived if admitted"	30% coinsurance	30% coinsurance	30% coinsurance	$0 copay	30% coinsurance	Varies	30% coinsurance	30% coinsurance	"30% coinsurance Group, 30% coinsurance Individual"	30% coinsurance	30% coinsurance	Varies	30% coinsurance	Varies	Not Covered	$4 copay	30% coinsurance	30% coinsurance; and 30% coinsurance covered every 1years	30% coinsurance	$250 credit	Varies	Varies												21.3868	0.3214	4.5565	4.4323	0.8761	0.928	1.0328	0.6144	2.6599	0.438	1.9699	0	0.0747	1.2959	4.0611	8.2813	0.1263	0.492	3.2288	2.4182	0.438	0.2157	0	0.2925	0.3005	0.0011	0.0791	0	0	0.0846											60.6059			25.5151	0.589545228	7.17796348	4.432301014	2.676562089	2.07909461	1.917827963	1.191299267	6.256691807	3.035481979	4.487275823	0	0.207148858	2.338739037	4.684755085	19.06008777	0.470012415	1.747866505	5.385372547	11.33767964	1.218476789	0.215708015	0	0.974970435	0.531877757	0.328568918	0.178304767	0	0	0.084583214	0	0	0	0	0	0	0	0	0	0	108.1232
H6642_003_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1521.891911	41.48699051	1368.431588	3461.26917	249.9079145	8.958221903	10.07752274	222.1609575	29.93447269	1216.33097	1392.11971	0	0.932846122	529.497877	7899.669217	10387.36505	209.8165222	769.0519192	4659.89846	13314.16748	5.5014092	80.63440303	0	2924.911305	393.8813904	280.5608719	168.8063102	20.77867219	5955	1847.421983											3400	"$200 copay, days 1-5"	"$200 copay, days 1-5"	"$75 copay, days 11-50"	$0 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$25 copay to $150 copay	$0 copay	20% coinsurance	Varies	$0 copay	$25 copay	"$25 copay Group, $25 copay Individual"	$25 copay	$25 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$10 copay	$10 copay; and $100 credit covered every 1years	$10 copay	$250 credit	Varies	Varies											78.54	74.63090677	24.64894902	0	87.5	0.14	0.102357395	31.5	0.139769359	26.25	26.36806417	0	0.14	28.22861941	0.939882112	12.93060465	17.5	17.5	7.760264146	8.947117505	0.14	0	0	2.8	7	14	7	0	0	0											NO	36.59882081	74.63090677	16.03984497	0	87.5	0.121886658	0.084244052	31.5	0.121656016	26.25	22.56690284	0	0.14	21.58040373	0	10.93648549	17.5	17.5	5.925206161	8.194671992	0.14	0	0	2.8	7	14	7	0	0	0												4.6416	0.258017643	1.82911921	0	1.82224521	1.091887726	0.848971353	0.583172513	3.641708691	2.660723997	2.617985853	0	0.130598457	0.952231496	0	9.466772266	0.305982428	1.121534049	2.300904922	9.092102949	0.770197288	0	0	0.682479305	0.229764144	0.327321017	0.098470348	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4738		13.01880777	4.6416	0.258017643	1.82911921	0	1.82224521	1.091887726	0.848971353	0.583172513	3.641708691	2.660723997	2.617985853	0	0.130598457	0.952231496	0	9.466772266	0.305982428	1.121534049	2.300904922	9.092102949	0.770197288	0	0	0.682479305	0.229764144	0.327321017	0.098470348	0	0	0	0	0	0	0	0	0	0	0	0	0	45.4738	NO	"30% copay, days 1-180"	"30% copay, days 1-180"	"30% copay, days 1-180"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, waived if admitted"	30% coinsurance	30% coinsurance	30% coinsurance	$0 copay	30% coinsurance	Varies	30% coinsurance	30% coinsurance	"30% coinsurance Group, 30% coinsurance Individual"	30% coinsurance	30% coinsurance	Varies	30% coinsurance	Varies	Not Covered	$4 copay	30% coinsurance	30% coinsurance; and 30% coinsurance covered every 1years	30% coinsurance	$250 credit	Varies	Varies												21.1389	0.3172	4.5129	4.5538	0.8142	0.8611	0.9584	0.6102	2.6335	0.434	1.9503	0	0.0739	1.2836	4.0736	8.3528	0.1373	0.5355	3.1117	2.5145	0.4337	0.2136	0	0.2925	0.298	0.0011	0.0785	0	0	0.0839											60.2688			25.7805	0.575177652	6.34205104	4.553790164	2.636450262	1.953003848	1.807331567	1.193366512	6.275178927	3.094697316	4.568292329	0	0.204538511	2.235814654	4.07357929	17.81960282	0.443324251	1.657074214	5.412582255	11.60662573	1.203916695	0.213622991	0	0.974970435	0.527769013	0.328466251	0.17695516	0	0	0.083893415	0	0	0	0	0	0	0	0	0	0	105.7426
H6642_004_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	O	T	V	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	0	0	0	0	0											0	YES	1635.717128	44.98808691	1235.844175	3433.070795	247.4084743	9.245249766	10.4006464	219.1871471	31.89650052	1200.050674	1373.460652	0	0.995005574	522.9308364	8153.135448	10277.20304	196.4034156	717.7690367	4583.562218	12419.17155	5.852206527	79.58442654	0	2924.911305	397.3085061	278.2751899	170.275074	20.60939186	5955	1849.836192											3400	"$200 copay, days 1-5"	"$200 copay, days 1-5"	"$150 copay, days 6-20"	$0 copay	$125 copay	20% coinsurance	20% coinsurance	"$50 copay, waived if admitted"	10% coinsurance to 25% coinsurance	$37.5 copay to 20% coinsurance	$25 copay to $150 copay	$0 copay	20% coinsurance	Varies	$0 copay	$20 copay	"$20 copay Group, $20 copay Individual"	$20 copay	$25 copay	Varies	20% coinsurance	Varies	Not Covered	$4 copay	$10 copay	$10 copay; and $100 credit covered every 1years	$10 copay	$250 credit	Varies	Varies											78.54	74.63090677	46.36094064	0	87.5	0.14	0.102357947	31.5	0.13979844	26.25	27.17738127	0	0.14	28.02075879	0.760929908	10.91830061	14	14	7.762629429	8.755605906	0.14	0	0	2.8	7	14	7	0	0	0											NO	38.32542898	74.63090677	37.98251209	0	87.5	0.122315129	0.084673076	31.5	0.122113569	26.25	23.16107568	0	0.14	21.00658239	0	8.938168103	14	14	6.019010638	8.013177311	0.14	0	0	2.8	7	14	7	0	0	0												5.2241	0.27979181	3.911705525	0	1.804020125	1.130833921	0.880654724	0.575366261	3.894995513	2.62511085	2.650902176	0	0.13930078	0.915415808	0	7.654947364	0.229137318	0.83739721	2.299042479	8.29308531	0.819308914	0	0	0.682479305	0.231763295	0.324654388	0.099327127	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5034		12.96052811	5.2241	0.27979181	3.911705525	0	1.804020125	1.130833921	0.880654724	0.575366261	3.894995513	2.62511085	2.650902176	0	0.13930078	0.915415808	0	7.654947364	0.229137318	0.83739721	2.299042479	8.29308531	0.819308914	0	0	0.682479305	0.231763295	0.324654388	0.099327127	0	0	0	0	0	0	0	0	0	0	0	0	0	45.5034	NO	"30% copay, days 1-180"	"30% copay, days 1-180"	"30% copay, days 1-180"	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	"30% coinsurance, waived if admitted"	30% coinsurance	30% coinsurance	30% coinsurance	$0 copay	30% coinsurance	Varies	30% coinsurance	30% coinsurance	"30% coinsurance Group, 30% coinsurance Individual"	30% coinsurance	30% coinsurance	Varies	30% coinsurance	Varies	Not Covered	$4 copay	30% coinsurance	30% coinsurance; and 30% coinsurance covered every 1years	30% coinsurance	$250 credit	Varies	Varies												22.5422	0.3388	4.0679	4.7572	0.8393	0.8883	0.9886	0.6424	2.8035	0.4608	2.0755	0	0.0787	1.364	4.2669	8.2309	0.1244	0.4843	2.9605	2.3547	0.4611	0.2271	0	0.2925	0.2962	0.0011	0.0789	0	0	0.0862											61.7118			27.7663	0.61854463	7.979556871	4.7571896	2.643306768	2.019128474	1.869265314	1.217796843	6.698446498	3.085941489	4.726412274	0	0.218020843	2.279384978	4.266925499	15.88582624	0.353489071	1.321649324	5.259546031	10.64777536	1.280371124	0.227090342	0	0.974970435	0.527954645	0.325790292	0.178259979	0	0	0.086192203	0	0	0	0	0	0	0	0	0	0	107.2151
H6793_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2060.056788	141.2266551	2698.282682	3469.401301	571.0391615	6.079670594	5.006079255	387.2024736	253.5434573	11456.16278	4526.141598	0	10.69440649	583.5058982	5028.218392	6037.097692	654.7600665	517.6173607	0	0	651.905785	1563.066216	1576.881712	315.6633207	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02033348	100	0	13.14050144	0	0	38.97960428	1.765126311	28.6562955	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.79045159	0	0	0.185222492	0.185222492	43.54611678	92.61124614	0	12.16958213	0	0	36.09949726	1.634705472	26.53895236	17.3558602	0	0	0	0	27.34179519	0	30	30	0	30	0	0	0												0	0	4.450019399	0	0	1.12609174	0.927238476	1.405097011	1.956747961	0	4.590104326	0	0	1.755355798	0.684971343	13.35152067	0.946993682	0	0	0	0	3.561419696	0	0.789158302	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8574	0	2.772884389	0	0	4.450019399	0	0	1.12609174	0.927238476	1.405097011	1.956747961	0	4.590104326	0	0	1.755355798	0.684971343	13.35152067	0.946993682	0	0	0	0	3.561419696	0	0.789158302	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8574	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.7387	0.0918	0.4623	0	0	0	0	0	0	0	0	0	0	0	0.6772	3.4218	0.1593	0	0	0	0.4038	0.3051	0	0	0.0202	0	0.0021	0	0	0											9.2824	0	0	3.7387	0.091773416	4.912271045	0	0	1.12609174	0.927238476	1.405097011	1.956747961	0	4.590104326	0	0	1.755355798	1.362185982	16.77336053	1.106342836	0	0	0	0.403795701	3.866526031	0	0.789158302	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1398
H6793_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	2060.056788	141.2266551	2698.282682	3469.401301	571.0391615	6.079670594	5.006079255	387.2024736	253.5434573	11456.16278	4526.141598	0	10.69440649	583.5058982	5028.218392	6037.097692	654.7600665	517.6173607	0	0	651.905785	1563.066216	1576.881712	315.6633207	109.2	145.92	15.89255327	9.5	2185.5	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0.2	0.2	47.02033348	100	0	13.14050144	0	0	38.97960428	1.765126311	28.6562955	18.74055358	0	0	0	0	29.52319111	0	30	30	0	30	0	0	0											NO	0	0	19.79045159	0	0	0.185222492	0.185222492	43.54611678	92.61124614	0	12.16958213	0	0	36.09949726	1.634705472	26.53895236	17.3558602	0	0	0	0	27.34179519	0	30	30	0	30	0	0	0												0	0	4.450019399	0	0	1.12609174	0.927238476	1.405097011	1.956747961	0	4.590104326	0	0	1.755355798	0.684971343	13.35152067	0.946993682	0	0	0	0	3.561419696	0	0.789158302	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8574	0	2.772884389	0	0	4.450019399	0	0	1.12609174	0.927238476	1.405097011	1.956747961	0	4.590104326	0	0	1.755355798	0.684971343	13.35152067	0.946993682	0	0	0	0	3.561419696	0	0.789158302	0.273	0	0.039731383	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8574	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.7387	0.0918	0.4623	0	0	0	0	0	0	0	0	0	0	0	0.6772	3.4218	0.1593	0	0	0	0.4038	0.3051	0	0	0.0202	0	0.0021	0	0	0											9.2824	0	0	3.7387	0.091773416	4.912271045	0	0	1.12609174	0.927238476	1.405097011	1.956747961	0	4.590104326	0	0	1.755355798	1.362185982	16.77336053	1.106342836	0	0	0	0.403795701	3.866526031	0	0.789158302	0.29325	0	0.041788757	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1398
H6793_003_0	2010	3	N/A																															D	D	D	V	T	O	Coin	V	V	O	O	V	O	O	V	V	V	V	V	V	S	O	T	V	P	P	P	P	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	YES	3313.657308	488.1018529	1695.775747	2480.101834	397.6346923	2690.575042	24.75447072	828.7505521	559.3340013	23377.05478	9182.667169	0	17.7271567	1290.136931	13129.70493	8687.152904	1661.823403	552.8621882	0	0	2917.19514	1887.622399	807.4176058	314.4594826	108.7835464	145.3635082	15.8319442	9.463770065	2177.165208	0											2500	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$75 Days 21-54 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a, 6a2); $0 n/c (6a1)"	$0 (10a)	$0 (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $30 (4b)"	$100 (9b)	$0/$0/$30 (8a1); $0 (8a2)	$0 (8b1); $100 (8b2); $30 (8b3)	Included in h.5.	$0 (12)	"$0 (3, 9d); $30 (5, 9c); $100 (9a)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $30 (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$30 (7b, 7d); $0 n/c (7b1); $0 (7f, 7f1)"	$0 (7e); $30 (7h)	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"$0 (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$30 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$30 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9); $0 (14a1, 14a6, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	21.36938268	0	0	0	0.107182926	48.9949856	100	0	13.81836735	0	0	38.92502671	0.488006138	29.7032295	19.22251364	0	0	0	0	29.73838588	0	30	0	0	30	0	0	0											NO	0	0	14.19543969	0	0	0	0.071200408	32.54681587	66.42887117	0	9.179385443	0	0	25.85745585	0.324176969	19.73152006	12.76929882	0	0	0	0	19.75487404	0	30	0	0	30	0	0	0												0	0	2.006023529	0	0	0	1.762528408	2.247765968	3.096327193	0	7.024270111	0	0	2.779971562	0.354695662	14.28422765	1.768359968	0	0	0	0	3.10747856	0	0.786148707	0	0	0.03957986	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2574	0	19.42218502	0	0	2.006023529	0	0	0	1.762528408	2.247765968	3.096327193	0	7.024270111	0	0	2.779971562	0.354695662	14.28422765	1.768359968	0	0	0	0	3.10747856	0	0.786148707	0	0	0.03957986	0	0	0	0	0	0	0	0	0	0	0	0	0	39.2574	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); $30 (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	30% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												6.7726	0.4228	0.3369	0	0	0	0	0	0	0	0	0	0	0	1.9636	6.4147	0.3745	0	0	0	1.3151	0.3479	0	0	0.0202	0	0.002	0	0	0											17.9703	0	0	6.7726	0.422828509	2.342932257	0	0	0	1.762528408	2.247765968	3.096327193	0	7.024270111	0	0	2.779971562	2.318285721	20.69888765	2.142817328	0	0	0	1.315131177	3.455347859	0	0.786148707	0.020172773	0	0.041629389	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2277
H6806_802_0	2010	3	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin											6.6179	0.0564	1.3554	0.0166	0.2618	0.348	0.093	0.3159	1.0088	0.7114	0.4351	0.0632	0.0055	0.9206	0.8867	3.4848	0.037	0.4608	1.0662	0.3149	1.0599	0.0195	0.0003		0.017		0.0001														19.5566	YES	323.6978903	4.438382043	1819.513687		305.8616478	13.7243911	3.667081599	281.2911696	39.78925775		487.4441817	41.59983169		58.46130193	2986.535151	7672.007018	175.9991393	1003.697249		9.918545328	41.80358484				225.6577086		0.784371715														2500	250 (Rider $0)	250 (Rider $0)	$0(day 1-15) $65 (days 16-100)	$0                                90/yr max	20.00%	20.00%	20.00%	$50 ER Copay;$50 UC Copay	$100 for OP Surgery and Cardiac Cath.;$100 for ASC	$0 Copay	"20.0% Copay for MRI, CT, Other Imaging, and Diag Rad.;0.0% Copay for Nuclear Med. and Radiation Therapy"	20%                                60 visit max/yr Copay	$0 Copay	"20.0% Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	20.0% Copay for Office Visits;$0 Copay for Preventive Services;20.0% Copay for PCP Ophthalmology Services	20.0% Copay for Office Visits;$0 Copay for Preventive Services	20%                                60 visit max/yr Copay	20.00%	No Cost Sharing	20% of the cost for diabetic related shoe inserts for foot inserts	20.0% Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	20.00%	No Coverage	20.00%	No Coverage	No Coverage	50.0% for Accupuncture											250	250	29.81552011		81.01487973	0.2	0.2	50	0.070976221		36.91485651	143.8194529		82.9668324	14.88380321	16.09374392	19.88328085	43.46098015		33.59378996	0.2				7.15073094		9.587118894														NO	194.9445042	194.9445042	23.24948714		63.17362224	0.155955603	0.155955603	38.98890084	0.055345697		28.7853936	112.1472478		64.69571203	11.60606255	12.54954771	15.50454531	33.88991691		26.19569891	0.155955603				5.575982791		7.475824558															5.2586	0.072103182	3.525230005	0	1.610199016	2.140395694	0.571901923	0.913936127	2.202164187	0	1.169272719	0.388775553	0	0.315182963	2.888492815	8.023351511	0.227398886	2.834601363	0	0.021651936	6.519503297	0	0	0	0.104855292	0	0.000488652	0	0	0	0	0	0	0	0	0	0	0	0	0	38.7881	250	10.95438942	11.8765	0.128490227	4.880596615	0.016632947	1.871974567	2.488367129	0.664877971	1.229786134	3.21099037	0.711381116	1.604347189	0.451980121	0.005455241	1.235790733	3.775223882	11.50811254	0.264367899	3.295432183	1.066171295	0.3365399	7.579401202	0.019546546	0.000282934	0	0.121901974	0	0.000568094	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3447	NO																																																																																		0	0	0	11.8765	0.128490227	4.880596615	0.016632947	1.871974567	2.488367129	0.664877971	1.229786134	3.21099037	0.711381116	1.604347189	0.451980121	0.005455241	1.235790733	3.775223882	11.50811254	0.264367899	3.295432183	1.066171295	0.3365399	7.579401202	0.019546546	0.000282934	0	0.121901974	0	0.000568094	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3447
H6864_001_0	2010	7	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	444.206	23.401	173.194	141.995	5.621	9.002	7.994	9.408	31.885	13.188	28.049	1.96	3.857	76.223	93.072	156.849	8.918	9.338	42.042	63.672	4.928	6.139	0	0	2.583	6.503	0.553	1.022	0.35	0												1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 20%, 9C OP Substance Abuse: 20% OP Substance Abuse (Group): 20%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0 (20% initial exam), 14D Pap Smears and Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 20% MH (Group): 20%, 7H Psychiatric: 20% Psychiatric (Group): 20%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $0, 7F Podiatry: $0, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): 20%, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Non Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											0.061567509	0.061571206	0.144636736	0	0.233051544	0.232999987	0.232988979	0.232687914	0.233000006	0.232967471	0.232969272	0.233000047	0.233000003	0.233000373	0.233000685	0.232999514	0.233001135	0.233011883	0.23300305	0.192056035	0.233000628	0.013283909	0	0	0	0	0	0	0	0											NO	0.061567509	0.061571206	0.144636736	0	0.233051544	0.232999987	0.232988979	0.232687914	0.233000006	0.232967471	0.232969272	0.233000047	0.233000003	0.233000373	0.233000685	0.232999514	0.233001135	0.233011883	0.23300305	0.192056035	0.233000628	0.013283909	0	0	0	0	0	0	0	0												27.3487	1.44082779	25.05021482	0	1.309982728	2.097465882	1.862513897	2.189127899	7.429205186	3.072375001	6.534555121	0.456680091	0.898681011	17.75998744	21.68583976	36.54574071	2.077904125	2.175864968	9.795914248	12.22859187	1.148227093	0.081549918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.1899	0	0	27.3487	1.44082779	25.05021482	0	1.309982728	2.097465882	1.862513897	2.189127899	7.429205186	3.072375001	6.534555121	0.456680091	0.898681011	17.75998744	21.68583976	36.54574071	2.077904125	2.175864968	9.795914248	12.22859187	1.148227093	0.081549918	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	183.1899	NO	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 20%, 9C OP Substance Abuse: 20% OP Substance Abuse (Group): 20%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0 (20% initial exam), 14D Pap Smears and Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 20% MH (Group): 20%, 7H Psychiatric: 20% Psychiatric (Group): 20%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $0, 7F Podiatry: $0, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): 20%, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Non Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered												17.3104	1.0115	14.7696	0	2.1014	2.1809	2.0513	1.8602	3.5356	1.454	3.0783	0.2139	0.4215	8.2828	11.1492	18.2608	1.0988	1.1414	4.8691	6.1794	0.664	0.0475	0	0	0	0	0	0	0	0											101.6816	0	0	44.6591	2.452320237	39.81984008	0	3.411358032	4.278343211	3.913765617	4.04928998	10.96475535	4.526405851	9.612816691	0.670568709	1.320178024	26.04278158	32.83507253	54.80655863	3.176705222	3.317261752	14.6650151	18.40800741	1.812272042	0.129081804	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	284.8715
H6900_001_0	2010	9	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	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	YES	1258.536298	57.328615	684.561211	534.057644	44.932034	8.242884	3.862114	351.833099	436.861957	1497.16827	1086.347499	100.080851	0.038663	615.178151	3818.466625	4391.321289	82.766221	717.403168			16.35686	0		2.55	2.69				0.04	0.25	9.871689	0.05	0.55	2.68	0.32	0.4	0.42				3700	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	99.894362	88.342889	24.600254	0	121.23045	0.161641	0.161641	40.41015	106.555164	62.93386	82.800567	121.23045	0.161641	92.147752	8.08203	24.24609	24.24609	40.903612			0.161641	0		0	0				0	0	0	0	0	0	0	0	0					10.4767	0.422047956	1.403364972	0	0.453927558	1.332388013	0.624275969	1.184802359	3.879158123	7.851881525	7.495849073	1.01107055	0.006249526	4.723940308	2.571746818	8.872697599	0.16722977	2.445365069	0	0	2.643939207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5667	0	14.807015	10.4767	0.422047956	1.403364972	0	0.453927558	1.332388013	0.624275969	1.184802359	3.879158123	7.851881525	7.495849073	1.01107055	0.006249526	4.723940308	2.571746818	8.872697599	0.16722977	2.445365069	0	0	2.643939207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.5667	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-80%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.8597	0.0932	0.3236	1.2562	1.594	1.1568	0.542	0.1836	2.2306	0.2959	0.9495	0.1589	0.001	0.646	1.1348	1.9484	0.0193	0.188			0.5631	0		0	0				0	0	0	0	0	0	0	0	0				20.1446	0	11.074488	17.3365	0.515247956	1.726963972	1.256174	2.047913558	2.489216013	1.166294969	1.368353359	6.109799123	8.147743525	8.445370073	1.16999655	0.007268526	5.369936308	3.706519818	10.8210816	0.18656877	2.633328069	0	0	3.207022207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.7113
H6900_002_0	2010	7	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	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	YES	1262.769235	57.521433	686.863652	535.853883	45.083157	8.876336	4.158911	353.016448	438.331291	1502.203817	1090.0013	100.417462	0.041634	617.247229	3831.309584	4406.090977	83.044596	719.816068			17.613855	0		2.55	2.69				0.04	0.25	9.904891	0.05	0.55	2.68	0.32	0.4	0.42				3700	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	99.601843	88.084196	24.467425	0	120.96855	0.161291	0.161291	40.32285	106.324967	62.797901	82.621688	120.96855	0.161291	91.948681	8.06457	24.19371	24.19371	40.815245			0.161291	0		0	0				0	0	0	0	0	0	0	0	0					10.4812	0.422227432	1.400482074	0	0.454470344	1.43167311	0.670794914	1.186219107	3.883796671	7.861270548	7.504812277	1.012279564	0.006715189	4.729589046	2.574822028	8.883307278	0.167429739	2.448289098	0	0	2.840956287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9603	0	15.075625	10.4812	0.422227432	1.400482074	0	0.454470344	1.43167311	0.670794914	1.186219107	3.883796671	7.861270548	7.504812277	1.012279564	0.006715189	4.729589046	2.574822028	8.883307278	0.167429739	2.448289098	0	0	2.840956287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.9603	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-80%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	7.0152	0.0953	0.3147	1.717	2.0301	1.5812	0.7409	0.2338	3.049	0.4044	1.2979	0.2172	0.0014	0.883	1.5511	2.6632	0.0264	0.2569			0.7697	0		0	0				0	0	0	0	0	0	0	0	0				24.8484	500	13.235192	17.4964	0.517539432	1.715137074	1.717034	2.484569344	3.01291311	1.411666914	1.419989107	6.932805671	8.265677548	8.802688277	1.229511564	0.008108189	5.612585046	4.125915028	11.54650628	0.193863739	2.705212098	0	0	3.610620287	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.8087
H6900_004_0	2010	9	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	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	YES	1209.358474	55.088475	657.8117	513.189122	43.176296	8.313287	3.8951	338.085076	419.791397	1438.665804	1043.898026	96.170151	0.038994	591.139812	3669.258471	4219.728604	79.532097	689.370344			16.496562	0		2.55	2.69				0.04	0.25	9.485949	0.05	0.55	2.68	0.32	0.4	0.42				3700	$175/Day(Days 1-7):1a	$175/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	"$30-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $30 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				123.4779	109.1993	50.7565	0	150	0.2	0.2	50	131.842079	77.868877	102.450209	150	0.2	114.015603	10	30	30	50.610566			0.2	0		0	0				0	0	0	0	0	0	0	0	0				NO	101.259904	89.550524	25.451999	0	122.30805	0.163077	0.163077	40.76935	107.502317	63.49327	83.536569	122.30805	0.163077	92.96684	8.15387	24.46161	24.46161	41.267198			0.163077	0		0	0				0	0	0	0	0	0	0	0	0					10.205	0.41110015	1.395218561	0	0.440067381	1.355705904	0.635201223	1.148625733	3.76071232	7.612133028	7.266971623	0.980198636	0.006359025	4.579700027	2.493221381	8.601779618	0.162123595	2.37069854	0	0	2.690209841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.115	0	13.702052	10.205	0.41110015	1.395218561	0	0.440067381	1.355705904	0.635201223	1.148625733	3.76071232	7.612133028	7.266971623	0.980198636	0.006359025	4.579700027	2.493221381	8.601779618	0.162123595	2.37069854	0	0	2.690209841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.115	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		50%-80%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.8838	0.0935	0.3232	1.2646	1.529	1.1646	0.5457	0.1761	2.2457	0.2979	0.9559	0.16	0.001	0.6503	1.1424	1.9615	0.0195	0.1892			0.5669	0		0	0				0	0	0	0	0	0	0	0	0				20.1707	0	11.195706	17.0888	0.50462715	1.718372561	1.264635	1.969026381	2.520325904	1.180871223	1.324688733	6.00637832	7.909988028	8.222887623	1.140194636	0.007385025	5.230047027	3.635637381	10.56328762	0.181592595	2.55992854	0	0	3.257084841	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.2857
H6900_801_0	2010	4	N/A																															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	NO	239.5095	0.816992	41.585703	13.437822	1.575863	7.286583	3.561772	17.568108	50.023832	10.79954	25.746929	9.101691	0.799644	16.479116	30.583156	67.071944	0.322313	4.991296			21.799988	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																			0.082174788	0.082174788	0.17608	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.082174788	0.082174788	0.17608	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.6816	0.067136145	7.32241057	0	0.367176079	1.697773839	0.829892876	4.093369164	11.65555286	2.51629282	5.999034457	2.120694003	0.186317052	3.839634028	7.125875348	15.62776295	0.075098929	1.162971968	0	0	5.079397204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.448	0	0	19.6816	0.067136145	7.32241057	0	0.367176079	1.697773839	0.829892876	4.093369164	11.65555286	2.51629282	5.999034457	2.120694003	0.186317052	3.839634028	7.125875348	15.62776295	0.075098929	1.162971968	0	0	5.079397204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.448	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.6638	0.0125	1.3631	0	1.4687	1.1194	0.5472	1.0793	2.8086	0.6635	1.4383	0.5591	0.0492	1.0048	1.3427	2.9445	0.0141	0.2497			0.957	0																			21.2855	0	0	23.3454	0.079626712	8.685533887	0	1.835891579	2.817222339	1.377093376	5.172625164	14.46413486	3.17976032	7.437343457	2.679777503	0.235480052	4.844446528	8.468537848	18.57230045	0.089195429	1.412631468	0	0	6.036444704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7335
H6900_802_0	2010	3	N/A																															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	NO	239.5095	0.816992	41.585703	13.437822	1.575863	7.286583	3.561772	17.568108	50.023832	10.79954	25.746929	9.101691	0.799644	16.479116	30.583156	67.071944	0.322313	4.991296			21.799988	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																			0.082174569	0.082174569	0.176081971	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.082174569	0.082174569	0.176081971	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.6816	0.067135965	7.322492557	0	0.367176079	1.697773839	0.829892876	4.093369164	11.65555286	2.51629282	5.999034457	2.120694003	0.186317052	3.839634028	7.125875348	15.62776295	0.075098929	1.162971968	0	0	5.079397204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4481	0	0	19.6816	0.067135965	7.322492557	0	0.367176079	1.697773839	0.829892876	4.093369164	11.65555286	2.51629282	5.999034457	2.120694003	0.186317052	3.839634028	7.125875348	15.62776295	0.075098929	1.162971968	0	0	5.079397204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4481	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.6638	0.0125	1.3631	0	1.4687	1.1194	0.5472	1.0793	2.8086	0.6635	1.4383	0.5591	0.0492	1.0048	1.3427	2.9445	0.0141	0.2497			0.957	0																			21.2855	0	0	23.3454	0.0796265	8.685631137	0	1.835891579	2.817222339	1.377093376	5.172625164	14.46413486	3.17976032	7.437343457	2.679777503	0.235480052	4.844446528	8.468537848	18.57230045	0.089195429	1.412631468	0	0	6.036444704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7335
H6900_803_0	2010	3	N/A																															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	NO	239.5095	0.816992	41.585703	13.437822	1.575863	7.286583	3.561772	17.568108	50.023832	10.79954	25.746929	9.101691	0.799644	16.479116	30.583156	67.071944	0.322313	4.991296			21.799988	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																			0.082174569	0.082174569	0.176081971	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.082174569	0.082174569	0.176081971	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.6816	0.067135965	7.322492557	0	0.367176079	1.697773839	0.829892876	4.093369164	11.65555286	2.51629282	5.999034457	2.120694003	0.186317052	3.839634028	7.125875348	15.62776295	0.075098929	1.162971968	0	0	5.079397204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4481	0	0	19.6816	0.067135965	7.322492557	0	0.367176079	1.697773839	0.829892876	4.093369164	11.65555286	2.51629282	5.999034457	2.120694003	0.186317052	3.839634028	7.125875348	15.62776295	0.075098929	1.162971968	0	0	5.079397204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4481	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.6638	0.0125	1.3631	0	1.4687	1.1194	0.5472	1.0793	2.8086	0.6635	1.4383	0.5591	0.0492	1.0048	1.3427	2.9445	0.0141	0.2497			0.957	0																			21.2855	0	0	23.3454	0.0796265	8.685631137	0	1.835891579	2.817222339	1.377093376	5.172625164	14.46413486	3.17976032	7.437343457	2.679777503	0.235480052	4.844446528	8.468537848	18.57230045	0.089195429	1.412631468	0	0	6.036444704	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7335
H6923_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.01161831	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6718.828576	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0											5000	$200/day 1-5	$200/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$35 per visit	$50 X-ray; $200 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$25 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$50 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	$50 Every 2 Yrs	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											122.5677481	122.5677481	47.56208437	0	100	0.2	0.2	47.5	200	5.25	39.25	35	25	35	25	35	35	35	50	35	$45 	0	0	0	0	0	0	0	0	0											NO	75.74525836	75.74525836	29.39274339	0	100	0.123597373	0.123597373	47.5	123.5973729	5.25	39.25	35	25	35	25	35	35	35	50	35	$45 	0	0	0	0	0	0	0	0	0												10.8126	0.480633492	2.859795939	0	1.956222648	1.237409721	0	0.957869753	4.135336866	0.957372935	9.47077346	0.157116481	0.000725633	0	9.627745183	19.59658335	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5426	0	12.07	10.8126	0.480633492	2.859795939	0	1.956222648	1.237409721	0	0.957869753	4.135336866	0.957372935	9.47077346	0.157116481	0.000725633	0	9.627745183	19.59658335	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5426	NO																																																																																		0			10.8126	0.480633492	2.859795939	0	1.956222648	1.237409721	0	0.957869753	4.135336866	0.957372935	9.47077346	0.157116481	0.000725633	0	9.627745183	19.59658335	0.632103257	1.617802048	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.5426
H6923_003_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	1712.993747	76.14472548	1167.551828	819.8933466	234.7467178	10.43992661	0	241.9881482	401.4975499	2188.280994	2895.523096	53.86850793	0.348303762	0	4621.317688	6413.004004	216.7211165	554.6749878	0	0	278	0	0	0	935.2732559	0	55.30506091	0	5.678551417	0											2500	$100/day 1-5	$100/day 1-5	"$0/d 1-10, $75/d 11-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$150 per procedure	$25 per visit	$50 X-ray; $125 Complex Radiology	$25 per visit	$25 per visit	$25 per visit	$0 PCP visit; $25 if no PCP selected	$25 per visit	$25 per visit	$25 per visit	$50 per visit	$25 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$500 Every 3 Yrs	Fitness/Coaching	0											61.28387407	61.28387407	47.56208437	0	100	0.2	0.2	47.5	150	3.75	32.125	25	25	25	0	25	25	25	50	25	$45 	0	0	0	0	0	0	0	0	0											NO	27.86925152	27.86925152	21.6291759	0	100	0.090951337	0.090951337	47.5	68.21350301	3.75	32.125	25	25	25	0	25	25	25	50	25	$45 	0	0	0	0	0	0	0	0	0												3.9783	0.176841376	2.104431988	0	1.956222648	0.949525287	0	0.957869753	2.282296194	0.683837811	7.751556621	0.112226058	0.000725633	0	0	13.36042501	0.451502326	1.155572891	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9639	0	11.38	3.9783	0.176841376	2.104431988	0	1.956222648	0.949525287	0	0.957869753	2.282296194	0.683837811	7.751556621	0.112226058	0.000725633	0	0	13.36042501	0.451502326	1.155572891	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9639	NO																																																																																		0			3.9783	0.176841376	2.104431988	0	1.956222648	0.949525287	0	0.957869753	2.282296194	0.683837811	7.751556621	0.112226058	0.000725633	0	0	13.36042501	0.451502326	1.155572891	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9639
H6923_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	336.375019	5.169162635	45.04839693	6.981835995	8.931895058	11.2770769	0	11.2710559	38.53968328	13.33592307	58.60375648	0.782171958	0.014880301	25.69312221	20.40928486	128.6428423	2.476381435	6.387308123	0	-1.01E-08	66.96020352	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.075207313	0.075207313	0.147620394	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075207313	0.075207313	0.147620394	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.2979	0.388758832	6.650062101	0	2.081131549	2.627558917	0	2.626156024	8.979746204	3.107270076	13.65467526	0.182246066	0.00346711	5.986497475	4.755363373	29.97378226	0.576996874	1.488242793	0	-2.35E-09	15.60172742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9815			25.2979	0.388758832	6.650062101	0	2.081131549	2.627558917	0	2.626156024	8.979746204	3.107270076	13.65467526	0.182246066	0.00346711	5.986497475	4.755363373	29.97378226	0.576996874	1.488242793	0	-2.35E-09	15.60172742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9815	NO																																																																																		0			25.2979	0.388758832	6.650062101	0	2.081131549	2.627558917	0	2.626156024	8.979746204	3.107270076	13.65467526	0.182246066	0.00346711	5.986497475	4.755363373	29.97378226	0.576996874	1.488242793	0	-2.35E-09	15.60172742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9815
H6923_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	336.375019	5.169162635	45.04839693	6.981835995	8.931895058	11.2770769	0	11.2710559	38.53968328	13.33592307	58.60375648	0.782171958	0.014880301	25.69312221	20.40928486	128.6428423	2.476381435	6.387308123	0	-1.01E-08	66.96020352	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.075207313	0.075207313	0.147620394	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.075207313	0.075207313	0.147620394	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												25.2979	0.388758832	6.650062101	0	2.081131549	2.627558917	0	2.626156024	8.979746204	3.107270076	13.65467526	0.182246066	0.00346711	5.986497475	4.755363373	29.97378226	0.576996874	1.488242793	0	-2.35E-09	15.60172742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9815			25.2979	0.388758832	6.650062101	0	2.081131549	2.627558917	0	2.626156024	8.979746204	3.107270076	13.65467526	0.182246066	0.00346711	5.986497475	4.755363373	29.97378226	0.576996874	1.488242793	0	-2.35E-09	15.60172742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9815	NO																																																																																		0			25.2979	0.388758832	6.650062101	0	2.081131549	2.627558917	0	2.626156024	8.979746204	3.107270076	13.65467526	0.182246066	0.00346711	5.986497475	4.755363373	29.97378226	0.576996874	1.488242793	0	-2.35E-09	15.60172742	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.9815
H6952_001_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.4514	0.7261	0.4213	0	1.2774	0	1.1769	0	0.0693	1.4486	1.9292	3.0654	0.281	0.1422	0	0	0.5807	0.1091	0	0	0	0	0	0	0	0											11.6787	NO	278.6032845	12.96201653	12.31704205	1988.755505	9.896734415	16.26887715	9.108851472	22.6118255	50.03344012	19.0858608	43.74163546	0	0.566656328	41.67510038	54.15008166	102.0209638	9.285100734	4.114701958	0	0	20.00565344	5.309481035	620.9308275	0	110.8805049	189.2360617	0	0	3696.01683	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14c, 14e, 14f, 14g, 14h, 14i, 14j); $0/20% (14b, 14d); $0 n/c (14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 17a, 18a); $0 n/c (13a1); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.070147949	0.070147949	0.165749144	0	0.193551622	0.193551622	0.193551622	0.103172714	0.193551622	0.015299977	0.163923436	0	0.193551622	0.144794091	0.189192334	0.193262377	0.435491149	0.193551622	0	0	0.193551622	0.14563526	0	0	0	0	0	0	0	0											NO	0.070147949	0.070147949	0.165749144	0	0.193551622	0.193551622	0.193551622	0.103172714	0.193551622	0.015299977	0.163923436	0	0.193551622	0.144794091	0.189192334	0.193262377	0.435491149	0.193551622	0	0	0.193551622	0.14563526	0	0	0	0	0	0	0	0												19.5434	0.909258881	2.041539182	0	1.915528997	3.148867557	1.763032975	2.332923405	9.68405348	0.29201324	7.170279198	0	0.109677251	6.034308266	10.24478032	19.71681399	4.043579188	0.796407237	0	0	3.872126669	0.773247649	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.3919	146	0	19.5434	0.909258881	2.041539182	0	2.366968879	3.874986163	2.184293277	2.332923405	10.96149856	0.29201324	8.347180389	0	0.178980055	7.4829465	12.17400369	22.78225239	4.324552701	0.938618507	0	0	4.452801314	0.882320049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0706	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	19.5434	0.909258881	2.041539182	0	2.366968879	3.874986163	2.184293277	2.332923405	10.96149856	0.29201324	8.347180389	0	0.178980055	7.4829465	12.17400369	22.78225239	4.324552701	0.938618507	0	0	4.452801314	0.882320049	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.0706
H6952_002_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.4513	0.726	0.4212	0	1.2772	0	1.1766	0	0.0693	1.4483	1.9288	3.0648	0.2809	0.1422	0	0	0.5805	0.109	0	0	0	0	0	0	0	0											11.6761	NO	277.7906852	12.92421036	12.28111706	1985.853096	9.867868716	16.22142589	9.082283782	22.54590618	49.88750812	19.03019328	43.6140547	0	0.565003567	41.55354706	53.9921427	101.7237539	9.25801898	4.10270065	0	0	19.94730316	5.293994928	620.9308275	0	110.8805049	189.2360617	0	0	3696.01683	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	20%/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1, 14c, 14e, 14f, 14g, 14h, 14i, 14j); $0/20% (14b, 14d); $0 n/c (14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"45% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 16b, 17a, 18a); $0 n/c (13a1); $0 (17b)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 (14a1, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.070325811	0.070325811	0.165822604	0	0.19353418	0.19353418	0.19353418	0.103279263	0.19353418	0.015299977	0.163908665	0	0.19353418	0.144781043	0.189175944	0.193244117	0.435451906	0.19353418	0	0	0.19353418	0.145623166	0	0	0	0	0	0	0	0											NO	0.070325811	0.070325811	0.165822604	0	0.19353418	0.19353418	0.19353418	0.103279263	0.19353418	0.015299977	0.163908665	0	0.19353418	0.144781043	0.189175944	0.193244117	0.435451906	0.19353418	0	0	0.19353418	0.145623166	0	0	0	0	0	0	0	0												19.5359	0.908905579	2.036486811	0	1.909769885	3.139400365	1.757732349	2.328524581	9.654938	0.291161528	7.148721477	0	0.109347502	6.016165885	10.21401454	19.65751699	4.031422011	0.794012808	0	0	3.860484971	0.770928301	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	94.1654	146	0	19.5359	0.908905579	2.036486811	0	2.361110525	3.865359344	2.178900042	2.328524581	10.93210225	0.291161528	8.325363943	0	0.178635071	7.464485657	12.14281381	22.72227879	4.312333756	0.936192815	0	0	4.441031963	0.879976723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8415	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	146	0	19.5359	0.908905579	2.036486811	0	2.361110525	3.865359344	2.178900042	2.328524581	10.93210225	0.291161528	8.325363943	0	0.178635071	7.464485657	12.14281381	22.72227879	4.312333756	0.936192815	0	0	4.441031963	0.879976723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.8415
H7002_002_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1130.044169	63.411074	424.42664	253.397442	41.590773	9.346873	4.124412	345.977904	411.028149	779.290243	1011.887346	75.979582	13.669328	582.443529	4002.251736	5140.354039	80.430696	984.296479			30.199454	0							0.04	0.25	0.05	0.55	2.87	0.32	0.4	0.42					3400	$175/Day(Days 1-5):1a	$175/Day(Days 1-5):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $125 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$10-$100/Visit:9d. $10 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $10 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$10/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					106.167425	88.6746	58.254672	0	100	0.2	0.2	50	125	48.853712	70.085961	50	5.007508	60.111526	10	35	35	10			0.2	0							0	0	0	0	0	0	0	0					NO	90.076265	75.234723	33.130073	0	83.291	0.166582	0.166582	41.6455	104.11375	40.690745	58.375297	41.6455	4.170804	50.067491	8.3291	29.15185	29.15185	8.3291			0.166582	0							0	0	0	0	0	0	0	0						8.4825	0.397559549	1.171773797	0	0.288678089	1.557020798	0.6870528	1.2007019	3.566140162	2.642491713	4.922435363	0.263683974	0.004751007	2.430123846	2.777929578	12.48756916	0.195391965	0.683191984	0	0	5.030685446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7897	0	10.246156	8.4825	0.397559549	1.171773797	0	0.288678089	1.557020798	0.6870528	1.2007019	3.566140162	2.642491713	4.922435363	0.263683974	0.004751007	2.430123846	2.777929578	12.48756916	0.195391965	0.683191984	0	0	5.030685446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7897	YES	20% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					6000	5.6984	0.1484	0.2922	1.3378	0.9522	1.6931	0.7471	0.1747	2.9303	0.3262	1.3336	0.2265	0.0007	0.591	1.7673	3.1252	0.0264	0.3388			1.0479	0							0	0	0	0	0	0	0	0					22.7578	0	12.399608	14.1809	0.545992549	1.463930797	1.337835	1.240860089	3.250111798	1.4341478	1.3754259	6.496402162	2.968732713	6.256084363	0.490154974	0.005442007	3.021152846	4.545215578	15.61280216	0.221759965	1.021983984	0	0	6.078632446	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5475
H7002_805_0	2010	5	N/A																															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	NO	313.854082	1.07059	54.49405	17.608968	2.065017	9.548364	4.667359	23.021309	65.551405	14.151755	33.738869	11.926888	1.047855	21.594287	40.076274	87.891307	0.42236	6.54061			28.566779	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																			0.079191979	0.079191979	0.21882776	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079191979	0.079191979	0.21882776	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				24.8547	0.084782141	11.9248109	0	0.481148961	2.224768812	1.087494647	5.363964997	15.27347737	3.297358915	7.861156477	2.778964904	0.244150215	5.031468871	9.337771842	20.47867453	0.09840988	1.52396213	0	0	6.656059507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6032	0	0	24.8547	0.084782141	11.9248109	0	0.481148961	2.224768812	1.087494647	5.363964997	15.27347737	3.297358915	7.861156477	2.778964904	0.244150215	5.031468871	9.337771842	20.47867453	0.09840988	1.52396213	0	0	6.656059507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6032	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.6268	0.0158	2.2198	0	1.9246	1.4669	0.7171	1.4142	3.6804	0.8693	1.8847	0.7327	0.0644	1.3168	1.7594	3.8586	0.0185	0.3272			1.2541	0																			28.1512	0	0	29.4815	0.100580941	14.1445997	0	2.405728961	3.691620312	1.804552147	6.778158497	18.95382887	4.166681915	9.745893477	3.511633404	0.308574715	6.348268371	11.09715484	24.33727103	0.11693338	1.85121063	0	0	7.910182007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.7544
H7002_806_0	2010	4	N/A																															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	NO	313.854082	1.07059	54.49405	17.608968	2.065017	9.548364	4.667359	23.021309	65.551405	14.151755	33.738869	11.926888	1.047855	21.594287	40.076274	87.891307	0.42236	6.54061			28.566779	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																			0.079191979	0.079191979	0.21882776	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079191979	0.079191979	0.21882776	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				24.8547	0.084782141	11.9248109	0	0.481148961	2.224768812	1.087494647	5.363964997	15.27347737	3.297358915	7.861156477	2.778964904	0.244150215	5.031468871	9.337771842	20.47867453	0.09840988	1.52396213	0	0	6.656059507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6032	0	0	24.8547	0.084782141	11.9248109	0	0.481148961	2.224768812	1.087494647	5.363964997	15.27347737	3.297358915	7.861156477	2.778964904	0.244150215	5.031468871	9.337771842	20.47867453	0.09840988	1.52396213	0	0	6.656059507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6032	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.6268	0.0158	2.2198	0	1.9246	1.4669	0.7171	1.4142	3.6804	0.8693	1.8847	0.7327	0.0644	1.3168	1.7594	3.8586	0.0185	0.3272			1.2541	0																			28.1512	0	0	29.4815	0.100580941	14.1445997	0	2.405728961	3.691620312	1.804552147	6.778158497	18.95382887	4.166681915	9.745893477	3.511633404	0.308574715	6.348268371	11.09715484	24.33727103	0.11693338	1.85121063	0	0	7.910182007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.7544
H7002_807_0	2010	5	N/A																															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	NO	313.854082	1.07059	54.49405	17.608968	2.065017	9.548364	4.667359	23.021309	65.551405	14.151755	33.738869	11.926888	1.047855	21.594287	40.076274	87.891307	0.42236	6.54061			28.566779	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																			0.079191979	0.079191979	0.21882776	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079191979	0.079191979	0.21882776	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				24.8547	0.084782141	11.9248109	0	0.481148961	2.224768812	1.087494647	5.363964997	15.27347737	3.297358915	7.861156477	2.778964904	0.244150215	5.031468871	9.337771842	20.47867453	0.09840988	1.52396213	0	0	6.656059507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6032	0	0	24.8547	0.084782141	11.9248109	0	0.481148961	2.224768812	1.087494647	5.363964997	15.27347737	3.297358915	7.861156477	2.778964904	0.244150215	5.031468871	9.337771842	20.47867453	0.09840988	1.52396213	0	0	6.656059507	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.6032	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				4.6268	0.0158	2.2198	0	1.9246	1.4669	0.7171	1.4142	3.6804	0.8693	1.8847	0.7327	0.0644	1.3168	1.7594	3.8586	0.0185	0.3272			1.2541	0																			28.1512	0	0	29.4815	0.100580941	14.1445997	0	2.405728961	3.691620312	1.804552147	6.778158497	18.95382887	4.166681915	9.745893477	3.511633404	0.308574715	6.348268371	11.09715484	24.33727103	0.11693338	1.85121063	0	0	7.910182007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	146.7544
H7006_001_0	2010	5	N/A																															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	V	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	YES	511.7008395	10.52265518	0	0	120.7358721	7.703130453	4.7030765	188.9754818	275.9721412	0	0	0	0	243.797762	2775.658353	2499.417098	115.8009917	336.9402418	0	751.4341905	5.198425445	0	0	0	232.4039733	0	0	0	0	0											1200	$100/Days Custom for IP Medical; $100/Days Custom for IP Surgical;	$100/Days Custom for IP Psych; $100/Days Custom for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Visit for Prof - CORF; $15/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Exam for PCP - Routine Physicals;	$15/Visit for Speclst - Office Visits; $15/Consult for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $15/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	0	0	50	0.1	0.1	47.48924934	74.91935784	0	0	0	0	15	15	15	15	15	0	15	0.2	0	0	0	15	0	0	0	0	0											YES	83.03260185	83.03260194	0	0	41.51630092	0.083032602	0.083032602	39.43155933	62.20749211	0	0	0	0	12.45489028	12.49639383	12.45489028	12.45489028	12.45489028	0	12.45489028	0.166065204	0	0	0	15	0	0	0	0	0											2200	3.5407	0.072810287	0	0	0.4177089	0.639610964	0.390508678	0.620966494	1.4306279	0	0	0	0	0.253039531	2.89047666	2.594163809	0.120190721	0.349712812	0	0.779919199	0.863277581	0	0	0	0.290504967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2542	0	3.046207244	3.5407	0.072810287	0	0	0.4177089	0.639610964	0.390508678	0.620966494	1.4306279	0	0	0	0	0.253039531	2.89047666	2.594163809	0.120190721	0.349712812	0	0.779919199	0.863277581	0	0	0	0.290504967	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.2542	YES	$200/Days Custom for IP Medical; $200/Days Custom for IP Surgical;	$200/Days Custom for IP Psych; $200/Days Custom for IP Substance Abuse;	$50/Day for SNF	20% Coinsurance for Home Health	$50/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$200/Case for ER - Facility; $200/Case for ER - Worldwide; $30/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $30/Visit for Prof - CORF; $30/Visit for Prof - CORF;	$30/Visit for PCP - Office Visits; $30/Consult for PCP - Consults; $30/Exam for PCP - Routine Physicals;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											3400	1.1377	0.0328	0.4429	0.4899	0.0718	0.2164	0.1292	0.4277	0.8218	0	0	0	0	0.0903	0.7329	0.688	0.0347	0.1185	0	0.2724	0.1377	0	0	0	0.0903	0	0	0	0	0											5.935	0	1.970073186	4.6783	0.105656577	0.442932193	0.489878164	0.489515454	0.856007297	0.519740619	1.048624653	2.252391326	0	0	0	0	0.343356471	3.623333908	3.282144113	0.154929653	0.468258237	0	1.052286366	1.001002266	0	0	0	0.380804581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	21.1892
H7006_002_0	2010	5	N/A																															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	V	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	YES	436.2315996	9.002356056	0	0	100.0345585	6.404049777	3.890805591	160.387545	234.2280625	0	0	0	0	202.9779024	2264.303368	2038.510296	95.09193352	280.490907	0	627.688362	4.281393816	0	0	0	190.4696541	0	0	0	0	0											1200	$100/Days Custom for IP Medical; $100/Days Custom for IP Surgical;	$100/Days Custom for IP Psych; $100/Days Custom for IP Substance Abuse;	No Cost-Sharing	No Cost-Sharing	$50/Run for Ambulance	10% Coinsurance for DME	10% Coinsurance for Prosthetics/Supplies; 10% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care;	$100/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Visit for Prof - CORF; $15/Visit for Prof - CORF;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; $15/Exam for PCP - Routine Physicals;	$15/Visit for Speclst - Office Visits; $15/Consult for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $15/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	0	0	50	0.1	0.1	47.59443753	74.91429153	0	0	0	0	15	15	15	15	15	0	15	0.2	0	0	0	15	0	0	0	0	0											YES	86.96423375	86.96423376	0	0	43.48211687	0.086964234	0.086964234	41.3901379	65.1486396	0	0	0	0	13.04463506	13.08184807	13.04463506	13.04463507	13.04463506	0	13.04463506	0.173928467	0	0	0	15	0	0	0	0	0											2200	3.1614	0.06524025	0	0	0.362476197	0.556923282	0.338360927	0.553205217	1.271636635	0	0	0	0	0.220647722	2.468439387	2.215968573	0.103369964	0.30490846	0	0.682330468	0.744656265	0	0	0	0.238087068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.2876	0	1.948026168	3.1614	0.06524025	0	0	0.362476197	0.556923282	0.338360927	0.553205217	1.271636635	0	0	0	0	0.220647722	2.468439387	2.215968573	0.103369964	0.30490846	0	0.682330468	0.744656265	0	0	0	0.238087068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.2876	NO	$200/Days Custom for IP Medical; $200/Days Custom for IP Surgical;	$200/Days Custom for IP Psych; $200/Days Custom for IP Substance Abuse;	$50/Day for SNF	20% Coinsurance for Home Health	$50/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$200/Case for ER - Facility; $200/Case for ER - Worldwide; $30/Visit for Urgent Care;	$200/Case for OP Fac - Surgery; $200/Case for OP Fac - ASC	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $30/Visit for Prof - CORF; $30/Visit for Prof - CORF;	$30/Visit for PCP - Office Visits; $30/Consult for PCP - Consults; $30/Exam for PCP - Routine Physicals;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	No Cost-Sharing	$30/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												1.0497	0.0294	0.3954	0.4374	0.0641	0.1932	0.1154	0.3818	0.7337	0	0	0	0	0.0806	0.6555	0.6142	0.031	0.1058	0	0.2432	0.123	0	0	0	0.0757	0	0	0	0	0											5.3292	0	1.34532891	4.2111	0.094676517	0.39544642	0.437359417	0.42658453	0.750120247	0.4537382	0.935015098	2.005300636	0	0	0	0	0.301281984	3.123982741	2.830192041	0.134384613	0.410744895	0	0.925497758	0.867615794	0	0	0	0.313818864	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.6169
H7015_001_0	2010	7	N/A	i.6.	i.6.	i.6.	i.6.	i.6.						Professional	Professional	Professional	Professional	Professional						Chiropractic	Podiatry	Hearing Exams	Vision Exams	Acupuncture						A	A	D	V	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	Coin	V	Coin	V	Coin			Coin	V	V	V			Coin	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	NO	337.0036229	17.5824454	737.1115591	0.13605665	402.199358	8.696255389	2.889750955	338.0163606	4.780140321	484.3747541	18.2590982		1.918663508	5.283033921	3165.258257	4788.953967	2.904044277	1149.945373	28.51947434	516.0083211	4.164419052			9.5	137.5	275	115				0	370.9021234	0.952508162	653.4130231	1066.666667							1A IP Acute: $150 per day; days 1-8	1B IP Psych: $150 per day; days 1-8 (up to 190 days)	2 SNF: $50 days 1-30; $0 per day for days 31-100	6 Home Health - $0 per day	10A Ambulance - $50 per trip	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $30	9B ASC Services - 20%;  9A Outpatient Hospital - 20%	8A Outpatient C/D/T - $0	"8B Outpatient X-Rays - $0; Outpatient Diagnostic Radiology - $50; Therapeutic Radiology - 20% ($2,000 OOP Maximum)"		12 ESRD - 20%	3 CORF - $30; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - 20%	7A Primary Care - $0-$10; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0; 14J Nutrition Therapy - $0	7D Physician Specialist - $30	7E Mental Health - 45%; 7H Psychiatric Services - 45%; ; 9C Outpatient Sub Abuse - 45%	7C Occupational Therapy - $30; 7I PT and ST Services - $30	"8B Outpatient X-Rays - $0; Outpatient Diagnostic Radiology - $50; Therapeutic Radiology - 20% ($2,000 OOP Maximum)"	7G Other Health Care - $30	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0 - $150	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $30	18B Hearing Aids - $0 ($500 max every 3 years)		14C Routine Physical Exams - $0	7B Chiropractic Services - $30	7F Podiatry Services - $30	18A Hearing Exams (Medicare Covered) - $30	17A Eye Exams (Medicare Covered) - $30	13B Acupuncture - $5						638.391846	885.678392	50	0	50	0.2	0.2	50	0.2	0	0.110565655		0.2	0.067879322	10	30	0.45	30	0.18194308	30	0.2	0		0.1	0	0	30			0	30	30	30	30	5						NO	638.391846	885.678392	50	0	50	0.2	0.2	50	0.2	0	0.06434025		0.2	0.067879322	10	30	0.45	30	0.154558605	30	0.2	0		0.1	0	0	30			0	30	30	30	30	5							17.9284	1.29769933	3.071298163	0	1.675830658	1.739251078	0.577950191	1.408401503	0.956028064	0	1.174794936	0	0.383732702	0.358608761	2.637715214	11.97238492	1.306819925	2.874863433	4.40793017	1.290020803	0.83288381	0	0	0.95	0	0	0.2875	0	0	0	0	0.927255308	0.00238127	1.633532558	0.444444444	0	0	0	0	0	60.1397	0	0	17.9284	1.29769933	3.071298163	0	1.675830658	1.739251078	0.577950191	1.408401503	0.956028064	0	1.174794936	0	0.383732702	0.358608761	2.637715214	11.97238492	1.306819925	2.874863433	4.40793017	1.290020803	0.83288381	0	0	0.95	0	0	0.2875	0	0	0	0	0.927255308	0.00238127	1.633532558	0.444444444	0	0	0	0	0	60.1397	NO																																																																																		0			17.9284	1.29769933	3.071298163	0	1.675830658	1.739251078	0.577950191	1.408401503	0.956028064	0	1.174794936	0	0.383732702	0.358608761	2.637715214	11.97238492	1.306819925	2.874863433	4.40793017	1.290020803	0.83288381	0	0	0.95	0	0	0.2875	0	0	0	0	0.927255308	0.00238127	1.633532558	0.444444444	0	0	0	0	0	60.1397
H7015_002_0	2010	7	N/A	i.6.	i.6.	i.6.	i.6.							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	Vision Exams							A	A	D	V	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	Coin	V	Coin	V	Coin			Coin	V	V	V			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	NO	473.7971271	14.95590142	617.2274366	0.059898182	563.6152924	9.142655533	2.089231158	577.1520441	6.252959686	479.9507301	23.25260506		1.233797373	6.391316355	3793.113665	5259.146966	3.669490751	754.5176132	27.15466119	642.6915961	8.048381671			9.5	137.5	275	115				0	294.1042226	0.910241858	524.3401617								1A IP Acute: $150 per day; days 1-8	1B IP Psych: $150 per day; days 1-8 (up to 190 days)	2 SNF: $50 days 1-30; $0 per day for days 31-100	6 Home Health - $0 per day	10A Ambulance - $50 per trip	11A DME - 10% coinsurance	11B Pros./Med Supp. - 10%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $30	9B ASC Services - 20%;  9A Outpatient Hospital - 20%	8A Outpatient C/D/T - $0	"8B Outpatient X-Rays - $0; Outpatient Diagnostic Radiology - $50; Therapeutic Radiology - 20% ($2,000 OOP Maximum)"		12 ESRD - 20%	3 CORF - $30; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - 20%	7A Primary Care - $0-$10; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0; 14J Nutrition Therapy - $0	7D Physician Specialist - $30	7E Mental Health - 45%; 7H Psychiatric Services - 45%; ; 9C Outpatient Sub Abuse - 45%	7C Occupational Therapy - $30; 7I PT and ST Services - $30	"8B Outpatient X-Rays - $0; Outpatient Diagnostic Radiology - $50; Therapeutic Radiology - 20% ($2,000 OOP Maximum)"	7G Other Health Care - $30	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0 - $150	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $30	18B Hearing Aids - $0 ($500 max every 3 years)		14C Routine Physical Exams - $0	7B Chiropractic Services - $30	7F Podiatry Services - $30	18A Hearing Exams (Medicare Covered) - $30	17A Eye Exams (Medicare Covered) - $30							638.391846	885.678392	50	0	50	0.1	0.1	50	0.2	0	0.110565655		0.2	0.10342944	10	30	0.45	30	0.18194308	30	0.2	0		0.1	0	0	30			0	30	30	30	30							NO	638.391846	885.678392	50	0	50	0.1	0.1	50	0.2	0	0.06434025		0.2	0.10342944	10	30	0.45	30	0.154558605	30	0.2	0		0.1	0	0	30			0	30	30	30	30								25.2057	1.103843227	2.571780986	0	2.348397052	0.914265553	0.208923116	2.404800184	1.250591937	0	1.496078414	0	0.246759475	0.661050271	3.160928054	13.14786742	1.651270838	1.886294033	4.196986553	1.60672899	1.609676334	0	0	0.95	0	0	0.2875	0	0	0	0	0.735260557	0.002275605	1.310850404	0	0	0	0	0	0	68.9578	0	0	25.2057	1.103843227	2.571780986	0	2.348397052	0.914265553	0.208923116	2.404800184	1.250591937	0	1.496078414	0	0.246759475	0.661050271	3.160928054	13.14786742	1.651270838	1.886294033	4.196986553	1.60672899	1.609676334	0	0	0.95	0	0	0.2875	0	0	0	0	0.735260557	0.002275605	1.310850404	0	0	0	0	0	0	68.9578	NO																																																																																		0			25.2057	1.103843227	2.571780986	0	2.348397052	0.914265553	0.208923116	2.404800184	1.250591937	0	1.496078414	0	0.246759475	0.661050271	3.160928054	13.14786742	1.651270838	1.886294033	4.196986553	1.60672899	1.609676334	0	0	0.95	0	0	0.2875	0	0	0	0	0.735260557	0.002275605	1.310850404	0	0	0	0	0	0	68.9578
H7015_003_0	2010	4	N/A	i.6.	i.6.	i.6.	i.6.							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	Vision Exams							A	A	D	V	T	Coin	Coin	V	Coin	V	Coin		Coin	Coin	V	V	Coin	V	Coin	V	Coin			Coin	V	V	V			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	NO	232.3463301	11.9930099	276.4434946	0	281.8389331	3.519456686	0.846051319	273.6789396	4.225807556	393.0488409	13.09276273		3.489696905	3.025577709	1631.929046	3357.09624	1.59999535	405.2762099	16.08109291	242.2003252	1.178505039			9.5	137.5	275	115				0	182.8073926	0.399842646	354.5508506								1A IP Acute: $150 per day; days 1-8	1B IP Psych: $150 per day; days 1-8 (up to 190 days)	2 SNF: $50 days 1-30; $0 per day for days 31-100	6 Home Health - $0 per day	10A Ambulance - $50 per trip	11A DME - 10% coinsurance	11B Pros./Med Supp. - 10%; 11C Diabetes Mon Supplies - 0%	4A Emergency Care - $50; 4B Urgent Care - $30	9B ASC Services - 20%;  9A Outpatient Hospital - 20%	8A Outpatient C/D/T - $0	"8B Outpatient X-Rays - $0; Outpatient Diagnostic Radiology - $50; Therapeutic Radiology - 20% ($2,000 OOP Maximum)"		12 ESRD - 20%	3 CORF - $30; 5 Partial Hosp - $0; 9D Cardiac Rehab Svcs - 20%	7A Primary Care - $0-$10; 14B Immunizations - $0; 14D Pap/Pelvic - $0; 14E Prostate Screening - $0; 14F Colorectal Screening - $0; 14G Bone Mass Meas. - $0; 14H Mammography - $0; 14I Diabetes Monitoring - $0; 14J Nutrition Therapy - $0	7D Physician Specialist - $30	7E Mental Health - 45%; 7H Psychiatric Services - 45%; ; 9C Outpatient Sub Abuse - 45%	7C Occupational Therapy - $30; 7I PT and ST Services - $30	"8B Outpatient X-Rays - $0; Outpatient Diagnostic Radiology - $50; Therapeutic Radiology - 20% ($2,000 OOP Maximum)"	7G Other Health Care - $30	15 Medicare Part B Rx Drugs - 20%	13A Blood - $0	10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0 - $150	17A Eye Exams (Routine) - $0	17B Eye Wear - $0; Eyewear every year	18A Hearing Exams (Routine) - $30	18B Hearing Aids - $0 ($500 max every 3 years)		14C Routine Physical Exams - $0	7B Chiropractic Services - $30	7F Podiatry Services - $30	18A Hearing Exams (Medicare Covered) - $30	17A Eye Exams (Medicare Covered) - $30							638.391846	885.678392	50	0	50	0.1	0.1	50	0.2	0	0.110565655		0.2	0.197714499	10	30	0.45	30	0.18194308	30	0.2	0		0.1	0	0	30			0	30	30	30	30							NO	638.391846	885.678392	50	0	50	0.1	0.1	50	0.2	0	0.06434025		0.2	0.197714499	10	30	0.45	30	0.154558605	30	0.2	0		0.1	0	0	30			0	30	30	30	30								12.3607	0.885162477	1.151847894	0	1.174328888	0.351945669	0.084605132	1.140328915	0.845161511	0	0.842391622	0	0.697939381	0.59820058	1.359940871	8.392740601	0.719997907	1.013190525	2.485471287	0.605500813	0.235701008	0	0	0.95	0	0	0.2875	0	0	0	0	0.457018481	0.000999607	0.886377127	0	0	0	0	0	0	37.527	0	0	12.3607	0.885162477	1.151847894	0	1.174328888	0.351945669	0.084605132	1.140328915	0.845161511	0	0.842391622	0	0.697939381	0.59820058	1.359940871	8.392740601	0.719997907	1.013190525	2.485471287	0.605500813	0.235701008	0	0	0.95	0	0	0.2875	0	0	0	0	0.457018481	0.000999607	0.886377127	0	0	0	0	0	0	37.527	NO																																																																																		0			12.3607	0.885162477	1.151847894	0	1.174328888	0.351945669	0.084605132	1.140328915	0.845161511	0	0.842391622	0	0.697939381	0.59820058	1.359940871	8.392740601	0.719997907	1.013190525	2.485471287	0.605500813	0.235701008	0	0	0.95	0	0	0.2875	0	0	0	0	0.457018481	0.000999607	0.886377127	0	0	0	0	0	0	37.527
H7015_004_0	2010	8	N/A	i.6.	i.6.	i.6.	i.6.							Professional	Professional	Professional	Professional							Chiropractic	Podiatry	Hearing Exams	Vision Exams							Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin		Coin	V	V				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	NO	724.7126126	83.98972381	55.36920168	0	19.76276689	21.61139054	1.914287369	19.63352676	29.01684009	14.64328278	19.53175588		12.66480661	34.05859739	17.78758186	74.08824825	10.81649305	6.568472142	26.49176527	15.9334179	5.662474844			9.5	0	0					0	5.329232644	0.58532078	6.126901628								1A IP Acute: Medicare FFS Cost-sharing	1B IP Psych: Medicare FFS Cost-sharing	2 SNF: Medicare FFS Cost-sharing	6 Home Health - $0 per day	10A Ambulance - 20% coinsurance	11A DME - 20% coinsurance	11B Pros./Med Supp. - 20%; 11C Diabetes Mon Supplies - 20%	4A Emergency Care - 20%; 4B Urgent Care - 0 - 20%	9B ASC Services - 20%;  9A Outpatient Hospital - 20%	8A Outpatient C/D/T - 20%; Medicare Covered Lab - $0	8B Outpatient X-Rays - 20%; Diagnostic Radiology - 20%; Therapeutic Radiology - 20%		12 ESRD - 20%	3 CORF - 20%; 5 Partial Hosp - 20%; 9D Cardiac Rehab Svcs - 20%	7A Primary Care - $0	7D Physician Specialist - 20%	7E Mental Health - 45%; 7H Psychiatric Services - 45%; 9C Outpatient Sub Abuse - 20%	7C Occupational Therapy - 20%; 7I PT and ST Services - 20%	8B Outpatient X-Rays - 20%; Diagnostic Radiology - 20%; Therapeutic Radiology - 20%	7G Other Health Care - 20%; 14B Immunizations - 20%; 14D Pap/Pelvic - 0-20%; 14E Prostate Screening - 20%; 14F Colorectal Screening - 20%; 14G Bone Mass Meas. - 20%; 14H Mammography - 20%; 14I Diabetes Monitoring - 20%; 14J Nutrition Therapy - 20%	15 Medicare Part B Rx Drugs - 20%	13A Blood - 20%	10B Transportation - $0	16A Preventative Dental - $0; 16B Comp Dental - $0 - 150	17A Eye Exams (Routine) - NA	17B Eye Wear - NA	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA		14C Routine Physical Exams - $0	7B Chiropractic Services - 20%	7F Podiatry Services - 20%	18A Hearing Exams (Medicare Covered) - 20%	17A Eye Exams (Medicare Covered) - 20%							0.061567114	0.061567114	0.144638709	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0.2	0.2	0	0.2	0.448650399	0.2	0.2	0.2	0.2	0.2		0.1	0	0				0	0.2	0.2	0.2	0.2							NO	0.061567114	0.061567114	0.144638709	0	0.2	0.2	0.2	0.2	0.2	0.2	0.2		0.2	0.2	0	0.2	0.448650399	0.2	0.2	0.2	0.2	0.2		0.1	0	0				0	0.2	0.2	0.2	0.2								44.6185	5.171004886	8.008529843	0	3.952553377	4.322278109	0.382857474	3.926705352	5.803368019	2.928656556	3.906351175	0	2.532961321	6.811719478	0	14.81764965	4.852823921	1.313694428	5.298353055	3.186683579	1.132494969	0	0	0.95	0	0	0	0	0	0	0	1.065846529	0.117064156	1.225380326	0	0	0	0	0	0	126.3254	0	0	44.6185	5.171004886	8.008529843	0	3.952553377	4.322278109	0.382857474	3.926705352	5.803368019	2.928656556	3.906351175	0	2.532961321	6.811719478	0	14.81764965	4.852823921	1.313694428	5.298353055	3.186683579	1.132494969	0	0	0.95	0	0	0	0	0	0	0	1.065846529	0.117064156	1.225380326	0	0	0	0	0	0	126.3254	NO																																																																																		0			44.6185	5.171004886	8.008529843	0	3.952553377	4.322278109	0.382857474	3.926705352	5.803368019	2.928656556	3.906351175	0	2.532961321	6.811719478	0	14.81764965	4.852823921	1.313694428	5.298353055	3.186683579	1.132494969	0	0	0.95	0	0	0	0	0	0	0	1.065846529	0.117064156	1.225380326	0	0	0	0	0	0	126.3254
H7015_801_0	2010	7	N/A																															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	NO	377.3939776	18.23095592	41.84162856	15.33313273	15.19519241	10.78811162	3.531245689	9.033517661	24.379932	11.08382283	21.43331		2.2595148	10.00070336	33.44559447	100.7138879	3.887352231	7.083981335	33.4773781	56.61386961	11.3996883																					1A IP Acute: Medicare FFS Cost-sharing	1B IP Psych: Medicare FFS Cost-sharing	2 SNF: Medicare FFS Cost-sharing	6 Home Health - $0 per day	10A Ambulance - Medicare FFS Cost-Sharing	11A DME - Medicare FFS Cost-Sharing	11B Pros./Med Supp. - Medicare FFS Cost-Sharing; 11C Diabetes Mon Supplies - Medicare FFS Cost-Sharing	4A Emergency Care - Medicare FFS Cost-Sharing; 4B Urgent Care - Medicare FFS Cost-Sharing	9B ASC Services - Medicare FFS Cost-Sharing;  9A Outpatient Hospital - Medicare FFS Cost-Sharing	8A Outpatient C/D/T - Medicare FFS Cost-Sharing	8B Outpatient X-Rays - Medicare FFS Cost-Sharing; Diagnostic Radiology - Medicare FFS Cost-Sharing; Therapeutic Radiology - Medicare FFS Cost-Sharing		12 ESRD - Medicare FFS Cost-Sharing	3 CORF - Medicare FFS Cost-Sharing; 5 Partial Hosp - Medicare FFS Cost-Sharing; 9D Cardiac Rehab Svcs - Medicare FFS Cost-Sharing	7A Primary Care - Medicare FFS Cost-Sharing	7D Physician Specialist - Medicare FFS Cost-Sharing	7E Mental Health - Medicare FFS Cost-Sharing; 7H Psychiatric Services - Medicare FFS Cost-Sharing; 9C Outpatient Sub Abuse - Medicare FFS Cost-Sharing	7C Occupational Therapy - Medicare FFS Cost-Sharing; 7I PT and ST Services - Medicare FFS Cost-Sharing	8B Outpatient X-Rays - Medicare FFS Cost-Sharing; Diagnostic Radiology - Medicare FFS Cost-Sharing; Therapeutic Radiology - Medicare FFS Cost-Sharing	"7G Other Health Care - Medicare FFS Cost-Sharing; 14B Immunizations, 14D Pap/Pelvic, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Meas., 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy - Medicare FFS Cost-Sharing;17A Eye Exams (Medicare Covered) - Medicare FFS Cost-Sharing; 18A Hearing Exams (Medicare Covered) - Medicare FFS Cost-Sharing; 7B Chiropractic Services - Medicare FFS Cost-Sharing; 7F Podiatry Services - Medicare FFS Cost-Sharing"	15 Medicare Part B Rx Drugs - Medicare FFS Cost-Sharing	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - NA	17A Eye Exams (Routine) - NA	17B Eye Wear - NA	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA													0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					23.2351	1.122427338	6.051919133	0	3.540479832	2.513630007	0.822780245	2.104809615	5.680524156	2.582530719	4.993961229	0	0.526466948	2.330163882	7.79282351	23.46633589	0.90575307	1.650567651	7.800229098	13.19103162	2.656127374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9676	0	0	23.2351	1.122427338	6.051919133	0	3.540479832	2.513630007	0.822780245	2.104809615	5.680524156	2.582530719	4.993961229	0	0.526466948	2.330163882	7.79282351	23.46633589	0.90575307	1.650567651	7.800229098	13.19103162	2.656127374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9676	NO																																																																																		0			23.2351	1.122427338	6.051919133	0	3.540479832	2.513630007	0.822780245	2.104809615	5.680524156	2.582530719	4.993961229	0	0.526466948	2.330163882	7.79282351	23.46633589	0.90575307	1.650567651	7.800229098	13.19103162	2.656127374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9676
H7015_802_0	2010	5	N/A																															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	NO	377.3939776	18.23095592	41.84162856	15.33313273	15.19519241	10.78811162	3.531245689	9.033517661	24.379932	11.08382283	21.43331		2.2595148	10.00070336	33.44559447	100.7138879	3.887352231	7.083981335	33.4773781	56.61386961	11.3996883																					1A IP Acute: Medicare FFS Cost-sharing	1B IP Psych: Medicare FFS Cost-sharing	2 SNF: Medicare FFS Cost-sharing	6 Home Health - $0 per day	10A Ambulance - Medicare FFS Cost-Sharing	11A DME - Medicare FFS Cost-Sharing	11B Pros./Med Supp. - Medicare FFS Cost-Sharing; 11C Diabetes Mon Supplies - Medicare FFS Cost-Sharing	4A Emergency Care - Medicare FFS Cost-Sharing; 4B Urgent Care - Medicare FFS Cost-Sharing	9B ASC Services - Medicare FFS Cost-Sharing;  9A Outpatient Hospital - Medicare FFS Cost-Sharing	8A Outpatient C/D/T - Medicare FFS Cost-Sharing	8B Outpatient X-Rays - Medicare FFS Cost-Sharing; Diagnostic Radiology - Medicare FFS Cost-Sharing; Therapeutic Radiology - Medicare FFS Cost-Sharing		12 ESRD - Medicare FFS Cost-Sharing	3 CORF - Medicare FFS Cost-Sharing; 5 Partial Hosp - Medicare FFS Cost-Sharing; 9D Cardiac Rehab Svcs - Medicare FFS Cost-Sharing	7A Primary Care - Medicare FFS Cost-Sharing	7D Physician Specialist - Medicare FFS Cost-Sharing	7E Mental Health - Medicare FFS Cost-Sharing; 7H Psychiatric Services - Medicare FFS Cost-Sharing; 9C Outpatient Sub Abuse - Medicare FFS Cost-Sharing	7C Occupational Therapy - Medicare FFS Cost-Sharing; 7I PT and ST Services - Medicare FFS Cost-Sharing	8B Outpatient X-Rays - Medicare FFS Cost-Sharing; Diagnostic Radiology - Medicare FFS Cost-Sharing; Therapeutic Radiology - Medicare FFS Cost-Sharing	"7G Other Health Care - Medicare FFS Cost-Sharing; 14B Immunizations, 14D Pap/Pelvic, 14E Prostate Screening, 14F Colorectal Screening, 14G Bone Mass Meas., 14H Mammography, 14I Diabetes Monitoring, 14J Nutrition Therapy - Medicare FFS Cost-Sharing;17A Eye Exams (Medicare Covered) - Medicare FFS Cost-Sharing; 18A Hearing Exams (Medicare Covered) - Medicare FFS Cost-Sharing; 7B Chiropractic Services - Medicare FFS Cost-Sharing; 7F Podiatry Services - Medicare FFS Cost-Sharing"	15 Medicare Part B Rx Drugs - Medicare FFS Cost-Sharing	13A Blood - $0	10B Transportation - NA	16A Preventative Dental - NA	17A Eye Exams (Routine) - NA	17B Eye Wear - NA	18A Hearing Exams (Routine) - NA	18B Hearing Aids - NA													0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.061567114	0.061567114	0.144638709	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					23.2351	1.122427338	6.051919133	0	3.540479832	2.513630007	0.822780245	2.104809615	5.680524156	2.582530719	4.993961229	0	0.526466948	2.330163882	7.79282351	23.46633589	0.90575307	1.650567651	7.800229098	13.19103162	2.656127374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9676	0	0	23.2351	1.122427338	6.051919133	0	3.540479832	2.513630007	0.822780245	2.104809615	5.680524156	2.582530719	4.993961229	0	0.526466948	2.330163882	7.79282351	23.46633589	0.90575307	1.650567651	7.800229098	13.19103162	2.656127374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9676	NO																																																																																		0			23.2351	1.122427338	6.051919133	0	3.540479832	2.513630007	0.822780245	2.104809615	5.680524156	2.582530719	4.993961229	0	0.526466948	2.330163882	7.79282351	23.46633589	0.90575307	1.650567651	7.800229098	13.19103162	2.656127374	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9676
H7086_001_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	334.810487	18.06249261	32.49489963	22.67066819	12.18600345	8.766009568	7.327964464	30.30895597	21.00746245	5.292163036	16.03653266	0.365340456	0.654077268	39.61922945	62.1240466	116.3037639	6.079076893	5.919409493	27.87941374	32.80645713	16.75999627	2.345250024	8.125803006	0	1.3258323	0.695325384	0	0	0	6.3717808												Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	Traditional Medicare Cost Sharing	10B Transportation: $0	0	0	0	0	0	0	0											0.074913376	0.074895463	0.1407424	0	0.232943416	0.232999996	0.232953767	0.23304167	0.233	0.233031928	0.232991536	0.232999875	0.232999985	0.233047291	0.232996638	0.232998295	0.232997047	0.233016949	0.23299354	0.233025081	0.233000181	0.233004264	0	0	0	0	0	0	0	0											NO	0.074913376	0.074895463	0.1407424	0	0.232943416	0.232999996	0.232953767	0.23304167	0.233	0.233031928	0.232991536	0.232999875	0.232999985	0.233047291	0.232996638	0.232998295	0.232997047	0.233016949	0.23299354	0.233025081	0.233000181	0.233004264	0	0	0	0	0	0	0	0												25.0818	1.352798744	4.57341016	0	2.838649268	2.042480191	1.707076929	7.063249708	4.894738757	1.233242957	3.736376378	0.085124281	0.152399993	9.233154085	14.47469399	27.09857867	1.416406962	1.379322741	6.4957233	7.644727342	3.905082171	0.546453255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.9555	0	0	25.0818	1.352798744	4.57341016	0	2.838649268	2.042480191	1.707076929	7.063249708	4.894738757	1.233242957	3.736376378	0.085124281	0.152399993	9.233154085	14.47469399	27.09857867	1.416406962	1.379322741	6.4957233	7.644727342	3.905082171	0.546453255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.9555	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.0818	1.352798744	4.57341016	0	2.838649268	2.042480191	1.707076929	7.063249708	4.894738757	1.233242957	3.736376378	0.085124281	0.152399993	9.233154085	14.47469399	27.09857867	1.416406962	1.379322741	6.4957233	7.644727342	3.905082171	0.546453255	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.9555
H7149_001_0	2010	7	N/A																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	V	COIN	COIN	COIN	P	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	YES	1380.859889	11.69405949	848.4105094	0	119.5930136	9.097316838	4.95150257	296.7267377	375.5328252	9.746902528	20.18958368	0.872742076	0.383599311	9.092883909	3816.968426	109.1367225	59.14724906	795.5813939	8.381272033	1410.660172	20.69646847	0	0	0	0	0	0	0	0	109.2226325											4600	1a $160 days 1-9	1b $160 days 1-9	2 $100 days 7-22	6 $0	"10a $150, 10b $0"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $260, 9b $260"	"8a $0, 8b 20%, 11c $0, 11c 20%"	8b 20%/$260 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0"	7a $10	"17a $40, 18a $40, 7b $40,7d $40,7f $40, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b 20% Ther., $260 Adv. Imaging, 14h $0"	"7g $40, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0	14c $10											148.8580385	145.210084	47.92899408	0	13.84299203	0.2	0.2	49.55978044	260	0.089307828	0.491019875	0.2	0.2	0.194001428	10	0.138674718	40	40	0.264097452	0.026520047	0.221926129	0	0	0	0	0	0	0	0	10											NO	122.1106511	119.1181751	39.31692726	0	11.35562974	0.164063227	0.164063227	40.65468763	213.2821955	0.073260652	0.402791527	0.164063227	0.164063227	0.159142502	8.203161367	0.113757109	32.81264547	32.81264547	0.216643401	0.021754822	0.182049585	0	0	0	0	0	0	0	0	8.203161367												14.0515	0.116081252	2.779741191	0	0.113171165	1.492535161	0.812359492	1.005277736	6.674538788	0.714064439	8.132193235	0.143184882	0.062934541	1.447064292	2.609267328	12.41507805	0.161731476	2.175427518	1.81574728	0.002557388	3.767783487	0	0	0	0	0	0	0	0	0.07466424	0	0	0	0	0	0	0	0	0	0	60.5669	0	13.26670308	14.0515	0.116081252	2.779741191	0	0.113171165	1.492535161	0.812359492	1.005277736	6.674538788	0.714064439	8.132193235	0.143184882	0.062934541	1.447064292	2.609267328	12.41507805	0.161731476	2.175427518	1.81574728	0.002557388	3.767783487	0	0	0	0	0	0	0	0	0.07466424	0	0	0	0	0	0	0	0	0	0	60.5669	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	14.0515	0.116081252	2.779741191	0	0.113171165	1.492535161	0.812359492	1.005277736	6.674538788	0.714064439	8.132193235	0.143184882	0.062934541	1.447064292	2.609267328	12.41507805	0.161731476	2.175427518	1.81574728	0.002557388	3.767783487	0	0	0	0	0	0	0	0	0.07466424	0	0	0	0	0	0	0	0	0	0	60.5669
H7149_801_0	2010	6	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	200.0158868	3.102272015	20.75578901	0	5.571144123	9.261241987	5.30660756	15.0882335	50.76757338	9.122950164	20.35736441	2.075826567	0.982475322	10.23866542	27.75625753	113.8115035	2.18425535	6.24548547	11.67437848	8.243344639	26.41688332	0	0	0	0	0	0	0	0	0												FFS Medicare  8.1%	FFS Medicare  8.1%	FFS Medicare  16.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												16.202	0.251294848	3.33414649	0	1.298076581	2.157869383	1.236439562	3.515558406	11.8288446	2.125647388	4.743265906	0.48366759	0.22891675	2.385609042	6.467208004	26.51808032	0.508931497	1.455198115	2.720130185	1.920699301	6.155133814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5367	0	0	16.202	0.251294848	3.33414649	0	1.298076581	2.157869383	1.236439562	3.515558406	11.8288446	2.125647388	4.743265906	0.48366759	0.22891675	2.385609042	6.467208004	26.51808032	0.508931497	1.455198115	2.720130185	1.920699301	6.155133814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5367	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.202	0.251294848	3.33414649	0	1.298076581	2.157869383	1.236439562	3.515558406	11.8288446	2.125647388	4.743265906	0.48366759	0.22891675	2.385609042	6.467208004	26.51808032	0.508931497	1.455198115	2.720130185	1.920699301	6.155133814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5367
H7149_802_0	2010	5	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	200.0158868	3.102272015	20.75578901	0	5.571144123	9.261241987	5.30660756	15.0882335	50.76757338	9.122950164	20.35736441	2.075826567	0.982475322	10.23866542	27.75625753	113.8115035	2.18425535	6.24548547	11.67437848	8.243344639	26.41688332	0	0	0	0	0	0	0	0	0												FFS Medicare  8.1%	FFS Medicare  8.1%	FFS Medicare  16.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												16.202	0.251294848	3.33414649	0	1.298076581	2.157869383	1.236439562	3.515558406	11.8288446	2.125647388	4.743265906	0.48366759	0.22891675	2.385609042	6.467208004	26.51808032	0.508931497	1.455198115	2.720130185	1.920699301	6.155133814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5367	0	0	16.202	0.251294848	3.33414649	0	1.298076581	2.157869383	1.236439562	3.515558406	11.8288446	2.125647388	4.743265906	0.48366759	0.22891675	2.385609042	6.467208004	26.51808032	0.508931497	1.455198115	2.720130185	1.920699301	6.155133814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5367	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.202	0.251294848	3.33414649	0	1.298076581	2.157869383	1.236439562	3.515558406	11.8288446	2.125647388	4.743265906	0.48366759	0.22891675	2.385609042	6.467208004	26.51808032	0.508931497	1.455198115	2.720130185	1.920699301	6.155133814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5367
H7149_803_0	2010	5	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	200.0158868	3.102272015	20.75578901	0	5.571144123	9.261241987	5.30660756	15.0882335	50.76757338	9.122950164	20.35736441	2.075826567	0.982475322	10.23866542	27.75625753	113.8115035	2.18425535	6.24548547	11.67437848	8.243344639	26.41688332	0	0	0	0	0	0	0	0	0												FFS Medicare  8.1%	FFS Medicare  8.1%	FFS Medicare  16.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												16.202	0.251294848	3.33414649	0	1.298076581	2.157869383	1.236439562	3.515558406	11.8288446	2.125647388	4.743265906	0.48366759	0.22891675	2.385609042	6.467208004	26.51808032	0.508931497	1.455198115	2.720130185	1.920699301	6.155133814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5367	0	0	16.202	0.251294848	3.33414649	0	1.298076581	2.157869383	1.236439562	3.515558406	11.8288446	2.125647388	4.743265906	0.48366759	0.22891675	2.385609042	6.467208004	26.51808032	0.508931497	1.455198115	2.720130185	1.920699301	6.155133814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5367	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	16.202	0.251294848	3.33414649	0	1.298076581	2.157869383	1.236439562	3.515558406	11.8288446	2.125647388	4.743265906	0.48366759	0.22891675	2.385609042	6.467208004	26.51808032	0.508931497	1.455198115	2.720130185	1.920699301	6.155133814	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.5367
H7179_001_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1597.125592	68.48796419	688.240498	1953.465474	201.3674082	18.46762456	5.1130343	550.4203678	261.8672908	5.996828205	8.442720131	0.171084314	0.653790926	6.708044474	4821.321798	2961.689602	62.22628549	40.09089369	14.22953401	93.77132914	6.058341116	0	0	0	401	4.991710774	0	0	0	0											2900	1a (IP Acute): $100 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $175 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $100 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $15 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $15 Copay per visit; 7i (PT/ST): $15 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 15 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $15 Copay per visit; 7b (Chiro): $15 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $15 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 20 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $15 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 15 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 15 copay; 18a1 (Routine Hearing Exam): 15 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											65.60621715	58.5190674	21.78608114	0	150	0.2	0.181749492	49.85289084	100	0	0.180934021	0.2	0.2	0.199791617	0	15	40	15	0.2	0.019206116	0.2	0	0	0	5	0	0	0	0	0											NO	59.95764087	53.48068186	19.91033908	0	137.0852721	0.182780363	0.166101191	45.56064737	91.39018141	0	0.16535593	0.182780363	0.182780363	0.182589921	0	13.70852721	36.55607256	13.70852721	0.182780363	0.017552505	0.182780363	0	0	0	5	0	0	0	0	0												7.98	0.305231919	1.14192514	0	2.300375496	3.375519118	0.849281085	2.089792357	1.994341601	0	1.396053837	0.031270853	0.119500143	1.224821309	0	3.383366874	0.189562384	0.045798926	2.60087939	1.645921691	1.107345787	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9481	0	2.994068424	7.98	0.305231919	1.14192514	0	2.300375496	3.375519118	0.849281085	2.089792357	1.994341601	0	1.396053837	0.031270853	0.119500143	1.224821309	0	3.383366874	0.189562384	0.045798926	2.60087939	1.645921691	1.107345787	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9481	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.98	0.305231919	1.14192514	0	2.300375496	3.375519118	0.849281085	2.089792357	1.994341601	0	1.396053837	0.031270853	0.119500143	1.224821309	0	3.383366874	0.189562384	0.045798926	2.60087939	1.645921691	1.107345787	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9481
H7179_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1955.573909	72.64058476	906.3413145	3161.229847	202.0440814	17.66818339	5.34504173	530.8115217	283.9912005	6.722857724	8.444432532	0.263327574	1.583624752	8.967061194	4379.59641	2868.596621	99.15237887	52.98545416	14.82832699	90.65945269	6.903878285	0	0	0	401	5.045126008	0	0	0	0											3400	1a (IP Acute): $100 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $175 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $100 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $15 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $15 Copay per visit; 7i (PT/ST): $15 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 15 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $15 Copay per visit; 7b (Chiro): $15 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $15 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 20 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $15 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 15 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 15 copay; 18a1 (Routine Hearing Exam): 15 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											59.82094998	73.92891164	20.43373447	0	150	0.2	0.18556931	49.76734078	100	0	0.181889797	0.2	0.2	0.198481954	0	15	40	15	0.2	0.015545643	0.2	0	0	0	5	0	0	0	0	0											NO	55.67363703	68.80351105	19.01708877	0	139.6006843	0.186134246	0.172704018	46.3170322	93.06712288	0	0.169279601	0.186134246	0.186134246	0.184721444	0	13.96006843	37.22684915	13.96006843	0.186134246	0.014467883	0.186134246	0	0	0	5	0	0	0	0	0												9.0728	0.41649394	1.436331103	0	2.350457669	3.288653989	0.923110181	2.048801196	2.20252033	0	1.429470166	0.049014279	0.294766799	1.656408492	0	3.337150428	0.307594221	0.061640047	2.76005946	1.311650341	1.285048178	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3991	0	2.550054412	9.0728	0.41649394	1.436331103	0	2.350457669	3.288653989	0.923110181	2.048801196	2.20252033	0	1.429470166	0.049014279	0.294766799	1.656408492	0	3.337150428	0.307594221	0.061640047	2.76005946	1.311650341	1.285048178	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3991	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.0728	0.41649394	1.436331103	0	2.350457669	3.288653989	0.923110181	2.048801196	2.20252033	0	1.429470166	0.049014279	0.294766799	1.656408492	0	3.337150428	0.307594221	0.061640047	2.76005946	1.311650341	1.285048178	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.3991
H7179_003_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	579.5501901	19.11329764	49.77331554	7461.500024	18.61971864	21.16551483	8.268032995	28.10575531	24.14780316	6.877019073	11.60505334	0.434688616	0	29.59955186	4662.546883	3356.043548	1122.875836	1.406611299	25.0355797	132.4442398	14.82614677	0	0	0	401	0.085373296	0	0	0	0												1a (IP Acute): 7.82% Coin MC CS; 1a1 (Add'l Days): 7.82% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.82% Coin MC CS;	2a (SNF): 21.75% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $8 Copay per visit;	7h (Psych): $8 Copay per visit; 7e (MH Non-Phys): 8 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 8 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $8 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $8 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 8 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $8 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 8 copay; 18a1 (Routine Hearing Exam): 8 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $21.5 OTC per month (cumulative benefit)											0.0782	0.0782	0.2175	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.153417529	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0782	0.0782	0.2175	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.153417529	0.2	0	0	0	5	0.2	0	0	0	0												45.3208	1.494659875	10.82569613	0	3.723943728	4.233102966	1.653606599	5.621151063	4.829560633	0	2.321010668	0.086937723	0	5.919910372	0	2.237362365	0.74858389	0.28132226	5.007115939	20.31926799	2.965229355	0	0	0	0.167083333	0.017074659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7734	0	0	45.3208	1.494659875	10.82569613	0	3.723943728	4.233102966	1.653606599	5.621151063	4.829560633	0	2.321010668	0.086937723	0	5.919910372	0	2.237362365	0.74858389	0.28132226	5.007115939	20.31926799	2.965229355	0	0	0	0.167083333	0.017074659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7734	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	45.3208	1.494659875	10.82569613	0	3.723943728	4.233102966	1.653606599	5.621151063	4.829560633	0	2.321010668	0.086937723	0	5.919910372	0	2.237362365	0.74858389	0.28132226	5.007115939	20.31926799	2.965229355	0	0	0	0.167083333	0.017074659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.7734
H7179_006_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1956.124844	72.66186951	906.5904606	3162.049003	202.1045367	17.67917968	5.348265755	530.9723816	284.0737915	6.726819286	8.449605052	0.263468908	1.584393496	8.972065053	4380.953057	2869.465241	99.17812747	52.99993671	14.83728086	90.71582165	6.907924365	0	0	0	401	5.046629146	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $225 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $150 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $20 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $20 Copay per visit; 7i (PT/ST): $20 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 20 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $20 Copay per visit; 7b (Chiro): $20 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $20 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 20 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $20 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 20 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 150 allowance (every 2 years);	18a (Hearing Exam): 20 copay; 18a1 (Routine Hearing Exam): 20 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): 18 OTC per month;											89.73217347	95.04948361	20.43384296	0	150	0.2	0.185568519	49.76735018	150	0	0.18188959	0.2	0.2	0.198481801	0	20	40	20	0.2	0.016319611	0.2	0	0	0	5	0	0	0	0	0											NO	82.08807671	86.95241629	18.69312648	0	137.2218128	0.182962417	0.169760324	45.52777339	137.2218128	0	0.166394795	0.182962417	0.182962417	0.18157355	0	18.2962417	36.59248341	18.2962417	0.182962417	0.014929377	0.182962417	0	0	0	5	0	0	0	0	0												13.3812	0.526510427	1.412250846	0	2.311095908	3.234625445	0.907923326	2.014499189	3.248426719	0	1.4059703	0.048204908	0.289884463	1.629089707	0	4.375035801	0.302431165	0.080808304	2.714664768	1.354330733	1.263890538	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6679	0	3.771466598	13.3812	0.526510427	1.412250846	0	2.311095908	3.234625445	0.907923326	2.014499189	3.248426719	0	1.4059703	0.048204908	0.289884463	1.629089707	0	4.375035801	0.302431165	0.080808304	2.714664768	1.354330733	1.263890538	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6679	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.3812	0.526510427	1.412250846	0	2.311095908	3.234625445	0.907923326	2.014499189	3.248426719	0	1.4059703	0.048204908	0.289884463	1.629089707	0	4.375035801	0.302431165	0.080808304	2.714664768	1.354330733	1.263890538	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6679
H7179_007_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1947.137975	72.31467168	902.5263794	3148.686881	201.1183876	17.50411535	5.296938293	528.3484277	282.7265635	6.663750018	8.367256962	0.261218825	1.572154859	8.892402102	4358.823371	2855.296264	98.75811514	52.76369666	14.69473252	89.81841068	6.843509554	0	0	0	401	5.022109877	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $150 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $20 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $20 Copay per visit; 7i (PT/ST): $20 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 20 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $20 Copay per visit; 7b (Chiro): $20 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $20 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 20 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $20 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 20 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 20 copay; 18a1 (Routine Hearing Exam): 20 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											89.71991099	109.8723396	20.43206586	0	150	0.2	0.185581223	49.76719622	150	0	0.181892913	0.2	0.2	0.198484115	0	20	40	20	0.2	0.016378036	0.2	0	0	0	5	0	0	0	0	0											NO	82.03761532	100.4644859	18.68256378	0	137.1562027	0.182874937	0.169690772	45.50586435	137.1562027	0	0.166318275	0.182874937	0.182874937	0.18148885	0	18.28749369	36.57498739	18.28749369	0.182874937	0.014975662	0.182874937	0	0	0	5	0	0	0	0	0												13.3115	0.605421359	1.405125554	0	2.298719528	3.201063991	0.898841549	2.003579324	3.231475155	0	1.391627741	0.047770376	0.287507721	1.613871833	0	4.351351035	0.301006401	0.080409647	2.687298284	1.345090156	1.251506378	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4803	0	3.775073369	13.3115	0.605421359	1.405125554	0	2.298719528	3.201063991	0.898841549	2.003579324	3.231475155	0	1.391627741	0.047770376	0.287507721	1.613871833	0	4.351351035	0.301006401	0.080409647	2.687298284	1.345090156	1.251506378	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4803	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.3115	0.605421359	1.405125554	0	2.298719528	3.201063991	0.898841549	2.003579324	3.231475155	0	1.391627741	0.047770376	0.287507721	1.613871833	0	4.351351035	0.301006401	0.080409647	2.687298284	1.345090156	1.251506378	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4803
H7179_008_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1946.634259	72.29521114	902.2985865	3147.93793	201.0631136	17.49457458	5.294141015	528.2013543	282.651051	6.660312827	8.362769101	0.261096199	1.57148787	8.888060578	4357.582995	2854.502089	98.73457333	52.75045533	14.68696383	89.76950298	6.839999033	0	0	0	401	5.020735565	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $150 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $20 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $20 Copay per visit; 7i (PT/ST): $20 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 20 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $20 Copay per visit; 7b (Chiro): $20 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $20 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 20 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $20 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 20 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 150 allowance (every 2 years);	18a (Hearing Exam): 20 copay; 18a1 (Routine Hearing Exam): 20 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): 18 OTC per month;											89.71922032	109.8744454	20.43196578	0	150	0.2	0.185581922	49.76718755	150	0	0.181893095	0.2	0.2	0.198484234	0	20	40	20	0.2	0.016381139	0.2	0	0	0	5	0	0	0	0	0											NO	82.03300574	100.4615397	18.68156634	0	137.1495519	0.182866069	0.169683183	45.5036498	137.1495519	0	0.166310377	0.182866069	0.182866069	0.181480158	0	18.28660692	36.57321383	18.28660692	0.182866069	0.014977772	0.182866069	0	0	0	5	0	0	0	0	0												13.3074	0.605240685	1.404695909	0	2.297976328	3.199164085	0.8983267	2.002924121	3.230455415	0	1.390815281	0.047745636	0.28737181	1.613006638	0	4.349929803	0.300920055	0.08038557	2.685747344	1.344547189	1.250803736	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4645	0	3.77573084	13.3074	0.605240685	1.404695909	0	2.297976328	3.199164085	0.8983267	2.002924121	3.230455415	0	1.390815281	0.047745636	0.28737181	1.613006638	0	4.349929803	0.300920055	0.08038557	2.685747344	1.344547189	1.250803736	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4645	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.3074	0.605240685	1.404695909	0	2.297976328	3.199164085	0.8983267	2.002924121	3.230455415	0	1.390815281	0.047745636	0.28737181	1.613006638	0	4.349929803	0.300920055	0.08038557	2.685747344	1.344547189	1.250803736	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4645
H7179_009_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1836.974556	70.96950382	830.7247171	2731.305077	201.5753113	18.86157936	5.253561057	564.5824273	275.3821942	6.45537955	8.428640353	0.230304574	1.318601046	8.160065616	4523.452245	2896.231469	90.3718531	48.28900923	14.59036427	91.87058624	6.940106285	0	0	0	401	5.275682871	0	0	0	0											3950	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $150 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $30 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $30 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $30 Copay per visit; 7i (PT/ST): $30 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 30 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $30 Copay per visit; 7b (Chiro): $30 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $30 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 30 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $30 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 30 copay; 18a1 (Routine Hearing Exam): 30 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											92.38902095	102.0492615	20.82848885	0	150	0.2	0.184257485	49.79835015	150	0	0.181551974	0.2	0.2	0.199068331	0	30	40	30	0.2	0.020055277	0.2	0	0	0	5	0	0	0	0	0											NO	85.25739573	94.17195007	19.22071149	0	138.4213105	0.184561747	0.170034417	45.95435261	138.4213105	0	0.167537748	0.184561747	0.184561747	0.183701995	0	27.68426211	36.91234948	27.68426211	0.184561747	0.018507185	0.184561747	0	0	0	5	0	0	0	0	0												13.0513	0.556944714	1.330593343	0	2.32519323	3.481126045	0.893286193	2.162084995	3.176563685	0	1.412115419	0.042505415	0.243363313	1.499020337	0	6.68166926	0.277986452	0.111403799	2.692823125	1.70026594	1.280878143	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0862	0	3.500835066	13.0513	0.556944714	1.330593343	0	2.32519323	3.481126045	0.893286193	2.162084995	3.176563685	0	1.412115419	0.042505415	0.243363313	1.499020337	0	6.68166926	0.277986452	0.111403799	2.692823125	1.70026594	1.280878143	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.0862	NO	1a (IP Acute): 30% Coinsurance; 1a1 (Add'l Days): 30% coin per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): 30% Coinsurance;	2a (SNF): 30% Coinsurance; 2a2 (Waiver 3 Day): 30% coin;	6a (Home Health): 30% Coinsurance;	10a (Ambulance): 30% Coinsurance;	11a (DME): Not Covered; 11b (Prosthetics): Not Covered;	11b (Medical Supplies): 30% Coinsurance; 11c (Diabetic Supplies): 30% Coinsurance;	4a (ER): Not Covered; 4a (ER) - Worldwide Coverage: n/a; 4b (UC): Not Covered;	9b (OP Surg): 30% Coinsurance;	8a (OP Diag Proc/Test/Lab): 30% Coinsurance;	8b (OP Diag): 30% Coinsurance; 8b (OP Therap Rad): Not Covered; 8b (X-Ray): 30% Coinsurance;	9a (OP Observation): 30% Coinsurance;	12 (Renal Dialysis): Not Covered;	3 (CORF): Not Covered; 5 (Partial Hosp): 30% Coinsurance; 9a (OP Chemo): Not Covered; 9a (OP Services): 30% Coinsurance; 9c (OP SA): Not Covered; 9d (OP Cardiac Rehab): 30% Coinsurance;	14b (Immunizations): 30% Coinsurance; 14c (Medicare Covered Physical Exam): 30% coin; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 30% coin; 14e (Prostate Screening): 30% coin; 14f (Colorectal Screening): 30% coin; 14g (Bone Mass): 30% coin; 14i (Diabetes Educ.): 30% coin; 14j (Nutrition Therapy Diabetes): 30% coin; 14h (Mammography): 30% Coinsurance; 7a (PCP w/Copay): $40 Copay per visit;	7d (SPC w/Copay): $40 Copay per visit;	7h (Psych): Not Covered; 7e (MH Non-Phys): n/a per visit;	7c (OT): $40 Copay per visit; 7i (PT/ST): $40 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 40 copay per office visit; 30% coin for all other procedures;	17a (Eye Exam): $40 Copay per visit; 7b (Chiro): $40 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $40 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 40 copay per visit; 7g1 (Prof. Other Coins): 30% Coinsurance; 8a (OP Diag Proc/Test/Lab): 30% Coinsurance; 8b (X-Ray): 30% Coinsurance; 9a (OP Chemo): Not Covered; 9b (OP ASC): 30% Coinsurance; All other Services: No Cost Sharing;	15 (Part B Rx): Not Covered;	13a (Blood): 30% Coinsurance; 16b (Comp. Dental): $40 Copay per visit;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): Not Covered;	17a1 (Routine Eye Exam): Not Covered;	17b1 (Non MCR Covered): Not Covered;	18a (Hearing Exam): 40 copay; 18a1 (Routine Hearing Exam): Not Covered;	18b (Hearing Aids) - Enhanced Benefit Limit ( $ allowance/ # years): 0% Coinsurance; 18b (Hearing Aids): Not Covered;		13c (OTC Rx): Not Covered;												4.1253	0.0897	0.3751	0.6055	0.1166	0	0.0777	0	0.4312	0.0955	0.1247	0.0034	0	0.1189	0.5846	0.4479	0	0.0106	0.2159	1.1758	0	0	0	0	0	0	0	0	0	0											8.5983	500	2.584755491	17.1766	0.646653613	1.705666967	0.605515576	2.441803744	3.481126045	0.971012976	2.162084995	3.607762869	0.095507766	1.536817709	0.045912786	0.243363313	1.617896852	0.584590476	7.129572155	0.277986452	0.121983281	2.908688527	2.876052691	1.280878143	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.6846
H7179_010_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1735.468892	67.04794344	784.8213789	2580.38141	190.4368686	16.71675072	4.901217661	506.7160426	260.1654061	6.022433148	7.863352211	0.214858614	1.168657437	7.606950431	4273.49994	2736.194468	81.10926864	45.62070447	13.61182449	85.69304439	6.150917932	0	0	0	401	4.734956345	0	0	0	0											3400	1a (IP Acute): $150 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $150 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $20 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $20 Copay per visit; 7i (PT/ST): $20 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 20 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $20 Copay per visit; 7b (Chiro): $20 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $20 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 20 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $20 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 20 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 20 copay; 18a1 (Routine Hearing Exam): 20 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											92.38902095	102.0492615	20.82848885	0	150	0.2	0.184257485	49.79835015	150	0	0.181551974	0.2	0.2	0.198876954	0	20	40	20	0.2	0.018065586	0.2	0	0	0	5	0	0	0	0	0											NO	84.36467307	93.1858839	19.01945311	0	136.9719132	0.182629218	0.168254002	45.47316864	136.9719132	0	0.165783475	0.182629218	0.182629218	0.181603713	0	18.26292176	36.52584353	18.26292176	0.182629218	0.01649652	0.182629218	0	0	0	5	0	0	0	0	0												12.201	0.520660156	1.243906118	0	2.17370852	3.052967105	0.824649486	1.920165338	2.969612786	0	1.303613851	0.039239461	0.213430993	1.381450443	0	4.164242125	0.246882038	0.069430613	2.485916857	1.413636984	1.12333733	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.515	0	3.552343763	12.201	0.520660156	1.243906118	0	2.17370852	3.052967105	0.824649486	1.920165338	2.969612786	0	1.303613851	0.039239461	0.213430993	1.381450443	0	4.164242125	0.246882038	0.069430613	2.485916857	1.413636984	1.12333733	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.515	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.201	0.520660156	1.243906118	0	2.17370852	3.052967105	0.824649486	1.920165338	2.969612786	0	1.303613851	0.039239461	0.213430993	1.381450443	0	4.164242125	0.246882038	0.069430613	2.485916857	1.413636984	1.12333733	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.515
H7179_011_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1810.178068	69.9342508	818.6066915	2691.462727	198.634873	18.01357921	5.281437407	528.5293626	271.3651132	6.489632967	8.47336425	0.231526612	1.259317894	8.197071695	4457.467318	2853.983289	84.6008937	47.58460326	14.6677834	92.34081843	6.628085162	0	0	0	401	4.938788688	0	0	0	0											3400	1a (IP Acute): $125 Copay per day (days 1-5); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $260 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $150 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $150 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 10% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $20 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $20 Copay per visit; 7i (PT/ST): $20 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 20 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $20 Copay per visit; 7b (Chiro): $20 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $20 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 20 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 10% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $100 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $20 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; 16b (Comp. Dental): 20 copay;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 20 copay; 18a1 (Routine Hearing Exam): 20 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											76.99085079	102.0492615	20.82848885	0	150	0.2	0.184257485	49.79835015	150	0	0.181551974	0.2	0.2	0.198835536	0	20	40	20	0.2	0.017584271	0.2	0	0	0	5	0	0	0	0	0											NO	70.81036993	93.85720356	19.156471	0	137.9586715	0.183944895	0.169466119	45.80076152	137.9586715	0	0.166977794	0.183944895	0.183944895	0.182873909	0	18.39448953	36.78897906	18.39448953	0.183944895	0.016172685	0.183944895	0	0	0	5	0	0	0	0	0												10.6816	0.546986101	1.306801279	0	2.283616932	3.313505942	0.895024702	2.017253941	3.119764208	0	1.41486367	0.042588138	0.231645098	1.499030544	0	4.374797144	0.259365042	0.072941207	2.698063881	1.493398923	1.219202431	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6375	0	3.270502417	10.6816	0.546986101	1.306801279	0	2.283616932	3.313505942	0.895024702	2.017253941	3.119764208	0	1.41486367	0.042588138	0.231645098	1.499030544	0	4.374797144	0.259365042	0.072941207	2.698063881	1.493398923	1.219202431	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6375	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.6816	0.546986101	1.306801279	0	2.283616932	3.313505942	0.895024702	2.017253941	3.119764208	0	1.41486367	0.042588138	0.231645098	1.499030544	0	4.374797144	0.259365042	0.072941207	2.698063881	1.493398923	1.219202431	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6375
H7179_012_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	V	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	YES	1740.338035	67.23605749	787.0233246	2587.621095	190.9711706	16.49229798	4.835409911	508.137718	260.895343	5.941571044	7.757772424	0.211973747	1.152966088	7.504813304	4285.489948	2743.871312	81.33683406	45.74870087	13.42906102	84.54245961	6.068330687	0	0	0	401	4.748241045	0	0	0	0											2900	1a (IP Acute): $100 Copay per day (days 1-4); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: Unlimited;	1b (IP Psych): $195 Copay per day (days 1-5);	2a (SNF): $35 Copay per day (days 11-100); 2a2 (Waiver 3 Day): 0 copay;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): $100 Copay per one-way trip;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	"4a (ER): $50 Copay per visit; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): $30 Copay per visit;"	9b (OP Surg): $100 Copay per visit;	8a (OP Diag Proc/Test/Lab): 0% Coinsurance;	8b (OP Diag): 10% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 0% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	"3 (CORF): $50 Copay per visit; 5 (Partial Hosp): $50 Copay per visit; 9a (OP Chemo): 20% Coinsurance; 9a (OP Services): 20% Coinsurance; 9c (OP SA): $40 Copay per visit; 9d (OP Cardiac Rehab): $25 Copay per visit; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0% coin; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $5 Copay per visit;	7h (Psych): $40 Copay per visit; 7e (MH Non-Phys): 40 copay per visit;	7c (OT): $5 Copay per visit; 7i (PT/ST): $15 Copay per visit;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 5 copay per office visit; 20% coin for all other procedures;	17a (Eye Exam): $5 Copay per visit; 7b (Chiro): $15 Copay per visit; 7b1 (Routine Chiro): Not Covered; 7f (Podiatry): $5 Copay per visit; 7f1 (Routine Podiatry): Not Covered; 7g (Prof. Other): 5 copay per visit; 7g1 (Prof. Other Coins): 0% Coinsurance; 8a (OP Diag Proc/Test/Lab): 0% Coinsurance; 8b (X-Ray): 0% Coinsurance; 9a (OP Chemo): 20% Coinsurance; 9b (OP ASC): $75 Copay per visit; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 16b (Comp. Dental): $5 Copay per visit;	10b (Transportation): 12 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coinsurance; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 5 copay; 18a1 (Routine Hearing Exam): 5 copay (1 exam per year);	18b (Hearing Aids): 1200 allowance (every 3 years);		13c (OTC Rx): $23.0 OTC per month											54.20064984	76.53694609	20.82848885	0	100	0.2	0.184257485	49.79835015	100	0	0.081551974	0.2	0.2	0.198898222	0	5	40	14.50568325	0.2	0.011158205	0.2	0	0	0	5	0	0	0	0	0											NO	50.44706123	71.23648918	19.38604159	0	93.07464279	0.186149286	0.171496996	46.34963652	93.07464279	0	0.075904208	0.186149286	0.186149286	0.18512381	0	4.653732139	37.22985711	13.50111287	0.186149286	0.01038546	0.186149286	0	0	0	5	0	0	0	0	0												7.3162	0.39913839	1.271438909	0	1.481214457	3.070029486	0.829258276	1.962666544	2.023561738	0	0.588847573	0.039458761	0.214623814	1.389319633	0	1.064103509	0.252346559	0.051471531	2.499810115	0.878012297	1.129615422	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6282	0	1.968882108	7.3162	0.39913839	1.271438909	0	1.481214457	3.070029486	0.829258276	1.962666544	2.023561738	0	0.588847573	0.039458761	0.214623814	1.389319633	0	1.064103509	0.252346559	0.051471531	2.499810115	0.878012297	1.129615422	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6282	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.3162	0.39913839	1.271438909	0	1.481214457	3.070029486	0.829258276	1.962666544	2.023561738	0	0.588847573	0.039458761	0.214623814	1.389319633	0	1.064103509	0.252346559	0.051471531	2.499810115	0.878012297	1.129615422	0	0	0	0.167083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	26.6282
H7179_013_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	556.8865185	13.69690978	52.63063384	3207.24179	20.80565447	23.8288309	9.004569464	39.62521111	35.23842939	8.162272224	16.72396211	0.957209485	0	16.70802514	5726.986706	4075.555	425.0285587	1.98846687	29.19164334	142.3803549	22.98219152	0	0	0	401	0.057849228	0	0	0	0												1a (IP Acute): 7.95% Coin MC CS; 1a1 (Add'l Days): 7.95% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.95% Coin MC CS;	2a (SNF): 21.23% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $8 Copay per visit;	7h (Psych): $8 Copay per visit; 7e (MH Non-Phys): 8 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 8 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $8 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $8 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 8 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $8 Copay per visit;	10b (Transportation): 100 one-way trips per year	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b (MCR Eyewear): 0% Coin MC CS; 17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 8 copay; 18a1 (Routine Hearing Exam): 8 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $21.5 OTC per month (cumulative benefit)											0.0795	0.0795	0.2123	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.151000606	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0795	0.0795	0.2123	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0	0.2	0	8	8	0.2	0.2	0.151000606	0.2	0	0	0	5	0.2	0	0	0	0												44.2725	1.088904327	11.17348356	0	4.161130893	4.765766181	1.800913893	7.925042222	7.047685878	0	3.344792423	0.191441897	0	3.341605029	0	2.717036667	0.283352372	0.397693374	5.838328669	21.49951989	4.596438304	0	0	0	0.167083333	0.011569846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.6243	0	0	44.2725	1.088904327	11.17348356	0	4.161130893	4.765766181	1.800913893	7.925042222	7.047685878	0	3.344792423	0.191441897	0	3.341605029	0	2.717036667	0.283352372	0.397693374	5.838328669	21.49951989	4.596438304	0	0	0	0.167083333	0.011569846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.6243	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	44.2725	1.088904327	11.17348356	0	4.161130893	4.765766181	1.800913893	7.925042222	7.047685878	0	3.344792423	0.191441897	0	3.341605029	0	2.717036667	0.283352372	0.397693374	5.838328669	21.49951989	4.596438304	0	0	0	0.167083333	0.011569846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.6243
H7179_014_0	2010	8	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	V	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	NO	370.4068647	8.884331239	34.72206412	2505.446012	13.11736276	17.55278604	6.201232788	25.29219367	26.71022145	6.102844185	11.13942505	0.565853988	0.356350889	11.05291183	4372.067241	3018.450382	252.5835414	1.411893031	19.40919282	100.5527901	13.88847439	0	0	0	401	0.041237822	0	0	0	0												1a (IP Acute): 7.95% Coin MC CS; 1a1 (Add'l Days): 7.95% Coin MC CS per day; 1a (IP Acute) - Limit: Standard MC;	1b (IP Psych): 7.95% Coin MC CS;	2a (SNF): 21.20% Coin MC CS; 2a2 (Waiver 3 Day): 0% coin;	6a (Home Health): 0% Coinsurance;	10a (Ambulance): 20.00% Coin MC CS;	11a (DME): 20.00% Coin MC CS; 11b (Prosthetics): 20.00% Coin MC CS;	11b (Medical Supplies): 20.00% Coin MC CS; 11c (Diabetic Supplies): 20.00% Coin MC CS;	"4a (ER): 20.00% Coin MC CS; 4a (ER) - Worldwide Coverage: $10,000 annual max; 4b (UC): 20.00% Coin MC CS;"	9b (OP Surg): 20.00% Coin MC CS;	8a (OP Diag Proc/Test/Lab): 0.00% Coin MC CS;	8b (OP Diag): 20.00% Coin MC CS; 8b (OP Therap Rad): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS;	9a (OP Observation): 20.00% Coin MC CS;	12 (Renal Dialysis): 20.00% Coin MC CS;	"3 (CORF): 20.00% Coin MC CS; 5 (Partial Hosp): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9a (OP Services): 20.00% Coin MC CS; 9c (OP SA): 20.00% Coin MC CS; 9d (OP Cardiac Rehab): 20.00% Coin MC CS; Outpatient rehab limited to the $1,810 Medicare allowed annual benefit limit;"	14b (Immunizations): 0% Coinsurance; 14c (Medicare Covered Physical Exam): 0 copay; 14c (Non-Medicare Covered Routine Exam): 0 copay (1 exam per year) ; 14d (Pap & Pelvic Exam): 0 copay; 14e (Prostate Screening): 0 copay; 14f (Colorectal Screening): 0 copay; 14g (Bone Mass): 0 copay; 14i (Diabetes Educ.): 0 copay; 14j (Nutrition Therapy Diabetes): 0 copay; 14h (Mammography): 0% Coinsurance; 7a (PCP w/Copay): 0% Coinsurance;	7d (SPC w/Copay): $8 Copay per visit;	7h (Psych): $8 Copay per visit; 7e (MH Non-Phys): 8 copay per visit;	7c (OT): 20.00% Coin MC CS; 7i (PT/ST): 20.00% Coin MC CS;	7g Physician Specialist Services Excluding Psychiatric (Radiology only): 8 copay per office visit; 20.00% Coin MC CS for all other procedures;	17a (Eye Exam): $8 Copay per visit; 7b (Chiro): $8 Copay per visit; 7b1 (Routine Chiro): 0% coin (5 visits) (per year); 7f (Podiatry): $8 Copay per visit; 7f1 (Routine Podiatry): 0% coin (3 visits) (per year); 7g (Prof. Other): 8 copay per visit; 7g1 (Prof. Other Coins): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20.00% Coin MC CS; 8b (X-Ray): 20.00% Coin MC CS; 9a (OP Chemo): 20.00% Coin MC CS; 9b (OP ASC): 20.00% Coin MC CS; All other Services: No Cost Sharing;	15 (Part B Rx): 20.00% Coin MC CS;	13a (Blood): 0.00% Coin MC CS; 16b (Comp. Dental): $8 Copay per visit;	10b (Transportation): 24 one-way trips per year;	"16a (Preventive Dental): Enhanced  Oral Exams, Prophylaxis, X-Rays, (0% CS preferred and 20% CS non-preferred), $1000 annual max; ; 16b (Comp. Dental):  MC CS;"	17a1 (Routine Eye Exam): 5 copay (1 visit per year);	"17b1 (Non MCR Covered): 0% Coinsuarnce,  150 allowance (every 2 years);"	18a (Hearing Exam): 8 copay; 18a1 (Routine Hearing Exam): 8 copay (1 exam per year);	18b (Hearing Aids): 1500 allowance (every 3 years);		13c (OTC Rx): $10.5 OTC per month (cumulative benefit)											0.0795	0.0795	0.212	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	8	8	0.2	0.2	0.153812229	0.2	0	0	0	5	0.2	0	0	0	0											NO	0.0795	0.0795	0.212	0	0.2	0.2	0.2	0.2	0.2	0	0.2	0.2	0.2	0.2	0	8	8	0.2	0.2	0.153812229	0.2	0	0	0	5	0.2	0	0	0	0												29.4473	0.706304333	7.361077593	0	2.623472552	3.510557209	1.240246558	5.058438735	5.342044291	0	2.22788501	0.113170798	0.071270178	2.210582367	0	2.012300255	0.168389028	0.282378606	3.881838564	15.46624883	2.777694877	0	0	0	0.167083333	0.008247564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6766	0	0	29.4473	0.706304333	7.361077593	0	2.623472552	3.510557209	1.240246558	5.058438735	5.342044291	0	2.22788501	0.113170798	0.071270178	2.210582367	0	2.012300255	0.168389028	0.282378606	3.881838564	15.46624883	2.777694877	0	0	0	0.167083333	0.008247564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6766	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	29.4473	0.706304333	7.361077593	0	2.623472552	3.510557209	1.240246558	5.058438735	5.342044291	0	2.22788501	0.113170798	0.071270178	2.210582367	0	2.012300255	0.168389028	0.282378606	3.881838564	15.46624883	2.777694877	0	0	0	0.167083333	0.008247564	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.6766
H7179_801_0	2010	4	N/A																															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	NO	275.2171199	5.976756477	24.10945334	40.09990638	7.953173756	18.30054711	5.214644108	16.12658788	28.36257674	6.417092416	8.48113118	0.22458851	1.185244051	8.236366389	25.65791217	25.09090496	0.959621775	1.292197682	14.29589934	90.20743058	6.318378022	0	0	0	0	0	0	0	0	0												FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance	FFS Medicare Deductible/Coinsurance																			0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.0817277	0.0817277	0.168597615	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.4929	0.488466561	4.064796329	0	1.853089485	4.264027476	1.215012077	3.757494977	6.608480381	1.495182533	1.976103565	0.052329123	0.276161864	1.919073369	5.978293536	5.846180855	0.223591874	0.30108206	3.330944547	21.01833133	1.472182079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6337		0	22.4929	0.488466561	4.064796329	0	1.853089485	4.264027476	1.215012077	3.757494977	6.608480381	1.495182533	1.976103565	0.052329123	0.276161864	1.919073369	5.978293536	5.846180855	0.223591874	0.30108206	3.330944547	21.01833133	1.472182079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6337	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0																			0		0	22.4929	0.488466561	4.064796329	0	1.853089485	4.264027476	1.215012077	3.757494977	6.608480381	1.495182533	1.976103565	0.052329123	0.276161864	1.919073369	5.978293536	5.846180855	0.223591874	0.30108206	3.330944547	21.01833133	1.472182079	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.6337
H7187_001_0	2010	4	N/A																															Coin	Coin	D	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	482.3203993	35.07624309	9094.514252	76.97514263	12.29927542	6.056575231	14.84031834	11.62703994	20.54090575	39.06163874	46.80603419	0	0.066189689	5.849460724	1.407696911	143.9253662	16.51896521	36.73456577	0	0	2.044343932	4.307621921	1942.430123	126.9461605	108.2028289	191.7298943	15.74742877	9.361811243	0	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11c); $0/20% (11b1)"	$50 (4a); $0 n/c (4a1); 20% (4b)	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"$0 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"$0 (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); 20% (7a1); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.0661702	0.066973886	0	0	0.2	0.2	0.131460585	0.038913557	0.2	0	0.035969027	0	0.2	0.151571724	0.000979357	0.199097842	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.0661702	0.066973886	0	0	0.2	0.2	0.131460585	0.038913557	0.2	0	0.035969027	0	0.2	0.151571724	0.000979357	0.199097842	0.2	0	0	0	0.2	0.2	0	0	0	0	0	0	0	0												31.9152	2.349192318	0	0	2.459855084	1.211315046	1.95091693	0.452449483	4.10818115	0	1.6835675	0	0.013237938	0.886612847	0.001378638	28.65522985	3.303793042	0	0	0	0.408868786	0.861524384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2614	0	0	31.9152	2.349192318	0	0	2.459855084	1.211315046	1.95091693	0.452449483	4.10818115	0	1.6835675	0	0.013237938	0.886612847	0.001378638	28.65522985	3.303793042	0	0	0	0.408868786	0.861524384	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2614	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												11.7321	0.8532	0.5157	0.0367	0.456	0.2246	0.5503	0.0559	0.7616	0.4345	1.3383	0	0.0016	0.1644	0.039	4.011	0.4604	0	0	0	0.057	0.12	0	0	0.0188	0	0.0019	0	0	0											21.8332	0	0	43.6474	3.202398231	0.515677007	0.036658341	2.915895634	1.43588469	2.501175925	0.508370206	4.86981024	0.434505869	3.021916222	0	0.014874087	1.050984892	0.040417431	32.66626465	3.764157646	0	0	0	0.465842306	0.981572864	0	0	0.018846804	0	0.001914811	0	0	0	0	0	0	0	0	0	0	0	0	0	102.0945
H7187_002_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	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	NO	327.87374	19.23734269	53.10964051	925.8102916	14.39169237	19.35468857	13.7644871	26.12354987	23.99925483	11.48192861	30.21229278	0	0.084921525	21.34989374	23.64765093	90.65291207	8.093034333	2.871656089	0	0	15.95344756	4.12937766	579.0122745	166.7362856	116.9675062	171.998988	0	0	75.8937576	0												"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080114065	0.08108711	0.184219613	0	0.2	0.2	0.2	0.116093085	0.2	0	0.166766196	0	0.2	0.150056486	0.167649571	0.199818453	0.2	0	0	0	0.2	0.199586763	0	0	0	0	0	0	0	0											NO	0.080114065	0.08108711	0.184219613	0	0.2	0.2	0.2	0.116093085	0.2	0	0.166766196	0	0.2	0.150056486	0.167649571	0.199818453	0.2	0	0	0	0.2	0.199586763	0	0	0	0	0	0	0	0												26.2673	1.559900525	9.783837434	0	2.878338475	3.870937713	2.752897421	3.032763489	4.799850965	0	5.038389143	0	0.016984305	3.203690023	3.964518522	18.11412469	1.618606867	0	0	0	3.190689511	0.82416912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.917	0	0	26.2673	1.559900525	9.783837434	0	2.878338475	3.870937713	2.752897421	3.032763489	4.799850965	0	5.038389143	0	0.016984305	3.203690023	3.964518522	18.11412469	1.618606867	0	0	0	3.190689511	0.82416912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.917	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"23% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												16.6813	0.9787	3.9639	0.4088	0.8532	1.1474	0.816	0.5989	1.4227	0.2042	1.4934	0	0.0034	0.9496	2.1464	8.3543	0.7458	0	0	0	1.4702	0.3798	0	0	0.0621	0	0	0	0	0											42.68	0	0	42.9486	2.538642522	13.7477159	0.40876823	3.731498681	5.018311467	3.568875998	3.631631981	6.222561281	0.204199569	6.531803889	0	0.020340485	4.153286766	6.110927643	26.46841267	2.364435521	0	0	0	4.660909188	1.203933323	0	0	0.062125793	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.597
H7187_003_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1764.359462	107.7988214	629.1086298	108.7872098	217.9517825	12.01523225	8.968903259	339.7360226	30.06588175	10066.90637	35.63398812	0	0.022104744	21.0594443	4996.385394	3842.524972	415.406653	357.5769143	0	0	16.05876462	840.290673	0	0	97.47559011	0	12.82317129	4.65329867	89.23037905	0											3600	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$29 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $29 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$29 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$29 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $29 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$29 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$29/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											166.0182673	126.2891031	81.80667226	0	150	0.2	0.121379525	49.99624458	0.2	3	0.149718207	0	0.2	0.152242612	6.671451942	29	38.5	29	0	0	0.2	27.80539722	0	0	29	0	0	0	0	0											YES	127.4985425	96.98737886	62.82580617	0	115.1968497	0.1535958	0.093216926	38.39606581	0.1535958	2.303936993	0.114980438	0	0.1535958	0.117090958	6.670269156	29	38.5	22.27139094	0	0	0.1535958	27.80539722	0	0	29	0	0	0	0	0											5000	18.7461	0.871260428	3.29368807	0	2.092279894	1.845489204	0.836053588	1.08704389	4.617993147	1.932793166	4.09721157	0	0.003395196	2.465870508	2.777269616	9.286102015	1.332763012	0.663644604	0	0	2.466558792	1.947051329	0	0	0.235566009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5981	0	13.59699015	18.7461	0.871260428	3.29368807	0	2.092279894	1.845489204	0.836053588	1.08704389	4.617993147	1.932793166	4.09721157	0	0.003395196	2.465870508	2.777269616	9.286102015	1.332763012	0.663644604	0	0	2.466558792	1.947051329	0	0	0.235566009	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.5981	NO	"$275 Days 1-19 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-19 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-34 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.6913	0.228	2.2262	0.0573	0.6623	0.8763	0.6541	0.4844	2.1927	0.6118	1.8792	0	0.0011	1.1635	1.6287	3.6361	0.4887	0.2404	0	0	1.1103	0.7687	0	0	0.0923	0	0.0121	0	0	0											22.7055	0	6.452903465	22.4374	1.099252321	5.519937637	0.057310221	2.754578315	2.721756708	1.490153177	1.571488168	6.810689436	2.544607038	5.976400839	0	0.004469924	3.629356891	4.405925832	12.92221751	1.821416037	0.904011568	0	0	3.576888332	2.715795898	0	0	0.327823535	0	0.012136721	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3036
H7187_008_0	2010	3	N/A																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2290.106361	213.8760224	42.85293866	852.751835	290.6189692	15.7259671	16.79184163	560.8266146	37.65836326	12234.58374	39.88218	0	0.16377324	25.80253822	7179.753015	5692.440402	822.7505975	315.2840851	0	0	21.22936201	1096.200692	655.7722089	0	138.3176088	0	14.31578951	4.684087207	77.28743891	0											3600	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	0.184219613	0	150	0.2	0.098382085	49.69436607	0.2	3	0.178843284	0	0.2	0.150004466	7.008379586	29.93055817	38.5	30	0	0	0.2	29.74657791	0	0	30	0	0	0	0	0											NO	118.4624751	90.22352892	0.131610275	0	107.1630806	0.142884107	0.070286182	35.50267571	0.142884107	2.143261612	0.127769315	0	0.142884107	0.10747052	6.890518138	29.93055817	38.5	21.43261612	0	0	0.142884107	29.74657791	0	0	30	0	0	0	0	0												22.6076	1.608054125	5.639887045	0	2.595302002	2.246990773	1.180234436	1.659237119	5.380781623	2.185159472	5.095718815	0	0.023400593	2.773012208	4.122684865	14.19815988	2.639658167	0.563113564	0	0	3.033338443	2.717351607	0	0	0.345794022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6155	0	22.68132544	22.6076	1.608054125	5.639887045	0	2.595302002	2.246990773	1.180234436	1.659237119	5.380781623	2.185159472	5.095718815	0	0.023400593	2.773012208	4.122684865	14.19815988	2.639658167	0.563113564	0	0	3.033338443	2.717351607	0	0	0.345794022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.6155	NO	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												11.9746	0.3305	2.1802	0.245	0.449	0.5831	0.6226	0.287	1.3963	0.378	1.2898	0	0.004	0.724	1.8941	7.0173	0.5681	0.2428	0	0	1.2131	0.3708	0	0	0.0452	0	0.0036	0	0	0											31.8194	0	0	34.5823	1.938575028	7.820124275	0.244997465	3.044291982	2.83008843	1.802853283	1.946286889	6.777102958	2.563194362	6.385559181	0	0.02744892	3.497004766	6.016821936	21.21541939	3.207747865	0.805941041	0	0	4.246444843	3.088142028	0	0	0.390994954	0	0.00356923	0	0	0	0	0	0	0	0	0	0	0	0	0	112.4349
H7187_009_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1368.581997	88.25984121	725.5306297	826.470394	166.6540934	8.611180186	7.318789977	271.5956694	18.61836552	8174.196335	22.30212541	0	0.029477945	13.76778614	4897.897528	3693.244053	373.478905	241.3850229	0	0	14.35419824	789.4618791	0	0	88.86092386	0	12.93248137	4.707863516	77.67974801	0											3350	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$85 Days 1-24 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	60.84817757	0	150	0.2	0.12410433	49.35144746	0.2	3	0.181420935	0	0.2	0.149191636	7.030721018	29.96279356	38.5	30	0	0	0.2	28.57235177	0	0	30	0	0	0	0	0											NO	147.6327267	112.4402101	48.75799677	0	120.1958679	0.160261157	0.099445518	39.5456004	0.160261157	2.403917359	0.145373645	0	0.160261157	0.119718231	6.913847285	29.96279356	38.5	24.03917359	0	0	0.160261157	28.57235177	0	0	30	0	0	0	0	0												16.8373	0.826996257	2.947951675	0	1.669261116	1.380037702	0.727820857	0.895034484	2.983800803	1.637507705	3.242141266	0	0.00472417	1.648255002	2.821942961	9.221659096	1.19824482	0.483558039	0	0	2.300420421	1.879731877	0	0	0.22215231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9285	0	9.364421352	16.8373	0.826996257	2.947951675	0	1.669261116	1.380037702	0.727820857	0.895034484	2.983800803	1.637507705	3.242141266	0	0.00472417	1.648255002	2.821942961	9.221659096	1.19824482	0.483558039	0	0	2.300420421	1.879731877	0	0	0.22215231	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9285	NO	"$300 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$300 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$125 Days 1-24 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.3926	0.2856	2.1565	0.6006	0.713	0.8842	0.7515	0.3823	1.9118	0.6995	2.0269	0	0.002	1.0499	1.6355	3.4675	0.4393	0.2285	0	0	1.3974	0.7268	0	0	0.0841	0	0.0122	0	0	0											23.8478	0	0	21.2299	1.112580579	5.104464209	0.600556853	2.38229457	2.264272983	1.479347613	1.277353058	4.895619544	2.336977526	5.269090102	0	0.006742123	2.69815388	4.457394238	12.68915642	1.637577208	0.712021237	0	0	3.697815879	2.606557402	0	0	0.30625633	0	0.01224018	0	0	0	0	0	0	0	0	0	0	0	0	0	76.7764
H7187_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	262.6188379	5.969348894	21.57002099	114.467502	7.37697517	12.64237451	9.434721368	11.80309264	31.00818993	14.56313388	36.74564072	0	0.022772817	21.72281756	21.74835372	88.01475569	3.113741105	4.086564305	0	0	16.65601678	4.836742131	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.081087111	0.081087111	0.184219613	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.081087111	0.081087111	0.184219613	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.295	0.484037259	3.973620919	0	1.718835215	2.945673262	2.198290079	2.750120586	7.224908253	3.393210195	8.561734287	0	0.005306066	5.06141649	5.067366416	20.50743808	0.725501677	0.952169483	0	0	3.88085191	1.126960917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8724	0	0	21.295	0.484037259	3.973620919	0	1.718835215	2.945673262	2.198290079	2.750120586	7.224908253	3.393210195	8.561734287	0	0.005306066	5.06141649	5.067366416	20.50743808	0.725501677	0.952169483	0	0	3.88085191	1.126960917	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8724	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.7671	0.0629	1.5839	0	0.5883	1.0083	0.7524	0.9413	2.473	1.1614	2.9305	0	0.0018	1.7324	1.6444	6.6547	0.2354	0.309	0	0	1.2593	0.3657	0	0	0	0	0	0	0	0											26.472	0	0	24.0622	0.546934755	5.557511774	0	2.307161362	3.953923842	2.950724938	3.691437028	9.697863427	4.554644557	11.49226079	0	0.007122237	6.793847638	6.711743598	27.16216964	0.960929374	1.261151633	0	0	5.140201206	1.492663466	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.3444
H7187_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	262.6188137	5.969348345	21.570019	114.4674968	7.376974492	12.64237335	9.434720501	11.80309156	31.00818708	14.56313254	36.74563734	0	0.022772815	21.72281556	21.74835172	88.0147476	3.113740818	4.086563929	0	0	16.65601525	4.836741687	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08108712	0.08108712	0.184219611	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08108712	0.08108712	0.184219611	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.295	0.484037264	3.973620516	0	1.718835057	2.945672991	2.198289877	2.750120333	7.224907589	3.393209883	8.5617335	0	0.005306066	5.061416025	5.06736595	20.50743619	0.725501611	0.952169395	0	0	3.880851554	1.126960813	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8724	0	0	21.295	0.484037264	3.973620516	0	1.718835057	2.945672991	2.198289877	2.750120333	7.224907589	3.393209883	8.5617335	0	0.005306066	5.061416025	5.06736595	20.50743619	0.725501611	0.952169395	0	0	3.880851554	1.126960813	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.8724	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.7671	0.0629	1.5839	0	0.5883	1.0083	0.7524	0.9413	2.473	1.1614	2.9305	0	0.0018	1.7324	1.6444	6.6547	0.2354	0.309	0	0	1.2593	0.3657	0	0	0	0	0	0	0	0											26.472	0	0	24.0622	0.546934761	5.557511212	0	2.30716115	3.953923478	2.950724667	3.691436689	9.697862536	4.554644138	11.49225973	0	0.007122236	6.793847014	6.711742981	27.16216714	0.960929286	1.261151517	0	0	5.140200733	1.492663329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.3444
H7187_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	255.5886919	5.809553069	20.9926047	112.9249965	7.179498049	12.30394587	9.182159637	11.48713106	30.17811962	14.17328768	35.76198235	0	0.022163202	21.14131099	21.16616357	85.65865442	3.030388156	3.977169473	0	0	16.21014538	4.707265498	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.08432161	0.08432161	0.181576511	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.08432161	0.08432161	0.181576511	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.5517	0.489870868	3.811763917	0	1.672823045	2.866819387	2.139443195	2.676501537	7.031501871	3.30237603	8.332541888	0	0.005164026	4.925925461	4.931716111	19.95846648	0.70608044	0.926680487	0	0	3.776963874	1.096792861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2031	0	0	21.5517	0.489870868	3.811763917	0	1.672823045	2.866819387	2.139443195	2.676501537	7.031501871	3.30237603	8.332541888	0	0.005164026	4.925925461	4.931716111	19.95846648	0.70608044	0.926680487	0	0	3.776963874	1.096792861	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.2031	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.8005	0.0637	1.5194	0	0.5726	0.9813	0.7323	0.9161	2.4068	1.1303	2.8521	0	0.0018	1.6861	1.6004	6.4766	0.2291	0.3007	0	0	1.2256	0.3559	0	0	0	0	0	0	0	0											25.8511	0	0	24.3521	0.553526405	5.331138345	0	2.245400061	3.848079715	2.871735833	3.592619513	9.438257545	4.432719503	11.18461998	0	0.006931579	6.611980485	6.53207432	26.43505494	0.935205881	1.227391374	0	0	5.002601158	1.452705776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.0542
H7188_003_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	P	O	O	O	O	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			0	YES	1357.571446	40.542371	245.960749	411.756223	29.349449	8.838601	4.116192	354.714379	428.030386	1277.664764	1129.399711	49.048376	0.047567	577.940128	3456.325826	3640.430112	70.793516	827.82656			17.371774	0		1.4	1.72				0.04	0.25	10.10533	0.05	0.55	2.4	0.25	0.32	0.4	0.42			4000	$200/Day(Days 1-8):1a	$200/Day(Days 1-8):1b	"$0/Day(Days 1-14) $80(Days 15-100):2. $0 SNF 1,2. $80 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	$0/Visit:8a	"$0-$75/Visit:14h. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $75 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $35 Radiology OP -- Facility"	$75/Visit:9a	20% Coins:12	"$0-$75/Visit:9d. $0 Cardiac Rehab,8b. $75 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $35 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			148.2254	133.6122	38.58248	0	150	0.2	0.2	50	190.683176	0	38.562726	75	0.2	42.808031	10	35	35	48.044057			0.2	0		0	0				0	0	0	0	0	0	0	0	0	0			NO	131.54189	118.573479	28.61921	0	128.65395	0.171539	0.171539	42.88465	163.547625	0	33.07498	64.326975	0.171539	36.716149	8.57693	30.019255	30.019255	41.207051			0.171539	0		0	0				0	0	0	0	0	0	0	0	0	0				14.8815	0.400604165	0.586600194	0	0.314660212	1.516164777	0.706087459	1.267650166	5.833612755	0	3.112906071	0.262927805	0.008159596	1.768311321	2.470388722	9.106916653	0.177097384	2.84269094	0	0	2.97993674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2362	0	7.512807	14.8815	0.400604165	0.586600194	0	0.314660212	1.516164777	0.706087459	1.267650166	5.833612755	0	3.112906071	0.262927805	0.008159596	1.768311321	2.470388722	9.106916653	0.177097384	2.84269094	0	0	2.97993674	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.2362	YES	$250/Day(Days 1-15)	$250/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			5000	3.3309	0.0956	0.2326	1.16	1.1212	1.3357	0.622	0.1993	2.5495	0.3232	1.1724	0.1511	0.0014	0.5502	1.3638	2.1378	0.0221	0.2396			0.649	0		0	0				0	0	0	0	0	0	0	0	0	0			17.2574	0	5.571379	18.2124	0.496177165	0.819226194	1.160025	1.435815212	2.851868777	1.328133459	1.466917166	8.383096755	0.323205	4.285315071	0.414042805	0.009509596	2.318559321	3.834138722	11.24471065	0.199231384	3.08227894	0	0	3.62890474	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.4935
H7188_801_0	2010	4	N/A																															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	NO	267.4316812	0.912244336	10.80035824	11.89374079	2.36064235	11.93166884	5.83231866	21.36303865	66.46333112	9.807566935	23.54585232	8.265645531	0.726218824	14.97390207	30.11343436	66.04176344	0.317367775	4.876740779			20.46968892	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																			0.083514918	0.083514918	0.178204614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083514918	0.083514918	0.178204614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.3345	0.076186011	1.924673669	0	0.550029668	2.78007884	1.358930248	4.977588005	15.48595615	2.285163096	5.48618359	1.925895409	0.169208986	3.488919183	7.016430206	15.38773088	0.073946692	1.136280602	0	0	4.769437519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2272	0	0	22.3345	0.076186011	1.924673669	0	0.550029668	2.78007884	1.358930248	4.977588005	15.48595615	2.285163096	5.48618359	1.925895409	0.169208986	3.488919183	7.016430206	15.38773088	0.073946692	1.136280602	0	0	4.769437519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2272	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3794	0.0013	0.0783	0	0.9323	0.5841	0.2855	0.4063	1.1533	0.1865	0.4065	0.1572	0.0138	0.2826	0.407	0.8927	0.0043	0.0753			0.0093	0																			6.2555	0	0	22.7139	0.077479696	2.002926937	0	1.48229552	3.364201132	1.644463477	5.383844652	16.63921006	2.471667183	5.892644063	2.083084299	0.183012312	3.771539479	7.42345897	16.28039405	0.078234994	1.211538791	0	0	4.778688428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4826
H7188_802_0	2010	4	N/A																															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	NO	267.4316812	0.912244336	10.80035824	11.89374079	2.36064235	11.93166884	5.83231866	21.36303865	66.46333112	9.807566935	23.54585232	8.265645531	0.726218824	14.97390207	30.11343436	66.04176344	0.317367775	4.876740779			20.46968892	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																			0.083514918	0.083514918	0.178204614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083514918	0.083514918	0.178204614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.3345	0.076186011	1.924673669	0	0.550029668	2.78007884	1.358930248	4.977588005	15.48595615	2.285163096	5.48618359	1.925895409	0.169208986	3.488919183	7.016430206	15.38773088	0.073946692	1.136280602	0	0	4.769437519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2272	0	0	22.3345	0.076186011	1.924673669	0	0.550029668	2.78007884	1.358930248	4.977588005	15.48595615	2.285163096	5.48618359	1.925895409	0.169208986	3.488919183	7.016430206	15.38773088	0.073946692	1.136280602	0	0	4.769437519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2272	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3794	0.0013	0.0783	0	0.9323	0.5841	0.2855	0.4063	1.1533	0.1865	0.4065	0.1572	0.0138	0.2826	0.407	0.8927	0.0043	0.0753			0.0093	0																			6.2555	0	0	22.7139	0.077479696	2.002926937	0	1.48229552	3.364201132	1.644463477	5.383844652	16.63921006	2.471667183	5.892644063	2.083084299	0.183012312	3.771539479	7.42345897	16.28039405	0.078234994	1.211538791	0	0	4.778688428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4826
H7188_803_0	2010	4	N/A																															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	NO	267.4316812	0.912244336	10.80035824	11.89374079	2.36064235	11.93166884	5.83231866	21.36303865	66.46333112	9.807566935	23.54585232	8.265645531	0.726218824	14.97390207	30.11343436	66.04176344	0.317367775	4.876740779			20.46968892	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																			0.083514918	0.083514918	0.178204614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.083514918	0.083514918	0.178204614	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				22.3345	0.076186011	1.924673669	0	0.550029668	2.78007884	1.358930248	4.977588005	15.48595615	2.285163096	5.48618359	1.925895409	0.169208986	3.488919183	7.016430206	15.38773088	0.073946692	1.136280602	0	0	4.769437519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2272	0	0	22.3345	0.076186011	1.924673669	0	0.550029668	2.78007884	1.358930248	4.977588005	15.48595615	2.285163096	5.48618359	1.925895409	0.169208986	3.488919183	7.016430206	15.38773088	0.073946692	1.136280602	0	0	4.769437519	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2272	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3794	0.0013	0.0783	0	0.9323	0.5841	0.2855	0.4063	1.1533	0.1865	0.4065	0.1572	0.0138	0.2826	0.407	0.8927	0.0043	0.0753			0.0093	0																			6.2555	0	0	22.7139	0.077479696	2.002926937	0	1.48229552	3.364201132	1.644463477	5.383844652	16.63921006	2.471667183	5.892644063	2.083084299	0.183012312	3.771539479	7.42345897	16.28039405	0.078234994	1.211538791	0	0	4.778688428	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4826
H7200_006_0	2010	5	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	313.87	19.32	85.7	87.86	20.09	19.04	16.7	16.82	30.28	7.64	21.71	0.87	1.55	40.77	54.03	108.55	5.5	6.18	24.82	28.38	8.21	3.95	0	15.21159904	1.64	2.27	0.37	0	0	0.5												1A IP Acute: Std. Medicare	1B IP Psych: Std. Medicare	2 SNF: Std. Medicare	6 Home Health: Std. Medicare	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: 20%, 4B Urgent Care: 20%"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: Std. Medicare, 5 Partial Hosp: 20%, 9C OP Substance Abuse: 20%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: 20%"	"7B Chiropractic: 20%, 7D Physician Specialist (excl. Radiology): 20%, 7F Podiatry: 20%"	"7E Mental Health: 20%, 7H Psychiatric: 20%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 0%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): 20%, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: Not covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): Not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: $0, 13E PERS: $0"											0.080859253	0.080868792	0.170874828	0	0.200012592	0.200000012	0.162658135	0.198778857	0.199999981	0.200095956	0.199989922	0.200000206	0.199999999	0.200030999	0.1978954	0.199998299	0.199996042	0.200005215	0.1999977	0.192249866	0	0.200008872	0	0	0	0	0	0	0	0											NO	0.080859253	0.080868792	0.170874828	0	0.200012592	0.200000012	0.162658135	0.198778857	0.199999981	0.200095956	0.199989922	0.200000206	0.199999999	0.200030999	0.1978954	0.199998299	0.199996042	0.200005215	0.1999977	0.192249866	0	0.200008872	0	0	0	0	0	0	0	0												25.3793	1.562385057	14.64397279	0	4.018252963	3.808000226	2.716390846	3.343460374	6.055999428	1.528733103	4.341781215	0.174000179	0.309999999	8.155263829	10.69228847	21.70981535	1.09997823	1.236032232	4.96394291	5.45605121	0	0.790035045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.9857	0	0	25.3793	1.562385057	14.64397279	0	4.018252963	3.808000226	2.716390846	3.343460374	6.055999428	1.528733103	4.341781215	0.174000179	0.309999999	8.155263829	10.69228847	21.70981535	1.09997823	1.236032232	4.96394291	5.45605121	0	0.790035045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.9857	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.3793	1.562385057	14.64397279	0	4.018252963	3.808000226	2.716390846	3.343460374	6.055999428	1.528733103	4.341781215	0.174000179	0.309999999	8.155263829	10.69228847	21.70981535	1.09997823	1.236032232	4.96394291	5.45605121	0	0.790035045	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.9857
H7200_007_0	2010	6	N/A																															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	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	0	0	0	0	0											0	NO	745.17	15.87	532.07	0	225.3	6.94	5.32	206.99	270.02	0	630.76	37.85	0.12	615.75	3661.08	4361.39	154.05	560.52	1407.46	80.04	7.47	578.82	0	0	0	0	0	0	0	0												1A IP Acute: $250 Per Day for days 1-7	1B IP Psych: $250 Per Day for days 1-7	2 SNF: $125 for days 20-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $200	8B OP Radiology: $95	9A OP Hospital: $200	12 Renal Dialysis: 20%	"3 CORF: $200, 5 Partial Hosp: $200, 9C OP Substance Abuse: $35, 9D Cardiac Rehab: $200"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $35"	"7B Chiropractic: $35, 7D Physician Specialist (excl. Radiology): $35, 7F Podiatry: $35"	"7E Mental Health: $35, 7H Psychiatric: $35"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): $95	"7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $35, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): Not covered	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC: $0, 13D Welcome Home: Not Covered, 13E PERS: $0"											250	250	125	0	100	0.199999994	0.159430239	48.61587516	200	0	95	82.0451843	0.200000033	83.62298603	15	35	35	35	95	35	0.199999207	35	0	0	0	0	0	0	0	0											NO	250	250	125	0	100	0.199999994	0.159430239	48.61587516	200	0	95	82.0451843	0.200000033	83.62298603	15	35	35	35	95	35	0.199999207	35	0	0	0	0	0	0	0	0												15.5244	0.330625	5.542395833	0	1.8775	1.387999961	0.848168874	0.838583333	4.500333333	0	4.993516667	0.258784185	0.024000004	4.290904471	4.57635	12.72072083	0.4493125	1.63485	11.14239167	0.23345	1.493994075	1.688225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3565	0	0	15.5244	0.330625	5.542395833	0	1.8775	1.387999961	0.848168874	0.838583333	4.500333333	0	4.993516667	0.258784185	0.024000004	4.290904471	4.57635	12.72072083	0.4493125	1.63485	11.14239167	0.23345	1.493994075	1.688225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3565	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.5244	0.330625	5.542395833	0	1.8775	1.387999961	0.848168874	0.838583333	4.500333333	0	4.993516667	0.258784185	0.024000004	4.290904471	4.57635	12.72072083	0.4493125	1.63485	11.14239167	0.23345	1.493994075	1.688225	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3565
H7220_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	Coin	V	V	V	V	Coin	Coin	V	Coin	Coin	V	V	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	YES	1476.154757	24.22512317	4710.524587	1811.815228	648.5143317	17.3547721	8.738813274	248.4307746	647.4879086	3.686388136	30.27504806	4.930486397	9.443911724	661.2932706	22.85045727	7239.770041	158.0279811	1040.081461	0	67.6260651	43.56437996	0	0	0	867.8802714	50.39270351	0	0	0	0											3400	1a (IP Acute): $340 Copay per day (days 1-10); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: 150 days;	1b (IP Psych): $250 Copay per day (days 1-10); 1b (IP Psych) - Limit: 150 days;	2a (SNF): $65 Copay per day (days 51-100); 2a2 (Waiver 3 Day): 3-day period is waived;	6a (Home Health): $0 Copay per visits;	10a (Ambulance): $50 Copay per trips;	11a (DME): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	4a (ER): $50 Copay per visits; n/a Worldwide Coverage; 4b (UC): $50 Copay per visits;	9b (OP ASC): $400 Copay per visits; 9b (OP Surg): $400 Copay per visits;	8a (OP Diag Proc/Test/Lab): 20% Coinsurance;	8b (OP Diag): $35 Copay per visits; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 20% Coinsurance;	9a (OP Observation): $100 Copay per visits;	12 (Renal Dialysis): 20% Coinsurance;	3 (CORF): $15 Copay per visits; 5 (Partial Hosp): Not Covered; 9a (OP Chemo): $0 Copay per visits; 9a (OP Other): $100 Copay per visits; 9c (OP SA): $25 Copay per visits; 9d (OP Cardiac Rehab): $25 Copay per visits;	14b (Immunizations): $0 Copay per visits; 14c (Routine Physical - Medicare covered only): 10% Coinsurance; 14h (Mammography): $0 Copay per visits; 7a (PCP w/Copay): $35 Copay per visits;	7d (SPC w/Copay): $55 Copay per visits;	7e (MH Non-Phys): $25 Copay per visits; 7h (Psych): $55 Copay per visits;	7c (OT): $25 Copay per visits; 7i (PT/ST): $25 Copay per visits;	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only): Not Covered;	7b (Chiro): $25 Copay per visits; 7f (Podiatry): $20 Copay per visits; 8a (OP Diag Proc/Test/Lab): 20% Coinsurance; 8b (X-Ray): 20% Coinsurance; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	"13a (Blood): $0 Copay per visits; 14a (Health Education/Wellness Programs): Covers written health educational materials, nutritional training and benefits, additional smoking cessation, nursing hotline; does not cover health club membership or fitness classes;"	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): Not Covered;	17a (Eye Exam): $25 Copay per visits;	"17b (Eyewear): $20 Copay for lenses for every two years, $20 copay for frames for every two years, $105 benefit limit;"															253.7802796	164.9066453	5.080675272	0	50	0.2	0.19635915	49.9081582	400	0.2	0.167264024	100	0.2	74.34905375	0.444260332	54.11764431	55	25	0	0.042190346	0.2	0	0	0	25	40	0	0	0	0											NO	197.9786791	128.646717	3.963528533	0	39.00592265	0.156023691	0.153183397	38.93427517	312.0473812	0.156023691	0.130485752	78.0118453	0.156023691	58.00106879	0.346575683	42.21817296	42.90651491	19.50296132	0	0.032913468	0.156023691	0	0	0	19.50296132	31.20473812	0	0	0	0												24.3539	0.25970688	1.555858217	0	2.107991655	2.707755593	1.338641099	0.806039345	16.83724219	0.575163882	3.950462412	0.032053029	1.473473961	3.196309706	7.919412827	25.47082198	0.565035827	1.690389042	0	2.225808309	6.79707534	0	0	0	1.410519614	0.131040926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.4047	0	29.70902121	24.3539	0.25970688	1.555858217	0	2.107991655	2.707755593	1.338641099	0.806039345	16.83724219	0.575163882	3.950462412	0.032053029	1.473473961	3.196309706	7.919412827	25.47082198	0.565035827	1.690389042	0	2.225808309	6.79707534	0	0	0	1.410519614	0.131040926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.4047	NO																																																																																		0	0	0	24.3539	0.25970688	1.555858217	0	2.107991655	2.707755593	1.338641099	0.806039345	16.83724219	0.575163882	3.950462412	0.032053029	1.473473961	3.196309706	7.919412827	25.47082198	0.565035827	1.690389042	0	2.225808309	6.79707534	0	0	0	1.410519614	0.131040926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.4047
H7220_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	V	V	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	YES	1476.154757	24.22512317	4710.524587	1811.815228	648.5143317	17.3547721	8.738813274	248.4307746	647.4879086	1426.882763	1841.24084	4.930486397	9.443911724	661.2932706	3879.412356	7764.496123	158.0279811	1040.081461	0	960.8573269	43.56437996	0	0	258.0307892	880.792897	50.39270351	0	0	0	0											3400	1a (IP Acute): $250 Copay per day (days 1-10); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: 150 days;	1b (IP Psych): $250 Copay per day (days 1-10); 1b (IP Psych) - Limit: 150 days;	2a (SNF): $65 Copay per day (days 51-100); 2a2 (Waiver 3 Day): 3-day period is waived;	6a (Home Health): $0 Copay per visits;	10a (Ambulance): $50 Copay per trips;	11a (DME): 10% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	4a (ER): $50 Copay per visits; n/a Worldwide Coverage; 4b (UC): $50 Copay per visits;	9b (OP ASC): $200 Copay per visits; 9b (OP Surg): $200 Copay per visits;	8a (OP Diag Proc/Test/Lab): $10 Copay per visits;	8b (OP Diag): $35 Copay per visits; 8b (OP Therap Rad): $25 Copay per visits; 8b (X-Ray): $25 Copay per visits;	9a (OP Observation): $100 Copay per visits;	12 (Renal Dialysis): 0% Coinsurance;	3 (CORF): $15 Copay per visits; 5 (Partial Hosp): Not Covered; 9a (OP Chemo): $0 Copay per visits; 9a (OP Other): $100 Copay per visits; 9c (OP SA): $25 Copay per visits; 9d (OP Cardiac Rehab): $10 Copay per visits;	14b (Immunizations): $0 Copay per visits; 14c (Routine Physical): $10 Copay per visits; 14h (Mammography): $0 Copay per visits; 7a (PCP w/Copay): $20 Copay per visits; 14d1 (Add'l Pap): 1 additional exam per year;	7d (SPC w/Copay): $40 Copay per visits; 18a (Hearing Exam): $25 Copay;	7e (MH Non-Phys): $25 Copay per visits; 7h (Psych): $40 Copay per visits;	7c (OT): $15 Copay per visits; 7i (PT/ST): $15 Copay per visits;	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only): Not Covered;	7b (Chiro): $25 Copay per visits; 7f (Podiatry): $15 Copay per visits; 8a (OP Diag Proc/Test/Lab): $10 Copay per visits; 8b (X-Ray): $25 Copay per visits; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	"13a (Blood): $0 Copay per visits; 14a (Health Education/Wellness Programs): Covers written health educational materials, nutritional training and benefits, additional smoking cessation, nursing hotline; does not cover health club membership or fitness classes;"	10b (Transportation): Not Covered;	16a (Preventive Dental): $10 Copay per visits; 16b (Comp. Dental): Not Covered;	17a (Eye Exam): $25 Copay per visits;	"17b (Eyewear): $20 Copay for lenses for every two years, $20 copay for frames for every two years, $105 benefit limit;"															189.7247947	164.9066453	5.080675272	0	50	0.1	0.19635915	49.9081582	200	10	32.79964653	100	0	73.66311792	18.13983916	38.98629723	40	15	0	14.658569	0.2	0	0	10	25	40	0	0	0	0											NO	161.5799286	140.4434461	4.326978711	0	42.58271273	0.085165425	0.167230106	42.50449527	170.3308509	8.516542546	27.93395852	85.16542546	0	62.73550778	15.4488712	33.20284591	34.06617018	12.77481382	0	12.48403266	0.170330851	0	0	8.516542546	21.29135637	34.06617018	0	0	0	0												19.8764	0.283521648	1.698528301	0	2.301291624	1.47802655	1.461392668	0.879952057	9.190597203	1.012675647	4.286095437	0.034992248	0	3.457214093	4.994378485	21.48361403	0.448617342	1.107237252	0	0.999614521	7.420357909	0	0	0.183127516	1.562772955	0.143057201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3035	0	14.68443616	19.8764	0.283521648	1.698528301	0	2.301291624	1.47802655	1.461392668	0.879952057	9.190597203	1.012675647	4.286095437	0.034992248	0	3.457214093	4.994378485	21.48361403	0.448617342	1.107237252	0	0.999614521	7.420357909	0	0	0.183127516	1.562772955	0.143057201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3035	NO																																																																																		0	0	0	19.8764	0.283521648	1.698528301	0	2.301291624	1.47802655	1.461392668	0.879952057	9.190597203	1.012675647	4.286095437	0.034992248	0	3.457214093	4.994378485	21.48361403	0.448617342	1.107237252	0	0.999614521	7.420357909	0	0	0.183127516	1.562772955	0.143057201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.3035
H7220_003_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	V	V	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	YES	1631.819022	26.77972386	5207.261356	2002.87574	716.9018134	19.08717371	9.611145914	274.6284301	715.7671513	1577.351171	2035.404358	5.450418697	10.38662925	731.0283237	4288.506232	8583.281939	174.6924327	1149.76069	0	1062.18217	47.9130975	0	0	259.4289034	879.4722509	55.70674195	0	0	0	0											3400	1a (IP Acute): $250 Copay per day (days 1-10); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: 150 days;	1b (IP Psych): $250 Copay per day (days 1-10); 1b (IP Psych) - Limit: 150 days;	2a (SNF): $65 Copay per day (days 51-100); 2a2 (Waiver 3 Day): 3-day period is waived;	6a (Home Health): $0 Copay per visits;	10a (Ambulance): $50 Copay per trips;	11a (DME): 10% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	4a (ER): $50 Copay per visits; n/a Worldwide Coverage; 4b (UC): $50 Copay per visits;	9b (OP ASC): $200 Copay per visits; 9b (OP Surg): $200 Copay per visits;	8a (OP Diag Proc/Test/Lab): $10 Copay per visits;	8b (OP Diag): $35 Copay per visits; 8b (OP Therap Rad): $25 Copay per visits; 8b (X-Ray): $25 Copay per visits;	9a (OP Observation): $100 Copay per visits;	12 (Renal Dialysis): 0% Coinsurance;	3 (CORF): $15 Copay per visits; 5 (Partial Hosp): Not Covered; 9a (OP Chemo): $0 Copay per visits; 9a (OP Other): $100 Copay per visits; 9c (OP SA): $25 Copay per visits; 9d (OP Cardiac Rehab): $10 Copay per visits;	14b (Immunizations): $0 Copay per visits; 14c (Routine Physical): $10 Copay per visits; 14h (Mammography): $0 Copay per visits; 7a (PCP w/Copay): $20 Copay per visits; 14d1 (Add'l Pap): 1 additional exam per year;	7d (SPC w/Copay): $40 Copay per visits; 18a (Hearing Exam): $25 Copay;	7e (MH Non-Phys): $25 Copay per visits; 7h (Psych): $40 Copay per visits;	7c (OT): $15 Copay per visits; 7i (PT/ST): $15 Copay per visits;	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only): Not Covered;	7b (Chiro): $25 Copay per visits; 7f (Podiatry): $15 Copay per visits; 8a (OP Diag Proc/Test/Lab): $10 Copay per visits; 8b (X-Ray): $25 Copay per visits; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;  Part C Home Infusion not bundled;	"13a (Blood): $0 Copay per visits; 14a (Health Education/Wellness Programs): Covers written health educational materials, nutritional training and benefits, additional smoking cessation, nursing hotline; does not cover health club membership or fitness classes;"	10b (Transportation): Not Covered;	16a (Preventive Dental): $10 Copay per visits; 16b (Comp. Dental): Not Covered;	17a (Eye Exam): $25 Copay per visits;	"17b (Eyewear): $20 Copay for lenses for every two years, $20 copay for frames for every two years, $105 benefit limit;"															189.6647368	164.9066453	5.080675272	0	50	0.1	0.19635915	49.90790157	200	10	32.79964653	100	0	73.56684677	18.13983916	38.98629723	40	15	0	14.658569	0.2	0	0	10	25	40	0	0	0	0											NO	161.4657987	140.3886861	4.325291589	0	42.5661094	0.085132219	0.167164901	42.48770396	170.2644376	8.51322188	27.92306685	85.1322188	0	62.62908896	15.44284756	33.18989986	34.05288752	12.76983282	0	12.47916504	0.170264438	0	0	8.51322188	21.2830547	34.05288752	0	0	0	0												21.9569	0.313297521	1.876910312	0	2.542976752	1.624933449	1.60664626	0.972360953	10.15580762	1.119028375	4.736227663	0.038667186	0	3.81530316	5.518895668	23.73985567	0.495731813	1.223520983	0	1.10459555	8.157896601	0	0	0.184047985	1.559821335	0.158081285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9015	0	16.2246384	21.9569	0.313297521	1.876910312	0	2.542976752	1.624933449	1.60664626	0.972360953	10.15580762	1.119028375	4.736227663	0.038667186	0	3.81530316	5.518895668	23.73985567	0.495731813	1.223520983	0	1.10459555	8.157896601	0	0	0.184047985	1.559821335	0.158081285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9015	NO																																																																																		0	0	0	21.9569	0.313297521	1.876910312	0	2.542976752	1.624933449	1.60664626	0.972360953	10.15580762	1.119028375	4.736227663	0.038667186	0	3.81530316	5.518895668	23.73985567	0.495731813	1.223520983	0	1.10459555	8.157896601	0	0	0.184047985	1.559821335	0.158081285	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.9015
H7220_004_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	V	V	V	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	NO	1386.444675	22.75289419	4424.252739	1446.450196	609.1022891	16.21002952	8.162390166	233.3329367	608.1382446	1340.167079	1729.343448	4.630846851	8.820979435	621.1046158	3643.64954	7218.700273	148.4241756	976.872781	0	902.4633206	40.6908187	0	0	182.2644536	510.8220111	40.23066743	73.77450301	0	0	0												1a (IP Acute): $0 Copay per day (days 1-100); 1a1 (Add'l Days): 0 copay per day; 1a (IP Acute) - Limit: 150 days;	1b (IP Psych): $0 Copay per day (days 1-100); 1b (IP Psych) - Limit: 150 days;	2a (SNF): $65 Copay per day (days 51-100); 2a2 (Waiver 3 Day): 3-day period is waived;	6a (Home Health): $0 Copay per visits;	10a (Ambulance): $50 Copay per trips;	11a (DME): 10% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance; 11c (Diabetic Supplies): 0% Coinsurance;	4a (ER): $50 Copay per visits; 50 copay Worldwide Coverage; 4b (UC): $50 Copay per visits;	9b (OP ASC): $150 Copay per visits; 9b (OP Surg): $150 Copay per visits;	8a (OP Diag Proc/Test/Lab): $0 Copay per visits;	8b (OP Diag): $35 Copay per visits; 8b (OP Therap Rad): $25 Copay per visits; 8b (X-Ray): $25 Copay per visits;	9a (OP Observation): $100 Copay per visits;	12 (Renal Dialysis): 0% Coinsurance;	3 (CORF): $15 Copay per visits; 5 (Partial Hosp): Not Covered; 9a (OP Chemo): $0 Copay per visits; 9a (OP Other): $100 Copay per visits; 9c (OP SA): $25 Copay per visits; 9d (OP Cardiac Rehab): $10 Copay per visits;	14b (Immunizations): $0 Copay per visits; 14c (Routine Physical): $10 Copay per visits; 14h (Mammography): $0 Copay per visits; 7a (PCP w/Copay): $10 Copay per visits; 14d1 (Add'l Pap): 1 additional exam per year;	7d (SPC w/Copay): $35 Copay per visits; 18a (Hearing Exam): $25 Copay;	7e (MH Non-Phys): $25 Copay per visits; 7h (Psych): $35 Copay per visits;	7c (OT): $15 Copay per visits; 7i (PT/ST): $15 Copay per visits;	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only): Not Covered;	7b (Chiro): $25 Copay per visits; 7f (Podiatry): $10 Copay per visits; 8a (OP Diag Proc/Test/Lab): $0 Copay per visits; 8b (X-Ray): $25 Copay per visits; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;  Part C Home Infusion not bundled;	"13a (Blood): $0 Copay; 14a (Health Education/Wellness Programs): Covers written health educational materials, nutritional training and benefits, additional smoking cessation, nursing hotline; does not cover health club membership or fitness classes;"	10b (Transportation): Not Covered;	16a (Preventive Dental): $10 Copay per visits; 16b (Comp. Dental): Not Covered;	17a (Eye Exam): $10 Copay per visits;	"17b (Eyewear): $20 Copay for lenses for every two years, $20 copay for frames for every two years, $105 benefit limit;"	18a1 (Routine Hearing Exam) $10 Copay;														11.72774638	0	5.080675272	0	50	0.1	0.19635915	49.90787983	150	0	32.79964653	100	0	73.55869092	9.173507229	33.54921442	35	15	0	11.84460221	0.2	0	0	10	10	40	10	0	0	0											NO	10.69708569	0	4.634174121	0	45.60588773	0.091211775	0.179102667	45.52186329	136.8176632	0	29.91713995	91.21177547	0	67.09418799	8.367318817	30.60083413	31.92412141	13.68176632	0	10.80367197	0.182423551	0	0	9.121177547	9.121177547	36.48471019	9.121177547	0	0	0												1.2359	0	1.708563129	0	2.314887551	1.478545573	1.46190585	0.885145837	6.933671128	0	4.311417496	0.03519898	0	3.472709155	2.540631446	18.40818747	0.394859284	1.113778759	0	0.81249314	7.422963638	0	0	0.13853887	0.388274855	0.12231702	0.056075862	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2361	0	5.321977623	1.2359	0	1.708563129	0	2.314887551	1.478545573	1.46190585	0.885145837	6.933671128	0	4.311417496	0.03519898	0	3.472709155	2.540631446	18.40818747	0.394859284	1.113778759	0	0.81249314	7.422963638	0	0	0.13853887	0.388274855	0.12231702	0.056075862	0	0	0	0	0	0	0	0	0	0	0	0	0	55.2361	YES	1a (IP Acute): 20% Coinsurance; 1a1 (Add'l Days): 20% Coinsurance; 1a (IP Acute) - Limit: 10 additional days;	1b (IP Psych): 20% Coinsurance;	2a (SNF): 20% Coinsurance; 2a2 (Waiver 3 Day): 3-day period is waived;	6a (Home Health): 20% Coinsurance;	10a (Ambulance): 20% Coinsurance;	11a (DME): 20% Coinsurance; 11b (Prosthetics): 20% Coinsurance;	11b (Medical Supplies): 20% Coinsurance; 11c (Diabetic Supplies): 20% Coinsurance;	4a (ER): $50 Copay per visits; 50 copay Worldwide Coverage; 4b (UC): $50 Copay per visits;	9b (OP ASC): 20% Coinsurance; 9b (OP Surg): 20% Coinsurance;	8a (OP Diag Proc/Test/Lab): 20% Coinsurance;	8b (OP Diag): 20% Coinsurance; 8b (OP Therap Rad): 20% Coinsurance; 8b (X-Ray): 20% Coinsurance;	9a (OP Observation): 20% Coinsurance;	12 (Renal Dialysis): 20% Coinsurance;	3 (CORF): 20% Coinsurance; 5 (Partial Hosp): Not covered; 9a (OP Chemo): 20% Coinsurance; 9a (OP Other): 20% Coinsurance; 9c (OP SA): 20% Coinsurance; 9d (OP Cardiac Rehab): 20% Coinsurance;	14b (Immunizations): Not covered; 14c (Routine Physical): Not covered; 14h (Mammography): Not covered; 7a (PCP w/Copay): 20% Coinsurance;	7d (SPC w/Copay): 20% Coinsurance; 18a (Hearing Exam): 20% Coinsurance;	7h (Psych): 20% Coinsurance;	7c (OT): 20% Coinsurance; 7i (PT/ST): 20% Coinsurance;	7d1 Physician Specialist Services Excluding Psychiatric (Radiology only): Not covered;	7b (Chiro): 20% Coinsurance; 7f (Podiatry): 20% Coinsurance; 8a (OP Diag Proc/Test/Lab): 20% Coinsurance; 8b (X-Ray): 20% Coinsurance; All other Services: No Cost Sharing;	15 (Part B Rx): 20% Coinsurance;	13a (Blood): 0% Coinsurance; 14a (Helath Education/Wellness Programs): Not covered;	10b (Transportation): Not Covered;	16a (Preventive Dental): Not Covered; 16b (Comp. Dental): Not Covered;	17a (Eye Exam): Not covered;	17b (Eyewear): Not covered ;															3400	7.1516	0.0588	2.2924	1.0013	0.2863	0.5479	0.2759	0.1562	1.9207	0.1164	0.9559	0.0027	0.2982	0.3155	0.6842	2.5945	0.0374	0.1726	0	0.3383	1.3754	0	0	0	0	0															20.5822	0	1.983089516	8.3875	0.058785061	4.000952708	1.001285435	2.601191928	2.026477168	1.737811051	1.041355886	8.854420012	0.116388076	5.267273053	0.037911019	0.298166843	3.7881818	3.224866219	21.00267311	0.4322885	1.28635857	0	1.150795544	8.798395135	0	0	0.13853887	0.388274855	0.12231702	0.056075862	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8183
H7226_001_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	2564.549476	18.38316653	4624.914194		428.7596019			369.5702293	336.9627093					1525.830007	2397.065431	7620.699976	563.4387879	1084.896333		39.40529838										361.8178811											3350	"1a (IP Acute), 1a1 (Add'l Days) - $50/days 1-5"	1b (IP Psych) - $50/days 1-5	2 (SNF) - $50 days 11-100; 2a2 (Waiver 3 Day) - $0	6 (Home Health)- $0	10a (Ambulance) - $150	11a (Medical Equip) - $0	"11b (Med Supp), 11c (Diab Supp) - $0"	4a (ER) $50 (WW Coverage)	"9a (OP Surgery), 9b (ASC) - $100"	8a (OP Diag Proc/Test/Lab) - $0	8b (OP Diag & Therap Rad) - $0	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA), 9d (Cardiac Rehab) - $15; 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	7a (PCP) - $15	"7b (Chiro), 7d (Spec), 7f (Pod) - $15; 17a (MCR Eye Exam) - $15; 18a (MCR Hearing Exam) - $15, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $15; 14i (Diab Mon.) - $15; 14a (Smoking Cessation) - $15"	"7e (MH), 7h (Psychiatric) - $15"	"7c (OT), 7i (PT/ST) - $15"	"8b (Professional Radiology) - 0%, 14h (Mammography)"	"7g (Prof. Other - allergy visits)  - $5; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - $0	13a (Blood) - $0			17a1 (Rountine Eye Exam) - $100 limit	17b1 (Non MCR Covered) - $200 limit	18a1 (Hearing Exam Non-covered) - $15; 18a2 (Fit & Eval for Hearing Aids) - $15	18b (Hearing Aids) - $500 limit		14c (Routine Physical) - $15											23.42600149	23.42600149	4.414855864		43.2621096			50	100					10.63264296	15	14.06530388	15	6.812278006		5										15											NO	22.42680109	22.42680109	4.226546914		41.41683023			47.86732618	95.73465236					10.17912377	14.36019785	13.46540347	14.36019785	6.521710667		4.786732618										15												4.7929	0.034356302	1.628951401	0	1.47982197	0	0	1.474194893	2.688250653	0	0	0	0	1.294301041	2.868527821	8.551316656	0.674257706	0.589614999	0	0.015718552	0	0	0	0	0	0	0	0	0	0.452272351	0	0	0	0	0	0	0	0	0	0	26.5445	0	1.162485642	4.7929	0.034356302	1.628951401	0	1.47982197	0	0	1.474194893	2.688250653	0	0	0	0	1.294301041	2.868527821	8.551316656	0.674257706	0.589614999	0	0.015718552	0	0	0	0	0	0	0	0	0	0.452272351	0	0	0	0	0	0	0	0	0	0	26.5445	NO																																																																																		0	0	0	4.7929	0.034356302	1.628951401	0	1.47982197	0	0	1.474194893	2.688250653	0	0	0	0	1.294301041	2.868527821	8.551316656	0.674257706	0.589614999	0	0.015718552	0	0	0	0	0	0	0	0	0	0.452272351	0	0	0	0	0	0	0	0	0	0	26.5445
H7226_002_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	P	P	P	P	Coin	P	Coin	O	P	P	P	P	P	P	P	P																																																			0	YES	1824.674433	59.91411745	1794.657578		216.6708792	4.775392611	6.035984198	254.7087701	258.7214735		15.27524646			311.3143421	2438.256822	5070.136873	438.3928876	618.3131057	20.11868318	43.75261083																					3350	"1a (IP Acute), 1a1 (Add'l Days) - $150 days 1-5"	1b (IP Psych) - $150 days 1-5	2 (SNF) - $100 days 11-100	6a (Home Health) - $0	10a (Ambulance) - $150	11a (Medical Equip) - 20%	"11b (Med Supp) - 20%,11b1 (Prosthetics) - 30%, 11c (Diabetic Supplies) - 0%"	4a (ER) $50 (WW Coverage)	"9a (OP Surgery) - $100, 9b (ASC) - $100"	8a (OP Diag Proc/Test/Lab) - $0	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA), 9d (Cardiac Rehab) - $25, 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	7a (PCP) - $15	"7b (Chiro) - $25, 7d (Spec) - $15, 7f (Pod) - $25; 17a (MCR Eye Exam) - $25; 18a (MCR Hearing Exam) - $25, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $25; 14i (Diab Mon.) - $25; 14a (Smoking Cessation) - $25"	"7e (MH), 7h (Psychiatric) - $25"	"7c (OT), 7i (PT/ST) - $25"	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	"7g (Prof. Other - allergy visits)  - $5; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - 0%	13a (Blood) - $0				17b1 (Non MCR Covered) - $100 limit				14c (Routine Physical) - $0											78.64215825	78.64215825	31.43224536		114.4055605	0.2	0.242442345	50	100		0.188047259			22.87061772	15	17.92953158	25	19.09537986	0.066738962	5																					NO	73.07360719	73.07360719	29.20656811		106.3046485	0.185838255	0.225275311	46.45956369	92.91912738		0.174731872			21.25117842	13.93786911	16.66050634	23.22978185	17.74326034	0.062013261	4.645956369																						11.1113	0.364845057	4.367982397	0	1.919426803	0.887450629	1.359758217	0.986138194	2.003347796	0	2.66907241	0	0	0.551316386	2.832008702	7.03925396	0.848647595	0.914240867	1.247625149	0.016939393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1193	0	2.980831086	11.1113	0.364845057	4.367982397	0	1.919426803	0.887450629	1.359758217	0.986138194	2.003347796	0	2.66907241	0	0	0.551316386	2.832008702	7.03925396	0.848647595	0.914240867	1.247625149	0.016939393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1193	NO																																																																																		0	0	0	11.1113	0.364845057	4.367982397	0	1.919426803	0.887450629	1.359758217	0.986138194	2.003347796	0	2.66907241	0	0	0.551316386	2.832008702	7.03925396	0.848647595	0.914240867	1.247625149	0.016939393	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1193
H7226_006_0	2010	1	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	P	P	P	P	Coin	P	Coin	O	P	P	P	P	P	P	P	P																																																			0	YES	1320.280753	67.50258751	1813.442325		224.6769444	7.065611227	5.926216988	279.8381165	296.3389904		22.73805473			414.7903644	2937.406934	5347.437884	444.2736523	568.4234207	21.4794747	51.36245893																					3350	"1a (IP Acute), 1a1 (Add'l Days) - $150 days 1-5"	1b (IP Psych) - $150 days 1-5	2 (SNF) - $100 days 11-100	6a (Home Health) - $0	10a (Ambulance) - $150	11a (Medical Equip) - 20%	"11b (Med Supp) - 20%,11b1 (Prosthetics) - 30%, 11c (Diabetic Supplies) - 0%"	4a (ER) $50 (WW Coverage)	"9a (OP Surgery) - $100, 9b (ASC) - $100"	8a (OP Diag Proc/Test/Lab) - $0	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA), 9d (Cardiac Rehab) - $25, 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	7a (PCP) - $15	"7b (Chiro) - $25, 7d (Spec) - $15, 7f (Pod) - $25; 17a (MCR Eye Exam) - $25; 18a (MCR Hearing Exam) - $25, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $25; 14i (Diab Mon.) - $25; 14a (Smoking Cessation) - $25"	"7e (MH), 7h (Psychiatric) - $25"	"7c (OT), 7i (PT/ST) - $25"	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	"7g (Prof. Other - allergy visits)  - $5; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - 0%	13a (Blood) - $0				17b1 (Non MCR Covered) - $100 limit				14c (Routine Physical) - $0											83.4944359	83.4944359	35.47510318		122.373574	0.2	0.234868375	50	100		0.187691502			22.46323369	15	18.41206127	25	21.11621213	0.066738962	5																					NO	77.2721965	77.2721965	32.83139905		113.2539522	0.185095439	0.217365325	46.27385985	92.5477197		0.173704205			20.78921055	13.88215795	17.03994285	23.13692992	19.54257281	0.061765387	4.627385985																						8.5017	0.434672767	4.961487385	0	2.120462661	1.307812415	1.288154083	1.079099149	2.285458152	0	3.949695715	0	0	0.718597018	3.39812892	7.593336328	0.85659403	0.925704674	1.326688074	0.01980616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7674	0	3.282743685	8.5017	0.434672767	4.961487385	0	2.120462661	1.307812415	1.288154083	1.079099149	2.285458152	0	3.949695715	0	0	0.718597018	3.39812892	7.593336328	0.85659403	0.925704674	1.326688074	0.01980616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7674	NO																																																																																		0	0	0	8.5017	0.434672767	4.961487385	0	2.120462661	1.307812415	1.288154083	1.079099149	2.285458152	0	3.949695715	0	0	0.718597018	3.39812892	7.593336328	0.85659403	0.925704674	1.326688074	0.01980616	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.7674
H7226_007_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	2187.790125	8.932227346	8644.186213		850.6012963			332.7982771	464.5172533					1477.207167	2740.441327	6779.825058	524.0032937	1788.008283		50.34025139										418.4436589											3350	"1a (IP Acute), 1a1 (Add'l Days) - $50/days 1-5"	1b (IP Psych) - $50/days 1-5	2 (SNF) - $50 days 11-100; 2a2 (Waiver 3 Day) - $0	6 (Home Health)- $0	10a (Ambulance) - $150	11a (Medical Equip) - $0	"11b (Med Supp), 11c (Diab Supp) - $0"	4a (ER) $50 (WW Coverage)	"9a (OP Surgery), 9b (ASC) - $100"	8a (OP Diag Proc/Test/Lab) - $0	8b (OP Diag & Therap Rad) - $0	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA), 9d (Cardiac Rehab) - $15; 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	7a (PCP) - $15	"7b (Chiro), 7d (Spec), 7f (Pod) - $15; 17a (MCR Eye Exam) - $15; 18a (MCR Hearing Exam) - $15, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $15; 14i (Diab Mon.) - $15; 14a (Smoking Cessation) - $15"	"7e (MH), 7h (Psychiatric) - $15"	"7c (OT), 7i (PT/ST) - $15"	"8b (Professional Radiology) - 0%, 14h (Mammography)"	"7g (Prof. Other - allergy visits)  - $5; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - $0	13a (Blood) - $0			17a1 (Rountine Eye Exam) - $100 limit	17b1 (Non MCR Covered) - $200 limit	18a1 (Hearing Exam Non-covered) - $15; 18a2 (Fit & Eval for Hearing Aids) - $15	18b (Hearing Aids) - $500 limit		14c (Routine Physical) - $15											22.93249328	22.93249328	3.401679875		34.70856222			50	100					10.7673878	15	13.73943819	15	6.204042873		5										15											NO	21.86291161	21.86291161	3.243024015		33.08973946			47.66797778	95.33595557					10.26519204	14.30039334	13.09862468	14.30039334	5.914683557		4.766797778										15												3.986	0.016273708	2.336108623	0	2.345514606	0	0	1.321985073	3.690433018	0	0	0	0	1.263651272	3.265782407	7.400531988	0.624454434	0.881291933	0	0.019996817	0	0	0	0	0	0	0	0	0	0.523054574	0	0	0	0	0	0	0	0	0	0	27.675	0	1.328334477	3.986	0.016273708	2.336108623	0	2.345514606	0	0	1.321985073	3.690433018	0	0	0	0	1.263651272	3.265782407	7.400531988	0.624454434	0.881291933	0	0.019996817	0	0	0	0	0	0	0	0	0	0.523054574	0	0	0	0	0	0	0	0	0	0	27.675	NO																																																																																		0	0	0	3.986	0.016273708	2.336108623	0	2.345514606	0	0	1.321985073	3.690433018	0	0	0	0	1.263651272	3.265782407	7.400531988	0.624454434	0.881291933	0	0.019996817	0	0	0	0	0	0	0	0	0	0.523054574	0	0	0	0	0	0	0	0	0	0	27.675
H7226_008_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	P	P	P	P	Coin	P	Coin	O	P	P	P	P	P	P	P	P																																																			0	YES	2125.917308	7.57193637	8802.594833		714.9500086	5.725792614	1.666980472	279.910035	323.6203621		16.74212918			950.3858458	2252.711686	4662.140671	517.4735758	843.62746	20.27519936	69.15968383																					3350	"1a (IP Acute), 1a1 (Add'l Days) - $150 days 1-5"	1b (IP Psych) - $150 days 1-5	2 (SNF) - $100 days 11-100	6a (Home Health) - $0	10a (Ambulance) - $150	11a (Medical Equip) - 20%	"11b (Med Supp) - 20%,11b1 (Prosthetics) - 30%, 11c (Diabetic Supplies) - 0%"	4a (ER) $50 (WW Coverage)	"9a (OP Surgery) - $100, 9b (ASC) - $100"	8a (OP Diag Proc/Test/Lab) - $0	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA), 9d (Cardiac Rehab) - $25, 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	7a (PCP) - $15	"7b (Chiro) - $25, 7d (Spec) - $15, 7f (Pod) - $25; 17a (MCR Eye Exam) - $25; 18a (MCR Hearing Exam) - $25, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $25; 14i (Diab Mon.) - $25; 14a (Smoking Cessation) - $25"	"7e (MH), 7h (Psychiatric) - $25"	"7c (OT), 7i (PT/ST) - $25"	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	"7g (Prof. Other - allergy visits)  - $5; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - 0%	13a (Blood) - $0				17b1 (Non MCR Covered) - $100 limit				14c (Routine Physical) - $0											68.79747985	68.79747985	6.803359751		34.70856222	0.2	0.236726648	50	100		0.161869727			19.47189483	15	15.13660167	25	11.11256125	0.066738962	5																					NO	64.11126947	64.11126947	6.339941975		32.34435317	0.186376796	0.220601772	46.5941991	93.1883982		0.150843806			18.14554689	13.97825973	14.10573943	23.29709955	10.35561783	0.062192969	4.65941991																						11.3579	0.040453871	4.650661706	0	1.927049631	1.067154884	0.367738846	1.086848658	2.513138598	0	2.525446479	0	0	1.437105911	2.624082421	5.480245123	1.004636117	0.72802363	1.260974855	0.026853667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0984	0	2.784721169	11.3579	0.040453871	4.650661706	0	1.927049631	1.067154884	0.367738846	1.086848658	2.513138598	0	2.525446479	0	0	1.437105911	2.624082421	5.480245123	1.004636117	0.72802363	1.260974855	0.026853667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0984	NO																																																																																		0	0	0	11.3579	0.040453871	4.650661706	0	1.927049631	1.067154884	0.367738846	1.086848658	2.513138598	0	2.525446479	0	0	1.437105911	2.624082421	5.480245123	1.004636117	0.72802363	1.260974855	0.026853667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.0984
H7226_009_0	2010	1	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	P	P	P	P	Coin	P	Coin	O	P	P	P	P	P	P	P	P																																																			0	YES	2815.20554	9.164618048	11141.02826		972.0424311	6.553877064	2.882596143	391.1952159	352.1475298		17.15670749			857.4057805	2408.309459	4995.852945	611.0500232	519.2087218	20.41996699	53.16876857																					3350	"1a (IP Acute), 1a1 (Add'l Days) - $150 days 1-5"	1b (IP Psych) - $150 days 1-5	2 (SNF) - $100 days 11-100	6a (Home Health) - $0	10a (Ambulance) - $150	11a (Medical Equip) - 20%	"11b (Med Supp) - 20%,11b1 (Prosthetics) - 30%, 11c (Diabetic Supplies) - 0%"	4a (ER) $50 (WW Coverage)	"9a (OP Surgery) - $100, 9b (ASC) - $100"	8a (OP Diag Proc/Test/Lab) - $0	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA), 9d (Cardiac Rehab) - $25, 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	7a (PCP) - $15	"7b (Chiro) - $25, 7d (Spec) - $15, 7f (Pod) - $25; 17a (MCR Eye Exam) - $25; 18a (MCR Hearing Exam) - $25, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $25; 14i (Diab Mon.) - $25; 14a (Smoking Cessation) - $25"	"7e (MH), 7h (Psychiatric) - $25"	"7c (OT), 7i (PT/ST) - $25"	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	"7g (Prof. Other - allergy visits)  - $5; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - 0%	13a (Blood) - $0				17b1 (Non MCR Covered) - $100 limit				14c (Routine Physical) - $0											68.79747985	68.79747985	6.803359751		34.70856222	0.2	0.24525972	50	100		0.160074528			19.19945498	15	15.10267504	25	11.11256125	0.066738962	5																					NO	62.87512505	62.87512505	6.217700068		31.72071411	0.182783222	0.224146809	45.69580542	91.39161084		0.14629469			17.54669118	13.70874163	13.81381232	22.84790271	10.15594873	0.060993812	4.569580542																						14.7505	0.048018875	5.772631013	0	2.569490005	1.197938764	0.646124726	1.489665039	2.681944167	0	2.509935204	0	0	1.253719537	2.751241011	5.750981247	1.16343429	0.43942143	1.245491633	0.020246581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2908	0	4.166737797	14.7505	0.048018875	5.772631013	0	2.569490005	1.197938764	0.646124726	1.489665039	2.681944167	0	2.509935204	0	0	1.253719537	2.751241011	5.750981247	1.16343429	0.43942143	1.245491633	0.020246581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2908	NO																																																																																		0	0	0	14.7505	0.048018875	5.772631013	0	2.569490005	1.197938764	0.646124726	1.489665039	2.681944167	0	2.509935204	0	0	1.253719537	2.751241011	5.750981247	1.16343429	0.43942143	1.245491633	0.020246581	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.2908
H7226_011_0	2010	2	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	P	P	P	P	P	P	P	P																																																			0	YES	1189.128322	27.34849741	2045.509949		251.6749501			278.829303	320.8431491					860.1734857	2939.488034	5678.034411	536.4947965	1132.87745		146.6456442										331.4885664											3350	"1a (IP Acute), 1a1 (Add'l Days) - $50/days 1-5"	1b (IP Psych) - $50/days 1-5	2 (SNF) - $50 days 11-100; 2a2 (Waiver 3 Day) - $0	6 (Home Health)- $0	10a (Ambulance) - $150	11a (Medical Equip) - $0	"11b (Med Supp), 11c (Diab Supp) - $0"	4a (ER) $50 (WW Coverage)	"9a (OP Surgery), 9b (ASC) - $100"	8a (OP Diag Proc/Test/Lab) - $0	8b (OP Diag & Therap Rad) - $0	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA), 9d (Cardiac Rehab) - $15; 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	7a (PCP) - $15	"7b (Chiro), 7d (Spec), 7f (Pod) - $15; 17a (MCR Eye Exam) - $15; 18a (MCR Hearing Exam) - $15, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $15; 14i (Diab Mon.) - $15; 14a (Smoking Cessation) - $15"	"7e (MH), 7h (Psychiatric) - $15"	"7c (OT), 7i (PT/ST) - $15"	"8b (Professional Radiology) - 0%, 14h (Mammography)"	"7g (Prof. Other - allergy visits)  - $5; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - $0	13a (Blood) - $0			17a1 (Rountine Eye Exam) - $100 limit	17b1 (Non MCR Covered) - $200 limit	18a1 (Hearing Exam Non-covered) - $15; 18a2 (Fit & Eval for Hearing Aids) - $15	18b (Hearing Aids) - $500 limit		14c (Routine Physical) - $15											25.89886744	25.89886744	10.40761548		79.55104435			50	100					11.47348608	15	14.36041299	15	8.130891711		5										15											NO	25.10463408	25.10463408	10.08844803		77.11147462			48.46666392	96.93332783					11.12163187	14.53999917	13.92009046	14.53999917	7.881543918		4.846666392										15												2.4877	0.057214502	1.719668402	0	1.61725221	0	0	1.12616051	2.591699512	0	0	0	0	0.797211071	3.561679465	6.586562721	0.650052825	0.744068615	0	0.059228543	0	0	0	0	0	0	0	0	0	0.414360708	0	0	0	0	0	0	0	0	0	0	22.4129	0	0.695934025	2.4877	0.057214502	1.719668402	0	1.61725221	0	0	1.12616051	2.591699512	0	0	0	0	0.797211071	3.561679465	6.586562721	0.650052825	0.744068615	0	0.059228543	0	0	0	0	0	0	0	0	0	0.414360708	0	0	0	0	0	0	0	0	0	0	22.4129	NO																																																																																		0	0	0	2.4877	0.057214502	1.719668402	0	1.61725221	0	0	1.12616051	2.591699512	0	0	0	0	0.797211071	3.561679465	6.586562721	0.650052825	0.744068615	0	0.059228543	0	0	0	0	0	0	0	0	0	0.414360708	0	0	0	0	0	0	0	0	0	0	22.4129
H7226_013_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	P	P	P	P	Coin	P	Coin	O	P	P	P	P	P	P	P	P																																																			0	YES	1506.889808	65.95892422	1431.511424		236.0827005	6.375317642	8.980370361	314.1682567	342.3723995		21.186497			409.7579401	3906.289238	6330.55092	680.4890476	599.5125402	23.92784113	100.0262365																					3350	"1a (IP Acute), 1a1 (Add'l Days) - $150 days 1-5"	1b (IP Psych) - $150 days 1-5	2 (SNF) - $100 days 11-100	6a (Home Health) - $0	10a (Ambulance) - $150	11a (Medical Equip) - 20%	"11b (Med Supp) - 20%,11b1 (Prosthetics) - 30%, 11c (Diabetic Supplies) - 0%"	4a (ER) $50 (WW Coverage)	"9a (OP Surgery) - $100, 9b (ASC) - $100"	8a (OP Diag Proc/Test/Lab) - $0	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA), 9d (Cardiac Rehab) - $25, 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	7a (PCP) - $15	"7b (Chiro) - $25, 7d (Spec) - $15, 7f (Pod) - $25; 17a (MCR Eye Exam) - $25; 18a (MCR Hearing Exam) - $25, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $25; 14i (Diab Mon.) - $25; 14a (Smoking Cessation) - $25"	"7e (MH), 7h (Psychiatric) - $25"	"7c (OT), 7i (PT/ST) - $25"	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	"7g (Prof. Other - allergy visits)  - $5; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - 0%	13a (Blood) - $0				17b1 (Non MCR Covered) - $100 limit				14c (Routine Physical) - $0											85.74	85.74	55.1		150	0.2	0.239926637	50	100		0.2			25	15	19.37379945	25	25	0.066738962	5																					NO	77.50602484	77.50602484	49.80851375		135.594865	0.180793153	0.216885467	45.19828834	90.39657667		0.180793153			22.59914417	13.5594865	17.51325147	22.59914417	22.59914417	0.060329737	4.519828834																						9.7328	0.426017835	5.941788035	0	2.667633492	1.15261378	1.947711818	1.183322288	2.579107738	0	3.830373601	0	0	0.771681564	4.413939682	9.239044185	1.281539174	1.129039194	1.443560357	0.037675122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7778	0	5.075750283	9.7328	0.426017835	5.941788035	0	2.667633492	1.15261378	1.947711818	1.183322288	2.579107738	0	3.830373601	0	0	0.771681564	4.413939682	9.239044185	1.281539174	1.129039194	1.443560357	0.037675122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7778	NO																																																																																		0	0	0	9.7328	0.426017835	5.941788035	0	2.667633492	1.15261378	1.947711818	1.183322288	2.579107738	0	3.830373601	0	0	0.771681564	4.413939682	9.239044185	1.281539174	1.129039194	1.443560357	0.037675122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.7778
H7226_015_0	2010	1	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	Coin	V	V	V	P	P	P	P	Coin	P	Coin	O	P	P	P	P	P	P	P	P																																																			0	YES	1543.884778	67.57825194	1466.655813		241.8786601	6.507040183	9.165916757	321.8812595	350.7778294		21.6242382			419.817722	4002.190778	6485.969412	697.1954264	614.2309014	24.42222215	102.4819353																					3350	"1a (IP Acute), 1a1 (Add'l Days) - $150 days 1-5"	1b (IP Psych) - $150 days 1-5	2 (SNF) - $100 days 11-100	6a (Home Health) - $0	10a (Ambulance) - $150	11a (Medical Equip) - 20%	"11b (Med Supp) - 20%,11b1 (Prosthetics) - 30%, 11c (Diabetic Supplies) - 0%"	4a (ER) $50 (WW Coverage)	"9a (OP Surgery) - $100, 9b (ASC) - $100"	8a (OP Diag Proc/Test/Lab) - $0	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	9a (OP Observation) - $0	12 (Renal Dialysis) - $0	"7i, 7c (OP PT/ST/OT), 9c (OP SA), 9d (Cardiac Rehab) - $25, 3 (CORF)- $0; 5 (Partial Hospitalization) - $0, 9a (OP Other excluding Surgery) - $0"	7a (PCP) - $15	"7b (Chiro) - $25, 7d (Spec) - $15, 7f (Pod) - $25; 17a (MCR Eye Exam) - $25; 18a (MCR Hearing Exam) - $25, 16b (Comp Dental) - $0, 14j (Nutrition Therap) - $25; 14i (Diab Mon.) - $25; 14a (Smoking Cessation) - $25"	"7e (MH), 7h (Psychiatric) - $25"	"7c (OT), 7i (PT/ST) - $25"	"8b (OP Therap Rad, CT scans, PET, scans, & MRI) - 20%, 8b (OP x-rays) - 0%"	"7g (Prof. Other - allergy visits)  - $5; 14b (Immun), 14d (Pap/Pelvic), 14e (Prostate), 14f (Colorectal), 14g (Bone Mass) - $0"	15 (Part B Rx) - 0%	13a (Blood) - $0				17b1 (Non MCR Covered) - $100 limit				14c (Routine Physical) - $0											85.74	85.74	55.1		150	0.2	0.239926637	50	100		0.2			25	15	19.37379945	25	25	0.066738962	5																					NO	77.25893083	77.25893083	49.64972112		135.1625802	0.180216774	0.216194022	45.05419339	90.10838679		0.180216774			22.5270967	13.51625802	17.45741814	22.5270967	22.5270967	0.060137402	4.505419339																						9.9399	0.435085291	6.068254341	0	2.724411983	1.172677787	1.981616413	1.208508376	2.634002027	0	3.89705044	0	0	0.788106202	4.507886933	9.435690007	1.308815732	1.153069909	1.468688987	0.038477008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7622	0	5.352856941	9.9399	0.435085291	6.068254341	0	2.724411983	1.172677787	1.981616413	1.208508376	2.634002027	0	3.89705044	0	0	0.788106202	4.507886933	9.435690007	1.308815732	1.153069909	1.468688987	0.038477008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7622	NO																																																																																		0	0	0	9.9399	0.435085291	6.068254341	0	2.724411983	1.172677787	1.981616413	1.208508376	2.634002027	0	3.89705044	0	0	0.788106202	4.507886933	9.435690007	1.308815732	1.153069909	1.468688987	0.038477008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.7622
H7226_807_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	192.7345119	0.524037475	55.77356111		7.84276454	8.347512348	5.111545929	10.9222937	43.73093596	14.73619939	24.78935577	8.481978638	0.140184002	51.11184703	17.70304599	111.7873971	2.92957113	5.411914938	21.88754382	17.16841968	9.153219661	0.514803156																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.07407979	0.07407979	0.151191373		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.07407979	0.07407979	0.151191373		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				14.2777	0.038820586	8.432481281	0	1.827364138	1.944970377	1.190990201	2.544894432	10.18930808	3.433534458	5.775919896	1.976301023	0.032662873	11.90906036	4.124809715	26.04646354	0.682590073	1.260976181	5.099797709	4.000241786	2.132700181	0.119949135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0416	0	0	14.2777	0.038820586	8.432481281	0	1.827364138	1.944970377	1.190990201	2.544894432	10.18930808	3.433534458	5.775919896	1.976301023	0.032662873	11.90906036	4.124809715	26.04646354	0.682590073	1.260976181	5.099797709	4.000241786	2.132700181	0.119949135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0416	NO																																																																																		0	0	0	14.2777	0.038820586	8.432481281	0	1.827364138	1.944970377	1.190990201	2.544894432	10.18930808	3.433534458	5.775919896	1.976301023	0.032662873	11.90906036	4.124809715	26.04646354	0.682590073	1.260976181	5.099797709	4.000241786	2.132700181	0.119949135	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.0416
H7252_001_0	2010	3	N/A																															D	A	D	V	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	712.5311052	3.373928661	266.0928847	0	191.0529461	8.227286594	5.101258432	211.0196172	358.8606798	0	13.50452926	0	0	439.3047914	0	3545.414559	168.7049372	490.2076663	27.07645674	0	6.777612601	0	0	0	0	0	0	0	0	0											3350	$50/Days 1-5 for IP Medical; $50/Days 1-5 for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$10/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	No Cost-Sharing	$10/Visit for Speclst - Office Visits; $10/Consult for Speclst - Consults;	$10/Visit for OP Psych - Non-Physician; $10/Visit for OP Psych - Psychiatrist; $10/Visit for OP Substance Abuse;	$10/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $10/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	No Cost-Sharing	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $300 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $800 every three years	No Cost-Sharing	Max Plan Benefit of $100 every three months											50	900	75	0	100	0.2	0.2	48.17811175	50	0	0.2	0	0	10	0	10	10	10	0.2	0	0.2	0	0	0	0	0	0	0	0	0											NO	49.82027821	896.7650079	74.73041731	0	99.64055641	0.199281113	0.199281113	48.00493861	49.82027821	0	0.199281113	0	0	9.964055639	0	9.964055641	9.964055639	9.964055642	0.199281113	0	0.199281113	0	0	0	0	0	0	0	0	0												2.9582	0.252135097	1.657102693	0	1.586385154	1.639542828	1.016584457	0.844165314	1.489878242	0	2.691197618	0	0	0.364771449	0	2.943892328	0.140082115	0.407038039	5.39582643	0	1.350650181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.7375	0	0.089237974	2.9582	0.252135097	1.657102693	0	1.586385154	1.639542828	1.016584457	0.844165314	1.489878242	0	2.691197618	0	0	0.364771449	0	2.943892328	0.140082115	0.407038039	5.39582643	0	1.350650181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.7375	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	2.9582	0.252135097	1.657102693	0	1.586385154	1.639542828	1.016584457	0.844165314	1.489878242	0	2.691197618	0	0	0.364771449	0	2.943892328	0.140082115	0.407038039	5.39582643	0	1.350650181	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.7375
H7252_002_0	2010	4	N/A																															D	A	D	V	T	Coin	Coin	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	P	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	YES	721.750414	3.343238264	287.6096754	0	198.0191634	8.510453434	5.298876063	223.4067025	38.95144579	0	14.3166006	0	0	463.3191644	0	3674.503317	171.7469421	489.7319193	27.9980933	349.9749914	7.245511259	0	0	0	0	311.7851414	0	0	0	0											3350	$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical;	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	20% Coinsurance for OP Fac - Surgery; 20% Coinsurance for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	No Cost-Sharing	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$5/Service for Vision Hardware; Max Plan Benefit of $140 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	Max Plan Benefit of $25 every three months											150	900	75	0	100	0.2	0.2	48.14094069	0.2	0	0.2	0	0	25	0	25	25	25	0.2	25	0.2	0	0	0	0	5	0	0	0	0											NO	148.3283447	889.9700681	74.16417235	0	98.88556313	0.197771126	0.197771126	47.6044403	0.197771126	0	0.197771126	0	0	24.72139078	0	24.72139078	24.72139079	24.72139078	0.197771126	24.72139078	0.197771126	0	0	0	0	4.944278158	0	0	0	0												8.9213	0.247948499	1.777527794	0	1.631769707	1.683121961	1.047964687	0.886262586	7.703471304	0	2.831410226	0	0	0.954491177	0	7.569902702	0.353818606	1.008904513	5.537214445	0.720989044	1.432952922	0	0	0	0	0.128462705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4375	0	0.500809645	8.9213	0.247948499	1.777527794	0	1.631769707	1.683121961	1.047964687	0.886262586	7.703471304	0	2.831410226	0	0	0.954491177	0	7.569902702	0.353818606	1.008904513	5.537214445	0.720989044	1.432952922	0	0	0	0	0.128462705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4375	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.9213	0.247948499	1.777527794	0	1.631769707	1.683121961	1.047964687	0.886262586	7.703471304	0	2.831410226	0	0	0.954491177	0	7.569902702	0.353818606	1.008904513	5.537214445	0.720989044	1.432952922	0	0	0	0	0.128462705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.4375
H7252_003_0	2010	4	N/A																															D	A	D	V	T	Coin	Coin	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	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	YES	0	4.214296493	382.7478457	0	284.7727259	12.28171527	7.589292484	309.014948	0	0	19.75017687	0	0	634.5668225	5722.68351	4929.256385	235.1906532	689.2174718	38.78908136	543.4215702	9.842799378	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	$900/Admit for IP Psych; $900/Admit for IP Substance Abuse;	$75/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for OP Fac - Radiology; 20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	No Cost-Sharing	$25/Case for OP Fac - Cardiovascular; $25/Case for OP Fac - Occ Therapy; $25/Case for OP Fac - Physical/Speech Therapy; $25/Case for OP Fac - CORF; $25/Visit for Prof - CORF; $25/Visit for Prof - CORF;	$5/Visit for PCP - Office Visits; $5/Consult for PCP - Consults;	$25/Visit for Speclst - Office Visits; $25/Consult for Speclst - Consults;	$25/Visit for OP Psych - Non-Physician; $25/Visit for OP Psych - Psychiatrist; $25/Visit for OP Substance Abuse;	$25/Visit for PT/ST (PCP); $25/Visit for Occ Therapy (PCP); $25/Visit for PT/ST (Specialist); $25/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (IP); 20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$25/Visit for Chiropractor;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $250 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $400 every three years	No Cost-Sharing	Max Plan Benefit of $100 every three months											0	900	75	0	100	0.2	0.2	48.20969723	0	0	0.2	0	0	25	5	25	25	25	0.2	25	0.2	0	0	0	0	0	0	0	0	0											NO	0	891.234969	74.26958073	0	99.02610764	0.198052215	0.198052215	47.74018667	0	0	0.198052215	0	0	24.75652691	4.951305382	24.75652691	24.75652691	24.75652691	0.198052215	24.75652691	0.198052215	0	0	0	0	0	0	0	0	0												0	0.312994034	2.368876836	0	2.349994551	2.432420917	1.503076189	1.229369275	0	0	3.911566281	0	0	1.309139218	2.361229472	10.16927236	0.485208645	1.421885907	7.682263492	1.121102561	1.949388221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6078	0	0.399365536	0	0.312994034	2.368876836	0	2.349994551	2.432420917	1.503076189	1.229369275	0	0	3.911566281	0	0	1.309139218	2.361229472	10.16927236	0.485208645	1.421885907	7.682263492	1.121102561	1.949388221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6078	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.312994034	2.368876836	0	2.349994551	2.432420917	1.503076189	1.229369275	0	0	3.911566281	0	0	1.309139218	2.361229472	10.16927236	0.485208645	1.421885907	7.682263492	1.121102561	1.949388221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.6078
H7252_004_0	2010	4	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	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	YES	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.941962765	0	0	0	0	0	0	0	0	0											3350	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	5% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	Max Plan Benefit of $250 for glasses and/or contacts every two years	No Cost-Sharing	Max Plan Benefit of $2000 every three years	No Cost-Sharing	Max Plan Benefit of $125 every three months											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.05	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.05	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.347098138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.3471	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.347098138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.3471	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.347098138	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0.3471
H7281_001_0	2010	3	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	922.4919513	11.49765624	908.3472459	28.96030566	132.9910039	11.26862687	2.937322299	182.7749293	329.2055887	3.52837392	326.6018462	0	0.073616598	738.0506517	3510.578762	3474.229523	567.2943309	708.9001071	37.96177891	42.31596072	3.136347849	0	0	0	0	0	0	0	0	0												1a:  Acute - $200/$0/day for 1-7/8-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $150/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $5/visit/17a:  Vision Exams - $40/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $40/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $40/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit												200	0.073944329	85	0	150	0.2	0.2	43.42655865	195.890634	0	55.71119399	0	0.2	54.71897265	5	38.31114866	40	40	0	0.006143532	0.2	0	0	0	0	0	0	0	0	0											NO	200	0.073944329	85	0	150	0.2	0.2	43.42655865	195.890634	0	55.71119399	0	0.2	54.71897265	5	38.31114866	40	40	0	0.006143532	0.2	0	0	0	0	0	0	0	0	0												15.3749	0.850186472	6.434126325	0	1.662387548	2.253725374	0.58746446	0.661440516	5.374024291	0	1.516281568	0	0.01472332	3.365447785	1.462741151	11.09181031	1.890981103	2.363000357	0	0.259969479	0.62726957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7904		0	15.3749	0.850186472	6.434126325	0	1.662387548	2.253725374	0.58746446	0.661440516	5.374024291	0	1.516281568	0	0.01472332	3.365447785	1.462741151	11.09181031	1.890981103	2.363000357	0	0.259969479	0.62726957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.7904	NO	1a:  Acute - 20.0% for 1-90		2:  Skilled Nursing Services - 20.0% for 1-100/2:  Non-Medicare Covered Stay - 20.0% for 1-100	6:  Home Health Services - 20.0%	10a:  Ambulance - 20.0%			4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - 20.0%/14c:  Routine Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%		7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%																				6.5944	0	1.3394	0.8254	0.2048	0	0	0.1174	0.9813	0.1516	0.4711	0	0.0015	0.1933	0.6467	1.6822	0	0.1304	0.6721	0.7432	0.1852	0.0321	0	0	0	0	0	0	0	0											14.9722		0	21.9693	0.850186472	7.77356741	0.825443613	1.867180077	2.253725374	0.58746446	0.778879648	6.355371521	0.151646989	1.987359661	0	0.016183341	3.558745669	2.109485965	12.77398094	1.890981103	2.493408927	0.672056312	1.003124892	0.812449405	0.032111036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7626
H7281_002_0	2010	2	N/A																															A	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	261.2317859	11.30882107	908.3472459	28.96030566	133.9477737	11.26862687	2.937322299	196.2395703	334.3890846	3.52837392	92.47421181	0	0.073616598	748.5129649	0	4215.905124	590.7993928	750.6001133	38.69937922	42.43960376	3.136347849	0	0	0	0	0	0	0	0	0												1a:  Acute - $250/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $50/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $50/visit/8b:  Outpatient Therapeutic Radiological Services - $50/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $20/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $20/visit/ Visits/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/7b:  Routine Chiropractic Care - $10/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $20/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $20/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit												250	0.073944329	85	0	100	0.2	0.2	29.57435364	95.88153372	0	50	0	0.2	27.38169037	0	18.66210252	20	20	0	0.003304393	0.2	0	0	0	0	0	0	0	0	0											NO	244.5201461	0.073944329	83.13684967	0	97.80805844	0.195616117	0.195841754	28.92610109	93.77986653	0	48.90402922	0	0.195616117	26.78149971	0	18.28236607	20	19.56161169	0	0.003231963	0.195616117	0	0	0	0	0	0	0	0	0												5.323	0.836223183	6.293094036	0	1.091764306	2.204325031	0.575250352	0.473037137	2.613246977	0	0.376863463	0	0.014400593	1.67052498	0	6.423060066	0.984665655	1.223578996	0	0.137163225	0.613520187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.8538		0.639433746	5.323	0.836223183	6.293094036	0	1.091764306	2.204325031	0.575250352	0.473037137	2.613246977	0	0.376863463	0	0.014400593	1.67052498	0	6.423060066	0.984665655	1.223578996	0	0.137163225	0.613520187	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	30.8538	YES	1a:  Acute - 20.0% for 1-90/1a:  Additional Days - 20.0% for 91-999		2:  Skilled Nursing Services - 20.0% for 1-100/2:  Non-Medicare Covered Stay - 20.0% for 1-100	6:  Home Health Services - 20.0%	10a:  Ambulance - 20.0%			4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - 20.0%/14c:  Routine Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%		7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%																			5000	4.6659	0	0.943	0.5811	0.1442	0	0	0.0603	0.6909	0.1068	0.3316	0	0.001	0.1361	0.4561	1.1883	0	0.0918	0.4731	0.5232	0.1304	0.0226	0	0	0	0	0	0	0	0											10.5465		4.434	9.9889	0.836223183	7.236079698	0.581124098	1.235941173	2.204325031	0.575250352	0.533378924	3.304129449	0.106761647	0.708509172	0	0.015428469	1.806609452	0.456121402	7.611352514	0.984665655	1.315388493	0.473137246	0.660355254	0.743889437	0.022606628	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.4002
H7281_003_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	346.2436504	11.49956828	61.4968468	34.72452124	6.810763119	12.02673524	3.12476264	188.7933851	42.42381991	4.235536205	11.15924269	0	0.088357117	15.69778676	53.47661644	127.1707128	7.670471952	7.847367086	43.23325588	48.53898535	3.764751637	0.655179808	0	0	0	0	0	0	0	0												1a:  Acute - MC Cost Shares for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - MC Cost Shares for 1-100/2:  Non-Medicare Covered Stay - MC Cost Shares for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - 20.0%/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - 20.0%/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/7-12 Additional Visits/17a:  Vision Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/7f:  Routine Footcare - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 45.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 45.0%/7h:  Psychiatric Services - Individual - 45.0%/7h:  Psychiatric Services - Group - 45.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit											0.073944329	0.073944329	0.149573229	0	0.2	0.2	0.2	81.80699947	0.2	0	0.2	0	0.2	0.2	0.069178904	0.2	0.45	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.073944329	0.073944329	0.149573229	0	0.2	0.2	0.2	81.80699947	0.2	0	0.2	0	0.2	0.2	0.069178904	0.2	0.45	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0												25.6028	0.850327857	9.198281921	0	1.362152624	2.405347049	0.624952528	1.287051696	8.484763982	0	2.231848539	0	0.017671423	3.139557353	3.699453712	25.43414256	3.451712378	1.569473417	8.646651177	9.70779707	0.752950327	0.131035962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.5979		0	25.6028	0.850327857	9.198281921	0	1.362152624	2.405347049	0.624952528	1.287051696	8.484763982	0	2.231848539	0	0.017671423	3.139557353	3.699453712	25.43414256	3.451712378	1.569473417	8.646651177	9.70779707	0.752950327	0.131035962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.5979	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	25.6028	0.850327857	9.198281921	0	1.362152624	2.405347049	0.624952528	1.287051696	8.484763982	0	2.231848539	0	0.017671423	3.139557353	3.699453712	25.43414256	3.451712378	1.569473417	8.646651177	9.70779707	0.752950327	0.131035962	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	108.5979
H7281_004_0	2010	1	N/A																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	V	V	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	542.7118004	11.49956828	364.4186092	2.611467057	44.05525102	6.271134262	10.24440104	91.46952804	10.28751569	8.659502632	5.580973253	0	0.206013942	63.91769601	0	0	7.670471952	1.119098503	23.32223839	30.68198732	1.432342807	0.755670991	0	0	0	0	0	0	0	0												1a:  Acute - MC Cost Shares for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $0/visit/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $0/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - $0/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $0/visit/7b:  Chiropractic Services - $0/visit/7f:  Podiatry Services - $0/visit/7-12 Additional Visits/17a:  Vision Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/7f:  Routine Footcare - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 45.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 45.0%/7h:  Psychiatric Services - Individual - 45.0%/7h:  Psychiatric Services - Group - 45.0%	7c:  Occupational Therapy Services - $0/visit/7i:  Physical/Speech Therapy - $0/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $0/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit											0.073944329	0.073944329	0	0	0.2	0.2	0.2	50	0.2	0	0.2	0	0.2	0.020995548	0	0	0.45	0	0	0.000369965	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.073944329	0.073944329	0	0	0.2	0.2	0.2	50	0.2	0	0.2	0	0.2	0.020995548	0	0	0.45	0	0	0.000369965	0.2	0.2	0	0	0	0	0	0	0	0												40.1305	0.850327857	0	0	8.811050205	1.254226852	2.048880209	0.381123033	2.057503137	0	1.116194651	0	0.041202788	1.341987066	0	0	3.451712378	0	0	0.011351252	0.286468561	0.151134198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9336		0	40.1305	0.850327857	0	0	8.811050205	1.254226852	2.048880209	0.381123033	2.057503137	0	1.116194651	0	0.041202788	1.341987066	0	0	3.451712378	0	0	0.011351252	0.286468561	0.151134198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9336	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	40.1305	0.850327857	0	0	8.811050205	1.254226852	2.048880209	0.381123033	2.057503137	0	1.116194651	0	0.041202788	1.341987066	0	0	3.451712378	0	0	0.011351252	0.286468561	0.151134198	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.9336
H7281_005_0	2010	3	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	1398.775222	11.49956828	1312.569777	45.67398295	173.7366063	12.31935743	7.282872399	184.3426786	416.3759185	4.135308693	358.9895539	0	0.073496865	880.8607215	4133.230182	4025.910267	566.4916752	911.7593277	42.27465975	44.31359566	2.669302065	0	0	0	0	0	0	0	0	0												1a:  Acute - $200/$0/day for 1-7/8-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $150/visit/8b:  Outpatient Therapeutic Radiological Services - $150/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $40/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $5/visit/17a:  Vision Exams - $40/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $40/visit/7b:  Chiropractic Services - $40/visit/ Visits/7f:  Podiatry Services - $40/visit/17a:  Vision Exams - $40/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $40/visit/7i:  Physical/Speech Therapy - $40/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $40/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $40/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service		16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service			14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit												200	0.073944329	85	0	150	0.2	0.01682759	43.42369258	195.890634	0	55.73837264	0	0.2	54.14258253	5	38.69536102	40	40	0	0.00521141	0.2	0	0	0	0	0	0	0	0	0											NO	200	0.073944329	85	0	150	0.2	0.01682759	43.42369258	195.890634	0	55.73837264	0	0.2	54.14258253	5	38.69536102	40	40	0	0.00521141	0.2	0	0	0	0	0	0	0	0	0												23.3129	0.850327857	9.297369253	0	2.171707579	2.463871486	0.122553189	0.667069984	6.797011888	0	1.667457794	0	0.014699373	3.974339526	1.722179243	12.98200427	1.888305584	3.039197759	0	0.230936306	0.533860413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7358		0	23.3129	0.850327857	9.297369253	0	2.171707579	2.463871486	0.122553189	0.667069984	6.797011888	0	1.667457794	0	0.014699373	3.974339526	1.722179243	12.98200427	1.888305584	3.039197759	0	0.230936306	0.533860413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7358	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	23.3129	0.850327857	9.297369253	0	2.171707579	2.463871486	0.122553189	0.667069984	6.797011888	0	1.667457794	0	0.014699373	3.974339526	1.722179243	12.98200427	1.888305584	3.039197759	0	0.230936306	0.533860413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7358
H7281_006_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	V	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	356.4267121	11.49956828	73.97306051	46.20726776	11.90130401	20.97666738	6.819348039	287.4590149	25.51637998	4.585341087	8.824165776	0	0.326819075	19.01448284	59.96079021	104.8571527	7.670471952	7.212091687	27.54488058	36.55379525	3.22986306	0.369421804	0	0	0	0	0	0	0	0												1a:  Acute - MC Cost Shares for 1-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - MC Cost Shares for 1-100/2:  Non-Medicare Covered Stay - MC Cost Shares for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - 20.0%/4a:  Worldwide Coverage - $0/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - 20.0%/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - $0/visit/17a:  Vision Exams - 20.0%/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/7-12 Additional Visits/17a:  Vision Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/7f:  Routine Footcare - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 45.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 45.0%/7h:  Psychiatric Services - Individual - 45.0%/7h:  Psychiatric Services - Group - 45.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  IP Phys (Surgery, Visits, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%	10b:  Transportation - $0/trip	"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14a:  Membership in Health Club/Fitness Classes - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit											0.073944329	0.073944329	0.149573229	0	0.2	0.2	0.2	77.04995801	0.2	0	0.2	0	0.2	0.2	0.070059311	0.2	0.45	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0											NO	0.073944329	0.073944329	0.149573229	0	0.2	0.2	0.2	77.04995801	0.2	0	0.2	0	0.2	0.2	0.070059311	0.2	0.45	0.2	0.2	0.2	0.2	0.2	0	0	0	0	0	0	0	0												26.3557	0.850327857	11.06438949	0	2.380260801	4.195333476	1.363869608	1.845725419	5.103275996	0	1.764833155	0	0.065363815	3.802896567	4.200811665	20.97143055	3.451712378	1.442418337	5.508976116	7.310759049	0.645972612	0.073884361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.398		0	26.3557	0.850327857	11.06438949	0	2.380260801	4.195333476	1.363869608	1.845725419	5.103275996	0	1.764833155	0	0.065363815	3.802896567	4.200811665	20.97143055	3.451712378	1.442418337	5.508976116	7.310759049	0.645972612	0.073884361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.398	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	26.3557	0.850327857	11.06438949	0	2.380260801	4.195333476	1.363869608	1.845725419	5.103275996	0	1.764833155	0	0.065363815	3.802896567	4.200811665	20.97143055	3.451712378	1.442418337	5.508976116	7.310759049	0.645972612	0.073884361	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	102.398
H7292_001_0	2010	7	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	379.4469445		67.14417641	22.06088431	21.5448899	27.68851257		19.56492075	18.60288673	88.02930823					293.4574705						10.52651707																					Medicare Standard Cost Sharing		Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing		Medicare Standard Cost Sharing	Medicare Standard Cost Sharing	Medicare Standard Cost Sharing					Medicare Standard Cost Sharing						Medicare Standard Cost Sharing																				0.053791433		0.114356179	0	0.233	0.233		0.233	0.233	0.233					0.233						0.233																				NO	0.053791433		0.114356179	0	0.233	0.233		0.233	0.233	0.233					0.233						0.233																					20.411	0	7.678351431	0	5.019959346	6.451423428	0	4.558626536	4.334472607	20.51082882	0	0	0	0	68.37559063	0	0	0	0	0	2.452678478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.7929			20.411	0	7.678351431	0	5.019959346	6.451423428	0	4.558626536	4.334472607	20.51082882	0	0	0	0	68.37559063	0	0	0	0	0	2.452678478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.7929	NO																																																																																		0			20.411	0	7.678351431	0	5.019959346	6.451423428	0	4.558626536	4.334472607	20.51082882	0	0	0	0	68.37559063	0	0	0	0	0	2.452678478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	139.7929
H7301_002_0	2010	8	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	P	T	Coin	V	P	V	P	O	P																																																			0	YES	1068.61569	39.61648507	688.1282857		72.64853291	4.199052881	7.041081538	260.8595173	292.1158517	1538.568286	611.8169895	10.96532754		765.4327223	3314.463037	4744.485781	100.2797402	397.6993925	2869.635146	3743.580148	19.38954283				138.5246787																3500	1a: $225 days 1-6;1a1: $225 days 1-6	1b: $225 days 1-6	"2: $0 days 1-20, $100 a day 21-100"	6: $0/visit	10a: $100/trip	11a: 20%	11b: 20%;11c: 20%	4a: $50/visit;4a1: $50/visit;4b: $30/visit	9a: $250/visit;9b: $250/visit	8a: $40/visit	8b: $25/visit;8b: $150/visit;8b: 20%	9a: $75/visit	12a: $0/visit	3: $40/visit;5: $75/visit;9a: $250/visit;9c: $40/visit;9d: $40/visit;7i: $40/visit;7e: $40/visit;7c: $40/visit	7a: $20/visit;14c: $20/visit;14d: $0/visit;14d1: $0/visit;14e: $0/visit;14e1: $0/visit;14f: $0/visit;14f1: $0/visit;14g: $0/visit;14g1: $0/visit	7b: $20/visit;7b1: $20/visit;7d: $40/visit;7f: $40/visit;7f1: $40/visit;14c1: $20/visit;16b: $40/visit;17a: $40/visit;18a: $40/visit	7e: $40/visit;7h: $40/visit	7c: $40/visit;7i: $40/visit	14h: $0/visit;14h1: $0/visit;7a: $20/visit;7d: $40/visit;8b: $25/visit	7g: $0/visit;14b: $0/visit;14i: $0/visit;14j: $0/visit7a: $20/visit;7d: $40/visit;8a: $40/visit;12a: $0/visit	15: 20%	13a: $0/visit;17b: $0/visit			17a1: $40/visit				14a: $0/visit												177.0283295	143.0452254	18.1863697		100	0.2	0.2	47.69940277	230.9788319	40	93.332916	75		99.79077609	20	36.23044969	39.81773724	35.89129379	9.791571322	10.41453769	0.2				40																NO	164.1756789	132.6598237	16.8659988		92.73977751	0.185479555	0.185479555	44.23632	214.2092548	37.09591101	86.55673865	69.55483313		92.54574372	18.59394991	33.9027091	36.92688093	33.28550601	9.080681459	9.658419085	0.2				40																	14.6201	0.437959661	0.967164237	0	0.561450732	0.77883846	1.305976671	0.96162209	5.214493241	4.756216019	4.413073605	0.063557627	0	5.90312838	5.135746641	13.40424344	0.308584836	1.10313546	2.171520222	3.013088829	3.877908567	0	0	0	0.461748929	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4595	0	4.955235841	14.6201	0.437959661	0.967164237	0	0.561450732	0.77883846	1.305976671	0.96162209	5.214493241	4.756216019	4.413073605	0.063557627	0	5.90312838	5.135746641	13.40424344	0.308584836	1.10313546	2.171520222	3.013088829	3.877908567	0	0	0	0.461748929	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4595	NO	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: $100/trip	OON: 30%	OON: 30%	OON: $50/visit;OON: $30/visit	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%			OON: 30%																	6.9471	0.051	0.7651	0.4909	0.5845	0.56	0.5918	0.1815	1.9034	0.2441	0.9201	0.0333	0.0057	0.8471	3.6537	3.2477	0.0418	0.3426	0.6094	0.6635	0.907				0.0337																23.6248	0	0	21.5672	0.48894053	1.732303777	0.490881994	1.145934257	1.338798799	1.897758289	1.143153476	7.117905743	5.000336207	5.333148436	0.096873534	0.00573525	6.750222117	8.789421204	16.65192133	0.350375339	1.445716581	2.780889628	3.676558921	4.784880559	0	0	0	0.495440937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.0844
H7301_801_0	2010	3	N/A																															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																																																			0	NO	229.1130767	2.512632874	26.68012982		6.048846267	6.53985917	11.85356764	13.88578402	41.57254716	6.236996949	20.01962102	0.994547175	0.258401128	24.73595443	28.19569464	97.97773918	2.367988918	4.239654948	24.40967499	8.169786195	22.05432468																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.084436219	0.084436219	0.18659574		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.084436219	0.084436219	0.18659574		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.3454	0.212157219	4.978398555	0	1.40938118	1.523787187	2.761881259	3.235387676	9.686403489	1.453220289	4.664571697	0.231729492	0.060207463	5.763477381	6.56959685	22.82881323	0.551741418	0.987839603	5.687454273	1.903560183	5.138657651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9937	0	0	19.3454	0.212157219	4.978398555	0	1.40938118	1.523787187	2.761881259	3.235387676	9.686403489	1.453220289	4.664571697	0.231729492	0.060207463	5.763477381	6.56959685	22.82881323	0.551741418	0.987839603	5.687454273	1.903560183	5.138657651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9937	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.4055	0.0264	0.7736		0.168	0.2228	0.323	0.4379	1.3115	0.2459	0.6316	0.0314	0.0082	0.7804	0.7684	2.7236	0.0336	0.1155	0.6652	0.2689	0.601																				12.5427	0	0	21.751	0.238565226	5.751951863	0	1.577421874	1.746563091	3.084908307	3.673330936	10.99794053	1.69916289	5.296218459	0.263167204	0.068405463	6.543872014	7.337970751	25.55242086	0.58535961	1.103376399	6.352653603	2.172494586	5.739670241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5364
H7301_802_0	2010	3	N/A																															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																																																			0	NO	229.1130767	2.512632874	26.68012982		6.048846267	6.53985917	11.85356764	13.88578402	41.57254716	6.236996949	20.01962102	0.994547175	0.258401128	24.73595443	28.19569464	97.97773918	2.367988918	4.239654948	24.40967499	8.169786195	22.05432468																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.084436219	0.084436219	0.18659574		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.084436219	0.084436219	0.18659574		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.3454	0.212157219	4.978398555	0	1.40938118	1.523787187	2.761881259	3.235387676	9.686403489	1.453220289	4.664571697	0.231729492	0.060207463	5.763477381	6.56959685	22.82881323	0.551741418	0.987839603	5.687454273	1.903560183	5.138657651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9937	0	0	19.3454	0.212157219	4.978398555	0	1.40938118	1.523787187	2.761881259	3.235387676	9.686403489	1.453220289	4.664571697	0.231729492	0.060207463	5.763477381	6.56959685	22.82881323	0.551741418	0.987839603	5.687454273	1.903560183	5.138657651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9937	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.4055	0.0264	0.7736		0.168	0.2228	0.323	0.4379	1.3115	0.2459	0.6316	0.0314	0.0082	0.7804	0.7684	2.7236	0.0336	0.1155	0.6652	0.2689	0.601																				12.5427	0	0	21.751	0.238565226	5.751951863	0	1.577421874	1.746563091	3.084908307	3.673330936	10.99794053	1.69916289	5.296218459	0.263167204	0.068405463	6.543872014	7.337970751	25.55242086	0.58535961	1.103376399	6.352653603	2.172494586	5.739670241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5364
H7301_803_0	2010	3	N/A																															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																																																			0	NO	229.1130767	2.512632874	26.68012982		6.048846267	6.53985917	11.85356764	13.88578402	41.57254716	6.236996949	20.01962102	0.994547175	0.258401128	24.73595443	28.19569464	97.97773918	2.367988918	4.239654948	24.40967499	8.169786195	22.05432468																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.084436219	0.084436219	0.18659574		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.084436219	0.084436219	0.18659574		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.3454	0.212157219	4.978398555	0	1.40938118	1.523787187	2.761881259	3.235387676	9.686403489	1.453220289	4.664571697	0.231729492	0.060207463	5.763477381	6.56959685	22.82881323	0.551741418	0.987839603	5.687454273	1.903560183	5.138657651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9937	0	0	19.3454	0.212157219	4.978398555	0	1.40938118	1.523787187	2.761881259	3.235387676	9.686403489	1.453220289	4.664571697	0.231729492	0.060207463	5.763477381	6.56959685	22.82881323	0.551741418	0.987839603	5.687454273	1.903560183	5.138657651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.9937	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.4055	0.0264	0.7736		0.168	0.2228	0.323	0.4379	1.3115	0.2459	0.6316	0.0314	0.0082	0.7804	0.7684	2.7236	0.0336	0.1155	0.6652	0.2689	0.601																				12.5427	0	0	21.751	0.238565226	5.751951863	0	1.577421874	1.746563091	3.084908307	3.673330936	10.99794053	1.69916289	5.296218459	0.263167204	0.068405463	6.543872014	7.337970751	25.55242086	0.58535961	1.103376399	6.352653603	2.172494586	5.739670241	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.5364
H7306_001_0	2010	4	N/A																															D	D	D	V	Coin	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	P	T	P	V	P	V	P	O	P																																																			0	NO	1622.196866	74.64162619	635.4709248		5.980031775	12.0001558	11.8184875	224.6556049	298.5840326		146.6246917	26.04915947	0.453468986	404.7029558	3007.458184	5110.676975	292.518016	344.3546976	304.8626633	979.9441399	29.18997994				138.5246787																	1a: Days 1 - 5: $195/day then $0;1a1: Days 1 - 5: $195/day then $0	1b: Days 1 - 5: $195/day then $0	"2: Days 1 - 4: $0/day, then $75/day"	6: $0/visit	10a: 20%	11a: 20%	11b: 20%;11c: 20%	4a: $50/visit;4a1: $50/visit;4b: $30/visit	9a: $280/visit;9b: $280/visit	8a: $0/visit	8b: $0/visit;8b: $250/visit;8b: 20%	9a: $280/visit	12a: 20%	3: 20%;5: 20%;9a: $280/visit;9c: 20%;9d: 20%;7i: $30/visit;7e: $30/visit;7c: $30/visit	7a: $10/visit;14c: $10/visit;14d: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $30/visit;7d: $30/visit;7f: $30/visit;16b: 20%;17a: $30/visit;18a: $30/visit	7e: $30/visit;7h: $30/visit;7a: $10/visit;7d: $30/visit	7c: $30/visit;7i: $30/visit;7a: $10/visit;7d: $30/visit	14h: $0/visit;7a: $10/visit;7d: $30/visit	7g: $30/visit;14b: $10/visit;14i: 20%;14j: 20%;17b: $0/visit7a: $10/visit;7d: $30/visit;8a: $0/visit;12a: 20%	15: 20%	13a: $0/visit			17a1: $30/visit	17b1: $65 per yr			14a: $0/visit												128.0588583	103.8879706	51.05024046		0.2	0.2	0.2	46	254.4563812		250.2023629	280	0.2	124.7251432	10	29.99983473	29.53788901	27.91685576	28.98921669	7.202267925	0.2				30																NO	128.0588583	103.8879706	51.05024046		0.2	0.2	0.2	46	254.4563812		250.2023629	280	0.2	124.7251432	10	29.99983473	29.53788901	27.91685576	28.98921669	7.202267925	0.2				30																	17.3114	0.646197255	2.70341196	0	1.196006355	2.400031159	2.3636975	0.861179819	6.331384369	0	3.057153694	0.607813721	0.090693797	4.206386176	2.506215153	12.77662205	0.720030391	0.801108369	0.736477484	0.588151687	5.837995988	0	0	0	0.346311697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0883	0	0	17.3114	0.646197255	2.70341196	0	1.196006355	2.400031159	2.3636975	0.861179819	6.331384369	0	3.057153694	0.607813721	0.090693797	4.206386176	2.506215153	12.77662205	0.720030391	0.801108369	0.736477484	0.588151687	5.837995988	0	0	0	0.346311697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.0883	NO	OON: 20%	OON: 20%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: $50/visit;OON: $30/visit	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%;OON: $30/visit	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%			OON: $30/visit	OON: $65 per yr																6.4678	0.1213	0.8086	2.1769	0.2067	0.4211	0.4147	0.1015	1.3578	0.0844	0.4102	0.0866	0.0134	0.7788	1.0431	3.899	0.0756	0.1011	1.3606	0.5438	1.0242				0.0385																21.5356	0	0	23.7792	0.7675221	3.512056794	2.176893099	1.402726919	2.821089257	2.778381272	0.962692588	7.689161242	0.084413784	3.467304379	0.69439255	0.104068145	4.98515673	3.549274281	16.67559929	0.795592379	0.902255053	2.097074592	1.131984643	6.86220581	0	0	0	0.384790774	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.6238
H7306_801_0	2010	2	N/A																															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																																																			0	NO	257.7799554	5.301421561	22.61861633		6.431261937	12.71307721	12.14535238	14.41427264	50.84908429	2.476699741	14.81705246	2.695131813	0.568354286	27.79763125	31.85453345	118.3361744	1.57304087	3.163484352	41.93908082	14.90333588	31.8761496																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.074646582	0.074646582	0.185997909		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.074646582	0.074646582	0.185997909		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.2424	0.395733002	4.207015333	0	1.498484031	2.962146989	2.829867105	3.358525526	11.84783664	0.57707104	3.452373224	0.627965712	0.132426549	6.476848082	7.422106295	27.57232865	0.366518523	0.737091854	9.771805831	3.472477261	7.427142857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3782	0	-1.15E-08	19.2424	0.395733002	4.207015333	0	1.498484031	2.962146989	2.829867105	3.358525526	11.84783664	0.57707104	3.452373224	0.627965712	0.132426549	6.476848082	7.422106295	27.57232865	0.366518523	0.737091854	9.771805831	3.472477261	7.427142857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3782	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.5897	0.0534	0.5656		0.1731	0.3464	0.331	0.3313	1.1686	0.0673	0.3406	0.0619	0.0131	0.6431	0.8858	3.2906	0.0327	0.088	1.1662	0.4713	0.8687																				13.4884	0	0	21.8321	0.449127127	4.772577106	0	1.671610239	3.308596929	3.160845714	3.689834653	13.0163914	0.644413513	3.79295376	0.689870558	0.145480444	7.119985318	8.307904874	30.86297534	0.39925192	0.825060807	10.93803161	3.943738445	8.295814537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8665
H7306_803_0	2010	1	N/A																															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																																																			0	NO	257.7799554	5.301421561	22.61861633		6.431261937	12.71307721	12.14535238	14.41427264	50.84908429	2.476699741	14.81705246	2.695131813	0.568354286	27.79763125	31.85453345	118.3361744	1.57304087	3.163484352	41.93908082	14.90333588	31.8761496																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.074646582	0.074646582	0.185997909		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.074646582	0.074646582	0.185997909		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.2424	0.395733002	4.207015333	0	1.498484031	2.962146989	2.829867105	3.358525526	11.84783664	0.57707104	3.452373224	0.627965712	0.132426549	6.476848082	7.422106295	27.57232865	0.366518523	0.737091854	9.771805831	3.472477261	7.427142857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3782	0	-1.15E-08	19.2424	0.395733002	4.207015333	0	1.498484031	2.962146989	2.829867105	3.358525526	11.84783664	0.57707104	3.452373224	0.627965712	0.132426549	6.476848082	7.422106295	27.57232865	0.366518523	0.737091854	9.771805831	3.472477261	7.427142857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3782	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.5897	0.0534	0.5656		0.1731	0.3464	0.331	0.3313	1.1686	0.0673	0.3406	0.0619	0.0131	0.6431	0.8858	3.2906	0.0327	0.088	1.1662	0.4713	0.8687																				13.4884	0	0	21.8321	0.449127127	4.772577106	0	1.671610239	3.308596929	3.160845714	3.689834653	13.0163914	0.644413513	3.79295376	0.689870558	0.145480444	7.119985318	8.307904874	30.86297534	0.39925192	0.825060807	10.93803161	3.943738445	8.295814537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8665
H7306_804_0	2010	1	N/A																															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																																																			0	NO	257.7799554	5.301421561	22.61861633		6.431261937	12.71307721	12.14535238	14.41427264	50.84908429	2.476699741	14.81705246	2.695131813	0.568354286	27.79763125	31.85453345	118.3361744	1.57304087	3.163484352	41.93908082	14.90333588	31.8761496																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.074646582	0.074646582	0.185997909		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.074646582	0.074646582	0.185997909		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.2424	0.395733002	4.207015333	0	1.498484031	2.962146989	2.829867105	3.358525526	11.84783664	0.57707104	3.452373224	0.627965712	0.132426549	6.476848082	7.422106295	27.57232865	0.366518523	0.737091854	9.771805831	3.472477261	7.427142857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3782	0	-1.15E-08	19.2424	0.395733002	4.207015333	0	1.498484031	2.962146989	2.829867105	3.358525526	11.84783664	0.57707104	3.452373224	0.627965712	0.132426549	6.476848082	7.422106295	27.57232865	0.366518523	0.737091854	9.771805831	3.472477261	7.427142857	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	114.3782	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				2.5897	0.0534	0.5656		0.1731	0.3464	0.331	0.3313	1.1686	0.0673	0.3406	0.0619	0.0131	0.6431	0.8858	3.2906	0.0327	0.088	1.1662	0.4713	0.8687																				13.4884	0	0	21.8321	0.449127127	4.772577106	0	1.671610239	3.308596929	3.160845714	3.689834653	13.0163914	0.644413513	3.79295376	0.689870558	0.145480444	7.119985318	8.307904874	30.86297534	0.39925192	0.825060807	10.93803161	3.943738445	8.295814537	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.8665
H7352_002_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	318.8749173	23.85424964	27.75807915		24.35874341	14.94215697	19.00806082	29.90233834	32.53362529	6.294650815	13.23046634	4.996696859	3.070613381	48.96200413	35.2932996	65.08410482	5.940592385	3.433739683	24.20780318	55.87982586	31.49117795	5.762071219																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.071443515	0.071443515	0.148466258		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.071443515	0.071443515	0.148466258		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				22.7815	1.704231433	4.121138132	0	5.675587215	3.481522574	4.428878171	6.967244834	7.580334692	1.46665364	3.082698658	1.164230368	0.715452918	11.40814696	8.223338808	15.16459642	1.384158026	0.800061346	5.64041814	13.01999942	7.337444462	1.342562594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.4902	0	0	22.7815	1.704231433	4.121138132	0	5.675587215	3.481522574	4.428878171	6.967244834	7.580334692	1.46665364	3.082698658	1.164230368	0.715452918	11.40814696	8.223338808	15.16459642	1.384158026	0.800061346	5.64041814	13.01999942	7.337444462	1.342562594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.4902	NO																																																																																		0	0	0	22.7815	1.704231433	4.121138132	0	5.675587215	3.481522574	4.428878171	6.967244834	7.580334692	1.46665364	3.082698658	1.164230368	0.715452918	11.40814696	8.223338808	15.16459642	1.384158026	0.800061346	5.64041814	13.01999942	7.337444462	1.342562594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.4902
H7352_003_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	290.1268181	23.38017863	28.48818751		21.60341463	13.02044495	14.50098367	31.16441399	27.98616871	8.801240551	11.32847013	3.402396127	2.908848208	46.66917933	33.95149505	61.38231347	6.212480771	2.720382263	23.749704	51.30195956	14.88691119	5.463008023																				Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share	Medicare Cost Share																			0.078940951	0.078940951	0.132708436		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.078940951	0.078940951	0.132708436		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				22.9029	1.845653537	3.780622812	0	5.03359561	3.033763673	3.378729194	7.261308459	6.520777309	2.050689048	2.639533539	0.792758298	0.677761633	10.87391878	7.910698348	14.30207904	1.44750802	0.633849067	5.533681032	11.95335658	3.468650308	1.272880869	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3147	0	0	22.9029	1.845653537	3.780622812	0	5.03359561	3.033763673	3.378729194	7.261308459	6.520777309	2.050689048	2.639533539	0.792758298	0.677761633	10.87391878	7.910698348	14.30207904	1.44750802	0.633849067	5.533681032	11.95335658	3.468650308	1.272880869	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3147	NO																																																																																		0	0	0	22.9029	1.845653537	3.780622812	0	5.03359561	3.033763673	3.378729194	7.261308459	6.520777309	2.050689048	2.639533539	0.792758298	0.677761633	10.87391878	7.910698348	14.30207904	1.44750802	0.633849067	5.533681032	11.95335658	3.468650308	1.272880869	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3147
H7406_001_0	2010	4	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	coin	T	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	0	0	0	0	0											0	YES	1140.577622	3.946600206	935.8914079	77.99430397	291.8631423	19.69218086	4.868840964	274.6424811	422.9586047	3.178593283	17.93036499	0	0.071691833	1327.626174	3668.297364	5907.829391	218.9931284	838.6389032	41.47522528	90.99832289	8.493931485	1.476003917	0	0	0	0	0	0	0	0											5000	1a:  Acute - $250/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$90/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$90/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $30/visit/17a:  Vision Exams - $30/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/ Visits/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $30/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $30/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%							/14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit												250	0.073386348	90	0	150	0.2	0.2	36.61721227	195.890634	0	0.2	0	0.2	52.99946283	30	30	30	30	0	29.76778695	0.2	0.2	0	0	0	0	0	0	0	0											NO	211.7886152	0.062169572	76.24390148	0	127.0731691	0.169430892	0.169430892	31.02043472	165.9496244	0	0.169430892	0	0.169430892	44.89873136	25.41463383	25.41463383	25.41463383	25.41463383	0	25.2179135	0.169430892	0.169430892	0	0	0	0	0	0	0	0												20.1301	0.245358446	5.946334358	0	3.090664537	3.336463773	0.824932068	0.709960763	5.8491518	0	3.037957738	0	0.012146811	4.967394245	7.769036191	12.51211006	0.463802514	1.77614172	0	0.19123232	1.43913439	0.25008066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.552		13.09	20.1301	0.245358446	5.946334358	0	3.090664537	3.336463773	0.824932068	0.709960763	5.8491518	0	3.037957738	0	0.012146811	4.967394245	7.769036191	12.51211006	0.463802514	1.77614172	0	0.19123232	1.43913439	0.25008066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.552	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	20.1301	0.245358446	5.946334358	0	3.090664537	3.336463773	0.824932068	0.709960763	5.8491518	0	3.037957738	0	0.012146811	4.967394245	7.769036191	12.51211006	0.463802514	1.77614172	0	0.19123232	1.43913439	0.25008066	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.552
H7406_004_0	2010	4	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	coin	T	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	0	0	0	0	0											0	YES	1237.044418	3.918972769	705.4316394	69.48902991	386.6726164	26.09368192	5.967185424	299.1920846	456.5177653	4.541711208	19.4929054	0	0.266460378	1261.953165	4076.435964	6132.525495	258.5874181	764.2507796	50.97471262	100.3890614	31.80780039	14.79764811	0	0	0	0	0	0	0	0											6000	1a:  Acute - $250/$0/day for 1-5/6-90	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$90/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$90/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $30/visit/17a:  Vision Exams - $30/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/ Visits/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $30/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $30/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%							/14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit												250	0.071660767	90	0	150	0.2	0.2	36.61551894	195.890634	0	0.2	0	0.2	51.35298079	29.99975084	29.88510322	30	30	0	29.85432813	0.2	0.2	0	0	0	0	0	0	0	0											NO	214.5872888	0.061551821	77.35398302	0	128.6335958	0.171574291	0.171650349	31.41958406	168.1017123	0	0.171773034	0	0.170934089	44.06402943	25.74468362	25.65541751	25.73042026	25.77028993	0	25.62052809	0.170927099	0.170746059	0	0	0	0	0	0	0	0												22.1212	0.24121991	4.547328921	0	4.144924087	4.477004962	1.024269463	0.783374238	6.39511817	0	3.348355504	0	0.045547162	4.633895117	8.745546184	13.11104183	0.554463578	1.641247014	0	0.214335064	5.436815039	2.526640104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9923		13.90567456	22.1212	0.24121991	4.547328921	0	4.144924087	4.477004962	1.024269463	0.783374238	6.39511817	0	3.348355504	0	0.045547162	4.633895117	8.745546184	13.11104183	0.554463578	1.641247014	0	0.214335064	5.436815039	2.526640104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9923	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	22.1212	0.24121991	4.547328921	0	4.144924087	4.477004962	1.024269463	0.783374238	6.39511817	0	3.348355504	0	0.045547162	4.633895117	8.745546184	13.11104183	0.554463578	1.641247014	0	0.214335064	5.436815039	2.526640104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9923
H7406_006_0	2010	2	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	V	coin	coin	T	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	0	0	0	0	0											0	NO	1120.243922	3.908229616	869.6579168	68.6566859	311.7000277	19.80922131	7.751081081	285.9930778	456.4861437	3.738490632	18.66583018	0	0.057519879	1257.078666	3636.377047	5584.388622	239.3607289	660.9658989	37.91642956	89.74731526	8.383650911	1.348124176	0	0	0	0	0	0	0	0												1a:  Acute - $250/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$90/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$90/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $25/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $150/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit	7a:  Primary Care - $25/visit/17a:  Vision Exams - $25/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/ Visits/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $25/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $25/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $25/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%							/14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit												250	0.073309223	90	0	150	0.2	0.2	33.13516375	195.890634	0	0.2	0	0.2	51.07928026	25	25	25	25	0	24.89452682	0.2	0.2	0	0	0	0	0	0	0	0											NO	250	0.073309223	90	0	150	0.2	0.2	33.13516375	195.890634	0	0.2	0	0.2	51.07928026	25	25	25	25	0	24.89452682	0.2	0.2	0	0	0	0	0	0	0	0												23.3384	0.286509277	6.522434376	0	3.896250346	3.961844263	1.550216216	0.789702289	7.451780008	0	3.733166036	0	0.011503976	5.350889456	7.575785514	11.63414296	0.498668185	1.377012289	0	0.186184746	1.676730182	0.269624835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1109		0	23.3384	0.286509277	6.522434376	0	3.896250346	3.961844263	1.550216216	0.789702289	7.451780008	0	3.733166036	0	0.011503976	5.350889456	7.575785514	11.63414296	0.498668185	1.377012289	0	0.186184746	1.676730182	0.269624835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1109	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	23.3384	0.286509277	6.522434376	0	3.896250346	3.961844263	1.550216216	0.789702289	7.451780008	0	3.733166036	0	0.011503976	5.350889456	7.575785514	11.63414296	0.498668185	1.377012289	0	0.186184746	1.676730182	0.269624835	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.1109
H7406_011_0	2010	1	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	358.6698641	4.106531803	53.39000491	78.6239983	12.06786435	21.33596105	5.275261378	10.6525949	46.64915305	3.350951193	18.9732969	0	0.074406741	22.06676906	45.47568761	130.3929081	1.680654452	6.626231467	40.74630222	44.15429643	8.562550187	1.501208757	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		"16a:  Preventive Dental - Oral Exams - $0/service/16a:  Preventive Dental - Prophylaxis - $0/service/16a:  Preventive Dental - Fluoride Treatment - $0/service/16a:  Preventive Dental - X-Rays - $0/service/16b:  Comprehensive Dental - Emergency Svcs - $0/visit/16b:  Comprehensive Dental - Diagnostic Svcs - $0/visit/16b:  Comprehensive Dental - Restorative Svcs - $0/visit/16b:  Comprehensive Dental - Endodontics/Periodontics/Extractions - $0/visit/16b:  Comprehensive Dental - Prosthodontics, Other - $0/visit"	17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	/14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit	13d:  Other: Over the Counter Benefit - $0/visit/											0.072897673	0.072897673	0.186704281	0	0.233	0.233	0.233	0.23079711	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072897673	0.072897673	0.186704281	0	0.233	0.233	0.233	0.23079711	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												26.1462	0.299356611	9.968142469	0	2.811812393	4.971278925	1.229135901	2.458588118	10.86925266	0.780771628	4.420778179	0	0.017336771	5.141557192	10.59583521	30.38154759	0.391592487	1.543911932	9.493888417	10.28795107	1.995074194	0.34978164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.1538		0	26.1462	0.299356611	9.968142469	0	2.811812393	4.971278925	1.229135901	2.458588118	10.86925266	0.780771628	4.420778179	0	0.017336771	5.141557192	10.59583521	30.38154759	0.391592487	1.543911932	9.493888417	10.28795107	1.995074194	0.34978164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.1538	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0		0	26.1462	0.299356611	9.968142469	0	2.811812393	4.971278925	1.229135901	2.458588118	10.86925266	0.780771628	4.420778179	0	0.017336771	5.141557192	10.59583521	30.38154759	0.391592487	1.543911932	9.493888417	10.28795107	1.995074194	0.34978164	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	134.1538
H7475_001_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	465.915999		257.7378599		69.67662533	33.81009041		28.69826984	19.56673097	191.3944331					323.8630406						42.29677308	6.731386821																				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																			0.082911984		0.15036564		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																			NO	0.082911984		0.15036564		0.233	0.233		0.233	0.233	0.233					0.233						0.233	0.233																				38.63	0	38.75491836	0	16.2346537	7.877751066	0	6.686696873	4.559048317	44.59490291	0	0	0	0	75.46008845	0	0	0	0	0	9.855148127	1.568413129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	244.2216	0	0	38.63	0	38.75491836	0	16.2346537	7.877751066	0	6.686696873	4.559048317	44.59490291	0	0	0	0	75.46008845	0	0	0	0	0	9.855148127	1.568413129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	244.2216	NO																																																																																		0	0	0	38.63	0	38.75491836	0	16.2346537	7.877751066	0	6.686696873	4.559048317	44.59490291	0	0	0	0	75.46008845	0	0	0	0	0	9.855148127	1.568413129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	244.2216
H7526_001_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	P	Coin	Coin			V	P	V	P	V	Coin																																																			0	YES	617.9858502	85.36658887			732.967803	15.35014658	12.90677992	496.4885268	208.9915167	7064.254917	648.1428568	51.59876638		1020.319939		2464.027676	906.4481247	314.0595169			17.8781088	0.001027944								5											3000	$100 (1a); $0 (1a1)	$100 (1b)	"$0 (2a, 2a2)"	$0 (6a)	$50 (10a)	20% (11a)	"20% (11b, 11c)"	"$50 (4a, 4a1, 4b)"	$25 (9b)	$25 (8a1); $0 (8a2)	"$25 (8b1, 8b2); $10 (8b3)"	$25 (9a)	$0 (12)	"$25 (5, 9a); $10 (3, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$10 (7b, 7d, 7f, 7g, 16b); $0 (17a, 18a)"	"$10 (7e, 7h)"	"$10 (7c, 7i)"			"20% (15, 15a1)"	20% (17b); 0% (13a)			$0 (17a1)	$0 (17b)	$0 (18a1)	$0 (18b)	$0 (14a)	20% (C )											100	100			50	0.2	0.2	50	25	12.5	22.86280488	25		24.36979421		10	10	10			0.2	0.174604085								0.2											NO	92.01146649	92.01146649			46.00573324	0.184022933	0.184022933	46.00573324	23.00286662	11.50143331	21.03640205	23.00286662		22.42300503		9.201146649	9.201146649	9.201146649			0.184022933	0.160655779								0.2												4.7385	0.654558753	0	0	2.810060102	2.824778995	2.375143496	1.903443227	0.400616999	6.770754734	1.136216144	0.098909962	0	1.906553261	0	1.889323333	0.695030177	0.240808973	0	0	3.289982018	0.000165145	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	32.7348	0	2.755251508	4.7385	0.654558753	0	0	2.810060102	2.824778995	2.375143496	1.903443227	0.400616999	6.770754734	1.136216144	0.098909962	0	1.906553261	0	1.889323333	0.695030177	0.240808973	0	0	3.289982018	0.000165145	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	32.7348	NO																																																																																		0	0	0	4.7385	0.654558753	0	0	2.810060102	2.824778995	2.375143496	1.903443227	0.400616999	6.770754734	1.136216144	0.098909962	0	1.906553261	0	1.889323333	0.695030177	0.240808973	0	0	3.289982018	0.000165145	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	32.7348
H7526_002_0	2010	7	N/A																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	321.4148948	112.0160644	42.27763375		24.44337452	24.38903064	21.56687359	74.03457797	75.66966365	20.8453847	36.21161833	9.322644834	1.777929797	96.66076241	69.0433454	59.17306649	28.30245608	6.541613736	24.15585546	55.67426363	61.30506199	4.508738717																				FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins		FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins	FFS Medicare eff. coins																			0.080980503	0.080980503	0.13034463		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080980503	0.080980503	0.13034463		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				26.0283	9.071117208	5.510662544	0	5.695306264	5.682644139	5.025081547	17.25005667	17.63103163	4.856974636	8.437307072	2.172176246	0.414257643	22.52195764	16.08709948	13.78732449	6.594472266	1.524196	5.628314322	12.97210343	14.28407944	1.050536121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	202.225	0	0	26.0283	9.071117208	5.510662544	0	5.695306264	5.682644139	5.025081547	17.25005667	17.63103163	4.856974636	8.437307072	2.172176246	0.414257643	22.52195764	16.08709948	13.78732449	6.594472266	1.524196	5.628314322	12.97210343	14.28407944	1.050536121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	202.225	NO																																																																																		0	0	0	26.0283	9.071117208	5.510662544	0	5.695306264	5.682644139	5.025081547	17.25005667	17.63103163	4.856974636	8.437307072	2.172176246	0.414257643	22.52195764	16.08709948	13.78732449	6.594472266	1.524196	5.628314322	12.97210343	14.28407944	1.050536121	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	202.225
H7526_003_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	P	Coin	Coin			V	P	V	P	V	Coin																																																			0	YES	712.8620506	18.62999567			433.4802657	28.75395292	41.68596313	468.9904428	394.073442	7164.646884	1320.475513	77.66290849		1847.57669		3628.783264	225.568988	434.761264			38.32697424	0.000415059								5											3000	$100 (1a); $0 (1a1)	$100 (1b)	"$0 (2a, 2a2)"	$0 (6a)	$50 (10a)	20% (11a)	"20% (11b, 11c)"	"$50 (4a, 4a1, 4b)"	$25 (9b)	$25 (8a1); $0 (8a2)	"$10 (8b1, 8b2); $10 (8b3)"	$25 (9a)	$0 (12)	"$25 (5, 9a); $10 (3, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$10 (7b, 7d, 7f, 7g, 16b); $0 (17a, 18a)"	"$10 (7e, 7h)"	"$10 (7c, 7i)"			"20% (15, 15a1)"	20% (17b); 0% (13a)			$0 (17a1)	$0 (17b)	$0 (18a1)	$0 (18b)	$0 (14a)	20% (C )											100	100			50	0.2	0.2	50	25	12.5	10	25		23.95218414		10	10	10			0.2	0.190276826								0.2											NO	86.161661	86.161661			43.0808305	0.172323322	0.172323322	43.0808305	21.54041525	10.77020762	8.6161661	21.54041525		20.6375997		8.6161661	8.6161661	8.6161661			0.172323322	0.163945674								0.2												5.1184	0.133765948	0	0	1.556224154	4.954976687	7.183463646	1.683708148	0.707375465	6.430394542	0.948119696	0.139407608	0	3.177462345	0	2.605516612	0.161961656	0.312164605	0	0	6.604631523	6.80E-05	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	42.7177	0	6.700236677	5.1184	0.133765948	0	0	1.556224154	4.954976687	7.183463646	1.683708148	0.707375465	6.430394542	0.948119696	0.139407608	0	3.177462345	0	2.605516612	0.161961656	0.312164605	0	0	6.604631523	6.80E-05	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	42.7177	NO																																																																																		0	0	0	5.1184	0.133765948	0	0	1.556224154	4.954976687	7.183463646	1.683708148	0.707375465	6.430394542	0.948119696	0.139407608	0	3.177462345	0	2.605516612	0.161961656	0.312164605	0	0	6.604631523	6.80E-05	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	42.7177
H7526_004_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	P	P	Coin	Coin			V	P	V	P	V	Coin																																																			0	YES	526.26924	12.38540596			326.2325796	15.59981737	22.47713714	377.8741421	359.8863738	7294.37869	1019.815966	68.86556858		1451.318126		3538.420705	175.1113689	477.5855044			30.58253499	0.000520972								5											3000	$100 (1a); $0 (1a1)	$100 (1b)	"$0 (2a, 2a2)"	$0 (6a)	$50 (10a)	20% (11a)	20% (11b); 5%( 11c)	"$50 (4a, 4a1, 4b)"	$25 (9b)	$25 (8a1); $0 (8a2)	"$25 (8b1, 8b2); $10 (8b3)"	$25 (9a)	$0 (12)	"$25 (5, 9a); $10 (3, 9c, 9d)"	"$0 (7a, 14b, 14c, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$10 (7b, 7d, 7f, 7g, 16b); $0 (17a, 18a)"	"$10 (7e, 7h)"	"$10 (7c, 7i)"			"20% (15, 15a1)"	20% (17b); 0% (13a)			$0 (17a1)	$0 (17b)	$0 (18a1)	$0 (18b)	$0 (14a)	20% (C )											100	100			50	0.2	0.167195125	50	25	12.5	22.11132986	25		23.55209618		10	10	10			0.2	0.160614766								0.2											NO	91.01178671	91.01178671			45.50589336	0.182023573	0.152167271	45.50589336	22.75294668	11.37647334	20.12391637	22.75294668		21.43518354		9.101178671	9.101178671	9.101178671			0.182023573	0.146178368								0.2												3.9914	0.093934827	0	0	1.237125415	2.839534502	3.420284612	1.432958368	0.682372956	6.915358724	1.710224267	0.130574551	0	2.5924392	0	2.683649921	0.132809988	0.362215917	0	0	5.566742304	7.62E-05	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	34.7917	0	3.337226541	3.9914	0.093934827	0	0	1.237125415	2.839534502	3.420284612	1.432958368	0.682372956	6.915358724	1.710224267	0.130574551	0	2.5924392	0	2.683649921	0.132809988	0.362215917	0	0	5.566742304	7.62E-05	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	34.7917	NO																																																																																		0	0	0	3.9914	0.093934827	0	0	1.237125415	2.839534502	3.420284612	1.432958368	0.682372956	6.915358724	1.710224267	0.130574551	0	2.5924392	0	2.683649921	0.132809988	0.362215917	0	0	5.566742304	7.62E-05	0	0	0	0	0	0	0	1	0	0	0	0	0	0	0	0	0	0	34.7917
H7678_001_0	2010	6	N/A																															D	D	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	O	V	T	V	V	V	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H7678_002_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	870.495772	19.18918994	330.4927778	0	232.2621243	12.76606156	8.534429297	244.0295102	390.2650448	0	596.3670235	0	0.442700644	15.72888098	4834.049745	6504.405273	211.3592007	663.4897163	2127.124281	1453.148619	8.935834321	0	0	2385.38276	0	0	0	0	0	0											3000	$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical;	$150/Days 1-5 for IP Psych; $150/Days 1-5 for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$75/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $25/Visit for Urgent Care;	$150/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	20% Coinsurance for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $10/Visit for PCP - Consults; $3/Procedure for PCP - Asst Surgeon (OP); $10/Visit for PCP - Tx Injections; $10/Visit for PCP - Allergy Testing; $10/Visit for PCP - Allergy Tx;	$20/Visit for Speclst - Office Visits; $7/Procedure for Speclst - Asst Surgeon (OP); $20/Visit for Speclst - Tx Injections; $20/Visit for Speclst - Allergy Testing; $20/Visit for Speclst - Allergy Tx; $20/Visit for Speclst - Consults;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $22/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	$23/Procedure for Prof Radiology (Office);	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	$3/Visit for Dental: Preventive Services;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											150	150	125	0	75	0.2	0.2	47.88375819	99.66944088	0	76.99465463	0	0.2	0.109622756	9.697462809	15.85095701	20.15786261	20	24.45566218	15	0.2	0	0	3.434202668	0	0	0	0	0	0											NO	145.0738299	145.0738299	120.8948583	0	72.53691496	0.193431773	0.193431773	46.31120127	96.39618343	0	74.46606287	0	0.193431773	0.10602262	9.378987134	15.33039361	19.49585554	19.34317732	23.6525105	14.50738299	0.193431773	0	0	3.321419558	0	0	0	0	0	0												10.5238	0.23198744	3.329573128	0	1.40396483	2.469361924	1.650829792	0.94177498	3.13500507	0	3.700758689	0	0.085632371	1.667617175	3.778207531	8.309591084	0.343385704	1.069499936	4.19265245	1.756781964	1.728474278	0	0	0.66023808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9792	0	1.731064278	10.5238	0.23198744	3.329573128	0	1.40396483	2.469361924	1.650829792	0.94177498	3.13500507	0	3.700758689	0	0.085632371	1.667617175	3.778207531	8.309591084	0.343385704	1.069499936	4.19265245	1.756781964	1.728474278	0	0	0.66023808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9792	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	10.5238	0.23198744	3.329573128	0	1.40396483	2.469361924	1.650829792	0.94177498	3.13500507	0	3.700758689	0	0.085632371	1.667617175	3.778207531	8.309591084	0.343385704	1.069499936	4.19265245	1.756781964	1.728474278	0	0	0.66023808	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.9792
H7731_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	P	P	P	P	P	P	Coin	P	T	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	NO	0	6.552464372	0	0	291.8156513	1.045372468	0.155393205	1185.741149	0	0	542.0596446	0	0.109071362	0	48.30761185	4483.342857	0.158587538	0	0	0	11.6394581	0	0	702.8043999	0	0	0	0	0	5.56381745												$0 copay	1B - $250 per admit	$0 copay	$0 copay	10A - $50 copay	11A - 20% coin on items >$150	11B - 20% coin on items >$150	4A - $50 copay	$0 copay	$0 copay	8B - $25 radiology	$0 copay	12 - 20% coinsurance	$0 copay	4B- $25 copay	7D - $5 Specialist copay	9C- $30 copay	$0 copay	$0 copay	$0 copay	20% Coinsurance for Part B Rx	$0 copay	$0 copay	16A - $15 copay	$0 copay	17B - $160 max	$0 copay	$0 copay	$0 copay	4A - $50 copay (foreign travel)											0	250	0	0	50	0.1	0.2	50	0	0	25	0	0.2	0	25	5	30	0	0	0	0.2	0	0	15	0	0	0	0	0	50											NO	0	250	0	0	50	0.1	0.2	50	0	0	25	0	0.2	0	25	5	30	0	0	0	0.2	0	0	15	0	0	0	0	0	50												0	0.136509674	0	0	1.215898547	0.104537247	0.031078641	4.940588119	0	0	1.129290926	0	0.021814272	0	0.100640858	1.868059524	0.000396469	0	0	0	2.32789162	0	0	0.8785055	0	0	0	0	0	0.023182573	0	0	0	0	0	0	0	0	0	0	12.7784			0	0.136509674	0	0	1.215898547	0.104537247	0.031078641	4.940588119	0	0	1.129290926	0	0.021814272	0	0.100640858	1.868059524	0.000396469	0	0	0	2.32789162	0	0	0.8785055	0	0	0	0	0	0.023182573	0	0	0	0	0	0	0	0	0	0	12.7784	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.136509674	0	0	1.215898547	0.104537247	0.031078641	4.940588119	0	0	1.129290926	0	0.021814272	0	0.100640858	1.868059524	0.000396469	0	0	0	2.32789162	0	0	0.8785055	0	0	0	0	0	0.023182573	0	0	0	0	0	0	0	0	0	0	12.7784
H7731_007_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	P	P	P	P	P	P	Coin	P	T	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	NO	0	1.090350643	0	0	114.7897193	5.93	0.86	119.5743396	0	0	5.86	0	0.08	0	32.0082201	0	0.034092429	0	0	0	6.68	0	0	978.7627951	0	0	0	0	0	3.764472289												$0 copay	1B - $250 per admit	$0 copay	$0 copay	10A - $50 copay	11A - 20% coin on items >$150	11B - 20% coin on items >$150	4A - $50 copay	$0 copay	$0 copay	8B - 20% coinsurance radiation therapy	$0 copay	12 - 20% coinsurance	$0 copay	4B- $25 copay	$0 copay	9C- $30 copay	$0 copay	$0 copay	$0 copay	20% Coinsurance for Part B Rx	$0 copay	$0 copay	16A - $15 copay	$0 copay	17B - $160 max	$0 copay	$0 copay	$0 copay	4A - $50 copay (foreign travel)											0	250	0	0	50	0.1	0.2	50	0	0	0.2	0	0.2	0	25	0	30	0	0	0	0.2	0	0	15	0	0	0	0	0	50											NO	0	250	0	0	50	0.1	0.2	50	0	0	0.2	0	0.2	0	25	0	30	0	0	0	0.2	0	0	15	0	0	0	0	0	50												0	0.022715638	0	0	0.478290497	0.593	0.172	0.498226415	0	0	1.172	0	0.016	0	0.066683792	0	8.52E-05	0	0	0	1.336	0	0	1.223453494	0	0	0	0	0	0.015685301	0	0	0	0	0	0	0	0	0	0	5.5941			0	0.022715638	0	0	0.478290497	0.593	0.172	0.498226415	0	0	1.172	0	0.016	0	0.066683792	0	8.52E-05	0	0	0	1.336	0	0	1.223453494	0	0	0	0	0	0.015685301	0	0	0	0	0	0	0	0	0	0	5.5941	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0.022715638	0	0	0.478290497	0.593	0.172	0.498226415	0	0	1.172	0	0.016	0	0.066683792	0	8.52E-05	0	0	0	1.336	0	0	1.223453494	0	0	0	0	0	0.015685301	0	0	0	0	0	0	0	0	0	0	5.5941
H7731_008_0	2010	3	N/A																															D	D	D	V	T	P	P	V	V	V	V	V	V	V	P	P	P	P	P	P	S	P	T	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay	$0 copay											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit	HMO-no OON benefit												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H7787_001_0	2010	8	N/A																															A	D	D	V	T	Coin	Coin	V	P	Coin	Coin	V	Coin	V	V	V	Coin	V	P	Coin	Coin																																																												0	NO	205.7591287	27.4699847	515.0420965	153.7565057	229.3132285	15.00338022	4.034134563	205.0935257	305.7065922	2.185110988	12.95303019	119.9290788	0.507329368	284.9311122	3313.62525	4689.261466	1.218163054	285.1021522	172.8530864	6.562570046	6.124995731																					"$300 per admit(Acute), $500 per admit (Rehab)"	$150/day for days 1-7	$100/day for days 21-100	no cost sharing	$100 per trip	20% Coinsurance	20% Coinsurance	$50 per ER visit; $25 per UC visit	"$85 OP Surg, $75 ASC"	20% Coinsurance	"20% coinsurance for X-rays/Ultrasounds/Radiation Therapy; $75 per MRI, CT, PET, CNM, Other Imaging"	$100 per visit	20% Coinsurance	$25 per CORF/Therapy visit; $25 per Cardiac Rehab session	$0 per visit; $0 per routine physical exam	$25 per visit	20% Coinsurance	$25 per visit	$75 per Colorectal Screening	20% Lab/Path	20% Coinsurance				$25 for one routine eye exam																315.2671756	150	100	0	100	0.2	0.2	33.13111441	80.0224	0.2	0.105080005	100	0.2	25	0	25	0.2	25	75	0.2	0.2																				NO	301.7726626	143.5794872	95.71965812	0	95.71965812	0.191439316	0.191439316	33.13111441	76.5971677	0.191439316	0.100582221	95.71965812	0.191439316	23.92991453	0	25	0.2	25	75	0.2	0.191439316																					5.1744	0.328677193	4.108304449	0	1.829148653	2.87223685	0.772291962	0.566248089	1.951354926	0.418316154	1.302844547	0.956630868	0.097122787	0.568198097	0	9.76929472	0.243632611	0.593962817	1.08033179	1.312514009	1.172564995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.118	0	0.864763974	5.1744	0.328677193	4.108304449	0	1.829148653	2.87223685	0.772291962	0.566248089	1.951354926	0.418316154	1.302844547	0.956630868	0.097122787	0.568198097	0	9.76929472	0.243632611	0.593962817	1.08033179	1.312514009	1.172564995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.118	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	no cost sharing	$100 per trip	30% Coinsurance	30% Coinsurance	$50 per ER visit; $25 per UC visit	30% Coinsurance	30% Coinsurance	"30% coinsurance for X-rays/Ultrasounds/Radiation Therapy, MRI, CT, PET, CNM, Other Imaging"	30% Coinsurance	30% Coinsurance	30% Coinsurance	$40 per visit; $0 per routine physical exam	$60 per visit	30% Coinsurance	$60 per visit	30% Coinsurance	30% Lab/Path	30% Coinsurance				$25 for one routine eye exam																	14.3136	0.1631	2.5987	0	0.2842	0.8417	0.2263	0.1245	1.7465	0.1226	0.7081	0.81	0.0285	0.519	1.7105	3.3852	0.0683	0.2058	0.1813	0.3588	0.3436	0	0	0	0	0	0	0	0	0											28.7401	1000	0	19.4879	0.491738715	6.706994478	0	2.113307185	3.713931613	0.998608291	0.690770342	3.697825748	0.540901627	2.010943531	1.766630379	0.125584138	1.087226013	1.7104592	13.15444913	0.311971975	0.799776636	1.261604304	1.671267839	1.516179351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.8581
H7787_002_0	2010	4	N/A																															A	D	D	V	T	Coin	Coin	V	P	Coin	Coin	V	Coin	V	V	V	Coin	V	P	Coin	Coin																																																												0	NO	205.7591287	27.4699847	515.0420965	153.7565057	229.3132285	15.00338022	4.034134563	205.0935257	305.7065922	2.185110988	12.95303019	119.9290788	0.507329368	284.9311122	3313.62525	4689.261466	1.218163054	285.1021522	172.8530864	6.562570046	6.124995731																					$500 per admit	$150/day for days 1-7	$100/day for days 21-100	no cost sharing	$100 per trip	20% Coinsurance	20% Coinsurance	$50 per ER visit; $25 per UC visit	$75 per procedure	20% Coinsurance	"20% coinsurance for X-rays/Ultrasounds/Radiation Therapy; $75 per MRI, CT, PET, CNM, Other Imaging"	$100 per visit	20% Coinsurance	$25 per CORF/Therapy visit; $25 per Cardiac Rehab session	$5 per visit; $0 per routine physical exam	$25 per visit	20% Coinsurance	$25 per visit	$75 per Colorectal Screening	20% Lab/Path	20% Coinsurance			Preventive Dental	$25 for one routine eye exam	**$100 limit on eyewear per plan year															500	150	100	0	100	0.2	0.2	33.13111441	75	0.2	0.105080005	100	0.2	25	5	25	0.2	25	75	0.2	0.2																				NO	478.5982906	143.5794872	95.71965812	0	95.71965812	0.191439316	0.191439316	33.13111441	71.78974359	0.191439316	0.100582221	95.71965812	0.191439316	23.92991453	5	25	0.2	25	75	0.2	0.191439316																					8.2063	0.328677193	4.108304449	0	1.829148653	2.87223685	0.772291962	0.566248089	1.828883156	0.418316154	1.302844547	0.956630868	0.097122787	0.568198097	1.380677187	9.76929472	0.243632611	0.593962817	1.08033179	1.312514009	1.172564995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4082	0	0.864763974	8.2063	0.328677193	4.108304449	0	1.829148653	2.87223685	0.772291962	0.566248089	1.828883156	0.418316154	1.302844547	0.956630868	0.097122787	0.568198097	1.380677187	9.76929472	0.243632611	0.593962817	1.08033179	1.312514009	1.172564995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.4082	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	no cost sharing	$100 per trip	30% Coinsurance	30% Coinsurance	$50 per ER visit; $25 per UC visit	30% Coinsurance	30% Coinsurance	"30% coinsurance for X-rays/Ultrasounds/Radiation Therapy, MRI, CT, PET, CNM, Other Imaging"	30% Coinsurance	30% Coinsurance	30% Coinsurance	$40 per visit; $0 per routine physical exam	$60 per visit	30% Coinsurance	$40 per visit	30% Coinsurance	20% Lab/Path	30% Coinsurance			Preventive Dental	$25 for one routine eye exam	**$100 limit on eyewear per plan year																14.3136	0.1631	2.5987	0	0.2842	0.8417	0.2263	0.1245	1.7465	0.1226	0.7081	0.81	0.0285	0.519	1.7105	3.3852	0.0683	0.2058	0.1813	0.3588	0.3436	0	0	0	0	0	0	0	0	0											28.7401	1000	0	22.5199	0.491738715	6.706994478	0	2.113307185	3.713931613	0.998608291	0.690770342	3.575353977	0.540901627	2.010943531	1.766630379	0.125584138	1.087226013	3.091136387	13.15444913	0.311971975	0.799776636	1.261604304	1.671267839	1.516179351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.1483
H7787_003_0	2010	4	N/A																															A	D	D	V	T	Coin	Coin	V	P	Coin	Coin	V	Coin	V	V	V	Coin	V	P	Coin	Coin																																																												0	NO	205.7591287	27.4699847	515.0420965	153.7565057	229.3132285	15.00338022	4.034134563	205.0935257	305.7065922	2.185110988	12.62200831	119.9290788	0.507329368	284.9311122	3313.62525	4689.261466	1.218163054	285.1021522	172.8530864	6.562570046	6.124995731																					"$250 per admit (Acute), $500 per admit (Rehab)"	$150/day for days 1-7	$100/day for days 21-100	no cost sharing	$100 per trip	20% Coinsurance	20% Coinsurance	$50 per ER visit; $25 per UC visit	$75 per procedure	20% Coinsurance	"20% coinsurance for X-rays/Ultrasounds/Radiation Therapy; $75 per MRI, CT, PET, CNM, Other Imaging"	$100 per visit	20% Coinsurance	$20 per CORF/Therapy visit; $20 per Cardiac Rehab session	$0 per visit; $0 per routine physical exam	$20 per visit	20% Coinsurance	$20 per visit	$75 per Colorectal Screening	20% Lab/Path	20% Coinsurance	0	0	Comprehensive Benefit	$20 for one routine eye exam	**$100 limit on eyewear per plan year	0	0	SilverFit (no cost sharing)	0											265.2671756	150	100	0	100	0.2	0.2	33.13111441	75	0.2	0.105080005	100	0.2	20	0	20	0.2	20	75	0.2	0.2																				NO	253.9128336	143.5794872	95.71965812	0	95.71965812	0.191439316	0.191439316	33.13111441	71.78974359	0.191439316	0.100582221	95.71965812	0.191439316	19.14393162	0	20	0.2	20	75	0.2	0.191439316																					4.3537	0.328677193	4.108304449	0	1.829148653	2.87223685	0.772291962	0.566248089	1.828883156	0.418316154	1.269549631	0.956630868	0.097122787	0.454558477	0	7.815435776	0.243632611	0.475170254	1.08033179	1.312514009	1.172564995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9554	0	0.864763974	4.3537	0.328677193	4.108304449	0	1.829148653	2.87223685	0.772291962	0.566248089	1.828883156	0.418316154	1.269549631	0.956630868	0.097122787	0.454558477	0	7.815435776	0.243632611	0.475170254	1.08033179	1.312514009	1.172564995	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9554	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	no cost sharing	$100 per trip	30% Coinsurance	30% Coinsurance	$50 per ER visit; $25 per UC visit	30% Coinsurance	30% Coinsurance	"30% coinsurance for X-rays/Ultrasounds/Radiation Therapy, MRI, CT, PET, CNM, Other Imaging"	30% Coinsurance	30% Coinsurance	30% Coinsurance	$40 per visit; $0 per routine physical exam	$60 per visit	30% Coinsurance	$60 per visit	30% Coinsurance	30% Lab/Path	30% Coinsurance	0	0	Comprehensive Benefit	$20 for one routine eye exam	**$100 limit on eyewear per plan year	0	0	SilverFit (no cost sharing)	0												14.3136	0.1631	2.5987	0	0.2842	0.8417	0.2263	0.1245	1.7465	0.1226	0.7081	0.81	0.0285	0.519	1.7105	3.3852	0.0683	0.2058	0.1813	0.3588	0.3436	0	0	0	0	0	0	0	0	0											28.7401	1000	0	18.6673	0.491738715	6.706994478	0	2.113307185	3.713931613	0.998608291	0.690770342	3.575353977	0.540901627	1.977648615	1.766630379	0.125584138	0.973586393	1.7104592	11.20059019	0.311971975	0.680984072	1.261604304	1.671267839	1.516179351	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.6954
H7787_004_0	2010	4	N/A																															A	D	D	V	T	Coin	Coin	V	P	Coin	Coin	V	Coin	V	V	V	Coin	V	P	Coin	Coin																																																												0	NO	225.3196122	26.69666541	499.2931578	155.310591	245.4245394	15.19846876	4.086418417	215.9863632	308.5936805	2.559341419	13.72901497	114.1603728	0.548951433	251.1643626	3240.108804	4586.232159	1.126862752	278.8380791	168.9362545	6.430367414	6.314898103																					$600 per admit	$175/day for days 1-7	$100/day for days 21-100	no cost sharing	$100 per trip	20% Coinsurance	20% Coinsurance	$50 per ER visit; $25 per UC visit	$175 per ASC & $275 OP Surgery	20% Coinsurance	"20% coinsurance for X-rays/Ultrasounds/Radiation Therapy; $75 per MRI, CT, PET, CNM, Other Imaging"	$100 per visit	20% Coinsurance	$35 per CORF/Therapy visit; $35 per Cardiac Rehab session	$10 per visit; $0 per routine physical exam	$35 per visit	20% Coinsurance	$35 per visit	$75 per Colorectal Screening	20% Lab/Path	20% Coinsurance	0	0	0	0	0	0	0	0	0											600	175	100	0	100	0.2	0.2	33.12947264	225.063	0.2	0.104615151	100	0.2	35	10	35	0.2	35	75	0.2	0.2																				NO	574.6398364	167.6032856	95.77330607	0	95.77330607	0.191546612	0.191546612	33.12947264	215.5502758	0.191546612	0.100193389	95.77330607	0.191546612	33.52065712	10	35	0.2	35	75	0.2	0.191546612																					10.7898	0.372870737	3.984913035	0	1.958759961	2.911215201	0.782739604	0.596292859	5.543121079	0.490233178	1.375556533	0.91112636	0.105149787	0.70159954	2.70009067	13.37651047	0.22537255	0.813277731	1.055851591	1.286073483	1.209597338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1902	0	1.3	10.7898	0.372870737	3.984913035	0	1.958759961	2.911215201	0.782739604	0.596292859	5.543121079	0.490233178	1.375556533	0.91112636	0.105149787	0.70159954	2.70009067	13.37651047	0.22537255	0.813277731	1.055851591	1.286073483	1.209597338	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1902	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	no cost sharing	$100 per trip	30% Coinsurance	30% Coinsurance	$50 per ER visit; $25 per UC visit	30% Coinsurance	30% Coinsurance	"30% coinsurance for X-rays/Ultrasounds/Radiation Therapy, MRI, CT, PET, CNM, Other Imaging"	30% Coinsurance	30% Coinsurance	30% Coinsurance	$40 per visit; $0 per routine physical exam	$60 per visit	30% Coinsurance	$60 per visit	30% Coinsurance	30% Lab/Path	30% Coinsurance	0	0	0	0	0	0	0	0	0												14.1652	0.1614	2.4628	0	0.3012	0.8526	0.2292	0.132	1.7895	0.1436	0.7702	0.8765	0.0308	0.516	1.6683	3.3046	0.0632	0.2009	0.1751	0.3515	0.3543																				28.5489	1000	0	24.955	0.534242459	6.447694811	0	2.25998509	3.763854498	1.011989075	0.728320657	7.33261698	0.633813107	2.14575897	1.78757945	0.13594615	1.217555796	4.368388599	16.68111717	0.288589936	1.014194333	1.230941805	1.637600235	1.563865281	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.7391
H7787_005_0	2010	5	N/A																															A	D	D	V	T	Coin	Coin	V	P	Coin	Coin	V	Coin	V	V	V	Coin	V	P	Coin	Coin																																																												0	NO	223.4819632	26.47893426	494.8589808	155.74815	249.9607438	15.25339673	4.101139147	219.0532854	309.4065518	2.664707502	14.04069715	112.5361704	0.560670293	243.7073546	3218.660635	4556.170694	1.101156784	277.0103736	167.7952414	6.393145231	6.368365879																					$500 per admit	$150/day for days 1-7	$100/day for days 21-100	no cost sharing	$100 per trip	20% Coinsurance	20% Coinsurance	$50 per ER visit; $25 per UC visit	$100 per ASC & $200 OP Surgery	20% Coinsurance	"20% coinsurance for X-rays/Ultrasounds/Radiation Therapy; $75 per MRI, CT, PET, CNM, Other Imaging"	$100 per visit	20% Coinsurance	$35 per CORF/Therapy visit; $35 per Cardiac Rehab session	$10 per visit; $0 per routine physical exam	$35 per visit	20% Coinsurance	$35 per visit	$75 per Colorectal Screening	20% Lab/Path	20% Coinsurance			Preventive Dental	$35 for one routine eye exam	* $100 limit on eyewear per year			Fitness Program- no cost sharing												500	150	100	0	100	0.2	0.2	33.12903985	150.042	0.2	0.104497494	100	0.2	35	10	35	0.2	35	75	0.2	0.2																				NO	478.9425372	143.6827612	95.78850745	0	95.78850745	0.191577015	0.191577015	33.12903985	143.7229923	0.191577015	0.10009659	95.78850745	0.191577015	33.52597761	10	35	0.2	35	75	0.2	0.191577015																					8.9196	0.317047199	3.950150264	0	1.995280548	2.922200212	0.785683995	0.604752085	3.705736289	0.510496709	1.405425902	0.898305983	0.107411541	0.680877276	2.682217196	13.28883119	0.220231357	0.807946923	1.048720259	1.278629046	1.220032525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3496	0	1.3	8.9196	0.317047199	3.950150264	0	1.995280548	2.922200212	0.785683995	0.604752085	3.705736289	0.510496709	1.405425902	0.898305983	0.107411541	0.680877276	2.682217196	13.28883119	0.220231357	0.807946923	1.048720259	1.278629046	1.220032525	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.3496	NO	30% Coinsurance	30% Coinsurance	30% Coinsurance	no cost sharing	$100 per trip	30% Coinsurance	30% Coinsurance	$50 per ER visit; $25 per UC visit	30% Coinsurance	30% Coinsurance	"30% coinsurance for X-rays/Ultrasounds/Radiation Therapy, MRI, CT, PET, CNM, Other Imaging"	30% Coinsurance	30% Coinsurance	30% Coinsurance	$40 per visit; $0 per routine physical exam	$60 per visit	30% Coinsurance	$60 per visit	30% Coinsurance	30% Lab/Path	30% Coinsurance			Preventive Dental	$35 for one routine eye exam	* $100 limit on eyewear per year			Fitness Program- no cost sharing													14.1235	0.1609	2.4245	0	0.306	0.8557	0.2301	0.1341	1.8016	0.1495	0.7877	0.8952	0.0315	0.5151	1.6552	3.28	0.0618	0.1994	0.1729	0.3495	0.3573																				28.4913	1000	0	23.0431	0.477943151	6.374666524	0	2.301310845	3.777920986	1.015759304	0.738893099	5.507346075	0.659987711	2.193113816	1.793469346	0.138865336	1.195968694	4.337389664	16.56878125	0.282006629	1.007364428	1.221607035	1.628120986	1.577300029	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.8409
H7908_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1497.774551	62.38821716	1171.2781	897.6567171	223.8812211	11.11006616	0	296.7492202	409.218117	2096.002977	2828.311668	34.18929182	0.221061608	4.616917923	4386.248736	5448.69824	196.0492546	683.5447271	0	0	278	0	0	0	822.5150425	0	49.23162054	0	109.58339	0												$200/day 1-5	$200/day 1-5	"$0/d 1-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $25 Urgent Care Ctr	$200 per procedure	$0 per visit	$35 X-ray; $175 Complex Radiology	$35 per visit	$25 per visit	$35 per visit	$15 PCP visit; $35 if no PCP selected	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$35 per visit	$45 per script	0	Not Covered	0	$0 per visit	Not Covered	$0 per visit	$1100 Every 3 Yrs	Fitness Only	0											122.5677481	122.5677481	40.33133874	0	100	0.2	0.2	47.5	200	0	45.5	35	25	35	15	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0											NO	122.5677481	122.5677481	40.33133874	0	100	0.2	0.2	47.5	200	0	45.5	35	25	35	15	35	35	35	35	35	$45 	0	0	0	0	0	0	0	0	0												15.2982	0.637231941	3.936601152	0	1.865676843	2.222013232	0	1.17463233	6.82030195	0	10.72401508	0.099718768	0.000460545	0.013466011	5.48281092	15.89203653	0.571810326	1.993672121	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7752	0	0	15.2982	0.637231941	3.936601152	0	1.865676843	2.222013232	0	1.17463233	6.82030195	0	10.72401508	0.099718768	0.000460545	0.013466011	5.48281092	15.89203653	0.571810326	1.993672121	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7752	NO																												0	0																																								0	0	0											0			15.2982	0.637231941	3.936601152	0	1.865676843	2.222013232	0	1.17463233	6.82030195	0	10.72401508	0.099718768	0.000460545	0.013466011	5.48281092	15.89203653	0.571810326	1.993672121	0	0	1.0425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.7752
H7908_801_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	349.1246515	5.365089562	46.75586768	7.246468735	9.270440945	11.70451228	0	11.69826307	40.00045405	13.84139497	60.82501643	0.811818646	0.015444309	26.66696939	21.1828586	133.5187958	2.570243795	6.629406455	0	-1.05E-08	69.49819812	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.069723925	0.069723925	0.145098039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.069723925	0.069723925	0.145098039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.3423	0.374075105	6.784184722	0	2.16001274	2.727151362	0	2.725695295	9.320105794	3.225045027	14.17222883	0.189153744	0.003598524	6.213403868	4.935606054	31.10987943	0.598866804	1.544651704	0	-2.44E-09	16.19308016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6191			24.3423	0.374075105	6.784184722	0	2.16001274	2.727151362	0	2.725695295	9.320105794	3.225045027	14.17222883	0.189153744	0.003598524	6.213403868	4.935606054	31.10987943	0.598866804	1.544651704	0	-2.44E-09	16.19308016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6191	NO																																																																																		0			24.3423	0.374075105	6.784184722	0	2.16001274	2.727151362	0	2.725695295	9.320105794	3.225045027	14.17222883	0.189153744	0.003598524	6.213403868	4.935606054	31.10987943	0.598866804	1.544651704	0	-2.44E-09	16.19308016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6191
H7908_802_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	349.1246515	5.365089562	46.75586768	7.246468735	9.270440945	11.70451228	0	11.69826307	40.00045405	13.84139497	60.82501643	0.811818646	0.015444309	26.66696939	21.1828586	133.5187958	2.570243795	6.629406455	0	-1.05E-08	69.49819812	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.069723925	0.069723925	0.145098039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.069723925	0.069723925	0.145098039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.3423	0.374075105	6.784184722	0	2.16001274	2.727151362	0	2.725695295	9.320105794	3.225045027	14.17222883	0.189153744	0.003598524	6.213403868	4.935606054	31.10987943	0.598866804	1.544651704	0	-2.44E-09	16.19308016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6191			24.3423	0.374075105	6.784184722	0	2.16001274	2.727151362	0	2.725695295	9.320105794	3.225045027	14.17222883	0.189153744	0.003598524	6.213403868	4.935606054	31.10987943	0.598866804	1.544651704	0	-2.44E-09	16.19308016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6191	NO																																																																																		0			24.3423	0.374075105	6.784184722	0	2.16001274	2.727151362	0	2.725695295	9.320105794	3.225045027	14.17222883	0.189153744	0.003598524	6.213403868	4.935606054	31.10987943	0.598866804	1.544651704	0	-2.44E-09	16.19308016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.6191
H7917_004_0	2010	4	N/A																															coin	coin	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	P	V	V	V	V	O	O											15.0278	0.2902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											15.318	NO	133.9456619	2.586362794	180.6201513	11.19531152	138.6040426	15.71473583	4.997174171	146.2548289	347.5751231	5.206483785	13.49143148	0	12.71694346	155.9613617	3173.782187	3544.970038	199.090411	172.754523	18.6748941	26.59017199	4.269458031	0	0	0	0	0	0	0	0	0												1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit/9b:  Ambulatory Surgical Center Services - $300/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $20/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $30/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												0	0	125	0	200	0.2	0.046903622	37.52595931	300	0	0.118246626	0	20	20	22.09321082	33.40328269	30	20	0	0.001655031	0.092797871	0	0	0	0	0	0	0	0	0											NO	0	0	120.6920534	0	193.1072854	0.193107285	0.045287155	36.27000075	289.660928	-2.67E-18	0.114171425	0	19.31072854	19.31072854	21.33179983	32.25208622	28.9660928	19.31072854	0	0.001597993	0.089599725	0	0	0	0	0	0	0	0	0												0	0	1.816618078	0	2.230454201	3.034629977	0.226307802	0.442055229	8.389911061	-1.39E-17	1.540335959	0	0.020464454	0.250977293	5.64187386	9.527723274	0.48057261	0.278001308	0	0.04249091	0.382542264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.305	1000	1.224	15.0278	0.290172986	1.816618078	0	2.230454201	3.034629977	0.226307802	0.442055229	8.389911061	-1.39E-17	1.540335959	0	0.020464454	0.250977293	5.64187386	9.527723274	0.48057261	0.278001308	0	0.04249091	0.382542264	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.623	YES	1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$175/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$175/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 30.0%/8b:  Outpatient Therapeutic Radiological Services - 30.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $20/service	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $35/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $45/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $45/visit/7h:  Psychiatric Services - Individual - $45/visit/7h:  Psychiatric Services - Group - $45/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $45/visit/9c:  Outpatient Substance Abuse Svcs - Group - $45/visit/7g:  Other Health Care Professional Services - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												4000	1.6698	0.0322	0.2734	0	0.1909	0.457	0.0341	0.0531	1.1705	0.2043	0.332	0	0.0022	0.05	0.9148	1.2749	0.0757	0.0517	0	0.0053	0.1442	0	0	0	0	0	0	0	0	0											6.9361	1000	0.367	16.6976	0.322414429	2.09006696	0	2.421369452	3.491674055	0.260391905	0.495116393	9.560363647	0.204303565	1.872342981	0	0.022693047	0.300980469	6.556647176	10.80264093	0.55627859	0.329722522	0	0.047801279	0.526709635	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.5591
H7917_005_0	2010	4	N/A																															coin	coin	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	P	V	V	V	V	O	O											15.0278	0.2902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											15.318	NO	124.8793266	2.411300519	204.6696938	12.22215212	124.9708162	15.09083148	4.799236756	169.9908705	353.0523493	8.802274708	15.67260075	0	11.96137713	220.6785116	3019.910327	3360.561059	187.163209	162.4050638	17.36518646	27.05983319	5.901013852	0	0	0	0	0	0	0	0	0												1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit/9b:  Ambulatory Surgical Center Services - $300/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $20/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $30/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												0	0	125	0	200	0.2	0.046903622	37.3977468	300	0	0.118246626	0	20	20	22.09294222	33.4165697	30	20	0	0.001618342	0.092797871	0	0	0	0	0	0	0	0	0											NO	0	0	120.7601225	0	193.216196	0.193216196	0.045312697	36.16103469	289.824294	3.94E-19	0.114235817	0	19.3216196	19.3216196	21.34357128	32.28311241	28.9824294	19.3216196	0	0.00156345	0.089650258	0	0	0	0	0	0	0	0	0												0	0	2.059661442	0	2.01219881	2.915793053	0.217466359	0.512253814	8.52692899	3.47E-18	1.790372346	0	0.019259432	0.355322188	5.371305943	9.040780868	0.452037041	0.261494072	0	0.042306689	0.529027415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.1062	1000	1.197	15.0278	0.290172986	2.059661442	0	2.01219881	2.915793053	0.217466359	0.512253814	8.52692899	3.47E-18	1.790372346	0	0.019259432	0.355322188	5.371305943	9.040780868	0.452037041	0.261494072	0	0.042306689	0.529027415	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.4242	YES	1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$175/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$175/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 30.0%/8b:  Outpatient Therapeutic Radiological Services - 30.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $20/service	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $35/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $45/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $45/visit/7h:  Psychiatric Services - Individual - $45/visit/7h:  Psychiatric Services - Group - $45/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $45/visit/9c:  Outpatient Substance Abuse Svcs - Group - $45/visit/7g:  Other Health Care Professional Services - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												4000	1.6698	0.0322	0.2739	0	0.1912	0.4594	0.0343	0.0531	1.1722	0.2046	0.3336	0	0.0022	0.0501	0.9161	1.2769	0.0758	0.0518	0	0.0053	0.1449	0	0	0	0	0	0	0	0	0											6.9474	1000	0.369	16.6976	0.322414429	2.333515694	0	2.203397081	3.375222702	0.251731649	0.56539981	9.6991167	0.204606433	2.123939217	0	0.021491327	0.40539949	6.287415358	10.31769356	0.52785525	0.313291959	0	0.047624518	0.673926683	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.3716
H7917_006_0	2010	4	N/A																															coin	coin	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	P	V	V	V	V	O	O											15.0278	0.2902	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											15.318	NO	124.8941977	2.411587665	187.3894443	12.38307193	145.3050158	16.23904753	5.176639707	191.5481402	352.1050433	8.789342229	14.88068017	0	12.79764898	227.6944166	3103.12094	3498.876928	200.3538621	173.8508435	17.01439193	26.36849127	6.747049005	0	0	0	0	0	0	0	0	0												1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit/9b:  Ambulatory Surgical Center Services - $300/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $20/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $30/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												0	0	125	0	200	0.2	0.046903622	37.31834604	300	0	0.118246626	0	20	20	22.08613507	33.3719816	30	20	0	0.001600674	0.092797871	0	0	0	0	0	0	0	0	0											NO	0	0	120.4764788	0	192.762366	0.192762366	0.045206265	35.99848707	289.1435491	-1.97E-19	0.113967497	0	19.2762366	19.2762366	21.28687826	32.16431066	28.91435491	19.2762366	0	0.001542748	0.089439686	0	0	0	0	0	0	0	0	0												0	0	1.881335034	0	2.334111554	3.130277223	0.234016548	0.574620271	8.484075154	-1.73E-18	1.695913878	0	0.020557542	0.365757621	5.504646474	9.378247038	0.482758556	0.279265833	0	0.040679946	0.603453943	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.0097	1000	1.314	15.0278	0.290172986	1.881335034	0	2.334111554	3.130277223	0.234016548	0.574620271	8.484075154	-1.73E-18	1.695913878	0	0.020557542	0.365757621	5.504646474	9.378247038	0.482758556	0.279265833	0	0.040679946	0.603453943	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3277	YES	1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$175/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$175/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 30.0%/8b:  Outpatient Therapeutic Radiological Services - 30.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $20/service	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $35/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $45/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $45/visit/7h:  Psychiatric Services - Individual - $45/visit/7h:  Psychiatric Services - Group - $45/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $45/visit/9c:  Outpatient Substance Abuse Svcs - Group - $45/visit/7g:  Other Health Care Professional Services - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												4000	1.6698	0.0322	0.2739	0	0.1913	0.455	0.034	0.0532	1.1726	0.2047	0.333	0	0.0022	0.0501	0.9159	1.2772	0.0758	0.0518	0	0.0052	0.1446	0	0	0	0	0	0	0	0	0											6.9427	1000	0.368	16.6976	0.322414429	2.155283606	0	2.525375677	3.58528145	0.268032231	0.627808646	9.656666585	0.204676902	2.028907363	0	0.022787868	0.41585217	6.420580937	10.65548031	0.558602878	0.33108156	0	0.045921042	0.748047273	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.2704
H7917_007_0	2010	4	N/A																															coin	coin	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	P	V	V	V	V	O	O											15.019	0.29	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											15.309	NO	106.4594722	2.055630723	214.1180921	10.15354137	121.8684276	17.24470715	5.464101664	185.5731113	357.3716547	6.797912258	14.38083411	0	12.52011102	159.1657384	3022.992753	3409.389417	195.9058836	169.9912482	16.66268646	27.2675498	5.40296945	0	0	0	0	0	0	0	0	0												1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $300/visit/9b:  Ambulatory Surgical Center Services - $300/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $20/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $30/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												0	0	125	0	200	0.2	0.046903622	37.31404969	300	0	0.118246626	0	20	20	22.1036356	33.36634206	30	20	0	0.001631416	0.092797871	0	0	0	0	0	0	0	0	0											NO	0	0	120.6028664	0	192.9645863	0.192964586	0.04525369	36.03114298	289.4468794	1.02E-18	0.114087057	0	19.29645863	19.29645863	21.3260945	32.19261196	28.94468794	19.29645863	0	0.001574028	0.089533514	0	0	0	0	0	0	0	0	0												0	0	2.151937972	0	1.959690893	3.327617781	0.247270761	0.557200942	8.620009188	6.94E-18	1.640667036	0	0.020132817	0.255944591	5.37238576	9.14642921	0.472536222	0.273352424	0	0.042919878	0.48374684	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	34.5718	1000	1.26	15.019	0.290002496	2.151937972	0	1.959690893	3.327617781	0.247270761	0.557200942	8.620009188	6.94E-18	1.640667036	0	0.020132817	0.255944591	5.37238576	9.14642921	0.472536222	0.273352424	0	0.042919878	0.48374684	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.8808	YES	1a:  Acute - 0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - 0/admit for 1-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$175/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$175/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $30/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 30.0%/8b:  Outpatient Therapeutic Radiological Services - 30.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $20/service	9d:  Cardiac Rehabilitation Services - $35/visit/3:  Rehab Services (CORF) - $35/day/5:  Partial Hospitalization - $45/day	7a:  Primary Care - $35/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $35/visit/18a:  Hearing Exams - $35/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $45/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $45/visit/7h:  Psychiatric Services - Individual - $45/visit/7h:  Psychiatric Services - Group - $45/visit	7c:  Occupational Therapy Services - $35/visit/7i:  Physical/Speech Therapy - $35/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $45/visit/9c:  Outpatient Substance Abuse Svcs - Group - $45/visit/7g:  Other Health Care Professional Services - $35/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												4000	1.6698	0.0322	0.278	0	0.1941	0.4708	0.035	0.0539	1.1899	0.2077	0.3377	0	0.0023	0.0508	0.9307	1.2964	0.077	0.0526	0	0.0055	0.1466	0	0	0	0	0	0	0	0	0											7.0309	1000	0.385	16.6888	0.322243939	2.429927881	0	2.153776577	3.798379987	0.282252461	0.611105033	9.809898887	0.207696331	1.978326943	0	0.022398418	0.306778144	6.303118116	10.44278741	0.549499413	0.325932546	0	0.048445912	0.630387201	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9117
H7917_008_0	2010	3	N/A																															D	D	coin	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	629.1908479	15.33741202	20.53717308	13.71990721	172.5058136	20.32220794	6.152615726	193.8773098	432.3560015	6.357592366	16.10345475	0	0.057934982	192.0536888	4156.449842	4342.046869	265.9588356	225.649133	23.01139776	32.65372615	5.258786004	0	0	842.3386355	334.6354204	0	47.24863594	0	0	0												1a:  Acute - $100/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 10.0%/11b:  Medical Supplies - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 10.0%/8b:  Outpatient Therapeutic Radiological Services - 10.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $10/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	0	0	100	0.1	0.023827889	23.01090039	100	0	0.058103925	0	0	10	10	24.93587037	10	10	0	0.00077915	0.046398935	0	0	0	10	0	10	0	0	0											NO	91.46583939	91.46583939	0	0	91.46583939	0.091465839	0.021794379	21.12715987	91.46583939	0	0.053145242	0	0	9.146583939	9.146583939	22.80780314	9.146583939	9.146583939	0	0.000712656	0.042439176	0	0	0	10	0	10	0	0	0												4.7958	0.116904105	0	0	1.314865753	1.858787807	0.13409244	0.341339743	3.295483716	0	0.855822005	0	0	0.146386265	3.168109781	8.252712518	0.202717901	0.171993228	0	0.023270886	0.223178544	0	0	0	0.27886285	0	0.039373863	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2197	0	2.322	4.7958	0.116904105	0	0	1.314865753	1.858787807	0.13409244	0.341339743	3.295483716	0	0.855822005	0	0	0.146386265	3.168109781	8.252712518	0.202717901	0.171993228	0	0.023270886	0.223178544	0	0	0	0.27886285	0	0.039373863	0	0	0	0	0	0	0	0	0	0	0	0	0	25.2197	YES	1a:  Acute - $200/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $25/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												2500	0.7518	0.0183	0.2078	0	0.097	0.3047	0.0227	0.0356	1.1703	0.1939	0.2231	0	0	0.0359	0.6009	1.0535	0.0435	0.0369	0	0.0023	0.1101	0	0	0	0.0311	0	0.0044	0	0	0											4.9439	0	1.759	5.5475	0.135229081	0.207798108	0	1.411847712	2.163508551	0.156817731	0.376900395	4.465792199	0.19386738	1.078945334	0	0	0.182301386	3.768975598	9.306243426	0.246243968	0.208922324	0	0.025548112	0.333289767	0	0	0	0.31001215	0	0.043771969	0	0	0	0	0	0	0	0	0	0	0	0	0	30.1636
H7917_009_0	2010	3	N/A																															D	D	coin	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	539.0056868	13.13902185	23.76118897	14.97749696	155.5379765	19.51537787	5.908911423	225.3567174	439.1692383	10.74960871	18.70683157	0	0.057654701	271.7549253	3954.934927	4116.17017	250.0256486	212.1308387	21.39803791	33.23636134	7.266322029	0	0	842.3386355	318.5059831	0	44.96624842	0	0	0												1a:  Acute - $100/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 10.0%/11b:  Medical Supplies - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 10.0%/8b:  Outpatient Therapeutic Radiological Services - 10.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $10/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	0	0	100	0.1	0.023827889	22.89376306	100	0	0.058103925	0	0	10	10	24.93640396	10	10	0	0.000727658	0.046398935	0	0	0	10	0	10	0	0	0											NO	92.09958483	92.09958483	5.84E-19	0	92.09958483	0.092099585	0.021945387	21.14917718	92.09958483	-1.29E-18	0.053513473	0	0	9.209958483	9.209958483	22.96632452	9.209958483	9.209958483	0	0.00067017	0.042733227	0	0	0	10	0	10	0	0	0												4.1368	0.100841538	1.39E-17	0	1.193748589	1.7973582	0.12967335	0.397175762	3.37060871	-1.39E-17	1.001067532	0	0	0.208570965	3.035398873	7.877774991	0.19189382	0.162809685	0	0.022274006	0.310513388	0	0	0	0.265421653	0	0.037471874	0	0	0	0	0	0	0	0	0	0	0	0	0	24.2395	0	2.052	4.1368	0.100841538	1.39E-17	0	1.193748589	1.7973582	0.12967335	0.397175762	3.37060871	-1.39E-17	1.001067532	0	0	0.208570965	3.035398873	7.877774991	0.19189382	0.162809685	0	0.022274006	0.310513388	0	0	0	0.265421653	0	0.037471874	0	0	0	0	0	0	0	0	0	0	0	0	0	24.2395	YES	1a:  Acute - $200/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $25/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												2500	0.7524	0.0183	0.208	0	0.0971	0.3061	0.0228	0.0356	1.1713	0.194	0.224	0	0	0.0359	0.6014	1.0544	0.0436	0.037	0	0.0023	0.1106	0	0	0	0.0312	0	0.0044	0	0	0											4.9504	0	1.767	4.8892	0.119181981	0.207973499	0	1.290812404	2.103474188	0.152504883	0.432774913	4.541904984	0.194031013	1.225046304	0	0	0.244516399	3.63676562	8.932195125	0.235456625	0.19976995	0	0.024552636	0.421114552	0	0	0	0.296632322	0	0.041878154	0	0	0	0	0	0	0	0	0	0	0	0	0	29.1898
H7917_010_0	2010	3	N/A																															D	D	coin	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	549.8365712	13.40303989	23.23827955	14.42728271	172.4258445	21.51101707	6.508269905	242.5593624	439.9657071	9.775755171	17.60579103	0	0.059689129	239.429799	4047.977095	4264.167564	266.0848918	225.7560837	20.89969077	33.53996068	8.285048631	0	0	842.3386355	325.2452725	0	45.95781105	0	0	0												1a:  Acute - $100/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 10.0%/11b:  Medical Supplies - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 10.0%/8b:  Outpatient Therapeutic Radiological Services - 10.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $10/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	0	0	100	0.1	0.023827889	22.84863987	100	0	0.058103925	0	0	10	10	24.93466818	10	10	0	0.000741197	0.046398935	0	0	0	10	0	10	0	0	0											NO	91.6793851	91.6793851	0	0	91.6793851	0.091679385	0.021845263	21.01100057	91.6793851	0	0.053269321	0	0	9.16793851	9.16793851	22.85995046	9.16793851	9.16793851	0	0.000679525	0.042538259	0	0	0	10	0	10	0	0	0												4.2007	0.102398538	0	0	1.317324617	1.972116818	0.142174865	0.424701242	3.361315458	0	0.93784853	0	0	0.18292314	3.092633758	8.123221605	0.203287494	0.172476491	0	0.022791242	0.352431542	0	0	0	0.271037727	0	0.038298176	0	0	0	0	0	0	0	0	0	0	0	0	0	24.9177	0	2.232	4.2007	0.102398538	0	0	1.317324617	1.972116818	0.142174865	0.424701242	3.361315458	0	0.93784853	0	0	0.18292314	3.092633758	8.123221605	0.203287494	0.172476491	0	0.022791242	0.352431542	0	0	0	0.271037727	0	0.038298176	0	0	0	0	0	0	0	0	0	0	0	0	0	24.9177	YES	1a:  Acute - $200/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $25/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												2500	0.7618	0.0186	0.2106	0	0.0983	0.3096	0.0231	0.036	1.1859	0.1964	0.2263	0	0	0.0364	0.6089	1.0675	0.0441	0.0374	0	0.0023	0.1117	0	0	0	0.0318	0	0.0045	0	0	0											5.0112	0	1.844	4.9625	0.120967343	0.210563037	0	1.415597002	2.281685664	0.165246608	0.460743652	4.547195878	0.196446948	1.164168737	0	0	0.21931614	3.70153778	9.190770627	0.247392712	0.20989696	0	0.025102369	0.464137498	0	0	0	0.302827994	0	0.042790205	0	0	0	0	0	0	0	0	0	0	0	0	0	29.9289
H7917_011_0	2010	3	N/A																															D	D	coin	coin	T	coin	coin	V	V	coin	coin	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	483.2809052	11.78065191	20.40418044	12.42322624	149.7302124	24.31603441	7.325956249	271.2281341	410.8821847	8.32222129	18.90283926	0	0.054486711	155.3015906	3835.790536	3975.472353	239.8304525	203.4808641	19.06018217	31.02430501	4.279028053	0	0	842.3386355	304.1414586	0	43.19163946	0	0	0												1a:  Acute - $100/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - 0/day for 1-100/2:  Non-Medicare Covered Stay - $0/day for 1-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 10.0%	11b:  Prosthetics Devices - 10.0%/11b:  Medical Supplies - 10.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $100/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 10.0%/8b:  Outpatient Therapeutic Radiological Services - 10.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $0/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $10/visit/3:  Rehab Services (CORF) - $10/day/5:  Partial Hospitalization - $10/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $25/visit/7b:  Chiropractic Services - $25/visit/7f:  Podiatry Services - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $10/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $10/visit/7h:  Psychiatric Services - Individual - $10/visit/7h:  Psychiatric Services - Group - $10/visit	7c:  Occupational Therapy Services - $10/visit/7i:  Physical/Speech Therapy - $10/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $10/visit/9c:  Outpatient Substance Abuse Svcs - Group - $10/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 10.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	0	0	100	0.1	0.023827889	22.7457934	100	0	0.058103925	0	0	10	10	24.93683821	10	10	0	0.000764655	0.046398935	0	0	0	10	0	10	0	0	0											NO	92.52979405	92.52979405	6.80E-19	0	92.52979405	0.092529794	0.022047897	21.09544457	92.52979405	0	0.053763442	0	0	9.252979405	9.252979405	23.07400504	9.252979405	9.252979405	0	0.000707534	0.042932839	0	0	0	10	0	10	0	0	0												3.7265	0.090838441	1.39E-17	0	1.154542143	2.249957656	0.161521929	0.476806506	3.168236994	0	1.016281697	0	0	0.119750202	2.957707569	7.644172425	0.184928853	0.156900354	0	0.021950752	0.183710824	0	0	0	0.253451215	0	0.035993033	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6032	0	1.881	3.7265	0.090838441	1.39E-17	0	1.154542143	2.249957656	0.161521929	0.476806506	3.168236994	0	1.016281697	0	0	0.119750202	2.957707569	7.644172425	0.184928853	0.156900354	0	0.021950752	0.183710824	0	0	0	0.253451215	0	0.035993033	0	0	0	0	0	0	0	0	0	0	0	0	0	23.6032	YES	1a:  Acute - $200/$0/day for 1-3/4-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-3/4-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$125/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$125/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $10/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $0/service	9d:  Cardiac Rehabilitation Services - $25/visit/3:  Rehab Services (CORF) - $25/day/5:  Partial Hospitalization - $25/day	7a:  Primary Care - $25/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $10/visit/18a:  Hearing Exams - $10/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $25/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $25/visit/7h:  Psychiatric Services - Individual - $25/visit/7h:  Psychiatric Services - Group - $25/visit	7c:  Occupational Therapy Services - $25/visit/7i:  Physical/Speech Therapy - $25/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $25/visit/9c:  Outpatient Substance Abuse Svcs - Group - $25/visit/7g:  Other Health Care Professional Services - $25/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $10/visit		18a:  Routine Hearing Test - $10/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												2500	0.7591	0.0185	0.2098	0	0.0979	0.3118	0.0231	0.0358	1.1817	0.1957	0.2252	0	0	0.0363	0.607	1.0638	0.0439	0.0373	0	0.0023	0.1112	0	0	0	0.0312	0	0.0044	0	0	0											4.9962	0	1.824	4.4855	0.109341355	0.209815864	0	1.252465813	2.561803817	0.184665508	0.512653031	4.349909374	0.195749866	1.24150417	0	0	0.156014064	3.564732954	8.7079333	0.228877566	0.194188037	0	0.02427733	0.294863007	0	0	0	0.284674348	0	0.040427082	0	0	0	0	0	0	0	0	0	0	0	0	0	28.5994
H7917_012_0	2010	3	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	865.9548486	26.75853813	203.6869055	12.6292988	158.7931631	17.7222092	5.635713699	171.2293938	391.8959664	5.852221328	14.7529229	0	13.43581455	175.9344881	3589.329658	3996.364958	229.5164211	194.7300654	21.02618322	29.95928177	4.809662809	0	0	842.3386355	0	0	40.7744973	0	0	0												1a:  Acute - $100/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-7/8-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$150/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$150/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 15.0%/8b:  Outpatient Therapeutic Radiological Services - 15.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $10/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service					18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	150	0	100	0.2	0.046903622	30.37544167	200	0	0.086854897	0	10	20	20	34.43561663	20	20	0	0.001461809	0.092797871	0	0	0	0	0	20	0	0	0											NO	89.08557225	89.08557225	133.6283584	0	89.08557225	0.178171145	0.04178436	27.16683499	178.1711445	2.37E-18	0.077375182	0	8.908557225	17.81711445	17.81711445	30.67716613	17.81711445	17.81711445	0	0.001302261	0.082669514	0	0	0	0	0	20	0	0	0												6.4287	0.198649974	2.268195568	0	1.178848317	3.157586297	0.235484688	0.387646724	5.818712739	1.39E-17	1.1415101	0	0.009974477	0.261220409	5.329291444	10.21642931	0.340776695	0.289127322	0	0.039014795	0.397612489	0	0	0	0	0	0.067957496	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7667	0	4.617	6.4287	0.198649974	2.268195568	0	1.178848317	3.157586297	0.235484688	0.387646724	5.818712739	1.39E-17	1.1415101	0	0.009974477	0.261220409	5.329291444	10.21642931	0.340776695	0.289127322	0	0.039014795	0.397612489	0	0	0	0	0	0.067957496	0	0	0	0	0	0	0	0	0	0	0	0	0	37.7667	YES	1a:  Acute - $200/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-7/8-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$200/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$200/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 25.0%/8b:  Outpatient Therapeutic Radiological Services - 25.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $10/service	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $45/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service					18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												3400	1.1023	0.0341	0.3065	0	0.0951	0.4483	0.0334	0.044	1.1478	0.1901	0.262	0	0.001	0.0422	0.734	1.2493	0.0598	0.0435	0	0.004	0.1413	0	0	0	0	0	0.0076	0	0	0											5.9463	0	1.633	7.531	0.232713146	2.574708554	0	1.273963622	3.605869776	0.26891652	0.431632553	6.966495788	0.190135931	1.403494425	0	0.011003746	0.303377791	6.063293772	11.46574983	0.400540318	0.332589288	0	0.04305394	0.538864072	0	0	0	0	0	0.075548426	0	0	0	0	0	0	0	0	0	0	0	0	0	43.713
H7917_013_0	2010	3	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	741.8330852	22.9230992	230.8077824	13.78692154	143.1741155	17.01860401	5.412483817	199.027983	398.0716179	9.895112133	17.137965	0	12.6507425	248.9463439	3415.309769	3788.475073	215.7664435	183.0640851	19.55200941	30.48939365	6.647622962	0	0	842.3386355	0	0	38.80484883	0	0	0												1a:  Acute - $100/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-7/8-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$150/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$150/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 15.0%/8b:  Outpatient Therapeutic Radiological Services - 15.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $10/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service					18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	150	0	100	0.2	0.046903622	30.25657219	200	0	0.086854897	0	10	20	20	34.69211754	20	20	0	0.00136832	0.092797871	0	0	0	0	0	20	0	0	0											NO	89.64563219	89.64563219	134.4684483	0	89.64563219	0.179291264	0.042047048	27.21127998	179.2912644	-7.01E-19	0.077861622	0	8.964563219	17.92912644	17.92912644	31.09996809	17.92912644	17.92912644	0	0.001226639	0.083189238	0	0	0	0	0	20	0	0	0												5.5418	0.17124631	2.586363696	0	1.069577841	3.05128703	0.227578967	0.451317181	5.947563641	-6.94E-18	1.33438975	0	0.009450698	0.371949206	5.102793389	9.818454489	0.322375321	0.273514927	0	0.037399481	0.553010689	0	0	0	0	0	0.064674748	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9348	0	4.257	5.5418	0.17124631	2.586363696	0	1.069577841	3.05128703	0.227578967	0.451317181	5.947563641	-6.94E-18	1.33438975	0	0.009450698	0.371949206	5.102793389	9.818454489	0.322375321	0.273514927	0	0.037399481	0.553010689	0	0	0	0	0	0.064674748	0	0	0	0	0	0	0	0	0	0	0	0	0	36.9348	YES	1a:  Acute - $200/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-7/8-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$200/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$200/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 25.0%/8b:  Outpatient Therapeutic Radiological Services - 25.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $10/service	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $45/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service					18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												3400	1.1034	0.0341	0.3068	0	0.0952	0.4504	0.0336	0.044	1.1489	0.1903	0.2631	0	0.001	0.0422	0.7347	1.2506	0.0598	0.0435	0	0.004	0.1419	0	0	0	0	0	0.0076	0	0	0											5.9552	0	1.641	6.6453	0.205342441	2.893173258	0	1.164785177	3.501678677	0.26117124	0.495353168	7.09645726	0.190319902	1.597442098	0	0.010480963	0.414147379	5.83749447	11.06908998	0.382196769	0.317018947	0	0.041441579	0.694905703	0	0	0	0	0	0.072279788	0	0	0	0	0	0	0	0	0	0	0	0	0	42.89
H7917_014_0	2010	3	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	756.7396226	23.38372039	239.5636586	13.28044435	158.7195509	18.75892354	5.961488169	214.2195177	398.7935529	8.998671135	16.12926429	0	13.46330454	219.334288	3495.657898	3924.676102	229.6252048	194.8223614	19.09665514	30.7729328	7.580050206	0	0	842.3386355	0	0	39.66054481	0	0	0												1a:  Acute - $100/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-7/8-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$150/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$150/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 15.0%/8b:  Outpatient Therapeutic Radiological Services - 15.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $10/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service					18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	150	0	100	0.2	0.046903622	30.2106438	200	0	0.086854897	0	10	20	20	34.55543017	20	20	0	0.001392236	0.092797871	0	0	0	0	0	20	0	0	0											NO	89.0633207	89.0633207	133.5949811	0	89.0633207	0.178126641	0.041773923	26.99360788	178.1266414	0	0.077355856	0	8.90633207	17.81266414	17.81266414	30.77621359	17.81266414	17.81266414	0	0.001239972	0.082648865	0	0	0	0	0	20	0	0	0												5.6165	0.173552649	2.667041869	0	1.178007522	3.341464046	0.249034747	0.481879805	5.919646349	0	1.247693043	0	0.009992388	0.325577334	5.188915008	10.06555583	0.340853054	0.289192108	0	0.038157574	0.626482549	0	0	0	0	0	0.066100908	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8256	0	4.635	5.6165	0.173552649	2.667041869	0	1.178007522	3.341464046	0.249034747	0.481879805	5.919646349	0	1.247693043	0	0.009992388	0.325577334	5.188915008	10.06555583	0.340853054	0.289192108	0	0.038157574	0.626482549	0	0	0	0	0	0.066100908	0	0	0	0	0	0	0	0	0	0	0	0	0	37.8256	YES	1a:  Acute - $200/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-7/8-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$200/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$200/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 25.0%/8b:  Outpatient Therapeutic Radiological Services - 25.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $10/service	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $45/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service					18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												3400	1.1186	0.0346	0.311	0	0.0965	0.4561	0.034	0.0446	1.1647	0.1929	0.2661	0	0.001	0.0428	0.7449	1.2679	0.0606	0.0441	0	0.0041	0.1435	0	0	0	0	0	0.0078	0	0	0											6.036	0	1.716	6.7351	0.208118947	2.978082165	0	1.274527714	3.797537917	0.283025309	0.526520968	7.084382576	0.192944308	1.513825765	0	0.01103686	0.368357396	5.93383834	11.33344849	0.401499408	0.333296023	0	0.042263008	0.769986134	0	0	0	0	0	0.073853945	0	0	0	0	0	0	0	0	0	0	0	0	0	43.8617
H7917_015_0	2010	3	N/A																															D	D	D	coin	T	coin	coin	V	V	coin	coin	O	V	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	NO	665.139114	20.55320826	225.124155	11.43569222	137.828016	21.20507035	6.710477922	239.5354969	372.4316774	7.660680039	17.31753431	0	12.13488822	142.2670192	3312.41898	3658.981718	206.9682213	175.5993539	17.41584265	28.46224082	3.915764849	0	0	842.3386355	0	0	37.27340169	0	0	0												1a:  Acute - $100/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-7/8-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$150/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$150/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $200/visit/9b:  Ambulatory Surgical Center Services - $200/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - 15.0%/8b:  Outpatient Therapeutic Radiological Services - 15.0%/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - $10/service/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $35/visit/7b:  Chiropractic Services - $35/visit/7f:  Podiatry Services - $35/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $0/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - $0/service	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service					18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	150	0	100	0.2	0.046903622	30.1058913	200	0	0.086854897	0	10	20	20	34.62685168	20	20	0	0.001438091	0.092797871	0	0	0	0	0	20	0	0	0											NO	90.23289652	90.23289652	135.3493448	0	90.23289652	0.180465793	0.042322496	27.23193343	180.465793	-9.06E-19	0.07837169	0	9.023289652	18.0465793	18.0465793	31.24481125	18.0465793	18.0465793	0	0.001297631	0.083734207	0	0	0	0	0	20	0	0	0												5.0015	0.154547959	2.539200572	0	1.036385092	3.826789836	0.284004177	0.543584559	5.6009315	-6.94E-18	1.357204425	0	0.009124718	0.213952754	4.981485985	9.527016094	0.311255702	0.264080639	0	0.036933494	0.327883464	0	0	0	0	0	0.062122336	0	0	0	0	0	0	0	0	0	0	0	0	0	36.078	0	3.897	5.0015	0.154547959	2.539200572	0	1.036385092	3.826789836	0.284004177	0.543584559	5.6009315	-6.94E-18	1.357204425	0	0.009124718	0.213952754	4.981485985	9.527016094	0.311255702	0.264080639	0	0.036933494	0.327883464	0	0	0	0	0	0.062122336	0	0	0	0	0	0	0	0	0	0	0	0	0	36.078	YES	1a:  Acute - $200/$0/day for 1-7/8-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $200/$0/day for 1-7/8-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$200/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$200/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $20/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $400/visit/9b:  Ambulatory Surgical Center Services - $400/visit	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - 25.0%/8b:  Outpatient Therapeutic Radiological Services - 25.0%/8b:  Outpatient X-Ray Services - $10/visit		12:  Renal Dialysis - $10/service	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $35/day	7a:  Primary Care - $30/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $35/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $35/visit/7h:  Psychiatric Services - Individual - $35/visit/7h:  Psychiatric Services - Group - $35/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $35/visit/9c:  Outpatient Substance Abuse Svcs - Group - $35/visit/7g:  Other Health Care Professional Services - $45/visit	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 10.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service					18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $0/visit		14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												3400	1.1142	0.0344	0.3098	0	0.0961	0.4593	0.0341	0.0444	1.1602	0.1922	0.2647	0	0.001	0.0426	0.7425	1.263	0.0604	0.0439	0	0.0041	0.1427	0	0	0	0	0	0.0077	0	0	0											6.0175	0	1.697	6.1157	0.188978481	2.849019107	0	1.132526155	4.286043785	0.318087585	0.587988979	6.761092662	0.192186426	1.621931687	0	0.010165086	0.256564777	5.724002451	10.79003614	0.371663837	0.308011315	0	0.041066342	0.470622274	0	0	0	0	0	0.069775304	0	0	0	0	0	0	0	0	0	0	0	0	0	42.0954
H7917_024_0	2010	6	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	290.6652006	5.640670748	36.29669936	23.03734708	11.43032014	32.51147196	9.539617775	10.94963951	66.72610107	13.61777745	27.55485876	0	0.088821908	16.00121799	62.20440511	167.7412909	2.472114064	3.29054167	33.84628625	50.5380318	10.71771448	0.082293062	0	1192.294623	0	0	0	0	0	36000												Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	"Standard Medicare Cost Sharing, Worldwide Coverage - $50/visit"	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	"Standard Medicare Cost Sharing, routine physical exam - $0/visit"	Standard Medicare Cost Sharing											0.084302641	0.084302641	0.199058977	0	0.233	0.233	0.233	0.232968312	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.084302641	0.084302641	0.199058977	0	0.233	0.233	0.233	0.232968312	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.5038	0.475523439	7.225183854	0	2.663264594	7.575172966	2.222730941	2.55091903	15.54718155	3.172942147	6.420282091	0	0.020695504	3.728283793	14.49362639	39.08372078	0.576002577	0.766696209	7.886184696	11.77536141	2.497227473	0.019174283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.204	0	0	24.5038	0.475523439	7.225183854	0	2.663264594	7.575172966	2.222730941	2.55091903	15.54718155	3.172942147	6.420282091	0	0.020695504	3.728283793	14.49362639	39.08372078	0.576002577	0.766696209	7.886184696	11.77536141	2.497227473	0.019174283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	153.204	NO	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	"Standard Medicare Cost Sharing, Worldwide Coverage - $50/visit"	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	Standard Medicare Cost Sharing	"Standard Medicare Cost Sharing, routine physical exam - $0/visit"	Standard Medicare Cost Sharing												2.828	0.0549	0.8182	0	0.2695	0.7678	0.2253	0.2811	1.7684	0.6514	0.7626	0	0.0028	0.5471	1.8236	4.8991	0.0758	0.1016	1.145	1.515	0.374	0.0029	0	0	0	0	0	0	0	0											18.9141	0	0	27.3319	0.530404225	8.043386804	0	2.932764691	8.342988178	2.448025682	2.832031615	17.31554677	3.824319749	7.18289574	0	0.023469909	4.275365726	16.31719156	43.98282413	0.651840799	0.868297721	9.03118502	13.29038602	2.871246928	0.022049302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	172.1181
H7917_801_0	2010	3	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	222.8851564	4.324288206	33.86941063	20.93977575	10.67773734	23.46680671	7.364931118	11.87238836	41.20754951	10.25903234	14.57259015	0	0.039654228	14.59334697	44.04979548	107.8887537	1.197099044	2.200383573	23.34956196	26.85703188	6.763427726	0	0	0	0	0	0	0	0	0												Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share											0.084162691	0.084162691	0.198861825	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.084162691	0.084162691	0.198861825	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												18.7586	0.363943733	6.735332814	0	2.487912799	5.467765963	1.716028951	2.766266487	9.601359037	2.390354536	3.395413505	0	0.009239435	3.400249843	10.26360235	25.13807962	0.278924077	0.512689372	5.440447937	6.257688428	1.57587866	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5598	0	0	18.7586	0.363943733	6.735332814	0	2.487912799	5.467765963	1.716028951	2.766266487	9.601359037	2.390354536	3.395413505	0	0.009239435	3.400249843	10.26360235	25.13807962	0.278924077	0.512689372	5.440447937	6.257688428	1.57587866	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5598	NO	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share												2.1667	0.042	0.7541	0	0.2523	0.5544	0.174	0.3047	1.0973	0.4771	0.3999	0	0.0013	0.5272	1.3011	3.1499	0.0377	0.0694	0.8005	0.8101	0.2339	0	0	0	0	0	0	0	0	0											13.1536	0	0	20.9253	0.405981345	7.489442764	0	2.740163027	6.022144399	1.890017642	3.070994619	10.69864964	2.867432532	3.795333027	0	0.010493698	3.927494237	11.56473449	28.28793718	0.316669751	0.582069564	6.240988176	7.06774989	1.809735728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.7134
H7917_802_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	222.8851564	4.324288206	33.86941063	20.93977575	10.67773734	23.46680671	7.364931118	11.87238836	41.20754951	10.25903234	14.57259015	0	0.039654228	14.59334697	44.04979548	107.8887537	1.197099044	2.200383573	23.34956196	26.85703188	6.763427726	0	0	0	0	0	0	0	0	0												Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share											0.084162691	0.084162691	0.198861825	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.084162691	0.084162691	0.198861825	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												18.7586	0.363943733	6.735332814	0	2.487912799	5.467765963	1.716028951	2.766266487	9.601359037	2.390354536	3.395413505	0	0.009239435	3.400249843	10.26360235	25.13807962	0.278924077	0.512689372	5.440447937	6.257688428	1.57587866	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5598	0	0	18.7586	0.363943733	6.735332814	0	2.487912799	5.467765963	1.716028951	2.766266487	9.601359037	2.390354536	3.395413505	0	0.009239435	3.400249843	10.26360235	25.13807962	0.278924077	0.512689372	5.440447937	6.257688428	1.57587866	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5598	NO	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share												2.1667	0.042	0.7541	0	0.2523	0.5544	0.174	0.3047	1.0973	0.4771	0.3999	0	0.0013	0.5272	1.3011	3.1499	0.0377	0.0694	0.8005	0.8101	0.2339	0	0	0	0	0	0	0	0	0											13.1536	0	0	20.9253	0.405981345	7.489442764	0	2.740163027	6.022144399	1.890017642	3.070994619	10.69864964	2.867432532	3.795333027	0	0.010493698	3.927494237	11.56473449	28.28793718	0.316669751	0.582069564	6.240988176	7.06774989	1.809735728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.7134
H7917_803_0	2010	2	N/A																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	222.8851564	4.324288206	33.86941063	20.93977575	10.67773734	23.46680671	7.364931118	11.87238836	41.20754951	10.25903234	14.57259015	0	0.039654228	14.59334697	44.04979548	107.8887537	1.197099044	2.200383573	23.34956196	26.85703188	6.763427726	0	0	0	0	0	0	0	0	0												Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share											0.084162691	0.084162691	0.198861825	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.084162691	0.084162691	0.198861825	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												18.7586	0.363943733	6.735332814	0	2.487912799	5.467765963	1.716028951	2.766266487	9.601359037	2.390354536	3.395413505	0	0.009239435	3.400249843	10.26360235	25.13807962	0.278924077	0.512689372	5.440447937	6.257688428	1.57587866	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5598	0	0	18.7586	0.363943733	6.735332814	0	2.487912799	5.467765963	1.716028951	2.766266487	9.601359037	2.390354536	3.395413505	0	0.009239435	3.400249843	10.26360235	25.13807962	0.278924077	0.512689372	5.440447937	6.257688428	1.57587866	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.5598	NO	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share	Standard Medicare Cost Share												2.1667	0.042	0.7541	0	0.2523	0.5544	0.174	0.3047	1.0973	0.4771	0.3999	0	0.0013	0.5272	1.3011	3.1499	0.0377	0.0694	0.8005	0.8101	0.2339	0	0	0	0	0	0	0	0	0											13.1536	0	0	20.9253	0.405981345	7.489442764	0	2.740163027	6.022144399	1.890017642	3.070994619	10.69864964	2.867432532	3.795333027	0	0.010493698	3.927494237	11.56473449	28.28793718	0.316669751	0.582069564	6.240988176	7.06774989	1.809735728	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.7134
H7949_801_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	362.5216047	4.897127118	26.76879318	395.3347586	13.69546989	9.018205801	11.01207707	28.18986332	46.44725351	37.71421124	72.17451039	0	0.344322243	15.60329347	33.32859348	176.3453231	1.608853811	6.856268914	0	0	26.89878757	13.85075402	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.06976311	0.06976311	0.145170245	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06976311	0.06976311	0.145170245	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												25.2906	0.341638817	3.886032252	0	3.191044485	2.101241952	2.565813957	6.568238155	10.82221007	8.787411218	16.81666092	0	0.080227083	3.635567379	7.76556228	41.08846027	0.374862938	1.597510657	0	0	6.267417503	3.227225686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.4078	0	0	25.2906	0.341638817	3.886032252	0	3.191044485	2.101241952	2.565813957	6.568238155	10.82221007	8.787411218	16.81666092	0	0.080227083	3.635567379	7.76556228	41.08846027	0.374862938	1.597510657	0	0	6.267417503	3.227225686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.4078	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.2906	0.341638817	3.886032252	0	3.191044485	2.101241952	2.565813957	6.568238155	10.82221007	8.787411218	16.81666092	0	0.080227083	3.635567379	7.76556228	41.08846027	0.374862938	1.597510657	0	0	6.267417503	3.227225686	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.4078
H7949_803_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	345.0170477	5.663382535	28.89304104	393.2101258	13.63980791	8.741637169	12.50142386	27.15796995	45.49255351	36.37453234	74.0441783	0	0.354345986	16.66191083	32.1394641	171.1077579	1.529783134	6.72050302	0	0	27.46983514	13.93284058	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.06976311	0.06976311	0.145170245	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.06976311	0.06976311	0.145170245	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												24.0695	0.395095178	4.194409833	0	3.178075243	2.03680146	2.912831758	6.327806998	10.59976497	8.475266035	17.25229354	0	0.082562615	3.882225224	7.488495134	39.8681076	0.35643947	1.565877204	0	0	6.400471588	3.246351856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.3323	0	0	24.0695	0.395095178	4.194409833	0	3.178075243	2.03680146	2.912831758	6.327806998	10.59976497	8.475266035	17.25229354	0	0.082562615	3.882225224	7.488495134	39.8681076	0.35643947	1.565877204	0	0	6.400471588	3.246351856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.3323	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	24.0695	0.395095178	4.194409833	0	3.178075243	2.03680146	2.912831758	6.327806998	10.59976497	8.475266035	17.25229354	0	0.082562615	3.882225224	7.488495134	39.8681076	0.35643947	1.565877204	0	0	6.400471588	3.246351856	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.3323
H7949_804_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	365.4365253	4.866745674	24.56062545	351.939411	15.03397253	9.257486197	10.72189837	28.02974377	51.50381045	39.14334957	74.4748667	0	0.27081425	13.63299179	34.81752002	183.0055765	1.732844411	6.990364813	0	0	32.13049238	13.21789557	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.069723926	0.069723926	0.145098039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.069723926	0.069723926	0.145098039	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												25.4797	0.339328613	3.563698599	0	3.502915599	2.156994284	2.49820232	6.5309303	12.00038783	9.12040045	17.35264394	0	0.06309972	3.176487088	8.112482166	42.64029933	0.403752748	1.628755001	0	0	7.486404726	3.079769668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.1362	0	0	25.4797	0.339328613	3.563698599	0	3.502915599	2.156994284	2.49820232	6.5309303	12.00038783	9.12040045	17.35264394	0	0.06309972	3.176487088	8.112482166	42.64029933	0.403752748	1.628755001	0	0	7.486404726	3.079769668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.1362	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	25.4797	0.339328613	3.563698599	0	3.502915599	2.156994284	2.49820232	6.5309303	12.00038783	9.12040045	17.35264394	0	0.06309972	3.176487088	8.112482166	42.64029933	0.403752748	1.628755001	0	0	7.486404726	3.079769668	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	149.1362
H8050_001_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	coin	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	820.3924752	18.64217738	690.0770476	23.33996118	236.7376739	13.54154349	3.620339441	314.5307155	29.65027096	1072.994984	761.5127222	0	0.042895878	1069.45884	556.423197	4206.559715	148.0010781	566.7733171	16.7649233	27.0037918	6.693121819	0	0	0	330.9918401	0	134.7609635	0	0	0											3200	1a:  Acute - $100/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $100/$0/day for 1-5/6-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$75/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$75/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $100/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $10/visit/8a:  Outpatient Lab Services - $10/visit	8b:  Outpatient Diagnostic Radiological Services - $20/visit/8b:  Outpatient Therapeutic Radiological Services - $20/visit/8b:  Outpatient X-Ray Services - $20/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $20/visit/3:  Rehab Services (CORF) - $20/day/5:  Partial Hospitalization - $20/day	7a:  Primary Care - $0/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $20/visit/7b:  Chiropractic Services - $20/visit/7f:  Podiatry Services - $20/visit/17a:  Vision Exams - $20/visit/18a:  Hearing Exams - $20/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $20/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $20/visit/7h:  Psychiatric Services - Individual - $20/visit/7h:  Psychiatric Services - Group - $20/visit	7c:  Occupational Therapy Services - $20/visit/7i:  Physical/Speech Therapy - $20/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $20/visit/9c:  Outpatient Substance Abuse Svcs - Group - $20/visit/7g:  Other Health Care Professional Services - $20/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $20/visit		18a:  Routine Hearing Test - $20/visit/18a:  Fitting for Hearing Aid - $20/visit	18b:  Hearing Aids - $0/service	14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												100	100	75	0	100	0.2	0.049612049	43.41838764	0.2	10	20	0	0.2	22.12829829	20	20	20	20	0	0.004850354	0.2	0	0	0	20	0	20	0	0	0											YES	90.0632636	90.0632636	67.5474477	0	90.0632636	0.180126527	0.04468223	39.11952098	0.180126527	9.00632636	18.01265272	0	0.180126527	19.92946762	18.01265272	18.01265272	18.01265272	18.01265272	-3.31E-18	0.004368387	0.180126527	0	0	0	20	0	20	0	0	0											5000	6.1573	0.139914611	3.88441194	0	1.776780627	2.439191201	0.16176484	1.025357577	5.340800339	0.805311917	1.143072017	0	0.007726686	1.776145444	0.835221484	6.314274941	0.222157668	0.850757578	-5.55E-17	0.11796301	1.205608789	0	0	0	0.551653067	0	0.224601606	0	0	0	0	0	0	0	0	0	0	0	0	0	34.98	0	3.773267713	6.1573	0.139914611	3.88441194	0	1.776780627	2.439191201	0.16176484	1.025357577	5.340800339	0.805311917	1.143072017	0	0.007726686	1.776145444	0.835221484	6.314274941	0.222157668	0.850757578	-5.55E-17	0.11796301	1.205608789	0	0	0	0.551653067	0	0.224601606	0	0	0	0	0	0	0	0	0	0	0	0	0	34.98	NO	1a:  Acute - 30.0% for 1-5/6-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-5/6-190/1b:  Non-Medicare Covered Stay - 30.0%	2:  Skilled Nursing Services - 30.0% for 1-100/2:  Non-Medicare Covered Stay - 30.0% for 1-100	6:  Home Health Services - 30.0%	10a:  Ambulance - 30.0%	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%		9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%/9b:  Ambulatory Surgical Center Services - 30.0%	8a:  Outpatient Diagnostic Procedures/Tests - 30.0%/8a:  Outpatient Lab Services - 30.0%	8b:  Outpatient Diagnostic Radiological Services - 30.0%/8b:  Outpatient Therapeutic Radiological Services - 30.0%/8b:  Outpatient X-Ray Services - 30.0%		12:  Renal Dialysis - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%	9d:  Cardiac Rehabilitation Services - 30.0%/3:  Rehab Services (CORF) - 30.0%/5:  Partial Hospitalization - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/18a:  Hearing Exams - 30.0%/:  Routine Exams - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/18a:  Hearing Exams - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 30.0%/7i:  Physical/Speech Therapy - 30.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 30.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 30.0%"	9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%			17a:  Routine Eye Exams - 30.0%		18a:  Routine Hearing Test - 30.0%/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service														6.4963	0.074	1.3115	0.8082	0.1988	0.3529	0.0872	0	0.9606	0.1465	0.4551	0	0.0014	0.5592	0.8004	1.9751	0.0315	0.1248	0.6557	0.8218	0.1784	0.0314	0	0	0.1131	0	0.0296	0	0	0											16.2137	500	9.882887706	12.6536	0.213921318	5.195864553	0.808195445	1.975569319	2.792046161	0.249007319	1.025357577	6.301398685	0.951819908	1.598186263	0	0.00913723	2.335389423	1.63559203	8.289386213	0.253705819	0.975553427	0.655744788	0.939727777	1.384040585	0.031440056	0	0	0.66479271	0	0.254230432	0	0	0	0	0	0	0	0	0	0	0	0	0	51.1937
H8050_005_0	2010	6	N/A																															D	D	D	coin	T	coin	coin	V	coin	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	1058.401747	28.22262258	697.4182928	23.58825864	235.5940757	13.68560246	3.658853691	281.2194678	29.96569938	1079.882017	755.0342445	0	0.043352217	1074.029179	3851.649243	4029.85838	141.2658044	540.9804416	16.54406854	26.97719525	6.764325243	0	0	0	0	0	0	0	37.03537117	0											5000	1a:  Acute - $175/$0/day for 1-10/11-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-10/11-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$110/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$110/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $200/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $45/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $12/visit/8a:  Outpatient Lab Services - $12/visit	8b:  Outpatient Diagnostic Radiological Services - $45/visit/8b:  Outpatient Therapeutic Radiological Services - $45/visit/8b:  Outpatient X-Ray Services - $45/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $45/visit/3:  Rehab Services (CORF) - $45/day/5:  Partial Hospitalization - $40/day	7a:  Primary Care - $15/visit/17a:  Vision Exams - $45/visit/18a:  Hearing Exams - $45/visit/:  Routine Exams - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $45/visit/7b:  Chiropractic Services - $45/visit/7f:  Podiatry Services - $45/visit/17a:  Vision Exams - $45/visit/18a:  Hearing Exams - $45/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $40/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $40/visit/7h:  Psychiatric Services - Individual - $40/visit/7h:  Psychiatric Services - Group - $40/visit	7c:  Occupational Therapy Services - $45/visit/7i:  Physical/Speech Therapy - $45/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $45/visit/9c:  Outpatient Substance Abuse Svcs - Group - $45/visit/7g:  Other Health Care Professional Services - $45/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $15/visit/14c:  Routine Exams - $15/visit												175	175	110	0	200	0.2	0.049612049	46.73879049	0.2	12	45	0	0.2	34.24284675	19.13667993	42.74992812	40	45	0	0.008121874	0.2	0	0	0	0	0	0	0	15	0											NO	156.6019321	156.6019321	98.4355002	0	178.9736367	0.178973637	0.044396244	41.84174408	0.178973637	10.7384182	40.26906826	0	0.178973637	30.64283407	17.12480601	38.25555053	35.79472734	40.26906826	0	0.007268007	0.178973637	0	0	0	0	0	0	0	15	0												13.8123	0.368309769	5.720893208	0	3.51376071	2.449362043	0.16243936	0.980559417	5.363070194	0.966352059	2.533710461	0	0.007758904	2.742608161	5.496562175	12.84703757	0.421380913	1.815398194	0	0.196070441	1.210635889	0	0	0	0	0	0	0	0.046294214	0	0	0	0	0	0	0	0	0	0	0	60.6545	0	7.12	13.8123	0.368309769	5.720893208	0	3.51376071	2.449362043	0.16243936	0.980559417	5.363070194	0.966352059	2.533710461	0	0.007758904	2.742608161	5.496562175	12.84703757	0.421380913	1.815398194	0	0.196070441	1.210635889	0	0	0	0	0	0	0	0.046294214	0	0	0	0	0	0	0	0	0	0	0	60.6545	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.8123	0.368309769	5.720893208	0	3.51376071	2.449362043	0.16243936	0.980559417	5.363070194	0.966352059	2.533710461	0	0.007758904	2.742608161	5.496562175	12.84703757	0.421380913	1.815398194	0	0.196070441	1.210635889	0	0	0	0	0	0	0	0.046294214	0	0	0	0	0	0	0	0	0	0	0	60.6545
H8050_006_0	2010	5	N/A																															D	D	D	coin	T	coin	coin	V	coin	P	P	O	coin	P	V	V	V	V	coin	coin	coin	O	T	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	0	0	0	0	0											0	YES	802.9373162	18.2455353	675.3945572	22.84336626	230.0456971	13.25342554	3.543310942	307.8385726	29.01941413	1045.78048	737.7291117	0	0.0419832	1044.129425	3850.380631	4040.923738	141.633183	542.3873257	16.16322015	26.21826918	6.550714972	0	0	0	0	0	0	0	0	0											3200	1a:  Acute - $175/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - $175/$0/day for 1-5/6-190/1b:  Non-Medicare Covered Stay - $0/day	2:  Skilled Nursing Services - $0/$110/day for 1-20/21-100/2:  Non-Medicare Covered Stay - $0/$110/day for 1-20/21-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $150/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - $0/service	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $40/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - $12/visit/8a:  Outpatient Lab Services - $12/visit	8b:  Outpatient Diagnostic Radiological Services - $30/visit/8b:  Outpatient Therapeutic Radiological Services - $30/visit/8b:  Outpatient X-Ray Services - $30/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $30/visit/3:  Rehab Services (CORF) - $30/day/5:  Partial Hospitalization - $30/day	7a:  Primary Care - $10/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - $30/visit/:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7d:  Physician Specialist Services - $30/visit/7b:  Chiropractic Services - $30/visit/7f:  Podiatry Services - $30/visit/17a:  Vision Exams - $30/visit/18a:  Hearing Exams - $30/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $30/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $30/visit/7h:  Psychiatric Services - Individual - $30/visit/7h:  Psychiatric Services - Group - $30/visit	7c:  Occupational Therapy Services - $30/visit/7i:  Physical/Speech Therapy - $30/visit		9c:  Outpatient Substance Abuse Svcs - Individual - $30/visit/9c:  Outpatient Substance Abuse Svcs - Group - $30/visit/7g:  Other Health Care Professional Services - $30/visit	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service							14b:  Other Immunizations - $0/visit/:  Routine Exams - $0/visit/14c:  Routine Exams - $0/visit												175	175	110	0	150	0.2	0.049612049	43.41838764	0.2	12	30	0	0.2	26.99382078	12.76586956	29.95220592	30	30	0	0.007149635	0.2	0	0	0	0	0	0	0	0	0											YES	145.4255602	145.4255602	91.4103521	0	124.6504801	0.16620064	0.041227771	36.1071873	0.16620064	9.97203841	24.93009603	0	0.16620064	22.43195147	10.60847847	24.89037899	24.93009603	24.93009603	0	0.005941369	0.16620064	0	0	0	0	0	0	0	0	0											5000	9.7306	0.221113933	5.144837857	0	2.389608883	2.202727809	0.146082813	0.926265417	4.823045206	0.869046926	1.532638133	0	0.006977635	1.951821716	3.403890002	8.381676942	0.294244071	1.126814009	0	0.155772419	1.088733022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3959	0	9.027755579	9.7306	0.221113933	5.144837857	0	2.389608883	2.202727809	0.146082813	0.926265417	4.823045206	0.869046926	1.532638133	0	0.006977635	1.951821716	3.403890002	8.381676942	0.294244071	1.126814009	0	0.155772419	1.088733022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	44.3959	NO	1a:  Acute - 30.0% for 1-5/6-90/1a:  Additional Days - 30.0% for 91-999	1b:  Psych - 30.0% for 1-5/6-190/1b:  Non-Medicare Covered Stay - 30.0%	2:  Skilled Nursing Services - 30.0% for 1-100/2:  Non-Medicare Covered Stay - 30.0% for 1-100	6:  Home Health Services - 30.0%	10a:  Ambulance - 30.0%	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%		9a:  Outpatient Hospital Services (Hospital Surgery) - 30.0%/9b:  Ambulatory Surgical Center Services - 30.0%	8a:  Outpatient Diagnostic Procedures/Tests - 30.0%/8a:  Outpatient Lab Services - 30.0%	8b:  Outpatient Diagnostic Radiological Services - 30.0%/8b:  Outpatient Therapeutic Radiological Services - 30.0%/8b:  Outpatient X-Ray Services - 30.0%		12:  Renal Dialysis - 30.0%/14i:  Diabetes Monitoring - 30.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 30.0%	9d:  Cardiac Rehabilitation Services - 30.0%/3:  Rehab Services (CORF) - 30.0%/5:  Partial Hospitalization - 30.0%	7a:  Primary Care - 30.0%/17a:  Vision Exams - 30.0%/18a:  Hearing Exams - 30.0%/:  Routine Exams - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%	7d:  Physician Specialist Services - 30.0%/7b:  Chiropractic Services - 30.0%/7f:  Podiatry Services - 30.0%/17a:  Vision Exams - 30.0%/18a:  Hearing Exams - 30.0%/14d:  Pap Smears and Pelvic Exams Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14f:  Colorectal Screening - 30.0%/14g:  Bone Mass Measurement - 30.0%/14b:  Immunizations (Hepatitis B) - 30.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 30.0%/7i:  Physical/Speech Therapy - 30.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 30.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 30.0%"	9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - 30.0%	15:  Medicare Part B Rx Drugs - Chemo - 30.0%/Medicare Part B Rx Drugs - Non-Chemo - 30.0%	13a:  Blood - 30.0%																				8.1279	0.0926	1.6408	1.0112	0.2487	0.4415	0.1092	0	1.2019	0.1833	0.5694	0	0.0018	0.6997	1.0684	2.6476	0.0395	0.1561	0.8387	1.0327	0.2232	0.0393	0	0	0	0	0	0	0	0											20.3736	1500	9.882887706	17.8586	0.313708253	6.785676485	1.011182784	2.638325581	2.644206245	0.255237218	0.926265417	6.024908587	1.05235204	2.10205942	0	0.008742453	2.651526084	4.472291578	11.02928146	0.333715893	1.282953735	0.838688959	1.188507531	1.311979962	0.039336578	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.7695
H8105_001_0	2010	5	N/A																															A	coin	D	coin	T	coin	coin	V	V	coin	V	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	248.4749702	2.742889927	842.1983218	18.53183882	124.5892388	10.41350179	2.574711479	195.8119028	374.9413011	10.35471577	216.9375639	0	0.051126577	1218.12161	0.435537068	4742.57238	157.3936106	602.7422228	25.71834565	76.59143699	6.358285703	0	0	0	0	0	0	0	0	0												1a:  Acute - $400/$0/admit for 1-90/1a:  Additional Days - $0/admit for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $75/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $15/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $15/visit/7i:  Physical/Speech Therapy - $15/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $15/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $15/visit/17a:  Vision Exams - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - $15/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $15/visit/7h:  Psychiatric Services - Individual - $15/visit/7h:  Psychiatric Services - Group - $15/visit	7c:  Occupational Therapy Services - $15/visit/7i:  Physical/Speech Therapy - $15/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $15/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $15/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit												400	0.078066914	85	0	75	0.2	0.2	25.94124293	97.95031435	0	100	0	0.2	24.28917505	15	15	15	15	0	15.04690587	0.2	0	0	0	0	0	0	0	0	0											NO	378.943982	0.073957469	80.52559617	0	71.05199662	0.189471991	0.189471991	24.57569474	92.79420539	0	94.73599549	0	0.189471991	23.01059178	14.21039932	14.21039932	14.21039932	14.21039932	0	14.25483606	0.189471991	0	0	0	0	0	0	0	0	0												7.8465	0.202857196	5.651543497	0	0.737692848	1.973066918	0.48783571	0.401017796	2.899365008	0	1.712649673	0	0.009687054	2.335808259	0.000515763	5.616153946	0.186385505	0.713767306	0	0.090983198	1.204717052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0706		1.782	7.8465	0.202857196	5.651543497	0	0.737692848	1.973066918	0.48783571	0.401017796	2.899365008	0	1.712649673	0	0.009687054	2.335808259	0.000515763	5.616153946	0.186385505	0.713767306	0	0.090983198	1.204717052	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.0706	YES	1a:  Acute - 20.0% for 1-90/1a:  Additional Days - 20.0% for 91-999	1b:  Psych - 30.0% for 1-190	2:  Skilled Nursing Services - 20.0% for 1-100/2:  Non-Medicare Covered Stay - 20.0% for 1-100	6:  Home Health Services - 20.0%	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - 30.0%/3:  Rehab Services (CORF) - 30.0%/5:  Partial Hospitalization - 30.0%/7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - 20.0%/17a:  Vision Exams - 20.0%/18a:  Hearing Exams - 20.0%/14c:  Routine Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/18a:  Hearing Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - 20.0%/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14c:  Routine Exams - 20.0%												4000	4.1987	0.0717	0.8476	0.5224	0.1296	0.3421	0.0846	0.0483	0.621	0.096	0.2981	0	0.0009	0.4082	0.4348	1.3095	0.0306	0.0825	0.425	0.5396	0.1171	0.0203	0	0	0	0	0	0	0.012	0											10.6406		7.428	12.0452	0.274605413	6.499163856	0.522354301	0.867267251	2.315153675	0.572415779	0.449323631	3.520367048	0.09596471	2.010755642	0	0.01061098	2.743962541	0.435317492	6.925685358	0.216970889	0.796251964	0.425013273	0.630543916	1.321856196	0.020320392	0	0	0	0	0	0	0.011995544	0	0	0	0	0	0	0	0	0	0	0	42.7111
H8130_001_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	595.1103773	7.142739398	90.01743178	0	24.72035173	8.354486982	7.556522143	24.21527095	105.6887305	8.582713507	47.12611202	0	1.126120249	40.86778125	120.6605607	337.4401719	6.270986187	6.594499888	120.0413539	147.0415929	18.46670105	2.05916612	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												45.2678	0.543321451	14.36040992	0	5.759841954	1.946595467	1.760669659	5.64215813	24.62547422	1.999772247	10.9803841	0	0.262386018	9.522193031	28.11391065	78.62356006	1.461139782	1.536518474	27.96963546	34.26069115	4.302741344	0.479785706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	299.419	0	0	45.2678	0.543321451	14.36040992	0	5.759841954	1.946595467	1.760669659	5.64215813	24.62547422	1.999772247	10.9803841	0	0.262386018	9.522193031	28.11391065	78.62356006	1.461139782	1.536518474	27.96963546	34.26069115	4.302741344	0.479785706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	299.419	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	45.2678	0.543321451	14.36040992	0	5.759841954	1.946595467	1.760669659	5.64215813	24.62547422	1.999772247	10.9803841	0	0.262386018	9.522193031	28.11391065	78.62356006	1.461139782	1.536518474	27.96963546	34.26069115	4.302741344	0.479785706	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	299.419
H8130_002_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	0	0	561.8718563	0	273.6269583	9.875967506	6.642953134	218.0651323	355.393673	0	620.9298955	0	0.710177917	256.8508638	93.177368	0	262.0082734	0	2229.58216	106.0157173	12.05558889	0	0	0	0	0	180.8587086	0	0	0											2700	No Cost-Sharing	No Cost-Sharing	$50/Days 11-100 for SNF	No Cost-Sharing	$50/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $25/Visit for Urgent Care;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$30/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	$3/Exam for Physical Exams (Routine);	No Cost-Sharing	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	No Cost-Sharing	$23/Procedure for Prof Radiology (Office);	$10/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Hearing Exam;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	50	0	50	0.2	0.2	47.35984298	50	0	76.70926377	0	0.2	19.8389641	3	0	15	0	24.41300646	10	0.2	0	0	0	0	0	10	0	0	0											NO	0	0	47.71704186	0	47.71704186	0.190868167	0.190868167	45.1974322	47.71704186	0	73.206783	0	0.190868167	18.9331336	2.863022506	0	14.31511256	0	23.29832902	9.54340837	0.190868167	0	0	0	0	0	9.543408371	0	0	0												0	0	2.234238574	0	1.088055752	1.885007819	1.267928291	0.821332003	1.413194564	0	3.788023343	0	0.135550357	0.40524931	0.022230742	0	0.312556494	0	4.328794895	0.084312607	2.301028158	0	0	0	0	0	0.143834043	0	0	0	0	0	0	0	0	0	0	0	0	0	20.2313	0	0.967941299	0	0	2.234238574	0	1.088055752	1.885007819	1.267928291	0.821332003	1.413194564	0	3.788023343	0	0.135550357	0.40524931	0.022230742	0	0.312556494	0	4.328794895	0.084312607	2.301028158	0	0	0	0	0	0.143834043	0	0	0	0	0	0	0	0	0	0	0	0	0	20.2313	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	2.234238574	0	1.088055752	1.885007819	1.267928291	0.821332003	1.413194564	0	3.788023343	0	0.135550357	0.40524931	0.022230742	0	0.312556494	0	4.328794895	0.084312607	2.301028158	0	0	0	0	0	0.143834043	0	0	0	0	0	0	0	0	0	0	0	0	0	20.2313
H8130_003_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	988.0425894	21.91528351	615.166545	0	211.9133965	9.487802571	6.233853217	252.89011	402.9707833	0	724.9054743	0	0.608187624	260.7867082	93.177368	0	127.9510789	0	2437.691395	114.3851214	10.90658695	0	0	0	0	0	180.8587086	0	0	0											3000	$50/Days 1-10 for IP Medical; $50/Days 1-10 for IP Surgical;	$50/Days 1-10 for IP Psych; $50/Days 1-10 for IP Substance Abuse;	$50/Days 11-100 for SNF	No Cost-Sharing	$50/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $25/Visit for Urgent Care;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$30/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	$3/Exam for Physical Exams (Routine);	No Cost-Sharing	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Substance Abuse;	No Cost-Sharing	$23/Procedure for Prof Radiology (Office);	$10/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Hearing Exam;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											50	50	50	0	50	0.2	0.2	47.54273869	50	0	76.75344741	0	0.2	21.02489126	3	0	15	0	24.41387123	10	0.2	0	0	0	0	0	10	0	0	0											NO	47.95312339	47.95312343	47.95312339	0	47.95312339	0.191812494	0.191812494	45.59645629	47.95312339	0	73.61135068	0	0.191812494	20.1641841	2.8771874	0	14.38593701	0	23.41442759	9.590624681	0.191812494	0	0	0	0	0	9.590624681	0	0	0												3.9483	0.087575525	2.458263103	0	0.846825771	1.81987907	1.19573093	0.960907737	1.610308975	0	4.44677259	0	0.116657985	0.4382126	0.022340729	0	0.153391347	0	4.756429054	0.091418731	2.09201964	0	0	0	0	0	0.144545666	0	0	0	0	0	0	0	0	0	0	0	0	0	25.1896	0	1.075216362	3.9483	0.087575525	2.458263103	0	0.846825771	1.81987907	1.19573093	0.960907737	1.610308975	0	4.44677259	0	0.116657985	0.4382126	0.022340729	0	0.153391347	0	4.756429054	0.091418731	2.09201964	0	0	0	0	0	0.144545666	0	0	0	0	0	0	0	0	0	0	0	0	0	25.1896	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.9483	0.087575525	2.458263103	0	0.846825771	1.81987907	1.19573093	0.960907737	1.610308975	0	4.44677259	0	0.116657985	0.4382126	0.022340729	0	0.153391347	0	4.756429054	0.091418731	2.09201964	0	0	0	0	0	0.144545666	0	0	0	0	0	0	0	0	0	0	0	0	0	25.1896
H8130_004_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	595.1911777	14.0561372	616.4037732	0	191.9770484	9.03787327	5.751040359	233.3610341	405.7245269	0	683.9684601	0	0.457365089	260.6778236	93.177368	7968.366187	138.114725	0	2197.890263	106.9766933	8.095435003	0	0	0	0	0	180.8587086	0	0	0											3350	$100/Days 1-8 for IP Medical; $100/Days 1-8 for IP Surgical;	$100/Days 1-8 for IP Psych; $100/Days 1-8 for IP Substance Abuse;	$50/Days 11-100 for SNF	No Cost-Sharing	$50/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $25/Visit for Urgent Care;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$30/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	$3/Exam for Physical Exams (Routine);	$15/Visit for Speclst - Office Visits; $5/Procedure for Speclst - Asst Surgeon (OP); $15/Visit for Speclst - Tx Injections; $15/Visit for Speclst - Allergy Testing; $15/Visit for Speclst - Allergy Tx; $15/Visit for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Substance Abuse;	No Cost-Sharing	$23/Procedure for Prof Radiology (Office);	$10/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Hearing Exam;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	50	0	50	0.2	0.2	47.50692238	50	0	76.7508835	0	0.2	20.42784115	3	11.36291959	15	0	24.41165567	10	0.2	0	0	0	0	0	10	0	0	0											NO	96.32449105	96.32449103	48.16224553	0	48.16224553	0.192648982	0.192648982	45.7608012	48.16224553	0	73.92989791	0	0.192648982	19.67701402	2.889734735	10.94527446	14.44867366	0	23.51440309	9.63244911	0.192648982	0	0	0	0	0	9.632449106	0	0	0												4.7776	0.112829189	2.473949156	0	0.770503812	1.741137086	1.107932071	0.889898991	1.62838369	0	4.213809869	0	0.088110919	0.427446766	0.022438156	7.267996246	0.166297883	0	4.306839799	0.08587063	1.559577313	0	0	0	0	0	0.145176026	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7858	0	1.212869854	4.7776	0.112829189	2.473949156	0	0.770503812	1.741137086	1.107932071	0.889898991	1.62838369	0	4.213809869	0	0.088110919	0.427446766	0.022438156	7.267996246	0.166297883	0	4.306839799	0.08587063	1.559577313	0	0	0	0	0	0.145176026	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7858	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.7776	0.112829189	2.473949156	0	0.770503812	1.741137086	1.107932071	0.889898991	1.62838369	0	4.213809869	0	0.088110919	0.427446766	0.022438156	7.267996246	0.166297883	0	4.306839799	0.08587063	1.559577313	0	0	0	0	0	0.145176026	0	0	0	0	0	0	0	0	0	0	0	0	0	31.7858
H8130_005_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	0	0	564.544194	0	285.0654982	10.29646467	6.902460867	219.0375651	358.8420526	0	626.7175602	0	0.708043443	627.7842939	93.177368	7462.626707	271.8434332	836.8706578	2169.344224	1875.827591	12.1099921	0	0	0	1030	0	180.8587086	0	0	0											3350	No Cost-Sharing	No Cost-Sharing	$50/Days 11-100 for SNF	No Cost-Sharing	$50/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $25/Visit for Urgent Care;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$30/Case for OP Fac - Cardiovascular; $10/Case for OP Fac - Occ Therapy; $10/Case for OP Fac - Physical/Speech Therapy; $10/Case for OP Fac - CORF; $10/Visit for Prof - CORF; $10/Visit for Prof - CORF;	$3/Exam for Physical Exams (Routine);	$10/Visit for Speclst - Office Visits; $3/Procedure for Speclst - Asst Surgeon (OP); $10/Visit for Speclst - Tx Injections; $10/Visit for Speclst - Allergy Testing; $10/Visit for Speclst - Allergy Tx; $10/Visit for Speclst - Consults;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $10/Visit for Occ Therapy (PCP); $15/Visit for PT/ST (Specialist); $10/Visit for Occ Therapy (Specialist);	$23/Procedure for Prof Radiology (Office);	$10/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams; $15/Visit for Podiatry;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$10/Exam for Vision Exams (Refractions);	No Cost-Sharing	$10/Exam for Hearing Exam;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0	0	50	0	50	0.2	0.2	47.3422687	50	0	76.72871399	0	0.2	14.02288553	3	7.984116903	15	12.47222861	24.41531605	10.61951189	0.2	0	0	0	10	0	10	0	0	0											NO	0	0	48.12912482	0	48.12912482	0.192516499	0.192516499	45.57083919	48.12912482	0	73.85771706	0	0.192516499	13.49818416	2.887747493	7.68537118	14.43873745	12.00554895	23.50175588	10.22215627	0.192516499	0	0	0	9.625824964	0	9.625824967	0	0	0												0	0	2.264251498	0	1.143329412	1.982239333	1.328837603	0.831810472	1.439229495	0	3.857327353	0	0.136310045	0.706162335	0.022422726	4.779421352	0.327089663	0.837257638	4.24861653	1.597916898	2.331373286	0	0	0	0.826216643	0	0.145076189	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8049	0	1.119703528	0	0	2.264251498	0	1.143329412	1.982239333	1.328837603	0.831810472	1.439229495	0	3.857327353	0	0.136310045	0.706162335	0.022422726	4.779421352	0.327089663	0.837257638	4.24861653	1.597916898	2.331373286	0	0	0	0.826216643	0	0.145076189	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8049	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	2.264251498	0	1.143329412	1.982239333	1.328837603	0.831810472	1.439229495	0	3.857327353	0	0.136310045	0.706162335	0.022422726	4.779421352	0.327089663	0.837257638	4.24861653	1.597916898	2.331373286	0	0	0	0.826216643	0	0.145076189	0	0	0	0	0	0	0	0	0	0	0	0	0	28.8049
H8189_001_0	2010	6	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	621.5457802	50.62861689	169.3033819	0	27.35861279	38.96021425	29.33623174	37.29139246	59.87573933	14.10208005	37.16725584	0	9.408201571	91.47427335	83.22725313	167.4291865	14.17359339	8.242091694	34.85038449	51.81863492	20.87554366	1.588303792	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.076509372	0.076509372	0.153665251	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076509372	0.076509372	0.153665251	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												47.5541	3.873563676	26.01604663	0	6.37455678	9.077729921	6.835341995	8.688894443	13.95104726	3.285784651	8.659970611	0	2.192110966	21.31350569	19.39194998	39.01100044	3.30244726	1.920407365	8.120139586	12.07374194	4.864001673	0.370074784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.8764	0	0	47.5541	3.873563676	26.01604663	0	6.37455678	9.077729921	6.835341995	8.688894443	13.95104726	3.285784651	8.659970611	0	2.192110966	21.31350569	19.39194998	39.01100044	3.30244726	1.920407365	8.120139586	12.07374194	4.864001673	0.370074784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.8764	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	47.5541	3.873563676	26.01604663	0	6.37455678	9.077729921	6.835341995	8.688894443	13.95104726	3.285784651	8.659970611	0	2.192110966	21.31350569	19.39194998	39.01100044	3.30244726	1.920407365	8.120139586	12.07374194	4.864001673	0.370074784	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	246.8764
H8393_001_0	2010	7	N/A																															D	D	D	V	T	COIN	COIN	V	V	COIN	COIN	COIN	COIN	COIN	P	COIN	P	P	COIN	P	COIN	V	T	COIN	V	COIN	COIN	COIN	P	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	YES	1069.486145	19.99838542	768.9176004	0	114.0122592	8.013561399	4.788115373	266.0789658	365.5370502	8.488133012	18.14951427	1.428220218	0.676784351	8.735269673	3476.106752	99.26537673	101.1496037	724.4544002	8.625549085	1354.146531	26.37858853	0	0	0	0	0	0	0	0	122.5733384											5000	1a $175 days 1-9	1b $175 days 1-9	2 $100 days 7-22	6 $0	"10a $150, 10b $0"	11a 20%	11b 20%	"4a $50, 4b $40"	"9a $260, 9b $260"	"8a $0, 8b 20%, 11c $0, 11c 20%"	8b 20%/$260 Adv. Imaging; 14h $0	5 20%	12 20%	"3 20%, 9d 20%, 13a $0"	7a $15	"17a $40, 18a $40, 7b $40,7d $40,7f $40, 14d - 14g $0, 14i - 14j $0, 17b 20%"	"7e $40, 7h $40, 9c $40"	"7c $40,7i $40"	"8b 20% Ther., $260 Adv. Imaging, 14h $0"	"7g $40, 14b $0, 14a $0"	"15 20%, 11c 20%"	15 20%							14a $0	14c $15											162.8134796	158.8235294	47.92899408	0	24.83212364	0.2	0.2	49.50835281	260	0.078904461	0.46675755	0.2	0.2	0.189272638	15	0.150103387	40	40	0.267748956	0.004535937	0.218202812	0	0	0	0	0	0	0	0	15											NO	137.8761865	134.4973562	40.58795956	0	21.02871653	0.169367041	0.169367041	41.92541613	220.1771535	0.066819075	0.395266726	0.169367041	0.169367041	0.160282734	12.70252808	0.127112833	33.87340823	33.87340823	0.226739242	0.003841191	0.184781823	0	0	0	0	0	0	0	0	12.70252808												12.2881	0.224144164	2.600733039	0	0.19979429	1.357233183	0.810948933	0.929622614	6.706908933	0.5671692	7.173899088	0.241893432	0.114624963	1.400112903	3.67961197	12.61790321	0.285523485	2.044978303	1.95575046	0.000433461	4.874283686	0	0	0	0	0	0	0	0	0.129749273	0	0	0	0	0	0	0	0	0	0	60.2034	0	10.8888216	12.2881	0.224144164	2.600733039	0	0.19979429	1.357233183	0.810948933	0.929622614	6.706908933	0.5671692	7.173899088	0.241893432	0.114624963	1.400112903	3.67961197	12.61790321	0.285523485	2.044978303	1.95575046	0.000433461	4.874283686	0	0	0	0	0	0	0	0	0.129749273	0	0	0	0	0	0	0	0	0	0	60.2034	NO	0.2	0.2	0.2	0.2	$150/$0	0.2	0.2	$50/$40	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																				5.3435	0.0363	0.6758	0.1848	0.1246	0.2202	0.1316	0.1497	1.1649	0.2333	0.4988	0.0393	0.0186	0.2401	0.6657	2.7072	0.0385	0.1329	0.2352	0.1775	0.3047	0	0	0	0	0	0	0	0	0											13.3234	0	0	17.6316	0.260492633	3.276507204	0.18479609	0.324415096	1.577475773	0.942544223	1.079317288	7.871813978	0.80045479	7.672715511	0.281146257	0.133225524	1.640190731	4.345322979	15.32514076	0.324069004	2.177864665	2.190992708	0.177920916	5.179012221	0	0	0	0	0	0	0	0	0.129749273	0	0	0	0	0	0	0	0	0	0	73.5267
H8393_801_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	186.1966073	2.887933221	19.32175268	0	5.186228711	8.621374359	4.93996922	14.04577373	47.25999559	8.492637243	18.95085559	1.932405823	0.914595209	9.531266715	25.83855246	105.9481633	2.033343163	5.813979201	10.86778505	7.673804464	27.08844373	0	0	0	0	0	0	0	0	0												FFS Medicare  8.1%	FFS Medicare  8.1%	FFS Medicare  16.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												15.0826	0.233932659	3.103787278	0	1.20839129	2.008780226	1.151012828	3.272665279	11.01157897	1.978784478	4.415549353	0.450250557	0.213100684	2.220785145	6.020382724	24.68592204	0.473768957	1.354657154	2.532193918	1.78799644	6.311607389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5177	0	0	15.0826	0.233932659	3.103787278	0	1.20839129	2.008780226	1.151012828	3.272665279	11.01157897	1.978784478	4.415549353	0.450250557	0.213100684	2.220785145	6.020382724	24.68592204	0.473768957	1.354657154	2.532193918	1.78799644	6.311607389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5177	NO	FFS Medicare  8.1%	FFS Medicare  8.1%	FFS Medicare  16.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																				2.1299	0.033	0.4383	0	0.1661	0.276	0.1582	0.4497	1.5132	0.2719	0.6068	0.0619	0.0293	0.3052	0.821	3.3663	0.0646	0.1847	0.3453	0.2438	0.8607	0	0	0	0	0	0	0	0	0											12.3259	0	0	17.2125	0.26696838	3.542100817	0	1.374446814	2.284824133	1.30918348	3.72239059	12.52477551	2.250706409	5.022328273	0.512123389	0.242384696	2.525962486	6.841344004	28.05218414	0.538373815	1.539383129	2.877493088	2.031814136	7.172281123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8436
H8393_802_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	186.1966073	2.887933221	19.32175268	0	5.186228711	8.621374359	4.93996922	14.04577373	47.25999559	8.492637243	18.95085559	1.932405823	0.914595209	9.531266715	25.83855246	105.9481633	2.033343163	5.813979201	10.86778505	7.673804464	27.08844373	0	0	0	0	0	0	0	0	0												FFS Medicare  8.1%	FFS Medicare  8.1%	FFS Medicare  16.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												15.0826	0.233932659	3.103787278	0	1.20839129	2.008780226	1.151012828	3.272665279	11.01157897	1.978784478	4.415549353	0.450250557	0.213100684	2.220785145	6.020382724	24.68592204	0.473768957	1.354657154	2.532193918	1.78799644	6.311607389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5177	0	0	15.0826	0.233932659	3.103787278	0	1.20839129	2.008780226	1.151012828	3.272665279	11.01157897	1.978784478	4.415549353	0.450250557	0.213100684	2.220785145	6.020382724	24.68592204	0.473768957	1.354657154	2.532193918	1.78799644	6.311607389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5177	NO	FFS Medicare  8.1%	FFS Medicare  8.1%	FFS Medicare  16.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																				2.1299	0.033	0.4383	0	0.1661	0.276	0.1582	0.4497	1.5132	0.2719	0.6068	0.0619	0.0293	0.3052	0.821	3.3663	0.0646	0.1847	0.3453	0.2438	0.8607	0	0	0	0	0	0	0	0	0											12.3259	0	0	17.2125	0.26696838	3.542100817	0	1.374446814	2.284824133	1.30918348	3.72239059	12.52477551	2.250706409	5.022328273	0.512123389	0.242384696	2.525962486	6.841344004	28.05218414	0.538373815	1.539383129	2.877493088	2.031814136	7.172281123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8436
H8393_803_0	2010	4	N/A																															COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	186.1966073	2.887933221	19.32175268	0	5.186228711	8.621374359	4.93996922	14.04577373	47.25999559	8.492637243	18.95085559	1.932405823	0.914595209	9.531266715	25.83855246	105.9481633	2.033343163	5.813979201	10.86778505	7.673804464	27.08844373	0	0	0	0	0	0	0	0	0												FFS Medicare  8.1%	FFS Medicare  8.1%	FFS Medicare  16.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																			0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081003486	0.081003486	0.160636943	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												15.0826	0.233932659	3.103787278	0	1.20839129	2.008780226	1.151012828	3.272665279	11.01157897	1.978784478	4.415549353	0.450250557	0.213100684	2.220785145	6.020382724	24.68592204	0.473768957	1.354657154	2.532193918	1.78799644	6.311607389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5177	0	0	15.0826	0.233932659	3.103787278	0	1.20839129	2.008780226	1.151012828	3.272665279	11.01157897	1.978784478	4.415549353	0.450250557	0.213100684	2.220785145	6.020382724	24.68592204	0.473768957	1.354657154	2.532193918	1.78799644	6.311607389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5177	NO	FFS Medicare  8.1%	FFS Medicare  8.1%	FFS Medicare  16.1%		FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%	FFS Medicare  23.3%																				2.1299	0.033	0.4383	0	0.1661	0.276	0.1582	0.4497	1.5132	0.2719	0.6068	0.0619	0.0293	0.3052	0.821	3.3663	0.0646	0.1847	0.3453	0.2438	0.8607	0	0	0	0	0	0	0	0	0											12.3259	0	0	17.2125	0.26696838	3.542100817	0	1.374446814	2.284824133	1.30918348	3.72239059	12.52477551	2.250706409	5.022328273	0.512123389	0.242384696	2.525962486	6.841344004	28.05218414	0.538373815	1.539383129	2.877493088	2.031814136	7.172281123	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.8436
H8558_001_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.4217018	23.12526479	438.72949	24.07513243	200.3283555	11.56596023	10.13431693	548.3143311	70.73155217	22.11310524	24.81764011	0.009400923	0.097384964	0.017217244	4102.980133	1904.398064	1.606774484	5.701231777	0	4.12556024	19.49828256	0.514975877																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	134.6675783	134.6675783	44.88919277	0	134.6675783	0.179556771	0.179556771	44.88919277	0.134667578	0	0.134667578	0.448891928	0.134667578	0.448891928	17.95567711	35.91135422	0.448891928	0.134667578	35.91135422	0	0.179556771	0.134667578																			4000	8.6683	0.259518617	1.641184388	0	2.248144542	2.076746474	1.819685225	2.051115642	9.52524684	0	3.342131493	0.004219998	0.013114597	0.007728682	6.139315537	5.699126121	0.721268095	0.767771077	0	0	3.501048657	0.069350554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5551		5.54	8.6683	0.259518617	1.641184388	0	2.248144542	2.076746474	1.819685225	2.051115642	9.52524684	0	3.342131493	0.004219998	0.013114597	0.007728682	6.139315537	5.699126121	0.721268095	0.767771077	0	0	3.501048657	0.069350554	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.5551	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2463	0.0373	0.2237	0	0.0282	0.3469	0.304	0.2764	1.6894	0	0.5927	0.0006	0.0023	0.0011	0.9402	0.7927	0.0982	0.1362	0	0.0001	0.0438	0.0009																			6.7609		0.00770778	9.9146	0.296831099	1.86483773	0	2.276297578	2.423686146	2.123680442	2.327479444	11.21466045	0	3.934822082	0.004794559	0.015440624	0.008780957	7.079557558	6.491806948	0.819470148	0.903944231	0	6.85E-05	3.544891545	0.070219016	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3159
H8558_002_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.4217018	23.12526479	438.72949	23.54600864	200.3283555	11.31176331	9.91158469	548.3143311	69.17701256	21.62710293	24.27219747	0.009194309	0.095244635	0.016838843	4102.980133	1904.398064	1.571460759	5.575929979	0	4.034888586	19.06974887	0.503657725																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	134.8386517	134.8386517	44.94621724	0	134.8386517	0.179784869	0.179784869	44.94621724	0.134838652	0	0.134838652	0.449462172	0.134838652	0.449462172	17.97848689	35.95697379	0.449462172	0.134838652	35.95697379	0	0.179784869	0.134838652																			4000	8.6794	0.259848294	1.643269247	0	2.251000447	2.033683883	1.781952955	2.053721253	9.327735102	0	3.272830381	0.004132494	0.012842658	0.007568423	6.147114545	5.706365939	0.706312167	0.75185088	0	0	3.428452302	0.067912529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.136		5.42	8.6794	0.259848294	1.643269247	0	2.251000447	2.033683883	1.781952955	2.053721253	9.327735102	0	3.272830381	0.004132494	0.012842658	0.007568423	6.147114545	5.706365939	0.706312167	0.75185088	0	0	3.428452302	0.067912529	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.136	NO	$175 - days 1-5	$175 - days 1-5	$55- days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2474	0.0373	0.2239	0	0.0281	0.3467	0.3038	0.2766	1.6884	0	0.5923	0.0006	0.0023	0.0011	0.9411	0.7934	0.0981	0.1361	0	0.0001	0.0428	0.0008																			6.7609		0.00770778	9.9268	0.297194274	1.867119374	0	2.279082647	2.380380648	2.085735331	2.330327135	11.01615466	0	3.865172092	0.004706402	0.015167316	0.008619502	7.088219455	6.499749728	0.804402581	0.88794391	0	6.85E-05	3.471223722	0.068759767	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8968
H8558_003_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.4217018	23.12526479	438.72949	25.92706569	200.3283555	12.45564948	10.91387977	548.3143311	76.17244079	23.81411334	26.72668935	0.010124071	0.104876115	0.018541648	4102.980133	1904.398064	1.922636135	7.163086078	0	4.442911027	20.99815045	0.554589406																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	134.0210512	134.0210512	44.67368372	0	134.0210512	0.178694735	0.178694735	44.67368372	0.134021051	0	0.134021051	0.446736837	0.134021051	0.446736837	17.86947349	35.73894698	0.446736837	0.134021051	35.73894698	0	0.178694735	0.134021051																			4000	8.6267	0.258272691	1.633305206	0	2.237351399	2.225758982	1.950252852	2.041268417	10.20871059	0	3.581939001	0.004522795	0.014055607	0.008283237	6.109841226	5.67176512	0.858912386	0.960004326	0	0	3.752258927	0.074326655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2176		6	8.6267	0.258272691	1.633305206	0	2.237351399	2.225758982	1.950252852	2.041268417	10.20871059	0	3.581939001	0.004522795	0.014055607	0.008283237	6.109841226	5.67176512	0.858912386	0.960004326	0	0	3.752258927	0.074326655	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.2176	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2418	0.0372	0.2229	0	0.0284	0.3477	0.3046	0.2754	1.6923	0	0.5937	0.0006	0.0023	0.0011	0.9368	0.7899	0.0996	0.1381	0	0.0001	0.0476	0.0009																			6.7609		0.00770778	9.8686	0.295451254	1.856168874	0	2.265716017	2.573417768	2.25487817	2.31665996	11.90096632	0	4.175627158	0.005099424	0.016385547	0.009339299	7.046647638	6.461629237	0.958556729	1.098145239	0	6.82E-05	3.799829189	0.075268951	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9784
H8558_004_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.4217018	23.12526479	438.72949	25.92706569	200.3283555	12.45564948	10.91387977	548.3143311	76.17244079	23.81411334	26.72668935	0.010124071	0.104876115	0.018541648	4102.980133	1904.398064	1.730372521	6.139788067	0	4.442911027	20.99815045	0.554589406																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	134.0945759	134.0945759	44.69819197	0	134.0945759	0.178792768	0.178792768	44.69819197	0.134094576	0	0.134094576	0.44698192	0.134094576	0.44698192	17.87927679	35.75855357	0.44698192	0.134094576	35.75855357	0	0.178792768	0.134094576																			4000	8.6315	0.258414381	1.634201247	0	2.238578823	2.226980047	1.951322772	2.042388269	10.21431114	0	3.583904073	0.004525277	0.014063318	0.008287781	6.11319312	5.674876683	0.773445231	0.823312277	0	0	3.754317438	0.074367431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.022		5.94	8.6315	0.258414381	1.634201247	0	2.238578823	2.226980047	1.951322772	2.042388269	10.21431114	0	3.583904073	0.004525277	0.014063318	0.008287781	6.11319312	5.674876683	0.773445231	0.823312277	0	0	3.754317438	0.074367431	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.022	NO	$175 - days 1-5	$175 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2421	0.0372	0.2045	0	0.0283	0.3477	0.3047	0.2754	1.6927	0	0.5938	0.0006	0.0023	0.0011	0.937	0.79	0.0986	0.1364	0	0.0001	0.0474	0.0009																			6.7408		0.007405186	9.8735	0.295600317	1.838718177	0	2.266859129	2.574716123	2.256015814	2.317828775	11.90697066	0	4.177733869	0.005101997	0.016393814	0.009344011	7.050202853	6.464889295	0.872016314	0.959747063	0	6.82E-05	3.8017463	0.075306926	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7628
H8558_005_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.4217018	23.12526479	438.72949	23.54600864	200.3283555	11.31176331	9.91158469	548.3143311	69.17701256	21.62710293	24.27219747	0.009194309	0.095244635	0.016838843	4102.980133	1904.398064	1.74606751	6.482310278	0	4.034888586	19.06974887	0.503657725																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	134.7668278	134.7668278	44.92227594	0	134.7668278	0.179689104	0.179689104	44.92227594	0.134766828	0	0.134766828	0.449222759	0.134766828	0.449222759	17.96891038	35.93782075	0.449222759	0.134766828	35.93782075	0	0.179689104	0.134766828																			4000	8.6747	0.259709882	1.642393935	0	2.249801417	2.03260061	1.78100377	2.052627307	9.322766541	0	3.271087057	0.004130293	0.012835817	0.007564392	6.14384019	5.703326356	0.784373265	0.873600393	0	0	3.426626084	0.067876354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3109		5.46	8.6747	0.259709882	1.642393935	0	2.249801417	2.03260061	1.78100377	2.052627307	9.322766541	0	3.271087057	0.004130293	0.012835817	0.007564392	6.14384019	5.703326356	0.784373265	0.873600393	0	0	3.426626084	0.067876354	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.3109	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.247	0.0373	0.2238	0	0.0281	0.3466	0.3037	0.2765	1.6877	0	0.5921	0.0006	0.0023	0.0011	0.9407	0.7931	0.099	0.1376	0	0.0001	0.0428	0.0008																			6.7609		0.01	9.9217	0.297041896	1.86616206	0	2.27791411	2.379160173	2.084665928	2.329132324	11.01050642	0	3.863190331	0.004703989	0.01515954	0.008615082	7.084585165	6.49641716	0.883407596	1.01116498	0	6.85E-05	3.469443947	0.068724512	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.0717
H8558_006_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.4217018	23.12526479	438.72949	23.28144674	200.3283555	11.18466484	9.80021857	548.3143311	68.39974275	21.38410177	23.99947615	0.009091002	0.094174471	0.016649643	4102.980133	1904.398064	1.726448774	6.409475331	0	3.989552759	18.85548203	0.49799865																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	134.8537429	134.8537429	44.95124765	0	134.8537429	0.179804991	0.179804991	44.95124765	0.134853743	0	0.134853743	0.449512476	0.134853743	0.449512476	17.98049906	35.96099812	0.449512476	0.134853743	35.96099812	0	0.179804991	0.134853743																			4000	8.6803	0.259877376	1.643453163	0	2.25125238	2.011058557	1.762128208	2.053951107	9.223961327	0	3.236419188	0.004086519	0.01269978	0.007484222	6.147802535	5.7070046	0.776060264	0.864341739	0	0	3.39030977	0.067156982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0994		5.402393639	8.6803	0.259877376	1.643453163	0	2.25125238	2.011058557	1.762128208	2.053951107	9.223961327	0	3.236419188	0.004086519	0.01269978	0.007484222	6.147802535	5.7070046	0.776060264	0.864341739	0	0	3.39030977	0.067156982	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.0994	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2475	0.0373	0.2239	0	0.0281	0.3464	0.3036	0.2766	1.6873	0	0.5919	0.0006	0.0023	0.0011	0.9412	0.7934	0.099	0.1375	0	0.0001	0.0423	0.0008																			6.7609		0.00770778	9.9278	0.297226273	1.867320406	0	2.279328036	2.357499003	2.065685993	2.330578041	10.91121582	0	3.828352107	0.004659892	0.015022834	0.008534321	7.088982642	6.500449555	0.875027089	1.001848064	0	6.85E-05	3.432590755	0.067994505	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.8602
H8578_001_0	2010	3	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	226.84	3.2	816.38	0	160.04	0	0	227.03	288.28	0	0	0	0	1170.47	4056.07	4921.75	150.85	542.55	0	90	0	648.73	0	0	330.93	0	156.96	0	0	0											3400	1A IP Acute: $200 Per Admit	1B IP Psych: $200 Per Admit	2 SNF: $25 for days 11-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $10"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $10, 5 Partial Hosp: $10, 9C OP Substance Abuse: $10, 9D Cardiac Rehab: $0"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7D Physician Specialist (excl. Radiology): $10, 7B Chiropractic: $10, 7F Podiatry: $10"	"7E Mental Health: $10, 7H Psychiatric: $10"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $10, 18A Hearing Exams (Medicare Covered): $10"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $10"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $10	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											200	200	25	0	50	0	0	46.39695194	100	0	0	0	0	10	10	10	10	10	0	10	0	10	0	0	10	0	10	0	0	0											NO	196.417362	196.417362	24.55217025	0	49.10434049	0	0	45.56583452	98.20868099	0	0	0	0	9.820868099	9.820868099	9.820868099	9.820868099	9.820868099	0	9.820868099	0	9.820868099	0	0	9.820868099	0	9.820868099	0	0	0												3.7129	0.052377963	1.670325062	0	0.654888221	0	0	0.862067618	2.35929988	0	0	0	0	0.95791929	3.319510706	4.02798813	0.123456496	0.444025999	0	0.073656511	0	0.530924313	0	0	0.27083499	0	0.128456955	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1887	0	0.35	3.7129	0.052377963	1.670325062	0	0.654888221	0	0	0.862067618	2.35929988	0	0	0	0	0.95791929	3.319510706	4.02798813	0.123456496	0.444025999	0	0.073656511	0	0.530924313	0	0	0.27083499	0	0.128456955	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1887	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 11-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay: $0, 13D Other 2 Copay: $0, 13E Other 3 Copay: $0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.7129	0.052377963	1.670325062	0	0.654888221	0	0	0.862067618	2.35929988	0	0	0	0	0.95791929	3.319510706	4.02798813	0.123456496	0.444025999	0	0.073656511	0	0.530924313	0	0	0.27083499	0	0.128456955	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1887
H8578_002_0	2010	3	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	226.84	3.2	816.38	0	160.04	0	0	227.03	288.28	0	0	0	0	1170.47	4056.07	4921.75	150.85	542.55	0	90	0	648.73	0	0	330.93	0	156.96	0	0	0											3400	1A IP Acute: $200 Per Admit	1B IP Psych: $200 Per Admit	2 SNF: $25 for days 11-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $10"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $10, 5 Partial Hosp: $10, 9C OP Substance Abuse: $10, 9D Cardiac Rehab: $0"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $10, 7F Podiatry: $10, 7D Physician Specialist (excl. Radiology): $10"	"7E Mental Health: $10, 7H Psychiatric: $10"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $10, 18A Hearing Exams (Medicare Covered): $10"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $10"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $10	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											200	200	25	0	50	0	0	46.39695194	100	0	0	0	0	10	10	10	10	10	0	10	0	10	0	0	10	0	10	0	0	0											NO	196.417362	196.417362	24.55217025	0	49.10434049	0	0	45.56583452	98.20868099	0	0	0	0	9.820868099	9.820868099	9.820868099	9.820868099	9.820868099	0	9.820868099	0	9.820868099	0	0	9.820868099	0	9.820868099	0	0	0												3.7129	0.052377963	1.670325062	0	0.654888221	0	0	0.862067618	2.35929988	0	0	0	0	0.95791929	3.319510706	4.02798813	0.123456496	0.444025999	0	0.073656511	0	0.530924313	0	0	0.27083499	0	0.128456955	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1887	0	0.35	3.7129	0.052377963	1.670325062	0	0.654888221	0	0	0.862067618	2.35929988	0	0	0	0	0.95791929	3.319510706	4.02798813	0.123456496	0.444025999	0	0.073656511	0	0.530924313	0	0	0.27083499	0	0.128456955	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1887	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 11-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay: $0, 13D Other 2 Copay: $0, 13E Other 3 Copay: $0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.7129	0.052377963	1.670325062	0	0.654888221	0	0	0.862067618	2.35929988	0	0	0	0	0.95791929	3.319510706	4.02798813	0.123456496	0.444025999	0	0.073656511	0	0.530924313	0	0	0.27083499	0	0.128456955	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1887
H8578_003_0	2010	2	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	YES	226.84	3.2	816.38	0	160.04	0	0	227.03	288.28	0	0	0	0	1170.47	4056.07	4921.75	150.85	542.55	0	90	0	648.73	0	0	330.93	0	156.96	0	0	0											3400	1A IP Acute: $200 Per Admit	1B IP Psych: $200 Per Admit	2 SNF: $25 for days 11-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $10"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $105 Partial Hosp: $109C OP Substance Abuse: $10, 9D Cardiac Rehab: $0"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $10, 7F Podiatry: $10, 7D Physician Specialist (excl. Radiology): $10"	"7E Mental Health: $10, 7H Psychiatric: $10"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $10, 18A Hearing Exams (Medicare Covered): $10"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $10"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $10	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											200	200	25	0	50	0	0	46.39695194	100	0	0	0	0	10	10	10	10	10	0	10	0	10	0	0	10	0	10	0	0	0											NO	196.417362	196.417362	24.55217025	0	49.10434049	0	0	45.56583452	98.20868099	0	0	0	0	9.820868099	9.820868099	9.820868099	9.820868099	9.820868099	0	9.820868099	0	9.820868099	0	0	9.820868099	0	9.820868099	0	0	0												3.7129	0.052377963	1.670325062	0	0.654888221	0	0	0.862067618	2.35929988	0	0	0	0	0.95791929	3.319510706	4.02798813	0.123456496	0.444025999	0	0.073656511	0	0.530924313	0	0	0.27083499	0	0.128456955	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1887	0	0.35	3.7129	0.052377963	1.670325062	0	0.654888221	0	0	0.862067618	2.35929988	0	0	0	0	0.95791929	3.319510706	4.02798813	0.123456496	0.444025999	0	0.073656511	0	0.530924313	0	0	0.27083499	0	0.128456955	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1887	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 11-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay: $0, 13D Other 2 Copay: $0, 13E Other 3 Copay: $0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.7129	0.052377963	1.670325062	0	0.654888221	0	0	0.862067618	2.35929988	0	0	0	0	0.95791929	3.319510706	4.02798813	0.123456496	0.444025999	0	0.073656511	0	0.530924313	0	0	0.27083499	0	0.128456955	0	0	0	0	0	0	0	0	0	0	0	0	0	19.1887
H8578_004_0	2010	5	N/A																															A	A	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	O	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	YES	226.46	3.19	797.11	0	158.44	7.53	5.22	224.13	282.68	0	265.52	0	0	115.88	3893.27	4734.62	146.21	520.34	0	86.32	0	622.17	0	0	320.59	0	152.06	0	0	0											3400	1A IP Acute: $500 Per Admit	1B IP Psych: $500 Per Admit	2 SNF: $50 for days 11-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 15%	"11B Prosthetics/Medical Supplies: 15%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $15"	9B ASC Services: $250	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $100	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $15, 5 Partial Hosp: $15, 9C OP Substance Abuse: $15, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $15, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $15, 7F Podiatry: $15, 7D Physician Specialist (excl. Radiology): $15"	"7E Mental Health: $15, 7H Psychiatric: $15"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $15, 18A Hearing Exams (Medicare Covered): $15"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $15"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $15	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $15	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											500	500	50	0	50	0.149999987	0.028639799	46.93771472	250	0	100	0	0	15	15	15	15	15	0	15	0	15	0	0	15	0	15	0	0	0											NO	490.552553	490.552553	49.0552553	0	49.0552553	0.147165753	0.028098653	46.05083157	245.2762765	0	98.11051059	0	0	14.71657659	14.71657659	14.71657659	14.71657659	14.71657659	0	14.71657659	0	14.71657659	0	0	14.71657659	0	14.71657659	0	0	0												9.2575	0.13040522	3.258536212	0	0.647692887	1.108158122	0.146674968	0.860114407	5.777891486	0	2.170858564	0	0	0.142113075	4.774633845	5.806449821	0.179309222	0.638135289	0	0.105861241	0	0.763017705	0	0	0.393165607	0	0.186483553	0	0	0	0	0	0	0	0	0	0	0	0	0	36.347	0	0.7	9.2575	0.13040522	3.258536212	0	0.647692887	1.108158122	0.146674968	0.860114407	5.777891486	0	2.170858564	0	0	0.142113075	4.774633845	5.806449821	0.179309222	0.638135289	0	0.105861241	0	0.763017705	0	0	0.393165607	0	0.186483553	0	0	0	0	0	0	0	0	0	0	0	0	0	36.347	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 11-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay: $0, 13D Other 2 Copay: $0, 13E Other 3 Copay: $0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.2575	0.13040522	3.258536212	0	0.647692887	1.108158122	0.146674968	0.860114407	5.777891486	0	2.170858564	0	0	0.142113075	4.774633845	5.806449821	0.179309222	0.638135289	0	0.105861241	0	0.763017705	0	0	0.393165607	0	0.186483553	0	0	0	0	0	0	0	0	0	0	0	0	0	36.347
H8578_005_0	2010	5	N/A																															A	A	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	O	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	YES	226.46	3.19	797.11	0	158.44	7.53	5.22	224.13	282.68	0	265.52	0	0	115.88	3893.27	4734.62	146.21	520.34	0	86.32	0	622.17	0	0	320.59	0	152.06	0	0	0											3400	1A IP Acute: $500 Per Admit	1B IP Psych: $500 Per Admit	2 SNF: $50 for days 11-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 15%	"11B Prosthetics/Medical Supplies: 15%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $15"	9B ASC Services: $250	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $100	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $15, 5 Partial Hosp: $15, 9C OP Substance Abuse: $15, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $15, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $15, 7F Podiatry: $15, 7D Physician Specialist (excl. Radiology): $15"	"7E Mental Health: $15, 7H Psychiatric: $15"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $15, 18A Hearing Exams (Medicare Covered): $15"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $15"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $15	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $15	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											500	500	50	0	50	0.149999987	0.028639799	46.93771472	250	0	100	0	0	15	15	15	15	15	0	15	0	15	0	0	15	0	15	0	0	0											NO	490.552553	490.552553	49.0552553	0	49.0552553	0.147165753	0.028098653	46.05083157	245.2762765	0	98.11051059	0	0	14.71657659	14.71657659	14.71657659	14.71657659	14.71657659	0	14.71657659	0	14.71657659	0	0	14.71657659	0	14.71657659	0	0	0												9.2575	0.13040522	3.258536212	0	0.647692887	1.108158122	0.146674968	0.860114407	5.777891486	0	2.170858564	0	0	0.142113075	4.774633845	5.806449821	0.179309222	0.638135289	0	0.105861241	0	0.763017705	0	0	0.393165607	0	0.186483553	0	0	0	0	0	0	0	0	0	0	0	0	0	36.347	0	0.7	9.2575	0.13040522	3.258536212	0	0.647692887	1.108158122	0.146674968	0.860114407	5.777891486	0	2.170858564	0	0	0.142113075	4.774633845	5.806449821	0.179309222	0.638135289	0	0.105861241	0	0.763017705	0	0	0.393165607	0	0.186483553	0	0	0	0	0	0	0	0	0	0	0	0	0	36.347	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 11-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay: $0, 13D Other 2 Copay: $0, 13E Other 3 Copay: $0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.2575	0.13040522	3.258536212	0	0.647692887	1.108158122	0.146674968	0.860114407	5.777891486	0	2.170858564	0	0	0.142113075	4.774633845	5.806449821	0.179309222	0.638135289	0	0.105861241	0	0.763017705	0	0	0.393165607	0	0.186483553	0	0	0	0	0	0	0	0	0	0	0	0	0	36.347
H8578_006_0	2010	3	N/A																															A	A	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	O	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	YES	226.46	3.19	797.11	0	158.44	7.53	5.22	224.13	282.68	0	265.52	0	0	115.88	3893.27	4734.62	146.21	520.34	0	86.32	0	622.17	0	0	320.59	0	152.06	0	0	0											3400	1A IP Acute: $500 Per Admit	1B IP Psych: $500 Per Admit	2 SNF: $50 for days 11-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 15%	"11B Prosthetics/Medical Supplies: 15%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $15"	9B ASC Services: $250	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $100	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $15, 5 Partial Hosp: $15, 9C OP Substance Abuse: $15, 9D Cardiac Rehab: $0"	"7A PCP: $15, 14B Immunizations: $0, 14C Physical Exams: $15, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $15, 7F Podiatry: $15, 7D Physician Specialist (excl. Radiology): $15"	"7E Mental Health: $15, 7H Psychiatric: $15"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $15, 18A Hearing Exams (Medicare Covered): $15"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $15"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $15	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $15	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											500	500	50	0	50	0.149999987	0.028639799	46.93771472	250	0	100	0	0	15	15	15	15	15	0	15	0	15	0	0	15	0	15	0	0	0											NO	490.552553	490.552553	49.0552553	0	49.0552553	0.147165753	0.028098653	46.05083157	245.2762765	0	98.11051059	0	0	14.71657659	14.71657659	14.71657659	14.71657659	14.71657659	0	14.71657659	0	14.71657659	0	0	14.71657659	0	14.71657659	0	0	0												9.2575	0.13040522	3.258536212	0	0.647692887	1.108158122	0.146674968	0.860114407	5.777891486	0	2.170858564	0	0	0.142113075	4.774633845	5.806449821	0.179309222	0.638135289	0	0.105861241	0	0.763017705	0	0	0.393165607	0	0.186483553	0	0	0	0	0	0	0	0	0	0	0	0	0	36.347	0	0.7	9.2575	0.13040522	3.258536212	0	0.647692887	1.108158122	0.146674968	0.860114407	5.777891486	0	2.170858564	0	0	0.142113075	4.774633845	5.806449821	0.179309222	0.638135289	0	0.105861241	0	0.763017705	0	0	0.393165607	0	0.186483553	0	0	0	0	0	0	0	0	0	0	0	0	0	36.347	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 11-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay: $0, 13D Other 2 Copay: $0, 13E Other 3 Copay: $0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.2575	0.13040522	3.258536212	0	0.647692887	1.108158122	0.146674968	0.860114407	5.777891486	0	2.170858564	0	0	0.142113075	4.774633845	5.806449821	0.179309222	0.638135289	0	0.105861241	0	0.763017705	0	0	0.393165607	0	0.186483553	0	0	0	0	0	0	0	0	0	0	0	0	0	36.347
H8578_007_0	2010	3	N/A																															A	A	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	O	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	YES	226.08	3.19	778.13	0	156.06	7.26	5.03	220.85	279.85	0	262.86	0	0	114.72	3651.5	4434.45	139.55	487.44	0	80.86	0	582.83	0	0	303.35	0	143.88	0	0	0											3400	1A IP Acute: $750 Per Admit	1B IP Psych: $750 Per Admit	2 SNF: $100 for days 11-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: $300	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $150	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $25, 5 Partial Hosp: $25, 9C OP Substance Abuse: $25, 9D Cardiac Rehab: $0"	"7A PCP: $25, 14B Immunizations: $0, 14C Physical Exams: $25, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7F Podiatry: $30, 7D Physician Specialist (excl. Radiology): $30"	"7E Mental Health: $25, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $25	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											750	750	100	0	75	0.200000019	0.038486796	47.9205343	300	0	150	0	0	25	25	30	25	25	0	25	0	25	0	0	25	0	25	0	0	0											NO	735.5647478	735.5647478	98.07529971	0	73.55647478	0.196150618	0.03774604	46.99820764	294.2258991	0	147.1129496	0	0	24.51882493	24.51882493	29.42258991	24.51882493	24.51882493	0	24.51882493	0	24.51882493	0	0	24.51882493	0	24.51882493	0	0	0												13.858	0.195537629	6.35961108	0	0.956601955	1.424053489	0.189862583	0.864962846	6.861593156	0	3.22250916	0	0	0.234399966	7.460874102	10.87275032	0.285133502	0.995954669	0	0.165216015	0	1.190858894	0	0	0.619815462	0	0.293980711	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0518	0	1.1	13.858	0.195537629	6.35961108	0	0.956601955	1.424053489	0.189862583	0.864962846	6.861593156	0	3.22250916	0	0	0.234399966	7.460874102	10.87275032	0.285133502	0.995954669	0	0.165216015	0	1.190858894	0	0	0.619815462	0	0.293980711	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0518	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 11-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay: $0, 13D Other 2 Copay: $0, 13E Other 3 Copay: $0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.858	0.195537629	6.35961108	0	0.956601955	1.424053489	0.189862583	0.864962846	6.861593156	0	3.22250916	0	0	0.234399966	7.460874102	10.87275032	0.285133502	0.995954669	0	0.165216015	0	1.190858894	0	0	0.619815462	0	0.293980711	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0518
H8578_008_0	2010	3	N/A																															A	A	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	O	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	YES	226.08	3.19	778.13	0	156.06	7.26	5.03	220.85	279.85	0	262.86	0	0	114.72	3651.5	4434.45	139.55	487.44	0	80.86	0	582.83	0	0	303.35	0	143.88	0	0	0											3400	1A IP Acute: $750 Per Admit	1B IP Psych: $750 Per Admit	2 SNF: $100 for days 11-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: $300	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $150	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $25, 5 Partial Hosp: $25, 9C OP Substance Abuse: $25, 9D Cardiac Rehab: $0"	"7A PCP: $25, 14B Immunizations: $0, 14C Physical Exams: $25, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7F Podiatry: $30, 7D Physician Specialist (excl. Radiology): $30"	"7E Mental Health: $25, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $25	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											750	750	100	0	75	0.200000019	0.038486796	47.9205343	300	0	150	0	0	25	25	30	25	25	0	25	0	25	0	0	25	0	25	0	0	0											NO	735.5647478	735.5647478	98.07529971	0	73.55647478	0.196150618	0.03774604	46.99820764	294.2258991	0	147.1129496	0	0	24.51882493	24.51882493	29.42258991	24.51882493	24.51882493	0	24.51882493	0	24.51882493	0	0	24.51882493	0	24.51882493	0	0	0												13.858	0.195537629	6.35961108	0	0.956601955	1.424053489	0.189862583	0.864962846	6.861593156	0	3.22250916	0	0	0.234399966	7.460874102	10.87275032	0.285133502	0.995954669	0	0.165216015	0	1.190858894	0	0	0.619815462	0	0.293980711	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0518	0	1.1	13.858	0.195537629	6.35961108	0	0.956601955	1.424053489	0.189862583	0.864962846	6.861593156	0	3.22250916	0	0	0.234399966	7.460874102	10.87275032	0.285133502	0.995954669	0	0.165216015	0	1.190858894	0	0	0.619815462	0	0.293980711	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0518	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 11-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay: $0, 13D Other 2 Copay: $0, 13E Other 3 Copay: $0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.858	0.195537629	6.35961108	0	0.956601955	1.424053489	0.189862583	0.864962846	6.861593156	0	3.22250916	0	0	0.234399966	7.460874102	10.87275032	0.285133502	0.995954669	0	0.165216015	0	1.190858894	0	0	0.619815462	0	0.293980711	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0518
H8578_009_0	2010	2	N/A																															A	A	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	O	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	YES	226.08	3.19	778.13	0	156.06	7.26	5.03	220.85	279.85	0	262.86	0	0	114.72	3651.5	4434.45	139.55	487.44	0	80.86	0	582.83	0	0	303.35	0	143.88	0	0	0											3400	1A IP Acute: $750 Per Admit	1B IP Psych: $750 Per Admit	2 SNF: $100 for days 11-100	6 Home Health: $0	10A Ambulance: $75	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: $300	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $150	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $25, 5 Partial Hosp: $25, 9C OP Substance Abuse: $25, 9D Cardiac Rehab: $0"	"7A PCP: $25, 14B Immunizations: $0, 14C Physical Exams: $25, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $30, 7F Podiatry: $30, 7D Physician Specialist (excl. Radiology): $30"	"7E Mental Health: $25, 7H Psychiatric: $25"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $25	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											750	750	100	0	75	0.200000019	0.038486796	47.9205343	300	0	150	0	0	25	25	30	25	25	0	25	0	25	0	0	25	0	25	0	0	0											NO	735.5647478	735.5647478	98.07529971	0	73.55647478	0.196150618	0.03774604	46.99820764	294.2258991	0	147.1129496	0	0	24.51882493	24.51882493	29.42258991	24.51882493	24.51882493	0	24.51882493	0	24.51882493	0	0	24.51882493	0	24.51882493	0	0	0												13.858	0.195537629	6.35961108	0	0.956601955	1.424053489	0.189862583	0.864962846	6.861593156	0	3.22250916	0	0	0.234399966	7.460874102	10.87275032	0.285133502	0.995954669	0	0.165216015	0	1.190858894	0	0	0.619815462	0	0.293980711	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0518	0	1.1	13.858	0.195537629	6.35961108	0	0.956601955	1.424053489	0.189862583	0.864962846	6.861593156	0	3.22250916	0	0	0.234399966	7.460874102	10.87275032	0.285133502	0.995954669	0	0.165216015	0	1.190858894	0	0	0.619815462	0	0.293980711	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0518	NO	1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0 for days 11-100	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: $0, 13C Other 1 Copay: $0, 13D Other 2 Copay: $0, 13E Other 3 Copay: $0"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.858	0.195537629	6.35961108	0	0.956601955	1.424053489	0.189862583	0.864962846	6.861593156	0	3.22250916	0	0	0.234399966	7.460874102	10.87275032	0.285133502	0.995954669	0	0.165216015	0	1.190858894	0	0	0.619815462	0	0.293980711	0	0	0	0	0	0	0	0	0	0	0	0	0	56.0518
H8578_010_0	2010	3	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	170.13	2.4	612.285	0	120.03	0	0	170.2725	216.21	0	0	0	0	877.8525	3042.0525	3691.3125	113.1375	406.9125	0	67.5	0	486.5475	0	0	248.1975	0	117.72	0	0	0												1A IP Acute: $200 Per Admit	1B IP Psych: $200 Per Admit	2 SNF: $25 for days 11-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $10"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $10, 5 Partial Hosp: $10, 9C OP Substance Abuse: $10, 9D Cardiac Rehab: $0"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $10, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $10, 7F Podiatry: $10, 7D Physician Specialist (excl. Radiology): $10"	"7E Mental Health: $10, 7H Psychiatric: $10"	"7C Occupational Therapy: $10, 7I Physical and Speech Therapy: $10"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $10, 18A Hearing Exams (Medicare Covered): $10"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $10"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $10	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											200	200	25	0	50	0	0	46.39695194	100	0	0	0	0	10	10	10	10	10	0	10	0	10	0	0	10	0	10	0	0	0											NO	196.417362	196.417362	24.55217025	0	49.10434049	0	0	45.56583452	98.20868099	0	0	0	0	9.820868099	9.820868099	9.820868099	9.820868099	9.820868099	0	9.820868099	0	9.820868099	0	0	9.820868099	0	9.820868099	0	0	0												2.7847	0.039283472	1.252743797	0	0.491166166	0	0	0.646550713	1.76947491	0	0	0	0	0.718439468	2.489633029	3.020991098	0.092592372	0.333019499	0	0.055242383	0	0.398193235	0	0	0.203126242	0	0.096342716	0	0	0	0	0	0	0	0	0	0	0	0	0	14.3915	0	0.2625	2.7847	0.039283472	1.252743797	0	0.491166166	0	0	0.646550713	1.76947491	0	0	0	0	0.718439468	2.489633029	3.020991098	0.092592372	0.333019499	0	0.055242383	0	0.398193235	0	0	0.203126242	0	0.096342716	0	0	0	0	0	0	0	0	0	0	0	0	0	14.3915	YES	1A IP Acute: $400 Per Admit	1B IP Psych: $400 Per Admit	2 SNF: $50 for days 11-100	6 Home Health: $0	10A Ambulance: $50	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $200	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $100	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $20, 5 Partial Hosp: $20, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $0"	"7A PCP: $20, 14B Immunizations: $0, 14C Physical Exams: $20, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $20	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $20	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $20	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 Copay: Not Covered, 13D Other 2 Copay: Not Covered, 13E Other 3 Copay: Not Covered"											3400	2.1743	0.0363	1.3099	0	0.166	0.571	0.0848	0.2204	1.7337	0	0.5587	0	0	0.0453	1.5811	1.9221	0.0595	0.211	0	0.0351	0	0.252	0	0	0.1287	0	0.0613	0	0	0											11.1513	0	0.175	4.959	0.07561361	2.562596216	0	0.657200081	0.570999674	0.084826133	0.866901041	3.503173046	0	0.55875	0	0	0.763765528	4.070715644	4.943139969	0.15204847	0.543982819	0	0.090346063	0	0.650240638	0	0	0.331837644	0	0.157596694	0	0	0	0	0	0	0	0	0	0	0	0	0	25.5428
H8578_801_0	2010	2	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	255.13	2.66	44.89	32.4	4.53	8.15	5.62	10.52	31.46	13.74	26.69	1.16	0.2	27.02	42.53	105.29	1.3	4.44	29.43	30.58	8.52	6.72	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.076488607	0.076560562	0.168495132	0	0.233229742	0.233000008	0.2329841	0.232893766	0.232999997	0.233025386	0.23294537	0.23300017	0.23299997	0.23306676	0.232988669	0.232996227	0.233010611	0.232964833	0.232998072	0.23300493	0.232998753	0.232997311	0	0	0	0	0	0	0	0											NO	0.076488607	0.076560562	0.168495132	0	0.233229742	0.233000008	0.2329841	0.232893766	0.232999997	0.233025386	0.23294537	0.23300017	0.23299997	0.23306676	0.232988669	0.232996227	0.233010611	0.232964833	0.232998072	0.23300493	0.232998753	0.232997311	0	0	0	0	0	0	0	0												19.5145	0.203651095	7.563746469	0	1.056530733	1.898950063	1.309370642	2.450042415	7.330179897	3.201768801	6.217311924	0.270280197	0.046599994	6.297463848	9.909008104	24.53217272	0.302913794	1.03436386	6.857133259	7.125290749	1.985149375	1.565741931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6722	0	0	19.5145	0.203651095	7.563746469	0	1.056530733	1.898950063	1.309370642	2.450042415	7.330179897	3.201768801	6.217311924	0.270280197	0.046599994	6.297463848	9.909008104	24.53217272	0.302913794	1.03436386	6.857133259	7.125290749	1.985149375	1.565741931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6722	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5145	0.203651095	7.563746469	0	1.056530733	1.898950063	1.309370642	2.450042415	7.330179897	3.201768801	6.217311924	0.270280197	0.046599994	6.297463848	9.909008104	24.53217272	0.302913794	1.03436386	6.857133259	7.125290749	1.985149375	1.565741931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6722
H8578_802_0	2010	2	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	255.13	2.66	44.89	32.4	4.53	8.15	5.62	10.52	31.46	13.74	26.69	1.16	0.2	27.02	42.53	105.29	1.3	4.44	29.43	30.58	8.52	6.72	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.076488607	0.076560562	0.168495132	0	0.233229742	0.233000008	0.2329841	0.232893766	0.232999997	0.233025386	0.23294537	0.23300017	0.23299997	0.23306676	0.232988669	0.232996227	0.233010611	0.232964833	0.232998072	0.23300493	0.232998753	0.232997311	0	0	0	0	0	0	0	0											NO	0.076488607	0.076560562	0.168495132	0	0.233229742	0.233000008	0.2329841	0.232893766	0.232999997	0.233025386	0.23294537	0.23300017	0.23299997	0.23306676	0.232988669	0.232996227	0.233010611	0.232964833	0.232998072	0.23300493	0.232998753	0.232997311	0	0	0	0	0	0	0	0												19.5145	0.203651095	7.563746469	0	1.056530733	1.898950063	1.309370642	2.450042415	7.330179897	3.201768801	6.217311924	0.270280197	0.046599994	6.297463848	9.909008104	24.53217272	0.302913794	1.03436386	6.857133259	7.125290749	1.985149375	1.565741931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6722	0	0	19.5145	0.203651095	7.563746469	0	1.056530733	1.898950063	1.309370642	2.450042415	7.330179897	3.201768801	6.217311924	0.270280197	0.046599994	6.297463848	9.909008104	24.53217272	0.302913794	1.03436386	6.857133259	7.125290749	1.985149375	1.565741931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6722	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5145	0.203651095	7.563746469	0	1.056530733	1.898950063	1.309370642	2.450042415	7.330179897	3.201768801	6.217311924	0.270280197	0.046599994	6.297463848	9.909008104	24.53217272	0.302913794	1.03436386	6.857133259	7.125290749	1.985149375	1.565741931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6722
H8578_803_0	2010	2	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	255.13	2.66	44.89	32.4	4.53	8.15	5.62	10.52	31.46	13.74	26.69	1.16	0.2	27.02	42.53	105.29	1.3	4.44	29.43	30.58	8.52	6.72	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.076488607	0.076560562	0.168495132	0	0.233229742	0.233000008	0.2329841	0.232893766	0.232999997	0.233025386	0.23294537	0.23300017	0.23299997	0.23306676	0.232988669	0.232996227	0.233010611	0.232964833	0.232998072	0.23300493	0.232998753	0.232997311	0	0	0	0	0	0	0	0											NO	0.076488607	0.076560562	0.168495132	0	0.233229742	0.233000008	0.2329841	0.232893766	0.232999997	0.233025386	0.23294537	0.23300017	0.23299997	0.23306676	0.232988669	0.232996227	0.233010611	0.232964833	0.232998072	0.23300493	0.232998753	0.232997311	0	0	0	0	0	0	0	0												19.5145	0.203651095	7.563746469	0	1.056530733	1.898950063	1.309370642	2.450042415	7.330179897	3.201768801	6.217311924	0.270280197	0.046599994	6.297463848	9.909008104	24.53217272	0.302913794	1.03436386	6.857133259	7.125290749	1.985149375	1.565741931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6722	0	0	19.5145	0.203651095	7.563746469	0	1.056530733	1.898950063	1.309370642	2.450042415	7.330179897	3.201768801	6.217311924	0.270280197	0.046599994	6.297463848	9.909008104	24.53217272	0.302913794	1.03436386	6.857133259	7.125290749	1.985149375	1.565741931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6722	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	19.5145	0.203651095	7.563746469	0	1.056530733	1.898950063	1.309370642	2.450042415	7.330179897	3.201768801	6.217311924	0.270280197	0.046599994	6.297463848	9.909008104	24.53217272	0.302913794	1.03436386	6.857133259	7.125290749	1.985149375	1.565741931	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.6722
H8604_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	NO	1675.135	50.065	1839.675	437.855	392.1	12.47171126	0	418.8	446.215	7575.965	718.675	209.285	1269.8	5140.83	3886.07	3210.43	161.785	337.63	714.115	0	15.83777866	0	0	0	221.9	160.8	0	0	0	0												$100 / days 1-10	$100 / days 1-10	$75 / days 21-100	$0.00 	125	20%	20%	$50.00 	$150.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$30 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											81.96721311	81.96721311	21.41925717	$0.00 	125	20%	20%	$50.00 	$150.00 	$0.00 	5	$0.00 	$0.00 	3	15	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	70.08196721	70.08196721	18.31346488	0	106.875	0.171	0.171	42.75	128.25	0	4.275	0	0	2.565	12.825	25.65	25.65	25.65	0	0	0.1539	0	0	0	25.65	12.825	0	0	0	0												9.7831	0.292387807	2.807568626	0	3.492140625	2.132662626	0	1.491975	4.768922813	0	0.256027969	0	0	1.098852413	4.153237313	6.862294125	0.345815438	0.721684125	0	0	2.437434136	0	0	0	0.47431125	0.171855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2902		7.002437053	9.7831	0.292387807	2.807568626	0	3.492140625	2.132662626	0	1.491975	4.768922813	0	0.256027969	0	0	1.098852413	4.153237313	6.862294125	0.345815438	0.721684125	0	0	2.437434136	0	0	0	0.47431125	0.171855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.2902	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$25.00 	$40.00 	$40.00 	$40.00 	$40.00 	$40.00 	20%	20%	0	0	0	0	0	0	0	0											3400	2.6061	0.0779	0.5235	0.0512	0	0.1848	0	0	0.4785	0.608	0.0577	0.0168	0	0.4126	0.3643	0.4816	0.0243	0.0506	0.1071	0	0.1634	0	0	0	0	0	0	0	0	0											6.2083	250	1.052871197	12.3891	0.370275343	3.331116222	0.051195114	3.492140625	2.317440874	0	1.491975	5.247456119	0.607987274	0.313703163	0.016795566	0	1.511414933	4.517556375	7.343858625	0.370083188	0.772328625	0.10711725	0	2.600813326	0	0	0	0.47431125	0.171855	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.4985
H8604_002_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	NO	1637.61	48.925	1802.15	428.925	384.1	12.21726469	0	410.2	435.385	7459.115	707.56	206.055	1250.2	5061.505	3933.38	3249.475	163.685	341.715	722.855	0	15.51465792	0	0	0	216.1	156.6	0	0	0	0												$150 / days 1-10	$150 / days 1-10	$75 / days 21-100	$0.00 	$125.00 	20%	20%	$50.00 	$200.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$35 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											122.9508197	122.9508197	21.41925717	$0.00 	$125.00 	20%	20%	$50.00 	$200.00 	$0.00 	5	$0.00 	$0.00 	3.5	15	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	100.5737705	100.5737705	17.52095237	0	102.25	0.1636	0.1636	40.9	163.6	0	4.09	0	0	2.863	12.27	28.63	28.63	28.63	0	0	0.14724	0	0	0	28.63	12.27	0	0	0	0												13.7251	0.410047643	2.631282026	0	3.272852083	1.998744503	0	1.398098333	5.935748833	0	0.241160033	0	0	1.207590735	4.02188105	7.752705771	0.390525129	0.815275038	0	0	2.284378233	0	0	0	0.515578583	0.1601235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.761		10.40404613	13.7251	0.410047643	2.631282026	0	3.272852083	1.998744503	0	1.398098333	5.935748833	0	0.241160033	0	0	1.207590735	4.02188105	7.752705771	0.390525129	0.815275038	0	0	2.284378233	0	0	0	0.515578583	0.1601235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.761	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$25.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	2.4516	0.0732	0.4915	0.0483	0	0.1739	0	0	0.4493	0.5743	0.0545	0.0159	0	0.3897	0.3528	0.5246	0.0264	0.0552	0.1167	0	0.154	0	0	0	0	0	0	0	0	0											5.9518	250	1.324230835	16.1767	0.483291468	3.122806973	0.048257194	3.272852083	2.17261547	0	1.398098333	6.385009148	0.57426623	0.295634031	0.01586387	0	1.597268517	4.374677633	8.277324958	0.416951642	0.870444025	0.116703038	0	2.438381627	0	0	0	0.515578583	0.1601235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.7128
H8604_003_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	NO	2100.545	82.365	2578.395	2272.685	449.2	18.23262515	0	400.6	361.38	14861.61	628.52	235.98	291.2	6344.765	3607.245	3244.25	165.68	31.54	896.04	0	19.87009753	0	0	0.095	267.1	157.1	0	0	0	0												$100 / days 1-10	$100 / days 1-10	$75 / days 21-100	$0.00 	125	20%	20%	$50.00 	$150.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$30 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											81.96721311	81.96721311	21.41925717	$0.00 	125	20%	20%	$50.00 	$150.00 	$0.00 	5	$0.00 	$0.00 	3	15	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	70.08196721	70.08196721	18.31346488	0	106.875	0.171	0.171	42.75	128.25	0	4.275	0	0	2.565	12.825	25.65	25.65	25.65	0	0	0.1539	0	0	0	25.65	12.825	0	0	0	0												12.2675	0.481025102	3.934945524	0	4.0006875	3.1177789	0	1.4271375	3.86224875	0	0.22391025	0	0	1.356193519	3.855243094	6.934584375	0.354141	0.06741675	0	0	3.058008009	0	0	0	0.57092625	0.167900625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6797		7.746845349	12.2675	0.481025102	3.934945524	0	4.0006875	3.1177789	0	1.4271375	3.86224875	0	0.22391025	0	0	1.356193519	3.855243094	6.934584375	0.354141	0.06741675	0	0	3.058008009	0	0	0	0.57092625	0.167900625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.6797	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$25.00 	$40.00 	$40.00 	$40.00 	$40.00 	$40.00 	20%	20%	0	0	0	0	0	0	0	0											3400	2.6084	0.1023	0.8351	0.1827	0	0.2701	0	0	0.5529	0.9178	0.0388	0.0146	0	0.3918	0.3382	0.4866	0.0249	0.0047	0.1344	0	0.205	0	0	0	0	0	0	0	0	0											7.1084	250	1.205511582	14.876	0.583304791	4.770083057	0.182669878	4.0006875	3.387909636	0	1.4271375	4.415165429	0.917799975	0.262725401	0.014573282	0	1.748023553	4.193422313	7.421221875	0.378993	0.07214775	0.134406	0	3.262983752	0	0	0	0.57092625	0.167900625	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.788
H8604_004_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	NO	2085.63	81.7	2565.285	2261.19	446.9	18.13981291	0	398.5	358.15	14709.42	622.06	233.51	288.3	6279.785	3412.78	3069.355	156.75	29.83	847.78	0	19.76894983	0	0	0.095	264	155.3	0	0	0	0												$150 / days 1-10	$150 / days 1-10	$75 / days 21-100	$0.00 	$125.00 	20%	20%	$50.00 	$200.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$35 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											122.9508197	122.9508197	21.41925717	$0.00 	$125.00 	20%	20%	$50.00 	$200.00 	$0.00 	5	$0.00 	$0.00 	3.5	15	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	100.5737705	100.5737705	17.52095237	0	102.25	0.1636	0.1636	40.9	163.6	0	4.09	0	0	2.863	12.27	28.63	28.63	28.63	0	0	0.14724	0	0	0	28.63	12.27	0	0	0	0												17.48	0.684739754	3.745519691	0	3.807960417	2.967673393	0	1.358220833	4.882778333	0	0.212018783	0	0	1.498252038	3.48956755	7.322969471	0.373979375	0.071169408	0	0	2.910780172	0	0	0	0.62986	0.15879425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5943		11.47940664	17.48	0.684739754	3.745519691	0	3.807960417	2.967673393	0	1.358220833	4.882778333	0	0.212018783	0	0	1.498252038	3.48956755	7.322969471	0.373979375	0.071169408	0	0	2.910780172	0	0	0	0.62986	0.15879425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	51.5943	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$25.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	2.4923	0.0976	0.7963	0.1749	0	0.2582	0	0	0.5272	0.8658	0.0366	0.0137	0	0.3696	0.3061	0.4955	0.0253	0.0048	0.1369	0	0.1962	0	0	0	0	0	0	0	0	0											6.7971	250	1.512323357	19.9722	0.782368464	4.541831329	0.174878394	3.807960417	3.225831572	0	1.358220833	5.409985423	0.865831671	0.248634724	0.013744958	0	1.867895215	3.795669967	7.818508758	0.39928625	0.075985383	0.13687185	0	3.107013011	0	0	0	0.62986	0.15879425	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.3914
H8604_801_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	NO	1824.76	64.315	2148.71	1340.83	406.3	14.25813858	0	393.8	386.745	10885.195	643.245	213.75	728.4	5522.825	3588.53	3095.575	157.035	172.045	775.01	0	16.53160122	0	0	0.095	236.1	152.9	0	0	0	0												$100 / days 1-10	$100 / days 1-10	$50 / days 21-100	$0.00 	100	20%	20%	$50.00 	$150.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$30 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											81.96721311	81.96721311	14.27950478	$0.00 	100	20%	20%	$50.00 	$150.00 	$0.00 	5	$0.00 	$0.00 	3	15	$30.00 	$30.00 	$30.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$30.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	71.06557377	71.06557377	12.38033065	0	86.7	0.1734	0.1734	43.35	130.05	0	4.335	0	0	2.601	13.005	26.01	26.01	26.01	0	0	0.15606	0	0	0	26.01	13.005	0	0	0	0												10.8065	0.380881865	2.216811688	0	2.9355175	2.472361229	0	1.4226025	4.191348938	0	0.232372256	0	0	1.197072319	3.889069388	6.709658813	0.340373363	0.372907538	0	0	2.579921687	0	0	0	0.51174675	0.165705375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4248		6.201269849	10.8065	0.380881865	2.216811688	0	2.9355175	2.472361229	0	1.4226025	4.191348938	0	0.232372256	0	0	1.197072319	3.889069388	6.709658813	0.340373363	0.372907538	0	0	2.579921687	0	0	0	0.51174675	0.165705375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.4248	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$25.00 	$40.00 	$40.00 	$40.00 	$40.00 	$40.00 	20%	20%	0	0	0	0	0	0	0	0											3400	2.4303	0.0857	0.6397	0.1116	0	0.2139	0	0	0.4824	0.7221	0.0427	0.0142	0	0.3664	0.3411	0.4709	0.0239	0.0262	0.1179	0	0.1726	0	0	0	0	0	0	0	0	0											6.2615	250	0.960535333	13.2368	0.466539821	2.856497748	0.111638156	2.9355175	2.686308351	0	1.4226025	4.673747894	0.722108649	0.275044232	0.014179877	0	1.563448823	4.230215825	7.180512063	0.364259213	0.399076488	0.1178831	0	2.752546407	0	0	0	0.51174675	0.165705375	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.6864
H8604_802_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	P	P	P	P	P	P	V	V	V	V	V	V	Coin	O	T	V	V	P	V	P	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	NO	1895.915	66.785	2228.035	1395.93	422.5	15.50048053	0	409.9	401.09	11428.405	675.355	224.39	764.7	5798.42	3839.9	3312.365	168.055	184.11	829.35	0	17.97203482	0	0	0.095	244.3	158.1	0	0	0	0												$150 / days 1-10	$150 / days 1-10	$75 / days 21-100	$0.00 	125	20%	20%	$50.00 	$200.00 	$0.00 	$50 Scans	$0.00 	$0.00 	"$35 Rad Ther, CORF"	"$15.00, $0.00 Prev."	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	"20%, 10% Chemo, $5 Diab Supp"	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											122.9508197	122.9508197	21.41925717	$0.00 	125	20%	20%	$50.00 	$200.00 	$0.00 	5	$0.00 	$0.00 	3.5	15	$35.00 	$35.00 	$35.00 	$0.00 	$0.00 	0.18	$0.00 	$0.00 	$0.00 	$35.00 	$15.00 	$0.00 	$0.00 	$0.00 	$0.00 											NO	100.5737705	100.5737705	17.52095237	0	102.25	0.1636	0.1636	40.9	163.6	0	4.09	0	0	2.863	12.27	28.63	28.63	28.63	0	0	0.14724	0	0	0	28.63	12.27	0	0	0	0												15.8899	0.559734939	3.253107926	0	3.600052083	2.535878615	0	1.397075833	5.468193667	0	0.230183496	0	0	1.383406372	3.92629775	7.902750829	0.400951221	0.439255775	0	0	2.646202407	0	0	0	0.582859083	0.16165725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3776		11.20869707	15.8899	0.559734939	3.253107926	0	3.600052083	2.535878615	0	1.397075833	5.468193667	0	0.230183496	0	0	1.383406372	3.92629775	7.902750829	0.400951221	0.439255775	0	0	2.646202407	0	0	0	0.582859083	0.16165725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3776	YES	20%	20%	20%	20%	0	30%	30%	0	20%	20%	20%	20%	0	20%	$25.00 	$45.00 	$45.00 	$45.00 	$45.00 	$45.00 	20%	20%	0	0	0	0	0	0	0	0											3400	2.5066	0.0883	0.6584	0.1154	0	0.2206	0	0	0.4965	0.7514	0.0444	0.0148	0	0.3812	0.3444	0.5348	0.0271	0.0297	0.1339	0	0.1784	0	0	0	0	0	0	0	0	0											6.5258	250	1.451960613	18.3965	0.64803089	3.911531058	0.115370562	3.600052083	2.756474928	0	1.397075833	5.96471858	0.75135692	0.2745845	0.014752451	0	1.764621685	4.270709833	8.437523442	0.428083258	0.46897985	0.133896375	0	2.8245985	0	0	0	0.582859083	0.16165725	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.9034
H8644_003_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	O	O	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	YES	1284.927032	46.802308	285.436983	869.49404	42.570066	10.195495	4.328708	353.341064	336.992927	998.395989	830.041843	88.415273	0.01063	542.372494	3915.327249	3228.863536	84.901659	765.637801			16.05261	0		1.43					0.04	0.25	1.738603	0.05	0.55	1.58	0.25	0.32	0.4	0.49			5000	$215/Day(Days 1-8):1a	$215/Day(Days 1-8):1b	"$0/Day(Days 1-14) $80(Days 15-100):2. $0 SNF 1,2. $80 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	$0/Visit:8a	"$0-$100/Visit:14h. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $35 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$0-$100/Visit:9d. $0 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $35 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			159.342305	143.633115	38.58248	0	150	0.2	0.2	50	192.964371	0	52.144774	50	0.2	45.025599	10	35	35	38.798422			0.2	0		0					0	0	0	0	0	0	0	0	0	0			NO	148.795916	134.12647	32.250478	0	134.8095	0.179746	0.179746	44.9365	173.422869	0	46.864073	44.9365	0.179746	40.465857	8.9873	31.45555	31.45555	34.869306			0.179746	0		0					0	0	0	0	0	0	0	0	0	0				15.9327	0.52311903	0.767123262	0	0.478237443	1.832599444	0.778067948	1.323159227	4.870190019	0	3.241595127	0.33108941	0.0019107	1.828963982	2.932351715	8.463806533	0.222552365	2.224771564	0	0	2.885392437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6376	0	4.85682	15.9327	0.52311903	0.767123262	0	0.478237443	1.832599444	0.778067948	1.323159227	4.870190019	0	3.241595127	0.33108941	0.0019107	1.828963982	2.932351715	8.463806533	0.222552365	2.224771564	0	0	2.885392437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.6376	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	Routine Chiropractic	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a			7500	3.9669	0.1388	0.3307	3.3221	2.2752	2.1557	0.9153	0.2777	4.1412	0.4021	1.5552	0.2649	0.0004	0.8013	1.8909	2.1184	0.0267	0.3449			0.8384	0		0					0	0	0	0	0	0	0	0	0	0			25.7671	500	3.869555	19.8996	0.66194503	1.097866262	3.322093	2.753471443	3.988313444	1.693320948	1.600879227	9.011385019	0.402126	4.796772127	0.59601341	0.0023327	2.630272982	4.823277715	10.58225153	0.249284365	2.569627564	0	0	3.723817437	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.4047
H8644_801_0	2010	4	N/A																															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	NO	284.1301377	0.969185779	10.04487155	24.344829	3.065014089	13.37713019	6.538995737	22.78062627	77.11019896	9.626062135	23.11012929	8.112719611	0.712704129	14.69681235	25.05467598	54.94747988	0.264057988	4.057558946			18.91782756	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																			0.082851658	0.082851658	0.182293858	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.082851658	0.082851658	0.182293858	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.5407	0.080298649	1.83111839	0	0.714148283	3.116871333	1.523586007	5.307885921	17.96667636	2.242872477	5.384660125	1.890263669	0.166060062	3.424357278	5.837739503	12.80276281	0.061525511	0.945411234	0	0	4.407853822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2447	0	0	23.5407	0.080298649	1.83111839	0	0.714148283	3.116871333	1.523586007	5.307885921	17.96667636	2.242872477	5.384660125	1.890263669	0.166060062	3.424357278	5.837739503	12.80276281	0.061525511	0.945411234	0	0	4.407853822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2447	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3964	0.0014	0.0766	0	1.2106	0.6549	0.3201	0.4332	1.338	0.1831	0.399	0.1543	0.0136	0.2774	0.3387	0.7427	0.0036	0.0626			0.008	0																			6.6138	0	0	23.9371	0.081651879	1.907688312	0	1.924708383	3.771757743	1.84368229	5.741086914	19.3046812	2.425933462	5.783611133	2.044540602	0.179626101	3.701753293	6.176404655	13.54547798	0.065092524	1.00801435	0	0	4.415808078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8586
H8644_802_0	2010	4	N/A																															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	NO	284.1301377	0.969185779	10.04487155	24.344829	3.065014089	13.37713019	6.538995737	22.78062627	77.11019896	9.626062135	23.11012929	8.112719611	0.712704129	14.69681235	25.05467598	54.94747988	0.264057988	4.057558946			18.91782756	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																			0.082851658	0.082851658	0.182293858	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.082851658	0.082851658	0.182293858	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.5407	0.080298649	1.83111839	0	0.714148283	3.116871333	1.523586007	5.307885921	17.96667636	2.242872477	5.384660125	1.890263669	0.166060062	3.424357278	5.837739503	12.80276281	0.061525511	0.945411234	0	0	4.407853822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2447	0	0	23.5407	0.080298649	1.83111839	0	0.714148283	3.116871333	1.523586007	5.307885921	17.96667636	2.242872477	5.384660125	1.890263669	0.166060062	3.424357278	5.837739503	12.80276281	0.061525511	0.945411234	0	0	4.407853822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2447	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3964	0.0014	0.0766	0	1.2106	0.6549	0.3201	0.4332	1.338	0.1831	0.399	0.1543	0.0136	0.2774	0.3387	0.7427	0.0036	0.0626			0.008	0																			6.6138	0	0	23.9371	0.081651879	1.907688312	0	1.924708383	3.771757743	1.84368229	5.741086914	19.3046812	2.425933462	5.783611133	2.044540602	0.179626101	3.701753293	6.176404655	13.54547798	0.065092524	1.00801435	0	0	4.415808078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8586
H8644_803_0	2010	4	N/A																															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	NO	284.1301377	0.969185779	10.04487155	24.344829	3.065014089	13.37713019	6.538995737	22.78062627	77.11019896	9.626062135	23.11012929	8.112719611	0.712704129	14.69681235	25.05467598	54.94747988	0.264057988	4.057558946			18.91782756	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																			0.082851658	0.082851658	0.182293858	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.082851658	0.082851658	0.182293858	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				23.5407	0.080298649	1.83111839	0	0.714148283	3.116871333	1.523586007	5.307885921	17.96667636	2.242872477	5.384660125	1.890263669	0.166060062	3.424357278	5.837739503	12.80276281	0.061525511	0.945411234	0	0	4.407853822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2447	0	0	23.5407	0.080298649	1.83111839	0	0.714148283	3.116871333	1.523586007	5.307885921	17.96667636	2.242872477	5.384660125	1.890263669	0.166060062	3.424357278	5.837739503	12.80276281	0.061525511	0.945411234	0	0	4.407853822	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.2447	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3964	0.0014	0.0766	0	1.2106	0.6549	0.3201	0.4332	1.338	0.1831	0.399	0.1543	0.0136	0.2774	0.3387	0.7427	0.0036	0.0626			0.008	0																			6.6138	0	0	23.9371	0.081651879	1.907688312	0	1.924708383	3.771757743	1.84368229	5.741086914	19.3046812	2.425933462	5.783611133	2.044540602	0.179626101	3.701753293	6.176404655	13.54547798	0.065092524	1.00801435	0	0	4.415808078	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.8586
H8649_002_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	P	V	P	V	P	O	O																																																			0	YES	813.6566362	36.50571391	766.2822249		59.1217535	11.99189218	25.82686278	353.0985972	424.3209343	1290.664746	640.6366873	10.07633833	0.044889748	913.1856406	3602.781655	4750.13508	188.110698	914.4182024	3048.398679	4640.973084	17.52093872				134.6239076		263.4854825			125.6507224											2500	1a: $150/d (1-7) then $0;1a1: $150/d (1-7) then $0	1b: $150/d (1-7) then $0	"2: $0 (1-20),$100/d (21-100)"	6: $0/visit	10a: $150/trip	11a: 20%	11b: 20%;11c: $15/visit	4a: $50/visit;4a1: $50/visit;4b: $25/visit	9a: $200/visit;9b: $200/visit	8a: $30/visit	8b: $75/visit;8b: $30/visit	9a: $200/visit	12a: 20%	3: $25/visit;5: $60/visit;9a: $200/visit;9c: $30/visit;9d: 25%;7i: $30/visit;7e: $30/visit;7c: $30/visit	7a: $15/visit;14b: $0/visit;14c: $15/visit;14d: $0/visit;14d1: $0/visit;14e: $0/visit;14e1: $0/visit;14f: $0/visit;14f1: $0/visit;14g: $0/visit;14g1: $0/visit	7b: $30/visit;7b1: $30/visit;7d: $30/visit;7f: $30/visit;7f1: $30/visit;16b: 20%;17a: $30/visit;18a: $30/visit	7e: $30/visit;7h: $30/visit;7a: $15/visit;7d: $30/visit	7c: $30/visit;7i: $30/visit;7a: $15/visit;7d: $30/visit	14h: $0/visit;14h1: $0/visit;7a: $15/visit;7d: $30/visit	7g: $30/visit;14b: $0/visit;14i: 20%;14j: 20%7a: $15/visit;7d: $30/visit;8a: $30/visit;12a: 20%	15: 20%	13a: $0/visit;17b: 20%		16a: $0/visit	17a1: $30/visit		18a1: $30/visit		14a: $0	14c1: $15/visit											125.6687114	99.38434429	17.99851117		150	0.2	0.196529861	45.66898158	180.0616525	30	72.06952802	200	0.2	94.78112523	15	30	29.97398881	29.74462341	7.274385922	6.886576602	0.2				30		30			15											NO	112.3434025	88.84610394	16.09003516		134.0947177	0.178792957	0.175690775	40.82646128	160.9687764	26.81894354	64.4276201	178.7929569	0.178792957	85.65747464	15	30	29.97398881	29.74462341	7.274385922	6.886576602	0.178792957				30		30			15												7.6174	0.270282538	1.027458995	0	0.66065957	2.144065863	4.537541525	1.201313851	5.691868466	2.88452208	3.439558093	0.150131527	0.008025971	6.518431321	4.503477068	11.8753377	0.469868996	2.266585423	1.847935703	2.663368054	3.132620442	0	0	0	0.336559769	0	0.658713706	0	0	0.157063403	0	0	0	0	0	0	0	0	0	0	64.0628	0	4.580685539	7.6174	0.270282538	1.027458995	0	0.66065957	2.144065863	4.537541525	1.201313851	5.691868466	2.88452208	3.439558093	0.150131527	0.008025971	6.518431321	4.503477068	11.8753377	0.469868996	2.266585423	1.847935703	2.663368054	3.132620442	0	0	0	0.336559769	0	0.658713706	0	0	0.157063403	0	0	0	0	0	0	0	0	0	0	64.0628	NO	OON: 30%		OON: 30%	OON: 30%	OON: $150/trip	OON: 30%	OON: 30%	OON: $50/visit;OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%		OON: 30%	OON: 30%	OON: 30%	OON: 20%	OON: 30%			OON: 30%		OON: 30%			OON: 30%												1.068		0.1927	0.406	0.6942	0.8322	0.3642	0.0231	0.3294	0.0224	0.2842	0.0029	0.0002	0.1033	1.3723	1.1586		0.0221	0.1267	0.4195	1.965				0.0253		0.0071			0.0048											9.4242	500	0	8.6854	0.270282538	1.220109871	0.406016096	1.354872738	2.976227177	4.901762304	1.224404785	6.021269599	2.906881833	3.723731047	0.153080314	0.008212489	6.62171057	5.875767126	13.03397857	0.469868996	2.288709333	1.974602011	3.082899728	5.097649192	0	0	0	0.361866708	0	0.665809779	0	0	0.161878891	0	0	0	0	0	0	0	0	0	0	73.487
H8649_003_0	2010	9	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	Coin	T	P	V	P	V	P	O	O																																																			0	YES	743.0103673	28.744212	767.591051		44.4684977	8.988269277	16.67457413	275.538997	373.9905246	1097.449719	623.5708003	18.76633192	0.033771001	842.5584686	3004.338023	3686.382695	149.8564201	631.5377077	2386.728741	3720.544804	16.64987363				152.3771465					111.9730715											3400	1a: $150/d (1-10) then $0;1a1: $150/d (1-10) then $0	1b: $150/d (1-10) then $0	"2: $0 (1-22),$100d (23-100)"	6: $0/visit	10a: $150/trip	11a: 20%	11b: 20%;11c: $20/visit	4a: $50/visit;4a1: $50/visit;4b: $35/visit	9a: $300/visit;9b: $300/visit	8a: $30/visit	8b: $75/visit;8b: $30/visit	9a: $300/visit	12a: 20%	3: $25/visit;5: $60/visit;9a: $300/visit;9c: $40/visit;9d: 25%;7i: $45/visit;7e: $40/visit;7c: $45/visit	7a: $20/visit;14b: $0/visit;14c: $20/visit;14d: $0/visit;14d1: $0/visit;14e: $0/visit;14f: $0/visit;14g: $0/visit	7b: $45/visit;7d: $45/visit;7f: $45/visit;16b: 20%;17a: $45/visit;18a: $45/visit	7e: $40/visit;7h: $40/visit;7a: $20/visit;7d: $40/visit	7c: $45/visit;7i: $45/visit;7a: $20/visit;7d: $45/visit	14h: $0/visit;7a: $20/visit;7d: $45/visit	7g: $45/visit;14b: $0/visit;14i: 20%;14j: 20%7a: $20/visit;7d: $45/visit;8a: $30/visit;12a: 20%	15: 20%	13a: 20%;17b: 20%		16a: $0/visit	17a1: $45/visit				14a: $0	14c1: $20/visit											134.6370273	114.6514077	15.671666		150	0.2	0.200709706	46.51828234	269.1845453	30	66.59536224	300	0.2	111.0564589	20	44.98918293	39.73349199	44.51475064	10.78598985	10.05740938	0.2				45					20											NO	128.7606865	109.6473552	14.98766359		143.4531299	0.19127084	0.19194957	44.48795466	257.4357702	28.69062598	63.68875433	286.9062598	0.19127084	106.6623132	20	44.98918293	39.73349199	44.51475064	10.78598985	10.05740938	0.19127084				45					20												7.9725	0.262643902	0.958699704	0	0.531595431	1.719193813	3.200677333	1.021513867	8.023211563	2.623876618	3.309537292	0.448681508	0.006459408	7.48910294	5.007230038	13.82061212	0.496193239	2.342728632	2.145269332	3.118253517	3.184635313	0	0	0	0.571414299	0	0	0	0	0.186621786	0	0	0	0	0	0	0	0	0	0	68.4407	0	1.826585987	7.9725	0.262643902	0.958699704	0	0.531595431	1.719193813	3.200677333	1.021513867	8.023211563	2.623876618	3.309537292	0.448681508	0.006459408	7.48910294	5.007230038	13.82061212	0.496193239	2.342728632	2.145269332	3.118253517	3.184635313	0	0	0	0.571414299	0	0	0	0	0.186621786	0	0	0	0	0	0	0	0	0	0	68.4407	NO	OON: 30%		OON: 30%	OON: 30%	OON: $150/trip	OON: 30%	OON: 30%	OON: $50/visit;OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%		OON: 30%	OON: 30%	OON: 30%	OON: 30%	OON: 30%			OON: 30%					OON: 30%												1.4789		0.1414	0.122	0.63	0.5471	0.375	0.0495	0.137	0.0321	0.1661	0.0022	0.0001	0.1107	1.5685	1.4556		0.0929	0.3354	0.3169	0.1316				0.0052					0.006											7.7041	500	0	9.4514	0.262643902	1.100057273	0.121997182	1.1616277	2.266270939	3.57567032	1.071012178	8.160217605	2.655959767	3.47565893	0.450845126	0.006596262	7.59983001	6.57571236	15.27622537	0.496193239	2.43565663	2.480676793	3.435107426	3.316219399	0	0	0	0.576628874	0	0	0	0	0.192609598	0	0	0	0	0	0	0	0	0	0	76.1448
H8649_801_0	2010	1	N/A																															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																																																			0	NO	195.2293606	3.384837832	33.10929761		6.077313155	10.15531659	24.08117878	14.66368629	49.5380095	7.112198796	19.00442996	0.863910334	0.056385351	33.06387527	27.51174654	101.8133924	1.625119017	6.148786722	22.34712654	10.81003517	21.17069957																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.082666836	0.082666836	0.163325905		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.082666836	0.082666836	0.163325905		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					16.139	0.279813834	5.407605997	0	1.416013965	2.366188765	5.610914656	3.416638905	11.54235621	1.65714232	4.428032181	0.201291108	0.013137787	7.703882939	6.410236943	23.72252042	0.378652731	1.432667306	5.206880483	2.518738195	4.932773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7845	0	0	16.139	0.279813834	5.407605997	0	1.416013965	2.366188765	5.610914656	3.416638905	11.54235621	1.65714232	4.428032181	0.201291108	0.013137787	7.703882939	6.410236943	23.72252042	0.378652731	1.432667306	5.206880483	2.518738195	4.932773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7845	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.272		0.0914		0.0145	0.0252	0.0597	0.0308	0.104	0.0149	0.0399	0.0018	0.0001	0.0687	0.0675	0.2499		0.0151	0.0548	0.0265	0.0524																				1.1893	0	0	16.411	0.279813834	5.499041422	0	1.430494316	2.391347604	5.670573504	3.447429689	11.64631142	1.672084633	4.467921747	0.203129184	0.013252422	7.77257747	6.477748329	23.97243435	0.378652731	1.447755883	5.26171835	2.545265063	4.985221411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9737
H8649_802_0	2010	1	N/A																															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																																																			0	NO	195.2293606	3.384837832	33.10929761		6.077313155	10.15531659	24.08117878	14.66368629	49.5380095	7.112198796	19.00442996	0.863910334	0.056385351	33.06387527	27.51174654	101.8133924	1.625119017	6.148786722	22.34712654	10.81003517	21.17069957																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.082666836	0.082666836	0.163325905		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.082666836	0.082666836	0.163325905		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					16.139	0.279813834	5.407605997	0	1.416013965	2.366188765	5.610914656	3.416638905	11.54235621	1.65714232	4.428032181	0.201291108	0.013137787	7.703882939	6.410236943	23.72252042	0.378652731	1.432667306	5.206880483	2.518738195	4.932773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7845	0	0	16.139	0.279813834	5.407605997	0	1.416013965	2.366188765	5.610914656	3.416638905	11.54235621	1.65714232	4.428032181	0.201291108	0.013137787	7.703882939	6.410236943	23.72252042	0.378652731	1.432667306	5.206880483	2.518738195	4.932773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7845	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.272		0.0914		0.0145	0.0252	0.0597	0.0308	0.104	0.0149	0.0399	0.0018	0.0001	0.0687	0.0675	0.2499		0.0151	0.0548	0.0265	0.0524																				1.1893	0	0	16.411	0.279813834	5.499041422	0	1.430494316	2.391347604	5.670573504	3.447429689	11.64631142	1.672084633	4.467921747	0.203129184	0.013252422	7.77257747	6.477748329	23.97243435	0.378652731	1.447755883	5.26171835	2.545265063	4.985221411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9737
H8649_803_0	2010	2	N/A																															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																																																			0	NO	195.2293606	3.384837832	33.10929761		6.077313155	10.15531659	24.08117878	14.66368629	49.5380095	7.112198796	19.00442996	0.863910334	0.056385351	33.06387527	27.51174654	101.8133924	1.625119017	6.148786722	22.34712654	10.81003517	21.17069957																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.082666836	0.082666836	0.163325905		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.082666836	0.082666836	0.163325905		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					16.139	0.279813834	5.407605997	0	1.416013965	2.366188765	5.610914656	3.416638905	11.54235621	1.65714232	4.428032181	0.201291108	0.013137787	7.703882939	6.410236943	23.72252042	0.378652731	1.432667306	5.206880483	2.518738195	4.932773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7845	0	0	16.139	0.279813834	5.407605997	0	1.416013965	2.366188765	5.610914656	3.416638905	11.54235621	1.65714232	4.428032181	0.201291108	0.013137787	7.703882939	6.410236943	23.72252042	0.378652731	1.432667306	5.206880483	2.518738195	4.932773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	104.7845	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				0.272		0.0914		0.0145	0.0252	0.0597	0.0308	0.104	0.0149	0.0399	0.0018	0.0001	0.0687	0.0675	0.2499		0.0151	0.0548	0.0265	0.0524																				1.1893	0	0	16.411	0.279813834	5.499041422	0	1.430494316	2.391347604	5.670573504	3.447429689	11.64631142	1.672084633	4.467921747	0.203129184	0.013252422	7.77257747	6.477748329	23.97243435	0.378652731	1.447755883	5.26171835	2.545265063	4.985221411	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.9737
H8684_001_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	P	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	1507.434497	67.00735843	1027.445609	721.506145	206.5771117	10.83107058	0	212.9495704	353.3178439	1925.687275	2548.060324	47.40428697	0.30650731	0	4066.759565	5163.697846	190.7145825	488.1139892	0	0	244.64	0	0	0	823.0404652	0	48.6684536	0	4.997125247	0												$500 per stay	$500 per stay	"$0/d 1-15, $75/d 16-20, $100/d 21-100"	$0 per visit	$100 per trip	0.2	0.2	$50 Emer Rm; $35 Urgent Care Ctr	$250 per procedure	$30 per visit	$30 X-ray; $125 Complex Radiology	$30 per visit	$25 per visit	$30 per visit	$10 PCP visit; $30 if no PCP selected	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$30 per visit	$45 per script	0	Not Covered	0	$0 per visit	$100 Every 2 Years	$0 per visit	Not Covered	Not Covered	0											84.53846451	84.53846451	47.8866492	0	100	0.2	0.2	48.5	250	4.5	34	30	25	30	10	30	30	30	30	30	45	0	0	0	0	0	0	0	0	0											YES	84.53846451	84.53846451	47.8866492	0	100	0.2	0.2	48.5	250	4.5	34	30	25	30	10	30	30	30	30	30	45	0	0	0	0	0	0	0	0	0											5000	10.6197	0.472058266	4.100077286	0	1.721475931	2.166214117	0	0.860671181	7.360788414	0.722132728	7.219504253	0.118510717	0.000638557	0	3.388966304	12.90924461	0.476786456	1.220284973	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2744	0	0	10.6197	0.472058266	4.100077286	0	1.721475931	2.166214117	0	0.860671181	7.360788414	0.722132728	7.219504253	0.118510717	0.000638557	0	3.388966304	12.90924461	0.476786456	1.220284973	0	0	0.9174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2744	NO	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$100 copay	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$50 copay	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$25 copay	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP	$500 ded; 20% coinsurance; $5000 max OOP		0	0	$500 ded; 20% coinsurance; $5000 max OOP	0	$500 ded; 20% coinsurance; $5000 max OOP	0	0	Not Covered												6.8149	0	0.9127	0.1414	0.1814	0.2285	0	0.1209	0.7808	0.2702	1.1873	0.0158	0.0301	0.5205	0.4135	2.6063	0.0502	0.1294	0	0	1.3566	0	0	0	0.1664	0	0.0108	0	0	0											15.9376	500	5.414847181	17.4345	0.472058266	5.012744069	0.141449868	1.902916925	2.394684256	0	0.981530699	8.141590644	0.992314462	8.406798486	0.134357283	0.030755994	0.52053482	3.802452191	15.51550937	0.526957189	1.349689888	0	-2.05E-10	2.273993302	0	0	0	0.166372699	0	0.010778235	0	0	0	0	0	0	0	0	0	0	0	0	0	70.212
H8684_801_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	321.7740605	4.944785898	43.0929908	6.678776934	8.5441902	10.78757523	0	10.78181559	36.86679949	12.75705351	56.05995576	0.748220387	0.014234395	24.57786635	19.5233834	123.05887	2.368889675	6.110055605	0	-9.66E-09	64.05367628	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.070951751	0.070951751	0.151196976	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070951751	0.070951751	0.151196976	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.8304	0.35084122	6.515529899	0	1.990796317	2.513505029	0	2.512163032	8.589964281	2.972393468	13.06196969	0.17433535	0.003316614	5.726642859	4.548948332	28.6727167	0.551951294	1.423642956	0	-2.25E-09	14.92450657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3637			22.8304	0.35084122	6.515529899	0	1.990796317	2.513505029	0	2.512163032	8.589964281	2.972393468	13.06196969	0.17433535	0.003316614	5.726642859	4.548948332	28.6727167	0.551951294	1.423642956	0	-2.25E-09	14.92450657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3637	NO	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Medicare FFS cost Sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.1132	0.0478	0.8885	0	0.2715	0.3428	0	0.3426	1.1714	0.4053	1.7812	0.0238	0.0005	0.7809	0.6203	3.9099	0.0753	0.1941	0	0	2.0352	0	0	0	0	0	0	0	0												16.0041			25.9437	0.398683205	7.404011248	0	2.262268542	2.856255715	0	2.854730718	9.761323046	3.37771985	14.84314738	0.198108353	0.003768879	6.507548704	5.169259468	32.58263262	0.62721738	1.617776086	0	-2.25E-09	16.95966656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3678
H8684_802_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	321.7740605	4.944785898	43.0929908	6.678776934	8.5441902	10.78757523	0	10.78181559	36.86679949	12.75705351	56.05995576	0.748220387	0.014234395	24.57786635	19.5233834	123.05887	2.368889675	6.110055605	0	-9.66E-09	64.05367628	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.070951751	0.070951751	0.151196976	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070951751	0.070951751	0.151196976	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.8304	0.35084122	6.515529899	0	1.990796317	2.513505029	0	2.512163032	8.589964281	2.972393468	13.06196969	0.17433535	0.003316614	5.726642859	4.548948332	28.6727167	0.551951294	1.423642956	0	-2.25E-09	14.92450657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3637			22.8304	0.35084122	6.515529899	0	1.990796317	2.513505029	0	2.512163032	8.589964281	2.972393468	13.06196969	0.17433535	0.003316614	5.726642859	4.548948332	28.6727167	0.551951294	1.423642956	0	-2.25E-09	14.92450657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3637	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.1132	0.0478	0.8885	0	0.2715	0.3428	0	0.3426	1.1714	0.4053	1.7812	0.0238	0.0005	0.7809	0.6203	3.9099	0.0753	0.1941	0	0	2.0352	0	0	0	0	0	0	0	0												16.0041			25.9437	0.398683205	7.404011248	0	2.262268542	2.856255715	0	2.854730718	9.761323046	3.37771985	14.84314738	0.198108353	0.003768879	6.507548704	5.169259468	32.58263262	0.62721738	1.617776086	0	-2.25E-09	16.95966656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3678
H8684_804_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	321.7740605	4.944785898	43.0929908	6.678776934	8.5441902	10.78757523	0	10.78181559	36.86679949	12.75705351	56.05995576	0.748220387	0.014234395	24.57786635	19.5233834	123.05887	2.368889675	6.110055605	0	-9.66E-09	64.05367628	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0.070951751	0.070951751	0.151196976	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.070951751	0.070951751	0.151196976	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.8304	0.35084122	6.515529899	0	1.990796317	2.513505029	0	2.512163032	8.589964281	2.972393468	13.06196969	0.17433535	0.003316614	5.726642859	4.548948332	28.6727167	0.551951294	1.423642956	0	-2.25E-09	14.92450657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3637			22.8304	0.35084122	6.515529899	0	1.990796317	2.513505029	0	2.512163032	8.589964281	2.972393468	13.06196969	0.17433535	0.003316614	5.726642859	4.548948332	28.6727167	0.551951294	1.423642956	0	-2.25E-09	14.92450657	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.3637	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													3.1132	0.0478	0.8885	0	0.2715	0.3428	0	0.3426	1.1714	0.4053	1.7812	0.0238	0.0005	0.7809	0.6203	3.9099	0.0753	0.1941	0	0	2.0352	0	0	0	0	0	0	0	0												16.0041			25.9437	0.398683205	7.404011248	0	2.262268542	2.856255715	0	2.854730718	9.761323046	3.37771985	14.84314738	0.198108353	0.003768879	6.507548704	5.169259468	32.58263262	0.62721738	1.617776086	0	-2.25E-09	16.95966656	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.3678
H8684_805_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	307.404277	4.723961688	41.16854435	6.380516165	8.16262382	10.30582378	0	10.30032135	35.22040224	12.18734911	53.55643069	0.714806367	0.013598715	23.48026818	18.65150829	117.5633079	2.263099819	5.837192789	0	-9.23E-09	61.1931677	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.90189135	2.401256941	0	2.399974874	8.206353722	2.839652344	12.47864835	0.166549884	0.003168501	5.470902487	4.345801432	27.39225074	0.527302258	1.36006592	0	-2.15E-09	14.25800807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7518			0	0	0	0	1.90189135	2.401256941	0	2.399974874	8.206353722	2.839652344	12.47864835	0.166549884	0.003168501	5.470902487	4.345801432	27.39225074	0.527302258	1.36006592	0	-2.15E-09	14.25800807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7518	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2593	0.3274	0	0.3273	1.119	0.3872	1.7016	0.0227	0.0004	0.746	0.5926	3.7353	0.0719	0.1855	0	0	1.9443	0	0	0	0	0	0	0	0												11.4207			0	0	0	0	2.161240171	2.728701069	0	2.727244175	9.325401957	3.226877663	14.18028222	0.189261231	0.003600569	6.216934644	4.938410719	31.12755766	0.599207111	1.545529454	0	-2.15E-09	16.2022819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1725
H8684_806_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	307.404277	4.723961688	41.16854435	6.380516165	8.16262382	10.30582378	0	10.30032135	35.22040224	12.18734911	53.55643069	0.714806367	0.013598715	23.48026818	18.65150829	117.5633079	2.263099819	5.837192789	0	-9.23E-09	61.1931677	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.90189135	2.401256941	0	2.399974874	8.206353722	2.839652344	12.47864835	0.166549884	0.003168501	5.470902487	4.345801432	27.39225074	0.527302258	1.36006592	0	-2.15E-09	14.25800807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7518			0	0	0	0	1.90189135	2.401256941	0	2.399974874	8.206353722	2.839652344	12.47864835	0.166549884	0.003168501	5.470902487	4.345801432	27.39225074	0.527302258	1.36006592	0	-2.15E-09	14.25800807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7518	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2593	0.3274	0	0.3273	1.119	0.3872	1.7016	0.0227	0.0004	0.746	0.5926	3.7353	0.0719	0.1855	0	0	1.9443	0	0	0	0	0	0	0	0												11.4207			0	0	0	0	2.161240171	2.728701069	0	2.727244175	9.325401957	3.226877663	14.18028222	0.189261231	0.003600569	6.216934644	4.938410719	31.12755766	0.599207111	1.545529454	0	-2.15E-09	16.2022819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1725
H8684_807_0	2010	2	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																											0	NO	307.404277	4.723961688	41.16854435	6.380516165	8.16262382	10.30582378	0	10.30032135	35.22040224	12.18734911	53.55643069	0.714806367	0.013598715	23.48026818	18.65150829	117.5633079	2.263099819	5.837192789	0	-9.23E-09	61.1931677	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	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered												0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0	0	0	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												0	0	0	0	1.90189135	2.401256941	0	2.399974874	8.206353722	2.839652344	12.47864835	0.166549884	0.003168501	5.470902487	4.345801432	27.39225074	0.527302258	1.36006592	0	-2.15E-09	14.25800807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7518			0	0	0	0	1.90189135	2.401256941	0	2.399974874	8.206353722	2.839652344	12.47864835	0.166549884	0.003168501	5.470902487	4.345801432	27.39225074	0.527302258	1.36006592	0	-2.15E-09	14.25800807	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.7518	NO	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Medicare FFS cost sharing	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered	Not Covered													0	0	0	0	0.2593	0.3274	0	0.3273	1.119	0.3872	1.7016	0.0227	0.0004	0.746	0.5926	3.7353	0.0719	0.1855	0	0	1.9443	0	0	0	0	0	0	0	0												11.4207			0	0	0	0	2.161240171	2.728701069	0	2.727244175	9.325401957	3.226877663	14.18028222	0.189261231	0.003600569	6.216934644	4.938410719	31.12755766	0.599207111	1.545529454	0	-2.15E-09	16.2022819	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.1725
H8707_001_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	P	O	O	O	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	YES	1101.398395	104.632133	361.444859	241.742141	40.497687	9.110943	3.922447	421.858882	425.446764	874.841051	1001.518698	50.960758	0.005013	571.415522	3880.043088	4836.242276	87.603291	902.77843			22.996052	0			2.69				0.04	0.25	7.6719	0.05	0.55	2.22	0.32	0.4	0.42				4900	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15				"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				137.58966	121.67922	58.254672	0	100	0.2	0.2	50	175	55.056732	89.968552	50	0.2	66.434686	15	35	35	15			0.2	0			0				0	0	0	0	0	0	0	0	0				NO	124.410772	110.024298	40.995153	0	86.3197	0.172639	0.172639	43.15985	151.059475	47.524806	77.660584	43.15985	0.172639	57.346222	12.947955	30.211895	30.211895	12.947955			0.172639	0			0				0	0	0	0	0	0	0	0	0					11.4188	0.959339748	1.234790608	0	0.291312349	1.572904089	0.677167328	1.517280506	5.355647068	3.464720936	6.481543914	0.183288223	0.000865439	2.730710115	4.186551942	12.17600365	0.220555119	0.974094541	0	0	3.970015421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4156	0	8.773113	11.4188	0.959339748	1.234790608	0	0.291312349	1.572904089	0.677167328	1.517280506	5.355647068	3.464720936	6.481543914	0.183288223	0.000865439	2.730710115	4.186551942	12.17600365	0.220555119	0.974094541	0	0	3.970015421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.4156	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins			"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.6477	0.1298	0.2349	1.1316	0.9349	1.6642	0.7165	0.2148	2.6303	0.3074	1.0784	0.1322	0.0001	0.4711	1.542	2.4407	0.029	0.2479			0.8036	0			0				0	0	0	0	0	0	0	0	0				21.357	0	11.905938	18.0665	1.089131748	1.469642608	1.131608	1.226260349	3.237128089	1.393649328	1.732116506	7.985910068	3.772121936	7.559915914	0.315462223	0.000994439	3.201784115	5.728521942	14.61667265	0.249601119	1.221957541	0	0	4.773621421	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.7726
H8707_003_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	YES	1076.11333	45.22652	344.445194	211.74052	38.112651	7.396959	4.137022	350.797996	366.250374	667.169911	961.20837	70.939088	11.69072	608.307407	3934.681627	4573.247253	60.961957	808.567776			19.142577	0							0.04	0.25	0.05	0.55	2.22	0.32	0.4	0.42					3900	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	"$0-$75/Proc:12. $0 Dialysis -- Dialysis Center,12. $75 Dialysis -- OP Hosp"	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					137.58966	121.67922	58.254672	0	100	0.2	0.2	50	175	50.837323	71.782375	50	4.175955	58.303794	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0					NO	120.878983	106.900914	38.577584	0	85.7343	0.171469	0.171469	42.86715	150.035025	43.585023	61.542117	42.86715	3.580226	49.98635	12.860145	30.007005	30.007005	12.860145			0.171469	0							0	0	0	0	0	0	0	0						10.84	0.40289636	1.10732195	0	0.272296788	1.268349163	0.709371025	1.253142526	4.579198668	2.423217993	4.929566497	0.253413044	0.003487952	2.533922246	4.216714688	11.43578777	0.152440479	0.866524903	0	0	3.282358536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.53	0	8.471951	10.84	0.40289636	1.10732195	0	0.272296788	1.268349163	0.709371025	1.253142526	4.579198668	2.423217993	4.929566497	0.253413044	0.003487952	2.533922246	4.216714688	11.43578777	0.152440479	0.866524903	0	0	3.282358536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.53	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0-$75/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					6000	6.7442	0.0861	0.2412	1.0628	0.903	1.3866	0.7755	0.1833	2.2178	0.2423	1.0782	0.1412	0.0005	0.5389	1.4563	2.2794	0.0179	0.2253			0.6871	0							0	0	0	0	0	0	0	0					20.2678	0	10.35123	17.5842	0.48901336	1.34856895	1.062754	1.175298788	2.654989163	1.484901025	1.436483526	6.797031668	2.665530993	6.007811497	0.394589044	0.003997952	3.072849246	5.673023688	13.71518277	0.170316479	1.091809903	0	0	3.969409536	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.7977
H8707_005_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	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	YES	1049.235714	58.876605	394.076268	235.277216	38.616654	7.476094	3.29891	321.237331	381.635891	723.563891	939.52818	70.54635	0.007501	540.79351	3716.054268	4772.771887	74.679168	913.910312			24.155027	0							0.04	0.25	11.844453	0.05	0.55	2.22	0.32	0.4	0.42				4900	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$100/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$100/Visit:9d. $15 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				137.58966	121.67922	58.254672	0	100	0.2	0.2	50	175	48.853712	70.085961	50	0.2	60.445636	15	35	35	15			0.2	0							0	0	0	0	0	0	0	0	0				NO	126.277864	111.675485	41.78328	0	87.7634	0.175527	0.175527	43.8817	153.58595	42.875679	61.509822	43.8817	0.175527	53.049145	13.16451	30.71719	30.71719	13.16451			0.175527	0							0	0	0	0	0	0	0	0	0					11.0413	0.547922785	1.372149921	0	0.282427404	1.312256352	0.579047776	1.174703349	4.884492573	2.585274427	4.815850926	0.257974481	0.001316628	2.390719444	4.076669464	12.21717841	0.191161183	1.002598453	0	0	4.239859424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9729	0	7.157753	11.0413	0.547922785	1.372149921	0	0.282427404	1.312256352	0.579047776	1.174703349	4.884492573	2.585274427	4.815850926	0.257974481	0.001316628	2.390719444	4.076669464	12.21717841	0.191161183	1.002598453	0	0	4.239859424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.9729	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.6983	0.1163	0.2612	1.0887	0.8995	1.3778	0.608	0.1651	2.3847	0.2655	1.0853	0.1843	0.0002	0.481	1.4382	2.5433	0.0215	0.2757			0.8528	0							0	0	0	0	0	0	0	0	0				20.7475	0	11.406672	17.7395	0.664241785	1.633361921	1.088737	1.181944404	2.690102352	1.187037776	1.339763349	7.269154573	2.850771427	5.901180926	0.442277481	0.001511628	2.871701444	5.514895464	14.76050741	0.212619183	1.278309453	0	0	5.092684424	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	73.7203
H8707_006_0	2010	4	N/A	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin			V				O	O	P	O	O	O	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	YES	999.970285	56.112134	375.572955	224.230096	36.803462	7.218645	3.185308	306.154071	363.7167	689.589937	895.41392	67.233942	0.007242	515.401288	3541.572018	4548.672904	71.17271	870.998902			23.323215	0			2.69				0.04	0.25	11.288313	0.05	0.55	2.22	0.32	0.4	0.42				4900	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$175/Visit:9b. $0 Surgery ASC -- Physician,9b. $175 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $175 Surgery OP -- Facility"	"$0-$75/Visit:8a. $0 Lab -- FSL,8a. $75 Lab -- OP"	"$0-$150/Visit:14h. $75 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $75 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $75 OP Other,5. $35 Partial Hospitalization,7h. $75 Psych -- OP,8b. $75 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15				"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				137.58966	121.67922	58.254672	0	100	0.2	0.2	50	175	48.853712	92.020516	50	0.2	63.922072	15	35	35	15			0.2	0			0				0	0	0	0	0	0	0	0	0				NO	126.674535	112.026286	42.694616	0	87.9871	0.175974	0.175974	43.99355	153.977425	42.984964	80.966183	43.99355	0.175974	56.243178	13.198065	30.795485	30.795485	13.198065			0.175974	0			0				0	0	0	0	0	0	0	0	0					10.5559	0.523836164	1.336245258	0	0.269852491	1.270293835	0.56053139	1.122400369	4.667013408	2.470166551	6.041520609	0.246488316	0.001274404	2.415650532	3.895158141	11.67321568	0.182649844	0.957958344	0	0	4.104279436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2944	0	6.886316	10.5559	0.523836164	1.336245258	0	0.269852491	1.270293835	0.56053139	1.122400369	4.667013408	2.470166551	6.041520609	0.246488316	0.001274404	2.415650532	3.895158141	11.67321568	0.182649844	0.957958344	0	0	4.104279436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.2944	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins			"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a				6000	6.6456	0.1154	0.2638	1.0642	0.8678	1.3467	0.5943	0.1592	2.3308	0.2595	1.0608	0.1801	0.0002	0.4701	1.4058	2.4859	0.021	0.2695			0.8336	0			0				0	0	0	0	0	0	0	0	0				20.3744	0	10.653336	17.2015	0.639241164	1.600055258	1.064164	1.137669491	2.617041835	1.15479939	1.281644369	6.997852408	2.729671551	7.102353609	0.426631316	0.001464404	2.885776532	5.300923141	14.15914168	0.203623844	1.227446344	0	0	4.937855436	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.6689
H8707_007_0	2010	4	N/A	r.	s.	t.	u.	v.	w.					Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered															A	A	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin							O	O	O	O	O	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	NO	206.094812	9.287302	421.103223	251.413247	41.265102	7.47028	3.296344	343.26877	407.809647	773.188114	1003.963896	75.384634	13.562293	577.882782	3970.912631	5100.103175	79.800894	976.589075			24.13624	0							0.04	0.25	0.05	0.55	2.22	0.32	0.4	0.42						$0/Admit:1a	$0/Admit:1b	$0/Day(Days 1-20) $0(Days 21-100):2	$0/Visit:6	$0/Trip:10a	20% Coins:11a	0% Coins:11b	$0/Visit:4a	"$0/Visit:9a, 9b"	$0/Visit:8a	"$0/Visit:14h, 8a, 8b, 9a"	$0/Visit:9a	$0/Proc:12	"$0/Visit:3, 5, 7h, 8b, 9a, 9d"	$0/Visit:7a	"$0/Visit:7b, 7d, 7f"	$0/Visit:7e	$0/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0	0	0	0			0.2	0							0	0	0	0	0	0	0	0					NO	0	0	0	0	0	0.194353	0	0	0	0	0	0	0	0	0	0	0	0			0.194353	0							0	0	0	0	0	0	0	0						0	0	0	0	0	1.451871329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.690950653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.1428	0	0.178482	0	0	0	0	0	1.451871329	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.690950653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	6.1428	YES	30% Coins	30% Coins	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$0/Trip	30% Coins	30% Coins	$0/Visit	30% Coins	30% Coins	30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a	$0: Nutritional benefit 14a					5000	5.9379	0.1031	0.2125	1.6932	0	1.6071	0.7091	0	3.7086	0.4129	1.6879	0.2866	0	0.748	2.2367	3.9553	0.0334	0.4288			1.3263	0							0	0	0	0	0	0	0	0					25.0873	1000	13.381465	5.9379	0.103115	0.21249	1.693172	0	3.058960329	0.709146	0	3.708555	0.412893	1.687873	0.286623	0	0.74801	2.236687	3.955311	0.033371	0.428777	0	0	6.017237653	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.2301
H8707_801_0	2010	3	N/A																															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	NO	245.221182	0.836467515	15.98985029	12.79864477	2.692834152	12.00423968	5.867862023	25.61256197	75.7180586	9.801876312	23.53221532	8.260821134	0.72571668	14.96528159	37.60571785	82.47297672	0.396304843	6.090154046			27.09937982	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																			0.080140198	0.080140198	0.19281137	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080140198	0.080140198	0.19281137	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.6521	0.067034672	3.083024937	0	0.627430357	2.796987845	1.367211851	5.96772694	17.64230765	2.283837181	5.483006169	1.924771324	0.169091986	3.48691061	8.762132258	19.21620358	0.092339028	1.419005893	0	0	6.314155498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3553	0	0	19.6521	0.067034672	3.083024937	0	0.627430357	2.796987845	1.367211851	5.96772694	17.64230765	2.283837181	5.483006169	1.924771324	0.169091986	3.48691061	8.762132258	19.21620358	0.092339028	1.419005893	0	0	6.314155498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3553	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3191	0.0011	0.1383	0	1.0635	0.5876	0.2872	0.4871	1.3139	0.1864	0.4062	0.1571	0.0138	0.2824	0.5083	1.1148	0.0054	0.094			0.0117	0																			6.9778	0	0	19.9712	0.068123926	3.221303455	0	1.690940367	3.384611866	1.654440236	6.454787289	18.95616341	2.470236921	5.889233883	2.081878899	0.182906703	3.769356647	9.270417923	20.33096058	0.097699888	1.51296992	0	0	6.325835007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.3331
H8707_802_0	2010	3	N/A																															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	NO	245.221182	0.836467515	15.98985029	12.79864477	2.692834152	12.00423968	5.867862023	25.61256197	75.7180586	9.801876312	23.53221532	8.260821134	0.72571668	14.96528159	37.60571785	82.47297672	0.396304843	6.090154046			27.09937982	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																			0.080140198	0.080140198	0.19281137	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080140198	0.080140198	0.19281137	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.6521	0.067034672	3.083024937	0	0.627430357	2.796987845	1.367211851	5.96772694	17.64230765	2.283837181	5.483006169	1.924771324	0.169091986	3.48691061	8.762132258	19.21620358	0.092339028	1.419005893	0	0	6.314155498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3553	0	0	19.6521	0.067034672	3.083024937	0	0.627430357	2.796987845	1.367211851	5.96772694	17.64230765	2.283837181	5.483006169	1.924771324	0.169091986	3.48691061	8.762132258	19.21620358	0.092339028	1.419005893	0	0	6.314155498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3553	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3191	0.0011	0.1383	0	1.0635	0.5876	0.2872	0.4871	1.3139	0.1864	0.4062	0.1571	0.0138	0.2824	0.5083	1.1148	0.0054	0.094			0.0117	0																			6.9778	0	0	19.9712	0.068123926	3.221303455	0	1.690940367	3.384611866	1.654440236	6.454787289	18.95616341	2.470236921	5.889233883	2.081878899	0.182906703	3.769356647	9.270417923	20.33096058	0.097699888	1.51296992	0	0	6.325835007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.3331
H8707_803_0	2010	3	N/A																															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	NO	245.221182	0.836467515	15.98985029	12.79864477	2.692834152	12.00423968	5.867862023	25.61256197	75.7180586	9.801876312	23.53221532	8.260821134	0.72571668	14.96528159	37.60571785	82.47297672	0.396304843	6.090154046			27.09937982	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																			0.080140198	0.080140198	0.19281137	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.080140198	0.080140198	0.19281137	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				19.6521	0.067034672	3.083024937	0	0.627430357	2.796987845	1.367211851	5.96772694	17.64230765	2.283837181	5.483006169	1.924771324	0.169091986	3.48691061	8.762132258	19.21620358	0.092339028	1.419005893	0	0	6.314155498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3553	0	0	19.6521	0.067034672	3.083024937	0	0.627430357	2.796987845	1.367211851	5.96772694	17.64230765	2.283837181	5.483006169	1.924771324	0.169091986	3.48691061	8.762132258	19.21620358	0.092339028	1.419005893	0	0	6.314155498	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.3553	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				0.3191	0.0011	0.1383	0	1.0635	0.5876	0.2872	0.4871	1.3139	0.1864	0.4062	0.1571	0.0138	0.2824	0.5083	1.1148	0.0054	0.094			0.0117	0																			6.9778	0	0	19.9712	0.068123926	3.221303455	0	1.690940367	3.384611866	1.654440236	6.454787289	18.95616341	2.470236921	5.889233883	2.081878899	0.182906703	3.769356647	9.270417923	20.33096058	0.097699888	1.51296992	0	0	6.325835007	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.3331
H8742_001_0	2010	10	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	2839.648692	162.1646302	1259.246153		119.8772764	8.593888565	0.087728295	512.9965055	287.2542363	16.59863214	32.86897276			212.275701	0.286457655	3021.377874	155.089128	562.5396334		629.2211882	13.10490755	540.920281		1354.269148	293.44927																3250	(1a/1a1) $270/Day Days 1 - 7	(1b) $270/Day Days 1 - 7	(2a/2a2) $133.5/Day Days 21-100	(6a) 0%	(10a) $100	(11a) 25%	(11b) 25% (11c) 0-25%	(4a) $50 (4a1) $50 (4b) $35 (4b1) n/c	(9b) $125	(8a) 10%	(8b1) 15% (8b2) 15% (8b3) 15%	(9a) $225	(12) $50	(3) $25 (5) $25 (9a) $225 (9c) $40 (9d) $25	(7a) $0 (14b) $0 (14c) $0 (14d) $0 (14d1) $0 (14d2) $0 (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $10 (14j) $10	(7b) $40 (7d) $35 (7f) $20	(7e) $40 (7h) $40	(7c) $25 (7i) $25		(7d) $35 (7g) $25	(15) 20%	(13a) $0 (16b) $0 (17a) $25 (17b) $0 (18a) $25	(10b) n/c	(16a) $15	(17a1) $25	(17b1) $0		(18b) n/c	(14a) $0  (14a6) n/c												124.9802082	106.2589007	86.7605172		100	0.25	0.25	49.165789	125	0.1	0.15			127.4549589	10	34.89252712	40	25		25	0.2	25		15	25																NO	97.32541584	82.74663523	67.56272483		77.87266259	0.194681656	0.194681656	38.28670898	97.34082824	0.077872663	0.116808994			99.39861658	7.787266259	27.2944968	31.14906504	19.46816565		19.46816565	0.155745325	19.46816565		11.68089939	19.46816565																	23.0308	1.118214792	7.089841775	0	0.777930225	1.673072461	0.01707909	1.636745659	2.33013044	1.29257968	3.839391638	0	0	1.758325917	0.000185894	6.872249061	0.402573444	0.912634564	0	1.020815193	2.041028088	0.877560469	0	1.318256806	0.476076583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4855	0	16.57551885	23.0308	1.118214792	7.089841775	0	0.777930225	1.673072461	0.01707909	1.636745659	2.33013044	1.29257968	3.839391638	0	0	1.758325917	0.000185894	6.872249061	0.402573444	0.912634564	0	1.020815193	2.041028088	0.877560469	0	1.318256806	0.476076583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4855	NO																																																																																		0	0	0	23.0308	1.118214792	7.089841775	0	0.777930225	1.673072461	0.01707909	1.636745659	2.33013044	1.29257968	3.839391638	0	0	1.758325917	0.000185894	6.872249061	0.402573444	0.912634564	0	1.020815193	2.041028088	0.877560469	0	1.318256806	0.476076583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.4855
H8742_003_0	2010	2	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	2428.835089	100.7241907	856.6750481		83.89367221	5.929863461	0.038015052	358.7910403	228.7939047	12.50744254	23.42336663	69.46580854	0.142914756	108.7029486	3096.521691	2302.313623	167.8283082	408.5692159		527.9487303	9.730218725	478.7982079		1315.635045	212.3636117																3250	(1a/1a1) $250/Day Days 1 - 7	(1b) $250/Day Days 1 - 7	(2a/2a2) $125/Day Days 21-100	(6a) 0%	(10a) $100	(11a) 25%	(11b) 25% (11c) 25%	(4a) $50 (4a1) $50 (4b) $35 (4b1) n/c	(9b) $100	(8a) 10%	(8b1) 15% (8b2) 15% (8b3) 15%	(9a) $200	(12) $50	(3) $25 (5) $25 (9a) $200 (9c) $30 (9d) $25	(7a) $7 (14b) $0 (14c) $0 (14d) $0 (14d1) $0 (14d2) $0 (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $10 (14j) $10	(7b) $35 (7d) $30 (7f) $30	(7e) $30 (7h) $30	(7c) $25 (7i) $25		(7d) $30 (7g) $25	(15) 20%	(13a) $0 (16b) $0 (17a) $25 (17b) $0 (18a) $25	(10b) n/c	(16a) $15	(17a1) $25	(17b1) $0		(18b) n/c	(14a) $0  (14a6) n/c												115.722415	98.38787103	81.23643933		99.99999421	0.25	0.25	49.10290551	100	0.1	0.15	200	50	43.43773884	7.001601905	30.11128644	30	25		25	0.2	25		15	25																NO	97.67103863	83.04048573	68.56448168		84.40113519	0.211002852	0.211002852	41.4434125	84.40114098	0.084401141	0.126601711	168.802282	42.20057049	36.66194719	5.909431894	25.47326208	25.32034229	21.10028524		21.10028524	0.168802282	21.10028524		12.66017115	21.10028524																	19.7689	0.697015477	4.894790054	0	0.590060098	1.251218105	0.008021284	1.23912709	1.609205551	1.055642421	2.965438304	0.977165583	0.00050259	0.332105147	1.524890337	4.887286525	0.354122518	0.718410583	0	0.9283224	1.642483125	0.84189823	0	1.388013736	0.373411065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.048	0	8.866736505	19.7689	0.697015477	4.894790054	0	0.590060098	1.251218105	0.008021284	1.23912709	1.609205551	1.055642421	2.965438304	0.977165583	0.00050259	0.332105147	1.524890337	4.887286525	0.354122518	0.718410583	0	0.9283224	1.642483125	0.84189823	0	1.388013736	0.373411065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.048	NO																																																																																		0	0	0	19.7689	0.697015477	4.894790054	0	0.590060098	1.251218105	0.008021284	1.23912709	1.609205551	1.055642421	2.965438304	0.977165583	0.00050259	0.332105147	1.524890337	4.887286525	0.354122518	0.718410583	0	0.9283224	1.642483125	0.84189823	0	1.388013736	0.373411065	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.048
H8742_008_0	2010	9	N/A																															D	D	D	Coin	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	V	V																																																			0	YES	2844.129715	96.11458732	802.3254788		92.16164621	7.365350939	0.097312892	432.4593074	288.2981603			83.71821038	0.095462545	108.960931	2.518564867	2997.009113	173.6647781	546.0576628		611.205836	12.57937521	516.8794118		1065.467501	151.361678																3000	(1a/1a1) $195/Day Days 1 - 7	(1b) $195/Day Days 1 - 7	(2a/2a2) $100/Day Days 21-100	(6a) 0%	(10a) $75	(11a) 10%	(11b) 10% (11c) 0-20%	(4a) $50 (4a1) $50 (4b) $30 (4b1) n/c	(9b) $100	(8a) $0	(8b1) $0 (8b2) $0 (8b3) $0	(9a) $175	(12) $50	(3) $25 (5) $25 (9a) $175 (9c) $35 (9d) $25	(7a) $0 (14b) $0 (14c) $0 (14d) $0 (14d1) $0 (14d2) $0 (14e) $0 (14f) $0 (14g) $0 (14h) $0 (14i) $10 (14j) $10	(7b) $35 (7d) $30 (7f) $15	(7e) $35 (7h) $25	(7c) $25 (7i) $25		(7d) $30 (7g) $30	(15) 20%	(13a) $0 (16b) $0 (17a) $10 (17b) $0 (18a) $25	(10b) n/c	(16a) $15	(17a1) $10	(17b1) $0		(18b) n/c	(14a) $0  (14a6) n/c												90.2634837	76.7425394	64.98915146		75	0.1	0.1	48.69755056	100			175	50	39.61316884	10	30.11091185	28.57130865	25		30	0.2	10		12.75	10																NO	77.73146847	66.08774709	55.9661778		64.58713863	0.086116185	0.086116185	41.93647266	86.11618485			150.7033235	43.05809242	34.44450088	8.611618485	25.95111157	24.60452097	21.52904621		25.83485545	0.17223237	8.611618485		10.97981357	8.611618485																	18.4232	0.529333045	3.7419242	0	0.496038085	0.634275923	0.008380215	1.51131816	2.068928138	0	0	1.051384378	0.000342536	0.31275874	0.00180741	6.481309822	0.356078223	0.979675055	0	1.315867869	2.166575602	0.370930691	0	0.97488621	0.108622419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5336	0	6.686624177	18.4232	0.529333045	3.7419242	0	0.496038085	0.634275923	0.008380215	1.51131816	2.068928138	0	0	1.051384378	0.000342536	0.31275874	0.00180741	6.481309822	0.356078223	0.979675055	0	1.315867869	2.166575602	0.370930691	0	0.97488621	0.108622419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5336	NO																																																																																		0	0	0	18.4232	0.529333045	3.7419242	0	0.496038085	0.634275923	0.008380215	1.51131816	2.068928138	0	0	1.051384378	0.000342536	0.31275874	0.00180741	6.481309822	0.356078223	0.979675055	0	1.315867869	2.166575602	0.370930691	0	0.97488621	0.108622419	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	41.5336
H8742_801_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																										0	NO	352.1104993	7.950996774	45.96184348		10.55615389	8.341103977	0.088021691	16.84710609	34.12070945	17.35967707	33.21356962	1.743343963	0.028480531	12.6707356	33.52583302	97.4642944	1.669869263	6.087357423		12.30835577	13.44065018	3.786144426																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																		0.0769376	0.0769376	0.153543466		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.0769376	0.0769376	0.153543466		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				27.0905	0.61173061	7.057140747	0	2.459583857	1.943477227	0.020509054	3.925375719	7.950125301	4.044804758	7.738761723	0.406199143	0.006635964	2.952281395	7.811519095	22.7091806	0.389079538	1.41835428	0	2.867846894	3.131671493	0.882171651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.417	0	0	27.0905	0.61173061	7.057140747	0	2.459583857	1.943477227	0.020509054	3.925375719	7.950125301	4.044804758	7.738761723	0.406199143	0.006635964	2.952281395	7.811519095	22.7091806	0.389079538	1.41835428	0	2.867846894	3.131671493	0.882171651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.417	NO																																																																																		0	0	0	27.0905	0.61173061	7.057140747	0	2.459583857	1.943477227	0.020509054	3.925375719	7.950125301	4.044804758	7.738761723	0.406199143	0.006635964	2.952281395	7.811519095	22.7091806	0.389079538	1.41835428	0	2.867846894	3.131671493	0.882171651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.417
H8742_802_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																										0	NO	352.1104993	7.950996774	45.96184348		10.55615389	8.341103977	0.088021691	16.84710609	34.12070945	17.35967707	33.21356962	1.743343963	0.028480531	12.6707356	33.52583302	97.4642944	1.669869263	6.087357423		12.30835577	13.44065018	3.786144426																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																		0.0769376	0.0769376	0.153543466		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.0769376	0.0769376	0.153543466		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				27.0905	0.61173061	7.057140747	0	2.459583857	1.943477227	0.020509054	3.925375719	7.950125301	4.044804758	7.738761723	0.406199143	0.006635964	2.952281395	7.811519095	22.7091806	0.389079538	1.41835428	0	2.867846894	3.131671493	0.882171651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.417	0	0	27.0905	0.61173061	7.057140747	0	2.459583857	1.943477227	0.020509054	3.925375719	7.950125301	4.044804758	7.738761723	0.406199143	0.006635964	2.952281395	7.811519095	22.7091806	0.389079538	1.41835428	0	2.867846894	3.131671493	0.882171651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.417	NO																																																																																		0	0	0	27.0905	0.61173061	7.057140747	0	2.459583857	1.943477227	0.020509054	3.925375719	7.950125301	4.044804758	7.738761723	0.406199143	0.006635964	2.952281395	7.811519095	22.7091806	0.389079538	1.41835428	0	2.867846894	3.131671493	0.882171651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.417
H8742_803_0	2010	1	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin																																																										0	NO	352.1104993	7.950996774	45.96184348		10.55615389	8.341103977	0.088021691	16.84710609	34.12070945	17.35967707	33.21356962	1.743343963	0.028480531	12.6707356	33.52583302	97.4642944	1.669869263	6.087357423		12.30835577	13.44065018	3.786144426																				Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																		0.0769376	0.0769376	0.153543466		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																			NO	0.0769376	0.0769376	0.153543466		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233		0.233	0.233	0.233																				27.0905	0.61173061	7.057140747	0	2.459583857	1.943477227	0.020509054	3.925375719	7.950125301	4.044804758	7.738761723	0.406199143	0.006635964	2.952281395	7.811519095	22.7091806	0.389079538	1.41835428	0	2.867846894	3.131671493	0.882171651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.417	0	0	27.0905	0.61173061	7.057140747	0	2.459583857	1.943477227	0.020509054	3.925375719	7.950125301	4.044804758	7.738761723	0.406199143	0.006635964	2.952281395	7.811519095	22.7091806	0.389079538	1.41835428	0	2.867846894	3.131671493	0.882171651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.417	NO																																																																																		0	0	0	27.0905	0.61173061	7.057140747	0	2.459583857	1.943477227	0.020509054	3.925375719	7.950125301	4.044804758	7.738761723	0.406199143	0.006635964	2.952281395	7.811519095	22.7091806	0.389079538	1.41835428	0	2.867846894	3.131671493	0.882171651	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.417
H8748_001_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1477.557147	93.12562113	783.3019649	892.2791912	179.9241458	10.03713129	8.530730321	293.1911136	22.93116596	8825.07752	27.46824035	0	0.036306283	16.95190954	5279.629357	3983.889711	392.6653902	260.6056243	0	0	17.16830809	852.3238244	0	0	88.86092386	0	12.93248137	4.707863516	77.67974801	0											3950	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $40 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	74.36970205	0	150	0.2	0.12410433	49.48630399	0.2	3	0.177075047	0	0.2	0.149409257	13.49433676	39.57980418	38.5	40	0	0	0.2	38.08711814	0	0	40	0	0	0	0	0											YES	160.6303181	118.4425108	59.43140664	0	119.8701991	0.159826932	0.099176072	39.54622076	0.159826932	2.397403983	0.141506808	0	0.159826932	0.119537783	13.37600088	39.57980418	38.5	31.96538644	0	0	0.159826932	38.08711814	0	0	40	0	0	0	0	0											7500	19.7784	0.919169365	3.879394799	0	1.797295265	1.604203903	0.846044321	0.966216709	3.665017907	1.763106333	3.886943004	0	0.005802722	2.026393689	5.885027245	13.14013122	1.25980146	0.694196624	0	0	2.743958012	2.705213183	0	0	0.29620308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8625	0	11.25346656	19.7784	0.919169365	3.879394799	0	1.797295265	1.604203903	0.846044321	0.966216709	3.665017907	1.763106333	3.886943004	0	0.005802722	2.026393689	5.885027245	13.14013122	1.25980146	0.694196624	0	0	2.743958012	2.705213183	0	0	0.29620308	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.8625	NO	"$325 Days 1-24 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$325 Days 1-24 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.2267	0.2696	2.3879	0.5759	0.6333	0.8479	0.7207	0.4108	1.9372	0.6213	2.0097	0	0.002	1.0652	2.6849	4.7718	0.4619	0.2609	0	0	1.375	1.0025	0	0	0.1081	0	0.0157	0	0	0											26.3892	0	3.717882775	24.0051	1.188798636	6.267289977	0.575893564	2.430617215	2.452125969	1.566707851	1.377015742	5.602209027	2.384380957	5.896672324	0	0.007847456	3.091565656	8.569914067	17.91197527	1.72170338	0.95509739	0	0	4.11897814	3.707747967	0	0	0.40433682	0	0.015737374	0	0	0	0	0	0	0	0	0	0	0	0	0	94.2517
H8748_002_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1426.992343	90.15208896	756.4958878	861.7437071	173.7668007	9.361906868	7.956845482	283.1707611	203.0688041	8523.06665	25.62037902	0	0.033863863	408.7007479	5102.504615	3849.029233	392.6653902	251.6872062	0	0	16.0133505	823.1556886	0	0	88.86092386	148.5218847	12.93248137	4.707863516	77.67974801	0											2800	"$175 Days 1-16 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-27 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$25 (3, 9d); $60 (5); $150 (9a); $40/$30 (9c)"	"$10 (7a); $25 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$25 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$25 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $25 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$25 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$25/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											158.6613559	122.8528282	68.10714999	0	150	0.2	0.12410433	49.48632794	150	3	0.178168725	0	0.2	58.74599281	6.938708611	25	38.5	25	0	0	0.2	23.81708963	0	0	25	30	0	0	0	0											NO	131.8075536	93.6548915	51.92039804	0	114.3501043	0.152466806	0.094608954	37.72511175	114.3501043	2.287002087	0.135824082	0	0.152466806	44.86632218	6.822109681	25	38.5	19.05835072	0	0	0.152466806	23.81708963	0	0	25	30	0	0	0	0												15.674	0.703598676	3.273130635	0	1.655854316	1.427380036	0.752788826	0.890220717	1.935078245	1.624355934	3.479864464	0	0.005163115	1.528074952	2.900820511	8.018810902	1.25980146	0.399728587	0	0	2.4415044	1.633764401	0	0	0.185126925	0.371304712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1604	0	11.20406926	15.674	0.703598676	3.273130635	0	1.655854316	1.427380036	0.752788826	0.890220717	1.935078245	1.624355934	3.479864464	0	0.005163115	1.528074952	2.900820511	8.018810902	1.25980146	0.399728587	0	0	2.4415044	1.633764401	0	0	0.185126925	0.371304712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.1604	NO	"$275 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$140 Days 1-27 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.1984	0.2674	2.6622	0.6529	0.7435	0.9613	0.817	0.3997	2.1963	0.7293	2.2911	0	0.0023	1.2043	1.7263	3.6237	0.4619	0.2382	0	0	1.5589	0.759	0	0	0.0841	0	0.0122	0	0	0											25.5901	0	0	19.8724	0.97099686	5.935341044	0.652913678	2.399319654	2.388703359	1.569834033	1.289922697	4.13134967	2.353678752	5.770963407	0	0.007481312	2.73235213	4.627120951	11.64246629	1.72170338	0.637942472	0	0	4.000419978	2.392792706	0	0	0.269230945	0.371304712	0.01224018	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7505
H8748_003_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1478.835208	90.96305228	783.9795071	893.0509968	180.0797769	10.05450268	8.545494562	293.444385	210.446327	8832.711054	27.51577998	0	0.036369119	423.4154392	5284.106308	3987.298403	392.6653902	260.8310435	0	0	17.19802149	853.0610693	0	0	88.86092386	148.5218847	12.93248137	4.707863516	77.67974801	0											3380	"$225 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$225 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$150 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $150 (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											165.816167	126.2891031	69.22791329	0	150	0.2	0.12410433	49.4863034	150	3	0.177048373	0	0.2	58.89205065	7.041853286	30	38.5	30	0	0	0.2	28.57686318	0	0	30	30	0	0	0	0											NO	132.0207587	100.5498047	55.11839891	0	119.4281243	0.159237499	0.098810316	39.40037597	119.4281243	2.388562487	0.1409637	0	0.159237499	46.9571996	6.921779106	30	38.5	23.88562487	0	0	0.159237499	28.57686318	0	0	30	30	0	0	0	0												16.2697	0.762193095	3.6009746	0	1.792215833	1.601053862	0.844383014	0.963484925	2.094434175	1.758123523	3.878726164	0	0.005791328	1.656866941	3.047951386	9.968246008	1.25980146	0.519176038	0	0	2.738569932	2.031484122	0	0	0.22215231	0.371304712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3867	0	9.90164995	16.2697	0.762193095	3.6009746	0	1.792215833	1.601053862	0.844383014	0.963484925	2.094434175	1.758123523	3.878726164	0	0.005791328	1.656866941	3.047951386	9.968246008	1.25980146	0.519176038	0	0	2.738569932	2.031484122	0	0	0.22215231	0.371304712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	55.3867	NO	"$275 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$140 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$15 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $35 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												4.3509	0.2698	2.8043	0.7012	0.7705	1.0324	0.8775	0.4142	2.3588	0.7558	2.4467	0	0.0025	1.2926	1.8006	3.7595	0.4619	0.2469	0	0	1.6742	0.7873	0	0	0.0841	0	0.0122	0	0	0											26.9041	0	0	20.6207	1.03199666	6.405304161	0.701216367	2.562691388	2.633496084	1.721873395	1.377688152	4.453186217	2.513942758	6.32547204	0	0.008281026	2.949472544	4.848600272	13.72778891	1.72170338	0.766044272	0	0	4.412814408	2.818769148	0	0	0.30625633	0.371304712	0.01224018	0	0	0	0	0	0	0	0	0	0	0	0	0	82.2908
H8748_004_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1509.021148	90.82789172	799.9820734	911.279927	183.75556	10.46915629	8.89791579	299.4262881	23.91818473	9013.004088	28.65054695	0	0.037869003	17.68062157	5389.845406	4067.80678	392.6653902	266.155119	0	0	17.90727802	870.4737264	0	0	88.86092386	148.5218847	12.93248137	4.707863516	77.67974801	0											3600	"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$30 (17b1, 17b4); $0 n/c (17b2, 17b5); $0 (17b3)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	81.80667226	0	150	0.2	0.12410433	49.48628989	0.2	3	0.176431498	0	0.2	0.148774065	10.2722484	30	38.5	30	0	0	0.2	28.57780171	0	0	30	30	0	0	0	0											YES	143.7293615	109.4673245	63.81898031	0	117.0179251	0.1560239	0.096816208	38.60521976	0.1560239	2.340358502	0.137637652	0	0.1560239	0.116208137	10.14265696	30	38.5	23.40358502	0	0	0.1560239	28.57780171	0	0	30	30	0	0	0	0											3900	18.0742	0.828557192	4.254503349	0	1.791891196	1.633438596	0.861462464	0.963284805	3.731808465	1.757805062	3.943394018	0	0.005908469	2.054632097	4.555612753	10.16951695	1.25980146	0.519081996	0	0	2.793963358	2.073018795	0	0	0.22215231	0.371304712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8654	0	12.23494798	18.0742	0.828557192	4.254503349	0	1.791891196	1.633438596	0.861462464	0.963284805	3.731808465	1.757805062	3.943394018	0	0.005908469	2.054632097	4.555612753	10.16951695	1.25980146	0.519081996	0	0	2.793963358	2.073018795	0	0	0.22215231	0.371304712	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.8654	NO	"$295 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$295 Days 1-14 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-23 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.0649	0.1867	2.9926	0.4699	0.5059	0.6918	0.588	0.4164	1.5805	0.4963	1.6344	0	0.0017	0.8686	2.6807	4.3575	0.4619	0.1853	0	0	1.1219	0.9089	0	0	0.0961	0	0.014	0	0	0											23.3238	0	8.113385621	21.1391	1.015273418	7.247066775	0.469862323	2.297834552	2.325244611	1.449440281	1.379675515	5.312331632	2.254124144	5.577769473	0	0.007576735	2.923214196	7.236284849	14.52700689	1.72170338	0.704349901	0	0	3.915820228	2.981893694	0	0	0.31827119	0.371304712	0.013988777	0	0	0	0	0	0	0	0	0	0	0	0	0	85.1891
H8748_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	276.1760139	6.061374277	35.68741968	1251.502245	8.190783707	14.0100058	11.90734461	18.26110639	32.00772797	17.59224361	38.34065684	0	0.050676953	23.65079425	36.39930111	121.3534342	2.981646893	4.222460925	0	0	23.64642708	7.191811506	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080116125	0.080116125	0.182989915	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080116125	0.080116125	0.182989915	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.1262	0.485613817	6.530437885	0	1.908452604	3.264331351	2.774411295	4.25483779	7.457800616	4.098992761	8.933373043	0	0.01180773	5.510635061	8.481037159	28.27535017	0.694723726	0.983833396	0	0	5.509617509	1.675692081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9771	0	0	22.1262	0.485613817	6.530437885	0	1.908452604	3.264331351	2.774411295	4.25483779	7.457800616	4.098992761	8.933373043	0	0.01180773	5.510635061	8.481037159	28.27535017	0.694723726	0.983833396	0	0	5.509617509	1.675692081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9771	NO	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.1262	0.485613817	6.530437885	0	1.908452604	3.264331351	2.774411295	4.25483779	7.457800616	4.098992761	8.933373043	0	0.01180773	5.510635061	8.481037159	28.27535017	0.694723726	0.983833396	0	0	5.509617509	1.675692081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9771
H8748_802_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	276.1760139	6.061374277	35.68741968	1251.502245	8.190783707	14.0100058	11.90734461	18.26110639	32.00772797	17.59224361	38.34065684	0	0.050676953	23.65079425	36.39930111	121.3534342	2.981646893	4.222460925	0	0	23.64642708	7.191811506	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080116125	0.080116125	0.182989915	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080116125	0.080116125	0.182989915	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.1262	0.485613817	6.530437885	0	1.908452604	3.264331351	2.774411295	4.25483779	7.457800616	4.098992761	8.933373043	0	0.01180773	5.510635061	8.481037159	28.27535017	0.694723726	0.983833396	0	0	5.509617509	1.675692081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9771	0	0	22.1262	0.485613817	6.530437885	0	1.908452604	3.264331351	2.774411295	4.25483779	7.457800616	4.098992761	8.933373043	0	0.01180773	5.510635061	8.481037159	28.27535017	0.694723726	0.983833396	0	0	5.509617509	1.675692081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9771	NO	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.1262	0.485613817	6.530437885	0	1.908452604	3.264331351	2.774411295	4.25483779	7.457800616	4.098992761	8.933373043	0	0.01180773	5.510635061	8.481037159	28.27535017	0.694723726	0.983833396	0	0	5.509617509	1.675692081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9771
H8748_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	276.1760139	6.061374277	35.68741968	1251.502245	8.190783707	14.0100058	11.90734461	18.26110639	32.00772797	17.59224361	38.34065684	0	0.050676953	23.65079425	36.39930111	121.3534342	2.981646893	4.222460925	0	0	23.64642708	7.191811506	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.080116125	0.080116125	0.182989915	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080116125	0.080116125	0.182989915	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												22.1262	0.485613817	6.530437885	0	1.908452604	3.264331351	2.774411295	4.25483779	7.457800616	4.098992761	8.933373043	0	0.01180773	5.510635061	8.481037159	28.27535017	0.694723726	0.983833396	0	0	5.509617509	1.675692081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9771	0	0	22.1262	0.485613817	6.530437885	0	1.908452604	3.264331351	2.774411295	4.25483779	7.457800616	4.098992761	8.933373043	0	0.01180773	5.510635061	8.481037159	28.27535017	0.694723726	0.983833396	0	0	5.509617509	1.675692081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9771	NO	"$0 n/c (1a, 1a1, 1a2, 1a3)"	"$0 n/c (1b, 1b1, 1b2)"	"$0 n/c (2a, 2a1, 2a2)"	"$0 n/c (6a, 6a1, 6a2)"	$0 n/c (10a)	$0 n/c (11a)	"$0 n/c (11b, 11b1, 11c)"	"$0 n/c (4a, 4a1, 4b)"	$0 n/c (9b)	"$0 n/c (8a1, 8a2)"	"$0 n/c (8b1, 8b2, 8b3)"	Included in h.5.	$0 n/c (12)	"$0 n/c (3, 5, 9a, 9c, 9d)"	"$0 n/c (7a, 7a1, 14b, 14b1, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14e1, 14f, 14f1, 14g, 14h, 14h1, 14i, 14j)"	"$0 n/c (7b, 7b1, 7d, 7f, 7f1)"	"$0 n/c (7e, 7h)"	"$0 n/c (7c, 7i)"	Included in h.2.	$0 n/c (7g)	"$0 n/c (15, 15a1, 15a2)"	"$0 n/c (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	22.1262	0.485613817	6.530437885	0	1.908452604	3.264331351	2.774411295	4.25483779	7.457800616	4.098992761	8.933373043	0	0.01180773	5.510635061	8.481037159	28.27535017	0.694723726	0.983833396	0	0	5.509617509	1.675692081	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	112.9771
H8778_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1255.975598	6.934518561	1044.462733	479.3427707	265.4625056	16.08763063	1.354726891	889.4372007	99.63752503	15.08442425	2565.678097	0	0.135875973	3214.695044	4813.624683	5406.200221	21.17096843	370.8902586	0	2852.037043	15.12062066	23.708664	257.2158192	266.7215536	188.5772411	248.5880146	34.47884715	0	0	0											1600	1a: $550 Days 1-1	1b: $150	2: $125 Days 4-15	6: none	10a: $100	11a: 20%	11b: 20%; 11c: 20%	4a: $50; 4b: $35	9b: $100	8a: 20%	8b: $50; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: 20%; 9a: $100; 9a: $50; 9d: $25	7a: $10	7d: $30	7h: $25; 7h: $35	7c: $25; 7i: $25	7d. 0%	14c: $10; 7b: $30; 7f: $30	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $20	18b. $0	14a. $0	13b. $0											114.6744969	44.04905153	64.91696182	0	66.71327563	0.200649423	0.198252965	13.64525104	86.36606165	0.003339763	19.7235286	0	0.200649423	10.35455217	8.442173373	14.98497854	13.47107359	23.17286057	0	2.870410396	0.195701267	0	0	19.99991309	9.302957151	14.72644379	18.43043399	0	0	0											NO	92.98013428	21.25354186	19.53208055	0	41.72536942	0.12436787	0.136355578	12.38390175	83.31161926	0.003101957	13.48880442	0	0.008634639	9.55395856	8.065239745	14.12753377	12.85327796	20.77435767	0	2.827704148	0.141981109	0	0	19.99991309	9.302957151	14.72644379	18.25988632	0	0	0												9.7317	0.012281923	1.700044186	0	0.923043426	2.000784348	0.184724568	0.917891909	0.691746962	0.046791235	2.883994172	0	0.00117324	2.559421936	3.235253093	6.364689684	0.022676362	0.642083907	0	0.672059748	2.146842486	0	0	0.444533991	0.146193833	0.305068119	0.052464986	0	0	0	0	0	0	0	0	0	0	0	0	0	35.6855	0	11.71495468	9.7317	0.012281923	1.700044186	0	0.923043426	2.000784348	0.184724568	0.917891909	0.691746962	0.046791235	2.883994172	0	0.00117324	2.559421936	3.235253093	6.364689684	0.022676362	0.642083907	0	0.672059748	2.146842486	0	0	0.444533991	0.146193833	0.305068119	0.052464986	0	0	0	0	0	0	0	0	0	0	0	0	0	35.6855	NO																																																																																		0		0	9.7317	0.012281923	1.700044186	0	0.923043426	2.000784348	0.184724568	0.917891909	0.691746962	0.046791235	2.883994172	0	0.00117324	2.559421936	3.235253093	6.364689684	0.022676362	0.642083907	0	0.672059748	2.146842486	0	0	0.444533991	0.146193833	0.305068119	0.052464986	0	0	0	0	0	0	0	0	0	0	0	0	0	35.6855
H8778_004_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	V	V																																																			0	YES	1526.569543	50.02106385	1153.288507	819.6305595	372.8882415	13.02297728	1.556255879	1258.284878	166.6070526	18.55064257	3091.270732	0	0.679766914	4153.349055	6879.755703	7863.003867	101.5201013	590.4186345	0	4410.034762	46.93223566	33.12741019	383.3330272	609.558874	420.1811099	489.0398427	44.74707751	0	0	0											1575	1a: $500 Days 1-1	1b: $150	2: $120 Days 4-16	6: none	10a: $100	11a: 20%	11b: 20%	4a: $50; 4b: $35	9b: $100	8a: 20%	8b: $50; 8b: $15; 8b: 20%	5. $0	12: 20%	9a: 20%; 9a: $100; 9a: $50; 9d: $25	7a: $10	7d: $30	7h: $25; 7h: $35	7c: $25; 7i: $25	7d. 0%	14c: $10; 7b: $30; 7f: $30	15: 20%	13a: none	10b: none	16b: $20	17a: $20	17b: $20	18a: $20	18b. $0	14a. $0	13b. $0											76.83753169	155.0103651	55.98169107	0	70.83760727	0.200659954	0.165452014	14.31608035	84.8286564	0.009285986	21.37742538	0	0.200659954	10.67516398	8.251869517	15.34575751	34.24867122	23.14769981	0	2.278969793	0.19714223	0	0	19.99974013	8.451154515	17.67472673	19.10893917	0	0	0											NO	59.57532621	72.57214675	17.50236725	0	48.06893396	0.120969092	0.128773375	12.62522147	81.20628356	0.0085313	13.31064389	0	0.033121199	8.072042351	7.811671163	13.66403049	30.00450358	19.3027252	0	2.156643772	0.067067984	0	0	19.99974013	8.451154515	17.67472673	17.95970471	0	0	0												7.5788	0.302511332	1.682106582	0	1.493695021	1.575377734	0.200404322	1.323843772	1.12746163	0.158261102	3.428900323	0	0.022514696	2.793834122	4.478532436	8.953360378	0.253838354	0.949724054	0	0.792572834	3.14765045	0	0	1.015918256	0.295917957	0.720303798	0.066970358	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3625	0	19.40486352	7.5788	0.302511332	1.682106582	0	1.493695021	1.575377734	0.200404322	1.323843772	1.12746163	0.158261102	3.428900323	0	0.022514696	2.793834122	4.478532436	8.953360378	0.253838354	0.949724054	0	0.792572834	3.14765045	0	0	1.015918256	0.295917957	0.720303798	0.066970358	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3625	NO																																																																																		0		0	7.5788	0.302511332	1.682106582	0	1.493695021	1.575377734	0.200404322	1.323843772	1.12746163	0.158261102	3.428900323	0	0.022514696	2.793834122	4.478532436	8.953360378	0.253838354	0.949724054	0	0.792572834	3.14765045	0	0	1.015918256	0.295917957	0.720303798	0.066970358	0	0	0	0	0	0	0	0	0	0	0	0	0	42.3625
H8778_801_0	2010	4	N/A																															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																																																			0	NO	221.2700511	4.207048283	27.47878877	7.626157166	6.857105166	8.754297788	0.993516371	11.36603705	7.469376171	12.47010155	30.38287667	0	0.456952497	43.6595974	46.01681262	45.99629244	1.267027195	4.771467433	0	15.62217861	31.20368954	0.7383261	0.64953676	4.238110344	0.656829065	1.601527646	0.272411377	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.080223011	0.080223011	0.187548652	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080223011	0.080223011	0.187548652	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.7509	0.33750208	5.153609794	0	1.597705504	2.039751385	0.231489314	2.648286632	1.740364648	2.905533662	7.079210263	0	0.106469932	10.17268619	10.72191734	10.71713614	0.295217337	1.111751912	0	3.639967616	7.270459664	0.172029981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.692	0	0	17.7509	0.33750208	5.153609794	0	1.597705504	2.039751385	0.231489314	2.648286632	1.740364648	2.905533662	7.079210263	0	0.106469932	10.17268619	10.72191734	10.71713614	0.295217337	1.111751912	0	3.639967616	7.270459664	0.172029981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.692	NO																																																																																		0		0	17.7509	0.33750208	5.153609794	0	1.597705504	2.039751385	0.231489314	2.648286632	1.740364648	2.905533662	7.079210263	0	0.106469932	10.17268619	10.72191734	10.71713614	0.295217337	1.111751912	0	3.639967616	7.270459664	0.172029981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.692
H8778_802_0	2010	4	N/A																															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																																																			0	NO	221.2700511	4.207048283	27.47878877	7.626157166	6.857105166	8.754297788	0.993516371	11.36603705	7.469376171	12.47010155	30.38287667	0	0.456952497	43.6595974	46.01681262	45.99629244	1.267027195	4.771467433	0	15.62217861	31.20368954	0.7383261	0.64953676	4.238110344	0.656829065	1.601527646	0.272411377	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.080223011	0.080223011	0.187548652	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.080223011	0.080223011	0.187548652	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												17.7509	0.33750208	5.153609794	0	1.597705504	2.039751385	0.231489314	2.648286632	1.740364648	2.905533662	7.079210263	0	0.106469932	10.17268619	10.72191734	10.71713614	0.295217337	1.111751912	0	3.639967616	7.270459664	0.172029981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.692	0	0	17.7509	0.33750208	5.153609794	0	1.597705504	2.039751385	0.231489314	2.648286632	1.740364648	2.905533662	7.079210263	0	0.106469932	10.17268619	10.72191734	10.71713614	0.295217337	1.111751912	0	3.639967616	7.270459664	0.172029981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.692	NO																																																																																		0		0	17.7509	0.33750208	5.153609794	0	1.597705504	2.039751385	0.231489314	2.648286632	1.740364648	2.905533662	7.079210263	0	0.106469932	10.17268619	10.72191734	10.71713614	0.295217337	1.111751912	0	3.639967616	7.270459664	0.172029981	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.692
H8822_001_0	2010	4	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	207.3384924	18.78197484	41.91674051	17.59735623	5.586796593	10.80815889	0	4.267917565	26.19234554	5.412813692	24.21123699	0	0	20.17464714	16.20857974	18.79007821	1.554424194	0	28.31645308	123.0624128	22.29803118	5.641904141	2	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	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing											0.074624334	0.074624334	0.184608733	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074624334	0.074624334	0.184608733	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												15.4725	1.401592369	7.738196367	0	1.301723606	2.518301021	0	0.994424793	6.102816511	1.26118559	5.64121822	0	0	4.700692784	3.776599079	4.378088224	0.362180837	0	6.597733567	28.67354218	5.195441264	1.314563665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4308	0	0	15.4725	1.401592369	7.738196367	0	1.301723606	2.518301021	0	0.994424793	6.102816511	1.26118559	5.64121822	0	0	4.700692784	3.776599079	4.378088224	0.362180837	0	6.597733567	28.67354218	5.195441264	1.314563665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4308	NO	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.4725	1.401592369	7.738196367	0	1.301723606	2.518301021	0	0.994424793	6.102816511	1.26118559	5.64121822	0	0	4.700692784	3.776599079	4.378088224	0.362180837	0	6.597733567	28.67354218	5.195441264	1.314563665	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.4308
H8822_002_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	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	YES	1190.630142	133.2443232	561.052612	570.849854	376.7210565	11.66872953	0	237.7320456	301.6082546	5230.105003	1717.941613	0	0	2380.128315	3087.807917	2946.008721	268.5703989	0	4118.729348	22980.56006	24.07345205	992.578088	0	374.9972153	454.6741997	0	0	0	0	6.08369408											3500	Days 1-5: $100 copay	Days 1-5: $100 copay	$0 copay	$0 copay	$50 copay	20% coinsurance	-	$50 copay; waived if admitted within 72 hours	$100 copay	$0 copay	-	-	-	-	$10 copay	$25 copay	$25 copay	-	$0 copay for Medicare covered x-rays; $100 copay for all other	"$25 copay for chiropractic, $25 copay for podiatry, $25 copay for physical medicine; $0 for all other"	20% coinsurance	"$25 copay for Medicare covered vision, $0 copay for Medicare covered hearing, $25 copay for vision exams, $0 copay for Medicare covered vision hardware"	-	$10 copay	$20 copay	-	-	-	-	-											60.8757565	42.78974891	0	0	50	0.2	0	42.30807087	100	0	0	0	0	0	10	25	25	0	35.38164251	2.020272394	0.2	18.97264754	0	10	20	0	0	0	0	0											NO	59.0494838	41.50605644	0	0	48.5	0.194	0	41.03882874	97	0	0	0	0	0	9.7	24.25	24.25	0	34.32019324	1.959664222	0.194	18.40346812	0	9.7	19.4	0	0	0	0	0												5.8588	0.460870533	0	0	1.522580937	2.263733528	0	0.813020392	2.438000058	0	0	0	0	0	2.495978066	5.953392624	0.542736014	0	11.77963226	3.752848447	4.670249698	1.522239933	0	0.303122749	0.735056623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1123	0	1.39522587	5.8588	0.460870533	0	0	1.522580937	2.263733528	0	0.813020392	2.438000058	0	0	0	0	0	2.495978066	5.953392624	0.542736014	0	11.77963226	3.752848447	4.670249698	1.522239933	0	0.303122749	0.735056623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1123	NO	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.8588	0.460870533	0	0	1.522580937	2.263733528	0	0.813020392	2.438000058	0	0	0	0	0	2.495978066	5.953392624	0.542736014	0	11.77963226	3.752848447	4.670249698	1.522239933	0	0.303122749	0.735056623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.1123
H8822_003_0	2010	4	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	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	YES	1298.609935	145.3284238	611.9352015	622.6209681	410.886378	12.72698175	0	259.2922733	328.9614986	5704.430013	1873.743967	0	0	2595.98524	3367.845224	3213.186075	292.9273969	0	4492.262257	25064.69688	26.25670466	1082.596283	0	374.9972153	454.6741997	0	0	0	0	6.635432191											3500	Days 1-5: $100 copay	Days 1-5: $100 copay	$0 copay	$0 copay	$50 copay	20% coinsurance	-	$50 copay; waived if admitted within 72 hours	$100 copay	$0 copay	-	-	-	-	$10 copay	$25 copay	$25 copay	-	$0 copay for Medicare covered x-rays; $100 copay for all other	"$25 copay for chiropractic, $25 copay for podiatry, $25 copay for physical medicine; $0 for all other"	20% coinsurance	"$25 copay for Medicare covered vision, $0 copay for Medicare covered hearing, $25 copay for vision exams, $0 copay for Medicare covered vision hardware"	-	$10 copay	$20 copay	-	-	-	-	-											60.8757565	42.78974891	0	0	50	0.2	0	42.30807087	100	0	0	0	0	0	10	25	25	0	0	2.020272394	0.2	18.97264754	0	10	20	0	0	0	0	0											NO	59.0494838	41.50605644	0	0	48.5	0.194	0	41.03882874	97	0	0	0	0	0	9.7	24.25	24.25	0	0	1.959664222	0.194	18.40346812	0	9.7	19.4	0	0	0	0	0												6.3902	0.50266748	0	0	1.660665778	2.469034459	0	0.886754267	2.659105447	0	0	0	0	0	2.722341556	6.493313526	0.591957448	0	0	4.093199143	5.093800704	1.660293848	0	0.303122749	0.735056623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2615	0	1.5212892	6.3902	0.50266748	0	0	1.660665778	2.469034459	0	0.886754267	2.659105447	0	0	0	0	0	2.722341556	6.493313526	0.591957448	0	0	4.093199143	5.093800704	1.660293848	0	0.303122749	0.735056623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2615	NO	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.3902	0.50266748	0	0	1.660665778	2.469034459	0	0.886754267	2.659105447	0	0	0	0	0	2.722341556	6.493313526	0.591957448	0	0	4.093199143	5.093800704	1.660293848	0	0.303122749	0.735056623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.2615
H8822_004_0	2010	3	N/A																															D	D	D	V	P	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	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	YES	1105.183906	123.68197	520.7883583	529.8824958	349.6854597	10.83131664	0	220.6710727	279.96317	4854.763599	1594.652575	0	0	2209.317078	2866.209659	2734.586761	249.2962944	0	3823.146438	21331.34735	22.34580734	921.3451677	0	374.9972153	454.6741997	0	0	0	0	5.64709438											3500	Days 1-5: $100 copay	Days 1-5: $100 copay	$0 copay	$0 copay	$50 copay	20% coinsurance	-	$50 copay; waived if admitted within 72 hours	$100 copay	$0 copay	-	-	-	-	$10 copay	$25 copay	$25 copay	-	$0 copay for Medicare covered x-rays; $100 copay for all other	"$25 copay for chiropractic, $25 copay for podiatry, $25 copay for physical medicine; $0 for all other"	20% coinsurance	"$25 copay for Medicare covered vision, $0 copay for Medicare covered hearing, $25 copay for vision exams, $0 copay for Medicare covered vision hardware"	-	$10 copay	$20 copay	-	-	-	-	-											60.8757565	42.78974891	0	0	50	0.2	0	42.30807087	100	0	0	0	0	0	10	25	25	0	0	2.020272394	0.2	18.97264754	0	10	20	0	0	0	0	0											NO	59.0494838	41.50605644	0	0	48.5	0.194	0	41.03882874	97	0	0	0	0	0	9.7	24.25	24.25	0	0	1.959664222	0.194	18.40346812	0	9.7	19.4	0	0	0	0	0												5.4384	0.427795902	0	0	1.413312066	2.101275429	0	0.75467353	2.263035624	0	0	0	0	0	2.316852808	5.52614408	0.503786262	0	0	3.483523184	4.335086623	1.412995535	0	0.303122749	0.735056623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.015	0	0.959228	5.4384	0.427795902	0	0	1.413312066	2.101275429	0	0.75467353	2.263035624	0	0	0	0	0	2.316852808	5.52614408	0.503786262	0	0	3.483523184	4.335086623	1.412995535	0	0.303122749	0.735056623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.015	NO	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	5.4384	0.427795902	0	0	1.413312066	2.101275429	0	0.75467353	2.263035624	0	0	0	0	0	2.316852808	5.52614408	0.503786262	0	0	3.483523184	4.335086623	1.412995535	0	0.303122749	0.735056623	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	31.015
H8953_001_0	2010	8	N/A	r.	s.	t.	u.	v.	w.	x.	y.			Part B Rx	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered													D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V					O	S	O			O	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	YES	1672.642913	57.532361	768.62666	1134.417145	226.275576	9.857693	3.730757	372.696324	300.642323	1180.035774	1427.035332	61.435349	20.938324	335.544599	4834.48488	4602.647038	71.28525	681.921561			13.619525	0		2.41	2.69					0.04	470.411935	0.05			0.45	0.49	0.55	2.34			3400	$150/Day(Days 1-7):1a	$150/Day(Days 1-7):1b	"$0/Day(Days 1-10) $75(Days 11-100):2. $0 SNF 1,2. $75 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$125/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $125 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$150/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$35-$150/Visit:9d. $75 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$5/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$75/Visit:7i. $75 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN749: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"					$0: Nurse hotline 14a	$35/Script:15	$0: Additional Smoking Cessation 14a			$0: Member Incentive Program 14a	$0: Nutritional benefit 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a			105.8382	93.5994	44.44425	0	100	0.2	0.2	50	103.52992	19.016477	69.842539	50	2.125332	86.447281	5	35	35	42.414724			0.2	0		0	0					0	35	0			0	0	0	0			NO	91.788179	81.17408	24.654737	0	85.6257	0.171251	0.171251	42.81285	88.648218	16.282992	59.803163	42.81285	1.819831	74.02109	4.281285	29.968995	29.968995	36.317904			0.171251	0		0	0					0	29.968995	0			0	0	0	0				12.7941	0.38917804	1.579190679	0	1.614583716	1.688139784	0.638895867	1.329682651	2.220950516	1.601209422	7.111768881	0.219185198	0.003175351	2.069781413	1.7248173	11.49472551	0.178028942	2.063830149	0	0	2.332357276	0	0	0	0	0	0	0	0	0	1.174814411	0	0	0	0	0	0	0	0	0	52.2284	0	9.575071	12.7941	0.38917804	1.579190679	0	1.614583716	1.688139784	0.638895867	1.329682651	2.220950516	1.601209422	7.111768881	0.219185198	0.003175351	2.069781413	1.7248173	11.49472551	0.178028942	2.063830149	0	0	2.332357276	0	0	0	0	0	0	0	0	0	1.174814411	0	0	0	0	0	0	0	0	0	52.2284	NO																																																																																		0	0	0	12.7941	0.38917804	1.579190679	0	1.614583716	1.688139784	0.638895867	1.329682651	2.220950516	1.601209422	7.111768881	0.219185198	0.003175351	2.069781413	1.7248173	11.49472551	0.178028942	2.063830149	0	0	2.332357276	0	0	0	0	0	0	0	0	0	1.174814411	0	0	0	0	0	0	0	0	0	52.2284
H8953_801_0	2010	2	N/A																															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	NO	252.553179	1.554163	24.325524	11.767088	5.731678	5.578228	2.357755	23.090381	65.281809	9.387059	30.776948	4.764654	1.015902	16.815084	77.952901	96.701977	0.338292	6.576713			24.859274	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																			0.079520439	0.079520439	0.165456358	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079520439	0.079520439	0.165456358	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.0831	0.123587724	4.0248126	0	1.335480974	1.299727124	0.549356915	5.380058773	15.2106615	2.187184747	7.171028884	1.110164382	0.236705166	3.917914572	18.16302593	22.53156064	0.078822036	1.532374129	0	0	5.792210842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7278	0	0	20.0831	0.123587724	4.0248126	0	1.335480974	1.299727124	0.549356915	5.380058773	15.2106615	2.187184747	7.171028884	1.110164382	0.236705166	3.917914572	18.16302593	22.53156064	0.078822036	1.532374129	0	0	5.792210842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7278	NO																																																																																		0	0	0	20.0831	0.123587724	4.0248126	0	1.335480974	1.299727124	0.549356915	5.380058773	15.2106615	2.187184747	7.171028884	1.110164382	0.236705166	3.917914572	18.16302593	22.53156064	0.078822036	1.532374129	0	0	5.792210842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7278
H8953_802_0	2010	2	N/A																															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	NO	252.553179	1.554163	24.325524	11.767088	5.731678	5.578228	2.357755	23.090381	65.281809	9.387059	30.776948	4.764654	1.015902	16.815084	77.952901	96.701977	0.338292	6.576713			24.859274	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																			0.079520439	0.079520439	0.165456358	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079520439	0.079520439	0.165456358	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.0831	0.123587724	4.0248126	0	1.335480974	1.299727124	0.549356915	5.380058773	15.2106615	2.187184747	7.171028884	1.110164382	0.236705166	3.917914572	18.16302593	22.53156064	0.078822036	1.532374129	0	0	5.792210842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7278	0	0	20.0831	0.123587724	4.0248126	0	1.335480974	1.299727124	0.549356915	5.380058773	15.2106615	2.187184747	7.171028884	1.110164382	0.236705166	3.917914572	18.16302593	22.53156064	0.078822036	1.532374129	0	0	5.792210842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7278	NO																																																																																		0	0	0	20.0831	0.123587724	4.0248126	0	1.335480974	1.299727124	0.549356915	5.380058773	15.2106615	2.187184747	7.171028884	1.110164382	0.236705166	3.917914572	18.16302593	22.53156064	0.078822036	1.532374129	0	0	5.792210842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7278
H8953_803_0	2010	2	N/A																															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	NO	252.553179	1.554163	24.325524	11.767088	5.731678	5.578228	2.357755	23.090381	65.281809	9.387059	30.776948	4.764654	1.015902	16.815084	77.952901	96.701977	0.338292	6.576713			24.859274	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																			0.079520439	0.079520439	0.165456358	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.079520439	0.079520439	0.165456358	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				20.0831	0.123587724	4.0248126	0	1.335480974	1.299727124	0.549356915	5.380058773	15.2106615	2.187184747	7.171028884	1.110164382	0.236705166	3.917914572	18.16302593	22.53156064	0.078822036	1.532374129	0	0	5.792210842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7278	0	0	20.0831	0.123587724	4.0248126	0	1.335480974	1.299727124	0.549356915	5.380058773	15.2106615	2.187184747	7.171028884	1.110164382	0.236705166	3.917914572	18.16302593	22.53156064	0.078822036	1.532374129	0	0	5.792210842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7278	NO																																																																																		0	0	0	20.0831	0.123587724	4.0248126	0	1.335480974	1.299727124	0.549356915	5.380058773	15.2106615	2.187184747	7.171028884	1.110164382	0.236705166	3.917914572	18.16302593	22.53156064	0.078822036	1.532374129	0	0	5.792210842	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.7278
H8980_002_0	2010	10	N/A																															D	D	D	V	T	COIN	COIN	V	V	O	COIN	O	O	O	P	P	P	P	COIN	P	COIN	V	T	V	V	V	V	V	P	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	NO	1699.144659	107.3706767	1133.601751	0	249.5995492	9.48406263	5.571100664	120.8622174	624.681724	875.3978943	23.93830464	0	0	336.336461	6003.227525	16473.48992	219.4876009	1764.213394	45.50444613	1522.331075	36.83318807	0	0	0	107.9894019	0	0	0	0	434.8825174												1a $165 days 1-5	1b $165 days 1-5	2 $70 days 6-100	6 $0	10a $100	11a 20%	11b 20%	4a $50	"9a $175, 9b $175"	8a $10	8b $95 ($25 x-ray) 15B Outpatient Chemotherapy Drugs 15%	5 $0	12 $0	4b $50 3 $0 9d $0	7a $15	"16b $25, 17a $25, 18a $25, 7b $40, 7d $40, 7f $40"	"7e $40, 7h $40, 9c $40"	"7c $40, 7i $40"	8b $95 ($25 x-ray) 15B Physician Chemotherapy Drugs 15%	7g $40	"11c 20%, 15A 20% coinsurance, 15B Physician Chemotherapy Drugs 15%"		10b $0		17a $25	17b 1 pair of glasses or contacts after cataract surgery			14a $0	"14c $15, 7f $40"											109.5416003	78.43284729	53.55579986	0	98.57198292	0.198966698	0.2	50	174.2996325	10	0.183043307	0	0	0.532302775	8.543835394	11.21257857	34.84768199	22.61388583	0.308391231	1.657066053	0.209527225	0	0	0	24.89140552	0	0	0	0	6.348072904											NO	109.5416003	78.43284729	53.55579986	0	98.57198292	0.198966698	0.2	50	174.2996325	10	0.183043307	0	0	0.532302775	8.543835394	11.21257857	34.84768199	22.61388583	0.308391231	1.657066053	0.209527225	0	0	0	24.89140552	0	0	0	0	6.348072904												15.5106	0.701782324	5.059245707	0	2.050293542	1.887012628	1.114220133	0.503592572	9.073482913	0.729498245	4.381746447	0	0	0.014919403	4.27421565	15.392525	0.637386177	3.324643355	14.03317217	0.210216929	7.717555687	0	0	0	0.224000666	0	0	0	0	0.230055494	0	0	0	0	0	0	0	0	0	0	87.0702	0	0	15.5106	0.701782324	5.059245707	0	2.050293542	1.887012628	1.114220133	0.503592572	9.073482913	0.729498245	4.381746447	0	0	0.014919403	4.27421565	15.392525	0.637386177	3.324643355	14.03317217	0.210216929	7.717555687	0	0	0	0.224000666	0	0	0	0	0.230055494	0	0	0	0	0	0	0	0	0	0	87.0702	NO	0.2	0.2	0.2	0	100	0.2	0.2	50	0.2	0.2	0.2	0.45	0.2	50	0.2	0.2	0.45	0.2	0.2	0.2	0.2		0		0.2	1 pair of glasses or contacts after cataract surgery			0.45	0.2												4.2854	0.0655	0.6215	0	0.1644	0.1715	0.1013	0.0348	0.7241	0.1303	0.4349	0.0447	0.0023	0.0915	0.619	1.8439	0.0023	0.2017	0.8273	0.1107	0.7014	0	0	0	0.0055	0	0.0007	0	0	0.036											11.2209	1000	0	19.796	0.76730235	5.680760349	0	2.214703561	2.058541952	1.21550267	0.538374234	9.797579434	0.85981117	4.816614296	0.04471193	0.002311094	0.106456575	4.893251652	17.236445	0.639711131	3.526353443	14.86044065	0.320892996	8.418959039	0	0	0	0.229497536	3.07E-05	0.000696206	0	0	0.266068829	0	0	0	0	0	0	0	0	0	0	98.291
H8980_003_0	2010	8	N/A																															D	D	D	V	T	O	O	V	V	O	O	O	O	O	P	P	P	P	P	P	S	V	T	V	V	V	V	V	P	O											12.2214	0	1.8526	0	2.38	1.5997	1.1516	0	10.3528	2.0003	6.2823	0.6459	0.0338	1.3214	0.0032	0.2496	0	3.2136	7.2378	0	5.9658	0	0.0094	0	0	0	0.0006	0	0	0.0881											56.6099	YES	0	0	0	0	0	0	0	116.2931875	0	0	0	0	0	0	6135.800499	18006.60795	0	0	5418.810743	1555.813058	0	0	0	0	262.4237292	0	0	0	0	410.0735345											2000	1a $0 per admit	1b $0 per admit	2 0% days 11-100	6 $0	10a $0	11a 0%	11b 0%	4a $50	"9a $0, 9b $0"	8a $0	8b $0	5 $0	12 $0	4b $50	7a $10	"16b $0, 17a $30, 18a $0, 7b $0, 7d $30, 7f $0"	"7e $0, 7h $0, 9c $0"	"7c $0, 7i $0"	8b $0	7g $0	15 $0		10b $0		17a $30	17b 1 pair of glasses after cataract surgery - Medicare Covered Only			14a $0	"14c $10, 7f $0"											0	0	0	0	0	0	0	50	0	0	0	0	0	0	5.700839249	7.975318939	0	0	0.002304377	1.204677354	0	0	0	0	10.97575928	0	0	0	0	1.751740972											NO	0	0	0	0	0	0	0	47.13891581	0	0	0	0	0	0	5.374627628	7.518957761	0	0	0.002172517	1.135743687	0	0	0	0	10.34770786	0	0	0	0	1.651503404												0	0	0	0	0	0	0	0.456827898	0	0	0	0	0	0	2.748136907	11.28257705	0	0	0.000981038	0.147250405	0	0	0	0	0.22629034	0	0	0	0	0.056436487	0	0	0	0	0	0	0	0	0	0	14.9185	1200	0.905474469	12.2214	0	1.852601816	0	2.379954234	1.599733046	1.151561407	0.456827898	10.35284412	2.000260161	6.282333918	0.645932496	0.033846573	1.321444207	2.751288759	11.53216592	0	3.213618161	7.238743054	0.147250405	5.965839255	0	0.009382033	0	0.22629034	0	0.000587575	0	0	0.144555256	0	0	0	0	0	0	0	0	0	0	71.5284	NO	0.3	0.3	0.3	0	0	0.3	0.3	50	0.3	0.3	0.3	0.45	0.3	50	0.3	0.3	0.45	0.3	0.3	0.3	0.3		0		0.3	1 pair of glasses after cataract surgery - Medicare Covered Only			0.45	0.3												5.9176	0.0905	0.897	0	0	0.2586	0.1527	0.0335	1.0128	0.1842	0.6146	0.0632	0.0033	0.1294	0.949	2.8267	0.0024	0.3092	1.2682	0.1697	0.9641	0	0	0	0.0088	0	0.0011	0	0	0.0509											15.9073	2000	0	18.139	0.090474112	2.749630519	0	2.379954234	1.85830338	1.304238855	0.490294687	11.36560649	2.184421765	6.896900438	0.709120555	0.037112671	1.450806913	3.700265276	14.35887839	0.002376089	3.522837876	8.50693805	0.316915802	6.929964631	0	0.009382033	0	0.235125488	4.94E-05	0.00170659	0	0	0.19549355	0	0	0	0	0	0	0	0	0	0	87.4358
H8980_801_0	2010	5	N/A																															COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	302.0171576	6.395465559	50.53072063	0	12.6101317	13.87926315	6.791562171	3.814570779	53.1315765	9.606829149	35.33131024	3.723284866	0.229324253	7.713498054	41.78347594	133.1491242	1.92300689	15.5860333	58.90904416	8.332623851	46.59058385	0	0	0	0	0	0	0	0	0												FFS 8.3%	FFS 8.3%	FFS 18.2%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%											0.082740576	0.082740576	0.181760554	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23267181	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.082740576	0.082740576	0.181760554	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23267181	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												24.9891	0.529164506	9.184491754	0	2.938160686	3.233868313	1.582433986	0.888794992	12.37965732	2.238391192	8.232195286	0.867525374	0.053432551	1.797245047	9.735549894	31.02374595	0.447429493	3.631545759	13.72580729	1.941501357	10.85560604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.2756	0	0	24.9891	0.529164506	9.184491754	0	2.938160686	3.233868313	1.582433986	0.888794992	12.37965732	2.238391192	8.232195286	0.867525374	0.053432551	1.797245047	9.735549894	31.02374595	0.447429493	3.631545759	13.72580729	1.941501357	10.85560604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.2756	NO	FFS 8.3%	FFS 8.3%	FFS 18.2%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%												2.2715	0.0338	0.8349	0	0.2671	0.294	0.1438	0.0808	1.1252	0.1929	0.7483	0.0789	0.0049	0.1634	0.8849	2.7841	0.0001	0.3301	1.2477	0.1762	1.0316	0	0	0	0	0	0	0	0	0											12.6941	0	0	27.2605	0.563003966	10.0193487	0	3.205239299	3.52782673	1.726277131	0.969586398	13.50483373	2.431292476	8.980501297	0.946383373	0.058289566	1.960599954	10.620499	33.80788932	0.447569606	3.96165233	14.97347962	2.117683997	11.8872087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.9697
H8980_802_0	2010	5	N/A																															COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	302.0187577	6.395499442	50.53098834	0	12.61019851	13.87933668	6.791598152	3.814590989	53.13185799	9.606880046	35.33149743	3.723304592	0.229325468	7.71353892	41.78369731	133.1498297	1.923017078	15.58611588	58.90935626	8.332667997	46.59083069	0	0	0	0	0	0	0	0	0												FFS 8.3%	FFS 8.3%	FFS 18.2%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%											0.082740573	0.082740573	0.181760557	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23267181	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.082740573	0.082740573	0.181760557	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23267181	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												24.9892	0.529167286	9.184540612	0	2.938176252	3.233885446	1.582442369	0.8887997	12.37972291	2.238403051	8.2322389	0.86752997	0.053432834	1.797254568	9.735601473	31.02391031	0.447431864	3.631564999	13.72588001	1.941511643	10.85566355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.2764	0	0	24.9892	0.529167286	9.184540612	0	2.938176252	3.233885446	1.582442369	0.8887997	12.37972291	2.238403051	8.2322389	0.86752997	0.053432834	1.797254568	9.735601473	31.02391031	0.447431864	3.631564999	13.72588001	1.941511643	10.85566355	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.2764	NO	FFS 8.3%	FFS 8.3%	FFS 18.2%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%												2.2715	0.0338	0.8349	0	0.2671	0.294	0.1438	0.0808	1.1252	0.1929	0.7483	0.0789	0.0049	0.1634	0.885	2.7842	0.0001	0.3301	1.2477	0.1762	1.0316	0	0	0	0	0	0	0	0	0											12.6942	0	0	27.2607	0.563006924	10.019402	0	3.20525628	3.527845421	1.726286277	0.969591535	13.50490527	2.431305357	8.980548876	0.946388387	0.058289875	1.960610342	10.62055527	33.80806843	0.447571978	3.961673319	14.97355895	2.117695216	11.88727167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.9705
H8980_803_0	2010	5	N/A																															COIN	COIN	COIN	V	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	COIN	V	T	V	V	V	V	V	P	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	NO	302.0171576	6.395465559	50.53072063	0	12.6101317	13.87926315	6.791562171	3.814570779	53.1315765	9.606829149	35.33131024	3.723284866	0.229324253	7.713498054	41.78347594	133.1491242	1.92300689	15.5860333	58.90904416	8.332623851	46.59058385	0	0	0	0	0	0	0	0	0												FFS 8.3%	FFS 8.3%	FFS 18.2%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%											0.082701606	0.082701606	0.18163499	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23267181	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.082701606	0.082701606	0.18163499	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.23267181	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0	0												24.9773	0.528915274	9.178146961	0	2.938160686	3.233868313	1.582433986	0.888794992	12.37965732	2.238391192	8.232195286	0.867525374	0.053432551	1.797245047	9.735549894	31.02374595	0.447429493	3.631545759	13.72580729	1.941501357	10.85560604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.2573	0	0	24.9773	0.528915274	9.178146961	0	2.938160686	3.233868313	1.582433986	0.888794992	12.37965732	2.238391192	8.232195286	0.867525374	0.053432551	1.797245047	9.735549894	31.02374595	0.447429493	3.631545759	13.72580729	1.941501357	10.85560604	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.2573	NO	FFS 8.3%	FFS 8.3%	FFS 18.2%	0	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%		FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%	FFS 23.3%			FFS 23.3%												2.2704	0.0338	0.8343	0	0.2671	0.294	0.1438	0.0808	1.1252	0.1929	0.7483	0.0789	0.0049	0.1634	0.8849	2.7841	0.0001	0.3301	1.2477	0.1762	1.0316	0	0	0	0	0	0	0	0	0											12.6924	0	0	27.2477	0.562738796	10.01242717	0	3.205239299	3.52782673	1.726277131	0.969586398	13.50483373	2.431292476	8.980501297	0.946383373	0.058289566	1.960599954	10.620499	33.80788932	0.447569606	3.96165233	14.97347962	2.117683997	11.8872087	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.9497
H8991_012_0	2010	3	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	T	V	V	V	V	V	O	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	NO	0	0	852.51	0	553.65	0	0	213.08	0	0	165.56	63.93	0.34	956.8	0	0	0	0	2825.09	0	15.19	0	0	0	0	0	0	0	0	0												1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $25 for days 11-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $25	8B OP Radiology: $25	9A OP Hospital: $25	12 Renal Dialysis: 20%	"3 CORF: $25, 5 Partial Hosp: $25, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $25"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $25	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC Rx: $0, 13D Welcome Home: Not Covered, 13E PERS : $0"											0	0	25	0	100	0	0	50	0	0	25	25	0.200000018	13.82054766	0	0	0	0	2.95	0	0.200000735	0	0	0	0	0	0	0	0	0											NO	0	0	25	0	100	0	0	50	0	0	25	25	0.200000018	13.82054766	0	0	0	0	2.95	0	0.200000735	0	0	0	0	0	0	0	0	0												0	0	1.7760625	0	4.61375	0	0	0.887833333	0	0	0.344916667	0.1331875	0.068000006	1.101958333	0	0	0	0	0.694501292	0	3.038011167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.6582	0	0	0	0	1.7760625	0	4.61375	0	0	0.887833333	0	0	0.344916667	0.1331875	0.068000006	1.101958333	0	0	0	0	0.694501292	0	3.038011167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.6582	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	1.7760625	0	4.61375	0	0	0.887833333	0	0	0.344916667	0.1331875	0.068000006	1.101958333	0	0	0	0	0.694501292	0	3.038011167	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	12.6582
H8991_017_0	2010	3	N/A																															A	A	D	V	T	O	O	V	V	V	V	V	V	V	V	V	V	V	V	V	S	V	T	V	V	V	V	V	O	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	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												1A IP Acute: 0%	1B IP Psych: 0%	2 SNF: $0	6 Home Health: $0	10A Ambulance: $0	11A DME: 0%	"11B Prosthetics/Medical Supplies: 0%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $0, 4B Urgent Care: $0"	9B ASC Services: $0	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $0	9A OP Hospital: $0	12 Renal Dialysis: $0	"3 CORF: $0, 5 Partial Hosp: $0, 9C OP Substance Abuse: $0, 9D Cardiac Rehab: $0"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	"7B Chiropractic: $0, 7D Physician Specialist (excl. Radiology): $0, 7F Podiatry: $0"	"7E Mental Health: $0, 7H Psychiatric: $0"	"7C Occupational Therapy: $0, 7I Physical and Speech Therapy: $0"	7D Physician Specialist (Radiology): $0	"7G Other Health Care: $0, 18A Hearing Exams (Medicare Covered): $0"	15 Part B Drugs: 0%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $0"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C OTC Rx: $0, 13D Welcome Home: $0, 13E PERS : $0"											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H8991_018_0	2010	4	N/A																															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	V	V	V	O	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	NO	788.6	17.54	592.02	0	254.64	11.72	8.42	194.54	253.08	0	107.9	26.06	0.1	425.63	0	3979.41	184.16	802.52	1986.77	1687.49	7.15	684.77	0	0	0	0	0	0	0	0												1A IP Acute: $75 Per Day for days 1-10	1B IP Psych: $75 Per Day for days 1-10	2 SNF: $100 for days 14-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $20"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $100	8B OP Radiology: $65	9A OP Hospital: $100	12 Renal Dialysis: 20%	"3 CORF: $100, 5 Partial Hosp: $100, 9C OP Substance Abuse: $20, 9D Cardiac Rehab: $100"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $20"	"7B Chiropractic: $20, 7D Physician Specialist (excl. Radiology): $20, 7F Podiatry: $20"	"7E Mental Health: $20, 7H Psychiatric: $20"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $65	"7G Other Health Care: $20, 18A Hearing Exams (Medicare Covered): $20"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $20, 17A Routine Eye Exams (Medicare Covered): $20"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC Rx: $0, 13D Welcome Home: Not Covered, 13E PERS : $0"											75	75	100	0	100	0.200000007	0.156795213	46.40074021	100	0	65	98.44559585	0.200000025	67.22129549	0	20	20	20	7.67	20	0.199999508	20	0	0	0	0	0	0	0	0											NO	75	75	100	0	100	0.200000007	0.156795213	46.40074021	100	0	65	98.44559585	0.200000025	67.22129549	0	20	20	20	7.67	20	0.199999508	20	0	0	0	0	0	0	0	0												4.9287	0.109625	4.9335	0	2.122	2.344000078	1.32021569	0.752233333	2.109	0	0.584458333	0.213791019	0.020000003	2.384283333	0	6.63235	0.306933333	1.337533333	1.269877158	2.812483333	1.42999648	1.141283333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7523	0	0	4.9287	0.109625	4.9335	0	2.122	2.344000078	1.32021569	0.752233333	2.109	0	0.584458333	0.213791019	0.020000003	2.384283333	0	6.63235	0.306933333	1.337533333	1.269877158	2.812483333	1.42999648	1.141283333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7523	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.9287	0.109625	4.9335	0	2.122	2.344000078	1.32021569	0.752233333	2.109	0	0.584458333	0.213791019	0.020000003	2.384283333	0	6.63235	0.306933333	1.337533333	1.269877158	2.812483333	1.42999648	1.141283333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	36.7523
H8991_022_0	2010	3	N/A																															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	V	V	V	O	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	NO	892.17	19.51	652.39	0	241.23	13.02	9.38	213.29	274.07	0	182.93	43.6	0.19	688.25	0	5241.1	251.35	1254.05	2470.44	2674.73	13.05	912.54	0	0	0	0	0	0	0	0												1A IP Acute: $50 Per Day for days 1-10	1B IP Psych: $50 Per Day for days 1-10	2 SNF: $75 for days 11-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $15"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $100	8B OP Radiology: $50	9A OP Hospital: $100	12 Renal Dialysis: 20%	"3 CORF: $100, 5 Partial Hosp: $100, 9C OP Substance Abuse: $15, 9D Cardiac Rehab: $100"	"7A PCP: $0, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $15"	"7B Chiropractic: $15, 7D Physician Specialist (excl. Radiology): $15, 7F Podiatry: $15"	"7E Mental Health: $15, 7H Psychiatric: $15"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $50	"7G Other Health Care: $15, 18A Hearing Exams (Medicare Covered): $15"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $15, 17A Routine Eye Exams (Medicare Covered): $15"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): $0, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $0	17B Eye Wear (Medicare Covered): $0	18A Routine Hearing Exams (Non Medicare Covered): $0	18B Hearing Aids (Non Medicare Covered): $0	14A Health Education/Wellness Program: Not Covered	"13B Acupuncture: Not Covered, 13C OTC Rx: $0, 13D Welcome Home: Not Covered, 13E PERS : $0"											50	50	75	0	100	0.2	0.156760192	44.95569413	100	0	50	100	0.199999989	63.96469306	0	15	15	15	5.9	15	0.200000785	15	0	0	0	0	0	0	0	0											NO	50	50	75	0	100	0.2	0.156760192	44.95569413	100	0	50	100	0.199999989	63.96469306	0	15	15	15	5.9	15	0.200000785	15	0	0	0	0	0	0	0	0												3.7174	0.081291667	4.0774375	0	2.01025	2.604	1.470410601	0.79905	2.283916667	0	0.762208333	0.363333333	0.037999998	3.668641667	0	6.551375	0.3141875	1.5675625	1.214633	3.3434125	2.610010247	1.140675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6178	0	0	3.7174	0.081291667	4.0774375	0	2.01025	2.604	1.470410601	0.79905	2.283916667	0	0.762208333	0.363333333	0.037999998	3.668641667	0	6.551375	0.3141875	1.5675625	1.214633	3.3434125	2.610010247	1.140675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6178	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	3.7174	0.081291667	4.0774375	0	2.01025	2.604	1.470410601	0.79905	2.283916667	0	0.762208333	0.363333333	0.037999998	3.668641667	0	6.551375	0.3141875	1.5675625	1.214633	3.3434125	2.610010247	1.140675	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.6178
H9001_001_0	2010	2	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	232.4433386	0.999040137	90.36497715	0	386.5696819	13.20212636	1.243143601	1182.742907	776.2171453	0	2690.169629	1067.972714	0	0	6429.179466	2769.772532	164.9461553	439.4838761	0	1164.958059	68.9605495	238.5490375	0	543.7605053	116.1650868	0	0	0	4.133988854	0											3400	PBP: 1A IP Acute: $350 Per Admit	1B IP Psych: $350 Per Admit	"2 SNF: $35 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $15	9B ASC Services: $0-75	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $0-75	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $15; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $15	7B Chiropractic: $20; 7D Physician Specialist: $20; 7F Podiatry: $20	7E Mental Health: $20; 7H Psychiatric: $20; 9C OP Substance Abuse: $20	7C Occupational Therapy: $20; 7I Physical and Speech Therapy: $20	Included in h.2.	7G Other Health Care: $15-20; 18A Medicare Covered Hearing Exams: $20; 17A Medicare Covered Eye Exams: $20	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-20	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-20	17A Routine Eye Exams: $20	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-15	13B Acupuncture: Not Covered											350	350	442.05	0	50	0.1	0.1	47.79339157	75	0	75	75	0	0	15	20	20	20	0	17.49733854	11.03424658	15	0	10	20	0	0	0	15	0											NO	348.25	348.25	439.83975	0	49.75	0.0995	0.0995	47.55442461	74.625	0	74.625	74.625	0	0	14.925	19.9	19.9	19.9	0	17.40985185	10.97907534	14.925	0	9.95	19.9	0	0	0	14.925	0												6.7457	0.028992977	3.312175747	0	1.602653473	1.313611573	0.123692788	4.687054868	4.827100373	0	16.72949238	6.641455315	0	0	7.996291961	4.593206116	0.273535708	0.728810761	0	1.690145601	0.063093589	0.296695365	0	0.450868086	0.192640436	0	0	0	0.005141649	0	0	0	0	0	0	0	0	0	0	0	62.3024	0	0.313713543	6.7457	0.028992977	3.312175747	0	1.602653473	1.313611573	0.123692788	4.687054868	4.827100373	0	16.72949238	6.641455315	0	0	7.996291961	4.593206116	0.273535708	0.728810761	0	1.690145601	0.063093589	0.296695365	0	0.450868086	0.192640436	0	0	0	0.005141649	0	0	0	0	0	0	0	0	0	0	0	62.3024	NO																																																																																		0	0	0	6.7457	0.028992977	3.312175747	0	1.602653473	1.313611573	0.123692788	4.687054868	4.827100373	0	16.72949238	6.641455315	0	0	7.996291961	4.593206116	0.273535708	0.728810761	0	1.690145601	0.063093589	0.296695365	0	0.450868086	0.192640436	0	0	0	0.005141649	0	0	0	0	0	0	0	0	0	0	0	62.3024
H9001_010_0	2010	2	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	160.8431078	0	63.14850597	0	275.9537872	8.203553276	0.897927545	920.0750092	744.8870122	0	2457.020146	37.04974197	0	0	6127.946946	2355.352764	159.4346109	420.2902014	0	1058.160297	67.14353101	198.486033	0	452.4389063	100.3988418	0	0	0	6.514001207	0											3400	PBP: 1A IP Acute: $500 Per Admit	1B IP Psych: $500 Per Admit	"2 SNF: $50 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $25	9B ASC Services: $0-100	8A OP C/D/T: $0	8B OP X-Ray: $0-100	9A OP Hospital: $0-100	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $25; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $25	7B Chiropractic: $25; 7D Physician Specialist: $25; 7F Podiatry: $25	7E Mental Health: $25; 7H Psychiatric: $25; 9C OP Substance Abuse: $25	7C Occupational Therapy: $25; 7I Physical and Speech Therapy: $25	Included in h.2.	7G Other Health Care: $25.00; 18A Medicare Covered Hearing Exams: $25; 17A Medicare Covered Eye Exams: $25	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-25	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-25	17A Routine Eye Exams: $25	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-25	13B Acupuncture: Not Covered											500	500	638.5	0	50	0.1	0.1	48.66389549	100	0	100	100	0	0	25	25	25	25	0	25	6.724137931	17.5	0	10	25	0	0	0	25	0											NO	497.5	497.5	635.3075	0	49.75	0.0995	0.0995	48.42057601	99.5	0	99.5	99.5	0	0	24.875	24.875	24.875	24.875	0	24.875	6.690517241	17.4125	0	9.95	24.875	0	0	0	24.875	0												6.6683	0	3.343226622	0	1.14405841	0.816253551	0.089343791	3.712546827	6.17635481	0	20.37279204	0.307204111	0	0	12.70272336	4.88245	0.330494662	0.871226563	0	2.193478115	0.037435413	0.288011504	0	0.37514726	0.208118432	0	0	0	0.013502982	0	0	0	0	0	0	0	0	0	0	0	64.5327	0	0.325118445	6.6683	0	3.343226622	0	1.14405841	0.816253551	0.089343791	3.712546827	6.17635481	0	20.37279204	0.307204111	0	0	12.70272336	4.88245	0.330494662	0.871226563	0	2.193478115	0.037435413	0.288011504	0	0.37514726	0.208118432	0	0	0	0.013502982	0	0	0	0	0	0	0	0	0	0	0	64.5327	NO																																																																																		0	0	0	6.6683	0	3.343226622	0	1.14405841	0.816253551	0.089343791	3.712546827	6.17635481	0	20.37279204	0.307204111	0	0	12.70272336	4.88245	0.330494662	0.871226563	0	2.193478115	0.037435413	0.288011504	0	0.37514726	0.208118432	0	0	0	0.013502982	0	0	0	0	0	0	0	0	0	0	0	64.5327
H9001_011_0	2010	3	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	186.9326674	2.332493176	79.26619697	0	370.4147551	12.40385772	3.20012552	1319.968093	807.6965543	0	3186.564257	1284.333879	0	0	7464.675176	2742.066482	528.2273191	515.0092139	0	1192.13088	193.4674968	237.1482273	0	540.5674291	116.234829	0	0	0	6.204706175	0											3400	PBP: 1A IP Acute: $500 Per Admit	1B IP Psych: $500 Per Admit	"2 SNF: $50 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $25	9B ASC Services: $0-100	8A OP C/D/T: $0	8B OP X-Ray: $0-100	9A OP Hospital: $0-100	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $25; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $25	7B Chiropractic: $25; 7D Physician Specialist: $25; 7F Podiatry: $25	7E Mental Health: $25; 7H Psychiatric: $25; 9C OP Substance Abuse: $25	7C Occupational Therapy: $25; 7I Physical and Speech Therapy: $25	Included in h.2.	7G Other Health Care: $25.00; 18A Medicare Covered Hearing Exams: $25; 17A Medicare Covered Eye Exams: $25	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-25	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-25	17A Routine Eye Exams: $25	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-25	13B Acupuncture: Not Covered											500	500	638.5	0	50	0.1	0.1	48.47713014	100	0	100	100	0	0	25	25	25	25	0	25	9.728099174	17.5	0	10	25	0	0	0	25	0											NO	497.5	497.5	635.3075	0	49.75	0.0995	0.0995	48.23474449	99.5	0	99.5	99.5	0	0	24.875	24.875	24.875	24.875	0	24.875	9.679458678	17.4125	0	9.95	24.875	0	0	0	24.875	0												7.7499	0.09670128	4.196534119	0	1.535677839	1.234183843	0.318412489	5.305693642	6.697150596	0	26.42192863	10.64926841	0	0	15.47364958	5.684075312	1.094971213	1.067571183	0	2.47118797	0.156055053	0.344111959	0	0.448220493	0.240945114	0	0	0	0.012861839	0	0	0	0	0	0	0	0	0	0	0	91.1991	0	0.458577304	7.7499	0.09670128	4.196534119	0	1.535677839	1.234183843	0.318412489	5.305693642	6.697150596	0	26.42192863	10.64926841	0	0	15.47364958	5.684075312	1.094971213	1.067571183	0	2.47118797	0.156055053	0.344111959	0	0.448220493	0.240945114	0	0	0	0.012861839	0	0	0	0	0	0	0	0	0	0	0	91.1991	NO																																																																																		0	0	0	7.7499	0.09670128	4.196534119	0	1.535677839	1.234183843	0.318412489	5.305693642	6.697150596	0	26.42192863	10.64926841	0	0	15.47364958	5.684075312	1.094971213	1.067571183	0	2.47118797	0.156055053	0.344111959	0	0.448220493	0.240945114	0	0	0	0.012861839	0	0	0	0	0	0	0	0	0	0	0	91.1991
H9001_013_0	2010	4	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	153.8155033	0.554290102	57.64597378	0	253.5681982	9.736825008	1.767169869	992.9993889	800.0160726	0	2985.649293	1170.293148	0	0	7739.2833	2720.36066	356.4302067	539.12578	0	1328.700249	184.5239677	212.9810562	0	485.479581	121.7917888	0	0	0	5.848758217	0											3400	PBP: 1A IP Acute: $500 Per Admit	1B IP Psych: $500 Per Admit	"2 SNF: $50 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $25	9B ASC Services: $0-100	8A OP C/D/T: $0	8B OP X-Ray: $0-100	9A OP Hospital: $0-100	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $25; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $25	7B Chiropractic: $25; 7D Physician Specialist: $25; 7F Podiatry: $25	7E Mental Health: $25; 7H Psychiatric: $25; 9C OP Substance Abuse: $25	7C Occupational Therapy: $25; 7I Physical and Speech Therapy: $25	Included in h.2.	7G Other Health Care: $25.00; 18A Medicare Covered Hearing Exams: $25; 17A Medicare Covered Eye Exams: $25	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-25	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-25	17A Routine Eye Exams: $25	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-25	13B Acupuncture: Not Covered											500	500	638.5	0	50	0.1	0.1	48.10821393	100	0	100	100	0	0	25	25	25	25	0	25	7.732727273	17.5	0	10	25	0	0	0	25	0											NO	497.5	497.5	635.3075	0	49.75	0.0995	0.0995	47.86767286	99.5	0	99.5	99.5	0	0	24.875	24.875	24.875	24.875	0	24.875	7.694063636	17.4125	0	9.95	24.875	0	0	0	24.875	0												6.3769	0.022979944	3.051909957	0	1.051251488	0.968814088	0.175833402	3.961047491	6.633466602	0	24.75600872	9.703680689	0	0	16.04288934	5.639080952	0.738850116	1.117562815	0	2.754284891	0.118311596	0.309044387	0	0.402543486	0.252464229	0	0	0	0.012123988	0	0	0	0	0	0	0	0	0	0	0	84.0891	0	0.423177375	6.3769	0.022979944	3.051909957	0	1.051251488	0.968814088	0.175833402	3.961047491	6.633466602	0	24.75600872	9.703680689	0	0	16.04288934	5.639080952	0.738850116	1.117562815	0	2.754284891	0.118311596	0.309044387	0	0.402543486	0.252464229	0	0	0	0.012123988	0	0	0	0	0	0	0	0	0	0	0	84.0891	NO																																																																																		0	0	0	6.3769	0.022979944	3.051909957	0	1.051251488	0.968814088	0.175833402	3.961047491	6.633466602	0	24.75600872	9.703680689	0	0	16.04288934	5.639080952	0.738850116	1.117562815	0	2.754284891	0.118311596	0.309044387	0	0.402543486	0.252464229	0	0	0	0.012123988	0	0	0	0	0	0	0	0	0	0	0	84.0891
H9001_014_0	2010	3	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	256.6848089	0	137.633779	0	557.5035887	16.73713395	1.606364956	1558.2556	831.8767407	0	3333.035019	62.37109614	0	0	7917.751713	3081.088684	435.7898965	432.113688	0	1419.739181	231.5619809	284.209486	0	647.841196	148.3404615	0	0	0	3.183271705	0											3400	PBP: 1A IP Acute: $350 Per Admit	1B IP Psych: $350 Per Admit	"2 SNF: $35 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $15	9B ASC Services: $0-75	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $0-75	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $15; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $15	7B Chiropractic: $20; 7D Physician Specialist: $20; 7F Podiatry: $20	7E Mental Health: $20; 7H Psychiatric: $20; 9C OP Substance Abuse: $20	7C Occupational Therapy: $20; 7I Physical and Speech Therapy: $20	Included in h.2.	7G Other Health Care: $15-20; 18A Medicare Covered Hearing Exams: $20; 17A Medicare Covered Eye Exams: $20	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-20	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-20	17A Routine Eye Exams: $20	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-15	13B Acupuncture: Not Covered											350	350	442.05	0	50	0.1	0.1	48.60155383	75	0	75	75	0	0	15	20	20	20	0	17.49495516	8.210253165	15	0	10	20	0	0	0	15	0											NO	348.25	348.25	439.83975	0	49.75	0.0995	0.0995	48.35854606	74.625	0	74.625	74.625	0	0	14.925	19.9	19.9	19.9	0	17.40748038	8.169201899	14.925	0	9.95	19.9	0	0	0	14.925	0												7.4492	0	5.044733914	0	2.311316961	1.665344828	0.159833313	6.279581265	5.173233481	0	20.72731152	0.387870254	0	0	9.847703693	5.109472067	0.722684912	0.716588533	0	2.059506828	0.157639714	0.353485548	0	0.537168325	0.245997932	0	0	0	0.003959194	0	0	0	0	0	0	0	0	0	0	0	68.9526	0	0.347040459	7.4492	0	5.044733914	0	2.311316961	1.665344828	0.159833313	6.279581265	5.173233481	0	20.72731152	0.387870254	0	0	9.847703693	5.109472067	0.722684912	0.716588533	0	2.059506828	0.157639714	0.353485548	0	0.537168325	0.245997932	0	0	0	0.003959194	0	0	0	0	0	0	0	0	0	0	0	68.9526	NO																																																																																		0	0	0	7.4492	0	5.044733914	0	2.311316961	1.665344828	0.159833313	6.279581265	5.173233481	0	20.72731152	0.387870254	0	0	9.847703693	5.109472067	0.722684912	0.716588533	0	2.059506828	0.157639714	0.353485548	0	0.537168325	0.245997932	0	0	0	0.003959194	0	0	0	0	0	0	0	0	0	0	0	68.9526
H9001_015_0	2010	4	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	200.13568	0	94.22555438	0	381.2797467	13.47348728	1.553704177	1147.43651	806.7233609	0	3094.069416	1416.269675	0	0	8083.045736	3052.649287	364.4845789	622.3392889	0	1342.991083	221.2117774	247.3167449	0	563.7460525	130.2250292	0	0	0	8.002655424	0											3400	PBP: 1A IP Acute: $350 Per Admit	1B IP Psych: $350 Per Admit	"2 SNF: $35 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $15	9B ASC Services: $0-75	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $0-75	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $15; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $15	7B Chiropractic: $20; 7D Physician Specialist: $20; 7F Podiatry: $20	7E Mental Health: $20; 7H Psychiatric: $20; 9C OP Substance Abuse: $20	7C Occupational Therapy: $20; 7I Physical and Speech Therapy: $20	Included in h.2.	7G Other Health Care: $15-20; 18A Medicare Covered Hearing Exams: $20; 17A Medicare Covered Eye Exams: $20	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-20	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-20	17A Routine Eye Exams: $20	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-15	13B Acupuncture: Not Covered											350	350	442.05	0	50	0.1	0.1	47.63692732	75	0	75	75	0	0	15	20	20	20	0	17.49526002	9.582342954	15	0	10	20	0	0	0	15	0											NO	348.25	348.25	439.83975	0	49.75	0.0995	0.0995	47.39874268	74.625	0	74.625	74.625	0	0	14.925	19.9	19.9	19.9	0	17.40778372	9.534431239	14.925	0	9.95	19.9	0	0	0	14.925	0												5.8081	0	3.45367869	0	1.580722283	1.340611984	0.154593566	4.53225399	5.016810901	0	19.24124418	8.80742704	0	0	10.05328813	5.062310068	0.604436927	1.032045987	0	1.948208193	0.175760707	0.307600202	0	0.467439435	0.215956507	0	0	0	0.009953303	0	0	0	0	0	0	0	0	0	0	0	69.8124	0	0.351336737	5.8081	0	3.45367869	0	1.580722283	1.340611984	0.154593566	4.53225399	5.016810901	0	19.24124418	8.80742704	0	0	10.05328813	5.062310068	0.604436927	1.032045987	0	1.948208193	0.175760707	0.307600202	0	0.467439435	0.215956507	0	0	0	0.009953303	0	0	0	0	0	0	0	0	0	0	0	69.8124	NO																																																																																		0	0	0	5.8081	0	3.45367869	0	1.580722283	1.340611984	0.154593566	4.53225399	5.016810901	0	19.24124418	8.80742704	0	0	10.05328813	5.062310068	0.604436927	1.032045987	0	1.948208193	0.175760707	0.307600202	0	0.467439435	0.215956507	0	0	0	0.009953303	0	0	0	0	0	0	0	0	0	0	0	69.8124
H9001_017_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	246.2468654	0.347315748	163.3383666	0	631.6234492	17.60519447	2.619129763	1646.881185	876.9271881	0	3578.825482	1489.704186	0	0	8233.837525	3409.410396	503.3794395	566.8039112	0	1509.972022	254.9317888	323.8955765	0	738.3036386	138.0260769	0	0	0	4.490004912	0											3400	PBP: 1A IP Acute: $200 Per Admit	1B IP Psych: $200 Per Admit	"2 SNF: $20 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	11B Prosthetic Medical Supplies: 0%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $10	9B ASC Services: $0-50	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $0-50	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $10; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $10	7B Chiropractic: $15; 7D Physician Specialist: $15; 7F Podiatry: $15	7E Mental Health: $15; 7H Psychiatric: $15; 9C OP Substance Abuse: $15	7C Occupational Therapy: $15; 7I Physical and Speech Therapy: $15	Included in h.2.	7G Other Health Care: $10-15; 18A Medicare Covered Hearing Exams: $15; 17A Medicare Covered Eye Exams: $15	15 Part B Drugs: $10-65	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-15	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-15	17A Routine Eye Exams: $15	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-10	13B Acupuncture: Not Covered											200	200	255.4	0	50	0.1	0.1	47.87140663	50	0	75	50	0	0	10	15	15	15	0	12.4964207	10.55692771	12.5	0	10	15	0	0	0	10	0											NO	199	199	254.123	0	49.75	0.0995	0.0995	47.63204959	49.75	0	74.625	49.75	0	0	9.95	14.925	14.925	14.925	0	12.4339386	10.50414307	12.4375	0	9.95	14.925	0	0	0	9.95	0												4.0836	0.005759653	3.459002978	0	2.61860555	1.751716849	0.260603411	6.537027191	3.635593967	0	22.25582096	6.17606527	0	0	6.827223615	4.24045418	0.626078178	0.704962365	0	1.564574951	0.223153332	0.335704269	0	0.612176767	0.171669933	0	0	0	0.003722962	0	0	0	0	0	0	0	0	0	0	0	66.0935	0	0.332532504	4.0836	0.005759653	3.459002978	0	2.61860555	1.751716849	0.260603411	6.537027191	3.635593967	0	22.25582096	6.17606527	0	0	6.827223615	4.24045418	0.626078178	0.704962365	0	1.564574951	0.223153332	0.335704269	0	0.612176767	0.171669933	0	0	0	0.003722962	0	0	0	0	0	0	0	0	0	0	0	66.0935	NO																																																																																		0	0	0	4.0836	0.005759653	3.459002978	0	2.61860555	1.751716849	0.260603411	6.537027191	3.635593967	0	22.25582096	6.17606527	0	0	6.827223615	4.24045418	0.626078178	0.704962365	0	1.564574951	0.223153332	0.335704269	0	0.612176767	0.171669933	0	0	0	0.003722962	0	0	0	0	0	0	0	0	0	0	0	66.0935
H9001_019_0	2010	4	N/A																															D	D	A	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	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	YES	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											3400	PBP: 1A IP Acute: $0 Per Day	1B IP Psych: $0 Per Day	2 SNF: $0 per admit	6 Home Health: $0	10A Ambulance: $0	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $0; 4B Urgent Care: $0	9B ASC Services: $0	8A OP C/D/T: $0	8B OP X-Ray: $0.00	9A OP Hospital: $0	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $0; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $0	7B Chiropractic: $0; 7D Physician Specialist: $0; 7F Podiatry: $0	7E Mental Health: $0; 7H Psychiatric: $0; 9C OP Substance Abuse: $0	7C Occupational Therapy: $0; 7I Physical and Speech Therapy: $0	Included in h.2.	7G Other Health Care: $0; 18A Medicare Covered Hearing Exams: $0; 17A Medicare Covered Eye Exams: $0	15 Part B Drugs: $0	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $0	10B Transportation: Not Covered	16A Preventive Dental Services: Not Covered; 16B Non-Medicare Covered Comprehensive Dental Services: Not Covered	17A Routine Eye Exams: $0	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: $0	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0	13B Acupuncture: 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											NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO																																																																																		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
H9001_020_0	2010	4	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	186.9326674	2.332493176	79.26619697	0	370.4147551	12.40385772	3.20012552	1319.968093	807.6965543	0	3186.564257	1284.333879	0	0	7464.675176	2742.066482	528.2273191	515.0092139	0	1192.13088	193.4674968	237.1482273	0	540.5674291	116.234829	0	0	0	6.204706175	0											3400	PBP: 1A IP Acute: $500 Per Admit	1B IP Psych: $500 Per Admit	"2 SNF: $50 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $25	9B ASC Services: $0-100	8A OP C/D/T: $0	8B OP X-Ray: $0-100	9A OP Hospital: $0-100	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $25; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $25	7B Chiropractic: $25; 7D Physician Specialist: $25; 7F Podiatry: $25	7E Mental Health: $25; 7H Psychiatric: $25; 9C OP Substance Abuse: $25	7C Occupational Therapy: $25; 7I Physical and Speech Therapy: $25	Included in h.2.	7G Other Health Care: $25.00; 18A Medicare Covered Hearing Exams: $25; 17A Medicare Covered Eye Exams: $25	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-25	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-25	17A Routine Eye Exams: $25	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-25	13B Acupuncture: Not Covered											500	500	638.5	0	50	0.1	0.1	48.47713014	100	0	100	100	0	0	25	25	25	25	0	25	9.728099174	17.5	0	10	25	0	0	0	25	0											NO	497.5	497.5	635.3075	0	49.75	0.0995	0.0995	48.23474449	99.5	0	99.5	99.5	0	0	24.875	24.875	24.875	24.875	0	24.875	9.679458678	17.4125	0	9.95	24.875	0	0	0	24.875	0												7.7499	0.09670128	4.196534119	0	1.535677839	1.234183843	0.318412489	5.305693642	6.697150596	0	26.42192863	10.64926841	0	0	15.47364958	5.684075312	1.094971213	1.067571183	0	2.47118797	0.156055053	0.344111959	0	0.448220493	0.240945114	0	0	0	0.012861839	0	0	0	0	0	0	0	0	0	0	0	91.1991	0	0.458577304	7.7499	0.09670128	4.196534119	0	1.535677839	1.234183843	0.318412489	5.305693642	6.697150596	0	26.42192863	10.64926841	0	0	15.47364958	5.684075312	1.094971213	1.067571183	0	2.47118797	0.156055053	0.344111959	0	0.448220493	0.240945114	0	0	0	0.012861839	0	0	0	0	0	0	0	0	0	0	0	91.1991	NO																																																																																		0	0	0	7.7499	0.09670128	4.196534119	0	1.535677839	1.234183843	0.318412489	5.305693642	6.697150596	0	26.42192863	10.64926841	0	0	15.47364958	5.684075312	1.094971213	1.067571183	0	2.47118797	0.156055053	0.344111959	0	0.448220493	0.240945114	0	0	0	0.012861839	0	0	0	0	0	0	0	0	0	0	0	91.1991
H9001_021_0	2010	3	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	153.8155033	0.554290102	57.64597378	0	253.5681982	9.736825008	1.767169869	992.9993889	800.0160726	0	2985.649293	1170.293148	0	0	7739.2833	2720.36066	356.4302067	539.12578	0	1328.700249	184.5239677	212.9810562	0	485.479581	121.7917888	0	0	0	5.848758217	0											3400	PBP: 1A IP Acute: $500 Per Admit	1B IP Psych: $500 Per Admit	"2 SNF: $50 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $25	9B ASC Services: $0-100	8A OP C/D/T: $0	8B OP X-Ray: $0-100	9A OP Hospital: $0-100	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $25; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $25	7B Chiropractic: $25; 7D Physician Specialist: $25; 7F Podiatry: $25	7E Mental Health: $25; 7H Psychiatric: $25; 9C OP Substance Abuse: $25	7C Occupational Therapy: $25; 7I Physical and Speech Therapy: $25	Included in h.2.	7G Other Health Care: $25.00; 18A Medicare Covered Hearing Exams: $25; 17A Medicare Covered Eye Exams: $25	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-25	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-25	17A Routine Eye Exams: $25	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-25	13B Acupuncture: Not Covered											500	500	638.5	0	50	0.1	0.1	48.10821393	100	0	100	100	0	0	25	25	25	25	0	25	7.732727273	17.5	0	10	25	0	0	0	25	0											NO	497.5	497.5	635.3075	0	49.75	0.0995	0.0995	47.86767286	99.5	0	99.5	99.5	0	0	24.875	24.875	24.875	24.875	0	24.875	7.694063636	17.4125	0	9.95	24.875	0	0	0	24.875	0												6.3769	0.022979944	3.051909957	0	1.051251488	0.968814088	0.175833402	3.961047491	6.633466602	0	24.75600872	9.703680689	0	0	16.04288934	5.639080952	0.738850116	1.117562815	0	2.754284891	0.118311596	0.309044387	0	0.402543486	0.252464229	0	0	0	0.012123988	0	0	0	0	0	0	0	0	0	0	0	84.0891	0	0.423177375	6.3769	0.022979944	3.051909957	0	1.051251488	0.968814088	0.175833402	3.961047491	6.633466602	0	24.75600872	9.703680689	0	0	16.04288934	5.639080952	0.738850116	1.117562815	0	2.754284891	0.118311596	0.309044387	0	0.402543486	0.252464229	0	0	0	0.012123988	0	0	0	0	0	0	0	0	0	0	0	84.0891	NO																																																																																		0	0	0	6.3769	0.022979944	3.051909957	0	1.051251488	0.968814088	0.175833402	3.961047491	6.633466602	0	24.75600872	9.703680689	0	0	16.04288934	5.639080952	0.738850116	1.117562815	0	2.754284891	0.118311596	0.309044387	0	0.402543486	0.252464229	0	0	0	0.012123988	0	0	0	0	0	0	0	0	0	0	0	84.0891
H9001_022_0	2010	1	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	232.4433386	0.999040137	90.36497715	0	386.5696819	13.20212636	1.243143601	1182.742907	776.2171453	0	2690.169629	1067.972714	0	0	6429.179466	2769.772532	164.9461553	439.4838761	0	1164.958059	68.9605495	238.5490375	0	543.7605053	116.1650868	0	0	0	4.133988854	0											3400	PBP: 1A IP Acute: $350 Per Admit	1B IP Psych: $350 Per Admit	"2 SNF: $35 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $15	9B ASC Services: $0-75	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $0-75	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $15; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $15	7B Chiropractic: $20; 7D Physician Specialist: $20; 7F Podiatry: $20	7E Mental Health: $20; 7H Psychiatric: $20; 9C OP Substance Abuse: $20	7C Occupational Therapy: $20; 7I Physical and Speech Therapy: $20	Included in h.2.	7G Other Health Care: $15-20; 18A Medicare Covered Hearing Exams: $20; 17A Medicare Covered Eye Exams: $20	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-20	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-20	17A Routine Eye Exams: $20	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-15	13B Acupuncture: Not Covered											350	350	442.05	0	50	0.1	0.1	47.79339157	75	0	75	75	0	0	15	20	20	20	0	17.49733854	11.03424658	15	0	10	20	0	0	0	15	0											NO	348.25	348.25	439.83975	0	49.75	0.0995	0.0995	47.55442461	74.625	0	74.625	74.625	0	0	14.925	19.9	19.9	19.9	0	17.40985185	10.97907534	14.925	0	9.95	19.9	0	0	0	14.925	0												6.7457	0.028992977	3.312175747	0	1.602653473	1.313611573	0.123692788	4.687054868	4.827100373	0	16.72949238	6.641455315	0	0	7.996291961	4.593206116	0.273535708	0.728810761	0	1.690145601	0.063093589	0.296695365	0	0.450868086	0.192640436	0	0	0	0.005141649	0	0	0	0	0	0	0	0	0	0	0	62.3024	0	0.313713543	6.7457	0.028992977	3.312175747	0	1.602653473	1.313611573	0.123692788	4.687054868	4.827100373	0	16.72949238	6.641455315	0	0	7.996291961	4.593206116	0.273535708	0.728810761	0	1.690145601	0.063093589	0.296695365	0	0.450868086	0.192640436	0	0	0	0.005141649	0	0	0	0	0	0	0	0	0	0	0	62.3024	NO																																																																																		0	0	0	6.7457	0.028992977	3.312175747	0	1.602653473	1.313611573	0.123692788	4.687054868	4.827100373	0	16.72949238	6.641455315	0	0	7.996291961	4.593206116	0.273535708	0.728810761	0	1.690145601	0.063093589	0.296695365	0	0.450868086	0.192640436	0	0	0	0.005141649	0	0	0	0	0	0	0	0	0	0	0	62.3024
H9001_023_0	2010	2	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	256.6848089	0	137.633779	0	557.5035887	16.73713395	1.606364956	1558.2556	831.8767407	0	3333.035019	62.37109614	0	0	7917.751713	3081.088684	435.7898965	432.113688	0	1419.739181	231.5619809	284.209486	0	647.841196	148.3404615	0	0	0	3.183271705	0											3400	PBP: 1A IP Acute: $350 Per Admit	1B IP Psych: $350 Per Admit	"2 SNF: $35 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $15	9B ASC Services: $0-75	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $0-75	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $15; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $15	7B Chiropractic: $20; 7D Physician Specialist: $20; 7F Podiatry: $20	7E Mental Health: $20; 7H Psychiatric: $20; 9C OP Substance Abuse: $20	7C Occupational Therapy: $20; 7I Physical and Speech Therapy: $20	Included in h.2.	7G Other Health Care: $15-20; 18A Medicare Covered Hearing Exams: $20; 17A Medicare Covered Eye Exams: $20	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-20	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-20	17A Routine Eye Exams: $20	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-15	13B Acupuncture: Not Covered											350	350	442.05	0	50	0.1	0.1	48.60155383	75	0	75	75	0	0	15	20	20	20	0	17.49495516	8.210253165	15	0	10	20	0	0	0	15	0											NO	348.25	348.25	439.83975	0	49.75	0.0995	0.0995	48.35854606	74.625	0	74.625	74.625	0	0	14.925	19.9	19.9	19.9	0	17.40748038	8.169201899	14.925	0	9.95	19.9	0	0	0	14.925	0												7.4492	0	5.044733914	0	2.311316961	1.665344828	0.159833313	6.279581265	5.173233481	0	20.72731152	0.387870254	0	0	9.847703693	5.109472067	0.722684912	0.716588533	0	2.059506828	0.157639714	0.353485548	0	0.537168325	0.245997932	0	0	0	0.003959194	0	0	0	0	0	0	0	0	0	0	0	68.9526	0	0.347040459	7.4492	0	5.044733914	0	2.311316961	1.665344828	0.159833313	6.279581265	5.173233481	0	20.72731152	0.387870254	0	0	9.847703693	5.109472067	0.722684912	0.716588533	0	2.059506828	0.157639714	0.353485548	0	0.537168325	0.245997932	0	0	0	0.003959194	0	0	0	0	0	0	0	0	0	0	0	68.9526	NO																																																																																		0	0	0	7.4492	0	5.044733914	0	2.311316961	1.665344828	0.159833313	6.279581265	5.173233481	0	20.72731152	0.387870254	0	0	9.847703693	5.109472067	0.722684912	0.716588533	0	2.059506828	0.157639714	0.353485548	0	0.537168325	0.245997932	0	0	0	0.003959194	0	0	0	0	0	0	0	0	0	0	0	68.9526
H9001_024_0	2010	3	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	200.13568	0	94.22555438	0	381.2797467	13.47348728	1.553704177	1147.43651	806.7233609	0	3094.069416	1416.269675	0	0	8083.045736	3052.649287	364.4845789	622.3392889	0	1342.991083	221.2117774	247.3167449	0	563.7460525	130.2250292	0	0	0	8.002655424	0											3400	PBP: 1A IP Acute: $350 Per Admit	1B IP Psych: $350 Per Admit	"2 SNF: $35 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 10%	11B Prosthetic Medical Supplies: 10%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $15	9B ASC Services: $0-75	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $0-75	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $15; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $15	7B Chiropractic: $20; 7D Physician Specialist: $20; 7F Podiatry: $20	7E Mental Health: $20; 7H Psychiatric: $20; 9C OP Substance Abuse: $20	7C Occupational Therapy: $20; 7I Physical and Speech Therapy: $20	Included in h.2.	7G Other Health Care: $15-20; 18A Medicare Covered Hearing Exams: $20; 17A Medicare Covered Eye Exams: $20	15 Part B Drugs: $5-40	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-20	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-20	17A Routine Eye Exams: $20	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-15	13B Acupuncture: Not Covered											350	350	442.05	0	50	0.1	0.1	47.63692732	75	0	75	75	0	0	15	20	20	20	0	17.49526002	9.582342954	15	0	10	20	0	0	0	15	0											NO	348.25	348.25	439.83975	0	49.75	0.0995	0.0995	47.39874268	74.625	0	74.625	74.625	0	0	14.925	19.9	19.9	19.9	0	17.40778372	9.534431239	14.925	0	9.95	19.9	0	0	0	14.925	0												5.8081	0	3.45367869	0	1.580722283	1.340611984	0.154593566	4.53225399	5.016810901	0	19.24124418	8.80742704	0	0	10.05328813	5.062310068	0.604436927	1.032045987	0	1.948208193	0.175760707	0.307600202	0	0.467439435	0.215956507	0	0	0	0.009953303	0	0	0	0	0	0	0	0	0	0	0	69.8124	0	0.351336737	5.8081	0	3.45367869	0	1.580722283	1.340611984	0.154593566	4.53225399	5.016810901	0	19.24124418	8.80742704	0	0	10.05328813	5.062310068	0.604436927	1.032045987	0	1.948208193	0.175760707	0.307600202	0	0.467439435	0.215956507	0	0	0	0.009953303	0	0	0	0	0	0	0	0	0	0	0	69.8124	NO																																																																																		0	0	0	5.8081	0	3.45367869	0	1.580722283	1.340611984	0.154593566	4.53225399	5.016810901	0	19.24124418	8.80742704	0	0	10.05328813	5.062310068	0.604436927	1.032045987	0	1.948208193	0.175760707	0.307600202	0	0.467439435	0.215956507	0	0	0	0.009953303	0	0	0	0	0	0	0	0	0	0	0	69.8124
H9001_025_0	2010	3	N/A																															A	A	A	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	O	T	V	V	V	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	YES	246.2468654	0.347315748	163.3383666	0	631.6234492	17.60519447	2.619129763	1646.881185	876.9271881	0	3578.825482	1489.704186	0	0	8233.837525	3409.410396	503.3794395	566.8039112	0	1509.972022	254.9317888	323.8955765	0	738.3036386	138.0260769	0	0	0	4.490004912	0											3400	PBP: 1A IP Acute: $200 Per Admit	1B IP Psych: $200 Per Admit	"2 SNF: $20 per day, days 1-20, $0 per day, days 21-100"	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	11B Prosthetic Medical Supplies: 0%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $10	9B ASC Services: $0-50	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $0-50	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $10; 14B Immunizations: $0; 14C Routine Physical Exams: $0; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $10	7B Chiropractic: $15; 7D Physician Specialist: $15; 7F Podiatry: $15	7E Mental Health: $15; 7H Psychiatric: $15; 9C OP Substance Abuse: $15	7C Occupational Therapy: $15; 7I Physical and Speech Therapy: $15	Included in h.2.	7G Other Health Care: $10-15; 18A Medicare Covered Hearing Exams: $15; 17A Medicare Covered Eye Exams: $15	15 Part B Drugs: $10-65	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $10-15	10B Transportation: Not Covered	16A Preventive Dental Services: 1 Visit Every Six Months; 16B Non-Medicare Covered Comprehensive Dental Services: $10-15	17A Routine Eye Exams: $15	17B Eye Wear: One pair of glasses/2 yrs	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-10	13B Acupuncture: Not Covered											200	200	255.4	0	50	0.1	0.1	47.87140663	50	0	75	50	0	0	10	15	15	15	0	12.4964207	10.55692771	12.5	0	10	15	0	0	0	10	0											NO	199	199	254.123	0	49.75	0.0995	0.0995	47.63204959	49.75	0	74.625	49.75	0	0	9.95	14.925	14.925	14.925	0	12.4339386	10.50414307	12.4375	0	9.95	14.925	0	0	0	9.95	0												4.0836	0.005759653	3.459002978	0	2.61860555	1.751716849	0.260603411	6.537027191	3.635593967	0	22.25582096	6.17606527	0	0	6.827223615	4.24045418	0.626078178	0.704962365	0	1.564574951	0.223153332	0.335704269	0	0.612176767	0.171669933	0	0	0	0.003722962	0	0	0	0	0	0	0	0	0	0	0	66.0935	0	0.332532504	4.0836	0.005759653	3.459002978	0	2.61860555	1.751716849	0.260603411	6.537027191	3.635593967	0	22.25582096	6.17606527	0	0	6.827223615	4.24045418	0.626078178	0.704962365	0	1.564574951	0.223153332	0.335704269	0	0.612176767	0.171669933	0	0	0	0.003722962	0	0	0	0	0	0	0	0	0	0	0	66.0935	NO																																																																																		0	0	0	4.0836	0.005759653	3.459002978	0	2.61860555	1.751716849	0.260603411	6.537027191	3.635593967	0	22.25582096	6.17606527	0	0	6.827223615	4.24045418	0.626078178	0.704962365	0	1.564574951	0.223153332	0.335704269	0	0.612176767	0.171669933	0	0	0	0.003722962	0	0	0	0	0	0	0	0	0	0	0	66.0935
H9001_801_0	2010	1	N/A																															A	A	A	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	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	YES	266.1676768	0	124.0216527	0	576.1794125	0	0	1187.367592	788.0314888	0	3219.622997	0	0	0	8590.366021	3027.170503	266.9068058	666.2237664	0	1423.794059	226.3441876	0	0	0	109.4037607	0	0	0	8.862543605	0											3400	PBP: 1A IP Acute: $450 Per Admit	1B IP Psych: $450 Per Admit	2 SNF: $450 per admit	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	11B Prosthetic Medical Supplies: 0%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $25	9B ASC Services: $225	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $225	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $25; 14B Immunizations: $0; 14C Routine Physical Exams: $25; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $25	7B Chiropractic: $35; 7D Physician Specialist: $35; 7F Podiatry: $35	7E Mental Health: $35; 7H Psychiatric: $35; 9C OP Substance Abuse: $35	7C Occupational Therapy: $35; 7I Physical and Speech Therapy: $35	Included in h.2.	7G Other Health Care: $25-35; 18A Medicare Covered Hearing Exams: $35; 17A Medicare Covered Eye Exams: $35	15 Part B Drugs: $10-65	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $25-35	10B Transportation: Not Covered	16A Preventive Dental Services: Not Covered; 16B Non-Medicare Covered Comprehensive Dental Services: Not Covered	17A Routine Eye Exams: Not Covered	17B Eye Wear: Not Covered	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-25	13B Acupuncture: Not Covered											450	450	450	0	50	0	0	47.92644757	225	0	75	225	0	0	25	35	35	35	0	29.99405116	11.2633452	0	0	0	35	0	0	0	25	0											NO	447.75	447.75	447.75	0	49.75	0	0	47.68681534	223.875	0	74.625	223.875	0	0	24.875	34.825	34.825	34.825	0	29.8440809	11.20702847	0	0	0	34.825	0	0	0	24.875	0												9.9314	0	4.627557918	0	2.388743814	0	0	4.71848159	14.70171246	0	20.02203051	0	0	0	17.8071129	8.785101063	0.774585793	1.933436889	0	3.540985423	0.211387146	0	0	0	0.317498831	0	0	0	0.018371314	0	0	0	0	0	0	0	0	0	0	0	89.7784	0	0.451770022	9.9314	0	4.627557918	0	2.388743814	0	0	4.71848159	14.70171246	0	20.02203051	0	0	0	17.8071129	8.785101063	0.774585793	1.933436889	0	3.540985423	0.211387146	0	0	0	0.317498831	0	0	0	0.018371314	0	0	0	0	0	0	0	0	0	0	0	89.7784	NO																																																																																		0	0	0	9.9314	0	4.627557918	0	2.388743814	0	0	4.71848159	14.70171246	0	20.02203051	0	0	0	17.8071129	8.785101063	0.774585793	1.933436889	0	3.540985423	0.211387146	0	0	0	0.317498831	0	0	0	0.018371314	0	0	0	0	0	0	0	0	0	0	0	89.7784
H9001_803_0	2010	1	N/A																															A	A	A	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	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	YES	241.3448016	0	94.59693527	0	462.6513179	0	0	1166.054179	797.2832305	0	3325.527656	0	0	0	8391.120004	3158.52001	363.8382195	600.1807545	0	1340.137442	194.4144382	0	0	0	115.2154362	0	0	0	6.26610267	0											3400	PBP: 1A IP Acute: $450 Per Admit	1B IP Psych: $450 Per Admit	2 SNF: $450 per admit	6 Home Health: $0	10A Ambulance: $50	11A DME: 0%	11B Prosthetic Medical Supplies: 0%; 11C Diabetes Monitoring Supplies: 0%	4A ER: $50; 4B Urgent Care: $25	9B ASC Services: $225	8A OP C/D/T: $0	8B OP X-Ray: $0-75	9A OP Hospital: $225	12 Renal Dialysis: $0	3 CORF: $0; 5 Partial Hosp: $0; 9D Cardiac Rehab: $0	7A PCP: $25; 14B Immunizations: $0; 14C Routine Physical Exams: $25; 14D Pap Smears: $0; 14D Pelvic Exams: $0; 14E Prostate Screening: $0; 14F Colorectal Screening: $0; 14G Bone Mass Measurement: $0; 14H Mammography: $0; 14I Diabetes Monitoring: $0; 14J Nutrition Therapy: $25	7B Chiropractic: $35; 7D Physician Specialist: $35; 7F Podiatry: $35	7E Mental Health: $35; 7H Psychiatric: $35; 9C OP Substance Abuse: $35	7C Occupational Therapy: $35; 7I Physical and Speech Therapy: $35	Included in h.2.	7G Other Health Care: $25-35; 18A Medicare Covered Hearing Exams: $35; 17A Medicare Covered Eye Exams: $35	15 Part B Drugs: $10-65	13A Blood: $0; 16B Medicare Covered Comprehensive Dental Services: $25-35	10B Transportation: Not Covered	16A Preventive Dental Services: Not Covered; 16B Non-Medicare Covered Comprehensive Dental Services: Not Covered	17A Routine Eye Exams: Not Covered	17B Eye Wear: Not Covered	18A Routine Hearing Exams: Not Covered	18B Hearing Aids: Not Covered	14A Health Education/Wellness Programs: $0-25	13B Acupuncture: Not Covered											450	450	450	0	50	0	0	47.73026935	225	0	75	225	0	0	25	35	35	35	0	29.99095023	12.83844509	0	0	0	35	0	0	0	25	0											NO	447.75	447.75	447.75	0	49.75	0	0	47.49161801	223.875	0	74.625	223.875	0	0	24.875	34.825	34.825	34.825	0	29.84099548	12.77425287	0	0	0	34.825	0	0	0	24.875	0												9.0052	0	3.529648147	0	1.918075255	0	0	4.614816638	14.87431527	0	20.68062511	0	0	0	17.39409251	9.166288279	1.055888833	1.741774565	0	3.332586278	0.206958266	0	0	0	0.334364797	0	0	0	0.012989109	0	0	0	0	0	0	0	0	0	0	0	87.8676	0	0.442644377	9.0052	0	3.529648147	0	1.918075255	0	0	4.614816638	14.87431527	0	20.68062511	0	0	0	17.39409251	9.166288279	1.055888833	1.741774565	0	3.332586278	0.206958266	0	0	0	0.334364797	0	0	0	0.012989109	0	0	0	0	0	0	0	0	0	0	0	87.8676	NO																																																																																		0	0	0	9.0052	0	3.529648147	0	1.918075255	0	0	4.614816638	14.87431527	0	20.68062511	0	0	0	17.39409251	9.166288279	1.055888833	1.741774565	0	3.332586278	0.206958266	0	0	0	0.334364797	0	0	0	0.012989109	0	0	0	0	0	0	0	0	0	0	0	87.8676
H9003_001_0	2010	5	N/A	q.										Other Non-Covered										Residential Treatment Facility										D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	Coin			V	O	V		V	Coin	D										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	YES	1041.851295	30.44513186	780.5496943	677.5437044	337.5164522	11.27701231	0.608508252	342.2321573	147.5952311	0.047779948	55.08856943	3.663288607	11.82725719	499.3119957	5813.995117	4276.205757	387.7495988	420.1413536	2532.256325	5998.725962	897.0048555	0.062342976	0	0	383.0338942	279.8068765	56.85655108	0	16.9703529	4.266102599	16.53272202	0	0	0	0	0	0	0	0	0	3250	$200/day $800max/admit	$200/day $800max/admit	$0 per day	$0 copay	$100 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$50/copay waived if admitted	$150 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	$0-$20 per visit	$0-$25 per visit	$0-$20 per visit	$10 - $20 per visit	$20 per visit	$0-$50 per visit	$0 copay	$0 or $10 generic/$45 brand per script	$0 copay			$20 per visit	$0 copay	$20 per visit		$0-$140 per class	$0 copay	$100/day $400max/admit										110.5636962	110.5636962	0	0	100	0.182759743	0.2	47.17630218	150	0	0	0	0	19.95395036	18.01692312	14.7832765	18.22176707	20	7.704819864	0	5.959808279	0	0	0	20	0	20	0	15	0	55.28184812	0	0	0	0	0	0	0	0	0	NO	104.0311025	104.0311025	0	0	97.08583094	0.177433815	0.194171662	45.80150498	145.6287464	0	0	0	0	19.37245851	17.49187952	14.35246683	17.69075398	19.41716619	7.480288387	0	5.786129391	0	0	0	19.41716619	0	19.41716619	0	15	0	52.01555127	0	0	0	0	0	0	0	0	0		9.0321	0.26393672	0	0	2.730672101	2.000923317	0.118155059	1.306228988	1.791175706	0	0	0	0	0.806075077	8.474808508	5.114508441	0.571631896	0.67982954	1.578500632	0	0.432515513	0	0	0	0.619786065	0	0.091999425	0	0.021212941	0	0.071663221	0	0	0	0	0	0	0	0	0	35.7057	0	1.378176229	9.0321	0.26393672	0	0	2.730672101	2.000923317	0.118155059	1.306228988	1.791175706	0	0	0	0	0.806075077	8.474808508	5.114508441	0.571631896	0.67982954	1.578500632	0	0.432515513	0	0	0	0.619786065	0	0.091999425	0	0.021212941	0	0.071663221	0	0	0	0	0	0	0	0	0	35.7057	NO																																																																																		0	0	0	9.0321	0.26393672	0	0	2.730672101	2.000923317	0.118155059	1.306228988	1.791175706	0	0	0	0	0.806075077	8.474808508	5.114508441	0.571631896	0.67982954	1.578500632	0	0.432515513	0	0	0	0.619786065	0	0.091999425	0	0.021212941	0	0.071663221	0	0	0	0	0	0	0	0	0	35.7057
H9003_006_0	2010	5	N/A	q.										Other Non-Covered										Residential Treatment Facility										D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	Coin			V		V		V	Coin	D										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0										0	YES	764.7600897	42.46823379	391.7656409	338.7887559	229.3456233	5.909812271	2.453168249	254.8909686	112.438821	1.077754539	21.60429489	3.453605992	5.239653354	235.3626571	4231.137806	3078.333966	308.2635397	275.8413623	1878.839206	4282.370962	620.4401494	0.051700973	0	0	273.2487193	0	36.19053542	0	17.87208286	0	5.841304735										3250	$250/day $1000max/admit	$250/day $1000max/admit	$0 per day	$0 copay	$150 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$50/copay waived if admitted	$200 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	$0-$30 per visit	$0-$35 per visit	$0-$30 per visit	$15 - $30 per visit	$30 per visit	$0-$100 copay	$0 copay	$0 or $10 generic/$45 brand per script	$0 copay			$30 per visit		$30 per visit		$0-$140 per class	$0 copay	$125/day $500max/admit										138.2046203	138.2046203	0	0	150	0.182759743	0.2	47.37835284	200	0	0	0	0	29.94950464	26.71764123	22.35343969	28.57028985	30	15.13035366	0	8.236136362	0	0	0	30	0	30	0	15	0	69.10231015										NO	122.7323885	122.7323885	0	0	142.4114263	0.173513838	0.189881902	44.98145869	189.8819017	0	0	0	0	28.43434448	25.36598264	21.2225682	27.12490485	28.48228526	14.36490163	0	7.819466177	0	0	0	28.48228526	0	28.48228526	0	15	0	61.36619423											7.8217	0.434352314	0	0	2.721786445	1.025434208	0.465812252	0.955447298	1.779174763	0	0	0	0	0.557698572	8.943914011	5.444179377	0.696801599	0.654716031	2.249111698	0	0.404292564	0	0	0	0.648562331	0	0.085899096	0	0.022340104	0	0.029871553	0	0	0	0	0	0	0	0	0	34.9411	0	2.463824349	7.8217	0.434352314	0	0	2.721786445	1.025434208	0.465812252	0.955447298	1.779174763	0	0	0	0	0.557698572	8.943914011	5.444179377	0.696801599	0.654716031	2.249111698	0	0.404292564	0	0	0	0.648562331	0	0.085899096	0	0.022340104	0	0.029871553	0	0	0	0	0	0	0	0	0	34.9411	NO																																																																																		0			7.8217	0.434352314	0	0	2.721786445	1.025434208	0.465812252	0.955447298	1.779174763	0	0	0	0	0.557698572	8.943914011	5.444179377	0.696801599	0.654716031	2.249111698	0	0.404292564	0	0	0	0.648562331	0	0.085899096	0	0.022340104	0	0.029871553	0	0	0	0	0	0	0	0	0	34.9411
H9003_801_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	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	YES	980.6051135	21.42436846	604.4793273	697.3260126	289.6694924	10.69358505	0.905936862	288.0872198	139.6293147	0.091388823	41.09130288	3.593892896	9.048809514	413.5787149	5560.772886	4584.428776	271.1997933	635.8489296	2531.983756	6180.911367	5.807264879	0.089471891																			3250	$750/admit	$750/admit	$0 per day	$0 copay	$100 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$50/copay waived if admitted	$150 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	$0-$15 per visit	$0-$15 per visit	$0-$150 per visit	$7-$15 per visit	$15 per visit	$20-$100 copay	$20 copay	0 or 40% Coin $150 max per Script	$0 copay																			140.0303745	140.0303745	0	0	100	0.182759743	0.2	47.46274766	150	0	0	0	0	14.9799666	13.81482283	17.53068204	13.60237022	15	15.37484032	0	0.085306652	0																			NO	129.3854921	129.3854921	0	0	96.13046962	0.175687799	0.192260939	45.62616223	144.1957044	0	0	0	0	14.40031225	13.28025406	16.85232698	13.07602237	14.41957044	14.7799062	0	0.082005685	0																				10.573	0.231000205	0	0	2.320505361	1.878732424	0.174176272	1.095359519	1.677828949	0	0	0	0	0.496305219	6.154039726	6.438191061	0.29551788	0.764055703	3.118540201	0	0.476228735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.6935	0	1.890747681	10.573	0.231000205	0	0	2.320505361	1.878732424	0.174176272	1.095359519	1.677828949	0	0	0	0	0.496305219	6.154039726	6.438191061	0.29551788	0.764055703	3.118540201	0	0.476228735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.6935	NO																																																																																		0			10.573	0.231000205	0	0	2.320505361	1.878732424	0.174176272	1.095359519	1.677828949	0	0	0	0	0.496305219	6.154039726	6.438191061	0.29551788	0.764055703	3.118540201	0	0.476228735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.6935
H9003_802_0	2010	2	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	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	YES	1123.780022	16.23836298	763.7586779	911.3887368	339.8858641	12.45676937	0.881603458	313.1229836	138.6133753	0.34426163	49.33940464	6.325256627	22.72457247	539.8318624	5752.754477	4569.120438	191.9126957	683.7780479	2784.509431	6451.312935	4.33067235	0.067414397																			3250	$750/admit	$750/admit	$0 per day	$0 copay	$100 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$50/copay waived if admitted	$150 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	$0-$15 per visit	$0-$15 per visit	$0-$150 per visit	$7-$15 per visit	$15 per visit	$0-$100 copay	$20 copay	0 or 40% Coin $150 max per Script	$0 copay																			140.0303745	140.0303745	0	0	100	0.182759743	0.2	47.79403423	150	0	0	0	0	15	13.77098054	17.30288901	14.14574929	15	16.14432874	0	0.094200495	0																			NO	129.3854921	129.3854921	0	0	96.13046962	0.175687799	0.192260939	45.94462956	144.1957044	0	0	0	0	14.41957044	13.23810826	16.63334846	13.59837523	14.41957044	15.51961903	0	0.090555378	0																				12.1167	0.175084049	0	0	2.722782311	2.188502397	0.169497909	1.198859957	1.665621107	0	0	0	0	0.648678631	6.346298881	6.333314368	0.217475071	0.821648811	3.601210463	0	0.392165673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5979	0	2.070175221	12.1167	0.175084049	0	0	2.722782311	2.188502397	0.169497909	1.198859957	1.665621107	0	0	0	0	0.648678631	6.346298881	6.333314368	0.217475071	0.821648811	3.601210463	0	0.392165673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5979	NO																																																																																		0			12.1167	0.175084049	0	0	2.722782311	2.188502397	0.169497909	1.198859957	1.665621107	0	0	0	0	0.648678631	6.346298881	6.333314368	0.217475071	0.821648811	3.601210463	0	0.392165673	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.5979
H9003_805_0	2010	2	N/A																															A	A	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	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	YES	993.5471099	21.70712662	604.4793273	697.3260126	289.6694924	10.69358505	0.905936862	288.0872198	142.1419244	0.091388823	41.09130288	3.593892896	9.048809514	437.9244095	5930.10088	4789.486573	287.1642206	673.2787664	2531.983756	6180.911367	937.4307899	0.089471891	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	3250	$100/admit	$100/admit	$0 per day	$0 copay	$100 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$50/copay waived if admitted	$50 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	$0-$5 per visit	$0-$10 per visit	$0-$50 per visit	$2-$5 per visit	$5 per visit	$0 copay	$20 copay	$0 or $20 generic/$40 brand per script	$0 copay																			18.6707166	18.6707166	0	0	100	0.182759743	0.2	47.46274766	50	0	0	0	0	4.993322201	4.939990406	5.807444348	4.475888834	5	0	0	5.096375727	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	18.63296777	18.63296777	0	0	99.47042327	0.18179189	0.198940847	47.211396	49.73521164	0	0	0	0	4.966878729	4.913829367	5.776689474	4.452185568	4.973521164	0	0	5.069386508	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		1.5427	0.033705683	0	0	2.401128918	1.944007037	0.180227846	1.133416652	0.589121558	0	0	0	0	0.181259786	2.428291987	2.305614722	0.106542367	0.279047183	0	0	0.396016583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5211	0	0.066786713	1.5427	0.033705683	0	0	2.401128918	1.944007037	0.180227846	1.133416652	0.589121558	0	0	0	0	0.181259786	2.428291987	2.305614722	0.106542367	0.279047183	0	0	0.396016583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5211	NO																																																																																		0			1.5427	0.033705683	0	0	2.401128918	1.944007037	0.180227846	1.133416652	0.589121558	0	0	0	0	0.181259786	2.428291987	2.305614722	0.106542367	0.279047183	0	0	0.396016583	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	13.5211
H9005_007_0	2010	4	N/A																																				Coin		V									V				Coin							Coin																																																					0	YES						44.2618		383.593									531.449				36.125							5.851													3000	1a: 0% coins	1b: 0% coins	2: 0% coins	6: 0% coins	10a: 0% coins	11a: 10% coinsurance	"11b, 11c: 10% coinsurance"	4a: $30 copay;	"9a, 9b: 0% coins"	8a: 0% coins	8b: 0% coins	5: 0% coins	12: 0% coins	"3, 9c, 9d: 0% coins"	"7a, 14b, 14c: 0% coins"	"7b, 7d, 7f: 0% coins"	"7e, 7h: $5/$10 Copay"	"7c, 7i: 0% coins"	7d: 0% coins	"7g, 14d, 14e, 14f, 14g, 14h, 14i,14j: 0% coins"	15: 20% coins (Part B drugs administered in office setting = 100%)	13a: 0% coinsurance	10b: 0% coinsurance	16a: 0% coinsurance	17a: 0% coinsurance	17b: 0% coinsurance	18a: 0% coinsurance	"18b: 50% up to $1,000 max"	14a: 0% coinsurance	13b: 0% coinsurance																0.1		30									9.75				0.01164							0.5													NO						0.0949		28.47									9.253				0.01105							0.4745														0	0	0	0	0	4.20044482	0	0.910074393	0	0	0	0	0	0	0	0	0.409791466	0	0	0	0.39918125	0	0	0	0	0	0	2.7762995	0	0	0	0	0	0	0	0	0	0	0	0	8.6958		0.467	0	0	0	0	0	4.20044482	0	0.910074393	0	0	0	0	0	0	0	0	0.409791466	0	0	0	0.39918125	0	0	0	0	0	0	2.7762995	0	0	0	0	0	0	0	0	0	0	0	0	8.6958	NO	"1a: 20% coins up to $100,000 of Medicare Allowable chg"	"1b: 20% coins up to $100,000 of Medicare Allowable chgs"	"2: 20% coins up to $100,000 of Medicare Allowable chgs"	"6: 20% coins up to $100,000 of Medicare Allowable chgs"	10a: 20% coins	"11a: 20% coins up to $100,000 of Medicare Allowable chgs"	"11b, 11c: 20% coins up to $100,000 of Medicare Allowable chgs"	4a: $30 copay	"9a, 9b: 20% coins up to $100,000 of Medicare Allowable chgs"	"8a: 20% coins up to $100,000 of Medicare Allowable chgs"	"8b: 20% coins up to $100,000 of Medicare Allowable chgs"	"5: 20% coins up to $100,000 of Medicare Allowable chgs"	"12: 20% coins up to $100,000 of Medicare Allowable chgs"	"3, 9c, 9d: 20% coins up to $100,000 of Medicare Allowable chgs"	"7a: 20% coins up to $100,000 of Medicare Allowable chgs"	"7b, 7d, 7f: 20% coins up to $100,000 of Medicare Allowable chgs"	"7e, 7h: 20% coins up to $100,000 of Medicare Allowable chgs"	"7c, 7i: 20% coins up to $100,000 of Medicare Allowable chgs"	"7d: 20% coins up to $100,000 of Medicare Allowable chgs"	"7g: 20% coins up to $100,000 of Medicare Allowable chgs"	"15: 20% coins up to $100,000 of Medicare Allowable chgs"	"13a: 20% coins up to $100,000 of Medicare Allowable charges"	"10b: 20% coins up to $100,000 of Medicare Allowable charges"							"13b: 20% coins up to $100,000 of Medicare Allowable charges"													0	0.0721	0.0074	0.2014	0.0222		0.0219	0.0131	0.016					0.0929						0.0038	0	0							0											0.4508			0	0	0.0721	0.0074	0.2014	4.22264482	0	0.931974393	0.0131	0.016	0	0	0	0	0.0929	0	0.409791466	0	0	0	0.40298125	0	0	0	0	0	0	2.7762995	0	0	0	0	0	0	0	0	0	0	0	0	9.1466
H9011_003_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1226.297792	39.7203572	382.0133863	2093.734005	172.0873568	6.752206606	14.00507342	217.6256071	297.3310908	14818.62491	5230.39812	0	0.126236722	432.6505302	5109.49338	8242.919708	107.4568429	853.7948367	0	0	32.66393221	1204.925358	540.1985767	232.1549823	143.2952366	188.4695416	17.62014849	4.743571824	3815.994299	0											1950	"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$0 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); $0 (8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 9a, 9c, 9d); $60 (5)"	"$0 (7a, 7a1, 14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a9, 14a10); $0 (14a1, 14a6, 14a7, 14a8); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	123.5018802	0	0	150	0.2	0.128990497	49.65880038	0	3	2.323802372	0	0.2	0.024403425	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	154.8102188	0	0	132.6944732	0.176925964	0.114108841	43.92965572	0	2.653889465	2.055704878	0	0.176925964	0.021587997	0	0	0	0	0	0	0.176925964	0	0	0	0	0	0	0	0	0												0	0.512426432	0	0	1.902920097	1.194640665	1.598102692	0.796684833	0	3.277249378	0.896012911	0	0.022334554	0.000778338	0	0	0	0	0	0	5.779097705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.9802	0	2.08408531	0	0.512426432	0	0	1.902920097	1.194640665	1.598102692	0.796684833	0	3.277249378	0.896012911	0	0.022334554	0.000778338	0	0	0	0	0	0	5.779097705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.9802	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0.512426432	0	0	1.902920097	1.194640665	1.598102692	0.796684833	0	3.277249378	0.896012911	0	0.022334554	0.000778338	0	0	0	0	0	0	5.779097705	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.9802
H9011_011_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	O	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1542.440218	680.4463725	480.4973268	2633.503507	216.4518781	8.492941191	17.61561396	273.574337	373.9837383	18638.90092	6578.806933	0	0.175896907	566.7208861	6320.850348	10389.11283	2504.193724	1073.905134	0	0	45.9686501	1515.557921	643.9128847	1484.449168	114.9844437	98.12005862	0	0	0	0												"$0 (1a, 1a1); $0 n/c (1a2, 1a3)"	"$0 (1b); $0 n/c (1b1, 1b2)"	"$0 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	$0 (4a); $50 (4a1); $40 (4b)	$0 (9b)	$0/$0/$7 (8a1); $0 (8a2)	"$15 (8b1); $0 (8b2, 8b3)"	Included in h.5.	20% (12)	"$0 (3, 5, 9a, 9c, 9d)"	"$0 (7a, 7a1, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"$0 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$0 (7e, 7h)"	"$0 (7c, 7i)"	Included in h.2.	$0 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 (10b)	"$0 (16a1, 16a2, 16a4, 16b2, 16b3, 16b4, 16b5); $0 n/c (16a3, 16a5, 16b1)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0	0	0	0	150	0.2	0.128990497	1.458039625	0	0	2.178564724	0	0.2	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0											NO	0	0	0	0	150	0.2	0.128990497	1.458039625	0	0	2.178564724	0	0.2	0	0	0	0	0	0	0	0.2	0	0	0	0	0	0	0	0	0												0	0	0	0	2.705648476	1.698588238	2.272246806	0.033240185	0	0	1.194363059	0	0.035179381	0	0	0	0	0	0	0	9.19373002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.133	0	0	0	0	0	0	2.705648476	1.698588238	2.272246806	0.033240185	0	0	1.194363059	0	0.035179381	0	0	0	0	0	0	0	9.19373002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.133	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	0	0	0	0	2.705648476	1.698588238	2.272246806	0.033240185	0	0	1.194363059	0	0.035179381	0	0	0	0	0	0	0	9.19373002	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.133
H9011_016_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	O	Coin	V	Coin	O	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1088.409708	82.11999032	273.9288747	1564.339349	128.5755607	5.044930473	10.46393066	162.5953341	222.1517747	11071.77797	54.85039348	0	0.094318128	325.9856926	3899.443838	6263.979086	357.888741	646.4778744	0	0	24.73253358	912.3474993	0	180.2557293	89.53491817	0	13.03057195	4.743571824	465.660634	0											2400	"$175 Days 1-14 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$175 Days 1-11 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-22 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	$175 (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); $175 (9a); $40/$30 (9c)"	"$5 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$5 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											154.5484949	122.8528282	68.51557614	0	150	0.2	0.128990497	49.65879144	175	3	0.169054539	0	0.2	68.92154256	4.080759123	29.93098003	38.5	30	0	0	0.2	29.76484917	0	0	30	0	0	0	0	0											YES	125.5575024	89.2139634	49.75502957	0	108.9278505	0.145237134	0.093671051	36.06150274	127.0824923	2.17855701	0.122764984	0	0.145237134	50.169546	4.000306656	29.93098003	38.5	21.7855701	0	0	0.145237134	29.76484917	0	0	30	0	0	0	0	0											7200	11.3882	0.610520818	1.135778272	0	1.167121622	0.732711243	0.98016738	0.488619341	2.352633433	2.010041627	6.733707673	0	0.013698495	1.362879517	1.299914262	15.62391941	1.148226378	1.173657421	0	0	3.592082294	2.262990476	0	0	0.223837295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3007	0	12.74428551	11.3882	0.610520818	1.135778272	0	1.167121622	0.732711243	0.98016738	0.488619341	2.352633433	2.010041627	6.733707673	0	0.013698495	1.362879517	1.299914262	15.62391941	1.148226378	1.173657421	0	0	3.592082294	2.262990476	0	0	0.223837295	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.3007	NO	"$375 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$140 Days 1-48 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$40 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$40 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a7, 14a8, 14a9, 14a10); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"												3.5299	0.2696	0.9428	0.7838	0.4447	0.4188	0.8686	0.2291	2.4781	0.7659	3.8093	0	0.0052	1.2705	3.5898	6.7076	0.421	0.5653	0	0	1.9464	0.9791	0	0.0316	0.0968	0	0.0141	0	0	0											30.168	0	4.351369942	14.9181	0.880088028	2.07860684	0.783794492	1.611820395	1.151479672	1.848754929	0.717713265	4.830722296	2.775911293	10.54298078	0	0.018917919	2.633360702	4.889759942	22.33151052	1.569219673	1.738939384	0	0	5.538439643	3.242121013	0	0.031623812	0.32068522	0	0.014094879	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4687
H9011_801_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	244.0555683	5.444284472	10.38519178	1910.064755	4.507962009	7.233743486	15.40163114	11.34018707	39.72176392	23.15854361	76.00376399	0	0.142721518	28.15672715	119.16134	147.7767297	2.687808911	9.481431051	0	0	40.43541663	7.100027421	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.5644	0.414126342	1.656741456	0	1.050355148	1.685462232	3.588580056	2.642263587	9.255170994	5.395940661	17.70887701	0	0.033254114	6.560517426	27.76459221	34.43197802	0.626259476	2.209173435	0	0	9.421452075	1.654306389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.6634	0	0	18.5644	0.414126342	1.656741456	0	1.050355148	1.685462232	3.588580056	2.642263587	9.255170994	5.395940661	17.70887701	0	0.033254114	6.560517426	27.76459221	34.43197802	0.626259476	2.209173435	0	0	9.421452075	1.654306389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.6634	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.5644	0.414126342	1.656741456	0	1.050355148	1.685462232	3.588580056	2.642263587	9.255170994	5.395940661	17.70887701	0	0.033254114	6.560517426	27.76459221	34.43197802	0.626259476	2.209173435	0	0	9.421452075	1.654306389	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	144.6634
H9011_802_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	248.6788206	5.415976126	10.66949999	2037.168276	4.578645915	6.978701879	14.63637641	11.334634	40.59082733	22.38707312	75.82511635	0	0.135335334	28.27448509	115.9659364	146.0449873	2.673833258	8.863612693	0	0	35.96965502	6.243375136	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.9161	0.411973032	1.702096921	0	1.066824498	1.626037538	3.410275703	2.640969723	9.457662769	5.216188038	17.66725211	0	0.031533133	6.587955026	27.02006318	34.02848204	0.623003149	2.065221758	0	0	8.38092962	1.454706407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.3072	0	0	18.9161	0.411973032	1.702096921	0	1.066824498	1.626037538	3.410275703	2.640969723	9.457662769	5.216188038	17.66725211	0	0.031533133	6.587955026	27.02006318	34.02848204	0.623003149	2.065221758	0	0	8.38092962	1.454706407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.3072	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.9161	0.411973032	1.702096921	0	1.066824498	1.626037538	3.410275703	2.640969723	9.457662769	5.216188038	17.66725211	0	0.031533133	6.587955026	27.02006318	34.02848204	0.623003149	2.065221758	0	0	8.38092962	1.454706407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.3072
H9011_803_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	249.3974388	5.517175734	10.70033211	2043.055171	4.59187703	6.998868542	14.67867179	11.3673882	40.70812444	22.45176604	76.04423154	0	0.135726419	28.35646365	116.3010483	146.4670199	2.738741911	8.889226266	0	0	36.07359812	6.261416893	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.9707	0.419670908	1.707015545	0	1.069907348	1.63073637	3.420130528	2.64860145	9.484992995	5.231261487	17.71830595	0	0.031624256	6.607056029	27.09814425	34.12681565	0.638126865	2.07118972	0	0	8.405148362	1.458910136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.7384	0	0	18.9707	0.419670908	1.707015545	0	1.069907348	1.63073637	3.420130528	2.64860145	9.484992995	5.231261487	17.71830595	0	0.031624256	6.607056029	27.09814425	34.12681565	0.638126865	2.07118972	0	0	8.405148362	1.458910136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.7384	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.9707	0.419670908	1.707015545	0	1.069907348	1.63073637	3.420130528	2.64860145	9.484992995	5.231261487	17.71830595	0	0.031624256	6.607056029	27.09814425	34.12681565	0.638126865	2.07118972	0	0	8.405148362	1.458910136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.7384
H9011_805_0	2010	4	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	249.3974388	5.10041066	10.70033211	2043.055171	4.59187703	6.998868542	14.67867179	11.3673882	40.70812444	22.45176604	76.04423154	0	0.135726419	28.35646365	116.3010483	146.4670199	2.738741911	8.889226266	0	0	36.07359812	6.261416893	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076066257	0.076066257	0.159529212	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												18.9707	0.387969148	1.707015545	0	1.069907348	1.63073637	3.420130528	2.64860145	9.484992995	5.231261487	17.71830595	0	0.031624256	6.607056029	27.09814425	34.12681565	0.638126865	2.07118972	0	0	8.405148362	1.458910136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.7067	0	0	18.9707	0.387969148	1.707015545	0	1.069907348	1.63073637	3.420130528	2.64860145	9.484992995	5.231261487	17.71830595	0	0.031624256	6.607056029	27.09814425	34.12681565	0.638126865	2.07118972	0	0	8.405148362	1.458910136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.7067	NO																																										0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	18.9707	0.387969148	1.707015545	0	1.069907348	1.63073637	3.420130528	2.64860145	9.484992995	5.231261487	17.71830595	0	0.031624256	6.607056029	27.09814425	34.12681565	0.638126865	2.07118972	0	0	8.405148362	1.458910136	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.7067
H9047_001_0	2010	9	N/A																															A				T	Coin		V	V		Coin			V	V				Coin		Coin				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	0	0	0	0	0	0	0	0	YES	220.7558596	0	0	0	287.1259219	25.91939297	0	399.2217958	422.2185412	0	2.414251291	0	0	261.2070442	3931.241426	0	0	0	194.1993687	0	0.001056649	0	0	0	142.2391372	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2500	$300/acute and MH admit	covered under a.1	no cost sharing	no cost sharing	$100 per trip	10% coins. for non-diabetic DME/Pros./Supplies	covered under e.1.	$50/ER visit; $25/Urgent Care visit	$100/visit	no cost sharing	10% coins. for fac. radiology	no cost sharing	no cost sharing	"$15/visit; diab. training, cardiac rehab, clinic"	$15/visit for all prof. visits	covered under i.1.	covered under i.1.	covered under i.1.	10% coins. for prof. radiology	no cost sharing	10% coins.	no cost sharing	no covered services	no covered services	$15/routine vision exam	no covered services	no covered services	no covered services	plan pays up to $350 for classes; see PBP notes	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	300	0	0	0	100	0.1	0	46.427917	100	0	0.1	0	0	15	15	0	0	0	0.1	0	0.1	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	288.9	0	0	0	96.3	0.0963	0	44.71008407	96.3	0	0.0963	0	0	14.445	14.445	0	0	0	0.0963	0	0.0963	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		5.3147	0	0	0	2.304185523	2.496037543	0	1.487436671	3.388303793	0	0.232492399	0	0	0.31442798	4.732231866	0	0	0	18.7013992	0	0.000101755	0	0	0	0.177798921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1491	0	1.497340208	5.3147	0	0	0	2.304185523	2.496037543	0	1.487436671	3.388303793	0	0.232492399	0	0	0.31442798	4.732231866	0	0	0	18.7013992	0	0.000101755	0	0	0	0.177798921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1491	NO	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.3147	0	0	0	2.304185523	2.496037543	0	1.487436671	3.388303793	0	0.232492399	0	0	0.31442798	4.732231866	0	0	0	18.7013992	0	0.000101755	0	0	0	0.177798921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	39.1491
H9047_013_0	2010	7	N/A																															A				T	Coin		V	V		Coin			V	V				Coin		Coin				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	0	0	0	0	0	0	0	0	YES	227.6790955	0	0	0	345.356389	26.07878461	0	482.1211777	416.1871013	0	26.60509356	0	0	112.9886691	13291.99659	0	0	0	21.25232913	0	36.62240932	0	0	0	145.1281773	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2500	$300/acute and MH admit	covered under a.1	no cost sharing	no cost sharing	$100 per trip	10% coins. for non-diabetic DME/Pros./Supplies	covered under e.1.	$50/ER visit; $25/Urgent Care visit	$100/visit	no cost sharing	10% coins. for fac. radiology	no cost sharing	no cost sharing	"$15/visit; diab. training, cardiac rehab, clinic"	$15/visit for all prof. visits	covered under i.1.	covered under i.1.	covered under i.1.	10% coins. for prof. radiology	no cost sharing	10% coins.	no cost sharing	no covered services	no covered services	$15/routine vision exam	no covered services	no covered services	no covered services	plan pays up to $350 for classes; see PBP notes	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	300	0	0	0	100	0.1	0	46.427917	100	0	0.1	0	0	15	15	0	0	0	0.1	0	0.1	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	288.9	0	0	0	96.3	0.0963	0	44.71008407	96.3	0	0.0963	0	0	14.445	14.445	0	0	0	0.0963	0	0.0963	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		5.4814	0	0	0	2.771485022	2.511386958	0	1.796306532	3.339901488	0	2.562070509	0	0	0.13601011	16.00024089	0	0	0	2.046599295	0	3.526738017	0	0	0	0.181410222	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3535	0	1.543476825	5.4814	0	0	0	2.771485022	2.511386958	0	1.796306532	3.339901488	0	2.562070509	0	0	0.13601011	16.00024089	0	0	0	2.046599295	0	3.526738017	0	0	0	0.181410222	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3535	NO	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	5.4814	0	0	0	2.771485022	2.511386958	0	1.796306532	3.339901488	0	2.562070509	0	0	0.13601011	16.00024089	0	0	0	2.046599295	0	3.526738017	0	0	0	0.181410222	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	40.3535
H9047_024_0	2010	10	N/A																															A		A	Coin	T	Coin		V	V		Coin		Coin	V	V				Coin		Coin	Coin			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	0	0	0	0	0	0	0	0	NO	139.0453228	0	0	9.729021921	134.878782	13.55591767	0	303.0079992	406.3552593	0	25.41248726	0	0	119.8624563	13275.35798	0	0	0	20.39534029	0	26.569373	0	0	0	156.3328341	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		$450/acute and MH admit	covered under a.1.	"Days 1-20 $0, Days 21-100 $50"	10% coins.	$100/trip	15% coins. for non-diabetic DME/Pros./Supplies	covered under e.1.	$50/ER visit; $25/urgent care visit	$150/visit	no cost sharing	10% coins. for fac. radiology	covered under h.4.	10% coins.; all other OP Facility	"$20/visit; diab. training, cardiac rehab, clinic"	$20/visit for all prof. visits	covered under i.1.	covered under i.1.	covered under i.1.	10% coins. for prof. radiology	covered under i.1.	10% coins.	10% coins.; includes some prof. and some OP fac.	no covered services	no covered services	$20/routine vision exam	no covered services	no covered services	no covered services	plan pays up to $350 for classes; see PBP notes	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	450	0	13.79161449	0.1	100	0.15	0	42.91976991	150	0	0.1	0	0	20	20	0	0	0	0.1	0	0.1	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	432	0	13.23994991	0.096	96	0.144	0	41.20297912	144	0	0.096	0	0	19.2	19.2	0	0	0	0.096	0	0.096	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		5.0056	0	0	0.933986104	1.079030256	1.952052145	0	1.040402689	4.876263112	0	2.439598777	0	0	0.19177993	21.24057277	0	0	0	1.957952668	0	2.550659808	0	0	0	0.260554723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5285	0	1.802830412	5.0056	0	0	0.933986104	1.079030256	1.952052145	0	1.040402689	4.876263112	0	2.439598777	0	0	0.19177993	21.24057277	0	0	0	1.957952668	0	2.550659808	0	0	0	0.260554723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	43.5285	YES	20% coins.	covered under a.1.	20% coins.	20% coins.	20% coins.	20% coins.	covered under e.1.	20% coins.	20% coins.	covered under h.5.	covered under h.5.	covered under h.5.	covered under h.5.	20% coins.	$30 copay/20% coins.	covered under i.1.	covered under i.1.	covered under i.1.	covered under i.1.	covered under i.1.	20% coins.	20% coins.	no covered services	no covered services	20% coins.	no covered services	no covered services	no covered services	20% coins.	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	3400	0.7047	0	0.2785	0.0012	0	0.1333	0	0.0838	0.0559	0	0	0	0	0.211	0.7845	0	0	0	0	0	0.0134	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.2663	0	0.09	5.7104	0	0.278491173	0.935213372	1.079030256	2.085358065	0	1.124204519	4.932120714	0	2.439598777	0	0	0.402785076	22.02507949	0	0	0	1.957952668	0	2.564017542	0	0	0	0.260554723	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	45.7948
H9047_033_0	2010	6	N/A																															A				T	Coin		V	V		Coin			V	V				Coin		Coin				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	0	0	0	0	0	0	0	0	YES	188.6159203	0	0	0	233.4912783	14.72416861	0	359.5029051	404.854596	0	24.91360853	0	0	55.47884338	10700.62152	0	0	0	18.61462628	0	30.22786149	0	0	0	138.4339256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2500	$300/acute and MH admit	covered under a.1	no cost sharing	no cost sharing	$100 per trip	10% coins. for non-diabetic DME/Pros./Supplies	covered under e.1.	$75/ER visit; $25/Urgent Care visit	$100/visit	no cost sharing	10% coins. for fac. radiology	no cost sharing	no cost sharing	"$15/visit; diab. training, cardiac rehab, clinic"	$15/visit for all prof. visits	covered under i.1.	covered under i.1.	covered under i.1.	10% coins. for prof. radiology	no cost sharing	10% coins.	no cost sharing	no covered services	no covered services	$15/routine vision exam	no covered services	no covered services	no covered services	plan pays up to $350 for classes; see PBP notes	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	300	0	0	0	100	0.1	0	45.49325926	100	0	0.1	0	0	15	15	0	0	0	0.1	0	0.1	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	288.9	0	0	0	96.3	0.0963	0	43.81000867	96.3	0	0.0963	0	0	14.445	14.445	0	0	0	0.0963	0	0.0963	0	0	0	15	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		4.5409	0	0	0	1.873767508	1.417937437	0	1.312485449	3.248958133	0	2.399180501	0	0	0.066782658	12.88087315	0	0	0	1.792588511	0	2.910943061	0	0	0	0.173042407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6175	0	1.246567449	4.5409	0	0	0	1.873767508	1.417937437	0	1.312485449	3.248958133	0	2.399180501	0	0	0.066782658	12.88087315	0	0	0	1.792588511	0	2.910943061	0	0	0	0.173042407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6175	NO	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	4.5409	0	0	0	1.873767508	1.417937437	0	1.312485449	3.248958133	0	2.399180501	0	0	0.066782658	12.88087315	0	0	0	1.792588511	0	2.910943061	0	0	0	0.173042407	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	32.6175
H9047_035_0	2010	8	N/A																															A		A	Coin	T	Coin		V	V		Coin		Coin	V	V				Coin		Coin	Coin			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	0	0	0	0	0	0	0	0	NO	122.659527	0	0	6.183943076	102.5370763	9.443367781	0	260.014415	362.2672244	0	29.48591073	0	0	82.5243723	9998.339905	0	0	0	17.58082449	0	26.90014881	0	0	0	141.335566	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		$450/acute and MH admit	covered under a.1.	"Days 1-20 $0, Days 21-100 $50"	10% coins.	$100/trip	15% coins. for non-diabetic DME/Pros./Supplies	covered under e.1.	$50/ER visit; $25/urgent care visit	$150/visit	no cost sharing	10% coins. for fac. radiology	covered under h.4.	10% coins.; all other OP Facility	"$20/visit; diab. training, cardiac rehab, clinic"	$20/visit for all prof. visits	covered under i.1.	covered under i.1.	covered under i.1.	10% coins. for prof. radiology	covered under i.1.	10% coins.	10% coins.; includes some prof. and some OP fac.	no covered services	no covered services	$20/routine vision exam	no covered services	no covered services	no covered services	plan pays up to $350 for classes; see PBP notes	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	450	0	13.79161449	0.1	100	0.15	0	42.91976991	150	0	0.1	0	0	20	20	0	0	0	0.1	0	0.1	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	432	0	13.23994991	0.096	96	0.144	0	41.20297912	144	0	0.096	0	0	19.2	19.2	0	0	0	0.096	0	0.096	0	0	0	20	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		4.4157	0	0	0.593658535	0.820296611	1.35984496	0	0.892780709	4.347206693	0	2.83064743	0	0	0.132038996	15.99734385	0	0	0	1.687759151	0	2.582414286	0	0	0	0.235559277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8953	0	1.485822258	4.4157	0	0	0.593658535	0.820296611	1.35984496	0	0.892780709	4.347206693	0	2.83064743	0	0	0.132038996	15.99734385	0	0	0	1.687759151	0	2.582414286	0	0	0	0.235559277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	35.8953	YES	20% coins.	covered under a.1.	20% coins.	20% coins.	20% coins.	20% coins.	covered under e.1.	20% coins.	20% coins.	covered under h.5.	covered under h.5.	covered under h.5.	covered under h.5.	20% coins.	$30 copay/20% coins	covered under i.1.	covered under i.1.	covered under i.1.	covered under i.1.	covered under i.1.	20% coins.	20% coins.	no covered services	no covered services	20% coins.	no covered services	no covered services	no covered services	20% coins.	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	3400	1.7166	0	0	0.0286	0	0.0565	0	0.0834	0	0	0	0	0	0.1365	0.5705	0	0	0	0	0	0.0022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2.5944	0	0.1	6.1324	0	0	0.622271482	0.820296611	1.41635906	0	0.976181002	4.347206693	0	2.83064743	0	0	0.268545892	16.56782811	0	0	0	1.687759151	0	2.584646405	0	0	0	0.235559277	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	38.4897
H9047_801_0	2010	7	N/A																															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	0	0	0	0	0	0	0	0	0	NO	211.4649554	0	31.64485708	18.32859228	8.692946805	20.87231494	0	17.84541204	64.96117057	0	0	0	0	71.80548496	213.8982673	0	0	0	0	0	38.97496477	0.000263078	0	0	0	0	0	0	0	0	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	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	0.083111171	0	0.127728648	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.083111171	0	0.127728648	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		17.5751	0	4.041954823	0	2.025456606	4.86324938	0	4.157981006	15.13595274	0	0	0	0	16.730678	49.83829627	0	0	0	0	0	9.081166791	6.13E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4499	0	0	17.5751	0	4.041954823	0	2.025456606	4.86324938	0	4.157981006	15.13595274	0	0	0	0	16.730678	49.83829627	0	0	0	0	0	9.081166791	6.13E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4499	NO	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	17.5751	0	4.041954823	0	2.025456606	4.86324938	0	4.157981006	15.13595274	0	0	0	0	16.730678	49.83829627	0	0	0	0	0	9.081166791	6.13E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.4499
H9047_804_0	2010	7	N/A																															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	0	0	0	0	0	0	0	0	0	NO	218.6995276	0	23.61721329	15.06750393	7.821241081	19.36791129	0	16.6152883	61.93274806	0	0	0	0	72.58071015	203.8432334	0	0	0	0	0	31.74257153	3.50E-05	0	0	0	0	0	0	0	0	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	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	0.084118974	0	0.131105793	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.084118974	0	0.131105793	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		18.3968	0	3.096353469	0	1.822349172	4.51272333	0	3.871362174	14.4303303	0	0	0	0	16.91130547	47.49547338	0	0	0	0	0	7.396019166	8.16E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9327	0	0	18.3968	0	3.096353469	0	1.822349172	4.51272333	0	3.871362174	14.4303303	0	0	0	0	16.91130547	47.49547338	0	0	0	0	0	7.396019166	8.16E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9327	NO	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	18.3968	0	3.096353469	0	1.822349172	4.51272333	0	3.871362174	14.4303303	0	0	0	0	16.91130547	47.49547338	0	0	0	0	0	7.396019166	8.16E-06	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	117.9327
H9047_805_0	2010	7	N/A																															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	0	0	0	0	0	0	0	0	0	NO	192.7055139	0	27.7586179	16.2421411	7.783317641	18.7579501	0	16.04431787	58.5764667	0	0	0	0	65.23635904	192.8654241	0	0	0	0	0	34.5029428	0.000211663	0	0	0	0	0	0	0	0	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	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	0.084434717	0	0.132068164	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.084434717	0	0.132068164	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		16.271	0	3.666029708	0	1.81351301	4.370602374	0	3.738326063	13.64831674	0	0	0	0	15.20007166	44.93764381	0	0	0	0	0	8.039185673	4.93E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6848	0	0	16.271	0	3.666029708	0	1.81351301	4.370602374	0	3.738326063	13.64831674	0	0	0	0	15.20007166	44.93764381	0	0	0	0	0	8.039185673	4.93E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6848	NO	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	16.271	0	3.666029708	0	1.81351301	4.370602374	0	3.738326063	13.64831674	0	0	0	0	15.20007166	44.93764381	0	0	0	0	0	8.039185673	4.93E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	111.6848
H9047_806_0	2010	7	N/A																															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	0	0	0	0	0	0	0	0	0	NO	185.1550827	0	21.97087044	13.61795042	7.336968928	17.54207321	0	17.16565734	68.1529359	0	0	0	0	64.21721043	209.0191829	0	0	0	0	0	26.47018353	0.000156005	0	0	0	0	0	0	0	0	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	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	Medicare FFS Cost sharing	0.083352338	0	0.128582509	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	NO	0.083352338	0	0.128582509	0	0.233	0.233	0	0.233	0.233	0	0	0	0	0.233	0.233	0	0	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0		15.4331	0	2.825069651	0	1.70951376	4.087303058	0	3.999598161	15.87963406	0	0	0	0	14.96261003	48.70146962	0	0	0	0	0	6.167552762	3.63E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7659	0	0	15.4331	0	2.825069651	0	1.70951376	4.087303058	0	3.999598161	15.87963406	0	0	0	0	14.96261003	48.70146962	0	0	0	0	0	6.167552762	3.63E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7659	NO	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services	no covered services		0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	15.4331	0	2.825069651	0	1.70951376	4.087303058	0	3.999598161	15.87963406	0	0	0	0	14.96261003	48.70146962	0	0	0	0	0	6.167552762	3.63E-05	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	113.7659
H9082_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	Coin	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	629.5658492	7.749849849	231.8219523	0	168.6016119	14.7725473	5.588550389	231.3367944	259.6937464	0	517.4974404	0	0.318619801	8.137741825	3486.48092	4303.223202	165.1796781	290.7992349	1260.231487	650.2836248	5.025369487	0	0	3212.33164	358.722776	0	0	0	0	0											2800	$175/Days 1-5 for IP Medical; $175/Days 1-5 for IP Surgical;	$175/Days 1-5 for IP Psych; $175/Days 1-5 for IP Substance Abuse;	$125/Days 21-100 for SNF	No Cost-Sharing	$125/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Diabetes Monitoring Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $35/Visit for Urgent Care;	$125/Case for OP Fac - Surgery; $100/Case for OP Fac - ASC	No Cost-Sharing	$70/Case for OP Fac - Radiology; $100/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	20% Coinsurance for OP Fac - Cardiovascular; $20/Case for OP Fac - Occ Therapy; $20/Case for OP Fac - Physical/Speech Therapy; $20/Case for OP Fac - CORF; $20/Visit for Prof - CORF; $20/Visit for Prof - CORF;	$5/Visit for PCP - Office Visits; $5/Visit for PCP - Consults; $2/Procedure for PCP - Asst Surgeon (OP); $5/Visit for PCP - Tx Injections; $5/Visit for PCP - Allergy Testing; $5/Visit for PCP - Allergy Tx;	$20/Visit for Speclst - Office Visits; $7/Procedure for Speclst - Asst Surgeon (OP); $20/Visit for Speclst - Tx Injections; $20/Visit for Speclst - Allergy Testing; $20/Visit for Speclst - Allergy Tx; $20/Visit for Speclst - Consults;	$20/Visit for OP Psych - Non-Physician; $20/Visit for OP Psych - Psychiatrist; $20/Visit for OP Substance Abuse;	$20/Visit for PT/ST (PCP); $20/Visit for Occ Therapy (PCP); $20/Visit for PT/ST (Specialist); $20/Visit for Occ Therapy (Specialist);	$23/Procedure for Prof Radiology (Office);	$20/Visit for Chiropractor; $20/Exam for Vision Exams; $20/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	$2/Visit for Dental: Preventive Services; $5/Service for Dental: Comprehensive Services;	$15/Exam for Vision Exams (Refractions);	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											175	175	125	0	125	0.2	0.2	47.69956336	112.485664	0	77.13025848	0	0.2	0.125606785	4.864288571	16.3209812	20	20	24.62023769	20	0.2	0	0	2.396260345	15	0	0	0	0	0											NO	168.4060438	168.4060438	120.2900312	0	120.2900312	0.19246405	0.19246405	45.90225574	108.2472323	0	74.22400962	0	0.19246405	0.120873952	4.681003394	15.70601071	19.246405	19.246405	23.69255329	19.246405	0.19246405	0	0	2.305969854	14.43480375	0	0	0	0	0												8.8352	0.108760129	2.32382249	0	1.690091097	2.843184283	1.075595041	0.884906725	2.342594107	0	3.200894583	0	0.061322857	0.983641017	1.360019085	5.632205809	0.264926249	0.466403321	2.488175138	1.042968501	0.967202964	0	0	0.617294994	0.431507739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6207	0	1.473044032	8.8352	0.108760129	2.32382249	0	1.690091097	2.843184283	1.075595041	0.884906725	2.342594107	0	3.200894583	0	0.061322857	0.983641017	1.360019085	5.632205809	0.264926249	0.466403321	2.488175138	1.042968501	0.967202964	0	0	0.617294994	0.431507739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6207	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.8352	0.108760129	2.32382249	0	1.690091097	2.843184283	1.075595041	0.884906725	2.342594107	0	3.200894583	0	0.061322857	0.983641017	1.360019085	5.632205809	0.264926249	0.466403321	2.488175138	1.042968501	0.967202964	0	0	0.617294994	0.431507739	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.6207
H9082_005_0	2010	7	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	367.4067364	2.732443488	45.77121401	0	14.40700449	18.31505588	9.25793306	19.87469466	40.35141653	5.682789455	19.59488203	0	0.762814576	37.48677398	43.88617211	110.5240528	2.827754281	3.973206579	33.47136713	42.46451219	10.82668348	1.192586382	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.076674119	0.076674119	0.169616487	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076674119	0.076674119	0.169616487	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												28.1706	0.209507697	7.763552525	0	3.356832047	4.267408021	2.157098403	4.630803855	9.401880052	1.324089943	4.565607513	0	0.177735796	8.734418338	10.2254781	25.75210431	0.658866748	0.925757133	7.798828542	9.894231341	2.52261725	0.277872627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.8153	0	0	28.1706	0.209507697	7.763552525	0	3.356832047	4.267408021	2.157098403	4.630803855	9.401880052	1.324089943	4.565607513	0	0.177735796	8.734418338	10.2254781	25.75210431	0.658866748	0.925757133	7.798828542	9.894231341	2.52261725	0.277872627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.8153	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	28.1706	0.209507697	7.763552525	0	3.356832047	4.267408021	2.157098403	4.630803855	9.401880052	1.324089943	4.565607513	0	0.177735796	8.734418338	10.2254781	25.75210431	0.658866748	0.925757133	7.798828542	9.894231341	2.52261725	0.277872627	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.8153
H9082_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	199.5180922	2.00850921	39.64432218	0	9.397784019	13.23061065	8.546678502	10.19847927	32.9664753	4.319695092	13.06596521	0	0.551690074	27.49117962	33.1396024	87.95493476	1.164207166	3.453496165	26.72104607	35.65262535	7.716579396	0.860452488	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.076833356	0.076833356	0.171763082	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.076833356	0.076833356	0.171763082	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												15.3296	0.154320502	6.809430948	0	2.189683677	3.082732281	1.991376091	2.376245669	7.681188744	1.006488956	3.044369894	0	0.128543787	6.405444852	7.721527358	20.4934998	0.27126027	0.804664606	6.226003734	8.307061706	1.797962999	0.20048543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0219	0	0	15.3296	0.154320502	6.809430948	0	2.189683677	3.082732281	1.991376091	2.376245669	7.681188744	1.006488956	3.044369894	0	0.128543787	6.405444852	7.721527358	20.4934998	0.27126027	0.804664606	6.226003734	8.307061706	1.797962999	0.20048543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0219	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	15.3296	0.154320502	6.809430948	0	2.189683677	3.082732281	1.991376091	2.376245669	7.681188744	1.006488956	3.044369894	0	0.128543787	6.405444852	7.721527358	20.4934998	0.27126027	0.804664606	6.226003734	8.307061706	1.797962999	0.20048543	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.0219
H9101_007_0	2010	3	N/A																															D	D	D	P	T	Coin	Coin	V	V	V	Coin	V	Coin	V	P	P	P	P	Coin	V	Coin	P	T	P	V	P	P	P	P	P																																																			0	NO	5296.391194	234.6713024	4649.717617		1413.571458	20.42451078	4.254642656	310.7666628	157.495419	857.585815	17.97661426		2.010143715	605.8921866	20.49696594	14625.48419	497.3211209	4185.059544	42.13982975		14.80163401	884.3642986								226.0060192												1a: $100/day days 1-7	1b: $100/day days 1-7	"2: $0/day days 1-14, $75/day days 15-59, $0/day days 60-100"	6: $0	10a: $50	11a: 20%	11b: 20% 11c: $0	4a: $50 4b: $50	9b: $200	8a: $0	"8b: $80 Diag Rad, $0 x-rays, 20% Ther Rad"		12: 20%	5: $20/per day 9a: $200 9c: $20 9d: $0	"7a: $0 Primary Care, $30 Urgent Care 14b: $0 14c: $0 14d: $0 14e: $0 14f: $0 14g: $0 14h: $0 14i: $0"	7b: $20 7d: $20 7f: $20	7e: $20 7h: $20	3: $25 7c: $25 7i: $25	"8b: $80 Diag Rad, $0 x-rays, 20% Ther Rad"	"7g: $20 16b: $0 MC Benefits, $400 Min $800 Max Comp (Dentures)"	15: 20%	"13a: $0 14j: $0 17a: $0 Routine, $20 Non-Routine 17b: $10 17B: $0,  up to $150 18a: $0"		16a: $0				"18b: $0,  up to $750"	14a: $0	13b: $20											59.72	59.72	38.4		27.9763419	0.032861336	0.05110292	28.67770936	185.055538	4.654848896	0.092020045		0.179200685	51.88908966	3.333333333	7.999038528	10.09399855	7.753540108	0.117122091		0.2	17.92615794								8.385043755											NO	59.72	59.72	38.4		27.9763419	0.032861336	0.05110292	28.67770936	185.055538	4.654848896	0.092020045		0.179200685	51.88908966	3.333333333	7.999038528	10.09399855	7.753540108	0.117122091		0.2	17.92615794								8.385043755												26.3584	1.167880848	14.87909637	0	3.295546534	0.671176705	0.217424664	0.742673003	2.42878329	0.332661032	1.65420885	0	0.360219131	2.619932833	0.005693602	9.749150958	0.41832989	2.704085586	4.935504988	0	2.960326802	1.321104508	0	0	0	0	0	0	0	0.15792253	0	0	0	0	0	0	0	0	0	0	76.9801	0	0	26.3584	1.167880848	14.87909637	0	3.295546534	0.671176705	0.217424664	0.742673003	2.42878329	0.332661032	1.65420885	0	0.360219131	2.619932833	0.005693602	9.749150958	0.41832989	2.704085586	4.935504988	0	2.960326802	1.321104508	0	0	0	0	0	0	0	0.15792253	0	0	0	0	0	0	0	0	0	0	76.9801	NO																																																																																		0	0	0	26.3584	1.167880848	14.87909637	0	3.295546534	0.671176705	0.217424664	0.742673003	2.42878329	0.332661032	1.65420885	0	0.360219131	2.619932833	0.005693602	9.749150958	0.41832989	2.704085586	4.935504988	0	2.960326802	1.321104508	0	0	0	0	0	0	0	0.15792253	0	0	0	0	0	0	0	0	0	0	76.9801
H9103_001_0	2010	4	N/A	q.	q.									Other Non-Covered	Other Non-Covered									Residential Treatment Facility	Expanded Care									D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	S	Coin			V	O	V		V	Coin	D	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	YES	1613.127019	65.81838069	1296.002326	1898.030466	982.518661	22.1083239	0.848354874	516.707055	141.6328008	0.339240485	17.12479185	3.466393203	22.74302137	770.7903873	7469.677297	5603.49964	408.296237	564.874743	3244.62649	8304.179136	1304.378071	0.058601271	0	0	431.5931108	361.9695978	120.9882197	39.38117275	12.77406655	4.270628257	34.52450419	89.73353564									3250	$150/day $600max/admit	$150/day $600max/admit	$0 per day	$0 copay	$100 copay	0-20% Coinsurance	0-20% Coinsurance	$0-$50/copay waived if admitted	$100 per visit	$0 copay	$0 per visit	$0 copay	$0 copay	$0-$15 per visit	$0-$20 per visit	$0-$15 per visit	$7 - $15 per visit	$15 per visit	$0-$25 copay	$0 copay	$0 or $10 generic/$40 brand per script	$0 copay			$15 per visit	$0 copay	$15 per visit	$0 Copay	$0-$140 per class	0 - 20% coinsurance	$75/day $300max/admit	20% Coinsurance									82.92277218	82.92277218	0	0	100	0.182759743	0.2	47.64028867	100	0	0	0	0	15	13.57489328	10.93066578	13.55522961	15	4.161380452	0	6.543098505	0	0	0	15	0	15	0	15	0	41.46138609	0.2									NO	80.4985065	80.4985065	0	0	98.34312548	0.179731643	0.196686251	46.85094886	98.34312548	0	0	0	0	14.75146882	13.34997433	10.74955837	13.33063646	14.75146882	4.0924316	0	6.434687573	0	0	0	14.75146882	0	14.75146882	0	15	0	40.24925325	0.2										10.8212	0.441523446	0	0	8.051996331	3.973565386	0.16685974	2.017351318	1.160717692	0	0	0	0	0.947524197	8.310000014	5.019595537	0.453570725	0.694394347	1.106534332	0	0.699438781	0	0	0	0.530552693	0	0.148729496	0	0.015967583	0	0.115798793	17.94670713	0	0	0	0	0	0	0	0	62.622	0	0.903383394	10.8212	0.441523446	0	0	8.051996331	3.973565386	0.16685974	2.017351318	1.160717692	0	0	0	0	0.947524197	8.310000014	5.019595537	0.453570725	0.694394347	1.106534332	0	0.699438781	0	0	0	0.530552693	0	0.148729496	0	0.015967583	0	0.115798793	17.94670713	0	0	0	0	0	0	0	0	62.622	NO																														20% Coinsurance																																									0.0067											0.0067			10.8212	0.441523446	0	0	8.051996331	3.973565386	0.16685974	2.017351318	1.160717692	0	0	0	0	0.947524197	8.310000014	5.019595537	0.453570725	0.694394347	1.106534332	0	0.699438781	0	0	0	0.530552693	0	0.148729496	0	0.015967583	0.006713768	0.115798793	17.94670713	0	0	0	0	0	0	0	0	62.6287
H9104_006_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	835.2243974	8.675876742	438.3021597	0	318.2434031	4.857749519	0.446990963	901.1825515	200.7280523	0	17.36720422	0	0	136.5376933	7654.782964	6937.373516	347.2310038	2981.355593	64.74253271	2720	0.534539851	0	0	0	279.96875	111.9875	83	13.61471164	0	10083.81836												copay/days 1-8	copay/days 1-8	copay/days 11-100	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$5/visit	$10/visit	$25/visit	$10/visit PT/OT/ST; $20/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain ILP services											100	100	50	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	5	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	14.11											NO	100	100	50	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	5	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	14.11												6.9602	0.072298973	1.826258999	0	2.652028359	0.291464971	0.024898528	3.47330775	1.112367957	0	0.78152419	0	0	0.113781411	3.189492902	5.781144597	0.723397925	2.732909293	6.344768205	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	50.9282			6.9602	0.072298973	1.826258999	0	2.652028359	0.291464971	0.024898528	3.47330775	1.112367957	0	0.78152419	0	0	0.113781411	3.189492902	5.781144597	0.723397925	2.732909293	6.344768205	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	50.9282	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			6.9602	0.072298973	1.826258999	0	2.652028359	0.291464971	0.024898528	3.47330775	1.112367957	0	0.78152419	0	0	0.113781411	3.189492902	5.781144597	0.723397925	2.732909293	6.344768205	2.266666667	0.10690797	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	50.9282
H9104_007_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	1020.084283	12.06931123	348.4665986	0	237.2978478	5.043900438	0.352274709	669.179177	186.0293883	0	13.68713758	0	0	0	4566.769149	4138.348966	216.6982766	1862.881343	62.51795343	2720	0.212918385	0	0	0	279.96875	111.9875	83	13.61471164	0	10083.81836												copay/days 1-10	copay/days 1-10	copay/days 11-100	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$5/visit	$10/visit	$25/visit	$10/visit PT/OT/ST; $20/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain ILP services											100	100	50	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	5	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	14.11											NO	100	100	50	0	100	0.06	0.055702532	46.25	66.5	0	0.045	0	0	10	5	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	14.11												8.5007	0.100577594	1.451944161	0	1.977482065	0.302634026	0.019622593	2.579128078	1.03091286	0	0.615921191	0	0	0	1.902820479	3.448624138	0.451454743	1.707641231	6.126759437	2.266666667	0.042583677	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	45.0002			8.5007	0.100577594	1.451944161	0	1.977482065	0.302634026	0.019622593	2.579128078	1.03091286	0	0.615921191	0	0	0	1.902820479	3.448624138	0.451454743	1.707641231	6.126759437	2.266666667	0.042583677	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	45.0002	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			8.5007	0.100577594	1.451944161	0	1.977482065	0.302634026	0.019622593	2.579128078	1.03091286	0	0.615921191	0	0	0	1.902820479	3.448624138	0.451454743	1.707641231	6.126759437	2.266666667	0.042583677	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	45.0002
H9104_008_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	913.7303956	11.85135474	352.6940718	0	210.2522006	5.622953286	0.356343889	954.3560597	217.7720587	0	13.84523983	0	0	0	5143.432957	4656.319475	247.4096831	2009.828647	71.95078829	2720	0.116594086	0	0	0	279.96875	111.9875	83	13.61471164	0	10083.81836												copay/days 1-10	copay/days 1-10	copay/days 11-100	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$10/visit	$10/visit	$25/visit	$10/visit PT/OT/ST; $20/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain ILP services											100	100	50	0	100	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	10	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	14.11											NO	100	100	50	0	100	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	10	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	14.11												7.6144	0.098761289	1.469558633	0	1.752101671	0.337377197	0.019845673	3.678247314	1.206820159	0	1.038392987	0	0	0	4.286194131	3.880266229	0.51543684	1.842342926	7.051177252	2.266666667	0.023318817	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	49.5557			7.6144	0.098761289	1.469558633	0	1.752101671	0.337377197	0.019845673	3.678247314	1.206820159	0	1.038392987	0	0	0	4.286194131	3.880266229	0.51543684	1.842342926	7.051177252	2.266666667	0.023318817	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	49.5557	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			7.6144	0.098761289	1.469558633	0	1.752101671	0.337377197	0.019845673	3.678247314	1.206820159	0	1.038392987	0	0	0	4.286194131	3.880266229	0.51543684	1.842342926	7.051177252	2.266666667	0.023318817	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	49.5557
H9104_009_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	P	Coin	V	V	V	V	V	V	V	Coin	V	Coin	O	T	P	V	P	V	P	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	NO	877.1775836	13.26130705	420.7387325	0	293.0792381	8.097160277	0.358650382	1829.874033	158.2943048	0	13.93485539	0	0	0	4791.274717	4337.512701	241.3424731	1960.541763	76.02985201	2720	0.157886104	0	0	0	279.96875	111.9875	83	13.61471164	0	10083.81836												copay/days 1-10	copay/days 1-10	copay/days 11-100	$0 Copay	$100/run	20% coinsurance for DME items over $100	20% coinsurance for Prosthetic items over $100	"$50 ER,$35 Urgent care"	$100/OP hospital and $50/ASC visits	$0 Copay	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$0 Copay	$0 Copay	$10/visit cardiac rehab	$10/visit	$10/visit	$25/visit	$10/visit PT/OT/ST; $20/visit CORF	10% coinsurance for specialized diagnostics; 20% coinsurance for therapeutic radiology	$10/visit for hearing/vision/dental/chiropractic/podiatry	20% coinsurance	$0 Copay	$0 Copay		$15/visit for routine vision	$25/service	$10/visit for routine hearing	$0 Copay	$0 Copay	$15/service for certain ILP services											100	100	50	0	100	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	10	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	14.11											NO	100	100	50	0	100	0.06	0.055692475	46.25	66.5	0	0.075	0	0	10	10	10	25	11	0.098	10	0.2	0	0	0	15	25	5	0	0	14.11												7.3098	0.110510892	1.753078052	0	2.442326984	0.485829617	0.019974128	7.052639502	0.877214272	0	1.045114154	0	0	0	3.992728931	3.614593918	0.502796819	1.797163282	7.450925497	2.266666667	0.031577221	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	53.2277			7.3098	0.110510892	1.753078052	0	2.442326984	0.485829617	0.019974128	7.052639502	0.877214272	0	1.045114154	0	0	0	3.992728931	3.614593918	0.502796819	1.797163282	7.450925497	2.266666667	0.031577221	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	53.2277	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			7.3098	0.110510892	1.753078052	0	2.442326984	0.485829617	0.019974128	7.052639502	0.877214272	0	1.045114154	0	0	0	3.992728931	3.614593918	0.502796819	1.797163282	7.450925497	2.266666667	0.031577221	0	0	0	0.349960938	0.233307292	0.034583333	0	0	11.85688975	0	0	0	0	0	0	0	0	0	0	53.2277
H9104_013_0	2010	10	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	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	NO	503.9261	2.379232277	87.07936954	40.45066078	18.82669196	7.503768364	0.567847479	32.75520224	28.82781727	15.77504492	22.06291388	0.156621471	0.313242941	33.1342266	681.865429	323.7747378	5.538955833	15.60607237	109.7795211	57.44998722	0.167554193	27.81601287	0	0	0	0	0	0	0	400												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 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$10/visit for Acupuncture/Chiropractic											0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10											NO	0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10												32.8371	0.155036818	13.54492909	0	4.386619226	1.748378029	0.132308462	7.631962123	6.716881424	3.675585466	5.140658935	0.036492803	0.072985605	7.720274798	158.874645	75.4395139	1.290576709	3.636214863	25.57862841	13.38584702	0.039040127	6.481131	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	368.8581			32.8371	0.155036818	13.54492909	0	4.386619226	1.748378029	0.132308462	7.631962123	6.716881424	3.675585466	5.140658935	0.036492803	0.072985605	7.720274798	158.874645	75.4395139	1.290576709	3.636214863	25.57862841	13.38584702	0.039040127	6.481131	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	368.8581	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			32.8371	0.155036818	13.54492909	0	4.386619226	1.748378029	0.132308462	7.631962123	6.716881424	3.675585466	5.140658935	0.036492803	0.072985605	7.720274798	158.874645	75.4395139	1.290576709	3.636214863	25.57862841	13.38584702	0.039040127	6.481131	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	368.8581
H9104_014_0	2010	10	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	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	NO	393.3039232	1.968558967	57.35409981	33.76270429	12.77412396	11.74762902	0.469832751	32.01005761	35.87931591	51.14624061	18.25468971	0.129587432	0.259174864	27.41501093	338.8059527	319.3984901	5.464089454	15.39513548	108.2957044	56.67347398	0	35.75058045	0	0	0	0	0	0	0	400												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 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$10/visit for Acupuncture/Chiropractic											0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10											NO	0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10												25.6287	0.128276302	8.921254471	0	2.976370883	2.737197563	0.109471031	7.458343423	8.359880608	11.91707406	4.253342701	0.030193872	0.060387743	6.387697546	78.94178698	74.4198482	1.273132843	3.587066567	25.23289911	13.20491944	0	8.329885244	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	284.291			25.6287	0.128276302	8.921254471	0	2.976370883	2.737197563	0.109471031	7.458343423	8.359880608	11.91707406	4.253342701	0.030193872	0.060387743	6.387697546	78.94178698	74.4198482	1.273132843	3.587066567	25.23289911	13.20491944	0	8.329885244	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	284.291	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			25.6287	0.128276302	8.921254471	0	2.976370883	2.737197563	0.109471031	7.458343423	8.359880608	11.91707406	4.253342701	0.030193872	0.060387743	6.387697546	78.94178698	74.4198482	1.273132843	3.587066567	25.23289911	13.20491944	0	8.329885244	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	284.291
H9104_015_0	2010	9	N/A																															Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	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	NO	481.1113177	2.202934795	35.46350155	25.02588914	21.9124733	11.44624668	0.525770847	66.18710637	23.25489572	63.32928253	20.42808563	0.145016059	0.290032117	30.67903096	274.9759166	379.2297367	6.487648717	18.27902559	128.5821715	67.28981908	0	8.432247224	0	0	0	0	0	0	0	400												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 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$0 Copay	$10/visit for Acupuncture/Chiropractic											0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10											NO	0.06516254	0.06516254	0.155546936	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	10												31.3504	0.143548826	5.516238993	0	5.105606279	2.666975477	0.122504607	15.42159578	5.418390702	14.75572283	4.759743951	0.033788742	0.067577483	7.148214214	64.06938858	88.36052865	1.511622151	4.259012962	29.95964597	15.67852784	0	1.964713603	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	298.6471			31.3504	0.143548826	5.516238993	0	5.105606279	2.666975477	0.122504607	15.42159578	5.418390702	14.75572283	4.759743951	0.033788742	0.067577483	7.148214214	64.06938858	88.36052865	1.511622151	4.259012962	29.95964597	15.67852784	0	1.964713603	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	298.6471	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			31.3504	0.143548826	5.516238993	0	5.105606279	2.666975477	0.122504607	15.42159578	5.418390702	14.75572283	4.759743951	0.033788742	0.067577483	7.148214214	64.06938858	88.36052865	1.511622151	4.259012962	29.95964597	15.67852784	0	1.964713603	0	0	0	0	0	0	0	0.333333333	0	0	0	0	0	0	0	0	0	0	298.6471
H9104_801_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	416.9588859	2.595458623	72.15908164	33.51979405	15.60090305	6.069161239	0.619453867	27.14288499	23.88842307	1.917379553	24.06800741	0.170855343	0.341710686	32.70312681	287.4436248	235.7006421	4.032233817	11.3608656	79.91699349	41.82228351	0.127278121	40.00993963	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																			0.065656535	0.065656535	0.153694472	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065656535	0.065656535	0.153694472	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												27.3761	0.17040882	11.09045195	0	3.635010411	1.414114569	0.144332751	6.324292204	5.566002574	0.446749436	5.607845726	0.039809295	0.07961859	7.619828547	66.97436458	54.91824962	0.939510479	2.647081684	18.62065948	9.744592059	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	232.711			27.3761	0.17040882	11.09045195	0	3.635010411	1.414114569	0.144332751	6.324292204	5.566002574	0.446749436	5.607845726	0.039809295	0.07961859	7.619828547	66.97436458	54.91824962	0.939510479	2.647081684	18.62065948	9.744592059	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	232.711	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			27.3761	0.17040882	11.09045195	0	3.635010411	1.414114569	0.144332751	6.324292204	5.566002574	0.446749436	5.607845726	0.039809295	0.07961859	7.619828547	66.97436458	54.91824962	0.939510479	2.647081684	18.62065948	9.744592059	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	232.711
H9104_803_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	363.7605461	2.264313048	62.95255439	29.24311965	13.61043788	5.294817982	0.540419894	23.67981833	20.84058192	1.672747738	20.99725372	0.149056502	0.298113003	28.53064815	250.7237037	205.5907067	3.517130002	9.909554618	69.70787614	36.47963258	0.127278121	40.00993963	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																			0.065880216	0.065880216	0.152824652	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065880216	0.065880216	0.152824652	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.9646	0.149173434	9.620702239	0	3.171232026	1.23369259	0.125917835	5.517397671	4.855855588	0.389750223	4.892360117	0.034730165	0.06946033	6.64764102	58.41862296	47.90263466	0.81949129	2.308926226	16.24193514	8.499754391	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	204.2159			23.9646	0.149173434	9.620702239	0	3.171232026	1.23369259	0.125917835	5.517397671	4.855855588	0.389750223	4.892360117	0.034730165	0.06946033	6.64764102	58.41862296	47.90263466	0.81949129	2.308926226	16.24193514	8.499754391	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	204.2159	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			23.9646	0.149173434	9.620702239	0	3.171232026	1.23369259	0.125917835	5.517397671	4.855855588	0.389750223	4.892360117	0.034730165	0.06946033	6.64764102	58.41862296	47.90263466	0.81949129	2.308926226	16.24193514	8.499754391	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	204.2159
H9104_804_0	2010	3	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	370.9040202	2.308779283	64.18880705	29.81739158	13.87771758	5.39879681	0.551032577	24.14483899	21.24984609	1.705596903	21.40959459	0.15198365	0.303967301	29.09092867	277.3363738	227.4128064	3.890450191	10.96138858	77.10690816	40.35170535	0.127278121	40.00993963	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																			0.065667189	0.065667189	0.153653493	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.065667189	0.065667189	0.153653493	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												24.3562	0.151611045	9.862834412	0	3.233508196	1.257919657	0.128390591	5.625747485	4.951214139	0.397404078	4.988435539	0.035412191	0.070824381	6.77818638	64.6193751	52.98718389	0.906474894	2.55400354	17.9659096	9.401947347	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	219.6246			24.3562	0.151611045	9.862834412	0	3.233508196	1.257919657	0.128390591	5.625747485	4.951214139	0.397404078	4.988435539	0.035412191	0.070824381	6.77818638	64.6193751	52.98718389	0.906474894	2.55400354	17.9659096	9.401947347	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	219.6246	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0			24.3562	0.151611045	9.862834412	0	3.233508196	1.257919657	0.128390591	5.625747485	4.951214139	0.397404078	4.988435539	0.035412191	0.070824381	6.77818638	64.6193751	52.98718389	0.906474894	2.55400354	17.9659096	9.401947347	0.029655802	9.322315935	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	219.6246
H9149_002_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	NO	1559.398376	91.90917615	826.6887097	941.7021358	189.8900636	11.17982965	9.501929283	309.4094688	25.03478068	9313.89461	29.98806839	0	0.039636878	18.50499992	5566.31308	4202.166976	373.478905	275.0404531	0	0	18.77028163	899.5336592	0	0	88.86092386	0	12.93248137	4.707863516	77.67974801	0												"$250 Days 1-7 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-7 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-21 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$20 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $20 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$20 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$20 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $20 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$20 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$20/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											184.2401855	140.3212257	66.85296818	0	150	0.2	0.12410433	49.48626851	0.2	3	0.176047485	0	0.2	0.148171896	6.852431202	20	38.5	20	0	0	0.2	19.0536717	0	0	20	0	0	0	0	0											NO	184.2401855	140.3212257	66.85296818	0	150	0.2	0.12410433	49.48626851	0.2	3	0.176047485	0	0.2	0.148171896	6.852431202	20	38.5	20	0	0	0.2	19.0536717	0	0	20	0	0	0	0	0												23.942	1.074734021	4.605549501	0	2.373625795	2.23596593	1.179230566	1.275960004	5.006956137	2.328473652	5.279324032	0	0.007927376	2.741920922	3.178564786	7.003611626	1.19824482	0.458400755	0	0	3.754056326	1.428284919	0	0	0.14810154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2209	0	0	23.942	1.074734021	4.605549501	0	2.373625795	2.23596593	1.179230566	1.275960004	5.006956137	2.328473652	5.279324032	0	0.007927376	2.741920922	3.178564786	7.003611626	1.19824482	0.458400755	0	0	3.754056326	1.428284919	0	0	0.14810154	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2209	NO	"$300 Days 1-Unlimited (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$300 Days 1-90 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-40 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$20 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$20 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a4, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10)"	"$0 n/c (13b, 13c, 13d, 13e)"												5.0051	0.2974	3.6111	0.7797	0.8124	1.148	0.9757	0.4367	2.5707	0.797	2.6531	0	0.0027	1.4097	2.4105	4.5041	0.4393	0.2975	0	0	1.8273	0.9466	0	0	0.0961	0	0.014	0	0	0											31.0347	0	0	28.947	1.372126576	8.216615429	0.779698388	3.186074892	3.38396186	2.154932029	1.712697992	7.57764167	3.12546799	7.93242569	0	0.010640773	4.151612164	5.589063973	11.50774689	1.637577208	0.755905881	0	0	5.581361889	2.374846599	0	0	0.24422042	0	0.013988777	0	0	0	0	0	0	0	0	0	0	0	0	0	100.2556
H9149_801_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	269.8022102	5.095232411	28.16679709	988.7872426	6.862962532	11.73882113	9.977025747	14.9970324	26.28651972	14.44772522	31.48747181	0	0.041618722	19.42184687	30.33804589	101.145515	2.14006725	3.519331673	0	0	19.70879571	5.994222439	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079771625	0.079771625	0.205536046	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079771625	0.079771625	0.205536046	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.5226	0.406454971	5.78929211	0	1.59907027	2.735145323	2.324646999	3.494308549	6.124759094	3.366319976	7.336580931	0	0.009697162	4.525290321	7.068764692	23.56690499	0.498635669	0.82000428	0	0	4.592149401	1.396653828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1772	0	0	21.5226	0.406454971	5.78929211	0	1.59907027	2.735145323	2.324646999	3.494308549	6.124759094	3.366319976	7.336580931	0	0.009697162	4.525290321	7.068764692	23.56690499	0.498635669	0.82000428	0	0	4.592149401	1.396653828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1772	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.7967	0.0528	2.3076	0	0.5473	0.9362	0.7957	1.196	2.0964	1.1522	2.5112	0	0.0033	1.5489	2.2938	7.6475	0.1618	0.2661	0	0	1.4902	0.4532	0	0	0	0	0	0	0	0											28.2571	0	0	24.3193	0.459271154	8.096912042	0	2.146403047	3.671336004	3.120331542	4.690347045	8.221153146	4.518550303	9.847759639	0	0.013016325	6.074215196	9.36260224	31.21444369	0.660444595	1.086098384	0	0	6.082317088	1.84987262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.4344
H9149_802_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	269.8022102	5.095232411	28.16679709	988.7872426	6.862962532	11.73882113	9.977025747	14.9970324	26.28651972	14.44772522	31.48747181	0	0.041618722	19.42184687	30.33804589	101.145515	2.14006725	3.519331673	0	0	19.70879571	5.994222439	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079771625	0.079771625	0.205536046	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079771625	0.079771625	0.205536046	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.5226	0.406454971	5.78929211	0	1.59907027	2.735145323	2.324646999	3.494308549	6.124759094	3.366319976	7.336580931	0	0.009697162	4.525290321	7.068764692	23.56690499	0.498635669	0.82000428	0	0	4.592149401	1.396653828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1772	0	0	21.5226	0.406454971	5.78929211	0	1.59907027	2.735145323	2.324646999	3.494308549	6.124759094	3.366319976	7.336580931	0	0.009697162	4.525290321	7.068764692	23.56690499	0.498635669	0.82000428	0	0	4.592149401	1.396653828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1772	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.7967	0.0528	2.3076	0	0.5473	0.9362	0.7957	1.196	2.0964	1.1522	2.5112	0	0.0033	1.5489	2.2938	7.6475	0.1618	0.2661	0	0	1.4902	0.4532	0	0	0	0	0	0	0	0											28.2571	0	0	24.3193	0.459271154	8.096912042	0	2.146403047	3.671336004	3.120331542	4.690347045	8.221153146	4.518550303	9.847759639	0	0.013016325	6.074215196	9.36260224	31.21444369	0.660444595	1.086098384	0	0	6.082317088	1.84987262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.4344
H9149_803_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	269.8022102	5.095232411	28.16679709	988.7872426	6.862962532	11.73882113	9.977025747	14.9970324	26.28651972	14.44772522	31.48747181	0	0.041618722	19.42184687	30.33804589	101.145515	2.14006725	3.519331673	0	0	19.70879571	5.994222439	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079771625	0.079771625	0.205536046	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079771625	0.079771625	0.205536046	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.5226	0.406454971	5.78929211	0	1.59907027	2.735145323	2.324646999	3.494308549	6.124759094	3.366319976	7.336580931	0	0.009697162	4.525290321	7.068764692	23.56690499	0.498635669	0.82000428	0	0	4.592149401	1.396653828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1772	0	0	21.5226	0.406454971	5.78929211	0	1.59907027	2.735145323	2.324646999	3.494308549	6.124759094	3.366319976	7.336580931	0	0.009697162	4.525290321	7.068764692	23.56690499	0.498635669	0.82000428	0	0	4.592149401	1.396653828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1772	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.7967	0.0528	2.3076	0	0.5473	0.9362	0.7957	1.196	2.0964	1.1522	2.5112	0	0.0033	1.5489	2.2938	7.6475	0.1618	0.2661	0	0	1.4902	0.4532	0	0	0	0	0	0	0	0											28.2571	0	0	24.3193	0.459271154	8.096912042	0	2.146403047	3.671336004	3.120331542	4.690347045	8.221153146	4.518550303	9.847759639	0	0.013016325	6.074215196	9.36260224	31.21444369	0.660444595	1.086098384	0	0	6.082317088	1.84987262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.4344
H9149_805_0	2010	2	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	NO	269.8022102	5.095232411	28.16679709	988.7872426	6.862962532	11.73882113	9.977025747	14.9970324	26.28651972	14.44772522	31.48747181	0	0.041618722	19.42184687	30.33804589	101.145515	2.14006725	3.519331673	0	0	19.70879571	5.994222439	0	0	0	0	0	0	0	0												"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.079771625	0.079771625	0.205536046	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.079771625	0.079771625	0.205536046	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												21.5226	0.406454971	5.78929211	0	1.59907027	2.735145323	2.324646999	3.494308549	6.124759094	3.366319976	7.336580931	0	0.009697162	4.525290321	7.068764692	23.56690499	0.498635669	0.82000428	0	0	4.592149401	1.396653828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1772	0	0	21.5226	0.406454971	5.78929211	0	1.59907027	2.735145323	2.324646999	3.494308549	6.124759094	3.366319976	7.336580931	0	0.009697162	4.525290321	7.068764692	23.56690499	0.498635669	0.82000428	0	0	4.592149401	1.396653828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.1772	NO	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"												2.7967	0.0528	2.3076	0	0.5473	0.9362	0.7957	1.196	2.0964	1.1522	2.5112	0	0.0033	1.5489	2.2938	7.6475	0.1618	0.2661	0	0	1.4902	0.4532	0	0	0	0	0	0	0	0											28.2571	0	0	24.3193	0.459271154	8.096912042	0	2.146403047	3.671336004	3.120331542	4.690347045	8.221153146	4.518550303	9.847759639	0	0.013016325	6.074215196	9.36260224	31.21444369	0.660444595	1.086098384	0	0	6.082317088	1.84987262	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	125.4344
H9184_001_0	2010	4	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	864.5803906	1.684859907	630.2730273	16.88882962	127.2798376	6.931100447	1.610438036	232.7198226	399.9660836	3.848119609	107.6225816	0	0.035889901	705.5936689	0.480606053	3714.006815	79.87754916	406.9873005	30.2261565	63.11621873	12.69200708	0	0	0	0	0	0	0	0	0												1a:  Acute - $100/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $75/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $15/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $15/visit/7i:  Physical/Speech Therapy - $15/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $15/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $15/visit/17a:  Vision Exams - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7e:  Mental Hlth Spec-Non-Physician - Individual - $15/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $15/visit/7h:  Psychiatric Services - Individual - $15/visit/7h:  Psychiatric Services - Group - $15/visit	7c:  Occupational Therapy Services - $15/visit/7i:  Physical/Speech Therapy - $15/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $15/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit												100	0.066973886	85	0	75	0.2	0.2	25.91462025	97.95031435	0	100	0	0.2	23.27067937	15	15	15	15	0	15.089004	0.2	0	0	0	0	0	0	0	0	0											NO	96.53525942	0.064312691	81.87340693	0	72.32498046	0.192523225	0.192436687	24.99051752	94.56451847	0	96.41311093	0	0.192053036	22.43734995	14.47834094	14.45267672	14.40397767	14.43788105	0	14.54277279	0.193414206	0	0	0	0	0	0	0	0	0												6.9552	0.108357874	4.30021667	0	0.767125981	1.334397811	0.30990736	0.484649067	3.151883342	0	0.864685658	0	0.006892764	1.319304339	0.000579865	4.473111652	0.095879536	0.48966952	0	0.076490402	2.454814477	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1932		1.001840597	6.9552	0.108357874	4.30021667	0	0.767125981	1.334397811	0.30990736	0.484649067	3.151883342	0	0.864685658	0	0.006892764	1.319304339	0.000579865	4.473111652	0.095879536	0.48966952	0	0.076490402	2.454814477	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	27.1932	YES	1a:  Acute - 20.0% for 1-90/1a:  Additional Days - 20.0% for 91-999	1b:  Psych - 30.0% for 1-190	2:  Skilled Nursing Services - 20.0% for 1-100/2:  Non-Medicare Covered Stay - 20.0% for 1-100	6:  Home Health Services - 20.0%	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - 30.0%/3:  Rehab Services (CORF) - 30.0%/5:  Partial Hospitalization - 30.0%7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - 20.0%/17a:  Vision Exams - 20.0%/14c:  Routine Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/14e:  Prostate Cancer Screening - /visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/14e:  Prostate Cancer Screening - /visit/14h:  Mammography - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - $0/visit7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14c:  Routine Exams - 20.0%												4000	4.3445	0.0361	0.6417	0.2712	0.1251	0.2452	0.0564	0.0462	0.4073	0.0851	0.2722	0	0.0005	0.3375	0.374	1.0217	0.0154	0.0552	0.3309	0.3345	0.2718	0.0102	0	0	0	0	0	0	0.0071	0											9.2895		5.127784136	11.2997	0.144425996	4.941902911	0.271206918	0.892219056	1.579566098	0.366303766	0.530808203	3.559182746	0.085108747	1.13685146	0	0.007357226	1.656789678	0.374544522	5.494779604	0.111254934	0.544834027	0.330916941	0.410985558	2.726605846	0.010215144	0	0	0	0	0	0	0.007097314	0	0	0	0	0	0	0	0	0	0	0	36.4827
H9184_002_0	2010	4	N/A																															D	coin	D	coin	T	coin	coin	V	V	coin	P	O	coin	P	V	V	V	V	coin	V	coin	O	T	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	0	0	0	0	0											0	NO	1036.413063	1.574219219	883.4353049	9.481000428	183.1066532	8.261898014	2.941807923	312.4981228	1027.619099	3.853885632	87.41764141	0	1.288258524	1152.871857	0.637710903	3878.338697	3.252261319	381.3095716	31.36184069	69.2930988	21.96915539	0	0	0	0	0	0	0	0	0												1a:  Acute - $100/$0/day for 1-5/6-90/1a:  Additional Days - $0/day for 91-999	1b:  Psych - MC Cost Shares for 1-190	2:  Skilled Nursing Services - $0/$85/day for 1-10/11-100/2:  Non-Medicare Covered Stay - $0/$85/day for 1-10/11-100	6:  Home Health Services - $0/visit	10a:  Ambulance - $75/trip	11a:  Durable Medical Equipment - 20.0%	11b:  Prosthetics Devices - 20.0%/11b:  Medical Supplies - 20.0%/11c:  Diabetes Monitoring Supplies - 20.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit/9b:  Ambulatory Surgical Center Services - $75/visit	8a:  Outpatient Diagnostic Procedures/Tests - $0/visit/8a:  Outpatient Lab Services - $0/visit	8b:  Outpatient Diagnostic Radiological Services - $100/visit/8b:  Outpatient Therapeutic Radiological Services - $100/visit/8b:  Outpatient X-Ray Services - $0/visit		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit	9d:  Cardiac Rehabilitation Services - $15/visit/3:  Rehab Services (CORF) - 20.0%/5:  Partial Hospitalization - 20.0%/7c:  Occupational Therapy Services - $15/visit/7i:  Physical/Speech Therapy - $15/visit/9a:  Outpatient Hospital Services (Hospital Surgery) - $100/visit	7a:  Primary Care - $0/visit/17a:  Vision Exams - $15/visit/14c:  Routine Exams - $0/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7d:  Physician Specialist Services - $15/visit/7b:  Chiropractic Services - $15/visit/ Visits/7f:  Podiatry Services - $15/visit/17a:  Vision Exams - $15/visit/14d:  Pap Smears and Pelvic Exams Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14f:  Colorectal Screening - $0/visit/14g:  Bone Mass Measurement - $0/visit/14b:  Immunizations (Hepatitis B) - $0/visit/14i:  Diabetes Monitoring - $0/visit/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - $0/visit/14e:  Prostate Cancer Screening - $0/visit/14h:  Mammography - $0	7e:  Mental Hlth Spec-Non-Physician - Individual - $15/visit/7e:  Mental Hlth Spec-Non-Physician - Group - $15/visit/7h:  Psychiatric Services - Individual - $15/visit/7h:  Psychiatric Services - Group - $15/visit	7c:  Occupational Therapy Services - $15/visit/7i:  Physical/Speech Therapy - $15/visit	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit"	"9c:  Outpatient Substance Abuse Svcs - Individual - 20.0%/9c:  Outpatient Substance Abuse Svcs - Group - 20.0%/7g:  Other Health Care Professional Services - $0/visit/7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - $0/visit/7d:  IP Phys (Surgery, Visits, Rad & Path) - $0/visit/7d:  OP Phys (Surgery, ER, Rad & Path) - $0/visit/18a:  Hearing Exams - $15/visit"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - $0/service/13a:  3-Pints Deductible Waived - $0/service			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14a:  Written health education materials - $0/service/14c:  Routine Exams - $0/visit												100	0.059424176	85	0	75	0.2	0.2	25.91660962	97.95031435	0	100	0	0.2	23.11740978	15	15	15	15	0	14.96331035	0.2	0	0	0	0	0	0	0	0	0											NO	92.48011821	0.054955549	78.60810048	0	69.36008866	0.184960236	0.184960236	23.96771121	90.58456649	0	92.48011821	0	0.184960236	21.37900789	13.87201773	13.87201773	13.87201773	13.87201773	0	13.8380871	0.184960236	0	0	0	0	0	0	0	0	0												7.9873	0.086512081	5.787097601	0	1.058357809	1.52812261	0.544117489	0.624155397	7.757202548	0	0.673699484	0	0.238276601	2.053938044	0.000737195	4.483365264	0.003759619	0.440794428	0	0.079906995	4.063420174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4108		3.042	7.9873	0.086512081	5.787097601	0	1.058357809	1.52812261	0.544117489	0.624155397	7.757202548	0	0.673699484	0	0.238276601	2.053938044	0.000737195	4.483365264	0.003759619	0.440794428	0	0.079906995	4.063420174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	37.4108	YES	1a:  Acute - 20.0% for 1-90/1a:  Additional Days - 20.0% for 91-999	1b:  Psych - 30.0% for 1-190	2:  Skilled Nursing Services - 20.0% for 1-100/2:  Non-Medicare Covered Stay - 20.0% for 1-100	6:  Home Health Services - 20.0%	10a:  Ambulance - 20.0%	11a:  Durable Medical Equipment - 30.0%	11b:  Prosthetics Devices - 30.0%/11b:  Medical Supplies - 30.0%/11c:  Diabetes Monitoring Supplies - 30.0%	4a:  Emergency Care / Post Stabilization Care - $50/visit/4b:  Urgently Needed Care / Urgent Care Centers - $15/visit/4a:  Worldwide Coverage - $50/visit	9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%/9b:  Ambulatory Surgical Center Services - 20.0%	8a:  Outpatient Diagnostic Procedures/Tests - 20.0%/8a:  Outpatient Lab Services - 20.0%	8b:  Outpatient Diagnostic Radiological Services - 20.0%/8b:  Outpatient Therapeutic Radiological Services - 20.0%/8b:  Outpatient X-Ray Services - 20.0%		12:  Renal Dialysis - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%	9d:  Cardiac Rehabilitation Services - 30.0%/3:  Rehab Services (CORF) - 30.0%/5:  Partial Hospitalization - 30.0%7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%/9a:  Outpatient Hospital Services (Hospital Surgery) - 20.0%	7a:  Primary Care - 20.0%/17a:  Vision Exams - 20.0%/14c:  Routine Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/14e:  Prostate Cancer Screening - /visit/14h:  Mammography - $0/visit	7d:  Physician Specialist Services - 20.0%/7b:  Chiropractic Services - 20.0%/7f:  Podiatry Services - 20.0%/17a:  Vision Exams - 20.0%/14d:  Pap Smears and Pelvic Exams Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14f:  Colorectal Screening - 20.0%/14g:  Bone Mass Measurement - 20.0%/14b:  Immunizations (Hepatitis B) - 20.0%/14i:  Diabetes Monitoring - 20.0%/14j:  Nutrition Therapy for Diabetes & Renal Dialysis - 20.0%/14e:  Prostate Cancer Screening - /visit/14h:  Mammography - $0/visit	7e:  Mental Hlth Spec-Non-Physician - Individual - 30.0%/7e:  Mental Hlth Spec-Non-Physician - Group - 30.0%/7h:  Psychiatric Services - Individual - 30.0%/7h:  Psychiatric Services - Group - 30.0%	7c:  Occupational Therapy Services - 20.0%/7i:  Physical/Speech Therapy - 20.0%	"7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%"	"9c:  Outpatient Substance Abuse Svcs - Individual - 30.0%/9c:  Outpatient Substance Abuse Svcs - Group - 30.0%/7g:  Other Health Care Professional Services - $0/visit7d:  Phys Svcs (Surgery, Misc. Med, Rad & Path) - 20.0%/7d:  OP Phys (Surgery, ER, Rad & Path) - 20.0%/18a:  Hearing Exams - 20.0%"	15:  Medicare Part B Rx Drugs - Chemo - 20.0%/Medicare Part B Rx Drugs - Non-Chemo - 20.0%	13a:  Blood - 20.0%/13a:  3-Pints Deductible Waived - 20.0%			17a:  Routine Eye Exams - $0/visit	17b:  Wear - $0/service	18a:  Routine Hearing Test - $0/visit/18a:  Fitting for Hearing Aid - $0/visit	18b:  Hearing Aids - $0/service	14c:  Routine Exams - 20.0%												4000	4.9424	0.0321	0.6476	0.1673	0.1187	0.2528	0.09	0.0608	0.3247	0.0623	0.4437	0	0.0172	0.4673	0.3719	0.8564	0.001	0.0359	0.309	0.1319	0.4752	0.006	0	0	0	0	0	0	0.0058	0											9.8199		5.776	12.9297	0.11860348	6.434696286	0.167261204	1.177073005	1.780932118	0.634135184	0.685004986	8.081899687	0.062296208	1.117356256	0	0.25544736	2.52122368	0.372660068	5.339804807	0.004711582	0.47673406	0.308951948	0.211850521	4.538573813	0.006004722	0	0	0	0	0	0	0.00581157	0	0	0	0	0	0	0	0	0	0	0	47.2307
H9302_001_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	P	P	V	Coin	V	T	V	V	V	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	YES	820.4389041	14.36741568	749.6799578	0	187.9924408	11.20307089	1.413825549	369.5101807	536.2112833	0	175.3676356	0	0.067617059	395.1328098	5233.383257	3361.160864	62.94376528	185.5591853	189.0075384	336.2072794	36.85691883	0	0	0	398.7984451	0	2.016304	0	0	0											1000	$100/Days 1-5 for IP Medical; $100/Days 1-5 for IP Surgical;	$100/Days 1-5 for IP Psych; $100/Days 1-5 for IP Substance Abuse;	$100/Days 11-21 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care; $15/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$130/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$15/Case for OP Fac - Cardiovascular; $15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Case for OP Fac - Other; $15/Visit for Prof - CORF; $15/Service for Prof - CORF; $50/Visit for partial hospitalization services;	$5/Visit for PCP - Office Visits; $5/Consult for PCP - Consults; 20% Coinsurance for PCP - Tx Injections;	$15/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Tx Injections; $15/Consult for Speclst - Consults; $5/Service for diabetic foot care;$15/Service for other medically necessary podiatry services;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Service for PT/ST (Specialist); $15/Service for Occ Therapy (Specialist);	$130/Procedure for Prof Radiology (Office);	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; $5/Service for Nutritional Therapy for Diabetes & Renal Dialysis;$5/Service for all Other Health Care Professional primary care services;$15/Service for all non-primary care Other Health Care Professional physician services;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	100	0	100	0.174275514	0.114962458	46.94011203	50	0	130	0	0.153129949	15	5	15	15	15	130	15	0.102134948	0	0	0	15	0	15	0	0	0											NO	89.45356181	89.45356185	89.45356181	0	89.45356181	0.155895655	0.102838013	41.98960213	44.72678091	0	116.2896304	0	0.136980193	13.41803428	4.472678091	13.41803427	13.41803426	13.41803427	116.2896304	13.41803427	0.091363349	0	0	0	13.41803427	0	13.41803438	0	0	0												6.1159	0.107101376	5.588461871	0	1.401382785	1.746510075	0.14539501	1.292965456	1.998583716	0	1.699453127	0	0.009262198	0.441825466	1.95060322	3.758347639	0.0703818	0.207486626	1.831634732	0.375936733	3.367371522	0	0	0	0.445924267	0	0.00225457	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5568	0	3.838221182	6.1159	0.107101376	5.588461871	0	1.401382785	1.746510075	0.14539501	1.292965456	1.998583716	0	1.699453127	0	0.009262198	0.441825466	1.95060322	3.758347639	0.0703818	0.207486626	1.831634732	0.375936733	3.367371522	0	0	0	0.445924267	0	0.00225457	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5568	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.1159	0.107101376	5.588461871	0	1.401382785	1.746510075	0.14539501	1.292965456	1.998583716	0	1.699453127	0	0.009262198	0.441825466	1.95060322	3.758347639	0.0703818	0.207486626	1.831634732	0.375936733	3.367371522	0	0	0	0.445924267	0	0.00225457	0	0	0	0	0	0	0	0	0	0	0	0	0	32.5568
H9302_002_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	P	P	V	Coin	V	T	V	V	V	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	YES	641.0867501	28.21353508	34.38987367	0	148.7945134	7.470229587	3.82699698	210.0178418	433.9297355	0	126.7246475	0	0.285087082	255.8110633	3783.079963	2985.08072	113.814413	156.7997475	155.8458105	644.382115	19.10208893	0	0	0	358.6003452	0	8.362656459	0	0	0											1000	$100/Days 1-5 for IP Medical; $100/Days 1-5 for IP Surgical;	$100/Days 1-5 for IP Psych; $100/Days 1-5 for IP Substance Abuse;	$100/Days 11-21 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care; $15/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$130/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$15/Case for OP Fac - Cardiovascular; $15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Case for OP Fac - Other; $15/Visit for Prof - CORF; $15/Service for Prof - CORF; $50/Visit for partial hospitalization services;	$5/Visit for PCP - Office Visits; $5/Consult for PCP - Consults; 20% Coinsurance for PCP - Tx Injections;	$15/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Tx Injections; $15/Consult for Speclst - Consults; $5/Service for diabetic foot care;$15/Service for other medically necessary podiatry services;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Service for PT/ST (Specialist); $15/Service for Occ Therapy (Specialist);	$130/Procedure for Prof Radiology (Office);	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; $5/Service for Nutritional Therapy for Diabetes & Renal Dialysis;$5/Service for all Other Health Care Professional primary care services;$15/Service for all non-primary care Other Health Care Professional physician services;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	100	0	100	0.154733841	0.199988303	47.44740926	50	0	130	0	0.2	15	5	15	15	15	130	15	0.108941307	0	0	0	15	0	15	0	0	0											NO	89.94838195	89.94838194	89.94838196	0	89.94838195	0.139180586	0.179886243	42.6781769	44.97419097	0	116.9328965	0	0.179896764	13.49225729	4.497419097	13.49225729	13.49225729	13.4922573	116.9328965	13.49225729	0.097990943	0	0	0	13.49225729	0	13.49225723	0	0	0												4.8054	0.211480152	0.257776124	0	1.11531881	1.039710933	0.688424108	0.74693155	1.626303233	0	1.234856675	0	0.051286243	0.28762239	1.417841339	3.35628976	0.127967779	0.176298545	1.518625169	0.724514108	1.871831704	0	0	0	0.40319401	0	0.009402593	0	0	0	0	0	0	0	0	0	0	0	0	0	21.6711	0	2.421550514	4.8054	0.211480152	0.257776124	0	1.11531881	1.039710933	0.688424108	0.74693155	1.626303233	0	1.234856675	0	0.051286243	0.28762239	1.417841339	3.35628976	0.127967779	0.176298545	1.518625169	0.724514108	1.871831704	0	0	0	0.40319401	0	0.009402593	0	0	0	0	0	0	0	0	0	0	0	0	0	21.6711	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.8054	0.211480152	0.257776124	0	1.11531881	1.039710933	0.688424108	0.74693155	1.626303233	0	1.234856675	0	0.051286243	0.28762239	1.417841339	3.35628976	0.127967779	0.176298545	1.518625169	0.724514108	1.871831704	0	0	0	0.40319401	0	0.009402593	0	0	0	0	0	0	0	0	0	0	0	0	0	21.6711
H9302_003_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	P	P	V	Coin	V	T	V	V	V	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	YES	505.2055188	13.59230821	158.21039	0	101.39876	7.219836439	1.838343388	233.4060339	308.2656573	0	111.8804897	0	0.129844227	232.4631581	3881.971984	2383.268623	58.29354571	110.6116887	131.2508462	405.5642303	23.24760244	0	0	0	252.7215289	0	5.489230607	0	0	0											2250	$200/Days 1-5 for IP Medical; $200/Days 1-5 for IP Surgical;	$200/Days 1-5 for IP Psych; $200/Days 1-5 for IP Substance Abuse;	$100/Days 11-33 for SNF	No Cost-Sharing	$150/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$150/Case for OP Fac - Surgery; $150/Case for OP Fac - ASC	No Cost-Sharing	$130/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$30/Case for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $30/Case for OP Fac - Other; $30/Visit for Prof - CORF; $30/Service for Prof - CORF; $150/Visit for partial hospitalization services;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; 20% Coinsurance for PCP - Tx Injections;	$30/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Tx Injections; $30/Consult for Speclst - Consults; $10/Service for diabetic foot care;$30/Service for other medically necessary podiatry services;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Service for PT/ST (Specialist); $30/Service for Occ Therapy (Specialist);	$130/Procedure for Prof Radiology (Office);	$25/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; $10/Service for Nutritional Therapy for Diabetes & Renal Dialysis;$10/Service for all Other Health Care Professional primary care services;$30/Service for all non-primary care Other Health Care Professional physician services;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	No Cost-Sharing	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											200	200	100	0	150	0.150441519	0.01666467	47.41405079	150	0	130	0	0.2	30	10	30	30	30	130	28.78629722	0.11253613	0	0	0	30	0	30	0	0	0											NO	186.7660483	186.7660484	93.38302416	0	140.0745362	0.14048684	0.015561973	44.2766745	140.0745362	0	121.3979314	0	0.186766049	28.01490724	9.338302415	28.01490725	28.01490723	28.01490725	121.3979314	26.88151488	0.105089641	0	0	0	28.01490725	0	28.01490716	0	0	0												7.8629	0.211548474	1.231180389	0	1.183615357	1.014292008	0.028608251	0.861203582	3.598347415	0	1.131838334	0	0.024250493	0.542702818	3.020919029	5.563920784	0.13609069	0.25823135	1.327798435	0.908515074	2.443082204	0	0	0	0.589997516	0	0.012815024	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9519	0	2.264061495	7.8629	0.211548474	1.231180389	0	1.183615357	1.014292008	0.028608251	0.861203582	3.598347415	0	1.131838334	0	0.024250493	0.542702818	3.020919029	5.563920784	0.13609069	0.25823135	1.327798435	0.908515074	2.443082204	0	0	0	0.589997516	0	0.012815024	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9519	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	7.8629	0.211548474	1.231180389	0	1.183615357	1.014292008	0.028608251	0.861203582	3.598347415	0	1.131838334	0	0.024250493	0.542702818	3.020919029	5.563920784	0.13609069	0.25823135	1.327798435	0.908515074	2.443082204	0	0	0	0.589997516	0	0.012815024	0	0	0	0	0	0	0	0	0	0	0	0	0	31.9519
H9302_004_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	P	P	V	Coin	V	T	V	V	V	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	YES	394.4717788	2.797139193	112.8594894	0	75.40145855	5.282811517	2.334586137	136.6711541	227.7934379	0	86.90693226	0	0.243519477	153.2461464	2537.187233	2003.241634	75.31625207	84.26618035	117.0738782	499.0600056	21.56438686	0	0	0	226.4411825	0	9.076625495	0	0	0											2250	$200/Days 1-5 for IP Medical; $200/Days 1-5 for IP Surgical;	$200/Days 1-5 for IP Psych; $200/Days 1-5 for IP Substance Abuse;	$100/Days 11-33 for SNF	No Cost-Sharing	$150/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$150/Case for OP Fac - Surgery; $150/Case for OP Fac - ASC	No Cost-Sharing	$130/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$30/Case for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $30/Case for OP Fac - Other; $30/Visit for Prof - CORF; $30/Service for Prof - CORF; $150/Visit for partial hospitalization services;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults; 20% Coinsurance for PCP - Tx Injections;	$30/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Tx Injections; $30/Consult for Speclst - Consults; $10/Service for diabetic foot care;$30/Service for other medically necessary podiatry services;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Service for PT/ST (Specialist); $30/Service for Occ Therapy (Specialist);	$130/Procedure for Prof Radiology (Office);	$25/Visit for Chiropractor; $30/Exam for Vision Exams; $30/Exam for Hearing/Speech Exams; $10/Service for Nutritional Therapy for Diabetes & Renal Dialysis;$10/Service for all Other Health Care Professional primary care services;$30/Service for all non-primary care Other Health Care Professional physician services;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Exam for Vision (Refractions)	No Cost-Sharing	$30/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											200	200	100	0	150	0.157389761	0.2	46.76638048	150	0	130	0	0.2	30	10	30	30	30	130	27.75543106	0.109289942	0	0	0	30	0	30	0	0	0											NO	189.8581612	189.8581613	94.92908062	0	142.3936209	0.149408653	0.189858161	44.39489503	142.3936209	0	123.4078048	0	0.189858161	28.47872419	9.492908062	28.47872419	28.47872419	28.47872418	123.4078048	26.34797553	0.103747937	0	0	0	28.47872419	0	28.47872419	0	0	0												6.2411	0.044254975	0.892803964	0	0.894723892	0.789297752	0.443240231	0.505625128	2.703027704	0	0.893749478	0	0.04623416	0.363687895	2.007107095	4.754147165	0.178742564	0.199982776	1.203985859	1.095768401	2.237260654	0	0	0	0.537396332	0	0.021540893	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0537	0	1.391736863	6.2411	0.044254975	0.892803964	0	0.894723892	0.789297752	0.443240231	0.505625128	2.703027704	0	0.893749478	0	0.04623416	0.363687895	2.007107095	4.754147165	0.178742564	0.199982776	1.203985859	1.095768401	2.237260654	0	0	0	0.537396332	0	0.021540893	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0537	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.2411	0.044254975	0.892803964	0	0.894723892	0.789297752	0.443240231	0.505625128	2.703027704	0	0.893749478	0	0.04623416	0.363687895	2.007107095	4.754147165	0.178742564	0.199982776	1.203985859	1.095768401	2.237260654	0	0	0	0.537396332	0	0.021540893	0	0	0	0	0	0	0	0	0	0	0	0	0	26.0537
H9302_005_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	P	P	V	Coin	V	T	V	V	V	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	YES	831.2731932	14.5571443	759.5798412	0	190.4749711	11.49402205	1.450543533	374.3897398	543.2922105	0	177.6834493	0	0.069373119	400.350728	5302.492593	3405.546605	63.77496792	188.0095832	191.5034736	340.6470578	37.74396943	0	0	0	399.7518942	0	2.02112464	0	0	0											1000	$100/Days 1-5 for IP Medical; $100/Days 1-5 for IP Surgical;	$100/Days 1-5 for IP Psych; $100/Days 1-5 for IP Substance Abuse;	$100/Days 11-21 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care; $15/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$130/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$15/Case for OP Fac - Cardiovascular; $15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Case for OP Fac - Other; $15/Visit for Prof - CORF; $15/Service for Prof - CORF; $50/Visit for partial hospitalization services;	$5/Visit for PCP - Office Visits; $5/Consult for PCP - Consults; 20% Coinsurance for PCP - Tx Injections;	$15/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Tx Injections; $15/Consult for Speclst - Consults; $5/Service for diabetic foot care;$15/Service for other medically necessary podiatry services;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Service for PT/ST (Specialist); $15/Service for Occ Therapy (Specialist);	$130/Procedure for Prof Radiology (Office);	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; $5/Service for Nutritional Therapy for Diabetes & Renal Dialysis;$5/Service for all Other Health Care Professional primary care services;$15/Service for all non-primary care Other Health Care Professional physician services;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	100	0	100	0.174275514	0.114962458	46.94011203	50	0	130	0	0.15312995	15	5	15	15	15	130	15	0.102279035	0	0	0	15	0	15	0	0	0											NO	88.72962744	88.72962747	88.72962744	0	88.72962744	0.154634015	0.10200576	41.64978652	44.36481372	0	115.3485157	0	0.135871634	13.30944412	4.436481372	13.30944412	13.30944412	13.30944412	115.3485157	13.30944411	0.090751806	0	0	0	13.30944411	0	13.30944439	0	0	0												6.1465	0.107637499	5.61643636	0	1.408397769	1.777366773	0.147963796	1.299437728	2.008588143	0	1.707960179	0	0.009425839	0.444037137	1.960367468	3.777161019	0.070734114	0.208525253	1.840803452	0.377818582	3.425333408	0	0	0	0.443372958	0	0.002241671	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7802	0	4.163443578	6.1465	0.107637499	5.61643636	0	1.408397769	1.777366773	0.147963796	1.299437728	2.008588143	0	1.707960179	0	0.009425839	0.444037137	1.960367468	3.777161019	0.070734114	0.208525253	1.840803452	0.377818582	3.425333408	0	0	0	0.443372958	0	0.002241671	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7802	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.1465	0.107637499	5.61643636	0	1.408397769	1.777366773	0.147963796	1.299437728	2.008588143	0	1.707960179	0	0.009425839	0.444037137	1.960367468	3.777161019	0.070734114	0.208525253	1.840803452	0.377818582	3.425333408	0	0	0	0.443372958	0	0.002241671	0	0	0	0	0	0	0	0	0	0	0	0	0	32.7802
H9302_006_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	P	P	V	Coin	V	T	V	V	V	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	YES	653.8055334	28.90243791	36.12460761	0	137.5523497	6.876827724	3.467835249	209.906483	437.2365252	0	136.3428697	0	0.40907655	297.8480737	3880.326766	3061.395732	109.4627153	152.1479215	162.6261554	655.1474802	21.68185674	0	0	0	359.0549961	0	8.319509981	0	0	0											1000	$100/Days 1-5 for IP Medical; $100/Days 1-5 for IP Surgical;	$100/Days 1-5 for IP Psych; $100/Days 1-5 for IP Substance Abuse;	$100/Days 11-21 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care; $15/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$130/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$15/Case for OP Fac - Cardiovascular; $15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Case for OP Fac - Other; $15/Visit for Prof - CORF; $15/Service for Prof - CORF; $50/Visit for partial hospitalization services;	$5/Visit for PCP - Office Visits; $5/Consult for PCP - Consults; 20% Coinsurance for PCP - Tx Injections;	$15/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Tx Injections; $15/Consult for Speclst - Consults; $5/Service for diabetic foot care;$15/Service for other medically necessary podiatry services;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Service for PT/ST (Specialist); $15/Service for Occ Therapy (Specialist);	$130/Procedure for Prof Radiology (Office);	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; $5/Service for Nutritional Therapy for Diabetes & Renal Dialysis;$5/Service for all Other Health Care Professional primary care services;$15/Service for all non-primary care Other Health Care Professional physician services;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	100	0	100	0.154733841	0.199988303	47.3809877	50	0	130	0	0.2	15	5	15	15	15	130	15	0.101421219	0	0	0	15	0	15	0	0	0											NO	89.36650882	89.36650884	89.36650882	0	89.36650882	0.138280232	0.178722565	42.34273455	44.68325441	0	116.1764615	0	0.178733018	13.40497632	4.468325441	13.40497632	13.40497634	13.40497632	116.1764615	13.40497632	0.090636603	0	0	0	13.40497632	0	13.40497625	0	0	0												4.869	0.215242498	0.269027505	0	1.024381106	0.95092933	0.619780409	0.740667874	1.628095908	0	1.319986012	0	0.073115486	0.332720531	1.444880234	3.419828108	0.122278759	0.169961607	1.574444273	0.731853038	1.965169835	0	0	0	0.401093643	0	0.009293569	0	0	0	0	0	0	0	0	0	0	0	0	0	21.8818	0	2.60347816	4.869	0.215242498	0.269027505	0	1.024381106	0.95092933	0.619780409	0.740667874	1.628095908	0	1.319986012	0	0.073115486	0.332720531	1.444880234	3.419828108	0.122278759	0.169961607	1.574444273	0.731853038	1.965169835	0	0	0	0.401093643	0	0.009293569	0	0	0	0	0	0	0	0	0	0	0	0	0	21.8818	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	4.869	0.215242498	0.269027505	0	1.024381106	0.95092933	0.619780409	0.740667874	1.628095908	0	1.319986012	0	0.073115486	0.332720531	1.444880234	3.419828108	0.122278759	0.169961607	1.574444273	0.731853038	1.965169835	0	0	0	0.401093643	0	0.009293569	0	0	0	0	0	0	0	0	0	0	0	0	0	21.8818
H9302_007_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	P	V	Coin	V	T	V	V	V	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	YES	624.1226144	10.7414085	631.3352283	0	121.6430619	5.576667958	3.496186403	156.8934959	236.7194521	0	86.468304	0	0.326738746	718.8194894	2731.54847	2393.481291	113.3356227	111.3514466	122.717132	743.5639235	19.28620467	0	0	0	359.7907837	0	12.33568401	0	0	0											3350	$250/Day for IP Medical; $250/Day for IP Surgical;	$250/Days 1-10 for IP Psych; $250/Days 1-10 for IP Substance Abuse;	$100/Days 1-30 for SNF	No Cost-Sharing	$150/Run for Ambulance	25% Coinsurance for DME	25% Coinsurance for Prosthetics/Supplies; 25% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $40/Visit for Urgent Care; $40/Visit for Urgent Care - Worldwide;	$250/Case for OP Fac - Surgery; $250/Case for OP Fac - ASC	No Cost-Sharing	$200/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$40/Case for OP Fac - Cardiovascular; $40/Case for OP Fac - Occ Therapy; $40/Case for OP Fac - Physical/Speech Therapy; $40/Case for OP Fac - CORF; $40/Case for OP Fac - Other; $40/Visit for Prof - CORF; $40/Visit for Prof - CORF; $50/Visit for partial hospitalization services;	$15/Visit for PCP - Office Visits; $15/Consult for PCP - Consults; 20% Coinsurance for PCP - Tx Injections;	$40/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Tx Injections; $40/Consult for Speclst - Consults; $15/Service for diabetic foot care;$40/Service for other medically necessary podiatry services;	$40/Visit for OP Psych - Non-Physician; $40/Visit for OP Psych - Psychiatrist; $40/Visit for OP Substance Abuse;	$40/Visit for PT/ST (PCP); $40/Visit for Occ Therapy (PCP); $40/Visit for PT/ST (Specialist); $40/Visit for Occ Therapy (Specialist);	$200/Procedure for Prof Radiology (Office);	$25/Visit for Chiropractor; $40/Exam for Vision Exams; $40/Exam for Hearing/Speech Exams; $5/Service for Nutritional Therapy for Diabetes & Renal Dialysis;$15/Service for all Other Health Care Professional primary care services;$40/Service for all non-primary care Other Health Care Professional physician services;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$40/Exam for Vision (Refractions)	No Cost-Sharing	$40/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											250	250	100	0	150	0.25	0.25	49.12948256	250	0	200	0	0.2	40	15	40	40	40	200	33.410116	0.2	0	0	0	40	0	40	0	0	0											NO	240.302639	240.302639	96.1210556	0	144.1815834	0.240302639	0.240302639	47.22377725	240.302639	0	192.2421112	0	0.192242111	38.44842224	14.41815834	38.44842224	38.44842224	38.44842225	192.2421112	32.11415618	0.192242111	0	0	0	38.44842224	0	38.44842222	0	0	0												12.4982	0.215099068	5.057050715	0	1.46155744	1.340088027	0.840142819	0.617425292	4.740359088	0	1.385237443	0	0.062812946	2.303122937	3.281991529	7.668798274	0.363131323	0.356773953	1.965950045	1.989910664	3.707620704	0	0	0	1.152782331	0	0.039523966	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0476	0	2.06	12.4982	0.215099068	5.057050715	0	1.46155744	1.340088027	0.840142819	0.617425292	4.740359088	0	1.385237443	0	0.062812946	2.303122937	3.281991529	7.668798274	0.363131323	0.356773953	1.965950045	1.989910664	3.707620704	0	0	0	1.152782331	0	0.039523966	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0476	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	12.4982	0.215099068	5.057050715	0	1.46155744	1.340088027	0.840142819	0.617425292	4.740359088	0	1.385237443	0	0.062812946	2.303122937	3.281991529	7.668798274	0.363131323	0.356773953	1.965950045	1.989910664	3.707620704	0	0	0	1.152782331	0	0.039523966	0	0	0	0	0	0	0	0	0	0	0	0	0	51.0476
H9302_008_0	2010	4	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	P	P	V	Coin	V	T	V	V	V	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	YES	815.8818202	18.11015869	951.9287713	0	295.9906444	13.26412146	8.041597767	602.0827318	637.9225756	0	224.6906195	0	0.717871775	1679.953504	4661.80876	4118.047571	227.5045788	255.5981846	250.1834651	1016.796316	34.75580758	0	0	0	341.5765102	0	11.71119464	0	0	0											1000	$100/Days 1-5 for IP Medical; $100/Days 1-5 for IP Surgical;	$100/Days 1-5 for IP Psych; $100/Days 1-5 for IP Substance Abuse;	$100/Days 11-21 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $15/Visit for Urgent Care; $15/Visit for Urgent Care - Worldwide;	$50/Case for OP Fac - Surgery; $50/Case for OP Fac - ASC	No Cost-Sharing	$130/Case for OP Fac - CT/MRI/PET	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Fac; 20% Coinsurance for Renal Dialysis - Prof	$15/Case for OP Fac - Cardiovascular; $15/Case for OP Fac - Occ Therapy; $15/Case for OP Fac - Physical/Speech Therapy; $15/Case for OP Fac - CORF; $15/Case for OP Fac - Other; $15/Visit for Prof - CORF; $15/Service for Prof - CORF; $50/Visit for partial hospitalization services;	$5/Visit for PCP - Office Visits; $5/Consult for PCP - Consults; 20% Coinsurance for PCP - Tx Injections;	$15/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Tx Injections; $15/Consult for Speclst - Consults; $5/Service for diabetic foot care;$15/Service for other medically necessary podiatry services;	$15/Visit for OP Psych - Non-Physician; $15/Visit for OP Psych - Psychiatrist; $15/Visit for OP Substance Abuse;	$15/Visit for PT/ST (PCP); $15/Visit for Occ Therapy (PCP); $15/Service for PT/ST (Specialist); $15/Service for Occ Therapy (Specialist);	$130/Procedure for Prof Radiology (Office);	$15/Visit for Chiropractor; $15/Exam for Vision Exams; $15/Exam for Hearing/Speech Exams; $5/Service for Nutritional Therapy for Diabetes & Renal Dialysis;$5/Service for all Other Health Care Professional primary care services;$15/Service for all non-primary care Other Health Care Professional physician services;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	No Cost-Sharing	$15/Exam for Routine Hearing Exams	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											100	100	100	0	100	0.2	0.2	48.67045962	50	0	130	0	0.2	15	5	15	15	15	130	15	0.2	0	0	0	15	0	15	0	0	0											NO	89.33046313	89.33046312	89.33046313	0	89.33046313	0.178660926	0.178660926	43.47754699	44.66523157	0	116.1296021	0	0.178660926	13.39956947	4.466523157	13.39956947	13.39956947	13.39956947	116.1296021	13.39956947	0.178660926	0	0	0	13.39956947	0	13.39956946	0	0	0												6.0736	0.134815739	7.086353168	0	2.203415113	2.369780226	1.436719306	2.181423356	2.374413297	0	2.174436019	0	0.128255636	1.875887808	1.735173065	4.598338709	0.254038617	0.285408803	2.421142187	1.135386072	6.209504776	0	0	0	0.381414848	0	0.013077081	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0726	0	5.383421173	6.0736	0.134815739	7.086353168	0	2.203415113	2.369780226	1.436719306	2.181423356	2.374413297	0	2.174436019	0	0.128255636	1.875887808	1.735173065	4.598338709	0.254038617	0.285408803	2.421142187	1.135386072	6.209504776	0	0	0	0.381414848	0	0.013077081	0	0	0	0	0	0	0	0	0	0	0	0	0	45.0726	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	20% Coinsurance for Renal Dialysis - Prof	$50/Visit for Prof - CORF; $50/Visit for Prof - CORF;	$50/Visit for PCP - Office Visits; $50/Consult for PCP - Consults; 20% Coinsurance for PCP - Tx Injections;	$50/Visit for Speclst - Office Visits; 20% Coinsurance for Speclst - Tx Injections; $50/Consult for Speclst - Consults; $50/Procedure for Speclst - Cardio;	$50/Visit for OP Psych - Non-Physician; $50/Visit for OP Psych - Psychiatrist; $50/Visit for OP Substance Abuse;	$50/Visit for PT/ST (PCP); $50/Visit for Occ Therapy (PCP); $50/Visit for PT/ST (Specialist); $50/Visit for Occ Therapy (Specialist);	$130/Procedure for Prof Radiology (Office);	$50/Visit for Chiropractor; $50/Exam for Vision Exams; $50/Exam for Hearing/Speech Exams;	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0.0084	0	0	0	0	0.0051	0.0575	2.7002	4.3893	0.1503	0.5128	0.472	1.0809	0	0	0	0	0	0	0	0	0	0											9.3766	0	0	6.0736	0.134815739	7.086353168	0	2.203415113	2.369780226	1.436719306	2.189859779	2.374413297	0	2.174436019	0	0.133346149	1.933420179	4.435348309	8.987670273	0.404314862	0.798221382	2.893143506	2.216286715	6.209504776	0	0	0	0.381414848	0	0.013077081	0	0	0	0	0	0	0	0	0	0	0	0	0	54.4491
H9302_801_0	2010	1	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	V	V	V	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	NO	287.17481	3.75594507	49.77573815	0	9.922199846	11.27032473	1.542073686	23.96272506	79.72787553	9.138825703	18.12793431	0	0.068022975	14.41086586	52.85749004	116.2361032	0.723492229	5.368927511	35.63686223	27.696962	37.13398788	0.155502835	0	0	0	0	0	0	0	0												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing											0.072140506	0.072140506	0.142892862	0	0.233	0.233	0.233	0.235333006	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.239485482	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072140506	0.072140506	0.142892862	0	0.233	0.233	0.233	0.235333006	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.239485482	0.233	0.233	0	0	0	0	0	0	0	0												20.7169	0.270955779	7.112597664	0	2.311872564	2.625985663	0.359303169	5.639220124	18.576595	2.129346389	4.223808695	0	0.015849353	3.357731746	12.31579518	27.08301205	0.168573689	1.25096011	8.303388899	6.633020299	8.652219175	0.03623216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7834	0	0	20.7169	0.270955779	7.112597664	0	2.311872564	2.625985663	0.359303169	5.639220124	18.576595	2.129346389	4.223808695	0	0.015849353	3.357731746	12.31579518	27.08301205	0.168573689	1.25096011	8.303388899	6.633020299	8.652219175	0.03623216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7834	NO																																																																																		0	0	0	20.7169	0.270955779	7.112597664	0	2.311872564	2.625985663	0.359303169	5.639220124	18.576595	2.129346389	4.223808695	0	0.015849353	3.357731746	12.31579518	27.08301205	0.168573689	1.25096011	8.303388899	6.633020299	8.652219175	0.03623216	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	131.7834
H9313_007_0	2010	8	N/A																															A	A	A	V	T	Coin	Coin	V	V	Coin	V	V	Coin	V	V	V	V	V	V	V	Coin	P	T	P	P	P	P	P	O	O											16.261	0.2508	2.8572	0.9338	0.3213	0.7958	0.7077	1.1986	2.7859	0.6705	1.8506	0.6332	0.0072	1.6878	2.7458	7.2233	0.1356	0.9104	1.6426	0.3025	1.4962	0.0031																			45.421	YES	222.8755993	4.511964284	71.80294402		279.950838	8.748982727	7.779744206	246.5712986	212.5052403		623.5749109	102.1074872		21.01743734	3112.975628	4080.617369	254.958506	996.202376																							3400	1a: $250 per Admit	1b: $250 per Admit	2: $100 per Admit	6: $0	10a: $50	11a: 20%	"11b, 11c:20%"	"4a: $50, 4b: $25"	"9a: $100, 9b: $100"	8a: 0%	8b: $20	9a: $100	12: 0%	"3, 9c, 9d: $20; 5, 13a: $0"	"7a: $15, 14: $0"	"7b, 7d, 7f, 7g, 17a, 18a: $20; 14: $0"	"7e,7h: $20"	"7c, 7i: $20"					10b: n/c	16: n/c	17a: n/c	17b: n/c	18a: n/c	18b: n/c	14a: n/c												250	250	100		50	0.2	0.2	47.26641139	100		20	100		20	15	20	20	20																							YES	228.7554674	228.7554674	91.50218697		45.75109348	0.183004374	0.183004374	43.24980012	91.50218697		18.30043739	91.50218697		18.30043739	13.72532804	18.30043739	18.30043739	18.30043739																							3400	4.2487	0.086011375	0.547510534	0	1.06733808	1.601102106	1.423727218	0.888679948	1.620391186	0	0.950974468	0.778588198	0	0.032052358	3.560550974	6.223090223	0.388821015	1.519244934	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	24.9368	500	2.315877342	20.5096	0.336855809	3.404747247	0.933790769	1.388629084	2.396948534	2.131407394	2.087286157	4.406307259	0.670475143	2.801613514	1.411826038	0.007198395	1.719852911	6.306385903	13.44638247	0.524385125	2.429670418	1.642582777	0.302518793	1.496203086	0.003083691	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.3578	NO	0.2	0.2	0.2	0.2	0.2	0.2	0.2	4a: $50	0.2	0.2	0.2	0.2	12: 0%	0.2	0.2	0.2	0.2	0.2	0.2	0.2; 15: $0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2												7.8102	0.031	1.2225	0.189	0.5715	0.1856	0.1519	0.1423	1.071	0.1972	0.5846	0.0382	0.0004	0.4083	0.897	2.8079	0.0689	0.4477	0.887	0.0453	0.2551	0.0022																			18.0147	500	14.10904937	28.3198	0.367867631	4.627294301	1.122760284	1.960166797	2.582557514	2.283295386	2.229590332	5.477308733	0.867673219	3.386168111	1.450045535	0.007574559	2.128190807	7.203337683	16.25423327	0.593285509	2.877409097	2.529541409	0.347814794	1.751302357	0.00527828	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.3725
H9313_012_1	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	P	T	P	P	P	P	P	O	O																																																			0	YES	316.1928316	3.839274352	90.99605797		246.2765538	11.86240378	11.78862465	281.9436443	279.0826701			93.59434176		62.22509245	3597.460574	5393.156216	332.4742913	1201.715227							86.02540757		148.7522673														3400	1a: $250 per Admit	1b: $250 per Admit	2: $100 per Admit	6: $0	10a: $50	11a: 20%	"11b, 11c:20%"	"4a: $50, 4b: $30"	"9a: $100, 9b: $75"	8a: 0%	8b: 0%	9a: $100	12: 0%	"3, 9c, 9d: $20; 5, 13a: $0"	"7a: $10, 14: $0"	"7b, 7d, 7f, 7g, 17a, 18a: $20; 14: $0"	"7e,7h: $20"	"7c, 7i: $20"					10b: n/c	16: n/c	17a: $20	17b: $40 Max. Benefit	18a: $20	18b: $250 every 3 years Max. Benefit	14a: n/c												250	250	100		50	0.2	0.2	47.82470584	96.00814336			100		20	10	20	20	20							20		20														YES	234.3559142	234.3559142	93.74236569		46.87118284	0.187484731	0.187484731	47.82204269	90.00030484			93.74236569		18.74847314	9.374236569	18.74847314	18.74847314	18.74847314							18.74847314		18.74847314														3400	6.1751	0.074979721	0.710848812	0	0.961939449	2.224019587	2.210187126	1.123593416	2.093127115	0	0	0.731146251	0	0.09721879	2.810287205	8.426120371	0.519448777	1.877527137	0	0	0	0	0	0	0.134403754	0	0.232406491	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4024	0	1.954525907	6.1751	0.074979721	0.710848812	0	0.961939449	2.224019587	2.210187126	1.123593416	2.093127115	0	0	0.731146251	0	0.09721879	2.810287205	8.426120371	0.519448777	1.877527137	0	0	0	0	0	0	0.134403754	0	0.232406491	0	0	0	0	0	0	0	0	0	0	0	0	0	30.4024	NO	0.2	0.2	0.2	0.2	0.2	0.2	0.2	4a: $50	0.2	0.2	0.2	0.2	12: 0%	0.2	0.2	0.2	0.2	0.2	0.2	0.2	15: $0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2												7.5303	0.225	1.5783	0.3143	0.8571	0.2798	0.3785	0.1521	1.033	0.3025	0.5834	0.1929		1.1991	1.6648	4.5776	0.1804	0.4635	0.8467	0.0826		0.0267			0.045		0.0031	0.0168													22.5336	0	0	13.7054	0.29999491	2.289159557	0.314320925	1.81908401	2.503814283	2.588704336	1.275648537	3.126171353	0.302520358	0.583444101	0.924037405	0	1.296327113	4.475092037	13.00369958	0.699834596	2.341044357	0.846678901	0.082615782	0	0.026747404	0	0	0.179411134	0	0.235458479	0.016773687	0	0	0	0	0	0	0	0	0	0	0	0	52.936
H9313_012_2	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	V	V	Coin	P	T	P	P	P	P	P	O	O																																																			0	YES	342.2977701	3.88441936	91.93001381		249.2893774	11.7063682	11.63494722	285.6816825	282.882354			94.85411917		63.06111999	3646.712386	5441.836266	336.638886	1217.583028							78.01750707		134.9052726														3400	1a: $250 per Admit	1b: $250 per Admit	2: $100 per Admit	6: $0	10a: $50	11a: 20%	"11b, 11c:20%"	"4a: $50, 4b: $30"	"9a: $100, 9b: $75"	8a: 0%	8b: 0%	9a: $100	12: 0%	"3, 9c, 9d: $20; 5, 13a: $0"	"7a: $10, 14: $0"	"7b, 7d, 7f, 7g, 17a, 18a: $20; 14: $0"	"7e,7h: $20"	"7c, 7i: $20"					10b: n/c	16: n/c	17a: $20	17b: $40 Max. Benefit	18a: $20	18b: $250 every 3 years Max. Benefit	14a: n/c												236.9476969	250	99.98594066		50	0.2	0.2	47.82458478	96.00691995			100		20	10	20	20	20							20		20														YES	221.8444798	234.0648197	93.6127647		46.81296394	0.187251856	0.187251856	47.82458478	89.88736964			93.62592788		18.72518558	9.362592788	18.72518558	18.72518558	18.72518558							18.72518558		18.72518558														3400	6.3281	0.07576716	0.717151896	0	0.972497886	2.192039171	2.178665458	1.138550654	2.11896256	0	0	0.740067077	0	0.098402598	2.845223591	8.491616163	0.525302134	1.89995568	0	0	0	0	0	0	0.121741025	0	0.210510522	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6545	0	2.009453584	6.3281	0.07576716	0.717151896	0	0.972497886	2.192039171	2.178665458	1.138550654	2.11896256	0	0	0.740067077	0	0.098402598	2.845223591	8.491616163	0.525302134	1.89995568	0	0	0	0	0	0	0.121741025	0	0.210510522	0	0	0	0	0	0	0	0	0	0	0	0	0	30.6545	NO	0.2	0.2	0.2	0.2	0.2	0.2	0.2	4a: $50	0.2	0.2	0.2	0.2	12: 0%	0.2	0.2	0.2	0.2	0.2	0.2	0.2	15: $0	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2	0.2												7.1756	0.2133	1.4912	0.2975	0.8126	0.2653	0.359	0.1481	0.98	0.2869	0.5535	0.183		1.1494	1.5905	4.3534	0.171	0.4391	0.8031	0.0784		0.0254			0.0552	0.0058	0.0195	0.0186													21.4755	0	0	13.5037	0.289056173	2.208357184	0.297469252	1.785129223	2.45737688	2.537661095	1.286665668	3.099007981	0.286929008	0.553477412	0.923034912	0	1.247835771	4.435717281	12.84505442	0.696323937	2.339020041	0.803064635	0.078360071	0	0.025365556	0	0	0.176958033	0.005779075	0.230041193	0.018642242	0	0	0	0	0	0	0	0	0	0	0	0	52.13
H9313_801_0	2010	3	N/A																															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																																																			0	NO	271.4703673	1.448802259	34.97537078		3.268517759	15.56754488	12.771667	13.75465942	49.54799107	14.03800419	23.27870692	9.149913616	1.799728054	26.82479936	38.24415771	57.33057858	0.873851371	4.993749392	29.7482455	59.71733209	30.52567366	5.033797983																				Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing											0.080408499	0.080408499	0.169094332		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080408499	0.080408499	0.169094332		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				21.8285	0.116496014	5.914136969	0	0.761564638	3.627237958	2.97579841	3.204835645	11.54468192	3.270854977	5.423938712	2.131929873	0.419336637	6.250178252	8.910888746	13.35802481	0.203607369	1.163543608	6.931341201	13.91413838	7.112481963	1.17287493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2364	0	0	21.8285	0.116496014	5.914136969	0	0.761564638	3.627237958	2.97579841	3.204835645	11.54468192	3.270854977	5.423938712	2.131929873	0.419336637	6.250178252	8.910888746	13.35802481	0.203607369	1.163543608	6.931341201	13.91413838	7.112481963	1.17287493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2364	NO	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing												4.5538	0.0314	1.0357		1.6853	0.4	0.3661	0.4225	1.1411	0.2621	0.654	0.0962	0.0082	0.901	2.1725	3.4636	0.0766	0.1219	1.1988	3.1182	0.6498	0.2075																			22.5663	0	0	26.3823	0.147927494	6.949825034	0	2.446842405	4.027253031	3.341943569	3.627324981	12.68578418	3.533004088	6.077957981	2.228149875	0.427539252	7.151213758	11.08336779	16.82160528	0.280219668	1.285470258	8.130137277	17.03229616	7.762242932	1.380358976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.8028
H9313_802_0	2010	3	N/A																															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																																																			0	NO	271.4703673	1.448802259	34.97537078		3.268517759	15.56754488	12.771667	13.75465942	49.54799107	14.03800419	23.27870692	9.149913616	1.799728054	26.82479936	38.24415771	57.33057858	0.873851371	4.993749392	29.7482455	59.71733209	30.52567366	5.033797983																				Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing											0.080408499	0.080408499	0.169094332		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080408499	0.080408499	0.169094332		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				21.8285	0.116496014	5.914136969	0	0.761564638	3.627237958	2.97579841	3.204835645	11.54468192	3.270854977	5.423938712	2.131929873	0.419336637	6.250178252	8.910888746	13.35802481	0.203607369	1.163543608	6.931341201	13.91413838	7.112481963	1.17287493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2364	0	0	21.8285	0.116496014	5.914136969	0	0.761564638	3.627237958	2.97579841	3.204835645	11.54468192	3.270854977	5.423938712	2.131929873	0.419336637	6.250178252	8.910888746	13.35802481	0.203607369	1.163543608	6.931341201	13.91413838	7.112481963	1.17287493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2364	NO	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing												4.5538	0.0314	1.0357		1.6853	0.4	0.3661	0.4225	1.1411	0.2621	0.654	0.0962	0.0082	0.901	2.1725	3.4636	0.0766	0.1219	1.1988	3.1182	0.6498	0.2075																			22.5663	0	0	26.3823	0.147927494	6.949825034	0	2.446842405	4.027253031	3.341943569	3.627324981	12.68578418	3.533004088	6.077957981	2.228149875	0.427539252	7.151213758	11.08336779	16.82160528	0.280219668	1.285470258	8.130137277	17.03229616	7.762242932	1.380358976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.8028
H9313_803_0	2010	4	N/A																															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																																																			0	NO	271.4703673	1.448802259	34.97537078		3.268517759	15.56754488	12.771667	13.75465942	49.54799107	14.03800419	23.27870692	9.149913616	1.799728054	26.82479936	38.24415771	57.33057858	0.873851371	4.993749392	29.7482455	59.71733209	30.52567366	5.033797983																				Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing											0.080408499	0.080408499	0.169094332		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.080408499	0.080408499	0.169094332		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				21.8285	0.116496014	5.914136969	0	0.761564638	3.627237958	2.97579841	3.204835645	11.54468192	3.270854977	5.423938712	2.131929873	0.419336637	6.250178252	8.910888746	13.35802481	0.203607369	1.163543608	6.931341201	13.91413838	7.112481963	1.17287493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2364	0	0	21.8285	0.116496014	5.914136969	0	0.761564638	3.627237958	2.97579841	3.204835645	11.54468192	3.270854977	5.423938712	2.131929873	0.419336637	6.250178252	8.910888746	13.35802481	0.203607369	1.163543608	6.931341201	13.91413838	7.112481963	1.17287493	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	120.2364	NO	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing	Medicare Cost Sharing												4.5538	0.0314	1.0357		1.6853	0.4	0.3661	0.4225	1.1411	0.2621	0.654	0.0962	0.0082	0.901	2.1725	3.4636	0.0766	0.1219	1.1988	3.1182	0.6498	0.2075																			22.5663	0	0	26.3823	0.147927494	6.949825034	0	2.446842405	4.027253031	3.341943569	3.627324981	12.68578418	3.533004088	6.077957981	2.228149875	0.427539252	7.151213758	11.08336779	16.82160528	0.280219668	1.285470258	8.130137277	17.03229616	7.762242932	1.380358976	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.8028
H9385_001_0	2010	7	N/A																															Coin	Coin	Coin		Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin			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	NO	582.6600935	15.50908969	331.8381922		58.43230123	59.23781244	18.62189722	29.90342396	29.04905056	6.993590086	13.52252735	0	1.870648149	75.83653062	108.2946685	110.3534617	11.45850003	13.49593227	112.0418267	36.6991406	21.12894689	0.855589109			331.2915877	261.2441826				0.867410514												Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	Medicare FFS Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$25/Exam for Vision (Refractions)	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	20% coins for non-Medicare immunizations											0.078940951	0.078940951	0.132708436		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			25	0				0.2											NO	0.078940951	0.078940951	0.132708436		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			25	0				0.2												45.9957	1.22430229	44.03772752	0	13.61472619	13.8024103	4.338902052	6.967497783	6.76842878	1.62950649	3.150748873	0	0.435861019	17.66991163	25.23265775	25.71235658	2.669830508	3.144552219	26.10574563	8.550899759	4.923044625	0.199352262	0	0	0.690190808	0	0	0	0	0.173482103	0	0	0	0	0	0	0	0	0	0	257.0379	0	0	45.9957	1.22430229	44.03772752	0	13.61472619	13.8024103	4.338902052	6.967497783	6.76842878	1.62950649	3.150748873	0	0.435861019	17.66991163	25.23265775	25.71235658	2.669830508	3.144552219	26.10574563	8.550899759	4.923044625	0.199352262	0	0	0.690190808	0	0	0	0	0.173482103	0	0	0	0	0	0	0	0	0	0	257.0379	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	45.9957	1.22430229	44.03772752	0	13.61472619	13.8024103	4.338902052	6.967497783	6.76842878	1.62950649	3.150748873	0	0.435861019	17.66991163	25.23265775	25.71235658	2.669830508	3.144552219	26.10574563	8.550899759	4.923044625	0.199352262	0	0	0.690190808	0	0	0	0	0.173482103	0	0	0	0	0	0	0	0	0	0	257.0379
H9385_002_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	P	V	V	V	V	V	Coin	V	Coin	V	T	V	V	P	V	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	NO	666.3670747	19.96457308	273.6447824	0	160.1952289	10.30084949	6.457271932	217.7437162	354.3417161	0	5.305717659	0	40.28660342	416.1463052	4070.562595	3557.547747	175.4797771	508.4330635	12.07291712	1113.79846	6.856112075	0	0	0	392.9024939	305.2820498	0	0	0	389												$150/Days 1-5 for IP Medical; $150/Days 1-5 for IP Surgical;	$150/Days Custom for IP Psych; $150/Days Custom for IP Substance Abuse;	$100/Days 21-100 for SNF	No Cost-Sharing	$100/Run for Ambulance	20% Coinsurance for DME	20% Coinsurance for Prosthetics/Supplies; 20% Coinsurance for Prosthetics;	$50/Case for ER - Facility; $50/Case for ER - Worldwide; $30/Visit for Urgent Care; $30/Visit for Urgent Care - Worldwide;	$150/Case for OP Fac - Surgery; $150/Case for OP Fac - ASC	No Cost-Sharing	20% Coinsurance for OP Fac - CT/MRI/PET	No Cost-Sharing	$25/Case for Renal Dialysis - Fac; $25/Procedure for Renal Dialysis - Prof	$30/Case for OP Fac - Cardiovascular; $30/Case for OP Fac - Occ Therapy; $30/Case for OP Fac - Physical/Speech Therapy; $30/Case for OP Fac - CORF; $30/Visit for Prof - CORF; $30/Visit for Prof - CORF;	$10/Visit for PCP - Office Visits; $10/Consult for PCP - Consults;	$30/Visit for Speclst - Office Visits; $30/Consult for Speclst - Consults;	$30/Visit for OP Psych - Non-Physician; $30/Visit for OP Psych - Psychiatrist; $30/Visit for OP Substance Abuse;	$30/Visit for PT/ST (PCP); $30/Visit for Occ Therapy (PCP); $30/Visit for PT/ST (Specialist); $30/Visit for Occ Therapy (Specialist);	20% Coinsurance for Prof Radiology (OP); 20% Coinsurance for Prof Radiology (Office);	$30/Visit for Chiropractor; $10/Exam for Vision Exams; $10/Exam for Hearing/Speech Exams;	20% Coinsurance for Part B Rx	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Exam for Vision (Refractions)	$25/Service for Vision Hardware	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	$15/Service  for IHRB;											150	150	100	0	100	0.2	0.2	48.14512228	150	0	0.2	0	25	30	10	30	30	30	0.2	16.91862033	0.2	0	0	0	15	25	0	0	0	15											NO	150	150	100	0	100	0.2	0.2	48.14512228	150	0	0.2	0	25	30	10	30	30	30	0.2	16.91862033	0.2	0	0	0	15	25	0	0	0	15												8.3296	0.249557164	2.280373187	0	1.334960241	2.060169898	1.291454386	0.873608153	4.429271451	0	1.061143532	0	0.083930424	1.040365763	3.392135496	8.893869368	0.438699443	1.271082659	2.414583425	1.570327773	1.371222415	0	0	0	0.491128117	0.636004271	0	0	0	0.48625	0	0	0	0	0	0	0	0	0	0	43.9997	0	0	8.3296	0.249557164	2.280373187	0	1.334960241	2.060169898	1.291454386	0.873608153	4.429271451	0	1.061143532	0	0.083930424	1.040365763	3.392135496	8.893869368	0.438699443	1.271082659	2.414583425	1.570327773	1.371222415	0	0	0	0.491128117	0.636004271	0	0	0	0.48625	0	0	0	0	0	0	0	0	0	0	43.9997	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	8.3296	0.249557164	2.280373187	0	1.334960241	2.060169898	1.291454386	0.873608153	4.429271451	0	1.061143532	0	0.083930424	1.040365763	3.392135496	8.893869368	0.438699443	1.271082659	2.414583425	1.570327773	1.371222415	0	0	0	0.491128117	0.636004271	0	0	0	0.48625	0	0	0	0	0	0	0	0	0	0	43.9997
H9385_805_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	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	NO	174.6247695	1.495130348	28.62885009	0	7.417260908	10.16729075	6.753392751	10.22027639	38.22303337	3.59779282	12.09344606	0	0.36401923	17.91566176	40.8907643	106.8101922	1.52257704	4.569029801	33.98483941	45.28088494	6.434031177	0.717439405	0	0	0	0	0	0	0	0												FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing		FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing		FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing																			0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												13.785	0.118027012	3.799289923	0	1.728221792	2.368978745	1.573540511	2.381324398	8.905966775	0.838285727	2.817772932	0	0.084816481	4.174349191	9.527548082	24.88677478	0.35476045	1.064583943	7.918467582	10.55044619	1.499129264	0.167163381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5445	0	0	13.785	0.118027012	3.799289923	0	1.728221792	2.368978745	1.573540511	2.381324398	8.905966775	0.838285727	2.817772932	0	0.084816481	4.174349191	9.527548082	24.88677478	0.35476045	1.064583943	7.918467582	10.55044619	1.499129264	0.167163381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5445	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.785	0.118027012	3.799289923	0	1.728221792	2.368978745	1.573540511	2.381324398	8.905966775	0.838285727	2.817772932	0	0.084816481	4.174349191	9.527548082	24.88677478	0.35476045	1.064583943	7.918467582	10.55044619	1.499129264	0.167163381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5445
H9385_807_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	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	NO	174.6247695	1.495130348	28.62885009	0	7.417260908	10.16729075	6.753392751	10.22027639	38.22303337	3.59779282	12.09344606	0	0.36401923	17.91566176	40.8907643	106.8101922	1.52257704	4.569029801	33.98483941	45.28088494	6.434031177	0.717439405	0	0	0	0	0	0	0	0												FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing		FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing		FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing																			0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												13.785	0.118027012	3.799289923	0	1.728221792	2.368978745	1.573540511	2.381324398	8.905966775	0.838285727	2.817772932	0	0.084816481	4.174349191	9.527548082	24.88677478	0.35476045	1.064583943	7.918467582	10.55044619	1.499129264	0.167163381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5445	0	0	13.785	0.118027012	3.799289923	0	1.728221792	2.368978745	1.573540511	2.381324398	8.905966775	0.838285727	2.817772932	0	0.084816481	4.174349191	9.527548082	24.88677478	0.35476045	1.064583943	7.918467582	10.55044619	1.499129264	0.167163381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5445	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.785	0.118027012	3.799289923	0	1.728221792	2.368978745	1.573540511	2.381324398	8.905966775	0.838285727	2.817772932	0	0.084816481	4.174349191	9.527548082	24.88677478	0.35476045	1.064583943	7.918467582	10.55044619	1.499129264	0.167163381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5445
H9385_808_0	2010	3	N/A																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	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	NO	174.6247695	1.495130348	28.62885009	0	7.417260908	10.16729075	6.753392751	10.22027639	38.22303337	3.59779282	12.09344606	0	0.36401923	17.91566176	40.8907643	106.8101922	1.52257704	4.569029801	33.98483941	45.28088494	6.434031177	0.717439405	0	0	0	0	0	0	0	0												FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing		FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing		FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing	FFS Medicare Cost Sharing																			0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.078940951	0.078940951	0.132708436	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												13.785	0.118027012	3.799289923	0	1.728221792	2.368978745	1.573540511	2.381324398	8.905966775	0.838285727	2.817772932	0	0.084816481	4.174349191	9.527548082	24.88677478	0.35476045	1.064583943	7.918467582	10.55044619	1.499129264	0.167163381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5445	0	0	13.785	0.118027012	3.799289923	0	1.728221792	2.368978745	1.573540511	2.381324398	8.905966775	0.838285727	2.817772932	0	0.084816481	4.174349191	9.527548082	24.88677478	0.35476045	1.064583943	7.918467582	10.55044619	1.499129264	0.167163381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5445	NO	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing	No Cost-Sharing												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	13.785	0.118027012	3.799289923	0	1.728221792	2.368978745	1.573540511	2.381324398	8.905966775	0.838285727	2.817772932	0	0.084816481	4.174349191	9.527548082	24.88677478	0.35476045	1.064583943	7.918467582	10.55044619	1.499129264	0.167163381	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5445
H9452_001_0	2010	8	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1529.454053	42.0179131	608.7228138	32.73445152	149.3172012	21.26434736	0.365608002	306.2296237	306.4011699	4382.716887	816.1723826	57.52713726	0.134791792	763.5694639	2611.643877	1950.215173	21.92113482	1215.465765	2859.825574	0	36.18880749	0	0	0	302.4	0	162	0	0	0	91.03050251	15.41173973	1573.160348	294.1514652	447.3666996	0.09637136	3.067989365	13.48387887	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	93.53699457	250	0.2	35	25	35	40	41.99932013	79.22875905	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	133.0548131	66.30380196	117.2313545	0	112.7224563	0.18035593	0.18035593	45.08898251	225.4449126	31.56228776	84.34975825	225.4449126	0.18035593	31.56228776	22.54449126	31.56228776	36.07118601	37.87413222	71.44688262	0	0.18035593	0	0	0	35	0	35	0	0	0	180.3559301	31.56228776	31.56228776	31.56228776	31.56228776	31.56228776	0.18035593	0.18035593	0	0		16.9584	0.232162282	5.946783334	0	1.402616807	3.835151145	0.065939571	1.150631846	5.75638208	11.52738096	5.736995263	1.080766703	0.024310499	2.008333262	4.906515212	5.129437708	0.065893444	3.836225925	17.02713518	0	6.526866033	0	0	0	0.882	0	0.4725	0	0	0	1.368157579	0.040535814	4.137711634	0.773674433	1.176659709	0.000253475	0.553330075	2.431897514	0	0	105.0547		11.29297474	16.9584	0.232162282	5.946783334	0	1.402616807	3.835151145	0.065939571	1.150631846	5.75638208	11.52738096	5.736995263	1.080766703	0.024310499	2.008333262	4.906515212	5.129437708	0.065893444	3.836225925	17.02713518	0	6.526866033	0	0	0	0.882	0	0.4725	0	0	0	1.368157579	0.040535814	4.137711634	0.773674433	1.176659709	0.000253475	0.553330075	2.431897514	0	0	105.0547	YES																																									5000																								0	0	0	0	0													0			16.9584	0.232162282	5.946783334	0	1.402616807	3.835151145	0.065939571	1.150631846	5.75638208	11.52738096	5.736995263	1.080766703	0.024310499	2.008333262	4.906515212	5.129437708	0.065893444	3.836225925	17.02713518	0	6.526866033	0	0	0	0.882	0	0.4725	0	0	0	1.368157579	0.040535814	4.137711634	0.773674433	1.176659709	0.000253475	0.553330075	2.431897514	0	0	105.0547
H9452_002_0	2010	13	N/A	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12			OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	0	0	Ambulatory Surgical Center	Urgent Care	Chiropractic	Podiatric	Vision Exam Diagnostic	Hearing Exam Diagnostic	Diabetes Supplies	Radiation-Chemotherapy	0	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	0	V	0	0	0	V	V	V	V	V	V	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	NO	1380.171995	35.47656069	515.4614787	61.94426171	128.8866058	19.09593659	0.529973293	306.6147367	217.0448399	4011.544995	520.7512437	38.14076211	0.245501914	386.1141839	3287.335911	2292.116467	32.32052983	1052.869426	3920.741869	0	31.06452893	0	0	0	302.4	0	162	0	0	0	146.0405253	5.082517183	721.7772475	264.4140452	376.5406981	0.126058845	2.68860804	17.22346687	0	0		$280/day (days 1-6); $1680 yrly max	$280/day (days 1-6); $1680 yrly max	$130/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$35 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$25 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay		$35 copay				$200 copay	$35 copay	$35 copay	$35 copay	$35 copay	$35 copay	20% coinsurance	20% coinsurance			280	280	130	0	125	0.2	0.2	50	250	35	93.85319126	250	0.2	35	25	35	40	39.0173663	81.7230814	0	0.2	0	0	0	35	0	35	0	0	0	200	35	35	35	35	35	0.2	0.2	0	0	NO	124.27902	37.55121734	117.7227226	0	113.1949256	0.181111881	0.181111881	45.27797024	226.3898512	31.69457917	84.98964002	226.3898512	0.181111881	31.69457917	22.63898512	31.69457917	36.22237619	35.332543	74.00510495	0	0.181111881	0	0	0	35	0	35	0	0	0	181.111881	31.69457917	31.69457917	31.69457917	31.69457917	31.69457917	0.181111881	0.181111881	0	0		14.2939	0.11101567	5.056794057	0	1.215775813	3.458500996	0.09598446	1.156907744	4.094729084	10.59535254	3.688205062	0.719556788	0.044463313	1.019810548	6.201829065	6.053972237	0.097560533	3.100046189	24.17957612	0	5.626155266	0	0	0	0.882	0	0.4725	0	0	0	2.20413952	0.01342402	1.906368843	0.698374324	0.994524914	0.000332949	0.486938859	3.119374481	0	0	101.5881		10.45149059	14.2939	0.11101567	5.056794057	0	1.215775813	3.458500996	0.09598446	1.156907744	4.094729084	10.59535254	3.688205062	0.719556788	0.044463313	1.019810548	6.201829065	6.053972237	0.097560533	3.100046189	24.17957612	0	5.626155266	0	0	0	0.882	0	0.4725	0	0	0	2.20413952	0.01342402	1.906368843	0.698374324	0.994524914	0.000332949	0.486938859	3.119374481	0	0	101.5881	YES																																									5000																								0	0	0	0	0													0			14.2939	0.11101567	5.056794057	0	1.215775813	3.458500996	0.09598446	1.156907744	4.094729084	10.59535254	3.688205062	0.719556788	0.044463313	1.019810548	6.201829065	6.053972237	0.097560533	3.100046189	24.17957612	0	5.626155266	0	0	0	0.882	0	0.4725	0	0	0	2.20413952	0.01342402	1.906368843	0.698374324	0.994524914	0.000332949	0.486938859	3.119374481	0	0	101.5881
H9503_001_0	2010	8	N/A	r.	s.	t.	u.							OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)							Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O		Coin					O	O	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	YES	982.387605	47.658083	680.570749	390.210296	32.171514	10.86479	3.37507	312.041456	366.556283	1369.063683	1001.558019	60.035165	0.065288	806.283242	3018.056009	3362.568126	96.446547	844.160112			25.088961	0		1.65					0.04	0.42	52.786045	0.05	0.55	1.11							6000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $35 DMAM -- OP,8b. $35 Radiology -- FSR,14h. $35 SMAM -- FSR,14h. $35 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$150/Visit:9d. $50 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,8b. $100 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Nutritional benefit 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a							158.7573	140.3991	58.254672	0	100	0.2	0.2	50	150	92.041913	92.886533	100	0.2	114.825704	10	35	35	39.000416			0.2	0		0					0	0	0	0	0	0							NO	145.458677	128.638289	37.902237	0	87.7569	0.175514	0.175514	43.87845	131.63535	80.77313	81.514342	87.7569	0.175514	100.767478	8.77569	30.714915	30.714915	34.225556			0.175514	0		0					0	0	0	0	0	0								11.9081	0.510887855	2.149596152	0	0.235272695	1.906922752	0.592372036	1.140991285	4.020980384	9.21529657	6.803445241	0.439041664	0.011458958	6.770594071	2.207126995	8.606749514	0.246862291	2.407654099	0	0	4.403463901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5768	0	9.126894	11.9081	0.510887855	2.149596152	0	0.235272695	1.906922752	0.592372036	1.140991285	4.020980384	9.21529657	6.803445241	0.439041664	0.011458958	6.770594071	2.207126995	8.606749514	0.246862291	2.407654099	0	0	4.403463901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.5768	YES	$250/Day(Days 1-15)	$250/Day(Days 1-15)	40% Coins(Days 1-7) 40%(Days 8-100)	40% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	$0/Service		0.5					$0: Nurse hotline 14a	$0: Nutritional benefit 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a							7500	3.058	0.1425	0.6696	2.9904	1.066	2.1363	0.6636	0.2281	4.1234	0.7086	1.9691	0.2681	0.0024	1.237	1.9956	3.4358	0.049	0.4442			1.2509	0		0					0	0	0	0	0	0							26.4386	500	6.950895	14.9661	0.653420855	2.819199152	2.99041	1.301289695	4.043242752	1.256005036	1.369071285	8.144367384	9.92388157	8.772496241	0.707188664	0.013869958	8.007558071	4.202700995	12.04257451	0.295813291	2.851869099	0	0	5.654361901	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.0154
H9503_003_0	2010	8	N/A	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O							O	O	P	O	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	NO	185.869088	5.293335	619.192687	355.018728	29.270089	8.102929	2.517118	283.899635	333.497979	1245.593087	911.231346	54.620824	0.048691	733.567652	2745.869126	3059.311018	87.748403	768.028553			18.711273	0							0.04	0.25	48.025474	0.05	0.55	1.11	0.42							$550/Admit:1a	$550/Admit:1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$0-$150/Visit:14h. $25 DMAM -- OP,8b. $25 Radiology -- FSR,14h. $25 SMAM -- FSR,14h. $25 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $25 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$150/Visit:9d. $50 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $40 Partial Hospitalization,7h. $150 Psych -- OP,8b. $100 Rad therapy,3. $50 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$25/Visit:7b, 7d, 7f"	$25/Visit:7e	"$25-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $25 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						550	550	45.891712	0	100	0.2	0.2	50	150	92.041913	88.237234	100	0.2	114.825704	10	25	25	31.66736			0.2	0							0	0	0	0	0	0	0						NO	509.37645	509.37645	32.543695	0	88.4909	0.176982	0.176982	44.24545	132.73635	81.448717	78.081922	88.4909	0.176982	101.610299	8.84909	22.122725	22.122725	28.022732			0.176982	0							0	0	0	0	0	0	0							7.8898	0.224691683	1.679234829	0	0.21584471	1.43407258	0.445484578	1.046772259	3.688942039	8.454329903	5.929224574	0.402787156	0.008617431	6.211502371	2.024870252	5.640024695	0.161769482	1.793521526	0	0	3.311558518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.563	0	6.638337	7.8898	0.224691683	1.679234829	0	0.21584471	1.43407258	0.445484578	1.046772259	3.688942039	8.454329903	5.929224574	0.402787156	0.008617431	6.211502371	2.024870252	5.640024695	0.161769482	1.793521526	0	0	3.311558518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.563	YES	$800/Admit	$800/Admit	40% Coins(Days 1-20) 40%(Days 21-100)	40% Coins	$100/Trip	40% Coins	40% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	$0/Service							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Nutritional benefit 14a						5000	1.7624	0.0502	0.4339	1.7605	0.7656	1.6769	0.5209	0.1638	2.4275	0.4171	1.1592	0.1579	0.0014	0.7282	1.1748	2.0227	0.0288	0.2615			0.6828	0							0	0	0	0	0	0	0						16.1961	0	5.68991	9.6522	0.274881683	2.113146829	1.760473	0.98143171	3.11096058	0.966397578	1.210574259	6.116407039	8.871478903	7.088417574	0.560647156	0.010036431	6.939710371	3.199677252	7.662717695	0.190587482	2.055033526	0	0	3.994381518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.7591
H9503_801_0	2010	3	N/A																															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	NO	225.776481	0.770148	39.201258	12.667323	1.485506	6.868785	3.357548	16.560785	47.155562	10.180314	24.270652	8.579818	0.753793	15.534232	28.829576	63.226164	0.303831	4.705104			20.550017	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																			0.072899936	0.072899936	0.150133918	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.072899936	0.072899936	0.150133918	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				16.4591	0.05614374	5.885438467	0	0.346122898	1.600426905	0.782308684	3.858662905	10.98724595	2.372013162	5.655061916	1.999097594	0.175633769	3.619476056	6.717291208	14.73169621	0.070792623	1.096289232	0	0	4.788153961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2009	0	0	16.4591	0.05614374	5.885438467	0	0.346122898	1.600426905	0.782308684	3.858662905	10.98724595	2.372013162	5.655061916	1.999097594	0.175633769	3.619476056	6.717291208	14.73169621	0.070792623	1.096289232	0	0	4.788153961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2009	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.0639	0.0105	1.0956	0	1.3845	1.0553	0.5159	1.0174	2.6476	0.6254	1.3558	0.527	0.0463	0.9473	1.2657	2.7757	0.0134	0.2353			0.9022	0																			19.4846	0	0	19.523	0.066604881	6.981040736	0	1.730608898	2.655683905	1.298170684	4.876057405	13.63482495	2.997385162	7.010888916	2.526143594	0.221884269	4.566737556	7.982947208	17.50742521	0.084190123	1.331619232	0	0	5.690329961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6855
H9503_802_0	2010	3	N/A																															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	NO	225.776481	0.770148	39.201258	12.667323	1.485506	6.868785	3.357548	16.560785	47.155562	10.180314	24.270652	8.579818	0.753793	15.534232	28.829576	63.226164	0.303831	4.705104			20.550017	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																			0.072900439	0.072900439	0.150134603	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.072900439	0.072900439	0.150134603	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				16.4592	0.056144127	5.885465324	0	0.346122898	1.600426905	0.782308684	3.858662905	10.98724595	2.372013162	5.655061916	1.999097594	0.175633769	3.619476056	6.717291208	14.73169621	0.070792623	1.096289232	0	0	4.788153961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2011	0	0	16.4592	0.056144127	5.885465324	0	0.346122898	1.600426905	0.782308684	3.858662905	10.98724595	2.372013162	5.655061916	1.999097594	0.175633769	3.619476056	6.717291208	14.73169621	0.070792623	1.096289232	0	0	4.788153961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2011	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.0639	0.0105	1.0956	0	1.3845	1.0553	0.5159	1.0174	2.6476	0.6254	1.3558	0.527	0.0463	0.9473	1.2657	2.7757	0.0134	0.2353			0.9022	0																			19.4846	0	0	19.5231	0.06660534	6.981072593	0	1.730608898	2.655683905	1.298170684	4.876057405	13.63482495	2.997385162	7.010888916	2.526143594	0.221884269	4.566737556	7.982947208	17.50742521	0.084190123	1.331619232	0	0	5.690329961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6857
H9503_803_0	2010	3	N/A																															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	NO	225.776481	0.770148	39.201258	12.667323	1.485506	6.868785	3.357548	16.560785	47.155562	10.180314	24.270652	8.579818	0.753793	15.534232	28.829576	63.226164	0.303831	4.705104			20.550017	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																			0.072900439	0.072900439	0.150134603	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.072900439	0.072900439	0.150134603	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																				16.4592	0.056144127	5.885465324	0	0.346122898	1.600426905	0.782308684	3.858662905	10.98724595	2.372013162	5.655061916	1.999097594	0.175633769	3.619476056	6.717291208	14.73169621	0.070792623	1.096289232	0	0	4.788153961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2011	0	0	16.4592	0.056144127	5.885465324	0	0.346122898	1.600426905	0.782308684	3.858662905	10.98724595	2.372013162	5.655061916	1.999097594	0.175633769	3.619476056	6.717291208	14.73169621	0.070792623	1.096289232	0	0	4.788153961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.2011	NO	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																				3.0639	0.0105	1.0956	0	1.3845	1.0553	0.5159	1.0174	2.6476	0.6254	1.3558	0.527	0.0463	0.9473	1.2657	2.7757	0.0134	0.2353			0.9022	0																			19.4846	0	0	19.5231	0.06660534	6.981072593	0	1.730608898	2.655683905	1.298170684	4.876057405	13.63482495	2.997385162	7.010888916	2.526143594	0.221884269	4.566737556	7.982947208	17.50742521	0.084190123	1.331619232	0	0	5.690329961	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.6857
H9519_001_0	2010	6	N/A																															A	A	A	V	T	Coin	Coin	V	V	P	P	V	V	V	V	V	Coin	V	P	V	Coin	O	T	V	V	V	V	P	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	YES	196.8423735	2.032087543	83.67907102	1285.306716	130.0950938	13.5406377	1.070583732	269.0559647	490.9284309	9344.426846	662.8869817	0	0	1886.192686	6130.964326	3186.207756	2.102704111	895.4233741	961.6292914	1492.886028	24.94164579	512.603966	0	0	450	450	42.30420273	1.370269184	12000	0											3400	1A IP Acute: $425 Per Admit	1B IP Psych: $425 Per Admit	2 SNF: $425 per Admit	6 Home Health: $20	10A Ambulance: $150	11A DME: 25%	"11B Prosthetics/Medical Supplies: 25%, 11C Diabetes Monitoring Supplies: 25%"	"4A ER: $50, 4B Urgent Care: $25"	9B ASC Services: $100	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $25/$75	9A OP Hospital: $25	12 Renal Dialysis: $0	"3 CORF: $25, 5 Partial Hosp: $25, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: $25"	"7A PCP: $10, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $25, 14J Nutrition Therapy: $25"	"7B Chiropractic: $25, 7D Physician Specialist (excl. Radiology): $25, 7F Podiatry: $25"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: $20, 7I Physical and Speech Therapy: $20"	7D Physician Specialist (Radiology): $25	"7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 0% to 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $25, 17A Routine Eye Exams (Medicare Covered): $25"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $5	17B Eye Wear (Medicare Covered): Various	18A Routine Hearing Exams (Non Medicare Covered): $25	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											425	425	425	20	150	0.140963852	0.140963852	49.5	100	0	37.5	25	0	24.5	10	25	0.420310473	20	25	25	0.046989109	25	0	0	5	27.5	35	0	0	0											NO	425	425	425	20	150	0.140963852	0.140963852	49.5	100	0	37.5	25	0	24.5	10	25	0.420310473	20	25	25	0.046989109	25	0	0	5	27.5	35	0	0	0												6.9715	0.071969767	2.963633765	2.142177859	1.626188673	1.908740449	0.150913607	1.109855855	4.091070257	0	2.071521818	0	0	3.850976734	5.109136938	6.637932824	0.883788559	1.49237229	2.003394357	3.110179225	1.171985704	1.067924929	0	0	0.1875	1.03125	0.123387258	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7774	0	0	6.9715	0.071969767	2.963633765	2.142177859	1.626188673	1.908740449	0.150913607	1.109855855	4.091070257	0	2.071521818	0	0	3.850976734	5.109136938	6.637932824	0.883788559	1.49237229	2.003394357	3.110179225	1.171985704	1.067924929	0	0	0.1875	1.03125	0.123387258	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7774	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	6.9715	0.071969767	2.963633765	2.142177859	1.626188673	1.908740449	0.150913607	1.109855855	4.091070257	0	2.071521818	0	0	3.850976734	5.109136938	6.637932824	0.883788559	1.49237229	2.003394357	3.110179225	1.171985704	1.067924929	0	0	0.1875	1.03125	0.123387258	0	0	0	0	0	0	0	0	0	0	0	0	0	49.7774
H9519_003_0	2010	9	N/A																															A	A	A	Coin	Coin	Coin	Coin	V	Coin	P	V	V	V	V	V	V	Coin	V	V	V	Coin	O	T	V	V	V	V	P	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	YES	238.5895843	2.681864964	90.33056172	14.52895979	13.29709572	12.11958225	1.271276977	252.9152655	58.79597097	7967.858825	724.391612	0	0	1019.70862	5950.092066	2998.330964	2.904324472	636.9282784	961.345384	1305.627198	18.02569041	518.7239962	0	0	450	450	32.43628026	1.779640229	12000	0											3400	1A IP Acute: $500 Per Admit	1B IP Psych: $500 Per Admit	2 SNF: $500 Per Admit	6 Home Health: 15%	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: $50, 4B Urgent Care: $50"	9B ASC Services: 20%	8A OP Diagnostic Procedures/Tests: $0	8B OP Radiology: $40/$100	9A OP Hospital: $40	12 Renal Dialysis: $0	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: 45%, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $40, 14J Nutrition Therapy: $40"	"7B Chiropractic: $40, 7D Physician Specialist (excl. Radiology): $40, 7F Podiatry: $40"	"7E Mental Health: 45%, 7H Psychiatric: 45%"	"7C Occupational Therapy: $15, 7I Physical and Speech Therapy: $15"	7D Physician Specialist (Radiology): $40	"7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 0% to 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $40, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: Not Covered	"16A Preventative Dental Services (Non Medicare Covered): Not Covered, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $5	17B Eye Wear (Medicare Covered): Various	18A Routine Hearing Exams (Non Medicare Covered): $40	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: Not Covered, 13C Other 1 CopayNot Covered, 13D Other 2 CopayNot Covered, 13E Other 3 CopayNot Covered"											500	500	500	0.15	0.2	0.144285332	0.144285332	49.5	0.2	0	55	40	0	37.5	25	40	0.409930514	15	40	40	0.048090911	40	0	0	5	27.5	40	0	0	0											NO	500	500	500	0.15	0.2	0.144285332	0.144285332	49.5	0.2	0	55	40	0	37.5	25	40	0.409930514	15	40	40	0.048090911	40	0	0	5	27.5	40	0	0	0												9.9412	0.111744373	3.763773405	2.179343968	2.659419143	1.748677946	0.18342662	1.04327547	11.75919419	0	3.320128222	0	0	3.186589438	12.39602514	9.994436546	1.190571223	0.796160348	3.204484613	4.35209066	0.866871877	1.729079987	0	0	0.1875	1.03125	0.108120934	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7534	0	0	9.9412	0.111744373	3.763773405	2.179343968	2.659419143	1.748677946	0.18342662	1.04327547	11.75919419	0	3.320128222	0	0	3.186589438	12.39602514	9.994436546	1.190571223	0.796160348	3.204484613	4.35209066	0.866871877	1.729079987	0	0	0.1875	1.03125	0.108120934	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7534	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	9.9412	0.111744373	3.763773405	2.179343968	2.659419143	1.748677946	0.18342662	1.04327547	11.75919419	0	3.320128222	0	0	3.186589438	12.39602514	9.994436546	1.190571223	0.796160348	3.204484613	4.35209066	0.866871877	1.729079987	0	0	0.1875	1.03125	0.108120934	0	0	0	0	0	0	0	0	0	0	0	0	0	75.7534
H9519_801_0	2010	1	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	259.7254588	4.166479641	43.66865786	17.21988179	13.66404002	15.14484338	4.162643079	13.72175275	56.07328975	10.55241475	16.17230882	0	0	31.63611221	61.83299984	116.3301177	2.03715469	4.280979068	46.28563587	59.24507028	17.23813029	18.87549895	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0											0.091140309	0.091140309	0.169895793	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.091140309	0.091140309	0.169895793	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.6715	0.379734242	7.419121269	0	3.183721325	3.528748508	0.969895837	3.19716839	13.06507651	2.458712638	3.768147955	0	0	7.371214146	14.40708896	27.10491742	0.474657043	0.997468123	10.78455316	13.80410138	4.016484357	4.397991256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.0003	0	0	23.6715	0.379734242	7.419121269	0	3.183721325	3.528748508	0.969895837	3.19716839	13.06507651	2.458712638	3.768147955	0	0	7.371214146	14.40708896	27.10491742	0.474657043	0.997468123	10.78455316	13.80410138	4.016484357	4.397991256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.0003	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.6715	0.379734242	7.419121269	0	3.183721325	3.528748508	0.969895837	3.19716839	13.06507651	2.458712638	3.768147955	0	0	7.371214146	14.40708896	27.10491742	0.474657043	0.997468123	10.78455316	13.80410138	4.016484357	4.397991256	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	145.0003
H9519_803_0	2010	1	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	254.6251894	4.753663899	40.45519052	15.9058844	14.25121292	11.94259857	1.430091743	12.92473733	60.79873853	10.62727614	16.20381692	0	0	19.72560026	54.8036808	106.4687749	1.920773967	2.929225046	42.27969624	48.85037445	18.00248435	15.48470356	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0											0.090981706	0.090981706	0.171586748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.090981706	0.090981706	0.171586748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.1662	0.432496452	6.941574575	0	3.32053261	2.782625467	0.333211376	3.011463798	14.16610608	2.476155341	3.775489343	0	0	4.59606486	12.76925763	24.80722454	0.447540334	0.682509436	9.851169225	11.38213725	4.194578852	3.60793593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.7443	0	0	23.1662	0.432496452	6.941574575	0	3.32053261	2.782625467	0.333211376	3.011463798	14.16610608	2.476155341	3.775489343	0	0	4.59606486	12.76925763	24.80722454	0.447540334	0.682509436	9.851169225	11.38213725	4.194578852	3.60793593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.7443	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.1662	0.432496452	6.941574575	0	3.32053261	2.782625467	0.333211376	3.011463798	14.16610608	2.476155341	3.775489343	0	0	4.59606486	12.76925763	24.80722454	0.447540334	0.682509436	9.851169225	11.38213725	4.194578852	3.60793593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.7443
H9519_804_0	2010	1	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	254.6251894	4.753663899	40.45519052	15.9058844	14.25121292	11.94259857	1.430091743	12.92473733	60.79873853	10.62727614	16.20381692	0	0	19.72560026	54.8036808	106.4687749	1.920773967	2.929225046	42.27969624	48.85037445	18.00248435	15.48470356	0	0	0	0	0	0	0	0												Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	Medicare Traditional Cost Sharing	0	0	0	0	0	0	0	0											0.090981706	0.090981706	0.171586748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.090981706	0.090981706	0.171586748	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												23.1662	0.432496452	6.941574575	0	3.32053261	2.782625467	0.333211376	3.011463798	14.16610608	2.476155341	3.775489343	0	0	4.59606486	12.76925763	24.80722454	0.447540334	0.682509436	9.851169225	11.38213725	4.194578852	3.60793593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.7443	0	0	23.1662	0.432496452	6.941574575	0	3.32053261	2.782625467	0.333211376	3.011463798	14.16610608	2.476155341	3.775489343	0	0	4.59606486	12.76925763	24.80722454	0.447540334	0.682509436	9.851169225	11.38213725	4.194578852	3.60793593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.7443	NO	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0												0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	0	0	23.1662	0.432496452	6.941574575	0	3.32053261	2.782625467	0.333211376	3.011463798	14.16610608	2.476155341	3.775489343	0	0	4.59606486	12.76925763	24.80722454	0.447540334	0.682509436	9.851169225	11.38213725	4.194578852	3.60793593	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.7443
H9572_001_1	2010	8	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	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	0	0	0	0	0											0	YES	915.7488316	5.829287053	310.2584961	118.1672748	143.9374064	8.354308059	0.122229927	215.227475	143.2445802	7777.352991	735.907596	0	10.81246818	862.9298375	5075.335948	1336.015722	183.4442602	343.9301204	2037.577975	6647.308382	196.0720957	1681.437433	0	0	0	0	0	0	0	0											5000	$200 copay per day (1-5)	$200 copay per day (1-5)	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"20% on contracted DME, 50% on non-contracted DME (PBP Section B-11, #11a)"	"20% on contracted DME, 50% on non-contracted DME (PBP Section B-11, #11a)"	"$50 copay, waived if admitted (PBP Section B-04, #4a); $35 copay (PBP Section B-04, #4b)"	"$150 copay (PBP Section B-09,#9a & #9b)"	"$0 copay JVHL & Quest, $25 copay other network hospital"	"$0 copay therapeutic, $35 low-tech, $100 high-tech"	"$100 copay (PBP Section B-05,#5)"	"$100 copay (PBP Section B-12, #12)"	"$35 copay (PBP Sections B-03, #3); $100 copay (PBP Sections B-09, #9c & 9d)"	"$25 copay (PBP Section B-07, #7a and PBP Section B-14, #14c); no cost-sharing (PBP Section B-14, #14b-#14j)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered											200	200	130	0	50	0.222028636	1.00E-17	47.91543954	150	0	48.525	0	0	70.50562133	24.05979583	33.45893311	35	35	15.42556687	7.697288451	78.51882781	11.82235359	0	0	0	0	0	0	0	0											YES	190.796444	190.796444	124.0176886	0	47.69911099	0.220918493	9.54E-18	45.71047738	143.097333	0	46.29198722	0	0	67.26110914	22.95261743	31.91922728	33.38937769	33.38937769	14.71571653	7.343076324	74.90556565	11.27831512	0	0	0	0	0	0	0	0											5000	14.5601	0.092683937	3.206461796	0	0.572140527	1.845621143	1.17E-18	0.819845886	1.708159783	0	2.838885419	0	0	4.836801498	9.707687029	3.553715791	0.510424141	0.956967724	2.498701658	4.067641066	1.223907603	1.580315102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5801	0	2.577991618	14.5601	0.092683937	3.206461796	0	0.572140527	1.845621143	1.17E-18	0.819845886	1.708159783	0	2.838885419	0	0	4.836801498	9.707687029	3.553715791	0.510424141	0.956967724	2.498701658	4.067641066	1.223907603	1.580315102	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.5801	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	50% coinsurance	50% coinsurance	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered												2.628	0.008	0.415	0.2913	0.0186	0.0725	0.0008	0.0273	0.5151	0.1769	0.3071	0	0.0015	0.1991	0.4124	0.1954	0.0201	0.0311	0.3127	1.9167	0.0377	0.3137	0	1.87	0	0	0	0	0	0											9.7708	500	4.187617145	17.1881	0.100652546	3.621420666	0.291331956	0.590710198	1.91809197	0.000798888	0.847138133	2.223217536	0.176867168	3.146017771	0	0.001512961	5.035918232	10.12010335	3.749069136	0.530562054	0.988027533	2.811357495	5.984371847	1.261646438	1.893966614	0	1.87	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.3509
H9572_001_2	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	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	0	0	0	0	0											0	YES	916.7096021	5.83540293	310.5840081	118.2912517	144.0884204	8.680364218	0.127000378	215.4532839	143.3948673	7785.512708	736.6796836	0	10.82381223	863.8351922	5080.660806	1337.417422	183.6367232	344.2909594	2039.715728	6654.282497	196.2778074	1683.201536	0	0	0	0	0	0	0	0											5000	$200 copay per day (1-5)	$200 copay per day (1-5)	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"20% coinsurance on DME, OOP max of $1000"	"20% coinsurance on DME, OOP max of $1000"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$150 copay (PBP Section B-09,#9a & #9b)"	"$0 copay JVHL & Quest, $25 copay other network hospital"	"$0 copay therapeutic, $35 low-tech, $100 high-tech"	"$100 copay (PBP Section B-05,#5)"	"$100 copay (PBP Section B-12, #12)"	"$100 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered											200	200	130	0	50	0.222028636	1.00E-17	47.91543954	150	0	48.525	0	0	70.50562133	24.05979583	33.5675054	35	35	15.42556687	7.697288451	81.49779578	11.82235359	0	0	0	0	0	0	0	0											YES	190.6600747	190.6600747	123.9290486	0	47.66501869	0.220918493	9.53E-18	45.67780642	142.9950561	0	46.25890063	0	0	67.21303516	22.93621236	31.99991544	33.36551308	33.36551308	14.70519867	7.337827957	77.69187918	11.2702541	0	0	0	0	0	0	0	0											5000	14.565	0.092714863	3.207531719	0	0.572331437	1.917652978	1.21E-18	0.82011945	1.708729757	0	2.83983269	0	0	4.838415429	9.710926263	3.566437033	0.510594458	0.957287042	2.499535417	4.068998345	1.270765975	1.580842417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7277	0	2.622413339	14.565	0.092714863	3.207531719	0	0.572331437	1.917652978	1.21E-18	0.82011945	1.708729757	0	2.83983269	0	0	4.838415429	9.710926263	3.566437033	0.510594458	0.957287042	2.499535417	4.068998345	1.270765975	1.580842417	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.7277	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	50% coinsurance	50% coinsurance	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered												2.6784	0.0081	0.4229	0.2969	0.0183	0.0734	0.0008	0.027	0.5249	0.1804	0.3133	0	0.0015	0.2021	0.4203	0.1991	0.0205	0.0306	0.3189	1.9537	0.0382	0.3197	0	1.87	0	0	0	0	0	0											9.9189	500	4.4651927	17.2434	0.100836276	3.630447661	0.296918412	0.590608542	1.991006855	0.000808645	0.847099915	2.233664034	0.180402326	3.153103893	0	0.001541973	5.04050124	10.13117737	3.765536389	0.531118527	0.987857503	2.818440507	6.022654182	1.308965733	1.900508375	0	1.87	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.6466
H9572_001_3	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	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	0	0	0	0	0											0	YES	803.5797004	5.115263685	272.2552525	103.693087	126.3066618	7.479302352	0.109427923	188.8644833	125.6986991	6824.713033	645.7670325	0	9.488060085	757.2304504	4453.663274	1172.368532	160.9743617	301.8024741	1787.997148	5833.086424	172.0554266	1475.479893	0	0	0	0	0	0	0	0											5000	$200 copay per day (1-5)	$200 copay per day (1-5)	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"20% coinsurance on DME, OOP max of $1000"	"20% coinsurance on DME, OOP max of $1000"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$150 copay (PBP Section B-09,#9a & #9b)"	"$0 copay JVHL & Quest, $25 copay other network hospital"	"$0 copay therapeutic, $35 low-tech, $100 high-tech"	"$100 copay (PBP Section B-05,#5)"	"$100 copay (PBP Section B-12, #12)"	"$100 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered											200	200	130	0	50	0.222028636	1.00E-17	47.91543954	150	0	48.525	0	0	70.50562133	24.05979583	33.5675054	35	35	15.42556687	7.697288451	80.10725089	11.82235359	0	0	0	0	0	0	0	0											YES	192.4642615	192.4642615	125.10177	0	48.11606539	0.220918493	9.62E-18	46.11004844	144.3481962	0	46.69664146	0	0	67.84906172	23.15325419	32.30272569	33.68124577	33.68124577	14.84435169	7.407264688	77.08891444	11.37690277	0	0	0	0	0	0	0	0											5000	12.8884	0.082042121	2.838301165	0	0.5064483	1.652316201	1.05E-18	0.725712539	1.512031707	0	2.512929298	0	0	4.281447964	8.593066488	3.155891592	0.451818087	0.847090275	2.211804873	3.600601258	1.105297172	1.39886594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.364	0	1.855935509	12.8884	0.082042121	2.838301165	0	0.5064483	1.652316201	1.05E-18	0.725712539	1.512031707	0	2.512929298	0	0	4.281447964	8.593066488	3.155891592	0.451818087	0.847090275	2.211804873	3.600601258	1.105297172	1.39886594	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	48.364	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	50% coinsurance	50% coinsurance	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered												2.4922	0.0076	0.3935	0.2763	0.0172	0.07	0.0008	0.0253	0.4884	0.1674	0.2906	0	0.0014	0.1882	0.3913	0.1853	0.0191	0.0287	0.2959	1.8172	0.0365	0.2974	0	1.87	0	0	0	0	0	0											9.3602	500	3.436147722	15.3805	0.089598878	3.231813141	0.276274644	0.523611331	1.722323112	0.000771669	0.751018856	2.000469017	0.167362532	2.803556714	0	0.001434764	4.469688498	8.984353357	3.34114822	0.470915184	0.875797326	2.507658949	5.417835252	1.141750202	1.696306567	0	1.87	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.7242
H9572_001_4	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	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	0	0	0	0	0											0	YES	906.7855859	5.772230652	307.2217211	117.010667	142.5285634	8.870183798	0.129777584	213.1208529	141.8425185	7701.229142	728.7046159	0	10.70663696	854.4835781	5025.659135	1322.938952	181.6487286	340.5637714	2017.634393	6582.245281	194.1529643	1664.979714	0	0	0	0	0	0	0	0											5000	$200 copay per day (1-5)	$200 copay per day (1-5)	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"20% coinsurance on DME, OOP max of $1000"	"20% coinsurance on DME, OOP max of $1000"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$150 copay (PBP Section B-09,#9a & #9b)"	"$0 copay JVHL & Quest, $25 copay other network hospital"	"$0 copay therapeutic, $35 low-tech, $100 high-tech"	"$100 copay (PBP Section B-05,#5)"	"$100 copay (PBP Section B-12, #12)"	"$100 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered											200	200	130	0	50	0.222028636	1.00E-17	47.91543954	150	0	48.525	0	0	70.50562133	24.05979583	33.5675054	35	35	15.42556687	7.697288451	84.19139509	11.82235359	0	0	0	0	0	0	0	0											YES	190.7223088	190.7223088	123.9695007	0	47.68057719	0.220918493	9.54E-18	45.69271628	143.0417316	0	46.27400017	0	0	67.23497441	22.94369905	32.01036064	33.37640404	33.37640404	14.70999864	7.340223124	80.28588625	11.27393286	0	0	0	0	0	0	0	0											5000	14.412	0.091741096	3.173843615	0	0.566320348	1.959587633	1.24E-18	0.811505889	1.690783289	0	2.81000646	0	0	4.787598459	9.608934225	3.528979413	0.50523178	0.947232836	2.473283266	4.026262418	1.298978567	1.564239125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2565	0	2.579580891	14.412	0.091741096	3.173843615	0	0.566320348	1.959587633	1.24E-18	0.811505889	1.690783289	0	2.81000646	0	0	4.787598459	9.608934225	3.528979413	0.50523178	0.947232836	2.473283266	4.026262418	1.298978567	1.564239125	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.2565	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	50% coinsurance	50% coinsurance	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered												2.7079	0.0082	0.4276	0.3002	0.0179	0.0739	0.0008	0.0265	0.5307	0.1825	0.3169	0	0.0016	0.2036	0.4248	0.2013	0.0208	0.03	0.3226	1.9753	0.0385	0.3232	0	1.87	0	0	0	0	0	0											10.0045	500	4.625805528	17.1199	0.09995195	3.601417123	0.30018837	0.584232448	2.033457978	0.000814351	0.838054399	2.221498659	0.1824717	3.126871161	0	0.001558954	4.99116855	10.03377126	3.730271448	0.525981881	0.977192786	2.79584648	6.001531987	1.337447906	1.887425559	0	1.87	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.261
H9572_001_5	2010	7	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	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	0	0	0	0	0											0	YES	904.022712	5.754643314	306.2856511	116.6541486	142.0942949	8.929116292	0.130639811	212.4714976	141.4103403	7677.764362	726.4843348	0	10.67401504	851.8800626	5010.346516	1318.908105	181.0952653	339.5261118	2011.486888	6562.189919	193.561402	1659.906707	0	0	0	0	0	0	0	0											5000	$200 copay per day (1-5)	$200 copay per day (1-5)	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"20% coinsurance on DME, OOP max of $1000"	"20% coinsurance on DME, OOP max of $1000"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$150 copay (PBP Section B-09,#9a & #9b)"	"$0 copay JVHL & Quest, $25 copay other network hospital"	"$0 copay therapeutic, $35 low-tech, $100 high-tech"	"$100 copay (PBP Section B-05,#5)"	"$100 copay (PBP Section B-12, #12)"	"$100 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered											200	200	130	0	50	0.222028636	1.00E-17	47.91543954	150	0	48.525	0	0	70.50562133	24.05979583	33.5675054	35	35	15.42556687	7.697288451	85.00976838	11.82235359	0	0	0	0	0	0	0	0											YES	190.7374553	190.7374553	123.9793459	0	47.68436382	0.220918493	9.54E-18	45.69634503	143.0530915	0	46.27767509	0	0	67.24031397	22.94552115	32.01290279	33.37905467	33.37905467	14.71116686	7.340806059	81.07273447	11.27482819	0	0	0	0	0	0	0	0											5000	14.3692	0.091468835	3.164424557	0	0.564639671	1.972606911	1.25E-18	0.809097572	1.685765529	0	2.801667167	0	0	4.773390239	9.580417664	3.518506414	0.503732397	0.944421721	2.46594327	4.014313626	1.307712679	1.559596912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.127	0	2.568373996	14.3692	0.091468835	3.164424557	0	0.564639671	1.972606911	1.25E-18	0.809097572	1.685765529	0	2.801667167	0	0	4.773390239	9.580417664	3.518506414	0.503732397	0.944421721	2.46594327	4.014313626	1.307712679	1.559596912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	54.127	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	50% coinsurance	50% coinsurance	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"40% coinsurance, no deductible"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered												2.7168	0.0082	0.429	0.3012	0.0178	0.074	0.0008	0.0264	0.5325	0.1831	0.318	0	0.0016	0.204	0.4262	0.202	0.0208	0.0298	0.3237	1.9818	0.0386	0.3243	0	1.87	0	0	0	0	0	0											10.0304	500	4.676425811	17.086	0.099706713	3.593405375	0.301176406	0.582444867	2.046633942	0.000816083	0.835519922	2.218227689	0.183096794	3.119617352	0	0.001564085	4.977413244	10.00664045	3.720460979	0.524550794	0.974202862	2.78961149	5.996113692	1.346263802	1.883847078	0	1.87	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.1573
H9572_001_6	2010	8	N/A																															A	A	D	V	T	Coin	Coin	V	P	P	P	P	P	P	P	P	P	P	P	P	S	P	T	V	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	0	0	0	0	0											0	YES	972.9356742	6.302172585	335.427398	127.7532832	155.6139488	10.3785333	0.151845893	232.6872361	154.8649189	8408.270233	795.6061581	0	11.68960113	932.9327438	5487.059185	1444.396473	198.3256918	371.830544	2202.871113	7186.553736	211.9779271	1817.839608	0	0	0	0	0	0	0	0											5000	$200 copay per day (1-5)	$200 copay per day (1-5)	"$130 for days 21-100 (PBP Section B-02,#2)"	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	"20% coinsurance on DME, OOP max of $1000"	"20% coinsurance on DME, OOP max of $1000"	"$50 copay, waived if admitted (PBP Section B-04,#4a)"	"$150 copay (PBP Section B-09,#9a & #9b)"	"$0 copay JVHL & Quest, $25 copay other network hospital"	"$0 copay therapeutic, $35 low-tech, $100 high-tech"	"$100 copay (PBP Section B-05,#5)"	"$100 copay (PBP Section B-12, #12)"	"$100 copay (PBP Sections B-03, #3; B-09, #9c & #9d)"	"$25 copay (PBP Section B-07,#7a;B-14,#14b & #14c)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"$35 copay (PBP Section B-07,#7b, #7d & #7f)"	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"no cost sharing (PBP B-16, #16a & #16b)"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered											200	200	130	0	50	0.222028636	1.00E-17	47.91543954	150	0	48.525	0	0	70.50562133	24.05979583	33.5675054	35	35	15.42556687	7.697288451	90.22449397	11.82235359	0	0	0	0	0	0	0	0											YES	189.2662565	189.2662565	123.0230667	0	47.31656412	0.220918493	9.46E-18	45.34387934	141.9496924	0	45.92072548	0	0	66.72167504	22.76853744	31.76598043	33.12159488	33.12159488	14.59769648	7.284184851	85.38226108	11.18786303	0	0	0	0	0	0	0	0											5000	15.3453	0.099399051	3.438775597	0	0.613593115	2.292809932	1.44E-18	0.879245163	1.831918966	0	3.044567665	0	0	5.187236281	10.41102604	3.82355584	0.547405268	1.02630172	2.679736991	4.362348821	1.508262893	1.694811713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7863	0	3.248132213	15.3453	0.099399051	3.438775597	0	0.613593115	2.292809932	1.44E-18	0.879245163	1.831918966	0	3.044567665	0	0	5.187236281	10.41102604	3.82355584	0.547405268	1.02630172	2.679736991	4.362348821	1.508262893	1.694811713	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	58.7863	NO	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing  (PBP Section B-06,#6)"	"$50 copay per trip (PBP Section B-10,#10a)"	50% coinsurance	50% coinsurance	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	40% coinsurance after deductible	50% coinsurance after deductible	40% coinsurance after deductible	"no cost sharing (PBP B-15, #15)"	"no cost sharing (PBP B-15, #13a)"	"not covered (PBP B-10, #10b)"	"80% coinsurance, no deductible"	"not covered (PBP B-17, #17a)"	"not covered (PBP B-17, #17b)"	"not covered (PBP B-18, #18a)"	"not covered (PBP B-18, #18b)"	"not covered (PBP B-14, #14a)"	not covered												2.916	0.0088	0.4604	0.3233	0.0181	0.0776	0.0009	0.0271	0.5715	0.1971	0.3422	0	0.0017	0.2177	0.4572	0.2168	0.0223	0.0304	0.3483	2.1277	0.0404	0.348	0	1.87	0	0	0	0	0	0											10.6234	500	5.987793196	18.2613	0.108240848	3.899204973	0.32325563	0.631740516	2.370362473	0.000855035	0.906364567	2.403415896	0.197058667	3.38676284	0	0.001678748	5.404955487	10.86821922	4.040315681	0.569749861	1.056655236	3.028086224	6.490075022	1.548654101	2.042832639	0	1.87	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.4098
H9572_801_0	2010	7	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	258.8732168	0.849516851	53.06290337	31.36137462	7.974128298	17.45013911	0.203073283	15.70711228	51.61669402	11.32697291	25.29911402	0	0.192420715	25.91563084	46.47584798	22.77521799	2.274555362	7.051570492	31.54808318	142.8498722	10.64914705	33.15650537	0	0	0	0	0	0	0	0												FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits											0.07438631	0.07438631	0.167830064	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07438631	0.07438631	0.167830064	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.2566	0.063192424	8.905550474	0	1.857971894	4.065882414	0.047316075	3.659757162	12.02668971	2.639184689	5.894693568	0	0.044834027	6.038341987	10.82887258	5.306625792	0.529971399	1.643015925	7.350703382	33.28402022	2.481251263	7.725465751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.65	0	0	19.2566	0.063192424	8.905550474	0	1.857971894	4.065882414	0.047316075	3.659757162	12.02668971	2.639184689	5.894693568	0	0.044834027	6.038341987	10.82887258	5.306625792	0.529971399	1.643015925	7.350703382	33.28402022	2.481251263	7.725465751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.65	NO	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits												1.0135	0.0033	0.4687	0	0.0978	0.2846	0.0025	0.1926	0.633	0.1736	0.3102	0	0.0024	0.3178	0.5699	0.2793	0.0279	0.0865	0.3869	1.7879	0.1306	0.4066	0	0	0	0	0	0	0	0											7.1756	0	0	20.2701	0.066518341	9.374263657	0	1.955759888	4.350472866	0.049806395	3.85237596	12.65967338	2.81281526	6.204940597	0	0.047193712	6.35614946	11.39881324	5.585921886	0.557864631	1.729490447	7.737582507	35.07188384	2.611843435	8.132069212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.8256
H9572_802_0	2010	7	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	295.2910833	0.770194534	58.09189501	35.08727365	9.186676536	20.87010146	0.245596591	18.07028416	54.46897546	12.61658258	25.40726721	0	0.160702207	27.70575628	49.08539353	22.50398754	4.09196988	6.201703986	32.22107213	147.6491807	10.16571907	33.26437394	0	0	0	0	0	0	0	0												FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits											0.074908323	0.074908323	0.169063696	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.074908323	0.074908323	0.169063696	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												22.1198	0.057693981	9.821230463	0	2.140495633	4.862733641	0.057224006	4.21037621	12.69127128	2.939663742	5.919893259	0	0.037443614	6.455441214	11.43689669	5.243429096	0.953428982	1.444997029	7.507509807	34.4022591	2.368612543	7.750599129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.421	0	0	22.1198	0.057693981	9.821230463	0	2.140495633	4.862733641	0.057224006	4.21037621	12.69127128	2.939663742	5.919893259	0	0.037443614	6.455441214	11.43689669	5.243429096	0.953428982	1.444997029	7.507509807	34.4022591	2.368612543	7.750599129	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	142.421	NO	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits												1.1642	0.003	0.5169	0	0.1127	0.3405	0.003	0.2216	0.668	0.1934	0.3116	0	0.002	0.3398	0.6019	0.276	0.0502	0.0761	0.3951	1.8446	0.1247	0.4079	0	0	0	0	0	0	0	0											7.653	0	0	23.284	0.060730506	10.33813733	0	2.253153298	5.203241414	0.060235795	4.431974958	13.35923293	3.133062672	6.231466588	0	0.039414331	6.795201278	12.03883862	5.519399049	1.003609455	1.521049504	7.902641902	36.24684338	2.493276361	8.158525399	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	150.074
H9572_803_0	2010	7	N/A																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	258.8732168	0.849516851	53.06290337	31.36137462	7.974128298	17.45013911	0.203073283	15.70711228	51.61669402	11.32697291	25.29911402	0	0.192420715	25.91563084	46.47584798	22.77521799	2.274555362	7.051570492	31.54808318	142.8498722	10.64914705	33.15650537	0	0	0	0	0	0	0	0												FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits											0.07438631	0.07438631	0.167830064	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.07438631	0.07438631	0.167830064	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0												19.2566	0.063192424	8.905550474	0	1.857971894	4.065882414	0.047316075	3.659757162	12.02668971	2.639184689	5.894693568	0	0.044834027	6.038341987	10.82887258	5.306625792	0.529971399	1.643015925	7.350703382	33.28402022	2.481251263	7.725465751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.65	0	0	19.2566	0.063192424	8.905550474	0	1.857971894	4.065882414	0.047316075	3.659757162	12.02668971	2.639184689	5.894693568	0	0.044834027	6.038341987	10.82887258	5.306625792	0.529971399	1.643015925	7.350703382	33.28402022	2.481251263	7.725465751	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.65	NO	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits	FFS Medicare Benefits												1.0135	0.0033	0.4687	0	0.0978	0.2846	0.0025	0.1926	0.633	0.1736	0.3102	0	0.0024	0.3178	0.5699	0.2793	0.0279	0.0865	0.3869	1.7879	0.1306	0.4066	0	0	0	0	0	0	0	0											7.1756	0	0	20.2701	0.066518341	9.374263657	0	1.955759888	4.350472866	0.049806395	3.85237596	12.65967338	2.81281526	6.204940597	0	0.047193712	6.35614946	11.39881324	5.585921886	0.557864631	1.729490447	7.737582507	35.07188384	2.611843435	8.132069212	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	140.8256
H9615_002_0	2010	11	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	NO			1031.1151		122.9239126	6.139336156	9.720502622	203.9490151			291.6718004	36.3291184		90.03553941	3361.30508	7624.834925	406.5131471	2022.039865			23.39369739				6.879303371		6.547741777			0.25												$0 Copay	$0 (190 day limit)	$0(day 1-15) $65 (days 16-100)	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	0.0% for OP Surgery and Cardiac Cath.;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$15 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 Copay	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture													29.81552011		35	0.2	0.2	49.93440741			15	15		15	10	15	15	15			0.059178974				15		15			0.5											YES			29.81552011		35	0.2	0.2	49.93440741			15	15		15	10	15	15	15			0.059178974				15		15			0.5											3000	0	0	2.561936084	0	0.358528079	1.227867231	1.944100524	0.848672768	0	0	0.364589751	0.045411398	0	0.112544424	2.801087566	9.531043656	0.508141434	2.527549831	0	0	1.384415004	0	0	0	0.008599129	0	0.008184677	0	0	0.125	0	0	0	0	0	0	0	0	0	0	24.3577	0	0	0	0	2.561936084	0	0.358528079	1.227867231	1.944100524	0.848672768	0	0	0.364589751	0.045411398	0	0.112544424	2.801087566	9.531043656	0.508141434	2.527549831	0	0	1.384415004	0	0	0	0.008599129	0	0.008184677	0	0	0.125	0	0	0	0	0	0	0	0	0	0	24.3577	NO	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20.0% for OP Surgery and Cardiac Cath.;20.0% for ASC	20.00%	"20.0% for MRI, CT, Other Imaging, and Diag Rad.;20.0% for Nuclear Med. and Radiation Therapy"	50.00%	$0 Copay	"$25 Copay for Card. Rehab and OP SA;20.0% for CORF, Chemotherapy; 50.0% for OP MH and Part. Hosp."	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$0 Copay for Preventive Services	50.00%	$25 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$25 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 Copay	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture												2.9643	0.0502	0.4276	0.3155	0.0187	0.0828	0.1311	0.0444	0.331	0.2663	0.1744	0.0689		0.0271	0.366	0.8302	0.0965	0.2202			0.1206				0.0007		0.0007														6.537	0	4.340006996	2.9643	0.050157071	2.989552632	0.3154584	0.377264847	1.310644794	2.075163476	0.893024622	0.330977538	0.266299547	0.539037963	0.114273659	0	0.139679019	3.167051436	10.36120159	0.604636131	2.747700491	0	0	1.504998137	0	0	0	0.009348117	0	0.008897566	0	0	0.125	0	0	0	0	0	0	0	0	0	0	30.8947
H9615_004_0	2010	10	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	NO			1115.184382		132.9923547	7.363842061	11.65928111	220.3722964			315.5620309	39.30476093		97.41016318	3636.622588	8249.369295	439.8097935	2187.660944			28.05962867				6.909493927		6.550774813			0.25												$0 Copay	$0 (190 day limit)	$0(day 1-15) $65 (days 16-100)	$0 Copay	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	0.0% for OP Surgery and Cardiac Cath.;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$15 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 Copay	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture													29.81552011		35	0.2	0.2	49.93929571			15	15		15	10	15	15	15			0.053379522				15		15			0.5											YES			29.81552011		35	0.2	0.2	49.93929571			15	15		15	10	15	15	15			0.053379522				15		15			0.5											3000	0	0	2.770816864	0	0.387894368	1.472768412	2.331856221	0.917103106	0	0	0.394452539	0.049130951	0	0.121762704	3.030518823	10.31171162	0.549762242	2.734576181	0	0	1.497809558	0	0	0	0.008636867	0	0.008188469	0	0	0.125	0	0	0	0	0	0	0	0	0	0	26.712	0	0	0	0	2.770816864	0	0.387894368	1.472768412	2.331856221	0.917103106	0	0	0.394452539	0.049130951	0	0.121762704	3.030518823	10.31171162	0.549762242	2.734576181	0	0	1.497809558	0	0	0	0.008636867	0	0.008188469	0	0	0.125	0	0	0	0	0	0	0	0	0	0	26.712	NO	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20.0% for OP Surgery and Cardiac Cath.;20.0% for ASC	20.00%	"20.0% for MRI, CT, Other Imaging, and Diag Rad.;20.0% for Nuclear Med. and Radiation Therapy"	50.00%	$0 Copay	"$25 Copay for Card. Rehab and OP SA;20.0% for CORF, Chemotherapy; 50.0% for OP MH and Part. Hosp."	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$0 Copay for Preventive Services	50.00%	$25 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$25 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 Copay	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture												3.3484	0.0567	0.4828	0.3563	0.0191	0.0935	0.148	0.0451	0.4336	0.3008	0.1971	0.0778		0.0299	0.3729	0.8458	0.109	0.2243			0.1229				0.0007		0.0007														7.2653	0	5.968438546	3.3484	0.056655995	3.253647629	0.356332801	0.406984795	1.566271584	2.479901189	0.962219306	0.433610497	0.300804365	0.591504259	0.126915795	0	0.151657238	3.403390302	11.15753888	0.658759896	2.95888221	0	0	1.620668711	0	0	0	0.009325287	0	0.008840108	0	0	0.125	0	0	0	0	0	0	0	0	0	0	33.9773
H9615_802_0	2010	4	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	NO				2222.194342	123.729811	5.963080415	9.441434275	205.2635676			293.5840225	36.56729482		90.62581914	3383.342047	7674.823913	409.1782777	2035.296509			22.72208187				6.881719884		6.547984548			0.25												$0 Copay	$0 (190 day limit)	$0(day 1-100)	$0(day 1-20) $15(days 21+)	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	0.0% for OP Surgery and Cardiac Cath.;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$15 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 Copay	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture														3.233912635	35	0.2	0.2	49.93482748			15	15		15	10	15	15	15			0.061327626				15		15			0.5											YES				3.233912635	35	0.2	0.2	49.93482748			15	15		15	10	15	15	15			0.061327626				15		15			0.5											3000	0	0	0	0.598865197	0.360878615	1.192616083	1.888286855	0.85415007	0	0	0.366980028	0.045709119	0	0.113282274	2.819451706	9.593529891	0.511472847	2.544120637	0	0	1.393491332	0	0	0	0.00860215	0	0.008184981	0	0	0.125	0	0	0	0	0	0	0	0	0	0	22.4246	0	0	0	0	0	0.598865197	0.360878615	1.192616083	1.888286855	0.85415007	0	0	0.366980028	0.045709119	0	0.113282274	2.819451706	9.593529891	0.511472847	2.544120637	0	0	1.393491332	0	0	0	0.00860215	0	0.008184981	0	0	0.125	0	0	0	0	0	0	0	0	0	0	22.4246	NO	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20.0% for OP Surgery and Cardiac Cath.;20.0% for ASC	20.00%	"20.0% for MRI, CT, Other Imaging, and Diag Rad.;20.0% for Nuclear Med. and Radiation Therapy"	50.00%	$0 Copay	"$25 Copay for Card. Rehab and OP SA;20.0% for CORF, Chemotherapy; 50.0% for OP MH and Part. Hosp."	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$0 Copay for Preventive Services	50.00%	$25 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$25 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 Copay	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture												2.834	0.048	0.4089	0.3016	0.0186	0.0791	0.1253	0.044	0.367	0.2546	0.1668	0.0658		0.0262	0.3626	0.8225	0.0923	0.2181			0.1195				0.0008		0.0007														6.3563	0	3.975304554	2.834	0.047952812	0.408884335	0.900460107	0.379442349	1.27175581	2.013589967	0.898115073	0.36700163	0.254596447	0.533761743	0.111545081	0	0.139461425	3.18203588	10.41602128	0.603726879	2.762238194	0	0	1.512960874	0	0	0	0.009367556	0	0.008914621	0	0	0.125	0	0	0	0	0	0	0	0	0	0	28.7809
H9615_804_0	2010	4	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	NO				2481.102366	138.1455803	7.942828678	12.57599926	228.7780531			327.7895183	40.82775299		101.1846399	3777.535475	8569.018204	456.8516685	2272.429053			30.26583425				6.924946045		6.55232718			0.25												$0 Copay	$0 (190 day limit)	$0(day 1-100)	$0(day 1-20) $15(days 21+)	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	0.0% for OP Surgery and Cardiac Cath.;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$15 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$15 Copay	$100 allowance	$15 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture														3.233912635	35	0.2	0.2	49.94152611			15	15		15	10	15	15	15			0.051406054				15		15			0.5											YES				3.233912635	35	0.2	0.2	49.94152611			15	15		15	10	15	15	15			0.051406054				15		15			0.5											3000	0	0	0	0.668639024	0.402924609	1.588565736	2.515199853	0.952127093	0	0	0.409736898	0.051034691	0	0.1264808	3.147946229	10.71127276	0.571064586	2.840536317	0	0	1.555847109	0	0	0	0.008656183	0	0.008190409	0	0	0.125	0	0	0	0	0	0	0	0	0	0	25.6832	0	0	0	0	0	0.668639024	0.402924609	1.588565736	2.515199853	0.952127093	0	0	0.409736898	0.051034691	0	0.1264808	3.147946229	10.71127276	0.571064586	2.840536317	0	0	1.555847109	0	0	0	0.008656183	0	0.008190409	0	0	0.125	0	0	0	0	0	0	0	0	0	0	25.6832	NO	20.00%	20.00%	20.00%	20.00%	$35 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20.0% for OP Surgery and Cardiac Cath.;20.0% for ASC	20.00%	"20.0% for MRI, CT, Other Imaging, and Diag Rad.;20.0% for Nuclear Med. and Radiation Therapy"	50.00%	$0 Copay	"$25 Copay for Card. Rehab and OP SA;20.0% for CORF, Chemotherapy; 50.0% for OP MH and Part. Hosp."	$25 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$0 Copay for Preventive Services	50.00%	$25 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$25 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 Copay	$100 allowance	$25 exam Copay	$600 every 3 yrs	No Cost Sharing	50.0% for Accupuncture												3.5024	0.0593	0.505	0.3727	0.0192	0.0978	0.1549	0.0454	0.4536	0.3146	0.2061	0.0814		0.031	0.3756	0.852	0.114	0.2259			0.1238				0.0007		0.0006														7.536	0	6.618994822	3.5024	0.05926206	0.504977933	1.041362439	0.422154911	1.686369871	2.670054601	0.997550146	0.453555734	0.314640778	0.615852613	0.132397486	0	0.157481361	3.523549728	11.56329737	0.685075919	3.066485831	0	0	1.679606448	0	0	0	0.009325315	0	0.008822491	0	0	0.125	0	0	0	0	0	0	0	0	0	0	33.2192
H9670_001_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	NO	344.1529641	9.048381324	1437.842174		154.6624963	9.624667693	7.010319073	344.597333	435.729611		1099.65188			221.1364357	4666.782708	6810.489963	301.9811867	393.6047935			27.98760416	0.150236026					239.5846989															1A: $100/stay - $200 annual max	1B: $100/stay - $200 annual max	"2: $25/day days 1-10, $60/day days 11-60, $0/day days 61-100 - $3200 annual max"	6: $0	10A: $100	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $15/45/37.50 for R30/R90/MO90 supplies"	4A: $50; 4B: $50	9A: $60 - $120 combined max; 9B: $60 - $120 combined max	8A: $0 labs	"8B: $20 x-rays, $50 advanced imaging, $0 ther rad; $200 annual max"		12: $0	3: $0; 5: $0; 7C: $20; 7I: $20; 9C: $30; 9D: $0	7A: $5; 14B: $0; 14C: $5; 14D: $0; 14E: $0; 14F: $0-$60; 14G: $0; 14H: $0; 14I: $0; 14J: $0	7B: $30; 7D: $30; 7F: $30; 7G: $30; 14A: $30; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $30 (Medicare-covered)	7E: $30; 7H: $30	7I: $20 7C: $20			15: 10%	13A: $0; 16B: $30 ( Medicare-covered); 17A: $30 (Medicare-covered)	10B: not covered	16A: routine not covered; 16B: routine not covered	17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)	18a: $30	"18b: $1,000 per 3 yrs combined IN & OON allowance"	14A: $0	13B: not covered											100	100	41.98		100	0.2	0.178885337	50	60		37.61954108			20.40654263	5	30	30	20			0.1	30					30														NO	88.15388808	88.15388808	37.00700222		88.15388808	0.176307776	0.157694379	44.07694404	52.89233285		33.16308814			17.98916075	4.407694404	26.44616642	26.44616642	17.63077762			0.088153888	26.44616642					26.44616642															2.5282	0.066470833	4.434185711	0	1.136175033	1.696903757	1.105487915	1.265733114	1.920562968	0	3.038987684	0	0	0.331504908	1.714146002	15.00927925	0.665520393	0.578296549	0	0	2.467216125	0.000331097	0	0	0	0	0.528008068	0	0	0	0	0	0	0	0	0	0	0	0	0	38.487	0	5.171881269	2.5282	0.066470833	4.434185711	0	1.136175033	1.696903757	1.105487915	1.265733114	1.920562968	0	3.038987684	0	0	0.331504908	1.714146002	15.00927925	0.665520393	0.578296549	0	0	2.467216125	0.000331097	0	0	0	0	0.528008068	0	0	0	0	0	0	0	0	0	0	0	0	0	38.487	YES	1A: 20%	1B: 20%	2: 20%	6: 20%	10A: 20%	11A: 50%	11B: 50%; 11C: 50%	4A: $50; 4B: $50	9A: 20%; 9B: 20%	8A: 20%	8A: 20%; 8B: 20%	9A: 20%; 9B: 20%	12: 20%	3: 20%; 5: 20%; 7C: 20%; 7I: 20%; 9C: $45	7A: $45; 14B: $0; 14C: $0; 14D: 20%; 14E: 20% 14F:20%; 14G: 20%; 14H: 20%; 14I: 50%; 14J: 50%	7B: $45; 7D: $45; 7F: $45; 14B: $0; 14D: 20$; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 50%; 14J: 50%; 18A: $45	7E: $45; 7H: $45	7C: 20%; 7I: 20%	8A: 20%; 8B: 20%	8A: 20%; 7d: 20%	15: 20%	13A: 20%; 16B: $45; 17A: $45		16A: no routine exams; 16B: 20%	17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)	18a: $45	"18b: 50% and $1,000 per 3 yrs combined IN & OON allowance"	14A: 50%												3200	3.9316	0.069	0.6834	0.3831	0.1048	0.2602	0.4107	0.1229	0.659	0.1255	0.3174	0.0779	0.0024	0.4571	1.1944	1.8171	0.0666	0.0445	0.399	0.8736	0.3406	0.0103			0.0013	0.0052	0.0475	0.002	0.093												12.5	250	12.54902304	6.4598	0.135517776	5.117564532	0.383058048	1.24092943	1.957124168	1.516181657	1.388589958	2.579606244	0.125497574	3.356369652	0.077864348	0.002396097	0.788574852	2.908537356	16.82640461	0.732121306	0.62284073	0.399045918	0.87359491	2.807819473	0.010627505	0	0	0.001303541	0.005214165	0.575535054	0.001974217	0.092952588	0	0	0	0	0	0	0	0	0	0	0	50.987
H9670_002_0	2010	6	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	NO	365.2247883	7.52225844	884.7512675		199.6406989	11.15229483	7.083794571	402.6482243	357.6133445		1113.973678			110.1193921	3760.61774	5651.156519	249.9369796	566.1130022			17.06914637						239.5322569															1A: $100/stay - $200 annual max	1B: $100/stay - $200 annual max	"2: $25/day days 1-10, $60/day days 11-60, $0/day days 61-100 - $3200 annual max"	6: $0	10A: $100	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $15/45/37.50 for R30/R90/MO90 supplies"	4A: $50; 4B: $50	9A: $60 - $120 combined max; 9B: $60 - $120 combined max	8A: $0 labs	"8B: $20 x-rays, $50 advanced imaging, $0 ther rad; $200 annual max"		12: $0	3: $0; 5: $0; 7C: $20; 7I: $20; 9C: $30; 9D: $0	7A: $5; 14B: $0; 14C: $5; 14D: $0; 14E: $0; 14F: $0-$60; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $30; 7D: $30; 7F: $30; 7G: $30; 14A: $30, 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $30 (Medicare-covered)"	7E: $30; 7H: $30	7I: $20; 7C: $20			15: 10%	13A: $0; 16B: $30 (Medicare-covered); 17A: $30 (Medicare-covered)	10B: not covered	16A: routine not covered; 16B: routine not covered	17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)	18a: $30	"18b: $1,000 per 3 yrs combined IN & OON allowance"	14A: $0	13B: not covered											100	100	41.98		100	0.2	0.178598181	50	60		36.73939574			20.97998336	5	30	30	20			0.1						30														NO	90.57048088	90.57048088	38.02148788		90.57048088	0.181140962	0.161757232	45.28524044	54.34228853		33.27504739			19.00167182	4.528524044	27.17114427	27.17114427	18.11409618			0.090570481						27.17114427															2.7565	0.056774547	2.803296632	0	1.506796176	2.020137412	1.145855	1.519501804	1.619460629	0	3.088960578	0	0	0.174371046	1.419170655	12.79569909	0.565922811	0.854552114	0	0	1.545960795	0	0	0	0	0	0.542363792	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4154	0	3.583070368	2.7565	0.056774547	2.803296632	0	1.506796176	2.020137412	1.145855	1.519501804	1.619460629	0	3.088960578	0	0	0.174371046	1.419170655	12.79569909	0.565922811	0.854552114	0	0	1.545960795	0	0	0	0	0	0.542363792	0	0	0	0	0	0	0	0	0	0	0	0	0	34.4154	YES	1A: 20%	1B: 20%	2: 20%	6: 20%	10A: 20%	11A: 50%	11B: 50%; 11C: 50%	4A: $50; 4B: $50	9A: 20%; 9B: 20%	8A: 20%	8A: 20%; 8B: 20%	9A: 20%; 9B: 20%	12: 20%	3: 20%; 5: 20%; 7C: 20%; 7I: 20%; 9C: $45	7A: $45; 14B: $0; 14C: $0; 14D: 20%; 14E: 20% 14F:20%; 14G: 20%; 14H: 20%; 14I: 50%; 14J: 50%	7B: $45; 7D: $45; 7F: $45; 14B: $0; 14D: 20$; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 50%; 14J: 50%; 18A: $45	7E: $45; 7H: $45	7C: 20%; 7I: 20%	8A: 20%; 8B: 20%	8A: 20%; 7d: 20%	15: 20%	13A: 20%; 16B: $45; 17A: $45		16A: no routine exams; 16B: 20%	17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)	18a: $45	"18b: 50% & $1,000 per 3 yrs combined IN & OON allowance"	14A: 50%												3200	4.2006	0.0573	0.4189	0.3041	0.1512	0.3176	0.4855	0.1518	0.6248	0.1258	0.3049	0.034	0.0005	0.4682	1.0517	1.5821	0.0572	0.059	0.3905	0.7993	0.2198	0.0056			0.0014	0.0057	0.05	0.0022	0.0979												11.9674	250	10.85403522	6.9572	0.114033761	3.222225355	0.304092484	1.658044914	2.337705861	1.631361626	1.671298502	2.244282227	0.125754928	3.393833481	0.033964935	0.000456222	0.642554521	2.470887034	14.37775474	0.623163395	0.913506554	0.390472699	0.79926697	1.765738768	0.005648708	0	0	0.001429016	0.005716063	0.592363185	0.002164248	0.097899163	0	0	0	0	0	0	0	0	0	0	0	46.3828
H9670_003_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P											23.1826	0.4067	4.0254	2.2726	0.7335	0.8367	1.3206	1.4332	3.8963	0.7419	1.8764	0.4603	0.0142	2.7118	3.3643	6.4104	0.169	0.2642	2.3671	5.1819	2.4332	0.0608			0.0502	0.2007	0.1156	0.076	0.2989												64.9045	YES								284.9560674							3774.902445												218.7558658															1A: $0	1B: $0	2: $0/day days 1-100	6: $0	10A: $0	11A: 0%	"11B: 0% prosthetics, $0 medical supplies; 11C: $0 training"	4A: $50; 4B: $50	9A: $0; 9B: $0	8A: $0 labs	"8B: $0 x-rays, $0 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $0; 7I: $0; 9C: $0; 9D: $0	7A: $15; 14B: $0; 14C: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	7B: $0; 7D: $0; 7F: $0; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $0	7E: $0; 7H: $0	7I: $0			15: 0%	13A: $0; 16B: $0; 17A: $0			17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)	18a: $20	"18b: $1,000 per 3 yrs combined IN & OON allowance"	14A: $0																			50							15												20														YES								45.81910247							13.74573074												18.32764099															0	0	0	0	0	0	0	1.088035938	0	0	0	0	0	0	4.324066049	0	0	0	0	0	0	0	0	0	0	0	0.334106581	0	0	0	0	0	0	0	0	0	0	0	0	0	5.7462	1000	0.524329546	23.1826	0.406714944	4.025382817	2.272643583	0.733479623	0.83674207	1.320590999	2.521282429	3.896277211	0.741944205	1.87636863	0.460335606	0.014165776	2.711768397	7.688360092	6.410435079	0.168958304	0.264228079	2.367135344	5.181940083	2.433165133	0.060780314	0	0	0.050178973	0.200715893	0.449708311	0.07599619	0.29889024	0	0	0	0	0	0	0	0	0	0	0	70.6507	YES	1A: 20%	1B: 20%	2: 20%	6: 20%	10A: 20%	11A: 50%	11B: 50%; 11C: 50%	4A: $50; 4B: $50	9A: 20%; 9B: 20%	8A: 20%	8A: 20%; 8B: 20%	9A: 20%; 9B: 20%	12: 20%	3: 20%; 5: 20%; 7C: 20%; 7I: 20%; 9C: 20%	7A: 20%; 14B: $0; 14C: 20%; 14D: 20%; 14E: 20%; 14F:20%; 14G: 20%; 14H: $20%; 14I: 50%; 14J: 50%	7B: 20%; 7D: 20%; 7F: 20%; 14B: $0; 14D: 20%; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 50%; 14J: 50%; 18A: 20%	7E: 20%; 7H: 20%	7C: 20%; 7I: 20%	8A: 20%; 8B: 20%	8A: 20%; 7d: 20%	15: 20%	13A: 20%; 16B: $20%; 17A: 20%		16A: no routine exams; 16B: 20%	17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)	18a: 20%	"18b: $1,000 per 3 yrs combined IN & OON allowance"	14A: $50%												3400	8.1675	0.1434	1.4195	0.7989	0.2403	0.5404	0.8528	0.3035	1.3718	0.2612	0.6606	0.1621	0.005	0.9547	1.138	2.2034	0.0594	0.0929	0.8321	1.8217	0.7907	0.0214			0.0056	0.0223	0.0376	0.0084	0.193												23.1082	1000	1.402166133	31.3501	0.550140474	5.44490937	3.071511785	0.973780743	1.377107705	2.173424888	2.824770129	5.268030369	1.003158757	2.536977323	0.622404881	0.019153088	3.666494322	8.826362623	8.613825356	0.228349857	0.3571157	3.199275569	7.003627237	3.223908574	0.082176767	0	0	0.055754415	0.223017659	0.487277199	0.084440211	0.491912702	0	0	0	0	0	0	0	0	0	0	0	93.759
H9670_004_0	2010	4	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P											25.4167	0.3461	2.5322	1.8513	1.1041	1.0526	1.6093	1.7771	3.7905	0.7629	1.8495	0.2061	0.0028	2.8494	3.1726	5.7294	0.1262	0.3589	2.377	4.8648	1.6111	0.0343			0.0545	0.2179	0.1255	0.0825	0.3245												64.2295	YES								330.2437305							3000.891663												216.923914															1A: $0	1B: $0	2: $0/day days 1-100	6: $0	10A: $0	11A: 0%	"11B: 0% prosthetics, $0 medical supplies; 11C: $0 training"	4A: $50; 4B: $50	9A: $0; 9B: $0	8A: $0 labs	"8B: $0 x-rays, $0 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $0; 7I: $0; 9C: $0; 9D: $0	7A: $15; 14B: $0; 14C: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	7B: $0; 7D: $0; 7F: $0; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $0	7E: $0; 7H: $0	7I: $0			15: 0%	13A: $0; 16B: $0; 17A: $0			17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)	18a: $20	"18b: $1,000 per 3 yrs combined IN & OON allowance"	14A: $0																			50							15												20														YES								46.46814555							13.94044366												18.58725822															0	0	0	0	0	0	0	1.278817811	0	0	0	0	0	0	3.486146765	0	0	0	0	0	0	0	0	0	0	0	0.336001734	0	0	0	0	0	0	0	0	0	0	0	0	0	5.101	1000	0.38770367	25.4167	0.346099325	2.532185423	1.851322672	1.104083575	1.052613574	1.609262084	3.055918621	3.790544865	0.762905281	1.849543008	0.206051793	0.002767715	2.849359654	6.658723355	5.729408358	0.126226096	0.358883461	2.376972759	4.864782991	1.61107785	0.034268473	0	0	0.054477935	0.217911738	0.461463255	0.082506978	0.324496933	0	0	0	0	0	0	0	0	0	0	0	69.3305	YES	1A: 20%	1B: 20%	2: 20%	6: 20%	10A: 20%	11A: 50%	11B: 50%; 11C: 50%	4A: $50; 4B: $50	9A: 20%; 9B: 20%	8A: 20%	8A: 20%; 8B: 20%	9A: 20%; 9B: 20%	12: 20%	3: 20%; 5: 20%; 7C: 20%; 7I: 20%; 9C: 20%	7A: 20%; 14B: $0; 14C: 20%; 14D: 20%; 14E: 20%; 14F:20%; 14G: 20%; 14H: $20%; 14I: 50%; 14J: 50%	7B: 20%; 7D: 20%; 7F: 20%; 14B: $0; 14D: 20%; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 50%; 14J: 50%; 18A: 20%	7E: 20%; 7H: 20%	7C: 20%; 7I: 20%	8A: 20%; 8B: 20%	8A: 20%; 7d: 20%	15: 20%	13A: 20%; 16B: $20%; 17A: 20%		16A: no routine exams; 16B: 20%	17A: $250 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $250 limit/2 yrs for glasses and exam (combined IN and OON)	18a: 20%	"18b: $1,000 per 3 yrs combined IN & OON allowance"	14A: $50%												3400	8.5216	0.1161	0.8498	0.6193	0.342	0.6384	0.976	0.3678	1.27	0.2556	0.6197	0.069	0.0009	0.9547	1.0068	1.8724	0.0422	0.1201	0.7952	1.6275	0.4983	0.0115			0.0061	0.0242	0.0388	0.0092	0.1968												21.8499	1000	1.078557925	33.9382	0.462246744	3.381961134	2.470618851	1.446116747	1.691030037	2.585289214	3.423760677	5.060534681	1.018510207	2.469216662	0.275087693	0.003695015	3.804013371	7.665507007	7.601805087	0.168453632	0.478940414	3.172142032	6.492303362	2.109334401	0.045749833	0	0	0.060531038	0.242124154	0.500264623	0.09167442	0.521306274	0	0	0	0	0	0	0	0	0	0	0	91.1804
H9670_801_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	NO	341.7269548	8.613929697	1313.376291		159.907255	9.552552707	6.773893716	348.7642192	413.9669266		1082.444665			197.3642318	4423.166299	6488.811111	287.2787382	417.2852488			25.05686405	0.120704931		469.8			239.5744005															1A: $150	1B: $150	"2: $0/day days 1-10, $50/day days 11-50, $0/day days 51-100"	6: $0	10A: $75	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $20 31-day/60 90-day"	4A: $50; 4B: $50	9A: $100; 9B: $100	8A: $0 labs	"8B: $10 x-rays, $50 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $25; 7I: $25; 9C: $25; 9D: $0	7A: $15; 14B: $0; 14C: $15; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $25; 7D: $25; 7F, 14A: $25; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $25"	7E: $25; 7H: $25	7I: $25			15: 20%	13A: $0; 16B: $25; 17A: $25		"16A: $25; 16B: $25 bitewing x-ray, 20% restorative"	17A: $200 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $200 limit/2 yrs for glasses and exam (combined IN and OON)	18A: $25	"18B: $1,000 limit every 3 yrs"	14A: $0												150	150	29.16		75	0.2	0.206959843	50	100		33.27738199			25	15	25	25	25			0.2	25		31.98275862			25														NO	132.1638728	132.1638728	25.69265687		66.08193639	0.176218497	0.182350762	44.05462426	88.10924852		29.3204512			22.02731213	13.21638728	22.02731213	22.02731213	22.02731213			0.176218497	22.02731213		28.17976828			22.02731213															3.7637	0.094870859	2.812010532	0	0.880581755	1.683336481	1.235224681	1.28038972	3.039526235	0	2.644813832	0	0	0.362283628	4.871523234	11.91092231	0.527331536	0.765972702	0	0	4.415482924	0.000221567	0	1.103237928	0	0	0.439765008	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8312	0	5.645308671	3.7637	0.094870859	2.812010532	0	0.880581755	1.683336481	1.235224681	1.28038972	3.039526235	0	2.644813832	0	0	0.362283628	4.871523234	11.91092231	0.527331536	0.765972702	0	0	4.415482924	0.000221567	0	1.103237928	0	0	0.439765008	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8312	YES	1A: 20%	1B: 20%	2: 20%	6: 20%	10A: 20%	11A: 50%	11B: 50%; 11C: 20%	4A: $50; 4B: $50	9A: 20%; 9B: 20%	8A: 20%	8A: 20%; 8B: 20%	9A: 20%; 9B: 20%	12: 20%	3: 20%; 5: 20%; 7C: 20%; 7I: 20%; 9C: 20%; 9D: 20%	7A: 20%; 14B: $0; 14C: 20%; 14D: 20%; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 20%; 14J: 20%	7B: 20%; 7D: 20%; 7F: 20%; 14B: $0; 14D: 20%; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 20%; 14J: 20%; 18A: 20%	7E: 20%; 7H: 20%	7I: 20%	8A: 20%; 8B: 20%	8A: 20%; 7d: 20%	15: 20%	13A: 20%; 16B: 20%; 17A: 20% MC services		16A: 50% routine services; 16B: 50%	17A: $200 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $200 limit/2 yrs for glasses and exam (combined IN and OON)	18A: 50%	18B: 50%	14A: 50%												3400	4.7344	0.0797	0.7579	0.4393	0.1344	0.2959	0.4136	0.175	0.7771	0.1494	0.375	0.0835	0.0024	0.5481	0.6527	1.2221	0.0323	0.056	0.4731	1.0244	0.3801	0.0113		0.1492	0.0027	0.008	0.0412	0.0271	0.1065												13.1524	500	9.431295797	8.498	0.174572042	3.569951096	0.439307384	1.014940366	1.979272008	1.648862427	1.455417305	3.816595302	0.149384737	3.019857928	0.083483792	0.002446167	0.910367021	5.524231935	13.13302695	0.559634675	0.821940395	0.473144067	1.024394917	4.795544827	0.01148549	0	1.252463427	0.002670527	0.008011582	0.480956132	0.027080933	0.10650832	0	0	0	0	0	0	0	0	0	0	0	54.9836
H9670_802_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	NO	341.7269548	8.613929697	1313.376291		159.907255	9.552552707	6.773893716	348.7642192	413.9669266		1082.444665			197.3642318	4423.166299	6488.811111	287.2787382	417.2852488			25.05686405	0.120704931		469.8			239.5744005															1A: $150	1B: $150	"2: $0/day days 1-10, $50/day days 11-50, $0/day days 51-100"	6: $0	10A: $75	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $20 31-day/60 90-day"	4A: $50; 4B: $50	9A: $100; 9B: $100	8A: $0 labs	"8B: $10 x-rays, $50 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $25; 7I: $25; 9C: $25; 9D: $0	7A: $15; 14B: $0; 14C: $15; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $25; 7D: $25; 7F, 14A: $25; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $25"	7E: $25; 7H: $25	7I: $25			15: 20%	13A: $0; 16B: $25; 17A: $25		"16A: $25; 16B: $25 bitewing x-ray, 20% restorative"	17A: $200 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $200 limit/2 yrs for glasses and exam (combined IN and OON)	18A: $25	"18B: $1,000 limit every 3 yrs"	14A: $0												150	150	29.16		75	0.2	0.206959843	50	100		33.27738199			25	15	25	25	25			0.2	25		31.98275862			25														NO	132.1638728	132.1638728	25.69265687		66.08193639	0.176218497	0.182350762	44.05462426	88.10924852		29.3204512			22.02731213	13.21638728	22.02731213	22.02731213	22.02731213			0.176218497	22.02731213		28.17976828			22.02731213															3.7637	0.094870859	2.812010532	0	0.880581755	1.683336481	1.235224681	1.28038972	3.039526235	0	2.644813832	0	0	0.362283628	4.871523234	11.91092231	0.527331536	0.765972702	0	0	4.415482924	0.000221567	0	1.103237928	0	0	0.439765008	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8312	0	5.645308671	3.7637	0.094870859	2.812010532	0	0.880581755	1.683336481	1.235224681	1.28038972	3.039526235	0	2.644813832	0	0	0.362283628	4.871523234	11.91092231	0.527331536	0.765972702	0	0	4.415482924	0.000221567	0	1.103237928	0	0	0.439765008	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8312	YES	1A: 20%	1B: 20%	2: 20%	6: 20%	10A: 20%	11A: 50%	11B: 50%; 11C: 20%	4A: $50; 4B: $50	9A: 20%; 9B: 20%	8A: 20%	8A: 20%; 8B: 20%	9A: 20%; 9B: 20%	12: 20%	3: 20%; 5: 20%; 7C: 20%; 7I: 20%; 9C: 20%; 9D: 20%	7A: 20%; 14B: $0; 14C: 20%; 14D: 20%; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 20%; 14J: 20%	7B: 20%; 7D: 20%; 7F: 20%; 14B: $0; 14D: 20%; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 20%; 14J: 20%; 18A: 20%	7E: 20%; 7H: 20%	7I: 20%	8A: 20%; 8B: 20%	8A: 20%; 7d: 20%	15: 20%	13A: 20%; 16B: 20%; 17A: 20% MC services		16A: 50% routine services; 16B: 50%	17A: $200 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $200 limit/2 yrs for glasses and exam (combined IN and OON)	18A: 50%	18B: 50%	14A: 50%												3400	4.7344	0.0797	0.7579	0.4393	0.1344	0.2959	0.4136	0.175	0.7771	0.1494	0.375	0.0835	0.0024	0.5481	0.6527	1.2221	0.0323	0.056	0.4731	1.0244	0.3801	0.0113		0.1492	0.0027	0.008	0.0412	0.0271	0.1065												13.1524	500	9.431295797	8.498	0.174572042	3.569951096	0.439307384	1.014940366	1.979272008	1.648862427	1.455417305	3.816595302	0.149384737	3.019857928	0.083483792	0.002446167	0.910367021	5.524231935	13.13302695	0.559634675	0.821940395	0.473144067	1.024394917	4.795544827	0.01148549	0	1.252463427	0.002670527	0.008011582	0.480956132	0.027080933	0.10650832	0	0	0	0	0	0	0	0	0	0	0	54.9836
H9670_803_0	2010	3	N/A																															A	A	D	V	T	Coin	Coin	V	V	P	P	P	P	P	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	P	P																																																			0	NO	341.7269548	8.613929697	1313.376291		159.907255	9.552552707	6.773893716	348.7642192	413.9669266		1082.444665			197.3642318	4423.166299	6488.811111	287.2787382	417.2852488			25.05686405	0.120704931		469.8			239.5744005															1A: $150	1B: $150	"2: $0/day days 1-10, $50/day days 11-50, $0/day days 51-100"	6: $0	10A: $75	11A: 20%	"11B: 20% prosthetics, $0 medical supplies; 11C: $0 training $20 31-day/60 90-day"	4A: $50; 4B: $50	9A: $100; 9B: $100	8A: $0 labs	"8B: $10 x-rays, $50 advanced imaging, $0 ther rad"		12: $0	3: $0; 5: $0; 7C: $25; 7I: $25; 9C: $25; 9D: $0	7A: $15; 14B: $0; 14C: $15; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0	"7B: $25; 7D: $25; 7F, 14A: $25; 14B: $0; 14D: $0; 14E: $0; 14F: $0; 14G: $0; 14H: $0; 14I: $0; 14J: $0; 18A: $25"	7E: $25; 7H: $25	7I: $25			15: 20%	13A: $0; 16B: $25; 17A: $25		"16A: $25; 16B: $25 bitewing x-ray, 20% restorative"	17A: $200 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $200 limit/2 yrs for glasses and exam (combined IN and OON)	18A: $25	"18B: $1,000 limit every 3 yrs"	14A: $0												150	150	29.16		75	0.2	0.206959843	50	100		33.27738199			25	15	25	25	25			0.2	25		31.98275862			25														NO	132.1638728	132.1638728	25.69265687		66.08193639	0.176218497	0.182350762	44.05462426	88.10924852		29.3204512			22.02731213	13.21638728	22.02731213	22.02731213	22.02731213			0.176218497	22.02731213		28.17976828			22.02731213															3.7637	0.094870859	2.812010532	0	0.880581755	1.683336481	1.235224681	1.28038972	3.039526235	0	2.644813832	0	0	0.362283628	4.871523234	11.91092231	0.527331536	0.765972702	0	0	4.415482924	0.000221567	0	1.103237928	0	0	0.439765008	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8312	0	5.645308671	3.7637	0.094870859	2.812010532	0	0.880581755	1.683336481	1.235224681	1.28038972	3.039526235	0	2.644813832	0	0	0.362283628	4.871523234	11.91092231	0.527331536	0.765972702	0	0	4.415482924	0.000221567	0	1.103237928	0	0	0.439765008	0	0	0	0	0	0	0	0	0	0	0	0	0	41.8312	YES	1A: 20%	1B: 20%	2: 20%	6: 20%	10A: 20%	11A: 50%	11B: 50%; 11C: 20%	4A: $50; 4B: $50	9A: 20%; 9B: 20%	8A: 20%	8A: 20%; 8B: 20%	9A: 20%; 9B: 20%	12: 20%	3: 20%; 5: 20%; 7C: 20%; 7I: 20%; 9C: 20%; 9D: 20%	7A: 20%; 14B: $0; 14C: 20%; 14D: 20%; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 20%; 14J: 20%	7B: 20%; 7D: 20%; 7F: 20%; 14B: $0; 14D: 20%; 14E: 20%; 14F: 20%; 14G: 20%; 14H: 20%; 14I: 20%; 14J: 20%; 18A: 20%	7E: 20%; 7H: 20%	7I: 20%	8A: 20%; 8B: 20%	8A: 20%; 7d: 20%	15: 20%	13A: 20%; 16B: 20%; 17A: 20% MC services		16A: 50% routine services; 16B: 50%	17A: $200 limit/2 yrs for glasses and exam (combined IN and OON)	17B: $200 limit/2 yrs for glasses and exam (combined IN and OON)	18A: 50%	18B: 50%	14A: 50%												3400	4.7344	0.0797	0.7579	0.4393	0.1344	0.2959	0.4136	0.175	0.7771	0.1494	0.375	0.0835	0.0024	0.5481	0.6527	1.2221	0.0323	0.056	0.4731	1.0244	0.3801	0.0113		0.1492	0.0027	0.008	0.0412	0.0271	0.1065												13.1524	500	9.431295797	8.498	0.174572042	3.569951096	0.439307384	1.014940366	1.979272008	1.648862427	1.455417305	3.816595302	0.149384737	3.019857928	0.083483792	0.002446167	0.910367021	5.524231935	13.13302695	0.559634675	0.821940395	0.473144067	1.024394917	4.795544827	0.01148549	0	1.252463427	0.002670527	0.008011582	0.480956132	0.027080933	0.10650832	0	0	0	0	0	0	0	0	0	0	0	54.9836
H9720_008_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin			P	V	V	V	V	O																																																				0	YES	1797.990012	75.65495888	717.8628975	4752.111028	338.0634489	16.14137461	3.113568475	281.8978762	217.5104179	980.2498416	12.36450722	38.2853064	0	1765.460035	3957.426009	8310.404636	707.2459181	1411.106229	4692.902954	5116.242518	18.65348651																				3400	$350 for 1st 7 days	$300 for 1st 7 days	$100 for days 10-100	$10 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/medical supplies; 20% diabetic monitoring supplies	$50 Copay; $15-35 UC	$250 OP hospital; $100 ASC	$15 Copay	20% Coinsurance	$350 Copay	20% Coinsurance	$35 Copay	$15 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												262.9246013	183.9156534	40.74391478	10	80	0.3	0.25	35.5	175	15	0.2	350	0.2	35	14.25	29.14285714	35	35	35	30	0.2	0	0	4.166666667	0	10	0	0	0												NO	189.6258346	132.6431954	29.38522605	7.212175416	57.69740333	0.216365262	0.180304385	25.60322273	126.2130698	10.81826312	0.144243508	252.4261396	0.144243508	25.24261396	10.27734997	21.01833978	25.24261396	25.24261396	25.24261396	21.63652625	0.144243508	0	0	3.00507309	0	7.212175416	0	0	0													28.4121	0.836259624	1.757880293	2.856088195	1.625448597	3.492432755	0.56139005	0.601457842	2.287721462	0.883716726	1.7834999	0.805351008	0	3.713735509	3.389321006	14.55590903	1.487727973	2.96833415	9.871761466	9.224809627	2.690644336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8056	0	36.26001171	28.4121	0.836259624	1.757880293	2.856088195	1.625448597	3.492432755	0.56139005	0.601457842	2.287721462	0.883716726	1.7834999	0.805351008	0	3.713735509	3.389321006	14.55590903	1.487727973	2.96833415	9.871761466	9.224809627	2.690644336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8056	NO																																																																																		0	0	0	28.4121	0.836259624	1.757880293	2.856088195	1.625448597	3.492432755	0.56139005	0.601457842	2.287721462	0.883716726	1.7834999	0.805351008	0	3.713735509	3.389321006	14.55590903	1.487727973	2.96833415	9.871761466	9.224809627	2.690644336	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.8056
H9720_009_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	2032.353538	67.97733921	655.0102202	4892.571307	274.2136841	17.37439816	9.952154891	255.7212576	232.1410568	872.6445023	11.39957819	36.26247879	0	1711.665203	4212.807264	9182.137888	432.5965515	1819.291415	5037.239657	5675.734089	17.59530966	0	0																		3400	$285 for 1st 7 days	$285 for 1st 7 days	$100 for days 10-100	$10 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/medical supplies; 20% diabetic monitoring supplies	$50 Copay; $15-35 UC	$250 OP hospital; $100 ASC	$15 Copay	20% Coinsurance	$350 Copay	20% Coinsurance	$35 Copay	$10 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												214.0957468	149.7598892	40.74391478	10	80	0.3	0.25	35.5	175	15	0.2	350	0.2	35	9.5	29.14285714	35	35	35	30	0.2	0	0	4.166666667	0	10	0	0	0												NO	152.4125246	106.6125	29.00516712	7.118895492	56.95116393	0.213566865	0.177972387	25.272079	124.5806711	10.67834324	0.14237791	249.1613422	0.14237791	24.91613422	6.762950717	20.74649543	24.91613422	24.91613422	24.91613422	21.35668648	0.14237791	0	0	2.966206455	0	7.118895492	0	0	0													25.813	0.603936173	1.583223409	2.902475318	1.30139904	3.710595743	1.771208765	0.538550652	2.410024054	0.776533127	1.623048115	0.752933991	0	3.554006661	2.374250659	15.87476515	0.898219478	3.777475757	10.45904495	10.10123946	2.505183413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3311	0	37.7722535	25.813	0.603936173	1.583223409	2.902475318	1.30139904	3.710595743	1.771208765	0.538550652	2.410024054	0.776533127	1.623048115	0.752933991	0	3.554006661	2.374250659	15.87476515	0.898219478	3.777475757	10.45904495	10.10123946	2.505183413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3311	NO																																																																																		0	0	0	25.813	0.603936173	1.583223409	2.902475318	1.30139904	3.710595743	1.771208765	0.538550652	2.410024054	0.776533127	1.623048115	0.752933991	0	3.554006661	2.374250659	15.87476515	0.898219478	3.777475757	10.45904495	10.10123946	2.505183413	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.3311
H9720_010_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	2428.984097	53.82992496	1083.597936	4489.063962	359.5398173	17.82007257	5.576725565	306.5893595	255.6710792	870.9241549	12.93319254	27.98254169	0	1585.414681	3722.393653	14075.35362	482.5126639	1454.065548	4908.796488	4556.553963	23.11602536	0	0																		3400	$225 for 1st 7 days	$225 for 1st 7 days	$100 for days 10-100	$0 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/medical supplise; 20% diabetic monitoring supplies	$50 Copay; $10-$30 UC	$150 OP hospital; $75 ASC	$15 Copay	20% Coinsurance	$150 Copay	20% Coinsurance	$30 Copay	$10 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												169.022958	118.2314915	40.74391478	0	80	0.3	0.25	34	112.5	15	0.2	150	0.2	30	9.5	25.14285714	30	30	30	30	0.2	0	0	4.166666667	0	10	0	0	0												NO	132.3314968	92.56582907	31.89923602	0	62.63362015	0.234876076	0.195730063	26.61928856	88.07852834	11.74380378	0.15658405	117.4380378	0.15658405	23.48760756	7.437742393	19.68485205	23.48760756	23.48760756	23.48760756	23.48760756	0.15658405	0	0	3.262167716	0	7.829202519	0	0	0													26.7859	0.415234303	2.880495527	0	1.876606695	4.18550871	1.091532846	0.680099219	1.876594366	0.852330198	2.025131672	0.273851232	0	3.103133154	2.307183756	23.08927113	0.944422341	2.846043412	9.607990458	8.918545942	3.61960088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3795	0	27.0003458	26.7859	0.415234303	2.880495527	0	1.876606695	4.18550871	1.091532846	0.680099219	1.876594366	0.852330198	2.025131672	0.273851232	0	3.103133154	2.307183756	23.08927113	0.944422341	2.846043412	9.607990458	8.918545942	3.61960088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3795	NO																																																																																		0	0	0	26.7859	0.415234303	2.880495527	0	1.876606695	4.18550871	1.091532846	0.680099219	1.876594366	0.852330198	2.025131672	0.273851232	0	3.103133154	2.307183756	23.08927113	0.944422341	2.846043412	9.607990458	8.918545942	3.61960088	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	97.3795
H9720_011_0	2010	5	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	2168.04113	83.24390108	723.2842174	5333.583579	347.502801	20.79090531	6.149207738	266.452388	228.1141258	979.8887626	11.22635029	28.46040665	0	1696.972626	4208.397857	11258.78165	532.9188377	1797.947427	5718.411131	5114.060411	16.15460748	0	0																		3400	$225 for 1st 7 days	$225 for 1st 7 days	$100 for days 10-100	$0 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/Medical supplies; 20% diabetic monitoring supplies	$50 Copay; $10-$30 UC	$150 OP hospital; $75 ASC	$15 Copay	20% Coinsurance	$150 Copay	20% Coinsurance	$30 Copay	$5 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	$30 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												169.022958	118.2314915	40.74391478	0	80	0.3	0.25	34	112.5	15	0.2	150	0.2	30	4.75	25.14285714	30	30	30	30	0.2	0	0	4.166666667	0	10	0	0	0												NO	125.0414237	87.46642582	30.14192374	0	59.18316668	0.221936875	0.184947396	25.15284584	83.22632815	11.09684375	0.147957917	110.9684375	0.147957917	22.19368751	3.514000522	18.60042381	22.19368751	22.19368751	22.19368751	22.19368751	0.147957917	0	0	3.082456598	0	7.397895835	0	0	0													22.5912	0.606753875	1.816764811	0	1.713859683	4.614268554	1.137279958	0.558502987	1.582091757	0.906139374	1.661027401	0.263183905	0	3.13850668	1.232359355	17.4515092	0.985619513	3.325256945	10.57605247	9.458321553	2.390202068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0089	0	30.25241789	22.5912	0.606753875	1.816764811	0	1.713859683	4.614268554	1.137279958	0.558502987	1.582091757	0.906139374	1.661027401	0.263183905	0	3.13850668	1.232359355	17.4515092	0.985619513	3.325256945	10.57605247	9.458321553	2.390202068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0089	NO																																																																																		0	0	0	22.5912	0.606753875	1.816764811	0	1.713859683	4.614268554	1.137279958	0.558502987	1.582091757	0.906139374	1.661027401	0.263183905	0	3.13850668	1.232359355	17.4515092	0.985619513	3.325256945	10.57605247	9.458321553	2.390202068	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.0089
H9720_025_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	2291.489552	52.54546202	719.3951247	6552.877449	406.9641069	25.954849	2.103240221	334.4930241	311.1785342	1122.391478	12.17096326	44.24628769	0	3661.642767	4883.913066	5462.723725	334.83669	1695.105561	4944.603394	6001.842805	41.73424846	0	0																		3400	$295 for 1st 7 days	$295 for 1st 7 days	$100 for days 10-100	$0 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/medical supplies; 20% Diabetic monitoring supplies	$50 Copay ER; $10-35 UC	$150 OP hospital; $75 ASC	$15 Copay	20% Coinsurance	$250 Copay	20% Coinsurance	$35 Copay	$10 per Visit	$35 per Visit	$35 per Visit	$30 per Visit	$35 per Visit	$35 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												221.6078782	155.0146221	40.74391478	0	80	0.3	0.25	34.75	112.5	15	0.2	250	0.2	35	9.5	29.14285714	35	30	35	35	0.2	0	0	4.166666667	0	10	0	0	0												NO	158.8921671	111.1450073	29.21326158	0	57.35975395	0.215099077	0.179249231	24.91564312	80.66215399	10.75495387	0.143399385	179.2492311	0.143399385	25.09489235	6.811470782	20.89533894	25.09489235	21.50990773	25.09489235	25.09489235	0.143399385	0	0	2.987487185	0	7.169969244	0	0	0													30.3416	0.48668048	1.751323163	0	1.945280087	5.582864071	0.377004192	0.694509068	2.091694237	1.005939047	1.745308645	0.660926087	0	7.65737759	2.772219262	9.512121981	0.700224224	3.038463685	10.34035749	12.55129993	5.984665557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2399	0	39.17059762	30.3416	0.48668048	1.751323163	0	1.945280087	5.582864071	0.377004192	0.694509068	2.091694237	1.005939047	1.745308645	0.660926087	0	7.65737759	2.772219262	9.512121981	0.700224224	3.038463685	10.34035749	12.55129993	5.984665557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2399	NO																																																																																		0	0	0	30.3416	0.48668048	1.751323163	0	1.945280087	5.582864071	0.377004192	0.694509068	2.091694237	1.005939047	1.745308645	0.660926087	0	7.65737759	2.772219262	9.512121981	0.700224224	3.038463685	10.34035749	12.55129993	5.984665557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	99.2399
H9720_026_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	2412.821092	51.44525864	697.8473227	6485.153722	425.2748521	23.7271366	1.750854912	346.1307654	292.2842056	1133.550884	12.68925508	49.5188183	0	3661.053042	4819.487583	5214.014651	335.3300977	1723.719227	5028.724209	5696.767908	43.74234176	0	0																		3400	$295 for 1st 7 days	$295 for 1st 7 days	$100 for days 10-100	$0 Copay	$100 Copay	30% Coinsurance	30% Prosthetics/medical supplies; 20% diabetic monitoring supplies	$50 Copay ER; $10-35 Urgenct Care	$150 OP hospital; $75 ASC	$15 Copay	20% Coinsurance	$250 Copay	20% Coinsurance	$35 Copay	$5 per Visit	$35 per Visit	$35 per Visit	$30 per Visit	$35 per Visit	$35 per Visit	20% Coinsurance			$0-75 detnal X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												221.6078782	155.0146221	40.74391478	0	80	0.3	0.25	34.75	112.5	15	0.2	250	0.2	35	4.75	29.14285714	35	30	35	35	0.2	0	0	4.166666667	0	10	0	0	0												NO	159.1959746	111.3575205	29.26911837	0	57.46942783	0.215510354	0.179591962	24.96328271	80.81638289	10.77551772	0.14367357	179.591962	0.14367357	25.14287468	3.412247277	20.93529157	25.14287468	21.55103544	25.14287468	25.14287468	0.14367357	0	0	2.993199366	0	7.183678479	0	0	0													32.0093	0.47740137	1.702114658	0	2.036691869	5.113443616	0.314439469	0.720046679	1.968446023	1.017883136	1.823110573	0.741098478	0	7.670783152	1.370440282	9.096409746	0.702596885	3.095661179	10.53638188	11.93609346	6.284618383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6169	0	38.66222914	32.0093	0.47740137	1.702114658	0	2.036691869	5.113443616	0.314439469	0.720046679	1.968446023	1.017883136	1.823110573	0.741098478	0	7.670783152	1.370440282	9.096409746	0.702596885	3.095661179	10.53638188	11.93609346	6.284618383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6169	NO																																																																																		0	0	0	32.0093	0.47740137	1.702114658	0	2.036691869	5.113443616	0.314439469	0.720046679	1.968446023	1.017883136	1.823110573	0.741098478	0	7.670783152	1.370440282	9.096409746	0.702596885	3.095661179	10.53638188	11.93609346	6.284618383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.6169
H9720_038_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	1844.846251	50.90114868	662.765843	7020.547144	289.636842	19.92538848	2.075628658	292.5366717	236.3780109	1346.921065	14.84973777	88.19524825	0	2763.894268	5038.241346	5958.480126	443.105225	2217.227167	5882.257248	4740.397624	17.29221995	0	0																		3400	$350 for 1st 7 days	$300 for 1st 7 days	$100 for days 10-100	$10 Copay	$100 Copay	30% Coinsurance	30% prosthetics/medical supplies; 20% diabetic monitoring supplies	$50 Copay; $15-35 UC	$250 OP hospital; S100 ASC	$15 Copay	20% Coinsurance	$350 Copay	20% Coinsurance	$35 Copay	$15 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												262.9246013	183.9156534	40.74391478	10	80	0.3	0.25	35.5	175	15	0.2	350	0.2	28.33333333	14.25	29.14285714	35	35	35	35	0.2	0	0	4.166666667	0	10	0	0	0												NO	183.0348558	128.0328084	28.36385995	6.961495993	55.69196794	0.20884488	0.1740374	24.71331077	121.8261799	10.44224399	0.13922992	243.6523597	0.13922992	19.72423865	9.92013179	20.28778832	24.36523597	24.36523597	24.36523597	24.36523597	0.13922992	0	0	2.90062333	0	6.961495993	0	0	0													28.1393	0.543084751	1.566549796	4.072792567	1.34420381	4.161315362	0.361237015	0.602462473	2.399752506	1.1720732	2.067527799	1.790748363	0	4.542975845	4.165001512	10.07369863	0.899696947	4.501938594	11.94354883	9.625075559	2.407594397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3805	0	42.06748996	28.1393	0.543084751	1.566549796	4.072792567	1.34420381	4.161315362	0.361237015	0.602462473	2.399752506	1.1720732	2.067527799	1.790748363	0	4.542975845	4.165001512	10.07369863	0.899696947	4.501938594	11.94354883	9.625075559	2.407594397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3805	NO																																																																																		0	0	0	28.1393	0.543084751	1.566549796	4.072792567	1.34420381	4.161315362	0.361237015	0.602462473	2.399752506	1.1720732	2.067527799	1.790748363	0	4.542975845	4.165001512	10.07369863	0.899696947	4.501938594	11.94354883	9.625075559	2.407594397	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.3805
H9720_039_0	2010	7	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	V	Coin	V	V	V	V	V	V	V	Coin	O	T	P	V	V	V	V	O																																																				0	YES	1844.803386	50.88648298	663.0747913	7018.58502	289.5463375	19.92742184	2.076324041	292.4629172	236.4276923	1346.853545	14.85031536	88.16502539	0	2764.559342	5038.498111	5957.89135	443.0386954	2216.60548	5882.368219	4739.852555	17.29709465	0	0																		3400	$300 for 1st 7 days	$300 for 1st 7 days	$100 for days 10-100	$10 Copay	$100 Copay	30% Coinsurance	30% prosthetics/medical supplies; 20% diabetic monitoring supplies	$50 Copay; $15-35 UC	$250 OP hospital; $100 ASC	$15 Copay	20% Coinsurance	$350 Copay	20% Coinsurance	$35 Copay	$10 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	$35 per Visit	20% Coinsurance			$0-75 dental X-ray	$0 - 1 / Year (Cap)	$10 1/Year - up to $100 (Cap)	$0 (1 / 2 Years) (cap)	$500 allowable/hearing aid (cap)	"newsletter, health club"												225.363944	157.6419886	40.74391478	10	80	0.3	0.25	35.5	175	15	0.2	350	0.2	21.66666667	9.5	29.14285714	35	35	35	35	0.2	0	0	4.166666667	0	10	0	0	0												NO	160.5240534	112.2865111	29.02140527	7.122880907	56.98304726	0.213686427	0.178072023	25.28622722	124.6504159	10.68432136	0.142457618	249.3008318	0.142457618	15.43290863	6.766736862	20.75811007	24.93008318	24.93008318	24.93008318	24.93008318	0.142457618	0	0	2.967867045	0	7.122880907	0	0	0													24.6779	0.47615547	1.60361352	4.166045436	1.374936053	4.258219577	0.369735222	0.616273648	2.455900847	1.199184675	2.115540554	1.831634514	0	3.555432644	2.841182575	10.3062137	0.920415961	4.605013249	12.22066075	9.847076537	2.464102905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9053	0	37.12296217	24.6779	0.47615547	1.60361352	4.166045436	1.374936053	4.258219577	0.369735222	0.616273648	2.455900847	1.199184675	2.115540554	1.831634514	0	3.555432644	2.841182575	10.3062137	0.920415961	4.605013249	12.22066075	9.847076537	2.464102905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9053	NO																																																																																		0	0	0	24.6779	0.47615547	1.60361352	4.166045436	1.374936053	4.258219577	0.369735222	0.616273648	2.455900847	1.199184675	2.115540554	1.831634514	0	3.555432644	2.841182575	10.3062137	0.920415961	4.605013249	12.22066075	9.847076537	2.464102905	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.9053
H9779_001_0	2010	11	N/A		e.2.			h.2.							DME/Prosthetics/Supplies			OP Facility - Other							Diabetic supplies			MRI/PET/CAT						D	D	D		T	Coin	Coin	V	V		V		Coin	V		V	V	V			Coin			V	V							Coin			V																																														0	YES	1434.510446	96.94818464	1013.241857		274.2247217	27.9730632	2.531050187	220.135961	242.9428326		1514.616016		0	5159.013674		4911.819019	381.3383838	1173.023136			15.29419299			100	541.6277603							5.478935104			324.4779899						3400	$100 Days 3-6	$200 Days 1-5	"$50 days 11-20, $124 days 21-100"		$50 waived if admitted	20%	20%	"$50 ER, $25 UC / waived if admitted"	"$180 Surgery, $50 ASC"		$20 to $60 or 20%/ varies by service		20%	$0 to $30 varies by service		$20 / $0 for preventive	$30 	$30 			20%			30	$10 							20%			20%						35.50670845	32.2533477	25.92798905		40	0.2	0.2	34.75	115		47.27272727		0.2	6		17.2	30	30			0.2			30	10							0.2			60						YES	33.77442198	30.67978484	24.66302515		38.0484967	0.190242484	0.190242484	33.05463151	109.389428		44.96640519		0.190242484	5.707274505		16.36085358	28.53637253	28.53637253			0.190242484			28.53637253	9.512124175							0.190242484			57.07274505						4000	4.0375	0.247862454	2.082467451	0	0.869486535	5.321665014	0.481513274	0.606376089	2.214614792	0	5.675569789	0	0	2.453658935	0	6.696795983	0.906834515	2.789485433	0	0	2.909605257	0	0	0.237803104	0.429335876	0	0	0	0	0	0	1.042326221	0	0	1.543237466	0	0	0	0	0	40.5461	0	2.067409146	4.0375	0.247862454	2.082467451	0	0.869486535	5.321665014	0.481513274	0.606376089	2.214614792	0	5.675569789	0	0	2.453658935	0	6.696795983	0.906834515	2.789485433	0	0	2.909605257	0	0	0.237803104	0.429335876	0	0	0	0	0	0	1.042326221	0	0	1.543237466	0	0	0	0	0	40.5461	NO	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%	20%		20%	20%	20%	20%	20%	20%	20%	20%											20%			20%							5.0175	0.1264	1.0786	0.5822	0.2047	0.5957	0.0539	0.1423	0.4927	0.1488	0.2574	0.0119		0.8001	0.3281	0.3573	0.0233	0.0796	0.3044	1.775	0.3832											0.1167			0.1809						13.0606	0	0	9.055	0.374259569	3.161086815	0.582182353	1.074155968	5.917413907	0.535417643	0.748635627	2.707285175	0.148787087	5.932953406	0.011861118	0	3.253803241	0.328130691	7.054117107	0.930092761	2.869107937	0.304397556	1.774990122	3.292809985	0	0	0.237803104	0.429335876	0	0	0	0	0	0	1.159012388	0	0	1.724139325	0	0	0	0	0	53.6068
H9793_001_0	2010	6	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	888.7070229	0	566.81572	0	183.0039683	14.05555211	0	289.6705825	505.7918804	4322.8477	1549.524848	0	0	1032.580837	3024.802809	5271.329794	0	0	0	1801.447389	27.86597092	0	0	0	369.7822072	0	163.0309343	0	0	0											3400	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											150	0	50	0	100	0.2	0	50	100	23	34	0	0	30	30	30	0	0	0	30	0.2	0	0	0	30	0	30	0	0	0											NO	136.1812499	0	45.39374996	0	90.78749993	0.181575	0	45.39374996	90.78749993	20.88112498	30.86774998	0	0	27.23624998	27.23624998	27.23624998	0	0	0	27.23624998	0.181575	0	0	0	30	0	30	0	0	0												10.0854	0	2.144157589	0	1.384539397	2.552136872	0	1.095769499	3.826631692	7.522160259	3.985862131	0	0	2.343635816	6.865357119	11.96427133	0	0	0	4.088722617	5.059763665	0	0	0	0.924455518	0	0.407577336	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2505	0	6.384537202	10.0854	0	2.144157589	0	1.384539397	2.552136872	0	1.095769499	3.826631692	7.522160259	3.985862131	0	0	2.343635816	6.865357119	11.96427133	0	0	0	4.088722617	5.059763665	0	0	0	0.924455518	0	0.407577336	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2505	NO																																																																																		0			10.0854	0	2.144157589	0	1.384539397	2.552136872	0	1.095769499	3.826631692	7.522160259	3.985862131	0	0	2.343635816	6.865357119	11.96427133	0	0	0	4.088722617	5.059763665	0	0	0	0.924455518	0	0.407577336	0	0	0	0	0	0	0	0	0	0	0	0	0	64.2505
H9793_002_0	2010	3	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	V	V	V	V	V	V	V	V	V	V	Coin	O	O	Coin	V	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	YES	919.407557	0	933.0727724	0	157.1666701	10.98773759	0	218.5036205	479.7385067	3986.858339	1351.642017	0	0	1065.218083	2780.559512	4741.195634	0	0	0	1536.734117	32.27831429	0	0	0	344.7271066	0	149.4395972	0	0	0											3400	"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											125	0	35	0	100	0.2	0	50	200	19	30	0	0	35	35	35	0	0	0	35	0.2	0	0	0	35	0	35	0	0	0											NO	113.2246753	0	31.70290909	0	90.57974025	0.18115948	0	45.28987012	181.1594805	17.21015065	27.17392207	0	0	31.70290909	31.70290909	31.70290909	0	0	0	31.70290909	0.18115948	0	0	0	35	0	35	0	0	0												8.675	0	2.46509344	0	1.186343013	1.990532834	0	0.824666716	7.242431555	5.717869386	3.060784571	0	0	2.814209338	7.345985451	12.52580784	0	0	0	4.059911833	5.847522648	0	0	0	1.005454061	0	0.435865492	0	0	0	0	0	0	0	0	0	0	0	0	0	65.1974	0	6.630613829	8.675	0	2.46509344	0	1.186343013	1.990532834	0	0.824666716	7.242431555	5.717869386	3.060784571	0	0	2.814209338	7.345985451	12.52580784	0	0	0	4.059911833	5.847522648	0	0	0	1.005454061	0	0.435865492	0	0	0	0	0	0	0	0	0	0	0	0	0	65.1974	NO																																																																																		0			8.675	0	2.46509344	0	1.186343013	1.990532834	0	0.824666716	7.242431555	5.717869386	3.060784571	0	0	2.814209338	7.345985451	12.52580784	0	0	0	4.059911833	5.847522648	0	0	0	1.005454061	0	0.435865492	0	0	0	0	0	0	0	0	0	0	0	0	0	65.1974
H9793_801_0	2010	4	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	271.4333732	0	36.70405708	15.88829013	8.46266566	30.00031648	0	12.6934179	55.02097559	27.73483151	49.42259948	0	0	27.6585854	26.26381938	58.70456621	0	0	0	112.3211887	51.85721617	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.081184136	0	0.176374027	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081184136	0	0.176374027	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												22.0361	0	6.473642362	0	1.971801099	6.990073739	0	2.957566371	12.81988731	6.462215742	11.51546568	0	0	6.444450399	6.119469916	13.67816393	0	0	0	26.17083698	12.08273137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.7224			22.0361	0	6.473642362	0	1.971801099	6.990073739	0	2.957566371	12.81988731	6.462215742	11.51546568	0	0	6.444450399	6.119469916	13.67816393	0	0	0	26.17083698	12.08273137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.7224	NO																																																																																		0			22.0361	0	6.473642362	0	1.971801099	6.990073739	0	2.957566371	12.81988731	6.462215742	11.51546568	0	0	6.444450399	6.119469916	13.67816393	0	0	0	26.17083698	12.08273137	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	135.7224
H9793_802_0	2010	4	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	283.2213005	0	70.24682169	22.7049787	11.09900677	25.87856284	0	12.27799795	48.84596629	26.08693674	42.91866525	0	0	30.96391399	27.47932174	64.48978447	0	0	0	103.6114527	48.25171488	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.081579433	0	0.17716041	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081579433	0	0.17716041	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												23.105	0	12.44495576	0	2.586068578	6.029705141	0	2.860773521	11.38111015	6.078256261	10.000049	0	0	7.21459196	6.402681964	15.02611978	0	0	0	24.14146848	11.24264957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5135			23.105	0	12.44495576	0	2.586068578	6.029705141	0	2.860773521	11.38111015	6.078256261	10.000049	0	0	7.21459196	6.402681964	15.02611978	0	0	0	24.14146848	11.24264957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5135	NO																																																																																		0			23.105	0	12.44495576	0	2.586068578	6.029705141	0	2.860773521	11.38111015	6.078256261	10.000049	0	0	7.21459196	6.402681964	15.02611978	0	0	0	24.14146848	11.24264957	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	138.5135
H9793_804_0	2010	4	N/A																															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	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	NO	277.9657851	0	52.4452689	19.07393164	9.724050502	28.11513665	0	12.52610139	52.09891715	26.92272908	46.28997096	0	0	29.02459916	26.84411252	61.14217014	0	0	0	108.2735679	49.47906921	0	0	0	0	0	0	0	0	0												"PBP 1a, 1b"		PBP 2	PBP 6	PBP 10a	"PBP 11a, 11b, 11c"		PBP 4a	"PBP 9a, 9b"	PBP 8a	PBP 8b			"PBP 7d, 12, 3, 5, 9a, 9c, 9d, 13a"	"PBP 7a, 14c-j"	"PBP 7b, 7c, 7d, 7f, 7g, 7i, 14d-j, 17a, 18a"				"PBP 4b, 7d, 7e, 7g, 7h, 9c, 14b"	PBP 15			"PBP 16a, 16b"	"PBP 17a, 17b"		"PBP 18a, 18b"		PBP 14a	PBP 13b-e											0.081361756	0	0.176736545	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0											NO	0.081361756	0	0.176736545	0	0.233	0.233	0	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0.233	0	0	0	0.233	0.233	0	0	0	0	0	0	0	0	0												22.6158	0	9.268995623	0	2.265703767	6.550826839	0	2.918581623	12.1390477	6.272995876	10.78556323	0	0	6.762731604	6.254678217	14.24612564	0	0	0	25.22774132	11.52862313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.8374			22.6158	0	9.268995623	0	2.265703767	6.550826839	0	2.918581623	12.1390477	6.272995876	10.78556323	0	0	6.762731604	6.254678217	14.24612564	0	0	0	25.22774132	11.52862313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.8374	NO																																																																																		0			22.6158	0	9.268995623	0	2.265703767	6.550826839	0	2.918581623	12.1390477	6.272995876	10.78556323	0	0	6.762731604	6.254678217	14.24612564	0	0	0	25.22774132	11.52862313	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	136.8374
H9847_001_0	2010	14	N/A																															D	D	D	V	T	Coin	Coin	V	Coin	V	Coin	Coin	Coin	Coin	V	V	V	V	V	V	Coin	P	T	P	V	P	V	P	O	P																																																			0	YES	1255.701495	55.8164496	853.8322464		127.0486014	10.21584272	11.07494372	223.9172889	40.52712295	864.3233928	19.11201034	2.999527161	0.252614934	29.71181026	3689.489983	5096.881197	293.0564917	424.5634339	3702.907419	9076.601217	19.44219137																				3400	1a: Days 1-10: $245.00/day then $0;1a1: Days 1-10: $245.00/day then $0	1b: Days 1-10: $245.00/day then $0 Lifetime limit of 190 days	2: Days 1-12: $0 copay Days 13-100: $110.00/day	6: $0/visit	10a: $125/trip	11a: 20%	11b: 20%;11c: 20%	4a: $50/visit;4a1: $50/visit;4b: $25/visit	9a: 20%;9b: 20%	8a: $45/visit	8b: $45/visit;8b: 20%	9a: 20%	12a: 20%	3: 20%;5: $245/visit;9a: 20%;9c: $40/visit;9d: $45/visit;7i: $45/visit;7e: $40/visit;7c: $45/visit	7a: $20/visit;14c: $20/visit	7b: $45/visit;7d: $45/visit;7f: $45/visit;14c1: $20/visit;16b: $45/visit;17a: $45/visit;18a: $45/visit	7e: $40/visit;7h: $40/visit;7a: $20/visit;7d: $45/visit	7c: $45/visit;7i: $45/visit;7a: $20/visit;7d: $45/visit	;7a: $20/visit;7d: $45/visit	7g: $45/visit;14b: $20/visit;14i: 20%;14j: $20/visit7a: $20/visit;7d: $45/visit;8a: $45/visit;12a: 20%	15: 20%								14a: $0/visit												209.6540189	186.7603589	59.90596615		125	0.2	0.2	45	0.2	45	0.211534069	0.2	0.2	0.175986445	20	44.99902223	39.92068017	44.09253064	10.98142919	10.95917773	0.2																				NO	177.2956517	157.9354391	50.65997478		105.7072818	0.169131651	0.169131651	38.05462146	0.169131651	38.05462146	0.178885532	0.169131651	0.169131651	0.148874715	16.91316509	38.0537946	33.75925272	37.28721251	9.286536246	9.267719114	0.169131651																					18.5525	0.73461629	3.604593339	0	1.119163526	1.727822345	1.873123515	0.710090639	6.854419212	2.740958294	3.418862132	0.507314981	0.042725181	4.423337284	5.200079433	16.16297251	0.824447347	1.319232248	2.865598664	7.009949216	3.288289924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9801	0	15.143	18.5525	0.73461629	3.604593339	0	1.119163526	1.727822345	1.873123515	0.710090639	6.854419212	2.740958294	3.418862132	0.507314981	0.042725181	4.423337284	5.200079433	16.16297251	0.824447347	1.319232248	2.865598664	7.009949216	3.288289924	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.9801	NO	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 40%	OON: 40%;OON: 20%	OON: $50/visit;OON: $25/visit	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 40%;OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 20%;OON: $10/visit	OON: 20%	OON: 20%																				2.258	0.04	0.2985	0.2657	0.0639	0.2383	0.2295	0.0474	0.4516	0.0441	0.2206	0.0334	0.0028	0.3363	0.3417	1.0278	0.0222	0.0392	0.2638	0.1466	0.2268																				6.5981	0	0	20.8105	0.774658064	3.903102687	0.265686322	1.18304545	1.966127467	2.10257807	0.757471821	7.305973647	2.785020717	3.63949192	0.54070874	0.045543512	4.759634293	5.541763543	17.19079593	0.846671239	1.358472457	3.129414322	7.156504126	3.515054075	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.5783
H9847_003_0	2010	11	N/A																															D	D	D	V	T	Coin	Coin	V	V	V	Coin	Coin	Coin	V	V	V	V	V	V	V	Coin	P	T	P	V	P	V	P	O	P																																																			0	YES	1353.367167	60.15772902	920.2156515		136.9301593	11.01040826	11.93632823	241.333078	269.9845248	931.5485456	20.59850003	3.232823718	0.272262762	546.5452196	3968.093178	5494.759165	315.8497744	457.5850343	3990.911329	9782.559089	20.95436181				146.2204941																2950	1a: Days 1-10: $245.00/day then $0;1a1: Days 1-10: $245.00/day then $0	1b: Days 1-10: $180.00/day then $0 Lifetime limit of 190 days	2: Days 1-7: $0 copay Days 8-100: $110.00/day	6: $0/visit	10a: $100/trip	11a: 20%	11b: 20%;11c: 20%	4a: $50/visit;4a1: $50/visit;4b: $25/visit	9a: $250/visit;9b: 20%	8a: $30/visit	8b: $30/visit;8b: 20%	9a: 20%	12a: 20%	3: 20%;5: $245/visit;9a: 20%;9c: $30/visit;9d: $30/visit;7i: $30/visit;7e: $30/visit;7c: $30/visit	7a: $10/visit;14c: $10/visit	7b: $30/visit;7d: $30/visit;7f: $30/visit;14c1: $10/visit;16b: $30/visit;17a: $30/visit;18a: $30/visit	7e: $30/visit;7h: $30/visit;7a: $10/visit;7d: $30/visit	7c: $30/visit;7i: $30/visit;7a: $10/visit;7d: $30/visit	;7a: $10/visit;7d: $30/visit	7g: $30/visit;14b: $10/visit;14i: 20%;14j: $10/visit7a: $10/visit;7d: $30/visit;8a: $30/visit;12a: 20%	15: 20%			16a: $150.00 yearly allowance	17a1: $30/visit	17b1: $100.00 yearly allowance			14a: $0/visit												209.6540189	188.3593461	59.90596615		100	0.2	0.2	45	227.531592	30	0.202260263	0.2	0.2	37.06085822	10	30	29.92068017	29.27402452	7.23471007	7.146965249	0.2				30																NO	166.1794037	149.3004713	47.48364848		79.26363855	0.158527277	0.158527277	35.66863735	180.3498186	23.77909156	0.160318844	0.158527277	0.158527277	29.42332307	7.926363855	23.77909156	23.71621978	23.20365698	5.73449444	5.664944702	0.158527277				23.77909156																	18.7418	0.748464775	3.641266377	0	0.904465221	1.745450042	1.892233613	0.71733517	4.05763834	1.84594818	3.302327713	0.512490741	0.043161074	1.340098048	2.621045861	10.88836511	0.624230222	0.884803848	1.907154902	4.618138023	3.321837921	0	0	0	0.28974921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.648	0	16.91	18.7418	0.748464775	3.641266377	0	0.904465221	1.745450042	1.892233613	0.71733517	4.05763834	1.84594818	3.302327713	0.512490741	0.043161074	1.340098048	2.621045861	10.88836511	0.624230222	0.884803848	1.907154902	4.618138023	3.321837921	0	0	0	0.28974921	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.648	NO	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 40%	OON: 40%;OON: 20%	OON: $50/visit;OON: $25/visit	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 40%;OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 20%	OON: 20%;OON: $10/visit	OON: 20%	OON: 20%		OON: $150.00 yearly allowance	OON: 20%	OON: $100.00 yearly allowance																2.4336	0.0432	0.3217	0.2864	0.0689	0.2568	0.2473	0.051	0.4867	0.0475	0.2378	0.036	0.003	0.3625	0.3674	1.1079	0.024	0.0423	0.2843	0.158	0.2444				0.0112																7.1218	0	0	21.1754	0.791620909	3.962984153	0.286350814	0.973315739	2.002290007	2.139534633	0.768334591	4.544313676	1.893437679	3.540117596	0.548481793	0.046198609	1.70255149	2.988488093	11.99625223	0.648182639	0.927096073	2.191489556	4.776091649	3.566239283	0	0	0	0.300979879	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.7698
H9847_801_0	2010	2	N/A																															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																																																			0	NO	236.4613915	4.241101438	31.58243141		6.162563965	11.43854592	12.40047011	13.59574315	45.37769124	4.426926295	22.18901058	3.35853146	0.282849648	33.75177056	34.1352169	104.913529	2.268306712	4.006293981	26.9423623	14.99050145	21.76916822																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.081759324	0.081759324	0.182685712		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.081759324	0.081759324	0.182685712		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.3329	0.346749586	5.769658964	0	1.435877404	2.665181199	2.889309534	3.167808155	10.57300206	1.031473827	5.170039465	0.78253783	0.065903968	7.864162541	7.953505538	24.44485225	0.528515464	0.933466498	6.277570415	3.492786839	5.072216196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7975	0	0	19.3329	0.346749586	5.769658964	0	1.435877404	2.665181199	2.889309534	3.167808155	10.57300206	1.031473827	5.170039465	0.78253783	0.065903968	7.864162541	7.953505538	24.44485225	0.528515464	0.933466498	6.277570415	3.492786839	5.072216196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7975	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				1.0213	0.0183	0.3052		0.0833	0.1554	0.1685	0.1765	0.589	0.0575	0.2878	0.0436	0.0037	0.438	0.432	1.3409	0.029	0.0512	0.3441	0.1912	0.2958																				6.0323	0	0	20.3543	0.365077677	6.074842727	0	1.519207241	2.820608007	3.057806956	3.344287804	11.16202561	1.088950406	5.457836752	0.826097829	0.069580298	8.302159546	8.385503015	25.78572893	0.557505093	0.984652811	6.621700876	3.683958239	5.368015362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8298
H9847_802_0	2010	2	N/A																															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																																																			0	NO	236.4613915	4.241101438	31.58243141		6.162563965	11.43854592	12.40047011	13.59574315	45.37769124	4.426926295	22.18901058	3.35853146	0.282849648	33.75177056	34.1352169	104.913529	2.268306712	4.006293981	26.9423623	14.99050145	21.76916822																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.081759324	0.081759324	0.182685712		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.081759324	0.081759324	0.182685712		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.3329	0.346749586	5.769658964	0	1.435877404	2.665181199	2.889309534	3.167808155	10.57300206	1.031473827	5.170039465	0.78253783	0.065903968	7.864162541	7.953505538	24.44485225	0.528515464	0.933466498	6.277570415	3.492786839	5.072216196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7975	0	0	19.3329	0.346749586	5.769658964	0	1.435877404	2.665181199	2.889309534	3.167808155	10.57300206	1.031473827	5.170039465	0.78253783	0.065903968	7.864162541	7.953505538	24.44485225	0.528515464	0.933466498	6.277570415	3.492786839	5.072216196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7975	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				1.0213	0.0183	0.3052		0.0833	0.1554	0.1685	0.1765	0.589	0.0575	0.2878	0.0436	0.0037	0.438	0.432	1.3409	0.029	0.0512	0.3441	0.1912	0.2958																				6.0323	0	0	20.3543	0.365077677	6.074842727	0	1.519207241	2.820608007	3.057806956	3.344287804	11.16202561	1.088950406	5.457836752	0.826097829	0.069580298	8.302159546	8.385503015	25.78572893	0.557505093	0.984652811	6.621700876	3.683958239	5.368015362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8298
H9847_803_0	2010	2	N/A																															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																																																			0	NO	236.4613915	4.241101438	31.58243141		6.162563965	11.43854592	12.40047011	13.59574315	45.37769124	4.426926295	22.18901058	3.35853146	0.282849648	33.75177056	34.1352169	104.913529	2.268306712	4.006293981	26.9423623	14.99050145	21.76916822																					Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																			0.081759324	0.081759324	0.182685712		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																				NO	0.081759324	0.081759324	0.182685712		0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																					19.3329	0.346749586	5.769658964	0	1.435877404	2.665181199	2.889309534	3.167808155	10.57300206	1.031473827	5.170039465	0.78253783	0.065903968	7.864162541	7.953505538	24.44485225	0.528515464	0.933466498	6.277570415	3.492786839	5.072216196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7975	0	0	19.3329	0.346749586	5.769658964	0	1.435877404	2.665181199	2.889309534	3.167808155	10.57300206	1.031473827	5.170039465	0.78253783	0.065903968	7.864162541	7.953505538	24.44485225	0.528515464	0.933466498	6.277570415	3.492786839	5.072216196	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	109.7975	NO	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS	Medicare FFS																				1.0213	0.0183	0.3052		0.0833	0.1554	0.1685	0.1765	0.589	0.0575	0.2878	0.0436	0.0037	0.438	0.432	1.3409	0.029	0.0512	0.3441	0.1912	0.2958																				6.0323	0	0	20.3543	0.365077677	6.074842727	0	1.519207241	2.820608007	3.057806956	3.344287804	11.16202561	1.088950406	5.457836752	0.826097829	0.069580298	8.302159546	8.385503015	25.78572893	0.557505093	0.984652811	6.621700876	3.683958239	5.368015362	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	115.8298
H9859_001_0	2010	3	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	333.0704862	6.060156321	921.2506674	1156.871556	162.5144405	6.819062383	6.247923287	207.9260615	33.62143115		514.6573062	41.47254105		58.24951715	3637.228334	6739.579816	309.6240363	1335.418876		4.371288083	19.5579629				112.5641762		1.548497397			0.25											3400	$300 per stay/$900 max	$300 per stay/$900 max	$0 days 1-15; $65/day days 16-100	"$0 days 1-20, $25 days 21+"	$50 Copay	20.00%	20.00%	$50 ER Copay;$25 UC Copay	20.0% for OP Surgery and Cardiac Cath.;$75 for ASC	$0 Copay	"$25 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$0 Copay for Preventive Services	$25 Copay	$25 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts	$25 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 Copay	$100 allowance	$25 exam Copay	No coverage	No Cost Sharing	50.0% for Accupuncture											238.1347604	292.4791086	29.81552011	5.389854392	50	0.2	0.2	49.96229602	0.194317392		25	25		25	15	25	25	25		37.67225307	0.101666989				25		25			0.5											NO	214.3092899	261.4816371	26.65561669	4.818627753	44.70090844	0.178803634	0.178803634	44.6672004	0.173723279		22.35045422	22.35045422		22.35045422	13.41027253	22.35045422	22.35045422	22.35045422		33.6796787	0.090892135				22.35045422		22.35045422			0.447009084												5.9483	0.132051633	2.046375389	0.464544449	0.605378594	1.219273133	1.117151387	0.773956255	5.840825267	0	0.958568713	0.077244178	0	0.108491931	4.064685268	12.55272251	0.576686487	2.487268204	0	0.012268632	1.77766501	0	0	0	0.209655039	0	0.002884135	0	0	0.111752271	0	0	0	0	0	0	0	0	0	0	41.0878	0	4.826920259	5.9483	0.132051633	2.046375389	0.464544449	0.605378594	1.219273133	1.117151387	0.773956255	5.840825267	0	0.958568713	0.077244178	0	0.108491931	4.064685268	12.55272251	0.576686487	2.487268204	0	0.012268632	1.77766501	0	0	0	0.209655039	0	0.002884135	0	0	0.111752271	0	0	0	0	0	0	0	0	0	0	41.0878	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									0.7692											0.7692	0	0	5.9483	0.132051633	2.046375389	0.464544449	0.605378594	1.219273133	1.117151387	0.773956255	5.840825267	0	0.958568713	0.077244178	0	0.108491931	4.064685268	12.55272251	0.576686487	2.487268204	0	0.012268632	1.77766501	0	0	0	0.209655039	0	0.002884135	0	0	0.880961499	0	0	0	0	0	0	0	0	0	0	41.857
H9859_002_0	2010	7	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	320.0949761	5.861720854	720.932893	331.4822391	136.5629144	6.803292662	3.106728541	193.4510106	28.51510172		667.030395	29.43419965		38.04136965	3879.899173	5651.063229	233.1126038	918.3491581		16.64373644	36.19550236				178.4590962		2.958617631			0.25											3400	$300 per stay/$900 max	$300 per stay/$900 max	$0 days 1-15; $65/day days 16-100	"$0 days 1-20, $25 days 21+"	$50 Copay	20.00%	20.00%	$50 ER Copay;$25 UC Copay	20.0% for OP Surgery and Cardiac Cath.;$75 for ASC	$0 Copay	"$25 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$25 Copay	$0 Copay	"$25 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$25 Copay for PCP Ophthalmology Services	$25 Copay for Office Visits;$0 Copay for Preventive Services	$25 Copay	$25 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts	$25 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No coverage	No coverage	$25 Copay	$100 allowance	$25 exam Copay	No coverage	No Cost Sharing	50.0% for Accupuncture											263.6146761	292.4791086	29.81552011	5.389854392	50	0.2	0.2	49.37431511	0.197791786		25	25		25	15.00146552	25	25	25		46.14366325	0.065944438				25		25			0.5											NO	246.5831915	266.5180091	27.1690279	4.911438867	45.56188823	0.182247553	0.182247553	45.0159557	0.180235345		22.78094411	22.78094411		22.78094411	13.66990191	22.78094411	22.78094411	22.78094411		42.04784855	0.060091062				22.78094411		22.78094411			0.5												6.5775	0.130187848	1.632253824	0.135671229	0.518505354	1.239883439	0.566193674	0.72569851	5.139429185	0	1.266298513	0.055878238	0	0.072218193	4.419820092	10.7280463	0.442543767	1.743405071	0	0.058319442	2.175026192	0	0	0	0.338788891	0	0.005616675	0	0	0.125	0	0	0	0	0	0	0	0	0	0	38.0963	0	3.511898423	6.5775	0.130187848	1.632253824	0.135671229	0.518505354	1.239883439	0.566193674	0.72569851	5.139429185	0	1.266298513	0.055878238	0	0.072218193	4.419820092	10.7280463	0.442543767	1.743405071	0	0.058319442	2.175026192	0	0	0	0.338788891	0	0.005616675	0	0	0.125	0	0	0	0	0	0	0	0	0	0	38.0963	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									0.5643											0.5643	0	0	6.5775	0.130187848	1.632253824	0.135671229	0.518505354	1.239883439	0.566193674	0.72569851	5.139429185	0	1.266298513	0.055878238	0	0.072218193	4.419820092	10.7280463	0.442543767	1.743405071	0	0.058319442	2.175026192	0	0	0	0.338788891	0	0.005616675	0	0	0.689331816	0	0	0	0	0	0	0	0	0	0	38.6606
H9859_003_0	2010	3	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	262.1827956	5.0366403	1015.165129	2130.551881	118.62724	6.552012674	10.37389951	197.2483824	30.38422572		281.4767276	35.0592733		86.88844437	3243.814291	7358.317055	392.3039191	1951.361645			24.96618492				4.623795989		2.940904825			0.25											3400	$500 per stay	$500 per stay	$0(day 1-15) $65 (days 16-100)	"$0 days 1-20, $30 days 21+"	$100 Copay	25.00%	20.00%	$50 ER Copay;$30 UC Copay	20.0% for OP Surgery and Cardiac Cath.;$100 for ASC	$0 Copay	"$30 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$30 Copay	$0 Copay	"$30 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$30 Copay for PCP Ophthalmology Services	$30 Copay for Office Visits;$0 Copay for Preventive Services	$30 Copay	$30 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$30 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$30 Copay	$100 allowance	$30 exam Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture											500	500	29.81552011	6.46782527	100	0.25	0.239170915	49.93959283	0.190971637		30	30		30	15	30	30	30			0.107026706				30		30			0.5											NO	423.7925803	423.7925803	25.27119241	5.482032721	84.75851607	0.21189629	0.202717718	42.32805781	0.161864726		25.42755482	25.42755482		25.42755482	12.71377741	25.42755482	25.42755482	25.42755482			0.090714248				25.42755482		25.42755482			0.42379258												9.2593	0.177874232	2.137869442	0.973312927	0.837889069	1.388347179	2.10297324	0.695761744	4.918134357	0	0.596438744	0.074289299	0	0.18411339	3.436761071	15.59200086	0.831277451	4.134862934	0	0	2.264788696	0	0	0	0.009797652	0	0.006231668	0	0	0.105948145	0	0	0	0	0	0	0	0	0	0	49.7279	0	8.942198586	9.2593	0.177874232	2.137869442	0.973312927	0.837889069	1.388347179	2.10297324	0.695761744	4.918134357	0	0.596438744	0.074289299	0	0.18411339	3.436761071	15.59200086	0.831277451	4.134862934	0	0	2.264788696	0	0	0	0.009797652	0	0.006231668	0	0	0.105948145	0	0	0	0	0	0	0	0	0	0	49.7279	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									0.0684											0.0684	0	0	9.2593	0.177874232	2.137869442	0.973312927	0.837889069	1.388347179	2.10297324	0.695761744	4.918134357	0	0.596438744	0.074289299	0	0.18411339	3.436761071	15.59200086	0.831277451	4.134862934	0	0	2.264788696	0	0	0	0.009797652	0	0.006231668	0	0	0.174307316	0	0	0	0	0	0	0	0	0	0	49.7963
H9859_004_0	2010	9	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	214.2594896	3.159575633	764.5542592	1338.075732	105.5530665	4.775616058	6.320520415	192.6028948	35.20098098		288.0490615	23.5203526		54.50669399	3499.79392	6599.078204	353.9906624	1488.534179		4.448007354	36.72950734				94.06014015		1.960226538			0.25											3400	$500 per stay	$500 per stay	$0(day 1-15) $65 (days 16-100)	"$0 days 1-20, $30 days 21+"	$100 Copay	25.00%	20.00%	$50 ER Copay;$30 UC Copay	20.0% for OP Surgery and Cardiac Cath.;$100 for ASC	$0 Copay	"$30 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$30 Copay	$0 Copay	"$30 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$30 Copay for PCP Ophthalmology Services	$30 Copay for Office Visits;$0 Copay for Preventive Services	$30 Copay	$30 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$30 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$30 Copay	$100 allowance	$30 exam Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture											500	500	29.81552011	6.46782527	100	0.25	0.238546387	49.5781477	0.196640567		30	30		30	15	30	30	30		50.65948785	0.071930358				30		30			0.5											NO	435.4556931	435.4556931	25.96667595	5.632902672	87.09113862	0.217727847	0.207752765	43.18021722	0.171256509		26.12734159	26.12734159		26.12734159	13.06367079	26.12734159	26.12734159	26.12734159		44.11992479	0.062644968				26.12734159		26.12734159			0.5												7.775	0.1146546	1.654411058	0.628104197	0.766061396	1.0397846	1.313105592	0.693052903	6.028397112	0	0.627163019	0.051210357	0	0.118676251	3.810012968	14.36803086	0.770736246	3.240953412	0	0.016353812	2.300918819	0	0	0	0.204795118	0	0.004267959	0	0	0.125	0	0	0	0	0	0	0	0	0	0	45.6507	0	6.747897749	7.775	0.1146546	1.654411058	0.628104197	0.766061396	1.0397846	1.313105592	0.693052903	6.028397112	0	0.627163019	0.051210357	0	0.118676251	3.810012968	14.36803086	0.770736246	3.240953412	0	0.016353812	2.300918819	0	0	0	0.204795118	0	0.004267959	0	0	0.125	0	0	0	0	0	0	0	0	0	0	45.6507	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									2.1145											2.1145	0	0	7.775	0.1146546	1.654411058	0.628104197	0.766061396	1.0397846	1.313105592	0.693052903	6.028397112	0	0.627163019	0.051210357	0	0.118676251	3.810012968	14.36803086	0.770736246	3.240953412	0	0.016353812	2.300918819	0	0	0	0.204795118	0	0.004267959	0	0	2.239532698	0	0	0	0	0	0	0	0	0	0	47.7653
H9859_802_0	2010	3	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES			1128.41796	94.25882251	298.397111	8.952591999	3.028188063	291.7561634	35.97791714		790.1470824	42.2980409		22.98083356	4317.939185	7322.429363	179.4253634	1110.938778		26.69376842	44.81052854				185.2688553		0.024742263			0.25											4000	$0 Copay	$0 Copay	$0(day 1-15) $65 (days 16-100)	"$0 days 1-20, $15 days 21+"	$50 Copay	20.00%	20.00%	$50 ER Copay;$15 UC Copay	20.0% for OP Surgery and Cardiac Cath.;$0 for ASC	$0 Copay	"$15 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$15 Copay	$0 Copay	"$15 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$10 Copay for Office Visits;$0 Copay for Preventive Services;$15 Copay for PCP Ophthalmology Services	$15 Copay for Office Visits;$0 Copay for Preventive Services	$15 Copay	$15 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$15 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$15 Copay	No Coverage	$15 exam Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture													29.81552011	3.233912635	50	0.2	0.2	49.23420983	0.2		15	15		15	10	15	15	15		44.48337757	0.054962316				14.95937823		15			0.5											NO			28.50263447	3.091511716	47.7983184	0.191193274	0.191193274	47.07734739	0.191193274		14.33949552	14.33949552		14.33949552	9.55966368	14.33949552	14.33949552	14.33949552		42.5246129	0.052542125				14.30302675		14.33949552			0.5												0	0	2.680240387	0.024283521	1.188573343	1.711675371	0.578969189	1.144592188	6.878735755	0	0.944192546	0.050544381	0	0.02746113	3.4398372	8.749995254	0.214405766	1.327525136	0	0.094595181	2.354440408	0	0	0	0.220825449	0	2.96E-05	0	0	0.125	0	0	0	0	0	0	0	0	0	0	31.7559	0	1.456660059	0	0	2.680240387	0.024283521	1.188573343	1.711675371	0.578969189	1.144592188	6.878735755	0	0.944192546	0.050544381	0	0.02746113	3.4398372	8.749995254	0.214405766	1.327525136	0	0.094595181	2.354440408	0	0	0	0.220825449	0	2.96E-05	0	0	0.125	0	0	0	0	0	0	0	0	0	0	31.7559	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									0.6225											0.6225	0	0	0	0	2.680240387	0.024283521	1.188573343	1.711675371	0.578969189	1.144592188	6.878735755	0	0.944192546	0.050544381	0	0.02746113	3.4398372	8.749995254	0.214405766	1.327525136	0	0.094595181	2.354440408	0	0	0	0.220825449	0	2.96E-05	0	0	0.747468707	0	0	0	0	0	0	0	0	0	0	32.3784
H9859_804_0	2010	3	N/A																															A	A	D	P	T	Coin	Coin	V	Coin	V	V	V	V	V	P	P	P	P	P	P	Coin	P	T	P	P	P	P	P	O	Coin																																																			0	YES	307.5660239	3.502646963	1031.004358	1491.955087	167.3757211	9.084699859	7.605414519	214.0078057	33.81675524		377.8696408	38.95109317		60.42511032	4029.05026	7606.649161	354.0140356	1789.103707		5.658559868	26.0203734				85.21936645		2.264247388			0.25											4000	$100 per stay/$300 max ($0 w/rider) Copay	$100 per stay/$300 max ($0 w/rider) Copay	$0(day 1-15) $65 (days 16-100)        ($0 w/rider)	"$0 days 1-20, $20 days 21+"	$50 Copay	20.00%	20.00%	$50 ER Copay;$20 UC Copay	20.0% for OP Surgery and Cardiac Cath.;$0 for ASC	$0 Copay	"$20 Copay for MRI, CT, Other Imaging, and Diag Rad.;$0 Copay for Nuclear Med. and Radiation Therapy"	$20 Copay	$0 Copay	"$20 Copay for Card. Rehab, CORF, OP MH/SA, and Part. Hosp.;$0 Copay for Chemotherapy"	$15 Copay for Office Visits;$0 Copay for Preventive Services;$20 Copay for PCP Ophthalmology Services	$20 Copay for Office Visits;$0 Copay for Preventive Services	$20 Copay	$20 Copay	No Cost Sharing	20% of the cost for diabetic related shoe inserts Copay for foot inserts	$20 Copay for Prof. Admin Rx;20.0% Copay for other Part B Rx	$0 Copay	No Coverage	No coverage	$20 Copay	No Coverage	$20 exam Copay	No Coverage	No Cost Sharing	50.0% for Accupuncture											86.70576891	97.49303621	29.81552011	4.311883513	50	0.2	0.2	49.73864482	0.2		20	20		20	15	20	20	20		51.1326497	0.07990012				20		20			0.5											NO	80.90586439	90.97036983	27.82074491	4.0234016	46.65480395	0.186619216	0.186619216	46.41093446	0.186619216		18.66192158	18.66192158		18.66192158	13.99644119	18.66192158	18.66192158	18.66192158		47.71167495	0.074554489				18.66192158		18.66192158			0.46654804												2.0737	0.026553091	2.39027577	0.500227874	0.650740121	1.695379564	1.419316494	0.827691854	6.310856345	0	0.5876478	0.060575187	0	0.093970723	4.699363751	11.82955751	0.550548514	2.782342757	0	0.022498281	1.93993563	0	0	0	0.132529761	0	0.003521267	0	0	0.11663701	0	0	0	0	0	0	0	0	0	0	38.7138	0	2.775791202	2.0737	0.026553091	2.39027577	0.500227874	0.650740121	1.695379564	1.419316494	0.827691854	6.310856345	0	0.5876478	0.060575187	0	0.093970723	4.699363751	11.82955751	0.550548514	2.782342757	0	0.022498281	1.93993563	0	0	0	0.132529761	0	0.003521267	0	0	0.11663701	0	0	0	0	0	0	0	0	0	0	38.7138	NO	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	No Coverage	30%; $5k/yr max benefit for Travel																																									2.222											2.222	0	0	2.0737	0.026553091	2.39027577	0.500227874	0.650740121	1.695379564	1.419316494	0.827691854	6.310856345	0	0.5876478	0.060575187	0	0.093970723	4.699363751	11.82955751	0.550548514	2.782342757	0	0.022498281	1.93993563	0	0	0	0.132529761	0	0.003521267	0	0	2.338598696	0	0	0	0	0	0	0	0	0	0	40.9358
H9988_001_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	812.7586084	13.32781863	466.8594179	14.45593498	232.0530798	11.16824114	11.78087079	577.4790617	82.23953669	25.47557779	29.98289613	0.000288404	0.298221224	0	4511.807275	2265.056587	1.351612366	8.029691845	0	4.661933219	23.66996801	0.677518472																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	132.3721977	132.3721977	44.12406589	0	132.3721977	0.176496264	0.176496264	44.12406589	0.132372198	0	0.132372198	0.441240659	0.132372198	0	17.64962635	35.29925271	0.441240659	0.132372198	35.29925271	0	0.176496264	0.132372198																			4000	8.9656	0.147019387	1.716644643	0	2.559781345	1.971152832	2.079279676	2.12339368	10.88622821	0	3.968901853	0.000127255	0.039476199	0	6.63597605	6.662900407	0.596386331	1.062907956	0	0	4.177660913	0.089684609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6831		7.15	8.9656	0.147019387	1.716644643	0	2.559781345	1.971152832	2.079279676	2.12339368	10.88622821	0	3.968901853	0.000127255	0.039476199	0	6.63597605	6.662900407	0.596386331	1.062907956	0	0	4.177660913	0.089684609	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.6831	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.3052	0.0214	0.237	0	0.0361	0.3201	0.3376	0.2744	1.8751	0	0.6835	0	0.0068	0	1.0284	0.9387	0.0721	0.1591	0	0	0.059	0.0013																			7.3557		0.02	10.2707	0.168421973	1.953652578	0	2.595917807	2.291228101	2.416912553	2.397749008	12.76134346	0	4.65241996	0.000144146	0.046276523	0	7.66433067	7.601580727	0.668469263	1.221994983	0	0	4.236636999	0.090950688	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.0388
H9988_002_0	2010	6	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	812.7586084	13.32781863	466.8594179	14.15159951	232.0530798	10.93312028	11.53285246	577.4790617	80.50817803	24.93924984	29.35167726	0.000282332	0.291942882	0	4511.807275	2265.056587	1.323157369	7.860645701	0	4.563787256	23.1716529	0.663254925																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	132.6184611	132.6184611	44.20615368	0	132.6184611	0.176824615	0.176824615	44.20615368	0.132618461	0	0.132618461	0.442061537	0.132618461	0	17.68246147	35.36492295	0.442061537	0.132618461	35.36492295	0	0.176824615	0.132618461																			4000	8.9822	0.1472929	1.719838265	0	2.564543527	1.933244781	2.039292193	2.127344012	10.67687067	0	3.892574268	0.000124808	0.038717016	0	6.648321527	6.675295974	0.58491698	1.042466736	0	0	4.097318596	0.087959847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2584		6.980266291	8.9822	0.1472929	1.719838265	0	2.564543527	1.933244781	2.039292193	2.127344012	10.67687067	0	3.892574268	0.000124808	0.038717016	0	6.648321527	6.675295974	0.58491698	1.042466736	0	0	4.097318596	0.087959847	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.2584	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.3065	0.0214	0.2372	0	0.0359	0.3199	0.3374	0.2746	1.8743	0	0.6829	0	0.0068	0	1.0295	0.9396	0.072	0.1589	0	0	0.0574	0.0012																			7.3557		0.016703395	10.2888	0.168717826	1.9570844	0	2.600477844	2.253095207	2.376687894	2.401960938	12.55112221	0	4.575518899	0.000141677	0.045513523	0	7.677793974	7.614933803	0.656888394	1.201408793	0	0	4.154730118	0.089192339	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.614
H9988_003_0	2010	4	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.4217018	23.12526479	438.72949	26.19162759	200.3283555	12.58274795	11.02524589	548.3143311	76.9497106	24.05711449	26.99941067	0.010227378	0.10594628	0.018730848	4102.980133	1904.398064	1.942254871	6.899407679	0	4.488246854	21.21241729	0.560248481																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	133.9569495	133.9569495	44.65231652	0	133.9569495	0.178609266	0.178609266	44.65231652	0.13395695	0	0.13395695	0.446523165	0.13395695	0.446523165	17.86092661	35.72185321	0.446523165	0.13395695	35.72185321	0	0.178609266	0.13395695																			4000	8.6226	0.258149161	1.632524004	0	2.236281285	2.247395376	1.969211077	2.040292089	10.3079485	0	3.616758693	0.004566761	0.01419224	0.008363758	6.106918918	5.669052342	0.867261792	0.924223606	0	0	3.788734283	0.075049178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3895		6.03	8.6226	0.258149161	1.632524004	0	2.236281285	2.247395376	1.969211077	2.040292089	10.3079485	0	3.616758693	0.004566761	0.01419224	0.008363758	6.106918918	5.669052342	0.867261792	0.924223606	0	0	3.788734283	0.075049178	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	50.3895	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2414	0.0372	0.2228	0	0.0284	0.3478	0.3048	0.2753	1.6929	0	0.5939	0.0006	0.0023	0.0011	0.9365	0.7896	0.0997	0.1376	0	0.0001	0.0481	0.001																			6.7609		0.01	9.864	0.295313812	1.855305393	0	2.264662017	2.595209688	2.27397267	2.315582261	12.00087213	0	4.210681232	0.005143766	0.0165231	0.009420509	7.04336957	6.458623317	0.966982209	1.061864565	0	6.82E-05	3.836817256	0.07600163	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1504
H9988_004_0	2010	7	N/A																															D	D	D	Coin	T	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	Coin	Coin																																																											0	YES	772.4217018	23.12526479	438.72949	25.6625038	200.3283555	12.32855102	10.80251365	548.3143311	75.39517099	23.57111218	26.45396803	0.010020764	0.103805951	0.018352447	4102.980133	1904.398064	1.903017399	6.760025706	0	4.3975752	20.7838836	0.54893033																			4000	$150 - days 1-5	$150 - days 1-5	$50 - days 11-100	0% Coinsurance	$150 Copay	20% Coinsurance	20% Coinsurance	$50 Copay	15% Coinsurance	0% Coinsurance	15% Coinsurance	50% Coinsurance	15% Coinsurance	50% Coinsurance	$20 Copay	$40 Copay	50% Coinsurance	15% Coinsurance	$40 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																			150	150	50	0	150	0.2	0.2	50	0.2	0	0.15	0.5	0.15	0.5	20	40	0.5	0.15	40	0	0.2	0.15																			YES	134.1152648	134.1152648	44.70508828	0	134.1152648	0.178820353	0.178820353	44.70508828	0.134115265	0	0.134115265	0.447050883	0.134115265	0.447050883	17.88203531	35.76407062	0.447050883	0.134115265	35.76407062	0	0.178820353	0.134115265																			4000	8.6328	0.258454251	1.634453382	0	2.238924205	2.204595847	1.931709306	2.042703381	10.11164332	0	3.547880928	0.004479791	0.013921963	0.008204478	6.114136301	5.675752238	0.850745608	0.906622638	0	0	3.716581405	0.073619937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9672		5.92	8.6328	0.258454251	1.634453382	0	2.238924205	2.204595847	1.931709306	2.042703381	10.11164332	0	3.547880928	0.004479791	0.013921963	0.008204478	6.114136301	5.675752238	0.850745608	0.906622638	0	0	3.716581405	0.073619937	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	49.9672	NO	$175 - days 1-5	$175 - days 1-5	$55 - days 11-100	0% Coinsurance	$150 Copay	25% Coinsurance	25% Coinsurance	$50 Copay	20% Coinsurance	0% Coinsurance	20% Coinsurance	50% Coinsurance	20% Coinsurance	50% Coinsurance	$25 Copay	$45 Copay	50% Coinsurance	20% Coinsurance	$45 Copay	$0 Copay	20% Coinsurance	15% Coinsurance																				1.2425	0.0372	0.223	0	0.0283	0.3476	0.3045	0.2755	1.6919	0	0.5936	0.0006	0.0023	0.0011	0.9373	0.7903	0.0996	0.1375	0	0.0001	0.047	0.0009																			6.7609		0.01	9.8753	0.295653053	1.85743667	0	2.267263541	2.552159987	2.236251694	2.31824228	11.80353167	0	4.141440129	0.005056139	0.016251397	0.009260025	7.051460623	6.466042644	0.950329853	1.044154518	0	6.83E-05	3.763624289	0.074551786	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	56.7281
R3175_001_0	2010	4	25																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1011.352922	124.4738458	420.8283686	2.782223559	97.55498614	3.127852785	4.841199551	317.9182674	22.23837652	8909.31312	25.23752754	0	0.373598698	11.82573291	4879.179384	3022.542691	384.2689133	414.8623488	0	0	4.673001879	1002.802738	0	297.5231241	123.7987216	172.2024543	12.70211635	4.485273228	88.92969654	0											3400	"$275 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$25 (16a1, 16a2); $0 n/c (16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											231.8698959	176.1020882	81.80667226	0	150	0.2	0.083594904	49.9589481	0.2	3	0.1692557	0	0.2	0.151937273	6.848029779	34.98588132	38.5	35	0	0	0.2	34.58637043	0	25	35	0	0	0	0	0											NO	181.3159728	137.707059	63.97059999	0	117.2959336	0.156394578	0.065368949	39.06654307	0.156394578	2.345918672	0.132353369	0	0.156394578	0.118810828	5.354973642	27.46267144	30.1059563	27.36905118	0	0	0.156394578	27.04560407	0	25	35	0	0	0	0	0												15.2812	1.428410602	2.243386936	0	0.953566932	0.489179217	0.316464125	1.034997307	3.477961514	1.741710334	3.340271787	0	0.058428811	1.405025123	2.177323083	6.917258069	0.964065259	0.946199071	0	0	0.730832158	2.260117151	0	0.619839842	0.361079605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7473	0	12.72672542	15.2812	1.428410602	2.243386936	0	0.953566932	0.489179217	0.316464125	1.034997307	3.477961514	1.741710334	3.340271787	0	0.058428811	1.405025123	2.177323083	6.917258069	0.964065259	0.946199071	0	0	0.730832158	2.260117151	0	0.619839842	0.361079605	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	46.7473	YES	"$375 Days 1-21 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-21 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-52 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$30 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$30 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"50% (16a1, 16a2); $0 n/c (16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											7800	1.4817	0.1694	0.4254	0.0012	0.2023	0.1556	0.2409	0.2195	1.1066	0.3695	1.0443	0	0.0124	0.4448	2.5387	2.999	0.3728	0.4164	0	0	0.3752	0.9994	0	0.0652	0.1589	0	0.0163	0.003	0	0											13.8186	0	3.755715904	16.7629	1.597764053	2.668793581	0.001160914	1.155838705	0.644827149	0.557371467	1.25454219	4.584585632	2.111164041	4.384551063	0	0.070822801	1.849805825	4.716053513	9.916292448	1.336902142	1.362599238	0	0	1.106058064	3.259515014	0	0.685086141	0.519982326	0	0.016303891	0.002950838	0	0	0	0	0	0	0	0	0	0	0	0	60.5659
R3175_002_0	2010	4	25																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1012.90546	118.9592647	403.7116329	1.519619692	109.6821582	3.429167327	4.480299253	333.3355759	23.68123559	8840.534948	23.97374721	0	0.048162228	15.29279173	4984.686511	3853.591408	381.4718327	385.931132	0	0	3.79941534	1023.155899	0	302.48	104.2551182	175.0714286	12.92610572	3.648	83.75668031	530.8125											3400	"$275 Days 1-13 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"$25 Days 1-100 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $10 (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$25 (16a1, 16a2); $0 n/c (16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$10 (13b); $0 n/c (13c, 13d, 13e)"											237.9055032	176.1020882	24.94650485	0	150	0.2	0.109532489	49.96738675	0.2	3	0.171751029	0	0.2	0.151215074	6.768627344	31.49911667	38.5	35	0	0	0.2	34.53782824	0	25	35	0	0	0	0	10											NO	210.5155786	136.4454655	19.32877402	0	116.2213352	0.15496178	0.084866747	38.71517604	0.15496178	2.324426705	0.133074226	0	0.15496178	0.117162785	5.244392718	24.80218516	29.83014271	27.11831156	0	0	0.15496178	26.76021676	0	25	35	0	0	0	0	10												17.7694	1.352621021	0.65027091	0	1.062283907	0.531389874	0.380228424	1.075428792	3.669686428	1.712431293	3.190287861	0	0.007463305	1.791746076	2.178471136	7.964790635	0.948279934	0.872150056	0	0	0.588764165	2.281656136	0	0.630166667	0.304077428	0	0	0	0	0.44234375	0	0	0	0	0	0	0	0	0	0	49.4039	0	13.79440824	17.7694	1.352621021	0.65027091	0	1.062283907	0.531389874	0.380228424	1.075428792	3.669686428	1.712431293	3.190287861	0	0.007463305	1.791746076	2.178471136	7.964790635	0.948279934	0.872150056	0	0	0.588764165	2.281656136	0	0.630166667	0.304077428	0	0	0	0	0.44234375	0	0	0	0	0	0	0	0	0	0	49.4039	YES	"$375 Days 1-21 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-21 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-52 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$45 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$30 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$45 (7b, 7d, 7f, 7f1); 50% (7b1)"	"$45/$35 (7e, 7h)"	"$45 (7c, 7i)"	Included in h.2.	$30 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $45 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"50% (16a1, 16a2); $0 n/c (16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$45 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$45 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"50% (13b); $0 n/c (13c, 13d, 13e)"											7800	1.5467	0.1604	0.4044	0.001	0.2253	0.1691	0.2209	0.2281	1.1676	0.3632	0.9948	0	0.0016	0.568	2.554	3.5377	0.3667	0.3838	0	0	0.3023	1.0088	0	0.0663	0.1338	0	0.0166	0.008	0	0.2574											14.6866	0	4.016277303	19.316	1.512988801	1.05463579	0.001004901	1.287616857	0.70046847	0.601134154	1.303550051	4.837313927	2.075674295	4.185056909	0	0.00904643	2.359776488	4.732511725	11.50245068	1.315012094	1.255962977	0	0	0.891049123	3.290483047	0	0.6965	0.43789482	0	0.016591394	0.008	0	0.699734375	0	0	0	0	0	0	0	0	0	0	64.0905
R3175_003_0	2010	4	25																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.6916	0.7432	0.6111	0	0.9051	0	1.1551	0	0.0105	0.6904	1.0712	3.7195	0.3493	0.1555	0	0	0.7187	0.1909	0	0	0	0	0	0	0	0											11.012	YES	313.2711641	16.74941522	48.24947884	967.9795408	14.06032957	15.59108345	12.66535582	22.85854424	19.14994966	10.9040754	24.4178109	0	0.203836426	14.70467013	23.92621935	78.27118075	6.609196859	3.177413156	0	0	15.23872236	4.176972552	501.1257619	315.30198	93.14529429	117.7514651	0	0	63.48984684	0											3400	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.071738824	0.072610145	0.142523248	0	0.2	0.2	0.2	0.111998102	0.2	0	0.166785035	0	0.2	0.149824855	0.169425392	0.199744825	0.2	0	0	0	0.2	0.199603377	0	0	0	0	0	0	0	0											NO	0.049046918	0.04964263	0.097441325	0	0.136737448	0.136737448	0.136737448	0.076571673	0.136737448	0	0.1140288	0	0.136737448	0.102433341	0.115833978	0.136562988	0.136737448	0	0	0	0.136737448	0.138176793	0	0	0	0	0	0	0	0												15.365	0.831485019	4.70149317	0	1.922573577	2.131884955	1.731828428	1.750316973	2.618515238	0	2.784333679	0	0.027872073	1.50624849	2.771469169	10.68894629	0.903724709	0	0	0	2.083704	0.577160671	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	52.3965	146	24.23118222	15.365	0.831485019	4.70149317	0	2.614172103	2.875077003	2.34288525	1.750316973	3.523579681	0	3.939442689	0	0.038324837	2.196693467	3.842655815	14.40841729	1.253024317	0.155456317	0	0	2.802432388	0.768105371	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.4085	YES	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											7500	3.7396	0.1999	0.9788	0.2801	0.8904	0.9771	0.7969	0.3583	1.1967	0.1374	1.3561	0	0.0102	0.762	2.3046	7.7667	0.6797	0.1067	0	0	1.5078	0.4117	0	0.0661	0.0441	0.0211	0	0	0	0											24.5921	630	8.361750077	19.1046	1.031429425	5.68024474	0.280115708	3.504586876	3.852159347	3.13979015	2.108568674	4.720325767	0.137423074	5.295504399	0	0.04856389	2.958701177	6.147305526	22.17507136	1.932768992	0.262202893	0	0	4.310212048	1.179818101	0	0.066115193	0.044097378	0.021053659	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.0007
R3175_004_0	2010	4	25																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1856.267144	215.0579502	27.98039206	707.6050253	207.0556956	11.27134871	12.25923799	445.7724307	31.56501313	12147.90415	33.88245002	0	0.140705681	18.51949327	6454.895631	4272.13076	659.3793763	348.4495828	0	0	16.21511497	980.4154386	667.3659641	0	118.594874	161.9523134	12.7477754	4.528554756	78.65384576	0											3400	"$275 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-9 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											231.8698959	176.1020882	0.142388625	0	150	0.2	0.105973877	49.62120941	0.2	3	0.176882295	0	0.2	0.150598583	7.153814456	34.79038854	38.5	35	0	0	0.2	34.74463963	0	0	35	0	0	0	0	0											NO	153.0338209	116.2271424	0.093976302	0	98.99979916	0.131999732	0.069942617	32.74993177	0.131999732	1.979995983	0.116742078	0	0.131999732	0.099394863	4.721507962	23.07663251	25.40994845	23.09995314	0	0	0.131999732	22.93141564	0	0	35	0	0	0	0	0												23.6726	2.08296425	2.629493778	0	1.708206024	1.487815012	0.857443183	1.216584724	4.166573281	2.004400118	3.955507616	0	0.018573112	1.840742499	2.53973676	8.215532632	1.396232997	0.670764086	0	0	2.140390833	1.87352616	0	0	0.345901716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.823	0	32.12333303	23.6726	2.08296425	2.629493778	0	1.708206024	1.487815012	0.857443183	1.216584724	4.166573281	2.004400118	3.955507616	0	0.018573112	1.840742499	2.53973676	8.215532632	1.396232997	0.670764086	0	0	2.140390833	1.87352616	0	0	0.345901716	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.823	YES	"30% Days 1-Unlimited (1a); 30% (1a1); $0 n/c (1a2, 1a3)"	"30% Days 1-Unlimited (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	50% (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 (17b1, 17b2); $0 n/c (17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											7800	3.0739	0.1133	0.9396	0.2099	0.3623	0.4734	0.5149	0.2581	1.3257	0.4252	1.2305	0	0.0039	0.5893	2.0997	6.3981	0.5688	0.2912	0	0	1.1576	0.4014	0	0	0.058	0	0.006	0.003	0	0											20.5036	0	10.4886586	26.7465	2.196225558	3.569043984	0.209908597	2.070552756	1.961210697	1.372330134	1.47464815	5.492301143	2.429575901	5.186020785	0	0.022512863	2.430017217	4.639485412	14.61359605	1.965013839	0.96191659	0	0	3.297949141	2.274915285	0	0	0.403910244	0	0.00601605	0.002979312	0	0	0	0	0	0	0	0	0	0	0	0	83.3266
R3175_801_0	2010	4	25																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	199.6945101	5.381147538	15.37050844	2.948119102	6.963445718	3.324382069	5.14538186	13.28441386	23.63565846	18.67187183	26.82325218	0	0.397072656	12.55049842	27.22706283	58.75962125	2.117767001	5.636700938	0	0	4.96661599	6.938496894	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.072738159	0.072738159	0.142338141	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072738159	0.072738159	0.142338141	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.5254	0.391414764	2.187809601	0	1.622482852	0.774581022	1.198873973	3.095268429	5.507108421	4.350546136	6.249817757	0	0.092517929	2.924266131	6.343905639	13.69099175	0.493439711	1.313351319	0	0	1.157221526	1.616669776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5357	0	0	14.5254	0.391414764	2.187809601	0	1.622482852	0.774581022	1.198873973	3.095268429	5.507108421	4.350546136	6.249817757	0	0.092517929	2.924266131	6.343905639	13.69099175	0.493439711	1.313351319	0	0	1.157221526	1.616669776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5357	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	0.9272	0.025	0.2431	0	0.3442	0.1643	0.2543	0.6566	1.1682	0.9228	1.3257	0	0.0196	0.6203	2.1714	4.6862	0.1689	0.4495	0	0	0.3961	0.5534	0	0	0	0	0	0	0	0											15.0967	0	0	15.4526	0.416398685	2.430899556	0	1.966645882	0.938886087	1.453180574	3.75184052	6.675282934	5.273389255	7.575536676	0	0.112142944	3.544565007	8.515309583	18.37717014	0.662335183	1.762887676	0	0	1.553317484	2.170026545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6324
R3175_802_0	2010	4	25																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	199.6945101	5.381147538	15.37050844	2.948119102	6.963445718	3.324382069	5.14538186	13.28441386	23.63565846	18.67187183	26.82325218	0	0.397072656	12.55049842	27.22706283	58.75962125	2.117767001	5.636700938	0	0	4.96661599	6.938496894	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.072738159	0.072738159	0.142338141	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072738159	0.072738159	0.142338141	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.5254	0.391414764	2.187809601	0	1.622482852	0.774581022	1.198873973	3.095268429	5.507108421	4.350546136	6.249817757	0	0.092517929	2.924266131	6.343905639	13.69099175	0.493439711	1.313351319	0	0	1.157221526	1.616669776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5357	0	0	14.5254	0.391414764	2.187809601	0	1.622482852	0.774581022	1.198873973	3.095268429	5.507108421	4.350546136	6.249817757	0	0.092517929	2.924266131	6.343905639	13.69099175	0.493439711	1.313351319	0	0	1.157221526	1.616669776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5357	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	0.9272	0.025	0.2431	0	0.3442	0.1643	0.2543	0.6566	1.1682	0.9228	1.3257	0	0.0196	0.6203	2.1714	4.6862	0.1689	0.4495	0	0	0.3961	0.5534	0	0	0	0	0	0	0	0											15.0967	0	0	15.4526	0.416398685	2.430899556	0	1.966645882	0.938886087	1.453180574	3.75184052	6.675282934	5.273389255	7.575536676	0	0.112142944	3.544565007	8.515309583	18.37717014	0.662335183	1.762887676	0	0	1.553317484	2.170026545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6324
R3175_803_0	2010	4	25																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	199.6945101	5.381147538	15.37050844	2.948119102	6.963445718	3.324382069	5.14538186	13.28441386	23.63565846	18.67187183	26.82325218	0	0.397072656	12.55049842	27.22706283	58.75962125	2.117767001	5.636700938	0	0	4.96661599	6.938496894	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.072738159	0.072738159	0.142338141	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.072738159	0.072738159	0.142338141	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.5254	0.391414764	2.187809601	0	1.622482852	0.774581022	1.198873973	3.095268429	5.507108421	4.350546136	6.249817757	0	0.092517929	2.924266131	6.343905639	13.69099175	0.493439711	1.313351319	0	0	1.157221526	1.616669776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5357	0	0	14.5254	0.391414764	2.187809601	0	1.622482852	0.774581022	1.198873973	3.095268429	5.507108421	4.350546136	6.249817757	0	0.092517929	2.924266131	6.343905639	13.69099175	0.493439711	1.313351319	0	0	1.157221526	1.616669776	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.5357	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	0.9272	0.025	0.2431	0	0.3442	0.1643	0.2543	0.6566	1.1682	0.9228	1.3257	0	0.0196	0.6203	2.1714	4.6862	0.1689	0.4495	0	0	0.3961	0.5534	0	0	0	0	0	0	0	0											15.0967	0	0	15.4526	0.416398685	2.430899556	0	1.966645882	0.938886087	1.453180574	3.75184052	6.675282934	5.273389255	7.575536676	0	0.112142944	3.544565007	8.515309583	18.37717014	0.662335183	1.762887676	0	0	1.553317484	2.170026545	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.6324
R3332_001_0	2010	6	9	e.3.	i.9.	q.1.	q.2.	i.2.	g.1.	h.6.	h.7.	h.8.	h.9.	DME/Prosthetics/Supplies	Professional	Other Non-Covered	Other Non-Covered	Professional	OP Facility - Surgery	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Electric Wheelchairs	Urgent Care	Worldwide ER	Worldwide Urgent Care	Allergy Shots	Ambulatory Surgical Center	Rehab	Radiation Therapy	IDTF - non-AIX	IDTF - AIX	D	D	D		T			V	V	V			V	V	V	V	V	V	V		Coin									V	Coin	V	V	V	V	V	V	V	V	V																																									0	YES	733.9738386	27.99636553	438.8822041		33.0479832			108.2092875	84.97922623	77.89605393			1.594530874	253.1355865	3009.325335	5792.233734	157.1122058	331.6095777	26.91448228		33.73465099									283.0339916	0.019688215	51.13302216	1.438434173	0.679715098	75.19107041	167.5996922	56.48144209	7.538310238	196.6686717	135.5565669	3400	"250/day, days 1 - 10"	"250/day, days 1 - 10"	"110/day, days 1 - 26"		150 per trip			50 copay	500 copay	15 copay			45 copay	500 copay	15 copay	45 copay	45 copay	45 copay	100 copay		20% of allowed amount									"uncovered pod, phys exams, uncovered rehab"	20% of allowed amount	25 copay	50 copay	25 copay	5 per shot	200 copay	45 copay	500 copay	75 copay	100 copay	202.2260773	202.2260773	103.4571832		150			50	500	15			45	500	15	45	45	45	100		0.2									26.07176664	0.2	25	50	25	5	200	45	500	75	100	YES	150.3193505	150.3193505	76.90213242		111.4984916			37.16616385	371.6616385	11.14984916			33.44954747	371.6616385	11.14984916	33.44954747	33.44954747	33.44954747	74.3323277		0.148664655									19.37975102	0.148664655	18.58308193	37.16616385	18.58308193	3.716616385	148.6646554	33.44954747	37.16616385	55.74924578	74.3323277	10000	9.1942	0.350699623	2.812581448	0	0.30706669	0	0	0.335143676	2.631959872	0.072377438	0	0	0.004444695	7.840065571	2.796126962	16.1456331	0.437944349	0.924349193	0.16671801	0	5.015150265	0	0	0	0	0	0	0	0	0.457094024	0.002926942	0.079184095	0.00445509	0.0010526	0.02328803	2.076345874	0.15743989	0.023347506	0.91367751	0.839686262	53.613	0	18.18082928	9.1942	0.350699623	2.812581448	0	0.30706669	0	0	0.335143676	2.631959872	0.072377438	0	0	0.004444695	7.840065571	2.796126962	16.1456331	0.437944349	0.924349193	0.16671801	0	5.015150265	0	0	0	0	0	0	0	0	0.457094024	0.002926942	0.079184095	0.00445509	0.0010526	0.02328803	2.076345874	0.15743989	0.023347506	0.91367751	0.839686262	53.613	YES	20% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	150 per trip	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	50 copay	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded			45 copay	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded		30% of allowed amount after $500 ded	30% of allowed amount after $500 ded								30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded			30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	30% of allowed amount after $500 ded	10000	16.0658	0.0987	0.4333	0.4272	1.3561	3.5229	0.7717	0.2312	3.2594	0.4456	0	0	0.0025	3.3461	4.7358	10.2349	0.6452	1.3732	0.9727		2.291	0.0329								0.4679	0	0.0413			0.0185	6.6132	1.0633	0.2455	1.3052	2.336	62.337	500	12.08683158	25.26	0.449393123	3.245906413	0.427170079	1.663129359	3.522896867	0.771720283	0.56634162	5.891370945	0.517947964	0	0	0.006984527	11.18616797	7.531960239	26.3805144	1.083096925	2.297583052	1.139378973	0	7.306144952	0.032947463	0	0	0	0	0	0	0	0.92501588	0.002926942	0.120461906	0.00445509	0.0010526	0.04181586	8.689521266	1.220775203	0.268812604	2.218889137	3.175659378	115.95
R3444_008_0	2010	8	15																															A	A	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	S	Coin	T	V	V	V	V	V	O	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	YES	443.7428331	19.87747909	300.2847111	871.6236557	929.8685418	55.15894659	42.84306589	32.87180751	31.53038965	9.085157422	21.15234451	0	0	23.94211063	52.4340596	109.969766	1.860107741	1.255719779	24.09496917	31.19277732	472.1696249	10.43107511	400	344.0329218	2383.539095	0	0	0	0	12000											90000	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45%, OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45%, MH (Group): 45%, 7H Psychiatric: 45%, Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: $50, 13D Meal Benefit: not covered"											1014.624033	503.197046	275.4469928	0	66.1784264	0.233	0.233	0.233912636	0.233	0.233	0.233	0	0	0.233	0.23205328	0.233	0.233	0.233	0.233	0.233	14.5621034	0.233	0	15	2.914993094	0	0	0	0	0											YES	1014.624033	503.197046	275.4469928	0	66.1784264	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.23205328	0.233	0.233	0.233	0.233	0.233	14.5621034	0.233	0	15	2.914993094	0	0	0	0	0											90000	37.5193	0.833524063	6.892710055	0	5.128103071	12.85203456	9.982434353	7.65913115	7.346580788	2.116841679	4.928496271	0	0	5.578511778	12.16749553	25.62295549	0.433405104	0.292582708	5.614127817	7.267917115	0.572981909	2.4304405	0	0.430041152	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	156.2487	0	0	37.5193	0.833524063	6.892710055	0	5.128103071	12.85203456	9.982434353	7.65913115	7.346580788	2.116841679	4.928496271	0	0	5.578511778	12.16749553	25.62295549	0.433405104	0.292582708	5.614127817	7.267917115	0.572981909	2.4304405	0	0.430041152	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	156.2487	YES	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45%, OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45%, MH (Group): 45%, 7H Psychiatric: 45%, Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: $50, 13D Meal Benefit: not covered"											90000	0	0	0	0	0	0	0	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.03	0	0	37.5193	0.833524063	6.892710055	0	5.128103071	12.85203456	9.982434353	7.68913115	7.346580788	2.116841679	4.928496271	0	0	5.578511778	12.16749553	25.62295549	0.433405104	0.292582708	5.614127817	7.267917115	0.572981909	2.4304405	0	0.430041152	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	156.2787
R3444_009_0	2010	10	15																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	S	V	T	V	V	V	V	V	O	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	YES	2176.146246	6.639206847	237.4879574	17.19030278	16.0793193	27.45218695	29.3030387	529.9721144	242.4806387	7.92095139	15.84077312	0	0	148.8140009	4360.395269	3106.267357	208.3855874	435.7239757	27.468942	15296.82396	813.5611139	482.227173	400	344.0329218	2383.539095	0	0	0	0	12000											3400	1A IP Acute: $230 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $30"	"9A OP Hospital: $100, 9B ASC Services: $100"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $40	"7E Mental Health: $40, MH (Group): $25, 7H Psychiatric: $40, Psychiatric (Group): $25"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $40, 7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $40	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											258.7247602	1249.833195	135.2320865	0	0.520802936	0.203657311	0.062079665	76.22373711	199.2579081	0.254790549	0.261775905	0	0	156.8417285	24.34496859	41.8771362	43.49794601	40.24090499	0.203010388	5.516329046	26.97170592	59.78802505	0	10	30	0	0	0	0	0											YES	242.7437935	1108.034606	122.1244196	0	0.516713709	0.198917279	0.061244914	75.5368622	187.1288121	0.248045635	0.255047752	0	0	147.1221895	23.98982506	41.50445965	42.80661767	40.21833222	0.196256651	5.310884656	26.32203179	59.39886374	0	10	30	0	0	0	0	0											3400	44.0205	0.613039245	2.416923246	0	8.308404708	5.460714326	1.79466209	3.336035881	3.78125949	1.964757421	4.040153571	0	0	1.824486803	8.717093309	10.74366235	0.743356847	1.460340967	5.390962556	6.769972306	1.784548459	2.386978845	0	0.286694102	5.958847737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8034	0	4.700966191	44.0205	0.613039245	2.416923246	0	8.308404708	5.460714326	1.79466209	3.336035881	3.78125949	1.964757421	4.040153571	0	0	1.824486803	8.717093309	10.74366235	0.743356847	1.460340967	5.390962556	6.769972306	1.784548459	2.386978845	0	0.286694102	5.958847737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.8034	YES	1A IP Acute: $230 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $30"	"9A OP Hospital: $100, 9B ASC Services: $100"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40, OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $40	"7E Mental Health: $40, MH (Group): $25, 7H Psychiatric: $40, Psychiatric (Group): $25"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $40, 7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $40	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											3400	0	0	0	5.8938	0	4.9088	0	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											10.8326	0	0.220374378	44.0205	0.613039245	2.416923246	5.893818096	8.308404708	10.36954201	1.79466209	3.366035881	3.78125949	1.964757421	4.040153571	0	0	1.824486803	8.717093309	10.74366235	0.743356847	1.460340967	5.390962556	6.769972306	1.784548459	2.386978845	0	0.286694102	5.958847737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.636
R3444_010_0	2010	8	15																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	S	V	T	V	V	V	V	V	O	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	YES	2176.146246	6.639206847	237.4879574	17.19030278	16.0793193	27.45218695	29.3030387	529.9721144	242.4806387	7.92095139	15.84077312	0	0	148.8140009	4360.395269	3106.267357	208.3855874	435.7239757	27.468942	15296.82396	813.5611139	482.227173	400	344.0329218	2383.539095	0	0	0	0	12000											3400	1A IP Acute: $215 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $100 for days 21-100	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $30"	"9A OP Hospital: $100, 9B ASC Services: $100"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, OP Substance Abuse (Group): $15, 9D Cardiac Rehab: $30"	"7A PCP: $15, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $30	"7E Mental Health: $30, MH (Group): $15, 7H Psychiatric: $30, Psychiatric (Group): $15"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $30, 7F Podiatry: $30, 7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $30	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											243.7247602	1249.833195	105.2320865	0	0.520802936	0.203657311	0.062079665	76.22373711	199.2579081	0.254790549	0.261775905	0	0	146.8417285	14.59915094	31.8771362	30.46013636	30.24090499	0.203010388	4.983025497	26.97170592	49.78802505	0	10	30	0	0	0	0	0											YES	228.8649626	1119.015917	92.9066264	0	0.517030391	0.199284361	0.06130956	75.5374503	188.0681259	0.248567982	0.2555688	0	0	137.7972698	14.19585385	31.45569068	29.82234658	30.14245015	0.196779681	4.78934933	26.37234452	49.3513714	0	10	30	0	0	0	0	0											3400	41.5036	0.619114845	1.838683744	0	8.313496741	5.470791541	1.796556403	3.336061854	3.800239941	1.968894902	4.048407383	0	0	1.708846918	5.158294499	8.142482095	0.517878934	1.094482351	5.405329631	6.1051528	1.787959498	1.983214359	0	0.286694102	5.958847737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8451	0	4.421265776	41.5036	0.619114845	1.838683744	0	8.313496741	5.470791541	1.796556403	3.336061854	3.800239941	1.968894902	4.048407383	0	0	1.708846918	5.158294499	8.142482095	0.517878934	1.094482351	5.405329631	6.1051528	1.787959498	1.983214359	0	0.286694102	5.958847737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	110.8451	YES	1A IP Acute: $215 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $100 for days 21-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $30"	"9A OP Hospital: $100, 9B ASC Services: $100"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, OP Substance Abuse (Group): $15, 9D Cardiac Rehab: $30"	"7A PCP: $15, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $30	"7E Mental Health: $30, MH (Group): $15, 7H Psychiatric: $30, Psychiatric (Group): $15"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $30, 7F Podiatry: $30, 7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $30	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											3400	0	0	0	5.8938	0	4.9179	0	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											10.8417	0	0.207283625	41.5036	0.619114845	1.838683744	5.893818096	8.313496741	10.38867798	1.796556403	3.366061854	3.800239941	1.968894902	4.048407383	0	0	1.708846918	5.158294499	8.142482095	0.517878934	1.094482351	5.405329631	6.1051528	1.787959498	1.983214359	0	0.286694102	5.958847737	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	121.6868
R3444_011_0	2010	9	15																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	381.53	29.76	93.38	65.67	22.02	30.69	24.75	20.93	29.94	7.12	20.67	1.51	2.7	42.23	51.55	99.09	6.29	5.41	22.23	32.85	10.43	3.53	1.75	5.651552795	2.64	1.72	0	0	0.5	5											90000	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45% OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45% MH (Group): 45%, 7H Psychiatric: 45% Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											0.082416542	0.082421153	0.185071071	0	0.233022045	0.233000015	0.232978798	0.232763636	0.232999957	0.2329714	0.233027166	0.233000269	0.233000015	0.233002722	0.233005551	0.23300203	0.233005245	0.232991548	0.232993459	0.233012247	0.232999046	0.232997383	0	0.044509891	0.134501263	0	0	0	0	0											YES	0.082416542	0.082421153	0.185071071	0	0.233022045	0.233000015	0.232978798	0.231833552	0.232999957	0.2329714	0.233027166	0.233000269	0.233000015	0.233002722	0.233005551	0.23300203	0.233005245	0.232991548	0.232993459	0.233012247	0.232999046	0.232997383	0	0.044509891	0.134501263	0	0	0	0	0											90000	31.4444	2.452853525	17.28193662	0	5.131145425	7.150770461	5.766225258	4.852276238	6.976018723	1.658756367	4.816671529	0.351830406	0.629100041	9.839704948	12.01143614	23.08817111	1.465602993	1.260484272	5.179444593	7.654452305	2.430180048	0.822480763	0	0.25155	0.355083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.8706	0	0	31.4444	2.452853525	17.28193662	0	5.131145425	7.150770461	5.766225258	4.852276238	6.976018723	1.658756367	4.816671529	0.351830406	0.629100041	9.839704948	12.01143614	23.08817111	1.465602993	1.260484272	5.179444593	7.654452305	2.430180048	0.822480763	0	0.25155	0.355083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.8706	YES	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45% OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45% MH (Group): 45%, 7H Psychiatric: 45% Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											90000	0	0	0	0	0	0	0	0.0195	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0195	0	0	31.4444	2.452853525	17.28193662	0	5.131145425	7.150770461	5.766225258	4.871742901	6.976018723	1.658756367	4.816671529	0.351830406	0.629100041	9.839704948	12.01143614	23.08817111	1.465602993	1.260484272	5.179444593	7.654452305	2.430180048	0.822480763	0	0.25155	0.355083333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	152.89
R3444_012_0	2010	6	15																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	V	V	O	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	YES	924.84	5.3	701.45	14.78706008	9.26	8.306498531	8.59	287.02	407.03	5.33	21.03	91.97	0.21	135.35	3178.68	2886.21	158.57	563.65	24.72	1247.07	9.82	513.25	0	280	370.67	0	0	0	0	0											3400	1A IP Acute: $270 Per Day for days 1-10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $40"	"9A OP Hospital: $175, 9B ASC Services: $175"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: $50	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40 OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $40	"7E Mental Health: $40 MH (Group): $25, 7H Psychiatric: $40 Psychiatric (Group): $25"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $40, 7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $40	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											270	1000	130	0	0.372705184	0.2	0.044676145	49.42373354	175	0.199879536	0.200025477	50	0.200000023	40	25	40	40	40	0.162203074	40	0.199998468	39.97661958	0	10	30	0	0	0	0	0											YES	268.0323996	992.712591	129.0526368	0	0.369989128	0.2	0.044350571	48.91310965	173.7247034	0.198422932	0.19856781	49.63562955	0.198542541	39.70850364	24.81781477	39.70850364	39.70850364	39.70850364	0.161021033	39.70850364	0.198540998	39.6852936	0	9.92712591	29.78137773	0	0	0	0	0											3400	20.6573	0.438448061	7.543664342	0	3.42609933	1.661299706	0.380971407	1.169920061	5.892597169	1.057594228	4.175881038	0.380415737	0.041693934	0.447878831	6.573990956	9.550590024	0.524714785	1.865141506	3.980439948	4.126606969	1.949672598	1.697373078	0	0.231632938	0.91992194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6938	0	0.575266256	20.6573	0.438448061	7.543664342	0	3.42609933	1.661299706	0.380971407	1.169920061	5.892597169	1.057594228	4.175881038	0.380415737	0.041693934	0.447878831	6.573990956	9.550590024	0.524714785	1.865141506	3.980439948	4.126606969	1.949672598	1.697373078	0	0.231632938	0.91992194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.6938	YES	1A IP Acute: $270 Per Day for days 1-10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $40"	"9A OP Hospital: $175, 9B ASC Services: $175"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: $50	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40 OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $40	"7E Mental Health: $40 MH (Group): $25, 7H Psychiatric: $40 Psychiatric (Group): $25"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $40, 7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $30	17B Eye Wear (Medicare Covered): $40	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											3400	0	0	0	5.6534	0	1.4863	0	0.0036	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											7.1433	0	0.054733744	20.6573	0.438448061	7.543664342	5.653386309	3.42609933	3.147571417	0.380971407	1.173518644	5.892597169	1.057594228	4.175881038	0.380415737	0.041693934	0.447878831	6.573990956	9.550590024	0.524714785	1.865141506	3.980439948	4.126606969	1.949672598	1.697373078	0	0.231632938	0.91992194	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.8371
R5287_001_0	2010	6	9																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	902.654571	88.90695782	657.3584855	1061.761041	135.5331644	7.426346987	8.204832421	225.2168754	41.33594316	9921.291309	54.86377106	0	0.042005874	12.65043113	5428.284492	5711.401838	368.9999152	780.5664393	0	0	21.94368511	1277.908247	0	412.4436754	142.0577143	0	14.98384091	12.70394698	362.7401502	0											3950	"$290 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$290 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$110 Days 1-26 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20%/30% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20%/30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20%/30% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											201.0053198	148.2134571	81.80667226	0	150	0.2	0.136966937	49.38269796	0.285	3	0.193477345	0	0.2	0.222420566	7.202759757	29.99286553	38.5	30	0	0	0.2	29.27638845	0	0	30	0	0	0	0	0											NO	150.3135025	110.8352947	61.1757313	0	112.1712868	0.149561716	0.10242505	36.92880517	0.213125445	2.243425736	0.144684019	0	0.149561716	0.166328007	5.386285536	22.43436101	28.79063027	22.43425736	0	0	0.149561716	21.89313443	0	0	30	0	0	0	0	0												11.3068	0.821169072	3.35119884	0	1.266910787	1.110697197	0.840380372	0.693082509	8.809741277	1.854806688	7.937910875	0	0.006282471	2.104121	2.436524187	10.67763756	0.885311678	1.459285699	0	0	3.281935194	2.33145142	0	0	0.355144286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.5304	0	20.62730387	11.3068	0.821169072	3.35119884	0	1.266910787	1.110697197	0.840380372	0.693082509	8.809741277	1.854806688	7.937910875	0	0.006282471	2.104121	2.436524187	10.67763756	0.885311678	1.459285699	0	0	3.281935194	2.33145142	0	0	0.355144286	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.5304	YES	"$375 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-27 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-67 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$40 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$40 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	2.6323	0.2476	0.5168	0.2686	0.1646	0.2165	0.2392	0.0901	1.205	0.241	1.3295	0	0.0008	0.2745	1.8387	2.5118	0.1765	0.3434	0	0	0.8687	0.5546	0	0.0724	0.0744	0	0.0088	0.0146	0	0											13.8903	0	4.599084848	13.939	1.068749279	3.868008789	0.268596262	1.431537613	1.327189023	1.079566497	0.783144078	10.0147609	2.095826766	9.267408374	0	0.007098837	2.378670243	4.275220455	13.18941907	1.061832952	1.802647039	0	0	4.150682745	2.886004896	0	0.07235854	0.429526726	0	0.008814024	0.014608877	0	0	0	0	0	0	0	0	0	0	0	0	75.4207
R5287_002_0	2010	5	9																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	847.274751	93.75499868	607.6789389	940.0831173	135.0653903	5.670805205	6.03969443	211.7264525	39.17286561	8672.900472	55.19013469	0	0.01901632	11.14131959	4777.674202	5254.863301	369.1417851	792.9022605	0	0	21.78642032	1251.687183	0	415.4880518	128.2744708	0	15.26508673	15.2948717	207.8873864	0											2950	"$285 Days 1-11 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$285 Days 1-8 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20%/30% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20%/30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$30 (3, 9d); $60 (5); 20%/30% (9a); $40/$30 (9c)"	"$10 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$30 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$30 (7c, 7i)"	Included in h.2.	$10 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $30 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$30 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$30/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a8, 14a9, 14a10); $0 (14a1, 14a6, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											236.6519909	171.9941595	76.91990366	0	150	0.2	0.143904475	49.48212474	0.285	3	0.194341451	0	0.2	0.222218328	7.162887031	29.99442257	38.5	30	0	0	0.2	29.16332973	0	0	30	0	0	0	0	0											NO	193.4287239	118.1497649	52.83940198	0	103.0410846	0.137388113	0.098853821	33.99127866	0.195778061	2.060821691	0.133501026	0	0.137388113	0.152650783	4.920477655	20.61252012	26.4472117	20.60821691	0	0	0.137388113	20.03347417	0	0	30	0	0	0	0	0												13.6573	0.923094254	2.675782644	0	1.159773692	0.779101225	0.597046872	0.599737737	7.669187659	1.489441785	7.367939592	0	0.002612616	1.700731161	1.959036596	9.026331294	0.813564245	1.361691814	0	0	2.993195172	2.089636904	0	0	0.320686177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1859	0	25.90998314	13.6573	0.923094254	2.675782644	0	1.159773692	0.779101225	0.597046872	0.599737737	7.669187659	1.489441785	7.367939592	0	0.002612616	1.700731161	1.959036596	9.026331294	0.813564245	1.361691814	0	0	2.993195172	2.089636904	0	0	0.320686177	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1859	YES	"$375 Days 1-27 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-27 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-67 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$40 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$40 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$40 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a6)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	2.3351	0.2398	0.4389	0.2157	0.1507	0.1519	0.1617	0.0779	1.049	0.1935	1.2312	0	0.0003	0.2218	1.4957	2.1232	0.1622	0.3204	0	0	0.7923	0.497	0	0.0729	0.0682	0	0.009	0.018	0	0											12.0265	0	5.370114312	15.9924	1.162924152	3.1146482	0.215659769	1.310478748	0.930959938	0.758784084	0.67766976	8.718199352	1.682985068	8.599183345	0	0.002952109	1.922549173	3.454712847	11.14950462	0.975779881	1.682089888	0	0	3.785511541	2.586623629	0	0.072892641	0.388934281	0	0.008979463	0.017991087	0	0	0	0	0	0	0	0	0	0	0	0	69.2124
R5287_003_0	2010	5	9																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.3236	0.6144	0.5578	0	1.3137	0	1.7766	0	0.003	0.6265	0.7283	4.5651	0.2175	0.357	0	0	0.8108	0.1489	0	0	0	0	0	0	0	0											12.0434	YES	384.455763	19.33159458	52.41868359	2480.591287	11.56673135	21.9631225	19.938728	34.8814704	46.95872328	25.09710414	63.50695159	0	0.108908224	22.39611266	27.96290822	163.2029552	7.773642748	12.76215339	0	0	28.98332154	5.587773244	475.7559121	305.0869784	187.7968095	182.3865907	0	0	78.25516436	0											3900	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.083483117	0.084497082	0.16038991	0	0.2	0.2	0.2	0.068017232	0.2	0	0.167357177	0	0.2	0.149699099	0.172087333	0.199975029	0.2	0	0	0	0.2	0.199845559	0	0	0	0	0	0	0	0											NO	0.053424297	0.054073175	0.102640132	0	0.127988265	0.127988265	0.127988265	0.043527038	0.127988265	0	0.107098774	0	0.127988265	0.09579864	0.110125796	0.127972285	0.127988265	0	0	0	0.127988265	0.129577856	0	0	0	0	0	0	0	0												20.5393	1.045320692	5.380260593	0	1.480405879	2.811021947	2.551923208	1.518287081	6.01016553	0	6.801516625	0	0.013938975	2.145517132	3.079437529	20.88545515	0.99493505	0	0	0	3.709525044	0.724051677	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	79.691	146	44.82288422	20.5393	1.045320692	5.380260593	0	1.803992079	3.425453383	3.109721002	1.518287081	7.323863788	0	8.578161428	0	0.016985747	2.772061725	3.80775629	25.450585	1.212407336	0.357028844	0	0	4.52035073	0.872921872	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.7344	YES	"22% (1a, 1a1); $0 n/c (1a2, 1a3)"	"22% (1b); $0 n/c (1b1, 1b2)"	"22% (2a, 2a2); $0 n/c (2a1)"	"22% (6a); $0 n/c (6a1, 6a2)"	22% (10a)	22% (11a)	"22% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	22% (9b)	"22% (8a1, 8a2)"	"22% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"22% (3, 5, 9a, 9c, 9d)"	"22% (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1); $0 (14b, 14d, 14e, 14f, 14g, 14h, 14i, 14j)"	"22% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"22% (7e, 7h)"	"22% (7c, 7i)"	Included in h.2.	22% (7g)	"22% (15, 15a1); $0 n/c (15a2)"	"22% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"$40 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											7500	7.7323	0.3888	1.3023	0.3196	0.296	0.5621	0.5103	0.1685	1.2018	0.1178	1.4632	0	0.0026	0.4851	1.9081	12.5307	0.5969	0.381	0	0	2.2253	0.4243	0	0.0535	0.0988	0.0307	0	0	0	0											32.7998	635	13.19106319	28.2716	1.434126261	6.682591302	0.319574641	2.100023523	3.987563341	3.620019915	1.686831085	8.525694992	0.117778277	10.04137387	0	0.019618196	3.257140606	5.715865636	37.98124753	1.809268096	0.737992265	0	0	6.74569191	1.29718485	0	0.053524031	0.098824315	0.03065347	0	0	0	0	0	0	0	0	0	0	0	0	0	0	124.5342
R5287_801_0	2010	5	9																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	163.0720603	4.249680248	20.23087091	1099.405811	4.416510181	8.513954879	9.064329487	15.80215526	50.29887061	21.86043561	53.85284514	0	0.036091067	11.98280052	27.92375087	122.7156396	2.007351048	7.027024773	0	0	24.2530831	6.912623809	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085783502	0.085783502	0.162194337	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.085783502	0.085783502	0.162194337	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												13.9889	0.364552454	3.281332691	0	1.029046872	1.983751487	2.11198877	3.681902176	11.71963685	5.093481497	12.54771292	0	0.008409219	2.791992522	6.506233953	28.59274403	0.467712794	1.637296772	0	0	5.650968362	1.610641348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.0683	0	0	13.9889	0.364552454	3.281332691	0	1.029046872	1.983751487	2.11198877	3.681902176	11.71963685	5.093481497	12.54771292	0	0.008409219	2.791992522	6.506233953	28.59274403	0.467712794	1.637296772	0	0	5.650968362	1.610641348	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.0683	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	1.8178	0.0474	0.2853	0	0.1337	0.2578	0.2744	0.4784	1.5229	0.6619	1.6305	0	0.0011	0.3628	1.1482	5.0458	0.0825	0.2889	0	0	0.9972	0.2842	0	0	0	0	0	0	0	0											15.3209	0	0	15.8067	0.411923677	3.566665969	0	1.162764827	2.241527104	2.386427989	4.160341442	13.24252752	5.755346325	14.17820669	0	0.009501942	3.15479381	7.654392886	33.63852238	0.550250346	1.926231497	0	0	6.648198074	1.894872174	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	118.3892
R5287_802_0	2010	5	9																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	170.2671259	4.232263525	21.12349742	1123.213172	4.611375449	8.889607607	9.464265844	16.49937798	52.51815744	22.82496178	56.22894044	0	0.037683477	12.5107372	29.15580264	128.1300992	1.998987085	7.337071169	0	0	25.32317766	7.217622605	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.082675559	0.082675559	0.159293783	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082675559	0.082675559	0.159293783	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.0769	0.349904754	3.364841806	0	1.07445048	2.071278572	2.205173942	3.844355068	12.23673068	5.318216094	13.10134312	0	0.00878025	2.915001768	6.793302015	29.85431311	0.465763991	1.709537582	0	0	5.900300396	1.681706067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9719	0	0	14.0769	0.349904754	3.364841806	0	1.07445048	2.071278572	2.205173942	3.844355068	12.23673068	5.318216094	13.10134312	0	0.00878025	2.915001768	6.793302015	29.85431311	0.465763991	1.709537582	0	0	5.900300396	1.681706067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9719	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	1.8292	0.0455	0.2926	0	0.1396	0.2691	0.2865	0.4995	1.5901	0.6911	1.7024	0	0.0011	0.3788	1.1988	5.2684	0.0822	0.3017	0	0	1.0412	0.2968	0	0	0	0	0	0	0	0											15.9147	0	0	15.9061	0.395372603	3.657436746	0	1.214068338	2.340427765	2.491721968	4.343904032	13.82681433	6.009283722	14.80377754	0	0.009921187	3.293787308	7.992120018	35.12272131	0.547957636	2.011220685	0	0	6.941529877	1.978477726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8867
R5287_805_0	2010	5	9																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	170.2671259	4.232263525	21.12349742	1123.213172	4.611375449	8.889607607	9.464265844	16.49937798	52.51815744	22.82496178	56.22894044	0	0.037683477	12.5107372	29.15580264	128.1300992	1.998987085	7.337071169	0	0	25.32317766	7.217622605	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.082675559	0.082675559	0.159293783	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.082675559	0.082675559	0.159293783	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												14.0769	0.349904754	3.364841806	0	1.07445048	2.071278572	2.205173942	3.844355068	12.23673068	5.318216094	13.10134312	0	0.00878025	2.915001768	6.793302015	29.85431311	0.465763991	1.709537582	0	0	5.900300396	1.681706067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9719	0	0	14.0769	0.349904754	3.364841806	0	1.07445048	2.071278572	2.205173942	3.844355068	12.23673068	5.318216094	13.10134312	0	0.00878025	2.915001768	6.793302015	29.85431311	0.465763991	1.709537582	0	0	5.900300396	1.681706067	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	106.9719	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	1.8292	0.0455	0.2926	0	0.1396	0.2691	0.2865	0.4995	1.5901	0.6911	1.7024	0	0.0011	0.3788	1.1988	5.2684	0.0822	0.3017	0	0	1.0412	0.2968	0	0	0	0	0	0	0	0											15.9147	0	0	15.9061	0.395372603	3.657436746	0	1.214068338	2.340427765	2.491721968	4.343904032	13.82681433	6.009283722	14.80377754	0	0.009921187	3.293787308	7.992120018	35.12272131	0.547957636	2.011220685	0	0	6.941529877	1.978477726	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.8867
R5342_001_0	2010	5	3																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1416.528494	94.98941337	848.0013285	99.31910834	120.935848	4.961792497	5.842088848	328.7500459	16.70263124	6493.61592	25.60573354	0	0.065285475	10.44955668	3527.659174	3360.504191	327.5282818	635.7413187	0	0	9.820989113	695.2126989	0	0	73.42735251	0	10.68984893	4.522044999	110.8809644	0											3400	"$200 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$100 Days 1-24 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											182.9570339	145.5956477	71.58609126	0	150	0.2	0.117276019	49.91156212	0.2	3	0.17138057	0	0.2	0.150396667	13.39738876	34.87705122	38.5	35	0	0	0.2	33.97414208	0	0	35	0	0	0	0	0											NO	142.6817828	105.1308025	51.69044091	0	108.3110699	0.14441476	0.084681941	36.03983131	0.14441476	2.166221399	0.12374942	0	0.14441476	0.108597493	9.673903408	25.1908943	27.79984128	25.27258298	0	0	0.14441476	24.53183786	0	0	35	0	0	0	0	0												16.8427	0.832192771	3.65279688	0	1.091557591	0.716556072	0.494719421	0.98734135	2.41210648	1.17221748	3.168694665	0	0.009428186	1.134795657	2.843852842	7.054508823	0.758769521	1.338902103	0	0	1.418295785	1.421237101	0	0	0.214163111	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5649	0	18.2225373	16.8427	0.832192771	3.65279688	0	1.091557591	0.716556072	0.494719421	0.98734135	2.41210648	1.17221748	3.168694665	0	0.009428186	1.134795657	2.843852842	7.054508823	0.758769521	1.338902103	0	0	1.418295785	1.421237101	0	0	0.214163111	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	47.5649	YES	"$250 Days 1-28 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-28 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-46 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											6800	5.4289	0.34	1.0823	0.1143	0.7904	0.7783	0.9164	0.715	2.62	0.8488	3.3864	0	0.0068	1.2259	2.6063	4.8027	0.5144	0.9181	0	0	1.2765	0.9898	0	0	0.1386	0	0.0214	0.003	0	0											29.5244	0	11.23369645	22.2716	1.172199991	4.735085362	0.114336511	1.881995847	1.494884219	1.411134647	1.702312672	5.032153174	2.021064621	6.555140324	0	0.016255493	2.360678367	5.450181584	11.8571804	1.273156131	2.257006402	0	0	2.694761991	2.411071498	0	0	0.352719107	0	0.021379698	0.00297503	0	0	0	0	0	0	0	0	0	0	0	0	77.0893
R5342_002_0	2010	5	3																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1434.314627	192.639413	865.1748739	160.6681118	128.871043	4.293461535	5.081470471	317.2891574	16.66906088	6042.019827	24.84025183	0	0.04321565	10.01430705	3189.781358	3230.491729	315.1166584	620.8946525	0	0	9.170992	658.6774968	0	0	71.35564583	0	10.80848526	4.563564483	109.0315067	0											2400	"$200 Days 1-12 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"$95 Days 1-24 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											171.9758	145.5956477	68.0067867	0	150	0.2	0.120499213	49.93969295	0.2	3	0.171795333	0	0.2	0.15045297	13.45821223	34.82091207	38.5	35	0	0	0.2	33.94032903	0	0	35	0	0	0	0	0											NO	125.2288438	126.7498419	43.09924732	0	95.06238145	0.126749842	0.076366281	31.64924094	0.126749842	1.901247629	0.108875156	0	0.126749842	0.095349451	8.529131366	22.08272332	24.39934457	22.18122234	0	0	0.126749842	21.5096567	0	0	35	0	0	0	0	0												14.9681	2.034751262	3.107365489	0	1.020899021	0.544195571	0.388053002	0.836830083	2.112800832	0.957281322	2.704486305	0	0.005477577	0.954858679	2.267172019	5.94483792	0.640719994	1.147683528	0	0	1.162421786	1.180660569	0	0	0.208120634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1867	0	24.25354838	14.9681	2.034751262	3.107365489	0	1.020899021	0.544195571	0.388053002	0.836830083	2.112800832	0.957281322	2.704486305	0	0.005477577	0.954858679	2.267172019	5.94483792	0.640719994	1.147683528	0	0	1.162421786	1.180660569	0	0	0.208120634	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.1867	YES	"$250 Days 1-20 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$250 Days 1-20 (1b); $0 n/c (1b1, 1b2)"	"$150 Days 1-32 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$25 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$25 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											4800	4.8246	0.6559	0.8684	0.1371	0.7393	0.5911	0.6996	0.606	2.2949	0.6932	2.8916	0	0.004	1.032	2.0883	4.0489	0.4344	0.787	0	0	1.0462	0.8209	0	0	0.1319	0	0.0216	0.003	0	0											25.4198	0	14.51209042	19.7928	2.690606622	3.975799766	0.137052658	1.760170725	1.135304553	1.087652337	1.442810487	4.407739667	1.650485039	5.596047779	0	0.009444098	1.986840103	4.355459661	9.993726787	1.075078224	1.934666519	0	0	2.208601394	2.001577852	0	0	0.34006544	0	0.021616971	0.003013673	0	0	0	0	0	0	0	0	0	0	0	0	67.6065
R5342_003_0	2010	4	3																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	T	V	P	P	P	P	O	O											0	0	0	0	0.5772	0.6735	0.4979	0	0.7165	0	0.9869	0	0.0083	0.5951	0.804	3.5784	0.3029	0.1662	0	0	0.7071	0.165	0	0	0	0	0	0	0	0											9.7791	YES	311.0840941	17.24476031	47.86733118	267.1574479	13.86242225	16.15941468	11.94751189	20.44253296	17.17217107	11.49091189	23.66203555	0	0.200507764	14.26388945	21.18429112	85.78671999	7.296414515	3.989274685	0	0	16.9390069	4.190391401	491.0014832	440.0422495	146.2682941	191.1525357	0	0	77.39583869	0											3400	"FFS (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	20% (10a)	20% (11a)	"20% (11b, 11b1, 11c)"	"$50 (4a, 4a1); 20% (4b)"	20% (9b)	$0/$0/20% (8a1); $0 (8a2)	"20% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"20% (3, 5, 9a, 9c, 9d)"	"20% (7a, 7a1); $0 (14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"20% (7b, 7d, 7f); $0 n/c (7b1); $0 (7f1)"	"20% (7e, 7h)"	"20% (7c, 7i)"	Included in h.2.	20% (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"20% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	$0 (10b)	"$0 (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 (17a1)	"$0 (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7, 14a8)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.085741117	0.086782507	0.17355782	0	0.2	0.2	0.2	0.153699777	0.2	0	0.1668707	0	0.2	0.150200686	0.16354064	0.199907309	0.2	0	0	0	0.2	0.199084414	0	0	0	0	0	0	0	0											NO	0.054180412	0.054838474	0.109672402	0	0.1263814	0.1263814	0.1263814	0.097123965	0.1263814	0	0.105446763	0	0.1263814	0.094912865	0.103342476	0.126322828	0.1263814	0	0	0	0.1263814	0.127704279	0	0	0	0	0	0	0	0												16.8547	0.945676336	5.249725166	0	1.751952333	2.042249452	1.509943281	1.985459854	2.170243023	0	2.495085061	0	0.025340452	1.353826613	2.189237087	10.83682107	0.922131083	0	0	0	2.140775409	0.535130912	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.0083	146	30.86530479	16.8547	0.945676336	5.249725166	0	2.32914724	2.71577871	2.007871439	1.985459854	2.886750762	0	3.481971802	0	0.033675068	1.948912104	2.993272538	14.41520146	1.225029667	0.166175436	0	0	2.847911514	0.700098741	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.7873	YES	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	30% (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	$50 (4a); $0 n/c (4a1); 20% (4b)	30% (9b)	"30% (8a1, 8a2)"	"30% (8b1, 8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 5, 9a, 9c, 9d)"	"30% (7a, 14b, 14c, 14c1, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"30% (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 18a); $0 (17b)"	50% (10b)	"50% (16a1, 16a2, 16a4); $0 n/c (16a3, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"50% (17b1, 17b3, 17b4); $0 n/c (17b2, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											7500	17.1212	0.9491	3.3563	0.25	3.1915	3.7218	2.7516	1.4665	3.9567	0.483	4.9019	0	0.0368	2.7888	2.9371	12.2983	1.0439	0.2237	0	0	2.4287	0.59	0	0.0965	0.1154	0.0324	0	0	0	0											64.7411	635	27.90651831	33.9758	1.894777267	8.605976996	0.249984477	5.52059852	6.437551942	4.759472403	3.451969557	6.843436803	0.483026832	8.383918122	0	0.070441359	4.73767896	5.930406779	26.71352758	2.268910374	0.389908301	0	0	5.276641378	1.290084251	0	0.096500493	0.115365664	0.032432008	0	0	0	0	0	0	0	0	0	0	0	0	0	0	127.5284
R5342_004_0	2010	5	3																															D	D	Coin	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	2016.258363	178.0933089	36.95553807	481.3623226	232.8536871	13.07926449	13.89553414	502.3578365	31.14502678	9546.152709	37.36036482	0	0.148718656	16.02275553	5570.266009	5583.755003	565.1194152	434.5059457	0	0	20.15452641	814.401084	0	0	134.1251771	0	11.3815444	4.537038413	78.80119349	0											3400	"$200 Days 1-17 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$200 Days 1-12 (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$20 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$20 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4); $0 (14a7)"	"$0 n/c (13b, 13c, 13d, 13e)"											182.9570339	145.5956477	0.169990188	0	150	0.2	0.096306291	49.76737928	0.2	3	0.173710375	0	0.2	0.150528375	13.4798649	34.83490126	38.5	35	0	0	0.2	34.60575824	0	0	35	0	0	0	0	0											NO	123.5051846	91.0010999	0.106248328	0	93.75393568	0.125005248	0.060193959	31.10591784	0.125005248	1.875078714	0.108573542	0	0.125005248	0.094084184	8.425269248	21.85938128	24.06351016	21.87591833	0	0	0.125005248	21.62950688	0	0	35	0	0	0	0	0												20.7515	1.350557249	3.926464128	0	1.8192458	1.634976695	0.836427211	1.302191799	3.893291784	1.491648978	4.056347135	0	0.018590612	1.507487875	3.910915909	10.17145247	1.133229732	0.792101382	0	0	2.519421564	1.467924488	0	0	0.391198433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.975	0	37.48156819	20.7515	1.350557249	3.926464128	0	1.8192458	1.634976695	0.836427211	1.302191799	3.893291784	1.491648978	4.056347135	0	0.018590612	1.507487875	3.910915909	10.17145247	1.133229732	0.792101382	0	0	2.519421564	1.467924488	0	0	0.391198433	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.975	YES	"30% (1a, 1a1); $0 n/c (1a2, 1a3)"	"30% (1b); $0 n/c (1b1, 1b2)"	"30% (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"30% (3, 9a, 9d); $75 (5); $45/$35 (9c)"	"30% (7a, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b)"	"30% (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"30% (7c, 7i)"	Included in h.2.	30% (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"30% (13a, 13a1, 16b, 17a, 17b, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	30% (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	30% (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); 30% Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											8900	16.3266	0.4564	1.3693	0.3462	0.9165	1.2355	1.3126	0.656	2.9419	0.7514	3.0068	0	0.0094	1.1474	2.6512	9.9332	0.6744	0.4105	0	0	1.9905	0.5242	0	0	0.1153	0	0.0078	0.003	0	0											46.786	0	27.89772908	37.0781	1.806966655	5.295757488	0.346181256	2.73570797	2.87042901	2.148983421	1.958183156	6.835215275	2.243081171	7.063148861	0	0.027955808	2.654889169	6.562159769	20.10463017	1.80764017	1.202577984	0	0	4.509956922	1.992098284	0	0	0.506542784	0	0.007846889	0.002984894	0	0	0	0	0	0	0	0	0	0	0	0	109.761
R5342_801_0	2010	5	3																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	199.4504956	4.8972	23.86635829	90.63349069	4.260197626	5.471886372	6.398993977	10.39901574	17.5109003	13.54275478	26.15087583	0	0.058097812	9.899804892	18.69397636	73.69430423	1.9125	5.233267644	0	0	10.79013335	4.77015379	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077880774	0.077880774	0.16680474	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077880774	0.077880774	0.16680474	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												15.5334	0.381397727	3.981021685	0	0.992626047	1.274949525	1.490965597	2.422970667	4.08003977	3.155461863	6.093154068	0	0.01353679	2.30665454	4.355696493	17.17077289	0.4456125	1.219351361	0	0	2.514101071	1.111445833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5431	0	0	15.5334	0.381397727	3.981021685	0	0.992626047	1.274949525	1.490965597	2.422970667	4.08003977	3.155461863	6.093154068	0	0.01353679	2.30665454	4.355696493	17.17077289	0.4456125	1.219351361	0	0	2.514101071	1.111445833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	68.5431	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	4.0055	0.0983	0.6213	0	0.7188	0.9232	1.0797	1.7546	2.9545	2.285	4.4123	0	0.0098	1.6703	2.6134	10.3025	0.2674	0.7316	0	0	1.5085	0.6669	0	0	0	0	0	0	0	0											36.6235	0	0	19.5388	0.479745568	4.602337208	0	1.711424219	2.198188835	2.570630339	4.177535632	7.034551328	5.440451488	10.50543805	0	0.023339294	3.976990586	6.969114389	27.47323662	0.71298	1.950962178	0	0	4.022561714	1.778313333	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	105.1666
R5342_802_0	2010	5	3																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	213.4163423	4.856438327	24.76980185	105.0777631	4.477045039	5.249483861	6.180820973	11.12303912	17.67107213	13.695885	27.09038822	0	0.069070814	11.04868375	18.2802353	72.69522382	1.890383395	5.371827632	0	0	10.3904232	4.655340765	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077788105	0.077788105	0.166687812	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077788105	0.077788105	0.166687812	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.6013	0.377773135	4.128824065	0	1.043151494	1.22312974	1.440131287	2.591668115	4.117359807	3.191141204	6.312060455	0	0.0160935	2.574343313	4.259294824	16.93798715	0.440459331	1.251635838	0	0	2.420968604	1.084694398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.012	0	0	16.6013	0.377773135	4.128824065	0	1.043151494	1.22312974	1.440131287	2.591668115	4.117359807	3.191141204	6.312060455	0	0.0160935	2.574343313	4.259294824	16.93798715	0.440459331	1.251635838	0	0	2.420968604	1.084694398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.012	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	4.2808	0.0974	0.6444	0	0.7554	0.8857	1.0429	1.8767	2.9815	2.3108	4.5708	0	0.0117	1.8642	2.5556	10.1628	0.2643	0.751	0	0	1.4526	0.6508	0	0	0	0	0	0	0	0											37.1593	0	0	20.8821	0.475186333	4.773207011	0	1.798537059	2.108844379	2.482984977	4.468393301	7.098896219	5.501967594	10.88286285	0	0.027747413	4.438522954	6.814871719	27.10077944	0.70473493	2.002617341	0	0	3.873549767	1.735511037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1713
R5342_803_0	2010	5	3																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	213.4163423	4.856438327	24.76980185	105.0777631	4.477045039	5.249483861	6.180820973	11.12303912	17.67107213	13.695885	27.09038822	0	0.069070814	11.04868375	18.2802353	72.69522382	1.890383395	5.371827632	0	0	10.3904232	4.655340765	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077788105	0.077788105	0.166687812	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077788105	0.077788105	0.166687812	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												16.6013	0.377773135	4.128824065	0	1.043151494	1.22312974	1.440131287	2.591668115	4.117359807	3.191141204	6.312060455	0	0.0160935	2.574343313	4.259294824	16.93798715	0.440459331	1.251635838	0	0	2.420968604	1.084694398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.012	0	0	16.6013	0.377773135	4.128824065	0	1.043151494	1.22312974	1.440131287	2.591668115	4.117359807	3.191141204	6.312060455	0	0.0160935	2.574343313	4.259294824	16.93798715	0.440459331	1.251635838	0	0	2.420968604	1.084694398	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.012	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	4.2808	0.0974	0.6444	0	0.7554	0.8857	1.0429	1.8767	2.9815	2.3108	4.5708	0	0.0117	1.8642	2.5556	10.1628	0.2643	0.751	0	0	1.4526	0.6508	0	0	0	0	0	0	0	0											37.1593	0	0	20.8821	0.475186333	4.773207011	0	1.798537059	2.108844379	2.482984977	4.468393301	7.098896219	5.501967594	10.88286285	0	0.027747413	4.438522954	6.814871719	27.10077944	0.70473493	2.002617341	0	0	3.873549767	1.735511037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1713
R5566_005_0	2010	4	19																															A	A	D	V	Coin	Coin	Coin	V	V	V	Coin	V	V	V	P	P	V	V	P	P	Coin	O	T	P	P	P	P	V	V	V																																																			0	YES	195.3026773		904.6676814		2.800353635	5.136149654	2.896071258	170.4346137	262.7261542		20.69997466			761.4596264	4944.316634	2296.104328	177.0735099	233.7506551			15.4110516	26.5207872			486.4653566																3350	"$225 / Day, Days 1-3 (1a, 1b)"	(included in a.1 above)	$0 Days 1-20; $125 Days 21+ (2)	$0 (6)	20% (10a)	20% (11a)	"20% (11b, 11c)"	"$50 (4a), $35 (4b)"	"$150 (9a, 9b)"	$0 (8a)	20% (8b)	$0 (9a)	$0 (12)	"$125 (5) $35 (3) $35 (9a, 9c, 9d)"	"$25 (7a, 14c) $0 (14b, 14d, 14e, 14f, 14g, 14h) $35 (14i)"	"20% (7b) $35 (7d, 7f)"	"$35 (7e, 7h)"	"$35 (7c, 7i)"	$0 (8b)	$35 (7g)	20% (15)	"$35 (14a, 14j, 16b, 17a) 20% (17b) $0 (13a)"	$0 n/c (10b)	$0 n/c (16a)	$35 (17a)	$0 n/c (17b)	$35 (18a)	$0 n/c (18b)	$0 (14a)	$0 n/c (13b)											575.2409889		32.57309402		0.2	0.2	0.2	48.65465159	150		0.2			35	25.02904466	18.03364589	35	35			0.2	17.07777508			35																NO	559.4836765		31.68083421		0.194521492	0.194521492	0.194521492	47.32187705	145.8911188		0.194521492			34.04126106	24.34343553	17.54004047	34.04126106	34.04126106			0.194521492	16.60997143			34.04126106																	9.1057	0	2.388385569	0	0.544728967	0.999091493	0.563348101	0.672107153	3.194117716	0	4.02658995	0	0	2.160087161	10.03013777	3.356146904	0.502317132	0.663097256	0	0	2.997780746	0.036709126	0	0	1.379991183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6204	0	1.200285691	9.1057	0	2.388385569	0	0.544728967	0.999091493	0.563348101	0.672107153	3.194117716	0	4.02658995	0	0	2.160087161	10.03013777	3.356146904	0.502317132	0.663097256	0	0	2.997780746	0.036709126	0	0	1.379991183	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	42.6204	YES	"OON: 40%; OOA: $225 / Day, Days 1-3 (1a, 1b)"	(included in a.1 above)	OON: 40%; OOA: $0 Days 1-20; $125 Days 21+ (2)	OON: 40%; OOA: $0 (6)	OON: 40%; OOA: 20% (10a)	OON: 40%; OOA: 20% (11a)	"OON: 40%; OOA: 20% (11b, 11c)"	"OON: 40%; OOA: $50 (4a), $35 (4b)"	"OON: 40%; OOA: $150 (9a, 9b)"	OON: 40%; OOA: $0 (8a)	OON: 40%; OOA: 20% (8b)	OON: 40%; OOA: $0 (9a)	OON: 40%; OOA: $0 (12)	"OON: 40%; OOA: $125 (5) $35 (3) $35 (9a, 9c, 9d)"	"OON: 40%; OOA: $25 (7a, 14c) $0 (14b, 14d, 14e, 14f, 14g, 14h) $35 (14i)"	"OON: 40%; OOA: 20% (7b) $35 (7d, 7f)"	"OON: 40%; OOA: $35 (7e, 7h)"	"OON: 40%; OOA: $35 (7c, 7i)"	OON: 40%; OOA: $0 (8b)	OON: 40%; OOA: $35 (7g)	OON: 40%; OOA: 20% (15)	"OON: 40%; OOA: $35 (14a, 14j, 16b, 17a) 20% (17b) $0 (13a)"	OON: 40%; OOA: $0 n/c (10b)	OON: 40%; OOA: $0 n/c (16a)	OON: 40%; OOA: $35 (17a)	OON: 40%; OOA: $0 n/c (17b)	OON: 40%; OOA: $35 (18a)	OON: 40%; OOA: $0 n/c (18b)	OON: 40%; OOA: $0 (14a)	OON: 40%; OOA: $0 n/c (13b)											8350	3.3779		1.0487	0.296	0.4569	0.2958	0.4486	0.0476	0.6096	0.5436	0.1789	0.0286	0.0097	0.3308	1.6738	0.6803	0.1088	0.1755	0.4649		0.3833	0.0348			0.0303																11.2242	0	1.847640264	12.4836	0	3.43708269	0.29603785	1.001650602	1.294846486	1.011997339	0.719659473	3.803698902	0.543565694	4.205499688	0.02856194	0.009694739	2.490892814	11.70389431	4.036474048	0.611079757	0.838629986	0.464890973	0	3.381047394	0.07149087	0	0	1.410260383	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	53.8446
R5566_804_0	2010	3	19																															A	A	D	V	Coin	Coin	Coin	V	V	V	Coin	V	V	V	P	P	V	V	P	P	Coin	O	T	P	P	P	P	V	V	V																																																			0	YES	284.316536		1439.676115		4.85473501	8.509878875	7.95838049	238.6039455	312.7322443		19.76336812	30.83654368	369.1706168	1763.438254	13314.14774	4392.184022	182.9661926	258.8740038	2799.695986	51.79153991	39.52940417	237.2700087																			3350	FFS Cost Sharing	(included in a.1 above)	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	"$50 (4a, 4b)"	FFS Cost Sharing	$0 (8a)	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																			921.3453071		32.38911116		0.233	0.233	0.233	50	407.7459626		0.233	143.4681688	11.74200367	44.59320792	13.08847167	18.67660982	17.23857349	30.48107295	17.07423405	11.29583214	0.233	20.91708239																			NO	664.5582242		23.36197952		0.16806084	0.16806084	0.16806084	36.06455794	294.1035579		0.16806084	103.4823217	8.469403432	32.16468661	9.4405989	13.47127354	12.43403065	21.98572843	12.31549407	8.147583854	0.16806084	15.0873066																				15.7454	0	2.802806993	0	0.815890844	1.430177392	1.33749211	0.717095485	7.664638809	0	3.321448248	0.265919761	0.260554574	4.726703235	10.47446071	4.930692701	0.189583937	0.474294462	2.873303275	0.03516466	6.64334487	0.298313781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0073	0	25.11899438	15.7454	0	2.802806993	0	0.815890844	1.430177392	1.33749211	0.717095485	7.664638809	0	3.321448248	0.265919761	0.260554574	4.726703235	10.47446071	4.930692701	0.189583937	0.474294462	2.873303275	0.03516466	6.64334487	0.298313781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0073	YES	0.5	(included in a.1 above)	0.5	0.5	0.5	0.5	0.5	"$50 (4a, 4b)"	0.5	$0 (8a)	0.5	0.5	0.5	0.5	50% (except 14b: $0)	0.5	0.5	0.5	0.5	0.5	0.5	0.5																			8350	6.1376		1.7597		0.5324	0.6048	0.8501	0.0602	0.5946	0.8154	0.3874	0.2089	0.0069	0.6122	1.4223	1.0378	0.1779	0.144	0.3441	0.0058	0.3809	0.0524																			16.1352	0	8.827627033	21.883	0	4.562468668	0	1.348309507	2.034966336	2.187548465	0.777274556	8.259255633	0.815412473	3.70888668	0.474772304	0.26745843	5.33889333	11.89680434	5.968442925	0.367525765	0.618246152	3.217362392	0.040982013	7.02423126	0.350704037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1425
R5566_805_0	2010	3	19																															A	A	D	V	Coin	Coin	Coin	V	V	V	Coin	V	V	V	P	P	V	V	P	P	Coin	O	T	P	P	P	P	V	V	V																																																			0	YES	284.316536		1439.676115		4.85473501	8.509878875	7.95838049	238.6039455	312.7322443		19.76336812	30.83654368	369.1706168	1763.438254	13314.14774	4392.184022	182.9661926	258.8740038	2799.695986	51.79153991	39.52940417	237.2700087																			3350	FFS Cost Sharing	(included in a.1 above)	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	"$50 (4a, 4b)"	FFS Cost Sharing	$0 (8a)	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing	FFS Cost Sharing																			921.3453071		32.38911116		0.233	0.233	0.233	50	407.7459626		0.233	143.4681688	11.74200367	44.59320792	13.08847167	18.67660982	17.23857349	30.48107295	17.07423405	11.29583214	0.233	20.91708239																			NO	664.5582242		23.36197952		0.16806084	0.16806084	0.16806084	36.06455794	294.1035579		0.16806084	103.4823217	8.469403432	32.16468661	9.4405989	13.47127354	12.43403065	21.98572843	12.31549407	8.147583854	0.16806084	15.0873066																				15.7454	0	2.802806993	0	0.815890844	1.430177392	1.33749211	0.717095485	7.664638809	0	3.321448248	0.265919761	0.260554574	4.726703235	10.47446071	4.930692701	0.189583937	0.474294462	2.873303275	0.03516466	6.64334487	0.298313781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0073	0	25.11899438	15.7454	0	2.802806993	0	0.815890844	1.430177392	1.33749211	0.717095485	7.664638809	0	3.321448248	0.265919761	0.260554574	4.726703235	10.47446071	4.930692701	0.189583937	0.474294462	2.873303275	0.03516466	6.64334487	0.298313781	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.0073	YES	0.5	(included in a.1 above)	0.5	0.5	0.5	0.5	0.5	"$50 (4a, 4b)"	0.5	$0 (8a)	0.5	0.5	0.5	0.5	50% (except 14b: $0)	0.5	0.5	0.5	0.5	0.5	0.5	0.5																			8350	6.1376		1.7597		0.5324	0.6048	0.8501	0.0602	0.5946	0.8154	0.3874	0.2089	0.0069	0.6122	1.4223	1.0378	0.1779	0.144	0.3441	0.0058	0.3809	0.0524																			16.1352	0	8.827627033	21.883	0	4.562468668	0	1.348309507	2.034966336	2.187548465	0.777274556	8.259255633	0.815412473	3.70888668	0.474772304	0.26745843	5.33889333	11.89680434	5.968442925	0.367525765	0.618246152	3.217362392	0.040982013	7.02423126	0.350704037	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.1425
R5674_001_0	2010	13	22	h.2.	h.2.	h.1.	h.1.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Complex diag xray	PET Scans	Chemotherapy	Genetic Testing							D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	V	Coin	V	V	V	V	V	V	V	V	V	Coin	Coin	Coin	Coin																																															0	YES	1028.33597	106.9769914	1651.777236	3133.951204	44.5127181	10.32506203	2.757267893	238.9396802	517.7360026	5100.934217	1379.394449	0	0	940.6579739	75.32712572	9829.732919	57.25972851	466.0719043	119.8891495	251.0052391	3.130457445	0									10.33167653	5.81342255	0.189768907	0							4000	"$175/Day,days 1-6"	"$175/Day,days 1-6"	"$50/day, days 11-100"	No cost sharing	$100/trip	20% coinsurance	20% coinsurance	$50/visit	"$150/visit OH, $100/visit ASC"	$10/visit lab	$15/visit	$150/visit OH	20% coinsurance	$40/visit	$10/visit	$35/visit	$35/visit	$35/visit	$35/visit	$25/visit	20% coinsurance	20% coinsurance							No Charge		20% coinsurance	20% coinsurance	20% coinsurance	50% coinsurance							76.17957115	76.17957115	14.49717135	0	100	0.2	0.2	50	102.7206965	10	15	150	0.2	25	10	35	35	35	35	25	0.2	0.2							0		0.2	0.2	0.2	0.5							NO	64.65	64.65	12.3032548	0	84.86658876	0.169733178	0.169733178	42.43329438	87.17555109	8.486658876	12.72998831	127.2998831	0.169733178	21.21664719	10	35	35	35	35	25	0.169733178	0.169733178							0		0.169733178	0.169733178	0.169733178	0.424332944								5.5402	0.576338541	1.693519684	0	0.314803545	1.752505586	0.467999841	0.844916483	3.761160112	3.607490721	1.463306268	0	0	1.66313403	0.062772605	28.67005435	0.167007541	1.359376388	0.349676686	0.522927581	0.531342489	0	0	0	0	0	0	0	0	0	1.753628287	0.986730682	0.03221008	0	0	0	0	0	0	0	56.1211	0	4.456099675	5.5402	0.576338541	1.693519684	0	0.314803545	1.752505586	0.467999841	0.844916483	3.761160112	3.607490721	1.463306268	0	0	1.66313403	0.062772605	28.67005435	0.167007541	1.359376388	0.349676686	0.522927581	0.531342489	0	0	0	0	0	0	0	0	0	1.753628287	0.986730682	0.03221008	0	0	0	0	0	0	0	56.1211	YES	$275/Days 1 - 5	$275/Days 1 - 5	40% Coinsurance	40% Coinsurance	$100/trip	30% Coinsurance	30% Coinsurance	$50/visit	40% Coinsurance	40% Coinsurance	40% Coinsurance	40% Coinsurance	20% Coinsurance	40% Coinsurance	$25/visit	$40/visit	$40/visit	$40/visit	$40/visit	$40/visit	20% coinsurance	$45/visit									30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance							9500	1.19	0.04	0.1827	0.7197	1.5305	0.4477	0.2437	0.1897	1.728	0.519	0.7536	0	0	0.3972	0.1216	8.5029	0	1.1182	0.1235	0.3287	0	0									0	0	0	0							18.1367	0	0.692061867	6.7302	0.616338541	1.876186677	0.719727553	1.845340871	2.200210902	0.711681188	1.034664943	5.489153298	4.126449583	2.216951926	0	0	2.060300705	0.184330709	37.1729596	0.167007541	2.477576415	0.473195283	0.851637428	0.531342489	0	0	0	0	0	0	0	0	0	1.753628287	0.986730682	0.03221008	0	0	0	0	0	0	0	74.2578
R5674_801_0	2010	11	22	h.1.	h.1.	h.2.	h.2.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Chemotherapy	Genetic Testing	Complex diag xray	PET Scans							D	D	D	V	T	Coin	Coin	V	V	P	P	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	V	V	V	V	V	V	V	V	Coin	Coin	V	V																																															0	NO	772.3402865	150.6010333	4291.681683	5082.586866	5.241853685	17.76062706	4.010429915	285.8052785	431.4130598	5649.338752	2257.960821	0	0	39.31701139	205.5010268	7688.966195	196.2120965	215.9945532	182.4850016	191.5940776	4.225589083	0									1.877354359	0	614.8975269	37.38685572								"$175/day, days 1-6"	"$175/day, days 1-6"	"$50/day, days 11-100"	No cost sharing	$150/trip	20% coinsurance	20% coinsurance	$50/visit	$150/visit- IH/$100/visit ASC	$10/procedure	$15/procedure	20% coinsurance	20% coinsurance	20% coinsurance	$10/visit	$25/visit	$25/visit	$25/visit	$25/visit	$25/visit	20% coinsurance	20% coinsurance									20% coinsurance	50% Coinsurance	$50/visit	$200/visit							76.17957115	76.17957115	26.02585365	0	150	0.2	0.2	50	104.3381694	10	15	0.2	0.2	0.2	10	25	25	25	25	25	0.2	0.2									0.2	0.5	50	200							NO	58.63555551	58.63555551	20.03214725	0	115.4552749	0.153940366	0.153940366	38.48509162	80.30928022	7.697018325	11.54552749	0.153940366	0.153940366	0.153940366	10	25	25	25	25	25	0.153940366	0.153940366									0.153940366	0.384850916	38.48509162	153.9403665								3.7739	0.735881271	7.164299951	0	0.050433305	2.734077439	0.617367051	0.916603527	2.887206026	3.623588658	2.172445727	0	0	6.052475143	0.171250856	16.01867957	0.408775201	0.449988652	0.380177087	0.399154328	0.650488732	0	0	0	0	0	0	0	0	0	0.289000618	0	1.972032305	0.479612189	0	0	0	0	0	0	51.9474		6.667451908	3.7739	0.735881271	7.164299951	0	0.050433305	2.734077439	0.617367051	0.916603527	2.887206026	3.623588658	2.172445727	0	0	6.052475143	0.171250856	16.01867957	0.408775201	0.449988652	0.380177087	0.399154328	0.650488732	0	0	0	0	0	0	0	0	0	0.289000618	0	1.972032305	0.479612189	0	0	0	0	0	0	51.9474	YES	"$275/day, days 1-5"	"$275/day, days 1-5"	30% coinsurance	30% coinsurance	"$150/trip, or 40%"	30% coinsurance	30% coinsurance	$50/visit	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$20/visit	$35/visit	$35/visit	$35/visit	$35/visit	$35/visit	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance							7500	0	0	0	2.2447	2.3714	0.5115	0.3064	0.0081	4.1788	1.095	0.6131	0	0	1.6222	0	0	0	5.1558	0.1464	1.3461	0	0									0	0	0	0							19.5996		22.36343018	3.7739	0.735881271	7.164299951	2.244727121	2.421833786	3.24560622	0.923769939	0.924733824	7.065984868	4.718633716	2.785584813	0	0	7.674714802	0.171250856	16.01867957	0.408775201	5.605761754	0.526545455	1.745227944	0.650488732	0	0	0	0	0	0	0	0	0	0.289000618	0	1.972032305	0.479612189	0	0	0	0	0	0	71.547
R5674_802_0	2010	11	22	h.1.	h.1.	h.2.	h.2.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Chemotherapy	Genetic Testing	Complex diag xray	PET Scans							D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	V	V	V	V	V	V	V	V	Coin	Coin	V	V																																															0	NO	605.8473935	114.2774898	3330.988707	14891.09541	131.6768747	13.06087377	4.068093147	200.9382691	364.6395617	5724.068359	1470.898546	0	0	34.84850914	88.56037916	8651.758716	166.4292561	1127.673065	128.4775472	265.2819212	3.455793045	0									0.230028657	0	409.2359875	26.82816567								"$175/day, days 1-6"	"$175/day, days 1-6"	"$50/day, days 11-100"	No cost sharing	$150/trip	20% coinsurance	20% coinsurance	$50/visit	$150/visit- IH/$100/visit ASC	$10/procedure	$15/procedure	20% coinsurance	20% coinsurance	20% coinsurance	$10/visit	$25/visit	$25/visit	$25/visit	$25/visit	$25/visit	20% coinsurance	20% coinsurance									20% coinsurance	50% Coinsurance	$50/visit	$200/visit							76.17957115	76.17957115	26.02585365	0	150	0.2	0.2	50	104.3426747	10	15	0.2	0.2	0.2	10	25	25	25	25	25	0.2	0.2									0.2	0.5	50	200							NO	62.14816942	62.14816942	21.23219044	0	122.3717235	0.163162298	0.163162298	40.79057449	79.73657714	8.158114897	12.23717235	0.163162298	0.163162298	0.163162298	10	25	25	25	25	25	0.163162298	0.163162298									0.163162298	0.407905745	40.79057449	163.1622979								3.1377	0.591844733	5.893682215	0	1.342793841	2.131042177	0.663759426	0.683032286	2.422925878	3.891467279	1.499969918	0	0	5.685962832	0.073800316	18.02449733	0.346727617	2.349318886	0.267661557	0.552670669	0.563855134	0	0	0	0	0	0	0	0	0	0.037532004	0	1.391080919	0.364778763	0	0	0	0	0	0	51.9161	0	6.907269074	3.1377	0.591844733	5.893682215	0	1.342793841	2.131042177	0.663759426	0.683032286	2.422925878	3.891467279	1.499969918	0	0	5.685962832	0.073800316	18.02449733	0.346727617	2.349318886	0.267661557	0.552670669	0.563855134	0	0	0	0	0	0	0	0	0	0.037532004	0	1.391080919	0.364778763	0	0	0	0	0	0	51.9161	YES	"$275/day, days 1-5"	"$275/day, days 1-5"	30% coinsurance	30% coinsurance	"$150/trip, or 40%"	30% coinsurance	30% coinsurance	$50/visit	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$20/visit	$35/visit	$35/visit	$35/visit	$35/visit	$35/visit	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance							7500	0.2152	0.1022	0.5786	0.3889	1.2704	0.186	0.1254	0.1174	0.9923	0.3661	0.4294	0	0	0.9218	0.1429	0	0	1.3738	0.0848	0.4521	0	0									0	0	0	0							7.7474	0	1.819714678	3.3529	0.694068702	6.472281516	0.388914415	2.613229696	2.317053624	0.789163393	0.800431354	3.4152733	4.257543522	1.929321581	0	0	6.607791513	0.216713399	18.02449733	0.346727617	3.723085863	0.352421165	1.004807145	0.563855134	0	0	0	0	0	0	0	0	0	0.037532004	0	1.391080919	0.364778763	0	0	0	0	0	0	59.6635
R5674_803_0	2010	11	22	h.1.	h.1.	h.2.	h.2.							OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other							Chemotherapy	Genetic Testing	Complex diag xray	PET Scans							D	D	D	V	T	Coin	Coin	V	V	V	V	Coin	Coin	Coin	V	V	V	V	V	V	Coin	Coin	V	V	V	V	V	V	V	V	Coin	Coin	V	V																																															0	NO	605.8473935	114.2774898	3330.988707	14891.09541	131.6768747	13.06087377	4.068093147	200.9382691	364.6395617	5724.068359	1470.898546	0	0	34.84850914	88.56037916	8651.758716	166.4292561	1127.673065	128.4775472	265.2819212	3.455793045	0									0.230028657	0	409.2359875	26.82816567								"$175/day, days 1-6"	"$175/day, days 1-6"	"$50/day, days 11-100"	No cost sharing	$150/trip	20% coinsurance	20% coinsurance	$50/visit	$150/visit- IH/$100/visit ASC	$10/procedure	$15/procedure	20% coinsurance	20% coinsurance	20% coinsurance	$10/visit	$25/visit	$25/visit	$25/visit	$25/visit	$25/visit	20% coinsurance	20% coinsurance									20% coinsurance	50% coinsurance	$50/visit	$200/visit							76.17957115	76.17957115	26.02585365	0	150	0.2	0.2	50	104.3426747	10	15	0.2	0.2	0.2	10	25	25	25	25	25	0.2	0.2									0.2	0.5	50	200							NO	62.14816942	62.14816942	21.23219044	0	122.3717235	0.163162298	0.163162298	40.79057449	79.73657714	8.158114897	12.23717235	0.163162298	0.163162298	0.163162298	10	25	25	25	25	25	0.163162298	0.163162298									0.163162298	0.407905745	40.79057449	163.1622979								3.1377	0.591844733	5.893682215	0	1.342793841	2.131042177	0.663759426	0.683032286	2.422925878	3.891467279	1.499969918	0	0	5.685962832	0.073800316	18.02449733	0.346727617	2.349318886	0.267661557	0.552670669	0.563855134	0	0	0	0	0	0	0	0	0	0.037532004	0	1.391080919	0.364778763	0	0	0	0	0	0	51.9161	0	6.907269074	3.1377	0.591844733	5.893682215	0	1.342793841	2.131042177	0.663759426	0.683032286	2.422925878	3.891467279	1.499969918	0	0	5.685962832	0.073800316	18.02449733	0.346727617	2.349318886	0.267661557	0.552670669	0.563855134	0	0	0	0	0	0	0	0	0	0.037532004	0	1.391080919	0.364778763	0	0	0	0	0	0	51.9161	YES	"$275/day, days 1-5"	"$275/day, days 1-5"	30% coinsurance	30% coinsurance	"$150/trip, or 40%"	30% coinsurance	30% coinsurance	$50/visit	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance	$20/visit	$35/visit	$35/visit	$35/visit	$35/visit	$35/visit	30% coinsurance	30% coinsurance									30% coinsurance	30% coinsurance	30% coinsurance	30% coinsurance							7500	0.2152	0.1022	0.5786	0.3889	1.2704	0.186	0.1254	0.1174	0.9923	0.3661	0.4294	0	0	0.9218	0.1429	0	0	1.3738	0.0848	0.4521	0	0									0	0	0	0							7.7474		1.819714678	3.3529	0.694068702	6.472281516	0.388914415	2.613229696	2.317053624	0.789163393	0.800431354	3.4152733	4.257543522	1.929321581	0	0	6.607791513	0.216713399	18.02449733	0.346727617	3.723085863	0.352421165	1.004807145	0.563855134	0	0	0	0	0	0	0	0	0	0.037532004	0	1.391080919	0.364778763	0	0	0	0	0	0	59.6635
R5826_001_0	2010	4	10	r.	s.	t.	u.	v.						Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered																D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	O	O	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	YES	1689.74431	59.462289	599.762262	516.679178	43.103076	9.962361	5.521476	380.108167	387.28005	1283.356743	966.62785	68.847535	1.055258	512.948444	4045.374569	3699.380334	104.922861	547.428222			29.451691	0		0.91					0.04	0.25	0.05	0.55	1.74	0.32	0.4						5900	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $40 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	$15/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a						158.7573	140.3991	58.254672	0	100	0.2	0.2	50	240.634107	40.671286	90.761544	150	0.2	56.932344	15	40	40	15			0.2	0		0					0	0	0	0	0	0	0						NO	141.065386	124.753024	35.777981	0	86.0402	0.17208	0.17208	43.0201	207.042067	34.993656	78.091414	129.0603	0.17208	48.984702	12.90603	34.41608	34.41608	12.90603			0.17208	0		0					0	0	0	0	0	0	0							19.8637	0.618175031	1.788190235	0	0.309049773	1.714323081	0.95013559	1.362690946	6.681938505	3.742445366	6.290444635	0.74045696	0.181588797	2.093885556	4.350810462	10.60984746	0.300919465	0.588760421	0	0	5.068046987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2554	0	10.99091	19.8637	0.618175031	1.788190235	0	0.309049773	1.714323081	0.95013559	1.362690946	6.681938505	3.742445366	6.290444635	0.74045696	0.181588797	2.093885556	4.350810462	10.60984746	0.300919465	0.588760421	0	0	5.068046987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	67.2554	YES	30% Coins	30% Coins	30% Coins(Days 1-8) 30%(Days 9-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a						7500	9.0888	0.1143	0.3594	2.9502	1.3173	1.8067	1.0013	0.363	4.0017	0.5802	1.9064	0.2693	0.051	1.0491	2.0241	2.5821	0.031	0.2392			1.411	0		0					0	0	0	0	0	0	0						31.1463	500	14.720429	28.9525	0.732485031	2.147569235	2.950185	1.626329773	3.521017081	1.95146559	1.725707946	10.6836475	4.322681366	8.196883635	1.00980196	0.232605797	3.143009556	6.374914462	13.19194746	0.331931465	0.827955421	0	0	6.479011987	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.4017
R5826_002_0	2010	7	6	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered			Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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	0	0	0	0	0	0			0	YES	1661.139527	137.735525	545.819475	277.100654	50.464015	9.540099	3.467058	455.497269	285.513752	1530.831211	79.848978	69.585177	0.000109	885.850202	3248.848616	3114.830009	201.318641	194.702331			23.201079	0		2.59					0.04	0.25	911.54436	0.70182	0.05	0.55	2.68	387.561802	0.32	0.4			6000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN814: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			158.7573	140.3991	50.7565	0	150	0.2	0.2	50	189.169333	124.526846	75	150	0.2	119.370808	15	35	35	100			0.2	0		0					0	0	122.341453	0	0	0	0	35	0	0			NO	136.866732	121.039889	31.566584	0	125.0748	0.166766	0.166766	41.6916	157.735443	103.834469	62.5374	125.0748	0.166766	99.535199	12.50748	29.18412	29.18412	83.3832			0.166766	0		0					0	0	102.012218	0	0	0	0	29.18412	0	0				18.9462	1.389291055	1.435804692	0	0.525981382	1.59096415	0.578187394	1.582534162	3.752969846	13.24608716	0.416128956	0.725279341	1.82E-05	7.347773012	3.386242424	7.57529773	0.489608948	1.352908617	0	0	3.869151141	0	0	0	0	0	0	0	0	0	7.749055164	0	0	0	0	0.942554178	0	0	0	0	76.9021	0	15.11192	18.9462	1.389291055	1.435804692	0	0.525981382	1.59096415	0.578187394	1.582534162	3.752969846	13.24608716	0.416128956	0.725279341	1.82E-05	7.347773012	3.386242424	7.57529773	0.489608948	1.352908617	0	0	3.869151141	0	0	0	0	0	0	0	0	0	7.749055164	0	0	0	0	0.942554178	0	0	0	0	76.9021	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			7500	9.5513	0.2804	0.3414	2.0181	2.7377	2.0475	0.7441	0.5148	3.998	0.8457	0.0956	0.8213	0	2.3525	2.0736	1.988	0.1285	0.1108			1.2379	0		0					0	0	2.0709	0	0	0	0	0.2474	0	0			34.2054	1000	16.735272	28.4975	1.669657055	1.777191692	2.018102	3.263682382	3.63843715	1.322279394	2.097346162	7.751013846	14.09183216	0.511684956	1.546567341	2.42E-05	9.700276012	5.459793424	9.56331273	0.618098948	1.463745617	0	0	5.107098141	0	0	0	0	0	0	0	0	0	9.819921164	0	0	0	0	1.189912178	0	0	0	0	111.1075
R5826_003_0	2010	3	7	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	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	YES	1116.524504	86.728158	565.470556	459.34659	34.960541	8.581166	3.271537	388.008816	303.13712	1164.207952	944.753078	89.747928	0.00189	700.542894	3864.692285	3722.533206	189.330181	528.561333			16.931268	0		1.13					0.04	0.25	25.173116	0.05	0.55	2.14	0.32	0.4					5900	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	244.499325	33.926488	96.36508	150	0.2	49.602423	15	35	35	15			0.2	0		0					0	0	0	0	0	0	0	0					NO	147.007831	130.008303	40.805475	0	89.0623	0.178125	0.178125	44.53115	217.756722	30.21571	85.824957	133.59345	0.178125	44.177059	13.359345	31.171805	31.171805	13.359345			0.178125	0		0					0	0	0	0	0	0	0	0						13.6782	0.939615054	1.922857886	0	0.259472183	1.528520194	0.582742528	1.439873232	5.500845464	2.931447488	6.756949358	0.999144611	0.000336656	2.57899373	4.302479796	9.669839934	0.491813624	0.5884361	0	0	3.015882113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1874	0	6.982372	13.6782	0.939615054	1.922857886	0	0.259472183	1.528520194	0.582742528	1.439873232	5.500845464	2.931447488	6.756949358	0.999144611	0.000336656	2.57899373	4.302479796	9.669839934	0.491813624	0.5884361	0	0	3.015882113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	57.1874	YES	30% Coins	30% Coins	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					7500	8.263	0.2111	0.428	3.3858	1.3218	1.6043	0.6116	0.4584	4.6791	0.847	2.4834	0.4459	0.0001	1.5682	2.5758	3.4201	0.0832	0.2955			0.9977	0		0					0	0	0	0	0	0	0	0					33.68	1000	12.08555	21.9412	1.150686054	2.350859886	3.385757	1.581235183	3.132846194	1.194385528	1.898297232	10.17991846	3.778466488	9.240299358	1.445071611	0.000449656	4.14716573	6.878252796	13.08996493	0.574994624	0.8839861	0	0	4.013559113	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.8674
R5826_004_0	2010	4	8	r.	s.	t.	u.							OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)							Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	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	YES	1458.367567	94.406542	335.184021	347.424264	42.948446	8.54063	3.873337	425.660912	412.080916	1066.553688	961.606377	78.073103	0.218717	650.208343	3857.73901	4106.859084	94.740558	775.098246			20.41552	0		0.93					0.04	0.25	32.070137	0.05	0.55	2.18							5900	$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a							144.519765	143.64207	58.254672	0	100	0.2	0.2	50	241.652911	35.811525	84.189881	150	0.2	52.480052	15	35	35	15			0.2	0		0					0	0	0	0	0	0							NO	133.121347	132.312876	44.93713	0	88.3125	0.176625	0.176625	44.15625	213.409727	31.626053	74.350188	132.46875	0.176625	46.346446	13.246875	30.909375	30.909375	13.246875			0.176625	0		0					0	0	0	0	0	0								16.1783	1.040933424	1.255183994	0	0.31607372	1.508488774	0.684128148	1.566299137	7.328506315	2.810906955	5.957967909	0.861853864	0.03863089	2.511237155	4.258582204	10.57837062	0.244030953	0.855635798	0	0	3.60589122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.601	0	7.553858	16.1783	1.040933424	1.255183994	0	0.31607372	1.508488774	0.684128148	1.566299137	7.328506315	2.810906955	5.957967909	0.861853864	0.03863089	2.511237155	4.258582204	10.57837062	0.244030953	0.855635798	0	0	3.60589122	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	61.601	YES	30% Coins	30% Coins	30% Coins(Days 1-10) 30%(Days 11-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a							7500	8.5067	0.1591	0.2408	1.9236	1.3505	1.5937	0.7228	0.4183	3.9277	0.5397	1.6616	0.3547	0.0109	1.6551	1.8773	3.6321	0.0348	0.3064			0.9567	0		0					0	0	0	0	0	0							29.8723	500	11.313933	24.685	1.200050424	1.496002994	1.923591	1.66658472	3.102138774	1.406878148	1.984576137	11.25618332	3.350567955	7.619524909	1.216569864	0.04951089	4.166324155	6.135843204	14.21045862	0.278879953	1.162069798	0	0	4.56260422	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.4733
R5826_005_0	2010	7	9	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered				Radiology				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	O	O	O	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	0	0	0	0	0				0	YES	1307.996057	40.139244	528.124098	564.84877	36.650458	7.474496	3.446975	291.353769	390.666973	847.361479	194.661607	100.78201	1.318598	424.725873	4034.934749	5694.269223	74.985214	187.40135			64.877028	0		1.08					0.04	0.25	1240.424187	0.05	0.55	2.59	792.488303	0.32	0.4				6000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,12. 20% Dialysis -- OP Hosp"	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN762: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				158.7573	140.3991	50.7565	0	150	0.2	0.2	50	122.108919	69.349949	75	150	0.001529	107.004344	15	35	35	100			0.2	0		0					0	0	93.80026	0	0	0	35	0	0				NO	141.061735	124.749795	34.006144	0	127.33485	0.16978	0.16978	42.44495	103.658139	58.871103	63.667425	127.33485	0.001298	90.83588	12.733485	29.711465	29.711465	84.8899			0.16978	0		0					0	0	79.626947	0	0	0	29.711465	0	0					15.3757	0.417280205	1.496622011	0	0.388906714	1.269019931	0.585227416	1.030541346	3.374650949	4.157092076	1.032800272	1.069421844	0.00171154	3.215029036	4.281565092	14.09875673	0.185660047	1.325706822	0	0	11.01482181	0	0	0	0	0	0	0	0	0	8.230932583	0	0	0	1.962165706	0	0	0	0	0	74.5136	0	12.904013	15.3757	0.417280205	1.496622011	0	0.388906714	1.269019931	0.585227416	1.030541346	3.374650949	4.157092076	1.032800272	1.069421844	0.00171154	3.215029036	4.281565092	14.09875673	0.185660047	1.325706822	0	0	11.01482181	0	0	0	0	0	0	0	0	0	8.230932583	0	0	0	1.962165706	0	0	0	0	0	74.5136	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$100/Visit	30% Coins	0%-20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				7500	2.5658	0.0696	0.5093	1.4838	1.4752	1.1902	0.5489	0.2443	3.8211	0.4579	0.2304	0.6177	0.0004	1.042	1.9106	2.6964	0.0355	0.1213			2.8243	0		0					0	0	1.9296	0	0	0	0.3753	0	0				24.1497	0	6.229264	17.9415	0.486914205	2.005965011	1.483813	1.864074714	2.459179931	1.134087416	1.274851346	7.195728949	4.615000076	1.263243272	1.687119844	0.00213954	4.257061036	6.192209092	16.79513773	0.221167047	1.446958822	0	0	13.83916581	0	0	0	0	0	0	0	0	0	10.16052958	0	0	0	2.337428706	0	0	0	0	0	98.6633
R5826_006_0	2010	6	11	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	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	YES	1262.985006	46.276593	540.719684	374.268393	39.727159	7.940985	3.979703	356.43947	348.177279	2149.460056	967.298321	81.73894	0.000638	854.698784	3318.026051	3519.267157	112.570769	832.978317			29.989888	0		2.74					0.04	0.25	10.118224	0.05	0.55	1.66	0.32	0.4					7500	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $40 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$35-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN814: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	50.7565	0	100	0.2	0.2	50	140.225285	95.830267	74.741244	100	0.2	84.577464	15	40	40	68.44768			0.2	0		0					0	0	0	0	0	0	0	0					NO	147.325663	130.289382	39.725032	0	88.5974	0.177195	0.177195	44.2987	124.235956	84.903125	66.218799	88.5974	0.177195	74.933434	13.28961	35.43896	35.43896	60.642865			0.177195	0		0					0	0	0	0	0	0	0	0						15.5058	0.502445725	1.790008896	0	0.29331025	1.407102837	0.705183473	1.315817096	3.604678093	15.20798965	5.337777758	0.60348813	0.00011305	5.337126243	3.674606016	10.393264	0.332449248	4.209515969	0	0	5.314058204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5348	0	9.169992	15.5058	0.502445725	1.790008896	0	0.29331025	1.407102837	0.705183473	1.315817096	3.604678093	15.20798965	5.337777758	0.60348813	0.00011305	5.337126243	3.674606016	10.393264	0.332449248	4.209515969	0	0	5.314058204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	75.5348	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					10000	3.4085	0.1104	0.7194	3.249	1.398	1.6582	0.831	0.392	5.5449	1.3538	2.5516	0.5295	0	2.1521	2.112	3.2915	0.0541	0.5101			1.7017	0		0					0	0	0	0	0	0	0	0					31.5679	500	4.461545	18.9143	0.612892725	2.509450896	3.249011	1.69128825	3.065312837	1.536211473	1.707783096	9.149600093	16.56175265	7.889337758	1.13298813	0.00014905	7.489211243	5.786652016	13.68479	0.386570248	4.719637969	0	0	7.015714204	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	107.1027
R5826_007_0	2010	7	12	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered			Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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	0	0	0	0	0	0			0	YES	1424.417088	64.640656	883.959723	460.924343	49.881371	8.666983	3.977178	431.269983	390.241452	2337.543401	103.80596	150.764853	0.002034	894.31147	3418.134612	3490.377394	134.612049	309.431495			22.372105	0		1.92					0.04	0.25	930.372082	7.952008	0.05	0.55	2.34	325.126841	0.32	0.4			6000	$215/Day(Days 1-8):1a	$215/Day(Days 1-8):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$35/Visit:7i			20% Coins:15			"DEN749: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$100/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			159.342305	143.633115	50.7565	0	150	0.2	0.2	50	185.55444	115.13795	75	150	0.2	117.91544	15	35	35	35			0.2	0		0					0	0	118.664786	0	0	0	0	100	0	0			NO	134.997828	121.688704	26.291055	0	122.59395	0.163459	0.163459	40.86465	151.652345	94.101441	61.296975	122.59395	0.163459	96.371464	12.259395	28.605255	28.605255	28.605255			0.163459	0		0					0	0	96.983899	0	0	0	0	81.7293	0	0				16.0244	0.655503138	1.936686141	0	0.509596192	1.416696374	0.650105539	1.468641409	4.931752609	18.33051687	0.530249278	1.540238238	0.000332476	7.18217547	3.492021864	8.320261283	0.320884332	0.737613902	0	0	3.656921911	0	0	0	0	0	0	0	0	0	7.519259336	0	0	0	0	2.214365761	0	0	0	0	81.4383	0	18.854003	16.0244	0.655503138	1.936686141	0	0.509596192	1.416696374	0.650105539	1.468641409	4.931752609	18.33051687	0.530249278	1.540238238	0.000332476	7.18217547	3.492021864	8.320261283	0.320884332	0.737613902	0	0	3.656921911	0	0	0	0	0	0	0	0	0	7.519259336	0	0	0	0	2.214365761	0	0	0	0	81.4383	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	$40/Visit			20%-30% Coins	0% Coins		50%-80%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	30% Coins	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			7500	8.8841	0.145	0.4284	2.1661	2.6673	1.8334	0.8413	0.4804	4.9368	1.4322	0.1224	0.5823	0.0001	1.9892	2.1503	2.1958	0.0847	0.1947			1.2558	0		0					0	0	2.1183	0	0	0	0	0.1886	0	0			34.6972	1000	15.753856	24.9086	0.800464138	2.365083141	2.166117	3.176888192	3.250113374	1.491438539	1.949082409	9.868572609	19.76267687	0.652693278	2.122500238	0.000447476	9.17141147	5.642337864	10.51602528	0.405567332	0.932273902	0	0	4.912718911	0	0	0	0	0	0	0	0	0	9.637561336	0	0	0	0	2.402936761	0	0	0	0	116.1355
R5826_008_0	2010	8	13	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered			Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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	0	0	0	0	0	0			0	YES	1521.823849	41.407624	597.095253	458.315236	38.678687	11.303079	5.204114	406.971559	391.369127	1709.678692	229.181639	116.95027	0.002912	659.826411	3740.108771	3867.700472	128.291976	240.630779			17.474557	0		1.84					0.04	0.25	880.432988	1.578034	0.05	0.55	2.53	275.101571	0.32	0.4			6000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN749: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			158.7573	140.3991	50.7565	0	150	0.2	0.2	50	187.454909	95.429143	75	150	0.2	113.172424	15	35	35	100			0.2	0		0					0	0	117.716289	0	0	0	0	35	0	0			NO	138.99662	122.923484	31.803312	0	126.24165	0.168322	0.168322	42.08055	157.764113	80.314216	63.120825	126.24165	0.168322	95.247157	12.624165	29.456385	29.456385	84.1611			0.168322	0		0					0	0	99.071324	0	0	0	0	29.456385	0	0				17.6274	0.424164117	1.582467219	0	0.406905106	1.902556863	0.875966877	1.427132253	5.145333598	11.44262531	1.205511177	1.230332921	0.000490154	5.237215813	3.934645854	9.494039514	0.314918153	1.687645921	0	0	2.941352383	0	0	0	0	0	0	0	0	0	7.268805151	0	0	0	0	0.675291482	0	0	0	0	74.8248	0	13.896157	17.6274	0.424164117	1.582467219	0	0.406905106	1.902556863	0.875966877	1.427132253	5.145333598	11.44262531	1.205511177	1.230332921	0.000490154	5.237215813	3.934645854	9.494039514	0.314918153	1.687645921	0	0	2.941352383	0	0	0	0	0	0	0	0	0	7.268805151	0	0	0	0	0.675291482	0	0	0	0	74.8248	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		50%-80%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			7500	9.0068	0.0838	0.3602	2.0578	2.1128	2.4426	1.1246	0.4631	5.062	0.9829	0.2762	0.5664	0.0002	1.7963	2.4036	2.4855	0.0824	0.1664			0.9693	0		0					0	0	2.0144	0	0	0	0	0.1768	0	0			34.6341	1000	14.221448	26.6342	0.507960117	1.942630219	2.05784	2.519711106	4.345119863	2.000560877	1.890270253	10.2073046	12.42551031	1.481664177	1.796693921	0.000658154	7.033506813	6.338195854	11.97958551	0.397364153	1.854066921	0	0	3.910679383	0	0	0	0	0	0	0	0	0	9.283215151	0	0	0	0	0.852083482	0	0	0	0	109.4588
R5826_009_0	2010	7	14	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	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	YES	1485.949121	70.732162	807.095661	444.815219	44.400015	7.855113	4.559541	307.331996	330.970229	1513.154063	1049.917011	107.602876	0.054532	1021.797885	3379.942533	3733.138657	148.862324	1142.233339			31.248371	0		1.42					0.04	0.25	17.604233	0.05	0.55	2.09	0.32	0.4					5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $50 SMAM -- FSR,14h. $50 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$50/Visit:9a	20% Coins:12	"$35-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$50/Visit:7i. $50 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	50.7565	0	100	0.2	0.2	50	139.128087	37.031115	48.50449	50	0.2	45.354491	15	35	35	39.061151			0.2	0		0					0	0	0	0	0	0	0	0					NO	138.592107	122.565747	28.842533	0	86.3725	0.172745	0.172745	43.18625	120.168407	31.9847	41.89454	43.18625	0.172745	39.173808	12.955875	30.230375	30.230375	33.738092			0.172745	0		0					0	0	0	0	0	0	0	0						17.1617	0.722445023	1.93989027	0	0.319578358	1.356931495	0.78763791	1.106043034	3.314347099	4.03314823	3.665482518	0.387247059	0.00942013	3.335642847	3.64917608	9.404515127	0.375013656	3.21139779	0	0	5.397999848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1777	0	10.442865	17.1617	0.722445023	1.93989027	0	0.319578358	1.356931495	0.78763791	1.106043034	3.314347099	4.03314823	3.665482518	0.387247059	0.00942013	3.335642847	3.64917608	9.404515127	0.375013656	3.21139779	0	0	5.397999848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	60.1777	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					10000	3.913	0.1647	0.8782	1.7255	1.5581	1.6358	0.9495	0.337	5.0549	0.991	2.7401	0.6595	0.003	2.7336	2.0304	2.7088	0.0684	0.7532			1.7415	0		0					0	0	0	0	0	0	0	0					30.6464	500	5.147616	21.0748	0.887169023	2.81810527	1.725478	1.877680358	2.992683495	1.73711891	1.443074034	8.369205099	5.02419223	6.405630518	1.046725059	0.01244713	6.069229847	5.67955708	12.11336513	0.443435656	3.96462179	0	0	7.139535848	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	90.824
R5826_010_0	2010	10	15	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Lab	Radiology	Renal Dialysis	Other					Therapy (PT/OT/ST)		D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O		Coin					O	O	V	V	P	V	V	O	O	O	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	0	YES	1322.08958	35.508011	355.166451	501.283263	1.520934	8.135577	5.358261	349.098947	46.284973	7.277557	20.93198	3.503327	0.000123	12.956864	3463.855245	3322.907812	99.977336	1.939693			22.398678	0		2.14					0.04	0.25	914.036917	295.324095	15.732992	156.790719	0	0.05	0.55	2.4	390.048746	0.4	5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. $35 Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15			"DEN814: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	$0/Proc:12	"$35/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Member Assistance 14a	158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.240684	0.25	0.231486	0.2	0.2	0.23437	15	35	35	0.25			0.2	0		0					0	0	0	19.485241	0	35	0	0	0	0	35	0	NO	142.413553	125.945293	34.742945	0	0.17484	0.17484	0.17484	43.71	0.210406	0.21855	0.202365	0.17484	0.17484	0.204886	13.113	30.597	30.597	0.21855			0.17484	0		0					0	0	0	17.033997	0	30.597	0	0	0	0	30.597	0		15.6903	0.372672237	1.028294039	0	0.265920101	1.422424283	0.936838353	1.271592914	9.738636029	1.590510082	4.235900133	0.612521693	2.15E-05	2.654680038	3.785127819	8.472584194	0.254917212	0.423919905	0	0	3.916184862	0	0	0	0	0	0	0	0	0	0	0.419212479	0	0.399777136	0	0	0	0	0.99452679	0	58.4866	0	8.199458	15.6903	0.372672237	1.028294039	0	0.265920101	1.422424283	0.936838353	1.271592914	9.738636029	1.590510082	4.235900133	0.612521693	2.15E-05	2.654680038	3.785127819	8.472584194	0.254917212	0.423919905	0	0	3.916184862	0	0	0	0	0	0	0	0	0	0	0.419212479	0	0.399777136	0	0	0	0	0.99452679	0	58.4866	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	20% Coins	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	30% Coins	$0: LifeSynch Member Assistance 14a	7500	9.0352	0.0888	0.281	1.4178	0.8936	1.1819	0.7784	0.2671	2.6888	0.4228	1.216	0.2035	0	0.7527	1.331	1.906	0.0228	0.1127			0.8272	0		0					0	0	0.0345	0.4766	0	0.0428	0.7259	0	0	0	0.103	0	24.8101	0	11.457159	24.7254	0.461452237	1.309259039	1.41776	1.159565101	2.604333283	1.715268353	1.538672914	12.42744703	2.013282082	5.451892133	0.816038693	2.65E-05	3.407377038	5.116173819	10.37855419	0.277693212	0.536601905	0	0	4.743433862	0	0	0	0	0	0	0	0	0	0.034544	0.895781479	0	0.442585136	0.725851	0	0	0	1.09757579	0	83.2966
R5826_011_0	2010	3	16	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	P	O	O	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	YES	1503.608125	76.157111	200.043819	1191.244352	27.750652	10.499215	6.733582	405.297354	418.627126	1222.86648	1082.557621	127.915309	0.027343	693.075712	3519.282485	3586.443633	60.236105	646.390924			21.127165	0		0.9					0.04	0.25	29.995186	0.05	0.55	2.87	0.32	0.4					5900	$195/Day(Days 1-8):1a	$195/Day(Days 1-10):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $35 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$15/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					144.519765	143.64207	58.254672	0	100	0.2	0.2	50	241.213413	36.545494	92.840625	150	0.2	52.333287	15	35	35	15			0.2	0		0					0	0	0	0	0	0	0	0					NO	133.022062	132.214194	47.765103	0	87.993	0.175986	0.175986	43.9965	212.250918	32.157476	81.693251	131.9895	0.175986	46.04963	13.19895	30.79755	30.79755	13.19895			0.175986	0		0					0	0	0	0	0	0	0	0						16.6678	0.839087587	0.796259468	0	0.203488593	1.847714851	1.185016162	1.485972086	7.404499316	3.277024957	7.369804288	1.406956473	0.004811985	2.659656675	3.870902796	9.204473092	0.154593705	0.710973457	0	0	3.71808526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8071	0	7.760809	16.6678	0.839087587	0.796259468	0	0.203488593	1.847714851	1.185016162	1.485972086	7.404499316	3.277024957	7.369804288	1.406956473	0.004811985	2.659656675	3.870902796	9.204473092	0.154593705	0.710973457	0	0	3.71808526	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.8071	YES	30% Coins	30% Coins	30% Coins	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					7500	9.0917	0.1262	0.2153	3.4461	0.8163	1.8327	1.1754	0.3726	4.8191	0.5749	2.0964	0.424	0.0013	2.1329	1.6851	2.5259	0.0422	0.2769			0.9515	0		0					0	0	0	0	0	0	0	0					32.6067	500	15.804866	25.7595	0.965272587	1.011541468	3.446143	1.019808593	3.680434851	2.360416162	1.858545086	12.22358032	3.851954957	9.466177288	1.830977473	0.006084985	4.792581675	5.556016796	11.73037309	0.196841705	0.987861457	0	0	4.66962826	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4137
R5826_012_0	2010	7	17	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered						Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	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	YES	1354.106398	61.635922	327.030052	721.034078	33.955984	9.302552	4.232962	333.754416	346.065651	1733.218202	1169.140807	86.423824	0.000503	447.16679	3670.355817	4158.497644	101.764326	626.763466			27.777834	0							0.04	0.25	26.668393	0.05	0.55	1.93	0.35						5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: OTC items 13c						158.7573	140.3991	48.2281	0	100	0.2	0.2	50	131.005982	27.418941	86.653669	100	0.2	85.800781	15	40	40	57.869424			0.2	0							0	0	0	0	0	0	0						NO	140.259693	124.040499	34.135078	0	86.2925	0.172585	0.172585	43.14625	113.048337	23.66049	74.775617	86.2925	0.172585	74.039639	12.943875	34.517	34.517	49.936973			0.172585	0							0	0	0	0	0	0	0							15.8272	0.637112543	0.930266361	0	0.244178896	1.605480937	0.730545747	1.200020956	3.260178862	3.417399328	7.285268767	0.621477319	8.68E-05	2.759005642	3.959052242	11.96157193	0.292716603	2.608222523	0	0	4.794037481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1338	0	9.662201	15.8272	0.637112543	0.930266361	0	0.244178896	1.605480937	0.730545747	1.200020956	3.260178862	3.417399328	7.285268767	0.621477319	8.68E-05	2.759005642	3.959052242	11.96157193	0.292716603	2.608222523	0	0	4.794037481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.1338	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: OTC items 13c						7500	3.9379	0.1722	0.394	2.8468	1.1385	1.8508	0.8422	0.3497	5.1008	0.6366	2.4405	0.5483	0	1.0914	2.2479	4.0894	0.0395	0.312			1.4767	0							0	0	0	0	0	0	0						29.5155	500	5.903531	19.7651	0.809329543	1.324276361	2.846765	1.382675896	3.456324937	1.572739747	1.549717956	8.360969862	4.054034328	9.725772767	1.169817319	0.00011381	3.850441642	6.207001242	16.05097893	0.332202603	2.920263523	0	0	6.270762481	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	91.6493
R5826_013_0	2010	10	18	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Lab	Radiology	Renal Dialysis	Other					Therapy (PT/OT/ST)		D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O		Coin					O	O	V	V	P	V	V	O	O	O	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	0	YES	1463.29217	32.474248	245.531086	907.900198	1.621331	8.517593	12.581705	379.784354	57.601238	10.213285	24.288048	8.62696	0.000095	14.913964	3618.528365	3766.299361	90.90731	2.043127			27.841777	0		2.2					0.04	0.25	435.330855	302.514831	5.638196	162.957506	0	0.05	0.55	3.57	304.659949	0.4	5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. $35 Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15			"DEN814: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	$0/Proc:12	"$35/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Member Assistance 14a	158.7573	140.3991	48.2281	0	0.2	0.2	0.2	50	0.243189	0.25	0.242231	0.2	0.2	0.23928	15	35	35	0.25			0.2	0		0					0	0	0	19.318275	0	35	0	0	0	0	35	0	NO	136.8734	121.045786	34.124708	0	0.169277	0.169277	0.169277	42.31935	0.205832	0.211597	0.205022	0.169277	0.169277	0.202523	12.695805	29.623545	29.623545	0.211597			0.169277	0		0					0	0	0	16.350737	0	29.623545	0	0	0	0	29.623545	0		16.6905	0.327572573	0.698223051	0	0.274454048	1.44183259	2.129793277	1.33935225	11.85617802	2.161100466	4.979584177	1.460345908	1.61E-05	3.020420731	3.828344209	9.297594884	0.224416399	0.432319544	0	0	4.712972485	0	0	0	0	0	0	0	0	0	0	0.412195037	0	0.402281584	0	0	0	0	0.752092309	0	66.4416	0	11.852771	16.6905	0.327572573	0.698223051	0	0.274454048	1.44183259	2.129793277	1.33935225	11.85617802	2.161100466	4.979584177	1.460345908	1.61E-05	3.020420731	3.828344209	9.297594884	0.224416399	0.432319544	0	0	4.712972485	0	0	0	0	0	0	0	0	0	0	0.412195037	0	0.402281584	0	0	0	0	0.752092309	0	66.4416	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	20% Coins	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	30% Coins	$0: LifeSynch Member Assistance 14a	7500	8.9337	0.0614	0.2058	1.9261	0.9183	1.1929	1.762	0.2801	3.2258	0.572	1.3602	0.4831	0	0.8352	1.1919	2.238	0.0221	0.1144			1.0485	0		0					0	0	0.036	0.436	0	0.0389	0.6987	0	0	0	0.0747	0	27.6558	0	14.216041	25.6242	0.388966573	0.903991051	1.926065	1.192802048	2.63470359	3.891834277	1.61945125	15.08194502	2.733061466	6.339756177	1.943469908	2.01E-05	3.855627731	5.020197209	11.53564088	0.246483399	0.546737544	0	0	5.761505485	0	0	0	0	0	0	0	0	0	0.036005	0.848184037	0	0.441184584	0.698721	0	0	0	0.826824309	0	94.0974
R5826_014_0	2010	7	21	r.	s.	t.	u.	v.	w.					OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)					Renal Dialysis	Other									D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O		Coin					O	O	P	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	YES	994.133031	17.089193	467.156339	520.748353	36.124934	8.662341	4.452168	359.922564	135.638894	1452.346193	1127.885249	59.856212	0.042743	0	3460.760116	3925.536044	33.468512	738.5657			23.966486	0		1.12					0.04	0.25	10.562068	322.856748	147.920734	0.05	0.55	2.68					5000	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$100/Visit:9a, 9b"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$35/Visit:3, 5, 7h, 8b, 9a, 9d"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	"$35-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $35 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a					137.58966	121.67922	58.254672	0	100	0.2	0.2	50	100	35.395158	66.204482	100	0.2	0	15	35	35	48.714021			0.2	0		0					0	0	0	83.597405	150	0	0	0					NO	126.566252	111.930524	40.593312	0	89.0963	0.178193	0.178193	44.54815	89.0963	31.535776	58.985744	89.0963	0.178193	0	13.364445	31.183705	31.183705	43.40239			0.178193	0		0					0	0	0	74.482195	133.64445	0	0	0						10.4853	0.159400194	1.580285252	0	0.268216496	1.54356853	0.793345172	1.336157031	1.007076966	3.816738685	5.54409588	0.444413918	0.007616503	0	3.854261519	10.20106316	0.086972684	2.671293046	0	0	4.27066004	0	0	0	0	0	0	0	0	0	0	2.003923272	1.647398762	0	0	0	0	0	0	0	51.7218	0	6.448319	10.4853	0.159400194	1.580285252	0	0.268216496	1.54356853	0.793345172	1.336157031	1.007076966	3.816738685	5.54409588	0.444413918	0.007616503	0	3.854261519	10.20106316	0.086972684	2.671293046	0	0	4.27066004	0	0	0	0	0	0	0	0	0	0	2.003923272	1.647398762	0	0	0	0	0	0	0	51.7218	YES	$195/Day(Days 1-7)	$195/Day(Days 1-7)	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	25% Coins	25% Coins	$50/Visit	30% Coins	30% Coins	$0-$100/Visit	$100/Visit	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	$40-$100/Visit			20%-30% Coins	$0/Service		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$40-$100/Visit	$0-$150/Visit	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a					7500	2.3573	0.0358	0.6511	1.745	1.4845	1.7603	0.9047	0.4622	1.0085	1.1661	1.8945	0.1537	0.0028	0	2.5097	2.8468	0.0243	0.8228			1.5516	0		0					0	0	0	0.6665	0.5699	0	0	0					22.6181	500	2.567742	12.8426	0.195236194	2.231414252	1.744992	1.752733496	3.30385953	1.698079172	1.798365031	2.015596966	4.982795685	7.43861288	0.598146918	0.010395503	0	6.363961519	13.04781316	0.111243684	3.494108046	0	0	5.82226604	0	0	0	0	0	0	0	0	0	0	2.670457272	2.217271762	0	0	0	0	0	0	0	74.3399
R5826_018_0	2010	7	9	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)			Professional	Other Non-Covered	Other Non-Covered				Radiology				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	O			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			0	0	0				0	YES	928.038257	37.233618	508.919734	298.233336	30.252582	3.817162	1.181268	188.36512	248.971086	391.14046	320.890525	43.409075	0	168.943678	2472.252042	3771.839955	24.015238	65.409921			26.813196	0		1.16					0.04	0.25	463.060516	0.05			445.014224	0.32	0.4				4000	$150/Day(Days 1-10):1a	$150/Day(Days 1-10):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$100/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $100 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$50-$125/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,12. 20% Dialysis -- OP Hosp"	"$30-$125/Visit:9d. $100 Cardiac Rehab,8b. $125 Nuclear Medicine,9a. $100 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN827: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $50 Advanced Imaging -- Office,9a. $125 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a			$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				119.30775	110.4939	50.7565	0	150	0.2	0.2	50	85.872416	47.600152	74.814731	100	0	88.571089	10	30	30	100			0.2	0		0					0	0	64.920636	0			30	0	0				NO	110.988063	102.788829	34.680038	0	135.8805	0.181174	0.181174	45.2935	77.789245	43.119549	67.77242	90.587	0	80.233892	9.0587	27.1761	27.1761	90.587			0.181174	0		0					0	0	58.809657	0			27.1761	0	0					8.5834	0.318933333	1.470779643	0	0.342561331	0.691570508	0.214015049	0.710976297	1.613939401	1.405483353	1.812293953	0.32769149	0	1.129584068	1.866282464	8.54199165	0.054386709	0.493774043	0	0	4.857853972	0	0	0	0	0	0	0	0	0	2.269369176	0	0	0	1.007812588	0	0	0	0	0	37.7127	0	4.190015	8.5834	0.318933333	1.470779643	0	0.342561331	0.691570508	0.214015049	0.710976297	1.613939401	1.405483353	1.812293953	0.32769149	0	1.129584068	1.866282464	8.54199165	0.054386709	0.493774043	0	0	4.857853972	0	0	0	0	0	0	0	0	0	2.269369176	0	0	0	1.007812588	0	0	0	0	0	37.7127	YES	$150/Day(Days 1-10)	$150/Day(Days 1-10)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75-$125/Visit	30% Coins	0%-20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		50%-55%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a			$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				6000	1.4695	0.0546	0.5399	0.9264	1.312	0.6549	0.2027	0.1702	2.7807	0.2096	0.44	0.2533	0	0.3958	1.1037	1.6839	0.0107	0.036			1.3146	0		0					0	0	0.3838	0			0.1987	0	0				14.1409	0	2.619643	10.0529	0.373534333	2.010700643	0.926377	1.654578331	1.346475508	0.416683049	0.881167297	4.394594401	1.615109353	2.252289953	0.58100749	0	1.525336068	2.970002464	10.22590365	0.065107709	0.529762043	0	0	6.172475972	0	0	0	0	0	0	0	0	0	2.653136176	0	0	0	1.206485588	0	0	0	0	0	51.8536
R5826_021_0	2010	5	12	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered			Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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	0	0	0	0	0	0			0	YES	1143.542092	30.612551	908.445091	347.234445	46.510661	5.369992	1.86682	294.736535	249.203987	1222.726383	71.546698	64.036006	0	371.565001	2172.655219	2693.909435	25.597194	185.518849			7.374569	0		2.47					0.04	0.25	542.49047	2.793325	0.05	0.55	2.34	195.546131	0.32	0.4			3400	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN814: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			137.58966	121.67922	50.7565	0	150	0.2	0.2	50	132.050532	104.048847	75	150	0	121.447888	10	30	30	100			0.2	0		0					0	0	122.703057	0	0	0	0	30	0	0			NO	114.587558	101.33701	21.963911	0	124.93845	0.166585	0.166585	41.64615	109.987926	86.664678	62.469225	124.93845	0	101.156739	8.32923	24.98769	24.98769	83.2923			0.166585	0		0					0	0	102.202198	0	0	0	0	24.98769	0	0				10.9196	0.258515366	1.662750594	0	0.484247491	0.894560117	0.31098421	1.022886829	2.28411914	8.830599022	0.372455565	0.666713278	0	3.132191986	1.508045419	5.609547821	0.053301229	1.287690969	0	0	1.228492577	0	0	0	0	0	0	0	0	0	4.620309869	0	0	0	0	0.407187175	0	0	0	0	45.5542	0	10.985594	10.9196	0.258515366	1.662750594	0	0.484247491	0.894560117	0.31098421	1.022886829	2.28411914	8.830599022	0.372455565	0.666713278	0	3.132191986	1.508045419	5.609547821	0.053301229	1.287690969	0	0	1.228492577	0	0	0	0	0	0	0	0	0	4.620309869	0	0	0	0	0.407187175	0	0	0	0	45.5542	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			6000	7.5084	0.0582	0.3882	1.6449	2.4751	1.1305	0.393	0.3268	2.9742	0.6203	0.084	0.3519	0	0.8421	1.1902	1.4757	0.014	0.0985			0.4437	0		0					0	0	1.1855	0	0	0	0	0.1071	0	0			23.3122	500	10.34056	18.428	0.316686366	2.050918594	1.644868	2.959340491	2.025068117	0.70399321	1.349648829	5.25833814	9.450923022	0.456442565	1.018616278	0	3.974312986	2.698242419	7.085291821	0.067323229	1.386175969	0	0	1.672153577	0	0	0	0	0	0	0	0	0	5.805764869	0	0	0	0	0.514309175	0	0	0	0	68.8665
R5826_023_0	2010	5	14	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional						Radiology				Therapy (PT/OT/ST)						A	A	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin					O	O	V	O	O	O	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	YES	182.549426	3.412145	646.713627	178.853845	31.867745	3.617064	1.240411	256.539278	239.204781	857.557283	63.758349	39.292076	0	485.678537	1950.958551	2523.009036	26.748024	259.84187			10.431395	0		3.27					0.04	0.25	466.683381	0.05	0.55	2.09	361.042431						3000	$550/Admit:1a	$550/Admit:1b	"$0/Day(Days 1-15) $128(Days 16-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN814: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i						550	550	58.69696	0	100	0.2	0.2	50	90.454989	39.358175	30	50	0	47.57699	10	30	30	50			0.2	0		0					0	0	42.910291	0	0	0	30						NO	498.5354	498.5354	30.536448	0	89.1666	0.178333	0.178333	44.5833	80.655638	35.094347	26.74998	44.5833	0	42.422784	8.91666	26.74998	26.74998	44.5833			0.178333	0		0					0	0	38.261648	0	0	0	26.74998							7.5839	0.141756256	1.645694753	0	0.236794873	0.645041874	0.221206215	0.953113966	1.607767852	2.507951072	0.14212788	0.145980868	0	1.716986306	1.449669506	5.624203438	0.059625759	0.965384004	0	0	1.860261965	0	0	0	0	0	0	0	0	0	1.488006271	0	0	0	0.804823151	0	0	0	0	0	29.8003	0	4.797225	7.5839	0.141756256	1.645694753	0	0.236794873	0.645041874	0.221206215	0.953113966	1.607767852	2.507951072	0.14212788	0.145980868	0	1.716986306	1.449669506	5.624203438	0.059625759	0.965384004	0	0	1.860261965	0	0	0	0	0	0	0	0	0	1.488006271	0	0	0	0.804823151	0	0	0	0	0	29.8003	YES	$800/Admit	$800/Admit	30% Coins(Days 1-15) 30%(Days 16-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit						5000	2.3851	0.0446	0.4783	0.9956	1.2713	0.8562	0.2936	0.3198	3.9826	0.653	0.0393	0.2517	0	1.2573	1.2017	1.5541	0.0165	0.1909			0.7057	0		0					0	0	1.3798	0	0	0	0.2224						18.0995	500	3.42207	9.969	0.186337256	2.123975753	0.995616	1.508053873	1.501272874	0.514836215	1.272919966	5.590375852	3.160905072	0.18140188	0.397730868	0	2.974312306	2.651410506	7.178313438	0.076101759	1.156280004	0	0	2.565915965	0	0	0	0	0	0	0	0	0	2.867822271	0	0	0	1.027216151	0	0	0	0	0	47.8998
R5826_026_0	2010	4	17	r.	s.	t.	u.	v.						OP Facility - Other	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered						Radiology	Therapy (PT/OT/ST)									D	D	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin								O	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	YES	1220.343541	20.871729	420.617618	438.743107	39.427237	5.801566	2.145839	243.927676	214.041626	2286.407418	105.878205	46.196444	4.973387	232.908314	2027.157107	2743.096038	27.666827	116.79539			14.753163	0								0.04	460.534515	199.31719	0.05	0.25	1.93						3400	$200/Day(Days 1-5):1a	$200/Day(Days 1-5):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15									$0: Nurse hotline 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$30/Visit:7i	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a						121.3342	101.3424	48.2281	0	100	0.2	0.2	50	87.252139	4.311998	30	50	0	48.099132	10	30	30	50			0.2	0								0	44.42844	30	0	0	0						NO	112.427056	93.902854	32.592212	0	89.9419	0.179884	0.179884	44.97095	78.476232	3.878293	26.98257	44.97095	0	43.261273	8.99419	26.98257	26.98257	44.97095			0.179884	0								0	39.959783	26.98257	0	0	0							11.4333	0.163326243	1.142404881	0	0.295513384	1.043608898	0.386002103	0.914138277	1.399765025	0.73894649	0.238072173	0.173124831	0	0.83965918	1.519386348	6.167981739	0.062210175	0.43769997	0	0	2.653857973	0	0	0	0	0	0	0	0	0	1.533571607	0.448174169	0	0	0	0	0	0	0	0	31.5907	0	3.57498	11.4333	0.163326243	1.142404881	0	0.295513384	1.043608898	0.386002103	0.914138277	1.399765025	0.73894649	0.238072173	0.173124831	0	0.83965918	1.519386348	6.167981739	0.062210175	0.43769997	0	0	2.653857973	0	0	0	0	0	0	0	0	0	1.533571607	0.448174169	0	0	0	0	0	0	0	0	31.5907	YES	$250/Day(Days 1-5)	$250/Day(Days 1-5)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins								$0: Nurse hotline 14a	30% Coins	$35/Visit	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a						5000	2.824	0.0403	0.3871	2.2871	1.5293	1.3353	0.4939	0.2957	3.912	0.3799	0.0634	0.4036	0	0.9802	1.2141	1.6429	0.0166	0.0932			0.9704	0								0	1.5019	0.1194	0	0	0						20.4901	500	3.706746	14.2573	0.203667243	1.529546881	2.28712	1.824779384	2.378925898	0.879898103	1.209801277	5.311723025	1.11880349	0.301484173	0.576714831	0	1.81981518	2.733486348	7.810869739	0.078780175	0.53092097	0	0	3.624230973	0	0	0	0	0	0	0	0	0	3.035505607	0.567549169	0	0	0	0	0	0	0	0	52.0809
R5826_053_0	2010	5	11	r.	s.	t.	u.	y.						OP Facility - Other	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered						Radiology	Therapy (PT/OT/ST)									A	A	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin						O	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	YES	195.241891	9.0536	453.268687	276.635211	41.358233	4.29186	1.823384	281.802544	261.692805	1226.069792	59.09287	30.442938	0.971218	452.511749	2063.586409	2580.018986	38.126505	193.87303			15.194258	0		2.74						0.04	512.497454	300.424051	0.05	0.25	1.66						3000	$550/Admit:1a	$550/Admit:1b	"$0/Day(Days 1-15) $128(Days 16-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN814: Dental 16a, 16b"						$0: Nurse hotline 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$30/Visit:7i	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a						550	550	58.69696	0	100	0.2	0.2	50	89.273506	32.544048	30	50	0	46.992898	10	30	30	50			0.2	0		0						0	43.785193	30	0	0	0						NO	497.28635	497.28635	34.906084	0	88.5249	0.17705	0.17705	44.26245	79.029282	28.809586	26.55747	44.26245	0	41.600416	8.85249	26.55747	26.55747	44.26245			0.17705	0		0						0	38.760798	26.55747	0	0	0							8.0909	0.375185975	1.318486239	0	0.305102787	0.759873813	0.322830137	1.039439251	1.72344954	2.943546926	0.13077976	0.112289918	0	1.568723084	1.522323171	5.709898068	0.084378626	0.715107941	0	0	2.690143379	0	0	0	0	0	0	0	0	0	1.655400858	0.664875227	0	0	0	0	0	0	0	0	31.7328	0	4.641112	8.0909	0.375185975	1.318486239	0	0.305102787	0.759873813	0.322830137	1.039439251	1.72344954	2.943546926	0.13077976	0.112289918	0	1.568723084	1.522323171	5.709898068	0.084378626	0.715107941	0	0	2.690143379	0	0	0	0	0	0	0	0	0	1.655400858	0.664875227	0	0	0	0	0	0	0	0	31.7328	YES	$800/Admit	$800/Admit	30% Coins(Days 1-15) 30%(Days 16-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		0.5						$0: Nurse hotline 14a	30% Coins	$35/Visit	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a	$0: Membership in health club/fitness class 14a						5000	2.4477	0.1135	0.3921	2.1202	1.5855	0.9763	0.4148	0.3376	4.3823	0.6178	0.035	0.3509	0	1.1863	1.2215	1.5272	0.0226	0.1479			0.9877	0		0						0	1.3804	0.1778	0	0	0						20.425	500	3.659198	10.5386	0.488687975	1.710573239	2.120182	1.890556787	1.736187813	0.737615137	1.377027251	6.10578754	3.561299926	0.16575876	0.463238918	0	2.755008084	2.743827171	7.237095068	0.106946626	0.863002941	0	0	3.677872379	0	0	0	0	0	0	0	0	0	3.035794858	0.842706227	0	0	0	0	0	0	0	0	52.1578
R5826_062_0	2010	8	6	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered			Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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	0	0	0	0	0	0			0	YES	1079.197186	35.348111	573.556916	328.812536	36.959487	4.22932	1.476791	242.357528	246.01759	1189.538277	96.192104	46.395176	0	294.718797	2254.36553	3132.886688	27.655041	144.359782			16.488551	0		2.59					0.04	0.25	566.185807	1.898485	0.05	0.55	1.17	332.536423	0.32	0.4			3400	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN814: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			137.58966	121.67922	50.7565	0	150	0.2	0.2	50	129.464658	52.963258	75	150	0	123.110663	10	30	30	100			0.2	0		0					0	0	109.591338	0	0	0	0	30	0	0			NO	119.449839	105.637032	25.931699	0	128.4831	0.171311	0.171311	42.8277	110.89347	45.365891	64.24155	128.4831	0	105.450931	8.56554	25.69662	25.69662	85.6554			0.171311	0		0					0	0	93.870899	0	0	0	0	25.69662	0	0				10.7425	0.311172461	1.239442109	0	0.395722455	0.724529039	0.252990543	0.864967958	2.273478686	4.497038651	0.514960822	0.49674967	0	2.589864294	1.609154843	6.70871656	0.05922009	1.030432906	0	0	2.82467016	0	0	0	0	0	0	0	0	0	4.429030892	0	0	0	0	0.712088508	0	0	0	0	42.2767	0	7.886479	10.7425	0.311172461	1.239442109	0	0.395722455	0.724529039	0.252990543	0.864967958	2.273478686	4.497038651	0.514960822	0.49674967	0	2.589864294	1.609154843	6.70871656	0.05922009	1.030432906	0	0	2.82467016	0	0	0	0	0	0	0	0	0	4.429030892	0	0	0	0	0.712088508	0	0	0	0	42.2767	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			5000	6.2618	0.0563	0.2667	1.3207	1.8902	0.8557	0.2988	0.2582	3.1185	0.3676	0.1085	0.2855	0	0.7182	1.1868	1.6493	0.0146	0.0828			0.9533	0		0					0	0	1.1405	0	0	0	0	0.1751	0	0			21.0091	500	10.166531	17.0043	0.367478461	1.506120109	1.320708	2.285902455	1.580204039	0.551774543	1.123189958	5.391947686	4.864656651	0.623477822	0.78229167	0	3.308025294	2.795990843	8.35805956	0.07377909	1.113250906	0	0	3.77798216	0	0	0	0	0	0	0	0	0	5.569550892	0	0	0	0	0.887156508	0	0	0	0	63.2858
R5826_063_0	2010	3	7	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered				Radiology				Therapy (PT/OT/ST)						A	A	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V				O	O	V	O	O	O	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	0	0	0	0	0	0				0	YES	186.8013	4.70528	539.039785	309.024325	34.735235	3.803389	1.328065	227.772251	231.212048	1117.950877	90.403183	43.603075	1.784232	276.982375	2118.695944	2944.34697	25.990738	135.672091			14.828002	0		2.91	1.72				0.04	0.25	532.112277	0.05	0.55	2.14	312.524105	0.32	0.4				2900	$550/Admit:1a	$550/Admit:1b	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				550	550	69.3508	0	100	0.2	0.2	50	86.785863	17.654419	30	50	0	47.116279	10	30	30	50			0.2	0		0	0				0	0	43.36412	0	0	0	30	0	0				NO	496.21275	496.21275	35.306076	0	88.8565	0.177713	0.177713	44.42825	77.11488	15.687099	26.65695	44.42825	0	41.865877	8.88565	26.65695	26.65695	44.42825			0.177713	0		0	0				0	0	38.531839	0	0	0	26.65695	0	0					7.7244	0.194568327	1.585948301	0	0.257204284	0.675911669	0.236014415	0.843293543	1.485824111	1.461450507	0.200822761	0.161434026	0	0.966342504	1.568832551	6.540609163	0.05773615	0.502306131	0	0	2.635128719	0	0	0	0	0	0	0	0	0	1.708605382	0	0	0	0.694244953	0	0	0	0	0	29.5007	0	4.895342	7.7244	0.194568327	1.585948301	0	0.257204284	0.675911669	0.236014415	0.843293543	1.485824111	1.461450507	0.200822761	0.161434026	0	0.966342504	1.568832551	6.540609163	0.05773615	0.502306131	0	0	2.635128719	0	0	0	0	0	0	0	0	0	1.708605382	0	0	0	0.694244953	0	0	0	0	0	29.5007	YES	$800/Admit	$800/Admit	30% Coins(Days 1-10) 30%(Days 10-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				5000	2.4226	0.061	0.4346	1.4195	1.4154	0.9197	0.3211	0.29	3.3517	0.3951	0.0569	0.3069	0	0.7719	1.3331	1.8526	0.0164	0.089			1.0246	0		0	0				0	0	1.2258	0	0	0	0.1966	0	0				17.9045	500	2.83762	10.147	0.255590327	2.020596301	1.419479	1.672601284	1.595579669	0.557143415	1.133334543	4.837513111	1.856561507	0.257704761	0.468331026	0	1.738211504	2.901915551	8.393191163	0.07408915	0.591318131	0	0	3.659736719	0	0	0	0	0	0	0	0	0	2.934421382	0	0	0	0.890884953	0	0	0	0	0	47.4052
R5826_064_0	2010	4	8	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional						Radiology				Therapy (PT/OT/ST)						A	A	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V				O	O	V	O	O	O	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	YES	182.553089	4.598273	526.781011	301.996533	33.94529	3.925452	1.370685	222.592284	225.953853	1092.526581	88.347246	42.61146	1.743656	270.683279	2070.51283	2877.387008	25.39966	132.586654			15.303881	0		0.93	1.72				0.04	0.25	520.011047	0.05	0.55	2.18	305.416722						2900	$550/Admit:1a	$550/Admit:1b	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i						550	550	69.3508	0	100	0.2	0.2	50	86.785863	17.65442	30	50	0	47.116279	10	30	30	50			0.2	0		0	0				0	0	43.36412	0	0	0	30						NO	497.7082	497.7082	35.944728	0	89.0674	0.178135	0.178135	44.5337	77.297912	15.724332	26.72022	44.5337	0	41.965245	8.90674	26.72022	26.72022	44.5337			0.178135	0		0	0				0	0	38.623294	0	0	0	26.72022							7.5715	0.190716515	1.57791668	0	0.25195156	0.699260392	0.244166972	0.8260715	1.455480087	1.431604223	0.196721487	0.158137165	0	0.94660751	1.536793287	6.40703449	0.056557042	0.492047856	0	0	2.726156842	0	0	0	0	0	0	0	0	0	1.673711629	0	0	0	0.680066834	0	0	0	0	0	29.1225	0	4.710203	7.5715	0.190716515	1.57791668	0	0.25195156	0.699260392	0.244166972	0.8260715	1.455480087	1.431604223	0.196721487	0.158137165	0	0.94660751	1.536793287	6.40703449	0.056557042	0.492047856	0	0	2.726156842	0	0	0	0	0	0	0	0	0	1.673711629	0	0	0	0.680066834	0	0	0	0	0	29.1225	YES	$800/Admit	$800/Admit	30% Coins(Days 1-10) 30%(Days 10-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit						5000	2.3787	0.0599	0.4389	1.4626	1.3809	0.9476	0.3309	0.283	3.4535	0.4071	0.0555	0.3162	0	0.7953	1.3006	1.8075	0.016	0.0917			1.0557	0		0	0				0	0	1.2631	0	0	0	0.1918						18.0366	500	2.905971	9.9502	0.250633515	2.01680668	1.462607	1.63286756	1.646870392	0.575051972	1.1090465	4.909002087	1.838719223	0.252217487	0.474358165	0	1.74192951	2.837400287	8.21448449	0.072512042	0.583763856	0	0	3.781894842	0	0	0	0	0	0	0	0	0	2.936771629	0	0	0	0.871916834	0	0	0	0	0	47.1591
R5826_065_0	2010	3	10	r.	s.	t.	u.	v.						OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional						Radiology				Therapy (PT/OT/ST)						A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin	V				O	O	V	O	O	O	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	YES	190.022389	4.786415	548.334662	314.352954	35.334188	4.163213	1.453707	231.699818	235.198929	1137.228148	91.962041	44.354941	0.202961	281.758493	2155.229458	2995.117515	26.438907	138.011539			16.230822	0		2.34	1.72				0.04	0.25	541.287699	0.05	0.55	1.74	317.913082						2900	$550/Admit:1a	$550/Admit:1b	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	20% Coins:12	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i						550	550	69.3508	0	100	0.2	0.2	50	86.785863	17.65442	30	50	0.2	47.116279	10	30	30	50			0.2	0		0	0				0	0	43.36412	0	0	0	30						NO	494.109	494.109	34.684554	0	88.4983	0.176997	0.176997	44.24915	76.804013	15.623861	26.54949	44.24915	0.176997	41.697106	8.84983	26.54949	26.54949	44.24915			0.176997	0		0	0				0	0	38.376509	0	0	0	26.54949							7.8243	0.197084227	1.584895266	0	0.260584631	0.736876211	0.257301778	0.854376667	1.5053518	1.480657876	0.203462107	0.163555703	0.035923488	0.979042812	1.589451193	6.626570209	0.058494958	0.508907774	0	0	2.872806802	0	0	0	0	0	0	0	0	0	1.731061021	0	0	0	0.703369183	0	0	0	0	0	30.1741	0	5.164493	7.8243	0.197084227	1.584895266	0	0.260584631	0.736876211	0.257301778	0.854376667	1.5053518	1.480657876	0.203462107	0.163555703	0.035923488	0.979042812	1.589451193	6.626570209	0.058494958	0.508907774	0	0	2.872806802	0	0	0	0	0	0	0	0	0	1.731061021	0	0	0	0.703369183	0	0	0	0	0	30.1741	YES	$800/Admit	$800/Admit	30% Coins(Days 1-7) 30%(Days 8-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS751: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit						5000	2.431	0.0612	0.4376	1.5205	1.409	0.9851	0.344	0.2887	3.5903	0.4232	0.0566	0.3287	0.0128	0.8268	1.3271	1.8442	0.0163	0.0953			1.0975	0		0	0				0	0	1.3131	0	0	0	0.1958						18.605	500	3.230433	10.2553	0.258318227	2.022451266	1.520527	1.669582631	1.722012211	0.601290778	1.143105667	5.0956348	1.903894876	0.260086107	0.492299703	0.048726488	1.805859812	2.916507193	8.470776209	0.074773958	0.604255774	0	0	3.970351802	0	0	0	0	0	0	0	0	0	3.044138021	0	0	0	0.899120183	0	0	0	0	0	48.779
R5826_066_0	2010	9	13	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered			Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	V	P	O	O	O	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	YES	1012.691489	33.169778	538.21138	308.549412	34.681853	3.929568	1.372124	227.422207	230.856717	1116.232793	90.26425	43.536066	0	276.556705	2115.439899	2939.822054	25.950795	135.463588			15.319928	0							0.04	0.25	531.294519	1.78149	0.05	0.55	2.53	312.043813					3400	$195/Day(Days 1-7):1a	$195/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	20% Coins:12	"$30-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $30 Partial Hospitalization,7h. $100 Psych -- OP,8b. $125 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$100/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i					137.58966	121.67922	50.7565	0	150	0.2	0.2	50	129.464658	52.963259	75	150	0	123.110663	10	30	30	100			0.2	0							0	0	109.591338	0	0	0	0	30					NO	121.463326	107.417685	29.735137	0	130.0569	0.173409	0.173409	43.3523	112.251814	45.921581	65.02845	130.0569	0	106.742608	8.67046	26.01138	26.01138	86.7046			0.173409	0							0	0	95.020731	0	0	0	0	26.01138						10.2504	0.296918397	1.333649093	0	0.375884524	0.681422457	0.237938651	0.821606312	2.159507105	4.271597885	0.489145356	0.471847149	0	2.460031996	1.528486419	6.372402382	0.056251333	0.978776351	0	0	2.656613395	0	0	0	0	0	0	0	0	0	4.206999464	0	0	0	0	0.67639085	0	0	0	0	40.3259	0	6.704952	10.2504	0.296918397	1.333649093	0	0.375884524	0.681422457	0.237938651	0.821606312	2.159507105	4.271597885	0.489145356	0.471847149	0	2.460031996	1.528486419	6.372402382	0.056251333	0.978776351	0	0	2.656613395	0	0	0	0	0	0	0	0	0	4.206999464	0	0	0	0	0.67639085	0	0	0	0	40.3259	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	20% Coins	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit					6000	7.0561	0.0634	0.3469	1.3259	1.9166	0.8591	0.3	0.2618	3.1308	0.3691	0.11	0.2867	0	0.721	1.2034	1.6724	0.0148	0.0831			0.9571	0							0	0	1.145	0	0	0	0	0.1775					22.0008	500	7.307161	17.3065	0.360366397	1.680588093	1.325947	2.292453524	1.540491457	0.537907651	1.083433312	5.290345105	4.640673885	0.599177356	0.758522149	0	3.181040996	2.731892419	8.044772382	0.071014333	1.061923351	0	0	3.613707395	0	0	0	0	0	0	0	0	0	5.352042464	0	0	0	0	0.85390285	0	0	0	0	62.3267
R5826_067_0	2010	10	15	r.	s.	t.	u.	v.	w.			z.		OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)			Professional		Lab	Radiology	Renal Dialysis	Other					Therapy (PT/OT/ST)		D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O									V	V	P	V	V	O			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	YES	1224.753886	40.115687	650.915394	373.16112	1.49968	4.612483	1.610584	275.045495	32.783616	4.362643	12.181658	3.849207	0	9.471632	2558.423039	3555.434722	31.385015	1.116419			17.982362	0									873.315943	194.443726	2.154543	48.225758	0	0.04			377.387267		3400	$225/Day(Days 1-15):1a	$225/Day(Days 1-8):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. $35 Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15										$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	$0/Proc:12	"$35/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Nurse hotline 14a			$35/Visit:7i		197.25885	150.313725	48.2281	0	0.2	0.2	0.2	50	0.238967	0.25	0.2311	0.2	0	0.232274	15	35	35	0.25			0.2	0									0	19.649955	0	35	0	0			35		NO	156.27142	119.080788	20.354428	0	0.163921	0.163921	0.163921	40.98035	0.195859	0.204902	0.189411	0.163921	0	0.190373	12.294105	28.686245	28.686245	0.204902			0.163921	0									0	16.10524	0	28.686245	0	0			28.686245			15.9495	0.398083968	1.10408421	0	0.245829045	0.756082826	0.26400854	0.939288388	6.420966246	0.893914276	2.307340023	0.630965861	0	1.803142999	2.62112679	8.499339293	0.075026519	0.228756486	0	0	2.947686761	0	0	0	0	0	0	0	0	0	0	0.260963573	0	0.115284659	0	0	0	0	0.902151967	0	47.3635	0	12.383168	15.9495	0.398083968	1.10408421	0	0.245829045	0.756082826	0.26400854	0.939288388	6.420966246	0.893914276	2.307340023	0.630965861	0	1.803142999	2.62112679	8.499339293	0.075026519	0.228756486	0	0	2.947686761	0	0	0	0	0	0	0	0	0	0	0.260963573	0	0.115284659	0	0	0	0	0.902151967	0	47.3635	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	20% Coins	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins									30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins	$0: Nurse hotline 14a			30% Coins		5000	6.294	0.0566	0.2557	0.97	0.8264	0.6285	0.2195	0.1974	1.7862	0.2377	0.6637	0.2097	0	0.5161	0.9165	2.0039	0.01	0.0608			0.7002	0									0.0323	0.3123	0	0.0114	0.5042	0			0.1024		17.5155	0	11.477667	22.2435	0.454679968	1.35980821	0.97003	1.072267045	1.384556826	0.48345854	1.136646388	8.207182246	1.131613276	2.971058023	0.840689861	0	2.319204999	3.53767279	10.50325729	0.084978519	0.289584486	0	0	3.647872761	0	0	0	0	0	0	0	0	0	0.032308	0.573214573	0	0.126695659	0.504229	0	0	0	1.004524967	0	64.8791
R5826_068_0	2010	3	16	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered				Radiology				Therapy (PT/OT/ST)						A	A	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	Coin		Coin	V				O	O	V	O	O	O	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	0	0	0	0	0	0				0	YES	183.007352	4.609715	528.091848	302.748018	34.029759	4.494284	1.569311	223.14618	226.516115	1095.245213	88.567088	42.717494	1.747994	271.356844	2075.665075	2884.547069	25.462864	132.916581			17.521544	0		2.3	2.69				0.04	0.25	521.305037	0.05	0.55	2.87	306.176718	0.32	0.4				2900	$550/Admit:1a	$550/Admit:1b	"$0/Day(Days 1-7) $100(Days 8-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$30/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				550	550	69.3508	0	100	0.2	0.2	50	86.785863	17.65442	30	50	0	47.116279	10	30	30	50			0.2	0		0	0				0	0	43.36412	0	0	0	30	0	0				NO	496.36345	496.36345	35.686188	0	88.8043	0.177609	0.177609	44.40215	77.069578	15.677884	26.64129	44.40215	0	41.841282	8.88043	26.64129	26.64129	44.40215			0.177609	0		0	0				0	0	38.509203	0	0	0	26.64129	0	0					7.5698	0.190674503	1.570465414	0	0.251832411	0.798225287	0.278723757	0.825680846	1.454791783	1.430927283	0.196628456	0.158062381	0	0.946159853	1.536066533	6.404004582	0.056530295	0.491815164	0	0	3.111983908	0	0	0	0	0	0	0	0	0	1.672920125	0	0	0	0.679745228	0	0	0	0	0	29.6251	0	4.878607	7.5698	0.190674503	1.570465414	0	0.251832411	0.798225287	0.278723757	0.825680846	1.454791783	1.430927283	0.196628456	0.158062381	0	0.946159853	1.536066533	6.404004582	0.056530295	0.491815164	0	0	3.111983908	0	0	0	0	0	0	0	0	0	1.672920125	0	0	0	0.679745228	0	0	0	0	0	29.6251	YES	$800/Admit	$800/Admit	30% Coins(Days 1-10) 30%(Days 10-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins	0% Coins		50%-55%	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				5000	2.3529	0.0593	0.4444	1.6266	1.3447	1.0538	0.368	0.2755	3.8406	0.4527	0.054	0.3517	0	0.8845	1.2665	1.76	0.0155	0.102			1.1741	0		0	0				0	0	1.4046	0	0	0	0.1868	0	0				19.0183	500	3.471657	9.9228	0.249941503	2.014881414	1.626556	1.596507411	1.852057287	0.646699757	1.101228846	5.295431783	1.883677283	0.250667456	0.509730381	0	1.830630853	2.802539533	8.164019582	0.072066295	0.593812164	0	0	4.286063908	0	0	0	0	0	0	0	0	0	3.077560125	0	0	0	0.866560228	0	0	0	0	0	48.6434
R5826_069_0	2010	10	18	r.	s.	t.	u.	v.	w.	x.	y.	z.	aa.	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Surgery	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Lab	Radiology	Renal Dialysis	Other					Therapy (PT/OT/ST)		D	D	D	V	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	V	V	Coin			Coin	O		Coin	V				O	O	V	V	P	V	V	O	O	O	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	0	0	YES	1112.687422	36.445053	591.355847	339.016426	1.493407	4.593189	1.603847	249.878499	32.646478	4.344393	12.1307	3.833105	0	9.43201	2324.324232	3230.108139	28.513248	1.111749			17.907137	0		2.46	2.69				0.04	0.25	793.406476	176.65189	1.9574	43.813043	0	0.05	0.55	3.57	342.855875	0.4	3000	$200/Day(Days 1-15):1a	$200/Day(Days 1-9):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	20% Coins:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"20%-25% Coins:9b. $0 Surgery ASC -- Physician,9b. 20% Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. 25% Surgery OP -- Facility"	25% Coins:8a	"20%-25% Coins:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	20% Coins:9a	20% Coins:12	"20%-25% Coins:9d. 25% Cardiac Rehab,8b. 25% Nuclear Medicine,9a. 25% OP Other,5. $35 Partial Hospitalization,7h. 25% Psych -- OP,8b. 20% Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	25% Coins:7i			20% Coins:15			"DEN750: Dental 16a, 16b"	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Visit:8a	"$0-$35/Visit:14h. 25% DMAM -- OP,8b. 20% Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. 20% Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. 25% Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. 25% Radiology OP -- Facility"	$0/Proc:12	"$35/Visit:3, 5, 7h, 8b, 9a, 9d"	"$0/Visit:9a, 9b"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Member Assistance 14a	175.3412	141.0078	48.2281	0	0.2	0.2	0.2	50	0.238967	0.25	0.2311	0.2	0	0.232274	15	35	35	0.25			0.2	0		0	0				0	0	0	19.649955	0	35	0	0	0	0	35	0	NO	139.427991	112.126723	22.72156	0	0.163292	0.163292	0.163292	40.82295	0.195107	0.204115	0.188683	0.163292	0	0.189642	12.246885	28.576065	28.576065	0.204115			0.163292	0		0	0				0	0	0	16.043382	0	28.576065	0	0	0	0	28.576065	0		12.9283	0.340538697	1.119710613	0	0.243861416	0.750031018	0.261895384	0.850064789	6.369556383	0.886755777	2.288856868	0.625915382	0	1.78870524	2.372144298	7.691981678	0.067899702	0.226924647	0	0	2.924092215	0	0	0	0	0	0	0	0	0	0	0.236174479	0	0.104333697	0	0	0	0	0.816455981	0	42.8942	0	11.08278	12.9283	0.340538697	1.119710613	0	0.243861416	0.750031018	0.261895384	0.850064789	6.369556383	0.886755777	2.288856868	0.625915382	0	1.78870524	2.372144298	7.691981678	0.067899702	0.226924647	0	0	2.924092215	0	0	0	0	0	0	0	0	0	0	0.236174479	0	0.104333697	0	0	0	0	0.816455981	0	42.8942	YES	30% Coins	30% Coins	30% Coins(Days 1-14) 30%(Days 14-100)	30% Coins	20% Coins	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins		0.5	"VIS752: Vision 7a, 7b"				$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	30% Coins	$0/Proc	30% Coins	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	30% Coins	$0: LifeSynch Member Assistance 14a	5000	6.2918	0.0566	0.2563	0.9676	0.8243	0.6269	0.2189	0.1796	1.7817	0.2371	0.662	0.2092	0	0.5147	0.9142	1.9988	0.0099	0.0607			0.6984	0		0	0				0	0	0.0322	0.3115	0	0.0114	0.5029	0	0	0	0.1021	0	17.4687	0	11.378144	19.2201	0.397114697	1.376017613	0.967553	1.068188416	1.376900018	0.480785384	1.029657789	8.151210383	1.123847777	2.950879868	0.835104382	0	2.30344924	3.286349298	9.690781678	0.077826702	0.287597647	0	0	3.622491215	0	0	0	0	0	0	0	0	0	0.032225	0.547627479	0	0.115715697	0.502941	0	0	0	0.918567981	0	60.3629
R5826_070_0	2010	5	21	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered				Radiology	Therapy (PT/OT/ST)									A	A	D	V	T	Coin	Coin	V	V	V	V	V	P	V	V	V	V	V			Coin	O		Coin						O	V	V	O	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	YES	176.279296	4.440245	508.677156	291.617834	32.778694	3.836297	1.339555	214.942467	218.188509	1054.979778	85.311021	41.147034	1.683731	261.38072	1999.355627	2778.500002	24.526751	128.030055			14.956301	0		2.86						0.04	502.139857	294.920482	0.05	0.25		0.55	2.68				2800	$550/Admit:1a	$550/Admit:1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$95/Visit:9b. $0 Surgery ASC -- Physician,9b. $75 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $95 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$30/Visit:14h, 8a, 8b, 9a"	$50/Visit:9a	"$0-$50/Proc:12. $0 Dialysis -- Dialysis Center,12. $50 Dialysis -- OP Hosp"	"$30-$50/Visit:9d. $50 Cardiac Rehab,8b. $50 Nuclear Medicine,9a. $50 OP Other,5. $30 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $30 Therapy (AT,PT,ST,OT) -- CORF"	$10/Visit:7a	"$30/Visit:7b, 7d, 7f"	$30/Visit:7e	$50/Visit:7i			20% Coins:15			"DEN750: Dental 16a, 16b"						$0: Nurse hotline 14a	"$0-$50/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $50 Advanced Imaging -- FSR,8b. $30 Advanced Imaging -- Office,9a. $50 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$30/Visit:7i	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a		$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				550	550	45.891712	0	100	0.2	0.2	50	86.785863	17.654419	30	50	0	47.116279	10	30	30	50			0.2	0		0						0	43.36412	30	0	0		0	0				NO	503.3611	503.3611	28.717427	0	89.5291	0.179058	0.179058	44.76455	77.698602	15.805843	26.85873	44.76455	0	42.182781	8.95291	26.85873	26.85873	44.76455			0.179058	0		0						0	38.823506	26.85873	0	0		0	0					7.3943	0.186253884	1.217324924	0	0.244553914	0.686919668	0.239858039	0.801816901	1.412745177	1.389570395	0.190945473	0.153494038	0	0.918813806	1.491670916	6.218915113	0.054896449	0.47760065	0	0	2.678045344	0	0	0	0	0	0	0	0	0	1.624569146	0.660099133	0	0	0	0	0	0	0	0	28.0424	0	3.681145	7.3943	0.186253884	1.217324924	0	0.244553914	0.686919668	0.239858039	0.801816901	1.412745177	1.389570395	0.190945473	0.153494038	0	0.918813806	1.491670916	6.218915113	0.054896449	0.47760065	0	0	2.678045344	0	0	0	0	0	0	0	0	0	1.624569146	0.660099133	0	0	0	0	0	0	0	0	28.0424	YES	$800/Admit	$800/Admit	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$35/Visit	30% Coins	$0-$50/Proc	30% Coins	$35/Visit	$35/Visit	$35/Visit	30% Coins			20%-30% Coins			0.5						$0: Nurse hotline 14a	30% Coins	$35/Visit	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a		$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a				5000	2.3275	0.0586	0.4412	1.4458	1.3487	0.9367	0.3271	0.2764	3.4138	0.4024	0.0542	0.3126	0	0.7862	1.2703	1.7653	0.0156	0.0907			1.0436			0						0	1.2485	0.1874	0	0		0	0				17.7526	500	2.749008	9.7219	0.244881884	1.658531924	1.445779	1.593301914	1.623626668	0.566937039	1.078199901	4.826531177	1.792001395	0.245148473	0.466077038	0	1.704983806	2.761980916	7.984262113	0.070479449	0.56826165	0	0	3.721636344	0	0	0	0	0	0	0	0	0	2.873096146	0.847480133	0	0	0	0	0	0	0	0	45.7951
R5826_072_0	2010	5	11	r.	s.	t.	u.	v.	w.	x.	y.	z.		OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered		Radiology	Renal Dialysis					Therapy (PT/OT/ST)				D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	O	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	0	0	0	0	0	0	0		0	YES	1299.296824	52.379908	486.512075	536.724966	36.063516	8.07581	4.090496	325.706824	348.942493	1306.451083	168.485143	93.052816	0.016459	567.085337	3514.494187	4167.242952	95.809453	217.831368			36.280723	0		1.2					0.04	0.25	954.921193	30.698379	0.05	0.55	1.66	2.09	535.691095	0.32	0.4		5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$35/Visit:14h, 8a, 8b, 9a"	$100/Visit:9a	20% Coins:12	"$35-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN767: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		158.7573	140.3991	50.7565	0	100	0.2	0.2	50	130.337704	59.684231	35	100	0.2	82.826024	15	35	35	100			0.2	0		0					0	0	72.86565	0	0	0	0	0	35	0	0		NO	139.684833	123.532114	32.295498	0	86.0744	0.172149	0.172149	43.0372	112.187396	51.372844	30.12604	86.0744	0.172149	71.292003	12.91116	30.12604	30.12604	86.0744			0.172149	0		0					0	0	62.718671	0	0	0	0	0	30.12604	0	0			15.1243	0.539216731	1.309345812	0	0.258678792	1.390242616	0.704174796	1.16812581	3.262245804	5.593008973	0.422982513	0.667455442	0.0028334	3.369054129	3.781349731	10.46187732	0.240529951	1.562475358	0	0	6.245690184	0	0	0	0	0	0	0	0	0	4.990949011	0	0	0	0	0	1.34485428	0	0	0	62.4394	0	10.242978	15.1243	0.539216731	1.309345812	0	0.258678792	1.390242616	0.704174796	1.16812581	3.262245804	5.593008973	0.422982513	0.667455442	0.0028334	3.369054129	3.781349731	10.46187732	0.240529951	1.562475358	0	0	6.245690184	0	0	0	0	0	0	0	0	0	4.990949011	0	0	0	0	0	1.34485428	0	0	0	62.4394	YES	$250/Day(Days 1-7)	$250/Day(Days 1-7)	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$40/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a		7500	3.3433	0.1192	0.5278	2.255	1.2561	1.6691	0.8454	0.3545	4.7146	0.7524	0.1036	0.5873	0.0009	1.5239	2.1602	2.5614	0.0589	0.1589			2.0203	0		0					0	0	2.1142	0	0	0	0	0	0.3293	0	0		27.4562	500	5.046965	18.4676	0.658412731	1.837127812	2.254962	1.514771792	3.059380616	1.549613796	1.52263781	7.976856804	6.345442973	0.526541513	1.254707442	0.0037404	4.892969129	5.941525731	13.02326332	0.299418951	1.721376358	0	0	8.265997184	0	0	0	0	0	0	0	0	0	7.105136011	0	0	0	0	0	1.67411528	0	0	0	89.8956
R5826_074_0	2010	7	9	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered				Radiology				Therapy (PT/OT/ST)						D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	O	O	O	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	0	0	0	0	0				0	YES	1307.996057	40.139244	528.124098	564.84877	36.650458	7.474496	3.446975	291.353769	390.666973	847.361479	194.661607	100.78201	1.318598	424.725873	4034.934749	5694.269223	74.985214	187.40135			64.877028	0		1.08					0.04	0.25	1240.424187	0.05	0.55	2.59	792.488303	0.32	0.4				6000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	"0%-20% Coins:12. 0% Dialysis -- Dialysis Center,12. 20% Dialysis -- OP Hosp"	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN762: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				158.7573	140.3991	50.7565	0	150	0.2	0.2	50	122.108919	69.349949	75	150	0.001529	107.004344	15	35	35	100			0.2	0		0					0	0	93.80026	0	0	0	35	0	0				NO	140.4556	124.213751	31.510803	0	127.0515	0.169402	0.169402	42.3505	103.427476	58.740101	63.52575	127.0515	0.001295	90.633749	12.70515	29.64535	29.64535	84.701			0.169402	0		0					0	0	79.449758	0	0	0	29.64535	0	0					15.3096	0.415487172	1.386801201	0	0.388041305	1.266194571	0.583924459	1.02824815	3.367141581	4.147841572	1.030502048	1.067042129	0.001707584	3.207874847	4.272037602	14.06738368	0.185246909	1.322756812	0	0	10.9902983	0	0	0	0	0	0	0	0	0	8.21261679	0	0	0	1.957799426	0	0	0	0	0	74.2086	0	13.453144	15.3096	0.415487172	1.386801201	0	0.388041305	1.266194571	0.583924459	1.02824815	3.367141581	4.147841572	1.030502048	1.067042129	0.001707584	3.207874847	4.272037602	14.06738368	0.185246909	1.322756812	0	0	10.9902983	0	0	0	0	0	0	0	0	0	8.21261679	0	0	0	1.957799426	0	0	0	0	0	74.2086	YES	$225/Day(Days 1-7)	$225/Day(Days 1-7)	30% Coins(Days 1-10) 30%(Days 11-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$100/Visit	30% Coins	0%-20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a				7500	2.5658	0.0696	0.5093	1.4838	1.4752	1.1902	0.5489	0.2443	3.8211	0.4579	0.2304	0.6177	0.0004	1.042	1.9106	2.6964	0.0355	0.1213			2.8243	0		0					0	0	1.9296	0	0	0	0.3753	0	0				24.1497	0	6.229264	17.8754	0.485121172	1.896144201	1.483813	1.863209305	2.456354571	1.132784459	1.27255815	7.188219581	4.605749572	1.260945048	1.684740129	0.002135584	4.249906847	6.182681602	16.76376468	0.220753909	1.444008812	0	0	13.8146423	0	0	0	0	0	0	0	0	0	10.14221379	0	0	0	2.333062426	0	0	0	0	0	98.3582
R5826_075_0	2010	4	17	r.	s.	t.	u.	v.	w.	x.				OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered	Other Non-Covered				Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	O	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	YES	1376.421934	57.433517	321.199686	723.80516	33.847866	9.519618	5.679971	343.580419	354.75466	1676.670065	1159.164536	92.198043	0.000429	501.827433	3663.965711	4055.046867	101.040868	621.381763			28.70489	0							0.04	0.25	23.167315	0.05	0.55	1.93	0.32	0.35	0.4				5000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-14) $100(Days 15-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $100 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$100/Visit:9a	20% Coins:12	"$40-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $40 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $40 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	"$40-$100/Visit:7i. $100 Therapy (AT,PT,ST,OT) -- OP,7i. $40 Therapy (AT,PT,ST,OT) - Specialist"			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a				158.7573	140.3991	48.2281	0	100	0.2	0.2	50	131.6454	32.527407	86.929678	100	0.2	85.996296	15	40	40	59.166382			0.2	0							0	0	0	0	0	0	0	0	0				NO	139.443681	123.318847	33.870064	0	85.8963	0.171793	0.171793	42.94815	113.078527	27.939839	74.669377	85.8963	0.171793	73.867637	12.884445	34.35852	34.35852	50.821733			0.171793	0							0	0	0	0	0	0	0	0	0					15.9944	0.590219591	0.906587827	0	0.242283871	1.635403735	0.975779258	1.229678614	3.342927867	3.903824306	7.212841145	0.659955897	7.37E-05	3.089067221	3.934013724	11.61045074	0.289301224	2.631641504	0	0	4.931299168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1798	0	10.183176	15.9944	0.590219591	0.906587827	0	0.242283871	1.635403735	0.975779258	1.229678614	3.342927867	3.903824306	7.212841145	0.659955897	7.37E-05	3.089067221	3.934013724	11.61045074	0.289301224	2.631641504	0	0	4.931299168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	63.1798	YES	$240/Day(Days 1-15)	$240/Day(Days 1-15)	30% Coins(Days 1-14) 30%(Days 15-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	0% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: OTC items 13c	$0: LifeSynch Member Assistance 14a				7500	3.9734	0.1593	0.3928	2.8388	1.124	1.8759	1.1193	0.3565	5.2817	0.6832	2.5616	0.5564	0	1.1509	2.2068	3.9559	0.0389	0.3131			1.5091	0							0	0	0	0	0	0	0	0	0				30.0976	500	6.236641	19.9679	0.749515591	1.299343827	2.838769	1.366291871	3.511304735	2.095053258	1.586225614	8.624611867	4.587039306	9.774484145	1.216403897	9.57E-05	4.239932221	6.140808724	15.56635774	0.328187224	2.944749504	0	0	6.440407168	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2774
R5826_076_0	2010	5	21	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	Professional	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered	Other Non-Covered			Radiology	Renal Dialysis	Therapy (PT/OT/ST)								A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	O								O	V	P	V	O	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	YES	235.253741	8.354145	474.091621	523.022598	35.142829	7.430583	3.763682	317.391662	340.034135	1273.097923	164.183786	90.677216	0.015143	552.607882	3424.770593	4060.854951	93.363477	212.270223			33.382029	0								0.04	930.542448	29.914662	522.015121	0.05	0.25		0.55	2.68			5000	$800/Admit:1a	$800/Admit:1b	"$0/Day(Days 1-20) $128(Days 21-100):2. $0 SNF 1,2. $128 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$150/Visit:9b. $0 Surgery ASC -- Physician,9b. $100 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $150 Surgery OP -- Facility"	"$0-$100/Visit:8a. $0 Lab -- FSL,8a. $100 Lab -- OP"	"$35/Visit:14h, 8a, 8b, 9a"	$100/Visit:9a	20% Coins:12	"$35-$100/Visit:9d. $100 Cardiac Rehab,8b. $100 Nuclear Medicine,9a. $100 OP Other,5. $35 Partial Hospitalization,7h. $100 Psych -- OP,8b. $100 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$100/Visit:7i			20% Coins:15									$0: Nurse hotline 14a	"$0-$100/Visit:14h. $100 DMAM -- OP,8b. $75 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $75 Advanced Imaging -- FSR,8b. $35 Advanced Imaging -- Office,9a. $100 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $100 Radiology OP -- Facility"	$0/Proc:12	$35/Visit:7i	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a		$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a			800	800	45.891712	0	100	0.2	0.2	50	130.337704	59.684231	35	100	0.2	82.826024	15	35	35	100			0.2	0								0	72.86565	0	35	0	0		0	0			NO	714.7344	714.7344	31.236286	0	86.9419	0.173884	0.173884	43.47095	113.318076	51.890605	30.429665	86.9419	0.173884	72.010519	13.041285	30.429665	30.429665	86.9419			0.173884	0								0	63.35078	0	30.429665	0	0		0	0				14.012	0.497582901	1.234071789	0	0.25461536	1.292059494	0.654444081	1.149776422	3.211001163	5.505151787	0.416338134	0.656970787	0.002633125	3.316131699	3.72195078	10.29753798	0.236751611	1.537931375	0	0	5.804600731	0	0	0	0	0	0	0	0	0	4.912549159	0	1.323728771	0	0	0	0	0	0	0	60.0378	0	8.96264	14.012	0.497582901	1.234071789	0	0.25461536	1.292059494	0.654444081	1.149776422	3.211001163	5.505151787	0.416338134	0.656970787	0.002633125	3.316131699	3.72195078	10.29753798	0.236751611	1.537931375	0	0	5.804600731	0	0	0	0	0	0	0	0	0	4.912549159	0	1.323728771	0	0	0	0	0	0	0	60.0378	YES	$950/Admit	$950/Admit	30% Coins(Days 1-20) 30%(Days 21-100)	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$40/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins									$0: Nurse hotline 14a	30% Coins	$0/Proc	$40/Visit	$0: Additional Smoking Cessation 14a	$0: Member Incentive Program 14a		$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a			7500	2.8978	0.1029	0.5248	1.6782	0.9901	1.2422	0.6292	0.2794	3.5088	0.56	0.0816	0.4371	0.0007	1.1342	1.7027	2.0189	0.0464	0.1183			1.5036									0	1.5735	0	0.2595	0	0		0	0			21.29	0	4.146021	16.9098	0.600487901	1.758889789	1.678243	1.24469336	2.534306494	1.283657081	1.429209422	6.719823163	6.065146787	0.497965134	1.094029787	0.003308125	4.450296699	5.42464378	12.31647298	0.283169611	1.656193375	0	0	7.308201731	0	0	0	0	0	0	0	0	0	6.486020159	0	1.583258771	0	0	0	0	0	0	0	81.3278
R5826_077_0	2010	3	8	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	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	YES	1353.366688	54.559683	506.758135	559.060622	37.564289	7.310792	3.703005	339.26102	363.463635	1360.818669	1170.156568	96.925182	0.0149	590.684431	3660.748854	4340.661572	99.796536	784.880084			32.843868	0							0.04	0.25	31.975884	0.05	0.55	2.18	0.32	0.4					5900	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $40 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	240.168852	29.842116	85.206191	150	0.2	52.415773	15	40	40	15			0.2	0							0	0	0	0	0	0	0	0					NO	144.039387	127.383121	39.591506	0	87.0697	0.174139	0.174139	43.53485	209.114299	25.983441	74.188775	130.60455	0.174139	45.638257	13.060455	34.82788	34.82788	13.060455			0.174139	0							0	0	0	0	0	0	0	0						16.2448	0.579165225	1.671943145	0	0.272559281	1.273094008	0.644837588	1.230806468	6.333786937	2.946562633	7.234373528	1.054905815	0.002594671	2.246483989	3.984253806	12.59800336	0.289641815	0.854240918	0	0	5.71939833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.1815	0	9.440264	16.2448	0.579165225	1.671943145	0	0.272559281	1.273094008	0.644837588	1.230806468	6.333786937	2.946562633	7.234373528	1.054905815	0.002594671	2.246483989	3.984253806	12.59800336	0.289641815	0.854240918	0	0	5.71939833	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.1815	YES	30% Coins	30% Coins	30% Coins	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					7500	8.3809	0.1104	0.3456	2.1656	1.388	1.603	0.8119	0.3917	4.5277	0.7226	2.3667	0.564	0.0009	1.4635	2.0818	3.8758	0.0389	0.3852			1.9402	0							0	0	0	0	0	0	0	0					33.1643	1000	11.7934	24.6258	0.689613225	2.017553145	2.165553	1.660529281	2.876051008	1.456754588	1.622538468	10.86146294	3.669162633	9.601039528	1.618873815	0.003465671	3.709975989	6.066067806	16.47384336	0.328578815	1.239395918	0	0	7.65959933	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.3458
R5826_078_0	2010	3	16	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	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	YES	1503.865238	76.170133	200.078026	1191.448052	27.755397	10.501011	6.734734	405.366659	418.698711	1223.075587	1082.742737	127.937182	0.027347	693.194226	3519.884272	3587.056905	60.246405	646.501455			21.130779	0							0.04	0.25	30.000315	0.05	0.55	2.87	0.32	0.4					5900	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $40 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	241.213413	36.545494	92.840625	150	0.2	53.348417	15	40	40	15			0.2	0							0	0	0	0	0	0	0	0					NO	144.571541	127.853738	46.630651	0	87.2371	0.174474	0.174474	43.61855	210.427586	31.881229	80.991469	130.85565	0.174474	46.539612	13.085565	34.89484	34.89484	13.085565			0.174474	0							0	0	0	0	0	0	0	0						18.118	0.811553019	0.777480717	0	0.201775029	1.832153393	1.17503598	1.473458824	7.342146585	3.249429406	7.307743735	1.395108592	0.00477134	2.68841586	3.838306203	10.43081473	0.175190722	0.704986401	0	0	3.686771535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2132	0	8.708833	18.118	0.811553019	0.777480717	0	0.201775029	1.832153393	1.17503598	1.473458824	7.342146585	3.249429406	7.307743735	1.395108592	0.00477134	2.68841586	3.838306203	10.43081473	0.175190722	0.704986401	0	0	3.686771535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.2132	YES	30% Coins	30% Coins	30% Coins	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					7500	9.1112	0.1265	0.2169	4.0261	0.9537	2.1412	1.3732	0.4353	5.6302	0.6717	2.4492	0.4954	0.0015	2.4919	1.9687	2.951	0.0494	0.3235			1.1117	0							0	0	0	0	0	0	0	0					36.5283	1000	16.464339	27.2293	0.938009019	0.994428717	4.026143	1.155485029	3.973328393	2.54825998	1.908736824	12.97229958	3.921121406	9.756945735	1.890494592	0.00625834	5.18032086	5.807033203	13.38183473	0.224549722	1.028475401	0	0	4.798462535	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	101.7414
R5826_079_0	2010	3	7	r.	s.	t.	u.	v.	w.					OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Other Non-Covered	Other Non-Covered					Renal Dialysis										D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin							O	O	P	O	O	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	YES	1355.936028	54.663263	507.720205	560.121987	37.635604	7.35699	3.726406	339.9051	364.153663	1363.402157	1172.378088	97.109193	0.014994	591.805834	3667.698715	4348.902233	99.985998	786.370163			33.051416	0							0.04	0.25	32.036589	0.05	0.55	2.14	0.32	0.4					5900	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-7) $84(Days 8-100):2. $0 SNF 1,2. $84 SNF 2"	$0/Visit:6	$100/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$250/Visit:9b. $0 Surgery ASC -- Physician,9b. $225 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $250 Surgery OP -- Facility"	"$0-$50/Visit:8a. $0 Lab -- FSL,8a. $50 Lab -- OP"	"$0-$150/Visit:14h. $50 DMAM -- OP,8b. $50 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $150 Advanced Imaging -- FSR,8b. $150 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $50 Radiology OP -- Facility"	$150/Visit:9a	20% Coins:12	"$15-$150/Visit:9d. $15 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $50 OP Other,5. $40 Partial Hospitalization,7h. $50 Psych -- OP,8b. $50 Rad therapy,3. $15 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$40/Visit:7b, 7d, 7f"	$40/Visit:7e	$15/Visit:7i			20% Coins:15								$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					158.7573	140.3991	58.254672	0	100	0.2	0.2	50	240.168852	29.842116	85.206191	150	0.2	52.415773	15	40	40	15			0.2	0							0	0	0	0	0	0	0	0					NO	143.967787	127.319801	39.525329	0	87.0297	0.174059	0.174059	43.51485	209.018231	25.971504	74.154692	130.54455	0.174059	45.61729	13.054455	34.81188	34.81188	13.054455			0.174059	0							0	0	0	0	0	0	0	0						16.2676	0.579976314	1.672317345	0	0.272951277	1.280550322	0.648614502	1.23257662	6.342896204	2.950800381	7.244778002	1.056422992	0.002609841	2.249714863	3.989983986	12.61612189	0.29005838	0.855469492	0	0	5.752896418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3063	0	9.495885	16.2676	0.579976314	1.672317345	0	0.272951277	1.280550322	0.648614502	1.23257662	6.342896204	2.950800381	7.244778002	1.056422992	0.002609841	2.249714863	3.989983986	12.61612189	0.29005838	0.855469492	0	0	5.752896418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	65.3063	YES	30% Coins	30% Coins	30% Coins	30% Coins	$100/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	30% Coins	30% Coins	20% Coins	30% Coins	30% Coins	30% Coins	30% Coins	30% Coins			20%-30% Coins	30% Coins							$0: Nurse hotline 14a	$0: Member Incentive Program 14a	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a					7500	8.3946	0.1106	0.3452	2.1728	1.3865	1.6083	0.8146	0.3913	4.5428	0.725	2.3746	0.5659	0.0009	1.4684	2.0888	3.8888	0.0391	0.3864			1.9467	0							0	0	0	0	0	0	0	0					33.2512	1000	11.936654	24.6622	0.690604314	2.017472345	2.172797	1.659447277	2.888869322	1.463247502	1.62389262	10.8857172	3.675817381	9.619360002	1.622276992	0.003483841	3.718102863	6.078761986	16.50492689	0.32912538	1.241912492	0	0	7.699587418	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.5576
R5826_080_0	2010	6	12	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered			Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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	0	0	0	0	0	0			0	YES	1328.654394	48.140712	565.024704	503.37873	38.307307	7.332017	3.315012	321.146362	372.186255	1138.152597	173.513927	102.991192	0.006699	519.379422	3743.294945	4871.811024	92.80722	204.664717			45.713325	0		2.41					0.04	0.25	1100.793291	44.266874	0.05	0.55	2.34	626.420206	0.32	0.4			6000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN749: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			158.7573	140.3991	50.7565	0	150	0.2	0.2	50	176.535609	90.109182	75	150	0.2	111.475223	15	35	35	100			0.2	0		0					0	0	99.942551	0	0	0	0	35	0	0			NO	140.947112	124.648427	33.362044	0	127.3803	0.16984	0.16984	42.4601	149.914392	76.520898	63.69015	127.3803	0.16984	94.664982	12.73803	29.72207	29.72207	84.9202			0.16984	0		0					0	0	84.871415	0	0	0	0	29.72207	0	0				15.6058	0.500055335	1.57086492	0	0.406633021	1.245269767	0.563021638	1.136325554	4.649673011	7.257704899	0.920927336	1.093254078	0.001137758	4.097253636	3.973516942	12.06669236	0.229868557	1.448347392	0	0	7.763951118	0	0	0	0	0	0	0	0	0	7.785490352	0	0	0	0	1.551542101	0	0	0	0	73.8674	0	12.832294	15.6058	0.500055335	1.57086492	0	0.406633021	1.245269767	0.563021638	1.136325554	4.649673011	7.257704899	0.920927336	1.093254078	0.001137758	4.097253636	3.973516942	12.06669236	0.229868557	1.448347392	0	0	7.763951118	0	0	0	0	0	0	0	0	0	7.785490352	0	0	0	0	1.551542101	0	0	0	0	73.8674	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		50%-80%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			7500	8.3362	0.1063	0.3574	1.8168	2.0629	1.562	0.7062	0.3603	4.4891	0.6953	0.2061	0.6821	0.0004	1.4102	2.3716	3.0865	0.0588	0.1456			2.643	0		0					0	0	2.1684	0	0	0	0	0.3969	0	0			33.6621	1000	13.089146	23.942	0.606377335	1.92828292	1.816847	2.469537021	2.807272767	1.269247638	1.496621554	9.138744011	7.953011899	1.127044336	1.775321078	0.001517758	5.507457636	6.345067942	15.15321136	0.288666557	1.593971392	0	0	10.40696212	0	0	0	0	0	0	0	0	0	9.953855352	0	0	0	0	1.948408101	0	0	0	0	107.5294
R5826_081_0	2010	7	6	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered			Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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	0	0	0	0	0	0			0	YES	1358.79527	49.232796	577.842439	514.798009	39.176319	7.562156	3.419064	328.431652	380.629399	1163.97189	177.450137	105.327574	0.00691	531.161683	3828.212581	4982.329346	94.912576	209.30759			47.14818	0		2.59					0.04	0.25	1125.765078	45.27108	0.05	0.55	1.17	640.630714	0.32	0.4			6000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN814: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			158.7573	140.3991	50.7565	0	150	0.2	0.2	50	176.535609	90.109182	75	150	0.2	111.475223	15	35	35	100			0.2	0		0					0	0	99.942551	0	0	0	0	35	0	0			NO	140.145229	123.939271	32.74317	0	126.75	0.169	0.169	42.25	149.172589	76.142259	63.375	126.75	0.169	94.196564	12.675	29.575	29.575	84.5			0.169	0		0					0	0	84.451456	0	0	0	0	29.575	0	0				15.8691	0.508489737	1.576699434	0	0.413799869	1.278004364	0.577821816	1.156353108	4.731622742	7.38562076	0.937158536	1.1125225	0.00116779	4.169467122	4.043549539	12.27936587	0.233919953	1.47387428	0	0	7.96804242	0	0	0	0	0	0	0	0	0	7.922708329	0	0	0	0	1.578887781	0	0	0	0	75.2181	0	13.546462	15.8691	0.508489737	1.576699434	0	0.413799869	1.278004364	0.577821816	1.156353108	4.731622742	7.38562076	0.937158536	1.1125225	0.00116779	4.169467122	4.043549539	12.27936587	0.233919953	1.47387428	0	0	7.96804242	0	0	0	0	0	0	0	0	0	7.922708329	0	0	0	0	1.578887781	0	0	0	0	75.2181	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		0.5					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			7500	8.3979	0.1071	0.3546	1.8474	2.0799	1.5883	0.7181	0.3633	4.5647	0.707	0.2078	0.6936	0.0004	1.434	2.3911	3.112	0.0593	0.1481			2.6875	0		0					0	0	2.2049	0	0	0	0	0.4001	0	0			34.0672	1000	13.844839	24.2669	0.615598737	1.931326434	1.847448	2.493748869	2.866316364	1.295942816	1.519626108	9.296301742	8.09263876	1.144978536	1.8060775	0.00155479	5.603423122	6.434696539	15.39138787	0.293203953	1.62195128	0	0	10.65556942	0	0	0	0	0	0	0	0	0	10.12759533	0	0	0	0	1.979032781	0	0	0	0	109.2854
R5826_082_0	2010	8	13	r.	s.	t.	u.	v.	w.	x.	y.			OP Facility - Other	OP Facility - Other	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Health & Education (Non-Covered)	Professional	Other Non-Covered	Other Non-Covered			Radiology	Renal Dialysis				Therapy (PT/OT/ST)					D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V			Coin	Coin		Coin					O	O	V	P	O	O	O	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	0	0	0	0	0	0			0	YES	1290.571721	46.760874	548.829634	488.950593	37.209321	6.997813	3.163909	311.941476	361.518434	1105.530198	168.540569	100.039198	0.006394	504.492664	3636.002425	4732.172313	90.147125	198.798496			43.629646	0		2.47					0.04	0.25	1069.241706	42.998071	0.05	0.55	2.53	608.465382	0.32	0.4			6000	$225/Day(Days 1-7):1a	$225/Day(Days 1-7):1b	"$0/Day(Days 1-13) $100(Days 14-100):2. $0 SNF 1,2. $100 SNF 2"	$0/Visit:6	$150/Trip:10a	20% Coins:11a	20% Coins:11b	$50/Visit:4a	"$0-$200/Visit:9b. $0 Surgery ASC -- Physician,9b. $150 Surgery ASC -- Facility,9a. $0 Surgery OP -- Physician,9a. $200 Surgery OP -- Facility"	"$0-$150/Visit:8a. $0 Lab -- FSL,8a. $150 Lab -- OP"	"$75/Visit:14h, 8a, 8b, 9a"	$150/Visit:9a	20% Coins:12	"$35-$150/Visit:9d. $100 Cardiac Rehab,8b. $150 Nuclear Medicine,9a. $150 OP Other,5. $35 Partial Hospitalization,7h. $150 Psych -- OP,8b. $125 Rad therapy,3. $35 Therapy (AT,PT,ST,OT) -- CORF"	$15/Visit:7a	"$35/Visit:7b, 7d, 7f"	$35/Visit:7e	$100/Visit:7i			20% Coins:15			"DEN749: Dental 16a, 16b"					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	"$0-$150/Visit:14h. $150 DMAM -- OP,8b. $100 Radiology -- FSR,14h. $0 SMAM -- FSR,14h. $0 SMAM -- OP,8b. $100 Advanced Imaging -- FSR,8b. $75 Advanced Imaging -- Office,9a. $150 Advanced Imaging -- OP,8a. $0 Radiology OP -- Physician,8a. $150 Radiology OP -- Facility"	$0/Proc:12	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$35/Visit:7i	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			158.7573	140.3991	50.7565	0	150	0.2	0.2	50	176.535609	90.109182	75	150	0.2	111.475223	15	35	35	100			0.2	0		0					0	0	99.942551	0	0	0	0	35	0	0			NO	141.962365	125.546279	34.158059	0	128.2029	0.170937	0.170937	42.7343	150.882513	77.015057	64.10145	128.2029	0.170937	95.276313	12.82029	29.91401	29.91401	85.4686			0.170937	0		0					0	0	85.4195	0	0	0	0	29.91401	0	0				15.2677	0.489221144	1.562246252	0	0.397528572	1.196185161	0.540829113	1.110883385	4.545567485	7.095205935	0.900307905	1.068776275	0.001092971	4.005516747	3.884550461	11.79652082	0.224721833	1.415919095	0	0	7.457920798	0	0	0	0	0	0	0	0	0	7.611174325	0	0	0	0	1.516803293	0	0	0	0	72.0887	0	11.935208	15.2677	0.489221144	1.562246252	0	0.397528572	1.196185161	0.540829113	1.110883385	4.545567485	7.095205935	0.900307905	1.068776275	0.001092971	4.005516747	3.884550461	11.79652082	0.224721833	1.415919095	0	0	7.457920798	0	0	0	0	0	0	0	0	0	7.611174325	0	0	0	0	1.516803293	0	0	0	0	72.0887	YES	30% Coins	30% Coins	30% Coins(Days 1-13) 30%(Days 14-100)	30% Coins	$150/Trip	30% Coins	30% Coins	$50/Visit	30% Coins	30% Coins	$75/Visit	30% Coins	20% Coins	30% Coins	$40/Visit	$40/Visit	$40/Visit	30% Coins			20%-30% Coins	0% Coins		50%-80%					$0: Nurse hotline 14a	$0: Member Incentive Program 14a	30% Coins	$0/Proc	$0: Additional Smoking Cessation 14a	$0: Health Education Materials 14a	$0: Membership in health club/fitness class 14a	$40/Visit	$0: LifeSynch Wellness Program 14a	$0: LifeSynch Member Assistance 14a			7500	8.2358	0.105	0.3613	1.7695	2.0447	1.5213	0.6878	0.3571	4.372	0.6772	0.2043	0.6643	0.0004	1.3734	2.3506	3.0593	0.0583	0.1418			2.5741	0		0					0	0	2.1118	0	0	0	0	0.3934	0	0			33.0633	1000	12.023156	23.5035	0.594262144	1.923503252	1.769462	2.442245572	2.717450161	1.228636113	1.468002385	8.917561485	7.772377935	1.104607905	1.733055275	0.001463971	5.378942747	6.235193461	14.85582882	0.283000833	1.557745095	0	0	10.0320008	0	0	0	0	0	0	0	0	0	9.722988325	0	0	0	0	1.910171293	0	0	0	0	105.152
R5826_801_0	2010	5	10																															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	YES	247.162336	0.843097	40.931451	13.207169	1.548815	7.161513	3.500637	18.634083	53.059115	11.45482	27.309172	9.653952	0.848163	17.467132	31.248585	68.364974	0.31678	5.041336			22.744796	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.085669713	0.085669713	0.190191682	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068877712	0.068877712	0.06742069	0	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335			0.189911335	0.189911335																				17.024	0.058070592	2.759626687	0	0.294137524	1.360052491	0.664810645	3.538823571	10.07652734	2.175400153	5.1863213	1.833394908	0.161075767	3.317206349	5.934460481	12.98328345	0.060160113	0.957406848	0	0	4.319494563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7042	0	25.64603291	17.024	0.058070592	2.759626687	0	0.294137524	1.360052491	0.664810645	3.538823571	10.07652734	2.175400153	5.1863213	1.833394908	0.161075767	3.317206349	5.934460481	12.98328345	0.060160113	0.957406848	0	0	4.319494563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7042	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.5782	0.0088	0.1837	0	0.9905	0.755	0.369	0.7855	2.0442	0.4829	1.0468	0.407	0.0357	0.731	0.9414	2.0596	0.0095	0.1741			0.6852	0																			14.2883	0	3.642274917	19.6022	0.06687782	2.943363389	0	1.284661287	2.115067108	1.033835207	4.324355997	12.12071862	2.658264175	6.233162468	2.240365957	0.196813728	4.048228346	6.875894742	15.04283403	0.069696928	1.131478826	0	0	5.004739846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9925
R5826_802_0	2010	4	6																															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	YES	243.45576	0.830454	40.317621	13.009108	1.525587	7.054116	3.448138	18.354636	52.263414	11.283038	26.899627	9.509176	0.835443	17.205188	30.779965	67.339738	0.312029	4.965734			22.403704	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.083075046	0.083075046	0.180198847	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.066396318	0.066396318	0.057104301	0	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756			0.189537756	0.189537756																				16.1646	0.055139088	2.302309571	0	0.289156336	1.337021316	0.653552339	3.478896518	9.905890205	2.138561702	5.098494936	1.802347879	0.158347991	3.261032723	5.833965493	12.76342282	0.059141276	0.941194079	0	0	4.24634778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4894	0	27.55476579	16.1646	0.055139088	2.302309571	0	0.289156336	1.337021316	0.653552339	3.478896518	9.905890205	2.138561702	5.098494936	1.802347879	0.158347991	3.261032723	5.833965493	12.76342282	0.059141276	0.941194079	0	0	4.24634778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4894	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.467	0.0084	0.1528	0	0.9779	0.7453	0.3643	0.7755	2.018	0.4767	1.0335	0.4018	0.0353	0.7217	0.9293	2.0331	0.0094	0.1719			0.6764	0																			13.9982	0	3.736429379	18.6316	0.063552249	2.455083489	0	1.267060656	2.08234407	1.017849994	4.254368733	11.92390089	2.615243732	6.131990456	2.204106993	0.193605834	3.982716695	6.763290113	14.79655832	0.068556723	1.113076063	0	0	4.922757476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4876
R5826_803_0	2010	5	7																															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	YES	216.587149	0.738802	35.868031	11.573378	1.357218	6.2756	3.067591	16.328956	46.495443	10.037803	23.930891	8.459711	0.743241	15.306363	27.382983	59.907894	0.277593	4.417698			19.931153	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.081880707	0.081880707	0.179724898	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068525984	0.068525984	0.066269657	0	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975			0.19513975	0.19513975																				14.8418	0.050627134	2.376962118	0	0.264847181	1.224619013	0.59860894	3.186428386	9.073109108	1.958774365	4.669868079	1.650825887	0.145035863	2.986879844	5.343508448	11.69041144	0.054169429	0.862068482	0	0	3.889360207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.868	0	20.96357768	14.8418	0.050627134	2.376962118	0	0.264847181	1.224619013	0.59860894	3.186428386	9.073109108	1.958774365	4.669868079	1.650825887	0.145035863	2.986879844	5.343508448	11.69041144	0.054169429	0.862068482	0	0	3.889360207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.868	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.366	0.0081	0.1868	0	0.9186	0.7001	0.3422	0.7285	1.8958	0.4478	0.9708	0.3774	0.0332	0.678	0.8731	1.91	0.0088	0.1615			0.6354	0																			13.2421	0	3.190583929	17.2079	0.058679904	2.563777326	0	1.183456915	1.924731445	0.940836096	3.91488918	10.96886743	2.406617078	5.640671548	2.028258229	0.178194235	3.664886695	6.21657659	13.60039511	0.062970725	1.023562038	0	0	4.524793344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.11
R5826_804_0	2010	6	8																															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	YES	237.237044	0.809241	39.287767	12.67681	1.486619	6.873928	3.360062	17.885794	50.928422	10.994831	26.212517	9.266278	0.814103	16.765706	29.993737	65.619643	0.304059	4.838891			21.831434	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.081709952	0.081709952	0.187790477	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.067103882	0.067103882	0.070264285	0	0.192291109	0.192291109	0.192291109	0.192291109	0.192291109	0.192291109	0.192291109	0.192291109	0.192291109	0.192291109	0.192291109	0.192291109	0.192291109	0.192291109			0.192291109	0.192291109																				15.9195	0.054303213	2.760526864	0	0.285863617	1.321795241	0.64611005	3.439279171	9.793082768	2.114208251	5.040433975	1.781822877	0.156544769	3.223896207	5.767528964	12.61807395	0.058467842	0.930475719	0	0	4.197990664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1099	0	22.97515531	15.9195	0.054303213	2.760526864	0	0.285863617	1.321795241	0.64611005	3.439279171	9.793082768	2.114208251	5.040433975	1.781822877	0.156544769	3.223896207	5.767528964	12.61807395	0.058467842	0.930475719	0	0	4.197990664	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1099	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.4503	0.0083	0.195	0	0.9713	0.7403	0.3618	0.7703	2.0046	0.4735	1.0266	0.399	0.0351	0.7169	0.9231	2.0196	0.0093	0.1707			0.6719	0																			13.9477	0	3.401112347	18.3698	0.062650505	2.955574782	0	1.257193288	2.0620972	1.007952138	4.209574202	11.79765348	2.587713733	6.066987376	2.18085232	0.191604238	3.940791411	6.690626534	14.6376412	0.067790013	1.101213304	0	0	4.869896261	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0576
R5826_805_0	2010	5	9																															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	YES	201.022226	0.71508	22.242069	11.339514	1.110976	7.523929	3.175167	16.492493	62.54987	6.429441	34.132627	11.948622	2.012056	14.317427	40.589382	97.30866	0.421633	7.040667			25.510787	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.084777368	0.084777368	0.161140858	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068781084	0.068781084	0.079429442	0	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973			0.188248973	0.188248973																				13.8265	0.049183977	1.766675136	0	0.209140091	1.41637191	0.597721928	3.104694875	11.77494881	1.210335667	6.42543199	2.249315824	0.378767476	2.695240934	7.64090949	18.31825534	0.079371979	1.325398334	0	0	4.802379462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8707	0	24.23646897	13.8265	0.049183977	1.766675136	0	0.209140091	1.41637191	0.597721928	3.104694875	11.77494881	1.210335667	6.42543199	2.249315824	0.378767476	2.695240934	7.64090949	18.31825534	0.079371979	1.325398334	0	0	4.802379462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8707	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.204	0.0079	0.176	0	0.7149	0.7981	0.3368	0.6996	2.4117	0.2727	1.3356	0.5068	0.0853	0.5958	1.2304	2.9497	0.0128	0.2326			0.7733	0																			15.3438	0	3.594408665	16.0305	0.057037385	1.942631569	0	0.924085595	2.214425089	0.934542472	3.804275935	14.18666771	1.483004669	7.761041181	2.756142947	0.464070073	3.29106211	8.87126226	21.26792933	0.092142427	1.55796015	0	0	5.5756899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2145
R5826_806_0	2010	5	11																															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	YES	270.198099	0.921675	44.7463	14.43809	1.693165	7.828973	3.826899	20.370797	58.004275	12.522421	29.854412	10.55371	0.927213	19.095087	34.160983	74.736656	0.346305	5.511193			24.864631	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.074049486	0.074049486	0.167501408	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.058189443	0.058189443	0.052875801	0	0.186723628	0.186723628	0.186723628	0.186723628	0.186723628	0.186723628	0.186723628	0.186723628	0.186723628	0.186723628	0.186723628	0.186723628	0.186723628	0.186723628			0.186723628	0.186723628																				15.7227	0.053631755	2.365996435	0	0.316153911	1.46185424	0.714572464	3.803709116	10.83076865	2.338231877	5.574524113	1.970627017	0.173132575	3.565503917	6.378662673	13.95509953	0.064663326	1.02906995	0	0	4.642814103	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9617	0	30.23555761	15.7227	0.053631755	2.365996435	0	0.316153911	1.46185424	0.714572464	3.803709116	10.83076865	2.338231877	5.574524113	1.970627017	0.173132575	3.565503917	6.378662673	13.95509953	0.064663326	1.02906995	0	0	4.642814103	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9617	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.2676	0.0077	0.1374	0	1.0392	0.7921	0.3872	0.8242	2.1447	0.5066	1.0983	0.427	0.0375	0.7669	0.9877	2.1608	0.01	0.1827			0.7188	0																			14.4964	0	3.990267219	17.9903	0.061380559	2.503367045	0	1.355379492	2.253942081	1.101758224	4.627864489	12.97543333	2.844879091	6.672837091	2.39760027	0.21064367	4.332452396	7.36632287	16.11589695	0.074659686	1.211775705	0	0	5.361661283	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4581
R5826_807_0	2010	7	12																															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	YES	294.014037	1.117293	66.152058	14.432614	2.14101	7.775862	3.691923	23.224734	51.934449	17.813839	26.043875	10.463104	0.213958	23.841839	28.381968	58.676879	0.295921	3.666577			24.421964	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.080380375	0.080380375	0.16921328	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.062518207	0.062518207	0.046943266	0	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547			0.186882547	0.186882547																				18.3812	0.069851155	3.105393673	0	0.400117401	1.453172894	0.689955973	4.340297438	9.705642095	3.3290956	4.867145688	1.955371523	0.039985016	4.455623592	5.304094462	10.96568458	0.05530247	0.685219248	0	0	4.56403883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3672	0	32.20052188	18.3812	0.069851155	3.105393673	0	0.400117401	1.453172894	0.689955973	4.340297438	9.705642095	3.3290956	4.867145688	1.955371523	0.039985016	4.455623592	5.304094462	10.96568458	0.05530247	0.685219248	0	0	4.56403883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3672	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.5688	0.0098	0.1281	0	1.3032	0.7802	0.3704	0.9318	1.9136	0.7148	0.9492	0.4198	0.0086	0.9536	0.8138	1.6824	0.0085	0.1248			0.7003	0																			14.382	0	4.04505465	20.9501	0.07960815	3.233534695	0	1.703329778	2.233416199	1.060363504	5.272111624	11.6191997	4.043856322	5.816395478	2.375212956	0.048603752	5.409232283	6.117921119	12.64812136	0.063822141	0.810042326	0	0	5.264335925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7492
R5826_808_0	2010	7	13																															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	YES	241.969405	0.825384	40.071473	12.929684	1.516274	7.011049	3.427089	18.242577	51.944333	11.214152	26.7354	9.45112	0.830343	17.100143	30.592046	66.928613	0.310125	4.935417			22.266922	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078905238	0.078905238	0.186888403	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.063990524	0.063990524	0.062502031	0	0.190899261	0.190899261	0.190899261	0.190899261	0.190899261	0.190899261	0.190899261	0.190899261	0.190899261	0.190899261	0.190899261	0.190899261	0.190899261	0.190899261			0.190899261	0.190899261																				15.4837	0.052816754	2.504548455	0	0.289455586	1.338404071	0.654228756	3.482494462	9.916134767	2.140773326	5.103768094	1.804211821	0.158511865	3.264404656	5.839998964	12.77662274	0.059202633	0.942167456	0	0	4.250738948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0622	0	25.61603494	15.4837	0.052816754	2.504548455	0	0.289455586	1.338404071	0.654228756	3.482494462	9.916134767	2.140773326	5.103768094	1.804211821	0.158511865	3.264404656	5.839998964	12.77662274	0.059202633	0.942167456	0	0	4.250738948	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0622	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.3607	0.008	0.1691	0	0.9787	0.746	0.3646	0.7762	2.0199	0.4772	1.0344	0.4021	0.0353	0.7223	0.9302	2.035	0.0095	0.1721			0.677	0																			13.9183	0	3.587755966	17.8444	0.060855001	2.67369419	0	1.268143985	2.084402255	1.018820392	4.258699079	11.93603888	2.617934265	6.138137017	2.20636012	0.19385339	3.986741136	6.770155696	14.81163007	0.068667315	1.114243431	0	0	4.927765779	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9805
R5826_809_0	2010	6	14																															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	YES	247.30876	0.843596	40.9557	13.214993	1.549732	7.165756	3.502711	18.645122	53.09055	11.461607	27.32535	9.659671	0.848666	17.477482	31.267098	68.405474	0.316968	5.044322			22.758271	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.076409473	0.076409473	0.166576573	0	0.23299997	0.233000026	0.233000026	0.23299999	0.233000007	0.233000011	0.233000011	0.233000011	0.233000011	0.233000011	0.232999998	0.232999998	0.232999998	0.232999998			0.232999991	0.233																			NO	0.06257806	0.06257806	0.064585859	0	0.191482314	0.19148236	0.19148236	0.19148233	0.191482344	0.191482348	0.191482348	0.191482348	0.191482348	0.191482348	0.191482337	0.191482337	0.191482337	0.191482337			0.191482332	0.191482339																				15.4761	0.052790601	2.645159062	0	0.296746269	1.372115872	0.670707369	3.570211412	10.16590298	2.194695417	5.232322171	1.849656482	0.162504558	3.346629286	5.987096998	13.09844003	0.060693773	0.965898565	0	0	4.357806792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5055	0	23.25445331	15.4761	0.052790601	2.645159062	0	0.296746269	1.372115872	0.670707369	3.570211412	10.16590298	2.194695417	5.232322171	1.849656482	0.162504558	3.346629286	5.987096998	13.09844003	0.060693773	0.965898565	0	0	4.357806792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5055	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.3309	0.008	0.1785	0	0.997	0.7599	0.3715	0.7906	2.0576	0.486	1.0537	0.4097	0.036	0.7358	0.9475	2.073	0.0096	0.1752			0.6896	0																			14.11	0	3.452294198	17.807	0.060750742	2.823689954	0	1.293713172	2.132036933	1.042183933	4.360836232	12.22346685	2.680705506	6.286051027	2.25931087	0.198460417	4.082411392	6.934574219	15.17145676	0.070288735	1.141132867	0	0	5.047432022	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6155
R5826_810_0	2010	6	15																															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	YES	217.184708	0.622554	32.47351	11.455199	1.219024	6.143909	3.221728	16.310379	51.848478	9.054603	26.158242	7.216122	0.626294	15.012769	30.986917	62.279981	0.233915	4.627305			18.715244	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.084195864	0.084195864	0.176613042	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.07035319	0.07035319	0.07077753	0	0.194580979	0.194580979	0.194580979	0.194580979	0.194580979	0.194580979	0.194580979	0.194580979	0.194580979	0.194580979	0.194580979	0.194580979	0.194580979	0.194580979			0.194580979	0.194580979																				15.2796	0.04379866	2.29839482	0	0.237198883	1.195487826	0.626886987	3.173689508	10.08872759	1.761853513	5.089896329	1.404120081	0.121864899	2.921199285	6.029464636	12.11849965	0.04551541	0.900385535	0	0	3.641630494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9783	0	20.37384552	15.2796	0.04379866	2.29839482	0	0.237198883	1.195487826	0.626886987	3.173689508	10.08872759	1.761853513	5.089896329	1.404120081	0.121864899	2.921199285	6.029464636	12.11849965	0.04551541	0.900385535	0	0	3.641630494	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.9783	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.4368	0.007	0.1925	0	0.8215	0.6824	0.3578	0.7244	2.1035	0.4022	1.0406	0.3205	0.0278	0.6627	0.9836	1.9769	0.0075	0.1705			0.5941	0																			13.5124	0	3.175757518	17.7164	0.050793616	2.490929077	0	1.058667643	1.877915203	0.984714076	3.898136009	12.19223969	2.164051161	6.130457503	1.724630916	0.149673176	3.583895053	7.013080185	14.0954432	0.05297866	1.070915702	0	0	4.235725697	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.4907
R5826_811_0	2010	6	16																															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	YES	312.373187	1.503243	44.225242	14.44544	2.016478	8.399368	3.671521	22.033214	67.812532	12.890811	32.831929	14.25087	0.82452	19.552662	36.302075	82.167554	0.375575	6.548567			25.192573	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.0789741	0.0789741	0.206296	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.058439382	0.058439382	0.059339825	0	0.180898611	0.180898611	0.180898611	0.180898611	0.180898611	0.180898611	0.180898611	0.180898611	0.180898611	0.180898611	0.180898611	0.180898611	0.180898611	0.180898611			0.180898611	0.180898611																				18.2549	0.087848591	2.624318143	0	0.364778069	1.519434004	0.664173049	3.985777808	12.26719285	2.331929804	5.939250352	2.577962588	0.149154523	3.537049397	6.566994943	14.86399639	0.067940996	1.184626674	0	0	4.557301463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.5446	0	37.74574622	18.2549	0.087848591	2.624318143	0	0.364778069	1.519434004	0.664173049	3.985777808	12.26719285	2.331929804	5.939250352	2.577962588	0.149154523	3.537049397	6.566994943	14.86399639	0.067940996	1.184626674	0	0	4.557301463	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	81.5446	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.4713	0.0119	0.1381	0	1.1649	0.7999	0.3496	0.839	2.3598	0.4909	1.1195	0.5427	0.0314	0.7395	0.9879	2.236	0.0102	0.2018			0.6855	0																			15.1799	0	4.610395834	20.7262	0.099725822	2.762454017	0	1.529698466	2.319290639	1.013784377	4.824748417	14.62697273	2.822834329	7.058779223	3.120632768	0.18054228	4.27654496	7.554888389	17.09996364	0.078178234	1.386474098	0	0	5.242810083	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	96.7245
R5826_812_0	2010	6	17																															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	YES	308.501046	0.622313	36.555278	18.636312	1.573143	7.054267	6.059724	19.86848	63.428333	10.059441	30.652169	8.467076	1.172487	14.407775	35.195351	77.747398	0.367705	6.432917			24.246795	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.075190208	0.075190208	0.188260379	0	0.23300002	0.233000018	0.233000018	0.233	0.233000011	0.233000007	0.233000007	0.233000007	0.233000007	0.233000007	0.233000007	0.233000007	0.233000007	0.233000007			0.232999997	0.233																			NO	0.058568364	0.058568364	0.068396234	0	0.186011636	0.186011634	0.186011634	0.18601162	0.186011629	0.186011625	0.186011625	0.186011625	0.186011625	0.186011625	0.186011626	0.186011626	0.186011626	0.186011626			0.186011618	0.18601162																				18.0684	0.036447855	2.500243361	0	0.292622903	1.312175734	1.127179165	3.695768155	11.79840753	1.871172972	5.70165978	1.57497457	0.218096213	2.680013647	6.54674446	14.4619199	0.068397405	1.19659735	0	0	4.51018557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.661	0	29.01177755	18.0684	0.036447855	2.500243361	0	0.292622903	1.312175734	1.127179165	3.695768155	11.79840753	1.871172972	5.70165978	1.57497457	0.218096213	2.680013647	6.54674446	14.4619199	0.068397405	1.19659735	0	0	4.51018557	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.661	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.4826	0.005	0.1591	0	0.9434	0.6973	0.599	0.7854	2.2969	0.3976	1.0848	0.3347	0.0464	0.5657	0.9942	2.1963	0.0104	0.2165			0.6849	0																			14.5002	0	3.979195958	20.551	0.041457806	2.659371746	0	1.235992386	2.009517613	1.726228669	4.481118238	14.09532425	2.268792309	6.786435738	1.909702611	0.264473599	3.245738648	7.540941132	16.65817096	0.078780402	1.413058113	0	0	5.195067792	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	92.1612
R5826_813_0	2010	5	18																															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	YES	242.986365	0.828853	40.239887	12.984025	1.522647	7.040514	3.441491	18.319247	52.162646	11.261284	26.847766	9.490842	0.833832	17.172016	30.720619	67.209903	0.311428	4.95616			22.360507	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.084577076	0.084577076	0.165030349	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.067656423	0.067656423	0.055037006	0	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608			0.189626608	0.189626608																				16.4396	0.056077229	2.214682919	0	0.288734386	1.335068788	0.652598265	3.473816669	9.891425623	2.135439086	5.091050798	1.799716175	0.158116734	3.256271146	5.825446775	12.74478593	0.059055035	0.939819809	0	0	4.240147094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6018	0	26.71384461	16.4396	0.056077229	2.214682919	0	0.288734386	1.335068788	0.652598265	3.473816669	9.891425623	2.135439086	5.091050798	1.799716175	0.158116734	3.256271146	5.825446775	12.74478593	0.059055035	0.939819809	0	0	4.240147094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6018	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	3.3725	0.0315	0.614	0	1.0695	0.8151	0.3984	0.8481	2.2071	0.5214	1.1302	0.4394	0.0386	0.7893	1.0164	2.2237	0.0103	0.188			0.7399	0																			16.4535	0	3.70167983	19.8121	0.087609229	2.828639919	0	1.358214579	2.150211594	1.050996679	4.321942131	12.09855685	2.656845768	6.22128324	2.239117346	0.19671346	4.045549132	6.841894064	14.96845861	0.069380913	1.127790878	0	0	4.980001221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0553
R5826_814_0	2010	10	21																															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	YES	229.381409	0.782445	37.98683	12.257042	1.437393	6.646312	3.2488	17.293541	49.242027	10.630758	25.344541	8.959444	0.787146	16.210541	29.000553	63.44678	0.293991	4.678661			21.108528	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.07632798	0.07632798	0.137673871	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.063431727	0.063431727	0.054199104	0	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039			0.193693039	0.193693039																				14.5501	0.049631837	2.058852136	0	0.278413019	1.287344373	0.629269947	3.34963852	9.53783788	2.059103829	4.909061181	1.73538194	0.152464701	3.139868958	5.617205257	12.28919966	0.05694401	0.90622407	0	0	4.088574947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6951	0	21.26851957	14.5501	0.049631837	2.058852136	0	0.278413019	1.287344373	0.629269947	3.34963852	9.53783788	2.059103829	4.909061181	1.73538194	0.152464701	3.139868958	5.617205257	12.28919966	0.05694401	0.90622407	0	0	4.088574947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6951	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.2706	0.0077	0.1528	0	0.9534	0.7268	0.3553	0.7561	1.9677	0.4648	1.0076	0.3918	0.0344	0.7037	0.9062	1.9825	0.0092	0.1676			0.6596	0																			13.5178	0	3.255305718	16.8207	0.057360844	2.211622042	0	1.231859484	2.014095135	0.984545414	4.105732366	11.50555658	2.523906434	5.916710843	2.127132492	0.186902071	3.84359355	6.523376753	14.27169179	0.066113724	1.073826061	0	0	4.748183028	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2129
R5826_815_0	2010	5	10																															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	YES	247.162336	0.843097	40.931451	13.207169	1.548815	7.161513	3.500637	18.634083	53.059115	11.45482	27.309172	9.653952	0.848163	17.467132	31.248585	68.364974	0.31678	5.041336			22.744796	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.085669713	0.085669713	0.190191682	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068877712	0.068877712	0.06742069	0	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335			0.189911335	0.189911335																				17.024	0.058070592	2.759626687	0	0.294137524	1.360052491	0.664810645	3.538823571	10.07652734	2.175400153	5.1863213	1.833394908	0.161075767	3.317206349	5.934460481	12.98328345	0.060160113	0.957406848	0	0	4.319494563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7042	0	25.64603291	17.024	0.058070592	2.759626687	0	0.294137524	1.360052491	0.664810645	3.538823571	10.07652734	2.175400153	5.1863213	1.833394908	0.161075767	3.317206349	5.934460481	12.98328345	0.060160113	0.957406848	0	0	4.319494563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7042	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.5782	0.0088	0.1837	0	0.9905	0.755	0.369	0.7855	2.0442	0.4829	1.0468	0.407	0.0357	0.731	0.9414	2.0596	0.0095	0.1741			0.6852	0																			14.2883	0	3.642274917	19.6022	0.06687782	2.943363389	0	1.284661287	2.115067108	1.033835207	4.324355997	12.12071862	2.658264175	6.233162468	2.240365957	0.196813728	4.048228346	6.875894742	15.04283403	0.069696928	1.131478826	0	0	5.004739846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9925
R5826_816_0	2010	5	6																															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	YES	243.45576	0.830454	40.317621	13.009108	1.525587	7.054116	3.448138	18.354636	52.263414	11.283038	26.899627	9.509176	0.835443	17.205188	30.779965	67.339738	0.312029	4.965734			22.403704	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.083075046	0.083075046	0.180198847	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.066396318	0.066396318	0.057104301	0	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756			0.189537756	0.189537756																				16.1646	0.055139088	2.302309571	0	0.289156336	1.337021316	0.653552339	3.478896518	9.905890205	2.138561702	5.098494936	1.802347879	0.158347991	3.261032723	5.833965493	12.76342282	0.059141276	0.941194079	0	0	4.24634778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4894	0	27.55476579	16.1646	0.055139088	2.302309571	0	0.289156336	1.337021316	0.653552339	3.478896518	9.905890205	2.138561702	5.098494936	1.802347879	0.158347991	3.261032723	5.833965493	12.76342282	0.059141276	0.941194079	0	0	4.24634778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4894	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.467	0.0084	0.1528	0	0.9779	0.7453	0.3643	0.7755	2.018	0.4767	1.0335	0.4018	0.0353	0.7217	0.9293	2.0331	0.0094	0.1719			0.6764	0																			13.9982	0	3.736429379	18.6316	0.063552249	2.455083489	0	1.267060656	2.08234407	1.017849994	4.254368733	11.92390089	2.615243732	6.131990456	2.204106993	0.193605834	3.982716695	6.763290113	14.79655832	0.068556723	1.113076063	0	0	4.922757476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4876
R5826_817_0	2010	5	7																															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	YES	216.587149	0.738802	35.868031	11.573378	1.357218	6.2756	3.067591	16.328956	46.495443	10.037803	23.930891	8.459711	0.743241	15.306363	27.382983	59.907894	0.277593	4.417698			19.931153	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.081880707	0.081880707	0.179724898	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068525984	0.068525984	0.066269657	0	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975			0.19513975	0.19513975																				14.8418	0.050627134	2.376962118	0	0.264847181	1.224619013	0.59860894	3.186428386	9.073109108	1.958774365	4.669868079	1.650825887	0.145035863	2.986879844	5.343508448	11.69041144	0.054169429	0.862068482	0	0	3.889360207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.868	0	20.96357768	14.8418	0.050627134	2.376962118	0	0.264847181	1.224619013	0.59860894	3.186428386	9.073109108	1.958774365	4.669868079	1.650825887	0.145035863	2.986879844	5.343508448	11.69041144	0.054169429	0.862068482	0	0	3.889360207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.868	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.366	0.0081	0.1868	0	0.9186	0.7001	0.3422	0.7285	1.8958	0.4478	0.9708	0.3774	0.0332	0.678	0.8731	1.91	0.0088	0.1615			0.6354	0																			13.2421	0	3.190583929	17.2079	0.058679904	2.563777326	0	1.183456915	1.924731445	0.940836096	3.91488918	10.96886743	2.406617078	5.640671548	2.028258229	0.178194235	3.664886695	6.21657659	13.60039511	0.062970725	1.023562038	0	0	4.524793344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.11
R5826_818_0	2010	5	8																															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	YES	237.237044	0.809241	39.287767	12.67681	1.486619	6.873928	3.360062	17.885794	50.928422	10.994831	26.212517	9.266278	0.814103	16.765706	29.993737	65.619643	0.304059	4.838891			21.831434	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.081721733	0.081721733	0.187759289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.067112717	0.067112717	0.07025725	0	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943			0.192289943	0.192289943																				15.9216	0.054310362	2.760250467	0	0.285861883	1.321787225	0.646106131	3.439258313	9.793023377	2.114195429	5.040403407	1.781812071	0.15654382	3.223876656	5.767493986	12.61799743	0.058467488	0.930470076	0	0	4.197965205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1114	0	22.97524944	15.9216	0.054310362	2.760250467	0	0.285861883	1.321787225	0.646106131	3.439258313	9.793023377	2.114195429	5.040403407	1.781812071	0.15654382	3.223876656	5.767493986	12.61799743	0.058467488	0.930470076	0	0	4.197965205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1114	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.4506	0.0083	0.195	0	0.9713	0.7403	0.3618	0.7703	2.0046	0.4735	1.0266	0.399	0.0351	0.7169	0.9231	2.0196	0.0093	0.1707			0.6719	0																			13.948	0	3.401175492	18.3723	0.062658815	2.955281614	0	1.257188567	2.062086907	1.007947106	4.209550975	11.79758793	2.587699455	6.06695365	2.180840287	0.19160318	3.940769654	6.690588717	14.63755847	0.06778963	1.101207136	0	0	4.869868735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0594
R5826_819_0	2010	5	9																															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	YES	201.022226	0.71508	22.242069	11.339514	1.110976	7.523929	3.175167	16.492493	62.54987	6.429441	34.132627	11.948622	2.012056	14.317427	40.589382	97.30866	0.421633	7.040667			25.510787	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.084777368	0.084777368	0.161140858	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068781084	0.068781084	0.079429442	0	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973			0.188248973	0.188248973																				13.8265	0.049183977	1.766675136	0	0.209140091	1.41637191	0.597721928	3.104694875	11.77494881	1.210335667	6.42543199	2.249315824	0.378767476	2.695240934	7.64090949	18.31825534	0.079371979	1.325398334	0	0	4.802379462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8707	0	24.23646897	13.8265	0.049183977	1.766675136	0	0.209140091	1.41637191	0.597721928	3.104694875	11.77494881	1.210335667	6.42543199	2.249315824	0.378767476	2.695240934	7.64090949	18.31825534	0.079371979	1.325398334	0	0	4.802379462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8707	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.204	0.0079	0.176	0	0.7149	0.7981	0.3368	0.6996	2.4117	0.2727	1.3356	0.5068	0.0853	0.5958	1.2304	2.9497	0.0128	0.2326			0.7733	0																			15.3438	0	3.594408665	16.0305	0.057037385	1.942631569	0	0.924085595	2.214425089	0.934542472	3.804275935	14.18666771	1.483004669	7.761041181	2.756142947	0.464070073	3.29106211	8.87126226	21.26792933	0.092142427	1.55796015	0	0	5.5756899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2145
R5826_820_0	2010	5	11																															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	YES	270.198099	0.921675	44.7463	14.43809	1.693165	7.828973	3.826899	20.370797	58.004275	12.522421	29.854412	10.55371	0.927213	19.095087	34.160983	74.736656	0.346305	5.511193			24.864631	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.07394846	0.07394846	0.167455481	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.058121333	0.058121333	0.052880944	0	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446			0.186739446	0.186739446																				15.7043	0.053568979	2.366226579	0	0.316180695	1.461978084	0.714633	3.804031353	10.8316862	2.338429965	5.574996368	1.970793962	0.173147242	3.565805974	6.379203052	13.95628176	0.064668804	1.02915713	0	0	4.643207427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9483	0	30.2152718	15.7043	0.053568979	2.366226579	0	0.316180695	1.461978084	0.714633	3.804031353	10.8316862	2.338429965	5.574996368	1.970793962	0.173147242	3.565805974	6.379203052	13.95628176	0.064668804	1.02915713	0	0	4.643207427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9483	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.2648	0.0077	0.1374	0	1.0393	0.7921	0.3872	0.8242	2.1448	0.5067	1.0984	0.427	0.0375	0.767	0.9877	2.1609	0.01	0.1827			0.7189	0																			14.4943	0	3.988573938	17.9691	0.061308218	2.503620143	0	1.355467154	2.254112325	1.101841441	4.628235005	12.97647651	2.845106858	6.673373686	2.397792228	0.210660534	4.332799381	7.366921107	16.11720576	0.07466575	1.211873587	0	0	5.362096717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4426
R5826_821_0	2010	5	12																															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	YES	294.014037	1.117293	66.152058	14.432614	2.14101	7.775862	3.691923	23.224734	51.934449	17.813839	26.043875	10.463104	0.213958	23.841839	28.381968	58.676879	0.295921	3.666577			24.421964	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.080380375	0.080380375	0.16921328	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.062518207	0.062518207	0.046943266	0	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547			0.186882547	0.186882547																				18.3812	0.069851155	3.105393673	0	0.400117401	1.453172894	0.689955973	4.340297438	9.705642095	3.3290956	4.867145688	1.955371523	0.039985016	4.455623592	5.304094462	10.96568458	0.05530247	0.685219248	0	0	4.56403883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3672	0	32.20052188	18.3812	0.069851155	3.105393673	0	0.400117401	1.453172894	0.689955973	4.340297438	9.705642095	3.3290956	4.867145688	1.955371523	0.039985016	4.455623592	5.304094462	10.96568458	0.05530247	0.685219248	0	0	4.56403883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3672	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.5688	0.0098	0.1281	0	1.3032	0.7802	0.3704	0.9318	1.9136	0.7148	0.9492	0.4198	0.0086	0.9536	0.8138	1.6824	0.0085	0.1248			0.7003	0																			14.382	0	4.04505465	20.9501	0.07960815	3.233534695	0	1.703329778	2.233416199	1.060363504	5.272111624	11.6191997	4.043856322	5.816395478	2.375212956	0.048603752	5.409232283	6.117921119	12.64812136	0.063822141	0.810042326	0	0	5.264335925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7492
R5826_822_0	2010	5	13																															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	YES	241.969405	0.825384	40.071473	12.929684	1.516274	7.011049	3.427089	18.242577	51.944333	11.214152	26.7354	9.45112	0.830343	17.100143	30.592046	66.928613	0.310125	4.935417			22.266922	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078762751	0.078762751	0.186654975	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.063891885	0.063891885	0.062486937	0	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261			0.190922261	0.190922261																				15.4599	0.05273534	2.503943606	0	0.289490461	1.33856533	0.654307582	3.482914056	9.917329527	2.14103126	5.10438303	1.804429204	0.158530963	3.264797973	5.840702606	12.77816215	0.059209766	0.942280975	0	0	4.251251104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0439	0	25.58306477	15.4599	0.05273534	2.503943606	0	0.289490461	1.33856533	0.654307582	3.482914056	9.917329527	2.14103126	5.10438303	1.804429204	0.158530963	3.264797973	5.840702606	12.77816215	0.059209766	0.942280975	0	0	4.251251104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0439	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.3568	0.008	0.1691	0	0.9788	0.7461	0.3646	0.7763	2.0201	0.4772	1.0345	0.4022	0.0353	0.7224	0.9302	2.0352	0.0095	0.1721			0.6771	0																			13.9154	0	3.585247638	17.8167	0.060760484	2.673077132	0	1.268261148	2.084626238	1.018929872	4.259183935	11.93740347	2.618232318	6.138838921	2.206611315	0.19387546	3.987195186	6.770937544	14.81334058	0.068675244	1.114371418	0	0	4.928334859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9593
R5826_823_0	2010	5	14																															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	YES	247.30876	0.843596	40.9557	13.214993	1.549732	7.165756	3.502711	18.645122	53.09055	11.461607	27.32535	9.659671	0.848666	17.477482	31.267098	68.405474	0.316968	5.044322			22.758271	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.07641431	0.07641431	0.166581851	0	0.23299997	0.233000026	0.233000026	0.23299999	0.233000007	0.233000011	0.233000011	0.233000011	0.233000011	0.233000011	0.232999998	0.232999998	0.232999998	0.232999998			0.232999991	0.233																			NO	0.062581511	0.062581511	0.06458616	0	0.191481593	0.191481639	0.191481639	0.191481609	0.191481623	0.191481627	0.191481627	0.191481627	0.191481627	0.191481627	0.191481616	0.191481616	0.191481616	0.191481616			0.19148161	0.191481617																				15.477	0.052793513	2.645171382	0	0.296745152	1.372110704	0.670704843	3.570197966	10.16586469	2.194687152	5.232302465	1.849649515	0.162503946	3.346616682	5.98707445	13.0983907	0.060693545	0.965894928	0	0	4.35779038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5061	0	23.25534608	15.477	0.052793513	2.645171382	0	0.296745152	1.372110704	0.670704843	3.570197966	10.16586469	2.194687152	5.232302465	1.849649515	0.162503946	3.346616682	5.98707445	13.0983907	0.060693545	0.965894928	0	0	4.35779038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5061	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.331	0.008	0.1785	0	0.997	0.7599	0.3715	0.7906	2.0576	0.486	1.0537	0.4097	0.036	0.7358	0.9475	2.073	0.0096	0.1752			0.6896	0																			14.1101	0	3.452374917	17.8079	0.060754112	2.823702517	0	1.293709349	2.132029703	1.042180399	4.36082064	12.22342298	2.680695921	6.286028461	2.259302793	0.198459707	4.082396792	6.934549099	15.1714018	0.070288481	1.141128753	0	0	5.047413738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6162
R5826_824_0	2010	5	15																															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	YES	234.59094	0.800215	38.849557	12.535415	1.470038	6.797258	3.322585	17.686299	50.360375	10.872195	25.920147	9.162924	0.805023	16.578705	29.659192	64.887732	0.300668	4.784919			21.58793	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.084360777	0.084360777	0.175733309	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068687519	0.068687519	0.061940844	0	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977			0.191632977	0.191632977																				16.1135	0.054964783	2.406374366	0	0.281707759	1.302578789	0.636716856	3.389278136	9.650708604	2.083471099	4.967154944	1.755918408	0.154268954	3.1770266	5.68367927	12.43462928	0.057617904	0.916948275	0	0	4.136959302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2035	0	24.25469517	16.1135	0.054964783	2.406374366	0	0.281707759	1.302578789	0.636716856	3.389278136	9.650708604	2.083471099	4.967154944	1.755918408	0.154268954	3.1770266	5.68367927	12.43462928	0.057617904	0.916948275	0	0	4.136959302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2035	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.4999	0.0085	0.1706	0	0.9611	0.7325	0.358	0.7622	1.9834	0.4685	1.0157	0.3948	0.0347	0.7093	0.9134	1.9982	0.0093	0.169			0.6649	0																			13.8539	0	3.493997239	18.6134	0.063489087	2.576996297	0	1.242767709	2.035045931	0.994764743	4.15145628	11.63406955	2.551975192	5.98288718	2.150751344	0.18893179	3.8863515	6.597039926	14.43284573	0.066915224	1.085916964	0	0	4.801818756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.0574
R5826_825_0	2010	5	16																															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	YES	309.175374	1.054631	51.201153	16.520848	1.937412	8.958337	4.378947	23.309374	66.371649	14.328836	34.16104	12.076129	1.060967	21.849637	39.088856	85.517749	0.39626	6.306208			28.451465	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078990386	0.078990386	0.206260902	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.057998656	0.057998656	0.054522708	0	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682			0.179750682	0.179750682																				17.9318	0.061167181	2.791625519	0	0.348251128	1.610267182	0.787118708	4.189875864	11.93034915	2.575618038	6.140470224	2.170692419	0.190709541	3.927487143	7.026248509	15.37187367	0.071228005	1.133545186	0	0	5.114170226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3725	0	40.56542405	17.9318	0.061167181	2.791625519	0	0.348251128	1.610267182	0.787118708	4.189875864	11.93034915	2.575618038	6.140470224	2.170692419	0.190709541	3.927487143	7.026248509	15.37187367	0.071228005	1.133545186	0	0	5.114170226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3725	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.4081	0.0082	0.1291	0	1.1055	0.8426	0.4118	0.8766	2.2814	0.5389	1.1683	0.4542	0.0399	0.8159	1.0506	2.2985	0.0107	0.1943			0.7647	0																			15.3992	0	4.760306987	20.3399	0.069366081	2.920697211	0	1.45375119	2.452831792	1.19894532	5.066519366	14.21171498	3.114544518	7.308752246	2.624853655	0.230644243	4.743364621	8.076838357	17.67032695	0.081883659	1.32784287	0	0	5.878881367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7716
R5826_826_0	2010	5	17																															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	YES	308.501046	0.622313	36.555278	18.636312	1.573143	7.054267	6.059724	19.86848	63.428333	10.059441	30.652169	8.467076	1.172487	14.407775	35.195351	77.747398	0.367705	6.432917			24.246795	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.0838192	0.0838192	0.150310166	0	0.211932949	0.256637307	0.256637307	0.222477614	0.249549075	0.201969552	0.201969552	0.201969552	0.201969552	0.201969552	0.238139687	0.238139687	0.238139687	0.238139687			0.22243442	0.233																			NO	0.065862945	0.065862945	0.04929819	0	0.169626041	0.205406335	0.205406335	0.178065737	0.199733084	0.161651577	0.161651577	0.161651577	0.161651577	0.161651577	0.190601284	0.190601284	0.190601284	0.190601284			0.178031166	0.186487602																				20.3188	0.040987367	1.802109035	0	0.266846019	1.448991128	1.244705695	3.537895534	12.66873655	1.626124497	4.954971444	1.368716184	0.189534372	2.329039543	6.708279085	14.81875387	0.070085045	1.226122239	0	0	4.31668518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9374	0	29.91456371	20.3188	0.040987367	1.802109035	0	0.266846019	1.448991128	1.244705695	3.537895534	12.66873655	1.626124497	4.954971444	1.368716184	0.189534372	2.329039543	6.708279085	14.81875387	0.070085045	1.226122239	0	0	4.31668518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9374	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.771	0.0056	0.1122	0	0.8582	0.7682	0.6599	0.75	2.4603	0.3447	0.9404	0.2902	0.0402	0.4904	1.0162	2.2449	0.0106	0.2213			0.6539	0																			14.6381	0	3.991062979	23.0898	0.046579216	1.914354807	0	1.125006804	2.217155042	1.904594662	4.287855377	15.12904518	1.970824893	5.895375161	1.658895454	0.229739417	2.819472512	7.724510152	17.06368047	0.08069816	1.447380425	0	0	4.970577577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5755
R5826_827_0	2010	5	18																															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	YES	242.986365	0.828853	40.239887	12.984025	1.522647	7.040514	3.441491	18.319247	52.162646	11.261284	26.847766	9.490842	0.833832	17.172016	30.720619	67.209903	0.311428	4.95616			22.360507	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.084577076	0.084577076	0.165030349	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.067656423	0.067656423	0.055037006	0	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608			0.189626608	0.189626608																				16.4396	0.056077229	2.214682919	0	0.288734386	1.335068788	0.652598265	3.473816669	9.891425623	2.135439086	5.091050798	1.799716175	0.158116734	3.256271146	5.825446775	12.74478593	0.059055035	0.939819809	0	0	4.240147094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6018	0	26.71384461	16.4396	0.056077229	2.214682919	0	0.288734386	1.335068788	0.652598265	3.473816669	9.891425623	2.135439086	5.091050798	1.799716175	0.158116734	3.256271146	5.825446775	12.74478593	0.059055035	0.939819809	0	0	4.240147094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6018	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	3.3725	0.0315	0.614	0	1.0695	0.8151	0.3984	0.8481	2.2071	0.5214	1.1302	0.4394	0.0386	0.7893	1.0164	2.2237	0.0103	0.188			0.7399	0																			16.4535	0	3.70167983	19.8121	0.087609229	2.828639919	0	1.358214579	2.150211594	1.050996679	4.321942131	12.09855685	2.656845768	6.22128324	2.239117346	0.19671346	4.045549132	6.841894064	14.96845861	0.069380913	1.127790878	0	0	4.980001221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0553
R5826_828_0	2010	6	21																															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	YES	229.381409	0.782445	37.98683	12.257042	1.437393	6.646312	3.2488	17.293541	49.242027	10.630758	25.344541	8.959444	0.787146	16.210541	29.000553	63.44678	0.293991	4.678661			21.108528	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.07632798	0.07632798	0.137673871	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.063431727	0.063431727	0.054199104	0	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039			0.193693039	0.193693039																				14.5501	0.049631837	2.058852136	0	0.278413019	1.287344373	0.629269947	3.34963852	9.53783788	2.059103829	4.909061181	1.73538194	0.152464701	3.139868958	5.617205257	12.28919966	0.05694401	0.90622407	0	0	4.088574947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6951	0	21.26851957	14.5501	0.049631837	2.058852136	0	0.278413019	1.287344373	0.629269947	3.34963852	9.53783788	2.059103829	4.909061181	1.73538194	0.152464701	3.139868958	5.617205257	12.28919966	0.05694401	0.90622407	0	0	4.088574947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6951	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.2706	0.0077	0.1528	0	0.9534	0.7268	0.3553	0.7561	1.9677	0.4648	1.0076	0.3918	0.0344	0.7037	0.9062	1.9825	0.0092	0.1676			0.6596	0																			13.5178	0	3.255305718	16.8207	0.057360844	2.211622042	0	1.231859484	2.014095135	0.984545414	4.105732366	11.50555658	2.523906434	5.916710843	2.127132492	0.186902071	3.84359355	6.523376753	14.27169179	0.066113724	1.073826061	0	0	4.748183028	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2129
R5826_831_0	2010	5	6																															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	YES	243.45576	0.830454	40.317621	13.009108	1.525587	7.054116	3.448138	18.354636	52.263414	11.283038	26.899627	9.509176	0.835443	17.205188	30.779965	67.339738	0.312029	4.965734			22.403704	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.083075046	0.083075046	0.180198847	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.066396318	0.066396318	0.057104301	0	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756	0.189537756			0.189537756	0.189537756																				16.1646	0.055139088	2.302309571	0	0.289156336	1.337021316	0.653552339	3.478896518	9.905890205	2.138561702	5.098494936	1.802347879	0.158347991	3.261032723	5.833965493	12.76342282	0.059141276	0.941194079	0	0	4.24634778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4894	0	27.55476579	16.1646	0.055139088	2.302309571	0	0.289156336	1.337021316	0.653552339	3.478896518	9.905890205	2.138561702	5.098494936	1.802347879	0.158347991	3.261032723	5.833965493	12.76342282	0.059141276	0.941194079	0	0	4.24634778	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.4894	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.467	0.0084	0.1528	0	0.9779	0.7453	0.3643	0.7755	2.018	0.4767	1.0335	0.4018	0.0353	0.7217	0.9293	2.0331	0.0094	0.1719			0.6764	0																			13.9982	0	3.736429379	18.6316	0.063552249	2.455083489	0	1.267060656	2.08234407	1.017849994	4.254368733	11.92390089	2.615243732	6.131990456	2.204106993	0.193605834	3.982716695	6.763290113	14.79655832	0.068556723	1.113076063	0	0	4.922757476	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.4876
R5826_832_0	2010	5	7																															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	YES	216.587149	0.738802	35.868031	11.573378	1.357218	6.2756	3.067591	16.328956	46.495443	10.037803	23.930891	8.459711	0.743241	15.306363	27.382983	59.907894	0.277593	4.417698			19.931153	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.081880707	0.081880707	0.179724898	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068525984	0.068525984	0.066269657	0	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975	0.19513975			0.19513975	0.19513975																				14.8418	0.050627134	2.376962118	0	0.264847181	1.224619013	0.59860894	3.186428386	9.073109108	1.958774365	4.669868079	1.650825887	0.145035863	2.986879844	5.343508448	11.69041144	0.054169429	0.862068482	0	0	3.889360207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.868	0	20.96357768	14.8418	0.050627134	2.376962118	0	0.264847181	1.224619013	0.59860894	3.186428386	9.073109108	1.958774365	4.669868079	1.650825887	0.145035863	2.986879844	5.343508448	11.69041144	0.054169429	0.862068482	0	0	3.889360207	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	64.868	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.366	0.0081	0.1868	0	0.9186	0.7001	0.3422	0.7285	1.8958	0.4478	0.9708	0.3774	0.0332	0.678	0.8731	1.91	0.0088	0.1615			0.6354	0																			13.2421	0	3.190583929	17.2079	0.058679904	2.563777326	0	1.183456915	1.924731445	0.940836096	3.91488918	10.96886743	2.406617078	5.640671548	2.028258229	0.178194235	3.664886695	6.21657659	13.60039511	0.062970725	1.023562038	0	0	4.524793344	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.11
R5826_833_0	2010	5	8																															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	YES	237.237044	0.809241	39.287767	12.67681	1.486619	6.873928	3.360062	17.885794	50.928422	10.994831	26.212517	9.266278	0.814103	16.765706	29.993737	65.619643	0.304059	4.838891			21.831434	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.081721733	0.081721733	0.187759289	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.067112717	0.067112717	0.07025725	0	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943	0.192289943			0.192289943	0.192289943																				15.9216	0.054310362	2.760250467	0	0.285861883	1.321787225	0.646106131	3.439258313	9.793023377	2.114195429	5.040403407	1.781812071	0.15654382	3.223876656	5.767493986	12.61799743	0.058467488	0.930470076	0	0	4.197965205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1114	0	22.97524944	15.9216	0.054310362	2.760250467	0	0.285861883	1.321787225	0.646106131	3.439258313	9.793023377	2.114195429	5.040403407	1.781812071	0.15654382	3.223876656	5.767493986	12.61799743	0.058467488	0.930470076	0	0	4.197965205	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.1114	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.4506	0.0083	0.195	0	0.9713	0.7403	0.3618	0.7703	2.0046	0.4735	1.0266	0.399	0.0351	0.7169	0.9231	2.0196	0.0093	0.1707			0.6719	0																			13.948	0	3.401175492	18.3723	0.062658815	2.955281614	0	1.257188567	2.062086907	1.007947106	4.209550975	11.79758793	2.587699455	6.06695365	2.180840287	0.19160318	3.940769654	6.690588717	14.63755847	0.06778963	1.101207136	0	0	4.869868735	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	84.0594
R5826_834_0	2010	5	9																															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	YES	201.022226	0.71508	22.242069	11.339514	1.110976	7.523929	3.175167	16.492493	62.54987	6.429441	34.132627	11.948622	2.012056	14.317427	40.589382	97.30866	0.421633	7.040667			25.510787	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.084777368	0.084777368	0.161140858	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068781084	0.068781084	0.079429442	0	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973	0.188248973			0.188248973	0.188248973																				13.8265	0.049183977	1.766675136	0	0.209140091	1.41637191	0.597721928	3.104694875	11.77494881	1.210335667	6.42543199	2.249315824	0.378767476	2.695240934	7.64090949	18.31825534	0.079371979	1.325398334	0	0	4.802379462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8707	0	24.23646897	13.8265	0.049183977	1.766675136	0	0.209140091	1.41637191	0.597721928	3.104694875	11.77494881	1.210335667	6.42543199	2.249315824	0.378767476	2.695240934	7.64090949	18.31825534	0.079371979	1.325398334	0	0	4.802379462	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	77.8707	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.204	0.0079	0.176	0	0.7149	0.7981	0.3368	0.6996	2.4117	0.2727	1.3356	0.5068	0.0853	0.5958	1.2304	2.9497	0.0128	0.2326			0.7733	0																			15.3438	0	3.594408665	16.0305	0.057037385	1.942631569	0	0.924085595	2.214425089	0.934542472	3.804275935	14.18666771	1.483004669	7.761041181	2.756142947	0.464070073	3.29106211	8.87126226	21.26792933	0.092142427	1.55796015	0	0	5.5756899	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.2145
R5826_835_0	2010	5	10																															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	YES	247.162336	0.843097	40.931451	13.207169	1.548815	7.161513	3.500637	18.634083	53.059115	11.45482	27.309172	9.653952	0.848163	17.467132	31.248585	68.364974	0.31678	5.041336			22.744796	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.085669713	0.085669713	0.190191682	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068877712	0.068877712	0.06742069	0	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335	0.189911335			0.189911335	0.189911335																				17.024	0.058070592	2.759626687	0	0.294137524	1.360052491	0.664810645	3.538823571	10.07652734	2.175400153	5.1863213	1.833394908	0.161075767	3.317206349	5.934460481	12.98328345	0.060160113	0.957406848	0	0	4.319494563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7042	0	25.64603291	17.024	0.058070592	2.759626687	0	0.294137524	1.360052491	0.664810645	3.538823571	10.07652734	2.175400153	5.1863213	1.833394908	0.161075767	3.317206349	5.934460481	12.98328345	0.060160113	0.957406848	0	0	4.319494563	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.7042	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.5782	0.0088	0.1837	0	0.9905	0.755	0.369	0.7855	2.0442	0.4829	1.0468	0.407	0.0357	0.731	0.9414	2.0596	0.0095	0.1741			0.6852	0																			14.2883	0	3.642274917	19.6022	0.06687782	2.943363389	0	1.284661287	2.115067108	1.033835207	4.324355997	12.12071862	2.658264175	6.233162468	2.240365957	0.196813728	4.048228346	6.875894742	15.04283403	0.069696928	1.131478826	0	0	5.004739846	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	86.9925
R5826_836_0	2010	5	11																															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	YES	270.198099	0.921675	44.7463	14.43809	1.693165	7.828973	3.826899	20.370797	58.004275	12.522421	29.854412	10.55371	0.927213	19.095087	34.160983	74.736656	0.346305	5.511193			24.864631	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.07394846	0.07394846	0.167455481	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.058121333	0.058121333	0.052880944	0	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446	0.186739446			0.186739446	0.186739446																				15.7043	0.053568979	2.366226579	0	0.316180695	1.461978084	0.714633	3.804031353	10.8316862	2.338429965	5.574996368	1.970793962	0.173147242	3.565805974	6.379203052	13.95628176	0.064668804	1.02915713	0	0	4.643207427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9483	0	30.2152718	15.7043	0.053568979	2.366226579	0	0.316180695	1.461978084	0.714633	3.804031353	10.8316862	2.338429965	5.574996368	1.970793962	0.173147242	3.565805974	6.379203052	13.95628176	0.064668804	1.02915713	0	0	4.643207427	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.9483	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.2648	0.0077	0.1374	0	1.0393	0.7921	0.3872	0.8242	2.1448	0.5067	1.0984	0.427	0.0375	0.767	0.9877	2.1609	0.01	0.1827			0.7189	0																			14.4943	0	3.988573938	17.9691	0.061308218	2.503620143	0	1.355467154	2.254112325	1.101841441	4.628235005	12.97647651	2.845106858	6.673373686	2.397792228	0.210660534	4.332799381	7.366921107	16.11720576	0.07466575	1.211873587	0	0	5.362096717	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	89.4426
R5826_837_0	2010	5	12																															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	YES	294.014037	1.117293	66.152058	14.432614	2.14101	7.775862	3.691923	23.224734	51.934449	17.813839	26.043875	10.463104	0.213958	23.841839	28.381968	58.676879	0.295921	3.666577			24.421964	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.080380375	0.080380375	0.16921328	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.062518207	0.062518207	0.046943266	0	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547	0.186882547			0.186882547	0.186882547																				18.3812	0.069851155	3.105393673	0	0.400117401	1.453172894	0.689955973	4.340297438	9.705642095	3.3290956	4.867145688	1.955371523	0.039985016	4.455623592	5.304094462	10.96568458	0.05530247	0.685219248	0	0	4.56403883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3672	0	32.20052188	18.3812	0.069851155	3.105393673	0	0.400117401	1.453172894	0.689955973	4.340297438	9.705642095	3.3290956	4.867145688	1.955371523	0.039985016	4.455623592	5.304094462	10.96568458	0.05530247	0.685219248	0	0	4.56403883	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.3672	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.5688	0.0098	0.1281	0	1.3032	0.7802	0.3704	0.9318	1.9136	0.7148	0.9492	0.4198	0.0086	0.9536	0.8138	1.6824	0.0085	0.1248			0.7003	0																			14.382	0	4.04505465	20.9501	0.07960815	3.233534695	0	1.703329778	2.233416199	1.060363504	5.272111624	11.6191997	4.043856322	5.816395478	2.375212956	0.048603752	5.409232283	6.117921119	12.64812136	0.063822141	0.810042326	0	0	5.264335925	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	88.7492
R5826_838_0	2010	5	13																															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	YES	241.969405	0.825384	40.071473	12.929684	1.516274	7.011049	3.427089	18.242577	51.944333	11.214152	26.7354	9.45112	0.830343	17.100143	30.592046	66.928613	0.310125	4.935417			22.266922	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078762751	0.078762751	0.186654975	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.063891885	0.063891885	0.062486937	0	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261	0.190922261			0.190922261	0.190922261																				15.4599	0.05273534	2.503943606	0	0.289490461	1.33856533	0.654307582	3.482914056	9.917329527	2.14103126	5.10438303	1.804429204	0.158530963	3.264797973	5.840702606	12.77816215	0.059209766	0.942280975	0	0	4.251251104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0439	0	25.58306477	15.4599	0.05273534	2.503943606	0	0.289490461	1.33856533	0.654307582	3.482914056	9.917329527	2.14103126	5.10438303	1.804429204	0.158530963	3.264797973	5.840702606	12.77816215	0.059209766	0.942280975	0	0	4.251251104	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.0439	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.3568	0.008	0.1691	0	0.9788	0.7461	0.3646	0.7763	2.0201	0.4772	1.0345	0.4022	0.0353	0.7224	0.9302	2.0352	0.0095	0.1721			0.6771	0																			13.9154	0	3.585247638	17.8167	0.060760484	2.673077132	0	1.268261148	2.084626238	1.018929872	4.259183935	11.93740347	2.618232318	6.138838921	2.206611315	0.19387546	3.987195186	6.770937544	14.81334058	0.068675244	1.114371418	0	0	4.928334859	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.9593
R5826_839_0	2010	5	14																															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	YES	247.30876	0.843596	40.9557	13.214993	1.549732	7.165756	3.502711	18.645122	53.09055	11.461607	27.32535	9.659671	0.848666	17.477482	31.267098	68.405474	0.316968	5.044322			22.758271	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.07641431	0.07641431	0.166581851	0	0.23299997	0.233000026	0.233000026	0.23299999	0.233000007	0.233000011	0.233000011	0.233000011	0.233000011	0.233000011	0.232999998	0.232999998	0.232999998	0.232999998			0.232999991	0.233																			NO	0.062581511	0.062581511	0.06458616	0	0.191481593	0.191481639	0.191481639	0.191481609	0.191481623	0.191481627	0.191481627	0.191481627	0.191481627	0.191481627	0.191481616	0.191481616	0.191481616	0.191481616			0.19148161	0.191481617																				15.477	0.052793513	2.645171382	0	0.296745152	1.372110704	0.670704843	3.570197966	10.16586469	2.194687152	5.232302465	1.849649515	0.162503946	3.346616682	5.98707445	13.0983907	0.060693545	0.965894928	0	0	4.35779038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5061	0	23.25534608	15.477	0.052793513	2.645171382	0	0.296745152	1.372110704	0.670704843	3.570197966	10.16586469	2.194687152	5.232302465	1.849649515	0.162503946	3.346616682	5.98707445	13.0983907	0.060693545	0.965894928	0	0	4.35779038	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	71.5061	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.331	0.008	0.1785	0	0.997	0.7599	0.3715	0.7906	2.0576	0.486	1.0537	0.4097	0.036	0.7358	0.9475	2.073	0.0096	0.1752			0.6896	0																			14.1101	0	3.452374917	17.8079	0.060754112	2.823702517	0	1.293709349	2.132029703	1.042180399	4.36082064	12.22342298	2.680695921	6.286028461	2.259302793	0.198459707	4.082396792	6.934549099	15.1714018	0.070288481	1.141128753	0	0	5.047413738	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	85.6162
R5826_840_0	2010	5	15																															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	YES	234.59094	0.800215	38.849557	12.535415	1.470038	6.797258	3.322585	17.686299	50.360375	10.872195	25.920147	9.162924	0.805023	16.578705	29.659192	64.887732	0.300668	4.784919			21.58793	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.084360777	0.084360777	0.175733309	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.068687519	0.068687519	0.061940844	0	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977	0.191632977			0.191632977	0.191632977																				16.1135	0.054964783	2.406374366	0	0.281707759	1.302578789	0.636716856	3.389278136	9.650708604	2.083471099	4.967154944	1.755918408	0.154268954	3.1770266	5.68367927	12.43462928	0.057617904	0.916948275	0	0	4.136959302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2035	0	24.25469517	16.1135	0.054964783	2.406374366	0	0.281707759	1.302578789	0.636716856	3.389278136	9.650708604	2.083471099	4.967154944	1.755918408	0.154268954	3.1770266	5.68367927	12.43462928	0.057617904	0.916948275	0	0	4.136959302	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	69.2035	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.4999	0.0085	0.1706	0	0.9611	0.7325	0.358	0.7622	1.9834	0.4685	1.0157	0.3948	0.0347	0.7093	0.9134	1.9982	0.0093	0.169			0.6649	0																			13.8539	0	3.493997239	18.6134	0.063489087	2.576996297	0	1.242767709	2.035045931	0.994764743	4.15145628	11.63406955	2.551975192	5.98288718	2.150751344	0.18893179	3.8863515	6.597039926	14.43284573	0.066915224	1.085916964	0	0	4.801818756	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.0574
R5826_841_0	2010	5	16																															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	YES	309.175374	1.054631	51.201153	16.520848	1.937412	8.958337	4.378947	23.309374	66.371649	14.328836	34.16104	12.076129	1.060967	21.849637	39.088856	85.517749	0.39626	6.306208			28.451465	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.078990386	0.078990386	0.206260902	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.057998656	0.057998656	0.054522708	0	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682	0.179750682			0.179750682	0.179750682																				17.9318	0.061167181	2.791625519	0	0.348251128	1.610267182	0.787118708	4.189875864	11.93034915	2.575618038	6.140470224	2.170692419	0.190709541	3.927487143	7.026248509	15.37187367	0.071228005	1.133545186	0	0	5.114170226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3725	0	40.56542405	17.9318	0.061167181	2.791625519	0	0.348251128	1.610267182	0.787118708	4.189875864	11.93034915	2.575618038	6.140470224	2.170692419	0.190709541	3.927487143	7.026248509	15.37187367	0.071228005	1.133545186	0	0	5.114170226	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	83.3725	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.4081	0.0082	0.1291	0	1.1055	0.8426	0.4118	0.8766	2.2814	0.5389	1.1683	0.4542	0.0399	0.8159	1.0506	2.2985	0.0107	0.1943			0.7647	0																			15.3992	0	4.760306987	20.3399	0.069366081	2.920697211	0	1.45375119	2.452831792	1.19894532	5.066519366	14.21171498	3.114544518	7.308752246	2.624853655	0.230644243	4.743364621	8.076838357	17.67032695	0.081883659	1.32784287	0	0	5.878881367	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7716
R5826_842_0	2010	5	17																															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	YES	308.501046	0.622313	36.555278	18.636312	1.573143	7.054267	6.059724	19.86848	63.428333	10.059441	30.652169	8.467076	1.172487	14.407775	35.195351	77.747398	0.367705	6.432917			24.246795	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.0838192	0.0838192	0.150310166	0	0.211932949	0.256637307	0.256637307	0.222477614	0.249549075	0.201969552	0.201969552	0.201969552	0.201969552	0.201969552	0.238139687	0.238139687	0.238139687	0.238139687			0.22243442	0.233																			NO	0.065862945	0.065862945	0.04929819	0	0.169626041	0.205406335	0.205406335	0.178065737	0.199733084	0.161651577	0.161651577	0.161651577	0.161651577	0.161651577	0.190601284	0.190601284	0.190601284	0.190601284			0.178031166	0.186487602																				20.3188	0.040987367	1.802109035	0	0.266846019	1.448991128	1.244705695	3.537895534	12.66873655	1.626124497	4.954971444	1.368716184	0.189534372	2.329039543	6.708279085	14.81875387	0.070085045	1.226122239	0	0	4.31668518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9374	0	29.91456371	20.3188	0.040987367	1.802109035	0	0.266846019	1.448991128	1.244705695	3.537895534	12.66873655	1.626124497	4.954971444	1.368716184	0.189534372	2.329039543	6.708279085	14.81875387	0.070085045	1.226122239	0	0	4.31668518	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	78.9374	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.771	0.0056	0.1122	0	0.8582	0.7682	0.6599	0.75	2.4603	0.3447	0.9404	0.2902	0.0402	0.4904	1.0162	2.2449	0.0106	0.2213			0.6539	0																			14.6381	0	3.991062979	23.0898	0.046579216	1.914354807	0	1.125006804	2.217155042	1.904594662	4.287855377	15.12904518	1.970824893	5.895375161	1.658895454	0.229739417	2.819472512	7.724510152	17.06368047	0.08069816	1.447380425	0	0	4.970577577	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.5755
R5826_843_0	2010	5	18																															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	YES	242.986365	0.828853	40.239887	12.984025	1.522647	7.040514	3.441491	18.319247	52.162646	11.261284	26.847766	9.490842	0.833832	17.172016	30.720619	67.209903	0.311428	4.95616			22.360507	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.084577076	0.084577076	0.165030349	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.067656423	0.067656423	0.055037006	0	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608	0.189626608			0.189626608	0.189626608																				16.4396	0.056077229	2.214682919	0	0.288734386	1.335068788	0.652598265	3.473816669	9.891425623	2.135439086	5.091050798	1.799716175	0.158116734	3.256271146	5.825446775	12.74478593	0.059055035	0.939819809	0	0	4.240147094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6018	0	26.71384461	16.4396	0.056077229	2.214682919	0	0.288734386	1.335068788	0.652598265	3.473816669	9.891425623	2.135439086	5.091050798	1.799716175	0.158116734	3.256271146	5.825446775	12.74478593	0.059055035	0.939819809	0	0	4.240147094	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	70.6018	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	3.3725	0.0315	0.614	0	1.0695	0.8151	0.3984	0.8481	2.2071	0.5214	1.1302	0.4394	0.0386	0.7893	1.0164	2.2237	0.0103	0.188			0.7399	0																			16.4535	0	3.70167983	19.8121	0.087609229	2.828639919	0	1.358214579	2.150211594	1.050996679	4.321942131	12.09855685	2.656845768	6.22128324	2.239117346	0.19671346	4.045549132	6.841894064	14.96845861	0.069380913	1.127790878	0	0	4.980001221	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	87.0553
R5826_844_0	2010	6	21																															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	YES	229.381409	0.782445	37.98683	12.257042	1.437393	6.646312	3.2488	17.293541	49.242027	10.630758	25.344541	8.959444	0.787146	16.210541	29.000553	63.44678	0.293991	4.678661			21.108528	0																			5000	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			0.07632798	0.07632798	0.137673871	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233			0.233	0.233																			NO	0.063431727	0.063431727	0.054199104	0	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039	0.193693039			0.193693039	0.193693039																				14.5501	0.049631837	2.058852136	0	0.278413019	1.287344373	0.629269947	3.34963852	9.53783788	2.059103829	4.909061181	1.73538194	0.152464701	3.139868958	5.617205257	12.28919966	0.05694401	0.90622407	0	0	4.088574947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6951	0	21.26851957	14.5501	0.049631837	2.058852136	0	0.278413019	1.287344373	0.629269947	3.34963852	9.53783788	2.059103829	4.909061181	1.73538194	0.152464701	3.139868958	5.617205257	12.28919966	0.05694401	0.90622407	0	0	4.088574947	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	66.6951	YES	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing	Medicare FFS Cost Sharing			Medicare FFS Cost Sharing	Medicare FFS Cost Sharing																			7000	2.2706	0.0077	0.1528	0	0.9534	0.7268	0.3553	0.7561	1.9677	0.4648	1.0076	0.3918	0.0344	0.7037	0.9062	1.9825	0.0092	0.1676			0.6596	0																			13.5178	0	3.255305718	16.8207	0.057360844	2.211622042	0	1.231859484	2.014095135	0.984545414	4.105732366	11.50555658	2.523906434	5.916710843	2.127132492	0.186902071	3.84359355	6.523376753	14.27169179	0.066113724	1.073826061	0	0	4.748183028	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	80.2129
R5941_001_0	2010	10	12	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	YES	929.2130509	42.01121226	373.4969016	346.4493402	69.85545618	9.027015837	1.713328637	250.1348133	356.9619522	3531.800426	705.6985481	86.29555195	0.060660111	104.4708647	3020.66958	2596.570493	23.77579161	1230.310902	1894.531806	0	33.93109312	0	0	745.9758882	302.4	239.2	129.6	0	0	0	0	59.05063823	252.0936837	329.5880405	86.48629702	0.714272416	615.7433134	20.7982279	12.57027144	0	4500	$200/day (days 1-7) w/$1400 yrly max	$200/day (days 1-7) w/$1400 yrly max	$128/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$35 copay	$20 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance			Lesser Dental	$35 copay; $50 yrls max	$35 copay; $75 yrls max	$35 copay; $50 yrls max		Silver Sneakers		$35 copay	$0 copay	$35 copay	$35 copay	$0 copay	20% coinsurance	$35 copay	$35 copay	20% coinsurance		200	200	128	0	125	0.2	0.2	50	200	0	92.3087739	200	0.2	35	20	35	40	44.33667717	80.37230042	0	0.2	0	0	0	35	35	35	0	0	0	35	0	35	35	0	0.2	35	35	0.2	0	NO	109.9536661	42.89055521	114.3748139	0	111.6941542	0.178710647	0.178710647	44.67766167	178.7106467	0	82.4828034	178.7106467	0.178710647	31.27436317	17.87106467	31.27436317	35.74212934	39.61718125	71.81692892	0	0.178710647	0	0	0	35	35	35	0	0	0	0	0	31.27436317	31.27436317	0	0.178710647	31.27436317	31.27436317	0.178710647	0		8.5142	0.150157018	3.55988655	0	0.650203841	1.613223838	0.306190069	0.931286547	5.316075111	0	4.850666217	1.285161158	0.010840608	0.272271647	4.498548451	6.76717405	0.070816452	4.0617875	11.338288	0	6.063847595	0	0	0	0.882	0.697666667	0.378	0	0	0	0	0	0.657005785	0.85897134	0	0.127648085	1.604748334	0.054204278	2.246441338	0	67.7673		8.046255017	8.5142	0.150157018	3.55988655	0	0.650203841	1.613223838	0.306190069	0.931286547	5.316075111	0	4.850666217	1.285161158	0.010840608	0.272271647	4.498548451	6.76717405	0.070816452	4.0617875	11.338288	0	6.063847595	0	0	0	0.882	0.697666667	0.378	0	0	0	0	0	0.657005785	0.85897134	0	0.127648085	1.604748334	0.054204278	2.246441338	0	67.7673	YES	$300/day (days 1-7)	$300/day (days 1-7)	30% Coinsurance	$0 copay	$125 copay	30% Coinsurance	30% Coinsurance	$50 copay	$275 copay	$0 copay	30% Coinsurance	$275 copay	20% coinsurance	$45 copay	$30 copay	$45 copay	$50 copay	$90/$45 OP/PR copay	30% Coinsurance		20% Coinsurance				$45 copay; $50 yrly max	$45 copay; $75 yrly max	$45 copay; $50 yrly max		Silver Sneakers		$45 copay	$0 copay	$45 copay	$45 copay	$0 copay	30% Coinsurance	$45 copay	$45 copay	20% coinsurance		4500	8.1091	0.1547	1.7396	0	1.1534	1.0749	0.0168	0.5338	2.0061	0	2.5486	0.7831	0	0.2121	2.5122	2.0668	0.0419	2.0699	4.3426	0	1.3207	0	0	0.3221	0.2835	0.2243	0.1215	0	0	0	0	0	0.9337	0.3209	0	0.5102	0.2783	0.028	0.335	0	34.0437		3.962920062	16.6233	0.30482619	5.299482563	0	1.803629809	2.688173454	0.323016313	1.465072172	7.322155121	0	7.399229604	2.068303931	0.010840608	0.484383044	7.010749848	8.833975697	0.112712603	6.131732744	15.68091212	0	7.384534394	0	0	0.322105263	1.1655	0.921916667	0.4995	0	0	0	0	0	1.590680785	1.179838518	0	0.637838305	1.883045015	0.082161022	2.581416436	0	101.811
R5941_003_0	2010	11	13	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	YES	1074.818024	75.35077523	268.4299563	469.9494035	33.55582296	11.49940786	1.631554101	258.8206352	239.2886331	3320.323818	636.822337	67.22608064	0	61.95510171	2764.56648	2321.440964	40.2974545	931.2950271	1443.676082	0	32.48886012	0	0	745.9758882	302.4	239.2	129.6	0	0	0	1.687940852	0.003617087	277.3179916	193.7442928	70.58020821	0.804748167	449.7075638	17.98089093	7.942159331	0	3350	$225/day (days 1-10) w/$2250 yrly max	$225/day (days 1-10) w/$2250 yrly max	$128/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$200 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$200 copay	20% coinsurance	$30 copay	$15 copay	$30 copay	$40 copay	$50/$30 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance			$0 deduct 1 exam/1 cleaning	$30 copay; $75 yrly max	$30 copay; $100 yrly max	$30 copay; $75 yrly max		Silver Sneakers		$30 copay	$0 copay	$30 copay	$30 copay	$0 copay	20% coinsurance	$30 copay	$30 copay	20% coinsurance		225	225	128	0	100	0.2	0.2	50	200	0	93.6444766	200	0.2	30	15	30	40	44.84646687	80.47735952	0	0.2	0	0	0	30	30	30	0	0	0	30	0	30	30	0	0.2	30	30	0.2	0	NO	126.7465313	110.0324814	111.6581866	0	87.23295824	0.174465916	0.174465916	43.61647912	174.4659165	0	81.68884717	174.4659165	0	26.16988747	13.08494374	26.16988747	34.8931833	39.12089972	70.20278143	0	0.174465916	0	0	0	30	30	30	0	0	0	26.16988747	0	26.16988747	26.16988747	0	0.174465916	26.16988747	26.16988747	0.174465916	0		11.3525	0.690919398	2.497700179	0	0.243931142	2.006254731	0.284650582	0.940737069	3.47897589	0	4.33510688	0.977388314	0	0.13511317	3.014516404	5.062654067	0.117175539	3.036091614	8.445839701	0	5.668198757	0	0	0	0.756	0.598	0.324	0	0	0	0.003681102	0	0.604781719	0.422522195	0	0.140401127	0.980733028	0.039213158	1.385636107	0	57.5427		8.388101813	11.3525	0.690919398	2.497700179	0	0.243931142	2.006254731	0.284650582	0.940737069	3.47897589	0	4.33510688	0.977388314	0	0.13511317	3.014516404	5.062654067	0.117175539	3.036091614	8.445839701	0	5.668198757	0	0	0	0.756	0.598	0.324	0	0	0	0.003681102	0	0.604781719	0.422522195	0	0.140401127	0.980733028	0.039213158	1.385636107	0	57.5427	YES	$300/day (days 1-10)	$300/day (days 1-10)	30% Coinsurance	$0 copay	$100 copay	30% Coinsurance	30% Coinsurance	$50 copay	$275 copay	$0 copay	30% Coinsurance	$275 copay	20% Coinsurance	$40 copay	$30 copay	$40 copay	$50 copay	$80/$40 OP/PR copay	30% Coinsurance		20% Coinsurance			20% Coinsurance	$40 copay; $75 yrly max	$40 copay; $100 yrly max	$40 copay; $75 yrly max		Silver Sneakers		$40 copay	$0 copay	$40 copay	$40 copay	$0 copay	20% Coinsurance	$40 copay	$40 copay	20% coinsurance		3350	9.6908	0.3639	1.5691		1.1751	1.2797	0.037	0.4896	3.2289		3.0932	0.7052		0.142	3.0116	2.674	0.0493	1.8026	5.4111		2.2509			0.3053	0.252	0.1993	0.108	0					0.6506	0.177		0.4023	0.3536	0.0209	0.6207		40.0639		5.753905257	21.0432	1.054782065	4.066831881	0	1.419036418	3.285966706	0.321677722	1.430323615	6.707915725	0	7.428287155	1.682626076	0	0.277114462	6.026072142	7.736693813	0.166446289	4.838691153	13.85698852	0	7.919117078	0	0	0.30534413	1.008	0.797333333	0.432	0	0	0	0.003681102	0	1.255359828	0.599534217	0	0.542718567	1.334330536	0.060113372	2.006336317	0	97.6065
R5941_007_0	2010	10	12	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo-Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	V	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	YES	929.1530705	42.00850045	373.4727925	346.426977	69.85094703	9.026433145	1.713218043	250.1189395	356.9389104	3531.572449	705.6529954	86.28998159	0.060656196	104.4641211	3020.474597	2596.402885	23.77425689	1230.231486	1894.409514	0	33.92856358	0	0	1491.951776	302.4	239.2	129.6	0	0	0	0	59.04682653	252.0774111	329.5667657	86.48071436	0.71422631	615.7035673	20.79688538	12.56946003	0	5000	$240/day (days 1-7) w/$1680 yrly max	$240/day (days 1-7) w/$1680 yrly max	$128/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$225 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$25 copay	$15 copay	$25 copay	$40 copay	$50/$40 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance			Richer Dental	$25 copay; $100 yrly max	$25 copay; $155 yrly max	$25 copay; $100 yrly max		Silver Sneakers		$25 copay	$0 copay	$25 copay	$25 copay	$0 copay	20% coinsurance	$25 copay	$25 copay	20% coinsurance		240	240	128	0	125	0.2	0.2	50	225	0	92.3028154	250	0.2	25	15	25	40	40.55854845	80.36711241	0	0.2	0	0	0	25	25	25	0	0	0	25	0	25	25	0	0.2	25	25	0.2	0	NO	133.7091148	52.15704374	115.9120237	0	113.1953357	0.181112537	0.181112537	45.27813427	203.7516042	0	83.58598538	226.3906713	0.181112537	22.63906713	13.58344028	22.63906713	36.22250741	36.72830805	72.77745813	0	0.181112537	0	0	0	25	25	25	0	0	0	0	0	22.63906713	22.63906713	0	0.181112537	22.63906713	22.63906713	0.181112537	0		10.353	0.1825866	3.607498932	0	0.658900116	1.634800208	0.310285266	0.943743244	6.060572967	0	4.91522508	1.627937239	0.010985598	0.197080854	3.419036359	4.898344935	0.0717636	3.765360082	11.48919243	0	6.144888229	0	0	0	0.63	0.498333333	0.27	0	0	0	0	0	0.475566453	0.621757011	0	0.129355339	1.161579533	0.039235174	2.276486796	0	66.3935		6.908470756	10.353	0.1825866	3.607498932	0	0.658900116	1.634800208	0.310285266	0.943743244	6.060572967	0	4.91522508	1.627937239	0.010985598	0.197080854	3.419036359	4.898344935	0.0717636	3.765360082	11.48919243	0	6.144888229	0	0	0	0.63	0.498333333	0.27	0	0	0	0	0	0.475566453	0.621757011	0	0.129355339	1.161579533	0.039235174	2.276486796	0	66.3935	YES	$300/day (days 1-7)	$300/day (days 1-7)	30% Coinsurance	$0 copay	$125 copay	30% Coinsurance	30% Coinsurance	$50 copay	$300 copay	$0 copay	30% Coinsurance	$300 copay	20% Coinsurance	$45 copay	$30 copay	$45 copay	$50 copay	$90$45 copay	30% Coinsurance		20% Coinsurance				$45 copay; $100 yrly max	$45 copay; $155 yrly max	$45 copay; $100 yrly max		Silver Sneakers		$45 copay	$0 copay	$45 copay	$45 copay	$0 copay	30% Coinsurance	$45 copay	$45 copay	20% coinsurance		5000	8.217	0.1567	1.7629		1.1689	1.0893	0.0171	0.5409	2.2177		2.5826	0.8658		0.2149	2.5458	2.0944	0.0425	2.0975	4.4007		1.3384			0.5006	0.2835	0.2243	0.1215	0					0.9462	0.3252		0.517	0.282	0.0283	0.3395		34.9211		3.5423182	18.57	0.339314306	5.370361503	0	1.827752799	2.724126942	0.327336556	1.484668086	8.278293741	0	7.497874714	2.49370131	0.010985598	0.412029175	5.964837672	6.992789415	0.114220099	5.862854802	15.88989779	0	7.483238805	0	0	0.500647773	0.9135	0.722583333	0.3915	0	0	0	0	0	1.421729068	0.946915689	0	0.646369195	1.443598347	0.067565831	2.615942082	0	101.3147
R5941_008_0	2010	9	12	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemo-Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	YES	929.1530705	42.00850045	373.4727925	346.426977	69.85094703	9.026433145	1.713218043	250.1189395	356.9389104	3531.572449	705.6529954	86.28998159	0.060656196	104.4641211	3020.474597	2596.402885	23.77425689	1230.231486	1894.409514	0	39.18499943	0	0	745.9758882	302.4	239.2	129.6	0	0	0	0	59.04682653	252.0774111	329.5667657	86.48071436	0.71422631	615.7035673	20.79688538	12.56946003	0	6000	$270/day (days 1-5) w/$1350 yrly max	$270/day (days 1-5) w/$1350 yrly max	$128/day (for days 21-100)	$0 copay	$125 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$35 copay	$20 copay	$35 copay	$40 copay	$50/$35 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$35 copay; $50 yrly max	$35 copay; $75 yrly max	$35 copay; $50 yrly max		Silver Sneakers		$35 copay	$0 copay	$35 copay	$35 copay	$0 copay	20% coinsurance	$35 copay	$35 copay	20% coinsurance		270	270	128	0	125	0.2	0.2	50	250	0	92.3028154	250	0.2	35	20	35	40	44.33381525	80.36711241	0	0.2	0	0	0	35	35	35	0	0	0	35	0	35	35	0	0.2	35	35	0.2	0	NO	128.8083675	53.31669004	117.5706611	0	114.8150987	0.183704158	0.183704158	45.92603949	229.6301974	0	84.78205489	229.6301974	0.183704158	32.14822764	18.37041579	32.14822764	36.74083159	40.721531	73.81886356	0	0.183704158	0	0	0	35	35	35	0	0	0	0	0	32.14822764	32.14822764	0	0.183704158	32.14822764	32.14822764	0.183704158	0		9.9736	0.186646183	3.659120259	0	0.668328615	1.6581933	0.314725278	0.957247691	6.830329372	0	4.985559249	1.651232126	0.011142795	0.279861362	4.623947853	6.955812583	0.072790497	4.174742465	11.65359645	0	7.198447324	0	0	0	0.882	0.697666667	0.378	0	0	0	0	0	0.675320166	0.882915617	0	0.131206343	1.649481537	0.05571525	2.309062071	0	73.5166		6.505858777	9.9736	0.186646183	3.659120259	0	0.668328615	1.6581933	0.314725278	0.957247691	6.830329372	0	4.985559249	1.651232126	0.011142795	0.279861362	4.623947853	6.955812583	0.072790497	4.174742465	11.65359645	0	7.198447324	0	0	0	0.882	0.697666667	0.378	0	0	0	0	0	0.675320166	0.882915617	0	0.131206343	1.649481537	0.05571525	2.309062071	0	73.5166	YES	$380/day (days 1-5)	$380/day (days 1-5)	30% Coinsurance	$0 copay	$125 copay	30% Coinsurance	30% Coinsurance	$50 copay	$300 copay	$0 copay	30% Coinsurance	$300 copay	20% Coinsurance	$45 copay	$30 copay	$45 copay	$50 copay	$90$45 copay	30% Coinsurance		20% Coinsurance				$45 copay; $50 yrly max	$45 copay; $75 yrly max	$45 copay; $50 yrly max		Silver Sneakers		$45 copay	$0 copay	$45 copay	$45 copay	$0 copay	30% Coinsurance	$45 copay	$45 copay	20% coinsurance		6000	9.2512	0.1726	1.7881		1.1856	1.1049	0.0173	0.5487	2.2495		2.6196	0.8782		0.218	2.5822	2.1244	0.0431	2.1275	4.4637		1.3575			0.3221	0.2835	0.2243	0.1215	0					0.9597	0.3298		0.5244	0.2861	0.0287	0.3443		36.1563		3.138778784	19.2247	0.359242611	5.447208424	0	1.853906937	2.763107701	0.332020562	1.505912871	9.079784512	0	7.60516518	2.529384805	0.011142795	0.497885476	7.206178184	9.080227412	0.115854526	6.302251182	16.1172735	0	8.555948962	0	0	0.322105263	1.1655	0.921916667	0.4995	0	0	0	0	0	1.635021848	1.212727137	0	0.655618383	1.935535885	0.084451304	2.653374776	0	109.673
R5941_009_0	2010	8	13	H.6	H.7	I.7	I.8	I.9	I.10	I.11	I.12	I.13		OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Professional	0	CORF	Bone Mass Measurement	Chiropractic	Podiatric	Physical Exam	Diabetes Supplies/Education	Vision Exam Diagnostic	Hearing Exam Diagnostic	Chemotherapy/Radiation	0	D	D	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	0	Coin	0	0	0	V	V	V	0	V	0	V	V	V	V	V	Coin	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	0	0	0	0	0	0	0	0	0	0	0	YES	1074.748644	75.34591136	268.4126293	469.9190684	33.55365694	11.49866558	1.631448785	258.8042006	239.2731871	3320.109492	636.7812302	67.22174122	0	61.95110253	2764.388028	2321.291116	40.29485331	931.2349123	1443.582893	0	32.48642367	0	0	0	302.4	239.2	129.6	0	0	0	1.687831895	43.40224316	277.3000908	193.7317867	70.57565228	0.875318003	449.6785353	17.97973027	7.941646667	0	3400	$275/day (days 1-9) w/$2475 yrly max	$275/day (days 1-9) w/$2475 yrly max	$128/day (for days 21-100)	$0 copay	$100 copay	20% coinsurance	20% coinsurance	$50 copay	$250 copay	$0 copay	$75/$125 copay for Lower/Higher Tier	$250 copay	20% coinsurance	$30 copay	$15 copay	$30 copay	$40 copay	$50/$30 OP/PR copay	$75/$125 copay for Lower/Higher Tier		20% coinsurance				$30 copay; $75 yrly max	$30 copay; $100 yrly max	$30 copay; $75 yrly max		Silver Sneakers		$30 copay	$0 copay	$30 copay	$30 copay	$0 copay	20% coinsurance	$30 copay	$30 copay	20% coinsurance		275	275	128	0	100	0.2	0.2	50	250	0	93.63843188	250	0.2	30	15	30	40	44.84357204	80.47216473	0	0.2	0	0	0	30	30	30	0	0	0	30	0	30	30	0	0.2	30	30	0.2	0	NO	146.9183146	127.2769412	111.2658547	0	86.92644899	0.173852898	0.173852898	43.46322449	217.3161225	0	81.39656372	217.3161225	0	26.0779347	13.03896735	26.0779347	34.7705796	38.98092478	69.95159522	0	0.173852898	0	0	0	30	30	30	0	0	0	26.0779347	0	26.0779347	26.0779347	0	0.173852898	26.0779347	26.0779347	0.173852898	0		13.1584	0.799149761	2.488763384	0	0.243058354	1.999076333	0.283632099	0.937372089	4.333160102	0	4.319316999	1.217364012	0	0.134629734	3.003730437	5.044539844	0.116756284	3.025033172	8.415077182	0	5.6478589	0	0	0	0.756	0.598	0.324	0	0	0	0.003667931	0	0.602617805	0.421010407	0	0.152176571	0.977223956	0.039072853	1.380678288	0	60.4213		9.051945864	13.1584	0.799149761	2.488763384	0	0.243058354	1.999076333	0.283632099	0.937372089	4.333160102	0	4.319316999	1.217364012	0	0.134629734	3.003730437	5.044539844	0.116756284	3.025033172	8.415077182	0	5.6478589	0	0	0	0.756	0.598	0.324	0	0	0	0.003667931	0	0.602617805	0.421010407	0	0.152176571	0.977223956	0.039072853	1.380678288	0	60.4213	YES	$350/day (days 1-9)	$350/day (days 1-9)	35% Coinsurance	$0 copay	$100 copay	35% Coinsurance	35% Coinsurance	$50 copay	$375 copay	$0 copay	35% Coinsurance	$375 copay	20% Coinsurance	$40 copay	$25 copay	$40 copay	$50 copay	$80/$40 OP/PR copay	35% Coinsurance		20% Coinsurance				$40 copay; $75 yrly max	$40 copay; $100 yrly max	$40 copay; $75 yrly max		Silver Sneakers		$40 copay	$0 copay	$40 copay	$40 copay	$0 copay	35% Coinsurance	$40 copay	$40 copay	20% coinsurance		3400	8.6765	0.3415	1.8241		1.1709	1.4877	0.043	0.4878	4.3873		3.5958	0.9582		0.1415	2.5007	2.6645	0.0491	1.796	6.2904		2.2429			0	0.252	0.1993	0.108	0					0.6483	0.1764		0.7125	0.3523	0.0208	0.6185		41.7461		6.211678772	21.8349	1.140622259	4.312866942	0	1.413959093	3.486731679	0.326675865	1.42520689	8.720505546	0	7.915115321	2.175610941	0	0.276122944	5.504380739	7.709011851	0.165850742	4.821067052	14.70549614	0	7.890723415	0	0	0	1.008	0.797333333	0.432	0	0	0	0.003667931	0	1.250868138	0.597389078	0	0.86469755	1.329556289	0.059898286	1.999157628	0	102.1674
R5941_801_0	2010	8	12																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	330.3924399	3.955889591	38.74701092	6.314185863	10.14907678	11.97722256	2.79688202	16.71141376	48.20407281	8.252548235	25.85636018	0	0.28063491	34.66837686	39.81128451	115.0906185	1.203215283	5.73797219	30.17486589	35.83903569	42.80664322	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.079443037	0.079443037	0.168297023	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.056955238	0.056955238	0.120657486	0	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107																				18.8176	0.225308635	4.675116929	0	1.695353621	2.000736429	0.467205458	2.791559907	8.052254522	1.378547807	4.319178464	0	0.046878689	5.791182738	6.650280299	19.22532473	0.200991226	0.958500181	5.040563715	5.986735567	7.150640317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4739		37.69624572	18.8176	0.225308635	4.675116929	0	1.695353621	2.000736429	0.467205458	2.791559907	8.052254522	1.378547807	4.319178464	0	0.046878689	5.791182738	6.650280299	19.22532473	0.200991226	0.958500181	5.040563715	5.986735567	7.150640317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4739	YES																																									6000																																									0			18.8176	0.225308635	4.675116929	0	1.695353621	2.000736429	0.467205458	2.791559907	8.052254522	1.378547807	4.319178464	0	0.046878689	5.791182738	6.650280299	19.22532473	0.200991226	0.958500181	5.040563715	5.986735567	7.150640317	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.4739
R5941_802_0	2010	7	13																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	316.0253883	3.783868494	69.90592485	4.965917383	6.853292021	16.38478503	2.925451014	17.6684387	47.73992297	8.534673477	26.74029707	0	0.290228819	35.85356524	37.18719557	107.5046281	1.12390752	5.359764113	28.18594408	33.47677036	64.30969317	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.080487184	0.080487184	0.187385498	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.057036978	0.057036978	0.132790115	0	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682																				18.0251	0.215820423	9.282815796	0	1.13157913	2.705368564	0.483034913	2.917318631	7.882562183	1.409199894	4.415215639	0	0.047921039	5.91995001	6.140151958	17.75059245	0.185573632	0.884975745	4.653913184	5.52750628	10.61847452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1971		41.19507994	18.0251	0.215820423	9.282815796	0	1.13157913	2.705368564	0.483034913	2.917318631	7.882562183	1.409199894	4.415215639	0	0.047921039	5.91995001	6.140151958	17.75059245	0.185573632	0.884975745	4.653913184	5.52750628	10.61847452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1971	YES																																									6000																																									0			18.0251	0.215820423	9.282815796	0	1.13157913	2.705368564	0.483034913	2.917318631	7.882562183	1.409199894	4.415215639	0	0.047921039	5.91995001	6.140151958	17.75059245	0.185573632	0.884975745	4.653913184	5.52750628	10.61847452	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1971
R5941_805_0	2010	7	12																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	329.9966843	3.951151088	38.68947101	6.306733314	10.14361893	11.98223014	2.798051376	16.70758752	48.21672974	8.251934437	25.85443706	0	0.280614037	34.66579834	39.8187305	115.1121441	1.203440323	5.739045375	30.18050956	35.84573874	42.85439372	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.079443037	0.079443037	0.168297023	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.056955238	0.056955238	0.120657486	0	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107																				18.795	0.225038753	4.668174309	0	1.694441914	2.001572922	0.467400793	2.790920753	8.0543688	1.378445275	4.318857217	0	0.046875202	5.790752008	6.651524115	19.22892048	0.201028818	0.958679451	5.041506462	5.987855279	7.158616803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.46		37.69074956	18.795	0.225038753	4.668174309	0	1.694441914	2.001572922	0.467400793	2.790920753	8.0543688	1.378445275	4.318857217	0	0.046875202	5.790752008	6.651524115	19.22892048	0.201028818	0.958679451	5.041506462	5.987855279	7.158616803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.46	YES																																									6000																																									0			18.795	0.225038753	4.668174309	0	1.694441914	2.001572922	0.467400793	2.790920753	8.0543688	1.378445275	4.318857217	0	0.046875202	5.790752008	6.651524115	19.22892048	0.201028818	0.958679451	5.041506462	5.987855279	7.158616803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.46
R5941_806_0	2010	7	13																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	316.0057776	3.783633689	69.79254326	4.973188874	6.862140648	16.38728857	2.925898012	17.6649145	47.73462141	8.536156468	26.74494349	0	0.290279249	35.85979517	37.1912586	107.516374	1.124030317	5.360349715	28.18902365	33.48042799	64.2886236	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.080487184	0.080487184	0.187385498	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.057036978	0.057036978	0.132790115	0	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682																				18.024	0.215807031	9.267759842	0	1.133040168	2.705781935	0.483108719	2.916736733	7.881686817	1.409444758	4.415982829	0	0.047929366	5.920978664	6.140822825	17.75253186	0.185593908	0.885072437	4.654421666	5.528110209	10.61499562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1838		41.18961706	18.024	0.215807031	9.267759842	0	1.133040168	2.705781935	0.483108719	2.916736733	7.881686817	1.409444758	4.415982829	0	0.047929366	5.920978664	6.140822825	17.75253186	0.185593908	0.885072437	4.654421666	5.528110209	10.61499562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1838	YES																																									6000																																									0			18.024	0.215807031	9.267759842	0	1.133040168	2.705781935	0.483108719	2.916736733	7.881686817	1.409444758	4.415982829	0	0.047929366	5.920978664	6.140822825	17.75253186	0.185593908	0.885072437	4.654421666	5.528110209	10.61499562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1838
R5941_807_0	2010	7	12																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	329.9966843	3.951151088	38.68947101	6.306733314	10.14361893	11.98223014	2.798051376	16.70758752	48.21672974	8.251934437	25.85443706	0	0.280614037	34.66579834	39.8187305	115.1121441	1.203440323	5.739045375	30.18050956	35.84573874	42.85439372	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.079443037	0.079443037	0.168297023	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.056955238	0.056955238	0.120657486	0	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107	0.167045107																				18.795	0.225038753	4.668174309	0	1.694441914	2.001572922	0.467400793	2.790920753	8.0543688	1.378445275	4.318857217	0	0.046875202	5.790752008	6.651524115	19.22892048	0.201028818	0.958679451	5.041506462	5.987855279	7.158616803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.46		37.69074956	18.795	0.225038753	4.668174309	0	1.694441914	2.001572922	0.467400793	2.790920753	8.0543688	1.378445275	4.318857217	0	0.046875202	5.790752008	6.651524115	19.22892048	0.201028818	0.958679451	5.041506462	5.987855279	7.158616803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.46	YES																																									6000																																									0			18.795	0.225038753	4.668174309	0	1.694441914	2.001572922	0.467400793	2.790920753	8.0543688	1.378445275	4.318857217	0	0.046875202	5.790752008	6.651524115	19.22892048	0.201028818	0.958679451	5.041506462	5.987855279	7.158616803	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	95.46
R5941_808_0	2010	7	13																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	O	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	Coin	T	P	V	P	V	P	O	V																																																			0	NO	316.0057776	3.783633689	69.79254326	4.973188874	6.862140648	16.38728857	2.925898012	17.6649145	47.73462141	8.536156468	26.74494349	0	0.290279249	35.85979517	37.1912586	107.516374	1.124030317	5.360349715	28.18902365	33.48042799	64.2886236	0																				Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare	Similar to 2010 FFS Medicare																			0.080487184	0.080487184	0.187385498	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233																			NO	0.057036978	0.057036978	0.132790115	0	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682	0.165114682																				18.024	0.215807031	9.267759842	0	1.133040168	2.705781935	0.483108719	2.916736733	7.881686817	1.409444758	4.415982829	0	0.047929366	5.920978664	6.140822825	17.75253186	0.185593908	0.885072437	4.654421666	5.528110209	10.61499562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1838		41.18961706	18.024	0.215807031	9.267759842	0	1.133040168	2.705781935	0.483108719	2.916736733	7.881686817	1.409444758	4.415982829	0	0.047929366	5.920978664	6.140822825	17.75253186	0.185593908	0.885072437	4.654421666	5.528110209	10.61499562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1838	YES																																									6000																																									0			18.024	0.215807031	9.267759842	0	1.133040168	2.705781935	0.483108719	2.916736733	7.881686817	1.409444758	4.415982829	0	0.047929366	5.920978664	6.140822825	17.75253186	0.185593908	0.885072437	4.654421666	5.528110209	10.61499562	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	100.1838
R6801_008_0	2010	7	17																															A	A	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	S	Coin	T	V	V	V	V	V	O	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	YES	455.2489098	11.68519025	309.5685123	1654.029461	1126.782589	50.38254947	35.34587407	29.14678965	37.52262587	10.02376844	16.7354858	0	0	32.5314976	74.42130221	139.4546559	1.860107741	2.141498762	42.65778005	51.48808231	482.6303898	12.28002876	400	461.829653	2188.012618	0	0	0	0	12000											90000	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45%, OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45%, MH (Group): 45%, 7H Psychiatric: 45%, Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: $19, 13D Meal Benefit: not covered"											1039.538983	763.3231035	330.9061915	0	55.36243703	0.233	0.233	0.234029273	0.233	0.233	0.233	0	0	0.233	0.231911119	0.233	0.233	0.233	0.233	0.233	18.01035231	0.233	0	15	3.175484429	0	0	0	0	0											YES	1039.538983	763.3231035	330.9061915	0	55.36243703	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.231911119	0.233	0.233	0.233	0.233	0.233	18.01035231	0.233	0	15	3.175484429	0	0	0	0	0											90000	39.4374	0.743297974	8.536511453	0	5.198452511	11.73913403	8.235588657	6.791201987	8.742771827	2.335538046	3.899368192	0	0	7.579838942	17.2591275	32.49293483	0.433405104	0.498969212	9.939262752	11.99672318	0.724361946	2.861246702	0	0.577287066	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	180.6014	0	0	39.4374	0.743297974	8.536511453	0	5.198452511	11.73913403	8.235588657	6.791201987	8.742771827	2.335538046	3.899368192	0	0	7.579838942	17.2591275	32.49293483	0.433405104	0.498969212	9.939262752	11.99672318	0.724361946	2.861246702	0	0.577287066	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	180.6014	YES	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45%, OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45%, MH (Group): 45%, 7H Psychiatric: 45%, Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: $19, 13D Meal Benefit: not covered"											90000	0	0	0	0	0	0	0	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.03	0	0	39.4374	0.743297974	8.536511453	0	5.198452511	11.73913403	8.235588657	6.821201987	8.742771827	2.335538046	3.899368192	0	0	7.579838942	17.2591275	32.49293483	0.433405104	0.498969212	9.939262752	11.99672318	0.724361946	2.861246702	0	0.577287066	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	180.6314
R6801_009_0	2010	10	17																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	S	V	T	V	V	V	V	V	O	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	YES	2415.388147	3.693786125	231.2517723	59.46822094	15.97170068	25.67399065	27.1283718	513.6541623	212.5866952	8.901338154	18.43569135	0	0	119.3255753	5786.378316	4052.902197	104.4927435	938.9131639	45.05086525	19748.76995	636.6635717	679.1565766	400	461.829653	2188.012618	0	0	0	0	12000											3400	1A IP Acute: $225 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	"9A OP Hospital: $175, 9B ASC Services: $175"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35, OP Substance Abuse (Group): $15, 9D Cardiac Rehab: $35"	"7A PCP: $15, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $35	"7E Mental Health: $35, MH (Group): $15, 7H Psychiatric: $35, Psychiatric (Group): $15"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $35, 7F Podiatry: $35, 7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $35	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											248.9250976	893.153801	127.7632675	0	0.610786231	0.210431798	0.099322837	82.43921027	316.81603	0.270415337	0.270806393	0	0	228.336264	15.70240102	40.2890538	31.43705312	35.42491909	0.216323059	5.296430602	25.99131517	43.97992668	0	10	10	0	0	0	0	0											YES	231.6782083	632.6244762	113.8780769	0	0.607307192	0.205147337	0.098002841	81.72528666	301.1778098	0.263585138	0.263934731	0	0	211.3754895	15.22743778	39.8224723	30.02774434	35.40409491	0.209459483	5.065665904	25.3529835	43.48346793	0	10	10	0	0	0	0	0											3400	46.6327	0.194731626	2.194542258	0	9.699728688	5.266950823	2.658657497	3.498211138	5.335532937	2.346260442	4.865819244	0	0	2.101875157	7.342642983	13.44971546	0.261473449	2.770114231	9.436330953	8.33672255	1.345110086	2.461006935	0	0.384858044	1.823343849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.4064	0	5.627258195	46.6327	0.194731626	2.194542258	0	9.699728688	5.266950823	2.658657497	3.498211138	5.335532937	2.346260442	4.865819244	0	0	2.101875157	7.342642983	13.44971546	0.261473449	2.770114231	9.436330953	8.33672255	1.345110086	2.461006935	0	0.384858044	1.823343849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	132.4064	YES	1A IP Acute: $225 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	"9A OP Hospital: $175, 9B ASC Services: $175"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35, OP Substance Abuse (Group): $15, 9D Cardiac Rehab: $35"	"7A PCP: $15, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $35	"7E Mental Health: $35, MH (Group): $15, 7H Psychiatric: $35, Psychiatric (Group): $15"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $35, 7F Podiatry: $35, 7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $35	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											3400	0	0	0	15.6104	0	3.1103	0	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											18.7507	0	0.351486655	46.6327	0.194731626	2.194542258	15.610408	9.699728688	8.377253536	2.658657497	3.528211138	5.335532937	2.346260442	4.865819244	0	0	2.101875157	7.342642983	13.44971546	0.261473449	2.770114231	9.436330953	8.33672255	1.345110086	2.461006935	0	0.384858044	1.823343849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	151.1571
R6801_010_0	2010	7	17																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	S	V	T	V	V	V	V	V	O	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	YES	2415.388147	3.693786125	231.2517723	59.46822094	15.97170068	25.67399065	27.1283718	513.6541623	212.5866952	8.901338154	18.43569135	0	0	119.3255753	5786.378316	4052.902197	104.4927435	938.9131639	45.05086525	19748.76995	636.6635717	679.1565766	400	461.829653	2188.012618	0	0	0	0	12000											3400	1A IP Acute: $220 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $100 for days 21-100	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	"9A OP Hospital: $175, 9B ASC Services: $175"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $25, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, OP Substance Abuse (Group): $10, 9D Cardiac Rehab: $25"	"7A PCP: $10, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $25	"7E Mental Health: $30, MH (Group): $10, 7H Psychiatric: $30, Psychiatric (Group): $10"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $30, 7F Podiatry: $30, 7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $10"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $10	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											243.9250976	893.153801	97.76326747	0	0.610786231	0.210431798	0.099322837	82.43921027	316.81603	0.270415337	0.270806393	0	0	218.336264	10.87036653	30.2890538	24.91814829	25.42491909	0.216323059	5.028649861	25.99131517	18.97992668	0	10	10	0	0	0	0	0											YES	227.6344381	647.6812871	84.43741213	0	0.607508256	0.205452743	0.098079127	81.72604161	302.0815918	0.263979876	0.264331866	0	0	202.2746615	10.38369191	29.76839296	23.59028792	25.32425385	0.209856151	4.80903934	25.3898747	18.30954847	0	10	10	0	0	0	0	0											3400	45.8188	0.199366346	1.627191767	0	9.702940033	5.274791804	2.660727032	3.498243454	5.351543941	2.349774145	4.873140702	0	0	2.011378363	5.006997475	10.0540321	0.205417825	1.981439609	9.454201175	7.914384302	1.347067359	1.036254188	0	0.384858044	1.823343849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.5759	0	5.379104587	45.8188	0.199366346	1.627191767	0	9.702940033	5.274791804	2.660727032	3.498243454	5.351543941	2.349774145	4.873140702	0	0	2.011378363	5.006997475	10.0540321	0.205417825	1.981439609	9.454201175	7.914384302	1.347067359	1.036254188	0	0.384858044	1.823343849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	122.5759	YES	1A IP Acute: $220 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $100 for days 21-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $25"	"9A OP Hospital: $175, 9B ASC Services: $175"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $25, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, OP Substance Abuse (Group): $10, 9D Cardiac Rehab: $25"	"7A PCP: $10, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $25	"7E Mental Health: $30, MH (Group): $10, 7H Psychiatric: $30, Psychiatric (Group): $10"	"7C Occupational Therapy: $25, 7I Physical and Speech Therapy: $25"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $30, 7F Podiatry: $30, 7G Other Health Care: $25, 18A Hearing Exams (Medicare Covered): $25"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $10"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $10	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											3400	0	0	0	15.6104	0	3.1149	0	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											18.7553	0	0.335987376	45.8188	0.199366346	1.627191767	15.610408	9.702940033	8.389724868	2.660727032	3.528243454	5.351543941	2.349774145	4.873140702	0	0	2.011378363	5.006997475	10.0540321	0.205417825	1.981439609	9.454201175	7.914384302	1.347067359	1.036254188	0	0.384858044	1.823343849	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	141.3312
R6801_011_0	2010	8	17																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	451.21	24.64	108.96	144.57	26.03	36.15	28.31	20.08	32.24	5.14	18.21	1.21	2.4	35.8	60.96	114.59	5.66	7.32	33.27	43.3	9.33	4.32	1.65	5.400372671	2.61	1.72	0	0	0.5	0											90000	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45% OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45% MH (Group): 45%, 7H Psychiatric: 45% Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											0.074680223	0.074673999	0.190358512	0	0.233026118	0.23299999	0.232981429	0.232844455	0.232999997	0.232802211	0.233053595	0.232999988	0.232999977	0.233003218	0.232994107	0.233005185	0.23300249	0.232978931	0.232990629	0.232988526	0.233003174	0.232989917	0	0.044510817	0.128295019	0	0	0	0	0											YES	0.074680223	0.074673999	0.190358512	0	0.233026118	0.23299999	0.232981429	0.231898645	0.232999997	0.232802211	0.233053595	0.232999988	0.232999977	0.233003218	0.232994107	0.233005185	0.23300249	0.232978931	0.232990629	0.232988526	0.233003174	0.232989917	0	0.044510817	0.128295019	0	0	0	0	0											90000	33.6965	1.839967327	20.74146344	0	6.065669846	8.422949626	6.595704255	4.656524786	7.511919917	1.196603365	4.243905972	0.281929986	0.559199944	8.34151522	14.20332077	26.70006419	1.318794092	1.705405772	7.751598228	10.08840318	2.173919618	1.006516442	0	0.240375	0.33485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	169.6771	0	0	33.6965	1.839967327	20.74146344	0	6.065669846	8.422949626	6.595704255	4.656524786	7.511919917	1.196603365	4.243905972	0.281929986	0.559199944	8.34151522	14.20332077	26.70006419	1.318794092	1.705405772	7.751598228	10.08840318	2.173919618	1.006516442	0	0.240375	0.33485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	169.6771	YES	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45% OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45% MH (Group): 45%, 7H Psychiatric: 45% Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											90000	0	0	0	0	0	0	0	0.019	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.019	0	0	33.6965	1.839967327	20.74146344	0	6.065669846	8.422949626	6.595704255	4.675516652	7.511919917	1.196603365	4.243905972	0.281929986	0.559199944	8.34151522	14.20332077	26.70006419	1.318794092	1.705405772	7.751598228	10.08840318	2.173919618	1.006516442	0	0.240375	0.33485	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	169.6961
R6801_012_0	2010	6	17																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	V	V	O	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	YES	998.42	5.15	662.4	34.53482523	10.65	10.68506414	9.87	274.81	389.44	4.03	18.68	66.31	0.17	97.55	3456.2	3138.2	190.56	677.36	36.1	1490.5	9.12	630.19	0	281.9	305.72	0	0	0	0	0											3400	1A IP Acute: $295 Per Day for days 1-10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	"9A OP Hospital: $150, 9B ASC Services: $150"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: $50	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40 OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $40	"7E Mental Health: $40 MH (Group): $25, 7H Psychiatric: $40 Psychiatric (Group): $25"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $40, 7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $10"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $10	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											295	1000	130	0	0.334518779	0.2	0.044684914	49.01804883	150	0.200203239	0.199971307	50	0.200000019	40	25	40	40	40	0.162205352	40	0.200002191	10	0	10	10	0	0	0	0	0											YES	291.9470246	989.6509307	128.654621	0	0.331056821	0.2	0.044222467	48.35590524	148.4476396	0.198131322	0.19790179	49.48254654	0.197930205	39.58603723	24.74127327	39.58603723	39.58603723	39.58603723	0.160526677	39.58603723	0.197932355	9.896509307	0	9.896509307	9.896509307	0	0	0	0	0											3400	24.2905	0.424725191	7.101735079	0	3.525755147	2.137012829	0.43647575	1.107390527	4.817620731	0.798469229	3.696805437	0.273432305	0.033648135	0.321801494	7.125899056	10.3524085	0.628626271	2.234499848	5.795013052	4.916915707	1.805143074	0.519723433	0	0.232485498	0.252130069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.8282	0	0.860553467	24.2905	0.424725191	7.101735079	0	3.525755147	2.137012829	0.43647575	1.107390527	4.817620731	0.798469229	3.696805437	0.273432305	0.033648135	0.321801494	7.125899056	10.3524085	0.628626271	2.234499848	5.795013052	4.916915707	1.805143074	0.519723433	0	0.232485498	0.252130069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	82.8282	YES	1A IP Acute: $295 Per Day for days 1-10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	"9A OP Hospital: $150, 9B ASC Services: $150"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: $50	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40 OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $40	"7E Mental Health: $40 MH (Group): $25, 7H Psychiatric: $40 Psychiatric (Group): $25"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $40, 7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $10"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): $10	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											3400	0	0	0	9.6566	0	1.254	0	0.0035	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											10.9141	0	0.119446533	24.2905	0.424725191	7.101735079	9.656577173	3.525755147	3.390968447	0.43647575	1.110936776	4.817620731	0.798469229	3.696805437	0.273432305	0.033648135	0.321801494	7.125899056	10.3524085	0.628626271	2.234499848	5.795013052	4.916915707	1.805143074	0.519723433	0	0.232485498	0.252130069	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	93.7423
R7444_001_0	2010	4	2																															D	D	D	V	T	Coin	Coin	V	Coin	O	Coin	V	Coin	Coin	V	V	V	V	V	V	Coin	O	T	V	P	P	P	P	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	YES	1570.56974	99.10598631	1730.721534	1961.668305	388.6295024	5.677276614	5.409407707	334.3520719	28.40990652	9690.021403	38.70309007	0	0.087989749	23.1217781	4372.860276	4626.488002	359.6211088	488.1512191	0	0	11.09942104	1177.271406	0	0	90.40554083	0	13.15727906	4.520277042	78.51007493	0											3800	"$275 Days 1-6 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$275 Days 1-6 (1b); $0 n/c (1b1, 1b2)"	"$90 Days 1-28 (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	20% (11a)	"20% (11b, 11b1); $0 (11c)"	"$50 (4a, 4a1); $40 (4b)"	20% (9b)	$0/$0/$10 (8a1); $10 (8a2)	"$16 (8b1); 20% (8b2, 8b3)"	Included in h.5.	20% (12)	"$35 (3, 9d); $60 (5); 20% (9a); $40/$30 (9c)"	"$15 (7a); $30 (7a1); $0 (14b, 14c, 14c1, 14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j); $0 n/c (14b1, 14e1, 14h1)"	"$35 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$40/$30 (7e, 7h)"	"$35 (7c, 7i)"	Included in h.2.	$15 (7g)	"20% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1, 17b); $35 (16b, 17a, 18a)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$35 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$35/$0 (18a1); $0 n/c (18a2)	"$0 (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a2, 14a3, 14a5, 14a6, 14a8, 14a9, 14a10); $0 (14a1, 14a7); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											190.6084929	140.5472438	69.22791329	0	150	0.2	0.112920511	48.56043438	0.2	3	0.172815619	0	0.2	0.149077251	11.1505503	34.92935398	38.5	35	0	0	0.2	34.55045552	0	0	35	0	0	0	0	0											NO	134.1424998	98.9114301	48.7197879	0	105.5638952	0.14075186	0.07946886	34.17485738	0.14075186	2.111277904	0.1216206	0	0.14075186	0.104914502	7.847303489	24.67737291	27.0947331	24.63157555	0	0	0.14075186	24.31520444	0	0	35	0	0	0	0	0												17.5567	0.816892903	7.026698835	0	3.418770339	0.799087245	0.429879465	0.952202864	3.998747193	1.704860673	4.707093023	0	0.012384721	2.425809835	2.859596808	9.514130807	0.811986497	1.001994469	0	0	1.562264159	2.385466243	0	0	0.263682827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2482	0	26.03947116	17.5567	0.816892903	7.026698835	0	3.418770339	0.799087245	0.429879465	0.952202864	3.998747193	1.704860673	4.707093023	0	0.012384721	2.425809835	2.859596808	9.514130807	0.811986497	1.001994469	0	0	1.562264159	2.385466243	0	0	0.263682827	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	62.2482	YES	"$375 Days 1-21 (1a); $0 (1a1); $0 n/c (1a2, 1a3)"	"$375 Days 1-21 (1b); $0 n/c (1b1, 1b2)"	"$175 Days 1-44 (2a, 2a2); $0 n/c (2a1)"	"30% (6a); $0 n/c (6a1, 6a2)"	$150 (10a)	30% (11a)	"30% (11b, 11b1, 11c)"	"$50 (4a, 4a1); $40 (4b)"	30% (9b)	30%/30%/$10 (8a1); $10 (8a2)	"$21 (8b1); 30% (8b2, 8b3)"	Included in h.5.	20% (12)	"$40 (3, 9d); $75 (5); 30% (9a); $45/$35 (9c)"	"$30 (7a, 14c, 14c1); $0 n/c (7a1, 14b1, 14e1, 14h1); $0 (14b); 30% (14d, 14d1, 14d2, 14e, 14f, 14f1, 14g, 14h, 14i, 14j)"	"$40 (7b, 7d, 7f, 7f1); $0 n/c (7b1)"	"$45/$35 (7e, 7h)"	"$40 (7c, 7i)"	Included in h.2.	$30 (7g)	"30% (15, 15a1); $0 n/c (15a2)"	"$0 (13a, 13a1); $40 (16b, 17a, 18a); 30% (17b)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$40 (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	$40 (18a1); $0 n/c (18a2)	"50% (18b1); $0 n/c (18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); $0 Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											7600	4.8479	0.2841	1.5772	0.6248	0.6271	0.2199	0.2095	0.1747	1.1002	0.3127	1.2725	0	0.0023	0.6651	1.8367	3.4152	0.2897	0.3616	0	0	0.74	0.8625	0	0	0.0952	0	0.0138	0.003	0	0											19.5358	0	8.119092498	22.4046	1.100978349	8.603916351	0.624837482	4.045882058	1.018954445	0.63937275	1.126867295	5.098994202	2.017586596	5.979591761	0	0.014656474	3.090912303	4.696295707	12.92929358	1.101704167	1.363616534	0	0	2.302284024	3.247948982	0	0	0.358846555	0	0.013849767	0.002973866	0	0	0	0	0	0	0	0	0	0	0	0	81.784
R7444_801_0	2010	4	2																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	254.2383028	5.864464688	50.23436165	2059.75172	12.42760075	5.961140444	5.679878092	20.69393267	29.83040185	20.04980189	40.63824457	0	0.092389237	24.26823416	19.79905522	96.24351935	2.538888938	6.037095985	0	0	11.65439209	7.390118597	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077700802	0.077700802	0.156406602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077700802	0.077700802	0.156406602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.7545	0.455673607	7.856985785	0	2.895630975	1.388945724	1.323411595	4.821686312	6.95048363	4.671603841	9.468710986	0	0.021526692	5.654498558	4.613179866	22.42474001	0.591561123	1.406643365	0	0	2.715473357	1.721897633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7372	0	0	19.7545	0.455673607	7.856985785	0	2.895630975	1.388945724	1.323411595	4.821686312	6.95048363	4.671603841	9.468710986	0	0.021526692	5.654498558	4.613179866	22.42474001	0.591561123	1.406643365	0	0	2.715473357	1.721897633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7372	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	2.9518	0.0681	0.7771	0	0.5312	0.2548	0.2428	0.8845	1.2749	0.8569	1.7369	0	0.0039	1.0372	1.4568	7.0815	0.1868	0.4442	0	0	0.8575	0.5438	0	0	0	0	0	0	0	0											21.1906	0	0	22.7063	0.523762767	8.634050313	0	3.426782219	1.64372275	1.566167569	5.706137648	8.225424415	5.528525255	11.20557513	0	0.025475375	6.69171427	6.069973508	29.50623685	0.778369898	1.850846532	0	0	3.572991259	2.26565478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9278
R7444_802_0	2010	4	2																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	254.2383028	5.864464688	50.23436165	2059.75172	12.42760075	5.961140444	5.679878092	20.69393267	29.83040185	20.04980189	40.63824457	0	0.092389237	24.26823416	19.79905522	96.24351935	2.538888938	6.037095985	0	0	11.65439209	7.390118597	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077700802	0.077700802	0.156406602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077700802	0.077700802	0.156406602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.7545	0.455673607	7.856985785	0	2.895630975	1.388945724	1.323411595	4.821686312	6.95048363	4.671603841	9.468710986	0	0.021526692	5.654498558	4.613179866	22.42474001	0.591561123	1.406643365	0	0	2.715473357	1.721897633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7372	0	0	19.7545	0.455673607	7.856985785	0	2.895630975	1.388945724	1.323411595	4.821686312	6.95048363	4.671603841	9.468710986	0	0.021526692	5.654498558	4.613179866	22.42474001	0.591561123	1.406643365	0	0	2.715473357	1.721897633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7372	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	2.9518	0.0681	0.7771	0	0.5312	0.2548	0.2428	0.8845	1.2749	0.8569	1.7369	0	0.0039	1.0372	1.4568	7.0815	0.1868	0.4442	0	0	0.8575	0.5438	0	0	0	0	0	0	0	0											21.1906	0	0	22.7063	0.523762767	8.634050313	0	3.426782219	1.64372275	1.566167569	5.706137648	8.225424415	5.528525255	11.20557513	0	0.025475375	6.69171427	6.069973508	29.50623685	0.778369898	1.850846532	0	0	3.572991259	2.26565478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9278
R7444_803_0	2010	4	2																															Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	Coin	Coin	Coin	V	Coin	Coin	Coin	T	V	P	P	P	P	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	YES	254.2383028	5.864464688	50.23436165	2059.75172	12.42760075	5.961140444	5.679878092	20.69393267	29.83040185	20.04980189	40.63824457	0	0.092389237	24.26823416	19.79905522	96.24351935	2.538888938	6.037095985	0	0	11.65439209	7.390118597	0	0	0	0	0	0	0	0											7500	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											0.077700802	0.077700802	0.156406602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.077700802	0.077700802	0.156406602	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.233	0	0	0	0	0	0	0	0												19.7545	0.455673607	7.856985785	0	2.895630975	1.388945724	1.323411595	4.821686312	6.95048363	4.671603841	9.468710986	0	0.021526692	5.654498558	4.613179866	22.42474001	0.591561123	1.406643365	0	0	2.715473357	1.721897633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7372	0	0	19.7545	0.455673607	7.856985785	0	2.895630975	1.388945724	1.323411595	4.821686312	6.95048363	4.671603841	9.468710986	0	0.021526692	5.654498558	4.613179866	22.42474001	0.591561123	1.406643365	0	0	2.715473357	1.721897633	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	98.7372	YES	"FFS (1a); $0 n/c (1a1, 1a2, 1a3)"	"FFS (1b); $0 n/c (1b1, 1b2)"	"FFS (2a, 2a2); $0 n/c (2a1)"	"$0 (6a); $0 n/c (6a1, 6a2)"	FFS (10a)	FFS (11a)	"FFS (11b, 11b1, 11c)"	"FFS (4a, 4b); $0 n/c (4a1)"	FFS (9b)	"FFS (8a1, 8a2)"	"FFS (8b1, 8b2, 8b3)"	Included in h.5.	FFS (12)	"FFS (3, 5, 9a, 9c, 9d)"	"FFS (7a, 14b, 14c, 14d, 14e, 14f, 14g, 14h, 14i, 14j); $0 n/c (7a1, 14b1, 14c1, 14d1, 14d2, 14e1, 14f1, 14h1)"	"FFS (7b, 7d, 7f); $0 n/c (7b1, 7f1)"	"FFS (7e, 7h)"	"FFS (7c, 7i)"	Included in h.2.	FFS (7g)	"FFS (15, 15a1); $0 n/c (15a2)"	"FFS (13a, 16b, 17a, 17b, 18a); $0 n/c (13a1)"	$0 n/c (10b)	"$0 n/c (16a1, 16a2, 16a3, 16a4, 16a5, 16b1, 16b2, 16b3, 16b4, 16b5)"	$0 n/c (17a1)	"$0 n/c (17b1, 17b2, 17b3, 17b4, 17b5)"	"$0 n/c (18a1, 18a2)"	"$0 n/c (18b1, 18b2, 18b3, 18b4)"	"$0 n/c (14a, 14a1, 14a2, 14a3, 14a5, 14a6, 14a7, 14a8, 14a9, 14a10); FFS Mcare Cov, $0 n/c Add'l (14a4)"	"$0 n/c (13b, 13c, 13d, 13e)"											10000	2.9518	0.0681	0.7771	0	0.5312	0.2548	0.2428	0.8845	1.2749	0.8569	1.7369	0	0.0039	1.0372	1.4568	7.0815	0.1868	0.4442	0	0	0.8575	0.5438	0	0	0	0	0	0	0	0											21.1906	0	0	22.7063	0.523762767	8.634050313	0	3.426782219	1.64372275	1.566167569	5.706137648	8.225424415	5.528525255	11.20557513	0	0.025475375	6.69171427	6.069973508	29.50623685	0.778369898	1.850846532	0	0	3.572991259	2.26565478	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	119.9278
R9896_008_0	2010	8	8																															A	A	D	V	T	Coin	Coin	Coin	Coin	Coin	Coin	V	V	Coin	Coin	Coin	Coin	Coin	Coin	Coin	S	Coin	T	V	V	V	V	V	O	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	YES	417.4164383	10.56795057	183.6800955	708.9078133	1003.691533	52.6006278	42.46210397	38.62492455	40.07016188	10.46524016	22.26673737	0	0	26.0580581	64.02425225	123.2529219	1.860107741	2.677435966	34.15443153	43.099891	494.0453135	12.61268836	400	211.1962286	2378.314673	0	0	0	0	12000											90000	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45%, OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45%, MH (Group): 45%, 7H Psychiatric: 45%, Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: $30, 13D Meal Benefit: not covered"											1025.072817	929.8261536	307.1601203	0	54.55929279	0.233	0.233	0.233776701	0.233	0.233	0.233	0	0	0.233	0.232011053	0.233	0.233	0.233	0.233	0.233	17.89288717	0.233	0	15	2.921396432	0	0	0	0	0											YES	1025.072817	929.8261536	307.1601203	0	54.55929279	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0.233	0.232011053	0.233	0.233	0.233	0.233	0.233	17.89288717	0.233	0	15	2.921396432	0	0	0	0	0											90000	35.6569	0.818863069	4.701600019	0	4.563391685	12.25594628	9.893670225	8.999607421	9.336347718	2.438400956	5.188149808	0	0	6.071527537	14.85433417	28.71793081	0.433405104	0.62384258	7.957982546	10.0422746	0.736658088	2.938756388	0	0.263995286	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0725	0	0	35.6569	0.818863069	4.701600019	0	4.563391685	12.25594628	9.893670225	8.999607421	9.336347718	2.438400956	5.188149808	0	0	6.071527537	14.85433417	28.71793081	0.433405104	0.62384258	7.957982546	10.0422746	0.736658088	2.938756388	0	0.263995286	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.0725	YES	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45%, OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: 20%, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: 20%"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45%, MH (Group): 45%, 7H Psychiatric: 45%, Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: $30, 13D Meal Benefit: not covered"											90000	0	0	0	0	0	0	0	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.03	0	0	35.6569	0.818863069	4.701600019	0	4.563391685	12.25594628	9.893670225	9.029607421	9.336347718	2.438400956	5.188149808	0	0	6.071527537	14.85433417	28.71793081	0.433405104	0.62384258	7.957982546	10.0422746	0.736658088	2.938756388	0	0.263995286	0.579	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	167.1025
R9896_009_0	2010	7	8																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	S	V	T	V	V	V	V	V	O	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	YES	2011.947583	6.955744157	179.8826528	28.9941252	14.2118746	30.83735728	30.35381328	582.7188021	232.2579248	7.694026082	18.58386173	0	0	121.5027003	5240.381079	3629.517442	136.3478121	672.8089341	34.27298826	17057.5111	718.8092729	518.6011249	400	211.1962286	2378.314673	0	0	0	0	12000											3400	1A IP Acute: $240 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $30"	"9A OP Hospital: $185, 9B ASC Services: $185"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35, OP Substance Abuse (Group): $20, 9D Cardiac Rehab: $35"	"7A PCP: $20, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $35	"7E Mental Health: $35, MH (Group): $20, 7H Psychiatric: $35, Psychiatric (Group): $20"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $35, 7F Podiatry: $35, 7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $35	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											265.3580281	969.8030651	133.0716134	0	0.663518368	0.209456593	0.088187552	79.16680379	313.5820055	0.260773028	0.267552829	0	0	168.0253479	20.0875416	39.12757919	33.90335326	35.54876169	0.211017208	5.363161734	22.09018289	51.65803317	0	10	25	0	0	0	0	0											YES	249.7905945	842.0478363	119.7303049	0	0.660745813	0.20442982	0.087118326	78.5404093	300.3515066	0.254412925	0.261191428	0	0	157.8783972	19.68795149	38.70678918	32.9060252	35.50176813	0.20465056	5.157267244	21.57952583	51.20794381	0	10	25	0	0	0	0	0											3400	41.8805	0.48808911	1.794783739	0	9.390436641	6.304075413	2.64437341	3.813914435	5.813251471	1.957459681	4.853945385	0	0	1.598554298	8.597697373	11.7072472	0.373888712	1.990492231	7.01398623	7.330845273	1.292630273	2.213041439	0	0.175996857	4.954822235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.19	0	4.538280878	41.8805	0.48808911	1.794783739	0	9.390436641	6.304075413	2.64437341	3.813914435	5.813251471	1.957459681	4.853945385	0	0	1.598554298	8.597697373	11.7072472	0.373888712	1.990492231	7.01398623	7.330845273	1.292630273	2.213041439	0	0.175996857	4.954822235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	126.19	YES	1A IP Acute: $240 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $30"	"9A OP Hospital: $185, 9B ASC Services: $185"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $35, 5 Partial Hosp: $35, 9C OP Substance Abuse: $35, OP Substance Abuse (Group): $20, 9D Cardiac Rehab: $35"	"7A PCP: $20, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $35	"7E Mental Health: $35, MH (Group): $20, 7H Psychiatric: $35, Psychiatric (Group): $20"	"7C Occupational Therapy: $35, 7I Physical and Speech Therapy: $35"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $35, 7F Podiatry: $35, 7G Other Health Care: $35, 18A Hearing Exams (Medicare Covered): $35"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $35"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $35	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											3400	0	0	0	3.7278	0	3.1651	0	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6.9229	0	0.132688867	41.8805	0.48808911	1.794783739	3.727816097	9.390436641	9.469142223	2.64437341	3.843914435	5.813251471	1.957459681	4.853945385	0	0	1.598554298	8.597697373	11.7072472	0.373888712	1.990492231	7.01398623	7.330845273	1.292630273	2.213041439	0	0.175996857	4.954822235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	133.1129
R9896_010_0	2010	8	8																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	V	V	V	V	V	V	Coin	V	S	V	T	V	V	V	V	V	O	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	YES	2011.947583	6.955744157	179.8826528	28.9941252	14.2118746	30.83735728	30.35381328	582.7188021	232.2579248	7.694026082	18.58386173	0	0	121.5027003	5240.381079	3629.517442	136.3478121	672.8089341	34.27298826	17057.5111	718.8092729	518.6011249	400	211.1962286	2378.314673	0	0	0	0	12000											3400	1A IP Acute: $210 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $100 for days 21-100	6 Home Health: $0	10A Ambulance: $150	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $30"	"9A OP Hospital: $185, 9B ASC Services: $185"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, OP Substance Abuse (Group): $15, 9D Cardiac Rehab: $30"	"7A PCP: $15, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $30	"7E Mental Health: $30, MH (Group): $15, 7H Psychiatric: $30, Psychiatric (Group): $15"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $30, 7F Podiatry: $30, 7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $30	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											235.3580281	969.8030651	103.0716134	0	0.663518368	0.209456593	0.088187552	79.16680379	313.5820055	0.260773028	0.267552829	0	0	163.0253479	15.26276589	34.12757919	27.38444843	30.54876169	0.211017208	5.068180325	22.09018289	46.65803317	0	10	25	0	0	0	0	0											YES	220.7164213	851.4571589	90.49217493	0	0.660950015	0.204800048	0.087197076	78.54104276	301.3259484	0.254881354	0.261659953	0	0	153.5889432	14.85710649	33.70099202	26.46057475	30.46844043	0.205119471	4.8752798	21.61713632	46.20430459	0	10	25	0	0	0	0	0											3400	37.0058	0.49354318	1.356497707	0	9.393338733	6.315492257	2.646763766	3.813945196	5.832111624	1.961063786	4.862652382	0	0	1.555122611	6.488074977	10.19319486	0.300653456	1.708286577	7.030057216	6.930011611	1.29488317	1.996800361	0	0.175996857	4.954822235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3091	0	4.280862516	37.0058	0.49354318	1.356497707	0	9.393338733	6.315492257	2.646763766	3.813945196	5.832111624	1.961063786	4.862652382	0	0	1.555122611	6.488074977	10.19319486	0.300653456	1.708286577	7.030057216	6.930011611	1.29488317	1.996800361	0	0.175996857	4.954822235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	116.3091	YES	1A IP Acute: $210 Per Day for days 1 - 10	1B IP Psych: $1000 Per Admit	2 SNF: $100 for days 21-100	6 Home Health: 30%	10A Ambulance: $150	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $30"	"9A OP Hospital: $185, 9B ASC Services: $185"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A OP Hospital: $50	12 Renal Dialysis: 20%	"3 CORF: $30, 5 Partial Hosp: $30, 9C OP Substance Abuse: $30, OP Substance Abuse (Group): $15, 9D Cardiac Rehab: $30"	"7A PCP: $15, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears: $0, Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $30	"7E Mental Health: $30, MH (Group): $15, 7H Psychiatric: $30, Psychiatric (Group): $15"	"7C Occupational Therapy: $30, 7I Physical and Speech Therapy: $30"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $30, 7F Podiatry: $30, 7G Other Health Care: $30, 18A Hearing Exams (Medicare Covered): $30"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $30"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): not covered"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $30	18A Routine Hearing Exams (Non Medicare Covered): not covered	18B Hearing Aids (Non Medicare Covered): not covered	14A Health Education/Wellness Program: $0	"13B Acupuncture: not covered, 13C OTC Drug Card: not covered, 13D Meal Benefit: not covered"											3400	0	0	0	3.7278	0	3.1708	0	0.03	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											6.9286	0	0.125170693	37.0058	0.49354318	1.356497707	3.727816097	9.393338733	9.486291085	2.646763766	3.843945196	5.832111624	1.961063786	4.862652382	0	0	1.555122611	6.488074977	10.19319486	0.300653456	1.708286577	7.030057216	6.930011611	1.29488317	1.996800361	0	0.175996857	4.954822235	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	123.2378
R9896_011_0	2010	8	8																															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											0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0	YES	380.96	29.72	75.08	70.81	23.14	32.25	26.01	22.29	34.67	6.6	20.47	0.96	1.71	31.69	58.63	111.27	7.07	6.08	27.23	38.26	8.1	4.1	2.5	5.651552795	2.6	1.72	0	0	0.5	0											90000	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45% OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45% MH (Group): 45%, 7H Psychiatric: 45% Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											0.080526012	0.080518045	0.183479933	0	0.233036852	0.232999989	0.233030514	0.232857457	0.232999981	0.233070428	0.232970702	0.233000072	0.232999986	0.232960834	0.23300875	0.232998893	0.233008128	0.23297369	0.233002918	0.23302698	0.232998322	0.233005391	0	0.044509891	0.122150641	0	0	0	0	0											YES	0.080526012	0.080518045	0.183479933	0	0.233036852	0.232999989	0.233030514	0.23197347	0.232999981	0.233070428	0.232970702	0.233000072	0.232999986	0.232960834	0.23300875	0.232998893	0.233008128	0.23297369	0.233002918	0.23302698	0.232998322	0.233005391	0	0.044509891	0.122150641	0	0	0	0	0											90000	30.6772	2.392996308	13.77567336	0	5.392472745	7.51424965	6.061123664	5.17068865	8.078109353	1.538264827	4.768910271	0.223680069	0.398429976	7.38252884	13.66130302	25.92578685	1.647367467	1.416480036	6.344669447	8.915612272	1.887286408	0.955322101	0	0.25155	0.317591667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.6973	0	0	30.6772	2.392996308	13.77567336	0	5.392472745	7.51424965	6.061123664	5.17068865	8.078109353	1.538264827	4.768910271	0.223680069	0.398429976	7.38252884	13.66130302	25.92578685	1.647367467	1.416480036	6.344669447	8.915612272	1.887286408	0.955322101	0	0.25155	0.317591667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.6973	YES	1A IP Acute: $1112 Per Admit	1B IP Psych: $1112 Per Admit	2 SNF: $139 for days 21-100	6 Home Health: $0	10A Ambulance: 20%	11A DME: 20%	"11B Prosthetics/Medical Supplies: 20%, 11C Diabetes Monitoring Supplies: 20%"	"4A ER: 20%, 4B Urgent Care: 20%"	"9A OP Hospital: 20%, 9B ASC Services: 20%"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: 20%	12 Renal Dialysis: 20%	"3 CORF: 20%, 5 Partial Hosp: 45%, 9C OP Substance Abuse: 45% OP Substance Abuse (Group): 45%, 9D Cardiac Rehab: 20%"	"7A PCP: 20%, 14B Immunizations: $0 Hepatitis B Vaccine: 20%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: 20%, 14F Colorectal Screening: 20%, 14G Bone Mass Measurement: 20%, 14H Mammography: 20%, 14I Diabetes Monitoring: 20%, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): 20%	"7E Mental Health: 45% MH (Group): 45%, 7H Psychiatric: 45% Psychiatric (Group): 45%"	"7C Occupational Therapy: 20%, 7I Physical and Speech Therapy: 20%"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: 20%, 7F Podiatry: 20%, 7G Other Health Care: 20%, 18A Hearing Exams (Medicare Covered): 20%"	15 Part B Drugs: 20%	"13A Blood: 20%, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): 20%"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $15, 16B Comprehensive Dental (Non Medicare Covered): $0"	17A Routine Eye Exams (Non Medicare Covered): $10	17B Eye Wear (Medicare Covered): 20%	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											90000	0	0	0	0	0	0	0	0.0197	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											0.0197	0	0	30.6772	2.392996308	13.77567336	0	5.392472745	7.51424965	6.061123664	5.190392712	8.078109353	1.538264827	4.768910271	0.223680069	0.398429976	7.38252884	13.66130302	25.92578685	1.647367467	1.416480036	6.344669447	8.915612272	1.887286408	0.955322101	0	0.25155	0.317591667	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	154.717
R9896_012_0	2010	7	8																															D	A	D	Coin	Coin	Coin	Coin	V	V	Coin	Coin	V	Coin	V	V	V	V	V	Coin	V	Coin	V	T	V	V	V	V	V	O	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	YES	828.22	4.68	488.46	23.48262945	9.12	9.400228738	8.39	273.96	422.28	4.59	19.36	51.74	0.12	78.49	3286.99	2984.56	150.31	534.28	28.14	1188.22	7.09	530.73	0	299.05	302.31	0	0	0	0	0											3400	1A IP Acute: $285 Per Day for days 1-10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: $0	10A Ambulance: $100	11A DME: 20%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	"9A OP Hospital: $150, 9B ASC Services: $150"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: $50	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40 OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $40	"7E Mental Health: $40 MH (Group): $25, 7H Psychiatric: $40 Psychiatric (Group): $25"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $40, 7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $40	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											285	1000	130	0	0.226937135	0.2	0.044683528	49.06318441	150	0.200076948	0.199954138	50	0.2	40	25	40	40	40	0.162206585	40	0.199999671	39.97738963	0	10	25	0	0	0	0	0											YES	281.6729311	988.326074	128.4823896	0	0.224287887	0.2	0.044161896	48.3443184	148.2489111	0.197741265	0.197619888	49.4163037	0.197665215	39.53304296	24.70815185	39.53304296	39.53304296	39.53304296	0.160312998	39.53304296	0.19766489	39.51069654	0	9.88326074	24.70815185	0	0	0	0	0											3400	19.4406	0.385447169	5.229875669	0	2.045505531	1.880045748	0.370518306	1.103700789	5.216879181	0.907632406	3.825921027	0.213066629	0.023719826	0.258579045	6.767954004	9.832394891	0.495184307	1.760142849	4.511207758	3.914496025	1.401444067	1.747459331	0	0.246299094	0.622460115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2005	0	0.846854462	19.4406	0.385447169	5.229875669	0	2.045505531	1.880045748	0.370518306	1.103700789	5.216879181	0.907632406	3.825921027	0.213066629	0.023719826	0.258579045	6.767954004	9.832394891	0.495184307	1.760142849	4.511207758	3.914496025	1.401444067	1.747459331	0	0.246299094	0.622460115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	72.2005	YES	1A IP Acute: $285 Per Day for days 1-10	1B IP Psych: $1000 Per Admit	2 SNF: $130 for days 21-100	6 Home Health: 30%	10A Ambulance: $100	11A DME: 40%	"11B Prosthetics/Medical Supplies: 35%, 11C Diabetes Monitoring Supplies: $0"	"4A ER: $50, 4B Urgent Care: $35"	"9A OP Hospital: $150, 9B ASC Services: $150"	8A OP Diagnostic Procedures/Tests: 20%	8B OP Radiology: 20%	9A Observations: $50	12 Renal Dialysis: 20%	"3 CORF: $40, 5 Partial Hosp: $40, 9C OP Substance Abuse: $40 OP Substance Abuse (Group): $25, 9D Cardiac Rehab: $40"	"7A PCP: $25, 14B Immunizations: $0 Hepatitis B Vaccine: 0%, 14C Physical Exams: $0, 14D Pap Smears and Pelvic Exams: $0, 14E Prostate Screening: $0, 14F Colorectal Screening: $0, 14G Bone Mass Measurement: $0, 14H Mammography: $0, 14I Diabetes Monitoring: $0, 14J Nutrition Therapy: $0"	7D Physician Specialist (excl. Radiology): $40	"7E Mental Health: $40 MH (Group): $25, 7H Psychiatric: $40 Psychiatric (Group): $25"	"7C Occupational Therapy: $40, 7I Physical and Speech Therapy: $40"	7D Physician Specialist (Radiology): 20%	"7B Chiropractic: $40, 7F Podiatry: $40, 7G Other Health Care: $40, 18A Hearing Exams (Medicare Covered): $40"	15 Part B Drugs: 20%	"13A Blood: $0, 16B Comprehensive Dental (Medicare Covered): $0, 17A Routine Eye Exams (Medicare Covered): $40"	10B Transportation: $0	"16A Preventative Dental Services (Non Medicare Covered): $10, 16B Comprehensive Dental (Non Medicare Covered): Not Covered"	17A Routine Eye Exams (Non Medicare Covered): $25	17B Eye Wear (Medicare Covered): $40	18A Routine Hearing Exams (Non Medicare Covered): Not Covered	18B Hearing Aids (Non Medicare Covered): Not Covered	14A Health Education/Wellness Program: $0	13B Acupuncture: Not Covered											3400	0	0	0	3.0798	0	0.9373	0	0.0033	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0											4.0205	0	0.053145538	19.4406	0.385447169	5.229875669	3.079829844	2.045505531	2.81733914	0.370518306	1.10703639	5.216879181	0.907632406	3.825921027	0.213066629	0.023719826	0.258579045	6.767954004	9.832394891	0.495184307	1.760142849	4.511207758	3.914496025	1.401444067	1.747459331	0	0.246299094	0.622460115	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	76.221
R9943_001_0	2010	9	24	H.6	H.7	H.8	H.9	I.7	I.8	I.9	I.10	I.11	I.12	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Cardiac Rehab Services	ASC	Urgent Care	Office Visit (Clinic)	Chiropractic	Podiatric	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Radiation/Chemo	A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	V	Coin	V	V	Coin	2.7806	0.101	0.3828	0	0.4148	0.254	0.056	0.1672	0.6186	1.98	0.4207	0.1511	0.0076	0.0077	0.9717	1.169	0.0224	0.7922	2.5326	0.0296	1.3947	0	0	0	0	0	0	0	0	0	0.0227	0.277	0.0036	0.0608	0.3012	0.1239	0.0317	0.1844	0.0003	0.6589	15.9187	YES	225.4607059	8.18744989	142.0448274	204.5760181	114.357846	5.10516884	1.125850864	165.6799963	119.3686558	6368.327949	340.6621249	36.45681936	0.306251516	14.89607497	3125.336284	2255.915533	26.98774556	1198.279738	3119.564384	1.191669658	28.03563217	0	0	0	302.4	0	0	0	0	0	43.74880228	133.6297841	4.927447582	117.3062041	581.2674835	239.1558914	0.637154225	355.7892565	0.603463898	13.24565678	3350	$850/admit	$850/admit	$130/day (for days 21-100)	$0 copay	$175 copay	20% Coinsurance	20% Coinsurance	$50 copay	$250 copay	$15 copay	$25/$150 copay for Lower/Higher Tier	$200 copay	10% Coinsurance	$25 copay	$15 copay	$25 copay	$40 copay	$50/$25 OP/PR copay	$25/$150 copay for Lower/Higher Tier	10% Coinsurance	20% Coinsurance				$20 copay	$100/$80 glasses/contacts	$0copay	$100 max / 2 yrs	Silver Sneakers		$25 copay	$100 copay	$35 copay	$25 copay	$25 copay	$25 copay	20% Coinsurance	$25 copay	$25 copay	20% Coinsurance	850	850	130	0	175	0.2	0.2	50	250	15	59.58333333	200	0.1	25	15	25	40	31.89438215	39.16666667	0.1	0.2	0	0	0	20	0	0	0	0	0	25	100	35	25	25	25	0.2	25	25	0.2	NO	522.9184911	522.9184911	114.2510989	0	153.7995562	0.175770921	0.175770921	43.94273035	219.7136517	13.1828191	52.365087	175.7709214	0.087885461	21.97136517	13.1828191	21.97136517	35.15418428	28.03052469	34.42180544	0.087885461	0.175770921	0	0	0	20	0	0	0	0	0	21.97136517	87.8854607	30.75991124	21.97136517	21.97136517	21.97136517	0.175770921	21.97136517	21.97136517	0.175770921		9.8248	0.356780745	1.352398135	0	1.465682163	0.897340231	0.197891844	0.606702617	2.185576939	6.996042945	1.486566817	0.534004061	0.026915056	0.027273925	3.43339524	4.130461998	0.079061015	2.799034148	8.948419857	0.104730437	4.927848899	0	0	0	0.504	0	0	0	0	0	0.080101743	0.978676262	0.012630654	0.214781454	1.064270012	0.437881785	0.111993185	0.651431307	0.00110491	2.328201296	56.766		7.753242028	12.6054	0.45775606	1.735150931	0	1.880496359	1.151303522	0.253898765	0.773949789	2.804134197	8.976047889	1.907291743	0.685136735	0.034532496	0.034992933	4.405107335	5.29945642	0.101436693	3.591210738	11.48098229	0.134371019	6.322518036	0	0	0	0.504	0	0	0	0	0	0.102771965	1.2556591	0.016205355	0.275568437	1.365477409	0.561810141	0.143689254	0.835797986	0.00141762	2.987123792	72.6847	YES	15% Coinsurance	15% Coinsurance	30% Coinsurance (days 1-100)	30% Coinsurance	$175 copay	30% Coinsurance	30% Coinsurance	$50 copay	30% Coinsurance	30% Coinsurance	$200 copay - High Tier	30% Coinsurance	10% Coinsurance	30% Coinsurance	$30 copay	$40 copay	30% Coinsurance	30% Coinsurance	$200 copay - High Tier	30% Coinsurance	25% Coinsurance				0.2	Multiple coverage amts	30% Coinsurance		Silver Sneakers		30% Coinsurance	30% Coinsurance	$35 copay	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	25% Coinsurance	3350	14.6179	0.3197	2.3854	0.5711	0.7496	0.6884	0.1518	0.3022	2.936	2.3293	0.7183	0.2181	0.0138	0.0285	3.5118	3.3798	0.1274	1.7207	2.714	0.9885	3.2268			0	0.086	0	0	0			0.5502	1.6982	0.0065	0.1343	0.5865	3.848	0.0859	1.165	0.0029	1.4883	51.3507		5.50777077	27.2233	0.777407653	4.120543267	0.571110468	2.630064838	1.839670313	0.40570537	1.076165116	5.740084535	11.30536577	2.62554454	0.903258553	0.048297198	0.063451384	7.916871224	8.679249605	0.22888097	5.311927939	14.19498795	1.122918807	9.549273464	0	0	0	0.59	0	0	0	0	0	0.652991768	2.953883629	0.022664832	0.409843152	1.951967212	4.409828314	0.229601361	2.00080323	0.004339305	4.475463443	124.0354
R9943_003_0	2010	9	24	H.6	H.7	H.8	H.9	I.7	I.8	I.9	I.10	I.11	I.12	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Cardiac Rehab Services	ASC	Urgent Care	Office Visit (Clinic)	Chiropractic	Podiatric	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Radiation/Chemo	A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	0	0	0	V	V	V	V	V	V	V	V	V	V	V	V	Coin	V	V	Coin	3.0268	0.1099	0.4167	0	0.258	0.2765	0.061	0.1821	0.5387	1.437	0.4585	0.1645	0.0083	0.0084	0.7052	1.2726	0.0244	0.8623	2.3614	0.0323	1.5182	0	0	0	0.1538	0	0	0	0	0.3991	0.0247	0.3015	0.0039	0.0662	0.3279	0.1349	0.0345	0.2007	0.0003	0.7173	16.0874	YES	225.4461525	8.186921393	142.0356585	204.5628128	114.3504642	5.104839303	1.125778191	165.6695796	119.3609506	6367.916875	340.6401353	36.45446608	0.306231748	14.89511343	3125.134545	2255.769914	26.98600351	1198.202389	3119.363017	1.191592736	28.03347662	0	0	745.9758882	302.4	143.52	162	12.6	0	784.6493478	43.74597831	133.6211583	4.927129517	117.2986321	581.2299628	239.140454	0.637113097	355.7662904	0.603424944	13.24480177	3350	$850/admit	$850/admit	$130/day (for days 21-100)	$0 copay	$100 copay	20% Coinsurance	20% Coinsurance	$50 copay	$200 copay	$10 copay	$25/$150 copay for Lower/Higher Tier	$200 copay	10% Coinsurance	$25 copay	$10 copay	$25 copay	$40 copay	$50/$25 OP/PR copay	$25/$100 copay for Lower/Higher Tier	10% Coinsurance	20% Coinsurance			$0 deduct 2 exams/2 cleanings	$20 copay	$175/$80 glasses/contacts	$0 copay	$100 max / 2 yrs	Silver Sneakers	$20 copay	$25 copay	$100 copay	$35 copay	$25 copay	$25 copay	$25 copay	20% Coinsurance	$25 copay	$25 copay	20% Coinsurance	850	850	130	0	100	0.2	0.2	50	200	10	59.64614961	200	0.1	25	10	25	40	31.89232337	33.54637955	0.1	0.2	0	0	0	20	0	0	0	0	20	25	100	35	25	25	25	0.2	25	25	0.2	NO	527.9737729	527.9737729	115.3630609	0	88.74081608	0.177481632	0.177481632	44.37040804	177.4816322	8.874081608	52.93047992	177.4816322	0.088740816	22.18520402	8.874081608	22.18520402	35.49632643	28.30150803	29.76933098	0.088740816	0.177481632	0	0	0	20	0	0	0	0	20	22.18520402	88.74081608	31.05928563	22.18520402	22.18520402	22.18520402	0.177481632	22.18520402	22.18520402	0.177481632		9.9191	0.360206648	1.36547236	0	0.845629459	0.906015211	0.199804951	0.612568904	1.765364694	4.709117835	1.502520487	0.539166512	0.027175255	0.027537594	2.311058249	4.170392981	0.079825332	2.825911212	7.738445842	0.105742912	4.975427186	0	0	0	0.504	0	0	0	0	1.307748913	0.080876121	0.988137553	0.01275276	0.21685784	1.074558776	0.44211498	0.113075872	0.657728978	0.001115592	2.350709036	52.7362		6.459131061	12.9459	0.470122231	1.782140656	0	1.103669825	1.182482041	0.260774613	0.794635749	2.304058497	6.14608585	1.961008458	0.703690964	0.035467673	0.035940578	3.016268205	5.442971314	0.104183706	3.68822644	10.09980089	0.138009928	6.493658408	0	0	0	0.657793535	0	0	0	0	1.706803136	0.105555138	1.289663679	0.016644213	0.283031122	1.402455984	0.577024555	0.147580512	0.858432281	0.00145601	3.068018268	68.8236	YES	15% Coinsurance	15% Coinsurance	30% Coinsurance (days 1-100)	30% Coinsurance	$100 copay	30% Coinsurance	30% Coinsurance	$50 copay	30% Coinsurance	30% Coinsurance	$200 copay - High Tier	30% Coinsurance	10% Coinsurance	30% Coinsurance	$25 copay	$40 copay	30% Coinsurance	30% Coinsurance	$150 copay - High Tier	30% Coinsurance	25% Coinsurance			20% Coinsurance	$40 copay	Multiple coverage amts	30% Coinsurance	Up to $100 every 2/yrs	Silver Sneakers	$20 copay	30% Coinsurance	30% Coinsurance	$35 copay	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	25% Coinsurance	3350	15.0137	0.3283	2.45	0.5866	0.4399	0.707	0.1559	0.3104	3.0155	2.3924	0.7377	0.224	0.0141	0.0292	3.0057	3.4713	0.1309	1.7673	2.0906	1.0153	3.3141			0.4052	0	0	0.0616	0		0.6491	0.5651	1.7442	0.0066	0.1379	0.6024	3.9522	0.0882	1.1966	0.003	1.5286	52.1409		5.024397519	27.9597	0.798430328	4.232131944	0.586576744	1.54359416	1.889490534	0.416692301	1.105035388	5.319517481	8.538484124	2.698712302	0.927719751	0.049605137	0.065169714	6.021990018	8.914292879	0.235079309	5.455542486	12.19042874	1.153328638	9.807797792	0	0	0.405182186	0.657793535	0	0.061600865	0	0	2.35588882	0.670675477	3.033877927	0.023278619	0.420942139	2.004828552	4.529251136	0.235819209	2.054987101	0.004456817	4.596663734	120.9645
R9943_004_0	2010	7	24	H.6	H.7	H.8	H.9	I.7	I.8	I.9	I.10	I.11	I.12	OP Facility - Other	OP Facility - Other	OP Facility - Other	OP Facility - Other	Professional	Professional	Professional	Professional	Professional	Professional	Cardiac Rehab Services	ASC	Urgent Care	Office Visit (Clinic)	Chiropractic	Podiatric	Diabetes Supplies	Vision Exam Diagnostic	Hearing Exam Diagnostic	Radiation/Chemo	A	A	D	V	T	Coin	Coin	V	V	V	V	V	Coin	V	V	V	V	V	V	Coin	Coin	0	0	0	V	V	V	V	V	0	V	V	V	V	V	V	Coin	V	V	Coin	2.933	0.1065	0.4038	0	0.25	0.2679	0.0591	0.1764	0.522	1.3924	0.368	0.1594	0.008	0.0098	1.025	1.4798	0.0236	0.9305	2.5903	0.0313	1.7524	0	0	0	0.1501	0	0	0	0	0.3895	0.0287	0.2922	0.0038	0.0769	0.3813	0.1569	0.0334	0.2334	0.0004	0.6951	16.9308	YES	225.4461525	8.186921393	142.0356585	204.5628128	114.3504642	5.104839303	1.125778191	165.6695796	119.3609506	6367.916875	340.6401353	36.45446608	0.306231748	14.89511343	3125.134545	2255.769914	26.98600351	1198.202389	3119.363017	1.191592736	33.39148376	0	0	745.9758882	302.4	143.52	162	12.6	0	784.6493478	43.74597831	133.6211583	4.927129517	117.2986321	581.2299628	239.140454	0.637113097	355.7662904	0.603424944	13.24480177	3350	$850/admit	$850/admit	$130/day (for days 21-100)	$0 copay	$100 copay	20% Coinsurance	20% Coinsurance	$50 copay	$200 copay	$10 copay	$30/$100 copay for Lower/Higher Tier	$200 copay	10% Coinsurance	$30 copay	$15 copay	$30 copay	$40 copay	$50/$30 OP/PR copay	$30/$100 copay for Lower/Higher Tier	10% Coinsurance	20% Coinsurance			$0 deduct 2 exams/2 cleanings	$20 copay	$175/$80 glasses/contacts	$0 copay	$100 max / 2 yrs	Silver Sneakers	$20 copay	$30 copay	$100 copay	$35 copay	$30 copay	$30 copay	$30 copay	20% Coinsurance	$30 copay	$30 copay	20% Coinsurance	850	850	130	0	100	0.2	0.2	50	200	10	49.40022807	200	0.1	30	15	30	40	35.5132132	37.97619058	0.1	0.2	0	0	0	20	0	0	0	0	20	30	100	35	30	30	30	0.2	30	30	0.2	NO	524.1371912	524.1371912	114.5247621	0	88.09597081	0.176191942	0.176191942	44.0479854	176.1919416	8.809597081	43.5196105	176.1919416	0.088095971	26.42879124	13.21439562	26.42879124	35.23838832	31.28570994	33.45549377	0.088095971	0.176191942	0	0	0	20	0	0	0	0	20	26.42879124	88.09597081	30.83358978	26.42879124	26.42879124	26.42879124	0.176191942	26.42879124	26.42879124	0.176191942		9.8471	0.357589165	1.355549999	0	0.839484596	0.899431548	0.198353045	0.608117602	1.752536469	4.674898493	1.235377167	0.535248597	0.026977783	0.032804987	3.44139702	4.968106013	0.079245273	3.123884366	8.696652499	0.104974519	5.883310358	0	0	0	0.504	0	0	0	0	1.307748913	0.096346111	0.980957139	0.012660091	0.258338422	1.280100446	0.526682761	0.112254194	0.783539418	0.001328983	2.333627341	56.8586		7.436106878	12.78	0.464098482	1.759305813	0	1.089528333	1.167330716	0.257433268	0.784542226	2.27453624	6.067335104	1.603339038	0.694674463	0.03501322	0.042576079	4.466430443	6.447875619	0.102848784	4.054345416	11.28698411	0.136241586	7.63567712	0	0	0	0.654118351	0	0	0	0	1.697266989	0.125043173	1.273139019	0.016430948	0.33528552	1.661383319	0.68355726	0.14568954	1.016919667	0.001724825	3.028707277	73.7894	YES	15% Coinsurance	15% Coinsurance	30% Coinsurance (days 1-100)	30% Coinsurance	$100 copay	30% Coinsurance	30% Coinsurance	$50 copay	30% Coinsurance	30% Coinsurance	$150 copay - High Tier	30% Coinsurance	10% Coinsurance	30% Coinsurance	$30 copay	$45 copay	30% Coinsurance	30% Coinsurance	$150 copay - High Tier	30% Coinsurance	25% Coinsurance			20% Coinsurance	$40 copay	Multiple coverage amts	30% Coinsurance		Silver Sneakers	$20 copay	30% Coinsurance	30% Coinsurance	$35 copay	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	30% Coinsurance	25% Coinsurance	3350	14.8214	0.3241	2.4186	0.5791	0.4343	0.6979	0.1539	0.3064	2.9768	2.3617	0.5462	0.2212	0.014	0.0289	3.5607	3.8552	0.1292	1.7447	2.0638	1.0023	3.2717			0.4052	0	0	0.0616	0		0.7274	0.5579	1.7219	0.0065	0.1361	0.5947	3.9016	0.0871	1.1812	0.003	1.5091	52.4052		5.331820312	27.6014	0.788199917	4.177904985	0.579060846	1.52381585	1.865280201	0.411353158	1.090964666	5.251357683	8.429079209	2.149527686	0.915832735	0.048969539	0.071430698	8.027081286	10.30307398	0.232067202	5.799016568	13.35082443	1.138550861	10.90735192	0	0	0.405182186	0.654118351	0	0.061600865	0	0	2.424667127	0.682922537	2.995004381	0.022980347	0.471429462	2.256037594	4.585143353	0.232797621	2.198142846	0.004687182	4.537765973	126.1946
R9943_805_0	2010	7	24																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	253.8546521	2.906467219	48.84049332	33.72836252	6.596709374	11.75316587	2.905939968	7.749849757	38.81401047	5.407668638	16.12091998	0	0.064772718	15.37607341	36.58134789	91.80274921	1.44308476	5.733598354	27.53032028	34.01486232	5.52993718	0.973683058	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.063901701	0.063901701	0.138968411	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.050319938	0.050319938	0.109431858	0	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0	0	0	0	0	0	0	0												12.774	0.14625325	5.344705911	0	1.210349941	2.156445404	0.533175568	1.421925639	7.121510529	0.992187323	2.957831464	0	0.011884358	2.821168629	6.711866437	16.84376949	0.264774064	1.051988201	5.051203505	6.240973227	1.01462089	0.178649257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8492	0	20.20242	12.774	0.14625325	5.344705911	0	1.210349941	2.156445404	0.533175568	1.421925639	7.121510529	0.992187323	2.957831464	0	0.011884358	2.821168629	6.711866437	16.84376949	0.264774064	1.051988201	5.051203505	6.240973227	1.01462089	0.178649257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8492	YES	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			6000	4.6156	0.0528	2.0365	0	0.5196	0.9187	0.2271	0.5892	2.501	0.3839	1.1924	0	0.0037	1.4631	2.533	6.3105	0.0832	0.3291	1.8376	2.1896	0.468	0.0819	0	0	0	0	0	0	0	0											28.3366	0	7.09218	17.3895	0.19909852	7.381238286	0	1.729938401	3.075147638	0.760322328	2.011081925	9.62254905	1.376048461	4.150262478	0	0.015580081	4.28427682	9.244847113	23.15425581	0.348009291	1.381131341	6.888783041	8.430617259	1.482641456	0.260507394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1859
R9943_806_0	2010	6	24																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	253.8546521	2.906467219	48.84049332	33.72836252	6.596709374	11.75316587	2.905939968	7.749849757	38.81401047	5.407668638	16.12091998	0	0.064772718	15.37607341	36.58134789	91.80274921	1.44308476	5.733598354	27.53032028	34.01486232	5.52993718	0.973683058	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.063901701	0.063901701	0.138968411	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.050319938	0.050319938	0.109431858	0	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0	0	0	0	0	0	0	0												12.774	0.14625325	5.344705911	0	1.210349941	2.156445404	0.533175568	1.421925639	7.121510529	0.992187323	2.957831464	0	0.011884358	2.821168629	6.711866437	16.84376949	0.264774064	1.051988201	5.051203505	6.240973227	1.01462089	0.178649257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8492	0	20.20242	12.774	0.14625325	5.344705911	0	1.210349941	2.156445404	0.533175568	1.421925639	7.121510529	0.992187323	2.957831464	0	0.011884358	2.821168629	6.711866437	16.84376949	0.264774064	1.051988201	5.051203505	6.240973227	1.01462089	0.178649257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8492	YES	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			6000	4.6156	0.0528	2.0365	0	0.5196	0.9187	0.2271	0.5892	2.501	0.3839	1.1924	0	0.0037	1.4631	2.533	6.3105	0.0832	0.3291	1.8376	2.1896	0.468	0.0819	0	0	0	0	0	0	0	0											28.3366	0	7.09218	17.3895	0.19909852	7.381238286	0	1.729938401	3.075147638	0.760322328	2.011081925	9.62254905	1.376048461	4.150262478	0	0.015580081	4.28427682	9.244847113	23.15425581	0.348009291	1.381131341	6.888783041	8.430617259	1.482641456	0.260507394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1859
R9943_807_0	2010	6	24																															coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	O	coin	coin	coin	coin	coin	coin	coin	coin	coin	coin	T	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	0	0	0	0	0											0	NO	253.8546521	2.906467219	48.84049332	33.72836252	6.596709374	11.75316587	2.905939968	7.749849757	38.81401047	5.407668638	16.12091998	0	0.064772718	15.37607341	36.58134789	91.80274921	1.44308476	5.733598354	27.53032028	34.01486232	5.52993718	0.973683058	0	0	0	0	0	0	0	0												Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			0.063901701	0.063901701	0.138968411	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0.233	0	0	0	0	0	0	0	0											NO	0.050319938	0.050319938	0.109431858	0	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0.183477833	0	0	0	0	0	0	0	0												12.774	0.14625325	5.344705911	0	1.210349941	2.156445404	0.533175568	1.421925639	7.121510529	0.992187323	2.957831464	0	0.011884358	2.821168629	6.711866437	16.84376949	0.264774064	1.051988201	5.051203505	6.240973227	1.01462089	0.178649257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8492	0	20.20242	12.774	0.14625325	5.344705911	0	1.210349941	2.156445404	0.533175568	1.421925639	7.121510529	0.992187323	2.957831464	0	0.011884358	2.821168629	6.711866437	16.84376949	0.264774064	1.051988201	5.051203505	6.240973227	1.01462089	0.178649257	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	74.8492	YES	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS		Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS	Similar to Medicare FFS																			6000	4.6156	0.0528	2.0365	0	0.5196	0.9187	0.2271	0.5892	2.501	0.3839	1.1924	0	0.0037	1.4631	2.533	6.3105	0.0832	0.3291	1.8376	2.1896	0.468	0.0819	0	0	0	0	0	0	0	0											28.3366	0	7.09218	17.3895	0.19909852	7.381238286	0	1.729938401	3.075147638	0.760322328	2.011081925	9.62254905	1.376048461	4.150262478	0	0.015580081	4.28427682	9.244847113	23.15425581	0.348009291	1.381131341	6.888783041	8.430617259	1.482641456	0.260507394	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	103.1859
